Toki Daisuke, Inui Masashi, Ishida Hideki, Okumi Masayoshi, Shimizu Tomokazu, Shirakawa Hiroki, Omoto Kazuya, Unagami Kohei, Setoguchi Kiyoshi, Koike Junki, Honda Kazuho, Yamaguchi Yutaka, Tanabe Kazunari
Department of Urology, Tokyo Women's Medical University, Yachiyo Medical Center, Chiba, Japan.
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Nephrology (Carlton). 2016 Jul;21 Suppl 1:20-5. doi: 10.1111/nep.12765.
Transplant glomerulopathy (TG) is a feature of chronic antibody-mediated injury in the glomerular capillaries in renal transplant recipients. TG is generally associated with proteinuria; however, renal function at the diagnosis of TG varies. This study aimed to determine which morphological abnormalities are associated with renal function and proteinuria at the diagnosis of TG.
A total of 871 renal transplantations were performed at Tokyo Women's Medical University between 2005 and 2013. TG was diagnosed in 127 biopsies from 58 (6.7%) recipients. Renal function was evaluated by the estimated glomerular filtration rate (eGFR). Proteinuria was assessed by a dipstick test: positive for +1 and over.
At diagnosis, of 127 biopsies, 72, 37, and 18 had mild, moderate, and severe TG (Banff cg). The severity of TG was not associated with decreased eGFR at the time of biopsy (cg1: 36.1 ± 14.8, cg2-3: 38.8 ± 14.5 mL/min per 1.73 m(2) , P = 0.25), whereas the severity of interstitial fibrosis (IF) (Banff ci) was significantly associated with decreased eGFR (ci0-1: 42.75 ± 13.32, ci2-3: 27.69 ± 11.94 mL/min per 1.73 m(2) , P < 0.0001). The multivariate analysis revealed that IF was the only independent risk factors for decreased eGFR (OR = 4.38, P = 0.0006). Meanwhile, TG was identified as the only independent risk factor for the incidence of proteinuria (OR = 2.67, P = 0.014).
Interstitial fibrosis was a critical determinant of impaired renal function at the diagnosis of TG. The severity of TG was significantly associated with proteinuria, but did not contribute to renal dysfunction.
移植肾小球病（TG）是肾移植受者肾小球毛细血管慢性抗体介导损伤的一个特征。TG通常与蛋白尿相关；然而，TG诊断时的肾功能各不相同。本研究旨在确定在TG诊断时哪些形态学异常与肾功能和蛋白尿相关。
2005年至2013年期间，东京女子医科大学共进行了871例肾移植手术。在58例（6.7%）受者的127份活检标本中诊断出TG。通过估计肾小球滤过率（eGFR）评估肾功能。通过试纸条试验评估蛋白尿：阳性为+1及以上。
在诊断时，127份活检标本中，72份、37份和18份分别有轻度、中度和重度TG（Banff分级cg）。活检时TG的严重程度与eGFR降低无关（cg1：36.1±14.8，cg2 - 3：38.8±14.5 mL/min/1.73 m²，P = 0.25），而间质纤维化（IF）（Banff分级ci）的严重程度与eGFR降低显著相关（ci0 - 1：42.75±13.32，ci2 - 3：27.69±11.94 mL/min/1.73 m²，P < 0.0001）。多变量分析显示，IF是eGFR降低的唯一独立危险因素（OR = 4.38，P = 0.0006）。同时，TG被确定为蛋白尿发生率的唯一独立危险因素（OR = 2.67，P = 0.014）。
间质纤维化是TG诊断时肾功能受损的关键决定因素。TG的严重程度与蛋白尿显著相关，但与肾功能不全无关。
