Acute Kidney Research Articles

24 Urine concentrations of nephrin, podocalyxin, NGAL, and KIM-1 could serve as biomarkers to evaluate kidney function in pregnancy and postpartum kidney injury recovery in preeclampsia

Introduction Glomerular podocyte and podocyte glycoprotein shedding have emerged as a significant kidney lesion in preeclampsia (PE). Objective To determine if podocyte glycoprotein nephrin and podocalyxin, and tubular injury biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1) could serve as biomarkers to evaluate kidney injury and postpartum kidney functional recovery in PE. Methods Urine specimen was collected from 88 pregnant women (28 normal pregnancy, 15 complicated with chronic hypertension (CHT), 11 mild PE, and 34 severe PE). Among the study subjects, urine specimens were also obtained from 11 normal and 9 severe PE pregnancies 6–8 weeks after delivery. Urine concentrations of nephrin, podocalyxin, soluble vascular cell adhesion molecule 1 (sVCAM-1), NGAL, KIM-1, and creatinine were measured by enzyme-linked immunosorbent assay (ELISA). Creatinine concentration was used to normalize urine levels of testing biomarkers for each sample. ANOVA and paired t -test were used for statistical analysis. Pearson product-moment correlation coefficient (Pearson r) was used to analyze the correlation of urine biomarkers with the urine proteinuria-to-creatinine ratio in severe PE. A p value of Results (1) Urine levels of nephrin, podocalyxin, sVCAM-1, NGAL, and KIM-1 were significantly higher in severe PE than in normal pregnant women before delivery, p p p Conclusions Nephrin and podocalyxin are podocyte glycoproteins. Increased nephrin and/or podocalyxin shedding are indicators of podocyte injury. sVCAM could be released from dysfunctioned glomerular endothelial cells or leaked from maternal plasma through the glomerular basement barrier. NGAL and KIM-1 are considered biomarkers of both acute or chronic kidney tubular injury. Thus, our results suggest that not only podocyte injury, but also tubular dysfunction occur in severe PE. Reduced shedding of these biomarkers in severe PE after delivery is an indicator of kidney function recovery in PE. Therefore, our data suggest that these urine biomarkers could serve as biomarkers to assess kidney injury during pregnancy and to evaluate postpartum kidney functional recovery in PE and pregnancy-associated kidney disorders.

Peptide inhibitor of complement C1 modulates acute intravascular hemolysis of mismatched red blood cells in rats.

Acute hemolytic transfusion reactions have a broad clinical presentation from mild and transitory signs and symptoms to shock, disseminated intravascular coagulation, renal failure, and death. We have recently developed a rat model of acute intravascular hemolysis showing that the classical complement pathway mediates antibody-dependent hemolysis. The objective of this study was to evaluate the role of the classical pathway inhibitor peptide inhibitor of complement C1 (PIC1) in this animal model. Male Wistar rats received a 15% transfusion of human red blood cells (RBCs) and blood was isolated from the animals up to 120 minutes. Animals received PIC1 either 2 minutes before or 0.5 minutes after transfusion. Sham-, vehicle-, and cobra venom factor (CVF)-treated animals were used as control groups with a subset of rats also receiving an equivalent dose of intravenous immunoglobulin (IVIG) before transfusion. Blood was analyzed for transfused RBC survival by flow cytometry and free hemoglobin (Hb) in isolated plasma by spectrophotometry. Vehicle-treated rats showed decreased human RBC survival and increased free Hb as expected. Rats receiving PIC1 before transfusion showed increased human RBC survival and decreased Hb similar to CVF-treated rats. Notably, rats receiving PIC1 after initiation of transfusion showed similar decreases in hemolysis as animals receiving PIC1 before transfusion. Compared to IVIG and saline controls, PIC1-treated animals demonstrated decreased hemolysis and protection from acute kidney injury. These results demonstrate that PIC1 has efficacy in an animal model of acute intravascular hemolysis in both prevention and rescue scenarios.

Opportunities for Care and Care Process Improvement in Patients With Acute Heart Failure and Kidney Disease

Opportunities for Care and Care Process Improvement in Patients With Acute Heart Failure and Kidney Disease

Safety, Efficacy, and Tolerability of Sofosbuvir and Ribavirin in Management of Recurrent Hepatitis C Virus Genotype 4 After Living Donor Liver Transplant in Egypt: What Have We Learned so far?

BackgroundRecurrence of HCV after living donor liver transplant (LDLT) is nearly universal, with almost one third of recipients developing cirrhosis and graft failure within 5 years after LDLT. Different studies have been published on the effect of sofosbuvir after liver transplantation on recurrent HCV with different genotypes.ObjectivesThe aim of this study was to evaluate the efficacy, safety, and tolerability of sofosbuvir and ribavirin in LDLT recipients with recurrent HCV genotype 4.Patients and MethodsThirty-nine Egyptian LDLT recipients were treated for recurrent HCV after LDLT with nucleos(t)ide analog NS5B polymerase inhibitor, sofosbuvir, and ribavirin without pegylated interferon for 6 months (November 2014 to June 2015) in this intention-to-treat analysis.ResultsOne recipient died 1 week after starting the treatment, but the remaining 38 patients completed 24 weeks of treatment and were then followed for 12 weeks after end of treatment (EOT). The sustained virological response (SVR) at week 12 after EOT was achieved in 76% (29/38) of recipients. SVR was significantly higher in treatment-naïve patients and in recipients with a low stage of fibrosis. Only 2 (5%) recipients developed severe pancytopenia and acute kidney injury.ConclusionsWe recommend initiating treatment as soon as possible after liver transplantation with newer combinations, such as ledipasvir/sofosbuvir or sofosbuvir/simeprevir, rather than sofosbuvir with Ribavirin, to achieve higher rates of SVR.

A Subpopulation of Label-Retaining Cells of the Kidney Papilla Regenerates Injured Kidney Medullary Tubules.

SummaryTo determine whether adult kidney papillary label-retaining cells (pLRCs) are specialized precursors, we analyzed their transcription profile. Among genes overexpressed in pLRCs, we selected candidate genes to perform qPCR and immunodetection of their encoded proteins. We found that Zfyve27, which encodes protrudin, identified a subpopulation of pLRCs. With Zfyve27-CreERT2 transgenic and reporter mice we generated bitransgenic animals and performed cell-lineage analysis. Post tamoxifen, Zfyve27-CreERT2 marked cells preferentially located in the upper part of the papilla. These cells were low cycling and did not generate progeny even after long-term observation, thus they did not appear to contribute to kidney homeostasis. However, after kidney injury, but only if severe, they activated a program of proliferation, migration, and morphogenesis generating multiple and long tubular segments. Remarkably these regenerated tubules were located preferentially in the kidney medulla, indicating that repair of injury in the kidney is regionally specified. These results suggest that different parts of the kidney have different progenitor cell pools.

Pattern of biopsy-proven kidney disease in the elderly in a tertiary care hospital in India: a clinicopathological study.

An aging population is an important demographic issue in India. The knowledge base about kidney diseases among the elderly Indians is inadequate. We aim to delineate the clinical profile and spectrum of biopsy-proven kidney disease in elderly patients. Records of all elderly patients (≥60 years) who had undergone kidney biopsy in the nephrology department from January 2010 to December 2014 were reviewed. Their clinical details and laboratory investigations at the time of biopsy were noted. Details of kidney biopsy were recorded from their biopsy reports. In total, 1728 patients underwent kidney biopsy during this period and 124 were elderly (7.2%). Their mean age was 64.9 ± 4.9 years, and they were predominantly males (63.7%). Mean serum creatinine was 3.0 ± 2.8 mg/dl, proteinuria was 4.0 ± 2.7 g/day, and 39.5% had microscopic hematuria. The most common indications for biopsy were nephrotic syndrome (NS)--39.5% and acute kidney injury/rapidly progressive glomerulonephritis (AKI/RPGN)--24.2%. Another 8.1% patients had NS with AKI. MN (39.0%) was the chief cause of NS, and pauci-immune crescentic glomerulonephritis (GN) (28.2%) was the leading cause of AKI/RPGN. MN, pauci-immune crescentic GN and acute on chronic tubulointerstitial nephritis (A/CTIN) and acute tubular injury (ATI) were more common in the elderly, while MCD, FSGS, IgA nephropathy and lupus nephritis were more frequent in the younger patients. 68.5% of the elderly patients biopsied were diagnosed with a renal disease which was potentially amenable to specific treatment. The spectrum of biopsy-proven kidney disease in the elderly Indians seen in our tertiary care hospital varies from the younger population. Kidney biopsy provides useful information with therapeutic and prognostic implications in these patients. The percentage of elderly patients among the total biopsied population is low in India, and these patients present late with renal dysfunction. Prospective studies are needed to assess the outcome of the commonly seen kidney diseases in elderly patients.

Statin use increases risk of acute and chronic kidney disease

Statin use increases risk of acute and chronic kidney disease

Screening for kidney disease in an oil producing community in Nigeria: A pilot study.

Petroleum products have been associated with acute and chronic kidney disease. Nigeria is a major oil producing and exporting country. The aim of this study was to screen for kidney disease in an oil producing community in Nigeria. This was a cross-sectional study carried out in Ido, Asari-Toru Local Government Area of Rivers State. All subjects were resident in the town and those aged 18 years and above were eligible. Spot urine samples were collected for dipstick urinalysis, and venous blood was collected for estimation of serum electrolyte, urea, creatinine, and lipid profile. The estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft and Gault formula. A total of 99 participants were screened: 75% were females, over 50% aged above 50 years, and the majority had low socioeconomic status. The mean eGFR of the participants was 80.2 ± 33.3 mL/min/1.73 m 2 , 32.6% of the participants had eGFR <60 mL/min, and 2% had eGFR <30 mL/min. Furthermore, 36.5% of the participants had proteinuria and 29.8% had 1 + proteinuria. There was a significant negative correlation of eGFR with a family history of diabetes mellitus (-0.35, P = 0.016), elevated systolic hypertension (-0.29, P = 0.035), and elevated total cholesterol (-0.23, P = 0.045), but there was a positive correlation with body mass index (0.24, P = 0.018). We conclude that the prevalence of kidney disease was high in the screened population in a Nigerian oil producing community.

Abstract 16820: Albuminuria and Outcomes in Patients With Non-ST-segment Elevation Acute Coronary Syndromes: Results From the TRACER Trial

Introduction: Patients with acute coronary syndromes (ACS) and kidney dysfunction are at increased risk of recurrent cardiovascular (CV) adverse events. Urinary albumin excretion (albuminuria) has been independently associated with CV outcomes. However, in a high-risk population of patients with ACS, the additional prognostic information of albuminuria to estimated glomerular filtration rate (eGFR) is less clear. Hypothesis: We studied the relationship between albuminuria and CV death and myocardial infarction (MI) in 12,944 patients with non-ST-segment elevation (NSTE)-ACS. Methods: Albuminuria was collected routinely at baseline by dipsticks and stratified into no/trace albuminuria, microalbuminuria (≥30mg/dL), and macroalbuminuria (≥300mg/dL). Baseline serum creatinine was obtained. Kaplan-Meier event rates for CV death, and the combination of CV death or MI were calculated. Multivariable adjusted Cox regression models, with baseline characteristics and biomarkers, and the addition of eGFR (Chronic Kidney Disease - Epidemiology (CKD-EPI) equation), were assessed. Results: Levels of albuminuria were available in 9736 patients (75.2%), and both serum creatinine and albuminuria measurements in 9473 (73.2%) patients. More patients with macroalbuminuria, compared with patients with no albuminuria, had diabetes (66% vs. 27%) or hypertension (86% vs. 68%) There was a significant increased risk in CV events with macroalbuminuria, which was significant in the adjusted model but did not remain significant when eGFR was added to the model (Table). Conclusions: High-risk patients with NSTE-ACS and albuminuria at presentation have an increased risk of adverse CV outcomes. However, in the present cohort, albuminuria did not provide additional independent prognostic value to eGFR.

Abstract 15998: Inflammatory Cytokines and Kidney Dysfunction are Associated in Individuals With Hypertensive Emergency

Introduction: Chronic hypertension and kidney dysfunction are associated. However, scarce studies have evaluated the participation of the inflammatory process in the pathogenesis of acute elevation of blood pressure (BP) (characterized by hypertensive crisis - HC) and kidney dysfunction. Thus, this study had objectives: 1- to identify clinical profile and renal function of the individuals with HC, subdivided in urgency (HU) and hypertensive emergency (HE) and 2- to evaluate relationship between kidney function and inflammatory cytokines: interleukins (IL-1β, IL-6, IL-8, IL-18), tumoral necrosis factor (TNF-α) and anti-inflammatory cytokine 10 (IL-10) in subjects with HC (HU and HE). Methods: We studied 274 individuals: 74 normotensive (NT), 74 controlled hypertensive (CH), 50 with HU and 78 individuals with HE. The glomerular filtration rate (GFR) was calculated by the Modification of Diet in Renal Disease equation (MDRD). The serum levels of cytokines were made by MULTIPLEX and ELISA technique. The Kruskall Wallis and Mann Whitney tests, and Spearman correlation were used for comparison between groups, with a significance level for p-value &lt;0.05. Results: The diastolic BP and heart rate were significantly higher in the HC group (120mmHg and 85bpm, respectively) compared to the CH group (75mmHg and 68 bpm, respectively). Individuals with HE were older. Potassium was significantly lower in HE group (4,2mEq/l) compared to NT, CH and HU groups (4.5, 4.4 and 4.4mEq/L, respectively; p&lt;0.05). The GFR was significantly lower in HE group (65ml/min/m2) in comparison to HU (73), CH (82) and NT (88mL/min/m2) (p&lt;0,001). All measured cytokines were significantly higher in patients with HE compared to NT and CH groups. It was observed negative correlation among GFR, diastolic BP, and creatinine for all the groups (p&lt;0,0001). There was also negative correlation between GFR and cytokines in HE individuals (p&lt;0,05). Conclusions: Individuals with HE present GFR reduction in comparison to others studied groups. It is also observed higher cytokines levels in HE group and negative correlation between GFR and inflammatory cytokines. This suggests the involvement of inflammatory cytokines in the pathogenesis of acute hypertensive event and kidney dysfunction.

Monitoring acute and chronic kidney failure using statistical process control techniques

ABSTRACTCreatinine tests are used to determine a patient's estimated glomerular filtration rate (eGFR) for the assessment of kidney function. This article describes how eGFR results for patients who need to have their cases referred for the attention of a specialist can be filtered out from among the numerous patients whose test results indicate that they are either displaying no reduction in kidney function or whose kidney function is reduced but remains stable. Automation of the process is a key ingredient of our solution because this is the means by which the human effort is directed to those patients in greatest need.

Abstract P210: Association of Perceived Stress and Aldosterone and Adiponectin Levels in a Rural Cohort of African Americans

African Americans (AA) have the highest prevalent rates of ESRD than any other group in this country. AA males have the highest risk with more than a two-fold greater risk of kidney injury compared to their female counterparts. The underlying pathophysiology that predisposes AA males to renal injury remains to be definitively determined. However, recent findings from our laboratory have shown that stress may exacerbate the renal injury associated with hypertension. Using an animal model of nitric oxide deficiency hypertension we showed that renal injury associated with this model of hypertension was increased following four weeks of intermittent stress (Pointer et al. 2012). The current study sought to determine whether we could find a similar association of stress and renal injury in a population prone to renal injury. To achieve this we recruited African Americans (11 males; 36 females) attending a health fair. We administered a perceived stress scale; measured resting blood pressure; and collected a blood sample for cortisol, adiponectin, and aldosterone measurement. Aldosterone (ALDO) is a hormone released from the adrenal gland in response to stress. ALDO levels have been linked to increased cardiovascular injury such as acute myocardial infarction and kidney disease. Adiponectin is an adipokine and appears to have protective actions in metabolic disease. In this sampling we found that non-normotensive (blood pressure above 120/80 mmHg) AA females had similar PSS scores as the males (24 ± 2 vs. 21 ± 2) and similar plasma cortisol levels (9.4 ± 0.5 vs. 9.8 ± 1μg/dL, respectively). However, in males cortisol was positively associated with ALDO (p=0.032) and negatively associated with adiponectin (p&lt;0.03). There was no significant association of cortisol with ALDO and adiponectin in females. These findings suggest that AA males may be predisposed to renal injury as a consequence of stress leading to 1) increased injury promoting (ALDO) and 2) decreased disease protective (adiponectin) agents. Further studies are needed to confirm these findings in a larger sampling.

Potential hyperacute renal rejection due to non-hla antibody in a pediatric patient

Non-HLA antigen targets have been associated with hyperacute, acute, and chronic kidney allograft rejection. Although there is controversy regarding the predictive role of non-HLA antibodies (Abs) in transplant (Txp) outcome - there are cases that indicate causality between the presence of such Abs and graft loss. A 17 month old boy with end-stage kidney disease, secondary to kidney dysplasia, received a living donor Txp from his uncle in April 2014. The presence of HLA abs was tested in 5 sera samples prior to Txp with a PRA of 7% and 0% for class I and II respectively (flow PRA). Single antigen testing confirmed the absence of donor specific HLA Abs (DSA). Initial and final flow cross matches were negative, as expected. During the Txp surgery, it was noted that the kidney became firm, urine output was below expectation and the child became increasingly pressor-dependent. Subsequently, the patient had an episode of ventricular tachycardia and an exploratory laparotomy demonstrated that the Txp kidney became tense and enlarged, with thrombosis of the renal vein. The kidney was nephrectomized within 48 hours and the patient’s status improved significantly. To investigate a potential role for HLA DSA, we tested a 2 days post-Txp serum sample, confirming the absence of HLA-DSA. We also repeated Abs testing on the pre-Txp serum sample ruling out HLA-DSA as the cause of rejection. To assess potential causes for this apparently hyperacute Ab mediated rejection, pre-Txp (pre-14 days) and post-Txp (post-24 days) samples were sent out for AT1R Abs screening and donor specific endothelial cell crossmatch (XM-One). Retrospective testing of a pre- and post-Txp sera for AT1R antibody was out of range for pre-Txp sample and the post-Txp sample was positive ( > 30 Units/ml). The XM-One assay using endothelial precursors isolated from the donor as targets was strongly positive using a pre-Txp serum but negative using post-Txp serum. Approximately two month’s post-Txp, the patient developed HLA Abs, on top of the AT1R antibodies. In conclusion, this patient still requires a kidney Txp and the question is how to proceed – shall we consider only obtaining an organ from a living donor? This would allow for the necessary time to run XM-One and potentially inhibit AT1R pathway with an AT 1 receptor antagonist. What to do if no living donor becomes available?

Blood transfusion and 30-day readmission rate in adult patients hospitalized with sickle cell disease crisis.

Sickle cell disease (SCD) patients hospitalized with vasoocclusive pain crisis tend to have prolonged length of stay (LOS) and high 30-day readmission rates. We investigated the associations of demographic characteristics, comorbidities, and blood transfusion during hospitalization with these outcomes. Repeated regression analysis was used to analyze 39,324 admissions of 4348 adults with sickle cell crisis from 2007 to 2012 in the Truven Health MarketScan Medicaid Databases. The mean (95% range) LOS was 5.9 (1.0-19.0) days and the 30-day readmission rate was 39.6% (95% confidence interval [CI], 39.1%-40.0%). Older age; chronic cardiopulmonary, renal, or liver disease; and sepsis were associated with both longer LOS and greater 30-day readmission rate. Female sex, iron overload, acute chest syndrome, acute renal failure, and stroke were additional predictors of longer LOS. Simple red blood cell transfusion was administered in 31.8% of the admissions, and these patients tended to have more severe disease (chronic cardiopulmonary or kidney disease, acute chest syndrome, acute kidney or liver failure, sepsis). Nevertheless, transfusion was associated with a reduced estimated odds ratio (OR) of inpatient mortality of 0.75 (95% CI, 0.57-0.99) and a decreased OR of 30-day readmission of 0.78 (95% CI, 0.73-0.83). Our findings point to blood transfusion as a potential means to reduce the 30-day readmission rate among Medicaid patients hospitalized with sickle cell crisis. There is a need for a prospective study to examine the potential benefit and safety of simple blood transfusion for this purpose.

PWE-141 Alfa pump for the treatment of refractory ascites: a “real world” experience from the uk

<h3>Introduction</h3> Up to 10% of cirrhotic patients with ascites become refractory to diuretic therapy requiring either large volume paracenteses (LVP), transcutaneous intrahepatic portosystemic shunt (TIPSS) or liver transplantation (LT). In patients where TIPSS or LT is contraindicated, repeated LVP is the only option. LVP is an uncomfortable procedure requiring hospital visits and has risk of complications. The ALFA pump is a surgically implanted automated low flow pump system that transports fluid from the peritoneal cavity to the bladder and is an alternative treatment option for patients with refractory ascites. Our aim was to evaluate the early “real world” experience of the ALFA pump for the treatment of refractory ascites from centres in the UK. <h3>Method</h3> Retrospective case note review of the outcomes of patients who had an ALFA pump implanted for refractory ascites outside trials at 4 NHS hospitals since Sept 2013. <h3>Results</h3> ALFA pumps were implanted in 9 patients (6 male, 3 female; median age 74, range 41–81) at four centres (4 NCL, 2 UCL, 2 CAM, 1 QEHB). 7 patients had ascites related to cirrhosis (4 Child-Pugh B, 3 Child-Pugh C), 1 due to congestive cardiac failure and 1 with portal hypertension due to arterio-venous malformation. Prior to insertion of the ALFA pump the median frequency of paracenteses was every 10 days (range 7 – 20) and the median volume of ascites drained was 9 litres (range 8 to 12). ALFA pumps were successfully implanted in all patients. Requirement for paracenteses was substantially reduced post ALFA pump implantation with 7 patients no longer requiring any paracenteses. In one patient the pump blocked after 3 weeks and required reimplantation with a second pump that also blocked and the patient has returned to LVP. In another patient the pump blocked after 8 months and a second ALFA pump was successfully implanted. All 9 patients had ALFA pump related complications including 4 post-operative seromas, 3 bladder catheter migrations/occlusions, 5 site related infections, 6 acute kidney injury/electrolyte disturbance and 1 urinary incontinence. 5 of the 9 patients were alive with a functioning pump 6 months after implantation. <h3>Conclusion</h3> The ALFA pump offers an alternative option for patients who have refractory ascites in whom TIPSS and LT are contraindicated. ALFA pump implantation substantially reduces the need for paracenteses in a cohort of patients who had previously required a significant number of LVP. ALFA pump related complications were frequent suggesting the need for careful patient selection in this high risk group. Outcomes of a randomised controlled trial are eagerly awaited. <h3>Disclosure of interest</h3> None Declared.

Kidney Injury Molecule-1 and its association with delayed clearance and drug exposure in pediatric oncology patients treated with high dose methotrexate.

10034 Background: High-dose methotrexate (HD-MTX) is a critical component of therapy for pediatric malignancies. The ability to identify patients at risk for delayed MTX clearance and acute kidney ...

Clinical associations of host genetic variations in the genes of cytokines in critically ill patients.

Host genetic variations may influence a changing profile of biochemical markers and outcome in patients with trauma/injury. The objective of this study was to assess clinical associations of single nucleotide polymorphisms (SNPs) in the genes of cytokines in critically ill patients. A total of 430 patients were genotyped for SNPs in the genes of pro- (IL1B, IL6, IL8) and anti-inflammatory (IL4, IL10, IL13) cytokines. The main end-points were sepsis, mortality and adult respiratory distress syndrome (ARDS). We evaluated the dynamic levels of bilirubin, blood urea nitrogen, creatine kinase, creatinine and lactate dehydrogenase in five points of measurements (between 1 and 14 days after admission) and correlated them with SNPs. High-producing alleles of proinflammatory cytokines protected patients against sepsis (IL1B -511A and IL8 -251A) and mortality (IL1B -511A). High-producing alleles of anti-inflammatory cytokines IL4 -589T and IL13 431A (144Gln) were less frequent in ARDS patients. The carriers of IL6 -174C/C genotypes were prone to the increased levels of biochemical markers and acute kidney and liver insufficiency. Genotype-dependent differences in the levels of biochemical indicators gradually increased to a maximal value on the 14th day after admission. These findings suggest that genetic variability in pro- and anti-inflammatory cytokines may contribute to different clinical phenotypes in patients at high risk of critical illness.

Acute Page Kidney Phenomenon Secondary to Lymphocele Compression in Renal Allograft Recipient: A Case Report

Acute renal failure after kidney transplantation frequently occurs and often represents a real challenge for the clinician. Acute rejection is the first diagnostic suspect but many other conditions, mimicking rejection, should be considered. A prompt diagnosis is recommended to avoid treatment delay or mistreatments. Page kidney phenomenon is a well-known condition in which an extrinsically compressed kidney results in hypertension and loss of renal function. It should be always considered among the acute complications of renal transplantation. Prompt recognition and early intervention are essential to restore renal function before irreversible damage occurs. We describe a Page kidney phenomenon as an acute complication due to a lymphocele compression.Proximal TEC-CD44 influenced the renal inflammatory milieu and TEC-CD44v3 associated with expression of anti-inflammatory molecules.

What every doctor should know about drug safety in patients with chronic kidney disease.

Drug safety is a very relevant issue when dealing with patients with chronic kidney disease (CKD) who need vascular access procedures and interventions. Drug dosage adjustments are needed for patients with acute or chronic kidney disease. In CKD patients, the estimated glomerular filtration rate is used to guide dose adjustments. Determining the influence of renal replacement therapies on drug dosage adjustment is also very important. Safety issues for the following drugs used for situations related to vascular access are reported: anticoagulants and antiplatelet agents, antibiotics, antimicrobials for catheter lock therapy, thrombolytics, local anesthetics, and painkillers. General principles of the interactions of drugs in CKD are also reported.

Трансплантация мультипотентных мезенхимальных cтромальных клеток крысам с острым рабдомиолизным канальцевым некрозом

The aim of a given work was investigation of stem cell therapy for acute rhabdomyolysis-caused kidney injury in an experiment induced by intramuscular injection of 50% glycerol (0,8 ml per 100 g of body weight). Results of experiment showed that in experimental animals with therapeutic transplantation of mesenchymal stem cells (MSC) from the human placenta the glomerular filtration and tubular reabsorption was less decrease, than at control group. Protein excretion in experimental group was higher than normal values only on the 3rd day of experiment, in other time its was closed to normal values, unlike control group at which all time of experiment the excretion of protein was almost twice higher than normal values. Thus, transplantation of MSCs to the animal with toxic kidney injury effectively restores renal function in comparison.