Lukenda V, Mikolasevic I, Racki S, Jelic I, Stimac D, Orlic L
Department of Internal Medicine, General Hospital "Dr. Josip Bencevic", Slavonski Brod, Croatia.
Int Urol Nephrol. 2014 Jul;46(7):1435-40. doi: 10.1007/s11255-014-0697-y. Epub 2014 Mar 29.
Chronic allograft nephropathy (CAN) is the most common cause of kidney allograft failure. Protocol biopsies remain the "gold standard" in CAN recognition. However, renal allograft biopsies have numerous limitations. It is an invasive procedure connected with risk of complications, patient discomfort, and sampling errors. The aim of our study was to investigate the usefulness of transient elastography (TE) for the assessment of kidney allograft fibrosis in renal transplant recipients (RTRs).
In this cross-sectional study, we involved 52 RTRs. Renal allograft stiffness was used to assess its fibrosis by using transient elastography (Fibroscan, Echosense, Paris, France). In 23 patients with a deterioration of graft function, percutaneous renal allograft biopsy was performed closely around the time of TE.
We have found that the renal allograft stiffness was highly negatively correlated with estimated glomerular filtration rate (eGFR) (r = -0.640; p < 0.0001). However, renal allograft stiffness showed a statistically significant difference between patients who had an eGFR > 50 ml/min per 1.73 m(2) and patients with eGFR < 50 ml/min per 1.73 m(2) (28 ± 2.7 vs. 33.9 ± 5.5 kPa; p = 0.0003). Also, there was a highly positive correlation between renal allograft stiffness and extent of interstitial fibrosis on renal biopsy (r = 0.727; p = 0.0001).
According to our results, parenchymal stiffness obtained by TE reflects interstitial fibrosis. Therefore, TE provides the opportunity for noninvasive screening of CAN.
慢性移植肾肾病（CAN）是肾移植失败最常见的原因。方案活检仍是CAN识别的“金标准”。然而，肾移植活检有诸多局限性。它是一种侵入性操作，存在并发症风险、患者不适以及取样误差。我们研究的目的是探讨瞬时弹性成像（TE）在评估肾移植受者（RTR）移植肾纤维化中的作用。
在这项横断面研究中，我们纳入了52名RTR。通过瞬时弹性成像（Fibroscan，Echosense，法国巴黎）利用移植肾硬度评估其纤维化情况。在23例移植肾功能恶化的患者中，在进行TE检查的同时紧密进行经皮肾移植活检。
我们发现移植肾硬度与估计肾小球滤过率（eGFR）高度负相关（r = -0.640；p < 0.0001）。然而，eGFR > 50 ml/（min·1.73 m²）的患者与eGFR < 50 ml/（min·1.73 m²）的患者之间移植肾硬度存在统计学显著差异（28 ± 2.7 vs. 33.9 ± 5.5 kPa；p = 0.0003）。此外，移植肾硬度与肾活检间质纤维化程度高度正相关（r = 0.727；p = 0.0001）。
根据我们的结果，TE获得的实质硬度反映了间质纤维化。因此，TE为CAN的无创筛查提供了机会。
