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Article ; Online: Challenges Posed by the Banff Classification: Diagnosis and Treatment of Chronic Active T-Cell-Mediated Rejection.

Yamamoto, Izumi / Kawabe, Mayuko / Hayashi, Ayaka / Kobayashi, Akimitsu / Yamamoto, Hiroyasu / Yokoo, Takashi

2023 Volume 147 Suppl 1, Page(s) 74–79

Abstract: The three primary sites of acute T-cell-mediated rejection (TCMR) in transplanted kidneys are the tubular epithelial cells, interstitium, and the vascular endothelial cells. The pathology of acute lesions is characterized by inflammatory cell ... ...

Abstract	The three primary sites of acute T-cell-mediated rejection (TCMR) in transplanted kidneys are the tubular epithelial cells, interstitium, and the vascular endothelial cells. The pathology of acute lesions is characterized by inflammatory cell infiltration; the final diagnosis suggested by the Banff 2019 classification is guided by grading of tubulitis (the t score), interstitial inflammation (the i score), and endarteritis (the v score). Consistent major issues when using the Banff classification are the etiological classifications of interstitial fibrosis and tubular atrophy (IFTA). From 2015 to 2019, technological advances (i.e., genetic analysis in paraffin sections) increased our understanding of IFTA status in patients with smoldering acute TCMR and the roles played by inflammatory cell infiltration (the i-IFTA score) and tubulitis (the t-IFTA score) in IFTA. These two scores were introduced when establishing the diagnostic criteria for chronic active TCMR. Despite the increase in complexity and the lack of a consensus treatment for chronic active TCMR, the Banff classification may evolve as new techniques (i.e., genetic analysis in paraffin sections and deep learning of renal pathology) are introduced. The Banff conference proceeded as follows. First, lesions were defined. Next, working groups were established to better understand the lesions and to derive better classification methods. Finally, the new Banff classification was developed. This approach will continue to evolve; the Banff classification will become a very useful diagnostic standard. This paper overviews the history of TCMR diagnosis using the Banff classification, and the clinical importance, treatment, and prospects for acute and chronic active TCMR.
MeSH term(s)	Humans ; Kidney Transplantation ; T-Lymphocytes ; Endothelial Cells ; Paraffin ; Kidney/pathology ; Kidney Diseases/pathology ; Graft Rejection/etiology ; Biopsy
Chemical Substances	Paraffin (8002-74-2)
Language	English
Publishing date	2023-03-16
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	207121-6
ISSN	2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
ISSN (online)	2235-3186 ; 1423-0186
ISSN	1660-8151 ; 0028-2766
DOI	10.1159/000530158
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Zs.A 169: Show issues

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Article ; Online: CASE REPORT: Serial Cases of False-Positive Flow-Cytometry T Cell Crossmatch Associated With Anti-Blood Type Antibodies in Patients Undergoing ABO-Incompatible Kidney Transplantation.

Hayashi, Ayaka / Yamamoto, Izumi / Kawabe, Mayuko / Kobayashi, Akimitsu / Ito, Makoto / Hotta, Kiyohiko / Shinohara, Nobuo / Tasaki, Tetsunori / Yokoo, Takashi / Iwami, Daiki

Frontiers in immunology

2022 Volume 13, Page(s) 862652

Abstract: Background: A positive flow-cytometry T cell crossmatch (FTXM) has important prognostic implications, even when the complement-dependent cytotoxicity crossmatch is negative. Recent studies have shown that ABO incompatibility is associated with positive ... ...

Abstract	Background: A positive flow-cytometry T cell crossmatch (FTXM) has important prognostic implications, even when the complement-dependent cytotoxicity crossmatch is negative. Recent studies have shown that ABO incompatibility is associated with positive FTXM, but the underlying mechanism remains poorly understood. Cases: In five ABO blood type O recipients of kidneys from wives with type B, FTXM was positive but complement-dependent cytotoxicity crossmatch was negative. Application of a solid-phase technique (LABScreen) revealed no case with antibodies to donor-specific human leukocyte antigen. After removal of type B antibodies from patient sera, FTXM was negative for all five patients. In one tested case, the eluate prepared from the donor's T lymphocyte agglutinated only type B red blood cells, implying the existence of blood type B substances on donor T lymphocytes. Discussion: False-positive FTXM reflects blood type B substrates bound to T lymphocytes. Repeat FTXM after incubation with donor-type red blood cells (to adsorb anti-ABO antibodies) was negative. This phenomenon explains the discrepancy between FTXM and solid-phase bead assays. Demonstration of type B substances on donor T lymphocytes is necessary before absolute test validity is confirmed. Conclusion: False-positive FTXM may be associated with type B antibodies bound to T lymphocytes when a blood type O recipient receives tissue from a type B donor. This phenomenon explains the false-positive FTXM observed in the setting of ABO-incompatible kidney transplantation.
MeSH term(s)	ABO Blood-Group System ; Anemia, Hemolytic, Autoimmune ; Antibodies ; HLA Antigens ; Histocompatibility Testing/methods ; Humans ; Kidney Transplantation/adverse effects ; Kidney Transplantation/methods ; T-Lymphocytes
Chemical Substances	ABO Blood-Group System ; Antibodies ; HLA Antigens
Language	English
Publishing date	2022-03-10
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2022.862652
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Article ; Online: Booster effect of the third dose of SARS-CoV-2 mRNA vaccine in Japanese kidney transplant recipients.

Kawabe, Mayuko / Kuroda, Takafumi / Yamamoto, Izumi / Kobayashi, Akimitsu / Ohki, Yutaro / Hayashi, Ayaka / Urabe, Fumihiko / Miki, Jun / Yamada, Hiroki / Kimura, Takahiro / Matsuo, Nanae / Tanno, Yudo / Horino, Tetsuya / Ohkido, Ichiro / Yamamoto, Hiroyasu / Yokoo, Takashi

Scientific reports

2023 Volume 13, Issue 1, Page(s) 9976

Abstract: The humoral response of kidney transplant recipients (KTR) to the mRNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is generally poor. We evaluated the booster effect of the third dose (D3) of two SARS-CoV-2 mRNA vaccines ... ...

Abstract	The humoral response of kidney transplant recipients (KTR) to the mRNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is generally poor. We evaluated the booster effect of the third dose (D3) of two SARS-CoV-2 mRNA vaccines 6 months after the second dose (D2) in Japanese KTR. The anti-spike (anti-S) antibody titer 1 and 3 months after the D3 was evaluated in 82 Japanese KTR. The primary endpoint was the seropositivity rate, and factors associated with the lack of a response were evaluated in a logistic regression model. Overall, the anti-S antibody seropositivity rate 1 and 3 months after the D3 was 74.7% and 76.0%. The anti-S antibody titers after the first and second doses were higher in patients vaccinated with the mRNA-1273 than with the BNT162b2 vaccine. Among the 38 KTR who were seronegative 5 months after the D2, 18 (47.4%) became seropositive following the D3. Factors associated with a non-response were mycophenolic acid dose, post-transplant duration, hemoglobin, and lymphocyte count. A humoral response 1 and 3 months after the D3 was obtained in ~ 75% of KTR, but 20% were non-responders. Additional studies are needed to clarify the factors hindering a vaccine response.
MeSH term(s)	Humans ; Antibodies, Viral ; BNT162 Vaccine/administration & dosage ; COVID-19/prevention & control ; East Asian People ; Kidney Transplantation ; Transplant Recipients ; Immunization, Secondary
Chemical Substances	Antibodies, Viral ; BNT162 Vaccine
Language	English
Publishing date	2023-06-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-36998-1
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Article ; Online: Peripheral Blood Absolute Lymphocyte Count as a Predictor of Cytomegalovirus Infection in Kidney Transplant Recipients.

Shiina, Yuki / Kawabe, Mayuko / Suehiro, Yohei / Katsumata, Haruki / Nakada, Yasuyuki / Kobayashi, Akimitsu / Yamamoto, Izumi / Urabe, Fumihiko / Miki, Jun / Yamada, Hiroki / Kimura, Takahiro / Tanno, Yudo / Ohkido, Ichiro / Yamamoto, Hiroyasu / Yokoo, Takashi

Transplantation proceedings

2023 Volume 55, Issue 7, Page(s) 1594–1597

Abstract: Background: Cytomegalovirus viremia and infection have been reported to increase the risks for acute graft rejection and mortality in kidney transplant recipients. Previous studies demonstrated that a lower absolute lymphocyte count in peripheral blood ... ...

Abstract	Background: Cytomegalovirus viremia and infection have been reported to increase the risks for acute graft rejection and mortality in kidney transplant recipients. Previous studies demonstrated that a lower absolute lymphocyte count in peripheral blood is associated with cytomegalovirus infection. The aim of this study was to investigate whether absolute lymphocyte count could predict cytomegalovirus infection in kidney transplant recipients. Methods: From January 2010 to October 2021, 48 living kidney transplant recipients in whom both donor and recipient were positive for immunoglobulin G of cytomegalovirus were included in this retrospective study. The primary outcome was defined as cytomegalovirus infection occurring ≥28 days after kidney transplantation. All recipients were followed for 1 year after kidney transplantation. The diagnostic accuracy of absolute lymphocyte count on day 28 post-transplantation for cytomegalovirus infection was analyzed using receiver operating characteristic curves. A Cox proportional hazards model was used to calculate hazard ratios for the incidence of cytomegalovirus infection. Results: There were 13 patients (27%) with cytomegalovirus infection. The sensitivity and specificity for cytomegalovirus infection were 62% and 71%, respectively; the negative predictive value was 83% when an absolute lymphocyte count of 1100 cells/μL on day 28 post-transplantation was used as the cutoff. The incidence of cytomegalovirus infection was significantly higher when the absolute lymphocyte count was <1100 cells/μL on day 28 post-transplantation (hazard ratio, 3.32; 95% CI, 1.08-10.2). Conclusion: Absolute lymphocyte count is an inexpensive and easy test that can effectively predict cytomegalovirus infection. Further validation is needed to confirm its utility.
MeSH term(s)	Humans ; Kidney Transplantation/adverse effects ; Retrospective Studies ; Cytomegalovirus Infections/epidemiology ; Cytomegalovirus ; Lymphocyte Count ; Transplant Recipients
Language	English
Publishing date	2023-07-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2023.04.042
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Zs.A 835: Show issues

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Article ; Online: Clinical and Pathological Significance of Mesangial C1q Deposition in Kidney Transplant Recipients with Recurrent IgA Nephropathy and Patients with Native IgA Nephropathy.

Hayashi, Ayaka / Kawabe, Mayuko / Yamamoto, Izumi / Ohki, Yutaro / Kobayashi, Akimitsu / Ueda, Hiroyuki / Tanno, Yudo / Urabe, Fumihiko / Miki, Jun / Yamada, Hiroki / Kimura, Takahiro / Okido, Ichiro / Tsuboi, Nobuo / Yamamoto, Hiroyasu / Yokoo, Takashi

Nephron

2023 Volume 147 Suppl 1, Page(s) 80–88

Abstract: Introduction: In kidney transplant recipients (KTRs) whose primary disease is IgA nephropathy (IgAN), IgAN recurrence occurs in approximately half of patients by 5 years postoperatively and is associated with graft survival. Although the alternative and ...

Abstract	Introduction: In kidney transplant recipients (KTRs) whose primary disease is IgA nephropathy (IgAN), IgAN recurrence occurs in approximately half of patients by 5 years postoperatively and is associated with graft survival. Although the alternative and lectin pathways are important in the primary pathogenesis of IgAN, the significance of mesangial C1q deposition, which triggers the classical pathway, is unknown. We investigated the clinicopathological significance of mesangial C1q deposition in both recurrent IgAN in KTRs and native IgAN. Methods: Between 2000 and 2021, we conducted a 1:2 matched case-control study of 18 KTRs diagnosed with recurrent IgAN, with a group of native IgAN patients as the control. We evaluated the rate and presence/absence of mesangial C1q deposition in terms of pathological findings and kidney outcomes in each group. Results: The rate of mesangial C1q deposition was significantly higher in the recurrent IgAN patients in KTRs than in native IgAN patients (11/18 [61.1%] vs. 5/36 [13.9%], p = 0.001). In the former group, the incidence of glomerular crescents was relatively higher in C1q-positive patients. There was no significant difference in the annual rate of estimated glomerular filtration rate decline between C1q-positive and C1q-negative patients in either group. Conclusion: Mesangial C1q deposition was more frequent in KTRs with recurrent IgAN than in patients with native IgAN, but we found no difference in kidney outcomes with respect to mesangial C1q deposition. Further large-scale investigations of the importance of mesangial C1q deposition are needed in both KTRs with recurrent IgAN and patients with native IgAN.
MeSH term(s)	Humans ; Glomerulonephritis, IGA/complications ; Complement C1q ; Kidney Transplantation ; Case-Control Studies ; Glomerular Mesangium/metabolism
Chemical Substances	Complement C1q (80295-33-6)
Language	English
Publishing date	2023-06-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	207121-6
ISSN	2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
ISSN (online)	2235-3186 ; 1423-0186
ISSN	1660-8151 ; 0028-2766
DOI	10.1159/000530916
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Zs.A 169: Show issues

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Article ; Online: Early Recurrence of Immunoglobulin A Nephropathy after Kidney Transplantation in a Patient with Down Syndrome.

Ohki, Yutaro / Kawabe, Mayuko / Yamamoto, Izumi / Kobayashi, Akimitsu / Kanzaki, Go / Koike, Kentaro / Ueda, Hiroyuki / Tanno, Yudo / Urabe, Fumihiko / Miki, Jun / Yamada, Hiroki / Kimura, Takahiro / Ohkido, Ichiro / Tsuboi, Nobuo / Yamamoto, Hiroyasu / Yokoo, Takashi

Nephron

2023 Volume 147 Suppl 1, Page(s) 35–40

Abstract: A 39-year-old male kidney transplant recipient with Down syndrome (DS) was admitted to our hospital for biopsy. He had proteinuria at age 9, was diagnosed with immunoglobulin A nephropathy (IgAN) at age 22, had a tonsillectomy at age 35, and underwent ... ...

Abstract	A 39-year-old male kidney transplant recipient with Down syndrome (DS) was admitted to our hospital for biopsy. He had proteinuria at age 9, was diagnosed with immunoglobulin A nephropathy (IgAN) at age 22, had a tonsillectomy at age 35, and underwent ABO-compatible kidney transplantation (from his mother) at age 36. His serum creatinine was stable at 2.21 mg/dL 3 months after the kidney transplant, and his urine protein was 0.11 g/day. A protocol biopsy was performed 7 months after the kidney transplant, and there was suspicion of early recurrence of IgAN. One year after the transplant, urine erythrocytes were elevated and proteinuria was 0.41 g/day; at 3 years and 5 months after the kidney transplant, hematuria was evident along with proteinuria (0.74 g/day). Therefore, an episode biopsy was performed. A total of 23 glomeruli were obtained, four of which exhibited global sclerosis; three others showed intra- and extracapillary proliferative glomerulonephritis compatible with IgAN recurrence. Here, we report a rare case of early recurrence of IgAN with disease progression despite tonsillectomy in a patient with DS.
MeSH term(s)	Male ; Humans ; Child ; Young Adult ; Adult ; Glomerulonephritis, IGA/complications ; Glomerulonephritis, IGA/surgery ; Glomerulonephritis, IGA/diagnosis ; Kidney Transplantation ; Down Syndrome/complications ; Kidney Glomerulus/pathology ; Proteinuria ; Glomerulonephritis, Membranoproliferative ; Recurrence
Language	English
Publishing date	2023-06-08
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	207121-6
ISSN	2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
ISSN (online)	2235-3186 ; 1423-0186
ISSN	1660-8151 ; 0028-2766
DOI	10.1159/000530915
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Zs.A 169: Show issues

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Article ; Online: A Case of Hypokalemia Caused by Left Native Renal Artery Stenosis in a Kidney Transplant Recipient.

Shiina, Yuki / Kobayashi, Akimitsu / Yamamoto, Izumi / Koda, Nagisa / Miyazawa, Kotaro / Kawabe, Mayuko / Sugano, Naoki / Urabe, Fumihiko / Miki, Jun / Yamada, Hiroki / Kimura, Takahiro / Maruyama, Yukio / Tanno, Yudo / Ohkido, Ichiro / Yamamoto, Hiroyasu / Yokoo, Takashi

Nephron

2023 Volume 147 Suppl 1, Page(s) 46–52

Abstract: A 39-year-old woman with end-stage renal failure of unknown origin was on peritoneal dialysis for 10 years. One year ago, she underwent ABO-incompatible living-donor kidney transplantation from her husband. After the kidney transplantation, her serum ... ...

Abstract	A 39-year-old woman with end-stage renal failure of unknown origin was on peritoneal dialysis for 10 years. One year ago, she underwent ABO-incompatible living-donor kidney transplantation from her husband. After the kidney transplantation, her serum creatinine level remained around 0.7 mg/dL, but her serum potassium level remained low at around 3.5 mEq/L despite potassium supplementation and spironolactone. The patient's plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were markedly elevated (20 ng/mL/h and 868 pg/mL, respectively). A CT angiogram of the abdomen performed 1 year previously suggested stenosis of the left native renal artery, which was considered responsible for the hypokalemia. Renal venous sampling was done on both the native kidneys and the transplanted kidney. Since renin secretion from the left native kidney was significantly elevated, a laparoscopic left nephrectomy was performed. Postoperatively, the renin-angiotensin-aldosterone system was markedly improved (PRA: 6.4 ng/mL/h, PAC: 147.3 pg/mL), and the serum potassium levels also improved. Pathological examination of the removed kidney showed many atubular glomeruli and hyperplasia of the juxtaglomerular apparatus (JGA) in residual glomeruli. In addition, renin staining showed strong positivity in the JGA of these glomeruli. Here, we report a case of hypokalemia caused by left native renal artery stenosis in a kidney transplant recipient. This valuable case study provides histological confirmation of maintained renin secretion in an abandoned native kidney after kidney transplantation.
MeSH term(s)	Humans ; Female ; Adult ; Renin ; Renal Artery ; Hypokalemia/etiology ; Renal Artery Obstruction/complications ; Kidney Transplantation/adverse effects ; Constriction, Pathologic/complications ; Aldosterone ; Potassium
Chemical Substances	Renin (EC 3.4.23.15) ; Aldosterone (4964P6T9RB) ; Potassium (RWP5GA015D)
Language	English
Publishing date	2023-03-20
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	207121-6
ISSN	2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
ISSN (online)	2235-3186 ; 1423-0186
ISSN	1660-8151 ; 0028-2766
DOI	10.1159/000530229
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Zs.A 169: Show issues

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Article: Long-Term Humoral Response After a Second Dose of SARS-CoV-2 mRNA Vaccine in Japanese Kidney Transplant Recipients.

Ohki, Yutaro / Kawabe, Mayuko / Yamamoto, Izumi / Katsumata, Haruki / Nakada, Yasuyuki / Kobayashi, Akimitsu / Urabe, Fumihiko / Miki, Jun / Yamada, Hiroki / Kimura, Takahiro / Matsuo, Nanae / Tanno, Yudo / Horino, Tetsuya / Ohkido, Ichiro / Yamamoto, Hiroyasu / Yokoo, Takashi

Frontiers in microbiology

2022 Volume 13, Page(s) 922042

Abstract: Background: The mortality rate due to COVID-19 in kidney transplant recipients (KTRs) is 16.8 to 32%. Vaccination against COVID-19 is expected to contribute to the prevention of infection, severe disease, and mortality; however, it has been reported ... ...

Abstract	Background: The mortality rate due to COVID-19 in kidney transplant recipients (KTRs) is 16.8 to 32%. Vaccination against COVID-19 is expected to contribute to the prevention of infection, severe disease, and mortality; however, it has been reported that the humoral response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine in KTRs is poor. Vaccination strategies against COVID-19 vary from country to country, and in Japan, the third dose is given 6 months after the second dose. Few studies have evaluated long-term humoral responses after the second dose of SARS-CoV-2 mRNA vaccine. In addition, the superiority of BNT162b2 vaccine and mRNA-1,273 vaccine in KTRs regarding humoral response is controversial. Methods: Ninety-four KTRs were administered a second dose of the BNT162b2 or mRNA-1,273 vaccines, and anti-spike (anti-S) and anti-nucleocapsid (anti-N) SARS-CoV-2 antibody levels were measured 5 months (149.2 ± 45.5 days) later. The cutoff value of anti-S antibodies was defined ≥50 AU/ml and 1.4 Index for anti-N antibodies. The primary outcome was the rate of seropositivity, and factors associated with an appropriate humoral response were assessed by univariate and multivariate analysis. Results: Of 94 KTRs, only 45 (47.9%) patients were positive for anti-S antibodies. The median anti-S SARS-CoV-2 IgG antibody titers was 35.3 (Interquartile range 3.8 to 159.7). Anti-N SARS-CoV-2 IgG antibodies in all patients were < 1.4 Index. Response to SARS-CoV-2 mRNA vaccines were 43.2 and 65% for BNT162b2 and mRNA-1,273, respectively ( Conclusion: The long-term humoral response after a second dose of SARS-CoV-2 mRNA vaccine in Japanese KTRs was poor. In comparison with high-dose, low-dose mycophenolic acid was related to an appropriate humoral response. Five months is too long to wait for a 3rd dose after 2nd dose of SARS-CoV-2 vaccine in KTRs. In this cohort, there was no statistical difference in humoral response to the BNT162b2 and mRNA-1,273 vaccines. Additional large observational studies and meta-analyses are needed to clarify the factors related to an appropriate humoral immune response to COVID-19 vaccination.
Language	English
Publishing date	2022-06-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2587354-4
ISSN	1664-302X
ISSN	1664-302X
DOI	10.3389/fmicb.2022.922042
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Article ; Online: Dietary Protein Intake and Single-Nephron Glomerular Filtration Rate.

Oba, Rina / Kanzaki, Go / Sasaki, Takaya / Okabayashi, Yusuke / Haruhara, Kotaro / Koike, Kentaro / Kobayashi, Akimitsu / Yamamoto, Izumi / Tsuboi, Nobuo / Yokoo, Takashi

Nutrients

2020 Volume 12, Issue 9

Abstract: High protein intake can increase glomerular filtration rate (GFR) in response to excretory overload, which may exacerbate the progression of kidney disease. However, the direct association between glomerular hemodynamic response at the single-nephron ... ...

Abstract	High protein intake can increase glomerular filtration rate (GFR) in response to excretory overload, which may exacerbate the progression of kidney disease. However, the direct association between glomerular hemodynamic response at the single-nephron level and dietary protein intake has not been fully elucidated in humans. In the present study, we evaluated nutritional indices associated with single-nephron GFR (SNGFR) calculated based on corrected creatinine clearance (SNGFR
MeSH term(s)	Cohort Studies ; Dietary Proteins/pharmacology ; Female ; Glomerular Filtration Rate/physiology ; Humans ; Kidney/anatomy & histology ; Living Donors ; Male ; Middle Aged ; Nephrons/physiology ; Retrospective Studies ; Tokyo ; Tomography, X-Ray Computed
Chemical Substances	Dietary Proteins
Language	English
Publishing date	2020-08-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu12092549
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Article ; Online: Kidney Transplant Graftectomy by Severe Mixed-Type Rejection with Acute and Chronic Active Vascular Lesions at Entire Levels of the Renal Vasculature.

Matsumoto, Naoto / Kobayashi, Akimitsu / Yamamoto, Izumi / Tanno, Yudo / Koike, Yusuke / Miki, Jun / Kimura, Takahiro / Yamaguchi, Yutaka / Yamamoto, Hiroyasu / Yokoo, Takashi

Nephron

2020 Volume 144 Suppl 1, Page(s) 59–64

Abstract: Vascular lesions related to allograft rejection have a big impact on graft survival. As such, investigation of these lesions is important to understand the pathophysiology of rejection and its management. We report a case of kidney transplant graftectomy ...

Abstract	Vascular lesions related to allograft rejection have a big impact on graft survival. As such, investigation of these lesions is important to understand the pathophysiology of rejection and its management. We report a case of kidney transplant graftectomy by severe mixed-type rejection with acute and chronic active vascular lesions caused by non-adherence to immunosuppressive treatment. The patient presented is a 29-year-old male who received a kidney transplantation in July 2011 (ABO compatible) from his father. He then did not come to the hospital for 3 months prior to his admission and also made his own decision to stop his medication regimen. On October 2013, the patient came to the hospital with dyspnea, nausea, and vomiting and had significant renal dysfunction (serum Cr 30.4 mg/dL, BUN 191 mg/dL). A kidney graft biopsy showed cortical necrosis with severe interstitial hemorrhage and thrombotic microangiopathy (TMA). Despite steroid pulse therapy, kidney graft function did not recover, and the patient underwent a subsequent graft resection. The resected kidney graft displayed various vascular lesions from the renal artery to the interlobular arteries and arterioles including endarteritis, TMA, fibrinoid necrosis, and transplant arteriopathy. This case shows the detailed pathological findings of the vascular lesions in the entire artery tree of kidney allograft, and the pathophysiology is discussed.
MeSH term(s)	Adult ; Biopsy ; Graft Rejection/pathology ; Humans ; Kidney/blood supply ; Kidney/pathology ; Kidney Transplantation/adverse effects ; Male ; Renal Artery/pathology ; Thrombotic Microangiopathies/etiology ; Thrombotic Microangiopathies/pathology
Language	English
Publishing date	2020-11-20
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	207121-6
ISSN	2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
ISSN (online)	2235-3186 ; 1423-0186
ISSN	1660-8151 ; 0028-2766
DOI	10.1159/000512144
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In stock of ZB MED Cologne/Königswinter

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