ORCID Profile
0000-0002-4685-4592
Current Organisations
Amsterdam University Medical Centers
,
The University of Newcastle
,
University of Newcastle Australia
,
John Hunter Hospital
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Publisher: Wiley
Date: 22-08-2016
DOI: 10.1111/NEP.12683
Publisher: Wiley
Date: 28-11-2018
DOI: 10.1111/TID.13021
Abstract: Guillain-Barré syndrome (GBS) is a common ascending polyneuropathy in adults. It is often associated with preceding viral or diarrhoeal illness with cytomegalovirus (CMV), Epstein-Barr virus (EBV), or C ylobacter jejuni. Solid organ transplant recipients are more susceptible to opportunistic infections with CMV than the general population as a result of immunosuppressive therapies to prevent graft rejection. However, reports of GBS are rare in this population. To systematically review cases of GBS in renal transplant patients to evaluate causative pathogens or triggers, management and associated morbidity and mortality. We conducted a systematic search of the MEDLINE database uncovering 17 cases of GBS in renal transplant patients in the literature. The majority of cases were in males (81%) and patients who received deceased donor renal transplants (87%). The mean age was 44.7 years (SD 13). The time between transplant and onset of symptoms ranged from 2 days to 10 years (Mean = 720 days). GBS was commonly associated with antecedent viral (CMV 12 EBV 1) or diarrhoeal (2) illness while two cases were attributed to calcineurin inhibitor use. All patients recovered fully or partially after treatment with anti-viral or anti-bacterial agents, immunoglobulins, and/or plasma exchange. Cytomegalovirus is the most common trigger for GBS in the post-renal transplant setting. Other triggers include c ylobacter jejuni and calcineurin inhibitors. GBS should be considered in transplant patients presenting with weakness or paralysis in order to institute timely management.
Publisher: Wiley
Date: 06-2018
DOI: 10.1111/NEP.13176
Abstract: Acute kidney injury is rarely the presenting feature of sarcoidosis. We present a case series of patients whose diagnosis of sarcoidosis was only brought to light by the development of renal impairment. Concurrent hypercalcaemia was noted, prompting further investigation. The patients discussed experienced a significant and rapid improvement in both renal function and hypercalcaemia in response to therapy with prednisolone. This is out of keeping with previous reports of sarcoidosis-induced renal impairment. Our case series highlights the importance of testing for hypercalcaemia in the context of acute kidney injury. Sarcoidosis is primarily a disease of the lungs and reticuloendothelial system however, the prevalence of renal involvement with sarcoidosis may be under-recognized. The renal manifestations of sarcoidosis are discussed in the context of the current literature. Furthermore, from our experience, we postulate that in the context of sarcoidosis-induced renal injury, concurrent hypercalcaemia may present prior to the development of chronic renal injury and therefore these patients may be more likely to recover renal function.
Publisher: Wiley
Date: 19-05-2007
DOI: 10.1111/J.1399-3062.2007.00234.X
Abstract: Lymphomatoid granulomatosis (LYG) is a rare multisystemic angiocentric lymphoproliferative disease, which can masquerade as necrotic tissue. There is a paucity of reports of LYG in renal transplant recipients. Herein, we describe LYG in a 56-year-old renal allograft recipient 11 years after transplantation, on azathioprine and prednisolone maintenance immunosuppression, presenting to us with fever, weight loss, and nodular and patchy opacities in both lung fields. Initial percutaneous s les showed necrotic tissue while open biopsy revealed characteristic histopathology with evidence of Epstein-Barr virus. We have reviewed the radiological and pathological findings, and discussed clinical features, differential diagnosis, and treatment of LYG.
Publisher: Wiley
Date: 04-07-2018
Abstract: Long-term hemodialysis (HD) imposes a significant burden on the quality of life of end-stage kidney disease patients. Optimizing dialysis dose is an important consideration in this population however, evidence exists that suggests that attainment of population dialysis targets is associated with increased intradialytic complications. In this prospective, before-after study, the blood flow rate (BFR) of 63 maintenance HD patients was increased by 100 mL/min to a maximum BFR of 400 mL/min to determine the impact on patient tolerability and urea reduction ratio (URR) of an increased BFR. Tolerability was assessed by time to recovery (TTR) after dialysis, a validated measure of patient tolerability, and intradialytic complications. Median pre-increase BFR was 252 mL/min compared to 349 mL/min post-increase. Mean TTR decreased from 4.67 h to 4.03 h (P = 0.688). No association was observed between percentage change in BFR (R2 = 0.0) or post-increase BFR (R2 = 0.0) and absolute change in TTR. A significant, positive association was observed between both the absolute and relative changes to BFR and the achieved URR. We found no evidence that increasing BFR by 100 mL/min diminishes patient tolerability.
Publisher: Wiley
Date: 26-07-0007
DOI: 10.1111/IMJ.15869
Abstract: Chronic kidney disease (CKD) of unknown aetiology is a form of tubulointerstitial CKD in the absence of traditional and known predisposing risk factors. Since the early 2000s, there is an emerging trend in marginalised agricultural communities among workers exposed to occupational and environmental hazards. CKD of unknown aetiology has received significant attention in recent years and is becoming increasingly relevant to the Australian medical community with the growing migrant population, which this case‐based communication illustrates.
Publisher: Elsevier BV
Date: 12-2017
Publisher: Wiley
Date: 21-05-2021
DOI: 10.1111/CEA.13885
Abstract: Severe asthma is a heterogeneous disease with different phenotypes based on clinical, functional or inflammatory parameters. In particular, the eosinophilic phenotype is associated with type 2 inflammation and increased levels of interleukin (IL)‐4, IL‐5 and IL‐13). Monoclonal antibodies that target the eosinophilic inflammatory pathways (IL‐5R and IL‐5), namely mepolizumab, reslizumab, and benralizumab, are effective and safe for severe eosinophilic asthma. Eosinophils threshold represents the most indicative biomarker for response to treatment with all three monoclonal antibodies. Improvement in asthma symptoms scores, lung function, the number of exacerbations, history of late‐onset asthma, chronic rhinosinusitis with nasal polyposis, low oral corticosteroids use and low body mass index represent predictive clinical markers of response. Novel Omics studies are emerging with proteomics data and exhaled breath analyses. These may prove useful as biomarkers of response and non‐response biologics. Moreover, future biomarker studies need to be undertaken in paediatric patients affected by severe asthma. The choice of appropriate biologic therapy for severe asthma remains challenging. The importance of finding biomarkers that can predict response continuous an open issue that needs to be further explored. This review describes the clinical effects of targeting the IL‐5 pathway in severe asthma in adult and paediatric patients, focusing on predictors of response and non‐response.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-01-2014
Publisher: Elsevier BV
Date: 04-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2020
Publisher: Informa UK Limited
Date: 10-01-2011
Publisher: Wiley
Date: 09-10-2011
DOI: 10.1111/J.1399-3062.2011.00682.X
Abstract: Cytomegalovirus (CMV) remains a major cause of morbidity and mortality among transplant recipients, frequently engaging the clinician in a struggle to balance graft preservation with control of CMV disease. Leflunomide has been shown to have immunosuppressive activity in experimental allograft models together with antiviral activity inhibiting CMV both in vitro and in vivo. Data are emerging about its potential role in ganciclovir-sensitive and -resistant CMV, primarily by virtue of a unique mechanism inhibiting virion assembly, as opposed to inhibition of viral DNA synthesis by current agents. This review aims to put in perspective, the knowledge acquired in the last decade or so on leflunomide for CMV. Evidence suggests that it might have activity against human CMV with good oral bioavailability and, more importantly in the resource-poor setting, is economical. Although the data presented here are not from randomized trials, several relevant observations have been made that could influence future, more structured assessments of the drug. An immune suppressive compound with antiviral features and experimental activity in chronic rejection is an attractive combination for organ transplantation, and it appears that leflunomide may just fit that niche.
Publisher: Dustri-Verlgag Dr. Karl Feistle
Date: 05-2018
DOI: 10.5414/CN109368
Publisher: Springer Science and Business Media LLC
Date: 13-11-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-05-2023
Publisher: SAGE Publications
Date: 24-04-2018
Publisher: Wiley
Date: 09-09-2011
DOI: 10.1111/J.1399-0012.2011.01509.X
Abstract: Long-term renal graft survival is h ered by allograft dysfunction and cardiovascular disease resulting from calcineurin inhibitors (CNIs). This has led to the development of immunosuppressive regimens involving mammalian target of rapamaycin (mTOR) inhibitors, sirolimus and everolimus. They seem to provide long-term benefits for kidney function in transplant patients because of their anti-proliferation and anti-tumor properties and absence of nephrotoxicity. Their use has been evaluated in therapeutic regimens aimed at reducing the nephrotoxicity associated with CNIs. Both proactive and reactive strategies have been used. Whether existing strategies of using mTORi in renal transplantation is applicable for Indian patient's remains to be seen. Data on side effect profile, economic viability and the impact of these drugs on infections, particularly in India, are worth documenting. After briefly reviewing available data from India, this article explores the indications, patient populations timing and practical aspects as well as the safety and efficacy of mTORi-based regimens for renal transplantation and suggests a framework which could allow transplant physicians to tailor its use to their own practice with particular reference to the Indian subcontinent.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 02-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-06-2007
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/08860220500531286
Abstract: Intravenous immunoglobulin preparations are being used for an increasing number of indications. To minimize adverse reactions, sugar additives such as sucrose, maltose, and glycine are added to some preparations to serve as stabilizing agents. Intravenous immunoglobulin infusion induces acute renal failure (ARF) via a mechanism of osmotic nephrosis. Most reported cases are related to the use of sucrose-based intravenous immunoglobulin. Herein, we describe a patient with lupus nephritis treated with an immunoglobulin preparation containing maltose who developed ARF with histologic changes characterized by vacuolization and swelling of renal proximal tubular cells. Our case draws nephrologists' attention to the potential of maltose-based immunoglobulin in producing renal failure. Awareness and exercising caution in high-risk groups is elementary to the prevention of this condition.
Publisher: Wiley
Date: 16-06-2022
DOI: 10.1111/TID.13880
Publisher: Oxford University Press (OUP)
Date: 02-06-2019
DOI: 10.1093/CKJ/SFY039
Publisher: Wiley
Date: 17-12-2017
DOI: 10.1111/NEP.13165
Abstract: Patients with a failed or failing renal transplant are increasing in number. Graft failure resulting in dialysis re-initiation is not uncommon, yet there are limited data to guide management of these patients. Physician practices vary regarding timing of dialysis initiation and the timing and extent of immunosuppression withdrawal. The risks of immunosuppression withdrawal need to be carefully balanced against the benefits of continuing low-dose therapy. The latter helps minimize the risk of sensitisation and has been proposed to possibly slow the loss of residual renal function however, the use of common immunosuppressive agents may contribute to cardiovascular disease, malignancy, and infection, the major causes of death following the loss of a renal transplant. The evolving area of personalised transplant immunosuppression may offer future tools for monitoring and managing patients during and after transplant failure. This article aims to discuss some of the important issues that arise when managing these patients.
Publisher: Wiley
Date: 23-06-2022
DOI: 10.1111/NEP.14078
Publisher: Elsevier BV
Date: 05-2023
Publisher: Medknow
Date: 2016
Abstract: Fanconi syndrome (FS) in an adult patient is an unusual finding and it merits thorough evaluation. Paraproteinemias are one of the common etiologies in adult FS and need to be ruled out. Among the various forms of renal involvement in multiple myeloma, light chain proximal tubulopathy (LCPT) is the rarest. Usually, it causes proximal tubular dysfunction which is characterized by intracytoplasmic deposition of crystallized, mostly kappa monoclonal light chains in proximal tubules however, glomerular crystal deposition is unusual. Herein, we are presenting a patient with renal dysfunction and FS. On evaluation, she was found to have multiple myeloma and renal biopsy showed LCPT with extensive crystal deposition in the proximal tubular epithelium along with crystal deposition in the glomerular capillary endothelium. The treatment of the underlying multiple myeloma caused remission of the FS.
Publisher: Wiley
Date: 10-2005
DOI: 10.1111/J.1440-1797.2005.00445.X
Abstract: IgA nephropathy (IgAN) is not well characterized in India. This retrospective study of 478 patients with IgAN was performed to clarify the presenting features, prognostic factors and the renal survival rates of the disease. Three hundred and forty-seven patients who had been followed on average for 27 months after diagnosis were ided into two groups based on renal function at diagnosis. In group 1 (229 patients), the creatinine clearance estimated by the Modification of Diet in Renal Disease formula was /=85 mL/min. The predominant modes of presentation were nephrotic syndrome, hypertension and renal failure. Twenty-nine percent of patients had more than a 20% decline in renal function at the last follow up. Multivariate analyses with stepwise logistic regression identified hypertension (odds ratio (OR) 3.5), nephrotic range proteinuria (OR 3.4) and sclerosed glomeruli on biopsy (OR 4.1) to be independently associated with progression in group 1 and hypertension (OR 2.3) in group 2. Seventeen percent of patients progressed to end-stage renal disease (ESRD). Using multivariate analysis by the Cox model, four risk factors for developing ESRD were identified: hypertension (hazard ratio (HR) 3.1) nephrotic proteinuria (HR 1.9) interstitial fibrosis (HR 2.5) and sclerosed glomeruli (HR 1.8). The renal survival rates at 1, 5 and 10 years were 84, 55 and 33%, respectively, with a median renal survival of 61 months from the time of biopsy. The relatively rapid rate of progression of IgAN in India is suggestive towards a 'malignant' nature of the disease in this country.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2004
Publisher: Informa UK Limited
Date: 2007
Publisher: Wiley
Date: 29-08-2007
DOI: 10.1111/J.1399-3046.2007.00774.X
Abstract: Renal transplantation is the optimal treatment for children with ESRD. We undertook this study to establish the outcome of pediatric renal transplants in a resource-constrained environment in a developing country. A retrospective analysis on 90 pediatric renal transplants (age at transplant 2 rejection episodes (p = 0.05), while sepsis (p = 0.01) was the most important contributor to patient loss. Pediatric renal transplantation in India can be accomplished successfully. The graft and patient survival in our study, the largest from India, is comparable to those published from developed countries and is encouraging given the limited resources.
Publisher: Dustri-Verlgag Dr. Karl Feistle
Date: 05-2019
DOI: 10.5414/CN109699
Publisher: Wiley
Date: 08-01-2016
DOI: 10.1111/HDI.12385
Publisher: Elsevier BV
Date: 09-2021
Publisher: Dustri-Verlgag Dr. Karl Feistle
Date: 09-2018
DOI: 10.5414/CN109519
No related grants have been discovered for Korneliusz Golebski.