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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Patients with chronic renal disease&#44; including those on hemodialysis&#44; have a high mortality rate&#44; and a significant proportion of this mortality is due to cardiovascular disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1&#44;2</span></a> Renal transplantation may lead to better long-term survival than hemodialysis&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Antibodies to cardiac troponin I are elevated in a significant number of patients with both ischemic cardiomyopathy and idiopathic dilated cardiomyopathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">4&#44;5</span></a> Absence of autoantibodies against cardiac troponin I was found in one study to predict improvement of left ventricular function after acute myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> In another study&#44; however&#44; the presence of the same type of autoantibodies in plasma was associated with improved survival in patients with chronic dilated cardiomyopathy&#44; but not with ischemic cardiomyopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We recently described a case of hemodialysis-associated dilated cardiomyopathy with a marked improvement in left ventricular ejection fraction &#40;LVEF&#41; after renal transplantation&#44; in association with high titers of anti-troponin I antibodies&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the present study&#44; anti-troponin I antibodies were measured in a group of consecutive renal transplant patients&#44; in order to characterize the pattern of these antibodies in this type of patients&#44; and also to correlate anti-troponin I antibodies with the cardiac features of the patients under study&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study protocol was approved by the institutional ethics committee&#44; and the patients gave their written consent&#46; A total of 48 consecutive patients with chronic renal failure and renal transplant were admitted to the study&#46; Peripheral venous blood samples were collected from all patients&#44; at the same time as collecting routine blood samples &#40;during November and December 2013&#41;&#44; and serum samples were frozen&#46; Anti-troponin I antibodies &#40;IgG and IgM&#41; were measured as previously described&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> blinded from patients&#8217; clinical data&#46; Clinical assessment and management of patients was also carried out blinded to the present study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Clinical data&#44; as well as data from cardiac tests&#44; were retrieved from each patient file&#46; All patients had echocardiographic and electrocardiographic data available&#44; allowing assessment of left ventricular systolic function&#44; as well as cardiac rhythm&#46; Additional cardiac data were available for some patients&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Data on the renal status of each patient were also retrieved from the files&#44; including date of transplant&#44; etiology of renal failure&#44; current renal function and current immunosuppressive therapy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Associations between the clinical data of interest and the presence of anti-troponin I antibodies with a titer &#8805;1&#58;80 were analyzed by the chi-square test &#40;SPSS version 22 software&#44; IBM&#44; Armonk&#44; NY&#41;&#44; with a significance level of p&#60;0&#46;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The mean age of the patients was 52&#46;9&#177;12&#46;6 years&#59; 18 were female and 30 male&#44; and all were Caucasian&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The main results are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The etiology of chronic renal failure was varied&#44; and undetermined in a significant number of cases&#44; sometimes due to inconclusive renal biopsy&#46; Autosomal dominant polycystic kidney disease &#40;ADPKD&#41; was present in seven cases&#44; and IgA nephropathy was also a relatively frequent diagnosis&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Most patients had arterial hypertension&#46; Concerning clinical cardiac disease&#44; four patients had a history of myocardial infarction and&#47;or angiographic coronary artery disease&#44; three had aortic valve disease&#44; one had surgically corrected ostium primum atrial septal defect and one had dilated cardiomyopathy associated with lung cancer chemotherapy&#46; All but one patient &#40;with atrial fibrillation&#41; were in sinus rhythm&#46; Pre-transplant cardiac data were available for some patients&#44; but there were no cases of pre-transplant dilated cardiomyopathy&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">With regard to anti-troponin I antibodies&#44; a titer &#60;1&#58;40 was seen in most patients &#40;30&#41;&#46; IgG antibody titers of 1&#58;80 or more were detected in eight patients&#44; with a single value of 1&#58;160&#44; in a patient with ADPKD&#46; Regarding IgM antibodies&#44; in six cases titers were higher than 1&#58;40&#44; with one value of 1&#58;320&#46; In only one patient were both anti-troponin I antibody IgG and IgM titers 1&#58;80 or more&#46; A titer of 1&#58;40 was seen in a further four patients in the case of IgM antibodies&#44; and in two in the case of IgG antibodies&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Nine patients had clinical cardiac disease&#44; eight with undetectable anti-troponin I antibodies&#44; while one patient had a 1&#58;80 IgM antibody titer&#46; Analysis by the chi-square test of the association between an anti-troponin I antibody titer &#8805;1&#58;80 and the presence of clinical cardiac disease yielded p&#61;0&#46;232&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Patients were under double or triple immunosuppressive therapy with prednisolone &#40;45 patients&#41;&#44; cyclosporine &#40;nine&#41;&#44; tacrolimus &#40;34&#41;&#44; everolimus &#40;five&#41;&#44; mycophenolate mofetil &#40;37&#41;&#44; and mycophenolic acid &#40;three&#41;&#46; Statins &#40;3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors&#41; were used by 26 patients&#46; Doses used were in the 10&#8211;20 mg range for pravastatin&#44; simvastatin and atorvastatin&#44; except in one case of simvastatin &#40;40 mg&#41;&#46; A 5-mg dose of rosuvastatin was used by some patients&#46; Analysis by the chi-square test of the association between anti-troponin I antibodies and statin therapy status yielded p&#61;0&#46;008&#44; corresponding to antibody titers of &#8805;1&#58;80 in 10&#47;22 patients not under statin therapy&#44; compared to 3&#47;26 patients under statin therapy&#46; The same analysis regarding the association between anti-troponin I antibodies and each immunosuppressive drug yielded non-significant results in each case &#40;data not shown&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">In the present study&#44; we describe levels of anti-troponin I antibodies in a series of renal transplant patients&#46; Most had low anti-troponin I antibody titers &#40;1&#58;40 or lower&#41;&#46; It is not known whether immunosuppressive therapy can alter the titers for anti-troponin I antibodies&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">One patient had dilated cardiomyopathy associated with lung cancer chemotherapy&#44; and all other patients had preserved LVEF&#46; Eight additional patients had clinical heart disease and one had atrial fibrillation&#46; We could find no association between the presence of clinical heart disease and the presence of anti-troponin I antibodies&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">A reversible cardiomyopathy is found in a significant number of patients with end-stage renal disease&#44; and LVEF increases in some of these patients after renal transplantation&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">8&#44;9</span></a> As stated above&#44; we recently described a case of hemodialysis-associated dilated cardiomyopathy with a marked improvement in LVEF after renal transplantation&#44; in association with high titers of anti-troponin I antibodies&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> However&#44; there appears to be no such case in this series of patients&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">An association was seen between the presence of anti-troponin I antibodies with a titer of 1&#58;80 or higher and the absence of statin therapy&#46; We may speculate that statins have an inhibitory effect on the production of anti-cardiac&#44; in this case anti-troponin I&#44; antibodies&#46; In fact&#44; while statins have marked effects on cardiovascular outcomes in both primary and secondary prevention&#44; similar effects have not been seen with some other types of drugs that decrease low-density lipoprotein cholesterol&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> indicating that additional mechanisms could be important in the actions of statins&#44; one of which could be the possible effect mentioned above&#46; Statins are believed to have immunomodulatory effects&#44; including effects on major histocompatibility complex class II molecules and T helper cells&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a> as well as on leukocyte function-associated antigen-1&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> Statin treatment has been associated with reduced heat shock protein antibody titers in patients with dyslipidemia&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a> The association now reported could represent a form of indication bias &#8211; patients with dyslipidemia&#44; and therefore with indication for statin therapy&#44; could be less prone to the presence of anti-troponin I antibodies &#8211; or even a mere chance association&#46; In the report by Leuschner et al&#46;&#44; the group of 108 patients with acute myocardial infarction were all treated with statins&#44; but 10 patients had a anti-troponin I titer &#8805;1&#58;160&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> Further studies are needed to clarify this matter&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study limitations</span><p id="par0095" class="elsevierStylePara elsevierViewall">The number of patients studied was relatively small&#46; Clinical data were retrieved from existing clinical records and were not obtained prospectively&#46; No attempt was made to characterize adherence to treatment by the patients under study&#46; Given these limitations&#44; the conclusions of the present report must be seen as preliminary&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0100" class="elsevierStylePara elsevierViewall">We conclude that anti-troponin I antibodies are seen in a minority of patients with renal transplant patients&#44; and are not associated with the presence of clinical heart disease&#44; but are associated with lack of statin therapy&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        1 => array:2 [
          "identificador" => "xpalclavsec462593"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres439403"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
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            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
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            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
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          "identificador" => "xpalclavsec462592"
          "titulo" => "Palavras-chave"
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          "identificador" => "sec0005"
          "titulo" => "Introduction"
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          "titulo" => "Discussion"
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          "identificador" => "sec0025"
          "titulo" => "Study limitations"
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          "identificador" => "sec0030"
          "titulo" => "Conclusion"
        ]
        10 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        11 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
        ]
        12 => array:2 [
          "identificador" => "xack131766"
          "titulo" => "Acknowledgments"
        ]
        13 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-05-12"
    "fechaAceptado" => "2014-08-16"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec462593"
          "palabras" => array:3 [
            0 => "Renal transplant"
            1 => "Anti-troponin I antibodies"
            2 => "Statins"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec462592"
          "palabras" => array:3 [
            0 => "Transplante renal"
            1 => "Anticorpos antitroponina I"
            2 => "Estatinas"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To characterize the prevalence and clinical correlates of anti-troponin I antibodies in renal transplant patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A group of 48 consecutive renal transplant patients under immunosuppressive therapy were studied&#46; Anti-troponin I antibodies were measured and clinical data were retrieved&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">An anti-troponin I antibody titer &#60;1&#58;40 was seen in most patients &#40;30&#41;&#46; IgG antibody titers &#8805;1&#58;80 were seen in eight patients&#44; with a single value of 1&#58;160&#46; Regarding IgM antibodies&#44; in six cases titers &#8805;1&#58;80 were seen&#44; with one value of 1&#58;320&#46; In only one patient were both anti-troponin I antibody IgG and IgM titers 1&#58;80 or higher&#46; Clinical cardiac disease was seen in nine patients&#46; The presence of an anti-troponin I antibody titer &#8805;1&#58;80 was not associated with the presence of clinical cardiac disease &#40;p<span class="elsevierStyleMonospace">&#61;</span>0&#46;232&#41;&#44; but was associated with statin therapy status &#40;p&#61;0&#46;008&#41;&#44; being less frequent in patients under statin therapy&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Anti-troponin I antibodies are seen in a minority of renal transplant patients&#44; and are not associated with the presence of clinical heart disease&#44; but are associated with lack of statin therapy&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Caracterizar a preval&#234;ncia e os aspetos cl&#237;nicos associados &#224; presen&#231;a de anticorpos antitroponina I em doentes com transplante renal&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Foi estudado um grupo de 48 doentes consecutivos com transplante renal sob terap&#234;utica imunossupressora&#46; Os anticorpos antitroponina I foram medidos e os dados cl&#237;nicos foram obtidos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Um t&#237;tulo &#60;1&#58;40 de anticorpos antitroponina I foi encontrado na maioria dos doentes &#40;30 doentes&#41;&#46; Os anticorpos IgG com t&#237;tulos &#8805;1&#58;80 foram encontrados em 8 doentes&#44; com um &#250;nico valor de 1&#58;160&#46; No caso dos anticorpos IgM&#44; em seis casos os t&#237;tulos foram &#8805;1&#58;80&#44; com um caso de t&#237;tulo de 1&#58;320&#46; Apenas num doente foram os t&#237;tulos dos anticorpos antitroponina I de tipo IgG e IgM simultaneamente &#8805;1&#58;80&#46; A doen&#231;a card&#237;aca cl&#237;nica existia em nove doentes&#46; A presen&#231;a de anticorpos antitroponina I com t&#237;tulos &#8805;1&#58;80 n&#227;o se associou com a presen&#231;a de doen&#231;a card&#237;aca cl&#237;nica &#40;n&#237;vel de signific&#226;ncia 0&#44;232&#41;&#44; mas associou-se com a aus&#234;ncia de terap&#234;utica com estatina &#40;n&#237;vel de signific&#226;ncia 0&#44;008&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#245;es</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Os anticorpos antitroponina I encontram-se presentes numa minoria de doentes com transplante renal&#44; n&#227;o se verificando uma associa&#231;&#227;o com a presen&#231;a de doen&#231;a card&#237;aca cl&#237;nica&#44; mas com uma associa&#231;&#227;o com aus&#234;ncia de terap&#234;utica com estatina&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#245;es"
          ]
        ]
      ]
    ]
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      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">ADPKD&#58; autosomal dominant polycystic kidney disease&#59; anti-TnI&#58; anti-troponin I antibody&#59; ASD&#58; atrial septal defect&#59; CAD&#58; coronary artery disease&#59; CV&#58; cardiovascular&#59; CRF&#58; chronic renal failure&#59; DCM&#58; dilated cardiomyopathy&#59; GN&#58; glomerulonephritis&#59; MI&#58; myocardial infarction&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-TnI IgG titer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anti-TnI IgM titer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Transplant date&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CRF etiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CV disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ADPKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">DCM post-lung cancer chemotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1993&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ADPKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Henoch-Schonlein purpura&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aortic stenosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&#58;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Membrano-proliferative GN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Possible nephronophthisis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&#58;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic pyelonephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic glomerulonephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diabetic nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aortic stenosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Systemic lupus erythematosus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cerebral hemorrhage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&#58;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic pyelonephritis&#44; lithiasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Familial nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Permanent pacemaker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#58;320&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgA nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ostium primum ASD &#40;surgery in 2004&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Chronic pyelonephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Atrial fibrillation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&#58;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#58;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&#58;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgA nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&#44; stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Malignant hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Probable Alport syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diabetic nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#58;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1997&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgA nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&#58;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ADPKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cerebral aneurysm &#40;surgery in 2011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgA nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#58;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgA nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aortic valve disease&#59; bioprosthesis &#40;surgery in 2013&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1998&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgA nephropathy or membrano-proliferative GN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IgA nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&#44; stroke&#44; CAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertensive nephroangiosclerosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#58;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alport syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#58;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Membrano-proliferative GN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Uric acid nephropathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&#44; CAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&#58;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ADPKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Supraventricular arrhythmia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Focal and segmental nephrosclerosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ADPKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MI with normal coronary arteries &#40;2005&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undetermined&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">MI&#59; CAD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&#58;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ADPKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ADPKD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cerebral hemorrhage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Main data on renal transplant patients &#40;n&#61;48&#41;&#46;</p>"
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            0 => array:3 [
              "identificador" => "bib0070"
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Cardiovascular and noncardiovascular mortality among patients starting dialysis"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;J&#46; de Jager"
                            1 => "D&#46;C&#46; Grootendorst"
                            2 => "K&#46;J&#46; Jager"
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                    0 => array:2 [
                      "doi" => "10.1001/jama.2009.1488"
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                        "tituloSerie" => "JAMA"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19861670"
                            "web" => "Medline"
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              "identificador" => "bib0075"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical epidemiology of cardiovascular disease in chronic kidney disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;N&#46; Foley"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Renal Care"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "4"
                        "paginaFinal" => "8"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients"
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                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46;K&#46; Port"
                            1 => "R&#46;A&#46; Wolfe"
                            2 => "E&#46;A&#46; Mauger"
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                    0 => array:1 [
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                        "paginaFinal" => "1343"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8360969"
                            "web" => "Medline"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Autoantibodies to cardiac troponin I in patients with idiopathic dilated and ischemic cardiomyopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Shmilovich"
                            1 => "A&#46; Danon"
                            2 => "O&#46; Binah"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ijcard.2006.04.077"
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                        "tituloSerie" => "Int J Cardiol"
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                        "volumen" => "117"
                        "paginaInicial" => "198"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16887211"
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Vol. 34. Issue 2.
Pages 85-89 (February 2015)
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Vol. 34. Issue 2.
Pages 85-89 (February 2015)
Original Article
Open Access
Anti-troponin I antibodies in renal transplant patients
Anticorpos antitroponina I em doentes com transplante renal
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José Pedro L. Nunesa,b,
Corresponding author
jplnunes@med.up.pt

Corresponding author.
, Susana Sampaioa,c, Ana Cerqueirac, Ziya Kayad, Nuno Pardal Oliveirab
a Faculdade de Medicina da Universidade do Porto, Portugal
b Department of Cardiology, Hospital São João, Porto, Portugal
c Department of Nephrology, Hospital São João, Porto, Portugal
d University of Heidelberg, Heidelberg, Germany
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Tables (1)
Table 1. Main data on renal transplant patients (n=48).
Abstract
Objective

To characterize the prevalence and clinical correlates of anti-troponin I antibodies in renal transplant patients.

Methods

A group of 48 consecutive renal transplant patients under immunosuppressive therapy were studied. Anti-troponin I antibodies were measured and clinical data were retrieved.

Results

An anti-troponin I antibody titer <1:40 was seen in most patients (30). IgG antibody titers ≥1:80 were seen in eight patients, with a single value of 1:160. Regarding IgM antibodies, in six cases titers ≥1:80 were seen, with one value of 1:320. In only one patient were both anti-troponin I antibody IgG and IgM titers 1:80 or higher. Clinical cardiac disease was seen in nine patients. The presence of an anti-troponin I antibody titer ≥1:80 was not associated with the presence of clinical cardiac disease (p=0.232), but was associated with statin therapy status (p=0.008), being less frequent in patients under statin therapy.

Conclusions

Anti-troponin I antibodies are seen in a minority of renal transplant patients, and are not associated with the presence of clinical heart disease, but are associated with lack of statin therapy.

Keywords:
Renal transplant
Anti-troponin I antibodies
Statins
Resumo
Objetivo

Caracterizar a prevalência e os aspetos clínicos associados à presença de anticorpos antitroponina I em doentes com transplante renal.

Métodos

Foi estudado um grupo de 48 doentes consecutivos com transplante renal sob terapêutica imunossupressora. Os anticorpos antitroponina I foram medidos e os dados clínicos foram obtidos.

Resultados

Um título <1:40 de anticorpos antitroponina I foi encontrado na maioria dos doentes (30 doentes). Os anticorpos IgG com títulos ≥1:80 foram encontrados em 8 doentes, com um único valor de 1:160. No caso dos anticorpos IgM, em seis casos os títulos foram ≥1:80, com um caso de título de 1:320. Apenas num doente foram os títulos dos anticorpos antitroponina I de tipo IgG e IgM simultaneamente ≥1:80. A doença cardíaca clínica existia em nove doentes. A presença de anticorpos antitroponina I com títulos ≥1:80 não se associou com a presença de doença cardíaca clínica (nível de significância 0,232), mas associou-se com a ausência de terapêutica com estatina (nível de significância 0,008).

Conclusões

Os anticorpos antitroponina I encontram-se presentes numa minoria de doentes com transplante renal, não se verificando uma associação com a presença de doença cardíaca clínica, mas com uma associação com ausência de terapêutica com estatina.

Palavras-chave:
Transplante renal
Anticorpos antitroponina I
Estatinas
Full Text
Introduction

Patients with chronic renal disease, including those on hemodialysis, have a high mortality rate, and a significant proportion of this mortality is due to cardiovascular disease.1,2 Renal transplantation may lead to better long-term survival than hemodialysis.3

Antibodies to cardiac troponin I are elevated in a significant number of patients with both ischemic cardiomyopathy and idiopathic dilated cardiomyopathy.4,5 Absence of autoantibodies against cardiac troponin I was found in one study to predict improvement of left ventricular function after acute myocardial infarction.5 In another study, however, the presence of the same type of autoantibodies in plasma was associated with improved survival in patients with chronic dilated cardiomyopathy, but not with ischemic cardiomyopathy.6

We recently described a case of hemodialysis-associated dilated cardiomyopathy with a marked improvement in left ventricular ejection fraction (LVEF) after renal transplantation, in association with high titers of anti-troponin I antibodies.7

In the present study, anti-troponin I antibodies were measured in a group of consecutive renal transplant patients, in order to characterize the pattern of these antibodies in this type of patients, and also to correlate anti-troponin I antibodies with the cardiac features of the patients under study.

Methods

The study protocol was approved by the institutional ethics committee, and the patients gave their written consent. A total of 48 consecutive patients with chronic renal failure and renal transplant were admitted to the study. Peripheral venous blood samples were collected from all patients, at the same time as collecting routine blood samples (during November and December 2013), and serum samples were frozen. Anti-troponin I antibodies (IgG and IgM) were measured as previously described,5 blinded from patients’ clinical data. Clinical assessment and management of patients was also carried out blinded to the present study.

Clinical data, as well as data from cardiac tests, were retrieved from each patient file. All patients had echocardiographic and electrocardiographic data available, allowing assessment of left ventricular systolic function, as well as cardiac rhythm. Additional cardiac data were available for some patients.

Data on the renal status of each patient were also retrieved from the files, including date of transplant, etiology of renal failure, current renal function and current immunosuppressive therapy.

Associations between the clinical data of interest and the presence of anti-troponin I antibodies with a titer ≥1:80 were analyzed by the chi-square test (SPSS version 22 software, IBM, Armonk, NY), with a significance level of p<0.05.

Results

The mean age of the patients was 52.9±12.6 years; 18 were female and 30 male, and all were Caucasian.

The main results are presented in Table 1. The etiology of chronic renal failure was varied, and undetermined in a significant number of cases, sometimes due to inconclusive renal biopsy. Autosomal dominant polycystic kidney disease (ADPKD) was present in seven cases, and IgA nephropathy was also a relatively frequent diagnosis.

Table 1.

Main data on renal transplant patients (n=48).

Anti-TnI IgG titer  Anti-TnI IgM titer  Age (years)  Gender  Transplant date  CRF etiology  CV disease 
<1:40  <1:40  60  Male  2002  ADPKD  DCM post-lung cancer chemotherapy 
<1:40  <1:40  44  Male  2006  Undetermined  Hypertension 
<1:40  <1:40  48  Male  1993  Undetermined  Hypertension 
<1:40  <1:40  63  Female  2013  ADPKD  Hypertension 
<1:40  <1:40  47  Male  1996  Undetermined  Hypertension 
<1:40  <1:40  71  Female  2008  Henoch-Schonlein purpura  Aortic stenosis 
1:80  1:40  52  Male  2011  Membrano-proliferative GN  Hypertension 
<1:40  <1:40  31  Female  2011  Possible nephronophthisis  Stroke 
1:80  <1:40  44  Female  2013  Chronic pyelonephritis  Hypertension 
<1:40  <1:40  59  Female  2013  Chronic glomerulonephritis  None 
<1:40  <1:40  48  Male  2012  Diabetic nephropathy  Aortic stenosis 
<1:40  <1:40  31  Female  2007  Systemic lupus erythematosus  Cerebral hemorrhage 
1:80  <1:40  33  Female  2013  Chronic pyelonephritis, lithiasis  None 
<1:40  <1:40  62  Female  2007  Familial nephropathy  Hypertension 
<1:40  <1:40  65  Male  2000  Undetermined  None 
<1:40  <1:40  65  Female  1995  Undetermined  Permanent pacemaker 
<1:40  1:320  49  Male  2004  Undetermined  Hypertension 
<1:40  <1:40  64  Female  2013  IgA nephropathy  Ostium primum ASD (surgery in 2004) 
<1:40  1:40  46  Male  2012  Chronic pyelonephritis  Hypertension 
<1:40  1:40  62  Male  2011  Undetermined  Atrial fibrillation 
<1:40  <1:40  45  Male  2011  Undetermined  Hypertension 
1:80  1:80  58  Male  2009  Undetermined  Hypertension 
1:80  <1:40  51  Male  2013  IgA nephropathy  Hypertension 
<1:40  <1:40  53  Male  2013  Undetermined  Hypertension, stroke 
<1:40  <1:40  55  Male  2013  Malignant hypertension  Hypertension 
<1:40  1:40  35  Female  2013  Probable Alport syndrome  Hypertension 
<1:40  1:40  69  Male  2006  Diabetic nephropathy  Hypertension 
<1:40  1:80  53  Male  1997  IgA nephropathy  Hypertension 
1:80  <1:40  34  Female  2011  ADPKD  Cerebral aneurysm (surgery in 2011) 
<1:40  <1:40  27  Male  2013  IgA nephropathy  Hypertension 
<1:40  1:80  64  Female  2008  IgA nephropathy  Aortic valve disease; bioprosthesis (surgery in 2013) 
<1:40  <1:40  59  Male  1998  IgA nephropathy or membrano-proliferative GN  Hypertension 
<1:40  <1:40  65  Male  2000  IgA nephropathy  Hypertension, stroke, CAD 
<1:40  <1:40  70  Female  2010  Hypertensive nephroangiosclerosis  Hypertension 
<1:40  1:80  27  Male  2013  Alport syndrome  Hypertension 
<1:40  1:160  50  Female  2007  Membrano-proliferative GN  Hypertension 
<1:40  <1:40  73  Male  1994  Uric acid nephropathy  Hypertension, CAD 
1:160  <1:40  46  Female  2003  ADPKD  Supraventricular arrhythmia 
<1:40  <1:40  45  Male  2011  Focal and segmental nephrosclerosis  Hypertension 
<1:40  <1:40  47  Male  2011  Undetermined  Hypertension 
1:40  <1:40  55  Female  2010  ADPKD  Hypertension 
1:40  <1:40  51  Male  2011  Undetermined  Hypertension 
<1:40  <1:40  36  Female  2013  Undetermined  None 
<1:40  <1:40  65  Male  2010  Undetermined  Hypertension 
<1:40  <1:40  66  Male  2012  Undetermined  MI with normal coronary arteries (2005) 
<1:40  <1:40  63  Male  2012  Undetermined  MI; CAD 
1:80  <1:40  66  Male  2001  ADPKD  Stroke 
<1:40  <1:40  69  Male  2013  ADPKD  Cerebral hemorrhage 

ADPKD: autosomal dominant polycystic kidney disease; anti-TnI: anti-troponin I antibody; ASD: atrial septal defect; CAD: coronary artery disease; CV: cardiovascular; CRF: chronic renal failure; DCM: dilated cardiomyopathy; GN: glomerulonephritis; MI: myocardial infarction.

Most patients had arterial hypertension. Concerning clinical cardiac disease, four patients had a history of myocardial infarction and/or angiographic coronary artery disease, three had aortic valve disease, one had surgically corrected ostium primum atrial septal defect and one had dilated cardiomyopathy associated with lung cancer chemotherapy. All but one patient (with atrial fibrillation) were in sinus rhythm. Pre-transplant cardiac data were available for some patients, but there were no cases of pre-transplant dilated cardiomyopathy.

With regard to anti-troponin I antibodies, a titer <1:40 was seen in most patients (30). IgG antibody titers of 1:80 or more were detected in eight patients, with a single value of 1:160, in a patient with ADPKD. Regarding IgM antibodies, in six cases titers were higher than 1:40, with one value of 1:320. In only one patient were both anti-troponin I antibody IgG and IgM titers 1:80 or more. A titer of 1:40 was seen in a further four patients in the case of IgM antibodies, and in two in the case of IgG antibodies.

Nine patients had clinical cardiac disease, eight with undetectable anti-troponin I antibodies, while one patient had a 1:80 IgM antibody titer. Analysis by the chi-square test of the association between an anti-troponin I antibody titer ≥1:80 and the presence of clinical cardiac disease yielded p=0.232.

Patients were under double or triple immunosuppressive therapy with prednisolone (45 patients), cyclosporine (nine), tacrolimus (34), everolimus (five), mycophenolate mofetil (37), and mycophenolic acid (three). Statins (3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors) were used by 26 patients. Doses used were in the 10–20 mg range for pravastatin, simvastatin and atorvastatin, except in one case of simvastatin (40 mg). A 5-mg dose of rosuvastatin was used by some patients. Analysis by the chi-square test of the association between anti-troponin I antibodies and statin therapy status yielded p=0.008, corresponding to antibody titers of ≥1:80 in 10/22 patients not under statin therapy, compared to 3/26 patients under statin therapy. The same analysis regarding the association between anti-troponin I antibodies and each immunosuppressive drug yielded non-significant results in each case (data not shown).

Discussion

In the present study, we describe levels of anti-troponin I antibodies in a series of renal transplant patients. Most had low anti-troponin I antibody titers (1:40 or lower). It is not known whether immunosuppressive therapy can alter the titers for anti-troponin I antibodies.

One patient had dilated cardiomyopathy associated with lung cancer chemotherapy, and all other patients had preserved LVEF. Eight additional patients had clinical heart disease and one had atrial fibrillation. We could find no association between the presence of clinical heart disease and the presence of anti-troponin I antibodies.

A reversible cardiomyopathy is found in a significant number of patients with end-stage renal disease, and LVEF increases in some of these patients after renal transplantation.8,9 As stated above, we recently described a case of hemodialysis-associated dilated cardiomyopathy with a marked improvement in LVEF after renal transplantation, in association with high titers of anti-troponin I antibodies.7 However, there appears to be no such case in this series of patients.

An association was seen between the presence of anti-troponin I antibodies with a titer of 1:80 or higher and the absence of statin therapy. We may speculate that statins have an inhibitory effect on the production of anti-cardiac, in this case anti-troponin I, antibodies. In fact, while statins have marked effects on cardiovascular outcomes in both primary and secondary prevention, similar effects have not been seen with some other types of drugs that decrease low-density lipoprotein cholesterol,10 indicating that additional mechanisms could be important in the actions of statins, one of which could be the possible effect mentioned above. Statins are believed to have immunomodulatory effects, including effects on major histocompatibility complex class II molecules and T helper cells,11 as well as on leukocyte function-associated antigen-1.12 Statin treatment has been associated with reduced heat shock protein antibody titers in patients with dyslipidemia.13 The association now reported could represent a form of indication bias – patients with dyslipidemia, and therefore with indication for statin therapy, could be less prone to the presence of anti-troponin I antibodies – or even a mere chance association. In the report by Leuschner et al., the group of 108 patients with acute myocardial infarction were all treated with statins, but 10 patients had a anti-troponin I titer ≥1:160.5 Further studies are needed to clarify this matter.

Study limitations

The number of patients studied was relatively small. Clinical data were retrieved from existing clinical records and were not obtained prospectively. No attempt was made to characterize adherence to treatment by the patients under study. Given these limitations, the conclusions of the present report must be seen as preliminary.

Conclusion

We conclude that anti-troponin I antibodies are seen in a minority of patients with renal transplant patients, and are not associated with the presence of clinical heart disease, but are associated with lack of statin therapy.

Ethical disclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that they have followed the protocols of their work center on the publication of patient data.

Right to privacy and informed consent

The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.

Conflicts of interest

The authors have no conflicts of interest to declare.

Acknowledgments

The authors would like to thank Marta Oliveira and the nursing staff of Hospital São João for their expert technical and nursing assistance.

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