Mycophenolate in refractory and relapsing lupus nephritis.

BACKGROUND: Mycophenolate (MF) is effective as induction and maintenance treatment in patients with lupus nephritis (LN). This study evaluates the efficacy and safety of MF in patients with refractory and relapsing LN. METHODS: Data were retrospectively obtained for 85 patients (35 refractory and 50 relapsing) from 11 nephrology departments in Spain. The primary endpoints were the incidence and cumulative number of renal responses and relapses and their relationship with baseline clinical and analytical data. The secondary endpoint was the appearance of side effects. RESULTS: The main clinical and analytical variables were similar both in refractory and relapsing LN. Most of the patients had received cyclophosphamide, and all of them switched to MF. 74 patients (87%) achieved a response (69% partial, 31% complete). Age at starting MF, gender, pathological classification, body mass index, blood pressure, baseline renal function, and proteinuria were not associated with achieving response. After stopping MF, 3 of 19 patients (15.7%) relapsed, all at 6 months of follow-up. No differences were found between clinical and analytical variables and number of relapses. Side effects were unremarkable, except for 1 patient, who died of thrombocytopenia and ovarian hemorrhage. CONCLUSIONS: Switching to MF from other immunosuppressive treatments is effective and safe in refractory and relapsing LN.

Optimización de donantes expandidos con el trasplante birrenal: estudio caso-control / Optimising expanded donor organs through dual kidney transplantation: a case-control study

Antecedentes: El perfil clínico de los donantes fallecidos se está transformando velozmente hacia un incremento de donantes con criterios expandidos (DCE), por lo que el número de riñones descartados para trasplante está creciendo. Con la finalidad de optimizar el aprovechamiento de riñones de DCE que individualmente podrían aportar una masa renal insuficiente, se ha sugerido su utilización como TX doble o birrenal (TXB). Pacientes y métodos: En un estudio de casos y controles, se analiza la experiencia de un único hospital entre mayo de 2007 y marzo de 2011. Los criterios para decidir TX único o doble quedaron definidos en un protocolo en el que la puntuación de la biopsia era un factor importante, pero no exclusivo, ya que se tenía en cuenta también la edad, los antecedentes del donante, el tamaño de los riñones y el aclaramiento de creatinina. Durante este intervalo se han trasplantado 80 riñones de donantes mayores de 65 años. De ellos, 40 han sido como trasplantes únicos (TXS) y otros 40 como TXB. Resultados: La edad media de los donantes para TXS fue de 68,7 ± 3,0 años y la de los TXB de 74,2 ± 4,3 años (p < 0,001), con predominio de mujeres en TXB (75%) respecto al TXS (40%) (p < 0,001). No se apreciaron diferencias entre ambos grupos respecto a filtrado glomerular o proteinuria. Los riñones derivados para TXB presentaban mayor puntuación en la biopsia que los de TXS (2,95 ± 1,01 vs. 1,8 ± 1,04; p < 0,001). Los receptores de TXB fueron de mayor edad que los de TXS, no encontrando diferencias entre grupos respecto a isquemia fría, retraso de la función del injerto, complicaciones hemorrágicas o reintervenciones. Sin embargo, los receptores de TXB alcanzaron mejor aclaramiento de creatinina en los cortes de 1, 3, 6 y 12 meses, aunque sólo resultara estadísticamente significativo a los 6 meses (53,4 ± 19,5 ml/min vs. 44,5 ± 15,6 ml/min; p < 0,05). La (..) (AU)

Introduction: In order to take full advantage of ECD kidneys, which may not provide sufficient renal mass if used individually, it has been suggested that such organs be used in dual or bilateral kidney transplantation (DTx). Patients and method: We analysed the experience in a single hospital between May 2007 and March 2011 in a case-control study. Criteria for determining whether to perform single or dual Tx were defined in a protocol in which the biopsy score was important, but not the only factor. Donor's age, medical history, kidney size and creatinine clearance were also considered. During this time period, 80 kidneys from donors over age 65 were transplanted. Single transplants (STx) accounted for 40 of the organs, and another 40 were used in DTx. Results: Mean donor age for STx was 68.7±3.0 years; for DTx, it was 74.2±4.3 years (P<.001), with more female donors for DTx (75%) than for STx (40%) (P<.001). There were no differences between groups with regard to glomerular filtration rate or proteinuria. Kidneys assigned to DTx received higher biopsy scores than those assigned to STx (2.95±1.01 vs 1.8±1.04; P<.001). DTx recipients were older than STx recipients. There were no differences between the groups regarding cold ischaemia time, delayed graft function, haemorrhagic complications (..) (AU)

Optimising expanded donor organs through dual kidney transplantation: a case-control study.

INTRODUCTION: In order to take full advantage of ECD kidneys, which may not provide sufficient renal mass if used individually, it has been suggested that such organs be used in dual or bilateral kidney transplantation (DTx). PATIENTS AND METHOD: We analysed the experience in a single hospital between May 2007 and March 2011 in a case-control study. Criteria for determining whether to perform single or dual Tx were defined in a protocol in which the biopsy score was important, but not the only factor. Donor's age, medical history, kidney size and creatinine clearance were also considered. During this time period, 80 kidneys from donors over age 65 were transplanted. Single transplants (STx) accounted for 40 of the organs, and another 40 were used in DTx. RESULTS: Mean donor age for STx was 68.7 ± 3.0 years; for DTx, it was 74.2 ± 4.3 years (P<.001), with more female donors for DTx (75%) than for STx (40%) (P<.001). There were no differences between groups with regard to glomerular filtration rate or proteinuria. Kidneys assigned to DTx received higher biopsy scores than those assigned to STx (2.95 ± 1.01 vs 1.8 ± 1.04; P<.001). DTx recipients were older than STx recipients. There were no differences between the groups regarding cold ischaemia time, delayed graft function, haemorrhagic complications or re-surgeries. However, DTx recipients achieved better creatinine clearance at 1, 3, 6 and 12 months, although the difference was only statistically significant at 6 months (53.4 ± 19.5ml/min vs 44.5 ± 15.6ml/min; P<.05). Renal artery thrombosis appeared in 2 STx patients and in both kidneys of 1 DTx patient. Another 2 patients in the DTx group each lost 1 kidney due to thrombosis and ureteral necrosis respectively, but were able to remain dialysis-free. Graft survival at 3 years was 90% for both groups. During the study period 3 patients died (2 in the STx group and 1 in the DTx group). CONCLUSIONS: Our preliminary experience indicates that DTx provides good results in terms of survival and renal function data, despite surgery being more complicated and the organs having characteristics that probably make them unsuitable for STx. The decision to perform DTx makes using ECD kidneys easier, and it should be based on a combination of pre-transplant histological criteria and the donor's clinical characteristics.

Nefritis lúpica: en busca de un futuro mejor / Lupus nephritis: in search of a better future

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[Psychological profile of potential organ donors and non-organ donors]. / Perfil psicológico de potenciales donantes y no donantes de órganos.

The aim of this research was to analyse the psychological profile of potential organ donors and potential non-organ donors, from a sample of people with qualifications lower than a Bachelor's degree. The variables examined were prosocial behaviour, the scales of the Constructive Thinking Inventory, and the dimensions of personality of the Big-Five Questionnaire. The results show that non-organ donors have a lower score in prosocial behaviour, are less efficient in their actions, with a tendency for less thought before acting, and they tend to be prejudiced. The results also reveal that this group has lower degrees of cooperation and empathy. They tend to be less reflective, less scrupulous, less willing to persevere in their actions, less interested in culture, and less open to new ideas and values. The above results are discussed, bearing in mind the utility of this knowledge to professionals dedicated to organ donation.

Perfil psicológico de potenciales donantes y no donantes de órganos / Psychological profile of potential organ donors and non-organ donors

El objetivo del presente estudio es analizar el perfil psicológico del potencial donante y no donante de órganos en una muestra de ciudadanos con un nivel de formación inferior al universitario. Las variables analizadas han sido la conducta prosocial, las escalas correspondientes al Inventario de Pensamiento Constructivo y las dimensiones de personalidad del Cuestionario Big-Five. Los resultados muestran que el grupo cuya intención es no donar presenta menor puntuación en conducta prosocial, es menos eficaz en sus actuaciones, con tendencia a acciones menos reflexionadas, y mayor tendencia al prejuicio, suspicacia e intolerancia. Asimismo, este grupo muestra un menor grado de cooperación, empatía, reflexión, escrupulosidad y perseverancia en la actuación, y menor interés por la cultura, así como menor apertura a ideas y valores nuevos. Los resultados se comentan en función de la utilidad que el conocimiento del perfil psicológico pueda proporcionar a los profesionales dedicados a la donación de órganos

The aim of this research was to analyse the psychological profile of potential organ donors and potential non-organ donors, from a sample of people with qualifications lower than a Bachelor's degree. The variables examined were prosocial behaviour, the scales of the Constructive Thinking Inventory, and the dimensions of personality of the Big-Five Questionnaire. The results show that non-organ donors have a lower score in prosocial behaviour, are less efficient in their actions, with a tendency for less thought before acting, and they tend to be prejudiced. The results also reveal that this group has lower degrees of cooperation and empathy. They tend to be less reflective, less scrupulous, less willing to persevere in their actions, less interested in culture, and less open to new ideas and values. The above results are discussed, bearing in mind the utility of this knowledge to professionals dedicated to organ donation

Long-term renoprotective effects of standard versus high doses of telmisartan in hypertensive nondiabetic nephropathies.

BACKGROUND: This report describes an open randomized study intended to evaluate the long-term renoprotective effects of "standard" (80 mg once daily) versus "high" (80 mg twice daily) doses of telmisartan in hypertensive patients without diabetes with biopsy-proven chronic proteinuric nephropathies. METHODS: We included 78 patients (age, 43.5 +/- 13.2 years; 71.8% men). After a 4-week wash-out period, patients were randomly assigned to telmisartan, 80 mg once daily (n = 40) or 80 mg twice daily (n = 38), during a mean follow-up of 24.6 +/- 2.2 months. RESULTS: Baseline characteristics were similar in both groups, including blood pressure, renal function, and proteinuria. Blood pressure control did not differ between groups during follow-up. In the group administered telmisartan, 80 mg once daily, serum creatinine level increased from 1.6 +/- 0.6 to 2.7 +/- 0.9 mg/dL (141 +/- 52 to 239 +/- 80 micromol/L), and estimated creatinine clearance declined from 68 +/- 30 to 50 +/- 34 mL/min (1.13 +/- 0.50 to 0.83 +/- 0.57 mL/s), whereas in those administered 80 mg twice daily, serum creatinine (1.6 +/- 0.7 to 1.6 +/- 0.8 mg/dL [141 +/- 62 to 141 +/- 71 micromol/L]) and estimated creatinine clearance values (67 +/- 38 to 74 +/- 38 mL/min [1.12 +/- 0.63 to 1.23 +/- 0.63 mL/s]) did not change during the study. The decrease in proteinuria was more pronounced (P < 0.01) in patients administered the high dose of telmisartan compared with those treated with the standard dose. Serum potassium levels and lipid profiles did not change significantly in either group. CONCLUSION: Long-term administration of high doses of telmisartan seems to improve the efficacy of the drug to decrease proteinuria and slow the progression to end-stage renal failure in nondiabetic hypertensive renal disease.

La toma de decisión sobre donación de órganos en la población andaluza / Decision making about organ donation in andalusian population

Se ha llevado a cabo una encuesta telefónica a 1.111 ciudadanos mayores de edad de la Comunidad Autónoma de Andalucía para comprobar cuáles son las variables asociadas a las decisiones de donar los órganos propios y de un familiar fallecido. A través del análisis de regresión logística se han obtenido dos modelos multivariantes, donde las variables comunes a ambas decisiones son las creencias religiosas, la actitud hacia el cuerpo intacto tras la muerte y hacia la autopsia, la preocupación por la modificación estética del cuerpo tras la extracción de los órganos, la experiencia de donar sangre y el conocimiento de la opinión familiar respecto a la donación. Asimismo, la decisión personal parece estar influida por la percepción del propio estado de salud, la percepción del grado de información sobre el tema y la creencia personal en torno a la resurrección. Por otro lado, variables como el sexo de quien decide, su lugar de residencia, el hecho de haber oído sobre petición de dinero para un trasplante y la preocupación por una posible extracción prematura de los órganos, contribuyen a predecir la decisión de donar los órganos de un familiar fallecido. Para aumentar el número de donaciones se deben diseñar actuaciones centradas especialmente en estas variables (AU)

A telephone survey was conducted by interviewing 1,111 citizens of Andalusian Community over eighteen, in order to know the sets of variables associated to decisions making concerning donation of people’s own organs and their deceased relatives. Logistic regression analysis reveals two multivariate models in which the common variables to both decisions are religious beliefs, concerns about body integrity after death, attitude towards autopsy, blood donation experience, and knowledge regarding relatives opinion towards organ donation. The decision concerning people’s own organ donation seems to be influenced by the perception of their own health conditions, perception of their level of information about the topic, and personal beliefs about resurrection. On the other hand, variables like sex, place of residence, having heard about money requesting for transplant, and concerns on premature harvest organs, contribute to predict decision over relatives' organ donation (AU)