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1.
Exp Clin Transplant ; 19(10): 1023-1031, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34498549

RESUMO

OBJECTIVES: There is scarcity of data on reoccurrence of SARS-CoV-2 infections in kidney transplant recipients. MATERIALS AND METHODS: We conducted a retrospective multicenter cohort study and identified 13 kidney transplant recipients (10 living and 3 deceased donors) with recurrent COVID-19, and here we report demographics, immunosuppression regimens, clinical profiles, treatments, and outcomes. RESULTS: COVID-19 second infection rate was 0.9% (13/1350) in kidney transplant recipients with a median age of 46 years; median time interval from transplant to first episode of COVID-19 diagnosis was 9.2 months (interquartile range, 2.2-46.5 months). The most common comorbidities were hypertension (84%) and diabetes (23%). Fever was significantly less common with recurrent COVID-19. COVID-19 severity ranged from asymptomatic (23%), mild (31%), and moderate (46%) during the first infection and asymptomatic (8%), mild (46%), and severe (46%) in the second infection. All 6 kidney transplant recipients with severe second infections died. The median interval between the 2 episodes based upon reverse transcriptase polymerase chain reaction COVID-19-positive tests was 135 days (interquartile range, 71-274 days) without symptoms. Statistically significant risk factors for mortality were dyspnea (P = .04), disease severity (P = .004), allograft dysfunction (P < .05), higher levels of neutrophil-to-lymphocyte ratio (P = .05), and intensive care unit/ventilator requirement (P = .004). Although our limited resources did not allow for molecular diagnostics and typing, we suggest that these second episodes were reinfections with SARS-CoV-2. CONCLUSIONS: To our knowledge, this is the largest study of kidney transplant recipients with reoccurring SARS-CoV-2 infection, and we observed 46% mortality.


Assuntos
COVID-19 , Transplante de Rim , Teste para COVID-19 , Pré-Escolar , Estudos de Coortes , Humanos , Lactente , Transplante de Rim/efeitos adversos , Estudos Retrospectivos , SARS-CoV-2 , Transplantados
4.
Nephrol Dial Transplant ; 25(9): 3011-7, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20233739

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is associated with significant morbidity and mortality. US data show that 11-15.6% of population has CKD, but there is no data from India on early stages of CKD. The aim of this study was to estimate the prevalence of early stages of CKD using the Kidney Disease Quality Outcomes Initiative (KDOQI) guidelines in an Indian population. METHODS: A cross-sectional study of Indian central government employees over 18 years of age was carried out. Data on anthropometric profile and investigations including routine urine exam, semi-quantitative microalbuminuria (MAU), serum creatinine, lipid profile and fasting blood glucose (FPG) were collected. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Diseases (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. RESULTS: A total of 3398 subjects, with 2244 (66.04%) males and 1154 (33.96%) females, were studied. Of the subjects, 9.96% (n = 284) were found to have MAU >30 mg/L, and 11.47% (n = 327) had a deranged albumin:creatinine ratio (ACR) of 30-300 mg/g. Mean GFR was 98 mL/min/1.73 m(2) (+/- 25.25) by the MDRD equation, and 100 mL/min/1.73 m(2) (+/- 19.48) by CKD-EPI. Using the MDRD equation for GFR, 189 (6.62%) had stage I CKD, 154 (5.40%) had stage II CKD and 86 (3.02%) had stage III CKD. By using the CKD-EPI equation, the corresponding percentages were 192 (6.73%), 122 (4.28%) and 60 (2.11%), respectively. Age >40 years, FPG >126 mg/dL and hypertension were found to be independent risk factors for CKD. CONCLUSIONS: Of the apparently healthy adult Indian central government employees, 15.04% and 13.12% were found to have early stages of CKD using the MDRD and CKD-EPI criteria for GFR, respectively.


Assuntos
Albuminúria , Creatinina/sangue , Nefropatias/diagnóstico , Nefropatias/epidemiologia , Adolescente , Adulto , Idoso , Doença Crônica , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Índia/epidemiologia , Nefropatias/mortalidade , Masculino , Pessoa de Meia-Idade , Saúde do Trabalhador , Prevalência , Prognóstico , Fatores de Risco , Taxa de Sobrevida , Adulto Jovem
5.
Ren Fail ; 31(7): 533-7, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19839846

RESUMO

10-30% of dialysis population awaiting renal transplantation is sensitized. Present desensitization protocols use intravenous immune globulins, rituximab, and plasmapheresis in various combinations; however, these regimens are unaffordable by many in developing countries. We tried desensitization with mycophenolate mofetil and plasmapheresis. Methods. Patients with high PRA titre (> or =50%) or positive crossmatch (>10%) were treated with MMF for a month before proposed transplant and were given five sittings of plasmapheresis. Results. 11 of 12 patients had normalization of PRA/crossmatch with this regimen and were successfully transplanted. One patient lost the graft due to graft vein thrombosis, and two patients died within three months after transplant due to septicemia and pulmonary embolism, respectively, with a functioning graft. No patient, including the two who died, developed clinical rejection over a mean follow-up of 10 months (range 1-16 months). Mean serum creatinine at last follow up was 1.1 mg/dL (range 0.9-1.3 mg/dL). Conclusions. Though the number of patients studied is small, we feel that highly sensitized patients awaiting living donor renal transplant should be tried on this simple and cost-effective regime before transplant. The more aggressive and expensive approaches incorporating IVIg and rituximab should be used only if this relatively low-cost regime is unsuccessful.


Assuntos
Dessensibilização Imunológica/métodos , Transplante de Rim/imunologia , Ácido Micofenólico/análogos & derivados , Plasmaferese/métodos , Imunologia de Transplantes , Adulto , Estudos de Coortes , Terapia Combinada , Redução de Custos , Análise Custo-Benefício , Dessensibilização Imunológica/economia , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Rejeição de Enxerto , Sobrevivência de Enxerto , Teste de Histocompatibilidade , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Falência Renal Crônica/cirurgia , Transplante de Rim/métodos , Transplante de Rim/mortalidade , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Cuidados Pré-Operatórios , Resultado do Tratamento , Listas de Espera , Adulto Jovem
6.
Natl Med J India ; 22(2): 70-1, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19852340

RESUMO

A living-unrelated renal transplant recipient presented with a history of fever with chills and rigors for 3 days. Clinically, the cause of the fever could not be localized. During a hospital stay of 72 hours, the patient developed sore throat, laryngeal stridor and acute myocardial infarction. A post-mortem revealed disseminated mucormycosis involving the larynx, heart, intestines, brain and the transplanted kidney.


Assuntos
Transplante de Rim/efeitos adversos , Doenças da Laringe/etiologia , Mucormicose/complicações , Infarto do Miocárdio/etiologia , Sons Respiratórios/etiologia , Adulto , Humanos , Masculino
7.
Ren Fail ; 29(3): 371-3, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17497455

RESUMO

Uremic hemorrhagic pericarditis occurs much less frequently in acute than in chronic renal failure, but when it does, it is a potentially fatal complication. The possibility of hemorrhagic pericarditis and cardiac tamponade should be considered in patients with acute renal failure and acute hemodynamic instability. This study reports a case of falciparum malaria complicated by acute renal failure that developed fatal cardiac tamponade in the recovery phase of acute renal failure.


Assuntos
Injúria Renal Aguda/complicações , Tamponamento Cardíaco/etiologia , Malária Falciparum/complicações , Injúria Renal Aguda/parasitologia , Injúria Renal Aguda/terapia , Tamponamento Cardíaco/parasitologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Pericardite/etiologia , Diálise Renal , Uremia/etiologia
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