RESUMO
BACKGROUND: Cystinosis is a rare genetic disorder characterized by the abnormal accumulation of cystine in the lysosomes of various tissues and organs leading to their dysfunction. The most common type is the infantile nephropathic cystinosis which without treatment leads to renal failure and before the introduction of cysteamine was the cause of death before puberty. CASE PRESENTATION: A 27-year-old female patient with infantile cystinosis developed end-stage renal disease at the age of 10. The first kidney transplantation from patient's father was carried out at the age of 12. The recurrent urinary tract infections led to the graft failure after 6 years. Following the removal of right appendages due to the ovarian tumor, the patient underwent the second kidney transplantation from her mother at the age of 19. After the transplantation, the cysteamine treatment was irregular due to limited availability of the medicine. When it became regular in 2017 the patient did not tolerate full doses. Despite elevated blood levels of cystine and the removal of right appendages, the patient naturally became pregnant in August 2017. Except for recurrent urinary tract infections, the renal parameters remained normal throughout the entire pregnancy. However, in the 32nd week of gestation, due to preeclampsia a caesarean section was performed. A healthy daughter was born, 1400/41 and with a 9 point Apgar score. CONCLUSIONS: Due to the possibility of treatment with cysteamine and kidney transplantations, patients with cystinosis live longer and their quality of life improves. These female patients can even naturally become pregnant and give birth to healthy children.
Assuntos
Cistinose , Complicações na Gravidez , Adulto , Cesárea , Cisteamina/uso terapêutico , Eliminadores de Cistina/uso terapêutico , Cistinose/terapia , Feminino , Humanos , Transplante de Rim , Gravidez , Resultado da GravidezRESUMO
OBJECTIVE: There are no specific recommendations for therapeutic plasma exchange (TPE) in children after renal transplantation. The purpose of this study was to report the experience with TPE in a pediatric transplant setting. MATERIALS AND METHODS: 59 patients (mean age 12.5 ± 4.5 years) undergoing renal transplantation. Indications for TPE included the recurrence of nephrotic syndrome (NS; n = 30) and atypical hemolytic uremic syndrome (n = 6), chronic antibody-mediated rejection (cAMR; n = 20), sensitization (n = 2), and immune thrombocytopenia (n = 1). The single-filtration TPE was performed in all cases. In 74.7% of patients, fresh frozen plasma was used as a replacement fluid. In 25.3% of patients, 4% albumin solution was used as a replacement fluid. Criteria for TPE efficacy included a decrease of proteinuria and normalization of renal function in NS; a normalization of platelet count, C3, and hemoglobin concentration in aHUS; improvement in renal function; and reduction of donor-specific antibodies in cAMR; and removal of antiplatelet antibodies in immune thrombocytopenia. RESULTS: Efficacy results for patients with NS: 59.3% achieved remission, 25.9% achieved partial remission, and 14.8% achieved no remission, respectively. For patients with atypical hemolytic uremic syndrome there was remission in 66.6% and no remission in 33.4%. For patients with cAMR there was remission in 75% and no remission in 25%. Antiplatelet antibodies disappeared after TPE in 1 patient. In 9% of TPE procedures, minor complications were noted. All patients were on posttransplant maintenance immunosuppression and several children received additional treatment (intravenous immunoglobulin therapy or rituximab) during TPE therapy. CONCLUSION: TPE therapy (combined with immunosuppression) was an effective tool in most pediatric cases after renal transplantation with low incidence of minor adverse events.
Assuntos
Terapia de Imunossupressão/métodos , Transplante de Rim/efeitos adversos , Troca Plasmática/métodos , Complicações Pós-Operatórias/terapia , Adolescente , Síndrome Hemolítico-Urêmica Atípica/etiologia , Síndrome Hemolítico-Urêmica Atípica/terapia , Criança , Feminino , Rejeição de Enxerto/terapia , Humanos , Masculino , Síndrome Nefrótica/etiologia , Síndrome Nefrótica/terapia , Púrpura Trombocitopênica Idiopática/etiologia , Recidiva , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Combined liver-kidney transplantation (CLKT) is a rare procedure in pediatric patients in which liver and kidney from 1 donor are transplanted to a recipient during a single operation. The aim of our study was to analyze indications and results of CLKT in children. MATERIALS AND METHODS: Between 1990 and 2017 we performed 722 liver transplantations in children; we performed 920 kidney transplantations in children since 1984. Among them, 25 received CLKT. Primary diagnosis was fibro-polycystic liver and kidney disease in 17 patients, primary hyperoxaluria type 1 in 6 patients, and atypical hemolytic uremic syndrome-related renal failure in 2 children. Age of patients at CLKT was 3 to 23 years (median 16 years) and body mass was 11 to 55 kg (median 35.5kg). All patients received whole liver graft. Kidney graft was transplanted after liver reperfusion before biliary anastomosis. Cold ischemia time was 5.5 to 13.3 hours (median 9.4 hours) for liver transplants and 7.3 to 15 hours (median 10.4 hours) for kidney transplants. In 8 patients X-match was positive. We analyzed posttransplant (Tx) course and late results in our group of pediatric recipients of combined grafts. RESULTS: Tx follow-up ranged from 1.5 to 17 years (median 4.5 years). Two patients died: 1 patient with oxalosis lost renal graft and died 2.6 years after Tx due to complications of long-term dialysis, and 1 died due to massive bleeding in early postoperative period. Twelve patients were transferred under the care of adult transplantation centers. Six patients were dialyzed after CLKT due to acute tubular necrosis, and time of kidney function recovery was 10 to 27 days in these patients. In 1 patient with aHUS, renal function did not recover. In children with oxalosis, hemodialysis was performed for 1 month after Tx as a standard, with the aim to remove accumulated oxalate. Primary immunosuppression consisted of daclizumab or basiliximab, tacrolimus, mycophenolate mofetil, and steroids. Acute rejection occurred in 4 liver and 3 kidney grafts. One patient required liver retransplantation due to hepatitis C virus recurrence and 2 patients required kidney retransplantation. Two patients required dialysis. CONCLUSIONS: CLKT in children results in low rate of rejection and high rate of patient and graft survival.
Assuntos
Transplante de Rim/métodos , Transplante de Fígado/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
IgA nephropathy (IgAN) is the most common form of glomerulonephritis in pediatric population. The clinical presentation of the disease in children ranges from microscopic hematuria to end-stage kidney disease. The aim of the study was to retrospectively assess clinical and kidney biopsy features in children with IgAN. We assessed a cohort of 140 children, 88 boys, 52 girls with the diagnosis of IgAN in the period of 2000-2015, entered into the national Polish pediatric IgAN registry. The assessment included the following: proteinuria, hematuria, glomerular filtration rate (GFR), arterial blood pressure, and the renal pathological changes according to the Oxford classification and crescents formation, as modifiable and unmodifiable risk factors. The incidence of IgAN in Poland was set at 9.3 new cases per year. The mean age at onset of IgAN was 11.9 ± 4.3 years, and the most common presentation of the disease was the nephritic syndrome, recognized in 52 % of patients. Kidney biopsy was performed, on average, 1.3 ± 2.0 years after onset of disease. Based on the ROC analysis, a cut-off age at onset of disease for GFR <90 mL/min/1.73 m2 (risk factor of progression) was calculated as 13.9 years. Unmodifiable lesions: segmental sclerosis, tubular atrophy/interstitial fibrosis (S1, T1-2) in the Oxford classification and crescents in kidney biopsy were significantly more common in Gr 1 (>13.9 years) compared with Gr 2 (<13.9 years), despite a significantly shorter time to kidney biopsy in the former. We conclude that IgAN in children may be an insidious disease. A regular urine analysis, especially after respiratory tract infections, seems the best way for an early detection of the disease.
Assuntos
Glomerulonefrite por IGA/epidemiologia , Glomerulonefrite por IGA/patologia , Rim/patologia , Sistema de Registros/estatística & dados numéricos , Adolescente , Análise de Variância , Biópsia , Pressão Sanguínea , Criança , Feminino , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/diagnóstico , Hematúria/diagnóstico , Humanos , Incidência , Masculino , Polônia/epidemiologia , Proteinúria/diagnóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
The aim of the study was to determine whether an elevated IgA level at the time of the diagnosis of IgA nephropathy has an effect on the severity of kidney biopsy findings and long-term outcomes in children. We retrospectively studied 89 children with IgA nephropathy who were stratified into Group 1- elevated serum IgA and Group 2 - normal serum IgA at baseline. The level of IgA, proteinuria, hematuria, glomerular filtration rate (GFR) and hypertension (HTN) were compared at baseline and after the end of the follow-up period of 4.0 ± 3.1 years. Kidney biopsy findings were evaluated using the Oxford classification. The evaluation of treatment included immunosuppressive therapy and renoprotection with angiotensin converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), or no treatment. The elevated serum IgA was found in 46 (52 %) patients and normal serum IgA level was found in 43 (48 %) patients. No differences were found between the two groups regarding the mean age of patients, proteinuria, and the number of patients with reduced GFR or HTN at baseline. In kidney biopsy, mesangial proliferation and segmental sclerosis were significantly more common in Group 1 compared with Group 2 (p < 0.05). Immunosuppressive therapy was used in 67 % children in Group 1 and 75 % children in Group 2. The Kaplan-Meier survival curves for renal function (with normal GFR) and persistent proteinuria did not differ significantly depending on the serum IgA level at baseline. We conclude that in IgA nephropathy the elevated serum IgA at baseline may be associated with mesangial proliferation and segmental sclerosis contribute to glomerulosclerosis, but has no effect on the presence of proteinuria or on the worsening of kidney function during several years of disease course.
Assuntos
Glomerulonefrite por IGA/sangue , Glomerulonefrite por IGA/patologia , Imunoglobulina A/sangue , Adolescente , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Biópsia , Criança , Feminino , Seguimentos , Taxa de Filtração Glomerular , Glomerulonefrite por IGA/terapia , Humanos , Hipertensão Renal/complicações , Hipertensão Renal/patologia , Imunossupressores/uso terapêutico , Estimativa de Kaplan-Meier , Rim/patologia , Testes de Função Renal , Masculino , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
INTRODUCTION: Kidney transplantation is efficacious as a renal replacement, particularly pre-emptive living donation. In Poland, the rate of transplantation of living donor kidneys is only 3%. The aim of the study was to identify the most common reasons to disqualify a potential living kidney donor. METHODS: We evaluated 124 kidney donor candidates for 111 potential recipients at 1 medical center for genders and ages of donor and recipient; thus relation, donor disqualification reasons, number of potential donors for a particular recipient, prior transplantations, and kidney vasculature. RESULTS: The 111 recipients of ages 2-62 years had, 1, 2, or 3 potential donors were tested in 101, 1, and 7, cases respectively. We had 18.9% recipients referred for pre-emptive transplantation; 59.5% were on haemodialysis and 21.6% on peritoneal dialysis. In all, 89% recipients sought first kidney transplantations. Kidneys were procured from 49/124 (39.5%) of the initially evaluated donors. The full examination was completed by 92 potential donors with 68/124 donors disqualified early. Single and multiple renal arteries were detected in 56 and 36 potential donors, respectively. Donor disqualification was due to medical contraindications (39.7%), earlier transplantation from a deceased donor (25%), immunologic constraints (23.5%), donor consent withdrawn (6%) or psychological and social reasons (4.4%). CONCLUSIONS: A considerable number of donor candidates are disqualified for medical reasons.
Assuntos
Transplante de Rim , Doadores Vivos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Polônia , Obtenção de Tecidos e Órgãos , Adulto JovemRESUMO
BACKGROUND: The results of pediatric renal transplantation have improved markedly in the last decade. However, a number of relevant clinical problems remain, such as organ damage caused by chronic rejection, long-term toxicity of immunosuppressive therapy, difficulty in developing tolerance-inducing protocols, secondary cardiovascular comorbidity, post-transplantation lymphoproliferative disease, suboptimal longitudinal growth, quality of life, adherence to immunosuppressive medication, and structured transition programs to adult care. These unmet clinical needs require intense collaborative and interdisciplinary clinical research. We recently founded the Cooperative European Paediatric Renal TransplAnt INitiative (CERTAIN; www.certain-registry.eu) as a research network and platform built on a novel, web-based registry. RESULTS: The registry's dataset provides essential information on generic kidney transplantation-related topics and also captures pediatric-specific topics, such as growth, physical and psychosocial development, and adherence. Due to its flexibility the system can be used as follows: (1) as a registry capturing a minimal or an extended dataset; (2) as a center and/or country-specific transplantation database; or (3) as a patient-specific electronic transplantation chart. The data can be exported directly from the CERTAIN web application into statistical software packages for scientific analyses. The rights regarding data ownership, evaluation, and publications are regulated in the registry's rules of procedure. Data quality is ensured by automatic software validation and a manual data review process. To avoid redundant data entry, CERTAIN has established interfaces for data change with Eurotransplant, the Collaborative Transplant Study (CTS), and the registry of the European Society of Pediatric Nephrology (ESPN) and European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) (ESPN/ERA-EDTA registry). CERTAIN fulfils all regulatory and ethical requirements of the European Union and Germany, in particular, regarding patients' data privacy and security. CONCLUSION: Using modern information technology, the recently established multinational CERTAIN Registry fills a gap in Europe for collaborative 5 research and quality assurance in the field of pediatric renal transplantation.
Assuntos
Internet , Transplante de Rim , Sistema de Registros , Criança , Europa (Continente) , HumanosRESUMO
We aimed to provide an overview of kidney allocation policies related to children and pediatric kidney transplantation (KTx) practices and rates in Europe, and to study factors associated with KTx rates. A survey was distributed among renal registry representatives in 38 European countries. Additional data were obtained from the ESPN/ERA-EDTA and ERA-EDTA registries. Thirty-two countries (84%) responded. The median incidence rate of pediatric KTx was 5.7 (range 0-13.5) per million children (pmc). A median proportion of 17% (interquartile range 2-29) of KTx was performed preemptively, while the median proportion of living donor KTx was 43% (interquartile range 10-52). The median percentage of children on renal replacement therapy (RRT) with a functioning graft was 62%. The level of pediatric prioritization was associated with a decreased waiting time for deceased donor KTx, an increased pediatric KTx rate, and a lower proportion of living donor KTx. The rates of pediatric KTx, distribution of donor source and time on waiting list vary considerably between European countries. The lack of harmonization in kidney allocation to children raises medical and ethical issues. Harmonization of pediatric allocation policies should be prioritized.
Assuntos
Regulamentação Governamental , Falência Renal Crônica/terapia , Transplante de Rim/estatística & dados numéricos , Transplante de Rim/tendências , Seleção de Pacientes , Padrões de Prática Médica , Adolescente , Adulto , Criança , Definição da Elegibilidade , Europa (Continente) , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Humanos , Falência Renal Crônica/mortalidade , Transplante de Rim/legislação & jurisprudência , Masculino , Sistema de Registros , Taxa de Sobrevida , Doadores de Tecidos/estatística & dados numéricos , Listas de Espera , Adulto JovemRESUMO
Monitoring of circulating Epstein-Barr virus (EBV) DNA in pediatric transplant patients has been shown to be useful in post-transplant patient management. It still remains unclear which blood sample type is more suitable, and how EBV DNA levels in whole blood (WB) correlate with those in peripheral blood mononuclear cells (PBMCs). The aim of this study was to compare EBV DNA load in WB and PBMCs of pediatric transplant recipients. After liver, kidney, or combined liver-kidney transplantation, 172 matched WB and PBMCs samples were collected from 84 children (130 samples from 42 patients consisted of multiple collections). The EBV DNA level in PBMCs was determined by home-made real-time polymerase chain reaction using TaqMan chemistry. In parallel, the viral load (VL) in WB was measured by a commercial LightCycler EBV Quant Kit. The EBV DNA levels and dynamics of VL changes were assessed and compared between WB and PBMCs. The overall correlation between EBV DNA level in PBMCs and WB was statistically significant and high, r(2) =0.87 (P<0.001). However, the sensitivity of EBV detection was lower in WB (93.9%). Longitudinal analysis of EBV DNA load dynamics in PBMCs and WB indicated that EBV DNA load fluctuations were larger in WB, but the trend of decreases and increases, with minor exceptions, was similar in both sample types. The high correlation of EBV DNA levels, as well as the similar dynamics of EBV DNA changes in both sample types, make WB a good alternative to EBV DNA monitoring in PBMCs of pediatric transplant recipients. However, the subtle increase of the VL may be detected earlier in PBMCs.
Assuntos
Herpesvirus Humano 4/genética , Transplante de Rim/efeitos adversos , Leucócitos Mononucleares/virologia , Transplante de Fígado/efeitos adversos , RNA Viral/sangue , Carga Viral , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Adulto JovemRESUMO
Minimizing steroid exposure in pediatric renal transplant recipients can improve linear growth and reduce metabolic disorders. This randomized multicenter study investigated the impact of early steroid withdrawal on mean change in height standard deviation score (SDS) and the safety and efficacy of two immunosuppressive regimens during the first 6 months after transplantation. Children received tacrolimus, MMF, two doses of daclizumab and steroids until day 4 (TAC/MMF/DAC, n=98) or tacrolimus, MMF and standard-dose steroids (TAC/MMF/STR, n=98). Mean change in height SDS was 0.16 +/- 0.32 with TAC/MMF/DAC and 0.03 +/- 0.32 with TAC/MMF/STR. The mean treatment group difference was 0.13 (p < 0.005 [95% CI 0.04-0.22]), 0.21 in prepubertal (p = 0.009 [95% CI 0.05-0.36]) and 0.05 in pubertal children (p = ns). Frequency of biopsy-proven acute rejection was 10.2%, TAC/MMF/DAC, and 7.1%, TAC/MMF/STR. Patient and graft survival and renal function were similar. Significantly greater reductions in total cholesterol and triglycerides but significantly higher incidences of infection and anemia were found with TAC/MMF/DAC (p < 0.05 all comparisons). Early steroid withdrawal significantly aided growth at 6 months more so in prepubertal than pubertal children. This was accompanied by significantly better lipid and glucose metabolism profiles without increases in graft rejection or loss.
Assuntos
Anticorpos Monoclonais/administração & dosagem , Crescimento , Imunoglobulina G/administração & dosagem , Imunossupressores/administração & dosagem , Falência Renal Crônica/cirurgia , Transplante de Rim , Esteroides/administração & dosagem , Tacrolimo/administração & dosagem , Adolescente , Anticorpos Monoclonais Humanizados , Criança , Pré-Escolar , Daclizumabe , HumanosRESUMO
OBJECTIVE: The first kidney transplantation was performed in Poland in 1966. Since that time approximately 11,000 patients have undergone the procedure, but most of them have received the kidney from deceased donors; only 342 procedures utilized living donors (LD; 2.7%). The aim of this study was to review the results of a LD follow-up in Poland. PATIENTS AND METHODS: A questionnaire was sent to 11 centers that had performed 197 LD kidney transplantations during the last 10 years. The donors, who were all genetically or emotionally related, were 23 to 61 years old. No donor showed an abnormality regarding cardiovascular function or metabolic abnormalities. RESULTS: The 6 centers that responded reported data on 118 donors. In 2 centers no donor follow-up was available. Eleven of 118 donors did not attend the control visits. Follow-up of the remaining donors ranged from 2 to 8 years. Four donors died at 4 to 5 years after nephrectomy due to cerebral hemorrhage, brain tumor, stomach cancer, or car accident. The overall mean serum creatinine had increased from 0.8 to 1.25 mg/dL, but 2 patients displayed a value >2 mg/dL. The calculated creatinine clearance (MDRD formula) had decreased from 95 to 65 mL/min (P < .05). In 3 donors proteinuria (>0.6 g/24 h) was observed at 3 to 5 years after donation. Of 3 patients who experienced mild hypertension, 2 required treatment. The remaining donors showed normal blood pressures. CONCLUSIONS: Since 2007, when the Living Donor Registry was introduced by law, transplant centers have been obliged to report data on each LD procedure together with follow-up data. All donors are life-insured (by Alianz SA) for 3 months from the time of transplantation. Stepwise interventional reno- and cardioprotection programs have been introduced after nephrectomy for LD, especially those with metabolic abnormalities at the time of donation.
Assuntos
Doadores Vivos , Nefrectomia/métodos , Pressão Sanguínea , Creatinina/sangue , Seguimentos , Humanos , Falência Renal Crônica/etiologia , Nefrectomia/efeitos adversos , Nefrectomia/normas , Obesidade/etiologia , Polônia , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Coleta de Tecidos e Órgãos/efeitos adversos , Coleta de Tecidos e Órgãos/métodos , Coleta de Tecidos e Órgãos/normasRESUMO
In a 6-month, multicenter, randomized, controlled, open-label, parallel-group trial, we investigated the efficacy and safety of adding basiliximab to a standard tacrolimus-based regimen in pediatric renal transplant recipients. Patients < 18 years received tacrolimus/azathioprine/steroids (TAS, n = 93) or tacrolimus/azathioprine/steroids/basiliximab (TAS + B, n = 99). Target tacrolimus levels were 10-20 ng/mL between days 0-21 and 5-15 ng/mL thereafter. Steroid dosing was identical in both groups. Basiliximab was administered at 10 mg (patients < 40 kg) or 20 mg (patients > or = 40 kg) within 4 h of reperfusion; the same dose was repeated on day 4. Biopsy-proven acute rejection rates were 20.4% (TAS) and 19.2% (TAS + B); steroid-resistant acute rejection rates were 3.2% and 3.0%, respectively. Patient survival was 100%; graft survival rates were 95% in both arms. The nature and incidence of adverse events were similar in both arms except toxic nephropathy and abdominal pain, which were significantly higher in the TAS + B arm (14.1% vs. 4.3%; p = 0.03 and 11.1% vs. 2.2%; p = 0.02; respectively). Median serum creatinine concentrations at 6 months were 86 micromol/L in the TAS and 91 micromol/L in the TAS + B arm; glomerular filtration rate was 79.4 and 77.6 (mL/min/1.73 m2), respectively. Adding basiliximab to a tacrolimus-based regimen is safe in pediatric patients, but does not improve clinical efficacy.
Assuntos
Anticorpos Monoclonais/farmacologia , Transplante de Rim , Proteínas Recombinantes de Fusão/farmacologia , Tacrolimo/farmacologia , Adolescente , Anticorpos Monoclonais/efeitos adversos , Basiliximab , Biópsia , Criança , Pré-Escolar , Feminino , Seguimentos , Rejeição de Enxerto , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Masculino , Proteínas Recombinantes de Fusão/efeitos adversos , Tacrolimo/efeitos adversos , Tacrolimo/sangueRESUMO
INTRODUCTION: The final decision about transplantation is based primarily on a negative result of a complement-dependent cytotoxicity cross-match. The significance of a positive flow cytometric cross-match (FCXM) is unclear. MATERIALS AND METHODS: From July 2002 to October 2004, FCXM was performed prior to cadaveric kidney transplantation in 63 patients aged 1.5 to 26 years (mean 13 +/- 5). Immunosuppression (not adjusted to results of FCXM) was considered standard (prednisone + mycophenolate mofetil or azathioprine + cyclosporine or rapamycin) in 57%, or "enhanced" (+ monoclonal antibodies and/or tacrolimus) in 43% of patients. RESULTS: Immunoglobulin IgG and/or IgM antibodies against T and/or B cells were found in 14/63 patients (22.2%). The distribution of immunosuppressive regimens was similar for FCXM(+) and FCXM(-) patients. Deteriorated graft function (creatinine > or =1.5 mg/dL) or demand for dialysis was observed in 6/14 (42.9%) FCXM(+) group versus 6/49 (12.2%) in the FCXM(-) group. During the first month after kidney transplantation biopsy-proven rejection episodes occurred more frequently among the FCXM(+) than the FCXM(-) group: 21.4% versus 4.1%, respectively. During the first 3 months after transplantation two of four kidneys in the FCXM(+) group (14.3%) demonstrated histological evidence of rejection plus one case of immunological cause of graft failure later found to be associated with an extremely high panel-reactive antibodies that were absent before transplantation (altogether 21.4%). Only one kidney (2.0%) was lost due to rejection among the FCXM(-) group. CONCLUSION: A positive flow cytometric cross-match should be considered an important risk factor for early kidney graft dysfunction.
Assuntos
Citometria de Fluxo/métodos , Teste de Histocompatibilidade/métodos , Transplante de Rim/imunologia , Adolescente , Adulto , Cadáver , Criança , Pré-Escolar , Quimioterapia Combinada , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Imunossupressores/uso terapêutico , Lactente , Fatores de Risco , Doadores de Tecidos , Falha de Tratamento , Resultado do TratamentoRESUMO
Severe clinical course of acute renal and acute liver failure is recognized as life-threatening condition, often developing in critically ill patients, demanding intensive care. Continuous renal replacement techniques, including venovenous hemodialysis/hemofiltration/hemodiafiltration/ultrafiltration (CWHD/CWHF/CWHDF/SCUF) are becoming the therapeutic modality of choice in unstable patients with acute renal failure. Recently introduced new technique--albumin dialysis (MARS--Molecular Adsorbent Recirculating System) is a very useful extracorporeal method of detoxication in patients with acute liver or kidney/liver failure. It may also serve as bridge to liver transplantation in patients with rapidly deteriorating chronic liver failure. Indications, benefit/risk ratio and specific clinical and technical aspects are briefly described in this review paper.
Assuntos
Injúria Renal Aguda/terapia , Falência Hepática Aguda/terapia , Terapia de Substituição Renal , Humanos , Falência Hepática Aguda/cirurgia , Transplante de Fígado , Terapia de Substituição Renal/métodos , Resultado do TratamentoRESUMO
We describe a case of multi-organ failure (liver-kidney insufficiency and brain oedema) caused by accidental, acute intoxication with a chromium and copper-containing substance, as an example of the introduction of the new extracorporeal procedure MARS (molecular adsorbents recirculating system) in a girl 3.5 years old.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/terapia , Cromo/intoxicação , Cobre/intoxicação , Diálise Renal , Desintoxicação por Sorção , Doença Aguda , Doença Hepática Induzida por Substâncias e Drogas/cirurgia , Pré-Escolar , Evolução Fatal , Feminino , Humanos , Transplante de Rim , Falência Hepática Aguda/cirurgia , Falência Hepática Aguda/terapia , Transplante de FígadoAssuntos
Ciclosporina/uso terapêutico , Taxa de Filtração Glomerular , Sobrevivência de Enxerto/fisiologia , Transplante de Rim/fisiologia , Tacrolimo/uso terapêutico , Adolescente , Criança , Ciclosporina/administração & dosagem , Emulsões , Feminino , Seguimentos , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Masculino , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do TratamentoAssuntos
Antígenos HLA/imunologia , Isoanticorpos/sangue , Transplante de Rim/imunologia , Complicações Pós-Operatórias/etiologia , Trombose/etiologia , Soro Antilinfocitário/sangue , Biomarcadores/sangue , Criança , Teste de Histocompatibilidade , Humanos , Polônia , Estudos Retrospectivos , Fatores de Tempo , Falha de TratamentoRESUMO
Many clinical aspects associated with chronic uraemia and long-term dialysis therapy may determine both the qualification for renal transplantation and post-transplant outcome. These include dialysis access, severe hyperparathyroidism, inadequate or excessive erythropoietin production, heart failure, viral hepatitis, defects of urinary tract and malnutrition. Some of them delay the qualification for transplant, the other on contrary make the need for transplantation very urgent. Selected aspects are discussed in this paper.
Assuntos
Falência Renal Crônica/terapia , Transplante de Rim , Insuficiência Cardíaca/etiologia , Hepatite Viral Humana/etiologia , Humanos , Hiperparatireoidismo/etiologia , Falência Renal Crônica/complicações , Distúrbios Nutricionais/etiologia , Seleção de Pacientes , Diálise Renal/efeitos adversos , Resultado do Tratamento , Infecções Urinárias/etiologiaRESUMO
We examined the plasma profile of sulfur amino acids (SAA) in patients with chronic renal failure (CRF) and looked for any correlation with serum folate (FA) and/or vitamin B12. Group 1 comprised 9 patients with CRF and glomerular filtration rate (GFR) >20 ml/min per 1.73 m2, 9 patients with GFR<20 ml/min per 1.73 m2 comprised group 2, and 14 patients on hemodialysis group 3. The control group comprised 16 healthy children. Homocysteine (Hcy), methionine (Met), cysteine (Cys), and serine (Ser) were measured with gas chromatography. FA and vitamin B12 were measured using enzymatic immunoassay. Median SAA concentrations were significantly lower in controls than in the three groups of patients. Hcy concentrations were 0.8 micromol/l in controls versus 5 micromol/(group 1), 9 micromol/l (group 2), and 20 micromol/l (group 3). Met concentrations were 26 micromol/l in controls versus 26 micromol/l (group 1), 66 micromol/l (group 2), and 281 micromol/l (group 3). Cys concentrations were 10 micromol/ in controls versus 98 micromol/l (group 1), 54 micromol/l (group 2), and 122 micromol/l (group 3). Ser concentrations were 88 micromol/ in controls versus 153 micromol/l (group 1), 239 micromol/l (group 2), and 240 micromol/l (group 3). The median concentrations of FA were lower in controls than in groups 2 and 3: 5.5 ng/ml versus 8 ng/ml and 15 ng/ml, respectively. Vitamin B12 concentrations did not differ between groups. Vitamin levels did not correlate with SAA. The only difference between patients with Hcy levels in the lower and upper quartile was in Met concentration (38 vs. 263 micromol/l, P<0.02) and GFR (P<0.01). In conclusion, patients with CRF had higher SAA concentrations than healthy children. FA concentrations are higher in CRF patients than in healthy children but did not correlate with concentrations of SAA.
Assuntos
Aminoácidos Sulfúricos/sangue , Ácido Fólico/sangue , Insuficiência Renal/sangue , Vitamina B 12/sangue , Adolescente , Adulto , Criança , Dieta , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Insuficiência Renal/fisiopatologiaRESUMO
Survival and causes of death in children dialyzed in a single center were analyzed. During the last 12 years a chronic dialysis program was introduced in 146 children in our center and 125 of them, eligible for observation, were included in this analysis; 58 patients were on hemodialysis (HD) and 67 on peritoneal dialysis [continuous ambulatory peritoneal dialysis/automated peritoneal dialysis (CAPD/APD)]. Mean age at the start of dialysis was 13.1 years in HD and 9.8 years in CAPD/APD patients. Overall, 16 patients died (12.5%); 6 (10.3%) on HD and 10 (14.9%) on CAPD/APD; 4 HD patients died of hemorrhagic stroke and 2 were killed in road traffic accidents. Of 10 CAPD/APD patients, 7 died of heart failure, ischemic stroke, and/or disseminated thromboembolic disease. Another was killed in a road traffic accident and 2 died during the course of severe infections. The 1-year patient survival rate was 96.6% in HD patients and 95% in CAPD/APD patients, 2-year survival 94% and 93% and 5-year survival 91% and 78%, respectively (P=0.2, NS). In conclusion, the survival rate for HD and CAPD patients is similar, although after 2 years of therapy, it is lower in CAPD patients. The main causes of death are cardiovascular. However, in CAPD/APD patients, heart failure with low cardiac output and thromboembolic complications are major causes of death, and in HD patients the main cause is hemorrhagic stroke.