Universal occurrence of glomerular abnormalities in patients receiving liver transplants.
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.
Crawford
D H
DH
Joint Liver Program, University of Queensland, Australia.
Endre
Z H
ZH
Axelsen
R A
RA
Lynch
S V
SV
Balderson
G A
GA
Strong
R W
RW
Kerlin
P
P
Powell
L W
LW
Fleming
S J
SJ
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