Volume 78 (2012), No. 3/2012(September)
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Original
Circadian rhythm of urinary potassium excretion in patients with CKD
Toshiyuki Miura, Michio Fukuda, Takehiro Naito, Hiroyuki Togawa, Ryo Sato, Yuji Sasagawa, Tatsuya Tomonari, Yoko Kato, Masashi Mizuno, Minamo Ono, Tadashi Ichikawa, Yuichi Shirasawa, Akinori Ito, Atsuhiro Yoshida and Genjiro Kimura
Page No. 169
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 (169-173)
Circadian rhythm of urinary potassium excretion in patients with CKD
Toshiyuki Miura, Michio Fukuda, Takehiro Naito, Hiroyuki Togawa, Ryo Sato, Yuji Sasagawa, Tatsuya Tomonari, Yoko Kato, Masashi Mizuno, Minamo Ono, Tadashi Ichikawa, Yuichi Shirasawa, Akinori Ito, Atsuhiro Yoshida and Genjiro Kimura
Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Aims: We previously reported in patients with chronic kidney disease (CKD) that the circadian rhythms of blood pressure (BP) and urinary sodium excretion were both impaired into non-dipper pattern as renal function deteriorated. However, the circadian rhythm of urinary potassium excretion has not been studied in relation to renal dysfunction. Methods: BP and urinary excretion rates of sodium (UNaV) and potassium (UKV) were evaluated for daytime and nighttime to estimate their circadian rhythms in 83 subjects with CKD. Results: As renal function deteriorated, night/day ratios of UNaV and UKV were both increased. Night/day ratio of UKV was positively correlated with night/day ratio of UNaV (r = 0.60, p < 0.0001). Multiple regression analysis (R2 = 0.37, p < 0.0001) revealed that night/day ratio of UKV was determined independently by the night/day ratio of UNaV (r = –0.55, p < 0.0001), rather than renal function or night/day ratio of BP. Conclusions: Circadian rhythm of natriuresis was regulated by renal function and night/day ratio of BP. On the other hand, the circadian rhythm of urinary potassium excretion was primarily determined by neither renal function nor BP, but was correlated with that of urinary sodium excretion.Correspondence to:
Michio Fukuda, MD
Department of Cardio-Renal Medicine and Hypertension
Nagoya City University
Graduate School of Medical Sciences
Mizuho-ku, Nagoya 467-8601, Japan
Email: [email protected]
Original
Apolipoprotein E and kidney function in older adults
Rebecca Kurnik Seshasai, Ronit Katz, Ian H. de Boer, David Siscovick, Michael G. Shlipak, Dena E. Rifkin and Mark J. Sarnak
Page No. 174
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 (174-180)
Apolipoprotein E and kidney function in older adults
Rebecca Kurnik Seshasai1, Ronit Katz2, Ian H. de Boer3, David Siscovick4, Michael G. Shlipak5, Dena E. Rifkin6 and Mark J. Sarnak1
1Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, 2Collaborative Health Studies Coordinating Center, 3Division of Nephrology, Department of Medicine, 4Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, 5General Internal Medicine Section, San Francisco VA Medical Center and Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, and 6Division of Nephrology, Department of Medicine, University of California, San Diego, CA, USA
Background: Previous studies suggest that the ε4 and ε2 alleles of apolipoprotein E (APOE) may be associated with decreased and increased risks of CKD, respectively, but there are limited data in older adults. We evaluated the associations of apolipoprotein E alleles with kidney function among older adults in the cardiovascular health study (CHS). Methods: Caucasian participants had APOE allelic analysis and serum creatinine and cystatin C measured at baseline (n = 3,844 for cross sectional analysis) and in follow up (n = 3,226 for longitudinal analysis). APOE variation was evaluated as an additive model with number of ε2, ε3 and ε4 alleles. GFR was estimated using the CKD epidemiology equation (eGFRcreat) and the cystatin C demographic equation (eGFRcys). The primary outcome was CKD defined by eGFR < 60 ml/min/1.73 m2. The secondary outcome was rapid progression defined by annual loss of eGFR > 3 ml/min/1.73 m2. Results: Mean eGFRcreat was 72 ml/min/1.73 m2 (25% CKD). Compared with the ε3 allele, the APOE ε4 allele was associated with reduced risk of CKD by eGFRcreat: unadjusted odds ratio (OR) and 95% confidence interval (CI) 0.79 (0.67 – 0.93) per allele, fully adjusted OR (95% CI) 0.80 (0.68 – 0.96) per allele. Results were consistent using eGFRcys. There was no association of the ε2 allele with CKD or between the apolipoprotein E gene with rapid progression. Conclusions: The apolipoprotein ε4 allele was associated with lower odds of CKD in elderly Caucasian individuals. Future research should confirm these findings in other races and explore mechanisms to explain these results.Correspondence to:
Mark J. Sarnak, MD, MS
Division of Nephrology
Tufts Medical Center, Box 391
800 Washington Street, Boston, MA, 02111, USA
Email: [email protected]
Original
Factors affecting response and tolerability to ferumoxytol in nondialysis chronic kidney disease patients
Steven Fishbane, W. Kline Bolton, Wolfgang C. Winkelmayer, William Strauss, Zhu Li and Brian J. G. Pereira
Page No. 181
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 (181-188)
Factors affecting response and tolerability to ferumoxytol in nondialysis chronic kidney disease patients
Steven Fishbane1, W. Kline Bolton2, Wolfgang C. Winkelmayer3, William Strauss4, Zhu Li4 and Brian J. G. Pereira4
1Hofstra North Shore LIJ, School of Medicine, Great Neck, NY, 2University of Virginia Health System, Charlottesville, VA, 3Stanford University School of Medicine, Palo Alto, CA, and 4AMAG Pharmaceuticals, Inc., Lexington, MA, USA
Background: Ferumoxytol is a unique intravenous (i.v.) iron therapy. This report examines factors affecting hemoglobin response to i.v. ferumoxytol, and the relationship between hematologic parameters, concomitant erythropoiesis-stimulating agents (ESA), and adverse events (AEs) in nondialysis CKD patients. Methods: A series of post-hoc efficacy and safety analyses were performed using pooled data from two identically designed Phase III studies in 608 nondialysis CKD patients randomized to receive two 510 mg i.v. injections of ferumoxytol within 5 ± 3 days versus oral iron. Results: Ferumoxytol resulted in a significant increase in hemoglobin in the presence and absence of ESA, and across a range of baseline hemoglobin, transferrin saturation, ferritin, and reticulocyte hemoglobin content levels. Adverse event rates with ferumoxytol were similar across quartiles of change in hemoglobin; there were no trends suggesting an increased rate of cardiovascular AEs with higher maximum achieved hemoglobin or faster rate of hemoglobin rise. There was no meaningful difference in the rate of AEs, serious AEs, and cardiovascular AEs between patients receiving or not receiving ESA. Conclusions: These analyses add to the knowledge of predictors of response and safety outcomes associated with i.v. iron therapy in nondialysis CKD patients.Correspondence to:
Steven Fishbane, MD
Hofstra North Shore LIJ
School of Medicine
Great Neck, NY 11021, USA
Email: [email protected]
Original
Initial use of once-monthly administration of C.E.R.A. is effective and safe in correcting renal anemia in non-dialysis patients: the MERCUR trial
Michael Koch, Dirk Henrich, Justus Faust, Jan Nawka, Thomas Rath and Christoph Wanner
Page No. 189
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 (189-197)
Initial use of once-monthly administration of C.E.R.A. is effective and safe in correcting renal anemia in non-dialysis patients: the MERCUR trial
Michael Koch2, Dirk Henrich3, Justus Faust4, Jan Nawka5, Thomas Rath6 and Christoph Wanner1
1Department of Nephrology, University of Würzburg, Würzburg, 2Center of Nephrology, Mettmann, 3Dialysezentrum, Saarlouis, 4KfH Nierenzentrum, Mainz, 5Nephrologische Gemeinschaftspraxis, Hoyerswerda, 6Westpfalz-Klinikum GmbH, Abteilung für Nephrologie und Transplantationsmedizin, Medizinische Klinik 3, Kaiserslautern, Germany
Background: Continuous erythropoietin receptor activator (C.E.R.A.) is routinely given once every 2 weeks to correct hemoglobin (Hb) level, but monthly use is recommended in the maintenance phase. Patients and methods: In an open-label, single- arm, multicenter trial, 184 ESA-naïve non-dialysis patients with renal anemia (Hb ≤ 10.5 g/dl) received C.E.R.A. monthly from the start of therapy. The trial comprised a titration phase (Months 2 – 7) and an evaluation phase (Months 8 – 9). Mean Hb increased from 9.8 ± 0.7 g/dl at baseline to 11.5 ± 1.1 g/ dl during the evaluation phase (mean change 1.6 ± 1.1 g/dl; 95% CI 1.4 – 1.8 g/dl). Among patients with two Hb values available during the evaluation phase, 18.1% (19/105) were maintained at 11.0 – 12.0 g/dl and 49.5% (52/105) at 11.0 – 13.0 g/dl. 20 patients started dialysis and received C.E.R.A during the titration phase. Results: Their mean Hb increased from 10.6 ± 1.6 g/dl (last pre-dialysis value) to 11.3 ± 1.6 g/dl. Nine patients (4.9%) experienced one adverse event with a suspected relation to C.E.R.A.; 5 were graded serious. 54 patients (29.3%) discontinued the study (22 for adverse events). Conclusion: Although no control arm was included, such that robust comparisons cannot be drawn, these results suggest that C.E.R.A. therapy can be initiated once a month in non-dialysis CKD patients with renal anemia without appearing to compromise the rate or degree of Hb correction.Correspondence to:
Prof. Dr. Michael Koch
Center of Nephrology Mettmann
Gartenstraße 8, 40822 Mettmann, Germany
Email: [email protected]
Original
Prevalence of chronic kidney disease and its risk factors among family practice patients in Lithuania
Inga Arūnė Bumblytė, Alanta Zilinskienė, Raymond Vanholder, Leonas Valius and Vytautas Kuzminskis
Page No. 198
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 (198-206)
Prevalence of chronic kidney disease and its risk factors among family practice patients in Lithuania
Inga Arūnė Bumblytė1, Alanta Zilinskienė1, Raymond Vanholder2, Leonas Valius3 and Vytautas Kuzminskis1
1Department of Nephrology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania, 2Department of Nephrology, Ghent University, Ghent, Belgium, and 3Department of Family Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Background: Early detection of chronic kidney disease (CKD) by the first line is essential. In many countries, serum creatinine measurements are reimbursed in home practice. In Lithuania however, until recently they were not. Therefore, the aim of this study was to assess the prevalence of risk factors of CKD in primary care patients, to evaluate the awareness of family practitioners and, finally, to investigate renal function parameters in patients at risk. Methods: We reviewed the charts of adult patients (n = 4,082) from four home practices in Kaunas and identified patients at increased risk for CKD (severe arterial hypertension, diabetes, cardiovascular disease (CVD), other causes of kidney damage). We noted age and gender in all patients, and renal function measurements performed over the preceding 24 months in the patients at risk. In the second part, we assessed nephrological status (history, clinical characteristics, serum creatinine, dipstick urinalysis and microalbuminuria, estimated glomerular filtration rate (eGFR) by the abbreviated MDRD formula) for those at risk who were referred by their family practitioners. Results: In total, 458 (11.2%) patients had risk factors for CKD. Severe arterial hypertension was found in 62.6% of these patients, diabetes in 20.9%, CVD in 6.2% and 34.5% had a history of kidney damage. Kidney tests had been performed by family practioner in 59% of these patients. Only 30.3% of these patients were referred to the nephrologist and an additional 20.1% came after receiving an invitation letter. eGFR < 60 ml/min/1.73 m2 was found in 42.9% of these patients, 23.4% had microalbuminuria and 7.8% overt proteinuria. Optimal blood pressure control (< 130/85 mmHg) was achieved in a minority (10.4%). 79.7% had abnormal BMI, 39% used no ACEI/ARB, and 16% were smokers. Kidney dysfunction was associated with a higher prevalence of microalbuminuria and a lower use of ACEI/ ARB. Conclusions: Risk factors for CKD were present in 11% of the patients in this primary care cohort. Kidney dysfunction was found in almost half of the patients at risk. However, awareness of this problem by family practitioners was low.Correspondence to:
Alanta Zilinskiene, MD
Hospital of Lithuanian
University of Health Sciences, Kauno klinikos
Department of Nephrology
Eiveniu 2, 50009, Kaunas, Lithuania
Email: [email protected]
Original
Clinical and pathological features of dense deposit disease in Chinese patients
Jinquan Wang, Zheng Tang, Chunlei Luo, Yanglin Hu, Caihong Zeng, Huiping Chen and Zhihong Liu
Page No. 207
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 (207-215)
Clinical and pathological features of dense deposit disease in Chinese patients
Jinquan Wang, Zheng Tang, Chunlei Luo, Yanglin Hu, Caihong Zeng, Huiping Chen and Zhihong Liu
Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Aims: Dense deposit disease (DDD) is a rare disease that has no universally effective treatment. Herein we explore the clinical and pathological features of DDD in Chinese patients and the therapeutic effect of Tripterygium wilfordii (TW). Materials and methods: Clinical and pathological data of 10 Chinese patients with biopsy-proved DDD were collected and analyzed retrospectively. Results: The patients consisted of 6 males and 4 females. All of them had heavy proteinuria and microscopic hematuria. Gross hematuria, renal insufficiency, anemia, hypertension and low serum complement 3 (C3) occurred in 3, 3, 5, 6 and 8 cases, respectively. Under light microscopy (LM), 8 cases exhibited membranoproliferative glomerulonephritis (MPGN). Periodic acid-Schiff (PAS) stain disclosed intense PAS-positive bright ribbon-like thickening of glomerular basement membranes (GBM). Immunofluorescence mainly showed diffuse fine granular and short linear deposition of C3 along the glomerular capillary wall. Under electron microscopy, ribbon-like electrondense intramembranous deposits were identified in the lamina densa of the GBM, along the tubule basement membranes (TBM) and wall of Bowman’s capsule. Before admission, 6 cases were treated with prednisone, cyclophosphamide and/or cyclosporin A with no response. Proteinuria in 8 cases who received TW during the course decreased at different degrees. Conclusions: The clinical and pathological features in DDD patients were various. The effect of TW in patients with DDD merits further investigation.Correspondence to:
Zheng Tang
#305 East Zhong Shan Road
Nanjing 210002, PR China
Email: [email protected]
Original
Effect of lanthanum carbonate vs. calcium carbonate on serum calcium in hemodialysis patients: a crossover study
Tatsunori Toida, Keiichi Fukudome, Shouichi Fujimoto, Kazuhiro Yamada, Yuji Sato, Susumu Chiyotanda and Kazuo Kitamura
Page No. 216
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 (216-223)
Effect of lanthanum carbonate vs. calcium carbonate on serum calcium in hemodialysis patients: a crossover study
Tatsunori Toida1,2, Keiichi Fukudome1,2, Shouichi Fujimoto3, Kazuhiro Yamada2, Yuji Sato2, Susumu Chiyotanda1 and Kazuo Kitamura2
1Chiyoda Hospital, 2Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine and 3Dialysis Division, University of Miyazaki Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
Background: Lanthanum carbonate (LC) is a non-calcium-containing phosphate binder and shows a comparable effect with other phosphate binders on hyperphosphatemia in dialysis patients. LC also contributes to a reduced oral calcium load compared with calcium carbonate (CaC) treatment. However, no crossover studies which compare the influence on serum calcium level between treatments with LC and CaC in hemodialysis (HD) patients have been carried out. Methods: After washout for 2 weeks, 50 patients on HD were randomized (1 : 1) to receive LC or CaC for 3 months. Thereafter, patients underwent a second 2-week washout period and were switched to the alternative binder for the next 3 months. Mineral and bone metabolism markers were measured with the changes of vitamin D doses. Results: The serum phosphate level showed a similar decrease from baseline to 3 months in both groups. During the study periods, hypercalcemia was observed only in patients taking CaC. The dose of vitamin D analogue was increased more frequently in the patients of the LC group compared with LC group. The iPTH level showed a significant decrease in the CaC group, but not in the LC group. Serum levels of BAP, TRAP5b, and ALP were significantly elevated in the LC group, whereas the FGF-23 level showed a significant decrease. Conclusion: LC effectively reduced the serum phosphate level (like CaC) and allowed the vitamin D analogue dosage to be increased without hypercalcemia in HD patients. LC is one of the useful phosphate binders without hypercalcemia. (UMIN-CTR registration number: UMIN000002331).Correspondence to:
Tatsunori Toida
Division of Circulatory and Body Fluid Regulation
Department of Internal Medicine
University of Miyazaki
5200 Kihara Kiyotake Miyazaki, Japan
Email: [email protected]
Nephrology Education
The frequency of Fabry disease with the E66Q variant in the α-galactosidase A gene in Japanese dialysis patients: a case report and a literature review
Y. Kikumoto, H. Sugiyama, H. Morinaga, T. Inoue, K. Takiue, M. Kitagawa, D. Saito, Y. Takatori, M. Kinomura, S. Kitamura, S. Akagi, K. Sada, K. Nakao, Y. Maeshima, H. Kitayama and H. Makino
Page No. 224
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 (224-229)
The frequency of Fabry disease with the E66Q variant in the α-galactosidase A gene in Japanese dialysis patients: a case report and a literature review
Y. Kikumoto1, H. Sugiyama1,2, H. Morinaga1, T. Inoue1, K. Takiue1, M. Kitagawa1, D. Saito1, Y. Takatori1, M. Kinomura1, S. Kitamura1, S. Akagi2, K. Sada1, K. Nakao1, Y. Maeshima1, H. Kitayama3 and H. Makino1
1Department of Medicine and Clinical Science, 2Center for Chronic Kidney Disease and Peritoneal Dialysis, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and 3Division of Internal Medicine, Takahashi Central Hospital, Takahashi, Japan
Fabry disease (FD) is an Xlinked disorder resulting in a deficiency in α-galactosidase A (α-Gal) activity. FD is one of the causes of progressive renal dysfunction, but its diagnosis is often delayed or missed completely. We herein report the case of a 70-year-old male who had been receiving hemodialysis (HD) for 23 y who was diagnosed with FD after his participation in a screening program for plasma α-Gal activity for 892 HD patients. He had a low plasma α-Gal activity level and was demonstrated to have an E66Q mutation in exon 2 of the α-Gal gene. One of his daughters had the same mutation. The proband died due to aspiration pneumonia before receiving enzyme replacement therapy. We reviewed previous studies and found E66Q mutation in 36% of Japanese FD patients on HD including the present case. The clinical characteristics of E66Q variant are also discussed.Correspondence to:
H. Sugiyama, MD, PhD
Department of Medicine and Clinical Science
Okayama University Graduate School of Medicine
Dentistry and Pharmaceutical Sciences
2-5-1 Shikata-cho, Kita-ku
Okayama 700-8558, Japan
Email: hitoshis@ md.okayama-u.ac.jp
Nephrology Education
Drug-induced TINU syndrome and genetic characterization
Domenico Santoro, Giuseppe Vita, Stefania Rovito, Lucia Venuto, Vittorio Cavallari, Roberto Vita, Vincenzo Savica, Guido Bellinghieri and Sebastiano Gangemi
Page No. 230
Abstract
HLAClinical Nephrology, Vol. 78 – No. 3/20112 (230-236)
Drug-induced TINU syndrome and genetic characterization
Domenico Santoro1, Giuseppe Vita3, Stefania Rovito1, Lucia Venuto5, Vittorio Cavallari4, Roberto Vita2, Vincenzo Savica1, Guido Bellinghieri1 and Sebastiano Gangemi5,6
1Division of Nephrology, University of Messina, Messina, 2Unit of Nephrology and Dialysis, Section of Endocrinology, Department of Experimental Medicine and Pharmacology, 3Unit of Tissue Typing-Department of Pathology and Experimental Microbiology, 4Department of Human Pathology, 5School and Division of Allergy and Clinical Immunology, Department of Human Pathology, and 6Institute of Biomedicine and Molecular Immunology “A. Monroy” (IBIM) – Consiglio Nazionale delle Ricerche (CNR), Palermo, Italy
Tubulointerstitial nephritis and uveitis (TINU) syndrome is due to a disregulation of cell-mediated immunity and genetical predisposition due a particular molecular characterization. We report the case of a 50-year-old woman who was admitted for acute renal failure. She had recently taken flurbiprofen for 10 d for recurrent bronchitis. A renal biopsy revealed acute tubulointerstitial nephritis. Prednisone was started and prognosis was favorable. Three months later the patient developed transitory blurred vision. The diagnosis was bilateral uveitis and she received topic and systemic corticosteroid therapy, with resolution of ocular symptoms. Recurrent episodes of uveitis experienced during the next 12 months were treated with same therapy. Genomic haplotype in our patients was HLA A*0278/2631,-B*1517/3802,- Cw*0701/1202, -DRB1*0101/1359 (DRB3* 52), -DQA1*0102/0102, DQB1*0603/0603. TINU syndrome is characterized by tubulointerstitial nephritis that tends to be selflimiting, whereas uveitis tends to relapse. HLA-DQA1*01 and -DQB1*06 haplotypes are strongly associated with TINU syndrome. This is the first report of TINU syndrome induced by flubiprofen intake. Our case emphasizes the importance of the association between drug exposure and strong susceptibility to TINU syndrome giving the molecular characterization.Correspondence to:
Dr. D. Santoro, MD
Division of Nephrology
University of Messina
98122 Messina, Italy
Email: [email protected]
Nephrology Education
A rare cause of childhood-onset nephrotic syndrome: lipoprotein glomerulopathy
Min-Tser Liao, I-Jung Tsai, Hui-Teng Cheng, Wei-Chou Lin, Yen-Wen Chang, Yi-Heng Lin and Yong-Kwei Tsau
Page No. 237
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 (237-240)
A rare cause of childhood-onset nephrotic syndrome: lipoprotein glomerulopathy
Min-Tser Liao1,2, I-Jung Tsai3, Hui-Teng Cheng4, Wei-Chou Lin5, Yen-Wen Chang3, Yi-Heng Lin3 and Yong-Kwei Tsau3
1Department of Pediatrics, Taoyuan Armed Forces General Hospital, 2Department of Physiology and Biophysics, National Defense Medical Center, 3Department of Pediatrics, 4Department of Internal Medicine and 5Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
We report on a 12-year-old female patient with lipoprotein glomerulopathy (LPG) who was proven to be heterozygous for ApoE2 Kyoto (Arg25Cys). Her family members have the same variant but do not have obvious signs of renal function impairment. Six months of treatment with a statin caused significant clinical improvement in the lipid profile, proteinuria, and renal function. Our case suggests that administration of a statin is a potential therapeutic strategy for improving nephrotic syndrome in patients with LPG.Correspondence to:
Yong-Kwei Tsau, MD
Department of Pediatrics
National Taiwan University Hospital
No.7, Chung-Shan South Road
Taipei, Taiwan
Email: [email protected]
Nephrology Education
From placenta to podocyte: vascular and podocyte pathophysiology in preeclampsia
Steven J. Wagner, Iasmina M. Craici, Joseph P. Grande and Vesna D. Garovic
Page No. 241
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 (241-249)
From placenta to podocyte: vascular and podocyte pathophysiology in preeclampsia
Steven J. Wagner1, Iasmina M. Craici1, Joseph P. Grande2 and Vesna D. Garovic1
1Division of Nephrology and Hypertension, and 2Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
Preeclampsia is a disorder of hypertension and proteinuria that affects 6 – 8% of normal pregnancies. Recent research has revealed many molecular mechanisms that may contribute to systemic endothelial dysfunction, glomerular capillary endotheliosis, dysregulation of the glomerular filtration apparatus, and podocyte loss. An ischemic placenta elaborates soluble FMS-like tyrosine kinase 1 (sFlt-1), a soluble receptor for vascular endothelial growth factor (VEGF). A variety of mediators, including nitric oxide, Angiotensin II receptor autoantibodies (AT1AA), and endothelin-1 may serve to maintain placental ischemia and systemic endothelial dysfunction. Endothelin-1 and decreased vascular endothelial growth factor may adversely affect overall expression and distribution of podocyte foot process proteins, leading to proteinuria. Podocyte derangements may lead to podocyte apoptosis and loss, as evidenced by the detection of live podocytes and podocyte products in the urine of preeclamptic women. In this review, we explore recent research elucidating the interactions of placenta, endothelium, and podocyte leading to the clinical syndrome of preeclampsia.Correspondence to:
Vesna D. Garovic, MD
200 1st Street SW
Rochester MN 55905, USA
Email: [email protected]
Letter to the Editor
Therapeutic resistance to ACEI and ARB combination in macroalbuminuric diabetic nephropathy
Narisa Futrakul and Prasit Futrakul
Page No. 250
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 – Letters to the editor
Therapeutic resistance to ACEI and ARB combination in macroalbuminuric diabetic nephropathy
Narisa Futrakul1 and Prasit Futrakul2
1Renal Microcirculation Research Group, Faculty of Medicine, Chulalongkorn University, Thailand and 2Academy of Science, The Royal Institute of Thailand, Bangkok, Thailand
Email: [email protected]
Letter to the Editor
Maintenance therapy with single-daily, high-dose mizoribine after cyclophosphamide therapy for prepubertal boys with severe steroid-dependent nephrotic syndrome
Shuichiro Fujinaga, Amane Endo, Tsuneki Watanabe, Daishi Hirano, Yoshiyuki Ohtomo, Toshiaki Shimizu and Kazunari Kaneko
Page No. 251
Abstract
Clinical Nephrology, Vol. 78 – No. 3/2012 – Letters to the editor
Maintenance therapy with single-daily, high-dose mizoribine after cyclophosphamide therapy for prepubertal boys with severe steroid-dependent nephrotic syndrome
Shuichiro Fujinaga1, Amane Endo1, Tsuneki Watanabe1, Daishi Hirano1, Yoshiyuki Ohtomo2, Toshiaki Shimizu3 and Kazunari Kaneko4
1Divisions of Nephrology, Saitama Children’s Medical Center, Saitama, 2Department of Pediatrics, Juntendo Nerima Hospital, 3Department of Pediatrics, Juntendo University School of Medicine, Tokyo and 4Department of Pediatrics, Kansai Medical University, Osaka, Japan
Correspondence to:
Shuichiro Fujinaga, MD, PhD
Division of Nephrology
Saitama Children’s Medical Center
2100 Magome, Iwatsuki-ku
Saitama-city Saitama 339 8551, Japan
Email: [email protected]
