Capillary leak syndrome as a complication of antibody-mediated rejection treatment: a case report

We report a case of capillary leak that developed during treatment of antibody-mediated rejection in a kidney transplant recipient. A 53-year-old female transplant recipient experienced an increase in serum creatinine from 1.1 to 1.8  mg/dL. Antibody-mediated rejection was diagnosed by graft biopsy. She was treated with five plasmapheresis sessions (on alternate days with albumin replacement), five doses of immunoglobulin (5 g/dose at 100 mg/kg), a single dose of rituximab (500 mg), and four doses of bortezomib on days 1, 4, 7, and 10 (1.72 mg/dose at 1.3 mg/m2 body surface area). During treatment, edema, slight diarrhea, pancytopenia, hypoalbuminemia, peripheral neuropathy, and postural hypotension were noted. Despite control of liquids, she presented with edema progressing to an increase of more than 10  kg body weight. Prerenal acute graft dysfunction associated with hypotension was diagnosed on day 12, heart failure or other infectious complications being discounted. On day 13, daily hemodialysis was prescribed, and a stable volume status was reached after five hemodialysis sessions. On day 20, the patient recovered diuresis and the edema and diarrhea abated, but she remained on chronic hemodialysis. After excluding other causes of distributive shock, the diagnosis of capillary leak syndrome was based on the presence of hypotension, generalized edema, and hypoalbuminemia in the absence of significant proteinuria. The concomitant presence...
Source: CEN Case Reports - Category: Urology & Nephrology Source Type: research

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ConclusionsOur study found that the decision-making process in ESRD is multifactorial and involves not only medical factors, but also assessment of social factors, quality of life, and patient/family preference. Bettering our understanding of this decision-making process will positively impact patients and families through more informed decision-making.
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
AbstractCardiovascular disease (CVD) is a life-limiting comorbidity in patients with chronic kidney disease (CKD). In childhood, imaging studies have demonstrated early phenotypic characteristics including increases in left ventricular mass, carotid artery intima-media thickness, and pulse wave velocity, which occur even in young children with early stages of CKD. Vascular calcifications are the signature of an advanced phenotype and are mainly found in adolescents and young adults treated with dialysis. Association studies have provided valuable information regarding the significance of a multitude of risk factors in prom...
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
AbstractBackgroundEnteral feeding by tube in chronic kidney disease (CKD) before 2 years of age improves growth. Whether it is effective after this age is unknown. We assessed whether height and weight SDS changed after tube feeding was started in children with CKD above 2 years of age.MethodsRetrospective study of pre-transplant, pre-pubertal children (
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
ConclusionsThe 20-year follow-up analysis of pediatric renal care services in European countries revealed that pediatric nephrology has become a well-established subspecialty in pediatrics and nephrology in 2017. The ESPN will continue its efforts to further improve pediatric renal care for European children by harmonizing remaining disparities of renal care services.
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
AbstractBackgroundBecause of the severe shortage of suitable deceased donors, ABO-incompatible living donor kidney transplantation (ABOi LDKT) is performed even in pediatric recipients in Japan. We performed pediatric ABOi LDKT using rituximab without anti-A/B antibody removal.MethodsThirteen pediatric recipients (mean age 7.4, range 3.4 –15.7, four females) whose baseline anti-A/B IgG titers were ≤ × 64 underwent ABOi LDKT without antibody removal and splenectomy between July 2013 and April 2017 at Toho University. Mycophenolate mofetil (MMF) was initiated on day − 10. Rituximab (...
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
ConclusionsFor closed-circuit dialysis using an RBC solution, the formula [dialysate flow rate (mL/min)  × time of dialysis (min)]/extracorporeal volume (mL) would be a better parameter to estimate efficacy, compared with other metrics. Additionally, the citrate concentration can be readily estimated from the ionized calcium concentration during closed-circuit dialysis.
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
ConclusionAlthough feasible in children with a colostomy, chronic PD is associated with an increased risk of peritonitis and mortality. Continued efforts to reduce infection risk for this complex patient population are essential.
Source: Pediatric Nephrology - Category: Urology & Nephrology Source Type: research
Publication date: Available online 9 December 2019Source: Canadian Journal of DiabetesAuthor(s): Lingning Huang, Yongze Zhang, Yunmin Wang, Ximei Shen, Sunjie YanAbstractAimsInvestigate association between diabetic peripheral neuropathy (DPN)and above normal blood pressure in non-hypertensive patients with type 2 diabetes mellitus(T2DM). Compare the achievement of clinical target for DPN and non-DPN withT2DM .MethodsA retrospective survey was administered to 3810 patients with type 2 diabetes. Cases were grouped according to the Toronto Clinical Scoring System (TCSS): Non-DPN, Mild DPN, Moderate DPN and Severe DPN. 1835 pa...
Source: Canadian Journal of Diabetes - Category: Endocrinology Source Type: research
A man who was born without testicles got a transplanted one from his identical twin brother during a six-hour operation performed early last week in Belgrade, Serbia, by an international team of surgeons.
Source: WebMD Health - Category: Consumer Health News Source Type: news
Conditions:   Hypertension;   Heart Failure;   Hypertensive Heart Disease;   Diastolic Dysfunction Intervention:   Sponsor:   Karolinska Institutet Enrolling by invitation
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
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