Pedro Aguiar

A Case Series of De Novo Inflammatory Bowel Disease After Kidney Transplantation

Diarrhea, which is common after transplantation, may be due to infections and immunosuppressive therapy. Inflammatory bowel disease (IBD) de novo or as an exacerbation of pre-existent disease is a rare complication after kidney transplantation with pre-existing disease having a less aggressive clinical course than the de novo disease. Cytomegalovirus mismatch, prescription of tacrolimus instead of cyclosporine or mycophenolate mofetil rather than azathioprine as well as low-dose corticosteroid treatments have been linked to an increased incidence of IBD. This series of renal transplant recipients with de novo IBD showed a higher incidence and more aggressive course than that previously described, possibly related to increased use of tacrolimus with minimization of steroids.

Cryptococcal infection in non-HIV immunosuppressed patients - Three case reports in a nephrology setting.

Cryptococcal infection has been increasing among immunosuppressed population. We report three cases of Cryptococcus neoformans infection in immunosuppressed patients – two renal transplanted and one with lupus nephritis. Early infection (<3months) was diagnosed in two – an allograft Cryptococcus infection and a central nervous system involvement. The third, a 10-year transplant vintage patient, presented with cryptococcal meningitis. Amphotericin B provided good clinical outcomes. We outline the importance of suspicion for cryptococcal infection in immunosuppressed patients.

A Case Series of Gastrointestinal Tuberculosis in Renal Transplant Patients

Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach.

Overhydration prevalence in peritoneal dialysis – A 2 year longitudinal analysis

BACKGROUND AND OBJECTIVES Hypervolemia is a major concern in dialysis patients, and is associated with increased cardiovascular risk and death. Cross sectional analysis have previously demonstrated that peritoneal dialysis (PD) patients are not more overhydrated when compared to haemodialysiś ones. This study was designed to evaluate longitudinal trends in hydration status and corporal composition in a PD population. METHODS We conducted a 2 year prospective observational study of 58 PD patients from a single centre. Incident and prevalent patients were included. Yearly measurements were performed using multifrequency electric bioimpedance. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also explored. RESULTS A total of 30 patients completed evaluation (female 63.3%, mean age 56.9 years, BMI 25.0 kg/m², diabetes 10.0%, APD-50.0%). Median PD vintage was 21.9 months, and 36.7% were anuric. At baseline 6.7% were overhydrated. On longitudinal analysis no significant changes were found in hydration status, systolic blood pressure, pro-BNP, nor albumin levels. Similar results were found among incident (n=11; APD- 45.5%; anuric- 9.1%) and prevalent (n=19; APD- 52.6%; anuric- 52.6%) patients (p>.05). However, at the second year, prevalent patients were moderately overhydrated compared to incident ones (median 10.2% vs 3.5%; p=.009). Nonetheless, no statistical difference was observed considering adequacy, TBW, or ECW. Moreover, nutritional parameters remained stable. CONCLUSIONS Peritoneal dialysis maintenance without increasing volume status, nor major deleterious corporal composition trends, is feasible under careful therapy strategies. Longitudinal application of BIA may be a useful clinical tool to evaluate adequacy beyond Kt/V.