فهرست مطالب

nephropathology - Volume:5 Issue: 3, Jul 2016

Journal of nephropathology
Volume:5 Issue: 3, Jul 2016

  • تاریخ انتشار: 1395/05/17
  • تعداد عناوین: 5
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  • Bahar Bastani* Pages 88-89
  • Lionel Rostaing, Asma Allal, Arnaud Del Bello, Federico Sallusto, Laure Esposito, Nicolas Doumerc, BÉnÉdicte Debiol, Audrey Delas, Xavier Game, Nassim Kamar Pages 90-97
    Background
    ABO-incompatible (ABOi) kidney-transplantation has very good long-term results, i.e. similar to those observed for living-kidney ABO-compatible transplantation. This is because patients are desensitized at pretransplant using apheresis and rituximab therapy, with tacrolimus-based immunosuppression.
    Objectives
    To assess the efficacy of a single, pretransplant (Day –1), specific immunoadsorption session using Glycosorb® columns (anti-A or anti-B; Glycorex Sweden) to treat large volumes of plasma (up to 18 L).
    Patients and
    Methods
    Prospective single-center study evaluating 12 consecutive patients (6 males), aged 40 (23–59) years. Incompatibilities were A into 0 (8), B into 0 (3), and AB into 0 (1). Pretransplant desensitization relied on rituximab (D–30), tacrolimus, mycophenolic acid, and steroids (all started on D–13), and a single session of specific immunoadsorption on D–1. Immunoadsorption was coupled in tandem with a hemodialysis session.
    Results
    Overall, 15 L (11–18) of plasma were treated per patient, i.e., 0.2 (0.11–0.36 L/kg). Isoagglutinin titers were 1/16 (1/5–1/64) before the procedure, decreasing after 6 hours to 1/5 (1/1–1/16 P = 0.008), and to 1/2 (1/1–1/8; P = 0.05) at completion of the session. The next day, i.e., the day of transplantation, there was no rebound of isoagglutinins [1/4 (1/1–1/5); P = ns]. The procedure was well tolerated with no side-effects and no significant changes in hemoglobin level, platelet counts, fibrinogen, or albumin levels.
    Conclusions
    For ABOi kidney-transplantation, a single, longer, specific immunoadsorption session was very efficient at 1-day pre-transplantation with no rebound. These results should be confirmed when isoagglutinin titers are higher (≥120).
    Keywords: ABO, incompatible kidney transplantation, Specific immunoadsorption, Glycosorb®, Large plasma volumes
  • Ali Monfared, Seyyede Zeinab Azimi*, Ehsan Kazemnezhad Pages 98-104
    Background
    Statins improve prognosis in patients with coronary heart diseases by decreasing the incidence of vascular events. Excess prevalence of hyperhomocysteinemia, an independent risk factor of cardiovascular diseases, has been observed in stable renal transplant recipients (RTRs).
    Objectives
    The objective of our study was to evaluate the association between atorvastatin administration and plasma total homocysteine (tHcy) levels in RTRs.
    Patients and
    Methods
    We performed a retrospective cross-sectional study in 148 cyclosporine A (CsA) treated stable RTRs. We compared tHcy level and other demographic and clinical variables in RTRs with and without atorvastatin.
    Results
    58.1% of the 148 RTRs were treated with atorvastatin (20-40 mg/day). Mean tHcy levels were lower in patients treated with atorvastatin compared to nonusers (14.80 ± 5.13 µmol/l versus 16.95 ± 7.87 µmol/l, P = 0.04). The comparison of 85 patients treated with atorvastatin and 61 non-users revealed that those subjects with atorvastatin were older, with higher estimated creatinine clearance and elevated body mass index (BMI). They were more likely to have higher systolic blood pressure and CsA trough level (C0). The association between lower tHcy levels and atorvastatin use was confirmed in the multivariate regression model (P = 0.004). However tHcy levels were independently and negatively associated with serum folate (P = 0.0001) and vitamin B12 levels (P = 0.001) and positively with serum BUN (P = 0.001) and diastolic blood pressure (P = 0.024) as well.
    Conclusions
    These data support the association between lower tHcy levels and atorvastatin administration in RTRs. Further clinical trials are recommended to clarify homocysteine lowering effect of atorvastatin.
    Keywords: Homocysteine, Atorvastatin, Transplantation, Renal, Transplant recipients
  • Marwa M. Shakweer*, Maha Behairy, Nadia G. Elhefnawy, Tamer W. Elsaid Pages 105-110
    Background
    Forkhead box P3 (Foxp3) functions as a master regulator in the development and function of T-regulatory (Treg) cells. Recent studies have shown that autoimmune diseases including systemic lupus erythematosus (SLE) are associated with an imbalance with the Treg cells and T helper (Th) subtypes.
    Objectives
    To evaluate immunohistochemical expression of Foxp3 positive Treg cells in lupus nephritis (LN) and analyze its association with clinicopathologic parameters.
    Materials And Methods
    Renal biopsy specimens of 50 patients with LN were studied. Specimens were divided into; group A; 25 LN cases without proliferative activity (Class II and V) and group B: 25 cases with proliferative activity (Class III and IV). Immunohistochemical staining for anti-human Foxp3 antibody and grading from grade 0 to grade 3 was done.
    Results
    Foxp3 expression in group A was (grade 0 in 14 [56.0%], grade in 11 [44.0 %]) in comparison to group B (grade in 6 [24.0%], grade in 11 [44.0%] and grade in 8 [32.0%]) (P
    Conclusions
    Immunohistochemical Foxp3 expression in renal tissue was higher in proliferative versus non-proliferative LN and is associated with activity and severity of LN. Further studies are needed to determine its prognostic value in LN.
    Keywords: Foxp3, Activity index, Chronicity index, Proteinuria, Lupus nephritis, T regulatory cells
  • Hamid Nasri, Zahra Hasanpour, Mehdi Nematbakhsh, Ali Ahmadi, Mahmoud Rafieian, Kopaei* Pages 111-115
    Background
    Recent retrospective observational studies suggest that high-potency statin therapy might increase the risk of acute kidney injury, however data on this subject is scares.
    Objectives
    This study, was designed to investigate the renal tubular cell effect of different doses of atorvastatin to detect the possible aggravation of renal function or morphology of the kidney.
    Materials And Methods
    In this experimental study 24 male Wistar rats were designated into 4 equal groups and treated as follows. Control group received phosphate buffer as the vehicle of atorvastatin for 7 days. Groups 1, II and III received atorvastatin at doses of 10, 50 and 150 mg/kg daily for 7 days, then on the day 8, all rats were anesthetized using ketamine and the blood samples were collected for evaluation of creatinine (Cr) and blood urea nitrogen (BUN) levels and then all rats were sacrificed, then the animals’ kidneys were dissected out and histopathological studies were performed
    Results
    Mean (±SD) of scores of injury to renal tubular cells in control group was 4.2 ± 2.2 and in groups I, II and III were 6.44 ± 4.9, 15.4 ± 8.5 and 25.8 ± 12.7 respectively. Group III which received 150 mg/kg/day of atorvastatin had significant renal damage in comparison to control group (P
    Conclusions
    In the present study we found, atorvastatin with a dose of 150 mg/kg/day for 7 days was nephrotoxic for rats, while lower doses at 10 mg/kg/day or 50 mg/kg/day for 7 days were not accompanied by renal injury. These findings imply further attention to the administration of higher doses of atorvastatin in clinical conditions.
    Keywords: Atorvastatin, HMG, COA reductase inhibitors, Renal toxicity, Rhabdomyolysis