Volume 72, No. 2/2009(August)
|
 Clinical Nephrology
Die Online-Versionen der Zeitschriften werden jeweils vor Erscheinen der Print-Ausgabe aktualisiert. Alle Inhalte dieser Website stehen Abonnenten der Zeitschrift nach einmaliger Registrierung ohne Mehrkosten zur Verfügung. Um die Artikel im PDF-Format betrachten zu können, benötigen Sie die Adobe Reader® Software.
|
| Preis für gesamte Ausgabe: 30.00$ |
 |
Editorial
Revisiting essential hypertension – a “mechanism-based” approach may argue for a better definition of hypertension
L.A. Calò
Abstract
L.A. Calò
Department of Clinical and Experimental Medicine, Clinica Medica 4, University of Padova, Italy
Several major overarching themes have recently emerged in our understanding of the pathophysiology of hypertension which may allow to revisit essential hypertension with an eye towards the possibility of adopting a more rational “mechanistic-based” definition of hypertension and moving away from the unsatisfactory “essential” label for hypertension from unknown cause. As our understanding of the biochemical and physiological mechanisms that control blood pressure rapidly evolves, the “essential” label of hypertension is losing both value as well as utility as it will describe an increasingly small number of hypertensive patients. This paper uses some recently identified pathways central to hypertension and uses this understanding of pathophysiology to argue for a better definition of hypertension.Correspondence to:
L.A. Calò MD, PhD
Department of Clinical and Experimental Medicine
Clinica Medica 4, University of Padova
Via Giustiniani, 2
35128 Padova, Italy
Email: renzcalo@unipd.it
Review
Adiponectin in chronic kidney disease has an opposite impact on protein-energy wasting and cardiovascular risk: two sides of the same coin
S.-H. Park, J.J. Carrero, B. Lindholm and P. Stenvinkel
Abstract
S.-H. Park1,2, J.J. Carrero1, B. Lindholm1 and P. Stenvinkel1
1Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden, and 2Division of Nephrology and Department of Internal Medicine, Kyungpook National University Hospital, Deagu, South Korea
Adiponectin, an anti-inflammatory, anti-atherogenic and insulin sensitizing adipokine exists in several isoforms in the circulation. In patients with chronic kidney disease (CKD), circulating levels of total as well as high-molecular-weight adiponectin are elevated. In contrast to initial studies, several recent and larger studies on outcomes do not support a protective effect of high adiponectin on cardiovascular disease (CVD) and overall mortality in CKD patients. Paradoxically, high adiponectin predicts increased overall and cardiovascular mortality in CKD patients. This effect seems unrelated to a direct effect of adiponectin, but rather due to a process of protein-energy (PEW) wasting. This review summarizes recent conflicting findings on adiponectin in relation to outcomes and discusses the pathophysiologic roles of adiponectin in PEW, insulin resistance and vascular injuries of CKD patients.Correspondence to:
P. Stenvinkel, MD, PhD
Division of Renal Medicine, K56
Karolinska University
Hospital at Huddinge
141 86 Stockholm, Sweden
Email: peter.stenvinkel@ki.se
Review
Lack of evidence for administering vitamin D analogs to kidney failure patients to improve survivability
T.L. Cantor
Abstract
T.L. Cantor
Scantibodies Laboratory, Inc., Santee, CA, USA
Introduction: The Kidney Disease Outcome Quality Initiative (K/DOQI) Bone Metabolism Guidelines recommend the use of active vitamin D analogs for the treatment of secondary hyperparathyroid bone disorder in end-stage renal disease (ESRD); however, the effect of vitamin D therapy on the mortality of ESRD patients has not yet been tested in randomized controlled trials. A 2005 publication entitled “Activated Injectable Vitamin D and Hemodialysis Survival: A Historical Cohort Study” claimed ESRD patients receiving injectable vitamin D had a survival advantage. In an effort to validate that conclusion, this author reviewed the publicly-available data of the US Renal Data System (USRDS) and other published reports to evaluate if the use of vitamin D analogs has been shown to be effective in the past decade in improving ESRD patient survival. Method: A review, examination, and comparison of the data extracted from the USRDS were made for the period of 1992 – 2002 which covered Medicare ESRD patients in terms of vitamin D administration and mortality. Other pertinent studies were reviewed in the same way. Results: This critical review revealed that scientific evidence for the administration of injectable vitamin D is insufficient in this cohort study as the design flaws inherently diminish the significance of their findings. The annual mortality rate in US Medicare hemodialysis patients has remained unchanged despite the dramatic increase in the percent of these patients receiving injectable vitamin D, which suggests that vitamin D analog therapy does not improve survivability in ESRD patients. Conclusion: The potentially harmful consequences of excessive vitamin D analog dosing should caution nephrologists and other CKD health professionals against the off-label use of vitamin D analogs for improved survivability in ESRD patients until additional randomized controlled studies/trials are done and the effects made clear. This review emphasizes the need for additional research to further elucidate the role of vitamin D in the treatment and mortality of ESRD patients.Correspondence to:
T.L. Cantor, BSc
Scantibodies Laboratory, Inc.
9336 Abraham Way
Santee, CA 92071, USA
Email: tom.cantor@scantibodies.com
Lead article (Original)
Today Balkan endemic nephropathy is a disease of the elderly with a good prognosis
D. Bukvic, S. Jankovic, I. Maric, M. Stošovic, A. Arsenovic and L. Djukanovic
Abstract
D. Bukvic1, S. Jankovic2, I. Maric1, M. Stošovic3, A. Arsenovic1 and L. Djukanovic4
1Special Hospital for Endemic Nephropathy, Lazarevac, 2Institute of Epidemiology, School of Medicine, Belgrade, 3Clinic of Nephrology, Clinical Center of Serbia, 4Academy of Medical Science, SMS, Belgrade, Serbia
Background: The outcome for Balkan endemic nephropathy (BEN) patients diagnosed in 1992 was analyzed in 2006 with the aim of detecting factors associated with disease progression and patient outcome. Methods: In 1992 BEN was detected in 119 patients (53 males, 56.9 ± 13.8 years) from the village of Šopic. Changes in creatinine clearance as well as outcome (death or onset of regular hemodialysis) were analyzed retrospectively in 2006. Results: During the 14-year period 47 patients deceased (5 on hemodialysis) at the mean age of 72.2 ± 8.2 years, while no data were available for 13 cases. Out of 59 remaining patients 3 were on hemodialysis in 2006 and 56 participated in the control examination. Of these 12 had creatinine clearance at least 50% lower than in 1992 and 44 had unchanged creatinine clearance. Logistic regression revealed age and proteinuria, but linear regression only age as significant prognostic factors for changes in creatinine clearance. The all-cause mortality rate varied between 1.1 and 5.3% per year and was similar to the mortality rate of the general population. The main cause of death was cardiovascular disease (40.5%) followed by malignant diseases (17%), most frequently (11%) due to upper urothelial tumors. Urine protein and age were found to be a significant independent predictor of all-cause mortality. Conclusion: In the village of Šopic BEN was commonly detected in patients in their fifties, progressed slowly, but most patients died from other causes at old age before end-stage renal disease occurred. Kidney function remained stable over the decade in three quarters of the surviving patients. Age and proteinuria were found to be prognostic factors for both disease progression and patient mortality.Correspondence to:
Dr. D. Bukvic
Special Hospital for Endemic Nephropathy
Djordja Kovacevica 27
11 000 Lazarevac, Serbia
Email: nefro@eunet.rs
Original
The clinical significance of parathyroid tissue calcium sensing receptor gene polymorphisms and expression levels in end-stage renal disease patients
P.A. Eren, K. Turan, I. Berber, M. Canbakan, M. Kara, G. Tellioglu, U. Bugan, C. Sevinç, F. Turkmen and M.I. Titiz
Abstract
P.A. Eren1, K. Turan2, I. Berber3, M. Canbakan3, M. Kara3, G. Tellioglu3, U. Bugan3, C. Sevinç3, F. Turkmen3 and M.I. Titiz3
1Departments of Molecular Genetics and 3Transplantation, Haydarpasa Numune Research and Training Hospital, and 2Department of Basic Sciences, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
Background: The calcium sending receptor (CaSR) allows parathyroid and kidney tubular cells to regulate PTH secretion and tubular calcium reabsorption. In the present report, we examined the relationship between CaSR gene polymorphisms and parathyroid CaSR expression and serum calcium/parathyroid hormone (PTH) levels and clinical progress in ESRD patients in the Turkish population. Methods: We genotyped the CaSR R990G and Q1011E variants in 192 end-stage renal disease (ESRD) patients by allele-specific PCR. CaSR expression in parathyroid tissues of operated 33 patients was quantified with quantitative reverse transcription-PCR. Results: Compared with other genotypes, the ratio of both codon 990-AA and 1011-CC polymorphisms was found higher in operated patients (p = 0.001). In the total patient group PTH levels were found higher in patients with CC1011 genotype than those with CG1011 (1015.15 ± 925.41 pg/ml; 523.84 ± 544.6 pg/ml, respectively, p = 0.002). There were statistically important higher Ca2+ levels in the AA990 allele carrying cases than AG990 positive ones (9.3 ± 1.0 mg/dl vs. 8.8 ± 0.9, p = 0.006). On the other hand, the expression of CaSR in parathyroid tissue was found inversely proportional with serum PTH level (r = –0.71). Conclusion: Present data suggest that co-presence of CaSR gene AA990 and CC1011 alleles is a possible risk factor for bad prognosis in secondary hyperparathyroidism. Patients carrying this genotype have tendency to require operation early in their medical therapy period and need postoperative close follow up for possible recurrences.Correspondence to:
P.A. Eren, MD PhD
Department of Molecular Genetics
Haydarpasa Numune Research and Training Hospital
Uskudar 34668, Istanbul, Turkey
Email: pinaren@yahoo.com
Original
Protamine-associated hypotension in patients on hemodialysis: retrospective study and prevalence of antiprotamine antibodies
Y.-T. Tsai, L.-C. Chang, Y.-F. Lin, C.-S. Tsai , C.-H. Lai and J.-S. Chen
Abstract
Y.-T. Tsai1, L.-C. Chang4, Y.-F. Lin2, C.-S. Tsai1 , C.-H. Lai3 and J.-S. Chen2
1Division of Cardiovascular Surgery, Department of Surgery, 2Division of Nephrology, Department of Medicine, Tri-Service General Hospital, 3School of Public Health, and 4Pharmacy, National Defense Medical Center, Taipei, Taiwan, R.O.C.
Aims: Protamine, when administered to neutralize heparin in cardiovascular surgery, is associated with occasionally severe antigen-antibody reactions associated with substantial morbidity and mortality. The objective of this study is to investigate whether patients on hemodialysis are more susceptible to the protamine adverse effects. Method: First, a retrospective analysis of a protamine-associated hypotension episode (PAHE) in 239 patients undergoing coronary artery bypass grafting surgery was performed for the incidence study in the period of 1999 to 2005. Second, an ELISA determination of serum anti-protamine IgG antibody in 255 serum samples from individuals without previous surgical histories was conducted for prevalence survey. In both studies, patients on HD were matched for age with non HD patients. Results: The highest incidence (57%) of PAHE occurred in patients on hemodialysis using of M-insulin (a mixed type of insulin aspart 30%, insulin aspart protamine 70%) formulation, and this group also exhibited a high anti-protamine IgG antibody titer in serum (odds ratio: 18.31). Conclusions: A substantial proportion of patients on hemodialysis are at high risk of acquiring protamine adverse effects, but definite conclusion about the association between uremia and PAHE, however, still needs to be made with caution.Correspondence to:
J.-S. Chen, MD, PhD
Division of Nephrology
Department of Internal Medicine
Tri-Service General Hospital
No 325 Sec 2 Cheng-Gung Road
Nei-Hu, Taipei, Taiwan 114
Email: dgschen@ndmctsgh.edu.tw
Original
The long-term survival rate of catecholamine-resistant septic shock in Japanese patients who received vasopressin therapy
N. Sawa, Y. Ubara, H. Katori, J. Hoshino, T. Suwabe, F. Takemoto, N. Uchida, K. Masuoka, A. Wake, S. Taniguchi and K. Takaichi
Abstract
N. Sawa1, Y. Ubara1, H. Katori1, J. Hoshino1, T. Suwabe1, F. Takemoto1, N. Uchida2, K. Masuoka2, A. Wake2, S. Taniguchi2 and K. Takaichi1
Departments of 1Nephrology and 2Hematology, Toranomon Hospital, Tokyo, Japan
Background: Septic shock is associated with vasopressin deficiency and hypersensitivity to its exogenous administration. The aim of this study is to review the 28-day survival rate, hemodynamic and renal effects of vasopressin therapy in refractory septic shock Japanese patients. Methods: 55 Japanese patients experiencing catecholamine-resistant septic shock were treated with vasopressin. Hemodynamic alterations and the serum concentrations of aspartate aminotransferase, total bilirubin and creatinine clearance were evaluated following vasopressin treatment. Results: In both, survivors and non-surviving patients, treatment with vasopressin resulted in a significantly increase in mean arterial pressure, hourly urine output, and a significant decrease in heart rate and total pressor dosage requirements. Creatinine clearance was significantly increased only in survivors. There were no significant changes in the serum concentrations of aspartate aminotransferase and total bilirubin. The 28-day survival rate was 45% (25 patients). Conclusions: In Japanese septic shock patients, vasopressin infusion improved hemodynamic status and reduced catecholamine requirement, and 28-day survival rate was 45%.Correspondence to:
N. Sawa, MD
Nephrology Center
Toranomon Hospital
2-2-2, Toranomon
Minatoku, 105-8470, Japan
Email: naokis@toranomon.gr.jp
Original
Analysis of peritoneal leukocyte population with different dialysis fluids
R. Palomar, M. López-Hoyos, P. Morales, M.J. Marín, L. Álvarez, M. Ruiz-Soto, E. Rodrigo, G. Fernández-Fresnedo, Á.LM de Francisco and M. Arias
Abstract
R. Palomar1, M. López-Hoyos2, P. Morales1, M.J. Marín2, L. Álvarez2, M. Ruiz-Soto2, E. Rodrigo1, G. Fernández-Fresnedo1, Á.LM de Francisco1 and M. Arias1
1Nephrology and 2Immunology Departments, Valdecilla University Hospital, Santander, Spain
Uremic patients have leukocyte defects. In peritoneal dialysis patients some alterations could be induced by dialysis fluids. We analyzed the changes in immune cells (blood and peritoneal effluent), with the use of three solutions with different biocompatibility. We included 21 patients, 9 on 1 exchange/day icodextrin and 12 with lactate-buffered solutions. A cytometric study (cell subsets, activation markers and toll-like receptors) was performed. In 12 it was repeated after 3 months switch to a low-glucose degradation product (GDP) fluid. With lactate fluids, we observed B-lymphopenia, increase of T-cells and T-lymphocyte activation. In peritoneal effluent more monocytes and activation markers related to blood were found with conventional fluids. Icodextrin induced an increase of blood natural-killer cells, B-lymphocytes and CD8+CD38+ compared with lactate-buffered solution. In peritoneum more monocytes and less B-lymphocytes were found with icodextrin compared with biocompatible solution. Low-GDP fluid induced a decrease in lymphocyte activation markers (blood and effluent). The most biocompatible solution (low-GDP) induced the lowest expression of peritoneal monocytes and TLR4. Low-GDP solutions preserve peritoneum immune defences better, which could be important to avoid peritonitis and preserve peritoneal function. Although we found an association between TLR4 expression and biocompatibility, further investigations are needed in order to determine if such molecule could be a marker of peritoneum dysfunction.Correspondence to:
R. Palomar, MD
Nephrology Department
Valdecilla Universitary Hospital
Avda. Marqués de Valdecilla s/n.
39008-Santander, Spain
Email: nefpfm@humv.es
Case report
Simultaneous peripheral tuberculous lymphadenitis and a tuberculous liver abscess in a hemodialysis patient
D.W. Kim, H.S. Cho, H.J. Lee, J.W. Seo, H.-J. Kim, D.J. Park, and S.-H. Chang
Abstract
D.W. Kim1, H.S. Cho1, H.J. Lee1, J.W. Seo1, H.-J. Kim1,2, D.J. Park1,2 and S.-H. Chang1,2
Department of Internal Medicine, 1School of Medicine, 2Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
A tuberculous liver abscess is an extremely rare condition. However, extrapulmonary tuberculosis is more common in end-stage renal disease patients. We report a 64-year-old woman on hemodialysis with liver cirrhosis. She had no evidence of pulmonary or intestinal tuberculosis on the chest radiograph, abdominal computed tomography (CT), or colonoscopy. She had fever and an enlarged right supraclavicular lymph node. A CT showed several cystic ring-enhancing nodules in the liver. Histopathologic examinations were performed on the enlarged lymph node and a cystic nodule in the liver, which revealed caseating granulomas. Systemic antituberculous therapy was started immediately. A subsequent sonographic examination of the lesion in the liver showed improvement. In end-stage renal disease patients, we should be concerned with extrapulmonary tuberculosis. The diagnosis and antituberculous therapy must be performed promptly.Correspondence to:
Se-Ho Chang, MD
Department of Internal Medicine
School of Medicine
Institute of Health Sciences
Gyeongsang National University
90, Chilam-Dong
Jinju Gyeongsangnam-Do 660-702
Republic of Korea
Email: shchang@gaechuk.gsnu.ac.kr
Case report
Spontaneous rupture of adrenocortical carcinoma: a coincidence or a tendency?
C.-Y. Lu, T.-H. Yen, M.-L. Hsieh and Y. Chen
Abstract
C.-Y. Lu1, T.-H. Yen2, M.-L. Hsieh3 and Y. Chen3
Departments of 1Surgery, 2Nephrology and 3Urology, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taoyuan, Taiwan
We report a rare case of adrenocortical carcinoma spontaneously rupturing. To our knowledge, this is the sixth reported case in literature that is not related to any preceding traumatic incidents or predisposing disease. Upon reviewing previous cases, tumor size greater than 10 cm in adults is a predisposing factor for spontaneous rupture, while the degree of lymph node invasion or the extent of distant metastasis is not indicative. Further study is warranted to validate our finding, but we suggest that if an adrenal tumor suspicious of malignant presentation is found incidentally, the size of tumor may warrant a more aggressive approach for prevention of tumor rupture and decrease in patient morbidity and mortality.Correspondence to:
Y. Chen, MD
Department of Urology
Chang Gung Memorial Hospital
5 Fu-Hsing Street, Kuei-Shan
Taoyuan 333, Taiwan
Email: yuiok2681@adm.cgmh.org.tw
Case report
Hereditary hemorrhagic telangiectasia in a patient with microscopic polyangiitis
T. Inoue, T. Nakamura, D. Katagiri, T. Hoshino, M. Tada, M. Shibata and F. Hinoshita
Abstract
T. Inoue, T. Nakamura, D. Katagiri, T. Hoshino, M. Tada, M. Shibata and F. Hinoshita
Division of Nephrology, International Medical Center of Japan, Tokyo, Japan
A 55-year-old Japanese woman with microscopic polyangiitis suffered repeated disturbance of consciousness and gastrointestinal bleeding. These problems were initially attributed to microscopic polyangiitis, but hereditary hemorrhagic telangiectasia was finally identified by further workup. Both microscopic polyangiitis and hereditary hemorrhagic telangiectasia are blood vessel-related diseases inducing similar symptoms. To our knowledge, this is the first observation of microscopic polyangiitis and hereditary hemorrhagic telangiectasia in the same patient. From a literature review of the clinical and pathologic manifestations of these diseases, a positive association may exist between the two diseases.Correspondence to:
T. Inoue, Division of Nephrology, International Medical Center of Japan, 162-8655 1-21-1 Toyama Shinjyuku, Tokyo, Japan
Email: tsuyoshi313@ hotmail.com
Letter to the Editor
Fictitious pseudohyperkalemia due to the dilution of plasma by anticoagulant
S.-W. Han, J.-I. Park, J.-H. Yi, I.-K. Park and H.-J. Kim
Abstract
S.-W. Han, J.-I. Park, J.-H. Yi, I.-K. Park and H.-J. Kim
Letter to the Editor
Anti-glomerular basement membrane disease with nephrotic proteinuria
E. Sengul, T. Eyileten, A. Ozcan, M.I. Yilmaz and M. Yenicesu
Abstract
E. Sengul, T. Eyileten, A. Ozcan, M.I. Yilmaz and M. Yenicesu
Letter to the Editor
Pantoea agglomerans: the gardener’s peritonitis?
M. Moreiras-Plaza, R. Blanco-García, P. Romero-Jung, D. Feijóo-Piñeiro, C. Fernandez-Fernandez and I. Ammari
Abstract
M. Moreiras-Plaza, R. Blanco-García, P. Romero-Jung, D. Feijóo-Piñeiro, C. Fernandez-Fernandez and I. Ammari
Letter to the Editor
Varicella glomerulonephritis preceding the cutaneous lesions
H. Matsukura, M. Murakami, H. Sakaki, T. Mitani and S. Shimura
Abstract
H. Matsukura, M. Murakami, H. Sakaki, T. Mitani and S. Shimura
