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Abstract
Background
Kidney injury molecule-1 (KIM-1) is known as a good ancillary marker of acute kidney injury (AKI) and its expression has also been observed in acute rejection and chronic graft dysfunction. We tested usefulness of KIM-1 as an indicator of acute and chronic renal graft injury by correlating KIM-1 expression with renal graft function and histology.
Methods
A total of 133 zero-time biopsies and 42 follow-up biopsies obtained within 1 year posttransplantation were selected. Renal tubular KIM-1 staining was graded semiquantitatively from 0 to 3 and the extent of staining was expressed as the ratio of KIM-1 positive/CD10 positive proximal tubules using Image J program.
Results
KIM-1 was positive in 39.8% of zero-time biopsies. KIM-1 positive cases were predominantly male and had received grafts from donors with older age, deceased donors, and poor renal function at the time of donation, compared with KIM-1 negative cases. KIM-1 expression showed correlation with delayed graft function and acute tubular necrosis. In comparison of KIM-1 expression between stable grafts (n=23) and grafts with dysfunction (n=19) at the time of repeated biopsy, the intensity/extent of KIM-1 staining and renal histology at zero-time did not differ significantly between the two groups. Histologically, KIM-1 expression was significantly increased with both acute and chronic changes of glomeruli, tubules and interstitium, peritubular capil-laritis, and arteriolar hyalinosis.
References
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Fig. 1.
Scoring of renal tubular kidney injury molecule-1 expression: (A) 0.5, focal staining, (B) 1, weak and entire staining, (C) 2, moderate and entire staining. and (D) 3, strong and entire staining (×400).
Fig. 2.
Renal tubular kidney injury molecule-1 (KIM-1) expression in patients with stable graft function and dysfunction (×200). (A, B) In a patient with stable renal function, tubular KIM-1 expression increased in the repeat biopsy (B, score 2) compared with zero time (A, score 0.5). (C, D) Tubular KIM-1 expression became prominent in the repeat biopsy (D, score 3) in a patient with graft dysfunction, who showed negative KIM-1 staining at zero time (C).
Table 1.
Patient’ s demography according to zero-time KIM-1 expression
Table 2.
Patient’ s demography according to zero-time KIM-1 staining intensity
Table 3.
Correlation between KIM-1 expression and light microscopic features
Table 4.
Changes of renal function and histology in KIM-1 positive cases at zero-time (n=5)
Table 5.
Changes of renal function and histology in KIM-1 negative cases at zero-time (n=37)
Table 6.
KIM-1 positivity and renal histology according to graft dysfunction at repeat biopsy
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