Kidney disease, chronic biopsy

Extensive expression of KlM-1 has been found in proximal tubule cells in biopsies from patients with acute tubular necrosis [302]. KlM-1 is also expressed in other conditions where proximal tubules are dedifferentiated, including renal cell carcinoma [303, 304], chronic cyclosporine nephrotoxicity [305], a protein-overload model of tubulointerstitial disease [306], polycystic kidney disease [307], and contrast nephropathy. In several chronic conditions, KlM-1 has been found primarily expressed at the luminal side of dedifferentiated proximal tubules, in areas with fibrosis and inflammation. Independent of the specific disease, renal KIM-1 correlated positively with the extent of renal damage and negatively with renal function. In these patients, urinary levels of KIM-1 were and correlated positively with tissue KIM-1 and negatively with renal function. Thus, KIM-1 is upregulated in renal disease and is associated with renal fibrosis and inflammation. Urinary KIM-1 is also associated with inflammation and renal function, and reflects tissue KIM-1. 

Interstitial nephritis has been found in kidney biopsies in patients treated with indinavir [146-151]. Some of these cases have described eosinophiluria and crystals (assumed to be indinavir) associated with histiocytes and giant cells in the renal tubules. Some of these patients were asymptomatic, while others reported classic symptoms of nephrohthiasis. Cortical atrophy was found in some patients, suggesting the progression from acute injury towards chronic kidney disease [152]. 

Chronic kidney disease can be present with a normal or near normal GFR if other markers of kidney disease are present, such as proteinuria, hematuria, biopsy results showing kidney damage, or anatomic abnormalities (e.g., cysts). 

Although CSA has been used for treatment of other autoimmune diseases such as atopic dermatitis, myasthenia gravis, systemic sclerosis and primary biliary cirrhosis, data about chronic structural injury in these situations are scarce. There are occasional reports of end stage renal failure or development of interstitial fibrosis in kidney biopsies in demyelinat-... 

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