No abstract

This is a prospective cohort study in renal transplant patients who fasted or who did not fast for three consecutive Ramadans. The baseline estimated glomerular filtration rate (GFR), mean arterial pressure (MAP), and urinary protein excretion before the first Ramadan were compared to those after the third Ramadan in 35 fasters and 33 nonfasters. The effect of age, time after transplantation, presence of diabetes mellitus (DM), and proteinuria on changes in the GFR were studied. The two groups were comparable in gender, age, donor source, time posttransplantation, presence of DM, hypertension, proteinuria, serum creatinine, and MAP. Among the fasters, there was no change in estimated GFR after fasting for three Ramadans (56.4 mL/min versus 55.4 mL/min, P=0.8) even after adjusting for age, DM, baseline GFR, proteinuria, or time after transplantation. There were no significant differences between the fasters and the nonfasters in the changes in GFR, MAP, and urinary protein excretion between baseline and the third Ramadan.

In the presence of good allograft function, the majority of pregnancies in renal transplant recipients have a good outcome but with increased incidence of preeclampsia, reduced gestational age, and low birth weights. Patients with baseline serum creatinine of above 150 micromol/L have an increased risk of allograft dysfunction resulting from the pregnancy.

Background. In clinical practice, the glomerular filtration rate (GFR) is often estimated by the Modification of Diet in Renal Disease (MDRD) or Cockcroft-Gault (CG) formulae. No data are available, however, on the performance of these formulae in Arab individuals. Methods. Plasma creatinine samples were obtained from 90 consecutive normal Arab kidney donors for the estimation of GFR (eGFR) using the simplified MDRD and CG formulae. The GFR was measured in these donors with chromium labelled EDTA {[51Cr] EDTA). Bias was assessed by calculating the difference between the measured GFR and the calculated GFR using each of the two formulae; precision was calculated using the r value of the regression analysis. Results. The group studied consisted of 90 donors, of whom 64 were males (71%). The mean age was 30.8 years (± 9.8) and mean BMI was 25.7 (± 5.7). The measured GFR (mean 112.4 ± 17.5) correlated better with the calculated GFR by CG formula (mean 107.7 ± 29.7) and showed poor correlation with the GFR estimated by the MDRD (mean 89.2 ± 13.8); bias = 4.8 and 23.3, respectively (p = 0.1 and < 0.0001, respectively). The correlation with CG formula was better in males (bias = 2, p = 0.5) and those under 30 years of age (bias = 1.0, p = 0.9). Based on our data, we calculated a correction factor to the CG formula to improve the correlation with the measured GFR in Arab individuals. By multiplying the CG formula by 1.0446, the bias was reduced from 4.8 (p = 0.1) to 0.0 (p = 0.5) with an increase in precision from 0.2 (p = 0.05) to 0.43 (p = 0.0001). Using CG formula, the frequency for values within 30% of the mean of the measured value was 75%, which improved to 80% using the revised formula. Conclusions. CG formula was found to be the most appropriate for calculation of GFR in Arab individuals. It is possible to reduce the bias and improve precision in Arab individuals with normal renal function by multiplying the result obtained by CG formula by 1.0446.

Objectives: To investigate the predictive value of urinary neutrophil gelatinase-associated lipocalin in the occurrence of delayed graft function after kidney transplant. Materials and Methods: In this prospective cohort study of 67 consecutive patients who received a living-related (40 patients [61%]) or deceased-donor kidney transplant (27 patients [39%]), urinary neutrophil gelatinase-associated lipocalin was determined in the first 100 mL perfusate of the donor kidney and in urine at 6 hours after transplant. Patients were followed (11 ± 7 mo) for changes in estimated glomerular filtration rate and delayed graft function. Results: The mean urinary neutrophil gelatinaseassociated lipocalin level at 6 hours after transplant was significantly higher after deceased-donor (781 ± 452 ng/mL) than living-donor transplant (229 ± 223 ng/mL; P ≤ 0.001). The decrease in estimated glomerular filtration rate from 6 to 12 months after transplant was positively correlated with the urinary neutrophil gelatinase-associated lipocalin levels in the perfusate in living-donor transplant. A significant correlation was noted between the occurrence of delayed graft function and the urinary neutrophil gelatinase-associated lipocalin level at 6 hours after living-donor transplant. In the deceased-donor group, the occurrence of delayed graft function was correlated with urinary neutrophil gelatinase-associated lipocalin levels in the perfusate. In deceased-donor kidney transplant, the mean urinary neutrophil gelatinase-associated lipocalin level in the perfusion fluid was significantly greater from donors who had terminal serum creatinine > 150 μmol/L, and urinary neutrophil gelatinase-associated lipocalin level at 6 hours after transplant was significantly greater in transplants with longer cold ischemia time and donors who had hypertension. Conclusions: Urinary neutrophil gelatinase-associated lipocalin levels in the donor kidney perfusate and 6 hours after transplant may be a useful predictor of delayed graft function and decreased graft function from 6 to 12 months after transplant.