scholarly journals Recurrent Glomerulonephritis after Renal Transplantation: The Clinical Problem

2020 ◽  
Vol 21 (17) ◽  
pp. 5954
Author(s):  
Barbara Infante ◽  
Michele Rossini ◽  
Serena Leo ◽  
Dario Troise ◽  
Giuseppe Stefano Netti ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Kidney Diseases ◽  
Treatment Options ◽  
Graft Loss ◽  
Clinical Problem ◽  
Microscopy Study ◽  
Electron Microscopy Study ◽  
Chronic Graft Dysfunction ◽  
A Minor ◽  
End Stage

Glomerulonephritis (GN) continues to be one of the main causes of end-stage kidney disease (ESKD) with an incidence rating from 10.5% to 38.2%. Therefore, recurrent GN, previously considered to be a minor contributor to graft loss, is the third most common cause of graft failure 10 years after renal transplantation. However, the incidence, pathogenesis, and natural course of recurrences are still not completely understood. This review focuses on the most frequent diseases that recur after renal transplantation, analyzing rate of recurrence, epidemiology and risk factors, pathogenesis and bimolecular mechanisms, clinical presentation, diagnosis, and therapy, taking into consideration the limited data available in the literature. First of all, the risk for recurrence depends on the type of glomerulonephritis. For example, recipient patients with anti-glomerular basement membrane (GBM) disease present recurrence rarely, but often exhibit rapid graft loss. On the other hand, recipient patients with C3 glomerulonephritis present recurrence in more than 50% of cases, although the disease is generally slowly progressive. It should not be forgotten that every condition that can lead to chronic graft dysfunction should be considered in the differential diagnosis of recurrence. Therefore, a complete workup of renal biopsy, including light, immunofluorescence and electron microscopy study, is essential to provide the diagnosis, excluding alternative diagnosis that may require different treatment. We will examine in detail the biomolecular mechanisms of both native and transplanted kidney diseases, monitoring the risk of recurrence and optimizing the available treatment options.

scholarly journals Pyelonephritis and Bacteremia Caused by Klebsiella variicola following Renal Transplantation

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Cody Lo ◽  
Shazia Masud ◽  
Gregory D. Deans
Keyword(s):  
Renal Transplantation ◽  
Graft Loss ◽  
First Year ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Increased Risk ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage ◽  
Oral Ciprofloxacin

Klebsiella variicola (K. variicola) is a Gram-negative organism genetically similar to Klebsiella pneumoniae (K. pneumoniae) that can cause a variety of diseases in humans. Bacteremia due to K. variicola is associated with a higher mortality rate than bacteremia with K. pneumoniae. Here, we describe a 65-year-old woman who developed pyelonephritis 2 months after receiving a renal transplantation following a longstanding history of end-stage renal disease secondary to polycystic kidney disease. Her creatinine on admission was unchanged from her posttransplant baseline, and an abdominal CT scan showed inflammatory changes around the transplanted kidney that were suggestive of an infection rather than allograft rejection. She was initially treated empirically with meropenem given a history of extended-spectrum beta-lactamase- (ESBL-) producing E. coli bacteriuria. After a day of therapy with meropenem, her therapy was streamlined based on culture results to ceftriaxone. She continued to improve, her kidney function remained stable, and she was prescribed oral ciprofloxacin to complete a 14-day total course of antibiotics. This case is the first reported instance of K. variicola bacteremia associated with pyelonephritis in a renal transplant recipient. Hospitalization with acute pyelonephritis within the first year following kidney transplant is common and is associated with increased risk of graft loss and mortality. However, K. variicola is not a commonly known organism to cause this infection. Despite the risk of allograft failure in this circumstance, this patient was successfully treated with a 14-day course of antibiotic therapy.

Renal transplantation

2021 ◽  
pp. 689-740
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Surgical Procedure ◽  
Long Term Outcomes ◽  
Chronic Graft Dysfunction ◽  
Short And Long Term ◽  
Stage Renal Disease ◽  
End Stage ◽  
Work Up

Kidney transplantation is the optimal treatment for end stage renal disease. However, there are risks both from early complications directly related to the surgical procedure, and from longer-term complications resulting from the effects of immunosuppression. This chapter describes the transplant process from the evaluation of patients with renal failure for suitability for transplantation, through the surgical procedure itself, the early and late management of recipients, and the management of the complications that can arise, including acute and chronic graft dysfunction, infection, malignancy, and cardiovascular disease. It also covers the short- and long-term outcomes of kidney transplantation. Since live kidney donors have become an increasingly important source of kidneys for renal transplantation, it also describes the work-up process for potential live donors and the long-term outcomes following donation. Finally, combined kidney/pancreas transplantation is included separately and includes a discussion around the selection and evaluation recipients, the surgical procedure, short- and long-term complications, and the outcomes.

scholarly journals Risk-Adjusted Analysis of Relevant Outcome Drivers for Patients after More Than Two Kidney Transplants

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Lampros Kousoulas ◽  
Florian W. R. Vondran ◽  
Paulina Syryca ◽  
Juergen Klempnauer ◽  
Harald Schrem ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Graft Survival ◽  
Patient Survival ◽  
Therapeutic Option ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Adjusted Analysis ◽  
Stage Renal Disease ◽  
End Stage

Renal transplantation is the treatment of choice for patients suffering end-stage renal disease, but as the long-term renal allograft survival is limited, most transplant recipients will face graft loss and will be considered for a retransplantation. The goal of this study was to evaluate the patient and graft survival of the 61 renal transplant recipients after second or subsequent renal transplantation, transplanted in our institution between 1990 and 2010, and to identify risk factors related to inferior outcomes. Actuarial patient survival was 98.3%, 94.8%, and 88.2% after one, three, and five years, respectively. Actuarial graft survival was 86.8%, 80%, and 78.1% after one, three, and five years, respectively. Risk-adjusted analysis revealed that only age at the time of last transplantation had a significant influence on patient survival, whereas graft survival was influenced by multiple immunological and surgical factors, such as the number of HLA mismatches, the type of immunosuppression, the number of surgical complications, need of reoperation, primary graft nonfunction, and acute rejection episodes. In conclusion, third and subsequent renal transplantation constitute a valid therapeutic option, but inferior outcomes should be expected among elderly patients, hyperimmunized recipients, and recipients with multiple operations at the site of last renal transplantation.

Outcome of Patients with Amyloidosis after Renal Transplantation: A Single-Center Experience

2012 ◽  
Vol 35 (6) ◽  
pp. 444-449 ◽  
Author(s):  
Meltem Gursu ◽  
Berna Yelken ◽  
Yasar Caliskan ◽  
Rumeyza Kazancioglu ◽  
Halil Yazici ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Kidney Diseases ◽  
Graft Loss ◽  
Survival Rates ◽  
Infectious Complications ◽  
Late Complications ◽  
Control Group ◽  
Single Center Experience ◽  
Prognostic Outcome

Aims: The prognostic outcome of patients with amyloidosis who receive a kidney transplant is controversial. The aim of the study was to analyze the renal transplantation outcome of patients with amyloidosis compared to transplant recipients with other kidney diseases. Methods: Among 940 patients who had renal transplantation in our unit between 1983 and 2009, 44 patients with amyloidosis were compared regarding early and late complications and survival, retrospectively, with a control group of 41 consecutive patients with the same donor type and a matched renal transplantation date. Results: The groups were similar regarding demographic parameters, HLA mismatch numbers and mean follow-up period. Groups were similar regarding early and late infectious and non-infectious complications, except recurrence of the primary disease, which was more common in the amyloidosis group. As the cause of graft loss, rejection (acute or chronic) was more common in the control group; whereas primary non-functioning graft, and death with a functioning graft were more common in the amyloidosis group. Patient survival rates at 1, 5, and 10 years were 87.6%, 78.1%, and 62.3 in the amyloidosis group; and 93.2%, 82.6%, and 69.3% in the control group. Graft survival rates at 1, 5 and 10 years were 87.6%, 75.4%, 56.4% in the amyloidosis group; and 93.2%, 80.3%, and 60.6% in the control group, respectively. These values did not show any statistical difference. Conclusions: The outcomes of renal transplantation in patients with amyloidosis are comparable with recipients whose primary problems are due to other kidney diseases; therefore, amyloidosis patients should be accepted as good candidates for transplantation.

scholarly journals Vascular Complications in Live Related Renal Transplant – BSMMU Experience

2020 ◽  
Vol 23 (1) ◽  
pp. 72-75
Author(s):  
Tohid Mohammad Saiful Hossain ◽  
Tahmina Karim ◽  
Md Habibur Rahman ◽  
AKM Khurshidul Alam ◽  
Abdul Matin Anamur Rashid Choudhury
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Renal Artery ◽  
Surgical Complication ◽  
Graft Loss ◽  
Vascular Complications ◽  
Artery Aneurysm ◽  
Vascular Complication ◽  
Allograft Loss ◽  
End Stage

Introduction: Renal Transplantation is the optimal treatment for end-stage renal disease.Among the surgical complication in Renal Transplant vascular complication is most dreadedand many lead to sudden allograft loss and increase patient morbidity and even mortality. Objective: To share our experience and analysis of outcome of vascular complicationsof Live related Renal Transplant in our Bangabandhu Sheikh Mujib Medical University(BSMMU), Dhaka. Materials & Methods: One hundred eighty two (182) live related Renal Transplantwere performed from July 2011 to March 2020. During this period we evaluated thiscases retrospectively to find out vascular complications and analyzed them for frequency,clinical presentation and their management and outcome. Result: The age of recipients range from 6-65 years, male 129, female 53 vascularcomplications are found in 8 cases — 1 Renal Artery Thrombosis, 2 venous thrombosis,1 Renal Artery aneurysm, 1 hematocele, 3 lymphocele. 4 patients needed graftnephrectomy, 2 lymphocele cases need lympho-peritoneal shunt and 1 improve bysclerotherapy with povidone-iodine, hematoma needs surgical evacuation. One patientdied after graft Nephrectomy due to sepsis. Conclusion: Major vascular complications are relatively uncommon after live relatedRenal Transplantation but still contributes a major factor of graft loss and patientmorbidity. According to these data we can conclude Renal Transplantation is safeprocedure for end stage renal disease. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.72-75

scholarly journals Recurrent Glomerular Diseases in Renal Transplantation with Focus on Role of Electron Microscopy

2021 ◽  
pp. 1-32
Author(s):  
Surya V. Seshan ◽  
Steven P. Salvatore
Keyword(s):  
Electron Microscopy ◽  
Renal Transplantation ◽  
Kidney Disease ◽  
Kidney Diseases ◽  
Graft Loss ◽  
Graft Function ◽  
Vascular Lesions ◽  
Glomerular Diseases ◽  
Transplant Kidney ◽  
Urine Testing

<b><i>Background:</i></b> The common causes of renal transplant complications include active or chronic rejection process, infections, and toxicity but also recurrent or de novo diseases, which play an important role in affecting long-term graft function or graft loss. <b><i>Summary:</i></b> Recurrent disease in renal transplantation is defined as recurrence of the original kidney disease leading to end-stage kidney disease. They comprise a heterogeneous group of predominantly glomerular and some tubulointerstitial and vascular lesions, which include primary kidney diseases (e.g., focal segmental glomerulosclerosis, membranous glomerulonephritis, and IgA nephropathy) or those secondary to systemic autoimmune, metabolic, and infectious processes that can range from subclinical to clinically overt acute, subacute, or chronic clinical presentations. In addition to the knowledge of prior renal disease and routine/periodic serum and urine testing for kidney function, a complete transplant renal biopsy examination is essential in the identification and differentiation of these diseases. The time of onset and severity of these diseases depend on the underlying etiopathogenetic mechanisms and the varied rates of recurrence in the early or late posttransplant period, often being modified by the current immunosuppressive protocols and other donor and recipient predisposing characteristics. <b><i>Key Messages:</i></b> Transplant kidney biopsy findings provide diagnostic accuracy and prognostic information regarding the potential for reversibility along with detection of unsuspected or clinically symptomatic recurrent diseases, with any concomitant rejection process or toxicity, for appropriate therapeutic decision-making. Routine electron microscopy in transplant kidney biopsies is a valuable tool in recognizing fully developed or early/subtle features of evolving recurrent diseases, often during the subclinical phases, in for cause or surveillance allograft biopsies.

A High Voltage Electron Microscopy Study of Sub-Oxide Formation in Vanadium

1971 ◽  
Vol 29 ◽  
pp. 212-213
Author(s):  
R. H. Geiss ◽  
R. L. Ladd ◽  
K. R. Lawless
Keyword(s):  
High Vacuum ◽  
Microscopy Study ◽  
Electron Microscopy Study ◽  
Ultra High Vacuum ◽  
Pure Oxygen ◽  
Pressure Oxidation ◽  
High Voltage Electron Microscopy ◽  
Oxidation Study ◽  
Voltage Electron ◽  
Good Agreement

Detailed electron microscope and diffraction studies of the sub-oxides of vanadium have been reported by Cambini and co-workers, and an oxidation study, possibly complicated by carbon and/or nitrogen, has been published by Edington and Smallman. The results reported by these different authors are not in good agreement. For this study, high purity polycrystalline vanadium samples were electrochemically thinned in a dual jet polisher using a solution of 20% H2SO4, 80% CH3OH, and then oxidized in an ion-pumped ultra-high vacuum reactor system using spectroscopically pure oxygen. Samples were oxidized at 350°C and 100μ oxygen pressure for periods of 30,60,90 and 160 minutes. Since our primary interest is in the mechanism of the low pressure oxidation process, the oxidized samples were cooled rapidly and not homogenized. The specimens were then examined in the HVEM at voltages up to 500 kV, the higher voltages being necessary to examine thick sections for which the oxidation behavior was more characteristic of the bulk.

Factors influencing adhesive bonding at the bone/implant interface

1992 ◽  
Vol 50 (2) ◽  
pp. 1114-1115
Author(s):  
Julie A. Martini ◽  
Robert H. Doremus
Keyword(s):  
Electron Microscopy ◽  
Adhesive Bonding ◽  
Microscopy Study ◽  
Electron Microscopy Study ◽  
Bone Implant ◽  
Factors Influencing ◽  
Lr White ◽  
Transmission Electron ◽  
New Zealand White Rabbits ◽  
Scanning Electron

Tracy and Doremus have demonstrated chemical bonding between bone and hydroxylapatite with transmission electron microscopy. Now researchers ponder how to improve upon this bond in turn improving the life expectancy and biocompatibility of implantable orthopedic devices.This report focuses on a study of the- chemical influences on the interfacial integrity and strength. Pure hydroxylapatite (HAP), magnesium doped HAP, strontium doped HAP, bioglass and medical grade titanium cylinders were implanted into the tibial cortices of New Zealand white rabbits. After 12 weeks, the implants were retrieved for a scanning electron microscopy study coupled with energy dispersive spectroscopy.Following sacrifice and careful retrieval, the samples were dehydrated through a graduated series starting with 50% ethanol and continuing through 60, 70, 80, 90, 95, and 100% ethanol over a period of two days. The samples were embedded in LR White. Again a graduated series was used with solutions of 50, 75 and 100% LR White diluted in ethanol.

Electron microscopy study of reactively sputter-deposited Ti/N films on silicon

1992 ◽  
Vol 50 (2) ◽  
pp. 1362-1363
Author(s):  
V. C. Kannan ◽  
A. K. Singh ◽  
R. B. Irwin ◽  
S. Chittipeddi ◽  
F. D. Nkansah ◽  
...  
Keyword(s):  
Integrated Circuits ◽  
Large Scale ◽  
Hexagonal Phase ◽  
Microscopy Study ◽  
Electron Microscopy Study ◽  
Process Conditions ◽  
Tin Films ◽  
Wide Range ◽  
Fcc Phase ◽  
Circuits Vlsi

Titanium nitride (TiN) films have historically been used as diffusion barrier between silicon and aluminum, as an adhesion layer for tungsten deposition and as an interconnect material etc. Recently, the role of TiN films as contact barriers in very large scale silicon integrated circuits (VLSI) has been extensively studied. TiN films have resistivities on the order of 20μ Ω-cm which is much lower than that of titanium (nearly 66μ Ω-cm). Deposited TiN films show resistivities which vary from 20 to 100μ Ω-cm depending upon the type of deposition and process conditions. TiNx is known to have a NaCl type crystal structure for a wide range of compositions. Change in color from metallic luster to gold reflects the stabilization of the TiNx (FCC) phase over the close packed Ti(N) hexagonal phase. It was found that TiN (1:1) ideal composition with the FCC (NaCl-type) structure gives the best electrical property.

Analytical Electron Microscopy Study of Second-Phase Particles in 7075 and 7475 Aluminum Alloys

1985 ◽  
Vol 43 ◽  
pp. 348-349
Author(s):  
M. Raghavan ◽  
J. Y. Koo ◽  
J. W. Steeds ◽  
B. K. Park
Keyword(s):  
Aluminum Alloys ◽  
Silicon Oxide ◽  
Analytical Electron Microscopy ◽  
Microscopy Study ◽  
Electron Microscopy Study ◽  
Partial Substitution ◽  
Second Phase ◽  
X Ray ◽  
Second Phase Particles ◽  
Almost All

X-ray microanalysis and Convergent Beam Electron Diffraction (CBD) studies were conducted to characterize the second phase particles in two commercial aluminum alloys -- 7075 and 7475. The second phase particles studied were large (approximately 2-5μm) constituent phases and relatively fine ( ∼ 0.05-1μn) dispersoid particles, Figures 1A and B. Based on the crystal structure and chemical composition analyses, the constituent phases found in these alloys were identified to be Al7Cu2Fe, (Al,Cu)6(Fe,Cu), α-Al12Fe3Si, Mg2Si, amorphous silicon oxide and the modified 6Fe compounds, in decreasing order of abundance. The results of quantitative X-ray microanalysis of all the constituent phases are listed in Table I. The data show that, in almost all the phases, partial substitution of alloying elements occurred resulting in small deviations from the published stoichiometric compositions of the binary and ternary compounds.

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