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Reflux nephropathy in transplants.

Alec J Howie1, Laura J Buist, Malcolm G Coulthard

  • 1Department of Pathology, University of Birmingham, UK.

Pediatric Nephrology (Berlin, Germany)
|August 13, 2002
PubMed
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Reflux nephropathy, causing renal scarring after urine infection, can affect adult kidney transplants. This study found evidence of this condition in transplanted kidneys, challenging previous assumptions about age-related risk.

Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Pediatric Nephrology

Background:

  • Reflux nephropathy, characterized by renal scarring post-urinary tract infection, typically affects infants.
  • Vesicoureteric reflux is common in kidney allografts, but reflux nephropathy in these grafts was previously considered unlikely due to presumed kidney maturation.
  • Evidence in adult pigs suggests continued risk, prompting investigation into adult human kidney transplants.

Purpose of the Study:

  • To investigate the occurrence of reflux nephropathy in adult kidney allografts.
  • To identify evidence of focal transplant renal scarring in pediatric recipients with urinary tract infections and vesicoureteric reflux.

Main Methods:

  • Pathological examination of 146 consecutive allograft nephrectomy specimens (1990-1999) for reflux nephropathy.

Related Experiment Videos

  • Review of case notes for adult recipients.
  • DMSA scanning and cystography in pediatric transplant recipients with urinary tract infections and vesicoureteric reflux to assess scarring and reflux.

    • Main Results:

    • Four transplanted kidneys from adult donors in adult recipients showed changes consistent with reflux nephropathy.
    • Three of these four also had evidence of glomerulopathy associated with hyperfiltration.
    • Two pediatric recipients with graft urinary tract infections and vesicoureteric reflux exhibited focal damage on DMSA scan, with one confirmed as reflux nephropathy scarring on biopsy.

    Conclusions:

    • Reflux nephropathy can develop in previously healthy adult human kidneys following transplantation.
    • The findings challenge the assumption that older kidneys are immune to reflux nephropathy.
    • Previous studies may have underestimated the risk due to a focus on severe scarring rather than mild or focal damage.