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Kotwal N, Bansal N, Muthukrishnan J, Verma V. Transplant endocrinology. Med J Armed Forces India 2023; 79:651-656. [PMID: 37981924 PMCID: PMC10654368 DOI: 10.1016/j.mjafi.2023.08.017] [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: 07/30/2023] [Accepted: 08/27/2023] [Indexed: 11/21/2023] Open
Abstract
Solid organ transplants and stem cell transplants are becoming more common but a significant proportion of patients are still on waiting lists, awaiting transplants. When endocrinologists treat transplant recipients who have underlying endocrine problems, which might include endocrine emergencies, there are special clinical care considerations to be aware of. The stage of the transplant (pre-transplant, early post-transplant, and chronic post-transplant) must be taken into account. Additionally, it's crucial to be knowledgeable about immunosuppressive medications, their typical adverse effects and drug interactions. The review article addresses a number of endocrine and metabolic abnormalities that are reported after transplantation.
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Affiliation(s)
- Narendra Kotwal
- Director & Commandant, Armed Forces Medical College, Pune, India
| | - Naresh Bansal
- Senior Adviser (Medicine) & Endocrinologist, Command Hospital (Southern Command), Pune, India
| | - J. Muthukrishnan
- Professor & Head, Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Vishesh Verma
- Professor, Department of Internal Medicine, Armed Forces Medical College, Pune, India
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Molinari P, Regalia A, Leoni A, Campise M, Cresseri D, Cicero E, Vettoretti S, Nardelli L, Brigati E, Favi E, Messa P, Castellano G, Alfieri CM. Impact of hyperparathyroidism and its different subtypes on long term graft outcome: a single Transplant Center cohort study. Front Med (Lausanne) 2023; 10:1221086. [PMID: 37636567 PMCID: PMC10449540 DOI: 10.3389/fmed.2023.1221086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose We studied the association between parathormone (PTH) levels and long-term graft loss in RTx patients (RTx-p). Methods We retrospectively evaluated 871 RTx-p, transplanted in our unit from Jan-2004 to Dec-2020 assessing renal function and mineral metabolism parameters at 1, 6, and 12 months after RTx. Graft loss and death with functioning graft during follow-up (FU, 8.3[5.4-11.4] years) were checked. Results At month-1, 79% had HPT, of which 63% with secondary HPT (SHPT) and 16% tertiary HPT (THPT); at month-6, HPT prevalence was 80% of which SHPT 64% and THPT 16%; at month-12 HPT prevalence was 77% of which SHPT 62% and THPT 15%. A strong significant correlation was found between HPT type, PTH levels and graft loss at every time point. Mean PTH exposure remained strongly and independently associated to long term graft loss (OR 3.1 [1.4-7.1], p = 0.008). THPT was independently associated with graft loss at month-1 when compared to HPT absence and at every time point when compared to SHPT. No correlation was found with RTx-p death. Discriminatory analyses identified the best mean PTH cut-off to predict long-term graft loss to be between 88.6 and 89.9 pg/mL (AUC = 0.658). Cox regression analyses highlighted that THPT was strongly associated with shorter long-term graft survival at every time-point considered. Conclusion High PTH levels during 1st year of RTx seem to be associated with long term graft loss.
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Affiliation(s)
- Paolo Molinari
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Post-Graduate School of Specialization in Nephrology, University of Milano, Milan, Italy
| | - Anna Regalia
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alessandro Leoni
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Mariarosaria Campise
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Donata Cresseri
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Elisa Cicero
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Post-Graduate School of Specialization in Nephrology, University of Milano, Milan, Italy
| | - Simone Vettoretti
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Luca Nardelli
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Emilietta Brigati
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Evaldo Favi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Piergiorgio Messa
- Department of Nephrology, Dialysis and Kidney Transplants, IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Giuseppe Castellano
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo M. Alfieri
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Demir C, Dursun AD, Sarıyıldız GT, Arslan Aİ. Serum irisin levels and osteoporosis in patients with advanced chronic kidney disease and renal transplant recipients. Int Urol Nephrol 2023:10.1007/s11255-023-03475-7. [PMID: 36773217 DOI: 10.1007/s11255-023-03475-7] [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: 07/07/2022] [Accepted: 01/18/2023] [Indexed: 02/12/2023]
Abstract
AIM To elucidate the association of serum irisin levels with bone mineral density (BMD) and calcium-phosphorus metabolism parameters in chronic kidney disease (CKD) patients and renal transplant recipients (RTRs). METHODS This is a cross-sectional study involving CKD patients and RTRs. Healthy volunteers served as controls. Age, gender, and dialysis vintage were recorded. Serum irisin, creatinine, glucose, calcium, albumin, 25(OH) vitamin D, ferritin, C-reactive protein, A1C, and lipid profile were studied in all participants. Estimated glomerular filtration rate (eGFR), corrected calcium, and body mass index (BMI) were calculated. RESULTS Overall, 49 patients (23 hemodialysis, 26 RTRs) and 25 control subjects were included. In hemodialysis (HD) group, 8 patients (34.8%) had osteoporosis, and 12 patients (52.2%) had osteopenia. In RTR group, 3 patients (11.5%) had osteoporosis, while 15 patients (57.7%) had osteopenia. Among controls, one had osteoporosis, and 7 had osteopenia. There was no significant difference between HD and RTRs; however, osteoporosis rate was significantly lower in control subjects. BMD measurements (femur and lumbar T- and Z-scores) were comparable between HD and RTR groups. Control group DEXA values were similar to RTRs; however, they were significantly higher compared to HD group. 25(OH) vitamin D levels were comparable between the HD and RTR groups, and these were significantly lower compared to values of the control group. Mean serum irisin level was 426.6 ± 191.2 pg/mL in hemodialysis group, 342.6 ± 174.8 in the RTR group, and 208.0 ± 186.1 in controls. Serum irisin levels were similar in RTR and HD groups, but their values were significantly higher compared to controls. When we compared serum irisin levels between patients with and without osteoporosis in the whole cohort and hemodialysis and RTR groups, there was no difference. Serum irisin was positively correlated with lumbar T-score both in hemodialysis and RTR groups. CONCLUSION Our study is the first in the literature revealing the positive correlation of serum irisin level with femur T-score in RTRs. Serum irisin level was also positively correlated with femur T-scores in hemodialysis patients.
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Affiliation(s)
- Canan Demir
- Department of Endocrinology and Metabolism, Atılım Üniversitesi Tıp Fakültesi, Kızılcaşarİncek Gölbaşı, 06830, Ankara, Turkey.
| | - Ali Doğan Dursun
- Department of Physiology, Medical School, Atilim University, and Vocational School of Health Services, Atilim University, Ankara, Turkey
| | - Gülçin Türkmen Sarıyıldız
- Department of General Surgery, Medicana International Ankara Hospital, and Operating Room Services, Vocational School of Health Services, Atılım University, Ankara, Turkey
| | - Aykut İlker Arslan
- Department of Medical Laboratory, Vocational School of Health Services, Atılım University, Medicana International Ankara Hospital, Ankara, Turkey
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Alubaidi G, Humadi Y, Hamoodi D, Mahdi H, Anid B, Jasim IA, Abdalfatah IM. Serum Interleukin-6 is associated with hypocalcemia, hypoferritinemia and hyperkalemia in end-stage renal disease patients. ITALIAN JOURNAL OF MEDICINE 2023. [DOI: 10.4081/itjm.2022.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Both of chronic inflammation and mineral disturbance are major concerns in patients with chronic kidney disease, particularly end-stage renal disease (ESRD). Objectives: The present study aimed to investigate the association between circulating IL-6 and minerals dysregulation in patients diagnosed with ESRF and on a continuous hemodialysis regimen. Methods: This cross-sectional study included 74 patients undergoing continuous hemodialysis. Serum samples were tested for IL-6 using an enzyme-linked immunosorbent assay. Mineral were analyzed using an electrolyte analyzer and biochemical tests. Parameter correlations were analyzed using the Pearson’s correlation test. Results: Among the studies group, the male: female ratio was 1:0.72. IL-6 mean value was 13.77 pg/ml ±9.79 SD. IL-6 was significantly negatively correlated with circulating iron and calcium levels (r= - 0.229, P= 0.049; r= -0.252, P= 0.03, respectively). IL-6 was significantly positively correlated with K+ levels (r= 0.269,P= 0.02). Conclusion: The present study highlighted the substantial role of IL-6 in mineral dysregulation in hemodialysis patients, highlighting this cytokine as a potential therapeutic target for minimizing and monitoring the clinical effects of mineral disturbances, including cardiovascular and neurological complications.
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Boissier R, Rodriguez-Faba O, Zakri RH, Hevia V, Budde K, Figueiredo A, García EL, Olsburgh J, Regele H, Yuan CY, Breda A. Evaluation of the Effectiveness of Interventions on Nephrolithiasis in Transplanted Kidney. Eur Urol Focus 2022:S2405-4569(22)00278-4. [PMID: 36567234 DOI: 10.1016/j.euf.2022.11.019] [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: 06/18/2022] [Revised: 08/08/2022] [Accepted: 11/16/2022] [Indexed: 12/25/2022]
Abstract
CONTEXT De Novo nephrolithiasis in renal transplant can have severe consequences since renal transplantation involves a single functioning kidney with medical and anatomical specificities (heterotopic transplantation on iliac vessels, immunosuppressive treatments, and comorbidities). OBJECTIVE To systematically review all available evidence on the prevalence of de novo nephrolithiasis in renal transplant, presentation, and stone characteristics, and to report in a meta-analysis the efficacy of stone treatments (extracorporeal shock wave lithotripsy [ESWL], medical treatment, percutaneous nephrolithotomy [PCNL], open surgery, and ureteroscopy). EVIDENCE ACQUISITION Medline, Embase, and the Cochrane Library were searched up to November 2021 for all relevant publications reporting the management of de novo nephrolithiasis in renal allografts. The primary outcome was stone-free rate (SFR) at 3 mo. Secondary outcomes included prevalence, stone characteristics (size, density, and composition), symptoms on presentation, need for drainage, complications, and recurrence. Data were narratively synthesized in light of methodological and clinical heterogeneity, and a meta-analysis was performed for SFR. The risk of bias of each included study was assessed. EVIDENCE SYNTHESIS We included 37 retrospective studies with 553 patients and 612 procedures; of the 612 procedures 20 were antegrade ureteroscopy, 154 retrograde ureteroscopy, 118 PCNL, 25 open surgery, 155 ESWL, and 140 surveillance/medical treatment. The prevalence of nephrolithiasis in renal transplant was 1.0%. The mean stone size on diagnosis was 11 mm (2-50). The overall SFR at 3 mo was 82%: 96% with open surgery, 95% with antegrade ureteroscopy, 86% with PCNL, 81% with retrograde ureteroscopy, and 75% with ESWL. CONCLUSIONS De novo nephrolithiasis in renal transplant is an infrequent condition. A high SFR were obtained with an antegrade approach (ureteroscopy, PCNL, and open approach) that should be considered in renal transplant patients owing to the heterotopic position of the renal graft. The choice of technique was correlated with stone size: generally ureteroscopy and ESWL for stones 11-12 mm (mean stone size) versus PCNL and open surgery for 17-25 mm stones. PATIENT SUMMARY De novo nephrolithiasis in renal transplants is an infrequent situation that can have severe consequences on the function of the renal graft. We evaluated the efficacy of each treatment and noted that antegrade approaches (open surgery, percutaneous nephrolithotomy, and antegrade ureteroscopy) were associated with the highest stone-free rate. As opposed to the management of nephrolithiasis in native kidney, an antegrade approach should be considered more in renal transplant patients.
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Affiliation(s)
- Romain Boissier
- Aix-Marseille University, Marseille, France; Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, France
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain
| | - Rhana Hassan Zakri
- Department of Urology & Renal Transplantation Guy's and St Thomas' Hospital, London, UK
| | - Vital Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
| | - Klemens Budde
- Department of Nephrology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Arnaldo Figueiredo
- Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal
| | - Enrique Lledó García
- Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jonathon Olsburgh
- Department of Urology & Renal Transplantation Guy's and St Thomas' Hospital, London, UK
| | - Heinz Regele
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Cathy Yuhong Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, Ontario, Canada
| | - Alberto Breda
- Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain.
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Leal R, Pardinhas C, Martinho A, Sá HO, Figueiredo A, Alves R. Challenges in the Management of the Patient with a Failing Kidney Graft: A Narrative Review. J Clin Med 2022; 11:jcm11206108. [PMID: 36294429 PMCID: PMC9605319 DOI: 10.3390/jcm11206108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
Patients with a failed kidney allograft have steadily increase in recent years and returning to dialysis after graft loss is one of the most difficult transitions for chronic kidney disease patients and their assistant physicians. The management of these patients is complex and encompasses the treatment of chronic kidney disease complications, dialysis restart and access planning, immunosuppression withdrawal, graft nephrectomy, and evaluation for a potential retransplant. In recent years, several groups have focused on the management of the patient with a failing renal graft and expert recommendations are arising. A review of Pubmed, ScienceDirect and the Cochrane Library was performed focusing on the specific care of these patients, from the management of low clearance complications to concerns with a subsequent kidney transplant. Conclusion: There is a growing interest in the failing renal graft and new approaches to improve these patients’ outcomes are being defined including specific multidisciplinary programs, individualized immunosuppression withdrawal schemes, and strategies to prevent HLA sensitization and increase retransplant rates.
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Affiliation(s)
- Rita Leal
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Correspondence: ; Tel.: +351-239-400400
| | - Clara Pardinhas
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, 3000-548 Coimbra, Portugal
| | - António Martinho
- Coimbra Histocompatibility Center, Portuguese Institute of Blood and Transplantation, 3041-861 Coimbra, Portugal
| | - Helena Oliveira Sá
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Arnaldo Figueiredo
- Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Urology and Kidney Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, 3000-548 Coimbra, Portugal
| | - Rui Alves
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, 3000-548 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
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