Relationship Between Albuminuria During the First Year and Antibody-Mediated Rejection in Protocol Biopsies in Kidney Transplant Recipients.

BACKGROUND: Antibody-mediated rejection is the main cause of deterioration of kidney transplants and frequently is detected only by means of protocol biopsies. The aim of this study was to relate the presence of albuminuria throughout the 1st year to the histologic findings detected by 1-year protocol biopsies in kidney graft recipients. METHODS: Retrospective observational study of 86 protocol biopsies 1 year after transplantation. Albuminuria was measured at 3, 6, 9, and 12 months in urine samples and expressed as albumin/creatinine (mg/g). RESULTS: Analysis of biopsies, reflected according to the Banff criteria, the following categories: fibrosis and tubular atrophy, 35 (40.7%); cellular rejection, 13 (15.1%); antibody-mediated rejection, 8 (9.3%); chronic glomerulopathy, 10 (11.6%); normal, 14 (16.3%); recurrence, 1 (1.2%); and other, 5 (5.8%). The proportions of patients with albuminuria for Banff scale scores (0 vs ≥1, respectively) at 6 and 12 months, respectively, after transplantation, were: for marker glomerulitis, 45.5% versus 59.3% (P = .021) and 36.4% versus 70.4% (P < .001); for marker glomerulopathy, 49.1% versus 50.0% (P = .051) and 42.1% versus 58.3% (P = .019); for marker peritubular capillaritis, 45.8% versus 60.9% (P = .047) and 39.0% versus 69.6% (P = .276); and for marker C4d, 49.2% versus 56.3% (P = .894) and 46.2% versus 56.3% (P = .774). CONCLUSIONS: The presence of albuminuria after renal transplantation is common, especially in patients with proteinuria. Persistent albuminuria after transplantation, even at low levels, can be indicative of subclinical antibody-mediated rejection. Additional broader studies to relate the albuminuria to histologic changes observed in protocol biopsies are required.

Ambulatory blood pressure monitoring in kidney transplant patients: RETENAL study.

Hypertension is common following renal transplantation, affecting up to 80% of transplant recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy, contributing to increased cardiovascular risk factors and mortality rates. The aim of the study was to compare the blood pressure (BP) control in kidney transplant patients through the use of ambulatory BP monitoring (ABMP) versus office BP measurements (oBP). A multicenter, cross-sectional, observational study was conducted in 30 nephrology/kidney transplant units. Eligible patients included hypertensive cadaveric kidney transplant recipients aged <70 years, with a functioning kidney for at least 1 year and with an estimated glomerular filtration ≥30 mL/min/1.73 m(2) and a serum creatinine < 2.5 mg/dL. Recorded data included demographic characteristics, oBP, and ABPM and labroatory investigations. The 868 patients showed a mean recipient age of was 53.2 ± 11.6 years and mean follow-up after transplantation, 5.5 ± 2.8 years. Mean systolic and diastolic oBP were 140.2 ± 18 and 80.4 ± 10 mm Hg, respectively. Seventy-six percent of patients had oBP higher than or equal to 130/80 mm Hg. Mean 24 hour ABPM were 131.5 ± 14 and 77.4 ± 8.7 mm Hg for systolic and diastolic BP, respectively. Using the ABPM, we observed that 36.5% of subjects were controlled (mean 24-hour BP < 130/85 mm Hg). The two methods (oBP and ABPM) showed significant agreement. After ABPM, 65% of patients diagnosed as true controlled hypertension were considered to have white-coat RH. In clinical practice ABPM may help for better adjustment of drugs for adequate BP control.

Risk of cardiovascular disease associated with refractory hypertension in renal transplant recipients.

BACKGROUND: Hypertension is common after renal transplantation, affecting as many as 80% of recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy because of increased cardiovascular risk factors. The prevalence of refractory hypertension in renal transplant recipients is unknown, and could be associated with a poor prognosis. OBJECTIVE: To investigate the effects of refractory hypertension on cardiovascular disease (CVD) after renal transplantation in 486 patients with grafts functioning for longer than 1 year. PATIENTS AND METHODS: Patients were classified into 2 groups: (1) 57 with refractory hypertension, that is, systolic blood pressure 130 mm Hg or greater or diastolic blood pressure 80 mm Hg or greater, and receiving treatment with at least 3 drugs, one of which was a diuretic; and (2) the remaining 429 patients. Patient and graft survival, and posttransplantation CVD were analyzed. RESULTS: Refractory hypertension was associated with male sex (82.5% vs 66.5% [P<.01]), poor renal function (mean [SD] serum creatinine concentration 2.2 [1.2] mg/dL vs 1.6 [0.6] mg/dL; Modification of Diet in Renal Disease score 39.2 [20.0] mL/min/1.73 m2 vs 49.2 [18.0] mL/min/1.73 m2 [P=.000]; and steroid therapy (94.7% vs 79.0% [P=.001]). In the group with refractory hypertension, 5-year patient and graft survival rates were lower, and the incidence of posttransplantation CVD was greater (relative risk, 1.7; 95% confidence interval, 1.05-2.18; P=.03). CONCLUSION: Refractory hypertension is an independent risk factor for increased cardiovascular morbidity and mortality in renal transplant recipients.

Ochrobactrum anthropiy peritonitis polimicrobiana en diálisis peritoneal: un predictor de resistencia / No disponible

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[Diagnosis of Parkinson's disease]. / Diagnóstico de la enfermedad de Parkinson.

INTRODUCTION AND DEVELOPMENT: The diagnosis of Parkinson's disease is one of the current challenges in the neurology. The development of imaging techniques (volumetric and diffusion-weighted magnetic resonance imaging and ultrasonography), and functional neuroimaging (single photon emission computed tomography and positron emission tomography) in recent years has opened new research fields, and are useful as diagnostic tools. CONCLUSION: Anyway the diagnosis is still a clinical process, and it should be reconsidered at each visit.

[Treatment of motor symptoms in Parkinson's disease]. / Tratamiento de los síntomas motores en la enfermedad de Parkinson.

INTRODUCTION: The physiopathology of the motor symptoms is the best known aspect of the Parkinson's disease. This knowledge led us to use several drugs and therapeutic strategies to improve these features of the Parkinson's disease. DEVELOPMENT AND CONCLUSIONS: Mainly based in the theory of continuous dopaminergic stimulation, new drugs, new routes of administration and new galenic formulations have been developed, as well surgical procedures and other therapies have been introduced to improve the management of patients with long diseases without a responses to the classic therapies. At the same time, several often-used drugs have disappeared due to its non-parkinsonian adverse effects and also the influence in quality of life of non-motor parkinsonian adverse effects have been ultimately recognized.

Diagnóstico de la enfermedad de Parkinson / Diagnosis of parkinson´s disease

Resumen. Introducción y desarrollo. El diagnóstico de la enfermedad de Parkinson es uno de los retos actuales en el campo neurológico. En los últimos años se han producido avances significativos, fundamentalmente en el campo de la neuroimagen (técnicas de volumetría y difusión en resonancia magnética y sonografía transcraneal) y en estudios también funcionales (tomografía por emisión de fotón único, tomografía por emisión de positrones) que abren nuevas campos en la investigación, y sirven al clínico como apoyo diagnóstico. Conclusión. A pesar de ello, éste sigue siendo un proceso clínico, que, además, ha de cuestionarse en cada momento (AU)

Summary. Introduction and development. The diagnosis of Parkinson’s disease is one of the current challenges in the neurology. The development of imaging techniques (volumetric and diffusion-weighted magnetic resonance imaging and ultrasonography), and functional neuroimaging (single photon emission computed tomography and positron emission tomography) in recent years has opened new research fields, and are useful as diagnostic tools. Conclusion. Anyway the diagnosis is still a clinical process, and it should be reconsidered at each visit (AU)

Tratamiento de los síntomas motores en la enfermedad de Parkinson / Treatment of motor symptoms in parkinson´s disease

Resumen. Introducción. En la enfermedad de Parkinson (EP), la fisiopatología de la sintomatología motora es la más estudiada. Este conocimiento permite que la mayoría del arsenal terapéutico en la EP intente mejorar este aspecto cardinal. Desarrollo y conclusiones. Basándose principalmente en el concepto de la terapia dopaminérgica continua, durante los últimos años hemos sido testigos de un rápido avance en el tratamiento de la EP con la aparición de nuevos fármacos, nuevas vías de administración y nuevas presentaciones galénicas, así como el desarrollo de técnicas quirúrgicas y otras terapias utilizadas en el paciente con EP evolucionada rebelde a la terapia farmacológica habitual. Al mismo tiempo, han desaparecido fármacos muy utilizados durante años debido al conocimiento de nuevos efectos secundarios no parkinsonianos, aunque también han cobrado importancia efectos secundarios parkinsonianos no motores con gran influencia en la calidad de vida de los pacientes y su entorno familiar (AU)

Summary. Introduction. The physiopathology of the motor symptoms is the best known aspect of the Parkinson’s disease. This knowledge led us to use several drugs and therapeutic strategies to improve these features of the Parkinson’s disease. Development and conclusions. Mainly based in the theory of continuous dopaminergic stimulation, new drugs, new routes of administration and new galenic formulations have been developed, as well surgical procedures and other therapies have been introduced to improve the management of patients with long diseases without a responses to the classic therapies. At the same time, several often-used drugs have disappeared due to its non-parkinsonian adverse effects and also the influence in quality of life of non-motor parkinsonian adverse effects have been ultimately recognized (AU)

¿Es la diferencia de presión arterial entre ambos brazos un parámetro útil para la predicción de enfermedad cardiovascular? Presentación de tres casos clínicos / Is the difference of blood pressure between both arms a useful parameter to predict cardiovascular disease? Presentation of three clinical cases

Se presentan tres casos en los que tras una exploración física anormal, debida a la existencia de cifras de presión arterial diferentes en ambos brazos, se demuestra la existencia de patología vascular como causa de las mismas. Se insiste en la necesidad de tomar la presión arterial en el brazo en el que se demuestren presiones más altas, pero también recomendamos la medición periódica en ambos brazos para reforzar el control de los factores de riesgo en aquellos pacientes en los que la medida de presiones diferentes podría ser el preludio del desarrollo de clínica a otros niveles potencialmente más peligrosos como el corazón, el riñón o el cerebro

Three cases are presented in which the existence of vascular diseases was demonstrated after an abnormal physical examination due to the existece of blood pressure values that were different in both arms as its cause. The need to measure blood pressure in the arm in which the highest pressure are shown is emphasized. However, we also recommend periodic measurement in both arms to reinforce the control of risk factors in those patients in whom different pressure measurements could be the prelude to the development of potentially dangerous symptoms on other levels such as the heart, kidney or brain

[Acute cell rejection in ex vivo model of swine-human renal xenotransplantation]. / Rechazo celular agudo en modelo ex vivo de xenotrasplante renal cerdo-hombre.

OBJECTIVE: Ex vivo perfusion model of pig-to-human kidney xenotransplantation to evaluate human antiporcine xenograft rejection once hyperacute rejection (HAR) is avoided. METHODS: Pig kidneys were perfused for 3 hours with pig blood (group 1; n = 5), human blood (group 2; n = 5), complement heat inactivated human blood (group 3; n = 5), platelet-depleted human blood (group 4; n = 5); and xenoreactive natural antibodies (XNA)-depleted human blood (group 5; n = 5). Tissue samples were studied with immunoperoxidase techniques. RESULTS: Pig kidneys perfused with human blood, group 2, showed HAR with interstitial haemorrhage, vascular thrombi and glomerular injury. Pig kidneys perfused with manipulated human blood (groups 3 to 5) had no histologic evidence of HAR, but showed signs of acute cellular rejection with different degrees of interstitial infiltrate of mononuclear cells, specially in the XNA-depleted group. CONCLUSIONS: The model may be valuable in the isolated evaluation of the elements involved in the pig-to-human xenorejection. The depletion of complement, platelets and XNA protected porcine kidneys form HAR in our study and allowed the development of an acute cellular rejection, a very unusual fact in this short time, 3 hours.

Rechazo celular agudo en modelo ex vivo de xenotrasplante renal cerdo-hombre / Cellular acute rejection pig to human in an ex vivo renal transplant model

OBJETIVOS: Desarrollo de un modelo ex vivo de perfusión de riñones de cerdo con sangre humana, intentando reproducir el xenotrasplante renal cerdo-hombre, para el estudio de las manifestaciones que se producen una vez evitado el rechazo hiperagudo. MÉTODO: Perfusión de los riñones de cerdo durante 3 horas con sangre de cerdo (grupo 1; n=5), sangre humana (grupo 2; n=5), sangre humana decomplementada por calor (grupo 3; n=5), sangre humana deplaquetada por centrifugación (grupo 4; n=5), sangre humana inmuonadsobida con proteína A estafilocócica (grupo 5; n=5). Las piezas se estudian por microscopía óptica e inmunohistoquímica. RESULTADOS: Rechazo hiperagudo con hemorragia difusa, trombosis y lesiones glomerulares en el grupo con sangre humana sin manipular. Ausencia de rechazo hiperagudo en el resto de los grupos: decomplementada, deplaquetada e inmunoadsorbida, con presencia de rechazo celular agudo con diferentes grados de infiltración intersticial de células mononucleares, en especial en el grupo con sangre inmunoadsorbida. CONCLUSIONES: El modelo que permite valorar de forma aislada elementos de la respuesta inmune xenogénica cerdo-hombre. La depleción de complemento, plaquetas y xenoanticuerpos protege a los riñones de cerdo del rechazo hiperagudo, observando por primera vez la presencia de rechazo celular agudo en 3 horas, manifestación que suele precisar para su aparición varios días (AU)

Hipertensión arterial por displasia fibromuscular en dos hermanas / Hypertension for fibromuscular dysplasia in two sisters

Presentamos a dos hermanas con hipertensión arterial descubierta cuando se encontraban embarazadas y producida en ambos casos por displasia fibromuscular de las arterias renales. Comentamos la infrecuente incidencia familiar de la misma y sus posibles causas y revisamos los procedimientos diagnósticos y terapéuticos utilizados (AU)

Pérdida de peso asociada al tratamiento con topiramato / Weight loss associated with topimarate treatment

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[Experimental renal transplantation of cirrhotic donors. I. Morphologic, immunofluorescence, and ultrastructural study]. / Trasplante renal experimental de donantes cirróticos I. Estudio morfológico, de inmunofluorescencia y ultraestructural.

The cirrhotic kidney can be successfully transplanted into healthy recipients. The histological lesions have not been well defined or correlated with the functional changes observed in cirrhosis. Methods to induce experimental cirrhosis in the rat that reliably reproduce this disease have been developed. The development of microsurgical techniques have made it possible to perform transplantation in the rat. We analyzed the renal lesions of cirrhotic rats and the evolution of the graft after transplantation into a healthy rat.

[Experimental renal transplantation of cirrhotic donor. II. Stereologic analysis]. / Trasplante renal experimental de donante cirrótico II. Análisis estereológico.

Cirrhotic nephromegaly is accompanied by an important glomerular growth that progress to glomerulosclerosis and is irreversible and independent of the initial cause. The deterioration of renal function in these patients following liver transplantation and in chronic cirrhotics may be secondary to glomerular sclerosis, also known as "hepatic glomerulosclerosis". We utilized stereologic methods to quantify the volumetric changes in cirrhotic rats, fundamentally the glomerular changes, before and after transplantation into healthy rats. We had initially intended to look for terminal cirrhotics that were potential kidney donors; however, currently many of these can be liver graft recipients. In our view, our findings can be applicable to these patients since the kidney is removed from a cirrhotic and transplanted into a healthy environment, as in our experiment.

[Experimental kidney transplantation in rats. Technical, functional, and histologic aspects]. / Trasplante renal experimental en ratas. Aspectos técnicos, funcionales e histológicos.

In recent years, different experimental transplantation techniques have been developed in animals to gain further insight into the immunologic and non-immunologic processes occurring in grafts. Microsurgery permits the application of these procedures to small animals, as the rat. We present our experience in experimental transplantation in rats, with special reference to isogenic transplantation (inbred animals), leaving solely the graft in the receptor. The technical characteristics, the analytic and histologic findings after transplantation are described.

Renal transplantation and immunological abnormalities in thrombotic microangiopathy of adults: report of 5 cases.

Renal transplantation was performed in five adult patients with thrombotic microangiopathy, three of whom had had a bilateral nephrectomy prior to transplantation. The graft remained functional in three patients 72, 18, and 12 months after transplantation. One patient developed a thrombosis of the renal artery and one patient died from infection. There was no clinical or histological evidence of recurrence of thrombotic microangiopathy in the five patients after transplantation. Immunological investigations were performed in four of five patients before transplantation: C3 and C1q levels were low in two patients; serum C3-splitting activity and circulating immune complexes were present in all four patients and remained unchanged on haemodialysis and/or after bilateral nephrectomy. Complement abnormalities and immune complexes were not detected in the three patients with successful renal transplantation.