The Relative Frequency of Biopsy Diagnosed Renal Diseases in Patients with Renal Transplantation

Document Type : Original Article(s)

Authors

1 Associate Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

3 Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Renal transplantation is the treatment of choice for patients with end stage renal disease (ESRD). In cases of ant graft dysfunction at any time after transplantation, kidney biopsy is the golden standard for diagnosis. Kidney biopsies are categorized according to the Banff classification. This study aimed to evaluate the frequency of different allograft biopsies.Methods: In this cross-sectional study, the renal allograft biopsies obtained in both Alzahra and Noor in Isfahan, centers during the years 2006 to 2008 were studied based on Banff classification. The information and data were obtained from the department of pathology. When the data were completely gathered, they were analyzed via SPSS software.Finding: From 161 specimens, 68% were men and 32% were women. 85% of the grafts were from living unrelated donors, 9.9% from cadaver and 5% from living related donors. The relative frequencies of pathology diagnosis of biopsies were as 13.7% Tubular atrophy and interstitial fibrosis (TA &IF) grade II, 9.9% TA &IF III, 6.8% Acute rejection (AR) IA, 5.6% AR IB, 5% infarction, 5% borderline, 4.3% AR IIA, 4.3% TA&IF I, 3.7% antibody rejection and 1.9% AR IIB; also 44.7% had unrelated pathology to rejection. The greatest mean age for the patients under biopsy was for TA&IF I (45.5 years) and the smallest was for acute tubular necrosis (ATN) (24 years). The greatest mean time for biopsy was for TA&IF III (2666.2 days after biopsy) and the smallest was for ATN (72.8 days after biopsy).Conclusion: A great number of studies on renal allograft pathologies have been done in different transplant centers around the world. No studies have been done on pathologies in Alzahra and Khorshid hospitals in Isfahan which are referral centers for transplantation. This study can give us a picture of the major causes of graft dysfunction in our country according to race, environment and...

Keywords


  1. Carpenter CB, Milford EL, Sayegh MH. Trans-plantation in the treatment of renal failure. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al. Harrison's Principles of Internal Medicine. 17th ed. New York: McGraw Hill Professional; 2008. p. 1776.
  2. Ghods AJ. Renal transplantation in Iran. Nephrol Dial Transplant 2002; 17(2): 222-8.
  3. Fassihi F. Kidney transplant in Iran. [cited 2004 August 16]. Available from: http:// http://cyberend.com/archives.htm
  4. Magee CC, Milford E. Clinical aspects of renal transplantation. In: Brenner BM. Brenner & Rector's The kidney. 7th ed. Philadelphia: WB. Saunders, Elsevier; 2004. p. 2810-6.
  5. Croker PB, Tisher CC. Indications for and Interpretation of the renal biopsy. In: Schrier WR. Diseases of the kidney and urinary tract .7th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 462.
  6. Nankivell BJ, Borrows RJ, Fung CL, O'Connell PJ, Allen RD, Chapman JR. The natural history of chronic allograft nephropathy. N Engl J Med 2003; 349(24): 2326-33.
  7. Mauiyyedi S, Colvin RB. Pathology of kidney transplantation. In: Morris P. Kidney Transplantation: Principles and Practice. 5th ed. Philadelphia: W.B. Saunders; 2001. p. 343.
  8. Racusen LC, Colvin RB, Solez K, Mihatsch MJ, Halloran PF, Campbell PM, et al. Antibody-mediated rejection criteria- an addition to the Banff 97 classification of renal allograft rejection. Am J Transplant 2003; 3(6): 708-14.
  9. Solez K, Hansen HE, Kornerup HJ, Madsen S, Sørensen AW, Pedersen EB, et al. Clinical validation and reproducibility of the Banff schema for renal allograft pathology. Transplant Proc 1995; 27(1): 1009-11.
  10. Solez K, Colvin RB, Racusen LC, Haas M, Sis B, Mengel M, et al. Banff 07 classification of renal allograft pathology: updates and future directions. Am J Transplant 2008; 8(4): 753-60.
  11. Ratnakar KS, George S, Datta BN, Fayek AH, Rajagopalan S, Fareed E, et al. Renal transplant pathology: bahrain experience. Saudi J Kidney Dis Transpl 2002; 13(1): 71-6.
  12. Bates WD, Davies DR, Welsh K, Gray DW, Fuggle SV, Morris PJ. An evaluation of the Banff classification of early renal allograft biopsies and correlation with outcome. Nephrol Dial Transplant 1999; 14(10): 2364-9.