Volume 80 (2013), No. 1/2013(July)
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Original
Effect of rosuvastatin and sevelamer on the progression of coronary artery calcification in chronic kidney disease: a pilot study
Marcelo M. Lemos, Renato Watanabe, Aluízio B. Carvalho, Alessandra D.B. Jancikic, Fabiana M. R. Sanches, Dejaldo M. Christofalo, Sérgio A. Draibe and Maria Eugênia F. Canziani
Page No. 1
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 (1-8)
Effect of rosuvastatin and sevelamer on the progression of coronary artery calcification in chronic kidney disease: a pilot study
Marcelo M. Lemos1, Renato Watanabe1, Aluízio B. Carvalho1, Alessandra D.B. Jancikic1, Fabiana M. R. Sanches1, Dejaldo M. Christofalo2, Sérgio A. Draibe1 and Maria Eugênia F. Canziani1
1Department of Internal Medicine, Division of Nephrology, and 2Department of Radiology, Hospital do Rim e Hipertensão, Federal University of São Paulo, São Paulo, Brazil
Introduction: Coronary artery calcification (CAC) is highly prevalent among chronic kidney disease (CKD) patients and its strong association with mortality has been recognized early in the course of CKD. The aim of the present study was to test the effect of rosuvastatin and sevelamer hydrochloride on the progression of CAC in nondialyzed CKD patients. Methods: An open-label, randomized and controlled pilot study was conducted including 117 CKD patients (62% men, 56.9 ± 11.2 years, eGFR 36 ± 16.5 ml/min). Patients were randomly assigned to rosuvastatin (n = 38; 10 mg/day), to sevelamer hydrochloride (n = 38; 2,400 mg/day) and to control (n = 41) groups. CAC (by multislice computed tomography) and biochemical analyses were performed at baseline and after 24 months. Results: At baseline, CAC was observed in 55%, 58% and 61% of patients in the rosuvastatin, sevelamer hydrochloride and control groups, respectively (p = 0.87). Calciumscore at baseline as well as its absolute and relative changes during 24 months were similar among the groups. Low density lipoprotein cholesterol (LDL-c) was higher and decreased significantly in the rosuvastatin group (p < 0.01). The analysis adjusting for LDL-c showed that the drug regimens were not associated with the progression of CAC (drug effect p = 0.85; time-effect p < 0.001; interaction p = 0.76). Conclusions: Treatment with rosuvastatin and sevelamer hydrochloride may not delay the progression of CAC in non-dialysis dependent CKD patients.Correspondence to:
Maria Eugênia F. Canziani, MD, PhD
Rua Pedro de Toledo 282
ZIP 04039-000 São Paulo – SP Brazil
Email: [email protected]
Original
Association between osteoprotegerin, fetuin-A, carotid intima media thickness, and urinary albumin excretion in Type 2 diabetes
Basak Unver Koluman, Ruya Mutluay, Ulver Boztepe Derici, Turgay Arinsoy, Zeynep Senli̇k, Burak Bahar, Banu Sancak, Suna Özhan Oktan and Sukru Sindel
Page No. 9
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 (9-16)
Association between osteoprotegerin, fetuin-A, carotid intima media thickness, and urinary albumin excretion in Type 2 diabetes
Basak Unver Koluman1, Ruya Mutluay2, Ulver Boztepe Derici3, Turgay Arinsoy3, Zeynep Senli̇k4, Burak Bahar5, Banu Sancak5, Suna Özhan Oktan6 and Sukru Sindel3
1Department of Hematology, Dıskapı Yıldırım Beyazıt Training and Research Hospital, 2Eskisehir Yunus Emre State Hospital, Eskisehir, 3Department of Nephrology, 4Department of Public Health, 5Department of Biochemistry, and 6Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
Aims: Vascular calcification and atherosclerosis play a vital role in the development of cardiovascular morbidity and mortality in diabetic patients, especially when complications of diabetic nephropathy occur. Osteoprotegerin (OPG) and fetuin-A are two markers of vascular calcification. We evaluated the association between these vascular markers and urinary albumin excretion in diabetic patients. Method: Three groups were arranged containing 40 patients: normoalbuminuric (Group 1), microalbuminuric (Group 2), and macroalbuminuric (Group 3). In addition to the obtained data, levels of hs-CRP (high sensitivity-CRP) and homocysteine were examined. Results: OPG levels of patients in Group 2 were higher than in Group 1 (p = 0.058). OPG levels in Group 3 were lower than in Groups 1 or 2 (p = 0.014 and 0.000, respectively). Levels of fetuin-A in Group 2 were determined to be lower than in Groups 1 and 3 (p = 0.001 and 0.000, respectively). Carotid intima media thickness (CIMT) in Group 3 was higher than in Group 1 (p = 0.002). CIMT in Group 2 was also higher than in Group 1 (p = 0.039). A positive correlation between fetuin-A and OPG was found (p = 0.012, r = 0.393). Additionally, a positive correlation between hs-CRP and fetuin-A in Group 2 (p = 0.020, r = 0.367) and a negative correlation between hs-CRP and OPG in Group 3 (p = 0.036, r = –0.333) were observed. Conclusions: The differences found between albuminuria and OPG or fetuin-A may be due to the different doses and variety of medications the patients received, in addition to genetic and racial factors. So far, in our country, polymorphisms related to OPG and fetuin-A have not been defined. Further detailed studies about polymorphisms will have additional value.Correspondence to:
Basak Unver Koluman
Department of Hematology
Diskapi Yıldırım Beyazıt Training and Research Hospital
Diskapi, 06110 Ankara, Turkey
Email: [email protected]
Original
The effect of phosphate binders, calcium and lanthanum carbonate on FGF23 levels in chronic kidney disease patients
Sagrario Soriano, Raquel Ojeda, Mencarnación Rodríguez, Yolanda Almadén, Mariano Rodríguez, Alejandro Martín-Malo and Pedro Aljama
Page No. 17
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 (17-22)
The effect of phosphate binders, calcium and lanthanum carbonate on FGF23 levels in chronic kidney disease patients
Sagrario Soriano1,3, Raquel Ojeda1,3, Mencarnación Rodríguez2,3, Yolanda Almadén2,3, Mariano Rodríguez1,2,3, Alejandro Martín-Malo1,3 and Pedro Aljama1,3
1Nephrology Unit, Reina Sofía University Hospital, 2Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC)/Fundación de Investigaciones Biomédicas de Córdoba (FIBICO), Reina Sofía University Hospital, Córdoba, and 3Instituto de Salud Carlos III (RETICs Red Renal RD06/0016/0007), Madrid, Spain
Background: Recent publications show that elevation of FGF23 is independently associated with progression or renal disease, left ventricular hypertrophy and cardiovascular mortality. Dietary restriction of phosphate and phosphate binders are used for control phosphate balance and elevation of serum FGF23 levels. The aim of this study is to compare the effectiveness of calcium carbonate vs. lanthanum carbonate in reducing serum FGF23 levels in Chronic Kidney Disease (CKD) patients. Methods: 32 patients from the Nephrology outpatient clinic with CKD 4 – 5 non-dialysis were included. Patients receive a 4-month treatmentperiod of calcium carbonate or lanthanumcarbonate. Patients had normal serum calciumconcentration, 25 (OH) levels >30 ng/ml and they were not on VDR activators or cinacalcet. Results: As compared with calcium carbonate, patients on lanthanum carbonate had lower serum levels of FGF23 (226 ± 11 vs. 158 ± 9 pg/ml) and less urinary excretion of phosphate. No significant changes in serum calcium and PTH levels were observed in both groups. Conclusions: In conclusion, in CKD 4 – 5 patients lanthanum carbonate is effective in reducing phosphate load and FGF23 levels; this effect was not observed with calcium carbonate.Correspondence to:
Sagrario Soriano, MD
Servicio de Nefrología
Avda Menendez Pidal S/N
Córdoba 14004, Spain
Email: [email protected]
Original
Smoking as the potential link between Kimmelstiel-Wilson lesion and non-diabetic nodular glomerulosclerosis in male patients – a single center retrospective study
Richárd Halmai, Péter Degrell, István András Szijártó, Viktória Mátyás, Gergő Attila Molnár, Tibor Kovács and István Wittmann
Page No. 23
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 (23-28)
Smoking as the potential link between Kimmelstiel-Wilson lesion and non-diabetic nodular glomerulosclerosis in male patients – a single center retrospective study
Richárd Halmai, Péter Degrell, István András Szijártó, Viktória Mátyás, Gergő Attila Molnár, Tibor Kovács and István Wittmann
2nd Department of Internal Medicine and Nephrological Center, University of Pécs, Pécs, Hungary
Background: The histological pattern of nodular glomerulosclerosis (NGS) can be found both in diabetic nephropathy (Kimmelstiel-Wilson (KW) lesion) and non-diabetic nodular glomerulosclerosis (non-diab NGS). Chronic smoking is considered to be a potential cause of non-diab NGS, but the prevalence of smokers in KW is unknown. Methods: In a retrospective analysis, native renal biopsy specimens (n = 644, 2001 – 2011) were evaluated and male patients’ characteristics, including smoking habits, were assessed within three groups: diabetic patients with KW (n = 15), diabetic patients with other classes of diabetic nephropathy (non-KW; n = 46), and patients with non-diab NGS (n = 7). Results: The majority of patients in the KW and non-diab NGS groups (13/15 = 87%, 7/7 = 100%, respectively; p = 1.0 vs. KW) were smokers, unlike the non-KW group (16/46 = 35%; p = 0.001 vs. KW). Cigarette pack-years showed a similar pattern (KW: 15 (6 – 30), non-KW: 0 (0 – 21), non-diab NGS: 30 (16 – 33); p = 0.010 non-KW vs. KW, p = 0.008 non-KW vs. non-diab NGS). Other known factors responsible for the worsening of non-KW or the development of non-diab NGS did not differ in the groups (age, body mass index, duration of diabetes mellitus, HbA1c, prevalence of hypertension, duration of hypertension, serum cholesterol, triglyceride, estimated glomerular filtration rate, and renin-angiotensin-aldosteron system-blocker treatment). Conclusions: We propose that chronic cigarette smoking could play a pivotal role in the development of KW lesions.Correspondence to:
Prof. Dr. István Wittmann
University of Pécs
Pacsirta utca 1, Pécs, 7624 Hungary
Email: [email protected]
Original
The association of chronic kidney disease complications by albuminuria and glomerular filtration rate: a cross-sectional analysis
Gautham Viswanathan, Mark J. Sarnak, Hocine Tighiouart, Paul Muntner and Lesley A. Inker
Page No. 29
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 (29-39)
The association of chronic kidney disease complications by albuminuria and glomerular filtration rate: a cross-sectional analysis
Gautham Viswanathan1, Mark J. Sarnak1, Hocine Tighiouart1, Paul Muntner2 and Lesley A. Inker1
1Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, and 2Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
Background: Albuminuria is strongly associated with future risk for cardiovascular and kidney outcomes, and has been proposed to be included in the classification of chronic kidney disease (CKD) along with glomerular filtration rate (GFR). Few data are available on whether albuminuria is associated with concurrent complications of CKD. Methods: A cross-sectional analysis of 1,665 participants screened for the Modification of Diet in Renal Disease (MDRD) study was performed to examine the association between albuminuria (determined using urine albumin-creatinine ratio (ACR)) and measured GFR (determined using urinary clearance of iothalamate) with anemia, acidosis, hyperphosphatemia, and hypertension. Results: Mean GFR (± SD) was 39 ml/min/1.73 m2 (± 21) and the median (25 – 75th percentile) ACR was 161 (38 – 680) mg/g. In multivariable models adjusted for age, sex, race, kidney disease etiology, and GFR, higher ACR levels were not associated with any complication. For example, comparing ACR > 300 mg/g vs. < 30 mg/g, the prevalence ratio (95% CI) for anemia was 0.98 (0.81 – 1.20), acidosis 1.13 (0.86 – 1.48), hyperphosphatemia 1.69 (0.91 – 3.17), and hypertension 1.04 (0.97 – 1.12). Lower levels of GFR were associated with all complications. For example, GFR levels < 30 ml/min/1.73 m2 vs. GFR levels 60 – 89 ml/min/1.73 m2 were associated with prevalence ratios (95% CI) of anemia 4.35 (3.18 – 5.96), acidosis 5.31 (3.41 – 8.29), hyperphosphatemia 23.8 (7.71 – 73.6), and hypertension 1.21 (1.10 – 1.32). Conclusions: Albuminuria is not associated with complications after controlling for GFR in patients younger than 70 years of age with non-diabetic CKD and GFR less than 90 ml/min/1.73 m2 and thus would not affect clinical action plans for decisions regarding evaluation and treatment of complications in similar populations.Correspondence to:
Lesley Inker, MD, MS
Division of Nephrology, Department of Medicine
Tufts Medical Center
800 Washington St Box 391
Boston MA, 02111, USA
Email: [email protected]
Original
Clinical and prognostic implications of serum uric acid levels on IgA nephropathy: a cohort study of 348 cases with a mean 5-year follow-up
Gen-yang Cheng, Dong-wei Liu, Na Zhang, Lin Tang, Zhan-zheng Zhao and Zhang-suo Liu
Page No. 40
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 (40-46)
Clinical and prognostic implications of serum uric acid levels on IgA nephropathy: a cohort study of 348 cases with a mean 5-year follow-up
Gen-yang Cheng1*, Dong-wei Liu1*, Na Zhang2, Lin Tang1, Zhan-zheng Zhao1 and Zhang-suo Liu1
1Department of Nephrology, and 2The First Affiliated Hospital, ZhengZhou University, Zhengzhou, China
*Both authors contributed equally to this work.
Aim: To assess the prognostic implications of serum uric acid levels on patients with IgA nephropathy in a longitudinal 8-year follow-up study and to identify an association between serum uric acid levels and the clinical and pathological phenotypes of IgA nephropathy. Subjects and methods: We reviewed the files of all consecutive patients with IgA nephropathy treated at our hospital between 2001 and 2009. Analyses were performed to investigate the association between the level of serum uric acid and both clinical and pathological phenotypes of IgA nephropathy. Prognosis was assessed based on follow-up data. Results: At the same glomerular filtration rate (GFR), there was no significant difference in the levels of 24 hours proteinuria, blood urea nitrogen (BUN), and serum creatinine between the two groups with different levels of serum uric acid (p > 0.05). The prevalence of glomerular sclerosis as well as the scores of tubulointerstitial and vascular injury was greater in patients with high serum uric acid levels compared to patients with normal levels of serum uric acid (p < 0.05). At the end of the follow-up period, patients with high serum uric acid levels had a higher prevalence of reduced GFR and end stage renal disease (ESRD) than those with normal serum uric acid levels (40.82 vs. 15.70% and 64.71 vs. 35.00%, respectively; p < 0.05). Conclusions: The serum uric acid level in patients with IgA nephropathy affects the pathophysiology and prognosis of the disease. We also identified a correlation between hyperuricemia and a higher risk of renal end points.Correspondence to:
Zhang-suo Liu, MD
Department of Nephrology
The First Affiliated Hospital
ZhengZhou University
No.1 Jianshe Road, Zhengzhou, Henan,450052, China
Email: [email protected]
Original
Tonsillectomy with steroid pulse therapy has more effect on the relapse rate than steroid pulse monotherapy in IgA nephropathy patients
Masaki Ohya, Haruhisa Otani, Yoshinobu Minami, Shintaro Yamanaka, Toru Mima, Shigeo Negi, Susumu Yukawa and Takashi Shigematsu
Page No. 47
Abstract
Tonsillectomy with steroid pulse therapy has more effect on the relapse rate than steroid pulse monotherapy in IgA nephropathy patients
Masaki Ohya1, Haruhisa Otani2, Yoshinobu Minami3, Shintaro Yamanaka1, Toru Mima1, Shigeo Negi1, Susumu Yukawa4 and Takashi Shigematsu1
1Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, 2Department of Internal Medicine, Kisen Kidney Disease Clinic, Wakayama City, 3Department of Internal Medicine, Arita Minami Hospital, Aritagawa City, and 4Department of Internal Medicine, Hakubunkai Kodama Hospital, Wakayama City, Wakayama, Japan
Aims: Both steroid pulse (SP) monotherapy and the combination of tonsillectomy and SP therapy (TSP) are effective for achieving clinical remission (CR), defined as negative hematuria and proteinuria, in patients with IgA nephropathy (IgAN). The role of tonsillectomy in the treatment of IgAN has been analyzed only from the aspect of CR or renal survival after TSP treatment, so there is no evidence of its effect on the relapse after CR. Methods: We retrospectively investigated relapse (re-appearance of urinary abnormalities) from CR after TSP or SP monotherapy in 62 IgAN patients (mean follow-up, 70.1 ± 35.3 months). The SP therapy comprised 0.5 g methylprednisolone administered intravenously on 3 consecutive days followed by oral prednisolone (30 mg/day) on 4 consecutive days, with the course repeated 3 times. Oral prednisolone (30 mg/day) was then given on alternative days and gradually tapered and finished over 1 year. Tonsillectomy was performed either before or within 6 months of starting SP therapy. Results: At baseline, the mean age was 34.6 years, the mean serum creatinine (Cr) level was 0.9 mg/dl, and the mean level of proteinuria was 876 mg/day. There were no differences between the TSP group (41 patients) and SP monotherapy group (21 patients). In total, 24 of the TSP and 10 of the SP patients achieved CR. Of the 34 patients who achieved CR, 13 relapsed after TSP or SP monotherapy. Using Kaplan-Meier analysis, tonsillectomy was associated with a lower incidence of relapse from CR after treatment (p = 0.045). Multivariate Cox regression analysis revealed that tonsillectomy reduced the rate of from CR after SP therapy. Conclusion: Tonsillectomy was associated with a reduction in the relapse rate from CR after SP therapy in IgAN patients.Correspondence to:
Masaki Ohya, MD, PhD
Division of Nephrology
Department of Internal Medicine
Wakayama Medical University
811-1 Kimiidera, Wakayama City, 641-8509, Japan
Email: [email protected]
Original
The renoprotective effect of cGMP phosphodiesterase inhibitor and nitroprusside in a rat model of cyclosporin A-induced nephrotoxicity
Jae Won Yang, Jae Seok Kim, Min Keun Kim, Jun Young Lee, Byoung-Geun Han and Seung Ok Choi
Page No. 53
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 (53-62)
The renoprotective effect of cGMP phosphodiesterase inhibitor and nitroprusside in a rat model of cyclosporin A-induced nephrotoxicity
Jae Won Yang, Jae Seok Kim, Min Keun Kim, Jun Young Lee, Byoung-Geun Han and Seung Ok Choi
Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Gangwon, South Korea
Background: The cyclosporin A (CsA) nephrotoxicity limits its usefulness as an immunosuppression. We studied the administration of both nitroprusside and phosphodiesterase-5 inhibitor (udenafil) in order to determine whether these agents could ameliorate the renal injury in CsA nephrotoxicity. Methods: 30 8-week-old SD rats were divided into 5 groups: the control (1), SQ with 15 mg/kg CsA (Group 2), CsA along with 5 mg/kg IP nitroprusside (Group 3), CsA with 10 mg/kg PO udenafil (Group 4), and CsA with udenafil and nitroprusside (Group 5). Results: Group showed an increase in creatinine compared o the control group. Group 5 showed a decrease in creatinine compared to Group 2. In TUNEL, Group 2 increased apoptosis in proximal tubules compared to control. Group 5 showed a decrease in apoptosis compared to Groups 2, 3, and 4. In IHC, the eNOS in Group 2 was stronger than in the controls. Groups 3, 4, and 5 showed decreased staining intensity compared to Group 2. In IHC, the VEGF in Groups 2, 3, and 4 increased compared to the controls. The eNOS protein expression was increased in both Groups 3 and 5 compared to the controls. The VEGF protein expression was increased in Groups 3 and 5 compared to Group 2. The eNOS mRNA was decreased in Group 2 compared to the control group and tended to increase in Groups 3, 4, and 5 compared to Group 2. The VEGF mRNA was increased in Group 2 and tended to increase more in Groups 3 and 5. Conclusion: The udenafil and nitroprusside ameliorated renal injury in rat model of CsA nephrotoxicity. The mechanism appears to be associated with decreasing tubular apoptosis by decreasing eNOS and increasing VEGF.Correspondence to:
Seung Ok Choi, MD
Department of Nephrology
Yonsei University Wonju College of Medicine
162 Il San-Dong, Wonju, Gangwon 220-701, South Korea
Email: [email protected]
Nephrology Education
Renal cell carcinoma presenting as exfoliative dermatitis (erythroderma) – a case report
Yan Keqiang, Liu Cheng, Xu Zhonghua, Liu Zhaoxu, Wang Kun, Jiang Yuliang and Fan Yidong
Page No. 63
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 (63-66)
Renal cell carcinoma presenting as exfoliative dermatitis (erythroderma) – a case report
Keqiang Yan1,2*, Cheng Liu2*, Zhonghua Xu2, Zhaoxu Liu2, Kun Wang1,2, Yuliang Jiang3 and Yidong Fan2*
1Shandong University School of Medicine, 2Department of Urinary Surgery, Qilu Hospital of Shandong University, Jinan and 3Department of Urinary Surgery, the People’s Hospital of Yinan County, Shandong Province, China
*Keqiang Yan and Cheng Liu contributed equally to the work
Many kinds of malignant disorders present as exfoliative dermatitis (erythroderma), however, coincident clearcell renal cell carcinoma (ccRCC) and erythroderma has not been reported. A case of synchronous erythroderma and ccRCC in a 57-year-old man is presented presented here. After the diagnosis of the kidney bulk through CT, the patient had a transperitoneal laparoscopic radical nephrectomy, and the syndrome of the erythroderma disappeared after the surgery. The experience of the current patient suggests that the syndrome of erythroderma may resolve spontaneously after radical nephrotomy.Correspondence to:
Univ.-Prof. Fan YD, or Xu Zhongua
Department of Urology
Qilu Hospital of Shandong University, 250012 China
Email: [email protected] and [email protected]
Nephrology Education
Anti-glomerular basement membrane disease treated with mycophenolate mofetil, corticosteroids, and plasmapheresis
Mari Mori, Uzoamaka Nwaogwugwu, Gwendolyn R. Akers and Rita L. McGill
Page No. 67
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 (67-71)
Anti-glomerular basement membrane disease treated with mycophenolate mofetil, corticosteroids, and plasmapheresis
Mari Mori1, Uzoamaka Nwaogwugwu1, Gwendolyn R. Akers2 and Rita L. McGill1
1Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, and 2Indiana Regional Medical Center, Indiana, PA, USA
An 18-year-old woman presented with anemia, pulmonary hemorrhage, and necrotizing glomerulonephritis, and was diagnosed with anti-glomerular basement membrane (anti-GBM) disease. Treatment was undertaken with plasma exchange, mycophenolate mofetil and corticosteroids, due to patient refusal of cyclophosphamide. Clinical remission was successfully induced with this fertility-sparing regimen. A relapse due to therapy non-adherence was successfully treated with a second course of plasmapheresis, mycophenolate, and steroids. Thereafter, 6 months of directly observed therapy resulted in a favorable outcome with well-preserved pulmonary and renal function. This case suggests the possibility that mycophenolate may have a role in the treatment of anti-GBM disease.Correspondence to:
Rita L. McGill, MD
Division of Nephrology and Hypertension
4th Floor, South Tower, 320 East North Avenue
Pittsburgh, PA 15212-4772, USA
Email: [email protected]
Nephrology Education
Successful treatment of life threatening theophylline intoxication in a pregnant patient by hemodialysis
Jonas Kneser, Patricia Wehmeier, Ralf Lichtinghagen, Marius M. Hoeper and Jan T. Kielstein
Page No. 72
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 (72-74)
Successful treatment of life threatening theophylline intoxication in a pregnant patient by hemodialysis
Jonas Kneser1, Patricia Wehmeier2, Ralf Lichtinghagen3, Marius M. Hoeper2 and Jan T. Kielstein4
1Department of Gastroenterology, Hepatology and Endocrinology, 2Department of Pulmonary, 3Medicine Institute for Clinical Chemistry and 4Department of Nephrology and Hypertension, Medical School Hannover, Germany
High-flux hemodialysis is the extracorporeal treatment of choice for various life threatening intoxications. Most published reports support the use of hemoperfusion in the context of severe theophylline poisoning, but the technique is limited by its significant side-effects. We present a potentially life threatening theophylline overdose treated with hemodialysis in a pregnant patient. For the first time the amount of theophylline removed was measured in the total collected spent dialysate, after a 3.75 hour hemodialysis and an 8 hour extended dialysis.Correspondence to:
Jan T. Kielstein
Department of Internal Medicine,
Division of Nephrology and Hypertension
Medical School Hannover
Carl-Neuberg-Strasse 1
30625 Hannover, Germany
Email: [email protected]
Nephrology Education
Cytomegalovirus polyradiculopathy of late onset in a young renal transplant recipient
Marios Papasotiriou, Evangelos Papachristou, Markos Marangos, Maria Koukoulaki, Eirini Savvidaki, Pantelitsa Kalliakmani and Dimitrios S. Goumenos
Page No. 75
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 (75-78)
Cytomegalovirus polyradiculopathy of late onset in a young renal transplant recipient
Marios Papasotiriou1, Evangelos Papachristou1, Markos Marangos2, Maria Koukoulaki1, Eirini Savvidaki1, Pantelitsa Kalliakmani1 and Dimitrios S. Goumenos1
1Nephrology, and 2Infectious Diseases, Department of Internal Medicine, University Hospital of Patras, Patras, Greece
Although cytomegalovirus (CMV) disease in CMV IgM/IgG-negative renal transplant recipients from CMV-positive donors (D+/R–) can occur after discontinuation of prophylaxis treatment as a flu-like syndrome or tissue invasive disease, involvement of the central nervous system is rare. Here, we report a case of CMV polyradiculopathy 6 months after renal transplantation that presented as a Guillain-Barre like syndrome and was successfully treated with foscarnet. This case highlights an uncommon aspect of CMV invasive disease which we should keep in mind in CMV (D+/R–) renal transplant recipients.Correspondence to:
Prof. Dimitrios S.
Goumenos Department of Internal Medicine-Nephrology
University Hospital of Patras
Patras 265 00, Greece
Email: [email protected]
Letter to the Editor
Clinicopathologic features and treatment response in nephrotic IgA nephropathy with minimal change disease
Keng Thye Woo, Kok Seng Wong, Hui Lin Choong, Marjorie Foo, York Moi Chin and Choong Meng Chan
Page No. 79
Abstract
Clinical Nephrology, Vol. 80 – No. 1/2013 – Letter to the editor
Clinicopathologic features and treatment response in nephrotic IgA nephropathy with minimal change disease
Keng Thye Woo, Kok Seng Wong, Hui Lin Choong, Marjorie Foo, York Moi Chin and Choong Meng Chan
Department of Renal Medicine, Singapore General Hospital, Singapore
Correspondence to:
Dr. Keng Thye Woo
Department of Renal Medicine
Singapore General Hospital
Outram Road, 169608 Singapore
Email: [email protected]
