Correction of Serum Leptin after Successful Kidney Transplantation.

Introduction: Serum leptin levels are increased in chronic kidney disease (CKD) patients primarily due to decreased clearance by kidneys. As leptin is a 16 Kda protein, it is also not cleared even by dialysis using conventional dialyzers or by continuous ambulatory peritoneal dialysis (CAPD). Studies have shown that elevated leptin levels are corrected after successful renal transplantation. With this intention, we determined if restoration of renal function with kidney transplantation can reduce serum leptin concentration in CKD patients. Materials and Methods: A total of 21 Patients undergoing living donor kidney transplantation were studied. There were 13 men and 8 women, from 16 to 45 years of age. All patients were receiving Hemodialysis prior to transplant. All patients received triple immunosuppressant therapy after the surgery. There were no graft rejections. Blood samples were collected under fasting conditions before and 6 days after transplantation. Results: The mean age of the patients was 28.38±9.38 years. Pre transplantation leptin concentration was 9.96 + 3.48 ng/ml and this decreased to 4.07±1.7 ng/ml within six days of transplantation (p<0.0001). However there was no concomitant change in Body Mass Index (BMI) as the follow-up was too short. Plasma Creatinine level declined from 7.5±1.6 mg/dl to 1.1±0.7 mg/dl within six days after transplantation. Conclusion: Successful renal transplantation immediately reduces serum leptin levels along with serum creatinine. The reduction in serum leptin levels after renal transplantation is likely due to reversal of renal function. Neither pre nor post transplant plasma Leptin levels correlated significantly with BMI in our study.

Strongyloides Hyperinfection in Renal Transplant - diagnosis by Endoscopic Intestinal Biopsy.

Introduction: Intestinal parasites continue to be a significant health problem in renal transplantation patients. Strongyloides infection is unique that it excretes larvae and can continue life cycle by auto infective cycle also. Presentation of the case: We present a 26 years old man presented with acute cellular rejection after three months of kidney transplantation. Before transplantation stool of both recipient and donor was negative for parasites. He received three doses of intravenous methylprednisolone. After one month he presented with severe epigastric pain and vomiting. On examination he was malnourished, dehydrated and lost two kilograms of weight over one month. His serum albumin was 2.9 mg/dL. Pain did not subside with proton pump inhibitors. Stool examination was negative for parasites. As index of suspicion for parasites was high, upper GI endoscopy was done; it showed multiple ulcers in duodenum. Biopsy of the ulcer showed strongyloides infection He was treated with ivermectin. Abdomen Pain was subsided soon. He gained weight of 1.5 kilograms over next month. Conclusion: When transplant patients from developing country with recent increase of immunosupression presents with severe abdomen pain, the intestinal parasitic infection should be entertained. If stool examination is negative and serology is unavailable, early evaluation by endoscopic biopsy is helpful to diagnose strongyloides. Prolonged treatment with ivermectin and follow-up stool examinations are important for complete cure of strongyloides infection.

Light chain immunofluorescence in various nephropathies.

Context: Light chain immunofluoresence (IF) in renal biopsy is routinely used in the diagnosis of light chain deposition disease (LCDD), amyloidosis and cast nephropathy. Light chain predominance has also been reported in certain glomerulopathies like IgA nephropathy. However, pathogenesis of this pattern of deposition in various glomerulopathies is uncertain. Aim: To discuss the pathogenesis and utility of light chain IF in nephropathies. Setting and Design: Retrospective study. Materials and Methods: The pattern of light chain IF and light microscopic diagnosis in 306 cases of various nephropathies was reviewed. Direct IF was done in all these cases with commercial fluorescence (Fluoresciene Isothiocynate ) conjugated polyclonal rabbit anti-human antisera against IgM, IgG, IgA, C3, C1q, kappa and lambda light chains. Results: Light chain deposits were seen in 240 (78.43%) cases. In IgA nephropathy, lupus nephritis and post-infectious glomerulonephritis (PIGN), lambda positivity was more as compared to kappa. Light chain deposits in LCDD and membranous nephropathy were more kappa type. The IF pattern in amyloidosis was not consistent. Conclusion: The pathogenesis of light chain predominance in glomerulopathies is not clear and it depends on isoelectric point and size of the immune complex. Light chain IF should be performed routinely in all the renal biopsies.