Language：English   Publisher：Nephrology  

We herein present the first reported case of a 65-year-old man on haemodialysis who developed amyloid arthritis involving both β2-microglobulin and transthyretin. He had begun haemodialysis 46 years prior, and 22 years later, he developed carpal tunnel syndrome due to dialysis-related amyloidosis. After 29 years on haemodialysis, he received a deceased-donor kidney transplant, allowing him to discontinue dialysis. Fourteen years post-transplant, he was diagnosed with wild-type transthyretin cardiac amyloidosis. Seventeen years after the kidney transplant, he had to resume haemodialysis because of kidney dysfunction and presented with persistent fever. Computed tomography revealed increased amyloid deposits in the joints compared with the time of his transplant. A biopsy of the shoulder joint confirmed the presence of amyloid deposits positive for both β2-microglobulin and transthyretin as determined by immunostaining and mass spectrometry. The patient was treated with glucocorticoids, tafamidis meglumine and β2-microglobulin adsorption therapy, leading to improvement in his symptoms. This case highlights that amyloid deposition can progress due to kidney dysfunction, even during periods without dialysis following a kidney transplant, and underscores the need to consider transthyretin amyloid deposition in patients undergoing dialysis.

DOI： 10.1111/nep.70162

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PubMed

Language：English  

DOI： 10.1159/000551506

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PubMed

Language：English   Publisher：(一社)日本腎臓学会  

Language：English   Publisher：Transplantation Proceedings  

Kidney transplantation (KTx) is the optimal treatment for end-stage kidney disease, but hypertension after KTx is significant complication affecting graft and patient survival. Although angiotensin II receptor blockers (ARBs) are widely used, the effect of their “early” introduction on outcomes remains unclear. This retrospective observational cohort study compared KTx recipients who started ARBs within the first 14 days post-transplant (early ARB [eARB] group) to those ARBs initiated after three months (conventional group). Propensity score matching was used to align the groups. Blood pressure control, estimated glomerular filtration rate, and serum potassium levels, urinary protein, and adverse events were analyzed. Between 2020 and 2022, 174 patients underwent living-donor KTx. Propensity score matching refined this to 38 matched pairs (76 individuals), which were analyzed. No significant difference in blood pressure control was observed between the two groups at any time point. Results showed that eARB use led to significantly lower urinary protein levels at 3 months compared to the conventional group (P = .019). There were no significant differences in adverse events, including hyperkalemia, rejection, or hypotension, between groups. Potassium-lowering agents were used slightly more in the eARB group, but the difference was not significant. Although eARBs initiation appears safe and potentially beneficial for kidney transplant recipients, further studies are needed to fully understand the long-term implications of this strategy.

DOI： 10.1016/j.transproceed.2025.05.003

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PubMed

Language：English   Publisher：Clinical and Experimental Nephrology  

Background: Encapsulated peritoneal sclerosis (EPS) is a serious complication in patients undergoing peritoneal dialysis (PD). Neutral-pH dialysate is associated with less peritoneal damage and a lower incidence of EPS than conventional PD solution. However, monitoring for peritoneal damage and predicting EPS remain important during PD therapy. Methods: We measured the mesothelial cell area, dialysate-to-plasma ratio of creatinine after 4 h, and concentrations of the potential biological markers effluent fibrin degradation products (eFDPs), cancer antigen-125, and interleukin-6 in the effluent dialysate from patients who had been undergoing PD therapy for > 5 years in our hospital. These biomarkers were obtained from the drainage fluid of the final measurement of peritoneal equilibration testing before withdrawal from PD therapy. The concentrations of these potential biomarkers were measured in 39 patients who withdrew from PD therapy and were enrolled in the study. Results: Three participants developed EPS after withdrawing PD. The dialysate-to-plasma ratio of creatinine, area of mesothelial cells, and interleukin-6 appearance rate in participants who developed EPS tended to be higher than those in patients who did not, but there were no significant differences. Significantly more eFDPs were in participants who developed EPS than in those who did not (138.5 ± 15.1 vs. 32.9 ± 7.4 µg/mL, P = 0.002). There was no difference in the cancer antigen-125 appearance rate between the groups. A cut-off value of eFDPs ≥ 119.1 µg/mL was optimal for predicting EPS (P = 0.006, specificity = 0.972, sensitivity = 1.000). Conclusion: This study shows that eFDPs may be a useful biological marker for predicting EPS in patients undergoing PD using neutral-pH dialysate.

DOI： 10.1007/s10157-024-02565-9

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PubMed

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese   Publisher：(株)日本臨床社