An Important Problem: Posttransplant Focal Segmental Glomerulosclerosis Recurrence and Plasmapheresis

OBJECTIVE : Focal segmental glomerulosclerosis (FSGS) as a primary glomerular disease are refractory to therapy and progress to End stage renal disease. (ESRD). After transplantation, the major problems are recurrence of the disease and its treatment. In this study, We investigated FSGS recurrence

Is decline in serum albumin an ominous sign for subsequent peritonitis in peritoneal dialysis patients?

Serum albumin levels have been used as a representative marker for morbidity and mortality in the dialysis population. We evaluated the significance of various biochemical values in peritoneal dialysis (PD) patients with a history of peritonitis. In 51 patients [27 women, 24 men; mean age: 42.6 years (range: 19 - 70 years); average duration of PD: 28.26 +/- 23.1 months] with history of peritonitis, we recorded serum albumin and cholesterol levels at the beginning of PD, at the last visit (1 month) before the peritonitis episode, and at months 1, 6, and 12 after the peritonitis episode. Routine data from peritoneal equilibration tests were also obtained. Serum albumin showed a significant decline from the basal measurement at the measurements 1 month before and after the peritonitis episode (p = 0.026 and 0.025 respectively). Serum cholesterol levels and dialysate-to-plasma creatinine at hours 2 and 4 revealed no significant alterations at the same time points. The decline in serum albumin relative to the first visit (basal level) may be a factor showing the likelihood of peritonitis. A decline in serum albumin during follow-up may be an indicator for subsequent peritonitis. The absence of a similar decline in serum cholesterol levels (mimicking albumin) may rule out low dietary intake or malnutrition. Pathophysiologic explanations for these relationships are not obvious. If the leading complication of PD is peritonitis, efforts should be focused on improving the factors that influence serum albumin levels

Association of HLA phenotypes of end-stage renal disease patients preparing for first transplantation with anti-HLA antibody status.

Patients with pre-transplantation high levels of panel reactive antibody (PRA) have an increased risk of graft failure, and renal transplantation in sensitized patients remains a highly significant challenge worldwide. The influence of anti-human leukocyte antigen (HLA) antibodies on the development of rejection episodes depends on patient-specific clinical factors and differs from patient to patient. The HLA typing of the recipient might influence the development of anti-HLA antibodies. Some HLA antigens appear to be more immunogenic than others. The aim of this study is to demonstrate the distribution of HLA phenotypes in PRA-positive and PRA-negative end-stage renal disease (ESRD) patients on the basis of having sensitizing events or not. Our study included 642 (mean age: 41.54; female/male: 310/332) ESRD patients preparing for the first transplantation and who are on the cadaveric kidney transplantation waiting list of Istanbul Medical Faculty in 2008-2009. Class I HLA-A,B typing was performed by complement-dependent cytotoxicity (CDC) method, whereas class II HLA-DRB1 typing was performed by low-resolution polymerase chain reaction (PCR)-sequence-specific primer (SSP). All serum samples were screened for the presence of IgG type of anti-HLA class I- and II-specific antibodies by enzyme-linked-immunosorbent assay (ELISA). PRA-negative group consisted of 558 (86.9%) and PRA-positive group included 84 (13.1%) patients. We have found statistically significant frequency of HLA-A3 (p = 0.018), HLA-A66 (p = 0.04), and HLA-B18 (p = 0.006) antigens in PRA-positive patients and DRB1*07 (p = 0.02) having the highest frequency in patients with sensitizing event history but no anti-HLA development suggesting that DRB1*07 might be associated with low risk of anti-HLA antibody formation.</