The Pathologic Analysis of Chronic Renal Failure in Renal Allograft Recipients / 대한이식학회지

ABSTRACT

As the patients with chronic renal failure (CRF) are usually diagnosed by clinical data, the exact etiology of renal disease is obscure in most renal allograft recipients. Recognition of original disease is important to manage the recipients after renal transplantation, because many renal diseases leading to CRF, such as glomerulonephritis (GN), diabetes, and hypertension, are known to recur and affect the prognosis of the renal recipients. PURPOSE: We investigated the excised native kidney to know the pathologic etiology of CRF in allograft recipients. We classified the pathologic entities and compared them with the clinical data. METHODS: Total 30 recipients without pathologic diagnosis for CRF were included in this study from June, 2000 to July, 2001. We performed pathologic and immunologic examination of native kidney obtained by unilateral nephrectomy of the recipients at the time of renal transplantation. We analyzed the preoperative clinical data to compare with the pathologic findings. RESULTS: The mean age of the recipients was 41 (23~59) years, and male to female ratio was 3 2 (male female =18 12). All recipients except two were primary renal transplants. The mean duration of pre-transplant dialysis was 400 (5~2970) days. The presumptive clinical diagnosis for CRF was made in 22 out of 30 cases (73%), and unknown in remaining 8 cases (27%). The pathologic diagnosis was made in 27 cases (90%), and it couldn't be made in the remaining three (10%) due to presence of severe chronic pathologic changes. Twenty cases (67%) were GN, including 8 chronic sclerosing GN, 7 IgA nephropathy, 2 membranoproliferative GN, 2 focal segmental GN, 1 mesangial proliferative GN. Four cases (13%) were tubulointerstitial disease (2 reflux nephropathy, 1 chronic pyelonephritis, 1 chronic tubulointerstitial nephritis). Three cases (10%) were systemic disease (2 diabetic nephropathy, 1 Wegener's granulomatosis). The preoperative diagnosis was different with the pathologic diagnosis in four (18%) out of 22 cases having presumptive clinical diagnosis. We could make a pathologic diagnosis in six out of seven clinically unknown cases. CONCLUSION: The pathologic diagnosis was made in 90 percent of renal recipients with CRF at the time of renal transplantation. The accurate diagnosis in the renal recipients is necessary and very important to manage the recipients and predict the prognosis after renal transplantation.