Successful renal contraction therapy in polycystic kidney patient with renal transcatheter arterial embolization prior to ABO incompatible kidney transplantation

28-year-old female received dialysis treatment due to chronic renal failure caused by polycystic kidney disease. Later, she underwent a laparoscopic splenectomy and ABO incompatible living kidney transplantation successfully following bilateral renal contraction therapy with renal transcatheter arterial embolization (renal TAE). A unilateral or bilateral native nephrectomy of a massively enlarged kidney performed at the time of renal transplantation is a common treatment in polycystic kidney patients scheduled for transplantation. On the other hand, when treated with renal TAE, such patients can avoid a laparotomy, which provides several advantages when undergoing peritoneal dialysis in the future or a laparoscopic splenectomy prior to ABO incompatible kidney transplantation. Furthermore, we consider that bilateral renal TAE is necessary for polycystic kidney patients prior to renal transplantation for a variety of reasons, including problems associated with contrast nephropathy if renal TAE for left kidney is remained after renal transplantation.     

Utility of the Japanese GFR estimation equation for evaluating potential donor kidney function

Background

In Japan, the number of living kidney transplantations has increased each year, and an accurate evaluation of renal function must be conducted before donation to minimize the risk to donors. Recently, the Japanese Society of Nephrology issued a new equation for estimating glomerular filtration rate (eGFR) in Japanese people. This study compared the accuracy of eGFR and creatinine clearance (Ccr) values with that of inulin clearance (Cin) for assessing renal function in kidney donors.

Methods

Clinical data were analyzed for 85 potential living kidney donors who had undergone routine measured GFR (mGFR) and Ccr measurements from October 2006 to November 2008 at a single center. Inulin clearance, representing the mGFR, was determined by standard method. The eGFR was calculated as: eGFR = 194 × Scr^?1.094 × Age^?0.287 (for females, ×0.739).

Results

Mean mGFR was 96.1 ± 14.7 (range 67.8–126.8); mean eGFR, 72.6 ± 12.7 (range 50.1–107.1); and mean Ccr, 117.3 ± 22.4 (range 35.1–170.1), in units of ml/min/1.73 m² for each. Relative to mGFR, the correlation coefficient for Ccr was 0.496, and the mean difference between the two values was 21.1 ml/min/1.73 m² (23.2%), with a root-mean square error (RMSE) of 19.6. The correlation coefficient between eGFR and mGFR was 0.502, and the mean difference between the two values was ?23.5 (23.7%), with a RMSE of 11.0. Bland–Altman plots showed that Ccr overestimated mGFR in 90.6% of cases, whereas eGFR underestimated mGFR in 95.3% of cases.

Conclusion

Ccr and eGFR values did not accurately estimate mGFR in Japanese living kidney donors.     

Adherence to Dietary Recommendations Measured by Smartphone-based Recipe Nutrition Calculator in Kidney Transplant Patients

BackgroundDietary restriction of protein, salt, and energy is recommended to prevent lifestyle related diseases, proteinuria, and graft dysfunction in kidney transplant patients. It is useful if the patients can evaluate meal components by themselves for each meal.Patients and methodsA total of 26 maintenance-phase kidney transplant patients were included in the study. The mean age, sex, body mass index, number of years post-transplantation, creatinine clearance, and 24-hour urinary excretion (24 UE) of protein were recorded on a medical chart. Estimated daily protein and salt oral intake were calculated from 24 UE of nitrogen and sodium, respectively. We compared these laboratory results and patients’ self-reported dietary intake using a smartphone-based recipe nutrition calculator (SRNC).ResultsEstimated daily protein and salt oral intake calculated from 24 UE of nitrogen and sodium were 55.4 ± 12.9 g/d and 8.5 ± 3.1 g/d, respectively. Estimated daily protein and salt oral intake measured by SRNC were 52.4 ± 13.8 g/day and 6.5 ± .9 g/day, respectively. The results of estimated daily protein and salt oral intake measured by SRNC were correlated to those calculated from 24 UE (R² = .287 and .217, respectively).ConclusionsThe results of estimated daily protein and salt oral intake measured by SRNC were correlated to those calculated from 24 UE in maintenance-phase kidney transplant patients. SRNC was useful as a measurement modality to evaluate the adherence to dietary guidance. Dietary therapy for these patients may have the potential to improve kidney graft function and survival.     

Actions of midazolam on excitatory transmission in dorsal horn neurons of adult rat spinal cord

BACKGROUND: Although intrathecal administration of midazolam, a water-soluble imidazobenzodiazepine derivative, has been found to produce analgesia, how it exerts this effect at the neuronal level in the spinal cord is not fully understood. METHODS: The effects of midazolam on electrically evoked and spontaneous excitatory transmission were examined in lamina II neurons of adult rat spinal cord slices using the whole cell patch clamp technique. RESULTS: Bath-applied midazolam (1 microm) diminished Adelta- and C-fiber evoked polysynaptic excitatory postsynaptic currents in both amplitude and integrated area. However, it affected neither Adelta- and C-fiber evoked monosynaptic excitatory postsynaptic currents in amplitude nor miniature excitatory postsynaptic currents in amplitude, frequency, and decay time constant. In the presence of a benzodiazepine receptor antagonist, flumazenil (5 microm), midazolam (1 microm) did not diminish Adelta-fiber evoked polysynaptic excitatory postsynaptic currents, suggesting that midazolam modulate the gamma-aminobutyric acid interneurons in the dorsal horn. CONCLUSIONS: Midazolam reduced excitatory synaptic transmission by acting on the gamma-aminobutyric acid type A/benzodiazepine receptor in interneurons, leading to a decrease in the excitability of spinal dorsal horn neurons. This may be a possible mechanism for the antinociception by midazolam in the spinal cord.     

Hb KOCHI [beta141(H19)Leu-->Val (g.1404 C-->G); 144-->146(HC1-3)Lys-Tyr-His-->0 (g.1413 A-->T)]: a new variant with increased oxygen affinity

A novel hemoglobin (Hb) variant was found in a specimen that showed an unusual profile in analyses of glycohemoglobin An abnormal beta-globin, 443 Da smaller than normal beta-globin, was detected by electrospray ionization mass spectrometry (ESI/MS) with intact globin. Mass spectrometry analysis of tryptic peptides derived from isolated abnormal Hb showed an abnormal peptide, characterized as betaT- 14 (141Leu-->Val and 144Lys-->0). Nucleotide sequencing revealed a heterozygosity of codon 141 CTG(Leu)-->GTG(Val), and codon 144 AAG(Lys)-->TAG(stop codon). The isopropanol stability test was normal. We named this novel variant Hb Kochi for the district where it was found. Functional studies carried out on diluted whole hemolysates and isolated Hb components from the proband demonstrated an increased oxygen affinity, consistent with the existence of mild erythrocytosis.     

Investigation of transport mechanism of pentazocine across the blood-brain barrier using the in situ rat brain perfusion technique

To characterize pentazocine (PTZ) transport across the blood-brain barrier (BBB), the cerebrovascular permeability-surface area product (PS(inf)) of PTZ was determined by a well-established in situ rat brain perfusion technique. The uptake kinetics of PTZ by the rat brain exhibited saturability, which indicates the simultaneous mechanisms of carrier-mediated transport and passive diffusion. The kinetic parameters were estimated as follows: maximal influx rate (V(max)), 27.2 +/- 5.2 nmol/s/g brain; apparent Michaelis constant (K(m)) for the saturable component of PTZ uptake, 2.9 +/- 0.5 mM; nonsaturable uptake rate constant (K(d)), 1.5 +/- 0.3 microL/s/g brain. BBB transport of PTZ was significantly inhibited by cationic drugs such as diphenhydramine, propranolol, and eptazocine (a narcotic-antagonist analgesic), but not by choline, suggesting that the PTZ transport system is shared by cationic drugs. Furthermore, co-perfusion of verapamil caused a significant (two-fold) increase in the BBB permeability to PTZ. This finding indicates that PTZ may be a substrate of the endogenous BBB efflux transport system, P-glycoprotein. These findings demonstrate that the primary mechanism governing the uptake of PTZ by the brain is carrier-mediated transport, not passive diffusion.     

The high incidence of left atrial appendage thrombosis in patients on maintenance haemodialysis

Background. The incidence of intracardiac thrombosis in haemodialysispatients has not been studied. Here we determined the incidencein end-stage renal disease patients on maintenance haemodialysis. Methods. Transoesophageal echocardiography was performed in215 patients (125 males, 90 females; mean age 60 ± 9years). Any potential candidate with current or past chronicor intermittent atrial fibrillation or with cardiovascular diseaseswas excluded from the study. Results. Thrombi were found in the left atrial appendages in71 out of 215 subjects (33%). Based on multiple logistic regressionanalyses, the probability of finding a thrombus was found tobe increased in patients on chronic antiplatelet therapy (oddsratio 4.268) and in those with diabetes mellitus and a low haematocrit(0.3; odds ratio 7.173). Other clinical parameters, includinggender, age, duration of haemodialysis, blood pressure, leftventricular dimension, smoking habit or type of anticoagulationduring dialysis, were not associated with the incidence of leftatrial appendage thrombosis. Conclusions. Maintenance haemodialysis patients have a highincidence of left atrial appendage thrombosis. Either chronicuse of antiplatelet drugs or the background conditions requiringantiplatelet therapy, and the concomitant presence of diabetesmellitus and a low haematocrit may be involved in left atrialappendage thrombosis.