A single 4-week course of rituximab was as effective as 18 months of standard therapy with daily oral cyclophosphamide (CyP) and azathioprine (AZA) for induction of remission and maintenance therapy of severe anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The number, rate, and severity of adverse events was similar between the treatment groups, Cees Kallenberg, MD, PhD, professor of clinical immunology at University Medical Center Groningen in Groningen, Netherlands, reported at the 48th Congress of the European Renal Association-European Dialysis and Transplant Association in Prague in June. Rituximab is a monoclonal antibody directed against B lymphocytes.
During pregnancy, the development of acute renal failure is especially daunting because two lives are involved and at risk. The outcomes of acute kidney injury (AKI), as in other settings, can be quite poor, with significant morbidity and mortality rates of 20–30 percent.
Variable definitions of AKI have been used for pregnancy. The normal baseline serum creatinine during pregnancy is approximately 0.5 mg/dL; thus, a rise over 48 hours to values greater than 1.0 mg/dL, or an increase from a baseline of more than 0.5 mg/dL in 48 hours, should trigger further evaluation for AKI. It has been suggested that
Pre-eclampsia is a systemic syndrome occurring in the second half of pregnancy, with cardinal manifestations of hypertension and proteinuria. Pre-eclampsia is one of the most common glomerular diseases in the world; it affects approximately 3–5 percent of all pregnancies. Although careful obstetric management—including antihypertensive medications and seizure prophylaxis with intravenous magnesium—is important for the treatment of pre-eclampsia, delivery of the neonate and placenta remains the only definitive treatment. Thus, pre-eclampsia remains a leading cause of maternal mortality, preterm birth, and consequent neonatal morbidity and mortality. In developing countries, where access to safe, emergent delivery is less readily available, pre-eclampsia claims
About 5 percent of pregnancies suffer complications from abnormal placental development. The process of placentation begins when blastocysts adhere to the uterine endometrium, forming a lineage of epithelial cells termed the invasive extravillous cytotrophoblast, which then invades the uterine wall to create the decidua, transforming the spiral arteries into a low-resistance uteroplacental circulation.
Impaired development of the uteroplacental vasculature, therefore, has its origins in the first trimester as a result of an abnormal interaction between the invading extravillous cytotrophoblast and the maternal immune system, resulting in decidual vasculopathy, with small, poorly developed spiral arteries. As these pregnancies progress, placental ischemia
The Nobel Laureate Joseph Murray provided the first report of pregnancy in a transplant recipient (1). Since that time, over 16,000 pregnancies have been documented in the world literature (2). Many more pregnancies have clearly occurred, now that pregnancy after transplantation is commonplace and is rarely reported. The data about pregnancy in transplant recipients come from case reports and registry reports, but these sources underrepresent the population of transplant recipients who have become pregnant (2).
This review relies on data from registry reports in the United States, the United Kingdom, and Europe, but we
A healthy pregnancy—a baby born at term, with minimal untoward physical consequences to the mother—is the ideal outcome and indeed, when it occurs, is nothing short of a miracle. That the maternal kidneys are such important players in this process is perhaps not news to the seasoned nephrologist, but it is a concept that bears emphasizing, particularly when a woman with kidney disease or even hypertension contemplates pregnancy. Why this should be so is likely a result of the critical role of the kidneys in adapting the circulation to the increasing demands of the conceptus, and accommodating
Even with protocols in place to improve compliance, many kidney transplant patients did not achieve risk factor targets for cardiovascular disease, a leading cause of graft failure and of death after transplantation, according to study results presented at the American Transplant Congress in Philadelphia in early May. But as time went on after transplantation, the modifiable risk factors of hypertension, hyperlipidemia, and diabetes mellitus could become better controlled, said lead author Rakesh Kumar, MD, of the State University of New York at Buffalo.
Although advances in immunosuppressive therapy can prevent immune-mediated damage to transplanted kidneys and improve short-term allograft survival,
Chronic use of opioids (COU) before kidney transplantation may be associated with an increased risk of early graft loss and higher mortality after transplant, according to a retrospective study from the University of Michigan presented at the American Transplant Congress in Philadelphia in May.
Of the 1064 adult patients who received a kidney graft at the university between 2004 and 2008, 42.5 percent reported that they had chronic pain and 10.2 percent reported that they had used opioids on a chronic basis before their transplants. The patients were followed up until the end of 2010. These figures are in line
Delays and errors in communication from donor organ centers to recipient centers frequently contribute to the transmission of infections. Rachael Miller, MD, presented the results of a study of potential donor-derived infections reported between January 2008 and June 2010 to the Ad Hoc Disease Transmission Advisory Committee (DTAC) of the Organ Procurement and Transplantation Network, administered by the United Network for Organ Sharing (UNOS). Miller is clinical professor in infectious diseases at the University of Iowa Carver College of Medicine in Iowa City.
Communication gaps occur at multiple levels and have been associated with adverse outcomes in organ recipients, but