title: Universal occurrence of glomerular abnormalities in patients receiving liver transplants.
abstract: We conducted a prospective study of renal histology and function in 18 consecutive nonalcoholic patients who underwent orthotopic liver transplantation (OLT). Despite well-preserved renal function, all patients had abnormal renal biopsies. Four patterns of glomerular injury were identified: minor glomerular abnormalities (eight patients), hepatic glomerulosclerosis (seven), membranoproliferative glomerulonephritis (one), and IgA nephropathy (one). In one patient there was insufficient tissue to allow classification. There was a trend toward lower plasma bilirubin and higher plasma albumin in patients with minor glomerular abnormalities than in the group of patients with more severe forms of glomerular injury (29 v 82 mumol/L, 35.5 v 30 g/L; P = 0.1, 0.1 greater than P greater than 0.05, respectively). Glomerular changes persisted in the three patients who died within 7 weeks post-OLT. IgM immunofluorescence was present in all biopsies and IgA in 11. IgM-containing circulating immune complexes occurred in five patients, suggesting a pathogenic role for IgM immune complex deposition. The significance of cirrhosis-associated glomerular abnormalities is not yet known. They may contribute to the hepatorenal syndrome and the renal dysfunction that occurs in up to 94% of patients post-OLT.
authors.affiliation: Joint Liver Program, University of Queensland, Australia.
authors.forename: D H
authors.initials: DH
authors.lastname: Crawford
authors.forename: Z H
authors.initials: ZH
authors.lastname: Endre
authors.forename: R A
authors.initials: RA
authors.lastname: Axelsen
authors.forename: S V
authors.initials: SV
authors.lastname: Lynch
authors.forename: G A
authors.initials: GA
authors.lastname: Balderson
authors.forename: R W
authors.initials: RW
authors.lastname: Strong
authors.forename: P
authors.initials: P
authors.lastname: Kerlin
authors.forename: L W
authors.initials: LW
authors.lastname: Powell
authors.forename: S J
authors.initials: SJ
authors.lastname: Fleming
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000209:etiology* / Q000473:pathology; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications / Q000209:etiology / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D007678:Kidney Glomerulus / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies