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Biomedical subjects

P Kinnaert

Publications and source records attributed to P Kinnaert.

At least 73 records · Page 4Linked to original sources
PubMed1992

Evolution of osteocalcin, alkaline phosphatase and parathyroid hormone after parathyroidectomy in patients receiving chronic maintenance hemodialysis.

Parathyroid hormone (PTH), osteocalcin and alkaline phosphatase (AP) were investigated before and after parathyroidectomy in 12 patients receiving hemodialysis. Early post-parathyroidectomy, PTH decreased (p less than 0.001), AP increased (p less than 0.05), but osteocalcin remained unchanged. At 3 months, osteocalcin and AP declined. A negative correlation was observed between aluminum staining and post-parathyroidectomy osteocalcin. In conclusion, early post-parathyroidectomy, osteocalcin and AP reflect persistent osteoblastic activity, which declined after 3 months. In patients receiving hemodialysis both variables may represent different aspects of osteoblastic activity and osteocalcin allows mixed uremic osteodystrophy after parathyroidectomy.

Adult↗
PubMed1991

[Favourable effects of some HLA-DR disparities on kidney graft survival. Proposal for a new recipient selection policy].

In a previous retrospective study conducted from 1980 to 1987 on 275 renal cadaveric transplants, we have shown that HLA-DR disparities between donor and recipient exerted differential effects on graft survival. Thus, the presence of DR4, DR5 and DR7 in the donor, or of DR5 in the recipient was associated with an excellent survival, whereas disparities due to the presence of DR1 and DR2 in the donor, or of DR2, DRw6 and DR7 in the recipient were detrimental for the graft. A prospective study on 158 renal cadaveric transplants performed from 1988 to 1990 yielded results that were similar to those of the retrospective study. Graft survival at 18 months was similar in recipients who had either the same DR antigens as those present in their donor or beneficial DR disparities only (83-90 percent), and significantly higher than in recipients with DR detrimental disparities only (62-65 percent). Graft survival in recipients with either mixed or neutral DR disparities occupied an intermediate position (77-78 percent). In conclusion, grafts with excellent outcome, similar to that observed in DR identical pairs, may be proposed to an ever increasing number of patients awaiting a renal transplant by adopting a selection policy based on the choice of beneficial DR disparities when a DR identical recipient is not available in the pool.

Actuarial Analysis↗
PubMed1991

Evidence that pentoxifylline reduces anti-CD3 monoclonal antibody-induced cytokine release syndrome.

Pretreatment with pentoxifylline (PTX), a methylxanthine known for its beneficial effects on tissue lesions induced by the injection of endotoxin or recombinant cytokines, was shown to decrease the systemic release of tumor necrosis factor and interleukin 2 occurring after the administration of the anti-CD3 monoclonal antibody 145-2C11 in mice. In parallel, PTX attenuated the hypothermia and the rise in blood urea nitrogen observed in this model. The protective effect of PTX on the toxicity of 145-2C11 was confirmed by the reduction of the mortality among D-galactosamine-sensitized animals. The mitigation by PTX of the release of cytokines did not affect the immunosuppression entailed by 145-2C11 as assessed by the unmodified cytotoxic T lymphocytes (CTL) unresponsiveness against alloantigens measured 48 hr after the injection of the mAb. In vitro experiments on human peripheral blood leukocytes indicated that PTX alone or in synergy with methylprednisolone (m-PDS) also inhibited the release of TNF and IL-2 induced by OKT3. Finally, in a preliminary pilot trial conducted in kidney transplant recipients, we observed that pretreatment with PTX (20 mg/kg i.v.) in addition to m-PDS (2 g i.v.) reduced by half the amount of TNF released in the blood stream after the first injection of OKT3, while no further reduction of the low levels of IL-2 was found.

Animals↗
PubMed1991

[Nephrotoxicity of anti-CD3 monoclonal antibodies].

The OKT3 monoclonal antibody entails a transient acute nephrotoxicity when used either to prevent or to treat renal allograft rejection. This nephrotoxicity was reproduced experimentally in mice injected with 145-2C11, an anti-CD3 monoclonal antibody which shares many properties with OKT3. Both clinical and experimental data suggest that the renal lesions are due to the systemic release of cytokines that occurs prior to the immunosuppression. Pre-treatment with corticosteroids before the injection of anti-CD3 monoclonal antibody mitigates both the release of cytokines and the nephrotoxicity, in a dose-dependent manner. Experimental data suggest that very high doses of methylprednisolone (50 mg/kg) administered 2 to 3 hours before the monoclonal antibody are necessary to obtain an optimal protection.

Animals↗
PubMed1991

The natural history of renal stone disease after parathyroidectomy for primary hyperparathyroidism.

The evolution of renal stone disease has been followed, before and after parathyroidectomy, in 197 patients with primary hyperparathyroidism. Before operation, 120 patients had had a previous history of renal colics or stones, or both, demonstrated on roentgenograms of the urinary tract. In 36 patients with stones that had been passed or removed before exploration of the neck, no recurrence of lithiasis has been observed. In 84 patients who still had stones at the time of the operation, the stones dissolved and disappeared within ten years in 88 per cent of those with urolithiasis and in 77 per cent with nephrocalcinosis. The rate of stone disappearance was similar in those with or without preoperative urinary tract infection and in patients operated upon for adenoma of the parathyroid gland or primary hyperplasia. This rate was slower for patients with a postoperative urinary infection. The frequency of renal colics, 0.66 per patient per year before parathyroidectomy, decreased to 0.02 per patient per year after the first postoperative year.

Adult↗
PubMed1990

Failure of two subsequent renal grafts by anti-GBM glomerulonephritis in Alport's syndrome: case report and review of the literature.

We describe a patient with Alport's syndrome who developed severe crescentic glomerulonephritis after each of two successive transplantations, leading to accelerated graft failure on both occasions. This complication occurred in the 7th postoperative month for the first transplant and in the immediate postoperative period for the second. Immunopathological studies of the second transplant demonstrated that the glomerular lesions were mediated by antiglomerular basement membrane (GBM) antibodies displaying the same pattern of reactivity as the MCA-Pl monoclonal antibody directed against the Good-pasture antigen. This observation indicates that the anti-GBM immunization induced by renal transplantation in some patients with Alport's syndrome may be responsible for recurrent graft failure.

Adult↗
PubMed1989

Central venous access for haemodialysis using the Hickman catheter.

One hundred and seven Hickman catheters for haemodialysis were inserted in 90 end-stage chronic renal failure patients, and were used for 1-448 days (median 45 days). Sixty-nine per cent of the patients were treated without any problem for 1-165 days (median 34 days). Clinically evident complications occurred in 44 catheters inserted in 28 patients, and included outflow obstruction (16.8% of the catheters) and thrombosis (13.1% of the catheters). However, many episodes of clotting or insufficient flow could be corrected by simple manoeuvres. Other less frequent complications were recorded: sepsis, mainly in patients with increased risk factors (4.1% of the catheters), laceration of the catheter (3.7%) and occasional cases of jugular-vein phlebitis, transient palsy of a vocal cord, haematoma of the wound, and bleeding of the cutaneous orifice. No clinical sign of subclavian or innominate-vein thrombosis was observed. Nevertheless, a prospective study conducted in 50 asymptomatic patients demonstrated a 12% rate of anomalies of the venous system, although two-thirds of these alterations were mild and had no consequence. When the present series is compared to the results obtained with currently available percutaneous haemodialysis catheters, it is concluded that the Hickman catheter is a safe, comfortable and efficient vascular access device.

Catheterization, Central Venous↗
PubMed1989

Release of tumor necrosis factor, interleukin-2, and gamma-interferon in serum after injection of OKT3 monoclonal antibody in kidney transplant recipients.

High levels of tumor necrosis factor-alpha, interleukin-2, and gamma-interferon appeared in the circulation of kidney transplant recipients after the first injection of the monoclonal antibody OKT3. This initial injection was systematically followed by fever. The three cytokines were released in all patients (n = 9), with peak serum levels of tumor necrosis factor occurring 1 hr after OKT3 injection and those of interleukin-2 and gamma-interferon after 2 hr. Cytokines were not released after the second and third OKT3 injections, when CD3+ cells had disappeared from blood. These findings suggest that circulating cytokines are released by T cells after activation by OKT3. These cytokines are probably involved in the systematic reactions observed after injection of OKT3.

Antibodies, Monoclonal↗
PubMed1989

[Identification of HLA-DR antigenic disparities favorable and unfavorable in renal transplantation].

In order to detect possible influences of donor (D)/recipient (R) HLA-DR antigen disparities on graft survival, 310 renal cadaver transplantations performed from January 1980 to July 1988 were analyzed. For each DR1 to DR7 specificity, 4 combinations were considered according to the presence (pos) or the absence (neg) of the antigen in the D and in the R. Logistic regression was used to study graft survival during two postoperative periods: A (month 1 to 3) and B (month 4 to 24). The following combinations exerted a beneficial effect on survival: DR5 and DR7 Dpos/Rneg for period A, DR4 Dpos/Rneg and DR5 Dneg/Rpos for period B, whereas DRw6 and DR7 Dneg/Rpos for period A, DR1 and DR2 Dpos/Rneg, DR2 and DRw6 Dneg/Rpos for period B exerted a detrimental effect. Graft survival at two years was similar (83%) in HLA-DR identical pairs and in recipients with beneficial and no detrimental HLA-DR disparities, contrasting with poorer outcome in patients with either mixed beneficial and detrimental HLA-DR disparities (67%: p less than 0.05) or detrimental (and no beneficial) HLA-DR disparities (55%: p less than 0.001). The use of relevant D/R HLA-DR disparities for predicting graft outcome could lead to results similar to those currently reported with the best HLA-matched kidneys, from a much smaller pool of recipients.

Graft Survival↗