Association of Brain-dead Donor's Urine Neutrophil Gelatinase-associated Lipocalin Levels With Kidney Allograft Function.

INTRODUCTION: Development of delayed graft function is more prevalent in patients receiving a kidney allograft from brain-dead than living donors. This study aimed to evaluate the association between urine neutrophil gelatinase-associated lipocalin (NGAL) levels in brain-dead donors and subsequent allograft function. MATERIALS AND METHODS: Urine NGAL concentration was measured in urine samples obtained from 24 brain-dead kidney allograft donors before organ retrieval. The 24 kidney recipients were followed for 6 months. The immunosuppressive therapy was similar for all of the recipients. Following transplantation, plasma creatinine was recorded daily during the recipient's stay in the hospital and then at 1, 3, and 6 months after transplantation. Delayed graft function was defined as the need for dialysis in the first 7 days after transplantation. RESULTS: The mean age of the donors was 28.7 ± 11.2 years and 70.8% were men. Their median urine NGAL level was 7.4 ng/ml (range, 2 ng/mL to 45 ng/mL). Urine NGAL levels were only associated with the need for cardiopulmonary resuscitation (P = .007). On the 1st day after transplantation, 16.7% of the recipients developed delayed graft function, which was declined to 12.5% on the 2nd day and to 8.3% during the 3rd day and the following days. No significant association was observed between the donor's urine NGAL levels and graft function (P = .86). CONCLUSIONS: Our results did not show any association between urine NGAL levels and outcome of allograft function obtained from brain-dead donors. Larger studies are required to confirm this finding.

Tacrolimus rescue therapy for corticosteroid-resistant and polyclonal antibody-resistant kidney allograft rejections.

INTRODUCTION: The conventional treatment of acute kidney allograft rejection consists of high-dose corticosteroids and polyclonal antibodies. We report our experience of tacrolimus rescue therapy in patients with acute rejections refractory to corticosteroids and polyclonal antibodies. MATERIALS AND METHODS: A total of 34 patients with a mean age of 42.3 years and clinical diagnosis of acute kidney allograft rejection underwent tacrolimus rescue therapy when treatment with corticosteroids and polyclonal antibodies failed. Kidney allograft biopsy results were available in 21 patients. All of the patients received tacrolimus, 0.1 mg twice daily, and in those who responded to the therapy after 4 to 6 months, tacrolimus was changed into cyclosporine. RESULTS: Pathologic examination of 21 biopsy specimens of the kidney allografts showed acute vascular rejection in 7 patients (33.3%), acute humoral rejection in 6 (28.6%), acute cellular rejection in 3 (14.3%), and accelerated acute rejection in 3 (14.3%). Twenty-six patients (76.5%) responded to rescue therapy with tacrolimus and discharged with a mean serum creatinine level of 1.4 mg/dL (range, 1.1 mg/dL to 1.7 mg/dL). Allograft nephrectomy was done in 8 patients (23.5%) because of no response to treatment of rejection, the pathology reports of which consisted of acute vascular rejection in 5 patients and extensive necrosis in 3. CONCLUSION: Tacrolimus therapy is able to salvage kidney allografts with acute refractory rejection. We recommend that tacrolimus be used as an alternative to the conventional drugs used for antirejection therapy. However, severe infectious complications as a result of overt immunosuppression must be considered.

Sexual dysfunction in aging men with lower urinary tract symptoms.

INTRODUCTION: Our aim was to evaluate the relationship between lower urinary tract symptoms (LUTS), age, and sexual dysfunction in the Iranian men aged 50 to 80 years. MATERIALS AND METHODS: A total of 357 men aged 50 to 80 years presenting at the urological clinic were enrolled in this study. The International Prostatic Symptom Score (IPSS) and the International Index of Erectile Function (IIEF) questionnaires were used to assess the LUTS and sexual function, respectively. The questionnaires were completed by face-to-face interview. Logistic regression model was used for multivariate analysis of the risk factors of sexual dysfunction and its domains assessed by the IIEF. RESULTS: Of the patients, 332 (93%) were sexually active with a median sexual attempts of 4.6 times per month. Frequency of sexual attempts was inversely related to LUTS severity (P < .001). Advanced age was positively associated with LUTS severity (r = 0.534, P < .001). Sexual dysfunction, defined as IIEF score of 20 and less, was present in 68.2% of the patients. All IIEF domain scores and the overall score were correlated with age (P < .001) and the IPSS (P < .001). In a multivariate analysis, age, diabetes mellitus, and the IPSS were strong independent predictors of the overall IIEF score. CONCLUSION: Sexual activity as an important component of the quality of life continues in the majority of men over 50 years. However, their sexual function can be severely affected by LUTS and its severity.