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Patients infected with human immunodeficiency virus (HIV) have long been considered unsuitable candidates for solid organ transplantation due to their poor prognosis. After the introduction of combination antiretroviral therapy, the survival of this group of patients improved significantly. HIV positive patients had been successfully transplanted for the last 18 years. HIV positive patients encounter very specific issues after transplantation, specifically related to drug interactions and higher rejection rates. Despite that, HIV positive patients have similar results to HIV negative patients post transplantation. We present the case of the first kidney transplantation in an HIV positive patient in Slovakia. The procedure was possible due to a change in legislation, as HIV positivity was an absolute contraindication for transplantation in Slovakia until October 2023. The aim of our case report is to draw attention to the possibility of kidney transplantation in an HIV positive patient and to the specific problems related to the preparation of an HIV positive patient for transplantation, post-transplant complications and the possibilities of their management (Fig. 6, Ref. 37). Text in PDF www.elis.sk [ABSTRACT FROM AUTHOR]

This in vivo study performed in rat adjuvant arthritis aims to advance the understanding of astaxanthin's therapeutic properties for the possible treatment of rheumatoid arthritis (RA) in monotherapy and along with the standard RA treatment, methotrexate (MTX), in combination therapy. The main goal was to elucidate astaxanthin's full therapeutic potential, evaluate its dose dependency, and compare its effects in monotherapy with other carotenoids such as β-carotene and β-cryptoxanthin (KXAN). Moreover, potential differences in therapeutic activity caused by using different sources of astaxanthin, synthetic (ASYN) versus isolated from Blakeslea trispora (ASTAP), were evaluated using one-way ANOVA (Tukey-Kramer post hoc test). KXAN was the most effective in reducing plasma MMP-9 levels in monotherapy, significantly better than MTX, and in reducing hind paw swelling. The differences in the action of ASTAP and ASYN have been observed across various biometric, anti-inflammatory, and antioxidative parameters. In combined therapy with MTX, the ASYN + MTX combination proved to be better. These findings, especially the significant anti-arthritic effect of KXAN and ASYN + MTX, could be the basis for further preclinical studies. [ABSTRACT FROM AUTHOR]

Conn's syndrome, defined as unilateral aldosterone-producing adenoma, accounts for 35-40% of cases of primary hyperaldosteronism. Primary hyperaldosteronism typically occurs in younger patients with poorly controlled arterial hypertension due to extracellular fluid retention, in whom at least a triple combination of antihypertensives, including a diuretic, is needed to maintain normotension. The clinical picture of arterial hypertension may be complemented by symptoms associated with hypokalaemia, such as weakness, fatigue, palpitations, convulsions, polydipsia, or polyuria. In addition to arterial hypertension and hypokalaemia, the diagnosis of Conn's syndrome relies on examination of serum renin and aldosterone concentrations, plasma renin activity, exercise or furosemide stimulation tests, and imaging studies, preferably computed tomography. The method of treatment of Conn's syndrome is adrenalectomy. In patients with primary hyperaldosteronism with underlying bilateral adrenal cortical hyperplasia or patients contraindicated for surgery, mineralocorticoid receptor antagonists are administered in combination with antihypertensives targeted for optimal blood pressure control. In the group of patients after kidney transplantation, the exact incidence of primary hyperaldosteronism is unknown. Based on a cross-sectional study performed in 2020, it is estimated to be approximately 15% in the group of patients with unsatisfactorily compensated arterial hypertension; in the cohort of normotensive recipients, the incidence of primary hyperaldosteronism is not documented. Diagnosis of Conn's syndrome in patients in the early period after kidney transplantation is problematic, as the prevalence of arterial hypertension in transplanted patients is high (70-90%) according to the literature. Mineral abnormalities, including hypokalaemia, are also common in the early post-transplant period, mainly due to factors such as duration of cold ischaemia, onset of graft function, donor parameters, post-transplant tubulopathy, and diuretics, the effects of immunosuppressive drugs (especially calcineurin inhibitors and corticosteroids), and possibly potassium-restricted dietary habits that the patient brings from the pre-transplant period, which may mask the effect of hyperaldosteronism on potassium. We present the case of a patient who was diagnosed with Conn's syndrome 7 months after primary kidney transplantation from a deceased donor based on persistent hypokalaemia unresponsive to replacement therapy. At the time of the first manifestation of severe hypokalaemia, the patient was treated with a dual combination of antihypertensives (amlodipine at a daily dose of 5 mg and carvedilol at a daily dose of 50 mg), without the need for a diuretics. We consider the case interesting because the spectrum of mineral and acid-base abnormalities in advanced renal failure and in the early post-transplant period, as well as acid-base and mineral imbalances, including hypokalaemia, and the high prevalence of arterial hypertension in the post-transplant period, may mask the picture of Conn's syndrome. [ABSTRACT FROM AUTHOR]

The gut microbiome (GM) of rheumatic arthritis (RA) patients is often altered in composition and function. Moreover, methotrexate (MTX), one of the most frequently used disease-modifying antirheumatic drugs, is known to negatively affect GM composition. The modulation of immune system activity is one of the therapeutic benefits of probiotics. The aim of the current investigation was to determine the impact of MTX therapy combined with one of the Lactobacillus strains, Lactoplantibacillus plantarum LS/07 (LB), on adjuvant arthritis (AA) in rats. Methods focused on biometric and inflammatory parameters in AA, particularly on plasmatic levels of IL-17A, MMP-9, and MCP-1, and the activities of gamma-glutamyl transferase in the spleen and joints were applied. Enhancing the effect of MTX, LB positively influenced all biometric and inflammatory parameters. The findings of the present study may be of help in proposing novel therapeutic strategies for RA patients. [ABSTRACT FROM AUTHOR]

In this study we investigated the potential antioxidant effect of carnosic acid and its combination with methotrexate (MTX) on mRNA expression of catalase (CAT) and heme oxygenase 1 (HO-1) in the liver as key parameters of oxidative stress in rat adjuvant arthritis (AA). We also examined arthritic score (AS) as representative clinical parameter monitored in this animal model. MTX was administrated in a subtherapeutic dose twice a week of 0.3 mg/kg b.w. The carnosic acid (CA) was administered daily in a dose of 100 mg/kg b.w., alone and in combination with MTX (CA+MTX). CA and MTX were administrated orally by gastric gavage. Plasma samples were collected on the 28th experimental day and used for PCR determination. The 28th experimental day was also used for AS analysis. We observed a significant decrease of CAT expression in the liver in the nontreated AA animal group, which indicated successful induction of AA. In MTX and CA groups, we did not observe any significant increment of CAT, but in the group with combination therapy, there was a significant increase of CAT expression compared to the AA group and to the MTX group itself. Expression of HO-1 was significantly increased in the AA group compared to the control group. MTX and CA groups did not significantly improve the levels of HO-1, but in CA+MTX we observed a significant decrease compared to the AA group. In the clinical parameter AS, we observed a very similar result as with markers of oxidative stress, meaning that CA+MTX was the only group that significantly lowered AS compared to the AA group. Monotherapy with CA as well as with MTX had no significant effect in our experiment on all evaluated parameters. Combination of CA and MTX has been proven to be more efficient than MTX in monotherapy, which might have promising effects in reducing side effects of MTX treatment by lowering the dose of MTX. [ABSTRACT FROM AUTHOR]

During rheumatoid arthritis (RA), there is a shift in redox balance. Natural compounds play a major role as an adjuvant in reducing the symptoms of RA. In this study we evaluated the effect of carotenoids (astaxanthin, beta-carotene, and beta-cryptoxanthin) in monotherapy or in combination therapy with methotrexate (MTX) on clinical parameters during adjuvant arthritis (AA). Male Lewis rats were divided into 8 groups. The AA was induced by an injection of Mycobacterium butyricum into the base of the tail. The clinical data were assessed every 7 days until the 28th day. MTX was administrated twice a week (0.3 mg/kg of body weight). Synthetic astaxanthin (ASYN, 20 mg/kg) and natural astaxanthin (ASTAP, 20 mg/kg, source: Blakeslea trispora) were both administrated alone and in combination with MTX. Dosage of beta-carotene was 20 mg/kg and of beta-cryptoxanthin was 10 µg/kg. Administration per os was used. In amelioration of the weight loss caused by arthritis we observed that combination of both astaxanthins with MTX was more effective as MTX alone. Further all carotenoids improved this parameter also in monotherapy. ASTAP had the highest effect. In the most important clinical outcome--changes of the hind paw volume--were all carotenoids effective excluding beta-carotene and ASYN. In conclusion, carotenoids could be a prospective addition to RA therapy. Further evaluation of inflammation and oxidative stress should be aimed. [ABSTRACT FROM AUTHOR]

Recurrence of the primary disease is one of the most common causes of graft failure in the first decade after kidney transplantation. We present a case of a patient with an unusually rapid recurrence of focal segmental glomerulonephritis in the graft, the recognition of its occurrence was hampered by the primary graft affection and oligoanuria and by insignificant histological changes in the first two biopsy samples in the early post-transplant period, as well as by unawareness of the disease leading to terminal renal failure, as no renal biopsy was performed due to grade 3 obesity. Only worsening of hypoalbuminemia and finding of massive proteinuria despite oligoanuria were crucial for further management. Disease recurrence in the graft was confirmed by electron microscopy. However, complex targeted therapy did not result in restoration of graft function and decrease in proteinuria. This case history was aimed to draw attention to the knowledge of the importance of the primary disease confirmed by renal biopsy and early (so called pre-emptive) treatment in case of diseases with a high potential of recurrence (Fig. 7, Ref. 10). Text in PDF www.elis.sk Keywords: kidney transplantation, recurrence, minimal changes in glomeruli, focal segmental glomerulosclerosis.

The result of a kidney transplantation may be affected by certain congenital or acquired urological diseases that need to be addressed before, during or after the kidney transplant. Complications accompanying kidney transplantation are not fundamentally different from the events that accompany other difficult surgical procedures. However, their course is usually modified by adverse circumstances in the recipient - uremia, dialysis treatment, immunosuppression. The incidence of urological complications is reported in the range of 1 to 30 % of the transplants, and they represent up to one half of all surgical complications. They can cause a significant morbidity and mortality and can lead to a delayed onset of the function and even to a loss of the transplanted kidney.Urological complications that need to be addressed before kidney transplantation include anomalies or pathological changes in the lower urinary tract, pelvic involvement in atherosclerosis or previous kidney transplants, infectious foci in lithiasis or pyonephrosis, large polycystic kidneys and malignancies. During the kidney transplantation itself, vascular complications, and complications connected with the reconstruction of the lower urinary tract can occur. Other complications are bacterial and viral infections and malignancies. All these complications require a rapid and accurate diagnosis and subsequent targeted treatment with intention to maintain a functional kidney transplant (Fig. 11, Ref. 36). Text in PDF www.elis.sk Keywords: kidney transplantation, urological, vascular, infectious, bleeding, complications.