ABSTRACT
no abstract
ABSTRACT
Background: Transplantation among ABO blood group incompatibility was considered an absolute contraindication until recent development of successful protocols. A living-donor across ABO barriers may provide another option for end-stage kidney disease patients. Objective: To report the first case of ABO-incompatible living-donor kidney transplantation (ABOi-LKT) in Thailand. Patients and method: The kidney transplantation across ABO barriers was performed following the Japanese recommended protocol. The kidney recipient was a thirty-four years old woman with blood group-O, whereas the kidney donor was her brother with blood group A. To reduce anti-donor (anti-blood group-A antibody) blood levels, the patient underwent double filtration plasmapheresis and received an intravenous anti-CD20 monoclonal antibody. A maintenance immunosuppressive regimen was similar to the one of ABO-compatible setting. Results: The kidney allograft had immediate good function. The transplantation was uneventful, and the patient went home within two weeks. Kidney allograft biopsies were performed on a protocol-driven basis at time-zero, the first and sixth month post-transplantation. Histologic studies showed unremarkable findings. The patient is now twelve months after transplantation and has achieved excellent kidney function. Conclusion: ABOi-LKT provides an alternative treatment for end-stage kidney disease patients. A multi-center study of ABOi-LKT in Thailand is ongoing, and this may change the national policy of organ donation in the near future.
ABSTRACT
Objective: Cadmium (Cd) is a cumulative poison. Long-term exposure to environmental Cd causes oxidative stress, renal dysfunction and bone defects. The present study aimed to investigate the status of renal impairment and risk of urolithiasis in inhabitants environmentally exposed to Cd in Mae Sot District, Tak Province of Thailand. Methods: A total of 77 non-smoking women were recruited to the study, 40 subjects from high Cd-polluted areas (Group 1), 17 subjects from the vicinity of Cd-polluted areas (Group 2) and 20 control subjects from non Cd-polluted areas living outside the Mae Sot District (Group 3). Blood and 24-hr urine samples were collected. Plasma creatinine (Cr), calcium (Ca), magnesium (Mg) and zinc (Zn) were measured. Levels of Cd, Zn, Mg, Ca, Cr, proteins and N-acetyl-β-glucosaminidase (NAG) activity were determined from urine samples. Results: Group 1 and Group 2 excreted urinary Cd significantly higher than Group 3. The prevalence of urinary Cd \> 2 mg/g Cr in Group 1, Group 2 and Group 3 were 25%, 11.8% and 0%, respectively. Creatinine clearance (CCr) of Group 1 was significantly lower than that of Group 2. Urinary excretions of proteins, Ca and Zn in Group 1 were significantly higher than in Group 2. Urinary levels of NAG activity and proteins in Group 1 were significantly higher than in Group 3. The urinary level of Ca in Group 1 was significantly higher than in Group 3. In contrast, urinary Mg in Group 1 was significantly lower than that in Group 3. In Group 1, urinary Cd was positively correlated with urinary NAG activity, proteins and Zn, but it was inversely correlated with CCr. Conclusion: The residents of high Cd-polluted areas had renal impairment, increased urinary Ca and decreased urinary Mg. Subjects who resided in the vicinity, manifested kidney damage. These local populations are at risk for kidney diseases, particularly urolithiasis.
ABSTRACT
Objective: The etiology of kidney stone is multifactorial including environmental, behavioral and genetic. Insights about predisposing causes and mineral composition are mandatory for better management of kidney stone disease. The present hospital-based study aims to explore the mineral constituents and etiologic risks of kidney stones in Thai patients from the four geographic regions of the country. Method: Two hundred and fifty six kidney stone patients from four geographic regions of Thailand, including the northeastern (n=103), the northern (n=81), the central (n=47) and the southern (n=25) were recruited in this study. Of these, 144 patients completed the food frequency questionnaire to assess the kidney stone risk. Mineral composition of stones were analyzed by Fourier transformed infrared spectrometry. Results: Kidney stone frequently affected peoples aged 40-49 years. Only 31.9 % of patients had a positive family history of renal stone. Calcium oxalate (CaOx) stone was the most prevalent type (73.8 %). Uric acid (UA) stone was found in 16.0 % commonly affected peoples aged 60-70 years. Mixed stones, notably CaOx mixed with calcium phosphate (CaP), were more prevalent than pure stones. The food frequency questionnaire data showed that 59.7 % of stone patients consumed less than two liters of water per day. Low intakes of fruits and vegetables were notably present. In contrast, high consumption of rice was observed in over 65 % of stone patients. Conclusion: CaOx mixed with CaP was the most prevalent stone type. UA stone was more likely to occur in the elderly. Kidney stone patients were found to consume less-than-adequate amounts of water, food high in carbohydrates, along with low consumtion of fruits and vegetables. These dietary habits might be risk factors in stone development among the Thai population. Keywords: Dietary risk factor, family history of renal stone, kidney stone risk factor, nephrolithiasis, stone composition.