Volume 77 (2012), No. 1/2012(January)
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Original
The effects of mycophenolate mofetil on encapsulated peritoneal sclerosis model in rats
Ender Hur, Devrim Bozkurt, Ozge Timur, Selahattin Bicak, Banu Sarsik, Fehmi Akcicek and Soner Duman
Page No. 1
Abstract
Clinical Nephrology, Vol. 77 – No. 1/2012 (1-7)
The effects of mycophenolate mofetil on encapsulated peritoneal sclerosis model in rats
Ender Hur1, Devrim Bozkurt1, Ozge Timur2, Selahattin Bicak2, Banu Sarsik3, Fehmi Akcicek1 and Soner Duman1
1Department of Nephrology, 2Department of Internal Medicine, and 3Department of Pathology, Ege University, Izmir, Turkey
Introduction: Encapsulated peritoneal sclerosis (EPS) is a devastating complication of peritoneal dialysis. We aimed to investigate the effects of mycophenolate mofetil (MMF) treatment in experimental EPS in rats. Methods: 40 nonuremic Wistar albino rats were divided equally into 4 groups: control rats received 2 ml isotonic saline intraperitoneally daily for 3 weeks without any other treatment. The chlorhexidine gluconate group received intraperitoneally 2 ml/200 g injection of chlorhexidine gluconate and ethanol dissolved in saline for 3 weeks. The resting group received chlorhexidine gluconate (0 – 3rd week) + peritoneal resting (4th – 6th week). The MMF group received chlorhexidine gluconate (0 – 3rd week) + 125 mg/l MMF in drinking water (4th – 6th week). Dialysate cytokine levels, leukocyte count, peritoneal thickness, inflammation and fibroblast activities were evaluated. Results: Although the MMF and resting groups showed beneficial effects on ultrafiltration and D1/D0 glucose compared to the chlorhexidine gluconate group, only MMF treatment improved dialysate TGFβ1, VEGF and MCP-1 levels compared to the resting group. Inflammatory activity and vascularity observed in a tissue biopsy, including capillaries number per mm2 of submesothelial area, decreased in the treatment group. Conclusions: MMF treatment has beneficial effects on EPS via inhibiting inflammation and neovascularisation by reducing dialysate VEGF overexpression. Correspondence to:
Dr. Ender Hur
Department of Nephrology
Ege University Medical School
Bornova 35100, Izmir, Turkey
Email: [email protected]
Original
Safety, immunogenicity and efficacy of subcutaneous biosimilar epoetin-α (HX575) in non-dialysis patients with renal anemia: a multi-center, randomized, double-blind study
Marianne Haag-Weber, Kai- Uwe Eckardt, Walter H. Hörl, Simon D. Roger, Andrea Vetter and Karsten Roth
Page No. 8
Abstract
Clinical Nephrology, Vol. 77 – No. 1/2012 (8-17)
Safety, immunogenicity and efficacy of subcutaneous biosimilar epoetin-α (HX575) in non-dialysis patients with renal anemia: a multi-center, randomized, double-blind study
Marianne Haag-Weber1, Kai-Uwe Eckardt2, Walter H. Hörl3, Simon D. Roger4, Andrea Vetter5 and Karsten Roth6
1Kuratorium für Dialyse und Nierentransplantation e.V., Straubing, 2Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen,Germany, 3Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria, 4Department of Renal Medicine, Gosford Hospital, Gosford, NSW, Australia, 5Clinical Research Department, Hexal AG, and 6Sandoz Biopharmaceutical Development, Hexal AG, Holzkirchen, Germany
Background: HX575 is a biosimilar version of epoetin-α that is approved for the treatment of anemia associated with chronic kidney disease (CKD) using the intravenous route of administration. Here we report data from a study of anemic pre-dialysis patients to assess the safety, immunogenicity and efficacy of subcutaneous (s.c.) administration of HX575 vs. Erypo®/Eprex® (Ortho Biotech, Neuss, Germany). Methods: This was a randomized, double-blind study in adult patients (n = 337) with Stage III – V CKD and a hemoglobin (Hb) level of 7.5 – 11.0 g/dl. Eligible patients were randomized to 52 weeks of treatment with HX575 or Erypo®/Eprex® at a starting dose of 25 IU/kg body weight 3 times weekly or 75 IU/kg body weight once weekly during Weeks 1 – 5. This could be adjusted after 5 weeks to maintain Hb levels between 10 and 12 g/dl. The primary objective was to assess the safety and immunogenicity of HX575 compared with Erypo®/Eprex®. Efficacy endpoints were mean absolute change in Hb from baseline to end of Week 13 and mean weekly epoetin dosage in Weeks 11 – 13. Results: HX575 was equivalent to Erypo®/Eprex® in terms of maintaining Hb levels and epoetin dose requirements. Two patients in the HX575 group developed neutralizing antibodies (NAbs) to erythropoietin, which resulted in the study being terminated prematurely. Aside from these two events, reported adverse events were as expected for patients with Stage III – V CKD and similar in both treatment groups. Conclusions: This study demonstrated the efficacy and therapeutic equivalence of s.c. HX575 compared with the reference epoetin-α, but 2 patients developed NAbs during treatment with s.c. HX575 in this study. Results of a thorough root-cause analysis reported elsewhere indicate that increased tungsten exposure in pre-filled syringes precipitated immunogenic reactions.Correspondence to:
Dr. Karsten Roth
Sandoz Biopharmaceutical Development
Hexal AG
Industriestrasse 25
83607 Holzkirchen, Germany
Email: [email protected]
Original
The value of early renal biopsy in systemic lupus erythematosus patients presenting with renal involvement
Yao P. Hsieh, Yao K. Wen and Moi L. Chen
Page No. 18
Abstract
Clinical Nephrology, Vol. 77 – No. 1/2012 (18-24)
The value of early renal biopsy in systemic lupus erythematosus patients presenting with renal involvement
Yao P. Hsieh1, Yao K. Wen1 and Moi L. Chen2
1Division of Nephrology, Department of Internal Medicine, 2Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan
Background: The goal of this study is to determine the value of early renal biopsy as a therapeutic guide in systemic lupus erythematosus (SLE) patients presenting with renal involvement. Methods: We retrospectively analyzed renal biopsies findings in SLE patients between January 2000 and December 2009 encountered at a medical center in Taiwan. An additional criterion for inclusion in this study was kidney biopsy done within 3 months of the first detection of sign(s) of renal disease. Results: There were 131 patients enrolled in this study. In patients presenting with acute renal failure, 91% of patients had proliferative lupus nephritis (Class IV, mixed Class V+III) and 9% had non-proliferative lupus nephropathy (pure Class V). In patients presenting with nephrotic range proteinuria, proliferative lupus nephritis (Class III, IV, mixed Class V+III) and non-proliferative lupus nephropathy (Class II, pure Class V) accounted for 55% and 36% of patients, respectively; and 9% had non-lupus nephropathy. In this group, except that elevated anti-double-stranded DNA antibody levels were more common in proliferative lupus nephritis (p = 0.043), no clinical findings could predict the renal morphology. In patients presenting with subnephrotic proteinuria, 49% of patients had proliferative lupus nephritis (Class III, IV, mixed Class V+III) and 51% had non-proliferative lupus nephropathy (Class II, pure Class V), and decreased C4 levels were more common in patients with proliferative lupus nephritis (p = 0.031). In patients presenting with isolated hematuria, all were not active forms of nephropathy. Immunosuppressive therapy was intensified because of biopsy findings in 29% of patients presenting with acute renal failure, 43% with nephrotic range proteinuria, and 53% with sub-nephrotic proteinuria. Conclusions: Our data suggested that similar clinical renal manifestations may be observed despite very different classes of lupus nephritis. Clinicians tended to wait for histological identification of severe lupus nephritis before initiating potential harmful treatment with aggressive immunosuppressive therapy. Therefore, in SLE patients with clinical sign(s) of renal disease, early renal biopsy may be helpful in planning treatment.Correspondence to:
Dr. Yao K. Wen
Division of Nephrology
Department of Internal Medicine
Changhua Christian Hospital
135 Nanhsiao Street
Changhua, 500, Taiwan
Email: [email protected]
Original
Morphology of Balkan endemic nephropathy: current state
Jasmina Marković-Lipkovski, Cane Tulić, Aleksandar Vuksanović, Dejan Dragičević, Milan Đokić, Sveta Tatić and Višnja Ležaić
Page No. 25
Abstract
Clinical Nephrology, Vol. 77 – No. 1/2012 (25-31)
Morphology of Balkan endemic nephropathy: current state
Jasmina Marković-Lipkovski1,2, Cane Tulić3, Aleksandar Vuksanović3, Dejan Dragičević3, Milan Đokić3, Sveta Tatić1,2 and Višnja Ležaić4
1Institute of Pathology, Faculty of Medicine, University of Belgrade, 2Department of Pathology, 3Institute of Urology, and 4Institute of Nephrology, Clinical Centre of Serbia, Belgrade, Serbia
Balkan endemic nephropathy (BEN) is interesting renal disease, because of its unique clinical, epidemiological and morphological characteristics: intensive interstitial fibrosis and tubular atrophy without any inflammation. In the present paper we evaluate the incidence of BEN from the morphological point of view for the last decade. Therefore we analyzed material obtained from autopsies, kidney biopsies and nephrectomy due to upper urothelial cancer (UUC) from the patients which were divided into two groups: those with permanent residence in BEN areas and those from nonendemic areas. At the Institute of Pathology, University of Belgrade for the last 15 years we had only 1 autopsy due to BEN out of 6,825. More than 30 years ago there were over 50 autopsy cases of BEN at the same institute. For the last decade we had only 2 kidney biopsies suspected for BEN out of 2,182, but morphologically not confirmed as BEN. However, previously we had over 40 kidney biopsies diagnosed as early or late stage of BEN. At the Clinical Center of Serbia 180 nephrectomies were performed due to UUC. The incidence of UUC for the last five years in BEN regions has significantly decreased, whereas at the same time in non-BEN regions it has remained on the same level. There was no morphological difference of the renal tissue adjacent to tumor between patients from BEN and non-BEN regions. According to our study based on routine pathological work, we could clearly conclude that BEN today is more clinical and epidemiological than a morphological entity.Correspondence to:
Prof. Jasmina Marković-Lipkovski, MD, PhD
Institute of Pathology
Faculty of Medicine
University of Belgrade
11000 Beograd, dr Subotića 1, Serbia
Email: [email protected]
Original
Clinicopathological impacts of activated transcription factor c-Jun in peritubular capillary endothelial cells in chronic antibodymediated rejection after kidney transplantation
Akimitsu Kobayashi, Takamune Takahashi, Shigeru Horita, Izumi Yamamoto, Hiroyasu Yamamoto, Kazunari Tanabe, Yutaka Yamaguchi and Tatsuo Hosoya
Page No. 32
Abstract
Clinicopathological impacts of activated transcription factor c-Jun in peritubular capillary endothelial cells in chronic antibodymediated rejection after kidney transplantation
Akimitsu Kobayashi1, Takamune Takahashi2, Shigeru Horita3, Izumi Yamamoto1, Hiroyasu Yamamoto1, Kazunari Tanabe4, Yutaka Yamaguchi5 and Tatsuo Hosoya1
1Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan, 2Division of Nephrology and Hypertension,Vanderbilt University Medical Center, Nashville, TN, USA, 3Kidney Center, 4Department of Urology, Tokyo Women’s Medical University, Tokyo, and 5Yamaguchi Pathology Laboratory, Japan
Aim: The transcription factor c-Jun is a major component of the activator protein-1 complex involved in renal physiological events, such as inflammation and fibrosis. We recently demonstrated c-Jun activation in peritubular capillary (PC) endothelial cells and infiltrating cells in acute antibody-mediated rejection after kidney transplantation. However, the clinicopathological role of PC endothelial c-Jun activation has remained undetermined. Material and method: We investigated endothelial c-Jun activation in PC using phosphorylated c-Jun (p-c-Jun) immunohistochemical staining in 21 cases of chronic active antibody-mediated rejection (CAMR), 14 cases of interstitial fibrosis and tubular atrophy (IF/TA) lacking specific etiology, and 8 normal control subjects (NC). Results: In CAMR cases, swollen PC endothelial cells showed strong p-c-Jun staining. More p-c-Jun-positive endothelial cells in PC were observed in CAMR than in IF/TA and NC subjects (p < 0.01). These findings were significantly correlated with reduced PC (rs = –0.78, p = 0.0005), the “ci + ct” score of the Banff classification (rs = 0.81, p = 0.0003) and serum creatinine level (rs = 0.48, p = 0.03). Conclusion: Endothelial c-Jun activation in PC may contribute to PC loss, interstitial fibrosis and late allograft deterioration in CAMR. These data suggest that c-Jun is an appropriate therapeutic target of CAMR.Correspondence to:
Akimitsu Kobayashi, MD
Division of Kidney and Hypertension
Department of Internal Medicine
The Jikei University School of Medicine
3-25-8, Nishi-shinbashi, Minato-ku,
Tokyo 105-8471, Japan
Email: [email protected]
Original
Urinary tract infection in patients with diabetes mellitus
Reinhard Fünfstück, Lindsay E. Nicolle, Markolf Hanefeld and Kurt G. Naber
Page No. 40
Abstract
Clinical Nephrology, Vol. 77 – No. 1/2012 (40-48)
Urinary tract infection in patients with diabetes mellitus
Reinhard Fünfstück1, Lindsay E. Nicolle2, Markolf Hanefeld3 and Kurt G. Naber4
1Department of Internal Medicine, Sophien- und Hufeland-Klinikum Weimar, Germany, 2University of Manitoba and Health Sciences Centre, Winnipeg, Manitoba, Canada, 3Center for clinical studies, GWT, Technical University Dresden, and 4Technical University of Munich, Department of Urology, Munich, Germany
Urinary tract infection occurs with increased frequency and severity in patients with diabetes mellitus. General host factors enhancing risk for urinary tract infection in diabetics include age, metabolic control, and long term complications, primarily diabetic nephropathy and cystopathy. Alterations in the innate immune system have been described and may also contribute. Treatment of asymptomatic bacteriuria in diabetic patients is not indicated. Early diagnosis and prompt intervention is recommended to limit morbidity of symptomatic infection. Clinical studies comparing management of urinary tract infection in persons with diabetes compared to those without as well as diabetic patients with good or poor glucose control will be necessary to improve care of urinary infection in persons with diabetes mellitus.Correspondence to:
Prof. Dr. Reinhard Fünfstück
Sophien- und Hufeland-Klinikum Weimar
Henry-van-de-Velde- Straße 2
99425 Weimar, Germany
Email: [email protected]
Original
Clinical characteristics of obstructive uropathy associated with rotavirus gastroenteritis in Japan
Akira Ashida, Mikiya Fujieda, Kazuhide Ohta, Hyogo Nakakura, Hideki Matsumura, Taku Morita, Takashi Igarashi and Hiroshi Tamai
Page No. 49
Abstract
Clinical Nephrology, Vol. 77 – No. 1/2012 (49-54)
Clinical characteristics of obstructive uropathy associated with rotavirus gastroenteritis in Japan
Akira Ashida1, Mikiya Fujieda2, Kazuhide Ohta3, Hyogo Nakakura1, Hideki Matsumura1, Taku Morita2, Takashi Igarashi4 and Hiroshi Tamai1
1Department of Pediatrics, Osaka Medical College, Osaka, 2Department of Pediatrics, Kochi Medical School, Kochi University, Kochi, 3Department of Pediatrics, Kanazawa Medical Center, National Hospital Organaization, Ishikawa, and 4Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Aims: Rotavirus gastroenteritis is severe and often results in dehydration and pre-renal azotemia. However, we have encountered four children with acute obstructive uropathy associated with acute rotavirus gastroenteritis, and several similar cases have been reported. Therefore, the aim of the present study was to clarify the epidemiology and clinical features of acute obstructive uropathy associated with acute rotavirus gastroenteritis in Japanese children. Patients and methods: We sent questionnaires to all members of the Japanese Society for Nephrology and all authors who had published case reports of this disease in Japan, inquiring about patient age at diagnosis, sex, the type of stones, laboratory data and other factors. Results: 21 reported patients were evaluable, ranging from 0.4 to 3 years. The sex distribution showed a strong male prevalence. Oliguria had appeared about 7 days after the onset of gastroenteritis. Most of the patients showed hyperuricemia and hyponatremia. The stones consisted mainly of ammonium acid urate. The patients were discharged with normal renal function. Conclusion: Although obstructive uropathy associated with rotavirus gastroenteritis is very rare, this disease condition should be explored when anuria is refractory to sufficient fluid replacement therapy or when oliguria persists despite recovery of the gastrointestinal symptoms.Correspondence to:
Akira Ashida, MD
Department of Pediatrics
Osaka Medical College
2 – 7 Daigakumachi,
Takatsuki, Osaka, Japan 569-8686
Email: [email protected]
Original
Tenecteplase for the improvement of blood flow rate in dysfunctional hemodialysis catheters
Jesse Goldman, Steven Fishbane, Matthew J. Oliver, Martha Blaney, Joan R. Jacobs and Susan M. Begelman
Page No. 55
Abstract
Tenecteplase for the improvement of blood flow rate in dysfunctional hemodialysis catheters
Jesse Goldman1, Steven Fishbane2, Matthew J. Oliver3, Martha Blaney4, Joan R. Jacobs4 and Susan M. Begelman4
1Temple University, Philadelphia, PA, 2Winthrop-University Hospital, Mineola, NY, USA, 3Sunnybrook Health Sciences Centre, Toronto, ON, Canada, and 4Genentech, Inc., South San Francisco, CA, USA
Background: We evaluated the efficacy and safety of the thrombolytic agent tenecteplase for the treatment of dysfunctional hemodialysis (HD) catheters. Methods: Data were pooled from 2 Phase III clinical studies: the randomized, placebo-controlled TROPICS 3 trial and the open-label TROPICS 4 trial. Eligible patients received either an initial dose of tenecteplase (2 mg/lumen) or placebo (TROPICS 3 only) for a 1-h intracatheter dwell. Treatment success was defined as blood flow rate (BFR) ≥ 300 ml/min and a ≥ 25 ml/min increase from baseline BFR, without line reversal, 30 min before and at the end of HD. All TROPICS 4 patients and the TROPICS 3 patients enrolled after the final protocol amendment without treatment success received an instillation of tenecteplase at the end of the initial visit for an extended dwell of up to 72 h. Results: A total of 372 patients with dysfunctional catheters were enrolled in the 2 studies. Of the 297 patients treated with tenecteplase at the initial visit, 31% achieved treatment success, with a mean (SD) change from baseline BFR of 73 (120) ml/min. Among the 179 patients who received a 1-h dwell of study drug followed by extended-dwell tenecteplase, 46% had treatment success at the end of the next HD session. Six catheter-related bloodstream infections and 2 thromboses were reported in patients following tenecteplase exposure. Conclusion: Tenecteplase, administered as a 1-h dwell or a 1-h dwell followed by an extended dwell, was associated with improved BFR in dysfunctional HD catheters in the TROPICS 3 and 4 clinical trials.Correspondence to:
Jesse Goldman, MD
Jesse Goldman, MD
Associate Professor of Medicine
Section of Nephrology, Hypertension & Kidney Transplantation
Drexel University Hospital
245 N. 15th st. (rm 6644)
Philadelphia PA 19102-1192
Email: [email protected]
Nephrology Education
Resolution of proteinuria in a patient with focal segmental glomerulosclerosis following BiPAP initiation for obesity hypoventilation syndrome
Isaac E. Hall, Michael Kashgarian, Gilbert W. Moeckel and Neera K. Dahl
Page No. 62
Abstract
Clinical Nephrology, Vol. 77 – No. 1/2012 (62-65)
Resolution of proteinuria in a patient with focal segmental glomerulosclerosis following BiPAP initiation for obesity hypoventilation syndrome
Isaac E. Hall1, Michael Kashgarian2, Gilbert W. Moeckel2 and Neera K. Dahl1
1Section of Nephrology, and 2Renal Pathology Laboratory, Yale University School of Medicine, New Haven, CT, USA
Associations between secondary focal segmental glomerulosclerosis and both obesity and obstructive sleep apnea have been previously described. Current theory suggests obesity induces glomerular hyperfiltration, leading to glomerulosclerosis. We describe a case of focal segmental glomerulosclerosis in the setting of severe obesity and obstructive sleep apnea with complete resolution of heavy proteinuria following treatment with bi-level positive airway pressure. The patient’s proteinuria resolved completely with treatment of obstructive sleep apnea although the patient remained morbidly obese.Correspondence to:
Dr. Isaac E. Hall
Yale University School of Medicine
Department of Internal Medicine
Section of Nephrology, BB114
333 Cedar Street, P.O. Box 208029
New Haven, CT 06520-8029, USA
Email: [email protected]
Nephrology Education
κ I light chain AL amyloidosis presenting with rapidly progressive renal and hepatic failure with unusual renal amyloid distribution
Yuji Oe, Izaya Nakaya, Mayumi Yahata, Okinora Murata, Hiroshi Yaegashi, Tsutomu Sakuma, Hiroshi Sato, Juris J. Liepnieks, Merrill D. Benson and Jun Soma
Page No. 66
Abstract
Clinical Nephrology, Vol. 77 – No. 1/2012 (66-70)
κ I light chain AL amyloidosis presenting with rapidly progressive renal and hepatic failure with unusual renal amyloid distribution
Yuji Oe1, Izaya Nakaya1, Mayumi Yahata1, Okinora Murata1, Hiroshi Yaegashi2, Tsutomu Sakuma2, Hiroshi Sato3, Juris J. Liepnieks4, Merrill D. Benson4 and Jun Soma1
Departments of 1Nephrology and 2Pathology, Iwate Prefectural Central Hospital, Morioka, 3Department of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Japan, and 4Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
A 65-year-old man suffering from generalized edema and jaundice was admitted to our hospital. Laboratory findings revealed marked renal dysfunction with heavy proteinuria as well as liver dysfunction with severe obstructive jaundice. On renal biopsy, the diagnosis of AL amyloidosis associated with κ I light chain was made. Interestingly, amyloid deposits were restricted to the glomeruli. Although hemodialysis was initiated, the patient died due to further deterioration of hepatic function. On autopsy, severe intrahepatic cholestasis was observed, and there was marked deposition of AL amyloid in the liver. Literature reviews showed that rapidly progressive renal failure is common in AL amyloidosis patients who presented with acute hepatic failure due to severe intrahepatic cholestasis. However, the detailed renal pathology in this condition has not been documented. The present case is very interesting because rapidly progressive renal and hepatic failure was simultaneously observed, and renal amyloid deposition was restricted to the glomeruli.Correspondence to:
Yuji Oe, MD
Department of Nephrology
Iwate Prefectural Central Hospital
1-4-1 Ueda, Morioka, 020-0066 Japan
Email: [email protected]
Nephrology Education
Repeated Epstein-Barr virus-associated hemophagocytic syndrome in a lupus nephritis patient
Shuhei Miura, Kazuhito Takeda, Yoshiharu Muto, Hideyuki Mukai, Masahide Furusho, Satsuki Nakashita, Atsuhiro Maeda and Hiroshi Kimura
Page No. 71
Abstract
Clinical Nephrology, Vol. 77 – No. 1/2012 (71-74)
Repeated Epstein-Barr virus-associated hemophagocytic syndrome in a lupus nephritis patient
Shuhei Miura, Kazuhito Takeda, Yoshiharu Muto, Hideyuki Mukai, Masahide Furusho, Satsuki Nakashita, Atsuhiro Maeda and Hiroshi Kimura
Department of Nephrology and Kidney Center, Iizuka Hospital, Iizuka City, Japan
A 55-year-old Japanese female was diagnosed with systemic lupus erythematosus (SLE) and developed nephrotic syndrome. She was diagnosed with lupus nephritis by a percutaneous renal biopsy. She was treated with intravenous steroid pulse therapy twice, but it proved to be ineffective. She achieved a complete remission after intravenous cyclophosphamide pulse (CPAIV) therapy. Thereafter, her lupus nephritis was well controlled and demonstrated only a low activity. However, she suffered Epstein- Barr virus (EBV)-associated hemophagocytic syndrome (HPS) twice, and in each case she was treated with anticancer drugs and achieved a complete remission. This was a rare case of lupus nephritis who showed repeated EBV-associated HPS.Correspondence to:
Dr. Shuhei Miura
Department of Nephrology and Kidney Center
Iizuka Hospital
3-83 Yoshio-Machi, Iizuka, 820-8505, Japan
Email: [email protected]
Nephrology Education
Stercoral ulcer as a cause of lower gastrointestinal (LGI) bleeding in chronic hemodialysis patients
Fahad Saeed, Amandeep Kalra, Nadia Kousar, Laura A. Pace and Jean L. Holley
Page No. 75
Abstract
Clinical Nephrology, Vol. 77 – No. 1/2012 (75-78)
Stercoral ulcer as a cause of lower gastrointestinal (LGI) bleeding in chronic hemodialysis patients
Fahad Saeed, Amandeep Kalra, Nadia Kousar, Laura A. Pace and Jean L. Holley
University of Illinois, Department of Internal Medicine, Urbana-Champaign, Urbana, IL, USA
Gastrointestinal (GI) bleeding is more common in patients with chronic kidney disease and is associated with higher mortality than in the general population. Stercoral ulceration of the colon is rarely reported in the nephrology literature. We observed 2 cases of stercoral ulcer presenting as lower gastrointestinal (LGI) bleeding in patients on chronic hemodialysis. Both patients were elderly (81 and 75 years, respectively) with a history of constipation. Diagnosis of stercoral ulcer as the cause of lower GI bleeding was made using endoscopic procedures. Stercoral ulcer should be considered in cases of lower GI bleeding in chronic dialysis patients.Correspondence to:
Fahad Saeed, MD
2311 Galen Dr Unit 51
Champaign, IL 61821, USA
Email: [email protected]
Nephrology Education
Tacrolimus-induced thrombotic microangiopathy: natural history of a severe, acute vasculopathy
John M. Carson, Eric D. Newman, John L. Farber and Edward J. Filippone
Page No. 79
Abstract
Clinical Nephrology, Vol. 77 – No. 1/2012 (79-84)
Tacrolimus-induced thrombotic microangiopathy: natural history of a severe, acute vasculopathy
John M. Carson1, Eric D. Newman1, John L. Farber3 and Edward J. Filippone2
1Department of Medicine, 2Division of Nephrology of the Department of Medicine, and 3Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, PA , USA
Calcineurin inhibitors (CNI) have been clearly associated with posttransplant thrombotic microangiopathy (PTTMA). We report a case of de novo PT-TMA involving predominantly small arteries and arterioles of a renal allograft in a patient receiving tacrolimus. Serial biopsies demonstrate the natural history of this lesion through the chronic nonspecific phase. The case is discussed in the context of a literature review of PT-TMA in general and CNI use in particular.Correspondence to:
Edward J. Filippone, MD, FACP228 S. Broad St,
Philadelphia, PA 19145, USA
Email: [email protected]
Letter to the Editor
Screening for anti-factor B autoantibody in a patient with acute renal injury due to dense deposit disease
Rafael T. Krmar1, Lillemor Skattum2, Peter Bárány3 and Mihály Józsi4
Page No. 85
Abstract
Screening for anti-factor B autoantibody in a patient with acute renal injury due to dense deposit disease
Rafael T. Krmar, Lillemor Skattum, Peter Bárány and Mihály Józsi
1Karolinska Institutet, Department for Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska University Hospital, Huddinge, 2Institute of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, Lund, 3Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska University Hospital, Huddinge, Sweden, and 4Junior Research Group Cellular Immunobiology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
Correspondence to:
R.T. Krmar, MD, PhD
Karolinska Institutet
Department for Clinical
Science, Intervention and Technology
Division of Pediatrics
Karolinska University Hospital
Huddinge, 141 86 Stockholm, Sweden
Email: [email protected]
Book review
Seyffart’s Directory of Drug Dosage in Kidney Disease
F. Keller
Page No. 87
Abstract
Seyffart’s Directory of Drug Dosage in Kidney Disease
F. Keller
Correspondence to:
Frieder Keller
Doctor of Medicine and Professor of Nephrology
Nephrology Division
Medical Department Innere 1
University Hospital
Albert Einstein Allee 23
89070 Ulm, Germany
Email: [email protected]
