title: Altitude and arteriolar hyalinosis after kidney transplantation.
abstract: The kidney is very susceptible to hypoxic injury. Calcineurin inhibitors (CNIs) induce vasoconstriction and might reduce renal tissue oxygenation. We aimed to investigate if the synergistic deleterious effects of CNI-treatment and hypoxia of high altitude living might accelerate the development of arteriolar hyalinosis in kidney allografts. We stratified all patients who received a kidney graft from 2000 to 2010 in our centre (n = 477) in three groups according to the residential elevation (below 400, between 400 to 600 and above 600 m above sea level) and we retrospectively re-evaluated all transplant biopsies performed during follow-up, specifically looking at the degree of arteriolar hyalinosis, the hallmark of chronic CNI nephrotoxicity. Living at high altitude was markedly associated with a higher degree of arteriolar hyalinosis (P < 0.001). Haemoglobin levels confirmed the functional relevance of different arterial oxygenation among the groups (P = 0.01). Thus, patients living at high altitude seem to be more susceptible to the development of arteriolar hyalinosis after kidney transplantation.
authors.affiliation: Division of Nephrology, University Hospital Zurich, Switzerland.
authors.forename: Pietro E
authors.initials: PE
authors.lastname: Cippà
authors.affiliation: Klinikum Wuppertal, Germany.
authors.forename: Scott O
authors.initials: SO
authors.lastname: Grebe
authors.affiliation: Department of Internal Medicine, Cantonal Hospital Graubuenden, Chur, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fehr
authors.affiliation: Division of Nephrology, University Hospital Zurich, Switzerland.
authors.forename: Rudolf P
authors.initials: RP
authors.lastname: Wüthrich
authors.affiliation: Division of Nephrology, University Hospital Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Mueller
mesh_terms: D000328:Adult; D000368:Aged; D000531:Altitude; D001160:Arterioles / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D001706:Biopsy; D065095:Calcineurin Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006818:Hyalin / Q000378:metabolism*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007668:Kidney / Q000098:blood supply*; D007674:Kidney Diseases / Q000139:chemically induced* / Q000378:metabolism / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents
keywords: altitude; cyclosporine A; hypoxia; tacrolimus; transplantation