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Medullary ray injury in renal allografts
Author(s) -
Kobayashi Akimitsu,
Yamamoto Izumi,
Ito Shinichi,
Akioka Yuko,
Yamamoto Hiroyasu,
Teraoka Satoshi,
Hattori Motoshi,
Tanabe Kazunari,
Hosoya Tatsuo,
Yamaguchi Yutaka
Publication year - 2010
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1111/j.1440-1827.2010.02593.x
Subject(s) - medicine , etiology , fibrosis , pathological , pathology , vesicoureteral reflux , atrophy , medullary cavity , gastroenterology , urology , reflux , disease
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.