RESUMEN
Abstract Here we report the case of a patient who developed urinary tract infection after a urodynamic study. The causative agent was Raoultella planticola, a rare opportunistic pathogen that usually invades immunocompromised patients. While a urinary tract infection with R. planticola has been previously described, this is the first report in which an R. planticola infection developed after a urodynamic study. We postulate that the mechanism of infection was direct invasion of the urinary tract from contaminated urodynamic study equipment. Here, we discuss the role played by isotonic solutions in facilitating bacterial reproduction.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Infecciones Urinarias/microbiología , Contaminación de Equipos , Enterobacteriaceae/aislamiento & purificación , Infecciones por Enterobacteriaceae/etiología , Urodinámica , Infecciones por Enterobacteriaceae/microbiologíaRESUMEN
Here we report the case of a patient who developed urinary tract infection after a urodynamic study. The causative agent was Raoultella planticola, a rare opportunistic pathogen that usually invades immunocompromised patients. While a urinary tract infection with R. planticola has been previously described, this is the first report in which an R. planticola infection developed after a urodynamic study. We postulate that the mechanism of infection was direct invasion of the urinary tract from contaminated urodynamic study equipment. Here, we discuss the role played by isotonic solutions in facilitating bacterial reproduction.
Asunto(s)
Infecciones por Enterobacteriaceae/etiología , Enterobacteriaceae/aislamiento & purificación , Contaminación de Equipos , Infecciones Urinarias/microbiología , Infecciones por Enterobacteriaceae/microbiología , Humanos , Masculino , Persona de Mediana Edad , UrodinámicaRESUMEN
BACKGROUND: Atypical hemolytic uremic syndrome (aHUS) is a very rare disease, which presents with microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. Progression to end-stage renal disease (ESRD) from acute kidney injury is observed in 60% of aHUS cases. The prognosis of aHUS patients who undergo kidney transplantation (Ktx) is generally poor, but these patients should be treated prophylactically with eculizumab to prevent recurrence after transplantation. CASE REPORT: An 18-year-old man was referred to our center with a history of rapid progression to ESRD with unknown etiology. He had anemia, thrombocytopenia, high levels of LDH, and indirect bilirubin and creatinine on initial laboratory results. Our diagnosis was aHUS due to initial results, normal level of ADAMTS activity, and lack of predisposing factors seen in typical HUS. We planned to perform genetic analysis for the patient and the donor candidate (mother). The variations found on exon 7 of the CFH gene had not been reported previously. According to PolyPhen analysis, this mutation was reported as a potential cause for aHUS. We decided to perform Ktx under eculizumab prophylaxis. Weekly administration of prophylaxis was extended to 1 month. The graft functioned immediately after Ktx. The patient has completed his first year uneventfully in our follow-up, with a creatinine 0.79 mg/dl at his last control visit. CONCLUSIONS: We found favorable results of an aHUS case successfully treated with kidney transplantation combined with short-term prophylactic eculizumab therapy.
Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Síndrome Hemolítico Urémico Atípico/complicaciones , Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Adolescente , Síndrome Hemolítico Urémico Atípico/diagnóstico , Progresión de la Enfermedad , Estudios de Seguimiento , Rechazo de Injerto/prevención & control , Supervivencia de Injerto , Humanos , Inyecciones Subcutáneas , Fallo Renal Crónico/etiología , Fallo Renal Crónico/fisiopatología , Masculino , Cuidados Preoperatorios/métodos , Prevención Primaria/métodos , Medición de Riesgo , Factores de Tiempo , Resultado del Tratamiento , TurquíaRESUMEN
Cytotoxic T-lymphocyte antigen-4 (CTLA-4) is a cell surface protein, which down-regulates the immune response at CTLA-4/CD28/B7 pathway. We aimed to investigate the influence of the -318 C/T, +49 A/G, -1661 A/G and CT60A/G, and CTLA-4 gene polymorphisms on acute rejection of kidney allograft in Turkish patients. The study design was a case-control study that consists of three groups: Group 1 (n = 34) represented the kidney transplant (Ktx) recipients who experienced acute rejection, Group 2 (n = 47) was randomly assigned Ktx recipients without acute rejection, and Group 3 (n = 50) consisting of healthy volunteers to evaluate the normal genomic distribution. The polymerase chain reaction-restriction fragment length polymorphism technique was used to determine the polymorphisms. Genotype and allele frequencies among three groups denoted similar distributions for +49 A/G, -1661 A/G, and CT60A/G. Conversely, -318 C/T genotype was three times more frequent in the acute rejection group than in the non-rejection group (OR = 3.45; 95%CI = 1.18-10.1, p = 0.015) and two times more frequent than the healthy control group (OR = 2.45; 95% CI = 0.98 - 6.11, p = 0.047). Additionally, having a T allele at -318 position was significantly associated with acute rejection (0.147 vs. 0.043, OR = 3.45; 95% CI = 1.13-10.56, p = 0.02). 318C/T gene polymorphism and T allelic variant were found to be associated with increased acute rejection risk in Turkish kidney allograft recipients.
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Antígeno CTLA-4/genética , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/genética , Fallo Renal Crónico/cirugía , Trasplante de Riñón , Polimorfismo de Nucleótido Simple/genética , Enfermedad Aguda , Adolescente , Adulto , Anciano , Aloinjertos , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Frecuencia de los Genes , Genotipo , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Complicaciones Posoperatorias , Pronóstico , Factores de Riesgo , Turquía , Adulto JovenRESUMEN
OBJECTIVES: Chronic hepatitis B virus infection remains a clinical problem for HBsAg (+) kidney transplant recipients. Lamivudine is the approved treatment; however, there are contrary views about optimal initiation. In case of resistance, novel nucleoside analogs should be considered but experience is limited. MATERIALS AND METHODS: The study was a retrospective cohort study that included 58 HBsAg (+) kidney transplant recipients. Medical records were reviewed for nucleoside analogs, viral replication, and graft/hepatic functions. Prophylactic and preemptive lamivudine modalities were compared to reveal optimal initiation. Additionally, novel nucleoside analogs were evaluated for safety and efficacy. RESULTS: The graft/patient survival rates for HBsAg (+) recipients were the same as those of hepatitis-free recipients (P = .18). Prophylactic group had 24 and the preemptive had 34 patients. In the prophylactic group, there were fewer hepatic dysfunctions (12.5% vs. 30%, P = .12), viral breakthroughs (16% vs. 32%, P = .17) and elevated alanine aminotransferase concentrations (37% vs. 52%, P = .24), however these did not reach statistical significance. Progressive hepatic dysfunction was observed in 5 patients. Treatment was altered to tenofovir (n = 4) and adefovir (n = 1), and adequate virologic/biochemical response was achieved. These nucleoside analogs were almost as safe as lamivudine, as there were no significant differences among proteinuria (4740 ± 9480 vs 1250 ± 430 mg/L; P = .60) and estimated glomerular filtration rate (1.23 ± 0.37 vs 1.10 ± 0.35 mL/s; P = .33) CONCLUSIONS: Lamivudine is an efficient means of providing comparable graft/patient survival with hepatitis-free kidney transplant recipients. The prophylactic initiation of lamivudine may be better in preventing hepatic dysfunction. Tenofovir can be an effective and safe treatment for lamivudine-resistant kidney transplant recipients.
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Adenina/análogos & derivados , Antivirales/administración & dosificación , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/efectos de los fármacos , Hepatitis B Crónica/tratamiento farmacológico , Trasplante de Riñón , Lamivudine/administración & dosificación , Organofosfonatos/administración & dosificación , Adenina/administración & dosificación , Adenina/efectos adversos , Adulto , Antivirales/efectos adversos , Biomarcadores/sangre , Esquema de Medicación , Femenino , Supervivencia de Injerto , Virus de la Hepatitis B/crecimiento & desarrollo , Virus de la Hepatitis B/inmunología , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/diagnóstico , Hepatitis B Crónica/mortalidad , Humanos , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/mortalidad , Lamivudine/efectos adversos , Masculino , Organofosfonatos/efectos adversos , Estudios Retrospectivos , Tenofovir , Factores de Tiempo , Resultado del Tratamiento , Replicación Viral/efectos de los fármacosRESUMEN
BACKGROUND: Refractory congestive heart failure (RCHF), due to its high mortality and hospitalization rates, is a growing health problem. In this study, as an alternative and/or supportive treatment to conventional medical therapies, we have evaluated the clinical value of peritoneal ultrafiltration, performed as a single daily exchange with icodextrin or conventional dextrose-based peritoneal dialysis solutions, in elderly patients with RCHF. METHODS: This was an observational study of 6 elderly patients with RCHF and non-terminal chronic kidney disease (CKD). Their mean age was 72.8 ± 4.9 years. Four of the six patients had NYHA class 4 and two had NYHA class 3 RCHF and a medical history of 18.6 ± 14.9 days/year hospitalization on average, due to decompensated congestive heart failure (CHF). Their baseline glomerular filtration rate, as calculated by the MDRD formula was 49.4 ± 14.6 mL/min/1.73 m(2). During hospitalization, patients were initially treated with several sessions of continuous veno-venous hemofiltration and, following the achievement of hemodynamic stabilization, peritoneal ultrafiltration was initiated as the maintenance ultrafiltration modality. Patients were followed up monthly in terms of their clinical status, hospitalization rates, weight changes, serum sodium levels, and renal function. Echocardiographic changes were also evaluated every 3 months. RESULTS: All patients tolerated peritoneal ultrafiltration well, their functional status improved by 1 or 2 NYHA classes to reach a mean of NYHA class 2 CHF status. During the follow-up period, with a mean daily ultrafiltration rate of 850 ± 176 mL, no hospitalization for decompensated CHF or acute renal failure was required. The patients' renal function was well preserved, with a mean GFR of 49 ± 14.6 mL/min/1.73 m(2) at baseline and 51.6 ± 22.9 mL/min/1.73 m(2) at the 6th month of the study. Additionally, their mean serum sodium levels increased from 128 ± 5.7 mEq/L to 138 ± 5 mEq/L. Echocardiographic evaluation did not show any significant changes during the observation period. No peritonitis or other non-infectious complication of chronic peritoneal dialysis was seen in any of the patients. CONCLUSIONS: Peritoneal ultrafiltration seems to be an efficient and safe procedure and a treatment of choice in elderly patients with RCHF without non-terminal CKD. Peritoneal ultrafiltration improves the quality of life and the effort capacity, and reduces hospitalization rates due to decompensated heart failure and acute renal failure.
Asunto(s)
Insuficiencia Cardíaca/terapia , Diálisis Peritoneal , Anciano , Soluciones para Diálisis/uso terapéutico , Ecocardiografía , Femenino , Tasa de Filtración Glomerular , Glucanos/uso terapéutico , Glucosa/uso terapéutico , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico por imagen , Hospitalización , Humanos , Icodextrina , Masculino , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapia , Estudios Retrospectivos , Sodio/sangre , UltrafiltraciónRESUMEN
BACKGROUND/AIMS: The aim of this study was to determine the effect of hepatitis C virus infection on patient and graft survival and liver function in renal transplant patients. METHODS: 1811 renal transplant patients were included in this study. One hundred renal transplant patients (5.5%) were anti-hepatitis C virus-positive. We evaluated demographic, clinical, biochemical, and serological data of patients and compared patient and graft survivals between hepatitis C virus-positive and -negative renal transplant patients. RESULTS: The median follow-up period was 35.7 months. One hundred (5.5%) patients were anti-hepatitis C virus-positive. There were no differences between anti-hepatitis C virus-positive and -negative renal transplant patients regarding age, etiology of renal disease, number of pre-transplant blood transfusions, and hepatitis B virus coinfection rate. Rate of graft loss in anti-hepatitis C virus-positive renal transplant patients was significantly higher than in anti-hepatitis C virus-negative patients (16.0% vs. 9.2%, p=0.026). Survival analysis revealed that patient survival was similar between anti-hepatitis C virus-positive and -negative renal transplant patients. Graft survival was lower in the anti-hepatitis C virus-positive group than in anti-hepatitis C virus-negative patients, especially after the fifth year of renal transplant (p<0.001). Thirty-three percent of anti-hepatitis C virus-positive patients were positive for hepatitis C virus RNA. Twenty-seven percent of anti-hepatitis C virus-positive patients had persistent alanine aminotransferase elevation. None of the patients developed cirrhosis during the follow-up period. CONCLUSION: Our findings suggest that hepatitis C virus infection in renal transplant patients does not adversely affect patient survival. Long-term graft survival seems to be lower in hepatitis C virus-positive compared to hepatitis C virus-negative renal transplant patients. Nevertheless, renal transplant can be considered as a safe and effective treatment modality in anti-hepatitis C virus-positive patients with end-stage renal disease.