Hypertension and nephrology

[Early histopathological changes in new onset diabetes mellitus after renal transplantation]

IBRAHIM Munir Yasmin1, BORDA Bernadett1, LENGYEL Csaba2, VÁRKONYI Tamás2, KEMÉNY Éva3, SZABÓ Viktor4, KUBIK András5, LÁZÁR György1

DECEMBER 10, 2013

Hypertension and nephrology - 2013;17(05-06)

[Introduction: New-onset diabetes after transplantation (NODAT) is one of the most common complications following kidney transplantation. The diagnosis of NODAT is often late or missed, therefore it impairs the implanted renal allograft. Patients and methods: Patients were randomized to receive cyclosporine A- or tacrolimusbased immunosuppression. One year after the transplantation, fasting and oral glucose tolerance tests were performed, and the patients were assigned to one of the following three groups based on the results: normal, impaired fasting glucose/impaired glucose tolerance (IFG/IGT), NODAT. Age, laboratory results, renal function, morphological abnormalities, and changes in the Banff score were evaluated. Results: NODAT developed in 14% of patients receiving cyclosporine A-based immunosuppression and in 26% of patients taking tacrolimus (p=0.0002). Albumin levels were similar, but uric acid level (p=0.002) and the age of the recipient (p=0.003) were significantly different between the diabetic and the normal group. The evaluation of renal function showed no significant differences in case of serum creatinine level, eGFR, and urea level. Evaluation of tissue samples revealed that acute cellular rejection (ACR) and interstitial fibrosis/ tubular atrophy (IF/TA) were significantly different in the NODAT group. Changes in the Banff score provided significant difference regarding tubulitis (“t”) and interstitial inflammation (“i”) (p=0.05). Discussion: The pathological effect of new-onset diabetes after kidney transplantation can be detected in the morphology of the renal allograft earlier, before any signs of functional impairment.]

AFFILIATIONS

  1. Szegedi Tudományegyetem, ÁOK, Sebészeti Klinika, Szeged
  2. Szegedi Tudományegyetem, ÁOK, I. Sz. Belgyógyászati Klinika, Szeged
  3. Szegedi Tudományegyetem, ÁOK, Patológia Intézet, Szeged
  4. Szegedi Tudományegyetem, ÁOK, Családorvosi Intézet, Szeged
  5. Semmelweis Egyetem, Urológiai Klinika, Budapest

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[Monitoring of effectiveness of ramipril-amlodipine fixed combination, a non-interventional trial (Ramona study). Subgroup analysis of patients with chronic kidney disease]

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[Hypertension and chronic kidney disease are independent cardiovascular risk factors. The 5th Cardiovascular Consensus Conference has recommended chronic kidney disease in high-risk category. In chronic kidney disease hypertension is observed in most cases. In patients with chronic kidney disease blood pressure targets are as 140/90 mmHg blood pressure below must be achieved without overt proteinuria. In chronic kidney disease combined antihypertensive therapy treatment should be initiated according the Hungarian Society of Hypertension recommendations. Aims: Monitoring the effectiveness and safety of the fix combination of ramipril/amlodipine Egiramlon® therapy in chronic kidney disease suffering from mild or moderate hypertension despite antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved known chronic kidney disease (age over 18 years) with mild or moderate hypertension. Ramipril/amlodipine fixed combination (5/5, 5/10, 10/5 or, 10/10 mg) were administered or titrated in three visits, during the 4 months of trial period. The doses of the fixed combination drugs were determined individually during the visits by the 923 physicians involved in the study. The target blood pressure value was <140/90 mmHg according the new guidelines of ESH/ESC. Results: 70.1% of total patient (9169) was fulfilled the protocol during the four month of trial (6423 patients). In this population 194 patients suffered from chronic kidney disease. The age of patients was 68.52±1.84 (mean±SD) years, 85 (43.8) women and 109 (56.2%) men. 74.74% of total patients with chronic kidney disease has reached target blood pressure at the end of 4th month (primary endpoint). The blood pressure has decreased significantly (all p<0.0001) from 158.04/90.46±9.97/8.30 mmHg (1. visit) to 138.77/82.12±10.68/7.21 mmHg 2. visit and to 130.40/78.59±7.56/5.75 at the and of trial (3. visit), it means -27.64/- 11.87 mmHg decrease from the beginning of the 4th Month (3. visit). eGFR level increased significantly from 46.3±16.49 ml/min/1,73m2 to 49.0±19.58 ml/min/1,73m2. Patients suffered from chronic kidney disease have tolerated well the various doses of fixed combination of ramipril/amlodipine, and adverse events have no occurred correlation of treatment.]

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[Primary membranous nephropathy is a common glomerular disorder characterized by subepithelial immune deposits. The pathomechanism underlying these lesions has only recently been elucidated: M-type phospholipase A2receptor (PLA2R) protein emerged as being the leading autoantigen. Antibodies to PLA2R, typically of IgG4 subclass are expressed in 70-80% of patients with primary membranous nephropathy. The level of autoantibody to PLA2R was shown to correlate with disease severity and to change parallel with disease activity in response to therapy. While mild forms of the disease are prone to spontaneous remission and carry excellent prognosis, severe forms often progress into end-stage renal disease without treatment and necessitate immunosuppression. The latest guidelines recommend the application of corticosteroids with alkylating agents or calcineurin inhibitors as first-line therapy. Promising new therapies that are currently being explored for this disease include rituximab, mycophenolate mofetil, and adrenocorticotropic hormone.]

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