Plasma cell-rich acute rejection (PCAR) is associated with poor allograft outcome in renal transplantation. Previous studies report a graft half-life of six months after a single PCAR episode. However, the management of this condition is unclear. Intravenous immunoglobulin (IVIG) therapy, by virtue of its immunomodulating properties, and its influence on B-cell maturation into plasma cells, may be a good candidate for reversing this type of rejection. We report four episodes of PCAR in two patients who responded well to IVIG with improvement in renal function.

High-potassium diets have been shown to be beneficial in cardiovascular disease partly because of a blood pressure-lowering effect. The effect of potassium on inflammation has not been studied. We investigated the influence of potassium supplementation on the degree of renal inflammation and the intracellular signaling mechanisms that could mediate inflammation in chronic kidney disease (CKD). CKD was created in male SpragueDawley rats by subtotal nephrectomy. Two groups of CKD rats were pair fed with diets containing 2.1% potassium (potassium-supplemented diet) or 0.4% potassium (basal diet). Body weight, blood pressure, and blood and urine electrolytes were measured biweekly. The animals were euthanized at week 8, and the remnant kidneys were analyzed by histology, immunohistochemistry, Western blotting, and real-time quantitative PCR. In the CKD pair-fed groups, blood potassium concentration did not differ significantly, but blood pressure was lower in the potassium-supplemented group. Compared with the basal diet, potassium supplementation decreased renal tubulointerstitial injury and suppressed renal inflammation as evidenced by decreased macrophage infiltration, lower expression of inflammatory cytokines, and decreased NF-B activation. These renoprotective effects were associated with downregulation of renal transforming growth facto-␤, upregulation of renal Smad7, and lower blood pressure. Our results show that potassium supplementation can reduce renal inflammation and hence, could modulate the progression of kidney injury in CKD.NF-B; potassium; Smad7; TGF-␤ THE MEDIATORS OF PROGRESSIVE chronic kidney disease (CKD) remain largely unsolved, especially the mechanisms leading to progressive fibrosis of the kidney. The presence of fibrosis in the kidney is generally preceded by glomerular and tubulointerstitial infiltration by inflammatory cells. It is likely that the infiltrating inflammatory cells activate NF-B, leading to the production and release of proinflammatory cytokines and adhesion molecules (e.g., IL-1␤, ICAM-1) as well as profibrotic cytokines [e.g., transforming growth factor (TGF)-␤]. The consequence is renal inflammation and progressive fibrosis of the kidney, leading to loss of function. Treatment strategies have included medications and dietary modifications such as limitation of protein and sodium intake to reduce the accumulation of potential uremic toxins and blood pressure. The potential influence of potassium intake on progressive kidney disease remains largely unknown.There are indications that potassium supplementation may be beneficial in cardiovascular diseases, especially for problems arising as a complication of hypertension (7,17,20,27,38). There are also indications that potassium supplementation might reduce local vascular inflammatory reactions. Ishimitsu et al. (16) reported that potassium supplementation suppressed macrophage activity in stroke-prone spontaneously hypertensive rats (SHPsp). In their study, the rats were fed a normal or high-potassium diet, and excised aort...

In this group, transplantation did not confer a survival benefit. It is our hope that these initial data will serve as a platform for future studies. We suggest MGUS screening in all patients older than 50 yr of age undergoing evaluation for transplantation.

Daclizumab can decrease the incidence of acute rejection (AR) in renal transplant (RTx) recipients. In this prospective study, 52 RTx patients were divided into two groups according to the dose of daclizumab: 1 mg/kg on day 0 and every 14 days for five doses (group 1, n = 30) or a truncated regimen of 2 mg/kg on day 0 and on the day of discharge (group 2, n = 22). The following variables were recorded: demographics; delayed graft function; AR at 3, 6, and 12 months; time to AR; chronic allograft nephropathy (CAN); and serum creatinine. The overall incidences of AR were 23% and 27% (P = 0.76) in groups 1 and 2, respectively, whereas at 6 months they were 21% and 18% (P = 1.0). Median time to AR was 10 days in group 1 and 94 days in group 2 (P = 0.09). The incidence of CAN was 6.6% in group 1 and 13% in group 2 (P = 0.63). These data suggest that the truncated dose of daclizumab is as effective as the standard regimen for AR prophylaxis.