Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Original article / research
Year : 2017 | Month : April | Volume : 11 | Issue : 4 | Page : EC39 - EC42

De Novo Focal Segmental Glomerulosclerosis in Renal Allograft-Histological Presentation and Clinical Correlation: Single Centre Experience

Rashmi D Patel, Aruna V Vanikar, Lovelesh A Nigam, Kamal V Kanodia, Kamlesh S Suthar, Himanshu V Patel

1. Professor, Department of Pathology, Laboratory Medicine and Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr. H.L. Trivedi, Ahmedabad, Gujarat, India. 2. Professor, Department of Pathology, Laboratory Medicine and Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr. H.L. Trivedi, Ahmedabad, Gujarat, India. 3. Assistant Professor, Department of Pathology, Laboratory Medicine and Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr. H.L. Trivedi, Ahmedabad, Gujarat, India. 4. Professor, Department of Pathology, Laboratory Medicine and Transfusion Services and Immunohematology, G. R. Doshi and K. M. Mehta Institute of Kidney Diseases and Research Centre (IKDRC)- Dr. H.L. Trivedi, Ahmedabad, Gujarat, India. 5. Associate Professor, Department

Correspondence Address :
Dr. Rashmi D Patel,
Dr. H.L. Trivedi Institute of Transplantation Sciences (ITS) Civil Hospital Campus,
Asarwa, Ahmedabad- 380016, Gujarat, India.
E-mail: rashmi381@yahoo.co.in

Abstract

Introduction: Recurrent or de novo glomerulonephritis are one of the well-known causes for renal allograft dysfunction in early and late period after renal transplantation. Focal Segmental Glomerulosclerosis (FSGS) is a devastating lesion of the renal allograft. De novo FSGS is uncommon compared to recurrent FSGS.

Materials and Methods: A retrospective evaluation of renal allograft biopsies was performed from 2007 to 2015, by light microscopy and immunohistochemistry including patient-donor demographics. Graft function status in terms of serum creatinine (SCr) and proteinuria were evaluated.

Results: Out of 2,599 renal allograft biopsies performed, 1.6% biopsies were reported as de novo FSGS. Majority were live related females donors with mean age of 43.8 years. Mean time of biopsy was 1.1 years post-transplant with proteinuria of 2.95 grams/24 hours and SCr of 2.24 mg/dL. Histopathological variants were collapsing 47.6%, Not Otherwise Specified/ classical 35.7%, cellular 9.5% and perihilar 7.1% biopsies. Associated Antibody Mediated Rejection (AMR) with T-Cell Rejection (TCR) was observed in 35.7% biopsies, acute on chronic CNI toxicity (calcineurin inhibitor) in five biopsies. Majority of the patients were on CNI based maintenance immunosuppression regimen. Total 28.6% patients and 23.8 % grafts were lost over a mean follow-up of 2.40 years. The mean SCr of remaining patients was 1.98 mg/dL.

Conclusion: De novo FSGS can occur after the first year of renal transplant with related Human Leukocyte Antigen (HLA)matched donors leading to poor allograft survival. Close monitoring of urinary proteinuria and evaluation of allograft biopsy help in appropriate therapeutic modification to improve long term outcome of graft function.

Keywords

Donors, Graft, Proteinuria, Renal transplantation, Toxicity

How to cite this article :

Rashmi D Patel, Aruna V Vanikar, Lovelesh A Nigam, Kamal V Kanodia, Kamlesh S Suthar, Himanshu V Patel. DE NOVO FOCAL SEGMENTAL GLOMERULOSCLEROSIS IN RENAL ALLOGRAFT-HISTOLOGICAL PRESENTATION AND CLINICAL CORRELATION: SINGLE CENTRE EXPERIENCE. Journal of Clinical and Diagnostic Research [serial online] 2017 April [cited: 2017 Apr 25 ]; 11:EC39-EC42. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2017&month=April&volume=11&issue=4&page=EC39-EC42&id=9728

DOI and Others

DOI: 10.7860/JCDR/2017/25502.9728

Date of Submission: Nov 18, 2016
Date of Peer Review: Jan 10, 2017
Date of Acceptance: Feb 09, 2017
Date of Publishing: Apr 01, 2017

Financial OR OTHER COMPETING INTERESTS: None.

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