A Rare Cause of Drug-Induced Skin Rash and Eosinophilia

Allopurinol is a well-known drug to treat hyperuricemia in patients with chronic kidney disease, gout, or tumor lysis syndrome. The most common side effects are nausea, vomiting, elevated liver enzyme, pancreatitis, and skin rashes. Drug reaction with eosinophilic and systemic symptoms (DRESS) syndrome is a rare but life-threating complication of allopurinol treatment. Here, we present a 60-year-old male patient admitted with skin rashes, stomatitis, dyspnea, jaundice, elevated liver enzymes, acute renal failure, and eosinophilia, who was diagnosed with allopurinol-related DRESS syndrome

Outcomes of renal transplants from spousal donors: 25 years of experience at our center

Objectives: Many transplantation teams have attempted renal transplants from living unrelated kidney donors, as well as from cadaveric and living related kidney donors. In this study, we evaluated the results for renal transplants from spousal donors at our center

Effects of arteriovenous fistula on clinical, laboratory and echocardiographic findings in renal allograft recipients

Purpose: Left ventricular hypertrophy (LVH) is frequently observed in patients with end-stage renal disease and renal allograft recipients, and is an independent and strong predictor of morbidity and mortality. Presence of a patent arteriovenous fistula (AVF) after renal transplantation may contribute to the persistent LVH. We investigated the clinical, laboratory, and echocardiographic findings in patients with renal transplants with or without AVF

Does pregnancy increase graft loss in female renal allograft recipients?

Although many transplanted women who were previously infertile can conceive during the posttransplant period, maternal and fetal complications are likely. We evaluated the effect of pregnancy after renal transplantation in this study

Lower serum prohepcidin levels associated with lower iron and erythropoietin requirements in hemodialysis patients with chronic hepatitis C

Background: Patients with chronic HCV infection have increased liver iron. Recently identified protein hepcidin synthesized in the liver, is thought to be a key regulator for iron homeostasis and is induced by infection and inflammation. Lower erythropoietin and iron supplementation requirements were previously reported in HD patients with HCV infection. We investigated the association of prohepcidin with inflammation and iron parameters in HD patients with and without chronic HCV infection

Lower serum prohepcidin levels associated with lower iron and erythropoietin requirements in hemodialysis patients with chronic hepatitis C

<p>Abstract</p> <p>Background</p> <p>Patients with chronic HCV infection have increased liver iron. Recently identified protein hepcidin synthesized in the liver, is thought to be a key regulator for iron homeostasis and is induced by infection and inflammation. Lower erythropoietin and iron supplementation requirements were previously reported in HD patients with HCV infection. We investigated the association of prohepcidin with inflammation and iron parameters in HD patients with and without chronic HCV infection.</p> <p>Methods</p> <p>Sixty patients (27 male, 33 female, mean age 50 ±15 years) on chronic HD were included. Parameters related to iron metabolism (ferritin, serum iron and total iron binding capacity (TIBC)), inflammation (hs-CRP, TNF-α and IL-6) and prohepcidin levels were measured. The response to treatment (erythropoiesis-stimulating agent (ESA) resistance index) was assessed from the ratio of the weekly erythropoietin (rhuEPO) dose to hemoglobin (Hb) per unit weight.</p> <p>Results</p> <p>Serum prohepcidin levels of HCV positive patients (135 ± 25 ng/mL) were significantly lower than HCV negative patients [148 ± 18 ng/mL, (p = 0.025)]. Serum IL-6 levels of HCV positive patients were also significantly lower than HCV negative patients (p = 0.016). Serum prohepcidin levels were positively correlated with ferritin (r = 0.405, p = 0.001) and IL-6 (r = 0.271, p = 0.050) levels in HD patients. In the HCV positive group, serum prohepcidin levels significantly correlated with ferritin levels (r = 0.514 p = 0.004). In the HCV negative group, serum prohepcidin levels significantly correlated with serum IL-6 levels (r = 0.418, p = 0.027). In multiple regression analysis performed to predict prohepcidin in HCV positive patients, serum ferritin was found to be an independent variable (r = 0.28, p = 0.008).</p> <p>Conclusions</p> <p>HCV positive HD patients have low levels of serum prohepcidin and IL-6 which might account for iron accumulation together with lower iron and rhuEPO requirements in these patients.</p

Serum uric acid level is associated with cardiac hypertrophy in renal transplant recipients

Background

Conversion to Sirolimus in Renal Transplant Recipients: A Single-Center Experience

Maintenance immunosuppression with calcineurin inhibitors (CNI) following renal transplantation is associated with nephrotoxicity and accelerated graft loss. Sirolimus (SRL) is a nonnephrotoxic immunosuppressive agent. We retrospectively analyzed our experience with kidney transplant recipients who were converted from CNI to SRL. A total of 58 renal transplant recipients were converted from CNI to SRL. SRL was started at a dose of 0.075 mg/kg and, at the same time, CNI dose was reduced by 50% daily for 3 days. SRL trough levels were targeted between 8 and 12 ng/mL. When target trough levels were achieved. CNI was withdrawn. The main indications for switching were posttransplant malignancies (n = 32) and chronic allograft. nephropathy (CAN) (n = 10). The mean time from transplantation to conversion was 84 +/- 71 months. Mean serum creatinine level was 1.63 +/- 0.52 mg/dL before conversion. Serum creatinine levels at the 1, 3, 6 months, and 1, 2, 3 years after conversion were 1.64 +/- 0.58 mg/dL (P = 0.67), 1.52 +/- 0.53 mg/dL (P = 0.414), 1.62 +/- 0.62 mg/dL (P = 0.734), and 1.48 +/- 0.58 mg/dL (P = 0.065), 1.58 +/- 0.53 mg/dL (P = 0.854), 1.88 +/- 0.77 mg/dL (P = 0.083), respectively. Daily proteinuria levels increased from 0.04 +/- 0.11 g/day at baseline to 0.55 +/- 1.33 g/day (P = 0.037) after conversion, in the responders group. In the nonresponders group, baseline proteinuria was 0.13 +/- 0.25 g/day, and increased to 1.44 +/- 2.44 g/day after conversion (P = 0.008). SRL was discontinued in 16 patients (31%) because of the occurrence of severe side effects. The proportion of patients remaining on SRL therapy over time was 43.1% at 1 year, 15.5% at 2 years after conversion, and 10.3% at 3 years after conversion. SRL conversion may be very useful in patients suffering from neoplasia; however, frequent side effects related with this intervention should be considered, and routine conversion from CNI to SRL to reduce nephrotoxicity should be discouraged

BK Virus Nephropathy in Renal Transplant Recipients: A Single Centre Experience

Introduction: BK virus nephropathy is an important cause of allograft failure in renal transplant recipients that is linked to highly potent immunosuppressive theraphy. We aimed to exhibit experience of our centre with BK virus nephropathy