Nodular Arteriolar Hyalinosis as Histopathologic Hallmark of Calcineurin Inhibitor Nephrotoxicity: Does It Always Have the Same Meaning?

Abstract Introduction Nodular arteriolar hyalinosis (NAH) is a typical, although not specific, histological finding of calcineurin inhibitor toxicity (CNIT). The objective of our study was to assess the reason why some patients showing strong NAH in renal graft biopsies who underwent calcineurin inh...

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Published in:	Transplantation proceedings 2015-10, Vol.47 (8), p.2357-2360
Main Authors:	Vázquez, L.C, González, A.P, Juega, J, Hernández-Gallego, A, López, D, Cañas, L, Bancu, I, Bonet, J, Lauzurica, R
Format:	Article
Language:	eng
Subjects:	Adult Arterioles - pathology Biopsy Calcineurin Inhibitors - adverse effects Cross-Sectional Studies Female Graft Rejection - prevention & control Humans Hyalin Immunosuppressive Agents - adverse effects Kidney - pathology Kidney Failure, Chronic - surgery Kidney Transplantation Male Middle Aged Retrospective Studies Risk Factors Surgery Transplants - pathology
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Summary:	Abstract Introduction Nodular arteriolar hyalinosis (NAH) is a typical, although not specific, histological finding of calcineurin inhibitor toxicity (CNIT). The objective of our study was to assess the reason why some patients showing strong NAH in renal graft biopsies who underwent calcineurin inhibitor (CNI) withdrawal presented very poor outcome whereas others improved graft function. Material and Methods We performed 207 renal graft biopsies between January 2011 and May 2014 due to clinical criteria. In 13 patients CNI withdrawal was performed, and the major histopathological finding was severe NAH. The results after this action were analyzed. Results We selected 2 groups: good outcome and poor outcome. Eight patients showed good results including stabilization or improvement of graft function. Five patients presented poor results requiring chronic hemodialysis. C4d staining was negative in all biopsy specimens, and peritubular capillaritis was not observed. To identify potential prognostic markers we retrospectively reviewed biopsy samples looking for minor or nonspecific features, especially inflammation scores both global and on fibrotic areas as per Banff classification. Mean serum creatinine level at time of biopsy and mean arteriolar hyalinosis score did not show significant differences between both groups. In contrast, the poor results group presented a higher mean global inflammation score compared with the good results patients. Conclusions NAH is not a risk factor for poor renal graft outcome by itself. Other histopathologic findings, usually considered as secondary markers, like the inflammation score, should be considered before deciding CNI withdrawal.
ISSN:	0041-1345 1873-2623