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Sá Martins V, Aguiar L, Dias C, Lourenço P, Pinheiro T, Velez B, Borges N, Adragão T, Calhau C, Macário F. Predictors of nutritional and inflammation risk in hemodialysis patients. Clin Nutr 2019; 39:1878-1884. [PMID: 31427179 DOI: 10.1016/j.clnu.2019.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/11/2019] [Revised: 06/29/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Malnutrition and chronic inflammation are prevalent complications in hemodialysis (HD) patients. Different nutritional assessment tools are used to identify patients at risk. A composite and comprehensive malnutrition inflammation score (MIS) has been correlated with morbidity and mortality, and appears to be a robust and quantitative tool. OBJECTIVES Determine malnutrition risk profile in a sample of portuguese HD patients; determine the association of clinical and laboratory factors with MIS, and the impact of each parameter on MIS. METHODS AND RESULTS We performed, between September 15th of 2015 and January 31st of 2016, a cross sectional analysis of 2975 patients, representing 25% of portuguese HD patients. 59% were men (66.7 ± 14.8 years); 31% diabetic; 79% and 21% performed, respectively, high-flux HD and HDF. A MIS >5 was considered to indicate higher risk and was present in 1489 patients (50%). Amongst all parameters, comorbilities/dialysis vintage, transferrin, functional capacity, changes in body weight and decreased fat stores showed the higher impact, while albumin had one of the lowest impact on the nutritional risk. MULTIVARIABLE ANALYSIS Higher age (>75 years, OR 1.71, p < 0.001), diabetes (OR 1.25, p = 0.026), lower P levels (OR 1.57,p = 0.001), higher Ca levels (OR 1.51, p < 0.001), higher ERI (OR 1.05, p < 0.001), higher Kt/V (OR 2.14, p < 0.001) and higher CRP (OR 1.01, p < 0.001) were independently associated with a higher risk of MIS>5; higher nPNA (OR 0.29, p < 0.001) and higher Pcreat (OR 0.88, p < 0.001) were associated with a risk reduction of MIS>5 (95% CI). CONCLUSIONS Routine clinical and analytic parameters were found to be associated with MIS range that might indicate higher risk, and may represent a simple alert sign for the need of further assessments.
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Affiliation(s)
- V Sá Martins
- Medical Department, DIAVERUM Portugal, Portugal.
| | - L Aguiar
- Medical Department, DIAVERUM Portugal, Portugal
| | - C Dias
- Medical Department, DIAVERUM Portugal, Portugal
| | - P Lourenço
- Medical Department, DIAVERUM Portugal, Portugal
| | - T Pinheiro
- Medical Department, DIAVERUM Portugal, Portugal
| | - B Velez
- Medical Department, DIAVERUM Portugal, Portugal
| | - N Borges
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Rua Dr Roberto Frias, 4200-465, Porto, Portugal
| | - T Adragão
- Medical Department, DIAVERUM Portugal, Portugal; Nephrology Department, Santa Cruz Hospital, Carnaxide, Portugal
| | - C Calhau
- NOVA Medical School, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Campo Mártires da Pátria, n.º 130, 1169-056, Lisboa, Portugal; CINTESIS, Center for Health Technology Services Research, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal; Unidade Universitária Lifestyle Medicine José de Mello Saúde by NOVA Medical School, Lisboa, Portugal
| | - F Macário
- Medical Department, DIAVERUM Portugal, Portugal
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Coelho ID, Romãozinho C, Teixeira AC, Rodrigues L, Ferreira E, Santos L, Macário F, Alves R, Figueiredo A. A Rare Manifestation of Tuberculosis in a Renal Transplant Patient: A Case Report. Transplant Proc 2019; 51:1618-1620. [PMID: 31155204 DOI: 10.1016/j.transproceed.2019.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cutaneous lesions in the presence of fever in patients undergoing immunosuppressive therapy are a diagnostic challenge and may represent manifestations of multiple diseases, such as fungal infections, nocardiosis, lymphoproliferative diseases, zoonosis, and tuberculosis. The authors report a case of a 66-year-old white man with chronic kidney disease since 2014 (chronic pyelonephritis) who had a renal transplant in the previous 6 months. Induction therapy was performed with thymoglobulin, and his current immunosuppression scheme included tacrolimus, mycophenolate mofetil, and prednisolone. The patient had no history of pulmonary tuberculosis. The patient presented with 2 cutaneous lesions, localized on the back and abdomen, that appeared to be firm, painful, subcutaneous, erythematous nodules with an approximately 5 cm diameter overlying an infected focus and purulent material inside. The patient also had a fever and fatigue. Blood analysis showed pancytopenia with an elevation of inflammatory markers and graft dysfunction. Tissue cultures and skin biopsy with histological analysis were performed. Histopathology of the lesion showed a nonspecific inflammatory infiltrate without granulomas, and acid-fast bacillus staining was negative. Nevertheless, serum QuantiFERON testing was positive. But polymerase chain reaction finally confirmed the presence of Mycobacterium tuberculosis, which confirmed the diagnosis of cutaneous tuberculosis. A chest computed tomography scan showed a lung pattern of miliary tuberculosis. The patient was treated with multidrug tuberculosis therapy, resulting in lesion clearance after 3 weeks. Tuberculosis is a serious infection, especially in high-risk patients, such as those in an immunocompromised state. The incidence of cutaneous tuberculosis is rare, but it should be considered in patients presenting with atypical skin lesions suggestive of an underlying infectious etiology.
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Affiliation(s)
- I D Coelho
- Nephrology Department, Amato Lusitano Hospital, Castelo Branco, Portugal.
| | - C Romãozinho
- Nephrology Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - A C Teixeira
- Nephrology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - L Rodrigues
- Nephrology Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - E Ferreira
- Nephrology Department, Coimbra University Hospital Center, Coimbra, Portugal
| | - L Santos
- Nephrology Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - F Macário
- Nephrology Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - R Alves
- Nephrology Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - A Figueiredo
- Urology and Kidney Transplantation Department, Coimbra University Hospital Center, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
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Teixeira AC, Ferreira E, Marques MG, Rodrigues L, Santos L, Romãozinho C, Afonso N, Sousa V, Ferreira C, Macário F, Alves R, Figueiredo A. Pretransplant Biopsy of Marginal Kidneys: Is It Necessary? Transplant Proc 2019; 51:1585-1589. [PMID: 31155197 DOI: 10.1016/j.transproceed.2019.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Pretransplant kidney biopsy from marginal donors is used to guide the decision of whether to accept or discard organs for transplantation; however, there is controversy about this procedure, and the need for a pretransplant biopsy is still a debate. We sought to determine if histologic evaluation before implantation of marginal kidneys would influence the outcome. METHODS A retrospective observational cohort study of marginal donor transplants at Centro Hospitalar e Universitário de Coimbra was done. From 2009 to 2016, 650 marginal kidney transplants were analyzed. We evaluated long-term graft survival in a cohort of patients who received marginal kidneys. The recipients were divided into 2 groups based on whether a pretransplant donor biopsy was performed. Continuous variables were summarized by mean and standard deviation or median and range, as applicable. Categorical variables were summarized by relative and absolute frequencies. The survival analysis was obtained and plotted using the Kaplan-Meier method and compared with the log-rank test. RESULTS The median age of recipients and donors were statistically different between both groups (P < .001), with the donors and the recipients being younger in the group without a pretransplant biopsy. The median cold ischemia time was higher in the biopsy group (P = .01). The survival analysis showed that graft survival didn't differ between the groups (P = .2). CONCLUSIONS Selection of kidneys based on histological findings may not influence the graft survival and implies a higher cold ischemia time. More data are necessary to provide insight into which clinical, histologic, and biochemical parameters are necessary for decision making on kidney acceptance.
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Affiliation(s)
- A C Teixeira
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - E Ferreira
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M G Marques
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - L Rodrigues
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - L Santos
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - C Romãozinho
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - N Afonso
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - V Sousa
- Pathology Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - C Ferreira
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
| | - F Macário
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - R Alves
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Figueiredo
- Urology and Transplantation Department, Coimbra Hospital and Universitary Centre, Coimbra, Portugal
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Cascais de Sá D, Rodrigues L, Santos L, Romãozinho C, Macário F, Marinho C, Pratas J, Alves R, Figueiredo A. Staphylococcus Infection-Associated Glomerulonephritis in a Kidney Transplant Patient: Case Report. Transplant Proc 2018; 50:853-856. [PMID: 29661452 DOI: 10.1016/j.transproceed.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Staphylococcus infection-associated glomerulonephritis is a rare cause of graft dysfunction in kidney transplant. Suspicion should be high in the setting of elevation of serum creatinine, active urinary sediment, with or without hypocomplementemia, and simultaneous Staphylococcus aureus infection. A kidney biopsy is usually diagnostic. CASE REPORT A 56-year-old man, who received a kidney transplant in 1998, with basal serum creatinine of 1.2 mg/dL and normal urinary sediment, was admitted to our kidney transplantation unit with graft dysfunction and a urinary tract infection caused by S aureus with septicemia, treated with antibiotics, in the context of recently intensified immunosuppression for a primary immune thrombocytopenia diagnosed 3 weeks earlier. After antibiotic treatment, the patient persisted with graft dysfunction, edema, and hypertension, with a S aureus isolation in the urine culture, active urinary sediment, and low C3. A kidney biopsy was performed, showing diffuse proliferative endocapillary and mesangial glomerulonephritis, with IgA(++) and C3(++) mesangial and endocapillary deposits in immunofluorescence. The patient was treated symptomatically and maintained his regular immunosuppression. At the last follow-up, his serum creatinine value was stable at 2.5 mg/dL. CONCLUSIONS The onset of a nephritic syndrome with a simultaneous S aureus infection should lead to suspicion of this uncommon entity, confirmed histologically. Despite its association with poor graft survival, our patient's graft survival remained stable.
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Affiliation(s)
- D Cascais de Sá
- Nephrology Department, Coimbra's University Hospital Center, Coimbra, Portugal; Nephrology Clinic, Coimbra's University Faculty of Medicine, Coimbra, Portugal.
| | - L Rodrigues
- Nephrology Department, Coimbra's University Hospital Center, Coimbra, Portugal; Nephrology Clinic, Coimbra's University Faculty of Medicine, Coimbra, Portugal
| | - L Santos
- Nephrology Department, Coimbra's University Hospital Center, Coimbra, Portugal; Nephrology Clinic, Coimbra's University Faculty of Medicine, Coimbra, Portugal
| | - C Romãozinho
- Nephrology Department, Coimbra's University Hospital Center, Coimbra, Portugal; Nephrology Clinic, Coimbra's University Faculty of Medicine, Coimbra, Portugal
| | - F Macário
- Nephrology Department, Coimbra's University Hospital Center, Coimbra, Portugal; Nephrology Clinic, Coimbra's University Faculty of Medicine, Coimbra, Portugal
| | - C Marinho
- Pathology Department, Coimbra's University Hospital Center, Coimbra, Portugal
| | - J Pratas
- Nephrology Department, Coimbra's University Hospital Center, Coimbra, Portugal; Nephrology Clinic, Coimbra's University Faculty of Medicine, Coimbra, Portugal
| | - R Alves
- Nephrology Department, Coimbra's University Hospital Center, Coimbra, Portugal; Nephrology Clinic, Coimbra's University Faculty of Medicine, Coimbra, Portugal
| | - A Figueiredo
- Urology and Kidney Transplantation Department, Coimbra's University Hospital Center, Coimbra, Portugal
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Leal R, Pinto H, Galvão A, Rodrigues L, Santos L, Romãozinho C, Macário F, Alves R, Campos M, Mota A, Figueiredo A. Early Rehospitalization Post-Kidney Transplant Due to Infectious Complications: Can We Predict the Patients at Risk? Transplant Proc 2017; 49:783-786. [PMID: 28457394 DOI: 10.1016/j.transproceed.2017.01.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 01/02/2023]
Abstract
INTRODUCTION Rehospitalization early post-kidney transplant is common and has a negative impact in morbidity, graft survival, and health costs. Infection is one the most common causes, and identifying the risk factors for early readmission due to infectious complications may guide a preventive program and improve outcome. The aim of this study was to evaluate the incidence, characterize the population, and identify the risk factors associated with early readmission for infectious complications post-kidney transplantation. METHODS We performed a retrospective cohort study of all the kidney transplants performed during 2015. The primary outcome was readmission in the first 3 months post-transplant due to infectious causes defined by clinical and laboratory parameters. RESULTS We evaluated 141 kidney transplants; 71% of subjects were men, with an overall mean age of 50.8 ± 15.4 years. Prior to transplant, 98% of the patients were dialysis dependent and 2% underwent pre-emptive living donor kidney transplant. The global readmission rate was 49%, of which 65% were for infectious complications. The most frequent infection was urinary tract infection (n = 28, 62%) and the most common agent detected by blood and urine cultures was Klebsiella pneumonia (n = 18, 40%). The risk factors significantly associated with readmission were higher body mass index (P = .03), diabetes mellitus (P = .02), older donor (P = .007), and longer cold ischemia time (P = .04). There were 3 graft losses, but none due to infectious complications. CONCLUSION There was a high incidence of early rehospitalization due to infectious complications, especially urinary tract infections to nosocomial agents. The risk factors identified were similar to other series.
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Affiliation(s)
- R Leal
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - H Pinto
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - A Galvão
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Rodrigues
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Santos
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Romãozinho
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F Macário
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - R Alves
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Campos
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Mota
- Urology and Kidney Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Figueiredo
- Urology and Kidney Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Ferreira E, Costa J, Romãozinho C, Santos L, Macário F, Bastos C, Alves R, Figueiredo A. Long-Term Outcomes of Kidney Transplantation From Expanded-Criteria Deceased Donors: A Single-Center Experience. Transplant Proc 2017; 49:770-776. [PMID: 28457392 DOI: 10.1016/j.transproceed.2017.01.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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
BACKGROUND Organ shortage has prompted the use of expanded-criteria donors (ECDs). Our objective was to compare long-term outcomes of kidney transplants from ECDs with those from concurrent standard-criteria donors (SCDs). In addition, we evaluated variables associated with graft survival in both groups. METHODS We retrospectively reviewed all 617 deceased-donor kidney transplantations performed from 2005 to 2009 in our department. The population was divided according to donor status into ECD or SCD. Patients were followed until 5 years after transplantation, death, graft failure, or loss to follow-up. RESULTS We transplanted 150 deceased-donor kidneys from ECDs and 467 from SCDs. ECD were older, more frequently women, had a lower pre-retrieval glomerular filtration rate, and more frequently died due to cerebrovascular accident. ECD recipients were older, presented a lower proportion of black race, more frequently were on hemodialysis, and presented a higher rate of first kidney transplants. Mean glomerular filtration rate was consistently lower in the ECD group. Patient and graft survivals were lower in the ECD group, but statistical significance was present only in graft survival censored for death with a functioning graft at 3 years and graft survival noncensored for death with a functioning graft at 5 years. Younger recipient ages, longer time on dialysis, acute rejection episodes, and glomerular filtration rate at 1 year after transplantation were independent risk factors for lower graft survival. CONCLUSIONS Transplantation with the use of ECD kidneys provide quite satisfactory patient and graft survival rates despite their poorer long-term outcomes.
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Affiliation(s)
- E Ferreira
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra-Hospitais da Universidade de Coimbra, Coimbra, Portugal.
| | - J Costa
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra-Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - C Romãozinho
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra-Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - L Santos
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra-Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - F Macário
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra-Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - C Bastos
- Department of Urology and Renal Transplantation, Centro Hospitalar e Universitário de Coimbra-Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - R Alves
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra-Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - A Figueiredo
- Department of Urology and Renal Transplantation, Centro Hospitalar e Universitário de Coimbra-Hospitais da Universidade de Coimbra, Coimbra, Portugal
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Costa JS, Ferreira E, Leal R, Bota N, Romãozinho C, Sousa V, Marinho C, Santos L, Macário F, Alves R, Pratas J, Campos M, Figueiredo A. Polyomavirus Nephropathy: Ten-Year Experience. Transplant Proc 2017; 49:803-808. [PMID: 28457399 DOI: 10.1016/j.transproceed.2017.01.072] [Citation(s) in RCA: 7] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND Polyomavirus nephropathy (BKVN) is an important cause of chronic allograft dysfunction (CAD). Recipient determinants (male sex, white race, and older age), deceased donation, high-dose immunosuppression, diabetes, delayed graft function (DGF), cytomegalovirus infection, and acute rejection (AR) are risk factors. Reducing immunosuppression is the best strategy in BKVN. The objective of our study was to evaluate CAD progression after therapeutic strategies in BKVN and risk factors for graft loss (GL). METHODS Retrospective analysis of 23 biopsies, from patients with CAD and histological evidence of BKVN, conducted over a period of 10 years. Glomerular filtration rate was <30 mL/min in 16 patients at the time of the BKVN diagnosis. RESULTS BKVN was histologically diagnosed in 23 recipients (19 men, 4 women). All patients were white, with age of 51.2 ± 12.1 years (6 patients, age >60 years), and 22 had a deceased donor. Diabetes affected 4 patients, DGF occurred in 3, cytomegalovirus infection in 2, and AR in 15. All patients were medicated with calcineurin inhibitors (CNI) (95.7% tacrolimus) and corticoids, and 16 also received an antimetabolite. One year after antimetabolite reduction/discontinuation and/or CNI reduction/switching and/or antiviral agents, graft function was decreased in 11 patients, increased/stabilized in 10, and unknown in 2. GL occurred in 9 patients. Older age (hazard ratio, 1.76; 95% confidence interval, 0.94-3.28) and DGF (hazard ratio, 2.60; 95% confidence interval, 0.54-12.64) were the main risk factors for GL. The lower GFR at the time of the BKVN diagnosis was associated with an increased risk of initiation of dialysis. CONCLUSIONS GL occurred in 39.1% of patients with BKVN and DGF; older age and lower GFR at the time of diagnosis were important risk factors. Early diagnosis of BKVN is essential to prevent GL.
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Affiliation(s)
- J S Costa
- Department of Nephrology, Coimbra Hospital and Universitary Center, Coimbra, Portugal.
| | - E Ferreira
- Department of Nephrology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - R Leal
- Department of Nephrology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - N Bota
- Department of Nephrology, Clínica Sagrada Esperança, Luanda, Angola
| | - C Romãozinho
- Department of Nephrology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - V Sousa
- Department of Anatomic Pathology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - C Marinho
- Department of Anatomic Pathology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - L Santos
- Department of Nephrology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - F Macário
- Department of Nephrology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - R Alves
- Department of Nephrology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - J Pratas
- Department of Nephrology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - M Campos
- Department of Nephrology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - A Figueiredo
- Department of Urology and Kidney Transplantation, Coimbra Hospital and Universitary Center, Coimbra, Portugal
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Pinto H, Leal R, Rodrigues L, Santos L, Romãozinho C, Macário F, Alves R, Pratas J, Sousa V, Marinho C, Prado E Castro L, Costa F, Campos M, Mota A, Figueiredo A. What Can We Do When All Collapses? Fatal Outcome of Collapsing Glomerulopathy and Systemic Lupus Erythematosus With Diffuse Alveolar Hemorrhage: Case Report. Transplant Proc 2017; 49:913-915. [PMID: 28457424 DOI: 10.1016/j.transproceed.2017.03.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Collapsing glomerulopathy (CG) is a rare form of glomerular injury. Although commonly associated with human immunodeficiency virus (HIV) infection, it can occur in association with systemic lupus erythematosus (SLE). CASE REPORT We present the case of a 50-year-old man, with chronic kidney disease secondary to focal and segmental glomerulosclerosis, who received a cadaveric kidney transplant in 2007. There were no relevant intercurrences until May 2015, when he presented with nephrotic range proteinuria (± 4 g/d). A graft biopsy was performed and it did not show any significant pathological changes. In September, he developed a full nephrotic syndrome (proteinuria 19 g/d) and a graft biopsy was repeated. CG features were evident with a rich immunofluorescence. Antinuclear antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies were positive; the remaining immunologic study was normal. Viral markers for HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) were negative. The patient was treated with corticosteroid pulses and plasmapheresis (seven treatments). A rapid deterioration of kidney function was seen and he became dialysis dependent. He was discharged with a low-dose immunosuppressive treatment. In October, he was hospitalized with diffuse alveolar hemorrhage (DAH). The auto-immune study was repeated, revealing complement consumption and positive titers of ANA and Anti-dsDNA antibodies. Anti-neutrophil cytoplasmic antibodies (ANCAs) and antiglomerular basement membrane antibody (anti-GBM) were negative. Treatment with intravenous corticosteroids, plasmapheresis, and human immunoglobulin was ineffective and the outcome was fatal. CONCLUSION This case report highlights the possible association of CG and SLE. To our knowledge, it is the first case of SLE presenting with CG and DAH, with the singularity of occurring in a kidney transplant recipient receiving immunosuppression.
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Affiliation(s)
- H Pinto
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - R Leal
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Rodrigues
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Santos
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Romãozinho
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F Macário
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - R Alves
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Pratas
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - V Sousa
- Pathology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Marinho
- Pathology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Prado E Castro
- Pathology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F Costa
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Campos
- Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Mota
- Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Figueiredo
- Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Pinto H, Leal R, Rodrigues L, Santos L, Romãozinho C, Macário F, Alves R, Bastos C, Roseiro A, Costa F, Campos M, Mota A, Figueiredo A. Surgical Complications in Early Post-transplant Kidney Recipients. Transplant Proc 2017; 49:821-823. [DOI: 10.1016/j.transproceed.2017.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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Grenha V, Parada B, Ferreira C, Figueiredo A, Macário F, Alves R, Coelho H, Sepúlveda L, Freire MJ, Retroz E, Mota A. Hepatitis B virus, hepatitis C virus, and kidney transplant acute rejection and survival. Transplant Proc 2016; 47:942-5. [PMID: 26036490 DOI: 10.1016/j.transproceed.2015.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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
The effect of hepatitis Bs-antigen (AgHBs) and anti-hepatitis C virus (HCV) positivity on renal transplant outcomes is still controversial. Some studies describe higher rates of acute rejection and allograft loss, and greater mortality in transplant recipients with hepatitis. We retrospectively evaluated data from 2284 allograft recipients who underwent transplantation at our hospital between July 1980 and December 2012. Statistical analysis was made using chi-square and Student t tests, Kaplan-Meier curves, and survival analysis. We identified 62 AgHBs+ patients, 99 anti-HCV+ patients, and 14 AgHBs+/anti-HCV+ patients; 2109 patients had "no hepatitis." Mean follow-up time was 7.93 years. No statistical differences were identified on allograft acute rejection rate or patient survival between groups. AgHBs+ patients had, however, an inferior allograft survival, with statistical significance. According to our study, hepatitis B has a harmful impact on allograft survival, although it does not compromise the patient survival.
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Affiliation(s)
- V Grenha
- Serviço de Urologia e Transplantação Renal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - B Parada
- Serviço de Urologia e Transplantação Renal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Ferreira
- Serviço de Urologia e Transplantação Renal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Figueiredo
- Serviço de Urologia e Transplantação Renal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F Macário
- Serviço de Nefrologia, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra, Portugal
| | - R Alves
- Serviço de Nefrologia, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, Coimbra, Portugal
| | - H Coelho
- Serviço de Urologia e Transplantação Renal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Sepúlveda
- Serviço de Urologia e Transplantação Renal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M J Freire
- Serviço de Urologia e Transplantação Renal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - E Retroz
- Serviço de Urologia e Transplantação Renal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Mota
- Serviço de Urologia e Transplantação Renal, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Santos T, Santos L, Macário F, Romãozinho C, Alves R, Campos M, Mota A. New Recipes With Known Ingredients: Combined Therapy of Everolimus and Low-dose Tacrolimus in De Novo Renal Allograft Recipients. Transplant Proc 2015; 47:906-10. [PMID: 26036483 DOI: 10.1016/j.transproceed.2015.03.042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Calcineurin inhibitors (CNIs) are the cornerstones of immunosuppressive management in renal allograft recipients even though their nephrotoxicity may contribute to a reduced long-term graft survival. This has created a great interest in improving immunosuppressive strategies in the early post-transplantation period. Proliferation signal inhibitors (PSIs), such as everolimus, are promising alternatives, although their side effects may have a drawback in de novo renal transplant recipients, for instance, delaying renal function in the presence of renal ischemia/acute tubular necrosis and predisposing to lymphocele development. STUDY AND METHODS A retrospective study was developed to compare the combined therapy of low-dose tacrolimus and everolimus (study group) with mycophenolate mofetil/mycophenolic acid and standard-dose tacrolimus (control group) in the first 3 months post-transplantation. The study's end-points concerned renal graft function, proteinuria, incidence of biopsy-proven acute rejection, surgical complication rates, and incidence of new-onset diabetes after renal transplantation. RESULTS There was no more delayed graft function in the study group and graft function distribution was similar between groups. Median serum creatinine and eGFR were comparable as well as proteinuria levels. Generally, adverse events were rare in both groups and there were no significant statistical differences between them in terms of biopsy-proven acute rejection, surgical complication, and new-onset diabetes after renal transplantation rates. CONCLUSION Despite the slightly lower tendency for serum creatinine in the study group, renal allograft function wasn't statistically different between groups. Moreover, there weren't more metabolic or surgical complications in the study group. Everolimus may be a choice in tacrolimus-sparing strategies, but a larger study and a longer follow-up are still required.
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Affiliation(s)
- T Santos
- Nephrology Department, CHUC, Coimbra, Portugal.
| | - L Santos
- Nephrology Department, CHUC, Coimbra, Portugal
| | - F Macário
- Nephrology Department, CHUC, Coimbra, Portugal
| | | | - R Alves
- Nephrology Department, CHUC, Coimbra, Portugal
| | - M Campos
- Nephrology Department, CHUC, Coimbra, Portugal
| | - A Mota
- Urology and Kidney Transplantation Department, CHUC, Coimbra, Portugal
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Aguiar B, Santos Amorim T, Romãozinho C, Santos L, Macário F, Alves R, Campos M, Mota A. Malignancy in Kidney Transplantation: A 25-Year Single-center Experience in Portugal. Transplant Proc 2015; 47:976-80. [DOI: 10.1016/j.transproceed.2015.03.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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13
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Guedes-Marques M, Romãozinho C, Santos L, Macário F, Alves R, Mota A. Kidney Transplantation: Which Variables Should Be Improved? Transplant Proc 2015; 47:914-9. [DOI: 10.1016/j.transproceed.2015.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Cotovio P, Neves M, Rodrigues L, Alves R, Bastos M, Baptista C, Macário F, Mota A. New-onset diabetes after transplantation: assessment of risk factors and clinical outcomes. Transplant Proc 2013; 45:1079-83. [PMID: 23622631 DOI: 10.1016/j.transproceed.2013.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND New-onset diabetes after transplantation (NODAT) is a serious complicatin of kidney transplantation (KT) with adverse impacts on graft and patient survivals. This study aims assess potential risk factors for development of NODAT and compare clinical outcomes of KT recipients with versus without NODAT. METHODS We retrospectively evaluated 648 patients who underwent KT between 2005 and 2009. From the 83 (12.8%) subjects who developed NODAT, we selected 47 for comparison with controls free of diabetes. RESULTS The diagnosis of NODAT was made at 4.3 ± 8.5 months after transplantation in 47 patients, including 76.6% males, with an overall mean age of 54.5 ± 10.8 years. Patients with NODAT presented higher pretransplantation fasting plasma glucose levels (P < .001) as well as cyclosporine and tacrolimus trough levels (P = .003 and P < .001, respectively). On multivariate analysis, higher pretransplantation fasting plasma glucose and higher tacrolimus, but not cyclosporine concentrations were independent predictors of NODAT. No differences were found for other potential risk factors. Upon follow-up at 6, 12, 24, 36, 48, and 60 months, renal function (estimated Glomerular Filtration Rate using Modification of Diet in Renal Disease), 24 hour proteinuria and proportions of patients with hypertension were similar between groups. Patients with NODAT showed comparable numbers of hospitalizations and infections, as well as acute rejection episodes and acute cardiovascular events as their counterparts. Event-free survival (loss of graft function/death with functioning graft) was similar between the groups (P = .418; K-M). DISCUSSION In our population, higher pretransplantation fasting plasma glucose levels and higher tacrolimus concentrations were independent predictors of NODAT. During a mean follow-up of 3 years, NODAT was not associated with worse clinical outcomes.
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Affiliation(s)
- P Cotovio
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
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15
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Abstract
INTRODUCTION Immunosuppression with calcineurin inhibitors (CNI) in renal transplantation is associated with chronic graft dysfunction, increased cardiovascular risk, and malignancies. Everolimus (EVR) appears to permit a CNI-sparing regimen among stable kidney recipients. AIM The aim of this study was to analyze the efficacy and safety of conversion from CNI to EVR. MATERIAL AND METHODS This was a retrospective registry-based study of all kidney transplant recipients converted from CNI to EVR between 2006 and 2010. One hundred fifty-one patients, including 69.5% males and with an overall mean age of 50.2 ± 12.7 years, underwent conversion to EVR at 37.0 ± 49.8 (16) months after transplantation with 33.7% during the first 6 months. Reasons for conversion included: CNI nephrotoxicity prevention (54.3%), chronic graft dysfunction (25.8%), malignant tumors (10.6%), CNI-adverse reactions (6.6%), and biopsy-proven CNI nephrotoxicity (2.6%). During a follow-up of 17.9 ± 9.9 months (range, 6-58.5), 18 patients (11.9%) were reconverted to CNI, 2 died with functioning grafts, and 2 lost kidney function. RESULTS We observed a significant (P < .001) increase in estimated glomerular filtration rate-Modification of Diet in Renal Disease (eGFR-MDRD) by 11.3% within 6 months: 56.7 ± 22.1 to 64.1 ± 23.4 mL/min/1.73 m(2). At final evaluation it was 13.7%, namely, to 65.5 ± 23.0 mL/min/1.73 m(2). At the end of follow-up the proportion of patients with >300 mg/d proteinuria increased from 7.9% to 23.3% (P = .001). Dyslipidemia prevalence increased from 69.5% to 77.5% (P = not significant [NS]) and arterial hypertension increased from 49% to 65.9% (P < .001) at the end of follow-up. Other reported side effects included oral ulcers (2.6%), edema (5.3%), interstitial pneumonitis (1.3%), and toxic hepatitis (1.3%), some of them leading to EVR discontinuation. CONCLUSION In our population, renal function improved significantly after conversion from CNI to EVR. Although side effects were common, most were mild, withdrawal of EVR was necessary in a low percentage of cases. EVR appears to be an effective, safe alternative to CNI for maintenance therapy in selected kidney transplant recipients.
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Affiliation(s)
- P Cotovio
- Department of Nephrology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
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Rodrigues L, Neves M, Machado S, Sá H, Macário F, Alves R, Mota A, Campos M. Uncommon cause of chest pain in a renal transplantation patient with autosomal dominant polycystic kidney disease: a case report. Transplant Proc 2013; 44:2507-9. [PMID: 23026633 DOI: 10.1016/j.transproceed.2012.07.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a common cause of end-stage renal disease (ESRD) and, because of its intrinsic systemic involvement, its treatment can be a medical and surgical challenge. This condition is often associated with the presence of hepatic cysts and their prevalence generally increases with age. Most patients remain asymptomatic, but some of these will develop complications associated with enlargement and infection of their cysts. Chest pain is a rare manifestation of these complications and, after exclusion of more common cardiovascular and pulmonary causes, should raise the suspicion of an infected hepatic cyst in these patients. We report the case of a 62-year-old male who underwent a kidney transplantation from a cadaveric donor in 1997 (etiology of the ESRD was ADPKD), and was admitted to the emergency department with complaints of chest pain radiating to both shoulders and the interscapular region. An echocardiogram was showed compression of the right atrium by a large liver cyst without associated ventricular dysfunction. Computer tomography-guided drainage of the cyst was performed and an Enterobacter aerogenes sensitive to carbamapenemes was isolated from respective cultures. The patient presented a favorable clinical outcome with prolonged administration of antibiotic therapy according to the antibiotic susceptibility testing. There was no need for surgical intervention.
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Affiliation(s)
- L Rodrigues
- Department of Nephrology, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
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17
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Neves M, Cotovio P, Machado S, Santos L, Macário F, Alves R, Pratas J, Xavier da Cunha M, Mota A, Campos M. C4d deposits in acute "cell-mediated" rejection: a marker for renal prognosis? Transplant Proc 2012; 44:2360-5. [PMID: 23026593 DOI: 10.1016/j.transproceed.2012.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Accumulation of C4d along peritubular capillaries (PTC) of renal allografts is normally attributed to antibody-mediated rejection. The prognostic implication of these deposits associated with "cell-mediated" rejection on graft survival remains uncertain. Our study aims to evaluate the impact of C4d deposits along PTC of patients with acute cell- mediated rejection on graft function and survival. METHODS We retrospectively analyzed patients transplanted between 2005 and 2010 with histopathologic diagnosis of acute rejection (AR). Eleven patients with "pure" antibody-mediated rejection were excluded. The remaining 79 patients were divided into two groups according to type of AR by Banff 2003 criteria: type I (69.6%) versus type II (30.4%). In each group, comparisons were made between C4d-negative (-) and C4d-positive (+) biopsies. RESULTS Fifty-five patients presented with type I AR: 35 (63.6%) C4d- and 20 (36.4%) C4d+. Twenty-four patients presented with type II AR: 13 (54.2%) C4d- and 11 (45.8%) C4d+. In the type I AR group, graft survival at the first and second years was similar in C4d- and C4d+ patients (94% and 91% versus 75% and 75%, respectively, log-rank P = .26). No differences were encountered in estimated glomerular filtration rate (eGFR) between subgroups at the first, second, and final years of follow-up. Graft loss occurred in 14.7% of C4d- patients versus 25% in C4d+ patients (P = NS). In the type II AR group, graft survival at the first and second years was similar in C4d- and C4d+ patients (85% and 85% versus 72% and 61%, respectively, log-rank P = .50). No differences were encountered in eGFR between subgroups at the first, second, and final years of follow-up. Graft loss occurred in 30.8% of C4d- patients versus 45.5% in C4d+ patients (P = NS). CONCLUSION Our results suggest that detection of C4d staining in acute "cell-mediated" rejection does not imply a worse renal prognosis.
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Affiliation(s)
- M Neves
- Department of Nephrology, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
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Abstract
BACKGROUND AND PURPOSE Older patients on hemodialysis have become candidates for renal transplantation, particularly in the period of increasing numbers of marginal donors. The purpose of this study was to evaluate short-term and long-term results of renal transplantation among recipients ≥65 years old for comparison with these in younger patients. PATIENTS AND METHODS We retrospectively studied 1,796 renal transplantations performed between June 1991 and May 2010, dividing the sample into 2 groups: ≥65 years old (n = 89) versus <65 years old (n = 1,707). RESULTS The mean ages were 42.17 and 67.45 years for the younger and older groups, respectively. Time of pretransplantation dialysis was significantly greater among the older group (52.76 vs 47.69 mo). There were no differences between the 2 groups regarding donor age, donor renal function, or cold ischemia times. After a mean follow-up of 73.37 versus 39.73 months for the younger versus older groups, respectively, we observed differences in initial graft function, with a greater rate of delayed graft function in the ≥65 group (28.1% vs 17.8%), and in acute rejection rate, which was higher among the younger group (19.4% vs 10.1%). Initial creatinine was better for the older group (1.71 vs 2.10 mg/dL), but similar between the groups at 10 years. Graft and patient survivals at 1, 5, and 10 years were lower among the older group. When analyzing graft survival censored for death with a functioning kidney, there were no differences between the younger and older groups: It was at 1, 5, and 10 years, namely 93.6% versus 90.6%, 87% versus 80.8%, and 76.7% versus 70.1%, respectively. CONCLUSIONS Selected recipients ≥65 years of age show good outcomes of transplantation.
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Affiliation(s)
- P Eufrásio
- Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal.
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Lopes K, Alves R, Neto P, Macário F, Mota A. The Prognostic Value of Pre-implantation Graft Biopsy on the Outcomes of Renal Transplantations. Transplant Proc 2011; 43:67-9. [DOI: 10.1016/j.transproceed.2010.12.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Santos L, Macário F, Alves R, Mota A, Campos M. Risks of Living Donor Nephrectomy. Transplant Proc 2010; 42:1484-6. [DOI: 10.1016/j.transproceed.2009.12.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 12/07/2009] [Indexed: 11/27/2022]
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Ferrer F, Mota A, Alves R, Bastos C, Macário F, Figueiredo A, Santos L, Roseiro A, Parada B, Pratas J, Nunes P, Campos M. Renal transplantation with expanded criteria donors: the experience of one Portuguese center. Transplant Proc 2009; 41:791-3. [PMID: 19376353 DOI: 10.1016/j.transproceed.2009.02.044] [Citation(s) in RCA: 13] [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: 10/20/2022]
Abstract
BACKGROUND The shortage of kidneys available for transplantation has led to enlarged criteria donors (ECD): namely, donors older than 60 years or aged between 50 and 59 years with 2 of the following characteristics-hypertension, predonation serum creatinine level higher than 1.5 mg/dL or cerebrovascular disease as the cause of death. The aim of this study was to analyze renal transplants using ECD compared with standard criteria donors (SCD) concerning the incidences of delayed graft function (DGF), acute rejection episodes (ARE), and patient and graft survivals. MATERIALS AND METHODS This retrospective study of 409 cadaveric renal transplants over the last 4 years identified ECD in contrast with SCD. RESULTS Of the transplants, 24.4% used ECD. The baseline characteristics of recipients of ECD versus SCD kidneys were similar, except for age and cold ischemia time. Comparing ECD and SCD, we observed an higher incidence of DGF (35% vs 18%), occurrence of ARE (34.4% vs 16.6%), average serum creatinine levels at 6 (1.87 vs 1.4 mg/dL), and 12 months (1.88 vs 1.43 mg/dL) as well as lower graft survival at 1 (82% vs 91%) and 3 years (75% vs 84%) after transplantation. Recipient survival at 1 year was not different. Multivariate analysis identified recipient age, cold ischemia time, ARE, and DGF as risk factors for graft failure. CONCLUSIONS Renal transplantation with grafts from ECD shows significantly worse outcomes with higher rates of DGF and ARE, worse graft function, and lower graft survival.
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Affiliation(s)
- F Ferrer
- Renal Transplantation Unit, Department of Urology and Renal Transplantation, Hospitais da Universidade de Coimbra, Portugal.
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Filipe R, Mota A, Alves R, Bastos C, Macário F, Figueiredo A, Roseiro A, Parada B, Sá H, Nunes P, Bastos M. Kidney transplantation with corticosteroid-free maintenance immunosuppression: a single center analysis of graft and patient survivals. Transplant Proc 2009; 41:843-5. [PMID: 19376367 DOI: 10.1016/j.transproceed.2009.02.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to assess the impact of a corticosteroid-free maintenance immunosuppression on graft survival in kidney transplantation. We analyzed 79 patients who were transplanted between June 1, 2006 and May 31, 2007. We excluded hyperimmunized patients, second transplantations, living donors, and black recipients. Patients underwent induction with thymoglobulin or basiliximab, followed by treatment with mycophenolate mofetil (MMF), tacrolimus, and methylprednisolone. On the 5th day, the patients were divided into 2 groups: group A (n = 45) discontinued steroid therapy; group B (n = 34) continued prednisone therapy. We performed a comparative analysis of incidence of delayed graft function (DGF), acute rejection episodes (ARE), renal function at 6 and 12 months, graft and patient survivals, causes of graft loss, and mortality. The 2 groups were similar for donor, recipient, and graft characteristics. The incidences of DGF were 8.9% in group A and 14.7% in group B; those for ARE were 2.3% in group A and 13.8% in group B (P = .077). The mean serum creatinine levels at 6 and 12 months were similar. There were 8 graft losses: 3 in group A (3 deaths with functioning grafts) and 5 in group B (1 death, 3 vascular causes, 1 kidney nonfunction). The 4 deaths were due to infection (n = 3) or neoplasia (n = 1). Graft survivals at 1 year were 98% in group A and 85% in group B, and patient survivals were 98% and 97%, respectively. An immunosuppressive regimen using antibody induction and steroid-free treatment proved to be effective in low-risk patients.
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Affiliation(s)
- R Filipe
- Renal Transplantation Unit, Departments of Urology and Kidney Transplantation, Coimbra University Hospital, Coimbra, Portugal.
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Nunes P, Mota A, Alves R, Figueiredo A, Parada B, Macário F, Rolo F. Simultaneous renal transplantation and native nephrectomy in patients with autosomal-dominant polycystic kidney disease. Transplant Proc 2007; 39:2483-5. [PMID: 17954154 DOI: 10.1016/j.transproceed.2007.07.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
UNLABELLED Our objective was to study the influence on transplant outcome of unilateral native nephrectomy of massively enlarged kidneys at the time of renal transplantation among patients with end-stage renal disease owing to autosomal-dominant polycystic kidney disease (ADPKD). PATIENTS AND METHODS We studied 159 renal transplants in patients with ADPKD divided into two groups according to the need to perform a unilateral native nephrectomy owing to enlarged kidneys (N+; n = 143) versus those not (N0; n = 16) needing this procedure. Parameters related to the donors, grafts, recipients, and operative data were correlated with short- and long-term outcomes. The groups were homogeneous in terms of recipient and donor ages, genders, HLA compatibilities, and length of pretransplant dialysis. RESULTS When no nephrectomy was needed surgery length was shorter (N0, 3.01 vs. N+, 4.23 hours; P < .001), less intraoperative crystalloids were infused (N0, 1.84 vs. N+, 2.76 L; P < .001), and less plasma (N0, 2.07 vs. N+, 2.93 U; P < .05), or blood (N0, 1.05 vs. N+, 1.81 U; P < .05) transfusions were required. Hospital stay was similar (N0, 12.70 vs N+, 16.50 days; P not significant [NS]). There was only one urologic complication in the nephrectomy group. There were no differences (P = NS) in rates of delayed graft function (N0, 19.9%; N+, 12.5%), acute rejections (N0, 25.5%; N0, 33.3%), chronic allograft dysfunction (N0, 15.8%; N+, 28.6%). Graft function at 1 month as well as 1 and 5 years were comparable. Patient and graft survivals were similar at 1 and 5 years. There were no differences in the causes of graft loss or patient death. CONCLUSION In patients with ADPKD native nephrectomy of massively enlarged kidneys may be safely performed during the transplant procedure with no repercussions on the length of hospital stay, graft short- and long-term function and patient survival. However the procedure eads to a longer operative time and greater need for fluids and blood products.
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Affiliation(s)
- P Nunes
- Department of Urology and Renal Transplantation, Hospitais da Universidade de Coimbra, 3000 Coimbra, Portugal.
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Nunes P, Mota A, Figueiredo A, Macário F, Rolo F, Dias V, Parada B. Efficacy of Renal Preservation: Comparative Study of Celsior and University of Wisconsin Solutions. Transplant Proc 2007; 39:2478-9. [DOI: 10.1016/j.transproceed.2007.07.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Figueiredo A, Moreira P, Parada B, Nunes P, Macário F, Bastos C, Mota A. Risk Factors for Delayed Renal Graft Function and Their Impact on Renal Transplantation Outcome. Transplant Proc 2007; 39:2473-5. [DOI: 10.1016/j.transproceed.2007.07.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Parada B, Figueiredo A, Nunes P, Macário F, Mota A. UP-01.68. Urology 2006. [DOI: 10.1016/j.urology.2006.08.712] [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: 10/24/2022]
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Nunes P, Parada B, Pratas J, Roseiro A, Figueiredo A, Macário F, Rolo F, Mota A. Cadaveric Donor Factor Variations During a 12-Year Period: Influence on Kidney Transplant Outcomes. Transplant Proc 2006; 38:1867-9. [PMID: 16908308 DOI: 10.1016/j.transproceed.2006.06.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/21/2022]
Abstract
UNLABELLED Our purpose was to evaluate changes in cadaveric donor factors between 1993 and 2004 and their impact on the short- and long-term outcomes of renal transplants in a single center. PATIENTS AND METHODS Cadaveric renal transplants performed in our unit between 1993 and 2004 were divided in two groups of identical length: A (n = 455; 1993-1998) and B (n = 465; 1999-2004). Major differences related to donor, graft, and recipient factors were analyzed between groups and correlated with main outcome parameters. Recipient age, gender, weight, etiology of end-stage renal disease, average length of dialysis, and cold ischemia were not different in the two periods. RESULTS Grafts harvested in our hospital were more frequent in group A (92.3 vs 78.2%; P < .005). Traumatic causes of death were more frequent before 1999: 90.9 vs 70.9% (P < .001). Mean donor age was higher after 1999: 31.37 vs 35.94 years (P < .005). Female donors were more frequent in the second period: 20.5 vs 26.6% (P < .05). Mean donor weight was also higher: 52.36 vs 67.86 kg (P < .05). All of these differences were unfavourable characteristics regarding graft outcomes. Delayed graft function (A = 13%, B = 24.2%), acute rejection episodes (A = 41.2%, B = 28%), and chronic allograft dysfunction (A = 23.5%, B = 14.4%) were also significantly different between the two cohorts (P < .005). Graft function (serum creatinine at 1 and 2 years), patient and graft survivals, causes of graft loss, and of patient death were similar across time. CONCLUSION The unfavorable tendency in the quality of cadaveric donors during the last 12 years had no negative impact on graft function and patient outcome.
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Affiliation(s)
- P Nunes
- Department of Urology and Renal Transplantation, Hospitais da Universidade de Coimbra, 3000 Coimbra, Portugal.
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Parada B, Figueiredo A, Nunes P, Bastos C, Macário F, Roseiro A, Dias V, Rolo F, Mota A. Pediatric renal transplantation: comparative study with renal transplantation in the adult population. Transplant Proc 2006; 37:2771-4. [PMID: 16182806 DOI: 10.1016/j.transproceed.2005.05.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [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
PURPOSE To retrospectively review our experience with pediatric renal transplantation and to compare the results with the adult population. PATIENTS AND METHODS Between January 1981 and August 2003, 74 renal transplants were performed in patients < or =18 years at the time of the transplant--the pediatric group versus 1153 patients in the adult group. We analyzed various risk factors for actuarial kidney graft and patient survivals using the Kaplan-Meier method. RESULTS Median ages were 13.8 +/- 3.5 and 42.6 +/- 2.4 years, respectively. There was no statistically significant difference in the human leukocyte antigen matching or immunosuppression. There was, however, a younger donor age and shorter ischemia time in the pediatric group. Overall, kidney transplant survival rates for patients < or =18 years at 1, 2, 5, and 10 years were 94.4%, 91.3%, 70.6%, and 58.2%, respectively, with no significant difference for patients older than 18 (91.2%, 89.3%, 78.8%, 60.5%, P = .4325). There was a significantly decreased graft survival in the adult group at 10 years when the donor age was over 60 years and when the ischemia time was > or =20 hours. The incidence of delayed graft function and the creatinine levels of functioning grafts did not differ between the two groups. During the follow-up, acute rejections were more frequent in the younger group. Patient survival in the pediatric group at 1, 2, 5, and 10 years was 98.6%, 98.8%, 98.6%, and 90.3%, respectively, significantly lower in the adult group (95.3%, 94.0%, 87.9%, 76.8%, P < .02). CONCLUSIONS Renal transplantation may be successfully performed in the pediatric patients with end-stage renal disease. Overall graft survival at 10 years did not differ significantly between the two groups. There is a higher incidence of acute rejections but longer patient survival in the pediatric population.
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Affiliation(s)
- B Parada
- Department of Urology and Renal Transplantation, University Hospital of Coimbra, Coimbra, Portugal.
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Abstract
PURPOSE Compare renal transplant long-term outcomes among recipients aged 60 years or older with those in younger patients. PATIENTS AND METHODS We analyzed 103 transplants in recipients above 60 years of age for the influence of key factors related to the graft and patient. The results were compared with 1060 transplant recipients aged 18 to 59 years. RESULTS The mean ages were 62.93 and 40.35 years for the older and younger group. The older group showed a higher prevalence of obesity and unknown etiologies for the end-stage renal disease. Important comorbidity was significantly more frequent among recipients aged more than 60 years, mainly of a cardiovascular nature (56% vs 18.5%). Donor age (39.75 vs 31.59 years), cold ischemia time (22.43 vs 20.49 hours) and human leukocyte antigen compatibilities (2.59 vs 2.36) were significantly greater in the older subset. After a mean follow-up of 4.72 and 6.07 years for the older versus younger group, we found no differences in initial graft function, acute rejection rate, and serum creatinine/clearance. Patient and graft survivals at 1, 5, and 10 years were lower among the 60+ group. There were no differences in graft survival censored for death with a functioning graft, namely, 95.1%, 89.4%, and 81.2% for the 60+ cohort. The main cause of graft loss in the older group was death with a functioning graft. CONCLUSION Renal transplantation should be considered for selected patients older than 60 years. Despite a shorter life expectancy, they benefit from it similar to younger recipients.
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Affiliation(s)
- P Nunes
- Department of Urology and Renal Transplantation, Hospitais da Universidade de Coimbra, Coimbra, Portugal.
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Abstract
PURPOSE To describe our initial results using a calcineurin inhibitor-free immunosuppression protocol in renal transplants. PATIENTS AND METHODS Between October 2001 and June 2003, 56 recipients of a renal allografts were started on an immunosuppression protocol without calcineurin inhibitors, consisting of basiliximab, sirolimus, mycophenolate mofetil, and steroids. We analyzed patient and graft survival, acute rejection episodes, and renal function. RESULTS The mean follow-up was 19.6 months. Actuarial patient survival at 1 and 2 years was 98.1% and 95.3%, respectively. Actuarial graft survival at 1 and 2 years was 92.9% and 87.6%, respectively. Acute rejection occurred in 27.8% of the patients, usually Banff 1 (73.3%). There was stable renal function with mean serum creatinine of 1.3, 1.4, 1.3, and 1.3 mg/dL at 1, 6, 12, and 24 months after transplant. CONCLUSIONS The use of immunosuppression free of calcineurin inhibitors is effective and safe. Further follow-up is needed to evaluate the impact on long-term results.
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Affiliation(s)
- B Parada
- Department of Urology and Renal Transplantation, University Hospital of Coimbra, Coimbra, Portugal.
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Lemos S, Macário F, Pratas J, Figueiredo A, Bastos C, Mota A, Campos M. TACROLIMUS VERSUS CYCLOSPORINE: A STUDY ABOUT TWO IMMUNOSUPPRESSIVE REGIMENS. Transplantation 2004. [DOI: 10.1097/00007890-200407271-01959] [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]
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Mota A, Figueiredo A, Macário F, Cunha FX, Freitas L, Parada B, Bastos C, Furtado L. Risk factors for chronic graft dysfunction in 918 renal transplants. Transplant Proc 2003; 35:1064-5. [PMID: 12947857 DOI: 10.1016/s0041-1345(03)00307-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Mota
- Department of Urology and Transplantation, Coimbra University Hospital, 3049 Coimbra, Portugal
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Baptista C, Bastos M, Gomes L, Macário F, Ruas L, Rodrigues D, Alves R, Gomes H, Ferreira C, Roseiro A, Paiva S, Barros L, Carvalheiro M, Mota A, Furtado AL, Ruas MM. [Kidney transplantation in patients with type I and type II diabetes mellitus]. ACTA MEDICA PORT 1998; 11:943-6. [PMID: 10021792] [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: 02/10/2023]
Abstract
A total of 618 patients with end-stage renal disease received kidney transplants between 1980 and September 1996. Twenty eight of them were diabetics. Better results were achieved for type 1 diabetic patients than for type 2 (mortality: 5.9% vs 27.3%; functioning graft: 88.2% vs 72.7%). The morbility was also higher in those patients (infections: 81.8% vs 29.4%; vascular complications: 45.5% vs 17.6%). Actuarial patient and graft survival were lower for type 2 than for non diabetic patients. For type 1 diabetics the results are similar to those for non diabetics. Better results can probably be achieved by restricting the selection criteria. The decision to transplant or maintain on dialysis should be made on a case by case basis.
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Affiliation(s)
- C Baptista
- Serviço de Endocrinologia, Diabetes e Metabolismo, Hospitais da Universidade de Coimbra
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Macário F, Macário MC, Ferro A, Gonçalves F, Campos M, Marques A. Sneddon's syndrome: a vascular systemic disease with kidney involvement? Nephron Clin Pract 1997; 75:94-7. [PMID: 9031277 DOI: 10.1159/000189506] [Citation(s) in RCA: 16] [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: 02/03/2023] Open
Abstract
Sneddon's syndrome is a systemic disease characterized by livedo reticularis and cerebrovascular disease. Other organs may be involved as well. Typical vascular lesions in the skin biopsy and/or digital arteries biopsy can be found. Arterial hypertension, cardiac pathology (ischemic disease, myocardial infarction, valvulopathy), venous thrombosis and even fetal death are also found sometimes. We present a case of Sneddon's syndrome in which typical vascular lesions in the kidney were demonstrated for the first time unequivocally confirming the systemic nature of this syndrome.
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Affiliation(s)
- F Macário
- Renal Unit, University Hospital of Coimbra, Portugal
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Macário F, Freitas L, Correia J, Campos M, Marques A. Nephrotic syndrome after recombinant hepatitis B vaccine. Clin Nephrol 1995; 43:349. [PMID: 7634556] [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: 01/26/2023] Open
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