HISTOLOGICAL FEATURES OF DIABETIC NEPHROPATHY IN RENAL
ALLOGRAFT RECIPIENTS
Pallav Gupta, Manoj Jain, Narayan Prasad*, RK Sharma*
Department of Pathology and Department of Nephrology*
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow- 226014, UP, India
Email address: mjain@sgpgi.ac.in
Objectives: To characterize histological features in recurrent diabetic nephropathy (DN)
and de novo DN in renal allograft biopsies from live related renal allograft recipients.
Methods: Live related renal allograft recipients who underwent renal biopsy secondary
to graft dysfunction or proteinuria from 1990 to 2009 at tertiary care hospital in north
India were retrospectively analyzed. Seven patients were found to have post transplant
DN.
Results: Based on clinical details, biochemistry records and histopathology findings,
three of the seven cases were found to be of new onset diabetes after transplantation
(NODAT) and four cases of recurrent DN. All the patients were on triple drug
immunosuppression. Patients with recurrent DN had a mean age of 60 years (range 47-65
years) as compared to de novo DN with mean age of 53 years (range 47-62 years).
Average time from transplantation to detection of DN on biopsy was 64 months in
patients with recurrent DN compared to 154 months for cases with de novo DN. The
patients with recurrent DN had mean S. creatinine of 2.1mg/dl at biopsy (range 1.6-2.5
mg/dl) and mean proteinuria of 3.4 g/day (range 2.0 - 4.5 g/day). One of the four patients
had history of hypertension and three had history of hyperlipidemia. Morphologically two
patients had diffuse lesions and another two had nodular glomerulosclerosis. The patients
with de novo DN had mean S. creatinine 2.3mg/dl at biopsy (range 1.6-3.3 mg/dl) and
mean proteinuria of 6.6 g/day (range 0.3 to 16.8 g/day). One of these patient had history
of hypertension and two had hyperlipidemia. One of the three patient morphologically
had diffuse lesion whereas other two had nodular glomerulosclerosis. All the seven renal
biopsies showed concentric arterial intimal hyalinosis and associated mild to moderate
interstitial fibrosis and tubular atrophy.
Conclusions: Both recurrent DN and de novo DN leads to chronic graft dysfunction and
is an important cause of end stage renal disease in renal allograft recipients . Recurrent
DN patient morphologically manifests earlier as compared to de novo post transplant DN.