Volume 81 (2014), No. 5/2014(May)
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Original
Tobacco exposure in children and adolescents with chronic kidney disease: parental behavior and knowledge. A study from the Midwest Pediatric Nephrology Consortium
Abiodun Omoloja, Adrienne Stolfi, Deepa Chand, Benjamin Laskin, Debbie Gipson, Hiren Patel, Jane Anne Smith, and Aftab Chishti
Page No. 307
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 (307-312)
Tobacco exposure in children and adolescents with chronic kidney disease: parental behavior and knowledge. A study from the Midwest Pediatric Nephrology Consortium
Abiodun Omoloja1, Adrienne Stolfi1, Deepa Chand2, Benjamin Laskin3, Debbie Gipson4, Hiren Patel5, Jane Anne Smith6, and Aftab Chishti6
1Wright State University, Dayton, OH, 2Rush Children’s Hospital, Chicago, IL, 3The Children’s Hospital of Philadelphia, Division of Nephrology, Philadelphia, PA, 4University of Michigan, School of Medicine, Ann Arbor, MI, 5Nationwide Children’s Hospital, Division of Nephrology, Columbus, OH, and 6University of Kentucky Children’s Hospital, Division of Nephrology, Hypertension & Renal Transplantation, Lexington, KY, USA
Aim: The incidence of cardiovascular disease (CVD) in children with chronic kidney disease (CKD) is high. Exposure to second hand smoke (SHS) is a known risk factor for CVD. Due to a recent report of high incidence of SHS in children with CKD, we sought to investigate via questionnaire the smoking behaviors of caregivers of children with CKD. Material and methods: A cross sectional study was conducted in which caregivers of children and adolescents with CKD were asked to complete a single anonymous self-administered survey. Results: Almost 40% of children and adolescents lived with one or more smokers. Over half of smokers smoked in the presence of their children and in the car. Smokers were significantly less aware of the detrimental effect of SHS exposure on the renal health of their children. Among smokers, almost 70% reported they had not been advised by their child’s nephrologist to quit tobacco use. Conclusion: There is a high prevalence of SHS exposure among children and adolescents with CKD, which may contribute to CVD. Caregivers are not fully aware of the detrimental effects of SHS exposure on the renal health of their children.Correspondence to:
Abiodun Omoloja, MD
Department of Pediatrics, Wright State University
One Children’s Plaza
Dayton, OH 45404, USA
Email: [email protected]
Original
Cognition may be related to arterial pulsatility index in HD patients
James B. Post, Kel G. Morin, John P. Handrakis, Dwindally Rosado Rivera, Christina Yen, Mary Sano, and Ann M. Spungen
Page No. 313
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 (313-319)
Cognition may be related to arterial pulsatility index in HD patients
James B. Post1,2,5, Kel G. Morin2, John P. Handrakis2,3, Dwindally Rosado Rivera2, Christina Yen2, Mary Sano4,6, and Ann M. Spungen2,7
1Nephrology Division, 2VA RR&D Center of Excellence for Medical Consequences of SCI, James J. Peters Veterans Affairs Medical Center, Bronx, NY, 3Department of Physical Therapy, School of Health Professionals, New York Institute of Technology, Old Westbury, NY, 4VA RR&D, James J. Peters Veterans Affairs Medical Center, Bronx, NY, 5Departments of Medicine, 6Psychiatry, and 7Rehabilitation Medicine, Mount Sinai School of Medicine, NY, USA
Aims: Hemodialysis (HD) patients have a heavy burden of subclinical cerebrovascular disease and cognitive changes consistent with a vascular etiology. Pulsatility index is associated with microangiopathy of cerebral blood vessels and an increased risk of cerebral infarction. The proposed study was to determine common carotid artery pulsatility index (CCAPI) and its relation to cognition in well-dialyzed HD patients with no history of stroke or dementia and matched controls. Methods: Observational, cross-sectional study of CCAPI and cognition in 37 hemodialysis outpatients and 18 matched controls with normal kidney function. Non-parametric analyses were used to compare variables between groups. Multiple regression and ANOVA models were used to adjust for risk factor differences. Results: Controls had a lower CCAPI than the HD group (1.7 ± 0.3 vs. 2.1 ± 0.4 cm/s, p = 0.006). HD patients scored significantly lower on all cognitive domains. Attention correlated with CCAPI in HD patients, independent of hypertension, diabetes, hyperlipidemia, and years on HD (r2 = –0.36, p = 0.01). CCAPI correlated with years on HD, independent of traditional cardiovascular risk factors. (r2 = 0.26, p = 0.04). Conclusion: In well-dialyzed hemodialysis patients with no history of stroke or dementia, CCAPI may correlate with cognitive function and represent a marker for underlying cerebral microvascular disease.Correspondence to:
James B. Post, MD
James J. Peters VA Medical Center
130 West Kingsbridge Road
4C-12 Outpatient Renal Practice
Bronx, NY 10468, USA
Email: [email protected]
Original
Evaluation of acid-base control, electrolyte balance, and filter patency of a Prismaflexbased regional citrate anticoagulation protocol for pre-dilution continuous veno-venous hemodiafiltration
Dmytro Khadzhynov, Torsten Slowinski, Ina Lieker, Hans-H. Neumayer, and Harm Peters
Page No. 320
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 (320-330)
Evaluation of acid-base control, electrolyte balance, and filter patency of a Prismaflexbased regional citrate anticoagulation protocol for pre-dilution continuous veno-venous hemodiafiltration
Dmytro Khadzhynov, Torsten Slowinski, Ina Lieker, Hans-H. Neumayer, and Harm Peters
Department of Nephrology, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Humboldt University Berlin, Germany
Background: Regional citrate anticoagulation (RCA) is increasingly used in patients requiring continuous renal replacement therapy (CRRT). This study evaluated a new RCA protocol based on the Prismaflex® dialysis device and an isotonic citrate solution (prismocitrate) for pre-dilution continous veno-venous hemodiafiltration. Methods: The Prismaflex®/Prismocitrate-based protocol involved an AN69ST® membrane (Prisma Flex ST100), a blood flow of 120 mL/min, 1.8 L/h Prismocitrate (10 mmol/L citrate/2 mmol/L citric acid) substitution fluid in pre-dilution mode, and 0.8 L/h dialysate flow (PrismOcal) at the start. In parallel, infusions of potassium, calcium, and magnesium were initiated. Blood pH, bicarbonate, base excess, and ionized calcium levels were measured in 6 hours intervals and magnesium levels every 24 hours. Scheduled hemofilter run time was 72 hours. Results: A consecutive series of 25 continuous renal replacement treatments was analyzed in 15 patients. After at least 6h of RRT, 69.9% of bicarbonate concentrations and 84.6% base excess (BE) calculations were below normal range. During CRRT, mean bicarbonate decreased from 22.9 to 20.2 mmol/L and mean BE from –1.5 to –4.2 mmol/L. In addition, 66.3% of ionized systemic calcium concentrations were out of the normal range, while 54.1% of the magnesium readings were above normal range. Five filters reached the scheduled run time of 72 hours, 19 treatments stopped prematurely because of RRT related reasons (5 filter clottings, 2 severe metabolic disarrangements, 12 major Prismaflex® hardware or software handling problems). One patient was switched to intermittent hemodialysis. Conclusions: The evaluated Prismaflex®/ Prismocitrate-based citrate anticoagulation protocol provides insufficient control of blood acid-base and electrolyte balance.Correspondence to:
Harm Peters, MD
Department of Nephrology
Charité Universitätsmedizin Berlin
Humboldt University,
Charitéplatz 1
10117 Berlin, Germany
Email: [email protected]
Original
Prospective evaluation of 24-hour urine profiles following bariatric surgery in a modern comprehensive care bariatric clinic
Ryan Hutchinson, Alexander S. Parker, Michelle Arnold, Steven P. Bowers, William E. Haley, Nancy Diehl, Ronald Stone, Scott A. Lynch, C. Daniel Smith and David D. Thiel
Page No. 331
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 (331-337)
Prospective evaluation of 24-hour urine profiles following bariatric surgery in a modern comprehensive care bariatric clinic
Ryan Hutchinson1, Alexander S. Parker2, Michelle Arnold2, Steven P. Bowers3, William E. Haley4, Nancy Diehl2, Ronald Stone5, Scott A. Lynch3, C. Daniel Smith3, and David D. Thiel1
1Department of Urology, 2Department of Health Sciences Research, 3Department of General Surgery, 4Department of Nephrology, and 5Department of Nutrition Services, Mayo Clinic, Jacksonville, FL, USA
Aims: To prospectively examine the effect of modern bariatric surgery on 24-hour urine parameters in a comprehensive care bariatric practice (CCBP). Materials and methods: 47 consecutive patients in our CCBP underwent serum and 24-hour urine analysis pre-operatively, and 30 returned at 12 months for repeat testing. Paired comparisons for serum metabolite and 24-hour urine measures were performed using a Wilcoxon signed-rank test for continuous variables and McNemar’s test for categorical variables. Statistical tests were two-sided, with threshold of significance set at p = 0.05. Results: All 30 patients with pre-operative and 12-month follow-up analysis were free of stone events. 20 (67%) had Roux-en-Y gastric bypass (RYGB), 6 (20%) had laparoscopic gastric banding (LGB), and 4 (13%)h ad laparoscopic sleeve gastrectomy (LSG). 24-hour urinary parameters were available for 27 patients. Median urine oxalate (mmol) was 0.29 pre-operatively and 0.21 at 12 months (p = 0.048). Median urine calcium (mg) was 143 pre-operatively and 180 at 12 months (p = 0.11). Median citrate excretion was 527 pre-operatively and 782 at 12 months (p = 0.22). Median serum creatinine was 0.7 pre-operatively and 0.8 at 12 months (p < 0.001). These trends were preserved with the exclusion of LGB and LSG patients. Conclusions: Modern bariatric surgery (RYGB, LGB, and LSG) as part of a CCBP can still demonstrate alterations of select urinary parameters (particularly oxalate and citrate) in select patients associated with an increased risk of urolithiasis at 1 year follow-up.Correspondence to:
David D. Thiel, MD
Department of Urology, Mayo Clinic
4500 San Pablo Road, Jacksonville, FL 32224, USA
Email: [email protected]
Original
Evaluation and predictive factors of renal function progression using cystatin C and creatinine in neonates born with CAKUT
Paloma Parvex, Chistophe Combescure, Maria Rodriguez, Jacques Birraux, and Eric Girardin
Page No. 338
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 (338-344)
Evaluation and predictive factors of renal function progression using cystatin C and creatinine in neonates born with CAKUT
Paloma Parvex1, Chistophe Combescure2, Maria Rodriguez3, Jacques Birraux4, and Eric Girardin1
1Pediatric nephrology unit, 2Division of Clinical Epidemiology, 3Pediatric Research Platform, and 4Pediatric Surgery Unit, University Hospital, Geneva, Switzerland
Background: Congenital anomalies of the kidney and urinary tract (CAKUT) is a main cause leading to endstage renal disease (ESRD) during childhood occurring at a frequency of 1 in every 500 pregnancies. No early predictive markers of long-term renal function (RF) are validated in these neonates. The aim of this study was to compare CysC and creatinine (creat) as markers of RF from birth to 2 years and to identify factors of RF progression. Methods: The 56 patients included in this study were followed for a median of 235 days (137 – 739). Repeated measures of CysC and creat during 2 years of RF evaluation were taken in 28 patients. Changes in RF with age were analyzed. Potential risk factors for RF progression were analyzed for: type of kidney disease (KD), bilateralism of KD, prenatal pelvic dilatation, reflux and initial relative RF (RRF) asymmetry obtained by scan. Results: With age, a rapid decrease of CysC (16.3%, p < 0.001), and creat (68.6%, p < 0.001) was observed at 1 month. Between 1 month and 1 year, CysC decreased 4% per month (p < 0.001) and creatinine stabilized (+ 1.9%/m, p = 0.11). After 1 year, both CysC and creat stabilized. In the multivariate model, CysC significantly increased in patients with bilateralism (p = 0.004) or asymmetric RRF (p = 0.03). Creat was not significant. Conclusion: CysC was a better marker than creat to follow RF in neonates with CAKUT. Using CysC, bilateralism, and RRF asymmetry were significantly associated with RF progression.Correspondence to:
Paloma Parvex MD
University Children’s Hospital Geneva
6 Willy-Donzé Street, 1211 Geneva, Switzerland
Email: [email protected]
Original
Myeloma progression and urinary gammaglobulin affect the urinary cystatin C to diagnose acute kidney injury in multiple myeloma
Jae Seok Kim, Jae Won Yang, Hyeoncheol Park, Young Sub Kim, Jun Young Lee, Jong In Lee, Byoung Geun Han and Seung Ok Choi
Page No. 345
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 (345-349)
Myeloma progression and urinary gammaglobulin affect the urinary cystatin C to diagnose acute kidney injury in multiple myeloma
Jae Seok Kim1, Jae Won Yang1, Hyeoncheol Park1, Young Sub Kim1, Jun Young Lee1, Jong In Lee2, Byoung Geun Han1, and Seung Ok Choi1
Department of 1Nephrology and 2Oncology, Yonsei University Wonju College of Medicine, Wonju, South Korea
Aims: Urinary cystatin C has been suggested as a useful biomarker for diagnosis of acute kidney injury (AKI). Multiple myeloma is often complicated by AKI. Therefore, we investigated whether the urinary cystatin C was available for diagnosis of AKI in multiple myeloma. Materials and methods: This study included 39 patients with monoclonal gammopathy of undetermined significance (MGUS) or multiple myeloma. We reviewed the medical records retrospectively and investigated whether urinary γ-globulin and myeloma progression had effects on urinary cystatin C excretion. Results: Spearman’s correlation analysis showed that serum β2-microglobulin and serum cystatin C had a significant positive correlation with the urinary cystatin C excretion (r = 0.513, p = 0.001, r = 0.659, p < 0.001) and FEcystatinC (r = 0.585, p = 0.002, r = 0.711, p < 0.001). The GFRcr also had a significant negative correlation with the urinary cystatin C excretion (r = –0.582, p < 0.001) and FEcystatinC (r = –0.474, p = 0.002). In addition, the urinary γ-globulin had a significant positive correlation with the urinary cystatin C excretion (r = 0.678, p < 0.001) and FEcystatinC (r = 0.731, p < 0.001). Urinary γ-globulin was the most significant factor to influence urinary cystatin C excretion in multiple regression test. Conclusion: These results indicate that urinary γ-globulin and myeloma progression can increase the fractional and total excretion of urinary cystatin C. Therefore, it is believed that the urinary cystatin C can be affected by urinary γ-globulin and myeloma progression in the diagnosis of AKI in multiple myeloma. In addition, urinary γ-globulin is believed to be the most significant factor to influence on urinary cystatin C.Correspondence to:
Seung Ok Choi, MD, PhD
Yonsei University Wonju College of Medicine
162, Ilsan-dong, Wonju-si,
Gangwon-do, 220-701, South Korea
Email: [email protected]
Nephrology Education
Aldosterone blockade as an alternative renin-angiotensin-aldosterone system blocking agent in cases of treatment associated anemia
Rupali S. Avasare, Gerald B. Appel and Andrew S. Bomback
Page No. 350
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 (350-354)
Aldosterone blockade as an alternative renin-angiotensin-aldosterone system blocking agent in cases of treatment associated anemia
Rupali S. Avasare, Gerald B. Appel, and Andrew S. Bomback
Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY, USA
Blockade of the renin-angiotensin-aldosterone system (RAAS) is a mainstay of therapy for proteinuric kidney disease due to effects on blood pressure, proteinuria, and overall cardiovascular risk. In this case series, we highlight one of the rare but serious side effects of the most commonly used RAAS blocking drugs, angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs): a severe anemia due to impaired erythropoiesis. The four patients presented here were switched to a mineralocorticoid receptor blocker (MRB) that targets aldosterone without any inhibition of angiotensin II, and resulting in significant rebounds back to baseline hemoglobin levels. Furthermore, all patients had optimal blood pressure control and proteinuria reductions. These data support the use of aldosterone blocking agents in kidney disease patients with anemia secondary to ACE-Is or ARB. Presumably, any patient – regardless of kidney status – for whom RAAS blockade is indicated (e.g., diabetic patients or patients with congestive heart failure) should be switched to MRB therapy if significant anemia develops after starting an ACE-Is or ARB.Correspondence to:
Rupali Avasare, MD
Department of Medicine, Division of Nephrology
Columbia University College of Physicians and Surgeons
622 West 168th Street, New York, NY, USA
Email: [email protected]
Nephrology Education
Rechallenge with intravenous recombinant human erythropoietin can be successful following the treatment of anti-recombinant erythropoietin associated pure red cell aplasia
Kearkiat Praditpornsilpa, Khajohn Tiranathanakul, Saengsuree Jootar, Kriang Tungsanga and Somchai Eiam-Ong
Page No. 355
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 (355-358)
Rechallenge with intravenous recombinant human erythropoietin can be successful following the treatment of anti-recombinant erythropoietin associated pure red cell aplasia
Kearkiat Praditpornsilpa1, Khajohn Tiranathanakul1, Saengsuree Jootar2, Kriang Tungsanga1, and Somchai Eiam-Ong1
1Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, and 2Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Anti recombinant human erythropoietin (r-HuEpo) associated pure red cell aplasia (PRCA) is an immunologic adverse effect of using subcutaneous r-HuEpo. Immunosuppressive agents have been suggested as treatment of this serious complication. After the reversal of anti-r-HuEpo antibody, the patients continue to have renal anemia and require long-term blood transfusion, albeit less frequently than when the antibody is positive. It is controversial whether re-challenging the patients with r-HuEpo is appropriate because re-challenging may cause the reappearance of the antibody. To balance the risk of antir-HuEpo antibody reappearance and longterm blood transfusion complications, we re-challenged r-HuEpo in five anti-r-HuEpo associated PRCA cases after a successful reversal of antibody using prednisolone in combination with cyclophosphamide. The rechallenge was performed intravenously since there were no reports of anti-r-HuEpo associated PRCA cases using this administration route. The duration after the reversal of antibody was 2.4 months before the re-challenge. Two patients were immediately re-challenged as soon as the antibodies reversed. After rechallenge with intravenous r-HuEpo, all patients responded to r-HuEpo: target level of Hb was maintained, blood transfusion was not required, and anti-r-HuEpo was consistently negative. All patients were followed for at least 6 months after re-challenge. Our data suggest that re-challenge with intravenous r-HuEpo can successfully treat anti- r-HuEpo associated PRCA.Correspondence to:
Kearkiat Praditpornsilpa, MD
Division of Nephrology, Department of Medicine
Faculty of Medicine, King Chulalongkorn Memorial Hospital
Bangkok, 10330 Thailand
Email: [email protected]
Nephrology Education
Spontaneous bilateral perirenal hemorrhage following prolonged fever: an uncommon presentation of polyarteritis nodosa
Mei-Mei Cheng, Chun-Sheng Yen, Chien-Ming Li, Chih-Chiang Chien and Wei-Chih Kan
Page No. 359
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 (359-362)
Spontaneous bilateral perirenal hemorrhage following prolonged fever: an uncommon presentation of polyarteritis nodosa
Mei-Mei Cheng1, Chun-Sheng Yen1, Chien-Ming Li2, Chih-Chiang Chien1,3, and Wei- Chih Kan1,3
1Division of Nephrology, 2Division of Infectious Disease, Department of Internal Medicine, Chi-Mei Medical Center, and 3Chung Hwa University of Medical Technology, Tainan, Taiwan
A 68-year-old man presented with a spontaneous bilateral perirenal hemorrhage following a 2-month fever of unknown origin. A renal biopsy for a pathologic diagnosis seemed very risky because of the patient’s bilateral perirenal hemorrhage. Therefore, we diagnosed polyarteritis nodosa using an abdominal computed tomography scan, a renal angiogram, and American College of Rheumatology criteria. The patient’s multiple symptoms then responded well to the prescribed immunosuppressive regimen. This case is an uncommon presentation of polyarteritis nodosa with fever of unknown origin before a spontaneous bilateral perirenal hemorrhage.Correspondence to:
Wei-Chih Kan, MD
Department of Internal Medicine
Chi-Mei Medical Center
901 Zhonghua Road, Yongkang Dist., Tainan City 710, Taiwan
Email: [email protected]
Nephrology Education
Severe manifestation of Bartter syndrome Type IV caused by a novel insertion mutation in the BSND gene
Augusto Luque de Pablos, Victor García-Nieto, Jesús C. López-Menchero, Elena Ramos-Trujillo, Hilaria González-Acosta and Félix Claverie-Martín
Page No. 363
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 (363-368)
Severe manifestation of Bartter syndrome Type IV caused by a novel insertion mutation in the BSND gene
Augusto Luque de Pablos1, Victor García-Nieto2, Jesús C. López-Menchero3, Elena Ramos-Trujillo4, Hilaria González-Acosta4, and Félix Claverie-Martín4
1Servicio de Nefrología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, 2Unidad de Nefrología Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, 3Servicio de Pediatría, Hospital General Universitario de Ciudad Real, and 4Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
Bartter syndrome Type IV is a rare subtype of the Bartter syndromes that leads to both severe renal salt wasting and sensorineural deafness. This autosomal recessive disease is caused by mutations in the gene encoding barttin, BSND, an essential subunit of the ClC-K chloride channels expressed in renal and inner ear epithelia. Patients differ in the severity of renal symptoms, which appears to depend on the modification of channel function by the mutant barttin. To date, only a few BSND mutations have been reported, most of which are missense or nonsense mutations. In this study, we report the identification of the first insertion mutation, p.W102Vfs*7, in the BSND gene of a newborn girl with acute clinical symptoms including early-onset chronic renal failure. The results support previous data indicating that mutations that are predicted to abolish barttin expression are associated with a severe phenotype and early onset renal failure.Correspondence to:
Félix Claverie-Martín, PhD
Unidad de Investigación
Hospital Universitario Nuestra Señora de Candelaria
Carretera del Rosario 145, 38010 Santa Cruz de Tenerife, Spain
Email: [email protected]
Nephrology Education
Membranoproliferative glomerulonephritis Type 3 associated with Kabuki syndrome
Naoto Nishizaki, Shuichiro Fujinaga, Daishi Hirano, Hitohiko Murakami, Kouichi Kamei, Yoshiyuki Ohtomo, Toshiaki Shimizu and Kazunari Kaneko
Page No. 369
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 (369-373)
Membranoproliferative glomerulonephritis Type 3 associated with Kabuki syndrome
Naoto Nishizaki1,4, Shuichiro Fujinaga1, Daishi Hirano1, Hitohiko Murakami2, Kouichi Kamei3, Yoshiyuki Ohtomo5, Toshiaki Shimizu6, and Kazunari Kaneko7
1Division of Nephrology, 2Division of Pathology, Saitama Children’s Medical Center, Saitama, 3Division of Nephrology, National Center for Child Health and Development, Tokyo, 4Department of Neonatology, Juntendo University Shizuoka Hospital, Shizuoka, 5Department of Pediatrics, 6Department of Pediatrics, Juntendo University School of Medicine, Tokyo, and 7Department of Pediatrics, Kansai Medical University, Osaka, Japan
First described in Japanese patients, Kabuki syndrome (KS) is a congenital condition associated with multiple anomalies and mental retardation. Although urological and immune abnormalities are common in KS, immune complex nephritis such as membranoproliferative glomerulonephritis (MPGN) has not yet been reported. We describe the first reported case of a KS patient with common variable immunodeficiency (CVI) and recurrent otitis media who developed severe proteinuria and hematuria due to MPGN Type 3 detected during the school urinary screening program in Japan. The patient was intravenously treated with methylprednisolone pulses followed by alternate-day prednisolone and an angiotensin receptor blocker. The patient showed remarkable improvement in both histological and urinary analyses. This case report suggests that immune abnormalities associated with KS can play an important role in the development of MPGN. Urinalysis should be regularly performed in KS patients with hypogammaglobulinemia and/or recurrent infection.Correspondence to:
Shuichiro Fujinaga, MD
Division of Nephrology
Saitama Children’s Medical Center
2100 Magome, Iwatsuki-ward,
Saitama-city, Saitama 339 8551, Japan
Email: [email protected]
Letter to the Editor
Hemolysis: a fatal complication of alkaptonuria in a severe renal failure patient
Stanislas Bataille, Valérie Moal, Robert R. Aquaro, Jean-Pierre Grünfeld, and Laurent Daniel
Page No. 374
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 – Letters to the editor
Hemolysis: a fatal complication of alkaptonuria in a severe renal failure patient
Stanislas Bataille1, Valérie Moal1, Robert R. Aquaron2, Jean-Pierre Grünfeld3, and Laurent Daniel4
1Nephrology and Renal Transplantation Center,Hôpital de la Conception, 2Laboratory for Biochemistry and Molecular Biologie, Campus Santé Timone, Aix-Marseille University, Marseille, 3Department of Nephrology, Hôpital Necker, Université Paris Descartes, Paris, and 4Laboratory for Anatomy, Pathology and Neuropathology, Hôpital de la Timone, Aix-Marseille University, Marseille, France
Correspondence to:
Stanislas Bataille, MD
Centre de néphrologie et transplantation rénale
Hôpital de La Conception
147 Boulevard Baille, 13005 Marseille, France
Email: [email protected]
Letter to the Editor
Response to a fire in a hemodialysis unit
Kuo-Hsiung Shu, Hsin-Ru Lin, Chi-Hung Cheng, Ming-Ju Wu, and Cheng-Hsu Chen
Page No. 377
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 – Letters to the editor
Response to a fire in a hemodialysis unit
Kuo-Hsiung Shu1,3, Hsin-Ru Lin2, Chi-Hung Cheng1,3, Ming-Ju Wu1,3, and Cheng-Hsu Chen1,4
1Division of Nephrology, Department of Medicine and 2Department of Nursing, Taichung Veterans General Hospital, Taichung, 3School of Medicine, Chung Shan Medical University, Taichung, and 4School of Medicine, China Medical University, Taichung, Taiwan
Correspondence to:
Kuo-Hsiung Shu, MD
Division of Nephrology, Department of Medicine
Taichung Veterans General Hospital
Taichung, Taiwan
Email: [email protected]
Letter to the Editor
Concurrent occurrence of juvenile reactive arthritis and IgA nephropathy
Hiro Matsukura, Noboru Igarashi, Taizo Kazama, and Kazuyoshi Saito
Page No. 379
Abstract
Clinical Nephrology, Vol. 81 – No. 5/2014 – Letters to the editor
Concurrent occurrence of juvenile reactive arthritis and IgA nephropathy
Hiro Matsukura1, Noboru Igarashi2, Taizo Kazama3, and Kazuyoshi Saito4
1Department of Pediatrics, Saiseikai Toyama Hospital, 2Department of Pediatrics, Toyama Prefectural Central Hospital, 3Department of Urology, Saiseikai Toyama Hospital, and 4Department of Pediatrics, Faculty of Medicine, University of Toyama, Japan
Correspondence to:
Hiro Matsukura, MD
Department of Pediatrics
Saiseikai Toyama Hospital
33-1 Kusunoki, Toyama, 931-8533, Japan
Email: [email protected]
