Long-Term Effect of Body Mass Index Changes on Graft Damage Markers in Patients After Kidney Transplantation.

BACKGROUND Both adiposity and underweight are negatively associated with graft and patient survival after kidney transplantation (KTx). The aim of this longitudinal study was to evaluate the changes in body mass index (BMI) after KTx and their relations with graft damage markers. MATERIAL AND METHODS The anthropometric measurements of body mass and height were performed in 92 consecutive deceased donor kidney transplant recipients (37 F; 55 M) from a single transplant center. Patient medical history, estimated glomerular filtration rate (eGFR), serum lipids, and ACR (urine albumin-to-creatinine ratio) was obtained from medical charts. RESULTS KTx recipients were on average 3.4±2.5 years after transplantation. Mean body BMI before KTx were 25.3±4.3 kg/m2 and increased after transplantation to 27.0±4.6 kg/m² (p=0.01). BMI increase after KTx was noted in 65% of recipients, most often in patients with normal pre-KTx BMI. Kidney function was better in patients with normal post-KTx BMI (55.2±15.8 ml/min/1.73 m²) than in obese patients (48.0±20.3 ml/min/1.73 m², p<0.05). Patients with normal post-KTx BMI had lower ACR (31.9±18.1 mg/g) than overweight (117.4±53.6 mg/g, p<0.05) and obese patients (280.0±81.7 mg/g, p<0.05). There were no differences in the mean BMI changes in recipients who received cyclosporine A or tacrolimus. CONCLUSIONS Patients after KTx showed an increase of BMI greater in those with normal pre-transplant body mass. The change in BMI over time has no effect on the graft function or magnitude of albuminuria. Overweight and obese patients after KTx have higher albuminuria and worse graft function than those with normal BMI. The type of calcineurin inhibitor has no effect on body mass after KTx.

Secondary tumours revealed during fine needle aspiration of the thyroid--analysis of prevalence and characteristics of ultrasound image.

INTRODUCTION: Metastases to the thyroid are revealed at autopsy with a frequency of 2-24%; however, clinically they appear less frequently, at 0.1-3%. The aim of the study was analysis of the frequency of revealing metastases to the thyroid (TM) and to the regional lymph nodes (NM) (neoplasms other than primary thyroid tumours) in preoperative diagnostics of the thyroid in patients with positive (C+) and negative (C-) history of cancer; analysis of ultrasound (US) images of metastases. MATERIAL AND METHODS: Results of US/fine needle aspiration (FNA) of the thyroid in 1276 C+ patients and 18,947 C- patients. RESULTS: TM and NM were diagnosed/suspected in 57 patients (0.3% of all examined; 40 TM, 22 NM, 5 both), and their frequency was higher in the C+ group (2.9% vs. 0.1% in C-, p < 0.0001). In the C+ group, diagnosis of metastasis accounted for 72.3% of FNA results from the category "malignant neoplasm"; in the C- group it was 9.5% (p < 0.0001). The highest relative frequency of TM was found for cancers infiltrating thyroid by direct extension (> 10%), lymphomas (7.7%), and kidney (5.3%) and lung (4.9%) cancers. The mean age of patients with metastasis (63.9 ± 11.7 years) was similar to that of the C+ group and higher than the C- group (53.9 ± 14.8 years, p < 0.0001). The proportion of males among the patients with metastasis was three-fold higher than in the patients without metastasis (p < 0.0001). TM lesions presented suspicious borders in US twice as often as primary cancers . CONCLUSIONS: Metastases to the thyroid are rare; however, for patients with a history of cancer, their presence is more likely than primary thyroid cancer. US/FNA imaging of metastases allows the selection of patients requiring further diagnostics and treatment.

Trends in the incidence of biopsy-proven glomerular diseases in the adult population in central Poland in the years 1990-2010.

BACKGROUND: There is a paucity of epidemiological data on biopsy-proven glomerulonephritis (GN) in Poland. The aim of this study was to assess the epidemiology of renal diseases based on histological diagnosis in the region of Central Poland over the last two decades. METHODS: Retrospective analysis of the results of 746 consecutive native kidney biopsies performed in the Caucasian adults from 1990 to 2010 in a single tertiary nephrology center serving an area of Central Poland. RESULTS: Primary GN was found in 81.4% of all biopsies. The mesangioproliferative GN including IgA nephropathy was the most frequent type of primary GN (51.2%). Membranoproliferative GN was diagnosed between 1990 and 2000 more frequently than in the following decade (26.7 vs. 7.3%, p < 0.001). There was a significant increase in the incidence of FSGS (4.8 vs. 17.3%, p < 0.001) and MCD (5.1 vs. 11.2%, p < 0.001) over time. Secondary GN was documented in 18.6% of biopsies and lupus nephritis was the most frequent cause (34.5%). CONCLUSION: Our analysis showed the decrease in the incidence of membranoproliferative GN with the parallel increase of FSGS and MCD over the last twenty years. Mesangioproliferative GN including IgA nephropathy remains the most frequent type of GN observed in our region.