The epidemiology of hospitalised acute kidney injury not requiring dialysis in England from 1998 to 2013: retrospective analysis of hospital episode statistics.

AIMS: Epidemiology studies of acute kidney injury (AKI) have focused on cases requiring dialysis but those not requiring dialysis represent the majority. To address this gap, we interrogated hospital episode statistics (HES) to investigate population trends in temporal epidemiology of AKI not requiring dialysis between 1998 and 2013. METHODOLOGY: In this retrospective observational study of HES data covering the entire English National Health Service, we identified 1,136,167 AKI events, not requiring dialysis, diagnosed between 1998 and 2013. We explored the effect of age, gender, ethnicity, Charlson's comorbidity score (CCS), method of admission, diagnosis period and AKI in diagnosis codes on temporal changes in the incidence and case-fatality of AKI with specific examination of its predictors. RESULT: The incidence of AKI increased from 15,463 cases (317 pmp) in 1998-1999 to 213,700 cases (3995 pmp) in 2012-2013. There was increase in proportion of people over 75 years from 51.1% in 1998-1999 to 63.4% in 2012-2013. Overall unadjusted case-fatality decreased from 42.3% in 1998-2003 to 27.1% in 2008-2013, p < 0.001. Compared with 1998-2003, the multivariable adjusted odds ratio for death was 0.64 in 2003-2008 (95% CI 0.63-0.65) and 0.35 in 2008-2013 (95% CI 0.34-0.35). Odds for death were higher for patients over 85 years (2.93; 95% CI 2.89-2.97), CCS of more than five (2.75; 95% CI 2.71-2.79), emergency admissions (2.14; 95% CI 2.09-2.18) and AKI in the secondary diagnosis code (1.35; 95% CI 1.33-1.36) and AKI in other diagnoses codes (2.17; 95% CI 2.15-2.20). CONCLUSIONS: In England, the incidence of AKI not requiring dialysis has increased and case-fatality has decreased over last 15 years. Efforts to reduce the incidence of AKI and improve survival should focus on elderly people, emergency admissions and those with multi-morbidity.

Regression of post-transplant Kaposi's sarcoma using sirolimus.

Kaposi's sarcoma (KS) is a recognised complication following kidney transplantation, but the incidence varies according to the geographical area. Although it is a rare tumour, its incidence increases dramatically after solid-organ transplantation. The immunosuppressive medications reactivate human herpes virus 8, which has been proposed as the offending agent. The usual treatment of KS is to reduce immunosuppression, chemotherapy and radiotherapy. Nevertheless, the mortality still remains considerably high and has been reported between 8 and 14%. Sirolimus (SRL) has properties which may be useful in the management of some posttransplant tumours such as KS. We report a renal transplant patient with KS, who had multiple relapses after radiotherapy but responded well to the change of immunosuppression from cyclosporine to SRL.

Acute renal failure in a renal transplant donor due to primary antiphospholipid syndrome.

Primary antiphospholipid antibody (APA) syndrome, a common prothrombotic disorder, has been known in dialysis patients and renal transplant recipients. We report a case of primary APA syndrome presenting as a posttransplant complication in a renal transplant donor. A renal donor presented with acute, painless anuria due to renal artery thrombosis 6 years following renal transplant surgery, subsequent thrombosis of jugular catheter and arteriovenous fistula occurred, despite anticoagulation treatment, due to primary APA syndrome. This incident represents the most catastrophic complication reported in a renal donor due to primary APA syndrome. The validity of a prothrombotic assay in an organ donor workup to detect predilection to hypercoagulable disorders and to prevent such complications is open to question. The actual significance of APA in the blood is unclear; hence, the presence of APA in a potential renal donor would pose an ethical and practical dilemma.

Effect of spleen extracts on the immune response in chickens to Ancylostoma caninum larvae.

Spleen extracts from WLH chickens nonsensitized and sensitized by repeated infections of Ancylostoma caninum larvae were injected separately into isologous recipients. Extracts from donors infected with repeated high dose (250 + 250 + 500) and low dose (125 + 125 + 250) of larvae induced a significant acquired protective immune response when compared to controls which received normal extracts. No significant difference was observed between the two experimental groups. The filariform Ancylostoma caninum larvae which can cause cutaneous larva migrans in man are found to be carried by a variety of paratenic hosts. Several studies from this lab have shown that the white leg horn (WLH) chicken successfully sustains and also responds immunologically to this parasite. The present authors have also shown that extracts of bursae of Fabricius and spleens of immunized chickens can induce immunity in syngeneic recipients. Here an attempt has been made to investigate whether repeatedly sensitized extracts of A. caninum infected chickens can cause expulsion of a challenge dose from the recipients.

A possible explanation for the synergism between mixed T- and B- cell populations in mice adoptively immunized with Ancylostoma caninum.

Ancylostoma caninum--mouse model was employed to study the cellular cooperation in the adoptive immune response. The syngeneic recipient mice were intraperitoneally injected once or twice with mixtures of thymus and bone marrow cells from infected (with 500 or 2000 larvae) and uninfected donors. The experimental recipients expelled and/or destroyed the challenge larval burden more readily and at a greater rate than the controls with unsensitized cells. The cooperation between sensitized thymus and bone marrow cells was, thus, found to be exposed in a better manifestation of adoptive immune response than either of these two alone. The cellular elements of delayed hypersensitivity after combining with the antibodies of humoral system could elicit a much better response in these recipients.

Ancylostoma caninum: a report on the peripheral eosinophilia in naive and immunized Swiss albino mice.

The number of peripheral eosinophils was counted in female Swiss albino mice on 1, 4, 9, 16 and 30 days after infection with various single (500, 1000 and 2000) and weekly repeated (500 + + 500 + 1000, 1000 + 1000 and 1000 + 1000 + 2000) doses of filariform Ancylostoma caninum larvae. The eosinophil response was significantly higher in infected than in uninfected mice and reached a peak on day 16 in naive and day 4 and 9 in immunized mice. Immunized mice were significantly more eosinophilic than the naive mice. An attempt has been made to correlate eosinophilia with immunity of mice to A. caninum larvae.

Ancylostoma caninum: immune response to and distribution pattern of larvae in mice with sensitized thymus and bone marrow cells.

Suspensions of thymus and bone marrow cells from Swiss albino donor mice infected with A. caninum larvae were injected separately or together into syngeneic, nonimmune recipients which were subsequently challenged with the larvae. The transfer of adoptive immunity through these cells has been confirmed and a cooperation and/or complementation between these two types was also observed. These sensitized cells helped the recipients in expelling and/or destroying the challenge larvae more effectively but had no remarkable effect on their distribution patterns.

Studies on experimental ancylostomiasis: transfer of acquired immunity to Ancylostoma caninum in mice through sensitized thymus and bone marrow cells.

An attempt has been made to transfer acquired immunity to Ancylostoma caninum infective larvae from infected Swiss albino female mice to nonimmune, isologous recipients of same sex, through immunized thymus and bone marrow cells. Immunized cells from donors infected with a single high dose of 1000 larvae were found to be more immunocompetent than cells from donors infected with a single, but low dose of 500 larvae.