Abstract Allograft biopsy is a cornerstone in the management of transplanted kidneys. It is a safe procedure, often performed in the outpatient setting. A rare complication is formation of a ...postbiopsy arteriovenous fistula (AVF). We present here a report of two cases of postbiopsy AVFs treated endovascularly. Selective embolization is a safe and effective method of treatment of postbiopsy AVFs in renal allografts.
The patient was born in 1967. In 2004 the patient started renal replacement therapy with peritoneal dialysis. In 2010, after the first episode of peritonitis caused by Staphylococcus aureus, due to ...poor response to antibiotic therapy, the peritoneal catheter was removed. A month after this episode, pain accompanied by fever and an increase in inflammatory parameters occurred. Initial computed tomography scans did not show any specific abnormalities and the second CT two months later diagnosed sclerosing peritonitis. Corticosteroid and tamoxifen therapy with enteral nutrition was initiated. Five months after the symptoms started, the patient developed intestinal obstruction, so a nasogastric tube was placed and total parenteral nutrition was introduced. After four months, the patient was surgically treated at the Manchester Royal Infirmary, resection of the terminal ileum and caecum was performed, and an ileocecal anastomosis with enterolysis was performed. Then, in 2012, a successful kidney transplant was performed. The patient has since remained without clinical signs of obstruction. Tamoxifen and corticosteroid therapy with adequate nutritional support, surgical treatment, and transplantation with long-term immunosuppressive therapy may be reasons for long-term remission and survival ten years after EPS diagnosis. Key words: Encapsulating peritoneal sclerosis (EPS); peritoneal dialysis (PD); EPS surgical treatment, kidney transplantation EPS
Aim. To investigate morphological findings of zero-time biopsies analyzed at the Department of Nephropathology and Electron Microscopy, Dubrava University Hospital, Zagreb. Materials and methods. The ...retrospective search of data was performed for the period from 2006 to 2018. A total of 316 zero-time renal biopsies were analyzed. Glomerular basement membrane (GBM) thickness was remeasured in 84 zero-time biopsies and 80 protocol biopsies of the same patients 12 months after transplantation. Results and conclusion. The acute tubular injury was present in 90% and glomerular pathology in 17% of zero-time biopsies, with thin basement membranes (TBM) being the most common entity (13%). Chronic graft changes were evaluated according to Banff classification. Most cases showed Banff scores ci0 (82.6%) and ct0 (65.1%). Banff scores cv2 and cv3 were present in 13% and ah2 and ah3 in 36.4% of specimens. Among 84 remeasured zero-time samples, TBM was present in 26 patients (31%). There were no differences between Banff scores and clinical parameters 12 months after transplantation between recipients with TBM and recipients with normal GBM thickness. Zero-time renal biopsy is of great importance for allograft assessment and comparison with consecutive biopsies. Further investigation is needed to determine the long-term significance of TBM on graft survival. Key words: Zero-time renal biopsies, Glomerular basement membrane, Thin basement membrane
Liver Graft Failure and Bile Cast Nephropathy Mrzljak, Anna; Jurekovic, Zeljka; Novak, Rafaela ...
The Korean journal of gastroenterology,
03/2020, Letnik:
75, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The consequences of graft failure after liver transplantation (LT) range far beyond the liver. The kidneys are often affected, where persistent and progressive cholestasis can result in acute kidney ...injury (AKI) leading to the development of bile cast nephropathy (BCN). BCN is an often unrecognized condition that is characterized by proximal tubulopathy and the formation of bile casts in the distal tubules, which is almost diagnosed exclusively on a kidney biopsy or autopsy. This condition is potentially reversible, provided the bilirubin levels can be reduced early. LT may represent a treatment option in the case of irreversible liver (or liver graft) failure, which is beneficial for both the liver and the kidney. This paper reports a case of BCN in a patient with idiopathic graft failure after LT. Despite his chronic kidney disease, liver re-transplantation led to the successful improvement of his AKI.
ObjectivesStudies have reported that the tunnelled dialysis catheter (TDC) is associated with inferior haemodialysis (HD) patient survival, in comparison with arteriovenous fistula (AVF). Since many ...cofactors may also affect survival of HD patients, it is unclear whether the greater risk for survival arises from TDC per se, or from associated conditions. Therefore, the aim of this study was to determine, in a multivariate analysis, the long-term outcome of HD patients, with respect to vascular access (VA).DesignRetrospective cohort study.ParticipantsThis retrospective cohort study included all 156 patients with a TDC admitted at University Hospital Merkur, from 2010 to 2012. The control group consisted of 97 patients dialysed via AVF. The groups were matched according to dialysis unit and time of VA placement. The site of choice for the placement of the TDC was the right jugular vein. Kaplan-Meier analysis with log-rank test was used to assess patient survival. Multivariate Cox regression analysis was used to determine independent variables associated with patient survival.Primary outcome measuresPatient survival with respect to VA.ResultsThe cumulative 1-year survival of patients who were dialysed exclusively via TDC was 86.4% and of those who were dialysed exclusively via AVF, survival was 97.1% (p=0.002). In multivariate Cox regression analysis, male sex and older age were independently negatively associated with the survival of HD patients, while shorter HD vintage before the creation of the observed VA, hypertensive renal disease and glomerulonephritis were positively associated with survival. TDC was an independent risk factor for survival of HD patients (HR 23.0, 95% CI 6.2 to 85.3).ConclusionTDC may be an independent negative risk factor for HD patient survival.
Objectives Chronic transplant dysfunction after kidney transplantation is a major reason of kidney graft loss and is caused by immunological and non-immunological factors. There is evidence that ...mycophenolate mofetil (MMF) may exert a positive effect on renal damage in addition to immunosuppression, by its direct antifibrotic properties. The aim of our study was to retrospectively investigate the role of MMF doses on progression of chronic allograft dysfunction and fibrosis and tubular atrophy (IF/TA). Setting Retrospective, cohort study. Participants Patients with kidney transplant in a tertiary care institution. This is a retrospective cohort study that included 79 patients with kidney and kidney–pancreas transplantation. Immunosuppression consisted of anti-interleukin 2 antibody induction, MMF, a calcineurin inhibitor±steroids. Primary outcome measures An association of average MMF doses over 1 year post-transplant with progression of interstitial fibrosis (Δci), tubular atrophy (Δct) and estimated-creatinine clearance (eCrcl) at 1 year post-transplant was evaluated using univariate and multivariate analyses. Results A higher average MMF dose was significantly independently associated with better eCrcl at 1 year post-transplant (b=0.21±0.1, p=0.04). In multiple regression analysis lower Δci (b=−0.2±0.09, p=0.05) and Δct (b=−0.29±0.1, p=0.02) were independently associated with a greater average MMF dose. There was no correlation between average MMF doses and incidence of acute rejection (p=0.68). Conclusions A higher average MMF dose over 1 year is associated with better renal function and slower progression of IF/TA, at least partly independent of its immunosuppressive effects.
Cilj istraživanja: Predstaviti iskustva našega transplantacijskog središta vezano za odstranjivanje tuneliranoga dijaliznog katetera (TDK) nakon bubrežne presadbe (TX, od engl. transplantation). ...Optimalno vrijeme uklanjanja TDK-a nakon TX-a nije poznato. Ispitanici i postupci: U 41 bolesnika (24 muška, medijan dobi 60 godina, 30 – 73) učinjeno je odstranjivanje TDK-a nakon TX-a (izolirano bubreg ili simultano s gušteračom ili jetrom) od 1. srpnja 2018. do 30. lipnja 2023. (tri od živog darovatelja, ostalo od preminulih). Ukupan broj bolesnika s TDK-om zbog provođenja hemodijalize (HD) u vrijeme TX-a među ukupno 249 bolesnika kojima je u opisanom razdoblju učinjen TX u našem središtu bio je 41 (16,5%). Vrijeme odstranjivanja planirano je nakon prve
protokolarne biopsije bubrega dva mjeseca nakon TX-a, a odluka je temeljena na rezultatima biopsije i stabilnoj funkciji presatka. Kateter je odstranjen standardnim postupkom, a pacijent je otpušten nekoliko sati poslije u slučaju izostanka razvoja komplikacija. Rezultati: Trideset i sedam bolesnika imalo je Hickmanov, a četiri Tesio tip
TDK-a, njih dvadeset i devet smješten u desnoj, osam u lijevoj unutarnjoj jugularnoj veni, tri u desnoj potključnoj veni, te jedan u lijevoj femoralnoj veni. Medijan vremena odstranjivanja TDK-a nakon TX-a (n = 36) bio je četiri mjeseca (1 – 14, interkvartilni raspon 2 – 5). Kaplan-Meierova analiza s pet cenzoriranih slučajeva koji još uvijek
čekaju odstranjenje TDK-a pokazala je medijan vremena od TX-a do uklanjanja TDK-a od četiri mjeseca, 95% intervali pouzdanosti 3,249 – 4,751. Jedan bolesnik imao je znakove infekcije tunela, a jedno odstranjivanje učinjeno je zbog sepse koja nije bila povezana s kateterom. Tri bolesnika su imala neuspjeh pri prvom odstranjivanju katetera, a jedan je imao umjereno poslijeproceduralno krvarenje. Zaključci: Iskustvo našeg središta pokazuje sigurnost u pristupu uklanjanja TDK-a tri do pet mjeseci nakon TX-a, s malim rizikom infekcije i krvarenja.
Life with diabetes in the COVID-19 era Madić, Višnja; Petrović, Aleksandra; Jugović, Dragana ...
Glasnik Antropološkog društva Srbije,
2023, Letnik:
56, Številka:
1-2
Journal Article
Recenzirano
Odprti dostop
The outbreak of the COVID-19 pandemic has changed the lives of billions of people, especially those with chronic diseases such as diabetes. The aim of this study was to evaluate the impact of the ...pandemic on the physical and mental health of diabetics living in the Balkans. The study was conducted as an online survey in April 2023. 129 people participated in the survey. 76 of them were diagnosed with type 1 and 53 with type 2 diabetes. 6.97% of all respondents had a close family member who died from the consequences of SARS-CoV-2 infection, and as many as 77.78% of these decedents suffered from diabetes and/or cardiovascular disease. The majority of the respondents were also infected with SARS-CoV-2. Most of them were diagnosed with diabetes before infection, and SARS-CoV-2-induced diabetes was mainly type 2. Although they regularly took prescribed pharmacotherapy and nutritional supplements, blood glucose was elevated in half of them, while D-dimer levels were elevated mainly in type 2 diabetics. Also, hospitalization during the acute phase was more frequent in type 2 diabetic patients. Most diabetics suffered from sleep disorders (p < 0.01), and type 2 diabetics also suffered from nightmares (p < 0.05). Consequently, the use of anxiolytics and antidepressants was more frequent in type 2 diabetic patients. Recovery was significantly faster in type 1 diabetics, due to less comorbidities such as hypertension, cardiovascular and liver diseases, which were more common in type 2 patients.
Uvod: IgA-nefropatija (IgAN) ima varijabilnu prezentaciju i prognozu. Međunarodni alat za predviđanje rizika u IgAN-u (IgAN-PT, od engl. International IgA Nephropathy Prediction Tool) predviđa ...napredovanje bubrežne bolesti do završnog stupnja ili smanjenje procijenjene glomerulske filtracije (eGFR) za 50%. Preporučuje se optimalna suportivna terapija najmanje tri mjeseca, praćena šestomjesečnom primjenom glukokortikoida samo u bolesnika s velikim rizikom napredovanja. Cilj: Istražiti koji su bolesnici imali veću vjerojatnost primiti imunosupresivnu terapiju (IS) te ishode liječenih IS-om. Ispitanici i metode: Retrospektivno kohortno istraživanje 48 bolesnika (33 muškarca), medijana dobi 50 godina (interkvartilni raspon, IQR, od engl. interquartile range 35 – 59), medijana praćenja 43 mjeseca (IQR 18 – 54), liječenih u Kliničkoj bolnici Merkur s novodijagnosticiranim idiopatskim IgAN-om u razdoblju od 2012. do 2021. godine. Rezultati: Imunosupresiju je primilo 17 bolesnika i oni su češće imali mezangijsku (M) (82% prema 54%, p=0,05), endokapilarnu hipercelularnost (E) (65% prema
21%, p=0,004) i polumjesece (C) (41% prema 14%, p=0,04). U odnosu na one bez IS-a nije bilo značajne razlike u eGFR-u kod biopsije (52 (IQR 38 – 81) prema 46 (IQR 30 – 72) ml/min/1,73 m2, p<0,05), ali su liječeni IS-om imali veću eGFR nakon dvije godine praćenja (66 IQR 37 – 97 prema 34 IQR 20 – 56 ml/min/1,73 m2, p=0,02). Omjer proteina prema kreatininu u urinu (uPCR) smanjio se nakon liječenja (kod biopsije, 106 IQR 50 – 317 prema završnom 47 IQR 20 – 129 mg/mmol), a nije bilo razlike u početnom i završnom uPCR između
onih koji jesu i nisu primali IS. Zbroj IIgAN se smanjio nakon liječenja (10,56% ± 12,66% prema 8,45% ± 9,22%, p=0,01), bez razlike u smanjenju između liječenih i neliječenih IS-om. Zaključci: Bolesnici s većim M, E i C su bili češće liječeni IS-om i oni su imali bolju eGFR nakon dvije godine; uPCR i zbroj IIgAN na kraju praćenja bili su manji neovisno o IS-u.
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