1 459

Cited 16 times in

Segmental glomerulosclerosis in IgA nephropathy after renal transplantation: relationship with proteinuria and therapeutic response to enalapril

Authors
 Hyeon Joo Jeong  ;  Yu Seun Kim  ;  Kiil Park  ;  Dae Suk Han  ;  Ho Yung Lee  ;  Kyu Hun Choi  ;  Soon Kim II  ;  Myoung Soo Kim  ;  Kye Won Kwon 
Citation
 CLINICAL TRANSPLANTATION, Vol.17(2) : 108-113, 2003 
Journal Title
CLINICAL TRANSPLANTATION
ISSN
 0902-0063 
Issue Date
2003
MeSH
Adult ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use* ; Biopsy ; Case-Control Studies ; Creatinine/blood ; Enalapril/therapeutic use* ; Female ; Glomerulonephritis, IGA/pathology* ; Glomerulosclerosis, Focal Segmental/pathology ; Humans ; Kidney Glomerulus/pathology* ; Kidney Transplantation/pathology* ; Male ; Proteinuria/drug therapy* ; Proteinuria/pathology ; Retrospective Studies
Keywords
enalapril ; glomerular hypertrophy ; IgA nephropathy ; renal transplantation ; segmental glomerulosclerosis
Abstract
INTRODUCTION:
Although graft dysfunction has been increasingly reported in post-transplant IgA nephropathy (Tx-IgAN), intragraft morphological changes have been largely overlooked. We evaluated glomerular changes in Tx-IgAN to identify the histological features pertaining to significant proteinuria and therapeutic response to enalapril.
MATERIALS AND METHODS:
Fifty-four renal allograft biopsies, diagnosed as Tx-IgAN at a median of 46 months after transplantation, were the subject of the study. In 10 patients, glomerular morphometry was performed. In 14 patients who have been treated with enalapril for more than 12 months, we correlated the therapeutic response to enalapril with allograft histology.
RESULTS:
No uniform pattern was found in the glomeruli of Tx-IgAN. The glomerular mesangium was mostly indistinct. Interstitial fibrosis was negative or mild in 88.9%. By morphometry, the glomerular tuft areas and mesangial areas were significantly larger in Tx-IgAN than those of the normal native kidney (p < 0.05), but were not different from transplant cases without glomerulonephritis. Proteinuria of >/=1 g/24 h was correlated with glomerulosclerosis, interstitial fibrosis and interstitial inflammation at time of biopsy (p < 0.005). The presence of segmental sclerosis (SS) correlated well with the amount of 24-h proteinuria (p < 0.001). After treatment with enalapril, the amount of proteinuria reduced in 64.3%. Therapeutic response to enalapril tended to be less effective in patients having SS (28.6 versus 71.4%), but this finding did not reach a statistical significance.
CONCLUSIONS:
Significant proteinuria was associated with advanced chronic injury, especially with the presence of SS in Tx-IgAN, but anti-proteinuric effect of enalapril was not affected by graft histology. It remains to be clarified whether glomerular mesangial expansion plays a role in graft dysfunction in a subset of Tx-IgAN showing prominent mesangial changes.
Full Text
http://onlinelibrary.wiley.com/doi/10.1034/j.1399-0012.2003.02067.x/abstract
DOI
10.1034/j.1399-0012.2003.02067.x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yu Seun(김유선) ORCID logo https://orcid.org/0000-0002-5105-1567
Jeong, Hyeon Joo(정현주) ORCID logo https://orcid.org/0000-0002-9695-1227
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/113408
사서에게 알리기
  feedback

qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse

Links