Kidney Transplantation: The Challenge of Human Leukocyte Antigen and Its Therapeutic Strategies.

Kidney transplantation remains the treatment of choice for end-stage renal failure. When the immune system of the recipient recognizes the transplanted kidney as a foreign object, graft rejection occurs. As part of the host immune defense mechanism, human leukocyte antigen (HLA) is a major challenge for graft rejection in transplantation therapy. The impact of HLA mismatches between the donor and the potential recipient prolongs the time for renal transplantation therapy, tethered to dialysis, latter reduces graft survival, and increases mortality. The formation of pretransplant alloantibodies against HLA class I and II molecules can be sensitized through exposures to blood transfusions, prior transplants, and pregnancy. These preformed HLA antibodies are associated with rejection in kidney transplantation. On the other hand, the development of de novo antibodies may increase the risk for acute and chronic rejections. Allograft rejection results from a complex interplay involving both the innate and the adaptive immune systems. Thus, further insights into the mechanisms of tissue rejection and the risk of HLA sensitization is crucial in developing new therapies that may blunt the immune system against transplanted organs. Therefore, the purpose of this review is to highlight facts about HLA and its sensitization, various mechanisms of allograft rejection, the current immunosuppressive approaches, and the directions for future therapy.

Clinical profile and outcome of patients with acute kidney injury requiring dialysis-an experience from a haemodialysis unit in a developing country.

BACKGROUND: The first government funded and sustainable dialysis unit was established in Ethiopia at Saint Paul's Hospital Millennium Medical College (SPHMMC). This has led to the development of a unique cohort of patients about which very little is known. This study was conducted to describe the clinical profile and outcome of adult Acute Kidney Injury (AKI) patients treated with intermittent haemodialysis at the dialysis center of SPHMMC. METHODS: A retrospective review of clinical records of cases of AKI who required haemodialysis support during the time period from August 1, 2013 to February 1, 2015 was conducted. RESULTS: A total of 151 cases AKI requiring dialysis were included for the study. Overall, the patients were generally younger with a mean age of 36.7 years and thus with few premorbid conditions. The most common causes of AKI were hypovolemia (22.5 %), acute glomerulonephritis (AGN) (21.9 %) and pregnancy related causes (18.5 %). Nearly a third (29.1 %) of patients succumbed to the AKI. CONCLUSION: Infections, AGN, obstetric causes and nephrotoxins were the primary causes of dialysis requiring AKI. Most of these causes can be prevented with simple interventions such as health education on oral rehydration, quality prenatal and emergency obstetric care, appropriate management of infections and taking appropriate precautions when prescribing potentially nephrotoxic medications.

Quality of life in patients on continuous ambulatory peritoneal dialysis in an African setting.

To determine the quality of life (QOL) of patients on continuous ambulatory peritoneal dialysis (CAPD), we studied all the CAPD patients attending their monthly follow-up care clinics at three tertiary hospitals in Johannesburg by administering the World Health Organization QOL-Bref questionnaire. The patients were grouped according to age, duration of peritoneal dialysis and gender. Data were analyzed to determine the significant differences in the QOL scores among the subgroups. There were 114 patients [64 males (56.1%), with a mean age of 42.4 ± 11.3 years) and 38 healthy control subjects (22 males (57.9%), with a mean age of 42.1 ± 12.4 years]. Twenty-one patients (18.4%) had hemoglobin <10 g/dL, while 16 patients (14%) had serum albumin <3 g/dL. The mean QOL scores in the physical, psychological, social relationships and environment domains of the CAPD patients were 55.7 ± 15.0, 56.6 ± 16.4, 55.3 ± 24.7 and 56.3 ± 16.6, respectively. The CAPD patients had significantly lower QOL scores compared with controls, and those aged <30 years had better scores in the physical and psychological domains, gender and hemoglobin concentration. Serum albumin levels did not have a significant impact on the QOL of the CAPD patients.