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End-stage Renal Failure (end-stage + renal_failure)
Selected AbstractsExtent and Severity of Coronary Disease and Mortality in Patients with End-Stage Renal Failure Evaluated for Renal TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2009D. G. Jones The purpose of this study is to explore the relationship between coronary artery disease (CAD), transplantation status and subsequent mortality in end-stage renal disease (ESRD) patients undergoing evaluation for renal transplantation. Two hundred fifty-three ESRD patients at high risk for CAD underwent coronary angiography as part of a renal transplant evaluation. The cohort was divided into three groups: Group 1 (n = 127) had no vessels with ,50% stenosis, Group 2 (n = 56) had one vessel with ,50% stenosis and Group 3 (n = 70) had two or more vessels with ,50% stenosis. Long-term survival was determined; median follow-up was 3.3 years. The baseline characteristics were similar except for older age and higher proportion of diabetes mellitus, dyslipidemia and peripheral vascular disease in Groups 2 and 3 patients as compared to Group 1. Survival was worse in Group 3 compared to Group 1 (p < 0.0001). Each of the three subgroups had better survival with renal transplantation than those who did not undergo transplantation (p < 0.0001). Although the degree of CAD is related to subsequent mortality, transplantation is associated with better survival regardless of the extent and severity of CAD. Thus, the presence of CAD should not exclude ESRD patients from consideration for this therapy. [source] RIFLE classification as predictive factor of mortality in patients with cirrhosis admitted to intensive care unitJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2009Evangelos Cholongitas Abstract Background and Aim:, To evaluate the association of the Risk, Injury, Failure, Loss and End-stage renal failure (RIFLE) score on mortality in patients with decompensated cirrhosis admitted to intensive care unit (ICU). Methods:, A cohort of 412 patients with cirrhosis consecutively admitted to ICU was classified according to the RIFLE score. Multivariable logistic regression analysis was used to evaluate the factors associated with mortality. Liver-specific, Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) and RIFLE scores on admission, were compared by receiver,operator characteristic curves. Results:, The overall mortality during ICU stay or within 6 weeks after discharge from ICU was 61.2%, but decreased over time (76% during first interval, 1989,1992 vs 50% during the last, 2005,2006, P < 0.001). Multivariate analysis showed that RIFLE score (odds ratio: 2.1, P < 0.001) was an independent factor significantly associated with mortality. Although SOFA had the best discrimination (area under receiver,operator characteristic curve = 0.84), and the APACHE II had the best calibration, the RIFLE score had the best sensitivity (90%) to predict death in patients during follow up. Conclusions:, RIFLE score was significantly associated with mortality, confirming the importance of renal failure in this large cohort of patients with cirrhosis admitted to ICU, but it is less useful than other scores. [source] End-stage renal failure and cardiac mortality after heart transplantationCLINICAL TRANSPLANTATION, Issue 1 2004Mario Sénéchal Abstract:, Background:, Coronary artery disease (CAD) is the leading cause of mortality after the first year of heart transplantation. End-stage renal failure (ESRF) is more frequent because of long-term survival. Impact of ESRF on cardiac mortality in heart transplant patients is unappreciated. The hypothesis of accelerated CAD in uremic patients has been suggested. Methods:, In Pitié La Salpêtrière hospital, 1211 heart transplants have been performed between 1982 and 2001. Thirty-three patients have reached ESRF. A case,control study was performed to identify risk factors responsible for ESRF and to appreciate the impact of ESRF on cardiac mortality. Results:, In cases at 6 months, serum creatinine tended to be higher (159 ± 31 ,mol/L vs. 141 ± 44 ,mol/L, p = 0.06) and cyclosporine (CSA) dosage (mg/kg) was significantly lower (5.4 ± 1.8 mg/kg vs. 7.7 ± 2.7 mg/kg, p = 0.002). Mean triglyceride level after transplantation until dialysis was significantly lower in cases (2.18 ± 0.82 mmol/L vs. 1.48 ± 0.62 mmol/L, p = 0.002). In cases and controls, cardiac mortality was responsible for 67% (10 of 15) and 38% (three of eight) of all deaths, respectively. High triglyceride level (2 mmol/L) was associated with cardiac mortality [p < 0.03, hazard ratio (HR) = 3.89]. Kaplan,Meier cardiac free survival rates were significantly lower in cases than in controls (p < 0.03). Conclusion:, These data suggest that CSA nephrotoxicity could result from individually determined susceptibility and that hypertriglyceridemia may have a negative impact on renal function and cardiac mortality. The risk of cardiac mortality is increased in heart transplant patients with ESRF. The hypothesis of accelerated atherosclerosis in ESRF patients after heart transplantation leading to higher cardiac mortality incidence needs further study. [source] MYH9 related disease: four novel mutations of the tail domain of myosin-9 correlating with a mild clinical phenotypeEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 4 2010Alessandro Pecci Abstract MYH9 -related disease (MYH9 -RD) is a rare autosomal dominant disorder caused by mutations in MYH9, the gene encoding the heavy chain of non-muscle myosin IIA. All patients present congenital macrothrombocytopenia and inclusion bodies in neutrophils. Some of them can also develop sensorineural deafness, presenile cataract, and/or progressive nephropathy leading to end-stage renal failure. We report four families, each with a novel mutation: two missense mutations, in exons 31 and 32, and two out of frame deletions in exon 40. They were associated with no bleeding diathesis, normal, or only slightly reduced platelet count and no extra-hematological manifestations, confirming that alterations of the tail domain cause a mild form of MYH9 -RD with no clinically relevant defects. [source] Dialysis quality and quantity: How much and how often?HEMODIALYSIS INTERNATIONAL, Issue 2007Elaine SPALDING Abstract Hemodialysis is accepted as standard therapy for end-stage renal failure but despite four decades of experience the morbidity and mortality associated with the treatment remains unacceptably high. Quality of dialysis is traditionally measured with reference to urea clearance but it is becoming increasingly apparent that other solutes across the range of molecular size are also important. More prolonged or more frequent therapy may improve dialysis delivery and enhance survival in patients with end-stage renal disease. [source] Effect of intermittent compression of upper arm veins on forearm vessels in patients with end-stage renal diseaseHEMODIALYSIS INTERNATIONAL, Issue 3 2005Rina R. Rus Abstract Native arteriovenous fistula is the best vascular access for chronic hemodialysis. Primary and long-term success depends, in part, on the state of arteries and veins at the time of the operation. The aim of our study was to investigate the effects of intermittent compression of upper arm veins on forearm vessels in patients with terminal renal disease. The study group was composed of 16 chronic hemodialysis patients who performed daily intermittent compression of the upper arm without vascular access by elastic band (Eschmarch). Ten chronic hemodialysis patients were included in the control group, which performed no specific activity. Forearm measurements were obtained at the beginning of the study and 4 and 8 weeks later during the course of intermittent compression of the upper arm veins. The forearm circumference and maximal handgrip strength were measured. The artery measures, including endothelium-dependent vasodilatation and forearm vein variables, were obtained by ultrasonography measurements. The forearm circumference, maximal handgrip strength, and artery variables, including endothelium-dependent vasodilatation, remained unchanged. The basal venous diameters (2.29 ± 0.19 mm at the beginning, 2.46 ± 0.19 mm after 4 weeks, and 2.53 ± 0.18 mm after 8 weeks) were significantly increased in the study group. The distensibility of veins was preserved in the study group. There were no significant changes in the control group. Our study demonstrated that daily intermittent compression of the upper arm veins increases the forearm vein diameter and preserves the distensibility of veins in patients with end-stage renal failure. [source] Beta-2-Microglobulin in nocturnal hemodialysis , A comparative study in low and high flux dialysersHEMODIALYSIS INTERNATIONAL, Issue 1 2005A.B. Reid In end-stage renal failure, impaired renal catabolism leads to retention of beta 2 microglobulin (ß2M), identified as the major constituent of hemodialysis (HD) related amyloidosis. It has been previously shown that, while using a high flux (HF) HD membrane, nocturnal hemodialysis (NHD) with its increased time and frequency provides a much higher clearance of ß2M compared to conventional HD. We compared serum ß2M levels between low flux (LF) and HF in a group of 9 NHD patients who dialyse 8 hours 6 nights/week. Fresenius polysulfone LF membrane size F6-F8 HPS dialyser were used for the first 15 months (mth) of NHD (SA 1.3,1.8 m2). Subsequently, polysulfone HF FX80 dialyzer were used (SA 1.8 m2). Blood flow and dialysate flow rates were unchanged throughout the study. ß2M levels were measured at 6, 12, 15 mth on LF and at 6, 12 mth on HF. Albumin, homocysteine (Hcy), and phosphate (Phos) levels were also recorded at these times. ß2M levels trended upwards during the 15 mth on LF (36.6 ± 10.57 at 6 mth vs 47.1 ± 11.7 at 15 mth). On introduction of HF, there was a significant fall in ß2M at 6 mth to 12.4 ± 3.5 (p < 0.003), while ß2M levels were unchanged at 12 mth of HF. A downward trend in Hcy levels with the use of HF was noted (12.9 ± 2.9 at 0 mth Vs 11.1 ± 3.7 at 12 mth). Plasma albumin and Phos levels remained unchanged as did the use of Phos supplementation. Levels of ß2M continued to rise on NHD with LF, indicating inadequate clearance. With the introduction of HF there was a significant fall in ß2M levels consistent with improved clearance. The implications of this are that ß2M clearance may be time and frequency dependent only if dialyser membrane flux is adequate. [source] A Case of Hemodialysis Patients with Encapsulating Peritoneal Sclerosis (EPS)-like FindingHEMODIALYSIS INTERNATIONAL, Issue 1 2003H Kawanishi Encapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of peritoneal dialysis (PD). Involvement of the inflammation is indispensable as the EPS emission factor. We experienced the surgery of the EPS-like case that emits it to the hemodialysis (HD) patient without the PD. Patient: In November 1996 the patients, a 47-year old male developed end-stage renal failure due to chronic nephritis and started HD. Before and during HD, he complicated alcohol liver cirrhosis with ascites. In September 2001 he had intestinal obstructive symptoms and recovered with repeated puncture and drainage of ascites. Abdominal CT examination revealed the intestine oppression by the ascites with thick tunic formation. At May 2002, he underwent a laparotomy. Thick capsules formed surroundings to the ascites. This capsules covered parietal peritoneum and intestine surface and oppressed the intestine. The total ablation of small intestine was succeeded. Ascites examinations IL-6 20,350 pg/mL FDP 80 micro-g/mL TAT 1090 micro-g/L, was suspected to conjecture the involvement of inflammation and coagulate-fibrinolysis. Histology of peritoneum showed absence of mesothelium but not fibrosis and sclerosis. Discussion: EPS is caused by the inflammation on the deteriorated peritoneum, resulting in encapsulation after the accumulation of inflammatory products such as fibrin. Even if there is not the peritoneum deterioration, chronic inflammation and stimulation that continues for long-time causing EPS-like findings with encapsulation. The encapsulating ileus findings irrespective of the peritoneum deterioration should call with encapsulated peritonitis (EP). [source] Position of nonmuscle myosin heavy chain IIA (NMMHC-IIA) mutations predicts the natural history of MYH9 -related disease,HUMAN MUTATION, Issue 3 2008Alessandro Pecci Abstract MYH9 -related disease (MYH9 -RD) is a rare autosomal-dominant disorder caused by mutations in MYH9, the gene for the heavy chain of nonmuscle myosin IIA (NMMHC-IIA). All patients present from birth with macrothrombocytopenia, but in infancy or adult life, some of them develop sensorineural deafness, presenile cataracts, and/or progressive nephritis leading to end-stage renal failure. No consistent correlations have been identified between the 27 different MYH9 mutations identified so far and the variable clinical evolution of the disease. We have evaluated 108 consecutive MYH9 -RD patients belonging to 50 unrelated pedigrees. The risk of noncongenital manifestations associated with different genotypes was estimated over time by event-free survival analysis. We demonstrated that all subjects with mutations in the motor domain of NMMHC-IIA present with severe thrombocytopenia and develop nephritis and deafness before the age of 40 years, while those with mutations in the tail domain have a much lower risk of noncongenital complications and significantly higher platelet counts. We also evaluated the clinical course of patients with mutations in the four most frequently affected residues of NMMHC-IIA (responsible for 70% of MYH9 -RD cases). We concluded that mutations at residue 1933 do not induce kidney damage or cataracts and cause deafness only in the elderly, those in position 702 result in severe thrombocytopenia and produce nephritis and deafness at a juvenile age, while alterations at residue 1424 or 1841 result in intermediate clinical pictures. These findings are relevant not only to patients' clinical management but also to the elucidation of the pathogenesis of the disease. Hum Mutat 29(3), 409,417, 2008. © 2007 Wiley-Liss, Inc. [source] Mycophenolate mofetil substitution for cyclosporine-dependent myasthenia gravis and nephrotoxicityINTERNAL MEDICINE JOURNAL, Issue 1 2007A. K. H. Lim Abstract Severe autoimmune myasthenia gravis is difficult to manage and may require immunosuppression with cyclosporine. However, cyclosporine dependency is associated with the risk of nephrotoxicity. Mycophenolate mofetil is a non-nephrotoxic alternative which should be considered to rescue cyclosporine-dependent, severe myasthenia gravis sufferers with renal impairment from progression to end-stage renal failure. However, the evidence is limited and studies have not assessed the outcome of a direct substitution in these cyclosporine-dependent patients. We study three such patients who successfully converted to mycophenolate mofetil, and briefly examine the evidence behind this option. We believe that total cyclosporine withdrawal is feasible, but strongly recommend overlapping mycophenolate mofetil treatment with cyclosporine. [source] Mycotic aneurysm of the renal transplant arteryINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2006SHIRO FUJIKATA Abstract, A case of mycotic aneurysm secondary to septicemia is reported. A 59-year-old man with end-stage renal failure underwent renal transplantation from a living donor. On the fifteenth postoperative day, he was febrile and his arm around an entry wound of the drip infusion had infectious signs. Cultures of the blood and pus discharge grew Methicillin-resistant Staphylococcus aureus. Vancomycin was administered intravenously for 30 days. Then the existence of a mycotic aneurysm on the transplant artery was not suspected by computed tomography. After his infectious signs disappeared, examinations revealed a pseudoaneurysm measuring 4 cm in diameter at the site of anastomosis between the renal transplant and external iliac arteries by computed tomography. He has been carefully followed up with a conservative management. This is the first case of a mycotic aneurysm treated conservatively and displaying an uneventful course without rupture. [source] Perioperative myocardial infarction in noncardiac surgery: the diagnostic and prognostic role of cardiac troponinsJOURNAL OF INTERNAL MEDICINE, Issue 1 2002S. LUCREZIOTTI Abstract.,Lucreziotti S, Foroni C, Fiorentini C (Università degli Studi di Milano, Ospedale S. Pado, Milano, Italy). Perioperative myocardial infarction in noncardiac surgery: the diagnostic and prognostic role of cardiac troponins (Review). J Intern Med 2002; 252: 11,20. Despite the number of technologies used, the diagnosis of perioperative myocardial infarction is still a challenge. Studies conducted in surgical series have demonstrated that cardiac troponins (cTns) have both a superior diagnostic sensitivity and specificity, compared with other traditional techniques, and an independent power to predict short- and long-term prognosis. Nevertheless, some points need to be clarified. They include the usefulness of cTns in patients with end-stage renal failure; the standardization of the cTns cut-off for the diagnosis of myocardial injury; the timing of postoperative blood samplings; the cost-effectiveness of a screening in asymptomatic patients; and the possible therapeutic strategies. [source] Effect of Iron(III) Chitosan Intake on the Reduction of Serum Phosphorus in RatsJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 7 2000JOSEPH BAXTER Because of the widespread use of aluminium- and calcium-containing phosphate binders for the control of hyperphosphataemia in patients with end-stage renal failure, an iron(III) chitosan complex was synthesised and fed to rats to measure its effect on serum phosphorus and calcium, intestinal phosphate binding and phosphate absorption. Thirty-six Wistar rats were randomly selected and distributed into a baseline group (n = 6), a control group (n = 8 (days 0,15), n = 8 (days 16,30)) and a treatment group (n = 8 (days 0,15), n = 8 (days 16,30)). The control groups ingested AIN-76 diet mix with a 1% w/w fibre content; however, the treatment groups had the fibre content completely substituted with iron(III) chitosan. The mean weights of the treated rats were slightly lower from 15 days (not significant); but overall, rat growth was not stunted in the treatment groups. The serum phosphorus levels of the treated group (n = 8) were significantly reduced after 15 days (P = 0.004; control: 5.7 ± 0.9 mg dL,1; treatment: 4.4±0.5 mg dL,1; 95% CI of difference: 0.5,2.2) and 30 days (P = 0.002; control: 5.5 ± 0.9 mg dL,1; treatment = 4.1 ± 0.6 mg dL,1; 95% CI of difference: 0.6,2.3) as compared with the respective control group. The serum calcium-phosphorus product was 62.0 ± 12.1 mg2 dL,2 for the control and 45.1 ± 6.6 mg2 dL,2 for the treatment group after 30 days (P = 0.004). The serum iron concentration of the treatment group did not differ from the baseline value after 15 and 30 days, but the treatment group was significantly higher than the control group (P < 0.05) after 30 days. The faeces phosphorus levels (mg day,1) were higher (P < 0.01) and its iron content was much higher (P < 0.01) for the treated group. The urine phosphorus (mg kg,1) was not significantly reduced for the treated group, but the mean was consistently less. The kidney and liver weights of both groups were similar, but the phosphorus content of the kidney (mg (g kidney),1) was higher for the treated group after 30 days (P = 0.041; control, 4.2 ± 1.2 mg g,1 vs treatment, 5.6 ± 1.4 mg g,1. Because iron(III) chitosan had a high phosphorus-binding capacity of 308 (mg P) per gram of Fe3+ for both the in-vitro (pH 7.5) and in-vivo studies, which is greater than nearly all commonly used phosphate binders, and a small net phosphorus absorption difference of 3.7 mg day,1, it is an efficient phosphate binder for lowering serum phosphate levels without increasing serum calcium levels. [source] RESEARCH INTO PAIN PERCEPTION WITH ARTERIOVENOUS FISTULA (AVF) CANNULATIONJOURNAL OF RENAL CARE, Issue 4 2008Ana E. Figueiredo RN SUMMARY Patients with end-stage renal failure (ESRF) undergoing haemodialysis (HD) are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula (AVF). Repeated AVF punctures lead to a considerable degree of pain, due to the calibre and length of the bevel of fistula needles. Pain is a sensitive, emotional and subjective experience. The objective of this study was to measure pain associated with AVF needling. The analogue visual scale (AVS) divided into 10 equal parts (0 indicating lack of pain, and 10 unbearable pain) was used. Patients7 perceptions were measured in three different HD sessions. Pain was considered mild during AVF needling. The buttonhole technique caused a mean degree of pain of 2.4 (±1.7), compared to 3.1 (±2.3) using the conventional ropeladder technique. Although without reaching a statistically significant difference, diminished pain was associated with the buttonhole technique. [source] Primary hyperoxaluria: Simultaneous combined liver and kidney transplantation from a living related donorLIVER TRANSPLANTATION, Issue 4 2003Ibrahim Astarcioglu Primary hyperoxaluria type 1 (PH1) is a rare inherited metabolic disorder in which deficiency of the liver enzyme AGT leads to renal failure and systemic oxalosis. Timely, combined cadaveric liver-kidney transplantation (LKT) is recommended for end-stage renal failure (ESRF) caused by PH1; however, the shortage of cadaveric organs has generated enthusiasm for living-related transplantation in years. Recently, successful sequential LKT from the same living donor has been reported in a child with PH1. We present a sister-to-brother simultaneous LKT in a pediatric patient who suffered from PH1 with ESRF. Twelve months after transplantation, his daily urine oxalate excretion was decreased from 160 mg to 19.5 mg with normal liver and renal allograft functions. In addition to the well-known advantages of living organ transplantation, simultaneous LKT may facilitate early postoperative hemodynamic stability and may induce immunotolerance and allow for low-dose immunosuppression. [source] Evaluation of the prognostic value of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria for acute kidney injuryNEPHROLOGY, Issue 5 2008JOSE R PEREZ VALDIVIESO SUMMARY: Aim: The experts have argued about the use of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria as a prognosis scoring system. We examined the association between in-hospital mortality and the RIFLE criteria, and discussed its accuracy as a prognosis factor. Methods: In this prospective study, we analysed the data gathered from a cohort of 956 patients admitted in a Spanish tertiary hospital between January 1998 and April 2006. Hazard ratios for mortality, and survival curves within 60 days were calculated. Discrimination and calibration of the model were also assessed. Results: Excluding 53 patients, 903 patients were finally analysed. We classified them into groups according to the maximum RIFLE class reached during their admission. The RIFLE class was assessed by the glomerular filtration rate criterion. We found an increase in the in-hospital mortality risk. Cox proportional hazard models showed that RIFLE classes risk, injury, and failure were significant predictive factors (hazard ratios were 2.77, 3.23 and 3.52, respectively; P for trend was 0.005). The multivariate analyses from the cross-classification of the participants according to Liano score values (severity of illness) and RIFLE classes showed additive effects of the exposures on in-hospital mortality. Conclusion: In this population, the risk of in-hospital mortality during the acute kidney injury (AKI) episode was positively associated with RIFLE classes. We showed that the RIFLE classification system had discriminative power in predicting hospital mortality within 60 days in AKI patients, but not better than a specific AKI predictive model. However, a combined use of both may give a more robust prognosis system. [source] Higher rate and earlier peritonitis in Aboriginal patients compared to non-Aboriginal patients with end-stage renal failure maintained on peritoneal dialysis in Australia: Analysis of ANZDATANEPHROLOGY, Issue 2 2005WAI H LIM SUMMARY Background: Aboriginal patients maintained on peritoneal dialysis (PD) have a higher rate of technique failure than any other racial group in Australia. Peritonitis accounts for the bulk of these technique, failures,, but, it, is, uncertain, whether, the, increased, risk, of, peritonitis, in, Aboriginal, patients was independent of associated comorbid conditions, such as diabetes mellitus. Methods: Using data collected by the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), peritonitis rates and time to first peritonitis were compared between Aboriginal (n = 238) and non-Aboriginal patients (n = 2924) commencing PD in Australia between 1 April 1999 and 31 March 2003. Results: Aboriginal PD patients were younger, and had a higher incidence of diabetes than their non-Aboriginal counterparts. Mean peritonitis rates were significantly higher among Aboriginal (1.15 episodes/year; 95% confidence interval (CI): 1.03,1.28) than non-Aboriginal patients (0.60 episodes/year; 95% CI: 0.57,0.62, P < 0.05). Using multivariate negative binomial regression, independent predictors of higher peritonitis rates include Aboriginal racial origin (adjusted odds ratio 1.78; 95% CI: 1.45,2.19), obesity, age and absence of a recorded dialysate : plasma creatinine ratio (D/P creatinine) measurement. Aboriginal racial origin was also associated with a shorter median time to first peritonitis (9.9 vs 19.3 months, P < 0.05), which remained statistically significant in a multivariate Cox proportional hazards model (adjusted hazard ratio 1.76; 95% CI: 1.47,2.11, P < 0.05). Conclusion: Aboriginal and obese PD patients have a higher rate of peritonitis and a shorter time to first peritonitis, independent of demographic and comorbid factors. Further investigation of the causes of increased peritonitis risk in Aboriginal patients is needed. [source] Polymorphism of renin-angiotensin system genes in IgA nephropathyNEPHROLOGY, Issue 5 2004KENG-THYE WOO SUMMARY: Background and Aims: Individuals are prone to disease because of certain disease-susceptible genes. The angiotensin I-converting enzyme (ACE) gene insertion/deletion (I/D), the angiotensinogen (AGT) gene, M235T, and the angiotensin II type 1 receptor (ATR) gene, A1166C, polymorphisms have been associated with IgA nephropathy (IgAN) and its progression. Several studies on Caucasians and Japanese patients have reported contradictory results. We determined these polymorphisms in 118 Chinese patients with IgAN and 94 healthy Chinese subjects to assess their clinical impact. Methods: Genotyping was performed with DNA isolated from peripheral leucocytes, polymerase chain reaction amplification of the polymorphic sequence, restriction enzymes digestion, and separation and identification of DNA fragments. Clinical data at renal biopsy and final status on renal function were determined from patients' records. Results: Comparing all IgAN patients with controls, AGT and ATR genotype distributions were similar, whereas there was a significant increase in the ACE DD genotype (P < 0.05). When comparing patients with end-stage renal failure (IgAN-ESRF) and those without (IgAN-nonESRF), there was no difference among the three gene polymorphisms. In contrast, there were significant differences in higher male prevalence (P < 0.05), increased serum creatinine at presentation (P < 0.05), more sclerosis (P < 0.01) and higher tubulointerstitial lesion score (P < 0.001) in the IgAN-ESRF group. Conclusion: Among the ACE, AGT and ATR gene polymorphisms, only the DD genotype may predispose the individual to IgAN in the Chinese population. None are significant for prognosticating ESRF. [source] Peritoneal mesothelial cells and the extracellular matrixNEPHROLOGY, Issue 6 2001Susan Yung SUMMARY: Continuous ambulatory peritoneal dialysis (CAPD) is an important treatment for patients with end-stage renal failure. Long-term success is dependent on the functional and structural integrity of the peritoneal membrane. Conventional peritoneal dialysis fluids are non-physiological. They contain glucose at high concentrations to provide the osmotic drive for ultrafiltration, lactate to correct the metabolic acidosis of renal failure, and a low pH to prevent caramelization of glucose during heat sterilization. These components, in isolation or acting together, exert adverse influences on both the resident cellular and extracellular elements of the peritoneal membrane, as well as phagocytic cells which infiltrate the peritoneum during inflammation, culminating in detrimental structural and functional effects, compromising the viability of the peritoneum during dialysis. Peritoneal biopsy studies of patients on long-term CAPD have demonstrated an intercellular space between adjacent mesothelial cells which allows the penetration of peritoneal dialysis fluid into the underlying submesothelium. This, together with episodes of peritonitis, can initiate a chronic inflammatory reaction within the peritoneum characterized by increased synthesis of matrix proteins. Perturbation of the regulatory mechanisms which govern the balance of synthesis and degradation of extracellular matrix can lead to progressive fibrosis. Human peritoneal mesothelial cells (HPMC) have been shown to synthesize fibronectin, laminin, collagens, proteoglycans and hyaluronan in vitro, and thus play a role in the pathogenesis of peritoneal fibrosis. This review will give an overview of extracellular matrix (ECM) synthesis by HPMC, how changes in the synthesis are affected by CAPD and postulate how these changes can compromise the dialytic properties of the peritoneum. [source] Evaluation by scanning acoustic microscopy (SAM) on glomerular lesion of IgA nephropathyNEPHROLOGY, Issue 2001H Kiyomoto IgA nephropathy (IgAN) is known to commonly cause of end-stage renal failure in Japan. The glomerular lesions of IgAN have histological variations. The determination of prognosis and therapeutic strategy should be carefully done by experts because morphological information from renal biopsies using ordinary optical microscopy is usually qualitative and subjective. Moreover, the histological items for the evaluation of glomerular lesions seems to be unsatisfactory for expression of the disease condition of IgAN. The beneficial properties of scanning acoustic microscopy (SAM) include not only observation of microstructure but also quantitative measurement of acoustic propagation speed (APS), indicating the tissue elasticity. In the present study we compared the APS of glomeruli with the pathological scores that were determined by ordinary light microscopy. We used stocked human renal biopsy specimens diagnosed as IgAN (n = 12) and normal/minimal changes (n = 5). All samples were taken by renal biopsy in Kagawa Medical University Hospital during 1997,2000 under informed consent of the patients. The obtained renal tissue were immersed in 10% formalin and embedded in paraffin. A fixed specimen was consecutively cut into 4 ,m slices. One of the deparaffinized 4 ,m-specimens was directly utilized for SAM without any staining, and the others were stained with haematoxylin-eosin and Masson Trichrome for counting cell number and evaluation of collagen accumulation. For the measurement of glomerular APS, the sample line was set on the equator of the glomerulus and then scanning of the X,Z axis was carried out to obtain the interference fringes that were analysed with a computer imaging software in order to calculate the APS. In light microscopic study, pathological scores were evaluated semiquantitatively by two independent investigators who were unaware of the sample number. Glomerular lesions were scored into five grades and glomerular cell number was also counted in individual glomerulus. The computer-assisted imaging analyser Win ROOF (Mitani, Fukui, Japan) was also used for the determination of glomerular collagen content in specimens stained by Masson Trichrome. A two-dimensional image (C-mode scanning) of SAM enabled imaging of glomerulus in renal biopsy specimen compatible with findings of ordinary light microscopy without staining dye. The glomerular APS in IgAN was significantly higher than in normal/minimal changes. This alteration of glomerular APS in IgAN was positively correlated to both semiquantitative pathological scores and glomerular collagen content determined by light microscopy. However, the cell number of glomelurus did not change between IgAN and normal/minimal change. As a result, we conclude that the glomerular lesion, especially matrix expansion in IgAN, was comparable with the absolute value among specimens. Therefore, it is suggested that SAM method is a novel and useful technique for quantitative evaluation of glomerular lesion in IgAN. [source] What delay should there be between primary infectious mononucleosis and renal transplantation?PEDIATRIC TRANSPLANTATION, Issue 8 2006L. Kerecuk Abstract:, A 17-yr-old girl in end-stage renal failure was due to undergo living-related pre-emptive renal transplantation when she developed acute infectious mononucleosis (AIM) from Epstein,Barr virus (EBV). In view of the risk of post-transplant lymphoproliferative disorder (PTLD) we were unsure as to the optimal delay between AIM and renal transplantation. This report describes the process used to determine maturation of the immune response to EBV using a combination of serology, immunophenotyping and molecular viral load estimation. These tests showed that EBV had not been cleared and dialysis was instituted rather than proceed directly to transplantation. After EBV viral load became undetectable in the blood, living-related donor was successfully performed 13 months after AIM. With 42-month post-transplant follow up there has been no evidence of PTLD. [source] Pediatric renal transplantation in a South African teaching hospital: A 20-year perspectivePEDIATRIC TRANSPLANTATION, Issue 4 2006G. J. Pitcher Abstract:, Introduction:, Renal transplantation is established as the standard of care for end-stage renal failure (ESRF) in the developed world. In emerging nations, the appropriateness of such costly interventions has been questioned. We undertook an analysis of all renal transplants undertaken under the care of the pediatric nephrology service at the Johannesburg Hospital, South Africa, in order to establish the outcomes of a transplantation service in a resource-constrained environment in a developing country. Methods:, This was a retrospective review of renal transplantation undertaken at a single teaching hospital in Johannesburg, part of the University of the Witwatersrand. Two hundred and eighty-two transplants were performed between 1984 and 2003. Demographic characteristics of the transplanted population, diagnosis, morbidity, graft survival, and mortality were recorded. Results:, Overall 1-, 5-, and 10-yr graft survival was 82, 44, and 23%. Overall 1-, 5-, and 10-yr patient survival was 97, 84, and 68%. The median graft survival for all transplantation episodes was 4.38 yr; 70% of patients survive 10 yr and 54% survive 20 yr or more. Although early graft survival was good, there was a more rapid rate of graft loss than when compared to results from developed centers with much poorer results at 5 and 10 yr. Causes of ESRF show marked variation between the races, and black patients have significantly worse outcomes than others. Compared with white patients, black recipients received fewer living donor kidneys (26 vs. 10%, p = 0.0019), a greater proportion of totally mismatched organs (56 vs. 36%, p = 0.015), less pre-emptive transplantation (7 vs. 35%, p = 0.0001) and experienced a higher rate of primary non-function (13 vs. 3%, p = 0.004). Surgical complications of transplantation occurred in 9% of recipients, but rarely led to graft loss. Conclusion:, Pediatric renal transplantation in Johannesburg can be accomplished with low complication rates, but medium and long-term graft survival is poor when compared with contemporary results achieved in developed countries. The difficulties of undertaking such complex, multidisciplinary interventions in a developing nation are daunting, but we believe that renal transplantation should still be the treatment of choice for all children with ESRF. The poorer outcomes in black recipients can be addressed by increasing education in our communities and expanding the pool of appropriate donors. Better institutional support would allow for improved long-term patient care. [source] Renal transplantation and long-term graft survival for all children and adolescents with end-stage renal failurePEDIATRIC TRANSPLANTATION, Issue 4 2004Alfred Drukker MD First page of article [source] Head circumference and development in young children after renal transplantationPEDIATRICS INTERNATIONAL, Issue 1 2009Osamu Motoyama Abstract Background:, Growth impairment, microcephaly and developmental delay in young children with chronic renal failure improve after successful renal transplantation. There have been few reports on head circumference (HC) and development after transplantation. Method:, Standard deviation scores (SDS) of height and HC and developmental quotient (DQ) after successful renal transplantation were evaluated in 12 recipients under 5 years of age. At the time of transplantation their mean age was 2.5 years and mean bodyweight was 9.0 kg. Results:, Mean height SDS was ,3.0 at transplantation and increased to ,2.3 at 1 year after transplant (P = 0.002). Mean HC-SDS increased from ,1.4 to ,0.9 at 1 year after transplant (P = 0.02). As for each category of DQ examined 1 year after transplant, mean scores of gross motor function, basic practice, personal relations, speech and recognition increased from 69 to 90 (P = 0.007), from 77 to 102 (P = 0.02), from 87 to 103 (P = 0.04), from 71 to 90 (P = 0.0006), and from 88 to 101 (P = 0.03), respectively. Conclusion:, In young children, physical growth, HC growth and DQ scores increased 1 year after transplantation. Dialysis and transplantation program should be planned in young children with end-stage renal failure in anticipation of growth and development of each patient. [source] Prognosis and pathological characteristics of five children with non-Shiga toxin-mediated hemolytic uremic syndromePEDIATRICS INTERNATIONAL, Issue 2 2007ICHIRO KAMIOKA Abstract Background: The three major signs of hemolytic uremic syndrome (HUS) are hemolytic anemia, thrombopenia and acute renal failure. HUS is classified into Shiga toxin-mediated HUS (Stx-HUS) and non-Shiga toxin-mediated HUS (nStx-HUS). The prognosis of nStx-HUS is reported to be less favorable than that of Stx-HUS. Although the association between the prognosis and pathological characteristics of HUS have been reported such that the prognosis was considered to be poor for thrombotic microangiopathy (TMA) with predominant arterial involvement (arterial TMA), good for TMA with predominant glomerular involvement (glomerular TMA) and dependent on the extent of necrosis in cases of renal cortical necrosis, it is not yet clear whether pathological findings are also related to the renal prognosis of nStx-HUS cases. Therefore the purpose of the present paper was to analyze renal biopsy findings and prognosis for five children with nStx-HUS. Methods: Clinical records of five cases of nStx-HUS among 74 cases of diagnosed HUS were reviewed, and information and data were summarized. Results: Histological examination of the kidney led to the diagnosis of arterial TMA in three cases, and glomerular TMA and severe renal cortical necrosis in one case each. Analysis of the relationship between renal histological findings and the prognosis found that three patients with arterial TMA and one patient with severe renal cortical necrosis later developed end-stage renal failure while one patient with glomerular TMA has continued to show normal renal function. Conclusions: These findings indicate that pathological findings are closely related to the prognosis in cases of nStx-HUS. [source] Negative Pressure Wound Therapy Used to Heal Complex Urinary Fistula Wounds Following Renal Transplantation into an Ileal ConduitAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2010Sarah Heap Transplantation into an ileal conduit is an established option for patients with end-stage renal failure and a nonfunctioning urinary tract. Urinary fistulae are more common following these complex transplants. Urinary fistula in this scenario can cause substantial morbidity and even result in graft loss. The management options depend on the viability of the transplant ureter, the level of local sepsis and the overall condition of the patient. Urinary diversion with a nephrostomy and ureteric stents has been described in aiding the healing of urinary leaks in renal transplants into a functioning urinary tract. We describe the successful use of negative wound pressure therapy to eradicate the local sepsis and help the healing of a recurrent urinary fistula following kidney transplantation into an ileal conduit. To our knowledge these are the first such cases reported in the literature. [source] Biopsy-Diagnosed Renal Disease in Patients After Transplantation of Other Organs and TissuesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010A. Schwarz Renal function deteriorates in about half of patients undergoing other transplants. We report the results of 105 renal biopsies from 101 nonrenal transplant recipients (bone marrow 14, liver 41, lung 30, heart 20). Biopsy indications were protracted acute renal failure (9%), creatinine increases (83%), heavy proteinuria (22%), or renal insufficiency before re-transplantation (9%). Histological findings other than nonspecific chronic changes, hypertension-related damage, and signs of chronic CNI toxicity included primary glomerular disease (17%), mostly after liver transplantation (21%) or after bone marrow transplantation (29%), and thrombotic microangiopathy (TMA) namely (10%). TMA had the most serious impact on the clinical course. Besides severe hypertension, one TMA patient died of cerebral hemorrhage, 5 had hemolytic-uremic syndrome, and 6 rapidly developed end-stage renal failure. TMA patients had the shortest kidney survival post-biopsy and, together with patients with acute tubular injury, the shortest kidney and patient survival since transplantation. Nine TMA patients had received CNI, 3 of them concomitantly received an mTOR-inhibitor. CNI toxicity is implicated in most patients with renal failure after transplant of other organs and may play a role in the development of TMA, the most serious complication. However, decreased renal function should not be routinely ascribed to CNI. [source] Thrombotic Microangiopathy After Kidney TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010M. Noris Thrombotic microangiopathy (TMA) is a severe complication of kidney transplantation that often causes graft failure. TMA may occur de novo, often triggered by immunosuppressive drugs and acute antibody-mediated rejection, or recur in patients with previous history of hemolytic uremic syndrome (HUS). Recurrent TMA is very rare in patients who had developed end-stage renal failure following HUS caused by Shiga-toxin producing E. scherichia coli, whereas disease recurrence is common in patients with atypical HUS (aHUS). The underlying genetic defect greatly impacts the risk of posttransplant recurrence in aHUS. Indeed recurrence is almost the rule in patients with mutations in genes encoding factor H or factor I, whereas patients with a mutation in membrane-cofactor-protein gene have a good transplant outcome. Prophylactic and therapeutic options for posttransplant TMA, including plasma therapy, combined kidney and liver transplantation and targeted complement inhibitors are discussed in this review. [source] Successful Long-Term Outcome of the First Combined Heart and Kidney Transplant in a Patient with Systemic AL AmyloidosisAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2009V. Audard Simultaneous cardiac and renal involvement is associated with a particularly poor prognosis in patients with AL amyloidosis (AL-A). We report the first case of a successful long-term outcome of combined heart and kidney transplantation not followed by autologous stem cell transplantation in a patient with systemic AL-A. The recipient was a 46-year-old man with end-stage renal failure associated with serious cardiac involvement in the context of AL-A. Before transplantation, two courses of oral melphalan plus prednisone induced partial hematologic remission, as shown by the decrease in circulating free light chain with no improvement of renal or heart function. The patient underwent combined heart and kidney transplantation as a rescue treatment. During the follow-up period (36 months), plasma cell dyscrasia remains in complete remission, with normal free lambda light chain levels and no recurrence of amyloid deposition on heart and kidney grafts. This case report demonstrates that combined heart and kidney transplantation not systematically associated with stem cell transplantation may be considered an additional therapeutic option in AL-A patients with severe organ dysfunction and partial hematologic remission. [source] Successful Hepatorenal Transplantation in Hereditary Amyloidosis Caused by a Frame-Shift Mutation in Fibrinogen A,-Chain GeneAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2006C. Mousson Hereditary systemic amyloidosis comprises several autosomal dominant diseases caused by mutations in a number of plasma proteins, including the fibrinogen A,-chain. Four mutations in the fibrinogen A,-chain that are able to induce amyloidosis have been identified so far, the most common being the Glu526Val mutation. We have observed a family in which the father and his son reached end-stage renal failure because of renal amyloidosis induced by a frame-shift mutation in the fibrinogen A,-chain gene producing a novel amyloid protein. Two kidney transplantations in the father and one in the son resulted in fast graft loss caused by recurrence of amyloid deposition. We then performed hepatorenal transplantation in the son. Three years later, liver and kidney functions are normal without recurrence of amyloid deposition. This case, together with three others with the Glu526Val mutation in the extensive literature, suggests that liver transplantation can cure hereditary fibrinogen amyloidosis, whatever the mutation may be. [source] | |||||||||||||||||||||||||||||||