Volume 77 (2012), No. 4/2012(April)
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Original
GSTT1 gene abnormality in minimal change nephrotic syndrome with elevated serum immunoglobulin E
Kohei Miyazaki, Keisuke Sugimoto, Shoji Tsuji, Anna Iharada, Shinsuke Fujita, Hidehiko Yanagida, Naoki Sakata, Mitsuru Okada, Kazunari Kaneko and Tsukasa Takemura
Page No. 261
Abstract
Clinical Nephrology, Vol. 77 – No. 4/2012 (261-266)
GSTT1 gene abnormality in minimal change nephrotic syndrome with elevated serum immunoglobulin E
Kohei Miyazaki1, Keisuke Sugimoto1, Shoji Tsuji2, Anna Iharada2, Shinsuke Fujita1, Hidehiko Yanagida1, Naoki Sakata1, Mitsuru Okada1, Kazunari Kaneko2 and Tsukasa Takemura1
1Department of Pediatrics, Kinki University School of Medicine, and 2Department of Pediatrics, Kansai Medical University, Osaka, Japan
Introduction: Imbalance between T-helper 1 (Th1) and 2 (Th2) lymphocytes and effects of reactive oxygen species (ROS) upon glomerular capillary walls have been implicated in minimal change nephrotic syndrome (MCNS). Methods: By polymerase chain reaction and comparative genomic hybridization, we evaluated mutations of the GSTT1 gene (GSTT1), a member of the glutathione S-transferase (GST) supergene family associated with both protection of cells from ROS and control of allergic reactions and serum immunoglobulin (Ig) E. Results: Among 15 children with MCNS, IgE elevation (over 2,000 IU/l) and GSTT1 deletion was found in 2 who showed severe allergic symptoms. Serum ROS concentrations in these 2 patients were significantly higher than in healthy controls or other MCNS patients. In addition, a Th2 shift caused by increased serum interleukin (IL)- 4 was observed. Conclusion: These results suggest presence of a GSTT1 abnormality in some children with MCNS having marked serum IgE elevations and various allergic complications. Defective ROS degradation and Th1/Th2 imbalance caused by GSTT1 abnormality could initiate proteinuria leading to MCNS.Correspondence to:
Tsukasa Takemura, MD, PhD
Department of Pediatrics
Kinki University School of Medicine
377-2 Ohno-higashi
Osaka-Sayama, 589-8511, Japan
Email: tsukasa@ med.kindai.ac.jp
Original
Gastrointestinal symptoms predict peritonitis rates in CAPD patients
Chun-yan Su, Juan Pei, Xin-hong Lu, Wen Tang and Tao Wang
Page No. 267
Abstract
Clinical Nephrology, Vol. 77 – No. 4/2012 (267-274)
Gastrointestinal symptoms predict peritonitis rates in CAPD patients
Chun-yan Su*, Juan Pei*, Xin-hong Lu, Wen Tang and Tao Wang
Division of Nephrology, Peking University Third Hospital, Beijing, China
*These authors contributed equally to the work of this study.
Objective: Peritonitis is still one of the major causes of peritoneal dialysis (PD) patients’ dropout. In the present study, we analyzed the relationship between gastrointestinal (GI) problems and peritonitis in our CAPD patients. Methods: It is a prospective observational study. In December, 2008, 158 patients on continuous ambulatory peritoneal dialysis (CAPD) for more than 3 months from our PD unit were included in this study. A questionnaire was used to evaluate their GI symptoms score (GISS). All patients were followed up for 24 months or until they dropped out from our PD program. All peritonitis events were recorded. Results: The patients’ PD duration was 22 (4 – 132) months before the study. During the 24 months follow-up, 37 patients dropped out. And 37 patients had 46 episodes of peritonitis (peritonitis group) whereas the other 121 patients did not have peritonitis (peritonitisfree group). The overall peritonitis rate was one episode per 75.87 patient months. The peritonitis free group had lower GISS (1.35 ± 1.94 vs. 2.95 ± 3.19, p = 0.006), higher albumin level and longer dialysis duration at baseline as compared to the peritonitis group. Multivariate Cox-regression analysis showed that only GISS (OR 1.206, 95% CI 1.093 – 1.330) and dialysis duration (OR 1.018, 95% CI 1.006 – 1.031) were the risk factors for the time to first peritonitis episodes during the follow-up. Further analysis identified 2 GISS components, belching and constipation, as the strongest predictors of peritonitis during the follow-up period (p < 0.005). Conclusion: Our study showed that GI symptoms could predict peritonitis in CAPD patients. Prevention and treatment for GI problems may thus be helpful to decrease peritonitis rate.Correspondence to:
Prof. Tao Wang, MD, PhD
Division of Nephrology
Peking University Third Hospital
49 North Garden Road, Haidian District
Beijing 100191, China
Email: [email protected]
Original
Reduction of uric acid levels with allopurinol treatment improves endothelial function in patients with chronic kidney disease
Berna Yelken, Yasar Caliskan, Numan Gorgulu, Ibrahim Altun, Akar Yilmaz, Halil Yazici, Huseyin Oflaz and Alaattin Yildiz
Page No. 275
Abstract
EnClinical Nephrology, Vol. 77 – No. 4/2012 (275-282)
Reduction of uric acid levels with allopurinol treatment improves endothelial function in patients with chronic kidney disease
Berna Yelken1, Yasar Caliskan1, Numan Gorgulu1, Ibrahim Altun2, Akar Yilmaz2, Halil Yazici1, Huseyin Oflaz2 and Alaattin Yildiz1
1Division of Nephrology, Department of Internal Medicine, and 2Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
Background: Endothelial dysfunction (ED) is a key event in the development of atherosclerotic cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). Association of hyperuricemia with CVD has been previously reported in the nonuremic population. In this prospective study, we aimed to evaluate the effects of treatment of hyperuricemia with allopurinol on ED and changes in the serum reactive oxygen species in patients with CKD. Methods: In this study, 19 (13 male) hyperuricemic (UA > 7 mg/dl) nondiabetic CKD patients without any comorbidity, aged < 60 years with creatinine clearance (CrCl) between 20 and 60 ml/min were evaluated. Endothelial functions were assessed by ischemia-induced forearm vasodilatation method (EDD). Oxidative stress was evaluated by measuring the serum oxidized LDL (ox-LDL), advanced oxidation protein products (AOPP) and nitrotyrosine (NT) levels. After measuring all these tests at baseline, allopurinol therapy was commenced for 8 weeks. After 8 weeks of allopurinol treatment, all measurements were repeated. Then, allopurinol treatment was ceased and same measurements were also repeated 8 weeks after ceasing of the treatment. Results: Serum creatinine, total cholesterol, albumin, hs-CRP, CrCl and proteinuria levels of the patients were similar among three study periods. After allopurinol therapy, the mean serum UA and NT levels significantly reduced as compared to baseline. At the 8th week after cessation of allopurinol treatment, serum UA levels were significantly increased. After allopurinol therapy, EDD value increased from 5.42 ± 8.3% at baseline to 11.37 ± 9% (p < 0.001). At the 8th week after ceasing allopurinol treatment, EDD returned to baseline values (5.96 ± 8%, p < 0.001). Conclusion: Treatment of hyperuricemia with allopurinol improve ED in patients with CKD. However, mechanism responsible for this beneficial effect seems to be apart from antioxidant effects of allopurinol.Correspondence to:
Prof. Alaattin Yildiz, MD
Istanbul School of Medicine
Department of Internal Medicine
Division of Nephrology
Millet Caddesi, Topkapi, Istanbul, Turkey
Email: [email protected], [email protected]
Original
Renal histology in patients with elevated serum creatinine and concurrent normal urinalysis
Yoon-Kyung Chang, Sang-Ju Lee, Byung-Ha Chung, Young Ok Kim and Young-Shin Shin
Page No. 283
Abstract
Renal histology in patients with elevated serum creatinine and concurrent normal urinalysis
Yoon-Kyung Chang1, Sang-Ju Lee1, Byung-Ha Chung2, Young Ok Kim and Young-Shin Shin3
1Division of Nephrology, Department of Internal Medicine, Dae-Jeon St. Mary’s Hospital, 2Seoul St. Mary’s Hospital and 3St. Vincent’s Hospital, The College of Medicine, The Catholic University of Korea, Seoul, Korea
Introduction: Diagnosis of kidney disease is currently and primarily based on the measurement of serum creatinine, blood urea nitrogen, and urine output, and most kidney diseases with elevated serum creatinine accompany abnormal findings of urinalysis with microscopy, such as proteinuria or hematuria. The purpose of the current study was to determine the histologic diagnosis of patients with elevated serum creatinine and a concurrent normal urinalysis without underlying disease. Methods: The medical records of patients who had undergone kidney biopsies between January 1, 2003 and March 1, 2008 in three medical centers were retrospectively reviewed. The patients with an elevated serum creatinine level and a normal urinalysis were enrolled. The exclusion criteria were as follows: diabetes mellitus; hypertension; chronic liver disease; malignancies; autoimmune diseases; dependence on medications; hypokalemic nephropathy; age < 18 years. Age, duration of follow-up, post-biopsy management, and the change in levels of BUN and serum creatinine from pre-biopsy to the last visit were analyzed. Results: All 15 patients were included. The most frequent single diagnosis was acute interstitial interstitial nephritis, followed by hypertensive nephrosclerosis. Chronic interstitial nephritis, mesangial proliferative glomerulonephritis, acute tubular necrosis, secondary amyoloidosis, focal segmental glomerulosclerosis, and minor glomerular change were listed. The young group (< 40 years of age) included more patients with acute interstitial nephritis, and the old group (≥ 40 years of age) included more patients with hypertensive nephrosclerosis. Conclusion: Based on a correct histological diagnosis, all of the patients, except one, were properly managed and had preserved kidney function until the last visit.Correspondence to:
Young-Shin Shin, MD, PhD
93 Ji-dong, Paldal-gu, Suwon-si
Gyeonggi-do, 442-723, South Korea
Email: [email protected]
Original
Rituximab therapy for Type I membranoproliferative glomerulonephritis
John J. Dillon, Michelle Hladunewich, William E. Haley, Heather N. Reich, Daniel C. Cattran and Fernando C. Fervenza
Page No. 290
Abstract
Clinical Nephrology, Vol. 77 – No. 4/2012 (290-295)
Rituximab therapy for Type I membranoproliferative glomerulonephritis
John J. Dillon1, Michelle Hladunewich2, William E. Haley3, Heather N. Reich2, Daniel C. Cattran2 and Fernando C. Fervenza1
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA, 2Toronto Glomerulonephritis Registry, University of Toronto, Toronto, Ontario, Canada and 3Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA
Aims: Type I membranoproliferative glomerulonephritis (MPGN) is an immune-complex disease with a relatively poor prognosis. It has no established treatment in adults. Our hypothesis was that this disease would respond to B cell depletion with rituximab, an anti-CD20 monoclonal antibody. Methods: We conducted an openlabel trial, in Canada and the United States, of rituximab in 6 adult patients with Type I MPGN (4 idiopathic, 2 with cryoglobulinemia). The rituximab dose was 1,000 mg intravenously on Day 1 and on Day 15. The patients were followed for 1 year. The primary outcome was the change in proteinuria. Results: Peripheral blood B cells were suppressed, after rituximab, in all patients. The mean urinary protein excretion was 3.9 ± 2.0 g/d before treatment. Proteinuria fell in all patients, at all-time points, after rituximab administration. The difference was statistically significant (p < 0.05) at 6, 9 and 12 months, but not at 3 months. The minimum mean urinary protein excretion was 1.4 ± 1.4 g/d at 9 months. There were 2 complete and 3 partial remissions among the 6 patients. The creatinine clearance did not change significantly over the course of the study. There were no adverse effects. Conclusions: Rituximab reduced proteinuria among patients with Type I MPGN. This trial suggests that B cells may play a role in this disease and that additional study of B-cell suppression is warranted.Correspondence to:
John J. Dillon, MD
Division of Nephrology and Hypertension
Mayo Clinic
200 1st St. SW
Rochester, MN 55905 USA
Email: [email protected]
Original
Evaluation of T-Cell receptor diversity in pediatric patients with minimal change nephrotic syndrome
Kazuhide Ohta, Masaki Shimizu, Tadafumi Yokoyama, Sayaka Nishio, Kazuyuki Ueno, Akiko Seno and Akihiro Yachie
Page No. 296
Abstract
Clinical Nephrology, Vol. 77 – No. 4/2012 (296-304)
Evaluation of T-Cell receptor diversity in pediatric patients with minimal change nephrotic syndrome
Kazuhide Ohta1,2, Masaki Shimizu2, Tadafumi Yokoyama1,2, Sayaka Nishio2, Kazuyuki Ueno2, Akiko Seno2 and Akihiro Yachie2
1Department of Pediatrics, Kanazawa Medical Center, National Hospital Organization, Kanazawa and 2Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan
Aims: To further elucidate the clinical relevance of T-cell abnormalities in minimal change nephrotic syndrome (MCNS), and to predict the consequences of MCNS, we studied T-cell receptor (TCR) diversity by analyzing CDR3 size distribution and the frequency of Vβ repertoire usage. Methods: Participants comprised 36 pediatric patients with MCNS. 18 were frequent relapsers (FRs) and/or steroid-dependent (SD) and 18 were non-frequent relapsers (NFRs). Serial changes in TCR Vβ repertoires were analyzed for these two groups of patients. Frequencies of Vβ repertoire usage were determined by flow cytometry, and TCR CDR3 length distribution was analyzed by GeneScan. Results: In NFRs, abnormalities in the distribution of Vβ repertoires were few in both CD4+ and CD8+ T cells. In FRs/ SD patients, patterns were normal in CD4+ T cells, while selected Vβ repertoires were significantly increased in CD8+ T cells in some patients. Furthermore, TCR diversity was significantly reduced in CD8+ T cells in FRs/SD patients, as shown by marked skewing of CDR3 size distributions. Of note was the finding that some FRs/SD patients showed improvements in the initially abnormal TCR diversity with improvement in clinical symptoms, eventually becoming NFRs. Conclusion: Analysis of TCR diversity may delineate the subgroup of FRs/SD patients and provide a rationale for early intervention with immunosuppressive therapy for these patients.Correspondence to:
K. Ohta, MD, PhD
Department of Pediatrics
Kanazawa Medical Center
National Hospital Organization
1-1 Shimo-Ishibikimachi, Kanazawa
Ishikawa 920-8650, Japan
Email: [email protected]. go.jp
Original
Relation of homocysteine to early nephropathy in patients with Type 2 diabetes
Jianbo Li, Ming Shi, Hongman Zhang, Lingfei Yan, Ming Xie, Lei Zhuang, Yun Zhu and Jiawei Chen
Page No. 305
Abstract
Clinical Nephrology, Vol. 77 – No. 4/2012 (305-310)
Relation of homocysteine to early nephropathy in patients with Type 2 diabetes
Jianbo Li, Ming Shi, Hongman Zhang, Lingfei Yan, Ming Xie, Lei Zhuang, Yun Zhu and Jiawei Chen
Endocrinology and Metabolism Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
Aim: To explore the relationship between plasma total homocysteine concentration and diabetic nephropathy in patients with Type 2 diabetes. Methods: Chinese patients with Type 2 diabetes (n = 183) were enrolled in a cross-sectional hospital based study. Early diabetic nephropathy status was documented by presence of microalbuminuria. Plasma total homocysteine concentration was measured using fluorescence polarization immunoassay. Traditional risk factors for diabetic nephropathy were obtained from fasting blood samples and interviewer- questionnaire. Results: Plasma total homocysteine levels were higher in subjects with early diabetic nephropathy than without (13.3 ± 2.9) μmol/l vs. (8.5 ± 1.4) μmol/l, p < 0.01). The association of homocysteine with the diabetic nephropathy was independent of major traditional risk factors for diabetic nephropathy (duration of diabetes, HbA1c, and blood pressure) and determinants of higher homocysteine concentration (age, gender, serum folate and vitamin B12, serum cystatin and creatinine levels, and Biguanide use) (OR: 1.37 (0.89 – 2.24), p < 0.05). Furthermore, per increase of 4.0 μmol/l plasma homocysteine was related to nephropathy, after controlling for per unit increase of other factors (OR: 1.15 (0.94 – 1.29), p < 0.05). Conclusion: Plasma total homocysteine concentration was independently associated with occurrence of early diabetic nephropathy in Chinese patients. Future prospective studies are warranted to clarify the relationship.Correspondence to:
Jianbo Li MD, PhD
Diabetic Nephropathy Study Group
Endocrinology and Metabolism
Department of the First Affiliated Hospital of Nanjing University
Guangzhou Road 300, Nanjing, 210029, China
Email: [email protected]
Original
A comparison of measured and estimated glomerular filtration rate in successfully treated HIV-patients with preserved renal function
Saskia M.E. Vrouenraets, Christoph A. Fux, Ferdinand W.N.M. Wit, Evian Fernandez Garcia, Kees Brinkman, Frans J. Hoek, Jan P. van Straalen, Hansjakob Furrer, Ray T. Krediet and Peter Reiss for the PREPARE Study Group
Page No. 311
Abstract
Clinical Nephrology, Vol. 77 – No. 4/2012 (311-320)
A comparison of measured and estimated glomerular filtration rate in successfully treated HIV-patients with preserved renal function
Saskia M.E. Vrouenraets1, Christoph A. Fux2, Ferdinand W.N.M. Wit1, Evian Fernandez Garcia3, Kees Brinkman4, Frans J. Hoek5, Jan P. van Straalen5, Hansjakob Furrer2, Ray T. Krediet6 and Peter Reiss1 for the PREPARE Study Group
1Center for Poverty-related Communicable Disorders, Center for Infection and Immunity, and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, the Netherlands, 2Clinic for Infectious Diseases, University Hospital Bern, Bern, Switzerland, 3IATEC, 4Onze Lieve Vrouwe Gasthuis, 5Department of Clinical Chemistry and 6Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands
Background: Monitoring of renal function becomes increasingly important in the aging population of HIV-1 infected patients. We compared Cockroft & Gault (C&G), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease (MDRD), Cystatin C- and 24 h urine-based estimated GFR (eGFR) with the gold standard, measured GFR (mGFR) using [125I]-iothalamate. Methods: Substudy within a randomized, multinational trial comparing continuing zidovudine/ lamivudine with switching to tenofovir/ emtricitabine in patients with suppressed HIV-1 infection. Accuracy (defined as the mean difference between eGFR and mGFR) and precision (defined as standard deviation (SD) of the mean difference between eGFR and mGFR) of the eGFRs were calculated using linear regression and Bland & Altman analysis. Results: We included 19 patients, 18 men, 15 Caucasian, mean (SD) age 46.0 y (± 8.9) and BMI 23.9 kg/m2 (± 3.0). Mean (SD) mGFR was 102 ml/min/1.73 m2 (± 19), 4 patients had mild renal dysfunction. All eGFRs tended to underestimate true GFR, with best accuracy for C&G (–1 ml/min/1.73 m2), CKD-EPI (–1 ml/min/1.73 m2), 24 hcreatinine clearance (–2 ml/min/1.73 m2) and MDRD-6 (0 ml/min/1.73 m2), and worst for cystatin C-based (–9 ml/min/1.73 m2) and MDRD-4 estimations (–10 ml/min/1.73 m2). Accuracy worsened at higher mGFR, but was not significantly influenced by age. C&G tended to overestimate at higher BMI. Precision was comparable for all GFR estimations. Conclusions: In this limited number of patients with preserved renal function and suppressed HIV-infection C&G and CKD-EPI appeared to be the best reflection of real GFR and most practical tool for monitoring GFR.Correspondence to:
SaskiaM.E. Vrouenraets, Internist – Infectious Diseases Specialist
Center for Poverty-related Communicable Disorders
Center for Infection and Immunity,
and Amsterdam Institute for Global Health and Development
Academic Medical Center
Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
Email: s.m.vrouenraets@ amc.uva.n
Nephrology Education
Membranous nephropathy: a rare renal manifestation of IgG4-related systemic disease
Nidhi Jindal, Dhiraj Yadav, Christopher Passero, Alyssa Krasinskas, Fiona Craig, Sheldon Bastacky and Kelly V. Liang
Page No. 321
Abstract
^Clinical Nephrology, Vol. 77 – No. 4/2012 (321-328)
Membranous nephropathy: a rare renal manifestation of IgG4-related systemic disease
Nidhi Jindal1, Dhiraj Yadav2, Christopher Passero3, Alyssa Krasinskas4, Fiona Craig4, Sheldon Bastacky4 and Kelly V. Liang3
University of Pittsburgh, 1Department of Medicine, 2Division of Gastroenterology, Hepatology, and Nutrition, 3Renal-Electrolyte Division and 4Department of Pathology, Pittsburgh, PA, USA
This is a case of IgG4-related systemic disease (ISD) and its rare renal manifestation as membranous nephropathy (MGN). The patient presented with peripheral edema, hematuria and proteinuria. 24-h urine revealed proteinuria of up to 15 g/d. Renal biopsy revealed MGN and many IgG4-positive plasma cells. Serum IgG4 levels were elevated at 750 mg/dl (9 – 89 mg/d). Biopsies of multiple tissues revealed many IgG4-positive plasma cells. Prednisone was initiated after making the diagnosis of ISD. However, the patient progressed into renal failure and eventually needed dialysis despite rituximab therapy. The renal manifestation of ISD typically shows tubulointerstitial nephritis, but, rarely, it may include glomerular abnormalities such as MGN or membranoproliferative glomerulonephritis. Castleman disease (CD) and ISD share similarities in pathology, particularly in the lymph nodes. Rituximab has shown promising results in some patients with ISD, CD, and MGN, and its use should be considered in steroid-resistant cases. Clinicians need to be made aware of ISD and its varied presentations. Timely initiation of steroid therapy can induce remission, and delay in therapy can cause permanent organ damage. Therefore, clinicians must have a high index of suspicion to make an early diagnosis of ISD in order to initiate appropriate treatment.Correspondence to:
K.V. Liang, MD
Renal-Electrolyte Division, University of Pittsburgh
A915 Scaife Hall
3550 Terrace Street, Pittsburgh, PA 15261, USA
Email: [email protected]
Nephrology Education
Vancomycin levels are frequently subtherapeutic during continuous venovenous hemodialysis (CVVHD)
F. Perry Wilson and Jeffrey S. Berns
Page No. 329
Abstract
Clinical Nephrology, Vol. 77 – No. 4/2012 (329-331)
Vancomycin levels are frequently subtherapeutic during continuous venovenous hemodialysis (CVVHD)
F. Perry Wilson and Jeffrey S. Berns
University of Pennsylvania Health System, Department of Medicine, Renal, Electrolyte and Hypertension Division, Philadelphia, PA, USA
Continuous renal replacement therapy (CRRT) is frequently used in the intensive care setting for the treatment of acute kidney injury. Dosing guidelines for many commonly used antibiotics were established during intermittent dialysis or in studies examining CRRT at lower blood and dialysis flow rates than are used in common practice. Herein we present data demonstrating frequent subtherapeutic levels of vancomycin in a population of patients on CRRT. Nephrology trainees should be educated as to the risks of under-dosing antibiotics in this population.Correspondence to:
F.P. Wilson, MD
University of Pennsylvania Health System
Department of Medicine
Renal, Electrolyte and Hypertension Division
3400 Spruce St., Philadelphia, PA 19104, USA
Email: [email protected]
Nephrology Education
Diabetic nephropathy among Mexican Americans
Subrata Debnath, Farook Thameem, Tahira Alves, Jacqueline Nolen, Hania Al-Shahrouri, Shweta Bansal, Hanna E. Abboud and Paolo Fanti
Page No. 332
Abstract
Clinical Nephrology, Vol. 77 – No. 4/2012 (332-344)
Diabetic nephropathy among Mexican Americans
Subrata Debnath1, Farook Thameem1, Tahira Alves1,2, Jacqueline Nolen1, Hania Al-Shahrouri1,2, Shweta Bansal1, Hanna E. Abboud1,2 and Paolo Fanti1,2
1Division of Nephrology, University of Texas Health Science Center at San Antonio and 2Renal Section, Audie L. Murphy VA Hospital, San Antonio, TX, USA
The incidence of diabetic nephropathy (DN) is growing rapidly worldwide as a consequence of the rising prevalence of Type 2 diabetes mellitus (T2DM). Among U.S. ethnic groups, Mexican Americans have a disproportionately high incidence and prevalence of DN and associated end-stage renal disease (ESRD). In communities bordering Mexico, as many as 90% of Mexican American patients with ESRD also suffer from T2DM compared to only 50% of non-Hispanic Whites (NHW). Both socio-economic factors and genetic predisposition appear to have a strong influence on this association. In addition, certain pathogenetic and clinical features of T2DM and DN are different in Mexican Americans compared to NHW, raising questions as to whether the diagnostic and treatment strategies that are standard practice in the NHW patient population may not be applicable in Mexican Americans. This article reviews the epidemiology of DN in Mexican Americans, describes the pathophysiology and associated risk factors, and identifies gaps in our knowledge and understanding that needs to be addressed by future investigations.Correspondence to:
Paolo Fanti, MD
Division of Nephrology, Department of Medicine
University of Texas Health Science Center at San Antonio
San Antonio, TX 78229, USA
Email: [email protected]
Letter to the Editor
Tacrolimus in steroidresistant and steroiddependent nephrotic syndrome revisited
Felix S. Seibert, Markus van der Giet, Walter Zidek and Timm H. Westhoff
Page No. 345
Abstract
Tacrolimus in steroidresistant and steroiddependent nephrotic syndrome revisited
Felix S. Seibert, Markus van der Giet, Walter Zidek and Timm H. Westhoff
Dept. of Nephrology, Charité – Campus Benjamin Franklin, Berlin, Germany
Correspondence to:
PD Dr. med. Timm H. Westhoff
Charité – Campus Benjamin Franklin
Dept. of Nephrology
Hindenburgdamm 30, 12200 Berlin, Germany
Email: [email protected]
