Unusual Case of Lipoprotein Glomerulopathy First Diagnosed in a Protocol Kidney Allograft Biopsy

The presence of B-cell clusters in allogenic T cell-mediated rejection (TCMR) of kidney allografts is linked to more severe disease entities. In this study we characterized B-cell infiltrates in patients with TCMR and examined the role of serum CXCL-13 in these patients and experimentally. CXCL-13 serum levels were analyzed in 73 kidney allograft recipients at the time of allograft biopsy. In addition, four patients were evaluated for CXCL13 levels during the first week after transplantation. ELISA was done to measure CXCL-13 serum levels. For further mechanistic understanding, a translational allogenic kidney transplant (ktx) mouse model for TCMR was studied in BalbC recipients of fully mismatched transplants with C57BL/6 donor kidneys. CXCL-13 serum levels were measured longitudinally, CD20 and CD3 composition and CXCL13 mRNA in tissue were examined by flow cytometry and kidneys were examined by histology and immunohistochemistry. We found significantly higher serum levels of the B-cell chemoattractant CXCL13 in patients with TCMR compared to controls and patients with borderline TCMR. Moreover, in patients with acute rejection within the first week after ktx, a >5-fold CXCL13 increase was measured and correlated with B-cell infiltrates in the biopsies. In line with the clinical findings, TCMR in mice correlated with increased systemic serum-CXCL13 levels. Moreover, renal allografts had significantly higher CXCL13 mRNA expression than isogenic controls and showed interstitial CD20+ B-cell clusters and CD3+ cell infiltrates accumulating in the vicinity of renal vessels. CXCL13 blood levels correlate with B-cell involvement in TCMR and might help to identify patients at risk of a more severe clinical course of rejection.

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ADVERSE IMPACT OF MILD HYPERTENSION POST TRANSPLANT ON 1 YEAR CHRONIC INTERSTIAL FIBROSIS AND TUBULAR ATROPY SCORES IN KIDNEY ALLOGRAFT BIOPSY AMONG A COHORT ON RAPID STEROID WITHDRAWL PROTOCOL.

Transplantation Journal ◽

10.1097/00007890-201007272-00715 ◽

2010 ◽

Vol 90 ◽

pp. 387

Author(s):

H. Chakkera ◽

Y. Devarapalli ◽

D. Mulligan ◽

M. Mazur ◽

K. Hamawi ◽

...

Keyword(s):

Mild Hypertension ◽

Adverse Impact ◽

Kidney Allograft ◽

Post Transplant ◽

Allograft Biopsy

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Concurrent cytomegalovirus glomerulitis and BK polyomavirus-associated nephropathy in a kidney allograft biopsy

Transplant Infectious Disease ◽

10.1111/tid.12498 ◽

2016 ◽

Vol 18 (2) ◽

pp. 247-250 ◽

Cited By ~ 5

Author(s):

I.O. Chikeka ◽

A. Paulk ◽

A. Haririan ◽

J.C. Papadimitriou ◽

C.B. Drachenberg

Keyword(s):

Kidney Allograft ◽

Allograft Biopsy ◽

Bk Polyomavirus

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Kidney allograft biopsy: timing to complications

Clinical Nephrology ◽

10.5414/cnp74039 ◽

2010 ◽

Vol 74 (07) ◽

pp. 39-45 ◽

Cited By ~ 15

Author(s):

Z. Yablon ◽

P. Recupero ◽

J. McKenna ◽

J. Vella ◽

M.G. Parker

Keyword(s):

Kidney Allograft ◽

Allograft Biopsy

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Liver Function Enzymes are Potential Predictive Markers for Kidney Allograft Dysfunction

Advancements in Journal of Urology and Nephrology ◽

10.33140/ajun.02.01.07 ◽

2020 ◽

Vol 2 (1) ◽

Keyword(s):

Liver Function ◽

Estimated Glomerular Filtration Rate ◽

Serum Alkaline Phosphatase ◽

Serum Biomarkers ◽

Kidney Allograft ◽

Individual Level ◽

Allograft Dysfunction ◽

Allograft Biopsy ◽

Allograft Function ◽

Pearson Correlations

Introduction: Biopsy of the allograft is the gold standard for assessing kidney allograft dysfunction. The aim of our pilot study was to identify serum biomarkers that could obviate the need for biopsy. Materials and Methods: We conducted a study to identify the biomarkers in the serum from different groups of chronic kidney disease (CKD) patients and kidney transplanted patients vs. healthy individuals. The four groups (n=25 in each group) were as follows: 1) Patients with unstable kidney allograft transplants requiring biopsy for cause, 2) Patients with stable kidney allograft transplants, 3) Patients with CKD not on immunosuppressive therapy and, 4) healthy subjects. We measured the activity and level of serum alkaline phosphatase (ALP) and other liver enzymes (alanine transaminase (ALT) and aspartate transaminase (AST)) as potential serum biomarkers in acute allograft dysfunction. Results: We found that ALP correlated with allograft biopsy findings, liver function, and clinical outcomes and possibly graft survival. Additionally, AST and ALT were higher in patients with graft rejection compared to non-rejected and stable kidney transplants. Moreover, the low Pearson correlations (r- values) between ALP level with age (r=0.179), gender, body mass index (r=0.236), creatinine (r=0.044) or estimated glomerular filtration rate (r=0.048) suggest that ALP may be an independent biomarker which is relatively unaffected by other individual-level variables. Conclusion: ALP may be a putative biomarker to predict kidney allograft function and rejection. Data also indicated that liver function plays an important role for the overall success of kidney transplantation.

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