ABSTRACT
Background: Kidney transplantation is the preferred mode of renal replacement therapy for the endstage renal disease, with dramatic improvements in patient and graft survival over the last 50 years. In the modern era of immunosuppression, 1-year patient survival is close to 98%, and 1-year allograft survival rates have improved to 90% for deceased donor kidney transplants and 95 % for living donor kidney transplants with some inter-center variability. The aim of the study: To elucidate the etiology of graft dysfunction among renal transplant recipients. Materials and methods: A retrospective study was conducted among 155 patients who underwent both cadavers and live donor transplant from October 2009 to March 2011 at a tertiary care center in Chennai, South India. All the transplant recipients were regularly followed with serum urea and creatinine, urine routine, calcineurin inhibitor drug levels in the serum, USG Abdomen, urine culture depending on the graft status. Graft dysfunction defined by a rise in the creatinine more than 25% or 0.3 to 0.5 mg per dl from the baseline. Those who developed graft dysfunction were presented for graft biopsy and managed based on the report accordingly. S. Thirumavalavan, Krishna Kumar, S. A. K. Noor Mohamed, R Vijaya Kumar. Etiology of graft dysfunction in renal transplant recipients. IAIM, 2019; 6(3): 313-318. Page 314 Results: Among the 155 transplant recipient patients, 66 (44%) patients developed graft dysfunction and underwent renal biopsy. The graft dysfunction was due to chronic allograft dysfunction (interstitial fibrosis and tubular atrophy) in 24 (15.4%) patients, acute cellular rejection in 13 (8.4%) patients, acute antibody-mediated rejection in 2 (1.3%) patients, acute tubular necrosis in 9 (5.8%) patients, calcineurin toxicity in 6 (3.9%) patients, thrombotic microangiopathy in 6 (3.9%) patients, IgA nephropathy in 3 (1.9%) patients and transplant renal artery stenosis in 1(0.6%) patient. Conclusion: Among the various causes, acute cellular, acute antibody rejection and chronic allograft nephropathy holds nearly 25% of the incidence of graft dysfunction. It indicates appropriate immunological evaluation, appropriate immunosuppression, use of induction agents in high-risk patients and protocol renal biopsy to identify early rejection in high-risk patient and appropriate early intervention is important to improve long-term term graft and patient survival.
ABSTRACT
Background: Proponents of routine urine dipstick screening to identify patients at risk for ESRD in the primary care setting have argued that urine dipsticks are inexpensive, low risk, acceptable to patients, and now, more accurate. Proponents believe that urine dipstick screening has the potential to improve outcomes for people with early disease and increase awareness of CKD. Most primary care physicians agree that populations who are at high risk for CKD should be tested and appropriately treated to decrease complications of ESRD. However, proponents of mass screening may not appreciate the challenges, limitations, and potential harms of screening. Urine dipstick testing does not meet all of the criteria for a good screening test. The aim of the study: To elucidate the diagnostic efficacy of the urine dipstick in detecting chronic kidney disease by assessing its validity as a screening test for detecting CKD. Materials and methods: A community-based cross-sectional study was conducted among 287 subjects aged 20 years and above residing in the P.K. Garden area of Chennai during November 2018 to January 2019. Subjects were interviewed with a questionnaire and blood samples were collected to estimate serum creatinine and a urine sample was collected to estimate the proteinuria using urine S. Thirumavalavan, Noormohamed, Balaji S.M., R Vijaya Kumar. Diagnostic efficacy of urine dipstick in detecting chronic kidney disease. IAIM, 2019; 6(3): 137-142. Page 138 dipstick. eGFR was calculated using CKD – EPI equation and CKD was diagnosed using KDOQI CKD guidelines. Results: The prevalence of Chronic Kidney Disease (<60 ml/min eGFR) in the study group was 10.45%. The Area under Curve (AUC) of the ROC curve for urine dipstick in detecting CKD was 0.948 (0.900 – 0.996) and the 2+ proteinuria was closest to the ideal test point. When proteinuria criteria set at dipstick 2+ or more, the sensitivity was 83.33% and specificity was 98.36%, positive predictive value was 83.33% and κ coefficient of agreement of proteinuria with CKD was 0.81. Conclusion: The urine dipstick test can be used as an effective screening tool in detecting CKD in primary care level. Non Communicable Diseases screening at primary health care level should include the screening of proteinuria using urine dipstick especially for people with risk factors like Diabetes and Hypertension.