nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное обществоnid-3735Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESХроническая трансплантационная нефропатия: клинико-морфологические сопоставленияChronic allograft nephropathy: clinico-morphological correlationsСтоляревичЕ. С.StolyarevishE. S.noemail@neicon.ruИльинскийИ. М.IlyinskyI. M.noemail@neicon.ruТыринВ. В.TyrinV. V.noemail@neicon.ruТомилинаН. А.TomilinaN. A.noemail@neicon.ruНИИ трансплантологии и искусственных органов Минздрава РФ, МоскваRussian Federation200128062025317883Copyright © Столяревич Е.С., Ильинский И.М., Тырин В.В., Томилина Н.А., 20252025Столяревич Е.С., Ильинский И.М., Тырин В.В., Томилина Н.А.Stolyarevish E.S., Ilyinsky I.M., Tyrin V.V., Tomilina N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/3735

Механизмы развития и прогрессирования хронической трансплантационной нефропатии (ХТН) до настоящего времени остаются невыясненными. Целью нашего исследования было изучить влияние характерных морфологических признаков ХТН - тубуло-интерстициального склероза (ТИС), хронической трансплантационной гломерулопатии (ХТГ) и гломерулосклероза на ее клиническую картину и темпы прогрессирования. Исследование проведено у 93 больных с дисфункцией трансплантата и морфологически верифицированной ХТН (Banff 1997). Длительность наблюдения с момента биопсии составляла не менее 12 мес. По результатам пункционной биопсии в зависимости от выраженности (ТИС) и характеру гломерулярной патологии больные были разделены на 7 групп, в которых исследовали средний уровень креатинина плазмы на момент биопсии, протеинурии, АГ, гематурии, а также частоту быстропрогрессирующего течения ХТН, при котором «почечная смерть» наступала в течение первого года после постановки диагноза. Полученные данные позволяют выделить два независимых типа ХТН: гломерулярный и тубуло-интерстициальный.Первый тип характеризуется яркой клинической картиной с выраженной протеинурией, АГ и реже гематурией. При втором типе, особенно на ранних стадиях, клинические симптомы значительно менее выражены. Если клиническая картина ХТН определяется прежде всего характером гломерулярной патологии, то темпы ее прогрессирования зависят, главным образом, от степени нефросклероза, и в частности от выраженности ТИС.

The aim of this study was to estimate the correlation between the histopathological finding in chronic allograft nephropathy (CAN) and its main clinical syndromes (arterial hypertension and proteinuria) as well as natural history. 93 kidney graft recipients with CAN have been observed for at least 12 months after graft biopsy. The histopathological diagnosis of CAN and its grading was made according to the Banff schema.The rate of CAN progression was estimated by graft survival since the time of biopsy. The results of our study showed, that the characteristic features of transplant glomerulopathy (TG) were severe hypertension and heavy proteinuria, associated (in 30% of cases) with hematuria. Clinical signs of CAN characterized by the dominating tubulo-interstitial sclerosis (TIS) were only moderate hypertension and mild (<1,0 g/24 hours) proteinuria. We suggest that there are two different types of CAN: glomerular type and tubulo-interstitial type. Clinical symptoms of CAN are determined by the type of glomerular lesion, but graft survival strongly correlated to the grading of TIS, while the role of TG was less significant.

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The authors declare that there are no conflicts of interest present.