Volume 80 (2013), No. 3/2013(September)
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Original
Osteoprotegerin and mortality in hemodialysis patients with cardiovascular disease
Simon Winther, Jeppe Hagstrup Christensen, Allan Flyvbjerg, Erik Berg Schmidt, Kaj Anker Jørgensen, Hanne Skou-Jørgensen and My Svensson
Page No. 161
Abstract
Clinical Nephrology, Vol. 80 – No. 3/2013 (161-167)
Osteoprotegerin and mortality in hemodialysis patients with cardiovascular disease
Simon Winther1, Jeppe Hagstrup Christensen5, Allan Flyvbjerg3, Erik Berg Schmidt4, Kaj Anker Jørgensen2, Hanne Skou-Jørgensen2 and My Svensson2
1Department of Cardiology, 2Department of Nephrology, 3Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, Aarhus, 4Department of Cardiology, and 5Department of Nephrology, Aalborg Hospital, Institute of Clinical Medicine, Aarhus University, Aalborg, Denmark
Background: Patients treated with hemodialysis (HD) have an increased mortality, mainly caused by cardiovascular disease (CVD). Osteoprotegerin (OPG) is a glycoprotein involved in the regulation of the vascular calcification process. Previous studies have demonstrated that OPG is a prognostic marker of mortality. The aim of this study was to investigate if OPG was a prognostic marker of all-cause mortality in high-risk patients with end-stage renal disease and CVD. Methods: We prospectively followed 206 HD patients with CVD. OPG was measured at baseline and the patients were followed for 2 years or until reaching the primary endpoint, i.e., all-cause mortality. Results: All-cause mortality during follow-up was 44% (90/206). High OPG was associated with increased mortality, using the first tertile as reference, with an unadjusted HR of 1.70 (CI 1.00 – 2.88) for the second tertile and HR of 1.63 (CI 0.96 – 2.78) for the third tertile. In a multivariate Cox-regression analysis age, CRP and OPG in both the second and third tertile were significantly associated with increased mortality In the unadjusted survival analysis, a test for trend of OPG yielded a p-value of 0.08; in the adjusted analyses, the p-value for trend was 0.03. Conclusions: In a high-risk population of hemodialysis patients with previously documented cardiovascular disease, a high level of OPG was an independent risk marker of all-cause mortality.Correspondence to:
Simon Winther, MD
Department of Cardiology
Aarhus University Hospital
Brendstrupgaardsvej 100
8200 Aarhus N, Denmark
Email: [email protected]
Original
Circulating levels of β2-microglobulin and cystatin C are associated with left atrial size: additional link between the kidney and the heart
Yu-Sheng Liu, Xin Wang, Wei-Dong Jiang, Zhi-Wei Huang, Yong-Mei Wang, Lin Hao, Jie-Ling Xing, Lin Wang, Xin-Xin Liu, Patricia Lounsbury, Mei Zhang and Qing-Hua Lu
Page No. 168
Abstract
Clinical Nephrology, Vol. 80 – No. 3/2013 (168-176)
Circulating levels of β2-microglobulin and cystatin C are associated with left atrial size: additional link between the kidney and the heart
Yu-Sheng Liu1*, Xin Wang1*, Wei-Dong Jiang1, Zhi-Wei Huang3, Yong-Mei Wang1, Lin Hao1, Jie-Ling Xing1, Lin Wang2, Xin-Xin Liu2, Patricia Lounsbury4, Mei Zhang2 and Qing-Hua Lu1
1Department of Cardiology, the Second Hospital of Shandong University, 2Department of Cardiology, The Qilu Hospital of Shandong University, 3Division of Internal Medicine, The Qilu Children’s Hospital of Shadong University, Jinan, China, and 4Cardiovascular Health, Assessment, Management, and Prevention Services (CHAMPS), University of Iowa Hospitals and Clinics, Iowa City, IA, USA
*Contributed equally
Objective: More attention is being paid to the relationship between kidney dysfunction and cardiovascular events Characteristic features include renal dysfunction, left ventricular (LV) and left atrial (LA) enlargement. The aim of this study is to evaluate the relationships between circulating levels of β2-microglobulin (β2-m) and cystatin C and left atrial size in patients with coronary artery disease. Materials and methods: We recruited 300 patients who presented with chest tightness or chest pain and subsequently underwent coronary angiography. Of these, 202 patients were diagnosed with coronary artery disease (CAD) and 98 patients without CAD (non-CAD). Laboratory measurements included liver, kidney function (urea nitrogen, creatinine, β2-m and cystatin C), fasting glucose, and lipid analysis. CrCl were calculated according to Cockroft-Gault formula. Echocardiology was used to evaluate the cardiac structure and function. Results: Significant differences of β2-m and cystatin C exist and no difference of creatinine and CrCl existed between the two groups. LA diameters were positively related to circulating levels of β2-m in the CAD group (r = 0.452, p < 0.001) and non-CAD group (r = 0.360, p < 0.001), and the similar relationships between LAD and circulating levels of cystatin C in the CAD group (r = 0.302, p < 0.001) and non-CAD group (r = 0.243, p = 0.016). LA diameters were negatively related to CrCl in both groups. After multivariate logistic regression analysis, the data indicated that the independent cardiovascular risk factors of LA enlargement for the patients with CAD were age, BMI, systolic blood pressure, LV mass, LVEDD, E/A, Em/Am, CrCl, and circulating levels of β2-m (OR = 1.630, 95% CI: 1.115 – 2.384, p = 0.012), cystatin C (OR = 4.504, 95% CI: 1.478 – 13.726, p = 0.008). Conclusions: A linear correlation exists between circulating levels of β2-m or cystatin C and LA diameters. Higher circulating levels of β2-m or cystatin C are independent cardiovascular risk factors of LA enlargement in patients with CAD, and could be a link between the kidney and the heart.Correspondence to:
Prof. Qing-Hua Lu
Department of Cardiology
the Second Hospital of Shandong University
Jinan, Beiyuan Big Street NO. 247
Shandong Province, China, 250033
and
Prof. Mei Zhang
Department of Cardiology
The Qilu Hospital of Shandong University
Wenhua Xi Street No. 107
Shandong Province, 250012 China
Email: [email protected]
Original
Study of oxidative stress in patients with advanced renal disease and undergoing either hemodialysis or peritoneal dialysis
Maria J. Puchades, Guillermo Saez, M. Carmen Muñoz, Miguel Gonzalez, Isidro Torregrosa, Isabel Juan and Alfonso Miguel
Page No. 177
Abstract
Clinical Nephrology, Vol. 80 – No. 3/2013 (177-186)
Study of oxidative stress in patients with advanced renal disease and undergoing either hemodialysis or peritoneal dialysis
Maria J. Puchades1, Guillermo Saez2, M. Carmen Muñoz2, Miguel Gonzalez1, Isidro Torregrosa1, Isabel Juan1 and Alfonso Miguel1
1Department of Nephrology, University Clinical Hospital, and 2Department of Biochemistry, Faculty of Medicine, CIBEROBN, University of Valencia, Spain
Oxidative stress (OS) is directly involved in the formation of atheroma plaque and has been shown to be present since the early stages of Chronic Kidney Disease (CKD); however, the net role that dialytica techniques may play in OS process is yet to be determined. We studied three groups: hemodialysis (HD, n = 30), peritoneal dialysis (PD, n = 31), predialysis (pre-D, n = 32), and one control group (C, n = 67). Using highresolution liquid chromatography columns (HPLC), the superoxide dismutase (SOD), glutathione oxidized/reduced ratio (GSSG/GSH), and nuclear, as well as mitochondrial 8-oxo-dG (8-oxo-dG mit) were measured in lymphocytes. Protein carbonyls and F2-isoprostanes were measured in plasma. The antioxidant enzyme activity was evaluated by a spectrophotometric assay of catalase, glutathione peroxidase (GPX), glutathione reductase (GSR), and superoxide dismutase (SOD). Compared to the control group, all groups had significantly higher levels of products derived from molecular oxidation with a significant decrease in antioxidant enzymes. Patients in the pre-D group showed higher values for most of the oxidized molecules. The PD group showed a better oxidative balance, with no significant differences in levels of mitochondrial 8-oxo-dG when compared to the control group. We speculated that the better control of OS observed in patients receiving PD might be explained by the fact that this technique is more biocompatible, and this might help reduce the risk of cardiovascular events.Correspondence to:
Maria J. Puchades
Department of Nephrology
University Clinical Hospital
Av. Blasco Ibañez, 17, 46010 Valencia, Spain
Email: [email protected]
Original
Oxidative stress and other risk factors for white matter lesions in chronic hemodialysis patients
Mònica Muñoz-Cortés, Carme Cabré, Diasol Villa, Joan Pere Vives, Mercedes Arruche, Jordi Soler, Maria Teresa Compte, Josep Aguilera, Manel Jariod, Marta Romeu, Montserrat Giralt and Alberto Martinez-Vea
Page No. 187
Abstract
Clinical Nephrology, Vol. 80 – No. 3/2013 (187-197)
Oxidative stress and other risk factors for white matter lesions in chronic hemodialysis patients
Mònica Muñoz-Cortés1, Carme Cabré2, Diasol Villa3, Joan Pere Vives3, Mercedes Arruche4, Jordi Soler4, Maria Teresa Compte5, Josep Aguilera6, Manel Jariod7, Marta Romeu1, Montserrat Giralt1 and Alberto Martinez-Vea2
1Pharmacology Unit, Department of Basic Health Sciences, Universitat Rovira i Virgili, Catalonia, 2Nephrology Service, 3Image Diagnostic Institute, Hospital Universitari de Tarragona Joan XXIII, Tarragona, 4Medical Care Nephrology Center, Reus, 5Nephrology Assistance Unit, Hospital de Jesús, Tortosa, 6Dialysis Center, Hospital Llevant, and 7Information Systems, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
Background: Chronic kidney disease (CKD) is a risk factor for cardiovascular disease and promotes oxidative tress (OS), which has been implicated in the pathogenesis of white matter lesions (WML), a form of small-vessel cerebrovascular disease. The relationship between OS and WML in chronic hemodialysis (HD) patients has not yet been studied. Methods: We studied 67 chronic HD patients, aged 40 – 65 years (average 54 years) without known cerebrovascular disease. All patients underwent brain magnetic resonance imaging and subcortical and periventricular WML were evaluated using semiquantitative measures. Patients were classified into two groups depending on the presence or absence of WML (Fazekas classification), and the WML were scored. Carotid ultrasonography was also performed to evaluate the presence of carotid artery plaques and/or stenosis. Markers of protein and lipid oxidation (protein carbonyl and oxLDL antibodies), the glutathione system, enzymatic antioxidants (superoxide dismutase, glutathione peroxidase, glutathione reductase and catalase) and total antioxidant capacity (ORAC) were measured. OS markers were compared to those of a group of 36 healthy subjects. Results: WML were present in 54% of the total population. Patients who had WML were older and had lower predialysis diastolic blood pressure than patients without WML. Other potential cardiovascular risk factors for WML, including obesity, hyperlipidemia, diabetes mellitus, presence of carotid artery plaques or stenosis, and duration and adequacy of HD were not related to the presence of WML. Compared to controls, HD patients had increased OS and decreased antioxidant capacity. However, OS did not differ between patients with WML and those without, and we found no association between OS markers and mean WML scores. After adjusting for several factors, only age and low predialysis diastolic blood pressure independently predicted an increased risk of WML. Conclusions: Our results confirm that chronic HD patients have increased OS, but this is not related to the presence or severity of WML.Correspondence to:
Alberto Martinez-Vea, MD
Servei de Nefrologia
Hospital Universitari de Tarragona Joan XXIII
Carrer del Doctor Mallafré Guasch, 4
43007 Tarragona, Spain
Email: [email protected]
Original
The associations between serum paraoxonase 1 activity and carotid atherosclerosis in renal transplant patients
Ozkan Gungor, Erkan Kismali, Ali Riza Sisman, Fatih Kircelli, Gulay Asci, Kenan Topal, Savas Sipahi, Pinar Tuncel, Mehmet Ozkahya and Huseyin Toz
Page No. 198
Abstract
Clinical Nephrology, Vol. 80 – No. 3/2013 (198-202)
The associations between serum paraoxonase 1 activity and carotid atherosclerosis in renal transplant patients
Ozkan Gungor1, Erkan Kismali2, Ali Riza Sisman3, Fatih Kircelli1, Gulay Asci1, Kenan Topal4, Savas Sipahi5, Pinar Tuncel2, Mehmet Ozkahya1 and Huseyin Toz1
1Ege University School of Medicine, Division on Nephrology, 2Ege University School of Medicine, Division on Radiology, Izmir, 3Dokuz Eylul University School of Medicine, Division on Biochemistry, Izmir, 4Pamukkale University School of Medicine, Division on Family Medicine, Denizli, and 5Sakarya Education and Research Hospital, Division of Nephrology, Sakarya, Turkey
Backgrounds and aims: Paraoxonase 1 (PON1) is a novel marker that has been shown to exert protective functions on atherosclerosis by preventing oxidative modification of serum lipoproteins. In this study, we investigated the effects of PON1 on CA-IMT in renal transplant patients. Methods: A total of 98 adult renal transplant recipients was enrolled in the study. CA-IMT was determined by B-mode Doppler ultrasonography. PON-1 activity was assessed by the rate of enzymatic hydrolysis of paraoxon to p-nitrophenol. Results: Mean age was 39.4 ± 9.6 years and 10% of the patients were diabetic. Time after transplant was 76 ± 59 months. Mean PON1 level was 62.1 ± 43.3 U/l. PON1 levels were negatively correlated with CA-IMT and positively with HDL cholesterol. Mean CA-IMT was 0.62 ± 0.10 mm (0.40 – 0.98). CA-IMT was positively correlated with age, male gender and negatively with proteinuria and PON1 levels. In linear regression analysis, PON1 levels were associated with CA-IMT. Conclusion: Reduced PON1 activity is significantly associated with increased carotid atherosclerosis in renal transplant patients.Correspondence to:
Ozkan Gungor, MD
Ege University School of Medicine
Division of Nephrology
35100 Bornova, Izmir, Turkey
Email: [email protected]
Original
Up-regulation of urinary markers predict outcome in IgA nephropathy but their predictive value is influenced by treatment with steroids and azathioprine
Maria Stangou, Aikaterini Papagianni, Christos Bantis, Dimitrios Moisiadis, Stratis Kasimatis, Michael Spartalis, Afroditi Pantzaki, George Efstratiadis and Dimitrios Memmos
Page No. 203
Abstract
Clinical Nephrology, Vol. 80 – No. 3/2013 (203-210)
Up-regulation of urinary markers predict outcome in IgA nephropathy but their predictive value is influenced by treatment with steroids and azathioprine
Maria Stangou1, Aikaterini Papagianni1, Christos Bantis1, Dimitrios Moisiadis1, Stratis Kasimatis1, Michael Spartalis1, Afroditi Pantzaki2, George Efstratiadis1 and Dimitrios Memmos1
1Department of Nephrology, Aristotle University of Thessaloniki, and 2Department of Pathology, Hippokration Hospital, Thessaloniki, Greece
Objective: Steroids and immunosuppressants can delay progression of renal function in IgAN, but their possible effect in local cytokines has not been studied. Material and methods: Histology in 53 IgAN patients (M/F 35/18 age 40.5 years (17 – 65)) was evaluated using the Oxford classification system. IL-1β, -2, -4, -5, -6, -10, -12 and -17, INF-γ and MCP-1 were measured subsequently by multiplex cytokine assay in first morning urine samples taken at the day of renal biopsy. After a 6-month course with RAASinhibitors + fish oils (FO), 35/53 patients, Group A, responded and continued on the same treatment, while in 18/53 who did not respond, Group B, steroids + azathiopine were added. Results: The presence of endocapillary proliferation had significant correlation with the urinary excretion of pro-inflammatory and pro-fibrotic cytokines (IL-1β, MCP-1, IL-17, INF-γ, IL-6 and IL-10). Serum creatinine at time of diagnosis had significant correlation with proteinuria (p = 0.02), urinary levels of IL-1β (p = 0.03), IL-2 (p = 0.01) and MCP-1 (p = 0.03). GFR was reduced from 65 ± 29 to 57 ± 34 ml/min, p = 0.005 in Group A and remained stable in Group B patients (GFR from 63 ± 24 to 61 ± 30 ml/min, p = NS). Most of the measured cytokines in the urine predicted deterioration of renal function in Group A, but the urinary excretion of IL-6 seemed to predict renal function outcome in both groups of patients. Conclusion: Several cytokines are excreted in the urine of patients with IgAN, and their levels predict the outcome of the disease. Steroids + aza may exert their beneficial effect through suppression of the production or activation of most cytokines.Correspondence to:
Maria Stangou, PhD
Consultant Nephrologist
Department of Nephrology
Aristotle University of Thessaloniki
Hippokration Hospital
49 Kontantinoupoleos Str
54642, Thessaloniki, Greece
Email: [email protected] or [email protected]
Original
Effect of dark chocolate on renal tissue oxygenation as measured by BOLD-MRI in healthy volunteers
Menno Pruijm, Lucie Hofmann, Julie Charollais-Thoenig, Valentina Forni, Marc Maillard, Andrew Coristine, Matthias Stuber, Michel Burnier and Bruno Vogt
Page No. 211
Abstract
Clinical Nephrology, Vol. 80 – No. 3/2013 (211-217)
Effect of dark chocolate on renal tissue oxygenation as measured by BOLD-MRI in healthy volunteers
Menno Pruijm1, Lucie Hofmann1, Julie Charollais-Thoenig1, Valentina Forni1, Marc Maillard1, Andrew Coristine2, Matthias Stuber2, Michel Burnier1 and Bruno Vogt1
1Department of Nephrology and 2Department of Radiology, University Hospital of Lausanne (CHUV), Switzerland
Background: Cocoa is rich in flavonoids, has anti-oxidative properties and increases the bioavailability of nitric oxide (NO). Adequate renal tissue oxygenation is crucial for the maintenance of renal function. The goal of this study was to investigate the effect of cocoa-rich dark chocolate (DC) on renal tissue oxygenation in humans, as compared to flavonoid-poor white chocolate (WC). Methods: Ten healthy volunteers with preserved kidney function (mean age ± SD 35 ± 12 years, 70% women, BMI 21 ± 3 kg/m2) underwent blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) before and 2 hours after the ingestion of 1 g/kg of DC (70% cocoa). Renal tissue oxygenation was determined by the measurement of R2* maps on 4 coronal slices covering both kidneys. The mean R2* (= 1/T2*) values in the medulla and cortex were calculated, a low R2* indicating high tissue oxygenation. Eight participants also underwent BOLD-MRI at least 1 week later, before and 2 hours after the intake of 1 g/kg WC. Results: The mean medullary R2* was lower after DC intake compared to baseline (28.2 ± 1.3 s–1 vs. 29.6 ± 1.3 s–1, p = 0.04), whereas cortical and medullary R2* values did not change after WC intake. The change in medullary R2* correlated with the level of circulating (epi)catechines, metabolites of flavonoids (r = 0.74, p = 0.037), and was independent of plasma renin activity. Conclusion: This study suggests for the first time an increase of renal medullary oxygenation after intake of dark chocolate. Whether this is linked to flavonoid-induced changes in renal perfusion or oxygen consumption, and whether cocoa has potentially renoprotective properties, merits further study.Correspondence to:
Dr. Menno Pruijm
Division of Nephrology and Hypertension
Consultation Centre Hospitalier Universitaire Vaudois
Rue du Bugnon 17, 1011 Lausanne, Switzerland
Email: [email protected]
Nephrology Education
Association of a novel in-frame deletion mutation of the MYH9 gene with end-stage renal failure: case report and review of the literature
Mami Ishida, Yasukiyo Mori, Noriyoshi Ota, Toru Inaba and Shinji Kunishima
Page No. 218
Abstract
Clinical Nephrology, Vol. 80 – No. 3/2013 (218-222)
Association of a novel in-frame deletion mutation of the MYH9 gene with end-stage renal failure: case report and review of the literature
Mami Ishida1*, Yasukiyo Mori1*, Noriyoshi Ota1, Toru Inaba2 and Shinji Kunishima3
1Division of Nephrology, Department of Medicine, 2Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, and 3Department of Advanced Diagnosis, Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
*These authors contributed equally to the report.
MYH9 disorders are autosomal dominant diseases characterized by giant platelets, thrombocytopenia, and granulocyte inclusion bodies. These diseases are caused by mutations in the MYH9 gene that encodes nonmuscle myosin heavy chain IIA. We describe the case of a 27-year-old male who presented with macrothrombocytopenia and leukocyte inclusion bodies. Chronic kidney disease, probably due to progressive glomerulosclerosis, and high-tone sensorineural deafness were evident. Although deterioration of renal function necessitated renal replacement therapy in the form of peritoneal dialysis, we reconsidered the etiology of the kidney disease due to the patient’s clinical history. We identified an in-frame deletion mutation in exon 24 of the MYH9 gene that resulted in the removal of 21 nucleotides. The patient was diagnosed with an MYH9 disorder. We report this novel abnormality of the nucleotide sequence and compare it with previous cases and their associated phenotypes.Correspondence to:
Yasukiyo Mori, MD, PhD
Department of Cardiology and Nephrology
Kyoto Prefectural University of Medicine
465 Kajii-cho, Kamigyou-ku, Kyoto, Japan
Email: [email protected]
Nephrology Education
Anti-neutrophil cytoplasmic antibody (ANCA) associated small-vessel vasculitis in a patient with diabetic nephropathy and autoimmune polyendocrinopathy syndrome (APS) Type 2: a case report
Jonathan S. Murray, Laura A. Baines, Simon H.S Pearce, Steve Ball, Nicola Leech, Katrina M Wood and Nigel S. Kanagasundaram
Page No. 223
Abstract
Clinical Nephrology, Vol. 80 – No. 3/2013 (223-226)
Anti-neutrophil cytoplasmic antibody (ANCA) associated small-vessel vasculitis in a patient with diabetic nephropathy and autoimmune polyendocrinopathy syndrome (APS) Type 2: a case report
Jonathan S. Murray1, Laura A. Baines1, Simon H.S. Pearce2,3, Steve Ball2,4, Nicola Leech2, Katrina M. Wood1 and Nigel S. Kanagasundaram1,5
1Renal Services, 2Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust, 3Institute of Human Genetics, 4School of Medical Sciences and 5Institute of Cellular Medicine, Newcastle University, Newcastle, UK
We present a 42-year-old woman with pre-existing autoimmune polyendocrinopathy syndrome (APS) Type 2 and chronic kidney disease due to Type 1 diabetic nephropathy, who developed a rapid deterioration in renal function due to perinuclear anti-neutrophil cytoplasmic antibody (pANCA)-associated vasculitis. Although possibly a chance occurrence, ANCA have been detected more frequently in patients with a history of certain autoimmune diseases. Such an association may simply reflect an underlying tendency to immune system dysfunction in these patients and the finding of positive ANCA serology does not reliably herald the development of ANCA-associated vasculitis. However, our case illustrates that positive ANCA serology in such circumstances is not always a benign phenomenon and should still be interpreted within the clinical context. Moreover, clinicians managing patients with pre-existing autoimmune disease should maintain a low threshold for appropriate assessment should such patients develop evidence suggestive of vasculitis.Correspondence to:
N.S. Kanagasundaram
Honorary Clinical Senior Lecturer
Institute of Cellular Medicine
Newcastle University, UK
Email: [email protected]
Nephrology Education
Resolution of epoetin-induced pure red cell aplasia 2 years later, successful re-challenge with continuous erythropoiesis receptor stimulator
Soo Kun Lim, Ping Chong Bee, Tee Chau Keng and Yip Boon Chong
Page No. 227
Abstract
Clinical Nephrology, Vol. 80 – No. 3/2013 (227-230)
Resolution of epoetin-induced pure red cell aplasia 2 years later, successful re-challenge with continuous erythropoiesis receptor stimulator
Soo Kun Lim1, Ping Chong Bee2, Tee Chau Keng1 and Yip Boon Chong1
1Division of Nephrology and 2Division of Hematology, Department of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
Epoetin-induced pure red cell aplasia (PRCA) is most commonly associated with epoetin-a; nevertheless, its occurrence has been reported in epoetin-β and darbepoetin-a. We report a young hemodialysis patient who developed PRCA 2 years after receiving intravenous epoetin-β. Epoetin- induced PRCA was confirmed by bone marrow aspiration, associated with markedly elevated anti-erythropoietin antibody. He was treated with prednisolone and cyclophosphamide for 3 months but continued to be transfusion-dependent. 17 months after the development of PRCA, he was started on intravenous continuous erythropoiesis receptor stimulator (CERA) in view of frequent transfusions. He tolerated the CERA injection well and the hemoglobin level stabilized 7 months later. Repeat bone marrow aspiration confirmed complete resolution of PRCA with disappearance of anti-erythropoietin antibody. To date, he maintained a stable hemoglobin level and has been transfusion-independent for the past 1 year. This is the first in the literature that reported the utilization of CERA in epoetin-induced PRCA. Very low or undetectable level of anti-erythropoietin antibody might be the key to the success of re-challenge strategy in cases of epoetininduced PRCA. Thus, routine checking of anti-erythropoietin antibody before the rechallenge with an alternative erythropoietin product is highly recommended.Correspondence to:
S.K. Lim, Division of Nephrology
Department of Medicine, University Malaya
Medical Center, 59100 Kuala Lumpur, Malaysia
Email: [email protected]
Nephrology Education
Stabilization of Hepatitis C associated collapsing focal segmental glomerulosclerosis with interferon α-2a and ribavirin
C. John Sperati
Page No. 231
Abstract
Clinical Nephrology, Vol. 80 – No. 3/2013 (231-234)
Stabilization of Hepatitis C associated collapsing focal segmental glomerulosclerosis with interferon α-2a and ribavirin
C. John Sperati
Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Hepatitis C virus (HCV) infection is associated with a variety of glomerular diseases, most notably cryoglobulin associated membranoproliferative glomerulonephritis Type I. Focal segmental glomerulosclerosis has only rarely been reported in association with HCV. More striking are multiple reports of de novo collapsing focal segmental glomerulosclerosis (cFSGS) developing during administration of interferon for treatment of HCV. Herein is presented a case of HCV associated cFSGS stabilized with combination therapy of interferon α-2a and ribavirin in a patient with advanced kidney disease.Correspondence to:
C. John Sperati, MD, MHS
1830 E Monument St, Rm 416
Baltimore, MD 21205, USA
Email: [email protected]
