Duplex sonographic measurements in allografted kidneys: a cross-sectional study.

OBJECTIVES: The measurement of color Doppler sonography indices, such as resistive index (RI) and pulsatility index (PI), can help in the evaluation of an transplanted kidney. The aim of this study was to determine the correlation between Doppler sonography indices and demographic paraclinical findings in transplanted kidneys. METHODS: A cross-sectional study was performed on 47 (27 male and 20 female) unrelated living renal transplanted patients. RESULTS: The mean age, body mass index (BMI), time since transplantation, pulse pressure index (PPI), intrarenal RI and PI were 38 +/- 13 years, 25 +/- 4.5, 48 +/- 31 months, 0.34 +/- 0.06, 0.69 +/- 0.06, and 1.3 +/- 0.3, respectively. There were significant negative correlations between time since transplantation and intrarenal RI and PI (r=-.38, P<.01; r=-.4, P<.01, respectively). There was a significant correlation between patient age, creatinine clearance, and intrarenal RI (r=.30, P=.039; r=.3, P=.043, respectively). There were no significant correlations between intrarenal RI, PI, and BMI, cyclosporine trough level, PPI, recipient and donor sexes, and rejection episodes. Diabetic patients displayed higher RI (0.76 +/- 0.02 vs 0.68 +/- 0.06, P=.048) and patients with serum high-density lipoprotein (HDL) level <40 mg/dL had higher PI than patients with HDL >or= 40 mg/dL (1.6 +/- 0.4 vs 1.2 +/- 0.3, P=.006). CONCLUSIONS: Intrarenal RIs did not decrease over a few years after transplantation. They can be a useful, feasible predictor of graft function. However, future multicenter trials should be performed to prove the predictive power of RI determination as a marker of renal function.

Antineutrophil cytoplasmic antibody-associated glomerulonephritis in chronic graft-versus-host disease after allogenic hematopoietic stem cell transplantation.

Graft-versus-host disease (GVHD) is one of the most frequent complications that occur after hematopoietic stem cell transplantation (HSCT). Recently, renal involvement, including membranous nephropathy, focal segmental glomerulosclerosis, and minimal change disease, has been described as a manifestation of chronic GVHD. This case report describes a patient who developed antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis after HSCT. Following preparation with chemotherapy, a 29-year-old man with chronic myeloid leukemia underwent allogenic peripheral blood stem cell (PBSC) transplantation, after which first acute and then chronic GVHD developed. Treatment with prednisone resulted in improvement in the patient's GVHD. After the termination of steroid therapy and about 10 months after PBSC transplantation, nephritic syndrome appeared and the patient's serum creatinine value increased to 1.7 mg/dL. Laboratory evaluation revealed perinuclear antineutrophilic cytoplasmic antibody (p-ANCA) in the serum. Histological examination of renal biopsy tissue showed focal segmental proliferative glomerulonephritis with glomerulosclerosis in 20% of available glomeruli, large cellular crescents in 6% of glomeruli, and no staining of immunoglobulins or complement along the capillary walls. Electron microscopy revealed no immune deposits. After treatment with prednisone 60 mg/d, diltiazem 120 mg/d, and enalapril 10 mg/d, the proteinuria gradually decreased, and p-ANCA was undetectable. These findings suggest that in this patient the ANCA-associated glomerulonephritis was associated with renal involvement that occurred during the course of chronic GVHD.