Tubulointerstitial nephritis and uveitis: report of a rare syndrome

Tubulointerstitial nephritis and uveitis [TINU] is a rare syndrome with unknown pathogenesis. Data have shown a higher prevalence in female gender. We present a man with tubulointerstitial nephritis and uveitis syndrome and antitubular antibody. A 23-year-old man presented with a history of weight loss, nausea, and vomiting, and uveitis. His serum creatinine was 2.1mg/d with pyuria and proteinuria in urinalysis. Other laboratory and imaging studies were unremarkable. Kidney biopsy showed granulomatous interstitial nephritis. Normal renal tissue specimen treated with patient's serum showed focal cytoplasmic staining in cortical tubular cells. The patient received prednisolone for 1 month. Interstitial nephritis and uveitis were well controlled. There was no recurrence in 1-year follow-up. We suggest that tubulointerstitial nephritis and uveitis syndrome should be considered in differential diagnosis of patients with interstitial nephritis and uveitis. Antitubular antibody may be used as a diagnosis marker for this syndrome

Estimation of glomerular filtration rate with creatinine-based versus cystatin C-based equations in kidney transplant recipients

Serum cystatin C is more sensitive for glomerular filtration rate [GFR] measurement, but it is not available for clinical use in all laboratories. Regarding the importance of accurate estimation of GFR in kidney transplant recipients, we compared cystatin C-based equations with creatinine-based formulas to estimate GFR as precisely and simply as possible in kidney transplant recipients. Seventy living donor kidney transplant recipients with stable kidney function were enrolled in our study. The patients' GFRs were estimated by 3 creatinine-based equations [the modification of diet in renal disease [MDRD], abbreviated MDRD, and Cockcroft-Gault] and 5 cystatin C-based equations [Filler, Le Bricon, Rule, Hoek, and Larsson], and the results were analyzed. The mean age of the recipients was 38.7 +/- 13.4 years. The mean GFRs were 67.1 +/- 25.9 mL/min/1.73 m[2], by the Cockcroft-Gault; 61.0 +/- 17.7 mL/min/1.73 m[2], by the abbreviated MDRD; and 60.0 +/- 18.6 mL/min/1.73 m[2], by the MDRD formulas. Cystatin C-based GFR estimations were 43.6 +/- 16.2 mL/min/1.73 m[2], 44.0 +/- 13.2 mL/min/1.73 m[2], 33.8 +/- 14.1 mL/min/1.73 m[2], 35.6 +/- 13.7 mL/min/1.73 m[2], and 36.9 +/- 13.6 mL/min/1.73 m[2] by the Filler, Le Bricon, Larsson, Rule, and Hoek equations, respectively. The estimates by creatinine-based and cystatin C-based equations were significantly different and the MDRD estimate was the closest to the cystatin C-based GFRs. Our findings revealed the MDRD equation could be provide a closer estimate of GFR to the cystatin C-based equations than other creatinine-based GFR calculations in kidney transplant recipients

Posttransplant diabetes mellitus in kidney allograft recipients at Shaheed Hasheminejad Hospital

Our aim was to evaluate the frequency and risk factors of posttransplant diabetes mellitus [PTDM] at our kidney transplant center, and to compare graft and patient outcomes between the kidney recipients with and without PTDM. We studied 203 kidney transplant recipients with a negative history of diabetes mellitus before transplantation. We examined them for PTDM and made diagnosis on the basis of the American Diabetes Association criteria. Measurements of plasma glucose were carried out from 3 months to 24 months after transplantation. All data including recipient and donor demographics, cause of end-stage renal disease, cytomegalovirus and hepatitis C virus antibody tests, and patient and graft outcomes were assessed in relation to PTDM. High fasting plasma glucose was seen in 24 [11.8%], 19 [9.4%], 16 [7.9%], and 13 [6.4%] patients at 3, 6, 12, and 24 posttransplant months, respectively. Moreover, impaired glucose tolerance was seen in 17 [8.4%], 16 [7.9%], 17 [8.4%], and 19 [9.4%] patients at the corresponding times, respectively. Accordingly, 39 patients [19.2%] were diagnosed to have PTDM. The mean age of the kidney recipients with PTDM was 46.5 +/- 12.3 years as compared to 38.6 +/- 13.4 years in nondiabetic kidney recipients [P = .02]. The 5-year patient and graft survival rates were not significantly different between the kidney recipients with and without PTDM. This study showed that PTDM is a common metabolic disorder in our kidney transplant patients. We recommend a less diabetogenic immunosuppressive protocol, especially for our older recipients