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Biomedical subjects

A Elli

Publications and source records attributed to A Elli.

At least 19 recordsLinked to original sources
PubMed2006

Meta-analysis: intradermal vs. intramuscular vaccination against hepatitis B virus in patients with chronic kidney disease.

BACKGROUND: Dialysis patients have suboptimal response towards hepatitis B virus (HBV) vaccine and intradermal hepatitis B virus vaccination has been used to improve the response rate; however, its efficacy remains unclear. DESIGN: Meta-analysis of controlled trials comparing intradermal vs. intramuscular vaccine against HBV among chronic kidney disease patients. IDENTIFICATION: Twelve studies involving 640 unique patients were included if they had controlled design, intervention and control group patients received intradermal or intramuscular vaccine against HBV, respectively. Patients were followed for a minimum of 7 months after the first vaccine dose. MAIN OUTCOME MEASURES: The odds ratio of failure to respond to HBV vaccine among patients who received vaccine by intradermal vs. intramuscular route was the end point of interest. It was calculated at completion of HBV vaccination and over follow-up. RESULTS: Pooling of study results demonstrated a decreased risk of failure to respond to HBV vaccine among patients who were vaccinated by intradermal vs. intramuscular route (pooled odds ratio at completion of vaccine protocol: 0.36; 95% CI: 0.21-0.62; test of study heterogeneity, P = 0.089). This difference did not occur over follow-up (6-60 months after completing vaccine schedule; pooled odds ratio: 1.1; 95% CI: 0.47-2.5). CONCLUSIONS: Dialysis patients show higher seroprotection after intradermal than intramuscular vaccination schedules; this was not apparent over follow-up. Further studies are warranted to assess if the higher seroprotection rates obtained by intradermal route translates into reduced incidence of de novo HBV virus among chronic kidney disease patients.

Administration, Cutaneous↗
PubMed2005

Review article: hepatitis C virus and calcineurin inhibition after renal transplantation.

The impact of hepatitis C virus on patient and graft survival after renal transplantation remains controversial. However, recent studies have given emphasis on the detrimental role of hepatitis C on long-term patient and graft survival after renal transplantation. Various mechanisms can promote the lower survival in hepatitis C virus-positive recipients, i.e. post-transplant diabetes mellitus, liver disease and infections. Novel evidence has been accumulated showing the inhibitory activity of ciclosporin on the hepatitis C virus replication rate in human hepatocytes; ciclosporin has been shown in vitro to suppress hepatitis C virus replication as effectively as interferon alpha. This effect has not been seen with tacrolimus and is separate from its immunosuppressive activity. Data from patients with normal kidney function or after bone marrow transplantation show that ciclosporin inhibits hepatitis C virus replication. It appears that the progression of liver fibrosis is slower in hepatitis C virus-positive liver transplant recipients treated with ciclosporin than tacrolimus. In contrast, the clinical outcome of hepatitis C in hepatitis C virus-positive patients after liver transplantation treated with ciclosporin vs. tacrolimus has given mixed results. No information after renal transplantation is available. Various parameters can promote the worsening of hepatitis C after renal transplantation but choice of calcineurin inhibition is one of the few risk factors that can potentially be modified by the physician. Prospective, comparative trials of ciclosporin and tacrolimus with large size and adequate follow-up after renal transplantation are in progress.

Calcineurin Inhibitors↗
PubMed2000

Effect of increased arterial resistance index on long-term outcome of well-functioning kidney grafts.

An abnormal vascular status is present in the transplanted kidney. To define whether vascular factors might influence kidney function of the graft, the renal volume, blood flow and vascular resistance of a group of healthy subjects were compared with those of a group of well functioning renal transplants by color Doppler ultrasonography. Sixty healthy subjects and 75 well functioning cadaver renal transplant recipients were compared by color Doppler ultrasonography. Subsequently, 15 couples of donors and recipients of a living related renal graft were compared to observe the differences between the two organs of the same subject in a different environment. The variables studied were: the diameters and the volume of the kidney, renal blood flow and renal resistance index (RI). The group of cadaver renal transplant patients showed higher mean blood pressure (P = 0.009), higher serum creatinine levels (P = 0.0001) and lower endogenous creatinine clearance (P < 0.0001) than healthy controls. The length (P < 0.00001) and volume (P < 0.001) of the kidneys of cadaver transplanted patients were significantly greater than those of healthy subjects, while the length and volume of the living donors kidneys were identical to those of the recipients. RI, measured on renal vessels, showed lower values in healthy subjects and in kidney donors than in transplanted patients (P < 0.00001). Well functioning transplanted kidneys showed increased renal arterial RI. This non-immunologic factor did not appear to be detrimental with renal function in time, at least until 50 months after successful grafting.

Adult↗
PubMed2000

Long-term results with cyclosporine monotherapy in renal transplant patients: a multivariate analysis of risk factors.

There is little information on the long-term outcome of patients initially assigned to cyclosporine (CsA) monotherapy and requiring the addition of steroid therapy during follow-up. The aim of this report is to describe our experience with 143 first renal transplant recipients (120 cadaver transplants, 23 living donor transplants) randomized to receive CsA monotherapy as a treatment arm of three consecutive controlled clinical trials. Median follow-up was 86 months. Thirty-four percent of the patients remained on the original CsA monotherapy, whereas the remaining 66% required the addition of steroid therapy. Cumulative patient and graft survivals at 11 years were 0.89 (95% confidence interval [CI], 0.83 to 0.95) and 0.62 (95% CI, 0.52 to 0.72), respectively. The 11-year graft survival for converted patients was 0.53 (95% CI, 0.39 to 0.67). Cumulative graft half-life was 19.9 +/- 3.47 (SE) years. According to the Cox model, variables at transplantation that correlated with a lower 11-year graft survival were yearly increases in age (relative risk [RR], 1. 04; P = 0.039), monthly increases in hemodialysis duration (RR, 1.01; P = 0.029), no blood transfusion before transplantation (RR, 1.99; P = 0.043), CsA administration in a double daily dose (RR, 2.35; P = 0.008), and a cadaver donor transplant (RR, 4.76; P = 0.039). Multivariate analysis of time-dependent variables showed that delayed graft function recovery (RR, 2.20; P = 0.019) and the need to add steroid and/or azathioprine therapy (RR, 5.28; P = 0.000) were also correlated with a lower graft survival. Patients who added steroid therapy developed infections (P < 0.001), cataracts (P < 0.001), cardiovascular complications (P = 0.004), and arterial hypertension (P = 0.024) more frequently than patients remaining on CsA monotherapy. Patients administered CsA in a single daily dose received significantly less CsA over the years (P = 0.0042) than patients administered CsA in two divided doses. They also showed a trend toward greater creatinine clearance levels, although not statistically significant. In conclusion, this analysis showed that in patients assigned to CsA therapy alone, good long-term patient and graft survival probabilities can be obtained. In approximately one third of the patients, the use of steroids could be avoided for up to 11 years, and these patients had a better long-term outcome than those who required the addition of steroid therapy. Finally, in patients administered CsA in a single daily dose, the possibility of reducing CsA dosage probably led to better intrarenal hemodynamics with improving creatinine clearances.

Adult↗
PubMed1999

The clinical status of cadaveric renal transplant patients treated for 10 year with cyclosporine therapy.

In this paper we assessed the clinical status of 150 cadaveric renal transplant patients who received cyclosporine without interruption for 10 yr. The mean creatinine clearance was 59.2 +/- 15.71 at 1 yr and 55.6 +/- 24.91 mL/min at 10 yr (p = 0.039). Patients were subdivided into four quartiles according to the mean creatinine clearance at 1 yr. The 14 patients with the lowest quartile showed a significant decrease of creatinine clearance from the 1st to 10th year (from 31.5 +/- 5.83 to 24.8 +/- 14.00 mL/min; p = 0.038) while no difference between the mean creatinine clearance at 1 and at 10 yr was found in the other three quartiles. At 10 yr, 84.6% patients needed antihypertensive therapy, a rate similar to that seen at 1 yr (81.4%). The mean plasma cholesterol (253 +/- 57.8 mg/dL) and triglyceride (197 +/- 113.1 mg/dL) at 10 yr were similar to those found at +/- yr (243 +/- 48.2 and 201 +/- 143.0 mg/dL, respectively). Most patients have a high degree of rehabilitation 10 yr after uninterrupted cyclosporine therapy and all patients but 3 were able to work.

Adult↗
PubMed1999

Uracil/tegafur plus oral calcium folinate in advanced breast cancer.

Uracil and tegafur (in a molar ratio of 4:1 [UFT]) has proven activity against breast cancer and is delivered in an easy-to-administer oral formulation. Orzel, which combines UFT with the oral biomodulator, calcium folinate, may provide even greater antitumor efficacy against breast cancer. Here, we describe the preliminary results of this phase II trial investigating the feasibility of 250 mg/m2/day of UFT plus 45 mg/day of oral calcium folinate administered to highly pretreated patients with advanced breast cancer. The results indicate a highly tolerable regimen and an overall response rate of 27.8% in a group of poor-prognosis patients. These findings warrant continued investigation.

Administration, Oral↗
PubMed1998

Spontaneous hypoglycaemia after pancreas transplantation in Type 1 diabetes mellitus.

Hypoglycaemia is an important complication of insulin treatment in Type 1 diabetes mellitus (DM). Pancreas transplantation couples glucose sensing and insulin secretion, attaining a distinctive advantage over insulin treatment. We tested whether successful transplantation can avoid hypoglycaemia in Type 1 DM. Combined kidney and pancreas transplanted Type 1 DM who complied with good function criteria (KP-Tx, n = 55), and isolated kidney or liver transplanted non-diabetic subjects on the same immunosuppressive regimen (CON-Tx, n = 14), underwent 1-day metabolic profiles in the first 3 years after transplantation, sampling plasma glucose (PG) and pancreatic hormones every 2 hours. KP-Tx had lower PG than CON-Tx in the night and in the morning and higher insulin concentrations throughout the day. KP-Tx had lower PG nadirs than CON-Tx (4.40+/-0.05 vs 4.96+/-0.16 mmol l(-1), ANOVA p = 0.001). Nine per cent of KP-Tx had hypoglycaemic values (PG < or = 3.0 mmol l(-1)) in the profiles, both postprandial and postabsorptive, whereas none of CON-Tx did (p < 0.02). In conclusion, after pancreas transplantation, mild hypoglycaemia is frequent, although its clinical impact is limited. Compared to insulin treatment in Type 1 DM, pancreas transplantation improves but cannot eliminate hypoglycaemia.

Adult↗
PubMed1998

Fibrillary glomerulonephritis in Castleman's disease.

Castleman's disease is an uncommon lymph node disorder which can be associated with renal disease. In this report we describe a patient with fever, weight loss, anorexia, increase in inflammatory proteins, anemia and nephrotic syndrome. Castleman's disease, plasma cell type, was diagnosed by histologic analysis after surgical excision of a pelvic lymph node. The disease was considered localized, since further investigations did not show any other pathologic mass. After resection of the pelvic lymphoid mass, clinical remission of systemic symptoms and laboratory abnormalities was observed, with the exception of the nephrotic syndrome. Renal biopsy was performed and showed a pattern compatible with fibrillary glomerulonephritis. Progressive decline in renal function was observed, despite immunosuppressive therapy.

Castleman Disease↗
PubMed1997

Prognostic factors of long-term allograft survival in 632 CyA-treated recipients of a primary renal transplant.

A total of 632 cyclosporin (CyA)-treated primary renal allograft recipients with a functioning graft at 6 months were retrospectively evaluated for risk factors correlated with long-term allograft function. Mean follow-up after the 6th month was 68.4 +/- 40.6 months. One hundred twenty-one of these patients (19%) were lost: 29 died (23/29 with a functioning graft), 77 of the remaining 92 (83%) lost their graft because of chronic allograft dysfunction, 9 due to recurrence of glomerulonephritis, 5 due to renal artery thrombosis, and 1 due to chronic CyA toxicity. At univariate analysis, factors correlated with a better renal (R) and pure renal (PR) allograft survival were: dialysis duration of less than 5 years, fewer than 2 rejections within the 6th post-Tx month, immediate graft function recovery, plasma creatinine below 1.5 mg/dl at the 6th month, age at Tx above 15 years, and receiving a living donor graft. Cox's regression analysis was also performed to obtain relative risks for the same parameters. Long-term dialysis patients had more frequent late recoveries (P = 0.002) and reductions in therapy (P = 0.01) in order to reduce the side effects of steroids. In young patients receiving an initial oral CyA dose of 17 mg/kg per day, steroids were stopped at the 6th month in order to achieve catch-up growth: only one such patient lost his graft. In contrast, 72% of the young patients who lost their grafts received an initial oral CyA dosage of 13 mg/ kg per day. Thus, young patients did worse not because of steroid withdrawal, but because of inadequate initial CyA dosage. These results suggest that although we cannot exclude alloantigen-independent mechanisms as factors that stimulate progression of chronic allograft dysfunction, it would appear that the initial lesions are induced by events mostly mediated by immunological mechanisms.

Cyclosporine↗
PubMed1997

The transplanted nephronic mass influences renal vascular resistance and blood flow of the kidney graft.

In order to assess whether the transplanted nephronic mass plays a role in the progression of chronic graft dysfunction, 83 well-functioning renal transplants were investigated. Plasma creatinine, creatinine clearance, renal volume, blood flow and renal vascular resistance were measured. The weight of the donor was considered as an index of the transplanted renal parenchyma and the weight of the recipient as an index of the required nephronic mass. To evaluate the adequacy of the transplanted nephronic mass, the ratio between the donor and the recipient's weight was calculated. This ratio showed a mean of 1.06 +/- 0.18 and a range between 0.63 and 1.6, indicating that a parenchymal mass between 30 and 80% of the physiologic one was transplanted in these subjects. Patients were divided into two groups: group A patients with a ratio > 1, group B patients with a ratio < 1. In group A, a regression analysis did not show any relationship between transplant age and creatinine clearance, renal volume, blood flow and renal vascular resistance as assessed by echo-color-Doppler ultrasonography. In patients with reduced nephronic mass, group B, there was a negative relationship between renal blood flow and transplant duration (p = 0.03) and a positive relationship between transplant age and renal vascular resistance (p = 0.01) and renal volume (p = 0.01). These data support the hypothesis that the difference in weight between donor and recipient may influence the outcome of the graft.

Adult↗
PubMed1996

Renal vascular damage in systemic sclerosis patients without clinical evidence of nephropathy.

OBJECTIVE: To evaluate the use of color-flow Doppler ultrasonography, a direct, noninvasive technique, for measurement of kidney blood flow in patients with systemic sclerosis (SSc). METHODS: Twenty-five normal volunteers and 25 SSc patients (median disease duration 8 years, range 2-21 years) were studied. All were free of clinical symptoms of renal damage. The resistance index (RI) was determined on main, interlobar, and cortical vessels. RESULTS: In SSc patients, the RI was significantly increased at every sampling site examined (P < 0.001). RI values were strongly correlated with disease duration (main artery r = 0.56, P < 0.04; interlobar artery r = 0.63, P < 0.02; cortical artery r = 0.75, P < 0.002). Regression analysis showed no relationship between RI and creatinine clearance values. CONCLUSION: Color-flow Doppler ultrasonography is a sensitive and noninvasive technique for evaluating vascular damage of the kidney in patients with SSc.

Adult↗
PubMed1996

Relevance of resistive index ultrasonographic measurement in renal transplantation.

The usefulness of the ultrasonographic measurement of resistive index (RI) is not yet fully understood. To obtain a better definition of its relevance in renal disease we studied this parameter in a group of 212 renal transplant patients, aged between 15 and 55 years: 81 first grafts with an excellent renal function, 44 hypertensive patients, 30 type II diabetics, 29 cases of chronic graft dysfunction, 28 cases during an episode of acute rejection. RI was measured in three different renal vascular areas: prerenal, interlobar and cortical. A two-way analysis of variance showed a statistical significance for the site of RI sampling and the type of pathology. There was no interaction between the two variables studied (p = 0.30). Plasma creatinine levels, analyzed as covariate, showed a high statistical correlation with RI values (p = 0.0001). The mean RI of the 80 transplanted patients with normal creatinine plasma levels showed a remarkable homogeneity and a statistically significant progressive reduction of the values from the main renal artery to the interlobar and cortical vessels (p = 0.00001). In the other groups a greater dispersion of data was present. RI values significantly increased in hypertensive and diabetic patients (p = 0.05) but more in acute rejection (p = 0.0001) or chronic graft dysfunction (p = 0.01). In acute rejection and in chronic graft dysfunction the curve of RI values tended to become flat, while in hypertensive and diabetic patients the aspect of the curve became steeper. In conclusion, RI is a hemodynamic index that reflects the vascular status of the explored area and is not only the simple expression of reduction of the kidney functional units. The differences observed in the various kidney areas stress the importance of measuring this parameter at more than one vascular site. The increase in RI values on the kidney cortex vessels is likely to be an index of glomerular hyperfiltration. If this hypothesis is true the measure of RI might be a reliable method for diagnosing in the kidney vascular damage, glomerular hypertension and hypertrophy.

Adolescent↗
PubMed1995

Nonacidotic kidney proximal tubulopathy with absorptive hypercalciuria.

We studied three patients with proximal tubulopathy characterized by defective reabsorption of phosphate, glucose, amino acids, urate, and low molecular weight proteins. This tubulopathy differs from Fanconi syndrome in that the patients had normal plasma bicarbonate and absorptive hypercalciuria associated with increased 1,25-dihydroxyvitamin D levels. The youngest patient was rachitic and may be classified with previously described patients, whereas the other two patients presented with nonrachitic osteopenic bone disease and their tubulopathy started during adult life. Kidney defects appeared sequentially in one of the nonrachitic patients. The two brothers of the youngest patient had similar kidney and bone disturbances. One of the other two patients had a brother with similar kidney reabsorption defects; an additional brother was probably affected and a sister presented with glycosuria, but no other reabsorption defects. The findings in these two families suggest a genetic transmission of proximal tubulopathy. The third case was sporadic. Renal histology of the three patients showed a great number of giant cells in the tubular lumen. We conclude that, at least in our adult patients, tubulopathy may represent a new entity among the proximal tubular dysfunction cases described to date. The features of this proximal defect suggest that it may be caused by a selective alteration of luminal cell membrane transport of phosphate, glucose, amino acids, urate, and proteins in the presence of a normal sodium gradient across the tubular cell membrane.

Amino Acids↗
PubMed1995

The well-functioning renal graft evaluated by color Doppler flowmetry.

The value of color Doppler ultrasound in the renal transplant follow-up has been evaluated. To do so we used a standardized protocol of analysis on a group of 86 outpatients with different transplant ages and a good and stable graft function defined as a plasma creatinine level < 105 microM/l. Renal volume increased after transplantation and averaged 198 +/- 54 cm3. The graft volume was positively related to the transplant age (p = 0.04). Mean renal blood flow/1.73 m2 body surface area was 301 +/- 98 ml/min, a value at the lower limit of normality. A statistical inverse relationship between renal blood flow and transplant age was found (p = 0.04). Renal vascular resistances increased along with the transplant age (p = 0.003). Renal function evaluated by creatinine plasma levels and creatinine clearance values did not show any statistical correlation with color Doppler findings in normal grafts. In conclusion, ultrasound measures allow us to obtain more sensitive information about the graft status and might be used for a better evaluation of the transplant follow-up.

Adult↗