1
|
Cuesta C, Fuentes-Calvo I, Sancho-Martinez SM, Valentijn FA, Düwel A, Hidalgo-Thomas OA, Agüeros-Blanco C, Benito-Hernández A, Ramos-Barron MA, Gómez-Alamillo C, Arias M, Nguyen TQ, Goldschmeding R, Martínez-Salgado C, López-Hernández FJ. Urinary KIM-1 Correlates with the Subclinical Sequelae of Tubular Damage Persisting after the Apparent Functional Recovery from Intrinsic Acute Kidney Injury. Biomedicines 2022; 10:1106. [PMID: 35625842 PMCID: PMC9139078 DOI: 10.3390/biomedicines10051106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/29/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
Acute kidney injury (AKI) poses an increased risk factor for new AKI episodes, progression to chronic kidney disease, and death. A worsened evolution has been linked to an incomplete renal repair beyond the apparent functional recovery based on plasma creatinine (pCr) normalization. However, structural sequelae pass largely unnoticed due to the absence of specific diagnostic tools. The urinary kidney injury molecule 1 (KIM-1) participates in renal tissue damage and repair and is proposed as a biomarker of early and subclinical AKI. Thus, we study in this paper the evolution of KIM-1 urinary excretion alongside renal tissue sequelae after an intrinsic AKI episode induced by cisplatin in Wistar rats. Creatinine clearance, pCr, proteinuria and the fractional excretion of Na+ and glucose were used to monitor renal function. Renal tissue damage was blindly scored in kidney specimens stained with hematoxylin-eosin and periodic acid-Schiff. KIM-1 urinary excretion and renal mRNA expression were also assessed. Finally, we analyzed urinary KIM-1 in patients apparently recovered from AKI. Our results show that, after the normalization of the standard markers of glomerular filtration and tubular function, the extent of persistent histological findings of tissue repair correlates with the renal expression and urinary level of KIM-1 in rats. In addition, KIM-1 is also elevated in the urine of a significant fraction of patients apparently recovered from an AKI. Besides its potential utility in the early and subclinical diagnosis of renal damage, this study suggests a new application of urinary KIM-1 in the non-invasive follow-up of renal repair after AKI.
Collapse
Affiliation(s)
- Cristina Cuesta
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.C.); (I.F.-C.); (S.M.S.-M.); (A.D.); (O.A.H.-T.)
- Translational Research on Renal and Cardiovascular Diseases (TRECARD)-REDINREN (ISCIII), Departamento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Isabel Fuentes-Calvo
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.C.); (I.F.-C.); (S.M.S.-M.); (A.D.); (O.A.H.-T.)
- Translational Research on Renal and Cardiovascular Diseases (TRECARD)-REDINREN (ISCIII), Departamento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Sandra M. Sancho-Martinez
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.C.); (I.F.-C.); (S.M.S.-M.); (A.D.); (O.A.H.-T.)
- Translational Research on Renal and Cardiovascular Diseases (TRECARD)-REDINREN (ISCIII), Departamento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Floris A. Valentijn
- Department of Pathology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands; (F.A.V.); (T.Q.N.); (R.G.)
| | - Annette Düwel
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.C.); (I.F.-C.); (S.M.S.-M.); (A.D.); (O.A.H.-T.)
- Translational Research on Renal and Cardiovascular Diseases (TRECARD)-REDINREN (ISCIII), Departamento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Omar A. Hidalgo-Thomas
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.C.); (I.F.-C.); (S.M.S.-M.); (A.D.); (O.A.H.-T.)
- Translational Research on Renal and Cardiovascular Diseases (TRECARD)-REDINREN (ISCIII), Departamento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Consuelo Agüeros-Blanco
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), 39011 Santander, Spain; (C.A.-B.); (A.B.-H.); (M.A.R.-B.); (C.G.-A.); (M.A.)
| | - Adalberto Benito-Hernández
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), 39011 Santander, Spain; (C.A.-B.); (A.B.-H.); (M.A.R.-B.); (C.G.-A.); (M.A.)
| | - María A. Ramos-Barron
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), 39011 Santander, Spain; (C.A.-B.); (A.B.-H.); (M.A.R.-B.); (C.G.-A.); (M.A.)
| | - Carlos Gómez-Alamillo
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), 39011 Santander, Spain; (C.A.-B.); (A.B.-H.); (M.A.R.-B.); (C.G.-A.); (M.A.)
| | - Manuel Arias
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), 39011 Santander, Spain; (C.A.-B.); (A.B.-H.); (M.A.R.-B.); (C.G.-A.); (M.A.)
| | - Tri Q. Nguyen
- Department of Pathology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands; (F.A.V.); (T.Q.N.); (R.G.)
| | - Roel Goldschmeding
- Department of Pathology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands; (F.A.V.); (T.Q.N.); (R.G.)
| | - Carlos Martínez-Salgado
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.C.); (I.F.-C.); (S.M.S.-M.); (A.D.); (O.A.H.-T.)
- Translational Research on Renal and Cardiovascular Diseases (TRECARD)-REDINREN (ISCIII), Departamento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
| | - Francisco J. López-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain; (C.C.); (I.F.-C.); (S.M.S.-M.); (A.D.); (O.A.H.-T.)
- Translational Research on Renal and Cardiovascular Diseases (TRECARD)-REDINREN (ISCIII), Departamento de Fisiología y Farmacología, Universidad de Salamanca, 37007 Salamanca, Spain
| |
Collapse
|
2
|
Paniagua-Sancho M, Quiros Y, Casanova AG, Blanco-Gozalo V, Agüeros-Blanco C, Benito-Hernández A, Ramos-Barron MA, Gómez-Alamillo C, Arias M, Sancho-Martínez SM, López-Hernández FJ. Urinary Plasminogen Activator Inhibitor-1: A Biomarker of Acute Tubular Injury. Am J Nephrol 2021; 52:714-724. [PMID: 34518454 DOI: 10.1159/000518455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) is a threatening, multiaetiological syndrome encompassing a variety of forms and damage patterns. AKI lacks sufficiently specific diagnostic tools to evaluate the distinct combination of pathophysiological events underlying each case, which limits personalized and optimized handling. Therefore, a pathophysiological diagnosis based on new urinary biomarkers is sought for practical (readiness and noninvasiveness) and conceptual reasons, as the urine is a direct product of the kidneys. However, biomarkers found in the urine may also have extrarenal origin, thus conveying pathophysiological information from other organs or tissues. Urinary plasminogen activator inhibitor-1 (PAI-1) has been associated to AKI, although its origin and traffic to the urine are not known. METHODS Herein, we studied the blood or renal origin of urinary PAI-1 (uPAI-1) in experimental AKI in Wistar rats, by means of the in situ renal perfusion method. For this purpose, urine was collected while the kidneys of rats with AKI showing increased uPAI-1 excretion, and controls, were in situ perfused with a saline solution. RESULTS Our results show that during perfusion, PAI-1 remained in the urine of AKI rats, suggesting that renal cells shed this protein directly to the urine. PAI-1 is also significantly increased in the urine of AKI patients. Its low correlation with other urinary markers such as NGAL or NAG suggests that PAI-1 provides complementary and distinct phenotypical information. CONCLUSION In conclusion, uPAI-1 is a biomarker produced by damaged kidneys following AKI, whose precise pathophysiological meaning in AKI needs to be further investigated.
Collapse
Affiliation(s)
- María Paniagua-Sancho
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Yaremi Quiros
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| | - Alfredo G Casanova
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Víctor Blanco-Gozalo
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Consuelo Agüeros-Blanco
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Adalberto Benito-Hernández
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - María A Ramos-Barron
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Carlos Gómez-Alamillo
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Manuel Arias
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Sandra M Sancho-Martínez
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain
- Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco J López-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain
- Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
- Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
- Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain
- Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
3
|
Martin-Lorenzo M, Ramos-Barron A, Gutierrez-Garcia P, Martin-Blazquez A, Santiago-Hernandez A, Calabia ER, Gómez-Alamillo C, Alvarez-Llamas G. High urine concentration of spermidine predicts and associates with in-hospital acute kidney injury after cardiac surgery. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
4
|
Sancho-Martínez SM, Sánchez-Juanes F, Blanco-Gozalo V, Fontecha-Barriuso M, Prieto-García L, Fuentes-Calvo I, González-Buitrago JM, Morales AI, Martínez-Salgado C, Ramos-Barron MA, Gómez-Alamillo C, Arias M, López-Novoa JM, López-Hernández FJ. Urinary TCP1-eta: A Cortical Damage Marker for the Pathophysiological Diagnosis and Prognosis of Acute Kidney Injury. Toxicol Sci 2021; 174:3-15. [PMID: 31825490 DOI: 10.1093/toxsci/kfz242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Acute kidney injury (AKI) is a serious syndrome with increasing incidence and health consequences, and high mortality rate among critically ill patients. Acute kidney injury lacks a unified definition, has ambiguous semantic boundaries, and relies on defective diagnosis. This, in part, is due to the absence of biomarkers substratifying AKI patients into pathophysiological categories based on which prognosis can be assigned and clinical treatment differentiated. For instance, AKI involving acute tubular necrosis (ATN) is expected to have a worse prognosis than prerenal, purely hemodynamic AKI. However, no biomarker has been unambiguously associated with tubular cell death or is able to provide etiological distinction. We used a cell-based system to identify TCP1-eta in the culture medium as a noninvasive marker of damaged renal tubular cells. In rat models of AKI, TCP1-eta was increased in the urine co-relating with renal cortical tubule damage. When kidneys from ATN rats were perfused in situ with Krebs-dextran solution, a portion of the urinary TCP1-eta protein content excreted into urine disappeared, and another portion remained within the urine. These results indicated that TCP1-eta was secreted by tubule cells and was not fully reabsorbed by the damaged tubules, both effects contributing to the increased urinary excretion. Urinary TCP1-eta is found in many etiologically heterogeneous AKI patients, and is statistically higher in patients partially recovered from severe AKI. In conclusion, urinary TCP1-eta poses a potential, substratifying biomarker of renal cortical damage associated with bad prognosis.
Collapse
Affiliation(s)
- Sandra M Sancho-Martínez
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Sánchez-Juanes
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| | - Víctor Blanco-Gozalo
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Miguel Fontecha-Barriuso
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Prieto-García
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| | - Isabel Fuentes-Calvo
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| | - José M González-Buitrago
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| | - Ana I Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Martínez-Salgado
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| | - María A Ramos-Barron
- Department of Nephrology, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carlos Gómez-Alamillo
- Department of Nephrology, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Manuel Arias
- Department of Nephrology, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - José M López-Novoa
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Francisco J López-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| |
Collapse
|
5
|
Blanco-Gozalo V, Casanova AG, Sancho-Martínez SM, Prieto M, Quiros Y, Morales AI, Martínez-Salgado C, Agüeros-Blanco C, Benito-Hernández A, Ramos-Barron MA, Gómez-Alamillo C, Arias M, López-Hernández FJ. Combined use of GM2AP and TCP1-eta urinary levels predicts recovery from intrinsic acute kidney injury. Sci Rep 2020; 10:11599. [PMID: 32665654 PMCID: PMC7360779 DOI: 10.1038/s41598-020-68398-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/15/2020] [Indexed: 12/21/2022] Open
Abstract
Deficient recovery from acute kidney injury (AKI) has immediate and long-term health, clinical and economic consequences. Pre-emptive recovery estimation may improve nephrology referral, optimize decision making, enrollment in trials, and provide key information for subsequent clinical handling and follow-up. For this purpose, new biomarkers are needed that predict outcome during the AKI episode. We hypothesized that damage pattern-specific biomarkers are expected to more closely associate to outcome within distinct subpopulations (i.e. those affected by specific pathological processes determining a specific outcome), as biomarker pleiotropy (i.e. associated to phenomena unrelated to AKI) introduced by unselected, heterogeneous populations may blur statistics. A panel of urinary biomarkers was measured in patients with AKI and their capacity to associate to normal or abnormal recovery was studied in the whole cohort or after sub-classification by AKI etiology, namely pre-renal and intrinsic AKI. A combination of urinary GM2AP and TCP1-eta best associates with recovery from AKI, specifically within the sub-population of renal AKI patients. This two-step strategy generates a multidimensional space in which patients with specific characteristics (i.e. renal AKI patients with good or bad prognosis) can be identified based on a collection of biomarkers working serially, applying pathophysiology-driven criteria to estimate AKI recovery, to facilitate pre-emptive and personalized handling.
Collapse
Affiliation(s)
- Víctor Blanco-Gozalo
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Alfredo G Casanova
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Instituto de Estudios de Ciencias de La Salud de Castilla y León (IECSCYL), Soria, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Sandra M Sancho-Martínez
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Prieto
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Yaremi Quiros
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Instituto de Estudios de Ciencias de La Salud de Castilla y León (IECSCYL), Soria, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Ana I Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Martínez-Salgado
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Instituto de Estudios de Ciencias de La Salud de Castilla y León (IECSCYL), Soria, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Consuelo Agüeros-Blanco
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Adalberto Benito-Hernández
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - María A Ramos-Barron
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Carlos Gómez-Alamillo
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Manuel Arias
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Francisco J López-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain. .,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain. .,Instituto de Estudios de Ciencias de La Salud de Castilla y León (IECSCYL), Soria, Spain. .,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain. .,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain. .,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
6
|
González-Guerrero C, Morgado-Pascual JL, Cannata-Ortiz P, Ramos-Barron MA, Gómez-Alamillo C, Arias M, Mezzano S, Egido J, Ruiz-Ortega M, Ortiz A, Ramos AM. CCL20 blockade increases the severity of nephrotoxic folic acid-induced acute kidney injury. J Pathol 2018; 246:191-204. [PMID: 29984403 DOI: 10.1002/path.5132] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/11/2018] [Accepted: 06/22/2018] [Indexed: 01/19/2023]
Abstract
The chemokine CCL20 activates the CCR6 receptor and has been implicated in the pathogenesis of glomerular injury. However, it is unknown whether it contributes to acute kidney injury (AKI). We identified CCL20 as upregulated in a systems biology strategy combining transcriptomics of kidney tissue from experimental toxic folic acid-induced AKI and from stressed cultured tubular cells and have explored the expression and function of CCL20 in experimental and clinical AKI. CCL20 upregulation was confirmed in three models of kidney injury induced by a folic acid overdose, cisplatin or unilateral ureteral obstruction. In injured kidneys, CCL20 was expressed by tubular, endothelial, and interstitial cells, and was also upregulated in human kidneys with AKI. Urinary CCL20 was increased in human AKI and was associated with severity. The function of CCL20 in nephrotoxic folic acid-induced AKI was assessed by using neutralising anti-CCL20 antibodies or CCR6-deficient mice. CCL20/CCR6 targeting increased the severity of kidney failure and mortality. This was associated with more severe histological injury, nephrocalcinosis, capillary rarefaction, and fibrosis, as well as higher expression of tubular injury-associated genes. Surprisingly, mice with CCL20 blockade had a lower tubular proliferative response and a higher number of cells in the G2/M phase, suggesting impaired repair mechanisms. This may be related to a lower influx of Tregs, despite a milder inflammatory response in terms of chemokine expression and infiltration by IL-17+ cells and neutrophils. In conclusion, CCL20 has a nephroprotective role during AKI, both by decreasing tissue injury and by facilitating repair. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Cristian González-Guerrero
- Laboratory of Nephrology, IIS-Fundación Jiménez Díaz, School of Medicine, UAM, Madrid, Spain.,Red de Investigación Renal (REDINREN)
| | | | - Pablo Cannata-Ortiz
- Pathology, IIS-Fundación Jiménez Díaz, School of Medicine, UAM, Madrid, Spain
| | - María Angeles Ramos-Barron
- Nephrology Investigation Unit, University Hospital Marqués de Valdecilla, IDIVAL (Instituto de Investigacion Valdecilla), Santander, Spain
| | - Carlos Gómez-Alamillo
- Red de Investigación Renal (REDINREN).,Nephrology Investigation Unit, University Hospital Marqués de Valdecilla, IDIVAL (Instituto de Investigacion Valdecilla), Santander, Spain
| | - Manuel Arias
- Red de Investigación Renal (REDINREN).,Nephrology Investigation Unit, University Hospital Marqués de Valdecilla, IDIVAL (Instituto de Investigacion Valdecilla), Santander, Spain
| | - Sergio Mezzano
- Division of Nephrology, School of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - Jesús Egido
- IIS-Fundación Jiménez Díaz, School of Medicine, UAM, Madrid, Spain.,Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Spain
| | - Marta Ruiz-Ortega
- Red de Investigación Renal (REDINREN).,Cellular Biology in Renal Diseases Laboratory. School of Medicine, UAM, Madrid, Spain
| | - Alberto Ortiz
- Laboratory of Nephrology, IIS-Fundación Jiménez Díaz, School of Medicine, UAM, Madrid, Spain.,Red de Investigación Renal (REDINREN)
| | - Adrián M Ramos
- Laboratory of Nephrology, IIS-Fundación Jiménez Díaz, School of Medicine, UAM, Madrid, Spain.,Red de Investigación Renal (REDINREN)
| |
Collapse
|
7
|
Pescador M, Ramos M, Arias M, Gómez-Alamillo C, Sánchez-Barba M, Quiros Y, Blanco-Gozalo V, Pieto M, Vicente-Vicente L, Casanova A, López-Hernández F, Morales A. Biomarkers for the prediction of acute kidney injury: Is canonical biplot analyses a useful tool? Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Fernández-Ruiz M, Arias M, Campistol JM, Navarro D, Gómez-Huertas E, Gómez-Márquez G, Díaz JM, Hernández D, Bernal-Blanco G, Cofan F, Jimeno L, Franco-Esteve A, González E, Moreso FJ, Gómez-Alamillo C, Mendiluce A, Luna-Huerta E, Aguado JM. Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice. Transpl Int 2015; 28:1042-54. [DOI: 10.1111/tri.12586] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/17/2014] [Accepted: 04/07/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Mario Fernández-Ruiz
- Unit of Infectious Diseases; Hospital Universitario “12 de Octubre”; Instituto de Investigación Hospital “12 de Octubre” (i+12); Madrid Spain
| | - Manuel Arias
- Department of Nephrology; Hospital Universitario “Marqués de Valdecilla”; Instituto de Formación e Investigación “Marqués de Valdecilla” (IFIMAV); Santander Spain
| | - Josep M. Campistol
- Department of Nephrology; Hospital Clinic; Institut d'Investigacions Biomèdiques “August Pi i Sunyer” (IDIBAPS); Barcelona Spain
| | - David Navarro
- Department of Microbiology; Hospital Clínico Universitario; Instituto de Investigación Sanitaria INCLIVA; University of Valencia; Valencia Spain
| | | | - Gonzalo Gómez-Márquez
- Department of Nephrology; Hospital Universitario Son Espases; Palma de Mallorca Spain
| | | | - Domingo Hernández
- Department of Nephrology; Hospital Universitario “Carlos Haya”; Málaga Spain
| | - Gabriel Bernal-Blanco
- Department of Nephrology; Hospital Universitario “Virgen del Rocío”; Instituto de Biomedicina de Sevilla (IBIS); Sevilla Spain
| | - Frederic Cofan
- Department of Nephrology; Hospital Clinic; Institut d'Investigacions Biomèdiques “August Pi i Sunyer” (IDIBAPS); Barcelona Spain
| | - Luisa Jimeno
- Department of Nephrology; Hospital Universitario “Virgen de la Arrixaca”; El Palmar; Murcia Spain
| | | | - Esther González
- Department of Nephrology; Hospital Universitario “12 de Octubre”; Instituto de Investigación Hospital “12 de Octubre” (i+12); Madrid Spain
| | - Francesc J. Moreso
- Department of Nephrology; Hospital Universitari Vall d'Hebron; Barcelona Spain
| | - Carlos Gómez-Alamillo
- Department of Nephrology; Hospital Universitario “Marqués de Valdecilla”; Instituto de Formación e Investigación “Marqués de Valdecilla” (IFIMAV); Santander Spain
| | - Alicia Mendiluce
- Department of Nephrology; Hospital Clínico Universitario; Valladolid Spain
| | - Enrique Luna-Huerta
- Department of Nephrology; Hospital Universitario “Infanta Cristina”; Badajoz Spain
| | - José María Aguado
- Unit of Infectious Diseases; Hospital Universitario “12 de Octubre”; Instituto de Investigación Hospital “12 de Octubre” (i+12); Madrid Spain
| | | |
Collapse
|
9
|
Ruiz San Millán JC, López-Hoyos M, Segundo DS, Quintela E, Rodrigo E, Gómez-Alamillo C, Romón I, Arias M. Predictive factors of allosensitization in renal transplant patients switched from calcineurin to mTOR inhibitors. Transpl Int 2014; 27:847-56. [PMID: 24707885 DOI: 10.1111/tri.12334] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/18/2013] [Accepted: 04/04/2014] [Indexed: 11/30/2022]
Abstract
Conversion of kidney-transplant recipients from calcineurin inhibitors to mTOR inhibitors has been suggested to be a risk factor for increased alloimmune response. We have analyzed the development of new HLA-antibodies (HLA-Abs) early after conversion in 184 patients converted in stable phase at our hospital and compared with a control group of nonconverted comparable 63 transplants. Using single-antigen solid-phase immunoassay analysis, a preconversion and a 3-6 months postconversion sera were prospectively analyzed in every patient for the appearance of new HLA-Abs. Renal function at 2 years postconversion and cumulative graft survival were compared between groups. In 16 patients, new HLA-Abs (3-DSA and 13-NonDSA), not present at the moment of conversion, were detected (8.7% vs. 3.1% in the control group). The type of mTORi used, type of CNI preconversion, the presence of steroids, time of conversion, or indication for conversion did not have influence on this effect but the presence of HLA-Abs before conversion highly correlated with the appearance of new specificities. Patients with de novo HLA-Abs showed a trend to worst graft function and survival. In conclusion, conversion to mTORi can be followed by early appearance of de novo HLA-Abs, especially in patients with HLA-Abs preconversion, and this complication should be screened early after conversion.
Collapse
Affiliation(s)
- Juan Carlos Ruiz San Millán
- Nephrology Department, Hospital Universitario Marqués de Valdecilla-IFIMAV, Universidad de Cantabria, Santander, Spain
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Arias M, Fernández-Fresnedo G, Gago M, Rodrigo E, Gómez-Alamillo C, Toyos C, Allende N. Clinical characteristics of resistant hypertension in renal transplant patients. Nephrol Dial Transplant 2013; 27 Suppl 4:iv36-8. [PMID: 23258809 DOI: 10.1093/ndt/gfs481] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Hypertension is a prevalent complication that occurs in 80-85% of all kidney transplant recipients. The pathogenesis of post-transplant hypertension is multifactorial and includes pre-transplant hypertension, donor hypertension, renin secretion from the native kidney, graft dysfunction, recurrent disease and immunosuppressive treatment. Hypertension negatively affects transplant and patient survival outcomes; cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with chronic renal disease and after successful renal transplantation. Hypertension is a well-known risk factor for CVD and it is frequently associated with other CVD risk factors. Despite increased awareness of the adverse effects of hypertension in both graft and patient survival, long-term studies have shown that arterial hypertension in the transplant population has not been adequately controlled. Resistant hypertension (RH) is defined as office blood pressure (oBP) that remains above goal (oBP ≥ 140/90 or 130/80 mmHg) in patients with diabetes or chronic kidney disease despite the concurrent use of three antihypertensive agents, at full doses, one of them being a diuretic. Despite studies in the general population and the high prevalence of hypertension in renal transplant patients, data about RH are very scarce and the prevalence of RH in renal transplant patients is unknown and could be associated with a worse prognosis.
Collapse
Affiliation(s)
- Manuel Arias
- Nephrology Service, Universitary Hospital Marqués de Valdecilla, 39008 Santander, Spain
| | | | | | | | | | | | | |
Collapse
|
11
|
San Segundo D, Fernández-Fresnedo G, Rodrigo E, Ruiz JC, González M, Gómez-Alamillo C, Arias M, López-Hoyos M. High regulatory T-cell levels at 1 year posttransplantation predict long-term graft survival among kidney transplant recipients. Transplant Proc 2013; 44:2538-41. [PMID: 23146447 DOI: 10.1016/j.transproceed.2012.09.083] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Regulatory T cells (Tregs) have gained an important role in mechanisms of tolerance and protection against the transplant rejection. However, only limited retrospective data have shown a relationship between peripheral blood Tregs and better long-term graft survival. The purpose of the present study was to investigate prospectively circulating Treg levels and their association with long-term graft survival. METHODS Ninety kidney transplant recipients underwent measurement of Treg levels in peripheral blood before as well as at 6 months and 1 year posttransplantation. Receiver operating characteristic curves were applied to test the sensitivity and specificity of Treg levels to predict prognosis. RESULTS Treg levels before transplantation correlated with those at 6 months and 12 months posttransplantation (P < .001 and P = .002, respectively). Patients who maintained high Treg levels (above 70th percentile) at both 6 and 12 months displayed better long-term graft survival at 4 and 5 years follow-up (P = .04 and P = .043 respectively). There was no effect on patient survival. CONCLUSION Detection of high levels of peripheral blood Tregs was associated with better graft survival possibly using as a potential marker of prognosis.
Collapse
Affiliation(s)
- D San Segundo
- Immunology Service, Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Spain
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Santos L, Rodrigo E, Piñera C, Quintella E, Ruiz JC, Fernández-Fresnedo G, Palomar R, Gómez-Alamillo C, de Francisco A, Arias M. New-onset diabetes after transplantation: drug-related risk factors. Transplant Proc 2013; 44:2585-7. [PMID: 23146462 DOI: 10.1016/j.transproceed.2012.09.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION New-onset diabetes after transplantation (NODAT), an important complication of renal transplantation leads to reduced graft function and increased patient morbidity and mortality. Because of its high incidence and immense impact on clinical outcomes, prevention of NODAT is highly desirable. Several modifiable and nonmodifiable risk factors for NODAT have been described. The aim of this study was to analyze the influence of various drugs on the development of NODAT during the first year. METHODS A retrospective analysis was performed on 303 adult kidney transplant recipients free of previously known diabetes. NODAT was defined as a fasting plasma glucose level ≥ 126 mg/dL confirmed by repeat testing on a different day. We excluded patients with transiently elevated fasting plasma glucose during the first 3 months. RESULTS NODAT was diagnosed in 37 recipients (12.2%). Univariate analysis identified several variables related to NODAT: recipient age (P < .001), body mass index (P < .001), donor age (P = .005), family history of diabetes (P < .001), statin use (P = .005), diuretic use (P = .040) and tacrolimus therapy (P = .029). After multivariate analysis, recipient age (relative risk [RR] = 1.060, 95% confidence interval [CI] 1.019- 1.102, P = .004), family history of diabetes (RR = 3.562, 95% CI 1.574-8.058, P = .002), smoking habit (RR 2.514, 95% CI 1.118-5.655, P = .026) and diuretic use (RR = 2.496, 95% CI 1.087-5.733, P = .031) were independently associated with NODAT development. CONCLUSIONS In our population of kidney transplant recipients, the main nonmodifiable risk factors for NODAT were recipient age and a family history of diabetes. Diuretic use was a modifiable risk factor associated with the development of NODAT. To reduce NODAT incidence, it is necessary to consider not only immunosuppressive therapy, but also concomitant drugs such as diuretics.
Collapse
Affiliation(s)
- L Santos
- Nephrology Service, Hospital Marqués de Valdecilla, University of Cantabria, Santander, Cantabria, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Rodrigo E, Ruiz JC, Fernández-Fresnedo G, Fernández MD, Piñera C, Palomar R, Monfá E, Gómez-Alamillo C, Arias M. Cystatin C and albuminuria as predictors of long-term allograft outcomes in kidney transplant recipients. Clin Transplant 2013; 27:E177-83. [PMID: 23373671 DOI: 10.1111/ctr.12082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2012] [Indexed: 12/18/2022]
Abstract
Although cystatin C (Cys) and albuminuria (Alb) are predictors of end-stage renal disease in the general population, there are limited data about the performance of these markers alone or combined with respect to the prediction of the kidney transplant outcome. We assessed the ability of one-yr creatinine (Cr), MDRD equation, Cys, Hoek equation, Alb, the logarithm of albuminuria (LogAlb), and two products of these variables for predicting death-censored graft loss (DCGL) in 127 kidney transplant recipients. Mean follow-up time was 5.6 ± 1.7 yr. During this time, 18 patients developed DCGL. The area under the receiver operating characteristic curve for DCGL ranged from 71.1% to 85.4%, with Cys*LogAlb being the best predictor. Cys-based variables and variables combining LogAlb and renal function estimates have better discrimination ability than Cr-based variables alone. After multivariate analysis, quartiles of all one-yr variables (except of Cr and MDRD) were independent predictors for DCGL. Predictors combining Alb and a Cr- or Cys-based estimate of renal function performed better than those markers alone to predict DCGL. Cys-based predictors performed better than Cr-based predictors. Using a double-marker in kidney transplantation, it is possible to identify the highest risk group in which to prioritize specialty care.
Collapse
Affiliation(s)
- Emilio Rodrigo
- Nephrology Service, University Hospital "Marqués de Valdecilla", University of Cantabria, Fundación Marqués de Valdecilla-IFIMAV, Santander, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Rodrigo E, Santos L, Piñera C, Millán JCRS, Quintela ME, Toyos C, Allende N, Gómez-Alamillo C, Arias M. Prediction at first year of incident new-onset diabetes after kidney transplantation by risk prediction models. Diabetes Care 2012; 35:471-3. [PMID: 22279030 PMCID: PMC3322708 DOI: 10.2337/dc11-2071] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our aim was to analyze the performance of two scores developed for predicting diabetes in nontransplant populations for identifying kidney transplant recipients with a higher new-onset diabetes mellitus after transplantation (NODAT) risk beyond the first year after transplantation. RESEARCH DESIGN AND METHODS We analyzed 191 kidney transplants, which had at least 1-year follow-up posttransplant. First-year posttransplant variables were collected to estimate the San Antonio Diabetes Prediction Model (SADPM) and Framingham Offspring Study-Diabetes Mellitus (FOS-DM) algorithm. RESULTS Areas under the receiver operating characteristic curve of FOS-DM and SADPM scores to predict NODAT were 0.756 and 0.807 (P < 0.001), respectively. FOS-DM and SADPM scores over 75 percentile (hazard ratio 5.074 and 8.179, respectively, P < 0.001) were associated with NODAT. CONCLUSIONS Both scores can be used to identify kidney recipients at higher risk for NODAT beyond the first year. SADPM score detects some 25% of kidney transplant patients with an eightfold risk for NODAT.
Collapse
Affiliation(s)
- Emilio Rodrigo
- Hospital Marqués de Valdecilla, University of Cantabria, ISCIII (REDINREN 06/16), Fundación Marqués de Valdecilla-IFIMAV, Nephrology Department, Santander, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Rodrigo E, Miñambres E, Ruiz JC, Ballesteros A, Piñera C, Quintanar J, Fernández-Fresnedo G, Palomar R, Gómez-Alamillo C, Arias M. Prediction of delayed graft function by means of a novel web-based calculator: a single-center experience. Am J Transplant 2012; 12:240-4. [PMID: 22026730 DOI: 10.1111/j.1600-6143.2011.03810.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Renal failure persisting after renal transplant is known as delayed graft function (DGF). DGF predisposes the graft to acute rejection and increases the risk of graft loss. In 2010, Irish et al. developed a new model designed to predict DGF risk. This model was used to program a web-based DGF risk calculator, which can be accessed via http://www.transplantcalculator.com . The predictive performance of this score has not been tested in a different population. We analyzed 342 deceased-donor adult renal transplants performed in our hospital. Individual and population DGF risk was assessed using the web-based calculator. The area under the ROC curve to predict DGF was 0.710 (95% CI 0.653-0.767, p < 0.001). The "goodness-of-fit" test demonstrates that the DGF risk was well calibrated (p = 0.309). Graft survival was significantly better for patients with a lower DGF risk (5-year survival 71.1% vs. 60.1%, log rank p = 0.036). The model performed well with good discrimination ability and good calibration to predict DGF in a single transplant center. Using the web-based DGF calculator, we can predict the risk of developing DGF with a moderate to high degree of certainty only by using information available at the time of transplantation.
Collapse
Affiliation(s)
- E Rodrigo
- Nephrology Department, Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Rodrigo E, Santos L, Piñera C, Quintanar J, Ruiz J, Fernández-Fresnedo G, Palomar R, Gómez-Alamillo C, Arias M. Early Prediction of New-Onset Diabetes Mellitus by Fifth-Day Fasting Plasma Glucose, Pulse Pressure, and Proteinuria. Transplant Proc 2011; 43:2208-10. [DOI: 10.1016/j.transproceed.2011.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
17
|
Fernández-Fresnedo G, Gago-Fraile M, Gómez-Alamillo C, Sanz de Castro S, Arias-Rodriguez M. Risk of cardiovascular disease associated with refractory hypertension in renal transplant recipients. Transplant Proc 2011; 42:2908-9. [PMID: 20970567 DOI: 10.1016/j.transproceed.2010.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hypertension is common after renal transplantation, affecting as many as 80% of recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy because of increased cardiovascular risk factors. The prevalence of refractory hypertension in renal transplant recipients is unknown, and could be associated with a poor prognosis. OBJECTIVE To investigate the effects of refractory hypertension on cardiovascular disease (CVD) after renal transplantation in 486 patients with grafts functioning for longer than 1 year. PATIENTS AND METHODS Patients were classified into 2 groups: (1) 57 with refractory hypertension, that is, systolic blood pressure 130 mm Hg or greater or diastolic blood pressure 80 mm Hg or greater, and receiving treatment with at least 3 drugs, one of which was a diuretic; and (2) the remaining 429 patients. Patient and graft survival, and posttransplantation CVD were analyzed. RESULTS Refractory hypertension was associated with male sex (82.5% vs 66.5% [P<.01]), poor renal function (mean [SD] serum creatinine concentration 2.2 [1.2] mg/dL vs 1.6 [0.6] mg/dL; Modification of Diet in Renal Disease score 39.2 [20.0] mL/min/1.73 m2 vs 49.2 [18.0] mL/min/1.73 m2 [P=.000]; and steroid therapy (94.7% vs 79.0% [P=.001]). In the group with refractory hypertension, 5-year patient and graft survival rates were lower, and the incidence of posttransplantation CVD was greater (relative risk, 1.7; 95% confidence interval, 1.05-2.18; P=.03). CONCLUSION Refractory hypertension is an independent risk factor for increased cardiovascular morbidity and mortality in renal transplant recipients.
Collapse
Affiliation(s)
- G Fernández-Fresnedo
- Nephrology Service, Hospital Universitario Marqués de Valdecilla, Instituto de Formación e Investigación Marqués de Valdecilla, Sanatander, Spain.
| | | | | | | | | |
Collapse
|
18
|
Segundo DS, Fernández-Fresnedo G, Gago M, Beares I, Ruiz-Criado J, González M, Ruiz JC, Gómez-Alamillo C, López-Hoyos M, Arias M. Kidney transplant recipients show an increase in the ratio of T-cell effector memory/central memory as compared to nontransplant recipients on the waiting list. Transplant Proc 2011; 42:2877-9. [PMID: 20970557 DOI: 10.1016/j.transproceed.2010.07.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Studies of allotolerance in animal models do not usually consider the presence of preexisting memory T cells and activated immune status. However, humans are exposed throughout life to a multitude of external agents that enhance the immune memory. In this article, we consider the effect that a previous kidney transplant has on the number of regulatory T cells (Tregs), effector memory T cells (TEM), and central memory T cells (TCM). Sixty-three patients with end-stage renal disease were studied just before being transplanted (51 first transplants and 12 retransplants). The numbers of Tregs (CD4+ CD25highCD127lowCD27+CD62L+CD45RO+FOXP3+), TEM (CD3+CD45RO+CD62L+), and TCM (CD3+CD45RO+CD62L-) cell subsets were quantified in peripheral blood by flow cytometry. The absolute number of Tregs was slightly lower in patients with previous allografts (median, 95% confidence interval [CI]: 16.7 cells/mm3, 12-20.5) than in those who received their first transplants (median, 95% CI: 19.6 cells/mm3, 19.3-29.6; P-NS). Clearer differences were found with the number of CD3+ TCM, since the transplanted patients had lower numbers (238 cells/mm3, 153-323) than those who had not yet received transplants (378 cells/mm3, 317-439; P=.029). As a result, the TEM/TCM ratios of both CD4+ and CD8+ T cells in patients with previous allografts were higher than in those who received first transplants. In conclusion, the assessment of just the number of Tregs in renal transplant patients is not enough and must be read together with the number of TEM and TCM. The TEM:TCM ratio increases in patients with previous allografts, probably due to activation of the immune response in renal transplantation.
Collapse
Affiliation(s)
- D S Segundo
- Servicio Inmunología, Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Santos L, Rodrigo E, Piñera C, Robledo C, Palomar R, Gómez-Alamillo C, González-Cotorruelo J, Arias M. Elevated serum gamma-glutamyltransferase and hypomagnesemia are not related with new-onset diabetes after transplantation. Transplant Proc 2011; 42:2914-6. [PMID: 20970569 DOI: 10.1016/j.transproceed.2010.07.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND New-onset diabetes mellitus after transplantation (NODAT) contributes to the risk of cardiovascular disease (CVD) and infection, reducing graft and patient survival in kidney transplant recipients. To reduce CVD and improve outcomes of kidney transplant recipients, it is of great interest to more precisely elucidate the risk factors that contribute to the development of NODAT. A previous study reported that hypomagnesemia is an independent predictor of NODAT. Elevated gamma-glutamyltransferase (GGT) activity increases the risk of incident type 2 diabetes in the general population. The objective of this study was to determine whether magnesium (Mg) and GGT were risk factors for NODAT among our population of kidney transplant recipients. METHODS We retrospectively analyzed 205 non-previously diabetic kidney transplant recipients. GGT was measured before transplantation as well as at months 1, 2, and 12. Mg was measured at months 1, 2, and 12. NODAT was defined at month 12 and at the end of follow-up according to the "2003 international consensus guidelines." RESULTS Although 36 patients (17.5%) developed NODAT at month 12, 55 patients (26.8%) displayed it at the end of follow-up. We did not observe any significant difference, either in mean Mg (month 1, 1.73±0.24 vs 1.75±0.30 [P=.824]; month 2, 1.71±0.22 vs 1.68±0.26 [P=.565]; month 12, 1.77±0.27 vs 1.80±0.24 [P=.596]) or GGT values (pretransplantation, 32 ± 27 vs 33±85 [P=.866]; month 1:39±24 vs 48±70 [P=.452]; month 2, 53±96 vs 48±83 [P=.739]; month 12, 40±37 vs 38±53 [P=.830]) between NODAT and non-NODAT patients at month 12 or at the end of follow-up. CONCLUSION Hypomagnesemia and high GGT activity were not risk factors for NODAT development in kidney transplant recipients.
Collapse
Affiliation(s)
- L Santos
- Service of Nephrology, Hospital Valdecilla, University of Cantabria, Santander, Spain
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Rodrigo E, López-Rasines G, Ruiz J, Lastra P, Gómez-Dermitt V, Gómez-Alamillo C, González-Cotorruelo J, Calabia A, Arias M. Determinants of Resistive Index Shortly after Transplantation: Independent Relationship with Delayed Graft Function. ACTA ACUST UNITED AC 2010; 114:c178-86. [DOI: 10.1159/000262300] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 09/04/2009] [Indexed: 11/19/2022]
|
21
|
Ramos-Barrón MA, Gómez-Alamillo C, Santiuste I, Agüeros C, Cosme LS, Benito A, Gimenez T, Merino J, Merino R, Arias M. Leflunomide derivative FK778 inhibits production of antibodies in an experimental model of alloreactive T-B cell interaction. EXP CLIN TRANSPLANT 2009; 7:218-224. [PMID: 20353370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The contribution of humoral immune response in allograft and xenograft rejection has been clearly demonstrated in recent years. For this reason, inhibition of alloantibody production has become essential in managing transplanted patients. Here, we assessed the effects of the leflunomide derivative FK778 (FK778) in the control of antibody production resulting from semiallogeneic cognate T-B-cell interactions. MATERIALS AND METHODS BALB/c mice were tolerized at birth with semiallogeneic spleen cells from (BALB/c X C57BL/6) F1 mice, with or without overexpression of human bcl-2 transgene in B cells. These tolerized mice were treated with different dosages of FK778, either from birth, or from the third week of age, when autoantibody production was detected. The production of autoantibodies, used as markers of semiallogeneic cognate T-B - cell interactions, was evaluated at different time points during drug administration or after the interruption of treatment. RESULTS FK778 treatment started at birth inhibited the production of semiallogeneic-driven antibodies in a dose-dependent manner. In addition, FK778 also reduced the levels of preformed circulating autoantibodies in adult mice, although the dosage required was 4 times higher than that used in neonates. However, the levels of IgG antibodies in these tolerized mice increased after FK778 withdrawal, indicating that FK778 failed to induce tolerance to semiallogeneic host CD4+ Th2 and/or donor B cells. CONCLUSIONS Our results demonstrate the efficacy of FK778 in the control of antibody production resulting from semiallogeneic cognate T-B - cell interactions.
Collapse
|
22
|
Fernández-Fresnedo G, Gómez-Alamillo C, Ruiz JC, de Francisco ALM, Arias M. Chronic renal disease in renal transplant patients: management of cardiovascular risk factors. Transplant Proc 2009; 41:1637-8. [PMID: 19545697 DOI: 10.1016/j.transproceed.2009.02.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 12/16/2008] [Accepted: 02/09/2009] [Indexed: 10/20/2022]
Abstract
Kidney transplantation is the treatment of choice for patients with end-stage renal disease. Despite improvements in short-term patient and graft outcomes, there has been no major improvement in long-term outcomes. The aim of this study was to determine the prevalence of cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes, chronic kidney disease, and obesity, and the impact of their control among 526 stable renal transplant recipients according to the guidelines in the general population. Mean blood pressure was 133 +/- 16/81 +/- 9 mm Hg. The proportion of patients on antihypertensive therapy was 75%, and on ACE inhibitors or angiotensin II receptor blockers, 26%. The mean cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides were 195 +/- 41, 115 +/- 32, 51 +/- 17, and 137 +/- 75 mg/dL, respectively. The proportion of patients on statin treatment was 49.7%, and those with body mass indices between 25 and 30, 30 and 35, and >35 kg/m(2) were 35%, 15%, and 4%. We observed a high prevalence of chronic kidney disease, hypertension, dyslipidemia, and obesity among renal transplant patients. Suboptimal control was frequent and control of some of these complications was far below targets established for nontransplant patients despite progressive intensification of therapy with functional graft decline. The findings of this study may have an impact on the management of renal transplant recipients.
Collapse
Affiliation(s)
- G Fernández-Fresnedo
- Nephrology Service, University Hospital Marqués de Valdecilla, Santander, Spain.
| | | | | | | | | |
Collapse
|
23
|
López-Hoyos M, San Segundo D, Benito MJ, Fernández-Fresnedo G, Ruiz JC, Rodrigo E, Gómez-Alamillo C, Benito A, Arias M. Association between serum soluble CD30 and serum creatinine before and after renal transplantation. Transplant Proc 2009; 40:2903-5. [PMID: 19010142 DOI: 10.1016/j.transproceed.2008.08.087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE There is increasing evidence that circulating levels of soluble CD30 (sCD30) may represent a biomarker for outcome in kidney transplantation. The aim of this study was to measure the pre- and posttransplantation serum levels of sCD30 in cadaveric kidney transplant recipients and correlate them with serum creatinine. PATIENTS AND METHODS Serum sCD30 was measured by a commercial enzyme-linked immunosorbent assay (ELISA) from prospective samples of 38 kidney allograft recipients serially transplanted at our center. Samples were collected at day 0 pretransplantation and at months 6, 12, 18, and 24 posttransplantation. We also studied sera from 29 patients with chronic kidney disease (CKD) at different stages of the K/DOQI guidelines, as a control group. RESULTS Serum levels of sCD30 decreased significantly in samples posttransplantation compared with pretransplantation. The significant decrease after transplantation may be related to the improvement in renal function since we observed a significant correlation between serum levels of sCD30 and creatinine (sCr) at all times of the study. In addition, the patients with chronic renal failure showed a significant association between serum sCD30 and sCr (r = .454; P = .013). CONCLUSIONS Our results did not suggest that the measurement of sCD30 may be used as a valuable biomarker in renal transplantation. Increased levels may be related to a decrease in its renal elimination.
Collapse
Affiliation(s)
- M López-Hoyos
- Servicio de Inmunología, Hospital Universitario Marqués de Valdecilla-IFIMAV, Santander, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Delgado P, Diaz JM, Silva I, Osorio JM, Osuna A, Bayés B, Lauzurica R, Arellano E, Campistol JM, Dominguez R, Gómez-Alamillo C, Ibernon M, Moreso F, Benitez R, Lampreave I, Porrini E, Torres A. Unmasking glucose metabolism alterations in stable renal transplant recipients: a multicenter study. Clin J Am Soc Nephrol 2008. [PMID: 18322043 DOI: 10.2215/cjn.0492110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Emerging information indicates that glucose metabolism alterations are common after renal transplantation and are associated with carotid atheromatosis. The aims of this study were to investigate the prevalence of different glucose metabolism alterations in stable recipients as well as the factors related to the condition. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A multicenter, cross-sectional study was conducted of 374 renal transplant recipients without pre- or posttransplantation diabetes. A standard 75-g oral glucose tolerance test was performed. RESULTS Glucose metabolism alterations were present in 119 (31.8%) recipients: 92 (24.6%) with an abnormal oral glucose tolerance test and 27 (7.2%) with isolated impaired fasting glucose. The most common disorder was impaired glucose tolerance (17.9%), and an abnormal oral glucose tolerance test was observed for 21.5% of recipients with a normal fasting glucose. By multivariate analysis, age, prednisone dosage, triglyceride/high-density lipoprotein cholesterol ratio, and beta blocker use were shown to be factors related to glucose metabolism alterations. Remarkably, triglyceride levels, triglyceride/high-density lipoprotein cholesterol ratio, and the proportion of recipients with impaired fasting glucose were already higher throughout the first posttransplantation year in recipients with a current glucose metabolism alteration as compared with those without the condition. CONCLUSIONS Glucose metabolism alterations are common in stable renal transplant recipients, and an oral glucose tolerance test is required for its detection. They are associated with a worse metabolic profile, which is already present during the first posttransplantation year. These findings may help planning strategies for early detection and intervention.
Collapse
Affiliation(s)
- Patricia Delgado
- Nephrology Section and Research Unit, Hospital Universitario de Canarias, University of La Laguna (Tenerife), Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Delgado P, Diaz JM, Silva I, Osorio JM, Osuna A, Bayés B, Lauzurica R, Arellano E, Campistol JM, Dominguez R, Gómez-Alamillo C, Ibernon M, Moreso F, Benitez R, Lampreave I, Porrini E, Torres A. Unmasking glucose metabolism alterations in stable renal transplant recipients: a multicenter study. Clin J Am Soc Nephrol 2008; 3:808-13. [PMID: 18322043 DOI: 10.2215/cjn.04921107] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Emerging information indicates that glucose metabolism alterations are common after renal transplantation and are associated with carotid atheromatosis. The aims of this study were to investigate the prevalence of different glucose metabolism alterations in stable recipients as well as the factors related to the condition. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A multicenter, cross-sectional study was conducted of 374 renal transplant recipients without pre- or posttransplantation diabetes. A standard 75-g oral glucose tolerance test was performed. RESULTS Glucose metabolism alterations were present in 119 (31.8%) recipients: 92 (24.6%) with an abnormal oral glucose tolerance test and 27 (7.2%) with isolated impaired fasting glucose. The most common disorder was impaired glucose tolerance (17.9%), and an abnormal oral glucose tolerance test was observed for 21.5% of recipients with a normal fasting glucose. By multivariate analysis, age, prednisone dosage, triglyceride/high-density lipoprotein cholesterol ratio, and beta blocker use were shown to be factors related to glucose metabolism alterations. Remarkably, triglyceride levels, triglyceride/high-density lipoprotein cholesterol ratio, and the proportion of recipients with impaired fasting glucose were already higher throughout the first posttransplantation year in recipients with a current glucose metabolism alteration as compared with those without the condition. CONCLUSIONS Glucose metabolism alterations are common in stable renal transplant recipients, and an oral glucose tolerance test is required for its detection. They are associated with a worse metabolic profile, which is already present during the first posttransplantation year. These findings may help planning strategies for early detection and intervention.
Collapse
Affiliation(s)
- Patricia Delgado
- Nephrology Section and Research Unit, Hospital Universitario de Canarias, University of La Laguna (Tenerife), Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Ramos-Barrón A, Piñera-Haces C, Gómez-Alamillo C, Santiuste-Torcida I, Ruiz JC, Buelta-Carrillo L, Merino R, de Francisco ALM, Arias M. Prevention of murine lupus disease in (NZBxNZW)F1 mice by sirolimus treatment. Lupus 2008; 16:775-81. [PMID: 17895299 DOI: 10.1177/0961203307081401] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sirolimus is a new immunosuppressive drug used to avoid allograft rejection. The immunosuppressive effect of sirolimus is due to inhibition of the mammalian target of rapamycin, necessary for the proliferation and clonal expansion of activated T-cells. Because T-cells play a central role in the pathogenesis of autoimmune disease developed in (NZBxNZW)F1 mice, we evaluated the therapeutic use of sirolimus in such mice. (NZBxNZW)F1 female mice received 1mg/kg/day of sirolimus from 12 to 37 weeks of age. The development of autoimmune disease was evaluated by measuring the serum levels of auto-antibodies (autoAbs) and their immunoglobulin isotypes, prevalence of glomerulonephritis and mortality rates. Sirolimus directly inhibited production of autoAbs, glomerular deposits of immunoglobulins and development of proteinuria; also the survival of these mice was prolonged. Our results demonstrate the beneficial effects of sirolimus in preventing the development of lupus disease in (NZBxNZW)F1 female mice.
Collapse
Affiliation(s)
- A Ramos-Barrón
- Department of Nephrology, Universitary Hospital Marqués de Valdecilla, Santander, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Rodrigo E, Fernández-Fresnedo G, Valero R, Ruiz JC, Piñera C, Palomar R, González-Cotorruelo J, Gómez-Alamillo C, Arias M. New-onset diabetes after kidney transplantation: risk factors. J Am Soc Nephrol 2007; 17:S291-5. [PMID: 17130277 DOI: 10.1681/asn.2006080929] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
New-onset diabetes after transplantation (NODAT) contributes to the risk for cardiovascular disease and infection, reducing graft and patient survival. For improvement of the outcome of kidney transplant recipients, it is of great interest to know precisely the risk factors that contribute to NODAT development. Nonmodifiable risk factors for development of NODAT are age, race, genetic background, family history of diabetes, and previous glucose intolerance. Modifiable risk factors are obesity and overweight, hepatitis C virus and cytomegalovirus infections, and immunosuppressive drugs. Both steroids and calcineurin inhibitors influence the appearance of NODAT, whereas the role of sirolimus in glucose metabolism currently is controversial.
Collapse
Affiliation(s)
- Emilio Rodrigo
- Nephrology service, University of Cantabria, Avda. Valdecilla s/n 39008, Santander, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Sánchez Fructuoso A, Ruiz San Millán JC, Calvo N, Rodrigo E, Moreno MA, Cotorruelo J, Conesa J, Gómez-Alamillo C, Arias M, Barrientos A. Evaluation of the efficacy and safety of the conversion from a calcineurin inhibitor to an everolimus-based therapy in maintenance renal transplant patients. Transplant Proc 2007; 39:2148-50. [PMID: 17889120 DOI: 10.1016/j.transproceed.2007.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Everolimus has recently been introduced into clinical practice with promising perspectives due to its efficacy, lack of nephrotoxicity, and antitumor effects. Experience in clinical trials associated with low-dose cyclosporine showed good results, but there is almost no experience in calcineurin inhibitor (CNI) elimination learning it as the primary immunosuppressant. We describe our experience in a series of 78 stable renal transplant patients who were switched to Everolimus with complete and quick elimination of the CNI: the procedure of conversion, pharmacokinetic results after conversion, evolution of renal parameters (renal function, proteinuria, and others), and safety data (acute rejection and adverse events). An initial dose of 3 mg/d was adequate to obtain the recommended trough levels between 5 and 10 ng/mL. Our results demonstrated that conversion to Everolimus was a simple, safe procedure that must be considered in patients CNI toxicity, especially those with malignant neoplasms and progressive deterioration of renal function due to chronic allograft nephropathy.
Collapse
|
29
|
Rodrigo E, Sánchez-Velasco P, Ruiz JC, Fernández-Fresnedo G, López-Hoyos M, Piñera C, Palomar R, Gómez-Alamillo C, González-Cotorruelo J, Leyba-Cobián F, Arias M. Cytokine Polymorphisms and Risk of Infection After Kidney Transplantation. Transplant Proc 2007; 39:2219-21. [PMID: 17889143 DOI: 10.1016/j.transproceed.2007.06.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Infection remains a significant cause of morbidity and mortality after solid organ transplantation. Genetic background has an influence on the incidence of infection. The aim of our study was to analyze the relationship between cytokine polymorphisms and infection in our kidney transplant recipients. METHODS DNA from 255 kidney transplant recipients was isolated routinely. Polymerase chain reaction sequence-specific primer was performed using commercially available cytokine genotyping primer packs to determine polymorphisms of interleukin (IL)-10, transforming growth factor-beta, tumor necrosis factor-alpha, interferon-gamma, IL-6, IL-4, IL-2, IL-12, IL-4R alpha, IL-1RA, IL-1R, IL-1 beta, and IL-1 alpha. The appearance and number of infections within the first year after transplantation were identified retrospectively. RESULTS One hundred twenty-two patients experienced at least one episode of infection in the first year after transplant. The frequency of the -511 IL-1beta CC genotype and the frequencies of the -1188 IL-12 CA and CC genotypes were significantly higher among the infected patients compared with the noninfected patients. We failed to observe significant differences in the genotype distribution of the other analyzed cytokines regarding the incidence of infection. After adjusting, recipient IL-1beta (-511 CC) genotype (relative risk [RR] 2.67, 95% confidence interval (CI) 1.30 to 5.49, P = .007) and recipient IL-12 (-1188 CA and CC) genotypes (RR 2.57, 95% CI 1.22 to 5.38, P = .012) predicted independently the risk of infection in the first year after kidney transplantation. CONCLUSION Kidney transplant recipients with -511 IL-1beta CC genotype or with -1188 IL-12 CA and CC genotypes were at higher risk of developing infections in the first year after transplantation. Patients with genetic susceptibility to infection may benefit from less potent immunosuppressive therapy and more intense preventive measures.
Collapse
Affiliation(s)
- E Rodrigo
- Service of Nephrology, Hospital Valdecilla. University of Cantabria, Santander, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Palomar R, Morales P, Rodrigo E, Castañeda O, Fernández-Fresnedo G, Gómez-Alamillo C, Arias M. Venous Graft Thrombosis in Patients on Peritoneal Dialysis Before Transplantation. Transplant Proc 2007; 39:2128-30. [PMID: 17889114 DOI: 10.1016/j.transproceed.2007.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has been described that patients on peritoneal dialysis (PD) suffer from thrombotic events (vascular access, deep venous thrombosis, and graft thrombosis) more frequently after transplantation than other recipients. We analyzed the incidence of allograft thrombosis among patients transplanted in a 6-year period (January 1, 2000, to December 31, 2005) to identify etiological factors, such as inherited thrombophilia. MATERIALS AND METHODS We performed 197 renal transplants in 189 patients, including 115 who had been on hemodialysis (HD), 44 on PD, and 30 preemptive. We recorded immunological and demographic data, studied graft and patient survivals, and evaluated the hypercoagulable state of those who experienced graft thrombosis. RESULTS The mean age of the patients at transplantation was 49 years. There were no demographic or immunological differences between the three groups of patients, except for the number of previous blood transfusions and panel reactive antibodies (PRA) levels. Forty-seven grafts were lost in the first year; 14 suffered venous thrombosis, and there were 10 acute rejection epidoses (ARE), 7 death-censored graft failures, 3 chronic allograft nephropathies (CAN), 6 primary nonfunctions, 5 removed due to infection, 1 primary disease relapse, and 1 hemolytic-uremic syndrome. Of the 14 cases of thrombosis in 12 patients, 10 had been on PD and 4 on HD immediately before transplant. One-year graft and patient survivals were similar: 74% HD, 68% PD, 86% preemptive, and 93% HD, 95% PD, and 96% preemptive, respectively. The hypercoagulable state showed inherited thrombophilia patterns in some cases, but most of them were normal. CONCLUSION Renal graft thrombosis was responsible for graft lost in PD patients within the first year, while in the HD group it was ARE and in the preemptive cohort, death with a functioning graft. The hypercoagulable state pretransplant should be more accurately studied to identify thrombotic factors other than those which are inherited.
Collapse
Affiliation(s)
- R Palomar
- Nephrology Department, Marqués de Valdecilla Hospital, Santander, Spain.
| | | | | | | | | | | | | |
Collapse
|
31
|
Ruiz JC, Sanchez-Fructuoso A, Rodrigo E, Conesa J, Cotorruelo JG, Gómez-Alamillo C, Calvo N, Barrientos A, Arias M. Conversion to everolimus in kidney transplant recipients: a safe and simple procedure. Transplant Proc 2007; 38:2424-6. [PMID: 17097956 DOI: 10.1016/j.transproceed.2006.08.190] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To date there is a substantial experience with rapamycin conversion in stable renal transplant recipients with respect to the procedure of conversion, initial doses, and target blood levels as well as adverse events, but in the case of Everolimus there is almost no experience with conversion and calcineurin inhibitor (CNI) withdrawal. We describe an initial experience among 32 renal transplant recipients who were converted to Everolimus with complete suspension of CNI in two Spanish transplant centers. Our results emphasised the procedure for conversion, the target levels, the adverse events, and the initial efficacy, over the first month after conversion. Our conclusions were that conversion from CNI to Everolimus was a simple, safe procedure with a predictable profile of adverse events, which were, in general, of mild intensity. There was a good correlation between initial dose and blood level. Initial doses of about 3 mg/d combined with rapid reduction in CNI exposure seemed to be adequate. The target range levels between 5 and 10 ng/mL seemed to be sufficient for complete CNI elimination, especially in patients also receiving antiproliferative drugs (such as mycophenolate mofetil or azathioprine) in whom levels near the lower end of the range might be adequate.
Collapse
Affiliation(s)
- J C Ruiz
- H.U. Valdecilla, Santander, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
San Segundo D, Ruiz JC, Fernández-Fresnedo G, Izquierdo M, Gómez-Alamillo C, Cacho E, Benito MJ, Rodrigo E, Palomar R, López-Hoyos M, Arias M. Calcineurin inhibitors affect circulating regulatory T cells in stable renal transplant recipients. Transplant Proc 2007; 38:2391-3. [PMID: 17097943 DOI: 10.1016/j.transproceed.2006.08.081] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Immunosuppression, although crucial for short-term management, has been described in renal transplantation to be a major hurdle for long-term graft survival. Efforts have been directed at achieving a true state of allotolerance, thereby reducing the load of immunosuppression. Recently, increased frequencies of CD4(+)CD25(high) regulatory T cells (Tregs) have been described as an additional mechanism to induce alloimmune tolerance. MATERIALS AND METHODS We assessed 64 renal transplant recipients with stable renal function for at least 1 year, divided into two groups: one composed of patients receiving rapamycin but not calcineurin inhibitors (CNIs), and another, of those receiving CNIs but not rapamycin. RESULTS We demonstrated that T cells with a regulatory phenotype were decreased in peripheral blood of renal transplant recipients under CNI therapy compared to those who were CNI-free. The Tregs in our patients showed a modest association with renal function as measured by the delta serum creatinine, which was not significant. CONCLUSIONS CNIs, but not rapamycin, reduce the frequencies of circulating Tregs in renal transplant recipients. The use of rapamycin might be further exploited in strategies reducing immunosuppression in renal transplantation. Furthermore, quantification of blood Tregs may be a suitable tool to identify those recipients who are candidates for reducing immunosuppression.
Collapse
Affiliation(s)
- D San Segundo
- Servicios de Inmunología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Segundo DS, Ruiz JC, Izquierdo M, Fernández-Fresnedo G, Gómez-Alamillo C, Merino R, Benito MJ, Cacho E, Rodrigo E, Palomar R, López-Hoyos M, Arias M. Calcineurin inhibitors, but not rapamycin, reduce percentages of CD4+CD25+FOXP3+ regulatory T cells in renal transplant recipients. Transplantation 2006; 82:550-7. [PMID: 16926600 DOI: 10.1097/01.tp.0000229473.95202.50] [Citation(s) in RCA: 201] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Immunosuppression in renal transplantation, although manageable in the short-term, is a major hurdle for long-term graft survival. Recently, increased frequencies of CD4CD25 regulatory T cells (Tregs) have been described as an additional mechanism that induces alloimmune tolerance. METHODS We assessed 64 renal transplant recipients with stable renal function for at least one year. Patients were divided into two groups according to the immunosuppression they were receiving at the moment of the study: one consisted of patients receiving rapamycin (Rapa) but not calcineurin inhibitors (CNI), and the other group received CNI but not Rapa. The Rapa group was further divided into three subgroups according to their previous experience with CNI: CNI-free, CNI withdrawal, and CNI conversion. Frequencies of blood Tregs were studied by flow cytometry after staining with monoclonal antibodies specific for different markers of Tregs. RESULTS Frequencies of CD4 T cells with regulatory phenotype and function were significantly decreased in peripheral blood of renal transplant patients receiving CNI compared with those receiving Rapa. This effect was independent of an early exposure to CNI because the CNI-free patients in the Rapa group showed similar frequencies of Tregs to the CNI withdrawal and CNI conversion groups. CONCLUSIONS CNI, but not Rapa, induce a decrease of circulating Tregs in stable renal transplant recipients. Thus, Rapa might be further explored in strategies using preservation of Tregs for transplant tolerance. Furthermore, quantification of blood Tregs may be a suitable tool to identify renal transplant recipients who may be candidates for reduced immunosuppression.
Collapse
Affiliation(s)
- David San Segundo
- Servicios Inmunología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Rodrigo E, de Cos MA, Fernández-Fresnedo G, Sánchez B, Ruiz JC, Piñera C, Palomar R, Cotorruelo JG, Gómez-Alamillo C, de Castro SS, de Francisco ALM, Arias M. Higher initial tacrolimus blood levels and concentration-dose ratios in kidney transplant recipients who develop diabetes mellitus. Transplant Proc 2006; 37:3819-20. [PMID: 16386549 DOI: 10.1016/j.transproceed.2005.09.196] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Posttransplantation diabetes mellitus (PTDM) is a common complication of kidney transplantation, associated with poorer graft and patient outcomes. Tacrolimus is a strong immunosuppressive drug associated with low acute rejection rates, but a higher risk for PTDM. High trough levels of tacrolimus during the first month after transplantation have been found to be a significant risk factor for the development of PTDM. The aim of this single-center study was to identify the risk factors for the development of PTDM among kidney transplant recipients under tacrolimus therapy. We examined 73 cadaveric kidney transplant recipients receiving tacrolimus between 1994 and 2003. Age, donor and recipient gender, dialysis method, body mass index (BMI), first year weight gain, mismatches, incidence of acute rejection and delayed graft function, hepatitis C serology, first year cumulative steroid dose, first tacrolimus blood level, first tacrolimus blood level <15 ng/mL, and corresponding tacrolimus daily doses and concentration/dose ratios (CDR) were also collected. PTDM was defined as at least 2 fasting blood glucose values > or =126 mg/dL, according to the World Health Organization criteria. Incidence of first year PTDM was 27.4%. Patients with PTDM showed significantly higher age, BMI, first tacrolimus blood level, first tacrolimus CDR, and CDR with tacrolimus blood level <15 ng/mL as well as less 1-year weight gain. After logistic regression, age (relative risk [RR] 1.060, confidence interval [CI] 95%, 1.001-1.122; P = .043) and first tacrolimus blood level (RR 1.154; CI 95%, 1.038-1.283; P = .008) remain significant risk factors for developing PTDM. Older age and initial tacrolimus blood levels were the main risk factors for PTDM among our group of patients. Kidney transplant recipients who develop PTDM maintain a high CDR of tacrolimus.
Collapse
Affiliation(s)
- E Rodrigo
- Service of Nephrology, Hospital Valdecilla, University of Cantabria, Santander, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Quereda C, Pascual J, García-López F, Alcázar R, Aljama P, Amenábar JJ, Arias M, Barrio V, Fernández-Rodríguez A, Fernández Juárez G, Fernández-Lucas M, Gallego N, Hernández D, Gómez-Alamillo C, Maduell F, Martínez Castelao A, Marcén R, Matesanz R, Martín de Francisco AL, Orte L, Liaño F, Luño J, Ortuño J, Pérez García R, Praga M, Saracho R, Selgas R, Rivera M, Rodríguez Pérez JC, Teruel JL, Tato A, Torres A, Valdés F. [Clinical research based nephrology (bases for the constitution of an Evidence Based Nephrology Group in the Spanish Society of Nephrology)]. Nefrologia 2006; 26:163-72. [PMID: 16808254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
|
36
|
Abstract
BACKGROUND Chronic allograft nephropathy is the main cause of late graft loss. It has been suggested that both alloantigen-dependent and alloantigen-independent factors influence the development of progressive transplant failure. The present study analyzed the importance of non-immunologic factors in the progression of kidney disease in transplant patients, with the emphasis on well-established risk factors for progression in native kidneys. METHODS A retrospective analysis was performed on 485 renal transplant patients who had functioning kidneys for at least 1 year. We investigated whether the initial presence and subsequent maintenance of proteinuria, hypertension, anemia, hyperlipidemia, and hyperparathyroidism influenced the progression of transplant failure. To analyze the relative effects of these factors, patients were categorized into two groups: group A had a baseline serum creatinine concentration of less than 1.5 mg/dL, and group B had a baseline serum creatinine concentration of 1.5 to 3 mg/dL. RESULTS High urine protein excretion was a significant independent risk factor for progression of renal failure (group A: relative risk, 3.73; 95% confidence interval [CI], 2.24-6.21; group B: relative risk, 4.01; 95% CI, 2.51-6.39). Hypertension was also a significant independent risk factor for progression, but the risk was lower than for proteinuria (group A: relative risk, 1.2; 95% CI, 1.04-1.75; group B: relative risk, 1.20; 95% CI, 1.02-2.1). Anemia, hyperlipidemia, and hyperparathyroidism had no influence on the progression of renal failure. CONCLUSION Our results show strong independent relationships between high blood pressure, urine protein excretion, and the relative risk of chronic progression of renal failure, as described for native kidney disease. These factors are potentially modifiable and are therefore attractive targets for therapeutic targets.
Collapse
Affiliation(s)
- Manuel Arias
- Nephrology Service, Universitary Hospital Marques de Valdecilla, Santander, Spain.
| | | | | | | | | | | |
Collapse
|
37
|
Rodrigo E, Piñera C, de Cos MA, Sánchez B, Ruiz JC, Fernández-Fresnedo G, Palomar R, González-Cotorruelo J, Gómez-Alamillo C, de Castro SS, de Francisco ALM, Arias M. Evolution of tacrolimus blood levels and concentration-dose ratios in patients who develop new onset diabetes mellitus after kidney transplantation. Transpl Int 2005; 18:1152-7. [PMID: 16162102 DOI: 10.1111/j.1432-2277.2005.00191.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
New onset diabetes mellitus (NODM) affects kidney transplantation outcome. Several risk factors, including immunosuppressive drug levels, are related with NODM development. This analysis evaluates the incidence and risk factors of NODM in kidney transplant patients receiving tacrolimus, taking into account 6-month blood levels and concentration-dose ratios (CDRs). Seventy-six patients under tacrolimus therapy who received a cadaveric renal transplant in our centre and with graft survival higher than 1 year were included in the study. NODM was defined as two fasting plasma glucose values > or =126 mg/dl or symptoms of diabetes plus casual plasma glucose concentrations > or =200 mg/dl throughout the first year. We examined previously reported variables related with NODM development. The incidence of NODM at 12 months was 27.6%. Risk factors for NODM included older age, higher first tacrolimus level, higher body mass index and lower first year weight gain. In multivariate analysis, the first year occurrence of NODM was significantly determined by the first tacrolimus blood level >20 ng/ml and age older than 50 years. CDR remains significantly higher in NODM throughout the 6 months. Older age and a high first tacrolimus blood level are associated with the development of NODM during the first year after kidney transplantation. NODM patients show higher CDR during the first 6 months.
Collapse
Affiliation(s)
- Emilio Rodrigo
- Department of Nephrology, Hospital Marqués de Valdecilla, University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Ramalle-Gómara E, Mosquera Lozano D, Brea Hernando A, Gómez-Alamillo C. [Validity of self-notified measures of weight and height in the estimation of obesity prevalence]. Med Clin (Barc) 1997; 108:716. [PMID: 9324589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
39
|
Gómez-Alamillo C, Sanchez-Casajús A, Sierra M, Huarte E, Díez J. Vasoconstriction of the afferent arteriole and defective renal synthesis of nitric oxide in essential hypertension. Kidney Int Suppl 1996; 55:S129-31. [PMID: 8743533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study was designed to investigate whether some relation exists between afferent arteriolar resistance (AAR) and the renal production of nitric oxide (NO) and prostacyclin (PGI2) in 21 patients with untreated essential hypertension and 20 normotensive controls. All subjects were studied in conditions of an unlimited Na+ diet both basally and after a four-hour amino acid infusion. AAR was calculated using Gomez's equations. Renal production of NO and PGI2 were assessed by radioimmunoassay of the urinary excretion of cGMP and 6-keto-PGF1 alpha, respectively. Baseline AAR was higher (P < 0.01) in hypertensives than in normotensives. The baseline urinary excretion of 6-keto-PGF1 alpha and cGMP were similar in the two groups of subjects. AAR diminished (P < 0.005) in normotensives and remained unchanged in hypertensives after amino acid infusion. Urinary excretion of 6-keto-PGF1 alpha was increased similarly in the two groups of subjects after infusion. Urinary excretion of cGMP remained unchanged in normotensives and decreased by 31% in hypertensives after infusion. These findings suggest that afferent vasoconstriction present in hypertensive patients is unresponsive to the vasodilatory manoeuvre of amino acid infusion. This lack of response may be due to a defective renal synthesis of NO in these patients.
Collapse
|
40
|
Díez J, Alonso A, Garciandía A, López R, Gómez-Alamillo C, Arrázola A, Fortuño A. Association of increased erythrocyte Na+/H+ exchanger with renal Na+ retention in patients with essential hypertension. Am J Hypertens 1995; 8:124-32. [PMID: 7755940 DOI: 10.1016/0895-7061(94)00172-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The goal of this study was to investigate the activity of the Na+/H+ exchanger in erythrocytes of patients with essential hypertension and its relation with urinary Na+ excretion. The study was performed in cells from 27 untreated hypertensive patients and 30 normotensive controls with similar age and sex distribution. All subjects were studied after 4 days on a controlled Na+ diet (145 mmol/day). The activity of the Na+/H+ exchanger was determined by acidifying cell pH and measuring the initial rate of the net Na(+)-dependent H+ efflux. The activity of the Na+/H+ exchanger was higher in hypertensive patients than in controls (301 +/- 45 v 162 +/- 23 mmol/L cells/h, mean +/- SEM; P < .01). With the upper limit of the normotensive population as a cut-off point (385 mmol/L cells/h), a subgroup of 12 hypertensive patients had an abnormally high activity of Na+/H+ exchanger. Compared with controls and with patients with normal exchanger activity, patients with increased exchanger activity were characterized by lower net (P < .01) and fractional (P < .05) Na+ excretion. The accumulative Na+ balance was higher (P < .01) in hypertensive patients with increased activity of the exchanger (39.90 +/- 3.47 mmol) than in the remaining hypertensive patients (0.59 +/- 6.96 mmol) or in the normotensive population (-5.71 +/- 6.12 mmol). After analyzing the relationship of renin activity with Na+ excretion it was observed that renin activity was inappropriately low in 9 (75%) patients with increased exchanger, in 6 (40%) patients with normal exchanger, and in 6 (20%) normotensives, these differences being significant (P<.01).
Collapse
Affiliation(s)
- J Díez
- Department of Internal Medicine, School of Medicine, University of Navarra, Pamplona, Spain
| | | | | | | | | | | | | |
Collapse
|
41
|
Alonso A, Arrázola A, Garciandía A, Esparza N, Gómez-Alamillo C, Díez J. Erythrocyte anion exchanger activity and intracellular pH in essential hypertension. Hypertension 1993; 22:348-56. [PMID: 8394284 DOI: 10.1161/01.hyp.22.3.348] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The present study was designed to examine the activity of the sodium-independent chloride-bicarbonate anion exchanger and the sodium-proton exchanger in erythrocytes of 30 normotensive and 35 hypertensive subjects and its relation to the previously reported decrease in erythrocyte pH. Erythrocyte cytosolic pH was measured by the pH-sensitive fluorescent probe 2'-7'-bis(2-carboxyethyl)- 5(6)-carboxyfluorescein. The activity of the anion exchanger was determined by acidifying cell pH and measuring the initial rate of the net sodium-independent, 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid-sensitive, bicarbonate influx driven by an outward proton gradient. The activity of the sodium-proton exchanger was determined by acidifying cell pH and measuring the initial rate of the net sodium-dependent proton efflux driven by an outward proton gradient. The activity of the anion exchanger was higher in hypertensive than control individuals (18,863 +/- 1081 vs 15,629 +/- 897 mmol/L cells per hour, P < .05). The activity of the sodium-proton exchanger was higher in hypertensive than control individuals (301 +/- 45 vs 162 +/- 23 mmol/L cells per hour, P < .005). Basal erythrocyte pH was lower in hypertensive than control individuals (7.27 +/- 0.02 vs 7.33 +/- 0.01, mean +/- SEM, P < .05). With the 100% confidence (lower) limit of the normotensive population as a cutoff point, a subgroup of 11 hypertensive patients had an abnormally low erythrocyte pH (< 7.19).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- A Alonso
- Department of Internal Medicine, School of Medicine, University of Navarra, Pamplona, Spain
| | | | | | | | | | | |
Collapse
|