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Acute kidney injury (AKI) incidence after neurosurgical operations has been reported as 10–14%. The literature regarding the incidence of nosocomial acute kidney disease (AKD) following neurosurgery is scarce. This retrospective, single-center, observational study aimed to assess the impact of different anaesthetics on development of postoperative AKI and persistent AKD in neurosurgical patients. We have categorized patients depending by the type of total intravenous anaestesia with propofol or sevoflurane. Most patients (74%) were on total intravenous anesthesia with propofol, while the rest (26%) were on sevoflurane. Patients were divided into subgroups with and without AKD depending on glomerular filtration rate 60 ml/min regarding kidney function at the end of intensive care unit stay. AKI was diagnosed in 341 (5.39%) patients. Significantly higher number of patients developed AKD in the sevoflurane group (16.9% vs. 6.3%). There was a significantly higher number of patients with both high and low AKI stages on sevoflurane and with hypotension during operation. Anaesthesia with sevoflurane had increased OR of 5.09 and ROC value of 0.681 for development of AKI. Anesthesia with sevoflurane had an increased OR of 4.98 and ROC value of 0.781 for development of AKD. Mortality was independently associated with anesthesia with sevoflurane, AKI development, hypotension during operation and AKD. Anesthesia with sevoflurane, hypotension during operation, and the development of AKD at the end of ICU stay were associated with higher mortality in the whole group (HR 6.996, HR 1.924 and HR 4.969, respectively). Patients treated with balanced anesthesia with sevoflurane had more frequent AKI and AKD with shorter survival. Renal toxicity of sevoflurane is pronounced in hypotension during operation and with a history of diabetes and coronary disease. [ABSTRACT FROM AUTHOR]

Background/Objectives: Fabry disease (FD) is a genetic lysosomal storage disease caused by a pathogenic variant in GLA gene coding for a functional alpha-galactosidase A enzyme whose disfunction leads to globotriaosylceramide (Gb3) accumulation in cells, which results in multiple organ disorders. The aim of this study was to identify mutations associated with Fabry disease among 829 kidney transplant recipients and to investigate the correlation between the factors such as age, dialysis vintage, eGFR, proteinuria and corticosteroid dose and the deviations in alpha-galactosidase A and lyso-Gb3 levels. Methods: Dry blood spot samples were collected for genetic analysis. The GLA genetic variants were analysed by an amplicon-based next-generation sequencing approach in all female patients and in male patients with reduced alpha-galactosidase A levels. Alpha-galactosidase A and Lyso-Gb3 were not determined in female patients. Pearson's correlation coefficient was used to assess the relationship between the above-mentioned factors with the activity of alpha-galactosidase A and Lyso-Gb3. Results: Genetic testing was performed in 476 patients, all female patients (334), 69 male patients with decreased level of alpha-galactosidase A activity, one male patient with alpha-galactosidase A levels above the quantification limit and 72 male patients with no interpretable results of alpha-galactosidase A activity due to preanalytical error. In 3 (0.4%) male patients, hemizygous mutations associated with Fabry disease were found, and those were c.427G>A p.(Ala143Thr), c.1181T>C p.(Leu394Pro), and c.352C>T p.(Arg118Cys). The dose of corticosteroid therapy seemed to be positively correlated to alpha-galactosidase A activity and negatively to Lyso-Gb3 levels in blood. Conclusions: Genetic testing of individuals with chronic kidney disease and reporting of genetic variants associated with the Fabry phenotype are important to improve the overall knowledge of the disease. Further research is needed to define factors influencing levels of alpha-galactosidase A and Lyso-Gb3. [ABSTRACT FROM AUTHOR]

Regenerative medicine shows significant potential in treating kidney diseases through the application of various types of stem and progenitor cells, including mesenchymal stem cells (MSCs), renal stem/progenitor cells, embryonic stem cells (ESCs), and induced pluripotent stem cells (iPSCs). Stem cells possess the unique ability to repair injured organs and improve impaired functions, making them a key element in the research of therapies for kidney tissue repair and organ regeneration. In kidney transplantation, reperfusion injury can cause tissue destruction, leading to an initially low glomerular filtration rate and long-term impact on function by creating irreversible interstitial fibrosis. MSCs have proven useful in repairing early tissue injury in animal models of kidney, lung, heart, and intestine transplantation. The use of stem cell therapies in solid organ transplantation raises the question of whether autologous or allogeneic cells should be preferred. Adipose-derived stem cells (ASCs), characterized by the lack of HLA Class II molecules and low expression of HLA Class I and co-stimulatory signals, are considered immune-privileged. However, the actual risk of graft rejection associated with allogeneic ASCs remains unclear. It has been demonstrated that donor-derived ASCs can promote the development of Treg cells in vitro, and some degree of tolerance induction has been observed in vivo. Nevertheless, a study comparing the efficacy of autologous and allogeneic ASCs in a rat model with a total MHC mismatch for kidney transplantation showed that donor-derived administration of ASCs did not improve the grafts' survival and was associated with increased mortality through an immunologically mediated mechanism. Given the lack of data, autologous ASCs appear to be a safer option in this research context. The aim of this review was to examine the differences between autologous and allogeneic ASCs in the context of their application in kidney transplantation therapies, considering potential immune reactions and therapeutic efficacy. Some have argued that ASCs harvested from end-stage renal disease (ESRD) patients may have lower regenerative potential due to the toxic effects of uremia, potentially limiting their use in transplantation settings. However, evidence suggests that the beneficial properties of ASCs are not affected by uremia or dialysis. Indeed, some investigators have demonstrated that ASCs harvested from chronic kidney disease (CKD) patients exhibit normal characteristics and function, maintaining consistent proliferative capacity and genetic stability over time, even after prolonged exposure to uremic serum Furthermore, no differences were observed in the response of ASCs to immune activation or their inhibitory effect on the proliferation of alloantigen-activated peripheral blood mononuclear cells between patients with normal or impaired renal function. This review presents the current achievements in stem cell research aimed at treating kidney diseases, highlighting significant progress and ongoing efforts in the development of stem cell-based therapies. Despite the encouraging results, further research is needed to overcome the current limitations and fully realize the potential of these innovative treatments. Advances in this field are crucial for developing effective therapies that can address the complex challenges associated with kidney damage and failure. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases, including sudden cardiac death (SCD), are the leading cause of mortality among kidney transplant recipients (KTRs). While implantable cardioverter defibrillators (ICDs) are established for SCD prevention in the general population, data on the benefits in patients with CKD is scarce and controversial, and there is no established general consensus on their use in this group of patients. Furthermore, data for KTRs are lacking. The aim of this study is to present our experience with ICDs in KTRs and evaluate the outcomes in this population. Methods: We retrospectively analyzed medical records of KTRs who received a kidney allograft between October 1973 and December 2023 and received ICDs for the prevention of SCD. Results: Of 2282 KTRs, 10 patients (0.44%) underwent an ICD implantation with an average age of 60.6 years at the time of implantation; 9 were male. Primary prevention of SCD was the most common indication, with only one patient receiving an ICD following sudden cardiac arrest. The female patient received an ICD while on dialysis, and the rest of the patients received ICDs in the posttransplant period with an average time of 9.1 years after KT. Kidney allograft function was reduced in all patients at the time of the ICD implantation with an average estimated glomerular filtration rate (eGFR) of 44 mL/min/1.73 m2. No ICD-related complications were recorded. Six patients are alive with an average follow-up of 5.2 years. Conclusions: ICD implantation in carefully selected KTRs may offer survival benefits and can be a valuable tool in preventing SCD. Larger studies are needed to confirm these findings and establish clear guidelines for ICD use in this specific population. [ABSTRACT FROM AUTHOR]

Background/Objectives: Protein–energy wasting (PEW) and sarcopenia are common in chronic hemodialysis (HD) patients, leading to numerous complications and increased mortality. This study aimed to compare the reliability of the SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls) and the Malnutrition–Inflammation Score (MIS) in assessing sarcopenia and predicting negative outcomes in HD patients. Methods: This cross-sectional study enrolled 109 HD patients. Nutritional assessments were performed, and blood samples were taken for routine blood laboratory investigations. The MIS was used as a scoring system to represent the severity of PEW, while the SARC-F was applied as an indicator of sarcopenia risk and general functional capacity. A multivariable logistic regression was conducted to analyze the association of several predictors with a negative cross-sectional outcome (death). Results: Patients with SARC-F scores ≥ 4 and MISs ≥ 6 were older, had significantly lower albumin and prealbumin levels, and more severe anemia. They were also more likely to report weight loss and poor appetite. A higher MIS was closely associated with unfavourable nutritional status according to the International Society of Renal Nutrition and Metabolism (ISRNM) criteria for PEW. However, in 71.25% of patients with satisfactory functional capacity (SARC-F scores 0–3), some form of PEW was still observed. After performing logistic regression modelling, only the MIS remained strongly associated with the probability of a negative outcome. Conclusions: The SARC-F alone often did not correspond to an increased sarcopenia risk or clear clinical and biochemical indicators of PEW in HD patients. When assessing nutritional risk in this group, it is recommended to use more detailed tools, such as the MIS, to ensure the accurate identification of those at the highest risk for negative outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: The novel coronavirus disease 2019 (COVID-19) has led to significant morbidity and mortality among kidney transplant recipients. SARS-CoV-2 has been hypothesized to cause an unusual immunological dysregulation triggering alloimmunity and leading to graft rejection. Methods: This prospective observational cohort study assessed 321 kidney transplant recipients who had COVID-19 infection. After the infection, patients' sera were tested for the presence of anti-HLA de novo DSA and non-DSA specificities. Logistic regression analysis and a stepwise multivariable logistic regression analysis were used to analyze the independent risk factors associated with the development of antibodies, adjusting for known confounders. The variables evaluated were acute COVID-19 characteristics (i.e., presentation, and need for hospitalization), demographic characteristics (i.e., age, gender, and primary renal disease), clinical characteristics (i.e., various comorbidities), and post-COVID-19 sequelae. Results: Anti-HLA de novo DSA developed in 18.7% of patients, while anti-HLA class I and class II non-DSA antibodies developed de novo in 84 (26.3%) and 83 (25.9%) patients, respectively. The development of DSA, HLA-DQ, and HLA-DR antibodies was predicted by the history of graft rejection. Obesity appeared to be protective against the emergence of de novo DSA. De novo DSA and HLA-DR antibody formation was positively linked with intravenous immunoglobulin use, CMV-hyperimmune globulin use, and decreased doses of immunosuppression during acute infection. Better allograft function during the acute disease was a protective factor against the formation of HLA-DQ and HLA-DR antibodies. Positive predictors of de novo DSA development were graft biopsy and the reactivation of EBV after infection. Conclusions: These findings suggest that the SARS-CoV-2 virus has an immunomodulatory effect and may be associated with an increased mortality in this population. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of cytomegalovirus (CMV) infection in a kidney transplant recipient with HIV. CMV is a common infection in immunocompromised patients, and gastrointestinal involvement is the most common manifestation in solid organ transplant recipients. However, in patients with HIV, CMV retinitis is the most common manifestation, followed by gastrointestinal involvement. The article presents a case of CMV infection in a kidney transplant recipient with HIV that resulted in biliary obstruction. The patient was successfully treated with antiviral therapy and a reduction in immunosuppressive therapy. The article emphasizes the need for vigilance in monitoring for atypical presentations of CMV infections in deeply immunocompromised patients. [Extracted from the article]

Introduction. Despite their potential benefits, mineralocorticoid receptor antagonists are rarely used in kidney transplant recipients due to the fear of complications. We aim to describe epidemiological, clinical and laboratory characteristics, treatment, and outcomes of kidney transplant patients treated with eplerenone. Methods. Kidney transplant recipients who received eplerenone were included in this single-center retrospective study. Serum electrolytes, uric acid, estimated glomerular filtration rate (eGFR), and proteinuria were recorded. Results. Ten kidney transplant recipients (6 male) received eplerenone for treatment of heart failure. With the median follow-up of 16 months (range 6-78 months), nine were alive with the functioning kidney allograft. Eplerenone was well tolerated. Only one patient developed mildly elevated potassium and one developed severe symptomatic hyponatremia, requiring hospitalization. The glomerular filtration rate decreased after eplerenone's introduction from 47.5(42-54) to 40 (35-48) ml/min/1.73m2 at three months (p<0.01) and remained stable in follow-up. Proteinuria decreased from 303 mg/24h to 185 mg/24h without a statistically significant difference. Eplerenone did not influence cyclosporine or tacrolimus trough levels. Uric acid increased after the introduction of eplerenone, requiring increased doses of allopurinol. Conclusions. Eplerenone may be used with caution in kidney transplant recipients. Careful monitoring of all electrolytes and not only of potassium is mandatory. In our cohort, eplerenone increased uric acid levels. Further studies are required to elucidate the clinical benefits and safety of eplerenone in this patient population. [ABSTRACT FROM AUTHOR]

Breast cancer is the 5th leading malignant cause of death worldwide. The mechanism behind its development is multifactorial and involves a combination of hormonal, genetic, environmental, and age-related factors affecting DNA damage. Due to their chronic immunosuppressive therapy, kidney transplant recipients are exposed to an increased risk of carcinogenesis. We present an unusual case of an 80-year-old kidney transplant recipient who developed an invasive breast cancer 8 years after cadaveric kidney transplantation. Chronic immunosuppressive therapy at the time of diagnosis included cyclosporine (100mg/day), mycophenolate mofetil (1000mg/day), and prednisolone (5mg/day). A core needle biopsy was performed after the ultrasound examination. The patient was treated with modified radical mastectomy and axillary lymph node resection. The pathohistological report confirmed invasive stage T3N1Mx breast carcinoma with metastatic lymph node involvement. The results of the pathohistological examination demonstrated the presence of breast carcinoma, characterized by positive expression of estrogen receptors (ER) and progesterone receptors (PR), while human epidermal growth factor receptor 2 (HER2) had a negative status. The patient began adjuvant hormone therapy with tamoxifen 10 mg 2x1 per day. He was switched from cyclosporine to an mTOR inhibitor. To date, the patient has been consistently monitored per scheduled follow-up appointments and continues to remain in remission without any further complications. Due to decreased awareness and minimal degree of suspicion, more than 40% of patients with male breast cancer (MBC) first present at the advanced stage, which typically takes the form of a lump or nipple inversion. As a result, MBC patients experience worse prognosis than their female counterparts. This case report demonstrates the importance of thorough and regular clinical examinations of male kidney transplant recipients. Although MBC is rare, the possibility of its existence should be emphasized, especially in a vulnerable population such as kidney transplant recipients. [ABSTRACT FROM AUTHOR]

Introduction. Anti-CMV immunoglobulin (CMV-HIG) contains antibodies against various infective pathogens and not only against the cytomegalovirus (CMV), thus possibly mimicking the convalescent plasma. Methods. A retrospective analysis concerning the practice of CMV-HIG off-label use during acute COVID- 19 in kidney transplant recipients (KTR). Results. From March 2020 to August 2022, 403 KTR (59.8% male) who developed COVID-19 were eligible for investigation. 151(44.4%) patients required hospitalization, and eighteen (5,6%) mechanical ventilation. Thirty-four (8.4%) patients received CMVHIG. Two patients had CMV reactivation and received CMVHIG 2 ml/kg in five doses. Others had hypogammaglobulinemia which was an additional off-label indication for using CMVHIG during acute COVID-19. 22 patients (6.5%) died, 4 of them from the CMVHIG group. Conclusion. A correction of hypogammaglobulinemia, potential remodeling of the immunological response, and CMV reactivation during acute infection, may justify the use of CMVHIG during acute COVID-19. [ABSTRACT FROM AUTHOR]

Introduction. Our stady aimed toinvestigate the rate of dermatologic disorders in kidney transplant recipients during the COVID-19 pandemic. Methods. We performed a retrospective observational single-center cohort study including all adult renal transplant recipients with a functioning kidney allograft and who have recovered from the SARS CoV-2 infection. The study was conducted at a tertiary center in Croatia from March 2020 to August 2022. The study included 321 patients (57% were male). Data were obtained retrospectively from hospital charts and records, while selfreported cosmetic problems were reported prospectively. Results. The study included 321 patients (57% were male). Overall, 59 patients (18%) reported or were diagnosed with dermatological conditions. Eleven patients presented with facial eruptions that were most pronounced in the area covered by the mask, one patient developed similar changes in the skin of her hands. Hair loss was reported by twenty female patients, with the hair loss persisting in three patients. Six patients were diagnosed with skin cancer in the areas covered by facial masks. Three had squamous cell skin cancer, two were diagnosed with basal cell skin cancer, and one had a neuroendocrine skin tumor on the chin. Conclusion. Dermatologic problems are frequent in kidney transplant recipients recovered from acute COVID- 19. Besides cosmetic problems, skin malignancies may be diagnosed with a delay. Kidney transplant recipients should be advised to regularly self-examine their skin for potential skin cancer with dermatologic evaluation when necessary. [ABSTRACT FROM AUTHOR]