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A Journal-Level Analysis of Progress in Transplantation.

Tue, 12/12/2017 - 16:48

A Journal-Level Analysis of Progress in Transplantation.

Prog Transplant. 2017 Jan 01;:1526924817746914

Authors: Feeley T, Lee S, Moon SI

Abstract
CONTEXT: Citations to articles published in academic journals represent a proxy for influence in bibliometrics.
OBJECTIVE: To measure the journal impact factor for Progress in Transplantation over time and to also identify related journals indexed in transplantation and surgery.
DESIGN: Data from Journal Citation Reports (ISI web of science) were used to rank Progress in Transplantation compared to peer journals using journal impact and journal relatedness measures. Social network analysis was used to measure relationships between pairs of journals in Progress in Transplantation's relatedness network.
MAIN OUTCOME MEASURES: Journal impact factor and journal relatedness.
RESULTS: Data from 2010 through 2015 indicate the average journal article in PIT was cited 0.87 times (standard deviation [SD] = 0.12) and this estimate was stable over time. Progress in Transplantation most often cited American Journal of Transplantation, Transplantation, American Journal of Kidney Diseases, and Liver Transplantation. In terms of cited data, the journal was most often referenced by Clinical Transplantation, Transplant International, and Current Opinion in Organ Transplantation.
CONCLUSION: The journal is listed both in surgery and transplantation categories of Journal Citation Reports and its impact factors over time fare better with surgery journals than with transplant journals. Network data using betweenness centrality indicate Progress in Transplantation links transplantation-focused journals and journals indexed in health sciences categories.

PMID: 29226776 [PubMed - as supplied by publisher]

Campath, calcineurin inhibitor reduction and chronic allograft nephropathy (the 3C Study) - results of a randomized controlled clinical trial.

Tue, 12/12/2017 - 16:48
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Campath, calcineurin inhibitor reduction and chronic allograft nephropathy (the 3C Study) - results of a randomized controlled clinical trial.

Am J Transplant. 2017 Dec 11;:

Authors: Haynes R, Blackwell L, Staplin N, Herrington WG, Emberson J, Judge PK, Storey BC, Landray MJ, Harden PN, Baigent C, Friend P

Abstract
Calcineurin inhibitors (CNI e.g. tacrolimus) reduce short-term kidney transplant failure, but chronic nephrotoxicity may contribute to late transplant loss. Elective conversion to inhibitors of the mammalian target of rapamycin pathway (mTOR e.g. sirolimus) might avoid long-term CNI renal damage and improve outcomes. The 3C Study was a pragmatic randomized controlled trial comprising sequential randomizations between alemtuzumab and basiliximab induction therapy (at the time of surgery) and between tacrolimus and sirolimus maintenance therapy at 6-months post-transplant. The primary outcome of this analysis was estimated glomerular filtration rate (eGFR) at 18 months after maintenance therapy randomization. 197 patients were assigned sirolimus-based and 197 to tacrolimus-based therapy. Allocation to sirolimus had no significant effect on eGFR at 18 months: baseline-adjusted mean (SE) eGFR 53.7 (0.9) mL/min/1.73m2 in the sirolimus group versus 54.6 (0.9) mL/min/1.73m2 in the tacrolimus group (p=0.50). Biopsy-proven acute rejection (29 [14.7%]) vs 6 [3.0%]; p<0.001) and serious infections (defined as opportunistic infections or those requiring hospitalisation; 95 [48.2%] versus 70 [35.5%]; p=0.008) were more common among participants allocated sirolimus. Compared with tacrolimus-based therapy, sirolimus-based maintenance therapy did not improve transplant function at 18 months after conversion and was associated with significant hazards of rejection and infection. This article is protected by copyright. All rights reserved.

PMID: 29226570 [PubMed - as supplied by publisher]

Case Report: Treatment of Light Chain Amyloidosis with Daratumumab Monotherapy in Two Patients.

Tue, 12/12/2017 - 16:48
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Case Report: Treatment of Light Chain Amyloidosis with Daratumumab Monotherapy in Two Patients.

Eur J Haematol. 2017 Dec 11;:

Authors: Gran C, Gahrton G, Alici E, Nahi H

Abstract
Immunoglobulin light-chain amyloidosis (AL) affects multiple organs, most prominently the kidney and the heart. Renal and cardiac impairment are both associated with poor prognosis.(1) Typical treatment regimens for AL include proteasome inhibitors, alkylating agents, and steroids as well as autologous stem cell transplantation (ASCT) for younger, fit patients. Complete response after treatment is associated with a better outcome and can be measured by free light chain (FLC) reduction.(2, 3) Monoclonal antibodies such as daratumumab (Dara, human IgG1 anti-CD38) have shown promising efficacy for the treatment of relapsed and refractory multiple myeloma. Recently, encouraging results were reported on patients with AL who received Dara treatment.(4, 5). This article is protected by copyright. All rights reserved.

PMID: 29226427 [PubMed - as supplied by publisher]

Does Mineralocorticoid Receptor Antagonism Prevent Calcineurin Inhibitor-Induced Nephrotoxicity?

Tue, 12/12/2017 - 16:48
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Does Mineralocorticoid Receptor Antagonism Prevent Calcineurin Inhibitor-Induced Nephrotoxicity?

Front Med (Lausanne). 2017;4:210

Authors: Mortensen LA, Bistrup C, Thiesson HC

Abstract
Calcineurin inhibitors have markedly reduced acute rejection rates in renal transplantation, thus significantly improved short-term outcome. The beneficial effects are, however, tampered by acute and chronic nephrotoxicity leading to interstitial fibrosis and tubular atrophy, which impairs long-term allograft survival. The mineralocorticoid hormone aldosterone induces fibrosis in numerous organs, including the kidney. Evidence from animal models suggests a beneficial effect of aldosterone antagonism in reducing calcineurin inhibitor-induced nephrotoxicity. This review summarizes current evidence of mineralocorticoid receptor antagonism in animal models of calcineurin inhibitor-induced nephrotoxicity and the results from studies of mineralocorticoid antagonism in renal transplant patients.

PMID: 29226122 [PubMed]

Dialysis Provision and Implications of Health Economics on Peritoneal Dialysis Utilization: A Review from a Malaysian Perspective.

Tue, 12/12/2017 - 16:48
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Dialysis Provision and Implications of Health Economics on Peritoneal Dialysis Utilization: A Review from a Malaysian Perspective.

Int J Nephrol. 2017;2017:5819629

Authors: Abdul Manaf MR, Surendra NK, Abdul Gafor AH, Seong Hooi L, Bavanandan S

Abstract
End-stage renal disease (ESRD) is managed by either lifesaving hemodialysis (HD) and peritoneal dialysis (PD) or a kidney transplant. In Malaysia, the prevalence of dialysis-treated ESRD patients has shown an exponential growth from 504 per million population (pmp) in 2005 to 1155 pmp in 2014. There were 1046 pmp patients on HD and 109 pmp patients on PD in 2014. Kidney transplants are limited due to lack of donors. Malaysia adopts public-private financing model for dialysis. Majority of HD patients were treated in the private sector but almost all PD patients were treated in government facilities. Inequality in access to dialysis is visible within geographical regions where majority of HD centres are scattered around developed areas. The expenditure on dialysis has been escalating in recent years but economic evaluations of dialysis modalities are scarce. Evidence shows that health policies and reimbursement strategies influence dialysis provision. Increased uptake of PD can produce significant economic benefits and improve patients' access to dialysis. As a result, some countries implemented a PD-First or Favored Policy to expand PD use. Thus, a current comparative costs analysis of dialysis is strongly recommended to assist decision-makers to establish a more equitable and economically sustainable dialysis provision in the future.

PMID: 29225970 [PubMed]

Uptake of home dialysis in younger adults: case studies that illustrate the multifaceted influence of home circumstances on dialysis decisions.

Tue, 12/12/2017 - 16:48
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Uptake of home dialysis in younger adults: case studies that illustrate the multifaceted influence of home circumstances on dialysis decisions.

Clin Case Rep. 2017 Dec;5(12):2051-2058

Authors: Collingridge L, Equinox KL, Frasca S, Simmonds R, Tomlins M, Chow J

Abstract
Younger adults considering home dialysis need support to ensure home circumstances are suitable and affordable. Home circumstances relate closely to the financial burden reported by younger home dialysis users. Attention to home circumstances of younger patients with chronic kidney disease by policymakers, funders, and healthcare practitioners is needed.

PMID: 29225855 [PubMed]

Complement-dependent cytotoxicity and Luminex technology for human leucocyte antigen antibody detection in kidney transplant candidates exposed to different sensitizing events.

Tue, 12/12/2017 - 16:48
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Complement-dependent cytotoxicity and Luminex technology for human leucocyte antigen antibody detection in kidney transplant candidates exposed to different sensitizing events.

Clin Kidney J. 2017 Dec;10(6):852-858

Authors: Katalinić N, Starčević A, Mavrinac M, Balen S

Abstract
Background: The aim of this study was to determine the frequency of exposure to different sensitizing events (SEs) and to assess their effects on human leucocyte antigen (HLA) alloimmunization in transplant candidates using two different HLA antibody screening techniques: complement-dependent cytotoxicity (CDC) and Luminex.
Methods: This retrospective study included HLA antibody screening results for 163 patients on the kidney transplant waiting list (WL) tested from March 2012 until the end of December 2015 at the Tissue Typing Laboratory, Rijeka, Croatia. All sera samples were tested using the CDC and Luminex techniques in parallel.
Results: Two-thirds of the patients [114 (70%)] on the WL were exposed to transfusions, pregnancies and/or kidney transplant. The pre-transplant sera of 104 (63.80%) patients were negative for antibodies. In the sera of 23 (14.11%) patients, HLA antibodies were detected by CDC and Luminex and in the sera of 36 (22.09%) patients by Luminex only.
Conclusion: In patients on kidney WL, previous organ transplantation represents the strongest immunogenic stimulus, followed by blood transfusions (the most frequent SE) and pregnancies. Although Luminex is more sensitive than CDC in HLA antibody detection, the decision on unacceptable HLA antigens in WL patients has to be based on the results of both assays and the patient's immunization history.

PMID: 29225816 [PubMed]

Hypercalcaemia preceding diagnosis of Pneumocystis jirovecii pneumonia in renal transplant recipients.

Tue, 12/12/2017 - 16:48
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Hypercalcaemia preceding diagnosis of Pneumocystis jirovecii pneumonia in renal transplant recipients.

Clin Kidney J. 2017 Dec;10(6):845-851

Authors: Ling J, Anderson T, Warren S, Kirkland G, Jose M, Yu R, Yew S, Mcfadyen S, Graver A, Johnson W, Jeffs L

Abstract
Background: The overall incidence of Pneumocystis jirovecii pneumonia (PJP) in solid organ transplant recipients is 5-15%. A timely diagnosis of PJP is difficult and relies on imaging and detection of the organism.
Methods: We present a case series of four patients displaying hypercalcaemia with an eventual diagnosis of PJP and document the management of the outbreak with a multidisciplinary team approach. We discuss the underlying pathophysiology and previous reports of hypercalcaemia preceding a diagnosis of PJP. We also reviewed the evidence concerning PJP diagnosis and treatment.
Results: Within our renal transplant cohort, four patients presented within 7 months with hypercalcaemia followed by an eventual diagnosis of PJP. We measured their corrected calcium, parathyroid hormone (PTH), 1,25-dihydroxycholecalciferol [1,25-(OH)2D3] and 25-hydroxycholecalciferol [25(OH)D] levels at admission and following treatment of PJP. All four patients diagnosed with PJP were 4-20 years post-transplantation. Three of the four patients demonstrated PTH-independent hypercalcaemia (corrected calcium >3.0 mmol/L). The presence of high 1,25(OH)2D3 and low 25(OH)D levels suggest negation of the negative feedback mechanism possibly due to an extrarenal source; in this case, the alveolar macrophages. All four patients had resolution of their hypercalcaemia after treatment of PJP.
Conclusions: Given the outbreak of PJP in our renal transplant cohort, and based on previous experience from other units nationally, we implemented cohort-wide prophylaxis with trimethoprim-sulphamethoxazole for 12 months in consultation with our local infectious diseases unit. Within this period there have been no further local cases of PJP.

PMID: 29225815 [PubMed]

Perioperative Plasma-Lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study.

Tue, 12/12/2017 - 16:48
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Perioperative Plasma-Lyte use reduces the incidence of renal replacement therapy and hyperkalaemia following renal transplantation when compared with 0.9% saline: a retrospective cohort study.

Clin Kidney J. 2017 Dec;10(6):838-844

Authors: Adwaney A, Randall DW, Blunden MJ, Prowle JR, Kirwan CJ

Abstract
Background: Kidney transplant recipients often receive large volumes of intravenous fluid replacement in the peri-operative period. Administration of 0.9% saline has previously been associated with acidosis, hyperkalaemia and acute kidney injury. The perioperative use of physiologically balanced replacement fluids may reduce the incidence of post-operative renal replacement therapy and hyperkalaemia.
Methods: A retrospective review of consecutive renal transplants before and after a change in perioperative fluid prescription from 0.9% saline to Plasma-Lyte 148.
Results: A total of 97 patients were included in the study, 59 receiving exclusively 0.9% saline and 38 receiving exclusively Plasma-Lyte. Patients in the Plasma-Lyte group were less likely to require emergency postoperative dialysis than those receiving 0.9% saline [odds ratio (OR) 0.15 (95% confidence interval 0.03-0.48), P = 0.004], and these patients had more favourable biochemical parameters with less hyperkalaemia, less acidosis and better diuresis. Patients in the Plasma-Lyte group also had a shorter length of hospital stay (7 days versus 11 days; P < 0.0001) and better graft function at 3 months postoperatively (estimated glomerular filtration rate 51 versus 44 mL/min/1.73 m2; P = 0.03); however, there was no difference in graft function at 1 year.
Conclusions: Plasma-Lyte in the perioperative period is safe in renal transplantation and is associated with a favourable biochemical profile, including a reduced incidence of hyperkalaemia, better diuresis and less frequent use of renal replacement therapy early after surgery. In patients receiving Plasma-Lyte, graft function was better at 3 months, but this difference did not persist up to 1 year after transplantation.

PMID: 29225814 [PubMed]

Effective immunosuppressive management with belatacept and eculizumab in post-transplant aHUS due to a homozygous deletion of CFHR1/CFHR3 and the presence of CFH antibodies.

Tue, 12/12/2017 - 16:48
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Effective immunosuppressive management with belatacept and eculizumab in post-transplant aHUS due to a homozygous deletion of CFHR1/CFHR3 and the presence of CFH antibodies.

Clin Kidney J. 2017 Dec;10(6):742-746

Authors: Münch J, Bachmann A, Grohmann M, Mayer C, Kirschfink M, Lindner TH, Bergmann C, Halbritter J

Abstract
Atypical haemolytic uraemic syndrome (aHUS) may clinically present as acute renal graft failure resulting from excessive activation of the complement cascade. While mutations of complement-encoding genes predispose for aHUS, it is generally thought to require an additional insult (e.g. drugs) to trigger and manifest the full-blown clinical syndrome. Calcineurin inhibitors (CNIs) used for immunosuppression act as potential triggers, especially in the post-transplantation setting. Therefore, CNI-free immunosuppressive regimens may be beneficial. We report on a 58-year-old woman who developed aHUS with acute graft failure within 20 days after renal transplantation. Genetic investigation revealed a homozygous deletion of the CFH-related 1 (CFHR1) and CFHR3 genes in addition to the presence of autoantibodies against complement factor H (CFH). The patient was treated with plasmapheresis and administration of the complement component 5 (C5) antibody eculizumab, and her immunosuppressive regimen was switched from CNI (tacrolimus) to the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) inhibitor belatacept. Renal graft function recovered and stabilized over an 18-month follow-up period. We describe the successful management of post-transplant aHUS using a CNI-free immunosuppressive regimen based on eculizumab and belatacept. Ideally, adequate molecular diagnostics, performed prior to transplantation, can identify relevant genetic risk factors for graft failure and help to select patients for individualized immunosuppressive regimens.

PMID: 29225802 [PubMed]

A Look-Ahead Strategy for Non-Directed Donors in Kidney Paired Donation.

Tue, 12/12/2017 - 16:48
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A Look-Ahead Strategy for Non-Directed Donors in Kidney Paired Donation.

Stat Biosci. 2017 Dec;9(2):453-469

Authors: Wang W, Bray M, Song PX, Kalbfleisch JD

Abstract
While there is a growing need for kidney transplants to treat end stage kidney disease, the supply of transplantable kidneys is in serious shortage. Kidney paired donation (KPD) programs serve as platforms for candidates with willing but incompatible donors to assess the possibility of exchanging donors, thus opening up new transplant opportunities for these candidates. In recent years, non-directed (or altruistic) donors (NDDs) have been incorporated into KPD programs beginning chains of transplants that benefit many candidates. In such programs, making optimal decisions in transplant exchange selection is of critical importance. With the aim of improving the selection of chains beginning with an NDD, this paper introduces a look-ahead multiple decision strategy to select chains, that are easy to extend in the future. Simulation studies are adopted to assess performance of this strategy. Taking into account the extensibility of chains increases the number of realized transplants.

PMID: 29225712 [PubMed]

The Clinical Efficacy of Seasonal Influenza Vaccination - Characteristics of two Outbreaks of Influenza A(H1n1) in Immunocompromised Patients.

Tue, 12/12/2017 - 16:48
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The Clinical Efficacy of Seasonal Influenza Vaccination - Characteristics of two Outbreaks of Influenza A(H1n1) in Immunocompromised Patients.

J Hosp Infect. 2017 Dec 07;:

Authors: Helanterä I, Janes R, Anttila VJ

Abstract
BACKGROUND: Influenza A(H1N1) causes serious complications in immunocompromised patients. The efficacy of seasonal vaccination in these patients has been questioned.
AIMS: We describe two outbreaks of influenza A(H1N1) in immunocompromised patients.
METHODS: Two outbreaks of influenza A(H1N1) occurred in our institution: on the kidney transplant ward in 2014 including patients early after kidney or simultaneous pancreas-kidney transplantation, and on the oncology ward in 2016 including patients receiving chemotherapy for malignant tumors. Factors leading to these outbreaks and the clinical efficacy of seasonal influenza vaccination were analyzed.
FINDINGS: Altogether 86 patients were exposed to influenza A(H1N1) during the outbreaks, among whom the seasonal influenza vaccination status was unknown in ten. Only 3/38 vaccinated patients were infected with influenza A(H1N1), compared to 20/38 unvaccinated patients (P=0.02). 1/38 vaccinated patient died related to influenza, compared to 7/38 unvaccinated patients (P=0.06). Shared factors behind the two outbreaks included old fashioned facilities not designed for the treatment of immunosuppressed patients. Vaccination coverage among patients was low, between 40-70% despite vaccination being offered to all patients free of charge. Vaccination coverage of health care workers on the transplant ward was low (46%), but, despite high coverage on the oncology ward (92%) the outbreak occurred.
CONCLUSIONS: Seasonal influenza vaccination was clinically effective with both a reduced risk of influenza infection and a trend towards reduced mortality in these immunocompromised patients. Several possible causes were identified behind these two outbreaks that require continuous awareness in health care professionals to prevent further outbreaks.

PMID: 29225054 [PubMed - as supplied by publisher]

Renal Involvement in Neuropathy, Ataxia, Retinitis Pigmentosa (NARP) Syndrome: A Case Report.

Tue, 12/12/2017 - 16:48
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Renal Involvement in Neuropathy, Ataxia, Retinitis Pigmentosa (NARP) Syndrome: A Case Report.

Am J Kidney Dis. 2017 Dec 07;:

Authors: Lemoine S, Panaye M, Rabeyrin M, Errazuriz-Cerda E, Mousson de Camaret B, Petiot P, Juillard L, Guebre-Egziabher F

Abstract
We report a case of a patient who had the mitochondrial cytopathy complex of neuropathy, ataxia, and retinitis pigmentosa (NARP) syndrome diagnosed at age 11 years with a biopsy-proven kidney involvement that progressed to end-stage renal disease at age 21 years. Mutations of mitochondrial DNA (mtDNA) are maternally inherited and lead to mitochondrial cytopathies with predominant neurologic manifestations: psychomotor retardation, epilepsy, ataxia, neuropathy, and myopathy. Given the ubiquitous nature of mitochondria, cellular dysfunction can also appear in tissues with high metabolic turnover; thus, there can be cardiac, digestive, ophthalmologic, and kidney complications. Mutations in the MT-ATP6 gene of mtDNA have been shown to cause NARP syndrome without renal involvement. We report a patient who had NARP syndrome diagnosed at age 11 years in whom glomerular proteinuria was present very early after diagnosis. Although neurologic manifestations were stable over time, he developed worsening proteinuria and kidney function. He started dialysis therapy at age 21 years. Kidney biopsy confirmed the mitochondrial cytopathy histologically, with abnormal mitochondria seen on electron microscopy. The MT-ATP6 gene mutation was detected in the kidney biopsy specimen.

PMID: 29224958 [PubMed - as supplied by publisher]

Kidney Transplant With and Without Native Nephrectomy for Polycystic Kidney Disease: Results of the National Inpatient Sample and the Rationale for a 2-Staged Procedure.

Tue, 12/12/2017 - 16:48
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Kidney Transplant With and Without Native Nephrectomy for Polycystic Kidney Disease: Results of the National Inpatient Sample and the Rationale for a 2-Staged Procedure.

J Am Coll Surg. 2017 Dec 07;:

Authors: Jean RA, Alexandre M, Yoo PS

Abstract
BACKGROUND: Polycystic kidney disease (PKD) is one of the most common causes of end-stage renal disease requiring hemodialysis or transplantation. In patients requiring transplant, there are several indications for native nephrectomy, including recurrent cyst infection, bleeding, or to provide room for the graft. There is disagreement about whether it is advisable to perform kidney transplant alone (KT), or to perform kidney transplant with simultaneous native nephrectomy (KTN). We compared postoperative outcomes of KTN and KT in a large national cohort.
STUDY DESIGN: The Nationwide Inpatient Sample (NIS) between 2000 and 2014 was examined for a diagnosis of PKD with evidence for KT or KTN. Logistic regression, adjusting for age, sex, comorbidity, and hospital region, was used to compare groups for the need for blood transfusion, the need for critical care interventions, and the development of postoperative complications.
RESULTS: A total of 4,003 hospitalizations were identified, which was representative of 19,302 weighted discharges nationally. In adjusted logistic regression models, KTN demonstrated significantly higher risk for blood transfusion (OR 2.06, 95%CI [1.44, 2.96], p<0.0001), postoperative complications (OR 1.44, 95%CI [1.05, 1.96], p=0.02) and critical care interventions (OR 1.44, 95%CI [1.07, 1.95], p=0.02). Other significant predictors for blood transfusion included female sex (OR 1.76, 95%CI [1.45, 2.13], p<0.0001), age over 61 years (OR 1.60, 95%CI [1.21, 2.10], p=0.001) and Charlson comorbidity score ≥2 (OR 1.52, 95%CI [1.10, 2.09], p=0.01).
CONCLUSIONS: Among patients with PKD, in comparison to KTN, KT-alone represents a decreased risk for negative postoperative outcomes. A 2-staged procedure should be considered, when feasible, to minimize adverse patient outcomes.

PMID: 29224797 [PubMed - as supplied by publisher]

Pharmacotherapy and Treatment Options for HIV-Associated Nephropathy.

Tue, 12/12/2017 - 16:48
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Pharmacotherapy and Treatment Options for HIV-Associated Nephropathy.

Expert Opin Pharmacother. 2017 Dec 09;:

Authors: Menez S, Hanouneh M, McMahon BA, Fine DM, Atta MG

Abstract
INTRODUCTION: Human immunodeficiency virus (HIV) remains a worldwide disease with significant mortality and morbidity. There are a multitude of HIV-related kidney diseases including HIV-associated nephropathy (HIVAN) most prominently. The risk of developing HIVAN increases with decreasing CD4 count, higher viral load, and based on genetic factors. The mortality rate for those with HIVAN-end stage renal disease (ESRD) remains 2.5-3 times higher than ESRD patient without HIVAN. Areas Covered: The epidemiology of HIVAN, particularly risk assessment will be explored in this review. Further, the pathogenesis of HIVAN, from viral-specific renal expression to the role of genetics as well as characteristic renal pathology will be described. Diagnosis and treatment of HIVAN focusing on ESRD progression, will be addressed with an emphasis on various treatment strategies, including medication, dialysis, and kidney transplantation. Expert Opinion: HIVAN is associated with a high risk for progression to ESRD and increased mortality. The backbone of HIVAN therapy remains cART, while adjunctive therapies including RAAS blockade and prednisone, should be considered. In those who progress to ESRD, dialysis remains the mainstay of management, though increasing evidence has demonstrated that kidney transplantation can be effective in those with controlled HIV disease.

PMID: 29224373 [PubMed - as supplied by publisher]

Functional vitamin B-6 status and long-term mortality in renal transplant recipients.

Tue, 12/12/2017 - 16:48
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Functional vitamin B-6 status and long-term mortality in renal transplant recipients.

Am J Clin Nutr. 2017 Dec;106(6):1366-1374

Authors: Minović I, van der Veen A, van Faassen M, Riphagen IJ, van den Berg E, van der Ley C, Gomes-Neto AW, Geleijnse JM, Eggersdorfer M, Navis GJ, Kema IP, Bakker SJ

Abstract
Background: Low plasma concentrations of pyridoxal 5'-phosphate (PLP) are common in renal transplant recipients (RTRs) and confer increased risk of long-term mortality. To our knowledge, it is not known whether low plasma PLP concentrations have functional (i.e., intracellular) consequences and, if so, whether such consequences are associated with increased risk of mortality.Objectives: We assessed the association of plasma PLP with functional vitamin B-6 status and explored the potential association of functional vitamin B-6 status with long-term mortality in RTRs.Design: In a longitudinal cohort of 678 stable RTRs with a median follow-up of 5.3 y (IQR: 4.8-6.1 y) and 297 healthy controls, PLP, plasma 3-hydroxykynurenine (3-HK), and xanthurenic acid (XA) were analyzed via validated assays. PLP was used as direct biomarker for vitamin B-6 status, and the 3-HK:XA ratio was used as functional biomarker of vitamin B-6 status with a higher ratio reflecting worse functional vitamin B-6 status.Results: Median PLP, 3-HK, and XA concentrations were 41 nmol/L (IQR: 29-60 nmol/L), 40.1 nmol/L (IQR: 33.0-48.0 nmol/L), and 19.1 nmol/L (IQR: 14.5-24.9 nmol/L), respectively, in healthy controls compared with 29 nmol/L (IQR: 17-50 nmol/L), 61.5 nmol/L (IQR: 45.6-86.5 nmol/L), and 25.5 nmol/L (IQR: 17.2-40.0 nmol/L), respectively, in RTRs (all P < 0.001). RTRs had a higher median 3-HK:XA ratio (2.38; IQR: 1.68-3.49) than did healthy controls (2.13; IQR: 1.63-2.71) (P < 0.05). In RTRs, the 3-HK:XA ratio was inversely associated with plasma PLP (β = -0.21, P < 0.001). Moreover, a higher 3-HK:XA ratio was independently associated with increased risk of all-cause mortality (HR per SD increment: 1.30; 95% CI: 1.13, 1.49), cancer mortality (HR per SD increment: 1.47; 95% CI: 1.12, 1.95), and infectious disease mortality (HR per SD increment: 1.50; 95% CI: 1.21, 1.86) in RTRs.Conclusions: Vitamin B-6-deficient RTRs have a worse functional vitamin B-6 status than do healthy controls and vitamin B-6-sufficient RTRs. Worse functional vitamin B-6 status in RTRs is independently associated with an increased risk of mortality particularly because of cancer and infectious disease. This trial was registered at clinicaltrials.gov as NCT02811835.

PMID: 28978540 [PubMed - indexed for MEDLINE]

Lipidomic and proteomic analysis of exosomes from mouse cortical collecting duct cells.

Tue, 12/12/2017 - 16:48
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Lipidomic and proteomic analysis of exosomes from mouse cortical collecting duct cells.

FASEB J. 2017 Dec;31(12):5399-5408

Authors: Dang VD, Jella KK, Ragheb RRT, Denslow ND, Alli AA

Abstract
Exosomes are endosome-derived nanovesicles that are involved in cellular communication and signaling. Exosomes are produced by epithelial cells and are found in biologic fluids including blood and urine. The packaged material within exosomes includes proteins and lipids, but the molecular comparison within exosome subtypes is largely unknown. The purpose of this study was to investigate differences between exosomes derived from the apical plasma membrane and basolateral plasma membrane of polarized murine cortical collecting duct principal cells. Nanoparticle tracking analysis showed that the size and concentration of apical and basolateral exosomes remained relatively stable across 3 different temperatures (23, 37, and 42°C). Liquid chromatography-tandem mass spectrometry analysis revealed marked differences between the proteins packaged within the two types of exosomes from the same cells. Several proteins expressed at the inner leaflet of the plasma membrane, including α-actinin-1, moesin, 14-3-3 protein ζ/δ, annexin A1/A3/A4/A5/A6, clathrin heavy chain 1, glyceraldehyde-3-phosphate dehydrogenase, α-enolase, filamin-A, and heat shock protein 90, were identified in samples of apical plasma membrane-derived exosomes, but not in basolateral plasma membrane exosomes from mouse cortical collecting duct cells. In addition to differences at the protein level, mass spectrometry-based shotgun lipidomics analysis showed significant differences in the lipid classes and fatty acid composition of the two types of exosomes. We found higher levels of sphingomyelin and lower levels of cardiolipin, among other phospholipids in the apical plasma membrane compared to the basolateral plasma membrane exosomes. The molecular analyses of exosome subtypes presented herein will contribute to our understanding of exosome biogenesis, and the results may have potential implications for biomarker discovery.-Dang, V. D., Jella, K. K., Ragheb, R. R. T., Denslow, N. D., Alli, A. A. Lipidomic and proteomic analysis of exosomes from mouse cortical collecting duct cells.

PMID: 28821634 [PubMed - indexed for MEDLINE]

Acute Peritonitis Caused by Staphylococcus capitis in a Peritoneal Dialysis Patient.

Tue, 12/12/2017 - 16:48
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Acute Peritonitis Caused by Staphylococcus capitis in a Peritoneal Dialysis Patient.

Perit Dial Int. 2017 1-2;37(1):115-116

Authors: Basic-Jukic N

Abstract
Acute peritonitis remains the most common complication of peritoneal dialysis (PD), with coagulase-negative staphylococci (CoNS) reported to account for more than 25% of peritonitis episodes (1). Staphylococcus capitis is a gram-positive, catalase-positive CoNS that was originally identified as a commensal on the skin of the human scalp (2). Advancement of microbiological technologies for bacterial identification enables diagnosis of previously unknown causes of acute peritonitis. This is the first reported case of acute peritonitis in a PD patient caused by S. capitis.

PMID: 28153968 [PubMed - indexed for MEDLINE]

Intraperitoneal Calcitriol for Treatment of Severe Hyperparathyroidism in Children with Chronic Kidney Disease: A Therapy Forgotten.

Tue, 12/12/2017 - 16:48
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Intraperitoneal Calcitriol for Treatment of Severe Hyperparathyroidism in Children with Chronic Kidney Disease: A Therapy Forgotten.

Perit Dial Int. 2016 11-12;36(6):688-690

Authors: Chanchlani R, Ackerman S, Piva E, Harvey E

Abstract
Active Vitamin D sterols such as calcitriol and alfacalcidol are quite effective in the treatment of mineral bone disease secondary to chronic kidney disease. However, some children on peritoneal dialysis (PD) are resistant to oral formulations of active Vitamin D, and use of an intravenous formulation in such patients is inconvenient. In these children, intraperitoneal (IP) calcitriol has been shown to be effective in the treatment of secondary hyperparathyroidism. However, its use has declined. We report 2 children, aged 1 and 9.5 years, on chronic cycler PD with severe secondary hyperparathyroidism refractory to oral active Vitamin D who were successfully treated with IP calcitriol for a period of 12 and 4 months, respectively. We also discuss the published literature on the efficacy of IP calcitriol for treatment of secondary hyperparathyroidism and specific considerations for its use in PD patients.

PMID: 27903853 [PubMed - indexed for MEDLINE]

A New Peritoneal Dialysis Training Guideline from the ISPD Nursing Committee.

Tue, 12/12/2017 - 16:48
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