Volume 73 (2010), No. 2/2010(February)
The online-version will be updated before the print-version of this Journal is published. Upon request we will send the password and user name by e-mail. The online-service is only available for subscribers of the print-version, if proof of purchase is submitted.
The use of the online-version will be charged with an extra fee (additional to the subscription of the print-version). The service can be used until December 31st of the year of subscription.
|
| Price of the complete print-issue: 30.00$ |
Add to Cart
|
Editorial
Diabetic kidney disease: act now or pay later
R.C. Atkins and P. Zimmet
Page No. 83
Abstract
Clinical Nephrology, Vol. 73 – Nr. 2/2010, S. 83-87
Diabetic kidney disease: act now or pay later
R.C. Atkins and P. Zimmet
Lead article
Relative hypoparathyroidism and hypoalbuminemia are associated with hip fracture in hemodialysis patients
B. Al Helal, W.S. Su, D.N. Churchill, and A.S. Gangji
Page No. 88
Abstract
Clinical Nephrology, Vol. 73 – No. 2/2010 (88-93)
Relative hypoparathyroidism and hypoalbuminemia are associated with hip fracture in hemodialysis patients
B. Al Helal1, W.S. Su1, D.N. Churchill1,2 and A.S. Gangji1,2
1Division of Nephrology, McMaster University and St. Joseph’s Healthcare, and 2Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
Aims: Patients with end-stage renal disease treated by hemodialysis are at an increased risk of hip fracture. In the general population, hip fractures are associated with increased morbidity and mortality. The objective of this study was to assess the predictors and outcomes of hip fracture in the hemodialysis population, including quality of life post hip fracture. Methods: A case-control study from 1999 to 2005 included 29 adult hemodialysis patients with hip fracture and 55 controls, matched on age, gender and number of years on hemodialysis. A logistic regression model was used to derive predictors of hip fracture. The association between time to death post hip fracture and parathyroid hormone was analyzed using a Kaplan-Meier curve. The ability to live independently 1 year after hip fracture was used as a measure of quality of life. Results: Variables associated with hip fracture were a reduction in serum parathyroid hormone by 100 pg/ml (OR = 1.65, 95% CI 1.10, 2.46) and a decrease in serum albumin by 1 g/l (OR = 1.18, 95% CI 1.00, 1.39). 40% of the cases died within the first year post hip fracture. Median survival time in patients with hip fracture and a serum PTH value < 100 pg/ml was 17 days (95% CI 0, 37 days) as compared with 280 days (95% CI 103, 471 days) for those with a PTH value > 100 pg/ml (p < 0.02). Among the patients who survived, 53% were subsequently discharged to a long term care facility. Conclusions: Relative hypoparathyroidism and hypoalbuminemia are associated with an increased risk of hip fracture in hemodialysis patients. There is also a significant reduction in quality of life in patients sustaining a hip fracture.Correspondence to:
A.S. Gangji
50 Charlton Avenue East
Hamilton, ON, L8N 4A6, Canada
Email: [email protected]
Original
C.E.R.A. safety profile: a pooled analysis in patients with chronic kidney disease
F. Locatelli, J.F.E. Mann, J.-C. Aldigier, D. Sanz Guajardo, R. Schmidt, B. Van Vlem, W. Sulowicz, F. C. Dougherty and U. Beyer
Page No. 94
Abstract
Clinical Nephrology, Vol. 73 – No. 2/2010 (94-103)
C.E.R.A. safety profile: a pooled analysis in patients with chronic kidney disease
F. Locatelli1, J.F.E. Mann2, J.-C. Aldigier3, D. Sanz Guajardo4, R. Schmidt5, B. Van Vlem6, W. Sulowicz7, F. C. Dougherty8 and U. Beyer8
1Department of Nephrology and Dialysis and Renal Transplant, A. Manzoni Hospital, Lecco, Italy, 2KFH Kidney Center, Munich, Germany, 3Néphrologie-Hémodialyse Hôpital Dupuytren, Limoges, France, 4University Hospital Puerta de Hierro Majadahonda, Madrid, Spain, 5West Virginia University School of Medicine, Morgantown, WV, USA, 6Department of Nephrology, Dialysis and Hypertension, O.L. Vrouw Ziekenhuis, Aalst, Belgium, 7Department of Nephrology, Collegium Medicum Jagiellonian University, Cracow, Poland, and 8F. Hoffmann-La Roche Ltd., Basel, Switzerland
Background: C.E.R.A., a continuous erythropoietin receptor activator, is a long-acting erythropoiesis-stimulating agent (ESA) that is approved for the treatment of renal anemia. This analysis evaluated the safety profile of C.E.R.A. in comparison to that of other ESAs in patients with chronic kidney disease (CKD). Methods: Safety parameters were analyzed in a pooled population comprising all patients with CKD on dialysis and not on dialysis from the completed Phase II and Phase III studies in the C.E.R.A. clinical program (Phase II/III population); patients were treated with either C.E.R.A. (n = 1,789) or comparator ESA (n = 948). Differences between treatment groups in safety parameters were identified by either a 2% difference in incidence between groups, or a statistically significant difference between groups (p ≤ 0.05 with the Fisher’s exact test, which was used as a conservative screening tool). To assess changes in safety findings over time, long-term safety data were analyzed from patients who were given the option to enter long-term safety studies upon completing their initial Phase II/III study (safety extension population). Results: Compared with the C.E.R.A. group, the incidence of adverse events (AEs) was higher in the comparator ESA group in the Phase II/III population (C.E.R.A. vs. comparator ESA, 89.5% vs. 91.8%, p = 0.067), and significantly so in the safety extension population (93.0% vs. 95.8%, p = 0.003). The incidence of serious AEs was significantly higher in the comparator ESA group than in the C.E.R.A. group in both analysis populations (Phase II/III population, 37.8% vs. 42.4%, p = 0.021; safety extension population, 53.3% vs. 59.7%, p = 0.001). However, there was no consistent pattern of clinical events that could explain these differences between the treatment groups. Conclusion: Analysis of safety events in patients with renal anemia receiving long-term treatment with C.E.R.A. shows a safety profile comparable to that of other ESAs.Correspondence to:
Prof. F. Locatelli
Azienda Ospedaliera di Lecco
Ospedale “Alessandro Manzoni”
Via Dell’ Eremo 9/11
23900 Lecco, Italy
Email: [email protected]
Original
Significance of self-reported sleep quality (SQ) in chronic kidney disease (CKD): the Renal Research Institute (RRI)-CKD study
B. Kumar, A. Tilea, B.W. Gillespie, X. Zhang, M. Kiser, G. Eisele, F. Finkelstein, P. Kotanko, N. Levin, S. Rajagopalan and R. Saran
Page No. 104
Abstract
Clinical Nephrology, Vol. 73 – No. 2/2010 (104-114)
Significance of self-reported sleep quality (SQ) in chronic kidney disease (CKD): the Renal Research Institute (RRI)-CKD study
B. Kumar1, A. Tilea2, B.W. Gillespie2, X. Zhang2, M. Kiser3, G. Eisele4, F. Finkelstein5, P. Kotanko6, N. Levin6, S. Rajagopalan7 and R. Saran2,8
1Division of Nephrology, Scott & White Hospital, Texas A&M University, Temple, TX, 2Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, 3Department of Medicine, University of North Carolina, Chapel Hill, NC, 4Department of Medicine, Medical College of Albany, Albany, NY, 5Metabolism Associates, New Haven, CT, 6Renal Research Institute, New York, NY, 7Department of Cardiovascular Medicine, Ohio State University, OH and 8Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
Background: There has been limited research on sleep quality (SQ) in CKD. Methods: This prospective cohort study of adults with CKD Stages 3 – 5 at four US centers collected self-reported SQ information from the Kidney Disease Quality of Life (KDQOL) instrument, including an estimated SQ score (0 – 100), and 3 SQ-related questions. “Poor” SQ was defined as SQ score ≤ 60. Logistic and multiple linear regression assessed associations between SQ and its potential predictors. Times to death and end stage renal disease (ESRD) were examined using Cox regression. A comparison with SQ in ESRD patients from the Dialysis Outcomes and Practice Patterns Study (DOPPS), was additionally performed. Results: Mean SQ score was 59.4 ± 23.6 (n = 689), and “poor” SQ was reported by 57%. Mean estimated glomerular filtration rate (eGFR) was 24.9 ± 10.6 ml/min/1.73 m2. Higher SQ significantly correlated with KDQOL mental and physical component summary scales. Significant predictors of lower SQ score included – younger age, presence of dyspnea, self-reported depression, pain, and itchiness. There were no significant pairwise differences in SQ from CKD Stage 3 through ESRD. Self-reported daytime sleepiness was significantly associated with higher risk of mortality prior to ESRD (HR = 1.85, p = 0.02). Conclusion: Self-reported “poor” SQ was common in a CKD cohort (Stages 3 – 5) and was not only associated with lower quality of life scores and several modifiable symptoms, but also with higher risk of pre-ESRD mortality. Greater attention to this clinical problem is highly recommended in this high-risk population.Correspondence to:
R. Saran, MD, MRCP, MS
Associate Professor of Medicine
Division of Nephrology
Department of Internal Medicine
Associate Director
Kidney Epidemiology and Cost Center
University of Michigan
315 W. Huron, Suite 240
Ann Arbor, MI 48103-4262, USA
Email: [email protected]
Original
Familial IgA nephropathy in southeastern Kentucky
K.A. Lavigne, S.Y. Woodford, C.V. Barker, B.A. Julian, J. Novak, Z. Moldoveanu, A.G. Gharavi and R.J. Wyatt
Page No. 115
Abstract
Clinical Nephrology, Vol. 73 – No. 2/2010 (115-121)
Familial IgA nephropathy in southeastern Kentucky
K.A. Lavigne1,2, S.Y. Woodford3, C.V. Barker3, B.A. Julian3,4, J. Novak4, Z. Moldoveanu4, A.G. Gharavi5 and R.J. Wyatt1,2
1Children’s Foundation Research Center at the Le Bonheur Children’s Medical Center, 2Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, 3Division of Nephrology, Department of Medicine, 4Department of Microbiology, University of Alabama at Birmingham, AL, and 5Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY, USA
Background: Two decades ago, pedigrees of patients with IgA nephropathy (IgAN) from Pike County, KY, USA, provided evidence for a role of genetic factors in the pathogenesis of this disorder. Subsequently additional pedigrees were described for several communities from northern Italy. Recently, we found another cluster of patients in the Clay County, KY area, about 100 miles southwest of Pike County. Aim: The purpose of this study was to evaluate and expand the pedigrees of patients with IgAN from Clay County, KY to provide additional insight into the mechanisms of inheritance of IgAN and assess the possible influence of a founder effect on the prevalence of IgAN in the region. Method: Since 1980, most patients with IgAN and their relatives in eastern KY have provided personal genealogic data. These data were used to construct pedigrees that included the patients born in Clay County. Nine of 11 patients with IgAN born in Clay County, KY, USA were members of 1 or more of 5 pedigrees, each with 3 – 11 patients with IgAN. Conclusion: Our findings suggest the possibility of a low-penetrance ancestral mutation in the IgAN kindreds from Clay County.Correspondence to:
Dr. R.J. Wyatt
301 Le Bonheur Children’s Medical Center
50 N. Dunlap
Memphis, TN 38103-2893, USA
Email: [email protected]
Original
Individual effect of renin-angiotensin system inhibition and corticosteroid therapy in IgA glomerulonephritis: results of a pilot study
M.J. Kim, H. Hopfer, M.T. Koller, O. Giannini, M.J. Mihatsch and M. Mayr
Page No. 122
Abstract
Clinical Nephrology, Vol. 73 – No. 2/2010 (122-130)
Individual effect of renin-angiotensin system inhibition and corticosteroid therapy in IgA glomerulonephritis: results of a pilot study
M.J. Kim1,2, H. Hopfer3, M.T. Koller4,5, O. Giannini6, M.J. Mihatsch3 and M. Mayr1,5
1Clinic for Transplantation Immunology and Nephrology, 2Clinic for Internal Medicine, 3Institute for Pathology, 4Basel Institute for Clinical Epidemiology and Biostatistics, 5Medical Outpatient Department, University Hospital Basel, Basel, and 6Nephrology and Internal Medicine Services, Ospedale Regionale Beata Vergine, Mendrisio, Switzerland
Background: The impact of different therapy modalities on the outcome of Immunoglobulin A glomerulonephritis (IgAGN) in individual patient is not clear. We present preliminary results from the sequential application of renin-angiotensin system (RAS) inhibition and corticosteroids to discriminate the individual effect of both therapies. Methods: Regardless of the degree of proteinuria, renal function and histological grading, patients with biopsy-proven IgAGN were treated with a standardized protocol. RAS inhibition was performed for 3 months. Thereafter, immunosuppressive therapy with prednisone (0.5 mg/kg body weight) on alternate days for 6 months was started. The primary endpoint was a maximal reduction of proteinuria (spot urine protein/ creatinine ratio (uPCR)), by RAS inhibition and by the combination of RAS inhibition and steroids. Results: 10 patients were treated according to the protocol. During a median follow-up of 18 months, uPCR decreased from initial 230 mg/mmol (2 g/g) (median, interquartile range (IQR) 146 – 396) to 154 mg/mmol (1.4 g/g) (IQR 88 – 190) at 3 months during the RAS inhibition period (33% reduction, p = 0.01) and further to 31 mg/mmol (0.3 g/g) (IQR 21 – 71) until end of the steroid period at 9 months (80% reduction compared to uPCR at 3 month, p < 0.001). At the last F/U, uPCR (median) remained stable at 41 mg/mmol (0.4 g/g). The estimated glomerular filtration rate was stable during the whole observation period. Conclusions: Sequential RAS inhibition and steroid treatment leads to a continuous decrease in proteinuria, beyond the decrease produced by isolated RAS inhibition. Our data suggest independent effects of both, RAS inhibition and steroids, on the reduction of proteinuria in a small, non selected group of patients with IgAGN. The hypothesis that patients with IgAGN, regardless of the degree of proteinuria, renal function and histological grading, may benefit from combination therapy with maximal RAS inhibition and low dose corticosteroids now has to be confirmed in a randomized study.Correspondence to:
M. Mayr, MD
Clinic for Transplantation Immunology and Nephrology
and Medical Outpatient Department
University Hospital Basel
4031 Basel, Switzerland
Email: [email protected]
Original
Paraoxonase 1 arylesterase activity and mass are reduced and inversely related to C-reactive protein in patients on either standard or home nocturnal hemodialysis
J. Kannampuzha, , P.B. Darling, , G.F. Maguire, S. Donnelly, , P. McFarlane, , C.T. Chan and P.W. Connelly
Page No. 131
Abstract
Clinical Nephrology, Vol. 73 – No. 2/2009 (131-138)
Paraoxonase 1 arylesterase activity and mass are reduced and inversely related to C-reactive protein in patients on either standard or home nocturnal hemodialysis
J. Kannampuzha1, 4, P.B. Darling1, 4, G.F. Maguire1, S. Donnelly1, 2, P. McFarlane1, 2, C.T. Chan3 and P.W. Connelly1
1Keenan Research Center, Li Ka Shing Knowledge Institute, 2Department of Medicine, Division of Nephrology, St. Michael’s Hospital, 3Toronto General Hospital, University Health Network, Toronto, and 4Departments of Nutritional Sciences and Medicine, University of Toronto, Ontario, Canada
Human serum paraoxonase (PON1) activity is reduced in standard hemodialysis (SHD) (4 hours, 3 days/week) patients. Home nocturnal hemodialysis (HNHD) (8 hours, 6 days/week), provides a greater dialysis dose resulting in a greater clearance of metabolites. Whether improvements in the metabolic milieu of HNHD patients results in different PON1 activity levels compared to SHD patients is unclear. We determined serum PON1 mass and arylesterase activities in a group of HNHD patients and compared them to SHD patients and a group of healthy controls (HC). Patients and methods: We measured PON1 arylesterase activity and mass, C-reactive protein (CRP), cystatin C, total and high-density lipoprotein (HDL) cholesterol, triglycerides, apolipoproteins A-I and B in 15 HNHD, 15 SHD and 15 HC participants. Results: PON1 arylesterase activity (p < 0.001) and mass (p < 0.05) were significantly higher in HC participants compared to SHD and HNHD participants, although no significant differences were noted between HD groups. CRP (p < 0.05) was significantly higher in SHD compared to HC participants and there were no significant differences noted between HD groups. Cystatin C (p < 0.001) was significantly different among the 3 groups. There were no significant differences noted in any lipoprotein parameters among the groups. PON1 activity (r = –0.636, p < 0.001) and mass (r = –0.425, p = 0.019) were inversely correlated with CRP in HD patients. Conclusion: PON1 is reduced in HNHD patients compared to HC subjects, independent of the concentration of HDL cholesterol. Within subjects on HD, the combination of increased CRP and reduced PON1 may identify subjects at a high risk for cardiovascular complications.Correspondence to:
Dr. P.W. Connelly
Room 5-029 Shuter Wing
J. Alick Little Lipid Research Laboratory
St. Michael’s Hospital
30 Bond Street
Toronto, ON, M5B 1W8, Canada
Email: [email protected]
Original
Renoprotective effects of telmisartan in patients with advanced chronic kidney disease
M. Tokunaga, N. Kabashima, R. Serino, T. Shibata, M. Matsumoto, T. Miyamoto, M. Miyazaki, Y. Furuno, J. Nakamata, Y. Fujimoto, M. Takeuchi, H. Abe, M. Okazaki, Y. Otsuji, and M. Tamura
Page No. 139
Abstract
Clinical Nephrology, Vol. 73 – No. 2/2010 (139-146)
Renoprotective effects of telmisartan in patients with advanced chronic kidney disease
M. Tokunaga1, N. Kabashima1, R. Serino2, T. Shibata1, M. Matsumoto2, T. Miyamoto2, M. Miyazaki2, Y. Furuno2, J. Nakamata2, Y. Fujimoto2, M. Takeuchi3, H. Abe3, M. Okazaki3, Y. Otsuji2,3 and M. Tamura1,2
1Kidney Center, 2Department of Nephrology, and 3Department of Cardiology, University of Occupational and Environmental Health University Hospital, Kitakyushu, Japan
Background: Angiotensin II receptor blockers (ARBs) provide renoprotective effects in patients with mild-to-moderate chronic kidney disease (CKD). However, there have been few reports regarding whether ARBs show clinical efficacy and safety in patients with advanced CKD. Methods: Seventy-two hypertensive patients with Stages 3 – 4 CKD receiving no ARBs were enrolled in this study and observed up to 48 months. Telmisartan was added to conventional antihypertensive agents (n = 36, mean estimated glomerular filtration ratio [eGFR] 19.7 ml/min/1.73 m2) whilst the remaining control patients were not treated with ARBs (n = 36, mean eGFR 19.2 ml/min/1.73 m2). Urinary protein excretion, kidney function, and the occurrence of end-stage renal disease requiring renal replacement therapy, hyperkalemia, and death were analyzed. Results: Baseline characteristics of each group were similar. During the observation period, the blood pressures of each group decreased at similar rates. In the telmisartan group, 17 patients (47.2%) were introduced to renal replacement therapy, as compared with 31 patients (86.1%) in the control group (relative risk 0.55, 95% confidence interval 0.19 – 0.92, p < 0.05). Telmisartan significantly reduced proteinuria levels (from 3.47 ± 3.00 to 2.41 ± 2.46 g/g · creatinine, p < 0.05) and was associated with a reduction of 49.6% in the decline rate of eGFR. The incidence of major adverse events in both groups was similar. Conclusions: The addition of telmisartan to conventional antihypertensive therapy is associated with significant improvement in kidney outcome without increased incidence of adverse effects, even in patients with advanced CKD.Correspondence to:
M. Tamura, MD, PhD
Chief, Associate Professor, Kidney Center
University of Occupational and Environmental
Health University Hospital
1-1 Iseigaoka, Yahatanishi
Kitakyushu 807-8555, Japan
Email: [email protected]
Case Report
Severe renal failure and microangiopathic hemolysis induced by malignant hypertension – case series and review of literature
L. Shavit, C. Reinus and I. Slotki
Page No. 147
Abstract
Clinical Nephrology, Vol. 73 – No. 2/2010 (147-152)
Severe renal failure and microangiopathic hemolysis induced by malignant hypertension – case series and review of literature
L. Shavit1, C. Reinus2 and I. Slotki1
1Nephrology Unit, and 2Department of Pathology, Shaare Zedek Medical Center, Jerusalem, Israel
Malignant nephrosclerosis is acute renal failure in the setting of malignant hypertension and may be associated with thrombotic microangiopathy. Although the prognosis has improved considerably over the past decades, renal dysfunction remains an important cause of morbidity and mortality. Adequate control of blood pressure is crucial, allows gradual healing of the necrotizing vascular lesions and may induce stabilization and improvement of renal function in about 50 – 80% of involved patients. In addition, recent investigations have provided a better understanding of the pathophysiology of malignant hypertension and offer possibilities for identifying patients at risk. We report 3 patients who developed severe acute renal failure requiring dialysis initiation in the setting of malignant hypertension. All patients had kidney biopsy proven malignant nephrosclerosis and presented with symptoms of thrombotic microangiopathy. Despite adequate blood pressure control the prognosis of our patients varied.Correspondence to:
L. Shavit, MD
Nephrology Unit
Shaare Zedek Medical Center
PO Box 3235
Jerusalem 91031, Israel
Email: [email protected]
Case Report
Computed tomographic peritoneography in the investigation of patent processus vaginalis in CAPD patients
J.Y. Xie, N. Chen, T. Shi, Z.P. Xu, Y. Lu and H. Ren
Page No. 153
Abstract
Clinical Nephrology, Vol. 73 – No. 2/2010 (153-156)
Computed tomographic peritoneography in the investigation of patent processus vaginalis in CAPD patients
J.Y. Xie1, N. Chen1, T. Shi2, Z.P. Xu3, Y. Lu4 and H. Ren1
1Nephrology Department, 2Surgical Department, 3Urology Department, and 4Radiology Department, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, P.R. China
Continuous ambulatory peritoneal dialysis (CAPD) is a useful and practical modality for the treatment of end-stage renal disease (ESRD). In the properly selected patient this method is well-tolerated with minimal complications. We report a case of intermittent massive genital edema secondary to patent processus vaginalis in a patient receiving CAPD. The diagnosis of patent processus vaginalis, which was strongly suggested by the intermittent nature of the symptoms, was confirmed by computerized tomography (CT) peritoneography.Correspondence to:
N. Chen, MD
Department of Nephrology
Ruijin Hospital
Shanghai Jiaotong University
School of Medicine
197 Ruijin Er Road
Shanghai, 200025, P.R. China
Email: [email protected]
Case Report
Type B insulin resistance syndrome with systemic lupus erythematosus
N. Sato, I. Ohsawa, M. Takagi, T. Gohda, S. Horikoshi, I. Shirato, Y. Yamaguchi and Y. Tomino
Page No. 157
Abstract
Clinical Nephrology, Vol. 73 – No. 2/2010 (157-162)
Type B insulin resistance syndrome with systemic lupus erythematosus
N. Sato1, I. Ohsawa1, M. Takagi1, T. Gohda1, S. Horikoshi1, I. Shirato1, Y. Yamaguchi2 and Y. Tomino1
1Division of Nephrology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, and 2Division of Pathology, Kashiwa Hospital, Jikei University School of Medicine, Chiba, Japan
Type B insulin resistance syndrome is a rare disease. Auto-antibodies to the insulin receptor frequently appear in the case of systemic lupus erythematosus (SLE). We report herein a case of a 56-year-old man who had presented discoid skin lesions since 1990. He was admitted to the hospital because of unconsciousness and severe hypoglycemia in 2006, and was diagnosed as having Type B insulin resistance syndrome with the presence of insulin receptor antibody. He had frequently repeated hypoglycemic and hyperglycemic episodes in spite of treatment with prednisolone (5 – 10 mg/day), and mild proteinuria of 1.5 g/day was observed. His laboratory findings on admission revealed pancytopenia and positive titer for antinuclear antibody (ANA). From these findings and his past history of skin lesions, we diagnosed him as SLE. We performed renal biopsy and his histological diagnosis was lupus nephritis Class 5 with the findings of podocytic shedding. Prednisolone dosage was increased from 10 to 60 mg/day. Thereafter, his glucose metabolism improved and proteinuria disappeared. The dose of prednisolone was tapered to 30 mg/day without recurrence of hypoglycemia and proteinuria. Early treatment with prednisolone might ameliorate proteinuria and insulin resistance. We experienced a rare case of Type B insulin resistance syndrome with increased activity of SLE, complicated with lupus nephritis. It appears that Type B insulin resistance syndrome should be suspected in differential diagnosis of hypoglycemia in SLE patients.Correspondence to:
Y. Tomino, MD
Division of Nephrology
Department of Internal Medicine
Juntendo University School of Medicine
2-1-1 Hongo, Bunkyo-ku
Tokyo 113-8421, Japan
Email: [email protected]
Case Report
Large perinephric abscess in a patient on maintenance hemodialysis diagnosed by positron emission tomography combined with computed tomography (PET-CT)
D. Katagiri, T. Inoue, A. Katsuma, S. Masumoto, E. Minami, T. Hoshino, M. Shibata, M. Tada, T. Nakamura, K. Kubota and F. Hinoshita
Page No. 163
Abstract
Clinical Nephrology, Vol. 73 – No. 2/2010 (163-166)
Large perinephric abscess in a patient on maintenance hemodialysis diagnosed by positron emission tomography combined with computed tomography (PET-CT)
D. Katagiri1, T. Inoue1, A. Katsuma1, S. Masumoto1, E. Minami1, T. Hoshino1, M. Shibata1, M. Tada1, T. Nakamura2, K. Kubota3 and F. Hinoshita1
1Department of Nephrology, International Medical Center of Japan, 2Department of Internal Medicine, Yokohama City Minato Red Cross Hospital, and 3Divison of Nuclear Medicine, Department of Radiology, International Medical Center of Japan
Perinephric abscesses in patients on maintenance hemodialysis (HD) have seldom been reported. The case of a maintenance HD patient with a left perinephric abscess is reported. Although the lesion could not be visualized using other imaging examinations, using FDG and positron emission tomography combined with computed tomography (PET-CT), the patient was diagnosed as having a left perinephric abscess and nephrolithiasis. At the patient’s request, the perinephric abscess was treated conservatively with antibiotic therapy alone, and it eventually remitted. This is the first case report of a perinephric abscess diagnosed by FDG PET-CT in a patient on maintenance HD. FDG PET-CT appears to be useful for identifying perinephric abscesses in HD patients, resulting in early diagnosis and appropriate therapy for this severe infection.Correspondence to:
D. Katagiri, MD
Department of Nephrology
International Medical Center of Japan
1-21-1, Toyama Shinjuku-ku, Tokyo,
Japan
Email: [email protected]
Letter to the Editor
Successful treatment of membranoproliferative glomerulonephritis associated with hepatitis B and C virus simultaneous infection patient
A. Mima, N. Iehara, T. Matsubara, S. Yamamoto, H. Abe, K. Nagai, M. Matsuura, T. Murakami, S. Kishi, T. Araoka, F. Kishi, N. Kondo, R. Shigeta, K. Yoshikawa, T. Takahashi, T. Kita, T. Doi and A. Fukatsu
Page No. 167
Abstract
Successful treatment of membranoproliferative glomerulonephritis associated with hepatitis B and C virus simultaneous infection patient
A. Mima, N. Iehara, T. Matsubara, S. Yamamoto, H. Abe, K. Nagai, M. Matsuura, T. Murakami, S. Kishi, T. Araoka, F. Kishi, N. Kondo, R. Shigeta, K. Yoshikawa, T. Takahashi, T. Kita, T. Doi and A. Fukatsu
Letter to the Editor
Contrast-induced ultrasonography with Levovist in a case of exercise-induced acute kidney injury without rhabdomyolysis
S. Goto, K. Kono, H. Fujii, M. Umezu and M. Fukagawa
Page No. 170
Abstract
Contrast-induced ultrasonography with Levovist in a case of exercise-induced acute kidney injury without rhabdomyolysis
S. Goto, K. Kono, H. Fujii, M. Umezu and M. Fukagawa
