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Long-term Renal Function (long-term + renal_function)

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Medical Sciences	100%

Selected Abstracts

Atorvastatin in dyslipidaemia of the nephrotic syndrome

NEPHROLOGY, Issue 2 2003
Pedro VALDIVIELSO
SUMMARY: The combined dyslipidaemia that accompanies the nephrotic syndrome increases the cardiovascular risk and appears to worsen long-term renal function. Our aim was to determine the efficacy and safety of 10 mg atorvastatin in the control of dyslipidaemia in these patients. We carried out a prospective, open, 6 month study of 10 patients with primary or secondary nephrotic syndrome (proteinuria >3.5 g/day, hypoalbuminaemia, oedema and hyperlipidaemia). The changes in lipids and plasma lipoproteins were measured, as well as the safety profile (transaminases, creatine phosphokinase, fibrinogen and antithrombin III activity) and parameters of renal function. The addition of 10 mg atorvastatin daily for 6 months resulted in a 41% reduction in low density lipoprotein (LDL) cholesterol and 31% in triglycerides (both P < 0.05), and a 15% increase in high density lipoprotein (HDL) cholesterol (NS). The drug was well tolerated and there was no change in the safety profile or deterioration in renal function. In fact, the levels of proteinuria fell in all but one patient (6.2 ± 2.6 vs 4.8 ± 2.5 g/24 h; P < 0.05). Atorvastatin, at the above dose, and for the time used proved to be a safe drug that effectively reduced dyslipidaemia in patients with nephrotic syndrome. [source]

Tacrolimus withdrawal and conversion to sirolimus at three months post-pediatric renal transplantation

PEDIATRIC TRANSPLANTATION, Issue 7 2008
Leonard C. Hymes
Abstract:, Nephrotoxicity caused by CNI may adversely affect long-term graft outcomes. For this reason, we have adopted a protocol for withdrawing TAC and converting to SRL at three months post-renal transplantation. All recipients received basiliximab induction and TAC, MMF, and prednisone. Patients without acute rejection by surveillance biopsy at three months were eligible for SRL conversion. Results: From August 2004 to September 2006, TAC was withdrawn and replaced by SRL in 30 first transplant recipients, who were followed for six to 39 months (mean 18 ± 8). Renal function did not improve significantly after SRL conversion (p = 0.25). Acute rejection occurred in three patients (10%) at five to 12 months after CNI withdrawal. There were no occurrences of wound healing problems, pneumonitis or post-transplant lymphoproliferative disease. Thrombocytopenia and diabetes each occurred in one patient. Four patients received treatment for hypercholesterolemia. CNI withdrawal and replacement with SRL was an effective regimen in children who did not display biopsy evidence of acute rejection at three months post-transplant. While these early results are promising, the ultimate benefit of this protocol to enhance the long-term renal function and graft survival requires ongoing follow-up. [source]

The use of renal scintigraphy in assessing the potential for recovery in the obstructed renal tract in children

BJU INTERNATIONAL, Issue 9 2001
A. Thompson
Objective To assess the value of renal scintigraphy with 99mTc-dimercaptosuccinic acid (DMSA) in predicting functional recovery after the surgical relief of obstructed kidneys in children. Patients and methods Forty-three children underwent surgery to relieve upper urinary tract obstruction; 37 had pelvi-ureteric junction obstruction and six had vesico-ureteric junction obstruction. The indication for surgery was a combination of an obstructed renogram with symptoms of either pain or pyelonephritis. Most children (41) had < 40% function on the affected side before surgery, with just two having hyperfunction (> 55%). In all patients intravenous urography before surgery showed hydronephrosis, and a micturating cystogram was used to exclude coexisting reflux in the presence of an associated megaureter. Diuretic renography (using 99mTc-mercaptoacetyl triglycine or 123I-hippuran) and DMSA scintigraphy were both carried out before surgery and the renography repeated 6 months afterward. Results The renographic drainage curves improved from obstructed to unobstructed or ,dilated unobstructed' on all postoperative studies. Regression analysis showed that preoperative DMSA scan was an excellent predictor of outcome (P < 0.001) whilst the preoperative renogram was a relatively poor predictor of the functional result. In four patients where the initial renographic function was < 10%, DMSA scintigraphy predicted correctly the capacity for recovery in three and the inability to improve in the fourth. Conclusion Before surgery, DMSA scintigraphy in children with upper urinary tract obstruction is a more useful estimate of probable long-term renal function than value from diuresis renography. If there is doubt about the desirability of reconstructive surgery, a DMSA scan may eliminate the need for more invasive methods of estimating recovery, e.g. a period of nephrostomy drainage. [source]

The effect of intestinal urinary reservoirs on renal function: a 10-year follow-up

BJU INTERNATIONAL, Issue 3 2000
E. Fontaine
Objective To study the effect of the storage of urine in intestinal reservoirs on long-term renal function and the possible causes of deterioration. Patients and methods Eighty-seven patients (aged 4,35 years) with bladder exstrophy who underwent reconstruction of the lower urinary tract using a bowel segment were enrolled in a prospective protocol. The glomerular filtration rate (GFR) was measured before and after surgery at 1, 2, 5 and 10 years using 51Cr-ethylenediamine tetra-acetic acid. Patients with a decline in GFR of > 5% were investigated to identify the cause. Results Of 58 patients with a follow-up of , 10 years, 53 were evaluable, four having been lost to follow-up and one refusing to accept the protocol. In these 53 patients, the mean ( sd) GFR decreased from 97.9 (20.4) to 92.9 (23.6) mL/min/1.73 m2 (P = 0.24). However, this decrease was accounted for by 10 patients (19%) whose GFR fell by ,,20% over the 10 years. The causes of renal deterioration in these 10 patients were; chronic retention and/or infection caused by inadequate catheterization in poorly compliant patients (five), uretero-ileal stenosis (one), a high-pressure reservoir (one) and uncertain causes (three). Conclusions For 80% of the patients, the storage of urine in intestinal reservoirs did not change renal function for at least 10 years. However, ,,20% of patients had some deterioration in renal function during the 10-year follow-up, usually from identifiable and remediable causes. The storage of urine in bowel does not appear to be inherently damaging to kidney function. Patients with an enterocystoplasty need regular monitoring of renal function; when deterioration is detected the urinary tract must be functionally assessed. [source]

Renal function with delayed or immediate cyclosporine microemulsion in combination with enteric-coated mycophenolate sodium and steroids: results of follow up to 30 months post-transplant

CLINICAL TRANSPLANTATION, Issue 3 2007
Georges Mourad
Abstract:, Background:, In the multicenter, open-label Myriade study, renal transplant patients were randomized to early cyclosporine microemulsion (CsA-ME, day 0) or delayed CsA-ME (day 6) with enteric-coated mycophenolate sodium (EC-MPS), steroids and interleukin-2 receptor induction. One-yr results have been published previously. We now report the results of an extension study in which patients were followed up for a period of three yr post-transplant. Methods:, All patients completing the one-yr core study on-treatment were eligible to enter the extension study. Results:, Of the 203 patients, 153 completed the core trial on-treatment; 144 (94%) entered the extension study with a minimum follow-up of one yr (73 early CsA-ME, 71 delayed CsA-ME). In 75% of patients receiving EC-MPS during the extension, the recommended dose was administered (1440 mg/d). Median creatinine clearance remained constant (57 mL/min) at 12, 24 and 30 months post-transplant and was similar in the early and delayed CsA-ME groups as well as in subpopulations with or without delayed graft function. One patient in the early CsA-ME group died. No grafts were lost. The incidence of BPAR from time of transplant to the end of the extension study was 17% (24/139). Seven patients (5%) discontinued the extension study prematurely because of adverse events. Conclusion:, These results suggest that a regimen of CsA-ME, EC-MPS and steroids results in excellent survival rates with stable renal function over a mean follow-up of 30 months. Immediate introduction of CsA-ME has no deleterious effect on long-term renal function, even among patients with delayed graft function. [source]