Significance of preimplantation analysis of kidney biopsies from expanded criteria donors in long-term outcome.

BACKGROUND: The shortage of organs has led to expanding the criteria for donors. Histologic evaluations before transplantation may enable the identification of organs unsuitable for single implantation. The aim of this study was to evaluate the histologic findings as prognostic factors of allograft survival from expanded criteria donors (ECDs). METHODS: We included a cohort of 136 single transplantations with kidneys from ECD and correlated the preimplantation pathologic findings with graft failure. Renal structures from ECD older (n=104) or younger (n=32) than 60 years were evaluated histologically for renal senescence and rated with a total histologic score. A multivariate Cox analysis was performed to identify predictors of graft failure. RESULTS: Glomerulosclerosis was the most prevalent lesion in biopsies from donors older and younger than 60 years (P=0.002); interstitial fibrosis was more severe in biopsies from older donors (P=0.001); older donors showed a higher prevalence of tubular atrophy (P=0.022), and vascular compartment showed no significant differences. Kidney biopsy-based scoring system ranged from 0 to 15 points, indicating the presence of changes in the renal parenchyma. Biopsies with total histologic scores less than or equal to 5 showed significantly better 5-year graft survival than those with scores more than 5 (P<0.001). A preimplantation score more than 5 points remained an independent predictor of graft failure (hazard ratio 6.95; 95% confidence interval 1.57-30). CONCLUSIONS: Histologic analysis of kidney biopsies before transplantation is a valuable tool for facilitating the selection of viable grafts from ECD donors. When the total score is more than 5, single kidney transplantation from ECD should not be recommended for patients similar to this study population.

Mesangial C4d deposition: a new prognostic factor in IgA nephropathy.

BACKGROUND: It has been shown that patients with IgA nephropathy can be divided into two groups on the basis of the pattern of complement activation. Activation of the lectin pathway of complement is associated with more severe renal disease. Glomerular deposition of C4d is a marker of activation of the lectin pathway of complement. The aim of our study was to determine whether C4d staining at the time of the renal biopsy could identify patients with a different long-term prognosis in IgA nephropathy. METHODS: This retrospective cohort study included all patients with IgA nephropathy who underwent renal biopsy at our centre from January 1992 to December 2006. We evaluated baseline age, sex, presence of macroscopic haematuria, hypertension, serum creatinine and glomerular filtration rate (GFR), urine protein, mesangial C4d staining, glomerulosclerosis, interstitial fibrosis and extracapillary proliferation. Kaplan-Meier survival and Cox proportional hazards analyses were performed, with end-stage renal disease (ESRD) being defined as onset of dialysis or transplantation. RESULTS: Nineteen patients (32.2%) were C4d positive and 40 patients (67.8%) C4d negative. Age, hypertension, absence of macroscopic haematuria, serum creatinine levels, GFR, glomerular sclerosis, interstitial fibrosis and C4d-positive staining were all univariately associated with evolution to ESRD. Renal survival at 10 years was 43.9% in C4d-positive patients versus 90.9% in C4d-negative patients (log-rank, P = 0.0005). CONCLUSION: Negative mesangial C4d staining in glomeruli in patients with IgA nephropathy helps to identify patients with a good long-term prognostic for whom aggressive treatments are not justified.

Necrotizing glomerulonephritis and pulmonary hemorrhage associated with carbimazole therapy.

Methimazole, carbimazole, and propylthiouracil (PTU) are the mainstays of antithyroid drug therapy. Adverse effects of these drugs have been documented in less than 15% of patients undergoing treatment for hyperthyroidism. Common problems include fever, skin rash, urticaria, arthralgias, and arthritis. Vasculitis associated with antineutrophil anticytoplasmic antibodies (ANCA) has been reported on several occasions following treatment with PTU. However, vasculitis rarely appears to be associated with carbimazole. We report the clinical history of a woman with a necrotizing glomerulonephritis and pulmonary hemorrhage associated with carbimazole therapy.

[Effects of stem-cell mobilization with recombinant human granulocyte colony stimulating factor in patients with percutaneously revascularized acute anterior myocardial infarction]. / Efectos de la movilización de células madre mediante el uso de factor estimulante de colonias granulocíticas en pacientes con infarto agudo de miocardio anterior revascularizado percutáneamente.

INTRODUCTION AND OBJECTIVES: This study reports the findings in a group of 13 patients aged 53+/-8 years with anterior wall acute myocardial infarction who were revascularized with stents and treated with recombinant human granulocyte colony stimulating factor (G-CSF). PATIENTS AND METHOD: Patients were initially treated with intravenous thrombolytics. The first cardiac catheterization was performed between days 0 and 5 after acute myocardial infarction, when the left anterior descending artery was stented. A 10-day course of 10 .g/kg/day G-CSF was started 5 days after acute myocardial infarction. Blood cell counts and immunophenotyping were done to assess the total number of circulating CD34+ cells and their subpopulations in serial fashion. At 3-month follow-up, cardiac catheterization was repeated. Functional recovery was defined as an increase in ejection fraction. RESULTS: All patients did well initially, but 1 had spontaneous spleen rupture on day 8 of G-CSF administration, which required emergency splenectomy. The gain in ejection fraction varied among patients from -22 to +18 (mean, 6.2%+/-12%), and correlated directly with the total number of circulating CD34+ CD38- cells/microL on the fifth day of G-CSF treatment (r=0.78; P<.003). The gain in ejection fraction correlated inversely with peak MB fraction creatine kinase (r=-0.82; P<.002). CONCLUSION: Stem-cell mobilization with G-CSF is a feasible and safe treatment for patients with revascularized acute myocardial infarction. However, because of the possibility of acute splenitis induced by massive cell mobilization, future studies should be designed with due caution to take this eventuality into account.

Comparative study of the immunohistochemical phenotype in breast cancer and its lymph node metastatic location.

At present, an important part of prognostic information, together with particular treatment strategies in breast cancer, take into account the immunohistochemical phenotype of the primary tumor location. However, the changing heterogeneity intrinsic to neoplastic cells in general leads us to consider the possibility that the expression of these proteins is modified during tumoral development and dissemination. With this hypothesis as a starting point, 60 patients with breast cancer were studied with immunohistochemistry, the expression of estrogen and progestagenic receptors, proliferation through the Ki-67 expression, and the overexpression of HER-2 and p53 in both the primary location and the lymph node metastases. If we consider significant change to be loss (from positive to negative) or gain (negative to positive) of expression in some of the studied determinations, we find that this is produced in 60% of the tumors studied. These results demonstrate the modification of immunohistochemical expression of the proteins studied between the primary tumor location and the lymph node metastases.

Isolated oesophageal involvement of Crohn's disease.

A 31-year-old male was admitted with complaints of dysphagia and odynophagia. An upper gastrointestinal tract series revealed inflammatory changes in the mid and distal oesophagus with intramural extravasation of the barium. An upper endoscopy showed multiple ulcerations and inflammation. The patient developed a large stricture with no response to serial endoscopic dilations and a surgical resection of the oesophagus was required. Gross examination of the surgical specimen revealed transmural inflammation, deep ulcerations and non-necrotizing epithelioid cell granuloma. All these pathological findings were characteristic of Crohn's disease of the oesophagus. After 36 months of follow-up there has been no recurrence of symptoms or of other sites of involvement.

[Isolated form of spongy myocardiopathy]. / Forma aislada de miocardiopatía espongiforme.

Noncompaction of the ventricular myocardium sometimes referred to as spongy myocardium, is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. The characteristic echocardiographic findings of this disease consist of multiple myocardial trabeculations and deep intertrabecular recesses communicating with the left ventricular cavity. Familial occurrence has been observed. We present an illustrative case of isolated noncompaction of the ventricular myocardium in a 16-year-old patient, with the typical clinical and echocardiographic features of the disease. The literature on the topic is reviewed.