Stellenbosch University: SUNJournals
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Comparison of serum cystatin C and creatinine based methods in detection of early renal dysfunction in critically ill patients
Full text linkEarly detection of renal dysfunction is of importance inthe care of critically ill patients. Cystatin C was proposedto be superior to serum creatinine in estimation of renal function. This work aimed to compare serum cystatin Cto serum creatinine and creatinine based formulae indetection of early decline in renal function at a singlepoint in critically ill patients. Fifty critically ill patientsadmitted to Cairo University Hospitals ICUs - Egypt wereincluded. Patients with chronic renal disease,thyroid disease, malignancy, patients receivingcorticosteroid therapy, with serum creatinine > 1.4 mg/dland patients receiving diuretics or large volumes of IVfluids were excluded. Serum creatinine, serum cystatinC, adjusted creatinine clearance (Adj Ccr), estimatedGFR (eGFR) by modification of diet in renal disease(MDRD), abbreviated MDRD (abb MDRD) andCockcroft-Gault (CG) formulae were measured. Patientswith renal dysfunction (adj Ccr < 80 ml/min/1.73m2)were 26 (52%) in number. Patients with renaldysfunction and high serum creatinine were 12/26(46.2%) while those with high cystatin C were 23/26(88.5%). Cystatin C was found to be significantlycorrelated with serum creatinine, adj Ccr and eGFR by all studied formulae. Using receiver operatingcharacteristic (ROC) analysis; AUC for Cystatin C(0.976) was more than that for eGFR by abb MDRD(AUC=0.839), MDRD (AUC=0.822), CG formulae(AUC=0.808) and serum creatinine (AUC=0.710)respectively. In conclusion; cystatin C was found to bebetter than serum creatinine, eGFR by abb MDRD,MDRD and CG formulae in detection of early renaldysfunction at a single point in critically ill patients
Vascular complications in adults and pediatrics live-donor renal transplantation: 3 decades of single centre experience
Full text linkWe analyzed the incidence of vascular complications in adults and pediatrics live donor renal transplantations over 3 decades and compared its impact upon patient and graft survival in both groups.Material and methods: Between March 1976 and December 2005, 1785 live-donor renal transplantswere performed in a single institute, of the 1546 adults and 239 pediatric (age ≤18 years). The incidence of different types of vascular complications were determined in both groups. Long term patient and graft survival in patients with or without vascular complications and in various types of vascular complications were calculated & compared in both groups.Results: The overall incidence of vascular complications was 2.9%, it was equally 2.9% in both groups. In adults, 46 complications in 45 patients included 16 arterial, 10 renal artery thrombosis (0.6%), 2 cases of spasm in renal artery(0.1%), renal artery stenosis in 5 (0.3%), renal vein thrombosis in one (0.06%) and hemorrhagic complications in 28 patients whereas there were no thrombotic complications in the pediatric group, 6 case of hemorrhage (2.5%) and one case of renal artery stenosis (0.4%). There is steady decrease of vascular complications over the last 3 decades. The vascular complications significantly adverse patient and graft survival in both groups (p<0.001). The 5-years patient and graft survival in adults and pediatrics with or without vascular complications were 59.5 ± 9.2%, 89.14 ± 0.89%, 57.5 ± 18.7% and 90.18 ± 2.2% for the patient and 40.14 ± 7.75%, 97.79 ± 1.14%, 28.57 ± 17.07% and 77.18 ± 3.02% for the graft. There is no statistical significant difference in either patient or graft survival in thrombotic, stenotic or hemorrhagic complications in adult or hemorrhagic complications in the pediatric group (p=0.22 and p=0.142 respectively).Conclusions: There is no increase in incidence of vascular complications in pediatrics than adult transplants. The survival either graft or patient is comparable between adult and pediatric with or without vascular complications and the subgroups of vascular complications
Diffusion weighted MRI in evaluation of transplanted kidney: Preliminary clinical experience
Full text linkPurpose: To evaluate the diagnostic performance ofDiffusion Weighted (DW) magnetic resonance(MR) imaging in evaluation of transplantedkidneys.Patients and methods: One hundred twelve patientswith transplanted kidney from live kidney donorswere evaluated with coronal T2w and DW MRI ofthe kidney. There was 86 males and 26 females andthe mean age was 26.911.5ys (range 10-55).Apparent diffusion coefficient (ADC) wascalculated and the kidneys studied for any areasdiffusion restriction. Our patients classified into 2groups: Group 1 included 81 patients with stablekidney function and normal serum creatinine andthe second group included 31 patients with alteredkidney function, it includes 18 patients with chronicnephropathies and 13 patients with acute cellularrejection.Results: The mean ADC values for group 1 was2.70.26 x 10-3 mm2 /sec (range 1.93-3.6). In casesof chronic nephropathies, the mean ADC valueswas 2.30.22mm2/sec (range 2.05-2.77) while incases of acute cellular rejection it was1.80.2mm2/sec (range 1.7-2.2). When we use the2.4mm2/sec as a low cutoff ADC value fordiagnosis of normal kidney function, the sensitivity,specificity and overall accuracy for DWI MRI was80%, 96% and 93.5% respectively.When we used the ADC value of 2mm2/sec as acutoff value between acute cellular rejection andchronic nephropathies, the sensitivity, specificityand overall accuracy of DWI MRI was 90%, 98%and 90% respectively.Conclusion: In this relatively large study includingstable and abnormal function in transplantedkidneys, we can conclude that DW MRI isrelatively a new technique that allows diagnosis oftransplanted kidney with normal and alteredfunction
The myth of the subclinical rejection: Is it real?
Full text linkIntroduction: Subclinical rejection (SCAR) of renalallografts refers to graft lymphocytic infiltrationtaking acute rejection histologic pattern despitestable renal function. There are no data to suggestthat subclinical tubulointerstitial inflammation isregulatory or in any way beneficial to the graft. Wehave investigated whether C57BL/6 CD8 T cellshome to long term engrafted (LTE) DBA/2 skinallografts and if it is protecting or rejecting.Methods and results: We transplanted two groupsof B6 CD4 KO mice, 6 mice each, with MHCmismatched DBA/2 skin. Only the 1st group wastreated with Rapamycin (RPM) as reported. After100 days of LTE, we challenged RPM treated hostswith a 2nd DBA/2 skin graft. The 2nd but not the 1stgraft was rejected. Then we investigated thefunctional effects of graft inflitrating CD8 T cells.DBA/2 skin grafts were harvested 100 daysposttransplantation from (i) RPM treated B6 CD4ko mice (N=5) and (ii) skin autografts (N=5) inDBA/2 recipients. LTE DBA/2 allografts or controlDBA/2 autografts were then transplanted ontoC57BL/6-Rag KO hosts, and peripheral bloodlymphocytes (PBL) samples were collected 30 dayspost skin transplantation. CD8T cells can not bedetected in PBL of nae RAG-/- mice. 4.6 % CD8T cells are detected in PBL of RAG-/- recipients ofLTE allografts, but not in recipients of syngeneicgrafts. To test the protective function of the grafthoming CD8 T cells (from LTE RPM mice) thatexpanded by homeostatic proliferation and arepresent in PBL of the RAG-/-, 0.2 x 106 CD8 Tcells from naive CD4KO mice were adoptivelytransferred into the RAG-/- hosts bearing the LTEDBA/2 allografts or DBA/2 autografts 30 daysfollowing skin transplantation. Survival of LTEDBA/2 skin allografts transplanted onto RAG-/-mice were significantly prolonged.Conclusion: Graft infiltrating CD8 T cells areregulatory and functionally active to protectallograft from rejection
Metabolic abnormalities in acute renal failure, influence on nutritional management
Full text linkNo abstract available
Adrenomedullin in patients with type 2 diabetes and kidney disease
Full text linkSecreting vasoactive factors such asadrenomedullin (AM) has been intensivelyinvestigated due to its vascular protective propertiesand promising potential as a therapeutic target. Therelationship between adrenomedullin and type (2)diabetes needs to be elucidated as it is associatedwith significant elevation in plasma adrenomedullinlevels.The aim of this study was to evaluate therole of adrenomedullin in the development ofvasculopathy and its significance as a markerdenoting renal affection in type 2 diabetic patients.Materials and Methods: This study was conductedon 60 diabetic patients, 20 without nephropathy, 20with nephropathy & 20 with diabetic nephropathy(DN) on haemodialysis as well as 20 age- and sex matchedhealthy controls. All were subjected to fullhistory, Echocardiography, lipid profile analysisand plasma adrenomedullin using ELISA method.Results: plasma AM concentration was elevated inall groups of diabetic patients and increment wasdependent on the severity of DN (P<0.0001,P<0.0001, P<0.0001 respectively). There werepositive correlation between adrenomedullin andleft ventricular internal dimensions both in diastole& systole (P<0.001, P<0.005) and negativecorrelation between AM and ejection fraction (EF)P<0.0001. There was positive correlation betweenadrenomedullin and cholesterol, triglycerides andLDL (p<0.002, p<0.001and p<0.003 respectively)and a negative correlation with HDL (P<0.004).Conclusion: Adrenomedullin is supposed to play arole in the pathogenesis of diabeticmicrovasculopathy in renal patients. So it can beused to identify high-risk subjects and modulatingits action would have therapeutic potential in theprevention of diabetic nephropathy
Post-transplant anemia in pediatric patients and its impact on patient and graft survival: single center experience
Full text linkIntroduction: Post-transplantation anemia (PTA)occurs frequently, with prevalence rates between 20and 60% depending on the criteria used for defininganemia.Aim of the work: We aimed to assess the prevalenceof anemia after 6 months of transplantation inpediatric renal transplant patients under differentprotocols of immunosuppression, and to determinethe impact of anemia upon long-term patient andgraft survival.Patients and methods: Based on the data of 108renal transplants performed in our center, patientswere categorized after 6 months according to theirhemoglobin (Hb) levels into two groups. The firstgroup with Hb more than 11gm/dl (group I, 29cases) and the second group with Hb lessthan11gm/dl (group II, 79cases). We compared thetwo groups regarding post transplant complications(rejection episodes, hypertension, diabetes mellitus,infections, hepatic dysfunction, and patient andgraft survival.Results: we found no significant difference betweenthe two groups regarding rejection episodes.However, the percentage of cases with chronicallograft nephropathy was significantly higher in the anemic group. The survivors with functioning graftswere significantly higher in cases with normal Hb.Moreover, living cases with graft failure weresignificantly higher in anemic group. Graft survivalrate was better in the non anemic group. However,no difference in patient survival was detected. Also,we found no difference between the two groupsregarding post-transplant complications.Conclusions: From this study, we can conclude thatthe prevalence of post-transplant anemia is highpediatric renal transplant patients especially thosereceiving CNI and MMF, and it was associated withpoorer graft outcome but no effect on patientsurvival
The therapeutic implications of oxidative stress in patients receiving haemodialysis
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Diagnostic and therapeutic aspects of recurrent renal stone disease (duplicate)
No full textThis paper was originally published in Vol 2, No 1 (1998) and can be accessed via the archive. It was re-published, in error, in Vol 13, No 1 (2009)