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. 1997 Jul;4(4):265-276.
doi: 10.1097/00125480-199707000-00032.

Tacrolimus (FK506)-Associated Renal Pathology

Parmjeet S Randhawa  1 , Thomas E Starzl, Anthony Jake Demetris
Affiliations

Tacrolimus (FK506)-Associated Renal Pathology

Parmjeet S Randhawa et al. Adv Anat Pathol. 1997 Jul.
No abstract available

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Figures

FIG. 1
FIG. 1
Tubular vacuolization in patient with tacrolimus nephrotoxicity. The vacuoles vary some what in size and affect proximal as well as distal tubules.
FIG. 2
FIG. 2
Electron micrograph prepared from a biopsy with tacrolimus-associated tubular vacuolization. Most vacuoles appear to represent dilatations in the endoplasmic reticulum, but some have a morphology consistent with lysosomes.
FIG. 3
FIG. 3
This afferent arteriole from a patient with clinical tacrolimus nephrotoxicity shows myocyte vacuolization. Hyalin material can be seen deposited in the intima (periodic acid Schiff’s stain).
FIG. 4
FIG. 4
Ultrastructurally, myocyte vacuoles resemble tubular vacuoles in that they reflect a combination of dilated endoplasmic reticulum and lysosomes.
FIG. 5
FIG. 5
Afferent arteriolar thrombosis in a renal transplant recipient biopsied for rising serum creatinine levels. The glomerular capillary loops show ischemic wrinkling.
FIG. 6
FIG. 6
Widespread glomerular capillary thrombosis in a patient with tacrolimus-associated hemolytic uremic syndrome. The detailed clinical course of this patient has been published (78).
FIG. 7
FIG. 7
Periodic acid Schiff (PAS)-stained section illustrating arteriolar hyaline change associated with tacrolimus therapy. The smaller of the two arterioles in this photomicrograph shows early hyalinosis confined to the intima. The larger arteriole shows transmural involvement, affecting greater than half its circumference, with hyalin material also lying in the vascular lumen.
FIG. 8
FIG. 8
Electron micrograph of an arteriole with severe tacrolimus-associated hyalinosis. There is massive accumulation of a highly electron-dense material, which takes circular to oval nodular profiles. The remnant myocytes show vacuolar degeneration.
FIG. 9
FIG. 9
A striped pattern of fibrosis seen in biopsy material from a patient on long-term tacrolimus therapy. This appearance is produced by areas of patchy fibrosis and tubular atrophy alternating with relatively normal parenchyma. It should be stressed that striped fibrosis is not a specific lesion and can be seen in many chronic disease, such as glomerulonephritis, pyelonephritis, renal artery stenosis, donor-transmitted nephrosclerosis and chronic vascular rejection.
See this image and copyright information in PMC

References

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