Syed Hussain

Successful treatment of radiation nephropathy with angiotensin II blockade.

PURPOSEnThe aim of this report is to document the successful treatment of radiation nephropathy.nnnMETHODSnClinical case report with statistical analysis of evolution of kidney function.nnnRESULTSnA case of radiation nephropathy was found in a kidney transplant recipient whose kidney transplant had been irradiated with 750 cGy 23 years previously. Use of the angiotensin II blocker, losartan, was associated with significant stabilization of the kidney function.nnnCONCLUSIONnRadiation nephropathy can be successfully treated. Other normal-tissue radiation injuries may also be treatable.

Rapid kidney allograft failure in patients with polyoma virus nephritis with prior treatment with antilymphocyte agents

Interstitial nephritis owing to polyoma virus infection (PVi) mimics acute allograft rejection. The risk factors for graft failure associated with PVi are unknown. This prompted us to analyse the relationship between the use of antilymphocyte agents (ALA) and graft dysfunction in renal transplant recipients with PVi.

Access to Kidney Transplantation among Patients Insured by the United States Department of Veterans Affairs

Ensuring equal access to kidney transplantation is of paramount importance. Veterans that receive care from the Department of Veteran Affairs (VA) must complete a complex process to be placed on the transplant wait-list, and only four VA hospitals in the United States transplant kidneys. This unique system may cause VA patients to wait longer for kidney transplants than other patients. We compared the time to transplantation among ESRD patients insured by the VA to those insured by private insurance or Medicare/Medicaid. Of 7395 veterans studied, 9.3% received transplants, compared to 35,450 of 144,651 (24.5%) patients with private insurance and 36,150 of 357,345 (10.1%) patients with Medicare/Medicaid insurance (P < 0.0001). We found that both VA-insured and Medicare/Medicaid-insured patients were approximately 35% less likely to receive transplants than patients with private insurance (hazard ratio [HR] 0.65; 95% CI 0.60 to 0.70; P < 0.0001). Most of this difference was explained by the fact that VA patients were less likely to be placed on the wait-list (HR 0.71; 95% CI 0.67 to 0.76), but even listed VA patients received transplants less frequently than those insured privately (HR 0.89; 95% CI 0.82 to 0.96). Interestingly, VA patients with supplemental private insurance had the same likelihood of transplantation as non-VA patients with private insurance. We conclude that VA-insured patients are less likely to receive transplants than privately insured patients, and that further studies are needed to identify the reasons for this disparity.

Phosphorus‐enriched hemodialysis during pregnancy: Two case reports

Successful pregnancy leading to delivery of a viable infant is an uncommon occurrence either in women with established renal disease or in those with renal failure requiring chronic dialytic treatment. The frequency of conception in patients with renal failure has increased, however, and the outcome of such pregnancies has improved over the past 32 years. Current guidelines for dialysis in pregnant women include prolonged dialysis times, generally 20 or more hours per week. This extensive dialysis regimen often results in a decrease in the serum inorganic phosphorus levels, with possible detrimental effects to the health of the mother and the unborn child. In this article, we report the successful multidisciplinary management of two pregnant women with end‐stage renal disease, both of whom developed hypophosphatemia after initiation of intensive hemodialysis. Sodium phosphate salts were added to the dialysate of each patient and this addition successfully corrected the decrease in serum inorganic phosphate concentration. One patient was able to carry the pregnancy for 28 weeks with delivery of a healthy 1260‐g infant. The pregnancy of the second patient ended at 25 weeks of gestation with delivery of a nonviable infant.

Outcome among patients with acute renal failure needing continuous renal replacement therapy: A single center study.

Outcome of acute renal failure (ARF) and use of continuous renal replacement therapy (CRRT) have shown a consistently high mortality. (1) Evaluate the short‐term patient survival. (2) Evaluate dialysis‐free survival. (3) Evaluate risk factors associated with overall survival and the continued need for intermittent dialysis. We identified adults (≥18 years) needing CRRT, treated in the critical care units of Froedtert Medical and Lutheran Hospital from January 1, 2003 till December 31, 2005. Patients were divided into two major groups needing CRRT, end stage renal disease (ESRD) (chronic dialysis) and non‐ESRD with ARF. Continuous renal replacement therapy was performed with an average of 2u2003L replacement fluid exchanges/h. Sigma stat software was used for analysis. Comparison was done for noncontinuous variables by chi‐square and t test for categorical and continuous variables, respectively. A total of 110 (ESRD 24/non‐ESRD 86) patients received CRRT during study period. Over all in‐hospital mortality among non‐ESRD patients was 63% vs. 46% for ESRD. Among non‐ESRD patients who survived, 47% needed intermittent hemodialysis on intensive care unit discharge and 28% continued to need hemodialysis at last follow‐up. Among non‐ESRD patients alive at discharge, those who were dialysis dependent on last follow‐up were older (64.5) than those who did not require dialysis on last follow‐up (58.4) P=0.347. Non‐ESRD patients who died were in the hospital for an average of 17.5 days compared with 29 days for those who were discharged from the hospital. Patients with ARF needing CRRT have high in‐hospital mortality. A significant percentage of patients remained dialysis dependant on last follow‐up.

Bk virus infection after renal transplantation

Purpose of reviewIncreasing prevalence of BK virus nephritis after renal transplantation has prompted review of important publications on this topic. Recent findingsNephritis from the BK virus occurs specifically in renal transplant recipients, but not after other solid organ transplantation. A mouse renal transplant model of polyoma nephritis unveils the role of alloimmune activity in the development of BK virus nephritis. BK virus nephritis occurs approximately 1 year after transplantation, as opposed to acute rejection, which occurs early after transplantation. No identifiable donor, recipient, or transplant variables correlate with this disease. Recipients who receive a kidney from a seropositive kidney donor and the lack of HLA C7 in either donor or recipient may play a role in BK virus infection. Mycophenolate mofetil and tacrolimus combination therapy is associated with a slightly higher chance of infection. Recovery from BK virus nephritis is associated with increase in BK virus-specific humoral and cellular immunity, which suggests that they are relevant factors in the pathogenesis of this disease. SummaryNephritis from BK virus infection occurs through seropositive donors. Lack of HLA C7 in donor and recipient and BK virus-specific humoral and cellular immune deficiencies may precipitate infection.