Renal Pathology in the Pediatric Transplant Patient

Abstract

Renal transplantation is a therapeutic goal for children with advanced chronic kidney disease. There are many causes of renal dysfunction in children with allografts--the transplanted kidney can develop a variety of morphologic alterations leading to dysfunction. Evaluation of the kidney biopsy is one of the best methods of determining the cause of graft dysfunction. Rejection is a major cause of renal allograft failure in children. The morphologic hallmarks of acute antibody-mediated and cell-mediated rejection and chronic allograft nephropathy have been codified in classification strategies that are useful in adults and children. Viral infection and Epstein-Barr virus-driven posttransplant lymphoproliferative disease also occur in the pediatric transplanted kidney. Drug toxicity from immunosuppressive agents also causes characteristic morphologic alterations in the renal allograft. As the survival of pediatric heart and liver transplant patients improves, the incidence of immunosuppression therapy-related disease in the native kidney in these patients will likely become more important clinically. In addition to renal lesions related to the allograft state, glomerular disease can recur or occur de novo in renal allografts. Here, we describe the pathology of the more common morphologic lesions in kidneys of children with a renal allograft.

Adverse Effects of Immunosuppression in Pediatric Solid Organ Transplantation

“…However, the long-term impact for children can become more significant as time after transplant increases. [99] Generally, renal dysfunction that occurs early, within 6 months following renal transplantation, is usually associated with ciclosporin-or tacrolimus-induced nephrotoxicity and is reversible. In contrast, renal dysfunction that occurs later following transplantation is generally irreversible, the result of CAN.…”

Non-invasive evaluation of stable renal allograft function using point shear-wave elastography

“…18,21 These findings might be explained with the edema, interstitial fibrosis or glomerular sclerosis that are present in renal allografts with SCR, possibly resulting in increased tissue stiffness. 22 A recent study reported that in enrolled 102 patients (50 with stable renal allograft function and 52 with renal allograft dysfunction) tissue elasticity on SWE had a moderate negative correlation with eGFR, with higher value than RI. 17 In addition, SWE was found to have a sensitivity of 78.0% and specificity of 86.5% in the prediction of renal allograft dysfunction, which were higher than those of RI.…”

Arteriovenous Fistula and Pseudoaneurysm: Two Important But Rare Complications of Percutaneous Renal Biopsy and Safety of the 16 G Automated Biopsy Needle

“…Renal biopsy is the most sensitive tool to evaluate causes of kidney diseases (1). Possible complications after renal biopsy are usually related to hemorrhage and include hematoma, pseudoaneurysm, hematuria, and formation of arteriovenous fi stula (AVF) (2).…”