Chronic Renal Transplant Research Articles

Continuation of lithium after a diagnosis of chronic kidney disease.

To investigate whether continued lithium or anticonvulsant treatment after a first diagnosis of chronic kidney disease (CKD) was associated with progression to irreversible end-stage kidney disease. Nationwide cohort study including all individuals in Denmark in a period from 1995 to 2012 with a diagnosis of CKD and (i) a history of lithium treatment (N=754, among whom 238 patients had a diagnosis of bipolar disorder) or (ii) a history of anticonvulsant treatment (N=5.004, among whom 199 patients had a diagnosis of bipolar disorder). End-stage CKD was defined as chronic dialysis or renal transplantation. Continuing lithium (HR=0.58 (95% CI: 0.37-0.90) and continuing anticonvulsants (HR=0.53 (95% CI: 0.44-0.64) were associated with decreased rates of end-stage CKD. In the subcohorts of patients with a diagnosis of bipolar disorder, continuing lithium was associated with decreased end-stage CKD (HR=0.40 (95% CI: 0.17-0.98), whereas continuing anticonvulsants was not (HR=0.70 (95% CI: 0.21-2.37). There were no interactions of continuing lithium and anticonvulsants. After an initial diagnosis of CKD, patients who are selected by their physicians to continue lithium treatment may not necessarily have an increased risk of developing end-stage CKD. Shifting to an anticonvulsant per se may not be associated with an advantage; however, this requires further investigation.

Bartonellosis in Chronic Kidney Disease: An Unrecognized and Unsuspected Diagnosis.

Systemic cat scratch disease or bartonellosis is a clinical entity caused by Bartonella henselae, which manifests with necrotizing granulomas in visceral organs. The cat flea, Ctenocephalides felis, is the vector responsible for horizontal transmission of the disease from cat to cat, and its bite can also infect humans. In immunocompromised patients including chronic kidney disease and renal transplant recipients, it can cause persistent and disseminated cat scratch disease. The aim of this paper is to perform a systematic review of the studies that have addressed the diagnostic methods of cat scratch disease in chronic kidney disease and renal transplant recipients. This review was searched via electronic PubMed and Google scholar databases. Few qualitative full-text original articles in chronic kidney disease and kidney transplant were extracted. At this paper, 19 articles identified including six articles in chronic kidney disease and 13 articles in renal transplant recipients. Of these six identified case reports in chronic kidney disease, serology via immunofluorescence antibody test was led to diagnosis of cat scratch disease in five patients and a one patient showed nonreactive serologic test. Polymerase chain reaction usage to detect deoxyribonucleic acid in tissue biopsy and bone marrow biopsy was led to diagnosis. Cat scratch disease diagnosis in 13 renal transplant recipients was attained more by combining serology and polymerase chain reaction to detect deoxyribonucleic acid in tissue specimens. These selected studies demonstrate that serology and polymerase chain reaction via deoxyribonucleic acid extraction of tissue specimens yield the best outcome in diagnostic field of bartonellosis.

Low utility of serum 25–hydroxyvitamin D3 and 1, 25-dihydroxyvitamin D3 in predicting peripheral Treg and Th17 cell counts in ESRD and renal transplant patients

BackgroundVitamin D has shown an immune-modulatory effect in different studies. Vitamin D stimulates Tregs and inhibits Th17 cells. The immune-modulatory role of vitamin D in chronic kidney disease (CKD) and renal transplant patients is unclear. We measured whether different serum levels of vitamin D were associated with an increased or decreased presence of lymphocyte subsets including Treg and Th17 cells in end-stage renal disease (ESRD) and renal transplant recipients. MethodsEighty-seven renal transplant recipients and 53 end-stage renal disease (ESRD) patients were enrolled in this study. The absolute counts of CD4+ and CD8+ T, CD16+ CD56+ NK, CD19+ B, CD4+ CD25+ CD127- Foxp3+ (Tregs), Helios+ Tregs, CD38+ Tregs, and CD4+ CD17+ (Th17) cells were analyzed in peripheral blood in both patient groups. In addition, serum 25 (OH) D3, 1, 25 (OH)2 D3, IL-6, IL-17, IL-23, and TGF-β1 were measured. The association between lymphocyte subset counts and 1, 25 (OH)2 D3 or 25 (OH) D3 was studied, as was the association between serum IL-6, IL-17, IL-23, or TGF-β1 and 1,25 (OH)2 D3 or 25 (OH) D3. ResultsSerum 25 (OH) D3 and 1,25 (OH)2 D3 levels were not independently associated with peripheral CD4+ T, CD19+ B, CD16+ CD56+ NK, Treg, or Th17 cell counts. In contrast to serum 25 (OH) D3, serum1, 25 (OH)2 D3 was positively associated with CD8+ T cells counts in renal transplant recipients. ConclusionOur findings indicate low utility of serum 25 (OH) D3 and 1, 25 (OH)2 D3 levels in predicting a change in lymphocyte subset counts in ESRD and renal transplant patients.

English

INTRODUCTION: The kidney and the skin are the two large networks of the body with their abundant blood supply, far in excess of their nutritional demands, the former for the constancy of the milieu interior and the latter maintaining mainly homeostasis. No wonder therefore, that they share many diseases and reflect mutually one another’s pathology which should be made use of by the clinician. Scientific and technologic improvements during the second-half of the 20th century have provided renal replacement therapy as a life sustaining option for many individuals who otherwise might have died. In each and every year of the last decade, the number of individuals with ESRD (end stage renal disease) has grown approximately from 20 to 30,000 per year. Cutaneous examination of patients with ESRD has shown that 50 – 100% of patients have at least one dermatologic condition. In addition to ESRD, uraemia and conditions associated with renal replacement therapy are fraught with numerous and often, relatively unique cutaneous manifestations. AIMS OF THE STUDY: 1. To study the various cutaneous manifestations and their incidence in patients with chronic renal failure. 2. To study the agewise and sexwise incidence of the individual cutaneous manifestation. 3. To study the incidence of cutaneous manifestations in renal transplant recipients. 4. To study the incidence of cutaneous manifestations of associated systemic disorder that may contribute to chronic renal failure. MATERIALS AND METHODS: This study was done for 2 years from October 2009 to October 2011 at Nephrology OPD, ward and medicine ward, Tirunelveli Medical College Hospital, Tirunelveli. Approval was obtained from the institutional ethical committee prior to the conduct of this study. During this period, 100 patients who had the presence of skin manifestations were selected and studied. 80 patients were known cases of chronic renal failure, diagnosed at Nephrology department or medical department and 20 patients were renal transplant recipients who were referral cases. Patient selection: Inclusion criteria: 1. Age : All ages, 2. Sex : Both males and females, 3. Patients with chronic renal failure, 4. Renal transplant patients. Exclusion criteria : 1. Patients with HIV infection, 2. Patients with previous malignancies, 3. Drug related cutaneous manifestations, 4. Patients on dialysis. SUMMARY: This clinical study of cutaneous manifestations of chronic renal failure and renal transplant recipients done during the period from October 2009 to October 2011, revealed the following: 1. Most of the specific cutaneous manifestations of chronic renal failure and renal transplantation were noted in this study. Pruritus (58.8%) and xerosis (57.5%) were the most common among the specific cutaneous manifestations of chronic renal failure, which is similar to another study[104]. Pigmentary changes (55%) and nail abnormalities (56.2%) were the next. Mucosal and hair abnormalities were noted in good percentage of cases. Nearly 4 % had perforating dermatosis. Interesting findings noted in this study were digital gangrene, poor wound healing and restless leg syndrome. The onset of cutaneous manifestations after CRF ranges between 6 months to 3 years in this study. 2. Skin changes due to renal transplantation were mostly due to infections (excluding medication related disorders), with fungal infections (40%) being the most commonly noted. The next to follow was viral infections (35%) with verruca vulgaris being the commonest manifestation. The high incidence of cutaneous infections in these patients could be due to impaired immunity resulting in increased susceptibility to infections. Premalignant and malignant lesions were not noted in this study. After renal transplantation, there is improvement in pruritus in 9 (45%) patients and xerosis in 6 (30%) patients. 3. Skin changes specific to associated systemic diseases helped in finding various etiologies of chronic renal failure such as diabetes mellitus, systemic lupus erythematosus, scleroderma, vasculitis and ITP. 4. Other associated skin conditions were not related to etiology and were found to be just coincidental. CONCLUSION: Pruritus and xerosis were the most common among the specific cutaneous manifestations of chronic renal failure, followed by nail abnormalities and pigmentary changes. Calciphylaxis and uremic frost were not noted in any patient. The incidence of hair and nail abnormalities were more among females than males in this study. Cutaneous manifestations of renal transplantation were mostly due to infections, of which fungal infections were commonly observed followed by viral infections.

Hepatitis C viral load, genotype, and increased risk of developing end-stage renal disease: REVEAL-HCV study.

This study reveals that chronic HCV infection is associated with an increased risk of developing ESRD and suggests that elevated serum levels of HCV RNA (>167,000 IU/mL) and HCV genotype 1 are strong predictors of ESRD, indicating clinical implications for the management of chronic HCV. (Hepatology 2017;66:784-793).

Radiofrequency ablation using Barrx® for the endoscopic treatment of gastric antral vascular ectasia: a series of three cases and a review of the literature on treatment options.

Gastric antral vascular ectasia (GAVE), also known as “watermelon stomach”, is an uncommon condition, which can cause gastrointestinal bleeding due to rupture of blood vessels that line the stomach. The pathogenesis of GAVE remains unclear; however it is thought that hemodynamic changes, mechanical stress, and autoimmune factors all have a part to play. A range of conditions are also commonly associated with the syndrome, such as portal hypertensive gastropathy, liver cirrhosis, and autoimmune disorders. Less commonly, chronic renal failure, cardiac diseases, and bone marrow transplantation have coexisted with GAVE. The diagnosis is usually based on visualization of the tissue upon endoscopy; however, histology plays a role in uncertain cases. The typical “watermelon” appearance relates to the tissue having a striped appearance radiating out from the pylorus. Medical treatment has failed to show satisfactory results and surgery is usually considered as a last resort, due to its increased risk for complications and mortality. Lasers and argon plasma coagulation have been used recently, and been shown to be as effective as surgery and a safer option. We present three cases of gastric antral vascular ectasia treated at our institution with radiofrequency ablation and review the literature on treatment modalities for GAVE.

Increased migration of antigen presenting cells to newly-formed lymphatic vessels in transplanted kidneys by glycol-split heparin.

BackgroundChronic renal transplant dysfunction is characterized by loss of renal function and tissue remodeling, including chronic inflammation and lymph vessel formation. Proteoglycans are known for their chemokine presenting capacity. We hypothesize that interruption of the lymphatic chemokine–proteoglycan interaction interferes with the lymphatic outflow of leukocytes from the renal graft and might decrease the anti-graft allo-immune response.MethodsIn a rat renal chronic transplant dysfunction model (female Dark-Agouti to male Wistar Furth), chemokines were profiled by qRT-PCR in microdissected tubulo-interstitial tissue. Disruption of lymphatic chemokine–proteoglycan interaction was studied by (non-anticoagulant) heparin-derived polysaccharides in vitro and in renal allografts. The renal allograft function was assessed by rise in plasma creatinine and urea.ResultsWithin newly-formed lymph vessels of transplanted kidneys, numerous CD45+ leukocytes were found, mainly MHCII+, ED-1-, IDO-, HIS14-, CD103- antigen presenting cells, most likely representing a subset of dendritic cells. Treatment of transplanted rats with regular heparin and two different (non-)anticoagulant heparin derivatives revealed worsening of kidney function only in the glycol-split heparin treated group despite a two-fold reduction of tubulo-interstitial leukocytes (p<0.02). Quantitative digital image analysis however revealed increased numbers of intra-lymphatic antigen-presenting cells only in the glycol-split heparin group (p<0.01). The number of intra-lymphatic leukocytes significantly correlates with plasma creatinine and urea, and inversely with creatinine clearance.ConclusionsTreatment of transplanted rats with glycol-split heparin significantly increases the number of intra-lymphatic antigen presenting cells, by increased renal diffusion of lymphatic chemokines, thereby increasing the activation and recruitment of antigen presenting cells towards the lymph vessel. This effect is unwanted in the transplantation setting, but might be advantageous in e.g., dendritic cell vaccination.

Development of next generation sequencing panel for UMOD and association with kidney disease.

Chronic kidney disease (CKD) has a prevalence of approximately 10% in adult populations. CKD can progress to end-stage renal disease (ESRD) and this is usually fatal unless some form of renal replacement therapy (chronic dialysis or renal transplantation) is provided. There is an inherited predisposition to CKD with several genetic risk markers now identified. The UMOD gene has been associated with CKD of varying aetiologies. An AmpliSeq next generation sequencing panel was developed to facilitate comprehensive sequencing of the UMOD gene, covering exonic and regulatory regions. SNPs and CpG sites in the genomic region encompassing UMOD were evaluated for association with CKD in two studies; the UK Wellcome Trust Case-Control 3 Renal Transplant Dysfunction Study (n = 1088) and UK-ROI GENIE GWAS (n = 1726). A technological comparison of two Ion Torrent machines revealed 100% allele call concordance between S5 XL™ and PGM™ machines. One SNP (rs183962941), located in a non-coding region of UMOD, was nominally associated with ESRD (p = 0.008). No association was identified between UMOD variants and estimated glomerular filtration rate. Analysis of methylation data for over 480,000 CpG sites revealed differential methylation patterns within UMOD, the most significant of these was cg03140788 p = 3.7 x 10−10.

Human Cytomegalovirus-Encoded Receptor US28 Is Expressed in Renal Allografts and Facilitates Viral Spreading In Vitro.

Renal transplantation is the preferred treatment for patients with end-stage renal disease. Human cytomegalovirus (HCMV) activation is associated with decreased renal graft function and survival. Human cytomegalovirus encodes several immune modulatory proteins, including the G protein-coupled receptor US28, which scavenges human chemokines and modulates intracellular signaling. Our aim was to identify the expression and localization of US28 in renal allograft biopsies by immunohistochemistry and determine its role in viral spreading in vitro. Immunohistochemistry revealed US28 in 31 of 34 renal transplant biopsies from HCMV-seropositive donors. Expression was independent of HCMV viremia or IgG serostatus. US28 was predominantly expressed in the cytoplasm of vascular smooth muscle cells (VSMCs) and tubular epithelial cells, with a median positivity of 20% and 40%, respectively. Also, US28-positive cells were present within arterial neointima. In contrast to US28, HCMV-encoded immediate early antigen was detected in less than 5% of VSMCs, tubular epithelial cells, interstitial endothelium, interstitial inflammatory infiltrates, and glomerular cells.Primary VSMCs were infected with green fluorescent protein-tagged wild type or US28-deficient HCMV. The viral spreading of US28-deficient HCMV, via culture medium or cell-to-cell transmission, was significantly impeded as shown by green fluorescent protein (ie, infected) cell quantification and quantitative real-time polymerase chain reaction. Additionally, the number and size of foci was smaller. In summary, HCMV-encoded US28 was detected in renal allografts from HCMV-positive donors independent of viremia and serostatus. Also, US28 facilitates HCMV spreading in VSMCs in vitro. Because the vasculature is affected in chronic renal transplant dysfunction, US28 may provide a potential target for therapeutic intervention.

Risk of Acute Kidney Injury After Intravenous Contrast Media Administration

The study objective was to determine whether intravenous contrast administration for computed tomography (CT) is independently associated with increased risk for acute kidney injury and adverse clinical outcomes. This single-center retrospective cohort analysis was performed in a large, urban, academic emergency department with an average census of 62,179 visits per year; 17,934 ED visits for patients who underwent contrast-enhanced, unenhanced, or no CT during a 5-year period (2009 to 2014) were included. The intervention was CT scan with or without intravenous contrast administration. The primary outcome was incidence of acute kidney injury. Secondary outcomes included new chronic kidney disease, dialysis, and renal transplantation at 6 months. Logistic regression modeling and between-groups odds ratios with and without propensity-score matching were used to test for an independent association between contrast administration and primary and secondary outcomes. Treatment decisions, including administration of contrast and intravenous fluids, were examined. Rates of acute kidney injury were similar among all groups. Contrast administration was not associated with increased incidence of acute kidney injury (contrast-induced nephropathy criteria odds ratio=0.96, 95% confidence interval 0.85 to 1.08; and Acute Kidney Injury Network/Kidney Disease Improving Global Outcomes criteria odds ratio=1.00, 95% confidence interval 0.87 to 1.16). This was true in all subgroup analyses regardless of baseline renal function and whether comparisons were made directly or after propensity matching. Contrast administration was not associated with increased incidence of chronic kidney disease, dialysis, or renal transplant at 6 months. Clinicians were less likely to prescribe contrast to patients with decreased renal function and more likely to prescribe intravenous fluids if contrast was administered. In the largest well-controlled study of acute kidney injury following contrast administration in the ED to date,intravenous contrast was not associated with an increased frequency of acute kidney injury.

A systematic review of the use of rituximab for the treatment of antibody-mediated renal transplant rejection.

Rituximab is a B-lymphocyte depleting agent that is used to treat hematological malignancies and autoimmune diseases. Recently, it has gained interest as an immunomodulatory agent in renal transplantation. This systematic review evaluates the evidence for its use in the treatment of acute and chronic antibody-mediated renal transplant rejection (AAMR; CAMR). A systematic search of four databases and three trial registries was conducted. The small number and heterogeneous nature of included studies precluded meta-analysis and thus a narrative review was conducted. A total of 28 records met the inclusion criteria (AAMR, 18 records relating to 9 studies; CAMR, 10 records relating to 7 studies). Two systematic reviews were identified that had differing inclusion criteria to this current review. Of seven primary studies in the setting of AAMR, four reported increased graft survival and one reported improved graft function with rituximab. This contrasts with CAMR in which only one of seven studies reported improved graft outcomes with a rituximab-based regimen; three studies reported inferior outcomes and three reported no difference. Only one study reported that rituximab was associated with an increase in adverse effects. The included studies suggest that rituximab may be of some benefit in the setting of AAMR but a lack of high quality evidence precludes firm conclusions from being drawn. Rituximab does not appear to reliably improve outcomes in CAMR. Further well-conducted studies are required to better define the effects and long-term safety profile of rituximab in the treatment of antibody-mediated renal transplant rejection.

Postoperative Impact of Diabetes, Chronic Kidney Disease, Hemodialysis, and Renal Transplant After Total Hip Arthroplasty

BackgroundThe prevalence of diabetes mellitus (DM), chronic kidney disease (CKD), hemodialysis (HD), and renal transplantation (RT) is increasing. This study assessed postoperative complications among diabetic patients with CKD, HD, or post-RT after total hip arthroplasty (THA). MethodsFour cohorts were created using a nationwide database: DM&THA, DM&CKD&THA, DM&HD&THA, and DM&RT&THA. Cohorts were matched to a control group by age and gender. Thirty-day medical complications and 90-day and 2-year surgical complications were evaluated. ResultsAll 30-day complications were higher in each cohort. Ninety-day and 2-year surgical complications in the DM&HD&THA cohort were increased compared to the DM&RT&THA cohort. Remarkably, no increased risk of periprosthetic joint infection, periprosthetic fracture, or revision was noted post-THA in the DM&RT&THA cohort. ConclusionDiabetic patients with worsening kidney function are associated with increased post-THA complications. Postsurgical risks decline following RT. Diabetic patients with kidney failure may want to undergo RT prior to THA to optimize surgical outcomes.

Transcervical resection of endometrium: A novel mode of management of patients with abnormal uterine bleeding with chronic kidney disease and renal transplant recipients

Objective: Abnormal uterine bleeding (AUB), especially in cases with chronic kidney diseases (CKDs) have a significant impact on physical, social, economic, and material quality of life of women. The objective of this study was to evaluate the efficacy, change in menstrual pattern, and patient satisfaction after transcervical resection of endometrium (TCRE) in women with AUB and CKD who underwent or were awaiting renal transplant and nonrespondents to medical management. Materials and Methodology: Eleven women with CKD (either underwent renal transplant or on dialysis) and AUB who did not respond to medical management underwent TCRE. The study period was 5 years. The main outcome measures were change in menstrual status, level of satisfaction with the procedure, and the need for repeat TCRE or hysterectomy. Results: The average age of the patients was 44.9 years. Out of the 22 women enrolled, 11 responded to medical management and only the remaining 11 women required TCRE. All 11 women underwent hysteroscopic-guided biopsy, and their histopathological reports revealed nonmalignant status. The average operating time for TCRE was 21.5 ± 8.02 min. Postoperatively 9 (81.81%) women had achieved amenorrhea while 2 (18.18%) developed oligomenorrhea. The duration from TCRE to amenorrhea ranges between 7 and 60 days with an average of 31.54 days. None of the women required hysterectomy. Conclusion: TCRE is clinically and cost effective alternative to medical management or hysterectomy in women with AUB and CKD. The cost-effectiveness, work performance, rapid convalescence, and improved the quality of life provide TCRE a “distinct edge” over the definitive management – hysterectomy.

Imaging the kidney using magnetic resonance techniques: structure to function.

MRI can noninvasively assess the structure and function of the kidney in a single MRI scan session. This review summarizes recent advancements in functional renal MRI techniques, with a particular focus on clinical applications. A number of MRI techniques now provide measures of relevance to the pathophysiology of kidney disease. Diffusion-weighted imaging, used in chronic kidney disease and renal transplantation, shows promise as a measure of renal fibrosis. Longitudinal relaxation time (T1) mapping has been utilized in cardiac MRI to measure fibrosis and oedema; recent work shows its potential in the kidney. Blood oxygen-level-dependent MRI to measure renal oxygenation has been extensively studied, but a number of other factors affect results making it hard to draw definite conclusions as to its utility as an independent measure. Phase contrast and arterial spin labelling can measure renal artery blood flow and renal perfusion without exogenous contrast, as opposed to dynamic contrast-enhanced studies. In general, current data on clinical use of functional renal MRI are restricted to cross-sectional studies. Renal MRI has seen significant recent advances. Current evidence demonstrates its potential, and next steps include wider evaluation of its clinical application.

Effect of Saxagliptin on Renal Outcomes in the SAVOR-TIMI 53 Trial.

Dipeptidyl peptidase 4 inhibitors may have a protective effect in diabetic nephropathy. We studied renal outcomes of 16,492 patients with type 2 diabetes, randomized to saxagliptin versus placebo and followed for a median of 2.1 years in the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53 (SAVOR-TIMI 53) trial. At baseline, 9,696 (58.8%) subjects had normoalbuminuria (albumin/creatinine ratio [ACR] <30 mg/g), 4,426 (26.8%) had microalbuminuria (ACR 30-300 mg/g), and 1,638 (9.9%) had macroalbuminuria (ACR >300 mg/g). Treatment with saxagliptin was associated with improvement in and/or less deterioration in ACR categories from baseline to end of trial (EOT) (P = 0.021, P < 0.001, and P = 0.049 for individuals with baseline normoalbuminuria, microalbuminuria, and macroalbuminuria, respectively). At 2 years, the difference in mean ACR change between saxagliptin and placebo arms was -19.3 mg/g (P = 0.033) for estimated glomerular filtration rate (eGFR) >50 mL/min/body surface area per 1.73 m2 (BSA), -105 mg/g (P = 0.011) for 50 ≥ eGFR ≥ 30 mL/min/BSA, and -245.2 mg/g (P = 0.086) for eGFR <30 mL/min/BSA. Analyzing ACR as a continuous variable showed reduction in ACR with saxagliptin (1 year, P < 0.0001; 2 years, P = 0.0143; and EOT, P = 0.0158). The change in ACR did not correlate with that in HbA1c (r = 0.041, 0.052, and 0.036; 1 year, 2 years, and EOT, respectively). The change in eGFR was similar in the saxagliptin and placebo groups. Safety renal outcomes, including doubling of serum creatinine, initiation of chronic dialysis, renal transplantation, or serum creatinine >6.0 mg/dL, were similar as well. Treatment with saxagliptin improved ACR, even in the normoalbuminuric range, without affecting eGFR. The beneficial effect of saxagliptin on albuminuria could not be explained by its effect on glycemic control.

Conséquences andrologiques de l’insuffisance rénale chronique : état de l’art pour le rapport annuel de l’Association française d’urologie

To describe the state of the art of current knowledge regarding gonadal consequences of end-stage chronic kidney disease (CKD) and renal transplantation. A systematic review of the literature search was performed from the databases Medline (NLM, Pubmed) and Embase, focused on the following keywords: "chronic kidney disease"; "chronic renal failure"; "hypogonadism"; "kidney transplantation"; "testicular dysfunction"; "testosterone". Publications obtained were selected based on methodology, language, date of publication (last 10years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 383articles. After reading titles and abstracts, 51were included in the text, based on their relevance. The prevalence of hypogonadism in CKD is reported between 24% and 66%, and decreases partially after renal transplantation. This is a hypogonadotropic hypogonadism whose pathophysiology is multifactorial, involving mainly a primitive testicular deficit, a hypothalamic-pituitary dysregulation, and an hyperprolactinemia. The consequences of this hypogonadism are not only sexual but also contribute to anemia, sarcopenia, atherosclerosis, and potentially in the progression of CKD. Hypogonadism is an independent risk factor for mortality in CKD patients. CKD is frequently associated with an hypogonadism whose correction is validated only in the setting of erectile dysfunction treatment. The other benefits of the correction of hypogonadism in the CKD patients, including overall survival, needs to be evaluated.

Endemic Indian clones of Klebsiella pneumoniae-harbouring New Delhi metallo-beta-lactamase-1 on a hybrid plasmid replicon type: A case of changing New Delhi metallo-beta-lactamase plasmid landscapes in India?

Purpose:blaNDM genes are MBL genes that confer resistance to carbapenems. Globally, they are associated with diverse clones and plasmids. In this study, we characterised three isolates of Klebsiella pneumoniae-harbouring blaNDM1 from patients undergoing chronic haemodialysis and renal transplantation. Materials and Methods: 3 blaNDM1-producing K. pneumoniae were isolated from end-stage renal disease patients undergoing haemodialysis and renal transplantation from a nephrology unit. All the three isolates were screened for clinically relevant resistant genes. Plasmid replicon content was analysed by polymerase chain reaction based replicon typing. Conjugation assays were done using azide-resistant Escherichia coli J53 as the recipient strain. Multilocus sequence typing and variable number tandem repeat typing were done to find the clonality. Replicon sequence based typing was attempted to find the diversity of replicon-associated sequences in IncHI3 plasmids. Results: All the 3 blaNDM positive isolates possessed the New Delhi metallo-beta-lactamase-1 (NDM-1) allele with an IncHI3 plasmid which was not transferable in one isolate. The isolates were found to be sequence type 14 (ST14; 2 nos) and ST38 both of which were previously reported to be the NDM-producing K. pneumoniae STs prevalent in India. Replicon sequence analysis revealed limited sequence diversity within the repHI3 and repFIB locus. Conclusion: To the best of our knowledge, this is the first report of IncHI3, a newly assigned enterobacterial plasmid incompatibility group from India. This could either be a case of importation or a widely circulating NDM plasmid type in India.

Intestinal metabolites, chronic kidney disease and renal transplantation: Enigma Variations?

Intestinal metabolites, chronic kidney disease and renal transplantation: Enigma Variations?

Carbapenemase producing Enterobacteriaceae from chronic hemo-dialysis and renal transplant patients from a tertiary care centre in Chennai, South India

Carbapenemase producing Enterobacteriaceae from chronic hemo-dialysis and renal transplant patients from a tertiary care centre in Chennai, South India

Carbapenemase producing enterobacteriaceae from chronic hemo-dialysis and renal transplant patients from a tertiary care centre in Chennai, South India

Carbapenemase producing enterobacteriaceae from chronic hemo-dialysis and renal transplant patients from a tertiary care centre in Chennai, South India