Browsing by Subject "KIDNEY INJURY"

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  • Vaheri, Antti; Henttonen, Heikki; Mustonen, Jukka (2021)
    Finland has the highest incidence of hantavirus infections globally, with a significant impact on public health. The large coverage of boreal forests and the cyclic dynamics of the dominant forest rodent species, the bank vole Myodes glareolus, explain most of this. We review the relationships between Puumala hantavirus (PUUV), its host rodent, and the hantavirus disease, nephropathia epidemica (NE), in Finland. We describe the history of NE and its diagnostic research in Finland, the seasonal and multiannual cyclic dynamics of PUUV in bank voles impacting human epidemiology, and we compare our northern epidemiological patterns with those in temperate Europe. The long survival of PUUV outside the host and the life-long shedding of PUUV by the bank voles are highlighted. In humans, the infection has unique features in pathobiology but rarely long-term consequences. NE is affected by specific host genetics and risk behavior (smoking), and certain biomarkers can predict the outcome. Unlike many other hantaviruses, PUUV causes a relatively mild disease and is rarely fatal. Reinfections do not exist. Antiviral therapy is complicated by the fact that when symptoms appear, the patient already has a generalized infection. Blocking vascular leakage measures counteracting pathobiology, offer a real therapeutic approach.
  • RIPTRANS Study Grp Collaborators; Uutela, Aki; Helanterä, Ilkka; Lemström, Karl; Passov, Arie; Syrjälä, Simo; Åberg, Fredrik; Mäkisalo, Heikki; Nordin, Arno; Lempinen, Marko; Sallinen, Ville (2020)
    Introduction Remote ischaemic preconditioning (RIPC) using a non-invasive pneumatic tourniquet is a potential method for reducing ischaemia-reperfusion injury. RIPC has been extensively studied in animal models and cardiac surgery, but scarcely in solid organ transplantation. RIPC could be an inexpensive and simple method to improve function of transplanted organs. Accordingly, we aim to study whether RIPC performed in brain-dead organ donors improves function and longevity of transplanted organs. Methods and analyses RIPTRANS is a multicentre, sham-controlled, parallel group, randomised superiority trial comparing RIPC intervention versus sham-intervention in brain-dead organ donors scheduled to donate at least one kidney. Recipients of the organs (kidney, liver, pancreas, heart, lungs) from a randomised donor will be included provided that they give written informed consent. The RIPC intervention is performed by inflating a thigh tourniquet to 300 mm Hg 4 times for 5 min. The intervention is done two times: first right after the declaration of brain death and second immediately before transferring the donor to the operating theatre. The sham group receives the tourniquet, but it is not inflated. The primary endpoint is delayed graft function (DGF) in kidney allografts. Secondary endpoints include short-term functional outcomes of transplanted organs, rejections and graft survival in various time points up to 20 years. We aim to show that RIPC reduces the incidence of DGF from 25% to 15%. According to this, the sample size is set to 500 kidney transplant recipients. Ethics and dissemination This study has been approved by Helsinki University Hospital Ethics Committee and Helsinki University Hospital's Institutional Review Board. The study protocol was be presented at the European Society of Organ Transplantation congress in Copenhagen 14-15 September 2019. The study results will be submitted to an international peer-reviewed scientific journal for publication.
  • Hemilä, Harri Olavi; Rezaei, Yousef (2017)
    McCullough et al. (1) reviewed the pathophysiology and treatment options for contrast-induced acute kidney injury (CI-AKI). They stated that no effective adjunctive pharmaceutical had been demonstrated that either prevented or treated CI-AKI. However, they also suggested that of the agents being investigated, statins were the most promising. We would like to point out that strong evidence has also emerged regarding the effect of vitamin E against CI-AKI, which was not mentioned in their review.
  • Rezaei, Yousef; Hemilä, Harri (2017)
    A recent meta-analysis by Su et al. compared 12 different prophylactic interventions against contrast medium–induced acute kidney injury (CIAKI). In their meta-analysis, Su et al. pooled different vitamins to a single group of “vitamins and analogues” but in so doing did not take into account that vitamin C is water soluble whereas vitamin E is fat soluble, and therefore their relative effects might be different... Su et al. had identified 3 randomized trials on vitamin E prophylaxis against CIAKI. We pooled the results of these 3 studies and calculated a pooled estimate of RR = 0.38 (95% CI 0.24-0.62), indicating that vitamin E significantly prevented CIAKI.