Handbook of kidney transplantation, 4th Ed./ Edit. : Gabriel M. Danovitch

xv, 542 hal. : ill.; 20 cm

Handbook of kidney transplantation, 4th Ed./ Edit. : Gabriel M. Danovitch

xv, 542 hal. : ill.; 20 cm

Effects of water immersion on renal function in the nephrotic syndrome

Effects of water immersion on renal function in the nephrotic syndrome. Nine adult patients with the nephrotic syndrome were studied during 4 hours of water immersion (WI) to the level of the neck in the seated position and under control conditions. During WI, sodium excretion (UNaV) rose from a mean prestudy level of 45.9 ± 18.7 µEq/min to a mean peak level of 242.2 ± 42.8 µEq/min during the 4th hour. During control studies, UNaV was unchanged. During WI, urine volume rose from 1.1 ± 0.4ml/min and reached a peak level of 7.5 ± 0.8ml/min during the 2nd hour. There were also marked increases in free water clearance and potassium excretion. Plasma renin activity fell from a prestudy level of 5.1 ± 1.3 ng/ml/hr to a nadir of 1.9 ± 0.4 ng/ml/hr during the 2nd hour of WI. Levels were unchanged during control studies. There was a considerable variation in the magnitude of the natriuretic effect of WI between the individual patients. Peak levels of UNaV varied from 55.3 to 488 µEq/min, and net negative sodium balance varied from 12.8 to 105mEq. These variations were found to be directly related to the patient's estimated plasma volume, such that y = 19.2x - 211 (r = 0.84) represented the relationship between the plasma volume and the peak UNaV, and y = 1.9x - 41 (r = 0.81) represented the relationship between plasma volume and net negative sodium balance. These studies indicate that in patients with nephrotic syndrome, as in normal subjects, WI provides a potent natriuretic stimulus that results from expansion of the central blood volume. The magnitude of the natriuresis in nephrotic patients is related to their plasma volume, an observation that might help predict therapeutic benefit of the procedure in the individual patient.Effets de l'immersion dans l'eau sur la fonction rénale dans le syndrome néphrotique. Neuf malades adultes atteints de syndrome néphrotique ont été étudiés au cours de 4 heures d'immersion dans l'eau (WI) jusqu'au cou en position assise et dans des conditions contrôles. Au cours de l'immersion l'excrétion de sodium (UNaV) a augmenté d'une valeur moyenne contrôle de 45,9 ± 18,7 µEq/mn à une valeur moyenne de pic de 242,2 ± 42,8 µEq/mn au cours de la quatrième heure. Au cours des études contrôles UNaV était inchangée. Au cours de l'immersion le débit urinaire a augmenté de 1,1 ± 0,4ml/mn et a atteint une valeur de pic de 7,5 ± 0,8ml/mn au cours de la deuxième heure. Une augmentation importante de la clearance de l'eau libre et de l'excrétion de potassium a été observée. L'activité rénine plasmatique a diminué d'une valeur de 5,1 ± 1,3 ng/ml/h avant l'étude à un minimum de 1,9 ± 0,4 ng/ml/h au cours de la deuxième heure de l'immersion. Au cours des études contrôles les valeurs ont été inchangées. Des variations individuelles considérables dans l'amplitude de l'effet natriurétique de l'immersion ont été observées. La valeur de pic de UNaV a varié de 55,3a488a varié de µEq/min, et net négative l'equilibre sodium 12,8mEq à 105mEq. Ces variations ont été corrélées au volume plasmatique estimé des malades de telle sorte que y = 19,2x - 211 (r = 0,84) a représenté la relation entre le volume plasmatique et la valeur de pic de UNaV, et que y = 1,9x - 41 (r = 0,81) a représenté la relation entre le volume plasmatique et le bilan négatif net de sodium. Ces études indiquent que chez des malades atteints de syndrome néphrotique comme chez les sujets normaux l'immersion produit un stimulus natriurétique puissant qui résulte d'une expansion du volume sanguin central. L'importance de la natriurèse chez les malades atteints de syndrome néphrotique était en relation avec leur volume plasmatique, une observation qui peut aider à prédire l'effet thérapeutique de cette manoeuvre pour un malade donné

Banking on living kidney donors - a new way to facilitate donation without compromising on ethical values

For permissions, please e-mail: [email protected]. Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year while waiting for a kidney transplant. Advocates of financial incentive programs or "regulated markets" in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie - at least in part - in facilitating so-called "altruistic donation;" harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Strategies designed to minimize financial barriers to donation and the use of paired kidney exchange programs are increasingly enabling donation, and now, an innovative program designed to address what has been termed "chronologically incompatible donation" is being piloted at the University of California, Los Angeles, and elsewhere in the United States. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program; in return, a commitment is made to the specified recipient that priority access for a living-donor transplant in a paired exchange program will be offered when or if the need arises in the future. We address here potential ethical concerns related to this form of organ "banking" from living donors, and argue that it offers significant benefits without undermining the well-established ethical principles and values currently underpinning living donation programs

Kidney Transplantation in Patients With Active Multiple Myeloma: Case Reports.

Kidney disease is a common complication in patients with multiple myeloma. Traditionally, patients with active multiple myeloma and end-stage renal disease have been excluded from kidney transplantation due to the risk of malignancy progression. The introduction of bortezomib-based therapy for patients with multiple myeloma and renal impairment has significantly improved survival in this population. In this report, we present 2 cases of patients with active and controlled multiple myeloma who underwent successful kidney transplantation without progression of their underlying malignancy. In patients with active multiple myeloma controlled with bortezomib, kidney transplantation should be considered a valid option for patients with end-stage kidney disease

Cold Ischemia Time, Kidney Donor Profile Index, and Kidney Transplant Outcomes: A Cohort StudyPlain-Language Summary

Rationale &amp; Objective: An average of 3,280 recovered deceased donor kidneys are discarded annually in the United States. Increased cold ischemia time is associated with an increased rate of organ decline and subsequent discard. Here we examined the effect of prolonged cold ischemia time on kidney transplant outcomes. Study Design: Retrospective observational study Setting &amp; Participants: Recipients of deceased donor kidney transplants in the United States from 2000 to 2018. Exposure: Recipients of deceased donor kidneys were divided based on documented cold ischemia time: ≤16, 16-24, 24-32, 32-40, and >40 hours. Outcomes: The incidence of delayed graft function, primary nonfunction, and 10-year death-censored graft survival. Analytical Approach: The Kaplan-Meier method was used to generate survival curves, and the log rank test was used to compare graft survival. Results: The rate of observed delayed graft function increased with cold ischemia time (20.9%, 28.1%, 32.4%, 37.5%, and 35.8%). Primary nonfunction also showed a similar increase with cold ischemia time (0.6%, 0.9%, 1.3%, 2.1%, and 2.3%), During a median follow-up time of 4.6 years, 37,301 recipients experienced death-censored graft failure. Analysis based on kidney donor profile index (KDPI) demonstrated significant differences in 10-year death-censored graft survival, with a death-censored graft survival in recipients of a kidney with a KDPI 85%. Limitations: Heterogeneity of acceptance patterns among transplant centers, presence of confounding variables leading to acceptance of kidneys with prolonged cold ischemia times. Conclusions: Cold ischemia time was associated with an increased risk of delayed graft function and primary nonfunction. However, the effect of increased cold ischemia time is modest and has less impact than the KDPI. Transplant programs should not consider prolonged cold ischemia time alone as a predominant reason to decline an organ, especially with a KDPI <85%