Neisseria gonorrhoeae is one of the microbes that can causes male urethritis. This microbe is most likely to be transmitted via sexual intercourse. In men, the representative infection sites are the ...urethra, and oral mucosa but gonococcemia is rere. We present a case of gonococcemia in a 47‐year‐old male successful kidney recipient. He temporarily lost his graft function due to acute kidney injury followed by sepsis; however, short‐course intermittent hemodialysis and long‐term intensive ceftriaxone inoculation saved his life and his graft function.
We report monozygotic twins of different sexual phenotypes. One of the twins had complete female external genitalia except for a mild clitoromegaly. She had bilateral gonads consisting of the wavy ...stroma and scant dysgenetic seminiferous tubules. No androgen secretion was induced by gonadotrophin stimulation. The other twin had hypospadiac male genitalia. His gonads were located intrascrotally and he had good androgenic response to a stimulation test. Conventional and fluorescence in situ hybridization chromosome analysis disclosed that both twins had a 47,X,idic(Y),idic(Y)/46,X,idic(Y)/45,X and 47,X, + mar × 2.ish idic(Y)(q11.2)(DYZ3 + + × 2)/46,X, + mar.ish idic(Y)(q11.2)(DZY3 + + )/45,X. These twins were clinically monochorionic and allelotype analysis in these twins and their parents with microsatellite markers showed the affirmative probability of 0.999999994 for monozygosity. The ratio of mosaicism, gonadal histology, and testosterone productivity were reasonably correlated to the genital virilization in these monozygotic twins, showing discordant sexual phenotypes.
Aim
Chronic active antibody‐mediated rejection (chronic ABMR) is one important cause of late‐stage renal allograft loss. However, few reports have used protocol biopsy to observe changes over time in ...cases that develop chronic ABMR. The aim of this study was to use protocol biopsy to clarify the histological features of cases that develop chronic ABMR.
Methods
We recruited 379 ABO compatible patients who underwent protocol biopsy at our hospital from 2010 to 2014. Seventeen of these patients were diagnosed with chronic ABMR (chronic ABMR group), and 12 patients were class 2 donor‐specific antibody (DSA) positive and were not diagnosed with chronic ABMR (class 2 DSA‐positive group). With the addition of a control group consisting of 30 DSA negative patients, these three groups were compared for Banff factors in protocol biopsies taken 3 months, 6 months, 1 year, 3 years, and 5 years after the transplant.
Results
Three months post transplant, the chronic ABMR group had a significantly higher number of patients exhibiting g + ptc > 0 than that in the control group (P = 0.01). At 1, 3, and 5 years post transplant, significantly more subjects in the chronic ABMR and class 2 DSA‐positive groups compared with the control group exhibited g + ptc > 0 (P < 0.03). Five years post transplant, the chronic ABMR group exhibited a significantly higher mean c4d score than that in the control group (P = 0.02). The only significant difference observed between the chronic ABMR group and the class 2 DSA‐positive group was in cg scores at 5 years post transplant, which were significantly higher in the chronic ABMR group (P = 0.03).
Conclusions
These results suggest that cases exhibiting microvascular inflammation in the early post‐transplant period may develop chronic ABMR, and it would be highly beneficial to perform focused electron microscope surveillance of these cases.
Aim
Recurrence of immunoglobulin A (IgA) nephropathy (IgAN) after renal transplantation is important as a cause of graft failure under improving rejection control. However, no specific therapy for ...recurrent IgAN is currently available. In this study, we evaluated the histological efficacy of tonsillectomy for allograft IgAN.
Methods
Fifteen kidney recipients (male 9, female 6, mean age 40.9 ± 9.3 years), who received a diagnosis of IgA nephropathy by allograft biopsy, were enrolled in this study. Tonsillectomy was performed 44.1 ± 27.1 months after the kidney transplantation. All patients underwent a repeat graft biopsy at 23.8 ± 15.8 months after tonsillectomy.
Results
Six patients had microhematuria before tonsillectomy. At 12 months after treatment, the microhematuria disappeared in five of these patients and one patient had mild hematuria. Three patients had severe proteinuria (more than 1.0 g/gCr) before tonsillectomy and improved after treatment. On histological analysis, four patients had acute lesions including cellular or fibrocellular crescents. The acute lesions disappeared after these treatments in all patients. Eleven patients had chronic lesions including global sclerosis, segmental sclerosis and fibrous crescents. The chronic lesion was ameliorated in six patients, unchanged in three and deteriorated in two patients.
Conclusions
Tonsillectomy improves not only clinical findings but also ameliorates histological damage caused by recurrent IgAN after kidney transplantation. Tonsillectomy is a novel and effective treatment for recurrent IgAN.
Summary at a Glance
Tonsillectomy improves clinical and histologic parameters in 15 Japanese patients with recurrent IgA nephropathy after kidney transplant. The availability of repeat biopsy in all patients is a strength of this study, while the lack of a control group is a drawback.
In Japan, living kidney donations are increasing instead of decreasing in relation to the number of cadaveric donors. Nowadays, most donors of nephrectomy have been handled through an endoscopic ...approach. The skill of endoscopic surgery is more crucial to ensure not only graft function, but also more donor safety than nephrectomy from other diseases, such as kidney cancer. Our institute introduced endoscopic living donor nephrectomy in 2002. Ninety-one cases of hand-assisted laparoscopic living donor nephrectomy (HALDN) and more recently 292 cases of retroperitoneoscopic living donor nephrectomy (RPLDN) have been performed. At total of 10 endoscopic donor surgeons (EDS) are now established. The key to technical tradition of living donor nephrectomy is to shorten the learning curve to achieve unchanged graft outcomes and donor safety. Herein we compared the results of 4 experienced surgeons with those of 6 trainees concerning perioperative outcomes, complications, and learning curves to verify our EDS training program.
Abstract Background Spontaneous rupture risk of a renal artery aneurysm (RAA) is extremely low. Indications for surgical repair of RAA remain uncertain. Objective Long-term outcomes of conservative ...therapy and surgical repair were evaluated. Patients The study included 58 patients (17 males, 41 females) who were diagnosed with RAA during the last 21 years. Median age at the time of diagnosis was 62 (19–85) years, and the median follow-up 69 months (range 3–216). Methods The patients were divided into two groups, conservative group ( n = 30) who had been followed with blood pressure control, and treatment group ( n = 29), who underwent an intervention. Results Multiple efferent aneurysmal branches were observed in seven conservative and 16 treatment cases ( P = .002). The median maximum diameter of the aneurysm was lower in the conservative than the treatment group (15 versus 25 mm, P = .005). Two conservative group cases showed increases in aneurysm size during follow-up. The hypertensive state showed essentially no change in either group during the follow-up. Renal function decreased with age similarly both in conservative and treatment groups. Conclusions Our conservative management criteria for RAA are justifiable and even too strict.
Reperfusion of ischemic organs induces a potent inflammatory response initiated by the generation of reactive oxygen species (ROS) that directly damage tissue and promote leukocyte infiltration and ...activation that also mediate tissue injury. We recently found that radiation-induced tissue injury, which is caused by radiation induced ROS, is attenuated by administration of CBLB502, a pharmacologically optimized derivative of the Toll-like receptor 5 (TLR5) agonist flagellin. Therefore, we tested the ability of CBLB502 to attenuate injury in a murine model of acute ischemic renal failure. CBLB502 given 30 minutes before imposition of bilateral renal pedicle occlusion provided marked protection against the renal dysfunction and inflammation that follows reperfusion of ischemic kidneys, including marked decreases in leukocyte infiltration, proinflammatory cytokine production, and tubular injury. Importantly, CBLB502 given within 30 minutes after ischemic kidney reperfusion reproduced the protective effects of pretreatment with the TLR5 agonist, indicating a window following reperfusion in which CBLB502 administration abrogates acute renal ischemic failure. Bone marrow reconstituted chimeras were used to show that the protective effects of CBLB502 could be delivered by intact MyD88 signaling on renal parenchymal cells. Consistent with this, antibody staining of kidney sections indicated that cells lining the renal vasculature expressed TLR5. Overall, these results indicate the use of TLR5 agonists as mitigators and protectants of acute renal ischemic failure.
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