Renal transplantation normalizes baroreflex sensitivity through improvement in central arterial stiffness.

BACKGROUND: In end-stage renal disease (ESRD) patients, the most common cause of mortality and morbidity are cardiovascular events. This could be attributed to the impaired baroreflex function observed in this group of patients. The effect of renal transplantation (RT) on the baroreflex sensitivity (BRS) in ESRD patients has been inadequately addressed. Therefore, we investigated baroreflex function and its relation to arterial stiffness indices and cardiovascular variability parameters (heart rate and blood pressure variability--HRV and BPV) in ESRD patients before and after transplantation to decipher the underlying mechanism of attenuated BRS in ESRD patients. METHODS: We studied 23 ESRD patients (mean age; 36 years) prospectively before and at 3 and 6 months after RT. Baroreflex function was determined by spontaneous method (sequence and spectral indices). Short-term HRV and BPV were assessed using power spectrum analysis of RR intervals and systolic blood pressure by frequency domain analysis. Arterial stiffness indices were assessed by carotid-femoral pulse-wave velocity (PWV), augmentation index (AI) and central pulse pressure using Sphygmocor Vx device (AtCor Medical, Australia). RESULTS: RT was associated with the normalization of BRS by 6 months. Arterial stiffness indices, such as AI and central pulse pressure, showed a significant reduction as early as 3 months after RT. PWV and frequency domain measures of HRV after RT did not show statistically significant changes except the LF/HF ratio which had a significant increase at 6 months when compared with baseline. Systolic BPV total power showed a significant reduction by 3 months after RT. CONCLUSIONS: Our data suggest that RT normalizes BRS in ESRD patients by 6 months which follows the improvement in the AI and central pulse pressure.

Crescentic glomerulonephritis developing in the course of idiopathic membranoproliferative glomerulonephritis.

Membranoproliferative glomerulonephritis (MPGN) is a rare cause of the nephrotic syndrome in adults and children. Though small focal crescents may be seen in up to 10% of cases of MPGN, the presence of more than 50% crescents (crescentic MPGN) is rare. Very few cases of crescentic transformation of MPGN, documented by subsequent renal biopsies, have been described in the literature. A young female patient underwent kidney biopsy for the nephrotic-nephritic syndrome and was diagnosed as idiopathic MPGN. She was administered immunosuppressive therapy (steroids and cyclophosphamide), with which her renal functions stabilized. Six months later, she presented with features suggestive of rapidly progressive renal failure and underwent a second renal biopsy. The second biopsy showed crescentic glomerulonephritis with immune complex deposition, suggestive of MPGN. A final diagnosis of crescentic transformation of MPGN was made. Crescentic transformation of MPGN is a rare occurrence, but needs to be considered in a patient diagnosed as MPGN and presenting with rapidly progressive renal failure. The cause of such transformation remains to be elucidated.

Reduction in augmentation index after successful renal transplantation.

BACKGROUND: Patients of end stage renal disease (ESRD) have an increased risk of cardiovascular events. Arterial stiffness is an established independent predictor of cardiovascular morbidity and mortality in ESRD patients. Carotid femoral pulse wave velocity (c-f PWV) and augmentation index (AI) are the indices which are used for the noninvasive assessment of arterial stiffness. Renal transplantation (RT) as a treatment modality in ESRD patients is associated with improvement in cardiovascular survival. Whether this improvement is due to attenuation of arterial stiffness has been inadequately investigated. The present study was conducted in ESRD patients before and 3 months after RT to assess the reversibility of the abnormalities of vascular compliance that are known to be associated with adverse outcome. METHODS: Arterial stiffness indices (c-f PWV and AI) were measured using the principle of applanation tonometry with a SphygmoCor CvMS system (Atcor Medicals, Australia) in 23 ESRD patients (age: 35.9 ± 9.3 years) before and 3 months after successful RT. RESULTS: After transplantation, augmentation index values reduced significantly as compared to their pre-transplant values (27.7 ± 11.3 % vs. 17.1 ± 9.0 %; P < 0.0001), while the carotid femoral pulse wave velocity values did not differ significantly (8.7 ± 2.0 vs. 8.6 ± 3.2 m/s). The augmentation index was correlated with the biochemical parameters of serum creatinine (Pearson r = 0.3628; P = 0.0128) and calcium phosphate product (Pearson r = 0.3868; P = 0.0079). CONCLUSIONS: Restoration of renal function following successful RT is associated with differential effects on the two indices of arterial stiffness. The salient finding of our study is that 3 months after transplantation, functional changes in vasculature lead to a significant reduction in the augmentation index, while the pulse wave velocity may take longer to show an improvement.

Epididymal abscess in renal transplant: uncommon presentation of Klebsiella septicemia.

We present a renal allograft recipient 16 months posttransplant with an unusual infectious complication. This gentleman was antihepatitis C virus pretransplant, had a live unrelated transplant, and was taking cyclosporine, mycophenolate mofetil, and prednisolone. He developed diabetes and left scrotal abscess 3 months posttransplant and underwent left orchiectomy. He developed acute right epididymitis progressing to epididymal abscess, septicemia, and acute chronic graft dysfunction. Blood cultures and aspirated pus cultures grew Klebsiella pneumoniae and were treated with intravenous antibiotics, to which he responded. This case highlights an unusual complication in renal transplant and its successful management.

Noonan syndrome: crossed fused ectopic kidneys and focal segmental glomerulosclerosis-a rare association.

Noonan syndrome is characterised by short stature, typical facial dysmorphology and congenital heart defects. Urogenital abnormalities are reported in 10% of the cases. We present a 14-year-old girl with characteristic features of Noonan syndrome and nephrotic-range proteinuria. She had crossed fused ectopic kidneys. Renal biopsy showed focal segmental glomerulosclerosis. Oral steroids were instituted and she responded well. The case highlights this novel renal presentation of Noonan syndrome.