Clinical Nephrology
Determination of red blood cells in urinary sediment: Do pH and specific gravity of urine matter?
Nuša Avguštin, Alexander Jerman, Žiga Rotar, Špela Borštnar, Andrej Škoberne, and Jelka Lindič
Volume 88 (2017) p. 7 - 9
Abstract
Clinical Nephrology, Vol. 88 – Suppl. 1/2017 (S7-S9)
Determination of red blood cells in urinary sediment: Do pH and specific gravity of urine matter?
Nuša Avguštin1, Alexander Jerman1, Žiga Rotar2, Špela Borštnar1, Andrej Škoberne1, and Jelka Lindič1
1Department of Nephrology and 2Department of Rheumatology,
University Medical Centre Ljubljana, Ljubljana, Slovenia
Introduction: It has been postulated that erythrocyte cell lysis in urine is common in the case of low urine specific gravity and high urine pH. We aimed to verify the influence of urine dipstick pH and specific gravity on erythrocyturia in the urine sediment in the case of positive dipstick hemoglobinuria. Methods: We retrospectively collected data on dipstick specific gravity, pH, and urine sediment analysis done by nephrologists in the clinical and research urine laboratory at the Department of Nephrology, University Medical Center Ljubljana. Results: During the 6-year observation period, we analyzed 843 second morning midstream urine samples with positive dipstick hemoglobinuria. Erythrocyturia in urinary sediment was detected significantly less often in urine samples with concomitant hemoglobinuria 1+ and pH < 6.0, (odds ratio (OR) 0.40; 95% confidence interval (CI) 0.21 – 0.76, p = 0.005). The difference was maintained in multivariate analysis including patient age, gender, and specific gravity (OR 0.32; 95% CI 0.15 – 0.65, p = 0.002). In samples with higher grade of hemoglobinuria (≥ 2+), the impact of cell lysis in the case of low pH was negligible. Specific gravity did not have any influence on erythrocyte detection in urinary sediment. Conclusions: Urinary pH < 6.0 impaired the detection of erythrocytes in urinary sediment, while the dipstick measured urine specific gravity did not have any impact on it. Urine samples with low-grade hemoglobinuria and low pH without erythrocyte detection in urinary sediment should be evaluated again to avoid false-negative results.
Correspondence to:
Assist. Prof. Jelka Lindič, MD, PhD
Department of Nephrology
University Medical Centre Ljubljana
Zaloška cesta 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Clinical Nephrology
Rhabdomyolysis and interferon-β: case report and short review
Alexander Jerman, Damjan Kovač, Željka Večerić-Haler, Alojzija Hočevar, Ajda Ota, Sanela Banović, and Jelka Lindič
Volume 88 (2017) p. 32 - 34
Abstract
Clinical Nephrology, Vol. 88 – Suppl. 1/2017 (S32-S34)
Rhabdomyolysis and interferon-β: case report and short review
Alexander Jerman1, Damjan Kovač1,2, Željka Večerić-Haler1,2, Alojzija Hočevar2,3, Ajda Ota4, Sanela Banović1, and Jelka Lindič1,2
1Department of Nephrology, University Medical Center Ljubljana, 2Medical Faculty, University of Ljubljana, 3Department of Rheumatology, University Medical Center Ljubljana, and 4Department of Food Science and Technology, Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
Background: We present a case of acute rhabdomyolysis in the setting of interferon-β treatment and concomitant pomelo juice ingestion, with concern of possible pharmacological interaction, which has not yet been described in the literature. Case presentation: A young Caucasian female with multiple sclerosis on chronic therapy with interferon-β presented with acute rhabdomyolysis after mild exercise and concomitant ingestion of pomelo extract. After stopping the suspected drugs, the signs of rhabdomyolysis diminished, the subsequent course was favorable. Conclusions: The most probable cause of rhabdomyolysis in our patient could have been the combination of interferon effect, which down-regulates P450 expression, with inhibition of the P450 activity by furanocoumarin derivatives from pomelo juice. Therefore, patients treated with drugs that have a possible interaction with inhibitors of cytochrome P450 should be warned against pomelo ingestion.
Correspondence to:
Jelka Lindič, MD
University Medical Center Ljubljana
Zaloška cesta 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Kidney Transplantation
Prevalence and risk factors for nonvertebral bone fractures in kidney transplant recipients – a single-center retrospective analysis
Alexander Jerman, Jelka Lindič, Andrej Škoberne, Špela Borštnar, Maja Martinuč Bergoč, Uroš Godnov, and Damjan Kovač
Volume 88 (2017) p. 101 - 108
Abstract
Clinical Nephrology, Vol. 88 – Suppl. 1/2017 (S101-S108)
Prevalence and risk factors for nonvertebral bone fractures in kidney transplant recipients – a single-center retrospective analysis
Alexander Jerman1, Jelka Lindič1, Andrej Škoberne1, Špela Borštnar1, Maja Martinuč Bergoč2, Uroš Godnov3, and Damjan Kovač1
1University Medical Center Ljubljana, Department of Nephrology, Ljubljana, 2General Hospital of Nova Gorica, Department of Nephrology, Šempeter, and 3Faculty of Management, University of Primorska, Koper, Slovenia
Background: Complex and longstanding bone disease superimposed by harmful influences of immunosuppression is the reason for increased risk of bone fracture in kidney transplant recipients. The aim of our study was to analyze the incidence and prevalence of nonvertebral bone fractures and early (in the first post-transplant year) clinical and laboratory risk factors for suffering bone fracture in the long-term post-transplant period. Methods: Clinical and laboratory data as well as bone mineral density (BMD) measurements of 507 first kidney transplant recipients who were transplanted in the period from 1976 to 2011 were analyzed. Results: The mean age of included patients was 54.3 ± 12.0 years, there were 45% females, and mean time on renal replacement treatment prior to transplantation was 63.4 ± 43.6 months. The average observation time post-transplant was 9.7 years (1.4 – 36.3 years). Post-transplant, 64 (12.6%) patients suffered 89 nonvertebral fractures (44 patients suffered 1 fracture, 15 patients 2 fractures, and 5 patients 3 fractures). Patients with fractures had significantly lower late BMD of femoral neck in the period of 1 – 10 years post-transplant, had osteopenia and osteoporosis more frequently in the same time period, and higher serum alkaline phosphatase in the first year post-transplant. 13 patients (13/64, 20.3%) had major fractures. Patients with major fractures were significantly older than patients with no major fractures and had lower serum albumin. Frequency of treatment with bisphosphonate, calcium, or phosphate did not differ between the groups. Vitamin D supplement (active form in 98% of cases) was prescribed more frequently in the group without fractures, but this was not statistically significant. Conclusion: Fracture rate in our transplant patient population was comparable to that reported in the literature. Except for a higher level of serum total alkaline phosphatase in the fracture group, we found no other early laboratory risk factors for bone fractures. BMD at the femoral region 1 – 10 years after kidney transplantation but not BMD at the time of transplantation was a risk factor for nonvertebral fractures. Osteopenia and osteoporosis in the post-transplant period were found to be a fracture risk factor.
Correspondence to:
Assoc. Prof. Damjan Kovač, MD, PhD, University Medical Centre Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia
Email: [email protected]
Clinical Nephrology
Rituximab for the treatment of membranous nephropathy: a single-center experience
Andreja Aleš Rigler, Alexander Jerman, Aleša Orsag, Nika Kojc, Damjan Kovač, Andrej Škoberne, Špela Borštnar, Željka Večerić Haler, Nuša Avguštin, Radoslav Kveder, Dušan Ferluga, Alenka Vizjak, and Jelka Lindič
Volume 88 (2017) p. 27 - 31
Abstract
Clinical Nephrology, Vol. 88 – Suppl. 1/2017 (S27-S31)
Rituximab for the treatment of membranous nephropathy: a single-center experience
Andreja Aleš Rigler1, Alexander Jerman1, Aleša Orsag1, Nika Kojc2, Damjan Kovač1, Andrej Škoberne1, Špela Borštnar1, Željka Večerić Haler1, Nuša Avguštin1, Radoslav Kveder1, Dušan Ferluga2, Alenka Vizjak2, and Jelka Lindič1
1Department of Nephrology, University Medical Center Ljubljana, and
2Institute of Pathology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
Background: Treatment of idiopathic membranous nephropathy with rituximab was introduced more than a decade ago following experimental data that suggested involvement of B-cell-mediated reactions in its pathogenesis. It was a logical step towards a more selective therapy with less severe side effects as compared to the recommended first-line immunosuppressive therapy with corticosteroids and different immunosuppressant drugs. Methods: We retrospectively analyzed the anonymous data of patients who were treated with rituximab for idiopathic membranous nephropathy at our institution from January 2006 to July 2016. Daily proteinuria and serum creatinine were analyzed 3, 6, 9, and 12 months after rituximab application. The patients were divided into 4 groups according to proteinuria. We separately analyzed remission rates in the whole group and in groups with different quantity of daily proteinuria. Other history data and laboratory parameters were also compared within different groups of patients. Results: The study involved 29 rituximab treatments in 26 patients: 7 (26.9%) female and 19 (73.1%) male patients. In 16 out of 29 treatment cases (55.1%), patients had been previously treated with cyclophosphamide and steroids, or cyclosporine with low dose of steroids, or both. In 72.4% of patients, antiphospholipase A2 receptor antibodies were present. In 2 cases of treatment (6.9%), patients received rituximab 375 mg/m2 of body surface area in 3 and 4 weekly doses, respectively. In all other cases, repeated rituximab applications were given as needed according to the levels of circulating CD-20 B-cells. The total remission rate in our cohort of patients was 37.9% (11 out of 29 cases). The average serum creatinine in the group of patients who achieved remission was significantly lower than in the group without remission (86.5 vs. 155.5 µmol/L, p = 0.003). There was no difference in the duration of the disease prior to treatment with rituximab between the groups (53.6 and 56.4 months, respectively). The remission rate was highest in the group with daily proteinuria less than 4 g per day (83.3%). There were no remissions in the group of patients with daily proteinuria more than 12 g per day. Conclusion: The remission rate after rituximab treatment in our cohort of patients with idiopathic membranous nephropathy was lower than in other studies. The reason for this is possibly the application of a single dose of rituximab in the majority of patients, which might have been insufficient in patients with higher proteinuria.
Correspondence to:
Andreja Aleš Rigler, MD, PhD
Department of Nephrology
University Medical Center Ljubljana
Zaloška 7, 1000 Ljubljana, Slovenia
Email: [email protected]
The predictive value of urinary erythrocyte morphology for proliferative glomerular kidney disease
Nuša Avguštin Rotar, Alexander Jerman, Andrej Škoberne, Špela Borštnar, Nika Kojc, and Jelka Lindič
Volume 96 (2021) p. 49 - 55
Abstract
Clinical Nephrology, Vol. 96 – Suppl. 1/2021 (S49-S55)
The predictive value of urinary erythrocyte morphology for proliferative glomerular kidney disease
Nuša Avguštin Rotar1,3, Alexander Jerman1,3, Andrej Škoberne1,3, Špela Borštnar1,3, Nika Kojc1,2,3, and Jelka Lindič1,3
1Department of Nephrology, University Medical Center Ljubljana, 2Institute of Pathology, Faculty of Medicine, and 3Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
Background and aim: Glomerular erythrocyturia (GlomEry) is usually associated with proliferative kidney diseases. In our retrospective cohort, we aimed to validate the predictive value of GlomEry criteria ≥ 40% dysmorphic erythrocytes (DysEry) or ≥ 5% acanthocytes (AcaEry) or at least 1 erythrocytic cast (CastEry) and of two new indices – the count of DysEry per high power field (HPF) and per microliter of urine (Stansfeld-Webb (SW)) method, for proliferative disease. Materials and methods: We included patients with erythrocyturia from 2015 to 2016. Based on renal histology, we divided them into a proliferative and a non-proliferative disease group. Urine erythrocyte count was done using SW and urinary sediment examination was carried out by skilled nephrologists. Sensitivity, specificity, and cutoff values were determined using ROC curves. Results: We included 90 patients (33% women), median age of 63 (IQR 51, 71) years. In the proliferative group, proteinuria was lower (2.4 vs. 6.6 g/day), and SW erythrocyturia was higher (174 (IQR 60, 353) vs. 44 (IQR 20, 67) × 106/L) than in the non-proliferative group. The threshold to differentiate between the proliferative and non-proliferative group was determined at ˃ 43% of DysEry (sensitivity 73%, specificity 79%, AUC 0.808) and at ˃ 2% AcaEry (sensitivity 71%, specificity 56%, AUC 0.647). No significant difference in CastEry was found between groups. Among tested parameters, the calculated number of DysEry/HPF > 6.7 (sensitivity 77%, specificity 92%, AUC 0.878), followed by DysEry/SW > 28 × 106/L (sensitivity 76%, specificity 86%, AUC 0.879), discriminated those two groups best. Conclusion: In concordance with known GlomEry criteria, > 43% of DysEry predicted proliferative kidney disease, whereas CastEry did not, and AcaEry predicted poorly. The best predictor of proliferative glomerular disease was DysEry/HPF, closely followed by DysEry/SW.Correspondence to:
Nuša Avguštin Rotar MD, Department of Nephrology, University Medical Center Ljubljana, Zaloška cesta 7, 1000 Ljubljana, Slovenia
Email: [email protected]
