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Syfte: Syftet med föreliggande uppsats är att mäta och beskriva hälsorelaterad livskvalitet hosnjurtransplanterade patienter, tolv till 24 månader efter transplantationen, i relation till den svenskanormalpopulationen. Vidare kommer korrelationen mellan livskvalitet och demografiska faktorer attundersökas. Metod: 54 patienter som njurtransplanterats för tolv till 24 månader sedan har deltagit i studien.Hälsorelaterad livskvalitet undersöktes med hjälp av SF-36 Hälsoenkät. Resultat: Undersökningsgruppen ansersig vara mer fysiskt begränsade och uppger i större utsträckning att de är begränsade att utföra arbete eller andrafysiska aktiviteter på grund av fysisk ohälsa, jämfört med motsvarande åldersgrupp i normalpopulationen.Dessutom värderar undersökningsgruppen sitt generella hälsotillstånd lägre än jämförelsegruppen. Det finnsingen signifikant skillnad i hälsorelaterad livskvalitet mellan njurtransplanterade kvinnor och män med avseendepå fysisk hälsa. Däremot skattar njurtransplanterade män sitt psykiska välbefinnande högre ännjurtransplanterade kvinnor (m=82,7/m=71,6). Ingen korrelation har kunnat påvisas beträffande ålder ochhälsorelaterad livskvalitet hos den valda patientgruppen. Slutsats: Njurtransplanterade patienter värderar sinhälsorelaterade livskvalitet lägre i flera aspekter än den svenska normalpopulationen. Detta gäller framför alltpatienternas fysiska hälsa. Skillnaderna är inte lika uttalade när det gäller psykisk hälsa.

This KwaZulu-Natal (KZN) based study investigates hypertension, glomerulonephritides and the rarity of IgA Nephropathy (IgAN) in Africans in association with the Human Leukocyte Antigen (HLA). A retrospective hypertensive study found a positive association with HLA-B40 (P c<0.05) and HLA-B15 (Pc<0.02) in Indians and Africans respectively. No association was found in Whites. A prospective study showed glomerulonephritides to be positively associated with HLA-A33 in Indians (Pc 0.049). No associations were found with glomerulonephritides in Africans and Whites. Combined Race groups show no HLA associations. HLA-A30; HLA-A34; HLA-A29; HLA-B42; HLA-B58; HLA-B70 and HLA-DR11 were extremely significantly higher in Africans compared to Indians and Whites (all P<0.0001). In conclusion, HLA-B40 and I 1LA-B15 are possible disease susceptibility markers in Indian and African hypertensives; HLA-A33 is a possible disease susceptibility marker for glomerulonephritides in Indians and alleles in linkage might be responsible for the rarity of IgAN in Africans but further studies need to be employed. / Thesis (M.Med)-University of KwaZulu-Natal, 2007.

The mammalian kidney and reproductive systems both derive from a common embryological origin, the intermediate mesoderm. Abnormal intermediate mesoderm development can result in congenital abnormalities of the urogenital system, yet the molecular mechanisms that govern intermediate mesoderm development are incompletely defined. The spatial and temporal expression of the proteins BMP2 and 4 and their receptor ALK3, in urogenital tissue, suggests a function for BMP-ALK3 signaling in the intermediate mesoderm. It was found that Alk3IM null kidneys display renal hypoplasia, associated with a decrease in kidney size and nephron number. The phenotype of renal hypoplasia in Alk3IM nulls was associated with early decreased number of developing nephron structures and secondary defects in branching morphogenesis. While neither apoptosis nor cell proliferation differed in metanephric mesenchyme cells in Alk3IM nulls, markers of renal progenitor cells were decreased in mutant animals. It was observed that Alk3 expression in the intermediate mesoderm also controls mesonephric tubule number. Alk3IM nulls had fewer mesonephric tubules and fewer derivative Leydig cells. The reduction in Leydig cells resulted in decreased levels in serum testosterone and defects in seminal vesicle formation and fertility. Alk3 expression was also required for normal development of the corpus epididymis. The morphological defects in nephrogenesis were associated with decreased phospho-p38 MAPK expression and in the testis with decreased Phospho-SMAD1/5/8. These results elucidated a requirement for Alk3 signaling in controlling progenitor cells derived from the intermediate mesoderm.

Vascular endothelial growth factor-A (VEGF) is required for endothelial cell differentiation and survival. To investigate the renoprotective properties of VEGF in diabetes an inducible Cre-loxP gene targeting system was used to excise VEGF from podocytes of adult mice (VEGFKO). Diabetes was induced by streptozotocin (STZ) at 2.5 weeks of age and VEGFKO was induced by doxycycline (dox) at 3-4 weeks of age. Blood and urine were collected weekly to monitor for hyperglycaemia and proteinuria, respectively. Mice were dissected 8 weeks after diabetes induction or earlier if morbidly ill; twenty percent of the mice in the DM+VEGFKO group died before the surrogate endpoint. Glomerular VEGF mRNA expression was decreased in VEGFKO mice compared to controls. However, DM+VEGFKO mice had significantly greater proteinuria, degrees of glomerular sclerosis, and glomerular cell apoptosis. These results confirm that VEGF is normally upregulated in diabetes but reducing VEGF expression in diabetes causes severe kidney injury.

Tyrimo tikslas buvo įvertinti sensitizaciją ŽLA antigenais, inksto transplantatų recipientams, kurie greta standartinės imunosupresijos vartojo monokloninius antikūnus prieš IL-2 receptorių ir monokloninių antikūnų nevartojusiems recipientams. Tyrime dalyvauja VULSK pacientai, kuriems 2000-2005 metais imtinai buvo atliktos inkstų transplantacijos (Tx), bei kurie prieš ir po Tx buvo tirti dėl teigiamai su limfocitų panele reaguojančių antikūnų skaičiaus, išreikšto procentais (PRA). Iš viso tyrime dalyvauja 189 recipientai. Dalis jų (n=83) greta standartinės imunosupresijos vartojo monokloninius antikūnus prieš IL-2 receptorių (basiliksimabą ar daklizumabą), kiti (n=106) gavo tik standartinę imunosupresiją. Pagrindiniai sensitizaciją ŽLA antigenais lemiantys veiksniai abiejose grupėse pasiskirstė nevienodai. Didesnė monokloninius antikūnus vartojusių dalis gavo kraujo perpylimus (72% vs. 57,3%), šioje grupėje taip pat daugiau buvo pakartotinų Tx (9,6% vs. 7,5%), tik gimdžiusių moterų skaičius didesnis buvo monokloninių antikūnų nevartojusioje grupėje (47,7% vs. 30,8%). Tirtos ligonių grupės palygintos taikant &#967;² kriterijų, skirtumas laikytas statistiškai reikšmingas, kai p<0,05. Išanalizavus recipientų sensitizaciją prieš Tx paaiškėjo, kad dauguma (58%; 110/189) buvo nesensitizuoti (PRA 0-10%), likę 42% (79/189) - sensitizuoti, iš kurių 14% (11/189) – labai sensitizuoti (PRA 50-100%). Po Tx monokloninius antikūnus vartojusių recipientų grupėje (n=83) 2% padaugėjo... [toliau žr. visą tekstą] / The aim of this study was to evaluate the sensitization with HLA antigens in kidney transplant recipients, who received induction therapy with monoclonal antibodies against IL-2R and in the group of patients, who were only under the triple drug therapy. This study comprises recipients, who received kidney transplant in the year 2000-2005, and who were tested for panel reactive antibody test before and after transplantation (Tx). The total number of 189 kidney transplant recipients takes part in this study. 83 received monoclonal antibodies against IL-2R (basiliximab or daclizumab), others (n=106) – did not. These groups were unequal in comparison to the main factors causing sensitization with HLA antigens. The group of patients, who received induction therapy with monoclonal antibodies had more blood transfuzions (72% vs. 57,3%), and previous transplantations (9,6% vs. 7,5%), in comparison with the other group. Only the number of pregnancies was higher in the group of patients who were only under the triple drug therapy (47,7% vs. 30,8%). Statistical analyses were caried out using chi-square test, differences were considered significant at p<0,05. 58% (110/189) of kidney transplant recipients were unsensitized (PRA 0-10%) before Tx, the rest 42% (79/189) were sensitized, from which 14% (11/189) were highly sensitized (PRA 50-100%). After Tx the number of medium sensitized (PRA 11-50%) kidney transplant recipients, who received induction therapy by monoclonal antibodies... [to full text]

This thesis investigates the role of Canadians in the international trade in human organs and the factors influencing patient decision making, assuming that patients make decisions regarding the management of their illness in a complex social, cultural, political and economic nexus. It engages a broad theoretical question of whether Canadians uphold values consistent with a commitment to consumerism, commodifying organs as needed and afforded, or altruism, supportive of voluntary organ donation systems. Semi-structured interviews were conducted with hemodialysis patients and their care givers in a southern Ontario hospital. Based on this analysis, Canadians appear to fall somewhere in the middle of the consumer-altruist divide. The dominant sentiment among participants was that Canadians ought not to be commodified, but the organs of foreign others in places removed from the Canadian value system hold potential, and provide opportunities for participating in a market when the supply of organs falls short of demand.

Our epidemiology research found that the incident and prevalent rates for Diabetes mellitus (DM) and Diabetic End Stage Renal Disease (DM-ESRD) were at rise in Saskatchewan between year 1980 and 2005. Combining concerns regarding the rising trends reported by research studies with the concerns of the significant health and financial burden imposed by DM-ESRD on individuals and societies, we sought to project the number of DM-ESRD patients in Saskatchewan up to year 2025 with the cost required for caring for those patients. An agent-based model (ABM) is developed to simulate DM to ESRD progression, treatments for DM-ESRD patients, and the assessments and waiting list processes preparing patients for kidney transplants. The model parameters were estimated from a wide variety of data sources. The agent based modeling approach is chosen for projections regarding the DM-ESRD situation in Saskatchewan because of its advantage in capturing heterogeneities of individual patients, ability to retain biographical information on patients, capacity to capture time-varying competing risks, better presentations features and easy integration with existing models built in either agent based or System Dynamic methods. The approach was also attractive due to its flexibility for future expansion to represent social networks. The model projects the incident and prevalent case count, cost, and person years lived for the DM-ESRD population in Saskatchewan between year 1980 and 2025. The projections captured the great challenges brought by the fast growing number of DM-ESRD patients and substantial cost associated with managing the disease. In addition to producing projection results, the research presented here demonstrates how the model can be used by policy makers to experiment and evaluate different policy/interventions in a safe context. By capturing both the individual level records and population level statistics, the model provide a wealth of data for detailed analysis, which can help health policy makers gain insights in the current and future diabetic-ESRD situation in the province, aiding in resources planning for managing the fast-growing ESRD population and the growing need for dialysis services.

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