Volume 78 (2012), No. 5/2012(November)
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
Change in ankle-brachial index over time and mortality in diabetics with proteinuria
Sirin Jiwakanon, Sharon Adler and Rajnish Mehrotra
Page No. 335
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (335-345)
Change in ankle-brachial index over time and mortality in diabetics with proteinuria
Sirin Jiwakanon1,2, Sharon Adler2,3 and Rajnish Mehrotra2,3
1Hatyai Hospital, Hatyai, Songkhla, Thailand, 2Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, and 3David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Peripheral arterial disease is common in diabetic chronic kidney disease (CKD) and is characterized either by abnormally low or high ankle-brachial index (ABI). Whether low or high ABI carries similar prognostic value is unknown. The association of baseline ABI with all-cause mortality over 40 ± 21 months (mean ± SD) was ascertained in 167 proteinuric diabetics (age 57 ± 7 years; median urine protein-creatinine, 2.5 mg/mg). Association of change in ABI with all-cause mortality was determined in 75 subjects with normal ABI (0.9 – 1.3) at baseline. Among 167 participants, 41% had an abnormal ABI: < 0.9, 18%; and > 1.3 or non-compressible arteries, 23%. Only individuals with low ABI had a significantly higher risk for all-cause mortality (hazards ratio (95% confidence interval), HR: 2.23 (1.07, 4.65)). In subjects with normal ABI at baseline with follow-up measurement (n = 75), vascular disease worsened in 39% over 23 ± 6 months: 17% had either a decrease in ABI by ≥ 0.1 or a final ABI < 0.9, and 21% had a final ABI > 1.3 or noncompressible arteries. Only individuals who had a decrease in ABI over time had a significantly higher risk for death (adjusted HR, 7.41 (1.63, 33.65)). Peripheral arterial disease is not uncommon and progresses rapidly in individuals with diabetes and proteinuria. Low or declining ABI is a strong predictor of all-cause mortality. Routine measurement of ABI is a simple bed-side procedure that may permit easy risk-stratification in diabetic CKD patients.Correspondence to:
Rajnish Mehrotra, MD
Division of Nephrology and Hypertension
Los Angeles Biomedical
Research Institute at Harbor-UCLA
1124 W Carson Street, Torrance, CA 90502, USA
Email: [email protected]
Original
The association between albumin to creatinine ratio and total protein to creatinine ratio in patients with chronic kidney disease
Sun Moon Kim, Chang-Hoon Lee, Jung Pyo Lee, Yun Kyu Oh, Yon Su Kim, Suhnggwon Kim and Chun Soo Lim
Page No. 346
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (346-352)
The association between albumin to creatinine ratio and total protein to creatinine ratio in patients with chronic kidney disease
Sun Moon Kim1, Chang-Hoon Lee2,3, Jung Pyo Lee2,3, Yun Kyu Oh2,3, Yon Su Kim3, Suhnggwon Kim3 and Chun Soo Lim2,3
1Department of Internal Medicine, Chungbuk National university Hospital, Cheongju, 2Department of Internal Medicine, Seoul National University Boramae Medical Center, and 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Aims: Although albumin to creatinine ratio (ACR) and total protein to creatinine ratio (PCR) in random urine have been supposed as alternatives to 24-h urine measurements, there are few studies comparing these tests in CKD patients. Therefore, we investigated the relations between ACR and PCR in CKD patients and the factors that affect the relationship. Methods: We enrolled 808 patients with CKD prospectively and compared ACR, PCR and urine dipstick test in random urine. Results: Albuminuria was well correlated with proteinuria (β = 1.114, p < 0.001). The association between albuminuria and proteinuria was greater in patients with following characteristics: dipstick protein positive compared with negative (p < 0.001 for interaction), urine creatinine level ≥ 60 mg/dl compared with < 60 mg/dl (p = 0.024 for interaction) and estimated glomerular filtration rate < 60 ml/min/1.73 m2 compared with ≥ 60 ml/min/1.73 m2 (p = 0.040 for interaction). However, the association between albuminuria and proteinuria was not affected by sex, the presence of diabetes, or old age (≥ 60 years). Conclusions: Both ACR and PCR in random urine are correlated well and can be used for monitoring of protein excretion in CKD patients, alternatively. However, the correlation is not strong in patients with low amount of protein excretion or with low urinary creatinine concentration.Correspondence to:
Prof. Dr. Chun Soo Lim
Department of Internal Medicine
Seoul National University Boramae Medical Center
425 Sindaebang2-dong
Dongjakgu, Seoul 156-707, Korea
Email: [email protected]
Original
Higher HOMA-IR index and correlated factors of insulin resistance in patients with IgA nephropathy
Yue Yang, Ri-bao Wei, Yuan-da Wang, Xue-guang Zhang, Na Rong, Li Tang and Xiang-mei Chen
Page No. 353
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (353-358)
Higher HOMA-IR index and correlated factors of insulin resistance in patients with IgA nephropathy
Yue Yang*, Ri-bao Wei*, Yuan-da Wang, Xue-guang Zhang, Na Rong, Li Tang and Xiang-mei Chen
State Discipline and State Key Laboratory of Kidney Disease (Chinese PLA General Hospital, 2011DAV00088), Beijing, China
*These authors contributed equally to this work as the first author.
Objective: To investigate the index of homeostasis model of insulin resistance (HOMA-IR) in IgA nephropathy (IgAN) patients, and to explore the possible correlated factors contributing to insulin resistance (IR) within these patients. Material: There were 255 IgAN patients and 45 membranous nephropathy (MN) patients in our database. We identified 89 IgAN subjects and 21 MN subjects without diabetes and undergoing glucocorticoid therapy for at least 6 months. Methods: Data regarding physical examination, blood chemistry and renal pathology were collected from 89 IgAN subjects and 21 MN subjects. Then 62 IgAN patients and 19 MN patients with chronic kidney disease (CKD) Stage 1 – 2 were selected for the comparison of HOMA-IR index, 89 IgAN patients were selected for multiple regression analysis to test for correlated factors of HOMA-IR index with IgAN patients. Results: Comparison between IgAN and MN show that HOMA-IR index was significantly higher in IgAN patients with CKD Stage 1 – 2. After logarithmic transformation with urine protein (UPr), Ln(UPr) (b = 0.186, p = 0.008), eGFR (b = –0.005, p = 0.014), > 50% of glomeruli with mesangial hypercellularity (b = 0.285, p = 0.027) and body mass index (BMI) (b = 0.039, p = 0.008) were correlated factors of HOMA-IR index in the multiple regression analysis. Conclusion: IgAN patients had higher HOMA-IR index compared with MN in the stages of CKD 1 – 2. For IgAN patients, more UPr, lower eGFR, > 50% of glomeruli with mesangial hypercellularity and higher BMI were correlated with IR.Correspondence to:
Ri-bao Wei, MD
State Discipline and State Key Laboratory of Kidney Disease
Chinese PLA General Hospital, 2011DAV00088
Beijing, China, 100853
Email: [email protected]
Original
Are Canadian pediatric nephrology patients really overweight?
Abeer Yasin, Andréanne Benidir and Guido Filler
Page No. 359
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (359-364)
Are Canadian pediatric nephrology patients really overweight?
Abeer Yasin, Andréanne Benidir and Guido Filler
Department of Pediatrics, Division of Pediatric Nephrology, Children’s Hospital, London Health Science Centre, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
Aims: To assess the influence of height age and short stature on BMI z-scores in children with chronic kidney disease (CKD) in view of the pandemic increase of childhood obesity. Materials: Pediatric nephrology patients older than 2 years of age from 2 tertiary centers in Ontario and age- and gender matched controls from a local reference population. Methods: We estimated height, weight and body mass index (BMI) z-scores of 705 nephrology patients (319 female) and 4,196 controls aged 2.01 – 19.92 years with chronological and height-adjusted age (corresponding age for a given height plotted on the 50th percentile). The National Health and Nutrition Examination Survey (NHANES III) was used for the z-score Estimation. Results: Chronological age-based patient weight z-scores were significantly heavier than in the NHANES data (median weight z-score +0.29, BMI z-score +0.51; significantly non-zero), not significantly different from height-adjusted age-based BMI z-score (+0.51). The children with kidney problems were shorter (–0.10 SD) than controls. Conclusion: The proportion of overweight nephrology patients was similar to matched controls and BMI z-score diminished with worsening GFR.Correspondence to:
Dr. Guido Filler, MD, PhD, FRCPC
Children’s Hospital, London Health Sciences Centre
University of Western Ontario
800 Commissioner’s Road East, Rm E6-104
London ON, Canada, N6A 5W9
Email: [email protected]
Original
Respiratory compensation to a primary metabolic alkalosis in humans
Mark Feldman, Naiara M. Alvarez, Michael Trevino and Gary L. Weinstein
Page No. 365
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (365-369)
Respiratory compensation to a primary metabolic alkalosis in humans
Mark Feldman, Naiara M. Alvarez, Michael Trevino and Gary L. Weinstein
Texas Health Presbyterian Hospital of Dallas, Dallas, TX, USA
There is limited and disparate information about the extent of the respiratory compensation (hypoventilation) that occurs in response to a primary metabolic alkalosis in humans. Our aim was to examine the influence of the plasma bicarbonate concentration, the plasma base excess, and the arterial pH on the arterial carbon dioxide tension in 52 adult patients with primary metabolic alkalosis, mostly due to diuretic use or vomiting. Linear regression analysis was used to correlate degrees of alkalosis with arterial carbon dioxide tensions. In this alkalotic cohort, whose arterial plasma bicarbonate averaged 31.6 mEq/l, plasma base excess averaged 7.8 mEq/l, and pH averaged 7.48, both plasma bicarbonate and base excess correlated closely with arterial carbon dioxide tensions (r = 0.97 and 0.96, respectively; p < 0.0001), while there was little relationship between arterial pH and arterial carbon dioxide tensions (p = 0.08). The arterial carbon dioxide tension increased 1.2 torr for each 1.0 mEq/l increment in plasma bicarbonate or base excess (95% confidence interval, 1.1 – 1.3 torr). This 1.2 torr increase amounts to a ~ 50% greater degree of espiratory compensation (hypoventilation) to primary metabolic alkalosis than has been reported in prior smaller studies.Correspondence to:
Mark Feldman, MD
8200 Walnut Hill Lane
Dallas, TX 75231, USA
Email: [email protected]
Original
Survival akin to injury, hospitalized patients with acute kidney injury based on the AKIN classification
Muhammad Shahed Ahmed, Rebecca Lim, Veenesh Selvaratnam, Angharad James, Patrick O. Kelly, Kottarathil A. Abraham and Christopher F. Wong
Page No. 370
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (370-375)
Survival akin to injury, hospitalized patients with acute kidney injury based on the AKIN classification
Muhammad Shahed Ahmed1, Rebecca Lim2, Veenesh Selvaratnam2, Angharad James2, Patrick O. Kelly3, Kottarathil A. Abraham2 and Christopher F. Wong2
1Department of Nephrology, Royal Liverpool University Hospital, 2Department of Nephrology, University Hospital Aintree, Liverpool, UK, and 3Beaumont Hospital, Dublin, Republic of Ireland
Introduction: Acute kidney injury (AKI) is often associated with severe consequences. The aim of the study was to determine whether the acute kidney injury network classification predicts hospital stay, renal recovery and mortality. Methods: Hospitalized patients who were referred to the nephrology service over 6 months were studied retrospective with further 12 months prospective follow up. Statistical analysis was performed on their demography and outcome. Results: Among the 238 patients who were referred, 166 had AKI, median age 74 years and 32% were diabetics. 10% (n = 17) required acute renal replacement therapy. The overall all-cause mortality of AKI group (n = 166) compared to non-AKI group (n = 72) at 1 year was 55% as opposed to 27.8% (p < 0.001). There was a significant statistical difference in the composite outcome and survival between the AKI stages in terms of renal recovery (p = 0.018). The AKI group had a median 8 day increase in length of stay compared to the non-AKI group (20 vs. 12 days; p = 0.0175). However, there was no significant statistical difference between pre and post admission AKI (p value = 0.191). Conclusion: The AKIN staging of AKI predicts both early and late mortality. AKI has a major impact on inpatient and 1-year-survival, renal recovery and length of stay. AKI and renal recovery following the insult were independent prognosticators. Early identification and management of AKI cases can help to prevent progression of the severity of AKI and therefore, mandates timely referral to nephrology team to prevent progression of AKIN class and its consequences.Correspondence to:
Muhammad Shahed Ahmed
Department of Nephrology
Royal Liverpool University Hospital, UK L7 8XP
Email: [email protected]
Original
Renal effects of high-dose celecoxib in elderly men with Stage D2 prostate carcinoma
Payam Benson, Michael Yudd, Derrick Sims, Victor Chang, Shanthi Srinivas and Basil Kasimis
Page No. 376
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (376-381)
Renal effects of high-dose celecoxib in elderly men with Stage D2 prostate carcinoma
Payam Benson1, Michael Yudd1, Derrick Sims2, Victor Chang1, Shanthi Srinivas1 and Basil Kasimis1
1Veterans Affairs New Jersey Health Care System, Department of Medicine, East Orange and 2Hackensack University Medical Center, Hackensack, NJ, USA
Aim: To prospectively study the clinical renal effects of daily high-dose celecoxib, a COX-2 inhibitor, in a cohort of elderly sick men (mean age 74.5 years) with advanced prostate cancer. Material and method: 44 men with advanced hormoneresistant prostate cancer participated in oncologic Phase II trials. All received celecoxib 400 mg bid for a median 6 months. Monthly laboratory measurement and blood pressure were monitored, and all cases of acute kidney injury (creatinine > 50% above baseline) and hyperkalemia (potassium > 5.5 mmol/l) were evaluated. Mean chemistries, BP, and estimated GFR (e-GFR) during treatment were compared to 6-month periods before and after treatment. Results: There was no change in e-GFR (pre, 78.1 ± 22 ml/min; during treatment, 76 ± 19 ml/min). Serum K rose (4.25 ± 0.4 mmol/l to 4.39 ± 0.3 mmol/l, p = 0.03), and bicarbonate fell (28.16 ± 0.2 to 26.18 ± 0.2 mmol/l, p < 0.01) with treatment. 15% of patients developed AKI, close to the incidence of AKI episodes in the pre- (9%) and post-treatment periods (13%). AKI was mild, short-lived, and reversible, except in a terminal patient who withdrew. All AKI occurred in states of renal hypoperfusion, and were not related to celecoxib alone. Hyperkalemia developed in 9% of patients. No patient developed new-onset proteinuria. Conclusion: High-dose celecoxib for 6 months was relatively well tolerated. e-GFR remained stable and there were minor electrolyte alterations. Although the AKI incidence was much higher than other studies, it was not much higher than in the pre- and post-treatment periods (high “background noise”). All AKI occurred in states of renal hypoperfusion, not unexpected for prostaglandin inhibitors.Correspondence to:
Dr. Michael Yudd
Veterans Affairs New Jersey Health Care System
Department of Medicine/111
385 Tremont Ave, East Orange, NJ 07018, USA
Email: [email protected]
Original
Efficacy and safety of lanthanum carbonate in German patients on dialysis
Frank Dellanna, Helmut Reichel and Frank Seibt
Page No. 382
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (382-390)
Efficacy and safety of lanthanum carbonate in German patients on dialysis
Frank Dellanna1, Helmut Reichel2 and Frank Seibt3
1Dialysis Center Karlstraße, Düsseldorf, 2Nephrology Center, Villingen-Schwenningen, and 3Dialysis Center Am Treptower Park, Berlin, Germany
Aims: To assess the treatment efficacy and tolerability of lanthanum carbonate (LC) in patients with end-stage renal disease (ESRD) and hyperphosphatemia under daily-practice conditions. Patients and methods: 698 patients on dialysis in 116 outpatient dialysis centers in Germany were enrolled in this post-marketing surveillance study (mean treatment duration 6 months). LC treatment was compared to pretreatment (no or other phosphate binders) regarding laboratory parameters, adverse events and tablet burden. Results: Compared to baseline, LC significantly reduced mean serum phosphate (SP), serum calcium, and calcium × phosphate product (p < 0.0001). In monotherapy with LC, mean tablet burden was decreased to 3.0 tablets per day thus reducing the mean pre-study phosphatebinder tablet burden by nearly 50%. Adverse drug reactions associated with LC were reported in only 2.0% of the patients (n = 14). Overall, LC was considered safe and well tolerated. Conclusions: Under daily-practice conditions, LC at an average dose of 2,509 ± 936 mg/d was well tolerated and effective in adjusting and maintaining control of SP in patients previously being unsatisfactorily controlled on other phosphate binders. The daily tablet burden with a phosphate binder can be reduced to 3 tablets of LC, particularly in patients on monotherapy. The lack of a comparison group should be considered in terms of careful interpretation of the study results.Correspondence to:
Prof. Dr. med. Frank Dellanna
Dialysezentrum Karlstraße
Karlstraße 17-19
40210 Düsseldorf, Germany
Email: [email protected]
Original
Long-term outcome of Hepatitis B-positive renal allograft recipients after development of antiviral treatment
Kyung Sun Park, Duck Jong Han, Jae Berm Park, Jung Sik Park and Su-Kil Park
Page No. 391
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (391-398)
Long-term outcome of Hepatitis B-positive renal allograft recipients after development of antiviral treatment
Kyung Sun Park1, Duck Jong Han2, Jae Berm Park2, Jung Sik Park1 and Su- Kil Park1
1Division of Nephrology, Department of Internal Medicine, and 2Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
Background/Aims: Hepatitis B virus (HBV) infection can adversely affect the clinical outcome of kidney transplantation (KT). Short-term efficacy of lamivudine has been demonstrated for chronic hepatitis B in KT recipients (KTR). Methods: To clarify the long-term impact of antiviral treatment for HBV-positive KTR, we retrospectively reviewed 94 HBV-positive (male 73%) and 282 age/sex-matched HBV-negative patients who underwent KT from February 1997 to November 2009, after lamivudine had come into wide use. Results: Mean follow-up was 75.7 months. 56 patients received antiviral agent for prophylaxis, and other 18 for HBV reactivation. During follow-up, 15 died, with 5 deaths being HBV related. Although the patient survival rate was lower for HBVpositive than HBV-negative KTRs (89% vs. 94% at 5 years, 78% vs. 88% at 10 years, p = 0.031), graft survival was comparable (86% vs. 92% at 5 years, 73% vs. 81% at 10 years, p = 0.113). In multivariate analysis, HBsAg positivity was a significant risk factor for patient death (OR 2.19, 95% CI 1.14 – 4.20, p = 0.019), but not significant for graft loss (OR 1.64, 95% CI 0.94 – 2.86, p = 0.079). Of the 26 hepatitis B e antigen (HBeAg)-positive patients, 14 experienced HBV reactivations, but all survived with stable liver chemistry, except for one who died of hepatocellular carcinoma. Among 57 HBeAg-negative patients, 12 died, whereas the remaining 45 survived without hepatic dysfunction. Conclusion: Long-term outcomes of HBV-positive KTRs may be favorable after antiviral agents have been introduced.Correspondence to:
Su-Kil Park, MD, PhD
Division of Nephrology
Department of Internal Medicine
University of Ulsan college of Medicine
Asan Medical Center
388-1 Poongnap-2 dong,
Songpa-gu, Seoul, 138-736, South Korea
Email: [email protected]
Nephrology Education
Prolonged hypophosphatemia following parathyroidectomy in chronic hemodialysis patients
Linda Shavit, Meyer Lifschitz and Itzchak Slotki
Page No. 399
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (399-405)
Prolonged hypophosphatemia following parathyroidectomy in chronic hemodialysis patients
Linda Shavit, Meyer Lifschitz and Itzchak Slotki
Adult Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
Background and objectives: Hypoparathyroidism in patients with functioning kidneys leads to hyperphosphatemia. This paper reviews data suggesting that hypoparathyroidism in patients on maintenance dialysis leads to hypophosphatemia. Design: Clinical data in two patients on dialysis with hypoparathyroidism following parathyroid surgery; literature review of dialysis patients with hypoparathyroidism following parathyroid surgery. Results: In the patients presented both here and in the literature, hypoparathyroidism in dialysis patients is associated with persistent hypophosphatemia or decrease in serum phosphorus from its pre-surgery level. Conclusion: In patients on maintenance dialysis, persistent hypoparathyroidism post-parathyroidectomy may lead to chronic hypophosphatemia, in contrast to the hyperphosphatemia usually associated with hypoparathyroidism. Proposed mechanisms for this paradoxical phenomenon include ongoing phosphorus deposition into bone (Hungry Bone Syndrome), phosphorus deposition into soft tissue and/or diminished intestinal phosphorus absorption or increased intestinal phosphorus loss. Correspondence to:
Linda Shavit, MD
PO Box 3235, Adult Nephrology
Shaare Zedek Medical Center
Jerusalem, Israel
Email: [email protected]
Nephrology Education
Recurrent posterior reversible encephalopathy syndrome in nephrotic syndrome: case report and review of the literature
Akio Yamada, Megumi Atsumi, Atsushi Tashiro, Tomoko Hiraiwa and Norishi Ueda
Page No. 406
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (406-411)
Recurrent posterior reversible encephalopathy syndrome in nephrotic syndrome: case report and review of the literature
Akio Yamada1, Megumi Atsumi1, Atsushi Tashiro1, Tomoko Hiraiwa1 and Norishi Ueda2
1Department of Pediatrics, Social Insurance Chukyo Hospital and 2Department of Developmental Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
Sequential neuroimaging before and after seizures has not been reported in patients with nephrotic syndrome and recurrent posterior reversible encephalopathy syndrome (PRES). We report a 13-year-old nephrotic female patient with recurrent PRES during and after cessation of cyclosporine A (CyA). She had headache, visual disturbance and acute hypertension, followed by seizures. The brain magnetic resonance imaging (MRI) before seizures revealed a high signal intensity area on fluid-attenuated inversion recovery and diffusion-weighted images and a low signal intensity area on T1-weighted images in bilateral parieto-occipital and left temporal lobes. Cessation of CyA resulted in clinical improvement. The follow-up MRI 2 months after the initial episode showed a complete resolution. Six months later, she had similar symptoms, edema, severe hypoalbuminemia, renal insufficiency, and acute pancreatitis before seizures. The brain MRI after seizures showed similar abnormalities in the same regions, which completely resolved 2 months later. Recurrence of acute severe hypertension, nephrotic state (edema/ hypoalbuminemia), and renal insufficiency may lead to recurrent PRES and thus early treatment of trigger factors, especially of hypertension, is important to reduce the episodes of PRES. Correspondence to:
Akio Yamada, MD
Department of Pediatrics
Social Insurance, Chukyo Hospital
1-1-10, Sanjou, Minami-ku,
Nagoya, Aichi 457-8510, Japan
Email: akio_yamada@ chukyo-hosp.jp
Nephrology Education
Pharmacokinetic effect of voriconazole on cyclosporine in the treatment of aspergillosis after renal transplantation
Seok J. Park, Im-Sook Song, Sun W. Kang, Hyun Joo, Tae H. Kim, Young C. Yoon, Euiyong Kim, Yeong-Lim Choi, Jae-Gook Shin, Ji H. Son and Yeong H. Kim
Page No. 412
Abstract
Pharmacokinetic effect of voriconazole on cyclosporine in the treatment of aspergillosis after renal transplantation
Seok J. Park1,2*, Im-Sook Song3*, Sun W. Kang1, Hyun Joo4, Tae H. Kim1, Young C. Yoon2, Euiyong Kim4, Yeong-Lim Choi3, Jae-Gook Shin3, Ji H. Son3 and Yeong H. Kim1,2
1Department of Nephrology, 2Organ Transplantation Center, 3Department of Pharmacology and PharmacoGenomics Research Center, and 4Department of Physiology, College of Medicine, Inje University, Busan Baik Hospital, Busan, Republic of Korea
*These two authors contributed equally to this work and are considered co-first authors.
Azole antifungal agents are essential drugs in the treatment of fungal infections in renal transplant patients. As azoles, these antifungal agents are inhibitors of CYP3A4 and P-glycoprotein (P-gp); and thus therapeutic drug monitoring is important. We evaluated a patient with cutaneous and pulmonary aspergillosis who was successfully treated with voriconazole and a low cyclosporine trough level (3.2 – 27.9 ng/ml) for 3 months. During that period, the patient showed good allograft function with the co-administration of voriconazole and cyclosporine. We measured the patient’s genotype of MDR1, CYP3A4, CYP3A5 and CYP2C19 enzymes in addition to the intracellular concentration of cyclosporine in peripheral blood mononuclear cells (PBMCs). The intracellular concentration of cyclosporine in PBMC is 3.2 times higher with no functionally defected alleles in MDR1, CYP3A4, CYP3A5 or CYP2C19 enzymes when cyclosporine is co-administered with voriconazole ex vivo. Although other confounding factors causing immunological modulation may exist, it is plausible that low serum and high intracellular cyclosporine concentrations, due to the inhibition of P-gp activity by voriconazole, also contribute to an immunosuppressive state. Correspondence to:
Sun W. Kang, MD or Yeong H. Kim, MD
Department of Nephrology, College of Medicine
Inje University
Busan 614-735, Republic of Korea
Email: kswnephrology@ hotmail.com, yeonghnl @inje.ac.kr
Nephrology Education
Autotransplantation for the treatment of severe renal artery stenosis in a solitary kidney after repeated percutaneous transluminal angioplasty: a case report
Michael Nguyen Quang, Bernd Krüger, Martin Wenning, Christopher D. Krüger, Faruk Tokmak, Klaus Kisters, Andreas Wunsch, Peter Schenker, Richard Viebahn and Bernhard K. Krämer
Page No. 418
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 (418-422)
Autotransplantation for the treatment of severe renal artery stenosis in a solitary kidney after repeated percutaneous transluminal angioplasty: a case report
Michael Nguyen Quang1, Bernd Krüger5, Martin Wenning1, Christopher D. Krüger2, Faruk Tokmak1, Klaus Kisters3, Andreas Wunsch4, Peter Schenker4, Richard Viebahn4 and Bernhard K. Krämer5
1Department of Medicine I, 2Department of Radiology, Marienhospital Herne, Ruhr-University Bochum, Bochum, 3Department of Medicine I, St. Anna Hospital, Herne, 4Department of Surgery, Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-University Bochum, Bochum and 5V. Medizinische Klinik, Mannheim University Hospital, University of Heidelberg, Heidelberg, Germany
A 66-year-old female suffering from massive atherosclerosis with a long history of renal artery stenosis in the left solitary kidney was admitted to reevaluate an in-stent restenosis. Advanced peripheral arterial disease had formerly been treated by aortobifemoral bypass surgery and a highly eccentric infrarenal abdominal aortic stenosis of 70 – 80% had been treated by patch angioplasty. In this patient several percutaneous transluminal renal angioplasties after a former stent deployment had resulted in recurrent in-stent restenoses. The renal artery stenosis was reevaluated and a re-angioplasty attempt was unsuccessful due to technical failure. Blood pressure remained difficult to manage. Renal function decreased as a result of presumed acute renal failure. A further progression of the renal artery stenosis was found. Autotransplantation to the left iliac fossa was done, because aortorenal bypass was considered impossible. Renal function normalized and follow-up Doppler ultrasonography examinations revealed a newly developed ostial anastomotic stenosis of 60 – 70%. While medical therapy and percutaneous transluminal angioplasty with stent deployment are common treatment options, surgical interventions are reserved for cases of complex stenoses. Autotransplantation as a complex option in the treatment of renal artery stenosis seems to be an adequate alternative in patients with severe, generalized atherosclerosis after failure of interventional procedures and the impossibility of standard surgical techniques.Correspondence to:
Dr. med. M. Nguyen Quang
Department of Medicine I
Marienhospital Herne, Ruhr-University Bochum
Hölkeskampring 40, 44625 Herne, Germany
Email: [email protected]
Letter to the Editor
Letter to the editor concerning the article “Renal endarteritis with acute endocapillary proliferative glomerulonephritis” by Kawaguchi et al., Clin Nephrol. 2012; 77: 151-155 and authors response
Yoichi Iwafuchi, Takashi Morita and Akira Kamimura
Page No. 423
Abstract
Clinical Nephrology, Vol. 78 – No. 5/2012 – Letter to the editor
Letter to the editor concerning the article “Renal endarteritis with acute endocapillary proliferative glomerulonephritis” by Kawaguchi et al., Clin Nephrol. 2012; 77: 151-155 and authors response
Yoichi Iwafuchi1, Takashi Morita2 and Akira Kamimura1
1Department of Internal Medicine, Koseiren Sanjo General Hospital, Sanjo, and 2Department of Pathology, Shinrakuen Hospital, Niigata, Japan
