Nonimmunologic parameters have less influence on the outcome of kidney transplantation than immunologic factors.

A 43-year-old Caucasian woman was admitted to the intensive care unit with severe sepsis of unknown focus and acute renal failure. Laboratory results showed a C-reactive protein of 149.4 mg l−1 (normal <7.5 mg l−1), procalcitonin 1.88 ng ml−1 (normal <0.5 ng ml−1), a leukocytosis of 20.7 Gpt l−1 (normal 4.4–11.3 Gpt l−1), urea of 28.1 mmol l−1 (normal 2.6–6.7 mmol l−1), and serum creatinine of 373 μmol l−1 (normal 58–96 μmol l−1). Urine analysis showed elevated leukocytes (4246 μl−1), many bacteria, and a positive nitrite test. The patient was placed on artificial ventilation and noradrenalin had to be given intravenously. Antibiotic treatment was initiated with meropenem and erythromycin. Continuous veno-veno hemofiltration was started because of acute renal failure. Ultrasonography of the kidney showed multiple circumscribed hyper-, iso-, and hypoechoic (to the renal cortex) masses in both kidneys. Magnetic resonance scans of the kidneys revealed changes compatible with renal infiltration by inflammatory cells (Figure 1). In addition, a CT scan showed multiple circular masses in both kidneys (Figure 2). One week before admission, the patient had complained of bilateral flank pain, fever, and nausea. In the past, the patient reported recurrent episodes of pyelonephritis that resolved after antibiotic therapy, without any history of urinary tract obstruction.Figure 2Computed tomography scan of the kidneys showing both kidneys with multiple circular masses.View Large Image Figure ViewerDownload (PPT) What is the working diagnosis? We performed a renal biopsy for further diagnosis. The renal biopsy findings (Figures 3 and 4) show the typical features of xanthogra nulomatous pyelonephritis with granulomatous inflammation associated with lipid-laden macrophages.Figure 4The periodic acid-Schiff-positive lipid-laden macrophages are found in the tubulointerstitium in which normal architecture has been completely destroyed (periodic acid-Schiff stain, original magnification ×350).View Large Image Figure ViewerDownload (PPT) However, despite treatment with ciprofloxacin for 6 months renal function remains impaired with a creatinine clearance of 26 ml min−1. Xanthogranulomatous pyelonephritis is a rare disease. Only a few cases with bilateral renal involvement have been documented.1.Tonelli S. Gianotti P. On the nature of xanthogranulomatous pyelonephritis.Urol Int. 1969; 24: 330-343Crossref PubMed Scopus (3) Google Scholar Late diagnosis is not uncommon, leading to irreversible damage of the kidneys by the disease. It is important to think of this rare disease as a potential differential diagnosis of renal tumors.1.Tonelli S. Gianotti P. On the nature of xanthogranulomatous pyelonephritis.Urol Int. 1969; 24: 330-343Crossref PubMed Scopus (3) Google Scholar Xanthogranulomatous pyelonephritis pathologically consists of a yellow-to-orange colored renal infiltrate because of the large lipid content. The granulomas are formed by macrophages with a high cytoplasmic content of neutral lipids. The disease process may also involve structures adjacent to the kidneys such as the psoas muscle.2.Saavedra J.S. Pow-Sang Godoy M. Benavente Corrales V. et al.Xanthogranulomatous pyelonephritis: clinical, radiological and patholocic characteristics.Arch Esp Urol. 2004; 57: 595-600PubMed Google Scholar Predisposing factors for the development of xanthogranulomatous pyelonephritis are urinary tract obstruction (stones, tumors, hydronephrosis, urethral stricture, vesicoureteral reflux, neurogenic bladder depletion disorders) and chronic urinary tract infection. In cases of xanthogranulomatous pyelonephritis usually only one kidney is involved. However, our case demonstrated that even bilateral involvement is possible and bilateral chronic pyelonephritis is presumably the cause of xanthogranulomatous pyelonephritis in this patient. Possibly, recurrent urinary tract infections were not consequently treated in our patient and likely chronic infection developed. Proteus mirabilis was the causative bacterium in this case. Reports of infection with Staphylococcus, Escherichia coli, Klebsiella, P. mirabilis, and Serratia marcescens associated with xanthogranulomatous pyelonephritis have been published.2.Saavedra J.S. Pow-Sang Godoy M. Benavente Corrales V. et al.Xanthogranulomatous pyelonephritis: clinical, radiological and patholocic characteristics.Arch Esp Urol. 2004; 57: 595-600PubMed Google Scholar Ultrasonography is the most important imaging method to diagnose renal lesions. In 15 cases, renal cell carcinoma was suspected by ultrasound but the correct diagnosis was xanthogranulomatous nephritis.3.Kim J. Ultrasonographic features of focal xanthogranulomatous pyelonephritis.J Ultrasound Med. 2004; 23: 409-416PubMed Google Scholar When there are clinical signs of infection, such as leukocytosis and elevation of C-reactive protein, or inflammation and a focal solid mass are seen in ultrasonography of the kidneys, xanthogranulom atous pyelonephritis should be considered. CT seems to be the most valuable imaging method for the diagnosis.4.Zorzos I. Mountzouris V. Korakianitis G. Katsou G. Analysis of 39 cases of xanthogranulomatous pyelonephritis with emphasis on CT findings.Scand J Urol Nephrol. 2003; 37: 342-347Crossref PubMed Scopus (44) Google Scholar One report favored magnetic resonance tomography because its contrast agent is less nephrotoxic than the CT contrast agent,5.Hallscheidt P. Weber M.A. Schenk J.P. Riedasch G. Magnetic resonance tomography of xanthogranulomatous pyelonephritis. Epidemiology, pathogenesis and symptoms.Urologe A. 2002; 41: 577-582Crossref PubMed Scopus (3) Google Scholar but systemic nephrogenic sclerosis is a potential complication of gadolinium. In unclear cases renal biopsy is helpful to determine the correct diagnosis. Nephrectomy is necessary in complicated cases such as the development of renocolic fistula, the formation of psoas, or of perirenal abscesses. In less severe cases antibiotic treatment is a therapeutic feature. Essential for the correct diagnosis is consideration of the complete medical history including the identification of recurrent episodes of pyelonephritis.

Approximately 10% to 20% of all annual renal transplantations are retransplantations and up to 20% of patients on waiting lists need a repeat kidney because of previous graft failure. The immunological risk is much greater among retransplanted patients than first-time kidney recipients. It is likely that retransplantation will become even more prevalent in the future. However, clinical studies or retrospective data are rare in this patient population. We retrospectively investigated 50 recipients after second or third renal transplantations in our center since 2001. Immunosuppression was performed with corticosteroids, mycophenolate mofetil (MMF), tacrolimus, and induction therapy with either thymoglobulin (2.5 mg/kg body weight; n = 27) or 20 mg basiliximab on days 0 and 4 (n = 22) after renal transplantation; 1 patient was treated with antithymoglobulin Fresenius after combined liver-kidney transplantation. Acute rejection occurred in 12 recipients (44.4%) after thymoglobulin and in 7 recipients (31.8%) after basiliximab induction therapy (P < .05). In 4 (14.8%) thymoglobulin- and 5 (22.7%) basiliximab-treated recipients, vascular rejections were observed (P = NS). Patients with basiliximab treatment showed improved renal function at 1 year after transplantation: serum creatinine 134.3 mumol/L versus 199.6 mumol/L in the thymoglobulin group (P < .05). Over the observation period the renal function remained stable or improved in both groups if rejection treatment was successful. However, allograft failure was higher in the basiliximab-treated group, namely, 18.1% versus 14.8% in thymoglobulin-treated patients, but the difference did not reach statistical significance. In 3 (11.1%) thymoglobulin- and 4 (18.2%) basiliximab-treated patients cytomegalovirus (CMV) infections complicated the follow-up (P = NS). In the follow-up period of 5 years, no malignant diseases were seen in either group. Three basiliximab-treated recipients died in the first year due to sepsis or cardiovascular complications. Two thymoglobulin-treated patients developed BK virus nephropathy in the follow-up period. In conclusion, we observed a high immunological risk and rejection risk among retransplanted kidney recipients in our center. Particularly, severe vascular rejections with a harmful long-term impact on allograft function were observed in this population. Induction treatment seems to be successful to reduce risk and achieve better results. Single-shot thymoglobulin may be preferable to reduce severe vascular rejection and prevent allograft failure than basiliximab with the same infection rate.

You have accessJournal of Urology1 Apr 2008GENOME-WIDE COPY NUMBER PROFILING OF RENAL CELL TUMORS USING ARRAY-CGH Jimsgene Sanjmyatav, Carsten Schwaenen, Sven Wessendorf, Jorg Schubert, and Kerstin Junker Jimsgene SanjmyatavJimsgene Sanjmyatav More articles by this author , Carsten SchwaenenCarsten Schwaenen More articles by this author , Sven WessendorfSven Wessendorf More articles by this author , Jorg SchubertJorg Schubert More articles by this author , and Kerstin JunkerKerstin Junker More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60388-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "GENOME-WIDE COPY NUMBER PROFILING OF RENAL CELL TUMORS USING ARRAY-CGH." The Journal of Urology, 179(4S), p. 135 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 135 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Jimsgene Sanjmyatav More articles by this author Carsten Schwaenen More articles by this author Sven Wessendorf More articles by this author Jorg Schubert More articles by this author Kerstin Junker More articles by this author Expand All Advertisement PDF DownloadLoading ...

Molekularbiologische Tumormarker und Prognoseparameter sind Voraussetzung für eine differenzierte Diagnostik und daraus resultierend für eine individuelle Prognosebewertung und Therapiewahl auch für Patienten mit Nierenzelltumoren (NZK). Es ist heute möglich, Tumoren sehr komplex unter Einsatz von Hochdurchsatzverfahren zu charakterisieren. Wir konnten metastasierungsspezifische molekulare Muster definieren, die zukünftig die Bewertung des Metastasierungspotenzials bereits am Primärtumor erlauben könnten. Da nun mehrere Therapeutika für Patienten mit metastasierten NZK zur Verfügung stehen, ist es notwendig, Patienten für die effektivste Therapie zu selektieren und frühzeitig das Therapieversagen zu erkennen. Wir konnten Biomarker im Tumorgewebe und im Serum identifizieren, die mit dem Therapieansprechen korrelieren.

Until now, no serum biomarkers are available for detection or monitoring of patients with renal cell carcinomas (RCC). Using ProteinChip technology, we identified Serum amyloid alpha 1 (SAA-1) as one of the relevant proteins which are significantly elevated in serum from patients with clear cell RCC. Based on these data, the aim of this study is to define the clinical value of SAA-1 for diagnosis, prognosis and therapy monitoring.

Über die Etablierung der laparoskopischen Tumornephrektomie und Prostatektomie wird derzeit nach länger dauernden Hospitationen Einzelner oder eines ganzen Teams an wenigen Zentren berichtet, sie ist aber in der gegenwärtigen Personalsituation an vielen Kliniken schwer realisierbar. Im Folgenden wird ein alternativer Ansatz vorgestellt.

Molecular biological tumor markers and prognostic parameters are necessary for differential diagnosis, individual prognosis, and therapy in patients with renal cell tumors. By using high throughput technologies, it is possible to characterize tumor samples comprehensively. Based on specific genetic alterations, histopathological subtypes were defined as independent tumor entities. Genetic characteristics can be used for diagnosis of primary tumor samples and also of biopsies. Furthermore, specific molecular patterns of metastatic tumors are known, allowing the determination of the primary tumor's metastatic potential. The specific protein patterns of serum samples of tumor patients were analyzed, and several candidate proteins have been identified. One of these is SAA-1, which is elevated in patients with clear cell renal cell carcinomas (RCC). New therapeutic options are now available for patients with metastatic RCC. Therefore, it is necessary to select the best therapy for each patient and to detect therapy resistance very early. Biomarkers in tumor tissue and serum were found to correlate with therapy response.

You have accessJournal of Urology1 Apr 2008IDENTIFICATION OF SPECIFIC PROTEIN PATTERNS IN TUMOR TISSUE FOR PREDICTION OF IMMUNE-CHEMOTHERAPY RESPONSE Christian Heinze, Thomas Steiner, Rico Pilchowski, Christian Melle, Joerg Schubert, and Kerstin Junker Christian HeinzeChristian Heinze , Thomas SteinerThomas Steiner , Rico PilchowskiRico Pilchowski , Christian MelleChristian Melle , Joerg SchubertJoerg Schubert , and Kerstin JunkerKerstin Junker View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60972-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "IDENTIFICATION OF SPECIFIC PROTEIN PATTERNS IN TUMOR TISSUE FOR PREDICTION OF IMMUNE-CHEMOTHERAPY RESPONSE." The Journal of Urology, 179(4S), p. 332 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 332 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetrics Author Information Christian Heinze More articles by this author Thomas Steiner More articles by this author Rico Pilchowski More articles by this author Christian Melle More articles by this author Joerg Schubert More articles by this author Kerstin Junker More articles by this author Expand All Advertisement PDF downloadLoading ...

To provide complex experimental and clinical analysis of renal cell tumors, it is necessary to investigate this tumor entity interdisciplinarily. The aim of the German Renal Cell Tumor Network is to answer current problems through interdisciplinary cooperation among clinicians and basic researchers from different fields. It is thus now possible to analyze more than 500 well-characterized tumor samples using different techniques.

Um die Gefahr von Nierenfunktionsstörungen bedingt durch die hiläre Gefäßokklusion bei partiellen Nephrektomien zu vermindern, testeten wir den Einsatz eines Lasers zur nephronsparenden Nierenteilresektion. Wir schlussfolgern, dass der Einsatz des Lasers bei ausgewählten Patienten eine sichere Alternative zur klassischen Operationsmethode darstellt.

Molecular biological tumor markers and prognostic parameters are necessary for differential diagnosis, individual prognosis, and therapy in patients with renal cell tumors. By using high throughput technologies for DNA, RNA, and protein analysis, it is possible to comprehensively characterize tumor samples. We identified specific molecular patterns of metastatic tumors, allowing the determination of metastatic potential of the primary tumor. Different therapeutic options are now available for patients with metastatic renal cell carcinoma. Therefore, it is necessary to select the best therapy for each patient and to detect therapy resistance very early. Biomarkers in tumor tissue and serum were found correlating with therapy response.

You have accessJournal of Urology1 Apr 2008PROTEIN PROFILING OF SERUM SAMPLES FOR PREDICTION OF IMMUNE-CHEMOTHERAPY RESPONSE Martina Walter, Kerstin Junker, Rico Pilchowski, Christian Melle, Joerg Schubert, and Thomas Steiner Martina WalterMartina Walter More articles by this author , Kerstin JunkerKerstin Junker More articles by this author , Rico PilchowskiRico Pilchowski More articles by this author , Christian MelleChristian Melle More articles by this author , Joerg SchubertJoerg Schubert More articles by this author , and Thomas SteinerThomas Steiner More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)61112-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "PROTEIN PROFILING OF SERUM SAMPLES FOR PREDICTION OF IMMUNE-CHEMOTHERAPY RESPONSE." The Journal of Urology, 179(4S), p. 380 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 380 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Martina Walter More articles by this author Kerstin Junker More articles by this author Rico Pilchowski More articles by this author Christian Melle More articles by this author Joerg Schubert More articles by this author Thomas Steiner More articles by this author Expand All Advertisement PDF DownloadLoading ...