Volume 83 (2015), No. 6/2015(June)
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Original
In the backwater of convective dialysis: decreased 25-hydroxyvitamin D levels following the switch to online hemodiafiltration
Fredrik Uhlin, Per Magnusson, Tobias E. Larsson, and Anders Fernström
Page No. 315
Abstract
Clinical Nephrology, Vol. 83 – No. 6/2015 (315-321)
In the backwater of convective dialysis: decreased 25-hydroxyvitamin D levels following the switch to online hemodiafiltration
Fredrik Uhlin1,2, Per Magnusson3, Tobias E. Larsson4,5, and Anders Fernström1
1Department of Nephrology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden, 2Department of Biomedical Engineering, Technomedicum, Tallinn University of Technology, Tallinn, Estonia, 3Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, 4Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, and 5Department of Nephrology, Karolinska University Hospital, Stockholm, Sweden
Background/aims: Vitamin D deficiency and elevated serum fibroblast growth factor-23 (FGF23) levels are hallmark features and surrogate markers of adverse clinical outcomes in patients with chronic kidney disease (CKD). Convection of molecules over the dialysis membrane during online hemodiafiltration (ol-HDF) increases the removal of larger waste molecules compared with traditional high-flux hemodialysis (HD). The primary aim of this study was to explore the long-term impact of ol-HDF on serum 25(OH)D and FGF23. Method: An observational, prospective, noncomparator study including 35 patients who were switched from HD to ol-HDF. Serum 25(OH)D and FGF23 were measured at baseline (i.e., time of switch to ol-HDF) and at 6, 12, and 24 months. Results: At follow-up time points, there was a significant reduction in serum 25(OH)D compared with baseline (p < 0.0001) whereas FGF23 was unaltered (p > 0.05). The decrease in 25(OH)D was more prominent in individuals with higher baseline 25(OH)D levels. Conclusion: Ol-HDF may lower systemic 25(OH)D levels by convective mechanisms although the clinical significance remains unknown. Further controlled studies are warranted to replicate these findings in larger patient cohorts.Correspondence to:
Fredrik Uhlin, PhD
Department of Nephrology and
Department of Medicine and Health Sciences
Linköping University, 581 85 Linköping, Sweden
Email: [email protected]
Original
The relation of mean platelet volume with microalbuminuria and glomerular filtration rate in obese individuals without other metabolic risk factors: the role of platelets on renal functions
Bennur Esen, Ahmet Engin Atay, Nalan Gunoz, Emel Saglam Gokmen, Hakan Sarı, Ilkay Cakır, Hasan Kayabası, and Dede Sit
Page No. 322
Abstract
Clinical Nephrology, Vol. 83 – No. 6/2015 (322-330)
The relation of mean platelet volume with microalbuminuria and glomerular filtration rate in obese individuals without other metabolic risk factors: the role of platelets on renal functions
Bennur Esen, Ahmet Engin Atay, Nalan Gunoz, Emel Saglam Gokmen, Hakan Sarı, Ilkay Cakır, Hasan Kayabası, and Dede Sit
Division of Nephrology, Department of Internal Medicine, Bagcilar Research and Training Hospital, Istanbul, Turkey
Introduction: Mean platelet volume (MPV) is an indirect indicator of platelet activity that plays a major role in the pathogenesis of endothelial injury. Obese individuals have higher microalbuminuria which is the initial step of renal endothelial injury. We aimed to analyze the relation of microalbuminuria and MPV in obese individuals without metabolic risk factors. Methods: A total of 290 obese individuals (body mass index (BMI) > 30 kg/m2) without an accompanying chronic disorder, and 204 nonobese healthy subjects were enrolled into the study. All participants underwent physical examination. Biochemical, hemogram, and hormonal parameters along with urine albumin analysis were performed. Glomerular filtration rate (GFR) was measured by Cockcroft-Gault (GFRC&G), modification of diet in renal disease (MDRD). The BMI was calculated as weight/height2 (kg/m2). Logistic regression analysis was used to analyze relation of variables. Results: The patient group consisted of 171 (59%) female (mean age: 37.15 ± 8.05 years) and 119 (41%) male (mean age 38.98 ± 10.68 years) obese individuals. 130 (63.7%) age matched female (mean age 36.18 ± 8.26 years) and 74 (36.3%) age matched male (mean age 36.49 ± 10.25 years) controls were assigned to the control group. There was a significant difference between groups with regard to BMI, spot microalbuminuria, spot urine microalbuminuria/ creatinine ratio but not with to MPV and spot urine creatinine (p: 0.01, 0.004, 0.002; respectively). GFR measured by MDRD and Cockcroft-Gault formula were significantly higher in the obese group (p < 0.001 for both). Correlation analysis revealed a significant correlation between BMI and spot urine microalbuminuria, spot urine microalbuminuria/creatinine ratio, GFR (Cockcroft-Gault Formula), Homeostasis Model Assessment of Insulin resistance (HOMA-IR), insulin, C-peptide, diastolic blood pressure, glucose, uric acid, total cholesterol, low density lipoprotein (LDL)-cholesterol, c-reactive protein (CRP), thyroid stimulating hormone (TSH), leukocyte count, platelet count. MPV was inversely and significantly correlated with spot urine creatinine, systolic blood pressure, triglyceride, C-peptide, and platelet count. Mean urea, creatinine, uric acid, triglyceride, total cholesterol, LDL-cholesterol, insulin, C-peptide, HOMA-IR were significantly higher in obese male individuals while obese female individuals had higher levels of mean high density lipoprotein (HDL), CRP, TSH, platelet count, spot urine microalbumin/creatinine rate, and GFR measured by MDRD. Conclusions: Obese individuals have higher microalbuminuria and nonsignificantly elevated MPV, however, urine albumin loss is independent of MPV.Correspondence to:
Bennur Esen, MD
Division of Nephrology
Department of Internal Medicine
Bagcilar Research and Training Hospital
34100 Istanbul, Turkey
Email: [email protected]
Original
Tubular dysfunction in renal transplant patients using sirolimus or tacrolimus
Pedro B. Banhara, Renato T. Gonçalves, Pedro T. Rocha, Alvimar G. Delgado, Maurilo Leite Jr, and Carlos P. Gomes
Page No. 331
Abstract
Clinical Nephrology, Vol. 63 – No. 6/2015 (331-337)
Tubular dysfunction in renal transplant patients using sirolimus or tacrolimus
Pedro B. Banhara, Renato T. Gonçalves, Pedro T. Rocha, Alvimar G. Delgado, Maurilo Leite Jr, and Carlos P. Gomes
Division of Nephrology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
Background: Tubular dysfunction is prevalent among kidney transplant patients using calcineurin inhibitors, but our knowledge of the tubular effects of mTOR inhibitors is more limited. Methods: 60 kidney transplant outpatients using either the calcineurin inhibitor tacrolimus or the mTOR inhibitor sirolimus were investigated for renal tubular dysfunction. Proximal tubule function was assessed by quantification of albumin and β2-microglobulin, tubular reabsorption of phosphate and fractional excretion of bicarbonate. Distal tubular function was evaluated by water deprivation test and by urinary acidification test using furosemide and fludrocortisone for pH, ammonium and titratable acidity measurements. Results: The prevalence of distal renal tubular acidosis (dRTA) was 17% for both treatment groups. 70% of patients treated with sirolimus and 94% using tacrolimus presented with urine concentrating defect (p = 0.04). Conclusion: Distal RTA and urine concentrating defect were highly prevalent after kidney transplantation both in the sirolimus and tacrolimus treated patients. Acidification test was essential for the appropriate diagnosis of dRTA while dipstick urine specific gravity test was able to detect urine concentrating defect in this population.Correspondence to:
Pedro Barcelos Banhara
Rua Pereira da Silva, 80/303, Laranjeiras,
22221-140, Rio de Janeiro-RJ, Brazil
Email: [email protected]
Original
Risk factors associated with efficacy outcomes in kidney transplantation: analysis of a contemporary cohort of patients from the A2309 trial
Giacomo Colussi, Marcela Vergara, Zailong Wang, and Róbert Roland
Page No. 338
Abstract
Clinical Nephrology, Vol. 83 – No. 6/2015 (338-344)
Risk factors associated with efficacy outcomes in kidney transplantation: analysis of a contemporary cohort of patients from the A2309 trial
Giacomo Colussi1, Marcela Vergara2, Zailong Wang2, and Róbert Roland3
1Division of Nephrology, Dialysis and Renal Transplantation, Niguarda-Ca’ Granda Hospital, Milan, Italy, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, and 3University Hospital of Louis Pasteur, Košice, Slovak Republic
Supplemental materialCorrespondence to:
Giacomo Colussi, MD
Piazza Ospedale, Maggiore, 3
20162 Milan, Italy
Email: [email protected]
Original
Preliminary report: nephroscope-assisted “pulling-thread” technique for placement of peritoneal dialysis catheter
Takashi Yoshida, Takaaki Inoue, Tomoko Masuda, Takashi Murota, Hiroya Masaki, Hidefumi Kinoshita, and Tadashi Matsuda
Page No. 345
Abstract
Clinical Nephrology, Vol. 83 – No. 6/2015 (345-350)
Preliminary report: nephroscope-assisted “pulling-thread” technique for placement of peritoneal dialysis catheter
Takashi Yoshida1, Takaaki Inoue1, Tomoko Masuda1, Takashi Murota1, Hiroya Masaki2, Hidefumi Kinoshita3, and Tadashi Matsuda3
1Departments of Urology and Andrology, 2Clinical and Laboratory Medicine, Kansai Medical University, Takii Hospital, and 3Department of Urology and Andrology, Kansai Medical University, Hirakata Hospital, Osaka, Japan
Background: Several catheter placement procedures have been described for initiation of peritoneal dialysis, including percutaneous insertion, open surgery, and laparoscopic surgery. However, the optimal approach to catheter placement for peritoneal dialysis remains controversial, because each procedure has specific advantages and disadvantages. Patients and methods: From June 2010 to October 2014, we performed a nephroscope-assisted “pulling-thread” technique for placement of peritoneal dialysis catheters in 46 patients with end-stage renal disease at our medical center. We retrospectively reviewed the operation-related data, early catheter-related complications during the first month after placement, and longterm technical catheter survival. Results: Catheters in all 46 patients were placed precisely in a single step during surgery. The mean operative time was 63.0 ± 18.2 minutes, and no intra-operative complications occurred in any patient. Early catheter-related complications included only exit-site infection (n = 2; 4.3%) and catheter obstruction (n = 2; 4.3%). There was a mean follow-up period of 18.3 ± 12.7 months. The probability of catheter survival at 1 year was 97.1% and at 2 years was 80.1%. Conclusion: Our technique has the advantages of simplicity, safety, minimal equipment, low early catheter- related complication rate, and favorable long-term catheter outcome, making it ideal for patients with end-stage renal disease.Correspondence to:
Tadashi Matsuda, MD
Professor and Chairman
Department of Urology and Andrology
and Vice Director
Hirakata Hospital, Vice President
Kansai Medical University
2-3-1 Shin-machi, Hirakata, Osaka 573-1191, Japan
Email: [email protected]
Nephrology Education
Light chain deposition disease and proximal tubulopathy in two successive kidney allografts
Fanny Drieux, Marie-Charlotte Loron, Arnaud Francois, Dominique Bertrand, Isabelle Etienne, Sebastien Bender, Michel Godin, and Dominique Guerrot
Page No. 351
Abstract
underClinical Nephrology, Vol. 83 – No. 6/2015 (351-356)
Light chain deposition disease and proximal tubulopathy in two successive kidney allografts
Fanny Drieux1,2, Marie-Charlotte Loron1,2, Arnaud Francois2, Dominique Bertrand1, Isabelle Etienne1, Sebastien Bender3, Michel Godin1,4, and Dominique Guerrot1,4
1Nephrology Department, 2Pathology Department, Rouen University Hospital, Rouen, 3CNRS UMR 7276 and Centre de Référence des Amyloses Primitives et des Autres Maladies de Dépôts d’Immunoglobuline Monoclonale, Limoges Medical University, and 4INSERM Unit 1096, Rouen Medical University, Rouen, France
Light chain proximal tubulopathy (LCPT) is a rare kidney disease associated with plasma cell dyscrasias, characterized by light chain deposits in the proximal tubular cells, with or without crystal formation. We describe an exceptional case of LCPT without crystal formation in a kidney allograft, in a patient who underwent two renal transplants for a light chain deposition disease (LCDD) complicating smoldering myeloma. This is the first description of this association in successive kidney allografts. We concisely describe pathology of LCDD and LCPT and discuss potential pathophysiological mechanisms relating these two conditions.Correspondence to:
Fanny Drieux
Nephrology & Pathology Departments
Rouen University Hospital
1 rue de Germont, 76031 Rouen, France
Email: [email protected]
Nephrology Education
Early and irreversible recurrence MPO-ANCA-positive glomerulonephritis after renal transplantation
Ludmilla Le Berre, Alexandre Dufay, Diego Cantarovich, Aurélie Meurette, Marie Audrain, Magali Giral, Gilles Blancho, Fadi Fakhouri, Maryvonne Hourmant, and Jacques Dantal
Page No. 357
Abstract
Clinical Nephrology, Vol. 83 – No. 6/2015 (357-362)
Early and irreversible recurrence MPO-ANCA-positive glomerulonephritis after renal transplantation
Ludmilla Le Berre1*, Alexandre Dufay2*, Diego Cantarovich2, Aurélie Meurette2, Marie Audrain3, Magali Giral2, Gilles Blancho2, Fadi Fakhouri2, Maryvonne Hourmant2, and Jacques Dantal2
1INSERM Unit U1064, 2ITUN (Institut Transplantation Urologie Néphrologie), Department of Nephrology, Clinical Immunology and Transplantation, and 3Laboratory of Immunology. Hôtel Dieu, Nantes University Hospital, Nantes, France
Kidney transplantation (KTx) is the treatment of choice for eligible patients suffering from anti-neutrophil cytoplasmic antibody (ANCA)- associated vasculitis (AAV) who are in clinical remission, regardless of ANCA status. With current immunosuppressive protocols, the recurrence rate of this primary disease in the kidney graft is low and is generally observed after the 1st year of transplantation, with a favorable outcome following conventional treatment. We report here two unusual observations of early (diagnosed within 2 weeks) and aggressive (graft failure despite therapy) recurrences in the kidney graft. These observations suggest that systematic induction by depleting antibodies and antibiotic prophylaxis may help prevent this rare but severe condition. In addition, we monitored these patients for the anti- lysosomal membrane protein-2 antibody (LAMP2ab) titers, but we found that LAMP2ab titers were not a surrogate marker of early recurrence if the LAMP2ab concentration was higher in AVV recipients before KTx. Finally, we must keep in mind that rare cases of early and aggressive recurrence ANCA-associated vasculitis on kidney graft are a challenge for early diagnosis and treatment.
*Authors contributed equally to this work.
Correspondence to:
Dr. Ludmilla Le Berre, PhD
INSERM U1064, CHU Hotel Dieu
30 bd Jean Monnet, 44093 Nantes cedex 1, France
Email: [email protected]
Nephrology Education
Refractory atypical hemolytic uremic syndrome with monoclonal gammopathy responsive to bortezomib-based therapy
Wisit Cheungpasitporn, Nelson Leung, Sanjeev Sethi, Morie A. Gertz, and Fernando C. Fervenza
Page No. 363
Abstract
Clinical Nephrology, Vol. 83 – No. 6/2015 (363-369)
Refractory atypical hemolytic uremic syndrome with monoclonal gammopathy responsive to bortezomib-based therapy
Wisit Cheungpasitporn1, Nelson Leung1,2, Sanjeev Sethi3, Morie A. Gertz2, and Fernando C. Fervenza1
1Division of Nephrology and Hypertension, 2Division of Hematology, and 3Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
Atypical hemolytic uremic syndrome (aHUS) is a relatively rare disorder described by the triad of hemolytic anemia, thrombocytopenia, and renal failure. Atypical HUS could be genetic, acquired, or idiopathic (without known genetic changes or environmental triggers). Monoclonal protein has uncommonly been reported as a cause of microangiopathic hemolytic anemia (MAHA). We report a 59-year-old white man who presented with acute kidney injury (AKI) with MAHA and was given a diagnosis of aHUS with monoclonal gammopathy. His kidney function and proteinuria worsened with persistent hemolysis despite eculizumab and later cyclophosphamide and prednisone treatment. He responded well to VRD (bortezomib, lenalidomide, and dexamethasone) regimen. Renal function, proteinuria, and hemolysis all improved, and he was been in remission for more than 15 months. To our knowledge, this is the first report of successful treatment with bortezomib-based regimen for a patient with aHUS and monoclonal protein refractory to eculizumab therapy.Correspondence to:
Dr. Fernando C. Fervenza
Division of Nephrology and Hypertension
Department of Medicine, Mayo Clinic
Rochester, MN 55905, USA
Email: [email protected]
Nephrology Education
Glomerulonephritis and cryoglobulinemia: first manifestation of visceral leishmaniasis
Milagros Ortiz, Carmen Mon, Juan Carlos Herrero, Aniana Oliet, Isabel Rodríguez, Olimpia Ortega, Paloma Gallar, Julie Hinostroza, Gabriela Cobo, Manuel del Alamo, Juana Jiménez, Rafael Torres, Cristina Digiogia, Juan San Martin, Ana I. Vigil, and Julia Blanco
Page No. 370
Abstract
Clinical Nephrology, Vol. 83 – No. 6/2015 (370-377)
Glomerulonephritis and cryoglobulinemia: first manifestation of visceral leishmaniasis
Milagros Ortiz1, Carmen Mon1, Juan Carlos Herrero1, Aniana Oliet1, Isabel Rodríguez1, Olimpia Ortega1, Paloma Gallar1, Julie Hinostroza1, Gabriela Cobo1, Manuel del Alamo2, Juana Jiménez3, Rafael Torres4, Cristina Digiogia1, Juan San Martin5, Ana I. Vigil1, and Julia Blanco6
1Nephrology Department, 2Microbiology Department, 3Biochemistry Department, 4Department of Internal Medicine, University Hospital Severo Ochoa, 5Department of Internal Medicine, Fuenlabrada University Hospital, and 6Clinico San Carlos Hospital, Madrid, Spain
Visceral leishmaniasis due to Leishmania Infantum is an endemic parasitic infection in the Mediterranean area. Since 2009, Europe’s largest outbreak of Leishmaniasis has been reported in the region of Madrid (Spain). Renal involvement is an unusual complication. Different forms of renal disease have been described: interstitial, glomerular, and vascular damage. Direct invasion of renal parenchyma by the parasite has been described as a mechanism of kidney damage, especially in the immunocompromised. Immune complex deposition and T cells adhesion molecules activation have demonstrated that a pathogenic role in glomerulonephritis related to visceral leishmaniasis. The association between mixed cryoglobulinemia and visceral leishmaniasis has been previously reported in six patients. Renal involvement is only described in one of them. From July 2009 to October 2012, 4 patients with membranoproliferative glomerulonephritis and mixed cryoglobulinemia with negative serology for hepatitis B and C were diagnosed in our hospital. Serology of Leishmania in serum bank samples was performed; it was positive in 3 patients. Leishmania parasite was confirmed by other tests. We present 3 patients with mixed cryoglobulinemia and membranoproliferative glomerulonephritis as first clinical manifestation of visceral leishmaniasis.Correspondence to:
Milagros Ortiz, MD
Avda Oreallana S/N 28911 Leganes/Madrid Spain
Email: [email protected]
Letter to the Editor
Acute kidney injury after cardiac surgery assisted by extra-corporeal circulation
Vincenzo Sepe, Cristian Monterosso, Antonella Degani, Carlo Pellegrini, and Andrea Maria D’Armini
Page No. 378
Abstract
Clinical Nephrology, Vol. 83 – No. 6/2015 – Letters to the editor
Acute kidney injury after cardiac surgery assisted by extra-corporeal circulation
Vincenzo Sepe2, Cristian Monterosso1, Antonella Degani1,3, Carlo Pellegrini1,3,4, and Andrea Maria D’Armini1,3,4
1School of “Cardiovascular Pathophysiology and Cardiac Perfusion”, University of Pavia, 2Unit of Nephrology, Dialysis, Transplantation, 3Unit of Cardiac Surgery, Fondazione IRCCS Policlinico “San Matteo”, and 4Chair of Cardiac Surgery, University of Pavia, Pavia, Italy
Correspondence to:
Dr. Vincenzo Sepe, MD
Unit of Nephrology, Dialysis, Transplantation
Fondazione IRCCS Policlinico San Matte
Viale Camillo Golgi, 19, 27100 Pavia, Italy
Email: [email protected]
Letter to the Editor
Little D, Nee R, Abbott K, et al. Cost utility analysis of sodium polystyrene sulfate vs. potential alternatives for chronic hyperkalemia. Clinical Nephrology, 2014; 81: 259-268
Barry Straube, Nancy Reaven, and Susan Funk
Page No. 380
Abstract
Clinical Nephrology, Vol. 83 – No. 6/2015 – Letters to the editor
Little D, Nee R, Abbott K, et al. Cost utility analysis of sodium polystyrene sulfate vs. potential alternatives for chronic hyperkalemia. Clinical Nephrology, 2014; 81: 259-268
Barry Straube1, Nancy Reaven2, and Susan Funk2
1Director, Marwood Group, New York, NY, and 2Strategic Health Resources, La Canada, CA, USA
Correspondence to:
Nancy Reaven, MA
Strategic Health Resources,
4565 Indiana Ave, Ste. 200
La Canada, CA 91011, USA
Email: [email protected]
Letter to the Editor
Reply to the letter
Dustin J. Little, Robert Nee, Maura A. Watson, Kevin C. Abbott, and Christina M. Yuan
Page No. 382
Abstract
Clinical Nephrology, Vol. 83 – No. 6/2015 – Letters to the editor
Reply to the letter
Dustin J. Little, Robert Nee, Maura A. Watson, Kevin C. Abbott, and Christina M. Yuan
Nephrology SVC, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
Correspondence to:
Christina Yuan, MD
Nephrology SVC
Department of Medicine
Walter Reed National Military Medical Center
Bethesda, MD, USA
Email: [email protected]
Book Review
Handbook of Dialysis
Guenter Seyffart
Page No. 384
Abstract
Handbook of Dialysis
Guenter Seyffart
Correspondence to:
Dr. med. Guenter Seyffart, MD
Renal Institute
Am Urseler Weg 4
61440 Oberusel, Germany
Email: [email protected]
