Volume 71, No. 4/2009(April)
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 Clinical Nephrology
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Original
Influence of low birth weight on microalbuminuria and blood pressure of school children
C.M. Salgado, P.C.B.V. Jardim, F.B.G. Teles and M.C. Nunes
Abstract
C.M. Salgado, P.C.B.V. Jardim, F.B.G. Teles and M.C. Nunes
Division of Pediatric Nephrology / Department of Pediatric and Hypertension League / Department of Internal Medicine, Federal University of Goiás (UFG), Goiânia, GO, Brazil
Low birth weight (LBW) is associated to an increased incidence of hypertension, renal and cardiovascular diseases in adulthood. The objective of this study was to evaluate possible changes in microalbuminuria (MA) and blood pressure (BP) in children with LBW. Material and Methods: The birth weight (BW) of 1,049 children between 8 and 11 years of age, enrolled in schools in the city of Goiânia/Brazil was investigated. Those in the LBW group (BW <= 2.5 kg) were compared to a similar group with normal birth weight – NBW (BW >= 3.0 kg). BP and 24-hour urine MA were evaluated. BW and prematurity (gestational age < 37 weeks) were obtained from the information contained in the children’s card. Results: There were 34 children with LBW and 34 with NBW. No significant difference was found regarding age, sex, race, weight, height, BMI, and family history of hypertension or diabetes. Children with LBW presented higher systolic BP (p = 0.019) and more albumin in the 24-hour urine then children with NBW (p = 0.024). Conclusion: We concluded that school children with LBW present with higher BP and more albumin excretion in the 24-hour urine. These findings can indicate presence of changes in both blood pressure and microalbuminuria in prepubertal children with low birth weight.Correspondence to:
C.M. Salgado; Federal University of Goiás, Department of Pediatric, Primeira Avenida SN, Goiânia, GO, 04023 Brazil
Email: claudia.ufg@uol.com.br
Original
The link between lower serum magnesium and kidney function in patients with diabetes mellitus Type 2 deserves a closer look
P.C. Pham, P.M. Pham, P.T. Pham, S.V. Pham, P.A. Pham and P.T. Pham
Abstract
P.C. Pham1, P.M. Pham2, P.T. Pham3, S.V. Pham4, P.A. Pham5 and P.T. Pham6
1Department of Medicine, Nephrology Division, UCLA-Olive View Medical Center, Sylmar, CA, 2Department of Medicine, Greater Los Angeles VA Medical Center, Sepulveda, CA, 3Department of Science, Pennsylvania State Worthington Scranton University, Dunmore, PA, 4Department of Medicine, Cardiology Division, Good Samaritan Hospital/UCLA-Harbor Medical Center, Sylmar, CA, 5Department of Medicine, Cardiology Division, Mercy General Hospital, Sacramento, CA, and 6Department of Medicine, Kidney and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Introduction: We previously reported that lower serum magnesium levels [Mg2+] can be associated with more rapid decline in renal function in patients with diabetes mellitus Type 2 (DM2). We now report long-term renal outcomes of the same patient cohort. Materials and methods: Most recent serum creatinine (SCr) and routine urinary analyses (RUA) for the 550 DM2 patients from our original study were collected. Data analysis: Patients with follow-up data were stratified according to the original study: Group 1 had initial [Mg2+] <= 1.6 mg/dl, Group 2 > 1.6 – 1.8 mg/dl, Group 3 > 1.8 – 2.0 mg/dl and Group 4 > 2.0 mg/dl. The change in renal function was defined by the ratio of the most recent to the initial SCr as well as slope of 1/SCr-versus-time. Any level of proteinuria detected from RUA provided evidence for overt proteinuria. Renal outcomes were analyzed for each defined patient group. Results: SCr were available for 329 out of 550 patients (59.8%). The duration of follow-up ranged from 93.8 ± 23.4 – 99.4 ± 22.4 months among 5 groups. The ratios of the most recent to the initial SCr were 1.54 ± 1.01, 1.28 ± 0.51, 1.26 ± 0.57 and 1.09 ± 0.29 for Groups 1 – 4, respectively; where the differences between Groups 1, 2 and 3 against Group 4 were significant (p = 0.02, 0.001 and 0.007, respectively). Accordingly, the mean slope of 1/SCr-versus-time was the best for Group 4. RUA were available for 176 patients: 22.2%, 9%, 7.3% and none from Groups 1 to 4, respectively, developed overt proteinuria. Conclusion: Our follow-up data suggest a link between low [Mg2+] and worse renal outcomes in DM2 patients.Correspondence to:
P.C. Pham; Department of Medicine, Nephrology Division, UCLA-Olive View, Medical Center, 14445 Olive View Drive, 2B182, Sylmar, CA 91342, USA
Email: pham.pc@ucla.edu
Original
NT-pro-BNP is an independent predictor of mortality in patients with end-stage renal disease
M. Svensson, A. Gorst-Rasmussen, E.B. Schmidt, K.A. Jorgensen and J.H. Christensen
Abstract
M. Svensson1, A. Gorst-Rasmussen2, E.B. Schmidt2, K.A. Jorgensen3 and J.H. Christensen1
1Department of Nephrology, Aalborg Hospital, Aarhus University Hospital, 2Department of Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark, and 3Department of Renal Medicine C, Skejby Hospital, Aarhus University Hospital, Aarhus, Denmark
Aim: Patients with end-stage renal disease (ESRD) have an increased mortality from cardiovascular disease (CVD). N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is an independent predictor of mortality in patients with ischemic heart disease and congestive heart failure. Previous data have shown markedly elevated levels of NT-pro-BNP in patients with ESRD, while the prognostic value of elevated levels of NT-pro-BNP in patients with ESRD is largely unknown. The aim of the present study was to examine if the level of NT-pro-BNP predicts mortality in patients with ERSD and CVD. Methods: We prospectively followed 206 patients with ESRD and documented CVD. Levels of NT-pro-BNP were measured at baseline, and patients were followed for 2 years or until they reached the predefined endpoint of all-cause mortality. Results: During follow-up, the total mortality was 44% (90/206). Patients who died were followed for a median of 314 days (interquartile range 179 – 530). Using Cox regression analysis, age, female sex, systolic blood pressure, dialysis efficiency and plasma levels of NT-pro-BNP were independent prognostic risk factors of mortality. In receiver operating characteristic curve analysis a cut off value for NT-pro-BNP was determined. Patients with values of NT-pro-BNP above 12.200 pg/ml had a 3 times higher risk of death than patients below the cut-off value (HR 3.05 95% CI 1.96 – 4.77, p < 0.0001). Conclusion: In spite of generally elevated levels of NT-pro-BNP, NT-pro-BNP is still an independent predictor of mortality and might add prognostic information in patients with ESRD and documented CVD.Correspondence to:
M. Svensson; Department of Nephrology, Aalborg Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
Email: my_svensson@hotmail.com
Original
Tartrate-resistant acid phosphatase isoform 5a as an inflammation marker in end-stage renal disease
A.J. Janckila, E.D. Lederer, B.A. Price and L.T. Yam
Abstract
A.J. Janckila1,2, E.D. Lederer3, B.A. Price3 and L.T. Yam1,3
1Special Hematology Laboratory, Veterans Affairs Medical Center, Louisville, Departments of 2Microbiology and Immunology, and 3Medicine, University of Louisville, School of Medicine, Louisville, KY, USA
Aim: End-stage renal disease (ESRD) is often complicated by chronic inflammation and malnutrition. We tested whether serum tartrate-resistant acid phosphatase (TRACP) isoform 5a relates to other markers of inflammation in ESRD. Material: Predialysis serum was collected from 99 ESRD patients (51 male, 48 female) aged 55 ± 15 years and a control group of 36 healthy subjects (8 male, 28 female) aged 43.2 ± 10.5 years. Methods: Serum TRACP 5a activity and protein, TRACP 5b activity and C-reactive protein (CRP) were estimated by in-house immunoassays. Commercial kits were used for serum bone-specific alkaline phosphatase, Ntelopeptides of Type I collagen, interleukin-6 (IL-6) and fetuin-A. Intact parathyroid hormone was determined by chemiluminescent assay. Albumin, cholesterol, triglycerides, ferritin and hemoglobin were compared to the hospital reference ranges. Bone mineral density (BMD) was measured at the heel in 69 patients and all control subjects and expressed as g/cm2 and age-corrected T-score. Results: Mean (median) levels of all serum markers were significantly elevated in ESRD except fetuin-A, which was significantly reduced. Mean BMD (g/cm2) was not different than control, but mean T-score was significantly reduced. TRACP 5a protein correlated with CRP, triglycerides and ferritin, but not with IL-6 or any other nutritional or bone markers or BMD. TRACP 5b activity correlated with all bone markers and BMD, but not with inflammation or nutritional markers. Conclusion: Our findings suggest that TRACP 5a may be a useful marker to estimate the degree of inflammation in ESRD patients on chronic hemodialysis.Correspondence to:
A.J. Janckila, PhD; VA Medical Center, 800 Zorn Ave., Louisville, KY 40206, USA
Email: anthony.janckila@va.gov
Original
Intercurrent events and comorbid conditions influence hemoglobin level variability in dialysis patients
A.L.M. DeFrancisco, I.C. Macdougall, F. Carrera, J. Braun, P. Bárány, I. Bridges, T. Wheeler, D. Tran and A. Dietrich
Abstract
A.L.M. DeFrancisco1, I.C. Macdougall2, F. Carrera3, J. Braun4, P. Bárány5, I. Bridges6, T. Wheeler7, D. Tran7 and A. Dietrich8
1Hospital Universitario Valdecilla, Servicio de Nefrologia, Santander, Spain, 2Department of Renal Medicine, King’s College Hospital, London, UK, 3Eurodial, Dialysis Unit, Leiria, Portugal, 4KfH Kuratorium für Dialyse und Nierentransplantation eV, Nürnberg, Germany, 5Division of Renal Medicine, Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden, 6Amgen International Biostatistics, Cambridge, UK, 7Amgen International Biostatistics, Uxbridge, UK, and 8Amgen International Medical Affairs, Zug, Switzerland
Background: To help identify factors contributing to intra-patient Hb variability, pooled records were analyzed from 5,592 patients undergoing hemodialysis (HD) in European, multicenter, open-label, single-arm Phase 3b trials. Patients und methods: Patients previously treated with recombinant human erythropoietin (rHuEPO) were switched to darbepoietin-alpha administered once a week (QW) or once every 2 weeks (Q2W), maintaining the same dosing schedule and route of ESA administration (intravenous or subcutaneous) up to and through the evaluation period. Patients were treated with darbepoietin-alpha to maintain Hb levels between 10 and 13 g/dl. Intrapatient variability was calculated using the SD model, taking all of an individual patient’s Hb values during the evaluation period (Weeks 21 – 24 after conversion) and calculating the SD of these Hb values. Adverse events (AE) of infection or inflammation were recorded. Results: Smaller variability was seen for patients 65 years of age or older compared with younger patients (p = 0.0044) and greater variability for patients less than 40 years of age compared with older patients (p < 0.01). Little difference in variability was seen in relation to sex overall or to the presence or absence of diabetes. Intra-patient Hb variability was greater in the presence of intercurrent conditions, including infection or inflammation (p = 0.0032), blood transfusion (p < 0.0001), hospitalization (p < 0.0001), or hospitalization for cardiovascular (CV) causes (p = 0.0012), than in their absence. Iron status differences had little detectable effect on intra-patient Hb variability. A larger number of changes made to the ESA dose during the evaluation period was also associated with greater Hb variability compared with fewer dose changes, but this association could not be proved as being causative. Although p values were calculated for some comparisons, statistical significance might not indicate clinical significance because of the large sample size. Multivariable analysis to assess the association between AE status and intra-patient Hb variability, adjusting for age, sex, diabetes status, number of dose changes and iron status showed that AE status was significantly associated with Hb variability. Conclusion: Additional studies would be needed to further investigate causes and effects of Hb variability and intercurrent events.Correspondence to:
Dr. A.L.M. DeFrancisco; Presidente de la Sociedad Espanola de Nefrologia, Servicio de Nefrologio, Hospital Universitario Valdecilla, Santander, Spain
Email: martinal@unican.es
Original
Elevation of serum apelin-13 is positively correlated with ADMA in patients on maintenance hemodialysis
D.-L. Zhang, H. Liao, Y.-Y. Wei, Y. Zhang, Q.-D. Zhang and Z.-G. Wang
Abstract
D.-L. Zhang, H. Liao, Y.-Y. Wei, Y. Zhang, Q.-D. Zhang and Z.-G. Wang
Department of Nephrology, Affiliated Beijing Friendship Hospital, Capital Medical University Beijing, Peoples Republic of China
Aim: Apelin and ADMA may have opposite impacts on the activity of NOS and production of NO. However, the circulating level and cardiovascular role of apelin are unclear in uremia patients with elevated ADMA. Our present study was to detect the serum level of apelin-13 and ADMA, and their correlations in maintenance hemodialysis (MHD) patients. Methods: 159 MHD patients without heart failure (HF) and twenty healthy volunteers were enrolled. Pre- and post-dialysis concentrations of serum apelin-13 and ADMA in MHD patients and in controls were determined. Nitrite and nitrate (NOx) were measured at the same time. The levels of apelin-13, ADMA, and NOx in dialysate or ultrafiltrate were tested, and the total removal (TR) of them in 1 session were calculated. It was also analyzed for the correlations among apelin-13, ADMA, NOx, apelin/ADMA ratio and other clinical parameters, such as blood pressure, urea reduction rate (URR), and so on. Results: The serum levels of apelin-13 and ADMA in MHD patients were both higher than healthy controls (104.63 ± 40.35 ng/ml versus 55.57 ± 21.06 ng/ml, p = 0.016; 1.05 ± 0.67µM vs. 0.35 ± 0.06 µM, p = 0.002, respectively). There was no significant difference in serum NOx levels between MHD patients and healthy controls (58.30 ± 40.09 µM vs. 68.11 ± 13.63 µM, p = 0.596). Except for the significantly increased NOx (from 58.30 ± 40.09 µM to 96.14 ± 58.07 µM, p < 0.001), the serum levels of apelin-13 (from 104.63 ± 40.35 ng/ml to 76.44 ± 40.47 ng/ml, p = 0.012) and ADMA (from 1.05 ± 0.67 µM to 0.83 ± 0.53 µM, p < 0.001) decreased significantly after hemodialysis session. Apelin-13, ADMA, and NOx all can be removed by HD. The predialysis serum level of apelin-13 was positively correlated with the one of ADMA (r = 0.349, p = 0.001) and LDL (r = 0.204, p = 0.041), but ADMA was positively correlated with SCr (r = 0.277, p = 0.027). There were negative relationships between serum levels of ADMA and NOx for both pre- and post-dialysis (r = –0.344, p = 0.047, and r = –0.612, p = 0.001, respectively). The apelin/ADMA ratio had significantly negative correlations with systolic blood pressure (SBP) (for predialysis, r = –0.277, p = 0.037, for postdialysis r = –0.754, p = 0.019, respectively). Conclusion: The serum concentrations of both ADMA and apelin-13 are increased in MHD patients without HF, and there were positive correlations between them predialysis. Both of them might affect patients blood pressure.Correspondence to:
Prof. Z.-G. Wang; Department of Nephrology, Affiliated Beijing Friendship, Hospital Capital Medical University, Beijing 100050, China
Email: zdlycy@sina.com; Liuwh0211@yahoo.com.cn
Original
Oxymetholone ameliorates insulin sensitivity in maintenance hemodialysis patients: a randomized controlled trial
P. Aramwit, N. Kobpipat, B. Satirapoj, J.D. Kopple and O. Supasyndh
Abstract
P. Aramwit1, N. Kobpipat1, B. Satirapoj2, J.D. Kopple3 and O. Supasyndh2
1Department of Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, 2Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand, and 3David Geffen School of Medicine at UCLA and UCLA School of Public Health, Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, CA, USA
Aims: To investigate the beneficial effects of oral oxymetholone on IR in hemodialysis (HD) patients by increasing skeletal muscle function and stimulating myocyte glucose uptake and metabolism. Methods: In a randomized, controlled double-blind study, 44 patients were randomly assigned to one of two groups: a treatment group that received oxymetholone 50 mg orally twice daily and a control group that received placebo twice daily for 24 weeks. IR was calculated by using HOMA, and dual-energy X-ray absorptiometry was used to determine body composition. All patients were encouraged to walk at least one kilometer daily and were monitored by the Barthel index activity score. Results: 25 men (57%) and 19 women (43%) were studied. 23 subjects were in the control group, and 21 subjects were in the treatment group. The mean age of patients and the duration of dialysis were 43.5 ± 9.9 years and 92.8 ± 37.8 months, respectively. After treatment, the HOMA index and body fat mass (FM) were significantly decreased in the treatment group compared to those in the control group (10.8 ± 16.4 vs. 3.1 ± 4.5; p < 0.05 and 1.73 ± 2.77 vs. 0.40 ± 1.12 kg; p < 0.05, respectively). Concurrently, the mean change of fat free mass (FFM) in the treatment group was higher than that in the control group (3.24 ± 1.74 vs. 0.65 ± 1.21 kg, p < 0.05). Two patients in the treatment group experienced an elevation in serum liver enzymes (9.52%). Conclusion: HD patients treated with short-term oral oxymetholone showed an increase in insulin sensitivity when compared to the placebo group, and this effect depended on changes in FFM and FM.Correspondence to:
P. Aramwit; Department of Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, 10330 Thailand
Email: aramwit@gmail.com
Original
Geographical prevalence, risk factors and impact of hepatitis B and C after renal transplantation
V. Kliem, U. Michel, M. Burg, A. Bock, J. Chapman, B. Dussol, L. Fritsche, Y. Lebranchu, F. Oppenheimer, E. Pohanka, M. Salvadori and G. Tufveson
Abstract
V. Kliem1, U. Michel2, M. Burg1, A. Bock3, J. Chapman4, B. Dussol5, L. Fritsche6, Y. Lebranchu7, F. Oppenheimer8, E. Pohanka9, M. Salvadori10 and G. Tufveson11
1Nephrological Center Niedersachsen Hann. Münden, 2Novartis Pharma GmbH Nürnberg, Germany, 3Nephrology Division, Kantonsspital Aarau, Switzerland, 4Centre for Transplant and Renal Research, Millennium Institute, Westmead Hospital, University of Sydney, Australia, 5Hôpital de la Conception, Marseille, France, 6Department of Nephrology, University Hospital Campus Charité Mitte, Berlin, Germany, 7CHU Tours, Hopital Bretonneau, Tours, France, 8Hopital Clinic de Barcelona, Unitat de Transplantament Renal, Barcelona, Spain, 9Division of Nephrology and Dialysis, Internal Medicine III, Medizinische Universität Wien, Vienna Austria, 10Renal Unit, Careggi University Hospital, Florence, Tuscany, Italy, and 11Department of Transplantation, Uppsala University Hospital, Uppsala, Sweden
Background: Hepatitis B (HBV) and hepatitis C (HCV) virus infections are major risk factors affecting long-term morbidity and mortality after renal transplantation. Hepatitis prevalence is subject to geographical variations. Objective: To compare and analyze the geographical prevalence, risk factors and impact of HBV and HCV infection in multinational cohorts of renal transplant recipients. Methods: From 1989 – 2002, data on 12,856 kidney transplant recipients in 37 countries were collected within the prospective MOST (Multinational Observational Study in Transplantation). Subgroup analyses of hepatitis-related prevalence, risk factors and impact were conducted on patients whose HBV and HCV status was available at time of transplantation. Countries were substratified according to population prevalence of >= 5% HBV or >= 10% HCV. Results: The prevalence of HBV was 2.9%, of HCV 8.7% and of HBV together with HCV 0.4%. Risk factors for hepatitis infection in renal transplant recipients were long dialysis time, retransplantation and blood transfusions. At each study endpoint up to 5 years after transplantation, no significant differences in graft function were observed, although the 1-year acute rejection rate tended to be lower in HCV+ patients. At 5 years post-transplant, there were no differences between the subgroups and regions regarding infections, post-transplant diabetes mellitus or malignancies including PTLD. Conclusions: Overall, HCV infections are more prevalent than HBV. Despite large geographical differences in prevalence, HBV and HCV status did not appear to have a significant impact on renal graft function, infections, malignancies and post-transplant diabetes mellitus up to 5 years after renal transplantation throughout the MOST countries.Correspondence to:
PD Dr. med. V. Kliem; Nephrological Center Niedersachsen, Vogelsang 105, 34346 Hann. Münden, Germany
Email: v.kliem@awogsd.de
Case Report
An unusual complication of treatment with orlistat
L. Karamadoukis, G.H. Shivashankar, L. Ludeman and A.J. Williams
Abstract
L. Karamadoukis1, G.H. Shivashankar2, L. Ludeman3 and A.J. Williams2
1The Richard Bright Renal Unit, Southmead Hospital, Bristol, 2Department of Renal Medicine and 3Department of Histopathology, Gloucestershire Royal Hospital, Gloucester, United Kingdom
We report an unusual complication of orlistat, a gastrointestinal and pancreatic lipase inhibitor used in the treatment of obesity. A 66-year-old man with history of Type 2 diabetes and obesity presented to our hospital with recurrent episodes of hypoglycemia over 2 weeks. His medications included twice daily biphasic insulin and 3 months previously he was prescribed orlistat as treatment for his obesity. On admission he was in acute renal failure with a creatinine concentration of 405 µmol/l. His renal function 4 months previously was normal. Urinalysis revealed neither blood nor protein, but microscopy of his urine revealed moderate amounts of crystals. A renal biopsy revealed normal glomeruli, but there were features of acute tubular necrosis associated with oxalate crystal deposition. Over the next few days his renal function declined and needed hemodialysis. 3 weeks after his admission he continued to require hemodialysis and he unexpectedly had a cardiac arrest and died. Our patient had acute tubular necrosis secondary to orlistat-induced acute oxalate nephropathy. The identification of high risk patients treated with orlistat and regular monitoring of their renal function might reduce the risk of renal failure due to acute oxalate nephropathy.Correspondence to:
Dr. G. Shivashankar; Flat 62, West Lodge, Castle Hill Hospital, Castle Road, Cottingham HU16 5JQ, United Kingdom
Email: girishshivashankar@doctors.org.uk
Case Report
Two consecutive cases of renal oncocytomatosis in a single-center experience
A. Sydor, W. Sulowicz, T. Stompór, B. Plezia, A. Wrona and K. Okon
Abstract
A. Sydor1, W. Sulowicz2, T. Stompór2, B. Plezia1, A. Wrona1 and K. Okon3
1First Department of Internal Medicine and Nephrology, St. Lukas Hospital, Tarnów, 2Chair and Department of Nephrology, Jagiellonian University, and 3Chair and Department of Clinical Pathomorphology, Jagiellonian University, Cracow, Poland
Renal oncocytoma is a rare finding and represents the small percentage of all kidney tumors. This kind of tumor is benign and diagnosed accidentally (on autopsy or during nephrectomy performed for other reasons). On rare occasions, truly multiple tumors are seen, affecting the entire renal parenchyma; this condition is called oncocytosis or oncocytomatosis. Here we present two cases of this condition, diagnosed consecutively in a single internal medicine department.Correspondence to:
W. Sulowicz, MD; Professor of Medicine, Chair and Department of Nephrology, Jagiellonian University, 15c Kopernika Str, 31-501 Cracow, Poland
Email: wladsul@mp.pl
Case Report
Spontaneous retroperitoneal hemorrhage due to massive rupture of renal angiomyolipoma treated with nephrectomy: an unusual onset of tuberous sclerosis complex
A. Granata, A. Basile, M. Figuera, R. Mignani and C.E. Fiore
Abstract
A. Granata1, A. Basile2, M. Figuera2, R. Mignani3 and C.E. Fiore2
1Department of Nephrology, Dialysis and Internal Medicine, 2Department of Radiology, “Vittorio Emanuele” Ferrarotto, Hospital, Catania, and 3Department of Nephrology and Dialysis “Infermi” Hospital, Rimini, Italy
Tuberous sclerosis complex (TSC) is a genetic and systemic disorder characterized by benign hamartomatous tumors that involve multiple organ systems. The classical clinical triad of TSC consists of seizure, adenoma sebaceum (facial angiofibromata) and mental retardation. Renal angiomyolipomas are documented in approximately 40 – 80% of tuberous sclerosis patients and usually are small and asymptomatic. Less frequently nodules are large and lead to retroperitoneal hemorrhage. In these cases diagnosis can be difficult but definitive only after the histological examination or the systemic investigation of other possible tissue involvements. We describe the case of a 28 year old woman who came to the emergency department with acute postprandial abdominal pain and severe anemia due to hemorrhagic renal angiomyolipoma treated by nephrectomy in whom the following examination led to the diagnosis of TSC.Correspondence to:
Dr. A. Granata, MD; Via F. Paradiso n°78/a, 95024 Acireale (CT), Italy
Email: antonio.granata4@tin.it
Case Report
Acute renal failure and hypercalcemia in an athletic young man
S.M. Titan, S.H. Callas, D.E. Uip, R. Kalil-Filho and P.C.A Galvão
Abstract
S.M. Titan1, S.H. Callas2, D.E. Uip2, R. Kalil-Filho2 and P.C.A Galvão2
1Renal Department, Hospital das Clínicas, Sao Paulo University Medical School, 2Hospital Sírio-Libanês, Sao Paulo, Brazil
Hypercalcemia is a life-threatening disorder and is related primarily to neoplastic diseases and primary and secondary hyperparathyroidism. The association of hypercalcemia and renal failure is frequent in the medical literature, although pathogenetic mechanisms remain to be elucidated. In this article, we present a case of hypercalcemia and acute renal failure secondary to vitamin D and vitamin A intoxication, after an over-the-counter intramuscular use by a young man starting an athletic performance program. A discussion of clinical picture, diagnosis and treatment is made, and we highlight the risk of pathological conditions triggered by inadvertent use of supplementation products and formulas available in health and fitness commercial centers.Correspondence to:
S. Titan, MD; R Cassiano Ricardo 39, 04640-020 Sao Paulo, Brazil
Email: silviatitan@superig.com.br
Case Report
Hemodialysis catheter placement via a persistent left superior vena cava
Y.S. Jang, S.H. Kim, D.H. Lee, D.H. Kim and A.Y. Seo
Abstract
Y.S. Jang, S.H. Kim, D.H. Lee, D.H. Kim and A.Y. Seo
Department of Internal Medicine, Division of Nephrology, Fatima Hospital, Daegu, Korea
Persistent left superior vena cava (PLSVC) is the most common thoracic venous circulation anomaly and discovered incidentally during hemodialysis catheter insertion. PLSVC may have some clinical implications for nephrologists. PLSVC can create difficulties during catheter insertion and cause serious complications; it can be mistaken for placement into other sites and cause inappropriate response such as catheter removal. Nephrologists who place hemodialysis catheters in the left jugular or subclavian vein should be aware of the existence of PLSVC.Correspondence to:
S.H. Kim; Department of Internal Medicine, Division of Nephrology, Fatima Hospital, 183, A-Yang-ro, Dong-gu, Daegu 701-600 Korea
Email: Shkim@fatima.or.kr
Case Report
Rupture of pectoralis major muscle in an elderly patient receiving long-term hemodialysis: case report and literature review
L.-C. Ho, C.-K. Chiang, J.-W. Huang, K.-Y. Hung and K.-D. Wu
Abstract
L.-C. Ho1,3, C.-K. Chiang1,2, J.-W. Huang1, K.-Y. Hung1 and K.-D. Wu1
1Department of Internal Medicine, 2Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, 3Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
Total or near-total rupture of the pectoralis major muscle is rare. It has mainly occurred in male patients between 20 – 40 years of age while performing weight-lifting. Major tendon rupture is a rare but well-documented complication of long-term dialysis. However, rupture of pectoralis major in dialysis patients had never been reported before. Here, we present a pectoralis major rupture in an elderly patient receiving maintenance hemodialysis. Both old age and long-term dialysis could be risk factors of rupture. The clinicians should pay more attention to this complication when taking care of elderly patients on hemodialysis.Correspondence to:
C.-K. Chiang MD, PhD; No. 7 Chung-Shan South Road, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Email: ckchiang@ntu.edu.tw
Case Report
Living donor kidney transplantation without transmission of multiple sclerosis after 10 years
A. Taylor and B.D. Kahan
Abstract
A. Taylor and B.D. Kahan
The University of Texas Medical School at Houston, Houston, TX, USA
We report the case of a successful renal transplant for over 10 years from a living donor with a history of multiple sclerosis.Correspondence to:
B.D. Kahan, PhD, MD; Division of Immunology and Organ Transplantation, The University of Texas, Medical School – Houston, 6431 Fannin, Suite 6.240, Houston, TX 77030, USA
Email: Barry.D.Kahan@uth.tmc.edu
Case Report
Inferior vena cava (IVC) filter thrombosis in a renal transplant recipient
M. Senitko, R. Sims, B. Dolmatch, M.A. Vazquez and C.Y. Lu
Abstract
M. Senitko1, R. Sims2, B. Dolmatch2, M.A. Vazquez1 and C.Y. Lu1
1Division of Nephrology, Department of Internal Medicine, and 2Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
We report a renal transplant patient with a functioning allograft who had an inferior vena cava (IVC) filter placed above the renal allograft vein. The patient occluded the IVC filter and developed extensive distal thrombosis. This included complete occlusion of the renal allograft vein (RAV). However, this complication did not lead to a loss of kidney transplant function. Alternate allograft venous drainage via capsular collaterals and subsequent recanalization of transplant vein were demonstrated.Correspondence to:
C.Y. Lu, MD; Division of Nephrology, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-8856, USA
Email: Christopher.Lu@UTSouthwestern.edu
Case Report
Pancytopenia in a simultaneous pancreas and kidney transplant recipient: an unexpected cause – a case of visceral leishmaniasis in a transplant recipient
H. Aardema, Y.W.J. Sijpkens and L.G. Visser
Abstract
H. Aardema1, Y.W.J. Sijpkens2 and L.G. Visser3
1Department of Internal Medicine, Leiden University Medical Center, Leiden, Department of Critical Care, University Medical Center Groningen, University of Groningen, The Netherlands, 2Department of Nephrology, Leiden University Medical Center, Department of Internal Medicine, Bronovo Hospital, The Hague, The Netherlands, and 3Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
A transplant recipient presented with fever and pancytopenia. Bone marrow biopsy showed Leishmania parasites. Travel history revealed a trip to Greece 17 months prior to admission. This case illustrates the importance of considering leishmaniasis as a cause of pancytopenia, especially in the immunocompromised, even in the absence of recent travel to an endemic area. Acknowledgment of this infection is vital as the outcome can be fatal if left untreated.Correspondence to:
H. Aardema; p/o Intensive and Respiratory Care, Department of Critical Care, University Medical Center Groningen, University of Groningen, PO Box 300001, 9700 RB Groningen, The Netherlands
Email: h.aardema@int.umcg.nl
Letter to the Editor
Glomerular crescent formation in renal amyloidosis – A clinico- pathological study and demonstration of upregulated cell-mediated immunity
J. Verine
Letter to the Editor
Arteriovenous graft infection caused by Mycobacterium abscessus in a hemodialysis patient
K.P. Kang, B.J. Jeon, C.S. Lee, T.H. Lee, S. Lee, W. Kim and S.K. Park
Abstract
K.P. Kang, B.J. Jeon, C.S. Lee, T.H. Lee, S. Lee, W. Kim and S.K. Park
