共查询到20条相似文献，搜索用时 31 毫秒
1.
Y. Yang K.Y. Kim I. Hwang T. Yim W. Do M.J. Kim S. Lee H.-Y. Jung J.-Y. Choi S.-H. Park Y.-L. Kim C.-D. Kim J.-H. Cho 《Transplantation proceedings》2017,49(5):1018-1022
Background
Precise monitoring of the glomerular filtration rate (GFR) is needed to estimate the allograft function in kidney transplant recipients (KTRs). The GFR is widely estimated with the use of formulas based on serum cystatin C (SCys) and serum creatinine (SCr) levels. We compared the efficacy of SCys-based equations with that of SCr-based equations to predict the allograft function.Methods
We calculated the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI Cr), CKD-EPI creatinine–cystatin C (CKD-EPI Cr/Cys), and CKD-EPI cystatin C (CKD-EP ICys) equations in 70 KTRs. The measured GFR (mGFR) was defined as the GFR estimated by technetium-99m–diethylene triamine pentaacetic acid (99mTc-DTPA) clearance. The accuracy and precision of the equations were compared with the mGFR. The performance characteristics of SCr and SCys were analyzed with the use of receiver operating characteristic (ROC) curves to ascertain the sensitivity and specificity at the cutoff value of <45 mL/min/1.73 m2 DTPA.Results
Overall, MDRD and CKD-EPICys did not show significant differences from mGFR (P = .05 and P = .077, respectively), whereas CKD-EPI Cr and CKD-EPI Cr/Cys significantly underestimated mGFR (P < .001 and P = .005, respectively). In the subgroup of patients with mGFR <45 mL/min/1.73 m2, CKD-EPI Cys showed little bias (P = .122), whereas MDRD significantly underestimated mGFR (P = .037). The area under the ROC curve for predicting mGFR <45 mL/min/1.73 m2 was 0.80 for SCys, which was better than that for SCr at 0.763.Conclusions
Cystatin C–based equations showed better predictive performance of the allograft function than creatinine-based equations for the KTRs, including patients with lower GFR. Cystatin C level might be a good alternate measurement to monitor the allograft function. 相似文献2.
C. Carillo Y. Pecoraro M. Anile S. Mantovani A. Oliva A. D&#x;Abramo D. Amore A. Pagini T. De Giacomo F. Pugliese E.A. Rendina F. Venuta D. Diso 《Transplantation proceedings》2017,49(4):699-701
Background
Acute kidney injury and chronic kidney failure are serious complications after lung transplantation. Glomerular filtration rate (GFR) is the primary indicator of renal function. Several equations have been proposed to evaluate the estimated GFR (eGFR). We compared three different equations to determine which has the better correlation with the development of acute and chronic renal failure in lung recipients.Methods
Twenty-two patients with a mean age of 54.4 ± 8.5 years underwent lung transplantation from 2010 to 2015. Thirteen (59%) had pulmonary fibrosis, 7 (32%) emphysema, 1 (4.5%) bronchiectasis, and 1 (4.5%) lymphangioleiomyomatosis. In all patients, eGFR was measured preoperatively using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Levey's Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. In 20 patients (90%) eGFR was calculated at 1, 3, and 6 months.Results
According to CKD-EPI and MDRD, eight patients (36.3%) had preoperative reduction in eGFR, whereas 6 patients (27.2%) had preoperative reduction according to the CG (P = .04). The mean values were higher for the CG (103.2 vs. 102 vs. 94.4). Five patients (22.7%) developed perioperative acute renal failure requesting a dialysis treatment; four of these showed a preoperative eGFR to the highest CG (P = .05). At 1 and 6 months after lung transplantation, the CG, MDRD and CKD-EPI eGFR values were, respectively, 86.6, 84.1 and 76.6 mL/min/1.73m2 and 75.8, 72.7, and 72.3 mL/min/1.73m2. CKD-EPI eGFR values are more predictable than the other equations of AKI.Conclusions
Preoperative assessment of eGFR using the MDRD and CKD-EPI seems to correlate better than the CG to the prediction of acute renal failure, whereas for the chronic form the three equations seem equivalent. 相似文献3.
I. Godinho J. Guerra M.J. Melo M. Neves J. Gonçalves M.A. Santana A. Gomes da Costa 《Transplantation proceedings》2018,50(3):719-722
Background
With the rising prevalence of living-donor kidney transplantation, evaluation of factors correlated with renal function in the donor-recipient pair constitutes a main goal for kidney transplantation clinicians. Our objective was to analyze the more relevant donor characteristics that contribute to donor and recipient estimated glomerular filtration rates (eGFR) after 1 year.Methods
We evaluated 48 consecutive donor-recipient pairs from our unit.Results
Mean donor age was 46 ± 11 years, with 71% being women. Mean recipient age was 35 ± 12 years, with 54% being men. Mean duration of donor hospitalization was 7 ± 2 days. Donor eGFR was 104 ± 11 mL/min/1.73 m2 before donation and 70 ± 14 mL/min/1.73 m2 at discharge. After 1 year, donor eGFR was 71 ± 12 mL/min/1.73 m2 and recipient eGFR was 69 ± 10 mL/min/1.73 m2. Donor eGFR <100 mL/min/1.73 m2 before donation and age >50 years correlated with 17.7- and 8.9-fold increased risks, respectively, of recipient eGFR <60 mL/min/1.73 m2 after 1 year. Donor being female, although statistically associated with worse graft function, compared with a male donor (P = .020), did not represent a significantly increased risk of recipient eGFR <60 mL/min/1.73 m2. Higher donor body mass index (BMI) also associated with a lower kidney function for donors (P = .048). In multivariate linear regression to predict pairs' eGFRs after 1 year, only donor eGFR before donation and at discharge retained statistical significance (P ≤ .001 and P = .045, respectively).Conclusions
Excluding unpredictable complications in the post-transplantation period, donor eGFR before donation, eGFR at discharge, and age were the best parameters to predict recipient and donor eGFRs after 1 year and can be used as a tool for managing expectations regarding the post-transplantation period. 相似文献4.
C.A. Mombelli M.C. Giordani N.C. Imperiali S.R. Groppa S.K. Villamil Cortez C.M. Schreck G.J. Rosa-Diez 《Transplantation proceedings》2018,50(2):418-422
Introduction
Living kidney donor (LKD) transplantation is increasing due to organ shortage. Clinical studies have shown that the risk of developing end-stage renal disease (ESRD) in donors is similar to that in the general population. Our goal was to evaluate postdonation renal outcomes assessed by glomerular filtration rate (GFR), proteinuria, and blood pressure.Methods
A total of 210 LKD transplants were performed at Hospital Italiano de Buenos Aires between 2000 and 2014. Postdonation outcomes were analyzed in 109 donors. GFR was assessed by 24-hour creatinine clearance (as 24-hour ClCr) and estimated using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Additionally, we correlated the predonation renal functional reserve (RFR) with postdonation GFR. Donor results were compared to the expected GFR (adjusted to age and single kidney). Other renal outcome indicators measured were albuminuria and blood pressure, and they were compared (predonation and postdonation) using univariate analysis.Results
A total of 109 patients were followed up for 47 ± 34 months (range, 12–168): 70% were female, age at donation was 48.58 years (range, 25–70), and predonation serum creatinine was 0.85 ± 0.17 mg/dL. Postnephrectomy GFR (24-hour ClCr) was significantly lower compared to predonation GFR (105.38 ± 21.78 mL/min/1.73 m2 vs 90.14 ± 17.78 mL/min/1.73 m2). However, postdonation GFR was not significantly different compared to the expected GFR. No differences were found for blood pressure or albuminuria. Age >50 and an RFR (<20%) was associated with a lower GFR.Conclusions
In this population of LKD, renal outcome (24-hour CrCl, albuminuria, and blood pressure) was within the expected outcome for healthy individuals after uninephrectomy. 相似文献5.
C.O. Akhimiona D.T. Nguyen E.A. Graviss A.O. Gaber W.N. Suki 《Transplantation proceedings》2018,50(10):3071-3075
Introduction
The assessment of the glomerular filtration rate (GFR) in kidney donor candidates is required for determining donor candidate acceptability. This assessment can be done using an estimated GFR (eGFR) or a measured GFR (mGFR). The primary objective of the present study was to compare, in healthy adult kidney donor candidates, GFR measured by the clearance of iothalamate to GFR estimated using the Chronic Kidney Disease Epidemiology Collaboration equation and to determine if eGFR was a suitable stand-alone assessment. A secondary objective was to explore demographic factors that affect the relationship of the eGFR and the mGFR.Methods
A retrospective review of kidney donor candidates' records at the J. C. Walter, Jr., Transplant Center, Houston Methodist Hospital, from January 2013 to March 2016 was undertaken. GFR was measured by the plasma clearance of radioisotopic iothalamate and estimated using the Chronic Kidney Disease Epidemiology Collaboration equation.Results
The median mGFR was 108 mL/min/1.73 m2. The eGFR underestimated the mGFR by 11.5%. The underestimation was greatest in subjects with an mGFR of ≥90 mL/min/1.73 m2. The eGFR overestimated the mGFR in donor candidates of black race.Conclusions
The Chronic Kidney Disease Epidemiology Collaboration eGFR can be used for screening potential kidney donors restricting the use of iothalamate (mGFR) to those donors with an eGFR below the transplant centers' acceptable GFR threshold for donation, thereby effecting cost savings and greater donor convenience. The eGFR in black donor candidates should be used with caution. 相似文献6.
M. Seija M. Nin J. Santiago L. Apaza A. Castaño L. Poggi I. Urioste A. Chiossoni A. Fernandez N. Navarrine M. Garau R. Astesiano M.S. Ferrari O. Noboa 《Transplantation proceedings》2018,50(10):3392-3396
Few studies have examined the relationship between non-immunological factors and glomerular filtration rate (GFR) decline in kidney transplant. Correcting these factors in native kidneys slows the progression of chronic kidney disease. The aim of this study was to analyze the association between the control of non-immunological factors and the annual decline of GFR.
Methods
A single-center, retrospective study was performed. We included 128 patients who received kidney transplants between 2000 and 2015, with at least 1-year post-transplant follow-up. Clinical records were reviewed. GFR was estimated by CKD-EPI. Three groups were defined according to the annual change in eGFR (ΔGFR 2016-1015): non-progressors (> ?1 mL/min/1.73 m2), slow progressors (> ?1 and < ?5 mL/min/1.73 m2), and fast progressors (< ?5 mL/min/1.73 m2). Percentage of achievement of KDIGO target was also analyzed.Results
The mean GFR was 62.5 mL/min/1.73 m2. Glomerulonephritis was the most common cause of kidney failure (36%). When the fast progressor group was compared with the non-progressor group, they differed significantly in age—patients were younger (40 ± 12.3 vs 45 ± 13.1 years)—post-transplant body mass index (27.4 ± 5.6 vs 25.2?x ± 5.9 kg/m2), and serum uric acid, which was significantly higher (6.4 ± 1.7 vs 5.5 ± 1.58 mg/dL). There were no differences between the groups with regard to blood pressure, dyslipidemia, proteinuria, or venous bicarbonate. Target systolic blood pressure was achieved by 45% of patients. Biopsy-proven acute rejection was higher in the fast progression group, although this was not statistically significant (13 [24.5%] vs 8 [13.1%]).Conclusions
High body mass index was associated with a faster decline in glomerular filtration rate in this study. Target blood pressure <140/90 mm Hg was achieved in less than 50% of cases. 相似文献7.
M. Kwapisz R. Kieszek M. Bieniasz K. Jędrzejko M. Nita K. Sułkowska P. Palczewski M. Durlik L. Pączek A. Kwiatkowski 《Transplantation proceedings》2018,50(6):1669-1673
Background
Multiple renal artery kidneys still represent a special challenge for surgeons, during both nephrectomy for organ donation and transplantation. Recognition of anatomical conditions with advanced imaging methods is one of the most important elements of the preoperative evaluation process.Aim
The purpose of the current study was to assess if anatomical abnormalities affect the outcomes of living kidney donor transplantation procedures.Patients and Methods
A retrospective analysis of 60 living kidney donors and their recipients was performed. Patients were assigned to two groups: pairs with a single allograft vessels (group I) and pairs with any anatomical abnormalities of the transplanted organ (group II). The impact of anatomical abnormalities on initial and long-term outcomes of the transplantation were analyzed.Results
The analyzed study group consisted of 60 pairs (35 included in group I and 25 in group II). Immediate graft function was observed in 65.7% vs 64% individuals, recpectively (n.s.). Mean serum creatinine concentration was 1.6, 1.46, and 1.44 mg/mL (group I) vs 1.78, 1.78, and 1.65 mg/mL (group II) at 1, 6, and 12 months posttransplant, respectively (n.s.). Glomerular filtration rate (using the Chronic Kindey Disease Epidemiology Collaboration equation) was estimated at 54.3, 59.9, and 61.0 mL/min/1.73 m2 (group I) vs 59.8, 57.6, and 59.8 mL/min/1.73 m2 (group II) at the same time points, respectively (n.s.).Conclusions
Presence of single renal vessels was not a predictor of immediate graft function in living-donor kidney transplantation. Transplantation outcomes for kidneys with anatomical anomalies did not differ when compared to organs with typical anatomy. Multiple renal arteries did not impact initial graft function if precise surgical technique and proper preoperative diagnostics were provided. 相似文献8.
M. Bieniasz R. Kieszek A. Jakubowska-Winecka M. Zatorski M. Kwapisz K. Jędrzejko M. Nita M. Durlik L. Pączek A. Kwiatkowski 《Transplantation proceedings》2018,50(6):1637-1639
Background
Living kidney transplantation is the optimal treatment of end-stage renal disease. The benefits for recipients are obvious. The psychological consequences for living kidney donors in Poland are not known.Objective
The objective of the study was to evaluate the psychological aspects of living kidney donation in Poland.Patients and methods
A total of 66 living donor open nephrectomies were performed in our institution between 1995 and 2005. The psychological aspects were assessed in 40 donors after nephrectomy. The study applied the Satisfaction With Life Scale (SWLS), the Situation Assessment Questionnaire, the Health Behaviors Survey, and our own questionnaire. The mean observation period was 65.6 months.Results
There was a trend toward better life satisfaction in living kidney donors compared to Polish adults. Donor life satisfaction was significantly lower when the recipient was dead than when the recipient was alive. Most donors perceived the kidney donation as a challenge in cognitive judgment. The mean score of the Health Behaviors Survey was not significantly different than in the general population in Poland. The mean pain score after donation was 3.2 in a 5-item scale (1 = severe pain, 5 = mild pain). The mean time of return to work was 3.5 months. No donors regretted their decisions about kidney donation.Conclusion
Living kidney donation in Poland has a positive impact on donors' quality of life. Among living kidney donors, the sense of danger concerning the risk of donation depends on the degree of the relationship with the recipient. 相似文献9.
L. Garcia-Covarrubias J. Barragan I. Castro K. Hernandez A. Reding H. Hinojosa P. Prieto A. Garcia C. Alejandra D. Ortuño M. Carmona D. Fernández H. Diliz 《Transplantation proceedings》2018,50(2):423-427
Background
Renal donation leads to a risk of developing chronic kidney disease, with an incidence of 0.47%. To evaluate for its presence, formulas based on serum creatinine are used, but up to 80% of these formulas underestimate the glomerular filtration rate (GFR) in donors. The aim of this work was to confirm the highest correlation of the GFR as measured with the use of DTPA-Tc99m with the GFR as estimated by means of the formula based on serum cystatin C (CKD-EPI creatinine–cystatin C) in healthy kidney donors.Methods
In this observational, analytic, cross-sectional study, the GFR of kidney donors was determined ≥1 year after donation by means of DTPA gammagram and estimation with the use of conventional formulations and with cystatin C.Results
Of 112 donors, 38 (34%) were included, 20 (60%) were female, with an overall average age of 40 years, 36.5 months after donation, and body mass index of 25.5 kg/m2. Correlation with the GFR as measured by means of DTPA gammagram was better with the use of CKD-EPI cystatin C (0.402; P = .020) and CKD-EPI creatinine-cystatin (0.549; P < .001) than the conventional formulas. Linear correlation with serum cystatin C was 0.825 (P < .001; 95% confidence interval, ?105.3 to ?63.2) for the CKD-EPI cystatin C formula, 0.77 (P < .001; ?89.9 to ?48.1) for the CKD-EPI creatinine-cystatin formula, and 0.525 (P = .002; ?91.1 to ?23.2) for DTPA-Tc99m scintigraphy.Conclusions
There is a strong correlation between estimate the GFR by equations based on cystatin C and the measurement of the GFR by DTPA-Tc99m gammagram. 相似文献10.
Serum Magnesium and Related Factors in Long-Term Renal Transplant Recipients: An Observational Study
N. Rodrigues A. Santana J. Guerra M. Neves C. Nascimento J. Gonçalves A.G. da Costa 《Transplantation proceedings》2017,49(4):799-802
Background
Low serum magnesium (MgS) is a known risk factor for cardiovascular and mineral bone disease. In renal transplant recipients (RTRs), low MgS levels have been related to higher glomerular filtration rates (GFR) and with calcineurin inhibitors, particularly tacrolimus. We aimed to evaluate MgS in renal transplant recipients with over 1 year of follow-up to establish related risk factors and the impact of the use of cyclosporine versus tacrolimus.Methods
Cross-sectional study of 94 RTRs with more than 12 months of follow-up. Hypomagnesemia was defined as serum magnesium level <1.5 mg/dL.Results
Hypomagnesemia was found in 5.3% of patients. MgS showed a negative correlation with creatinine clearance. A positive correlation between MgS with urinary magnesium and phosphorus was found. Cyclosporine versus tacrolimus analysis did not show a significant difference regarding MgS when considering all the population and the subgroup of patients with GFR >45 mL/min/1.73 m2. On the subgroup with GFR <45 mL/min/1.73 m2, those on tacrolimus had lower MgS than those on cyclosporine, but those same patients presented with significantly different GFR, higher in the tacrolimus subgroup.Conclusions
Hypomagnesemia has a low prevalence in RTRs with more than 1 year of follow-up. MgS levels evidenced a strong correlation with GFR. A significant difference on MgS levels between patients on tacrolimus and cyclosporine was found only when considering GFR <45 mL/min/1.73 m2, in which patients on tacrolimus had significantly higher GFR than patients on cyclosporine, which may explain these results. 相似文献11.
Background
Hyperuricemia has been associated with kidney disease and remains controversial with regard to its gender-specific differences and impact in living kidney donation.Methods
Between 2006 and 2015, charts of live kidney donors who underwent nephrectomy and had a minimum follow-up of 1 year were reviewed. A total of 291 donors were included and divided based on gender-specific pre-donation serum uric acid (SUA) tertiles. Renal functional outcomes included were estimated glomerular filtration rate (eGFR) at 6-month and 1-year follow-up and percentage of donors with a 1-year eGFR <60 mL/min/1.72 m2. Logistic regression analysis was done.Results
Mean SUA tertiles were 5.8 ± 1.1 mg/dL in males and 4.1 ± 1 mg/dL in females. Females in the highest tertile (SUA >4.5 mg/dL) had lower 6-month (59.9 ± 10.3 vs 66.9 ± 14.1 vs 67.3 ± 12.1; P = .018) and 1-year (60.8 ± 10.6 vs 67.6 ± 10.8 vs 67.8 ± 11.8; P = .021) eGFR and a higher percentage of donors with 1-year eGFR <60 mL/min/1.73 m2 (59.5% vs 31.6% vs 23%; P = .002) compared with donors in the lower SUA tertiles (≤4.5 mg/dL). In males, there were similar eGFRs among SUA tertiles at 6-month and 1-year follow-up. In multivariate analysis, SUA was shown to be a significant predictor of developing stage 3 CKD (eGFR <60 mL/min/1.72 m2), 1 year after donation in females but not in males.Conclusions
Predonation SUA level is associated with the development of delayed renal recovery (GFR <60 mL/min/1.72 m2) 1 year after donation in females but not in males. 相似文献12.
Validity of Current Equations to Estimate Glomerular Filtration Rate in Kidney Transplant Recipients
Background
Assessing glomerular filtration rate (GFR) is important in surveillance of kidney transplant recipients. This study aimed to determine accuracy of current equations to estimate GFR in Arabic kidney transplant recipients versus measurement of true GFR by 99m technetion diethylene triamine pentaacetic acid (99mTc- DTPA).Methods
GFR measurements were performed in 158 adult kidney transplant recipients including 91 males (58%), age of overall mean 46 ± 13 years. There were 82 Egyptians (52%) and 76 from different Arab countries (48%). All grafts were obtained from living related kidney donors.Results
The serum creatinine values range from 0.7 to 8 mg/dL; the true GFR values ranged from 8 to 105 mL/min/1.73 m2. We estimated GFR using the Modification of Diet in Renal Disease (MDRD), abbreviated MDRD (aMDRD), Walser, Nankivell, Cockcroft-Gault, Mayo Clinic Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and El-Minia equations. All eight estimated eGFRs correlated with 99mTc-DTPA clearance (P < .05), but their r2 was low ranging from 0.66 to 0.53 Their respective r2 values were: MDRD 0.66, aMDRD 0.60, Walser 0.53, Nankivell 0.58, Cockcroft-Gault 0.59, Mayo Clinic 0.59, CKD-EPI 0.61, and El-Minia equation 0.61. These results were not significantly different when we restricted our analysis to those with body mass indexes < 25 kg/m2, or to Arabic non-Egyptian subjects.Conclusions
All eight equations are far from ideal. In an unselected kidney transplantation population in the Arab area, current GFR prediction equations cannot substitute for GFR measurement. 相似文献13.
Y. Xiong J. Jiang H. Zhang Q. Fu R. Deng J. Li L. Liu X. Yuan X. He C. Wang 《Transplantation proceedings》2018,50(8):2412-2415
Objectives
To compare the clinical outcome of kidney transplantation from living-related and deceased donors.Patients and methods
Consecutive adult kidney transplants from living-related or deceased donors from February 2004 to December 2015 in a single center were enrolled for retrospective analysis. Estimated glomerular filtration rate (eGFR) was compared with linear mixed models controlling the effect of repeated measurement at different time points.Results
There were 536 living-related and 524 deceased donor kidney transplants enrolled. The 1-year, 3-year, and 5-year graft survival rates were 98.8%, 98.5% and 97.2% in living-related kidney transplantation (KTx), and 94.9%, 91.3% and 91.3% in deceased donor KTx (log-rank, P < .001). A significantly higher incidence of delayed graft function (DGF) was observed in deceased donor KTx (20.6% vs 2.6%, P < .001). eGFR in deceased donor KTx was significantly higher than that in living-related KTx (68.0 ± 23.7 vs 64.7 ± 17.9 mL/min/1.73 m2 at 1 year postoperation, 70.1 ± 23.3 vs 64.3 ± 19.3 mL/min/1.73 m2 at 2 years postoperation, and 72.5 ± 26.2 vs 65.2 ± 20.4 mL/min/1.73 m2 at 3 years postoperation; P < .001). The donor age was significantly higher in living-related KTx group (47.5 ± 11.0 vs 31.1 ± 14.4 years, P < .001).Conclusion
Living-related graft survival is superior to deceased graft survival at this center, while better 5-year renal allograft function is obtained in deceased donor KTx patients, which may be attributable to the higher age of living-related donors. 相似文献14.
M. Dürr N. Lachmann B. Zukunft D. Schmidt K. Budde S. Brakemeier 《Transplantation proceedings》2017,49(8):1747-1756.e1
Background
Conversion to belatacept at a later point after kidney transplantation (KT) as a rescue therapy has been shown to be beneficiary in an increasing number of patients, but prognostic factors for a favorable outcome have never been investigated.Methods
The present study analyzed all KT patients after late conversion to belatacept in a single center regarding graft survival and changes in estimated glomerular filtration rate (eGFR), proteinuria, and mean fluorescence intensity (MFI) of donor-specific antibodies (DSA).Results
A total of 69 KT patients were converted to belatacept. eGFR increased from 28.9 ± 18.2 mL/min/1.73 m2 at time of conversion to 34.8 ± 20.1 mL/min/1.73 m2 after 18 months (P = .025). After conversion, 26/69 patients (37.7%) showed a sustained increase in eGFR of >5 mL/min/1.73 m2 after 12 months and were defined as responders. All other patients (43/69, 62.3%) were defined as nonresponders. In multivariate analysis, nonresponders presented with significantly higher proteinuria (552 ± 690 vs 165 ± 158 mg/L; P = .004) at the time of conversion. Changes of eGFR from before conversion and the time of conversion were similar in both subgroups (?5.7 ± 9.2 and 29.2 ± 17.3 mL/min/1.73 m2 in responders and ?4.6 ± 10.7 and 28.7 ± 19.0 mL/min/1.73 m2 in nonresponders). HLA antibody panel reactivity did not change after conversion. DSA-MFI was higher in nonresponders (7,155 ± 6,785) than in responders (2,336 ± 2,173; P = .001). One patient (1/69, 1.4%) developed de novo DSA after conversion, and no antibody-mediated rejection was diagnosed within 1,540 treatment months.Conclusions
Late conversion to belatacept is beneficiary for a subgroup of patients, with lower proteinuria at the time of conversion being an indicator for a favorable outcome. 相似文献15.
H.J. Kwon D.H. Kim H.R. Jang S.-H. Jung D.H. Han H.H. Sung J.B. Park J.E. Lee W. Huh S.J. Kim Y.-G. Kim D.J. Kim H.Y. Oh 《Transplantation proceedings》2017,49(9):1999-2006
Background
Despite compensatory hyperfiltration in remaining nephrons following donor nephrectomy, some donors show impaired renal adaptation and low estimated glomerular filtration rate (eGFR). We investigated the factors predicting early renal adaptation after nephrectomy and identified kidney donors at risk of inadequate renal adaptation.Methods
A total of 265 living kidney donors from 2010 to 2013 were retrospectively analyzed. Renal function was serially followed for 6 months after the operation. Regression analyses were performed to identify the independent predictors of low eGFR (eGFR <60 mL/min/1.73 m2) and impaired renal adaptation (%Modification of Diet in Renal Disease [MDRD] <66% of baseline eGFR).Results
A total of 148 donors belonged to the low eGFR group, and changes in eGFR (ΔeGFR) at postoperative (PO) 1 day and 1 month were identified as independent predictors of low eGFR. Impaired renal adaptation was related to age, ΔeGFR PO 2–3 days, and ΔeGFR PO 1 month. Early renal adaptation was associated with age, male gender, and residual kidney computerized tomography angiography (CTA) volume. The best sensitivity and specificity were obtained with a cutoff value of ΔeGFR 31 at PO 1 day and 1 month for predicting low eGFR and with a value of ΔeGFR 27 at PO 2–3 days and 1 month for predicting impaired renal adaptation.Conclusions
Our study showed that the degree of early renal adaptation determines subsequent renal function in kidney donors. Closer monitoring and management may be required in old or male donors with small residual CTA kidney volume as well as donors with persistent ΔeGFR >27 within 1 month of nephrectomy. 相似文献16.
Pyry P. Jämsä Niku K.J. Oksala Antti P. Eskelinen Esa R. Jämsen 《The Journal of arthroplasty》2018,33(1):230-234.e1
Background
In arthroplasty clinics, we tend to evaluate patient's kidney function looking at serum creatinine (SCr), while estimated glomerular filtration rate (eGFR) is recommended. We reported the prevalence of chronic kidney disease (CKD; eGFR <60 mL/min/1.73 m2) in different patient groups and investigated whether CKD is missed by evaluation based on SCr.Methods
Preoperative SCr values were used to calculate eGFR in 20,575 consecutive hip or knee arthroplasties.Results
Prevalence of CKD was 9%-12%. It was higher among older women, knee arthroplasty patients, and patients with hypertension, diabetes, or coronary disease. Using SCr instead of eGFR leads to missing CKD in up to 7% of the cases. In older women and older patients with body mass index <25 kg/m2, half of CKD cases were missed.Conclusion
Use of eGFR instead of SCr to detect CKD more accurately is recommended. 相似文献17.
Qi Huang Yunshuang Chen Min Zhang Sihe Wang Weiguang Zhang Guangyan Cai Xiangmei Chen Xuefeng Sun 《International urology and nephrology》2018,50(4):733-743
Purpose
We compared the performance of technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) renal dynamic imaging (RDI), the MDRD equation, and the CKD EPI equation to estimate glomerular filtration rate (GFR).Methods
A total of 551 subjects, including CKD patients and healthy individuals, were enrolled in this study. Dual plasma sample clearance method of 99mTc-DTPA was used as the true value for GFR (tGFR). RDI and the MDRD and CKD EPI equations for estimating GFR were compared and evaluated.Results
Data indicate that RDI and the MDRD equation underestimated GFR and CKD EPI overestimated GFR. RDI was associated with significantly higher bias than the MDRD and CKD EPI equations. The regression coefficient, diagnostic precision, and consistency of RDI were significantly lower than either equation. RDI and the MDRD equation underestimated GFR to a greater degree in subjects with tGFR ≥ 90 ml/min/1.73 m2 compared with the results obtained from all subjects. In the tGFR60-89 ml/min/1.73 m2 group, the precision of RDI was significantly lower than that of both equations. In the tGFR30-59 ml/min/1.73 m2 group, RDI had the least bias, the most precision, and significantly higher accuracy compared with either equation. In tGFR < 30 ml/min/1.73 m2, the three methods had similar performance and were not significantly different.Conclusions
RDI significantly underestimates GFR and performs no better than MDRD and CKD EPI equations for GFR estimation; thus, it should not be recommended as a reference standard against which other GFR measurement methods are assessed. However, RDI better estimates GFR than either equation for individuals in the tGFR30-59 ml/min/1.73 m2 group and thus may be helpful to distinguish stage 3a and 3b CKD.18.
M. Bieniasz R. Kieszek M. Kwapisz K. Jędrzejko M. Durlik L. Pączek A. Kwiatkowski 《Transplantation proceedings》2018,50(6):1602-1604
Background
Transforming growth factor-β (TGF-β) is involved in the pathogenesis of hypertension and the development of hypertensive target organ damage. TGF-β may promote blood pressure elevation through several mechanisms. The identification of risk factors of hypertension in living kidney donors may provide proper postoperative management.Objective
The objective of the study was to determine the serum TGF-β concentration in living kidney donors after nephrectomy.Patients and Methods
A total of 66 living donor open nephrectomies were performed in the Department of General and Transplantation Surgery at the Medical University of Warsaw between 1995 and 2005. Forty living kidney donors reported for the follow-up. Physical examination, blood and urine tests, ECG, ambulatory blood pressure monitoring, cardiac sonography, and ophthalmoscopy were performed. Serum TGF-β concentration was measured by ELISA. Statistical analysis was performed using SPSS version 13.0.Results
The mean observation period was 65.6 months. The mean donor age at the time of donation and at the follow-up visit was 40.7 and 46.2, respectively. Hypertension was observed in 24% women and in 37% men after surgery. The significantly higher frequency of hypertension was observed after nephrectomy (P = .001). The strongest predictor of hypertension was age. The mean serum TGF-β concentration was 39.3 ng/mL. No significant differences were observed between hypertensive and normotensive donors (P = .061). A significantly higher TGF-β concentration was found 4 and 5 years after donation (P = .02).Conclusions
TGF-β is not associated with hypertension and glomerular filtration rate in living kidney donors after nephrectomy. Careful monitoring of hypertension in living kidney donors after nephrectomy is essential. 相似文献19.
Ł. Chrobak A. Dębska-Ślizień M. Jankowska Z. Śledziński B. Rutkowski 《Transplantation proceedings》2014
Background
Estimation of glomerular filtration rate (eGFR) after renal transplantation is performed with the use of methods that are standardized for a population of nontransplantation patients with chronic kidney disease. The aim of the study was to compare the performance of GFR estimation formulas in renal transplant recipients.Methods
The Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas were compared with measured creatinine clearance or clearance estimated by the Cockroft-Gault (C-G) formula. The influence of age, body mass index, and eGFR on the relative performance of these formulas also was studied by subgroups analysis.Results
Mean measured or estimated creatinine clearance overestimates the values of GFR calculated using the MDRD or CKD-EPI equation. This was statistically significant (P < .05) in whole-study population and in subgroups of patients at age above 25 years, with body mass index above 25, and in a subgroup with eGFR-MDRD <50 mL/min/m2. The mean bias from creatinine clearance was 7.46 mL/min for MDRD, 4.4 mL/min for CKD-EPI and −1.65 mL/min for C-G formula. There was a statistically significant (P < .05) negative correlation between eGFR value and bias from creatinine clearance for all 3 methods of estimation. The correlation coefficient was −0.4 for MDRD, −0.36 for CKD-EPI, and −0.46 for C-G clearance.Conclusions
Measured and estimated creatinine clearance overestimate values of eGFR calculated by the MDRD or CKD-EPI formula in a population of kidney transplant recipients, especially in subjects with obesity and worse renal function. Accuracy of analyzed GFR estimation formulas decreases with deterioration of renal graft function. 相似文献20.
Simon Hsu Dena E. Rifkin Michael H. Criqui Natalie C. Suder Pranav Garimella Charles Ginsberg Antoinette M. Marasco Belinda J. McQuaide Emma J. Barinas-Mitchell Matthew A. Allison Christina L. Wassel Joachim H. Ix 《Journal of vascular surgery》2018,67(6):1855-1863.e1