Clinical graft evolution of lymphocytes, polymorphonuclear cells, and antigen expression in tubular renal cells in the urine sediment of 20 renal allograft recipients.

Urinary samples from 20 kidney transplant recipients were studied to determine the cellular composition of the sediments using an immunocytological (IC) technique. The expression of HLA class I (A, B, C) and class II (DR, DQ, DP), CD2, CD3, CD4, CD8, and interleukin (IL)-2 receptor (IL-2R) on lymphocytes was assessed using a panel of monoclonal antibodies. The results were correlated with graft function and with the number of episodes of acute renal graft rejection (AR) during a period of 6 months posttransplantation. The cellular infiltration of lymphocytes (LC) and polymorphonuclear cells (PMNC) also was studied using a standard cytology (SC) technique. During this period, 17 of 30 episodes of graft dysfunction due to AR occurred in 12 patients: 8 to acute tubular necrosis (ATN) (n = 8); 4 to cyclosporine (CsA) toxicity (n = 4) and 1 to amphotericin toxicity (n = 1). The diagnosis of AR was made clinically by 3 independent observers, using biopsy in some cases. The immunocytology showed a significantly increased expression of HLA-DR, DO, and DP namely, greater than 20% positivity in 10% of samples on the tubular epithelial cells (TEC) of patients presenting with versus without AR (P < or =.001). In addition, a high correlation was observed between the expression of IL-2R and the presence of AR (p < or =.002). The standard cytology results showed a significantly increased percentage of LC and decreased percentage of PMNCs in samples obtained 2 days prior to the clinical manifestations of patients who developed AR (P =.001). A greater level of expression of antigen determinants was observed prior to AR. These results suggest that immunocytology of urinary sediments, which is a noninvasive technique, has enormous clinical potential for the differential diagnosis of AR, ATN, and CsA toxicity. In our study, the use of HLA class IL-specific monoclonal antibodies (Abs) gave a 100% specificity, 95% sensitivity, and 95% predictability. Although our results also indicate a potential value in the increased IL-2R expression, these findings must be confirmed by further studies. Furthermore, the combination of both immunologic and SC techniques in urinary sediments allows early detection of AR and is cost effective and simple features that could be used routinely for follow-up of renal transplant recipients.

Basiliximab: efficacy and tolerability in adults and children.

UNLABELLED: An open, single arm, prospective clinical trial to assess the efficacy and safety of basiliximab (Simulect) combined with cyclosporine microemulsion (Neoral), steroids, and azathioprine was performed in four centers in Chile, two adult and two pediatric. The 23 patients who were enrolled were followed for 12 months. There were four acute rejection episodes (three adults and one child) and three graft losses (two adults and one child) during the study. Renal function in both adult and pediatric patients at 6 and 12 months was good. Basiliximab was well tolerated. The incidence of infections was low, with only one CMV infection. There were no deaths. CONCLUSIONS: The incidence of acute rejection episodes among renal allograft recipients treated with basiliximab is low, showing that the drug is well tolerated. In particular the number of CMV infections is extremely low.

[Renal transplantation in patients with neurogenic bladder]. / Transplante renal en pacientes con vejiga neurogénica.

BACKGROUND: Renal transplantation can be done in patients with neurogenic bladder and clean intermittent self catheterization maintains renal function AIM: To retrospective assess the results of renal transplantation in patients with neurogenic bladder. PATIENTS AND METHODS: The medical records of seven patients aged 10 to 22 years old (3 female) followed during 7 to 32 months were reviewed. All patients had urinary tract infection, prior to transplantation, were instructed on self catheterization and received tri-associated immunosuppression. RESULTS: Grafts came from alive related donors in 5 patients and from cadavers in two. Prior to transplantation, three patients were subjected to nephrectomy and three to bladder enlargement, leaving a pigtail catheter. After transplantation, one lymphocele was drained, one uretherostomy due to an impacted lithiasis and one nephrectomy plus vesical enlargement due to intravesical pressures over 40 cm H2O, were done. One uretheral stricture was treated with dilatation. Seven episodes of pyelonephritis, 19 urinary tract infections and 77 asymptomatic bacteriurias were documented. Serum creatinine at the end of follow up ranged from 0.7 to 2.1 mg/dl. There were 0.7 acute rejection episodes per patient and all grafts survived. CONCLUSIONS: Renal transplantation in patients with neurogenic bladder is feasible, performing a vesical enlargement. There is however a high frequency of infectious episodes.

[Nail-patella syndrome associated with monoclonal gammopathy. Review regarding a case]. / Síndrome uña-rótula asociado a gammopatia monoclonal. Revisión a propósito de un caso.

A 54 years old female with significant impairment of renal function is presented. On physical examination, the presence of dystrophic nails, elbow dysplasia and prominent iliac horns. Familial study showed similar nail and bone deformities in 3 of six sons. The nail patella syndrome diagnosis was based on these findings. This is a rare autosomal dominant hereditary disease, probably related to congenital alterations in collagen metabolism. Clinical characteristics include bone abnormalities that principally involve knees and elbows, nail alterations and the presence of iliac horns, that are considered pathognomonic of the syndrome. Renal involvement is observed in 30 to 55% of cases. This patient had also an IgA-lambda paraprotein, whose relationship to the above mentioned syndrome is uncertain, since no evidences of malignant plasma cell dyscrasia were demonstrated.

[Pregnancy in a class-T diabetic patient]. / Embarazo en una paciente diabética clase T.

We report the pregnancy of a 35 year old diabetic woman with a positive Australia antigen, 3 years after a successful cadaver kidney transplant. Immunosuppressive therapy with prednisone, azathioprine and cyclosporine was maintained. Pregnancy was complicated by an acute rejection episode on week 13, mild hypertension and intrahepatic cholestasis on week 22. Cesarean section and tubal ligation were performed at 32 and a half weeks. A 2020 g female infant was delivered, with Apgar scores of 8 and 9 at 1 and 5 min, respectively. Mild respiratory distress, jaundice and hypocalcemia were noted. The Australia antigen was negative. No fetal anomalies were detected. The high risk of pregnancy in a class T diabetic patient is confirmed in this case.

[Parasitic infections in renal transplantation patients]. / Infecciones parasitarias en trasplantados renales.

We performed indirect hemagglutination tests for toxoplasmosis and Chagas disease, complement fixation test for toxoplasmosis, stool examination for parasites and Graham test for enteroparasites in 51 patients before and after renal transplant. Post transplant surveys were performed at 3, 6, 9, 12 and 18 months. 18 patients who were positive for toxoplasmosis remained so and 5 new asymptomatic cases were detected in the post transplant period (15%). Two patients who were positive for Chagas disease remained positive and asymptomatic. One patient receiving a kidney from a Chagas positive donor remains negative. Asymptomatic enteric infection was detected in 45% of patients at some time during follow up: amebic infection (25%), giardiasis (14%) and oxyuriasis (24%). Two patients showed asymptomatic cryptosporidiasis.

A prospective one-year study evaluating the clinical outcome of recipients of living donor kidneys treated with cyclosporin and azathioprine.

Thirty recipients of living related donor kidneys treated either with cyclosporin or azathioprine were evaluated clinically and functionally in a 1-year prospective study. Only the azathioprine group showed either accelerated or chronic rejection (one patient each). The azathioprine patients had higher rate of infectious episodes (P = 0.05), leukopenia (P = 0.003) and steroidal side-effects (P less than 0.007). During the early post-transplant period the renal functional performance was the same in both groups. Afterwards, however, the plasma creatinine was higher in the cyclosporin group (P less than 0.01). Mean arterial pressure remained similar throughout the study in both groups. The anaemia correction was similar in both groups but the haematocrit was greater in the cyclosporin-treated subjects (P less than 0.005).