Myocardial remodeling after kidney transplantation: a case report

Abstract

BackgroundLupus nephritis (LN) is one of the most common manifestations of systemic lupus erythematosus (SLE) and is often the most serious organ complication and the cause of premature death of such a patient. Most of other organs and systems can be also affected. A typical complication is a cardiovascular involvement leading to the development of heart failure. According to current therapeutic standards, kidney transplantation is the treatment of choice in patients with renal failure in course of LN. On the contrary, a kidney transplantation in a patient with an additional heart disease poses a serious clinical challenge.Case presentationWe present a case of a 49-year-old woman with renal and heart failure following a long-term SLE prepared for kidney transplantation. During the SLE course, the function of the heart and kidneys gradually deteriorated. The patient required the initiation of renal replacement therapy and was dialyzed until a kidney transplantation for 4 years. In the preparation of the patient for the surgical procedure, due to the extremely low ejection fraction, it was decided to include cardioprotective treatment with Levosimendan. The postoperative period was not straightforward but successful. In the monthly and five-month follow-up, a continuous improvement of heart function with normal renal function was noted.ConclusionsKidney transplantation in patients with lupus suffering from heart failure requires the involvement of a team of specialists. Patients with extremely low ejection fraction in the perioperative period should undergo careful hemodynamic supervision in the intensive care unit. Cardioprotective and thus nephroprotective Levosimendan therapy together with optimal fluid and hemodynamic therapy in the peri-transplant period may be a bridge for heart remodeling after kidney transplantation.

Echocardiographic evaluation of myocardial structural and functional changes in patients with stage 5 chronic kidney disease before and after kidney transplantation

“…Ранее в исследовании М. Łukaszewski et al (2018) было показано, что у пациентов с ХБП С5 и сердечно-сосудистыми заболеваниями (ССЗ) существует повышенный риск смерти по сравнению с общей популяцией [3].…”

“…По сравнению с гемодиализом (ГД), преимуществом ТП является нормализация ССС за счет ремоделирования миокарда с улучшением систолической функции. ТП положительно влияет на эластичность аорты, что снижает постнагрузку ЛЖ и, возможно, является одним из основных механизмов, поддерживающих обратное ремоделирование ЛЖ [3]. По данным T. Zapolski et al (2019) успешная ТП у больных с уремической кардиомиопатией инициирует процесс ремоделирования ЛП.…”

The atrial uremic cardiomyopathy regression in patients after kidney transplantation – the prospective echocardiographic study

“…It has been shown that regression of kidney failure after the transplantation procedure improves cardiac function in patients with congestive cardiomyopathy and long period of dialysis [11]. An important benefit of the KTx is cardiovascular improvement due to myocardial remodeling with improved systolic heart function [12]. The KTx also positively affects the elasticity of the aorta, which reduces the left ventricle afterload and perhaps it is one of the basic mechanisms supporting reverse remodeling of the left ventricle [13].…”