RESUMO
A high rate of recurrence has been described in atypical hemolytic uremic syndrome renal transplant recipients, favored by certain immunosuppressant drugs that can induce complement activation. We present four case series in which three patients were diagnosed pretransplantation and a fourth who had onset in the very early post-transplantation period. The patients received different immunosuppression schedules, and all had improvement after more than 2-years. We suggest the need to stratify the risk of atypical hemolytic uremic syndrome recurrence using genetic studies and the available drugs as the main factors that allow graft survival improvement today.
Assuntos
Síndrome Hemolítico-Urêmica Atípica/imunologia , Terapia de Imunossupressão/efeitos adversos , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/imunologia , Adulto , Idoso , Síndrome Hemolítico-Urêmica Atípica/cirurgia , Ativação do Complemento , Feminino , Sobrevivência de Enxerto/imunologia , Humanos , Terapia de Imunossupressão/métodos , Rim/imunologia , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de RiscoRESUMO
An attractive method for producing cis-1,2-dihydroxy-3-methylcyclohexa-3,5-diene (toluene cis glycol) was developed employing a cis dihydrodiol dehydrogenase "deficient" strain of Rhodococcus (MA 7249). The toluene cis glycol produced was found to have optical rotations of [alpha]D25 = +25.8 (c 0.45, CH3OH) and +72.8 (c 0.42, CHCl3) which indicated an absolute configuration of (1S,2R) when compared with previously published values. When cultivated in laboratory fermentor in the presence of toluene vapors, MA 7249 reached a toluene cis glycol concentration up to 18 g/l in 110 h. Culture MA 7249 also accumulated cis (1S,2R) dihydrodiols from dihydronaphthalene, biphenyl, chlorobenzene, and styrene.
