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Y F Vanrenterghem

Publications and source records attributed to Y F Vanrenterghem.

15 recordsLinked to original sources
PubMed2001

Posttransplantation diabetes mellitus in FK-506-treated renal transplant recipients: analysis of incidence and risk factors.

BACKGROUND: The development of posttransplantation diabetes mellitus has a major impact on the quality of life and long-term outcome. METHODS: One hundred thirty-nine patients without known glucose metabolism abnormalities and treated with FK-506, methylprednisolone, and mycophenolate mofetil/azathioprine were analyzed for incidence of and risk factors for developing impaired fasting glycemia (IFG) and diabetes mellitus (DM). RESULTS: Using the American Diabetes Association criteria, 15% developed IFG and 32% developed DM in the first year after transplantation. High trough levels of FK-506 during the first month after transplantation (especially >15 ng/ml) and high body mass index (BMI) were significant risk factors for IFG or DM. Patients with (steroid-treated) acute rejections in addition to high trough levels of FK-506 were most prone to develop DM, whereas high BMI conferred risk of developing IFG. Patients with posttransplantation glycemic abnormalities also had higher levels of serum triglycerides at the time of transplantation, but they needed a lower dose of FK-506 to obtain higher trough levels of FK-506, suggesting metabolic differences already present before transplantation. The only risk factor retained for persistent IFG or DM beyond the first year was a higher number of trough levels of FK-506 >15 ng/ml during the first month after transplantation. CONCLUSIONS: Induction with an FK-506 based immunosuppressive regimen resulted in a high incidence of glucose metabolism disorders in renal transplantation recipients. Higher trough levels of FK-506 during the first month, acute rejections, and higher BMI were the most obvious risk factors.

Adult↗
PubMed2001

Tailoring immunosuppressive therapy for renal transplant recipients.

During the past decade several new potent immunosuppressive agents with different modes of action and different side-effect profiles have become available. Nowadays immunosuppression after renal transplantation is no longer one single regimen applicable to all patients. In the selection of the optimal immunosuppressive protocol, individual drug-related toxicity, recipient-related risk factors as well as donor organ characteristics have to be taken into account. This article will give an overview of the most recently developed immunosuppressive agents available for clinical use. Their individual mode of action and their different efficacy and safety profile will be described as basis for selection of each of these drugs in an attempt to tailor the optimal therapeutic regimen for the individual patient both in terms of short-term and long-term outcome.

Antibodies, Monoclonal↗
PubMed1999

Differences in gastric motor activity in renal transplant recipients treated with FK-506 versus cyclosporine.

BACKGROUND: Little is known concerning gastric motility after renal transplantation and on the impact of immunosuppressants on gastric emptying. METHODS: Gastric emptying was measured in renal transplant recipients, taking different immunosuppressive therapy (steroids and cyclosporine/azathioprine/FK-506), and compared with normal volunteers. RESULTS: After renal transplantation, gastric emptying of liquids was normal, irrespective of the type of immunosuppression. However, solid gastric emptying was significantly faster in FK-506-treated patients compared with patients taking cyclosporine for all measured emptying parameters. Compared with normal volunteers solid gastric emptying was slower in patients taking cyclosporine, comparable in azathioprine treated patients, and characterized by an unusual short lag phase in patients taking FK-506. CONCLUSIONS: In stable renal transplant recipients gastric emptying of solids was significantly faster in patients on FK-506 compared with patients taking cyclosporine. Therefore, FK-506 may be the immunosuppressant of choice after solid organ transplantation in patients with problems related to gastroparesis.

Analysis of Variance↗
PubMed1999

Which calcineurin inhibitor is preferred in renal transplantation: tacrolimus or cyclosporine?

Cyclosporine and tacrolimus are potent inhibitors of the calcineurin-dependent cytokine synthesis in activated lymphocytes. In renal transplant patients tacrolimus is more powerful in preventing severe and refractory rejections, even when compared with the new cyclosporine microemulsion formulation. Both drugs are equally nephrotoxic, but tacrolimus induces less hypertension and less pronounced hyperlipidaemia. Especially in some categories of patients, a higher incidence of de-novo diabetes mellitus is seen with tacrolimus therapy.

Arteriosclerosis↗
PubMed1997

Impact of new immunosuppressive agents on late graft outcome.

Several new immunosuppressive agents have recently been launched for clinical use after kidney transplantation. FK506 or tacrolimus (Prograf) has been tested as an alternative for cyclosporine A (CsA). Both tacrolimus and CsA interfere with the early stage of lymphocyte proliferation by blocking interleukin-2 synthesis. Mycophenolate mofetil (MMF) (Cell-Cept) blocks the de novo synthesis of guanine nucleotides, the pathway essential for purine synthesis in dividing T- and B-lymphocytes, and has been used in conjunction with CsA and corticosteroids. In several prospective randomized trials a significant reduction in the incidence of acute rejection has been shown. As early acute rejection and especially recurrent acute rejection, is one of the most important risk factors for chronic rejection and late graft loss, there is a growing interest in the potential beneficial effect of these drugs on the late graft survival. In the European MMF trial, a further reduction of the late graft loss after one year is seen for patients treated with 2 g MMF. A retrospective comparison of international registry data has also shown a significant increase in the graft half-life of patients receiving tacrolimus compared with CsA treated patients. Taking into account the still limited follow-up of the available trials and the fact they were not primarily designed with adequate statistical benefits of these new drugs on the late graft outcome must be made with caution.

Graft Survival↗
PubMed1996

Isolated zygomycosis in a bought living unrelated kidney transplant.

We report the first case of zygomycosis by Absidia corymbifera, only localized in an unrelated living donor kidney was bought and transplanted in India. Zygomycosis was diagnosed 2.5 months post-transplantation, in the clinical setting of rapid transplant failure, following an episode of cytomegalovirus (CMV) colitis, CMV nephritis, and acute rejection. Treatment consisted of transplantectomy. One year later, the patient is doing well, without clinical or serological evidence of persistent mycotic or virological infections. We speculate that this isolated mycotic infection originated with the donor or was due to the poor hygienic conditions in the operating theater or surgical ward. Another possibility is that this isolated renal involvement resulted from a subclinical pulmonary infection with hematogenous dissemination to the kidney in a manner comparable to renal tuberculosis. The patient received no amphotericin and was cured with transplantectomy alone.

Humans↗
PubMed1995

Active Heymann nephritis in complement component C6 deficient rats.

The mechanisms of renal injury that result in proteinuria in active Heymann nephritis (AHN) remain unclear, though data suggest that in analogy of the passive form of the disease the membrane attack complex C5b-9 may be involved. AHN was induced in an inbred strain of PVG/c-rats that are totally deficient in the C6 component of complement and are unable to form the lytic C5b-9 complex, as well as in non-complement deficient PVG/c+ rats that are immunologic identical to the deficient strain. In both groups of animals comparably high titers of anti-Fx1A autoantibodies were found after three weeks and persisted at 40 weeks. Proteinuria was also similar in both groups, and was first evident at six weeks. High levels of urinary protein, ranging from 200 mg/24 hr to 500 mg/24 hr, were found after 10 weeks and persisted up to one year. Renal biopsy findings at various times post-immunization were identical in both groups, including immunofluorescence staining for Ig and C3 deposits, and also EM findings of subepithelial electron-dense deposits were not different. The injection of heterologous rabbit complement, that partially and temporarily restored the CH50 activity in PVG/c- rats did not alter or hasten the disease. Long-term follow-up showed that all rats in both groups continued to have severe proteinuria and that most animals died between 8 to 12 months after disease induction, without renal impairment. EM findings in serial biopsies demonstrated that the growth of the subepithelial deposits as measured by surface area occurred between weeks 4 and 12. A positive correlation (r = 0.94) between the size of the deposits and the level of proteinuria was found. These studies demonstrate that the membrane attack complex of complement does not play a major role in AHN. The relationship of the size of the immune deposits to the level of proteinuria suggests that the growth of the immune deposits on itself initiate secondary mechanisms that damage the permselective characteristics of the glomerular membrane.

Animals↗
PubMed1994

A new single nephron model of focal and segmental glomerulosclerosis in the Munich-Wistar rat.

The hypothesis that damage to the visceral epithelial cell plays a central role in the pathogenesis of focal and segmental glomerulosclerosis was tested by injecting saponin solutions of increasing concentration (0.1, 0.3, 0.6 and 1.0 mg/ml) in Bowman's space of superficial glomeruli in the Munich-Wistar rat. The microinjections were performed both with and without intermittent clamping of the renal vessels during two minutes. After 8 to 14 days the injected glomeruli were examined by light microscopy. The injected glomeruli were classified as, normal (NL), showing visceral epithelial cell damage (VECD), showing focal and segmental glomerulosclerosis (FSGS) or showing global sclerosis (GS). Swelling and intracellular vacuolation of the visceral epithelial cells (VEC) were considered as VECD. FSGS-lesions were seen most frequently in the glomeruli injected with 10 nl of a saponin solution with a concentration higher than 0.3 mg/ml. In view of the light microscopic lesions four glomeruli in a 0 mg/ml, the 0.1 mg/ml and the 0.6 mg/ml saponin groups were examined after 40 minutes with transmission electron microscopy (TEM) to evaluate the selectivity of the lesions. In the 0 and 0.1 mg/ml group only occasional limited fusion of the foot processes of the podocytes was seen. In the 0.6 mg/ml group segmental lysis of the VEC without ultrastructural damage to the capillary basement membrane or the endothelial and mesangial cells was seen. It is concluded that it is possible to induce direct segmental lysis of the visceral epithelial cells in a single glomerulus, and that this damage to the visceral epithelial cells is related to the development of focal and segmental glomerulosclerosis.

Animals↗
PubMed1988

Role of prostaglandins in protein-induced glomerular hyperfiltration in normal humans.

In six healthy male volunteers we studied the effect of indomethacin on the renal hemodynamic adaptations to an acute oral protein load. Control and protein loading studies without and with indomethacin were performed under sustained water diuresis. In the control studies without indomethacin, creatinine (CCr) and inulin clearance (CIn) remained stable and p-aminohippurate (PAH) clearance (CPAH) and kaliuresis slightly decreased while natriuresis progressively increased. Urinary prostaglandin E2 (PGE2) excretion remained stable. Indomethacin had no effect on these control values except on natriuresis and PGE2 excretion. After protein loading CCr, CIn, and CPAH progressively increased to reach a peak 2 h after protein intake. Natriuresis, kaliuresis, and urinary PGE2 excretion also increased significantly. After indomethacin the peak increase of CCr, CIn, and CPAH during the 2nd h was significantly blunted. Indomethacin had no effect on the increased sodium and potassium excretion. The increase of PGE2 excretion was significantly attenuated by indomethacin. The results presented suggest that renal prostaglandins play at least a partial role in the renal hemodynamic adaptations to protein loading.

Adult↗