Article Figures & Data
Figures
- Figure 1.
Some of the characteristic features used for diagnosing and scoring calcineurin inhibitor toxicity (CNIT). (A) Proximal tubules with cytoplasmic isometric vacuoles. (B) Afferent arteriolar hyaline (ah) in subendothelial, medial, and peripheral locations. The efferent arteriole seems unaffected, and the glomerulus shows slight retraction of the capillary tuft, likely as a result of ischemia. (C) Tubular atrophy with a striped pattern of interstitial fibrosis.
- Figure 2.
Mean CNIT and other chronicity scores at different study points after transplantation. CNIT, CNIT score; BChS, Banff chronicity score (transplant glomerulopathy [cg] + interstitial fibrosis [ci] + tubular atrophy [ct] + chronic vascular changes [cv]; http://tpis.upmc.edu/tpis/schema/KNCode97.html);MBChS, modified Banff chronicity score (glomerulosclerosis [gs] + ci + ct + cv; gs: 0, no global gs; 1, up to 25% gs; 2, 26 to 50% gs; 3, >50% gs); CADI, chronic allograft damage index (interstitial inflammation in nonfibrotic areas: 0% = 0, 1 to 25% = 1, 26 to 50% = 2, >50% = 3; interstitial fibrosis: 0% = 0, 1 to 25% = 1, 26 to 50% = 2, >50% = 3; tubular atrophy: 0% = 0, up to 15% = 1, 15 to 30% = 2, >30% = 3; mesangial matrix: 0% = 0, 1 to 25% = 1, 26 to 50% = 2, >50% = 3; gs: 0% = 0, <15% = 1, 16 to 50% = 2, >50% = 3; vascular intimal proliferation: 0% = 0, 1 to 25% = 1, 26 to 50% = 2, >50% = 3).
- Figure 3.
Various parameters of CNIT score at different study points after transplantation. tv, tubular isometric vacuolization.
- Figure 4.
Correlation among CNIT, BChS, MBChS, and CADI scores with creatinine clearance (CrCl) at 12 and 24 mo.
- Figure 5.
Development of CNIT model score. For reducing the number of parameters for analysis, interstitial fibrosis was excluded because the scores were similar to that of tubular atrophy; mesangial matrix increase was seen only in biopsies with recurrent GN.
Tables
Histologic Feature Extent Score (0 to 3) Tubular isometric None 0 vacuoles 1 to 25% 1 26 to 50% 2 >50% 3 Interstitial fibrosis 0 to 5% 0 6 to 25% 1 26 to 50% 2 >50% 3 Arteriolar medial None 0 hyalinosis 10% or fewer arterioles 1 11 to 30% of arterioles 2 >30% arterioles 3 Glomerulosclerosis None 0 1 to 25% 1 26 to 50% 2 >50% 3 Tubular atrophy None 0 1 to 25% 1 26 to 50% 2 >50% 3 Mesangial matrix None 0 increase 1 to 25% 1 26 to 50% 2 >50% 3 Total score 18 ↵a CNIT, calcineurin inhibitor toxicity.
- Table 3.
Pathologic diagnoses for protocol biopsies (performed in the setting of stable graft function at different time points after transplantation for surveillance)a
Biopsy Diagnosis 3 Mo 6 Mo 12 Mo 24 Mo Total % Biopsies CNITb 17 18 18 14 67 40.9 CAN 18 15 15 10 58 35.7 Acute rejectionb 0 1 1 0 2 1.3 Acute rejection + CNIT 0 0 0 1 1 0.6 No significant abnormality 7 2 1 2 12 7.3 Other (reflux, ATN, GN, etc.) 0 1 3 2 6 3.7 Inadequate 4 7 4 3 18 11 Total 46 44 42 32 164 100
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