CMV in Organ Transplantation
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This document summarizes key information about cytomegalovirus (CMV) infection in kidney transplant recipients. CMV is the most important viral infection following solid organ transplantation and can cause significant disease. The risk of CMV infection and disease depends on the CMV status of the donor and recipient. Strategies to prevent CMV include prophylactic antiviral treatment based on risk factors. Preemptive treatment using viral monitoring is also used. Ganciclovir and valganciclovir are effective therapies for both prophylaxis and treatment of CMV infection and disease in transplant patients.
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Human Immunodeficiency Virus (HIV) is an enveloped RNA virus that causes acquired immunodeficiency syndrome (AIDS). It belongs to the retrovirus family and there are two types, HIV-1 and HIV-2. HIV infects and destroys CD4+ T cells of the immune system, ultimately weakening the body's ability to fight infections and disease. Common routes of transmission include sexual contact, contaminated blood transfusions, and from mother to child during pregnancy, childbirth or breastfeeding. While antiretroviral treatment can slow the progression of the disease, there is currently no cure for HIV/AIDS.
Cytomegalovirus (cmv), the hidden enemy in liver transplantation 2015
Cytomegalovirus (CMV) is a common infection in liver transplant recipients that can cause direct tissue damage or indirect effects like rejection. It is transmitted from donor to recipient in 50-97% of transplant cases and reactivates due to immunosuppression. Prevention methods include preemptive antiviral therapy for high-risk patients based on viral load screening or prophylaxis for 3-6 months. Valganciclovir is commonly used but toxicity and late-onset infection are risks, especially in donor-positive/recipient-negative cases. Treatment involves reducing immunosuppression and antivirals like intravenous ganciclovir or valganciclovir for 2-6 months. CMV
Viral infections associated with immunosuppressive therapy edited
This document discusses viral infections that commonly affect transplant recipients who are immunosuppressed. It outlines the most frequent viruses seen, including CMV, EBV, BK polyomavirus, hepatitis viruses, herpes viruses, respiratory viruses, HIV. For each virus, it describes presentation, risk factors, diagnosis, and treatment recommendations. Prevention strategies like vaccination, antiviral prophylaxis and preemptive therapy are also discussed. The document emphasizes the increased risk of viral reactivation and infection in transplant patients receiving immunosuppression.
HIV.pptx
HIV is transmitted through sexual contact, blood exposure, and vertically from mother to child. It targets CD4+ cells. Children experience more rapid disease progression than adults, with half of untreated children dying within 2 years. Clinical manifestations in children commonly include failure to thrive, recurrent bacterial infections, and lymphocytic interstitial pneumonitis. Opportunistic infections indicate severe immune deficiency from HIV.
An overview of Hepatitis C infection
This document provides an overview of Hepatitis C infection. It discusses that HCV affects over 170 million people worldwide and is a major cause of liver disease. The virus has 7 major genotypes that vary in their genetic sequences. HCV enters liver cells and uses the host cell machinery to replicate. Most infections become chronic, which can lead to liver cirrhosis and cancer over time. Chronic infection is typically asymptomatic but can cause complications like liver damage and cancer. Effective treatments target the virus life cycle but a vaccine is still needed to control the global impact of HCV.
C.pptx hepatitis virus alkjflaj a kjsadkf ka fk
Hepatitis C virus (HCV) infection is the most common chronic blood-borne infection in the United States, affecting approximately 3.2 million people. Unlike hepatitis B, HCV patients almost always develop hepatocellular carcinoma (HCC) or liver cancer in the presence of cirrhosis. The annual risk of HCC for HCV patients with cirrhosis is 1-4%. HCV is a small RNA virus that replicates rapidly in liver cells and mutates frequently, making it difficult to treat. HCV is transmitted through blood exposure and infected mothers can pass it to their babies. While most HCV infections are asymptomatic, 75-85% of infections become chronic and 5-20% of those develop cirrhosis over 20-
Hiv
Human Immunodeficiency Virus (HIV) is an enveloped RNA virus that infects and destroys CD4+ T cells of the immune system. HIV belongs to the retrovirus family and has two types, HIV-1 and HIV-2. HIV replication involves binding to CD4 receptors on cells, integration into the host genome, and production of new virus particles. Infection progresses to AIDS as CD4 cells are depleted. There is currently no cure for HIV/AIDS, but treatment with antiretroviral drugs can suppress the virus and prolong life.
Hiv and surgeons
The document discusses HIV and precautions that surgeons should take. It covers topics like the types and structure of HIV, how it is transmitted through sexual contact, blood/bodily fluids, and from mother to child. It also discusses the virus's life cycle, clinical manifestations over time, and treatments. Regarding surgery, it emphasizes the importance of standard precautions like protective barriers, careful disposal of sharps and fluids, handwashing, and minimizing risk through deliberate technique. Emergency care requires similar protections due to unknown patient status.
The role of viral infection in the pathogenesis of post transplant malignancy...
The role of viral infection in the pathogenesis of post transplant malignancy...Mohamed Yassine Keniz
Viral infections are very common in kidney transplant recipients due to their immunosuppressed state. Herpesviruses like CMV are among the most frequent, while hepatitis B/C and BK virus also commonly infect transplant patients. The immunosuppression needed to prevent graft rejection also allows opportunistic viruses to cause disease and promotes reactivation of latent viruses. Certain viruses are directly oncogenic, such as EBV which can cause post-transplant lymphoproliferative disorder. Minimizing immunosuppression where possible can help reduce cancer risk in transplant recipients.MICRO-VIRALONCOGENESIS.pptx
Viruses can cause cancer through both direct and indirect mechanisms. Directly, some viruses encode oncogenic proteins that inactivate tumor suppressor genes like p53, leading to uncontrolled cell growth. Indirectly, chronic viral infections cause inflammation and oxidative stress that damage DNA over many years and increase cancer risk. Several viruses are known human carcinogens, including hepatitis B and C viruses, human papillomavirus, Epstein-Barr virus, human T-cell lymphotropic virus type-1, Kaposi's sarcoma-associated herpesvirus, and Merkel cell polyomavirus, which are associated with liver cancer, cervical cancer, lymphomas, sarcomas, and other cancers.
Approach to congenital cmv infection in newborn
This document provides an overview of congenital cytomegalovirus (CMV) infection. CMV is a herpesvirus that can be transmitted from mother to fetus. Approximately 40,000 infants are born with congenital CMV annually in the US, with 10-15% experiencing hearing loss. Symptomatic infants may experience jaundice, hepatosplenomegaly, or hearing loss at birth. Treatment involves antiviral therapy with ganciclovir or valganciclovir for symptomatic infants or those with hearing loss or central nervous system involvement to improve outcomes. Adverse effects require monitoring bloodwork during the recommended 6 month course of treatment.
Cytomegalo vrius
Cytomegalovirus (CMV) is a common virus. Once infected, your body retains the virus for life. Most people don't know they have CMV because it rarely causes problems in healthy people.
If you're pregnant or if your immune system is weakened, CMV is cause for concern. Women who develop an active CMV infection during pregnancy can pass the virus to their babies, who might then experience symptoms. For people who have weakened immune systems, especially people who have had an organ, stem cell or bone marrow transplant, CMV infection can be fatal.
CMV spreads from person to person through body fluids, such as blood, saliva, urine, semen and breast milk. There is no cure, but there are medications that can help treat the symptoms.
EBV and kidney transplant
1. Epstein-Barr virus (EBV) commonly infects B cells and epithelial cells and is the leading cause of post-transplant lymphoproliferative disorder (PTLD).
2. PTLD risk is highest in the first year after transplant and among EBV-negative recipients of organs from EBV-positive donors.
3. Treatment of PTLD involves reducing immunosuppression when possible, along with antiviral agents, immune globulin, monoclonal antibodies, and chemotherapy.
aids drugs.pptx
This document discusses various approaches to treating HIV/AIDS, including antiretroviral medications, screening and prevention of opportunistic infections, and management of comorbidities. It provides details on drug classes, individual drug mechanisms of action, guidelines for use, and recommendations for prophylaxis based on CD4 count. Lifestyle factors like vaccinations, lipid and diabetes screening, and smoking cessation are also addressed.
human papilloma virus_ 2023_LN.pptx
HPV is a double stranded DNA virus that can cause warts and cancers. It is categorized into low-risk HPVs that cause warts and high-risk HPVs linked to cancers like cervical cancer. HPV is commonly transmitted sexually and globally infects about 11.7% of people. Persistent infection with high-risk HPV types can lead to cancer through viral proteins that inactivate tumor suppressor genes. While most HPV infections clear naturally, vaccination is recommended to prevent infection and cancer.
Viral hepatitis c. corrected
A 45-year-old woman presents with fatigue, weakness, loss of appetite, and abnormal liver function tests. Laboratory results show elevated AST, ALT, bilirubin levels and positive tests for HCV antibody and RNA. A liver biopsy revealed severe inflammation and bridging fibrosis. The patient is diagnosed with chronic hepatitis C virus infection based on her history of blood transfusion, symptoms, laboratory abnormalities and biopsy findings. The best course of action is to treat her HCV infection with antiviral therapy to reduce liver damage and prevent progression to cirrhosis.
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Cytomegalovirus infection in critically ill patients: Focus on HSCT recipients
Cytomegalovirus infection in critically ill patients: Focus on HSCT recipients
Human cmv in immuncompromised and congential patients 2019
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Amacing
The AMACING trial studied 328 patients with an eGFR of 30-59 who received prophylactic hydration with 0.9% saline prior to intravascular iodinated contrast material to protect against contrast-induced nephropathy, compared to 332 controls who received no prophylactic hydration. The trial found comparable rates of contrast-induced nephropathy (2.7% vs 2.6%) but higher costs (€1455 vs €792 per patient) and complication rates (5.5% vs 0%) for the hydration group compared to controls. The trial concluded that prophylactic hydration was not superior to no hydration in protecting renal function in high-risk patients.
Amacing
The AMACING trial studied 328 patients with an eGFR of 30-59 who received prophylactic hydration with 0.9% saline prior to intravascular iodinated contrast material to assess whether it protects renal function compared to no hydration. The trial found contrast-induced nephropathy occurred in 2.7% of hydrated patients and 2.6% of non-hydrated patients, demonstrating hydration was not inferior. Hydrated patients experienced more complications like congestive heart failure and cost over €1500 per patient compared to no complications and under €1000 costs for non-hydrated patients.
TA-TMA
The document discusses hematopoietic stem cell transplantation (HSCT) associated thrombotic microangiopathy (TMA). TMA causes symptoms like elevated blood pressure, acute kidney injury with proteinuria, hemolysis, anemia, and thrombocytopenia. Causes of TMA include viruses, calcineurin inhibitors, sirolimus, chemotherapy, radiation, complement disorders, graft-versus-host disease, and abnormalities in cytokines and coagulation pathways. Treatment involves treating underlying infections, changing calcineurin inhibitors, using alternative agents for GVHD, and newer complement-based therapies.
HSCT-TMA
This document discusses hematopoietic stem cell transplantation (HSCT) associated thrombotic microangiopathy (TMA). TMA causes symptoms like elevated blood pressure, acute kidney injury, proteinuria, hemolysis, anemia, and thrombocytopenia. Causes of TMA include viruses, calcineurin inhibitors, sirolimus, chemotherapy, radiation, complement disorders, graft-versus-host disease, and coagulation abnormalities. Treatment focuses on altering graft-versus-host disease treatment, though data on therapies like plasma exchange is limited. Newer complement-based therapies also show promise.
TA-TMA
This document discusses hematopoietic stem cell transplantation (HSCT) associated thrombotic microangiopathy (TMA). TMA causes symptoms like elevated blood pressure, acute kidney injury, proteinuria, hemolysis, anemia, and thrombocytopenia. Causes of TMA include viruses, calcineurin inhibitors, sirolimus, chemotherapy, radiation, complement disorders, graft-versus-host disease, and coagulation abnormalities. Treatment focuses on altering graft-versus-host disease treatment, though data on therapies like plasma exchange is limited. Newer complement-based therapies also show promise.
TA-TMA
The document discusses hematopoietic stem cell transplantation-associated thrombotic microangiopathy (HSCT-TMA). HSCT-TMA can cause elevated blood pressure, acute kidney injury, proteinuria, hemolysis, anemia, and thrombocytopenia. It may be triggered by viruses, chemotherapy, radiation, graft-versus-host disease, complement disorders, cytokines, or coagulation pathways. Treatment focuses on altering graft-versus-host disease treatment and newer complement-based therapies as plasma exchange has no established benefit.
HSCT-TMA
This document discusses thrombotic microangiopathy (TMA) associated with hematopoietic stem cell transplantation. TMA can cause elevated blood pressure, kidney injury, proteinuria, hemolysis, anemia, and low platelet count. It is often caused by viruses like BK, CMV, adenovirus, HHV6/8, and parovirus B19, as well as medications like calcineurin inhibitors and sirolimus. Treatment focuses on altering graft-versus-host disease treatment since TMA is often linked to GVHD, cytokines, and coagulation pathway abnormalities, though data on therapies plasma exchange is limited.
Acute Kidney Injury in the Cardiac Surgery Patient
A recent review on risk factors, treatment and prevention of acute kidney injury in cardiac surgery unit.
Aki cticu final
1) Dr. SP has a 1.8% risk of needing dialysis after CABG surgery given his risk factors. Fluids such as lactated ringers are preferred over hetastarch if IV fluids are needed.
2) Risk factors for developing acute kidney injury after cardiac surgery include pre-existing chronic kidney disease, diabetes, older age, procedures with longer bypass or clamp times, low hematocrit during bypass, and transfusions of blood products.
3) Prevention strategies include optimizing volume status, avoiding nephrotoxins like NSAIDs, and considering off-pump surgery for high-risk patients. Treatment is largely supportive with fluid management and early use of renal replacement therapy if needed.
Primary hyperoxaluria and the Kidney
Primary Hyperoxaluria results from a genetic defect causing overproduction of oxalate by the liver. This leads to high oxalate levels in the urine and tendency to form calcium oxalate crystals in the kidneys. If untreated, it can progress to kidney failure and systemic oxalosis. The document discusses the various types of Primary Hyperoxaluria and recommendations for treatment including medications, dialysis optimization with daily or nocturnal hemodialysis, and combined kidney-liver transplantation as the definitive treatment.
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Journal Club:Stem cells and Kidney Transplantation
Mesenchymal stem cells have immunomodulatory properties and may provide benefits in kidney transplantation. A randomized controlled trial compared induction therapy with autologous mesenchymal stem cells to anti-IL-2 receptor antibody induction in living-related kidney transplant recipients. Patients receiving mesenchymal stem cells had lower rates of acute rejection and opportunistic infection within the first year, as well as better kidney function. No safety issues or compromises in graft survival were observed with mesenchymal stem cell treatment.
Proteinuria, A medical student prespective
A medical student rotating via Nephrology takes us via using a concept map as her understanding of proteinuria improved from her first encounter.
Journal Club:SuPAR and FSGS
suPAR is a circulating protein that is elevated in patients with FSGS. suPAR binds to and activates beta-3 integrin in podocytes, leading to foot process effacement and proteinuria. Studies found that suPAR levels correlated with beta-3 integrin activity in podocytes and were higher in recurrent FSGS post-transplant. Mouse models also demonstrated that suPAR induces albuminuria through beta-3 integrin binding. Blocking suPAR reduced proteinuria, improved morphology, and may be a potential treatment for suPAR-mediated glomerulopathy. However, further research is still needed to clarify the relationship between suPAR and human FSGS.
FGF-23 and Mortality in Dialysis patients- Journal Club
Elevated levels of fibroblast growth factor 23 (FGF23) are independently associated with increased risks of mortality and end-stage renal disease in patients with chronic kidney disease stages 2 through 4. A study of over 3,800 patients found that higher FGF23 levels predicted death and renal failure even after adjusting for factors like age, kidney function, phosphate, and parathyroid hormone. The relationship between FGF23 and mortality risk was consistent across all levels of FGF23 and kidney function stages. In contrast, parathyroid hormone and the calcium-phosphate product were not independently associated with mortality when accounting for FGF23.
Journal Club: Daily Corticosteroids Reduce Infection-associated Relapses in F...
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This randomized controlled trial examined the effectiveness of short-term daily prednisolone doses during infections to reduce relapse rates in patients with frequently relapsing nephrotic syndrome. The study found that the intervention group, who received daily prednisolone for 7 days during infections, had significantly fewer relapses over one year compared to the control group. Specifically, the intervention was associated with a 59% reduction in relapse rates. The number needed to treat was 6, meaning this intervention reduced relapse frequency to less than 3 per year for every 6 patients treated. Overall, short-term daily prednisolone during infections appears effective for reducing relapses in this patient population.Journal Club: Residual renal function
1) The CHOICE study examined the association between residual urine output and mortality, quality of life, and inflammation in 734 incident hemodialysis patients over 1 year.
2) Patients who produced at least 250cc of urine per day had lower all-cause and cardiovascular mortality compared to those with less urine output, both at baseline and at 1 year.
3) Higher urine output at baseline and 1 year was also associated with better quality of life and lower erythropoietin dose requirements.
Cystic disease of the kidney
There are many different types of kidney cysts that can be classified in various ways. An ideal classification system would take into account morphological features, pathogenesis, and therapeutic potential. Autosomal dominant polycystic kidney disease (ADPKD) is the most common cystic kidney disease and is characterized by multiple bilateral cysts of varying sizes in the kidneys and liver. It has a prevalence of 1 in 400 to 1,000 people and is caused by mutations in the PKD1 or PKD2 genes.
Viruses and the kidney
The document presents 12 cases of renal diseases caused by various viruses. It discusses the clinical presentation and pathology of each case and identifies the virus responsible. The viruses discussed are mostly DNA and RNA viruses, including HIV, HTLV-1, parvovirus B19, hepatitis C, cytomegalovirus, BK polyomavirus, Epstein-Barr virus, human herpesvirus 8, measles, mumps, adenovirus, coxsackie B virus, and influenza A. The document also notes trends in interstitial diseases being caused by certain viruses and outlines future research using viral microarrays to identify new viral causes of renal disease.
Hematuria post transplant
1) Retrospective studies have found the incidence of hematuria after kidney transplant to be higher than in the general population, around 12-13%, though the causes are generally similar.
2) Persistent hematuria after transplant has been associated with worse graft outcomes like failure, though not necessarily increased mortality.
3) Malignancies found in patients with persistent hematuria post-transplant have been located in the native urinary tract, not the transplant kidney. Longer hematuria duration increases cancer risk.
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Chapter 2
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