losartan-potassium and Cadaver

Patients with chronic allograft nephropathy (CAN) very frequently suffer anemia. Correction of anemia by means of recombinant erythropoietin (rEpo) is possible and useful, but safety and efficacy must be assessed.. This multicenter, prospective, open study included patients with a cadaver renal transplant, CAN, and non-ferropenic anemia. The aim of the study was to determine the safety and efficacy of treatment with rEpo to target hematocrit (HCT) values around 35% and/or hemoglobin (Hb) levels of 11 g/dL.. Twenty-four patients were included: 71% males and 29% females aged 49.5 +/- 14 years. At last follow-up, 48% did not show anemia-related symptoms, and 19% experienced adverse events possibly or probably related to rEpo. In 86% of cases, anemia was corrected and in 71%, graft survival was conserved. Patients whose anemia was not corrected had poor initial renal function (sCr 5 +/- 1 mg/dL vs sCr 3.2 +/- 1 mg/dL, P = .028). Patients with graft survival showed correction of anemia (P = .001) on a relatively low dose of rEpo and without a significant increase in blood pressure.. All patients who had graft survival and only half of those who lost their graft showed a correction of anemia. The rEpo treatment neither accelerated nor decelerated renal failure. The difference between patients in whom anemia was corrected, or not, did not depend upon the previous level of HCT/Hb, but upon worse renal function. Thus, rEpo in patients with CAN is safe and effective, so administration should be initiated early to avoid adverse events deriving from anemia.

Topics: Adult; Anemia; Blood Pressure; Cadaver; Chronic Disease; Creatinine; Erythropoietin; Female; Glomerular Filtration Rate; Humans; Kidney Transplantation; Male; Middle Aged; Safety; Tissue Donors; Transplantation, Homologous

the kidney is the major site of erythropoietin production. Many efforts have been made to identify renal erythropoietin-producing cells. Previous studies showed conflicting results, but the predominant localization reported was the peritubular interstitial and tubular epithelial cells. This study was conducted to identify the erythropoietin-producing cells in renal biopsies from 10 cadaveric donors and 45 patients with familial amyloidosis ATTR V30M, thirteen of them with anemia. Familial amyloidosis Type I (FAP-I) is a genetic disorder caused by a transthyretin (TTR) protein variant presenting a single amino acid substitution of methionine for valine at position 30 of the polypeptide chain (TTR V30M). Anemia in FAP-I is associated with inappropriately low serum erythropoietin levels.. erythropoietin expression was detected by in situ hybridization (ISH) and confirmed by laser capture microdissection followed by PCR. Renal segments were identified by immunohistochemistry.. erythropoietin was mainly expressed by epithelial distal tubular cells and collecting tubules and additionally, in a few biopsies, by glomerular cells. A similar expression pattern was observed in donors and FAP-I patients. No increased mRNA erythropoietin expression was found in anemic patients, all of them presenting only a slight expression in medulla and cortex.. these results suggest the distal nephron as the major site of erythropoietin production, and support the notion that an inappropriate erythropoietin production is the cause of anemia in familial amyloidosis ATTR V30M.

Topics: Adult; Amyloidosis, Familial; Anemia; Biopsy; Cadaver; Case-Control Studies; Erythropoietin; Female; Humans; Immunohistochemistry; In Situ Hybridization; Kidney Diseases; Male; Middle Aged; Mutation; Nephrons; Polymerase Chain Reaction; Portugal; Prealbumin; RNA, Messenger

Posttransplant anemia (PTA) is associated with a higher risk of cardiac mortality, which is the most frequent cause of death among renal transplant recipients. In this study, we sought to determine the prevalence and causes of PTA among Turkish patients.. The study included 75 (52 male, 23 female) adults. Anemia was defined as an hemoglobin (Hb) level < or = 13 g/dL for men and < or = 12 g/dL for women.. The prevalence of PTA was 49.3% at a mean duration of 60.45 months after renal transplantation. The most frequent causes of PTA were erythropoietin (EPO) and iron deficiency. The mean Hb level of 12.76 +/- 2.31 g/dL was significantly higher in male compared to female patients (13.26 +/- 2.31 g/dL vs 11.64 +/- 1.93 g/dL, P = .005). The Hb value was positively correlated with creatinine clearance and serum albumin level, and negatively correlated with serum creatinine level, the amount of proteinuria, and cyclosporine level. Creatinine clearance and serum albumin level were found to be an independent risk factors for PTA upon multivariate analysis. Only 12 of 37 anemic patients received treatment for anemia: 5 (13.5%) with EPO and 7 (18.9%) with iron preparations.. PTA a common complication was unfortunately neglected in this setting. Impaired renal allograft function and decreased serum albumin were major risk factors for PTA. Increased cyclosporine levels were also correlated with decreased Hb concentrations.

Topics: Adult; Anemia; Anemia, Iron-Deficiency; Cadaver; Cyclosporine; Erythropoietin; Family; Female; Hemoglobins; Humans; Immunosuppressive Agents; Kidney Transplantation; Living Donors; Male; Middle Aged; Prevalence; Tissue Donors

The purpose of this study was to evaluate erythropoietin (Epo) and Epo receptor (EpoR) expression in the retina and in vitreous fluid from diabetic and nondiabetic donors. To gain insight into the mechanisms responsible for the regulation of Epo production in the retina, we also assessed retinal expression of hypoxia-inducible factors (HIF-1alpha and HIF-2alpha).. Eighteen postmortem eyes from 9 diabetic patients without clinically detectable retinopathy were compared with 18 eyes from 9 nondiabetic donors. mRNA of Epo, HIF-1alpha, and HIF-2alpha (quantitative RT-PCR) were measured separately in neuroretina and retinal pigment epithelium (RPE). Epo and EpoR were assessed in the retina (immunofluorescence by confocal laser microscopy) and in the vitreous fluid (radioimmunoassay and enzyme-linked immunosorbent assay, respectively).. Epo and EpoR mRNAs were significantly higher in the RPE than in the neuroretina. Higher expression of Epo was detected in the retinas (both in the RPE and in the neuroretina) from diabetic donors. By contrast, EpoR expression was similar in both groups. We did not find any difference in HIF-1alpha and HIF-2alpha mRNA expression between diabetic and nondiabetic donors (both in RPE and neuroretina). Intravitreal Epo concentration was higher in diabetic donors than in nondiabetic control subjects. However, EpoR concentrations were similar in both groups.. Epo overexpression is an early event in the retina of diabetic patients, and this is not associated with any change in EpoR. At this early stage, other factors apart from hypoxia seem to be more important in accounting for the Epo upregulation that exists in the diabetic retina.

Topics: Aged; Basic Helix-Loop-Helix Transcription Factors; Cadaver; Diabetes Mellitus; Erythropoietin; Glial Fibrillary Acidic Protein; Humans; Hypoxia-Inducible Factor 1; Microscopy, Confocal; Middle Aged; Pigment Epithelium of Eye; Receptors, Erythropoietin; Reference Values; Retina; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Signal Transduction

Liver dysfunction is a frequent complication that arises in the period following kidney transplantations, often resulting in death. We reported a case proving hemosiderosis as a cause of prolonged liver dysfunction after cadaveric kidney transplantation.. A 47-year-old man, who had been undergoing hemodialysis, was referred to our hospital on 2 November 1999. On the same day, cadaveric kidney transplantation was performed, and serum creatinine level reached a normal level within 2 weeks after surgery. However, serum transaminase gradually increased in the postoperative period. Serum ALT rose up to 116 IU/L on day 20 after the operation and 215 IU/L on day 30. Microscopic examination by needle biopsy revealed hemosiderosis of the liver. Recombinant human erythropoietin was administered and phlebotomy was performed. Liver function improved as a result.. Early histological diagnosis can be a useful marker in predicting the course of chronic liver disease.

Topics: Cadaver; Chronic Disease; Erythropoietin; Hemosiderosis; Humans; Kidney Transplantation; Liver Diseases; Male; Middle Aged; Recombinant Proteins

Topics: Cadaver; Canada; Costs and Cost Analysis; Cyclosporine; Erythropoietin; Humans; Immunosuppression Therapy; Kidney Transplantation; Living Donors; Netherlands; Socioeconomic Factors; Tissue Donors; United States

In a group of 15 patients after the first transplantation of a cadaverous kidney the authors monitored for the period of one month the serum erythropoietin concentration (Epo), haemoglobin levels (Hb), the haematocrit (Ht) and serum creatinine (Cr). The objective of the investigation was to evaluate in relation to serum concentrations of Epo and the function of the graft. Erythropoietin was examined by the authors own method before and after transplantation during the first 10 days daily and then on the 12th, 15th, 20th, 25th and 30th day. Normal values are 22-44 mU/ml. The mean Epo value before transplantation was 41.9 +/- 18.8 mU/ml. After transplantation the highest mean value of Epo was recorded on the second day when it reached a value of 102.8 +/- 144 mU/ml. The mean Epo serum concentration at the end of the study was 45.9 +/- 20.9 mU/ml and did not differ significantly from values recorded before transplantation. Between Hb and Ht values and Epo serum concentrations no correlation was revealed. Conversely, statistical analysis revealed a close inverse relationship between the drop of creatininaemia and the rise of Hb and Ht values. From the results of the investigation ensues that the decisive condition for the onset of the erythropoietic response after renal transplantation is adjustment of the milieu interiéur, induced by the restored excretory function of the graft which creates prerequisites for a normal response of the bone marrow to Epo.

Topics: Adolescent; Adult; Aged; Cadaver; Creatinine; Erythropoiesis; Erythropoietin; Female; Hematocrit; Hemoglobins; Humans; Kidney; Kidney Transplantation; Male; Middle Aged

Topics: Amputation, Surgical; Bloodletting; Cadaver; Erythropoietin; Glomerulonephritis; Hematocrit; Humans; Hypertension, Renal; Ischemia; Kidney Transplantation; Leg; Male; Middle Aged; Polycythemia; Postoperative Complications; Renal Dialysis

Although use of human recombinant erythropoietin has alleviated symptoms of anemia in renal failure, effects of increased hematocrit (HCT) on early post-transplant renal function are unknown. Of 244 consecutive primary cadaveric kidney recipients transplanted over 74 months, 43% had HCT > or = 30% and 57% had HCT < 30% at transplantation. The incidence of delayed graft function (DGF) was greater in recipients with HCT > or = 30% (61%) than in recipients with HCT < 30% (33%; P = 0.0001). Ten percent of recipients with HCT > or = 30% experienced primary nonfunction (PNF) of the allograft (P = 0.0001). No recipient with HCT < 30% had PNF. Absolute rises in HCT over the 3 months preceding transplantation were greatest in those with PNF (2.5 +/- 2.4) followed by those with DGF (2.0 +/- 3.1) and immediate graft function (IGF) (0.2 +/- 5.2; P = 0.0328). Logistic regression analysis identified HCT > or = 30% (P = 0.0014), cold storage > or = 24 hr (P = 0.0006) and rising HCT (P = 0.0090) as independent predictors of DGF with relative risks of 3.1-, 3.3-, and 2.7-fold, respectively. Recipients with rising pretransplant HCTs who underwent dialytic fluid removal within 24 hr before transplantation had DGF with greater frequency (67%) than nondialyzed recipients with rising HCTs (45%). Primary cadaveric kidney recipients with HCT > or = 30% at transplantation have significantly greater risk for DGF and PNF. Rising pretransplant HCT levels may predispose recipients to DGF; this risk may be heightened in those undergoing hemodialysis shortly before transplantation.

Topics: Adult; Antigen-Antibody Reactions; Black People; Blood Transfusion; Cadaver; Erythropoietin; Female; Graft Survival; Hematocrit; Hemodynamics; Humans; Intraoperative Care; Kidney Transplantation; Male; Middle Aged; Time Factors; Tissue Donors; Transplantation, Homologous; White People

Following successful kidney transplantation, renal anemia is gradually corrected during the first 3-4 months. Serum erythropoietin (EPO) levels are increased after the first postoperative day following grafting. In this study, the serum EPO levels in the early posttransplant phase were investigated in 8 living-donor and 7 cadaveric-kidney transplant recipients with special emphasis on the first 24 h. Despite a considerable difference in cold ischemic time of the graft in the two groups the increase in serum EPO levels was noticed at about the same time (8 h) in both groups and the first peak of serum EPO, which was observed after 24 h, reached the same level in both groups. After 9-11 days, serum EPO reached levels which usually are observed during the first months following transplantation. The EPO response seems to be blunted in relation to the degree of anemia in the early posttransplant phase.

Topics: Adult; Aged; Cadaver; Creatine; Erythropoietin; Female; Humans; Kidney Transplantation; Male; Middle Aged; Time Factors; Tissue Donors

The effects of EPO on transfusion requirements and HLA allosensitization were studied in a group of 145 sensitized patients on a single cadaveric renal allograft waiting list. All patients included in the study had PRA levels greater than 40% and at least six months of follow-up after the general availability of EPO. A total of 108 (74%) of these patients received EPO during the study period while 37 (26%) did not. The EPO patients had a much higher incidence of prior transfusions than the non-EPO patients (64% vs. 39% P less than 0.05). During the follow-up period, there was a marked reduction in transfusion incidence in the patients who received EPO from 64% to 14% (P less than 0.05). A lesser and nonsignificant reduction in incidence of transfusions was seen in the non-EPO-EPO patients. Analysis of PRA levels in the EPO and non-EPO groups demonstrated a reduction in PRA levels over time but there was no difference between the two groups. When the patients were divided by the need for transfusions in the follow-up period, a comparison of these two groups demonstrated significant differences. At the six-month follow-up point, patients in the nontransfused group had a significantly lower mean PRA than the transfused patients (49% vs. 62%, respectively, P less than 0.05). Furthermore, a greater number of patients in the nontransfused group had PRA declines greater than or equal to 15% compared with the nontransfused group (56/46% vs. 4/15%, respectively; P = .007). Stepwise logistic regression analysis of possible risk factors for persistent high PRA levels demonstrated that continued transfusion was the only significant factor. This study suggests that the institution of EPO therapy in sensitized patients on a single cadaveric waiting list can result in substantial reduction in the need for on-going transfusions. However, the decline in PRA levels appears to be more closely tied to the avoidance of transfusion rather than to the specific institution of EPO therapy.

Topics: Adolescent; Adult; Antibodies; Antibodies, Anti-Idiotypic; Blood Grouping and Crossmatching; Blood Transfusion; Cadaver; Child; Cytotoxicity, Immunologic; Erythropoietin; Female; Follow-Up Studies; Humans; Immunization; Immunoglobulin G; Immunoglobulin M; Isoantibodies; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Transplantation, Homologous

We present here results of studies on four patients (three men, one woman) who had had cadaver renal transplants and in whom renal artery stenosis and hypertension developed. Erythropoietin-dependent erythrocytosis developed in association with these changes in the three men. All patients had stable renal function and the hypertension was well controlled. Absolute erythrocytosis thought to be secondary to local renal hypoxia due to decreased renal blood flow developed in two of the men. Erythrocytosis developed in the other man but his RBC mass was at the upper limit of normal. In these patients, we suspect that the erythropoietin-dependent erythrocytosis is secondary to intrarenal hypoxia due to renal artery stenosis. Erythrocytosis or elevated erythropoietin levels failed to develop in the woman despite severe renal artery stenosis. Possible reasons for this discrepancy are discussed.

Topics: Adult; Cadaver; Creatinine; Erythropoietin; Female; Hematocrit; Humans; Kidney Transplantation; Male; Polycythemia; Postoperative Complications; Renal Artery Obstruction; Renin; Transplantation, Homologous

Topics: Adult; Bloodletting; Cadaver; Creatinine; Erythrocyte Count; Erythropoietin; Female; Hematocrit; Hemoglobins; Humans; Kidney Transplantation; Male; Polycythemia; Postoperative Complications; Tissue Donors; Transplantation, Homologous

Topics: Cadaver; Erythropoietin; Graft Rejection; Histocompatibility Testing; Humans; Kidney Glomerulus; Kidney Transplantation; Leukocytosis; Renin; Transplantation Immunology; Transplantation, Homologous

Topics: Blood Pressure; Cadaver; Erythropoietin; Female; Graft Rejection; Hematocrit; Humans; Kidney Function Tests; Kidney Transplantation; Male; Renin; Time Factors; Transplantation Immunology; Transplantation, Homologous

Topics: Adult; Azathioprine; Cadaver; Dactinomycin; Erythropoietin; Female; Humans; Immune Tolerance; Kidney; Kidney Transplantation; Polycythemia; Prednisone; Transplantation, Homologous; Urea