Does the pathohistological pattern of renal biopsy change during time?

Biopsy registries are one of the most important sources of accurate epidemiological data and the clinical presentation of renal diseases. A detailed analysis of clinicopathologic correlations over a period of 20 years (1987-2006) was performed earlier by our centre. The aim of this study was to check the current state and to register possible changes in clinicopathologic findings recorded under better socioeconomical circumstances and new management. Records of 665 renal biopsies performed at our institution were prospectively followed from 2007 to 2014. The results were compared with our previously published data. The average annual incidence of renal biopsies increased by 10% and included more elderly patients. Nephrotic syndrome (NS) remained the most common clinical indication for biopsy, while acute kidney injury participated more frequently than in the previous study (p < 0.001). Membranous nephropathy (MN) was still the most common cause of NS. Primary glomerulonephritis (PGN) remained the most prevalent disease, while MN was the most prevalent PGN. In comparison with the earlier period, MN was a more common diagnosis (p = 0.002), while the prevalence of mesangioproliferative non-IgA nephropathy decreased significantly during the time (p = 0.012). LN remained the most frequent secondary glomerulonephritis. The pathohistological pattern of renal biopsy remained largely unchanged during time. However, acute kidney injury was more frequently an indication for biopsy in the current study. The significant increase of biopsied elderly patients is due to the rise in their relative numbers in our population.

Is It Useful to Measure Efficiency Indices of a Deceased-Donor Kidney Transplant Program in One Intensive Care Unit?

BACKGROUND: Before 2010, donor detection rate and donor conversion rate at our tertiary level care institution were low. To assess the effectiveness of the implemented organizational changes, an analysis of organizational indicators with the use of the DOPKI (Improving the Knowledge and Practices in Organ Donation) project was conducted. METHODS: Three groups of DOPKI indicators were used: indicators of the potential for deceased organ donation, indicators on areas for improvement in the deceased donation process, and indicators of program effectiveness. We compared the 3-year period before instituting organizational measures with the 3-year period after the changes. RESULTS: Significant differences in almost all DOPKI indicators were found. Most importantly, the number of actual donors has increased significantly, pointing to the effectiveness of the organizational measures that we put in place in 2010. In addition, the study highlights the value of the use of DOPKI indicators in one intensive care unit to improve the transplant program on a hospital level. CONCLUSIONS: We conclude by arguing that despite the lack of a uniform national database, DOPKI indicators could still be useful for improving the quality of donor programs.

Epidemic varicella zoster virus reactivation in renal transplant recipients: a case report.

Immunosuppression after transplantation renders the transplant recipient susceptible to a broad array of viral pathogens. Of 31 patients transplanted during 2012 in our center, 6 (19.3%) experienced varicella zoster virus (VZV) reactivation. The median time from transplantation to reactivation was 6.2 months. Immunosuppression consisted of antithymocyte globulin in 5 patients and basiliximab in 1, followed by tacrolimus, mycophenolic acid, and prednisolone. Two patients had T-cell-mediated rejection and were treated with pulse doses of corticosteroids. All patients received valganciclovir as prophylaxis of CMV infection. In 3 patients a disseminated vesicular skin rash was the sole manifestation of VZV reactivation. Two were successfully treated with acyclovir and 1 with ganciclovir. Ramsay Hunt syndrome complicated herpes zoster in the fourth patient, whereas the remaining 2 patients had visceral involvement, pneumonitis, and encephalitis, and died in spite of full doses of antiviral therapy. This was the first case of "epidemic" VZV reactivation in the 35-year history of our transplant center. VZV-specific cellular immunity pretransplantation is not sufficient to protect kidney transplant recipients from herpes zoster episodes. Considering the potentially devastating consequences of VZV reactivation, additional treatment options and universal prophylaxis should be contemplated.

Determination of dioxins/furans and PCBs by quadrupole ion-trap gas chromatography-mass spectrometry.

The versatility and sensitivity of the quadrupole ion trap tandem mass spectrometer has been applied to the determination of polychlorodibenzo-p-dioxins (PCDDs) and polychlorodibenzofurans (PCDFs), and of polychlorinated biphenyls (PCBs). A brief introduction to the theory of ion confinement in a quadrupole ion trap permits discussion of ion trajectory stability, mass-selective ion ejection, the frequencies of ion motion, and the role of resonant excitation of ion motion. The tandem mass spectrometric examination of PCDDs and PCDFs eluting and co-eluting from a gas chromatographic column is described. Illustrative examples are given of the analysis of field samples containing PCDDs and PCDFs. A comparison is presented of the performance of each of a quadrupole ion trap tandem mass spectrometer, a triple stage quadrupole mass spectrometer, and a sector instrument of relatively high mass resolution for the determination of PCDDs and PCDFs. This comparison is made with respect to instrument tuning, calibration plots, detection limits, ion signals at low concentration, relative response factors, ionization cross-sections, and the examination of field samples. The application of quadrupole ion trap tandem mass spectrometry to the examination of PCBs is focused upon those PCB congeners that have the greatest toxicity. 39 congeners of the total of 209 PCB congeners have been identified as having the greatest toxicities. Chemical ionization has been used for the determination of co-eluting congeners #77 and #110 where the toxicity of the former is much greater than that of the latter. An analytical protocol, based on the variation of molecular ion fragmentation according to the degree (or absence) of chlorine ortho-substitution, has been proposed for distinguishing between toxic and nontoxic PCB congeners.