Clinical usefulness of kidney biopsy in liver transplant recipients with renal impairment.
- Author:
Jong Hoon LEE
1
;
Yul Hee CHO
;
Seung Jee RYU
;
Sin Seung KIM
;
Youn Hee LEE
;
In Ae JANG
;
Bum Soon CHOI
;
Jong Young CHOI
;
Dong Goo KIM
;
Yeong Jin CHOI
;
Chul Woo YANG
;
Byung Ha CHUNG
Author Information
1. Division of Nephrology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. chungbh@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Calcineurin inhibitor;
Chronic kidney disease;
Kidney biopsy;
Liver transplantation
- MeSH:
Atrophy;
Biopsy*;
Calcineurin;
Creatinine;
Diagnosis;
Fibrosis;
Glomerular Filtration Rate;
Glomerulonephritis;
Glomerulonephritis, IGA;
Humans;
Kidney Failure, Chronic;
Kidney*;
Liver Transplantation;
Liver*;
Methods;
Renal Insufficiency, Chronic;
Retrospective Studies;
Steroids;
Transplantation*
- From:Kidney Research and Clinical Practice
2013;32(4):153-157
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Chronic kidney disease is a common complication after liver transplantation. In this study, we analyzed the results of kidney biopsy in liver transplantation recipients with renal impairment. METHODS: Between 1999 and 2012, 544 liver transplants were performed at our hospital. We retrospectively analyzed the clinical and histological data of 10 liver transplantation recipients referred for kidney biopsy. RESULTS: The biopsies were performed at a median of 24.5 months (range, 3-73 months) after liver transplantation. The serum creatinine level was 1.81+/-0.5mg/dL at the time of kidney biopsy. There were no immediate complications. The most common diagnosis was glomerulonephritis (GN), such as immunoglobulin A nephropathy (n=4), mesangial proliferative GN(n=1), focal proliferative GN (n=1), and membranous GN (n=1). Typical calcineurin inhibitor (CNI)-induced nephrotoxicity was detected in three cases (30%).Chronic tissue changes such as glomerulosclerosis, interstitial fibrosis, and tubular atrophy were present in 90%, 80%,and 80% of cases, respectively, and mesangial proliferation was detected in 40%of cases. We began treatment for renal impairment based on the result of kidney biopsy; for example, angiotensin-receptor blockers or steroids were prescribed for GN, and the CNI dose was reduced for CNI nephrotoxicity. As a result, eight of 10 patients showed improvement in glomerular filtration rate, but two progressed to end-stage renal disease. CONCLUSION: Kidney biopsy is a safe and effective method for determining the cause of renal impairment after liver transplantation. Management of patients based on the result of kidney biopsy may improve renal outcomes.
