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Submitted by Dulce Barreto (mdulce.barreto@chlc.min-saude.pt) on 2018-12-04T13:46:17Z No. of bitstreams: 1 Port J Nephrol Hypert 2018_32_85.pdf: 866308 bytes, checksum: de61365b3b783c44458827f629d828b1 (MD5) Made available in DSpace on 2018-12-04T13:46:17Z (GMT). No. of bitstreams: 1 Port J Nephrol Hypert 2018_32_85.pdf: 866308 bytes, checksum: de61365b3b783c44458827f629d828b1 (MD5) Previous issue date: 2018 info:eu-repo/semantics/publishedVersion

Nicolescu, V.-N., Carvalho, J., Hochbichler, E., Bruckman, V., Piqué-Nicolau, M.,Hernea, C., Viana, H., Štochlová, P., Ertekin, M., Tijardovic, M., Dubravac, T., Vandekerkhove, K.,Kofman, P.D., Rossney, D., Unrau, A. (2017). Silvicultural guidelines for European coppice forests.COST Action FP1301 Reports. Freiburg, Germany: Albert Ludwig University of Freiburg

The biodiversity–productivity relationship (BPR) is foundational to our understanding of the global extinction crisis and its impacts on ecosystem functioning. Understanding BPR is critical for the accurate valuation and effective conservation of biodiversity. Using ground-sourced data from 777,126 permanent plots, spanning 44 countries and most terrestrial biomes, we reveal a globally consistent positive concave-down BPR, whereby a continued biodiversity loss would result in an accelerating decline in forest productivity worldwide. The value of biodiversity in maintaining forest productivity—US$396–579 billion per year according to our estimation—is by itself over five times greater than the total cost of effective global conservation. This highlights the need for a worldwide re-assessment of biodiversity values, forest management strategies, and conservation priorities.

Submitted by Dulce Barreto (mdulce.barreto@chlc.min-saude.pt) on 2018-12-04T11:07:27Z No. of bitstreams: 1 Port J Nephrol Hypert 2016_30_153.pdf: 416867 bytes, checksum: f627b9e4565a45efd90523260ed3206b (MD5) Made available in DSpace on 2018-12-04T11:07:27Z (GMT). No. of bitstreams: 1 Port J Nephrol Hypert 2016_30_153.pdf: 416867 bytes, checksum: f627b9e4565a45efd90523260ed3206b (MD5) Previous issue date: 2016 info:eu-repo/semantics/publishedVersion

Oxalate Nephropathy is characterised by the presence of tubular crystalline deposits of calcium oxalate, which can lead to both acute and chronic tubular injury and progressive renal failure. Enteric hyperoxaluria is the most common cause of moderate hyperoxaluria; it occurs in conditions associated with fat or bile acid malabsorption, which include jejunoileal bypass and other bariatric procedures such as Roux‑en‑Y gastric bypass surgery. We present the clinical case of a 69‑year‑old man who was hospitalised for non‑oliguric renal dysfunction, with a serum creatinine of 10 mg/dl and normocytic normochromic anaemia. There was no prior history of renal disease. Twenty months before admission the patient was diagnosed with a gastro‑oesophageal junction adenocarcinoma and was treated with pre‑operative chemotherapy, followed by total gastrectomy, with a Roux‑en‑Y gastric bypass reconstruction. On discharge from gastric surgery, renal function was normal. On the first day of hospital stay haemodialysis was initiated. Over the following days, the rapid unexplained renal impairment was investigated, and this workup [2] included a kidney biopsy. Histological examination of the biopsy specimen revealed a predominantly interstitial nephropathy with tubular atrophy and interstitial fibrosis, with bright intra‑tubular calcium oxalate crystals in over 50% of the tubules and so the histological diagnosis was of oxalate nephropathy. Subsequently, no recovery of renal function was observed, so the patient is currently undergoing regular haemodialysis. Oxalate nephropathy is a rare but severe complication of Roux‑en‑Y gastric bypass surgery that can lead to a rapid progression to kidney failure. Although the treatment of obesity is the main indication for this surgery, this is also the preferred approach for gastrointestinal reconstruction after total gastrectomy for treatment of gastric carcinoma. Considering the rapid progression of oxalate nephropathy to kidney failure, patients who undergo Roux‑en‑Y gastric bypass surgery should have regular follow‑up of renal function. info:eu-repo/semantics/publishedVersion

Submitted by Dulce Barreto (mdulce.barreto@chlc.min-saude.pt) on 2018-12-04T11:01:34Z No. of bitstreams: 1 Port J Nephrol Hypert 2016_30_76.pdf: 620795 bytes, checksum: 5f01e51b3bd734e0c32c4399063472dc (MD5) Made available in DSpace on 2018-12-04T11:01:34Z (GMT). No. of bitstreams: 1 Port J Nephrol Hypert 2016_30_76.pdf: 620795 bytes, checksum: 5f01e51b3bd734e0c32c4399063472dc (MD5) Previous issue date: 2016 info:eu-repo/semantics/publishedVersion

Submitted by Dulce Barreto (mdulce.barreto@chlc.min-saude.pt) on 2018-12-04T11:54:41Z No. of bitstreams: 1 Port J Nephrol Hypert 2016_30_228.pdf: 1105259 bytes, checksum: c5079ffc0922dfaca191cf901918eacd (MD5) Made available in DSpace on 2018-12-04T11:54:41Z (GMT). No. of bitstreams: 1 Port J Nephrol Hypert 2016_30_228.pdf: 1105259 bytes, checksum: c5079ffc0922dfaca191cf901918eacd (MD5) Previous issue date: 2016 info:eu-repo/semantics/publishedVersion

Myeloma-associated renal disorders are rare events among renal transplants and can occur as recurrent or de novo disease. We describe an unusual case of renal allograft dysfunction due to myeloma cast nephropathy occurring 19 years after having received a renal transplant in a patient with no prior history of multiple myeloma or monoclonal gammopathy preceding transplantation. Our patient was treated with five cycles of chemotheraphy(bortezomib, melphalan and steroids), which resulted in short-term improvement in allograft dysfunction and complete haematological remission. The longer patient and graft survival after renal transplantation make post-transplant lymphoproliferative disease more frequent. Multiple myeloma after kidney transplant is rare and an elevated index of suspicion is necessary to make a timely diagnosis of this serious disease. Further work is needed to identify the best treatment options for these patients. info:eu-repo/semantics/publishedVersion

Background: Tubulointerstitial nephritis (TIN) is a common cause of kidney injury typically seen in association with drug exposure, infection or autoimmune diseases. However, TIN with interstitial immune complex deposition, without glomerular injury, is rarely observed. Case: We report a case of a 64-yearold Indian woman admitted for dialysis-requiring renal failure, without involvement of other organs. Urinalysis showed blood 3+ and 24h proteinuria of 1.5 g. Renal ultrasound revealed normal sized kidneys with loss of parenchymal-sinus differentiation. Laboratory tests disclosed low C3, positive ANA but negative anti-dsDNA, SSA and SSB. Serum protein electrophoresis was normal. The renal biopsy showed tubulointerstitial nephritis with positive immunoglobulin staining involving the interstitium and tubular basement membrane with glomerular sparing. The patient started prednisolone (1mg/kg/day) without recovery of the renal function. Conclusion: Idiopathic hypocomplementaemic tubulointerstitial nephritis is a rare disease with few cases described in the literature. To our knowledge this is the first case reported in Portugal A nefrite tubulo-intersticial (NTI) é uma causa comum de lesão renal, tipicamente associada a toma de fármacos, infecções ou doenças auto-imunes. No entanto, as NTI com deposição de imuno-complexos no interstício, sem envolvimento glomerular são raramente observadas. Apresentámos o caso de uma doente do sexo feminino, 64 anos, etnia indiana, admitida no nosso hospital, por insuficiência renal dependente de diálise. A análise sumária de urina revelou hematúria (3+) e a proteinúria nas 24h foi quantificada em 1,5g. A ecografia renal revelou rins de dimensões normais com perda da diferenciação parenquimo-sinusal. Analiticamente salienta-se, C3 baixo, ANA positivo, mas anticorpo anti dsDNA, SSA e SSB negativo. A electroforese de proteínas séricas não apresentava alterações. O doseamento de imunoglobulinas era normal, sem evidência de componente monoclonal. O restante estudo imunológico não apresentou alterações. Durante o internamento a doente realizou uma biópsia renal que mostrou nefrite tubulo-intersticial, com depósito de imunoglobulinas envolvendo o interstício e a membrana basal tubular, poupando os glomérulos. A doente iniciou terapêutica com prednisolona (1mg/Kg/dia), sem recuperação da função renal. A nefrite tubulo-intersticial hipocomplementémica idiopática é uma doença rara, com poucos casos descritos na literatura. Tanto quanto sabemos, este é o primeiro caso descrito em Portugal

Circulating anti-phospholipase A2 receptor antibodies (anti-PLA2R) have been described in 70% to 80% of the patients with idiopathic membranous nephropathy (iMN), but not in patients with secondary membranous nephropathy or other glomerular diseases. The goal of this study was to evaluate the sensitivity and specificity of the assay for anti-PLA2R in the diagnosis of iMN. Anti-PLA2R IgG, Elisa and immunofluorescence tests were used to detect circulating anti-PLA2R. These tests were applied in 53 patients who had a kidney biopsy. Of these, 38 had histological diagnosis of membranous nephropathy (MN) and the remaining had other glomerular diseases. The MN was classified as idiopathic in 33 patients after clinical exclusion of secondary causes. Anti-PLA2R were positive in 57.6% of the patients with iMN. All patients with secondary membranous nephropathy or other glomerular diseases did not show circulating anti-PLA2R. The sensitivity was 57.6% (CI 39.2-74.5) and specificity 100% (CI 47.8-100), AUC 0.788; p < 0.0001 for the detection of iMN. 71.4% of the iMN patients that tested negative for anti-PLA2R were in partial or complete remission. The detection of anti-PLA2R in the studied population had a specificity of 100% for the iMN diagnosis. Prior treatments seem to make the test negative and contribute to a lower sensitivity.

Introduction: The Henoch-Schönlein purpura (HSP) is an immunoglobulin A (IgA)-mediated smallvessel systemic vasculitis, rare in adults. The association with solid tumours has been described, especially with lung cancer. Case Report: We present the case of a 60-year-old Caucasian male, diagnosed with lung adenocarcinoma that underwent surgical resection without (neo)adjuvant theraphy. Two months latter he was admitted for abdominal pain, purpuric rash on his lower extremities and acute kidney injury, with serum creatinine (Scr) of 2 mg/dl. Urinalysis revealed haematuria and 24h proteinuria (P24h) of 1.5 g. The serum protein electrophoresis, complement components C3 and C4, circulating immune complexes, cryoglobulins, ANCA, ANA, anti-dsDNA and the remaining immunologic study as screening for viral infections (HCV, HBV and HIV) were negative. Renal ultrasound was normal and kidney biopsy revealed mild mesangial proliferation; 2 cellular glomerular crescents and 1 fibrinoid necrosis lesion; large amounts of red blood cell casts; lymphocytic infiltration in the intertubular interstitial capillaries; moderate arteriolar hyalinosis. Immunofluorescence demonstrated mesangial and parietal deposits of IgA. The diagnosis of HSP was assumed, and the patient started prednisolone 1 mg/kg/day. Ten months after diagnosis the patient’s baseline Scr is 1.4 mg/dl with P24h of 0.18g, without haematuria. Conclusion: Although this is a rare association and the exact mechanism behind the disease is yet unknown, physicians should be aware of it. The early recognition and treatment may prevent renal disease progression.

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2016-03-09T15:36:09Z No. of bitstreams: 1 RPNH 2015 248.pdf: 450396 bytes, checksum: e9826b6a897ebdcffbfcc9d99b5ddb9b (MD5) Made available in DSpace on 2016-03-09T15:36:09Z (GMT). No. of bitstreams: 1 RPNH 2015 248.pdf: 450396 bytes, checksum: e9826b6a897ebdcffbfcc9d99b5ddb9b (MD5) Previous issue date: 2015

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2016-01-26T16:41:58Z No. of bitstreams: 1 RPNH 2015 173.pdf: 336979 bytes, checksum: 14bc5d994cbaf22c5feb5647fe3c5a47 (MD5) Made available in DSpace on 2016-01-26T16:41:58Z (GMT). No. of bitstreams: 1 RPNH 2015 173.pdf: 336979 bytes, checksum: 14bc5d994cbaf22c5feb5647fe3c5a47 (MD5) Previous issue date: 2015

Wood modification by furfurylation depends on impregnation, so only some species can be treated and even so generally only sapwood samples can be used. Another question is that if the impregnation is not even the properties may vary along the board. The objective of this work was to determine the differences in the main wood properties along the treated board. Furfurylation was tested in maritime pine samples (Pinus pinaster Aiton,) with both sapwood and heartwood. Density, dimensional stability and water absorption by the water soaking method were determined. The differences between untreated and treated wood and also between treated heartwood and sapwood are high. Despite the higher density (and furfuryl content) near the sides of the board the differences along sapwood boards are very small. The authors would like to thank the Portuguese Foundation for Science and Technology (FCT) through the project PEst-OE/CED/UI4016/2011, and the Center for Studies in Education, Technologies and Health (CI&DETS). 4 4pp DE/NCE 2014 10-12 de março

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2015-04-29T16:18:35Z No. of bitstreams: 1 RPNH 2014 353.pdf: 1830201 bytes, checksum: f82c77d74a5615cdd8590964181c68ed (MD5) Made available in DSpace on 2015-04-29T16:18:35Z (GMT). No. of bitstreams: 1 RPNH 2014 353.pdf: 1830201 bytes, checksum: f82c77d74a5615cdd8590964181c68ed (MD5) Previous issue date: 2014

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2015-04-29T09:55:44Z No. of bitstreams: 1 RPNH 2014 168.pdf: 330492 bytes, checksum: a8e3272656187900d032746b1e6c1c79 (MD5) Made available in DSpace on 2015-04-29T09:55:44Z (GMT). No. of bitstreams: 1 RPNH 2014 168.pdf: 330492 bytes, checksum: a8e3272656187900d032746b1e6c1c79 (MD5) Previous issue date: 2014

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2015-04-29T16:10:29Z No. of bitstreams: 1 RPNH 2014 84.pdf: 2726889 bytes, checksum: 92751fc2b3125c82d5ff0ee097e441d3 (MD5) Made available in DSpace on 2015-04-29T16:10:29Z (GMT). No. of bitstreams: 1 RPNH 2014 84.pdf: 2726889 bytes, checksum: 92751fc2b3125c82d5ff0ee097e441d3 (MD5) Previous issue date: 2014

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2015-04-29T16:33:22Z No. of bitstreams: 1 RPNH 2013 309.pdf: 371116 bytes, checksum: f1726fd9aa6318de3426a29ce8b0893d (MD5) Made available in DSpace on 2015-04-29T16:33:22Z (GMT). No. of bitstreams: 1 RPNH 2013 309.pdf: 371116 bytes, checksum: f1726fd9aa6318de3426a29ce8b0893d (MD5) Previous issue date: 2013

Introduction. Peritubular capillary complement 4d staining is one of the criteria for the diagnosis of antibody-mediated rejection, and research into this is essential to kidney allograft evaluation. The immunofluorescence technique applied to frozen sections is the present gold-standard method for complement 4d staining and is used routinely in our laboratory. The immunohistochemistry technique applied to paraffin-embedded tissue may be used when no frozen tissue is available. Material and Methods. The aim of this study is to evaluate the sensitivity and specificity of immunohistochemistry compared with immunofluorescence. We describe the advantages and disadvantages of the immunohistochemistry vs. the immunofluorescence technique. For this purpose complement 4d staining was performed retrospectively by the two methods in indication biopsies (n=143) and graded using the Banff 07 classification. Results. There was total classification agreement between methods in 87.4% (125/143) of cases. However, immunohistochemistry staining caused more difficulties in interpretation, due to nonspecific staining in tubular cells and surrounding interstitium. All cases negative by immunofluorescence were also negative by immunohistochemistry. The biopsies were classified as positive in 44.7% (64/143) of cases performed by immunofluorescence vs. 36.4% (52/143) performed by immunohistochemistry. Fewer biopsies were classified as positive diffuse in the immunohistochemistry group(25.1% vs. 31.4%) and more as positive focal (13.2% vs. 11.1%). More cases were classified as negative by immunohistochemistry (63.6% vs. 55.2%). Study by ROC curve showed immunohistochemistry has a specificity of 100% and a sensitivity of 81.2% in relation to immunofluorescence (AUC: 0.906; 95% confidence interval: 0.846-0.949; p=0.0001). Conclusions. The immunohistochemistry method presents an excellent specificity but lower sensitivity to C4d detection in allograft dysfunction. The evaluation is more difficult, requiring a more experienced observer than the immunofluorescence method. Based on these results, we conclude that the immunohistochemistry technique can safely be used when immunofluorescence is not available.

Background: Acute kidney injury in the pandemic swine origin influenza A virus (H1N1) infection has been reported as coursing with severe illness, although renal pathogenic mechanisms and histologic features are still being characterised. Case Report: We present two patients admitted with H1N1 pneumonia, sepsis, acute respiratory distress syndrome and need for invasive mechanical ventilation who developed acute kidney injury and became dialysis-dependent. In both cases a kidney biopsy was performed to establish a definitive diagnosis. Severe acute tubular necrosis was identified, with no further abnormalities. Conclusion: This report seems to confirm that the acute kidney injury in H1N1 infection is focused on the tubular cells. Our cases corroborate the renal histopathologic findings of other studies, highlighting the central role of the tubular cell. We bring new evidence of the histopathology of AKI in H1N1 infection since our data were collected in living patients and not via post-mortem studies.

The present work analyses the suitability of existing and planned wood-fired power plant in Portugal according to the forest biomass resource available for use as energy. Following the European Union strategy in climate and energy, which aims the decrease of greenhouse gas emissions and increasing the share of renewable energies (wind, solar, biomass, etc) consumption, Portugal established, in a first commitment, that the production of electrical energy from renewable sources should reach 45 % of the total supply by 2010. Further to the EU’s "20-20­20" initiative, which set the objectives for 2020, the goal was increased to 60%. In order to fulfil this target, part of this energy will be obtained from biomass forest resources. Hence, in addition to the two existing electric power plants, with 22 MW of power capacity, 13 new power plants with 86.4 MW, are in construction. Despite the main goal is the electricity generation, the government incentive the construction of combined heating and power plants. Considering that wood-fuel demand will increase significantly across the different regions, it will be necessary to apply rational resource exploitation actions associated with regional and local needs. For example, there may be significant competition in some areas due to the presence of pulp mills or other biomass consuming industries. In these cases special solutions and compromises will be needed, or it may not be feasible to construct a power plant in such a location. This article evaluates if the biomass availability is sufficient to fulfil the future demands, considering two scenarios (fully condensing plants and cogeneration plants). The results show that if only electricity is generated some regions will need to find alternative fuel sources to fulfil the demand. However, if cogeneration is implemented the exiting wood fuel resource will be sufficient to fulfil the demand., Proceedings of the 19th European Biomass Conference and Exhibition, 6-10 June 2011, Berlin, Germany, pp. 228-234

Renal transplant in highly sensitised patients is associated with increased morbidity. The aim of this retrospective study was to evaluate the clinical evolution of 30 highly sensitised deceased donor kidney transplants and the influence of different timing of B cell directed treatment and its importance in the outcome of these patients. All recipients had negative complement dependent lymphocytotoxicity cytotoxic T cell crossmatch and no identified anti human leucocyte antigen class I donor specific antibodies. T cell flow crossmatch was performed within 24h of transplantation with serum obtained pretransplant (historic, recent or baseline). Posttransplant flow crossmatch were performed prospectively starting on the 3rd posttransplantation day. The immunosuppressive regime included thymoglobulin, tacrolimus, mycofenolate mofetil and steroids. Positive flow crossmatch occurred in 20/29 patients by the 3rd posttransplantation day, and in 17/27 patients after the 3rd posttransplantation day. All patients were started on intravenous immunoglobulin before transplantation: in nine patients (group A) at 400mg/kg/day for five days; in the remaining 21 patients (group B), as a continued infusion of 2g/kg during 48h. In group A, Rituximab was added only in the presence of antibody mediated rejection; in group B, introduced on the 3rd posttransplantation day whenever a positive flow crossmatch (with serum obtained pre or posttransplant) was reported. Antibody mediated rejection was observed in 44.4% of patients in group A, and 19% of those in group B. Mean follow-up was 12.2±5.5 months. Overall allograft survival was 76.6%, 81% in group B, and 66.6% in group A. At last follow up, mean serum creatinine was 1.3±0.6 mg/dl. Renal transplantation with pretransplant positive flow crossmatch is highly associated with antibody mediated rejection, despite introduction of intravenous immunoglobulin pretransplantation. However high dose intravenous immunoglobulin for 48h plus Rituximab by the 3rd posttransplantation day reduce the incidence of antibody mediated rejection by more than 50% and allowed for allograft survival of 81% at one year, with an excellent renal function.

Background: In the haemodynamically unstable patient the method of treatment of acute renal failure is still largely controversial. The purpose of our study was to compare slow extended dialysis with continuous haemodiafiltration in the critical patient with indication for renal replacement therapy and haemodynamic instability. Patients and Methods: This is a cohort study comparing in 63 ventilated critical patients a 12 month period when only continuous haemodiafiltration was used (n=25) with an equal period of slow extended dialysis (n=38). Our primary objective was to evaluate the impact of the dialytic procedure on cardiovascular stability in those patients. As secondary aims we considered system coagulation/thrombosis and predictors of mortality. In the two groups we analysed the first session performed, the second session performed and the average of all the sessions performed in each patient. Results: In these patients, mortality in the intensive care unit was high (68% in the continuous haemodiafiltration group and 63% in the slow extended dialysis group). We did not find any association between the dialytic technique used and death; only the APACHE score was a predictor of death. Slow extended dialysis was a predictor of haemodynamic stability, a negative predictor of sessions that had to be interrupted for haemodynamic instability, and a predictor of achieving the volume removal initially sought. Slow extended dialysis was also associated with less coagulation of the system. Conclusions: Our data suggested that slow extended dialysis use was not inferior to continuous haemodiafiltration use in terms of cardiovascular tolerability.

Polyomavirus nephropathy is a major complication in renal transplantation, associated with renal allograft loss in 14 to 80% of cases. There is no established treatment, although improvement has been reported with a variety of approaches. The authors report two cases of polyomavirus infection in renal allograft recipients. In the first case, a stable patient presented with deterioration of renal function, worsening hypertension and weight gain following removal of ureteral stent placed routinely at the time of surgery. Ultrasound examination and radiology studies revealed hydronephrosis due to ureteral stenosis. A new ureteral stent was placed, but renal function did not improve. Urinary cytology revealed the presence of decoy cells and polyomavirus was detected in blood and urine by qualitative polymerase chain reaction. Renal biopsy findings were consistent with polyomavirus -associated nephropathy. In the second case, leucopaenia was detected in an asymptomatic patient 6 months after transplantation. Mycophenolate mophetil dosage was reduced but renal allograft function deteriorated, and a kidney biopsy revealed polyomavirus -associated nephropathy, also with SV40 positive cells. In both patients immunosuppression with tacrolimus was reduced, mycophenolate mophetil stopped and intravenous immune globulin plus ciprofloxacin started. As renal function continued to deteriorate, therapy with leflunomide (40 mg/day) was associated and maintained during 5 and 3 months respectively. In the first patient, renal function stabilised within one month of starting leflunomide and polymerase chain reaction was negative for polyomavirus after 5 months. A repeated allograft biopsy 6 months later showed no evidence of polyomavirus nephropathy. In the second patient, polyomavirus was undetectable in blood and urine by polymerase chain reaction after 3 months of leflunomide treatment, with no evidence of polyomavirus infection in a repeated biopsy 6 months after beginning treatment.

Antiphospholipid syndrome nephropathy and lupus nephritis have similar clinical and laboratory manifestations and achieving the accuracy of diagnosis required for correct treatment frequently necessitates a kidney biopsy. We report the case of a 29-year-old woman referred to the nephrology service for de novo hypertension, decline of renal function and proteinuria. She had had systemic lupus erythematosus and antiphospholipid syndrome since the age of 21 and was taking oral anticoagulation. Two weeks later, after treatment of hypertension and achievement of adequate coagulation parameters, a percutaneous renal biopsy was performed. The biopsy revealed chronic lesions of focal cortical atrophy, arterial fibrous intimal hyperplasia and arterial thromboses, which are typical features of antiphospholipid syndrome nephropathy. We describe the clinical manifestations and histopathology of antiphospholipid syndrome nephropathy and review the literature on renal biopsy in patients receiving anticoagulation.

BACKGROUND: The major causes of renal transplant loss are death and chronic allograft dysfunction (CAD). The aims of this study were to determine the incidence of CAD in our population and the relation between allograft survival and immunosuppressive regimens. METHODS: We studied retrospectively 473 patients who received deceased donor kidney transplants with at least 1 allograft biopsy between January 1990 and May 2007. Clinical data included age, gender, biopsy data, and immunosuppression before and after kidney biopsy. Mean age was 45.4 +/- 12.7 years including 65% males with a mean follow-up of 6.7 +/- 4.5 years. CAD was observed in 177 of 473 biopsies: 48 patients showed interstitial fibrosis (IF); 101 chronic rejection (CR); 16 transplant glomerulopathy (TG); and 12, CR and TG. Mean follow-up since the discovery of the histologic feature was 60.5 +/- 50.5 months for IF; 38.3 +/- 40.8 for CR, and 18.2 +/- 19.2 for TG. RESULTS: CAD, which was more common in younger patients (P = .03), correlated upon univariate and multivariate analysis with CKD stage 5d development (P < .001). Deposition of C4d in peritubular capillaries was more frequent among CAD patients (P = .004), an association with particular relevance to recipients with CR (P = .02) and TG (P < .001). When we analyzed CAD subpopulation, we observed a positive correlation between allograft survival and immunosuppression modification after biopsy. Substitution of sirolimus (40/177) was shown in univariate, multivariate and Cox regression analyses to be a renal protector (P < .002). Allograft survival was also correlated with initial mycophenolate mofetil versus azathioprine, (62/177) immunosuppression (P < .001). CONCLUSION: CAD, a frequent histologic feature, may benefit from sirolimus conversion.

Aim: To characterise clinically the patients with C4d in peritubular capillaries deposits (C4dPTCD) and/or circulating anti-HLA class I/II alloantibodies. To determine the correlation between positive C4dPTCD and circulating anti-HLA class I/II alloantibodies during episodes of graft dysfunction. Subjects and Methods: C4d staining was performed in biopsies with available frozen tissue obtained between January 2004 and December 2006. The study was prospective from March 2005, when a serum sample was obtained at the time of biopsy to detect circulating anti-HLA class I/II alloantibodies. Results: We studied 109 biopsies in 86 cadaver renal transplant patients. Sixteen of these (14.7%) presented diffuse positive C4dPTCD. There was a 13.5% rate of +C4dPTCD incidence within the first six months of transplantation and 16% after six months (p>0.05). Half of the +C4dPTCD in the first six months was associated with acute humoral rejection. After six months, the majority of +C4dPTCD (n=7/8) was present in biopsies with evidence of interstitial fibrosis/tubular atrophy and/or transplant glomerulopathy. The C4dPTCD was more frequent in patients with positive anti-HCV antibodies(p

Introduction: The clinical importance of humoral-mediated acute rejection has been progressively recognised. Early recognition and treatment with plasmapheresis and intravenous immunoglobulin have recently improved short term prognosis. Case report: In this report we describe the clinical features of three 2nd transplant patients developing severe acute humoral rejection during the first week post-transplant while on anti-thymocyte globulin therapy. Treatment with plasmapheresis/ intravenous immunoglobulin/rituximab resulted in rapid reversal of oliguria,and recovery of renal function within the 1st week of treatment in 2/3 patients. Diagnosis was confirmed by graft biopsies revealing peritubular neutrophiles and C4d deposits. Sequential graft biopsies in all three patients revealed complete histological recovery within two weeks. One patient never recovered renal function, and one patient lost his graft at three months following hemorrhagic shock. After 2 years follow up, the remaining patient maintains a serum creatinine of 1.1mg/dl. Conclusion: The regimen using plasmapheresis plus intravenous immunoglobulin and rituximab was effective in rapidly reversing severe acute humoral rejection.

One of the most fundamental questions in ecology is how many species inhabit the Earth. However, due to massive logistical and financial challenges and taxonomic difficulties connected to the species concept definition, the global numbers of species, including those of important and well-studied life forms such as trees, still remain largely unknown. Here, based on global ground-sourced data, we estimate the total tree species richness at global, continental, and biome levels. Our results indicate that there are ∼73,000 tree species globally, among which ∼9,000 tree species are yet to be discovered. Roughly 40% of undiscovered tree species are in South America. Moreover, almost one-third of all tree species to be discovered may be rare, with very low populations and limited spatial distribution (likely in remote tropical lowlands and mountains). These findings highlight the vulnerability of global forest biodiversity to anthropogenic changes in land use and climate, which disproportionately threaten rare species and thus, global tree richness., Proceedings of the National Academy of Sciences of the United States of America, 119 (6), ISSN:0027-8424, ISSN:1091-6490

[EN] The identity of the dominant root-associated microbial symbionts in a forest determines the ability of trees to access limiting nutrients from atmospheric or soil pools, sequester carbon and withstand the effects of climate change. Characterizing the global distribution of these symbioses and identifying the factors that control this distribution are thus integral to understanding the present and future functioning of forest ecosystems. Here we generate a spatially explicit global map of the symbiotic status of forests, using a database of over 1.1 million forest inventory plots that collectively contain over 28,000 tree species. Our analyses indicate that climate variables—in particular, climatically controlled variation in the rate of decomposition—are the primary drivers of the global distribution of major symbioses. We estimate that ectomycorrhizal trees, which represent only 2% of all plant species, constitute approximately 60% of tree stems on Earth. Ectomycorrhizal symbiosis dominates forests in which seasonally cold and dry climates inhibit decomposition, and is the predominant form of symbiosis at high latitudes and elevation. By contrast, arbuscular mycorrhizal trees dominate in aseasonal, warm tropical forests, and occur with ectomycorrhizal trees in temperate biomes in which seasonally warm-and-wet climates enhance decomposition. Continental transitions between forests dominated by ectomycorrhizal or arbuscular mycorrhizal trees occur relatively abruptly along climate-driven decomposition gradients; these transitions are probably caused by positive feedback effects between plants and microorganisms. Symbiotic nitrogen fixers—which are insensitive to climatic controls on decomposition (compared with mycorrhizal fungi)—are most abundant in arid biomes with alkaline soils and high maximum temperatures. The climatically driven global symbiosis gradient that we document provides a spatially explicit quantitative understanding of microbial symbioses at the global scale, and demonstrates the critical role of microbial mutualisms in shaping the distribution of plant species., This work was made possible by the Global Forest Biodiversity Database, which represents the work of over 200 independent investigators and their public and private funding agencies (see Supplementary Acknowledgements), Supplementary information is available for this paper at https://doi.org/10.1038/s41586-019-1128-0.