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1.
Transplant Proc ; 51(2): 383-385, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30879547

ABSTRACT

The plasma cell dyscrasias (PCDs) include a number of entities such as multiple myeloma, primary amyloidosis, and monoclonal immunoglobulin deposition disease. Hematopoietic cell transplant (HCT) is the only cure for a variety of hematologic and oncologic diseases. Clinically significant renal impairment is a common feature in plasma cell myeloma, affecting 20% to 55% of patients at initial diagnosis; 2% to 3% of patients present with failure sufficiently severe to require hemodialysis. This circumstance is associated with a high early mortality. The necessity for immunosuppression after HCT could complicate its management and may precipitate the development of complications. In some patients an effective alternative could be kidney transplant (KT); however, the presence of 2 transplants will require optimal adjustment of immunosuppression and management of complications. At present, there are few published cases of KT after HCT, and the experience of managing 2 transplants is limited. We would like to describe our experience with 4 patients who had a PCD and initially received HCT and received subsequent KT. In our experience the progress and outcome of KT after HCT were optimal. We would like to address that a higher incidence of cytopenia associated with the combination of immunosuppression (lenalidomide, tacrolimus, mycophenolate, etc.) and other drugs (ie, valganciclovir) should be considered together with an increased risk of opportunistic infections and PCD relapse.


Subject(s)
Hematopoietic Stem Cell Transplantation , Kidney Transplantation , Paraproteinemias/complications , Paraproteinemias/surgery , Renal Insufficiency/surgery , Adult , Aged , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Renal Insufficiency/etiology
2.
Transplant Proc ; 48(9): 2884-2887, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27932098

ABSTRACT

OBJECTIVE: The aim of this exploratory study was to analyze the urinary excretion of Clara cell protein (CC16), a new marker of proximal tubular dysfunction (PTD), in kidney transplantation (KT). MATERIALS AND METHODS: Urinary concentrations of CC16, ß2-microglobulin (ß2m), and N-acetyl-glucosaminidase (NAG) were measured in 50 KT patients (72% men; mean age 50.4 ± 12.4 years; diabetes in 24%; duration of KT 4.3 ± 3.1 years) and 10 healthy controls (6 men; mean age 33.6 ± 13.4 years). RESULTS: Urinary levels of ß2m, NAG, and CC16 were significantly higher in KT patients than in controls: ß2m: 0.77 (interquartile range [IQ] 0.22 to 4.62) g/g vs 0.069 (IQ 0.05 to 0.10) g/g; NAG: 3.16 (IQ 2.09 to 5.33) U/g vs 1.73 (IQ 1.25 to 2.07) U/g; CC16: 26.01 (IQ 8.62 to 123.3) g/g vs 2.51 (IQ 0.83 to 7.18) g/g (P < .001). Elevated levels of ß2m, NAG, and CC16 were found in 81%, 28%, and 71% of KT patients, respectively. Urinary levels of ß2m, NAG, and CC16 significantly increase as glomerular filtration rate (GFR) decreases. Interestingly, in patients with GFR >60 mL/min, we still found high levels of ß2m, NAG, and CC16 in 77%, 13%, and 52%, respectively. Diabetic subjects had significant higher levels of the 3 markers compared with nondiabetic subjects, without differences in albumin excretion or GFR. CC16 showed a positive correlation with urinary albumin (r = 0.42, P < .001), NAG (r = 0.352, P < .05), and ß2m (r = 0.75, P < .001). CONCLUSION: PTD is highly prevalent in KT patients. This is the first study that analyzes CC16 in KT patients, showing that the urinary excretion of this protein is significantly increased in this population. Further studies are needed to examine the clinical value of CC16 in KT patients.


Subject(s)
Fanconi Syndrome/urine , Kidney Transplantation/adverse effects , Postoperative Complications/urine , Uteroglobin/urine , Acetylglucosaminidase/urine , Adult , Albuminuria/urine , Biomarkers/urine , Case-Control Studies , Diabetes Mellitus/urine , Fanconi Syndrome/etiology , Female , Glomerular Filtration Rate , Humans , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Period , Risk Factors , beta 2-Microglobulin/urine
3.
Biol Trace Elem Res ; 85(3): 269-75, 2002 Mar.
Article in English | MEDLINE | ID: mdl-11934250

ABSTRACT

Chronic alcoholics frequently show associated malnutrition. Both ethanol and malnutrition exert profound changes on zinc and copper metabolism. In this study, we found higher hair zinc and copper values in 43 male alcoholics than in 39 controls. Hair copper was significantly related to the amount of ethanol consumed, whereas hair zinc was higher in consumers of distilled beverages. No relation was observed between hair zinc and copper and nutritional status, kind of diet consumed, style of life, and liver cirrhosis. Consequently, hair zinc and copper levels are related only with alcohol intake.


Subject(s)
Alcoholism/metabolism , Copper/analysis , Hair/chemistry , Zinc/analysis , Adult , Aged , Alcohol Drinking/adverse effects , Alcoholism/complications , Body Weight , Feeding Behavior , Humans , Male , Middle Aged , Nutrition Disorders/complications , Nutrition Disorders/metabolism , Nutritional Physiological Phenomena
4.
Cytokine ; 15(4): 232-6, 2001 Aug 21.
Article in English | MEDLINE | ID: mdl-11563884

ABSTRACT

We studied 174 patients with SIRS criteria, 45 with sepsis, eight with severe sepsis and 13 with septic shock. Serum TNF-alpha, IL-6, IL-8 and IL-10 levels were raised in SIRS patients, even in those cases in which an infection could not be documented, and more intensely in severe sepsis and in patients who died (11%). The slope of the regression line between IL-10 and TNF-alpha was sharper in patients with severe sepsis and in those who died; an imbalance between pro- and anti-inflammatory cytokines may be related to poor prognosis. Increased IL-6 and IL-10, decreased muscle mass, raised BUN and low body temperature were all independently related to prognosis.


Subject(s)
Inflammation/immunology , Sepsis/diagnosis , Sepsis/immunology , Shock, Septic/diagnosis , Shock, Septic/immunology , Age Factors , Aged , Body Temperature , Cytokines/biosynthesis , Female , Humans , Interleukin-10/biosynthesis , Interleukin-10/blood , Interleukin-6/blood , Interleukin-8/blood , Kinetics , Male , Middle Aged , Muscles/pathology , Prognosis , Sepsis/mortality , Shock, Septic/mortality , Treatment Outcome , Tumor Necrosis Factor-alpha/biosynthesis
5.
Alcohol Alcohol ; 36(4): 335-8, 2001.
Article in English | MEDLINE | ID: mdl-11468135

ABSTRACT

This study was performed in order to analyse the prevalence, clinical characteristics and mortality of heavy drinkers among hospitalized patients during a 2-year period. Chronic excessive alcohol consumption (daily intake >80 g of ethanol for males and >40 g for females) was found in 278 of 2913 hospital admissions and was strongly associated with the male sex (90.69%). Heavy drinkers were significantly younger than other admissions (15 and 10 years for men and women, respectively), but showed similar mortality rates to other admissions, despite a much earlier age at death (19.5 years for men and 22 years for women). There was a trend towards higher mortality rates among severe alcoholic women than severe alcoholic men and non-alcoholic women. Liver cirrhosis was the entity most frequently observed in the heavy drinkers, and was significantly more prevalent in alcoholic women.


Subject(s)
Alcoholism/mortality , Hospital Mortality , Adult , Age Distribution , Aged , Female , Humans , Male , Middle Aged , Prevalence , Sex Characteristics , Spain/epidemiology
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