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Xiaoli Li, Yunfei Hao, Rong Xue, Xueting Qi, Zhigang Ma
RATIONALE: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and anti-glomerular basement membrane (GBM) antibody disease are both rare autoimmune diseases. Monoclonal gammopathy of undetermined significance (MGUS) is one of the most common causes of plasma cell dyscrasias (PCD). The three entities can cause renal lesions via different mechanisms and, however, they have not been reported in a single patient with renal lesion. PATIENT CONCERNS: Here, we describe a patient with half-year fatigue and 40-day nausea and vomiting...
February 2019: Medicine (Baltimore)
Yu Ho Lee, Se-Yun Kim, Haena Moon, Jung-Woo Seo, Dong-Jin Kim, Seon Hwa Park, Yang-Gyun Kim, Ju-Young Moon, Jin Sug Kim, Kyung-Hwan Jeong, Sung-Jig Lim, Chan-Duck Kim, Jae Berm Park, Byung Ha Chung, Yeong Hoon Kim, Jaeseok Yang, Hyung-In Yang, Kyoung Soo Kim, Sang-Ho Lee
Endocan is a water-soluble proteoglycan exclusively secreted by vascular endothelium. Endocan levels may be elevated in kidney transplant recipients experiencing antibody-mediated rejection (ABMR), which is characterized by vascular inflammation in transplanted kidney. We evaluated the clinical relevance of endocan as markers of microvascular inflammation in patients who underwent kidney transplantation. Plasma and urinary endocan levels were measured in 203 kidney transplant recipients and were compared across different etiologies of allograft dysfunction and various pathologic scores...
February 12, 2019: Scientific Reports
Fahad Aziz, Sandesh Parajuli, Maha Mohamed, Neetika Garg, Brenda Muth, Didier Mandelbrot, Thomas Ellis, Weixiong Zhong, Arjang Djamali
BACKGROUND: Risk factors for graft loss in kidney transplant recipients with g3 lesions are poorly defined. MATERIALS AND METHODS: We evaluated outcomes in 37 consecutive kidney transplant biopsies diagnosed with g3 glomerulitis based on Banff 2013 criteria in a single-center observational study. RESULTS: The diagnosis of g3 glomerulonephritis was made 6.1 ± 6.6 years after transplant. The majority of patients were Caucasian (86%), male (65%), and received basiliximab induction (54%)...
February 2019: Clinical Nephrology
Asad Ali, Nouman Safdar Ali, Muhammad Bilal Malik, Zohaib Sayyed, Malik Qistas Ahmad
Our article will discuss bladder pain syndrome (BPS), which is the presence of chronic suprapubic pain to bladder filling accompanied by other urinary symptoms, such as frequency, urgency, discomfort with filling, and relief with emptying of the bladder in the absence of infections or other pathology. It is mostly seen in females and occurs in 0.06%-30% of the population. Some of the proposed mechanisms causing BPS include damage to the bladder lining, a problem manifesting in the pelvic musculature, endocrine, neurological, allergic, autoimmune system, and inflammatory system; however, a definite cause has not been yet identified...
September 17, 2018: Curēus
Ömer Acar, Tufan Tarcan
Herein, we aimed to review, report and discuss the role of cystoscopy and clinical phenotyping in interstitial cystitis/bladder pain syndrome (IC/BPS). For this purpose; a comprehensive nonsystematic review of the relevant literature was conducted. We reviewed articles published in English and indexed in the PubMed, Embase, and Google Scholar databases. Original manuscripts, review articles, case series, and case reports were taken into consideration. Data regarding the indications for, technique and possible findings of cystoscopy with hydrodistension (HD) and biopsy, as well as clinical implications of cystoscopic information and the concept and utility of clinical phenotyping within the context of IC/BPS were extracted and discussed...
November 20, 2018: Journal of the Turkish German Gynecological Association
Richard Seto, Lauren M Mathias, Andrew Kelly, Richard S Panush
We cared for a woman with sero-positive rheumatoid arthritis (RA), in clinical remission on oral methotrexate (MTX) and hydroxychloroquine, who wished to donate a kidney to a brother with end-stage renal disease (ESRD). We could find scant literature about this unusual clinical circumstance, and therefore review pertinent aspects of renal disease in RA, perioperative medical management, maintenance of disease remission, outcomes for RA patients who have donated kidneys, and relevant ethical issues. Renal complications in RA are not uncommon, with as many as 50% of patients at risk of reduced eGFR...
January 2019: Clinical Rheumatology
Saleh Yazdani, Jasper Callemeyn, Stéphane Gazut, Evelyne Lerut, Henriette de Loor, Max Wevers, Line Heylen, Carole Saison, Alice Koenig, Olivier Thaunat, Lieven Thorrez, Dirk Kuypers, Ben Sprangers, Laure-Hélène Noël, Leentje Van Lommel, Frans Schuit, Marie Essig, Wilfried Gwinner, Dany Anglicheau, Pierre Marquet, Maarten Naesens
Despite partial elucidation of the pathophysiology of antibody-mediated rejection (ABMR) after kidney transplantation, it remains largely unclear which of the involved immune cell types determine disease activity and outcome. We used microarray transcriptomic data from a case-control study (n=95) to identify genes that are differentially expressed in ABMR. Given the co-occurrence of ABMR and T-cell-mediated rejection (TCMR), we built a bioinformatics pipeline to distinguish ABMR-specific mRNA markers. Differential expression of 503 unique genes was identified in ABMR, with significant enrichment of natural killer (NK) cell pathways...
November 2, 2018: Kidney International
J Zhou, Y L Zu, R R Gui, Yanli Zhang, Y W Fu, F K Yu, H F Zhao, Z Li, Q D Lin, J Wang, W L Zuo, Y P Song
Objective: To explore the occurrence, clinical characteristics, diagnosis and treatment of glomerulitis after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: Analysis were carried out based on the clinical data of 6 patients with de novo glomerulitis following allo-HSCT hospitalized in Henan Tumor Hospital from January 2008 to December 2016, and the clinical manifestation, pathology, diagnosis, treatment and outcome were investigated. Results: The occurrence of glomerulitis was 1.26% (6/478)...
September 14, 2018: Zhonghua Xue Ye Xue za Zhi, Zhonghua Xueyexue Zazhi
Sandesh Parajuli, Robert R Redfield, Neetika Garg, Fahad Aziz, Maha Mohamed, Brad C Astor, Weixong Zhong, Arjang Djamali, Didier A Mandelbrot
BACKGROUND: Limited information exists about outcomes of HLA DSA negative (DSA-) microvascular inflammation (MVI). METHODS: We report our experience with 25 DSA- patients with MVI compared to 155 DSA+ patients who met Banff 2013 criteria for ABMR. We also compared outcomes to 228 DSA+ patients whose biopsies were negative for rejection, and served as a negative control. RESULTS: There were no significant differences in the baseline characteristics between the DSA- MVI and DSA+ ABMR groups...
October 17, 2018: Transplantation
M Shrestha, D Singh, M R Sigdel, M P Kafle
BACKGROUND: Increasing graft survival is the prime focus of every transplantation program. Detection of subclinical abnormalities with the help of protocol renal graft biopsies performed at predetermined intervals after transplantation has been one of the approaches. The objective was to study the abnormalities in protocol renal graft biopsy specimens at 6 months posttransplantation. METHODS: This was a hospital-based observational descriptive study. It included the recipients who underwent kidney transplantation between October 2014 and September 2015...
October 2018: Transplantation Proceedings
Daniela Ramos, Archivaldo Reche-Junior, Daniel S Mills, Priscila L Fragoso, Alexandre Gt Daniel, Mariana F Freitas, Silvia G Cortopassi, Geni Patricio
Objective The aim was to perform a case-control medical evaluation of cats from multi-cat households presenting with inappropriate latrining and spraying behavior. Methods Owners of 18 'spraying' and 23 'latrining' cats with normal control subjects available from the same households were recruited for a case-control study. Otherwise overtly healthy dyads (each dyad consisting of a case cat and a control cat) were brought together to the veterinary hospital of the University of São Paulo for a medical work-up (ie, physical examination, complete blood count, biochemical profile, urinalysis and urine culture, abdominal ultrasound of the urinary system and in females, where possible, cystoscopy)...
September 28, 2018: Journal of Feline Medicine and Surgery
Alberto Mella, Ester Gallo, Maria Messina, Cristiana Caorsi, Antonio Amoroso, Paolo Gontero, Aldo Verri, Francesca Maletta, Antonella Barreca, Fabrizio Fop, Luigi Biancone
AIM: To evaluate the role of a therapeutic regimen with plasma exchange, intravenous immunoglobulins and rituximab in chronic-active antibody-mediated rejection (cAMR) settings. METHODS: We compared 21 kidney transplant recipients (KTRs) with a diagnosis of cAMR in a retrospective case-control analysis: nine KTRs treated with plasmapheresis, intravenous immunoglobulins and rituximab (PE-IVIG-RTX group) vs 12 patients (control group) not treated with antibody-targeted therapies...
September 10, 2018: World Journal of Transplantation
Byron Smith, Lynn D Cornell, Maxwell Smith, Cherise Cortese, Xochiquetzal Geiger, Mariam P Alexander, Margaret Ryan, Walter Park, Martha Catalina Morales Alvarez, Carrie Schinstock, Walter Kremers, Mark Stegall
Poor reproducibility in scoring antibody-mediated rejection (ABMR) using the Banff criteria might limit the use of histology in clinical trials. We evaluated the reproducibility of Banff scoring of 67 biopsies by six renal pathologists at three institutions. Agreement by any two pathologists was poor: 44.8-65.7% for glomerulitis, 44.8-67.2% for peritubular capillaritis, and 53.7-80.6% for chronic glomerulopathy (cg). All pathologists agreed on cg0 (n = 20) and cg3 (n = 9) cases, however, many disagreed on scores of cg1 or cg2...
September 4, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Mark Haas
The Banff classification of renal allograft pathology defines specific morphologic lesions that are used in the diagnosis of active (glomerulitis, peritubular capillaritis, endarteritis) and chronic (transplant glomerulopathy, peritubular capillary basement membrane multilayering, transplant arteriopathy) antibody-mediated rejection (ABMR). However, none of these individual lesions are specific for ABMR, and for this reason Banff requires 1 or more additional findings, including C4d deposition in peritubular capillaries, presence of circulating donor-specific antibodies (DSAs), and/or expression in the tissue of transcripts strongly associated with ABMR, for a definitive diagnosis of ABMR to be made...
December 2018: American Journal of Transplantation
Andriy V Trailin, Tamara N Nykonenko, Tetyana I Ostapenko, Sergiy R Vildanov, Olexandr S Nykonenko
OBJECTIVES: Our aim was to evaluate which histologic lesions in a donor kidney were associated with graft function up to 5 years and with its dynamics. MATERIALS AND METHODS: We retrospectively investigated the association between acute and chronic individual histologic lesions and composite scores in preimplant and postreperfusion biopsies from deceased-donor (n = 101) and living-donor (n = 29) kidneys with initial graft function and function at discharge, at 6 months, and at 5 years and slopes of estimated glomerular filtration rate from discharge to 6 months and from 6 months to 5 years...
August 17, 2018: Experimental and Clinical Transplantation
Nicolas Kozakowski, Harald Herkner, Farsad Eskandary, Michael Eder, Wolfgang Winnicki, Johannes Kläger, Gregor Bond, Željko Kikic
Background: Peritubular capillaritis (ptc), reported by the ptc score, is a major feature of kidney allograft rejection and microvascular inflammation (MVI). MVI sum scores (ptc + glomerulitis score ≥2) are accepted diagnostic surrogates of human leucocyte antigen (HLA)-antibody interaction. However, low-grade inflammation is common and ptc scores (number of leucocytes/capillary) may not mirror all aspects of ptc morphology. Recently we observed a relationship of the diffuse extent of ptc (inflammation of >50% of the renal cortex) with graft loss and significantly higher donor-specific antibody levels, suggesting potential inclusion of diffuse ptc as an additional surrogate of antibody-antigen interaction...
July 20, 2018: Nephrology, Dialysis, Transplantation
Daqiang Zhao, Tao Liao, Siwen Li, Yannan Zhang, Haofeng Zheng, Jing Zhou, Fei Han, Yu Dong, Qiquan Sun
Antibody-mediated rejection (AMR) is the main barrier to renal graft survival, and mouse renal AMR models are important to study this process. Current mouse models are established by priming the recipient to donor skin for over 7 days before kidney transplantation. The robustness of AMR in these cases is too strong to mimic clinical AMR and it is unclear why altering the priming times ranging from 7 to 91 days fails to reduce the AMR potency in these models. In the present study, we found that the donor-recipient combination and skin graft size were determinants of donor-specific antibody (DSA) development patterns after skin transplantation...
2018: Frontiers in Immunology
Shigeo Hara
The Banff histopathology classification system is the gold standard for assessing the causes of kidney allograft dysfunction triggered by antibody-mediated and T-cell-mediated immune reactions, thereby providing mechanistic insight and guiding therapeutic decisions. The original Banff classification (1993) consisted of four histological categories representing cell-mediated rejection: interstitial inflammation (i), tubulitis (t), endoarteritis (v), and transplant glomerulitis (g). The revised Banff 2007 classification added total inflammation score (ti) from both scarred and unscarred areas based on evolving interpretations of interstitial infiltrates...
July 2018: Nephrology
Aki Mafune Hamada, Izumi Yamamoto, Mayuko Kawabe, Haruki Katsumata, Takafumi Yamakawa, Ai Katsuma, Yasuyuki Nakada, Akimitsu Kobayashi, Yusuke Koike, Jun Miki, Hiroki Yamada, Takahiro Kimura, Yudo Tanno, Ichiro Ohkido, Nobuo Tsuboi, Hiroyasu Yamamoto, Takashi Yokoo
Plasma cell-rich acute rejection (PCAR) is a rare type of acute rejection in renal transplantation. Despite aggressive immunotherapy, approximately 40-60% of patients develop graft loss within 1 year after an episode of PCAR. However, the reason for this outcome remains obscure. This study retrospectively identified six patients with PCAR diagnosed between 2009 and 2015 at a single university hospital. Clinicopathological data were collected. Five of the six patients were male, and mean age at the onset of PCAR was 49...
July 2018: Nephrology
Ken Sakai, Hideyo Oguchi, Masaki Muramatsu, Seiichiro Shishido
Accurate interpretation of renal allograft biopsy is necessary to guide therapy, especially when an episode biopsy is taken to rescue the graft. Contrarily, a protocol biopsy is carried out routinely to identify baseline conditions (biopsy at 0 or 1 h), subclinical rejection, histological change under current immunosuppression regimen, drug nephrotoxicity, viral infection, and recurrence of glomerulonephritis. Semiquantitative scoring for active lesions including tubulitis, glomerulitis, capillaritis, arteritis, arteriopathy, and others such as polyomavirus infection are key factors in transplant pathology...
July 2018: Nephrology
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