Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan.
Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan,
Nephron. 2020;144 Suppl 1(Suppl 1):79-85. doi: 10.1159/000511917. Epub 2020 Nov 20.
Medullary ray injury was recently reported in renal transplant biopsies. This study was performed to clarify the clinicopathological features of medullary ray injury in paediatric living renal transplant recipients.
Paediatric recipients who completed a 5-year follow-up after living renal transplantation were enroled. We evaluated the clinical and pathological parameters of the presence or absence of medullary ray injury in their 1-year protocol biopsies.
Of 48 1-year protocol biopsies, 18 (37.5%) showed histological evidence of medullary ray injury. The 48 paediatric recipients were classified as those with medullary ray injury (n = 18; MRI-1Y [+] group) and those without medullary ray injury (n = 30; MRI-1Y [-] group) in the 1-year protocol biopsies. The prevalence of histological evidence of calcineurin inhibitor (CNI) nephrotoxicity, chronic obstruction or reflux nephropathy, and imaging findings of vesicoureteral reflux was 66.7, 22.2, and 7.7% in the MRI-1Y (+) group and 33.3, 13.3, and 15.4% in the MRI-1Y (-) group, respectively. Only the prevalence of CNI nephrotoxicity was significantly different between the 2 groups. There was no significant difference in the mean estimated glomerular filtration rate at 1, 3, or 5 years after transplantation between the 2 groups.
In total, 37.5% of 1-year protocol biopsies showed histological evidence of medullary ray injury. This finding suggests that CNI nephrotoxicity might be the main contributor to medullary ray injury in 1-year protocol biopsies. The presence of medullary ray injury had little influence on renal function, at least during the first 5 years after transplantation.
最近有研究报道在肾移植活检中发现了髓质射线损伤。本研究旨在阐明儿童活体肾移植受者髓质射线损伤的临床病理特征。
纳入完成活体肾移植后 5 年随访的儿童受者。我们评估了 1 年方案活检中髓质射线损伤的存在或不存在的临床和病理参数。
在 48 例 1 年方案活检中，18 例（37.5%）有髓质射线损伤的组织学证据。48 例儿童受者分为 1 年方案活检中有髓质射线损伤者（n=18；MRI-1Y[+]组）和无髓质射线损伤者（n=30；MRI-1Y[-]组）。MRI-1Y（+）组中钙调磷酸酶抑制剂（CNI）肾毒性、慢性梗阻或反流性肾病的组织学证据和影像学发现的膀胱输尿管反流的发生率分别为 66.7%、22.2%和 7.7%，MRI-1Y（-）组分别为 33.3%、13.3%和 15.4%。仅 CNI 肾毒性的发生率在两组间有显著差异。两组间移植后 1、3 和 5 年的平均估计肾小球滤过率无显著差异。
1 年方案活检中，37.5%的活检有组织学证据显示存在髓质射线损伤。这一发现提示，CNI 肾毒性可能是 1 年方案活检中髓质射线损伤的主要原因。髓质射线损伤的存在对肾功能的影响很小，至少在移植后 5 年内是如此。
