Volume 89 (2018), No. 6/2018(June)
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Review
Mini-review of kidney disease following hematopoietic stem cell transplant
Ramy Sedhom, Daniel Sedhom, and Edgar Jaimes
Page No. 389
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 (389-402)
Mini-review of kidney disease following hematopoietic stem cell transplant
Ramy Sedhom1, Daniel Sedhom1, and Edgar Jaimes2
1Rutgers Robert Wood Johnson Medical School, Department of Internal Medicine, New Brunswick, NJ, and 2Memorial Sloan Kettering Cancer Center, Department of Medicine Renal Service, New York, NY; Renal Division, Weill-Cornell Medical College, New York, NY, USA
Advancements in hematopoietic cell transplantation (HCT) have broadened indications for its use and resulted in more long-term survivors. Stem cell transplantation is associated with several well-known toxicities, although renal complications are not well defined. Acute and chronic kidney disease remains a common complication following transplantation itself. Incidence and risk factors for the development of chronic kidney disease (CKD) is less well understood. Recent estimates suggest that nearly 15% of subjects undergoing HCT will develop CKD, a complication that can progress to end-stage renal disease (ESRD), disrupts overall quality of life, and reduces overall survival. Several commonly-reported risk factors include acute kidney injury, graft-versus-host disease, and long-term calcineurin inhibitor use. This review highlights the incidence, timeline, etiology, risk factors, and prognosis of kidney disease in the setting of hematopoietic stem cell transplantation. Investigation of the causes of CKD is needed, as are ways to prevent, mitigate, and treat kidney injury. Renal disease importantly reflects prognosis, with dialysis-requiring patients carrying greater than 80% mortality after 3 years. Although CKD following HCT is common, prospective studies are needed to confirm risk factors and better define the underlying mechanisms in order to promote therapies that prevent this complication.
Correspondence to:
Ramy Sedhom, MD,
Department of Internal Medicine
MEB 488, 1 Robert Wood Johnson Place
New Brunswick, NJ 08901, USA
Email: [email protected]
Original
Association between preoperative
renin-angiotensin system inhibitor use
and postoperative acute kidney injury risk
in patients with hypertension
Nana Xu, Qian Long, Ting He, Xing Liu, Haijiang Dai, Yao Lu, Jia Wen, Qiaoyu Wu, and Hong Yuan
Page No. 403
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 (403-412)
Association between preoperative
renin-angiotensin system inhibitor use
and postoperative acute kidney injury risk
in patients with hypertension
Nana Xu1, Qian Long2, Ting He2, Xing Liu2, Haijiang Dai2, Yao Lu1, Jia Wen2, Qiaoyu Wu2, and Hong Yuan1#2
1Center of Clinical Pharmacology, and 2Department of Cardiology, the Third Xiangya Hospital, Central South University, Changsha, China
Purpose: To determine whether preoperative renin-angiotensin system (RAS) inhibitor use within 7 days of noncardiac surgery is associated with a lower incidence of postoperative acute kidney injury (AKI) in hypertensive patients. Materials and methods: We retrospectively analyzed 12,545 hypertensive patients undergoing noncardiac surgery at the Third Xiangya Hospital of Central South University from February 2007 to November 2015. According to the use of RAS inhibitors within 7 days of surgery, the patients were divided into a RASI group and a non-RASI group. We used a multivariable logistic regression model and propensity score matching (PSM) analysis to examine the association between preoperative RAS inhibitor use and postoperative AKI incidence. Results: Among the 12,545 hypertensive patients undergoing noncardiac surgery who met the inclusion/exclusion criteria, 18.74% received preoperative RAS inhibitor treatment within 7 days of surgery. After PSM, 2,192 patients in each group were matched successfully. The incidence of postoperative AKI in the RASI group was significantly lower than that in the non-RASI group (7.39% vs. 12.32%, p < 0.001). The multivariable logistic regression analysis and the PSM analysis demonstrated similar associations between preoperative RAS inhibitor use and postoperative AKI incidence. This association was modified by the presence of preoperative congestive heart failure (CHF) (p-value for the interaction: 0.027), and the observed association was not evident in patients without CHF (CHF: adjusted odds ratios (ORs): 0.47; 95% CI: 0.31 – 0.70 vs. no CHF: adjusted OR: 0.80; 95% CI: 0.62 – 1.03). Conclusion: The preoperative use of RAS inhibitors in hypertensive patients was associated with a lower incidence of AKI following noncardiac surgery, and this association was not significant in the subgroup population without CHF.
Correspondence to:
Hong Yuan, MD, PhD, FACC
, Member of ISH
Center of Clinical Pharmacology
Department of Cardiology
Hunan Research Center of Hypertension
The Third XiangYa Hospital, Central South University
138 Tong-Zi-Po Road, Changsha, Hunan 410013, People’s Republic of China
Email: [email protected]
Original
Full age spectrum equation may be an alternative method to estimate the glomerular filtration rate in Chinese patients with chronic kidney disease
Lingxiong Chai, Meifang Wang, Kedan Cai, Qun Luo, Haihong Yi, and Jianyong Wu
Page No. 413
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 (413-421)
Full age spectrum equation may be an alternative method to estimate the glomerular filtration rate in Chinese patients with chronic kidney disease
Lingxiong Chai1#2, Meifang Wang1, Kedan Cai2, Qun Luo2, Haihong Yi3, and Jianyong Wu1
1Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 2Department of Nephrology, Ningbo No. 2 Hospital, and 3Department of Nuclear Medicine, Ningbo No. 2 Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, China
Objective: To assess the performance of the full age spectrum (FAS) equation in comparison to other equations in subjects with chronic kidney disease (CKD) for the first time in China. Materials and methods: The measured glomerular filtration rate (mGFR) obtained by the 99mTc-diethylenetriamine pentaacetic acid renogram was used as the reference standard. Bias, precision, and accuracy were analyzed to identify which of these four equations performed better: FAS equation, the Modification of Diet in Renal Disease (MDRD) equation, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and the Berlin Initiative Study-1 (BIS-1) equation. κ-test and the Bland-Altman method were applied to evaluate the classification and the agreement between the estimated glomerular filtration rate (eGFR) and mGFR, respectively. Results: 396 subjects were enrolled in this study. The precision (root mean square error, RMSE) of the FAS equation was 19.49 (95% CI 17.98, 21.27) in adults (18 – 70 years) and 14.06 (95% CI 12.50, 16.07) in older adults (≥ 70 years), better than the corresponding values of MDRD equation 22.32 (95% CI 20.59, 24.36) and 20.76 (95% CI 18.46, 23.72)(p < 0.05), superior to 17.59 (15.64, 20.10) for CKD-EPI equation in older adults, respectively. The FAS equation showed the least bias (1.28 (95% CI –1.38, 4.03)) in older adults and the highest percentage (63.64%) of accuracy (30%) in all participants. The FAS correctly classified subjects into GFR categories. Conclusion: The FAS equation improved the precision and accuracy of eGFR, especially in older adults. It also decreased the bias of the estimated GFR. The FAS equation is applicable to adults and may be an alternative to measuring eGFR in China.
Correspondence to:
Jianyong Wu
Kidney Disease Center, The First Affiliated Hospital
College of Medicine, Zhejiang University
79 Qingchun Street, Hangzhou City 310000, Zhejiang, China
Email: wujianyong1964@
zju.edu.cn
Original
Automated peritoneal dialysis could rapidly improve left heart failure by increasing peritoneal dialysis ultrafiltration: a single-center observational clinical study
Cong Yang, Jixing Liu, Nirong Gong, Yanhong Lin, Yanfang He, Zhixiu Yi, Liping Hu, Jianping Jiang, and Jun Ai
Page No. 422
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 (422-428)
Automated peritoneal dialysis could rapidly improve left heart failure by increasing peritoneal dialysis ultrafiltration: a single-center observational clinical study
Cong Yang*, Jixing Liu*, Nirong Gong, Yanhong Lin, Yanfang He, Zhixiu Yi, Liping Hu, Jianping Jiang, and Jun Ai
State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
Ultrafiltration failure (UFF) is a major cause of water retention, left heart failure (LHF), and peritoneal dialysis (PD) failure. Automated peritoneal dialysis (APD) might have better ultrafiltration (UF) than continuous ambulatory peritoneal dialysis (CAPD). Here, we have studied whether short-term APD could increase UF and improve LHF. 47 patients were included in this study from December 1, 2015, to January 1, 2017. All patients had been treated with CAPD before they came to our center and were treated with APD in the hospital. 24-hour peritoneal UF volume, 24-hour urine volume, body weight, blood pressure, LHF class, serum creatinine, blood urea nitrogen, albumin, potassium, hemoglobin, and glucose were collected and compared before and after receiving short-time APD. A total of 47 patients (31 men, mean age 46.8 ± 16.2 years, mean duration 26 months (2 – 195 months)) were enrolled in this study. Of the 47 patients, peritoneal dialysis UF was significantly increased when receiving short-term APD compared to CAPD (1,261.9 ± 329.6 mL vs. 706.2 ± 222.3 mL, p < 0.001), and body weights had significantly decreased 3 days after treatment with APD (57.73 ± 10.5 vs. 59.81 ± 10.8, p < 0.001). LHF class was significantly decreased 3 days after receiving APD (1.7 ± 0.8 vs. 2.4 ± 1.0, p < 0.001). Blood pressure was well controlled 3 days after treatment with APD (146.6 ± 14.4 vs. 162.5 ± 23.8 of SBP, p = 0.007, and 85.6 ± 11.1 vs. 95.6 ± 14.7 of DBP, p = 0.001). In conclusion, short-term APD could significantly increase ultrafiltration, rapidly alleviate edema and improve LHF, and might be an effective method to treat UFF and LHF in PD patients.
*These authors contributed equally to this work.Correspondence to:
Dr. Jun Ai
Division of Nephrology, Nanfang Hospital
1838 North Guangzhou Ave
Guangzhou 510515, China
Email: [email protected]
Original
Thrombotic microangiopathy in patients with diabetic nephropathy is associated with low VEGF expression and end-stage renal disease
Kriscia Hernández-Arteaga, Virgilia Soto-Abraham, Monserrat Pérez-Navarro, Bernardo de León-Garza, Adrian Rodríguez-Matías, M. Guadalupe Olvera-Soto, and Rafael Valdez-Ortiz
Page No. 429
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 (429-437)
Thrombotic microangiopathy in patients with diabetic nephropathy is associated with low VEGF expression and end-stage renal disease
Kriscia Hernández-Arteaga1#2#3, Virgilia Soto-Abraham4, Monserrat Pérez-Navarro1#5, Bernardo de León-Garza4, Adrian Rodríguez-Matías1, M. Guadalupe Olvera-Soto2, and Rafael Valdez-Ortiz2
1International Society of Nephrology Fellow 2014 – 2016, 2Department of Nephrology, Hospital General de México “Dr. Eduardo Liceaga”, Mexico-City, 3Hospital Nacional de San Juan de Dios de San Miguel, El Salvador, El Salvador, 4Department of Pathology, and 5Department of Research, Hospital General de México “Dr. Eduardo Liceaga”, Mexico-City, Mexico
Background: Thrombotic microangiopathy (TMA) has been associated with diabetic nephropathy, but its pathogenesis is unknown. Objectives: To determine the role of vascular endothelial growth factor (VEGF) expression in patients with TMA and diabetes mellitus. Materials and methods: Retrospective cohort study, patients were divided into diabetic nephropathy patients either without thrombotic microangiopathy (DN-TMA) or with thrombotic microangiopathy (DN+TMA). VEGF levels were analyzed using immunohistochemistry. Statistical analysis was performed with SPSS 20.0 software. Results: There were 36 patients included in this study with a mean age of 47.6 ± 9.3 years. The average time since the diagnosis of diabetes mellitus was 6.8 ± 4.1 years. There were 21 patients (58.3%) with DN+TMA and 15 patients (41.7%) with DN-TMA. Patients with DN+TMA had a higher systolic blood pressure (p = 0.014) and diastolic blood pressure (p < 0.001) as well as proteinuria (p = 0.006), and a lower rate of glomerular filtration at baseline (p = 0.01). VEGF assessment showed lower arteriolar and glomerular expression in patients with DN+TMA (p < 0.001). The VEGF expression levels had an inverse relationship with proteinuria (r = –0.373; p = 0.03) and were directly proportional with glomerular filtration (r = 0.712; p < 0.01). Kaplan-Meier curves showed a higher probability of end-stage renal disease in patients with DN+TMA (log-rank p < 0.012). Conclusion: TMA is associated with low VEGF expression and end-stage renal disease in patients with diabetic nephropathy.
Correspondence to:
Dr. Rafael Valdez Ortiz, MD, PhD,
Department of Nephrology
Hospital General de México
Dr. Balmis 148/ Colonia Doctores,
Delegación Cuauhtémoc/Mexico City,
Mexico 06726
Email: [email protected]
Original
Clinical and histological features of antineutrophil cytoplasmic antibody-associated vasculitis related to antithyroid drugs
Jumpei Hasegawa, Junichi Hoshino, Akinari Sekine, Noriko Hayami, Tatsuya Suwabe, Keiichi Sumida, Koki Mise, Toshiharu Ueno, Masayuki Yamanouchi, Ryo Hazue, Naoki Sawa, Kenichi Ohashi, Takeshi Fujii, Kenmei Takaichi, and Yoshifumi Ubara
Page No. 438
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 (438-444)
Clinical and histological features of antineutrophil cytoplasmic antibody-associated vasculitis related to antithyroid drugs
Jumpei Hasegawa1#2, Junichi Hoshino1, Akinari Sekine1, Noriko Hayami1, Tatsuya Suwabe1, Keiichi Sumida1, Koki Mise1#3, Toshiharu Ueno1, Masayuki Yamanouchi1, Ryo Hazue1, Naoki Sawa1, Kenichi Ohashi4#5, Takeshi Fujii4, Kenmei Takaichi1#6, and Yoshifumi Ubara1#6
1Nephrology Center, Toranomon Hospital, Toranomon, 2Department of Nephrology, Tokyo Metropolitan Health and Medical Treatment Corporation Okubo Hospital, Tokyo, 3Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 4Department of Pathology, Toranomon Hospital, Toranomon, 5Department of Pathology, Yokohama City University, Graduate School of Medicine, Yokohama, and 6Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Toranomon, Tokyo, Japan
Background: Antithyroid drugs such as propylthiouracil and methimazole have been reported to cause antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), but little is known about long-term outcomes. Materials and methods: We identified AAV patients who underwent renal biopsy and retrospectively assessed their clinical and histological findings. Patients with AAV who had received propylthiouracil or methimazole were defined as having antithyroid drug-associated AAV (ATD-AAV), and the other patients were defined as having primary AAV. Results: Seven patients with ATD-AAV and 83 patients with primary AAV were identified. Compared with the primary AAV group, the patients with ATD-AAV were significantly younger (mean ± standard deviation; 45.4 ± 21.4 years vs. 65.9 ± 13.8 years, p < 0.01), and had lower serum creatinine (median [interquartile range]; 0.7 mg/dL [0.6 – 1.5] vs. 2.3 mg/dL [1.0 – 4.0], p = 0.02), as well as a higher frequency of positivity for MPO-ANCA/PR3-ANCA (42.9 vs. 4.8%, p < 0.01). While glomerular crescents varied, interstitial fibrosis and tubular atrophy were milder in ATD-AAV patients. Kaplan-Meier analysis showed a significantly higher kidney survival rate in patients with ATD-AAV than in those with primary AAV (p = 0.05). Conclusion: Patients with ATD-AAV were younger and had milder kidney involvement, resulting in a better long-term outcome compared with primary AAV.
Correspondence to:
Yoshifumi Ubara, MD,
Nephrology Center, Toranomon Hospital
Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa 212-0015, Japan
Email: [email protected]
Original
Effects of adding Rheum officinale to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on renal function in patients with chronic renal failure: A meta-analysis of randomized controlled trials
Yue Yang, Ye-ping Ma, Zheng Zhang, Pei-lin Dai, Ping Li, and Wen-ge Li
Page No. 445
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 (445-452)
Effects of adding Rheum officinale to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on renal function in patients with chronic renal failure: A meta-analysis of randomized controlled trials
Yue Yang1#2, Ye-ping Ma1#2, Zheng Zhang1#2, Pei-lin Dai2, Ping Li2, and Wen-ge Li1#2
1School of Basic Medicine, Peking Union Medical College, and
2Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
Objective: Rheum officinale is a traditional medicinal herb used widely in China to treat chronic renal failure, but the proof of evidence-based medicine is poor. This meta-analysis aims to assess the benefits of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) supplemented with Rheum officinale for delaying the progression of chronic renal failure. Materials and methods: The MEDLINE, EMBASE, Cochrane Library, SinoMed, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases were searched to identify studies published before September 2016 that investigated the effects of ACEI/ARB plus the Chinese patented medicine Rheum (CPM-Rheum) compared to ACEI/ARB alone in lowering serum creatinine (SCr) and blood urea nitrogen (BUN) levels in chronic renal failure patients. Review Manager 5.3 was used to perform the meta-analysis. Fixed- and random-effects models were used to analyze the data. Results: The meta-analysis included nine clinical trials. Comparisons of patients before and after treatment with ACEI/ARB plus CPM-Rheum or ACEI/ARB alone revealed that ACEI/ARB plus CPM-Rheum resulted in significantly greater reductions in SCr (short-term: weighted mean difference (WMD): 17.26, 95% confidence interval (CI): 7.28 – 27.24; long-term: WMD: 63.71, 95% CI: 51.01 – 76.41) and BUN (short-term: WMD: 1.70, 95% CI: 1.27 – 2.12; long-term: WMD: 3.98, 95% CI: 3.14 – 4.82) than ACEI/ARB alone. Conclusion: In patients with chronic renal failure, the addition of CPM-Rheum to ACEI/ARB significantly lowered both SCr and BUN, particularly after long-term administration. Thus, the combination of ACEI/ARB and CPM-Rheum may improve the treatment of patients with impaired renal function.
Correspondence to:
Wen-ge Li, PhD
Department of Nephrology
China-Japan Friendship Hospital
Beijing, China
Email: wenge_lee2002@
126.com
NephroPharmacology
Potentially inappropriate prescribing of drugs in elderly patients on chronic hemodialysis treatment
Gorana Nedin Ranković, Slobodan Janković, Radmila Veličković Radovanović, Zorica Jović, Gordana Pešić, Svetlana Pavlović, Branislava Ranković, Jasmina Ranković, Dragana Stokanović, Dane Krtinić
Page No. 453
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 (453-460)
Potentially inappropriate prescribing of drugs in elderly patients on chronic hemodialysis treatment
Gorana Nedin Ranković1, Slobodan M. Janković2, Radmila Veličković Radovanović3, Zorica Jović1, Gordana Pešić1, Svetlana Pavlović4, Branislava Ranković5, Jasmina Ranković6, Dragana Stokanović1, and Dane Krtinić7
1Department of Pharmacology, Faculty of Medicine, University of Niš, Niš, 2Department of Pharmacology, University of Kragujevac, Faculty of Medical Sciences, Department of Clinical Pharmacology, Clinical Center of Kragujevac, Kragujevac, 3Department of Pharmacy, Faculty of Medicine, University of Niš, Department of Pharmacotherapy, Faculty of Medicine, University of Niš, Clinic of Nephrology, 4Clinic of Urology, Clinical Center of Niš, Niš, Serbia, 5Institute of Pathology, Faculty of Medicine, University of Ljubljana, Slovenia, Ljubljana, Slovenia, 6Health Center, and 7Clinic of Oncology, Clinical Center of Niš, Niš, Serbia
Purpose: The aim of this study was to determine the prevalence of potentially inappropriate drug prescription (PIP) in older patients who were on chronic hemodialysis treatment and to explore the factors that lead to PIP. Materials and methods: The study was performed at the Department of Nephrology, Clinical Center Niš, Serbia. It included patients who were 65 years old and older who suffered from the end-stage of kidney failure and were treated by hemodialysis. Univariate and subsequent multivariate logistic regression was used to analyze risk factors for PIP or omission (PPO) according to the STOPP and START criteria. Results: The study included 83 patients. According to the START criteria, PPO was found in 18 (22%) patients, and 32 (39%) patients experienced PIPs according to the STOPP criteria. The following factors were associated with PIP according to the START criteria: a number of comorbidities, reading the patient leaflet, and having the habit of drinking coffee. According to the STOPP criteria, polypharmacy was associated with PIP (OR = 1.287, p = 0.021): each additional drug increased the risk of potentially inadequate medications (PIM) by 28.7%. Conclusion: Adequate consideration of potential risk factors, as well as the implementation of valid criteria for assessment of PIP, are just some of the measures that would contribute to solving complex therapeutic problems and designing strategies for rational prescribing according to the individual characteristics of patients.
Correspondence to:
Gorana Nedin Ranković, MD
Department of Pharmacology, Faculty of Medicine
University of Niš
Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia
Email: [email protected]
Nephrology Education
Successful treatment of nephrotic syndrome induced by lambda light chain deposition disease using lenalidomide: A case report and review of the literature
Akira Mima, Dai Nagahara, and Kosuke Tansho
Page No. 461
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 (461-468)
Successful treatment of nephrotic syndrome induced by lambda light chain deposition disease using lenalidomide: A case report and review of the literature
Akira Mima, Dai Nagahara, and Kosuke Tansho
Department of Nephrology, Kindai University Nara Hospital, Kindai University Faculty of Medicine, Nara, Japan
Background: Light chain deposition disease (LCDD) is a monoclonal immunoglobulin deposition disease (MIDD) that is characterized by the deposition of monoclonal light chains in multiple organs, including the kidney. It is a rare disorder caused by an underlying monoclonal plasma cell dyscrasia. LCDD with renal involvement causes proteinuria, which sometimes can lead to nephrotic syndrome. The monoclonal light chains are mostly in the κ form. Treatment of LCDD is the same as that for multiple myeloma (MM); however, some conventional anticancer drugs show substantial toxicity and therefore cannot be administered to older patients or those with renal impairment. Case presentation: An 80-year-old woman was referred to our department with severe nephrotic syndrome (13.6 g/gCr) and anemia. A renal biopsy showed mesangial proliferation and mesangial matrix expansion, and immunohistochemistry showed positive staining for λ chains along the glomerular basement membrane, but was negative for κ chains or amyloid deposition. A bone marrow biopsy revealed 64% plasma cells. Immunoglobulin G (IgG)-λ type M protein was detected, and the levels of free λ chain was significantly increased. We concluded that her nephrotic syndrome was caused by LCDD, which resulted from IgG-λ MM. The induction of a BCD (bortezomib, cyclophosphamide, and dexamethasone) treatment regimen did not lead to a hematological response or decrease in proteinuria. The administration of combination therapy of lenalidomide and prednisolone led to the successful reduction of proteinuria and hematuria. Conclusions: We presented a very rare case report describing the successful treatment of LCDD (λ chain)-induced nephrotic syndrome with lenalidomide.
Correspondence to:
Akira Mima, MD, PhD,
Department of Nephrology
Kindai University Nara Hospital
Kindai University Faculty of Medicine
Nara 630-0293, Japan
Email: amima@
med.kindai.ac.jp
Nephrology Education
Successful use of rituximab in glomerular basement membrane nephritis associated with HIV interstitial nephritis secondary to Castleman disease
Nathan Calabro, Kammi Henriksen, Seah H. Lim, and Eric Kerns
Page No. 469
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 (469-473)
Successful use of rituximab in glomerular basement membrane nephritis associated with HIV interstitial nephritis secondary to Castleman disease
Nathan Calabro1, Kammi Henriksen2, Seah H. Lim3, and Eric Kerns1
1 Department of Medicine, Division of Kidney Disease and Hypertension, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, 2Department of Pathology, The University of Chicago Medicine, Chicago, IL, and 3Department of Medicine, Division of Hematology and Oncology, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
We report a case of glomerular basement membrane crescentic glomerulonephritis and multicentric Castleman disease-associated interstitial nephritis in a patient with human immunodeficiency virus (HIV) infection. The patient received corticosteroids, cyclophosphamide, and plasmapheresis, and within 3 weeks, there was worsening thrombocytopenia, anemia, and renal function requiring initiation of hemodialysis. He then received 8 weekly doses of rituximab, and there was steady improvement in renal function, such that he stopped dialysis within 6 weeks and has remained in disease remission at 1-year follow-up. This is the first case report of acute kidney injury caused by both antiglomerular basement membrane disease and multicentric Castleman disease, with a favorable response to rituximab.
Correspondence to:
Eric S. Kerns, MD
, Assistant Professor of Medicine
Department of Medicine
Division of Kidney Disease and Hypertension
Rhode Island Hospital and Alpert Medical School of Brown University
Providence, RI 02903, USA
Email:
[email protected]
Nephrology Education
Membranoproliferative glomerulonephritis and interstitial nephritis in the setting of Epstein-Barr virus-related hemophagocytic syndrome
Iolanda Godinho, Estela Nogueira, Sofia Jorge, António Teixeira Alves, and António Gomes da Costa
Page No. 474
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 (474-479)
Membranoproliferative glomerulonephritis and interstitial nephritis in the setting of Epstein-Barr virus-related hemophagocytic syndrome
Iolanda Godinho1, Estela Nogueira1, Sofia Jorge1, António Teixeira Alves2#3, and António Gomes da Costa1
1Division of Nephrology and Renal Transplantation, Department of Medicine Centro Hospitalar Lisboa Norte, EPE, Lisbon, 2Department of Anatomic Pathology,
Hospital Prof. Doutor Fernando da Fonseca, Amadora, and 3Anatomic Pathology Institute, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal
Background: Hemophagocytic syndrome (HPS) is a rare, aggressive disorder characterized by dysregulation of lymphocyte and macrophage activity, which culminates in tissue infiltration with hemophagocytosis and ultimately organ failure. Renal involvement frequently ensues and usually results in acute tubular necrosis with associated interstitial inflammation. Less frequently, glomerulopathy can also be found. Case: We report a case of a 24-year-old Caucasian woman with previous asymptomatic hematuria, mild proteinuria, and normal renal function who presented to us with fever. Laboratory findings revealed pancytopenia, elevated lactate dehydrogenase, and ferritin as well as liver and kidney failure. Renal biopsy showed a tubulointerstitial nephritis superimposed in a membranoproliferative glomerulonephritis with crescents. Extensive etiologic investigation was negative except for Epstein-Barr virus (EBV) viral load. EBV-DNA was then identified by in situ hybridization in the renal biopsy. HPS could be diagnosed with the presence of six criteria: fever, splenomegaly, bicytopenia, high ferritin, hypertriglyceridemia, and high levels of soluble CD25. Steroid therapy was initiated with resolution of HPS as well as complete recovery of renal and liver function. Conclusion: In this case, we believe that EBV triggered both HPS and tubulointerstitial nephritis. Steroid therapy successfully treated the inflammatory syndrome, allowing renal function recovery without compromising EBV infection resolution.
Correspondence to:
Iolanda Godinho, MD
Division of Nephrology and Renal Transplantation
Department of Medicine
Centro Hospitalar Lisboa Norte, EPE
Av. Prof. Egas Moniz, 1649-035 Lisbon, Portugal
Email: iolandagodinho@
gmail.com
Letter to the Editor
Comment to: Ranković et al. Potentially inappropriate prescribing of drugs in elderly patients on chronic hemodialysis treatment. Clin Nephrol. 2017. Epub ahead of print
Anunciación González-López, Angel Chocarro-Martinez, and Alvaro Nava-Rebollo
Page No. 480
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 – Letters to the editor
Comment to: Ranković et al. Potentially inappropriate prescribing of drugs in elderly patients on chronic hemodialysis treatment. Clin Nephrol. 2017. Epub ahead of print
Anunciación González-López1, Angel Chocarro-Martinez2, and Alvaro Nava-Rebollo1
1Departments of Nephrology and 2Internal Medicine, Complejo Hospitalario Zamora, Zamora, Spain
Correspondence to:
Anunciación González-López, MD
Avda. Requejo S/N
49012 Zamora, Spain
Email: [email protected]
Letter to the Editor
Response to González-López et al.
Gorana Nedin Ranković, Slobodan M. Janković, Radmila Veličković Radovanović, Zorica Jović, Gordana Pešić, Svetlana Pavlović, Branislava Ranković, Jasmina Ranković, Dragana Stokanović, and Dane Krtinić
Page No. 481
Abstract
Clinical Nephrology, Vol. 89 – No. 6/2018 – Letters to the editor
Response to González-López et al.
Gorana Nedin Ranković1, Slobodan M. Janković2, Radmila Veličković Radovanović3, Zorica Jović1, Gordana Pešić1, Svetlana Pavlović4, Branislava Ranković5, Jasmina Ranković6, Dragana Stokanović1, and Dane Krtinić7
1Department of Pharmacology, Faculty of Medicine, University of Nis, Niš, 2Department of Pharmacology, University of Kragujevac, Faculty of Medical Sciences, Department of Clinical Pharmacology, Clinical Center of Kragujevac, Kragujevac, 3Department of Pharmacy, Faculty of Medicine, University of Nis, Department of Pharmacotherapy, Faculty of Medicine, University of Nis, Clinic of Nephrology, 4Clinic of Urology, Clinical Center of Nis, Niš, Serbia, 5Institute of Pathology, Faculty of Medicine, University of Ljubljana, Slovenia, Ljubljana, Slovenia, 6Health Center, and 7Clinic of Oncology, Clinical Center of Nis, Niš, Serbia
Correspondence to:
Gorana Nedin Ranković, MD
Faculty of Medicine
University of Niš
Bulevar dr Zorana Đinđića 81
1800 Niš, Serbia
Email: [email protected]
