Clinicaland prognostic features of lipoprotein glomerulopathy in renal allografts / 中华器官移植杂志

ABSTRACT

Objective To explore the clinical and prognostic features of lipoprotein glomerulopathy (LPG) in renal allografts .Methods Retrospective analysis was performed for two case of LPG in renal allografts . The onset time was 6 and 9 years after living transplantation respectively . Initial symptoms included proteinuria and hypoproteinemia .Color Doppler ultrasound showed an enlarged graft size and greater parenchymal echogenicity .One patient had hyperlipemia and elevated apolipoprotein E (ApoE) . Methylprednisolone pulse was offered with an early control of hyperlipidaemia and proteinuria by fenofibrate and angiotensin-converting enzyme inhibitors (ACEIs) . Yet it had no effect on graft function .The definite diagnosis was made by graft biopsy .Pathological examination indicated non-homogeneous lipid deposition in glomerular capillary ,glomerular sclerosis , mesangial hypercellularity and tubular atrophy .Results During a follow-up period of 8 and 10 years post-transplantation , two cases eventually lost their grafts within 2 and 1 year after biopsy respectively .With long-term dietary control and drug therapy , regular dialysis continued and both awaited a second transplantation .Conclusions LPG is generally steroid-resistant and refractory in renal allografts .And routine biopsy is recommended for patients with a high risk of occurrence .Early controls of hyperlipemia and hypoproteinemia and other risk factors should be also properly managed .