Division of Nephrology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Division of Hepatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Kidney Res Clin Pract. 2013 Dec;32(4):153-7. doi: 10.1016/j.krcp.2013.08.002. Epub 2013 Oct 24.
Chronic kidney disease is a common complication after liver transplantation. In this study, we analyzed the results of kidney biopsy in liver transplantation recipients with renal impairment.
Between 1999 and 2012, 544 liver transplants were performed at our hospital. We retrospectively analyzed the clinical and histological data of 10 liver transplantation recipients referred for kidney biopsy.
The biopsies were performed at a median of 24.5 months (range, 3-73 months) after liver transplantation. The serum creatinine level was 1.81±0.5 mg/dL at the time of kidney biopsy. There were no immediate complications. The most common diagnosis was glomerulonephritis (GN), such as immunoglobulin A nephropathy (n=4), mesangial proliferative GN (n=1), focal proliferative GN (n=1), and membranous GN (n=1). Typical calcineurin inhibitor (CNI)-induced nephrotoxicity was detected in three cases (30%). Chronic tissue changes such as glomerulosclerosis, interstitial fibrosis, and tubular atrophy were present in 90%, 80%, and 80% of cases, respectively, and mesangial proliferation was detected in 40% of cases. We began treatment for renal impairment based on the result of kidney biopsy; for example, angiotensin-receptor blockers or steroids were prescribed for GN, and the CNI dose was reduced for CNI nephrotoxicity. As a result, eight of 10 patients showed improvement in glomerular filtration rate, but two progressed to end-stage renal disease.
Kidney biopsy is a safe and effective method for determining the cause of renal impairment after liver transplantation. Management of patients based on the result of kidney biopsy may improve renal outcomes.
慢性肾脏病是肝移植后的常见并发症。在本研究中，我们分析了肾功能损害的肝移植受者肾活检的结果。
1999 年至 2012 年间，我院共进行了 544 例肝移植。我们回顾性分析了 10 例因肾功能损害而接受肾活检的肝移植受者的临床和组织学资料。
活检在肝移植后中位数 24.5 个月（范围 3-73 个月）进行。行肾活检时血清肌酐水平为 1.81±0.5mg/dL。无即刻并发症。最常见的诊断是肾小球肾炎（GN），如免疫球蛋白 A 肾病（n=4）、系膜增生性 GN（n=1）、局灶增生性 GN（n=1）和膜性 GN（n=1）。3 例（30%）存在典型的钙调神经磷酸酶抑制剂（CNI）诱导的肾毒性。90%、80%和 80%的病例分别存在肾小球硬化、间质纤维化和肾小管萎缩的慢性组织改变，40%的病例存在系膜增生。我们根据肾活检结果开始治疗肾功能损害；例如，针对 GN 给予血管紧张素受体阻滞剂或类固醇，针对 CNI 肾毒性减少 CNI 剂量。结果，10 例患者中有 8 例肾小球滤过率改善，但有 2 例进展至终末期肾病。
肾活检是确定肝移植后肾功能损害原因的一种安全有效的方法。根据肾活检结果对患者进行管理可能改善肾脏结局。
