Value of Plasmatic Villin-1 in the Prediction of Early Graft Dysfunction in Kidney Transplant Recipients: Diagnostic Accuracy Test.

OBJECTIVES: One of the complications of kidney transplant is delayed graft function. Villin-1 has been detected in urine of patients with acute kidney injury. In addition, it is redistributed during acute kidney injury from the brush borders of the proximal tubular cells toward the basolateral membrane, which positions villin-1 closer to the renal vasculature, suggesting that it could be also released in the blood and thus can be a novel biomarker for delayed graft function. MATERIALS AND METHODS: In this diagnostic accuracy test multicenter study, 41 patients undergoing kidney transplant and attending renal transplant clinics were assigned into 2 groups according to serum creatinine levels during the first 2 days posttransplant: delayed graft function group and normal graft function group. We measured plasmatic villin-1 in comparison to serum creatinine levels at the time of declamping (time 0) and at 1, 3, 5, 7, 12, 24, 48, 72, 96, and 120 hours after declamping. RESULTS: Statistically significant differences were noted in comparisons between groups at same time points with regard to plasmatic villin-1 levels; also, plasmatic villin-1 started to increase above reference range in patients with end-stage renal disease at 5 hours after declamping; a peak was shown at hour 7 in the delayed graft function group, which decreased but did not reach the reference range until 120 hours after declamping. CONCLUSIONS: Plasmatic villin-1 is a promising novel biomarker for detection of early graft dysfunction in kidney transplant recipients.

Assessment of cognitive dysfunction in kidney disease.

Cognitive dysfunction includes reduced mental alertness, intellectual impairment, decreased attention and concentration, memory deficits and diminished perceptual-motor coordination. Chronic kidney disease (CKD) patients may suffer from cognitive impairment, which may decrease an individual's quality of life, increase resource utilization and result in suboptimal medical care. This study was carried out on 120 patients with different stages of CKD from our nephrology outpatient clinic divided into three groups: Group I: 50 CKD patients, stage 3 and stage 4; Group II: 50 end-stage renal disease patients on regular hemodialysis with K t/v >1.1; and Group III: 20 acute kidney injury patients, followed-up till their renal functions stabilized besides Group IV: 20 healthy subjects served as controls. All patients underwent laboratory investigations and psychometric tests, which include trial making test part B, digit span test, digit symbol test and mini-mental state examination. There was a significant difference of mean values of cognitive function tests in Groups I, II and III on comparing them with Group IV. Stage 3 CKD scored better than stage 4 CKD, which was worse than hemodialysis patients, and lastly acute kidney injury patients had mild cognitive impairment, which was restored after recovery. We found an association between hemoglobin and cognitive function tests score in the studied groups. The degree of cognitive impairment was associated with the severity of CKD, and dialysis improved cognitive performance.