scholarly journals Early puberty in end stage renal failure and renal transplant recipients

2019 ◽  
Vol 32 (6) ◽  
pp. 577-583
Author(s):  
Carmit Avnon Ziv ◽  
Shimrit Tzvi-Behr ◽  
Efrat Ben-Shalom ◽  
Choni Rinat ◽  
Rachel Becker-Cohen ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Precocious Puberty ◽  
Breast Development ◽  
Delayed Puberty ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Early Puberty ◽  
Release Formulation ◽  
Triptorelin Acetate

Abstract Background Delayed puberty and hypogonadism are common in children with chronic kidney disease and in renal transplant recipients, but precocious puberty has rarely been reported in these populations. We describe six girls with precocious and/or early-onset, rapidly progressive puberty before and following renal transplantation. Methods Of 112 children under the age of 18 years (67 boys, 45 girls) who received renal transplants between 2010 and 2018, six girls presented with precocious or rapidly progressive early puberty at ages 6–7/12, 7–2/12, 7–4/12, 8, 8–8/12 and 8–11/12 years. Clinical evaluation included measurements of height, weight, body mass index (BMI), Tanner staging and bone age assessment. Gonadotropin responses to intravenous gonadotropin releasing hormone (GnRH) or intramuscular triptorelin acetate were determined. Results Tanner breast stage 3 was noted at 2–6 years following renal transplantation in five girls, four with preserved kidney function. One girl began puberty before renal transplantation. Peak luteinizing hormone (LH) and follicular stimulating hormone (FSH) levels were 6.5, 20.2, 7.83, 19.1, 9 and 2.2 mIU/mL and 13, 8.3, 8.01, 7.5, 8.1 and 7.7 mIU/mL, respectively. Treatment with an intramuscular slow-release formulation of triptorelin acetate every 4 weeks slowed progression of breast development. Conclusions Although delayed puberty is more common in children with renal disease, precocious puberty can also be seen. Evaluation of growth and puberty by a pediatric endocrinologist should be part of the routine care for all children following kidney transplantation.

scholarly journals A clinical study of cutaneous manifestations in renal transplant recipients

2019 ◽  
Vol 5 (1) ◽  
pp. 160
Author(s):  
Pradeep Vittal Bhagwat ◽  
R. Rajagopal ◽  
P. S. Murthy ◽  
R. S. V. Kumar
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Viral Infections ◽  
Fungal Infections ◽  
Common Finding ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Drug Induced ◽  
Cutaneous Manifestations ◽  
Dermatological Examination

<p class="abstract"><strong>Background:</strong> Chronic renal failure is becoming common entity with increased incidence of diabetes mellitus and resulting diabetic nephropathy. With the availability of renal transplantation services in many centers, increased availability of donors, improved surgical technique and availability of better drugs, the survival of renal transplant recipients has increased. The objective of the study was to study the cutaneous manifestations in renal transplant recipients.</p><p class="abstract"><strong>Methods:</strong> Fifty consenting, consecutive renal transplant recipients attending the OPD and in-patients at Command Hospital Air Force, Bangalore during July 2001 to March 2003 were included in the study. Detailed history was taken and clinical examination was carried out with special emphasis on the Dermatological examination. Relevant investigations were carried out.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 50 renal transplant recipients were studied of which 42 (84%) were males and 8 (16%) were females. The age of patients ranged from 16 years to 60 years. Infections were the most common finding, encountered in 38 (76%) patients, followed by drug induced manifestations in 24 (48%) patients. Cellulitis was noted in 1 (2%) patient, viral infections were seen in 18 (36%) patients, fungal infection was the commonest in this study, encountered in 38 (76%) patients. Monomorphic acne was seen in 13 (26%) patients. Hypertrichosis/hirsutism were the commonest drug induced manifestation in this study, seen in 16 (32%) patients.</p><p class="abstract"><strong>Conclusions:</strong> In patients with renal transplantation, superficial fungal infections and viral infections of the skin are seen more commonly. Monomorphic acne and hypertrichosis due to immunosuppressive are also seen frequently. These changes are moderately influenced by the immunosuppressive regimen used.</p>

scholarly journals Explained and Unexplained Ischemic Heart Disease Risk after Renal Transplantation

2000 ◽  
Vol 11 (9) ◽  
pp. 1735-1743 ◽  
Author(s):  
BERTRAM L. KASISKE ◽  
HARINI A. CHAKKERA ◽  
JOSEPH ROEL
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Transplantation ◽  
Relative Risk ◽  
Renal Transplant ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Calcium Channel Antagonists ◽  
Relative Risks ◽  
Cholesterol Levels

Abstract. Whether the high incidence of ischemic heart disease (IHD) among renal transplant patients can be attributed to the same risk factors that have been identified in the general population is unclear. The risk for major IHD events occurring >1 yr after transplantation among 1124 transplant recipients was estimated by using the risk calculated from the Framingham Heart Study (FHS). The FHS risk predicted IHD (relative risk, 1.28; 95% confidence interval, 1.20 to 1.40; P < 0.001); however, the FHS risk tended to underestimate the risk of IHD for renal transplant recipients. This was largely attributable to increased risks associated with diabetes mellitus and, to a lesser extent, age and cigarette smoking for renal transplant recipients. For men, the relative risks for diabetes mellitus were 2.78 (1.73 to 4.49) and 1.53 for the transplant recipient and FHS populations, respectively; the relative risks for age (in years) were 1.06 (1.04 to 1.08) and 1.05, respectively, and those for smoking were 1.95 (1.20 to 3.19) and 1.69, respectively. For women, the relative risks for diabetes mellitus were 5.40 (2.73 to 10.66) and 1.82, respectively. There was a tendency for the risk associated with cholesterol levels to be higher for transplant recipients, compared with the FHS population, but the risks associated with high-density lipoprotein cholesterol levels and BP appeared to be comparable. Independent of these and other risk factors, the adjusted risk of IHD for the transplant recipient population has decreased. Compared with the era before 1986, transplantation between 1986 and 1992 was associated with a lower relative risk of 0.60 (0.39 to 0.92); transplantation after 1992 was associated with an even lower relative risk of 0.27 (0.11 to 0.63) for IHD. Of concern was the fact that dihydropyridine calcium channel antagonists were associated with an increased risk for IHD (relative risk, 2.26; 95% confidence interval, 1.24 to 4.12; P = 0.008), and this association was independent of other antihypertensive agents and risk factors. Therefore, although the FHS risk predicts IHD after renal transplantation, it tends to underestimate the risks, especially the risk associated with diabetes mellitus. The unexpected finding that dihydropyridine calcium channel antagonists were associated with an increased IHD risk merits further evaluation.

P1763TUBERCULOSIS IN RENAL TRANSPLANT RECEPIENTS - DO RITUXIMAB AND OTHER IMMUNOSUPRESSION HAVE A ROLE?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anupma Kaul ◽  
Dharmendra Bhaduria ◽  
Narayan Prasad ◽  
Amit Gupta
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Immunosuppressive Agents ◽  
Induction Agent ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Significant Difference ◽  
High Prevalence ◽  
Mean Time

Abstract Background and Aims Rituximab is an anti CD 20 agent used widely in renal transplant recipients. Its use is associated with various infections;however, its association with Tuberculosis (TB) is not well established and has not been studied in post renal transplantation patients. Method This is a single centre, retrospective analysis of 56 renal transplant recipients who received rituximab for various reasons and 287 post renal transplant patients who did not receive rituximab during the study period from January 2013 to June 2017. The association between use of rituximab and incidence of TB was studied. Other factors associated with tuberculosis were also investigated. Results Baseline characteristics were similar in both the groups. Mean time for occurrence of TB was 18.4 + 10.6 months after renal transplantation. Rituximab use was not significantly associated with tuberculosis or any other infection. Higher number of rejection episodes (60% vs 32.72%, p=0.029) was the only factor associated with greater incidence of TB. However, no specific type of rejection was associated with tuberculosis. Use of plasmapheresis in post transplant period for treatment of humoral rejections was associated with significantly higher incidence of TB (33.33% vs 13.41%, p=0.031), however when pre- transplant plasmapheresis was also considered, there was no significant difference. The choice of induction agent was not associated with higher incidence of TB. Conclusion Use of rituximab is not associated with higher incidence of TB when compared to other immunosuppressive agents. Routine screening and prophylaxis may not be advisable especially in a country like India with high prevalence of TB; as it will further delay transplantation and may adversely affect the outcome of the patients.

scholarly journals Barriers and Facilitators of Fruit and Vegetable Consumption in Renal Transplant Recipients, Family Members and Healthcare Professionals—A Focus Group Study

Nutrients ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 2427 ◽  
Author(s):  
Boslooper-Meulenbelt ◽  
Patijn ◽  
Battjes-Fries ◽  
Haisma ◽  
Pot ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Healthcare Professionals ◽  
Vegetable Consumption ◽  
Family Members ◽  
Fruit And Vegetable Consumption ◽  
Barriers And Facilitators ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Fruit And Vegetable

Low fruit and vegetable consumption is associated with poor outcomes after renal transplantation. Insufficient fruit and vegetable consumption is reported in the majority of renal transplant recipients (RTR). The aim of this study was to identify barriers and facilitators of fruit and vegetable consumption after renal transplantation and explore if certain barriers and facilitators were transplant-related. After purposive sampling, RTR (n = 19), their family members (n = 15) and healthcare professionals (n = 5) from a Dutch transplant center participated in seven focus group discussions (three each for RTR and family members, one with healthcare professionals). Transcripts were analyzed using social cognitive theory as conceptual framework and content analysis was used for identification of themes. Transplant-related barriers and facilitators were described separately. In categorizing barriers and facilitators, four transplant-related themes were identified: transition in diet (accompanied by, e.g., fear or difficulties with new routine), physical health (e.g., recovery of uremic symptoms), medication (e.g., cravings by prednisolone) and competing priorities after transplantation (e.g., social participation activities). Among the generic personal and environmental barriers and facilitators, food literacy and social support were most relevant. In conclusion, transplant-related and generic barriers and facilitators were identified for fruit and vegetable consumption in RTR. The barriers that accompany the dietary transition after renal transplantation may contribute to the generally poorer fruit and vegetable consumption of RTR. These findings can be used for the development of additional nutritional counseling strategies in renal transplant care.

Successful Triplet Pregnancy following Renal Transplantation

1980 ◽  
Vol 25 (4) ◽  
pp. 320-322 ◽  
Author(s):  
A. B. MacLean ◽  
F. Sharp ◽  
J. D. Briggs ◽  
S. G. MacPherson
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Clinical Course ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Triplet Pregnancy ◽  
Successful Case

There are now many reported successful pregnancies to renal transplant recipients, but this is believed to be the first reported successful case of triplets. The clinical course, complications and management of the pregnancy are described.

scholarly journals Efficacy and Safety of Sitagliptin for the Treatment of New-Onset Diabetes after Renal Transplantation

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Brian P. Boerner ◽  
Clifford D. Miles ◽  
Vijay Shivaswamy
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Kidney Transplant ◽  
Hemoglobin A1c ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
First Line ◽  
New Onset

New-onset diabetes after transplantation (NODAT) is a common comorbidity after renal transplantation. Though metformin is the first-line agent for the treatment of type 2 diabetes, in renal transplant recipients, metformin is frequently avoided due to concerns about renal dysfunction and risk for lactic acidosis. Therefore, alternative first-line agents for the treatment of NODAT in renal transplant recipients are needed. Sitagliptin, a dipeptidyl-peptidase-4 (DPP-4) inhibitor, has a low incidence of hypoglycemia, is weight neutral, and, in a small study, did not affect immunosuppressant levels. However, long-term sitagliptin use for the treatment of NODAT in kidney transplant recipients has not been studied. We retrospectively analyzed renal transplant recipients diagnosed with NODAT and treated with sitagliptin to assess safety and efficacy. Twenty-two patients were started on sitagliptin alone. After 12 months of followup, 19/22 patients remained on sitagliptin alone with a significant improvement in hemoglobin A1c. Renal function and immunosuppressant levels remained stable. Analysis of long-term followup (32.5±17.8 months) revealed that 17/22 patients remained on sitagliptin (mean hemoglobin A1c < 7%) with 9/17 patients remaining on sitagliptin alone. Transplant-specific adverse events were rare. Sitagliptin appears safe and efficacious for the treatment of NODAT in kidney transplant recipients.

scholarly journals Severe hyperparathyroidism associated with prolonged hungry bone syndrome in a renal transplant recipient.

1997 ◽  
Vol 8 (10) ◽  
pp. 1626-1631
Author(s):  
A M Miles ◽  
M S Markell ◽  
N Sumrani ◽  
J Hong ◽  
E A Friedman
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Transplant Recipient ◽  
Renal Transplant Recipient ◽  
Pathological Fracture ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Hungry Bone Syndrome ◽  
Persistent Hyperparathyroidism ◽  
Hungry Bone

Although widely believed to resolve within 6 to 12 months of successful renal transplantation, hyperparathyroidism may persist or develop after renal transplantation and eventually require parathyroidectomy. Avid calcium retention by demineralized bones (hungry bone syndrome) is well-recognized after parathyroidectomy and usually resolves after a few weeks. This report documents the case of a renal transplant recipient with persistent hyperparathyroidism who developed a pathological fracture of the pelvis and required parathyroidectomy 1 year after transplant and then manifested severe and prolonged hungry bone syndrome lasting for more than 20 months postoperatively. The clinical features and treatment of hyperparathyroidism in renal transplant recipients are discussed, as are diagnosis, pathogenesis, and management of hungry bone syndrome. Recognition of renal transplant recipients at greater risk for severe hungry bone syndrome should permit earlier and more aggressive management of this sometimes protracted complication of parathyroid surgery.

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