Haemochromatosis in a kidney transplant recipient: a case report

Abstract Background Iron overload is inevitably related to chronic kidney disease (CKD) treatment. Haemochromatosis leads to multiorgan damage and is associated with increased mortality. Primary haemochromatosis is the most common autosomal recessive disease in white populations. In most cases, the classic form of hereditary haemochromatosis is caused by mutations, mainly C282Y and H63D, in the haemochromatosis gene (HFE). Secondary haemochromatosis can be triggered by iron administration and blood transfusions. Haemochromatosis is rarely reported in kidney transplant recipients. Atypical factors may evoke haemochromatosis in patients without HFE mutations or other standard risk factors. Case presentation In the current study, we present a patient who started to have haemochromatosis symptoms after kidney transplantation. A 37-year-old man after kidney transplantation from a deceased donor was admitted to the hospital due to high serum ferritin levels and impaired graft function. The patient’s past medical history included arterial hypertension, embolization of both renal arteries and necrosis of the left femoral head. Glomerulonephritis was suspected as a cause of CKD; however, severe kidney failure was diagnosed, kidney biopsy was not performed, and the patient started intermittent haemodialysis. While on dialysis to treat anaemia, the patient had received erythropoietin and iron intravenously, and the maximal serum ferritin level was 2115 ng/ml. After kidney transplantation, ferritin levels started to increase rapidly, with a maximum level of 9468 ng/ml one and a half years after surgery. His genetic study showed HFE C282Y heterozygosity. Symptoms of haemochromatosis, such as skin hyperpigmentation, elevated activity of aminotransferases, impaired glucose tolerance and heart failure, were observed. Therapeutic phlebotomy was started, and 36 procedures were performed. After treatment, graft function significantly improved, most haemochromatosis symptoms resolved, and the serum ferritin level significantly decreased. Conclusions Haemochromatosis can occur in heterozygotic HFE patients after kidney transplantation. Iron administration, infections, type of immunosuppression and liver dysfunction should be considered potential triggers of haemochromatosis in this group of patients.

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PREDICTIVE SIGNIFICANCE OF HIGH SERUM FERRITIN LEVELS IN THE DEBUT OF MALIGNANT LYMPHOMA

"Medical & pharmaceutical journal "Pulse" ◽

10.26787/nydha-2686-6838-2020-22-12-74-81 ◽

2020 ◽

pp. 74-81

Author(s):

Babaeva T.N. ◽

Seregina O.B. ◽

Pospelova T.I.

Keyword(s):

Serum Ferritin ◽

Serum Ferritin Level ◽

Ferritin Level ◽

Prognostic Significance ◽

Average Concentration ◽

High Serum ◽

Control Group ◽

Malignant Neoplasms ◽

Significant Prognostic Factor ◽

Malignant Lymphomas

At present, the serum ferritin level is not included in the list of prognostic factors; however, it is known that its increased serum level in patients with malignant neoplasms relates with the tumor burden, the degree of disease activity and correlates with a worse prognosis in patients with hematologic malignancies.The normalization of serum ferritin level during remission period confirms the involving of hyperferritinemia in mechanisms of tumor progression and may testify for clinical importance of measurement of serum ferritin level in patients, including those with malignant lymphomas. Objective:The aim of this study was to assess of the prognostic significance of high ferritin levels at the onset of the disease in patients with malignant lymphomas. Materials and methods:98 patients with malignant lymphomaswere enrolled in this study, including 72 patients (73.5%) with non-Hodgkins lymphomas (NHL) and 26 patients (26.5%) with Hodgkin’s lymphoma (HL). The increased serum ferritin level (more than 350 ng/ml) was found in 53 (54.2%) patients with malignant lymphomas at the onset of disease and its average concentration was 587,62±131,6 ng/ml (8.3 times higher values of control group, p<0.001).Also the positive statistical correlationsbetween increased ferritin level and increased level of LDH (r=0.47, p<0.001, n=98) and C-reactive protein (r=0.41, p<0.001, n=98) as well as the presence of B-symptomswere found. The median OS was significantly shorter in the group of patients with increased ferritin level (more than 350 ng/ml) at the onset of disease in comparison with group of patients with normal ferritin level, where the median OS was not reach during the observation period. Patients with increased ferritin level before starting chemotherapy also showed worse results of overall survival and increased mortality risk (OR 8.122; 95% CI, 1.764-37.396;р<0.05) compare with a group of patients with ferritin level ˂350 hg/ml at the onset of disease. Conclusion:These results make it possible to include lymphomas’s patients with increased ferritin level at the onset of disease in the group with poor prognosis and lower OS, while the increased ferritin level in patients without previous blood transfusions should be considered as a significant prognostic factor.

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Is delayed graft function associated with ureteral stenosis in the kidney transplant recipient? A case-control study

Canadian Urological Association Journal ◽

10.5489/cuaj.5794 ◽

2019 ◽

Vol 13 (11) ◽

Cited By ~ 1

Author(s):

Axel Cayetano-Alcaraz ◽

Juan Sebastian Rodriguez-Alvarez ◽

Mario Vilatobá-Chapa ◽

Josefina Alberú-Gómez ◽

Bernardo Gabilondo-Pliego ◽

...

Keyword(s):

Risk Factor ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Graft Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Transplant Patients ◽

Increased Risk ◽

Kidney Transplant Patients ◽

Control Study

Introduction: Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients. Methods: We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008–2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type. Results: From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36–4.37) and ureteral duplication (OR 3.29; 95% CI 2.40–4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96–11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors. Conclusions: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.

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High serum ferritin level is an independent risk factor for metabolic syndrome in a Chinese male cohort population

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-015-0004-9 ◽

2015 ◽

Vol 7 (1) ◽

pp. 11 ◽

Cited By ~ 8

Author(s):

Qin Tang ◽

Zhenfang Liu ◽

Yan Tang ◽

Aihua Tan ◽

Yong Gao ◽

...

Keyword(s):

Metabolic Syndrome ◽

Risk Factor ◽

Serum Ferritin ◽

Independent Risk Factor ◽

Serum Ferritin Level ◽

Ferritin Level ◽

High Serum ◽

Male Cohort ◽

Chinese Male

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Extremely high serum ferritin level in a patient with Hemophagocytic Syndrome and Adult-Onset Still's disease

Electronic Journal of General Medicine ◽

10.29333/ejgm/81893 ◽

2017 ◽

Vol 14 (3) ◽

Cited By ~ 1

Author(s):

Gokhan Sargin ◽

Taskin Senturk ◽

Irfan Yavasoglu ◽

Firuzan Kacar-Doger

Keyword(s):

Serum Ferritin ◽

Serum Ferritin Level ◽

Hemophagocytic Syndrome ◽

Ferritin Level ◽

High Serum ◽

Adult Onset Still’S Disease ◽

Adult Onset ◽

Still’S Disease ◽

Still's Disease ◽

Adult Onset Still's Disease

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PATTERN DYSTROPHY-LIKE CHANGES ASSOCIATED WITH VERY HIGH SERUM FERRITIN LEVEL IN β-THALASSEMIA MAJOR

Retinal Cases & Brief Reports ◽

10.1097/icb.0000000000001038 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

King Hans Kurnia ◽

Elvioza Elvioza ◽

Mohamad Sidik ◽

Teny Tjitra Sari ◽

Rita Sita Sitorus

Keyword(s):

Serum Ferritin ◽

Serum Ferritin Level ◽

Ferritin Level ◽

Thalassemia Major ◽

High Serum ◽

Pattern Dystrophy ◽

Very High

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Detection of endocrine disorders in young children with multi-transfused thalassemia major

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01116-2 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Ramadan A. Mahmoud ◽

Ashraf Khodeary ◽

Marwa S. Farhan

Keyword(s):

Serum Ferritin ◽

Serum Ferritin Level ◽

Ferritin Level ◽

Thalassemia Major ◽

High Serum ◽

Endocrine Disorders ◽

Inclusion Criteria ◽

Poor Patient ◽

Poor Patient Compliance ◽

Iron Chelating Agents

Abstract Background Beta thalassemia major (TM) is the most common inherited genetic disorder worldwide. Patients are at risk of iron overload, which leads to various forms of tissue damage, including endocrinopathies. The aim of this study was to evaluate the prevalence and risk factors of endocrine disorders in young patients with multi-transfused TM receiving iron chelation therapy. Methods The inclusion criteria included all known cases of TM according to hemoglobin electrophoresis data, aged 12 years or younger, during the study period. The patient’s age, gender, parent’s consanguinity, clinical examination, and types of iron chelating agents used were recorded. Serum ferritin level, complete blood count (CBC), blood glucose homeostasis, thyroid, and parathyroid functions were determined. Results One hundred twenty patients met the inclusion criteria; 70% of them had malnutrition. The presence of endocrine disorders was observed in 28/120 (23.33%) patients. The most common endocrine disorders were thyroid disorders, either subclinical or clinical hypothyroidism in 11/120 (9.17%) patients, followed by abnormalities in glucose homeostasis 9/120 (7.5%). The prevalence of impaired glucose tolerance, impaired fasting glucose, and diabetes mellitus in the present study was 5 (4.17%), 4 (3.33%), and 0 (00%), respectively, while the least frequent endocrine disorder seen in our patients was hypoparathyroidism in 8/120 (6.66%). We noted that high serum ferritin levels and poor patient compliance to therapy were significantly associated with increased endocrine disorders (OR 0.98, 95% CI 0.96–0.99, P = 0.003 and OR 0.38, 95% CI 0.16:0.93, P = 0.03, respectively). Combined chelating iron agents significantly decreased the prevalence of endocrine disorders when compared with monotherapy (OR 0.40, 95% CI 0.16:0.97, P = 0.04). Conclusion Endocrine disorders could occur in TM patients early before or equal to 12 years of life in about one-fourth of the patients. A high serum ferritin level and poor patient compliance to therapy were significantly associated with increased endocrine disorders. Combined iron-chelating agents were associated with a decreased prevalence of endocrine disorders when compared with monotherapy.

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MO999COMPARISON OF BASILIXIMAB VS NO INDUCTION ON 12-MONTHS RENAL FUNCTION IN KIDNEY TRANSPLANT RECIPIENTS IN THE TACROLIMUS ERA

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab111.0023 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Zdenek Lys ◽

Ivo Valkovsky ◽

Pavel Havranek ◽

Jarmila Dedochova ◽

Jana Polaskova ◽

...

Keyword(s):

Renal Function ◽

Kidney Transplantation ◽

Serum Creatinine ◽

Kidney Transplant ◽

Interleukin 2 ◽

Graft Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Median Serum ◽

Transplant Center

Abstract Background and Aims IL2-RA (Interleukin 2 receptor antagonist) are recommended for the induction immunosuppression of kidney transplant recipients in patients with low/standard immunological risk. Studies showing the effectiveness of these substances have often been performed in patients taking cyclosporine. We aimed to find out whether the same results would be obtained with the more effective tacrolimus in an immunosuppressive regimen. Method Induction immunosuppression using IL2-RA basiliximab in all patients undergoing kidney transplantation has been routinely used in our transplant center since April 1, 2018. We retrospectively compared outcomes of kidney transplantation of the last 40 patients before introduction of induction and the first 40 patients after the induction (monitored period of analysis is June 2017 to January 2019). All patients in each group received baseline immunosuppression of tacrolimus, corticosteroid and mycophenolate. We selected patients with low immunological risk (1st transplant, panel reactive antibodies up to 20%, without donor specific antibodies, donation after brain death) in both groups and evaluated their renal outcomes (serum creatinine and estimated glomerular filtration rate/eGFR) at 12 months after transplantation. Results Patients in the groups withnout and with basiliximab induction were of comparable age (51.9 years vs. 54.7) and with similar retransplantation rate (20%). The 1-year survival of patients and kidneys was the same (97.4% patient survival and 92.1% renal survival). Renal transplant function at 12 months was analyzed in 21 patients without and 19 patients with basiliximab induction with low baseline immunological risk. The patients who received basiliximab inductive immunosuppression had better graft function 12 months compared to patients without basiliximab administration: median serum creatinine level 112 µmol/L vs. 127 µmol/L (P=0.047) and eGFR 0.85 ml/s vs. 0.77 ml/s (P=0.347). Better renal function was also shown in the subgroup of patients older than 65 years. Conclusion At our transplant center, the introduction of basiliximab induction in patients at low immunological risk led to improved graft function in the short term despite the growing subpopulation of geriatric patients.

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Pulmonary functions in kidney transplant recipients: Single centre observational study

International Journal of Physiotherapy and Research ◽

10.16965/ijpr.2021.167 ◽

2021 ◽

Vol 9 (5) ◽

pp. 3986-3991

Author(s):

Harda Shah ◽

◽

Nehal Shah ◽

Keyword(s):

Kidney Transplantation ◽

Waist Circumference ◽

Pulmonary Function ◽

Kidney Transplant ◽

Physical Inactivity ◽

Graft Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

High Waist Circumference ◽

Pulmonary Functions

Background: Kidney transplantation in India is steadily increasing with advancement in medicines and surgical expertise. Subjects with kidney disease have spectrum of pulmonary pathologies but little is known regarding status on pulmonary function after kidney transplantation. Method: 149 kidney transplant recipients between 18 to 60 years of age, having stable graft function and more than 6months of post-transplant duration were included in the study. Forced vital capacity (FVC), forced expiratory volume in first second (FEV1), the ratio of FEV1/FVC and peak expiratory flow rate (PEFR) were evaluated. Result: 11 (7.4%) had a restrictive ventilatory impairment, none had obstructive lung function. FEV1 and FVC were lower among subjects with high waist circumference, over weight and obese. FEV1/FVC ratio were lower in subjects with comorbidities or physical inactivity. Conclusion: Restrictive lung functions present in few kidney transplant recipients. High waist circumference, over weight, obesity, comorbidity and physical inactivity alters pulmonary functions in kidney transplant recipients. KEY WORDS: Kidney transplantation, pulmonary function test, anthropometry, physical activity, comorbidity.

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Acute Renal Failure and Volume Overload Syndrome Secondary to a Femorofemoral Arteriovenous Fistula Angioplasty in a Kidney Transplant Recipient

Case Reports in Transplantation ◽

10.1155/2013/197524 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Dominique Bertrand ◽

Geoffroy Desbuissons ◽

Nicolas Pallet ◽

Albane Sartorius ◽

Christophe Legendre ◽

...

Keyword(s):

Renal Failure ◽

Kidney Transplantation ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Function ◽

Clinical Symptoms ◽

Kidney Transplant Recipient ◽

Volume Overload ◽

Kidney Transplant Recipients ◽

The Impact

Experimental and clinical studies analyzing the impact of AVF on cardiovascular and renal parameters, as well as outcomes, in kidney transplant recipients are lacking. On the other hand, it is not known whether AVF ligation after transplantation modifies hemodynamic parameters and kidney function. We report a case of a renal transplant recipient who developed an acute congestive heart failure accompanied by renal failure, which were triggered by femorofemoral AVF angioplasty. Prompt AVF ligation rapidly reversed clinical symptoms and normalized cardiac and renal functions. This paper illustrates the potential deleterious consequences of high-output AVF after kidney transplantation and raises considerations regarding the impact of the fistula on cardiac status and kidney function after kidney transplantation and, consequently, the management AVF after transplantation.

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