bluuebunny/crossref_metadata_2025 huggingface dataset:
Relapsing Tinea capitis by Microsporum canis in an Adult Female Renal Transplant Recipient
Authors: Virgili Annarosa , Zampino Maria Rosaria
Published: April 2003

Scalp ringworm is very uncommon in adults. The occurrence and the atypical clinical course of this unusual dermatophytosis in a female renal transplant recipient are described. Furthermore, the prevalence and the clinical features of superficial fungal infection in renal transplant recipients are reviewed. As immunosuppression enhances the risk of antifungal therapy failure, more prolonged treatment and careful follow-up are necessary to obtain complete recovery from any dermatophytosis in renal transplant recipients.
Life-Threatening Hematuria from an Arteriovenous Fistula Complicating an Open Renal Biopsy
Authors: Tarif Nauman , Dunne Patrick M. , Parachuru Prasadarao R. , Bakir Asad A.
Published: April 2003

Arteriovenous fistulae and pseudoaneurysms are not rare after renal biopsy. The majority of these lesions (80%) are asymptomatic or show only transient symptoms. We present here a patient who developed life-threatening hematuria following an open renal biopsy. Arteriovenous fistula and pseudoaneurysm were detected in the biopsied kidney by color-coded Doppler sonography, confirmed by angiography, and the fistula was sealed by superselective arterial embolization with metallic coils. Color-coded Doppler sonography successfully detects the majority of arteriovenous fistulae after renal biopsy, and selective arterial embolization obviates the need for surgical intervention in most cases.
99mTc-Labelled Red Blood Cell Scintigraphy for Localization of Gastrointestinal Bleeding in Chronic Renal Failure
Authors: Oliveras A. , Aubia J. , Cao H. , Puig J.M. , Barbosa F. , Mir M. , Orfila A. , Lloveras J. , Masramon J.
Published: April 2003

Angiodysplasia (AD) may be the source of bleeding in patients with gastrointestinal hemorrhage, with special occurrence in the elderly population and in patients with chronic renal failure (CRF). Although several techniques have been tested for its diagnosis, the gold standard is not well defined yet. We analyze the usefulness of 99mTc-labelled red blood cell (99mTc RBC) scintigraphy in the localization of bleeding from AD lesions in a cohort of 21 patients. Other investigative methods include fibrocolonoscopy examination, angiography, or diagnostic laparotomy. Group A (AD and CRF): 11 patients. Group B (AD without CRF): 10 patients. 99mTc RBC scintigraphy showed 88.9% sensitivity and specificity in group A, while in group B it had 100% sensitivity and specificity. Arteriography showed 100% sensitivity and specificity. On the contrary, fibrocolonoscopy had a very low sensitivity (30%). Our results suggest that 99mTc RBC scintigraphy may be the preferred diagnostic tool for AD, especially in patients with CRF, in whom arteriography may accelerate the decline of renal function.
Effect of an α-Adrenergic Blocker, and ACE Inhibitor and Hydrochlorothiazide on Blood Pressure and on Renal Function in Type 2 Diabetic Patients with Hypertension and Albuminuria
Authors: Rachmani Rita , Levi Zohar , Slavachevsky Inna , Half-Onn Elizabeth , Ravid Mordchai
Published: April 2003

α-Adrenergic blockers are potential alternative antihypertensive agents for diabetic patients. Data on their relative efficacy and their effect on kidney function and albuminuria are very limited however. 76 patients with diabetes type 2, hypertension (≧140/90 mm Hg) and albuminuria (≧30 mg/24 h) were randomized into three groups to receive cilazapril (2.5–10 mg), doxazosin (2–8 mg) or both. Patients of the first and second groups received a single agent for 4 months, the agents were then crossed for an additional period of 4 months followed by the addition of hydrochlorothiazide (25 mg) for a third 4-month period. Blood pressure was monitored monthly, creatinine clearance and HbA1c were measured before and at the end of each treatment period. Patients of the third group received reduced doses of cilazapril and doxazosin for 4 months. Hydrochlorothiazide was then added for the subsequent 4 months. There was a significant decline in blood pressure values during the first period in all groups. Cilazapril: systolic blood pressure (SBP) 160 ± 6 to 149 ± 5 mm Hg; diastolic blood pressure (DBP): 101 ± 3 to 94 ± 3 mm Hg (p = 0.001). Albuminuria declined from 350 ± 105 to 205 ± 96 mg/24 h (p = 0.001), creatinine clearance (CrCl) was unchanged. Doxazosin: SBP: 160 ± 7 to 151 ± 6 mm Hg; DBP: 97 ± 4 to 90 ± 4 mm Hg (p = 0.001). Albuminuria 373 ± 121 to 322 ± 107 mg/24 h (p = 0.065) and CrCl 87 ± 7 to 91 ± 6 ml/min. The combination of both agents at half doses was equipotent or superior to either drug alone. Cross-over of cilazapril and doxazosin reproduced the hypotensive effect and reversed the antialbuminuric effect. The addition of hydrochlorothiazide resulted in a further decline of 6–14 mm Hg in SBP and 3–11 mm Hg in DPB.
Accuracy of Noninvasive Ultrasonic Volume Measurements on Human Kidney Transplants
Authors: Solvig Jan , Ekberg Henrik , Hansen Flemming , Brunkvall Jan , Länne Toste
Published: April 2003

Purpose: To evaluate the precision in volume measurement on human kidney transplants with the aid of noninvasive ultrasonic technique. Material and Methods: A Philips P700 ultrasound machine was used for noninvasive volume determination of 28 porcine kidneys compared to plethysmography. Also, the volume of 46 human transplanted kidneys in situ were measured by ultrasound. Since the configuration of the two types of kidneys differed, a new formula for volume measurement, suitable for kidney transplants, was developed with the aid of clay model experiments. Results: With the standard ellipsoid formula the accuracy of ultrasonic volume determination of the porcine kidneys was good compared with plethysmography, with intra- and interobserver variability of 10.9 and 9.2%, respectively. However, since the width and depth in relation to length of the transplanted kidneys were greater than in the porcine ones (55 vs. 47.5% and 54 vs. 28%, p < 0.01), a new ellipsoid formula was created (r = 1.0, p < 0.0001). Conclusion: Noninvasive ultrasonic kidney volume measurements show an acceptable reproducibility (CV 10%). Since the previously used formula for calculating kidney volume was inaccurate on human kidney transplants, a new and accurate ellipsoid formula fitting for human transplanted kidneys is suggested.
Intravenous Drug Use and Glomerular Deposition of Lipid-Like Material
Authors: Lynn Kelvin L. , Pickering Warren , Gardner Jacqui , Bailey Ross R. , Robson Richard A.
Published: April 2003

We present a series of 5 intravenous drug users (4 male, age range 24–47 years) with glomerular deposition of a lipid-like material. Three patients presented with the nephrotic syndrome, 1 with acute renal failure and 1 with hypertension and an active urinary sediment. All were continuing to use opiates intravenously (mixed with lemon juice or acetic anhydride and sodium bicarbonate). Investigations: plasma creatinine 0.10–0.30 mmol/l, urinary protein excretion 1.0–6.75 g/24 h, hepatitis C antibody positive (4), all seronegative for hepatitis B and HIV. Renal biopsy showed large vacuolated areas consistent with heavy deposition of lipid-like material in all glomerular cells and infiltrating macrophages. Two showed ATN and another FGS. We suggest that these changes are due to the pattern of illicit drug availability and preparation peculiar to these users.
Trimetazidine Reverses Deleterious Effects of Ischemia-Reperfusion in the Isolated Perfused Pig Kidney Model
Authors: Hauet Thierry , Mothes Denis , Goujon Jean-Michel , Germonville Thierry , Caritez Jean Claude , Carretier Michel , Eugene Michel , Tillement Jean-Paul
Published: April 2003

Background: Delayed graft function has remained an important complication after renal transplantation. Methods: The purpose of this study was to evaluate Euro-Collins (EC) plus trimetazidine (TMZ) in comparison with standard EC solution after 24- or 48-hour cold storage. The normothermic isolated perfused pig kidney technique combined with proton nuclear magnetic spectroscopy was used. Results: The study verified that TMZ plus EC had a beneficial preservation effect over EC in terms of better perfusate flow rate at both 24 and 48 h (p < 0.01 and p < 0.001, respectively). In addition, TMZ also was beneficial in terms of increased glomerular filtration rate, better proximal tubular functions, and less tubular injury markers. Lipid peroxidation, evaluated by malondialdehyde renal tissue levels, was decreased in kidney homogenates preserved with TMZ, particularly after 48-hour cold storage. Citrate excretion which reflects a better intracellular pH regulation was detected in urine from kidneys preserved with TMZ. Histological data paralleled findings of the above when comparing cellular injury factors such as vacuolization, necrosis, tubular structure, and interstitial edema. Conclusion: These results indicate that, under the conditions of our experiments, the addition of TMZ to EC solution increased the preservation quality of kidneys particularly after prolonged cold ischemia.
Distributional Patterns of Phospholipase C Isozymes in Rat Kidney
Authors: Cha Seok Ho , Cha Jung-Ho , Cho Young-Jin , Noh Dong Young , Lee Kweon-Haeng , Endou Hitoshi
Published: April 2003

As the first step to investigate the physiological function of phospholipase C (PLC), we determined the distribution patterns of PLC isozymes in normal rat kidneys using Western blotting analysis and immunohistochemistry. Western blotting analysis was performed in four regions (cortex, outer stripe and inner stripe of the outer medulla, and the inner medulla). PLC-β1 and β3 were detected in the inner stripe of the outer medulla and the inner medulla. PLC-γ1 was distributed homogeneously along the corticomedullary axis. PLC-γ2 was observed in the medulla and PLC-δ1 showed a gradual increase from the cortex to the inner medulla. In contrast, no PLC-β4 was detected in all regions. On immunohistochemistry, the immunoreactivities to PLC antibodies were observed as follows: PLC-β1, from the thick ascending limb (TAL) to the inner medullary collecting tubule (IMCT); PLC-β3, in the glomerulus (Glm), the ascending thin limb (ATL) and the collecting tubule; PLC-β4, Glm, the proximal convoluted tubule (PCT), ATL, the distal convoluted tubule, the connecting tubule, and the collecting tubules; PLC-γ1, PCT, TAL and IMCT; PLC-δ1, homogeneously from PCT to IMCT. PLC-β3 immunoreactivities were detected in the nuclei of the TAL, ATL, outer medullary collecting tubule (OMCT) and IMCT. PLC-β4 and γ2 were observed in Glm, MTAL, ATL, OMCT and IMCT. These results suggest the intrarenal site-specific existence of PLC isozymes that may regulate kidney functions through the PLC-mediated signal transductions.
Biochemical Renal Manifestations Induced by Consecutive Administration of Gentamicin in Rats
Authors: Soejima Akinori , Ishizuka Shunji , Suzuki Michihiko , Miyake Nobuyuki , Fukuoka Kazuhito , Nagasawa Toshihiko
Published: April 2003

In the present study, we investigated the generation of lipid peroxides and changes in total phospholipid levels in the kidney tissue of rats with acquired resistance to gentamicin (GM). GM resistance was induced in Sprague-Dawley male rats by subcutaneously administering each rat a dose of 80 mg/kg/day of GM for 40 consecutive days. Twelve days after the GM administration, serum urea nitrogen peaked at 35 mg/dl. The urinary creatinine excretion progressively decreased, beginning 4 days after the start of GM administration. The fractional excretion of sodium progressively increased, beginning 4 days after the start of GM administration, peaking on the 10th day. However, despite the continuation of GM administration, the urinary creatinine excretion gradually increased, and the serum urea nitrogen concentrations recovered to previous levels after 21 days. We also analyzed the relationship between the acquired resistance to GM and changes in the reduced glutathione content and glutathione peroxidase activity. Simultaneously, we investigated sequential changes in the activities of phospholipase A2 and phospholipase C, which release peroxidized membrane phospholipids into the cytoplasm via hydrolysis, as well as the relationship between changes in the kidney tissue phospholipid composition (sphingomyelin/phosphatidylcholine ratio) and renal function. We found that (1) the kidney tissue glutathione content rapidly decreased after GM administration before subsequently increasing and being maintained at a higher level; (2) the glutathione peroxidase activity showed a persistent decrease after GM administration; (3) the kidney tissue phospholipase A2 activity decreased after GM administration, while the phospholipase C activity exhibited a sustained increase from 21 days, and (4) the spingomyelin/phosphatidylcholine ratio decreased on the 4th day before stabilizing when acquired resistance was obtained. Based on these findings, we conclude that an increased supply of reduced glutathione and the induction of an antioxidase, substituting for glutathione peroxidase, may play a significant role in the acquisition of resistance to acute renal failure which occurs with continuous GM administration. Improved membrane fluidity, achieved by maintenance of the membrane phospholipid composition by increased phospholipase C activity, may be an additional factor contributing to the recovery of the renal function.
Measurement of Vascular Access Recirculation Unaffected by Cardiopulmonary Recirculation: Evaluation of an Ultrasound Method
Authors: Alloatti S. , Molino A. , Bonfant G. , Ratibondi S. , Bosticardo G.M.
Published: April 2003

Recently developed devices provide detection of access recirculation (AR) and cardiopulmonary recirculation (CPR) by optical, thermal, conducimetrical, and ultrasound methods (USM). We evaluated the last one both in vitro reproducing AR by a bypass pump and in vivo. In vitro, the USM sensitivity was about 5%. In vivo, the USM was compared with the traditional urea method (UM) in 69 patients. 8.7% of the cases resulted positive by both UM and USM. One case was USM positive and UM negative. The UM sensitivity threshold was 6–10%. The accuracy (in vitro) and the repeatability (in vivo) of the USM were satisfactory. USM clearly distinguished AR from CPR. In conclusion, AR determination by USM, avoiding misleading interferences with CPR, is a rapid, easy, and noninvasive method to routinely exclude a potential cause of reduced dialytic efficiency.
Focal Segmental Glomerular Sclerosis among Patients Infected with Hepatitis C Virus
Authors: Stehman-Breen Catherine , Alpers Charles E. , Fleet W.P. , Johnson Richard J.
Published: April 2003

This study describes the occurence of hepatitis C virus (HCV) infection in the setting of focal segmental glomerular sclerosis (FSGS). All patients with the pathologic diagnosis of idiopathic FSGS between 1992 and 1996 at the University of Washington Hospitals were examined using a retrospective cohort study design. FSGS was determined by renal biopsy in the absence of secondary causes. Demographic, laboratory, and outcome data were collected in a standardized fashion. Six patients (50%) were infected with HCV. Patients with HCV infection and FSGS were primarily Black (67%), hypertensive (100%), had a history of intravenous drug abuse (83%), and had normal liver enzymes. Those with HCV infection and a history of IVDA appeared clinically and histologically similar to previously described cases of ‘heroin nephropathy’. We demonstrate that there is a high prevalence of HCV infection in our population of patients with idiopathic FSGS. Although this may simply reflect an epiphenomenon, we propose that HCV infection may play a role in the development of FSGS in a predisposed host.
Poor Renal Accumulation of 99mTc-DMSA in Idiopathic Tubular Proteinuria
Authors: Suzuki Shigeo , Suzuki Junzo , Kume Kazunari , Yoshida Kazuo , Suyama Hidekazu , Kawasaki Yukihiko , Nozawa Ruriko , Suzuki Hitoshi , Fujiki Tomoo , Kamiyama Satoru , Suzuki Akira
Published: April 2003

In Japanese patients idiopathic tubular proteinuria presents mainly as asymptomatic tubular low molecular weight proteinuria. This disease has recently been shown to resemble Dent’s disease which is characterized by tubular proteinuria, hypercalciuria, rickets and eventual renal failure. We report on 4 children with idiopathic tubular proteinuria. Although they had normal renal function, as evidenced by serum creatinine or creatinine clearance, they had very poor renal accumulation of 99mTc-DMSA and the presence of large amounts of tracer in the bladder. Additionally, the patient with the largest amounts of tubular proteinuria had the poorest renal accumulation of the 4 patients. The renal accumulation of tracer decreased with time from a maximum at 10 min after injection. These findings demonstrate that the tracer, once taken to be confined to the proximal tubular cells, is immediately excreted to the tubular lumen. We suggest that poor renal accumulation of 99mTc-DMSA is very important in elucidating the mechanism of idiopathic tubular proteinuria, and that 99mTc-DMSA renoscintigraphy is useful in the evaluation of the patient’s renal function over time.
Immune Response to Haemophilus influenzae Type b Vaccination inRenal Transplant Recipients with Well-Functioning Allografts
Authors: Sever Mehmet Ş. , Yildiz Alaattin , Eraksoy Haluk , Badur Selim , Yüksel-Önel Derya , Görçin Bilal , Türk Süleyman , Erkoç Reha
Published: April 2003

Background: Haemophilus influenzae infection is a mild and self-limited disease in the healthy population. However, it may show an aggressive course in the immunocompromised state which underlines the importance of vaccination against this agent. On the other hand, posttranplant immunosuppression may impair immune responses and thus the efficacy of the vaccination. Methods: Forty-three renal transplant recipients with well-functioning allografts were immunized with H. influenzae type b vaccine in order to investigate the immune response. The patients received a double or a triple immunosuppressive protocol. Seven healthy members of the dialysis unit served as controls. After obtaining basal serum samples, the patients and the control subjects were immunized with H. influenzae type b conjugate vaccine. After 6 and 12 weeks, serum samples obtained again to determine H. influenzae type b antibody titers. Results: The antibody titers 6 and 12 weeks after vaccination were significantly higher as compared with the basal values, similar to those of the control subjects. These titers did not show statistically significant differences between the double and triple immunosuppressive therapy groups. After 12 weeks of vaccination, the antibody titers did not show a statistically significant difference as compared with those obtained after 6 weeks. Conclusion: H. influenzae type b vaccination is safe and effective in patients with well-functioning renal allografts and should be recommended to renal transplant recipients who may have the risk of invasive disease on the basis of the immunosuppressive state.
Tetracycline-Induced Acute Interstitial Nephritis as a Cause of Acute Renal Failure
Authors: Bihorac A. , Özener Ç. , Akoglu E. , Kullu S.
Published: April 2003

Acute interstitial nephritis with severe acute renal failure is reported following tetracycline treatment in a 22-year-old male medical student. Acute renal failure developed within 48 h of a single repeated tetracycline dose and presented 2 days after taking the drug when there was oliguria, nausea, vomiting and bilateral loin pain without rash and fever. The serum creatinine concentration was 8.6 mg/dl and blood urea nitrogen 84 mg/dl. Examination of the urinary sediment revealed 15–20 RBCs per high-power field, and occasional granular and hyaline casts. Percutaneous renal biopsy performed immediately after admission revealed acute interstitial nephritis with immune complexes along the tubular basement membrane and intact glomeruli and was consistent with type 2 interstitial nephritis. Within 4 days of commencement of steroid treatment and hemodialysis, the urine output started to increase with improvement in serum creatinine and BUN levels and after 2 weeks of therapy hemodialysis was discontinued. He remains well 1 year following his illness with complete normalization of his renal function. Although a number of renal side effects of tetracycline antibiotics have been reported, acute interstitial nephritis is rarely caused by tetracycline treatment having been reported just twice following systemic use of minocycline.
Interleukin-6 Localization and the Prognosis of IgA Nephropathy
Authors: Taniguchi Yoshihiko , Yorioka Noriaki , Kumagai Junko , Katsutani Masahira , Kuratsune Masatoshi , Amimoto Dai , Yamakido Michio
Published: April 2003

Various cytokines and growth factors may be involved in IgA nephropathy. To clarify whether interleukin-6 was a prognostic factor for this disease, we investigated interleukin-6 positivity of renal biopsy specimens and its relationship with the prognosis. The subjects were 90 patients with IgA nephropathy (42 males and 48 females with a median age of 32.7 ± 13.8 years). Renal biopsy specimens were stained for interleukin-6 using an enzyme-antibody method. Fifty-two of 90 patients showed glomerular positivity for interleukin-6. Among the patients positive for interleukin-6, 24-hour urinary protein excretion and serum creatinine levels were significantly higher at the time of biopsy than in the patients without interleukin-6 positivity, while creatinine clearance was significantly lower. In the interleukin-6-positive patients without steroid therapy, serum creatinine increased significantly after 1 year (Δs-Cr; 1.04 ± 0.45 mg/dl) and creatinine clearance decreased significantly (ΔCcr; –11.7 ± 3.2 ml/min) compared to the interleukin-6-negative patients without steroid therapy. Steroid therapy improved 24-hour urinary protein excretion, serum creatinine, and creatinine clearance in the interleukin-6-positive patients, while these parameters worsened without steroid therapy. On the other hand, the IL-6-negative patients showed no differences of clinical parameters irrespective of the presence or absence of steroid therapy. In conclusion, glomerular interleukin-6 positivity may be a prognostic factor and an indicator of the need for steroid therapy in IgA nephropathy.
New Developments in Kidney Development
Authors: Hammerman Marc R.
Published: April 2003

Background/Aims: The number of kidney transplantations performed per year is limited due to the availability of donor organs. One possible solution to the organ shortage is the use of renal xenografts. However, the transplantation of xenografts is complicated by rejection. Methods: It has been postulated that the host immune response might be attenuated following the transplantation of embryonic kidneys (metanephroi) rather than developed (adult kidneys). Transplanted metanephroi become chimeric organs in that their blood supply originates from the host. It is possible to transplant a developing metanephros, without the use of immunosuppression, from one outbred rat to another. Results: Transplanted metanephroi grow, develop, become vascularized, and function in host rats. In contrast, developed adult kidneys transplanted from one rat to another undergo rejection within 7 days after transplantation. Conclusions: These observations suggest that metanephric tissue may be less immunogenic than adult kidney. Transplantation of metanephroi represents a new development that could lead to a novel therapeutic approach to the treatment of chronic renal failure.
Association between HLA-DRB1*15 and Japanese Patients with Rheumatoid Arthritis Complicated by Renal Involvement
Authors: Tokunaga NobukoKimoto , Noda Ritsuya , Kaneoka Hidetoshi , Ogahara Satoru , Murata Toshiaki , Hiratsuka Toshiki , Michinaga Isao , Naito Setsuya
Published: April 2003

We performed serological phenotyping of HLA antigens in 175 patients with rheumatoid arthritis (RA) with (n = 41) and without (n = 134) renal involvement (RI), and DNA typing of HLA class II alleles in 75 patients. Among the patients with RA, the frequency of serologically determined HLA-DR4 was found to be significantly increased (odds ratio: 1.8, confidence interval: 1.3–2.5, p = 2.4×10–4). In the patients without RI, the frequency of serological DR4 significantly increased (odds ratio: 2.2, confidence interval: 1.6–3.3, p = 2.6×10–5). On the other hand, among the patients with RI, a serological determinant, DR15, did significantly increase (odds ratio: 2.7, confidence interval: 0.9–8.4, p = 1.2×10–3) in comparison to the controls. At the DNA level, we found that the association of Japanese RA patients with serological HLA-DR4 was based on that with a genotype of HLA-DRB1*0405 (odds ratio: 2.4, confidence interval: 1.5–4.0, p = 4.4×10–4) and also found an association of HLA-DRB1*1501 (odds ratio: 2.8, confidence interval: 1.2–6.6, p = 0.017) with RA patients having RI. Our results confirmed the association of HLA-DRB1*04 with RA over the ethnic barrier at the DNA level. Our results also suggested a distinct genetic effect of HLA-DRB1*1501 in the aspect of the susceptibility of RI in RA.
Adrenergic Blockade in Diabetic and Uninephrectomized Rats: Effects on Renal Size and on Renal and Urinary Contents of Epidermal Growth Factor
Authors: Thulesen Jesper , Poulsen Steen Seier , Jørgensen Per Erik , Nexø Ebba
Published: April 2003

The present study reports on the effects of adrenergic blocking agents on the renal growth and on the renal content and urinary excretion of epidermal growth factor (EGF) in streptozotocin-induced diabetic or uninephrectomized rats. Diabetic and uninephrectomized rats were allocated to groups treated with either saline or adrenergic antagonists and compared to controls and sham-operated controls, respectively. 24-hour urine samples were obtained on days 7, 14, and 21 and renal tissue samples on day 21. The 24-hour urinary excretion of EGF from controls and saline-treated diabetic rats was comparable. In adrenergic antagonist treated diabetic rats, it was reduced by at least 40% throughout the study period. Uninephrectomy caused a 50% reduction in the urinary excretion of EGF. This was not influenced by treatment with an adrenergic antagonist. After 3 weeks, saline-treated diabetic rats had an increase of 33% in kidney weight when compared to controls. The adrenergic antagonist treated diabetic groups had a significantly lower increase of 15%. Postnephrectomized renal growth was not affected by adrenergic antagonists. The total renal content of EGF was comparable in the saline-treated diabetic group and the control group, but was reduced by approximately 50% in the kidneys from the adrenergic antagonist treated diabetic groups. Renal EGF mRNA levels were also reduced in adrenergic antagonist treated diabetic rats. In contrast to diabetes, the renal growth following nephrectomy was not affected by adrenergic blocking agents. These results provide evidence for fundamental differences between diabetes-related renal growth and that observed in compensation to nephrectomy and suggest a connection between adrenergic activity, renal growth, and EGF in diabetes.
Influence of Albumin Infusion on the Urinary Excretion of β2-Microglobulin in Patients with Proteinuria
Authors: Branten Amanda J.W. , Wetzels Jack F.M.
Published: April 2003

Most filtered proteins are reabsorbed by the renal proximal tubule by a mechanism that involves binding to the brush border membrane and endocytosis. Under normal conditions the low-molecular-weight protein β2-microglobulin (β2M), which is used to detect tubular injury, is reabsorbed almost completely. However, in proteinuric patients an increased urinary excretion of β2M may not simply reflect tubular damage but might also result from a decreased tubular reabsorption due to competitive mechanisms. To examine the magnitude of such an effect we have studied the renal effects of albumin infusion (40 g in 2 h of a 20% solution) in 10 patients with a glomerular disease and proteinuria >3.5 g/24 h. Before, during and after albumin infusion the GFR (inulin clearance), RPF (PAH clearance), blood pressure and the urinary excretion of albumin, IgG, transferrin and β2M were measured. Albumin infusion resulted in a slight decrease of the GFR (72 ± 11 ml/min before and 67 ± 10 ml/min after infusion), an increase of the RPF (379 ± 66 ml/min before and 445 ± 83 ml/min after), a decrease of the filtration fraction (0.20 before and 0.17 after), and hemodilution. After infusion the urinary excretion of albumin increased from 4.5 ± 0.7 to 8.4 ± 1.6 mg/min (p < 0.05). The urinary excretion of IgG and transferrin increased, probably reflecting a change in glomerular size-selectivity. In contrast, the urinary excretion of β2M did not change significantly (baseline 12 ± 5 µg/min, end 13 ± 6 µg/min, percentage change 16.8 ± 11%). To correct for changes in tubular load we calculated the fractional reabsorption of β2M. The initial rise in albuminuria during infusion did not affect fractional tubular reabsorption (Δ%: 0.72 ± 0.52%, median 0.005%). In the period after infusion a slight decrease was noted (median –0.33%, p < 0.01). A decrease in the fractional reabsorption was particularly observed in patients with pre-existing tubular damage. In conclusion: infusion of albumin in proteinuric patients has no clinically relevant effect on the tubular reabsorption of β2M. Therefore, β2M is useful as a parameter to detect tubular injury and alterations in tubular handling of proteins in patients with proteinuria and glomerular diseases.
Effect of γ-Glutamyl Carboxylation of Renal Microsomes on Calcium Oxalate MonohydrateCrystal Binding in Hyperoxaluria
Authors: Angayarkanni Narayanasamy , Selvam Ramasamy
Published: April 2003

Aim: The γ-carboxy glutamic acid (gla) containing proteins have been shown recently to have a role in calcium oxalate urolithiasis. Therefore, the effect of carboxylation on calcium oxalate monohydrate (COM) binding was studied in experimental hyperoxaluria. Methods: Urolithiasis was induced in experimental rats by oral feeding 1% ethylene glycol (EG). The microsomes were carboxylated in presence of reduced vitamin K and COM binding activity was determined. Results: Microsomal proteins adsorbed maximally with COM crystals. On carboxylation of the renal microsomal proteins, a significant increase in the COM crystal adsorption by 2.5-fold (p < 0.001) was observed in the hyperoxaluric condition. Further cyboxylated microsomes of EG-treated rats showed significant binding with calcium oxalate. Conclusion: This study presents an increased COM adsorption after the carboxylation of renal microsomes of hyperoxaluric rats.
Interaction between Erythropoietin and Peripheral Polymorphonuclear Leukocytes in Hemodialysis Patients
Authors: Kristal Batya , Shurtz-Swirski Revital , Shasha Shaul M. , Manaster Joseph , Shapiro Galina , Furmanov Michael , Hassan Kamal , Weissman Irith , Sela Shifra
Published: April 2003

The effect of erythropoietin (EPO) on the oxidative stress and inflammation caused by polymorphonuclear leukocytes (PMNLs) in chronic hemodialysis (HD) patients was investigated in vivo and in vitro. The studies were performed on isolated PMNLs from peripheral blood of healthy controls and HD patients before and following 6 weeks of EPO treatment. The oxidative stress was expressed by the rate of superoxide release from phorbol 12-myristate 13-acetate stimulated PMNLs, and the inflammatory state was evaluated by in vitro PMNL survival, in addition to white blood cell and PMNL counts of the enrolled subjects. Following 6 weeks of EPO treatment, in HD patients, the rate of superoxide release from PMNLs as well as WBC and PMNL counts fell significantly when compared with the pretreatment values. PMNLs from HD patients and healthy controls incubated in vitro with increasing amounts of EPO displayed a significant reduction in their rates of superoxide release and a significant improvement in survival. We have concluded that EPO interacts with PMNLs, attenuating their primed state in HD patients, thus reducing oxidative stress and the extent of inflammation. To the best of our knowledge, this attenuation of the primed state of PMNLs by EPO is a new finding.
Yellow Nails and Minimal Change Nephrotic Syndrome
Authors: Yáñez Sonsoles , Val-Bernal J. Fernando , Fernández-Llaca Héctor
Published: April 2003

We report a case of a 38-year-old man showing the yellow nail syndrome in association with minimal change nephrotic syndrome. Treatment with prednisone and vitamin E resulted in complete resolution of the nephrotic syndrome and slow improvement of the yellow nails, respectively. Although the rare yellow nail syndrome has been described in association with renal disease, this is the first report of the association of this syndrome with minimal change nephrotic syndrome.
Control of Cytomegalovirus Disease in Renal Transplant Patients Treated with Prednisone, Azathioprine and Cyclosporine Using Intensive Monitoring and Decreased Immunosuppression
Authors: Gómez E. , de Oña M. , Mélon S. , Alvarez R. , Laures A. , Rodríguez M. , Pobes A. , Alvarez-Grande J.
Published: April 2003

Background: The aim of this trial was to study the effectiveness of intensive monitoring, together with an early decrease in immunosuppression, in reducing the prevalence of CMV disease in renal transplant recipients treated with prednisone, azathioprine and cyclosporine. Methods: From 1/95 to 11/97 a prospective, longitudinal study was conducted among 146 consecutive, unselected, renal transplant patients in our unit. Only 96 patients whose immunosuppressive regimens consisted of prednisone, azathioprine and cyclosporine and whose follow-up period was greater than 4 months were included in the study. Preemptive therapy was administered to 27 high-risk patients. CMV antigenemia (CMV-AG) and other virological tests were performed weekly for the first 4 posttransplant months. The immunosuppression was decreased when the first positive CMV-AG was detected. Azathioprine was completely withdrawn when the CMV-AG count was greater than 10 cells per 105 PBLs. The cyclosporine dose was gradually decreased in the next 4 weeks, but it was not withdrawn in any patient. The prednisone dose was modified according to the immunosuppressive protocol. Results: 53% (51/96) of the patients had positive CMV-AG on at least one occasion. The dose of azathioprine was decreased after CMV-AG detection in 41/51 (80.4%) patients and it was completely withdrawn in 23 of these (45%). The mean decrease in the dose of azathioprine was 73 ± 31 (25–175) mg, a mean percentage decrease of 76 ± 27% (25–100%). The dose of cyclosporine was progressively decreased during the 4 weeks after detection of the first CMV-AG (mean cyclosporine levels: 210 ± 66, 196 ± 54 and 164 ± 36 ng/ml at the time of first CMV-AG detection, 2 and 4 weeks respectively, p < 0.0001, repeated measures analysis of variance). None of the 45 patients without CMV-AG and only 2 of 51 (3.9%) patients with CMV-AG developed symptomatic CMV disease (2% of the total). CMV disease was of moderate intensity in both patients. Only 3/51 (5.8%) patients developed acute rejection after the first CMV-AG detection in the 4 posttransplant months. Conclusion: The results of this study suggest that intensive monitoring and an early reduction of immunosuppression, together with preemptive therapy in high-risk patients, is effective in diminishing the prevalence and severity of CMV disease.
Hyponatremia-Associated Rhabdomyolysis
Authors: Trimarchi Hernan , Gonzalez Juan , Olivero Juan
Published: April 2003

Background: Hyponatremia is the most frequent electrolyte disorder. However, hyponatremia rarely results from excessive water intake, unless the kidney is unable to excrete free water, such as in patients on thiazide diuretics; in addition, hyponatremia is an uncommon cause of rhabdomyolysis. Methods: We present a 51-year-old hypertensive woman on chronic hydrochlorothiazide therapy who developed acute water intoxication and severe myalgias. Results: The patient developed acute hypotonic hyponatremia and subsequent rhabdomyolysis. We discuss the mechanisms responsible for the development of hyponatremia and its association with rhabdomyolysis. Conclusion: Muscle enzymes should be monitored in patients with acute hyponatremia who develop muscle pain, and hyponatremia-induced rhabdomyolysis must be considered in patients with myalgias receiving thiazide diuretics.
Evidence of Altered Homocysteine Metabolism in Chronic Renal Failure
Authors: Henning Bernhard F. , Riezler Reiner , Tepel Martin , Langer Klaus , Raidt Holger , Graefe Ulrich , Zidek Walter
Published: April 2003

The fasting serum concentrations of total homocysteine and metabolites of transsulfuration (cystathionine, cysteine, methylmalonic acid, 2-methylcitric acid) and remethylation (methionine) were determined by gas chromatography-mass spectrometry in 40 nondialyzed patients with chronic renal disease and in 50 patients with end-stage renal disease requiring chronic maintenance hemodialysis. The nondialyzed patients and 28 of the dialysis patients did not receive additional vitamin supplementations. Twenty-two of the dialysis patients received daily oral vitamin preparations containing 10 mg pyridoxine (vitamin B6), 6 µg cyanocobalamin (vitamin B12), and 1 mg folic acid. In the nondialyzed patients, linear regression analysis showed positive correlations between serum concentrations of creatinine and total homocysteine (r = 0.68, p < 0.0001), cystathionine (r = 0.73, p < 0.0001), methylmalonic acid (r = 0.77, p < 0.0001), and 2-methylcitric acid (r = 0.81, p < 0.0001). Serum homocysteine was positively correlated with serum concentrations of cystathionine (r = 0.59, p < 0.0001), cysteine (r = 0.69, p = 0.004), methylmalonic acid (r = 0.64, p = 0.0001), and 2-methylcitric acid (r = 0.64, p < 0.0001). There was no significant correlation between serum concentrations of homocysteine and methionine (r = –0.14, p = 0.63). In the hemodialysis patients receiving oral vitamin supplementation, serum homocysteine and cystathionine concentrations were significantly lower than in hemodialysis patients not receiving vitamins (homocysteine 21.8 ± 1.1 vs. 33.2 ± 3.7 µmol/l, p = 0.0004; cystathionine 2,075.9 ± 387.1 vs. 3,171.3 ± 680.2 nmol/l, p = 0.02; mean ± SEM). In summary, our results show increased intermediate products of the transsulfuration pathway, but no increase in remethylation of homocysteine in chronic renal disease, including end-stage renal disease requiring chronic maintenance dialysis.
Apoptosis Induced by Inhibition of Contact with Extracellular Matrix in Mouse Collecting Duct Cells
Authors: Park Mi Young , Lee Ryang Hwa , Lee Sang Ho , Jung Jin Sup
Published: April 2003

Cell-matrix interactions have major effects upon phenotypic features such as gene regulation, cytoskeletal structure, differentiation and aspects of cell growth control. Detachment from the matrix epithelial cells induces programmed cell death, and this cell detachment induced apoptosis has been referred to as ‘anoikis’. This study was undertaken to determine whether apoptosis is induced by inhibition of contact with extracellular matrix (ECM) in collecting duct cells and to investigate the signaling mechanisms of the process. Upon detachment from ECM, mouse inner medullary collecting duct cells (mIMCD-3) and mouse outer cortical collecting duct cells (M-1), which were derived from an SV40 transgenic mouse, entered into programmed cell death. Forced suspension of mIMCD-3 or M-1 cells did not affect the expression of Bcl-2-related proteins and did not activate c-Jun NH2-terminal kinase. Detachment of cells from ECM activated p38 mitogen-activated protein kinase (p38), but its inhibition with SB203580 did not protect cells from anoikis. Detachment of cells from matrix inhibited NF-ĸB activity, and the inhibition of NF-ĸB activity by overexpression of nonphosphorylatable I-ĸB increased detachment-induced apoptotic cell death in M-1 cells. Forced suspension of M-1 cells still activated p53 activity. Caspase-8 was activated during anoikis, but the time course of its activation was in accordance with DNA fragmentation. These results indicate that detachment from ECM induces apoptosis in the kidney collecting duct cells. Changes in expression levels of Bcl-2-related proteins or activation of JNK/p38 kinase are not critical for anoikis. Decrease in NF-ĸB activity and activation of p53 induced by inhibition of interaction with ECM play roles in anoikis in SV-40-transformed collecting duct cells. Caspase-8 is activated during detachment-induced apoptosis, the mechanisms of which are independent of activation of cell death receptors.
Historadioautographic Localization, Pharmacology and Ontogeny of V1a Vasopressin Binding Sites in the Rat Kidney
Authors: Arpin-Bott M.P. , Waltisperger E. , Freund-Mercier M.J. , Stoeckel M.E.
Published: April 2003

The localization and pharmacological characteristics of vasopressin (VP) binding sites of the V1a subtype in developing and adult rat kidney were investigated by radioautography on kidney sections incubated in the presence of a radioiodinated selective V1a antagonist. Their localization after in vivo systemic infusion of the radioligand was also investigated. V1a binding sites first appear at embryonic day 16 on vascular elements. In the adult, they were localized in the cortex (vascular and tubular structures, juxtaglomerular apparatus), the outer medulla outer stripe (vasa recta) and inner stripe (thin descending limbs of short looped nephrons) and the inner medulla (collecting ducts). Data obtained in vitro were confirmed by in vivo binding at postnatal day 30 (PN30). Whatever their localizations, the V1a binding sites exhibited full V1a pharmacological profile in postnatal stages rats and in adult rats: a high affinity (nM range) for VP and for the V1a agonist, a lower affinity (µM range) for oxytocin and no affinity for the oxytocin agonist. The presence of V1a binding sites in these different structures raises the question of the putative roles of VP in modulating renal functions. A striking finding is the presence of V1a binding sites in the outer medullary thin descending limbs of short looped nephrons suggesting their colocalization with urea transporters.
Assessment of Renal Function in the Early Stages of Nephrotoxicity Induced by Iodinated Contrast Media
Authors: Duan Shao Bin , Wu Han Wen , Luo Ji An , Liu Fu You
Published: April 2003

To determine whether there are early renal function parameters (RFP) which can be monitored to rapidly detect nephrotoxicity induced by contrast media (CM), we observed RFP in 16 patients with normal renal function before and after administration of CM. Forty-eight hours after diatrizoate meglumine administration, blood urea nitrogen (BUN) and serum creatinine (SCr) increased (p < 0.05). In all patients, acute tubular damage was revealed by early urinary RFP. Increases in levels of serum angiotensin-I-converting enzyme (ACE), β2-microglobulin (β2M) and urinary albumin (Alb) were associated with alterations in glomerular function. The changes in early RFP occurred earlier than those of BUN and SCr. The present study demonstrates that serum ACE, β2M, urinary Alb, γ-glutamyl-transpeptidase and N-acetyl-β-D-glucosidase are sensitive parameters for the early assessment of subclinical nephrotoxicity induced by CM.
Apolipoprotein E Polymorphism in IgA Nephropathy
Authors: Yorioka Noriaki , Nishida Yoji , Oda Hiroaki , Watanabe Takehiko , Yamakido Michio
Published: April 2003

Background/Aim: To clarify the role of the apolipoprotein E (Apo E) phenotype in IgA nephropathy, we investigated its relationship with histological damage and clinical factors. Methods: The subjects were 104 consecutive patients (41 men and 63 women) with IgA nephropathy. The Apo E phenotype was identified by plasma isoelectric focusing and immunoblotting, and the frequencies of Apo E alleles were calculated. Results: The frequencies of the phenotypes and the alleles were as follows: 2/2 = 0, 2/3 = 0.086, 3/3 = 0.654, 2/4 = 0.010, 4/3 = 0.211, 4/4 = 0.010, 3/5 = 0.029, Ε2 = 0.048, Ε3 = 0.817, Ε4 = 0.120, and others = 0.015. There were no significant differences between the IgA nephropathy patients and healthy individuals in the frequencies of Apo E phenotypes and the alleles. However, the Apo E2 phenotype was significantly more common among patients with severe histological damage than in those with mild damage. The serum triglyceride levels were significantly elevated, and the Apo E2 phenotype was significantly more prevalent in patients with severe histological damage as compared with those with mild damage. Conclusion: The Apo E2 phenotype appears to be associated with the severity of histological damage in IgA nephropathy.
Nephrotic Syndrome due to Membranous Nephropathy Associated with Metastatic Prostate Cancer: Rapid Remission after Initial Endocrine Therapy
Authors: Matsuura Hiroshi , Sakurai Masaki , Arima Kiminobu
Published: April 2003

A case of severe nephrotic syndrome (urinary protein excretion 12.9 g/day) due to membranous nephropathy associated with untreated prostate cancer and multiple bone metastases is described. A combination of initial endocrine treatment and steroid therapy resulted in normalization of prostate-specific antigen levels followed by a rapid decrease of urinary protein excretion within 4 months. No proteinuria was subsequently detected. Seven months after the initiation of therapy, the patient remained well with complete clinical remission from the nephrotic syndrome. This rapid achievement of remission may have been due to tumor shrinkage by androgen ablation in addition to steroid therapy of the membranous nephropathy. The nephrotic syndrome is a rare complication of prostate cancer, and, to the best of our knowledge, no previous cases have been reported of membranous nephropathy as one of the first disease manifestations.
Evaluation of IGF System Component Levels and Mitogenic Activity of Uremic Serum on Normal Human Osteoblasts
Authors: Wagner Michaela S. , Stracke Sylvia , Jehle Peter M. , Keller Frieder , Zellner Dietmar , Baylink David J. , Mohan Subburaman
Published: April 2003

To test the hypothesis that impairment in bone formation in renal osteodystrophy in adults with chronic renal failure (CRF) might be mediated in part by alterations in circulating levels of the insulin-like growth factor (IGF) system components, we compared serum levels of IGF-I, IGF-II, IGF-binding protein (IGFBP)-3, IGFBP-4 and IGFBP-5 in adults with CRF (CRF patients with parathyroid hormone (PTH) < 100 pg/ml, PTH > 300 pg/ml and end-stage renal failure (ESRF) patients) versus age-matched controls. To evaluate the biological significance of alterations in circulating level of IGF system components, we compared the mitogenic activity of the sera on proliferation of normal human osteoblasts in vitro by using [3H]thymidine incorporation. We found severalfold increased serum levels of IGFBP-3 (2-fold), IGFBP-4 (5-fold) and slightly increased IGF-II levels in ESRF patients as well as a 2.6-fold increase in free IGF-I in CRF patients with PTH < 100 pg/ml. The mitogenic activity was found to be increased in serum of kidney failure patients compared to controls. This was most pronounced in CRF patients with PTH < 100 pg/ml showing also a significant increase in free IGF-I and the lowest levels of the IGF-inhibitory IGFBP-4. Our data support the hypothesis that alterations in serum levels of stimulating (i.e. free IGF-I) and inhibitory IGF system components (i.e. IGFBP-4) may influence osteoblastic cell proliferation in renal osteodystrophy.