Current Issue : April - June Volume : 2012 Issue Number : 2 Articles : 6 Articles
Introduction: To evaluate whether alkaline phosphatase (AP) treatment improves renal function in sepsis-induced\r\nacute kidney injury (AKI), a prospective, double-blind, randomized, placebo-controlled study in critically ill patients\r\nwith severe sepsis or septic shock with evidence of AKI was performed.\r\nMethods: Thirty-six adult patients with severe sepsis or septic shock according to Systemic Inflammatory Response\r\nSyndrome criteria and renal injury defined according to the AKI Network criteria were included. Dialysis\r\nintervention was standardized according to Acute Dialysis Quality Initiative consensus. Intravenous infusion of\r\nalkaline phosphatase (bolus injection of 67.5 U/kg body weight followed by continuous infusion of 132.5 U/kg/24 h\r\nfor 48 hours, or placebo) starting within 48 hours of AKI onset and followed up to 28 days post-treatment. The\r\nprimary outcome variable was progress in renal function variables (endogenous creatinine clearance, requirement\r\nand duration of renal replacement therapy, RRT) after 28 days. The secondary outcome variables included changes\r\nin circulating inflammatory mediators, urinary excretion of biomarkers of tubular injury, and safety.\r\nResults: There was a significant (P = 0.02) difference in favor of AP treatment relative to controls for the primary\r\noutcome variable. Individual renal parameters showed that endogenous creatinine clearance (baseline to Day 28)\r\nwas significantly higher in the treated group relative to placebo (from 50 �± 27 to 108 �± 73 mL/minute (mean �±\r\nSEM) for the AP group; and from 40 �± 37 to 65 �± 30 mL/minute for placebo; P = 0.01). Reductions in RRT\r\nrequirement and duration did not reach significance. The results in renal parameters were supported by\r\nsignificantly more pronounced reductions in the systemic markers C-reactive protein, Interleukin-6, LPS-binding\r\nprotein and in the urinary excretion of Kidney Injury Molecule-1 and Interleukin-18 in AP-treated patients relative to\r\nplacebo. The Drug Safety Monitoring Board did not raise any issues throughout the trial.\r\nConclusions: The improvements in renal function suggest alkaline phosphatase is a promising new treatment for\r\npatients with severe sepsis or septic shock with AKI....
With the notable growth in the qualitative investigation of living kidney donation, there is value in aggregating results from this\r\nbody of research to learn from accumulated experience. The present paper aims to draw a complete portrait of living donors�\r\nand recipients� experience of donation by metasummarizing published studies.We found that donors� experience, particularly the\r\ndecision-making process, has been more extensively studied than the recipients� perspective. Donors differ in their initial level\r\nof motivation to donate but on the whole report positive experiences and personal benefits. They also identify difficult periods\r\nand the need for additional resources. Recipients report an often positive but more ambivalent reaction to donation. In terms of\r\nrelational issues between dyads, while the topic remains understudied, the donor-recipient relationship and gift reciprocity have\r\nreceived the most attention. Results are discussed in terms of their implications for future practice and research....
Background: Healthy individuals can host Staphylococcus aureus in the nasopharynx, body surface and vagina. Most\r\ninvasive infections by this bacterium are endogenous, caused by strains spread from the nasopharynx of carriers. S.\r\naureus is a pathogen involved in the etiology of hospital- and community-acquired infections. Transplant and dialysis\r\npatients are at risk of colonization or infection by multi-resistant S. aureus. Infection is directly linked to individual\r\nimmunity, and the major histocompatibility complex (MHC) plays a crucial role in determining susceptibility to diseases.\r\nDifferent MHC specificities have been shown to be more frequent in individuals suffering from certain diseases. This\r\nstudy aimed to investigate the association between HLA class I (HLA-A and -B) and class II (HLA-DRB1) molecules and\r\nnasal carriage of S. aureus in dialysis and kidney transplant patients at a hospital in Southern Brazil.\r\nResults: The sample consisted of 70 dialysis and 46 kidney transplant patients, totaling 116 patients. All subjects\r\nwere typed for HLA molecules using LABType�® SSO (One Lambda). Nasal swab samples of S. aureus were isolated\r\nfrom the nasal cavity (both nostrils) of patients undergoing dialysis or kidney transplantation.\r\nIn renal dialysis patients, HLA-A*02 was the most frequent allele in both carriers (25.5%) and non-carriers (21.2%) of\r\nS. aureus. Allele A*68 was not observed in the carrier group, but the allele was observed six times in the noncarrier\r\ngroup (p = 0.0097). Regarding HLA-B and HLA-DRB1, no allele was shown to be involved in protection\r\nagainst or susceptibility to carriage of S. aureus. In kidney transplant patients, allele A*03 was more frequent in the\r\nnon-carrier (20.83%) than in the carrier (5.88%) group (p = 0.0486). HLA-B*15 was present in carriers (5.88%) and\r\nnon-carriers (25%) (p = 0.0179). Regarding class II alleles, DRB1*03 appeared to be related to susceptibility to\r\ncarriage of S. aureus (p = 0.0319).\r\nConclusions: Our findings suggest that HLA-DRB1*03 may be involved in susceptibility to nasal carriage of S.\r\naureus in transplant patients. In addition, HLA-A*68 (dialysis patients) and HLA-A*03 and HLA-B*15 (transplant\r\npatients) appear to be associated with increased resistance to S. aureus nasal carriage....
Background. Diabetes is a risk factor for delayed graft function in kidney transplantation, and hyperglycemia increases ischemia\r\nreperfusion injury in animal models. Methods. To explore the role of perioperative hyperglycemia in ischemia reperfusion injury,\r\nwe conducted a prospective study of 40 patients undergoing living donor renal transplantation. Blood glucose levels were\r\nmonitored intraoperatively, and serum samples were obtained at the time anesthesia was induced and one hour after allograft\r\nreperfusion. The percentage change in neutrophil gelatinase-associated lipocalin (NGAL), a protein whose expression is increased\r\nwith renal ischemia, was then used to determine the extent of injury. Results. In a multivariate model including recipient, donor,\r\nand transplant factors, recipient blood glucose >160 mg/dL at the time of allograft reperfusion (�Ÿ 0.19, P-value < 0.01), warm\r\nischemia time >30 minutes (�Ÿ 0.11, P-value 0.13), and recipient age (�Ÿ 0.05, P-value 0.05) were associated with percentage change\r\nin NGAL. These same predictors were associated with the percentage change in creatinine on postoperative day 2. Conclusions.\r\nHyperglycemia is associated with increased ischemic injury in renal transplantation. Both creatinine and NGAL, a marker of\r\nischemic injury and renal function, fall less rapidly in patients with elevated blood glucose....
Introduction: The accurate prediction of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an\r\nunmet clinical need. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel sensitive and specific marker of\r\nAKI.\r\nMethods: A total of 207 consecutive patients presenting to the emergency department with AHF were enrolled.\r\nPlasma NGAL was measured in a blinded fashion at presentation and serially thereafter. The potential of plasma\r\nNGAL levels to predict AKI was assessed as the primary endpoint. We defined AKI according to the AKI Network\r\nclassification.\r\nResults: Overall 60 patients (29%) experienced AKI. These patients were more likely to suffer from pre-existing\r\nchronic cardiac or kidney disease. At presentation, creatinine (median 140 (interquartile range (IQR), 91 to 203)\r\numol/L versus 97 (76 to 132) umol/L, P < 0.01) and NGAL (114.5 (IQR, 67.1 to 201.5) ng/ml versus 74.5 (60 to 113.9)\r\nng/ml, P < 0.01) levels were significantly higher in AKI compared to non-AKI patients. The prognostic accuracy for\r\nmeasurements obtained at presentation, as quantified by the area under the receiver operating characteristic curve\r\nwas mediocre and comparable for the two markers (creatinine 0.69; 95%CI 0.59 to 0.79 versus NGAL 0.67; 95%CI\r\n0.57 to 0.77). Serial measurements of NGAL did not further increase the prognostic accuracy for AKI. Creatinine, but\r\nnot NGAL, remained an independent predictor of AKI (hazard ratio (HR) 1.12; 95%CI 1.00 to 1.25; P = 0.04) in\r\nmultivariable regression analysis.\r\nConclusions: Plasma NGAL levels do not adequately predict AKI in patients with AHF....
Little is known on long-term outcomes in kidney transplantation. This study evaluated changes and predictors of generic and\r\ntransplantation-specific health-related quality of life (HQoL) over six years in N = 102 kidney transplant survivors using the\r\nShort-form Health Survey-36 and the Transplant Effects questionnaire. Mixed models analysis was used to determine long-term\r\noutcomes. Emotional HQoL improved over time: Mental Component score, Mental Health, Energy (Ps = .000). Physical HQoL\r\ndeteriorated: Physical Component Score (P = .001), Pain (P = .002). LRD transplant recipients had greater decline in physical\r\nfunctioning (P = .003) and PCS (P = .000) compared to cadaver recipients. Worry about the transplant (P = .036) and feelings\r\nof responsibility (P = .008) increased significantly over time. Worry about the transplant and perceived ability to work predicted\r\n12.7% and 31.1% in variance in MCS and PCS, respectively. Efforts should be made to maintain HQoL and emotional outcomes\r\nwith ongoing monitoring and support programs throughout the course of posttransplant care....
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