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INTRODUCTION: Large-scale Indian data on the use of anti-T-lymphocyte globulin (ATLG) (Grafalon®) as induction therapy in kidney transplantation (KT) patients is lacking. The aim of this study was to determine the 1-year patient and graft survival outcomes with the use of ATLG as induction regimen in KT. METHODS: In a prospective, multicentric, observational study, adult patients who underwent ABO-compatible KT and had received ATLG as a part of induction were included in the study. The primary outcome measure was overall survival and death-censored graft survival at 12 months. The primary safety outcome was assessed by development of infectious complications and graft rejection. RESULTS: In total, 359 patients were included in this study. The mean age was 42.77 ± 12.30 years and 83% were male. The average ATLG dose per patient was 6.2 ± 2.2 mg/kg whereas average cumulative dose per patient was 389.6 ± 149.8 mg. The rate of graft dysfunction was 13.4% of patients and 6.7% had biopsy-proven acute rejection (BPAR). There were a total of 12 (3.3%) deaths and one graft loss. Overall survival and death-censored graft survival at 12 months were 96.65% and 99.44%, respectively. The rate of infections was 13.6% with urinary tract infections being most common. CONCLUSION: ATLG at an average dose of 6 mg/kg is an effective and safe induction regimen immunosuppressant for ABO-compatible KT with favourable impact on survival and graft function in Indian patients.
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Trasplante de Riñón , Adulto , Femenino , Rechazo de Injerto/prevención & control , Humanos , Inmunosupresores/uso terapéutico , Trasplante de Riñón/efectos adversos , Linfocitos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Most cases of Baclofen toxicity have been reported in patients with impaired kidney functions, within a few days to weeks after ingestion. We report three cases of Baclofen induced encephalopathy in chronic kidney disease patients; two developed encephalopathy within 6-8 h after ingestion of a single tablet and third on 4th day of consuming 2.5 mg twice daily dose. All three cases recovered fully following haemodialysis treatment.
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OBJECTIVES: There is scarcity of data on reoccurrence of SARS-CoV-2 infections in kidney transplant recipients. MATERIALS AND METHODS: We conducted a retrospective multicenter cohort study and identified 13 kidney transplant recipients (10 living and 3 deceased donors) with recurrent COVID-19, and here we report demographics, immunosuppression regimens, clinical profiles, treatments, and outcomes. RESULTS: COVID-19 second infection rate was 0.9% (13/1350) in kidney transplant recipients with a median age of 46 years; median time interval from transplant to first episode of COVID-19 diagnosis was 9.2 months (interquartile range, 2.2-46.5 months). The most common comorbidities were hypertension (84%) and diabetes (23%). Fever was significantly less common with recurrent COVID-19. COVID-19 severity ranged from asymptomatic (23%), mild (31%), and moderate (46%) during the first infection and asymptomatic (8%), mild (46%), and severe (46%) in the second infection. All 6 kidney transplant recipients with severe second infections died. The median interval between the 2 episodes based upon reverse transcriptase polymerase chain reaction COVID-19-positive tests was 135 days (interquartile range, 71-274 days) without symptoms. Statistically significant risk factors for mortality were dyspnea (P = .04), disease severity (P = .004), allograft dysfunction (P < .05), higher levels of neutrophil-to-lymphocyte ratio (P = .05), and intensive care unit/ventilator requirement (P = .004). Although our limited resources did not allow for molecular diagnostics and typing, we suggest that these second episodes were reinfections with SARS-CoV-2. CONCLUSIONS: To our knowledge, this is the largest study of kidney transplant recipients with reoccurring SARS-CoV-2 infection, and we observed 46% mortality.
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COVID-19 , Trasplante de Riñón , Prueba de COVID-19 , Preescolar , Estudios de Cohortes , Humanos , Lactante , Trasplante de Riñón/efectos adversos , Estudios Retrospectivos , SARS-CoV-2 , Receptores de TrasplantesAsunto(s)
COVID-19 , Trasplante de Riñón , Complicaciones Posoperatorias , Obstrucción de la Arteria Renal , Arteria Renal , Terapia Trombolítica , Trombosis , Trasplantes/irrigación sanguínea , Angiografía/métodos , COVID-19/sangre , COVID-19/complicaciones , COVID-19/diagnóstico , Prueba de COVID-19/métodos , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Supervivencia de Injerto , Humanos , Huésped Inmunocomprometido , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/virología , Arteria Renal/diagnóstico por imagen , Arteria Renal/patología , Obstrucción de la Arteria Renal/diagnóstico , Obstrucción de la Arteria Renal/etiología , Obstrucción de la Arteria Renal/fisiopatología , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/métodos , Trombosis/diagnóstico , Trombosis/etiología , Trombosis/fisiopatología , Insuficiencia del TratamientoAsunto(s)
Androstenos/efectos adversos , Etinilestradiol/efectos adversos , Infarto/inducido químicamente , Riñón/irrigación sanguínea , Adolescente , Androstenos/uso terapéutico , Etinilestradiol/uso terapéutico , Femenino , Dolor en el Flanco/etiología , Humanos , Infarto/complicaciones , Síndrome del Ovario Poliquístico/tratamiento farmacológicoRESUMEN
BACKGROUND: Chronic kidney disease (CKD) is associated with significant morbidity and mortality. US data show that 11-15.6% of population has CKD, but there is no data from India on early stages of CKD. The aim of this study was to estimate the prevalence of early stages of CKD using the Kidney Disease Quality Outcomes Initiative (KDOQI) guidelines in an Indian population. METHODS: A cross-sectional study of Indian central government employees over 18 years of age was carried out. Data on anthropometric profile and investigations including routine urine exam, semi-quantitative microalbuminuria (MAU), serum creatinine, lipid profile and fasting blood glucose (FPG) were collected. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Diseases (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. RESULTS: A total of 3398 subjects, with 2244 (66.04%) males and 1154 (33.96%) females, were studied. Of the subjects, 9.96% (n = 284) were found to have MAU >30 mg/L, and 11.47% (n = 327) had a deranged albumin:creatinine ratio (ACR) of 30-300 mg/g. Mean GFR was 98 mL/min/1.73 m(2) (+/- 25.25) by the MDRD equation, and 100 mL/min/1.73 m(2) (+/- 19.48) by CKD-EPI. Using the MDRD equation for GFR, 189 (6.62%) had stage I CKD, 154 (5.40%) had stage II CKD and 86 (3.02%) had stage III CKD. By using the CKD-EPI equation, the corresponding percentages were 192 (6.73%), 122 (4.28%) and 60 (2.11%), respectively. Age >40 years, FPG >126 mg/dL and hypertension were found to be independent risk factors for CKD. CONCLUSIONS: Of the apparently healthy adult Indian central government employees, 15.04% and 13.12% were found to have early stages of CKD using the MDRD and CKD-EPI criteria for GFR, respectively.
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Albuminuria , Creatinina/sangre , Enfermedades Renales/diagnóstico , Enfermedades Renales/epidemiología , Adolescente , Adulto , Anciano , Enfermedad Crónica , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Humanos , India/epidemiología , Enfermedades Renales/mortalidad , Masculino , Persona de Mediana Edad , Salud Laboral , Prevalencia , Pronóstico , Factores de Riesgo , Tasa de Supervivencia , Adulto JovenRESUMEN
10-30% of dialysis population awaiting renal transplantation is sensitized. Present desensitization protocols use intravenous immune globulins, rituximab, and plasmapheresis in various combinations; however, these regimens are unaffordable by many in developing countries. We tried desensitization with mycophenolate mofetil and plasmapheresis. Methods. Patients with high PRA titre (> or =50%) or positive crossmatch (>10%) were treated with MMF for a month before proposed transplant and were given five sittings of plasmapheresis. Results. 11 of 12 patients had normalization of PRA/crossmatch with this regimen and were successfully transplanted. One patient lost the graft due to graft vein thrombosis, and two patients died within three months after transplant due to septicemia and pulmonary embolism, respectively, with a functioning graft. No patient, including the two who died, developed clinical rejection over a mean follow-up of 10 months (range 1-16 months). Mean serum creatinine at last follow up was 1.1 mg/dL (range 0.9-1.3 mg/dL). Conclusions. Though the number of patients studied is small, we feel that highly sensitized patients awaiting living donor renal transplant should be tried on this simple and cost-effective regime before transplant. The more aggressive and expensive approaches incorporating IVIg and rituximab should be used only if this relatively low-cost regime is unsuccessful.
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Desensibilización Inmunológica/métodos , Trasplante de Riñón/inmunología , Ácido Micofenólico/análogos & derivados , Plasmaféresis/métodos , Inmunología del Trasplante , Adulto , Estudios de Cohortes , Terapia Combinada , Ahorro de Costo , Análisis Costo-Beneficio , Desensibilización Inmunológica/economía , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Prueba de Histocompatibilidad , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/cirugía , Trasplante de Riñón/métodos , Trasplante de Riñón/mortalidad , Donadores Vivos , Masculino , Persona de Mediana Edad , Ácido Micofenólico/administración & dosificación , Cuidados Preoperatorios , Resultado del Tratamiento , Listas de Espera , Adulto JovenRESUMEN
A living-unrelated renal transplant recipient presented with a history of fever with chills and rigors for 3 days. Clinically, the cause of the fever could not be localized. During a hospital stay of 72 hours, the patient developed sore throat, laryngeal stridor and acute myocardial infarction. A post-mortem revealed disseminated mucormycosis involving the larynx, heart, intestines, brain and the transplanted kidney.
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Trasplante de Riñón/efectos adversos , Enfermedades de la Laringe/etiología , Mucormicosis/complicaciones , Infarto del Miocardio/etiología , Ruidos Respiratorios/etiología , Adulto , Humanos , MasculinoRESUMEN
Uremic hemorrhagic pericarditis occurs much less frequently in acute than in chronic renal failure, but when it does, it is a potentially fatal complication. The possibility of hemorrhagic pericarditis and cardiac tamponade should be considered in patients with acute renal failure and acute hemodynamic instability. This study reports a case of falciparum malaria complicated by acute renal failure that developed fatal cardiac tamponade in the recovery phase of acute renal failure.