Faculty of Medicine
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Item type:Publication, Celiac-Like Duodenopathy Associated With Enteric-Coated Mycophenolate Sodium Immunosuppression in Renal Transplant Recipients: Report of 4 Cases(2023-05); ; ; Celiac-like disease and celiac sprue associated with widespread use of mycophenolic acid are among the most frequent complications of renal transplant. Most cases have been observed in patients receiving mycophenolate mofetil; however, there have been rare instance after administration of enteric-coated mycophenolate sodium. Here, we describe 4 renal transplant recipients with celiac-like duodenopathy that occurred in association with enteric-coated mycophenolate sodium treatment in a time period of 14 to 19 years after living donor kidney transplant. Three of 4 patients had diarrhea, and all 4 patients had marked loss of body weight. Esophago-gastroduodenoscopy was not diagnostically helpful; however, randomly performed duodenal biopsies showed mild villous atrophy and intraepithelial lymphocytosis. Replacement of enteric-coated mycophenolate sodium with azathioprine was successful with stopping diarrhea, allowing regained body weight, and stabilization of renal function. This potential complication in kidney transplant recipients can occur more than a decade after transplant. Diagnosis and treatment initiation are urgent to cure this disease. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, No difference of arteriovenous fistula successful creation and maturation between diabetic and non-diabetic patients after three months of surgery: The beneficial role of preoperative doppler ultrasound.(2019); ; ; INTRODUCTION: The arteriovenous fistula (AVF) has become a symbol of hemodyalisis (HD) which guarantees the successful treatment and allows a multidecade survival of patients. However the AVF creation and maturation is still a significant medical challenge especially in diabetic patients (DP). Due to the peripheral diabetic vasculopathy the rate of fistula failure of DP is still higher than the nondiabetic patients (NDP). The aim of the study was to compare the outcomes of DP and NDP with chronic kidney disease ( CKD) stage 5 undergoing creation of a new upper limb AVF using a preoperative vessels mapping by Doppler ultrasound. METHODS: Medical records for creation of AVF in the patients with CKD stage 5 for year 2018 were analyzed in a single center. Preoperative Doppler ultrasound for assessing the adequacy of blood vessels and to determine the location of AVF creation, were performed in all patients, a vein diameter > 2mmand an artery diameter _ 1.6 mmare considered adequate. Three different types of AVF were created: the distal (radial-cephalic), middle-arm (radial-cephalic) and proximal (brachial-cephalic). Primary thrombosis of AVF was defined as an immediate failure of fistula within 24 hours of creation and primary failure was defined as thrombosis of fistula within 3 mounts. The demographic variables, location of the AVF creation, and HDtime were included as parameters for determination of the successful maturation of AVF. RESULTS: We analyzed 367 created AVF in 238 men (64,85%) and 129 female (35,15%). The average age of patients was 61.4614.2 years and mean HD vintage was 14 months. Successful AVF was created in 301 patients (82%) while primary thrombosis occurred in 66 patients (18%) of created fistulas. AVF maturation within 3 months was successful in 272 patients (74,15%), while the primary failure occurred in 95 patients (25,85%) of created fistulas. The distal AVF was dominant location in 168 (47,78%), followed by middle-arm location in 136 (37,06%) and proximal in 63 (17,16%) of created fistulas. AVF was created in 104 (28,3%) DP and 263 (71,7%) NDP. The DP were significantly older than NDP (64,12 vs. 60,40 years, p=0.000), and with shorter HD vintage in DP compared to NDP (7,06 vs. 16,49 months, p=0.004). There was no association between successful AVF creation and diabetes mellitus (OR=1,0, 95%CI 0,91-1,08, p=0,010). The AVF maturation was also not associated with diabetes mellitus (OR=1,0, 95%CI 0,93-1,14, p=0,413). CONCLUSIONS: Using a preoperative Doppler ultrasound in the creation and maturation of AVF in DP are comparable with NDP regarding primary thrombosis and fistula failure for a period of three months of follow up. Further analysis are needed for the assessment of long term AVF functional capacity in both groups of patients - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Primary Renal Squamous Cell Carcinoma in Native Polycystic Kidney and Ureter 16 Years After Living Donor Kidney Transplant(2021-07-16); Jovic, GoranWe describe a case of a 55-year-old woman with polycystic kidney disease who received a living donor kidney transplant 16 years earlier and was on immunosuppressive therapy with satisfactory renal function. The donor was her mother. The patient presented with flank pain on the right side and macrohematuria, and noncontrast computed tomography and magnetic resonance imaging led to the diagnosis of tumors in the remaining right native polycystic kidney and ureter, as well as secondary retroperitoneal dissemination. We performed right radical nephrectomy and ureterectomy with extirpation of 2 metastases; the left native kidney remained intact. Histology showed squamous metaplastic changes and invasive epithelial neoplasm in the lumen of the renal pelvis and ureter with extensive squamous differentiation positive for nuclear p63 as squamous cell immunohistochemical marker. After surgery, an immunosuppressive therapy with methylprednisolone was administered, without calcineurin inhibitors and mycophenolate mofetil. Twelve months later the patient was still alive, with a glomerular filtration rate of 29 mL/min. Needs remain for further treatment modalities in patients with primary squamous cell carcinoma in nonfunctioning kidneys and improvements in imaging technique accuracy.