Volume 68, No. 3/2007(September)
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 Clinical Nephrology
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Originals
Correlation between pulse wave velocity and other measures of arterial stiffness in chronic kidney disease
Abstract
N.J. Wimmer, R.R. Townsend, M.M. Joffe, J.P. Lash and A.S. Go for the Chronic Renal Insufficiency Cohort (CRIC) Study Investigators
1Department of Medicine, Renal-Electrolyte and Hypertension Division, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, 2Department of Medicine, University of Illinois at Chicago, Chicago, IL and 3Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco, San Francisco, CA, USA
Aim: Pulse wave velocity (PWV), augmentation index (AIx) and time to first wave reflection (Tr) are all measures of arterial stiffness, but whether these parameters behave similarly in different populations is not well-understood. Given the large burden of cardiovascular disease in individuals with chronic kidney disease (CKD), assessing the relationship between vascular stiffness parameters in this population is important. Method: A subset of 152 participants enrolled in the Chronic Renal Insufficiency Cohort Study had vascular stiffness parameters (aortic PWV, central AIx, and Tr) measured using the SphygmoCor system. Linear association between these parameters was assessed using Pearson correlation coefficients. Reproducibility across operators of the device was also tested within individuals. Results: Association was largest between PWV and heart rate-adjusted AIx (AIx-75). The correlation coefficient was 0.371 (p = 0.0003) for ideal studies and 0.305 (p = 0.0001) for all technically acceptable studies. The association between ideal PWV and AIx-75 measurements was 0.361 (p = 0.005) for men and 0.423 (p = 0.01) for women. Bland-Altman plots comparing the mean value of PWV (n = 31) or AIx-75 (n = 21) when measured by 2 different individuals against the difference in their respective values demonstrate that both measures of arterial stiffness are reproducible across multiple technicians. Conclusions: Thus, we conclude that PWV and AIx-75, despite measuring different quantities in different units, are related measures of arterial stiffness and are reproducible across multiple operators in the population with CKD.Correspondence to:
R.R. Townsend, MD
Renal-Electrolyte and Hypertension Division
University of Pennsylvania School of Medicine
210 White Building, 3400 Spruce Street
Philadelphia, PA 19104, USA
Email: townsend@mail.med.upenn.edu
Originals
Oxidative status and prevalent cardiovascular disease in patients with chronic renal failure treated by hemodialysis
Abstract
M. Dirican, E. Sarandol, Z. Serdar, N. Ocak and K. Dilek
1Department of Biochemistry, 2Department of Nephrology,
Medical Faculty of Uludag University, Bursa, Turkey
Background: Hemodialysis (HD) patients are exposed to oxidative stress which contributes to cardiovascular disease (CVD). The purpose of this study was to investigate the oxidative and antioxidative status in HD patients with (CVD+, n = 38) and without (CVD�, n = 67) prevalent CVD. Patients and methods: A total of 105 HD patients and 21 healthy controls were assessed for lipid peroxidation indices (plasma malondialdehyde (MDA)), oxidizability of apolipoprotein B-containing lipoproteins (apo B-DeltaMDA) and red blood cells (RBC-MDA) together with various components of the antioxidant system in plasma (paraoxonase/arylesterase activities, total carotenoids, vitamins C and E) and RBC (superoxide dismutase and glutathione peroxidase activities). Results: Plasma MDA and RBC-MDA were significantly higher, vitamin C and total carotenoid levels were significantly lower in both CVD+ and CVD� HD groups than in the control group. Plasma MDA levels were significantly higher and serum paraoxonase activity, uric acid and albumin levels were significantly lower in patients with CVD+ HD patients compared to those of the CVD� patients. Conclusion: This study suggests that the elevated level of plasma MDA and the lower activity of paraoxonase could contribute to the increased incidence of cardiovascular disease in hemodialysis patients.Correspondence to:
M. Dirican, MD
Uludag University Medical Faculty
Department Biochemistry
16059 Gorukle/Bursa, Turkey
Email: mdirican@uludag.edu.tr
Originals
The economics of home nocturnal hemodialysis: how should we cost the benefits?
Abstract
P. Komenda, A. Levin and B. Manns
Department of Internal Medicine, Takasago Municipal Hospital, Takasago, Japan
Although venous thrombosis is a major complication in nephrotic syndrome, cerebral venous thrombosis (CVT) is rarely reported. We describe a 29-year-old male with nephrotic syndrome who suddenly developed headache and nausea. Although computed tomography scan and magnetic resonance imaging detected no abnormal lesions, phase-contrast magnetic resonance venography (PC MRV) demonstrated extensive thrombosis of the superior sagittal sinus. After receiving systemic anticoagulant therapy and oral prednisolone, his neurological symptoms improved dramatically, and complete remission from nephrotic syndrome was achieved. Follow-up PC MRV demonstrated recanalization of the superior sagittal sinus, and renal biopsy confirmed the diagnosis of minimal change nephrotic syndrome. Although CVT is difficult to detect with conventional diagnostic methods, PC MRV may help the establishment of an early diagnosis and prompt treatment for a successful outcome.Correspondence to:
H. Komaba, MD
Division of Nephrology and Dialysis Center, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
Email: hkomaba@med.kobe-u.ac.jp
Originals
A pilot study in hemodialysis of an electrophysiological tool to measure sudden cardiac death risk
Abstract
A.N. Friedman, W.J. Groh and M. Das
1Division of Nephrology and
2Division of Cardiology, Indiana University, Indianapolis, IN, USA
Background: The hemodialysis procedure may play a role in the elevated risk of sudden cardiac death seen in hemodialysis patients. Methods: Microvolt T wave alternans, a promising noninvasive electrophysiological test developed to measure sudden cardiac death risk, was used to test the hypotheses that high-risk hemodialysis patients commonly manifest cardiac electrophysiology that is associated with higher sudden death risk in nondialysis patients and that the hemodialysis procedure modifies cardiac electrophysiology in a manner predisposing to malignant ventricular arrhythmias. To test this hypothesis, microvolt T wave alternans tracings were done in 9 patients before and immediately after an early week hemodialysis session. Results: 7 of 9 individuals had non-negative (i.e. higher risk) tracings either before or after hemodialysis. 2 of 4 subjects with tracings initially negative before hemodialysis became non-negative after hemodialysis. Conclusion: This pilot study provides the first objective preliminary evidence using microvolt T wave alternans that high-risk hemodialysis patients commonly exhibit abnormal cardiac repolarization and that hemodialysis treatments can acutely alter repolarization in a potentially harmful manner.Correspondence to:
A. Friedman, MD
1481 W. 10th St.-111N, Indianapolis, IN 46202, USA
Email: allfried@iupui.edu
Case Reports
ANCA-related crescentic glomerulonephritis in systemic sclerosis:
revisiting the ?normotensive scleroderma renal crisis?
Abstract
L. Arnaud, A. Huart, E. Plaisier, H. Francois, B. Mougenot, K. Tiev, A. Kettaneh, P. Ronco and J.-P. Rougier
1Department of Nephrology and Dialysis,
2Department of Pathology, H
The scleroderma renal crisis is characterized by acute onset of severe hypertension and by rapidly progressive hyper-reninemic renal failure. There is, however, a very limited subset of patients with rapidly progressive renal failure who remain normotensive and develop ANCA-positive crescentic glomerulonephritis. We report a case of normotensive acute renal failure secondary to anti-MPO antibody-associated crescentic glomerulonephritis in a patient with diffuse systemic sclerosis. She was referred to our department with normal blood pressure and no extrarenal clinical manifestation of vasculitis. She presented with rapidly progressive renal failure, microscopic hematuria and minimal proteinuria. P-ANCA were positive by immunofluorescence, with ELISA-confirmed specificity for myeloperoxidase. Renal biopsy revealed typical features of pauciimmune glomerulonephritis with crescent formation and fibrinoid necrosis. The patient was initially treated with i.v. cyclophosphamide only. Because of ongoing deteriorating renal function, additional treatment with intravenous pulses of methylprednisolone followed by oral prednisone was started and allowed renal function improvement. After 9 months, serum creatinine had almost returned to normal level with minimal proteinuria, no hematuria and negative ANCA testing. Control kidney biopsy only revealed scar lesions. The association of ANCA-positive crescentic glomerulonephritis and systemic sclerosis is a very rare event. Treatment with intravenous cyclophosphamide and corticosteroids allows rapid and long-term improvement of renal function. The onset of typical scleroderma renal crisis triggered by high-dose corticosteroids is unlikely but requires a close follow-up of patients with overlapping systemic sclerosis. Diagnosis and treatment are discussed and previously published cases are reviewed.Correspondence to:
J.P. Rougier MD, PhD
Department of Nephrology and Dialysis, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France
Email: jean-philippe.rougier@tnn.aphp.fr
Case Reports
Multicentric Castleman disease with secondary AA renal amyloidosis, nephrotic syndrome and chronic renal failure, remission after high-dose melphalan and autologous stem cell transplantation
Abstract
M. Ogita, J. Hoshino, Y. Sogawa, N. Sawa, H. Katori, F. Takemoto, Y. Ubara, S. Hara, S. Miyakoshi and K. Takaichi
1Kidney Center, 2Department of Hematology, Toranomon Hospital, Tokyo, Japan
Multicentric Castleman disease is a systemic lymphoproliferative disease with incomplete understood etiology. The various renal complications of this disease may include minimal change disease, mesangial proliferative glomerulonephritis, membranous glomerulonephritis and nephrotic syndrome, caused by secondary amyloidosis. In several reported cases of localized Castleman disease associated with renal amyloidosis and nephrotic syndrome, resection of organs involved by lymphoid proliferation resulted in complete remission. However, therapy of multicentric Castleman disease with renal amyloidosis is not well-established. We treated a case of a 39-year-old woman with multicentric Castleman disease complicated by nephrotic syndrome caused by secondary AA amyloidosis. The patient underwent autologous peripheral blood stem cell transplantation (auto-PBSCT), achieving complete remission. Autologous stem cell transplantation may be an attractive choice in therapy for refractory multicentric Castleman disease.Correspondence to:
M. Ogita, MD
Kidney Center, Toranomon Hospital, 2-2-2 toranomon, Minato-ku, Tokyo, Japan, 105-8470
Email: m-ogita@sa2.so-net.ne.jp
Case Reports
Ibuprofen-induced HUS
Abstract
N.J. Schoenmaker, J.J. Weening and R.T. Krediet
Departments of Medicine and Pathology, Academic Medical Center,
University of Amsterdam, The Netherlands
Background: Hemolytic uremic syndrome (HUS) is a disease characterized by nonimmune hemolytic anemia, thrombocytopenia and renal impairment. There are many causes for HUS, but adverse reactions to drugs have been increasingly reported. Even the NSAIDs which have been reported as safe and effective painkillers are described as cause of recurrent HUS. Patient case: We describe a case of a 44-year-old woman who was admitted to our hospital because of thrombocytopenia and anemia after the use of 8 tablets of 400 mg ibuprofen (NSAIDs). The diagnosis HUS was made and she recovered completely after treatment with fresh-frozen plasma and seven plasma exchanges. Conclusion: No cause could be identified except the use of ibuprofen. Recognition of a drug-induced HUS is necessary to avoid reexposure and recurrent HUS.Correspondence to:
Dr. N.J. Schoenmaker
Divison of Nephrology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Email: niks50@hotmail.com
Case Reports
Early detection and successful treatment of cerebral venous thrombosis associated with minimal change nephrotic syndrome
Abstract
H. Komaba, H. Kadoguchi, N. Igaki and T. Goto
Department of Internal Medicine, Takasago Municipal Hospital, Takasago, Japan
Although venous thrombosis is a major complication in nephrotic syndrome, cerebral venous thrombosis (CVT) is rarely reported. We describe a 29-year-old male with nephrotic syndrome who suddenly developed headache and nausea. Although computed tomography scan and magnetic resonance imaging detected no abnormal lesions, phase-contrast magnetic resonance venography (PC MRV) demonstrated extensive thrombosis of the superior sagittal sinus. After receiving systemic anticoagulant therapy and oral prednisolone, his neurological symptoms improved dramatically, and complete remission from nephrotic syndrome was achieved. Follow-up PC MRV demonstrated recanalization of the superior sagittal sinus, and renal biopsy confirmed the diagnosis of minimal change nephrotic syndrome. Although CVT is difficult to detect with conventional diagnostic methods, PC MRV may help the establishment of an early diagnosis and prompt treatment for a successful outcome.Correspondence to:
H. Komaba, MD
Division of Nephrology and Dialysis Center, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
Email: hkomaba@med.kobe-u.ac.jp
Case Reports
Early detection and successful treatment of cerebral venous thrombosis associated with minimal change nephrotic syndrome
Abstract
H. Komaba, H. Kadoguchi, N. Igaki and T. Goto
Department of Internal Medicine, Takasago Municipal Hospital, Takasago, Japan
Although venous thrombosis is a major complication in nephrotic syndrome, cerebral venous thrombosis (CVT) is rarely reported. We describe a 29-year-old male with nephrotic syndrome who suddenly developed headache and nausea. Although computed tomography scan and magnetic resonance imaging detected no abnormal lesions, phase-contrast magnetic resonance venography (PC MRV) demonstrated extensive thrombosis of the superior sagittal sinus. After receiving systemic anticoagulant therapy and oral prednisolone, his neurological symptoms improved dramatically, and complete remission from nephrotic syndrome was achieved. Follow-up PC MRV demonstrated recanalization of the superior sagittal sinus, and renal biopsy confirmed the diagnosis of minimal change nephrotic syndrome. Although CVT is difficult to detect with conventional diagnostic methods, PC MRV may help the establishment of an early diagnosis and prompt treatment for a successful outcome.Correspondence to:
H. Komaba, MD
Division of Nephrology and Dialysis Center, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
Email: hkomaba@med.kobe-u.ac.jp
Case Reports
Goodpasture?s syndrome in a patient using cocaine ?
A case report and review of the literature
Abstract
A.E. Sirvent, R. Enr
1Nephrology Section,
2Pathology Section,
3Radiology Diagnostic Service,
4Pneumology Section, Hospital General Universitario de Elche, Spain
Glomerulonephritis is a very rare form of cocaine-induced renal pathology. We report a 26-year-old woman having inhaled cocaine, who presented with antiglomerular basement membrane glomerulonephritis and pulmonary hemorrhage. She was treated with immunosuppressive therapy and plasmapheresis. Maintenance hemodialysis was required on discharge. We stress the importance of early detection and treatment of this renal association for the potential fatal consequences implicated.Correspondence to:
Dra. A.E. Sirvent
Nephrology Section, Hospital de Elche, Cami de l?Almazara s/n, 03203, Elche (Alicante) Spain
Email: emma_@wanadoo.es
Case Reports
Tumor lysis syndrome and acute renal failure � an increasing spectrum of presentations
Abstract
E. Mukherjee, D. Mukherji, S.A. Jayawardene and S.P. Kon
1Department of Nephrology, Kings College Hospital, and
2Department of Medical Oncology, St. Georges Hospital, London, United Kindom
Tumor lysis syndrome has historically been associated with hyperuricemia and uric acid crystal deposition. We present three cases of tumor lysis syndrome resulting in renal failure in the context of normouricema, highlighting the spectrum of clinical presentations and mechanisms of renal damage. Two cases occurred following the treatment of hematological malignancies and were associated with hyperphosphatemia; the third resulted from ischemic necrosis following transarterial chemoembolization of a hepatic tumor. We also discuss the role of renal biopsy in the investigation of tumor lysis syndrome.Correspondence to:
Dr. D. Mukherji
St. Georges Hospital, Blackshaw Road, Tooting, London SW17 0QT, United Kingdom
Email: dmukherji@doctors.org.uk
Case Reports
Roundup intoxication and a rationale for treatment
Abstract
R.V. Sampogna and R. Cunard
1Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, San Diego, La Jolla, CA and
2Department of Medicine, Columbia University, New York, NY, USA
A 51-year-old man with no history of renal disease was admitted to our hospital after an intentional ingestion of RoundupCorrespondence to:
R. Cunard, MD, FRCPC
Research Service and Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA
Email: rcunard@ucsd.edu
Letters to the Editor
Celiac sprue-associated membranous nephropathy
Abstract
C. Halma and F. Ubels
Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
Correspondence to:
Dr. C. Halma
Internal Medicine, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR Leeuwarden, The Netherlands
Email: c.halma@znb.nl
Letters to the Editor
Long-term mizoribine intermittent pulse therapy, but not azathioprine therapy, attenuated histologic progression in a patient with severe lupus nephritis
Abstract
H. Tanaka, K. Tsugawa, E. Oki, K. Suzuki, S. Waga and E. Ito
1Department of Pediatrics, Hirosaki University School of Medicine and 2National Aomori Hospital, Hirosaki, Japan
Correspondence to:
H. Tanaka, MD
Department of Pediatrics, Hirosaki University School of Medicine,
5 Zaifu-cho, Hirosaki, 036-8562, Japan
Email: hirotana@cc.hirosaki-u.ac.jp
