Histopathology of renal failure after heart transplantation

A diverse spectrum

Sean P. Pinney, Revathi Balakrishnan, Steven Dikman, Ajith Nair, Kimmarie Hammond, Michael Domanski, Anelechi C. Anyanwu, Graciela Deboccardo

Research output: Contribution to journalArticle

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Abstract

Background: Chronic kidney disease occurs frequently after heart transplantation and is associated with significant morbidity and mortality. Herein we describe the histopathology associated with renal failure in a cohort of heart transplant recipients. Methods: Over a 4-year period all patients with an estimated GFR <30 ml/min/1.73 m 2 or significant proteinuria were referred to the kidney transplant clinic for clinical evaluation. A percutaneous renal biopsy was performed as part of a standardized evaluation. Results: Eighteen patients underwent renal biopsy 5.8 ± 4.1 years after transplantation. Hypertension (88.9%), Type 2 diabetes (55.6%) and allograft vasculopathy (38.9%) were prevalent. All patients were receiving calcineurin inhibitors. Mean creatinine was 2.9 ± 1.2 mg/dl with an estimated GFR 27.9 ± 9.1 ml/min/1.73 m 2. Eight patients (44%) had proteinuria >1 g per 24 hours. The major histologic findings were nephrosclerosis plus diabetic glomerulopathy (50%), nephrosclerosis and focal segmental glomerulosclerosis (22.2%) and nephrosclerosis alone (22.2%). One patient had direct CNI toxicity consisting of nodular sub-adventitial hyalinosis. Eleven patients (61.1%) had glomerular disease and 11 patients (61.1%) had moderate or severe tubular atrophy. During follow-up, 5 patients (27.8%) started hemodialysis, 4 (22.2%) died, and 2 (11.1%) received a renal transplant. Conclusions: We observed diverse histologic patterns in this series of renal biopsies suggesting that chronic kidney disease after heart transplantation has a complex and varied pathologic basis. Further defining the renal injuries that precede heart transplantation and predispose to the progression of kidney disease after transplant may assist in treating this population.

Original languageEnglish (US)
Pages (from-to)233-237
Number of pages5
JournalJournal of Heart and Lung Transplantation
Volume31
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Heart Transplantation
Renal Insufficiency
Nephrosclerosis
Chronic Renal Insufficiency
Kidney
Transplants
Focal Segmental Glomerulosclerosis
Adventitia
Kidney Diseases
Atrophy
Renal Dialysis
Morbidity
Biopsy
Mortality
Wounds and Injuries
Population

Keywords

  • calcineurin inhibitors
  • chronic kidney disease
  • diabetes mellitus
  • heart transplantation
  • hypertension

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Pinney, S. P., Balakrishnan, R., Dikman, S., Nair, A., Hammond, K., Domanski, M., ... Deboccardo, G. (2012). Histopathology of renal failure after heart transplantation: A diverse spectrum. Journal of Heart and Lung Transplantation, 31(3), 233-237. https://doi.org/10.1016/j.healun.2011.08.012

Histopathology of renal failure after heart transplantation : A diverse spectrum. / Pinney, Sean P.; Balakrishnan, Revathi; Dikman, Steven; Nair, Ajith; Hammond, Kimmarie; Domanski, Michael; Anyanwu, Anelechi C.; Deboccardo, Graciela.

In: Journal of Heart and Lung Transplantation, Vol. 31, No. 3, 03.2012, p. 233-237.

Research output: Contribution to journalArticle

Pinney, SP, Balakrishnan, R, Dikman, S, Nair, A, Hammond, K, Domanski, M, Anyanwu, AC & Deboccardo, G 2012, 'Histopathology of renal failure after heart transplantation: A diverse spectrum', Journal of Heart and Lung Transplantation, vol. 31, no. 3, pp. 233-237. https://doi.org/10.1016/j.healun.2011.08.012
Pinney, Sean P. ; Balakrishnan, Revathi ; Dikman, Steven ; Nair, Ajith ; Hammond, Kimmarie ; Domanski, Michael ; Anyanwu, Anelechi C. ; Deboccardo, Graciela. / Histopathology of renal failure after heart transplantation : A diverse spectrum. In: Journal of Heart and Lung Transplantation. 2012 ; Vol. 31, No. 3. pp. 233-237.
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abstract = "Background: Chronic kidney disease occurs frequently after heart transplantation and is associated with significant morbidity and mortality. Herein we describe the histopathology associated with renal failure in a cohort of heart transplant recipients. Methods: Over a 4-year period all patients with an estimated GFR <30 ml/min/1.73 m 2 or significant proteinuria were referred to the kidney transplant clinic for clinical evaluation. A percutaneous renal biopsy was performed as part of a standardized evaluation. Results: Eighteen patients underwent renal biopsy 5.8 ± 4.1 years after transplantation. Hypertension (88.9{\%}), Type 2 diabetes (55.6{\%}) and allograft vasculopathy (38.9{\%}) were prevalent. All patients were receiving calcineurin inhibitors. Mean creatinine was 2.9 ± 1.2 mg/dl with an estimated GFR 27.9 ± 9.1 ml/min/1.73 m 2. Eight patients (44{\%}) had proteinuria >1 g per 24 hours. The major histologic findings were nephrosclerosis plus diabetic glomerulopathy (50{\%}), nephrosclerosis and focal segmental glomerulosclerosis (22.2{\%}) and nephrosclerosis alone (22.2{\%}). One patient had direct CNI toxicity consisting of nodular sub-adventitial hyalinosis. Eleven patients (61.1{\%}) had glomerular disease and 11 patients (61.1{\%}) had moderate or severe tubular atrophy. During follow-up, 5 patients (27.8{\%}) started hemodialysis, 4 (22.2{\%}) died, and 2 (11.1{\%}) received a renal transplant. Conclusions: We observed diverse histologic patterns in this series of renal biopsies suggesting that chronic kidney disease after heart transplantation has a complex and varied pathologic basis. Further defining the renal injuries that precede heart transplantation and predispose to the progression of kidney disease after transplant may assist in treating this population.",
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