Comparison of the Urine Protein to Creatinine Ratio with 24-Hour Urinary Protein Amounts in Patients with Kidney Transplants / 대한내과학회지

BACKGROUND/AIMS: Many studies have reported the correlation between the spot urine protein to creatinine (P/C) ratio and 24-hour urinary protein amounts in patients with glomerulonephritis. This correlation has also been reported in Western patients with kidney transplants, but no prior study has reported on this association in Eastern populations. We compare the correlation between the spot urine P/C ratio and 24-hour urinary protein amounts and the associating factors in Korean patients with kidney transplants. METHODS: The study included 66 patients with kidney transplants from our hospital. The subjects had urine samples evaluated between January 2005 and July 2010. We compared 24-hour urinary protein amounts with a spot urine P/C ratio collected in the morning and analyzed the factors affecting the correlation in each group. RESULTS: The 24-hour urinary protein amounts were 1.31 +/- 1.69 g/day and the spot urine P/C ratio was 1.29 +/- 1.70 in all subjects. A strong positive linear correlation was observed between the 24-hour urinary protein amounts and the spot urine P/C ratio (r = 0.95). The primary factor affecting accurate quantitation of proteinuria using the spot urine P/C ratio was gender (p = 0.003). The spot urine P/C ratio and the 24-hour urinary protein levels were 1.05 +/- 1.51 and 1.26 +/- 1.68 g/day in males (p = 0.005) and 1.57 +/- 1.88 and 1.36 +/- 1.72 g/day in females (p = 0.047), respectively. CONCLUSIONS: We determined that the spot urine P/C ratio provides an accurate estimate of 24-hour urinary protein levels in Korean patients with kidney transplants.

Case of ABO-Incompatible Living Donor Kidney Transplantation without Blood Products in a Jehovah's Witness / 대한이식학회지

ABO-incompatible kidney transplantations have been performed successfully in Korea without splenectomy using plasmapheresis, anti-CD20 monoclonal antibody infusions and other immunosuppressants. However, there is no report of a case of ABO-incompatible kidney transplantation in a Jehovah's Witness. Hence, we report our experience of successful ABO-incompatible kidney transplantation without blood products in a Jehovah's Witness. The recipient was treated with six sessions of plasmapheresis and he received intravenous rituximab before transplantation. Immunosuppressive regimen consisted of tacrolimus, mycophenolate mofetil and steroid. The replacement fluid for plasmapheresis was 5%% albumin solution instead of fresh frozen plasma. We measured the clotting factors before and after plasmapheresis and used cryoprecipitate to prevent bleeding.

A Case of Reversible Posterior Leukoencephalopathy Syndrome in a Patient with ABO Incompatible Kidney Transplantation / 대한신장학회지

Reversible posterior leukoencepalopathy syndrome (RPLS) was noted by a reversible syndrome of headache, altered mental status, seizure, and visual loss associated with findings indicating predominantly posterior leukoencephalopathy on imaging studies. We report a successful treatment of RPLS after secondary ABO incompatibility kidney transplantation with blood pressure control. A 41-year-old female whose primary kidney disease was chronic glomerulonephritis had graft failure developed after living donor kidney transplantation (1st kidney transplantation). She was admitted to our hospital for 2nd ABO incompatibility kidney transplantation. She had undergone 6 times of plasmapheresis and received additional two doses of rituximab (375 mg/m2) and intravenous immunoglobulin (0.5 g/kg) before kidney transplantation. She received basiliximab induction therapy, tacrolimus, steroid and mycophenolate mofetile after transplantation. The ABO antibody titer had been low (below 1:1) and evidences of rejection were not detected. Generalized tonic clonic type seizure, eyeball deviation, facial cyanotic change and loss of consciousness occurred at post operation 7th day. Several minutes later, she recovered her consciousness without disability and neurologic deficit. She did not represent attacks any more after we controlled blood pressure without withdrawal of immunosuppressants or dose reduction.

Rituximab and Plasmapheresis for Post-transplant Recurrence of FSGS / 대한신장학회지

Focal segmental glomerular sclerosis (FSGS) is known to recur in 20-40% of the renal allografts with graft loss in about half of these cases. We report a successful treatment of a recurrent FSGS after kidney transplantation with rituximab and plasmapheresis. An 16-year-old patient whose primary kidney disease was FSGS developed recurrence of proteinuria after living donor kidney transplantation despite preemptive plasmapheresis and one dose of rituximab (375 mg/m2). After kidney transplantation, nephrotic range proteinuria was detected. Kidney biopsy was done and showed recurrent FSGS. She undergone 11 times of plasmapheresis in the first 4 week post transplantation. In addition, she received additional one dose of rituximab (375 mg/m2) on day 14. Proteinuria was decreased below nephrotic range at 37 day. Ten months later, proteinuria was at 30 mg/day with excellent graft function. No significant adverse events related to rituximab or plasmapheresis were observed. Rituximab with plasmapheresis may be another option for recurrent FSGS after kidney transplantation.