title: Outcomes of de novo allograft diabetic nephropathy in renal allograft recipients.
abstract: OBJECTIVE
  Despite increased use of diabetogenic immunosuppressive drugs and increased incidence of new-onset diabetes after transplant in renal allograft recipients, there are few case studies on the subject of de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes. We sought to study the outcomes of allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes in patients with new-onset diabetes after transplant.
  
  
  METHODS
  We reviewed the case records of all new-onset diabetes after transplant patients who underwent graft biopsy for graft dysfunction from 1992 to 2010. We analyzed the clinical characteristics and outcomes of new-onset diabetes after transplant patients with de novo allograft diabetic nephropathy and interstitial fibrosis/tubular atrophy without specific glomerular changes.
  
  
  RESULTS
  Of the 1989 recipients, 421 patients developed new-onset diabetes after transplant and 26 underwent graft biopsy. Of the 26 patients, 9 had histopathologic evidence of de novo allograft diabetic nephropathy, and 17 had interstitial fibrosis/tubular atrophy without specific glomerular changes. The mean duration from transplant to developing novo allograft diabetic nephropathy was 115.2 months (range, 33-192 mo), and from developing new-onset diabetes after transplant to allograft diabetic nephropathy, was 109.66 months (range, 27-188.4 mo). Of the 9 patients with de novo allograft diabetic nephropathy, 3 died (33.3%), 2 reached end-stage renal disease (22.2%), and 4 remained stable (44.4%). Of the 17 with interstitial fibrosis/tubular atrophy, 2 died (11.7%), 5 developed end-stage renal disease (29.4%), and 10 remained stable on triple immunosuppression and insulin therapy during follow-up (58.8%).
  
  
  CONCLUSIONS
  De novo allograft diabetic nephropathy is a significant cause of graft and patient loss in renal allograft recipients who develop new-onset diabetes after transplant.
authors.affiliation: Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Pin, India, 226014. narayan.nephro@gmail.com
authors.forename: Narayan
authors.initials: N
authors.lastname: Prasad
authors.forename: Pallav
authors.initials: P
authors.lastname: Gupta
authors.forename: Manoj
authors.initials: M
authors.lastname: Jain
authors.forename: Dharmendra
authors.initials: D
authors.lastname: Bhadauria
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.forename: Raj Kumar
authors.initials: RK
authors.lastname: Sharma
authors.forename: Anupama
authors.initials: A
authors.lastname: Kaul
mesh_terms: D000328:Adult; D001284:Atrophy; D001706:Biopsy; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D006085:Graft Survival; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors
chemical_list: D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D007328:Insulin