Urine Periostin as a Biomarker of Renal Injury in Chronic Allograft Nephropathy

Background

Chronic allograft nephropathy (CAN) represents the main cause of renal allograft failure after transplantation. Noninvasive CAN testing is required. Periostin promotes the expression of a mesenchymal phenotype in renal tubules and is a promising urine biomarker for progressive renal injury. Information regarding periostin expression in the setting of CAN remains scarce.

Methods

Subjects were recruited from our outpatient transplantation clinic. Random urine samples were collected from CAN patients (n = 24) and renal transplant patients with normal renal function (transplant controls, n = 18). Control samples were collected from healthy volunteers (n = 18) who had normal renal function. Urine periostin was measured by enzyme-linked immunosorbent assay.

Results

The median urine periostin in CAN patients was significantly higher than in transplant and healthy controls (1.74 vs 0.00 vs 0.14 ng/mg creatinine, respectively; P < .001). Urine periostin enzyme-linked immunosorbent assay at a cutoff value of 0.152 ng/mg creatinine demonstrated the sensitivity, specificity, and accuracy for distinguishing CAN patients from transplant patients with normal renal function (91.7%, 77.8%, and 85.7%, respectively). In addition, urine periostin levels correlated directly with urine protein creatinine ratio (R = 0.566, P < .001) and serum creatinine (R = 0.522; P < .001), whereas inverse significant correlations were evidenced with estimated glomerular filtration rate (R = −0.431; P < .001).

Conclusion

The appearance of urine periostin in CAN patients but not in healthy and transplant controls underscores its value as a potential biomarker for chronic progressive renal injury in transplant recipients.     

Migraine in Thai children: prevalence in junior high school students

A cross-sectional study to determine the prevalence of migraine in seventh grade Thai students in 4 junior high schools in Bangkok, Thailand, according to the diagnostic criteria of the second edition of the Classification of Headache of the International Headache Society was conducted in July 2004. The study included a screening self-administered questionnaire and face-to-face interview with physical examination. The diagnosis of migraine was made and confirmed by 2 pediatric neurologists. All of 1789 students in participating schools completed the questionnaire. After 2 interviews, 248 students (13.8%) were diagnosed with migraine. The prevalence in girls was higher than that in boys (16.2% vs 11.7%). Migraine as having aura was diagnosed in 34 students (13.7%). One student had sporadic hemiplegic migraine. Among 248 children, 176 (71%) reported the duration of headache between 1 and 2 hours. The leading precipitating factor of migraine was the stress related to daily school activities (17.7%). There were 32 students (12.9%) with frequent and intense headache who were referred to their primary physicians for further management. This study had disclosed a high prevalence of migraine in seventh grade Thai students in Bangkok City and reflected the existing burden of this illness in Thai students.     

Epidemiology and risk factors of injury in Thai children

A case-control study was carried out to identify risk factors of injury in 200 children (mean age 6.68 +/- 3.9 years) attending the Emergency Room, Ramathibodi Hospital from April to August 1987. Traffic and falls were the most common causes of injuries in all age groups. Falls, traffic and sport injuries were responsible for the age-specific injury in infants, 1-10 years and more than 10 year-old children respectively. Most of the injuries occurred at home and on the street, during school term, working day, and between 3-8 pm. Twenty two percent of them needed hospitalization. Another 200 patients, matched sex and age range (mean age 6.38 +/- 3.8 year) from the general out patient department were selected as controls. Parents or care providers were interviewed. The result showed that boys, children older than 6 years of age not attending school, higher rank of order of the child in the family, large family size, the more care providers at the time, parental education lower than primary school level and low family income were risk factors of injury in these children (OR = 1.8, 2.4, 1.6-2.7, 1.7-3.3, 6.2, 2.1, 1.8 and 2.4 respectively).     

Prevalence of significant QTc prolongation and long QT syndrome in adolescents with syncope

A total of 664 high school students having >or=1 episode of syncope and 560 students without syncope (controls) underwent 12-lead ECG. A significant QT prolongation was defined as corrected QT (QTc)>470 ms in male and >480 ms in female. A diagnosis of LQTS was made by Schwartz's score. Most students had only 1 episode of syncope (66.1%), 2 (16.9%), 3 (11.6%), and >or=4 (5.4%). Most syncopal episodes were related to non-exertional events with only 11.4% related to exertion. The QTc distribution of the study group was almost identical to controls with mean QTc of 405.1+/-23.2 vs 402.5+/-23.4 ms, respectively. Only one male (0.15%) in the study group had significant QTc prolongation. None met the criteria for diagnosis of LQTS (score>or=4). In conclusion, the prevalence of LQTS in adolescents having syncope seems to be low in this cohort study.     

Ocular toxicity of chloroquine among Thai patients

BACKGROUND: Chloroquine has been prescribed for the treatment of various diseases. The most serious side-effect of chloroquine is retinopathy. The frequency of occurrence of retinopathy varies from 0.001 to 40% depending on the criteria used. The purpose of this study was to evaluate the incidence of ocular toxicity from chloroquine treatment among Thai patients. METHODS: A retrospective study was carried out in patients treated with chloroquine at Ramathibodi Hospital over the past 10 years (1987-1997). Patients eligible for review were followed by ophthalmic examination by an ophthalmologist for at least 6 months after starting treatment. RESULTS: One hundred and fifty-five patients were studied. Nineteen were men and 136 were women. They ranged in age from 10 to 70 years. Most patients received 250 mg of chloroquine per day. The duration of treatment varied from 6 months to 14 years, and the cumulative dose of chloroquine ranged from 26 to 1771 g. Fourteen patients (9%) had only corneal deposition, while 22 (14.2%) developed retinopathy. There were no correlations between corneal deposits or retinopathy and age, sex, duration of treatment, or cumulative dose of chloroquine. CONCLUSIONS: The present study confirms the finding reported by Mackenzie (Am J Med 1983; 75 (Suppl 1A): 40-45) that retinopathy is not related to the duration of treatment and cumulative dose of chloroquine. Based on our finding that retinopathy can be detected as early as 9 months after starting chloroquine therapy, we recommend routine ophthalmic examination before treatment and every 6 months thereafter.     

Pseudallescheria boydii brain abscess in a renal transplant recipient: first case report in Southeast Asia

Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous filamentous fungi that rarely cause central nervous system (CNS) infection. Brain abscess caused by P. boydii is a highly lethal infection, usually seen in organ transplant recipients who receive a number of immunosuppressive agents. We have presented a case of a 48-year-old man 6 years after renal transplantation who received methylprednisolone followed by antithymocyte globulin for treatment of acute cellular rejection. Eight weeks later, he developed fever, headache, and left-sided hemiparesis. Further investigation with magnetic resonance imaging of the brain showed multiple ring-enhancing hypodense lesions with marked edema which were compatible with brain abscesses. Following surgical drainage, multiple fungal elements were initially described as Aspergillus species. The patient failed to improve and died from rapidly progressive infection despite treatment with amphotericin B. Later a diagnosis was finally made by the isolation of P. boydii in pus culture. The specific diagnosis is difficult to rapidly make, because P. boydii mimics other fungi morphologically in tissue sections and may produce infections clinically similar to other mycoses. Culture of the organism is required for definitive diagnosis. P. boydii infections are important complications of transplantation. They are difficult to treat due to resistance to amphotericin B. Physicians should consider P. boydii a possible cause of brain abscess in organ transplant recipients, especially with heavy immunosuppressive agents. This is the first case report of CNS infection due to P. boydii in a renal transplant patient in Southeast Asia.     

Prevalence and manifestations of tuberculosis in renal transplant recipients: a single-center experience in Thailand

This retrospective review presented the prevalence and manifestations of tuberculosis among renal transplant recipients in our center between 1987 and mid 2007. The prevalence of tuberculosis was 5/151 (3.3%) recipients with a median age of 49 years (range = 38-55). The median time of diagnosis after transplantation was 23 months (range = 1-47). All five patients had pulmonary tuberculosis. None developed extrapulmonary infection. Presenting symptoms were fever (60%), productive cough (80%), weight loss (40%), and hemoptysis (20%). One patient had non-parathyroid-related hypercalcemia. Cyclosporine dosage needed to be increased in all patients. Two subjects who experienced side effects of hepatitis and/or jaundice from rifampicin were switched to second-line drugs. Infection with Mycobacterial tuberculosis is a not uncommon problem in renal transplant recipients especially in endemic areas. Tuberculosis must be excluded for immunosuppressed patients with clinical or radiological suspicion.