BACKGROUND Interferons(IFNs)are characterized by a wide range of biological effects,which justifies their potential therapeutic use in several pathologies,but also elicit a wide array of adverse effects in almost ever...BACKGROUND Interferons(IFNs)are characterized by a wide range of biological effects,which justifies their potential therapeutic use in several pathologies,but also elicit a wide array of adverse effects in almost every organ system.Among them,renal involvement is probably one of the most complex to identify.CASE SUMMARY We describe four cases of kidney damage caused by different IFN formulations:IFN-β-related thrombotic microangiopathy,IFN-β-induced systemic lupus erythematosus,and two cases of membranous nephropathy secondary to pegylated-IFN-α2B.In each case,we carefully excluded any other possible cause of renal involvement.Once suspected as the casual relationship between drug and kidney damage,IFN treatment was immediately discontinued.In three cases,we observed a complete and persistent remission of clinical and laboratory abnormalities after IFN withdrawal,while the patient who developed thrombotic microangiopathy,despite IFN withdrawal and complement-inhibitor therapy with eculizumab,showed persistent severe renal failure requiring dialysis.CONCLUSION This case series highlights the causal relationship between IFN treatment and different types of renal involvement and enables us to delineate several peculiarities of this association.展开更多
Kidney transplantation(KT)is the treatment of choice for patients with end-stage renal disease,providing a better survival rate and quality of life compared to dialysis.Despite the progress in the medical management o...Kidney transplantation(KT)is the treatment of choice for patients with end-stage renal disease,providing a better survival rate and quality of life compared to dialysis.Despite the progress in the medical management of KT patients,from a purely surgical standpoint,KT has resisted innovations during the last 50 years.Recently,robot-assisted KT(RAKT)has been proposed as an alternative approach to open surgery,especially due to its potential benefits for fragile and immunocompromised recipients.It was not until 2014 that the role of RAKT has found value thanks to the pioneering Vattikuti Urology Institute-Medanta collaboration that conceptualized and developed a new surgical technique for RAKT following the Idea,Development,Exploration,Assessment,Long-term follow-up recommendations for introducing surgical innovations into real-life practice.During the last years,mirroring the Vattikuti-Medanta technique,several centers developed RAKT program worldwide,providing strong evidence about the safety and the feasibility of this procedure.However,the majority of RAKT are still performed in the living donor setting,as an“eligible”procedure,while only a few centers have realized KT through a robotic approach in the challenging scenario of cadaver donation.In addition,despite the spread of minimally-invasive(predominantly robotic)surgery worldwide,many KTs are still performed in an open fashion.Regardless of the type of incision employed by surgeons,open KT may lead to nonnegligible risks of wound complications,especially among obese patients.Particularly,the assessment for KT should consider not only the added surgical technical challenges but also the higher risk of postoperative complications.In this context,robotic surgery could offer several benefits,including providing a better exposure of the surgical field and better instrument maneuverability,as well as the possibility to integrate other technological nuances,such as the use of intraoperative fluorescence vascular imaging with indocyanine green to assess the ureteral vascularization before the uretero-vesical anastomosis.Therefore,our review aims to report the more significant experiences regarding RAKT,focusing on the results and future perspectives.展开更多
文摘BACKGROUND Interferons(IFNs)are characterized by a wide range of biological effects,which justifies their potential therapeutic use in several pathologies,but also elicit a wide array of adverse effects in almost every organ system.Among them,renal involvement is probably one of the most complex to identify.CASE SUMMARY We describe four cases of kidney damage caused by different IFN formulations:IFN-β-related thrombotic microangiopathy,IFN-β-induced systemic lupus erythematosus,and two cases of membranous nephropathy secondary to pegylated-IFN-α2B.In each case,we carefully excluded any other possible cause of renal involvement.Once suspected as the casual relationship between drug and kidney damage,IFN treatment was immediately discontinued.In three cases,we observed a complete and persistent remission of clinical and laboratory abnormalities after IFN withdrawal,while the patient who developed thrombotic microangiopathy,despite IFN withdrawal and complement-inhibitor therapy with eculizumab,showed persistent severe renal failure requiring dialysis.CONCLUSION This case series highlights the causal relationship between IFN treatment and different types of renal involvement and enables us to delineate several peculiarities of this association.
文摘Kidney transplantation(KT)is the treatment of choice for patients with end-stage renal disease,providing a better survival rate and quality of life compared to dialysis.Despite the progress in the medical management of KT patients,from a purely surgical standpoint,KT has resisted innovations during the last 50 years.Recently,robot-assisted KT(RAKT)has been proposed as an alternative approach to open surgery,especially due to its potential benefits for fragile and immunocompromised recipients.It was not until 2014 that the role of RAKT has found value thanks to the pioneering Vattikuti Urology Institute-Medanta collaboration that conceptualized and developed a new surgical technique for RAKT following the Idea,Development,Exploration,Assessment,Long-term follow-up recommendations for introducing surgical innovations into real-life practice.During the last years,mirroring the Vattikuti-Medanta technique,several centers developed RAKT program worldwide,providing strong evidence about the safety and the feasibility of this procedure.However,the majority of RAKT are still performed in the living donor setting,as an“eligible”procedure,while only a few centers have realized KT through a robotic approach in the challenging scenario of cadaver donation.In addition,despite the spread of minimally-invasive(predominantly robotic)surgery worldwide,many KTs are still performed in an open fashion.Regardless of the type of incision employed by surgeons,open KT may lead to nonnegligible risks of wound complications,especially among obese patients.Particularly,the assessment for KT should consider not only the added surgical technical challenges but also the higher risk of postoperative complications.In this context,robotic surgery could offer several benefits,including providing a better exposure of the surgical field and better instrument maneuverability,as well as the possibility to integrate other technological nuances,such as the use of intraoperative fluorescence vascular imaging with indocyanine green to assess the ureteral vascularization before the uretero-vesical anastomosis.Therefore,our review aims to report the more significant experiences regarding RAKT,focusing on the results and future perspectives.
