Polymer embolization from minimally invasive interventions.

Many of the tools used in interventional nephrology, such as glidewires and sheaths, are coated with a hydrophilic polymer to increase their lubricity; however, this polymer can shear off, which causes polymer embolization. We describe 3 cases in which polymer emboli were found on histopathologic examination in an arteriovenous graft, a transplanted kidney, and the myocardium. A review of the literature shows that although most of these phenomena are benign, in some patients, it may present with significant morbidity.

Cross Reactive Epitope Group antibodies in sensitized kidneys transplant recipients was associated with early acute Antibody Mediated Rejection.

BACKGROUND: Antibody Mediated Rejection (AMR) is a major cause of early graft loss, graft dysfunction, and chronic allograft nephropathy. Patients with elevated pre-transplant Panel Reactive Antibodies (PRA) are at much higher risk to develop AMR. We, retrospectively, studied the attack rate of AMR in sensitized recipients and evaluated whether preformed antibodies to donor Cross Reactive Epitope Group (CREG) and/or choice of induction immunosuppressive agent affected the frequency of this complication. METHODS: From the period between September 2002 and March 2008, we identified 19 sensitized renal transplant recipients (with mean PRA of 44.5+/-26%) and recorded the induction agent, number of HLA antigen mismatches, CREG match, CREG antibodies, PRA levels, clinical course, biopsy proven rejection episodes and presence of donor specific antibody. Nine patients were induced with Alemtuzumab (Campath-1H) and ten received horse or rabbit derived polyclonal antithymocyte antibody ATGAM (Pharmacia) or Thymoglobulin (Genzyme). All recipients were cross-match negative at time of transplant. RESULTS: Out of the 19 patients, 9 patients developed acute rejection (47.4%), 4 had AMR and 5 had Acute Cellular Rejection (ACR). Out of 19 patients, 9 patients had existing CREG antibodies (as per CREG Model proposed by McKenna, Takemoto et al.). All patients who developed AMR were found of have preformed antibodies to donor CREG. The median time interval for the development of acute humoral rejection was only 6 days and biopsies showed acute vascular rejection with Complement (C(4)D) deposition. CONCLUSIONS: Pre-existing CREG antibodies in sensitized renal transplant patients appear to identify a group at high risk to develop AMR.

Plasmapheresis in a patient with rhabdomyolysis: a case report.

INTRODUCTION: Cardiovascular benefits and improved survival have resulted in statins becoming the most prescribed drugs in USA. There is a small but significant risk of developing statin induced rhabdomyolysis especially in combination with other lipid lowering medications for example fibrates like Gemfibrozil. CASE PRESENTATION: We describe a case of an 82 year old male patient who developed rhabdomyolysis while taking a combination of Simvastatin and Gemfibrozil and was successfully managed with plasmapheresis. CONCLUSION: There are only a few cases of rhabdomyolysis treated with plasmapheresis reported in literature. Most of the case reports of using this technique in rhabdomyolysis have been from Asia, Australia and Europe. We suggest that plasmapheresis may be considered as an option in severe life threatening rhabdomyolysis.

Pregnancy in end-stage renal disease patients on hemodialysis: two case reports.

INTRODUCTION: Pregnancy in patients with end-stage renal disease is rare due to numerous factors that impair fertility. Even if pregnancy does occur pregnancy outcome with a live birth has a low success rate. CASE PRESENTATION: We report two cases of successful pregnancy in patients with end-stage renal disease on hemodialysis. CONCLUSION: The purpose of hemodialysis is not only to maintain life but also to make quality of life as normal as possible for the end-stage renal disease patient. Propagation of life is basic to all life forms and the ability to do so can be considered as a success in a patient with end-stage renal disease.