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2017 ; 11
(4
): EC39-EC42
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De Novo Focal Segmental Glomerulosclerosis in Renal Allograft-Histological
Presentation and Clinical Correlation: Single Centre Experience
#MMPMID28571148
Patel RD
; Vanikar AV
; Nigam LA
; Kanodia KV
; Suthar KS
; Patel HV
J Clin Diagn Res
2017[Apr]; 11
(4
): EC39-EC42
PMID28571148
show ga
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.
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