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Zhang H, Yang L. Ureaplasma urealyticum infection following organ transplantation: a case report and narrative review. Ren Fail 2024; 46:2395466. [PMID: 39192626 PMCID: PMC11360648 DOI: 10.1080/0886022x.2024.2395466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 08/16/2024] [Accepted: 08/17/2024] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE One case of Ureaplasma urealyticum (UU) infection after kidney transplantation was reported, and relevant literature was collected to provide a scientific reference basis for clinical diagnosis and treatment. METHODS A case of UU infection after renal transplantation in our hospital was analyzed retrospectively. PubMed, Embase and Cochrane databases were searched for case reports of UU infection after organ transplantation before 30 June 2024. The clinical and laboratory characteristics, treatment and prognosis of UU infection were summarized and analyzed. RESULTS A 65-year-old man underwent renal transplantation on 26 January 2022 due to chronic renal disease (grade 2) caused by focal sclerosing glomerulonephritis. Hyperammonaemia and coma occurred after the operation, and the patient died. A total of 38 case reports or series of cases were included in this study, involving 44 patients. The case reports included 22 cases of kidney transplantation, 11 cases of lung transplantation, 4 cases of heart transplantation,1 case of liver transplantation and 6 cases of multiple organ transplantation. Ureaplasma urealyticum infection occurred in 74.47% of cases within 1 month after transplantation, and the main symptoms after the infection were mental. After the onset of the disease, the most abnormal examination index was the increase of blood ammonia, followed by the increase of white blood cells. Therapeutic drugs included tetracyclines (doxycycline or minocycline), quinolones and azithromycin. The clinical symptoms could be significantly improved after 24 h of taking the fastest-acting medication. The highest mortality rate was in patients infected with Ureaplasma after lung transplantation. CONCLUSION Early identification of UU and timely and correct drug treatment are essential to saving the lives of patients.
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Affiliation(s)
- Hongru Zhang
- Department of Pharmacy, ZhangJiakou First Hospital, Zhangjiakou, Hebei Province, China
| | - Liping Yang
- Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, China
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Alateeq NM, Mohammed MB, Alsubaie AT, Alshehri AA, Attallah D, Agabawi S, Thabit AK. Beyond urinalysis: evaluation of various clinical and laboratory reflex criteria to warrant urine culture collection in the emergency department. Int J Emerg Med 2024; 17:77. [PMID: 38926667 PMCID: PMC11201778 DOI: 10.1186/s12245-024-00656-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Clinical criteria are essential for diagnosing urinary tract infections (UTIs) followed by urine testing, including urinalysis (UA). No study has evaluated the potential related factors that may guide the appropriate collection of urine cultures. Therefore, we aimed to assess the factors that may guide the appropriate collection of urine cultures. METHODS This was a case-control study of patients for whom a urine culture and a UA were ordered in the emergency department (ED) between February 2018 and December 2022. The cases included patients with positive cultures, whereas the controls included patients without growth. Patients were excluded if they were pregnant, underwent any urological procedure, received antibiotics within 3 days before ED presentation, or before culture collection. RESULTS Of the 263 patients, 123 had growth and 140 did not have growth in urine cultures. In the univariate analysis, female gender, urinary symptoms, urinary white blood cell (WBC) count > 5 cells/hpf, and nitrite in urine were significantly associated with growth (P < 0.05). However, only female gender (aOR, 1.86; 95% CI, 1.06-3.24), urinary WBC count > 5 cells/hpf (aOR, 4.60; 95% CI, 2.21-9.59), and positive nitrite in urine (aOR, 21.90; 95% CI, 2.80-171.00) remained significant in the multivariable analysis. These factors also remained significant in the subgroup of patients with urinary symptoms, except for the female gender. CONCLUSION A high urinary WBC count and positive nitrite in UA should be utilized as a guide to collect urine culture, particularly in female patients, to limit the unnecessary ordering of urine culture in the ED. These factors can be used as evidence-based UA reflex criteria as an antimicrobial stewardship intervention.
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Affiliation(s)
- Nada M Alateeq
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd Jeddah, Jeddah, 22254-2265, Saudi Arabia
| | - Manal B Mohammed
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd Jeddah, Jeddah, 22254-2265, Saudi Arabia
| | - Albandari T Alsubaie
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd Jeddah, Jeddah, 22254-2265, Saudi Arabia
| | - Amal A Alshehri
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd Jeddah, Jeddah, 22254-2265, Saudi Arabia
| | - Dalya Attallah
- Department of Clinical and Molecular Microbiology Laboratory, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Salem Agabawi
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abrar K Thabit
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd Jeddah, Jeddah, 22254-2265, Saudi Arabia.
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Waldecker-Gall S, Waldecker CB, Babel N, Baraliakos X, Seibert F, Westhoff TH. Urinary calprotectin as a diagnostic tool for detecting significant bacteriuria. Sci Rep 2024; 14:12230. [PMID: 38806578 PMCID: PMC11133377 DOI: 10.1038/s41598-024-62605-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
Pyuria in dipstick examination serves as the most widespread screening tool for urinary tract infections (UTI). The absence of pyuria, however, does not exclude UTI. We investigated the diagnostic value of urinary calprotectin, a mediator protein of the innate immune system, which is released by leukocytes, for the detection of UTI and compared it with dipstick pyuria. Since even low numbers of leukocytes in the urine significantly increase urinary calprotectin concentrations, calprotectin might be a more sensitive marker than pyuria detected by dipstick. All 162 patients were prospectively included and underwent a urine dipstick, urine culture, quantification of proteinuria and determination of calprotectin in the urine. Urinary calprotectin was determined using an enzyme-linked immunosorbent assay (ELISA). UTI was defined as urine cultures with detection of one or a maximum of two uropathogenic bacteria with ≥ 105 colony-forming units per millilitre (CFU/ml). Exclusion criteria were acute kidney injury, chronic renal insufficiency and tumors of the urinary tract. 71 (43.8%) patients had a UTI. Of the 91 patients without UTI, 23 had a contamination and 19 had evidence of ≥ 105 CFU/ml considered to be asymptomatic bacteriuria. The median calprotectin concentration in patients with UTI and pyuria was significantly higher than in patients with UTI and without pyuria (5510.4 vs. 544.7 ng/ml). In ROC analyses, calprotectin revealed an area under the curve (AUC) of 0.70 for the detection of significant bacteriuria. Pyuria in dipstick examinations provided an AUC of 0.71. There was no significant difference between these AUCs in the DeLong test (p = 0.9). In patients with evidence of significant bacteriuria but without pyuria, a significantly higher calprotectin concentration was measured in the urine than in patients with neither pyuria nor UTI (544.7 ng/ml vs 95.6 ng/ml, p = 0.029). Urinary calprotectin is non-inferior to dipstick pyuria in the detection of UTI.
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Affiliation(s)
| | | | - Nina Babel
- Center for Translational Medicine, University Hospital Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | | | - Felix Seibert
- Medical Department 1, University Hospital Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Timm H Westhoff
- Medical Department 1, University Hospital Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany.
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Torres-Gutiérrez M, Burgos-Camacho V, Caamaño-Jaraba JP, Lozano-Suárez N, García-López A, Girón-Luque F. Prevalence and Modifiable Factors for Holistic Non-Adherence in Renal Transplant Patients: A Cross-Sectional Study. Patient Prefer Adherence 2023; 17:2201-2213. [PMID: 37701427 PMCID: PMC10493132 DOI: 10.2147/ppa.s419324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/12/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction In renal transplant recipients, compliance with medical therapy is vital. Non-adherence is considered a risk factor for worst outcomes in kidney recipients, with attributed outcomes of 64% for graft loss and 80% for late acute rejection. Most literature defines adherence as self-based immunosuppression compliance but does not consider other relevant factors such as consult and procedure compliance. Therefore, this study aims to describe adherence prevalence in kidney transplant recipients and the factors related to non-adherence. Methods This cross-sectional study included 1030 renal transplant patients followed by Colombiana de Trasplantes between January 2019 and July 2021. Sociodemographic and clinical variables were obtained based on clinical records. The mental-health group diagnosed holistic adherence in a semi-structured interview. The diagnosis considered medication intake failure, frequency and number of failures to medical controls or other procedures, suspicious non-adherence behaviors, and serum levels of immunosuppressants. A bivariate followed a descriptive analysis, and a forward logistic regression was performed for non-adherence. Results Patients had a median of 47 years, and 58.1% were male. Non-adherence was presented in 30.7% of patients. The non-adherence patients were younger, with a higher prevalence of males, single, divided transplant care, had a longer time after transplantation, psychopathological diagnosis, and more reinforcement education by only nursing. Older age and multidisciplinary reinforcement education were protective factors. On the other hand, poor social support, psychopathology diagnosis, and longer time after transplant presented as non-adherence risk factors. Conclusion Holistic non-adherence was diagnosed in approximately one-third of renal transplant recipients. Its definition included more than just medication non-compliance and could identify more non-adherent patients. Notably, there is a need to consider the related factors in the health follow-up and encourage future research in modifiable factor interventions aiming to increase adherence and achieve better outcomes for renal transplant patients.
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Affiliation(s)
| | | | | | | | - Andrea García-López
- Department of Transplant Research, Colombiana de Trasplantes, Bogotá, Colombia
| | - Fernando Girón-Luque
- Department of Transplant Research, Colombiana de Trasplantes, Bogotá, Colombia
- Department of Transplant Surgery, Colombiana de Trasplantes, Bogotá, Colombia
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Hammer N, Legouis D, Pasch A, Huber A, Al-Qusairi L, Martin PY, de Seigneux S, Berchtold L. Calcification Propensity (T50) Predicts a Rapid Decline of Renal Function in Kidney Transplant Recipients. J Clin Med 2023; 12:3965. [PMID: 37373661 DOI: 10.3390/jcm12123965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Serum creatinine level, proteinuria, and interstitial fibrosis are predictive of renal prognosis. Fractional excretion of phosphate (FEP)/FGF23 ratio, tubular reabsorption of phosphate (TRP), serum calcification propensity (T50), and Klotho's serum level are emerging as determinants of poor kidney outcomes in CKD patients. We aimed at analysing the use of FGF23, FEP/FGF23, TRP, T50, and Klotho in predicting the rapid decline of renal function in kidney allograft recipients. METHODS We included 103 kidney allograft recipients in a retrospective study with a prospective follow-up of 4 years. We analysed the predictive values of FGF23, FEP/FGF23, TRP, T50, and Klotho for a rapid decline of renal function defined as a drop of eGFR > 30%. RESULTS During a follow-up of 4 years, 23 patients displayed a rapid decline of renal function. Tertile of FGF23 (p value = 0.17), FEP/FGF23 (p value = 0.78), TRP (p value = 0.62) and Klotho (p value = 0.31) were not associated with an increased risk of rapid decline of renal function in kidney transplant recipients. The lower tertile of T50 was significantly associated with eGFR decline >30% with a hazard ratio of 3.86 (p = 0.048) and remained significant in multivariable analysis. CONCLUSION T50 showed a strong association with a rapid decline of renal function in kidney allograft patients. This study underlines its role as an independent biomarker of loss of kidney function. We found no association between other phosphocalcic markers, such as FGF23, FEP/FGF23, TRP and Klotho, with a rapid decline of renal function in kidney allograft recipients.
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Affiliation(s)
| | - David Legouis
- Division of Intensive Care, University Hospital of Geneva, 1205 Geneva, Switzerland
| | - Andreas Pasch
- Calciscon AG, 2503 Biel, Switzerland
- Department of Physiology and Pathophysiology, Johannes Kepler University, 4040 Linz, Austria
| | - Aurélie Huber
- Service of Internal Medicine, Hospital La Chaux-de-Fonds, 2000 Neuchatel, Switzerland
| | - Lama Al-Qusairi
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA
| | - Pierre-Yves Martin
- Service of Nephrology, Department of Internal Medicine Specialties, University Hospital of Geneva, 1205 Geneva, Switzerland
| | - Sophie de Seigneux
- Service of Nephrology, Department of Internal Medicine Specialties, University Hospital of Geneva, 1205 Geneva, Switzerland
| | - Lena Berchtold
- Service of Nephrology, Department of Internal Medicine Specialties, University Hospital of Geneva, 1205 Geneva, Switzerland
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Yuksel Y, Tekin I, Erbis H, Yuksel D, Sarier M, Yanıkoglu A, Yavuz HA, Demirbas A. A Single-Center Experience With Kidney Transplantation in Patients Who Had Low Left Ventricular Ejection Fraction. EXP CLIN TRANSPLANT 2023. [PMID: 36656127 DOI: 10.6002/ect.2022.0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Left ventricular hypertrophy is one of the most typical cardiac abnormalities detected in patients with end-stage renal disease. In patients with congestive heart failure, the most crucial factor determining patient survival is left ventricular ejection fraction. Herein, we present our experience with living donor kidney transplant recipients with a left ventricular ejection fraction of <50%. MATERIALS AND METHODS Patients who underwent living donor kidney transplant in our center between November 2008 and November 2021 and had pretransplant left ventricular ejection fraction <50% were included. All patients had dialysis the day before surgery. All patients underwent 2-dimensional echocardiograms after dialysis and were categorized according to New York Heart Association classification, pretransplant and on posttransplant day 5. Demographic parameters and additional data, including pretransplant and posttransplant day 5 New York Heart Association classification, left ventricular ejection fraction at 6 months, and graft survival at 6 months, as well as patient survival data, were analyzed. RESULTS Our study included 31 patients (mean age of 46.6 ± 18.3; range, 11-77 years). We found significant differences in New York Heart Association classifications before and after transplant, indicating that kidney transplant had a positive effect on pretransplant congestive heart failure in patients with low left ventricular ejection fraction (P = .001). The mean pretransplant left ventricular ejection fraction was 32 ± 9.9% (range, 1%-45%), whereas the mean 6-month posttransplant left ventricular ejection fraction was 52 ± 8.7% (range, 28%-63%) (P < .001). Both graft loss and all-cause mortality rates were 12.9%. CONCLUSIONS Low left ventricular ejection fraction is not a contraindication for kidney transplant. We suggest that myocardial scintigraphy should be performed in patients with end-stage renal disease and low left ventricular ejection fraction, and kidney transplant should be considered in those without ischemic findings.
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Affiliation(s)
- Yucel Yuksel
- From the Department of General Surgery and Transplantation, Sanko University, Gaziantep, Turkey
- From the Health Sciences Institute, Molecular Oncology, Istinye University, Istanbul, Turkey
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Mu Y, Li JJ, Wu X, Zhou XF, Tang L, Zhou Q. Cefoperazone-sulbactam and ornidazole for Gardnerella vaginalis bloodstream infection after cesarean section: A case report. World J Clin Cases 2022; 10:9323-9331. [PMID: 36159406 PMCID: PMC9477693 DOI: 10.12998/wjcc.v10.i26.9323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/23/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gardnerella vaginalis (G. vaginalis) is a facultative anaerobic bacteria known to cause bloodstream infections. However, cases are very rare in clinics. There is very limited clinical experience in the treatment of bloodstream infections caused by G. vaginalis. Therefore, there is an urgent need for effective antibacterial drugs to treat patients with bloodstream infections caused by G. vaginalis.
CASE SUMMARY A woman who underwent a cesarean section presented with a sudden onset of high fever 1-d post-surgery. The blood cultures suggested an infection due to G. vaginalis, and treatment with cefoperazone-sulbactam was started. After 5 d of treatment, there was a decrease in the hemogram; however, the temperature and C-reactive protein levels remained high. Based on clinical experience and a review of literature, the treatment was modified to include ornidazole in combination with cefoperazone-sulbactam. Following a week of treatment, the temperature, hemogram and C-reactive protein levels returned to normal, and blood cultures turned negative, suggesting a therapeutic effect of the combination treatment.
CONCLUSION This case highlighted the effective use of cefoperazone-sulbactam combined with ornidazole for bloodstream infection caused by G. vaginalis following a cesarean section.
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Affiliation(s)
- Yu Mu
- National Clinical Pharmacist Training Base, The Affiliated Suzhou Hospital, Nanjing Medical University/Suzhou Municipal Hospital, Suzhou 215002, Jiangsu Province, China
- Department of Pharmacy, Xuzhou Maternity and Child Health Hospital/Affiliated Xuzhou Maternity and Child Health Hospital, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
| | - Jing-Jing Li
- Department of Pharmacy, The Affiliated Suzhou Hospital, Nanjing Medical University/Suzhou Municipal Hospital, Suzhou 215002, Jiangsu Province, China
| | - Xiao Wu
- Department of Obstetrics, The Affiliated Suzhou Hospital, Nanjing Medical University/Suzhou Municipal Hospital, Suzhou 215002, Jiangsu Province, China
| | - Xin-Fang Zhou
- Department of Obstetrics, The Affiliated Suzhou Hospital, Nanjing Medical University/Suzhou Municipal Hospital, Suzhou 215002, Jiangsu Province, China
| | - Lian Tang
- Department of Pharmacy, The Affiliated Suzhou Hospital, Nanjing Medical University/Suzhou Municipal Hospital, Suzhou 215002, Jiangsu Province, China
| | - Qin Zhou
- Department of Pharmacy, The Affiliated Suzhou Hospital, Nanjing Medical University/Suzhou Municipal Hospital, Suzhou 215002, Jiangsu Province, China
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Wongtanasarasin W, Phinyo P. Emergency department visits and hospital admissions in kidney transplant recipients during the COVID-19 pandemic: A hospital-based study. World J Transplant 2022; 12:250-258. [PMID: 36159077 PMCID: PMC9453295 DOI: 10.5500/wjt.v12.i8.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/27/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several studies have demonstrated that the coronavirus disease 2019 (COVID-19) has affected daily living and the healthcare system. No previous study has described the consequences of COVID-19 on emergency department (ED) visits and hospital admission among kidney transplant (KT) recipients. AIM To investigate the impact of the COVID-19 pandemic on ED visits and hospital admissions within 1 year in patients who underwent KT in Thailand. METHODS We conducted a retrospective study at a university hospital in Thailand. We reviewed the hospital records of KT patients who visited the ED during the outbreak of COVID-19 (from January 2020 to December 2021). We used the previous 2 years as the control period in the analysis. We obtained baseline demographics and ED visit characteristics for each KT patient. The outcomes of interest were ED visits and ED visits leading to hospital admission within the 1st year following a KT. The rate of ED visits and ED visits leading to hospital admissions between the two periods were compared using the stratified Cox proportional hazards model. RESULTS A total of 263 patients were included in this study: 112 during the COVID-19 period and 151 during the control period. There were 34 and 41 ED visits after KT in the COVID-19 and control periods, respectively. The rate of first ED visit at 1 year was not significantly different in the COVID-19 period, compared with the control period [hazard ratio (HR) = 1.02, 95% confidence interval (CI): 0.54-1.92; P = 0.96]. The hospital admission rate was similar between periods (HR = 0.92, 95%CI: 0.50-1.69; P = 0.78). CONCLUSION ED visits and hospital admissions within the 1st year in KT recipients were not affected by the COVID-19 pandemic. Despite these findings, we believe that communication between post-KT patients and healthcare providers is essential to highlight the importance of prompt ED visits for acute health conditions, particularly in post-KT patients.
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Affiliation(s)
- Wachira Wongtanasarasin
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, United States
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Chen X, Chen S, Li Z, Pan X, Jia Y, Hu Z, Niu K, Liu B, Ren Q. Correlation of Body Mass Index with Clinicopathologic Parameters in Patients with Idiopathic Membranous Nephropathy. Diabetes Metab Syndr Obes 2022; 15:1897-1909. [PMID: 35757192 PMCID: PMC9231685 DOI: 10.2147/dmso.s366100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/12/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the association between body mass index (BMI) and clinicopathologic parameters in patients with idiopathic membranous nephropathy (IMN). METHODS This study was retrospective and included patients with biopsy-proven IMN from 2018 to 2021 in Hebei General Hospital. Patients were categorized into two groups based on BMI. Clinical and histopathologic data were analyzed at the time of renal biopsy. Pathological data included immunofluorescence staining, glomerulosclerosis (GS, 0-2), mesangial cell proliferation (MCP, 0-1), tubular atrophy (TA, 0-1), interstitial fibrosis (IF, 0-1), vascular wall thickness (VWT, 0-1) and a combination score (GMTIV) graded from 0 to 5. RESULTS Our study revealed that the obese group had a higher prevalence of hypertension and diabetes than the overweight/normal weight group (P=0.001, P=0.002). Systolic blood pressure (P=0.005), diastolic blood pressure (P<0.001), haemoglobin (P=0.006), triglycerides (P<0.001), serum uric acid (P=0.05), 24 h urine proteinuria concentration (UP) (P=0.012), MCP (P=0.042), IF (P=0.033), and GMITV (P=0.033) score were higher in obese group compared to the other group, while the high-density lipoprotein-cholesterol (P=0.034) and immunoglobulin A deposition score (P=0.005) were lower. Factors significantly associated with UP were the ratio of lymphocyte count to white blood cell count, serum pre-albumin, immunoglobulin G, microscopic hematuria, anti-phospholipase A2 receptor (anti-PLA2R), C3 deposit on multivariable analysis (adjusted R 2=0.343). Binary logistic regression analysis illustrated that MCP was correlated to BMI (OR=2.528, P=0.036). Ordinal logistic regression analysis demonstrated that GMTIV was associated with BMI (OR=1.114, P=0.010) and C3 deposit (OR=1.655, P=0.001). CONCLUSION High BMI was associated with MCP and GMTIV score in IMN patients. Obesity may play an essential role in mesangial lesions of IMN. This study emphasized the relation between BMI and histological parameters under the universal usage of anti-PLA2R antibodies for diagnosis and prognosis in IMN.
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Affiliation(s)
- Xing Chen
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Shuchun Chen
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, People’s Republic of China
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Correspondence: Shuchun Chen, Department of Endocrinology, Hebei General Hospital, 348 Heping West Road, Shijiazhuang, Hebei, 050051, People’s Republic of China, Tel/Fax +86 311 85988406, Email
| | - Zelin Li
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Xiaoyu Pan
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Yujiao Jia
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, People’s Republic of China
| | - Zhijuan Hu
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Kai Niu
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Bing Liu
- Department of Nephrology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Qingjuan Ren
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, People’s Republic of China
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Wang X, Zu Q, Lu J, Zhang L, Zhu Q, Sun X, Dong J. Effects of Donor-Recipient Age Difference in Renal Transplantation, an Investigation on Renal Function and Fluid Proteome. Clin Interv Aging 2021; 16:1457-1470. [PMID: 34349505 PMCID: PMC8326938 DOI: 10.2147/cia.s314587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/06/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Our previous study revealed that a young internal environment ameliorated kidney aging by virtue of an animal model of heterochronic parabiosis and a model of heterochronic renal transplantation. In this research, we used proteome to investigate the effects of donor-recipient age difference in clinical renal transplantation. Methods This study included 10 pairs of renal transplantation donors and recipients with an age difference of greater than 20 years to their corresponding recipients/donors. All recipients have received transplantation more than 3 years ago. Renal function and the serum/urine proteomes of the donors and recipients were analyzed. Results The renal function was similar between the young recipients and the old donors. In contrast, the renal function of the young donors was significantly superior to that of the old recipients. Furthermore, 497 and 975 proteins were identified in the serum and urine proteomes, respectively. The content of SLC3A2 in the blood was found to be related to aging, while the contents of SERPINA1 and SERPINA3 in the urine were related to immune functions after renal transplantation. Conclusion This study demonstrated that, in the human body, a younger internal environment could ameliorate kidney aging and provided not only clinical evidence for increasing the age limit of kidney transplant donors but also new information for kidney aging research.
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Affiliation(s)
- Xinning Wang
- Department of Urology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Qiang Zu
- Department of Urology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jinshan Lu
- Department of Urology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Lei Zhang
- Department of Urology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Qiang Zhu
- Department of Urology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xuefeng Sun
- Department of Nephrology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jun Dong
- Department of Urology, Chinese PLA General Hospital, Beijing, People's Republic of China
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Ozturk SA, Yuksel Y, Erbis H, Aliosmanoglu I, Sarier M, Yayar O, Yavuz HA, Demirbas A. Laparoscopic Live Donor Nephrectomy: Experience of High-Volume Center with 2,477 Cases. Urol Int 2020; 105:100-107. [PMID: 33207353 DOI: 10.1159/000511377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Donors' health and safety are mandatory in the living-donor kidney transplantation procedure. Laparoscopic live donor nephrectomy (LLDN) provides an increase in donor numbers with its benefits and becomes a standard of care. We aimed to explain the results, complication rates, tips, and tricks of the largest number of LLDN case series ever performed in the literature. MATERIALS AND METHODS Between August 2012 and December 2019, 2,477 live donor case files were analyzed retrospectively. Age, gender, hospitalization times, body mass index, warm ischemia times, operation times, numbers of arteries, side of the kidneys, and complications were noted. RESULTS 1,421 (57.4%) of 2,477 donors were female (p = 0.007). Operation times and warm ischemia times were found longer in right-sided LLDN and donors with multiple renal arteries (p = 0.046, <0.001, and <0.001, respectively). Obesity (BMI >30 kg/m2) did not affect warm ischemia times while prolonging the operation times (p = 0.013). Hospitalization times and numbers of complications were higher in obese donors. CONCLUSIONS LLDN seems to be a reliable solution with fewer complications and higher satisfaction rates. We hope to illuminate the way with tips and trick points for beginner transplant surgeons based on the experience obtained from 2,477 LLDN cases.
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Affiliation(s)
- Sefa Alperen Ozturk
- Department of Urology, Suleyman Demirel University School of Medicine, Isparta, Turkey,
| | - Yucel Yuksel
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - Halil Erbis
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - Ibrahim Aliosmanoglu
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - Mehmet Sarier
- Department of Urology, Istinye University Medical Faculty, Istanbul, Turkey
| | - Ozlem Yayar
- Department of Nephrology and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - Havva Asuman Yavuz
- Department of Nephrology and Transplantation, Medical Park Hospital, Antalya, Turkey
| | - Alper Demirbas
- Department of General Surgery and Transplantation, Medical Park Hospital, Antalya, Turkey
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Zhou Y, Yang G, Liu H, Chen Y, Li X, Ge J, Wang X, Niu H, Dong W, Jiang T, Shi H, Peng L, Liu L. A Noninvasive and Donor-independent Method Simultaneously Monitors Rejection and Infection in Patients With Organ Transplant. Transplant Proc 2019; 51:1699-1705. [PMID: 31399160 DOI: 10.1016/j.transproceed.2019.04.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/17/2019] [Accepted: 04/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rejection and infection are 2 major complications affecting the health and survival of patients receiving an allograft organ transplantation. We describe a diagnostic assay that simultaneously monitors for rejection and infection in recipients of kidney transplant by sequencing of cell-free DNA (cfDNA) in plasma. METHODS By using cfDNA in plasma, we established a noninvasive method that simultaneously monitors rejection and infection in patients with a history of organ transplant. A total of 6200 single-nucleotide polymorphisms were captured by liquid hybridization and sequenced by next-generation sequencing. The donor-derived cfDNA (ddcfDNA) level was calculated based on maximum likelihood estimation, without relying on the donor's genotype. We also analyzed the nonhuman cfDNA to test for infections in the patients' plasma. RESULTS Artificial ddcfDNA levels quantified by a donor-dependent and donor-independent algorithm were significantly correlated, with the multivariate coefficient of determination, or R2 value, of 0.999. This technique was applied on 30 patients (32 samples) after kidney transplantation, and a significant difference was observed on the ddcfdNA levels between nonrejection and rejection. Furthermore, 1 BK virus infection and 1 cytomegalovirus infection were revealed by this method, and the enrichment efficiency of the viral sequences was 114 and 489 times, respectively, which are consistent with clinical results. CONCLUSION This method can be used to simultaneously monitor for acute rejection as well as a broad spectrum of infections for patients of allograft organ transplant because it provides comprehensive information for clinicians to optimize immunosuppression therapy.
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Affiliation(s)
- Yang Zhou
- Institute of Life Sciences, Jiangsu University, Zhenjiang, China
| | - Gongda Yang
- Institute of Life Sciences, Jiangsu University, Zhenjiang, China
| | - Haitao Liu
- Institute of Life Sciences, Jiangsu University, Zhenjiang, China
| | - Yawen Chen
- Institute of Life Sciences, Jiangsu University, Zhenjiang, China
| | - Xiaofeng Li
- Institute of Life Sciences, Jiangsu University, Zhenjiang, China
| | - Jun Ge
- Institute of Life Sciences, Jiangsu University, Zhenjiang, China; AlloDx Biotech Co, Ltd, Suzhou, China
| | - Xiaochen Wang
- Institute of Life Sciences, Jiangsu University, Zhenjiang, China
| | | | | | | | - Haifeng Shi
- Institute of Life Sciences, Jiangsu University, Zhenjiang, China
| | - Longkai Peng
- Department of Urological Organ Transplantation, Center of Organ Transplantation, Second Xiangya Hospital, Central South University, Changsha, China
| | - Lei Liu
- Department of Urological Organ Transplantation, Center of Organ Transplantation, Second Xiangya Hospital, Central South University, Changsha, China.
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Yuksel Y, Yuksel D, Yucetin L, Erbis H, Sarier M, Karatas O, Emek M, Erdogan M, Yavuz A, Demirbas A. Use of Tacrolimus During Pregnancy After Kidney Transplantaion. Transplant Proc 2019; 51:2361-2366. [DOI: 10.1016/j.transproceed.2019.01.150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/31/2019] [Indexed: 11/24/2022]
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