Volume 75 (2011), No. 5/2011(May)
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Original
Fetuin-A, coronary artery calcification and outcome in maintenance hemodialysis patients
H.H. Jung, H.J. Baek and S.-W. Kim
Page No. 391
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (391-396)
Fetuin-A, coronary artery calcification and outcome in maintenance hemodialysis patients
H.H. Jung, H.J. Baek and S.-W. Kim
Department of Internal Medicine, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, South Korea
Background/Aims: Previous studies have suggested that serum fetuin-A, a calcification inhibitor, predicts mortality in dialysis patients. This study investigated the relationships between fetuin-A, vascular calcification, and outcome in such patients. Methods: 58 patients on maintenance hemodialysis underwent multirow spiral computed tomography to determine baseline coronary artery calcification (CAC) score. Serum fetuin-A was measured repeatedly over time. Results: Time-averaged fetuin-A inversely correlated with age and baseline CAC score. After partial correlation analysis controlling for age, the association between fetuin-A and CAC became insignificant. During the study, 27 of 58 patients died and 26 experienced at least one cardiovascular event. Low fetuin-A was associated with a significant increase in all-cause mortality and the occurrence of a cardiovascular event. The association of fetuin-A with mortality and cardiovascular event remained significant even when adjusting for confounding factors, including age and CAC score. Conclusion: Time-averaged fetuin-A was associated with survival and cardiovascular outcome, independent of vascular calcification.Correspondence to:
H.H. Jung, MD
Department of Internal Medicine
Kangwon National University Hospital
School of Medicine, Kangwon National University
Chuncheon, Gangwon-do 200-701, South Korea
Email: [email protected]
Original
Interleukin 10 and residual kidney function are associated with risk of vascular calcification in patients undergoing peritoneal dialysis
C.-T. Lee, Y.-C. Tsai, C.-Y. Su, H.-Y. Ng, C.-Y. Hsu, S.-F. Ko, T.-C. Chen, C.-C. Kuo, C.-C. Yang, T.T.-Y. Chiou, W.-C. Lee, Y.-K. Yang and K.-K. Lam
Page No. 397
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (397-402)
Interleukin 10 and residual kidney function are associated with risk of vascular calcification in patients undergoing peritoneal dialysis
C.-T. Lee1, Y.-C. Tsai1, C.-Y. Su1, H.-Y. Ng1, C.-Y. Hsu2, S.-F. Ko3, T.-C. Chen1, C.-C. Kuo1, C.-C. Yang1, T.T.-Y. Chiou1, W.-C. Lee1, Y.-K. Yang1 and K.-K. Lam1
1Division of Nephrology, Department of Internal Medicine, Chang-Gung Memorial Hospital Kaohsiung Medical Center, Chang-Gung University College of Medicine, 2Department of Neurology, Kaohsiung Medical University, and 3Department of Radiology, Chang-Gung Memorial Hospital Kaohsiung Medical Center, Chang-Gung University College of Medicine, Kaohsiung, Taiwan
Aims: Vascular calcification is a common complication among dialysis patients and its pathogenesis involves a variety of factors. The roles of pro-inflammatory cytokines and residual kidney function (RKF) in peritoneal dialysis (PD) patients with vascular calcification have not been investigated. Materials and methods: 157 stable PD patients were enrolled. All patients had plain X-ray film examination including chest (posterior-anterior view, CXR) and pelvis. Vascular calcification was interpreted as calcified deposit over aortic arch and linear calcification of pelvic arteries. Relevant biochemical data, pro-inflammatory markers, and PD-related factors were measured and collected. Results: Vascular calcification prevalence in CXRs was higher than that in pelvis films (38.2% vs. 22.3%, p < 0.05). Patients with vascular calcification in CXR had higher incidence of calcification in pelvis films (p < 0.05). Only a minor portion (14.6%) had two calcification sites. Regression analysis revealed that age, PD duration, body mass index, and RKF were independent factors associated with vascular calcification in CXR. Age, diabetes, IL-10 and RKF were factors associated in pelvis films. Factors independently related to vascular calcification in both films were age, duration, diabetes, IL-10, and RKF. Conclusions: Besides traditional risk factors, IL-10 and RKF were important factors associated with vascular calcification in PD patients.Correspondence to:
C.-T. Lee, MD, PhD
Division of Nephrology
Department of Internal Medicine
Chang-Gung Memorial Hospital
123, Ta-Pei Road
Niao-Sung Shang, Kaohsiung Hsien 833, Kaohsiung, Taiwan
Email: [email protected]
Original
Impact of renal failure on metabolic bone parameters in a vitamin D-deficient patient cohort
W. Reinhardt, S. Dolff, P. John, A. Kribben and O. Witzke
Page No. 403
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (403-409)
Impact of renal failure on metabolic bone parameters in a vitamin D-deficient patient cohort
W. Reinhardt1,2, S. Dolff2, P. John1, A. Kribben2 and O. Witzke2
1Endocrine Outpatient Clinic and Dialysis Center Herne, Herne, and 2University Hospital Essen, Department of Nephrology, University Duisburg-Essen, Germany
Introduction: Chronic renal failure is associated with major changes in bone metabolism, but studies evaluating bone metabolism with mild or moderate renal failure are rare. Moreover, the study populations were often heterogenous and/or patients were pretreated with calcium and vitamin-D preparations. Therefore, we prospectively evaluated metabolic bone parameters in patients with renal insufficiency (Stage 1 – 4) on their first visit to outpatient nephrologists. Patients and methods: 285 patients were prospectively evaluated regarding renal function, serum phosphorous, plasma parathyroid hormone (PTH), serum 25-OH-vitamin-D and serum bone specific alkaline phosphatase (BAP) concentrations. Patients were subdivided according to the stages of chronic kidney disease. Results: Hypocalcemia occurred in only 10% of patients in Stage 4, whereas serum phosphorous was elevated at the same stage in 40% of the patients. PTH increased from Stage 1 to 4 continually with a high prevalence of elevated PTH levels (> 65 pg/ml) in Stage 1: 44%; Stage 4: 84%. Serum 25-OH-vitamin-D levels were very low irrespective of renal function: < 15 ng/dl, i.e., 37.5 nmol/l in 70% of all patients. 25-OH-D was negatively correlated with PTH (r = 0.3, p < 0.0002). BAP was within the normal range in all stages but with a high prevalence of BAP values < 7.5 ng/ml in up to 25% in Stage 4. Only 6.5% of patients had features of classical renal hyperparathyroidism. Nearly 20% had low BAP levels in the presence of normal (9.5%) or increased (9.6%) PTH levels. Conclusion: This study demonstrates a high prevalence of hyperphosphatemia in patients with moderate renal failure. Hyperparathyroidism was present even in earlier stages and was aggravated by a high prevalence of vitamin D deficiency. However, also in the presence of elevated PTH levels, there is indication of low bone turnover as evidenced by low BAP levels, suggesting adynamic bone disease.Correspondence to:
PD Dr. W. Reinhardt
Endocrine Outpatient Clinic and Dialysis
Center Herne
Wiescherstraße 20
44623 Herne, Germany
Email: [email protected]
Original
Mineral metabolism management in Canadian peritoneal dialysis patients
S.D. Soroka, K.M. Beard, D.C. Mendelssohn, S.H. Cournoyer, G.A. Da Roza and D.F. Geary
Page No. 410
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (410-415)
Mineral metabolism management in Canadian peritoneal dialysis patients
S.D. Soroka1, K.M. Beard2, D.C. Mendelssohn3, S.H. Cournoyer4, G.A. Da Roza5 and D.F. Geary6
1Department of Nephrology, Dalhousie University, Halifax, NS, 2Agro Health Associates, Burlington, ON, 3Department of Nephrology, Humber River Regional Hospital, Toronto, ON, 4Department of Nephrology, Hôpital Charles LeMoyne, Greenfield Park, QC, 5Department of Nephrology, Royal Columbian Hospital, New Westminster, BC, and 6Department of Nephrology, Hospital for Sick Children, Toronto, ON, Canada
Background: Abnormal mineral metabolism is associated with increased morbidity and mortality in dialysis patients. Therefore, the goal of this study was to compare a) mineral metabolism control among a cohort of Canadian peritoneal dialysis (PD) patients to K/DOQI-defined targets and b) the effect of different treatment strategies on mineral metabolism parameters. Methods: We looked at a cohort of 317 Canadian PD patients from 9 clinics that used the PhotoGraph™ software program which tracks mineral metabolism management. Serum phosphorus (P), calcium (Ca) and intact parathyroid hormone (iPTH) values were collected for the patients. Data were categorized and analyzed by the type of phosphate binder prescribed, vitamin D use, and dosing and reimbursement criteria for the phosphate binder, sevelamer. Results: The majority of patients achieved K/DOQI-set targets for serum P. Patients who resided in Quebec (QC), which had greater access to sevelamer, had lower mean concentrations of P and Ca, were less likely to take Ca-based phosphate binders (CBBs) exclusively and were exposed to less exogenous Ca than in Ontario (ON). Conclusion: Availability of the phosphate binder sevelamer and reduced doses of elemental Ca were associated with more mineral metabolism parameters within suggested target ranges. Further studies that focus on patient outcomes are warranted.Correspondence to:
S.D. Soroka, BMus, MD, MSc, FRCPC, CHE
Professor of Medicine, Dalhousie University
5088 Dickson Building, 5820 University Avenue
Halifax, NS, B3H 1V8, Canada
Email: [email protected]
Original
Evolution of microbiological trends and treatment outcomes in peritoneal dialysis-related peritonitis
S.-T. Huang, Y.-W. Chuang, C.-H. Cheng, M.-J. Wu, C.-H. Chen, T.-M. Yu and K.-H. Shu
Page No. 416
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (416-425)
Evolution of microbiological trends and treatment outcomes in peritoneal dialysis-related peritonitis
S.-T. Huang1, Y.-W. Chuang1, C.-H. Cheng1,2,5, M.-J. Wu1,4, C.-H. Chen1,3,6, T.-M. Yu1,3 and K.-H. Shu1,2
1Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, 2School of Medicine, Chung-Shan Medical University, 3School of Medicine, China Medical University, Taichung, 4Institute of Clinical Medicine, National Yang Ming University, Taipei, 5Department of Biotechnology, Hung Kuang University, and 6Department of Life Science, Tunghai University, Taichung, Taiwan
Background and aim: Peritoneal dialysis (PD)-related peritonitis is a major risk factor of technique failure and contributes to significant mortality in patients undergoing PD. The aim of this study was to examine the evolution of microbiological trends and treatment outcomes of PD-related peritonitis in our hospital over the past 26 years. Methods: A total of 630 patients entered our CAPD program from February 1984 to June 2010. Among them, 119 patients (18.9%) experienced 599 episodes of peritonitis. Microbiological trends, treatment responses, techniques and patient survival were analyzed. Results: The incidence rate of total peritonitis showed a steady decline from 1.08 episodes/patient-year in 1984 to 0.25 episode/ patient-year in 2009 (p < 0.001). A similar trend was found in gram-positive (p < 0.001) and gram-negative peritonitis (p = 0.015). In contrast, there was a trend toward an increased proportion of gram-negative peritonitis. This increase was not due to an increased rate of gram-negative peritonitis but to the more dramatic fall in gram-positive peritonitis. Treatment of peritonitis resulted in a complete cure in 78.0% of patients, while 16.7% of patients required catheter removal and 5.3% died. Gram-positive organisms were associated with a more favorable outcome compared to gram-negative pathogens as manifested by a higher cure rate (p = 0.023). The patient survival and technique survival were much improved after 2000 compared to that before 2000 (p < 0.0001). Conclusion: A remarkable improvement in the outcome of PD-related peritonitis has been achieved in the past 26 years in our hospital. To further decrease peritonitis rates, attention needs to be directed at reducing gram-negative peritonitis.Correspondence to:
K.-H. Shu, MD
Division of Nephrology
Department of Medicine
Taichung Veterans General Hospital, No.160, Sec.3
Chung-Kang Road, Taichung, 40705, Taiwan
Email: [email protected]
Original
Postdialysis fatigue is associated with sedentary behavior
P.L. Gordon, J.W. Doyle and K.L. Johansen
Page No. 426
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (426-433)
Postdialysis fatigue is associated with sedentary behavior
P.L. Gordon1,3, J.W. Doyle2 and K.L. Johansen1,3
1Department of Medicine, University of California, 2Northern California Institute for Research and Education, and 3Nephrology Section, San Francisco VA Medical Center, San Francisco, CA, USA
Abstract. Postdialysis fatigue (PDF) is a common and debilitating phenomenon that adversely affects the quality of life of hemodialysis patients. Excessive ultrafiltration and rapid osmolar flux are implicated in the pathogenesis of PDF, but simple adjustments do not always ameliorate this symptom. Increased physical activity has long been associated with reduced fatigue in sedentary fatigued patients. The aim of the study was to examine the extent to which physical activity is associated with PDF. This was a retrospective cross-sectional study of hemodialysis patients (n = 58, age 55 ± 13 years, 38 M, 20 F). Physical activity was measured by self-report using the Human Activity Profile (HAP) (n = 58) and accelerometry (n = 26). Postdialysis fatigue was assessed by a questionnaire rating frequency, severity, and duration of symptoms. 86% (50/58) of patients reported PDF ranging from mild to severe. The PDF index was inversely correlated with the adjusted score of the HAP (p < 0.05). Least squares linear regression was used to assess the association of physical activity with PDF, controlling for Kt/V and dialysis vintage. In the adjusted model (R2 = 0.40), physical activity remained the most significant predictor (p < 0.01) of PDF after adjusting for Kt/V and/or vintage. Further studies are needed to evaluate whether increasing habitual physical activity can mitigate PDF symptoms.Correspondence to:
P.L. Gordon, RN, PhD
Department of Medicine, Nephrology Division
University of California, San Francisco
San Francisco Veterans Affairs Medical Center
Box 111J, 4150 Clement Street
San Francisco, CA 94121, USA
Email: [email protected]
Original
Dialysis-associated morbidity, ultrafiltration, and cardiovascular variables in children with HIV infection
R. Gordillo, M. del Rio and R.P. Woroniecki
Page No. 434
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (434-439)
Dialysis-associated morbidity, ultrafiltration, and cardiovascular variables in children with HIV infection
R. Gordillo, M. del Rio and R.P. Woroniecki
Division of Pediatric Nephrology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
Children infected with HIV on maintenance hemodialysis (HD) have increased mortality with adequate single pool Kt/V, as compared to non-HIV children on HD. It is unclear if HIV subjects on HD have similar dialysis-associated morbidity (DAM) and blood volume changes (dBV) as non-HIV subjects. It is also unclear how those variables are related to left ventricular mass index (LVMI), shortening fraction (SF), pre- and postdialysis blood pressure and mortality. Methods: We investigated the relationship between LVMI, SF and dBV and DAM using noninvasive monitoring of hematocrit in HIV vs. non-HIV subjects and their association with mortality. We used a cross-sectional study design and analyzed 18 pediatric subjects (9 had vertically transmitted HIV) on HD over a 17-month period. HIV subjects tolerated fluid removal during HD treatments as well as non-HIV subjects. Results: In our study we confirmed an association of LVMI with DAM in subjects on HD. We found that HIV subjects who did not survive had a significantly lower SF and similar viral load as compared to subjects who survived. Conclusions: Noninvasive monitoring of hematocrit in HIV subjects with compromised heart function allows effective ultrafiltration. Routine echocardiography should be periodically performed in all HIV-infected children on renal replacement therapy because subclinical abnormalities, i.e. increased LVMI or reduced SF in this population can be predictors of mortality.Correspondence to:
R.P. Woroniecki, MD, MS
3326 Bainbridge Ave.
Bronx, NY 10467, USA
Email: [email protected]
Original
Renin angiotensin system blockade and activated vitamin D as a means of preventing deep vein thrombosis in renal transplant recipients
L. Moscarelli, M. Zanazzi, E. Bertoni, L. Caroti, G. Rosso, S. Farsetti, F. Annunziata, N. Paudice and M. Salvadori
Page No. 440
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (440-450)
Renin angiotensin system blockade and activated vitamin D as a means of preventing deep vein thrombosis in renal transplant recipients
L. Moscarelli, M. Zanazzi, E. Bertoni, L. Caroti, G. Rosso, S. Farsetti, F. Annunziata, N. Paudice and M. Salvadori
Renal Unit Careggi University Hospital, Florence, Italy
Background: Venous thromboembolism (VTE) is one of the thrombotic complications that occur in renal transplant recipients (RTR). The observation that vitamin D receptor activators, angiotensin-converting enzyme inhibitors (ACEi), and angiotensin receptor blockers (ARBs) have a protective effect against protrombotic state suggests that their possible combination could reduce the incidence of VTE in RTR. Objectives: to evaluate the incidence of VTE in RTR and the timing of occurrence after renal transplantation (Tx); to compare the incidence of VTE in our RTR and RTR on calcitriol, ACEi, ARBs and their combination therapy. Risk factors were also evaluated. Results: During follow-up, 96 of 769 RTRs, 73 males 23 females, developed a first episode of VTE: 23 in the first 3 months after Tx; 15 from 3 to 6 months; 9 from 6 to 12 months; 13 from 12 to 48 months and 36 after more than 48 months. The incidence was significantly lower in RTR on treatment with a combination of calcitriol 0.25 µg/day, an ACEi and an ARB and in RTR on treatment with only calcitriol 0.5 µg/day (9.4% and 9%, respectively, vs. 14.5% (p < 0.05)). However, the most decreased rate (5.6% vs. 14.5% (p < 0.01)) was in patients treated with a combination of calcitriol 0.5 µg/day, an ACEi and an ARB. Conclusion: A combination therapy with calcitriol 0.5 µg/day, ACEi, and ARB is associated with a 60% lower rate risk of VTE.Correspondence to:
Dr. L. Moscarelli
Renal Unit Careggi
University Hospital
Viale Pieraccini 18
50139 Florence, Italy
Email: [email protected]
Original
Cytochrome P450 polymorphisms and the response of lupus nephritis to cyclophosphamide therapy
J. Winoto, H. Song, C. Hines, H. Nagaraja and B.H. Rovin
Page No. 451
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (451-457)
Cytochrome P450 polymorphisms and the response of lupus nephritis to cyclophosphamide therapy
J. Winoto1, H. Song1, C. Hines1, H. Nagaraja2 and B.H. Rovin1
1Department of Internal Medicine, Nephrology Division and 2Department of Statistics, The Ohio State University College of Medicine, Columbus, OH, USA
Background and aims: The addition of cyclophosphamide to corticosteroids significantly improves the prognosis of severe kidney involvement in systemic lupus erythematosus (SLE). However, not all patients respond to cyclophosphamide. It has been suggested that genetic variations that reduce the metabolism of cyclophosphamide reduce its effectiveness. Cyclophosphamide is metabolized and activated by the cytochrome P450 (CYP) system and in particular CYP enzymes 2B6 and 2C19. Both CYP2B6 and CYP2C19 have variant alleles (CYP2B6*5 and CYP2C19*2) that attenuate or eliminate enzymatic activity. This investigation was done to determine the impact of CYP2B6*5 and CYP2C19*2 on the renal response in cyclophosphamide-treated lupus nephritis (LN) patients. Methods: Patients with SLE (n = 237), unclassified autoimmune disease (n = 51), and healthy controls (n = 294) were genotyped for CYP2B6*5 and CYP2C19*2. Associations between these alleles and achievement of complete or partial response, development of end-stage renal disease, and time to remission were determined. Results: The frequencies of the variant alleles CYP2B6*5 and CYP2C19*2 were 6.3 % and 15.9%, respectively. CYP2C19*2 genotypes were more frequent among African Americans than European Americans, and CYP2B6*5 genotypes were more frequent among European Americans than African Americans. Among LN patients treated with cyclophosphamide (n = 36), there were no differences between those with or without these genotypes relative to the frequency of complete or partial remissions or time to remission. Conclusion: This retrospective analysis failed to show an association between CYP2B6*5 and CYP2C19*2 and treatment outcomes in LN. This suggests that genotyping for these CYP450 variants may not be useful in individualizing treatment for severe LN.Correspondence to:
B.H. Rovin, MD
Nephrology Division
Ohio State University College of Medicine
395 West 12th Avenue, Columbus, OH 43210, USA
Email: [email protected]
Original
Higher serum beta2-microglobulin levels are associated with better survival in chronic hemodialysis patients: a reverse epidemiology
K.M. Kim, S.-S. Kim, H. Kim, T. Koo, E.Y. Im and S.B. Kim
Page No. 458
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (458-465)
Higher serum beta2-microglobulin levels are associated with better survival in chronic hemodialysis patients: a reverse epidemiology
K.M. Kim1, S.-S. Kim2, H. Kim1, T. Koo1, E.Y. Im1 and S.B. Kim1
1Department of Internal Medicine, and 2Department of Medical Information Management, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Aims:beta2-Microglobulin (beta2-M) has been considered a surrogate marker of putative mid-molecular weight (MW) uremic toxins, compounds difficult to dialyze by low-flux dialysis membranes. This study was performed to evaluate the relationship between serum beta2-M and survival of chronic hemodialysis (CHD) patients and the association of beta2-M levels and factors associated with mortality. Methods: Part I of this study is a retrospective cohort evaluation that determined the relationship between beta2-M and mortality, and Part II is a cross-sectional study that evaluated the relationship between beta2-M and factors associated with mortality. Laboratory parameters, including beta2-M, albumin, prealbumin, creatinine, blood urea nitrogen (BUN), high-sensitivity C-reactive protein (hs-CRP), lipid battery, KT/V, and normalized protein nitrogen appearance (nPNA), were reviewed in Part I and measured in Part II. Clinical and demographic data, including age, sex, duration of hemodialysis, presence of cardiovascular disease, and presence of diabetes mellitus, were also recorded. Results: Part I: During the follow-up period of 5 years, there were 95 all-cause deaths among the 289 patients. Comparison of survivors and non-survivors indicated that serum beta2-M was higher in survivors (36.8 ± 12.3 vs. 32.6 ± 13.2 µg/ml, p = 0.009). Kaplan-Meier analysis indicated that all-cause mortality in the lower beta2-M group was significantly higher compared to the higher beta2-M group (p < 0.0001). Multivariate Cox regression analyses indicated elevated beta2-M levels were significantly associated with lower mortality rate (relative risk: 0.608; 95% CI: 0.37 to 0.99; p = 0.046). Part II: The mean serum beta2-M concentration was 37.1 ± 14.4 µg/ml. Univariate analysis indicated that beta2-M was positively correlated with nPNA, duration of HD, BMI, and the concentrations of creatinine, albumin, BUN, and hs-CRP, but was negatively correlated with HDL-C concentration. Multiple regression analysis indicated that levels of nPNA (p < 0.001), duration of hemodialysis (p < 0.001), creatinine (p < 0.001), albumin (p = 0.006), BUN (p = 0.011), and HDL-C (p = 0.038) were independently associated with serum beta2-M concentration. Conclusion: Our results showed that higher serum beta2-M levels are associated with better survival in CHD patients and that nutritional status might be an independent predictor of serum beta2-M concentration in these patients.Correspondence to:
S.B. Kim, MD
Department of Internal Medicine
Asan Medical Center
388-1 Pungnap-2 dong
Songpa-gu, Seoul, 138-736, South Korea
Email: [email protected]
Original
Idiopathic hypercalcemia in infants with renal dysplasia
N. Al Kalbani, M. Frieling, J.C. Jun, C. Teh, E. Harvey and D.F. Geary
Page No. 466
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (466-471)
Idiopathic hypercalcemia in infants with renal dysplasia
N. Al Kalbani, M. Frieling, J.C. Teh, E. Harvey and D.F. Geary
The Hospital for Sick Children, Division of Nephrology, Toronto, Canada
Background: We have observed infants with renal dysplasia who developed sustained hypercalcemia, without vitamin D or calcium supplementation (idiopathic). This has not been previously described. Objectives: 1) Define incidence, severity and duration of idiopathic hypercalcemia in infants with renal dysplasia below 12 months of age. 2) Evaluate phosphate, parathyroid hormone (PTH) and vitamin D levels in these infants. Methods: A retrospective study was conducted from June 2005 to June 2008. Patients receiving calcium-containing phosphate binders or daily supplemental vitamin D in excess of 400 IU were excluded. Hypercalcemia was defined as at least three corrected calcium values above normal lab values for age, in a one-week interval. Results: 15 of 99 (15%) infants with renal dysplasia had hypercalcemia. All were males; 10/15 (67%) were below one month of age at presentation; 9/15 (60%) had posterior urethral valves (PUV). Mean hypercalcemia duration was 5.2 ± 6.0 months. Mean corrected calcium was 3.07 mmol/l (12.3 mg/dl). Only 3/10 infants had elevated PTH levels. None had elevated phosphate levels and only 1/8 patients who had 25-hydroxyvitamin D measured had an elevated level. Conclusions: Idiopathic hypercalcemia in infants with renal dysplasia is common. Neonates and those with PUVs are at greatest risk. Most have normal levels of 25-hydroxyvitamin D, phosphate and PTH.Correspondence to:
D.F. Geary, MB, MRCP (UK), FRCP(C)
Division of Nephrology
The Hospital for Sick Children
555 University Ave, Toronto, Canada M5G 1X8
Email: [email protected]
Original
The effects of oral iron supplementation on the progression of anemia and renal dysfunction in patients with chronic kidney disease
S.M. Kim, C.-H. Lee, Y.K. Oh, K.W. Joo, Y.S. Kim, S. Kim and C.S. Lim
Page No. 472
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (472-479)
The effects of oral iron supplementation on the progression of anemia and renal dysfunction in patients with chronic kidney disease
S.M. Kim1,2, C.-H. Lee2,3, Y.K. Oh2,3, K.W. Joo2,4, Y.S. Kim2,4, S. Kim2,4 and C.S. Lim2,3,4
1Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, 2Department of Internal Medicine, Seoul National University College of Medicine, 3Department of Internal Medicine, Seoul National University Boramae Medical Center, and 4Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
Aims: Oral iron traditionally has been administered to patients with chronic kidney disease (CKD). However, there are limited data on the effect of oral iron in CKD patients. Here, we evaluate the effects of oral iron therapy on renal anemia and progression of renal disease in CKD patients. Methods: Anemic patients with nondialytic CKD who were naive to erythropoiesis-stimulating agents (ESAs) were recruited for the prospective observational study. The participants were classified into oral iron or control group, and they were asked to keep their treatment status for 1 year. The primary outcomes were change in Hb and estimated glomerular filtration rate (eGFR). Results: A total of 182 participants were enrolled and 138 completed a 12-month follow-up. No change in Hb level was observed during the follow-up period in the iron group, whereas a significant decrease in Hb was observed in the control group. Oral iron supplementation was effective, especially in patients with eGFR < 30 ml/min/1.73 m2. The changes in eGFR did not differ between the two groups. The incidences of drug-related adverse events were equivalent in two groups. Conclusions: Oral iron supplementation might attenuate the progression of anemia in nondialytic CKD patients without ESAs and not impact kidney function.Correspondence to:
Prof. C.S. Lim, MD, PhD
Department of Internal Medicine
Seoul National University Boramae Medical Center
425 Sindaebang2-dong, Dongjak-gu
Seoul 156-707, Korea
Email: [email protected]
Nephrology Education
Acute renal failure and nephrotic syndrome due to membranoproliferative nephritis during the second trimester of pregnancy
L. De Galasso, A. Gigante, N. Pirozzi, B. Barbano, K. Giannakakis, R. Cianci and G. Stirati
Page No. 480
Abstract
Clinical Nephrology, Vol. 75 – No. 5/2011 (480-483)
Acute renal failure and nephrotic syndrome due to membranoproliferative nephritis during the second trimester of pregnancy
L. De Galasso1, A. Gigante1, N. Pirozzi1, B. Barbano1, K. Giannakakis2, R. Cianci1 and G. Stirati1
1Department of Nephrology, and 2Department of Experimental Medicine and Pathology, La Sapienza University Rome, Italy
We report the case of a patient with acute renal failure and nephrotic syndrome during the second trimester of an otherwise uncomplicated pregnancy. Despite pregnancy, percutaneous renal biopsy was performed to evaluate the etiology, showing Type I membranoproliferative glomerulonephritis. Two therapeutic options were considered: pregnancy termination, suggested by the gynecologists, and our proposal of starting steroid therapy, in order to reduce proteinuria and improve renal function. The patient refused pregnancy termination. She received i.v. methylprednisolone boluses, followed by maintenance oral prednisone and aspirin, with prompt acute renal failure resolution and reduced proteinuria. At Week 34 + 5 days of gestation, cesarean section was performed, without intra- and postoperative complications both for mother and newborn. Clinical maternal and fetal outcomes were excellent. One-year follow-up showed normal renal function and absence of proteinuria. Lacking guidelines concerning treatment of acute renal failure due to primary nephropathy in pregnancy, we consider this case of interest for our decision-making process and for the favorable outcome.Correspondence to:
Dr. B. Barbano, MD
Department of Nephrology
First Faculty of Medicine “Sapienza”
University of Rome
Viale dell’Università, 37, 00185, Rome, Italy
Email: [email protected]
Letter to the Editor
Hyperkeratotic pruritic papules in a hemodialysis patient
S. Lee, H.S. Park, S.K. Yun, K.P. Kang, W. Kim and S.K. Park
Page No. 484
Abstract
Hyperkeratotic pruritic papules in a hemodialysis patient
S. Lee, H.S. Park, S.K. Yun, K.P. Kang, W. Kim and S.K. Park
