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De Novo Focal Segmental Glomerulosclerosis in Renal Allograft-Histological Presentation and Clinical Correlation: Single Centre Experience.
J Clin Diagn Res. 2017 Apr; 11(4):EC39-EC42.JC

Abstract

INTRODUCTION

Recurrent or de novo glomerulonephritis are one of the well-known causes for renal allograft dysfunction in early and late period after renal transplantation. Focal Segmental Glomerulosclerosis (FSGS) is a devastating lesion of the renal allograft. De novo FSGS is uncommon compared to recurrent FSGS.

AIM

To find out the incidence of de novo FSGS.

MATERIALS AND METHODS

A retrospective evaluation of renal allograft biopsies was performed from 2007 to 2015, by light microscopy and immunohistochemistry including patient-donor demographics. Graft function status in terms of serum creatinine (SCr) and proteinuria were evaluated.

RESULTS

Out of 2,599 renal allograft biopsies performed, 1.6% biopsies were reported as de novo FSGS. Majority were live related females donors with mean age of 43.8 years. Mean time of biopsy was 1.1 years post-transplant with proteinuria of 2.95 grams/24 hours and SCr of 2.24 mg/dL. Histopathological variants were collapsing 47.6%, Not Otherwise Specified/ classical 35.7%, cellular 9.5% and perihilar 7.1% biopsies. Associated Antibody Mediated Rejection (AMR) with T-Cell Rejection (TCR) was observed in 35.7% biopsies, acute on chronic CNI toxicity (calcineurin inhibitor) in five biopsies. Majority of the patients were on CNI based maintenance immunosuppression regimen. Total 28.6% patients and 23.8% grafts were lost over a mean follow up of 2.40 years. The mean SCr of remaining patients was 1.98 mg/dL.

CONCLUSION

De novo FSGS can occur after the first year of renal transplant with related Human Leukocyte Antigen (HLA)matched donors leading to poor allograft survival. Close monitoring of urinary proteinuria and evaluation of allograft biopsy help in appropriate therapeutic modification to improve long term outcome of graft function.

Authors+Show Affiliations

Professor, Department of Pathology, Laboratory Medicine and Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr. H.L. Trivedi, Ahmedabad, Gujarat, India.Professor, Department of Pathology, Laboratory Medicine and Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr. H.L. Trivedi, Ahmedabad, Gujarat, India.Assistant Professor, Department of Pathology, Laboratory Medicine and Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr. H.L. Trivedi, Ahmedabad, Gujarat, India.Professor, Department of Pathology, Laboratory Medicine and Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr. H.L. Trivedi, Ahmedabad, Gujarat, India.Associate Professor, Department of Pathology, Laboratory Medicine and Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr. H.L. Trivedi, Ahmedabad, Gujarat, India.Professor, Department of Nephrology and Clinical Transplantation, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr. H.L. Trivedi, Ahmedabad, Gujarat, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28571148

Citation

Patel, Rashmi D., et al. "De Novo Focal Segmental Glomerulosclerosis in Renal Allograft-Histological Presentation and Clinical Correlation: Single Centre Experience." Journal of Clinical and Diagnostic Research : JCDR, vol. 11, no. 4, 2017, pp. EC39-EC42.
Patel RD, Vanikar AV, Nigam LA, et al. De Novo Focal Segmental Glomerulosclerosis in Renal Allograft-Histological Presentation and Clinical Correlation: Single Centre Experience. J Clin Diagn Res. 2017;11(4):EC39-EC42.
Patel, R. D., Vanikar, A. V., Nigam, L. A., Kanodia, K. V., Suthar, K. S., & Patel, H. V. (2017). De Novo Focal Segmental Glomerulosclerosis in Renal Allograft-Histological Presentation and Clinical Correlation: Single Centre Experience. Journal of Clinical and Diagnostic Research : JCDR, 11(4), EC39-EC42. https://doi.org/10.7860/JCDR/2017/25502.9728
Patel RD, et al. De Novo Focal Segmental Glomerulosclerosis in Renal Allograft-Histological Presentation and Clinical Correlation: Single Centre Experience. J Clin Diagn Res. 2017;11(4):EC39-EC42. PubMed PMID: 28571148.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - De Novo Focal Segmental Glomerulosclerosis in Renal Allograft-Histological Presentation and Clinical Correlation: Single Centre Experience. AU - Patel,Rashmi D, AU - Vanikar,Aruna V, AU - Nigam,Lovelesh A, AU - Kanodia,Kamal V, AU - Suthar,Kamlesh S, AU - Patel,Himanshu V, Y1 - 2017/04/01/ PY - 2016/11/18/received PY - 2017/02/09/accepted PY - 2017/6/3/entrez PY - 2017/6/3/pubmed PY - 2017/6/3/medline KW - Donors KW - Graft KW - Proteinuria KW - Renal transplantation KW - Toxicity SP - EC39 EP - EC42 JF - Journal of clinical and diagnostic research : JCDR JO - J Clin Diagn Res VL - 11 IS - 4 N2 - INTRODUCTION: Recurrent or de novo glomerulonephritis are one of the well-known causes for renal allograft dysfunction in early and late period after renal transplantation. Focal Segmental Glomerulosclerosis (FSGS) is a devastating lesion of the renal allograft. De novo FSGS is uncommon compared to recurrent FSGS. AIM: To find out the incidence of de novo FSGS. MATERIALS AND METHODS: A retrospective evaluation of renal allograft biopsies was performed from 2007 to 2015, by light microscopy and immunohistochemistry including patient-donor demographics. Graft function status in terms of serum creatinine (SCr) and proteinuria were evaluated. RESULTS: Out of 2,599 renal allograft biopsies performed, 1.6% biopsies were reported as de novo FSGS. Majority were live related females donors with mean age of 43.8 years. Mean time of biopsy was 1.1 years post-transplant with proteinuria of 2.95 grams/24 hours and SCr of 2.24 mg/dL. Histopathological variants were collapsing 47.6%, Not Otherwise Specified/ classical 35.7%, cellular 9.5% and perihilar 7.1% biopsies. Associated Antibody Mediated Rejection (AMR) with T-Cell Rejection (TCR) was observed in 35.7% biopsies, acute on chronic CNI toxicity (calcineurin inhibitor) in five biopsies. Majority of the patients were on CNI based maintenance immunosuppression regimen. Total 28.6% patients and 23.8% grafts were lost over a mean follow up of 2.40 years. The mean SCr of remaining patients was 1.98 mg/dL. CONCLUSION: De novo FSGS can occur after the first year of renal transplant with related Human Leukocyte Antigen (HLA)matched donors leading to poor allograft survival. Close monitoring of urinary proteinuria and evaluation of allograft biopsy help in appropriate therapeutic modification to improve long term outcome of graft function. SN - 2249-782X UR - https://www.unboundmedicine.com/medline/citation/28571148/De_Novo_Focal_Segmental_Glomerulosclerosis_in_Renal_Allograft_Histological_Presentation_and_Clinical_Correlation:_Single_Centre_Experience_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28571148/ DB - PRIME DP - Unbound Medicine ER -
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