Pregnancy outcomes and chronic kidney disease: Ecuadorian single center experience
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BACKGROUND: Pregnancy is uncommon in women with chronic kidney disease (CKD), even more so in end-stage renal diseases (ESRD), and it is associated with high risks and complications that could lead to fetal and maternal morbidity or mortality and adverse outcomes. MATERIAL AND METHODS: This was a descriptive observational study with 14 pregnant women with CKD. Comparison of clinical and biochemical variables between CKD-5D and non-dialysis dependent CKD patients was performed.Categorical variables were summarized as frequencies and percentages. For continuous variables, mean and standard deviation were reported. The significance of differences between groups was assessed by Student's t-test, and p-value ≤ 0.05 was considered statistically significant. RESULTS: 57% of patients (n = 8/14) were on chronic hemodialysis (HD). Mean time on dialysis was 11 ± 4 months. All HD patients were on intensified therapy (24 hours weekly) since 12 weeks of pregnancy. The presence of severe hypertension, valvular heart disease, diastolic dysfunction, activity of systemic lupus erythematosus, and abortions were more frequent in the HD-CKD group. Patients with CKD but no HD had decreased renal function. The mean gestational age at delivery and birth weight in the HD-CKD group was lower than in the non-HD-CKD group but without statistically significant differences. There were no neonatal or maternal deaths in either group. DISCUSSION: Pregnancy in women with ESRD is complicated by increased adverse maternal and fetal outcomes, these remain high in women with kidney disease notwithstanding advances in obstetric and neonatal care. A HD condition seems to be related to worse outcomes. Preconception counseling and tight control after conception, including multidisciplinary evaluation and individualized therapy should be done.

A search for cyclophilin-A gene variants in cyclosporine A-treated renal transplanted patients.

BACKGROUND: The cyclophilin A (CypA)-cyclosporine (CsA) complex promotes immune response. The variation at the CypA gene could explain CsA-pharmacokinetics and clinical outcomes among CsA-treated patients. METHODS: The study included 290 kidney transplanted patients (65% male; mean age 51 +/- 15 yr), treated with CsA. The five CypA- exons and the promoter region were analysed through single-strand conformation analysis, denaturing high performance liquid chromatography, and direct sequencing. The effect of a promoter polymorphism (-11 G/C) on gene expression was analysed in cell-cultures. RESULTS: We found two polymorphisms in the promoter (-11 G/C) and exon 1 (+36 G/A). Genotype frequencies did not differ between patients according to their pharmacokinetics status. In vitro studies showed that -11 G/C affected gene expression. The -11 G allele was significantly associated with clinical nephrotoxicity (p = 0.006). The strongest predictors for nephrotoxicity were a donor age > or =55 yr, and the promoter GG + GC genotypes. CONCLUSIONS: Our work suggests that a CypA-promoter polymorphism (-11 G/C) could be associated with clinical nephrotoxicity. Replication of this study in other populations is necessary to define the role of CypA-variants in the main clinical outcomes among CsA-treated kidney-transplanted patients.