Renal glomerular lesions in unselected patients with cirrhosis undergoing orthotopic liver transplantation

• Published in: Pathology 1995-07, Vol.27 (3), p.237-246
• Main Authors: Axelsen, Roy A., Crawford, Darrell H.G., Endre, Zoltan H., Lynch, Stephen V., Balderson, Glenda A., Strong, Russell W., Fleming, Simon J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Female; Fluorescent Antibody Technique, Indirect; Follow-Up Studies; Glomerular Mesangium - pathology; Glomerular Mesangium - ultrastructure; Glomerulonephritis; Glomerulonephritis - etiology; Glomerulonephritis - immunology; Glomerulonephritis - pathology; Glomerulonephritis, IGA - immunology; Glomerulonephritis, IGA - pathology; Glomerulosclerosis, Focal Segmental - immunology; Glomerulosclerosis, Focal Segmental - pathology; Humans; liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - surgery; Liver Transplantation - adverse effects; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Microscopy, Fluorescence; Middle Aged; orthoptic liver transplantation; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0031-3025; 1465-3931
• DOI: 10.1080/00313029500169053

Renal biopsies were obtained from 23 patients at the time of orthotopic liver transplantation. Twelve biopsies showed minor glomerular abnormalities, 2 exhibited IgA nephropathy and one showed mesangiocapillary glomerutonephritis type I. The remaining 8 patients had gtomerular lesions diagnosed as hepatic gtomerulosclerosis (HGS). Immunofluorescence, available in 6 of the 8 biopsies with HGS, revealed granular deposits of immunoglobulins and complement in glomerular capillary walls and/or the mesangium. IgA was seen in 5 biopsies with HGS, but the staining for this protein was no more intense than that for the other immunoglobulins in 4 of these. Electron microscopy in HGS revealed partial mesangial interposition, hypertrophy of mesangial and endothelial cells, granular material in a widened subendothelial space, slender projections of endothelial cytoplasm extending into the subendotheliat space, and clusters of vesicles in the mesangium and glomerular capillary walls. These ultrastructural abnormalities have not hitherto been reported as a group of associated pathological changes. The renal biopsies were obtained from patients with advanced hepatic disease not selected because of urinary abnormalities or renal dysfunction. The frequency of lesions in this group of patients therefore probably reflects the true incidence of glomerular lesions in cirrhosis and related conditions. Progressive decline in renal function was not observed in any patient during follow up which ranged from 11 days to 55 mths.