Comparison of serum creatinine and spot urine interleukin-18 levels following radiocontrast administration.

Radiocontrast administration is an important cause of acute renal failure. In this study, compared the plasma creatinine levels with spot urine IL-18 levels following radiocontrast administration. Twenty patients (11 males, 9 females) underwent radiocontrast diagnostic and therapeutic-enhanced examinations. The RIN Mehran risk score was low (≤5). The radiocontrast agents used were 623 mg/mL Iopromid (1.5 mL/kg), and 100 mL of 650 mg/mL meglumine diatrizoate as three-way oral and rectal contrast material for abdominal computed tomography (CT) scans. Serum blood urea nitrogen, creatinine, Na, K, Cl, Ca, P, creatinine clearance, and spot urine IL-18 levels were analyzed before and repeated at 24, 48, and 72 h after radiocontrast administration. Six and 24-h urinary IL-18 levels were measured with a human IL-18 ELISA kit following radiocontrast administration. An increase in plasma creatinine 24 and 48 h following radiocontrast administration was observed compared with precontrast values, but it was not statistically significant (P=0.052 and P=0.285, respectively). A statistically significant increase in IL-18 levels was observed at 6 and 24 h, compared with precontrast values (P=0.048 and P=0.028, respectively). A tendency for postcontrast 24-h urinary IL-18 levels to increase was observed compared with 6 h, but the increase was not statistically significant (P=0.808). Our results show that plasma creatinine starts to increase at 24(th) hour; however, spot urine IL-18 levels go up at 6(th) hour following radiocontrast administration implying urine IL-18 to be an earlier parameter for kidney injury.

The clinical significance of parathyroid tissue calcium sensing receptor gene polymorphisms and expression levels in end-stage renal disease patients.

BACKGROUND: The calcium sending receptor (CaSR) allows parathyroid and kidney tubular cells to regulate PTH secretion and tubular calcium reabsorption. In the present report, we examined the relationship between CaSR gene polymorphisms and parathyroid CaSR expression and serum calcium/parathyroid hormone (PTH) levels and clinical progress in ESRD patients in the Turkish population. METHODS: We genotyped the CaSR R990G and Q1011E variants in 192 end-stage renal disease (ESRD) patients by allele-specific PCR. CaSR expression in parathyroid tissues of operated 33 patients was quantified with quantitative reverse transcription-PCR. RESULTS: Compared with other genotypes, the ratio of both codon 990-AA and 1011-CC polymorphisms was found higher in operated patients (p = 0.001). In the total patient group PTH levels were found higher in patients with CC1011 genotype than those with CG1011 (1015.15 +/- 925.41 pg/ml; 523.84 +/- 544.6 pg/ml, respectively, p = 0.002). There were statistically important higher Ca2+ levels in the AA990 allele carrying cases than AG990 positive ones (9.3 +/- 1.0 mg/dl vs. 8.8 +/- 0.9, p = 0.006). On the other hand, the expression of CaSR in parathyroid tissue was found inversely proportional with serum PTH level (r = -0.71). CONCLUSION: Present data suggest that co-presence of CaSR gene AA990 and CC1011 alleles is a possible risk factor for bad prognosis in secondary hyperparathyroidism. Patients carrying this genotype have tendency to require operation early in their medical therapy period and need postoperative close follow up for possible recurrences.

Rare gallbladder parasitosis mimicking cholelithiasis: Dicrocoelium dendriticum.

Cholelithiasis is increasingly diagnosed in childhood and infancy. Biliary parasites are the rarest cause of cholelithiasis in all age groups. We present a twelve-year-old girl with non-hemolytic gallbladder stone and discuss the clinical features and differential diagnosis of Dicrocoelium dendriticum (DD) invasion that causes and/or mimics cholelithiasis in children.

Evaluation of pretransplant serum cytokine levels in renal transplant recipients.

AIM: Cytokines are early predictors of graft dysfunction. In this study we evaluated pretransplant cytokine levels and graft outcomes among renal transplant recipients. PATIENTS AND METHODS: Donor selection was based on results of blood group matching and negative crossmatches. A panel of 35 human serum samples from patients (female/male = 0.4) awaiting renal transplantation and 15 healty control sera were analyzed for interleukin (IL) 1alpha, IL-2, IL-6, IL-10, tumor necrosis factor-alpha, interferon-gamma, transforming growth factor-beta concentrations by enzyme-linked immunosorbent assay. The average age of the patients was 34.5 +/- 10.1 years (range 15 to 60). The average duration of renal replacement therapy before renal transplantation was 42.1 +/- 57.9 months (range 0 to 288). The types of renal replacement therapy were; hemodialysis (n = 27) and CAPD (n = 8). RESULTS: Pretransplant IL-6 levels were higher among recipients who displayed acute rejection episodes compared with those fact of this complications (P < .05) or control sera (P < .05). Pretransplant IL-6 levels were higher among recipients with graft failure than those with a functioning graft (P < .05). Pretransplant IL-10 levels were higher among recipients with acute rejection episodes and graft failure than those without acute rejection or control subjects, but the difference did not reach significance. There was no correlation between pretransplant cytokine levels and age, gender, type, or duration of renal replacement therapy (P > .05). CONCLUSION: High pretransplant serum IL-6 levels are associated with an increased risk of acute rejection episodes and graft failure. IL-10 might contribute an anti-inflammatory action to patients with high serum IL-6 levels.

Outcome of renal allograft in Turkish patients with pretransplantation hepatitis C virus infection.

BACKGROUND: The aim of the present study was to investigate the impact of hepatitis C virus (HCV) infection on the long-term survival of renal transplant recipients. METHODS: Outcomes and survivals among 325 patients who received renal allografts from July 1991 to September 2005 were compared between those known to have pretransplantation HCV infection (Group I, HCV+ group, n = 33) versus a matched cohort of those without this infection (Group II, HCV- control group, n = 33). Allograft performance, liver function, cholesterol, and glucose levels were determined both at transplantation and at a mean of postgrafting year 8. A one-way analysis of variance (ANOVA) statistical method was used for multivariate analysis. RESULTS: Thirty-three patients (10.15%, 19 women and 14 men) were positive for HCV antibody. The mean follow-up period was 8 years (range, 0.5-14 years). The mean survival rates were similar in Groups I and II (96.6% and, 100%, respectively). Although the allograft survival rate was lower in Group I (84.8% vs 90.9%), the rejection rate among the HCV- group was 6%; only 1 patient died of hepatic failure. In spite of a significant rise in both total and direct bilirubin values (P < .01) in both groups, we failed to observe an adverse effect on graft survival. A significant rise in the fasting glucose level was seen in both HCV+ and HCV- patients. CONCLUSIONS: Chronic HCV infection before transplantation did not have a significant impact on graft survival or mortality compared with noninfected patients.

Pediatric renal transplantation: Clinical analysis of 28 cases.

We performed an outcome analysis of 28 pediatric renal transplant recipients whose mean age at transplantation was 15.2 +/- 2 years (range: 11 to 17 years) and the M/F ratio, 0.75. Four patients received cadaveric grafts. One patient needed retransplantation due to primary nonfunction. Mean HLA match was 3.6 (range: 3 to 5). Immunosuppression was cyclosporine (n = 13) or tacrolimus (n = 11) or sirolimus (n = 4), as well as steroids and azathioprine or mycophenolate mofetil. Delayed graft function occurred in four patients. The main complications were arterial hypertension (n = 11), anemia (n = 4), urinary tract infection (n = 10), hypercholesterolemia (n = 7), and cytomegalovirus infection (n = 1). An acute rejection episode (ARE) occurred in four patients. ARE and hypertension rates were similar between the immunosuppressive drug groups. All the patients with graft failure were on cyclosporine (P = .03). Hemodialysis and peritoneal dialysis (median duration: 6 months) were performed preoperatively in 25 and 3 patients, respectively. The length of pretransplant dialysis was longer among patients with graft failure (P > .05). Noncompliance (10.7%) resulted in an ARE in one patient and graft loss in two patients. One patient died with a functioning graft. Primary disease recurred in one patient. The median follow-up period was 44 months (range: 6 to 157 months). Mean serum creatinine level was 1.35 +/- 0.74 mg/dL at the last follow-up. One- and 3-year graft survival rates were 92% and 86%, respectively, and patient survival was 100%, each. Seventeen patients (60.7%) continued their education after the transplantation; six started working. Successful transplantation in the pediatric age group together with intensive rehabilitation posttransplantation are important to make these children productive individuals to the society.

Blood pressure and graft outcome in renal transplantation.

To investigate the effects of blood pressure (BP) on kidney function, we reviewed 116 patients who had a median follow-up of 40.5 months. Systolic and diastolic hypertension (HTN) at month 6 resulted in significantly higher serum creatinine (SCr) levels at 1 year, compared with patients with normal BP, namely, 2.2 versus 1.4 mg/dL (P = .0001) and 1.87 versus 1.5 mg/dL (P = .04), respectively. Mean systolic and diastolic BP at the end of 1 and 6 months were significantly higher among patients who had returned to hemodialysis or who had an SCr > or =2 mg/dL at their last follow-up. Mean age, mean donor age, donor type, and sex had no significant effect on graft function. Patients receiving Rapamune-based treatment (n = 9) had no graft failure; graft outcomes were similar between cyclosporine-based and tacrolimus-based immunosuppression therapy. Patients with biopsy-proved acute rejection showed significantly lower graft survival. By multivariate analysis, systolic HTN at the end of 1 month (P = .006) and 6 months (P = .01), and diastolic HTN at the end of 6 months (P = .04) were independent risk factors for graft outcome. Actuarial 5-year graft survival was 95%, versus 76% in patients with normal BP versus systolic HTN at 1 month, respectively (P = .02). A significant difference in 5-year graft survival was observed between patients with normal diastolic BP and diastolic HTN at 6 months (95% versus 67%, respectively; P = .001). Since systolic and diastolic BP at different times before and after transplantation correlate with graft function, more attention should be paid to maintain normal BP in patients with renal transplants.

The effect of HBsAg-positivity of kidney donors on long-term patient and graft outcome.

The number of patients on the kidney waiting list is increasing, creating a shortage of donor organs. To solve this problem, there is an interest in transplanting organs formerly considered marginal or undesirable. We performed seven (four living related, three cadaveric) kidney transplants from hepatitis B surface antigen (HBsAg)-positive donors. Hepatitis B e antigen (HBeAg) and hepatitis B virus (HBV) DNA were negative in the living donors and were unknown in cadaveric donors. Liver function tests were in the normal range in all of the donors. All of the recipients were HBsAg-negative and hepatitis B surface antibody (anti-HBs)-positive. Recipients receiving kidneys from cadaveric donors were given prophylactic lamivudine treatment postoperatively. Anti-HBs remained positive throughout the follow-up period in all but one patient with a cadaveric graft. None of the patients receiving a kidney from an HBsAg-positive donor developed clinical HBV infection in a mean follow-up period of 42.6 +/- 36.8 months (range: 16 to 121 months, median 30 months). Liver function tests remained in the normal ranges in all patients. All the grafts are still functioning with a mean serum creatinine level of 1.6 +/- 0.85 mg/dL. In conclusion, transplants from HBsAg-positive and HBeAg-/HBV DNA-negative donors seem to carry no risk to the recipients who are immune to HBV. Even cadaveric donors with HBsAg-positivity and unknown HBeAg/HBV DNA status can be used with caution in selected recipients without significantly affecting graft and patient outcome.