Enseñando soporte vital básico a la población general. Análisis de las intervenciones de los alumnos / Teaching basic life support to the general population. Alumni intervention analysis

OBJETIVOS: Estudiar la tasa de detección e intervención en situaciones de urgencia extrahospitalaria por parte de los alumnos de cursos de soporte vital básico (SVB). Definir variables de los alumnos asociados a una mayor tasa de detección e intervención. Estudio de eficiencia de las intervenciones. DISEÑO: Estudio descriptivo transversal. Ámbito: Comarca del Poniente de Almería. PACIENTES: Alumnos de un plan de formación masiva en SVB a población general «Plan Salvavidas» desarrollado entre 2003 y 2009. Intervención: En 2010 se encuestó a los alumnos del «Plan Salvavidas» sobre si habían presenciado situaciones de urgencia y datos relacionados con dichas situaciones. Variables principales: Tasa de detección de situación de urgencias. Intervención en situaciones de urgencias. Perfil sociodemográfico de intervinientes. RESULTADOS: Tres mil ochocientos sesenta y cuatro alumnos formados fueron llamados por teléfono: obtuvimos respuestas de 1.098, el 63,9% fueron mujeres, la edad media fue 26,61 ± 10,6. Un 11,75% habían presenciado situaciones de urgencia, de media 3 años tras el curso. Un 23,3% de las urgencias fueron paradas cardíacas. Los alumnos intervinieron en un 98% de los casos posibles. La relación de los alumnos con la víctima era inexistente en el 63% de los casos, la mayoría se presenciaron fuera del domicilio. Se asoció a una mayor tasa de detección de situaciones de urgencia: ser trabajador del ámbito sanitario y ser mayor de 18 años. CONCLUSIONES: En nuestra serie la tasa de urgencias extrahospitalarias presenciadas tras los cursos de SVB fue del 11,75%. El intervencionismo fue alto. La población diana más eficiente fueron los trabajadores del ámbito sanitario

OBJECTIVES: The aim of this study was to investigate the rate at which the alumni of basic life support courses witnessed and intervened in out-of-hospital emergency situations, and to identify the variables characterizing those alumni associated with a greater number of witnessing events and interventions. An analysis of the efficiency of the courses was also carried out. DESIGN: A descriptive, cross-sectional study was made. SETTING: A district in the province of Almería (Spain). PATIENTS: Alumni of a mass basic life support training program targeted to the general population «Plan Salvavidas» conducted between 2003-2009. INTERVENTIONS: In 2010 the alumni were administered a telephone survey asking whether they had witnessed an emergency situation since attending the program, with the collection of information related to this emergency situation. Main variables of interest: Rate of out-of-hospital emergencies witnessed by the alumni. Rate of intervention of the alumni in emergency situations. Variables characterizing alumni with a greater likelihood of witnessing an emergency situation. RESULTS: A total of 3,864 trained alumni were contacted by telephone. Of 1,098 respondents, 63.9% were women, and the mean age was 26.61 ± 10.6 years. Of these alumni, 11.75% had witnessed emergency situations, an average of three years after completing the course. Of these emergencies, 23.3% were identified as cardiac arrest. The alumni intervened in 98% of the possible cases. In 63% of the cases, there was no connection between the alumni and the victim. The majority of the emergency situations occurred in the street and in public spaces. A greater likelihood of witnessing an emergency situation was associated with being a healthcare worker and with being over 18 years of age. CONCLUSIONS: The rate of out-of-hospital emergencies witnessed by these alumni after the course was 11.75%. The level of intervention among the alumni was high. The most efficient target population consisted of healthcare workers

[Teaching basic life support to the general population. Alumni intervention analysis]. / Enseñando soporte vital básico a la población general. Análisis de las intervenciones de los alumnos.

OBJECTIVES: The aim of this study was to investigate the rate at which the alumni of basic life support courses witnessed and intervened in out-of-hospital emergency situations, and to identify the variables characterizing those alumni associated with a greater number of witnessing events and interventions. An analysis of the efficiency of the courses was also carried out. DESIGN: A descriptive, cross-sectional study was made. SETTING: A district in the province of Almería (Spain). PATIENTS: Alumni of a mass basic life support training program targeted to the general population «Plan Salvavidas¼ conducted between 2003-2009. INTERVENTIONS: In 2010 the alumni were administered a telephone survey asking whether they had witnessed an emergency situation since attending the program, with the collection of information related to this emergency situation. MAIN VARIABLES OF INTEREST: Rate of out-of-hospital emergencies witnessed by the alumni. Rate of intervention of the alumni in emergency situations. Variables characterizing alumni with a greater likelihood of witnessing an emergency situation. RESULTS: A total of 3,864 trained alumni were contacted by telephone. Of 1,098 respondents, 63.9% were women, and the mean age was 26.61±10.6 years. Of these alumni, 11.75% had witnessed emergency situations, an average of three years after completing the course. Of these emergencies, 23.3% were identified as cardiac arrest. The alumni intervened in 98% of the possible cases. In 63% of the cases, there was no connection between the alumni and the victim. The majority of the emergency situations occurred in the street and in public spaces. A greater likelihood of witnessing an emergency situation was associated with being a healthcare worker and with being over 18 years of age. CONCLUSIONS: The rate of out-of-hospital emergencies witnessed by these alumni after the course was 11.75%. The level of intervention among the alumni was high. The most efficient target population consisted of healthcare workers.

High-protein diets and renal status in rats.

INTRODUCTION: High-protein (HP) diets might affect renal status. We aimed to examine the effects of a HP diet on plasma, urinary and morphological renal parameters in rats. MATERIAL AND METHODS: Twenty Wistar rats were randomly distributed in 2 experimental groups with HP or normal-protein (NP) diets over 12 weeks. RESULTS AND DISCUSSION: Final body weight was a 10%lower in the HP group (p < 0.05) whereas we have not observed differences on food intake, carcass weight and muscle ashes content. No significant clear differences were observed on plasma parameters, whereas urinary citrate was an 88% lower in the HP group (p = 0.001) and urinary pH a 15% more acidic (p < 0.001). Kidney wet mass was ~22 heavier in the HP group (p < 0.001). Renal mesangium area was a 32% higher in the HP group (p < 0.01). Glomerular 1 and 2 were also ~30 higher in the HP diet (p < 0.01 and p < 0.05, respectively) and glomerular area a 13% higher (p < 0.01). CONCLUSION: High-protein diet promoted a worse renal profile, especially on urinary and morphological markers, which could increase the risk for developing renal diseases in the long time.

Introducción: Las dietas hiperproteicas (HP) pueden afectar la función renal. El objetivo del presente estudio fue examinar los efectos de una dieta HP sobre parámetros renales plasmáticos, urinarios y morfológicos en ratas. Material y métodos: Veinte ratas Wistar fueron distribuidas aleatoriamente en 2 grupos experimentales con dieta HP o normoproteicas durante 12 semanas. Resultados y discusión: El peso corporal final fue un 10% inferior en el grupo de dieta HP (p < 0,05) mientras que no se han observado diferencias en la ingesta de comida, peso de la carcasa del animal y el contenido muscular de cenizas. No se observaron claras diferencias en los parámetros plasmáticos, mientras que el citrato urinario fue de un 88% inferior en el grupo de dieta HP (p = 0,001) y el pH urinario un 15% más ácido (p < 0,001). El peso del riñón en sustancia fresca fue un 22% más pesado en el grupo de dieta HP (p < 0,001). El área mesangial fue un 32% mayor en el grupo HP (p < 0,01). El floculo glomerular 1 y 2 fueron también ~ 30 mayores en la dieta HP (p < 0,01 y p < 0,05, respectivamente) y el área glomerular un 13% mayor (p <0,01). Conclusión: Una dieta hiperproteica promueve un peor perfil renal, especialmente en los marcadores urinarios y morfológico, que podrían aumentar el riesgo de desarrollar enfermedades renales a largo plazo.

High-protein diets and renal status in rats / Dietas hiperproteicas y estado renal en ratas

Introduction: High-protein (HP) diets might affect renal status. We aimed to examine the effects of a HP diet on plasma, urinary and morphological renal parameters in rats. Material and methods: Twenty Wistar rats were randomly distributed in 2 experimental groups with HP or normal-protein (NP) diets over 12 weeks. Results and discussion: Final body weight was a 10% lower in the HP group (p < 0.05) whereas we have not observed differences on food intake, carcass weight and muscle ashes content. No significant clear differences were observed on plasma parameters, whereas urinary citrate was an 88% lower in the HP group (p = 0.001) and urinary pH a 15% more acidic (p < 0.001). Kidney wet mass was ~22 heavier in the HP group (p < 0.001). Renal mesangium area was a 32% higher in the HP group (p < 0.01). Glomerular 1 and 2 were also ~30 higher in the HP diet (p < 0.01 and p < 0.05, respectively) and glomerular area a 13% higher (p < 0.01).Conclusion: High-protein diet promoted a worse renal profile, especially on urinary and morphological markers, which could increase the risk for developing renal diseases in the long time (AU)

Introducción: Las dietas hiperproteicas (HP) pueden afectar la función renal. El objetivo del presente estudio fue examinar los efectos de una dieta HP sobre parámetros renales plasmáticos, urinarios y morfológicos en ratas.Material y métodos: Veinte ratas Wistar fueron distribuidas aleatoriamente en 2 grupos experimentales con dieta HP o normoproteicas durante 12 semanas. Resultados y discusión: El peso corporal final fue un 10% inferior en el grupo de dieta HP (p < 0,05) mientras que no se han observado diferencias en la ingesta de comida, peso de la carcasa del animal y el contenido muscular de cenizas. No se observaron claras diferencias en los parámetros plasmáticos, mientras que el citrato urinario fue de un 88% inferior en el grupo de dieta HP (p = 0,001) y el pH urinario un 15% más ácido (p < 0,001). El peso del riñón en sustancia fresca fue un 22% más pesado en el grupo de dieta HP (p < 0,001). El Área mesangial fue un 32% mayor en el grupo HP (p < 0,01). El floculo glomerular 1 y 2 fueron también ~ 30 mayores en la dieta HP (p < 0,01 y p < 0,05, respectivamente) y el área glomerular un 13% mayor (p <0,01). Conclusión: Una dieta hiperproteica promueve un peor perfil renal, especialmente en los marcadores urinarios y morfológico, que podrían aumentar el riesgo de desarrollar enfermedades renales a largo plazo (AU)

[Methotrexate-associated lymphoproliferative disorder presenting as oral ulcers in a patient with rheumatoid arthritis]. / Ulceras orales como manifestación clínica de proceso linfoproliferativo asociado a metotrexato en una paciente con artritis reumatoide.

Methotrexate-associated lymphoproliferative disorders are a heterogeneous group of lymphoid proliferations or lymphomas that develop in patients with autoimmune diseases treated using methotrexate. These lymphoproliferative disorders are often associated with Epstein-Barr virus infection and occasionally regress after the withdrawal of methotrexate therapy. The lymphoproliferative disorder in this case was diffuse large B-cell lymphoma, unusually presenting as oral ulcers in a 79-year-old woman on treatment with methotrexate for longstanding rheumatoid arthritis. Latent membrane protein 1 positivity was detected by immunohistochemistry and Epstein-Barr-virus encoded small RNA positivity by chromogenic in situ hybridization. Clonality was confirmed by immunohistochemistry (kappa light-chain restriction), polymerase chain reaction (monoclonal immunoglobulin H gene rearrangement), and capillary electrophoresis (GeneScan). Staging procedures were negative. Withdrawal of methotrexate therapy led to complete remission within 6 weeks, and the patient is alive and disease-free 18 months after the diagnosis was made. The oral cavity is not often involved in the initial presentation of methotrexate-associated lymphoproliferative disorders, and presentation with intraoral ulcers is very rare. We have performed a review of the literature on methotrexate-associated lymphoproliferative disorders presenting as ulcers in the oral cavity.

Úlceras orales como manifestación clínica de proceso linfoproliferativo asociado a metotrexato en una paciente con artritis reumatoide / Methotrexate-Associated Lymphoproliferative Disorder Presenting As Oral Ulcers in a Patient With Rheumatoid Arthritis

Los procesos linfoproliferativos asociados a metotrexato son un grupo heterogéneo de proliferaciones linfoides o linfomas que se desarrollan en pacientes con enfermedades autoinmunes tratados con metotrexato. Con frecuencia, se asocian a infección por el virus de Epstein-Barr (VEB) y, ocasionalmente, involucionan al suspender el metotrexato. Se presenta un caso de proceso linfoproliferativo tipo linfoma B difuso de célula grande, con una presentación clínica inusual de úlceras orales, afectando a una paciente de 79 años, con artritis reumatoide de larga evolución en tratamiento con metotrexato. Se detectó positividad para LMP-1 (proteína latente de membrana-1) y EBER (Epstein-Barr encoded RNA) por inmunohistoquímica e hibridación in situ cromogénica, respectivamente. Se confirmó la clonalidad del infiltrado por inmunohistoquímica (restricción de cadenas ligeras), PCR (reordenamiento monoclonal del gen IgH) y electroforesis capilar (GeneScan). El estudio de extensión fue negativo. La suspensión del metotrexato condujo a la remisión completa en 6 semanas. Dieciocho meses después del diagnóstico la paciente continúa libre de enfermedad. Los procesos linfoproliferativos asociados a metotrexato raramente afectan primariamente a la cavidad oral y, sólo excepcionalmente, se manifiestan en forma de úlceras. Se revisa la literatura relativa a procesos linfoproliferativos asociados a metotrexato con presentación clínica de úlceras orales (AU)

Methotrexate-associated lymphoproliferative disorders are a heterogeneous group of lymphoid proliferations or lymphomas that develop in patients with autoimmune diseases treated using methotrexate. These lymphoproliferative disorders are often associated with Epstein-Barr virus infection and occasionally regress after the withdrawal of methotrexate therapy. The lymphoproliferative disorder in this case was diffuse large B-cell lymphoma, unusually presenting as oral ulcers in a 79-year-old woman on treatment with methotrexate for longstanding rheumatoid arthritis. Latent membrane protein 1 positivity was detected by immunohistochemistry and Epstein-Barr-virus encoded small RNA positivity by chromogenic in situ hybridization. Clonality was confirmed by immunohistochemistry (K light-chain restriction), polymerase chain reaction (monoclonal immunoglobulin H gene rearrangement), and capillary electrophoresis (GeneScan). Staging procedures were negative. Withdrawal of methotrexate therapy led to complete remission within 6 weeks, and the patient is alive and disease-free 18 months after the diagnosis was made. The oral cavity is not often involved in the initial presentation of methotrexate-associated lymphoproliferative disorders, and presentation with intraoral ulcers is very rare. We have performed a review of the literature on methotrexate-associated lymphoproliferative disorders presenting as ulcers in the oral cavity (AU)

Recomendaciones para la indicación, obtención, procesamiento y evaluación de biopsias en el trasplante renal / No disponible

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[Pathology related to altitude: the experience on K2]. / Patología derivada de la altura: experiencia en el K2.

The pathology related with the altitude is a common entity above 3000 m. It includes mild symptoms to severe illness such as cerebral or pulmonary edema. Cold-induced injuries may produce permanent tissue loss and surgical amputation. Recognition is made mainly through symptoms. Adequate treatment of these patients allows for rapid resolution of the symptoms and improves outcome.

Patología derivada de la altura: experiencia en el K2 / Pathology related with altitude: The experience in K2

La patología relacionada con la altura es un trastorno frecuente por encima de los 3.000 metros de altitud. Puede comprender desde síntomas leves hasta cuadros graves como el edema cerebral o pulmonar relacionado con la altitud. Las lesiones locales en forma de congelaciones de distinta profundidad pueden producir pérdidas importantes de tejido y amputaciones. El diagnóstico es eminentemente clínico y el tratamiento adecuado de estos pacientes permite una rápida resolución de la sintomatología y evita el desarrollo de secuelas posteriores

The pathology related with the altitude is a common entity above 3000 m. It includes mild symptoms to severe illness such as cerebral or pulmonary edema. Cold-induced injuries may produce permanent tissue loss and surgical amputation. Recognition is made mainly through symptoms. Adequate treatment of these patients allows for rapid resolution of the symptoms and improves outcome

Rechazo subclínico, una entidad de interés emergente / subclinical rejection, a condition of an emergent interes

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Expresión inmunohistoquímica de glicoproteína P como factor pronóstico en sarcomas óseos / Immunohistochemical expression of glycoprotein P as a prognostic factor in bone sarcomas

Se presenta un estudio inmunohistoquímico de expresión de glicoproteína P en 44 tumores óseos malignos (32 osteosarcomas y 12 condrosarcomas) con el propósito de analizar la inmunorreactividad por estirpe histológico y su valor pronóstico potencial. El principio del procedimiento es la determinación de la molécula de glicoproteína P mediante un método inmunohistoquímico que emplea un cóctel de anticuerpos monoclonales específicos (JSB1 y MRK16) prediluidos y el procedimiento estándar de la fosfatasa-antifosfatasa alcalina, con incubación doble de anticuerpo secundario y ese complejo. Las muestras de tejido fueron obtenidas antes de la quimioterapia. La inmunoexpresión se clasificó en seis grados según una escala semicuantitativa de positividad celular.Hay que destacar la expresión intensa y constante de glicoproteína P en la membrana celular de los condrosarcomas (positividad del 100 por ciento y puntuación semicuantitativa de 3,83ñ 1,03). En los osteosarcomas la tinción fue menos constante (positividad del 59,37 por ciento y puntuación semicuantitativa de 2,79 ñ 1,81). Los pacientes con osteosarcomas localizados de alto grado (IIB) y que expresaban glicoproteína P tenían una menor supervivencia (log rank; p < 0,05) e intervalo libre de enfermedad (log rank; p < 0,001). Los hallazgos sustentan a la expresión de glicoproteína P como factor pronóstico en el osteosarcoma (AU)

Cytokines and Fas regulate apoptosis in murine renal interstitial fibroblasts.

Renal fibrosis is characterized by an increased number of fibroblasts and excessive deposition of extracellular matrix. Apoptotic cell death is a physiological mechanism to limit cell numbers, and an insufficient rate of death may contribute to fibroblast accumulation. However, little is known about the regulation of renal fibroblast survival. The authors have studied the interaction of cytokines and the Fas receptor in the regulation of apoptosis of renal fibroblasts and have observed that murine renal fibroblasts express Fas and the Fas ligand. Tumor necrosis factor alpha (TNFalpha) and agonistic anti-Fas antibodies induce apoptosis of renal fibroblasts in a time- and dose-dependent manner. Serum contains survival factors for renal fibroblasts. Both serum deprivation and TNFalpha increase the sensitivity to Fas-induced death and the expression of fas mRNA and Fas receptor. By contrast, insulin-like growth factor-1 decreases apoptosis induced by both serum deprivation and Fas activation and partially prevents the increase in Fas receptor expression induced by serum deprivation. Murine renal fibroblasts express constitutively both fas ligand mRNA and cell-surface Fas ligand, but the authors could not demonstrate a role for Fas ligand in the autocrine regulation of fibroblast survival. These data suggest that Fas and other cytokines cooperate to regulate renal fibroblast apoptosis. Modulation of the Fas death-signaling pathway in renal fibroblasts could represent a new therapeutic target for renal fibrosis.

Adverse clinical outcome in Hodgkin's disease is associated with loss of retinoblastoma protein expression, high Ki67 proliferation index, and absence of Epstein-Barr virus-latent membrane protein 1 expression.

Previous studies have shown that in non-Hodgkin's lymphomas and others neoplasms, tumoral progression, treatment response, and outcome are related to the expression of different oncogenic and tumor suppressor proteins. This study aimed to determine the prognostic significance of the expression of p53, bcl2, retinoblastoma protein (Rb), Ki67, CD15, and latent membrane protein 1-Epstein-Barr Virus (LMP1-EBV) proteins in Hodgkin's disease. A retrospective study was performed on 140 patients collected at the 11 participating centers belonging to the Spanish Collaborative Group for the Study of Hodgkin's Disease. A highly sensitive immunohistochemical method with previous microwave-induced antigen retrieval technique was used for the demonstration of the above-mentioned proteins. A Cox's multivariate analysis was performed to evaluate the impact of the variables in the overall survival, together with a logistic regression model for the achievement of complete remission. Univariate statistical analysis confirmed the prognostic significance of the alredy known clinical parameters: stage, age over 60 years, and B symptoms. High proliferation index (Ki67) and loss of Rb expression were also found to be adverse prognostic factors influencing respectively lower overall survival and failure to achieve complete remission. Multivariate analysis confirmed the independent significance of these two parameters and additionally identifies LMP1-EBV expression as a favorable prognostic marker, in relation with overall survival. Histopathological type, p53, bcl2, and CD15 expression lack significant influence on the outcome of this series. The progression of the disease or the response to treatment in HD patients is the consequence of the interrelationship of different factors, among which LMP1 expression, loss of Rb, and high growth fraction seems to play a more relevant role.

Agonistic anti-Fas antibodies induce glomerular cell apoptosis in mice in vivo.

Recent studies suggest that apoptotic cell death regulates the cell complement in glomerular diseases. However, little is-known about the factors that promote glomerular cell apoptosis. Activation of the Fas receptor by the Fas ligand or agonistic antibodies triggers apoptosis in some cell types that express Fas. Cultured human mesangial cell are among the cells that undergo apoptosis upon Fas activation, but it is unclear whether mesangial cells are sensitive to death induced by Fas in vivo. We have now explored the role of Fas in experimental glomerular injury. Murine mesangial cells in culture express fas and undergo apoptosis when stimulated with the Jo2 agonistic anti-Fas mAb. A fas mRNA transcript is present in normal murine kidney and freshly isolated glomeruli. Balb-c mice developed hematuria and proteinuria within 24 hours of the intraperitoneal injection of 10 micrograms Jo2 anti-Fas mAb. In addition to liver cell apoptosis, glomerular cell apoptosis and mesangial cell depletion were evident in the kidney at three hours and more pronounced at 24 hours. Glomerular and liver injury were not prevented by decomplementation. These data suggest that Fas activation in vivo by specific antibodies induces glomerular and mesangial cell apoptosis in mice.

Intraepithelial and lamina propria leucocyte subsets in inflammatory bowel disease: an immunohistochemical study of colon and rectal biopsy specimens.

AIMS: To gain new insights into the pathogenesis and differential diagnosis of ulcerative colitis and colonic Crohn's disease. METHODS: Immunohistochemistry for different leucocyte subsets was performed in biopsy specimens of the sigmoid colon and rectum from 55 patients with inflammatory bowel disease and 11 healthy controls. RESULTS: Colonic biopsy specimens from patients with active ulcerative colitis had significantly higher numbers of CD45+ and CD3+ leucocytes compared with those from patients with inactive disease, and higher numbers of total leucocytes and macrophages than those from patients with Crohn's disease. Rectal biopsy specimens from patients with Crohn's disease had greater numbers of intraepithelial leucocytes (CD45, CD3 and CD8 cells) than specimens from patients with active or inactive ulcerative colitis, or from healthy controls. CONCLUSIONS: Because of the phenotypic differences in the inflammatory infiltrate in the mucosa from the sigmoid colon and the rectum, the segment of the intestine to be biopsied should be specified. Assessment of the leucocytic component of the intraepithelial infiltrate in rectal biopsy specimens was more useful than examination of colonic biopsy specimens in the differential diagnosis of ulcerative colitis and Crohn's disease.

Relationship between P-glycoprotein expression and cyclosporin A in kidney. An immunohistological and cell culture study.

P-glycoprotein (P-gp), encoded in humans by the mdr-1 gene, acts physiologically as an efflux pump to expel hydrophobic substances from cells. This glycoprotein is closely related to multidrug resistance in tumor cells and can be modulated by cyclosporin A (CsA). We investigated the relationship between CsA and P-gp in 52 renal allograft biopsies and in cultures of Madin-Darby canine kidney (MDCK) renal tubule cells to determine whether the intrarenal accumulation of CsA or chronic stimulation with the drug modified the expression of P-gp. Expression of P-gp and CsA was analyzed by immunohistochemistry. Immunostaining was evaluated semiquantitatively. Modulation of P-gp in MDCK cells after chronic stimulation with CsA for 7, 30, and 60 days was analyzed by flow cytometry. P-gp and CsA immunostaining in renal post-transplant biopsies showed considerable overlap in all cases (Spearman's test, r = 0.577, P < 0.001). After 7 days in vitro, the number of cells expressing P-gp increased progressively; a further increase in mean fluorescence was found after 60 days (P < 0.001, Student's t-test). Our findings suggest that in non-neoplastic cells, CsA may stimulate P-gp as a mechanism of detoxification. Individual differences in the adaptive responses to glycoprotein may be responsible for the appearance of nephrotoxicity or a CsA-resistant rejection reaction in cases of overexpression on lymphocytes and macrophages.

Influence of intrarenal deposits of ciclosporin A on acute renal transplant rejection.

Immunohistochemical techniques were used to study the presence of ciclosporin A (CsA) and leukocyte subsets in 36 posttransplant renal biopsy specimens histologically diagnosed as acute graft rejection. Glomeruli from patients with CsA deposits contained more leukocytes (p < 0.05) than glomeruli from tissues without deposits. In contrast, the interstitium from patients without deposits contained significantly more B lymphocytes than interstitia from kidneys with CsA deposits. In both glomeruli and interstitia, the CD4/CD8 ratios were higher in tissues without deposits, although the difference was not significant. The plasma levels of creatinine increased with the intensity of renal CsA deposits, and significantly more patients on hemodialysis had deposits as compared with patients not on hemodialysis. Our findings suggest two types of acute nonvascular rejection: (1) predominantly interstitial, with a good prognosis, characterized by low numbers of intrarenal CsA deposits and a predominance of B lymphocytes and (2) predominantly glomerular, with a poor prognosis, characterized by high levels of intrarenal CsA and a predominance of CD8-positive cells and macrophages.