Tuesday, August 25, 2015

Fluorodeoxyglucose F18 Positron Emission Tomography Coupled With Computed Tomography in Suspected Acute Renal Allograft Rejection [feedly]

----
Fluorodeoxyglucose F18 Positron Emission Tomography Coupled With Computed Tomography in Suspected Acute Renal Allograft Rejection
// AJT - Early

Management of kidney transplant recipients (KTRs) with suspected acute rejection (AR) ultimately relies on kidney biopsy; however, noninvasive tests predicting nonrejection would help avoid unnecessary biopsy. AR involves recruitment of leukocytes avid for fluorodeoxyglucose F18 (18F-FDG), thus 18F-FDG positron emission tomography (PET) coupled with computed tomography (CT) may noninvasively distinguish nonrejection from AR. From January 2013 to February 2015, we prospectively performed 32 18F-FDG PET/CT scans in 31 adult KTRs with suspected AR who underwent transplant biopsy. Biopsies were categorized into four groups: normal (n = 8), borderline (n = 10), AR (n = 8), or other (n = 6, including 3 with polyoma BK nephropathy). Estimated GFR was comparable in all groups. PET/CT was performed 201 ± 18 minutes after administration of 3.2 ± 0.2 MBq/kg of 18F-FDG, before any immunosuppression change. Mean standard uptake values (SUVs) of both upper and lower renal poles were measured. Mean SUVs reached 1.5 ± 0.2, 1.6 ± 0.3, 2.9 ± 0.8, and 2.2 ± 1.2 for the normal, borderline, AR, and other groups, respectively. One-way analysis of variance demonstrated a significant difference of mean SUVs among groups. A positive correlation between mean SUV and acute composite Banff score was found, with r2 = 0.49. The area under the receiver operating characteristic curve was 0.93, with 100% sensitivity and 50% specificity using a mean SUV threshold of 1.6. In conclusion, 18F-FDG PET/CT may help noninvasively prevent avoidable transplant biopsies in KTRs with suspected AR.

----

Shared via my feedly reader

Monday, August 17, 2015

Randomized Controlled Trial of Mycophenolate Mofetil in Children, Adolescents, and Adults With IgA Nephropathy

I thought you would be interested in this article.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation 2015 Jul 21;

Randomized Controlled Trial of Mycophenolate Mofetil in Children, Adolescents, and Adults With IgA Nephropathy.
Ronald J Hogg, R Curtis Bay, J Charles Jennette, Richard Sibley, Sumit Kumar, Fernando C Fervenza, Gerald Appel, Daniel Cattran, Danny Fischer, R Morrison Hurley, Jorge Cerda, Brad Carter, Beverly Jung, German Hernandez, Debbie Gipson, Robert J Wyatt

PMID: 26209543

Sent using journal reader: Read by QxMD



Alberto Reino Buelvas

Efficacy of Febuxostat for Slowing the GFR Decline in Patients With CKD and Asymptomatic Hyperuricemia: A 6-Month, Double-Blind, Randomized, Placebo-Controlled Trial

I thought you would be interested in this article.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation 2015 Jul 30;

Efficacy of Febuxostat for Slowing the GFR Decline in Patients With CKD and Asymptomatic Hyperuricemia: A 6-Month, Double-Blind, Randomized, Placebo-Controlled Trial.
Dipankar Sircar, Soumya Chatterjee, Rajesh Waikhom, Vishal Golay, Arpita Raychaudhury, Suparna Chatterjee, Rajendra Pandey

PMID: 26233732

Sent using journal reader: Read by QxMD



Alberto Reino Buelvas

Clinical Utility of Urinary Cytology to Detect BK Viral Nephropathy

Transplantation - Current Issue Clinical Utility of Urinary Cytology to Detect BK Viral Nephropathy

imageBackground: Reactivation of BK polyoma virus can result in destructive viral allograft nephropathy (BKVAN) with limited treatment options. Screening programs using surrogate markers of viral replication are important preventive strategies, guiding immunosuppression reduction. Methods: We prospectively evaluated the diagnostic test performance of urinary decoy cells and urinary SV40T immunochemistry of exfoliated cells, to screen for BKVAN, (defined by reference histology with SV40 immunohistochemistry, n = 704 samples), compared with quantitative viremia, from 211 kidney and 141 kidney-pancreas transplant recipients. Results: The disease prevalence of BKVAN was 2.6%. Decoy cells occurred in 95 of 704 (13.5%) samples, with a sensitivity of 66.7%, specificity of 88.6%, positive predictive value (PPV) of 11.7%, and negative predictive value of 98.5% to predict histologically proven BKVAN. Quantification of decoy cells improved the PPV to 32.1% (10 ≥ cells threshold). Immunohistochemical staining of urinary exfoliated cells for SV40T improved sensitivity to 85.7%, detecting atypical or degenerate infected cells (specificity of 92.3% and PPV of 33.3%), but was hampered by technical failures. Viremia occurred in 90 of 704 (12.8%) with sensitivity of 96.3%, specificity of 90.3%, PPV of 31.5%, and negative predictive value of 99.8%. The receiver-operator curve performance of quantitative viremia surpassed decoy cells (area under the curve of 0.95 and 0.79, respectively, P = 0.0018 for differences). Combining decoy cell and BK viremia in a diagnostic matrix improved prediction of BKVAN and diagnostic risk stratification, especially for high-level positive results. Conclusions: Although quantified decoy cells are acceptable surrogate markers of BK viral replication with unexceptional test performances, quantitative viremia displayed superior test characteristics and is suggested as the screening test of choice.


http://journals.lww.com/transplantjournal/Fulltext/2015/08000/Clinical_Utility_of_Urinary_Cytology_to_Detect_BK.31.aspx

Sent with Reeder



Alberto Reino Buelvas

Antiphospholipase A2 Receptor Antibody Levels Predict the Risk of Posttransplantation Recurrence of Membranous Nephropathy

Transplantation - Current Issue Antiphospholipase A2 Receptor Antibody Levels Predict the Risk of Posttransplantation Recurrence of Membranous Nephropathy

imageBackground: Secretory phospholipase A2 receptor (PLA2R) is the target antigen of the auto-antibodies produced in most (∼70%) patients with primary membranous nephropathy (pMN). The applicability of anti-PLA2R1 antibody monitoring for the prediction of MN recurrence in kidney transplant recipients still is a matter of debate. Methods: We sought to characterize the presence and concentration of anti-PLA2R antibodies by enzyme-linked immunosorbent assay (ELISA) in a cohort of 21 patients with pMN before and after transplantation to evaluate whether anti-PLA2R concentrations could predict pMN recurrence. Results: The presence of pMN recurrence was significantly correlated with the existence of a positive ELISA assay at graft biopsy or with high level of anti-PLA2R1 activity before transplantation (P = 0.03). In the receiver operating characteristic analysis, anti-PLA2R levels (cut-off of 45 U/mL) during the pretransplantation period accurately predicted pMN recurrence, with a sensitivity of 85.3%, specificity of 85.1%, negative predictive value of 92%, and an area under the curve of 90.8%. This finding supports the hypothesis that anti-PLA2R cause pMN recurrence in humans and indicates the need to prove in an experimental model. Furthermore, 6 of 7 patients with recurrence were carriers of HLA DQA1* 05:01/05 and DQB1* 02:01, confirming these DQ alleles as those associated with higher anti-PLA2R levels. Conclusions: This study is the first to demonstrate pretransplantation circulating anti-PLA2R antibodies in a cohort of renal transplant recipients who prospectively developed recurrent disease. Currently, anti-PLA2R levels measured by ELISA may be a rational tool to establish the risk of MN recurrence in renal allograft recipients.


http://journals.lww.com/transplantjournal/Fulltext/2015/08000/Antiphospholipase_A2_Receptor_Antibody_Levels.30.aspx

Sent with Reeder



Alberto Reino Buelvas

Changing Kidney Allograft Histology Early Posttransplant: Prognostic Implications of 1-Year Protocol Biopsies

AJT - Early Changing Kidney Allograft Histology Early Posttransplant: Prognostic Implications of 1-Year Protocol Biopsies

Allograft histology 1 year posttransplant is an independent correlate to long-term death-censored graft survival. We assessed prognostic implications of changes in histology first 2 years posttransplant in 938 first kidney recipients, transplanted 1999–2010, followed for 93.4 ± 37.7 months. Compared to implantation biopsies, histology changed posttransplant showing at 1 year that 72.6% of grafts had minor abnormalities (favorable histology), 20.2% unfavorable histology, and 7.2% glomerulonephritis. Compared to favorable, graft survival was reduced in recipients with unfavorable histology (hazards ratio [HR] = 4.79 [3.27–7.00], p < 0.0001) or glomerulonephritis (HR = 5.91 [3.17–11.0], p < 0.0001). Compared to unfavorable, in grafts with favorable histology, failure was most commonly due to death (42% vs. 70%, p < 0.0001) and less commonly due to alloimmune causes (27% vs. 10%, p < 0.0001). In 80% of cases, favorable histology persisted at 2 years. However, de novo 2-year unfavorable histology (15.3%) or glomerulonephritis (4.7%) related to reduced survival. The proportion of favorable grafts increased during this period (odds ratio = 0.920 [0.871–0.972], p = 0.003, per year) related to fewer DGF, rejections, polyoma-associated nephropathy (PVAN), and better function. Graft survival also improved (HR = 0.718 [0.550–0.937], p = 0.015) related to better histology and function. Evolution of graft histologic early posttransplant relate to long-term survival. Avoiding risk factors associated with unfavorable histology relates to improved histology and graft survival.




http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajt.13423

Sent with Reeder



Alberto Reino Buelvas

Sunday, August 16, 2015

Coronary Events in Obese Hemodialysis Patients Before and After Renal Transplantation [feedly]

----
Coronary Events in Obese Hemodialysis Patients Before and After Renal Transplantation
// Clinical Transplantation

Abstract

We examined the impact of obesity (BMI ≥ 30 kg/m2, n=357) on prognosis in 1696 hemodialysis (HD) patients before and after renal transplantation (TX). End-points were coronary events, composite CV events, and death.

Obese HD patients were older (55.9 ± 9.2 v 54.2 ± 11), had more diabetes (54% v 40%), dyslipidemia (49% v 30%), altered myocardial scan (38% v 31%), MI (16% v 10%), coronary intervention (11% v 7%), higher total-cholesterol (186 ± 52 v 169 ± 47), and triglycerides (219 ± 167 v 144 ± 91). Obese undergoing TX had more dyslipidemia (46% v 31%), angina (23% v 14%), MI (18% v 5%), increased total-cholesterol (185 ± 56 v 172 ± 48) and triglycerides (237 ± 190 v 149 ± 100). Obesity was independently associated with coronary events (Log-rank=0.008, HR 2.55 %CI 1.27-5.11) and death (Log-rank 0.046, HR 1.52, % CI 1.007 – 2.30) in TX but not in HD.

Obese HD patients had more risk factors and ischemic heart disease but these characteristics did not interfere with prognosis. In TX patients obesity predict coronary events and death.

This article is protected by copyright. All rights reserved.

----

Shared via my feedly reader