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Aim: Renal dysfunction is a common complication of cirrhosis, occurring either as part of multiorgan involvement in acute illness or secondary to advanced liver disease. To date, no study has comprehensively assessed multiple renal function parameters in hospitalized patients with cirrhosis through a multiparametric analysis of renal biochemistry markers. Methods: We conducted a retrospective, observational study including all consecutive patients hospitalized with cirrhosis who underwent a 43‐multiparametric renal function assessment between January 1, 2021, and June 30, 2023. Results: All patients showed at least one of the following renal abnormalities: Kidney Disease: Improving Global Outcomes stage G2 or higher, sodium and/or chloride excretion fraction <1%, electrolyte‐free water clearance <0.4 mL/min, or tubular maximum phosphate reabsorption capacity <0.8 mmol/L. The estimated glomerular filtration rate equations significantly overestimated the measured creatinine clearance with median differences of +14 mL/min/1.73 m2 (95% CI 6–29) and +9 mL/min/1.73 m2 (95% CI 2–15) for European Kidney Function Consortium equations, respectively. Notably, 54% and 39% of patients demonstrated estimated glomerular filtration rates exceeding 30% of the measured creatinine clearance when the Chronic Kidney Disease ‐ Epidemiology Collaboration and European Kidney Function Consortium formulas were employed, respectively. Substantial discrepancies in Kidney Disease: Improving Global Outcomes stage assignments were observed between the estimated glomerular filtration rate‐ and measured creatinine clearance‐based assessments. Conclusions: This study underscores the value of a multiparametric renal function assessment as a routine tool for evaluating renal function in patients with cirrhosis. A high prevalence of medically actionable renal abnormalities spanning multiple renal function modules, including alterations in glomerular function, salt and solute‐free water excretion, and proximal tubule phosphate reabsorption, has been demonstrated in hospitalized patients with cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Delayed graft function is a manifestation of acute kidney injury unique to transplantation usually related to donor ischemia or recipient immunological causes. Ischemia also considered the most important trigger for innate immunity activation and production of non‐HLA antibodies. While ischemia is inevitable after deceased donor transplantation, this complication is rare after living transplantation. Heterologous Immunity commonly used to describe the activation of T cells recognizing specific pathogen‐related antigens as well unrelated antigens is common post‐viral infection. In transplant‐setting induction of heterologous immunity that cross‐react with HLA‐antigens and subsequent reactivation of memory T cells can lead to allograft rejection. Methods: Here we describe a non‐sensitized child with ESRD secondary to lupus nephritis and recent history of COVID‐19 infection who experienced 17 days of anuria after first kidney living transplantation from her young HLA‐haploidentical uncle donor. Graft histology showed acute cellular rejection, evidence of mild antibody‐mediated rejection and vascular wall necrosis in some arterioles suggesting possibility of intraoperative graft ischemia. Both pre‐ and post‐transplant sera showed very high level of several non‐HLA antibodies. Results: The patient was treated for cellular and antibody‐mediated rejection while maintained on hemodialysis before her graft function started to improve on day seventeen post transplantation. Conclusion: The cellular rejection likely trigged by ischemia that activated T‐cells‐mediated immunity. The high level of non‐ HLA‐antibodies further aggravated the damage and the rapid onset of rejection may be partly related to memory T‐cell activation induced by heterologous immunity. [ABSTRACT FROM AUTHOR]

Anastaze Stelle K, Belli DC, Parvex P, Girardin E, Giroud A, Wildhaber B, McLin VA. Glomerular and tubular function following orthotopic liver transplantation in children treated with tacrolimus. Abstract: The aim of this study was to analyze the impact of TAC on medium term (three-yr follow-up) renal function in pediatric liver transplant (OLT) recipients. Glomerular and tubular indices were retrospectively analyzed in 24 consecutive OLT pediatric recipients on TAC. CrCl increased significantly each month post-OLT (p = 0.003), with a trend toward significance between pre-OLT and 36 months (p = 0.17). There was no correlation between CrCl and TAC troughs (p = 0.783). Sixteen percent of patients had CrCl <60 mL/min/1.73 m2 pre-OLT vs. none at 36 months post-OLT. TRP values were normal throughout the study. UPr/Cr decreased insignificantly over time and correlated significantly with TAC trough levels (p = 0.031). UCa/Cr values normalized by the third-month post-OLT, decreasing significantly over the time (p = 0.000) but did not correlate with TAC troughs. At three months post-OLT, 65.2% of patients needed antihypertensive therapy, and no patients needed more than one antihypertensive treatment after one yr. Despite nephrotoxic side effects in the early postoperative phase, this study shows that 65.5% patients had a normal renal function by three yr post-OLT. Tubular indices correlated with TAC trough levels. [ABSTRACT FROM AUTHOR]

Dagan A, Eisenstein B, Bar-Nathan N, Cleper R, Krause I, Smolkin V, Davidovits M. Tubular and glomerular function in children after renal transplantation. Pediatr Transplantation 2005: 9: 440–444. © 2005 Blackwell Munksgaard Glomerular and tubular function of transplanted kidneys were assessed in 46 children aged 15.7 ± 4.6 yr, 4.2 ± 2.8 yr after renal transplantation. There were 34 cadaveric, and 12 living-related donors. Twelve patients (26%) had acute episodes (acute tubular necrosis, rejection, or urinary tract infection) during follow-up. All patients were on triple immunosuppression. The mean serum creatinine was 1.5 ± 0.6 mg/dL. Creatinine clearance (Ccreat) calculated from a 24-h urine collection was 48.0 ± 19.7 mL/min/1.73 m2, and that estimated from the Schwartz formula, 61.0 ± 22.5 mL/min/1.73 m2. A positive correlation was found between the calculated and estimated clearances. Mean urine concentrating ability was 487 ± 184 mOsmol/kg, with a value lower than 400 mOsmol/kg in 35% of patients. There was a positive correlation between urine osmolality and estimated Ccreat. Metabolic acidosis (bicarbonate <22 mmol/L) was found in 41% of patients, with relatively alkaline urine and high chloride level. Fractional excretion (FE) of sodium was above 1% in 68% of patients (mean 1.66 ± 1.06%), and FEMg was above 3% (mean 10.9 ± 5.2%) in 93% of patients. Tubular reabsorption of phosphate (TP)/glomerular filtration rate (GFR) was 3.2 ± 0.8 mg/dL glomerular filtrate (GF). FEK, FEUA, and Ca/creatinine in urine were normal. There were no functional group differences between the cadaveric and living-related kidneys. Significant group differences were found in those with acute episodes and those with a normal course. Estimated Ccreat was 54 ± 20 vs. 67 ± 20 mL/min/1.73 m2 in the acute episodes and the normal course groups, respectively. Also, the FENA, FEUA, and FEMg were higher in the acute episodes group −2.3 ± 1.6, 10.6 ± 4.4, and 14.8 ± 6.5%, respectively, compared with the normal course group −1.4 ± 0.6, 8.2 ± 2.8, and 9.6 ± 4.0%, respectively. There were no between-group differences in plasma bicarbonate, FEK, TP/GFR, and urine osmolality. We believe that most, if not all tubular dysfunctions in the transplanted kidney are secondary to renal failure and interstitial damage from acute episodes and nephrotoxic drugs. These dysfunctions are similar to those in chronic renal failure, where interstitial fibrosis plays a role in kidney function deterioration. [ABSTRACT FROM AUTHOR]

Background Cigarette smoking accelerates progression of renal failure in diabetic and nondiabetic renal disease. Renal hemodynamics during smoking are characterised by a reversible decrease in glomerular filtration rate (GFR) and filtration fraction (FF) accompanied by increased renovascular resistance (RVR), systemic blood pressure, heart rate and plasma catecholamine concentrations. Materials and methods To further assess the role of sympathetic overactivity we compared the effects of different pharmacological interventions on smoking-induced changes of renal hemodynamics in occasional smokers. In a first series, placebo pretreatment plus smoking was compared to Prazosin pretreatment (3 mg) plus smoking. In a second study, placebo pretreatment plus smoking was compared to Atenolol pretreatment (50 mg) plus smoking. Results Basal blood pressure was significantly lower with Prazosin and Atenolol. On placebo, GFR and FF decreased significantly during smoking and RVR increased. With Prazosin pretreatment compared to placebo pretreatment no statistically significant differences for the changes of GFR, FF, RPF and RVR were seen. In contrast, with Atenolol pretreatment compared to placebo pretreatment, the smoking-induced changes in active renin, GFR and RVR were significantly smaller. Conclusion It is suggested that the acute renal hemodynamic effects of smoking are mediated, at least in part, via increased sympathetic activity operating mainly through beta-1 adrenergic mechanisms. [ABSTRACT FROM AUTHOR]