Role of biopsy of kidney allograft in early diagnosis and differential diagnosis of renal allograft diseases / 解放军医学杂志

ABSTRACT

Objective To investigate the role of biopsy kidney allograft in the early diagnosis and differential diagnosis of acute and chronic rejection and other diseases involving renal allograft,and to determine the optimal time for early biopsy in chronic allograft rejection.Methods Non-random biopsy of renal allograft was performed in 44 kidney transplant recipients with the clinical manifestation of diagnosis-unconfirmed allograft diseases,in the presence increased in serum creatinine,microalbuminuria or/and proteinuria,glomerular hematuria and so on.Another 6 kidney transplant recipients received routine allograft biopsy 1 month after operation.Pathological evaluation was performed in all sections according to Banff 97 classification and based on clinical data.Results Chronic allograft rejection was discovered in the renal allograft specimens of 31.3%,76.5% and 88.2% recipients,respectively,in the 1st year,the 2nd to 3rd year and over 3 years after operation,and most of them showed no obvious clinical manifestation.A part of recipients with clinical diagnosis of acute rejection also showed pathological manifestations of chronic rejection and/or glomerulonephritis and chronic cyclosporine nephropathy.A part of recipients with clinical diagnosis of chronic rejection showed pathological manifestations of acute rejection and/or glomerulonephritis and chronic cyclosporine nephropathy.Pathological features of acute or chronic rejection,glomerulonephritis and chronic cyclosporine nephropathy were observed respectively in recipients with disorders of kidney allograft with unknown diagnosis.No obvious clinical symptoms were observed in nearly half of the patients with pathological diagnosis of glomerulonephritis.Good therapeutic effect was obtained in these recipients who were correctly treated on the basis of definite pathological diagnosis.Conclusions It is indicated that optimal time for early diagnosis in chronic renal allograft rejection might be the 2nd and 3rd year after transplantation,and routine biopsy should be performed in this period.It is suggested that biopsy of renal allograft is of importance value for rectification of clinical diagnosis and for recipients with clinically undefined renal allograft diseases.It is also indicated that there might be coexistence of acute,chronic rejection and/or glomerulonephritis and chronic cyclosporine nephropathy.