Volume 78 (2012), No. 2/2012(August)
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Original
Cinacalcet for hemodialyzed patients with or without a high PTH level to control serum calcium and phosphorus: ECO (evaluation of cinacalcet HCl outcome) study
Keitaro Yokoyama, Ichiro Ohkido, Mari Ishida, Hiroyuki Hashimoto, Jun Urae, Hiroshi Sekino, Yasuo Kimura, Hidetaka Shimada, Mitsuyoshi Urashima and Tatsuo Hosoya
Page No. 87
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2012 (87-92)
Cinacalcet for hemodialyzed patients with or without a high PTH level to control serum calcium and phosphorus: ECO (evaluation of cinacalcet HCl outcome) study
Keitaro Yokoyama1, Ichiro Ohkido1, Mari Ishida2, Hiroyuki Hashimoto2, Jun Urae3, Hiroshi Sekino3, Yasuo Kimura4, Hidetaka Shimada5, Mitsuyoshi Urashima6 and Tatsuo Hosoya1
1Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, 2Jinyukai Kitasaito Hospital, Asahikawa, 3Kojin-kai Kimachi Hospital, Sendai, 4Shin Kashiwa Clinic, Kashiwa, 5Jyosuikai Shimada Hospital, Kumamoto, and 6Division of Molecular Epidemiology, The Jikei University School of Medicine, Tokyo, Japan
Background: We investigated the influence of cinacalcet on serum Ca and P in hemodialyzed patients with or without a high PTH level, according to K/DOQI guideline, to control serum Ca and P levels. Methods: We recruited 130 patients in this prospective cohort study and classified them into Group A (iPTH > 300 pg/ml), Group B (iPTH = 181 – 300 pg/ml), and Group C (iPTH ≤ 180 pg/ml). After 24 weeks on cinacalcet, serum Ca, P and iPTH were measured. Results: The achievement rate of the target iPTH level in JSDT guideline was significantly higher in Group B compared with Group A. The achievement rate of serum Ca and P target levels in the Japanese Society for Dialysis Therapy (JSDT) guideline was higher in Group C. In Group A and Group C, the simultaneous achievement rates (Ca, P, and iPTH) in KDOQI guideline increased after treatment with cinacalcet (p < 0.01). There was no difference in the reduction of Ca and P among the groups, while the iPTH reduction was significantly lower in groups B and C compared with that in A. Conclusion: Administration of cinacalcet to patients with or without high PTH levels, according to the K/DOQI guideline, facilitates the control of Ca and P levels.Correspondence to:
Keitaro Yokoyama
3-25-8 Nishi-Shinbashi
Minato-ku, 105-8471 Tokyo, Japan
Email: [email protected]
Original
Changes in peritoneal membrane permeability and proteinuria in patients on peritoneal dialysis after treatment with paricalcitol – a preliminary study
Francisco Coronel, Secundino Cigarran, Antonio Gomis, Beatriz Rodríguez-Cubillo, José Antonio Herrero, Pablo Delgado and Jesus Delgado
Page No. 93
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2012 (93-99)
Changes in peritoneal membrane permeability and proteinuria in patients on peritoneal dialysis after treatment with paricalcitol – a preliminary study
Francisco Coronel1, Secundino Cigarran2, Antonio Gomis1, Beatriz Rodríguez- Cubillo1, José Antonio Herrero1, Pablo Delgado1 and Jesus Delgado1
1Nephrology Service, Hospital Clinico San Carlos, Madrid, and 2Nephrology Service, Hospital da Costa, Burela, Lugo, Spain
Background: Patients on peritoneal dialysis (PD) have protein loss through peritoneal membrane (PM) and experience changes in permeability of the membrane. Paricalcitol is a selective vitamin D receptor activator with an effect upon systemic inflammation and an inhibitory effect upon the renin-angiotensin-aldosterone system (RAAS). Methods: This study explores the possible effect of paricalcitol upon the PM in 23 patients on PD with high iPTH levels. Peritoneal kinetic studies were performed before and after paricalcitol, measuring also ultrafiltration/ day, peritoneal protein losses and proteinuria. Results were compared with a control group of 15 patients not receiving any form of vitamin D. Results: With a mean dose of 1.3 μg/day, peritoneal protein loss decreased from 0.91 ± 0.35 to 0.76 ± 0.26 g/l (15.4%) (p = 0.007) and from 7.55 to 6.46 g/d (p < 0.033), and ultrafiltration increased from 844 to 1,002 ml/d (15.8%) (p = 0.037) and from 284 to 323 ml/4 h. (NS), with minimal change in the creatinine dialysate/plasma ratio 0.67 ± 0.12 vs. 0.65 ± 0.11. Proteinuria decreased from 1.65 to 1.25 g/l (21.9%) (p = 0.01) and iPTH decreased from 668 ± 303 to 291 ± 148 pg/ml (p < 0.001). In the control group, no changes in peritoneal membrane permeability and proteinuria were found. Conclusions: The results of the study indicate that paricalcitol is effective in treating hyperparathyroidism in patients on PD, and suggest an effect upon proteinuria and PM permeability (not previously reported), with diminished peritoneal protein loss and increased ultrafiltration. The antiinflammatory, antifibrotic and RAAS-modulating actions described for paricalcitol may be responsible for these findings, and could be important for preserving the peritoneum as a dialyzing membrane.Correspondence to:
Dr. Francisco Coronel, MD, PhD
Nephrology Department
Hospital Clinico San Carlos
C/Prof. Martin Lagos s/n Madrid 28040, Spain
Email: [email protected]
Original
The efficacy of steroid pulse therapy in patients with IgA nephropathy
Tae Young Kim, Soon Bae Kim and Su-Kil Park
Page No. 100
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2012 (100-105)
The efficacy of steroid pulse therapy in patients with IgA nephropathy
Tae Young Kim, Soon Bae Kim and Su-Kil Park
Division of Nephrology, Department of Internal Medicine,College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
Background: The efficacy and proper doses of steroid pulse therapy in patients with immunoglobulin A nephropathy (IgAN) have not been established. We therefore investigated the effects of methylprednisolone (MP) pulse therapy in patients with histologically active IgAN and established renal impairment at the time of treatment. Methods: We assessed 22 patients (8 males, 14 females) with established renal impairment (Stage 3, 4 or 5 CKD; median eGFR, 34.05 ml/min/1.73 m2) and active IgAN (median histological Grade 3). All patients had been maintained on an angiotensin receptor blocker or an angiotensinconverting enzyme inhibitor. Patients were treated with 500 mg intravenous MP every 2 weeks for 6 months to improve or stabilize renal function. The efficacy of MP pulse therapy was analyzed by comparing the slopes of the eGFR (ml/min/1.73 m2) and log transformed urine albumin/creatinine ratios (mg/g) before, during, and after treatment using linear regression coefficients. Results: All patients completed the planned 6 months of MP pulse therapy. Linear regression analysis showed improvements in the monthly decline of eGFR in 16 of 22 patients (73%) after treatment. The rate of eGFR decline in the before treatment period differed significantly from that in the after treatment period (–0.931 ± 0.871 vs 0.141 ± 0.998, p = 0.007). Patients with initial eGFR ≥ 30 ml/min/1.73 m2 showed significantly improved 10-month dialysisfree renal survival after MP pulse therapy (p = 0.040). In contrast, there was no improvement in urinary albumin to creatinine ratio (p = NS). MP pulse therapy was well tolerated, except for one patient with facial flushing and palpitation. There were no other serious adverse events during the study period. Conclusions: MP 500 mg every 2 weeks for 6 months was safe and effective in patients with IgAN and preexisting renal dysfunction.Correspondence to:
Su-Kil Park, MD
Division of Nephrology
Department of Internal Medicine
Asan Medical Center, Seoul, Korea
Email: [email protected]
Original
Trends in hospitalization characteristics for pediatric nephrotic syndrome in the USA
Rose M. Ayoob, David S. Hains and William E. Smoyer
Page No. 106
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2012 (106-111)
Trends in hospitalization characteristics for pediatric nephrotic syndrome in the USA
Rose M. Ayoob, David S. Hains and William E. Smoyer
Center for Clinical and Translational Research, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA
Aim: The overall aim of the current study was to analyze trends in hospital charges, length of stay (LOS), and mortality for children hospitalized with nephrotic syndrome (NS) in the US. Methods: Hospitalization characteristics for children ages 0 – 17 years discharged with the principal diagnosis of NS (ICD-9-CM 581.9) in 2000, 2003, and 2006 were evaluated using the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database (KID). Results: The mean number of children hospitalized with a principal diagnosis of NS was 1,869 per year. These discharges accounted for mean total hospital charges that increased from $11,338 to $16,760 and aggregate hospital charges that increased from $21 to $31 million dollars from 2000 to 2006. Compared to non-children’s hospitals, children’s hospitals had significantly higher mean hospital charges and longer lengths of stay. Importantly, the estimated mortality rate for NS (< 0.5%) was notably lower than prior reports and remained stable throughout the study period. Conclusions: The national health care expenditures for pediatric NSrelated hospitalizations are both significant and growing, although mortality is now far lower than previously reported.Correspondence to:
Rose M. Ayoob, MD
Division of Pediatric Nephrology
700 Children’s Drive, Columbus, OH 43205, USA
Email: [email protected]
Original
Has the incidence of childhood steroid sensitive nephrotic syndrome changed?
John David Spencer, M. Colleen Hastings Robert J. Wyatt and Bettina H. Ault
Page No. 112
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2012 (112-115)
Has the incidence of childhood steroid sensitive nephrotic syndrome changed?
John David Spencer1, M. Colleen Hastings2,3, Robert J. Wyatt2,3 and Bettina H. Ault2,3
1Pediatric Nephrology Fellowship Program, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, 2Division of Pediatric Nephrology, The University of Tennessee Health Sciences Center and 3The Children’s Foundation Research Center at the Le Bonheur Children’s Hospital, Memphis, TN, USA
Nephrotic syndrome is among the most common types of pediatric kidney disease. However, there are few published data on its incidence and racial patterns. This study examines the incidence and racial patterns of childhood steroid sensitive nephrotic syndrome (SSNS). For the period 1/1/1996 to 12/31/2006, a retrospective chart review was performed of children less than 10 years of age who presented to Le Bonheur Children’s Hospital in Memphis, TN with newly diagnosed SSNS. At the time of diagnosis, 38 children were found to reside in Shelby County, TN, with 31 children residing within the Memphis city limits. The annual incidence of SSNS in Shelby County was 2.4 cases/100,000 children. The incidence was higher in males (4.0/100,000) (p = 0.0002), children less than 5 years of age (3.6/100,000) (p = 0.007), and African Americans (3.7/100,000) compared to Caucasians (0.9/100,000) (p = 0.00006). These findings confirm that SSNS is a rare pediatric disease. They also suggest that the incidence of SSNS in Shelby County is comparable to that in prior reports. Our study is one of the first to show that SSNS may be more common in African Americans.Correspondence to:
John David Spencer, MD
Nationwide Children’s Hospital
700 Children’s Drive, Columbus, OH 43205, USA
Email: [email protected]
Original
Idiopathic nephrotic syndrome in children: review of 282 Croatian cases
Danko Batinić, Danko Milošević, Marijana Čorić, Mira Šćukanec-Špoljar, Paško Konjevoda, Danica Batinić, Ljiljana Nižić, Kristina Vrljičak, Maja Lemac and Daniel Turudić
Page No. 116
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2012 (116-121)
Idiopathic nephrotic syndrome in children: review of 282 Croatian cases
Danko Batinić1, Danko Milošević1, Marijana Čorić2, Mira Šćukanec-Špoljar2, Paško Konjevoda3, Danica Batinić1, Ljiljana Nižić1, Kristina Vrljičak1, Maja Lemac1 and Daniel Turudić1
1Department of Pediatrics, University of Zagreb School of Medicine, 2Department of Pathology and Cytology, University Hospital Center, and 3Institute Rudjer Bošković, Center for NMR, Zagreb, Croatia
Recent data suggests increased incidence of focal segmental glomerulosclerosis (FSGS) among children with idiopathic nephrotic syndrome (INS). To determine the causes and possible longitudinal changes in the etiology of INS, 282 Croatian children diagnosed with INS between 1990 and 2009 were evaluated. In total, 122 children were assessed as having minimal change nephrotic syndrome (MCNS) based on their initial presentation, laboratory findings and clinical course. Kidney biopsy was performed in the remaining 160 children. MCNS was present in 18.1% of all biopsies performed. Total incidence of MCNS (assessed + biopsy proven) was only 53.5%. In contrast, FSGS was found in 40.6% of all biopsies and accounted for 23.1% of all cases. Mesangial proliferative glomerulonephritis (MesPGN) was the third most common diagnosis, present in 26.9% of the biopsies, and accounted for 15.2% of all cases. There were no significant longitudinal differences in the incidence of different causes of INS. The overall response to steroids at presentation was 71.6%. A higher proportion of initial steroid responders among children with FSGS (43.1%) and MesPGN (67.4%) than previously reported was noted. A longitudinal tendency of increasing steroid resistance in FSGS and MesPGN groups was observed.Correspondence to:
Danko Batinić, MD
Department of Pediatrics
University of Zagreb School of Medicine
University Hospital Centre Zagreb
Kišpatićeva 12, Zagreb, Croatia
Email: [email protected]
Original
Long term effects of low protein diet on depressive symptoms and quality of life in elderly Type 2 diabetic patients
Tiziana Ciarambino, Pietro Castellino, Giuseppe Paolisso, Ludovico Coppola, Nicola Ferrara, Giuseppe Signoriello and Mauro Giordano
Page No. 122
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2012 (122-128)
Long term effects of low protein diet on depressive symptoms and quality of life in elderly Type 2 diabetic patients
Tiziana Ciarambino1, Pietro Castellino2, Giuseppe Paolisso1, Ludovico Coppola1, Nicola Ferrara3, Giuseppe Signoriello1 and Mauro Giordano1
1Department of Gerontology, Geriatrics and Metabolic Diseases, Second University of Naples, Naples, 2Department of Internal Medicine, University of Catania, Catania and 3S. Maugeri Foundation, Bioengeneering Department of Rehabilitation Institute of Telese, Italy
Objectives: The long term effects of a low protein diet (LPD) on depressive symptoms and the quality of life in elderly Type 2 diabetic are unclear. Methods: 38 elderly Type 2 diabetic patients with CRD (Stage 3 – 4) were enrolled in the study. After 4 weeks on a normal protein diet regimen (NPD) providing 1.0 g/kg per day, all participants were assigned for 30 months, randomly, to a LPD (0.7 g/kg per day), either 7 days a week (LPD 7/7) or 6 days a week (LPD 6/7). Mini mental state examination (MMSE), activities daily living (ADL), cumulative illness severity (CIRS-IS), geriatric depression scale (GDS-15) and short-form healthy survey (SF- 36) were evaluated every 3 months. Results: Before the LPD regimen creatinine clearance (CrCl), MMSE, ADL, CIRS-IS, GDS-15 and SF-36 were similar in both LPD 7/7 and LPD 6/7 groups. After 30 months, the mean GDS- 15 increased significantly more in LPD 7/7 group than in LPD 6/7 group (p < 0.05). Both mean SF-36 MCS and SF-36 PCS were decreased significantly more in LPD 7/7 group than in LPD 6/7 group (p < 0.05). After 30 months, the decline in CrCl observed was similar in LPD 7/7 and LPD 6/7 groups (2.77 ± 0.3 and 2.84 ± 0.3 ml/min/year, respectively). Conclusion: In elderly Type 2 diabetic patients, long term effects of LPD 6/7 regimen in comparison to LPD 7/7 are associated with a similar decline in CrCl, but with decreased depressive symptoms and a better quality of life.Correspondence to:
Mauro Giordano, MD
Associate Professor of Medicine
Second University of Naples
Department of Geriatrics and Metabolic Diseases
p.zza L. Miraglia, 80138 Naples, Italy
Email: [email protected]
Original
Second measurement of morning systolic blood pressure is more closely associated with albuminuria
Kazumi Sakabe, Michiaki Fukui, Emi Ushigome, Masahide Hamaguchi, Toru Tanaka, Haruhiko Atsuta, Masayoshi Ohnishi5, Yohei Oda, Goji Hasegawa and Naoto Nakamura
Page No. 129
Abstract
Second measurement of morning systolic blood pressure is more closely associated with albuminuria
Kazumi Sakabe1, Michiaki Fukui1, Emi Ushigome1, Masahide Hamaguchi2, Toru Tanaka3, Haruhiko Atsuta4, Masayoshi Ohnishi5, Yohei Oda6, Goji Hasegawa1 and Naoto Nakamura1
1Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, 2Immunology Frontier Research Center at Osaka University, 3Department of Diabetes, Endocrinology and Reumatology, Kyoto First Red Cross Hospital, 4Department of Metabolism, Endocrinology and Nephrology, Kyoto Second Red Cross Hospital, Kyoto, 5Department of Endocrinology and Hematology, Osaka General Hospital of West Japan Railway Company, Osaka, and 6Department of Cardiology, Social insurance Kyoto Hospital, Kyoto, Japan
Background/Aims: It is important to control blood pressure as well as to control blood glucose for the prevention of diabetic nephropathy. However, to our knowledge, there are no reports investigating which blood pressure, including morning, evening and clinic, is more closely associated with albuminuria and whether one measurement is sufficient or not in patients with Type 2 diabetes. Methods: We measured morning, evening and clinic blood pressure and compared the area under the curve (AUC) of blood pressure for urinary albumin excretion equal to or more than 30 mg/g creatinine using receiver-operating characteristic curve analyses and odds ratio for albuminuria defined as urinary albumin excretion equal to or more than 30 mg/g creatinine in 858 patients with Type 2 diabetes. Results: Odds ratio (95% confidence interval (CI)) of morning, evening and clinic systolic blood pressure for albuminuria was 1.034 (1.024 – 1.044), 1.033 (1.023 – 1.043) and 1.013 (1.055 – 1.021), respectively (p < 0.001 in all), and AUC of morning, evening and clinic systolic blood pressure was 0.644 (0.628 – 0.700) (p < 0.001 vs. clinic), 0.660 (0.623 – 0.696) (p < 0.001 vs. clinic) and 0.597 (0.559 – 0.636), respectively. AUC of the second morning systolic blood pressure was greater than the first (p = 0.033). Conclusion: The second measurement of morning systolic blood pressure is more closely associated with albuminuria than the first measurement of the morning in addition to clinic systolic blood pressure.Correspondence to:
Michiaki Fukui, MD, PhD
Department of Endocrinology and Metabolism
Kyoto Prefectural University of Medicine
Graduate School of Medical Science
465 Kajii-cho, Kawaramachi-Hirokoji
Kamigyo-ku, Kyoto 602-8566, Japan
Email: [email protected]
Original
Relationship between antioxidant enzyme genotype and activity and kidney function: a case-control study
Amanda Crawford, Robert G. Fassett, Jeff S. Coombes, Dale A. Kunde, Kiran D.K. Ahuja, Iain K. Robertson, Madeleine J. Ball and Dominic P. Geraghty
Page No. 135
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2012 (135-144)
Relationship between antioxidant enzyme genotype and activity and kidney function: a case-control study
Amanda Crawford1, Robert G. Fassett2,3, Jeff S. Coombes4, Dale A. Kunde1, Kiran D.K. Ahuja1, Iain K. Robertson1, Madeleine J. Ball1 and Dominic P. Geraghty1
1University of Tasmania, School of Human Life Sciences, Launceston, Tasmania, 2University of Queensland, School of Medicine, St. Lucia, 3Renal Medicine Royal Brisbane and Women’s Hospital, Brisbane, and 4University of Queensland, School of Human Movement Studies, St. Lucia, Queensland, Australia
Background: Oxidative stress is associated with the progression of chronic kidney disease (CKD). Links between antioxidant enzyme SNPs such as superoxide dismutase (SOD) Ala16Val, glutathione peroxidase (GPx) Pro197Leu and catalase C- 262T and CKD have not been investigated. This study compared antioxidant genotypes and activities of CKD patients with population controls, and determined their relationship to kidney function. Methods: CKD patients (n = 230) and controls (n = 224) were screened for the GPx, SOD and catalase SNPs. Plasma and red blood cell (RBC) GPx, RBC SOD and RBC catalase activities, and estimated glomerular filtration rate (eGFR) were measured. Results: Significantly more CKD patients (n = 5) had the GPx Leu/Leu genotype compared to controls (n = 0), and had lower eGFR (p = 0.054). CKD patients had significantly lower plasma GPx and RBC catalase activities compared to controls, whereas RBC GPx and RBC SOD activities were significantly higher in CKD patients (p < 0.001). Conclusions: CKD is associated with reduced plasma GPx and catalase activities and enhanced RBC GPx and SOD activities. Although, genotype frequencies were similar for both groups, lower eGFR was associated with the GPx Leu/ Leu genotype.Correspondence to:
Dominic Geraghty
Locked Bag 1320
School of Human Life Sciences
University of Tasmania
Launceston, TAS 7248, Australia
Email: [email protected]
Nephrology Education
Congenital adrenal hyperplasia: a rare cause of renal failure and a successful renal transplantation
Ozkan Gungor, Fatih Kircelli, Juan Jesus Carrero, Ender Hur, Hamad Dheir, Adnan Simsir, Firat Okmen, Huseyin Toz and Cuneyt Hoscoskun
Page No. 145
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2012 (145-148)
Congenital adrenal hyperplasia: a rare cause of renal failure and a successful renal transplantation
Ozkan Gungor1, Fatih Kircelli1, Juan Jesus Carrero2, Ender Hur1, Hamad Dheir1, Adnan Simsir3, Firat Okmen4, Huseyin Toz1 and Cuneyt Hoscoskun5
1Division of Nephrology, Ege University School of Medicine, Izmir, Turkey, 2Division of Renal Medicine, Center for Gender Medicine and Centre for Molecular Medicine, Karolinska Institutet, Sweden, 3Department of Urology, 4Department of Obstetrics and Gynecology, and 5Department of General Surgery, Ege University School of Medicine, Izmir, Turkey
Congenital adrenal hyperplasia belongs to a group of autosomal recessive disorders affecting steroid biosynthesis; a rare disease with a prevalence of 1 case per 16,000 population. A 30-year-old phenotypically male patient had been diagnosed with 11-β hydroxylase deficiency at the age of 16; presenting with ambiguous genitalia, growth retardation, presence of menstrual cycles, severe hypertension, hypokalemia and renal dysfunction. He developed endstage renal disease due to hypertension and was treated with hemodialysis for 3 y. After careful evaluation, he was approved to undergo renal transplantation. The patient has now finished 6th month after transplantation and is currently under follow-up at our outpatient clinic, having no problems related to the transplant. While early treatment to prevent hypertension is mandatory in patients with congenital adrenal hyperplasia, once renal failure occurs, renal transplantation may the best choice of treatment. In this study, we describe the first report of a successful renal transplantation in an adrenal hyperplasia.Correspondence to:
O. Gungor, MD
Ege University School of Medicine
Division of Nephrology
35100, Bornova, Izmir, Turkey
Email: ozkangungor@ yahoo.com.tr
Nephrology Education
Isolated idiopathic transient hyperphosphatasemia in an adult patient after renal transplantation: a case report
Hyeon Jeong Lee, Jong Woo Seo, Dong Won Lee, Hyun-Jung Kim, Dong Jun Park and Se-Ho Chang
Page No. 149
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2012 (149-153)
Isolated idiopathic transient hyperphosphatasemia in an adult patient after renal transplantation: a case report
Hyeon Jeong Lee1, Jong Woo Seo1, Dong Won Lee1, Hyun-Jung Kim1,2, Dong Jun Park1,2 and Se-Ho Chang1,2
1Department of Internal Medicine, School of Medicine, and 2Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
Transient hyperphosphatasemia (TH) is characterized by the isolated elevation of serum alkaline phosphatase (ALP) in children. There is no evidence of liver or bone disease and the ALP levels return to normal within 4 months. Few adult cases have been reported. Here, we report the case of TH in a 54-year-old woman, who for 4 years after receiving a renal transplant, was regularly followed up at a renal outpatient clinic. Her underlying disease was chronic glomerulonephritis, for which she was taking immunosuppressive drugs (cyclosporine and mycophenolate mofetil). Routine laboratory analyses revealed that her ALP level had risen to 909 IU/l, which is a seven-fold increase relative to the upper normal limit (35 – 130 IU/l). The levels of intact parathyroid hormone; the tumor markers CEA, α-FP, CA 19-9, and CA 125; and other serum parameters were normal. The patient lacked symptoms, relevant clinical signs, and evidence of acute infection or acute chronic gastrointestinal disease. Lymph node enlargement and malignancy were not detected on a physical examination and ultrasonographic analysis of the abdomen, respectively. A bone scan showed no evidence of bone pathology. ALP isoenzyme analysis by electrophoresis showed patterns similar to those seen in TH of infancy and childhood. The ALP levels of the patient returned spontaneously to 126 IU/l 5 months after diagnosis. While isolated hyperphosphatasemia in renal transplantation patients may be a benign condition, we recommend that such cases be differentially diagnosed from other diseases that can trigger hyperphosphatasemia, including malignancy, infection, bone and liver diseases.Correspondence to:
Se-Ho Chang, MD, PhD
Division of Nephrology
Department of Internal Medicine
School of Medicine
Gyeongsang National University
90 Chilam-dong, Jinju,
Gyeongsangnam-do, 660-702, Republic of Korea
Email: [email protected]
Nephrology Education
P2 purinoceptors: Renal pathophysiology and therapeutic potential
John W. R. Booth, Frederick W. K. Tam and Robert J. Unwin
Page No. 154
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2012 (154-163)
P2 purinoceptors: Renal pathophysiology and therapeutic potential
John W. R. Booth1, Frederick W. K. Tam2 and Robert J. Unwin1
1UCL Center for Nephrology, Royal Free Hospital, University College London and 2Imperial College Kidney and Transplant Institute, Hammersmith Hospital Campus, London, UK
P2 purinoceptors, categorized into P2X and P2Y receptors, bind extracellular ATP and related di- and tri-phosphate nucleotides and are expressed throughout the kidney. P2X receptors are non-selective cation channels and P2Y receptors are metabotropic G protein-coupled receptors. Both families may couple to a range of second messenger systems and provoke outcomes including cell proliferation, cytokine secretion, membrane channel regulation and cell death. The cellular response to ATP release may vary widely and depends on both the pattern of local receptor expression and the action of ectonucleotidases altering agonist availability, creating a finely tuned network. P2 signaling participates in disparate physiological processes, including control of water and solute transport and autoregulation of renal blood flow. Given the ubiquity, complexity and diversity of the P2 network, it is not surprising that P2 signaling also contributes to mechanisms of renal disease. This review summarizes the current evidence for P2 receptor involvement in a range of kidney diseases, and highlights areas that may lead to potential therapeutic advances. Particular attention is paid to the pro-inflammatory P2X7 receptor, currently at the heart of renal P2 pathophysiology and for which selective receptor antagonists are now available.Correspondence to:
Dr. John Booth
UCL Center for Nephrology
UCL Medical School, Royal Free Hospital
Rowland Hill Street, London NW3 2PF, UK
Email: [email protected]
Nephrology Education
Retroperitoneal sarcoma presenting as acute renal failure, secondary to bilateral renal artery invasion
Amit Gupta, Omar Pacha, Rony Skaria, Tam Huynh, Luan Truong and Abdul Abdellatif
Page No. 164
Abstract
Clinical Nephrology, Vol. 78 – No. 2/2011 (164-168)
Retroperitoneal sarcoma presenting as acute renal failure, secondary to bilateral renal artery invasion
Amit Gupta1, Omar Pacha1, Rony Skaria1, Tam Huynh3,4, Luan Truong5,6 and Abdul Abdellatif1,2
1Department of Medicine, 2Division of Nephrology, 3Department of Surgery, 4Division of Vascular and Endovascular Surgery, Baylor College of Medicine, 5Department of Pathology and 6Division of Nephropathology, The Methodist Hospital, Houston, TX, USA
Retroperitoneal sarcoma is a rare tumor accounting for 10 – 15% of all soft tissue malignancies with an incidence of 2.5 per million. Of those, liposarcoma is the most common type of retroperitoneal sarcoma accounting for 41% of cases. It usually presents late with vague symptoms such as abdominal discomfort or palpable mass. Vascular invasion is seen in 18% of retroperitoneal sarcomas but acute renal failure secondary to bilateral renal artery invasion/stenosis by these tumors has never been described yet. In this report, we describe the first case, to our knowledge, in the medical literature and discuss epidemiology, diagnosis, and management. Treatment is primarily surgical and the ability to completely resect the tumor is the most important predictor of survival. Active clinical trials are currently testing the use of adjunct chemotherapy and radiotherapy to improve morbidity and mortality.Correspondence to:
A. Abdellatif, MD, FASN
Department of Medicine
Baylor College of Medicine
One Baylor Plaza, BCM 620
Houston, TX 77030, USA
Email: [email protected]
