Biomedical subjects

David A Goldfarb

Publications and source records attributed to David A Goldfarb.

At least 19 recordsLinked to original sources

PubMed2006

Differences in proteinuria and graft function in de novo sirolimus-based vs. calcineurin inhibitor-based immunosuppression in live donor kidney transplantation.

BACKGROUND: Calcineurin inhibitor(CNI)-free protocols using sirolimus (SRL) in kidney transplantation have proven effective, although reports have linked SRL to proteinuria. We sought to investigate this link and its impact on graft function. METHODS: We retrospectively analyzed 184 live donor kidney transplant recipients who exclusively received de novo CNI-based (n = 106) or SRL-based (n = 78) regimens. Estimated glomerular filtration rate (GFR) and semi-quantitative dipstick proteinuria measurements were obtained at one, six, 12, and 24 months and six and 12 months, respectively. RESULTS: SRL-treated patients had higher frequencies of proteinuria (> or =1+) at 6 months (40.8% vs. 21.4%, P = 0.006) and 12 months (37.8% vs. 18.4%, P = 0.004) than those treated with CNI. Independent predictors of proteinuria at 12 months were GFR at one month (OR 0.62 per 10 ml/min/1.73 m, P<0.001), delayed graft function (OR 11.5, P = 0.02), and a SRL-based regimen (OR 4.18, P=0.002). By univariable analysis, SRL vs. CNI patients had higher GFR at each point. SRL-treated patients without proteinuria had higher GFR at 12 months compared to CNI-treated patients with and without proteinuria (66 vs. 50 or 56 ml/min/1.73 m, P < 0.05). No difference in GFR was seen between SRL-treated patients with proteinuria vs. CNI-treated patients without proteinuria (57 vs. 56 ml/min/1.73 m, P > 0.05). Absence of proteinuria and a SRL-based regimen remained independently associated FS with higher GFR at 12 months by multivariable analyses. CONCLUSIONS: De novo SRL-based immunosuppression is associated with a higher frequency of semi-quantitative proteinuria, however, estimated graft function at 1 year posttransplant remains superior to that of CNI-treated patients. Nevertheless, the long-term implications of these findings need to be determined.

Adult↗

PubMed2006

The mTOR pathway is regulated by polycystin-1, and its inhibition reverses renal cystogenesis in polycystic kidney disease.

Autosomal-dominant polycystic kidney disease (ADPKD) is a common genetic disorder that frequently leads to renal failure. Mutations in polycystin-1 (PC1) underlie most cases of ADPKD, but the function of PC1 has remained poorly understood. No preventive treatment for this disease is available. Here, we show that the cytoplasmic tail of PC1 interacts with tuberin, and the mTOR pathway is inappropriately activated in cyst-lining epithelial cells in human ADPKD patients and mouse models. Rapamycin, an inhibitor of mTOR, is highly effective in reducing renal cystogenesis in two independent mouse models of PKD. Treatment of human ADPKD transplant-recipient patients with rapamycin results in a significant reduction in native polycystic kidney size. These results indicate that PC1 has an important function in the regulation of the mTOR pathway and that this pathway provides a target for medical therapy of ADPKD.

Animals↗

PubMed2006

Non-small cell lung carcinoma metastatic to the kidney.

INTRODUCTION: Renal metastasis by non-small cell lung cancer is uncommon and usually described at autopsy. CASE PRESENTATION: We report the rare case of a 77-year-old man with localized non-small cell lung carcinoma who underwent extirpative surgery and 2 years later presented with gross hematuria and was noted to have a large infiltrating renal mass on computed tomography. CONCLUSIONS: In patients with a prior history of resected localized non-small cell lung carcinoma, presence of a renal lesion should prompt the clinician to consider the possibility of metastasis. Further evaluation should consider this scenario.

Aged↗

PubMed2005

Laparoscopic live donor nephrectomy has equivalent early and late renal function outcomes compared with open donor nephrectomy.

OBJECTIVES: To assess the patterns of early functional recovery and long-term function in laparoscopic and open procured live donor nephrectomy (LDN) kidneys, highlighting the radionuclide scan as an additional tool for assessment, because of concerns regarding renal functional recovery after laparoscopic LDN. METHODS: We reviewed the donor and recipient records of 101 laparoscopic and 35 open LDNs performed between August 1997 and September 2001. Data were collected on demographic, immunologic, and intraoperative variables and ureteral/vascular complications. Delayed renal function recovery in recipients was evaluated by serum creatinine greater than 2.5 mg/dL on postoperative day 5, dialysis in first postoperative week, and two renographic criteria--the time to peak activity and the time to one-half peak activity on postoperative day 5. Long-term outcomes were evaluated by serum creatinine at 1, 3, 6, and 12 months and 2 and 3 years, creatinine clearance at 1 year, and patient and allograft survival. RESULTS: Donor and recipient age, sex, body mass index, and number of HLA mismatches did not differ between the two groups. The mean operating room time and blood loss were comparable. No differences were found in the early functional parameters (renography, creatinine at postoperative day 1 and 5, or dialysis in week 1) or long-term outcome (patient and graft survival, creatinine, and rejection at 1 year and patient and graft survival at 1, 2, and 3 years). CONCLUSIONS: Early recovery of graft function, longer term renal function, and 3-year patient and allograft survival are similar for live donor kidneys obtained by either a laparoscopic or an open surgical technique.

Adult↗

PubMed2005

Current management of transplant renal artery stenosis: clinical utility of duplex Doppler ultrasonography.

OBJECTIVES: To perform a retrospective study to determine the clinical utility of Doppler ultrasonography (DUS) and to determine its role in the management of transplant renal artery stenosis (TRAS). METHODS: Patients undergoing DUS between January 1998 and January 2001 for clinical suspicion of TRAS were included in the study. A total of 51 patients were divided into two groups according to the peak systolic velocity. Additional management was based on the clinical and DUS findings and their congruence. Patients were followed up and their outcome was analyzed. RESULTS: Of the 51 patients who entered the study, 26 were in the low probability group (LPG) and 25 in the high probability group (HPG). Nine patients in the LPG underwent additional investigations; eight underwent magnetic resonance angiography and one angiography. Of these 9 patients, 6 had stenosis, 4 of whom required angiography. In total, 5 patients from the LPG underwent angioplasty, and 4 of them had stenosis (1 with TRAS, 2 with common iliac artery stenosis, and 1 with renal artery ostial stenosis). Three patients underwent angioplasty and 2 of them improved. In the HPG, 20 of 25 patients underwent additional investigations, including magnetic resonance angiography in 12 and angiography in 8, with stenosis in 15 patients. Of the HPG, 13 of 25 patients underwent angiography, with 10 requiring angioplasty--8 for TRAS and 2 for adjacent renal artery stenosis, with improvement in 8 patients. Congruent clinical and DUS findings were highly predictive of significant stenosis more amenable to improvement. CONCLUSIONS: The results of our study have shown that high-probability DUS and congruent clinical findings are likely to identify a significant stenosis that is amenable to treatment. Low-probability DUS findings do not eliminate the possibility of stenosis, but intervention in this group is less likely to result in improvement.

Female↗

PubMed2005