The etiologies of functional deterioration in transpanted kidney are diverse and several diagnostic methods are used for differential diagnosis. In order to find out the causes of transplant kidney diseases, we have reviewed the 52 renal
allograft
biopsies perfonrmed in 44 patients admitted to Seoul National University Hospital (SNUH) from January 1979 to December 1990 and analyzed their clinical characteristics.
1) The ratio of male to female in 44 patients was 37:7, and their average age at biopsy was 31.7 years (range: 9-56 years).
2) The biopsies were done because of delayed functional recovery after transplantation in 6 cases, rapid deterioration of renal function in 17 cases, slow progression of azotemia in 19 cases, persistent proteinuria over 2 gm/day in 8 cases, and
gross
yhematuria comined with proteinuria in 2 cases.
3) In 52 cases of renal allograft biopsies, the clinical evidences of functional derangement of transplanted kidney appeared at 8.9 months after transplantation in average, and the biopsies were performed at 15.5 months after transplantation in
average.
4) The results of biopsies were hyperacute rejection (1), acute rejection (13), chronic rejection (14), acute tubular necrosis (4), renal infarct (2), tubulointerstitial nephritis (2), glomerulonephritis (12), transplant glomerulopathy (1), CsA
nephrotoxicity (2) and no pathologic lesion (1). The results of biopsies were rejection, tubulointerstitial lesion and renal infarct in 38 cases among the 42 cases in which the major indication for biopsy was azotemia. And all of the 10 cases in
which
the major indication for biopsies was persistent proteinuria and/or hematuria were glomerulonephritis.
5) The glomerulonephritis in transplanted kidney, that is recurrent or de novo glomerulonephritis, was found in 11 patients (The biopsy was performed twice in one patient). The results showed membranous nephropathy in 3 patients, focal segmental
glomeruosclerosis (FSGS) in 3 patients, membranoproliferative glomerulonephritis (MPGN) type 1 in 2 patients, IgA nephropathy in 2 patients and minimal change lesion in 1 patient. In these patients, 2 patients (1 MPGN type 1 patient and 1 ESGS
patient)
expire and another 2 patients (1 MPGN type 1 patient and 1 FSGS patient) lost renal allograft function, and the rest patients are maintaining their renal allograft function till now.
6) There was no major complications of the biopsies as to lead deterioration of renal allograft function in these 52 cases except bleeding in one cases that required transfusion.
In conclusion, we found that various diseases could occur in transplanted kidney and the clinical manifestations could be similar in different diseases. Although the probability of glomerulonephritis was high in patients who showed proteinuria
and/or
hematuria without azotemia, the underlying glomerular pathologies were more diverse in patients with azotemia. And we found that the biopsy was an useful and safe method for differential diagnosis for transplant kidney diseases.
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