De novo diabetes mellitus in kidney allografts: nodular sclerosis and diffuse glomerulosclerosis leading to graft failure

Owda, Ali; Abdallah, Abdallah H.; Haleem, Abdul; Hawas, Fahad; Mousa, Dujanah; Fedail, Halima; Al-Sulaiman, M. H.; Al-Khader, Abdullah A

doi:10.1093/ndt/14.8.2004

Cited by 17 publications

(8 citation statements)

References 12 publications

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“…In addition, reduced graft survival has been reported to be associated with PTDM [7,11], the latter possibly in part caused by allograft diabetic nephropathy [12].…”

mentioning

confidence: 99%

New-Onset Posttransplantation Diabetes Mellitus: Insulin Resistance or Insulinopenia? Impact of Immunosuppressive Drugs, Cytomegalovirus and Hepatitis C Virus Infection

Hjelmesæth¹,

Åsberg²,

Müller³

et al. 2005

CDR

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New-onset PTDM is characterized by a variety of clinical manifestations, ranging from predominantly insulin resistance which can be handled with lifestyle intervention, to beta-cell failure requiring insulin treatment. The etiology is multi-factorial, but diabetogenic immunosuppressive drugs are of major importance. Future studies should therefore address the effects of different immunosuppressive regimens on the incidence of PTDM. In addition, the impact of cytomegalovirus infection and hepatitis C on PTDM needs further evaluation.

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“…In addition, reduced graft survival has been reported to be associated with PTDM [7,11], the latter possibly in part caused by allograft diabetic nephropathy [12].…”

mentioning

confidence: 99%

New-Onset Posttransplantation Diabetes Mellitus: Insulin Resistance or Insulinopenia? Impact of Immunosuppressive Drugs, Cytomegalovirus and Hepatitis C Virus Infection

Hjelmesæth¹,

Åsberg²,

Müller³

et al. 2005

CDR

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“…The interval between transplantation and biopsy is about 5 yr (10). Though NODAT develops in about 5-15% of renal transplant recipients, de novo diabetic nephropathy is rare with only 10 cases identified (7,(13)(14)(15)(16)(17)(18). Three of these cases reported had nodular while the others manifested diffuse diabetic glomerulosclerosis.…”

Section: Discussionmentioning

confidence: 99%

“…Glomerular basement membrane thickening and increased mesangial volume appear at 2–10 yr after transplantation (2–7). These lesions progress to overt nephropathy as manifested by azotemia, nephrotic range proteinuria and eventual graft failure in the second decade post‐transplantation (12, 14, 16, 17) though graft failure within the first decade has been reported about 8 yr after transplantation (19).…”

Section: Discussionmentioning

confidence: 99%

Allograft diabetic nephropathy may progress to end‐stage renal disease

Salifu

Nicastri

Markell

et al. 2004

Pediatric Transplantation

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Mesangial expansion and glomerular basement membrane thickening characteristic of diabetic nephropathy recur in diabetic recipients of renal allografts from non-diabetic donors but progression to renal failure is minimally documented. Three female renal allograft recipients (aged 40, 62 and 73 yr), who developed end-stage renal disease (ESRD) due to recurrent diabetic nephropathy (two patients) and de novo diabetes (one patient) are reported. Onset of proteinuria, uncontrolled hypertension, azotemia, renal allograft pathologic findings and the need for hemodialysis were analyzed. None of the kidney donors (one cadaver, two living related) had known diabetes or perturbed glucose metabolism pre-transplantation. The three patients presented had different varieties of diabetes; type 1, type 2 and new onset diabetes after transplantation (NODAT). In each subject, proteinuria was detected by dipstick at a mean of 8.3 yr (range 8-9) post-transplantation and increased to the nephrotic range (3.7-4.8 g/day) inducing hypoalbuminemia and azotemia. A histopathologic diagnosis of allograft diabetic nephropathy was made in a mean of 11.7 yr (range 10-14), based on glomerular basement membrane thickening, nodular and diffuse intercapillary glomerulosclerosis, arteriolosclerosis, and tubular atrophy with marked tubular basement membrane thickening characteristic of advanced diabetic nephropathy. All three patients manifested uremia and resumed hemodialysis. Two patients died from sepsis within 2 months and one patient died 2.5 yr later after resumption of maintenance hemodialysis. We infer that recurrent or de novo diabetic nephropathy in renal allografts follows a clinical decade-long course irrespective of diabetes. Reports of ESRD due to allograft diabetic nephropathy (ADN) have been limited because of shorter survival of diabetic transplant recipients and few kidney biopsies performed in patients with chronic allograft dysfunction. The occurrence of allograft diabetic nephropathy in some, but not all patients, however, suggests that individual genetic variability modulates disease expression.

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“…Hekim (nefrolog, endokrinolog) ve diğer yardımcı sağlık personelin (diyabet eğitim hemşiresi, diyetisyen, psikolog, vb) biraraya gelmesiyle oluşan ekip anlayışı ile hasta odaklı yaklaşım NODAT'ın teşhisi ve çok yönlü tedavisinin başarılı bir şekilde gerçekleşmesine olanak verecektir. sendrom ve bozulmuş greft fonksiyonu bildirmiştir (46). Bir hastada diyabetik nodüler skleroz, diğer iki hastada da diffüz diyabetik glomerüler skleroz görülüp her üçünde de greft bozukluğu bildirilmiştir.…”

Section: Sonuçunclassified

New-Onset Diabetes After Renal Transplantation

Bozkurt¹

2015

Turk Neph Dial Transpl

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ÖZBöbrek nakli sonrası gelişen diyabet (new-onset diabetes mellitus after transplantation, NODAT) böbrek alıcılarında yaygın olarak görülmektedir. NODAT, mikrovasküler ve kardiyovasküler hastalıklara yatkınlık kazandarak, hem greft sağkalımı azaltmakta hem de mortaliteyi artırmaktadır. Var olan ya da nakil sonrasında ortaya çıkan birçok risk faktörü ile kullanılan immünosüpresifler NODAT oluşumuyla ilişkilidir. Farklı sınıflandırma sistemleri ve tanımlamalardan dolayı böbrek nakli sonrası gelişen NODAT'ın gerçek insidansını belirlemek zordur. NODAT ve NODAT ile ilişkili faktörlerin iyi bilinmesi, yüksek riskli hastaların ayırt edilmesinde ve önleme/tedavi yaklaşımlarının belirlenmesinde klinisyenler için büyük önem taşımaktadır. NODAT riski, önleyici tedbirler alınarak ve immünosüpresif kullanımının iyi planlaması ile azaltılabilmektedir. Tanı sonrası NODAT'a yönelik özel antihiperglisemik tedavinin uygulanması, glisemik kontrol için gerekli olup nakil sonrası mortalite ve morbiditenin anlamlı ölçüde azalmasına katkı sağlamaktadır. Bu derlemede, NODAT gelişiminde rol oynayan risk faktörleri, tanı ve tedavi yaklaşımları güncel bilgiler ışığında özetlenecektir. ANAHTAR SÖZCÜKLER: Böbrek nakli, Böbrek nakli sonrası yeni başlayan diyabet (NODAT), Diabetes mellitus, İnsülin direnci ABSTRACTNew-onset diabetes mellitus after transplantation (NODAT) is common in kidney recipients, threatening health and longevity by predisposing to microvascular and cardiovascular disease and by reducing graft survival. Several risk factors, already present before or arising after transplantation, in particular the employed immunosuppressive regimens, have been related to the development of NODAT. The real incidence of NODAT after kidney transplantation is difficult to establish, because different classification systems and definitions have been employed over the years. Awareness of NODAT and of the NODATrelated factors is of paramount importance for the clinicians in order to individuate higher risk patients and arrange screening strategies. The risk of NODAT can be reduced by planning preventive measures and by tailoring immunosuppressive regimens according to the patient characteristics. Once NODAT has been diagnosed, the administration of specific antihyperglycemic therapy is mandatory to reach a tight glycemic control, which contributes to significantly reduce posttransplant mortality and morbidity. In this review, we summarize current knowledge on risk factors, diagnosis, treatment of NODAT.

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De novo diabetes mellitus in kidney allografts: nodular sclerosis and diffuse glomerulosclerosis leading to graft failure

Cited by 17 publications

References 12 publications

New-Onset Posttransplantation Diabetes Mellitus: Insulin Resistance or Insulinopenia? Impact of Immunosuppressive Drugs, Cytomegalovirus and Hepatitis C Virus Infection

New-Onset Posttransplantation Diabetes Mellitus: Insulin Resistance or Insulinopenia? Impact of Immunosuppressive Drugs, Cytomegalovirus and Hepatitis C Virus Infection

Allograft diabetic nephropathy may progress to end‐stage renal disease

New-Onset Diabetes After Renal Transplantation

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