Figure 1716

Microradioangiography comparing the vasculature of the kidney in a patient with no disease (panel A) and a patient with homozygous sickle cell disease (panel B) [22]. Despite the frequency of renal damage in sickle cell disease, only 4% of patients progress to end-stage renal disease, and little experience exists with renal transplantation. Three patients have been reported with recurrent sickle cell nephropathy. In one case, a patient developed renal dysfunction 3.5 years after transplantation; a biopsy showed glomerular sclerosis, tubular atrophy, and interstitial fibrosis, without features of rejection. A second study reported recurrent sickle cell nephropathy leading to graft failure in two of eight patients receiving transplantation [23]. Concentration defects were observed within 12 months of grafting. Patients also suffered an increased incidence of sickle cell crises after renal transplantation, possibly associated with the increase in hematocrit.

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