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2013
2013
2013
BACKGROUND
Focal segmental glomerulosclerosis (FSGS) recurs after kidney transplantation in more than 30% of cases and can lead to allograft loss. Serum soluble urokinase-type plasminogen activator receptor (suPAR) is implicated in the pathogenesis of native and recurrent FSGS.
METHODS
We conducted a retrospective study of 25 adults with posttransplantation FSGS. We investigated the relationship between suPAR levels and podocyte changes and the impact of therapy on podocyte structure. We assessed response to therapy by improvement in proteinuria, allograft function, and resolution of histologic changes.
RESULTS
A median (interquartile range) of 15 (10-23) plasmapheresis sessions was administered; 13 of the subjects also received rituximab. Median pretreatment suPAR levels were higher among those with severe (≥75%) versus those with mild (≤25%) podocyte foot process effacement (13,030 vs. 4806 pg/mL; P=0.02). Overall, mean±SD of proteinuria improved from 5.1±3.8 to 2.1±2.8 mg/dL (P=0.003), mean podocyte effacement decreased from 57%±33% to 22%±22% (P=0.0001), estimated glomerular filtration rates increased from median (interquartile range) of 32.9 (20.6-44.2) to 39.3 (28.8-63.4; P<0.0001), and suPAR levels decreased from a median of 6.781 to 4.129 pg/mL (P=0.02) with therapy.
CONCLUSIONS
Podocyte effacement is the first pathologic manifestation of FSGS after transplantation. The degree of podocyte effacement correlates with suPAR levels at time of diagnosis. Response to therapy results in significant reduction of suPAR levels and complete or significant improvement of podocyte effacement.
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2013
2013
2013
2013
BACKGROUND
The purpose of the present study was to evaluate the anatomy and contribution of the patellar vascular supply and to quantify the effect of a transverse fracture on patellar perfusion.
METHODS
In twenty matched pairs of fresh-frozen cadaveric knees, the superficial femoral artery, anterior tibialis artery, and posterior tibialis artery were cannulated. One side of each matched pair was randomly selected to undergo one of two osteotomies: (1) midpatellar osteotomy or (2) distal-pole osteotomy. For volumetric analysis, comparisons were performed between contrast-enhanced magnetic resonance images and precontrast magnetic resonance images as well as between osteotomized patellar bone fragments and the corresponding intact areas on the control side. We then injected a urethane polymer compound and dissected all specimens to examine extraosseous vascularity.
RESULTS
Magnetic resonance imaging demonstrated that the largest arterial contribution to the patella entered at the inferior pole in 100% of the specimens; in 80% of these specimens, the artery entered inferomedially. It also revealed an overall decrease in contrast enhancement in both transverse osteotomy groups, with an average reduction in enhancement in the proximal fragment of 36%.
CONCLUSIONS
If possible, surgical interventions about the knee should be carefully planned to preserve the peripatellar ring (the source of the entire patellar blood supply), especially the inferior patellar network. Distal-pole patellectomy should be avoided to retain vascularized bone at the reduced fracture site.
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