留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

肾移植术后局灶节段性肾小球硬化临床病理特征分析

张敏月, 兰平, 宫惠琳, 等. 肾移植术后局灶节段性肾小球硬化临床病理特征分析[J]. 器官移植, 2023, 14(1): 113-119. doi: 10.3969/j.issn.1674-7445.2023.01.015
引用本文: 张敏月, 兰平, 宫惠琳, 等. 肾移植术后局灶节段性肾小球硬化临床病理特征分析[J]. 器官移植, 2023, 14(1): 113-119. doi: 10.3969/j.issn.1674-7445.2023.01.015
Zhang Minyue, Lan Ping, Gong Huilin, et al. Clinicopathological features analysis of focal segmental glomerulosclerosis after kidney transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 113-119. doi: 10.3969/j.issn.1674-7445.2023.01.015
Citation: Zhang Minyue, Lan Ping, Gong Huilin, et al. Clinicopathological features analysis of focal segmental glomerulosclerosis after kidney transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(1): 113-119. doi: 10.3969/j.issn.1674-7445.2023.01.015

肾移植术后局灶节段性肾小球硬化临床病理特征分析

doi: 10.3969/j.issn.1674-7445.2023.01.015
基金项目: 

国家自然科学基金 82170768

详细信息
    作者简介:
    通讯作者:

    郑瑾,研究员,研究方向为肾移植,Email: jzheng@mail.xjtu.edu.cn

  • 中图分类号: R617

Clinicopathological features analysis of focal segmental glomerulosclerosis after kidney transplantation

More Information
  • 摘要:   目的  探讨肾移植术后复发及新发局灶节段性肾小球硬化(FSGS)的临床和病理特征。  方法  选取经移植肾穿刺活组织检查(活检)病理确诊为FSGS的受者34例,根据自体肾原发病及循环渗透因子检测,将34例受者分为复发FSGS组(12例)和新发FSGS组(22例)。比较复发与新发两组间受者在临床指标及移植肾病理损伤程度的差异。  结果  两组受者系膜增生评分、肾小球球性硬化率、肾小管萎缩评分、间质纤维化评分和足细胞增生发生率之间的差异均无统计学意义(均为P > 0.05); 复发FSGS组受者的节段性肾小球硬化率为0.10(0.08,0.27),低于新发FSGS组受者的0.19(0.13,0.33)(P < 0.05)。两组受者抗体介导的排斥反应、药物性肾小管损伤、BK病毒感染发生率之间的差异均无统计学意义(均为P > 0.05); 复发FSGS组受者T细胞介导的排斥反应发生率为17%,低于新发FSGS组受者的55%(P < 0.05)。免疫组织化学结果显示移植肾组织内浸润炎症细胞主要为T细胞; 复发FSGS组和新发FSGS组管周毛细血管C4d沉积阳性率分别为33%(4/12)和32%(7/22),差异无统计学意义(P > 0.05); 免疫荧光结果显示多数病例移植肾肾小球节段性硬化区IgM团块状沉积,电子显微镜显示移植肾肾小球均存在足突广泛融合或节段性分布。  结论  复发FSGS组肾损伤程度和T细胞介导的排斥反应发生率低于新发FSGS组。综合分析肾移植受者术前和术后的临床表现、实验室检测和病理学检查等有助于复发和新发FSGS的早期诊断和治疗。

     

  • 图  1  移植肾免疫组织化学、免疫荧光和电镜图片

    注:A图为复发FSGS,图示肾小球节段性硬化(苏木素-伊红,×200); B图为新发FSGS,图示肾小球节段性硬化(过碘酸-雪夫,×200); C图为复发FSGS,图示足细胞增生(过碘酸-六胺银,×400); D图为急性TCMR,图示肾小管炎(过碘酸-雪夫,×200); E图为慢性活动性AMR,图示肾小球毛细血管基底膜增厚、双轨形成(过碘酸-雪夫,×200); F图为新发FSGS伴药物性肾损伤(苏木素-伊红,×200); G图为新发FSGS受者BKV感染的肾小管上皮细胞核SV40(+)(免疫组化,×100); H图为肾小球节段性硬化区IgM团块状沉积(免疫荧光,×200); I图为电镜示足突广泛融合或节段性分布(磷钨酸,×4 300)。

    Figure  1.  Immunohistochemistry, immunofluorescence and electron microscopy images of renal allograft

    表  1  两组受者病理学参数的比较

    Table  1.   Comparison of pathological parameters of recipients between the two groups

    病理学参数 复发FSGS组(n=12) 新发FSGS组(n=22) 统计值 P
    系膜增生评分[M(P25, P75),分] 1.25(1.00,1.25) 1.00(1.00,1.00) -1.888 0.136
    肾小球球性硬化率[M(P25, P75)] 0.07(0,0.33) 0.20(0.07,0.38) -1.305 0.204
    节段性肾小球硬化率[M(P25, P75)] 0.10(0.08,0.27) 0.19(0.13,0.33) -2.244 0.025
    肾小管萎缩评分[M(P25, P75),分] 1.0(1.0,1.0) 1.0(1.0,1.0) -0.974 0.488
    间质纤维化评分[M(P25, P75),分] 1.0(0,1.0) 1.0(1.0,1.0) -0.735 0.534
    足细胞增生发生率[n(%)] 4(33) 7(32) 0.031 0.583
    下载: 导出CSV

    表  2  两组受者并发症发生率比较

    Table  2.   Comparison of complication rates of recipients between the two groups[n(%)]

    并发症 复发FSGS组(n=12) 新发FSGS组(n=22) 统计值 P
    AMR 0 4(18) 2.473 0.158
    TCMR 2(17) 12(55) 4.600 0.035
    药物性肾小管损伤 0 5(23) 3.197 0.095
    BKV感染 0 1(5) 0.562 0.647
    下载: 导出CSV
  • [1] 黄远航, 范立明, 邓素雄, 等. 移植肾肾炎复发与新发患者的存活情况及影响因素分析[J]. 器官移植, 2019, 10(1): 67-73. DOI: 10.3969/j.issn.1674-7445.2019.01.010.

    HUANG YH, FAN LM, DENG SX, et al. Analysis of survival and influencing factors of patients with recurrent and de novo nephritis of renal allograft[J]. Organ Transplant, 2019, 10(1): 67-73. DOI: 10.3969/j.issn.1674-7445.2019.01.010.
    [2] JACOBS-CACHÁ C, VERGARA A, GARCÍA-CARRO C, et al. Challenges in primary focal segmental glomerulosclerosis diagnosis: from the diagnostic algorithm to novel biomarkers[J]. Clin Kidney J, 2020, 14(2): 482-491. DOI: 10.1093/ckj/sfaa110.
    [3] O'SHAUGHNESSY MM, HOGAN SL, THOMPSON BD, et al. Glomerular disease frequencies by race, sex and region: results from the International Kidney Biopsy Survey[J]. Nephrol Dial Transplant, 2018, 33(4): 661-669. DOI: 10.1093/ndt/gfx189.
    [4] LIM WH, SHINGDE M, WONG G. Recurrent and de novo glomerulonephritis after kidney transplantation[J]. Front Immunol, 2019, 10: 1944. DOI: 10.3389/fimmu.2019.01944.
    [5] ZHU Y, FAN Y, XU F, et al. Focal segmental glomerulosclerosis superimposed on transplant glomerulopathy: implications for graft survival[J]. Am J Nephrol, 2021, 52(10/11): 788-797. DOI: 10.1159/000519648.
    [6] SHABAKA A, TATO RIBERA A, FERNÁNDEZ-JUÁREZ G. Focal segmental glomerulosclerosis: state-of-the-art and clinical perspective[J]. Nephron, 2020, 144(9): 413-427. DOI: 10.1159/000508099.
    [7] LOUPY A, HAAS M, SOLEZ K, et al. The Banff 2015 kidney meeting report: current challenges in rejection classification and prospects for adopting molecular pathology[J]. Am J Transplant, 2017, 17(1): 28-41. DOI: 10.1111/ajt.14107.
    [8] GURUSWAMY SANGAMESWARAN KD, BARADHI KM. Focal segmental glomerulosclerosis[M]. Treasure Island (FL): StatPearls Publishing, 2022.
    [9] 闵敏, 张炯. 利妥昔单抗治疗特发性局灶节段肾小球硬化的机制和疗效[J]. 肾脏病与透析肾移植杂志, 2021, 30(6): 575-580. DOI: 10.3969/j.issn.1006-298X.2021.06.016.

    MIN M, ZHANG J. Mechanism and efficacy of rituximab in idiopathic focal segmental glomerulosclerosis[J]. Chin J Nephrol Dial Transplant, 2021, 30(6): 575-580. DOI: 10.3969/j.issn.1006-298X.2021.06.016.
    [10] KIENZL-WAGNER K, WALDEGGER S, SCHNEEBERGER S. Disease recurrence-the sword of damocles in kidney transplantation for primary focal segmental glomerulosclerosis[J]. Front Immunol, 2019, 10: 1669. DOI: 10.3389/fimmu.2019.01669.
    [11] DE VRIESE AS, SETHI S, NATH KA, et al. Differentiating primary, genetic, and secondary FSGS in adults: a clinicopathologic approach[J]. J Am Soc Nephrol, 2018, 29(3): 759-774. DOI: 10.1681/ASN.2017090958.
    [12] RUDNICKI M. FSGS recurrence in adults after renal transplantation[J]. Biomed Res Int, 2016: 3295618. DOI: 10.1155/2016/3295618.
    [13] 梅长林, 陈惠萍, 周新津. 临床肾脏病理学[M]. 北京: 人民卫生出版社, 2021.
    [14] UFFING A, PÉREZ-SÁEZ MJ, MAZZALI M, et al. Recurrence of FSGS after kidney transplantation in adults[J]. Clin J Am Soc Nephrol, 2020, 15(2): 247-256. DOI: 10.2215/CJN.08970719.
    [15] 上海市医师协会肾脏内科医师分会局灶节段性肾小球硬化专家协作组. 成人局灶节段性肾小球硬化诊治专家共识[J]. 中华内科杂志, 2021, 60(9): 791-796. DOI: 10.3760/cma.j.cn112138-20210701-00454.

    Expert Collaboration Group of Focal Segmental Glomerulosclerosis of the Nephrologist Branch of Shanghai Medical Doctor Association. Expert consensus on diagnosis and treatment of focal segmental glomerulosclerosis in adults[J]. Chin J Intern Med, 2021, 60(9): 791-796. DOI: 10.3760/cma.j.cn112138-20210701-00454.
    [16] DE SOUZA L, PRUNSTER J, CHAN D, et al. Recurrent glomerulonephritis after kidney transplantation: a practical approach[J]. Curr Opin Organ Transplant, 2021, 26(4): 360-380. DOI: 10.1097/MOT.0000000000000887.
    [17] FRANCIS A, TRNKA P, MCTAGGART SJ. Long-term outcome of kidney transplantation in recipients with focal segmental glomerulosclerosis[J]. Clin J Am Soc Nephrol, 2016, 11(11): 2041-2046. DOI: 10.2215/CJN.03060316.
    [18] 朱莹, 徐峰, 梁少姗, 等. 移植肾局灶节段性肾小球硬化的临床病理特征及预后[J]. 肾脏病与透析肾移植杂志, 2021, 30(2): 107-112. DOI: 10.3969/j.issn.1006-298X.2021.02.002.

    ZHU Y, XU F, LIANG SS, et al. Clinicopathological features and allograft outcomes of post-transplant focal segmental glomerulosclerosis[J]. Chin J Nephrol Dial Transplant, 2021, 30(2): 107-112. DOI: 10.3969/j.issn.1006-298X.2021.02.002.
    [19] THEOPHILUS UI, JOHN JR, IHAB S, et al. Recurrent focal segmental glomerulosclerosis after kidney transplantation in african americans: review of the current evidence[J]. Exp Clin Transplant, 2021, 19(12): 1245-1256. DOI: 10.6002/ect.2020.0542.
    [20] BUGLIONI A, FIDLER ME, ALEXANDER MP, et al. De novo pauci-immune glomerulonephritis in renal allografts[J]. Mod Pathol, 2020, 33(3): 440-447. DOI: 10.1038/s41379-019-0355-0.
    [21] HARSHMAN LA, BARTOSH S, ENGEN RM. Focal segmental glomerulosclerosis: risk for recurrence and interventions to optimize outcomes following recurrence[J]. Pediatr Transplant, 2022, 26(6): e14307. DOI: 10.1111/petr.14307.
    [22] 朱莹. 移植肾复发和新发局灶节段性肾小球硬化的研究进展[J]. 医学研究生学报, 2021, 34(8): 861-865. DOI: 10.16571/j.cnki.1008-8199.2021.08.015.

    ZHU Y. Update on recurrent and de novo focal segmental glomerulosclerosis after kidney transplantation[J]. J Med Postgrad, 2021, 34(8): 861-865. DOI: 10.16571/j.cnki.1008-8199.2021.08.015.
    [23] BALOGLU I, TONBUL HZ, TURKMEN K, et al. Are kidney donor risk index/kidney donor profile index scores predictor of future graft function?[J]. Saudi J Kidney Dis Transpl, 2021, 32(4): 979-985. DOI: 10.4103/1319-2442.338310.
    [24] PARK SE, YOON SS, PARK SC, et al. Analysis of pre-transplant resuscitation factors influencing immediate graft function after deceased donor kidney transplantation[J]. Transplant Proc, 2018, 50(10): 3088-3094. DOI: 10.1016/j.transproceed.2018.08.011.
    [25] JAHN L, RÜSTER C, SCHLOSSER M, et al. Rate, factors, and outcome of delayed graft function after kidney transplantation of deceased donors[J]. Transplant Proc, 2021, 53(5): 1454-1461. DOI: 10.1016/j.transproceed.2021.01.006.
    [26] HUSAIN SA, KING KL, COLEY S, et al. Association between procurement biopsy findings and deceased donor kidney outcomes: a paired kidney analysis[J]. Transpl Int, 2021, 34(7): 1239-1250. DOI: 10.1111/tri.13899.
    [27] SHOJI J, MⅡ A, TERASAKI M, et al. Update on recurrent focal segmental glomerulosclerosis in kidney transplantation[J]. Nephron, 2020, 144(Suppl 1): 65-70. DOI: 10.1159/000510748.
    [28] 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]. J Clin Diagn Res, 2017, 11(4): EC39-EC42. DOI: 10.7860/JCDR/2017/25502.9728.
    [29] HANSRIVIJIT P, GHAHRAMANI N. Combined rituximab and plasmapheresis or plasma exchange for focal segmental glomerulosclerosis in adult kidney transplant recipients: a meta-analysis[J]. Int Urol Nephrol, 2020, 52(7): 1377-1387. DOI: 10.1007/s11255-020-02462-6.
    [30] BOONPHENG B, HANSRIVIJIT P, THONGPRAYOON C, et al. Rituximab or plasmapheresis for prevention of recurrent focal segmental glomerulosclerosis after kidney transplantation: a systematic review and meta-analysis[J]. World J Transplant, 2021, 11(7): 303-319. DOI: 10.5500/wjt.v11.i7.303.
    [31] DIRIM AB, DEMIR E, GULLER N, et al. Efficacy of intravenous combined immunosuppression with plasmapheresis in adult patients with refractory primary focal segmental glomerulosclerosis[J]. J Clin Apher, 2022, 37(4): 376-387. DOI: 10.1002/jca.21985.
    [32] ALKANDARI O, NAMPOORY N, NAIR P, et al. Recurrent focal segmental glomerulosclerosis and abatacept: case report[J]. Exp Clin Transplant, 2016, 14(4): 456-459. DOI: 10.6002/ect.2014.0154.
    [33] ALHAMAD T, MANLLO DIECK J, YOUNUS U, et al. ACTH gel in resistant focal segmental glomerulosclerosis after kidney transplantation[J]. Transplantation, 2019, 103(1): 202-209. DOI: 10.1097/TP.0000000000002320.
    [34] ALLEN PJ, CHADBAN SJ, CRAIG JC, et al. Recurrent glomerulonephritis after kidney transplantation: risk factors and allograft outcomes[J]. Kidney Int, 2017, 92(2): 461-469. DOI: 10.1016/j.kint.2017.03.015.
    [35] COSIO FG, FRANKEL WL, PELLETIER RP, et al. Focal segmental glomerulosclerosis in renal allografts with chronic nephropathy: implications for graft survival[J]. Am J Kidney Dis, 1999, 34(4): 731-738. DOI: 10.1016/S0272-6386(99)70400-2.
  • 加载中
图(2) / 表(2)
计量
  • 文章访问数:  28
  • HTML全文浏览量:  1
  • PDF下载量:  8
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-09-22
  • 网络出版日期:  2023-01-17
  • 刊出日期:  2023-01-15

目录

    /

    返回文章
    返回