We present a case of an immunocompromised patient with unusual presentation of herpes zoster infection. After having been treated with corticosteroids for several weeks, the patient developed the ...zoster infection with atypical clinical course and skin localization. Parenteral treatment with acyclovir for 10 days resulted in a complete clinical resolution of the skin lesions. Similar cases of unusual presentation of herpes zoster have been described in immunocompromised patients.
1
An obligatory step in the biosynthesis of endothelin‐1 (ET‐1) is the conversion of its inactive precursor, big ET‐1, into the mature form by the action of specific, phosphoramidon‐sensitive, ...endothelin converting enzyme(s) (ECE). Disparate effects of big ET‐1 and ET‐1 on renal tubule function suggest that big ET‐1 might directly influence renal tubule function. Therefore, the role of the enzymatic conversion of big ET‐1 into ET‐1 in eliciting the functional response (generation of 1,2‐diacylglycerol) to big ET‐1 was studied in the rat proximal tubules.
2
In renal cortical slices incubated with big ET‐1, pretreatment with phosphoramidon (an ECE inhibitor) reduced tissue immunoreactive ET‐1 to a level similar to that of cortical tissue not exposed to big ET‐1. This confirms the presence and effectiveness of ECE inhibition by phosphoramidon.
3
In freshly isolated proximal tubule cells, big ET‐1 stimulated the generation of 1,2‐diacylglycerol (DAG) in a time‐and dose‐dependent manner. Neither phosphoramidon nor chymostatin, a chymase inhibitor, influenced the generation of DAG evoked by big ET‐1.
4
Big ET‐1‐dependent synthesis of DAG was found in the brush‐border membrane. It was unaffected by BQ123, an ETA receptor antagonist, but was blocked by bosentan, an ETA B‐nonselective endothelin receptor antagonist.
5
These results suggest that the proximal tubule is a site for the direct effect of big ET‐1 in the rat kidney. The effect of big ET‐1 is confined to the brush‐border membrane of the proximal tubule, which may be the site of big ET‐1‐sensitive receptors.
Uporaba generičkih imunosupresijskih lijekova može smanjiti trošak transplantacije, iako je ukupan trošak vezan uz prevođenje bolesnika s originalnog na generički pripravak predmet trajnih rasprava s ...obzirom na potrebu učestalog praćenja bolesnika. Hrvatsko društvo za nefrologiju, arterijsku hipertenziju, dijalizu i transplantaciju osnovalo je radnu skupinu s ciljem donošenja preporuka za uporabu generičkih imunosupresiva nakon transplantacije bubrega. Imunosupresijski lijekovi pripadaju tzv. "lijekovima uske terapijske širine” s velikim varijacijama u serumskoj koncentraciji lijeka s obzirom na unos hrane i pića, druge lijekove, ali i funkciju jetre i bubrega. Nemogućnost održavanja odgovarajuće ravnoteže imunosupresije rezultira poremećajem funkcije presatka, ali ugrožava i život bolesnika. Podatci o terapijskoj ekvivalenciji različitih generičkih imunosupresiva su rijetki ili ih uopće nema. Radovi o toj temi se nedovoljno objavljuju. Postojanje velikog broja različitih generičkih oblika na tržištu nosi opasnost nekontroliranog prevođenja bolesnika s jednog na drugi oblik lijeka od strane ljekarnika ili liječnika obiteljske medicine, što može imati teške posljedice budući da generički lijekovi ne moraju biti međusobno bioekvivalentni, već se bioekvivalencija uspoređuje samo s originatorom. Hrvatsko društvo za nefrologiju, dijalizu i transplantaciju bubrega se ne protivi uporabi generičkih imunosupresiva, ali smatra da se smiju rabiti samo pod strogim nadzorom i uz indikaciju nefrologa koji se bave transplantacijskom medicinom. Potrebno je uložiti daljnje napore u edukaciju bolesnika, liječnika obiteljske medicine i ljekarnika kako bi se izbjegle neželjene pojave nekontrolirane uporabe imunosupresijskih lijekova.
Aim To investigate the effects of angiotensin-converting enzyme inhibitor
(cilazapril) and angiotensin II type I receptor antagonist (losartan) on
tubular and interstitial cell apoptosis and ...caspase-3 activity in rats with
obstructive nephropathy after unilateral ureteral obstruction.
Methods Rats with unilateral obstructive nephropathy and sham-operated
rats were treated with cilazapril, losartan, or the vehicle (water).
Tubular and interstitial cell apoptosis was detected morphologically on
hematoxylin and eosin-stained renal specimens and by the terminal deoxynucleotidyl
transferase-mediated nick end-labeling. Caspase-3 activity
in whole-kidney tissue homogenates was measured colorimetrically.
Results After unilateral ureter ligation, there was a significant increase in
the number of apoptotic tubular and interstitial cells in the obstructed
kidney (13.17 ± 8.73 vs. 3.00 ± 4.53 cells per high power field; P = 0.049
and 6.33 ± 3.27 vs 2.00 ± 2.35 cells per high power field; P = 0.036,
respectively, vs sham-operated rats, 10 days after ligation). In rats with
unilateral obstructive nephropathy, neither cilazapril nor losartan had an
effect on tubular cell apoptosis. However, cilazapril caused a significant
increase in the number of renal apoptotic interstitial cells (7.00 ± 9.74 vs
0.8 ± 1.41 cells per high power field, P = 0.019). Caspase-3 activity was
not significantly different in rats with unilateral obstructive nephropathy
than in sham-operated rats.
Conclusion Rats with unilateral obstructive nephropathy had increased
apoptosis of tubular and interstitial cells in comparison with sham-operated
rats. Neither cilazapril nor losartan had an effect on tubular cell
apoptosis, and cilazapril even increased interstitial cell apoptosis.
Dual Kidney Transplantation: Case Report Vidas, Željko; Kocman, Branislav; Knotek, Mladen ...
Collegium antropologicum,
06/2010, Volume:
34, Issue:
2
Web Resource
Open access
Chronic shortage of kidney transplants worldwide has led to the use of organs from so called marginal or borderline donors, now termed »expanded-criteria donors«. There has been an emerging practice ...of dual kidney transplantation (DKT) to compensate for sub optimal nephron mass of such kidneys. We performed DKT in »Merkur« University Hospital in August 2005. The donor was a 72-year old female with a history of long-term hypertension, aneurysm of the posterior cerebral artery, cerebrovascular insult (CVI), and with normal creatinine values and kidney function at the time of explantation. Initial biopsy of donor kidneys revealed acute tubular damage, with connective changes in 22% and 11% of glomeruli in the left and the right kidney, respectively.The recipient was a 60-year old male diagnosed with the IgA nephropathy on the last biopsy in 1999, and on dialysis since November 2003. Postoperative course was uneventful without any surgical complications. A triple immunosuppressive protocol was used. On follow-up ultrasonography 4 years posttransplantation both kidneys appeared of normal size and parenchymal pattern and with no signs of dilatation of the canal system, and color Doppler examination demonstrated normal flow in both kidneys. In conclusion, the use of DKT, ie. donors by the expanded-criteria will continue to increase, and further studies of the results will, with no doubt, support this method.
Polyomavirus virus associated nephropathy (PVAN) is an important cause of graft failure in the renal transplant population. The prevalence of PVAN has increased from 1% to 10% in the past decade, ...leading to loss of transplanted organ in 30% to 80% of cases. In the absence of specific antiviral drugs, early detection of disease and modification/reduction of immunosuppressive regimen is currently the cornerstone of therapy. In the setting of multiorgan transplantation, like simultaneous pancreas and kidney transplantation (SPKT), diagnosis and therapy of PVAN can be even more challenging problem. We report a first described case of PVAN in patient after SPKT in Croatia. Patient is a 32 years old Caucasian male with type 1 diabetes mellitus and end stage renal failure, diagnosed for PVAN 6 month after SPKT. Patient was treated with reduced immunosuppressive regimen. At 32 month follow up, patient has preserved kidney and pancreas function with estimated glomerular filtration (eGFR) rate of 91 mL/min and no signs of PVAN on his 2 year protocol kidney biopsy.
BK virus associated nephropathy (BKVAN) in transplanted kidney, although recognized as a distinct entity in the 1970-es, continues to represent a challenge in kidney transplantation, mainly because ...the optimal treatment approach has not been determined yet. The fact that about 10–20% of patients have simultaneously some stage of acute rejection, complicate the treatment even more. Herein we present a case of BK nephropathy in the patient, one year after combined liver and kidney transplantation, complicated by episode of acute T-cell mediated rejection. Identification of decoy cells by cytology urine exam in patient with acute kidney graft function deterioration, raised suspicion of BKVAN. Diagnosis has been made by histological examination and confirmed with immunohistochemical staining for BK virus in kidney graft biopsy. One month after he had been treated for BKVAN with intravenous immunoglobulin, leflunomide and overall immunosuppression therapy reduction, there was further deterioration of graft function due to an episode of acute T-cell mediated rejection (Banff classification IA). He received 500 mg of metilprednisolon intravenously and mycophenolate mofetil had been reintroduced, which resulted in slow partial recovery of the graft function, but never to the baseline values. For the past two years his renal graft function has been stable, maintaining lower levels of immunosupressive therapy. According to our knowledge this is the first documented case of BK virus associated nephropathy, diagnosed and confirmed with immunohistochemical staining of tissue from kidney biopsy in Croatia.
Childhood infection with polyomaviruses leads to a life-long latent infection of renal and urinary tract epithelia. Replication in the reno-urinary epithelium is associated with viral cytopathic ...changes such as nuclear inclusions and decoy cells. During the 2005-2009 period, cytological urine analysis was performed in 154 samples (94 male and 60 female) from patients with kidney transplantation (n=19), simultaneous pancreas-kidney transplantation (SPKT) (n=9) and simultaneous kidney and liver transplantation (n=2). Urine samples were analyzed monthly following transplantation according to the protocol. The period from transplantation to the first occurrence of decoy cells in the urine and the period of decoy cell persistence in the urine were assessed. The presence of decoy cells (<10 and >10 decoy cells) and red blood cells (<20 E, 20-100 E and >100 E) per cytospin smear was semiquantitatively determined, along with analysis of inflammatory cells (neutrophilic granulocytes) and fungi. In patients with decoy cells detected, their sensitivity, specificity, and negative and positive predictive value for BK virus nephropathy were calculated. Correlation of the study parameters was estimated by use of Kruskal-Wallis test (Statistica 7.1, StatSoft Inc., Tulsa, USA). Decoy cells were found in 30 patients (20 male and 10 female), age median 40 (range 16-69) years, at a mean of day 115 (range day 5–747) post transplantation, whereas their presence was recorded for a mean of 141 (range 77–771) days. Immunohistochemical staining of kidney biopsy sample for polyomavirus (SV40 large T-antigen) yielded positive reaction in 2/30 (7%) patients. Erythrocyturia was present in 29/30 patients with decoy cells. The number of decoy cells per cytospin smear generally ranged less than 10 in 25/30 patients, whereas more than 10 decoy cells per cytospin smear were only recorded in 5/30 patients. Immunohistochemistry produced positive finding for BK virus in one patient with SPKT and simultaneous kidney and liver transplantation each, which was statistically significantly more common as compared with patients with kidney transplantation alone (p=0.0244). Immunohistochemical positivity for BK virus was more significant in cases with more than 10 decoy cells detected in cytospin smear (p=0.013). In BK nephropathy, the finding of urinary decoy cells showed a 100% sensitivity, 84% specificity, 100% negative predictive value and 6% positive predictive value. BK virus nephropathy remains a significant post transplantation complication.
PDF
