Systemic lupus erythematosus after renal transplantation: is complement a good marker for graft survival?

BACKGROUND: Renal transplantation is considered a safe procedure for patients with systemic lupus erythematosus (SLE). However, the recurrence of disease and its impact on graft survival remains controversial. METHODS: To analyze the presence of lupus serology activity during dialysis and its impact on lupus recurrence after transplantation, we performed a retrospective analysis of 23 lupus patients who received 26 kidney transplantations. RESULTS: Twenty-three patients received 26 renal transplantations from 1984 to 2003. Twelve patients presented pretransplant lupus activity (low complement and ANA > 1/40), without correlation with length of dialysis, but associated with proliferative glomerulonephritis (class IV) pretransplant. Among 26 grafts, 6 were lost in the first 6 months posttransplant. Among the remaining 20 functioning grafts, low complement activity occurred in 8, being associated with recurrence of immune deposits in 3 cases. Analysis of lupus activity showed that only one patient with a normal complement level posttransplant presented SLEDAI > 4, associated with persistent proteinuria and a graft biopsy without immune deposits. Graft survival was reduced in the presence of low complement posttransplantation. CONCLUSION: Low complement levels after renal transplantation, in association with proteinuria may be considered to be a risk factor for recurrence of immune deposits, with a negative impact on graft survival.

Percutaneous renal graft biopsy: a clinical, laboratory and pathological analysis.

CONTEXT: Renal allograft biopsies have been used as a good method for monitoring the evolution of kidney transplants for at least 20 years. Histological analysis permits differential diagnosis of the causes of allograft dysfunction to be made. OBJECTIVES: To correlate the data of urinalysis and serum creatinine with histological diagnosis of renal graft in a group of renal transplant patients. DESIGN: Accuracy study, retrospective analysis. SETTING: A university terciary referral center. SAMPLE: 339 percutaneous allograft biopsies obtained from 153 patients. Blood and urine samples were obtained before the graft biopsy. MAIN MEASUREMENTS: Laboratory evaluation and hystological analysis (light microscopy, immunofluorescent electronic microscopy). RESULTS: Most of the biopsies (58.9%) were performed during the first month post-transplant. An increase in serum creatinine was associated with acute tubular and/or cortical necrosis. Proteinuria and normal serum creatinine were associated with glomerular lesions. Non-nephrotic range proteinuria and an increase in serum creatinine were associated with chronic rejection. CONCLUSION: Evaluation of serum creatinine and urinalysis can be useful in suggesting the histological graft diagnosis.

Acute tubulointerstitial nephritis and uveitis with antineutrophil cytoplasmic antibody.

We report a case of acute tubulointerstitial nephritis and uveitis (TINU syndrome) in a 47-year-old woman who also was found to have antineutrophil cytoplasmic antibody. The patient developed severe acute renal failure that improved after a high dose (1 mg/kg/d) of corticosteroid therapy. The diagnosis of the disorder is discussed, as well as the finding of antineutrophil cytoplasmic antibody.

[Prevalence of diabetic nephropathy in adult patients with chronic kidney failure]. / Prevalência da nefropatia diabética em pacientes adultos com insuficiência renal crônica terminal.

UNLABELLED: Diabetic nephropathy is a frequent cause of end-stage renal failure in patients admitted for renal replacement therapy. PURPOSE: To evaluate the prevalence of DN, as the underline disease, in patients with ESRF. METHODS: 1,303 [male (M) = 767 and female (F) = 536] patients with ESRF who were on a waiting list for cadaver kidney transplant at Nephrology Unit-University Hospital (HC-UNICAMP), from August/90 to June/93--group 1--and 193 (M = 112 and F = 81) patients admitted for renal replacement therapy in a year period (April/92 to March/93), in the city of Campinas, State of São Paulo, Brazil, were studied. RESULTS: The prevalence of DN was 10.1% in group 1 and 17.6% in group 2 (x2 = 7.15; p = 0.007), being the third cause of ESRF in both groups, and it was preceded by glomerulonephritis and arterial hypertension. In group 1 the reduction of number of patients with increase in duration of dialysis was significantly greater in patients with diabetic nephropathy (x2 = 30.9; p < 0.001). Among patients with DN 35 (26%) in group 1 and 6 (18%) in group 2 had less than 35 years when they were admitted for renal replacement therapy and are likely to be type 1 (insulin-dependent) diabetic patients. CONCLUSION: In our studied groups DN was a frequent cause of ESRF.

The effect of perchloric acid fixation on DNA preservation in the salivary gland of Bradysia hygida.

In Bradysia hygida (Diptera, Sciaridae) well spread polytene chromosomes, free of cytoplasm, and with good morphology are consistently obtained if before squashing in acetic acid solution, the salivary glands are fixed in 7% perchloric acid containing small amounts of ferric ions (SAUAIA et al. 1971). We show here that, with regard to the preservation of total incorporated 3H-thymidine and with regard to the relative autoradiographic labelling of expanded chromosome regions as compared to the labelling of a non-expanded one, this method is equivalent to fixing the salivary glands in ethanol-acetic (3:1). We show also that if this kind of preparation is subject to mild acid hydrolysis a small amount of the total 3H-labelled material may be lost.