Search

Recurrence of focal segmental glomerulosclerosis (FSGS) is a major challenge in kidney transplantation. Several clinical factors, including initial steroid sensitivity, have been associated with increased post-transplant FSGS recurrence risk. However, conflicting data have been reported, possibly due to the heterogeneous pathophysiology of FSGS and the lack of genetic testing of FSGS patients. Further, the response to immunosuppressive therapies have not been evaluated. This study aimed to assess the risk factors for post-transplant recurrence in stringently selected patients based on a comprehensive clinicopathological evaluation and genetic testing. Fifty-nine patients aged 1–25 years at FSGS onset who underwent kidney transplantation between 2002 and 2018 were enrolled. Patients with secondary, familial, syndromic, and genetic FSGS and those who did not undergo genetic testing were excluded. Data from 15 kidney transplant recipients were analyzed. Nine (60%) patients experienced post-transplant FSGS recurrence, while six patients did not. The proportion of patients who achieved complete or partial remission with initial steroid and/or additional therapies with immunosuppressive agents and/or plasmapheresis was significantly higher in the FSGS recurrence group than the group without FSGS recurrence (P=0.04). In conclusion, this study suggests that the response to steroid treatment, other immunosuppressive agents, and/or plasmapheresis may predict post-transplant FSGS recurrence.

Silicone gel sheet treatment is widely used to treat hypertrophic scars and keloids since it is easily applied and prevents scar pain and itching. We used Cica-Care silicone gel sheets in the conservative treatment of six patients for 24 weeks and recorded pain, itching, redness, and scar elevation every 4 weeks. We also investigated the number of mast cells and Fas antigen expression in the lesional skin (one patient) before and after treatment. The pain and itching clearly decreased after 4 weeks of the silicone gel sheeting and disappeared after 12 weeks. Twelve weeks were required for a reduction in scar redness and elevation. After 24 weeks, a decrease in the number of mast cells and the enhanced expression of Fas antigen by lesional fibroblasts were observed. Thus, silicone gel sheeting is effective and safe, especially with more severe symptoms of pain and itching possibly induced by mediators derived from increased mast cells.

Vasoactive intestinal peptide (VIP), a potent systemic vasodilator, was recently identified in nerve fibers within the pulmonary arterial wall of cats and other mammals. We have investigated the smooth muscle relaxant action of VIP on isolated strips of kitten pulmonary artery that were placed in a 5-ml bath and precontracted with prostaglandin endoperoxide (PGH2) analogue. The action of VIP was compared with that of acetylcholine, isoproterenol, and prostaglandin E1 (PGE1). The effectiveness of VIP as a relaxant of pulmonary artery, measured as maximal relaxation and expressed in weight equivalents, was 29.9 +/- 2.0 X 10(-2) g in the presence of adrenergic and cholinergic blockers, or 28.8 +/- 4.5 X 10(-2) g in the absence of blockers. This relaxation was similar to that of acetylcholine (30.4 +/- 4.0 X 10(-2) g) and isoproterenol (26.4 +/- 2.2 X 10(-2) g), but smaller than that of PGE1 (41.1 +/- 3.7 X 10(-2) g). Judging by the EC50 or EC10 (effective concentration needed to develop 50 or 10%, respectively, of maximal relaxation), VIP was at least 40 times as potent as acetylcholine, 2,770 times as potent as isoproterenol, and 120 times as potent as PGE1, on a molar basis. The effect of VIP was unaltered in the presence of atropine, propranolol, or phenoxybenzamine in the incubation medium. The findings demonstrate the potent relaxant action of VIP in isolated pulmonary arterial strips and the independence of this action from cholinergic and adrenergic receptors. The results support the possibility that VIP may play an important role in regulating pulmonary vascular tone in kittens.