Effect of lymph leakage on renal allograft outcome from living donors.

Lymph leakage is a cause of prolonged fluid discharge in renal transplant patients. Lymph leakage during early post-transplantation is responsible for extracting immune substances; therefore, it may play a role in prognosis of the transplanted kidney. In this study, we aimed to investigate the effects of lymph leakage on different factors that play significant roles in renal allograft outcome. During the present case-control study, we evaluated 62 renal allograft recipients in which 31 subjects were complicated with lymph leakage and enrolled as the study group. The other 31 subjects were included in the control group who did not experience any lymph leakage during their post-transplantation period. All kidneys were transplanted from living donors. We investigated and compared the renal allograft rejection rate, hospitalization duration, serum urea, creatinine (Cr) and cyclosporine (CsA) levels, antithymoglobin (ATG) administration and treatment duration between the study and the control groups. There were no significant difference in the urea and Cr levels between the two groups (P >0.05). Early (one week) and late (one month) serum CsA levels of the study group were significantly higher than in the control group (P = 0.005 and P = 0.006). The number of days in which ATG receivers responded to therapy was significantly lower for the control group (P = 0.008). 21.93% of the study group subjects experienced allograft rejection, while this rejection probability was 28.38% for the control group (P = 0.799). Lymph leakage has no prominent role in renal function, which is estimated by Cr and urea levels in patients' serum during the days after transplantation. CsA level was higher in patients with lymph leakage, and all cases of allograft rejection were in the subjects with lymph leakage.

Remnant kidney function and size in living unrelated kidney donors after nephrectomy.

There are few published reports examining the extended outcome of donors after nephrectomy. The aim of present prospective study was to evaluate the changes of glomerular filtration rate (GFR) and ultrasonographic kidney size in unrelated living kidney donors during post-nephrectomy period. Thirty nine unrelated living kidney donors were prospectively followed after nephrectomy. Length, anterioposterior (AP) diameter, and cortical thickness of the kidney were determined before, one week and three months after nephrectomy. GFR and serum creatinine (Cr) level were assessed simultaneously. The mean age of participants was 25.41 +/- 2.67 years with the male to female ratio of 29 to 10. Although GFR decreased 1 week after nephrectomy (P= 0.001), considering the pre-nephrectomy GFR as a result of both kidneys' function and half of its value as a marker of the remnant kidney's function [(123.68 +/- 17.99)/2], the calculated GFR for the remnant kidney increased about 63% after one week and 91%, after three months of nephrectomy (P= 0.003). Remnant kidney length, AP diameter, and cortical thickness were significantly increased during post-nephrectomy follow up (P< 0.001, P< 0.001, and P= 0.001, respectively). Results of present study showed that the GFR of remnant kidney was increased after nephrectomy, and serum Cr level was not changed, despite the mild increase at first post nephrectomy week. Also, remnant kidney size increased following nephrectomy in donors.

Arterial atherosclerosis in patients with chronic kidney disease and its relationship with serum and tissue endothelin-1. [corrected].

Instruction. We investigated the correlation between atherosclerosis and tissue and serum levels of endothelin-1 in patients with chronic kidney disease (CKD). MATERIALS AND METHODS. Arterial samples were obtained from 35 patients with CKD during arteriovenous fistula placement. Thirty-one patients with cardiovascular disease who underwent coronary artery bypass graft (CABG) were selected as the atherosclerotic group, and a piece of their aorta punched during CABG was obtained. Also, a small piece of the renal artery was dissected during donation in 24 kidney donors (control group). Tissue endothelin-1 level was measured and atherosclerosis grading was determined by pathologic examination. Serum levels of endothelin-1 were also measured in the three groups. Results. The mean tissue endothelin-1 levels were 10.73+/-7.57 pg/mL, 12.16 +/- 3.95 pg/mL, and 0.93 +/- 1.06 pg/mL in the patients with CKD, those with CABG, and donors, respectively (P < .001). The mean serum endothelin-1 level was 25.23 +/- 15.15 pg/mL in the patients with CKD, 21.13 +/- 17.22 pg/mL in the patients with CABG, and 2.66 +/- 1.51 pg/mL in the donors (P < .001). Atherosclerosis grades correlated with tissue endothelin-1 level (r = 0.823, P < .001) and serum endothelin-1 level (r = 0.608, P < .001) in the patients with CKD. Multiple regression analysis showed tissue endothelin-1 level as the main predicting factor of atherosclerosis (P < .001). CONCLUSIONS. Tissue endothelin-1 concentration is more important than serum endothelin-1 or lipids levels in prediction of atherosclerosis. Thus, blockade of tissue endothelin-1 receptors with its antagonists may prevent atherosclerosis progression.

Post-transplant urological and vascular complications.

To determine the prevalence of urological and vascular complications in renal trans-plant recipients (RTx) at Tabriz Renal Transplant Center, we studied 55 recipients of renal allo-grafts (25 male and 29 female patients with a mean age of 38.3 +/- 13.4 years) from October 2005 to November 2006. The surgical complications in our study included hematomas: 20.4%, renal artery stenosis: 20.4%, calculi: 7.4%, hydronephrosis or ureteral stricture: 5.6%, urinary leakage: 5.6%, lymphoceles: 1.9%, and renal vein thrombosis: 1.9%. We conclude that the most common urologic complications in our center were ureteric strictures and urine leaks, and the most common vascular complication was renal artery stenosis.

Postnephrectomy changes in Doppler indexes of remnant kidney in unrelated kidney donors.

INTRODUCTION: We aimed to evaluate the intralobar renal arteries indexes using the Doppler ultrasonography indexes, which have become the established method of kidney monitoring, in living unrelated kidney donors during the postnephrectomy period. MATERIALS AND METHODS: In this prospective study, we evaluated and followed up 34 living unrelated kidney donors. The Doppler ultrasonography indexes, including resistive index, pulsatility index, and peak systolic velocity, along with the grey-scale ultrasonographic indexes of cortical thickness, length, and anteroposterior diameter of the kidney were determined before nephrectomy, and then, 1 week and 3 months after nephrectomy. In addition, glomerular filtration rate were assessed simultaneously. RESULTS: The resistive index and pulsatility index did not change 1 week and 3 months after nephrectomy (P = .66 and P = .38, respectively). The peak systolic velocity at 1 week was significantly higher than its prenephrectomy value (P = .02). Also, the peak systolic velocity at 3 months was significantly higher than that prior to nephrectomy (P < .001). Indexes of the kidney size all increased during the follow-up period. The estimated glomerular filtration rate increased decreased 1 week after nephrectomy, but it reach to a level comparable with its preoperative values after 3 months. CONCLUSION: Results of the present study showed an increased peak systolic velocity in association with unaltered resistive index and pulsatility index in the remnant kidney of donors, during the short-term follow-up. This finding indicates the increased blood flow and kidney size in the remnant kidney of donors, following nephrectomy.

Evaluation mannose-binding lectin gene and promoter polymorphism in renal transplant recipients.

OBJECTIVE: The aim of present study was to determine the distribution of the alleles of mannose-binding lectin gene and promoter variants in renal transplant recipients and seek correlation between these variants and diseases that cause renal dysfunctions. METHODS: One hundred and thirteen renal recipients' samples were compared with 120 normal controls from Azarbaijan population of Iran. Blood samples were obtained from renal transplant recipients who received a kidney between March 2004 and July 2005. Mannose-binding lectin genotypes were investigated by polymerase chain reaction and restriction fragment length polymorphism. RESULTS: Allelic and genotypic frequency of the polymorphism at position- 550, -221, +4 and at codon 52, 54 and 57 did not show statistical differences between recipients and controls (P > 0.05) but significant frequency of allele B (codon 54) (P = 0.02) and Lx haplotype (P = 0.002) of promoter was observed in patients with Lupus Erythematosus and infection source of renal dysfunctions. CONCLUSION: Our findings provide evidence that presence of different alleles and haplotypes that cause low concentration of mannose-binding lectin in serum is a risk factor for severity of systemic Lupus Erythematosus and susceptibility to renal infections that cause renal dysfunction.