bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case of Guillain-Barré Syndrome Developed Minimal Change Nephrotic Syndrome Simultaneously
Authors: Kitamura Hiroshi , Nakano Takashi , Kakihara Masahiro , Nishino Masami , Isshiki Keiji , Kawano Kiyoshi , Yamauchi Atsushi , Imai Enyu , Kamada Takenobu , Abe Hiroshi
Published: April 2003

A case who developed Guillain-Barré syndrome (GBS) and nephrotic syndrome (NS) simultaneously is reported. In this case, the onset of nephrotic change of proteinuria coincided with the development of the neurological disturbance. Analysis of renal biopsy by light, immunofluorescent and electron microscopy showed minor glomerular abnormalities. The occurrence of GBS in association with NS is rare, and moreover most cases in the previous reports had membranous nephropathy. Only 1 case had minimal change nephrotic syndrome (MCNS). To our knowledge, this is the first report of a case beneficially treated with glucocorticoids, suggesting that immune disorder may play an important role in the association between MCNS and GBS.
Lack of Effect of Gemfibrozil on Cyclosporine Blood Concentrations in Kidney-Transplanted Patients
Authors: Pisanti Nicola , Stanziale Pasquale , Imperatore Paola , D’Alessandro Riccardo , De Marino Valeria , Capone Domenico , De Marino Vincenzo
Published: April 2003

Forty kidney-transplanted patients with hypertriglyceridemia, under treatment with cyclosporine alone or associated with other immunosuppressive drugs, were treated with gemfibrozil. This drug, for a long-term treatment (ranging from 4 to 6 months), was able to decrease hypertriglyceridemia and did not modify either polyclonal (P) and monoclonal (M) cyclosporine blood levels or P/M ratio. These data seem to exclude an effect of gemfibrozil on cyclosporine blood concentrations. Therefore, the use of gemfibrozil in kidney-transplanted patients does not require modifications of cyclosporine dose.
Removal of Serum Beta-2 Microglobulin Using High-Performance Membranes and Analysis of Changes in Serum BMG Levels after Dialysis
Authors: Yasuhiro Isami , Eiichi Nakamura , Mineo Okamoto , Muneto Yoshioka , Toshihiro Ikuma , Masahiro Fujii , Yoshifumi Nakajima , Masahito Minami , Ryuichi Miyano
Published: April 2003

Background/Aims: The present study was undertaken to analyze the β2-microglobulin (BMG)-removing efficiency of high-performance membranes (HPMs) in relation to changes in serum BMG levels after dialysis. Methods: In 10 stable dialysis patients, six different HPMs were used in a crossover method. Serum BMG levels were measured immediately before dialysis, immediately after, 4 h after, and immediately before the next dialysis. On the basis of these measurements, the BMG removal rate was calculated. Results: The BMG removal rate as calculated on the basis of the BMG level immediately after dialysis was 11.29% higher than the rate calculated on the basis of the BMG level 4 h after dialysis. Conclusion: The BMG removal rate can be overestimated if it is calculated on the basis of the BMG level immediately after dialysis.
Unusual Cause of Early Graft Dysfunction after Kidney Transplantation
Authors: Krumme Bernd , Pisarski Przemyslaw , Blum Ulrich , Kirste Günter , Schollmeyer Peter
Published: April 2003

Background/Aims: Transplant renal artery stenosis usually develops in the later period after renal transplantation and is usually due to atherosclerosis and fibrosis at the anastomosis. A kinking renal artery stenosis, however, is a rare cause of early graft dysfunction. Methods: In a 34-year-old-man early graft failure developed within 1 week after kidney transplantation. In the presence of histologically proven ischemic damage an arterial kinking stenosis was diagnosed by color Doppler sonography. Selective arteriography confirmed the sharp kinking of the transplant renal artery; however, a significant stenosis could not be visualized by arteriography. Results: Due to progressive loss of renal function surgical resection of scar tissue in the kink of the transplant artery and nephropexy was performed. Immediately thereafter graft function and blood pressure significantly improved so that the successful clinical outcome of this unusual case of early graft failure confirmed the relevance of the arterial kinking stenosis. Conclusions: In this unusual case of early graft dysfunction relevant kinking renal artery stenosis could not be adequately visualized by arteriography, although color Doppler sonography clearly demonstrated the stenosis. Therefore, both methods should be considered if parenchymal causes of graft dysfunction are excluded by biopsy and a kinking renal artery stenosis is suspected.
A Case of Multicentric Castleman’s Disease Associated with Renal Amyloidosis and Pure Red Cell Aplasia
Authors: Funabiki Kazuhiko , Kaneko Shohgo , Terajima Miki , Tomita Hideaki , Kawano Yasunobu , Tomino Yasuhiko
Published: April 2003

This is the first reported case of multicentric Castleman’s disease (MCD) associated with renal amyloidosis and pure red cell aplasia (PRCA). Inguinal lymph node biopsy showed follicular hyperplasia with prominent germinal centers and plasma cell proliferation in the interfollicular areas. Renal biopsy specimens revealed intraglomerular amyloid deposits, defined as AA amyloidosis. Since amyloid deposits were not present in the gastric and rectal mucosal tissues, his renal disorder was found to be an unusual secondary amyloidosis associated with MCD. Following treatment by plasma exchange, there was progressive deterioration of anemia due to PRCA detected by bone marrow aspiration. Subsequently he was successfully treated with steroid pulse therapy not only for anemia but also for renal function.
End-Stage Renal Failure due to Crescentic Glomerulonephritis in a Patient with Behçet’s Syndrome
Authors: Sakemi Takanobu , Yoshiyuki Tomiyoshi , Ikeda Yuji , Suzuki Noriaki , Nagasawa Kohei
Published: April 2003

We report a rare case of a patient with Behçet’s syndrome who developed end-stage renal failure due to crescentic glomerulonephritis (GN). A 20-year-old male patient had suffered from uveitis, aphthous mouth ulcers and genital ulceration for the past 7 years. His renal function rapidly deteriorated and renal biopsy specimens obtained when his serum creatinine level was 3 mg/dl showed diffuse proliferative GN with fibrous crescent formation in 75% of glomeruli excluding totally sclerotic glomeruli. Immune complexes were identified by demonstration of complement and immunoglobulins in the glomeruli. He developed end-stage renal failure during a 1-year course and received maintenance hemodialysis. We reviewed the literature on severe forms of GN in patients with Behçet’s syndrome.
Effect of L-Carnitine Supplementation on Lipid Parameters in Hemodialysis Patients
Authors: Elisaf Moses , Bairaktari Eleni , Katopodis Kostas , Pappas Michael , Sferopoulos George , Tzallas Christos , Tsolas Orestes , Siamopoulos Kostas C.
Published: April 2003

It has been reported that cumulative carnitine losses through dialysis membranes may worsen hyperlipidemia during long-term hemodialysis. However, carnitine supplementation has not shown a consistent beneficial response. We undertook the present study to determine if there is any hypolipidemic effect of L-carnitine on Greek dialysis patients in concert with the dialysate buffer composition (acetate or bicarbonate). A total of 28 patients (16 male, 12 female), mean age 43 years (range 21–61), with end-stage renal disease on maintenance hemodialysis for a mean period of 25 months (range 7–84) were studied. The dialysis schedule was 4 h, 3 times/week using cuprophane hollow-fiber dialyzers and acetate (n = 14) or bicarbonate (n = 14) dialysate. In all patients L-carnitine (5 mg/kg body weight) was infused intravenously 3 times/week at the end of each hemodialysis session. Blood samples for carnitine and lipid determinations were obtained before treatment, and 3 and 6 months following treatment. Even though L-carnitine did not modify most of the serum lipid levels, a significant decrease in serum triglycerides was evident in the whole group of patients (from 225 ± 76 to 201 ± 75 mg/dl, p = 0.03). Furthermore, L-carnitine could decrease serum triglycerides only in hypertriglyceridemic patients (from 260 ± 64 to 226 ± 82 mg/dl, p < 0.05). L-Carnitine resulted in a reduction of serum triglycerides in both patients on bicarbonate and on acetate dialysis, while there were no significant differences in the changes of lipid parameters after L-carnitine between the two groups of hemodialysis patients. We conclude that relatively low doses of L-carnitine supplementation could contribute to the management of some hypertriglyceridemic hemodialysis patients.
Human Immunodeficiency Virus-Associated Nephropathy in the Bronx: Low Prevalence in a Predominantly Hispanic Population
Authors: Mokrzycki Michele H. , Oo Than N. , Patel Kamlesh , Chang C.J.
Published: April 2003

Reports of human immunodeficiency virus-associated nephropathy (HIVAN) occurring in Hispanics, females and heterosexuals are scarce. We reviewed 858 charts from our total HIV population to determine the prevalence and epidemiology of HIVAN at our center, and to evaluate the renal and patient survival among individual groups, according to race, sex and HIV risk factor. The prevalence of HIVAN was low (1.9%), relative to other centers (4–13%). Although Hispanics accounted for 56% of the HIV population, only 38% of HIVAN patients were Hispanic. The absolute risk of HIVAN in blacks was 3.6%, and in Hispanics was 1.3%. The relative risk of blacks vs. Hispanics was 2.8% (p < 0.04). Women and men were represented equally in both the HIVAN and HIV populations. The mean (± SE) rate of decline in glomerular filtration rate was 3.7 ± 0.9 ml/min/month, and patient survival following the onset of HIVAN was 23.6 ± 4.8 months. We found no difference in renal or patient survival between individual groups. In summary, the risk of HIVAN in Hispanics is similar to that for whites. Male sex is not an independent risk factor. Both renal and patient survival are similar in blacks and Hispanics, and in men compared to women.
Cimetidine-Induced Climacteric Symptoms in a Young Man Maintained on Chronic Hemodialysis
Authors: Bastani Bahar , Galli David , Gellens Mary E.
Published: April 2003

We present the case of a young man on maintenance hemodialysis who developed frequent episodes of ‘fluttering, racing heartbeats’, hot flashes, profuse sweating, anxiety, dizziness, and shortness of breath. These symptoms started approximately 1 month after taking cimetidine 400 mg/day with an occasional extra dose. His workup included a total of 72 h of cardiac monitoring, two-dimensional echocardiogram, and thyroid function tests, all of which were essentially unremarkable. When the drug cimetidine was temporarily discontinued, and on another occasion after the drug was totally withdrawn, the patient noticed marked improvement in his symptoms at 48 h with total resolution on the 5th day after discontinuation. This is the 2nd such case reported in the literature.
Efficacy of Percutaneous Transluminal Coronary Angioplasty for Patients on Hemodialysis
Authors: Sanai Toru , Kimura Genjiro , Inenaga Takashi , Nonogi Hiroshi , Haze Kazuo , Omae Teruo
Published: April 2003

Ischemic heart disease has become more important in regard to mortality in hemodialysis (HD) patients. We examined the therapeutic outcome of initial percutaneous transluminal angioplasty (PTCA) in maintenance HD patients with angina pectoris. They consisted of 8 men and 4 women with a mean age of 56.3 ± 8.6 years and a mean duration of HD of 4.3 ± 4.0 years. Thirty-six non-HD patients treated with initial PTCA were matched for age, sex and coronary risk factors, and used as a control. Angiographic lesion success was confirmed by angiography in 21 (84%) of the 25 stenotic sites attempted and clinical success was obtained in 9 (75%) of the 12 HD patients, while there were 40 (78%) lesions successfully removed out of the 51 stenotic sites and there were 26 (72%) clinically successful cases out of the 36 non-HD patients, respectively. Angina recurred in 4 (44%) of 9 HD patients, and in 10 (38%) of 26 non-HD patients after successful PTCA, where the follow-up periods were 23 ± 20 and 28 ± 25 months, respectively. There was no significant difference in cumulative lesion survival curve between the two groups. In conclusion, PTCA for chronic HD patients is as effective as that for non-HD patients, at least regarding initial PTCA.
The Metaphorical and Mythical Use of the Kidney in Antiquity
Authors: Maio Giovanni
Published: April 2003

While the Syrians and the Arabs viewed the liver as the center of life, the kidneys, in contrast, held a primary place of importance in Israel. In Hebrew tradition, they were considered to be the most important internal organs along with the heart. In the Old Testament most frequently the kidneys are associated with the most inner stirrings of emotional life. But they are also viewed as the seat of the secret thoughts of the human; they are used as an omen metaphor, as a metaphor for moral discernment, for reflection and inspiration. This field of tension in metaphoric usage is resolved under the conception of the kidneys as life center. In the Old Testament the kidneys thus are primarily used as metaphor for the core of the person, for the area of greatest vulnerability. For us today, this metaphorical use of the kidneys has lost its meaning. One reason for its disappearance is certainly the monopoly of causal-analytic rationality in science of today. The kidney has developed from myth to organ, and with this transition a variety of perspectives and ways of looking at knowledge inherent in imaginative thought have been lost. But the metaphor uncovers a deeper level of truth, it represents another form of reconstruction of reality which needs not necessarily be subordinate to the scientific rationality. Today as well, these imaginative ideas can provide an approach to an essential level of reality which may otherwise remain hidden.
The Contribution of Nephrology to the Development of Current Concepts of Disease
Authors: George C.R.P.
Published: April 2003

Historians and philosophers of science rarely comment upon nephrological contributions to the development of general concepts of disease. In the present study, I examine this topic by starting from the premises that an idea of disease pervades most human societies, that received explanations of disease vary between people, societies and eras, and that an understanding of renal disease has often reflected general explanatory trends. Traditionally, most students of disease have belonged to one of four schools: descriptive, causal, mechanistic, or statistical. Descriptivists have tended to focus on manifestations, be these of a symptomatic, a structural, or a functional type. Causationists have focussed upon identification of the origins of diseases. Mechanists have emphasised pathogenetic processes. Statisticians have calculated mathematical differences of parameters from the mean (‘the normal’), without explaining the reasons for these. Mechanists currently appear to hold the ascendancy in nephrology through their focus upon the links that connect causes with manifestations. As, however, all schools of thought have historically waxed and waned, I question the wisdom of granting any of them hegemony. Rather, I promote an event idea of disease that encompasses the causal, mechanistic and descriptive schools. Such considerations should assist nephrologists both to treat disease and to identify those of their predecessors who most advanced knowledge.
Theophilus’ Auctoritas: The Role of De urinis in the Medical Curriculum of the 12th–13th Centuries
Authors: Angeletti Luciana Rita , Gazzaniga Valentina
Published: April 2003

The three principles to know, to know how and to know how to be are already condensed in the works of Theophilos (7th–9th centuries). Theophilus’ De urinis was included in Latin translation in the Articella, probably because of its intermediate position between the texts of high doctrinal value by Hippocrates and Galen (lacking, however, a unifying ‘theory of urine’) and the epitomes, short manuals without any theoretical background. It thus forms an excellent synthesis of a cultural approach reconciling iatrosophia and techne and offers to the reader a text reconciling the theory and the practice, useful to health workers in hospitals, novice beginners and medical scholars. Thanks to his strong attention to the correlation between symptoms and pathology and to his search for assessment scales, Theophilus became the author on whom the birth of medical medieval studies was founded.
The Contribution of French-SpeakingScientists to the Origins of Renal Physiologyand Pathophysiology (1790–1910)
Authors: Richet Gabriel
Published: April 2003

Some contributions: (1) urinary urea, its chemical composition and physiological meaning, Fourcroy and Vauquelin (1790–1808); (2) in binephrectomized animals blood urea is high and chemically identical to that of urine, Prevost and Dumas (1821); (3) urea level in renal vein blood is 50% of that in the arteries, Picard (1856); (4) retained potassium is the uremic poison, Feltz and Ritter (1881); (5) polyuria induced by intravenous injections of sugars or urea, Richet and Moutard Martin (1880); is the kidney in command of the concentration of the blood? Using cryoscopy, Hédon got the clue, the osmotic load (1900); (6) methylene dye excretion measures the global renal function and thus the degree of renal failure, Achard and Castaigne (1897); (7) the disentanglement of chronic uremia and edema, Widal and Achard (1900–1910); (8) evaluation of the global renal function by the ratio plasma urea/urine urea output, Ambard’s Constant (1905), initial step of the concept of clearance; (9) a circulating nephropoietic factor in one-kidney animals, Carnot (1910). In bled animals he also disclosed a hemopoietic factor which later became the renal erythropoietin.
Evolution of Nephrology
Authors: Schreiner George E.
Published: April 2003

Nephrology in America was the first and largest of the new internal medical specialties to emerge after World War II. It was a novel fusion of traditional basic sciences and new clinical tools such as renal biopsy, new imaging, molecular target drugs, dialysis, hemoperfusion and transplantation. The immediate roots were provided by great scientists/clinicians like John Peters, Homer Smith and Tom Addis. The caldron was formed by the tensions arising from newly formed organizations such as the AHA (including NYHA and WHA), NIH, ISN, ASN, ASAIO and NKF. Without these tensions, nephrology might have become a much smaller and narrower specialty of clinical physiology, salt and water and acid-base metabolism. The evolution was rapid from attendance 100+ at the first ISN in Evian, France in 1960 to the 1998 ASN meeting in Philadelphia which drew more than 10,000 nephrologists. This is a personalized history of those tensions and their interactions written by the only nephrologist who has been President of the WHA, ASN, ISN, ASAIO and the NKF.
Josep Trueta (1897–1977): Military Surgeon and Pioneer Investigator of Acute Renal Failure
Authors: Better Ori S.
Published: April 2003

The great Spanish military and orthopedic surgeon J. Trueta gained his field and clinical experience in the Spanish civil war (1936–1939) and in Britain during World War II. As part of his major contribution to traumatology, he searched for the causes of the characteristic oliguria of combat casualties. For this purpose he studied the effect of induced ischemic myopathy on renal perfusion in the rabbit. He and his coworkers demonstrated conclusively that in this model there was an extreme renal cortical vasoconstriction with preservation of the medullary circulation. This early first demonstration of posttraumatic vasomotor nephropathy was independently confirmed 20 years later in the USA when ‘preferential renal cortical ischemia’ was demonstrated in acute renal failure in man. Thus, Trueta discovered in the early 40s the circulatory component of acute renal failure as part of his monumental contribution to military medicine.
Minimal-Change Nephrotic Syndrome and Acute Renal Failure in a Patient with Aged Onset Insulin-Dependent Diabetes mellitus and Autoimmune Thyroiditis
Authors: Kagiyama Shuntaro , Tsuruta Hiroshi , Tominaga Mitsuhiro , Morishita Kazuo , Doi Yasufumi , Onoyama Kaoru
Published: April 2003

A 61-year-old woman with a 2-year history of insulin-dependent diabetes mellitus (IDDM) developed nephrotic syndrome. Renal biopsy showed minimal-change nephrotic syndrome (MCNS), and no evidence of diabetic glomerulosclerosis. Although steroid therapy was initiated, plasma urea and creatinine rose and hemodialysis was required. After 4 weeks, she responded to steroids and her renal function returned to normal. MCNS, which is not associated with diabetic glomerulosclerosis, has rarely been seen in IDDM patients with nephrotic syndrome. Her human leukocyte antigen typing was A24, BW52, BW61, DR2 and DR9. This typing has been reported to be associated with both IDDM and renal disease.
Chronic Interstitial Nephritis due to 5-Aminosalicylic Acid
Authors: Agharazii Mohsen , Marcotte Jean , Boucher Daniel , Noël Réal , Lebel Marcel
Published: April 2003

Nephrotoxicity has recently been reported with the use of 5-aminosalicylic acid (5-ASA) which has structural similarities to phenacetin and aspirin. The present paper describes 2 cases of interstitial nephritis and 1 case of end-stage failure associated with 5-ASA treatment. The first patient presented with severe renal failure which was partially reversed with 5-ASA discontinuation and steroid therapy. The second had severe renal failure (serum creatinine 469 mmol/l) but renal function stabilized with 5-ASA withdrawal. The third patient had end-stage renal failure and underwent hemodialysis and a successful kidney transplant.
Detection of de novo Hepatitis C Virus Infection by Polymerase Chain Reaction in Hemodialysis Patients
Authors: Fabrizi Fabrizio , Martin Paul , Dixit Vivek , Brezina Maria , Russell James , Conrad Andy , Schmid Peter , Gerosa Silvia , Gitnick Gary
Published: April 2003

Patients on chronic hemodialysis (HD) treatment have been identified by serological testing, including second- and third-generation enzyme-linked immunosorbent assay (ELISA), as a high-risk group for hepatitis C virus (HCV) infection. Previous studies have shown that de novo cases of HCV may occur in HD units in the absence of other parenteral exposures, which suggests the spread of HCV between patients. In addition, the reverse-transcription polymerase chain reaction (RT-PCR), which directly detects HCV virus, has identified HCV infection in chronic HD patients who are seronegative. The aim of this study was to determine the incidence of HCV infection detected by RT-PCR technology in a large cohort of chronic HD patients. One hundred and twenty chronic HD patients, HCV-negative by serological assays (second-generation ELISA) and molecular techniques (branched DNA and RT-PCR), were observed for a mean period of 9.5 months. They were tested monthly for serum alanine aminotransferase levels (ALT) and by second-generation ELISA. At the end of the follow-up period, they were again evaluated by branched DNA and RT-PCR testing. HCV RNA was detected in patients’ sera by RT followed by PCR using two separate primer sets from the 5′-untranslated region of the HCV genome. Southern blot was performed using a digoxigenin-labeled probe. Two patients who had HCV RNA detectable by RT-PCR at the end of the follow-up period remained branched-DNA-negative. Thus, the incidence of de novo acquisition of HCV infection in the current investigation was 2.1% per year. In 1 patient RT-PCR positivity and anti-HCV ELISA seroconversion occurred. The 2nd patient remained anti-HCV ELISA-negative, although viremic. In both patients, the onset of positivity by RT-PCR was associated with a rise of ALT levels into the ‘abnormal range’ in our laboratory. In these 2 patients, de novo acquisition of HCV infection was observed in the absence of obvious parenteral risk factors other than their presence in the HD environment. In conclusion, de novo acquisition of HCV infection may be undetected by ELISA and branched-DNA assays. The need to monitor chronic HD patients by serial ALT testing is emphasized. RT-PCR shoud be incorporated into diagnostic testing for HCV infection in chronic HD patients. RT-PCR technology can identify HCV in HD individuals with raised ALT activity.
QRS Amplitude and Volume Changes during Hemodialysis
Authors: Ojanen Seppo , Kööbi Tiit , Korhonen Päivi , Mustonen Jukka , Pasternack Amos
Published: April 2003

Background: According to several studies the QRS amplitude of the ECG increases during hemodialysis. The detailed background to this phenomenon has not been defined. Two main mechanisms have been suggested: myocardial ischemia and volume changes. New noninvasive technologies make possible a comparison of QRS complex changes synchronously with myocardial ischemia and extracellular water (ECW)/blood volume (BV) changes during hemodialysis. Methods: In this study hemodialysis-related changes in body weight, biochemical blood variables, BV, ECW, ST segment and QRS complex were analyzed in 15 patients (age 36–76, time on dialysis 0–6 years) undergoing chronic hemodialysis treatment. QRS complex and ST segment changes were measured using a dynamic vectorcardiographic monitoring system. The ECG parameters measured were QRS vector difference (QRS-VD) and ST vector magnitude (ST-VM6). Bioimpedance analysis was used to detect changes in the ECW. Continuous measurement of BV changes was implemented using an on-line optical reflection method based on the reflection of infrared light by erythrocyte membranes. Blood hemoglobin (B-Hb), hematocrit (B-Hcr), plasma sodium (P-Na), chloride (P-Cl), magnesium (P-Mg), potassium (P-K), ionized calcium (P-iCa), phosphate (P-Pi), creatinine (P-Crea) and urea (S-Urea) were monitored. Results: The mean QRS-VD increase during the dialysis session was almost fourfold (372 ± 300%) from 4.16 ± 2.40 to 15.60 ± 7.0 μVs (p < 0.001). This change was due to a change in amplitude, since the duration of the QRS complex did not alter significantly. The correlation between the changes in QRS-VD and body weight from the start to the end of the dialysis session was moderate and statistically significant (r = –0.55, p < 0.05). The correlation between the changes in QRS-VD and ECW varied from r = –0.67 to –0.97, being statistically significant in all patients (p < 0.001). The correlation between BV and QRS-VD was assessed at one minute intervals during the dialysis and varied from r = –0.22 to –0.98, being significant in 14 of the 15 patients (p < 0.001). Significant ST segments alterations (ST-VM6 elevation > 100 μV) did not occur during dialysis. Laboratory parameters reflecting volume and osmotic changes during hemodialysis correlated with QRS-VD change: B-Hcr (r = 0.56, p < 0.05), B-Hb (r = 0.63, p < 0.05), P-Na (r = 0.62, p < 0.05) and S-Urea (r = –0.62, p < 0.05). Conclusions: The increase in QRS complex amplitude during hemodialysis is correlated to reduced ECW. The mechanism involved is most probably augmentation of electrical resistance of the tissues around the heart caused by loss of interstitial fluid.
A Low-Calorie Unrestricted Protein Diet Attenuates Kidney Damage in Uninephrectomized Spontaneously Hypertensive Rats
Authors: Reisin Efrain , Harris Kimiyo Y. , Azar Silvia , DeBoisblanc Bennett , Thakur Vashu , Liuzza Gerald F.
Published: April 2003

Background/Aims: Uninephrectomized, spontaneously hypertensive rats (UNX-SHR) develop glomerular hyperfiltration, hyperfusion, and interstitial infiltrate of the remnant kidney. Consequently, UNX-SHR is a useful animal model to investigate mechanisms involved in the progression of hypertensive renal disease. Methods: Body weight; tail systolic blood pressure (SBP); urine excretion of protein, urea, and electrolytes; and serum biochemistry were determined in UNX-SHR at 2 months of age prior to uninephrectomy (week 0), prior to treatment (week 8) with a low-calorie (LC) or control diet, and one month after diet treatment (week 12). The LC diet was modified to allow equal intake of protein, sodium phosphorus, and other nutrients in both groups. Results: UNX-SHR treated with the LC diet had significantly lower body weights and SBP at the end of the experiment than did the controls (p < 0.0001). Changes in serum biochemistry and 24-hour urinary excretion of protein, sodium, potassium, and urea nitrogen in both groups were not statistically significant. The final glomerular filtration rate and renal plasma flow were similar in both groups, but the LC diet significantly reduced the glomerular damage index (0.0007), mesangial expansion index (p < 0.002), volume of interstitium per cortex (p < 0.0003), tubular interstitium volume fraction (p < 0.0008), glomerular volume (p < 0.02), and remnant kidney weight (p < 0.01). Conclusion: We demonstrated that in UNX-SHR, the prevention of renal damage by LC diet may involve diminished glomerular growth and interstitial infiltrate without changes in renal hemodynamics. Consequently, LC diet, regardless of protein ingestion, may be an important tool in the prevention of renal damage in hypertension. Additional studies of obese-hypertensive rats may confirm the beneficial effect of a LC diet and weight reduction on the renal damage of obesity-hypertension.
Clinical Findings and Outcomes of Intra-Hemodialysis Cardiopulmonary Resuscitation
Authors: Lai Ming-Nan , Hung Kuan-Yu , Huang Jenq-Wen , Tsai Tun-Jun
Published: April 2003

Renal failure with severe uremia is still an important cause of mortality, despite effective renal replacement therapy. Cardiopulmonary arrest (CPA) is the most severe complication during hemodialysis (HD). To acquire more information about cardiopulmonary resuscitation (CPR) during HD, we retrospectively enrolled 24 patients (11 males and 13 females) who had CPR during HD in a medical center during a 3-year period. Their mean age was 66.8 ± 16.8 years. The CPR rate of the patients from our outpatient department (0.02%) was significantly lower than that from general wards (0.11%), the intensive care unit (ICU, 0.16%), or the emergency room (ER, 0.38%). Eighteen patients (75%) were initially resuscitated successfully. Only 11 patients (45.8%) survived more than 24 h after CPR, and 2 patients (8.3%) survived more than 1 month, but none survived until discharge. The rates of surviving 24 h and surviving to discharge during HD were lower than those in the general wards, the ICU or the ER. Sepsis (33.3%) and cardiogenic shock (25%) were the two leading causes of death. For analyzing factors affecting the outcome of CPR, we divided the patients into 2 groups by survival time (≦24 vs. >24 h). Patients with heart disease or with prolonged CPR durations (>30 min) had shorter survival. No significant survival difference between the 2 groups was found due to factors of age, sex, diabetic nephropathy, pre-arrest morbidity scores, pre-arrest laboratory data, renal failure pattern, HD duration, the preceding HD time and ultrafiltrated volume.
The Plasma Leptin Concentration Is Closely Associated with the Body Fat Mass in Nondiabetic Uremic Patients
Authors: Clausen Peter , Nielsen Palle Kjærulff , Olgaard Klaus , Feldt-Rasmussen Bo
Published: April 2003

Plasma leptin is associated with the body mass index and, more precisely, with the body fat mass. Plasma leptin has been found to be elevated in uremic patients. This study aimed at investigating the plasma leptin concentration and associations between plasma leptin, body fat mass, and glomerular filtration rate in nondiabetic predialysis uremic patients and in nondiabetic patients on chronic hemodialysis. Plasma leptin, body fat mass, and creatinine clearance were measured in 22 predialysis uremic patients, 18 hemodialysis patients, and 24 healthy control subjects. The logarithmically transformed plasma leptin concentration was closely associated with the body fat mass in all groups (r = 0.93, r = 0.83, and r = 0.72, respectively; p < 0.000001, < 0.000002 and p < 0.001, respectively). In predialysis uremic patients the plasma leptin concentration was slightly elevated as compared with controls 10.4 (3.1–59.5) ng/ml versus 5.4 (1.6–47.5) ng/ml (median and range in parentheses; p < 0.05), whereas the plasma leptin concentration was normal in hemodialysis patients. Plasma leptin was not significantly associated with the creatinine clearance in predialysis patients. In conclusion; the glomerular filtration rate seemed to have a limited influence on the plasma leptin concentration in nondiabetic uremic subjects matched by body fat mass to controls. The plasma leptin concentration was closely associated with the body fat mass, and the leptin level might, therefore, be useful as an indicator of the fat mass in nondiabetic uremic patients.
Human Granulocytic Ehrlichiosis Presenting with Acute Renal Failure and Mimicking Thrombotic Thrombocytopenic Purpura
Authors: Modi Kulwant S. , Dahl David C. , Berkseth Robert O. , Schut Ronald , Greeno Edward
Published: April 2003

We present the case of an elderly female patient presenting with recurrent acute renal failure, fever, altered mental status, abdominal pain, thrombocytopenia and a small number of fragmented red cells on peripheral smear mimicking recurrent thrombotic thrombocytopenic purpura (TTP). Eventually, however, she was diagnosed to have human granulocytic ehrlichiosis (HGE), and after treatment for HGE her clinical and laboratory abnormalities resolved. Ehrlichiosis mimicking TTP, diagnosed at postmortem examination, has been described in a single prior case. As illustrated in this case, there are potential difficulties in diagnosing HGE after plasma exchange, blood transfusion and immunosuppressive therapy. Ehrlichiosis, a potentially curable disease, should be considered in the differential diagnosis of thrombotic microangiopathic disorders.
Clinical Implications of Antineutrophil Cytoplasmic Antibody Test in Lupus Nephritis
Authors: Chin Ho Jun , Ahn Curie , Lim Chun Soo , Chung Hee Kyoung , Lee Jung Geon , Song Yong Wook , Lee Hyun Soon , Han Jin Suk , Kim Suhnggwon , Lee Jung Sang
Published: April 2003

To elucidate the prevalence and clinical implications of antineutrophil cytoplasmic antibody (ANCA) in lupus nephritis (LN), we examined ANCA by indirect immunofluorescence and by ELISA against antilactoferrin (anti-LF) and antimyeloperoxidase (anti-MPO) antibody. To discriminate perinuclear ANCA (pANCA) with antinuclear antibody (ANA), all the ANCA-positive sera were tested again after incubating patients’ sera with single-stranded (SS) and double-stranded (ds) DNA. These results were compared with clinicopathologic manifestations and clinical courses of LN. ANCA was positive in 19 (37.3%) of 51 LN patients. Among these LN patients, 3 had cytoplasmic ANCA (cANCA) and 16 had pANCA. ANCA was not found in 8 SLE patients without nephritis and 30 normal controls. The presence of ANCA, particularly pANCA, was associated with the presence of nephritis (18/51 cases vs. 0/8 cases, p < 0.05), especially with diffuse proliferative lupus nephritis, WHO class IV (17/18 cases vs. 21/31 cases, p < 0.05) as well as the presence of anti-dsDNA antibody (17/19 cases vs. 18/30 cases, p < 0.05). Patients with ANCA frequently had deterioration of renal function (3/16 vs. 0/26 cases). Anti-LF antibody was positive in 13 patients. Among those, 12 patients had nephritis. Five patients with anti-LF antibody did not have ANCA, but 7 had pANCA, and 1 had cANCA. Patients with anti-LF antibody had lower initial creatinine levels than those without it [serum creatinine (mg/dl): 0.78 (0.6–1.0) vs. 1.43 (0.5–5.0), p < 0.05]. Anti-MPO antibody was positive in only 1 patient, suggesting that MPO is a rare antigen for ANCA in LN.
Hyperparathyroidism and Anemia in Renal Failure
Authors: Gallieni Maurizio , Corsi Carlo , Brancaccio Diego
Published: April 2003

Patients with severe secondary hyperparathyroidism, usually associated with osteitis fibrosa on bone histology, show considerable resistance to Epoetin, partly because of replacement of the cellular components of the bone marrow by fibrous tissue. In case of unexplained resistance to Epoetin, investigation of secondary hyperparathyroidism is strongly recommended, with measurement of serum parathyroid hormone, calcium, phosphate, and alkaline phosphatase levels and, where needed, skeletal radiology and bone biopsy. Treatment of severe secondary hyperparathyroidism consists of active vitamin D metabolites or parathyroidectomy, although the marrow fibrosis, if present, may be irreversible. The finding of a progressive inability of the bone marrow to respond to Epoetin treatment with higher levels of parathyroid hormone suggests the importance to prevent metabolic bone disease and in particular secondary hyperparathyroidism. Moreover, there are several reports of a beneficial action on hemoglobin levels of an effective treatment of hyperparathyroidism. Larger, controlled studies are necessary to confirm these preliminary and exciting findings, and to elucidate the mechanisms underlying the improvement in anemia after medical or surgical treatment of hyperparathyroidism.
The Significance of Atherogenic Indices in Patients on Hemodialysis
Authors: Oishi Kazuhiro , Nagake Yoshio , Yamasaki Hiroko , Fukuda Shinji , Ichikawa Haruo , Ota Kosuke , Makino Hirofumi
Published: April 2003

Atherosclerotic diseases (ASD) are the major cause of mortality and morbidity in patients on hemodialysis (HD). To evaluate the significance and usefulness of atherogenic indices, we examined lipoprotein(a) (Lp(a)), remnant-like particles cholesterol (RLP.C), homocysteine (Hcy), cardiac troponin T (TnT), and ankle-arm blood pressure index (AABI) in 114 patients on HD (male 79, female 35; age 62.1 ± 1.3 years). As a result, serum cardiac TnT and AABI levels in patients with diabetes mellitus (DM) (n = 33) were significantly higher than those in patients without DM (n = 81). In patients with cerebrovascular diseases (CVD), serum levels of both RLP.C and Hcy, and AABI levels were significantly higher than those in patients without CVD. In patients with coronary artery diseases (CAD), serum cardiac TnT and AABI levels were significantly higher than those in patients without CAD. In patients with peripheral vascular diseases (PVD), serum levels of both Hcy and cardiac TnT were significantly higher than those in patients without PVD. Multiple regression analysis did show that the presence of DM, serum Hcy levels and age were independent factors as- sociated with ASD: ASD = –0.348 + 0.426 × DM (scored: 0, absence; 1, presence) + 0.005 × Hcy (nmol/ml) + 0.010 × Age (years) (p < 0.001). In conclusion, the presence of DM and advanced age are major determinants for atherosclerosis. In addition, serum Hcy levels are independent risk factors for atherosclerosis irrespective of the absence of DM.
Subcutaneous Nodules Attributed to Nocardiosis in a Renal Transplant Recipient on Tacrolimus Therapy
Authors: Wong Kim-Ming , Chak Wai-Leung , Chan Yiu-Han , Choi Koon-Shing , Chau Ka-Foon , Lee King-Chung , Li Chun-Sang
Published: April 2003

We report a renal transplant patient who suffered from disseminated nocardiosis after empirical tacrolimus rescue therapy for chronic allograft rejection. The nocardiosis presented initially as only mildly tender subcutaneous calf nodules without any other signs of inflammation nor constitutional upset, which later spread to the lung and brain causing bronchopneumonia and brain abscesses. The risk factors for nocardial infection in our patient include the use of potent immunosuppressive agents such as tacrolimus, poorly controlled diabetes mellitus and kidney dysfunction. She responded well to combination antibiotic therapy comprising parenteral meropenem, cefotaxime and oral minocycline. We conclude that in transplant recipients, especially those receiving newer and more potent immunosuppressive agents like tacrolimus, nocardial infection can present as apparently ‘cold’ subcutaneous nodules without any systemic upset. An associated brain lesion should be excluded even in patients without neurological symptoms.
Hemophagocytic Syndrome as an Unusual Form of Presentation of Tuberculosis in a Hemodialysis Patient
Authors: Castellano I. , Gómez-Martino J.R. , Hernández T. , Mateos L. , Argüello C.
Published: April 2003

We present an unusual manifestation of tuberculosis in a patient on hemodialysis. A 73-year-old woman was admitted to our hospital with a picture of fever, dyspnea and weight loss. She had chronic renal failure and had started periodic hemodialysis 5 years before. Fifteen days after admission, she began with pancytopenia, abnormal liver function and coagulopathy. A bone marrow aspiration was made 1 week later showing macrophage elements with phagocytic activity. Eight weeks later, bone marrow culture in Lowenstein media confirmed the presence of tuberculosis. After the beginning of antituberculosis therapy, the laboratory disturbances disappeared and the clinical situation improved. We think that fever of unknown origin and pancytopenia in patients on maintenance hemodialysis must lead to an early bone marrow biopsy or aspiration since after the diagnosis a specific therapy can cure the disease.
G-Protein β3 Subunit C825T Variant, Nephropathy and Hypertension in Patients with Type 2 (Non-Insulin-Dependent) Diabetes mellitus
Authors: Zychma Marcin J. , Zukowska-Szczechowska Ewa , Ossowska-Szymkowicz Iwona , Trautsolt Wanda , Grzeszczak Wladyslaw
Published: April 2003

Background: There is substantial evidence that hereditary factors contribute to the predisposition to diabetic nephropathy. On the other hand, it has been suggested that genetics of diabetic nephropathy and hypertension may overlap. Recently, a C to T substitution (C825T) in the gene encoding for the guanine-nucleotide-binding protein β3 subunit (GNB3) was identified, and this molecular variant was found to be associated with enhanced activation of G proteins and increased risk of the development of hypertension. The aim of the study was to test whether GNB3 C825T polymorphism contributes to the development of incipient or overt nephropathy or hypertension in type 2 diabetic patients. Methods: GNB3 genotype was determined in 130 type 2 diabetic patients with overt proteinuria or chronic renal failure, 155 diabetic patients with microalbuminuria and 163 control subjects with normoalbuminuria and known type 2 diabetes duration of at least 10 years. Results: No differences in GNB3 genotype distributions or allele frequencies between the study groups were found. Also, no differences between normotensive and hypertensive patients were demonstrated. Conclusion: The study provided evidence against the major impact of the GNB3 C825T polymorphism on the increased risk of the development of nephropathy or hypertension in type 2 diabetic patients.
Simultaneous Occurrence of Minimal Change Glomerular Disease, Sarcoidosis and Hashimoto’s Thyroiditis
Authors: Nishimoto Ai , Tomiyoshi Yoshiyuki , Sakemi Takanobu , Kanegae Futoshi , Nakamura Megumi , Ikeda Yuji , Shimazu Kanako , Yonemitsu Nobuhisa
Published: April 2003

We herein report a very rare case of a patient suffering from simultaneous occurrence of three immune disorders, i.e. Hashimoto's thyroiditis, sarcoidosis and minimal change glomerular disease. A 66-year-old man was admitted to our hospital for evaluation of nephrotic syndrome. Six months before admission, he was pointed out as having positive proteinuria, hypoalbuminemia and associated pretibial pitting edema. Initial laboratory data showed high gammaglobulinemia, high titers of both antimicrosomal and antithyroglobulin antibodies with normal thyroid function. Chest X-ray and CT scan revealed bilateral hilar lymphadenopathy with interstitial shadow. Ga-citrate scan disclosed positive accumulation in the thyroid glands, the mediastinum, the lungs and the kidneys. The diagnosis of minimal change nephritic syndrome and pulmonary sarcoidosis was made, based on the findings of transbronchial lung biopsy and kidney biopsy. After one and a half months of admission, thyroid function had gradually deteriorated. The histological findings of the thyroid were consistent with the features of Hashimoto's thyroiditis. Treatment with prednisolone and cyclophosphamide resulted in a decrease in urinary protein excretion, reduction in the size of mediastinal lymphadenopathy and disappearance of positive findings of Ga-citrate scan in the thyroid glands and the kidneys. Simultaneous occurrence of minimal change-glomerular disease, sarcoidosis and Hashimoto's thyroiditis in our case suggests that similar immunological abnormalities may be involved in the pathogenesis of the diseases.
Does Immunosuppressive Regimen Influence the Lipid Disturbances in Kidney Recipients?
Authors: Kisielnicka Ewa , Zdrojewski Zbigniew , Wróblewska Malgorzata , Kortas Barbara , Łysiak-Szydłowska Wiesława , Rutkowski Bolesław
Published: April 2003

Though it is said that some immunosuppressive agents are implicated in the development of hyperlipidemia in kidney recipients, this subject is still controversial. Main plasma lipid parameters, as well as apolipoproteins A1 and B were measured periodically in 39 kidney first cadaveric, nondiabetic recipients during 24 months of clinic follow-up after transplantation. Standard triple immunosuppressive therapy: prednisone + cyclosporine + azathioprine was administrated from the beginning. After the second year of kidney transplantation, a significant reduction refers to values of TC, LDL, apo A1 and apo B. In the group with antirejection - methylprednisolone therapy, and without it only TG in the 24th month and apo B in the 1st month were statistically lower in the latter group (both p < 0.05). In the multiple regression test, a linear coincidence was observed between apo A1, apo B and prednisone cumulative dosage after the 1st month, TG and cyclosporine in the 6th month and LDL and cyclosporine in the 12th month after transplantation. It appears that steroids had an impact on lipids directly after transplantation, while cyclosporine did so thereafter.
Ceftriaxone Is an Efficient Component of Antimicrobial Regimens in the Prevention and Initial Management of Infections in End-Stage Renal Disease
Authors: Trimarchi Hernan , Lafuente Priscilla , Suki Wadi N.
Published: April 2003

Background: Infection is a frequent complication in patients with end-stage renal disease. The most common organisms isolated are gram-positive cocci and gram-negative bacilli. Therefore, the usual initial therapeutic approach in these situations is the simultaneous intravenous administration of vancomycin plus an aminoglycoside. This treatment's adverse effects include ototoxicity, nephrotoxicity, and less than ideal tissue penetrance. Methods: We assessed the efficacy of intravenous ceftriaxone in the prevention and in the initial empirical treatment of infections in end-stage renal disease patients, and tested the stability of blood levels of this antibiotic in this population. We studied 104 patients, 65 of them falling into the prevention group (1 g of ceftriaxone i.v. for 5 days) and 39 into the treatment group (1 g of ceftriaxone i.v. or intraperitoneally for 10-14 days). Results: Peak serum ceftriaxone concentrations were well above the minimal inhibitory concentration for 90% of strains. Trough serum concentrations of the drug prior to the next dose were also considerably in excess of the minimal inhibitory concentration. In the prevention group, 8 of 65 developed an infection, which was sensitive to ceftriaxone, whereas in 22 of the 39 patients from the treatment group, cultures showed organisms sensitive to ceftriaxone and in the remaining 17 patients sensitivity was not done. Conclusions: The present study demonstrates the efficacy of a simplified dosing schedule in achieving blood levels of the antibiotic well in excess of minimal inhibitory concentration of any of the organisms encountered. It also shows the usefulness of ceftriaxone in the prevention and/or treatment of bacterial infections and the lack of the side effects vancomycin and/or aminoglycosides possess.