Remuzzi et al used a histologic score to evaluate a potential donor kidney prior to transplantation. This is used to help decide whether to place one or both of the kidneys, or to reject the donation. The authors are from multiple hospitals in Italy.
Specimen: needle biopsy from the donor kidney
Histologic parameters:
(1) blood vessels
(2) glomeruli
(3) renal tubules
(4) connective tissue (interstitium)
|
Parameter |
Finding |
Points |
|
blood vessels |
normal |
0 |
|
|
minimal to mild change |
1 |
|
|
moderate change |
2 |
|
|
marked change (lumen occluded OR thickness of wall > luminal diameter) |
3 |
|
glomeruli |
normal |
0 |
|
|
minimal to mild change |
1 |
|
|
moderate change |
2 |
|
|
marked change (> 50% of glomeruli are globally sclerotic) |
3 |
|
renal tubules |
normal |
0 |
|
|
minimal to mild change |
1 |
|
|
moderate change |
2 |
|
|
marked change (> 50% of tubules atrophic |
3 |
|
connective tissue |
normal |
0 |
|
|
minimal to mild change |
1 |
|
|
moderate change |
2 |
|
|
marked change (> 50% of parenchyma replaced by connective tissue) |
3 |
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the greater the histologic evidence of abnormal function.
• The score was used to decide how to use the kidney:
|
Total Score |
Decision |
|
0 to 3 |
single transplant |
|
4 to 6 |
dual transplant |
|
>= 7 |
discard kidneys |
Limitation:
• The assumption of the interpretation process is that all or most of the histologic parameters are affected to a similar extent.
• In theory one or two of the parameters could show marked change while the other are normal and the kidney could still be transplanted. I doubt if anyone would feel comfortable with a donor kidney showing marked change. The decision rule could be modified to exclude any kidney with marked change.
|
Total Score |
Number of Parameters with Marked Change |
Decision |
|
0 to 3 |
0 |
single transplant |
|
4 to 6 |
0 |
dual transplant |
|
>= 7 |
0 |
discard kidneys |
|
NA |
>=1 |
discard kidneys |
Purpose: To evaluate histologic features of a biopsy from a donor kidney prior to transplantation using the score of Remuzzi et al.
Specialty: Nephrology, Clinical Laboratory, Surgery, general
Objective: other testing, selection
ICD-10: N18.0,
