Đặc điểm mô bệnh học và siêu cấu trúc thận thải ghép mạn tính tại Việt Nam

Abstract

Diagnosis of chronic renal allograft rejection currently relies primarily on histopathology, but some early-stage lesions may not be clearly detected. The Banff Conference has recommended using ultrastructural analysis to improve diagnostic accuracyThis cross-sectional descriptive study included 53 patients with chronic renal allograft rejection (43 retrospective, 10 prospective) at the Military Hospital 103 and Viet Duc Hospital from 2022 to 2024. Lesions were evaluated according to Banff 2019 criteria using light microscopy, C4d immunohistochemistry, and transmission electron microscopy for ultrastructural analysis. Chronic T cell-mediated rejection was most common (31/53, 58.5%), followed by chronic antibody-mediated rejection (16/53, 30.2%) and mixed rejection (6/53, 11.3%). Lesion scores g0 and cg0 accounted for 60.3% and 79.2% respectively. C4d was positive in 56.6% of cases. Ultrastructural analysis revealed characteristic lesions: glomerular capillary basement membrane thickening, endothelial serrated appearance, podocyte foot process effacement (ABMR); interstitial collagen fiber proliferation, peritubular capillary basement membrane thickening, inflammatory cell infiltration (TCMR). Ultrastructural analysis provides more detailed information than conventional histopathology and has value in supporting accurate diagnosis of chronic renal allograft rejection.