Volume 77 (2012), No. 6/2012(June)
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Original
Mycophenolate sodium dosing in combination with tacrolimus: pharmacokinetic evaluation of a novel regimen in de novo tacrolimus-treated kidney transplant patients
Bertrand Pons, Xavier Delavenne, Manolie Mehdi, Nicolas Maillard, Catherine Sauron, François Berthoux, Eric Alamartine, Thierry Basset and Christophe Mariat
Page No. 425
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 (425-431)
Mycophenolate sodium dosing in combination with tacrolimus: pharmacokinetic evaluation of a novel regimen in de novo tacrolimus-treated kidney transplant patients
Bertrand Pons1, Xavier Delavenne2, Manolie Mehdi1, Nicolas Maillard1, Catherine Sauron1, François Berthoux1, Eric Alamartine1, Thierry Basset2 and Christophe Mariat1
1Service de Néphrologie, Dialyse, Transplantation Rénale, and 2Laboratoire de Pharmacologie, Hôpital NORD, CHU de Saint-Etienne, Université Jean MONNET, Saint-Etienne, France
Background: There are no clear guidelines concerning the appropriate dose of mycophenolate acid (MPA) to be used in association with tacrolimus. When MPA is given at an approved fixed dose in cyclosporine-treated patients, initial systemic underexposureis frequent and associated with the occurrence of acute rejection. We pharmacologically evaluated in tacrolimus-treated recipients a novel dosing regimen of MPA with an initial high dose followed by a gradualde crease over time. Methods: 15 de novo tacrolimus-treated kidney transplant patients were administered mycophenolate sodium at the dose of 720 mg b.i.d. for the first week post-transplant, 540 mg b.i.d. until Day 30, and then 360 mg b.i.d. until Day 90. MPA exposure was evaluated by the 12 h area under MPA concentration versus time curve (AUC) determined at Days 2, 7, 15, 30 and 90 post-transplant. Results: Median MPA AUC was constantly within the therapeutic window of 30 – 60 mg/l × h throughout the three months of evaluation. More than 75% of patients had a MPA AUC above 30 mg/l × h at Day 2 and Day 7 post-transplant. Conclusion: This exploratory study suggests that such a dosing regimen of mycophenolate sodium might quickly offer and sustain an optimal exposure to MPA in tacrolimus-treated kidney transplant patients.Correspondence to:
Bertrand Pons, MD
Service de Néphrologie, Dialyse et Transplantation Rénale
Hôpital NORD, C-H-U de Saint-Etienne
42055 Saint-Etienne, France
Email: bertrand.pons@ chu-st-etienne.fr
Original
Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients
Frank J. O’Brien, James Lineen, Claire M. Kennedy, Paul J. Phelan, Patrick O Kelly, Mark D. Denton, Colm Magee and Peter J. Conlon
Page No. 432
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 (432-437)
Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients
Frank J. O’Brien, James Lineen, Claire M. Kennedy, Paul J. Phelan, Patrick O Kelly, Mark D. Denton, Colm Magee and Peter J. Conlon
Department of Nephrology, Beaumont Hospital, Dublin, Ireland
Background: It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival. Materials and methods: This was a single center, national, retrospective cohort study. Data was collected on patients who received kidney transplants over a 14-year period (n = 2,013). The primary outcomes were graft survival and mortality in patients who received blood transfusions in the perioperative period compared to those who did not. Results: Patients who received blood transfusions had lower hemoglobin levels, were more likely to be male, and had higher rates of delayed graft function compared to those who did not receive a transfusion. The one year graft survival of those transfused was 83% compared to 94% in those not transfused (p = < 0.0001). Adjustment for confounding showed that the receipt of a blood transfusion remained associated with increased graft loss. Hemoglobin levels prior to transfusion did not have an influence on graft outcome. Conclusion: Perioperative blood transfusion is associated with reduced long-term graft survival.Correspondence to:
Dr. Frank O’Brien
Department of Nephrology
Beaumont Hospital
Beaumont Road, Dublin 9, Ireland
Email: [email protected]
Original
Fluid balance as an early indicator of acute kidney injury in CV surgery
Bhagwan Dass, Michiko Shimada, Ganesh Kambhampati, Noel I. Ejaz, Amir A. Arif and A. Ahsan Ejaz
Page No. 438
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 (438-444)
Fluid balance as an early indicator of acute kidney injury in CV surgery
Bhagwan Dass1, Michiko Shimada2, Ganesh Kambhampati1, Noel I. Ejaz1, Amir A. Arif1 and Abutaleb A. Ejaz1
1Division of Nephrology, Hypertension and Transplantation, University of Florida, Gainesville, FL, USA and 2Division of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Japan
Background: We hypothesized that positive fluid balance (FB) is the result of intraoperative kidney injury and associated renal vasoconstriction, and therefore may be an early clinical indicator of acute kidney injury (AKI). Since rapid changes in fluid volume occur during cardiovascular (CV) surgery, we investigated the influence of immediate postoperative FB on AKI. Materials and methods: Data from the Nesiritide Study were retrospectively analyzed to investigate the association between FB and AKI. Results: Patients were classified into a negative FB (NegFB, median –1,221 ml, IQR –1,974 to –653 ml, n = 71) and a PosFB (median 849 ml, IQR 328 – 1,552 ml, n = 19) group based on FB status in the first 24 h postoperatively. The PosFB group had a higher incidence of AKI (NegFB 25.3% vs. PosFB 47.3%, p = 0.090) compared to the NegFB group. The difference in the incidence of AKI was significantly higher (NegFB 25.3% vs. high- PosFB 80%, p = 0.001) in the subset of patients who had FB ≥ 849 ml (highPosFB, n = 10). The highPosFB group demonstrated a significantly elevated risk for AKI in both unadjusted (OR = 9.8, 95% CI 1.9 – 51.2, p = 0.007) and multivariate models (OR = 8.1, 95% CI 1.5 – 45.1, p = 0.03). Conclusions: PosFB in the immediate postoperative period may be an independent early indicator of AKI in patients undergoing CV surgery.Correspondence to:
Annn Ahsan Ejaz, MD
Division of Nephrology, Hypertension and
Transplantation
University of Florida
P.O. Box 100224
Gainesville, FL 32610-0224, USA
Email: ejazaa@ medicine.ufl.edu
Original
The effect of Omega-3 fatty acids on the atherogenic lipoprotein phenotype in patients with nephrotic range proteinuria
Samira Bell, Josephine Cooney, Christopher J. Packard, Muriel J. Caslake and Christopher J. Deighan
Page No. 445
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 (445-453)
The effect of Omega-3 fatty acids on the atherogenic lipoprotein phenotype in patients with nephrotic range proteinuria
Samira Bell1, Josephine Cooney2, Christopher J. Packard2, Muriel J. Caslake2 and Christopher J. Deighan3
1Renal Unit, Ninewells Hospital, Dundee, 2Vascular Biochemistry, Institute of Cardiovascular and Medical Sciences, University of Glasgow and 3Renal Unit, Glasgow Royal Infirmary, Glasgow, UKr Biochemistry, Institute of Cardiovascular and Medical Sciences, University of Glasgow and Renal Unit, Glasgow Royal Infirmary, Glasgow, UK
Aims: Patients with nephrotic range proteinuria are known to have an increased risk of cardiovascular disease partly due to possessing the atherogenic lipoprotein phenotype. The aim of this study was to examine the effect of high dose Omega-3 fatty acids on atherogenic triglyceride rich lipoproteins in patients with nephrotic range proteinuria, comparing their effect on lipoprotein profiles in age and sex matched controls. Methods: 17 patients with nephrotic range proteinuria and 17 age and sex matched controls were studied. Fasting lipids and lipoproteins were measured before and after 8 weeks treatment with 4 g daily of Omega-3 fatty acids (Omacor®). Results: In patients with proteinuria treatment reduced plasma triglyceride by a mean of 0.45 mmol/l (95%CI 0.16 – 0.74, p = 0.005) and plasma very low density lipoprotein cholesterol by a mean of 0.38 (95%CI 0.01 – 0.75, p = 0.04). LDL III concentration fell from 178.8 mg/dl (61.6 – 231.0) to 96.1 mg/dl (49.3 – 204.5), p = 0.05. In patients treatment altered the LDL profile so that LDLIII which was the major subfraction present at baseline was reduced from 49.9% to 29.8% (p = 0.01). Remnant lipoproteins (RLP) also fell with a mean reduction of 3.5 mg/dl in RLP-Cholesterol (95%CI 0.1 – 6.9, p = 0.05) and 12.4 mg/dl in RLP-triglyceride (95%CI 2.6 – 22.2, p = 0.03). There was however a 0.6 mmol/l rise in LDL-C (p = 0.06) in the patients. Treatment did not alter HDL-C. Conclusion: In patients with nephrotic range proteinuria, Omega-3 fatty acids reduced triglyceride rich lipoproteins, LDL III and remnant lipoproteins. A tendency to an increase in LDL-C was observed but this was offset by an alteration in the distribution of the LDL profile towards lighter, larger LDL particles. We propose that treatment with Omega-3 fatty acids in conjunction with a statin may be the ideal therapy in these patients.Correspondence to:
Samira Bell, MRCP, MD
Renal Unit, Ninewells Hospital
Dundee, DD1 9SY, UK
Email: [email protected]
Original
ANCA-associated crescentic glomerulonephritis with immune complex deposits
Keiichi Sumida, Yoshifumi Ubara, Kazufumi Nomura, Junichi Hoshino, Tatsuya Suwabe, Rikako Hiramatsu, Eiko Hasegawa, Noriko Hayami, Masayuki Yamanouchi, Naoki Sawa, Fumi Takemoto, Kenmei Takaichi and Kenichi Ohashi
Page No. 454
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 (454-460)
ANCA-associated crescentic glomerulonephritis with immune complex deposits
Keiichi Sumida1, Yoshifumi Ubara1, Kazufumi Nomura1, Junichi Hoshino1, Tatsuya Suwabe1, Rikako Hiramatsu1, Eiko Hasegawa1, Noriko Hayami1, Masayuki Yamanouchi1, Naoki Sawa1, Fumi Takemoto1, Kenmei Takaichi1 and Kenichi Ohashi2
1Nephrology Center and 2Department of Pathology, Toranomon Hospital, Tokyo, Japan
Background: Several authors have reported cases of anti-neutrophil cytoplasmic antibody (ANCA)-associated crescentic glomerulonephritis (CGN) with definite immune complex (IC) deposits, however, the clinical and pathological significance of IC deposits in patients with ANCA-associated CGN remains unclear. Methods: Renal biopsy specimens from 28 patients with a diagnosis of CGN and positivity for anti-myeloperoxidase (MPO)-ANCA were retrospectively evaluated. Clinical data were compared between patients with IC deposits (Group A) and patients without IC deposits (Group B). Results: In 12 patients (43%; Group A), IC deposits were detected in the mesangium and/or along the glomerular capillary walls, while typical pauci-immune CGN without IC deposits was found in 16 patients (57%; Group B). Compared with Group B, Group A had lower levels of MPO-ANCA (171 ± 156 vs. 352 ± 299 EU) and C-reactive protein (CRP) (0.63 ± 1.04 vs. 4.45 ± 4.00 mg/dl), as well as less pulmonary involvement (8.3% vs. 56.3%) at diagnosis. However, Group A had significantly heavier proteinuria (2.46 ± 1.67 vs. 0.76 ± 0.52 g/d). Group A was classified into three subgroups: Group A1 with mesangial IgA and C3 deposits, A2 with mesangial IgG and C3 deposits, and A3 with IgG and C3 deposits mainly in the capillary walls. Conclusions: ANCA-associated CGN causes two types of renal involvement, which are the pauci-immune type without IC deposits and the IC deposition type that involves three patterns of IC deposition in the glomeruli. The reason why IC deposits are associated with renal-limited vasculitis and not systemic vasculitis remains unclear.Correspondence to:
Keiichi Sumida, MD
Nephrology Center, Toranomon Hospital
2-2-2, Toranomon, Minato-ku
Tokyo, 105-8470, Japan
Email: k-sumida@ toranomon.gr.jp
Original
Renal biopsy in patients aged 80 years and older: a single-center experience in Japan
Ayumi Omokawa, Atsushi Komatsuda, Mizuho Nara, Takashi Fujiwara, Ryuta Sato, Masaru Togashi, Shin Okuyama, Ken-ichi Sawada and Hideki Wakui
Page No. 461
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 (461-467)
Renal biopsy in patients aged 80 years and older: a single-center experience in Japan
Ayumi Omokawa, Atsushi Komatsuda, Mizuho Nara, Takashi Fujiwara, Ryuta Sato, Masaru Togashi, Shin Okuyama, Ken-ichi Sawada and Hideki Wakui
Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
Background: There is a paucity of data on renal biopsy in a large number of the very elderly (age ≥ 80 years) worldwide. Methods: Clinicopathological features in 73 patients aged ≥ 80 years were evaluated and compared with control groups of 172 patients aged 60 – 61 years and 128 patients aged 70 – 71 years. Results: The common indications for biopsy in the very elderly were nephrotic syndrome (NS), followed by proteinuria without NS and/or hematuria, and acute kidney injury (AKI). Histological diagnoses were considered to potentially modify treatment in 57 cases (78.1%): the most frequent diagnosis was membranous nephropathy, followed by minimal change disease, and various other diseases. There were no biopsy procedure-related serious complications. Clinical assessment of treatments was evaluated in 38 of 54 patients with AKI and/or NS. Improvement in renal dysfunction or NS was observed in 24 of 30 (80%) patients who received immunosuppressive therapy. There were statistically significant differences in the disease spectrum between the very elderly and control groups. Conclusions: This is the first report of renal biopsy findings in a relatively large number of Japanese very elderly patients. Histological observations are useful aids in estimating the prognosis and therapy selection for renal disorders, even in the very elderly.Correspondence to:
Ayumi Omokawa, MD
Department of Hematology, Nephrology, and
Rheumatology
Akita University Graduate School of Medicine
1-1-1 Hondo, Akita City, Akita 010-8543, Japan
Email: [email protected]
Original
The prevalence of peripheral neuropathy in hemodialysis patients
Emanuele Mambelli, Massimo Barrella, Maria Grazia Facchini, Elena Mancini, Carmelo Sicuso, Serena Bainotti, Marco Formica and Antonio Santoro
Page No. 468
Abstract
The prevalence of peripheral neuropathy in hemodialysis patients
Emanuele Mambelli1, Massimo Barrella2, Maria Grazia Facchini1, Elena Mancini1, Carmelo Sicuso3, Serena Bainotti3, Marco Formica4 and Antonio Santoro1
1Nephrology, Dialysis and Hypertension Unit, Policlinico S. Orsola-Malpighi Bologna, 2Endocrinology Unit, L. Sacco Hospital, Milano, 3Nephrology Unit, S. Croce e Carle Hospital and 4Nephrology and Dialysis Unit, ASL Cuneo 1, Cuneo, Italy
Background/Aims: Uremic Neuropathy (UN) highly limits the individual self-sufficiency causing near-continuous pain. An estimation of the actual UN prevalence among hemodialysis patients was the aim of the present work. Methods: We studied 225 prevalent dialysis patients from two Italian Centers. The Michigan Neuropathy Score Instrument (MNSI), already validated in diabetic neuropathy, was used for the diagnosis of UN. It consisted of a questionnaire (MNSI_Q) and a physical-clinical evaluation (MNSI_P). Patients without any disease possibly inducing secondary neuropathy and with MNSI score ≥ 3 have been diagnosed as affected by UN. Electroneurographic (ENG) lower limbs examination was performed in these patients to compare sensory conduction velocities (SCV) and sensory nerve action potentials (SNAP) with the MNSI results. Results: 37 patients (16.4%) were identified as being affected by UN, while 9 (4%) presented a score < 3 in spite of neuropathic symptoms. In the 37 UN patients a significant correlation was found between MNSI_P and SCV (r2 = 0.1959; p < 0.034) as well as SNAP (r2 = 0.3454; p = 0.027) both measured by ENG. Conclusions: UN is an underestimated disease among the dialysis population even though it represents a huge problem in terms of pain and quality of life. MNSI could represent a valid and simple clinical-instrumental screening test for the early diagnosis of UN in view of an early therapeutic approach.Correspondence to:
Antonio Santoro, MD
Nephrology, Dialysis and Hypertension Unit
Policlinico S.Orsola-Malpighi
Via P.Palagi, 9, 40138 Bologna, Italy
Email: antonio.santoro@ aosp.bo.it
Original
Dietary intervention focused on phosphate intake in hemodialysis patients with hyperphosphoremia
L.M. Lou, A. Caverni, J.A. Gimeno, R. Moreno, J. Pérez, R. Alvarez, B. Campos, M. García, A. Gutiérrez, S. Bielsa, J. Castilla, A. Sanz and F. Martín on behalf the Aragón CKD Research Group
Page No. 476
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 (476-483)
Dietary intervention focused on phosphate intake in hemodialysis patients with hyperphosphoremia
L.M. Lou, A. Caverni, J.A. Gimeno, R. Moreno, J. Pérez, R. Alvarez, B. Campos, M. García, A. Gutiérrez, S. Bielsa, J. Castilla, A. Sanz and F. Martín on behalf the Aragón CKD Research Group
Miguel Servet University, Clinic University, San Juan de Dios, Alcañiz and Military Hospital. ALCER Ebro. IIS Aragón, Spain
Background: Elevated serum phosphorus has been identified as a cardiovascular risk factor. This study aimed to assess the effectiveness of dietary intervention to reduce phosphorus intake and to improve the calcium-phosphorus metabolism in hemodialysis patients. Design: Patients were included in a 6-month, 2-group experimental study if their previous 3-month average serum phosphorus was over 5.5 mg/dl. Patients were allocated to intensive dietary intervention or usual dietary recommendations. The clinical end-points were the multivariate-adjusted change in serum phosphorus and the number of patients who achieved serum phosphorus levels of < 5.5 mg/dl and serum phosphorus levels of < 5 mg/dl. Results: 80 dialysis patients completed the study, 41 in the experimental group and 39 in the control group. After 6 months, phosphorus intake (702 ± 168 vs. 872 ± 242 mg/24 h; p = 0.002) was lower in the experimental group than in the control group, with no inter-group differences in protein-caloric intake. Serum phosphorus decreased 1.67 mg/dl in the experimental group and 0.58 mg/dl in the control group (multivariate-adjusted difference 0.93 mg/ dl; 95% CI 0.34 – 1.52; p = 0.003). Serum phosphorus < 5.5 mg/dl and serum phosphorus < 5 mg/dl were attained more frequently in the experimental group (51 vs. 18%, p = 0.002 and 31.7 vs. 15.4%, p = 0.08 respectively). Conclusions: Intensive dietary intervention focusing on phosphorus intake may be useful to reduce phosphorus retention and to improve calcium-phosphorus metabolism in hemodialysis patients.Correspondence to:
Dr. Luis M. Lou
Department of Nephrology
Miguel Servet University Hospital
Isabel la Católica N. 3, Zaragoza 5009, Spain
Email: [email protected]
Nephrology Education
Fractional excretion and reabsorption in chronic kidney disease
Kenneth R. Phelps and Ruth L. Lieberman
Page No. 484
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 (484-490)
Fractional excretion and reabsorption in chronic kidney disease
Kenneth R. Phelps1 and Ruth L. Lieberman2
1Stratton Veterans Affairs Medical Center and 2Albany Medical College Internal Medicine Group, Albany, NY, USA
The concepts of fractional excretion and reabsorption are often employed to elucidate the contribution of tubular transport to plasma concentrations. Fractional excretion of substance x, FEx, is the ratio of the urinary excretion rate to the filtration rate of x, or Ex/Fx. Fractional tubular reabsorption of x, FTRx, is the ratio of the reabsorption rate to the filtration rate of x, or TRx/Fx. When plasma is in equilibrium with respect to x, net influx (Ix) from gut and tissue determines Ex, and [x]p = Ex/GFR + TRx/GFR. In chronic kidney disease (CKD), Ex/GFR rises as GFR falls if Ix does not fall commensurately; at the same time, TRx/GFR may fall, remain unchanged, or rise. If TRx/GFR rises, a simultaneous, proportionately greater increment in Ex/GFR causes FEx to rise also and FTRx to fall secondarily. In this circumstance, FTRx is lower than normal even though reabsorption of x is increased per volume of filtrate. This paper reviews pertinent homeostatic principles, illustrates the potential for divergence of TRx/GFR and FTRx as GFR falls, and summarizes the conditions required for the divergence. Clinical examples show reduced FTRx despite increased TRx/GFR for phosphorus and urate, and analyses suggest that such discrepancies are often inevitable. Methods are described and arguments are advanced for using TRx/GFR to quantify tubular function in CKD.Correspondence to:
Dr. Kenneth R. Phelps
Stratton Veterans Affairs Medical Center
113 Holland Avenue, Albany, NY 12208, USA
Email: [email protected]
Nephrology Education
Licorice-related rhabdomyolysis: a big price for a sweet tooth
Megha Shah, Christina Williams, Ashim Aggarwal and Wajid M. Choudhry
Page No. 491
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 (491-495)
Licorice-related rhabdomyolysis: a big price for a sweet tooth
Megha Shah1, Christina Williams1, Ashim Aggarwal1 and Wajid M. Choudhry2
1Unity Health System, and 2University of Rochester, Rochester, NY, USA
A 50-year-old lady on hydrochlorothiazide (HCTZ) presented to the hospital after 4 days of generalized muscle aches and dark urine. She admitted to consuming one and a half bags of black licorice bites containing 2% natural licorice during the past 3 weeks. Examination showed high blood pressure, while labs revealed elevated creatine kinase, hypokalemia, hypocalcemia and hypophosphatemia with low aldosterone and plasma renin levels and high intact PTH. The active component of licorice is glycyrrhizic acid, which inhibits an enzyme required to convert cortisol to a less active metabolite, cortisone. This causes excess cortisol, simulating syndrome of apparent mineralocorticoid excess (AME), thus resulting in hypertension, hypokalemia and metabolic alkalosis. In our patient, licoriceinduced hypokalemia resulted in rhabdomyolysis. The rhabdomyolysis along with the effect of licorice led to secondary hypocalcaemia, which in turn triggered secondary hyperparathyroidism. This might have had a phosphaturic effect that caused hypophosphatemia, further worsening rhabdomyolysis. Conclusion: This case illustrates the complex relationship of various electrolytes, which can lead to self perpetuation of the disease, hence demanding more vigilance.Correspondence to:
M. Shah, MD
Unity Health System
1555, Long Pond Road
Rochester, NY 14626, USA
Email: [email protected]
Nephrology Education
Membranous nephropathy induced by pegylated interferon α-2a therapy for chronic viral hepatitis B
Ming-Shien Tsai, Jui-Hao Chen, Yu-Wei Fang, An-Hang Yang and Chung-Hsin Chang
Page No. 496
Abstract
Clinical Nephrology, Vol. 77 – No. 2/2012 (496-500)
Membranous nephropathy induced by pegylated interferon α-2a therapy for chronic viral hepatitis B
Ming-Shien Tsai1, Jui-Hao Chen2, Yu-Wei Fang1, An-Hang Yang3 and Chung-Hsin Chang1,4
1Division of Nephrology, 2Division of Gastroenterology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, 3Department of Pathology, Veterans General Hospital-Taipei, and 4Department of Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
Interferon is used to treat chronic viral hepatitis because of low drug resistance and a high remission rate. However, its propensity to induce and modify autoimmunity has been reported. We used pegylated interferon α-2a to treat a patient with chronic viral hepatitis B. After 5 months of this therapy, the patient developed membranous nephropathy. Complete remission of his nephrotic syndrome was achieved after 1 year of cyclosporine and corticosteroid therapy. During this same period, his chronic viral hepatitis B was controlled by entecavir. To our knowledge, this is the first case in which membranous nephropathy developed during pegylated interferon α-2a therapy for chronic hepatitis B. The autoimmune modulation induced by interferon is the most likely mechanism for this complication. Correspondence to:
C.-H. Chang, MD
Division of Nephrology, Department of Internal Medicine
Shin-Kong Wu Ho-Su Memorial Hospital
95, Wen Chang Rd, Shih-Lin
Taipei 111, Taiwan
Email: [email protected]
Nephrology Education
Membranous nephropathy with predominance of C1q: another variant of C1q nephropathy?
E.S.G. den Deurwaarder, E.J. Steenbergen, E.K. Hoogeveen and J.F.M. Wetzels
Page No. 501
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2011 (501-504)
Membranous nephropathy with predominance of C1q: another variant of C1q nephropathy?
E.S.G. den Deurwaarder1, E.J. Steenbergen2, E.K. Hoogeveen3 and J.F.M. Wetzels4
1Department of Internal Medicine, ZGT Twenteborg Hospital Almelo, Almelo, 2Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, 3Department of Nephrology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, and 4Department of Nephrology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
Originally described as a proliferative glomerulonephritis, C1q nephropathy is nowadays mostly recognized as a variant of focal segmental glomerulosclerosis or minimal change disease. We describe a 30-year-old male patient with nephrotic range proteinuria. Kidney biopsy demonstrated a membranous nephropathy with predominant staining for C1q. Under conservative therapy the outcome was favorable. We suggest that this case represents another variant of C1q nephropathy, thus broadening the spectrum of the disease.Correspondence to:
E.S.G. den Deurwaarder, MD
Department of Internal Medicine
Division of Nephrology
ZGT Twenteborg Hospital Almelo
Zilvermeeuw 1
7600 SZ, Almelo, The Netherlands
Email: E.denDeurwaarder@ nier.umcn.nl or [email protected]
Nephrology Education
A case report of minimal change nephrotic syndrome complicated with portal, splenic and superior mesenteric vein thrombosis
Jun Wang, QiuLing Fan, Ying Chen, Xuezhu Dong, YuXia Zhang, JiangMin Feng, JianFei Ma and LiNing Wang
Page No. 505
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 (505-509)
A case report of minimal change nephrotic syndrome complicated with portal, splenic and superior mesenteric vein thrombosis
Jun Wang*, QiuLing Fan*, Ying Chen, Xuezhu Dong, YuXia Zhang, JiangMin Feng, JianFei Ma and LiNing Wang
Department of Nephrology, the First Affiliated Hospital of China Medical University, Shenyang, China
*These authors contributed equally to this paper.
Background: Venous thrombosis is common in nephrotic syndrome, but portal vein thrombosis has a relatively low incidence in patients with nephrotic syndrome. We describe here a case of an 18-yearold male student with newly diagnosed nephrotic syndrome that was complicated with portal, splenic and superior mesenteric vein thrombosis. Conclusion: In the presence of newly diagnosed nephrotic syndrome of minimal change disease, thrombus formation can occur and should be noted, particularly when it occurs, in rare sites. The recognition in nephrotic syndrome complicated with portal, splenic and superior mesenteric vein thrombosis should be emphasized.Correspondence to:
QiuLing Fan, MD, PhD, Associate Professor
Division of Nephrology, The First Hospital
China Medical University
NO.155 North Nanjing Street
Heping District Shenyang, 110001, Liaoning Province, China
Email: [email protected]
Letter to the Editor
The uncertainty of rituximab and steroid dosing in refractory steroid-resistant nephrotic syndrome
Daishi Hirano, Shuichiro Fujinaga and Naoto Nishizaki
Page No. 510
Abstract
Clinical Nephrology, Vol. 77 – No. 6/2012 – Letter to the editor
The uncertainty of rituximab and steroid dosing in refractory steroid-resistant nephrotic syndrome
Daishi Hirano1,2, Shuichiro Fujinaga1 and Naoto Nishizaki1,3
1Division of Nephrology, Saitama Children’s Medical Center, Saitama, 2Department of Pediatrics, Jikei University School of Medicine, Tokyo, and 3Department of Pediatrics, Juntendo University School of Medicine, Jutendo, Japan
Correspondence to:
Shuichiro Fujinaga, MD, PhD
Division of Nephrology
Saitama Children’s Medical Center
2100 Magome, Iwatsuki-ward
Saitama-city Saitama 339 8551, Japan
Email: [email protected]
