Overlooked constrictive pericarditis as a cause of relapsing ascites and impairment of renal allograft function.

Herein we have presented a case of overlooked relapsing constrictive pericarditis with ascites in a renal transplant patient. The first symptoms of constriction appeared during hemodialysis. After a 2-year period of remission, they relapsed at 1 year after transplantation causing deterioration of renal function. We noted that constrictive pericarditis can be misdiagnosed due to symptoms characteristic of heart failure. The diagnosis should be evident from right heart catheterization and computed tomographic (CT) imaging of the thickness or calcification of the pericardium. Once the diagnosis was established surgical treatment allowed total recovery with improved graft function.

Weight reduction in renal transplant recipients program: the first successes.

INTRODUCTION: Overweight and obesity in kidney graft recipients, both at transplantation and further on, are connected with the development of complications of metabolic syndrome. Hypertension, diabetes, and atherosclerosis are risk factors for chronic allograft nephropathy, shortened graft function, and lower recipient life expectancy. The aim of this study was to present the initial results from a weight reduction in renal transplant recipients program. MATERIAL: Thirty-four overweight and obese kidney transplant recipients were enrolled in the study: 9 overweight (26%), 19 obese (55.8%), and 6 morbidly obese (17.6%). The control group encompassed 418 kidney transplant recipients, in whom fluctuations in body mass and body mass index (BMI) were monitored for 56 months. METHODS: During the first visit, we performed an account of dietary habits and anthropometric measurements. At the second visit following a 6-month interval, patients received dietary guidelines based on an analysis of diet questionnaires. RESULTS: Six months after enrollment, despite not having received dietary guidelines during the first visit, only 27% of study subjects and 80% of controls experienced weight gain. CONCLUSIONS: Patients enrolled in the first step of the weight reduction program had no weight nor BMI increase after 6 months. Recipients having experienced body mass increase constituted only 27% of the study group, whereas increase in body mass occurred in 80% of controls. Reducing body mass accretion in kidney transplant recipients should be the target of preventive measures and nonpharmacological therapeutic interventions conducted by qualified personnel. Greater interest by medical personnel in the issue of body mass increase in recipients may be a strong motivating factor for them to undertake weight loss measures.

Posttransplant overweight and obesity: myth or reality?

UNLABELLED: Posttransplant body mass index (BMI) increase in kidney transplant recipients is an underestimated issue, predisposing to morbidity linked with development of polymetabolic syndrome. AIM: The aim of the study was to assess the incidence of overweight and obesity among endstage renal disease patients before and after kidney transplantation. MATERIAL: Four hundred eighteen kidney graft recipients were enrolled in the study which lasted a mean of 56 months. Inhabitants of Lower Silesia (n = 3855) were used as controls. Overweight was defined as BMI between 25 and 30 kg/m(2) and obesity as >30 kg/m(2). METHODS: Mean BMI calculated in 418 patients, both pretransplant and after a 4.5-year observation period was compared with results of the Lower Silesian population. RESULTS: Mean pretransplant BMI in men (n = 242) and women (n = 189) was lower than in controls: men pretransplant BMI 24.3 kg/m(2) versus 25.7 kg/m(2) in the normal population; women, pretransplant BMI 23.17 kg/m(2) versus 25.2 kg/m(2) in the control group respectively. Mean total pretransplant BMI values increased from 23.82 to 25.9 kg/m(2) at last checkup ("last BMI"). A lesser posttransplant BMI increase was noted in men (7%) compared with women (9.6%). Before transplant, overweight or obesity occurred in 38% (n = 157), after a 4.5-year observation period, 65% (n = 232). CONCLUSIONS: Our observations documented that obesity is a widespread issue in kidney graft recipients, affecting two thirds of the population. It should be the target of preventive measures and nonpharmacologic therapeutic interventions.

Kidney transplantation and enzyme alpha-galactosidase A therapy in patient with Fabry disease: a case report.

Fabry disease, an X-linked recessive glycolipid storage disease, is caused by a deficiency of the lysosomal enzyme alpha-galactosidase A (alpha-Gal A), which cleaves a fatty substance called globotriaosylceramide (GL3). The abnormal storage of GL3 in blood vessel walls leads to ischemia and necrosis, particularly in blood vessels of the skin, kidneys, heart, brain, and nervous system. The aim of our study was to present the results of cadaveric kidney transplantation with enzyme alpha-Gal A therapy in a patient with Fabry disease. The patient was diagnosed with Fabry disease at the age of 33 years, based on enzymatic tests. Renal manifestations occurred a year later as proteinuria. At the age of 35 years, the glomerular filtration rate (GFR) was within the normal range. The patient received supplemental enzyme treatment with alpha-Gal (1 mg/kg every 2 weeks). At 3 months after starting supplementation, renal function worsened with serum creatinine levels at 1.7 to 1.8 mg/dL. The following months of supplementation (alpha-Gal 1 mg/kg) concurred with progressive renal dysfunction. After 27 months of supplementation at 37 years, with a creatinine value of 5.5 mg/dL, hemodialysis began and months later the patient received a cadaveric kidney graft. The patient no longer required dialysis. On postoperative day 5 the serum creatinine was 3.9 mg/dL; on day 7, 2.2 mg/dL; on day 14, 1.5 mg/dL. Enzyme supplementation began on posttransplant day 13. Renal graft function has been good during 5 months of observation with creatinine levels at 1.2 to 1.3 mg/dL. The treatment does not interfere with tacrolimus metabolism. Simultaneous chronic enzyme supplementation is the optimal treatment in the fifth stage of end-stage renal disease in Fabry disease.

Incidence and outcome of transplant renal artery stenosis: single center experience.

Since the incidence of transplant renal artery stenosis (TRAS) in renal allografts varies from 1% to 23%, we sought to examine its incidence, to analyze treatment options, and to ascertain its outcomes. Retrospective analysis of 793 kidney allograft recipients transplanted between 1996 and 2004 revealed an incidence of 0.9% (n = 7). Time from kidney transplantation to the first symptoms varied from 1 week to 3 years (median, 4 months). Three patients experiences refractory hypertension and six patients developed allograft dysfunction. Screening color Doppler ultrasonography showed hemodynamic changes in six patients with the definitive diagnosis confirmed by angiography in all patients. One patient with an anastomotic stenosis was treated with a surgical operation and six patients, percutaneous transluminal angioplasty (PTA), with stenting in three cases. Both surgical as well as PTA treatment were successful in all but one patient, who underwent PTA alone, developed chronic renal insufficiency necessitating hemodialysis and finally lost his allograft. In the other patients all symptoms resolved after treatment and the patients are doing well with functioning allografts. Although TRAS was an uncommon complication, if recognized promptly it could be treated by surgery or PTA with a high success rate.

Immunocytological urinalysis and monocyte chemotactic peptide-1 in renal transplant recipients with polyomavirus replication.

In some patients polyomavirus replication induces chronic tubulointerstitial inflammation in the transplanted kidney. The aim of this study was to investigate whether immunocytological urinalysis and monocyte chemoattractant protein-1 (MCP-1) assays could be used for an early diagnosis of nephropathy for patients with polyomavirus replication. We analyzed 1189 urine sediments from 174 renal allograft recipients who were transplanted between 2000 and 2005. Decoy cells were identified by an immunofluorescence method using specific antibodies (JC/BK monoclonal antibody). A similar method was used to detect CD3(+), CD14(+), and HLA-DR(+) cells with appropriate antibodies. The urinary excretion of MCP-1 was assayed by enzyme-linked immunosorbent assay. The results of urine sediment analysis and MCP-1 concentrations were compared with those of patients with stable graft function (control group n = 65). In 17 patients (10%) decoy cells were identified in urine. In 12 patients polyomavirus DNA was detected in plasma or urine by a polymerase chain reaction method. Polyomavirus nephropathy was diagnosed in eight patients by the presence of intranuclear viral inclusions or immunohistochemical staining with SV40 large T-antigen specimens from a renal biopsy, as well as by clinical and histopathological evidence (group I). Polyomavirus replication was diagnosed in four patients by urinary excretion of decoy cells and polyomavirus DNA detection (group III). In five patients only decoy cells were found. The patients of groups I and II showed an increased number of CD3, CD14, HLA-DR surface antigen-positive cells and greater excretion of MCP-1 compared with the control group (P < .02). The number of excreted cells was higher among patients with more severe infiltration. The results of patients from group III were similar to the control group. In conclusion, increased excretion of cells with CD3, CD14, and HLA-DR surface antigens and of MCP-1 were associated with intragraft tubulointerstitial inflammation in patients with polyomavirus nephropathy. Asymptomatic polyomavirus replication was associated with hidden tubulointerstitial inflammation. Monitoring cell excretion and chemokine content may be utilized for early detection of polyomavirus-induced nephropathy.

Biopsy eosinophilia as a predictor of renal graft dysfunction.

AIM: The aim of this research was to assess the impact of eosinophilia in renal biopsy specimens obtained during an acute rejection (AR) episode on the severity and reversibility of rejection and on long-term graft function. MATERIAL: Among 165 renal graft recipients who underwent transplantation (Tx) in 2001 and 2002 whose biopsy specimens revealed AR, 49 with tissue eosinophilia were compared with control group of 48 without this feature. The average biopsy time was 60.6 and 95.8 days, respectively. Biopsies during delayed graft function were performed in 46.9% of patients with eosinophilia and 29% in the control group. The immunosuppressive regimen was based on tacrolimus or cyclosporine. RESULTS: Tissue eosinophilia was observed in 49 of 165 patients (29.6%): 5 patients had eosinophilia <10/mm(2), 31 patients 10-100/mm(2), 13 patients >100mm(2) (3 patients >300/mm(2)). Severity of AR according to Banff score was statistically lower in the control group (P <.002). Patients with tissue eosinophilia who initially received steroid-free treatment presented with significantly higher (P =.02) biopsy/patients index (2.3 vs 1.81) than the total eosinophilic group. Serum creatinine values at 6 and 12 months after transplantation (Tx) were higher among eosinophilic when compared with the control group (2.41 vs 1.82 mg/dL, P <.002; 2.10 vs 1.98 mg/dL, P =.006, respectively). Chronic rejection within the first year occurred in 25% of patients with tissue eosinophilia, and 8.3% of patients in the control group. One-year graft survival rate among patients with tissue eosinophilia was lower compared with the control group (89.8% and 93.7%, respectively). CONCLUSIONS: Biopsy eosinophilia is a negative predictor that indicates a more severe course of AR and a worse response to treatment with the threat of chronic graft dysfunction.

The development and evolution of U.S. Army field rations.

Armed conflicts create large masses of personnel that need to be fed nutritious foods in less than favorable conditions. The United States military, private industry, and academia continue to work together to develop rations that meet the needs of military personnel who find themselves in varying climates, conditions, and geography.