Alkalmas-e a vizelet neutrofil gelatináz asszociálta lipokalin meghatározása a rejekció előrejelzésére veseátültetés után?

INTRODUCTION: Delayed graft function and acute rejection have negative impact on graft survival. AIM: To asses the predictive value of urinary neutrophil gelatinase-associated lipocalin, which has been found to be a promising biomarker for the diagnosis of acute kidney injury. METHOD: In this prospective study urinary neutrophil gelatinase-associated lipocalin levels of 27 kidney recipients were measured. RESULTS: Patients were grouped as follows: group 1, no complication; group 2, rejection; group 3, delayed graft function requiring dialysis; group 4, rejection plus delayed graft function. There were no significant differences between groups 1 and 2, and between groups 3 and 4. Patients in groups 3 and 4 had significantly higher urinary neutrophil gelatinase-associated lipocalin levels as compared to those in groups 3 and 4. There was a paralIel change in urinary neutrophil gelatinase-associated lipocalin levels in groups 1 and 2. CONCLUSIONS: In these patients urinary neutrophil gelatinase-associated lipocalin levels failed to provide useful information in both cases of normal and impaired function. Orv. Hetil., 2015, 156(48), 1956-1959

High frequency of ulcers, not associated with Helicobacter pylori, in the stomach in the first year after kidney transplantation

BACKGROUND: Although gastrointestinal (GI) symptoms are very frequent in organ transplant patients, there is a paucity of data about the endoscopic findings of kidney recipients. METHODS: Two thousand one hundred and thirty-five kidney transplants were performed between 1994 and 2007. During that period, 672 gastroscopies were performed in 543 of those patients. Their mean age was 49.5 years and 56.9% were male. Immunosuppressive combinations included cyclosporine-mycophenolate-steroids, cyclosporine-steroids and tacrolimus-mycophenolate mofetil-steroids. Ninety-eight percent of the patients received acid suppression therapy. RESULTS: The rate of clinically significant endoscopic findings was 84%. Macroscopic findings included inflammation in 46.7%, oesophagitis in 24.7%, ulcer in 16.9% and erosions in 14.8% of cases. Twenty-nine percent of endoscopies showed ulcer disease more frequently in the first 3 months (P=0.0014) after transplantation than later, and 45.7% of all ulcers developed in the first year. The presence of Helicobacter pylori was verified in 20.9% of cases, less than in the general, and also in the uraemic population (P<0.0001). There was no association between the presence of H. pylori and ulcers (P=0.28). Steroid pulse treatment for rejection was not associated with more ulcers (P=0.11); the use of mycophenolate mofetil increased the risk of erosions by 1.8-fold. CONCLUSION: More than 25% of all kidney recipients required upper endoscopy in their 'post-transplant life'; the prevalence of 'positive findings' and ulcer disease was higher than in the general population (P<0.0001). The most vulnerable period is the first 3 months. Mycophenolate mofetil had an impact on GI complications, whilst the presence of H. pylori in the transplant population is not associated with the presence of ulcers

Molecular Pathogenesis of Post-Transplant Acute Kidney Injury: Assessment of Whole-Genome mRNA and MiRNA Profiles.

Acute kidney injury (AKI) affects roughly 25% of all recipients of deceased donor organs. The prevention of post-transplant AKI is still an unmet clinical need. We prospectively collected zero-hour, indication as well as protocol kidney biopsies from 166 allografts between 2011 and 2013. In this cohort eight cases with AKI and ten matched allografts without pathology serving as control group were identified with a follow-up biopsy within the first twelve days after engraftment. For this set the zero-hour and follow-up biopsies were subjected to genome wide microRNA and mRNA profiling and analysis, followed by validation in independent expression profiles of 42 AKI and 21 protocol biopsies for strictly controlling the false discovery rate. Follow-up biopsies of AKI allografts compared to time-matched protocol biopsies, further baseline adjustment for zero-hour biopsy expression level and validation in independent datasets, revealed a molecular AKI signature holding 20 mRNAs and two miRNAs (miR-182-5p and miR-21-3p). Next to several established biomarkers such as lipocalin-2 also novel candidates of interest were identified in the signature. In further experimental evaluation the elevated transcript expression level of the secretory leukocyte peptidase inhibitor (SLPI) in AKI allografts was confirmed in plasma and urine on the protein level (p<0.001 and p = 0.003, respectively). miR-182-5p was identified as a molecular regulator of post-transplant AKI, strongly correlated with global gene expression changes during AKI. In summary, we identified an AKI-specific molecular signature providing the ground for novel biomarkers and target candidates such as SLPI and miR-182-5p in addressing AKI

Successful Treatment of the Gastrointestinal Manifestation of Prototheca in a Kidney Transplant Recipient

The Prototheca species are achlorophyllic algae and they are recognized pathogens in animals. They have been reported to cause infections in humans; the majority of the infected patients are immunocompromised. Organ transplant recipients are at risk of infection caused by such unusual organisms.Here we present a highly atypical case report of Prototheca mimicking a cecum tumor in a kidney recipient 7 years after the transplantation. Three years before this Prototheca infection, after a native nephrectomy, the patient underwent a complicated duodeno-jejunal reconstruction with feeding catheter jejunostomy. Imaging studies indicated a tumor-like space occupying lesion in the cecum. The patient was treated successfully with colon resection. Detailed histology excluded malignancy and proved Prototheca wickerhamii.The pathogenesis and many biological aspects of human protothecosis are unclear. Usually, treatment involves both medical and surgical approaches. The surgical treatment should be complete excision. The literature suggests an extremely high mortality rate, and therefore we advocate aggressive surgery in organ transplant recipients. This case is the first report of a successfully treated gastrointestinal manifestation of protothecosis in an organ transplant recipient

A gastrointestinalis traktus cytomegalovirus-fertőzése szervtranszplantált betegeken = Gastrointestinal cytomegalovirus infections in organ transplant patients

A cytomegalovirus (CMV) az immunszupprimált szervtranszplantált betegek egyik veszélyes fertőzése. A transzplantáltak 80-90%-ánál a fertőzés inaktív; a tünetekkel járó CMV-betegség gyakorisága 30-40%-os. Gastrointestinalis CMV-betegség a szervátültetettek mintegy 10%-ában fordul elő, a kórkép a tápcsatorna bármelyik szakaszát érintheti. A CMV-betegség leggyakrabban a nyálkahártya károsodásával, fekélyekkel, eróziókkal, vérzésekkel jár, oka lehet a tápcsatorna motilitási zavarának, ritkábban gastrointestinalis gyulladásos teriméknek, perforációknak. A diagnosztika alapja az endoszkópos vizsgálat biopsziás mintavétellel. A biopsziás minta szövettani vizsgálatakor keresni kell a CMV-fertőzésre jellemző cytomegaliás sejteket intranukleáris („bagolyszem”) és intracitoplazmatikus zárványokkal. A vírus kimutatására számos mikrobiológiai, immunhisztokémiai és molekuláris biológiai módszer létezik. Igazolt kórkép esetén a kezelés kettős: az elváltozásoknak, tüneteknek megfelelő gasztroenterológiai kezelés mellett meg kell kezdeni az antivirális terápiát általában intravénás ganciclovirrel és/vagy orális valganciclovirrel. Lényeges a betegség kialakulásának megelőzése is: a magas rizikójú betegcsoportban általános profilaxis javasolt per os valganciclovirrel, speciális esetekben hiperimmunglobulinnal; közepes kockázat esetén a mikrobiológiai surveillance eredménye alapján preemptív kezelés kezdhető. | Cytomegalovirus (CMV) is a major pathogen of immunocompressed organ transplant patients. 80-90% of all transplant patients are infected by the virus; however, the incidence of CMV disease is 30-40%. Gastrointestinal CMV disease occurs in 10% of all transplants involving any part of the gastrointestinal tract. Mucosal injury, ulcerations, erosions, hemorrhage, gastrointestinal dysmotility, rarely gastrointestinal masses, perforations are the most common pathological findings of the CMV disease. The method of specific diagnostics is endoscopy with mucosal biopsy. The biopsy samples must be investigated histopathologically for specific cytomegalic cells with intranuclear (“owl’s eye”) and intracytoplasmatic inclusions. Different microbiological, immunohistochemical and molecular biological assays can be performed to detect CMV in the mucosa. In case of gastrointestinal CMV disease, both gastroenterological and antiviral treatment are needed by ganciclovir i.v. and/or valganciclovir orally. The prevention of the disease should be achieved by general prophylaxis in high-risk patients (oral valganciclovir, in special cases hyperimmune globulin), and by preemptive therapy using microbiological surveillance in middle-risk patients

Prototheca Infections and Ecology from a One Health Perspective

International audiencePrototheca microalgae were only recognized as pathogens of both humans and animals in the 1960s; however, since then, these microbes have been drawing increasing interest in both human and veterinary medicine. The first human outbreak of protothecosis in a tertiary care chemotherapy ward in 2018 further highlighted the need to understand in more depth and detail their ecology, etiology, pathogenesis and routes of transmission between different hosts, environments and habitats from a One Health perspective. Protothecal infections have been reported in a growing number of cattle herds around the world in recent decades, and Prototheca has become an important bovine mastitis pathogen in certain countries and regions. The survival of Prototheca in the environment and its ability to spread in the herd pose a serious challenge to the management of infected dairy farms. Prevention of the disease is particularly important, as there is no effective and reliable treatment for it and the chances of self-healing are minimal. Therefore, the development of more effective drugs is needed for the treatment of human and animal protothecosis. The prudent use of antibiotics and their replacement by alternative or preventive measures, when possible, may further contribute to the control of protothecal infections

Kidney donor and recipient characteristics comparing AKI and control groups in the Basic and independent validation datasets.

<p>Continuous data are provided as median and 1^st and 3^rd quartile; categorical data are shown as counts.</p><p>na … not applicable,</p>a<p>Fisher's exact test,</p>b<p>mean (range),</p>c<p>median (range),</p><p>n. st. … not stated.</p><p>PGF … primary graft function, AKI … acute kidney injury.</p

AKI mRNA signature as verified in the independent evaluation dataset.

<p><b>bold</b>......molecular features discussed as biomarker candidates of acute kidney injury.</p><p>Raw p-values and fold changes of verified differentially regulated genes are provided.</p

AKI miRNA signature as verified in the evaluation dataset.

<p>Raw p-values and fold changes of verified differentially regulated miRNAs are provided.</p

SLPI protein concentration (ng/ml) measured by sandwich ELISA in (A) EDTA-plasma and (B) urine of AKI and PGF patients.

<p>Three AKI patients were anuric at the time of post-TX biopsy. (C) Relative gene expression levels of SLPI in post-TX biopsies. Individual data points as well as median, 1^st and 3^rd quartile are provided.</p