Morphological differentiation between rejection and XXXX nephrotoxicity in renal allografts.

@entity1 @entity8 @entity6517 @entity75 @entity3468 @entity205 @entity617
In a prospective study of @entity8 in 60 consecutive allograft recipients treated with @entity205 and @entity617 routine renal biopsies at one week and one month after transplantation, as well as for all episodes of @entity8 , were performed. The one year graft survival of this group was 88%. In a retrospective clinical analysis of these @entity1 35 episodes of dysfunction due to rejection, defined by a response to antirejection treatment alone, and 30 episodes due to @entity205 nephrotoxicity, defined by a response to reduction in @entity205 dose alone, were identified. The morphological findings from these biopsies were compared with 20 samples from routine biopsies taken from @entity1 with stable renal function. All @entity1 diagnosed as having rejection had a diffuse, interstitial mononuclear cell infiltrate (32 of 35) or @entity3468 (19 of 35), or both. In contrast, focal mononuclear cell infiltrates were common in both @entity1 with nephrotoxicity and those with stable function (17 of 30 and 14 of 20, respectively). There were no important differences between biopsies from those with nephrotoxicity and those with stable function, except that @entity6517 was considerably more common in the nephrotoxic @entity1 than in those with stable function. Many @entity1 with stable function were, in retrospect, in a state of stable mild nephrotoxicity. In our experience rejection should only be diagnosed when there is at least a diffuse interstitial infiltrate or an @entity3468 . Focal mononuclear cell infiltrates do not denote rejection. The development of @entity75 in the absence of rejection is indicative of nephrotoxicity.
