Pediatric kidney transplantation is safe and available for patients with urological anomalies as well as those with primary renal diseases.

The aim of the current study was to evaluate long-term outcomes of pediatric live kidney transplantation in patients with genitourinary anomalies relative to those with primary kidney diseases. The study included 35 pediatric patients who received a live kidney transplantation during the last 25 yr (28 males, six females). Median age at the time of transplantation was nine yr (range 1-15 yr), and the median follow-up period was 151 months (range 6-239 month). The patients were divided into two groups. The urological group (n = 14) included patients with primary obstructive/reflux nephropathy. The renal group (n = 20) included patients with primary renal disorders. Differences between groups in graft survival, clinical course, and final graft function were evaluated. Original diseases represented in the urological group included five cases with primary VUR and eight cases with secondary VUR. Diseases in the renal group included eight cases with bilateral hypo-dysplastic kidney, three cases with focal/segmental glomerular sclerosis, two cases with membranous proliferative glomerulonephritis, two cases with congenital nephrotic syndrome and five cases with other forms of chronic nephritis. Ten of 14 cases in the urological group, relative to six of 20 in the renal group, were preemptive. Median age at transplantation was 7.5 or 10 yr old, respectively, in the urological or renal group. Twelve kidney recipients in the urological group had also undergone other urinary surgeries, including upper urinary tract drainage, ureteroneocystostomy, augmentation cystoplasty, endoscopic incision of posterior-urethral valve, urethroplasty, etc. Cumulative post-operative complications occurred in nine or 16, respectively, in the urological or renal group. The acute rejection free and overall graft survival were similar in both groups. One patient in the urological group lost his graft while six patients in the renal group lost their grafts. Thus, the post-transplant clinical outcome of pediatric transplantation in patients with urological anomalies is comparable to that of recipients with primary renal disease. Appropriate urinary tract reconstruction and management is essential to reduce the risk of graft dysfunction because of urinary problems.

Renal failure due to tubulointerstitial nephropathy in an infant with cranioectodermal dysplasia.

Cranioectodermal dysplasia (CED) is a rare autosomal recessive disease with characteristic craniofacial, skeletal, and ectodermal-derived tissue abnormalities. In this disease, tubulointerstitial nephropathy (TIN) has been reported as one of the life-threatening combinations. Here we report a sporadic case of CED showing signs of renal failure during the perinatal period. Renal biopsy at the age of 6 months revealed TIN consisting of marked interstitial fibrosis with inflammatory cell infiltration accompanied by scattered tubular atrophy. Glomeruli were often sclerosed and others showed prominent immaturity; the findings are supportive of progressive deterioration of renal function in this infant. This case suggests that TIN in CED can occur during the fetal period and progress rapidly, leading to end-stage renal failure in infancy.

Glomerular localization of erythropoietin receptor mRNA and protein in neonatal and mature mouse kidney.

BACKGROUND/AIMS: Erythropoietin (EPO) possesses well-established hematopoietic properties as the primary stimulator of red blood cell formation by binding to its receptor (EPO-R). Recent evidence suggests pathophysiological roles of EPO in several non-hematopoietic tissues including kidney. Our aim was to further clarify the glomerular localization of EPO-R in normal kidney, as well as changes in its expression during glomerulogenesis. METHODS: We analyzed EPO-R mRNA and protein expression in neonatal and adult mouse kidney by in situ hybridization and immunohistochemistry. To confirm the precise localization and developmental changes of EPO-R expression in podocytes in mature and developing glomeruli, we examined co-expression with the podocyte markers WT-1 and synaptopodin. RESULTS: In addition to tubular expression as reported recently, EPO-R expression was observed in podocytes as well as endocapillary cells in the glomeruli from adult mice. In newborn kidney, EPO-R mRNA and protein expression was first observed in developing podocytes in S-shaped bodies with expression subsequently increasing in glomeruli at the capillary-loop and maturing stages. Immunoelectron microscopy also demonstrated cytoplasmic expression of EPO-R that was prominent at the basal sides of podocytes in glomeruli at the late capillary-loop and maturing stage. CONCLUSION: EPO-R is expressed in developing and mature podocytes in mouse kidney, suggesting a possible role for EPO in podocyte biology.

Transgene of MIF induces podocyte injury and progressive mesangial sclerosis in the mouse kidney.

BACKGROUND: Recent evidence suggests that macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine that plays a pathogenic role in glomerulonephritis. Renal expression of MIF is up-regulated in infiltrating and intrinsic renal cells, which include glomerular epithelial cells. The aim of the current study was to further clarify the role of MIF produced by podocytes in the process of renal disease. METHODS: We generated transgenic mice carrying a murine MIF cDNA driven by cytomegalovirus enhancer and beta-actin/beta-globin promoter, a hybrid promoter transactivated in podocytes in vivo. RESULTS: MIF expression was markedly up-regulated in podocytes in neonatal and adult transgenic kidneys. A longitudinal study of the MIF transgenic mice demonstrated a progressive matrix increase in mesangium accompanied by collagen IV accumulation, representing no significant glomerular cell hypercellularity. The glomeruli in transgenic kidney were not accompanied by influx of macrophages and T cells at the early stage of disease progression. Although a significant number of the mice showing higher expression of MIF died from renal failure at 8 weeks, most of them survived with significant proteinuria and progressive renal failure. Podocytes of transgenic mice frequently underwent characteristic ultrastructural changes, such as cell flattening, contracted foot processes, and villous transformation. In addition, immunohistochemical expression of synaptopodin, an actin-associated protein distributed in differentiated podocyte foot process, was significantly attenuated in transgenic kidney. CONCLUSION: Our results indicate that podocyte-expressed MIF could induce an injury of podocytes themselves, thereby accelerating the progression of glomerulosclerosis and leading to end-stage renal failure.