MO1002EFFICACY OF PLASMAPHERESIS IN KIDNEY TRANSPLANT PATIENTS WITH FOCAL SEGMENTAL GLOMERULOSCLEROSIS : A SINGLE CENTER EXPERIENCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Imen El Meknassi ◽  
Zellema Dorsaf ◽  
Azzabi Awatef ◽  
Sahtout Wissal ◽  
Ben Aicha Narjes ◽  
...  

Abstract Background and Aims Plasmapheresis (PP) have been used in kidney transplant (KT) patients for multiple immunological renal diseases. Focal segmental glomerulosclerosis (FSGS) is one of the most prevalent indication for PP. It can be used either for curative or preventive treatment of its recurrence. The aim of our study was to assess the outcomes of PP among KT patients with FSGS. Method We performed a retrospective study including all KT patients with FSGS who underwent PP during the period from December 2007 to December 2018. PP was performed using a filtration technique by a Prismaflex machine. Results Among 275 KT patients, we have identified 5 patients with FSGS who underwent PP either before or after transplantation. The mean age was 26.4 years. All patients but one received a living-donor kidney with number of mismatches between 3 and 5. All patients were under corticosteroids, mycophenolate mofetil and cyclosporine. Two patients presented recurrent FSGS within 3 days following the transplantation. Mean serum creatinine level and proteinuria before PP were 517 ±191 µmol/l and 17.7 ±7.5 g/day respectively. The PP was used basing on Canaud protocol combined to rituximab. The mean number of PP sessions was 29. Only one patient required hemodialysis. None of the patients had lost his graft. The mean serum creatinine level was 172±55 µmol/l. One patient died of septic shock. PP was used in two other patients before transplantation in order to prevent the recurrence of FSGS. They have preserved a normal kidney function after a period of follow-up (37 months and 7 years). No rejection or recurrence of FSGS was noted during the follow-up period. Another patient aged 20, underwent 5 sessions of PP on alternate days immediately after transplantation to prevent the recurrence of FSGS. His baseline serum creatinine level was at 136 µmol/l. The recurrence of his initial renal disease occurred after 21 months requiring other sessions of PP. Rituximab was tried but stopped in front of allergy reaction. His renal function remained stable. Overall, PP was well tolerated in all patients with no incident. Conclusion Recurrence of the FSGS after transplantation is a concern for nephrologists due to the difficulty of treatment. Our study shows the efficacy of plasmapheresis before kidney transplantation to prevent recurrence of FSGS.

2016 ◽  
Vol 8 (12) ◽  
pp. 1231-1234 ◽  
Author(s):  
Shelby L Hall ◽  
Stephan A Munich ◽  
Marshall C Cress ◽  
Leonardo Rangel-Castilla ◽  
Elad I Levy ◽  
...  

BackgroundCombining non-contrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) imaging (referred to as a CT stroke study, CTSS) provides a rapid evaluation of the cerebrovascular axis during acute ischemic stroke. Iodinated contrast-enhanced CT imaging is not without risk, which includes renal injury. If a patient's CTSS identifies vascular pathology, digital subtraction angiography (DSA) is often performed within 24–48 h. Such patients may receive multiple administrations of iodinated contrast material over a short time period.ObjectiveWe aimed to evaluate the incidence of acute kidney injury (AKI) in patients who underwent a CTSS and DSA for evaluation of acute ischemic symptoms or for stroke intervention within a 48 h period between August 2012 and December 2014.MethodsWe identified 84 patients for inclusion in the analysis. Patients fell into one of two cohorts: AKI, defined as a rise in the serum creatinine level of ≥0.5 mg/dL from baseline, or non-AKI. Clinical parameters included pre- and post-imaging serum creatinine level, time between CTSS and DSA, and type of angiographic procedure (diagnostic vs intervention) performed.ResultsFour patients (4.7%) experienced AKI, one of whom had baseline renal dysfunction (defined as baseline serum creatinine level ≥1.5 mg/dL). The mean difference between baseline and peak creatinine values was found to be significantly greater in patients with AKI than in non-AKI patients (1.65 vs −0.09, respectively; p=0.0008).ConclusionsThis study provides preliminary evidence of the safety and feasibility of obtaining CTSS with additional DSA imaging, whether for diagnosis or intervention, to identify possible acute ischemic stroke.


2003 ◽  
Vol 31 (02) ◽  
pp. 267-275 ◽  
Author(s):  
Hirozo Goto ◽  
Yutaka Shimada ◽  
Kiyoaki Tanikawa ◽  
Shigehiko Sato ◽  
Hiroaki Hikiami ◽  
...  

We studied the effect of traditional herbal medicines containing Daio (Rhei Rhizoma) on the long-term progression of diabetic nephropathy with overt proteinuria in eight patients [mean age 60 (45–73) years; duration of diabetes 18 (7–36) years]. At the beginning of the study, mean HbA1c was 8.2% and mean serum creatinine was 1.0 ± 0.3 mg/dl. Every patient had diabetic neuropathy and retinopathy. Three of the patients had hypertension and four had ischemic heart disease. After 107 ± 25 months, the mean serum creatinine level had significantly increased to 4.8 ± 2.6 mg/dl. The mean serum creatinine levels of five patients not advancing to dialysis treatment increased from 1.2 ± 0.3 to 3.2 ± 1.0 mg/dl, and the three patients requiring dialysis increased from 0.8 ± 0.1 to 7.5 ± 2.1 mg/dl. In the control group, treated without traditional herbal medicines, the mean serum creatinine level had significantly increased from 1.0 ± 0.3 to 9.5 ± 1.9 mg/dl after 71 ± 12 months. All of the control group required dialysis treatment. Diabetic nephropathy with overt proteinuria is reported to develop into renal failure after 6–7 years. In this retrospective study, traditional herbal medicines with Daio were considered to be effective in prolonging the pre-dialysis period of diabetic nephropathy.


2021 ◽  
Author(s):  
Samet Senel ◽  
Yalcin Kizilkan ◽  
Serdar Toksoz

Abstract Introduction: Giant hydronephrosis, which implies a collecting system containing more than one liter of fluid, is becoming increasingly rare with the widespread availability of imaging facilities. We aimed to report a case and management of bilateral giant hydronephrosis due to bilateral ureteropelvis stenosis.Case presentation: A 45-year old male presented at the Emergency Department with the complaint of difficulty passing stools. On computed tomography (CT), bilateral giant hydronephrosis was determined covering the whole abdomen. After bilateral nephrostomy, 8 liters of urine was drained from the right kidney and 10 liters of urine from the left kidney after bilateral nephrostomy in the patient whose serum creatinine level was 1.06 mg/dl at the time of admission. Bilateral pyeloplasty was applied to the patient who was diagnosed with bilateral ureteropelvis stenosis after dynamic renal scintigraphy. After 4 years of follow-up, serum creatinine level was 1.3 mg / dl. Hydronephrosis was still present despite being smaller than its previous condition and the presence of bilateral double J stents.Conclusions: An interesting finding of the current case was that the creatinine level might be normal despite the fact that bilateral giant hydronephrosis. So rather than nephrectomy, pyeloplasty was applied and to date there has been no need for hemodialysis.


2020 ◽  
Vol 7 (2) ◽  
pp. e21-e21
Author(s):  
Vahideh Ebrahimzadeh Attari ◽  
Seyed Sadroddin Rasi Hashemi ◽  
Solmaz Oloufi ◽  
Leili Aghebati Maleki ◽  
Dariush Shanehbandi ◽  
...  

Introduction: The FOXP3 protein is an immune regulatory protein that specifically maintains the function and differentiation of regulatory T cells (Tregs) and prevents autoimmunity. Variations in FOXP3 gene may alter its function and also the immune response. Objectives: The present study was conducted to investigate the association of the FOXP3 gene polymorphisms -3499 A/G and -3279 A/C with renal allograft function and survival in kidney transplant recipients. Patients and Methods: In this cross-sectional study, 150 eligible kidney transplant recipients were evaluated. Kidney function was evaluated at three- and five-year post-transplant using serum creatinine level and glomerular filtration rate as indicators. Genotyping of the study participants was performed using the PCR– restriction fragment length polymorphism method. Results: The frequencies of AA, AG, and GG genotypes of the -3499 A/G polymorphism were 62.42%, 29.53%, and 8.05%, respectively. For the -3279 A/C polymorphism, the frequencies of the AA, AC, and CC genotypes were 21.33%, 32%, and 46.67%, respectively. The mean ± SD of serum creatinine level, three and five years after transplantation were 1.70 ± 1.58 and 1.87 ± 1.94, respectively. Serum creatinine level and kidney function did not show any significant association with these polymorphisms. Conclusion: In the present study, only 10% of participants experienced episodes of severe kidney dysfunction and we did not find any significant association between kidney function and the subjects’ genotypes. Further epidemiologic studies with greater sample sizes may be needed to clarify this association.


2014 ◽  
Vol 3 (2) ◽  
Author(s):  
Regina Ivanovna ◽  
Efrida Efrida ◽  
Roza Kurniati

AbstrakPenyakit ginjal merupakan penyebab kematian nonAIDS paling tinggi pada penyandang HIV. Penggunaan regimen anti- retroviral diselidiki memiliki kontribusi terhadap kejadian penyakit ginjal. Disfungsi tubulus ditemukan pada penyandang HIV dengan terapi tenofovir. Pemeriksaan kreatinin digunakan untuk skrining kerusakan ginjal. Tujuan penelitian ini adalah untuk mengetahui perbedaan kadar kreatinin sebelum dan setelah terapi tenofovir. Telah dilakukan penelitian secara kohort retrospektif terhadap penyandang HIV dengan terapi tenofovir di RS dr. M. Djamil Padang periode 2012-2013. Dilakukan pemeriksaan kreatinin serum sebelum dan setelah terapi tenofovir dengan metode Jaffe. Data kadar kreatinin serum didapatkan melalui rekam medik. Hasil perbedaan rata-rata kadar kreatinin serum sebelum dan setelah terapi tenofovir dianalisis menggunakan uji T berpasangan. Sebanyak 18 subyek penelitian dipilih dari jumlah total 652 penyandang HIV rawat inap dan rawat jalan. Sebanyak 196 penyandang HIV memakai terapi tenofovir (30%). Rentang lama pemberian terapi tenofovir adalah 2-57 minggu. Pada hasil penelitian, didapatkan perbedaan rata-rata kadar kreatinin serum yang bermakna sebelum dan setelah terapi tenofovir sebesar 0,7± 0,2 mg/dLdan 0,9 ± 0,5 mg/dL (P<0,05). Dapat disimpulkan bahwa terdapat peningkatan kreatinin serum setelah terapi tenofovir pada penyandang HIV.Kata kunci: HIV, tenofovir, kreatinin serumAbstractKidney disease is the highest nonAIDS related mortality among HIV patients. The use of antiretroviral therapy is investigated to contribute in kidney disease. Tubular dysfunction is found in HIV patients with tenofovir therapy. Creatinine test is used to screen kidney dysfunction. The aim of this study was to determine the mean difference of serum creatinine level before and after tenofovir administration.A cohort retrospective research was carried out in DR..M. Djamil Hospital upon HIV patients with tenofovir within 2012-2013. Serum creatinine test was conducted before and after administration of tenofovir with automatic machine and Jaffe reaction. The result of mean difference of serum creatinine before and after administration of tenofovir is analised by paired T test.Eighteen research subjects is determined from total amount of in and out patient. A total of 196 patients were administered with tenofovir (30%). The range of tenofovir administration was between 2-57 weeks. From the research, obtained a significant mean difference before (0,7± 0,2 mg/dL) and after (0,9 ± 0,5 mg/dL) administration of tenofovir (P<0,05).The conclusion of this study is there is increasing of serum creatinine level before and after administration of tenofovir.Keywords: HIV, tenofovir, serum creatinine


2020 ◽  
Vol 17 (1) ◽  
pp. 23-28
Author(s):  
AHM Manjurul Islam ◽  
Md Shahidul Islam ◽  
Md Anwar Hossain ◽  
Abm Mobasher Alam ◽  
Shahi Farzana Tasmin

Objectives: To determine the effectiveness of transurethral resection of bladder neck in the management of primary bladder neck obstruction (PBNO) in female Patients and Methods: This prospective study has been done with thirty female patients aged from 27 to 48 years who were presented with difficult micturition or urinary retention. These patients had unremarkable physical findings with normal perianal sensation, anal sphincter tone and lower extremity reflexes. Patients associated with cystocele, meatal stenosis, stricture urethra, urethral caruncle and urethral diverticula that may lead to mechanical bladder outflow obstruction were excluded from the study. Preoperative investigations include uroflowmetry, ultrasonography, serum creatinine, urethrocystoscopy with simultaneous “water flow test” was done. Seven patients presented with obstructed voiding symptom without renal impairment (serum creatinine, mean±SEM 1.24±0.04) and were initially treated with á-blocker (category A). Among the other 23 patients those had renal impairment 18 presented with near retention and these patients were on indwelling catheterization before operation (category B, serum creatinine, mean±SEM 2.72±0.13).Rest of the 5 patients presented with nausea, vomiting, and disorientation in addition to near retention and were put on haemodialysis along with indwelling catheterization to reach near normal creatinine level before operation(category C, serum creatinine, mean±SEM,9.34±0.96 ). PBNO causing voiding difficulty were diagnosed in all the cases and were undergone transurethral bladder neck resection (BNR). Three months after operations, their pre- and post-operative symptoms were analyzed, and serum creatinine levels, ultrasonographic findings (MCC, PVR), uroflowmetric study were compared. Results: Twenty-nine (96.33%) Patients become symptom free. Their average pre- and post-operative values of MCC (Maximum Cystometric Capacity), PVR (Post Voidal Residual urine), Qmax (Peak urinary flow during uroflowmetric study, Serum creatinine level were changed from 679.50 to 482.17ml, from 574.50 to 29.37ml, from 8.43 to 29.37ml/sec, from 3.48 to 1.13 mg/dl respectively. One patient (3.33%) did not continent ever postoperatively. One patient had become dry after using pad for stress incontinent for one month only. Serum creatinine level of category C patient did not reach to the normal level (post operative creatinine level Mean±SEM,2.8±0.15)within this three moths follow up period. Conclusions: Our short term follow-up suggests that judicious Transurethral BNR is effective in relieving voiding difficulty due to primary bladder neck obstruction in female. A thorough gynaecological, neurological and urological examination is essential along with uroflowmetric, ultrasonographic and cystoscopic study to reach a correct diagnosis and making a treatment plan. Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.23-28


1998 ◽  
Vol 42 (12) ◽  
pp. 3103-3106 ◽  
Author(s):  
Mary J. Camp ◽  
John R. Wingard ◽  
Claire E. Gilmore ◽  
Lillian S. Lin ◽  
Suzanne P. Dix ◽  
...  

ABSTRACT This study evaluated the efficacy of low-dose dopamine for prevention of amphotericin B-induced nephrotoxicity in autologous bone marrow transplant and leukemia patients. Seventy-one patients undergoing cytoreductive therapy who required amphotericin B were randomly assigned in an unblinded fashion to a group receiving continuous-infusion low-dose dopamine (3 μg/kg/min) or a group receiving no dopamine. Amphotericin B was dosed at 0.5 or 1.0 mg/kg/day based on computerized tomography scan results or presence of positive blood cultures. No patient received saline boluses. The rate of nephrotoxicity, severity as graded by Southwest Oncology Group toxicity criteria, and time to each grade of nephrotoxicity were compared between the two groups. Eighty percent of the no-dopamine group and 66.7% of the dopamine group developed nephrotoxicity, defined as a 1.5-fold or greater increase in baseline serum creatinine level (P = 0.20). No statistical difference was noted at any grade of nephrotoxicity between the two groups. Thirty-four percent of patients in the no-dopamine group versus 17.6% in the dopamine group had a 2.5-fold or greater increase in serum creatinine level, which was not statistically significant (P = 0.0888). Ten patients developed grade IV nephrotoxicity and were withdrawn from the study, 7 in the no-dopamine group and 3 in the dopamine group (P = 0.19). The time to each grade of nephrotoxicity was also not significantly different for the two groups. Eleven adverse drug reactions were reported in the dopamine group in comparison to one in the no-dopamine group. Thus, dopamine offers little in the way of prevention of nephrotoxicity associated with amphotericin B therapy. Although the significance of drug reactions in the dopamine group is not clearly established due to lack of cardiac monitoring in the no-dopamine group, dopamine therapy is not without complications.


2020 ◽  
Vol 12 (2) ◽  
pp. 135-142
Author(s):  
AHM Waliul Islam ◽  
Shams Munwar ◽  
Shahabuddin Talukder ◽  
AQM Reza ◽  
Azfar H Bhuiyan ◽  
...  

Background: Several studies has shown that impaired renal function might be an important predictor of adverse cardiovascular events in patient with ST elevated myocardial Infarction (STEMI) undergoing primary percutaneous intervention (pPCI). Exact data on clinical impact of baseline or admission serum creatinine level of STEMI patient undergoing pPCI in our patient population not well established. Therefore, we have carried out this non-randomized study to see the effects of S. creatinine level on major adverse cardiovascular outcomes among STEMI patient undergoing pPCI. Methods: Patients were enrolled in this observational non-randomized prospective cohort between November 2017-July 2019, who were presented into our emergency department with acute onset of severe chest pain or angina with ECG evidenced of acute ST elevated myocardial infarction. Total 137 patient (F 12; Male 125) were enrolled in this study. Results: Out of 137 patients, female :12 (8.75%) vs Male: 125 (91.2%). Among, these patient females were more obese (BMI: Female 27.0 ± 2.2 vs male 25.4 ± 4.9) and developed CAD in advance age (Female 59.1 ± 14.5 vs Male 53.4 ± 10.5). Among the 137 patients, 89 (65%) were dyslipidemia, 72 (52.6%) were hypertensive, Diabetic 66(48%), Smoker 70 (51%) and FH positive for CAD were 31 (22.6%). According to the involvement of myocardium infarction, STEMI diagnosis of Anterior MI were 48.9% (n=67) and Inferior MI 51.1% (n=70). An elevated serum creatinine level was defined as creatinine >1.2mg/dl. Based on baseline serum creatinine level, patients were divided into group-A and Group-B. In Group-A. Total 68 patients have S. Creatinine level <1.2 and in Group-B, 69 patients have S. Creatinine level >1.2. Anterior MI were higher in group -B patient than Group-A; Ant MI as 35 (50.4%) vs 31(45.6%), Inf MIL: 34 (49.35) vs 34 (50%), Shock 11 (15.9%) vs 6 (8.8%0, CHB 4 (5.8%) vs 4 (5.9%), Death 12 (17.4%) vs 2 (2.9%) and LVF 5(7.2%) vs 1(1.5%) with 7 days in-hospital stay after primary PCI. Territory wise involvement of vessel in Group-B patient has more involvement of LAD 35 (50.7%) and Group-A has RCA 26(38.2%). Conclusion: In this present study, we found, that in acute STEMI patients, baseline higher serum creatinine level is associated with more AMI related complications and death than in lower serum creatinine level. Thus, we may conclude that baseline admission serum creatinine level may be an important predictor for both in-hospital and 12-month survival outcomes in STEMI patients undergoing pPCI. Cardiovasc. j. 2020; 12(2): 135-142


2020 ◽  
Vol 32 (2) ◽  
pp. 60-66
Author(s):  
Salma Akter ◽  
Firoza Begum ◽  
Sharmin Abbasi

During pregnancy Nitric oxide is one of the most important relaxing factors for myometrium and also in the control of blood flow in uterus and placenta. Nitric oxide is generated by endothelial type II nitric oxide synthase (NOS) and acts as a vasodilator. Objective:To investigate the level of nitric oxide (NO) production in pregnancies complicated by preeclampsia and in normal pregnancy. Materials and Methods: A case control study was undertaken in Department of Gynaecology and Obstetrics of Bangabandhu Sheikh Mujib Medical University (BSMMU), from january to july 2014. The study population was pregnant women having preeclampsia and normal pregnancy who attended the OPD Department of Obstetrics and Gynecology in BSMMU between 29 to 40 weeks of gestation. As because of transient and volatile nature of nitric oxide, it was unsuitable to measure the nitric oxide level by conventional method. However, two stable break down product, nitrate (NO3 -) and nitrate (NO2 -) could be easily detected by sprectophototric means. Nitrate (NO2 -) was first converted to Nitrite (NO3 -) by reduction process using cadmium. Then concentration was measured by using Griess reagent in UV sprectophototric machine. This procedure was done in the Biochemistry Department, Dhaka University. Results: The mean nitrite level was found 18.37}3.64 mol/L in case group and 25.57}2.11mol/ L in control group, which was significantly (p<0.05) higher in control group. The mean serum creatinine level was found 1.19}0.28 mg/dl in case group and 0.65}0.1 mg/dl in control group. The mean serum creatinine level was significantly (p<0.05) higher in case groups. Nitrite level had no correlation with onset of hypertension (r=-0.006; p=0.966), onset of proteinuria (r=0.071; p=0.623), systolic blood pressure (r=0.012; p=0.933), diastolic blood pressure (r=-0.159; p=0.269) and urine protein (r=0.047, p=0.748). Conclusion: As pregnancy progressed there was a decrease in plasma nitric oxide levels in preeclampsia. Urine uric acid to creatinine ratio increased with the decrease in nitric oxide levels and can be used as a marker for preeclampsia. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 60-66


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