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Abstract

P.-C.T. Pham, P.-M.T. Pham, P.-A.T. Pham, S.V. Pham, H.V. Pham, J.M. Miller, N. Yanagawa and P.T.T. Pham

¹Nephrology Division, Olive View-UCLA Medical Center, Sylmar, CA, ²Department of Medicine, Central Maine Medical Center, Lewiston, ME, ³Cardiology Division, Roseville Kaiser Permanente, Roseville, CA, ⁴Cardiology Division, Sacramento VA Medical Center, Ma
Aims: Hypomagnesemia has been implicated in adversely affecting diabetic complications. This is a retrospective study designed to determine whether there is any association between serum magnesium concentration [Mg2+] and the rate of renal function deterioration, as determined by the slope of serum creatinine reciprocals versus time (1/SCr-vs-t), in patients with diabetes mellitus type 2 (DM2). Materials and methods: DM2 patients without known kidney disease seen at Olive View-UCLA Medical Center for any reason during January – March 2001 were included. For each patient, all available data from our electronic database for [Mg2+], hemoglobin A1C (HbA1C), serum creatinine (SCr), lipid profiles, routine urinary analysis, as well as history of hypertension and pharmacy profiles were retrieved. The average of all parameters obtained and linear regression analyses for the slope of 1/SCr-vs-t plot were performed for each patient. Patients were stratified by gender and divided into four groups based on increasing [Mg2+]. Correlations between each parameter including the slope of 1/SCr-vs-t and the four magnesium groups were analyzed. Results: 252 males and 298 females with a mean follow-up of 62.6 ± 22.5 months were included. Patients belonging to lower [Mg2+] groups for both genders had significantly worse slopes of 1/SCr-vs-t plot independent of the presence of hypertension and use of ACEI/ARB, diuretics, HMG-CoA enzyme inhibitors or aspirin. In a multivariate regression analysis controlling for age, HbA1C and various components of the lipid profile, [Mg2+] remained an independent predictor for the slope of 1/SCr-vs-t. A trend for worse proteinuria based on routine urinary analysis was observed among patients belonging to the lowest [Mg2+] group. Conclusions: Lower [Mg2+] is associated with a faster renal function deterioration rate in DM2 patients.Correspondence to:
P.-C.T. Pham
Olive View-UCLA Medical Center
Department of Medicine
Nephrology Division
14445 Olive View Drive, 2B-182
Sylmar, CA 91342, USA
Email: [email protected]

Abstract

F.A. Shiekh¹, V.M. Miller³ and J.C. Lieske¹,²

¹Departments of Internal Medicine, ²Laboratory Medicine and Pathology and ³Surgery, Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
Although much has been learned regarding the pathogenesis of kidney stones, the reason(s) why some individuals form stones while others do not remains incompletely understood. Nanoparticles, which have been observed in geologic samples, have also been isolated from biologic specimens, including kidney stones. These nanoparticles have certain properties that are consistent with a novel life form, including in vitro self-replication, and contain lipids, DNA and proteins. Therefore, it has been hypothesized that nanoparticles may represent a type of infective agent that initiates stone formation in some individuals. Despite a large body of intriguing and suggestive evidence, the true biologic nature of these entities has been elusive, and controversy remains as to whether these nano-sized particles are analogous to other recently described unusual and novel microorganisms, or a transmissible, yet inert nanoparticle. Although unique DNA or RNA has yet to be identified, a proteomic biosignature is beginning to emerge that may allow more definitive clinical investigation. This review evaluates the current evidence regarding nanoparticles as causal to disease and emphasizes the need for additional research to further elucidate their role in human stone formation.Correspondence to:
J.C. Lieske, MD; Mayo Clinic Division of Nephrology and Hypertension, 200 1st Street SW, Rochester, MN 55905, USA
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 75 – No. 1/2011 (16-25)

Impact of immunosuppressive therapy on hepatitis C infection after renal transplantation

A. Kahraman¹, O. Witzke², A. Scherag³, C. Pütter³, M. Miller¹, A. Dechêne¹, S.R. Ross⁴, G. Gerken¹ and P. Hilgard¹,⁵

¹Department of Gastroenterology and Hepatology, ²Department of Nephrology, ³Institute for Medical Informatics, Biometry, and Epidemiology, ⁴Institute for Virology, University Hospital Essen, and ⁵Academic Teaching Hospital EVK, Muelheim a. d. Ruhr, Muelheim, Germany
Background: Among patients after renal transplantation (NTx), hepatitis C virus (HCV) infection is a risk factor for graft loss and patient death caused by hepatic decompensation. Also, HCV has been implicated in the pathogenesis of glomerular diseases in native and transplanted kidneys. Therefore, the aim of this retrospective cohort study was to determine the effects of the widely used calcineurin inhibitors (CNI) cyclosporine A (CsA) and tacrolimus (Tac) on hepatitis C virus replication, inflammatory activity, development of liver fibrosis, and long-term renal graft function. Subjects and methods: A cohort of 71 patients with HCV infection after kidney transplantation under immunosuppression with either CsA or Tac were analyzed for viral kinetics and serum transaminases. In addition, presence of liver fibrosis was detected by non-invasive measurements using the FibroScan. Graft function was determined biochemically. Patients with interferon therapy prior to transplantation were excluded from the study in order to avoid any impact of the antiviral therapy on outcomes. Results: In the early period after transplantation, hepatitis C viral load was lower in patients treated with Tac as compared to CsA. This effect became negligible 3 months after transplantation. However, hepatic inflammatory activity was reduced in the CsA-treated group. Extent of liver fibrosis was similar in both groups of HCV-infected patients as well as in a control group of non-HCV-infected patients after renal transplantation (NTx), respectively. Renal function and glomerular filtration rate, as calculated by the modification of diet in renal disease (MDRD) formula, were significantly better in patients treated with Tac. Conclusions: During long-term immunosuppression, the CNIs cyclosporine A versus tacrolimus showed no significant differences in HCV-infected patients after renal transplantation with respect to viral replication and development of liver fibrosis. However, function of the renal graft is significantly better preserved in patients receiving tacrolimus.Correspondence to:
P. Hilgard, MD
Associate Professor of Medicine
Academic Teaching Hospital EVK
Wertgasse 30
45468 Muelheim a. d. Ruhr, Germany
Email: [email protected]

Abstract

Verdauungskrankheiten, Jahrgang 33, Nr. 3/2015, S. 121–129

Akute obere gastrointestinale Blutung

M. Mille, T. Engelhardt und A. Stier

Klinik für Allgemein- und Viszeralchirurgie, HELIOS Klinikum Erfurt
Die obere gastrointestinale Blutung (oGIB) stellt nach wie vor eine häufige klinische Notfallsituation dar und ist trotz aller therapeutischen Innovationen noch immer mit einer hohen Letalität verbunden. Neben stabilisierenden Maßnahmen und adäquaten Managementstrategien ist die Endoskopie der Goldstandard in der Diagnostik bzw. Therapie der oGIB und somit einer der entscheidenden Faktoren im Patienten-Outcome. Dabei sind gerade in den letzten Jahrzehnten entsprechende Fortschritte in der endoskopischen Therapie gastrointestinaler Blutungen gemacht worden und neue Blutstillungstechniken entwickelt worden. Gerade um eine sichere Hämostase zu erreichen, ist deshalb die Kenntnis verschiedener Verfahren unabdingbar, um situationsabhängig auf eine geeignete Technik zurückgreifen zu können. Diese Arbeit versucht deshalb einen Überblick über den aktuellen Stand des endoskopischen Managements der oGIB und ihrer Techniken zu geben.Correspondence to:
Dr. Dr. med. univ. M. Mille
Klinik für Allgemein- und Viszeralchirurgie
HELIOS Klinikum Erfurt
Nordhäuser Straße 74
D–99089 Erfurt
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 86 – No. 1/2016 (51-54)

Renal amyloid A amyloidosis as a complication of hidradenitis suppurativa

Kristine D. Schandorff¹, Iben M. Miller², Dorrit Krustrup³, Gregor B.E. Jemec², and Peter Marckmann⁴

¹Department of Nephrology, Herlev Hospital, Herlev, ²Department of Dermatology, Roskilde Hospital, Roskilde, ³Department of Pathology, Herlev Hospital, Herlev, and ⁴Department of Internal Medicine, Division of Nephrology, Roskilde Hospital, Roskilde, Denmark
Rheumatic disease is the dominant cause of amyloid A (AA) amyloidosis, but other chronic inflammatory diseases may have similar consequences. Hidradenitis suppurativa (HS) is a relatively common, but little known skin disease characterized by chronic inflammation. Here we present a case of chronic HS leading to biopsy-verified severe renal AA amyloidosis and dialysis dependency.Correspondence to:
Kristine D. Schandorff
Department of Nephrology, Herlev Hospital
Herlev Ringvej 75, 2730 Herlev, Denmark
Email: [email protected]

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