Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022672 (acute tubular necrosis)
 2,175 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Withdrawal of steroid therapy in renal transplant recipients is associated with a risk of acute allograft rejection. To define clinical risk factors for rejection associated with steroid withdrawal, we analyzed the clinical characteristics of 107 patients with drawn from steroid therapy at various times after transplantation. Both univariate and multivariate analyses suggested that the timing of steroid withdrawal is an important predictor of steroid withdrawal failure. Withdrawal of steroids was successful in only 13 of 32 patients (41%) in whom prednisone was discontinued shortly after transplantation. In contrast, steroid withdrawal has been successful in 59 of 75 patients (79%) in whom prednisone was discontinued at least 6 months after transplantation. Black race and donor-recipient racial mismatch also were significant predictors of rejection associated with steroid withdrawal. In patients undergoing steroid withdrawal at least 6 months posttransplant, serum creatinine concentration also correlated independently with the risk of rejection. Neither age, sex, HLA match, pretransplant PRA, source of the allograft (cadaver vs. living relative), acute tubular necrosis, nor the presence of diabetes was predictive of the outcome of steroid withdrawal.
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PMID:Withdrawal of steroids after renal transplantation--clinical predictors of outcome. 173 83

The role of platelet transfusion as a preparative method for kidney transplantation is still a matter of debate. Two groups of 28 male patients transplanted between 1983 and 1988, paired for age, date of transplant, absence of anti-HLA antibody and immunosuppressive therapy have been compared. Group I was given 5 purified platelet transfusions at 1-week intervals before transplantation. Each transfusion contained 7.6 x 10(6) platelets contaminated by less than 1 leukocyte in 10(5) platelets. Group II received from 3 to 5 whole blood transfusions. In all cases it was a first transplant from cadaveric donors and previously untransfused patients before entering the protocol. No patient in group I developed cytotoxic antibodies. Acute tubular necrosis occurred with the same incidence in group I and in group II but was more severe and longer in group I, requiring hemodialysis in 62.5% and only 22% in group II. ATN was significantly associated with graft loss in group I (P less than 0.05). The total number of rejections and the number of patients undergoing rejection were not significantly different in both groups. However, the intensity of rejection was significantly higher in group I with 41% (21/51) of severe or irreversible rejections versus 9/46 (19.5%) in group II (P less than 0.05). The first rejection occurred significantly earlier in group I than in group II since 75% of the first rejection episodes occurred in the first 10 days versus 38% in group II (P less than 0.02) with a mean delay of 12.8 +/- 3.2 and 19.10 +/- 3.3 days, respectively. Although platelet transfusions are devoid of leukocytes the incidence of CMV infection was not significantly different in both groups: 57% in group I and 68% in group II. Purified platelet transfusions did not induce humoral immunization but lack of sensitization does not imply indefinite graft prolongation. Because platelets do not carry class II antigens, purified platelets transfusions represent a useful model to analyze the role of class I antigens alone in the induction of unresponsiveness in organ transplantation.
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PMID:The value of platelet transfusions as preparation for kidney transplantation. 184 72

The outcome of renal transplantation in CAPD patients is still controversial since age and clinical differences often make comparison with hemodialysis patients difficult. The aim of this study was to analyse two homogeneous groups of patients, on CAPD and on hemodialysis. 18 CAPD (Group A) and 18 hemodialysis patients (Group B) were selected for a case-control analysis, matched for age, presence of acute tubular necrosis and Cyclosporine A regimen. Group A and B were not different for male/female ratio, donor age, HLA-Dr mismatches, arterial pressure, cold ischemia, or follow-up. Patient, graft survival and number of rejection episodes did not differ significantly at 1 year; serum creatinine at 6 and 12 months and CyA doses at 1 and 6 months were not different; hospitalization rates for first and subsequent admissions did not differ. Infection-free patients were 9/18 in Group A and 15/18 in Group B, with 12 episodes in Group A and 3 in Group B. Post transplant cholesterol levels showed a trend to increase in both groups and triglycerides levels to a decrease; differences in pre and post transplant in body weight were not significant at 12 months. In conclusion, the outcome of transplantation in CAPD patients is not significantly different from that in hemodialysis patients with similar clinical characteristics.
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PMID:Comparison between two dialytic populations undergoing renal transplantation. 198 44

In renal transplantation, preformed cytotoxic antibody against donor HLA class I antigens causes hyperacute rejection of renal allografts, but its pathogenic significance when it develops in the posttransplant period is unknown. In the present studies we describe the clinical and pathologic features of patients with rejection associated with anti-class I. In the course of 400 consecutive cadaveric renal transplants, 7 patients were identified who had antibody against donor class I HLA antigens in association with atypical but distinctive patterns of rejection. All 7 were presensitized. In 3 patients, the transplant had been inadvertently performed with a positive donor-specific T cell crossmatch. In the remaining 4, the T cell crossmatch on current sera was negative but became positive posttransplant. The clinical picture was deterioration of graft function with rapid onset of oliguria, apparently due to acute tubular necrosis, but with persistence of blood flow demonstrable by radioisotope scan studies. Renal histology showed that the typical lesions observed in cell-mediated rejection, such as tubulitis and interstitial infiltration, were absent. Granular complement deposition (6), polymorphonuclear infiltration (6), and endothelial injury in the microvasculature (6) were common, and mononuclear infiltrates were absent (2) or not prominent (4). In 3 patients the glomerular changes resembled a picture of hemolytic uremic syndrome, with capillary fibrin thrombi and widening of the subendothelial space. IgG staining was negative. The pathologic features suggest that anti-class I antibody appearing or persisting in the early posttransplant period injures the endothelium of the microvasculature, with the clinical presentation different from that of hyperacute rejection. Particularly in sensitized patients, rapid deterioration in function, leading to a picture of acute tubular necrosis, with pathologic features of endothelial injury in the microcirculation, should suggest the diagnosis of anti-class I-mediated rejection.
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PMID:The significance of the anti-class I antibody response. I. Clinical and pathologic features of anti-class I-mediated rejection. 230 Oct 35

Monitoring of immunoglobulin-secreting cells in peripheral blood was performed in 88 renal transplant recipients using a reverse hemolytic plaque-forming cell assay. Comparison with other in vitro tests for rejection (plasma neopterin, CD4/CD8 ratio) demonstrated that the number of immunoglobulin-secreting cells in peripheral blood provides a highly sensitive rejection marker. Evidence of rejection was obtained 1.7 +/- 0.4 (mean +/- SEM) days before a rise in creatinine, with a significant PFC rise in 95% (73/77) of rejection episodes. The PFC response was not influenced by HLA matching, number of preoperative blood transfusions, acute tubular necrosis, or uremia. A significant PFC rise in the absence of an ongoing rejection episode occurred in the presence of bacterial or viral infections, in case of posttransplant surgical complications, and regularly during the early posttransplant period (days 4-9). However, even early posttransplant the PFC peak was significantly higher in patients with an ongoing rejection episode than in patients without rejection (P less than 0.001).
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PMID:B lymphocyte response as an indicator of acute renal transplant rejection. I. Immunoglobulin-secreting cells in peripheral blood. 257 82

Graft survival was examined in 15 renal allograft recipients from a group of 20 patients with IgM autolymphocytotoxic antibody that could be removed in a crossmatch assay using a reducing agent, dithioerythritol (DTE). The significant differences in this group of 20 patients compared with end-stage renal disease (ESRD) patients lacking autolymphocytotoxic antibodies included an increased frequency of black patients (P = 0.002), a lack of previous transplants (P = 0.003), and an increased frequency of the HLA-DR1 phenotype (P = 0.0001). Sex and the number of transfusions did not appear significant, whereas the cause of ESRD was primarily systemic lupus erythematosus. Fifteen of the 20 patients were transplanted against a positive donor crossmatch. Eleven were recipients of cadaveric kidneys, nine of which are still functioning for periods ranging from 0.5 to 40 months. Two fo the cadaveric recipients died with functional grafts. Four received living-related donor transplants, one of which was lost to acute rejection one month posttransplant, while the remaining three have survived 1.5, 9, and 21 months, respectively. Fourteen patients had immediate allograft function with no hyperacute rejection and only one case of acute tubular necrosis (ATN) was found. In summary, a negative crossmatch using DTE-treated, autologous reactive recipient sera may identify a group of patients who can be transplanted with minimal concern for hyperacute rejection or ATN. In addition to cause of ESRD, race, transplant history, and HLA-DR phenotype may further define this group of transplant candidates having IgM autolymphocytotoxic antibody. Extrapolation of these conclusions to transplant candidates lacking autolymphocytotoxic antibodies is not warranted.
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PMID:Successful renal allografts in recipients with crossmatch-positive, dithioerythritol-treated negative sera. Race, transplant history, and HLA-DR1 phenotype. 264 5

We compared early (less than 70 days) cumulative survival, cause of death, and morbidity (defined as the number of organ system failures and reoperations) of 236 patients who needed dialysis for acute tubular necrosis (ATN) after transplantation with that of a control group of 215 transplant patients who had immediate renal function after transplantation. The patients were matched for age, number of transplants, time of transplantation, diabetic status, living-related vs cadaveric donor, and number of HLA matches. There were no differences in cumulative survival after transplantation, causes of death, organ system failure, or surgical complications as evident from the number of reoperations. The ATN patients' overall clinical course was similar to that described for other postsurgical patients with ATN in their native kidneys. We conclude that the poor survival and the surgical complications in patients with postoperative ATN are due to the basic disease and not to acute renal failure or to dialysis. To improve survival, research should be focused on the basic disease and the surgical procedures rather than on dialysis technique.
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PMID:Why do patients with postsurgical acute tubular necrosis die? 299 Mar 83

In a prospective randomized trial we evaluated the influence of the calcium antagonist diltiazem (Dil) on the development of acute tubular necrosis (ATN) in cadaveric kidney transplantation. Dil was added to Eurocollin's solution (20 mg/l) at donor nephrectomy. The graft recipient received a preoperative bolus injection of Dil (0.28 mg/kg) which was followed by an infusion of Dil (0.0022 mg/min/kg) for 2 days. Thereafter, Dil was applied orally. Immunosuppressive therapy consisted of ciclosporin (CS) and low-dose steroids. There were no significant differences between the groups with respect to donor characteristics, HLA matching and ischemic periods. In the control group (n = 22), 9 patients (41%) developed ATN compared to 2 patients (10%) in the Dil group (p less than 0.05). In the control group, 3.5 +/- 0.4 HD per patient were necessary compared to 0.6 +/- 0.2 in the Dil group (p less than 0.05). Although CS blood levels were significantly higher in the Dil group (1st week 1,150 vs. 728 ng/ml; p less than 0.01), the GFR of grafts with primary function was significantly higher in the Dil group (day 7:39 vs. 24 ml/min; p less than 0.05). A significant reduction of the CS dose by 30% (p less than 0.01) led to comparable CS levels. In the Dil group, significantly fewer rejection episodes occurred during the first month. Our data indicate that the application of the calcium antagonist Dil lowered the incidence of posttransplant ATN. In addition, there is a possibility that Dil not only ameliorates ischemic damage in the kidney, but also reduces CS nephrotoxicity.
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PMID:Prevention of posttransplant acute tubular necrosis by the calcium antagonist diltiazem: a prospective randomized study. 331 61

Renal transplantation is the treatment of choice for adults and children with end-stage renal disease. More than 7500 kidney transplants are performed in the United States each year with an average 2-year graft survival rate of 95, 85, and 75 per cent for HLA-identical, living related, and cadaver donor recipients, respectively. New immunosuppressive modalities including donor specific transfusions and cyclosporine have resulted in improved results with fewer infectious complications. Careful attention to hemostasis, minimization of tissue injury, and aseptic technique is necessary in uremic and immunosuppressed patients. The most common complications requiring radiologic evaluation and treatment after renal transplantation include acute tubular necrosis, renal artery or renal vein thrombosis, lymphocele, ureteral necrosis, bladder disruption, bleeding, ureteral obstruction or stricture, and renal artery stenosis. The most useful radiologic studies are renograms, echograms, computed axial tomograms, cystograms, arteriograms, percutaneous nephrostograms, and intravenous or retrograde pyelograms.
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PMID:Renal transplantation: clinical considerations. 354 72

We analyzed the survival results of 300 consecutive kidney transplants (TXs) performed at Hennepin County Medical Center, Minneapolis, Minnesota, between March 1965 and April 1980. The graft survival result were compared between three sequential time periods, each comprising 100 renal TXs. The proportion of live donor TXs decreased from 27% in period 1 to 16% in period 2 and 5% in period 3, while the number of older patients, diabetic and multiple TX patients increased steadily. A comprehensive patient care scheme utilizing clinical protocols was developed in period 2 and carried out effectively in period 3. The Cox multivariate regression models used in this analysis allowed us to assess the influence of each variable on the graft survival results, while the effects of all others were held constant. Among the nondiabetic patients who received antilymphocyte globulin, the 1 and 5 year graft survival rates were 59.7 and 38.8% in period 1, 85.3 and 74.3% in period 2, 90.4 and 83.1% in period 3 (periods 1 versus 2: P = 0.008, periods 1 versus 3: P less than 0.0001). This improvement in graft survival was independent of the effects of the following variables, that is, the recipient's age, donor source, prior dialysis, co-existing medical problems, splenectomy, previous TXs, blood transfusions, cytotoxic antibodies, cold ischemia time, HLA mismatches, and post-TX acute tubular necrosis. Our observations indicate that reduced immunosuppression, frequent use of biopsy specimens and comprehensive patient care, played an important role in minimizing the loss of renal transplants in the later time periods and contributed indirectly for the improved graft survival results of our institution.
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PMID:Factors contributing for improved graft survival in recipients of kidney transplants. 635 14


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