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Buckenmayer A, Siebler N, Haas CS. Pre-existing chronic kidney disease, aetiology of acute kidney injury and infection do not affect renal outcome and mortality. J Nephrol 2024; 37:391-400. [PMID: 37787894 PMCID: PMC11043156 DOI: 10.1007/s40620-023-01774-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/18/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND We aimed to study the role of aetiology, pre-existing chronic kidney disease (CKD) and infections in acute kidney injury (AKI) on renal outcome and mortality. METHODS This retrospective study analysed patients with AKI admitted to a university nephrology department from January 1st, 2020 through December 31st, 2020. Aetiology of AKI, underlying renal disease in case of pre-existing CKD and presence of infections were assessed. Development of renal function and risk of death were studied with follow-up until January 31st, 2023. RESULTS Of 1402 patients screened, 432 patients (30.8%, 67.9 ± 15.4 years) fulfilled the inclusion criteria, half of the population presented with advanced CKD. Even though CKD patients were more often in need of chronic dialysis at time of discharge (6.9% vs 4.5%, p < .001), duration of hospital stay was shorter and in-hospital mortality tended to be lower when compared to AKI without prior renal disease. Neither aetiology of AKI nor pre-existing CKD had an impact on the combined endpoint of end-stage kidney disease and mortality (log rank 0.433 and 0.909). Overall, septic patients showed the highest in-hospital mortality (23.5%) and longest hospital stay (30.0 ± 22.8 days, p < .001), while patients with urosepsis had the shortest hospitalisation time (9.7 days) with lowest risk for dialysis (4.4%). Of note, outcome did not differ in patients with AKI when considering the infectious status. CONCLUSIONS Overall renal outcome and mortality in AKI patients were not affected by the cause of AKI, pre-existent CKD or infectious status. Only severity of AKI had a negative impact on outcome.
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Affiliation(s)
- Anna Buckenmayer
- Department of Internal Medicine, Nephrology and Intensive Care Medicine, Phillips University, Baldinger Straße 1, 35043, Marburg, Germany.
| | - Nadja Siebler
- Department of Internal Medicine, Nephrology and Intensive Care Medicine, Phillips University, Baldinger Straße 1, 35043, Marburg, Germany
| | - Christian S Haas
- Department of Internal Medicine, Nephrology and Intensive Care Medicine, Phillips University, Baldinger Straße 1, 35043, Marburg, Germany
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2
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Blank N, Kötter I, Schmalzing M, Rech J, Krause K, Köhler B, Kaudewitz D, Nitschke M, Haas CS, Lorenz HM, Krusche M. Clinical presentation and genetic variants in patients with autoinflammatory diseases: results from the German GARROD registry. Rheumatol Int 2024; 44:263-271. [PMID: 37747561 PMCID: PMC10796580 DOI: 10.1007/s00296-023-05443-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023]
Abstract
To investigate clinical symptoms and genetic variants in patients from the German anti-IL-1 registry for autoinflammatory orphan diseases (GARROD) between 2013 and 2022. Multicentre, retrospective analysis of demographic, clinical and genetic data of patients with autoinflammatory diseases (AID) who received anti-IL-1 targeted therapy. The cohort comprised 152 patients with familial Mediterranean fever (FMF; n = 71), cryopyrin-associated periodic syndromes (CAPS; n = 43), TNF-receptor associated periodic syndrome (TRAPS; n = 19), mevalonate kinase deficiency (MKD; n = 3) and unclassified AID (uAID; n = 16). Inflammatory attacks started in 61.2% of the patients before the age of 18 years. The delay between the first AID attack and anti-IL-1 therapy was 17.8 years. Monogenetic AIDs were diagnosed by clinical symptoms. Genetic analyses confirmed the diagnosis in 87.3% of patients with FMF, 65.2% with CAPS and 94.8% with TRAPS. Among this group, heterozygous MEFV variants and variants of unknown significance (VUS) were detected in 22.5% of patients with FMF, 51.2% with CAPS and 47.4% with TRAPS. Patients with VUS were older at disease onset which is consistent with a milder phenotype. Twenty-four patients had secondary AA amyloidosis (AA) at initiation of anti-IL-1 therapy. The mean age of these patients was 16.4 years at their first attack and 44.9 years at the time of AA diagnosis. Turkish-Armenian ancestry correlated with MEFV variants and higher FMF disease activity compared to German ancestry. Molecular genetic analyses should substantiate the clinical diagnosis of a monogenetic AID. Our data support the concept of variable penetrance of VUS which can be associated with late-onset AID.
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Affiliation(s)
- Norbert Blank
- Department of Internal Medicine V, Division of Rheumatology and Amyloidosis Center, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- Zentrum Für Seltene Erkrankungen Heidelberg (ZSE HD), Heidelberg, Germany.
- Internal Medicine 5, Amyloidosis Center and Division of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Ina Kötter
- Department of Rheumatology, University Hospital Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
- Clinic for Rheumatology and Immunology, Bad Bramstedt, Germany
| | - Marc Schmalzing
- Department of Internal Medicine II, Rheumatology and Clinical Immunology, University of Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Jürgen Rech
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3-Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
- Zentrum Für Seltene Erkrankungen Erlangen (ZSE ER), Erlangen, Germany
| | - Karoline Krause
- Department of Dermatology, Charité-Campus Mitte, Luisenstraße 2, 10117, Berlin, Germany
| | - Birgit Köhler
- Städtisches Klinikum Karlsruhe, Department of Internal Medicine I, Nephrology and Rheumatology, Moltkestraße 90, 76133, Karlsruhe, Germany
| | - Dorothee Kaudewitz
- Department of Internal Medicine V, Division of Rheumatology and Amyloidosis Center, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- Zentrum Für Seltene Erkrankungen Heidelberg (ZSE HD), Heidelberg, Germany
| | - Martin Nitschke
- Division of Nephrology, Internal Medicine I, Universityhospital S.-H. Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Christian S Haas
- University of Marburg, Department of Internal Medicine, Nephrology and Intensive Care Medicine, Baldingerstrasse 1, 35033, Marburg, Germany
| | - Hanns-Martin Lorenz
- Department of Internal Medicine V, Division of Rheumatology and Amyloidosis Center, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- Zentrum Für Seltene Erkrankungen Heidelberg (ZSE HD), Heidelberg, Germany
| | - Martin Krusche
- Department of Rheumatology, University Hospital Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
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3
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Buckenmayer A, Siebler N, Haas CS. Evaluation of simple diagnostic parameters in acute kidney injury in hospitalized patients-diagnostic recommendations for non-nephrologists. Intern Emerg Med 2023; 18:1769-1776. [PMID: 37452960 PMCID: PMC10504189 DOI: 10.1007/s11739-023-03365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
Acute kidney injury (AKI) is very common in hospitalized patients, affecting patient's mortality and morbidity. Major causes are prerenal AKI and acute tubular necrosis (ATN). Even though a variety of parameters/indices exist, their reliability and practicability are controversial: in fact, there is a need for a simple diagnostic approach for AKI in in-patients with parameters easily obtained in any hospital. The objective of the study was: (1) to assess reliability of simple laboratory parameters/indices to differentiate pre-/intrarenal AKI; (2) to evaluate the most reliable and feasible parameters/indices; and (3) to identify the possible impact of confounding factors. Retrospectively, in-patients with AKI hospitalized in 2020 in a university nephrology department were included. Spot urine and 24-h collection urine was analyzed with urine sodium (UNa), urine specific gravity (USG), fractional excretion of sodium (FENa), fractional excretion of urea (FEUrea), urine osmolality (UOsm), urine to plasma creatinine ratio (UCr/PCr) and renal failure index (RFI). Overall, 431 patients were included. UNa, UOsm, USG and RFI showed high specificity > 85% for prerenal AKI, UNa and RFI provided good specificity for ATN. Loop diuretics, ACE inhibitors/AT1 blockers or pre-existing chronic kidney disease had no impact. In patients with AKI, UNa, USG and RFI: (1) proved to be very specific for prerenal AKI and showed high sensitivity for ATN; (2) can be easily determined using serum and spot urine; and (3) are not confounded by medication or comorbidities. These parameters/indices are helpful to identify the aetiology of AKI and to guide therapy, thereby improving patients' safety and outcome.
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Affiliation(s)
- Anna Buckenmayer
- Department of Internal Medicine, Nephrology & Intensive Care Medicine, Phillips University, Baldinger Straße 1, 35043, Marburg, Germany.
| | - Nadja Siebler
- Department of Internal Medicine, Nephrology & Intensive Care Medicine, Phillips University, Baldinger Straße 1, 35043, Marburg, Germany
| | - Christian S Haas
- Department of Internal Medicine, Nephrology & Intensive Care Medicine, Phillips University, Baldinger Straße 1, 35043, Marburg, Germany
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4
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Buckenmayer A, Möller B, Ostermaier C, Hoyer J, Haas CS. Tunneled central venous catheters for hemodialysis-unfairly condemned? Catheter-related complications in a university hospital setting. J Vasc Access 2023:11297298221150479. [PMID: 36814105 DOI: 10.1177/11297298221150479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Central venous catheters (CVCs) provide an immediate hemodialysis access but are considered to be of elevated risk for complications. It remains unclear, if CVCs per se have relevant impact on clinical outcome. We provide an assessment of CVC-associated complications and their impact on mortality. METHODS In a single center retrospective study, CVC patients between JAN2015-JUN2021 were included. Data on duration of CVC use, complications and comorbidities was collected. Estimated 6-month mortality was compared to actual death rate. RESULTS About 478 CVCs were analyzed. Initiation of dialysis was the main reason for CVC implantation. Death was predominant for termination of CVC use. Infections were rare (0.6/1000 catheter days), complications were associated with certain comorbidities. Actual 6-month mortality was lower than predicted (14.3% vs 19.6%). CONCLUSION (1) CVCs are predominantly implanted for initiation of hemodialysis; (2) serious complications are rare; (3) complications are associated with certain comorbidities; and (4) CVC patients survive longer than predicted.
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Affiliation(s)
- Anna Buckenmayer
- Department of Internal Medicine, Nephrology & Intensive Care Medicine, Phillips University, Marburg, Germany
| | - Bianca Möller
- Department of Internal Medicine, Nephrology & Intensive Care Medicine, Phillips University, Marburg, Germany
| | - Claudia Ostermaier
- Department of Internal Medicine, Nephrology & Intensive Care Medicine, Phillips University, Marburg, Germany
| | - Joachim Hoyer
- Department of Internal Medicine, Nephrology & Intensive Care Medicine, Phillips University, Marburg, Germany
| | - Christian S Haas
- Department of Internal Medicine, Nephrology & Intensive Care Medicine, Phillips University, Marburg, Germany
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5
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Seidel D, Simon M, Sprute R, Lubnow M, Evert K, Speer C, Seeßle J, Khatamzas E, Merle U, Behrens C, Blau IW, Enghard P, Haas CS, Steinmann J, Kurzai O, Cornely OA. Results from a national survey on COVID-19-associated mucormycosis in Germany: 13 patients from six tertiary hospitals. Mycoses 2021; 65:103-109. [PMID: 34655486 PMCID: PMC8662289 DOI: 10.1111/myc.13379] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Most COVID-19-associated mucormycosis (CAM) cases are reported from India and neighbouring countries. Anecdotally cases from Europe have been presented. OBJECTIVE To estimate the disease burden and describe the clinical presentation of CAM in Germany. METHODS We identified cases through German mycology networks and scientific societies, and collected anonymised clinical information via FungiScope®. RESULTS We identified 13 CAM cases from six tertiary referral hospitals diagnosed between March 2020 and June 2021. Twelve patients had severe or critical COVID-19, eleven were mechanically ventilated for a median of 8 days (range 1-27 days) before diagnosis of CAM. Eleven patients received systemic corticosteroids. Additional underlying medical conditions were reported for all but one patient, five were immunocompromised because of malignancy or organ transplantation, three were diabetic. Eleven patients developed pneumonia. Mortality was 53.8% with a median time from diagnosis of mucormycosis to death of 9 days (range 0-214 days) despite treatment with liposomal amphotericin B and/or isavuconazole in 10 of 13 cases. CAM prevalence amongst hospitalised COVID-19 patients overall (0.67% and 0.58% in two centres) and those admitted to the intensive care unit (ICU) (1.47%, 1.78% and 0.15% in three centres) was significantly higher compared to non-COVID-19 patients (P < .001 for respective comparisons). CONCLUSION COVID-19-associated mucormycosis is rare in Germany, mostly reported in patients with comorbidities and impaired immune system and severe COVID-19 treated in the ICU with high mortality compared to mainly rhino-orbito-cerebral CAM in patients with mild COVID-19 in India. Risk for CAM is higher in hospitalised COVID-19 patients than in other patients.
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Affiliation(s)
- Danila Seidel
- Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Michaela Simon
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Rosanne Sprute
- Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Matthias Lubnow
- Department of Anesthesiology and Intensive Care, University Hospital Regensburg, Regensburg, Germany
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Claudius Speer
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Jessica Seeßle
- Department of Gastroenterology and Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Elham Khatamzas
- Centre for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Uta Merle
- Department of Gastroenterology and Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher Behrens
- Department Medizinische Mikrobiologie und Technische Hygiene, Medizet, Städtisches Klinikum München GmbH, Munich, Germany
| | - Igor Wolfgang Blau
- Department of Hematology, Oncology and Cancer Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - Philipp Enghard
- Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany
| | - Christian S Haas
- Department of Internal Medicine, Nephrology and Intensive Care Medicine, University of Marburg, Marburg, Germany
| | - Joerg Steinmann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany.,Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | - Oliver Kurzai
- National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knoell Institute, Jena, Germany.,Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany
| | - Oliver A Cornely
- Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, Germany
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6
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Dahmen L, Wolf R, Haas CS. Tongue Ulcer and Hemorrhagic Paronychia as Presenting Manifestations of Granulomatosis with Polyangiitis. Dtsch Arztebl Int 2021; 118:65. [PMID: 33785118 DOI: 10.3238/arztebl.m2021.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Schönermarck U, Ries W, Schröppel B, Pape L, Dunaj-Kazmierowska M, Burst V, Mitzner S, Basara N, Starck M, Schmidbauer D, Mellmann A, Dittmer R, Jeglitsch M, Haas CS. Relative incidence of thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome in clinically suspected cases of thrombotic microangiopathy. Clin Kidney J 2019; 13:208-216. [PMID: 32296526 PMCID: PMC7147316 DOI: 10.1093/ckj/sfz066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 04/29/2019] [Indexed: 12/27/2022] Open
Abstract
Background Data are lacking on the relative incidence of thrombotic thrombocytopenic purpura (TTP), haemolytic uraemic syndrome (HUS) caused by Shiga toxin–producing Escherichia coli (STEC) and atypical HUS (aHUS) in patients presenting with thrombotic microangiopathies (TMAs). Methods This was a prospective, cross-sectional, multicentre and non-interventional epidemiological study. Patients fulfilling criteria for TMAs (platelet consumption, microangiopathic haemolytic anaemia and organ dysfunction) were included in the study. The primary objective was to assess the relative incidence of TTP, STEC-HUS, aHUS and ‘other’ physician-defined diagnoses. The secondary objective was to develop an algorithm to predict a severe deficiency in ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity (≤10%) using routine laboratory parameters. A post hoc classification using the recent Kidney Disease: Improving Global Outcomes diagnostic criteria was then undertaken to further classify patient groups. Results aHUS was diagnosed with a relative incidence of 61%, whereas TTP, STEC-HUS and ‘other’ were diagnosed in 13, 6 and 20% of patients, respectively. In the post hoc analysis, 27% of patients with a TMA were classified as ‘primary aHUS’ and 53% as ‘secondary aHUS’. Multivariate analysis revealed that severe deficiency in ADAMTS13 activity (≤10%) was unlikely to underlie TMA if platelet and serum creatinine were above threshold values of 30 × 109/L and 1.8 mg/dL, respectively (negative predictive value of 92.3 and 98.1, respectively, if one or both values were above the threshold). Conclusions In this study, aHUS was the most common single diagnosis among patients presenting with a TMA. In the absence of an ADAMTS13 activity result, platelet count and serum creatinine may aid in the differential diagnosis.
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Affiliation(s)
- Ulf Schönermarck
- Medizinische Klinik IV, Klinikum der Universität, LMU, Munich, Germany
| | - Wolfgang Ries
- Internal Medicine, Diakonissenkrankenhaus, Flensburg, Germany
| | - Bernd Schröppel
- Medical Clinic I, Section of Nephrology, University of Ulm, Ulm, Germany
| | - Lars Pape
- Pediatric Nephrology, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Volker Burst
- Department II of Internal Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.,Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Steffen Mitzner
- Division of Nephrology, Rostock University Medical Centre, Rostock, Germany.,Fraunhofer IZI Project Group 'Extracorporeal Immunomodulation', Rostock, Germany
| | - Nadezda Basara
- Medizinische Klinik I, St. Franziskus-Hospital, Flensburg, Germany
| | - Michael Starck
- Clinic for Hematology, Clinic Munich-Schwabing, Munich, Germany
| | | | | | | | | | - Christian S Haas
- Internal Medicine, Nephrology and Intensive Care Medicine, Phillips University of Marburg, Marburg, Germany
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8
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Sun L, Pan X, Wada J, Haas CS, Wuthrich RP, Danesh FR, Chugh SS, Kanwar YS. Withdrawal: Isolation and functional analysis of mouse UbA52 gene and its relevance to diabetic nephropathy. J Biol Chem 2019; 294:10382. [DOI: 10.1074/jbc.w119.009588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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9
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Müller RU, Haas CS, Sayer JA. Practical approaches to the management of autosomal dominant polycystic kidney disease patients in the era of tolvaptan. Clin Kidney J 2018; 11:62-69. [PMID: 29423204 PMCID: PMC5798152 DOI: 10.1093/ckj/sfx071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/07/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease worldwide. The renal phenotype is characterized by progressive cystic enlargement of the kidneys leading to a decline in renal function, hypertension and often end-stage renal disease (ESRD). Supportive care with blood pressure control and management of pain, urinary infections and renal stone disease has, until recently, been the mainstay of treatment. With the recent approval of tolvaptan for use in ADPKD, the disease progression may now be targeted specifically. Algorithms that guide treatment initiation have been proposed but a more pragmatic and patient-individualized approach is often needed to make decisions regarding therapy. It is highly important to identify ADPKD patients with rapidly progressive disease who are likely to benefit most from this treatment and avoid treatment in patients that are unlikely to reach ESRD. METHODS AND RESULTS Here we present a series of cases of ADPKD patients in whom therapy with tolvaptan has been considered and report the rationale for the treatment decisions based on available lifestyle, clinical, biochemical, radiological and genetic data. CONCLUSIONS These cases provide a discussion for the use of tolvaptan in ADPKD within the nephrology clinic and allow insights into the practicalities of using this therapy outside of clinical trials.
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Affiliation(s)
- Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | | | - John A Sayer
- Newcastle University, Institute of Genetic Medicine, Newcastle-upon-Tyne, UK
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10
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Ferreira CER, Haas CS, Goularte KL, Rovani MT, Cardoso FF, Schneider A, Gasperin BG, Lucia T. Expression of paraoxonase types 1, 2 and 3 in reproductive tissues and activity of paraoxonase type 1 in the serum and seminal plasma of bulls. Andrologia 2017; 50. [PMID: 29143963 DOI: 10.1111/and.12923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 11/28/2022] Open
Abstract
The paraoxonases types 1, 2 and 3 (PON1, PON2 and PON3, respectively) are enzymes that degrade lipid peroxides, preventing oxidative damages relevant for male reproductive function. This study determined the expression of those three paraoxonases in reproductive tissues of bulls and evaluated correlations among the activity of PON1 in the serum and seminal plasma with breeding soundness parameters in bulls. The expression of PON1, PON2 and PON3 was characterised by RT-PCR in samples of testicular parenchyma, vesicular glands and epididymis collected from three slaughtered bulls. All three paraoxonases were expressed in the testicular parenchyma, PON2 and PON3 were both expressed in the epididymis head and PON3 was also expressed in the epididymis tail. The PON1 activity was determined in samples of serum and seminal plasma from 110 bulls submitted to breeding soundness evaluation. There was a strong correlation (r = .90) between the activity of the PON1 in both serum and seminal plasma (p < .0001). The PON1 activity in the seminal plasma was positively correlated with ejaculate's colour, sperm mass activity (p = .04), motility, vigour and viability (all p < .01). Thus, PON1 may be a potential marker for sperm motility and viability in bulls.
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Affiliation(s)
- C E R Ferreira
- ReproPEl, Universidade Federal de Pelotas, Pelotas-RS, Brazil.,Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas-RS, Brazil
| | - C S Haas
- ReproPEl, Universidade Federal de Pelotas, Pelotas-RS, Brazil.,Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas-RS, Brazil
| | - K L Goularte
- ReproPEl, Universidade Federal de Pelotas, Pelotas-RS, Brazil.,Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas-RS, Brazil
| | - M T Rovani
- Faculdade de Nutrição, Universidade Federal de Pelotas, Pelotas-RS, Brazil
| | | | - A Schneider
- Faculdade de Nutrição, Universidade Federal de Pelotas, Pelotas-RS, Brazil
| | - B G Gasperin
- ReproPEl, Universidade Federal de Pelotas, Pelotas-RS, Brazil.,Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas-RS, Brazil
| | - T Lucia
- ReproPEl, Universidade Federal de Pelotas, Pelotas-RS, Brazil.,Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas-RS, Brazil
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11
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Kampmeyer D, Lehnert H, Moenig H, Haas CS, Harbeck B. Experience pays off! Endocrine centres are essential in the care of patients with adrenal insufficiency. Eur J Intern Med 2016; 35:e27-e28. [PMID: 27444736 DOI: 10.1016/j.ejim.2016.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - Hendrik Lehnert
- Department of Medicine I, University of Luebeck, Luebeck, Germany
| | - Heiner Moenig
- Department of Medicine I, Christian-Albrechts-University, Kiel, Germany
| | - Christian S Haas
- Department of Medicine I, University of Luebeck, Luebeck, Germany
| | - Birgit Harbeck
- Department of Medicine I, University of Luebeck, Luebeck, Germany.
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Abstract
Hydrocortisone replacement therapy is a cornerstone in the treatment of adrenal insufficiency (AI). While urinary cortisol has been used as a diagnostic tool for AI, it remains unclear whether it is a useful parameter to monitor hydrocortisone replacement therapy. Aim of this study was to evaluate possible differences in cortisol metabolism between adrenal insufficient patients and healthy subjects and to assess the value of urinary cortisol in AI management. In a case-control study, urinary cortisol excretion was determined in 14 patients with primary and secondary AI receiving hydrocortisone infusions from midnight to 8:00 AM. Results were correlated with serum cortisol levels and compared to urinary values obtained from 53 healthy volunteers. Urinary cortisol excretion in healthy subjects was 14.0±7.8 μg/8 h (range: 0.24-35.4), levels did not differ between 3 groups aged 20-34 years, 35-49 years, and ≥50 years. Patients with AI receiving hydrocortisone infusions demonstrated significantly higher rates of urinary cortisol excretion (51.6±37.8 μg/8 h; range 17.1-120.0, p<0.001); the values correlated with serum cortisol levels (r(2)=0.98). Of interest, patients with secondary AI showed significantly higher serum cortisol levels after hydrocortisone infusion than those with primary AI, conceivably due to residual adrenal function. In conclusion, we showed that: (i) there is a wide inter-individual variability in urinary cortisol excretion rates; (ii) cortisol metabolism in adrenal insufficient patients differs when compared to controls; (iii) there is a strong correlation between urinary and serum cortisol levels; and (iv) urinary cortisol levels despite their variability may help to discriminate between secondary and primary adrenal insufficiency.
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Affiliation(s)
- C S Haas
- Department of Medicine I, University of Luebeck, Luebeck, Germany
| | - A-H Rahvar
- Department of Medicine I, University of Luebeck, Luebeck, Germany
| | - S Danneberg
- Department of Medicine I, University of Luebeck, Luebeck, Germany
| | - H Lehnert
- Department of Medicine I, University of Luebeck, Luebeck, Germany
| | - H Moenig
- Department of Medicine I, University of Kiel, Kiel, Germany
| | - B Harbeck
- Department of Medicine I, University of Luebeck, Luebeck, Germany
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Kampmeyer D, Lehnert H, Moenig H, Haas CS, Harbeck B. A strong need for improving the education of physicians on glucocorticoid replacement treatment in adrenal insufficiency: An interdisciplinary and multicentre evaluation. Eur J Intern Med 2016; 33:e13-5. [PMID: 27108240 DOI: 10.1016/j.ejim.2016.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/11/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | - Hendrik Lehnert
- Department of Medicine I, University of Luebeck, Luebeck, Germany
| | - Heiner Moenig
- Department of Medicine I, Christian-Albrechts-University, Kiel, Germany
| | - Christian S Haas
- Department of Medicine I, University of Luebeck, Luebeck, Germany
| | - Birgit Harbeck
- Department of Medicine I, University of Luebeck, Luebeck, Germany.
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Harbeck B, Lindner U, Haas CS. Low-dose tolvaptan for the treatment of hyponatremia in the syndrome of inappropriate ADH secretion (SIADH). Endocrine 2016; 53:872-3. [PMID: 26961548 DOI: 10.1007/s12020-016-0912-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Birgit Harbeck
- Department of Medicine I, University of Luebeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ulrich Lindner
- Department of Medicine I, University of Luebeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christian S Haas
- Department of Medicine I, University of Luebeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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15
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Harbeck B, Haas CS, Suefke S, Kropp P, Moenig H. Headache and Depression in Patients with Hypothalamic-pituitary Disorders-etiology and Risk Factors. Exp Clin Endocrinol Diabetes 2015; 123:571-4. [PMID: 26465705 DOI: 10.1055/s-0035-1559630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Headache and depression are common problems in patients with hypothalamic-pituitary disorders (HPD). AIM To determine the prevalence of headache and depression in patients with HPD and the specific characteristics in affected individuals in comparison to patients with cardiovascular problems (CD). METHODS Patients with HPD and CD were asked to complete a questionnaire regarding headache and depression. RESULTS There were no significant differences between the HPD and the CD group. Prevalence of headache was not associated with the treatment modality of pituitary disease, hormone excess syndromes or any hormonal replacement therapy. However, ACTH, TSH and GH deficiency were associated with less headache when compared to patients with adequate secretion. Interestingly, patients who had prior surgery suffered significantly more often from depression. In addition, headache and depression were significantly more common in patients with microadenomas than in macroadenomas. DISCUSSION The risk for headache and depression is mainly influenced by a combination of factors, but a specific pituitary hormone deficiency may decrease risk for headache.
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Affiliation(s)
- B Harbeck
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - C S Haas
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - S Suefke
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - P Kropp
- Institute of Medical Psychology and Medical Sociology, University of Rostock, Germany
| | - H Moenig
- Department of Medicine I, Christian-Albrechts-University, Kiel, Germany
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Berndt M, Harbeck B, Lindner U, Pauli D, Haas CS. Hyponatremia Due to Thyrotropin Deficiency: A Fairy Tale? Mayo Clin Proc 2015; 90:1305-7. [PMID: 26355406 DOI: 10.1016/j.mayocp.2015.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/15/2015] [Accepted: 05/29/2015] [Indexed: 11/18/2022]
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Abstract
OBJECTIVES Irregular sleep patterns can adversely affect physiological functions and have been associated with increased physiological and psychological stress. Nocturnal work of physicians during 24-hour on-call shifts (OCS) disrupts the sleep/wake cycle. Chronic exposure to distress has been shown to affect cardiovascular homeostasis and to impair performance in neurocognitive and simulated clinical tasks. METHODS In a prospective cohort study, biochemical and physiological stress parameters were assessed in 11 female and 9 male physicians (median age: 32 years, range 26-42 years) before a normal working day and after a 24-hour OCS in internal medicine. In addition, various tests of attentional performance (TAP) were conducted. RESULTS The levels of thyroid stimulating hormone (TSH) were significantly higher after a 24- hour OCS, while there were no significant changes in cortisol, epinephrine, and norepinephrine levels. Heart rate variability and skin resistance increased following an OCS, although the differences were not statistically significant. Intrinsic alertness was comparable, while phasic alertness was significantly improved following a 24-hour OCS. Focused attention tended to be better following a night shift. There was no correlation with age or medical working experience; however, men experienced more stress than women. CONCLUSIONS Following a 24-hour OCS, (i) TSH may be an early and sensitive biochemical predictor of stress; (ii) other classical biochemical stress parameters do not depict the psychological stress perceived by physicians; (iii) there may be a mismatch between experienced and objective stress levels; (iv) neurocognitive functions are not impaired, while performance may even be improved; and (v) men might be more sensitive to distress.
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Harbeck B, Haas CS, Suefke S, Moenig H. Cardiovascular risk factors and disease in patients with hypothalamic-pituitary disorders. Int J Cardiol 2015; 184:464-465. [PMID: 25756565 DOI: 10.1016/j.ijcard.2015.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/01/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Birgit Harbeck
- Department of Internal Medicine I, University of Luebeck, Luebeck, Germany.
| | - Christian S Haas
- Department of Internal Medicine I, University of Luebeck, Luebeck, Germany
| | - Sven Suefke
- Department of Internal Medicine I, University of Luebeck, Luebeck, Germany
| | - Heiner Moenig
- Department of Medicine I, Christian-Albrechts-University, Kiel, Germany
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19
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Harbeck B, Haas CS, Mönig H. Effect of hydrocortisone replacement therapy on body mass index after pituitary surgery. J Endocrinol Invest 2015; 38:183-4. [PMID: 25430997 DOI: 10.1007/s40618-014-0218-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Affiliation(s)
- B Harbeck
- Department of Medicine I, University of Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany.
| | - C S Haas
- Department of Medicine I, University of Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany
| | - H Mönig
- Department of Medicine I, University of Kiel, Kiel, Germany
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20
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Schröder T, Hubold C, Muck P, Lehnert H, Haas CS. A hypertensive emergency with acute visual impairment due to excessive liquorice consumption. Neth J Med 2015; 73:82-85. [PMID: 25753073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hypokalaemic hypertension is the classical presentation of primary hyperaldosteronism but may also result from other mineralocorticoid activity, such as liquorice ingestion. Onset of hypertension as well as serum renin and aldosterone levels are central for the diagnosis. Liquorice ingestion has been reported to induce hypertension, hypokalaemia and metabolic alkalosis due to inhibition of the enzyme 11-β-hydroxy steroiddehydrogenase 2. Here, we report the case of a hypertensive emergency with acute visual impairment due to hypertensive retinopathy in clear conjunction with a considerable consumption of liquorice.
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Affiliation(s)
- T Schröder
- Department of Medicine I, Campus Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
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21
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Harbeck B, Süfke S, Harten P, Haas CS, Lehnert H, Mönig H. High prevalence of fibromyalgia-associated symptoms in patients with hypothalamic-pituitary disorders. Clin Exp Rheumatol 2013; 31:S16-S21. [PMID: 23981240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/28/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Various complaints of patients with fibromyalgia often resemble clinical features observed in patients with hypothalamic-pituitary diseases. The aim of this study was to evaluate whether patients with hypothalamic-pituitary diseases are at increased risk for fibromyalgia syndrome (FMS). METHODS A questionnaire for evaluating fibromyalgia-associated symptoms was sent to 121 patients with hypothalamic-pituitary disorders (HPD) (60 women, 61 men; mean age, 55.4 years; range, 21-83 years) of the endocrine outpatient clinic. 115 patients (57 women, 58 men; mean age 56.9 years; range, 21 to 82 years) with cardiovascular diseases (CD) served as controls. RESULTS Fibromyalgia-associated symptoms regarding muscular complaints were significantly more frequent in the HPD group than in CD patients (53.7 % vs. 35.7%, p= 0.003). In particular, we found a significant higher prevalence of autonomic symptoms in the HPD group as compared to the CD group regarding several qualities (cold hands, p=0.039; flatulence, p=0.022; tiredness, p=0.017). In addition, swollen and painful finger joints were reported more often in the HPD group than in the CD group (p=0.002). Of note, no differences regarding any fibromyalgia-associated symptom were detected when patients with hypothalamic-pituitary hormone excess syndromes were compared to those with a pituitary pathology without hormonal excess. Similarly, prevalence of fibromyalgia-associated symptoms was not related to the treatment modality of pituitary disease; i.e. surgical vs. conservative or any hormonal replacement therapy. CONCLUSIONS Our data suggest that patients with hypothalamic-pituitary disorders may be at increased risk of developing fibromyalgia-associated symptoms.
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Affiliation(s)
- Birgit Harbeck
- Department of Medicine I, University of Lübeck, Lübeck, Germany.
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Isozaki T, Arbab AS, Haas CS, Amin MA, Arendt MD, Koch AE, Ruth JH. Evidence that CXCL16 is a potent mediator of angiogenesis and is involved in endothelial progenitor cell chemotaxis : studies in mice with K/BxN serum-induced arthritis. ACTA ACUST UNITED AC 2013; 65:1736-46. [PMID: 23633118 DOI: 10.1002/art.37981] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 04/11/2013] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To examine the possibility that CXCL16 recruits endothelial cells (ECs) to developing neovasculature in rheumatoid arthritis (RA) synovium. METHODS We utilized the RA synovial tissue SCID mouse chimera system to examine human microvascular EC (HMVEC) and human endothelial progenitor cell (EPC) recruitment into engrafted human synovium that was injected intragraft with CXCL16-immunodepleted RA synovial fluid (SF). CXCR6-deficient and wild-type (WT) C57BL/6 mice were primed to develop K/BxN serum-induced arthritis and evaluated for angiogenesis. HMVECs and EPCs from human cord blood were also examined for CXCR6 expression, by immunofluorescence and assessment of CXCL16 signaling activity. RESULTS CXCR6 was prominently expressed on human EPCs and HMVECs, and its expression on HMVECs could be up-regulated by interleukin-1β. SCID mice injected with CXCL16-depleted RA SF exhibited a significant reduction in EPC recruitment. In experiments using the K/BxN serum-induced inflammatory arthritis model, CXCR6(-/-) mice showed profound reductions in hemoglobin levels, which correlated with reductions in monocyte and T cell recruitment to arthritic joint tissue compared to that observed in WT mice. Additionally, HMVECs and EPCs responded to CXCL16 stimulation, but exhibited unique signal transduction pathways and homing properties. CONCLUSION These results indicate that CXCL16 and its receptor CXCR6 may be a central ligand/receptor pair that is closely associated with EPC recruitment and blood vessel formation in the RA joint.
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Affiliation(s)
- Takeo Isozaki
- University of Michigan Medical School, Ann Arbor, MI, USA
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23
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Haas CS, Pohlenz I, Lindner U, Muck PM, Arand J, Suefke S, Lehnert H. Renal tubular acidosis type IV in hyperkalaemic patients--a fairy tale or reality? Clin Endocrinol (Oxf) 2013; 78:706-11. [PMID: 22891694 DOI: 10.1111/j.1365-2265.2012.04446.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 02/15/2012] [Accepted: 04/21/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Hyperkalaemia is a common feature in hospitalized patients and often attributed to drugs antagonizing the renin-angiotensin-aldosterone system (RAAS) and/or acute kidney injury (AKI), despite significantly preserved glomerular filtration rate (GFR). The objective of this study was to determine the prevalence and role of renal tubular acidosis type IV (RTA IV) in the development of significant hyperkalaemia. DESIGN A single-centre retrospective study. PATIENTS Patients admitted to a University Hospital over 12 months. MEASUREMENTS Patients with a potassium value > 6·0 mm were identified. Clinical and laboratory data were revisited, and patients with a normal anion gap metabolic acidosis were evaluated for the existence of RTA IV. RESULTS A total of 57 patients having significant hyperkalaemia (>6·0 mm) were identified. Twelve patients had end-stage renal disease, while 21 patients had solely AKI or progressive chronic renal failure. RTA IV was present in 24 patients (42%), of whom 71% had pre-existing renal insufficiency because of diabetic nephropathy or tubulointerstitial nephritis. All hyperkalaemic patients with urinary/serum electrolytes suggestive of RTA IV had evidence of AKI, but creatinine levels were significantly lower (P < 0·05), while the number of drugs antagonizing the RAAS was comparable. CONCLUSION We demonstrated that RTA IV (i) is very common in patients with hyperkalaemia; (ii) should always be suspected in hyperkalaemic patients with only moderately impaired GFR; and (iii) may result in significant hyperkalaemia in the presence of both AKI and drugs antagonizing the RAAS.
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Affiliation(s)
- Christian S Haas
- Department of Medicine I, University of Luebeck, Ratzeburger Allee 160, Luebeck, Germany.
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24
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Grajecki DS, Haas CS, Hubold C, Lehnert H. Sucessfull treatment of EBV-associated SIADH with V2 receptor antagonist. Exp Clin Endocrinol Diabetes 2013. [DOI: 10.1055/s-0033-1336746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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Haas CS, Lehne W, Muck P, Boehm A, Rupp J, Steinhoff J, Lehnert H. Acute kidney injury and thrombocytopenic fever--consider the infrequent causes. Am J Emerg Med 2013; 31:441.e5-9. [PMID: 23407036 DOI: 10.1016/j.ajem.2012.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/04/2012] [Indexed: 11/19/2022] Open
Affiliation(s)
- Christian S Haas
- Department of Medicine I, University of Luebeck, 23538 Luebeck, Germany.
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26
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Harbeck B, Joost A, Lehne W, Böhm A, Süfke S, Werth S, Lehnert H, Haas CS. A hypertensive patient presenting with paraneoplastic perimyocarditis and myositis due to pheochromocytoma. Int J Cardiol 2012; 160:e23-4. [DOI: 10.1016/j.ijcard.2012.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 01/10/2012] [Indexed: 10/14/2022]
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Haap MM, Gatidis S, Horger M, Riessen R, Lehnert H, Haas CS. Computed tomography angiography in patients with suspected pulmonary embolism—too often considered? Am J Emerg Med 2012; 30:325-30. [DOI: 10.1016/j.ajem.2010.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 12/07/2010] [Accepted: 12/08/2010] [Indexed: 11/29/2022] Open
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Amann K, Haas CS, Schüssler J, Daniel C, Hartner A, Schöcklmann HO. Beneficial effects of integrin αvβ3-blocking RGD peptides in early but not late phase of experimental glomerulonephritis. Nephrol Dial Transplant 2011; 27:1755-68. [PMID: 22049183 DOI: 10.1093/ndt/gfr603] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Integrin αvβ3 plays an important role in the regulation of cell proliferation and neoangiogenesis. We found mesangial de novo expression of integrin αvβ3 in mesangioproliferative glomerulonephritis (MesGN). The aim of the study was to clarify if blockade of αvβ3 integrin with the specific αvβ3-blocking cyclic peptide RGDdFV (cRGD) has beneficial effects on the course of this disease. METHODS Habu snake venom (Habu) GN was induced in male C57BL/6 mice 1 week after uninephrectomy (6 mg Habu toxin/kg body weight intravenously). After 24 h, nephritic animals received αvβ3-inhibitory cRGD or cRAD control peptides for 3 or 7 days, respectively. The kidneys were investigated using morphometry, immunohistochemistry and TaqMan polymerase chain reaction. RESULTS At Day 3, serum creatinine and albuminuria were lower after cRGD compared to cRAD treatment. At Day 3, glomerulosclerosis index, percentage of glomerular injury, mesangial cell (MC) number and volume density of mesangial matrix were significantly lower (P < 0.05) in cRGD-treated mice than in cRAD-treated controls. At Day 7, only a mild effect of cRGD on mesangial matrix expansion and fibronectin messenger RNA was still detectable (P < 0.05). Complementary in vitro studies in MCs revealed that inhibition of αvβ3 by cRGD-blocked adhesion, reduced proliferation and increased apoptosis of MCs. CONCLUSION Habu GN inhibition of integrin αvβ3 by cRGD partly ameliorates early injury but has no or only mild effects on late glomerular lesions.
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Affiliation(s)
- Kerstin Amann
- Department of Pathology, University of Erlangen-Nürnberg, Erlangen, Germany
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29
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Haap M, Haas CS. Acute Leriche syndrome following percutaneous transluminal angioplasty. J Cardiovasc Med (Hagerstown) 2011; 12:524-6. [PMID: 21415763 DOI: 10.2459/jcm.0b013e3283451f3d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Michael Haap
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology and Vascular Medicine, University Hospital Tuebingen, Tuebingen, Germany
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30
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Lindner U, Paetzel M, Haas CS. An unusual cause of dyspnea in a patient with prior mitral valve annuloplasty and congestive heart failure. J Thorac Cardiovasc Surg 2011; 141:1313-4. [PMID: 21281944 DOI: 10.1016/j.jtcvs.2010.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 12/04/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Ulrich Lindner
- Department of Medicine I, University of Luebeck, Luebeck, Germany
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31
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Letterer S, Lindner U, Bernd HW, Vogt FM, Helmchen U, Lehnert H, Haas CS. Progressive renal insufficiency, hypercalcaemia, bicytopaenia and a history of breast cancer. NDT Plus 2011; 4:28-31. [PMID: 25984096 PMCID: PMC4421631 DOI: 10.1093/ndtplus/sfq184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 09/27/2010] [Accepted: 10/01/2010] [Indexed: 11/12/2022] Open
Abstract
Sarcoidosis can affect all organs and may mimic a variety of other diseases. In the absence of typical pulmonary features, extrapulmonary manifestations may be difficult to diagnose. We describe here the very uncommon case of a patient with mild pulmonal involvement but distinct renal, bone marrow and lymph node sarcoidosis. Treatment with glucocorticoids significantly improved kidney function and normalized serum calcium levels as well as the blood count. This case underscores the importance of sarcoidosis to be considered as a differential diagnosis of renal failure associated with hypercalcaemia and nephrocalcinosis. Bone marrow involvement should always be suspected if mono-, bi- or pancytopaenia coexist.
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Affiliation(s)
- Sebastian Letterer
- Department of Medicine I and Nuclear Medicine , University of Luebeck , Luebeck , Germany
| | - Ulrich Lindner
- Department of Medicine I and Nuclear Medicine , University of Luebeck , Luebeck , Germany
| | - Heinz-Wolfram Bernd
- Department of Pathology and Nuclear Medicine , University of Luebeck , Luebeck , Germany
| | - Florian M Vogt
- Clinic for Radiology and Nuclear Medicine , University of Luebeck , Luebeck , Germany
| | - Udo Helmchen
- Kidney Registry, Institute of Pathology , University Hospital Hamburg-Eppendorf , Germany
| | - Hendrik Lehnert
- Department of Medicine I and Nuclear Medicine , University of Luebeck , Luebeck , Germany
| | - Christian S Haas
- Department of Medicine I and Nuclear Medicine , University of Luebeck , Luebeck , Germany
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32
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Busch MC, Haap M, Kristen A, Haas CS. Asymptomatic Sustained Ventricular Fibrillation in a Patient With Left Ventricular Assist Device. Ann Emerg Med 2011; 57:25-8. [DOI: 10.1016/j.annemergmed.2010.05.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 05/11/2010] [Accepted: 05/18/2010] [Indexed: 11/26/2022]
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33
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Muck PM, Steinhoff J, Lehnert H, Haas CS. [Resistant hypertension despite nine different antihypertensive drugs?]. Med Klin (Munich) 2010; 105:943-947. [PMID: 21240595 DOI: 10.1007/s00063-010-1161-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 09/20/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Treatment-resistant hypertension is a common problem in an outpatient setting and often results in hospital admission. Non-identified secondary hypertension, hypertensive nephrosclerosis and non-compliance are major reasons for treatment resistance. CASE REPORT A 75-year old woman was admitted to the emergency room because of a hypertensive crisis with alleged treatment-resistant hypertension and progressive headache. Two months ago, renal artery stenosis had been ruled out and a diagnosis of hypertensive cardiomyopathy was established. On admission, the patient had a blood pressure of 210/100 mmHg despite an antihypertensive treatment with nine different drugs. Further investigations ruled out secondary hypertension due to an endocrine cause but were consistent with hypertensive nephrosclerosis. With a supervised drug intake the blood pressure was rather normal to hypotensive, resulting in the need for significant reduction of the antihypertensive medication. The apparent discrepancies were discussed in detail with the patient who finally admitted a previous inconsistent intake of the antihypertensive drugs. Following thorough training and education on the purpose of continued antihypertensive therapy, the patient could be discharged with a normotensive blood pressure profile. CONCLUSIONS Therapy of treatment-resistant hypertension should always consider non-compliance and secondary hypertension as possible reason.
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Affiliation(s)
- Philip M Muck
- Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Lübeck, Germany
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Abstract
Thrombocytopenia, fever, and acute renal failure are characteristic features of nephropathia epidemica, the predominant hantavirus infection in Europe. However, clinical presentation and blood cell counts may point to other disorders, such as a hematologic disease, particularly when impairment of renal function is not evident. This differential diagnosis often results in further extensive and unnecessary testing. We describe 3 patients with hantavirus infection with no renal failure, in whom a hematologic disorder was initially suspected. Serologic testing of hantavirus finally unraveled the mystery, and outcome of the patients was excellent. It is conceivable that similar cases often remain undiagnosed. Thus, testing for hantavirus should always be considered in cases of thrombocytopenia and fever of unknown origin, especially in areas endemic for the infection.
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Affiliation(s)
| | | | | | | | | | - Christian S. Haas
- Individual reprints of this article are not available. Address correspondence to Christian S. Haas, MD, University Hospital Schleswig-Holstein, Campus Luebeck, Department of Medicine I, Ratzeburger Allee 160, 23538 Luebeck, Germany ()
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Haap M, Haas CS, Teichmann R, Horger M, Raible A, Lamprecht G. Mystery or misery? Primary group A streptococcal peritonitis in women: case report. Am J Crit Care 2010; 19:454-8. [PMID: 19635804 DOI: 10.4037/ajcc2009615] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Acute primary peritonitis in the absence of other comorbid conditions such as liver cirrhosis, immunosuppression, or nephrotic syndrome is a rare disorder in young adults. In women, ascending genital infections are thought to be a major pathogenic cause of this type of peritonitis. Pus was detected in the peritoneal cavity by abdominal paracentesis in a 27-year-old woman who had no predisposing features for severe peritonitis. Abdominal computed tomography showed perirectal edema. Laparotomy was performed, but no intra-abdominal focus of infection could be detected. The abdomen was irrigated via a subhepatic and retroperitoneal presacral approach, and broad-spectrum antibiotic therapy was started. Blood cultures revealed group A streptococci, usually a common cause of upper respiratory tract infections or erysipelas. Within a few days, the patient recovered completely and returned to normal life.
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Affiliation(s)
- Michael Haap
- Department of Endocrinology, Metabolism, Nephrology, Clinical Chemistry, and Vascular Medicine, Eberhard-Karls-University, Tübingen, Germany
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Amin MA, Rabquer BJ, Mansfield PJ, Ruth JH, Marotte H, Haas CS, Reamer EN, Koch AE. Interleukin 18 induces angiogenesis in vitro and in vivo via Src and Jnk kinases. Ann Rheum Dis 2010; 69:2204-12. [PMID: 20679476 DOI: 10.1136/ard.2009.127241] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Interleukin 18 (IL-18) is a novel mediator of angiogenesis in rheumatoid arthritis (RA). OBJECTIVE To examine the role of IL-18 in RA angiogenesis and the signalling mechanisms involved. METHODS Human dermal microvascular endothelial cell (HMVEC) chemotaxis, capillary morphogenesis assays and Matrigel plug angiogenesis assays were performed in vivo using IL-18 with or without signalling inhibitors. A novel model of angiogenesis was devised using dye-tagged HMVECs to study their homing into RA and normal (NL) synovial tissues (STs) engrafted in severe combined immunodeficient (SCID) mice. RESULTS IL-18-mediated angiogenesis depended on Src and Jnk, as the inhibitors of Src and Jnk blocked IL-18-induced HMVEC chemotaxis, tube formation and angiogenesis in Matrigel plugs. However, inhibitors of Janus kinase 2, p38, MEK, phosphatidylinositol-3-kinase and neutralising antibodies to vascular endothelial growth factor or stromal derived factor-1α did not alter IL-18-induced HMVEC migration. These results were confirmed with Jnk or Src sense or antisense oligodeoxynucleotides. Moreover, IL-18 induced phosphorylation of Src and Jnk in HMVECs. As proof of principle, IL-18 null mice had a significantly decreased angiogenesis compared with wild-type mice in Matrigel plug angiogenesis assays in vivo. IL-18 markedly enhanced mature HMVEC homing to human RA ST compared with NL ST in SCID mice, confirming the role of IL-18-induced angiogenesis in RA ST in vivo. CONCLUSION Targeting IL-18 or its signalling intermediates may prove to be a potentially novel therapeutic strategy for angiogenesis-dependent diseases, such as RA.
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Affiliation(s)
- M Asif Amin
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
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Tschritter O, Maksimovic O, Haas CS. A sound investigation. Am J Med 2010; 123:520-1. [PMID: 20569757 DOI: 10.1016/j.amjmed.2010.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 01/22/2010] [Accepted: 01/22/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Otto Tschritter
- Division of Endocrinology, Diabetology, Nephrology, and Vascular Medicine, Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
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Haas CS, Haap M. A mediastinal mass. J Fam Pract 2010; 59:347-350. [PMID: 20544067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Affiliation(s)
- Ulrich Lindner
- Department of Medicine I, University of Luebeck, Germany
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Braun N, Haap M, Overkamp D, Kimmel M, Alscher MD, Lehnert H, Haas CS. Characterization and outcome following Puumala virus infection: a retrospective analysis of 75 cases. Nephrol Dial Transplant 2010; 25:2997-3003. [PMID: 20223893 DOI: 10.1093/ndt/gfq118] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infection with the Puumala virus (PUUV), which belongs to the Hantavirus family, is a common but often neglected cause of acute kidney injury (AKI) in endemic areas of Europe. The objective of the present study was to systematically analyse clinical presentation and renal outcomes following PUUV infection. METHODS In a retrospective study, we analysed data from 75 patients who were admitted to two large hospitals in Germany over an 8-year period and who tested positive for PUUV infection. Clinical and laboratory data were collected from patient files; creatinine levels before admission and during follow-up were obtained from phone calls. RESULTS Patients were between 16 and 82 years old (average +/- SD, 40.4 +/- 13.4) with a male to female ratio of 2.5:1. They showed a wide variety of clinical presentations with renal failure being the cause of admission in only 50%. AKI developed in 95% of patients who showed maximum creatinine levels of 4.3 +/- 0.3 mg/dl. Four patients required temporary dialysis, and one patient died from pulmonary complications. Thrombocytopaenia (137 +/- 11 x 10(3)/microl) was present in almost all cases, and elevated levels of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were observed in 57 and 100% of patients, respectively. Urinalysis revealed mild to nephrotic proteinuria in 85%, which was often associated with haemoglobinuria. All patients showed full recovery of renal function and return to pre-existing normal serum creatinine levels. CONCLUSION In a majority of cases, PUUV infection results in thrombocytopenic AKI. Fever is a requirement for diagnosis, while elevated LDH and CRP values are also frequently observed. Overall, early renal outcomes were excellent.
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Affiliation(s)
- Niko Braun
- Department of Internal Medicine IV, Division of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
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Nitschke M, Paetzel M, Haas CS. Unusual complication of percutaneous nephrostomy in a renal transplant recipient. NAJMS 2010; 2:537-9. [PMID: 22558562 PMCID: PMC3338217 DOI: 10.4297/najms.2010.2537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Context: Ureteral obstruction, resulting in impaired graft function, is a well-known problem following renal transplantation. Management of ureteral complications includes percutaneous nephrostomy, which is considered to be a safe and effective measure. Case Report: Here, we demonstrate a case of a 35-year old renal allograft recipient with primary graft function but stagnating serum creatinine following extraction of the double-J catheter. Ureteral stenosis was suspected by ultrasound imaging and magnetic resonance tomography, and urinary flow was preserved with a percutaneous nephrostomy. However, early displacement of the percutaneous nephrostomy catheter resulted in distinct clinical discomfort. CT imaging suggested an intra-abdominal position of the catheter's tip, requiring immediate surgical action. Conclusion: The present case demonstrates that performing PCN following renal transplantation may have unexpected risks.
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Affiliation(s)
| | | | - Christian S. Haas
- Department of Medicine I, University of Luebeck, Germany
- Correspondence to: Christian S. Haas, University Hospital Schleswig-Holstein – Campus Luebeck, Department of Medicine I, Ratzeburger Allee 160, 23538 Luebeck, Germany. Tel.: +49-4515005060, Fax: +49-4515005066,
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Bigalke B, Schwimmbeck PL, Haas CS, Lindemann S. Effect of interleukin-15 on the course of myocarditis in Coxsackievirus B3-infected BALB/c mice. Can J Cardiol 2009; 25:e248-54. [PMID: 19584981 DOI: 10.1016/s0828-282x(09)70511-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Cytokines have an important role in both the initiation and perpetuation of viral myocarditis. Because a causative therapy of myocarditis is not yet well established and immunomodulation is a promising approach, the influence of interleukin (IL)-15, a proinflammatory cytokine, on the course of experimental myocarditis in Coxsackievirus B3 (CVB3)-infected mice was examined. METHODS Hearts from CVB3-infected (n=14), sham-infected (n=14) and CVB3-infected BALB/c mice treated with IL-15 (n=6) or a competitive IL-15 fusion protein (n=6) were analyzed for hemodynamic function, cellular infiltrates and myocardial collagen content. RESULTS Induction of myocarditis was associated with significant loss of body and heart weight, decreased left ventricular function, and increased collagen content and cellular infiltrates in the myocardium. Treatment of infected animals with IL-15 resulted in normalization of body and heart weight, and significantly improved systolic and diastolic left ventricular function, comparable with that of uninfected animals. This was paralleled by a significant reduction of myocardial collagen content to levels observed in animals without disease and by markedly reduced cellular infiltration of lymphocytes and macrophages in the myocardium. Inhibition of intrinsic IL-15 with IL-15 fusion protein tended to aggravate the disease. CONCLUSIONS Treatment with IL-15 has a positive effect on CVB3- induced murine myocarditis and seems to be a promising approach to modifying clinical course, hemodynamics and histopathology of virus-induced myocarditis. Further studies are needed to identify the underlying mechanisms.
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Affiliation(s)
- Boris Bigalke
- Medizinische Klinik III, Klinik für Kardiologie und Kreislauferkrankungen, Eberhard Kearls Universität Tübingen, D-72076 Tübingen, Germany
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Haap M, Artunc F, Haas CS, Horger M, Teichmann R, Riessen R. [A rare differential diagnosis of acute abdominal pain--case 04/2009]. Dtsch Med Wochenschr 2009; 134:1473. [PMID: 19572247 DOI: 10.1055/s-0028-1082828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
HISTORY AND FINDINGS A 44-year-old woman was referred to the emergency department for acute paraumbilical abdominal pain with colics. 5 days previously, a tooth extraction had been performed and postoperatively ibuprofen had been prescribed for pain relief. The medical history was empty besides a penicillin allergy and two caesarean sections 20 and 21 years ago. INVESTIGATIONS The physical examination revealed paraumbilical pain on palpation. Abdominal ultrasound could identify some free fluid and an aperistaltic intestinal loop as well as an echo-rich structure in the hypogastric region. An abdominal CT scan showed a hypodense tubular structure of 6.5 x 3.3 cm indicating a possible ischaemic intestinal segment, and a dilated intestinal loop as well as an uterus myomatosis. Due to therapy refractory symptoms and increasing leucocytes on the second day after admission, a diagnostic laparoscopy was performed. DIAGNOSIS Intraoperatively, a volvulus of the ileum as well as an adhesive strangulation of the small intestine could be identified. TREATMENT AND COURSE Consecutively, surgery with an ileocoecal resection and a side-to-side ileotransversostomy was performed. Within a few days, the patient recovered completely and resumed normal activities of daily living. CONCLUSIONS In the evaluation of unclear acute abdominal pain, interdisciplinary cooperation is very important to ensure a fast and appropriate diagnosis and therapy as shown in our case.
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Affiliation(s)
- Michael Haap
- Medizinische Universitätsklinik Tübingen, Abteilung für Endokrinologie, Diabetes, Nephrologie, Angiologie und Klinische Chemie, Tübingen, Germany
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Haas CS, Overkamp D. [Rupture of an abdominal aortic aneurysm]. Dtsch Med Wochenschr 2009; 134 Suppl Falldatenbank:F1-32. [PMID: 19172556 DOI: 10.1055/s-0028-1082825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abdominal aortic aneurysms, i.e., enlargements of the abdominal aorta > 3 cm, are often the consequence of atherosclerotic vascular changes. Aneurysms of the abdominal aorta are often incidentally detected and asymptomatic. Expansion of the aneurysms are common and associated with an increased risk of rupture, resulting in a life-threatening situation. Here, we demonstrate the case of a 79-year old man being admitted to the hospital for presyncope and repeated hypotension. Before finishing the diagnostic tests, the patient's situation suddenly worsened in the emergency room, due to rupture of a huge infrarenal aneurysm not known until then. Emergency surgery, however, was not successful, confirming the bad outcome for patients in this situation. Early diagnosis and surgical repair where appropriate are essential to affect prognosis of this disease.
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Amann K, Haas CS, Zeiler GA, Benz K, Bader BL, Hartner A, Hilgers KF. Lack of nidogen-2 increases blood pressure, glomerular and tubulointerstitial damage in DOCA-salt hypertension. Eur J Clin Invest 2009; 39:116-25. [PMID: 19200165 DOI: 10.1111/j.1365-2362.2008.02065.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nidogen-2, an extracellular matrix protein, is ubiquitous in renal basement membranes linking the laminin and collagen IV networks. Nidogen-2-deficient (nidogen-2(-/-)) mice do not exhibit a phenotype, and renal basement membranes appear normal. The functional role of nidogen-2 in the adult kidney under pathological conditions however remains unclear. We tested the hypothesis that nidogen-2 mediated cell-matrix interactions are important to maintain glomerular integrity and structure in renal hyperperfusion and hypertension. MATERIALS AND METHODS Two weeks after unilateral nephrectomy (UNX), desoxycorticosterone (DOCA)-salt hypertension was induced in nidogen-2(-/-) mice and their wild type littermates for 6 weeks. Renal damage was assessed by means of semiquantitative scoring, morphometric analysis, immunohistochemistry and measurement of serum creatinine and albumin excretion. RESULTS UNX alone resulted in a very mild increase in renal damage in nidogen-2(-/-) mice compared to wild type animals. Following DOCA-salt treatment, blood pressure, serum creatinine and albumin excretion were significantly higher in nidogen-2(-/-) than in wild type mice. In addition, nidogen-2(-/-) mice showed increased mesangial cell hyperplasia and matrix expansion with higher expression of fibronectin and its receptor alpha8 integrin. Glomerular capillaries were significantly reduced in size and number. CONCLUSIONS We demonstrate that in both mild and severe glomerular damage, lack of nidogen-2 is associated with: (i) increased mesangioproliferation; (ii) higher mesangial matrix expansion; and (iii) reduction in glomerular capillary supply. These findings suggest a critical role for nidogen-2 in the maintenance of glomerular structure in the diseased kidney.
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Affiliation(s)
- K Amann
- University of Erlangen-Nuernberg, University of Luebeck, Erlangen, Germany.
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Affiliation(s)
- Christian S Haas
- Department of Internal Medicine, Division of Cardiology and Cardiovascular Medicine, University Hospital Tübingen, Tübingen, Germany.
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Affiliation(s)
- Michael Haap
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology and Vascular Medicine, University Hospital Tuebingen, Tuebingen, Germany
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Amin MA, Ruth JH, Haas CS, Pakozdi A, Mansfield PJ, Haghshenas J, Koch AE. H-2g, a glucose analog of blood group H antigen, mediates mononuclear cell recruitment via Src and phosphatidylinositol 3-kinase pathways. ACTA ACUST UNITED AC 2008; 58:689-95. [PMID: 18311817 DOI: 10.1002/art.23296] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Monocyte recruitment by proinflammatory cytokines is a hallmark of rheumatoid arthritis (RA). Lewis(y-6) and H (Le(y)/H) are blood group antigens up-regulated on RA synovial endothelium. We have previously shown that both soluble Le(y)/H and a glucose analog of H, H-2g, are angiogenic and mediateleukocyte-endothelial adhesion via induction of intercellular adhesion molecule 1. We hypothesized that soluble Le(y)/H plays an important role in monocyte recruitment in RA. METHODS We examined the role of H-2g in monocyte chemotaxis in vitro. We used an RA synovial tissue (ST)-SCID mouse chimera model to evaluate the role of H-2g in monocyte recruitment in vivo. We used Western blots to examine signaling molecules activated by H-2g in monocytes. RESULTS H-2g induced human monocyte migration in vitro, which was mediated by Src and phosphatidylinositol 3-kinase (PI 3-kinase), since inhibitors and antisense oligodeoxynucleotides (ODNs) of Src and PI 3-kinase significantly decreased H-2g-induced monocyte migration (P < 0.05). H-2g significantly increased mononuclear cell (MNC) homing in vivo into an RA ST-SCID mouse chimera (P < 0.05). Transfection of MNCs with Src antisense ODNs blocked H-2g-induced MNC recruitment into the RA ST-SCID mouse chimera. Additionally, H-2g induced marked phosphorylation of protein kinase CalphaI/betaII (PKCalphaI/betaII), Src, IkappaBalpha, and Akt in monocytes. Src, Akt, and NF-kappaB were shown to be downstream targets of PKCalphaI/betaII, since an inhibitor of PKCalphaI/betaII reduced H-2g-mediated phosphorylation of Src, Akt, and NF-kappaB in monocytes. CONCLUSION These data suggest that H-2g may be a novel mediator of monocyte recruitment in chronic inflammatory diseases like RA.
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Affiliation(s)
- M Asif Amin
- Department of Internal Medicine/Division of Rheumatology, University of Michigan Medical School, Ann Arbor, MI 48109-2200, USA.
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Haas CS, Amin MA, Ruth JH, Allen BL, Ahmed S, Pakozdi A, Woods JM, Shahrara S, Koch AE. In vivo inhibition of angiogenesis by interleukin-13 gene therapy in a rat model of rheumatoid arthritis. ACTA ACUST UNITED AC 2007; 56:2535-48. [PMID: 17665443 DOI: 10.1002/art.22823] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Interleukin-13 (IL-13) is a pleiotropic cytokine that can affect vessel formation, an important component of the rheumatoid arthritis (RA) synovial tissue pannus. The purpose of this study was to use a gene therapy approach to investigate the role of IL-13 in angiogenesis in vivo, using a rat adjuvant-induced arthritis model of RA. METHODS Ankle joints of female rats were injected preventatively with an adenovirus vector containing human IL-13 (AxCAIL-13), a control vector with no insert (AxCANI), or phosphate buffered saline (PBS). Joints were harvested at the peak of arthritis, and histologic and biochemical features were evaluated. RESULTS AxCAIL-13-treated joint homogenates had lower hemoglobin levels, suggesting reduced joint vascularity, and both endothelial cell migration and tube formation were significantly inhibited (P < 0.05). Similarly, AxCAIL-13 inhibited capillary sprouting in the rat aortic ring assay and vessel growth in the Matrigel plug in vivo assay. IL-13 gene delivery resulted in up-regulation and association of phosphorylated ERK-1/2 and protein kinase Calpha/betaII, suggesting a novel pathway in IL-13-mediated angiostasis. The angiostatic effect of AxCAIL-13 was associated with down-regulation of proangiogenic cytokines (IL-18, cytokine-induced neutrophil chemoattractant 1/CXCL1, lipopolysaccharide-induced CXC chemokine/CXCL5) and up-regulation of the angiogenesis inhibitor endostatin. The expression and activity of matrix metalloproteinases 2 and 9, which participate in angiogenesis, was impaired in response to IL-13 as compared with AxCANI and PBS treatment. CONCLUSION Our findings support a role for IL-13 as an in vivo antiangiogenic factor and provide a rationale for its use in RA to control pathologic neovascularization.
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MESH Headings
- Angiogenesis Inhibitors/genetics
- Angiogenesis Inhibitors/metabolism
- Animals
- Arthritis, Rheumatoid/genetics
- Arthritis, Rheumatoid/therapy
- Cell Movement/drug effects
- Cells, Cultured
- Disease Models, Animal
- Endothelium, Vascular/cytology
- Endothelium, Vascular/drug effects
- Female
- Genetic Therapy
- Hemoglobins/analysis
- Hindlimb
- Humans
- Interleukin-13/genetics
- Interleukin-13/metabolism
- Joints/chemistry
- Matrix Metalloproteinase 2/metabolism
- Matrix Metalloproteinase 9/metabolism
- Neovascularization, Pathologic/pathology
- Neovascularization, Pathologic/physiopathology
- Neovascularization, Pathologic/prevention & control
- Rats
- Rats, Sprague-Dawley
- Tissue Extracts/pharmacology
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Affiliation(s)
- Christian S Haas
- University of Michigan Medical School, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA
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