IgA Nephropathy Recurrence after Kidney Transplantation: Role of Recipient Age and Human Leukocyte Antigen-B Mismatch.

BACKGROUND: Recurrence of immunoglobulin (Ig)A nephropathy (rIgAN) is a growing cause of kidney allograft dysfunction. This study was aimed at investigating factors associated with rIgAN and the subsequent progression to end-stage renal disease (ESRD). METHODS: Retrospective study including consecutive patients with IgA nephropathy (IgAN) who received a kidney transplant in our center between 1992 and 2016 and had a renal biopsy by clinical indication. The date of detection of chronic kidney disease (CKD) 5 was used as renal outcome. RESULTS: Eighty-six kidney transplants were performed in patients with IgAN, 38 (44%) were from living donors (related n = 26). rIgAN was diagnosed in 23 allografts (27%). Renal function and proteinuria at the end of the follow-up period were worst in the rIgAN patients compared to those without rIgAN (2.2 vs. 1.4 mg/dL, p = 0.014, and 1.16 vs. 0.49 g/day, p = 0.005, respectively). Risk of rIgAN and progression to CKD 5 decreased with patient's age (hazard ratio [HR] 0.95, 95% CI 0.92-0.98, p = 0.002, and HR 0.97, 95% CI 0.83-0.97, p = 0.008 per year, respectively). Patients with rIgAN had a higher risk of progression to CKD 5 (HR 6.7, 95% CI 1.3-35.7, p = 0.025). Full donor-recipient mismatch in the human leukocyte antigen (HLA)-B loci decreased the risk of rIgAN (HR 0.22, 95% CI 0.06-0.76, p = 0.017). CONCLUSIONS: rIgAN was an independent risk factor for ESRD after renal allograft. Younger age increased the risk of rIgAN and CKD 5. Conversely, HLA-B mismatching was a potential protective factor for rIgAN of this glomerular disease.

Onco-Nefrología: cáncer, quimioterapia y riñón / Onco-Nephrology: Cancer, chemotherapy and kidney

La enfermedad renal crónica (ERC), el cáncer y las enfermedades hematológicas comparten áreas de influencia recíproca. El cáncer puede afectar al riñón bien como lesiones glomerulares o como consecuencia de los efectos tóxicos de la medicación o radiación, con procesos agudos (microangiopatía trombótica, insuficiencia renal aguda, nefropatías intersticiales, entre otros) o crónicos (empeoramiento de la ERC tras la nefrectomía por cáncer renal, fibrosis intersticial, trastornos hidroelectrolíticos). En sentido opuesto, los pacientes que precisan tratamiento renal sustitutivo con diálisis y particularmente con trasplante renal son de alto riesgo para la aparición de cáncer debido a la situación de inmunosupresión que generan. Además de la quimioterapia convencional, se han desarrollado tratamientos innovadores: agentes diana contra factores de crecimiento y su receptor, fármacos antiangiogénicos, proteínas inmunorreguladoras, reguladoras del ciclo celular o bloqueantes enzimáticos. También otros enfoques inmunoterapéuticos, como vacunas, terapia celular adoptiva (células CAR T) o desarrollo de anticuerpos. Todas estas novedades terapéuticas mejorarán los resultados frente al cáncer y enfermedades hematológicas pero no están exentas de problemas secundarios con afectación renal. La Onco-Nefrología es ya un área importante para la Sociedad Española de Nefrología, con gran número de interconsultas. El especialista en Nefrología precisa una mejor comprensión de áreas de tan rápida evolución de la biología del cáncer y su tratamiento, para convertirse en miembro valioso del equipo de atención del cáncer y proporcionar la mejor atención nefrológica posible

Chronic kidney disease (CKD), cancer and haematological diseases share areas of reciprocal influence. Cancer can affect the kidney either as glomerular lesions or as a result of the toxic effects of medication or radiation with acute (thrombotic microangiopathy, acute kidney injury, interstitial nephropathies among others) or chronic processes (worsening of CKD after nephrectomy due to renal cancer, interstitial fibrosis, hydroelectrolytic disorders). On the other hand, patients who require renal replacement therapy with dialysis and particularly with kidney transplantation are at high risk of onset of cancer due to the immunosuppression situation that they generate. In addition to conventional chemotherapy, innovative treatments have been developed: target agents against growth factors and their receptor; anti-angiogenic drugs; immunoregulatory proteins; cell cycle regulators; and enzyme inhibitors. Other immunotherapeutic approaches have also been developed, such as vaccines, adoptive cell therapy (CAR T cells) or development of antibodies. All these therapeutic advances will improve the outcomes against cancer and haematological diseases, but they are not free from secondary renal problems. Onco-Nephrology is already an important area for the Spanish Society of Nephrology with a large number of inter-consultations. Nephrologists need a better understanding of rapidly evolving areas of cancer biology and its treatment in order to become valued members of the cancer care team and to provide the best nephrology care possible

Onco-Nephrology: Cancer, chemotherapy and kidney. / Onco-Nefrología: cáncer, quimioterapia y riñón.

Chronic kidney disease (CKD), cancer and haematological diseases share areas of reciprocal influence. Cancer can affect the kidney either as glomerular lesions or as a result of the toxic effects of medication or radiation with acute (thrombotic microangiopathy, acute kidney injury, interstitial nephropathies among others) or chronic processes (worsening of CKD after nephrectomy due to renal cancer, interstitial fibrosis, hydroelectrolytic disorders). On the other hand, patients who require renal replacement therapy with dialysis and particularly with kidney transplantation are at high risk of onset of cancer due to the immunosuppression situation that they generate. In addition to conventional chemotherapy, innovative treatments have been developed: target agents against growth factors and their receptor; anti-angiogenic drugs; immunoregulatory proteins; cell cycle regulators; and enzyme inhibitors. Other immunotherapeutic approaches have also been developed, such as vaccines, adoptive cell therapy (CAR T cells) or development of antibodies. All these therapeutic advances will improve the outcomes against cancer and haematological diseases, but they are not free from secondary renal problems. Onco-Nephrology is already an important area for the Spanish Society of Nephrology with a large number of inter-consultations. Nephrologists need a better understanding of rapidly evolving areas of cancer biology and its treatment in order to become valued members of the cancer care team and to provide the best nephrology care possible.

Escasa hemoglobina glucosilada y su posible relación con mayor tiempo de almacenamiento eritrocitario en solución aditiva AS-1 / Relationship between glucosilate hemoglobin and storage time of erythrocytes in AS-1 additive solution

La solución aditiva AS-1 permite un almacenamiento eritrocitario mayor que otras soluciones. Su composición hace esperable altos niveles del prooxidante HbA1c. Durante el almacenamiento hay una disminución de la actividad de la G6PD. Este trabajo busca evidencia sobre las ventajas de la solución AS-1 en los mecanismos prooxidantes y/o antioxidantes. Objetivo: Describir el comportamiento de la HbA1c, la actividad de G6PD, FRAP y otros parámetros habituales de lesión de eritrocitos en AS-l. Métodos: En 9 unidades de glóbulos rojos empaquetados en AS-1, fue determinada la HbA1c, la actividad de G6PD y el FRAP del sobrenadante, junto con otras variables indicativas de deterioro. Los datos fueron agrupados por día de muestreo (1,14,28,42) y analizados mediante diferencia sobre medias (ANOVA). Resultados: La concentración promedio de HbA1c fue de 5,37 por ciento en el día uno y de 5,58 por ciento en el 42, sin representar aumento significativo. La actividad de G6PD disminuyó en un 59,42 por ciento durante los 42 días (12,31 Vs 5,0, p<0,05) y un se produjo un aumento significativo del FRAP (320 Vs 556 um p<0.05). Conclusiones: El no aumento de HbA1c representa escaso incremento del daño oxidativo,que sumado al aumento del FRAP permiten una mejor preservación de eritrocitos en AS-l, a pesar de la disminución de la actividad de G6PD. Esto permite suponer que dentro de las ventajas de la solución AS-l, se encuentra el evitar la acumulación de HbA1c y el permitir un aumento de los mecanismos antioxidantes inespecíficos mediante procesos que deberán ser estudiados.

Estudo da translocaçäo bacteriana após sutura primária de colo com e sem limpeza mecânica: trabalho experimental em cäes / Bacteria translocation study after primary colocolonic suture with and without mechanical purging in dogs

O objetivo do presente trabalho foi investigar a ocorrencia de translocaçäo bacteriana em cäes submetidos a suturas colocólicas primárias, no colo descendente, com e sem limpeza intestinal. Para o estudo, foram utilizados três grupos de oito animais. O Grupo I (obs. de 1 a 8) foi utilizado como grupo-controle. Nesse grupo, os animais foram submetidos à laparotomia sob anestesia geral, exposiçäo das alças intestinais ao ar ambiente da sala cirúrgica pelo período de cinco minutos. No Grupo II (obs. de 9 a 16), realizou-se colotomia e sutura colocólica primária, sem limpeza do conteúdo cólico e fechamento da parede abdominal. No Grupo III (obs. de 17 a 24), realizou-se colotomia, limpeza do reto, limpeza do colo por meio de lavagem mecânica transoperatória retrógrada, seguida de sutura colocólica terminoterminal e fechamento da parede abdominal. Todos os animais foram mantidos em observaçäo pelo período de 24 horas. Após esse período foi realizada a coleta de amostras de sangue e amostras de linfonodo mesentérico, do fígado, baço, rim e pulmäo para realizaçäo de culturas. As culturas foram realizadas em meios específicos para Escherichia coli e Enterococcus faecalis. Os resultados foram: näo ocorreu translocaçäo bacteriana para o sangue portal nos Grupos II e III. Ocorreu translocaçäo bacteriana para os linfonodos, fígado, baço, rim e pulmäo nos Grupos II e III. Observaram-se índices de translocaçäo bacteriana mais elevados no Grupo II do que no Grupo III, porém sem significância estatística. A Escherichia coli foi a bactéria isolada nas culturas positivas dos Grupos II e III