Kidney Transplant in a Pediatric Patient With Congenital Abnormalities of the Urinary Tract.

Kidney transplant is the gold standard surgical treatment for patients with end-stage chronic kidney disease. Over the past decade, the frequency and prevalence of chronic kidney disease in children have been increasing, with it being a serious problem worldwide. Kidney transplant in Uzbekistan is still at an early stage, with the first successful kidney transplant performed in 2018. Here, we describe a successful kidney transplant in a pediatric female patient with a congenital abnormality of the urinary tract. The patient first showed symptoms at 7 years of age and was diagnosed with urolithic illness with inflammation of both kidneys. At presentation, she was 14 years of age with end-stage chronic kidney disease (diagnosed with stage 5 chronic kidney disease at age 13 years) caused by an anomaly in the development of the urinary tract. She received a kidney transplant from her mother as a living donor. There was vesicoureteral reflux on both sides and ureterohydronephrosis from 2 sides. On day 9 posttransplant, her creatinine level decreased from 0.40 to 0.066 mmol/L. Doppler ultrasonogram showed normal size and echogenicity of the graft, as well as adequate blood flow in the renal and iliac vessels. The patient was discharged on day 10 posttransplant in a satisfactory condition. In about 50% of cases, the cause of chronic renal failure in children is congenital anomalies of the urinary tract. The most common causes of hydronephrosis in newborns and children are vesicourethral reflux, which leads to the expansion of the urinary tract collecting system and the development of chronic renal failure. Early and accurate diagnosis and timely treatment of urinary tract abnormalities can reduce the incidence of end-stage chronic kidney disease in children.

Case Report of Patient With Venous Thrombosis of the Transplanted Kidney in the Early Postoperative Period.

Renal allograft thrombosis is not a rare complication of kidney transplant and usually occurs in the early period after transplant, but it can also occur later after transplant. Several factors are associated with this infamous complication. The cause of venous anastomosis thrombosis is most often inflection or twisting of the renal vein, anastomosis stenosis, hypotension, hypercoagulation, or acute rejection of the graft. Doppler ultrasonography can allow identification of signs of thrombosis in the graft vein. With early diagnosis and timely intervention, graft function can be preserved and restored. Here, we describe a 13-year-old boy with a diagnosis of chronic kidney disease that was detected in 2017. He underwent kidney transplant, and the donor was a cousin from his mother's side of the family. HLA compatibility showed HLA-A, HLA-B, and HLADR matches, with 10% cross-matches. The patient underwent heterotopic kidney transplant in the right iliac region with the imposition of an end-toside anastomosis between the kidney artery and the external iliac artery and between the renal vein and external iliac vein. After surgery, the patient's hourly diuresis did not exceed 50 mL/hour. Graft Doppler ultrasonography showed a reversible blood flow of the graft vessels with high vascular resistance index. We suspected venous anastomosis thrombosis, and the patient was urgently taken to the operating room for revision. When the external iliac vein was opened below the anastomosis, thrombosis of the external iliac vein occurred with spread of the graft to the vein, completely covering the lumen of the vein. Thrombectomy was performed with reperfusion of the transplanted kidney with Custodial solution through the artery opening. The external iliac vein and artery opening were sutured. After blood flow started, the size, consistency, and color of the kidney returned to normal.

Three-Year Experience of Kidney Transplantation at a Single Center in Uzbekistan.

OBJECTIVES: In this study, we analyzed the results of the first 100 kidney transplants from related donors performed at the Republican Research Center of Emergency Medicine in Uzbekistan. MATERIALS AND METHODS: This study included 100 patients who underwent kidney transplant from a living donor at the Republican Research Center of Emergency Medicine from March 2018 to January 2021. RESULTS: Immediate graft function was noted in 84 cases (84%) and delayed graft function in 16 cases (16%). Delayed graft function occurred mainly when multiple vessels were present in a donor kidney (35.5%) compared with the presence of a single renal artery and vein (12.1%). The delayed graft function was influenced by the average duration of warm ischemia (80.26 ± 38.35 min with multiple arteries and 50.44 ± 14.44 min with a single renal artery and vein; P = .001). There were 3 cases (3%) of acute cellular rejection, which was successfully treated with pulse therapy and methylprednisolone; there was also 1 case (1%) of hyperacute rejection, which resulted in graft removal. Complications in the form of ureteral stenosis were noted in 2 cases (2%) and ureteral necrosis with anastomotic insufficiency in 1 case (1%). Two recipients (2%) underwent renal graft nephrectomy. In our short-term study, 1-year survival rate for kidney transplant patients was 93%, with graft survival rate of 91%. CONCLUSIONS: Delayed graft function developed when duration of warm ischemia was increased, which was influenced by the number of vessels in the donor kidney. This is an important prognostic factor for acute rejection development. The risk of vascular complications increases due to postoperative hemodialysis trough, with development of delayed graft function. Recipient deaths during the first year after kidney transplant were mainly from pulmonary embolism, infection, and sepsis as a result of immunosuppression, hypovolemic shock, and acute ischemic stroke.

Infection status of hydatid cysts in humans and sheep in Uzbekistan.

Uzbekistan is endemic of cystic echinococcosis (CE). In order to estimate endemicity of CE, we collected data from emergency surgery due to CE in 2002-2010 and also investigated the prevalence of hydatid cysts in the liver and lungs of sheep at an abattoir in Uzbekistan from July 2009 to June 2010. In 14 emergency hospitals, 8,014 patients received surgical removal or drainage of CE during 2002-2010, and 2,966 patients were found in 2010. A total of 22,959 sheep were grossly examined of their liver and lungs, and 479 (2.1%) and 340 (1.5%) of them were positive for the cyst in the liver and lungs, respectively. Echinococcus granulosus is actively transmitted both to humans and sheep, and CE is a zoonotic disease of public health priority in Uzbekistan.

Helicobacter pylori infection and cytokine gene polymorphisms in Uzbeks.

Recent studies have reported that Helicobacter pylori (H. pylori) persistent infection and gastric atrophy development were associated with genetic polymorphisms of cytokines. This study aimed to determine possible associations of host genotypes with the seropositivity of anti-H. pylori IgG and anti-CagA IgG, as well as gastric atrophy measured with serum pepsinogens (PG) among an Uzbek population. Subjects were 84 patients with peptic ulcer disease, 35 with other miscellaneous diseases, and 48 healthy persons, for a total of 167 participants. Using a polymerase chain reaction with confronting two-pair primers, their DNA was genotyped for polymorphisms of interleukins (IL) (IL-1B C-31T, IL-2 T-330G, IL-4 C-33T, IL-8 T-251A, IL-10 T-819C, and IL-13 C-1111T) and tumor necrosis factor A (TNF-A) (C-857T and T-1031C). Among 167 participants, 124 (74.9%) were anti-H. pylori IgG seropositive, 142 (85.6%) were anti-CagA IgG seropositive, and 44 (26.3%) exhibited gastric atrophy (PG1 < 70 ng/ml and PG1/PG2<3). The adjusted odds ratio (OR) of IL-4 -33CT for anti-H. pylori IgG seropositivity was significant; OR = 2.33 (95% confidence interval (CI), 1.04-5.19), relative to -33CC. In addition, those with TNF-A-1031TC had a significantly increased risk for anti-H. pylori IgG seropositivity; OR = 2.82 (95% CI, 1.05-7.57), relative to -1031TT. No alleles were associated with the risk of anti-CagA IgG seropositivity or gastric atrophy. The significant associations with cytokine polymorphisms indicated that genetic traits might play a role in the persistent infection of H. pylori among Uzbeks. In addition to confirming the above associations, lifestyle interactions with the genotypes also remain to be elucidated.

Possibilities of chromoesophagoscopy for diagnosis of Barrett's esophagus.

When the distal esophagus is covered with columnar gastric mucosa up to 2 cm from the esophagogastric junction it is considered normal. If the distal esophagus is covered with columnar epithelium more than 2 cm from the esophagogastric junction, it is called Barrett's esophagus. We have developed a new chromoesophagoscopic method to improve diagnostic testing for Barrett's esophagus. The distinctive feature of this method is that 4 to 5 ml of a 1% solution of neutral red is administered intravenously, after which excretion of the stain by the esophageal mucosa is examined by endoscopy. Chromoesophagoscopy has been carried out in 11 patients with reflux esophagitis. It revealed Barrett's esophagus in four patients, which was proved by histologic evaluation of biopsy specimens obtained from the stained zone of the esophageal mucosa. These observations suggest that chromoesophagoscopy is an effective, accessible, feasible, safe method for diagnosing Barrett's esophagus. It allows us to determine the length of the metaplastic epithelium and the topography of gastric glands; it also allows us to examine parietal cells in the esophagus and estimate the functional activity of these parietal cells in metaplastic epithelium.