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Mpratsiakou A, Papasotiriou M, Ntrinias T, Tsiotsios K, Papachristou E, Goumenos DS. Safety and Efficacy of Long-Term Administration of Dipeptidyl peptidase IV Inhibitors in Patients With New Onset Diabetes After Kidney Transplant. EXP CLIN TRANSPLANT 2021; 19:411-419. [PMID: 34053420 DOI: 10.6002/ect.2020.0519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The appearance of new onset diabetes is common after kidney transplant. Treatment options are limited because of renal function-related contraindications, interactions with immunosuppressive drugs, and side effects. We investigated the long-term safety and efficacy of dipeptidyl peptidase IV inhibitors in renal transplant recipients with new onset diabetes. MATERIALS AND METHODS We treated 12 patients with dipeptidyl peptidase IV inhibitors, and 5 patients received insulin monotherapy as initial treatment of new onset diabetes after kidney transplant. All patients were followed for 12 months after diagnosis. Glycosylated hemoglobin A1c, estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration equation), plasma immunosuppressive trough levels, serum lipids, blood pressure, and body weight were measured during outpatient visits. Effects of dipeptidyl peptidase IV inhibitors and insulin on the aforementioned parameters were measured to compare values at time of diagnosis versus mean values of the last 6 months of follow-up. RESULTS Patients were treated with linagliptin (4 patients), sitagliptin (4 patients), vildagliptin (2 patients), and alogliptin (2 patients). Patients had a mean age of 59.4 ± 12 years and a mean glycosylated hemoglobin A1c of 6.6% at diagnosis, which was decreased to 6.1% (P = .03) at 1 year of follow-up. Renal function remained stable, and plasma tacrolimus levels did not appear to be affected. No significant differences were shown in serum total, low-density lipoprotein, and high-density lipoprotein cholesterol levels aftertreatment. Nevertheless,triglyceride levels were significantly reduced (from 214.4 to 174.9 mg/dL; P = .0039). A decrease in body weight was also observed. Finally, patients treated with dipeptidyl peptidase V inhibitors achieved better glycosylated hemoglobin A1c levels than those treated with insulin. CONCLUSIONS Dipeptidyl peptidase IV inhibitors appear to be a safe, effective, and hypoglycemia-free option fortreatment of new onset diabetes in renaltransplant recipients and possibly provide better diabetes control than insulin therapy.
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Affiliation(s)
- Adamantia Mpratsiakou
- From the Department of Nephrology and Renal Transplantation, University Hospital of Patras, Patras, Greece
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Tarnowski M, Słuczanowska-Głabowska S, Pawlik A, Mazurek-Mochol M, Dembowska E. Genetic factors in pathogenesis of diabetes mellitus after kidney transplantation. Ther Clin Risk Manag 2017; 13:439-446. [PMID: 28435278 PMCID: PMC5388273 DOI: 10.2147/tcrm.s129327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Posttransplant diabetes mellitus (PTDM) is one of the major metabolic complications after transplantation of solid organs including the kidney. This type of diabetes mellitus affects allograft survival, cardiovascular complications and overall patient survival. The modifiable risk factors that contribute to PTDM include obesity, some viral infections (eg, hepatitis C virus, cytomegalovirus) and especially immunosuppressive drugs including corticosteroids, tacrolimus, cyclosporine and sirolimus. Currently, predisposing genetic factors have been considered important in PTDM development. The commonly evaluated genetic determinants include genes encoding transcription factors, cytokines, chemokines, adipokines, ionic channels, glucose transporters, cytochrome P450 enzymes and other enzymes metabolizing drugs, drug transporters. Unfortunately, the results of studies are inconclusive and differ between populations. There is a need for large genome-wide association study to identify the genetic risk factors associated with PTDM development.
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Affiliation(s)
| | | | | | | | - Elżbieta Dembowska
- Department of Periodontology, Pomeranian Medical University, Szczecin, Poland
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Szyguła-Jurkiewicz B, Zakliczyński M, Szczurek W, Skrzypek M, Gąsior M, Zembala M. Perioperative Risk Factors of Cardiac Allograft Vasculopathy in the Long-Term Follow-up. Transplant Proc 2016; 48:1736-41. [DOI: 10.1016/j.transproceed.2015.10.087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/03/2015] [Indexed: 10/21/2022]
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Bae J, Lee MJ, Choe EY, Jung CH, Wang HJ, Kim MS, Kim YS, Park JY, Kang ES. Effects of Dipeptidyl Peptidase-4 Inhibitors on Hyperglycemia and Blood Cyclosporine Levels in Renal Transplant Patients with Diabetes: A Pilot Study. Endocrinol Metab (Seoul) 2016; 31:161-7. [PMID: 26754588 PMCID: PMC4803553 DOI: 10.3803/enm.2016.31.1.161] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/08/2015] [Accepted: 11/30/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The use of dipeptidyl peptidase-4 (DPP-4) inhibitors is increasing among renal transplant patients with diabetes. However, the glucose-lowering efficacies of various DPP-4 inhibitors and their effects on blood cyclosporine levels have not been fully investigated. We compared the glucose-lowering efficacies of DPP 4 inhibitors and evaluate their effects on the blood levels of cyclosporine in renal transplant recipients with diabetes. METHODS Sixty-five renal allograft recipients who received treatment with DPP-4 inhibitors (vildagliptin, sitagliptin, or linagliptin) following kidney transplant were enrolled. The glucose-lowering efficacies of the DPP-4 inhibitors were compared according to the changes in the hemoglobin A1c (HbA1c) levels after 3 months of treatment. Changes in the trough levels of the cyclosporine were also assessed 2 months after treatment with each DPP-4 inhibitor. RESULTS HbA1c significantly decreased in the linagliptin group in comparison with other DPP-4 inhibitors (vildagliptin -0.38%±1.03%, sitagliptin -0.53%±0.95%, and linagliptin -1.40±1.34; P=0.016). Cyclosporine trough levels were significantly increased in the sitagliptin group compared with vildagliptin group (30.62±81.70 ng/mL vs. -24.22±53.54 ng/mL, P=0.036). Cyclosporine trough levels were minimally changed in patients with linagliptin. CONCLUSION Linagliptin demonstrates superior glucose-lowering efficacy and minimal effect on cyclosporine trough levels in comparison with other DPP-4 inhibitors in kidney transplant patients with diabetes.
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Affiliation(s)
- Jaehyun Bae
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Yeong Choe
- Division of Endocrinology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Jin Wang
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myoung Soo Kim
- Department of Transplantation Surgery, Yonsei University Health System, Seoul, Korea
| | - Yu Seun Kim
- Department of Transplantation Surgery, Yonsei University Health System, Seoul, Korea
| | - Joong Yeol Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea.
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Sever MS. Transplantation-steroid-impaired glucose metabolism: a hope for improvement? Nephrol Dial Transplant 2013; 29:479-82. [PMID: 24285429 DOI: 10.1093/ndt/gft478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zhang J, Takahashi HK, Liu K, Wake H, Liu R, Sadamori H, Matsuda H, Yagi T, Yoshino T, Mori S, Nishibori M. Histamine inhibits adhesion molecule expression in human monocytes, induced by advanced glycation end products, during the mixed lymphocyte reaction. Br J Pharmacol 2010; 160:1378-86. [PMID: 20590628 DOI: 10.1111/j.1476-5381.2010.00800.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND PURPOSE Post-transplant diabetes mellitus is a frequent complication among transplant recipients. Ligation of advanced glycation end products (AGEs) with their receptor on monocytes/macrophages plays important roles in the genesis of diabetic complications. The enhancement of adhesion molecule expression on monocytes/macrophages activates T-cells, reducing allograft survival. Out of four distinct AGE subtypes (AGE-2, AGE-3, AGE-4 and AGE-5), only AGE-2 and AGE-3 induced expression of intercellular adhesion molecules (ICAMs), output of cytokines and proliferation of lymphocytes, during the mixed lymphocyte reaction (MLR). Here we have assessed the role of histamine in the actions of AGEs during the MLR. EXPERIMENTAL APPROACH Human peripheral blood cells were used in these experiments. Flow cytometry was used to examine the expression of the ICAM-1, B7.1, B7.2 and CD40. Production of the cytokine interferon-gamma, and levels of cAMP were determined by elisa. Lymphocyte proliferation was determined by [(3)H]-thymidine uptake. KEY RESULTS Histamine concentration dependently inhibited the action of AGE-2 and AGE-3. The actions of histamine were antagonized by an H(2)-receptor antagonist, famotidine, and mimicked by H(2)/H(4)-receptor agonists, dimaprit and 4-methylhistamine. The effects of histamine were reversed by a protein kinase A (PKA) inhibitor, H89, and mimicked by dibutyryl cAMP and an adenylate cyclase activator, forskolin. CONCLUSIONS AND IMPLICATIONS Histamine down-regulated AGE-2- and AGE-3-induced expression of adhesion molecules, cytokine production and lymphocyte proliferation via histamine H(2) receptors and the cAMP/PKA pathway.
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Affiliation(s)
- J Zhang
- Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Advanced glycation end products enhance monocyte activation during human mixed lymphocyte reaction. Clin Immunol 2009; 134:345-53. [PMID: 19914138 DOI: 10.1016/j.clim.2009.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 10/16/2009] [Accepted: 10/20/2009] [Indexed: 11/24/2022]
Abstract
Posttransplant diabetes mellitus (PTDM) is a frequent complication among transplant recipients. Ligation of advanced glycation end products (AGEs) with their receptor (RAGE) on monocytes/macrophages plays roles in the diabetes complications. The enhancement of adhesion molecule expression on monocytes/macrophages activates T-cells, leading to reduced allograft survival. We investigated the effect of four distinct AGE subtypes (AGE-2/AGE-3/AGE-4/AGE-5) on the expressions of intracellular adhesion molecule (ICAM)-1, B7.1, B7.2 and CD40 on monocytes, the production of interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha and the proliferation of T-cells during human mixed lymphocyte reaction (MLR). AGE-2 and AGE-3 selectively induced the adhesion molecule expression, cytokine production and T-cell proliferation. The AGE-induced up-regulation of adhesion molecule expression was involved in the cytokine production and T-cell proliferation. AGE-2 and AGE-3 up-regulated the expression of RAGE on monocytes; therefore, the AGEs may activate monocytes, leading to the up-regulation of adhesion molecule expression, cytokine production and T-cell proliferation.
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Ganji MR, Charkhchian M, Hakemi M, Nederi GH, Solymanian T, Saddadi F, Amini M, Najafi I. Association of hyperglycemia on allograft function in the early period after renal transplantation. Transplant Proc 2007; 39:852-4. [PMID: 17524830 DOI: 10.1016/j.transproceed.2007.03.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hyperglycemia is common following renal transplantation. This study was conducted to evaluate the relationship of perioperative serum glucose levels and acute rejection in 100 nondiabetic patients who underwent renal transplantation. Blood glucose was measured immediately following surgery and every 6 hours during the first 48 hours posttransplant as well as for 1 month to evaluate occurrence of acute rejection episodes (ARE). The rate of ARE was 33%. The mean blood glucose level immediately after surgery in patients with versus without ARE was 249.67 +/- 61.78 and 184.82 +/- 73.35 mg/dL, respectively (P=.000). There was no significant correlation between ARE and donor or recipient age or sex, delayed graft function, type of donor, or treatment. This study suggested a correlation between immediate blood glucose and ARE. In this regard, blood glucose monitoring and control during operation and immediate postoperatively may reduce the acute rejection rate.
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Affiliation(s)
- M R Ganji
- Nephrology Department, Tehran University of Medical Sciences, Tehran, Iran.
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Chisholm MA, Spivey CA, Mulloy LL. Effects of a medication assistance program with medication therapy management on the health of renal transplant recipients. Am J Health Syst Pharm 2007; 64:1506-12. [PMID: 17617501 DOI: 10.2146/ajhp060634] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The effects of a medication assistance program with medication therapy management (MTM) on the clinical outcomes and health-related quality of life (HQOL) of renal transplant recipients were studied. METHODS All renal transplant recipients who were enrolled in the Medication Access Program at the Medical College of Georgia for at least one year were included in the study. Patients' demographics, number of graft rejections (for one year pre-enrollment and one year post-enrollment), and diagnoses of hypertension, diabetes, and dyslipidemia were recorded and confirmed by medical and pharmacy records. The use of antihypertensive, antidiabetic, antilipemic, and immunosuppressant agents and laboratory values for fasting blood glucose, glycosylated hemoglobin (HbA(1c)), blood pressure, low-density-lipoprotein (LDL) cholesterol, total cholesterol, triglycerides, and serum immunosuppressant concentrations were identified for one year pre-enrollment and one year post-enrollment. HQOL was measured at the time of enrollment and one year post-enrollment. RESULTS Thirty-six adult renal transplant recipients were included in the study. All patients had hypertension, 72% had dyslipidemia, and 42% had diabetes. Patients received significantly more antihypertensive agents post-enrollment versus pre-enrollment (p < 0.001) and significantly more antidiabetic agents (p = 0.004) and antilipemics (p = 0.001). Measures of fasting blood glucose, glycosylated hemoglobin, LDL cholesterol, total cholesterol, triglycerides, blood pressure, and number of graft rejections decreased from pre-enrollment levels (p < 0.01). A significantly greater number of patients reached target serum cyclosporine levels post-enrollment versus pre-enrollment (p = 0.008). HQOL was significantly increased one year post-enrollment (p < 0.01). CONCLUSION A medication assistance program that included MTM services improved medication access, clinical outcomes, and HQOL in renal transplant recipients.
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Affiliation(s)
- Marie A Chisholm
- Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ 85750, USA.
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Golightly LK, Jones MA, Hamamura DH, Stolpman NM, McDermott MT. Management of Diabetes Mellitus in Hospitalized Patients: Efficiency and Effectiveness of Sliding-Scale Insulin Therapy. Pharmacotherapy 2006; 26:1421-32. [PMID: 16999652 DOI: 10.1592/phco.26.10.1421] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVE To determine the efficiency and effectiveness of current prescribing practices relative to short- and intermediate-acting insulins in the prevention or treatment of acute hyperglycemic episodes in hospitalized patients with diabetes mellitus or hyperglycemia, and to identify clinical findings that influence the effectiveness of insulin therapy in these patients. DESIGN Retrospective observational study. SETTING University-affiliated hospital. PATIENTS Ninety consecutive adult inpatients who had orders placed for as-needed subcutaneous regular or lispro sliding-scale insulin. MEASUREMENTS AND MAIN RESULTS Medical records were reviewed for patients' clinical characteristics and responses to administered insulin that were recorded during each of the first 5 days of hospitalization in which sliding-scale insulin therapy was used. Despite the immediate or bedside availability of both computerized and manual means to record finger-stick blood glucose levels and insulin injections, uncertainties or missing information related to execution, timing, blood glucose levels, or insulin dose were present in approximately 30% of all anticipated points of care involving insulin. Ten episodes of hypoglycemia in six patients were associated with sliding-scale insulin. Appropriately timed, successive glucose measurements documented a decrement in elevated blood glucose values to within the target range of 90-130 mg/dl after 76 (12%) of 621 sliding-scale insulin injections. Glucose levels remained elevated, and insulin effects were therefore subtherapeutic after 523 injections (84%). Despite blood glucose levels that remained persistently elevated, corresponding adjustments in either the timing or the dose of insulin were made infrequently. Sliding-scale insulin regimens were never adjusted in 73 patients (81%). Through 5 days of therapy, the proportion of patients who attained good glycemic control ranged from 2-10% (mean 6%). The mode of overall glycemic control was poor, with 51-68% of patients in this category on any given day. Overall, treated diabetic and hyperglycemic patients were more likely to be poorly controlled than relatively well controlled. CONCLUSION Our findings reveal outcomes associated with sliding-scale insulin that are widely variable, often ineffectual, and prone to deficiencies in monitoring, documentation, and prescribing soundness. Efforts to improve glycemic control in hospitalized patients are clearly needed.
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Affiliation(s)
- Larry K Golightly
- Department of Pharmacy, University of Colorado Hospital, Denver, Colorado 80262, USA.
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Sezer S, Akgul A, Altunoglu A, Altinoglu A, Arat Z, Ozdemir FN, Haberal M. Posttransplant Diabetes Mellitus: Impact of Good Blood Glucose Regulation on Renal Transplant Recipient Outcome. Transplant Proc 2006; 38:533-6. [PMID: 16549167 DOI: 10.1016/j.transproceed.2005.12.106] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Posttransplant diabetes mellitus (PTDM) is a frequent complication among renal transplant recipients. This study sought to compare clinical outcomes of patients with PTDM who had strict glucose control with nondiabetic patients and to identify risk factors for atherosclerotic disease in both groups. We retrospectively examined 204 renal allograft recipients transplanted at our center between 1996 and 2002. Demographic features, dialysis and posttransplantation duration, smoking, body mass index, medications, comorbid diseases, number of HLA mismatches, and laboratory parameters including serum levels of creatinine, albumin, calcium, phosphorus, C-reactive protein, lipid parameters, and parathyroid hormone were analyzed as possible risk factors for atherosclerotic disease. Patients were followed for a mean of 59.7 +/- 23.6 months. PTDM was diagnosed according to the American Diabetic Association criteria or the need for an insulin/oral hypoglycemic agent. Twenty-six patients developed PTDM, and these patients had very good diabetes control. One patient with poorly regulated PTDM was excluded. Adverse events which were documented in 24 patients were more frequent among patients with PTDM. Mean age was found to be an independent risk factor for atherosclerotic disease, whereas PTDM was not. There were no differences regarding other atherosclerosis-related or other risk factors (including serum C-reactive protein levels and lipid profiles) between the groups. Nondiabetic subjects tended to have longer graft survival than patients with PTDM, but this finding was not statistically significant. PTDM is an important risk factor for developing atherosclerotic disease. Good control of blood glucose levels can decrease the high morbidity rates and negative influence of PTDM on patient and graft survival rates in this population.
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Affiliation(s)
- S Sezer
- Department of Nephrology, Baskent University School of Medicine, Ankara, Turkey.
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Koselj M, Rott T, Koselj MK, Hvala A, Arnol M, Kandus A. De novo diabetic nephropathy on renal allografts. Transplant Proc 2004; 35:2919-21. [PMID: 14697938 DOI: 10.1016/j.transproceed.2003.10.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posttransplant diabetes mellitus (PTDM) is a well-recognized clinical problem following renal transplantation. Long-term risks of PTDM are similar to those of diabetes mellitus in general population. The aim of our study was to identify de novo diabetic nephropathy (DN) in our group of patients with PTDM. METHODS Thirty-four patients with PTDM were reviewed retrospectively. Light microscopy, immunofluorescence, and electron microscopy techniques were performed in 10 of 21 patients with graft biopsy. RESULTS Five patients (four women, one man), aged 47.4 years (range, 29 to 58), four of whom received cadaveric grafts, were found to have de novo DN. Their serum creatinine was 211.4 micromol/L (range, 140 to 294). Three patients were slightly proteinuric (0.3 to 0.5 g/L). PTDM was diagnosed 2.4 months after transplantation (range, 1 to 6). Histologic diagnosis of de novo DN was made, on average, 52.6 months after transplantation (range, 8 to 115), and 50.2 months (range, 2 to 114) after PTDM. De novo DN presented as diffuse diabetic glomerulosclerosis in four patients and nodular diabetic sclerosis in one patient, and combined with transplant glomerulopathy in all five patients. The mean graft survival time for this group of patients was equivalent with a control group. Although the difference in slopes of serum creatinine between the studied groups was clinically relevant, it was not statistically significant. CONCLUSION In view of our findings, when histologic de novo DN was found in 5 out of 10 patients, one could conclude that de novo DN could be a frequent complication of PTDM.
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Affiliation(s)
- M Koselj
- Department of Endocrinology and Diabetes, University Medical Centre, Zaloska 7, Ljubljana, 1000 Slovenia.
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