Hyperuricemia and gout following pediatric renal transplantation

Hyperuricemia and gout are common complications in adult renal transplant recipients. In pediatric recipients, however, hyperuricemia seems to be rare, but data are scarce. Thirty-two children (21 males, 11 females) were investigated for a median time of 4.8years (range: 0.4-11.2years) following renal transplantation. The median age of this pediatric study group was 13.9years (range: 5.7-20.3years), and the calculated glomerular filtration rate (GFR) was 61ml/min per 1.73m2 (range:12-88ml/min per 1.73m2). All patients were given calcineurin inhibitors, with 22 and ten children receiving cyclosporine A (CSA) and tacrolimus (TAC), respectively. The median plasma uric acid was 385μmol/l (range: 62-929μmol/l); 15 children (47%) were above the age-related normal range. Only one patient experienced gouty arthritis. There was a significant correlation between plasma uric acid concentration and both time span after transplantation and plasma creatinine, and an inverse correlation to GFR (p<0.05). No significant correlation was found between plasma uric acid and body mass index (BMI). Plasma uric acid concentrations were neither different among CSA- and TAC-treated children, nor did they correlate with drug exposure or blood trough levels of CSA or TAC. Plasma uric acid concentration was not different when compared to children with chronic renal failure (CRF) of a similar degree in native kidneys. We conclude that hyperuricemia is common among pediatric renal transplant recipients and rather a consequence of chronic renal transplant dysfunction than the use of calcineurin inhibitors. Gout, however, is rar

Psychosocial impact of living-related kidney transplantation on donors and partners

Living-related kidney transplantation (LRKT) is an option for children with end-stage renal failure. In addition to medical concerns, there is uncertainty about the psychological impact of living-related donation on parent donors and families. A survey was conducted on the decision making process and medical and psychosocial consequences of LRKT. Between 1992 and 1999, 20 parents donated a kidney for their child. A questionnaire including 24 items was sent to parent donors and their partners. Nineteen parents and partners responded; the median time after LRKT was 3years. Donors and partners reported an independent decision making process with no significant influence of partners, relatives, or hospital staff. Partners were more concerned about medical problems than donors themselves (P <0.02). Donors and partners cited no medical problems except sustained pain. Both reported an improved personal relationship towards the transplanted child. Donors and partners also cited an improved personal relationship. The vast majority (18/19) of couples still supported the decision for organ donation. In conclusion, there was a high degree of satisfaction with the decision making process in LRKT. The great majority of donors and partners did not report negative medical or psychological consequences. The relationship between donor, partner, and recipient child improved after LRK

Krankheitsverlauf bei jungen Patienten mit einem Harnblasenkarzinom - eine retrospektive Vergleichsstudie

Hintergrund: Etwa drei Prozent aller Krebserkrankungen des Menschen sind Karzinome der Harn-blase (TCCB), wobei das TCCB der häufigste maligne Tumor des Harntraktes und nach dem Prostatakarzinom der zweithäufigste des Urogenitaltrakts ist. Die wesentli-chen Riskofaktoren sind Alter und (männliches) Geschlecht sowie einige chemische Noxen und Nikotinabusus. Die Inzidenz des TCCBs ist proportional ansteigend mit zu dem Lebensalter der Pat mit einem Altersgipfel um das 65. Lebensjahr. Weniger als 1% der Patienten Pat mit einem TCCB sind bei Erstdiagnose (ED) jünger als 45 Jahre. Die Prognose dieser Pat. ist nur unzureichend an größeren Fallzahlen dokumentiert. Ziel der vorliegenden Arbeit war es, den Langzeitverlauf dieser Pat. zu beobachten. Material und Methode: Mittels einer telephonischen und schriftlichen Befragung anhand eines vorher erar-beiteten Fragebogens wurden 57 Pat. (=PG 45) mit einem Durchschnittsalter von 37,4 Jahren (17-45 Jahre) und einem oberflächlichen TCCB (< T2) hinsichtlich des Rezidivverhaltens mit einem identischen Kontrollkollektiv (TNM, Grading, Risikopro-fil), das älter als 65 Jahre alt war (65-98 Jahre, Ø73,4 Jahre, n=217, =KK65), vergli-chen. Die Patientensubgruppen wurden hierbei aus der Urologischen Klinik der Lud-wig-Maximilians Universität München und der Urologischen Klinik der St. Josef-Klinik in Regensburg rekrutiert. Die medianen zensierten Nachbeobachtungszeiten (d.h. für die Pat. ohne Rezidiv) betrugen 53 (PG 45) und 36,6 Monate (KK 65). Berechnungen zur Rezidivwahrscheinlichkeit wurden mittels der Methode von Kaplan-Meier durch-geführt, Log-Rank-Test, Vierfeldertafel-Analyse und der Chi-Quadrat Test dienten der Überprüfung signifikanter Unterschiede beider Kollektive. Ergebnisse: Bei ED fanden sich signifikante Unterschiede in beiden Patientenkollektiven bzgl. Tumostadium und Tumorgrading, wobei sich in der KK65 jeweils ein fortgeschrittene-res Tumorstadium sowie ein schlechteres Tumorgrading zeigten. Auch bei der übli-chen Unterscheidung in (oberflächliche) low-, intermediate- und (aggressivere) high-risk Tumore fanden sich signifikante Unterschiede zum Nachteil des älteren Kontroll-kollektivs. Was die Rezidivinzidenz betrifft, so entwickelten 29/57 der jungen Pat. (PG 45) ein Rezidiv. Die mediane Zeit bis zum Rezidiv betrug 89 (PG 45) vs. 72 Monate (KK 65) (log rank 0,392). Nach 10 Jahren betrug die tumorspezifische Rezidivrate nach Kap-lan-Meier-Schätzung 51,6 % (PG 45) gegenüber 61,6 % (KK 65). Von den Patienten, die bis zum 5. Jahr tumorfrei waren, entwickelten laut Kaplan-Meier-Schätzung nach weiteren fünf Jahren noch 20,5 % (PG 45) und bei dem Kontrollkollektiv noch 25,9 % ein Rezidiv. Schlussfolgerung: Das Risiko in beiden Subgruppen, nach 5 Jahren tumorfreien Intervalls ein Rezidiv zu erleiden ist nicht unerheblich. Die Prognose junger Pat. mit einem TCCB bezüg-lich des Rezidivverhaltens unterscheidet sich nicht von der älterer Patienten. Diese hohe Rate an Rezidiven und Krankheitsprogression bei jungen Patienten mit eigent-lich positiver tumorbiologischen Kriterien sollte Anlass zu weiteren Untersuchungen bezüglich ihrer Ursache. Da die Rezidivrate auch bei Patienten mit initial wenig fort-geschrittenen Karzinom signifikant ist, sollten auch diese Karzinome im Stadium pTa engmaschige Kontrollen erhalten. Die Tumornachsorge bei jüngeren Patienten sollte auch im Langzeitverlauf den Richtlinien älterer Pat. entsprechen

Transplantation of infant en bloc kidneys into paediatric recipients

En bloc renal transplantation (EBT) from infant donors is an option for children with end-stage renal failure. Owing to potential complications, EBT is not performed in all paediatric nephrology centres. We evaluated the perioperative and long-term course of five children undergoing EBT. Primary diagnosis was atypical (diarrhoea-negative) haemolytic uraemic syndrome (n=2), interstitial nephropathy (two siblings) and branchio-oto-renal syndrome (n=1). Recipient and donor ages ranged between 5.9 and 11.1 years and 0.3 and 2.5 years, respectively. Follow-up time after EBT was 2.1-13.2 years. Perioperative complications included (1) a renal artery thrombosis, with immediate intraoperative reconstruction and primary non-functioning of the graft, with recovery after 10 days, and (2) a vesico-ureteric obstruction, successfully managed with temporary insertion of a JJ-catheter. All grafts had good long-term function. Absolute glomerular filtration rate (GFR; millilitres/minute) increased in all patients, whereas relative GFR (millilitres/minute per 1.73m2 body surface area) remained stable during the follow-up period in all but one. Kidney size increased significantly, with maximal growth during the first year after EBT; magnetic resonance imaging (MRI) showed normal structure and vasculature. EBT is a safe and effective option for young children with end-stage renal failure. Absolute GFR and graft size increase and adapt to the children's growing body mas

Providing Insurance for Good Repayment Performance: The Individual Emergency Fund, Philippines

Asymmetric information impairs the functioning of credit markets, in particular in developing countries where incomplete property rights and lack of collateral are a common joint occurrence. In such an environment financial institutions enable lending by transferring the responsibilities for the screening and monitoring of the borrowers as well as the enforcement of credit contracts, to the borrowers themselves to ease problems of asymmetric information. This comprises non-collateral based lending methodologies such as peer monitoring through co-signers (Klonner and Rai, 2010) and, especially, peer screening and monitoring in individual and joint liability group lending with the possibility to impose social sanctions (Gin and Karlan, 2014). In addition, improved personal identification through fingerprints may alleviate credit market imperfections (Gin et al., 2012). These approaches have in common that they rely on the punishment of non-compliance with credit contracts as principle enforcement mechanism, e.g. through legal action or social sanctions. They contrast with alternative mechanisms which reward compliance, rather than punishing non-compliance, with credit contracts. One example is dynamic incentives, i.e. offering bigger loans sizes to clients when the build up a positive credit history. Another example, and subject to this impact evaluation, is conditioning gratuitous insurance provision for the client through the financial institution on clients' good standing with the financial institution (clients are in good standing if they are neither in arrears nor completely defaulted on their loans). We evaluate the impact of such a conditional insurance provision on the repayment performances of microfinance clients in a Randomized Controlled Trial. The impact evaluation employs weekly data on the financial activities of roughly 22000 clients in 700 client centers from the management information system (MIS) of the microfinance institution. To evaluate the impact of the IEF on clients, we complement the weekly MIS data with weekly data on a subsample of 500 to 700 clients collected through phone surveys

Overconfidence, Underconfidence, and the Use of Persuasive Messages in the Attainment of Savings Goals

The presentation analyzes whether the success of persuasive messages depends on an individual's behavioral bias: If at the onset of a savings period saving goals are chosen with over- or underconfidence, i.e. individuals over- or underestimate their savings potential, individuals might save too little and even stop saving altogether. Thus, given an individual's characteristics different dis- or encouraging messages might help to achieve the savings goals. The messages encourage some individuals to reconsider their self-set goal and to choose either a more ambitious or a more cautious goal. In our experiment we randomly assign moneyboxes in combination with these persuasive messages to 940 current and former clients of a microfinance institution in rural Ethiopia. Two baseline surveys and a recently collected follow-up data allow for an in-depth analysis of the mechanisms and the steps involved in the persuasive process that is likely to lead to different saving performances

Do Transparent Moneyboxes increase Savings? A Note on Visual Feedback and Savings Behavior

Limited attention may play a role in explaining the inability to reach savings goals (Karlan, McConnell, Mullainathan and Zinman, forthcoming). Presuming that attention is a scarce resource and important for the pursuit of saving plans, limits to attention in inter-temporal consumption and saving decisions may cause savers not to reach their savings goals. In turn, constant feedback on the savings performance may help to reach savings goals in the presence of limited attention. In this presentation we will draw on a simple experiment to test whether the visual representation of savings balances stimulates savings behavior and helps individuals reach their savings goals. Doing so, we randomly offer transparent and non-transparent moneyboxes as a complementary savings device to current and former clients of a microfinance organization in Ethiopia. We test whether the visual representation of saving balances via transparent money boxes increases savings and helps microfinance clients reach their savings goals. While this is our working hypothesis, we also test whether the visual representation of saving balances via transparent money boxes decreases savings (i.e. because of a higher temptation to spend money that can be seen, or because it is more difficult to hide savings from others). The hypotheses are currently under investigation as the final phase of the data-collection was completed in February 2015

Proteomic analysis of mononuclear cells of patients with minimal-change nephrotic syndrome of childhood

Background/Aims. Recently, peripheral blood mononuclear cell transcriptome analysis has identified genes that are upregulated in relapsing minimal-change nephrotic syndrome (MCNS). In order to investigate protein expression in peripheral blood mononuclear cells (PBMC) from relapsing MCNS patients, we performed proteomic comparisons of PBMC from patients with MCNS in relapse and controls. Methods. PBMC from a total of 20 patients were analysed. PBMC were taken from five patients with relapsing MCNS, four in remission, five patients with other glomerular diseases and six controls. Two dimensional electrophoresis was performed and proteome patterns were compared. Results. Automatic heuristic clustering analysis allowed us to pool correctly the gels from the MCNS patients in the relapse and in the control groups. Using hierarchical population matching, nine spots were found to be increased in PBMC from MCNS patients in relapse. Four spots were identified by mass spectrometry. Three of the four proteins identified (l-plastin, α-tropomyosin and annexin III) were cytoskeletal-associated proteins. Using western blot and immunochemistry, l-plastin and α-tropomyosin 3 concentrations were found to be enhanced in PBMC from MCNS patients in relapse. Conclusions. These data indicate that a specific proteomic profile characterizes PBMC from MCNS patients in relapse. Proteins involved in PBMC cytoskeletal rearrangement are increased in relapsing MCNS. We hypothesize that T-cell cytoskeletal rearrangement may play a role in the pathogenesis of MCNS by altering the expression of cell surface receptors and by modifying the interaction of these cells with glomerular cell