EVALUATION OF CHRONIC RENAL-DISEASE IN HEART-TRANSPLANT RECIPIENTS - IMPORTANCE OF PRETRANSPLANTATION NATIVE KIDNEY HISTOLOGIC EVALUATION

Although long-term use of cyclosporine has been implicated in the path ogenesis of arteriolar hyalinosis, interstitial fibrosis, and glomerul osclerosis observed in the native kidneys of heart transplant recipien ts, it is not clear that these histologic abnormalities are entirely s pecific for a drug-induced toxic nephropathy. The purpose of this stud y was to determine whether long-standing congestive heart failure, par ticularly when complicated by disease processes such as atherosclerosi s and hypertension, may independently predispose to the development of similar renal histopathology. Records and specimens were selected fro m autopsy files for evaluation of clinical profiles and kidney histolo gy in 16 patients who died of end-stage cardiomyopathy of varying caus es without having recourse to heart transplantation. The study cohort consisted of 12 men and four women. Cardiomyopathies were the result o f coronary artery disease in six patients and nonischemic causes in th e other 10 patients. The mean age at the time of death was 53 +/- 3 ye ars (range 28 to 74 years). Thirteen (81%) of 16 patients had a histor y of hypertension. Nadir serum creatinine concentrations during the mo nth before death were 1.7 +/- 0.2 mg/dl (range 1.2 to 3.5 mg/dl). Inte rstitial fibrosis, tubular atrophy, and glomerulosclerosis were presen t in 15 (94%) of 16 patients. Arteriosclerosis and arteriolosclerosis were found in 13 (81%) of 16 and 14 (88%) of 16 patients, respectively . A nodular pattern of arteriolar hyalinosis was observed in two patie nts with ischemic disease. These findings are qualitatively similar to histologic abnormalities described in the native kidneys of heart tra nsplant recipients receiving long-term cyclosporine immunosuppressive therapy. It follows that only limited inferences can be made from post transplantation biopsy specimens regarding the impact of long-term cyc losporine use on native renal morphology in the absence of baseline, p retransplantation native kidney histologic data.