219 research outputs found
Frequency of BK virus nephropathy in graft dysfunction biopsies
No full textBackground. BK virus nephropathy is the most common type of viral disease to occur following renal transplantation. Although its frequency differs according to transplantation center, the rate is between 1.5% and 20%. Diagnosis can be established histologically by renal allograft biopsy. The aim of this study was to determine the frequency of BK virus nephropathy in patients who had had a renal biopsy for graft dysfunction at our center. Methods. Biopsies received in the last 3 years from patients with graft dysfunction were used in the study. We have found the BK virus in biopsies of 5 of 41 patients (11%). All these patients had been treated with immunosuppressive drugs following transplantation surgery. Biopsies were performed because of disturbance of renal function. Only 1 patient had had a urinary examination. Morphological diagnosis of BK virus nephropathy was followed by serological examination. Results. The most frequent morphological changes with BK virus infection in our samples were basophilia, nuclear inclusions, and nuclear enlargement on tubular epithelium. Decoy cells were not found in the biopsy from the only patient who had had a urinary examination. Treatment of the patients with BK virus nephropathy with immunosuppressive drugs has been reduced, and antiviral treatment has been started. Conclusion. BK virus nephropathy should be kept in mind in the differential diagnosis of transplant rejection and drug toxicity
Renal replacement therapy in the ICU: comparison of clinical features and outcomes of patients with acute kidney injury and dialysis-dependent end-stage renal disease
No full textThe goal of this study is to study clinical features and outcomes of the patients who had renal replacement therapy (RRT) in the intensive care unit (ICU) between 2000 and 2007. We retrospectively studied 222 patients. Overall ICU mortality and invasive mechanical ventilation (IMV) rates were 58.1 and 61.3 %. The mean APACHE II score was 27.6 +/- A 8.3. Chronic dialysis (CD) patients formed 45.5 % of the study population. Acute kidney injury (AKI) patients had higher rates of IMV (73 vs. 51.5 %, p = 0.002), cancer (27.8 vs. 7.9 %, p a parts per thousand currency sign 0.001) and mortality (67.8 vs. 50.5 %, p = 0.010) than CD patients. AKI patients with normal kidney function (NKF) before ICU admission had poorer prognosis than acute-on-chronic kidney disease (CKD) and CD patients (78.6, 51 and 50.5 %, respectively, p a parts per thousand currency sign 0.001). Multivariate analysis showed that IMV (OR, 14.8; 95 % CI, 5.47-40.05; p a parts per thousand currency sign 0.001) and having NKF before hospitalization (OR, 2.8; 95 % CI, 1.04-7.37; p = 0.041) were predictors of overall ICU mortality. Additionally, IMV is found as a prognostic factor for both AKI (OR, 18.7; 95 % CI, 4.48-77.72; p a parts per thousand currency sign 0.001) and CD patients (OR, 8.14; 95 % CI, 2.01-33.04; p = 0.003), but APACHE II score is meaningful only for CD patients (OR, 1.13; 95 % CI, 1.02-1.26; p = 0.024). The areas under the ROC curves for APACHE II score were 0.52 (95 % CI, 0.39-0.66) for AKI and 0.78 (95 % CI, 0.55-0.89) for CD patients. The observed ICU mortality among patients requiring RRT is high and IMV is associated with mortality. AKI patients have increased mortality compared to CD patients. AKI patients with past NKF have poorer prognosis than acute-on-CKD and CD patients
The association between perceived stress with sleep quality, insomnia, anxiety and depression in kidney transplant recipients during Covid-19 pandemic
No full textBackground The psychological distress and sleep problems caused by current Covid-19 outbreak is not well known in kidney transplant recipients. In this study, we aimed to investigate the association between perceived stress with sleep quality, insomnia, anxiety, depression and kidney function in kidney transplant recipients during the Covid-19 pandemic. Material and methods A hundred-six kidney transplant recipients were enrolled. Questionnaire of Socio-demographics, Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISO and Hospital Anxiety Depression Scale (HADS) are performed. The laboratory data is recorded. The perceived stress related to Covid-19 pandemic and its associations were investigated. Results The mean age of patients was 44.2 +/- 13.3 years, and 65 of the patients (61.3%) were men. Forty-nine (46.2%) of the patients had high-perceived stress; 51 (48.1%) of the patients had poor sleep quality, 40 (37.7%) of the patients had insomnia, 25 (23.6%) of the patients had anxiety and 47 (44.3%) of the patients had depression. The patients having a history of Covid-19 infection in own or closed relatives (9.09 +/- 4.17 vs 6.49 +/- 4.16, p:0.014) and the patients who have a rejection episode any of time (8.24 +/- 5.16 vs 6.37 +/- 3.57, p:0.033) have had significantly higher anxiety scores, when they compared to others. The high PSS were positively correlated with PSQI, ISI, HAD-A and HAD-D. Regression analyses revealed that high-perceived stress is an independent predictor of anxiety and depression. There was not significant difference between kidney function with PSS, PSQI, ISI, HAD-A and HAD-D. Conclusions High PSS is positively correlated with poor sleep quality and insomnia and also an independent predictor of anxiety and depression in kidney transplant recipients during the outbreak of Covid-19. As the pandemic is still spreading worldwide quickly early identification and intervention of sleep disturbances and psychiatric disorders are essential to protect graft function with high compliance to treatment in transplantation patients
Recurrent Candidal Esophagitis and Esophageal Carcinoma in a Kidney Transplant Recipient
No full textLate Pulmonary Toxicity Associated With Everolimus in a Renal Transplant Patient and Review of the Literature
No full textThe use of inhibitors of mammalian target of rapamycin is associated with adverse pulmonary effects. Although sirolimus-related pneumonitis has been well described, reports on pneumonitis with everolimus are scarce. We report a case of everolimus-induced pneumonitis in a renal transplant recipient 5 years after initiation of everolimus treatment, and we also review the literature regarding everolimus-induced pneumonitis in renal transplant patients
An Alternative for Short Renal Vein During Kidney Transplantation: Long-term Experience With Polyethylene Terephthalate (Dacron) Vascular Graft
No full textOBJECTIVE To describe the first long-term experience with the polyethylene perephthalate vascular graft to lengthen a short renal vein during kidney transplantation. MATERIALS AND METHODS The polyethylene terephthalate vascular graft was interposed between the short renal vein of the donor kidney and the recipient's external iliac vein using 6-0 Prolene suture on a 13-mm needle. The postoperative follow-up protocol of the patients included regular serum creatinine levels and Doppler ultrasound scans. RESULTS The median follow-up period was 74.5 months (range 51-128). Postoperative Doppler ultrasonography showed no complications in any of the patients. None of our patients experienced any kind of rejection. The median creatinine level at the last follow-up visit was 0.99 mg/dL (range 0.73-1.56). CONCLUSION In our experience, the use of polyethylene terephthalate vascular grafts as a venous graft for the short renal vein in kidney transplantation provides an alternative option with long-term success. UROLOGY 82: 245-247, 2013. (C) 2013 Elsevier Inc
Baseline carotid intima‐media thickness is associated with cardiovascular morbidity and mortality in peritoneal dialysis patients
No full textCarotid intima-media thickness (CIMT) is an early marker of atherosclerosis and is increased in peritoneal dialysis (PD) patients. Association of CIMT with cardiovascular disease (CVD) or mortality is less clear. Fibroblast growth factor-23 (FGF-23) is a hormone associated with vascular calcification, atherosclerosis, and mortality in the hemodialysis population. We investigated whether baseline CIMT and FGF-23 are associated with CVD and mortality in PD patients. Fifty-five PD patients were included. CVD was defined as ischemic heart disease, stroke, or peripheral artery disease. Intact FGF-23 was measured in plasma. CIMT was measured by ultrasonography. Twenty-one patients developed CVD and 12 died over 47.1 +/- 33.8 months. Patients with CVD were older (55.9 +/- 10.5 vs. 42.5 +/- 12.9 years, P < .01), had lower albumin (3.8 +/- 0.5 vs. 4.2 +/- 0.3 g/dL, P < .01) and higher CIMT (0.87 +/- 0.22 vs. 0.61 +/- 0.11 mm, P < .01). Patients with mortality were also older (53.5 +/- 11.5 vs. 45.8 +/- 13.8 years, P = .05), had lower albumin (3.7 +/- 0.6 vs. 4.1 +/- 0.3 g/dL, P < .01), higher CRP (15.0 +/- 8.5 vs. 7.6 +/- 8.4 mg/L, P < .01) and CIMT (0.9 +/- 0.3 vs. 0.6 +/- 0.1 mm, P < .01). Albumin and CIMT were associated with CVD and CIMT > 0.75 mm was associated with cardiovascular mortality. FGF-23 did not show any correlations. CIMT at baseline is associated with CVD and mortality in PD patients
Impact of the Anatomical Localization of the Exit Site on Complications in Patients on Peritoneal Dialysis
No full textBackground: Infections are the most common complications in patients with peritoneal dialysis (PD). The association between the anatomical localization of the exit site (ES) and infectious complications is unclear. In this study, we evaluated the relationship between the anatomic location of the ES and infectious complications of PD. Methods: We examined the ES of 53 patients on PD. To define the anatomical localization of the ES, its distance from the line between right and left anterior superior iliac spines (A line), umbilicus (B line), and the anterior superior iliac spine on the catheter side (C line) was measured. Results: Coiled catheters were used in all patients. The mean lengths of A line, B line, and C line were 4.1 +/- 2.2 cm (range, 0-9.5 cm), 9.6 +/- 2.9 cm (range, 4-17 cm), and 9.3 +/- 2.9 cm (range, 5-18 cm), respectively. ES infection was documented in 9 patients (17%), tunnel infection in 1 patient (2%), and peritonitis in 27 (50.9%) patients. The B line was significantly longer in those with peritonitis than those without peritonitis (10.6 +/- 3 vs. 8.7 +/- 2.7 cm; P = .036). Other variables were not associated with infectious complications. Conclusion: There was an association between the anatomical localization of the ES and the development of peritonitis. An ES close to the umbilicus could reduce the risk of peritonitis by enabling access by the patient to perform daily care
Elevated Plasma Levels of PAI-1 Predict Cardiovascular Events and Cardiovascular Mortality in Prevalent Peritoneal Dialysis Patients
No full textBackground. Elevated plasminogen activator inhibitor-1 (PAI-1) levels are associated with increased cardiovascular (CV) risk in the general population. It has been shown that peritoneal dialysis (PD) patients have increased plasma levels of PAI-1. The aim of this study was to investigate whether PAI-1 independently predicted CV outcome in PD patients. Material and Methods. Seventy-two PD patients (53% females, mean age 49.9 +/- 16.1 years) were studied. Twelve patients who underwent kidney transplantation and 14 patients who transferred to hemodialysis during follow-up were excluded from the analysis. The remaining 46 patients (54% female, mean age 54 +/- 16 years, dialytic age 42 +/- 30 months) were followed a mean time of 45.4 +/- 19.4 months (range 8-71 months). Baseline PAI-1, clinical, and laboratory parameters were assessed in all patients. Survival analyses were made with Kaplan-Meier and Cox regression analysis, with all-cause mortality and CV mortality and CV events (CVEs) as clinical end points. Results. During the follow-up, 29 patients died (17 from CV causes), and 28 fatal and non-fatal CVEs were recorded. The patients were divided according to plasma PAI-1 levels (i.e., <= or >41 ng/mL). The significant independent predictors of all-cause of mortality were age (>60 years; p = 0.018), CRP (>5 mg/L; p = 0.015), and serum albumin (<3.5 g/L; p = 0.011). Multivariable Cox regression analysis showed that plasma PAI-1 >41 ng/mL was independently predictive of higher CV mortality (p = 0.021) and CVEs (p = 0.001). The only other independent predictor of CV mortality was only CRP (>5 mg/L; p = 0.008). Conclusions. Plasma levels of PAI-1 >41 ng/mL is a significant predictor of CV mortality and CVEs in PD patients
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