PubMed · 4916971
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1970-09-26. Successes and problems.. https://pubmed.ncbi.nlm.nih.gov/4916971/
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Characterizing kidney disease is challenged by marked cellular heterogeneity and limited tissue availability from renal biopsies. Conventional diagnostic workflows rely on multiple serial sections for parallel staining, increasing tissue consumption, sampling bias, and loss of spatial information, thereby constraining molecular characterization within intact tissue architecture. High-plex spatial proteomics may overcome these limitations by enabling comprehensive molecular profiling on a single section. Here, we present and evaluate a high-plex cyclic immunofluorescence imaging workflow (MACSima™, Miltenyi Biotec) applied to kidney transplant biopsies, including BK virus nephropathy (BKVN) and focal segmental glomerulosclerosis (FSGS), to characterize spatial immune organization with a focus on complement system components. Feasibility and subcellular resolution were first assessed in a lupus nephritis section, demonstrating compatibility with diagnostic immune panels and preservation of tissue morphology. A 48-marker multiplex panel interrogating immunity, oxidative stress, senescence, and fibrosis was then applied to BKVN samples, including paired pre- and post-treatment biopsies, revealing distinct proteomic patterns and dynamic changes following therapy. In FSGS, a glomerulus-focused panel identified spatially resolved innate and adaptive immune signatures, including complement-related patterns supporting exploratory analysis of glomerular immune architecture. Structural, nuclear, membrane, and phosphorylated signaling markers enabled precise delineation of renal compartments and assessment of cellular states such as proliferation, DNA damage, and pathway activation. The workflow also supported detection of extracellular vesicles in cultured renal cells, highlighting its versatility. Overall, this approach provides a robust, tissue-sparing platform for integrated spatial and molecular profiling of renal biopsies, reducing sampling bias while enabling discovery-level phenotyping from a single section. This unified strategy is particularly suited to kidney transplantation, where diagnosis, therapeutic decision-making, and longitudinal monitoring are closely interconnected.
Chronic dialysis is a viable modality for treatment of end-stage renal disease in children, however, its limitation include negative effects on growth, progressive bone disease, and a poorer quality of life. Renal transplantation, on the other hand, allows the child a virtually normal life-style, with good prospects for employment and family life as an adult. Both patient and graft survival are significantly improved in children transplanted in centres with full paediatric facilities where special problems in young children are better addressed, such as that of fluid balance during the perioperative period, the age-related heightened immune responsiveness, and the different pharmacokinetic and pharmacodynamic handling of the various immunosuppressive agents in the child. Moreover, consideration of the problems of growth and developmental is crucial for maximal psychosocial rehabilitation of the paediatric transplant recipient.
In our experience both ultrasound and CT are highly diagnostic in the identification of the posttransplant fluid collections and hydronephrosis. As is the case elsewhere in the abdomen, the two examinations appear to be complementary. Ultrasound should be the initial diagnostic modality due to the advantages mentioned before; CT is helpful in resolving questionable abnormalities noted on ultrasound or in difficult clinical situations. Combination of the two examinations in selected cases improves sensitivity and specificity in the detection of postoperative complications.