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1.
Transplant Rev (Orlando) ; 34(4): 100567, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32690437

RESUMO

The global pandemic of severe acute respiratory coronavirus 2 (SARS-CoV-2), which causes the novel beta coronavirus 2019 disease (COVID-19), has become an unprecedented medical, economic, and psychosocial crisis. The pandemic and its management strategies have resulted in immense challenges for health systems, not only in caring for those with COVID-19 but also in the ongoing management of chronic medical conditions. Kidney transplant recipients present a unique challenge given their need for ongoing monitoring and management as well as their higher risk of COVID-19 infection. In the absence of clear guidelines, it is unclear how to best provide routine care to this unique patient population during the pandemic. Rigorous medical and psychosocial patient-centered risk stratification strategies are needed to avoid adverse outcomes in stable solid organ transplant recipients. This review will focus on the challenges faced by kidney transplant recipients and health care providers and provides strategies to address these issues.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Nefropatias/complicações , Nefropatias/psicologia , Transplante de Rim , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Nefropatias/cirurgia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia
2.
Curr Urol Rep ; 21(9): 33, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32666391

RESUMO

PURPOSE OF REVIEW: Advances in preservation and transplantation techniques have made renal autotransplantation (RA) a modality that can be utilized in complex renovascular diseases (renal artery aneurysms), high ureteric injuries, chronic kidney pain, as well as conventionally unresectable renal tumours. In the current review, we present the Oxford experience, the only UK commissioned centre to perform RA for complex renal cell cancers, and review the published RA experience from other UK centres. RECENT FINDINGS: The evidence and literature generated from the RA experience in the UK are largely limited to case reports. The main indications reported for performing RAs include renovascular disease, ureteral pathology and prophylaxis from radiation. Renal autotransplantation is an option for a highly select group of patients. It has short-term and long-term complication rates comparable to those of other major operations. Extensive preoperative counselling in conjunction with multidisciplinary professionals is of utmost importance for informed decision making.


Assuntos
Nefropatias/cirurgia , Transplante de Rim , Humanos , Nefropatias/complicações , Nefropatias/mortalidade , Transplante Autólogo , Reino Unido
3.
BMC Complement Med Ther ; 20(1): 166, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493345

RESUMO

BACKGROUND: The purpose of this study was to identify the clinicopathologic characteristics and prognosis of upper tract urothelial carcinoma (UTUC) patients complicated with aristolochic acid nephropathy(AAN) after radical nephroureterectomy (RNU). METHODS: The clinical data of 42 UTUC patients with AAN (AAN group) and 238 UTUC patients without AAN (Non-AAN group) were retrospectively reviewed. All patients received a RNU with excision of bladder cuff. Demographic and clinical data, including preoperative indexes, intraoperative indexes and surgical outcomes were compared. RESULTS: There were no significant differences in age, tumor location, surgery approach, tumor pathologic grade, stage, the mean operative time and estimated blood loss between the two groups (all p > 0.05). There were more female patients in the AAN group (p < 0.001), and 57.1% were high grade tumors. The AAN group showed a higher complications rate (p = 0.003). The median follow-up time was 43.2 months. The AAN group showed a worse estimated 5-year overall survival rate (35.1% vs. 63.0%, p = 0.014), however, no significant difference was found between the two groups with regard to disease specific survival (63.5% vs. 81.5%, p = 0.091). Multivariate binary logistic regression analysis showed that AAN was an independent factor related with overall and disease specific survival. 38.9% of all patients experienced any types of recurrence, and the estimated 5-year recurrence-free survival rate was lower in the AAN group (37.1% vs. 63.7%, p = 0.001). In the comparison of subgroups stratified by recurrence type, the AAN group had a higher intravesical (p = 0.030) and contralateral recurrence rate (p = 0.040). CONCLUSION: UTUC with AAN occurred more frequently in female patients who were more likely to develop high-grade tumors. However, these patients showed a worse overall survival and a lower recurrence-free survival rate than the other patients. AA-related UTUC might be associate with an increased risk of intravesical and contralateral recurrence after RUN.


Assuntos
Ácidos Aristolóquicos/efeitos adversos , Medicamentos de Ervas Chinesas/efeitos adversos , Nefropatias/induzido quimicamente , Nefroureterectomia , Neoplasias da Bexiga Urinária/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/cirurgia
4.
Am J Cardiol ; 129: 42-45, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32540168

RESUMO

Studies have shown that highly selected patients who underwent combined heart-kidney (HK) and heart-liver transplants (HLv) have short- and long-term outcomes comparable to those observed in primary heart transplantation (HT). Adults patients with stage D heart failure that underwent combined HK, HLv, and heart-lung (HL) were identified in the United Network for Organ Sharing registry from 1991 to 2016, with follow-up through March 2018. We conducted inverse probability of treatment weighting survival analysis of long-term survival stratified by type of combined organ transplant, accounting for donor, recipient, and operative characteristics. We identified 2,300 patients who underwent combined organ transplant (HK 1,257, HLv 212, HL 831). HL recipients were more likely white (77%), women (58%), with congenital heart disease (44.5%), and longer waiting list time (median 195 days). HK transplant increased significantly during the study period where as HL decreased significantly. Median survival was 12.2 years for HK (95% confidence intervals [CI] 10.8 to 12.8), 12 for HLv (95% CI 8.6 to 17.6) but significantly lower at 4.5 years for HL (95% CI 3.6 to 5.8). Combined HK and HLv transplantation rates are increasing and long-term survival is comparable to primary HT, unlike HL which is associated with decreasing trends and significantly lower survival.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração , Transplante de Rim , Transplante de Fígado , Mortalidade , Adulto , Afro-Americanos , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Restritiva/complicações , Grupo com Ancestrais do Continente Europeu , Feminino , Rejeição de Enxerto , Cardiopatias Congênitas/complicações , Insuficiência Cardíaca/complicações , Transplante de Coração-Pulmão , Hispano-Americanos , Humanos , Nefropatias/complicações , Nefropatias/cirurgia , Hepatopatias/complicações , Hepatopatias/cirurgia , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros , Reoperação , Taxa de Sobrevida
5.
Transplant Proc ; 52(5): 1547-1551, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32307145

RESUMO

The decline of allograft kidney function in the long term remains a significant issue in renal transplantation, with drug nephrotoxicity and cardiovascular complications as important risk factors. Our study aimed to evaluate the estimated glomerular filtration rate (eGFR) trend and metabolic cardiovascular risk factors over 10 years in a cohort of kidney transplant (KT) recipients converted from twice-daily (TD) tacrolimus (Tac) to once-daily (OD)-Tac. We enrolled 55 consecutive KT recipients who had been at the outpatient clinic between 2009 and 2011. Thirty-seven reached the 10-year follow-up. We compared the observed eGFR with the expected eGFR trend described in KT-recipients and monitored blood pressure and metabolic cardiovascular risk factors. The observed eGFR remained stable throughout the complete follow-up (P = .188). The observed decline of eGFR was significantly lower compared with the expected decline for KT patients (P < .001). The blood pressure was maintained within target values. The monitoring of plasma glucose levels demonstrated the stability of median values (P = .686), as well as cholesterol level (P = .250), high-density lipoprotein (HDL) cholesterol (P = .294), and triglycerides (P = .592) throughout the follow-up. The monitoring of tacrolimus plasma level demonstrated that median trough levels remained constant (median values 4.4-5.5 ng/mL) throughout the entire follow-up period (P = .149). We suggest that the reasonable control of metabolic risk factors for cardiovascular disease over long-term follow-up may significantly contribute to the preservation of eGFR compared with the decline expected in KT recipients.


Assuntos
Taxa de Filtração Glomerular/fisiologia , Imunossupressores/administração & dosagem , Nefropatias/fisiopatologia , Transplante de Rim/efeitos adversos , Tacrolimo/administração & dosagem , Adulto , Aloenxertos/fisiopatologia , Doenças Cardiovasculares/etiologia , Esquema de Medicação , Feminino , Seguimentos , Humanos , Rim/fisiopatologia , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Fatores de Risco , Transplante Homólogo , Resultado do Tratamento
6.
Nephrol Dial Transplant ; 35(3): 512-519, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32133530

RESUMO

BACKGROUND: In renal transplant recipients (RTRs), cardiovascular mortality is the most common cause of long-term renal graft loss. Oxidative stress (OS) has been associated with cardiovascular disease and is known to be enhanced in RTRs. We aimed to prospectively investigate whether the concentration of the OS biomarker malondialdehyde (MDA) is associated with long-term risk of cardiovascular mortality in a large cohort of RTRs. METHODS: The plasma MDA concentration was measured using the thiobarbituric acid reaction assay in 604 extensively phenotyped RTRs with a functioning allograft for ≥1 year. The association between MDA and cardiovascular mortality was assessed using Cox proportional hazard regression analyses in the overall cohort and within subgroups according to significant effect modifiers. RESULTS: Median circulating MDA concentration at baseline was 5.38 [interquartile range (IQR) 4.31-6.45] µmol/L. During a follow-up period of 6.4 (IQR 5.6-6.8) years, 110 (18%) RTRs died, with 40% of deaths due to cardiovascular causes. MDA concentration was significantly associated with the risk for cardiovascular mortality {hazard ratio [HR] 1.31 [95% confidence interval (CI) 1.03-1.67] per 1-SD increment}, independent of adjustment for potential confounders, including renal function, immunosuppressive therapy, smoking status and blood pressure. The association between MDA concentration and the risk for cardiovascular mortality was stronger in RTRs with relatively lower plasma ascorbic acid concentrations [≤42.5 µmol/L; HR 1.79 (95% CI 1.30-2.48) per 1-SD increment] or relatively lower estimated glomerular filtration rates [≤45 mL/min/1.73 m2; HR 2.09 (95% CI 1.45-3.00) per 1-SD increment]. CONCLUSIONS: Circulating MDA concentration is independently associated with long-term risk for cardiovascular mortality, particularly in RTRs with relatively lower ascorbic acid concentrations or renal function. Further studies are warranted to elucidate whether OS-targeted interventions could decrease cardiovascular mortality in RTRs.


Assuntos
Biomarcadores/sangue , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/mortalidade , Nefropatias/mortalidade , Transplante de Rim/mortalidade , Malondialdeído/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Nefropatias/cirurgia , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Transplantados
7.
Med Oncol ; 37(4): 26, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32166542

RESUMO

RENAL score has been validated on predicting adverse events and relapses in percutaneous treatments of renal lesions. To better fit interventional issues a modified score (mRENAL) has been introduced, but the only difference from the RENAL score is on the dimensional parameter. However, it remains of surgical derivation while a specific interventional score is missing. This study aims to obtain a specific score (ABLATE) to better quantify the risk of complications and relapses in percutaneous kidney ablation procedures compared to the existing surgical scores. Taking inspiration from previous papers, a score was built to quantify the real difficulties faced in percutaneous treatment of renal lesions. The ABLATE score was used on 71 cryoablations to evaluate its predictivity of complications and relapses. Logistic regression was used to predict complication incidence; Cox-regression was used for relapses; ROC analysis was used to evaluate the accuracy of the different scores. Between January 2014 and November 2019, 71 lesions in 68 patients were treated. Overall, malignant histology was found in 62 lesions (87.3%). Mean and median RENAL, mRENAL, and ABLATE scores were 7.04 and 7, 7.19 and 7, and 5.11 and 4, respectively. Out of 71 treatments, we experienced 3 bleeding with anemia (4.2%), only 2 of which needed further treatment (2.82%). The mean and median RENAL, mRENAL, and ABLATE scores in those with complications were 7.66 and 7.01 (p = 0.69), 8.0 and 7.1 (p = 0.54), and 6.6 and 5.0 (p = 0.38), respectively. Out of 62 malignant lesions, we experienced 2 persistent and 6 recurrent lesions (3.2% and 8.4%, respectively). At Cox-regression analyses, mABLATE score outperformed both RENAL and mRENAL scores in predicting recurrences (HR 1.48; p < 0.001 vs. 1.41; p = 0.1 vs. 1.38: p = 0.07, respectively). The ABLATE score showed to be a better predictor of relapses than RENAL and mRENAL. The small number of complications conditioned a lack of statistic power on complications for all the scores. At the moment to quantify the risks in percutaneous kidney ablation procedures, surgical scores are used. A specific score better performs this task.


Assuntos
Nefropatias/patologia , Nefropatias/cirurgia , Nefrostomia Percutânea/métodos , Técnicas de Ablação/efeitos adversos , Técnicas de Ablação/métodos , Idoso , Feminino , Humanos , Masculino , Nefrostomia Percutânea/efeitos adversos , Complicações Pós-Operatórias , Valor Preditivo dos Testes , Recidiva , Resultado do Tratamento
8.
Curr Urol Rep ; 21(1): 5, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-32006250

RESUMO

PURPOSE OF THE REVIEW: To update the most relevant literature regarding complex vascular cases in kidney transplant setting involving the graft, especially during the harvesting procedure and back-table preparation from the subsequent implant. RECENT FINDINGS: Challenging situations affecting the kidney graft such as multiple vessels, renal artery aneurysms, kidney anatomical anomalies, or major injuries do not contraindicate the transplant, but require an exhaustive graft viability assessment and several bench surgery techniques. Graft vessel conditioning in the back-table might include simple anastomosis between them, enlarging with venous patch or reconstruction with donor or synthetic grafts. Compared with conventional transplant, literature reports longer warm ischemia time (40 vs 32 min) and slightly increased rates of delayed graft function (10.3% vs 8.2%) and vascular complications (10.8% vs 8.1%), but similar graft and patient survival. Kidney graft vascular complex cases require exhaustive assessment, meticulous harvesting, good surgical technique in the bench table, and proper surgery in the recipient. Despite its complexity, vascular complex kidney transplant offers comparable outcomes in the long term to conventional population when technically well performed, with slightly increased rates of vascular complications and delayed graft function.


Assuntos
Doenças Cardiovasculares/cirurgia , Transplante de Rim/métodos , Rim/cirurgia , Coleta de Tecidos e Órgãos/métodos , Transplantes/irrigação sanguínea , Aneurisma/cirurgia , Função Retardada do Enxerto , Sobrevivência de Enxerto , Humanos , Rim/anormalidades , Rim/irrigação sanguínea , Nefropatias/cirurgia , Falência Renal Crônica/cirurgia , Artéria Renal/cirurgia , Transplantes/anormalidades , Transplantes/cirurgia , Doenças Vasculares/cirurgia , Malformações Vasculares/cirurgia , Lesões do Sistema Vascular/cirurgia , Isquemia Quente
9.
Virol J ; 17(1): 5, 2020 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924245

RESUMO

BACKGROUND: BK Polyomavirus (BKPyV) causes premature graft failure in 1 to 15% of kidney transplant (KT) recipients. High-level BKPyV-viruria and BKPyV-DNAemia precede polyomavirus-associated nephropathy (PyVAN), and guide clinical management decisions. In most cases, BKPyV appears to come from the donor kidney, but data from biopsy-proven PyVAN cases are lacking. Here, we report the early fulminant course of biopsy-proven PyVAN in two male KT recipients in their sixties, receiving kidneys from the same deceased male donor. CASE PRESENTATIONS: Both recipients received intravenous basiliximab induction, and maintenance therapy consisting of tacrolimus (trough levels 3-7 ng/mL from time of engraftment), mycophenolate mofetil 750 mg bid, and prednisolone. At 4 weeks post-transplant, renal function was satisfactory with serum creatinine concentrations of 106 and 72 µmol/L in recipient #1 and recipient #2, respectively. Plasma BKPyV-DNAemia was first investigated at 5 and 8 weeks post-transplant being 8.58 × 104 and 1.12 × 106 copies/mL in recipient #1 and recipient #2, respectively. Renal function declined and biopsy-proven PyVAN was diagnosed in both recipients at 12 weeks post-transplant. Mycophenolate mofetil levels were reduced from 750 mg to 250 mg bid while tacrolimus levels were kept below 5 ng/mL. Recipient #2 cleared BKPyV-DNAemia at 5.5 months post-transplant, while recipient #1 had persistent BKPyV-DNAemia of 1.07 × 105 copies/mL at the last follow-up 52 weeks post-transplant. DNA sequencing of viral DNA from early plasma samples revealed apparently identical viruses in both recipients, belonging to genotype Ib-2 with archetype non-coding control region. Retrospective serological work-up, demonstrated that the donor had high BKPyV-IgG-virus-like particle ELISA activity and a high BKPyV-genotype I neutralizing antibody titer, whereas both KT recipients only had low neutralizing antibody titers pre-transplantation. By 20 weeks post-transplant, the neutralizing antibody titer had increased by > 1000-fold in both recipients, but only recipient #2 cleared BKPyV-DNAemia. CONCLUSIONS: Low titers of genotype-specific neutralizing antibodies in recipients pre-transplant, may identify patients at high risk for early fulminant donor-derived BKPyV-DNAemia and PyVAN, but development of high neutralizing antibody titers may not be sufficient for clearance.


Assuntos
Aloenxertos/virologia , Anticorpos Neutralizantes/sangue , Transplante de Rim , Nefrose/virologia , Infecções por Polyomavirus/cirurgia , Adulto , Idoso , Anticorpos Neutralizantes/biossíntese , Vírus BK/patogenicidade , DNA Viral/sangue , Humanos , Rim/patologia , Rim/cirurgia , Rim/virologia , Nefropatias/cirurgia , Nefropatias/virologia , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Transplantados , Viremia
10.
Transplant Proc ; 52(1): 302-308, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31926746

RESUMO

BACKGROUND: The proportion of lung transplant candidates with comorbid renal dysfunction (RD) may rise as sicker patients are being considered for lung transplant (LT). There is lack of data regarding the characteristics and outcome of patients with RD and the role of simultaneous lung-kidney transplant (SLuKi) among these patients. METHODS: The United Network of Organ Sharing database was queried for adult patients (18 years or older) undergoing LT between 1995 and 2014. Pretransplant RD was defined as estimated glomerular filtration rate (eGFR), using the Chronic Kidney Disease Epidemiology Collaboration equation of <60 mL/min/1.73 m2 at the time of transplant listing. The recipient, donor, and procedure-related variables and survival were compared among patients with RD undergoing LT alone (split on the basis of eGFR impairment: 30-60 mL/min/1.73 m2 and ≤ 30 mL/min/1.73 m2) vs those with SLuKi. RESULTS: The frequency of pretransplant RD was 5.42% (n = 1337). Patients with RD have significantly higher 1-year mortality (23.2% vs 15%; P < .001) and 3-year mortality (38.3% vs 28%; P < .001) than patients with eGFR > 60mL/min/1.73 m2. The proportion of patients with RD undergoing SLuKi was 2.84% (38 of 1337). Both the number and proportion of patients undergoing SLuKi progressively increased during the study period, especially in the lung allocation score era (30 of 38 SLuKi patients in the post lung allocation score era (linear R2 = 0.641, P < .001). The patients who underwent SLuKi were significantly younger, had lower body mass index, serum albumin, and listing eGFR (P < .001 for all comparisons). Patients with SLuKi were more likely to have cystic fibrosis or vascular diseases as the underlying diagnosis (29.7% vs 13.8%, P = .004). Despite higher need of early dialysis support after transplant, there was no difference in the 30-day, 1-year, or 3-year survival between the 2 groups. CONCLUSIONS: A significant proportion of LT candidates have a pre-existing RD, and this comorbidity is associated with significantly worse 1- and 3-year survival. Despite being the sicker group at baseline, patients with RD who undergo SLuKi have 1-year outcomes similar to patients with LT alone.


Assuntos
Nefropatias/epidemiologia , Transplante de Rim , Pneumopatias/epidemiologia , Transplante de Pulmão , Adulto , Comorbidade , Feminino , Humanos , Nefropatias/cirurgia , Transplante de Rim/métodos , Pneumopatias/cirurgia , Transplante de Pulmão/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
J Laparoendosc Adv Surg Tech A ; 30(5): 514-519, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31928507

RESUMO

Background: Percutaneous aspiration with sclerotherapy (PAS) and laparoscopic marsupialization (LM) are minimally invasive treatment modalities for renal cysts. We aimed to compare the efficacy and cost/effectiveness of LM and PAS for the treatment of simple symptomatic renal cysts. Methods: Data were prospectively collected from three health care institutions in which 80 patients with symptomatic simple renal cysts underwent a single session of PAS with 95% ethanol (PAS group, n = 40) or underwent LM under general anesthesia (LM group, n = 40) between March 2012 and May 2016. We compared the patient profile, duration of procedure, duration of hospital stay, radiological and symptomatic success rates, treatment costs, and incidence of complications between the two groups. Results: At the 6-month follow-up, the radiological success rate in the LM group was significantly greater than that in the PAS group (97.5% versus 60%; P < .001). The symptomatic success rate was comparable in the two groups (95% versus 90%; P = .675). The treatment failure rate did not significantly differ between the two groups (5.0% versus 17.5%, P = .154). The mean total cost in the PAS and LM groups was 1256 USD and 2343 USD, respectively (P = .001). No significant between-group difference was noted regarding the overall complication rate (P = .615). Conclusions: Both LM and PAS are effective and safe procedures for the treatment of symptomatic simple renal cysts. A single session of PAS seems to be a cost-effective method for the management of symptomatic simple renal cysts.


Assuntos
Cistos/terapia , Nefropatias/terapia , Laparoscopia , Escleroterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Cistos/diagnóstico por imagem , Cistos/cirurgia , Etanol/uso terapêutico , Feminino , Custos de Cuidados de Saúde , Humanos , Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/economia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Soluções Esclerosantes/uso terapêutico , Escleroterapia/efeitos adversos , Escleroterapia/economia , Sucção/efeitos adversos , Sucção/economia , Resultado do Tratamento
12.
Nephrol Dial Transplant ; 35(5): 888-894, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30165691

RESUMO

BACKGROUND: Whether calcium oxalate (CaOx) deposition in kidney allografts following transplantation (Tx) adversely affects patient outcomes is uncertain, as are its associated risk factors. METHODS: We performed a retrospective cohort study of patients who had kidney allograft biopsies performed within 3 months of Tx at Brigham and Women's Hospital and examined the association of CaOx deposition with the composite outcome of death or graft failure within 5 years. RESULTS: Biopsies from 67 of 346 patients (19.4%) had CaOx deposition. In a multivariable logistic regression model, higher serum creatinine [odds ratio (OR) = 1.28 per mg/dL, 95% confidence interval (CI) 1.15-1.43], longer time on dialysis (OR = 1.11 per additional year, 95% CI 1.01-1.23) and diabetes (OR = 2.26, 95% CI 1.09-4.66) were found to be independently associated with CaOx deposition. CaOx deposition was strongly associated with delayed graft function (DGF; OR = 11.31, 95% CI 5.97-21.40), and with increased hazard of the composite outcome after adjusting for black recipient race, donor type, time on dialysis before Tx, diabetes and borderline or acute rejection (hazard ratio 1.90, 95% CI 1.13-3.20). CONCLUSIONS: CaOx deposition is common in allografts with poor function and portends worse outcomes up to 5 years after Tx. The extent to which CaOx deposition may contribute to versus result from DGF, however, cannot be determined based on our retrospective and observational data. Future studies should examine whether reducing plasma and urine oxalate prevents CaOx deposition in the newly transplanted kidney and whether this has an effect on clinical outcomes.


Assuntos
Oxalato de Cálcio/metabolismo , Rejeição de Enxerto/mortalidade , Sobrevivência de Enxerto , Nefropatias/mortalidade , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Aloenxertos , Feminino , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/metabolismo , Humanos , Nefropatias/metabolismo , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
13.
Nephrol Dial Transplant ; 35(4): 706-714, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30753729

RESUMO

BACKGROUND: Kidney transplant recipients (KTRs) experience substantial survival benefit compared with dialysis patients. However, their mortality and graft failure risk remain high. KTRs are often low in micronutrient status, including vitamins D and K. We investigated the association of both vitamins D and K status, and vitamin D treatment with all-cause mortality and death-censored graft failure. METHODS: We studied 461 KTRs from a single-centre study at median 6.1 years after transplantation. At baseline, vitamins D and K concentrations were measured by 25-hydroxyvitamin D [25(OH)D] and dephosphorylated uncarboxylated matrix gla protein (dp-ucMGP) and patients were categorized into: 25(OH)D <50/≥50 nmol/L and median dp-ucMGP <1057/≥1057 pmol/L. RESULTS: Mean age was 52 ± 12 years, and 122 KTRs (26%) had low vitamins D and K status. During median 9.8 years follow-up, 128 patients (28%) died and 48 (10%) developed death-censored graft failure. Low vitamins D and K status was associated with 2.33 (1.26-4.30) [hazard ratio (95% confidence interval)] increased mortality risk and 3.25 (1.17-9.08) increased graft failure risk compared with KTR with 25(OH)D ≥50 nmol/L and dp-ucMGP <1057 pmol/L. Dp-ucMGP was strongly associated with mortality (per 500 pmol/L increase): 1.41 (1.08-1.41) for vitamin D treatment versus no treatment 1.07 (0.97-1.18), and graft failure 1.71 (1.17-2.49) for vitamin D treatment versus 1.19 (1.05-1.36) no treatment, P-interaction <0.07 for vitamin D treatment (n = 44). CONCLUSIONS: Combined vitamins D and K deficiency are highly prevalent and are associated with increased mortality and graft failure risk compared with high vitamins D and K status. Low vitamin K status was strongly associated with an increased risk of premature mortality and graft failure for patients treated with vitamin D versus no vitamin D treatment.


Assuntos
Rejeição de Enxerto/mortalidade , Nefropatias/mortalidade , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Vitamina D/sangue , Deficiência de Vitamina K/complicações , Vitamina K/sangue , Feminino , Rejeição de Enxerto/sangue , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/patologia , Sobrevivência de Enxerto , Humanos , Nefropatias/sangue , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida
14.
Nephrol Dial Transplant ; 35(4): 714-721, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31106364

RESUMO

BACKGROUND: After transplantation, cell-free deoxyribonucleic acid (DNA) derived from the donor organ (ddcfDNA) can be detected in the recipient's circulation. We aimed to investigate the role of plasma ddcfDNA as biomarker for acute kidney rejection. METHODS: From 107 kidney transplant recipients, plasma samples were collected longitudinally after transplantation (Day 1 to 3 months) within a multicentre set-up. Cell-free DNA from the donor was quantified in plasma as a fraction of the total cell-free DNA by next generation sequencing using a targeted, multiplex polymerase chain reaction-based method for the analysis of single nucleotide polymorphisms. RESULTS: Increases of the ddcfDNA% above a threshold value of 0.88% were significantly associated with the occurrence of episodes of acute rejection (P = 0.017), acute tubular necrosis (P = 0.011) and acute pyelonephritis (P = 0.032). A receiver operating characteristic curve analysis revealed an equal area under the curve of the ddcfDNA% and serum creatinine of 0.64 for the diagnosis of acute rejection. CONCLUSIONS: Although increases in plasma ddcfDNA% are associated with graft injury, plasma ddcfDNA does not outperform the diagnostic capacity of the serum creatinine in the diagnosis of acute rejection.


Assuntos
Biomarcadores/sangue , Ácidos Nucleicos Livres/sangue , Rejeição de Enxerto/diagnóstico , Nefropatias/sangue , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Doadores de Tecidos/provisão & distribução , Adolescente , Adulto , Idoso , Ácidos Nucleicos Livres/genética , Feminino , Rejeição de Enxerto/sangue , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Humanos , Nefropatias/genética , Nefropatias/cirurgia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Prognóstico , Curva ROC , Taxa de Sobrevida , Adulto Jovem
15.
Clin Exp Nephrol ; 24(2): 185-189, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31655937

RESUMO

BACKGROUND: There is no written consensus as to when and in what conditions simple nephrectomy should be performed for hypo-functioning obstructed kidneys. We aimed to assess renal function and the requirement of nephrectomy in patients that underwent percutaneous nephrostomy (PCN) despite being indicated for nephrectomy due to a split renal function of less than 10% caused by ureteral obstruction. METHODS: This prospective study includes 18 patients with unilateral upper urinary tract obstruction and renal parenchymal loss on Technetium-99 m dimercaptosuccinic acid (DMSA) scintigraphy. Each patient underwent DMSA scan (DMSA-1) prior to PCN. After a 2-week follow-up period, a second DMSA scan was performed to assess renal function of each kidney (DMSA-2). Nephrectomy was performed in the kidneys functioning below 10% of their capacity, whereas kidneys functioning above 10% of their capacity were treated as appropriate to their etiologies. Renal functions and DMSA results were compared before and after nephrostomy with Paired-samples t-test and one-way ANOVA. RESULTS: Following nephrostomy, 8 (44.4%) patients had a kidney functioning above 10% of its capacity on DMSA scan and received etiology-based treatment. Glomerular filtration rates of these patients also improved significantly. A total of 9 patients who did not improve renal functions underwent nephrectomy. CONCLUSION: The results indicated that in obstructed kidneys functioning below 10% of their capacity, renal function can be recovered by using a diversion technique (such as PCN) that could alleviate the pressure within the renal pelvis and kidney parenchyma, instead of directly performing simple nephrectomy.


Assuntos
Taxa de Filtração Glomerular , Nefropatias/cirurgia , Rim/cirurgia , Nefrostomia Percutânea , Obstrução Ureteral/complicações , Adulto , Idoso , Tomada de Decisão Clínica , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/fisiopatologia , Nefropatias/diagnóstico por imagem , Nefropatias/etiologia , Nefropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Compostos Radiofarmacêuticos/administração & dosagem , Recuperação de Função Fisiológica , Ácido Dimercaptossuccínico Tecnécio Tc 99m/administração & dosagem , Fatores de Tempo , Resultado do Tratamento , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/fisiopatologia
16.
Clin Imaging ; 59(2): 172-178, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31821975

RESUMO

AIM: To review the experience of a single tertiary center with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA syndrome) and evaluate if MRI findings correlate with outcome. METHODS: Patients (n = 32) diagnosed with OHVIRA syndrome between 2001 and 2019 were analyzed. Presenting symptoms, age of menarche, age at operation, MRI findings, management, and outcome were reviewed. In sagittal MRI planes, distance from hematocolpos to perineum was measured. Measurements were compared among patients who underwent single-stage vaginoplasty and hemihysterectomy. RESULTS: Mean age at diagnosis and mean age of menarche was 16.8 ± 6.4 (10-33) and 12.8 ± 1.0 (10-15). Main presenting complaints were abdominal pain/dysmenorrhea. Eighteen anomalies (56.3%) were on right side. Twenty-eight had ipsilateral renal agenesis, 3 patients had normal renal anatomy and one had unilateral multicystic dysplastic kidney. In MRI, 21 patients had hematocolpos, 11 patients had both hematocolpos and hematometra. 28 patients underwent single-stage vaginoplasty and vaginal septum resection. One had hemihysterectomy due to sepsis at presentation. Three patients had hemihysterectomy due to proximal vaginal septum and impossibility of vaginoplasty. During follow-up, 7 cases (21.9%) had married and 5 of these (71.4%) were pregnant or had delivered. Five patients had reoperation during follow-up. MRI images of 19 patients indicated mean distances from hematocolpos to perineum whom underwent vaginoplasty or hemihysterectomy were 33.9 ± 18.1 mm (10-79 mm) and 87.3 ± 11.0 mm (80-100), respectively (p = .009). CONCLUSIONS: Gold standard treatment of OHVIRA syndrome is single-stage vaginoplasty. Distance from hematocolpos to perineum in MRI may correlate with surgical outcome. Hemihysterectomy may be an alternative for extreme proximal vaginal septum or infectious complications.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Anormalidades Congênitas/diagnóstico por imagem , Anormalidades Congênitas/cirurgia , Nefropatias/congênito , Rim/anormalidades , Imagem por Ressonância Magnética/métodos , Vagina/anormalidades , Vagina/diagnóstico por imagem , Adolescente , Adulto , Criança , Feminino , Humanos , Histerectomia/métodos , Rim/diagnóstico por imagem , Rim/cirurgia , Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia , Síndrome , Resultado do Tratamento , Vagina/cirurgia , Adulto Jovem
17.
Medicine (Baltimore) ; 98(49): e18167, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804331

RESUMO

RATIONALE: Renal actinomycosis is a rare clinical infection, subacute to chronic presentation caused by the Actinomyces bacteria. Actinomyces israelii is diagnosed in the overpowering majority of reported cases. Abdominopelvic manifestation forms 10% to 20% of all actinomycosis, and may be misdiagnosed as either a malignancy or chronic inflammation due to the lower correct preoperative diagnostic rate (<10%). PATIENT CONCERNS: A 38-year-old man with alcoholic liver cirrhosis experienced right flank pain, abdominal pain, and fever for 3 days. Leukocytosis, acute kidney injury, and impaired liver function were found. A computed tomographic scan demonstrated multiple renal cystic lesions, along with fluid accumulation at the right subphrenic and retroperitoneal spaces. DIAGNOSES: Renal actinomycosis was confirmed via cultures of both the abscess and nephrectomy specimen which grew A israelii and the pathological findings of multiple renal abscesses of actinomycosis with the characteristics of sulfur granules. INTERVENTIONS: A nephrectomy was performed for an inadequate percutaneous drainage of renal abscess. OUTCOMES: A full course of antibiotics with intravenous penicillin G (3 million units every 4 hours) was prescribed for 2 weeks, followed by oral penicillin V given at a dose of 2 grams per day for 6 months at our out-patient facility. LESSONS: A precise diagnosis of primary renal actinomycosis depends on any histopathological findings and/or cultures of specimens. A high dose of intravenous penicillin G is the first choice, followed by oral penicillin V, with the duration of each being dependent upon the individual condition.


Assuntos
Abscesso Abdominal/complicações , Actinomicose/complicações , Nefropatias/complicações , Cirrose Hepática Alcoólica/complicações , Espaço Retroperitoneal/patologia , Abscesso Abdominal/tratamento farmacológico , Actinomicose/tratamento farmacológico , Actinomicose/cirurgia , Adulto , Antibacterianos/uso terapêutico , Humanos , Nefropatias/tratamento farmacológico , Nefropatias/cirurgia , Masculino , Nefrectomia
18.
Rev Med Liege ; 74(10): 521-526, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31609555

RESUMO

The role of medical imaging is of major impor¬tance in the follow-up of patients with kidney transplant.There as many and various renal transplant complications. The development of techniques in medical imaging, especially the progression of clinical and biological monitoring improve their detection. In this article, we will remind the diverses complications of renal transplant and their expression in the various imaging modalities, including Doppler ultrasound which remains the principal examination modality.


Assuntos
Nefropatias , Transplante de Rim , Angiografia , Humanos , Nefropatias/cirurgia , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias , Ultrassonografia
19.
Int J Chron Obstruct Pulmon Dis ; 14: 2235-2243, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31576119

RESUMO

Background: To describe trends and outcomes during admission for solid organ transplants, excluding lungs, in people with or without COPD in Spain (2001-2015). Methods: We used national hospital discharge data to select all hospital admissions for kidney, heart and liver transplants. We estimated admission rates stratified by COPD status. We analyzed the Charlson Comorbidity Index, therapeutic procedures and outcomes. Results: We identified 52,020 admissions (33,293 for kidney transplant, 3,937 for heart transplant and 14,790 for liver transplant). Patients with COPD accounted for 2.5%, 4.2% and 3.5% of kidney, heart and liver transplant patients, respectively. The number of kidney and liver transplants increased among COPD patients over the study period, whereas the number of heart transplants remained stable. In all cases, COPD patients were significantly older and had more coexisting medical conditions than those without COPD. Among patients who underwent a kidney transplant, there were no significant differences in the clinical characteristics analyzed between the groups, but the overall in-hospital mortality (IHM) rate was significantly higher in COPD patients than in those without COPD (2.22% vs 0.58%, p=0.008). There were no differences for any of the study variables or for the IHM rate in patients who underwent a heart transplant (14.63% in both groups). Among patients who underwent a liver transplant, COPD patients had lower prevalences of infection and complications than those without COPD. The IHM rate was also significantly lower in COPD patients than in non-COPD controls who underwent a liver transplant (4.07% vs 8.91%, p=0.002). Conclusion: COPD prevalence in patients undergoing renal, heart and liver transplants is lower than it has been described in the general population. However, we did not find differences in the clinical characteristics analyzed between COPD and non-COPD patients. Furthermore, the IHM rate was only higher in COPD patients who underwent a kidney transplant but not in those undergoing a heart or liver transplant.


Assuntos
Cardiopatias/complicações , Cardiopatias/cirurgia , Transplante de Coração/tendências , Nefropatias/complicações , Nefropatias/cirurgia , Transplante de Rim/tendências , Hepatopatias/complicações , Hepatopatias/cirurgia , Transplante de Fígado/tendências , Doença Pulmonar Obstrutiva Crônica/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Fatores de Tempo , Resultado do Tratamento
20.
Ann Transplant ; 24: 553-568, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31582715

RESUMO

BACKGROUND Interstitial fibrosis and tubular atrophy (IF/TA) have been recognized as crucial factors contributing to graft loss resulting from chronic renal allograft injuries. Recent studies have indicated a significant association between the progression of organ fibrosis and single nucleotide polymorphisms (SNPs) found on certain genes. Our research sought to understand these potential associations and detect the potential impact of SNPs on ubiquitin-related genes related to allograft fibrosis in kidney transplant recipients. MATERIAL AND METHODS There were 200 patients enrolled in this study, from which samples were extracted for total DNA. Targeted next-generation sequencing was used to detect SNPs on 9 genes (FBXL21, PIAS1/2, SUMO1/2/3/4, UBE2D1, and UBE2I). Minor allele frequency (MAF) and Hardy-Weinberg equilibrium (HWE) tests were used and followed by linkage disequilibrium analysis. General linear models (GLM) were used to identify significant confounding factors. Finally, multiple inheritance models and haplotype analyses were conducted to explore associations between SNPs and the degree of the severity of renal allograft fibrosis. RESULTS In total, 144 SNPs were identified in targeted sequencing. After filtering based on results from MAF and HWE tests, 15 tagger SNPs were selected for further analyses of associations. GLMs indicated that the administration of sirolimus significantly contributed to the degree of severity of allograft fibrosis (P=0.011). After adjusting for confounding factors and applying a Bonferroni correction, multiple inheritance model analyses indicated that the recessive model of rs644731 of the PIAS2 gene was significantly correlated with the occurrence of IF/TA (P=0.01). Furthermore, single-locus based analysis of rs644731 did not indicate that it had a positive influence on IF/TA in a degree-dependent manner. Finally, linkage disequilibrium analysis revealed 3 haplotypes all lacking significant correlation with respect to the IF/TA experimental cohort. CONCLUSIONS We are the first to reveal that mutations of rs644731 in the PIAS2 gene were significantly correlated with the progression of IF/TA in kidney transplant recipients.


Assuntos
Nefropatias/patologia , Transplante de Rim , Rim/patologia , Polimorfismo de Nucleotídeo Único , Proteínas Inibidoras de STAT Ativados/genética , Ubiquitina/genética , Adulto , Alelos , Feminino , Fibrose/genética , Fibrose/patologia , Frequência do Gene , Humanos , Nefropatias/genética , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade
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