Volume 77 (2012), No. 3/2012(March)
The online-version will be updated before the print-version of this Journal is published. Upon request we will send the password and user name by e-mail. The online-service is only available for subscribers of the print-version, if proof of purchase is submitted.
The use of the online-version will be charged with an extra fee (additional to the subscription of the print-version). The service can be used until December 31st of the year of subscription.
|
| Price of the complete print-issue: 30.00$ |
Add to Cart
|
Original
Role of oxidative stress in cardiovascular effects of anemia treatment with erythropoietin in predialysis patients with chronic kidney disease
Alberto Martinez-Vea, Luis Marcas, Alfredo Bardají, Marta Romeu, Cristina Gutierrez, Carmen García, Teresa Compte, Rosa Nogues, Carmen Peralta and Montserrat Giralt
Page No. 171
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (171-181)
Role of oxidative stress in cardiovascular effects of anemia treatment with erythropoietin in predialysis patients with chronic kidney disease
Alberto Martinez-Vea1, Luis Marcas1, Alfredo Bardají2, Marta Romeu4, Cristina Gutierrez3, Carmen García1, Teresa Compte5, Rosa Nogues3, Carmen Peralta1 and Montserrat Giralt4
1Nephrology Service, 2Cardiology Service, 3Research Unit, of the Hospital Universitari de Tarragona Joan XXIII, IISPV, 4Pharmacology Unit, Department of Basic Medical Sciences, Universitat Rovira i Virgili, Tarragona, and 5Nephrology Assistance Unit, Hospital de Jesús, Tortosa, Spain
Background/Aim: Oxidative stress (OS) is involved in left ventricular hypertrophy (LVH). Short-term treatment with erythropoietin (EPO) in chronic kidney disease (CKD) complicated by anemia and LVH is associated with a reduction in left ventricular mass (LVM). We proposed to assess whether the pro-oxidant status of CKD influences these outcomes. Methods: Predialysis patients (n = 76) with CKD and hemoglobin (Hb) levels < 11 g/dl received EPO for 6 months. The effects of this anemia correction on LVH regression were evaluated using echocardiography. Patients with LVM decrease > 10% were considered “responders” (n = 25) to treatment and those with LVM change < 10% were considered “non-responders” (n = 24). Measurement of OS included plasma and erythrocyte oxidized (GSSG) and reduced (GSH) glutathione, GSH redox ratio (GSSG/GSH), erythrocyte glutathione peroxidase (GPx) and oxidized LDL (Ox- LDL). Results: 49 patients completed the study. With EPO therapy, mean Hb levels increased from 9.9 ± 0.6 to 12.8 ± 1.5 g/ dl (p < 0.0001) and LVM index decreased from 69.2 ± 17.7 to 64.1 ± 19.6 g/m2.7 (p = 0.01). At 6 months, “non-responders” had higher systolic blood pressure, pulse pressure, GSSG and GSH redox ratio and lower GSH than “responders”. In multivariate analysis, and following adjustment for confounding variables, systolic blood pressure and GSH redox ratio independently predicted LVH regression. Conclusion: Blood pressure and plasma GSH redox ratio (a marker of OS) are important predictors of LVH regression in anemic predialysis patients treated with EPO.Correspondence to:
Alberto Martinez-Vea, MD
Nephrology Service
Hospital Universitari de Tarragona Joan XXIII
Carrer del Doctor Mallafré Guasch, 4
43007 Tarragona, Spain
Email: amartinezv.hj23.ics@ gencat.cat
Original
Is the sodium level per se related to mortality in hospitalized patients with severe hyponatremia?
Seok Hui Kang, Hyung Wook Kim, So Young Lee, In O Sun, Hyeon Seok Hwang, Sun Ryoung Choi, Byung Ha Chung, Hun Suk Park, Cheol Whee Park, Chul Woo Yang, Yong Soo Kim and Bum Soon Choi
Page No. 182
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (182-187)
Is the sodium level per se related to mortality in hospitalized patients with severe hyponatremia?
Seok Hui Kang, Hyung Wook Kim, So Young Lee, In O Sun, Hyeon Seok Hwang, Sun Ryoung Choi, Byung Ha Chung, Hun Suk Park, Cheol Whee Park, Chul Woo Yang, Yong Soo Kim and Bum Soon Choi
Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Introduction: Severe hyponatremia is a serious medical condition that is associated with morbidity and mortality. Controversy still exists regarding the prevalence, cause and mortality of hyponatremia. Patients and methods: Of the hyponatremic patients, we studied 116 severe hyponatremic patients. Severe hyponatremia was defined as a serum sodium concentration equal to or less than 120 mmol/l at least twice. Results: The mean age of the patients was 67.3 ± 14.9 years. The mean sodium level at the time of diagnosis was 114.9 ± 5.2 mmol/l. Normal extracelluar fluid volume (ECFV) was reported in 44 patients (37.9%). 24 (20.7%) of 44 patients were diagnosed with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Excess ECFV and depleted ECFV were reported in 37 (31.9%) and 18 patients (15.5%), respectively. In 17 patients (14.7%), the exact causes could not be determined due to incomplete laboratory studies. On the univariate analysis, age (p = 0.030), the Charlson’s risk index (p = 0.000) and the correction rate (p = 0.000) were associated with the 1-year survival. The time of onset (p = 0.051) and the initial serum sodium level (p = 0.986) were not associated with the 1-year survival. On the multivariate analysis, the Charlson’s risk index (p = 0.003) and the correction rate (p = 0.033) were independently associated with 1-year survival. Conclusion: This study showed that the sodium level per se is not related to mortality, but a higher Charlson’s risk index and a slow rate of correcting the sodium are related with mortality. For improving the survival of patients with severe hyponatremia, we should pay more attention to correct the underlying comorbidity.Correspondence to:
Bum Soon Choi, MD
Department of Internal Medicine
Seoul St. Mary’s Hospital
505 Banpo-Dong, Seocho-Ku
137-040, Seoul, Korea
Email: [email protected]
Original
Pumping iron: revisiting risks, benefits and strategies in treatment of iron deficiency in end-stage renal disease
Neeraj Singh and Anil K. Agarwal
Page No. 188
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (188-195)
Pumping iron: revisiting risks, benefits and strategies in treatment of iron deficiency in end-stage renal disease
Neeraj Singh and Anil K. Agarwal
Division of Nephrology, The Ohio State University, Columbus, OH, USA
Iron deficiency is a common cause of anemia in patients with end stage renal disease (ESRD). Intravenous iron administration, especially in those requiring treatment with erythropoiesis stimulating agents (ESA) is an essential component of the management of anemia in ESRD patients. Iron improves hemoglobin, reduces ESA dose requirement and also has nonerythropoietic effects including improvement in physical performance, cognition and amelioration of restless leg syndrome. However, iron can promote oxidative stress, cause endothelial dysfunction, inflammation and tissue injury, and has a potential to cause progression of both CKD and cardiovascular disease. In this review, we discuss the benefits and risks associated with i.v. iron and the practical aspects of iron administration that can minimize the complications related to iron therapy in ESRD.Correspondence to:
Prof. Anil K. Agarwal, MD
Division of Nephrology, The Ohio State University
395 W 12th Avenue, Ground Floor
Columbus, OH 43210, USA
Email: anil.agarwal@ osumc.edu
Original
A study of the association of higher parathormone levels with health-related quality of life in hemodialysis patients
Pavlos Malindretos, Pantelis Sarafidis, Anastasios Lazaridis and Pavlos Nikolaidis
Page No. 196
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (196-203)
A study of the association of higher parathormone levels with health-related quality of life in hemodialysis patients
Pavlos Malindretos, Pantelis Sarafidis, Anastasios Lazaridis and Pavlos Nikolaidis
First Medical Department, Division of Nephrology and Hypertension, AHEPA, University Hospital, Thessaloniki, Greece
Secondary hyperparathyroidism (SHPT) is associated with poor outcome including mortality, hospitalization, as well as greater healthcare resource utilization and costs in chronic kidney disease (CKD). We hypothesized that SHPT is also associated with poor self reported health-related quality of life (HRQOL) in prevalent hemodialysis (HD) patients. We conducted a case-control study in patients with CKD receiving longterm HD treatment, in six dialysis clinics in Greece. HRQOL was estimated with the KDQOL-SFTM questionnaire, version 1.3, which includes 43 kidney disease targeted items, and 36 items that provide a generic core and an overall health rating item, with a higher score reflecting a more favorable health state. A total of 156 completed the questionnaire, 50 with high parathormone levels (i.e., PTH > 300 pg/ml and or under vitamin D receptor activators, mean: 329 ± 160.9 pg/ml) and 106 with low parathormone levels (PTH < 300 pg/ml, mean: 132.4 ± 69.0 pg/ml) in a 2 : 1 randomization assignment. Patients with high and with low PTH were 62.1 ± 14.9 and 65.9 ± 14.2 y old and the median dialysis vintage time was 31 and 37 months, respectively. There were no significant differences regarding the presence of comorbidities between groups. Patients with high PTH, compared to patients with low PTH, had lower pain component summary (57.6 ± 33.5 vs. 69.2 ± 28.9; p = 0.041) and physical component summary (41.0 ± 23.8 vs. 50.0 ± 20.8; p = 0.031). Both pain component summary and physical component summary differences remained significant after adjustment for age, gender and vintage (p = 0.036 and p = 0.029, respectively). Low PTH patients scored better in 18 out of 23 subscales. In HD patients, SHPT appears to be associated with worse pain component summary score (p = 0.036) and physical component summary score (p = 0.029). Additional studies are needed to verify these associations and to examine whether correction of SHPT can improve HRQOL.Correspondence to:
Pavolos Malindretos
First Medical Department, Division of Nephrology and Hypertension
AHEPA, University Hospital, Thessaloniki, Greece
Email: [email protected]
Original
Genitourinary abnormalities in an asymptomatic screening population: findings on virtual colonoscopy
Jason M. Durbin, Sean P. Stroup, Hernan O. Altamar, James O. L’Esperance, Dane R. Lacey and Brian K. Auge
Page No. 204
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (204-210)
Genitourinary abnormalities in an asymptomatic screening population: findings on virtual colonoscopy
Jason M. Durbin1, Sean P. Stroup2, Hernan O. Altamar3, James O. L’Esperance4, Dane R. Lacey5 and Brian K. Auge6
1Naval Medical Center San Diego, 2University of California, San Diego, CA, 3Uniformed Services University of the Health Sciences Department of Surgery, Staff Urologist, National Naval Medical Center, Bethesda, MD, 4Uniformed Services University of the Health Sciences Department of Surgery, 5Uniformed Services University of the Health Sciences Department of Radiology, and 6Uniformed Services University of the Health Sciences, Chairman and Residency Director, Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA
Introduction: The true incidences of genitourinary conditions in the modern era are not completely known. We sought to determine the incidence of genitourinary abnormalities in a group of asymptomatic adult patients undergoing axial imaging with virtual colonoscopy. Methods: We performed a post-hoc analysis of imaging results from a prospective, IRBapproved study that randomized patients to screening “virtual” CT colonography (CTC) followed by standard endoscopic colonoscopy. CTC scans were reviewed separately by an independent radiologist and a urologist for genitourinary abnormalities. Genitourinary abnormalities were characterized as of minor, moderate, or major clinical significance. Identified nephroliths were categorized by location, laterality, size, and number. Student’s t-tests and Fisher’s exact-tests were used for continuous and categorical variables as appropriate. Results: Of 490 patients undergoing CTC and eligible for analysis, no genitourinary abnormalities were found in 294 (60%), minor genitourinary abnormalities were found in 100 (20.4%), moderate genitourinary abnormalities were found in 86 (17.6%), and major genitourinary abnormalities were found in 10 (2%). Renal cysts (n = 60, 12%) were the most common minor urologic findings. Moderate and major genitourinary findings of nephrolithiasis, adrenal adenomas, and renal masses were noted in 13.9%, 3%, and 2% of the population, respectively. The largest stone was 1.2 cm, and the smallest was 1 mm; while 59% had stones < 3mm, 20% between 3 mm and 5 mm, 18% between 5 mm and 10 mm, and 3% > 10 mm in size. Unilateral stones were found in 85%, while bilateral were found in 15%, and the average number of stones was 2, (range 1 – 16). Age and male sex were significantly associated with moderate or major genitourinary findings p = 0.04 and p = 0.05, respectively. Conclusions: CT colonography in an asymptomatic screening population helped to identify nephrolithiasis in 13.9%. Moderate and major urologic abnormalities were found in 20% of the cohort. Risk factors included male sex and older age. Correspondence to:
B.K. Auge, MD, FACS
Department of Urology
Naval Medical Center San Diego
34800 Bob Wilson Drive
San Diego, CA 92134, USA
Email: brian.auge@ med.navy.mi
Original
Association between anti-C1q antibodies and glomerular tuft necrosis in lupus nephritis
Noémie Jourde-Chiche, Laurent Daniel, Laurent Chiche, Stéphane Burtey, Julien Mancini, Sophie Jego, Marielle San Marco and Nathalie Bardin
Page No. 211
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (211-218)
Association between anti-C1q antibodies and glomerular tuft necrosis in lupus nephritis
Noémie Jourde-Chiche1,2, Laurent Daniel3, Laurent Chiche4, Stéphane Burtey2, Julien Mancini5, Sophie Jego6, Marielle San Marco6 and Nathalie Bardin2,6
1Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, 2INSERM UMRS 608, UFR Pharmacie, 3Service d’Anatomie Pathologique, Hôpital de la Timone, 4Service de Médecine Interne, Hôpital de la Conception, 5Service de Santé Publique, Hôpital de la Timone and 6Laboratoire d’Immunologie, Hôpital de la Conception, 1-6Université Aix-Marseille, Marseille, France
Background: Proliferative glomerulonephritis includes various glomerular lesions in patients with systemic lupus erythematosus (SLE) that might have distinct pathogenic mechanisms. The aim of the study was to determine whether anti-C1q antibodies, which are associated with lupus nephritis, were specifically associated with given glomerular histopathological lesions. Methods: The presence and titer of anti-C1q antibodies were determined in a retrospective study including 63 SLE patients with biopsy-proven lupus nephritis. Results: We confirmed the correlation between the presence of anti-C1q antibodies with both clinical and immunological markers of disease activity. We showed that the presence of anti- C1q antibodies was significantly associated with glomerular tuft necrosis and crescents, major criteria of active lesions. Additionally, no necrosis was found in patients without anti- C1q antibodies, giving anti-C1q antibodies a 100% negative predictive value for glomerular tuft necrosis. Conversely, there was no difference in the percentage of glomeruli showing endocapillary proliferation or wire loops according to the anti-C1q status. Conclusion: Our data highlight for the first time an association of anti-C1q antibodies with necrotizing forms of lupus nephritis suggesting new insights into the pathogenesis and the treatment of this entity.Correspondence to:
Noémie Jourde-Chiche, MD, PhD
Centre de Néphrologie et Transplantation Rénale
Hôpital de la Conception
147 Bd Baille, 13005 Marseille, France
Email: [email protected]
Original
Urine endothelin-1 levels as a predictor of renal scarring in children with urinary tract infections
A. Yilmaz, A. Gedikbasi, E. Sevketoglu, S. Karyagar, S. Hatipoglu, A. Kiyak, M. Mulazimoglu, G. Aydogan and T. Ozpacaci
Page No. 219
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (219-224)
Urine endothelin-1 levels as a predictor of renal scarring in children with urinary tract infections
A. Yilmaz1, A. Gedikbasi2, E. Sevketoglu3, S. Karyagar4, S. Hatipoglu3, A. Kiyak5, M. Mulazimoglu6, G. Aydogan7 and T. Ozpacaci6
1Pediatric Nephrology Department, Istanbul University Istanbul Medical Faculty, 2Biochemistry Department, 3Department of Pediatrics, Pediatrician, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, 4Nuclear Medicine Department, Trabzon Numune Training and Research Hospital, Trabzon, 5Pediatric Nephrology Department, Bakirkoy Maternity and Childrens Hospital, 6Nuclear Medicine Department, Okmeydani Training and Research Hospital, and 7Department of Pediatrics, Bakirkoy Maternity and Childrens Hospital, Istanbul, Turkey
Aims: Endothelin-1 (ET-1) contributes to renal fibrogenesis in several manners such as increasing collagen synthesis in mesangium, decreasing extracellular matrix (ECM) degradation by mesangial cells and stimulating mesangial contraction. The aim of our study was to investigate whether urine level of ET-1 (uET-1) could represent a useful biomarker of renal scarring and if so, to determine the optimal cutoff level for uET-1 to predict a renal scar. Methods: 44 children with renal scarring and 32 children without renal scarring were enrolled in the study. Urine ET-1 was measured by enzyme-linked immunosorbent assay. Results: Mean uET-1 level was significantly higher in the scar group than in controls (2.75 ± 1.35 fmol/ml vs. 0.68 ± 0.41 fmol/ml, p = 0.001). The optimal cut-off level was 1.064 fmol/ml for uET-1 to predict renal scarring. Using this cut-off point, sensitivity and specificity were 97.73% and 93.91%, respectively. AUC was found 0.975 (95% CI 0.917 – 0.996) for uET-1. Mean urine Endothelin-1/Creatinine ratio (uET-1/Cr) was also significantly higher in the scar group than in the control group (4.04 ± 2.29 fmol/mg Cr vs. 1.09 ± 0.67 fmol/mg Cr, p = 0.0001). Using 1.67 fmol/mgCr as optimal cut-off level, sensitivity and specificity were 95.45% and 84.09%, respectively. AUC was 0.945 (95% CI 0.875 – 0.982) for uET-1/Cr. Conclusion: Our study suggests that both uET-1 and uET-1/Cr can be used for prediction of renal scarring in children with normal renal function. Measuring urine level of ET-1 can help us to avoid unnecessary DMSA studies if the patient’s uET-1 level is found to be under the determined cut-off point.Correspondence to:
A. Yilmaz, MD
Istanbul University, Istanbul Medical Faculty
Istanbul, Turkey
Email: [email protected]
Original
Changes in renal function in long-term survivors of allogeneic hematopoietic stem-cell transplantation: single-center experience
Seok Hui Kang, Hoon Suk Park, In O Sun, Sun Ryoung Choi, Byung Ha Chung, Bum Soon Choi, Chang Ki Min, Jun Young Do, Chul Woo Yang, Yong Soo Kim, Kyung Woo Yoon and Cheol Whee Park
Page No. 225
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (225-230)
Changes in renal function in long-term survivors of allogeneic hematopoietic stem-cell transplantation: single-center experience
Seok Hui Kang1, Hoon Suk Park2, In O Sun2, Sun Ryoung Choi2, Byung Ha Chung2, Bum Soon Choi2, Chang Ki Min3, Jun Young Do1, Chul Woo Yang2, Yong Soo Kim2, Kyung Woo Yoon1 and Cheol Whee Park2
1Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, The Yeungnam University of Korea, Daegu, Divisions of 2Nephrology and 3Hematology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
Background: Renal dysfunction after allogeneic hematopoietic stem cell transplantation (HSCT) has been increasingly reported. However, there are few reports on the changes of the estimated glomerular filtration rate (eGFR) in long-term survivors after allogeneic HSCT. Patients and methods: The medical records at Seoul St. Mary’s Hospital in Korea were reviewed to identify all adult (> 18-years-of-age) patients who had undergone high-dose chemotherapy and allogeneic HSCT between January 2001 and December 2005. Among these patients, those with < 5 years of follow-up and relapse within 5 years after HSCT were excluded. 85 patients were enrolled. Results: The mean follow-up was 76.0 ± 13.5 months. The eGFR recorded 3 months after HSCT was significantly decreased compared with the eGFR recorded before HSCT. Subsequently, early decreased eGFR was maintained during the 60 months after HSCT. Multivariate analysis showed that acute kidney injury (AKI) during HSCT, hypertension (HTN) and eGFR before HSCT was differently associated with changes in eGFR. The eGFR in patients who had AKI decreased significantly at 3 months after HSCT. After 3 months, the eGFR recovered to reach a lower level than in patients without AKI. The level was maintained during the 60 months after HSCT. The eGFR in patients who had low eGFR before HSCT (< 90 ml/min) decreased significantly at 3 months after HSCT, which was also maintained during the 60 months after HSCT. The eGFR in patients who had HTN also decreased significantly at 3 months after HSCT. By contrast, the eGFR decreased consistently and slowly from 3 to 60 months. Conclusion: AKI and low baseline eGFR are associated with early renal dysfunction in patients after HSCT, but are not closely associated with long-term decline in eGFR. In contrast, eGFR in patients with HTN continuously decrease after 3 months of HSCT. Therefore, HTN seems to play a major role in the long-term decline in eGFR. These findings suggest that eGFR at 3 months after HSCT should be monitored closely for all patients who have undergone HSCT. Additionally, long-term follow-up of renal function is needed to prevent further renal damage for patients with HTN.Correspondence to:
Cheol Whee Park, MD
Department of Internal Medicine
Seoul St. Mary’s Hospital
505 Banpo-Dong, Seocho-Ku, 137-040, Seoul, Korea
Email: [email protected]
Nephrology Education
Pulmonary vascular calcification in a nocturnal hemodialysis patient
Brandon Bernard, Philip McFarlane, Farah Moid, Errol Colak and Jeffrey Perl
Page No. 231
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (231-236)
Pulmonary vascular calcification in a nocturnal hemodialysis patient
Brandon Bernard1, Philip McFarlane1, Farah Moid2, Errol Colak3 and Jeffrey Perl1
1Division of Nephrology, St. Michael’s Hospital, University of Toronto, 2Division of Pathology, St. Joseph’s Health Centre, and 3Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, Canada
Although vascular calcification in end-stage renal disease (ESRD) is common, metastatic pulmonary calcification (MPC) is an under-recognized complication of ESRD with the majority of individuals being asymptomatic. Similar to calcification in other arterial vascular beds, elevated serum calcium and phosphate appear to be potent risk factors although the exact pathogenesis of MPC remains largely unclear. Nocturnal hemodialysis (NHD) is a form of renal replacement therapy that offers superior control of serum phosphate and uremia compared to conventional (3 times weekly) intermittent hemodialysis and shows promise in delaying the progression of vascular calcification. Here, we report the first case of MPC involving the pulmonary vasculature in a patient treated with nocturnal hemodialysis and discuss the epidemiology, pathogenesis, histology and natural history of MPC.Correspondence to:
J. Perl
St. Michael’s Hospital
30 Bond St., Shuter Wing-3-060
Toronto ON, M5B 1W8, Canada
Email: [email protected]
Nephrology Education
Retroperitoneal mass in a patient with Wegener’s granulomatosis
Jasmeet Kaur, Frederick Miller, Nand K. Wadhwa and Edward P. Nord
Page No. 237
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (237-241)
Retroperitoneal mass in a patient with Wegener’s granulomatosis
Jasmeet Kaur1, Frederick Miller2, Nand K. Wadhwa1 and Edward P. Nord1
1Department of Medicine, Division of Nephrology, and 2Department of Pathology, School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
Wegener’s granulomatosis (WG) is a necrotizing vasculitis that classically involves the upper and lower respiratory tracts and kidneys. Uncommonly, other sites may also be involved. We report on a patient previously diagnosed with and treated for WG who presented with flank pain and on further imaging was found to have a retroperitoneal mass. A surgical specimen of the tissue revealed multiple foci of necrotizing vasculitis. Consideration should be given to the possibility that mass-like lesions in patients with WG may not be tumors since the management and outcome differ from that of an active vasculitis.Correspondence to:
E.P. Nord, MD
Division of Nephrology, Department of Medicine
School of Medicine, HSC T-16 Rm-080
State University of NY at Stony Brook
Stony Brook NY 11794, USA
Email: [email protected]
Nephrology Education
Disseminated kidney tuberculosis complicating autosomal dominant polycystic kidney disease: a case report
Hideki Takeshita, Morimasa Amemiya, Koji Chiba, Masayasu Urushibara, Jun-ichi Satoh and Akira Noro
Page No. 242
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (242-245)
Disseminated kidney tuberculosis complicating autosomal dominant polycystic kidney disease: a case report
Hideki Takeshita1, Morimasa Amemiya2, Koji Chiba1, Masayasu Urushibara1, Jun-ichi Satoh2 and Akira Noro1
1Department of Urology and 2Department of Nephrology, Saitama Red Cross Hospital, Saitama, Japan
Mycobacterium tuberculosis infection in patients with autosomal dominant polycystic kidney disease (ADPKD) is rare, and its diagnosis and treatment are difficult because numerous cysts are exposed to infection and antibiotics do not easily penetrate infected cysts. Here, we report the case of a 43-year-old Japanese man with disseminated urogenital tuberculosis (TB) and ADPKD without human immunodeficiency virus (HIV) infection. Delayed diagnosis and ineffective anti-TB chemotherapy worsened his condition. Finally, he underwent bilateral nephrectomy but experienced postoperative complications. In conclusion, kidney TB should be recognized as a cause of renal infection in ADPKD, and surgical treatment should be instituted without delay. The importance of early diagnosis and treatment cannot be overemphasized to prevent kidney TB deterioration.Correspondence to:
H. Takeshita, MD
Department of Urology, Saitama Red Cross Hospital
8-3-33 Kamiochiai, Chuo Ward
Saitama City, Saitama 338-8553, Japan
Email: [email protected]
Nephrology Education
Proteasome inhibition with bortezomib: an effective therapy for severe antibody mediated rejection after renal transplantation
Kalathil K. Sureshkumar, Sabiha M. Hussain, Richard J. Marcus, Tina Y. Ko, Akhtar S. Khan, Kusum Tom, Carlos A. Vivas, George Parris, Katherine M. Jasnosz and Ngoc L. Thai
Page No. 246
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (246-253)
Proteasome inhibition with bortezomib: an effective therapy for severe antibody mediated rejection after renal transplantation
Kalathil K. Sureshkumar1, Sabiha M. Hussain1, Richard J. Marcus1, Tina Y. Ko1, Akhtar S. Khan2, Kusum Tom2, Carlos A. Vivas2, George Parris3, Katherine M. Jasnosz3 and Ngoc L. Thai2
Divisions of 1Nephrology and Hypertension, 2Abdominal Transplantation, and 3Department of Pathology, Allegheny General Hospital, Pittsburgh, PA, USA
Antibody-mediated rejection (AMR) following renal transplantation is less responsive to conventional anti-rejection therapies. Plasmapheresis (PP), intravenous immunoglobulin (IVIg), rabbit antithymocyte globulin (rATG) and rituximab deplete immature B-cells but not mature plasma cells. The proteasome inhibitor bortezomib has activity against mature plasma cell, the source of damaging donor-specific antibody (DSA).We present the successful use of bortezomib in 2 patients who developed AMR following kidney transplantation. The first patient was a 54-year-old white female who received living-unrelated kidney transplantation from her husband. She developed severe AMR early after transplantation with rising DSA titers consistent with an anamnestic immune response by memory cells to the donor antigens. Renal function deteriorated despite treatment with pulse methylprednisolone (MP), PP and IVIg. After initiation of therapy with bortezomib, DSA titers became negative and serum creatinine returned to baseline with histological resolution of AMR. The second patient was a 19-year-old white male who received deceased donor kidney transplantation and developed AMR within 2 weeks, refractory to therapy with pulse MP, PP and IVIg with rising DSA. Bortezomib use resulted in disappearance of DSA and renal function improvement. Both patients tolerated the treatment well with stable renal function at last follow-up. The novel mechanisms of action and preliminary results with bortezomib are encouraging, but require larger studies and longer follow-up.Correspondence to:
K.K. Sureshkumar, MD, FRCP (Glasg), FASN
320 East North Avenue
Pittsburgh, PA 15212 USA
Email: [email protected]
Nephrology Education
Proliferative glomerulonephritis with monoclonal IgM deposits without Waldenström’s macroglobulinemia: case report and review of the literature
Mayumi Yahata, Izaya Nakaya, Satoko Takahashi, Tsutomu Sakuma, Hiroshi Sato and Jun Soma
Page No. 254
Abstract
Clinical Nephrology, Vol. 77 – No. 3/2012 (254-260)
Proliferative glomerulonephritis with monoclonal IgM deposits without Waldenström’s macroglobulinemia: case report and review of the literature
Mayumi Yahata1, Izaya Nakaya1, Satoko Takahashi1, Tsutomu Sakuma2, Hiroshi Sato3 and Jun Soma1
Departments of 1Nephrology and 2Pathology, Iwate Prefectural Central Hospital Morioka, Iwate, Japan and 3Department of Bio-Pharmaceutical Science, Tohoku University Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
A 38-year-old man was presented with nephrotic syndrome associated with hematuria and mild hypocomplementemia. Renal biopsy revealed lobular mesangial proliferation, thickened capillary walls, and intraluminal protein thrombi. Immunofluorescence showed marked and mild depositions of immunoglobulin (Ig) M heavy chains and complement C3, respectively, in a peripheral lobular pattern. On light chain staining, only kappa (κ) light and IgM heavy chains showed a similar pattern. Electron microscopy showed fine granular electrondense deposits in subendothelial areas and numerous globular deposits (varying size and density) in glomerular capillary lumens. Serum levels of Ig κ, but not of free κ, light chains were significantly increased. Bone marrow aspiration revealed a normocellular marrow. Waldenström’s macroglobulinemia and cryoglobulinemia were ruled out. Clinically, steroid therapy was ineffective and proteinuria persisted. This report demonstrates that glomerular deposition of monoclonal IgM-κ can produce membranoproliferative- like changes in the glomeruli. This condition may be recognized as proliferative glomerulonephritis with monoclonal IgM deposits similar to the recently recognized proliferative glomerulonephritis with monoclonal IgG deposits.Correspondence to:
Mayumi Yahata, MD
Department of Nephrology
Iwate Prefectural Central Hospital
1-4-1 Ueda, Morioka
Iwate 020-0066, Japan
Email: [email protected]
