Littérature scientifique sur le sujet « Rejection kidney pathology »

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040 .1

Abstract Chronic allograft rejection is the most common cause of long-term allograft failure. One reason is that current diagnostics and therapeutics for chronic allograft rejection are very limited. We here show that enhanced NFκB signaling in kidney grafts contributes to chronic active antibody-mediated rejection (CAAMR), which is a major pathology of chronic kidney allograft rejections. Moreover, we found that urinary orosomucoid 1 (ORM1) is a candidate marker molecule and therapeutic target for CAAMR. Indeed, urinary ORM1 concentration was significantly higher in kidney transplant recipients pathologically diagnosed with CAAMR than in kidney transplant recipients with normal histology, calcineurin inhibitor toxicity, or interstitial fibrosis and tubular atrophy. Additionally, we found that kidney biopsy samples with CAAMR expressed more ORM1 and had higher NFκB and STAT3 activation in tubular cells than samples from non-CAAMR samples. Consistently, ORM1 production was induced after cytokine-mediated NFκB and STAT3 activation in primary kidney tubular cells. The loss- and gain-of-function of ORM1 suppressed and promoted NFκB activation, respectively. Finally, ORM1-enhanced NFκB-mediated inflammation development in vivo. These results suggest that an enhanced NFκB-dependent pathway following NFκB and STAT3 activation in the grafts is involved in the development of chronic allograft rejection after kidney transplantation and that ORM1 is a non-invasive candidate biomarker and possible therapeutic target for chronic kidney allograft rejection.

Kidney transplantation is the treatment of choice for patients with end-stage kidney failure, but transplanted allograft could be affected by viral and bacterial infections and by immune rejection. The standard test for the diagnosis of acute pathologies in kidney transplants is kidney biopsy. However, noninvasive tests would be desirable. Various methods using different techniques have been developed by the transplantation community. But these methods require improvements. We present here a cost-effective method for kidney rejection diagnosis that estimates donor/recipient-specific DNA fraction in recipient urine by sequencing urinary cell DNA. We hypothesized that in the no-pathology stage, the largest tissue types present in recipient urine are donor kidney cells, and in case of rejection, a larger number of recipient immune cells would be observed. Extensive in-silico simulation was used to tune the sequencing parameters: number of variants and depth of coverage. Sequencing of DNA mixture from 2 healthy individuals showed the method is highly predictive (maximum error < 0.04). We then demonstrated the insignificant impact of familial relationship and ethnicity using an in-house and public database. Lastly, we performed deep DNA sequencing of urinary cell pellets from 32 biopsy-matched samples representing two pathology groups: acute rejection (AR, 11 samples) and acute tubular injury (ATI, 12 samples) and 9 samples with no pathology. We found a significant association between the donor/recipient-specific DNA fraction in the two pathology groups compared to no pathology (P = 0.0064 for AR and P = 0.026 for ATI). We conclude that deep DNA sequencing of urinary cells from kidney allograft recipients offers a noninvasive means of diagnosing acute pathologies in the human kidney allograft.

The renal transplant is a notoriously difficult organ to assess for pathology. Radionuclide imaging can help, but, although sensitive, the evaluation is not very specific. For this reason, a different approach was used to examine renal images and results were correlated with histology. The transplant score is determined from images of perfusion and function on certain criteria such as time of appearance of the kidney after tracer injection, intensity of background, size and homogeneity of tracer uptake by the kidney. Although small, the pilot study could distinguish between hyperacute rejection, acute rejection, chronic rejection and cyclosporin toxicity.

Allograft kidney transplantation, which triggers host cellular- and antibody-mediated rejection of the kidney, is a major contributor to kidney damage during transplant. Here, we asked whether PrC-210 would suppress damage seen in allograft kidney transplant. Brown Norway (BN) rat kidneys were perfused in situ (UW Solution) with or without added 30 mM PrC-210, and then immediately transplanted into Lewis (LEW) rats. 20 h later, the transplanted BN kidneys and LEW rat plasma were analyzed. Kidney histology, and kidney/serum levels of several inflammation-associated cytokines, were measured to assess mismatch-related kidney pathology, and PrC-210 protective efficacy. Twenty hours after the allograft transplants: (i) significant histologic kidney tubule damage and mononuclear inflammatory cell infiltration were seen in allograft kidneys; (ii) kidney function metrics (creatinine and BUN) were significantly elevated; (iii) significant changes in key cytokines, i.e., TIMP-1, TNF-alpha and MIP-3A/CCL20, and kidney activated caspase levels were seen. In PrC-210-treated kidneys and recipient rats, (i) kidney histologic damage (Banff Scores) and mononuclear infiltration were reduced to untreated background levels; (ii) creatinine and BUN were significantly reduced; and (iii) activated caspase and cytokine changes were significantly reduced, some to background. In conclusion, the results suggest that PrC-210 could provide broadly applicable organ protection for many allograft transplantation conditions; it could protect transplanted kidneys during and after all stages of the transplantation process—from organ donation, through transportation, re-implantation and the post-operative inflammation—to minimize acute and chronic rejection.

Abstract Purpose of the study. To study the morphological changes of long-functioning kidney transplants and determine the main causes of transplant dysfunction. Materials and methods. A total of 52 recipients aged 20 to 70 years were analyzed retrospectively at different times after transplant surgery (5 to 22 years).Morphological changes in the kidney transplant are comparable according to light microscopy. The morphological changes in the graft were studied in the initial and long-term period. Morphological studies were conducted in monitoring mode. Results. In the early period after transplantation, ischemic injuries, primary graft function, and episodes of acute rejection were taken into account. In the distant period, morphological changes were evaluated in accordance with the recommendations of the Banff-classification.When analyzing long-term results, antigen- dependent (immune) and antigen-independent (visible) factors that affect the renal transplant are distinguished. The main clinical and laboratory indicators of allografts dysfunction are increased creatinine and proteinuria.In antigen-dependent forms (cellular, humoral and mixed rejection), humoral rejection is the most common (25%) allografts dysfunction.Antigen-independent forms of dysfunction (streptococcal infection 25%, inflammatory diseases 19,2%, recurrent pathology 3,8%, signs of cyclosporine nephrotoxicity in combination with other forms was found in 59,2%, nephrosclerosis 65,4%). Conclusions. The data obtained suggest that antigen-dependent (immune) factors, and in particular humoral rejection, are the most common cause of allografts dysfunction, and antigen- independent factors contribute to the progression of chronic rejection and the development of nephrosclerosis. Keywords: renal transplant, antigen-dependent, antigen-independent, dysfunction.

La transplantation rénale est le meilleur traitement de l’insuffisance rénale chronique terminale, que ce soit en termes d’espérance ou de qualité de vie. Malgré les progrès réalisés en immunologie de la transplantation et dans la gestion globale des patients transplantés, la principale étiologie de perte de greffon reste le rejet, et en particulier le rejet humoral.L’évaluation du risque de rejet humoral repose principalement sur le dosage des anticorps anti-HLA dirigés contre le greffon. Pourtant, il apparait que ces anticorps ont un faible pouvoir prédictif de l’incidence et du pronostic du rejet, ce qui pourrait être expliqué par une hétérogénéité de leurs caractéristiques intrinsèques. Ces caractéristiques dépendent des cellules responsables de leur sécrétion, plasmocytes à courte et longue durée de vie, et donc indirectement des cellules responsables du maintien du pool de ces cellules sécrétrices d’anticorps : les lymphocytes B mémoires. Il a été montré en pathologies infectieuses que ces lymphocytes B mémoires sont hétérogènes en termes de phénotype, de fonction, de degré de clonalité et de diversification de leur BCR (B-cell receptor). Néanmoins, ceci n’a pas encore été analysé en transplantation rénale. Un des objectifs de cette thèse était d’étudier le degré d’hétérogénéité des lymphocytes B mémoires HLA-spécifiques chez des patients immunisés en attente de transplantation rénale. Pour ce faire, une analyse en cellule unique de lymphocytes B mémoires HLA-spécifiques de patients présentant différents contextes et degré d’immunisation a été réalisée, dans le but d’identifier leurs caractéristiques phénotypiques et transcriptomiques et la diversification de leur répertoire BCR.La deuxième partie des travaux s’est concentrée sur les modalités diagnostiques du rejet de greffe rénale. Depuis quelques années, des outils de biologie moléculaire sont disponibles, permettant d’évaluer des centaines de transcrits exprimés dans le tissu de biopsie. Ces outils donnent la possibilité de décrire de nouvelles voies physiopathologiques, et potentiellement d’améliorer le diagnostic du rejet, en particulier le rejet humoral. Néanmoins, leur utilisation en pratique courante est restreinte du fait de leur faible disponibilité, des difficultés à interpréter les données produites, et de leur coût. De plus, du fait de cette sous-utilisation en pratique clinique, leur impact exact dans la prise en charge des patients n’est pas déterminé. Au cours de cette thèse, un outil de diagnostic moléculaire ayant des caractéristiques compatibles avec une utilisation en pratique clinique a été développé. Celui-ci permet de diagnostiquer le rejet et de le classer en rejet humoral ou cellulaire. Dans un second temps, cet outil a été confronté à des situations cliniques litigieuses, afin d’évaluer son intérêt en pratique courante.À travers ces travaux, cette thèse vise d’une part à améliorer la compréhension de la réponse humorale en transplantation rénale, afin de contribuer à terme à mieux stratifier le risque immunologique en transplantation, et d’autre part à améliorer les modalités diagnostiques du rejet en aidant à la généralisation des outils de biologie moléculaire appliqués aux biopsies de greffons rénaux
Kidney transplantation is the best treatment of end-stage renal disease, improving life quality and quantity. Despite advances in pathophysiological knowledge of kidney transplant immunology, kidney transplant rejection remains the major cause of allograft dysfunction, especially antibody-mediated rejection.Antibody-mediated rejection risk assessment is based on the evaluation of donor-specific anti-HLA antibodies. However, these antibodies have a poor predictive value for incidence and prognosis of rejection. This could be explained by the heterogeneity of their intrinsic characteristics. These characteristics depend on cells responsible for their secretion, which include short- and long- lived plasma cells. Consequently, they indirectly depend on the cells responsible for maintaining the pool of these antibody-secreting cells, such as memory B cells. In infectious diseases, it is known that memory B cells are heterogeneous in terms of phenotype, function, degree of clonality, and diversification of their B-cell receptor (BCR). However, this heterogeneity has not been examined in the context of kidney transplantation.The aim of the first part of this thesis was to study the heterogeneity of HLA-specific memory B cells in sensitised patients on kidney transplant waiting list. To this end, single-cell analysis of HLA-specific memory B cells from patients with various aetiologies and degrees of immunisation was performed. This led to their phenotypic and transcriptomic characterisation and to the assessment of their BCR repertoire.The second part of this thesis was dedicated to the diagnosis of kidney transplant rejection.In recent years, biopsy-based transcriptomics has emerged, enabling the assessment of hundreds of transcripts in kidney biopsy tissue. These tools provide the opportunity to elucidate new physiopathological pathways and potentially enhance the diagnosis of rejection, especially humoral rejection. However, their application in clinical practice is still limited due to their restricted availability, required expertise for data processing and interpretation, and cost. Furthermore, their exact impact on patient management remains undetermined. Here, a molecular diagnostic tool with characteristics suitable for clinical use was developed. This tool enables the diagnosis of rejection and its classification between antibody-mediated and T-cell mediated rejection. Subsequently, this tool was assessed in ambiguous clinical situations to evaluate its impact in clinical practice.Through these studies, this thesis focused on enhancing our understanding of the humoral response in renal transplantation, which could help improving immunological risk stratification in transplantation. Additionally, it aimed to improve biopsy-based transcriptomics in the diagnosis of kidney transplant rejection

Abstract This chapter on renal pathology covers a broad spectrum of kidney disorders, encompassing acute and chronic conditions affecting renal function. It begins by exploring acute kidney injury (AKI) and chronic kidney disease (CKD), elucidating their diverse causes and consequences. The chapter delves into various acute renal conditions like acute tubular injury, tubulointerstitial nephritis offering insights into their pathophysiology and histopathology. Diabetic nephropathy, a leading cause of CKD, is thoroughly explored, emphasizing its multifaceted histopathological features. The chapter extends its scope to encompass glomerular diseases such as minimal change disease, focal segmental glomerulosclerosis, membranous glomerulonephritis, IgA nephropathy, lupus nephritis, and infection-related glomerulonephritis, offering a comprehensive understanding of their pathological features. Rare renal disorders including C3 glomerulopathy, ANCA vasculitis, anti-glomerular basement membrane disease, monoclonal gammopathy-associated kidney disease, and hereditary renal diseases like Alport's syndrome are detailed, shedding light on their complexities and diagnostic challenges. The chapter culminates by exploring kidney transplantation focusing on the important role pathologists play in assessing biopsies for the presence of rejection.