Volume 78 (2012), No. 4/2012(October)
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Editorial
Vernon M. Pais Jr.
Page No. 253
Abstract
Vernon M. Pais Jr.
Editorial
Vernon M. Pais Jr.
Original
Vascular stiffness in incident peritoneal dialysis patients over time
Mila Tang, Alexandra Romann, Giusy Chiarelli, Ognjenka Djurdjev, Monica Beaulieu Mhairi Sigrist, Paul Taylor, Suneet Singh and Adeera Levin
Page No. 254
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (254-262)
Vascular stiffness in incident peritoneal dialysis patients over time
Mila Tang1, Alexandra Romann2, Giusy Chiarelli3*, Ognjenka Djurdjev2, Monica Beaulieu1,2, Mhairi Sigrist1, Paul Taylor1, Suneet Singh1 and Adeera Levin1,2
1Division of Nephrology, University of British Columbia, 2BC Provincial Renal Agency, Vancouver, Canada, and 3Nephrology and Dialysis Unite, Ospedale di Circolo di Melegnano, Milano, Italy
Objective: Vascular stiffness is prevalent in end-stage renal disease patients and predicts adverse events. This study describes the prevalence of vascular stiffness and its associated factors in a cohort of incident peritoneal dialysis (PD) patients. Methods: In a prospective observational study of 50 patients, carotid-femoral pulse wave velocity (PWV) were conducted at baseline, 3, 6 and 12 months after initiation of PD. Aortic calcification scores (ACS) were derived using plain lateral abdominal films. We examined the association of significant changes in PWV (defined as 1 m/s or 15% change from baseline) over 6 months in conjunction with demographic and clinical data. Results: The mean age was 58 years, 67% were male, and 48% were Caucasian. One third was diabetic, and 23% had pre-existing cardiovascular disease. Median eGFR was 8.7 ml/ min. ACS was strongly correlated with PWV (r = 0.62, p < 0.0001). Over 6 months, 42% demonstrated significant increases, while 23% demonstrated decreases in their PWV. Factors shown to be associated with increasing PWV were Caucasian race (OR = 4.50; CI: 0.97 – 20.83), higher phosphate (OR = 8.36; CI: 1.10 – 63.51) and a lower baseline PWV (OR = 0.67; CI: 0.45 – 0.99). Decrease in PWV was associated with the absence of calcium based phosphate binder usage (OR = 0.11; CI: 0.02 – 0.73). Changes in weight and PWV at 12 months were significantly correlated (p = 0.007, r = 0.57). Conclusion: In this group of incident PD patients, we demonstrate a lower prevalence of vascular calcification than in hemodialysis patients, a correlation of calcification with PWV, and an important finding that PWV can change in either direction over a short period of time, which are associated with modifiable risk factors.Correspondence to:
Mila Tang
St. Paul’s Hospital
1081 Burrard Street, Comox Rm. 302
Vancouver, B.C. V6Z 1Y6, Canada
Email: [email protected]
Original
Effect of a treatment strategy consisting of pravastatin, vitamin E, and homocysteine lowering on arterial compliance and distensibility in patients with mild-to-moderate chronic kidney disease
Susanna J.E. Veringa, Prabath W.B. Nanayakkara, Frans J. van Ittersum, Irene L. Vegting, Coen van Guldener, Yvo M. Smulders Piet M. ter Wee and Coen D.A. Stehouwer
Page No. 263
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (263-272)
Effect of a treatment strategy consisting of pravastatin, vitamin E, and homocysteine lowering on arterial compliance and distensibility in patients with mild-to-moderate chronic kidney disease
Susanna J.E. Veringa1, Prabath W.B. Nanayakkara1,2, Frans J. van Ittersum3, Irene L. Vegting1, Coen van Guldener4, Yvo M. Smulders1,2, Piet M. ter Wee3 and Coen D.A. Stehouwer5
1Department of Internal Medicine, 2The Institute for Research in Extramural Medicine, 3Department of Nephrology, VU University Medical Center, Amsterdam, 4Department of Internal Medicine, Amphia Hospital, Breda, and 5Department of Internal Medicine and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
Background: Arterial stiffness is increased in chronic kidney disease (CKD). Intervention studies aimed at reduction of arterial stiffness in dialysis patients have been disappointing. We therefore investigated the effect of pravastatin, vitamin E, and homocysteine lowering on arterial compliance and distensibility coefficients in mild-to-moderate CKD. Methods: This is a sub-study of the ATIC study, a randomized, double-blind trial in 93 CKD patients. The treatment group received pravastatin to which vitamin E supplementation was added after 6 months and homocysteine lowering therapy after another 6 months. Measurement of the distensibility coefficient (DC) and the compliance coefficient (CC) of the common carotid (CCA), femoral (FA) and brachial artery (BA) was performed at 0, 6, 12, 18 months. Young’s elastic modulus (YEM) was measured in the common carotid artery. Results: After 18 months, CCA-DC increased from mean (SD) 15.15 (6.67) to 16.52 (6.37) × 10–3kPa–1 in the treatment and decreased from 18.44 (8.19) to 16.26 (7.35) in the placebo group (p = 0.057). CCA-CC increased from 0.64 (0.24) to 0.71 (0.26) mm2kPa–1 in the treatment and decreased from 0.77 (0.28) to 0.69 (0.25) in the placebo group (p < 0.0001). FA-DC had increased from 6.64 (3.45) to 11.46 (6.83) in the treatment group, and from 6.46 (2.85) to 7.08 (2.73) in the placebo group (p = 0.0001). FA-CC had increased from 0.46 (0.24) to 0.74 (0.44) in the treatment group, and from 0.48 (0.27) to 0.53 (0.21) in the placebo group (p = 0.008). BA-DC and CC, and CCA YEM were not significantly different between the groups. Conclusion: In patients with mild-to-moderate CKD, 18 months of treatment consisting of pravastatin, vitamin E and homocysteine lowering resulted in significant improvement of compliance and distensibility in CCA and FA. Since pravastatin was used throughout the observation period, it remains unclear whether the beneficial effects are attributable solely to the ongoing effect of pravastatin treatment, or if the additional interventions further slowed the progression of vascular stiffness. Therefore, larger studies with a longer period of follow-up observing the separate effects are needed.Correspondence to:
Dr. Prabath W.B. Nanayakkara, MD
Department of Internal Medicine
VU University Medical Center
PO box 7057
1007 MB Amsterdam, The Netherlands
Email: [email protected]
Original
Impact of atherosclerosis on the relationship of glycemic control and mortality in diabetic patients on hemodialysis
Masaaki Inaba, Kiyoshi Maekawa, Senji Okuno, Yasuo Imanishi, Yasuaki Hayashino, Masanori Emoto, Tetsuo Shoji, Eiji Ishimura, Tomoyuki Yamakawa and Yoshiki Nishizawa
Page No. 273
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (273-280)
Impact of atherosclerosis on the relationship of glycemic control and mortality in diabetic patients on hemodialysis
Masaaki Inaba1, Kiyoshi Maekawa3, Senji Okuno3, Yasuo Imanishi1, Yasuaki Hayashino4, Masanori Emoto1, Tetsuo Shoji1, Eiji Ishimura2, Tomoyuki Yamakawa3 and Yoshiki Nishizawa1
1Department of Metabolism, Endocrinology and Molecular Medicine, 2Department of Nephrology, Osaka City University Graduate School of Medicine, 3Kidney Center, Shirasagi Hospital, Osaka, and 4Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
Objective: The impact of preexisting cardiovascular disease (CVD) on glycemic control-improved survival in hemodialysis patients with diabetes mellitus (DM) was investigated. Glycoalbumin (GA) was used as a glycemic marker. Methods: A single-center 4-year follow-up study was performed in an observational cohort of 178 DM hemodialysis patients to analyze the relationship between GA and all-cause mortality in patients with (n = 70) and without (n = 108) CVD. The subjects were divided into three categories based on GA value at the start of study. Results: Baseline characteristics did not differ between the two groups of patients. During the 4-year follow-up, 24 of 108 (23.3%) CVD(–) patients and 30 of 70 (42.8%) CVD(+) patients died. The mortality was significantly higher in the CVD(+) group. Multivariate Cox analyses including GA, logCRP, age, gender, hemodialysis duration, albumin, hemoglobin, BMI, SBP, DBP, smoking habit, and SUN as independent variables showed that GA, in addition to logCRP and age, was independently associated with mortality in all patients. Kaplan-Meier analysis showed lower GA levels to be a significant predictor of lower mortality in the CVD(–) group, but not in the CVD(+) group. Multivariable-adjusted Cox proportional hazards models demonstrated a significant association between GA with allcause mortality risk in the CVD(–) group (p = 0.004), in contrast with the CVD(+) group in the same model (p = 0.842). Conclusion: These results demonstrate a beneficial effect of improved glycemic control on survival in DM hemodialysis patients, which might be attenuated by the presence of CVD.Correspondence to:
Masaaki Inaba
Department of Metabolism, Endocrinology and Molecular Medicine
1-4-3, Asahi-machi, Abeno-ku, 545-8585 Osaka, Japan
Email: [email protected]
Original
Do serum hepcidin-25 levels correlate with oxidative stress in patients with chronic kidney disease not receiving dialysis?
Yukio Maruyama, Keitaro Yokoyama, Hiroyasu Yamamoto, Masaaki Nakayama and Tatsuo Hosoya
Page No. 281
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (281-286)
Do serum hepcidin-25 levels correlate with oxidative stress in patients with chronic kidney disease not receiving dialysis?
Yukio Maruyama1, Keitaro Yokoyama1, Hiroyasu Yamamoto1, Masaaki Nakayama2 and Tatsuo Hosoya1
1Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, and 2Department of Nephrology and Hypertension, Fukushima Medical University School of Medicine, Fukushima, Japan
Aims: Iron metabolism is an important factor of anemia in chronic kidney disease (CKD). Hepcidin is a regulator of iron homeostasis and has a major role in the anemia of chronic disease (ACD). Oxidative stress (OS) is also associated with iron metabolism. However, the clinical utility of hepcidin, especially its association with OS, in CKD patients not receiving dialysis is still unclear. Methods: We recruited 117 patients (62 ± 15 years, 85 males, and median estimated glomerular filtration rate (eGFR) 22 ml/min/1.73 m2) with CKD not receiving dialysis. Serum 8-hydroxy-2’-deoxyguanosine (8-OHdG), a marker of DNA oxidative injury, and serum hepcidin-25 were measured by ELISA and by liquid chromatography tandem mass spectrometry, respectively. Results: Hepcidin-25 was associated positively with ferritin, high-sensitive C-reactive protein (hsCRP) and 8-OHdG, and negatively with eGFR and hemoglobin. Sex, oral iron, hemoglobin, transferrin saturation (TSAT), ferritin, and hsCRP were independently associated with hepcidin-25 in a multiple regression model. In contrast, neither eGFR nor 8-OHdG independently affected hepcidin- 25. Conclusions: The close association between hepcidin and serum ferritin, oral iron and hsCRP indicates that it plays a key role in the pathogenesis of anemia in patients with CKD not receiving dialysis. In contrast, effects of eGFR and OS were not apparent.Correspondence to:
Yukio Maruyama, MD, PhD
Division of Kidney and Hypertension
The Jikei University School of Medicine
3-19-18 Nishi-shinbashi, Minato-ku, Tokyo 105-8471, Japan
Email: [email protected]
Original
Alteplase for blood flow restoration in hemodialysis catheters: a multicenter, randomized, prospective study comparing “dwell” versus “push” administration
Lavern M. Vercaigne, James Zacharias, Keevin N. Bernstein and the PUSH Protocol Investigators
Page No. 287
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (287-296)
Alteplase for blood flow restoration in hemodialysis catheters: a multicenter, randomized, prospective study comparing “dwell” versus “push” administration
Lavern M. Vercaigne1, James Zacharias2, Keevin N. Bernstein2 and the PUSH Protocol Investigators
1Faculty of Pharmacy, and 2Department of Internal Medicine, Section of Nephrology, University of Manitoba and the Manitoba Renal Program, Winnipeg, Manitoba, Canada
Aims: Catheter-related thrombosis is a frequent complication of providing hemodialysis via central venous catheters. The primary aim of this study was to compare the efficacy of an alteplase “dwell” protocol over 30 minutes (with an additional 90 minutes where necessary) to a new 30 minute “push” protocol in restoring function to occluded hemodialysis catheters. Methods: This was a prospective, randomized, parallel arm, multicenter study. Participants included hemodialysis patients using central venous catheters for vascular access. A new alteplase push protocol was the intervention and was compared to an alteplase dwell protocol. The primary outcome of this study was the proportion of patients with pre-thrombolytic blood flows less than 200 ml/min achieving a post thrombolytic blood flow ≥ 300 ml/ min. Secondary outcomes included recovery of Kt/V and liters processed per hour at the hemodialysis session following the intervention, time from thrombolytic to future catheter interventions, and the presence of serious adverse events. Results: 82 patients were included in the intention-to-treat analysis. 65% (28/43) of catheters receiving the dwell protocol achieved blood flow ≥ 300 ml/min compared to 82% (32/39) in the push protocol. The difference was not statistically significant despite a 17% separation in the point estimates, p = 0.84. A non-significant result may have been associated with an inability to enrol the required a priori sample size. Kt/V, liters processed per hour and time to next catheter event were not significantly different. There were no serious adverse events attributed to the study medication. Conclusions: The alteplase push protocol was effective and safe for managing dysfunctional hemodialysis catheters and was more practical than a 2 h dwell.Correspondence to:
Prof. Lavern M. Vercaigne, PharmD
Faculty of Pharmacy
University of Manitoba and the Manitoba Renal Program
750 McDermot Ave.
Winnipeg, Manitoba,R3E OT5 Canada
Email: [email protected]
Original
Tubulointerstitial nephritis in active tuberculosis – a single center experience
Joerg Latus, Kerstin Amann, Niko Braun, Mark Dominik Alscher and Martin Kimmel
Page No. 297
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (297-302)
Tubulointerstitial nephritis in active tuberculosis – a single center experience
Joerg Latus1, Kerstin Amann2, Niko Braun1, Mark Dominik Alscher1 and Martin Kimmel1
1Robert-Bosch Hospital, Department of Internal Medicine, Division of Nephrology, Stuttgart, and 2University of Erlangen-Nürnberg, Department of Pathology, Nephropathology, Erlangen, Germany
Background: Tuberculosis (TB) is a common disease worldwide, but kidney affection, i.e. tubulointerstitial nephritis (TIN) caused by Mycobacterium tuberculosis is rare. More frequent in patients with TB is drug induced TIN, i.e. the result of intensive antitubercular treatment. Patients and methods: In the time between April 2005 until August 2011 data from all patients (4 male, 1 female) with clinical evidence of active TB and significant renal disease were collected. All patients were treated with antitubercular treatment according to standard protocols. All patients underwent kidney biopsy due to progressive renal failure and all of the renal biopsies revealed an interstitial inflammation with eosinophilia. Epitheloid granulomata were found in 3 of 5 patients, whereas caseating granulomata were found in only one patient. No patient had sterile leucozyturia and all patients were negative for Mycobacterium tuberculosis on PCR; of note, none of the renal biopsies examined were positive for acid and alcohol fast bacilli by Ziehl-Neelsen staining. Conclusions: TB associated TIN is rare, but needs a rapid recognition and an early treatment. Kidney biopsy should be performed in patients with TB and renal disease to ensure the diagnosis of renal involvement of active TB and established correct treatment (intensifying TB treatment or changing TB therapy in drug induced TIN). Additionally, negative PCR of the histopathological samples should not exclude TB associated TIN and sterile leukocyturia is less common than expected.Correspondence to:
Jörg Latus, MD
Department of Internal Medicine
Division of Nephrology
Robert-Bosch Hospital
Auerbachstr. 110, 70376 Stuttgart, Germany
Email: [email protected]
Original
Long-term impact of prophylactic antiviral treatment in Hepatitis B surface antigenpositive renal allograft recipients
Kyung Sun Park, Won Seok Yang, Duck Jong Han, Jae Berm Park, Jung Sik Park and Su-Kil Park
Page No. 303
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (303-311)
Long-term impact of prophylactic antiviral treatment in Hepatitis B surface antigenpositive renal allograft recipients
Kyung Sun Park1, Won Seok Yang1, 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: Antiviral prophylaxis has been shown to prevent hepatic dysfunction in Hepatitis B virus (HBV)-positive kidney transplantation recipients (KTRs). However the long-term effects of antiviral prophylaxis on the patient death, graft loss, or hepatic decompensation have not been determined. Method: We therefore retrospectively analyzed outcomes in 94 HBV-positive patients, who underwent KT between February 1997 and November 2009 and were followed-up for a mean 75.7 months. Of the 94 KTRs, 56 received antiviral prophylaxis (Group 1), 51 with lamivudine and 5 with entecavir, and 38 did not (Group 2). Result: Of the latter group, 20 experienced HBV reactivation and 18 did not (mean 85 months); of those with reactivation, 16 received lamivudine, 2 received entecavir and 2 received no antiviral treatment. Cox-regression analysis showed that antiviral prophylaxis had no benefit on patient death (OR 1.29, 95% CI 0.37 – 4.49, p = 0.693), graft failure (OR 1.25, 0.45 – 3.46, p = 0.666) or hepatic decompensation (OR 2.01, 0.35 – 11.57, p = 0.434). Lamivudine resistance occurred in 21 lamivudine-treated Group 1 and 4 lamivudine-treated Group 2 patients (p = 0.243), with mean times of resistance after KT of 82 and 132 months, respectively (p = 0.001). Conclusion: These findings indicate that lamivudine-based antiviral prophylaxis for HBV-positive renal recipients has no long-term clinical benefits.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
Spontaneous bilateral renal pelvis thrombus formation presenting as anuric acute renal failure
Jason Reese, Timothy Tausch, Megan Barnwell, Andrew C. Peterson and MaryAnne McDonald
Page No. 312
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (312-315)
Spontaneous bilateral renal pelvis thrombus formation presenting as anuric acute renal failure
Jason Reese1, Timothy Tausch2, Megan Barnwell1, Andrew C. Peterson2 and MaryAnne McDonald3
1Internal Medicine Residency Program, 2Department of Surgery, Division of Urology, and 3Department of Nephrology, Madigan Army Medical Center, Tacoma, WA, USA
A 59-year-old woman was admitted to the internal medicine service after presenting to the emergency department with complaints of abdominal pain and hematuria. Upon further evaluation, the patient was found to be significantly coagulopathic secondary to the intentional ingestion of brodifacoum, the active ingredient in D-Con rat poison, in an attempt to commit suicide. The patient was treated and discharged only to return several days later with new pain and the inability to urinate. She was found to be in acute renal failure and renal ultrasonography revealed bilateral ureteral and renal pelvis thrombus leading to acute obstructive nephropathy. She was taken emergently to the operating room for placement of bilateral ureteral stents which resulted in decompression of her collecting system and resolution of her renal failure.Correspondence to:
Jason Reese, DO
Internal Medicine Residency
Madigan Army Medical Center
Tacoma, WA 98431, USA
Email: Jason.m.reese@ us.army.mil
Nephrology Education
Fanconi syndrome and chronic kidney disease in paroxysmal nocturnal hemoglobinuria: effect of eculizumab therapy
Eric Moumas, Frank Bridoux, Fannie Leroy, Simohamed Belmouaz, Edouard Randriamalala, Estelle Desport, Brigitte Dreyfus, Sébastien Delbès, Nathalie Quellard and Guy Touchard
Page No. 316
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (316-321)
Fanconi syndrome and chronic kidney disease in paroxysmal nocturnal hemoglobinuria: effect of eculizumab therapy
Eric Moumas1, Frank Bridoux1, Fannie Leroy1, Simohamed Belmouaz1, Edouard Randriamalala2, Estelle Desport1, Brigitte Dreyfus2, Sébastien Delbès1, Nathalie Quellard3 and Guy Touchard1
1Department of Nephrology, 2Department of Hematology and Oncology, and 3Department of Pathology, CHU Poitiers, Université Poitiers, Hôpital Jean Bernard, Poitiers, France
The association of Fanconi syndrome (FS) and chronic kidney disease (CKD) has been rarely described during the course of paroxysmal nocturnal hemoglobinuria (PNH). We report 2 patients with PNH and CKD associated with proximal tubule dysfunction, which manifested as full-blown FS in one case. In both patients, abnormal iron load within the kidneys was demonstrated by magnetic resonance imaging, which correlated with diffuse and numerous hemosiderin inclusions within proximal tubular cells. After 12 months, eculizumab treatment resulted in significant decrease in the kidney iron load in both cases. Glomerular filtration rate improved in one case and was stabilized in the other, in whom pretreatment kidney biopsy had shown severe extensive interstitial fibrosis. However, symptoms of proximal tubular dysfunction persisted in both patients. These data suggest that hemosiderin deposition in proximal tubules is probably an important mechanism involved in the development of FS, an under recognized and early manifestation of CKD in PNH. Prolonged treatment with eculizumab may improve long-term renal function in PNH patients with CKD. Correspondence to:
Prof. F. Bridoux
Department of Nephrology
Hôpital Jean Bernard
2 rue de la Milétrie, 86021 Poitiers, France
Email: [email protected]
Nephrology Education
Elevated serum creatinine in a kidney transplant recipient: unusual suspect
Zelal Adibelli, Edward Woo, Peter Abt and Simin Goral
Page No. 322
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (322-324)
Elevated serum creatinine in a kidney transplant recipient: unusual suspect
Zelal Adibelli1, Edward Woo2, Peter Abt3 and Simin Goral1
1Department of Medicine, Renal, Electrolyte, and Hypertension Division, 2Department of Surgery, Vascular Surgery and Endovascular Therapy, and 3Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
We report a rare form oftransplant renal artery stenosis discovered 3months after transplantation. Our patient hadmechanical renal artery “kinking”, whichresponded to balloon angioplasty. Dopplerultrasound, followed by an arteriogram confirmedthe diagnosis. This case demonstratesthat transplant renal artery “kinking” stenosis,though rare, can cause graft dysfunctionand worsening hypertension in kidney transplantrecipients.Correspondence to:
Simin Goral, MD
University of Pennsylvania Medical Center
3400 Spruce Street, One Founders
Philadelphia, PA 19104, USA
Email: simin.goral@ uphs.upenn.edu
Nephrology Education
Newly developed hypertension due to juxtaglomerular cell tumor in pregnancy
Yu Seob Shin, Jai Seong Cha, Myoung Jae Kang, Jong Kwan Park, Hyung Jin Kim and Myung Ki Kim
Page No. 325
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (325-327)
Newly developed hypertension due to juxtaglomerular cell tumor in pregnancy
Yu Seob Shin1, Jai Seong Cha1, Myoung Jae Kang2, Jong Kwan Park1, Hyung Jin Kim1 and Myung Ki Kim1
1Department of Urology, and 2Department of Pathology, Chonbuk National University Medical School and Research Institute of Clinical Medicine, Jeonju, Korea
An unusual case of juxtaglomerular cell tumor (JCT) is presented. A 29-year-old woman visited our hospital for the management of incidentally detected renal mass due to newly developed hypertension in the 20th week of pregnancy. Laboratory studies showed increased basal plasma renin activity and hypokalemia but serum aldosterone level was normal. Abdominal computed tomography scan showed about 2.4 cm sized multicystic mass in the right kidney. Nephron-sparing surgery was performed with excellent results. On histological examination, the tumor exhibited a structure typical feature of JCT. A few days later the patient’s blood pressure had been normalized.Correspondence to:
M.K. Kim, MD
Department of Urology
Chonbuk National University Medical School
634-18, Geumam-dong, Dukjin-gu,
Jeonju #561-712, Korea
Email: [email protected]
Nephrology Education
Thomsen-Friedenreich antigen exposure as a cause of Streptococcus pyogenes-associated hemolytic-uremic syndrome
Masaki Shimizu, Tadafumi Yokoyama, Natsuma Sakashita, Akira Sato, Kazuyuki Ueno, Chisato Akita, Kazuhide Ohta, Etsuko Kitano, Michiyo Hatanaka, Hajime Kitamura, Yutaka Saikawa and Akihiro Yachie
Page No. 328
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 (328-331)
Thomsen-Friedenreich antigen exposure as a cause of Streptococcus pyogenes-associated hemolytic-uremic syndrome
Masaki Shimizu1, Tadafumi Yokoyama1, Natsuma Sakashita1, Akira Sato1, Kazuyuki Ueno1, Chisato Akita2, Kazuhide Ohta3, Etsuko Kitano4, Michiyo Hatanaka4, Hajime Kitamura5, Yutaka Saikawa2 and Akihiro Yachie1
1Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, 2Department of Pediatrics, School of Medicine, Kanazawa Medical University, Uchinada, 3Department of Pediatrics, Kanazawa Medical Center, Kanazawa, 4Department of Medical Technology, Kobe Tokiwa University, Kobe, and 5Department of Nutritional Sciences for Wellbeing, Kansai University of Welfare Sciences, Kashiwara, Osaka, Japan
Infection with Streptococcus pyogenes, a Group A beta-hemolytic streptococcus (GAS), is a rare cause of hemolyticuremic syndrome (HUS). Invasive infections with Streptococcus pneumoniae that produce neuraminidase are a well-recognized cause of HUS without diarrhea. The Thomsen- Friedenreich antigen (T antigen) plays a role in the pathophysiology of pneumococcal HUS. We describe the case of a 3-year-old boy with GAS-associated HUS and show how T-antigen exposure was implicated in this case. He had no diarrhea and cultures for blood, urine, and stool were negative. The urinary pneumococcal antigen was negative; his direct Coombs test was positive. Glomerular capillary loops, tubular epithelium on his renal biopsy specimen, and red blood cells in his blood smear showed positive fluorescence with anti-T lectin. Although the pathogenesis of GAS-associated HUS is not well understood, T-antigen exposure may be implicated in some cases with GAS-associated HUS.Correspondence to:
M. Shimizu, MD, PhD
Department of Pediatrics, School of Medicine
Institute of Medical, Pharmaceutical and Health Sciences,
Kanazawa University
13-1 Takaramachi, Kanazawa 920-8641, Japan
Email: shimizum@ staff.kanazawa-u.ac.jp
Letter to the Editor
Long-term multidrug therapy in an adolescent patient with proliferative lupus nephritis: a trial of less cytotoxic therapy
Tomomi Aizawa-Yashiro, Kazushi Tsuruga, Shojiro Watanabe, Taketora Echizenya, Etsuro Ito and Hiroshi Tanaka
Page No. 332
Abstract
Clinical Nephrology, Vol. 78 – No. 4/2012 – Letter to the editor
Long-term multidrug therapy in an adolescent patient with proliferative lupus nephritis: a trial of less cytotoxic therapy
Tomomi Aizawa-Yashiro1, Kazushi Tsuruga1, Shojiro Watanabe1, Taketora Echizenya2, Etsuro Ito1 and Hiroshi Tanaka1,3
1Department of Pediatrics, Hirosaki University Hospital, 2Section of Pediatrics, Iwate Prefectural Chubu Hospital and 3Department of School Health Science, Faculty of Education, Hirosaki University, Hirosaki, Japan
Correspondence to:
Hiroshi Tanaka, MD, PhD
Department of School Health Science
Hirosaki University Faculty of Education
Hirosaki 036-8563, Japan
Email: [email protected]
