No abstract

No abstract

the plasma soluble urokinase-type plasminogen activator receptor (supAR) is a biomarker for focal segmental glomerulosclerosis (fSGS), but its value is under discussion because of ambiguous results arising from different ELISA methods in previous studies. The aim of this study was to compare diagnostic performance of two leading suPAR ELISA kits and examine four objectives in 146 subjects: (1) plasma suPAR levels according to glomerular disease (primary, secondary and recurrent FSGS after kidney transplantation, other glomerulonephritis) and in healthy controls; (2) suPAR levels based on glomerular filtration rate; (3) sensitivity and specificity of suPAR for FSGS diagnosis and determination of optimal cut-offs; (4) suPAR as prognostic tool. Patients with FSGS showed significant higher suPAR values than patients with other glomerulonephritis and healthy individuals. This applied to subjects with and without chronic kidney disease. Although both suPARnostic ™ assay and Quantikine Human upAR ELISA Kit exerted high sensitivity and specificity for FSGS diagnosis, their cut-off values of 4.644 ng/mL and 2.789 ng/mL were significantly different. Higher suPAR was furthermore predictive for progression to end-stage renal disease. In summary, suPAR values must be interpreted in the context of population and test methods used. Knowing test specific cut-offs makes suPAR a valuable biomarker for FSGS.Focal segmental glomerulosclerosis (FSGS) represents up to 20 percent of glomerular disease and is a leading cause of end-stage renal failure 1 . It affects native kidneys as well as renal allografts and the rate of recurrence of disease after transplantation is close to 30% in FSGS patients 2 .The pathophysiology and etiology of FSGS is still unclear 3 . However, it has been speculated that certain circulating factors might contribute to the initiation of renal injury 4 as evidenced by recurrence of FSGS after kidney transplantation 5 and the induction of remission after plasma exchange in subjects with recurrent FSGS early post renal transplantation 6 . Further evidence of potential circulating factors is the induction of proteinuria in kidneys of rats by administration of serum from FSGS patients 7 and the transmission of FSGS from mother to child 8 . In addition, it was reported that re-transplantation of a renal allograft with rapidly recurrent FSGS in a recipient with primary FSGS as underlying disease into a second recipient without native FSGS resulted in complete remission 9,10 .Several proteins have been suggested as the causative circulating factors responsible for the occurrence of primary FSGS or recurrence of disease after kidney transplantation, including cardiotrophin-like cytokine-1

Kidney transplantation (KTx) in end-stage renal disease is associated with a significant increase in quality of life (QoL) and self-perceived health, optimally leading to the maintenance of employment or return to work (RTW) in working-age patients. The aim of this study was to assess individual factors including the QoL and mental health of kidney transplant recipients (KTRs) associated with employment after transplantation. A cross-sectional study including working-age patients with a history of KTx after 2012 was conducted at two Austrian study centers (Vienna and Graz). Brief Symptom Inventory (BSI-18), World Health Organization Quality of Life (WHOQOL-Bref) and Workability Index (WAI) were assessed along with detailed questionnaires on employment status. Out of n = 139 KTRs (43.2 ± 9.07 years; 57.6% male), 72 (51.8%) were employed. Employed patients were more frequently in a partnership (p = 0.018) and had higher education levels (p = 0.01) and QoL scores (<0.001). Unemployed KTRs reported fatigue and mental health issues more often (p < 0.001), and had significantly higher anxiety, depression and somatization scores (BSI-18). In unadjusted logistical regression, workability score (WAS; odds ratio (OR) = 3.39; 95% confidence interval (CI) = 1.97–5.82; p < 0.001), partnership (OR = 5.47; 95% CI 1.43–20.91; p = 0.013) and no psychological counseling after KTx (OR = 0.06; 95% CI = 0.003–0.969; p = 0.048) were independently associated with employment. Self-assessed mental health, workability and QoL were significantly associated with employment status after KTx. Thus, in order to facilitate RTW after KTx in Austria, vocational rehabilitation and RTW programs addressing KTRs should focus on increasing social support and care for their mental health.

No abstract