De Novo Focal Segmental Glomerulosclerosis in Renal Allograft-Histological Presentation and Clinical Correlation: Single Centre ExperienceCorrespondence Address :
Dr. Rashmi D Patel,
Dr. H.L. Trivedi Institute of Transplantation Sciences (ITS) Civil Hospital Campus,
Asarwa, Ahmedabad- 380016, Gujarat, India.
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.
Donors, Graft, Proteinuria, Renal transplantation, Toxicity
Rashmi D Patel, Aruna V Vanikar, Lovelesh A Nigam, Kamal V Kanodia, Kamlesh S Suthar, Himanshu V Patel. DE NOVO FOCAL SEGMENTAL
GLOMERULOSCLEROSIS IN RENAL
AND CLINICAL CORRELATION:
SINGLE CENTRE EXPERIENCE. Journal of Clinical and Diagnostic Research [serial online] 2017 April [cited: 2017 Jun 23 ]; 11:EC39-EC42. Available from
Date of Submission: Nov 18, 2016
Date of Peer Review: Jan 10, 2017
Date of Acceptance: Feb 09, 2017
Date of Publishing: Apr 01, 2017
Financial OR OTHER COMPETING INTERESTS: None.
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