Obstructive urological complications can occur following a kidney transplant and can lead to urinary obstruction and subsequently to allograft failure. These complications include narrowing of the ureter, a leak between ureter and urinary bladder or a haematoma that compresses the allograft or the efferent urinary tract. Although this can normally be detected by ultrasound, in the first few months following a kidney transplant this test is not always sufficiently diagnostically conclusive for detecting urinary obstructions. Where there is no clear diagnosis for restricted renal function following a transplant, a pathohistological workup of a kidney biopsy is therefore essential to establish the cause so that appropriate treatment can be started.
Histological findings indicate complications
"Histology results are one of the most important diagnostic tools in clarifying the cause of restricted renal function. Unfortunately, the existing literature on the subject inadequately describes the histological criteria that indicate a urinary obstruction," says lead author Marija Bojic from MedUni Vienna’s Department of Medicine III. The present study enabled the study team, led by Zeljko Kikic, to describe a specific histological phenotype that is associated with just such obstructive urological complications.
The study involved the examination of biopsies from 976 kidney transplant patients. In particular, they were looking for the presence of "tubular ectasia" – i.e. distension of the renal tubules. Says Kikic: "These changes were observed in earlier animal models where a urinary obstruction was stimulated. We therefore wanted to investigate whether this also occurs in humans." In addition to this, further changes in the renal tubules (tubuli) were analysed and the results correlated with the existence of proven obstructive urological complications.
The MedUni Vienna researchers have now mapped out and described exact features that indicate a urinary obstruction. "These results can be used for the earlier detection of occult urinary obstructions, so that patients can receive the necessary treatment more quickly," says Bojic. The results have been published in the leading journal "Transplantation" and presented at the international conference of the Banff Foundation in Pittsburgh. This foundation is playing a major role in drafting the international guidelines on allograft rejection.
The paper is an example of successful interdisciplinary collaboration at MedUni Vienna. Several departments and institutes (Internal Medicine III/Division of Nephrology and Dialysis, Surgery/Division of Transplantation, Urology, Emergency Medicine and the Department of Pathology) are collaborating both in the scientific field and in the day-to-day care of their mutual patients who have undergone a kidney transplant operation.
Bojic M, Regele H, Herkner H, Berlakovich G, Kläger J, Bauer C, Seitz C, Kikic Z: “Tubular Ectasia in Renal Allograft Biopsy - Associations with Occult Obstructive Urological Complications.” Transplantation, Online First. doi: 10.1097/TP.0000000000002699