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Obesity in kidney transplantation.

Kidney transplantation is the preferred modality of renal replacement therapy. Long-term patient and graft survival have only improved marginally over the recent decade, mainly because of the development of cardiovascular disease after transplantation. Obesity is a risk factor for cardiovascular disease and is common before and after transplantation. This article reviews the literature assessing the role of pre- and post-transplant obesity on patient and graft survival, discusses the underlying obesity-related mechanisms leading to inferior kidney transplant outcomes, and explores the role of …

IgG4-related kidney disease.

PURPOSE OF REVIEW: IgG4-related disease (IgG4-RD) is a recently recognized systemic autoimmune disease that has received increased attention in the literature in the past several years. Renal involvement can take several forms, which are described in this review. RECENT FINDINGS: IgG4-RD may affect the kidney in various patterns. IgG4-related tubulointerstitial nephritis (TIN), presenting as either a mass lesion, renal failure, or both, has become an accepted manifestation of IgG4-RD. Two large series with biopsies and one clinical series of IgG4-related TIN have been published in the past tw…

[Kidney involvement in sarcoidosis].

Sarcoidosis is a chronic multisystemic inflammatory disorder of unknown etiology, characterized by the presence of non-necrotizing epithelio … ms to be the most frequent glomerular disease that may occur in association with sarcoidosis. Among kidney allograft recipients, the risk of recurrence of granulomatous tubulointerstitial nephritis is high and may have a negative impact on the graft survival.

ABO-incompatible kidney transplantation.

Owing to the shortage of deceased donors in Japan, since 1989, we have performed ABO-incompatible kidney transplantation (ABO-IKTx) to expand the indication for living donor kidney transplantation. During the past two decades, about 2000 ABO-IKTxs were performed. Since 2001 the success rate for these kidney transplants has reached 96% for 1-year, 91% for 5-year and 83% for 9-year graft survival, similar to outcomes of ABO-compatible kidney transplantation (ABO-CKTx). This dramatic improvement in results means that ABO-IKTx has become accepted as a therapeutic alternative for end-stage renal fa…

[Migraine-induced kidney stones?].

A 42-year old woman was referred for a metabolic evaluation after two episodes of kidney stones. Her laboratory results revealed a normal anion-gap metabolic acidosis, a marked hypocitraturia (0,6 mmol/24h; norm 1,6-4,5) and a urinary pH of 7,0 confirming renal tubular acidosis (RTA). We identified topiramate, our patient's medication for migraine, as the cause of the RTA. Topiramate, a carboanhydrase inhibitor leads to RTA of a mixed (proximal and distal) type and thus significantly increases the risk for kidney stones.

IgG4-related kidney disease.

IgG4-related kidney disease is a term that refers to any form of renal involvement by IgG4-related disease (IgG4-RD), a recently recognized systemic immune-mediated disease. The most common renal manifestation is IgG4-related tubulointerstitial nephritis (IgG4-TIN), which presents as acute or chronic renal insufficiency, renal mass lesions, or both. On biopsy, IgG4-TIN shows a plasma cell-rich interstitial inflammatory infiltrate with increased IgG4+ plasma cells, along with expansile interstitial fibrosis; tubular basement membrane immune complex deposits are common. IgG4-TIN usually shows a …

Endothelins and kidney acidification.

Endothelins (ETs) were initially identified for their vasoactive properties, but they also influence kidney tubule transport including acidification. They contribute importantly to enhancing kidney acidification in response to an acid challenge to systemic acid-base balance and enhance tubule acidification in settings of chronically reduced glomerular filtration rate (GFR) as in chronic kidney disease. ETs also contribute pathophysiologically to the increased kidney acidification in some forms of chronic metabolic alkalosis. In addition, chronically increased ET activity in the kidney, as in c…

[Cytopenias following kidney transplantation].

Cytopenias frequently occur during the first months after solid organ transplantation. Many mechanisms are involved but drugs toxicity and infections are the major causes of cytopenias. Anemia is also related with chronic kidney graft dysfunction. Several drugs are pointed out but antithymocyte globulin, antiproliferative drugs and antiviral drugs are mainly responsible for cytopenias. Infectious causes are mainly viral and can rarely induce macrophage activation syndromes. Passenger lymphocyte syndrome is only described after ABO incompatible transplantations. Thrombotic microangiopathies are…

Kidney regeneration: any prospects?

Chronic kidney disease is a leading cause of mortality and morbidity in western countries which affects about 11% of the adult population. With the increasing rate of chronic kidney disease and limited alternatives for its treatment, potential regenerative approaches for kidney damage are urgently needed, but are limited by the complexity of this organ. Bone marrow-derived stem cells as well as mesenchymal stem cells were envisioned for the development of this type of treatment. However, most studies suggested that these cells cannot differentiate into renal epithelial cells, and concluded tha…

Bortezomib in kidney transplantation.

Although current therapies for pretransplant desensitization and treatment of antibody-mediated rejection (AMR) have had some success, they do not specifically deplete plasma cells that produce antihuman leukocyte antigen (HLA) antibodies. Bortezomib, a proteasome inhibitor approved for the treatment of multiple myeloma (a plasma cell neoplasm), induces plasma cell apoptosis. In this paper we review the current body of literature regarding the use of this biological agent in the field of transplantation. Although limited experience with bortezomib may seem to show promise in the realm of trans

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… Introduction Kidney transplantation is the treatment of choice for most patients with stage five chronic kidney disease (CKD). The risk of death is less than half of that for dialysis patients regardless of the immunosuppression protocol used [ 1 ]. … It is not surprising that the demand for donor kidneys continually outpaces the supply. The United Network for Organ Sharing (UNOS) has over 80,000 patients on the kidney transplant waiting list, many of whom are highly sensitized. …

ABO-incompatible kidney transplantation.

INTRODUCTION: Kidney transplantation is the optimal treatment for many patients with end-stage renal disease (ESRD). Due to shortage of donor kidneys in Denmark, there is a need to expand the possibilities for donation. At the Odense University Hospital (OUH), we have introduced ABO-incompatible kidney transplantation. We used antigenspecific immunoadsorptions to remove blood group antibodies and anti-CD20 antibody (rituximab) to inhibit the antibody production. The aim of introducing the ABO-incompatible kidney transplantation at the OUH was to increase the rate of living donor kidney transpl…

Hereditary interstitial kidney disease.

Autosomal-dominant interstitial kidney disease is characterized by slow progression of chronic kidney disease in patients with bland urinary sediment and no or low-grade proteinuria. There are at least three subtypes. Patients with mutations in the UMOD gene encoding uromodulin suffer from precocious gout in addition to chronic kidney failure. Diagnosis can be achieved through genetic analysis of the UMOD gene. Patients with mutations in the REN gene encoding renin suffer from anemia in childhood, hyperuricemia, mild hyperkalemia, and progressive kidney disease. Genetic analysis of the REN gen…

Diabetes after kidney donation.

Kidney donors, similar to the general population, are at risk for development of type 2 diabetes mellitus (T2DM). The course of donors who develop T2DM has not been studied. We surveyed 3777 kidney donors regarding the development of T2DM. Of the 2954 who responded, 154 developed T2DM 17.7 +/- 9.0 years after donation. The multivariable risk of development of T2DM was associated with type 1 DM in the recipient, male gender and body mass index >30 kg/m(2) at time of donation. Compared to age, gender, duration after donation and body mass index (BMI)-matched non-diabetic donor controls; diabetic…

Kidney transplantation: future challenges.

Kidney transplantation is the best replacement therapy for the patients with end-stage renal disease, by offering an increased longevity and quality of life. However, the demand for kidney exceeds the available supply, so that the number of people on waiting list is steadily increasing. Many transplant centers have tried to supply to this chronic shortage of organs, by utilizing kidney from older donors or from donors with a previous hepatitis, and this strategy resulted in a safe way to increase the donor pool. Living transplantation has progressively increased in last years so that the numbe…

Lithium-associated kidney microcysts.

Long-term lithium therapy is associated with impairment in concentrating ability and, occasionally, progression to advanced chronic kidney disease from tubulointerstitial nephropathy. Biopsy findings in patients with lithium-induced chronic tubulointerstitial nephropathy include tubular atrophy and interstitial fibrosis interspersed with tubular cysts and dilatations. Recent studies have shown that cysts are seen in 33-62.5% of the patients undergoing lithium therapy. MR imaging is highly capable of defining renal morphological features and has been demonstrated to be superior to US and CT sca…