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1.
《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2022,42(5):578-584
IntroductionThere is no consensus on the most appropriate treatment for chronic active antibody-mediated rejection (cAMR). Recent studies suggest that treatment with tocilizumab (TCZ) may stabilize graft function, decrease the intensity of donor-specific HLA antibodies (DSAs) and reduce inflammation of microcirculation.Patients and methodsObservational study with renal allograft recipients diagnosed with cAMR (n = 5) who had not submitted a response to traditional treatment based on the combination of plasma replacements, immunoglobulins, and rituximab. Patients were told to be treated with TCZ as compassionate use in six doses per month (8 mg/kg/month). Renal function, proteinuria, and the intensity of DSAs were monitored during follow-up.ResultsFive patients, average age 60 ± 13 years, three male and two retrasplants (cPRA average 55%) with preformed DSAs. Treatment with TCZ was initiated within 47 ± 52 days of biopsy. In two cases treatment was discontinued after the first dose, by severe bicitopenia with cytomegalovirus viremia and by graft failure, respectively. In the three patients who completed treatment, no stability of renal function (serum creatinine from 1.73 ± 0.70 to 2.04 ± 0.52 mg/dL, e-FGR 4 6 ± 15 to 36 ± 16 mL/min), showed increased proteinuria (3.2 ± 4.0 to 6.9 ± 11.0 g/g) and the intensity of DSAs maintain stable. No changes were observed in the degree of inflammation of microcirculation (g + pt 4.2 ± 0.8 vs. 4.3 ± 1.0) or in the degree of transplant glomerulopathy (cg 1.2 ± 0.4 vs. 1.8 ± 1.0).ConclusionsTCZ therapy does not appear to be effective in modifying the natural history of chronic active antibody-mediated rejection, does not improve the degree of inflammation of microcirculation and does not reduces the intensity of DSAs. 相似文献
2.
Bimal Bhindi Christine M. Lohse Phillip J. Schulte Ross J. Mason John C. Cheville Stephen A. Boorjian Bradley C. Leibovich R. Houston Thompson 《European urology》2019,75(5):766-772
Background
Partial nephrectomy (PN) is generally favored for cT1 tumors over radical nephrectomy (RN) when technically feasible. However, it can be unclear whether the additional risks of PN are worth the magnitude of renal function benefit.Objective
To develop preoperative tools to predict long-term estimated glomerular filtration rate (eGFR) beyond 30 d following PN and RN, separately.Design, setting, and participants
In this retrospective cohort study, patients who underwent RN or PN for a single nonmetastatic renal tumor between 1997 and 2014 at our institution were identified. Exclusion criteria were venous tumor thrombus and preoperative eGFR <15 ml/min/1.73 m2.Intervention
RN and PN.Outcome measurements and statistical analysis
Hierarchical generalized linear mixed-effect models with backward selection of candidate preoperative features were used to predict long-term eGFR following RN and PN, separately. Predictive ability was summarized using marginal , which ranges from 0 to 1, with higher values indicating increased predictive ability.Results and limitations
The analysis included 1152 patients (13 206 eGFR observations) who underwent RN and 1920 patients (18 652 eGFR observations) who underwent PN, with mean preoperative eGFRs of 66 ml/min/1.73 m2 (standard deviation [SD] = 18) and 72 ml/min/1.73 m2 (SD = 20), respectively. The model to predict eGFR after RN included age, diabetes, preoperative eGFR, preoperative proteinuria, tumor size, time from surgery, and an interaction between time from surgery and age (marginal ). The model to predict eGFR after PN included age, presence of a solitary kidney, diabetes, hypertension, preoperative eGFR, preoperative proteinuria, surgical approach, time from surgery, and interaction terms between time from surgery and age, diabetes, preoperative eGFR, and preoperative proteinuria (marginal ). Limitations include the lack of data on renal tumor complexity and the single-center design; generalizability needs to be confirmed in external cohorts.Conclusions
We developed preoperative tools to predict renal function outcomes following RN and PN. Pending validation, these tools should be helpful for patient counseling and clinical decision-making.Patient summary
We developed models to predict kidney function outcomes after partial and radical nephrectomy based on preoperative features. This should help clinicians during patient counseling and decision-making in the management of kidney tumors. 相似文献3.
4.
Bo-Lennart Johansson Ulla Berg Ulla Freyschuss Kerstin Hall Staffan Troell 《Pediatric nephrology (Berlin, Germany)》1990,4(6):589-592
The influence of metabolic control (HbA1c), noradrenaline (NA) and insulin-like growth factors (IGF-I and IGF-II) on renal function and size was investigated in 11 insulin-dependent diabetes mellitus patients aged 11–17 years. Renal function was evaluated in terms of glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). Renal size was determined as renal parenchymal volume (RPV) by ultrasonography. The patients' HbA1c values ranged from 8.2% to 12.9% (normal range 5.5–8.5%) and their GFR and ERPF were higher than normal. Their IGF-II values were higher, and NA and IGF-I levels were lower than those of healthy controls. Inverse correlations between NA and GFR (r=–0.66) and NA and ERPF (r=–0.63) were found. No correlation was found between serum IGF-I and renal functional parameters. The IGF-II values correlated with GFR and HbA1c (r=0.63,r=0.70 respectively). There were linear correlations between RPV and GFR, RPV and ERPF, HbA1c and GFR, and ERPF and RPV. Decreased NA concentrations and increased IGF-II values appear to be factors contributing to renal hyperfunction in these patients. 相似文献
5.
脂蛋白(a)对肾小球系膜细胞的作用 总被引:21,自引:0,他引:21
目的探讨脂蛋白(a)[Lp(a)]对肾小球系膜细胞(GMC)的作用。方法将体外培养的系膜细胞,加脂蛋白(a)刺激后,测定细胞生长率和细胞上清中血小板活化因子(PAF)、肿瘤坏死因子(TNF)、乳酸脱氢酶(LDH)及纤维连结蛋白(FN)水平,并以未经刺激者作对照。结果经脂蛋白(a)刺激48小时,在终浓度5~20mg/L时细胞生长率轻度增加,而在50~400mg/L时细胞生长率明显下降。刺激18小时,细胞上清中PAF的水平明显高于对照,且与脂蛋白(a)浓度呈明显正相关(r=0.937,P<0.01);L929细胞的杀伤率有所增加,但未达50%;LDH的水平在脂蛋白(a)100mg/L以下时有所增加;刺激18、48、72小时后的细胞上清纤维连结蛋白均为阴性。结论脂蛋白(a)对系膜细胞体外增殖有低浓度轻度促进、高浓度抑制的双向作用,对细胞PAF的产生具有浓度依赖的促进作用,并能增加细胞上清中LDH及TNF水平,因而可通过多种途径介导肾小球损伤。 相似文献
6.
雷帕霉素对炎性反应状态下肾小球系膜细胞内脂质稳态的影响 总被引:2,自引:1,他引:1
Objective To investigate the effect of rapamycin on cholesterol homeostasis of glomerular mesangial cells and the underlying mechanism. Methods Glomerular mesangial cell line (HMCL) cells were cultured and divided into control group, IL-1β group and different concentration rapamycin groups. Intracellular cholesterol accumulation was observed and measured by oil O staining and HPLC. Real-time quantitative PCR and Western blot were used to detect the mRNA and protein expression of LDLR, PPARγ, LXRα, ABCA1 in HMCL after the treatment with IL-1β and rapamycin. Results Rapamycin had no significant influence on intracellular cholesterol concentration under normal condition. IL-1β significantly increased the intracellular cholesterol concentration by 143% of control (P<0.05), and 10, 50, 100 ?滋g/L rapamycin could significantly inhibit the effect of IL-1β (87%, 116%, 96% of control respectively, all P<0.05). Rapamycin could suppress the increased expression of LDLR caused by IL-1β on both mRNA and protein level in a dose-dependent manner(P<0.01). Rapamycin dose-dependently up-regulated the reduced mRNA and protein expression of ABCA1, the decreased mRNA expression of PPARγ and LXRα induced by IL-1β as well (P<0.01). Conclusion Rapamycin may contribute to the maintenance of intracellular cholesterol homeostasis in glomerular mesangial cells under inflammatory state by both reducing cholesterol uptake and promoting cholesterol efflux. 相似文献
7.
血清胱抑素C对高血压和糖尿病早期肾功能损伤的诊断价值 总被引:1,自引:0,他引:1
目的探讨血清胱抑素C(Cys-C)水平对高血压、糖尿病早期肾功能损害的临床价值。方法收集22例高血压患者、28例糖尿病患者及44例肾病患者的血清标本,用酶法测定血清肌酐、尿素氮,用颗粒增强免疫比浊法测定血清Cys-C,放射免疫法测定β2-微球蛋白。结果血清Cys-C和β2-微球蛋白的异常检出率显著高于血清肌酐、尿素氮;高血压及糖尿病两组患者血清Cys-C水平均较正常对照组明显升高(P<0.01);肾病组各项检测指标均显著高于高血压组、糖尿病组和正常对照组。结论对早期肾功能损害的诊断价值,血清Cys-C测定敏感性稍次于β2-微球蛋白,但其特异性优于血清β2-微球蛋白,综合比较,血清Cys-C可作为高血压及糖尿病早期肾功能损害的辅助诊断指标之一。 相似文献
8.
H. Sonnenberg 《Pediatric nephrology (Berlin, Germany)》1990,4(4):354-357
The greater than 40-fold range of voluntary salt intake in humans requires corresponding adjustments in renal excretion to maintain balance. Although many mechanisms have been implicated in the regulation of salt output by the kidney, surprisingly little consideration has been given to their quantitative significance and possible interaction. This survey summarizes the effects of changes in glomerular filtration rate, proximal peritubular physical factors, and plasma concentrations of aldosterone and atrial natriuretic factor (ANF), singly and in combination, on the level of salt excretion. Contrary to expectation, even large increases in filtration or decreases in proximal reabsorption have only minor natriuretic effects, due to constancy of fractional reabsorption in downstream nephron segments. Lack of aldosterone release increases salt excretion as much or more than the upstream mechanisms, whereas ANF-induced inhibition of reabsorption in the medullary collccting duct has the largest effect. It may be concluded, therefore, that the potency of these natriuretic factors increases with distance along the nephron, even though each is operating on a progressively small tubular load. However, none of the mechanisms, in isolation, is sufficient to explain salt balance over the range of voluntary intake. Combination of factors demonstrates synergism rather than simple additivity, resulting in more than enough reserve capacity for salt excretion. 相似文献
9.
Atul K. Sharma Moira S. Mills Vijay L. Grey Keith N. Drummond 《Pediatric nephrology (Berlin, Germany)》1997,11(6):711-713
Accurate, timed urine collections for the measurement of glomerular filtration rate (GFR) may be impractical in infants or
in patients with urological abnormalities. GFR may be measured without urine collection using a constant subcutaneous infusion
of iothalamate. We compare the infusion clearance with conventional renal clearance in 14 children and young adults. The mean
clearance ratio (infusion clearance/renal clearance ± 1 SD) was 0.99±0.1 and the mean discrepancy between the two methods
was 8.5%±4.7%. The 95% limits of agreement for the ratio of the two methods are 0.83–1.23. These data indicate that subcutaneous
infusion of iothalamate is a practical method for measuring GFR in children without a urine collection.
Received March 18, 1996; received in revised form February 12, 1997; accepted March 26, 1997 相似文献
10.
To evaluate the effect of interleukin-8 (IL8) on glomerular basement membrane (GBM) sulfated compounds and albuminuria, we
infused IL8 in 1% bovine serum albumin (BSA) for 5 days into the left renal artery of Holtzman male rats at the rate of 10
μl/h using an osmotic pump. Control rats received 1% BSA. A significant increase in urinary albumin/creatinine ratio was seen
on the last day of IL8 infusion (0.38±0.11, mean ± SEM) when compared with albumin/creatinine ratio prior to infusion (0.19±0.04,
P = 0.04). No significant differences in urinary albumin excretion prior to and after infusion of 1% BSA were observed. On
the last day of infusion, rats were injected with 35sulfate (1.0 mCi/200 g body weight) intraperitoneally and killed after 8 h. Glomeruli were isolated and GBM obtained. After
5 days of IL8 administration, there was a significant increase in 35sulfate uptake by GBM of the infused kidney (76±10 cpm/dry glomerular weight, mean ± SEM) compared with the uptake seen in
the contralateral kidney (53±9, P = 0.05). The in vivo infusion of IL8 increased the 35sulfate uptake by GBM and augmented the urinary albumin/creatinine ratio, suggesting that IL8 may induce albuminuria by altering
the metabolism of the GBM sulfated compounds. This hypothesis needs to be confirmed by studies on glomerular charge selectivity
and GBM anionic sites during the course of the infusion. Moreover, the persistence of the effect needs to be evaluated by
prolonging the infusion for more than 5 days.
Received June 3, 1996; received in revised form and accepted October 18, 1996 相似文献