Medullary ray injury in renal allografts

Non‐immune injury leading to interstitial fibrosis and tubular atrophy (IF/TA) in renal allografts has various etiologies, but pathological means of verification have yet to be developed. Medullary ray injury (MRI) is a pathological feature of many non‐immune injuries inducing IF/TA and pathological...

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Bibliographic Details
Published in:Pathology international 2010-11, Vol.60 (11), p.744-749
Main Authors: Kobayashi, Akimitsu, Yamamoto, Izumi, Ito, Shinichi, Akioka, Yuko, Yamamoto, Hiroyasu, Teraoka, Satoshi, Hattori, Motoshi, Tanabe, Kazunari, Hosoya, Tatsuo, Yamaguchi, Yutaka
Format: Article
Language:English
Subjects:
Adult
calcineurin inhibitor toxicity
chronic obstruction
Female
Fibrosis - etiology
Fibrosis - pathology
Humans
Inflammation - etiology
Inflammation - pathology
Kidney - pathology
kidney transplantation
Kidney Transplantation - adverse effects
Kidney Transplantation - pathology
Male
medullary ray
reflux nephropathy
Statistics, Nonparametric
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Summary:Non‐immune injury leading to interstitial fibrosis and tubular atrophy (IF/TA) in renal allografts has various etiologies, but pathological means of verification have yet to be developed. Medullary ray injury (MRI) is a pathological feature of many non‐immune injuries inducing IF/TA and pathological determination of calcineurin inhibitor (CNI) toxicity proceeding to striped fibrosis. We investigated the contribution of CNI toxicity to MRI and other non‐immune etiologies related to IF/TA. In this study MRI is defined as fibrosis and inflammation localized exclusively to the medullary ray. Thirty‐six protocol biopsies showing MRI were analyzed and classified histopathologically as following: MRI related to CNI toxicity; chronic obstruction or reflux nephropathy; and acute or chronic pyelonephritis. The etiology of MRI was CNI toxicity (n= 16, 44.4%), chronic obstruction (n= 13, 36.1%), acute or chronic pyelonephritis (n= 2, 5.6%), and other (n= 5, 13.9%). We performed cystography in seven cases of MRI related to chronic obstruction or reflux nephropathy and six cases showing vesicoureteral reflux. The ci+ct score showed significant progression after one year in 30 of the 36 cases (1.53 ± 1.04 vs. 3.03 ± 1.13, P < 0.01). MRI has various etiologies and may also predict changes in urological complications. The classification of MRI may be useful to determine the non‐immune etiology leading to IF/TA.
ISSN:1320-5463
1440-1827
DOI:10.1111/j.1440-1827.2010.02593.x