Presumed monozygotic twin kidney transplantation with a thin basement membrane nephropathy donor: A case report

@#Identical or Monozygotic twin kidney transplant usually possess an excellent immunological match and provide the opportunity to minimize or even avoid immunosuppression toxicity. However, there are concerns regarding disease recurrence among end stage kidney disease (ESKD) patients with an unknown etiology. Together with the risk of inherent, familial disease affecting donors and recipients alike, more invasive tests such as a pretransplant biopsy are being considered to ascertain renal prognosis. A 30-year-old female, known case of CKD Stage 5D from an unknown etiology, with secondary hyperparathyroidism and heart failure, presented at our OPD for kidney transplantation. Her donor is her identical twin who is asymptomatic and denies comorbidities. The recipient discloses a previous history of blood transfusion. Immunological workup revealed the following: matched blood type, zero HLA mismatch, negative T-cell tissue crossmatch but with a positive Class I HLA antigen screen. Antibody specificity revealed the presence of donor specific antibodies (DSA). After workup completion, the patient underwent a right kidney transplant with a preimplantation wedge biopsy on the donor kidney. Immediate graft function was noted post operatively. The wedge biopsy revealed a thinned glomerular basement membrane, consistent with Thin Basement Membrane Nephropathy (TBMN). The patient was started on immunosuppression and prophylaxis during the duration of the post operative period without any complications. Five months post-transplant, both the recipient and donor maintain an adequate renal function without any signs of allograft rejection. In this case report, we have demonstrated that TBMN may serve as a viable donor for a presumed monozygous twin kidney transplantation. When a live donor with TBMN is being considered, a thorough work-up and identification of high-risk features are essential to exclude other progressive renal diseases during the pretransplant evaluation.

Minimal change disease associated with SARS-CoV-2 (COVID-19) infection among adult Filipinos: A report of two cases and review of related literature

@#A 40-year-old Filipino female with a history of right total mastectomy for a low-grade phyllodes tumor was admitted due to stillbirth. Her laboratory results revealed an incidental finding of a positive COVID-19 RT-PCR swab, serum creatinine 1.04 mg/dL, urine RBC 1/HPF, and a 24-hour urine protein of 9.22 grams with hypoalbuminemia and dyslipidemia. Serologic workup was noted to be negative. A kidney biopsy was performed which demonstrated unremarkable light microscopy (LM) and immunofluorescence (IF) with widespread podocyte-foot process effacement, consistent with minimal change disease. She was started on prednisone (1 mg/kg/day) and achieved complete remission after six weeks. A 61-year-old Filipino male with a history of Type 2 Diabetes Mellitus, Hypertension, Dyslipidemia, and mild COVID-19 infection four months prior, now presented with diarrhea. On admission, his COVID-19 RT-PCR swab revealed a reinfection. Workup demonstrated a serum creatinine 3.39 mg/dL, urine RBC 2/HPF, and urine ACR 2.6 g/g. Serologic tests were negative. He was diagnosed with Nephrotic Syndrome and underwent kidney biopsy. Findings showed an unremarkable LM and IF with widespread podocyte-foot process effacement, consistent with minimal change disease. He was started on prednisone (1 mg/kg/day) and achieved complete remission after eight weeks. SARS-CoV-2 (COVID-19) may present with a variety of kidney involvement which includes glomerulopathies such as MCD. An accurate diagnosis using the patient’s clinical presentation, renal histopathology, and adjunct laboratory examinations, is essential to direct effective management and good outcomes.

Post-operative Aspirin in preventing early renal allograft thrombosis: A meta-analysis

@#BACKGROUND: Kidney transplantation (KT) remains to be the preferred mode of renal replacement therapy as it offers the best clinical outcomes, a better quality of life, and lesser complications compared to dialysis. However, KT still carries a number of complications, one of which is graft thrombosis. Despite advancements in treatment, graft thrombosis is still an important cause of early graft loss. Prevention therefore, is of significance. A growing number of evidence suggests that low-dose aspirin has a role in the primary prevention of allograft thrombosis. RESEARCH QUESTION: Among renal transplant recipients, does postoperative aspirin prevent early renal allograft thrombosis? OBJECTIVE: To conduct a meta-analysis to determine the effect of postoperative aspirin on preventing renal allograft thrombosis. METHODS: A systematic search of PubMed, Google Scholar, CENTRAL, and clinicaltrials.gov was done by two independent authors. All randomized and non-randomized studies determining the effect of postoperative aspirin on renal vein/allograft thrombosis were reviewed for eligibility and quality assessment. Studies on both adult and pediatric kidney transplant recipients were included. RESULTS: Five non-randomized cohort studies (3 in adults, 2 in children) with a total of 2,393 patients were included. Using the Newcastle-Ottawa scale, two studies were found to have good quality, while three had poor quality. In a fixed-effects meta-analysis, aspirin was associated with a reduced risk for renal allograft thrombosis in adults (RR 0.13; 95% CI 0.06, 0.28;I2 22%) and children (RR 0.11; 95% CI 0.03, 0.40; I2 0%). CONCLUSION: Post-operative aspirin was associated with reduced risk for renal allograft thrombosis in both adults and children. However, the best available evidence is limited to observational studies. A well-designed randomized controlled trial is needed to confirm this finding.

Cerebral Palsy Growth Charts versus Standard Growth Charts for Assessing Growth in Children with Cerebral Palsy.

Background: In 2011 the American Life Expectancy Project created growth charts specifically designed for use in children with cerebral palsy (Brooks et al., 2011). The charts differ from the standard Royal College of Paediatrics and Child Health (RCPCH) growth charts as they are based upon the measured growth of children with cerebral palsy and are divided by gross motor function classification system (GMFCS). This research aims to determine the differences in plotted growth between the cerebral palsy growth chart and the standard RCPCH growth charts for children with cerebral palsy. Methods: Children with a primary diagnosis of cerebral palsy attending special schools in Islington were identified by their electronic patient records. Ethical approval was not needed as research was limited to secondary use of anonymous information. The children were stratified based on GMFCS and given a score from 1-5, with 5 being divided between tube fed and non tube fed (Day et al., 2007). Growth was then retrospectively plotted on both a RCPCH standard growth chart and a cerebral palsy growth chart. One weight was plotted for every six months of the data collected. Excel was used to convert the data to centiles and calculate how many centiles each plotted growth was away from the 50th, with the 50th being classified as 0. Mean centiles for each age group were calculated for both the cerebral palsy and RCPCH growth charts and variations between the two charts were determined. Results: In total 36 children were identified ranging in age from two to 18 years, with the mean age 11.6 years + 4.2. Stastical analysis was only done on children with GMFCS score of 4 or 5 as sample sizes for GMFCS 1-3 were too small. Plotted data on the cerebral palsy growth charts showed that on average children were 1 centile + 0.96 above the 50th centile whilst RCPCH growth chart shows that they were 3 centiles + 1.00 below the 50th centile. Discussion: The results show a clear difference between growth centiles for weight of children with cerebral palsy when plotted on the two different charts. These outcomes mirror those discovered by Day et al. (2007) however, the results from this research show that there is more variation between centiles as age increases which was not found by Day et al. [2]. Conclusion: This study shows that there is a difference in plotted growth between the cerebral palsy growth chart and the standard RCPCH growth charts however further research is needed to determine whether this difference is significant.