Preemptive HLA Antibody Screening Prior to Episodic Transplant Renal Biopsy Enables Early Diagnosis and Therapeutic Response in Asymptomatic Chronically Active Antibody-Related Rejection: A Case Report.

Common management of renal transplant recipients includes episodic renal biopsy based on clinical findings such as an increase in proteinuria or serum creatinine. When antibody-related rejection is suspected from the renal biopsy, subsequent testing for donor-specific antibodies (DSAs) is performed. We instead performed preemptive screening of asymptomatic post-renal transplant recipients for DSAs prior to renal biopsy. In this case, a 30-year-old woman with a secondary transplant was positive for 61 anti-HLA antibodies of class I and class II, among which DQ2 was a DSA with a mean fluorescence index of 2039. The patient had a living kidney transplant 9 years earlier. She had never been diagnosed with rejection, her serum creatinine was around 1.0 mg/dL, and her proteinuria was negative. Following the positive DSA result, a renal biopsy was performed, and she was diagnosed as C4d-negative chronic-active antibody-mediated rejection (CAABMR) with a Banff score of cg1b, (g + ptc) ≥ 2, and C4d 0. Intravenous steroid pulse, deoxyspagarin, antithymocyte globulin, rituximab, and oral everolimus were administrated. The treatment resulted in a gradual decrease in the DSA, which became negative 1 year later. The patient's serum creatinine remains around 1.0 mg/dL, and proteinuria remains negative. Treatments for advanced CAABMR are often expensive and ineffective. Our present case suggests that early detection and treatment through preemptive HLA antibody screening could improve the prognosis of renal transplants.

Analytical and clinical validation of rapid chemiluminescence enzyme immunoassay for urinary thioredoxin, an oxidative stress-dependent early biomarker of acute kidney injury.

BACKGROUND: Oxidative stress is now recognized to be an important therapeutic target in kidney diseases. However, there are currently no biomarkers that can be used clinically to diagnose renal oxidative stress. METHODS: A rapid assay system for urinary thioredoxin 1, an oxidative stress-dependent biomarker of acute kidney injury (AKI), was developed as a chemiluminescence enzyme immunoassay and validated analytically and clinically. RESULTS: Analytic evaluation revealed that hemolytic hemoglobin caused measurements to be abnormally high, above the detectable range. However, urine sediment containing red blood cells did not affect the measurements. Assays using our proposed chemiluminescence enzyme immunoassay were completed within as little as 6 min, whereas a conventional ELISA > 4 h. Aciduria

Study on factors of body image in Japanese and Vietnamese adolescents.

Over-concern about thinness, especially among young girls including adolescents, is common in Japan. Behind the problem, there is a complicated social phenomenon and an effective strategy is not known yet. In this study, we tried to find a clue by comparing body image between two countries which have different social backgrounds. Subjects were Japanese and Vietnamese junior high school students from 12 to 15 y old. Three schools each and 1-2 classes from each grade were randomly selected to involve 374 (boys 196, girls 178) and 714 (boys 352, girls 362), respectively, in Japan and Vietnam. Height and weight of subjects were measured and their satisfaction about their body shape and experience with dieting were asked by a questionnaire. Questions about their body image concerning their desire, liking of the opposite sex, own liking and health were answered by marking silhouettes. About 60% of Japanese thought that obese (silhouette 9) is unhealthy, while about 85% of Vietnamese thought that thinness (silhouette 1) is unhealthy. Most of the Japanese girls overestimated their body weight and were dissatisfied with their body shape and 78.3% wanted to lose weight. About 30% of them experienced weight loss including 2.8% of the low BMI students. Vietnamese girls also had similar tendencies in their desire about their body image as the Japanese but they were less serious. The girls in both countries preferred the thinner body image to the healthy body image and thought that boys liked the thinner body image. Japanese boys were mostly satisfied with their body shape; however, about half (46%) of the Vietnamese boys wanted a bigger and more muscular body image. In conclusion, the biggest problem with body image was the over-concern about thinness of the Japanese girls, which was based on their own misconception. Therefore, as the strategy to correct their body image, education about good health and also information about the boys' favorite body image are recommended.