Posttranplant Urinary Tract Infection Rates and Graft Outcome in Kidney Transplantation for End-Stage Renal Disease Due to Reflux Nephropathy Versus Chronic Glomerulonephritis

Sahutoglu, Tuncay/0000-0003-2015-4421; sevinc, mustafa/0000-0003-2804-4884; Seyahi, Nurhan/0000-0001-7427-618XWOS: 000383528700033PubMed: 27569945Background. the goal of this study was to evaluate posttransplant urinary tract infection (UTI) rates and graft outcome in kidney transplantation for end-stage renal disease (ESRD) due to vesicoureteral reflux (VUR)-related reflux nephropathy (RN) versus chronic glomerulonephritis (CGN). Methods. A total of 62 patients with ESRD who underwent kidney transplantation for VUR-related RN (VUR-RN group, n = 31; mean +/- standard deviation age, 34.1 +/- 6.0 years; 58.1% female) or CGN (CGN group, n = 31; mean age, 34.2 +/- 6.8 years; 71.0% male) at our unit between January 1996 and January 2011 were included in this retrospective study. Baseline recipient and donor characteristics, renal replacement therapy, posttransplant data on serum creatinine levels, graft outcome, and UTIs were recorded. Posttransplant UTIs and graft outcome were compared between the VUR-RN and CGN groups, as well as between patients with and without pretransplant nephrectomy in the VUR-RN group. Results. the frequency of overall (72 vs 18 of 90; P =.05) UTI episodes was significantly higher in the VUR-RN group than in the CGN group; Escherichia coli (64.2%) was the most common pathogen. the VUR-RN and CGN groups were similar in terms of 1-year (100.0% for each), 5-year (95.8% vs 96.8%), and 10-year (82.0% vs 96.8%) graft survival. VUR-RN patients with and without nephrectomy were similar in terms of 1-year (100.0% for each), 5-year (91.7% vs 85.7%), and 10-year (81.5% vs 85.7%) graft survival. Conclusions. Our findings indicate kidney transplantation is a safe and effective option in ESRD patients with RN secondary to VUR. It resulted in high 1-year, 5-year, and 10-year graft survival rates

The incidence of new onset diabetes after transplantation and related factors: Single center experience [Incidencia de diabetes postrasplante de nueva aparición y factores relacionados: experiencia de un único centro]

PubMed ID: 28262264Aim New-onset diabetes after transplantation (NODAT) is a frequent metabolic complication and is considered a risk factor for patients undergoing renal transplant. The aim of this study was to evaluate the incidence and developing duration of new-onset diabetes after transplant (NODAT) and influencing factors. Methods All patients’ data was investigated retrospectively. Diabetics, follow-up period < 6 months, age < 18years were excluded. Demographic, clinical and laboratory data was recorded. Patients were divided into two groups: with/without NODAT. NODAT group was divided into four subgroups according to the time of developing NODAT, which were 0–3, 3–6, 6–12 and 12 months later. Two groups were compared, to investigate the incidence of NODAT and risk factors associated with the occurrence of NODAT. Results We retrospectively analyzed the records of 570 patients, of which 420 patients were included. Seventy (16.6%) patients had NODAT (36 female, mean age 51.7 ± 8.2 years, mean follow-up 41.6 ± 21.5 months), 52.8% of patients developed NODAT within the first three months of being diagnosed. 350 patients (116 female, mean age 43.2 ± 12.5 years, mean follow-up 41.6 ± 21.5 months) were without NODAT. The incidence of impaired fasting glucose (IFG) during the first week after transplant was found to be higher in the patients with NODAT (p < 0.001). There was positive correlation between NODAT and older age, obesity, family history of diabetes, presence of IFG, fasting plasma glucose, total and LDL-cholesterol, triglycerides, parathormone. Old age, obesity, presence of IFG, pretransplant hypertriglyceridemia and hyperparathyroidism were predictors of development of NODAT. Conclusion Incidence of NODAT, especially the first six months, was high. All patients should be screened for IFG within the first week. Patients with dyslipidemia, elderly and obese patients should be closely monitored for the risk of development of NODAT. © 2017 Sociedad Española de Nefrologí

Effect of initial PET status on clinical course in peritoneal dialysis patients

Introduction. To investigate the effect on mortality of initial peritoneal equilibration test (PET) in PD patients (pts). Methods. We included patients who initiated therapy between 2001-2014. Patients underwent initial PET in the first three months. They were divided into four groups according to the initial PET (high, high-average, lowaverage, low transport). Sociodemographic data, clinical courses and infectious complications between groups were compared, and the reasons for PD withdrawal were obtained. Technique survival analyses of patients were done. Results. In a total of 367 pts were PD was started, 104 pts were excluded. Data of the remaining 263 patients were evaluated. Thirty-seven pts (23F, mean age 44.6±16.5 years, mean follow-up 30.5±20.8 months) had high transport, 90 pts (49F, mean age 41.5±16 years, mean followup 42.6±27.7 months) had high-average transport, 91 pts (55F, mean age 44.5±14.9 years, mean follow-up 50±29.2 months) had low-average transport and 45 pts (17F, mean age 43.5±14 years, mean follow-up (63.4±34.5 months) had low transport. There was no difference between groups in terms of age, gender, body mass index, initial daily urine and ultrafiltration volume, initial albumin levels, presence of diabetes mellitus (p>0.05). Peritonitis and catheter exit-site/tunnel infection attacks were higher in patients with high transport (p=0.01 and 0.008, respectively). There was a difference between groups with respect to the last status of patients (p< 0.009). The major causes of deaths were peritonitis and/or sepsis and cardiovascular causes in all patients. The mortality and technique survival rate was found higher in patients with high transport (log rank: 0.004 and 0.027, respectively). Age (OR:1.045, p<0.001), initial albumin (OR: 0.482, p= 0.007), daily urine volume (OR: 1.045, p<0.001) and presence of catheter exit-site/tunnel infection (OR: 0.249, p<0.001) were found to predict patient survival. Only presence of catheter exit-site/tunnel infection (OR: 0.452, p=0.013) were found to predict patient survival. Conclusions. Initial PET has effects on PD patient survival; patients with high transport have the worst survival and frequent infectious complications

Can eculizumab be discontinued in aHUS? Case report and review of the literature

Nephrolog

Renal Damage Frequency in Patients with Solitary Kidney and Factors That Affect Progression

Background. The aim of this study is to assess renal damage incidence in patients with solitary kidney and to detect factors associated with progression. Methods. Medical records of 75 patients with solitary kidney were investigated retrospectively and divided into two groups: unilateral nephrectomy (group 1) and unilateral renal agenesis/dysplasia (group 2). According to the presence of kidney damage, each group was divided into two subgroups: group 1a/b and group 2a/b. Results. Patients in group 1 were older than those in group 2 (p=0.001). 34 patients who comprise group 1a had smaller kidney size (p=0.002) and higher uric acid levels (p=0.028) than those in group 1b at presentation. Uric acid levels at first and last visit were associated with renal damage progression (p=0.004, 0.019). 18 patients who comprise group 2a were compared with those in group 2b in terms of presence of DM (p=0.038), HT (p=0.003), baseline proteinuria (p=0.014), and uric acid (p=0.032) levels and group 2a showed higher rates for each. Progression was more common in patients with DM (p=0.039), HT (p=0.003), higher initial and final visit proteinuria (p=0.014, for both), and higher baseline uric acid levels (p=0.047). Conclusions. The majority of patients with solitary kidney showed renal damage at presentation. Increased uric acid level is a risk factor for renal damage and progression. For early diagnosis of renal damage and reducing the risk of progression, patients should be referred to a nephrologist as early as possible