Acute vascular rejection after kidney transplantation outcome and effect of different therapeutic modalities

Background: Steroid resistant acute vascular rejection (AVR) is a great obstacle in successful renal transplantation (KTx). The aim of this work was to evaluate the outcome of histologically confirmed acute vascular rejection - which occurred in severe aggressive form in 39 patients following kidney transplantation as well as to study the outcome of therapy. These cases were chosen from 1000 renal allograft recipients who underwent kidney transplantation in the period between March, 1976 and April 1997 in Urology-Nephrology Center, Mansoura, Egypt.Methods: Statistical analysis of risk factors leading to AVR was carried out. The outcome of different rescue therapies used for AVR as well as graft survival functions were also analyzed.Results: Survival analysis for grafts with AVR revealed 60%, 53%, 30 %, 0% graft survival at 1, 2, 5, 10 yrs respectively after Tx. A statistically significant difference was found in comparison to patients who only experienced acute cellular rejection (90%, 84%, 71%, 46% graft survival at 1, 2, 5, 10 years post- KTx respectively) or patients who passed without rejection in their post-transplantation follow up (95%, 91.3%, 83.3%, 65.5% graft survival at 1, 2, 5, 10 yrs respectively). No statistically significant difference on the overall graft survival between the different modalities of therapy was noted. Steroid pulses + plasma exchange were given for 14 patients with AVR, whereas ATG, MAB ± plasma exchange were added to steroid resistant cases (25 patients). Logistic regression analysis of these data showed that prior blood transfusion, donor-recipient consanguinity, retransplantation are the most significant variables related to occurrence of AVR after kidney transplantation. At last follow up, 14 patients 35.9%) were living with functioning grafts, 16 patients (41%) were living on dialysis, 5 patients died with functioning grafts (12.8%) and 4 patients (10.25%) died with failed grafts.In conclusion: AVR remains a major obstacle for renal transplantation as it markedly impaired graft survival and responded poorly to therapy. Prior blood transfusion decreased the incidence of AVR whereas retransplantation and unrelated donation account significantly to the occurrence of AVR after renal Tx

Hemodialysis associated dysautonomia; Effect of optimization of dialysis and nutrition: A prospective study

Background: Autonomic neuropathy is common among hemodialysis patients, even if they are asymptomatic. The aim of this study is to assess the effect of optimization of patients' dialysis and nutrition on the presence of autonomic dysfunction in these patients guided by sympathetic skin response (SSR) test. Methods: Fifteen patients on maintenance hemodialysis (12 males and 3 females) their age ranged from 24 to 67 years, most of them were on bicarbonate dialysis were included in our study. Initially, the patients were assessed clinically and by laboratory investigations and their dialysis was assessed by studying their urea kinetic modeling. Their nutrition was assessed by laboratory parameters and by calculating the normalized protein catabolic rate (nPCR). Their autonomic functions were assessed by clinical examination, hand grip and SSR test. Dialysis dose was readjusted to achieve a target kt/v value of 1.3/session thrice weekly. Also, their nutrition was reviewed to achieve nPCR of 1.2 gm/kg/day and caloric intake of 30-40 KCal/kg/day through diet manipulation and support. They were reassessed after 3 months. Results: Analysis of the data showed a statistically significant improvement of the observed subclinical autonomic neuropathy evidenced by a significant change in the hand grip (p = 0.044), and a high statistically significant improvement in the sympathetic skin response test parameters (both amplitude and latency) (p=0.001) after optimization of both hemodialysis and nutrition status. Conclusion: Improving dialysis and patients nutrition by using urea kinetic modeling is valuable in improving their autonomic functions as assessed by SSR test

Post-transplant anemia in pediatric patients and its impact on patient and graft survival: single center experience

Introduction: Post-transplantation anemia (PTA)occurs frequently, with prevalence rates between 20and 60% depending on the criteria used for defininganemia.Aim of the work: We aimed to assess the prevalenceof anemia after 6 months of transplantation inpediatric renal transplant patients under differentprotocols of immunosuppression, and to determinethe impact of anemia upon long-term patient andgraft survival.Patients and methods: Based on the data of 108renal transplants performed in our center, patientswere categorized after 6 months according to theirhemoglobin (Hb) levels into two groups. The firstgroup with Hb more than 11gm/dl (group I, 29cases) and the second group with Hb lessthan11gm/dl (group II, 79cases). We compared thetwo groups regarding post transplant complications(rejection episodes, hypertension, diabetes mellitus,infections, hepatic dysfunction, and patient andgraft survival.Results: we found no significant difference betweenthe two groups regarding rejection episodes.However, the percentage of cases with chronicallograft nephropathy was significantly higher in the anemic group. The survivors with functioning graftswere significantly higher in cases with normal Hb.Moreover, living cases with graft failure weresignificantly higher in anemic group. Graft survivalrate was better in the non anemic group. However,no difference in patient survival was detected. Also,we found no difference between the two groupsregarding post-transplant complications.Conclusions: From this study, we can conclude thatthe prevalence of post-transplant anemia is highpediatric renal transplant patients especially thosereceiving CNI and MMF, and it was associated withpoorer graft outcome but no effect on patientsurvival

Impact of CD 28, CD86, CTLA-4 and PD-1 genes polymorphisms on acute renal allograft rejection and graft survival among Egyptian recipients

Abstract To study the impact of four gene polymorphisms on acute renal allograft rejection (AR) and graft survival among Egyptian population. These 4 gene polymorphisms include: (1) CD 28 (rs3116496), (2) CD86 (rs1129055), (3) CTLA-4 (rs3087243), (4) PD-1 (rs2227982). This is a non-concurrent cohort study including 50 kidney transplant recipients diagnosed histopathologically as (AR) [study group] and another 50 matched allograft recipients without AR [control group]. Blood samples were taken from both groups and subjected to genotyping for the selected four genetic polymorphisms by TaqMan genotyping assay. The difference in genotypic distribution of CD 28: rs3116496 and CD86: rs1129055 wasn't statistically significant between the study and control groups (P = 0.22 and 0.33 respectively) and also both polymorphisms had no effect on graft survival (P = 0.36 and 0.74 respectively) while the addition of C allele to IVS3 +17T/C polymorphism in CD28 gene showed a protective effect against AR (P = 0.03). CTLA-4: rs3087243 AG genotype showed a protective effect against AR as it was more frequent in no rejection group compared to those with AR (P = 0.001) with a statistically significant impact on graft survival (P < 0.001), while PD-1: rs2227982 AG genotype was equally distributed between both groups (variant of unknown significance). There was no detected association between CD86 polymorphism: rs1129055 and CD 28 polymorphism: rs3116496 with the development of AR. However, C allele of CD 28 IVS3 +17T/C polymorphism and CTLA-4 polymorphism: rs3087243AG genotype both demonstrated a protective effect against AR

Kimura Disease: A Case Report and Review of the Literature with A New Management Protocol

Copyright © 2010 Mohamed Ashraf Fouda et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Kimura disease (KD) is a chronic inflammatory disorder with angiolymphatic proliferation, usually affecting young men of Asian race but is rare in other races. The etiology of KD is still unknown. It is often accompanied by nephrotic syndrome. Herein, we present an atypical manifestation of Kimura disease occurring in a Caucasian man with steroid-responsive early membranous glomerulonephritis. Kimura disease can present atypically in a middle-aged Caucasian man with secondary steroid-responsive nephrotic syndrome. Steroid, endoxan, and MMF can be used safely and successfully in such situation. The diagnosis of KD can be difficult and misleading, and patients with this disease are often evaluated using avoidable procedures by just not being aware of KD. 1

Sleep disorders in hemodialysis patients

The prevalence of sleep disorders is higher in patients with kidney failure than the general population. We studied the prevalence of sleep disorders in 88 (mean age; 41.59 &#177; 16.3 years) chronic hemodialysis (HD) patients at the Urology and Nephrology Center, Mansoura Uni-versity, Egypt over 4-month period. The investigated sleep disorders included insomnia, restless leg syndrome (RLS), obstructive sleep apnea syndrome (OSAS), excessive daytime sleepiness (EDS), narcolepsy and sleep walking, and we used a questionnaire in accordance with those of the International Restless Legs Syndrome Study Group, the Berlin questionnaire, Italian version of Epworth Sleepiness Scale, International Classification of Sleep Disorders, and the specific ques-tions of Hatoum&#x2032;s sleep questionnaire. The prevalence of sleep disorders was 79.5&#x0025; in our pa-tients, and the most common sleep abnormality was insomnia (65.9&#x0025;), followed by RLS (42&#x0025;), OSAS (31.8&#x0025;), snoring (27.3&#x0025;), EDS (27.3&#x0025;), narcolepsy (15.9&#x0025;), and sleep walking (3.4&#x0025;). Insomnia correlated with anemia (r=0.31, P= 0.003), anxiety (r=0.279, P= 0.042), depression (r=0.298, P= 0.24) and RLS (r=0.327, P= 0.002). Also, RLS correlated with hypoalbuminemia (r=0.41, P= &lt; 0.0001), anemia (r=0.301 and P= 0.046), hyperphosphatemia (r=0.343 and P= 0.001). EDS correlated with OSAS (r=0.5, P= &lt; 0.0001), snoring (r=0.341, P= 0.001), and social worry (r=0.27, P= 0.011). Sleep disorders are quite common in the HD patients, especially those who are anemic and hypoalbuminemic. Assessment of sleep quality, preferably with polysomno-graphy, is necessary to confirm our results. Interventional studies for management of sleep disor-ders in HD patients are warranted

Field responses of barley genotypes across a salinity gradient in an arid Mediterranean environment

11 Pags.- 7 Figs.- 4 Tabls.Salinity is one of the most widespread abiotic stresses affecting crop growth and productivity, particularly when soil and irrigation water are salty. Field experiments were performed in an arid Mediterranean climate to investigate agronomic responses of twenty-one diverse barley genotypes to naturally occurring salinity. Three saline fields (7.72 dS/m) were irrigated with well water of three incremental salinity levels, low (5.25 dS/m), intermediate (8.35 dS/m), and high (11.12 dS/m). The results revealed considerable genotypic variability at the three salinity levels and significant genotype by salinity interaction that could be traced to specific yield components. Increasing salinity level decreased performance of all agronomic traits, but with different patterns, with yield components determined earlier being more affected than traits determined later. Days to heading exhibited a strong and negative relationship with grain yield across all salinity levels, while 1000-grain weight demonstrated the highest association with grain yield, followed by number of grains per spike, plant height, and harvest index, consistently at the three salinity levels. The genotypes were classified based on their yield indices at the three salinity levels into six groups varying from highly salt-tolerant (group A) to highly salt-sensitive genotypes (group F). Genotype-by-salinity interaction was studied based on rankings of performance across salinity levels. Close examination of yield component trends across levels allowed the identification of genotypes with different behaviors, indicating the presence of variation in potentially different mechanisms of response to salinity. This diversity of responses could be used in breeding to improve tolerance over the whole crop cycle, from plant establishment and tillering to grain filling.Peer reviewe