Early proteinuria as a predictor of chronic allograft nephropathy

Jedan od vodećih uzroka zatajenja bubrežnog presatka su kronična nefropatija presatka koja se patohistološki manifestira intersticijskom fibozom i tubularnom atrofijom (IF/TA). Cilj rada je bio odrediti utjecaj rane proteinurije na progresiju IF/TA-e. U studiju je uključeno 75 bolesnika s transplantiranim bubregom ili bubregom i gušteračom koji su imali biopsije bubrega na dan transplantacije (Tx) i na 12 mj. te im je određivana proteinurija u periodu 1-3 mj. i 12 mj. poslije Tx. Prosječna progresija ci skora bila je 0.62±0.78, a ct skora 0.72±0.78, a prosječne vrijednosti proteinurija mjerene u razdoblju od kraja prvog do kraja trećeg mjeseca od implantacije su 0.26±0.21g/24h. U univarijantnoj analizi iznos rane proteinurije pozitivno korelira (R=0.37, p<0.001) s iznosom skora ci godinu dana po implantaciji kao i sa iznosom ct skora godinu dana po implantaciji (R=0.3, p<0.01). U multivarijatnoj analizi rana proteinurija ostaje neovisni prediktor progresije ci skora tijekom prve godine od Tx (p=0.02). AUC rane proteinurije za predikciju progresije intersticijske fibroze tijekom 1 god. od Tx je 0.7, p<0.01. Rana proteinurija je neovisan negativan prediktor progresije IF/TA-e.One of major causes of kidney allograft failure is chronic allograft nephropathy which is manifest by interstitial fibrosis and tubular atrophy (IT/FA). Aim of study was to determine influence of early proteinuria on IT/FA progression. 75 patients with kidney and simultaneous kidney/pancreas transplantation who had kidney biopsies performed on the day of transplantation (Tx) and 12 months after and whose proteinuria was measured in period 1-3 months and 12 months after Tx were included in the study. Average ci score progression was 0.62±0.78 and ct score progression was 0.72±0.78 and average proteinuria values measured between 1 and 3 months after implantation were 0.26±0.21g/24h. Univariate analysis showed that early proteinuria positively correlates (R=0.37, p<0.001) with ci score 1 year after implantation and also with ct score 1 year after implantation (R=0.3, p<0.01). Multivariate analysis showed that early proteinuria remains independent predictor of ci score progression during first year after Tx (p=0.02). AUC of early proteinuria for prediction of interstitial fibrosis progression during 1 year after Tx is 0.7, p<0.01. Early proteinuria is independent negative predictor of IT/FA progression

Early proteinuria as a predictor of chronic allograft nephropathy

Jedan od vodećih uzroka zatajenja bubrežnog presatka su kronična nefropatija presatka koja se patohistološki manifestira intersticijskom fibozom i tubularnom atrofijom (IF/TA). Cilj rada je bio odrediti utjecaj rane proteinurije na progresiju IF/TA-e. U studiju je uključeno 75 bolesnika s transplantiranim bubregom ili bubregom i gušteračom koji su imali biopsije bubrega na dan transplantacije (Tx) i na 12 mj. te im je određivana proteinurija u periodu 1-3 mj. i 12 mj. poslije Tx. Prosječna progresija ci skora bila je 0.62±0.78, a ct skora 0.72±0.78, a prosječne vrijednosti proteinurija mjerene u razdoblju od kraja prvog do kraja trećeg mjeseca od implantacije su 0.26±0.21g/24h. U univarijantnoj analizi iznos rane proteinurije pozitivno korelira (R=0.37, p<0.001) s iznosom skora ci godinu dana po implantaciji kao i sa iznosom ct skora godinu dana po implantaciji (R=0.3, p<0.01). U multivarijatnoj analizi rana proteinurija ostaje neovisni prediktor progresije ci skora tijekom prve godine od Tx (p=0.02). AUC rane proteinurije za predikciju progresije intersticijske fibroze tijekom 1 god. od Tx je 0.7, p<0.01. Rana proteinurija je neovisan negativan prediktor progresije IF/TA-e.One of major causes of kidney allograft failure is chronic allograft nephropathy which is manifest by interstitial fibrosis and tubular atrophy (IT/FA). Aim of study was to determine influence of early proteinuria on IT/FA progression. 75 patients with kidney and simultaneous kidney/pancreas transplantation who had kidney biopsies performed on the day of transplantation (Tx) and 12 months after and whose proteinuria was measured in period 1-3 months and 12 months after Tx were included in the study. Average ci score progression was 0.62±0.78 and ct score progression was 0.72±0.78 and average proteinuria values measured between 1 and 3 months after implantation were 0.26±0.21g/24h. Univariate analysis showed that early proteinuria positively correlates (R=0.37, p<0.001) with ci score 1 year after implantation and also with ct score 1 year after implantation (R=0.3, p<0.01). Multivariate analysis showed that early proteinuria remains independent predictor of ci score progression during first year after Tx (p=0.02). AUC of early proteinuria for prediction of interstitial fibrosis progression during 1 year after Tx is 0.7, p<0.01. Early proteinuria is independent negative predictor of IT/FA progression

Early proteinuria as a predictor of chronic allograft nephropathy

Jedan od vodećih uzroka zatajenja bubrežnog presatka su kronična nefropatija presatka koja se patohistološki manifestira intersticijskom fibozom i tubularnom atrofijom (IF/TA). Cilj rada je bio odrediti utjecaj rane proteinurije na progresiju IF/TA-e. U studiju je uključeno 75 bolesnika s transplantiranim bubregom ili bubregom i gušteračom koji su imali biopsije bubrega na dan transplantacije (Tx) i na 12 mj. te im je određivana proteinurija u periodu 1-3 mj. i 12 mj. poslije Tx. Prosječna progresija ci skora bila je 0.62±0.78, a ct skora 0.72±0.78, a prosječne vrijednosti proteinurija mjerene u razdoblju od kraja prvog do kraja trećeg mjeseca od implantacije su 0.26±0.21g/24h. U univarijantnoj analizi iznos rane proteinurije pozitivno korelira (R=0.37, p<0.001) s iznosom skora ci godinu dana po implantaciji kao i sa iznosom ct skora godinu dana po implantaciji (R=0.3, p<0.01). U multivarijatnoj analizi rana proteinurija ostaje neovisni prediktor progresije ci skora tijekom prve godine od Tx (p=0.02). AUC rane proteinurije za predikciju progresije intersticijske fibroze tijekom 1 god. od Tx je 0.7, p<0.01. Rana proteinurija je neovisan negativan prediktor progresije IF/TA-e.One of major causes of kidney allograft failure is chronic allograft nephropathy which is manifest by interstitial fibrosis and tubular atrophy (IT/FA). Aim of study was to determine influence of early proteinuria on IT/FA progression. 75 patients with kidney and simultaneous kidney/pancreas transplantation who had kidney biopsies performed on the day of transplantation (Tx) and 12 months after and whose proteinuria was measured in period 1-3 months and 12 months after Tx were included in the study. Average ci score progression was 0.62±0.78 and ct score progression was 0.72±0.78 and average proteinuria values measured between 1 and 3 months after implantation were 0.26±0.21g/24h. Univariate analysis showed that early proteinuria positively correlates (R=0.37, p<0.001) with ci score 1 year after implantation and also with ct score 1 year after implantation (R=0.3, p<0.01). Multivariate analysis showed that early proteinuria remains independent predictor of ci score progression during first year after Tx (p=0.02). AUC of early proteinuria for prediction of interstitial fibrosis progression during 1 year after Tx is 0.7, p<0.01. Early proteinuria is independent negative predictor of IT/FA progression

Immune-mediated diseases after coronavirus disease 2019 vaccination: rare but important complication

Since the beginning of mass vaccination against coronavirus disease 2019 (COVID-19), vaccine-linked immune-mediated diseases have been increasingly reported. The development of these diseases after COVID-19 vaccination may be attributed to the mechanisms of molecular mimicry and cross-reactivity between the viral spike protein and self-antigens. The most frequent vaccine-linked glomerular disease is immunoglobulin A nephropathy (IgAN). Cutaneous vasculitis has also been reported after COVID-19 vaccination. In both diseases, deposition of immune complexes activates the inflammatory response with end-organ damage. We report on a case of de novo IgAN in a young man and a case of severe cutaneous vasculitis in a 68-year-old woman, both after the second dose of Pfizer-BioNTech COVID-19 vaccine. Neither of the patients had a history of autoimmunity or adverse reactions to vaccines. The temporal association between vaccination and disease development in the absence of other possible intercurrent inciting events suggests a causal mechanism, although coincidental co-occurrence cannot be excluded. In both cases, immunosuppressive treatment was warranted to stop disease progression and to partially or completely resolve the disease. A timely reaction is needed if new-onset signs of an immune-mediated disease appear after vaccination

The Risk of Falling and Consequences of Falling in Patients with Atrial Fibrillation Receiving Different Types of Anticoagulant

Objective: Our objective was to investigate the predictors of falls requiring a visit to the emergency department in patients with nonvalvular atrial fibrillation (AF) receiving different types of anticoagulants and to investigate the clinical consequences of falling in the same population. ----- Methods: A total of 1217 patients with nonvalvular AF from two institutions were retrospectively evaluated. Each patient underwent a physical examination, and clinical histories and medication profiles were taken from each patient at baseline. ----- Results: The median age of our cohort was 71 years; 52.3% were males, and 86.1% of patients were receiving anticoagulation at study baseline. The 5-year freedom-from-falling rate was 81.6%. The use and type of anticoagulation was not significantly associated with the risk of falling (P = 0.222), whereas higher Morse Fall Scale (MFS), CHA2DS2-VASC (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category), and HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly [> 65 years], drugs/alcohol concomitantly) scores were significantly associated with a higher hazard of the first fall in univariate analyses. In the multivariate Cox regression model, MFS, older age, osteoporosis, higher levels of high-density lipoprotein cholesterol, higher diastolic blood pressure, and use of amiodarone, diuretics, or short- and medium-acting benzodiazepines were mutually independent predictors of the first fall. Of 163 patients, 93 (57%) had a bone fracture during the fall. Type of anticoagulation significantly affected survival after the first fall (P < 0.001): patients inadequately anticoagulated with warfarin had worse survival rates, and patients receiving apixaban and dabigatran had the best survival rates after the first fall. ----- Conclusion: Older patients who had comorbidities and were taking amiodarone, diuretics, or short- or medium-acting benzodiazepines had the highest risk of falls. The type and quality of anticoagulation did not seem to affect the risk of falling but did significantly affect survival after the first fall

Clinical Significance of Zero-Time Renal Transplant Biopsies and Thin Glomerular Basement Membranes in Zero-Time Renal Transplant Biopsies

Cilj. Ispitati morfološke karakteristike nultih biopsija bubrega analiziranih na Odjelu za nefropatologiju i elektronsku mikroskopiju Kliničke bolnice Dubrava, Zagreb. ----- Materijali i metode. Retrospektivno pretraživanje podataka provedeno je za razdoblje od 2006. do 2018. godine. Analizirano je ukupno 316 nultih biopsija bubrega. Debljina glomerularne bazalne membrane (GBM) ponovno je izmjerena u 84 nulte i 80 protokolarnih biopsija istih pacijenata 12 mjeseci nakon transplantacije. ----- Rezultati i zaključak. Akutno tubularno oštećenje bilo je prisutno u 90% nultih biopsija, a u 17% biopsija pronađena je glomerularna patologija, od toga je najčešći entitet bio tanke bazalne mebrane (TBM ) (13%). Kronične promjene presatka procijenjene su prema Banff klasifikaciji. Većina slučajeva pokazala je Banff skorove ci0 (82,6%) i ct0 (65,1%). Banff skorovi cv2 i cv3 bili su prisutni u 13%, a ah2 i ah3 u 36,4% uzoraka. Među 84 ponovno izmjerenih nultih biopsija TBM su bile prisutne u 26 pacijenata (31%). Nije bilo razlika između Banff skorova i kliničkih parametara 12 mjeseci nakon transplantacije između primatelja s TBM i primatelja s normalnom debljinom GBM. Nulte biopsije bubrega su iznimno važne za procjenu presatka i usporedbu s kasnijim protokolarnim biopsijama. Kako bi se utvrdio dugoročni značaj TBM -a na preživljavanje presatka potrebna su dodatna istraživanja.Aim. To investigate morphological findings of zero-time biopsies analyzed at the Department of Nephropathology and Electron Microscopy, Dubrava University Hospital, Zagreb. ----- Materials and methods. The retrospective search of data was performed for the period from 2006 to 2018. A total of 316 zero-time renal biopsies were analyzed. Glomerular basement membrane (GBM) thickness was remeasured in 84 zero-time biopsies and 80 protocol biopsies of the same patients 12 months after transplantation. ----- Results and conclusion. The acute tubular injury was present in 90% and glomerular pathology in 17% of zero-time biopsies, with thin basement membranes (TBM ) being the most common entity (13%). Chronic graft changes were evaluated according to Banff classification. Most cases showed Banff scores ci0 (82.6%) and ct0 (65.1%). Banff scores cv2 and cv3 were present in 13% and ah2 and ah3 in 36.4% of specimens. Among 84 remeasured zero-time samples, TBM was present in 26 patients (31%). There were no differences between Banff scores and clinical parameters 12 months after transplantation between recipients with TBM and recipients with normal GBM thickness. Zero-time renal biopsy is of great importance for allograft assessment and comparison with consecutive biopsies. Further investigation is needed to determine the long-term significance of TBM on graft survival

Resistant and Relapsing Collapsing Glomerulopathy Successfully Treated with Rituximab&mdash;A Case Report

Collapsing glomerulopathy (CG) or collapsing focal segmental glomerulosclerosis (cFSGS) is an aggressive disease with a high tendency of progression to end-stage renal disease due to common resistance to conventional immunosuppressants. Rituximab (RTX), a monoclonal antibody against CD20 B cells, showed some benefit in the treatment of CG. We are reporting about female patients with an idiopathic form of CG presenting with nephrotic syndrome (NS) and renal insufficiency resistant to several immunosuppressive agents such as steroids (ST), calcineurin inhibitors (CNI), and cyclophosphamide (CYC). This multidrug-resistant disease responded to RTX with complete remission. Forty-four months after initial RTX administration, a relapse of CG with severe NS and acute renal insufficiency occurred. Repeated application of RTX led to complete remission again. To the best of our knowledge, we are reporting the first case of the relapsing multidrug-resistant form of CG, which responded to RTX. Current data about the treatment of CG with RTX is lacking and is based on rare case reports and small case series. Thus, our report can contribute to determining the role of RTX in the treatment of CG

Resistant and Relapsing Collapsing Glomerulopathy Successfully Treated with Rituximab—A Case Report

Collapsing glomerulopathy (CG) or collapsing focal segmental glomerulosclerosis (cFSGS) is an aggressive disease with a high tendency of progression to end-stage renal disease due to common resistance to conventional immunosuppressants. Rituximab (RTX), a monoclonal antibody against CD20 B cells, showed some benefit in the treatment of CG. We are reporting about female patients with an idiopathic form of CG presenting with nephrotic syndrome (NS) and renal insufficiency resistant to several immunosuppressive agents such as steroids (ST), calcineurin inhibitors (CNI), and cyclophosphamide (CYC). This multidrug-resistant disease responded to RTX with complete remission. Forty-four months after initial RTX administration, a relapse of CG with severe NS and acute renal insufficiency occurred. Repeated application of RTX led to complete remission again. To the best of our knowledge, we are reporting the first case of the relapsing multidrug-resistant form of CG, which responded to RTX. Current data about the treatment of CG with RTX is lacking and is based on rare case reports and small case series. Thus, our report can contribute to determining the role of RTX in the treatment of CG

Survival after hospital discharge in patients hospitalized for acute coronavirus disease 2019: data on 2586 patients from a tertiary center registry

Aim: To assess the long-term survival after hospital discharge of patients hospitalized due to coronavirus disease 2019 (COVID-19). ----- Methods: We retrospectively reviewed data on post-discharge survival of 2586 COVID-19 patients hospitalized in our tertiary hospital from March 2020 to March 2021. ----- Results: Among 2586 patients, 1446 (55.9%) were men. The median age was 70 years, interquartile range (IQR, 60-80). The median Charlson comorbidity index was 4 points, IQR (2-5). The median length of hospital stay was 10 days, IQR (7-16). During a median follow-up of 4 months, 192 (7.4%) patients died. The median survival time after hospital discharge was not reached, and 3-month, 6-month, and 12-month survival rates were 93%, 92%, and 91%, respectively. In a multivariate analysis, mutually independent predictors of worse mortality after hospital discharge were age >75 years, Eastern Cooperative Oncology Group status 4, white blood cell count >7 ×109/L, red cell distribution width >14%, urea on admission >10.5 mmol/L, mechanical ventilation during hospital stay, readmission after discharge, absence of obesity, presence of chronic obstructive pulmonary disease, dementia, and metastatic malignancy (P<0.05 for all). ----- Conclusion: Substantial risk of death persists after hospital admission due to COVID-19. Factors related to an increased risk are older age, higher functional impairment, need for mechanical ventilation during hospital admission, parameters indicating more pronounced inflammation, impaired renal function, and particular comorbidities. Interventions aimed at improving patients' functional capacity may be needed