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Çetinkaya Yaprak A, Avanaz A, Erkan Pota Ç, Arabacı Tur KT, Yaprak M. Long-term ocular complications after kidney transplantation. Sci Rep 2025; 15:15222. [PMID: 40307442 PMCID: PMC12043929 DOI: 10.1038/s41598-025-99847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 04/23/2025] [Indexed: 05/02/2025] Open
Abstract
To assess long-term ocular complications and identify factors affecting these complications in pre-emptive and dialysis patients who have undergone kidney transplantation. We included 548 patients who had a complete ophthalmologic examination at least one year after kidney transplantation. The patients were divided into two groups: those who received dialysis before kidney transplantation (group 1) and those who did not (group 2). We recorded the presence of diabetes mellitus (DM) and hypertension (HT), which could contribute to concomitant retinopathy. Data collected included best corrected visual acuity (BCVA), refractive error (measured with KR-8900; Topcon, Tokyo, Japan), intraocular pressure (IOP, measured with Full Auto Tonometer TX-F; Topcon), slit-lamp examination of the anterior segment, and dilated fundus examination for both eyes. Refractive error, lens opacity, pinguecula, pterygium, arcus lipoides, corneal calcification, macular drusen, central serous chorioretinopathy (CSC), hypertensive retinopathy, and diabetic retinopathy were all recorded. All patients received a maintenance immunosuppressive protocol consisting of combinations of steroids, calcineurin inhibitors (CNI), mycophenolate mofetil, and mammalian target of rapamycin (mTOR) inhibitors. Our study included 257 recipients in group 1 and 291 recipients in group 2. In group 1, 37 recipients (12.7%) required myopic correction, while 35 recipients (13.6%) in group 2 needed similar correction. Additionally, 47 recipients (16.2%) in group 1 required hyperopic correction, compared to 35 recipients (13.6%) in group 2. There was no statistically significant difference between the two groups (p > 0.05).Regarding anterior segment findings, 56 recipients (21.8%) in group 1 and 35 recipients (12%) in group 2 were diagnosed with dry eye, with a statistically significant higher incidence in group 1 (p = 0.003). The rates of arcus lipoides, pinguecula, pterygium, cataract, and glaucoma were similar in both groups (p > 0.05). For posterior segment findings, diabetic retinopathy was observed in 65 patients (25.3%) in group 1 and 47 patients (16.2%) in group 2, showing a statistically significant higher incidence in group 1 (p = 0.011). Other posterior segment conditions, including macular drusen, hypertensive retinopathy, and central serous chorioretinopathy (CSC), were present at similar rates in both groups, with no statistically significant differences found (p > 0.05). We identified dry eyes, cataracts, and retinopathy as the most common ocular complications, with dry eyes and diabetic retinopathy being significantly more prevalent in group 1. Our study indicates that the risk of developing and progressing diabetic retinopathy is higher in patients who received dialysis before transplantation compared to those who underwent pre-emptive transplantation. This finding underscores the importance of preoperative factors in the development of ocular complications after successful kidney transplantation, independent of postoperative factors.
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Affiliation(s)
| | - Ali Avanaz
- Department of General Surgery, Akdeniz University Hospital, Antalya, Turkey
| | - Çisil Erkan Pota
- Department of Ophthalmology, Akdeniz University Hospital, Antalya, Turkey
| | | | - Muhittin Yaprak
- Department of General Surgery, Akdeniz University Hospital, Antalya, Turkey.
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Zhao W, Li J, Yang G, Ren G, Zhang L, Wang T. Non-typical anti-GBM disease with intraglomerular granulomatous reaction and anti-PLA2R-negative membranous nephropathy in the context of IgM/κ paraproteinemia. Int Urol Nephrol 2023; 55:1389-1391. [PMID: 36456884 DOI: 10.1007/s11255-022-03424-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Affiliation(s)
- WenTing Zhao
- Department of Nephrology, The First Hospital of HeBei Medical University, No. 89 East DongGang Road, ShiJiaZhuang, 050030, People's Republic of China
| | - Jing Li
- Department of Nephrology, The First Hospital of HeBei Medical University, No. 89 East DongGang Road, ShiJiaZhuang, 050030, People's Republic of China
| | - Guang Yang
- TaiYuan KingMed Center for Clinical Laboratory, No. 2 LongSheng Street, TaiYuan, 030000, People's Republic of China
| | - GuangWei Ren
- Department of Nephrology, The First Hospital of HeBei Medical University, No. 89 East DongGang Road, ShiJiaZhuang, 050030, People's Republic of China
| | - LiHong Zhang
- Department of Nephrology, The First Hospital of HeBei Medical University, No. 89 East DongGang Road, ShiJiaZhuang, 050030, People's Republic of China
| | - Tao Wang
- Department of Nephrology, The First Hospital of HeBei Medical University, No. 89 East DongGang Road, ShiJiaZhuang, 050030, People's Republic of China.
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Zhang SS, Hu WY, Li YJ, Yu J, Sang S, Alsalman ZM, Xie DQ. Lipoprotein (a) variability is associated with mean follow-up C-reactive protein in patients with coronary artery disease following percutaneous coronary intervention. World J Clin Cases 2022; 10:12909-12919. [PMID: 36569022 PMCID: PMC9782931 DOI: 10.12998/wjcc.v10.i35.12909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Increased lipoprotein (a) [lp (a)] has proinflammatory effects, which increase the risk of coronary artery disease. However, the association between lp (a) variability and follow-up C-reactive protein (CRP) level in patients undergoing percutaneous coronary intervention (PCI) has not been investigated.
AIM To explore the association between lp (a) variability and mean CRP levels within the 1st year post-PCI.
METHODS Results of lp (a) and CRP measurements from at least three follow-up visits of patients who had received PCI were retrospectively analyzed. Standard deviation (SD), coefficient of variation (CV), and variability independent of the mean (VIM) are presented for the variability for lp (a) and linear regression analysis was conducted to correlate lp (a) variability and mean follow-up CRP level. The relationship of lp (a) variability and inflammation status was analyzed by restricted cubic spline analysis. Finally, exploratory analysis was performed to test the consistency of results in different populations.
RESULTS A total of 2712 patients were enrolled. Patients with higher variability of lp (a) had a higher level of mean follow-up CRP (P < 0.001). lp (a) variability was positively correlated with the mean follow-up CRP (SD: β = 0.023, P < 0.001; CV: β = 0.929, P < 0.001; VIM: β = 1.648, P < 0.001) by multivariable linear regression analysis. Exploratory analysis showed that the positive association remained consistent in most subpopulations.
CONCLUSION Lp (a) variability correlated with mean follow-up CRP level and high variability could be considered an independent risk factor for increased post-PCI CRP level.
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Affiliation(s)
- Si-Si Zhang
- Department of Cardiology, Ningbo Ninth Hospital, Ningbo 315300, Zhejiang Province, China
| | - Wen-Yi Hu
- Department of Cardiology, Ningbo Ninth Hospital, Ningbo 315300, Zhejiang Province, China
| | - Yi-Jing Li
- Department of Cardiology, Ningbo Ninth Hospital, Ningbo 315300, Zhejiang Province, China
| | - Juan Yu
- Department of Cardiology, Ningbo Ninth Hospital, Ningbo 315300, Zhejiang Province, China
| | - Shang Sang
- Department of Cardiology, Ningbo Ninth Hospital, Ningbo 315300, Zhejiang Province, China
| | - Zakareya M Alsalman
- Department of Cardiology, Ningbo Ninth Hospital, Ningbo 315300, Zhejiang Province, China
| | - Da-Qi Xie
- Department of Cardiology, Ningbo Ninth Hospital, Ningbo 315300, Zhejiang Province, China
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Tao J, Dai W, Ye C, Yao Q, Zhou M, Li Y. Preprocedural Lp(a) level and ApoB/ApoA-Ι ratio and the risk for contrast-induced acute kidney injury in patients undergoing emergency PCI. Lipids Health Dis 2021; 20:130. [PMID: 34627286 PMCID: PMC8502341 DOI: 10.1186/s12944-021-01535-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High serum Lipoprotein(a) (Lp(a)) level and Apolipoprotein B/Apolipoprotein AΙ (ApoB/ApoA-Ι) ratio are risk factors for cardiovascular disease and kidney disease and have been found to be correlated with the prevalence and prognosis of various kidney diseases. However, it is not clear whether the serum Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI are correlated with the prevalence of contrast-induced acute kidney injury (CI-AKI). METHODS A total of 931 participants undergoing emergency PCI from July 2018 to July 2020 were included. According to whether the serum creatinine concentration was higher than the baseline concentration (by ≥25% or ≥ 0.5 mg/dL) 48-72 h after contrast exposure, these participants were divided into a CI-AKI group (n = 174) and a non-CI-AKI group (n = 757). Serum Lp(a), ApoA-Ι and ApoB concentration were detected in the patients when they were admitted to hospital, and the ApoB/ApoA-Ι ratio was calculated. Logistic regression and restricted cubic spline analyses were used to explore the correlation between the Lp(a) concentration or the ApoB/ApoA-Ι ratio and the risk of CI-AKI. RESULTS Among the 931 participants undergoing emergency PCI, 174 (18.69%) participants developed CI-AKI. Compared with the non-CI-AKI group, the Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI in the CI-AKI group were significantly higher (P < 0.05). The incidence of CI-AKI was positively associated with the serum Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI in each logistic regression model (P < 0.05). After adjusting for all the risk factors included in this study, restricted cubic spline analyses found that the Lp(a) level and the ApoB/ApoA-Ι ratio before PCI, within certain ranges, were positively associated with the prevalence of CI-AKI. CONCLUSION High Lp(a) levels and high ApoB/ApoA-Ι ratios before PCI are potential risk factors for CI-AKI.
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Affiliation(s)
- Jun Tao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang district, Wuhan, 430060, Hubei, China
| | - Wen Dai
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang district, Wuhan, 430060, Hubei, China
| | - Chenglin Ye
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Yao
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang district, Wuhan, 430060, Hubei, China
| | - Man Zhou
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang district, Wuhan, 430060, Hubei, China
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuchang district, Wuhan, 430060, Hubei, China.
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Kang Y, Chen Y, Zhang Z, Shen H, Zhou W, Wu C. A case of peritoneal dialysis-associated peritonitis caused by Rhodococcus kroppenstedtii. BMC Infect Dis 2021; 21:565. [PMID: 34120601 PMCID: PMC8201711 DOI: 10.1186/s12879-021-06280-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rhodococcus kroppenstedtii is an aerobic, gram-positive bacterium firstly identified in the environment, which has not been reported in human-related infection. Herein, we reported the first case of peritoneal dialysis (PD)-associated peritonitis caused by R. kroppenstedtii which was identified by whole genome sequencing. CASE PRESENTATION A 69-year-old man was admitted to hospital with abdominal pain and fever. Over the last 2 years, he had been undergoing continuous ambulatory peritoneal dialysis (CAPD) due to end-stage renal disease. Clinical symptom and sign in combination with laboratory examinations supported the clinical diagnosis of PD-associated peritonitis. Thus, ceftizoxime and teicoplanin were empirically used after PD effluent was collected for bacterial culture. A gram-positive bacterium was found from the PD effluent culture, which could not be identified by either Vitek 2 Compact ANC card or matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The strain was finally confirmed to be R. kroppenstedtii by whole genome sequencing (WGS) through the average nucleotide identity (ANI) analysis. With a continuous treatment with teicoplanin and imipenem for 15 days and intraperitoneal catheter removed, the infection symptom was improved evidenced by a normal body temperature, also with white blood cell count (WBC), procalcitonin (PCT) and C-reactive protein (CRP) dropped to normal levels. Peritoneal dialysis effluent culture showed a negative result. Then, hemodialysis and arteriovenous fistula angioplasty were performed, but the patient developed a progressive blood pressure loss, accompanied by multiple organ disorder, and died on Feb 25, 2020. CONCLUSIONS To the best of our knowledge, this is the first time to report a peritoneal dialysis-associated peritonitis caused by R. kroppenstedtii which was identified by average nucleotide identity analysis based on WGS.
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Affiliation(s)
- Yi Kang
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, 321# Zhongshan Road, Gulou District, Nanjing City, Jiangsu Province, 210008, P. R. China
| | - Yuxin Chen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, 210008, P. R. China
| | - Zhifeng Zhang
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, 210008, P. R. China
| | - Han Shen
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, 210008, P. R. China
| | - Wanqing Zhou
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, 210008, P. R. China.
| | - Chao Wu
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, 321# Zhongshan Road, Gulou District, Nanjing City, Jiangsu Province, 210008, P. R. China.
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Abbas F, El Kossi M, Jin JK, Sharma A, Halawa A. De novo glomerular diseases after renal transplantation: How is it different from recurrent glomerular diseases? World J Transplant 2017; 7:285-300. [PMID: 29312858 PMCID: PMC5743866 DOI: 10.5500/wjt.v7.i6.285] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/31/2017] [Accepted: 11/10/2017] [Indexed: 02/05/2023] Open
Abstract
The glomerular diseases after renal transplantation can occur de novo, i.e., with no relation to the native kidney disease, or more frequently occur as a recurrence of the original disease in the native kidney. There may not be any difference in clinical features and histological pattern between de novo glomerular disease and recurrence of original glomerular disease. However, structural alterations in transplanted kidney add to dilemma in diagnosis. These changes in architecture of histopathology can happen due to: (1) exposure to the immunosuppression specifically the calcineurin inhibitors (CNI); (2) in vascular and tubulointerstitial alterations as a result of antibody mediated or cell-mediated immunological onslaught; (3) post-transplant viral infections; (4) ischemia-reperfusion injury; and (5) hyperfiltration injury. The pathogenesis of the de novo glomerular diseases differs with each type. Stimulation of B-cell clones with subsequent production of the monoclonal IgG, particularly IgG3 subtype that has higher affinity to the negatively charged glomerular tissue, is suggested to be included in PGNMID pathogenesis. De novo membranous nephropathy can be seen after exposure to the cryptogenic podocyte antigens. The role of the toxic effects of CNI including tissue fibrosis and the hemodynamic alterations may be involved in the de novo FSGS pathophysiology. The well-known deleterious effects of HCV infection and its relation to MPGN disease are frequently reported. The new concepts have emerged that demonstrate the role of dysregulation of alternative complement pathway in evolution of MPGN that led to classifying into two subgroups, immune complex mediated MPGN and complement-mediated MPGN. The latter comprises of the dense deposit disease and the C3 GN disease. De novo C3 disease is rather rare. Prognosis of de novo diseases varies with each type and their management continues to be empirical to a large extent.
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Affiliation(s)
- Fedaey Abbas
- Department of Nephrology, Jaber El Ahmed Military Hospital, Safat 13005, Kuwait
- Faculty of Health and Science, University of Liverpool, Institute of Learning and Teaching, School of Medicine, Liverpool L69 3GB, United Kingdom
| | - Mohsen El Kossi
- Faculty of Health and Science, University of Liverpool, Institute of Learning and Teaching, School of Medicine, Liverpool L69 3GB, United Kingdom
- Doncaster Royal Infirmary, Doncaster DN2 5LT, United Kingdom
| | - Jon Kim Jin
- Faculty of Health and Science, University of Liverpool, Institute of Learning and Teaching, School of Medicine, Liverpool L69 3GB, United Kingdom
- Nottingham Children Hospital, Nottingham NG7 2UH, United Kingdom
| | - Ajay Sharma
- Faculty of Health and Science, University of Liverpool, Institute of Learning and Teaching, School of Medicine, Liverpool L69 3GB, United Kingdom
- Royal Liverpool University Hospitals, Liverpool L7 8XP, United Kingdom
| | - Ahmed Halawa
- Faculty of Health and Science, University of Liverpool, Institute of Learning and Teaching, School of Medicine, Liverpool L69 3GB, United Kingdom
- Department of Transplantation Surgery, Sheffield Teaching Hospitals, Sheffield S5 7AU, United Kingdom
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Nemcsik J, Kiss I, Tislér A. Arterial stiffness, vascular calcification and bone metabolism in chronic kidney disease. World J Nephrol 2012; 1:25-34. [PMID: 24175239 PMCID: PMC3782208 DOI: 10.5527/wjn.v1.i1.25] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 10/18/2011] [Accepted: 12/27/2011] [Indexed: 02/06/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have an extremely poor cardiovascular outcome. Arterial stiffness, a strong independent predictor of survival in CKD, is connected to arterial media calcification. A huge number of different factors contribute to the increased arterial calcification and stiffening in CKD, a process which is in parallel with impaired bone metabolism. This coincidence was demonstrated to be part of the direct inhibition of calcification in the vessels, which is a counterbalancing effect but also leads to low bone turnover. Due to the growing evidence, the definition of “CKD mineral bone disorder” was created recently, underlining the strong connection of the two phenomena. In this review, we aim to demonstrate the mechanisms leading to increased arterial stiffness and the up-to date data of the bone-vascular axis in CKD. We overview a list of the different factors, including inhibitors of bone metabolism like osteoprotegerin, fetuin-A, pyrophosphates, matrix Gla protein, osteopontin, fibroblast growth factor 23 and bone morphogenic protein, which seem to play role in the progression of vascular calcification and we evaluate their connection to impaired arterial stiffness in the mirror of recent scientific results.
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Affiliation(s)
- János Nemcsik
- János Nemcsik, Department of Family Medicine, Semmelweis University, 1125 Budapest, Hungary
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