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Peripheral blood monocytes, which serve as precursors for tissue macrophages and dendritic cells (DC), play a key role in the immune response to kidney allograft, reparation processes and homeostasis regulation. In this prospective study, we used multicolor flow cytometry to monitor the phenotypic patterns of peripheral monocytes in subjects with uncomplicated outcomes and those with acute rejection. We found a reciprocal increase in the proportion of "classical monocytes" (CD14+CD16-) along with a decline in pro-inflammatory "intermediary" (CD14+CD16+) and "non-classical" (CD14lowCD16+) monocytes in subjects with normal outcomes. In subjects with acute rejection, we observed no reduction in "intermediary" monocytes and no increase in "classical" monocytes. Patients with uncomplicated outcomes exhibited downregulated HLA-DR in all three monocyte subpopulations. However, non-classical monocytes were unaffected in subjects with acute rejection. Expression of CD47 was downregulated after transplantation, while patients with antibody-mediated rejection and donor-specific antibodies showed higher pre-transplant values. In monocytes isolated at the time of biopsy, CD47 expression was higher in individuals with acute rejection compared to patients with normal outcomes one year post-transplant. Expression of CD209 (DC-SIGN) and the proportion of CD163+CD206+ subpopulations were upregulated during the first week after kidney transplantation. CD209 was also upregulated in samples taken on the day of biopsy confirming acute rejection. Our data demonstrate that kidney allograft transplantation is associated with phenotypic changes in peripheral blood monocytes during acute rejection. [ABSTRACT FROM AUTHOR]

M2 macrophages expressing CD163 are known to suppress immune responses but have been also found in biopsies of patients with chronic kidney allograft injury associated with interstitial fibrosis. The aim of our study was to evaluate the expression of CD163 in blood monocytes, precursors of tissue macrophages, in kidney allograft recipients with uncomplicated outcome (n=94) compared with those developing acute rejection (n=44). Blood samples were collected before the transplantation and at 1 week, 1 month and 1 year. The expression of CD163 increased during the first week after the transplantation not only in classical (CD14+CD16-) but also in intermediate (CD14+CD16+) and nonclassical (CD14lowCD16+) monocytes in all patients regardless of their rejection status. In patients developing acute rejection, higher pre-transplant expression of CD163 on blood monocytes was found. In vitro experiments confirmed strong induction of membrane CD163 on monocytes together with CD206 (an alternative marker of M2 macrophages) in response to IL-10. We assume from our data that dramatic upregulation of CD163 by peripheral blood monocytes may have a pathophysiological role in early phases after kidney allograft transplantation and high pre-transplant expression of CD163 on blood monocytes might be involved in events leading to acute rejection. [ABSTRACT FROM AUTHOR]

Transplantation is a method of choice for the treatment of irreversible chronic organ failure for patients who are able to undergo transplantation. Patient care in the early period after transplantation is a continuation of anesthesia care during the actual procedure. Immunosuppression is initiated immediately before, during or after transplantation. During the first week, most patients receive induction immunosuppression to prevent later rejection of the transplanted organ as well as antibiotic prophylaxis. In outpatient controls, in addition to the biochemical examination to monitor the condition of the transplanted organ, the level of immunosuppression and the imaging of the transplanted organ are also monitored. The main infectious complications od renal transplantation are particularly resistant urinary tract infections (hospital) strains, but pneumonia is also common. In the first year, opportunistic virosis, especially cytomegalovirus disease, should also be considered. Regular influenza vaccination may be considered essential. In addition to infections, patients more often suffer from skin tumors that are easy to detect, and in the Czech Republic also from renal cancer. Cardiovascular comorbidity is common, and its treatment is not different from other populations. However, the risk factors for atherosclerosis are more frequent and more intensive than in the general population because of the higher risk. [ABSTRACT FROM AUTHOR]

Chronic kidney disease is defined as abnormalities in renal function or structure present after more than 3 months, affecting health. Currently, the most common CKDs are diabetic nephropathy, hypertensive (ischemic) nephropathy, glomerular disease and hereditary nephropathy. Glomerular filtration (GFR) is generally accepted as the best marker of renal function, currently we use the GFR estimate of CKD‑EPI. Serum creatinine alone is not suitable for assessing renal function. Epidemiological data suggest the importance of albuminuria for cardiovascular disease, and albuminuria often precedes GFR decline. To assess chronic kidney disease, the ratio of albumin and creatinine concentrations in the morning urine sample should be investigated. The nephrologist should examine patients with eGFR <30 ml / min (<0.5 ml / s). Changing regulations on preventive examinations and follow‑up care aims to increase the detection of chronic kidney disease in high‑risk populations of diabetics and patients with cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Kidney transplantation represents a treatment of choice for end stage renal disease (ESRD) patients. ESRD is associated with several comorbidities and the long-term survival of patients treated with dialysis has been limited. The aim of pretransplant work-up in kidney transplant candidates is to eliminate surgical morbidity and mortality and to identify patients at risk for immunosuppression related diseases. In ideal situation, kidney transplantation should be performed just before the start of dialysis therapy. The evaluation of cardiovascular system and ischemic heart disease screening have been routinely performed before the placement on the waiting list, however, the benefit of this procedures have not been verified in prospective randomized trials. Urological work-up is important in anuric patients in whom disorders of lower urinary tracts are obvious with normal dieresis. Similarly, chronic infections should be treated before patient placement on the waiting list. Successfully treated malignancies have not represents the contraindication for transplantation if the patients wait for a defined period of time without the disease recurrence. After HLA antigen and panel reactive antibodies determination, patients are placed on the waiting list. The waiting time depends on blood group and HLA match. In the Czech Republic, patients wait for transplantation for about 1,5 years. When placed on the waiting list, patients should be routinely screened for concomitant diseases that may influence the outcome of kidney transplantation. [ABSTRACT FROM AUTHOR]

Purpose: This work investigated the effects of diuresis, duration of dialysis and age on lower urinary tract function in urologically healthy males on the waiting list for kidney transplant. Materials and methods: The study included all men who had kidney transplants at our centre between January 2009 and December 2014 who had normal urological findings prior to inclusion on the list. Diuresis, the duration of haemodialysis, age, and parameters of function of the lower urinary tract as determined by filling and voiding cystometry were evaluated. Results: The study included 127 men (median age, 59 years; median diuresis, 250 mL; median duration of dialysis, 469.5 days). We found that greater diuresis was accompanied by significantly higher FDV, FDV/Cmax, NDV, Cmax and compliance and by significantly lower Pdet.max, PdetQmax and BOOI. Longer duration of dialysis was accompanied by significantly lower FDV, NDV and Cmax, compliance and Qmax.p and with significantly higher Pdet.max, PdetQmax and BOOI. Older age was associated with significantly higher Pdet.max and with significantly lower compliance. Worsening of the basic parameters of the storage function of the lower urinary tract occurred when diuresis decreased to 500-750 mL, when the duration of dialysis was one year and when patients were older than 54 years. Conclusion: In healthy male patients on the waiting list for kidney transplant, there were connections between the occurrence of dysfunctions of the lower urinary tract and diuresis, duration of dialysis and age. Patients should be monitored for dysfunctions of the lower urinary tract before and after transplantation. [ABSTRACT FROM AUTHOR]