Contraception in Chronic Kidney Disease and Renal Transplantation

Schmidt, Elizabeth O.; Pachtman, Sarah; Diedrich, Justin T.

doi:10.1007/978-3-030-25324-0_16

Cited by 3 publications

(5 citation statements)

References 72 publications

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“…Implant site infection and foreign body response including fibrous encapsulation are important considerations for any implant. In the clinic, various implants have been found safe and effective in chronically suppressed SOT recipients, including cochlear implants (99,100), various joint replacement surgeries (101)(102)(103)(104), mesh hernia repair (105), breast reconstruction (106), permanent pacemakers (107), dental implants (108), and both subcutaneous contraceptive implants (109) and intrauterine devices (110)(111)(112). Translation of the scaffold implant to the clinic will likewise involve preclinical assessment of the implant parameters, including surface topography (113), to coordinate prevention of fibrous encapsulation with timing of scaffold residence and biopsy for immunosurveillance in extended tempos of rejection relative to the murine models used in this study.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers from subcutaneous engineered tissues predict acute rejection of organ allografts

Urie,

Morris,

Farris

et al. 2024

Sci. Adv.

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Invasive graft biopsies assess the efficacy of immunosuppression through lagging indicators of transplant rejection. We report on a microporous scaffold implant as a minimally invasive immunological niche to assay rejection before graft injury. Adoptive transfer of T cells into Rag2 −/− mice with mismatched allografts induced acute cellular allograft rejection (ACAR), with subsequent validation in wild-type animals. Following murine heart or skin transplantation, scaffold implants accumulate predominantly innate immune cells. The scaffold enables frequent biopsy, and gene expression analyses identified biomarkers of ACAR before clinical signs of graft injury. This gene signature distinguishes ACAR and immunodeficient respiratory infection before injury onset, indicating the specificity of the biomarkers to differentiate ACAR from other inflammatory insult. Overall, this implantable scaffold enables remote evaluation of the early risk of rejection, which could potentially be used to reduce the frequency of routine graft biopsy, reduce toxicities by personalizing immunosuppression, and prolong transplant life.

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Section: Discussionmentioning

confidence: 99%

Biomarkers from subcutaneous engineered tissues predict acute rejection of organ allografts

Urie,

Morris,

Farris

et al. 2024

Sci. Adv.

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“…Moreover, start of menstruation cycle is considered as one of the major advantages of kidney transplant women of reproductive age. Patients with stable creatinine level are even more likely to attain normal menstruation cycle within six months [6].…”

Section: Discussionmentioning

confidence: 99%

“…In CKD, other organ functions are also highly affected. In females, irregular pattern of menstruation has been reported in 66% to 80% of the women, leading to either amenorrhea, polymenorrhea, oligomenorrhea or heavy menstrual bleeding [3][4][5][6]. In the end stage renal disease (ESRD), the pulsatile secretion of gonadotropin releasing hormone (GnRH) is affected, eventually results in loss of release of luteinizing hormone (LH) and causing anovulation [7][8][9].…”

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confidence: 99%

Pattern of menstrual cycle after kidney transplant in reproductive women

Khan¹,

Hamid²,

Rashid

et al. 2021

RJTAO

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Background. In reproductive women, transplant disturbs the menstrual cycle pattern. The two major conditions usually encountered are amenorrhea and menorrhagia.The objective of the study was to assess the pattern of menstrual cycle after kidney transplant in reproductive women.Materials and methods. This cross-sectional study was carried out in a public sector hospital of Karachi, Pakistan. A total 69 patients of reproductive age were included who underwent living kidney donor transplant for more than a year ago. Women having genital tract infection, using hormonal treatment, organic cause of genital tract, clotting disorder and severe cardiac and/ or peripheral vascular disease were excluded. Frequency and percentages were calculated for demographic characteristics. Correlation and association analysis was calculated for type of menstruation with menstrual cycle pattern. A P-value less than 0.05 was considered statistically significant.Results. Majority of female included in the study aged between 35–39 years (36, 52.2%). The most frequent menstrual disturbance observed was heavy menstrual bleeding (22, 31.9%) and amenorrhea (21, 30.4%). Only 2.9% cases showed normal menstrual pattern. The cross tabulation indicated that 26.1% patients had amenorrhea, 24.6% had oligomenorrhea and 31.9% had menorrhagia. The Durbin–Watson value of 0.656 indicated a strong positive relationship between menstruation cycle pattern (dependent variable) and type of menstruation, marital status, donor’s age, children and living location of the patients (independent variables).Conclusion. From the result of the present study, it is concluded that the reproductive age women have shown a disturbed pattern of menstrual cycle after kidney transplant. The major observation was that such patients reported amenorrhea, menorrhagia, oligomenorrhea and hypomenorrhea.

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“…56 For instance, with the progestin-only intrauterine device, injectable, and subdermal implant, some individuals experience a cessation of bleeding after months to a year of use despite initially having irregular and/or heavy bleeding. 53,[56][57][58] The combined oral contraceptive pill, transdermal patch, and vaginal ring can also regulate bleeding, and if used continuously without hormone-free weeks (i.e., long/extended-cycle use), they can prevent uterine bleeding and related symptoms. 57,59 It is important to note, however, that estrogen-containing options increase thrombotic risk.…”

Section: Kidney Disease and Abnormal Uterine Bleedingmentioning

confidence: 99%

“…59 Tranexamic acid, danazol therapy, gonadotropinreleasing hormone agonists, and nonsteroidal antiinflammatory medications are additional treatment options, though risks and timelines of use must be assessed carefully in the context of CKD, especially with the latter. 56 Though abnormal uterine bleeding is prevalent in the context of kidney disease, a study consisting of largely pediatric nephrologists from the United States and Puerto Rico reported that almost 90% were not at all confident/somewhat confident in managing abnormal uterine bleeding. 45 In addition, in a study of adult nephrologists from the United States and Canada, more than 65% of the respondents reported a lack of confidence in women's health issues, including menstrual disorders, 60 whereas only 15% reported discussing menstrual irregularities with their patients.…”

Section: Kidney Disease and Abnormal Uterine Bleedingmentioning

confidence: 99%

Female Reproductive and Gynecologic Considerations in Chronic Kidney Disease: Adolescence and Young Adulthood

Chang

Dumanski

Ahmed

2022

Kidney International Reports

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Chronic kidney disease (CKD) increasingly affects younger people, including adolescents and young adults. CKD among females is accompanied by unique reproductive and gynecologic health concerns; though to date, this area has not been well studied. Hormonal disruptions attributed to CKD may underlie the high prevalence of abnormal uterine bleeding and influence the age of menarche in adolescents. Period poverty as a socioeconomic barrier further exacerbates the female-specific burdens of CKD. Reduced fertility in CKD is likely multifactorial and may be related to a reduction in ovarian reserve, reproductive hormone disturbances, and gonadotoxic medication use in addition to low sexual function and activity. Fertility, sexual function and activity, and risk of sexually transmitted infections increase with transplantation. Pregnancy is possible at any stage of CKD, although often accompanied by high risks of maternal and fetal complications. Contraception is thus an important consideration in CKD, but use is low and the risks and benefits of different forms in the setting of CKD are not well characterized. Though patients with CKD report reproductive health as an important element of care, many nephrologists report lack of confidence and training in this area, highlighting the need for targeted research and education. The unique reproductive health care needs of the growing transgender youth population warrant attention in nephrology training with multidisciplinary input. This review will discuss female reproductive health and gynecologic considerations in adolescents and young adults with CKD while proposing clinical and research strategies to improve this understudied yet important aspect of kidney care.

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Contraception in Chronic Kidney Disease and Renal Transplantation

Cited by 3 publications

References 72 publications

Biomarkers from subcutaneous engineered tissues predict acute rejection of organ allografts

Biomarkers from subcutaneous engineered tissues predict acute rejection of organ allografts

Pattern of menstrual cycle after kidney transplant in reproductive women

Female Reproductive and Gynecologic Considerations in Chronic Kidney Disease: Adolescence and Young Adulthood

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