Transplantation of kidneys with tumors

The shortage of donors in the face of the increasing number of patients wait-listed for renal transplantation has prompted several strategies including the use of kidneys with a tumor, whether found by chance on harvesting from a deceased donor or intentionally removed from a living donor and transplanted after excision of the lesion. Current evidence suggests that a solitary well-differentiated renal cell carcinoma, Fuhrman nuclear grade I-II, less than 1\ua0cm in diameter and resected before grafting may be considered at minimal risk of recurrence in the recipient who, however, should be informed of the possible risk and consent to receive such a graft

[Renal biopsy collection (2000-2008) from a single center, the Policlinico Umberto I, Sapienza University, Rome.].

AbstractThe collection of data about renal biopsies is an important starting point for clinical and epidemiological studies about kidney disease. The aim of this study was the evaluation of the frequency of the different kidney diseases, their clinical presentation and the demographic features of the population based on renal biopsies performed at our center during the years 2000-2008. Clinical presentations were defined as nephrotic syndrome (NS), urinary abnormalities, macroscopic hematuria, acute renal failure (ARF) and chronic renal failure (CRF). Kidney diseases were divided into five groups: 1) primary glomerulonephritis; 2) secondary glomerulonephritis; 3) tubulointerstitial nephritis (TIN); 4) vascular-disease-associated kidney disease; 5) miscellaneous. Primary glomerulonephritis was the most common (58.64%), followed by secondary glomerulonephritis (27.03%); TIN and vascular diseases were diagnosed in 1.46% and 7.78% of cases, respectively. The most common indications to perform renal biopsies were urinary abnormalities in 45.01% of cases, followed by CRF (21.51%) and NS (21.37%); macroscopic hematuria (6.41%) and ARF (5.70%) were less common. The most common kidney disease in men was IgA nephropathy (27.91%), while lupus nephritis was the most common in women (18.88%). In patients older than 65 years of age membranous glomerulonephritis (34.67%) was the most common kidney disease. The availability of these data is useful to assess the distribution and clinical presentation of kidney diseases among patients hospitalized at the Policlinico Umberto I in Rome

Renal cancer in kidney transplanted patients

Renal cancer occurs more frequently in renal transplanted patients than in the general population, affecting native kidneys in 90\ua0% of cases and the graft in 10\ua0%. In addition to general risk factors, malignancy susceptibility may be influenced by immunosuppressive therapy, the use of calcineurin inhibitors (CNI) as compared with mammalian target of rapamycin inhibitors, and the length of dialysis treatment. Acquired cystic kidney disease may increase the risk for renal cancer after transplantation, while autosomal dominant polycystic kidney disease does not seem to predispose to cancer development. Annual ultrasound evaluation seems appropriate in patients with congenital or acquired cystic disease or even a single cyst in native kidneys, and every 2\ua0years in patients older than 60\ua0years if they were on dialysis for more than 5\ua0years before transplantation. Immunosuppression should be lowered in patients who develop renal cancer, by reduction or withdrawal of CNI. Although more evidence is still needed, it seems reasonable to shift patients from CNI to everolimus or sirolimus if not already treated with one of these drugs, with due caution in subjects with chronic allograft nephropathy