title: Histopathology of renal failure after heart transplantation: a diverse spectrum.
abstract: BACKGROUND
  Chronic kidney disease occurs frequently after heart transplantation and is associated with significant morbidity and mortality. Herein we describe the histopathology associated with renal failure in a cohort of heart transplant recipients.
  
  
  METHODS
  Over a 4-year period all patients with an estimated GFR <30 ml/min/1.73 m(2) or significant proteinuria were referred to the kidney transplant clinic for clinical evaluation. A percutaneous renal biopsy was performed as part of a standardized evaluation.
  
  
  RESULTS
  Eighteen patients underwent renal biopsy 5.8 ± 4.1 years after transplantation. Hypertension (88.9%), Type 2 diabetes (55.6%) and allograft vasculopathy (38.9%) were prevalent. All patients were receiving calcineurin inhibitors. Mean creatinine was 2.9 ± 1.2 mg/dl with an estimated GFR 27.9 ± 9.1 ml/min/1.73 m(2). Eight patients (44%) had proteinuria >1 g per 24 hours. The major histologic findings were nephrosclerosis plus diabetic glomerulopathy (50%), nephrosclerosis and focal segmental glomerulosclerosis (22.2%) and nephrosclerosis alone (22.2%). One patient had direct CNI toxicity consisting of nodular sub-adventitial hyalinosis. Eleven patients (61.1%) had glomerular disease and 11 patients (61.1%) had moderate or severe tubular atrophy. During follow-up, 5 patients (27.8%) started hemodialysis, 4 (22.2%) died, and 2 (11.1%) received a renal transplant.
  
  
  CONCLUSIONS
  We observed diverse histologic patterns in this series of renal biopsies suggesting that chronic kidney disease after heart transplantation has a complex and varied pathologic basis. Further defining the renal injuries that precede heart transplantation and predispose to the progression of kidney disease after transplant may assist in treating this population.
authors.affiliation: Division of Cardiology, Mount Sinai Medical Center, New York, NY, USA. sean.pinney@mssm.edu
authors.forename: Sean P
authors.initials: SP
authors.lastname: Pinney
authors.forename: Revathi
authors.initials: R
authors.lastname: Balakrishnan
authors.forename: Steven
authors.initials: S
authors.lastname: Dikman
authors.forename: Ajith
authors.initials: A
authors.lastname: Nair
authors.forename: Kimmarie
authors.initials: K
authors.lastname: Hammond
authors.forename: Michael
authors.initials: M
authors.lastname: Domanski
authors.forename: Anelechi C
authors.initials: AC
authors.lastname: Anyanwu
authors.forename: Graciela
authors.initials: G
authors.lastname: Deboccardo
mesh_terms: D000368:Aged; D001706:Biopsy; D009202:Cardiomyopathies / Q000601:surgery*; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000150:complications / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications / Q000473:pathology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000150:complications / Q000473:pathology; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology* / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies