Diagnostic efficacy of C4d immunostaining in the detection of the humoral component of renal allograft rejection and therapeutic implications.

Context: In the current scenario of renal transplantation, the role of immunological methods in the detection of C4d has emerged as a useful adjunct in the recognition of acute humoral rejection (AHR). Few reports of this nature are available from the Indian context although there are several from the Western literature. Aims: To study the humoral component of renal allograft rejection in patients presenting clinically with graft dysfunction by histopathological detection of polymorphs in the peritubular capillaries and the expression of C4d using immunological techniques, as well as the response of patients to appropriate antirejection therapy. Settings and Design: This study from a tertiary care center reemphasizes the importance of recognition of AHR as a cause of renal allograft dysfunction. Materials and Methods: Percutaneous renal biopsies were obtained from 40 postrenal transplant patients and evaluated for C4d using immunofluorescence and immunohistochemical methods. Statistical a0 nalysis used: SPSS software. Results: Positive expression of C4d was seen in a total of 19/40 cases (44.4%) indicating immunological evidence of AHR. Diffusely positive cases were treated with IV immunoglobulin therapy, plasmapheresis and Rituximab following which graft function was restored. Patients with minimal to focal positive expression of C4d responded well to pulse steroids and change in immunosuppressive therapy. Conclusions: C4d staining is a useful adjunct to routine histopathological methods in evaluating the humoral component of acute renal allograft dysfunction and helps in planning appropriate antirejection therapy with the goal of achieving long-term graft survival.

Correlation of anemia, secondary hyperparathyroidism with left ventricular hypertrophy in Chronic Kidney Disease patients.

AIMS: To demonstrate the correlation of anemia and intact parathormone with left ventricular hypertrophy in a cohort of Chronic Kidney Disease (CKD) patients in a tertiary care centre. METHODS: A cross-sectional study was done over 2 years on 230 renal failure patients (160 males, 70 females), aged 15-75 years, who had elevated serum creatinine and reduced GFR. The patients were assessed based on clinical history and a number of laboratory parameters including serum creatinine, calcium, iPTH level, Hb, Hct, GFR and LVMI. Settings : Patients were seen as inpatients and outpatients in a tertiary care centre. RESULTS : In CKD stages I, II and III, 51% of the patients had anemia Hb<11gm/dl), 16%of the patients had elevated iPTH, 79% of male patients and 71% of female patients had LVH. In Stage IV CKD, 55% of the patients had anemia, 25% of the patients had elevated iPTH, 74% of male patients and 100% of female patients had LVH. In stage V CKD, 76% of the patients had anemia, 31% of the patients had elevated iPTH, 77% of male patients and 96% of female patients had LVH. In all five stages, 78% of male patients and 71% of female patients with elevated iPTH had LVH, 81% of male patients and 90% of female patients with anemia had LVH. Systemic hypertension was present in 69% of the patients. CONCLUSION: Anemia is widely prevalent in our cohort of CKD patients. Severity of anemia is correlated to LVH and secondary hyperparathyroidism in these patients.

Renal abscess.

This study analyses the pre-disposing factors, diagnostic modalities, therapeutic options and prognostic factors involved in 7 subjects with renal abscess. Most often they presented with high fever and flank pain. USG and CT were used to establish the diagnosis. Urine culture yielded organisms in five cases and hence empirical antibiotic therapy for Gram-negative organism was offered. Complicated abscess in our series carried high mortality especially in immuno suppressed and cachectic patients.