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Complement in Kidney Transplantation.

Thu, 06/15/2017 - 15:45
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Complement in Kidney Transplantation.

Front Med (Lausanne). 2017;4:66

Authors: Cernoch M, Viklicky O

Abstract
The complement system is considered to be an important part of innate immune system with a significant role in inflammation processes. The activation can occur through classical, alternative, or lectin pathway, resulting in the creation of anaphylatoxins C3a and C5a, possessing a vast spectrum of immune functions, and the assembly of terminal complement cascade, capable of direct cell lysis. The activation processes are tightly regulated; inappropriate activation of the complement cascade plays a significant role in many renal diseases including organ transplantation. Moreover, complement cascade is activated during ischemia/reperfusion injury processes and influences delayed graft function of kidney allografts. Interestingly, complement system has been found to play a role in both acute cellular and antibody-mediated rejections and thrombotic microangiopathy. Therefore, complement system may represent an interesting therapeutical target in kidney transplant pathologies.

PMID: 28611987 [PubMed - in process]

Diagnosis and Management of Hepatobiliary Complications in Autosomal Recessive Polycystic Kidney Disease.

Thu, 06/15/2017 - 15:45
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Diagnosis and Management of Hepatobiliary Complications in Autosomal Recessive Polycystic Kidney Disease.

Front Pediatr. 2017;5:124

Authors: Wehrman A, Kriegermeier A, Wen J

Abstract
Autosomal recessive polycystic kidney disease (ARPKD) is a congenital hepatorenal fibrocystic disease. The hepatic manifestations of ARPKD can range from asymptomatic to portal hypertension and massively dilated biliary system that results in liver transplantation. Hepatic complications of ARPKD typically present with signs of portal hypertension (splenomegaly and thrombocytopenia) or cholangitis. Liver disease in ARPKD does not always correlate with severity of renal disease. Management of ARPKD-related liver disease is largely treating specific symptoms, such as antibiotics for cholangitis or endoscopic treatment for variceal bleeding. If complications cannot be managed medically, liver transplantation may be indicated. This mini-review will discuss the clinical manifestations and management of children with ARPKD liver disease.

PMID: 28611971 [PubMed - in process]

Renal Function and Outcomes With Use of Left Ventricular Assist Device Implantation and Inotropes in End-Stage Heart Failure: A Retrospective Single Center Study.

Thu, 06/15/2017 - 15:45
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Renal Function and Outcomes With Use of Left Ventricular Assist Device Implantation and Inotropes in End-Stage Heart Failure: A Retrospective Single Center Study.

J Clin Med Res. 2017 Jul;9(7):596-604

Authors: Verma S, Bassily E, Leighton S, Mhaskar R, Sunjic I, Martin A, Rihana N, Jarmi T, Bassil C

Abstract
BACKGROUND: Left ventricular assist device (LVAD) and inotrope therapy serve as a bridge to transplant (BTT) or as destination therapy in patients who are not heart transplant candidates. End-stage heart failure patients often have impaired renal function, and renal outcomes after LVAD therapy versus inotrope therapy have not been evaluated.
METHODS: In this study, 169 patients with continuous flow LVAD therapy and 20 patients with continuous intravenous inotrope therapy were analyzed. The two groups were evaluated at baseline and at 3 and 6 months after LVAD or inotrope therapy was started. The incidence of acute kidney injury (AKI), need for renal replacement therapy (RRT), BTT rate, and mortality for 6 months following LVAD or inotrope therapy were studied. Results between the groups were compared using Mann-Whitney U test and Chi-square with continuity correction or Fischer's exact at the significance level of 0.05.
RESULTS: Mean glomerular filtration rate (GFR) was not statistically different between the two groups, with P = 0.471, 0.429, and 0.847 at baseline, 3 and 6 months, respectively. The incidence of AKI, RRT, and BTT was not statistically different. Mortality was less in the inotrope group (P < 0.001).
CONCLUSION: Intravenous inotrope therapy in end-stage heart failure patients is non-inferior for mortality, incidence of AKI, need for RRT, and renal function for 6-month follow-up when compared to LVAD therapy. Further studies are needed to compare the effectiveness of inotropes versus LVAD implantation on renal function and outcomes over a longer time period.

PMID: 28611860 [PubMed - in process]

A Case of Diabetic Macular Edema with Prominent Chorioretinal Folds.

Thu, 06/15/2017 - 15:45
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A Case of Diabetic Macular Edema with Prominent Chorioretinal Folds.

Case Rep Ophthalmol. 2017 Jan-Apr;8(1):163-169

Authors: Sato T, Kohmoto R, Fukumoto M, Morishita S, Kimura D, Tajiri K, Kobayashi T, Kida T, Kojima S, Ikeda T

Abstract
PURPOSE: To report a case of diabetic macular edema with prominent chorioretinal folds.
CASE REPORT: This study involved a 55-year-old male with untreated bilateral diabetic retinopathy who had undergone cataract surgery at another clinic. Following that surgery, diabetic macular edema rapidly exacerbated, accentuating marked cystoid macular edema and radial chorioretinal folds in the macula. Investigation of his medical history revealed that in addition to diabetes, he had uncontrolled hypertension and severe diabetic nephropathy. Vitreous surgery was performed on both eyes due to a resistance to a subtenon injection of triamcinolone acetonide or intravitreal injection of an antivascular endothelial growth factor agent. After surgery, the macular edema and chorioretinal folds showed a tendency towards improvement. Thereafter, kidney transplant surgery was performed for renal failure, and a mild tendency of chorioretinal folds was observed.
CONCLUSION: In the case presented in this study, we observed remarkable cystoid macular edema in the fovea centralis and theorize that distortion with the surrounding tissue might have occurred, thus leading to the formation of chorioretinal folds around the macula.

PMID: 28611649 [PubMed]

Functional Budd-Chiari Syndrome Associated With Severe Polycystic Liver Disease.

Thu, 06/15/2017 - 15:45
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Functional Budd-Chiari Syndrome Associated With Severe Polycystic Liver Disease.

Clin Med Insights Gastroenterol. 2017;10:1179552217713003

Authors: de Menezes Neves PDM, Balbo BEP, Watanabe EH, Rocha-Santos V, Andraus W, D'Albuquerque LAC, Onuchic LF

Abstract
A 50-year-old woman with end-stage renal disease secondary to autosomal dominant polycystic kidney disease was referred to a quaternary care center due to significantly increased abdominal girth. Her physical examination revealed tense ascites and abdominal collateral veins. A 10-L paracentesis improved abdominal discomfort and disclosed a transudate, suggestive of portal hypertension. A computed tomographic scan revealed massive hepatomegaly caused by multiple cysts of variable sizes, distributed throughout all hepatic segments. Contrast-enhanced imaging uncovered extrinsic compression of hepatic and portal veins, resulting in functional Budd-Chiari syndrome and portal hypertension. Although image-guided drainage followed by sclerosis of dominant cysts could potentially lead to alleviation of the extrinsic compression, the associated significant risk of cyst hemorrhage and infection precluded this procedure. In this scenario, the decision was to submit the patient to a liver-kidney transplantation. After 1 year of this procedure, the patient maintains normal liver and kidney function and refers significant improvement in quality of life.

PMID: 28611533 [PubMed - in process]

Occult Hepatitis C Infection Among Hemodialysis Patients: A Prevalence Study.

Thu, 06/15/2017 - 15:45
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Occult Hepatitis C Infection Among Hemodialysis Patients: A Prevalence Study.

Ann Hepatol. 2017 Aug 01;16(4):510-513

Authors: Naghdi R, Ranjbar M, Bokharaei-Salim F, Keyvani H, Savaj S, Ossareh S, Shirali A, H Mohammad-Alizadeh A

Abstract
INTRODUCTION AND AIM: Occult hepatitis C infection (OHCI) is the presence of HCV-RNA in the liver or peripheral blood mononuclear cells (PBMC) accompanying with negative serologic results. The aim of this study was to evaluate the prevalence of OHCI among Iranian chronic hemodialysis (HD) patients.
MATERIAL AND METHODS: In this cross sectional study 200 chronic HD patients with negative HCV antibody enrolled the study. Blood sample of patients were obtained, followed by Polymerase Chain reaction (PCR) testing for detection of HCV RNA. Patients with positive serum HCV RNA were considered as manifest hepatitis C infection (MHCI). However, patients with negative serum HCV RNA underwent further tests on PBMCs for detection of OHCI.
RESULTS: Serum HCV RNA was positive in 2 (1%) patients whom considered as MHCI, and 6 (3.03%) patients had positive PBMC HCV RNA.
CONCLUSION: In conclusion, chronic HD patients have been considered as a high risk group for hepatitis C infection. The results of this study suggest that these patients are also at risk for OHCI. Furthermore, evaluating PBMCs to detect HCV RNA would be a sensitive diagnostic method to find OHCI patients.

PMID: 28611267 [PubMed - in process]

Very-late-onset cytomegalovirus disease: a case-report and review of the literature.

Thu, 06/15/2017 - 15:45
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Very-late-onset cytomegalovirus disease: a case-report and review of the literature.

BMC Res Notes. 2017 Jun 13;10(1):210

Authors: Burgan H, Gosteli G, Giovannini M, Lienhard R, Clerc O

Abstract
BACKGROUND: Cytomegalovirus (CMV) infection remains one of the most common and feared complications of transplantation, justifying prophylaxis or preemptive strategies guided by donor and recipient CMV serostatus. In case of seronegative donor and recipient (D-/R-), no prophylaxis is recommended. Late-onset CMV disease is usually defined as occurring after prophylaxis discontinuation in D+/R- transplant patients.
CASE PRESENTATION: We are reporting the case of a D-/R- kidney Caucasian transplant recipient presenting with CMV primoinfection 12 years after renal transplant, and discuss the role of a secondary prophylaxis so late after transplantation.
CONCLUSIONS: Primary infections leading to late-onset CMV disease in transplant patients remain rare. Recurrent disease has been described in as many as one-third of these patients. A systematic secondary prophylaxis in this particular group of patients is questionable.

PMID: 28610622 [PubMed - in process]

In-depth characterization of CD24(high)CD38(high) transitional human B cells reveals different regulatory profiles.

Thu, 06/15/2017 - 15:45
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In-depth characterization of CD24(high)CD38(high) transitional human B cells reveals different regulatory profiles.

J Allergy Clin Immunol. 2016 May;137(5):1577-1584.e10

Authors: Simon Q, Pers JO, Cornec D, Le Pottier L, Mageed RA, Hillion S

Abstract
BACKGROUND: CD24(high)CD38(high) transitional B cells represent cells at a key stage in their developmental pathway. In addition, these B cells have been widely ascribed regulatory functions and involvement in the control of chronic inflammatory diseases. However, the phenotypic and functional overlap between these cells and regulatory B cells remains controversial.
OBJECTIVE: In this study we wanted to explore the regulatory properties of CD24(high)CD38(high) human B cells.
METHODS: We used multicolor flow cytometry in combination with bioinformatics and functional studies to show that CD24(high)CD38(high) B cells can be distinguished into multiple subsets with different regulatory functions.
RESULTS: For the first time, the study reveals that human transitional B cells encompass not only transitional type 1 and type 2 B cells, as previously suggested, but also distinct anergic type 3 B cells, as well as IL-10-producing CD27(+) transitional B cells. Interestingly, the latter 2 subsets differentially regulate CD4(+) T-cell proliferation and polarization toward TH1 effector cells. Additional analyses reveal that the percentage of type 3 B cells is reduced and the frequency of CD27(+) transitional B cells is increased in patients with autoimmune diseases compared with those in matched healthy subjects.
CONCLUSION: This study provides evidence for the existence of different transitional B-cell subsets, each displaying unique phenotypic and regulatory functional profiles. Furthermore, the study indicates that altered distribution of transitional B-cell subsets highlights different regulatory defects in patients with different autoimmune diseases.

PMID: 26525227 [PubMed - indexed for MEDLINE]

StatPearls

Thu, 06/15/2017 - 15:45

StatPearls

Book. 2017 06

Authors:

Abstract
Hepatorenal syndrome (HRS) is a multiorgan condition affecting the kidneys and the liver. It is a cause of acute kidney injury that can be seen in those with acute or chronic liver disease. The first association of renal failure in cirrhosis was observed in the late 1800's. In the mid to late 1900's, further research revealed that renal failure in liver cirrhosis was functional. This was demonstrated in patients with HRS with normal kidney histology in addition to the absence of proteinuria. This was further demonstrated clinically when kidney's from patients with HRS were transplanted into those with chronic kidney disease as well as the improvement of renal function in liver cirrhosis patient's that underwent liver transplant. Further research investigating renal clearance established the association of renal vasoconstriction in HRS.


PMID: 28613606

StatPearls

Thu, 06/15/2017 - 15:45

StatPearls

Book. 2017 06

Authors:

Abstract
Mycobacterium chelonae is a nontuberculous mycobacterium (NTM), which is classified as rapidly growing mycobacterium (RGM), class IV in the Runyon classification. M. chelonae was first isolated from a turtle in 1903 by Freidmann, who referred to it as "turtle tubercle bacillus. RGMs account for 50% of known mycobacterial species and are divided into six groups, which are as follows: Mycobacterium fortuitum group, M. chelonae/Mycobacterium abscessus complex, Mycobacterium smegmatis, Mycobacterium mucogenicum group, Mycobacterium mageritense/Mycobacterium wolinskyi and the pigmented RGM. M. chelonae and M. abscessus were considered identical until 1992 when M. chelonae was elevated to species status. Both M. chelonae and M. abscessus have an identical sequence in the 54-510 region but can be differentiated by their intergenic sequence (ITS), hsp65, or gene sequences. Susceptibility profiles can be helpful, but they are not ideal in differentiating between the M. chelonae group and M. abscessus group. M. chelonae group is characterized by high MICs of cefoxitin (> 64 mg/L) and susceptibility to tobramycin (MIC ≤ 4 mg/L), whereas M. abscessus shows lower MICs of cefoxitin (≤ 64 mg/L) and resistance to tobramycin (MIC of > 8 mg/L) (3). M. chelonae is ubiquitous in the environment and has been found in soil, water, and aquatic animals. M. chelonae grows optimally at 30-32 °C and may have a long incubation period. It is commonly associated with skin and soft tissue infections, especially infections of the extremities (cellulitis, abscessus). M chelonae also causes catheter-related infections and post-surgical infections after implants, transplants, and injections such as sclerotherapy. The eye is second most frequent organ involved. Pulmonary infections are rare when compared to M. abscessus. Invasive infections like bacteremia, osteomyelitis, intraabdominal abscess, and disseminated cutaneous infections are common in immunosuppressed patients such as those on steroids, monoclonal antibodies, and post-transplant immunosuppression. Cancer patients and chronic kidney disease patients are also susceptible to disseminated and invasive disease due to M. chelonae.


PMID: 28613557

Hemodialysis and Kidney Transplantation as Predisposing Conditions to Onychomycosis.

Wed, 06/14/2017 - 12:45

Hemodialysis and Kidney Transplantation as Predisposing Conditions to Onychomycosis.

Nephron. 2017 Jun 14;:

Authors: Filho AMS, Ventura CG, Criado PR, Del Negro GB, Freitas RS, Luiz OC, Giudice MC, Neto ED, Benard G

Abstract
BACKGROUND/AIM: Onychomycosis (OM) is one of the commonest superficial fungal infections. Patients undergoing hemodialysis (HD) treatment and kidney transplant recipients (KTR) are considered at risk of contracting fungal infections, but the few published data do not reach the conclusion of whether they are predisposed to OM. This study aimed to determine the prevalence and etiology of OM in these patients and to determine the antifungal susceptibility profile of the isolated fungal species.
METHODS: We recruited 149 HD patients, 187 KTR, and a control group comprising 174 patients attending an internal medicine service with other diseases than renal diseases. All patients underwent an examination of all toenails to check for the presence of OM. Antifungal susceptibility tests were performed following the Clinical and Laboratory Standards Institute (CLSI) recommendations.
RESULTS: The prevalence rates of OM in HD patients (23.4%) and KTR (23.0%) were significantly higher than those in age- and sex-matched control groups (13.2%). In HD patients, OM was associated with diabetes but not with the duration of dialysis. In KTR, OM was more prevalent in those without diabetes and likely also in those using mycophenolate mofetil or azathioprine but was not associated with the duration of transplantation. Trichophyton rubrum was the most prevalent species (45.9%) followed by T. mentagrophytes (24.5%) and Candida parapsilosis (18.0%). Fluconazole, itraconazole, voriconazole, and terbinafine were all efficient against the isolates of dermatophyte, with terbinafine showing the lowest and fluconazole the highest minimal inhibitory concentrations. All isolates of C. parapsilosis were sensitive to the antifungals according to the CLSI criteria.
CONCLUSION: We found a high prevalence of OM in HD and KTR patients and suggest that these conditions should be considered a risk factor of OM. All 4 antifungals evaluated in the study showed good in vitro activity against the etiologic agents.

PMID: 28609764 [PubMed - as supplied by publisher]

Development of next generation sequencing panel for UMOD and association with kidney disease.

Wed, 06/14/2017 - 12:45

Development of next generation sequencing panel for UMOD and association with kidney disease.

PLoS One. 2017;12(6):e0178321

Authors: Bailie C, Kilner J, Maxwell AP, McKnight AJ

Abstract
Chronic kidney disease (CKD) has a prevalence of approximately 10% in adult populations. CKD can progress to end-stage renal disease (ESRD) and this is usually fatal unless some form of renal replacement therapy (chronic dialysis or renal transplantation) is provided. There is an inherited predisposition to CKD with several genetic risk markers now identified. The UMOD gene has been associated with CKD of varying aetiologies. An AmpliSeq next generation sequencing panel was developed to facilitate comprehensive sequencing of the UMOD gene, covering exonic and regulatory regions. SNPs and CpG sites in the genomic region encompassing UMOD were evaluated for association with CKD in two studies; the UK Wellcome Trust Case-Control 3 Renal Transplant Dysfunction Study (n = 1088) and UK-ROI GENIE GWAS (n = 1726). A technological comparison of two Ion Torrent machines revealed 100% allele call concordance between S5 XL™ and PGM™ machines. One SNP (rs183962941), located in a non-coding region of UMOD, was nominally associated with ESRD (p = 0.008). No association was identified between UMOD variants and estimated glomerular filtration rate. Analysis of methylation data for over 480,000 CpG sites revealed differential methylation patterns within UMOD, the most significant of these was cg03140788 p = 3.7 x 10-10.

PMID: 28609449 [PubMed - in process]

HIV in the dialysis population: Current issues and future directions.

Wed, 06/14/2017 - 12:45

HIV in the dialysis population: Current issues and future directions.

Semin Dial. 2017 Jun 13;:

Authors: Boyle SM, Lee DH, Wyatt CM

Abstract
Antiretroviral therapy has significantly reduced mortality due to HIV infection, but the aging HIV-positive patient population now faces a growing burden of comorbidity. This review describes the changing epidemiology of chronic kidney disease and end-stage renal disease in this population, and highlights recent advances in antiretroviral therapy and kidney transplantation that directly impact the care of patients with HIV infection and end-stage renal disease.

PMID: 28608994 [PubMed - as supplied by publisher]

All's well following living kidney donation?

Wed, 06/14/2017 - 12:45

All's well following living kidney donation?

Transpl Int. 2017 Jun 13;:

Authors: Scandling J

Abstract
Wellbeing following living kidney donation, both physical and psychosocial, continues to be a concern and area of investigative focus decades following the acceptance of kidney transplantation as treatment for end-stage kidney disease. In this issue, Maple and colleagues report their prospective study of wellbeing in living kidney donors during the first year after donation, using a comprehensive array of psychosocial outcome measures. Their aim was to produce a quantitative analysis to better inform both transplant teams and potential donors. Their thorough assessment found that while donors felt that donation had changed their outlook on life for the better, there was no quantitative improvement in the measures of psychosocial health. But, reassuringly, there was also no evidence of harm. This article is protected by copyright. All rights reserved.

PMID: 28608627 [PubMed - as supplied by publisher]

A Five-Tier System for Improving the Categorization of Transplant Program Performance.

Wed, 06/14/2017 - 12:45

A Five-Tier System for Improving the Categorization of Transplant Program Performance.

Health Serv Res. 2017 Jun 13;:

Authors: Wey A, Salkowski N, Kasiske BL, Israni AK, Snyder JJ

Abstract
OBJECTIVE: To better inform health care consumers by better identifying differences in transplant program performance.
DATA SOURCE: Adult kidney transplants performed in the United States, January 1, 2012-June 30, 2014.
STUDY DESIGN: In December 2016, the Scientific Registry of Transplant Recipients instituted a five-tier system for reporting transplant program performance. We compare the differentiation of program performance and the simulated misclassification rate of the five-tier system with the previous three-tier system based on the 95 percent credible interval.
DATA COLLECTION: Scientific Registry of Transplant Recipients database.
PRINCIPAL FINDINGS: The five-tier system improved differentiation and maintained a low misclassification rate of less than 22 percent for programs differing by two tiers.
CONCLUSION: The five-tier system will better inform health care consumers of transplant program performance.

PMID: 28608369 [PubMed - as supplied by publisher]

ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association...

Wed, 06/14/2017 - 12:45

ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons.

J Nucl Cardiol. 2017 Jun 12;:

Authors: Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, Smith PK

Abstract
The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes and stable ischemic heart disease (SIHD) were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing SIHD and acute coronary syndromes individually. This document presents the AUC for SIHD.Clinical scenarios were developed to mimic patient presentations encountered in everyday practice. These scenarios included information on symptom status; risk level as assessed by noninvasive testing; coronary disease burden; and, in some scenarios, fractional flow reserve testing, presence or absence of diabetes, and SYNTAX score. This update provides a reassessment of clinical scenarios that the writing group felt were affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization.A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range of 4 to 6 indicate that coronary revascularization may be appropriate for the clinical scenario.As seen with the prior coronary revascularization AUC, revascularization in clinical scenarios with high symptom burden, high-risk features, and high coronary disease burden, as well as in patients receiving antianginal therapy, are deemed appropriate. Additionally, scenarios assessing the appropriateness of revascularization before kidney transplantation or transcatheter valve therapy are now rated. The primary objective of the AUC is to provide a framework for the assessment of practice patterns that will hopefully improve physician decision making.

PMID: 28608183 [PubMed - as supplied by publisher]

Transperitoneal laparoscopic nephrectomy in acute Grade 4 renal trauma with literature review and a note on some unusual complications.

Wed, 06/14/2017 - 12:45

Transperitoneal laparoscopic nephrectomy in acute Grade 4 renal trauma with literature review and a note on some unusual complications.

J Minim Access Surg. 2017 Jul-Sep;13(3):225-227

Authors: Valsangkar RS, Rizvi SJ, Quadri SJF, Modi PR

Abstract
Most renal traumas are successfully managed conservatively. Grade 4 and 5 trauma, however, can require nephrectomy which is almost always by laparotomy and laparoscopic nephrectomy (LN) is still considered contraindicated in acute trauma setting. We report successful transperitoneal LN in an acute grade 4 renal trauma with retroperitoneal haematoma, extensive parenchymal devascularisation and urinary extravasation though retroperitoneoscopic nephrectomy in trauma has been reported recently. However, we believe transperitoneal approach is more logical and replicates all the principles of open renal trauma surgery more accurately. A review of LN in renal trauma and some unusual problems to be anticipated during laparoscopic procedures in acute trauma setting is presented.

PMID: 28607293 [PubMed - in process]

Transition structures and timing of transfer from paediatric to adult-based care after kidney transplantation in Germany: a qualitative study.

Wed, 06/14/2017 - 12:45

Transition structures and timing of transfer from paediatric to adult-based care after kidney transplantation in Germany: a qualitative study.

BMJ Open. 2017 Jun 12;7(6):e015593

Authors: Prüfe J, Dierks ML, Bethe D, Oldhafer M, Müther S, Thumfart J, Feldkötter M, Büscher A, Sauerstein K, Hansen M, Pohl M, Drube J, Thiel F, Rieger S, John U, Taylan C, Dittrich K, Hollenbach S, Klaus G, Fehrenbach H, Kranz B, Montoya C, Lange-Sperandio B, Ruckenbrod B, Billing H, Staude H, Brunkhorst R, Rusai K, Pape L, Kreuzer M

Abstract
OBJECTIVES: It is known that transition, as a shift of care, marks a vulnerable phase in the adolescents' lives with an increased risk for non-adherence and allograft failure. Still, the transition process of adolescents and young adults living with a kidney transplant in Germany is not well defined. The present research aims to assess transition-relevant structures for this group of young people. Special attention is paid to the timing of the process.
SETTING: In an observational study, we visited 21 departments of paediatric nephrology in Germany. Participants were doctors (n=19), nurses (n=14) and psychosocial staff (n=16) who were responsible for transition in the relevant centres. Structural elements were surveyed using a short questionnaire. The experiential viewpoint was collected by interviews which were transcribedverbatim before thematic analysis was performed.
RESULTS: This study highlights that professionals working within paediatric nephrology in Germany are well aware of the importance of successful transition. Key elements of transitional care are well understood and mutually agreed on. Nonetheless, implementation within daily routine seems challenging, and the absence of written, structured procedures may hamper successful transition.
CONCLUSIONS: While professionals aim for an individual timing of transfer based on medical, social, emotional and structural aspects, rigid regulations on transfer age as given by the relevant health authorities add on to the challenge.
TRIAL REGISTRATION NUMBER: ISRCTN Registry no 22988897; results (phase I) and pre-results (phase II).

PMID: 28606904 [PubMed - in process]

Can immunosuppression be stopped after liver transplantation?

Wed, 06/14/2017 - 12:45

Can immunosuppression be stopped after liver transplantation?

Lancet Gastroenterol Hepatol. 2017 Jul;2(7):531-537

Authors: Clavien PA, Muller X, de Oliveira ML, Dutkowski P, Sanchez-Fueyo A

Abstract
Liver transplantation has improved dramatically over the past three decades, mainly as a result of advances in surgical techniques and management of post-transplant complications. The focus has now turned towards rescuing additional organs in the face of scarce organ supply, or prevention of long-term toxicity associated with immunosuppression. The liver appears to be privileged in terms of immune tolerance, with a low incidence of antibody-mediated rejection, which is in sharp contrast to other solid organ transplants, such as kidney, lung, and heart transplants. However, tolerogenic processes remain poorly understood, and strategies for complete drug withdrawal should be selected carefully to avoid graft rejection. In this Review, we summarise the current understanding of liver-specific immune responses and provide an outlook on future approaches.

PMID: 28606879 [PubMed - in process]

[Common therapeutic approaches of sarcopenia in the elderly and uremic myopathy].

Wed, 06/14/2017 - 12:45

[Common therapeutic approaches of sarcopenia in the elderly and uremic myopathy].

Nephrol Ther. 2017 Jun 09;:

Authors: Chauveau P, Moreau K, Lasseur C, Combe C, Aparicio M

Abstract
The gradual loss of weight and function of muscle in patients with chronic kidney disease as in the elderly impacts the quality of life. Early management should help slow the functional limitation. Physical activity is the first therapy to propose that ensures stability of muscle mass and improved function. Resistance training programs have proven effective but are not yet widely available in nephrology units. The nutritional management should not be forgotten because there is a resistance to anabolism and protein intake should be involved in physical activity program. Associated treatments should not be neglected: vitamin D, anti-inflammatory, androgens. Some are still under evaluation. Therapeutic option, tomorrow, could be anti-myostatin antibodies and glitazones.

PMID: 28606408 [PubMed - as supplied by publisher]

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