Abstract
Renal interstitial fibrosis and arterial lesions predict loss of function in chronic kidney disease. Noninvasive estimation of interstitial fibrosis and vascular lesions is currently not available. The aim of the study was to determine whether phosphocalcic markers are associated with, and can predict, renal chronic histological changes. We included 129 kidney allograft recipients with an available transplant biopsy in a retrospective study. We analyzed the associations and predictive values of phosphocalcic markers and serum calcification propensity (T50) for chronic histological changes (interstitial fibrosis and vascular lesions). PTH, T50 and vitamin D levels were independently associated to interstitial fibrosis. PTH elevation was associated with increasing interstitial fibrosis severity (r = 0.29, p = 0.001), while T50 and vitamin D were protective (r = -0.20, p = 0.025 and r = -0.23, p = 0.009 respectively). On the contrary, fibroblast growth factor 23 (FGF23) and Klotho correlated only modestly with interstitial fibrosis (p = 0.045) whereas calcium and phosphate did not. PTH, vitamin D and T50 were predictors of extensive fibrosis (AUC: 0.73, 0.72 and 0.68 respectively), but did not add to renal function prediction. PTH, FGF23 and T50 were modestly predictive of low fibrosis (AUC: 0.63, 0.63 and 0.61) but did not add to renal function prediction. T50 decreased with increasing arterial lesions (r = -0.21, p = 0.038). The discriminative performance of T50 in predicting significant vascular lesions was modest (AUC 0.61). In summary, we demonstrated that PTH, vitamin D and T50 are associated to interstitial fibrosis and vascular lesions in kidney allograft recipients independently of renal function. Despite these associations, mineral metabolism indices do not show superiority or additive value to fibrosis prediction by eGFR and proteinuria in kidney allograft recipients, except for vascular lesions where T50 could be of relevance.
Highlights
Renal interstitial fibrosis (IF) and arterial lesions are predictive of loss of renal function in chronic kidney disease (CKD) [1,2,3]
We examined the association and predictive value of phosphocalcic markers and T50 with chronic renal histological lesions (IF and vascular lesions) in kidney allograft recipients
Our analysis revealed that parathyroid hormone (PTH), 25D and T50 levels are associated to IF independently of renal function
Summary
Renal interstitial fibrosis (IF) and arterial lesions are predictive of loss of renal function in chronic kidney disease (CKD) [1,2,3]. Kidney allografts are very prone to develop IF and vascular lesions secondary to acute or chronic rejection, and to calcineurin inhibitors toxicity [4,5,6]. IF and arterial lesions are evaluated by histopathology which necessitates kidney biopsies [7,8,9,10]. Established noninvasive tools to estimate kidney IF and vascular lesions are currently not available. These would be very helpful for the evaluation of the whole organ without the inherent risks associated to repeated biopsies. A better non-invasive appreciation of the formation of IF and arterial lesions in patients would allow earlier treatment adaptation and better follow-up
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