Revista de nefrología y terapéutica

Introduction: Visceral leishmaniasis is a disease caused by the protozoan Leishmania sp. and is transmitted by Lutzomyia longipalpis (sand fly). In renal transplant recipients, Visceral Leishmaniasis causes severe damage to the liver, spleen, and hematopoietic system as well as poor outcomes for patients and transplanted kidneys. This study describes the largest series of cases of this disease in renal transplant recipients, providing important information about the diagnostic routines and therapeutic strategies in this patient population. Methods: A retrospective, descriptive study was performed to analyze the distribution and evaluate the extent of the epidemiologic, clinical, diagnostic, and therapeutic aspects of 30 renal transplant recipients from endemic regions who presented with Visceral Leishmaniasis in the post-transplantation period. Results: In this study, Visceral Leishmaniasis was more frequent in men (80%); the mean age of presentation was 40±10.5 years. The majority (66.7%) of patients worked in urban areas. Most of the patients (90%) cohabitated with domestic animals and were from low-income households. In 73.3% of cases, diagnosis was made by direct isolation of Leishmania forms. The drug chosen for treatment was liposomal amphotericin, resulting in a high degree of disease remission (80%). Conclusion: This study describes the largest series of Visceral Leishmaniasis in renal transplant recipients and expands clinical-epidemiological knowledge for transplantation teams to perform adequate disease management for this specific patient population

About 1.9 million people worldwide have end-stage renal disease, a stage of chronic kidney disease where affected individuals require long-term renal replacement therapy of which 75% are on maintenance hemodialysis. Africa has the lowest dialysis uptake rates in the world despite chronic kidney disease being three to four times more common in Africa than it is in the developed world. Several factors are responsible for this low rate of dialysis uptake in sub-Saharan Africa. These include inadequacy of dialysis infrastructure, lack of reimbursements or government subsidies for dialysis and severe shortage of trained nephrology personnel. In addition, there is no regulation governing dialysis practice in most countries in the region, and no renal data on basis of which plans to tackle these issues can be developed. Increased financial commitments on the part of governments in sub-Saharan Africa are essential not only to improve patient access to dialysis, but also to fund research needed to provide epidemiologic data on kidney disease, train and retain nephrology personnel and develop effective, safe and affordable dialysis modalities for patients with ESRD in the region

Background: Recently, off-pump coronary artery bypass (OPCABG) grafting without cardiopulmonary bypass has become a less stressful surgical procedure for coronary artery bypass grafting (CABG). Many reports have discussed the risk factors involved associated with on-pump coronary artery bypass grafting and acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). However, only a few papers have evaluated the risk factors for AKI requiring CRRT after OPCABG. Aim: The purpose of this study was to assess the risk factors for AKI requiring CRRT after OPCAB. Methods: An observational study of 237 consecutive non dialysis patients who underwent isolated CABG using OPCABG was conducted from September 2010 to June 2012. AKI was defined as proposed by the Acute Kidney Injury Network. Variables with P<0.05 in bivariate analysis collected from pre-, intra- and postoperative data were tested in the multivariate and proportional hazards regression analyses for risk factors of AKI requiring CRRT after OPCABG. Results: Among 237 subjects, 33 patients needed CRRT due to AKI. The risk factors that were independently associated with AKI requiring CRRT were: pre-estimated glomerular filtration rate (GFR) (less than 60 ml/min/1.73m2), pre-serum albumin level (less than 3.5 g/dl), pre-hemoglobin level (less than 12g/dL), intra-urine volume (less than 600 mL), use of intra-aortic balloon pump (IABP), and post-PaO2/FiO2 (P/F) (less than 300). Conclusion: In conclusion, it is possible that the risk of developing AKI requiring CRRT after OPCABG depended on the levels of GFR, serum albumin and hemoglobin before surgery, on the levels of urine volume and use of IABP during surgery and the levels of P/F after surgery

Background: UTI is a common infection in children. Its highest prevalence takes place during infancy and toilet training period in which most infants use diaper. However, the impact of diaper use on UTI in children has been conflicting. Objective: To determine the correlation between duration of superabsorbent diaper usage with incidence of UTI in children. Methods: We performed a prospective cohort study from August-September 2011. We recruited children who used diaper every day, went to play group or posyandu (community health care centres) at Yogyakarta City. Subjects were divided into 2 groups. We compared the incidence of UTI among children who used a diaper > 4 hours per day (group I) and those who used a diaper ≤ 4 hours per day (group II). Results: There were 180 children included in this study. Out of 90 children in group I, 26 (28.9%) had UTI whereas 9 (10%) of 90 children from group II had UTI. Multivariate analysis showed that UTI was significantly higher in children who used diaper > 4 hours per day compared to children who used diaper ≤ 4 hours per day (OR 3.65; 95%CI 1.60-8.35). The Mantel Haenszel analysis showed that the risk ratio for girls was 3.13 (95%CI 1.50-6.55) and boys was 1.56 (95%CI 0.27-8.94), use of diaper in girls > 4 hours per day therefore increased the risk of UTI. Conclusions: The use of superabsorbent diaper > 4 hours per day increased the risk of UTI 365 times compared with the use of ≤ 4 hours per day. Girls who used diaper > 4 hours per day in girls significantly increased the risk UTI

Aim: The detection and prognosis of nephropathy in transthyretin amyloidosis depends on albuminuria and renal function. Knowing that urinary levels of alpha-1 microglobulin and beta-2 microglobulin reflect tubular dysfunction while urinary alpha-2 macroglobulin implies glomerular damage, we decide investigate the diagnostic value of these markers in the patients with transthyretin amyloidosis. Methods: Serum and urinary samples collected from 30 patients and 11 asymptomatic carriers were tested for alpha-1 microglobulin, beta-2 microglobulin, alpha-2 macroglobulin, albumin, creatinine and cystatin C. Results: Pathological urinary alpha-1 microglobulin was detected in 17 patients, beta-2 microglobulin in 6 and alpha-2 macroglobulin in 5; 5 patients had albuminuria (mg/g creatinine) 30-300 and in 20 patients values >300 were present. Asymptomatic carriers did not present pathological excretion of these biomarkers and albuminuria was >30 in 1 individual. The excretion rates of alpha-1 microglobulin and beta-2 microglobulin were positively correlated with albuminuria (P<0.001), serum creatinine (P<0.05) and cystatin C (P<0.001). Urinary alpha-2 macroglobulin was almost exclusively found in the presence of albuminuria, although their levels do not correlate. Conclusion: Urinary biomarkers emerge as a potential approach to detect renal disease but unexpectedly, urinary alpha-2 macroglobulin was not a marker of the severity of albuminuria

Aim: The aim of this study was to detect and compare the enzymes, globulins and reactants of the early phase in patients with untreated rheumatoid arthritis and to reveal the effect of untreated rheumatoid arthritis on tubular function and sensitivity on brush border area. Material and Methods: The samples of serum and urine were examined in 70 participants (35 patients with untreated rheumatoid arthritis, 35 individuals of the healthy control group). We used in the study the kinetic assay for determination of alanine aminopeptidase (AAP) (Standards methods under IFCC), γ-glutamiytransferase and MEIA (Microparticle Enzyme Immunoassay) (Abbot Axsym system) for detection of β 2-microglobulin in urine. Results: Of 35 patients with RA, 16 patients showed presence of γ-GT (sensitivity of the test - 45.71%), 24 patients showed presence of AAP enzymuria (sensitivity of the test - 68.57%), while the presence of β2-microglobulin in urine was very low (sensitivity of the test - 0%). From 18 RF negative patients, 14 patients were AAP positive, 10 patients were γ-GT positive, while the presence of β2-microglobulin in urine was not detected. Among 17 RF positive patients with RA, the presence of AAP was detected in 10 patients, the presence of γ-GT in 6 patients, while the presence of β2-microglobulin in urine was not detected. Conclusion: In untreated rheumatoid arthritis AAP had higher sensitivity than γ-GT and β2-microglobulin in detection of asymptomatic renal damage

Quantification of urine albumin is an established method of screening, diagnosis and monitoring the progression of kidney disease. Renal disease is a frequent accompaniment of Human Immunodeficiency Virus (HIV) infection. Limited data exists with regard to the epidemiology of microalbuminuria in indigenous African HIV patients. To study this issue further, we evaluated 90 antiretroviral-naïve HIV seropositive adults and compared them with an equivalent number of age and sex matched HIV seronegative controls. Individuals with known confounders of urine albumin were excluded from the study. We found microalbuminuria in 35.6% of HIV cases as against 13.3% in the seronegative group (p=0.001). In addition, there was a positive correlation between cluster of differentiation 4 (CD4) cell count and microalbuminuria (p=0.001). Similarly, decreasing estimated glomerular filtration rate (eGFR) correlated with the finding of microalbuminuria. Our findings suggest that microalbuminuria is a frequent finding in adult anti-retroviral naïve seropositive Nigerians particularly in those with lower CD4 cell counts and lower eGFR.

Background: Although age had a strong effect on the risk of development to end-stage renal disease (ESRD), it is reported that stage 4 CKD patients aged >75 years were less likely to subsequently commence renal replacement therapy (RRT) than those aged <75 years. In the present study, the longitudinal follow-up of elderly patients with stage 4 CKD was carried out in a single center in order to evaluate the prognosis of the patients >75 years in comparison with those between 74 and 65 years and to characterize patients with stage 4 CKD older than 75 years. Methods: This was a prospective, observational, single-center cohort study. Patients were recruited from specialist renal clinics from January 2004 to December 2005. All participating patients were followed for 5 years or until death, commencement of dialysis therapy, receiving renal transplantation, finding of neoplasm, or occurrence of a cardiovascular event. We utilized electronic databases to determine the incidence of RRT and morbidity. Results: The underlying renal disease of CKD included diabetic nephropathy (DM) (91 patients, 51%) chronic glomerulonephritis (GN) (41 patients, 23%), hypertensive nephrosclerosis (HT) (44 patients, 25%), and other diseases (3 patients, 1%) in the younger group (74 and 65 years)and DM (24 patients, 23%), GN (24 patients, 23%), HT(54 patients, 51%), and other diseases (4 patients, 4%) in the elderly population (older than 75 years). A proportion of the underlying renal diseases were significantly differences between the two groups. In the elderly group, the prevalence of diabetic nephropathy was significantly lower (P<0.01) and that of HT was significantly higher (P<0.01). The incidencefree rates at 1 year and 3 years were 90% and 81% in the elderly group and those were 90% and 57% in the younger group, respectively. In the patients without diabetic nephropathy, introduction to RRT was significantly lower compared with those with diabetic nephropathy in the younger group (P<0.05). The incidence-free rates at 1 year and 3 years were 88% and 80% in the patients without diabetic nephropathy and those were 87% and 38% in the patients with diabetic nephropathy, respectively. In the late referral patients, the prevalence of diabetic nephropathy were significantly higher and that of GN and HT were significantly lower compared with those of the non-late referral patients (P<0.01). Conclusions: From these findings, it is concluded that in the patients >75 years, the values of eGFR may be overestimated and a prognosis of diabetic nephropathy was poor. Besides, the early nephrology referral is encouraged.