Dustri Online Services

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (91-100)

FOXP3+ regulatory T-cells in renal allografts: correlation with long-term graft function and acute rejection

D. Kollins¹, B. Stoelcker¹, U. Hoffmann⁴, T. Bergler¹, S. Reinhold¹, M.C. Banas¹, P. Rümmele², S. Farkas³, B.K. Krämer⁵ and B. Banas¹

¹Department of Internal Medicine II, ³Department of Surgery, ²Institute of Pathology, School of Medicine, University Hospital Regensburg, ⁴Clinic Barmherziger Brüder, Regensburg, and ⁵Department of Internal Medicine V, University Medical Center Mannheim, University of Heidelberg, Germany
Background: The interpretation of a cellular infiltrate as cytotoxic or tolerogen represents an unsolved challenge in current transplantation. The so-called regulatory CD4+ CD25+ T-cells which express the FOXP3 gene have received increasing interest with respect to this question. The existing studies concerning the role of FOXP3+ Tregs for transplant tolerance yielded contradictory results. Methods: We examined the numbers of the FOXP3+ Tregs in two groups of renal allograft biopsies both showing cellular infiltration, but either without (n = 29) or with signs of acute cellular rejection (n = 26), by means of immunofluorescence and correlated the amount of FOXP3+ Tregs to renal function at the time of biopsy and after 1 and 2 years of follow up. Results: The number of FOXP3+ Tregs within infiltrates in non-rejecting biopsies did not correlate with renal function after 1 and 2 years. There were no significant differences in the numbers of FOXP3+ Tregs between biopsies with or without borderline infiltrates. Increased numbers of FOXP3+ Tregs were not associated with an ameliorated severity of graft rejection and did not correlate with outcome after the rejection episode and renal function after 1 and 2 years. Conclusions: The identification of the FOXP3+ regulatory cells within the allograft cannot be considered as an appropriate marker for the interpretation of infiltrates as cytotoxic or tolerogenic or as a prognostic marker for later transplant function.Correspondence to:
D. Kollins, MD
Internal Medicine II – Nephrology/Transplantation
University Hospital Regensburg
Franz-Josef-Strauß-Allee 11
93053 Regensburg, Germany
Email: dmitrij.kollins@klinik.uni-regensburg.de

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (101-106)

Is monitoring of FOXP3 Treg cells in renal transplants during acute cellular rejection episodes useful?

S. Batsford¹, M. Dickenmann², U. Dürmüller¹, H. Hopfer¹, F. Gudat¹ and M. Mihatsch¹

¹Institute for Pathology and ²Clinic for Nephrology and Transplant Immunology, University Hospital Basel, Basel, Switzerland
Background: The FOXP3 (forkhead Box p3) transcription factor is a marker for T regulatory cells (Treg). During cellular immune responses, Treg are expected to increase in number to ultimately control and limit this response. In renal transplants massive infiltration by T cells is often seen during rejection crises. This prompted us to examine changes in the numbers of FOXP3 positive T cells accompanying acute cellular rejection events. Methods: A total of 32 transplant biopsies from 23 patients were studied retrospectively, these 16 protocol biopsies and 16 biopsies taken during rejection episodes included 9 serial pairs (protocol – rejection). To quantify FOXP3 positive T cells, frozen sections were double immunostained with anti-CD3 and anti-FOXP3 antibodies. Areas revealing T cell infiltrates were measured morphometrically and the number of FOXP3 positive cells per 1,000 µm² of CD3 positive cells was taken as an FOXP3 index. Results: This index was 0.46 (median, range 0.00 – 1.00) in the 16 protocol biopsies and 0.48 (median, range 0.16 – 2.31) in rejection episode biopsies. The highest values were seen during rejection crises, exceeding 1.00 in 6/16 biopsies, whereas no protocol biopsies had values greater than 1.00 (0/16) (difference significant p < 0.02). In serial biopsies no consistent behavior was observed; the FOXP3 index remained unchanged, fell slightly or rose to a maximum of 13 fold. Expression levels of FOXP3 could vary within weeks. No correlations were found between donor type, initial therapy, therapy at biopsy, serum creatinine at the time of biopsy, at 3 months or 1 year later, and any of the morphometric parameters (CD3 and FOXP3) studied. Conclusions: During rejection of renal allografts the fraction of FOXP3+ Treg cells within the infiltrating T-cell population can increase transiently. This phenomenon was not consistently seen in acute cellular rejection and the information does not appear to be of value for individual patient management in such cases.Correspondence to:
Prof. S. Batsford
Turmackerstr. 4
79418 Schliengen, Germany
Email: stephen.batsford@uniklinik-freiburg.de

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (107-112)

Ezetimibe is effective in the treatment of persistent hyperlipidemia of renal allograft recipients

E. Savvidaki, M. Koukoulaki, A. Benou, M. Roumeliotou, C. Fourtounas, P. Kalliakmani, E. Papachristou, J.G. Vlachojannis and D. Goumenos

Transplantation Center, University Hospital of Patras, Patras, Greece
Introduction: Ezetimibe is a hypolipidemic agent acting via inhibition of cholesterol absorption from the small intestine. The effectiveness and safety of long-term administration of ezetimibe was evaluated in renal allograft recipients with persistent hyperlipidemia. Patients and methods: 67 renal allograft recipients with post-transplantation hyperlipidemia resistant to statins were included in the study; 11 were treated with ezetimibe (10 mg/day) alone and 56 with ezetimibe and statin. The effectiveness of ezetimibe was assessed by determination of total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C) and triglycerides (TR). Its safety was determined by liver enzymes (ALT, AST), LDH, CPK, serum creatinine and blood levels of immunosuppressive drugs (cyclosporine, tacrolimus, everolimus, sirolimus) over the follow-up period of 18 ± 6 months. Results: A significant reduction of TC and LDL-C blood levels by 25% and 34% respectively, was observed during the first month of treatment with ezetimibe (p < 0.001). This reduction was maintained for the whole period of ezetimibe adminstration. Renal function remained stable over the follow-up period, while no changes of the blood levels of immunosuppressive drugs were observed. Liver enzymes, LDH and CPK remained normal in all patients except for one diabetic patient who developed rhabdomyolysis. Apart from gastrointestinal symptoms in 2 patients, no other side effects were observed. Conclusion: Combination of ezetimibe with statins represents an effective and safe regimen for treatment of persistent hyperlipidemia in renal allograft recipients.Correspondence to:
Prof. D.S. Goumenos
Department of Internal Medicine – Nephrology
University Hospital of Patras
Rio – Patras, 25604 Greece
Email: dgoumenos@med.upatras.gr

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (113-119)

Arteriovenous access creation defers chronic hemodialysis initiation

J.U. Jeong¹, H.K. Kim², Y.P. Cho², T.W. Kwon² and S.B. Kim¹

¹Division of Nephrology, Department of Internal Medicine, and ²Department of Vascular Surgery, Asan Medical Center, University of UIsan College of Medicine, Seoul, Republic of Korea
Aims: This study evaluated whether arteriovenous access (AVA) creation before hemodialysis might affect the rate of decline of renal function. Methods: This was a retrospective, case-control study comparing two groups of 80 patients each. The AVA group underwent AVA creation more than 2 months before initiation of chronic hemodialysis (CHD). The catheter group (i.e., the control group) commenced CHD through a temporary catheter. The catheter group patients were matched with AVA group patients in terms of age, gender, nature of underlying disease, and rate of decline in estimated glomerular filtration rate (eGFR) before AVA creation. The zero point (Z-point) was defined as the date of AVA creation for AVA patients, or the date on which the same eGFR was attained by each catheter group patient compared with a matched AVA patient. Time-to-dialysis was defined as the interval from the Z-point to the date of initiation of dialysis. The rates of change in eGFR before and after the Z-point were also measured. Results: The AVA and catheter groups were similar in terms of baseline characteristics. The Z-point eGFR (ml/min/1.73 m²) was 11.4 ± 3.1 in the AVA group and 11.3 ± 3.2 in the catheter group. The eGFR at the time of dialysis was 6.4 ± 2.0 in the AVA group and 6.1 ± 1.9 in the catheter group. The mean and median dialysis-free time was longer in the AVA than in the catheter group (14.2 ± 9.4 vs. 5.9 ± 4.1 months, 13.1 (3 – 41) vs. 5.0 (2 – 17) months, p < 0.001). Multivariate proportional Cox’s hazard modeling showed that the AVA group and the Z-point eGFR were each independent predictors of the time to initiation of CHD. The mean changes in eGFR per month (delta eGFR) before the Z-point were similar for the two groups. For the AVA group, the mean delta eGFR was lower after the Z-point compared to before (–0.63 vs. –0.21 ml/min/1.73 m², p = 0.002). For the catheter group, the mean delta eGFR was similar before and after the Z-point (–0.63 vs. –0.67 ml/min/1.73 m²). The mean delta eGFR after the Z-point was less in the AVA group compared to the catheter group (–0.67 vs. –0.21 ml/min/1.73 m², p = 0.002). Conclusion: In this retrospective observational study, AVA creation appears to retard the rate of decline in eGFR and to defer CHD initiation.Correspondence to:
S.B. Kim, MD, PhD
Division of Nephrology, Asan Medical Center
388-1, Pungnap-dong
Songpa-gu, Seoul, Republic of Korea
Email: sbkim@amc.seoul.kr

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (120-124)

A new form of myeloma “kidney”: shortened hemofilter survival and implications for membrane filtration plasmapheresis

A.-P. Dana¹, C.A. Ahmar¹, W.L. Clapp² and E.A. Ross¹

¹Division of Nephrology, Hypertension and Transplantation, and ²Department of Pathology, University of Florida, Gainesville, FL
Background: Despite rigorous focus on extracorporeal CRRT parameters such as access, blood flow, hemoconcentration, and anticoagulation, some patients have unexpected repetitive hemofilter clotting. We instead explored patient or disease-related factors that could be responsible, and present a case of plasma cell dyscrasia in which paraproteins caused hollow fiber failure. Methods: A patient with IgG kappa chain multiple myeloma complicated by sepsis and acute renal failure was started on CVVH with a regional citrate anticoagulation protocol that typically yields filter life of > 50 h. Polysulfone hemofilters repetitively clotted every 2 – 4 h, even after excluding circuit-related problems. Failed filters were examined by light, electron (EM), and immunofluorescence (IF) microscopy. Results: Imaging of the hemofilters revealed several ultrastructural features typical for myeloma-associated alterations in native human tissue. Red cell rouleaux formation occurred within the hollow fibers. There was extensive protein layering on the luminal surface of the fibers with some extension into their walls: these deposits were IF+ for IgG kappa, and had a fibrillary substructure on EM. Conclusion: Extracorporeal hollow fiber phenomena recapitulate many intra-corporeal paraprotein effects such as those described in the kidney with plasma cell dyscrasias. Rapid protein layering suggests fouling of the membrane, decreased solute clearance before total device failure, and raises the theoretical concern that this might also occur during filtration plasmapheresis: we thus suggest serial serum free light chain levels to confirm their removal when using that technique. These findings emphasize the importance of disease rather than circuit-related factors that are under-appreciated causes of premature hemofilter failure.Correspondence to:
E.A. Ross, MD
Division of Nephrology, Hypertension and
Transplantation
University of Florida
Box 100224, Gainesville, FL 32610-0224, USA
Email: rossea@medicine.ufl.edu

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2010 (125-134)

Social support from health care providers is associated with reduced illness intrusiveness in hemodialysis patients

L. Neri¹,², D. Brancaccio³, L.A. Rocca Rey⁴, F. Rossa³, A. Martini⁵, V.E. Andreucci³ and the MigliorDialisi Study Group*

¹Dipartimento di Medicina del Lavoro, Clinica del Lavoro “L. Devoto” – Ospedale San Paolo, Università di Milano, Milano, ²Department of Health Management and Policy, Center for Outcomes Research, Saint Louis University, Saint Louis, MO, USA, ³Fondazione Italiana del Rene Onlus, Napoli, ⁴Dipartimento di Medicina e Chirurgia, Cattedra di Nefrologia, Ospedale San Paolo, Università di Milano, Milano, and ⁵U.O. Nefrologia e Dialisi, Ospedale San Carlo Borromeo, Milano, Italy

*Centers participating in the MigliorDialisi Network are listed in Appendix I.
Background: End-stage renal disease (ESRD) disrupts patients’ life styles, interests and activities negatively affecting their quality of life. Social support has been previously associated with favorable health outcomes. However, no study has examined the association of social support from health care providers with perceived health and ESRD intrusiveness on patients’ lives. Methods: A self-administered questionnaire was completed by 1,238 Italian hemodialysis patients. The Self-Rated Health (SRH) and the Illness Intrusiveness Rating Scale (IIRS) assessed disease burden. 10 items assessed social support from health care providers (SS-HC). The nursing staff of each center provided patients’ clinical information. Linear regression was used to assess correlates of SRH and IIRS. Mediational analysis was used to assess direct and indirect associations of SS-HC with SRH through IIRS. Results: Higher SS-HC was associated with smaller IIRS and higher SRH. Further correlates of better SRH were younger age, no post-dialysis hypotension, no diabetes and cardiovascular diseases, better sleep quality, and smaller burden of oral therapy. Conclusions: Our results suggest that social support might reduce illness burden and improve patients’ perceived health. Further research should assess the efficacy and cost-effectiveness of structured support programs for dialysis patients.Correspondence to:
Dr. L. Neri, MD
Dipartimento di Medicina del Lavoro
Distaccamento Polo San Paolo
Via Di Rudinì 8, 20143 Milano, Italy
Email: lneri@slu.edu, luca.neri@unimi.it

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (135-140)

Erectile dysfunction in male hemodialysis patients in China – one center experience

J. Bao¹, Q. Yu¹, H. Yu², J. Hao¹, J. Liu¹, J. Yao¹ and W. Yuan¹

¹Department of Nephrology, Shanghai First People’s Hospital Affiliated to Jiaotong University, Shanghai, and ²The Affiliated Cardiovascular Hospital of Medical College, Qingdao University, Qingdao, Shandong Province, China
Objective: To evaluate the prevalence and the risk factors of erectile dysfunction in a Chinese cohort of hemodialysis (HD) patients. Methods: 63 male hemodialysis patients were assigned to HD group and 47 health volunteers were recruited as controls. The International Index of Erectile Function (IIEF-5) was used to assess erectile dysfunction (ED). All data were obtained by patient interviews and medical chart review. We measured the blood sex hormone of all the patients and volunteers. We divided those under 50 years HD patients into two groups according to erectile function (EF) score, Group A: EF score >= 12, no ED or mild ED; Group B: EF score < 12, moderate or severe ED. Results: The incidence of ED was significantly higher and the erectile function score was significantly lower in the HD group than that in the control group. The level of Follicle Stimulating Hormone, Luteinizing Hormone, Prolactin, Estradiol, Progesterone were significantly higher and the level of testosterone was significantly lower in the HD group than that in the control group. Patients in Group A were younger and duration of dialysis were shorter than patients in Group B. The level of High Density Lipoprotein was higher and FSH was lower in Group A than that in Group B. A significant negative correlation was found between the EF score and the age, duration of dialysis, the level of FSH and PRL in the HD group. There was a positive correlation trend between EF score and T level, but this did not reach statistical significance (p > 0.05). More patients had hypertension in the HD group. Conclusion: The age, duration of dialysis, hypertension, lipid disorder, the abnormality of hypothalamic-pituitary-gonadal axis were risk factors for ED in HD patients.Correspondence to:
Dr. Q. Yu
Shanghai First People’s Hospital Affiliated to Jiaotong University
100 Haining Road, Shanghai 200080, China
Email: yuqingsl@yahoo.com.cn

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (141-149)

Metabolic syndrome loses its predictive power in late-stage chronic kidney disease progression – a paradoxical phenomenon

C.-C. Lee¹,², C.Y. Sun¹,², I.-W. Wu¹,², S.-Y. Wang² and M.-S. Wu¹,²

¹School of Medicine, Chang Gung University, Taoyuan, and ²Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
Background: Metabolic syndrome (MS) is a significant determinant of CKD. The aim of this study was to determine the possible impact of MS on CKD progression. Methods: 746 CKD subjects were included. The presence of MS was determined according to the modified criteria proposed by the Adult Treatment Panel (ATP) III. The study endpoints were stage-to-stage CKD progression or starting renal replacement therapy during the study period. CKD Stages 1, 2 and 3 were defined as early-stage CKD, while CKD Stages 4 and 5 were defined as late-stage CKD. Results: Early-stage CKD patients with MS had a higher risk of CKD progression than those without MS. Cox regression analysis showed that MS was a significant determinant of CKD progression in early-stage (HR: 1.60, p = 0.041) but not late-stage CKD patients (HR: 1.00, p = 0.975). The results of subgroup analysis in non-diabetic subjects also showed that only early-stage CKD subjects with MS had significant risks of CKD progression (HR: 2.21, p = 0.010). In diabetic patients, the association between MS and CKD progression was not significant in both early- and late-stage CKD. Conclusions: Our findings suggested that the impact of MS on CKD progression might be prominent in non-diabetic early-stage CKD subjects, and became non-significant in diabetic late-stage CKD and diabetic CKD patients.Correspondence to:
M.-S. Wu, MD
Division of Nephrology
Chang Gung Memorial Hospital
222, Mai-Chin Road, Keelung, Taiwan
Email: maxwu1@adm.cgmh.org.tw

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (150-157)

Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacrolimus

G. Garces¹, G. Contreras², D. Carvalho³, I.M. Jaraba², C. Carvalho⁴, A. Tzakis⁵, J. Moon⁵, K. Ratnam¹ and D. Roth²

¹Denver Nephrology PC, Denver, CO, ²Division of Nephrology and Hypertension, ³PGY-¹ General Surgery, ⁴PGY-¹ Internal Medicine, Jackson Memorial Hospital, and ⁵Division of Transplantation, University of Miami, Miller School of Medicine, Miami, FL, USA
Introduction: Chronic kidney disease (CKD) is common in liver transplant recipients receiving calcineurin inhibitors. Method and population: The goals of this case-control study were to identify risk factors associated with CKD and its effect on mortality in 294 liver transplant recipients receiving calcineurin inhibition with tacrolimus. Results: Hepatitis C virus (HCV) was the most common indication (42%) for transplantation. CKD 4 and 5 (estimated glomerular filtration rate (eGFR) of <= 29 ml/min/1.73 m²) developed in 10.8% of recipients during a mean follow-up of 52 months. The incidence density of CKD was 2.56 per 100 patient-years. End-stage renal disease developed in 2.7%. By univariate analysis, CKD patients were older (mean ± sd, 57 ± 10 vs. 51 ± 11, p < 0.05) with hypertension (56 vs. 32%, p < 0.05), had lower preoperative hematocrit (31 ± 6 vs. 34 ± 5, p < 0.05), alanine aminotransferase (median (95% confidence limit) 46 (34 – 80) vs. 68 (56 – 77), < 0.05) and eGFR (56 ± 28 vs. 91 ± 35 ml/ min/1.73 m², p < 0.05), had higher preoperative prothrombin time (16.1 (14.6 – 17.2) vs. 14.8 (14.5 – 15.1) seconds, p < 0.05), and required more perioperative renal replacement therapy (RRT) (41% vs. 6.5%, p < 0.05) compared to controls. Perioperative need for RRT (hazard ratio (95% CI) 2.72 (1.05 – 7.03)) and lower preoperative eGFR: 60 – 89 (4.08 (1.23 – 13.5)), 30 – 59 (4.26 (1.18 – 15.36)), and <= 29 (5.91 ((1.28 – 27.19)) vs. eGFR >= 90 ml/min/1.73 m² were independently associated with development of CKD adjusting for important covariates. The development of CKD (2.36 (1.22 – 4.59)) was independently associated with late mortality with an attributable risk of 12.8%. Conclusion: Data demonstrate that CKD is an important clinical event associated with increased risk for death after primary liver transplantation.Correspondence to:
G. Contreras. MD, MPH
University of Miami, Miller School of
Medicine
Division of Nephrology and Hypertension
Clinical Research Building
1120 NW 14th Street, Suite 360 E
Miami, FL 33136, USA
Email: gcontrer@med.miami.edu

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (158-164)

Glomerulocystic kidney disease in an adult with enlarged kidneys: a case report and review of the literature

Y. Obata¹, ², A. Furusu¹, M. Miyazaki³, T. Nishino⁴, T. Kawazu¹, Y. Kanamoto¹, M. Nishikido⁴, ⁵, T. Taguchi⁶ and S. Kohno¹

¹Second Department of Internal Medicine, Nagasaki University School of Medicine, ²Career Development Center for Medical Doctor, Nagasaki University Hospital, ³Miyazaki Clinic, ⁴Division of Blood Purification, Nagasaki University Hospital, ⁵Department of Urology, Nagasaki University School of Medicine, and ⁶Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
We report the case of a 31-year-old male with enlarged kidneys and glomerulocystic kidney disease (GCKD). The patient had no family history of renal disease or other diseases. On initial presentation he complained of poor eyesight, and hypertensive retinopathy and elevated serum creatinine (5.0 mg/dl) were found at that time. Renal biopsy showed cystic dilatation of Bowman’s capsule and atrophy of the glomerular tuft. Thus, an adult case of sporadic GCKD was diagnosed. Based on previous reports, kidney size in patients with adult type GCKD varies from small to large. Our patient’s kidneys are the largest ever reported (right kidney was 22 cm × 10 cm, left kidney was 19 cm × 10 cm). A review of the literature dealing with sporadic adult GCKD suggested that it is difficult to diagnose this disease early in its course.Correspondence to:
A. Furusu, MD, PhD
Second Department of Internal Medicine
Nagasaki University School of Medicine
1-7-1 Sakamoto, Nagasaki 852-8501, Japan

Email: furusua-ngs@umin.ac.jp

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (165-170)

Successfully treated multicentric Castleman’s disease with renal thrombotic microangiopathy using rituximab and corticosteroid

J.P. Lee¹, D.K. Kim², D.Y. Oh², J.H. Paik³, K.C. Moon³, S. Kim¹,² and Y.S. Kim¹,²

¹Seoul National University Kidney Research Institute, ²Department of Internal Medicine, and ³Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
Thrombotic microangiopathy (TMA) is a rare renal complication accompanied with Castleman’s disease. We report the first case of TMA combined plasma cell type multicentric Castleman’s disease (MCD) which was successfully treated with rituximab and corticosteroid. A previously healthy 60-year-old Korean man was admitted due to acute renal failure, thrombocytopenia, and multiple lymphadenopathies. The result of lymph node biopsy was plasma cell type Castleman’s disease and TMA was revealed by kidney biopsy. After treatment with rituximab, prednisolone and temporary hemodialysis, complete remission was achieved. The combination of corticosteroid and rituximab was associated with improvement for this patient.Correspondence to:
Y.S. Kim, Professor
Department of Internal Medicine
Seoul National University
College of Medicine
28 Yongon, Jongno-gu, Seoul, 110-744, Korea
Email: yonsukim@snu.ac.kr

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (171-173)

Successful treatment of life-threatening pentoxifylline intoxication by high-flux hemodialysis

G. Eden¹, M. Busch², W.N. Kühn-Velten³, A. Schneider² and J.T. Kielstein¹

Department of ¹Nephrology and Hypertension, ²Department of Gastroenterology, Hepatology and Endocrinology, Center for Internal Medicine, Medical School Hannover, Hannover, and ³Medizinisches Labor Bremen, Bremen, Germany
High-flux hemodialysis is the method of choice for the treatment of many life threatening intoxications. Reports on intoxication with pentoxifylline are rare, and although pharmacokinetic properties of the drug suggest a potential role for hemodialysis, there are no published reports on extracorporeal treatment attempts. We report the first case of successful treatment of potentially life-threatening pentoxifylline intoxication by high-flux hemodialysis. Based on this single case, dialysis should be considered, especially in anuric patients with pentoxifylline intoxication.Correspondence to:
Dr. J.T. Kielstein
Department of Internal Medicine
Division of Nephrology and Hypertension
Medical School Hannover
Carl-Neuberg-Straße 1, 30625 Hannover, Germany
Email: Kielstein@yahoo.com

Abstract

Clinical Nephrology, Vol. 75 – No. 2/2011 (174-178)

Arteriovenous dialysis access-associated transvenous pacemaker infection

R.G. Carrillo¹, J.D. Garisto¹, L. Salman² and A. Asif²

¹Cardiothoracic Surgery and ²Interventional Nephrology, University of Miami, Miller School of Medicine, Miami, FL, USA
Abstract. Pacemaker (PM), implantable cardioverter defibrillator and cardiac resynchronization therapy devices also provide support to chronic hemodialysis patients with cardiac rhythm abnormalities. However, these devices can get infected. In general, device infection is either primary or metastatic spread from a distant source. Arteriovenous grafts are commonly used to provide dialysis therapy. Compared to a fistula an arteriovenous graft runs a higher risk of infection. In this analysis, we report 2 chronic hemodialysis patients who have been successfully receiving dialysis through an arteriovenous graft for approximately 2 years. Both had had a PM device for about the same duration. Access infection necessitated surgical removal of the arteriovenous graft in these patients. However, due to bacteremia (methicillin-resistant Staphylococcal aureus (MRSA)), infection spread to involve the transvenous PM leads in both patients. In 1 patient the infection also involved the PM pocket. Lead and wound culture confirmed MRSA in both patients. PM device and leads were removed in both patients. After the resolution of bacteremia, both patients received an epicardial pacemaker. None of the patients had valvular endocarditis. While dialysis was provided with a catheter, an arteriovenous fistula was planned. In conclusion, contamination of the transvenous PM device can occur due to hematogenous spread of infection from an infected arteriovenous graft. Epicardial instead of a transvenous PM might be the better option for such patients to provide long-term cardiac rhythm support.Correspondence to:
A. Asif, MD
Professor of Medicine
Section of Interventional Nephrology
Division of Nephrology
University of Miami Miller School of Medicine
Miami, FL 33136, USA
Email: Aasif@med.miami.edu

Abstract

Early recurrence of Type 2 diabetic nephropathy after kidney transplantation

Shopping Overview
Type	Qtty	Price
Your basket is empty

Username:
Password:

Volume 75, No. 2/2011(February)