APOL1 risk variants and kidney disease: what we know so far

There are striking differences in chronic kidney disease between Caucasians and African descendants. It was widely accepted that this occurred due to socioeconomic factors, but recent studies show that apolipoprotein L-1 (APOL1) gene variants are strongly associated with focal segmental glomerulosclerosis, HIV-associated nephropathy, hypertensive nephrosclerosis, and lupus nephritis in the African American population. These variants made their way to South America trough intercontinental slave traffic and conferred an evolutionary advantage to the carries by protecting against forms of trypanosomiasis, but at the expense of an increased risk of kidney disease. The effect of the variants does not seem to be related to their serum concentration, but rather to local action on the podocytes. Risk variants are also important in renal transplantation, since grafts from donors with risk variants present worse survival.

Analysis of economic impact between the modality of renal replacement therapy

INTRODUCTION

Chronic kidney disease (CKD) is a major health problem, determining the reduction in life expectancy and an increased risk of cardiovascular disease.

METHOD

An observational, cohort, retrospective, based on patient's medical records data with CKD under hemodialysis, peritoneal dialysis and kidney transplantation in the city of Curitiba, in the period from January to June 2014, evacuativo the financial impact on the Unified Health System (SUS) and the supplementary health.

RESULTS

The lowest cost of a kidney transplant in the first year was R$ 40,743.03 when cyclosporine was used and the highest was R$ 48,388.17 with the use of tacrolimus. In the second year post-transplant, hemodialysis and peritoneal dialysis have a higher cost compared to kidney transplant. Transplantation with deceased donor, treated with tacrolimus: R$ 67,023.39; Hemodialysis R$ 71,717.51 and automated peritoneal dialysis automatic R$ 69,527.03.

CONCLUSIONS

After the first two years of renal replacement therapy, transplantation demonstrates lower costs to the system when compared to other modalities evaluated. Based on that, this therapy justifies improvements in government policies in this sector.

Pelvic kidney for living transplantation: case report and review of the literature

INTRODUCTION

The difference between available kidneys and the number of patients on waiting list for kidney transplantation continues to grow. For this reason the trend is to use donors with expanded criteria, such as a pelvic kidney, as we describe below.

CASE REPORT

Male patient 25 years-old with end-stage kidney disease, receives as a graft a pelvic kidney from his father, 49 years-old, known to have controlled systemic arterial hypertension and nephrolithiasis by history without new episodes in the last 10 years. Function and anatomy of the pelvic kidney were evaluated through magnetic angioressonance, computerized tomography and scintigraphy. After an initial rejection episode promptly treated, the patient has had an uneventful recovery.

CONCLUSION

To increase the number of kidneys available for transplantation, it is reasonable to use a pelvic kidney, after a thorough investigation.