RESUMEN
INTRODUCTION: Renal transplant recipients (RTRs) are at risk of developing osteoporosis and osteopenia due to underlying renal osteodystrophy, hypophosphatemia, and immunosuppression. This process occurs more frequently in the first year after renal transplantation (RTX), resulting in eventual bone loss and fractures. The purpose of this study was to evaluate the effect of low-dose alendronate to prevent early bone loss after RTX. PATIENTS AND METHODS: We prospectively studied 43 successful RTR including 22 men and 21-women with a mean overall age of 39.16±11.73 years, mean body mass index of 23.6±3.73, and mean dialysis duration of 25.73±17.67 months. We matched them based on age and sex: the alendronate-treated group received vitamin D (Vit D) during the study plus 30 mg alendronate weekly from 1 month after RTX. The control group only received Vit D. We measured serum calcium, phosphate, alkaline phosphatase, blood urea, creatinine, and intact parathyroid hormone (iPTH) at the pretransplant baseline and monthly thereafter as well as BMD of the lumbar spine, femur, and radius pretransplant baseline versus 3 and 6 months after RTX. RESULTS: At 6 month after RTX, the lumbar BMD in the alendronate group increased significantly from 0.819±0.11 to 0.863±0.14 (P<.01), while it decreased in the control group from 0.897±0.17 to 0.817±0.16 (P<.001). There was also a significant increase in radius BMD (P<.001) and a nonsignificant increase in femoral BMD in the alendronate versus a significant decrease of femoral and radius BMD (P<.001) in the control group at 6 months. Upon multivariate analysis, there was a significant correlation between alendronate and spine BMD (r=.45, P<.001) but no linear regression between age, sex, BMI, dialysis duration of or iPTH with femoral, spine, or radius BMD changes at month 6. CONCLUSION: Low-dose alendronate was significantly useful to mitigate fast bone loss and increase BMD immediately after RTX.
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Alendronato/farmacología , Conservadores de la Densidad Ósea/farmacología , Enfermedades Óseas/complicaciones , Huesos/efectos de los fármacos , Fallo Renal Crónico/complicaciones , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/métodos , Adulto , Índice de Masa Corporal , Densidad Ósea , Densitometría/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
INTRODUCTION: Most kidney transplantation surgeons tend to prefer the left-sided kidney for donation. Because one of the veins to join the left renal vein is the left testicular (gonadal) vein, its flow may be damaged by manipulation of the left renal vein during left-sided nephrectomy. We sought to evaluate changes of the left-sided pampiniform venous plexus and testis following left-sided nephrectomy in kidney donors. METHODS: During the present cross-sectional study (June 2007-July 2008), 54 healthy males who were candidates for left kidney donation underwent an ultrasound study of the left-sided pampiniform venous plexus diameter as well as the left testis size before and 4 months after left-sided nephrectomy. RESULTS: The patient mean age was 25.07 +/- 2.49 years. The mean diameters of left pampiniform vein before versus 4 months after nephrectomy were 1.37 +/- 0.40 versus 2.04 +/- 0.49 mm, respectively. The mean sizes of left testis before and 4 months after nephrectomy were 21.86 +/- 2.47 versus 21.50 +/- 2.17 mL, respectively. The mean left pampiniform vein diameter significantly increased at 4 months after left-sided nephrectomy (P < .001), but the mean left testis size was not significantly changed (P = .136). CONCLUSION: Four months after left-sided nephrectomy, the left pampiniform venous plexus diameter increased, whereas there was no significant change in left testis size. Therefore, in patients with left-sided nephrectomy, a high risk of varicocele may be predicted.
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Nefrectomía/efectos adversos , Donantes de Tejidos/estadística & datos numéricos , Varicocele/etiología , Adulto , Estudios Transversales , Estudios de Seguimiento , Lateralidad Funcional , Humanos , Riñón/diagnóstico por imagen , Masculino , Nefrectomía/métodos , Venas Renales/anatomía & histología , Venas Renales/patología , Testículo/irrigación sanguínea , Ultrasonografía , Adulto JovenRESUMEN
BACKGROUND: As renin-angiotensin system (RAS) activity may affect the severity of oxidative stress and inflammatory markers, we assessed the effects of enalapril (E) and/or losartan (L) on these markers in renal transplant recipients with RAS polymorphisms. PATIENTS AND METHODS: After determination by PCR of RAS genotypes, consisting of the angiotensin-converting enzymes (ACE I/D), angiotensinogens (AGT M235T) and angiotensin II type 1 receptors (ATR1 A1166C), 76 recipients were recruited randomly and assigned 4 groups. The first (n = 17) and second (n = 24) groups were treated with E (E(+): 10 mg/d) and L (L(+): 50 mg/d) alone, respectively. The third positive control group (n = 17) received E + L (E(+)L(+): 10 mg/d + 50 mg/d) and the fourth negative control group (n = 18) received no medication (E(-):L(-)). High-sensitivity C-reactive protein (hs-CRP) and total antioxidant (TA) inflammatory and antioxidative markers were measured after 2 months. After a 2-week washout period, the E(+) group was changed to L(+) and vice versa in a crossover design. They were followed for another 8 weeks before retesting hs-CRP and TA. A value of P < or = .05 was considered significant. RESULTS: After 2 and 4 months of treatment with the drug regimen, hs-CRP and TA levels were significantly decreased and consequently increased among the E(+)L(+), L(+) and E(+) groups (P < .05). On analyzing the relationship between RAS polymorphisms and baseline hs-CRP or TA levels, CC genotype of ATR1 showed lower hs-CRP levels (P = .04). However, none of the RAS polymorphisms predicted the antioxidant and anti-inflammatory response rates to the drugs (P > .05). CONCLUSION: Although hs-CRP was lower in the CC genotype patients of ATR1 polymorphisms E and/or L reduced hs-CRP and increased TA regardless of the RAS genotype.
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Antioxidantes/uso terapéutico , Proteína C-Reactiva/metabolismo , Enalapril/uso terapéutico , Trasplante de Riñón/inmunología , Losartán/uso terapéutico , Polimorfismo Genético , Sistema Renina-Angiotensina/genética , Adulto , Antihipertensivos/uso terapéutico , Proteína C-Reactiva/efectos de los fármacos , Creatinina/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estrés Oxidativo , Reacción en Cadena de la Polimerasa , Sistema Renina-Angiotensina/efectos de los fármacosRESUMEN
Atherosclerosis may be evaluated by structural or functional changes of the main arteries. We sought to investigate the probable associations of static and dynamic arterial changes with lipoprotein (a) and homocysteine levels, the two risk factors for atherosclerosis. Intima-media thickening and vasodilatory responses to nitroglycerine of the common carotid artery and the renal transplant artery were studied by color Doppler sonography in 75 renal transplant recipients and 30 controls. At 3, 5, and 10 minutes after 0.4 mg of sublingual nitroglycerine are measured resistive index and peak systolic velocity of the common carotid artery and renal transplant artery. Intima-media thickening in renal transplant recipients and controls were 0.86 +/- 0.34 mm and 0.74 +/- 0.14 mm (P = .05), respectively. Although intima-media thickness did not correlate with the duration of renal transplantation, it was significantly higher in older renal transplant recipients. Peak systolic velocity of common carotid artery was significantly decreased by nitroglycerine in the controls (81.8 +/- 16.7 m/s to 73.2 +/- 12.8 m/s, P = .03). This decrement was more obvious in renal transplant recipients, especially at 10 minutes (69.6 +/- 18.5 m/s vs 59.3 +/- 2 m/s, P = .01). These reductions did not correlate with intima-media thickening, latter of which also did not correlate with homocysteine concentrations, which were higher among renal transplant patients with creatinine more than 1.8 mg/dL. Basal resistive indices of the common carotid artery and renal transplant artery were higher among graft recipients with dysfunction than recipients with good function, (0.7 vs 0.59, P = .003). In conclusion, neither homocysteine nor lipoprotein(a) concentrations predict static and dynamic vascular properties.