Ambulatory blood pressure monitoring in kidney transplant patients: RETENAL study.

Hypertension is common following renal transplantation, affecting up to 80% of transplant recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy, contributing to increased cardiovascular risk factors and mortality rates. The aim of the study was to compare the blood pressure (BP) control in kidney transplant patients through the use of ambulatory BP monitoring (ABMP) versus office BP measurements (oBP). A multicenter, cross-sectional, observational study was conducted in 30 nephrology/kidney transplant units. Eligible patients included hypertensive cadaveric kidney transplant recipients aged <70 years, with a functioning kidney for at least 1 year and with an estimated glomerular filtration ≥30 mL/min/1.73 m(2) and a serum creatinine < 2.5 mg/dL. Recorded data included demographic characteristics, oBP, and ABPM and labroatory investigations. The 868 patients showed a mean recipient age of was 53.2 ± 11.6 years and mean follow-up after transplantation, 5.5 ± 2.8 years. Mean systolic and diastolic oBP were 140.2 ± 18 and 80.4 ± 10 mm Hg, respectively. Seventy-six percent of patients had oBP higher than or equal to 130/80 mm Hg. Mean 24 hour ABPM were 131.5 ± 14 and 77.4 ± 8.7 mm Hg for systolic and diastolic BP, respectively. Using the ABPM, we observed that 36.5% of subjects were controlled (mean 24-hour BP < 130/85 mm Hg). The two methods (oBP and ABPM) showed significant agreement. After ABPM, 65% of patients diagnosed as true controlled hypertension were considered to have white-coat RH. In clinical practice ABPM may help for better adjustment of drugs for adequate BP control.

Three-month experience with tacrolimus once-daily regimen in stable renal allografts.

INTRODUCTION: MR-4, the new oral formulation of tacrolimus that allows once-daily dosing, may improve patient compliance. The purpose of this study was to evaluate the safety and efficacy parameters among a group of stable renal allografts after conversion to MR-4. METHODS: We enrolled 82 stable kidney recipients, who had received their grafts 43.9 +/- 38.3 months prior. They were of mean age 56 +/- 12 years and included 70.7% men. Sixty-six patients were converted on a milligram-for-milligram basis from their total daily dose; the remaining patients were converted at the physician's discretion. Three patients were excluded: 1 because of the development of abdominal pain, and 2 because of dosing errors. Tacrolimus trough levels and renal function tests were evaluated at entry and on days 7, 30, and 90. RESULTS: Only 5 (7.6%) converted patients required a later dose adjustment. In the group of 61 patients who did not require this adjustment, the mean tacrolimus trough levels decreased during the first week (6.8 +/- 1.7 to 5.8 +/- 2.0; P < .000). Thirty-eight patients completed 3 months of follow-up. Their tacrolimus trough levels, serum creatinine levels, and proteinuria remained stable. The number of capsules per patient needed after the conversion to MR-4 was lower (3.9 +/- 1.6 versus 2.9 +/- 1.0; P < .000). There were no cases of acute rejection episodes. CONCLUSION: Based on a milligram-for-milligram conversion, only 7.6% of our patients required a dose adjustment. With this conversion, an initial decrease in tacrolimus trough levels was documented at day 7, which remained stable to the end of the study. The patients needed a lower number of capsules. These results supported the safety of MR-4.

Síndrome del ácido transretinoico y necrosis cortical renal / All-trans retinoic acid sindrome and renal cortical necrosis

Se describe el caso de una paciente con leucemia aguda promielocítica (LAP) que desarrolló síndrome del ácido transretinoico (SAR). ElSAR se presenta en enfermos con LAP tratados con ácido transretinoico (ATRA). Tiene incidencia de 5 a 27% con mortalidad de hasta 29%. Clínicamente se manifiesta con fiebre, hipotensión, insuficiencia respiratoria, renal y hepática, infiltrados pulmonares, derrame pleural y pericárdico, y edema generalizado. Es secundario al efecto del ATRA sobre la diferenciación de los promielocitos, lo que desencadena respuesta inflamatoria sistémica, daño endotelial con síndrome de fuga capilar y obstrucción de la microcirculación e infiltración tisular. El tratamiento consiste en la suspensión del ATRA, esteroides y medidas de soporte

We described a patient with acute promyelocytic leucemia (APL) who developed all-trans retinoic acid syndrome (ATRAS). ATRAS presents inpatients with APL treated with all-trans retinoic acid (ATRA). It has an incidence from 5-27% with mortality of 29%. ATRAS clinical manifestations are fever, hypotension, respiratory, renal and hepatic insufficiency, lung infiltrates, pleural and pericardic efussion, and generalized edema. It is secondary to ATRA effect on promyelocyte differentiation, which causes systemic inflammatory response syndrome, endothelium damage with increase in capillary permeability, microcirculation obstruction, and tissue infiltration. Treatment is based on ATRA suspension, steroids and support measures

Recidiva de vasculitis en trasplante renal tratada con rituximab / The recurrence of the vasculitis in the renal transplant treatment with rituximab

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[All-trans retinoic acid syndrome [corrected] and renal cortical necrosis]. / Síndrome del ácido transretinoico y necrosis cortical renal.

We described a patient with acute promyelocytic leukemia (APL) who developed all-trans retinoic acid syndrome (ATRAS). ATRAS presents in patients with APL treated with all-trans retinoic acid (ATRA). It has an incidence from 5-27% with mortality of 29%. ATRAS clinical manifestations are fever, hypotension, respiratory, renal and hepatic insufficiency, lung infiltrates, pleural and pericardic effusion, and generalized edema. It is secondary to ATRA effect on promyelocyte differentiation, which causes systemic inflammatory response syndrome, endothelium damage with increase in capillary permeability, microcirculation obstruction, and tissue infiltration. Treatment is based on ATRA suspension, steroids and support measures.

[Parvovirus B9 infection in a renal transplant recipient. Diagnosis by detection of viral genome in peripheral blood]. / Infección por parvovirus B19 en trasplante renal. Diagnóstico por detección del genoma viral en sangre periférica.

Parvovirus B19 can produce a picture known as pure red blood aplasia in recipients of solid organ. Occasionally the viruses cause decrease of the other blood cells, and various extra-hematologic manifestations. Common diagnosis is realised by bone marrow examination. The diagnostic value of the viral genome in the blood stream is not well defined. We reported the case of a male of 17 years of age, whose diagnosis was done by repeated determinations of the viral parvovirus B19 genome in peripheral blood. It was confirmed by a biopsy of the iliac crest. The patient was treated with unspecific IgG immunoglobulins, with complete recovery from the symptoms and signs. It did not have any recurrence of the disease. This case suggests that the realisation of PCR of Parvovirus B19 in renal transplant patients with pure red cell aplasia could be of greater interest in the diagnosis and monitoring of the disease. The detection of the viral genome could avoid the administration of unnecessary blood transfusions, and possibly the realization of bone marrow biopsy.

Infección por parvovirus B19 en trasplante renal. Diagnóstico por detección del genoma viral en sangre periférica / Parvovirus B19 infection in a renal transplant recipient. Diagnosis by detection of viral genome in peripheral blood

El parvovirus B19 puede producir un cuadro de anemia conocido como aplasiapura de células rojas en los receptores de trasplantes de órganos. A veces se asocia adisminución de las otras series sanguíneas y a variada patología extrahematológica. Eldiagnóstico se suele hacer mediante examen de la médula ósea. El valor de la deteccióndel genoma viral en sangre no está bien delimitado. Se describe el caso de unvarón de 17 años que presentó fiebre, anemia recitulocipénica y hepatitis debida ainfección por parvovirus B19, cuyo diagnóstico se realizó mediante determinaciónseriada del genoma viral en sangre periférica y se confirmó por biopsia de cresta iliaca.El paciente respondió al tratamiento con inmunoglobulinas, recuperándose completamentede los síntomas y no presentando recaídas.Se sugiere que ante la presencia de anemia de origen no filiado en un paciente contrasplante renal se debe realizar una PCR de Parvovirus B19 en sangre periférica, sobretodo si se acompaña de reticulocitopenia. La detección del genoma viral en plasma permiterealizar un diagnóstico y tratamiento precoz, evitando la administración de transfusionessanguíneas innecesarias, y posiblemente la realización de una biopsia ósea

Parvovirus B19 can produce a picture known as pure red blood aplasia in recipientsof solid organ. Occasionally the viruses cause decrease of the other blood cells, and various extra-hematologic manifestations. Common diagnosis is realised by bonemarrow examination. The diagnostic value of the viral genome in the blood stream isnot well defined.We reported the case of a male of 17 years of age, whose diagnosis was done byrepeated determinations of the viral parvovirus B19 genome in peripheral blood. Itwas confirmed by a biopsy of the iliac crest. The patient was treated with unspecificIgG immunoglobulins, with complete recovery from the symptoms and signs. It didnot have any recurrence of the disease.This case suggests that the realisation of PCR of Parvovirus B19 in renal transplantpatients with pure red cell aplasia could be of greater interest in the diagnosis andmonitoring of the disease. The detection of the viral genome could avoid the administrationof unnecessary blood transfusions, and possibly the realization of bonemarrow biopsyParvovirus B19 can produce a picture known as pure red blood aplasia in recipients of solid organ. Occasionally the viruses cause decrease of the other blood cells, and various extra-hematologic manifestations. Common diagnosis is realised by bone marrow examination. The diagnostic value of the viral genome in the blood stream is not well defined. We reported the case of a male of 17 years of age, whose diagnosis was done by repeated determinations of the viral parvovirus B19 genome in peripheral blood. It was confirmed by a biopsy of the iliac crest. The patient was treated with unspecific IgG immunoglobulins, with complete recovery from the symptoms and signs. It did not have any recurrence of the disease. This case suggests that the realisation of PCR of Parvovirus B19 in renal transplant patients with pure red cell aplasia could be of greater interest in the diagnosis and monitoring of the disease. The detection of the viral genome could avoid the administration of unnecessary blood transfusions, and possibly the realization of bone marrow biopsy

Immunoprophylaxis with Simulect (basiliximab) in kidney transplantation: results from routine clinical practice at 18 kidney transplant units.

OBJECTIVE: The objective of this study is to assess a Simulect (basiliximab) regimen in routine clinical practice in the Spanish kidney transplantation units to evaluate efficacy and safety. METHODS: In this prospective, observational study, data on demographics, parameters of efficacy, and safety in patients who under with kidney transplantation treated with Simulect (basiliximab) were collected through an on-line collection system. RESULTS: One hundred sixty three patients at 18 kidney transplant units included 12 months follow-up. The patient mean age was 52 years (DS 13,67) including 96 (58.90%) men and 67 (41.10%) women. Cold ischemia time was 19 hours (DS 6,79). Only 2 patients presented with PRA >50%. For prophylactic immunosuppression, 67.13% of patients received triple therapy with CNI (cyclosporine 49.65% or tacrolimus 17.48%), MMF (66.43%) or AZA (10.49%), and steroids. Incidence of acute rejection (AR) at 12 months was 12.27% (1.84% steroid-resistant). In subgroup analysis, AR was 13.5% in nondiabetics and 4.5% in diabetics, including 3 steroid-resistant episodes (1.84%) in nondiabetics and none in diabetics. In relation to donor age, AR was incidence 10.3% in patients with kidneys from donors aged 50 years or younger and 10.6% when donors were older than 50 years, including 1 (1.73%) and 2 (1.93%) steroid-resistant episodes, respectively. The graft and patient survival rates at 12 months were 90% and 98%, respectively. CONCLUSIONS: Simulect (basiliximab) used in routine clinical practice provided good prophylaxis against acute rejection in several kidney transplant patient populations, similar to that observed in randomized clinical studies with excellent tolerability and safety.

[Gingival hyperplasia in renal transplants treated with cyclosporin]. / Agrandamiento gingival en trasplantados renales tratados con ciclosporinas.

Cyclosporine is a Metabolita produced by the Topocladium inflamatum fungus. This substance produces an immunosuppression of the selective type, which has been responsible for the increased use of this drug for immunological caused pathologies, especially in organ transplants to inhibit body rejection. One of its secondary characteristics or effects is gingival hyperplasia (in 30 por 100 of the cases noted) an effect which generally occurs on the level or in the area of the dental papilla. An anatomopathological study of these tissues shows an increase in collagens along with a large infiltration of plasmatic cells in different states of maturity. In this article, two cases of renal transplants using cyclosporine were monitored to evaluate its effect in any on the gingival tissues.