移植肾糖尿病肾病的临床病理及预后分析

Clinicopathological features and prognosis of post-transplant diabetic nephropathy

目的:探讨移植肾糖尿病肾病(DN)的临床病理特征及预后。方法:回顾性分析国家肾脏疾病临床医学研究中心2009年12月至2021年7月行移植肾活检确诊为DN患者的临床病理及随访资料。结果:13例患者均为男性,其中4例移植前患糖尿病(DM),9例移植后糖尿病(PTDM),移植肾活检时平均年龄46.6岁,中位血清肌酐(SCr)144.1(90.2,194.5)μmol/L,中位尿蛋白1.4(0.5,3.8)g/24h。9例PTDM患者移植后出现DM的中位时间为24.6月,DM出现到移植肾DN诊断的平均时间为71.6月。肾活检病理均表现为系膜基质增生和肾小球基膜增厚,3例伴K-W结节。11例合并非糖尿病肾脏病变(NDRD),IgA肾病(IgAN)5例,膜性肾病(MN)2例,局灶节段性肾小球硬化(FSGS)和慢性移植肾肾小球病(TG)各1例,2例移植肾重复活检合并TG。2例失随访,余11例末次随访时距肾移植的平均时间为150.3月,活检后中位随访17.0月,移植肾DN合并IgAN和MN者SCr相对稳定,而合并TG或FSGS者2例SCr倍增,2例进展为终末期肾病。结论:移植肾DN主要表现为中等量蛋白尿和移植肾功能不全,病理下典型K-W结节并不常见,合并NDRD发生率高。

Objective:To explore the clinicopathological features and prognosis of post-transplant diabetic nephropathy(DN).Methodology:Patients with allograft biopsy-proven DN from December 2009 to July 2021 were reviewed retrospectively.Results:In 13 patients who were all male,4 recipients had the history of diabetes mellitus(DM)before transplantation and 9 recipients developed post-transplantation DM(PTDM).At the time of allograft biopsy,the mean age of the 13 patients was 46.6 years,and the median levels of serum creatinine(SCr)and proteinuria were 144.1(90.2,194.5)μmol/L and 1.4(0.5,3.8)g/24 h,respectively.PTDM was diagnosed at a median time of 24.6 months after transplantation.Allograft biopsy and histologic diagnosis of post-transplant DN was made,on average,71.6 months after PTDM.Of 13 cases showing mesangial matrix expansion and glomerular basement membrane thickening,only 3 recipients existed K-W nodules.Eleven patients combined with nondiabetic kidney disease(NDRD),including IgA nephropathy(IgAN)in 5,membranous nephropathy(MN)in 2,focal segmental glomerulosclerosis(FSGS)and chronic graft glomerulopathy(TG)in 1 case each.Two recipients accompanied with TG in repeat allograft biopsy.Among 11 patients with available follow-up information,the mean time from last follow-up to transplantation were 150.3 months,and the median time from last follow-up to allograft biopsy were 17.0 months.Recipients complicated with IgAN or MN had a relatively stable SCr,while 2 of 4 cases with TG or FSGS developed allograft failure,and the SCr doubled in the rest of 2 cases.Conclusion:Patients with post-transplant DN mainly presented with moderate albuminuria and allograft dysfunction.Histologically,typical K-W nodules were not always present,and the inclunce of coexisting NDRD was high.