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Chronic Kidney Disease II: Clinical Manifestations01:24

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Chronic Kidney Disease I: Introduction01:25

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Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
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Nephrotic Syndrome II : Assessment and Medical Management01:26

Nephrotic Syndrome II : Assessment and Medical Management

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IntroductionNephrotic syndrome is a kidney disorder marked by excessive protein loss in the urine, leading to various systemic complications. This condition often results from damage to the glomeruli—the kidney's filtering units—causing proteinuria, low blood protein levels, and fluid retention. Understanding the assessment, diagnosis, and management of nephrotic syndrome is essential for effective treatment and prevention of further kidney damage.AssessmentPatient History: Document...
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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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Polyomavirus Nephropathy: Ten-Year Experience.

J S Costa1, E Ferreira1, R Leal1

  • 1Department of Nephrology, Coimbra Hospital and Universitary Center, Coimbra, Portugal.

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|May 2, 2017
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Summary
This summary is machine-generated.

Polyomavirus nephropathy (BKVN) is a major cause of kidney transplant failure. Older age and delayed graft function are key risk factors for graft loss in BKVN patients.

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Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Virology

Background:

  • BK polyomavirus nephropathy (BKVN) is a significant contributor to chronic allograft dysfunction (CAD).
  • Identified risk factors include recipient demographics, deceased donation, intense immunosuppression, diabetes, delayed graft function (DGF), cytomegalovirus infection, and acute rejection (AR).
  • Immunosuppression reduction is the primary therapeutic strategy for BKVN.

Purpose of the Study:

  • To assess chronic allograft dysfunction (CAD) progression following therapeutic interventions for BKVN.
  • To identify risk factors associated with graft loss (GL) in kidney transplant recipients with BKVN.

Main Methods:

  • Retrospective analysis of 23 kidney transplant biopsies with histological evidence of BKVN over a 10-year period.
  • Patients included those with CAD and BKVN, with 16 having a glomerular filtration rate (GFR) <30 mL/min at diagnosis.
  • Therapeutic strategies involved antimetabolite reduction/discontinuation, calcineurin inhibitor (CNI) modification, and antiviral agents.

Main Results:

  • BKVN was diagnosed in 23 recipients (19 male, 4 female), predominantly white, with a mean age of 51.2 years.
  • Common comorbidities included diabetes (4 patients), DGF (3), cytomegalovirus infection (2), and AR (15).
  • One year post-intervention, graft function decreased in 11 patients, stabilized/improved in 10. Graft loss (GL) occurred in 9 patients (39.1%). Older age and DGF emerged as significant risk factors for GL. Lower GFR at diagnosis correlated with increased risk of dialysis initiation.

Conclusions:

  • Graft loss occurred in 39.1% of BKVN patients, with DGF being a notable factor.
  • Older recipient age and lower GFR at BKVN diagnosis are critical risk factors for graft loss.
  • Prompt diagnosis of BKVN is crucial for mitigating graft loss and improving long-term outcomes.