Volume 102 (2024), No. 4/2024(October)
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Original
Risk factors for in-hospital mortality among patients hospitalized with COVID-19 and end-stage kidney disease
Jackson Heilbronn, Amir Abdipour, Giv Heidari-Bateni, Mohammad Sharif, Sahib Grewal, Sergio Infante, Kwame Agyeman, Zohreh Gholizadeh Ghozloujeh, Lida Gharibvand, and Sayna Norouzi
Page No. 187
Abstract
Clinical Nephrology, Vol. 102 – No. 4/2024 (187-191)
Risk factors for in-hospital mortality among patients hospitalized with COVID-19 and end-stage kidney disease
Jackson Heilbronn1, Amir Abdipour1, Giv Heidari-Bateni1, Mohammad Sharif1, Sahib Grewal1, Sergio Infante1, Kwame Agyeman1, Zohreh Gholizadeh Ghozloujeh1, Lida Gharibvand2, and Sayna Norouzi1
1Department of Internal Medicine, Division of Nephrology, and 2Department of Allied Health Studies, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA
Aims: The mortality rate for COVID-19 infection varies significantly depending on age and comorbidities but remains high in hospitalized patients overall. Several retrospective studies have identified patients with end-stage kidney disease (ESKD) to be at increased risk. The objective of this study was to study in-hospital outcomes of ESKD patients at an academic medical center and identify characteristics that place them at a higher risk for in-hospital mortality.
Materials and methods: A retrospective chart review was conducted including adult patients (≥ 18 years old) admitted to Loma Linda Medical Center for COVID-19 infection with a previous diagnosis of ESKD. Patients with prior kidney transplants were excluded. The main outcome of this study was the rate of in-hospital mortality.
Results: 21 of the 91 patients died with a mortality rate of 23%. Age, D-dimer > 0.4 µg/mL, ejection fraction less than 50%, and ferritin > 300 ng/mL were predictors for mortality in unadjusted univariate analysis. Adjusted multivariable analysis demonstrated that only an ejection fraction of less than 50% was associated with increased mortality risk.
Conclusion: Cardiovascular disease is the leading cause of mortality for ESKD patients and also places them at increased risk of mortality in the setting of severe COVID-19 infection.Correspondence to:
Sayna Norouzi, MD
Department of Internal Medicine
Division of Nephrology, Loma Linda University
11234 Anderson Street, MC 1516B
Loma Linda, CA, 92354, USA
Email: [email protected]
Original
Association of vitamin intake with health-related quality of life in hemodialysis patients
Ursula Alchabab, Razane El Hajj Chehade, Chloe Kharsa, Rebecca Kassab, Serena Maria Dib, Dania Chelala, Jenny Hawi, Celine Boueri, Hiba Azar, Serge Finianos, Ibrahim Abdo, Chadia Beaini, and Mabel Aoun
Page No. 192
Abstract
Clinical Nephrology, Vol. 102 – No. 4/2024 (192-201)
Association of vitamin intake with health-related quality of life in hemodialysis patients
Ursula Alchabab1, Razane El Hajj Chehade1, Chloe Kharsa1, Rebecca Kassab1, Serena Maria Dib1, Dania Chelala1#2, Jenny Hawi3, Celine Boueri3, Hiba Azar1#2, Serge Finianos1#2, Ibrahim Abdo4, Chadia Beaini1#4, and Mabel Aoun1#5
1Nephrology Department, Faculty of Medicine, Saint-Joseph University, Beirut, 2Hotel-Dieu De France Hospital, Beirut, 3Saint-Georges Hospital, Ajaltoun, 4Bellevue Medical Center, Lebanon, and 5AUB Santé, Lorient, France
Background: It is still uncertain whether vitamin intake is associated with better quality of life in hemodialysis patients. This study aims to assess the association between the quantity of supplemented vitamins and health-related quality of life (HRQoL) in this population.
Materials and methods: This cross-sectional study included all patients on chronic hemodialysis from three units. Vitamins and micronutrients assessed were B1, B6, B12, C, D, folic acid, menaquinone, carnitine, zinc, and coenzyme Q10. Quality of life scores included the 8 domains of SF-36 and the 11 domains of the Kidney Disease Quality of Life (KDQOL). Bivariate analysis compared two groups of patients divided based on the median of vitamin intake. Spearman Rho test assessed the correlation between number of vitamins and different dimensions of HRQoL.
Results: A total of 183 patients were included. Median number of vitamins supplemented was 2 (1,3); 112 patients had an intake of ≤ 2 vitamins, and 71 patients were taking > 2 vitamins. There was a significant association between higher vitamin intake and the burden of kidney disease that remained significant in the multivariable analysis (p = 0.03), but no correlation between the number of vitamins (0 – 13) and different HRQoL scores. Sub-analyses of each category of vitamins showed no significant difference in HRQoL scores except for Vitamin B and staff encouragement (p = 0.01) and for multivitamins and quality of social interaction (p = 0.03).
Conclusion: A higher number of vitamins in hemodialysis patients is associated with an increased perception of the burden of kidney disease. Interventional studies are needed to assess whether selective vitamin supplementation in case of deficiencies is associated with better quality of life.Correspondence to:
Dr. Mabel Aoun
AUB Santé
Rue Camille Desmoulins
56100, Lorient, France
Email: [email protected]
Original
Biopsy-proven BK virus nephropathy in renal transplant recipients: A multi-central study from Turkey (BK-TURK STUDY)
Ozkan Gungor, Hamad Dheir, Mahmud Islam, Huseyin Toz, Abdulmecit Yildiz, Ayse Sinangil, Erhan Tatar, Gulay Asci, Ozkan Ulutas, Eda Altun, Orcun Altunoren, Suheyla Apaydin, Alparslan Ersoy, Berfu Korucu, Seda Safak, Ulver Derici, Saliha Yildirim, Nurhan Seyahi, Seyda Gul Ozcan, Kadir Gokhan Atilgan, Mehmet Deniz Ayli, Caner Cavdar, Ozcan Uzun, Rahmi Yilmaz, Arda Erdut, Mustafa Sevinc, Umut Kasapoğlu, Ismail Kocyigit, Cihan Uysal, Kultigin Turkmen, Hakan Ozer, Arzu Velioglu, Ebru Ok, Bulent Kaya, Zulfikar Yilmaz, Oktay Ozkan, Egemen Cebeci, Kenan Turgutalp, Meltem Gursu, Enver Yuksel, Necmi Eren, Erkan Dervisoglu, Fatma Betul Guzel, Gursel Yildiz, Serkan Bakirdogen, Ayca Inci, Can Sevinc, and Aydin Turkmen
Page No. 202
Abstract
Clinical Nephrology, Vol. 102 – No. 4/2024 (202-211)
Biopsy-proven BK virus nephropathy in renal transplant recipients: A multi-central study from Turkey (BK-TURK STUDY)
Ozkan Gungor1, Hamad Dheir2, Mahmud Islam2, Huseyin Toz3, Abdulmecit Yildiz4, Ayse Sinangil5, Erhan Tatar6, Gulay Asci3, Ozkan Ulutas7, Eda Altun8, Orcun Altunoren1, Suheyla Apaydin8, Alparslan Ersoy4, Berfu Korucu9, Seda Safak10, Ulver Derici9, Saliha Yildirim9, Nurhan Seyahi11, Seyda Gul Ozcan11, Kadir Gokhan Atilgan12, Mehmet Deniz Ayli12, Caner Cavdar13, Ozcan Uzun13, Rahmi Yilmaz14, Arda Erdut14, Mustafa Sevinc15, Umut Kasapoğlu16, Ismail Kocyigit17, Cihan Uysal17, Kultigin Turkmen18, Hakan Ozer18, Arzu Velioglu19, Ebru Ok20, Bulent Kaya21, Zulfikar Yilmaz22, Oktay Ozkan23, Egemen Cebeci23, Kenan Turgutalp24, Meltem Gursu25, Enver Yuksel26, Necmi Eren27, Erkan Dervisoglu27, Fatma Betul Guzel1, Gursel Yildiz28, Serkan Bakirdogen29, Ayca Inci30, Can Sevinc31, and Aydin Turkmen10
1Division of Nephrology, Faculty of Medicine, Kahramanmaras Sutcu İmam University, Kahramanmaras, 2Division of Nephrology, Faculty of Medicine, Sakarya University, Sakarya, 3Division of Nephrology, Faculty of Medicine, Ege University, Izmir, 4Division of Nephrology, Faculty of Medicine, Uludag University, Bursa, 5Division of Nephrology, Faculty of Medicine, Demiroglu Bilim University, Florence Nightingale Hospital, Istanbul, 6Division of Nephrology, Faculty of Medicine, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, 7Division of Nephrology, Faculty of Medicine, İnonu University, Malatya, 8Division of Nephrology, Faculty of Medicine, Bahcesehir University, Medical Park Goztepe Hospital, Istanbul, 9Division of Nephrology, Faculty of Medicine, Gazi University, Ankara, 10Division of Nephrology, Faculty of Medicine, Istanbul University, 11Division of Nephrology, Faculty of Medicine, Istanbul Cerrahpasa University, Istanbul, 12Division of Nephrology, Faculty of Medicine, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, 13Division of Nephrology, Faculty of Medicine, Dokuz Eylul University, Izmir, 14Division of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey, 15Renal Department, Manchester University NHS Trust, Manchester, UK, 16Division of Nephrology, Faculty of Medicine, University of Health Sciences, Bakirkoy Doctor Sadi Konuk Training and Research Hospital, Istanbul, 17Division of Nephrology, Faculty of Medicine, Erciyes University, Kayseri, 18Division of Nephrology, Necmettin Erbakan University Meram School of Medicine, Konya, 19Division of Nephrology, Marmara University School of Medicine, Istanbul, 20Division of Nephrology, Kent Private Hospital, Izmir, 21Division of Nephrology, Faculty of Medicine, Cukurova University, Adana, 22Division of Nephrology, Faculty of Medicine, Dicle University, Diyarbakir, 23Division of Nephrology, Faculty of Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, 24Division of Nephrology, Faculty of Medicine, Mersin University, Mersin, 25Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, 26Division of Nephrology, Faculty of Medicine, University of Health Sciences, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, 27Division of Nephrology, Faculty of Medicine, Kocaeli University, Kocaeli, 28Division of Nephrology, Faculty of Medicine, University of Health Sciences, Cam and Sakura Hospital, Istanbul, 29Division of Nephrology, Faculty of Medicine, Canakkale 18 Mart University, Canakkale, 30Division of Nephrology, Antalya Training and Research Hospital, Antalya, and 31Division of Nephrology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
Aim: BK polyomavirus infection is a challenging complication of renal transplantation. The management is not standardized and is based on reports from transplantation centers’ experiences, usually with small sample sizes. Therefore, we aimed to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients.
Materials and methods: Our study was carried out with the participation of 30 transplantation centers from all regions of Turkey. Only cases with allograft biopsy-proven BKVN were included in the study.
Results: 13,857 patients from 30 transplantation centers were screened, and 207 BK nephropathy cases were included. The mean age was 46.4 ± 13.1 years, and 146 (70.5%) patients were male. The mean time to diagnosis of BK nephropathy was 15.8 ± 22.2 months after transplantation. At diagnosis, the mean creatinine level was 1.8 ± 0.7 mg/dL, and the mean estimated glomerular filtration rate was 45.8 ± 19.6 mL/min/1.73m2. In addition to dose reduction or discontinuation of immunosuppressive drugs, 18 patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), 5 patients with cidofovir plus IVIG, and 12 patients with leflunomide plus IVIG. None of the patients receiving leflunomide or leflunomide plus IVIG had allograft loss. During follow-up, allograft loss occurred in 32 (15%) out of 207 patients with BK nephropathy.
Conclusion: BKVN is still a frequent cause of allograft loss in kidney transplantation and is not fully elucidated. The results of our study suggest that leflunomide treatment is associated with more favorable allograft outcomes.Correspondence to:
Dr. Mahmud Islam
Nephrology Department
Sakarya University Faculty of Medicine
Division of Nephrology
Adnan Menderes Cad. Saglik Sok. No. 1,
Adapazari, Sakarya 54100, Turkey
Email: [email protected]
Original
Efficacy of urokinase in maintaining patency of hemodialysis catheters: A meta-analysis
Jiaxiu Deng, Weixiang Luo, Weiwei Zhang, Shiyi Xiong, and Liping Wang
Page No. 212
Abstract
Clinical Nephrology, Vol. 102 – No. 4/2024 (212-222)
Efficacy of urokinase in maintaining patency of hemodialysis catheters: A meta-analysis
Jiaxiu Deng1, Weixiang Luo2, Weiwei Zhang3, Shiyi Xiong4, and Liping Wang1
1Department of Blood Purification, 2Department of Nursing, 3Department of Nephrology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, and 4Department of Pain Management, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
Background: Catheter malfunctions are associated with reduced blood flow and interrupted dialysis during hemodialysis.
Aim: This meta-analysis aimed to determine whether the use of urokinase to lock hemodialysis catheters can maintain their patency and prevent catheter-related bloodstream infections (CRBSIs).
Materials and methods: The PubMed, Cochrane Library, Web of Science, Embase, and Chinese medical databases were searched for controlled trials of hemodialysis catheter locking using urokinase from database inception until July 15, 2021. The primary outcome was catheter malfunction, and the secondary outcomes were the peak catheter blood flow rate (Qb) and CRBSIs.
Results: Across 16 trials, 1,041 patients were randomized to receive either urokinase/urokinase mixture (treated) or heparin (control) locks once or thrice a week. Locking with urokinase alone or in combination with another substance significantly prevented catheter malfunction. The effect on Qb was significant, with that in the treated group being better than in the control group. Similarly, the incidence of CRBSIs in the treated group was lower.
Conclusion: Urokinase locking maintains catheter patency more effectively than heparin. Prophylactic locking with urokinase or urokinase mixtures reduces incidences of catheter malfunction, which ensures the smooth progression of hemodialysis and reduces patient medical costs. The results of this study have important clinical implications and will provide guidance to medical practitioners globally.Correspondence to:
Jiaxiu Deng, MD
Department of Blood Purification
Shenzhen People’s Hospital
The Second Clinical Medical College
Jinan University, The First Affiliated Hospital
Southern University of Science and Technology
Shenzhen 518020, Guangdong, China
Email: [email protected]
Nephro
Pharmacology
Efficacy and safety analysis of sodium zirconium cyclosilicate and calcium polystyrene sulfonate on rapid reduction of potassium in moderate to severe hyperkalemia patients with chronic kidney disease without dialysis
XiaoJuan Fu, Sen Zhang, Fang Gao, and Nan Mao
Page No. 223
Abstract
Clinical Nephrology, Vol. 102 – No. 4/2024 (223-231)
Efficacy and safety analysis of sodium zirconium cyclosilicate and calcium polystyrene sulfonate on rapid reduction of potassium in moderate to severe hyperkalemia patients with chronic kidney disease without dialysis
XiaoJuan Fu1, Sen Zhang2, Fang Gao1, and Nan Mao1
1Department of Nephrology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, and 2Department of Nuclear Medicine, Deyang People’s Hospital, DeYang, Sichuan, China
Background: Hyperkalemia is a common complication of chronic kidney disease (CKD). This study aims to investigate the efficacy and safety of sodium zirconium cyclosilicate and calcium polystyrene sulfonate in reducing potassium in patients with acute and severe hyperkalemia in CKD who are not undergoing dialysis.
Materials and methods: A retrospective real-world study was conducted among 73 patients with non-dialysis chronic kidney disease who were hospitalized in the First Affiliated Hospital of Chengdu Medical College from June 2020 to June 2022. 33 patients treated with sodium zirconium cyclosilicate were categorized as SZC group, and the other 40 patients treated with calcium polystyrene sulfonate were categorized as CPS group. Serum potassium, serum sodium, magnesium, calcium, and phosphorus levels were examined. Adverse reactions were recorded during medication.
Results: Significantly decreased serum potassium was observed in both groups, whereas the potassium reduction was higher in the SZC group than in the CPS group at 2, 4, 24, and 48 hours after medication while there was no statistically significant difference in the serum potassium level between the two groups at 72 hours. For those people whose initial potassium exceeded 6 mmol/L, the potassium reduction was more obvious in the SZC group than in the CPS group at 2 and 4 hours after medication. The control rate of hyperkalemia in the SZC group was significantly higher than in the CPS group at 4, 24, and 48 hours. No distinct change was observed in serum sodium, calcium, magnesium, and phosphorus before and 72 hours after medication. No severe adverse reactions occurred.
Conclusion: Sodium zirconium cyclosilicate has a more obvious effect on reducing potassium particularly for those patients with moderate to severe hyperkalemia who need rapid potassium reduction.Correspondence to:
Nan Mao
Department of Nephrology
the First Affiliated Hospital of Chengdu Medical College
Number 278 Baoguang Road
Chengdu, Sichuan, China, 610500
Email: [email protected]
Nephrology
Education
Post-COVID-19 complement-mediated TMA: A case report
Jan A. Jochims, Babak Yazdani, Bernd Krüger, Zoran V. Popovic, and Bernhard K. Krämer
Page No. 232
Abstract
Clinical Nephrology, Vol. 102 – No. 4/2024 (232-237)
Post-COVID-19 complement-mediated TMA: A case report
Jan A. Jochims1#2*, Babak Yazdani1#2#3*, Bernd Krüger1#2#3, Zoran V. Popovic2#4**, and Bernhard K. Krämer1#2#3#5**
1Vth Department of Medicine, University Hospital Mannheim, 2Transplant Center Mannheim, 3European Center for Angioscience ECAS, Medical Faculty Mannheim, 4Institute of Pathology, University Medical Center Mannheim, and 5Mannheim Center for Innate Immunoscience, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
*Contributed equally as first authors; #contributed equally as senior authors.
Systemic COVID-19 disease is associated with a variety of organ involvement in infected patients. A rarely reported complication is the induction of complement-mediated thrombotic microangiopathy (TMA). TMA is an extremely rare pathological condition that results in thrombosis in capillaries and small arterioles, due to an endothelial injury. It is often combined with thrombocytopenia, Coombs-negative hemolytic anemia, and end-organ damage. This case involves a patient who was admitted to our hospital for the purpose of diagnosis and treatment of acute kidney injury (AKIN 3) with severe proteinuria after a preceding SARS-CoV-2 infection. A 77-year-old male patient had COVID-19 pneumonia in January 2021 with the need of high-flow oxygen therapy in the intensive care unit. In March 2021, he was hospitalized again due to elevated serum creatinine levels and proteinuria. The patient exhibited normal vital parameters. A renal biopsy showed severe TMA. A diagnosis of COVID-19-associated TMA was made, and treatment with high-dose glucocorticoid therapy and plasma exchange was initiated. Additionally, therapy with eculizumab was established. Unfortunately, the kidney failure was initially progressive, so that hemodialysis (HD) was temporarily necessary. In May 2021, kidney function recovered to an estimated glomerular filtration rate of ~ 30 mL/min/1.73m2 corresponding to chronic kidney disease stage 3bA3 – 4A3. COVID-19-associated TMA is an extremely rare disease. TMA may be a possible long-term complication with the risk of end-stage renal disease if not properly diagnosed and treated.
*Contributed equally as first authors;
**contributed equally as senior authors.Correspondence to:
PD Dr. med. Babak Yazdani
V Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Rheumatology)
University Hospital Mannheim
Medical Faculty Mannheim of the University of Heidelberg
Theodor-Kutzer-Ufer 1 – 3
68167 Mannheim, Germany
Email: [email protected]
Nephrology
Education
Fibrillary glomerulonephritis in a patient with rheumatoid arthritis: A case report and review of the literature
Olivia Schreiber, Michael Chau, Solomon Dawson, and Vinay Srinivasan
Page No. 238
Abstract
Clinical Nephrology, Vol. 102 – No. 4/2024 (238-243)
Fibrillary glomerulonephritis in a patient with rheumatoid arthritis: A case report and review of the literature
Olivia Schreiber1, Michael Chau2, Solomon Dawson1#3, and Vinay Srinivasan1#3
1Cooper Medical School of Rowan University, 2Department of Internal Medicine, and 3Division of Nephrology, Cooper University Hospital, Camden, NJ, USA
Fibrillary glomerulonephritis (FGN) is a rare glomerular disease defined by the presence of microfibrils that deposit within the glomeruli. While initially thought to be idiopathic, FGN is now recognized to be associated with infection, malignancies, and autoimmune disorders. We describe a case of biopsy-proven FGN in a patient with seropositive rheumatoid arthritis (RA) and provide a review of the literature regarding the association of FGN with RA.Correspondence to:
Vinay Srinivasan, MD MBA
Division of Nephrology
Cooper University Hospital
101 Haddon Avenue
Camden, NJ 08103, USA
Email: [email protected]
Nephrology
Education
Influenza vaccination-associated cryoglobulinemic vasculitis
Estelle Taki, Stephanie Wirtshafter, and Abdallah S. Geara
Page No. 244
Abstract
Clinical Nephrology, Vol. 102 – No. 4/2024 (244-247)
Influenza vaccination-associated cryoglobulinemic vasculitis
Estelle Taki1, Stephanie Wirtshafter2, and Abdallah S. Geara2#3
1Saint Joseph Medical School, Beirut, Lebanon, 2Division of Renal, Electrolytes and Hypertension University of Pennsylvania, Philadelphia, PA, USA, and 3Division of Nephrology, Lebanese American University, Lebanon
Mixed cryoglobulinemia is a small vessel vasculitis associated with viral infections, mainly hepatitis C virus, however, other important causes include lymphoproliferative and autoimmune disorders. Influenza vaccine-induced cryoglobulinemia has been rarely reported. A 68-year-old male presented on three occasions following influenza vaccination with purpuric rash and lower extremities swelling. His lab work showed mixed cryoglobulins. On his most recent presentation, in addition to the purpura, he presented with thrombocytopenia and nephritic syndrome. A kidney biopsy showed endocapillary proliferative glomerulonephritis with organized deposits, consistent with mixed type cryoglobulinemic glomerulonephritis. The patient was treated with rituximab infusion with progressive improvement of the acute kidney injury (AKI) and complete recovery. It is unclear why cryoglobulins are produced as a response to a vaccination, but this association is important to be aware of for prompt monitoring and treatment.Correspondence to:
Abdallah S. Geara, MD
Hospital of the University of Pennsylvania
Division of Renal, Electrolytes and Hypertension
3400 Spruce Street, 1 Founders
Philadelphia, PA 19104, USA
Email: [email protected]
Nephrology
Education
Kidney complications of Wilson disease and its treatments: A case report and literature review
Maria Salman, Ayub Akbari, and Gregory L. Hundemer
Page No. 248
Abstract
Clinical Nephrology, Vol. 102 – No. 4/2024 (248-253)
Kidney complications of Wilson disease and its treatments: A case report and literature review
Maria Salman1, Ayub Akbari1#2, and Gregory L. Hundemer1#2
1Department of Medicine, Division of Nephrology, University of Ottawa, and 2Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
Wilson disease is a rare autosomal recessive genetic disorder of copper metabolism that leads to copper accumulation and subsequent organ dysfunction. While classically considered a condition that primarily affects the liver and nervous system, Wilson disease and its treatments can also result in a wide range of kidney complications as well. We present the case of a 31-year-old female with a longstanding (> 10 year) history of Wilson disease who developed acute-onset nephrotic syndrome including heavy proteinuria, hypoalbuminemia, and edema after being transitioned from zinc to D-penicillamine for copper chelation therapy. Following simple cessation of D-penicillamine (and without any immunosuppressive therapies including corticosteroids), the nephrotic syndrome showed remarkable improvement including complete remission within several months. This review comprehensively summarizes the kidney complications associated with Wilson disease and its treatments.Correspondence to:
Dr. Gregory L. Hundemer
Ottawa Hospital – Riverside Campus
1967 Riverside Drive, Office 5-33
Ottawa, Ontario, K1H 7W9 Canada
Email: [email protected]
Letter to the Editor
Denosumab for immobilizationinduced hypercalcemia in patients with end-stage renal disease
Jugal Thaker and Abdallah S. Geara
Page No. 254
Abstract
Clinical Nephrology, Vol. 102 – No. 4/2024 – Letter to the editor
Denosumab for immobilizationinduced hypercalcemia in patients with end-stage renal disease
Jugal Thaker1 and Abdallah S. Geara1#2
1Division of Renal, Electrolytes and Hypertension University of Pennsylvania, Philadelphia, PA, and 2Division of Nephrology, Lebanese American University, Lebanon, TN, USA
Correspondence to:
Abdallah S. Geara, MD
Hospital of the University of Pennsylvania
Division of Renal, Electrolytes and Hypertension
3400 Spruce Street, 1 Founders
Philadelphia, PA 19104
Email: [email protected]
