Identification of differential gene expression patterns in human arteries from patients with chronic kidney disease.

Uremia accelerates atherosclerosis, but little is known about affected pathways in human vasculature. This study aimed to identify differentially expressed arterial transcripts in patients with chronic kidney disease (CKD). Global mRNA expression was estimated by microarray hybridization in iliac arteries ( n = 14) from renal transplant recipients and compared with renal arteries from healthy living kidney donors ( n = 19) in study 1. Study 2 compared nonatherosclerotic internal mammary arteries (IMA) from five patients with elevated plasma creatinine levels and age- and sex-matched controls with normal creatinine levels. Western blotting and immunohistochemistry for selected proteins were performed on a subset of study 1 samples. Fifteen gene transcripts were significantly different between the two groups in study 1 [fold changes (FC) > 1.05 and false discovery rates (FDR) < 0.005]. Most upregulated mRNAs associated with cellular signaling, apoptosis, TNFα/NF-κB signaling, smooth muscle contraction, and 10 other pathways were significantly affected. To focus attention on genes from genuine vascular cells, which dominate in IMA, concordant deregulated genes in studies 1 and 2 were examined and included 23 downregulated and eight upregulated transcripts (settings in study 1: FC > 1.05 and FDR < 0.05; study 2: FC > 1.2 and P < 0.2). Selected deregulated gene products were investigated at the protein level, and whereas HIF3α confirmed mRNA upregulation, vimentin showed upregulation in contrast to the mRNA results. We conclude that arteries from CKD patients display change in relatively few sets of genes. Many were related to differentiated vascular smooth muscle cell phenotype. These identified genes may contribute to understanding the development of arterial injury among patients with CKD.

Avoiding steroids in pediatric renal transplantation: long-term experience from a single centre.

We report our experience in pediatric renal transplantation avoiding steroids whenever possible. Immunosuppression consisted of an initial induction with antithymocyte globulin followed by maintenance therapy with a calcineurin inhibitor and MMF. Steroids were only given to selected patients because of the primary disease, recurrence, rejection, or PTLD. Thirty-four transplants grafted into 32 recipients between 1995 and 2005 were followed for a median of 3.5 yr (range 1-9.8). All patients survived. Graft rejection occurred in 10 cases during the first year post-transplantation and graft survival at one, five, and seven yr was 97, 88 and 88%, respectively. Steroids were given to half of the patients (n = 16); in nine cases due to rejection. Only four patients (13%) were continuously on steroids. Calculated GFR at one to five yr post-transplant were 73, 74, 68, 64, and 70 mL/min/1.73 m(2). Unfortunately PTLD occurred in three patients, but all survived with functioning grafts. Accordingly, our findings indicate that steroid avoidance in pediatric renal transplantation is possible with good results with respect to acute graft rejection as well as long-term graft survival.

[Endovascular treatment of abdominal aortic aneurysms]. / Endovaskulaer behandling af abdominale aortaaneurismer.

INTRODUCTION: The endovascular method of treating abdominal aortic aneurysms was introduced as an alternative to conventional surgical repair in the hope of reducing the operative mortality and morbidity. MATERIAL AND METHODS: Thirty patients were selected for endovascular aneurysm repair on the basis of anatomical criteria. The result of the treatment was evaluated by angiography on completion of surgery and by contrast-enhanced CT scans at 1, 3, 6, and 12 months, and annually thereafter. RESULTS: Exclusion of the aneurysm sac was achieved in 27 patients. Acute conversion to open surgical repair was necessary in one patient, owing to arterial damage. Two patients had primary endoleak. In one patient the endoleak disappeared spontaneously, in the second patient conversion to open repair was performed during follow up. The operative mortality was 0%, and the incidence of early complications requiring treatment was 13%. During a median follow-up period of 22 months, secondary endoleaks were detected in five patients and graft-limb occlusion occurred in three patients. Secondary intervention was performed in eight patients (29%). DISCUSSION: In selected patients, endovascular repair is feasible and associated with few major perioperative complications. The observed rate of secondary intervention emphasises the need for continued surveillance.