Studies of the serological development after 26 renal transplants confirm the high frequency of a... more Studies of the serological development after 26 renal transplants confirm the high frequency of antibody rises not only against the herpes virus group, but also against other virus groups such as measles, Coxsackie B viruses. These antibody rises correlate with febrile episodes and hepatic dysfunction in which CMV is the most often involved. However, the frequency of antibody rises against various viral antigens without any clinical event to suggest viral etiology; the lack of concomitant virus isolation (except the herpes group), as well as the ocurrence of simultaneous antibody rises against several viruses, all suggest that some of these various antibody rises observed may be related to immunological dysfunction rather than to virus infection.
Due to its structure, the glomerular capillary has a filtration function since it is interposed b... more Due to its structure, the glomerular capillary has a filtration function since it is interposed between the blood stream and the urinary space exposed to circulating plasma proteins, which are likely to form a deposit. The role of renal biopsy is to diagnose glomerulonephritis and systemic autoimmune diseases, on the basis of two samples: one for light microscopy and the other for immunofluorescence (IF). Electron microscopy has specific indications. IF is necessary to identify immune deposits. Renal biopsy has made possible the identification and characterization of lesions such as those related to the new viral diseases that emerged over the last decade: cryoglobulinemia and hepatitis C virus (HCV), the BK virus, the positivity of the C4d marker in humoural rejection of transplants, glomerular lesions due to monoclonal immunoglobulin. Besides, the recent molecular biology techniques as applied in renal transplantation are likely to improve the matching donors/recipients, and to tr...
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 1993
Sixty HIV-infected patients presenting renal symptoms who underwent percutaneous renal biopsies w... more Sixty HIV-infected patients presenting renal symptoms who underwent percutaneous renal biopsies were analysed. According to the CDC classification, 44 patients were staged in group IV, five in group III, and 11 in group II. Patients were divided in two groups according to their ethnic origin (29 black patients and 31 white patients). Risk factors such as homosexuality, multiple transfusions or intravenous drug abuse (IVDA) were identified in all white patients except two, but in only nine (31%) of the black patients. Three main patterns of renal disease were observed: focal and segmental glomerulosclerosis (FSGS) was found predominantly in black patients (23 black patients versus 3 Caucasians, P < 0.001) and was associated with the nephrotic syndrome; immune-complex-type glomerulonephritis (ICGN) was frequent in black and white patients (21% and 52% respectively) including four cases of IgA nephritis all seen in white patients; and 10 cases of lupus-like nephritis (4 black and 6 ...
Two main types of renal disorder may affect the HIV-infected patients. The first type characteriz... more Two main types of renal disorder may affect the HIV-infected patients. The first type characterized by acute renal failure is not related directly to HIV infection, but results from complications secondary to diagnosis and therapeutic intervention in patients with severe immunodepression. The second type of renal complication includes three quite specific histological renal patterns. The typical "HIV-associated nephropathy" (HIVN), involves essentially the black population, both in Europe (84%) and in North America (83%) and could represent a pathogen-induced disease occurring on a specific genetic background. The two other types of nephropathy, i.e. immune complex-type glomerulonephritis and tubulointerstitial nephritis, involve both black and white seropositive populations and might be the consequence of dysregulation of the immune system.
Renal biopsies from hypertensive pregnant women performed 8 to 10 days postpartum were processed ... more Renal biopsies from hypertensive pregnant women performed 8 to 10 days postpartum were processed by morphometric analysis. We allocated the 74 patients into four groups according to the respective forms of pregnancy hypertension, i.e. preeclampsia and gestational hypertension. Groups I and II included preeclamptic women, with (group I) or without (group II) de novo FSGS. Groups III and IV included biopsies of women with isolated gestational hypertension, appeared during the third trimester (group III) or earlier (group IV). The control group included 17 biopsies from age-matched nonpregnant women presenting with isolated hematuria. Glomerular lesions of typical preeclampsia were seen in all the biopsies of groups I and II, and in some of women with gestational hypertension of groups III and IV. Our morphometric analysis of these renal biopsies showed a progressive increase in glomerular size from early gestational hypertension, gestational hypertension of the 3rd trimester, isolated...
Journal of the American Society of Nephrology, 2015
Kidney allograft rejection can occur in clinically stable patients, but long-term significance is... more Kidney allograft rejection can occur in clinically stable patients, but long-term significance is unknown. We determined whether early recognition of subclinical rejection has long-term consequences for kidney allograft survival in an observational prospective cohort study of 1307 consecutive nonselected patients who underwent ABO-compatible, complement-dependent cytotoxicity-negative crossmatch kidney transplantation in Paris (2000-2010). Participants underwent prospective screening biopsies at 1 year post-transplant, with concurrent evaluations of graft complement deposition and circulating anti-HLA antibodies. The main analysis included 1001 patients. Three distinct groups of patients were identified at the 1-year screening: 727 (73%) patients without rejection, 132 (13%) patients with subclinical T cell-mediated rejection (TCMR), and 142 (14%) patients with subclinical antibody-mediated rejection (ABMR). Patients with subclinical ABMR had the poorest graft survival at 8 years post-transplant (56%) compared with subclinical TCMR (88%) and nonrejection (90%) groups (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). In a multivariate Cox model, subclinical ABMR at 1 year was independently associated with a 3.5-fold increase in graft loss (95% confidence interval, 2.1 to 5.7) along with eGFR and proteinuria (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Subclinical ABMR was associated with more rapid progression to transplant glomerulopathy. Of patients with subclinical TCMR at 1 year, only those who further developed de novo donor-specific antibodies and transplant glomerulopathy showed higher risk of graft loss compared with patients without rejection. Our findings suggest that subclinical TCMR and subclinical ABMR have distinct effects on long-term graft loss. Subclinical ABMR detected at the 1-year screening biopsy carries a prognostic value independent of initial donor-specific antibody status, previous immunologic events, current eGFR, and proteinuria.
Studies of the serological development after 26 renal transplants confirm the high frequency of a... more Studies of the serological development after 26 renal transplants confirm the high frequency of antibody rises not only against the herpes virus group, but also against other virus groups such as measles, Coxsackie B viruses. These antibody rises correlate with febrile episodes and hepatic dysfunction in which CMV is the most often involved. However, the frequency of antibody rises against various viral antigens without any clinical event to suggest viral etiology; the lack of concomitant virus isolation (except the herpes group), as well as the ocurrence of simultaneous antibody rises against several viruses, all suggest that some of these various antibody rises observed may be related to immunological dysfunction rather than to virus infection.
Due to its structure, the glomerular capillary has a filtration function since it is interposed b... more Due to its structure, the glomerular capillary has a filtration function since it is interposed between the blood stream and the urinary space exposed to circulating plasma proteins, which are likely to form a deposit. The role of renal biopsy is to diagnose glomerulonephritis and systemic autoimmune diseases, on the basis of two samples: one for light microscopy and the other for immunofluorescence (IF). Electron microscopy has specific indications. IF is necessary to identify immune deposits. Renal biopsy has made possible the identification and characterization of lesions such as those related to the new viral diseases that emerged over the last decade: cryoglobulinemia and hepatitis C virus (HCV), the BK virus, the positivity of the C4d marker in humoural rejection of transplants, glomerular lesions due to monoclonal immunoglobulin. Besides, the recent molecular biology techniques as applied in renal transplantation are likely to improve the matching donors/recipients, and to tr...
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 1993
Sixty HIV-infected patients presenting renal symptoms who underwent percutaneous renal biopsies w... more Sixty HIV-infected patients presenting renal symptoms who underwent percutaneous renal biopsies were analysed. According to the CDC classification, 44 patients were staged in group IV, five in group III, and 11 in group II. Patients were divided in two groups according to their ethnic origin (29 black patients and 31 white patients). Risk factors such as homosexuality, multiple transfusions or intravenous drug abuse (IVDA) were identified in all white patients except two, but in only nine (31%) of the black patients. Three main patterns of renal disease were observed: focal and segmental glomerulosclerosis (FSGS) was found predominantly in black patients (23 black patients versus 3 Caucasians, P < 0.001) and was associated with the nephrotic syndrome; immune-complex-type glomerulonephritis (ICGN) was frequent in black and white patients (21% and 52% respectively) including four cases of IgA nephritis all seen in white patients; and 10 cases of lupus-like nephritis (4 black and 6 ...
Two main types of renal disorder may affect the HIV-infected patients. The first type characteriz... more Two main types of renal disorder may affect the HIV-infected patients. The first type characterized by acute renal failure is not related directly to HIV infection, but results from complications secondary to diagnosis and therapeutic intervention in patients with severe immunodepression. The second type of renal complication includes three quite specific histological renal patterns. The typical "HIV-associated nephropathy" (HIVN), involves essentially the black population, both in Europe (84%) and in North America (83%) and could represent a pathogen-induced disease occurring on a specific genetic background. The two other types of nephropathy, i.e. immune complex-type glomerulonephritis and tubulointerstitial nephritis, involve both black and white seropositive populations and might be the consequence of dysregulation of the immune system.
Renal biopsies from hypertensive pregnant women performed 8 to 10 days postpartum were processed ... more Renal biopsies from hypertensive pregnant women performed 8 to 10 days postpartum were processed by morphometric analysis. We allocated the 74 patients into four groups according to the respective forms of pregnancy hypertension, i.e. preeclampsia and gestational hypertension. Groups I and II included preeclamptic women, with (group I) or without (group II) de novo FSGS. Groups III and IV included biopsies of women with isolated gestational hypertension, appeared during the third trimester (group III) or earlier (group IV). The control group included 17 biopsies from age-matched nonpregnant women presenting with isolated hematuria. Glomerular lesions of typical preeclampsia were seen in all the biopsies of groups I and II, and in some of women with gestational hypertension of groups III and IV. Our morphometric analysis of these renal biopsies showed a progressive increase in glomerular size from early gestational hypertension, gestational hypertension of the 3rd trimester, isolated...
Journal of the American Society of Nephrology, 2015
Kidney allograft rejection can occur in clinically stable patients, but long-term significance is... more Kidney allograft rejection can occur in clinically stable patients, but long-term significance is unknown. We determined whether early recognition of subclinical rejection has long-term consequences for kidney allograft survival in an observational prospective cohort study of 1307 consecutive nonselected patients who underwent ABO-compatible, complement-dependent cytotoxicity-negative crossmatch kidney transplantation in Paris (2000-2010). Participants underwent prospective screening biopsies at 1 year post-transplant, with concurrent evaluations of graft complement deposition and circulating anti-HLA antibodies. The main analysis included 1001 patients. Three distinct groups of patients were identified at the 1-year screening: 727 (73%) patients without rejection, 132 (13%) patients with subclinical T cell-mediated rejection (TCMR), and 142 (14%) patients with subclinical antibody-mediated rejection (ABMR). Patients with subclinical ABMR had the poorest graft survival at 8 years post-transplant (56%) compared with subclinical TCMR (88%) and nonrejection (90%) groups (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). In a multivariate Cox model, subclinical ABMR at 1 year was independently associated with a 3.5-fold increase in graft loss (95% confidence interval, 2.1 to 5.7) along with eGFR and proteinuria (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Subclinical ABMR was associated with more rapid progression to transplant glomerulopathy. Of patients with subclinical TCMR at 1 year, only those who further developed de novo donor-specific antibodies and transplant glomerulopathy showed higher risk of graft loss compared with patients without rejection. Our findings suggest that subclinical TCMR and subclinical ABMR have distinct effects on long-term graft loss. Subclinical ABMR detected at the 1-year screening biopsy carries a prognostic value independent of initial donor-specific antibody status, previous immunologic events, current eGFR, and proteinuria.
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