Renal Allograft Rupture: A Clinicopathologic Review

Transplantation Proceedings Volume 32, Issue 8, December 2000, Pages 2597-2598 -------------------------------------------------------------------------------- doi:10.1016/S0041-1345(00)01801-7 | How to Cite or Link Using DOI Copyright © 2000 Elsevier Science Inc. All rights reserved. Cited By in Scopus (4) Permissions & Reprints Renal allograft rupture: a clinicopathologic review M Ramosa, , L Martinsa, L Diasa, A.C Henriquesa, J Soaresa, J Queirósa and A.M Sarmentoa aDepartments of Urology and Nefrology, Hospital Geral de Santo António, Oporto, Portugal Available online 19 December 2000. Article Outline Patients and methods Results Discussion References Renal allograft rupture (RAR) is a rare but very serious complication of renal transplantation, requiring emergency surgery. The most common cause is acute allograft rejection, but other causes such as renal vein thrombosis (RVT), acute tubular necrosis (ATN), renal biopsy, and lymphatic obstruction have been reported.[1] and [2] We reviewed our experience with the aim of identifying RAR predisposing conditions. Patients and methods In a consecutive series of 934 renal transplants performed between July 1983 and September 1999, 11 patients (1.2%) had RAR. In these cases we studied donor and recipient characteristics, preservation conditions, clinical signs and symptoms, treatment, and pathology findings. This group of patients was then compared with their paired cohort. Data analysis was computer-based. In the statistical analysis t test and Fisher’s exact test were used. Results All 11 kidneys that suffered RAR were from cadaver donors, nine male and two female. The mean age was 29.5 years with good terminal serum creatinine (mean 1.1 mg/dL). All organs were stored in Eurocollins solution and the mean cold ischemia time was 21 hours and 25 minutes (range, 10 hours to 29 hours and 20 minutes). Excluding one black patient, all recipients were Caucasian. Eight were female and 3 were male, with a mean age of 33.8 years. The mean HLA match was 1.7, and the mean peak panel reactive antibody (PRA) was 22% (range 0 to 93%) and current was 15% (range 0 to 67%). All patients had cyclosporine treatment, eight had delayed graft function requiring dialysis, and three underwent renal allograft biopsy. In two patients rupture occurred in the second allograft; the others were first transplants. The day of RAR was a mean of 5.3 (range 2 to 13). All patients had new onset of severe allograft pain, eight had a drop in daily hematocrit, and six had hypotension. The four patients with more precocious ruptures had sudden onset of bleeding through the drainage tube. Transplant nephrectomy was performed in 10 patients, and surgical conservative treatment with fibrin glue and collagen foam was performed in one. All patients survived RAR. Three had a second transplant and currently have functioning allografts. Pathology examination revealed RVT in three patients and some degree of rejection in the remaining eight. One patient had a rupture on the second day because of hyperacute rejection, and three had severe acute cellular rejection, but in four patients the dominant figure was ATN with minimal rejection. Excluding the patient with hyperacute rejection, the day of rupture was later for those with severe acute rejection, a mean of 9.6 days (range 6 to 13). In those with ATN, the day of RAR was a mean of 4.5 (range 3 to 6) and the patients with RVT had ruptures even sooner, on mean third day (range 2 to 4). Variables associated with RAR were: sex mismatch (P = .004), current PRA (P = .012), and a need for dialysis (P = .042). Age of the recipient, transplant number, cold ischemia time, total HLA match, and peak PRA were not associated with RAR. Discussion Higher current PRA and a need for dialysis are variables associated with rejection and ATN. Therefore they are expected to be related to rupture. The well-documented conditions that are associated with ATN and rejection3 must be the same, which in extreme conditions predispose to RAR. We find no explanation for the statistically significant association of sex mismatch and RAR, other than random error. Acute allograft rejection is the most frequent cause of graft rupture in the literature (60 to 80%),3 but ATN has received little note. In our series, ATN was responsible for 36% of the ruptures, as much as severe acute rejection. ATN alone can cause RAR,4 because of interstitial edema and rise in intrarenal pressure. But when associated with rejection, it seems that these two conditions can act synergistically to cause allograft rupture. Our data suggests that rupture occurs later when caused by rejection, rather than when RVT is responsible. To our knowledge this finding had never been reported in world literature. Perhaps the timing of RVT is related to technical problems, such as twisting and kinking of the vein or intima tear, although the thrombogenic effect of cyclosporine can also have a role in this process.5 All these patients were on cyclosporine therapy, which may explain the small number of RAR caused by rejection alone and the significant number of patients that had RVT (27%). It appears that cyclosporine therapy is changing the etiology of the graft rupture.6 References 1 T. Grochowiecki, J. Szmidt and K. Madej et al., Transplantation Proc 28 (1996), p. 3461. View Record in Scopus | Cited By in Scopus (2) 2 R.S. Lord, D.J. Effeney and J.M. Hayes et al., Ann Surg 177 (1973), p. 268. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (4) 3 G.J. Azar, A. Zarifian and G.D. Frentz et al., Clin Transplantation 10 (1996), p. 635. View Record in Scopus | Cited By in Scopus (12) 4 Y.H. Chan, K.M. Wong and K.C. Lee et al., Am J Kidney Dis 34 (1999), p. 355. Abstract | Article | PDF (86 K) 5 R.M. Jones, J.A. Murie and A. Ting et al., Clin Transplant 2 (1988), p. 122. 6 A.J. Richardson, R.M. Higgins and A.J. Jaskowski et al., Br J Surg 77 (1990), p. 558. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (19

Evolution in swimming "science" research

Swimming seems to be one of the sports more studied . More than one decade ago, Clarys (1996) made an content analysis of the research about swimming. However, in these last 13 years several developments happened in the aquatic activities

Evolution on Swimming Science Research: content analysis of the “Biomechanics and Medicine in Swimming” Proceedings Books from 1971 to 2006

Swimming seems to be one of the sports more studied . More than one decade ago, Clarys (1996) made an content analysis of the research about swimming. However, in these last 13 years several developments happened in the aquatic activities

Hyperhomocysteinemia in Renal Transplantation: Preliminary Results

Cardiovascular disease (CVD) is a major cause of morbidity and mortality after renal transplantation (RT).[1] and [2] The excess risk of CVD in RT is due in part to a higher prevalence of established atherosclerotic risk factors, including hypertension, dyslipidemia, diabetes, obesity, and physical inactivity.[1] and [2] However, some renal-related risk factors like immunosuppressive medication and residual renal insufficiency also contribute to this excess CVD risk and may complicate the management of dyslipidemia and hypertension in this population.[1] and [2] Accordingly, there is a compelling need to identify and safely manage other putative CVD risk factors among RT patients. Elevated plasma homocysteine is emerging as an important risk factor for cardiovascular disease in general populations.[3] and 4 R Clarke, L Daly and K Robinson et al., N Engl J Med 324 (1991), p. 1149. View Record in Scopus | Cited By in Scopus (1372)[4] Some studies have demonstrated that hyperhomocysteinemia is present in patients with impaired renal function and is associated with CVD.[5], [6] and [7] Only a small number of studies are available on the prevalence and determinants of hyperhomocysteinemia in renal transplant recipients.[8], [9], [10], [11], [12], [13], [14] and [15] We undertook this study to 1. estimate the prevalence of hyperhomocysteinemia in renal transplant recipients; 2. examine the relationships between plasma total homocysteine (tHcy) and its metabolic determinants vitamin B6, vitamin B12, and folic acid; and 3. identify other determinants of tHcy

Key climate change stressors of marine ecosystems along the path of the east african coastal current

For the countries bordering the tropical Western Indian Ocean (TWIO), living marine resources are vital for food security. However, this region has largely escaped the attention of studies investigating potential impacts of future climate change on the marine environment. Understanding how marine ecosystems in coastal East Africa may respond to various climatic stressors is vital for the development of conservation and other ocean management policies that can help to adapt to climate change impacts on natural and associated human systems. Here, we use a high-resolution (1/4°) ocean model, run under a high emission scenario (RCP 8.5) until the end of the 21st century, to identify key regionally important climate change stressors over the East African Coastal Current (EACC) that flows along the coasts of Kenya and Tanzania. We also discuss these stressors in the context of projections from lower resolution CMIP5 models. Our results indicate that the main drivers of dynamics and the associated ecosystem response in the TWIO are different between the two monsoon seasons. Our high resolution model projects weakening of the Northeast monsoon (December–February) winds and slight strengthening of the Southeast monsoon (May–September) winds throughout the course of the 21st century, consistent with CMIP5 models. The projected shallower mixed layers and weaker upwelling during the Northeast Monsoon considerably reduce the availability of surface nutrients and primary production. Meanwhile, primary production during the Southeast monsoon is projected to be relatively stable until the end of the century. In parallel, a widespread warming of up to 5 °C is projected year-round with extreme events such as marine heatwaves becoming more intense and prolonged, with the first year-long event projected to occur as early as the 2030s. This extreme warming will have significant consequences for both marine ecosystems and the coastal populations dependent on these marine resources. These region-specific stressors highlight the importance of dynamic ocean features such as the upwelling systems associated with key ocean currents. This indicates the need to develop and implement a regional system that monitors the anomalous behaviour of such regionally important features. Additionally, this study draws attention to the importance of investment in decadal prediction methods, including high resolution modelling, that can provide information at time and space scales that are more directly relevant to regional management and policy making

Functional characterization of LDL receptor gene variants found in patients with clinical diagnosis of familial hypercholesterolaemia

Aim: Familial Hypercholesterolaemia (FH) is an autosomal disorder of lipid metabolism presenting increased cardiovascular risk due to lifelong exposure to high LDL levels. LDLR mutations are the cause of disease in about 90% of the cases, but proof of pathogenicity has only been obtained for about 10% of the variants. The lack of functional characterization of variants found in patients with a clinical diagnosis of FH makes it difficult to reach a definite FH diagnosis. In the Portuguese Familial Hypercholesterolemia Study (PFHS), 142LDLR alterations were found in 861 index patients and their relatives up to date. Until now, 82 of these alterations have already been proved to be mutations causing disease or are established null alleles and 15 were classified by in vitro studies as non-pathogenic. The remaining 38 variants, 21 of unknown significance (VUS), found in 102 index cases have not been yet functionally characterized.Project grant FCT_PTDC/SAU-GMG/101874/2008; UID/MULTI/04046/2013 centre grant from FCT, Portugal (to BioISI)N/

Impact of Homocysteinemia on Long-Term Renal Transplant Survival

Impact of Homocysteinemia on Long-Term Renal Transplant Survival I. Fonseca, L. Martins, J. Queirós, D. Mendonça, L. Dias, A.M. Sarmento, A.C. Henriques, and A. Cabrita ABSTRACT Aim. We prospectively followed cohort of 202 renal transplant recipients for years to examine the impact of fasting homocysteinemia on long-term patient and renal allograft survival. Methods. Cox proportional hazards regression analysis was used to identify independent predictors of all-cause mortality and graft loss. Results. Hyperhomocysteinemia (tHcy 15 mol/L) was present in 48.7% of the 202 patients, predominantly among men (55.8%as opposed to women (37.1%)At the end of the follow-up period, 13 (6.4%patients had died including 10 from cardiovascular disease, and 23 had (11.4%had lost their grafts. Patient death with functioning allograft was the most prevalent cause of graft loss (13 recipients)Levels of tHcy were higher among patients who died than among survivors (median 23.9 vs 14.3 mol/L; .005)Median tHcy concentration was also higher among the patients who had lost their allografts than those who did not (median 19.0 vs 14.1 mol/L; .001)In Cox regression model including gender, serum creatinine concentration, transplant duration, traditional cardio- vascular risk factors, and associated conditions, such as past cardiovascular disease, only tHcy concentration (ln) (HR 5.50; 95% CI, 1.56 to 19.36; .008) and age at transplantation (HR 1.07; 95% CI, 1.02 to 1.13; .01) were independent predictors of patient survival. After censoring data for patient death, tHcy concentration was not risk factor for graft loss. Conclusions. This prospective study shows that tHcy concentration is significant predictor of mortality, but not of graft loss, after censoring data for patient death

Manual de referência FPN para o ensino e aperfeiçoamento técnico em natação: consulta rápida

Não basta ter mais pessoas a nadar, é preciso garantir que o façam com qualidade na sua prática. Desta forma é necessário garantir, para além da disponibilidade de infraestruturas devidamente registadas e cadastradas, a existência de programas diversificados e técnicos competentes para a aprendizagem. Aprender a nadar, em qualquer idade, deve ser uma experiencia de fortalecimento e enriquecimento pessoal e levar a uma motivação para a prática de atividades em meio aquático ao longo da vida.info:eu-repo/semantics/publishedVersio

Manual de referência FPN para o ensino e aperfeiçoamento técnico em natação: versão completa

Não basta ter mais pessoas a nadar, é preciso garantir que o façam com qualidade na sua prática. Desta forma é necessário garantir, para além da disponibilidade de infraestruturas devidamente registadas e cadastradas, a existência de programas diversificados e técnicos competentes para a aprendizagem. Aprender a nadar, em qualquer idade, deve ser uma experiencia de fortalecimento e enriquecimento pessoal e levar a uma motivação para a prática de atividades em meio aquático ao longo da vida.info:eu-repo/semantics/publishedVersio