scholarly journals Renal Allograft Dysfunction Possibly Caused by Amiodarone Nephrotoxicity: a Case-Report

2017 ◽  
Vol 15 (1) ◽  
pp. 39-40
Author(s):  
Nikolina Basic-Jukic ◽  
Lea Katalinic ◽  
Marijana Coric ◽  
Monika Kocman ◽  
Branimir Krtalic ◽  
...  
Keyword(s):  
Renal Allograft ◽  
Potent Inhibitor ◽  
Interstitial Fibrosis ◽  
Deceased Donor ◽  
Immunosuppressive Drugs ◽  
Tubular Atrophy ◽  
Careful Revision ◽  
Global Glomerulosclerosis ◽  
Trough Levels ◽  
Important Drug

AbstractAmiodarone is a potent inhibitor of CYP3A4 and can increase serum concentrations of drugs that are substrates of this enzyme system. Immunosuppressive drugs are also metabolized through the cytochrome metabolic pathway what may lead to important drug-drug interactions. A 60-year-old female received her second allograft from the deceased donor and was treated with tacrolimus, mycophenolate mofetil and steroids. Amiodarone was introduced for treatment of paroxysmal atrial fibrillation four days after the transplantation. One month after the discharge she was readmitted to hospital for evaluation of the creeping creatinine. Biopsy showed borderline acute rejection. She received 3 boluses of 6- methilprednisolone but creatinine continued to rise. Repeated biopsy was without signs of rejection with mild interstitial fibrosis/tubular atrophy, mild global glomerulosclerosis and moderate arterial sclerosis. However, tubular vacuolization was prominent. After careful revision of her therapy we decided to replace amiodarone with sotalol. One week later her creatinine fell from 350 to 220 μmol/l and remained stable. This case illustrates possible amiodarone nephrotoxicity in a renal transplant recipient. We suggest that patients who need amiodarone in combination with tacrolimus be closely monitored by both cardiologists and nephrologists, with frequent determinations of tacrolimus trough levels and serum creatinine measurements.

scholarly journals Fenofibrate Improved Interstitial Fibrosis of Renal Allograft through Inhibited Epithelial-Mesenchymal Transition Induced by Oxidative Stress

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Yishu Wang ◽  
Lei Pang ◽  
Yanghe Zhang ◽  
Jiahui Lin ◽  
Honglan Zhou
Keyword(s):  
Oxidative Stress ◽  
Rat Model ◽  
Renal Allograft ◽  
Epithelial Mesenchymal Transition ◽  
Interstitial Fibrosis ◽  
Peroxisome Proliferator ◽  
Tubular Atrophy ◽  
Peroxisome Proliferator Activated Receptor ◽  
Mesenchymal Transition ◽  
Stage Renal Disease

The best treatment for end-stage renal disease is renal transplantation. However, it is often difficult to maintain a renal allograft healthy for a long time following transplantation. Interstitial fibrosis and tubular atrophy (IF/TA) are significant histopathologic characteristics of a compromised renal allograft. There is no effective therapy to improve renal allograft function once IF/TA sets in. Although there are many underlying factors that can induce IF/TA, the pathogenesis of IF/TA has not been fully elucidated. It has been found that epithelial-mesenchymal transition (EMT) significantly contributes to the development of IF/TA. Oxidative stress is one of the main causes that induce EMT in renal allografts. In this study, we have used H2O2 to induce oxidative stress in renal tubular epithelial cells (NRK-52e) of rats. We also pretreated NRK-52e cells with an antioxidant (N-acetyl L-cysteine (NAC)) 1 h prior to the treatment with H2O2. Furthermore, we used fenofibrate (a peroxisome proliferator-activated receptor α agonist) to treat NRK-52e cells and a renal transplant rat model. Our results reveal that oxidative stress induces EMT in NRK-52e cells, and pretreatment with NAC can suppress EMT in these cells. Moreover, fenofibrate suppresses fibrosis by ameliorating oxidative stress-induced EMT in a rat model. Thus, fenofibrate may effectively prevent the development of fibrosis in renal allograft and improve the outcome.

P0661DIAGNOSTIC VALUE OF FULL AGE SPECTRUM EQUATION AS A PREDICTOR OF MORPHOLOGICAL LESIONS IN PATIENTS WITH GLOMERULONEPHRITIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Saganova Elena ◽  
Olga Galkina ◽  
Vasiliy Sipovskii ◽  
Ivan Kayukov, ◽  
Alexei Smirnov
Keyword(s):  
Serum Creatinine ◽  
Interstitial Fibrosis ◽  
Severe Heart Failure ◽  
Kidney Injury ◽  
Roc Curves ◽  
Diagnostic Value ◽  
Tubular Atrophy ◽  
Mild Degree ◽  
Severe Group ◽  
Global Glomerulosclerosis

Abstract Background and Aims Glomerular filtration rate (GFR) is generally accepted as a best overall index of kidney function. However, it remains controversial to choose the optimal equation to estimate GFR in patients with glomerulonephritis (GN). Recent studies have reported that newly developed full age spectrum equation based on normalized serum creatinine (FASsCr) showed improved validity and was less biased, more accurate than currently recommended sCr-based eGFR equations. Our aim was to assess FASsCr equation as a predictor of various morphological lesions in patients with GN. Method 100 patients [48 female, age Me 39 (27; 54) years] with biopsy proven primary GN and without acute kidney injury, infectious diseases, severe heart failure, respiratory insufficiency, cancer were included in the study. Minimal change disease was diagnosed in 9% of cases based on the results of kidney biopsy, in 28% – focal segmental glomerulosclerosis, in 26% – membranous nephropathy and in 37% – IgA-nephropathy. Serum creatinine (sCr) level was measured by enzymatic method (Uni Cel DxC 800 PRO, «Beckman Coulter»,USA). eGFR was calculated using FASsCr equation. The extent of global glomerulosclerosis (GS) was assessed quantitatively as a sum of full and focal sclerotic glomeruli. Tubulo-interstitial fibrosis (TIF) and tubular atrophy (TA) were assessed semi-quantitatively (0-lesions absent; 1-mild focal tubular and interstitial lesions; 2-moderate tubular and interstitial lesions; 3 - diffuse tubular and interstitial lesions). All patients consistently were separated into 2 groups according to the degree of each morphological lesion (GS, TIF or TA): “mild” (GS<25% or TIF/TA grade 0 or 1) and “severe” (GS ≥ than 25% or TIF/TA grade 2-3). Results eGFR using FASsCr equation positively correlated (p<0,001 in all cases) with GS (r=0,44), TIF (r=0,64) and TA (r=0,61) and was significantly higher in patients with “mild” GS, TIF and TA (p<0,001) in comparison with “severe” group. Using ROC-analysis all patients were separated (p<0.001) in 2 groups using FASsCr equation according to the degree of morphological lesions (“mild” or “severe”): GS (Sn – 48.8%, Sp – 88.1%, ACC – 72.0%, AUC – 0.696, cut-off value – 47 ml/min/1.73m2), TIF (Sn - 75.4%, Sp – 76.9%, ACC – 76.0%, AUC – 0.815, cut-off value – 72 ml/min/1.73m2), TA (Sn – 65.9%, Sp – 88.8%, ACC – 70.0%, AUC – 0.798, cut-off value – 74 ml/min/1.73m2), (Figure). Conclusion Our results show that FASsCr equation is a significant marker of various morphological lesions in patients with GN. FASsCr equation predominantly can be used as a predictor of mild degree of interstitial sclerosis and tubular atrophy with high diagnostic value. Figure: ROC curves with 95% CI of BM panel for A – GS; B – TIF; C – TA

scholarly journals Reproducibility of Deceased Donor Kidney Procurement Biopsies

2020 ◽  
Vol 15 (2) ◽  
pp. 257-264 ◽  
Author(s):  
S. Ali Husain ◽  
Kristen L. King ◽  
Ibrahim Batal ◽  
Geoffrey K. Dube ◽  
Isaac E. Hall ◽  
...  
Keyword(s):  
Interstitial Fibrosis ◽  
Organ Procurement ◽  
Deceased Donor ◽  
Event Analysis ◽  
Time To Event ◽  
Allograft Survival ◽  
Donor Kidney ◽  
Tubular Atrophy ◽  
Deceased Donor Kidney ◽  
Probability Of Death

Background and objectivesUnfavorable histology on procurement biopsies is the most common reason for deceased donor kidney discard. We sought to assess the reproducibility of procurement biopsy findings.Design, setting, participants, & measurementsWe compiled a continuous cohort of deceased donor kidneys transplanted at our institution from 1/1/2006 to 12/31/2016 that had at least one procurement biopsy performed, and excluded cases with missing biopsy reports and those used in multiorgan transplants. Suboptimal histology was defined as the presence of advanced sclerosis in greater than or equal to one biopsy compartment (glomeruli, tubules/interstitium, vessels). We calculated κ coefficients to assess agreement in optimal versus suboptimal classification between sequential biopsy reports for kidneys that underwent multiple procurement biopsies and used time-to-event analysis to evaluate the association between first versus second biopsies and patient and allograft survival.ResultsOf the 1011 kidneys included in our cohort, 606 (60%) had multiple procurement biopsies; 98% had first biopsy performed at another organ procurement organization and their second biopsy performed locally. Categorical agreement was highest for vascular disease (κ=0.17) followed by interstitial fibrosis and tubular atrophy (κ=0.12) and glomerulosclerosis (κ=0.12). Overall histologic agreement (optimal versus suboptimal) was κ=0.15. First biopsy histology had no association with allograft survival in unadjusted or adjusted analyses. However, second biopsy optimal histology was associated with a higher probability of death-censored allograft survival, even after adjusting for donor and recipient factors (adjusted hazard ratio, 0.50; 95% confidence interval, 0.34 to 0.75; P=0.001).ConclusionsDeceased donor kidneys that underwent multiple procurement biopsies often displayed substantial differences in histologic categorization in sequential biopsies, and there was no association between first biopsy findings and post-transplant outcomes.

Intragraft Tubular Vimentin and CD44 Expression Correlate With Long-Term Renal Allograft Function and Interstitial Fibrosis and Tubular Atrophy

2010 ◽  
Vol 90 (5) ◽  
pp. 502-509 ◽  
Author(s):  
Jesper Kers ◽  
Yi-Chun Xu-Dubois ◽  
Eric Rondeau ◽  
Nike Claessen ◽  
Mirza M. Idu ◽  
...  
Keyword(s):  
Renal Allograft ◽  
Interstitial Fibrosis ◽  
Tubular Atrophy ◽  
Cd44 Expression ◽  
Allograft Function

Comparison of Ultrasound Corticomedullary Strain with Doppler Parameters in Assessment of Renal Allograft Interstitial Fibrosis/Tubular Atrophy

2015 ◽  
Vol 41 (10) ◽  
pp. 2631-2639 ◽  
Author(s):  
Jing Gao ◽  
Jonathan M. Rubin ◽  
William Weitzel ◽  
Jun Lee ◽  
Darshana Dadhania ◽  
...  
Keyword(s):  
Renal Allograft ◽  
Interstitial Fibrosis ◽  
Tubular Atrophy

URINARY CELL mRNA PROFILES ACCURATELY PREDICT RENAL ALLOGRAFT INTERSTITIAL FIBROSIS AND TUBULAR ATROPHY

2008 ◽  
Vol 86 (Supplement) ◽  
pp. 13
Author(s):  
T Muthukumar ◽  
R Wanchoo ◽  
D Dadhania ◽  
R Ding ◽  
C Snopkowski ◽  
...  
Keyword(s):  
Renal Allograft ◽  
Interstitial Fibrosis ◽  
Tubular Atrophy

scholarly journals Alveolar echinococcosis in patient after cadaveric kidney transplantation

2011 ◽  
Vol 48 (4) ◽  
pp. 229-236 ◽  
Author(s):  
S. Dražilová ◽  
J. Kinčeková ◽  
Ľ. Beňa ◽  
M. Zachar ◽  
M. Švajdler ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Ct Scan ◽  
Alveolar Echinococcosis ◽  
Clinical Symptoms ◽  
Interstitial Fibrosis ◽  
Graft Function ◽  
Deceased Donor ◽  
Chronic Haemodialysis ◽  
Tubular Atrophy ◽  
Long Term Treatment

Abstract52-years old man years following the kidney transplantation from deceased donor was admitted to the hospital with fever and progressive abdominal pain. The patient was diagnosed with chronic hepatitis C seven years before admission. Graft function in posttransplant period was stable and optimal, the patient was treated with standard maintenance immunosupresive protocol (cyclosporine A, mycophenolate mofetil and low-dose prednison), metylprednisolon bolus therapy (1 g/m2 body surface area), was administered two months prior to admission due to creeping creatinine (suspection of acute rejection was not confirmed by biopsy). Empiric antibiotic treatment due to febrile status was ineffective. Abdominal ultrasound and computer tomography (CT) scan revealed three tumorous lesions in the liver, radical surgical intervention was not executable. Histological examination of the tissue from the lesions demostrated alveolar echinococcosis, serology for Echinoccocus multilocularis was positive. Long-term treatment by mebendazol 200 mg twice daily led to disappearance of the clinical symptoms, but after the therapy cessasion patient was again hospitalized with fever and progression of cystic lesions in CT scan. Following the mebendazol therapy reinstalation the clinical course of echinococcosis was improved and remained stable, transplant kidney failure occurred due to progression of interstitial fibrosis/tubular atrophy and chronic haemodialysis was initiated one year later.

scholarly journals Procurement Biopsies in the Evaluation of Deceased Donor Kidneys

2018 ◽  
Vol 13 (12) ◽  
pp. 1876-1885 ◽  
Author(s):  
Dustin Carpenter ◽  
S. Ali Husain ◽  
Corey Brennan ◽  
Ibrahim Batal ◽  
Isaac E. Hall ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Vascular Disease ◽  
Graft Failure ◽  
Interstitial Fibrosis ◽  
Frozen Section ◽  
Deceased Donor ◽  
Hazard Ratio ◽  
Donor Kidney ◽  
Tubular Atrophy ◽  
Deceased Donor Kidney

Background and objectivesBiopsies taken at deceased donor kidney procurement continue to be cited as a leading reason for discard; however, the reproducibility and prognostic capability of these biopsies are controversial.Design, setting, participants, & measurementsWe compiled a retrospective, single-institution, continuous cohort of deceased donor kidney transplants performed from 2006 to 2009. Procurement biopsy information—percentage of glomerulosclerosis, interstitial fibrosis/tubular atrophy, and vascular disease—was obtained from the national transplant database. Using univariable, multivariable, and time-to-event analyses for death-censored graft survival, we compared procurement frozen section biopsy reports with reperfusion paraffin-embedded biopsies read by trained kidney pathologists (n=270). We also examined agreement for sequential procurement biopsies performed on the same kidney (n=116 kidneys).ResultsFor kidneys on which more than one procurement biopsy was performed (n=116), category agreement was found in only 64% of cases (κ=0.14). For all kidneys (n=270), correlation between procurement and reperfusion biopsies was poor: overall, biopsies were classified into the same category (optimal versus suboptimal) in only 64% of cases (κ=0.25). This discrepancy was most pronounced when categorizing percentage of glomerulosclerosis, which had 63% agreement (κ=0.15). Interstitial fibrosis/tubular atrophy and vascular disease had agreement rates of 82% (κ=0.13) and 80% (κ=0.15), respectively. Ninety-eight (36%) recipients died, and 56 (21%) allografts failed by the end of follow-up. Reperfusion biopsies were more prognostic than procurement biopsies (hazard ratio for graft failure, 2.02; 95% confidence interval, 1.09 to 3.74 versus hazard ratio for graft failure, 1.30; 95% confidence interval, 0.61 to 2.76), with procurement biopsies not significantly associated with graft failure.ConclusionsWe found that procurement biopsies are poorly reproducible, do not correlate well with paraffin-embedded reperfusion biopsies, and are not significantly associated with transplant outcomes.

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