Cheigh J S, Mouradian J, Soliman M, Tapia L, Riggio R R, Stenzel K H, Rubin A L
Am J Kidney Dis. 1983 Jan;2(4):449-55. doi: 10.1016/s0272-6386(83)80077-8.
This is a study of the incidence and clinicopathological significance of focal segmental glomerulosclerosis (FSG) in 154 renal allografts (22 biopsies, 128 nephrectomies and four necropsies) from 137 cadaveric and 17 living-related donors. FSG was identified in 18 grafts (11.7%) from 16 patients: six as recurrent FSG in four patients (two developed FSG in two consecutive transplants) and 12 as de novo FSG. The incidence of recurrent FSG in patients who had FSG as their original kidney disease was 30.8% whereas that of de novo FSG in patients who had renal diseases other than FSG was 8.7%. Histologically, recurrent FSG was characterized by mild degrees of obliterative arteriopathy of rejection and preferential involvement of the juxtamedullary glomeruli. Whereas, in de novo FSG, the occlusive vascular changes of rejection were severe and the glomeruli in the outer cortical region were mostly involved. Clinically, however, the differences between them were less clear, although nephrotic syndrome tends to occur more often and earlier in patients with recurrent FSG. Obliterative arteriopathy of chronic rejection and consequent glomerular ischemia appeared to be of major importance in the pathogenesis of de novo FSG in renal allografts.
这是一项关于137例尸体供体和17例亲属活体供体的154个肾移植（22例活检、128例肾切除标本和4例尸检）中局灶节段性肾小球硬化（FSG）的发生率及临床病理意义的研究。在16例患者的18个移植肾中发现了FSG（11.7%）：4例患者中6个为复发性FSG（2例患者在连续两次移植中均发生FSG），12个为新发FSG。以FSG作为原发性肾病的患者中复发性FSG的发生率为30.8%，而原发性肾病不是FSG的患者中新发FSG的发生率为8.7%。组织学上，复发性FSG的特征为轻度的排斥性闭塞性动脉病，且近髓肾小球优先受累。而在新发FSG中，排斥性闭塞性血管改变严重，且大多累及皮质外层区域的肾小球。然而在临床上，尽管复发性FSG患者中肾病综合征往往更常且更早出现，但两者之间的差异并不那么明显。慢性排斥性闭塞性动脉病及随之而来的肾小球缺血在肾移植新发FSG的发病机制中似乎起主要作用。
