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Renal Transplant Artery Stenosis: Clinical Manifestations, Diagnosis and Treatment

Open Journal of Nephrology 2024年第2期14卷 262-274页

作者： Rihab Dkhissi Latifa Driouch Naima Ouzeddoun Loubna Benamar Tarik Bouattar Department of Nephrology-dialysis-Renal Transplantation IbnSina Hospital Mohammed V University Rabat Morocco

Introduction: Renal transplant artery stenosis (RTAS) is a common and early complication of renal transplantation, which can lead to severe post-transplant hypertension, as well as significant morbidity and mortality, particulary graft loss. The aim of this study is to determine the prevalence, clinico-radiological characteristics and evaluate the outcomes of luminal angioplasty as a first-line treatment for RTAS, through the analysis of medical records of 27 kidney transplant patients. Material and Methods: This is a retrospective, single-center, and descriptive study conducted at the Nephrology department of the Ibn-Sina Hospital in Rabat, including 27 renal transplant patients with RTAS during the period from 1998 to 2023. All patients with clinically suspected RTAS and confirmed by Doppler ultrasound of the transplanted renal artery were included in the study. Results: The mean age of donors was 48.66 ± 13.55 years, with a female predominance (65%). The donor was deceased in 15% of cases. The mean age of the recipients was 39 ± 16 years with a male-to-female ratio of 4.4. The median onset of RTAS was 3.6 ± 3.4 months after renal transplantation. Seven patients (26%) had high blood pressure (HBP) before their transplantation. Six patients (22%) had hypertriglyceridemia and 7 patients (26%) had pure hypercholesterolemia. The main clinical signs were worsening of preexisting HBP, de novo HBP and acute renal failure (ARF). Stenosis was confirmed by renal Doppler ultrasound in all patients. It was severe in 63%, with a stenosis degree greater than 70%. Six patients underwent angioplasty, resulting in the stabilization of graft function with a nadir of 15 mg/l creatinine and blood pressure control with dual therapy in 5 patients. No graft loss cases were noted. Conclusion: RTAS is a significant vascular complication of renal transplantation that predicts unfavorable outcomes for both the patient and the graft. Early diagnosis is crucial to successfully restore graft f

关键词： RTAS Post Transplant Hypertension Graft Function Luminal Angioplasty

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Concerns about the application of resistance exercise with blood-flow restriction and thrombosis risk in hemodialysis patients

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Journal of Sport and Health Science 2024年第4期13卷 548-558,F0003页

作者： Hugo de Luca Correa Lysleine Alves Deus Dahan da Cunha Nascimento Nicholas Rolnick Rodrigo Vanerson Passos Neves Andrea Lucena Reis Thais Branquinho de Araujo Carmen Tzanno-Martins Fernanda Silveira Tavares Luiz Sinesio Silva Neto Claudio Avelino Rodrigues Santos Paolo Lucas Rodrigues-Silva Fernando Honorato Souza Vitoria Marra da Motta Vilalva Mestrinho Rafael Lavarini dos Santos Rosangela Vieira Andrade Jonato Prestes Thiago dos Santos Rosa Post-graduate Program of Physical Education Catholic University of BrasıliaBrasılia 71966-700Brazil The Human Performance Mechanic Lehman CollegeNew YorkNY 10011USA Clinical Group Home dialysis center and RenalClass Sao Paulo 01239-040Brazil Department of Medicine Catholic University of BrasıliaBrasılia 71966-700Brazil Faculty of Medicine Federal University of TocantinsTocantins 77001-090Brazil Embrapa Genetic Resources and Biotechnology Brasılia 70770-917Brazil Graduate Program of Genomic Sciences and Biotechnology Brasılia 71966-700Brazil

Background:Hemodialysis(HD) per se is a risk factor for *** the growing body of evidence on blood-flow restriction(BFR) exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training *** aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE) with BFR on this ***:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate of vascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD ***,RE+BFR significantly increases D-dimer after 4 *** with borderline baseline D-dimer levels(400-490 ng/mL) displayed increased risk of elevating D-dimer over the normal range(≥500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.

关键词： Blood-flow restriction Chronic kidney disease Coagulation Hemodialysis vascular occlusion exercises

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Hemodialysis bilayer bionic blood vessels developed by the mechanical stimulation of hepatitis B viral X(HBX)genetransfected hepatic stellate cells

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2024年第6期25卷 499-512页

作者： Hongyi LIU Yuanyuan ZHOU Peng GUO Xiongwei ZHENG Weibin CHEN Shichao ZHANG Yu FU Xu ZHOU Zheng WAN Bin ZHAO Yilin ZHAO Department of Oncology and vascular Interventional Radiology Zhongshan Hospital Affiliated to Xiamen UniversitySchool of MedicineXiamen UniversityXiamen 361004China School of Medicine Xiamen UniversityXiamen 361102China Xiamen Health and Medical Big Data center Xiamen 361008China Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma(Zhongshan Hospital Affiliated to Xiamen University) Xiamen 361004China Xiamen Key Laboratory of Cellular Intervention and Interventional Medical Materials Xiamen 361004China

Artificial vascular graft(AVG)fistula is widely used for hemodialysis treatment in patients with renal ***,it has poor elasticity and compliance,leading to stenosis and *** ideal artificial blood vessel for dialysis should replicate the structure and components of a real artery,which is primarily maintained by collagen in the extracellular matrix(ECM)of arterial *** have revealed that in hepatitis B virus(HBV)-induced liver fibrosis,hepatic stellate cells(HSCs)become hyperactive and produce excessive ECM ***,mechanical stimulation can encourage ECM secretion and remodeling of a fiber *** on the above factors,we transfected HSCs with the hepatitis B viral X(HBX)gene for simulating the process of HBV ***,these HBX-HSCs were implanted into a polycaprolactonepolyurethane(PCL-PU)bilayer scaffold in which the inner layer is dense and the outer layer consists of pores,which was mechanically stimulated to promote the secretion of collagen nanofiber from the HBX-HSCs and to facilitate crosslinking with the *** obtained an ECM-PCL-PU composite bionic blood vessel that could act as access for dialysis after ***,the vessel scaffold was implanted into a rabbit’s neck arteriovenous fistula *** exhibited strong tensile strength and smooth blood flow and formed autologous blood vessels in the rabbit’s *** study demonstrates the use of human cells to create biomimetic dialysis blood vessels,providing a novel approach for creating clinical vascular access for dialysis.

关键词： Composite bilayer bionic blood vessel Extracellular matrix(ECM) Hepatic stellate cells(HSCs) Hepatitis B viral X(HBX)gene Mechanical force

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Infective Endocarditis in Chronic Hemodialysis Patients: Specificities and Therapeutic Management

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Open Journal of Internal Medicine 2024年第2期14卷 247-258页

作者： Imane Saidi Amal Zniber Mina Agrou Tarik Bouattar Naima Ouzeddoun Loubna Benamar Department of Nephrology Dialysis and Renal Transplantation Ibn Sina University Hospital Rabat Morocco Faculty of Medicine and Pharmacy Mohammed V University Rabat Rabat Morocco Acute Medical Unit Ibn Sina University Hospital Rabat Morocco

Infective endocarditis (IE) is a frequent complication in chronic hemodialysis patients (CHD). The repeated placement and manipulation of central venous catheters, underlying valvulopathies, and immunosuppression are the main predisposing factors for these patients to develop IE. We aimed to highlight the clinical and microbiological specificities of IE in CHD patients, detail the therapeutic management in these patients and identify the risk factors for in-hospital mortality. We included 28 CHD patients in whom the diagnosis of IE was established according to modified Duke criteria. The mean age was 47 ± 17 years. Among them, 57% were hypertensive and 39% were diabetic. The average duration of hemodialysis was 3.5 ± 7 years. The vascular access was a tunnelled jugular catheter, arteriovenous fistula, and temporary catheter in 54%, 28%, and 18% of patients, respectively. Half of the patients presented with heart failure at admission. Methicillin-sensitive Staphylococcus is the most commonly implicated pathogen. Transthoracic echocardiography revealed vegetation in all patients. In 60% of cases, the lesion is located on the mitral valve, and in 35% it is on the tricuspid valve. Patients initially received empirical antibiotic therapy, which was adjusted according to bacteriological results. Valve surgery was indicated in 12 patients, with aortic valve replacement being the most performed procedure followed by tricuspid annuloplasty. The in-hospital mortality rate was 32%. Factors associated with mortality were severe mitral insufficiency (p = 0.036), heart failure (p = 0.043), and the presence of Methicillin-resistant Staphylococcus in blood cultures (p = 0.047). IE is a complication with high morbidity and mortality. Its increasing incidence, specificities in chronic CHD patients, and the complexity of its management require a rigorous preventive strategy. A multidisciplinary collaboration between nephrologists, infectious disease specialists, cardiologists, and sur

关键词： Infective Endocarditis Infectious Complications Chronic Hemodialysis Patients

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vascular Grafts: Technology Success/ Technology Failure

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Biomedical Engineering Frontiers 2023年第1期4卷 228-238页

作者： Buddy Ratner center for dialysis Innovation(CDI) Departments of Bioengineering and Chemical EngineeringUniversity of WashingtonSeattleWA 98195USA

vascular prostheses(grafts)are widely used for hemodialysis blood access,trauma repair,aneurism repair,and cardiovascular ***,smaller-diameter(≤4 mm)grafts that would be valuable for many reconstructions have not been achieved to date,although hundreds of papers on small-diameter vascular grafts have been *** perspective article presents a hypothesis that may open new research avenues for the development of small-diameter vascular grafts.A historical review of the vascular graft literature and specific types of vascular grafts is presented focusing on observations important to the hypothesis to be *** in critically reviewing the vascular graft literature are *** hypothesis that perhaps the“biocompatible biomaterials”comprising our vascular grafts—biomaterials that generate dense,nonvascularized collagenous capsules upon implantation—may not be all that biocompatible is *** of materials that heal with tissue reconstruction and vascularity,in contrast to the fibrotic encapsulation,are *** prohealing materials may lead the way to a new generation of vascular grafts suitable for small-diameter reconstructions.

关键词： vascular healing hypothesis

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Sono-Guided Endostripping: An Appropriate Alternative for Endovascular Varice Procedures

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Surgical Science 2014年第12期5卷 526-532页

作者： Hossein Hemmati Mohammad Reza Asgary Mohammad Sadegh Esmaeli Delshad Davoud Mohammadi Sina Montazeri Cyrus Emir Alavi vascular surgery and dialysis research center Guilan University of Medical Sciences Rasht Iran

Objective: This article is aimed at introducing Sono-Guided Endostripping Technique of the Great Saphenous vein and comparing it with radiofrequency ablation in 104 patients. Methods: 52 patients underwent Sono-Guided Endostripping and 52 patients had radiofrequency ablation with Celon Olympus device. They were followed for 3 months with physical examination and Doppler Sonography for possible complications and recanalization. Results: Recanalization rate was 11.5% in RFAs while it was 0.0% in the Endostripping group. There were no significant differences for other complications (hematoma, DVT, paresthesia) but pain, which had 1.21 and 3.15 VAS scores for RFA and Endostripping groups, respectively. Recanalization rate was more in RFA comparing with the Endostripping group (11.5% vs. 0.0%,?P?< 0.013). RFA was more expensive. Conclusion: Sono-Guided Endostripping is a safe and cost-effective method (due to no need for using RFA probe);however, the patient must be admitted to the hospital and take appropriate anesthesia. Cosmetic result of the technique is fairly comparable with RFA scars in the thigh and leg.

关键词： Catheter Ablation Saphenous Vein Surgical Procedures Varicose Veins-surgery

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Sequential treatment for diabetic foot ulcers in dialysis patients:A case report

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World Journal of Diabetes 2023年第8期14卷 1323-1329页

作者： Jin-Jun Wang Yuan-Yuan Yu Pin-Yi Wang Xian-Ming Huang Xiao Chen Xi-Guang Chen College of Marine Life Science Ocean University of ChinaQingdao 266003Shandong ProvinceChina Department of vascular surgery Qingdao Haici Hospital Affiliated to Qingdao UniversityQingdao 266033Shandong ProvinceChina

BACKGROUND Diabetic foot ulcers(DFUs)are common in patients with diabetes,especially those undergoing *** severe cases,these ulcers can cause damage to the lower extremities and lead to *** treatments such as flap transposition and transfemoral amputation are not always applicable in all ***,there is a need for alternative treatment *** SUMMARY This report describes a 62-year-old female patient who was admitted to the hospital with plantar and heel ulcers on her left *** patient had a history of renal failure and was undergoing regular *** subtraction angiography showed extensive stenosis and occlusion in the left superficial femoral artery,left peroneal artery and left posterior tibial *** evaluation by a multidisciplinary team,the patient was diagnosed with type 2 DFUs(TEXAS 4D).Traditional treatments were deemed unsuitable,and the patient was treated with endovascular surgery in the affected area,in addition to supportive medical treatment,local debridement,and sequential repair using split-thickness skin and tissue-engineered skin grafts combined with negative pressure *** four months,the wound had completely healed,and the patient was able to walk with a walking *** This study demonstrates a new treatment method for DFUs was successful,using angioplasty,skin grafts,and negative pressure.

关键词： Diabetic foot dialysis Plantar and heel ulcers Percutaneous transluminal angioplasty Tissue-engineered skin Wound repair Case report

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Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm

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Chinese Medical Journal 2013年第3期126卷 409-414页

作者： GUO Wei ZHANG Hong-peng LIU Xiao-ping JIA Xin XIONG Jiang MA Xiao-hui Department of vascular surgery Chinese People's Liberation Army General Hospital Beijing 100853 China

Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm （JAAA）. The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients. Methods Between March 2011 and May 2012, nine male patients （mean age, （79.6±8.6） years） with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution. All patients were treated in the hybrid operating room under general anesthesia. Follow-up computed tomography angiography （CTA） was routinely performed before discharge, at 3, 6, and 12 months and annually thereafter. Results Procedural success was achieved in all cases. Total sixteen small fenestrations, two large fenestrations and eight scallops were used. Intra-operative complications occurred in four patients, which included one proximal type I endoleak, two type II endoleaks, and one renal artery dissection. The mean hospital stay was （8.9±1.4） days, mean blood loss was （360.5±46.8） ml, and mean iodinated contrast volume was （230.6±58.3） ml. The mean follow-up time was （7.6±4.2） months. The visceral graft patency was 100% until now. One patient had an increase of serum creatinine of more than 30%, but did not require dialysis. No patients died, no stent fractured, and migration were diagnosed during the follow-up. Conclusions The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory. However, long-term fenestrated graft durability and branch vessel patency remain to be determined.

关键词： abdominal aortic aneurysm juxtarenal aneurysm endovascular aortic repair, fenestrated stent-graft

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Pathological Fractures in Chronic Hemodialysis Patients in a Teaching Hospital in Senegal: Prevalence and Associated Risk Factors

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Open Journal of Nephrology 2023年第3期13卷 211-219页

作者： Ahmed Tall Lemrabott Baratou Coundoul Niakhaleen Keita Maria Faye Moustapha Faye Mansour Mbengue Bacary Ba Seynabou Diagne Abdou Niang El Hadji Fary Ka Department of Nephrology Aristide Le Dantec University Hospital Dakar Senegal Department of Nephrology Dalal Jamm National Hospital Center Dakar Senegal dialysis center National Hospital Center of Pikine Pikine Senegal

Introduction: The lack of follow-up and adequate management of chronic kidney disease-mineral and bone disorder (CKD-MBD) in chronic hemodialysis patients is associated with pathological fractures. Few studies are available on the subject in sub-Saharan Africa. The objective of this work was to evaluate the prevalence of pathological fractures in our chronic hemodialysis patients, to analyze their clinical aspects and to determine the factors associated with their occurrence. Patients and Methods: We conducted a retrospective, descriptive and analytical study over 9 years (January 1, 2011, to December 31, 2020) based on the medical records of chronic hemodialysis patients at the CHU Aristide Le Dantec. The diagnosis of pathological fracture was retained in front of any fracture occurring spontaneously or following minimal trauma and confirmed by X-ray. Results: Nineteen cases of pathological fractures were collected with a hospital prevalence of 19.39%. The mean age was 53.32 ± 13.94 years with a sex ratio of 0.36. The average seniority in dialysis was 84.16 ± 29.88 months. Among these patients, one had had 3 episodes of fractures and another 6 episodes. The circumstances of occurrence of the fractures were the fall in 63% of the cases, spontaneously in 37% of the cases. The predominant site of fractures was the femoral neck (47.38% cases). Female gender (p 5 years (p = 0.049), gait disturbances prior to the fracture (p = 0.001), positive CRP (p = 0.028) and the presence of vascular calcifications (p = 0.002) were significantly associated with the occurrence of pathological fractures. Conclusion: This study has identified the factors associated with the occurrence of pathological invoices in hemodialysis patients in our context. These fractures are often associated with the lack of regular biological follow-up due to the low socioeconomic level of our patients.

关键词： Pathological Fractures CKD-MBD Hyperparathyroidism Osteomalacia Adynamic Bone Disease Chronic Hemodialysis

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Multifaceted relationship between diabetes and kidney diseases:Beyond diabete

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World Journal of Diabetes 2023年第10期14卷 1450-1462页

作者： Pasquale Esposito Daniela Picciotto Francesca Cappadona Francesca Costigliolo Elisa Russo Lucia Macciò Francesca Viazzi Department of Internal Medicine and Medical Specialties(DiMI) University of GenoaGenoa 16132Italy Unit of Nephrology Dialysis and TransplantationIRCCS Ospedale Policlinico San MartinoGenoa 16132Italy

Diabetes mellitus is one of the most common causes of chronic kidney *** involvement in patients with diabetes has a wide spectrum of clinical presentations ranging from asymptomatic to overt proteinuria and kidney *** development of kidney disease in diabetes is associated with structural changes in multiple kidney compartments,such as the vascular system and *** alterations include thickening of the glomerular basement membrane,loss of podocytes,and segmental mesangiolysis,which may lead to microaneurysms and the development of pathognomonic Kimmelstiel-Wilson *** lesions directly related to diabetes,awareness of the possible coexistence of nondiabetic kidney disease in patients with diabetes is *** nondiabetic lesions include focal segmental glomerulosclerosis,IgA nephropathy,and other primary or secondary renal *** diagnosis of these conditions is crucial in guiding clinical management and therapeutic ***,the relationship between diabetes and the kidney is bidirectional;thus,new-onset diabetes may also occur as a complication of the treatment in patients with renal ***,we review the complex and multifaceted correlation between diabetes and kidney diseases and discuss clinical presentation and course,differential diagnosis,and therapeutic opportunities offered by novel drugs.

关键词： Diabetes Diabetic kidney disease Nondiabetic kidney disease Biomarkers Glomerular disease Kidney biopsy Sodium-glucose cotransporter-2 inhibitors

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