scholarly journals Pyelonephritis and Bacteremia Caused by Klebsiella variicola following Renal Transplantation

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Cody Lo ◽  
Shazia Masud ◽  
Gregory D. Deans
Keyword(s):  
Renal Transplantation ◽  
Graft Loss ◽  
First Year ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Increased Risk ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage ◽  
Oral Ciprofloxacin

Klebsiella variicola (K. variicola) is a Gram-negative organism genetically similar to Klebsiella pneumoniae (K. pneumoniae) that can cause a variety of diseases in humans. Bacteremia due to K. variicola is associated with a higher mortality rate than bacteremia with K. pneumoniae. Here, we describe a 65-year-old woman who developed pyelonephritis 2 months after receiving a renal transplantation following a longstanding history of end-stage renal disease secondary to polycystic kidney disease. Her creatinine on admission was unchanged from her posttransplant baseline, and an abdominal CT scan showed inflammatory changes around the transplanted kidney that were suggestive of an infection rather than allograft rejection. She was initially treated empirically with meropenem given a history of extended-spectrum beta-lactamase- (ESBL-) producing E. coli bacteriuria. After a day of therapy with meropenem, her therapy was streamlined based on culture results to ceftriaxone. She continued to improve, her kidney function remained stable, and she was prescribed oral ciprofloxacin to complete a 14-day total course of antibiotics. This case is the first reported instance of K. variicola bacteremia associated with pyelonephritis in a renal transplant recipient. Hospitalization with acute pyelonephritis within the first year following kidney transplant is common and is associated with increased risk of graft loss and mortality. However, K. variicola is not a commonly known organism to cause this infection. Despite the risk of allograft failure in this circumstance, this patient was successfully treated with a 14-day course of antibiotic therapy.

scholarly journals Electroconvulsive Therapy in a Renal Transplantation Patient: A Rare Combination of Disease and Treatment

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Giovanni Malaty ◽  
Kerilyn Godbe ◽  
Mehdi Elmouchtari ◽  
Gurjot Malhi ◽  
Justin White ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Renal Disease ◽  
Electroconvulsive Therapy ◽  
End Stage Renal Disease ◽  
Psychotic Symptoms ◽  
Safety And Efficacy ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

The safety and efficacy of electroconvulsive therapy (ECT) for the treatment of psychiatric disorders have been demonstrated in a wide variety of patients, including postoperative patients and those who are pregnant. While several reports highlight the safety of this treatment in heart and liver transplantation patients, there is a relative lack of literature detailing the safety profile of ECT in an individual with recent kidney transplantation. Here, we explore the case of a patient with a recent renal transplant secondary to diabetes-related end-stage renal disease (ESRD) who underwent a successful course of ECT treatment. A 57-year-old Caucasian male with a past psychiatric history of schizoaffective disorder, bipolar type, and a past medical history of end-stage renal disease with recent right renal transplantation was admitted to the inpatient psychiatry unit. The admission was via a temporary detention order (TDO) for suicidality and auditory hallucinations promoting self-harm. The patient’s depressive and delusional history was well-documented and had been refractory to several courses of psychotherapeutic and pharmacologic management. Electroconvulsive therapy was subsequently initiated and was well-tolerated. Treatments progressively alleviated his depressive and psychotic symptoms and did not adversely affect the function of his transplanted kidney, which was closely monitored throughout the treatment process. This case demonstrated the safety and efficacy of ECT treatment in an individual with recent renal transplant and may prompt further trials into establishing safety and efficacy in larger study populations.

Abstract P477: Clinical Outcomes In Individuals With And Without Heart Failure Presenting With Acute Coronary Syndromes

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Stephen Clarkson ◽  
Todd Brown ◽  
Nita Limdi ◽  
Chrisly Dillon ◽  
Mark Beasley
Keyword(s):  
Heart Failure ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Clinical Characteristics ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Increased Risk ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

Objective: To determine the risk for major adverse cardiovascular events (MACE) following acute coronary syndrome (ACS) in patients with and without heart failure (HF) and whether this risk varies by race and comorbidity. Methods: We studied adults with and without HF who underwent percutaneous coronary intervention (PCI) for the treatment of ACS in the Pharmacogenomic Resource to improve Medication Effectiveness Genotype Guided Antiplatelet Therapy study. ACS was defined by the presence of ≥2 of the following: ischemic symptoms, acutely elevated cardiac troponin, or ischemic electrocardiographic changes. HF was defined prior to PCI as a known history of HF, left ventricular ejection fraction <50%, or brain natriuretic peptide level >400 pg/mL. Demographic and clinical characteristics were collected prior to PCI. Race was self-reported. Participants were followed for up to 1 year for MACE. We constructed Cox proportional hazard models, adjusted for demographic and clinical characteristics, separately in those with and without HF to identify independent predictors of MACE. Results: Since 2014, 1,230 individuals have undergone PCI for ACS. Those with HF (n=419) were older and had more comorbidities than those without HF (n=811). The incidence of MACE per 100 person years was 40.4 in those with HF and 22.2 in those without HF (p<0.001). African American race was associated with increased risk for MACE following ACS in those without but not with a history of HF. Other clinical factors associated with MACE following ACS were older age and end stage renal disease in those with HF and diabetes, end stage renal disease, and peripheral arterial disease in those without HF (Table). Conclusions: Individuals with HF are at increased risk of MACE following ACS irrespective of race. However, in those without HF, African Americans have a higher risk of MACE following ACS relative to their white counterparts. Individuals with end stage renal disease are at high risk of MACE following ACS regardless of HF status.

scholarly journals Renal Transplantation in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Current Perspectives

2020 ◽  
Vol 45 (2) ◽  
pp. 157-165 ◽  
Author(s):  
Zdenka Hruskova ◽  
Vladimir Tesar ◽  
Duvuru Geetha
Keyword(s):  
Renal Transplantation ◽  
Survival Rates ◽  
Rapidly Progressive Glomerulonephritis ◽  
Recurrence Risk ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Number Of Patients ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage ◽  
Risk Of Relapse

Background: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is the leading cause of rapidly progressive glomerulonephritis, which may follow an unfavorable disease course. Despite therapeutic advances, a number of patients with AAV will eventually develop end-stage renal disease (ESRD). Renal transplantation (RTx) is associated with a survival benefit and improves quality of life in patients with ESRD. Summary: In recent years, RTx has been increasingly used also in patients with vasculitis. The posttransplant patient- and graft-survival rates in AAV were at least comparable to other diagnoses in most studies. Prior to transplantation, patients should be in stable remission for 12 months. Persistent ANCA positivity does not exclude patients from the waiting list. Even though the recurrence risk is generally low with modern posttransplant immunosuppression, including mycophenolate mofetil and tacrolimus, patients with AAV, particularly those with positive antiproteinase-3 ANCA who may have increased risk of relapse or recurrence of the disease, require constant surveillance. Similar to treatment of relapsing disease in the nontransplant setting, rituximab may become treatment of choice for posttransplant recurrences. Key Messages: RTx is the preferred renal replacement therapy of choice for AAV patients with ESRD. It is recommended that patients should be in remission for about 12 months prior to proceeding with RTx. ANCA positivity alone is not a contraindication for transplantation. The risk of relapse posttransplantation is minimal with currently used posttransplant immunosuppressive regimen.

Seizures in Dialysis Patients Treated with Recombinant Erythropoietin. Review of the Literature and Guidelines for Prevention

1994 ◽  
Vol 17 (1) ◽  
pp. 5-13 ◽  
Author(s):  
M. Beccari
Keyword(s):  
Previous History ◽  
Hypertensive Encephalopathy ◽  
Cerebral Hypoperfusion ◽  
Recombinant Erythropoietin ◽  
Human Erythropoietin ◽  
Treatment And Prevention ◽  
Increased Risk ◽  
History Of ◽  
Stage Renal Disease ◽  
End Stage

Anemia is one of the major limitations to rehabilitation in patients with end-stage renal disease (ESRD). The efficacy of recombinant human erythropoietin (rHuEPO) in the treatment of renal anemia is well established. Nevertheless, rHuEPO therapy has been associated with serious untoward effects. There appears to be an increased risk of hypertension, not infrequently accompanied by hypertensive encephalopathy and seizures. The mechanism of hypertension remains uncertain. It is associated with an increase in blood viscosity, a reversal of hypoxic vasodilatation, and, possibly, a direct pressor effect of the hormone. Seizures, otherwise, may be the result of cerebral hypoperfusion and, finally, of a focal cerebral edema. The guidelines for rHuEPO treatment and prevention of associated convulsions are outlined. The possible convulsive risk induced by this treatment, even at low doses, particularly in patients with a previous history of seizures, is stressed.

scholarly journals Intraoperative Diagnosis of Stanford Type A Dissection by Transesophageal Echocardiogram in a Patient Presenting for Renal Transplantation

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
William R. Hand ◽  
John S. Ikonomidis ◽  
Charles F. Bratton ◽  
Thomas M. Burch ◽  
Matthew D. McEvoy
Keyword(s):  
Renal Transplantation ◽  
Type A ◽  
Physical Exam ◽  
Transesophageal Echocardiogram ◽  
Aortic Replacement ◽  
Sternal Border ◽  
History Of ◽  
Diastolic Murmur ◽  
Stage Renal Disease ◽  
End Stage

A 48-year-old patient with hypertensive end-stage renal disease presented for cadaveric renal transplantation. On physical exam, a previously undocumented diastolic murmur was heard loudest at the left lower sternal border. The patient had a history of pericardial effusions and reported “a feeling of chest fullness” when lying flat. As such, a transesophageal echocardiogram (TEE) was performed after induction of anesthesia to evaluate the pericardial space and possibly determine the etiology and severity of the new murmur. The TEE revealed a Stanford Type A aortic dissection. The renal transplant was cancelled (organ reassigned within region), and the patient underwent an urgent ascending and proximal hemiarch aortic replacement. This case demonstrates the importance of a thorough physical exam and highlights the utility of TEE for noncardiac surgical cases.

scholarly journals Risk-Adjusted Analysis of Relevant Outcome Drivers for Patients after More Than Two Kidney Transplants

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Lampros Kousoulas ◽  
Florian W. R. Vondran ◽  
Paulina Syryca ◽  
Juergen Klempnauer ◽  
Harald Schrem ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Graft Survival ◽  
Patient Survival ◽  
Therapeutic Option ◽  
Graft Loss ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Adjusted Analysis ◽  
Stage Renal Disease ◽  
End Stage

Renal transplantation is the treatment of choice for patients suffering end-stage renal disease, but as the long-term renal allograft survival is limited, most transplant recipients will face graft loss and will be considered for a retransplantation. The goal of this study was to evaluate the patient and graft survival of the 61 renal transplant recipients after second or subsequent renal transplantation, transplanted in our institution between 1990 and 2010, and to identify risk factors related to inferior outcomes. Actuarial patient survival was 98.3%, 94.8%, and 88.2% after one, three, and five years, respectively. Actuarial graft survival was 86.8%, 80%, and 78.1% after one, three, and five years, respectively. Risk-adjusted analysis revealed that only age at the time of last transplantation had a significant influence on patient survival, whereas graft survival was influenced by multiple immunological and surgical factors, such as the number of HLA mismatches, the type of immunosuppression, the number of surgical complications, need of reoperation, primary graft nonfunction, and acute rejection episodes. In conclusion, third and subsequent renal transplantation constitute a valid therapeutic option, but inferior outcomes should be expected among elderly patients, hyperimmunized recipients, and recipients with multiple operations at the site of last renal transplantation.

scholarly journals Peritonitis following Endoscopy in a Patient on Peritoneal Dialysis with a Discussion of Current Recommendations on Antibiotic Prophylaxis

2015 ◽  
Vol 9 (3) ◽  
pp. 302-306 ◽  
Author(s):  
Amy L. Gould ◽  
Elie Chahla ◽  
Christine Hachem
Keyword(s):  
Peritoneal Dialysis ◽  
Gastrointestinal Endoscopy ◽  
Previous History ◽  
Invasive Procedures ◽  
Limited Evidence ◽  
Increased Risk ◽  
History Of ◽  
American Society ◽  
Stage Renal Disease ◽  
End Stage

Patients on peritoneal dialysis (PD) are at increased risk for peritonitis. We report a case of a patient with end-stage renal disease on continuous ambulatory PD (CAPD) who developed peritonitis within 24 h of upper endoscopy with biopsy and colonoscopy with polypectomy. He had a previous history of peritonitis unrelated to invasive procedures and eventually was transitioned to hemodialysis because of his recurrent peritonitis. The International Society for Peritoneal Dialysis (ISPD) and newly revised American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend prophylactic antibiotics for CAPD patients undergoing endoscopic procedures. Other guidelines do not address this issue, and there has been limited evidence to support recommendations.

Could Antioxidant Supplementation Delay Progression of Cardiovascular Disease in End-Stage Renal Disease Patients?

2020 ◽  
Vol 19 (1) ◽  
pp. 41-54 ◽  
Author(s):  
Stefanos Roumeliotis ◽  
Athanasios Roumeliotis ◽  
Xenia Gorny ◽  
Peter R. Mertens
Keyword(s):  
Oxidative Stress ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Close Association ◽  
Omega 3 ◽  
Endstage Renal Disease ◽  
Increased Risk ◽  
Underlying Mechanisms ◽  
Stage Renal Disease ◽  
End Stage

In end-stage renal disease patients, the leading causes of mortality are of cardiovascular (CV) origin. The underlying mechanisms are complex, given that sudden heart failure is more common than acute myocardial infarction. A contributing role of oxidative stress is postulated, which is increased even at early stages of chronic kidney disease, is gradually augmented in parallel to progression to endstage renal disease and is further accelerated by renal replacement therapy. Oxidative stress ensues when there is an imbalance between reactive pro-oxidants and physiologically occurring electron donating antioxidant defence systems. During the last decade, a close association of oxidative stress with accelerated atherosclerosis and increased risk for CV and all-cause mortality has been established. Lipid peroxidation has been identified as a trigger for endothelial dysfunction, the first step towards atherogenesis. In order to counteract the deleterious effects of free radicals and thereby ameliorate, or delay, CV disease, exogenous administration of antioxidants has been proposed. Here, we attempt to summarize existing data from studies that test antioxidants for CV protection, such as vitamins E and C, statins, omega-3 fatty acids and N-acetylcysteine.

scholarly journals Effects of renal transplantation on erectile dysfunction: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Irham Arif Rahman ◽  
Nur Rasyid ◽  
Ponco Birowo ◽  
Widi Atmoko
Keyword(s):  
Systematic Review ◽  
Erectile Dysfunction ◽  
Kidney Transplantation ◽  
Renal Transplantation ◽  
End Stage Renal Disease ◽  
Erectile Function ◽  
Meta Analysis ◽  
Post Transplantation ◽  
Stage Renal Disease ◽  
End Stage

AbstractErectile dysfunction (ED) is a major global health burden commonly observed in patients with end-stage renal disease (ESRD). Although renal transplantation improves the problem in some patients, it persists in ≈20–50% of recipients. Studies regarding the effects of kidney transplantation on ED present contradictory findings. We performed a systematic review to summarise the effects of kidney transplantation on ED. A systematic literature search was performed across PubMed, Cochrane, and Scopus databases in April 2020. We included all prospective studies that investigated the pre and posttransplant international index of erectile function (IIEF-5) scores in recipients with ED. Data search in PubMed and Google Scholar produced 1326 articles; eight were systematically reviewed with a total of 448 subjects. Meta-analysis of IIEF-5 scores showed significant improvements between pre and post transplantation. Our findings confirm that renal transplantation improves erectile function. Furthermore, transplantation also increases testosterone level. However, the evidence is limited because of the small number of studies. Further studies are required to investigate the effects of renal transplantation on erectile function.

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