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Chronic pancreatitis (CP) has anecdotally been linked to enteric hyperoxalur ia and oxalate nephropathy, both in native and transplanted kidneys. Pancreatic exocrine function can be evaluated by fecal elastase-1 (a pancreatic enzyme) and fecal acids teatocrit (a reliable and inexpensive measure of steatorrhea on a spot stool sample). Our aim was to evaluate the prevalence and determinants of hyperoxaluria in a cohort of patients with CP.Methods :Ali adults with CP seen at the gastro-enterology day clinic in Saint-Luc University Hospital were enrolled from 01/03/2012 to 31/10/2012. The diagnosis of CP was based on the presence of at least one clinical feature together with well-defined abnormalities in pancreas imaging. Baseline characterist ics (demographics, medications, and physical examination) were recorded. Oxaluria (two separate measures), fecal acid steatocrit and fecal elastase-1levels were measured in ail patients. Results are expressed as mean ± standard deviation (minimum - maximum).Results : 48 patients were included. The cohort was 96% Caucasian,50% male and 40% diabetic (63% on insulin).BMI was 23.8 ± 4.4 (14.5-36.2) kg/m2 Etiology of CP was toxic/alcoholic in 52%, idiopathie in 27% and genetic, autoimmune or obstructive in 21% of patients. 5/48 patients had a newly diagnosed CP. CP was diagnosed a mean of 7.2 ± 7.4 (0-27) years before inclusion and was/had been complicated (pseudocysts, bile duct or duodenal obstruction, pancreatic ascites,pancreatic fistula) in 18/48 patients. Estimated GFR was >60 ml/min/1.73m2 in 41/48 patients, with a plasma creatinine level of 0.8 ± 0.2 (0.4-1.4) mg/dl. Proteinuria was 0.1 ± 0.1(0.04-0.4) g/g of creatininuria. 17% of patients had clinical steatorrhea (>3 loose stools per day) and 50% were taking pancreatine pills (Creon®).The 2 oxaluria measures were well correlated (correlation p=0.68; p=0.05). 11/48 of patients (23%) had hyperoxaluria (>32 mg/g of creatininuria, mean 29 (9-87)). The determinants of hyperoxaluria were identified using the student t-test and the z-test as follows; pancreatic atrophy (p=0.007), acid steatocrit >31% (p=0.001), clinical steatorrhea (p=0.04), low fecal elastase-1 level (p<0.001), low carotene level (p=0.004), excessive alcohol intake (p=0.04), and long term diabetes (p<0.001). By logistic regression, hyperoxaluria was independently associated with both acid steatocrit >31% (p=0.04) and pancreatic atrophy (p=0.05). The presence of both factors has low sensitivity (64%) but moderate specificity (84%) for hyperoxaluria with a negative predictive value of 89%. The absence of both factors is thus associated with a low risk (3%) of hyperoxaluria.Conclusions: To our knowledge, this study is the first to define the prevalence of hyperoxaluria in a cohort of patients with CP. Approximate ly one out of four patients had hyperoxaluria. Hyperoxaluria was significantly associated with signs of intestinal malabsorpt ion and pancreatic insufficiency, and with radiological characteristics of CP. These patients are possibly at risk of developing urolithiasis and/or oxalate nephropathy, especially in case of intercurrent hypovolemia. lntensifying pancreatic enzyme supplements and treatment with calcium carbonate should therefore be considered in patients with hyperoxaluria . L'hyperoxalurie entérique et la néphropathie oxalique ont été rapportés dans la pancréatite chronique (PC). La fonction pancréatique peut être évaluée par le dosage de l'élastase fécale (une enzyme pancréatique) et du stéatocrite acide (une mesure simple et fiable de la stéatorrhée) sur un échantillon de selles. Le but de notre étude a été d'établir la prévalence et les déterminants de l'hyperoxalurie dans une cohorte de patients atteints de PC.Matériel et méthodes : Tous les patients vus en consultation de gastro-entérologie dans les cliniques universita ires Saint-Luc du 01/03/2012 au 31/10/2012 ont été inclus. Le diagnostic de PC s'est basé sur la présence d'au moins un critère clinique et sur la mise en évidence d'anomalies radiologiques caractéristiques. Les données relatives aux patients (données démograph iques, cliniques et le traitement ) ont été notées à l'inclusion. L'oxalurie (2 mesures), l'élastase fécale et le stéatocrite acide ont été dosés chez tous les patients. Les résultats sont exprimés en moyenne ± déviation standard (valeur minimale - valeur maximale).Résultats : 48 patients ont été inclus. La cohorte contient 96% de caucasiens, 50% d'hommes et 40% de diabétiques dont 63% insulinodépendants . Le BMI est de 23,8 ± 4,4 (14,5-36,2) kg/m2. L'étiologie de la PC est toxique/alcoolique dans 52%, idiopathique dans 27% et génétique, auto-immune ou obstructive/biliaire dans 21% des cas.5 patients sur 48 ont été diagnostiqués de PC dans l'année précédant l'inclusion. La PC a évolué sur une durée de 7,2 ± 7,4 (0-27) années et s'est compliquée (pseudokyste, obstruction biliaire ou duodénale, ascite pancréatique, fistule pancréatique) chez 18 patients sur 48. Le taux de filtrationglomérulaire a été estimé à >60 ml/min/ 1,73m2 chez 41 patients avec une créatinine plasmatique de 0,8 ±0,2 (0,4-1,4) mg/dl. La protéinurie a été de 0,1± 0,1(0,04-0,4) g/g de créatininurie. 17% des patients présentaient une stéatorrhée clinique (>3 selles/jour) à l'inclusion et 50% étaient sous traitement substitutif par Créon®.Les 2 valeurs d'oxalurie avaient une bonne corrélation (p=0,68 ; p=0,05). 11 patients sur 48 (23%) ont présenté une hyperoxalurie (> 32 mg/g de créatininurie, moyenne de 29 (9-87)). Le t-test de student et le z-test ont permis d'identifier les déterminants de l'hyperoxalurie, à savoir; l'atrophie pancréatique(p=0,007), un stéatocrite acide >31% (p=0,001), la présence d'une stéatorrhée clinique (p=0,04), une valeur basse d'élastase féca le (p<0,001), une valeur basse de carotène (p=0,004), une consommation excessive d'alcool (p=0,04), et une durée d'évolution longue du diabète (p<0,001). Après l'analyse par régression logistique, l'hyperoxalurie a été indépendamment assoc iée à la présence d'un stéatocrite acide>31% (p=0,04) et d'une atrophie pancréatique (p=0,05). La présence de ces deux facteurs est peu sensible (64%) mais assez spécifique (84%) de l'hyperoxalurie avec une va leur prédictive négative de 89%. Leur absence s'accompagne donc d'une faible probabilité (3%) de trouver une hyperoxalurie.Conclusion : À notre connaissance, cette étude est la première à établir la prévalence de l'hyperoxalurie dans la PC. Près d'un patient atteint de PC sur quatre est hyperoxalurique. L'hyperoxalurie a été associée à des signes de malabsorption intestinale et d'insuffisance pancréatique, et à des caractéristiques radiologiques de PC Ces patients sont à risque de développer des lithiases urinaires et/ou une néphropathie oxalique surtouten cas d'hypovolémie. Il importe donc de d'optimaliser le traitement substitutif par Créon® et de prescrire des suppléments de carbonate de calcium en cas d'hyperoxalurie.

Hyperoxaluria --- Pancreatitis, Chronic

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Advances in immunosuppression and kidney transplant techniques have led to significant improvements in the short-term survival of the renal allograft. Long-term graft survival, however, has relatively lagged behind and has now become one of the main problems in kidney transplantation. In this Special Issue, we discuss the recent research developments in kidney transplants that may affect long-term allografts, as well as the survival of the patient. The latest developments in living kidney donation are also explored.

Medicine --- malondialdehyde --- oxidative stress --- new-onset diabetes --- renal transplantation --- BK virus --- BK virus nephropathy --- kidney allograft --- transplantation --- Alport syndrome --- children --- autosomal dominant polycystic kidney disease --- epidemiology --- hospitalization --- kidney transplantation --- subarachnoid hemorrhage --- malignancy --- post-transplant malignancy --- renal cell carcinoma --- meta-analysis --- systematic reviews --- tacrolimus --- C/D-ratio --- pharmacokinetics --- opportunistic infection --- allograft survival --- urological complications --- ureteric stent --- urinary tract infection --- timing of removal --- living donor --- ethnicity --- age --- obesity --- genetic relationship donor/recipient --- atypical hemolytic uremic syndrome --- eculizumab --- glucose intolerance --- insulin secretion --- insulin resistance --- oral glucose tolerance test --- healthy subject --- hyperchloremia --- kidney graft dysfunction --- living donor kidney transplantation --- Uropathogenic E. coli --- UPEC --- phylogeny --- genomics --- antibiotic resistance --- virulence traits --- night-time renal transplantation --- graft survival --- patient survival/outcome --- surgical complications --- acute rejection --- lymphocyte --- CD45RC --- Belatacept --- cardiovascular high risk --- outcome --- machine perfusion --- organ preservation --- temperature --- hypothermic --- normothermic --- transplant --- proton-pump inhibitors --- iron --- iron deficiency --- polyomavirus --- BKV --- kidney --- glomerulus --- BKVAN --- nephropathy --- fluid management --- delayed graft function --- goal-directed fluid therapy --- calcineurin inhibitor nephrotoxcity --- C/D ratio --- tacrolimus metabolism --- ADPKD --- native nephrectomy --- patient outcome --- perioperative complications --- epidermal growth factor --- creatinine --- graft failure --- renal transplantation. --- new onset diabetes after renal transplantation --- single nucleotide polymorphisms --- n/a --- urinary biomarkers --- α-GST --- π-GST --- nephrotoxicity --- urinary excretion of N1-methylnicotinamide --- mortality --- niacin status --- dietary intake --- tryptophan --- vitamin B3 --- Kidney transplant --- vitamin C --- cancer mortality --- oxidative stress. --- mycophenolic acid --- immunosuppression --- plasmapheresis --- oxalate --- hyperoxaluria --- kidney transplant recipients --- post-transplantation diabetes mellitus --- all-cause mortality --- cardiovascular mortality --- infectious mortality --- magnesium --- hypomagnesaemia --- cancer --- kidney transplant --- survival --- living kidney donation --- living-donor kidney transplantation --- beliefs --- inequity --- ischemia reperfusion injury --- innate immune system --- adaptive immune system --- apoptosis --- necrosis --- hypoxic inducible factor --- endothelial dysfunction --- proton pump inhibitor --- transplant rejection --- GFR --- insulin-like growth factor 1 --- growth hormone --- muscle mass --- patient survival --- physical activity --- renal transplant recipients --- kidney transplant (KT) --- donor-specific antibodies (DSA) --- C3d-binding assay --- antibody-mediated rejection (AMR) --- arsenic --- diet --- fish consumption --- post-transplant diabetes mellitus --- N1-methyl-2-pyridone-5-carboxamide --- N1-methylnicotinamide --- urinary excretion --- kidney function --- biomarker --- branched chain amino acids --- posttransplant diarrhea --- methanogenesis --- Methanosphaera stadtmanae --- mucins --- sulfate-reducing bacteria --- acute humoral rejection --- first-line therapy --- outcomes --- proteasome inhibitor --- renal transplant --- transplant recipients --- calcineurin inhibitors --- FK506 --- pharmacokinetic --- fast tacrolimus metabolizers

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Advances in immunosuppression and kidney transplant techniques have led to significant improvements in the short-term survival of the renal allograft. Long-term graft survival, however, has relatively lagged behind and has now become one of the main problems in kidney transplantation. In this Special Issue, we discuss the recent research developments in kidney transplants that may affect long-term allografts, as well as the survival of the patient. The latest developments in living kidney donation are also explored.

malondialdehyde --- oxidative stress --- new-onset diabetes --- renal transplantation --- BK virus --- BK virus nephropathy --- kidney allograft --- transplantation --- Alport syndrome --- children --- autosomal dominant polycystic kidney disease --- epidemiology --- hospitalization --- kidney transplantation --- subarachnoid hemorrhage --- malignancy --- post-transplant malignancy --- renal cell carcinoma --- meta-analysis --- systematic reviews --- tacrolimus --- C/D-ratio --- pharmacokinetics --- opportunistic infection --- allograft survival --- urological complications --- ureteric stent --- urinary tract infection --- timing of removal --- living donor --- ethnicity --- age --- obesity --- genetic relationship donor/recipient --- atypical hemolytic uremic syndrome --- eculizumab --- glucose intolerance --- insulin secretion --- insulin resistance --- oral glucose tolerance test --- healthy subject --- hyperchloremia --- kidney graft dysfunction --- living donor kidney transplantation --- Uropathogenic E. coli --- UPEC --- phylogeny --- genomics --- antibiotic resistance --- virulence traits --- night-time renal transplantation --- graft survival --- patient survival/outcome --- surgical complications --- acute rejection --- lymphocyte --- CD45RC --- Belatacept --- cardiovascular high risk --- outcome --- machine perfusion --- organ preservation --- temperature --- hypothermic --- normothermic --- transplant --- proton-pump inhibitors --- iron --- iron deficiency --- polyomavirus --- BKV --- kidney --- glomerulus --- BKVAN --- nephropathy --- fluid management --- delayed graft function --- goal-directed fluid therapy --- calcineurin inhibitor nephrotoxcity --- C/D ratio --- tacrolimus metabolism --- ADPKD --- native nephrectomy --- patient outcome --- perioperative complications --- epidermal growth factor --- creatinine --- graft failure --- renal transplantation. --- new onset diabetes after renal transplantation --- single nucleotide polymorphisms --- n/a --- urinary biomarkers --- α-GST --- π-GST --- nephrotoxicity --- urinary excretion of N1-methylnicotinamide --- mortality --- niacin status --- dietary intake --- tryptophan --- vitamin B3 --- Kidney transplant --- vitamin C --- cancer mortality --- oxidative stress. --- mycophenolic acid --- immunosuppression --- plasmapheresis --- oxalate --- hyperoxaluria --- kidney transplant recipients --- post-transplantation diabetes mellitus --- all-cause mortality --- cardiovascular mortality --- infectious mortality --- magnesium --- hypomagnesaemia --- cancer --- kidney transplant --- survival --- living kidney donation --- living-donor kidney transplantation --- beliefs --- inequity --- ischemia reperfusion injury --- innate immune system --- adaptive immune system --- apoptosis --- necrosis --- hypoxic inducible factor --- endothelial dysfunction --- proton pump inhibitor --- transplant rejection --- GFR --- insulin-like growth factor 1 --- growth hormone --- muscle mass --- patient survival --- physical activity --- renal transplant recipients --- kidney transplant (KT) --- donor-specific antibodies (DSA) --- C3d-binding assay --- antibody-mediated rejection (AMR) --- arsenic --- diet --- fish consumption --- post-transplant diabetes mellitus --- N1-methyl-2-pyridone-5-carboxamide --- N1-methylnicotinamide --- urinary excretion --- kidney function --- biomarker --- branched chain amino acids --- posttransplant diarrhea --- methanogenesis --- Methanosphaera stadtmanae --- mucins --- sulfate-reducing bacteria --- acute humoral rejection --- first-line therapy --- outcomes --- proteasome inhibitor --- renal transplant --- transplant recipients --- calcineurin inhibitors --- FK506 --- pharmacokinetic --- fast tacrolimus metabolizers

Choose an application

• Reference Manager
• EndNote
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Advances in immunosuppression and kidney transplant techniques have led to significant improvements in the short-term survival of the renal allograft. Long-term graft survival, however, has relatively lagged behind and has now become one of the main problems in kidney transplantation. In this Special Issue, we discuss the recent research developments in kidney transplants that may affect long-term allografts, as well as the survival of the patient. The latest developments in living kidney donation are also explored.

Medicine --- malondialdehyde --- oxidative stress --- new-onset diabetes --- renal transplantation --- BK virus --- BK virus nephropathy --- kidney allograft --- transplantation --- Alport syndrome --- children --- autosomal dominant polycystic kidney disease --- epidemiology --- hospitalization --- kidney transplantation --- subarachnoid hemorrhage --- malignancy --- post-transplant malignancy --- renal cell carcinoma --- meta-analysis --- systematic reviews --- tacrolimus --- C/D-ratio --- pharmacokinetics --- opportunistic infection --- allograft survival --- urological complications --- ureteric stent --- urinary tract infection --- timing of removal --- living donor --- ethnicity --- age --- obesity --- genetic relationship donor/recipient --- atypical hemolytic uremic syndrome --- eculizumab --- glucose intolerance --- insulin secretion --- insulin resistance --- oral glucose tolerance test --- healthy subject --- hyperchloremia --- kidney graft dysfunction --- living donor kidney transplantation --- Uropathogenic E. coli --- UPEC --- phylogeny --- genomics --- antibiotic resistance --- virulence traits --- night-time renal transplantation --- graft survival --- patient survival/outcome --- surgical complications --- acute rejection --- lymphocyte --- CD45RC --- Belatacept --- cardiovascular high risk --- outcome --- machine perfusion --- organ preservation --- temperature --- hypothermic --- normothermic --- transplant --- proton-pump inhibitors --- iron --- iron deficiency --- polyomavirus --- BKV --- kidney --- glomerulus --- BKVAN --- nephropathy --- fluid management --- delayed graft function --- goal-directed fluid therapy --- calcineurin inhibitor nephrotoxcity --- C/D ratio --- tacrolimus metabolism --- ADPKD --- native nephrectomy --- patient outcome --- perioperative complications --- epidermal growth factor --- creatinine --- graft failure --- renal transplantation. --- new onset diabetes after renal transplantation --- single nucleotide polymorphisms --- urinary biomarkers --- α-GST --- π-GST --- nephrotoxicity --- urinary excretion of N1-methylnicotinamide --- mortality --- niacin status --- dietary intake --- tryptophan --- vitamin B3 --- Kidney transplant --- vitamin C --- cancer mortality --- oxidative stress. --- mycophenolic acid --- immunosuppression --- plasmapheresis --- oxalate --- hyperoxaluria --- kidney transplant recipients --- post-transplantation diabetes mellitus --- all-cause mortality --- cardiovascular mortality --- infectious mortality --- magnesium --- hypomagnesaemia --- cancer --- kidney transplant --- survival --- living kidney donation --- living-donor kidney transplantation --- beliefs --- inequity --- ischemia reperfusion injury --- innate immune system --- adaptive immune system --- apoptosis --- necrosis --- hypoxic inducible factor --- endothelial dysfunction --- proton pump inhibitor --- transplant rejection --- GFR --- insulin-like growth factor 1 --- growth hormone --- muscle mass --- patient survival --- physical activity --- renal transplant recipients --- kidney transplant (KT) --- donor-specific antibodies (DSA) --- C3d-binding assay --- antibody-mediated rejection (AMR) --- arsenic --- diet --- fish consumption --- post-transplant diabetes mellitus --- N1-methyl-2-pyridone-5-carboxamide --- N1-methylnicotinamide --- urinary excretion --- kidney function --- biomarker --- branched chain amino acids --- posttransplant diarrhea --- methanogenesis --- Methanosphaera stadtmanae --- mucins --- sulfate-reducing bacteria --- acute humoral rejection --- first-line therapy --- outcomes --- proteasome inhibitor --- renal transplant --- transplant recipients --- calcineurin inhibitors --- FK506 --- pharmacokinetic --- fast tacrolimus metabolizers --- malondialdehyde --- oxidative stress --- new-onset diabetes --- renal transplantation --- BK virus --- BK virus nephropathy --- kidney allograft --- transplantation --- Alport syndrome --- children --- autosomal dominant polycystic kidney disease --- epidemiology --- hospitalization --- kidney transplantation --- subarachnoid hemorrhage --- malignancy --- post-transplant malignancy --- renal cell carcinoma --- meta-analysis --- systematic reviews --- tacrolimus --- C/D-ratio --- pharmacokinetics --- opportunistic infection --- allograft survival --- urological complications --- ureteric stent --- urinary tract infection --- timing of removal --- living donor --- ethnicity --- age --- obesity --- genetic relationship donor/recipient --- atypical hemolytic uremic syndrome --- eculizumab --- glucose intolerance --- insulin secretion --- insulin resistance --- oral glucose tolerance test --- healthy subject --- hyperchloremia --- kidney graft dysfunction --- living donor kidney transplantation --- Uropathogenic E. coli --- UPEC --- phylogeny --- genomics --- antibiotic resistance --- virulence traits --- night-time renal transplantation --- graft survival --- patient survival/outcome --- surgical complications --- acute rejection --- lymphocyte --- CD45RC --- Belatacept --- cardiovascular high risk --- outcome --- machine perfusion --- organ preservation --- temperature --- hypothermic --- normothermic --- transplant --- proton-pump inhibitors --- iron --- iron deficiency --- polyomavirus --- BKV --- kidney --- glomerulus --- BKVAN --- nephropathy --- fluid management --- delayed graft function --- goal-directed fluid therapy --- calcineurin inhibitor nephrotoxcity --- C/D ratio --- tacrolimus metabolism --- ADPKD --- native nephrectomy --- patient outcome --- perioperative complications --- epidermal growth factor --- creatinine --- graft failure --- renal transplantation. --- new onset diabetes after renal transplantation --- single nucleotide polymorphisms --- urinary biomarkers --- α-GST --- π-GST --- nephrotoxicity --- urinary excretion of N1-methylnicotinamide --- mortality --- niacin status --- dietary intake --- tryptophan --- vitamin B3 --- Kidney transplant --- vitamin C --- cancer mortality --- oxidative stress. --- mycophenolic acid --- immunosuppression --- plasmapheresis --- oxalate --- hyperoxaluria --- kidney transplant recipients --- post-transplantation diabetes mellitus --- all-cause mortality --- cardiovascular mortality --- infectious mortality --- magnesium --- hypomagnesaemia --- cancer --- kidney transplant --- survival --- living kidney donation --- living-donor kidney transplantation --- beliefs --- inequity --- ischemia reperfusion injury --- innate immune system --- adaptive immune system --- apoptosis --- necrosis --- hypoxic inducible factor --- endothelial dysfunction --- proton pump inhibitor --- transplant rejection --- GFR --- insulin-like growth factor 1 --- growth hormone --- muscle mass --- patient survival --- physical activity --- renal transplant recipients --- kidney transplant (KT) --- donor-specific antibodies (DSA) --- C3d-binding assay --- antibody-mediated rejection (AMR) --- arsenic --- diet --- fish consumption --- post-transplant diabetes mellitus --- N1-methyl-2-pyridone-5-carboxamide --- N1-methylnicotinamide --- urinary excretion --- kidney function --- biomarker --- branched chain amino acids --- posttransplant diarrhea --- methanogenesis --- Methanosphaera stadtmanae --- mucins --- sulfate-reducing bacteria --- acute humoral rejection --- first-line therapy --- outcomes --- proteasome inhibitor --- renal transplant --- transplant recipients --- calcineurin inhibitors --- FK506 --- pharmacokinetic --- fast tacrolimus metabolizers