Early calcification of renal allografts detected by protocol biopsies: causes and clinical implications.
Interstitial calcification has been described in renal allografts, however, the etiology and significance of this finding for the graft are unclear. The aim of this study was to examine calcification in serial protocol biopsies, to test the hypothesis that calcification is related to parameters of calcium homeostasis in these patients and to analyze a possible relation between calcification and graft function at 1 year. We studied 213 patients with 586 protocol biopsies obtained 6 weeks, 3 and 6 months after transplantation. Calcifications increased over time, from 6.1% at 6 weeks to 17.8% at 6 months. Out of the 213 patients, 56 had calcification in one or more biopsies. Patients age and gender, underlying renal disease, dialysis mode and duration, previous transplantations, donor type, age and gender, HLA matches and ischemia time had no influence on calcification. Calcification was not related to rejection episodes, acute tubular lesions, calcineurin inhibitor toxicity or tubulointerstitial fibrosis and tubular atrophy. Patients with calcification had significantly higher serum parathormone and calcium levels. In patients with calcification, high PTH levels correlated with an inferior outcome of graft function at 1 year after transplantation (p<0.05). Therefore, treatment of hyperparathyroidism should be considered earlier and more often in these patients.
Division of Nephrology, Department of Internal Medicine, Medical School Hannover, Hannover, Germany. wgwinner@t-online.de
Wilfried
W
Gwinner
Sylvia
S
Suppa
Michael
M
Mengel
Ludwig
L
Hoy
Hans H
HH
Kreipe
Hermann
H
Haller
Anke
A
Schwarz
D000328:Adult; D001706:Biopsy; D002114:Calcinosis / Q000175:diagnosis* / Q000209:etiology; D002118:Calcium / Q000378:metabolism; D005260:Female; D006085:Graft Survival; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000209:etiology; D016030:Kidney Transplantation; D007684:Kidney Tubules / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous
D010281:Parathyroid Hormone; D002118:Calcium