1
|
Salamin M, Segerer S, Buchkremer F. Estimating glomerular filtration rate with cystatin C: a systematic comparison of the new EKFC and the CKD-EPI equation. Clin Kidney J 2024; 17:sfad243. [PMID: 38468699 PMCID: PMC10926324 DOI: 10.1093/ckj/sfad243] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Indexed: 03/13/2024] Open
Affiliation(s)
- Melanie Salamin
- Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Segerer
- Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | | |
Collapse
|
2
|
Buchkremer F, Schuetz P, Mueller B, Segerer S. Classifying Hypotonic Hyponatremia by Projected Treatment Effects - A Quantitative 3-Dimensional Framework. Kidney Int Rep 2023; 8:2720-2732. [PMID: 38106585 PMCID: PMC10719653 DOI: 10.1016/j.ekir.2023.09.002] [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: 02/11/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction The diagnostic algorithms currently used for hypotonic hyponatremia focus primarily on impaired urinary dilution and often neglect the influence of free water intake and solute excretion. We hypothesized that, in each case of hypotonic hyponatremia different pathophysiological mechanisms play a role simultaneously. Methods Using clinical data of the previous observational Co-Med study, we defined each case of hypotonic hyponatremia concurrently in 3 dimensions as follows: (i) high net free water intake (HNFWI), (ii) impaired dilution of the urine (IDU), and (iii) low nonelectrolyte solute excretion (LNESE). For each dimension, a "standard delta sodium" (sdna) was calculated reflecting the expected difference to the serum sodium concentration, that would result from changing a dimension to a specific and equivalent target level. Results Results from 279 patients were used for this analysis. With target levels of free water intake and urine osmolality at the fifth percentile, and nonelectrolyte solute excretion at the 95th percentile, median (interquartile range) sdna values were 7.1 (4.8-10.2) for HNFWI, 11.8 (7.0-18.6) for IDU and 2.6 (1.6-4.2) mmol/l per 24 hours for LNESE. Sdna results in individual patients were highest with IDU in 68.5%, HNFWI in 30.8% and 0.7% with LNESE. At an sdna-level of at least 4mmol/l per 24 hours, the prevalence of HNFWI was 78.9%, IDU 87.1%, and LNESE 26.5%. 77.5% of patients had 2 or all 3 mechanisms present. Hyponatremia was mostly multifactorial in subgroups according to classic categories of hyponatremia and typical comorbidities as well. Conclusion Hypotonic hyponatremia can be quantitatively defined by 3 dimensions. Most cases should be considered multifactorial.
Collapse
Affiliation(s)
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical Faculty of the University of Basel, Basel, Switzerland
- Division of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology & Metabolism, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Segerer
- Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
3
|
Nickler M, Stampf S, Bernasconi L, Segerer S, Blum CA, Kim MJ. Performance of synacthen test in chronic hemodialysis patients. BMC Nephrol 2023; 24:330. [PMID: 37936106 PMCID: PMC10631216 DOI: 10.1186/s12882-023-03347-3] [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: 05/12/2023] [Accepted: 09/23/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Adrenal function tests (Synacthen test) in chronic hemodialysis (HD) patients are currently performed off dialysis. The study aimed to demonstrate equivalence of serum cortisol concentrations pre- and during HD, each for standard-dose (250 µg) and low-dose (1 µg) Synacthen test. METHODS In a single-center cross-over diagnostic equivalence study, Synacthen tests were performed in four settings, in standard- and low-dose as well as pre- and during HD. Serum cortisol concentration was measured at 30 and 60 min after Synacthen administration, and additionally at 20 min in low dose test. Based on a multivariable linear mixed model the means of cortisol concentration on log-scale were estimated in each dose and test time combination. Differences in means were calculated and the TOST approach was applied to test for equivalence. Equivalence was proven if the 90% confidence interval of the difference of two cortisol means was entirely between - 0.22 and 0.22. RESULTS In 28 chronic HD patients, serum cortisol concentrations at 30 and 60 min after Synacthen administration in both standard- and low-dose were shown to be equivalent pre- and during HD. In 10 of 56 low-dose tests, the cortisol peak was already reached after 20 min. However, cortisol concentrations at 20 and 30 min after low-dose Synacthen test pre- and during HD showed no significant difference. CONCLUSION These results suggest that the adrenal function test may be carried out during an ongoing HD session, leading to a more patient-friendly performance of the test, less organizational effort and potentially earlier diagnosis of adrenal insufficiency.
Collapse
Affiliation(s)
- Manuela Nickler
- Medical University Department, Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | - Susanne Stampf
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Luca Bernasconi
- Center for Laboratory Medicine, Institut of Immunology & Clinical Chemistry, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Segerer
- Medical University Department, Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | - Claudine A Blum
- Hormonpraxis Aarau, Aarau, Switzerland
- University of Basel, Basel, Switzerland
| | - Min Jeong Kim
- Medical University Department, Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland.
| |
Collapse
|
4
|
Legay C, Haeusermann T, Pasquier J, Chatelan A, Fuster DG, Dhayat N, Seeger H, Ritter A, Mohebbi N, Ernandez T, Stoermann C, Buchkremer F, Segerer S, Wuerzner G, Ammor N, Roth B, Wagner CA, Bonny O, Bochud M. Differences in the food consumption between kidney stone formers and non-formers in the Swiss Kidney Stone Cohort. J Ren Nutr 2023:S1051-2276(23)00067-5. [PMID: 37120128 DOI: 10.1053/j.jrn.2023.04.007] [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] [Received: 06/19/2022] [Revised: 04/09/2023] [Accepted: 04/16/2023] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVE Diet has a major influence on the formation and management of kidney stones. However, kidney stone formers' diet is difficult to capture in a large population. Our objective was to describe the dietary intake of kidney stone formers in Switzerland and to compare it to non-stone formers. METHODS We used data from the Swiss Kidney Stone Cohort (n=261), a multicentric cohort of recurrent or incident kidney stone formers with additional risk factors, and a control group of CT-scan proven non-stone formers (n=197). Dieticians conducted two consecutive 24-h dietary recalls, using structured interviews and validated software (GloboDiet). We took the mean consumption per participant of the two 24-h dietary recalls to describe the dietary intake and used two-part models to compare the two groups. RESULTS The dietary intake was overall similar between stone and non-stone formers. However, we identified that kidney stone formers had a higher probability of consuming cakes and biscuits (odds ratio, OR[95% CI] =1.56[1.03; 2.37]) and soft drinks (OR=1.66[1.08; 2.55]). Kidney stone formers had a lower probability of consuming nuts and seeds (OR =0.53[0.35; 0.82]), fresh cheese (OR=0.54[0.30; 0.96]), teas (OR=0.50[0.3; 0.84]), and alcoholic beverages (OR=0.35[0.23; 0.54]), especially wine (OR=0.42[0.27; 0.65]). Furthermore, among consumers, stone formers reported smaller quantities of vegetables (β coeff[95% CI]= - 0.23[- 0.41; - 0.06]), coffee (β coeff= - 0.21[- 0.37; - 0.05]), teas (β coeff= - 0.52[- 0.92; - 0.11]) and alcoholic beverages (β coeff= - 0.34[- 0.63; - 0.06]). CONCLUSION Stone formers reported lower intakes of vegetables, tea, coffee, and alcoholic beverages, more specifically wine, but reported drinking more frequently soft drinks than non-stone formers. For the other food groups, stone formers and non-formers reported similar dietary intakes. Further research is needed to better understand the links between diet and kidney stone formation and develop dietary recommendations adapted to the local settings and cultural habits.
Collapse
Affiliation(s)
- Constance Legay
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland; Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland; National Center of Competence in Research NCCR Kidney.CH
| | | | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), Department Formation, Research and Innovation, University of Lausanne, Lausanne, Switzerland
| | - Angeline Chatelan
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western, Geneva, Switzerland; Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Daniel G Fuster
- National Center of Competence in Research NCCR Kidney.CH; Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nasser Dhayat
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Ritter
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Nilufar Mohebbi
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Ernandez
- Service of Nephrology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Florian Buchkremer
- Nephrologie, Dialyse und Transplantation, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Segerer
- Nephrologie, Dialyse und Transplantation, Kantonsspital Aarau, Aarau, Switzerland
| | - Grégoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - Nadia Ammor
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - Beat Roth
- Department of Urology, Lausanne University Hospital, CHUV, University of Lausanne, Switzerland
| | - Carsten A Wagner
- National Center of Competence in Research NCCR Kidney.CH; Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Olivier Bonny
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland; National Center of Competence in Research NCCR Kidney.CH; Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland; Service of Nephrology, Fribourg State Hospital, Fribourg, Switzerland.
| | - Murielle Bochud
- Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland; National Center of Competence in Research NCCR Kidney.CH
| |
Collapse
|
5
|
Bonny O, Fuster D, Seeger H, Ernandez T, Buchkremer F, Wuerzner G, Dhayat N, Ritter A, Stoermann C, Segerer S, Häusermann T, Pasch A, Kim M, Mayr M, Krapf R, Roth B, Bochud M, Mohebbi N, Wagner CA. The Swiss Kidney Stone Cohort: A Longitudinal, Multicentric, Observational Cohort to Study Course and Causes of Kidney Stone Disease in Switzerland. Kidney Blood Press Res 2023; 48:194-201. [PMID: 36780886 DOI: 10.1159/000529094] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/22/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Kidney stone disease has a high prevalence worldwide of approximately 10% of the population and is characterized by a high recurrence rate. Kidney stone disease results from a combination of genetic, environmental, and lifestyle risk factors, and the dissection of these factors is complex. METHODS The Swiss Kidney Stone Cohort (SKSC) is an investigator-initiated prospective, multicentric longitudinal, observational study in patients with kidney stones followed with regular visits over a period of 3 years after inclusion. Ongoing follow-ups by biannual telephone interviews will provide long-term outcome data. SKSC comprises 782 adult patients (age >18 years) with either recurrent stones or a single stone event with at least one risk factor for recurrence. In addition, a control cohort of 207 individuals without kidney stone history and absence of kidney stones on a low-dose CT scan at enrolment has also been recruited. SKSC includes extensive collections of clinical data, biochemical data in blood and 24-h urine samples, and genetic data. Biosamples are stored at a dedicated biobank. Information on diet and dietary habits was collected through food frequency questionnaires and standardized recall interviews by trained dieticians with the Globodiet software. CONCLUSION SKSC provides a unique opportunity and resource to further study cause and course of kidney disease in a large population with data and samples collected of a homogeneous collective of patients throughout the whole Swiss population.
Collapse
Affiliation(s)
- Olivier Bonny
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
- Service of Nephrology, Fribourg State Hospital, Fribourg, Switzerland
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Daniel Fuster
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
- Department of Nephrology and Hypertension, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Harald Seeger
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Ernandez
- Service of Nephrology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Gregoire Wuerzner
- Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
| | - Nasser Dhayat
- Department of Nephrology and Hypertension, University Hospital Bern and University of Bern, Bern, Switzerland
- Nephrology & Renal Care Center, B. Braun Medical Care AG, Hochfelden, Switzerland
| | - Alexander Ritter
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | | | - Stephan Segerer
- Division of Nephrology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Tanja Häusermann
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Andreas Pasch
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
- Calciscon AG, Biel, Switzerland
| | - Minjeong Kim
- Division of Nephrology, Cantonal Hospital Aarau, Aarau, Switzerland
- Medical Outpatient Clinic, Basel University Hospital, Basel, Switzerland
| | - Michael Mayr
- Medical Outpatient Clinic, Basel University Hospital, Basel, Switzerland
| | - Reto Krapf
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Beat Roth
- Department of Urology, Lausanne University Hospital, Lausanne, Switzerland
| | - Murielle Bochud
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nilufar Mohebbi
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
- Department of Nephrology and Hypertension, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Carsten A Wagner
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
6
|
Shahverdyan R, Konner K, Segerer S, Wasse H. Novel classification of proximal forearm perforator vein in the planning and creation of percutaneous and surgical Gracz-type arteriovenous fistulae. J Vasc Access 2022:11297298221141480. [PMID: 36474323 DOI: 10.1177/11297298221141480] [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: 02/17/2024] Open
Abstract
BACKGROUND The perforator vein determines whether it is feasible to create a percutaneous (pAVF) or surgical "Gracz-type" arteriovenous fistula (sAVF). Creating a standard anatomic classification of the antecubital region is beneficial to both the selection of the appropriate device and/or procedure and technical outcomes. Accordingly, an analysis of a large cohort of patients undergoing pAVF/sAVF was performed, focusing on perforator vein anatomical suitability, and a novel anatomical classification of the antecubital region was developed and proposed. METHODS Between August 2018 and July 2022, chronic or end-stage kidney disease patients as well as patients anticipated an initiation of apheresis, who were referred for vascular access planning, underwent a standardized evaluation of upper extremities. A vessel mapping summary detailing the vasculature and the access creation plan was completed, indicating the anatomical suitability for sAVF and pAVF (Ellipsys and WavelinQ) techniques. RESULTS Of 524 patients, 36.5% were female (average age 65 years). 53.2% were on dialysis, 41.6% had diabetes, and 13.2% had a previously failed permanent dialysis access. The anatomy for successful pAVF creation was judged to be suitable in 54% of patients for an Ellipsys-pAVF, and 29.8% for WavelinQ-pAVF. Of the WavelinQ group, 54.4% had suitable anatomy for ulnar, 26.9% for radial, and 18.6% for both ulnar/radial anastomoses. Additionally, 60.7% had suitable anatomy for pAVF creation with at least one of the systems, while 22.5% were suited for both types of pAVF-systems. 80.3% were candidates for creation of a Gracz-AVF. CONCLUSION Overall, we found that about 60% of patients are likely candidates for a pAVF, with 80% being candidates for creation of a Gracz-AVF. Male patients have significantly higher suitability for most types of AVF creation, and younger patients are more suitable for Ellipsys-pAVF and RCAVFs. Most importantly, a universal classification of perforator vein was developed, which is indispensable in modern vascular access planning.
Collapse
Affiliation(s)
| | - Klaus Konner
- Vascular Access Unit, University Hospital of Cologne, Cologne, Germany
| | - Stephan Segerer
- Department of Nephrology, Asklepios Clinic Barmbek, Hamburg, Germany
| | - Haimanot Wasse
- Department of Internal Medicine and Division of Nephrology and Hypertension, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
7
|
Buchkremer F, Segerer S. The 2009 and 2021 CKD-EPI Equations: A Graphical Analysis of the Effect of Refitting GFR Estimating Equations Without a Race Coefficient. Kidney Med 2022; 4:100448. [PMID: 35607637 PMCID: PMC9123604 DOI: 10.1016/j.xkme.2022.100448] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
8
|
Kläger J, Eskandary F, Böhmig GA, Kozakowski N, Kainz A, Colin Aronovicz Y, Cartron JP, Segerer S, Regele H. Renal allograft DARCness in subclinical acute and chronic active ABMR. Transpl Int 2021; 34:1494-1505. [PMID: 33983671 PMCID: PMC8453966 DOI: 10.1111/tri.13904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/10/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 01/13/2023]
Abstract
Gene expression profiling of renal allograft biopsies revealed the Duffy antigen receptor for chemokines (DARC) as being strikingly upregulated in antibody‐mediated rejection (ABMR). DARC has previously been shown to be associated with endothelial injury. This study aimed at assessing the value of DARC immunohistochemistry as diagnostic marker in ABMR. The study was performed on 82 prospectively collected biopsies of a clinically well‐defined population (BORTEJECT trial, NCT01873157) of DSA‐positive patients with gene expression data available for all biopsies. Diagnostic histologic assessment of biopsies was performed according to the Banff diagnostic scheme. DARC expression was focally accentuated, on peritubular capillaries (PTC) mostly in areas of interstitial fibrosis and/or inflammation. DARC positivity was associated with diagnosis of ABMR and correlated with DARC gene expression levels detected by microarray analysis. Still, as previously described, a substantial number of biopsies without signs of rejection showed DARC‐positive PTC. We did not observe significantly reduced graft survival in cases showing histologic signs of ABMR and being DARC‐positive, as compared to DARC‐negative ABMR. In summary, the upregulation of DARC, detected by immunohistochemistry, is associated with but not specific for ABMR. We did not observe reduced graft survival in DARC‐positive patients.
Collapse
Affiliation(s)
- Johannes Kläger
- Department of Pathology, Medical University Vienna, Vienna, Austria
| | - Farsad Eskandary
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Georg A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | | | - Alexander Kainz
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria
| | - Yves Colin Aronovicz
- Laboratoire d'Excellence GR-Ex, Paris, France.,Institut National de la Transfusion Sanguine, Paris, France
| | - Jean-Pierre Cartron
- Université Sorbonne Paris Cité, Université Paris Diderot, Inserm U1134, Institut National de la Transfusion Sanguine, Unité Biologie Intégrée du Globule Rouge, Paris, France
| | - Stephan Segerer
- Division of Nephrology, Dialysis and Transplantation, Kantonsspital Aarau, Aarau, Switzerland
| | - Heinz Regele
- Department of Pathology, Medical University Vienna, Vienna, Austria
| |
Collapse
|
9
|
Buchkremer F, Segerer S. A Simple Method to Remove Timing Bias From the Kidney Disease: Improving Global Outcomes Definition and Classification of Acute Kidney Injury. Kidney Int Rep 2021; 6:1747-1748. [PMID: 34169217 PMCID: PMC8207322 DOI: 10.1016/j.ekir.2021.03.896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Stephan Segerer
- Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
10
|
von Moos S, Segerer S, Davenport A, Sadoune M, Gerritsen K, Pottecher J, Ruschitzka F, Mebazaa A, Arrigo M, Cippà PE. Vascular endothelial growth factor D is a biomarker of fluid overload in haemodialysis patients. Nephrol Dial Transplant 2021; 36:529-536. [PMID: 31923307 DOI: 10.1093/ndt/gfz281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/27/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Improved understanding and assessment of the complex physiology of volume regulation in haemodialysis (HD) patients are required to improve patient care and reduce mortality associated with fluid overload (FO). METHODS We searched for FO-related biomarkers among 184 peptides associated with cardiovascular disease in a cohort of 30 HD patients. First, we assessed the direct impact of HD on the peptides of interest by comparing plasma concentrations before and after treatment. Then, we compared cardiovascular peptide profiles between patients with and without FO as defined by bioimpedance analysis (BIA). The plasma concentration of selected candidate biomarkers for FO was determined by enzyme-linked immunosorbent assay (ELISA) and correlated with previously described FO-related clinical and laboratory parameters. For validation, results were confirmed in an independent cohort of 144 HD patients. RESULTS We found seven peptides positively [NT-proBNP, B-type natriuretic peptide (BNP), vascular endothelial growth factor D (VEGFD), tumour necrosis factor-related apoptosis-inducing ligand receptor 2, growth differentiation factor 15, tumour necrosis factor ligand superfamily member 13B, chitinase-3-like protein 1] and five negatively (leptin, renin, epidermal growth factor receptor, interleukin-1 receptor antagonist, myeloblastin) correlated to FO. In addition to natriuretic peptides, VEGFD emerged as third peptide highly correlated with BIA (ρ = 0.619, P < 0.0001). In line with this, VEGFD concentration verified by ELISA correlated with BIA, BNP and soluble CD146 but not with vascular endothelial growth factor C (VEGFC). Notably, levels of VEGFD were unrelated to cardiac systolic function (P = 0.63), contrary to BNP (P = 0.0003). Finally, we observed that 1-year all-cause mortality was higher in patients with high BNP (P = 0.0002), FO (defined by BIA, P = 0.04) and high VEGFD (P = 0.02), but not with high VEGFC (P = 0.48). CONCLUSION VEGFD is a novel FO-related biomarker with unique diagnostic and prognostic properties.
Collapse
Affiliation(s)
- Seraina von Moos
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Segerer
- Department of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Malha Sadoune
- INSERM UMR-S 942, MASCOT, Université de Paris, Paris, France
| | - Kerem Gerritsen
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Julien Pottecher
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, EA3072, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandre Mebazaa
- INSERM UMR-S 942, MASCOT, Université de Paris, Paris, France.,Department of Anesthesiology and Critical Care Medicine, St Louis and Lariboisière University Hospitals, Paris, France
| | - Mattia Arrigo
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Pietro E Cippà
- Division of Nephrology, Regional Hospital of Lugano, Lugano, Switzerland
| |
Collapse
|
11
|
Bargetzi A, Emmenegger N, Wildisen S, Nickler M, Bargetzi L, Hersberger L, Segerer S, Kaegi-Braun N, Tribolet P, Gomes F, Hoess C, Pavlicek V, Bilz S, Sigrist S, Brändle M, Henzen C, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Admission kidney function is a strong predictor for the response to nutritional support in patients at nutritional risk. Clin Nutr 2021; 40:2762-2771. [PMID: 33933742 DOI: 10.1016/j.clnu.2021.03.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are at substantial risk of malnutrition, which negatively affects clinical outcomes. We investigated the association of kidney function assessed at hospital admission and effectiveness of nutritional support in hospitalized medical patients at risk of malnutrition. METHODS This is a secondary analysis of an investigator-initiated, randomized-controlled, Swiss multicenter trial (EFFORT) that compared individualised nutritional support with usual hospital food on clinical outcomes. We compared effects of nutritional support on mortality in subgroups of patients stratified according to kidney function at the time of hospital admission (estimated glomerular filtration rates [eGFR] <15, 15-29, 30-59, 60-89 and ≥ 90 ml/min/1.73 m2). RESULTS We included 1943 of 2028 patients (96%) from the original trial with known admission creatinine levels. Admission eGFR was a strong predictor for the beneficial effects of nutritional support in regard to lowering of 30-day mortality. Patients with an eGFR <15, 15-29 and 30-59 had the strongest mortality benefit (odds ratios [95%CI] of 0.24 [0.05 to 1.25], 0.37 [0.14 to 0.95] and 0.39 [0.21 to 0.75], respectively), while patients with less severe impairment in kidney function had a less pronounced mortality benefits (p for interaction 0.001). A similar stepwise association of kidney function and response to nutritional support was found also for other secondary outcomes. CONCLUSION In medical inpatients at nutritional risk, admission kidney function was a strong predictor for the response to nutritional therapy. Initial kidney function may help to individualize nutritional support in the future by identification of patients with most clinical benefit. CLINICAL TRIAL REGISTRATION Registered under ClinicalTrials.gov Identifier no. NCT02517476.
Collapse
Affiliation(s)
- Annika Bargetzi
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | | | | | - Manuela Nickler
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | - Laura Bargetzi
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Lara Hersberger
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Stephan Segerer
- Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | - Nina Kaegi-Braun
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Pascal Tribolet
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Filomena Gomes
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; The New York Academy of Sciences, New York City, NY, USA
| | - Claus Hoess
- Internal Medicine, Kantonsspital Muensterlingen, Switzerland
| | | | - Stefan Bilz
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Sarah Sigrist
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | - Michael Brändle
- Internal Medicine & Endocrinology/Diabetes, Kantonsspital St.Gallen, Switzerland
| | | | | | | | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Jacques Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Zeno Stanga
- Division of Diabetes, Endocrinology, Nutritional Medicine & Metabolism, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Switzerland.
| |
Collapse
|
12
|
Bonani M, Achermann R, Seeger H, Scharfe M, Müller T, Schaub S, Binet I, Huynh-Do U, Dahdal S, Golshayan D, Hadaya K, Wüthrich RP, Fehr T, Segerer S. Dialysis after graft loss: a Swiss experience. Nephrol Dial Transplant 2021; 35:2182-2190. [PMID: 32170950 DOI: 10.1093/ndt/gfaa037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 01/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients returning to dialysis after graft loss have high early morbidity and mortality. METHODS We used data from the Swiss Transplant Cohort Study to describe the current practice and outcomes in Switzerland. All patients who received a renal allograft between May 2008 and December 2014 were included. The patients with graft loss were divided into two groups depending on whether the graft loss occurred within 1 year after transplantation (early graft loss group) or later (late graft loss group). Patients with primary non-function who never gained graft function were excluded. RESULTS Seventy-seven out of 1502 patients lost their graft during follow-up, 40 within 1 year after transplantation. Eleven patients died within 30 days after allograft loss. Patient survival was 86, 81 and 74% at 30, 90 and 365 days after graft loss, respectively. About 92% started haemodialysis, 62% with definitive vascular access, which was associated with decreased mortality (hazard ratio = 0.28). At the time of graft loss, most patients were on triple immunosuppressive therapy with significant reduction after nephrectomy. One year after graft loss, 77.5% (31 of 40) of patients in the early and 43.2% (16 out of 37) in the late-loss group had undergone nephrectomy. Three years after graft loss, 36% of the patients with early and 12% with late graft loss received another allograft. CONCLUSION In summary, our data illustrate high mortality, and a high number of allograft nephrectomies and re-transplantations. Patients commencing haemodialysis with a catheter had significantly higher mortality than patients with definitive access. The role of immunosuppression reduction and allograft nephrectomy as interdependent factors for mortality and re-transplantation needs further evaluation.
Collapse
Affiliation(s)
- Marco Bonani
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland
| | - Rita Achermann
- Department Transplant Immunology and Nephrology, University Basel Hospital, Basel, Switzerland
| | - Harald Seeger
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland
| | - Michael Scharfe
- Department of Clinical Research, Clinical Trial Unit, University Basel Hospital, Basel, Switzerland
| | - Thomas Müller
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland
| | - Stefan Schaub
- Department of Clinical Research, Clinical Trial Unit, University Basel Hospital, Basel, Switzerland
| | - Isabelle Binet
- Division of Nephrology/Transplantation Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Uyen Huynh-Do
- Department of Nephrology and Hypertension, University of Bern, Bern, Switzerland
| | - Suzan Dahdal
- Department of Nephrology and Hypertension, University of Bern, Bern, Switzerland
| | - Dela Golshayan
- Transplantation Center, CHUV University Hospital, Lausanne, Switzerland
| | - Karine Hadaya
- Division of Nephrology, Geneva University Hospital, Geneva, Switzerland
| | - Rudolf P Wüthrich
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland
| | - Thomas Fehr
- Department of Internal Medicine, Kantonsspital Graubünden, Chur, Switzerland
| | - Stephan Segerer
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland.,Division of Nephrology, Dialysis and Transplantation, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
13
|
Affiliation(s)
| | - Andreas Bock
- Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Segerer
- Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
14
|
Affiliation(s)
- Florian Buchkremer
- Division of Nephrology, Dialysis and Transplantation, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Segerer
- Division of Nephrology, Dialysis and Transplantation, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
15
|
Buchkremer F, Segerer S. Estimating glomerular filtration rate: a systematic comparison of the new European Kidney Function Consortium equation with the Chronic Kidney Disease Epidemiology Collaboration equation. Clin Kidney J 2021; 14:448-450. [PMID: 33564455 PMCID: PMC7857821 DOI: 10.1093/ckj/sfaa264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Stephan Segerer
- Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
16
|
Wanner-Seleznik GM, Reding T, Chen R, Gupta AK, Lenggenhager D, Browning J, Segerer S, Heikenwalder M, Graf R. Amelioration of Murine Autoimmune Pancreatitis by Targeted LTβR Inhibition and Anti-CD20 Treatment. Immunohorizons 2020; 4:688-700. [PMID: 33154038 DOI: 10.4049/immunohorizons.2000079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022] Open
Abstract
Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis, for which treatment options, especially the long-term management, are limited. The only therapy that has been established and accepted so far is corticosteroids, but the relapse rate is significant. In the current study, we discern the effector mechanisms of targeted LTβR pathway inhibition using LTβR-Ig. Furthermore, the efficacy of LTβR-Ig therapy is compared with the depletion of immune cell subsets (CD4+ and CD20+), which are suggested to play a pathological role in AIP development. Three well-established mouse models of AIP were used to examine treatment efficacies and mechanisms. Tg(Ela1-Lta,b) mice represent a genetic model, in which AIP develops spontaneously. In MRL/Mp and IL-10-/- mice, AIP is induced by repeated polyinosinic:polycytidylic acid injection. Mice with AIP were treated with anti-CD20, anti-CD4 mAbs, or targeted LTβR-Ig. LTβR-Ig and anti-CD20 treatment led to significant improvement of AIP, including a decrease in autoantibody production and pancreatic inflammation in Tg(Ela1-Lta,b) and IL-10-/- mice. The molecular mechanism of this beneficial effect possibly involves the downregulation of Stat3 and noncanonical NF-κb activation. Anti-CD4 treatment reduced Th1 and Th2 signature but did not alleviate AIP. Additionally, in contrast to anti-CD20 or anti-CD4 treatments, blocking LTβR signaling disrupted tertiary lymphoid organs in all three models. We demonstrate that treatment with LTβR-Ig or anti-CD20 Ab alleviated murine AIP. LTβR-Ig treatment for AIP was effective in both lymphotoxin-dependent and lymphotoxin-independent AIP models, possibly because of its dual anti-inflammatory and antiautoimmune mechanisms.
Collapse
Affiliation(s)
- Gitta M Wanner-Seleznik
- Swiss Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Theresia Reding
- Swiss Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Rong Chen
- Swiss Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Anurag Kumar Gupta
- Swiss Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Jeffrey Browning
- Department of Microbiology, Boston University School of Medicine, Boston, MA 02118
| | - Stephan Segerer
- Department of Nephrology, University Hospital Zurich, 8091 Zurich, Switzerland; and
| | - Mathias Heikenwalder
- Department Chronic Inflammation and Cancer, German Cancer Center, 69120 Heidelberg, Germany
| | - Rolf Graf
- Swiss Hepato-Pancreato-Biliary Centre, Visceral and Transplantation Surgery, University Hospital Zurich, 8091 Zurich, Switzerland;
| |
Collapse
|
17
|
Haas L, Eckart A, Haubitz S, Mueller B, Schuetz P, Segerer S. Estimated glomerular filtration rate predicts 30-day mortality in medical emergency departments: Results of a prospective multi-national observational study. PLoS One 2020; 15:e0230998. [PMID: 32251482 PMCID: PMC7135226 DOI: 10.1371/journal.pone.0230998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 03/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Renal failure is common in patients seeking help in medical emergency departments. Decreased renal function is associated with increased mortality in patients with heart failure or sepsis. In this study, the association between renal function (reflected by estimated glomerular filtration rate (eGFR) at the time of admission) and clinical outcome was evaluated. METHODS/OBJECTIVES Data was used from a prospective, multi-national, observational cohort of patients treated in three medical emergency departments of tertiary care centers. The eGFR was calculated from the creatinine at the time of admission (using the Chronic Kidney Disease-Epidemiology Collaboration equation,CKD-EPI). Uni- and multivariate regression models were used for eGFR and 30-day mortality, in hospital mortality, length of stay and intensive care unit admission rate. RESULTS 6983 patients were included. The 30-day mortality was 1.8%, 3.5%, 6.9%, 11.1%, 13.6%, and 14.2% in patients with eGFR of above 90, 60-89, 45-59, 30-44, 15-29, and <15 ml/min/1.73m2, respectively. Using multivariate regression, the adjusted odds ratio (OR) was 2.31 (for 15-29 ml/min/1.73m2, 95% confidence interval 1.36 to 3.90, p = 0.002) and 3.73 (for eGFR <15ml/min/1.73m2 as compared to >90 ml/min/1.73m2, 95% CI 2.04 to 6.84, p<0.001). For 10 ml/min/1.73m2 decrease in eGFR the OR for the 30-day mortality was 1.15 (95% CI1.09 to 1.22, p<0.001).The eGFR was also significantly associated with in-hospital mortality, the percentage of ICU-admissions, and with a longer hospital stay. No association was found with hospital readmission within 30 days. As limitations, only eGFR at admission was available and the number of patients on hemodialysis was unknown. CONCLUSION Reduced eGFR at the time of admission is a strong and independent predictor for adverse outcome in this large population of patients admitted to medical emergency departments.
Collapse
Affiliation(s)
- Laurent Haas
- Division of Nephrology, Dialysis and Transplantation, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- * E-mail:
| | - Andreas Eckart
- Division of Nephrology, Dialysis and Transplantation, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Stephan Segerer
- Division of Nephrology, Dialysis and Transplantation, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
18
|
Bergamin B, Senn O, Corsenca A, Dutkowski P, Weber M, Wüthrich RP, Segerer S, Thut MP. Finding the Right Position: A Three-Year, Single-Center Experience with the “Self-Locating” Catheter. Perit Dial Int 2020; 30:519-23. [DOI: 10.3747/pdi.2009.00106] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundPeritoneal dialysis (PD) catheter displacement is a major cause of dysfunction. Various catheter forms have been designed to improve outcome. One of them is based on the classical Tenckhoff catheter, but includes a small tungsten cylinder at the distal end to optimize location and to prevent dislocations.MethodsIn this retrospective study, we analyzed the functionality and complication profile of the self-locating catheter implanted at our center from November 2005 to September 2008 in our PD program.ResultsData from 27 self-locating catheters implanted in 25 patients (12 women) were obtained. Patients were followed for up to 30 months (median observation time: 13 months), resulting in a cumulative study period of 357 PD months. A total of 22 complications were identified, including 1 episode of peritonitis per 52 patient–months, 1 tunnel infection, and 1 exit-site infection. The “functional catheter failure incidence rate” was approximately 0.01 catheters per month on PD (or approximately 1 catheter loss per 100 PD months). The catheter survival was 93% at 1 year.ConclusionsThe “self-locating” PD catheter demonstrates low rates of catheter migration and dislocations, and good catheter survival.
Collapse
Affiliation(s)
- Brigitte Bergamin
- Division of Nephrology, University Hospital Zurich; University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of General Practice and Health Services Research, University of Zurich; University Hospital Zurich, Zurich, Switzerland
| | - Alf Corsenca
- Division of Nephrology, University Hospital Zurich; University Hospital Zurich, Zurich, Switzerland
| | - Philipp Dutkowski
- Division of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Markus Weber
- Division of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Rudolf P. Wüthrich
- Division of Nephrology, University Hospital Zurich; University Hospital Zurich, Zurich, Switzerland
| | - Stephan Segerer
- Division of Nephrology, University Hospital Zurich; University Hospital Zurich, Zurich, Switzerland
| | - Martina Pechula Thut
- Division of Nephrology, University Hospital Zurich; University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
19
|
Arrigo M, Von Moos S, Gerritsen K, Sadoune M, Tangvoraphonkchai K, Davenport A, Mebazaa A, Segerer S, Cippà PE. Soluble CD146 and B-type natriuretic peptide dissect overhydration into functional components of prognostic relevance in haemodialysis patients. Nephrol Dial Transplant 2019; 33:2035-2042. [PMID: 29733422 DOI: 10.1093/ndt/gfy113] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/31/2018] [Indexed: 12/20/2022] Open
Abstract
Background Accurate volume status evaluation and differentiation of cardiac and non-cardiac components of overhydration (OH) are fundaments of optimal haemodialysis (HD) management. Methods This study, by combining bioimpedance measurements, cardiovascular biomarkers and echocardiography, aimed at dissecting OH into its major functional components, and prospectively tested the association between cardiac and non-cardiac components of OH with mortality. In the first part, we validated soluble CD146 (sCD146) as a non-cardiac biomarker of systemic congestion in a cohort of 30 HD patients. In the second part, we performed a prospective 1-year follow-up study in an independent cohort of 144 HD patients. Results sCD146 incrementally increased after the short and long intervals after HD (+53 ng/mL, P = 0.006 and +91 ng/mL, P < 0.001), correlated with OH as determined by bioimpedance and well-diagnosed OH (area under the receiver operating characteristics curve 0.72, P = 0.005). The prevalence of OH was lower for low-sCD146 and low-BNP patients (B-type natriuretic peptide, 29%) compared with subjects with either one or both biomarkers elevated (65-74%, P < 0.001). Notably, most low-BNP but high-sCD146 subjects were overhydrated. Systolic dysfunction was 2- to 3-fold more prevalent among high-BNP compared with low-BNP patients (44-68% versus 21-23%, chi-square P < 0.001), regardless of sCD146. One-year all-cause mortality was markedly higher in patients with high-BNP (P = 0.001) but not with high-sCD146. In multivariate analysis, systolic dysfunction and BNP, but not OH, were associated with lower survival. Conclusions The combination of BNP and sCD146 dissects OH into functional components of prognostic value. OH in HD patients is associated with higher mortality only if resulting from cardiac dysfunction.
Collapse
Affiliation(s)
- Mattia Arrigo
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Seraina Von Moos
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Kerem Gerritsen
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | | | - Kamonwan Tangvoraphonkchai
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK.,Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Alexandre Mebazaa
- INSERM UMR-S 942, Paris, France.,Department of Anesthesiology and Critical Care Medicine, St Louis and Lariboisère University Hospitals, Paris, France
| | - Stephan Segerer
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland.,Department of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | - Pietro E Cippà
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland.,Center for Regenerative Medicine and Stem Cell Research, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
20
|
Abstract
We present the first report of a patient with peritoneal dialysis (PD)-related peritonitis due to Clostridium ramosum, an anaerobe bacterium that is commonly found in normal fecal flora. On rare occasions, it can be pathogenic in immunocompromised individuals. Clostridium species, including Clostridium ramosum, should be included in the differential diagnosis of PD-related peritonitis.
Collapse
Affiliation(s)
- Jennifer Scotti Gerber
- Division of Nephrology, University Hospital Zurich, Switzerland .,Division of Nephrology and Dialysis, Ospedale Regionale di Lugano, Switzerland
| | | | - Stephan Segerer
- Division of Nephrology, University Hospital Zurich, Switzerland.,Division of Nephrology, Dialysis and Transplantation, Kantonsspital Aarau, Switzerland
| |
Collapse
|
21
|
Seleznik GM, Reding T, Peter L, Gupta A, Steiner SG, Sonda S, Verbeke CS, Dejardin E, Khatkov I, Segerer S, Heikenwalder M, Graf R. Development of autoimmune pancreatitis is independent of CDKN1A/p21-mediated pancreatic inflammation. Gut 2018; 67:1663-1673. [PMID: 28774888 DOI: 10.1136/gutjnl-2016-313458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/07/2017] [Accepted: 06/19/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Chronic pancreatitis (CP) and autoimmune pancreatitis (AIP) are characterised by different inflammatory processes. If pancreatic inflammation is a prerequisite for autoimmunity is still unclear. AIP is considered mostly a T cell-mediated disease; however, in induction of CP, macrophages play a pivotal role. p21-a member of cyclin-dependent kinase inhibitors-can influence inflammatory processes, in particular can regulate T cell activation and promote macrophage development. We therefore examined the role of p21-mediated inflammation in AIP. DESIGN We intercrossed lymphotoxin (LT) overexpressing mice (Tg(Ela1-LTa,b))-a model to study AIP development-with p21-deficient mice. Furthermore, we characterised p21 expression in human AIP and non-AIP specimens. RESULTS p21 deficiency in LT mice (LTp21-/-) prevented early pancreatic injury and reduced inflammation. In acinar cells, diminished proliferation and abrogated activation of non-canonical nuclear factor kappa-light-chain-enhancer of activated B cell (NF-κB) pathway was observed. In contrast, 12-month-old LT mice with and without p21 had similar inflammatory signatures and T-B cell infiltration. Interestingly, LT and LTp21-/- mice had comparable tertiary lymphoid organs (TLOs), autoantibodies and elevated IgG levels. However, acinar cell proliferation, acinar-to-ductal metaplasia and acinar non-canonical NF-κB pathway activation remained impaired in LTp21-/- pancreata. CONCLUSIONS Our findings indicate that p21 is crucial for pancreatic inflammation in LT-driven pancreatic injury. p21 is involved in early acinar secretion of inflammatory mediators that attract innate immune cells. However, p21 is not essential for humoral immune response, accountable for autoimmunity. Remarkably, p21 renders acinar cells less susceptible to proliferation and transdifferentiation. We therefore suggest that AIP can also develop independent of chronic inflammatory processes.
Collapse
Affiliation(s)
- Gitta M Seleznik
- Department of Visceral and Transplantation Surgery, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Theresia Reding
- Department of Visceral and Transplantation Surgery, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Peter
- Department of Visceral and Transplantation Surgery, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Anurag Gupta
- Department of Visceral and Transplantation Surgery, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Sabrina G Steiner
- Department of Visceral and Transplantation Surgery, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Sabrina Sonda
- Department of Visceral and Transplantation Surgery, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Caroline S Verbeke
- Department of Pathology, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Emmanuel Dejardin
- Laboratory of Molecular Immunology and Signal Transduction, GIGA-Research, University of Liège, Liège, Belgium
| | - Igor Khatkov
- Department of Medicine and Dentistry, Moscow State University, Moscow, Russia
| | - Stephan Segerer
- Division of Nephrology, University Hospital, Zurich, Switzerland.,Division of Nephrology, Dialysis and Transplantation, Kantonsspital Aarau, Aarau, Switzerland
| | - Mathias Heikenwalder
- School of Medicine, Institute of Virology, TUM-Helmholtz Zentrum Munich, Munich, Germany.,Department of Chronic Inflammation and Cancer, German Cancer Center (DKFZ), Heidelberg, Germany
| | - Rolf Graf
- Department of Visceral and Transplantation Surgery, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
22
|
Buchkremer F, Segerer S, Bock A. Monitoring Urine Flow to Prevent Overcorrection of Hyponatremia: Derivation of a Safe Upper Limit Based on the Edelman Equation. Am J Kidney Dis 2018; 73:143-145. [PMID: 30122547 DOI: 10.1053/j.ajkd.2018.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/30/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Florian Buchkremer
- Division of Nephrology, Dialysis & Transplantation, Kantonsspital Aarau, Switzerland.
| | - Stephan Segerer
- Division of Nephrology, Dialysis & Transplantation, Kantonsspital Aarau, Switzerland
| | - Andreas Bock
- Division of Nephrology, Dialysis & Transplantation, Kantonsspital Aarau, Switzerland
| |
Collapse
|
23
|
Arrigo M, Vodovar N, Von Moos S, Masson E, Segerer S, Cippà PE, Mebazaa A. High accuracy of proximity extension assay technology for the quantification of plasma brain natriuretic peptide. J Clin Lab Anal 2018; 32:e22574. [PMID: 29797353 DOI: 10.1002/jcla.22574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/25/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Novel multiplex assays allow the simultaneous identification of a large number of plasma proteins. While these new technologies have been shown to be highly sensitive and accurate for the identification of plasma proteins, the use of this technology to quantify those proteins has not been properly investigated. In this pilot study, we tested the accuracy of the proximity extension assay (PEA) for the quantification of the cardiac biomarker brain natriuretic peptide (BNP) compared to a standard clinically approved method. METHODS Concentrations of BNP were assessed in 120 plasma samples from 30 patients with PEA and compared to chemiluminescent microparticle immunoassay (CMIA). Venous blood samples were collected from in tubes containing ethylenediaminetetraacetic acid, centrifuged within 6 hours at 3,500 rpm for 15 minutes at 4°C, frozen and stored at -80°C until analyzed. Correlation between the CMIA and PEA techniques was tested using the Spearman's rank correlation coefficient (rho) and the agreement was described with a Bland-Altman plot. RESULTS Brain natriuretic peptide values obtained by CMIA and PEA were highly correlated (Spearman's rho = 0.865, P < .0001). In two patients, PEA consistently overestimated resp. underestimated BNP values compared to CMIA. After removal of those two patients, a very high correlation between the two techniques was shown (rho = 0.966, P < .0001). A high agreement between the two techniques over the whole range of tested concentrations was shown. CONCLUSION This pilot study showed for the first time an excellent correlation between a clinically approved method and the PEA-based approach for quantification of circulating plasma BNP.
Collapse
Affiliation(s)
- Mattia Arrigo
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Seraina Von Moos
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Elisabeth Masson
- Department of Biochemistry, Lariboisère University Hospital, Paris, France
| | - Stephan Segerer
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland.,Department of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| | - Pietro E Cippà
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland.,Center for Regenerative Medicine and Stem Cell Research, University of Southern California, Los Angeles, CA, USA
| | - Alexandre Mebazaa
- INSERM, UMR-S 942, Paris, France.,Department of Anesthesiology and Critical Care Medicine, St. Louis and Lariboisère University Hospitals, Paris, France
| |
Collapse
|
24
|
Bonani M, Achermann R, Seeger H, Müller T, Schaub S, Binet I, Huynh-Do U, Dahdal S, Golshayan D, Hadaya K, Wüthrich R, Fehr T, Segerer S. SP695DIALYSIS AFTER GRAFT LOSS: THE SWISS EXPERIENCE. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marco Bonani
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Rita Achermann
- STCS, Statistics and Data Management, University Hospital Basel, Basel, Switzerland
| | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Müller
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Schaub
- Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland
| | - Isabelle Binet
- Division of Nephrology/Transplantation Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Uyen Huynh-Do
- Department of Nephrology and Hypertension, University Hospital Bern, Bern, Switzerland
| | - Suzan Dahdal
- Department of Nephrology and Hypertension, University Hospital Bern, Bern, Switzerland
| | - Dela Golshayan
- Department of Nephrology and Transplantation Center, CHUV University Hospital, Lausanne, Switzerland
| | - Karin Hadaya
- Division of Nephrology, University Hospital Geneva, Geneva, Switzerland
| | - Rudolf Wüthrich
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Fehr
- Department of Internal Medicine, Kantonsspital Graubünden, Chur, Switzerland
| | - Stephan Segerer
- Nephrology, Kantonsspital Aarau, Aarau, Switzerland
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
25
|
Segerer S, Neumann S, Hess S. SP524DEVELOPMENT OF A NOVEL CONNECTION DEVICE FOR PATIENTS ON PERITONEAL DIALYSIS (PD). Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp524] [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: 11/13/2022] Open
Affiliation(s)
| | | | - Stephan Hess
- PDZ - Product Development Group, ETH Zürioch, Zürich, Switzerland
| |
Collapse
|
26
|
Segerer S, Neumann S. SP520PATIENTS WHO BENEFIT FROM A NOVEL CONNECTION DEVICE IN PERITONEAL DIALYSIS (PD). Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp520] [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: 11/13/2022] Open
|
27
|
Seeger H, Lindenmeyer MT, Cohen CD, Jaeckel C, Nelson PJ, Chen J, Edenhofer I, Kozakowski N, Regele H, Boehmig G, Brandt S, Wuethrich RP, Heikenwalder M, Fehr T, Segerer S. Lymphotoxin expression in human and murine renal allografts. PLoS One 2018; 13:e0189396. [PMID: 29300739 PMCID: PMC5754061 DOI: 10.1371/journal.pone.0189396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/26/2017] [Indexed: 01/23/2023] Open
Abstract
The kidney is the most frequently transplanted solid organ. Recruitment of inflammatory cells, ranging from diffuse to nodular accumulations with defined microarchitecture, is a hallmark of acute and chronic renal allograft injury. Lymphotoxins (LTs) mediate the communication of lymphocytes and stromal cells and play a pivotal role in chronic inflammation and formation of lymphoid tissue. The aim of this study was to assess the expression of members of the LT system in acute rejection (AR) and chronic renal allograft injury such as transplant glomerulopathy (TG) and interstitial fibrosis/tubular atrophy (IFTA). We investigated differentially regulated components in transcriptomes of human renal allograft biopsies. By microarray analysis, we found the upregulation of LTβ, LIGHT, HVEM and TNF receptors 1 and 2 in AR and IFTA in human renal allograft biopsies. In addition, there was clear evidence for the activation of the NFκB pathway, most likely a consequence of LTβ receptor stimulation. In human renal allograft biopsies with transplant glomerulopathy (TG) two distinct transcriptional patterns of LT activation were revealed. By quantitative RT-PCR robust upregulation of LTα, LTβ and LIGHT was shown in biopsies with borderline lesions and AR. Immunohistochemistry revealed expression of LTβ in tubular epithelial cells and inflammatory infiltrates in transplant biopsies with AR and IFTA. Finally, activation of LT signaling was reproduced in a murine model of renal transplantation with AR. In summary, our results indicate a potential role of the LT system in acute renal allograft rejection and chronic transplant injury. Activation of the LT system in allograft rejection in rodents indicates a species independent mechanism. The functional role of the LT system in acute renal allograft rejection and chronic injury remains to be determined.
Collapse
Affiliation(s)
- Harald Seeger
- Division of Nephrology, University Hospital, Zuerich, Switzerland
- Institute of Physiology and Zuerich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zuerich, Switzerland
- * E-mail:
| | - Maja T. Lindenmeyer
- Nephrological Center, Medical Clinic and Policlinic IV, University of Munich, Munich, Germany
| | - Clemens D. Cohen
- Nephrological Center, Medical Clinic and Policlinic IV, University of Munich, Munich, Germany
| | - Carsten Jaeckel
- Nephrological Center, Medical Clinic and Policlinic IV, University of Munich, Munich, Germany
| | - Peter J. Nelson
- Nephrological Center, Medical Clinic and Policlinic IV, University of Munich, Munich, Germany
| | - Jin Chen
- Division of Nephrology, University Hospital, Zuerich, Switzerland
- Institute of Physiology and Zuerich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zuerich, Switzerland
| | - Ilka Edenhofer
- Division of Nephrology, University Hospital, Zuerich, Switzerland
- Institute of Physiology and Zuerich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zuerich, Switzerland
| | | | - Heinz Regele
- Clinical Institute of Pathology, University of Vienna, Vienna, Austria
| | - Georg Boehmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Austria
| | - Simone Brandt
- Institute of Surgical Pathology, University Hospital Zuerich, Zurich, Switzerland
| | - Rudolf P. Wuethrich
- Division of Nephrology, University Hospital, Zuerich, Switzerland
- Institute of Physiology and Zuerich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zuerich, Switzerland
| | - Mathias Heikenwalder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Fehr
- Department of Internal Medicine, Kantonsspital Graubuenden, Chur, Switzerland
| | - Stephan Segerer
- Division of Nephrology, University Hospital, Zuerich, Switzerland
- Institute of Physiology and Zuerich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zuerich, Switzerland
- Division of Nephrology, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
28
|
Kitterer D, Segerer S, Braun N, Alscher MD, Latus J. Gender-Specific Differences in Peritoneal Dialysis. Kidney Blood Press Res 2017; 42:276-283. [PMID: 28531889 DOI: 10.1159/000477449] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/13/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Gender-specific differences between patients on renal replacement therapy have so far rarely been investigated. In the present study we aimed to describe gender-specific differences in a large cohort of peritoneal dialysis (PD) patients. METHODS Clinical information for all patients who started PD at our center has been collected since the start of the PD-program in 1979. We used Cox regression to examine associations between technique failure and gender. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS A total of 745 patients (315 women and 430 men with a median age of 57 years; IQR 43-67) started PD between 1979 and 2015 in our center. Women were significantly younger at PD start 54 (40-65) years vs. 58 (47-68) years, p<0.001. Within the last almost 15 years, more man than women started PD, but technical survival rates were significantly better in female compared to men (HR=0.662, CI 95% (0.496-0.885) P=0.005). Cardiovascular events were the main cause of death over the study period in both sexes, but decreased over time. Additionally, death due to PD-associated peritonitis decreased significantly over the three decades in both sexes. CONCLUSIONS Our data suggest that technical survival rates were significantly better in female compared to men over three decades and death due to cardiovascular events and PD-associated peritonitis decreased significantly over the three decades in both sexes.
Collapse
Affiliation(s)
- Daniel Kitterer
- Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Stephan Segerer
- Division of Nephrology, University Hospital, Zurich, Switzerland
| | | | - M Dominik Alscher
- Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Joerg Latus
- Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| |
Collapse
|
29
|
Kitterer D, Biegger D, Segerer S, Braun N, Alscher MD, Latus J. Alteration of membrane complement regulators is associated with transporter status in patients on peritoneal dialysis. PLoS One 2017; 12:e0177487. [PMID: 28542228 PMCID: PMC5438122 DOI: 10.1371/journal.pone.0177487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/27/2017] [Indexed: 01/05/2023] Open
Abstract
Introduction A growing body of evidence from animal models and cell culture studies indicate an important role of a local regulatory complement system (CS) in peritoneal injury during peritoneal dialysis (PD). We investigated the expression of the local regulatory CS (reflected by CD46,CD55,CD59) in the peritoneal tissue of patients with different membrane function characteristics. Patients and methods Biopsies from the parietal peritoneum were taken from 24 patients on PD, 22 uremic patients prior to PD. PD patients were grouped according to the dialysate-to-plasma ratio of creatinine (D/P Cre) and ratio of dialysate glucose at 4 hours versus dialysate glucose at time zero (D/D0 glucose) into low or low-average peritoneal transport status (L/LA) and high-average or high-transport status (HA/H) groups. CD46, CD55, and CD59 RNA expression were analyzed by real-time polymerase chain reaction (RT-PCR). Further localization of membrane complement regulators (CRegs) and semiquantitatively analysis was done by immunohistochemistry (IHC). Results CD46 and CD59 expression were similar in all groups. CD55 expression was significantly decreased in the HA/H group compared to the L/LA group and to uremic controls (p < 0.05 and p = 0.05, respectively). No statistically significant differences in CD46, CD55, and CD55 expression were detected when considering the history of peritonitis. There was no statistically significant correlation between PD duration and the expressions of CD46, CD55, and CD59. IHC revealed strong CD46, CD55, and CD59 expression in mesothelial cells. CD55 and CD59 were additionally detected in the vasculature. Using IHC, CD46 was lower in PD patients compared to uremic controls (p>0.05), but there was no difference between the L/LA compared to the H/HA group. Moreover IHC confirmed decreased expression of CD55 in the HA/H group compared to the L/LA group and uremic controls (p<0.0001 and p = 0.0001, respectively). Conclusion CD55 expression is decreased in patients with fast transporter membrane function, whereas peritonitis and PD duration do not appear to alter CReg expression.
Collapse
Affiliation(s)
- Daniel Kitterer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
- * E-mail:
| | - Dagmar Biegger
- Dr. Margarete Fischer–Bosch Institute of Clinical Pharmacology, University of Tuebingen, Stuttgart, Germany
| | - Stephan Segerer
- Division of Nephrology, Dialysis & Transplantation, Kantonsspital Aarau, Aarau, Switzerland
| | - Niko Braun
- Nephrology Center Stuttgart, Stuttgart, Germany
| | - M. Dominik Alscher
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Joerg Latus
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| |
Collapse
|
30
|
Kitterer D, Greulich S, Grün S, Segerer S, Mustonen J, Alscher MD, Braun N, Latus J. Electrocardiographic abnormalities and relative bradycardia in patients with hantavirus-induced nephropathia epidemica. Eur J Intern Med 2016; 33:67-73. [PMID: 27296590 DOI: 10.1016/j.ejim.2016.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nephropathia epidemica (NE), caused by Puumala virus (PUUV), is characterized by acute kidney injury (AKI) and thrombocytopenia. Cardiac involvement with electrocardiographic (ECG) abnormalities has been previously reported in NE; however, its prognostic value is unknown. Relative bradycardia is an important clinical sign in various infectious diseases, and previous smaller studies have described pulse-temperature deficit in patients with PUUV infection. METHODS We performed a cross-sectional survey of 471 adult patients with serologically confirmed NE. Data were collected retrospectively from medical records and prospectively at follow-up visits. Patients for whom ECGs were recorded during the acute phase of disease were enrolled retrospectively (n=263). Three patients were excluded because of documented pre-existing ECG abnormalities prior to NE. All patients with ECG abnormalities during the acute phase underwent follow-up. RESULTS A total of 46 patients had ECG abnormalities at the time of admission to hospital (18%). T-wave inversion was the most frequent ECG abnormality (n=31 patients), followed by ST segment changes (nine patients with elevation and six with depression). No major adverse cardiac events occurred during follow-up (median 37months; range 34-63months). Of note, ECG abnormalities reverted to normal in the majority of the patients during follow-up. During the acute phase of NE, 149 of 186 patients had relative bradycardia, without implications for disease course. CONCLUSIONS Transient ECG abnormalities were detected in 18% of patients during acute NE but were not associated with negative cardiovascular outcome. Relative bradycardia was identified in 80% of the patients with acute NE.
Collapse
Affiliation(s)
- Daniel Kitterer
- Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Simon Greulich
- Division of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Stefan Grün
- Division of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Stephan Segerer
- Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland
| | - M Dominik Alscher
- Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Joerg Latus
- Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
| |
Collapse
|
31
|
Kitterer D, Braun N, Alscher MD, Segerer S, Latus J. The number of patients with severe encapsulating peritoneal sclerosis is decreasing in a large referral center in Germany. Int J Nephrol Renovasc Dis 2016; 9:183-6. [PMID: 27540308 PMCID: PMC4981167 DOI: 10.2147/ijnrd.s108529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 12/23/2022] Open
Abstract
Background Encapsulating peritoneal sclerosis (EPS) is the most severe complication associated with long-term peritoneal dialysis (PD). Previous studies noticed a sharp decline in new patients with severe EPS. We investigated the number of severe EPS patients in our large referral center over almost 20 years. Methods All late-stage EPS patients who underwent major surgery due to extensive symptoms caused by bowel obstruction (vomiting, abdominal pain, and weight loss) between March 1997 and end of December 2015 in our hospital were included in the present study. An index was calculated between the number of patients with severe EPS and the implanted PD catheters in our center. Results Between 1979 and 2015, a total of 745 PD catheters were implanted in our center, with a steady increase in the numbers between 2003 and 2015. First patient with severe EPS was treated in 1998, then a rise in the number of patients with EPS was present in 2005. The number of patients with EPS peaked in the period of 2010–2012 (15 patients within 3 years). Afterward, both the absolute numbers and the index between the number of patients with severe EPS and the implanted catheters demonstrated a prominent reduction in the next 3-year period from 2013 to 2015. Conclusion Our data support the hypothesis that there seems to be a decrease of late-stage EPS incidence over the last years, but data about milder or asymptomatic patients are lacking. This should be kept in mind while giving the patients information about different renal replacement therapies at start of dialysis.
Collapse
Affiliation(s)
- Daniel Kitterer
- Division of General Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Niko Braun
- Nephrology Center Stuttgart, Stuttgart, Germany
| | - M Dominik Alscher
- Division of General Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Stephan Segerer
- Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Joerg Latus
- Division of General Medicine and Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| |
Collapse
|
32
|
Kitterer D, Segerer S, Dippon J, Alscher MD, Braun N, Latus J. Smoking Is a Risk Factor for Severe Acute Kidney Injury in Hantavirus-Induced Nephropathia Epidemica. Nephron Clin Pract 2016; 134:89-94. [PMID: 27388481 DOI: 10.1159/000447783] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/21/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Hantaviruses are zoonotic pathogens causing emerging diseases worldwide. Patients typically present with fever, acute kidney injury (AKI) and thrombocytopenia. Puumala virus (PUUV) that causes nephropathia epidemica (NE) is common in Germany. Recently, a study from Finland revealed an association between nicotine consumption and the severity of AKI in NE. Differences between individuals in Finland and Germany might modulate the effect; therefore, the aim of our study was to prove that smoking is a risk factor for a severe course of NE in Germany. METHODS A cross-sectional prospective survey of 485 patients with hantavirus infections was performed. Clinical and laboratory data during the acute course of the disease were obtained from medical reports and files, while follow-up (including smoking status) data were collected prospectively. RESULTS Smoking information was available for 298 out of 485 patients (61%). Male was the predominant gender (67%), median age at the time of diagnosis was 50 (interquartile range, IQR 41-60) years and 34% of patients were current smokers during the phase of acute NE. Patients in the smoking group were significantly younger than in the non-smoking group (p < 0.0001). Peak serum creatinine levels were significantly higher in the smoking group than in the non-smoking patients (median 301 (IQR 186-469 μmol/l) vs. median 240 (IQR 137-469 μmol/l), p < 0.05). In addition, severe AKI (stages 2 and 3 using KDIGO criteria) was more common in current smokers (80%) than in the non-smokers (68%, p < 0.05). CONCLUSION Current smoking is a risk factor for severity of AKI in patients with acute PUUV infection in Germany. Therefore, information about smoking habits needs to be an integral part of the documentation in patients with suspected acute PUUV infection, and increased monitoring of kidney function should be done in NE patients who are current smokers.
Collapse
Affiliation(s)
- Daniel Kitterer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany
| | | | | | | | | | | |
Collapse
|
33
|
Schott F, Gross AJ, Netsch C, Segerer S. [Thrombotic thrombocytopenic purpura after circumcision]. Urologe A 2016; 56:361-363. [PMID: 27272154 DOI: 10.1007/s00120-016-0147-9] [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: 10/21/2022]
Abstract
After circumcision, a young man developed a wound healing disorder. After presenting to our hospital for further wound care, laboratory results showed acute renal failure with hemolytic anemia and thrombocytopenia, which led to the diagnosis of postoperative thrombotic thrombocytopenic purpura (TTP). After therapy with plasma exchange and immunosuppressive therapy with prednisolone and rituximab, the patient recovered with normalization of laboratory results. The TTP is associated with low activity of ADAMTS13 with microvascular platelet aggregation and hemolytic anemia.
Collapse
Affiliation(s)
- F Schott
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland.
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - S Segerer
- Abteilung für Nephrologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| |
Collapse
|
34
|
Thalhammer C, Clemens RK, Valentin ML, Alonso E, Segerer S, Husmann M, Amann-Vesti BR. Vertebral and internal mammary artery steal syndrome in patients with hemodialysis access. VASA 2016; 45:163-8. [DOI: 10.1024/0301-1526/a000511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Background: Increased flow in the subclavian artery feeding a vascular access for hemodialysis can induce steal phenomena in the vertebral (VA) and internal mammary artery (IMA). The aim of this study was to describe the hemodynamic effects of access flow on the VA and IMA in patients with native fistulas and grafts. Patients and methods: Peak systolic (PSV) and end diastolic (EDV) velocity measurements of the VA, IMA and carotid arteries, as well as flow volume measurements of the subclavian artery, were performed. Flow measurements at the side of the vascular access were compared with the contralateral side. Fifty-five patients were consecutively included, most with a radio-cephalic fistula on the left arm with a mean shunt volume of 1156 ml/min. Results: Pathologic flow patterns were observed in the ipsilateral VA in four patients (7.3 %); contralateral VA flow was normal in all patients. Peak systolic velocity of the VA was significantly decreased at the side of the shunt arm with a PSV of 42.6 ± 11.8 cm/s compared to 48.4 ± 15.6 cm/s contralateral (p < 0.05). The IMA flow pattern were normal in all patients. The PSV of the IMA was significantly decreased (p < 0.01) at the side of the shunt arm (87.5 ± 29.1 cm/s) compared to the non-shunt arm (95.9 ± 27.4 cm/s). Conclusion: We describe significant hemodynamic effects of fistulas to the vertebral and internal mammary arteries. Doppler spectral analysis of the vertebral and internal mammary arteries should be integrated in ultrasound, especially in patients with cerebrovascular or cardiac symptoms.
Collapse
Affiliation(s)
- Christoph Thalhammer
- Clinic for Angiology, University Hospital Zürich and University of Zürich, Switzerland
| | - Robert K. Clemens
- Clinic for Angiology, University Hospital Zürich and University of Zürich, Switzerland
| | - Marie-Luise Valentin
- Clinic for Angiology, University Hospital Zürich and University of Zürich, Switzerland
| | - Elena Alonso
- Clinic for Angiology, University Hospital Zürich and University of Zürich, Switzerland
| | - Stephan Segerer
- Clinic for Nephrology, University Hospital Zürich and University of Zürich, Switzerland
| | - Marc Husmann
- Clinic for Angiology, University Hospital Zürich and University of Zürich, Switzerland
| | | |
Collapse
|
35
|
Kraus AK, Chen J, Edenhofer I, Ravens I, Gaspert A, Cippà PE, Mueller S, Wuthrich RP, Segerer S, Bernhardt G, Fehr T. The Role of T Cell Costimulation via DNAM-1 in Kidney Transplantation. PLoS One 2016; 11:e0147951. [PMID: 26840537 PMCID: PMC4739582 DOI: 10.1371/journal.pone.0147951] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/11/2016] [Indexed: 11/19/2022] Open
Abstract
DNAX accessory protein-1 (DNAM-1, CD226) is a co-stimulatory and adhesion molecule expressed mainly by natural killer cells and T cells. DNAM-1 and its two ligands CD112 and CD155 are important in graft-versus-host disease, but their role in solid organ transplantation is largely unknown. We investigated the relevance of this pathway in a mouse kidney transplantation model. CD112 and CD155 are constitutively expressed on renal tubular cells and strongly upregulated in acutely rejected renal allografts. In vitro DNAM-1 blockade during allogeneic priming reduced the allospecific T cell response but not the allospecific cytotoxicity against renal tubular epithelial cells. Accordingly, absence of DNAM-1 in recipient mice or absence of CD112 or CD155 in the kidney allograft did not significantly influence renal function and severity of rejection after transplantation, but led to a higher incidence of infarcts in CD112 and CD155 deficient kidney allografts. Thus, DNAM-1 blockade is not effective in preventing transplant rejection. Despite of being highly expressed, CD112 and CD155 do not appear to play a major immunogenic role in kidney transplantation. Considering the high incidence of renal infarcts in CD112 and CD155 deficient grafts, blocking these molecules might be detrimental.
Collapse
Affiliation(s)
- Anna K. Kraus
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Jin Chen
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Ilka Edenhofer
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Inga Ravens
- Institute of Immunology, Hannover Medical School, Hannover, Germany
| | - Ariana Gaspert
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Pietro E. Cippà
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Steffen Mueller
- Department of Molecular Genetics and Microbiology, Stony Brook University, New York, New York, United States of America
| | - Rudolf P. Wuthrich
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Stephan Segerer
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | | | - Thomas Fehr
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
| |
Collapse
|
36
|
Riwanto M, Kapoor S, Rodriguez D, Edenhofer I, Segerer S, Wüthrich RP. Inhibition of Aerobic Glycolysis Attenuates Disease Progression in Polycystic Kidney Disease. PLoS One 2016; 11:e0146654. [PMID: 26752072 PMCID: PMC4708993 DOI: 10.1371/journal.pone.0146654] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/21/2015] [Indexed: 12/17/2022] Open
Abstract
Dysregulated signaling cascades alter energy metabolism and promote cell proliferation and cyst expansion in polycystic kidney disease (PKD). Here we tested whether metabolic reprogramming towards aerobic glycolysis (“Warburg effect”) plays a pathogenic role in male heterozygous Han:SPRD rats (Cy/+), a chronic progressive model of PKD. Using microarray analysis and qPCR, we found an upregulation of genes involved in glycolysis (Hk1, Hk2, Ldha) and a downregulation of genes involved in gluconeogenesis (G6pc, Lbp1) in cystic kidneys of Cy/+ rats compared with wild-type (+/+) rats. We then tested the effect of inhibiting glycolysis with 2-deoxyglucose (2DG) on renal functional loss and cyst progression in 5-week-old male Cy/+ rats. Treatment with 2DG (500 mg/kg/day) for 5 weeks resulted in significantly lower kidney weights (-27%) and 2-kidney/total-body-weight ratios (-20%) and decreased renal cyst index (-48%) compared with vehicle treatment. Cy/+ rats treated with 2DG also showed higher clearances of creatinine (1.98±0.67 vs 1.41±0.37 ml/min), BUN (0.69±0.26 vs 0.40±0.10 ml/min) and uric acid (0.38±0.20 vs 0.21±0.10 ml/min), and reduced albuminuria. Immunoblotting analysis of kidney tissues harvested from 2DG-treated Cy/+ rats showed increased phosphorylation of AMPK-α, a negative regulator of mTOR, and restoration of ERK signaling. Assessment of Ki-67 staining indicated that 2DG limits cyst progression through inhibition of epithelial cell proliferation. Taken together, our results show that targeting the glycolytic pathway may represent a promising therapeutic strategy to control cyst growth in PKD.
Collapse
Affiliation(s)
- Meliana Riwanto
- Nephrology, Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Sarika Kapoor
- Nephrology, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Daniel Rodriguez
- Nephrology, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Ilka Edenhofer
- Nephrology, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Stephan Segerer
- Nephrology, Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Rudolf P. Wüthrich
- Nephrology, Institute of Physiology, University of Zurich, Zurich, Switzerland
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
| |
Collapse
|
37
|
Seleznik G, Seeger H, Bauer J, Fu K, Czerkowicz J, Papandile A, Poreci U, Rabah D, Ranger A, Cohen CD, Lindenmeyer M, Chen J, Edenhofer I, Anders HJ, Lech M, Wüthrich RP, Ruddle NH, Moeller MJ, Kozakowski N, Regele H, Browning JL, Heikenwalder M, Segerer S. The lymphotoxin β receptor is a potential therapeutic target in renal inflammation. Kidney Int 2016; 89:113-26. [PMID: 26398497 DOI: 10.1038/ki.2015.280] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 07/14/2015] [Accepted: 07/16/2015] [Indexed: 02/07/2023]
Abstract
Accumulation of inflammatory cells in different renal compartments is a hallmark of progressive kidney diseases including glomerulonephritis (GN). Lymphotoxin β receptor (LTβR) signaling is crucial for the formation of lymphoid tissue, and inhibition of LTβR signaling has ameliorated several non-renal inflammatory models. Therefore, we tested whether LTβR signaling could also have a role in renal injury. Renal biopsies from patients with GN were found to express both LTα and LTβ ligands, as well as LTβR. The LTβR protein and mRNA were localized to tubular epithelial cells, parietal epithelial cells, crescents, and cells of the glomerular tuft, whereas LTβ was found on lymphocytes and tubular epithelial cells. Human tubular epithelial cells, mesangial cells, and mouse parietal epithelial cells expressed both LTα and LTβ mRNA upon stimulation with TNF in vitro. Several chemokine mRNAs and proteins were expressed in response to LTβR signaling. Importantly, in a murine lupus model, LTβR blockade improved renal function without the reduction of serum autoantibody titers or glomerular immune complex deposition. Thus, a preclinical mouse model and human studies strongly suggest that LTβR signaling is involved in renal injury and may be a suitable therapeutic target in renal diseases.
Collapse
Affiliation(s)
- Gitta Seleznik
- Division of Visceral & Transplantation Surgery, Swiss Hepato-Pancreato-Biliary Center, Zurich, Switzerland; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Harald Seeger
- Division of Nephrology, University Hospital, Zurich, Switzerland; Institute of Physiology and Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Judith Bauer
- Institute of Virology, Technische Universität München, Helmholz Zentrum, Munich, Germany
| | - Kai Fu
- Department of Immunobiology, Biogen, Cambridge, Massachusetts, USA
| | - Julie Czerkowicz
- Department of Immunobiology, Biogen, Cambridge, Massachusetts, USA
| | - Adrian Papandile
- Department of Immunobiology, Biogen, Cambridge, Massachusetts, USA
| | - Uriana Poreci
- Department of Immunobiology, Biogen, Cambridge, Massachusetts, USA
| | - Dania Rabah
- Department of Immunobiology, Biogen, Cambridge, Massachusetts, USA
| | - Ann Ranger
- Department of Immunobiology, Biogen, Cambridge, Massachusetts, USA
| | - Clemens D Cohen
- Division of Nephrology, University Hospital, Zurich, Switzerland; Institute of Physiology and Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Maja Lindenmeyer
- Division of Nephrology, University Hospital, Zurich, Switzerland; Institute of Physiology and Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Jin Chen
- Division of Nephrology, University Hospital, Zurich, Switzerland; Institute of Physiology and Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Ilka Edenhofer
- Division of Nephrology, University Hospital, Zurich, Switzerland; Institute of Physiology and Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Hans J Anders
- Division of Nephrology, Medizinische Klinik und Poliklinik IV, Campus Innenstadt, University of Munich-LMU, Munich, Germany
| | - Maciej Lech
- Division of Nephrology, Medizinische Klinik und Poliklinik IV, Campus Innenstadt, University of Munich-LMU, Munich, Germany
| | - Rudolf P Wüthrich
- Division of Nephrology, University Hospital, Zurich, Switzerland; Institute of Physiology and Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Nancy H Ruddle
- Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Marcus J Moeller
- Department of Nephrology and Clinical Immunology, Rheinisch-Westfälische Technische Hochschule (RWTH) University Hospital Aachen, Aachen, Germany
| | | | - Heinz Regele
- Clinical Institute of Pathology, University of Vienna, Vienna, Austria
| | - Jeffrey L Browning
- Department of Immunobiology, Biogen, Cambridge, Massachusetts, USA; Department of Microbiology and Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Mathias Heikenwalder
- Institute of Virology, Technische Universität München, Helmholz Zentrum, Munich, Germany; Institute of Surgical Pathology, University Hospital, Zurich, Switzerland
| | - Stephan Segerer
- Division of Nephrology, University Hospital, Zurich, Switzerland; Institute of Physiology and Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland.
| |
Collapse
|
38
|
Rodriguez D, Kapoor S, Edenhofer I, Segerer S, Riwanto M, Kipar A, Yang M, Mei C, Wüthrich RP. Inhibition of Sodium-Glucose Cotransporter 2 with Dapagliflozin in Han: SPRD Rats with Polycystic Kidney Disease. Kidney Blood Press Res 2015; 40:638-47. [PMID: 26698317 DOI: 10.1159/000368540] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Dapagliflozin (DAPA) is a selective inhibitor of the sodium-glucose cotransporter 2 (SGLT2) which induces glucosuria and osmotic diuresis. The therapeutic effect of DAPA in progressing stages of polycystic kidney disease (PKD) has not been studied. METHODS We examined the effect of DAPA in the Han: SPRD rat model of PKD. DAPA (10 mg/kg/day) or vehicle (VEH) was administered orally via gavage to 5 week old male Han: SPRD (Cy/+) or control (+/+) rats (n = 8-9 per group) for 5 weeks. Blood and urine were collected at baseline and after 2.5 and 5 weeks of treatment to assess renal function and albuminuria. At the end of the treatment, rats were sacrificed and kidneys were excised for histological analysis. RESULTS After 5 weeks of treatment, DAPA-treated Cy/+ and +/+ rats exhibited significantly higher glucosuria, water intake and urine output than VEH-treated rats. DAPA-treated Cy/+ rats also exhibited significantly higher clearances for creatinine and BUN and less albuminuria than VEH-treated Cy/+ rats. DAPA treatment for 5 weeks resulted in a significant increase of the kidney weight in Cy/+ rats but no change in cyst growth. The degree of tubular epithelial cell proliferation, macrophage infiltration and interstitial fibrosis was also similar in DAPA-and VEH-treated Cy/+ rats. CONCLUSION The induction of glucosuria with the SGLT2-specific inhibitor DAPA was associated with improved renal function and decreased albuminuria, but had no effect on cyst growth in Cy/+ rats. Overall the beneficial effects of DAPA in this PKD model were weaker than the previously described effects of the combined SGLT1/2 inhibitor phlorizin.
Collapse
Affiliation(s)
- Daniel Rodriguez
- Division of Nephrology, University Hospital, Zx00FC;rich, Switzerland
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Kitterer D, Segerer S, Alscher MD, Braun N, Latus J. Puumala Hantavirus-Induced Hemorrhagic Fever with Renal Syndrome Must Be Considered across the Borders of Nephrology to Avoid Unnecessary Diagnostic Procedures. PLoS One 2015; 10:e0144622. [PMID: 26650941 PMCID: PMC4674130 DOI: 10.1371/journal.pone.0144622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/19/2015] [Indexed: 12/12/2022] Open
Abstract
Background Nephropathia epidemica (NE), a milder form of hemorrhagic fever with renal syndrome, is caused by Puumala virus and is characterized by acute kidney injury and thrombocytopenia. Methods A cross-sectional prospective survey of 456 adult patients with serologically confirmed NE was performed. Results Of the 456 investigated patients, 335 had received inpatient treatment. At time of admission to hospital, 72% of the patients had still an AKI and thrombocytopenia was present in 64% of the patients. The 335 patients were treated in 29 different hospitals and 6 of which had nephrology departments. 10 out of 335 patients received treatment in university hospitals and 63% of patients admitted themselves to hospital. Initially, the patients were admitted to 12 different clinical departments (29% of the patients were referred to a nephrology department) and during the course of the disease, 8% of the patients were transferred to another department in the same hospital and 3% were transferred to a nephrology department at another hospital. Regarding diagnostic procedures, in 28% of the inpatients computed tomography to exclude pulmonary embolism or due to severe gastrointestinal symptoms, lumbar puncture to exclude meningitis, magnetic resonance tomography of the brain owing to suspected stroke because of visual disorders, gastroscopy, or colonoscopy due to gastrointestinal symptoms was performed at time of admission to hospital. Conclusions NE must be considered by physicians across the borders of nephrology to avoid unnecessary diagnostic procedures especially in areas where NE is endemic.
Collapse
Affiliation(s)
- Daniel Kitterer
- Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Stephan Segerer
- Division of Nephrology, University Hospital, Zurich, Switzerland
| | - M. Dominik Alscher
- Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Joerg Latus
- Department of Internal Medicine, Division of General Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
- * E-mail:
| |
Collapse
|
40
|
Latus J, Schwab M, Tacconelli E, Pieper FM, Wegener D, Dippon J, Müller S, Zakim D, Segerer S, Kitterer D, Priwitzer M, Mezger B, Walter-Frank B, Corea A, Wiedenmann A, Brockmann S, Pöhlmann C, Alscher MD, Braun N. Clinical course and long-term outcome of hantavirus-associated nephropathia epidemica, Germany. Emerg Infect Dis 2015; 21:76-83. [PMID: 25533268 PMCID: PMC4285283 DOI: 10.3201/eid2101.140861] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The consequences of associated hematuria may be long-lasting, and hantavirus IgG is detectable years after acute infection. Human infection with Puumala virus (PUUV), the most common hantavirus in Central Europe, causes nephropathia epidemica (NE), a disease characterized by acute kidney injury and thrombocytopenia. To determine the clinical phenotype of hantavirus-infected patients and their long-term outcome and humoral immunity to PUUV, we conducted a cross-sectional prospective survey of 456 patients in Germany with clinically and serologically confirmed hantavirus-associated NE during 2001–2012. Prominent clinical findings during acute NE were fever and back/limb pain, and 88% of the patients had acute kidney injury. At follow-up (7–35 mo), all patients had detectable hantavirus-specific IgG; 8.5% had persistent IgM; 25% had hematuria; 23% had hypertension (new diagnosis for 67%); and 7% had proteinuria. NE-associated hypertension and proteinuria do not appear to have long-term consequences, but NE-associated hematuria may. All patients in this study had hantavirus-specific IgG up to years after the infection.
Collapse
|
41
|
Kitterer D, Segerer S, Steurer W, Dippon J, Geissler A, Ulmer C, Braun N, Alscher MD, Latus J. C-reactive protein levels in combination with abdominal CT scans is a useful tool to predict the macroscopic appearance in late-stage EPS patients prior to surgery. Int J Nephrol Renovasc Dis 2015; 8:83-90. [PMID: 26316796 PMCID: PMC4540114 DOI: 10.2147/ijnrd.s84910] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Diagnosis of encapsulating peritoneal sclerosis (EPS) is based on clinical symptoms, radiologic findings, and macroscopic or histological criteria. Two diagnostic scores for radiologic findings in computed tomography (CT) scans of patients with EPS have been established in the past (by Tarzi et al and Vlijm et al). The macroscopic appearance of EPS has previously been separated into three types. The use of CT scan as a tool to predict different macroscopic phenotypes, leading to specific surgical techniques and different medical treatment, has not yet been investigated. Methods We retrospectively analyzed 30 patients with late-stage EPS who underwent major surgery with peritonectomy and enterolysis. The preoperative CT scans were scored according to the two aforementioned established diagnostic CT scores. The macroscopic phenotype, surgical procedure, and laboratory values at the time of surgery were evaluated. CT findings in the different macroscopic phenotypes were analyzed. Results All patients had highly predictive CT scores for EPS. The macroscopic Type III had significantly higher CT scores compared with the other macroscopic phenotypes. Patients with macroscopic Type I had significantly higher C-reactive protein values compared to EPS Type III. Operation time was significantly longer, and repeated surgery and intraoperative complications were more frequent in EPS Type I compared with EPS Type III (P<0.05). Using the CT score and CRP level, the sensitivities for prediction of EPS I and III were 78% and 87% with corresponding specificities of 67% and 93%. Conclusion Abdominal CT scans might help to identify patients with a higher risk of complications and provide important information for the surgical intervention prior to surgery.
Collapse
Affiliation(s)
- Daniel Kitterer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Stephan Segerer
- Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Wolfgang Steurer
- Department of General, Visceral and Trauma Surgery, Robert-Bosch-Hospital, University of Stuttgart, Stuttgart, Germany
| | - Juergen Dippon
- Department of Mathematics, University of Stuttgart, Stuttgart, Germany
| | - Angela Geissler
- Department of Radiology and Nuclear Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Christoph Ulmer
- Department of General, Visceral and Trauma Surgery, Robert-Bosch-Hospital, University of Stuttgart, Stuttgart, Germany
| | - Niko Braun
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Mark Dominik Alscher
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Joerg Latus
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| |
Collapse
|
42
|
Cippà PE, Auinger K, Wüthrich RP, Segerer S. An infectious cause of acute kidney injury with low serum potassium. BMJ Case Rep 2015. [PMID: 26202313 DOI: 10.1136/bcr-2015-209910] [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: 11/04/2022] Open
Abstract
A 67-year-old man was referred to our hospital because of acute kidney injury, thrombocytopenia and hyperbilirubinemia. Despite severe kidney failure, hypokalemia was present. One infectious cause explained the whole clinical picture.
Collapse
Affiliation(s)
- Pietro E Cippà
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland
| | - Katja Auinger
- Medical Intensive Care Unit, University Hospital Zürich, Zürich, Switzerland
| | - Rudolf P Wüthrich
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland
| | - Stephan Segerer
- Division of Nephrology, University Hospital Zürich, Zürich, Switzerland
| |
Collapse
|
43
|
Sugano Y, Lindenmeyer MT, Auberger I, Ziegler U, Segerer S, Cohen CD, Neuhauss SCF, Loffing J. The Rho-GTPase binding protein IQGAP2 is required for the glomerular filtration barrier. Kidney Int 2015; 88:1047-56. [PMID: 26154927 DOI: 10.1038/ki.2015.197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/27/2015] [Accepted: 05/07/2015] [Indexed: 01/09/2023]
Abstract
Podocyte dysfunction impairs the size selectivity of the glomerular filter, leading to proteinuria, hypoalbuminuria, and edema, clinically defined as nephrotic syndrome. Hereditary forms of nephrotic syndrome are linked to mutations in podocyte-specific genes. To identify genes contributing to podocyte dysfunction in acquired nephrotic syndrome, we studied human glomerular gene expression data sets for glomerular-enriched gene transcripts differentially regulated between pretransplant biopsy samples and biopsies from patients with nephrotic syndrome. Candidate genes were screened by in situ hybridization for expression in the zebrafish pronephros, an easy-to-use in vivo assay system to assess podocyte function. One glomerulus-enriched product was the Rho-GTPase binding protein, IQGAP2. Immunohistochemistry found a strong presence of IQGAP2 in normal human and zebrafish podocytes. In zebrafish larvae, morpholino-based knockdown of iqgap2 caused a mild foot process effacement of zebrafish podocytes and a cystic dilation of the urinary space of Bowman's capsule upon onset of urinary filtration. Moreover, the glomerulus of zebrafish morphants showed a glomerular permeability for injected high-molecular-weight dextrans, indicating an impaired size selectivity of the glomerular filter. Thus, IQGAP2 is a Rho-GTPase binding protein, highly abundant in human and zebrafish podocytes, which controls normal podocyte structure and function as evidenced in the zebrafish pronephros.
Collapse
Affiliation(s)
- Yuya Sugano
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.,Institute of Anatomy, University of Zurich, Zurich, Switzerland.,Institute of Molecular Life Sciences, University of Zurich, Zurich, Switzerland
| | | | - Ines Auberger
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Urs Ziegler
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.,Center for Microscopy and Image Analysis, University of Zurich, Zurich, Switzerland
| | - Stephan Segerer
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Clemens D Cohen
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.,Institute of Physiology, University of Zurich, Zurich, Switzerland.,Division of Nephrology, Klinikum Harlaching, Munich, Germany
| | - Stephan C F Neuhauss
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.,Institute of Molecular Life Sciences, University of Zurich, Zurich, Switzerland
| | - Johannes Loffing
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.,Institute of Anatomy, University of Zurich, Zurich, Switzerland
| |
Collapse
|
44
|
Kitterer D, Latus J, Ulmer C, Fritz P, Biegger D, Ott G, Alscher MD, Witowski J, Kawka E, Jörres A, Seeger H, Segerer S, Braun N. Activation of nuclear factor of activated T cells 5 in the peritoneal membrane of uremic patients. Am J Physiol Renal Physiol 2015; 308:F1247-58. [DOI: 10.1152/ajprenal.00617.2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/25/2015] [Indexed: 11/22/2022] Open
Abstract
Peritoneal inflammation and fibrosis are responses to the uremic milieu and exposure to hyperosmolar dialysis fluids in patients on peritoneal dialysis. Cells respond to high osmolarity via the transcription factor nuclear factor of activated T cells (NFAT5). In the present study, the response of human peritoneal fibroblasts to glucose was analyzed in vitro. Expression levels of NFAT5 and chemokine (C-C motif) ligand (CCL2) mRNA were quantified in peritoneal biopsies of five nonuremic control patients, five uremic patients before PD (pPD), and eight patients on PD (oPD) using real-time PCR. Biopsies from 5 control patients, 25 pPD patients, and 25 oPD patients were investigated using immunohistochemistry to detect the expression of NFAT5, CCL2, NF-κB p50, NF-κB p65, and CD68. High glucose concentrations led to an early, dose-dependent induction of NFAT5 mRNA in human peritoneal fibroblasts. CCL2 mRNA expression was upregulated by high concentrations of glucose after 6 h, but, most notably, a concentration-dependent induction of CCL2 was present after 96 h. In human peritoneal biopsies, NFAT5 mRNA levels were increased in uremic patients compared with nonuremic control patients. No significant difference was found between the pPD group and oPD group. CCL2 mRNA expression was higher in the oPD group. Immunohistochemistry analysis was consistent with the results of mRNA analysis. CD68-positive cells were significantly increased in the oPD group. In conclusion, uremia results in NFAT5 induction, which might promote early changes of the peritoneum. Upregulation of NFAT5 in PD patients is associated with NFκB induction, potentially resulting in the recruitment of macrophages.
Collapse
Affiliation(s)
- Daniel Kitterer
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Joerg Latus
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Christoph Ulmer
- Department of General, Visceral, and Trauma Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Peter Fritz
- Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany
| | - Dagmar Biegger
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, University of Tuebingen, Stuttgart, Germany
| | - German Ott
- Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany
| | - M. Dominik Alscher
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Janusz Witowski
- Department of Pathophysiology, University of Medical Sciences, Poznan, Poland
| | - Edyta Kawka
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Achim Jörres
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland; and
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Stephan Segerer
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland; and
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Niko Braun
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| |
Collapse
|
45
|
Latus J, Goffin E, Schroeder JA, Fritz P, Ott G, Ulmer C, Steurer W, Kimmel M, Biegger D, Segerer S, Alscher MD, Braun N. Gadolinium deposits could influence the course of encapsulating peritoneal sclerosis. Perit Dial Int 2015; 34:561-5. [PMID: 25075001 DOI: 10.3747/pdi.2013.00137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Joerg Latus
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Eric Goffin
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Josef A Schroeder
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Peter Fritz
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - German Ott
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Christoph Ulmer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Wolfgang Steurer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Martin Kimmel
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Dagmar Biegger
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Stephan Segerer
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - M Dominik Alscher
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Niko Braun
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany; Department of Nephrology, Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium; Department of Pathology, Central EM Unit, University Medical Center, Regensburg, Germany; Dr. Margarete-Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Diagnostic Medicine, Division of Pathology, Robert-Bosch Hospital, Stuttgart, Germany; Department of General, Visceral and Trauma Surgery, Robert-Bosch Hospital, Stuttgart, Germany; Division of Nephrology, University Hospital, Zurich, Switzerland
| |
Collapse
|
46
|
Kapoor S, Rodriguez D, Riwanto M, Edenhofer I, Segerer S, Mitchell K, Wüthrich RP. Effect of Sodium-Glucose Cotransport Inhibition on Polycystic Kidney Disease Progression in PCK Rats. PLoS One 2015; 10:e0125603. [PMID: 25927597 PMCID: PMC4416041 DOI: 10.1371/journal.pone.0125603] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/24/2015] [Indexed: 11/21/2022] Open
Abstract
The sodium-glucose-cotransporter-2 (SGLT2) inhibitor dapagliflozin (DAPA) induces glucosuria and osmotic diuresis via inhibition of renal glucose reabsorption. Since increased diuresis retards the progression of polycystic kidney disease (PKD), we investigated the effect of DAPA in the PCK rat model of PKD. DAPA (10 mg/kg/d) or vehicle was administered by gavage to 6 week old male PCK rats (n=9 per group). Renal function, albuminuria, kidney weight and cyst volume were assessed after 6 weeks of treatment. Treatment with DAPA markedly increased glucose excretion (23.6 ± 4.3 vs 0.3 ± 0.1 mmol/d) and urine output (57.3 ± 6.8 vs 19.3 ± 0.8 ml/d). DAPA-treated PCK rats had higher clearances for creatinine (3.1 ± 0.1 vs 2.6 ± 0.2 ml/min) and BUN (1.7 ± 0.1 vs 1.2 ± 0.1 ml/min) after 3 weeks, and developed a 4-fold increase in albuminuria. Ultrasound imaging and histological analysis revealed a higher cyst volume and a 23% higher total kidney weight after 6 weeks of DAPA treatment. At week 6 the renal cAMP content was similar between DAPA and vehicle, and staining for Ki67 did not reveal an increase in cell proliferation. In conclusion, the inhibition of glucose reabsorption with the SGLT2-specific inhibitor DAPA caused osmotic diuresis, hyperfiltration, albuminuria and an increase in cyst volume in PCK rats. The mechanisms which link glucosuria to hyperfiltration, albuminuria and enhanced cyst volume in PCK rats remain to be elucidated.
Collapse
Affiliation(s)
- Sarika Kapoor
- Division of Nephrology, University Hospital, Zürich, Switzerland
- Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - Daniel Rodriguez
- Division of Nephrology, University Hospital, Zürich, Switzerland
- Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - Meliana Riwanto
- Division of Nephrology, University Hospital, Zürich, Switzerland
- Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - Ilka Edenhofer
- Division of Nephrology, University Hospital, Zürich, Switzerland
- Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - Stephan Segerer
- Division of Nephrology, University Hospital, Zürich, Switzerland
- Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - Katharyn Mitchell
- Clinic for Equine Internal Medicine, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | - Rudolf P. Wüthrich
- Division of Nephrology, University Hospital, Zürich, Switzerland
- Institute of Physiology, University of Zürich, Zürich, Switzerland
- * E-mail:
| |
Collapse
|
47
|
Latus J, Kitterer D, Segerer S, Artunc F, Alscher MD, Braun N. Determination of procalcitonin levels in patients with nephropathia epidemica - a useful tool or an unnecessary diagnostic procedure? Kidney Blood Press Res 2015; 40:22-30. [PMID: 25662000 DOI: 10.1159/000368479] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Puumala virus causes nephropathia epidemica (NE), a milder form of hemorrhagic fever with renal syndrome that occurs in Central and Northern Europe. Several studies have sought to identify risk factors for severe NE. However, elevated procalcitonin (PCT) levels have not previously been investigated as a predictive marker for a severe course of NE. METHODS A cross-sectional prospective survey of 456 adults with serologically confirmed NE was performed. RESULTS PCT levels at the time of diagnosis were available for 43 out of 456 patients, and in 24 of these patients (56%) PCT levels were elevated ("PCT positive"). C-reactive protein (CRP) levels at admission to hospital and peak CRP levels during the acute course of the disease were higher in the PCT-positive compared with the PCT-negative group (p<0.05). Severe acute kidney injury (AKI) (RIFLE I and F) was present in similar numbers of PCT-positive and -negative patients (p=0.7), but antibiotics were more frequently used in the PCT-positive than the PCT-negative group (p<0.05). Within the PCT-positive group, PCT levels were similar among those receiving and not receiving antibiotics (p=0.13), and neither the duration of hospital stay nor CRP peak levels were lower in those treated with antibiotics (p=0.12 and p=0.13, respectively). CONCLUSIONS Elevated PCT levels are common in patients with acute NE. There was no association between PCT levels and severity of disease, including AKI or thrombocytopenia. It is important to distinguish Puumala virus infection from other causes of AKI with thrombocytopenia. However, PCT might not be useful in differentiating hantavirus infection from bacterial infection.
Collapse
Affiliation(s)
- Joerg Latus
- Department of Internal Medicine, Division of Nephrology, Robert-Bosch Hospital, Stuttgart, Germany
| | | | | | | | | | | |
Collapse
|
48
|
Latus J, Kitterer D, Dippon J, Müller S, Artunc F, Segerer S, Alscher MD, Braun N. Polyuria in Hantavirus Infection Reflects Disease Severity and Is Associated with Prolonged Hospital Stay: A Systematic Analysis of 335 Patients from Southern Germany. Nephron Exp Nephrol 2014; 128:000368934. [PMID: 25531933 DOI: 10.1159/000368934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/08/2014] [Indexed: 02/28/2024]
Abstract
Background/Aims: Puumala virus (PUUV) infection leads to nephropathia epidemica (NE), especially in endemic areas in Central Europe. The clinical course of NE is characterized by acute kidney injury (AKI) with thrombocytopenia followed by polyuria to a different degree. The prevalence of polyuria and its associated risk factors have not been reported in a large cohort of NE patients. Methods: Clinical and laboratory data during the acute phase of the disease were obtained from the medical reports and files of 335 patients who received in-hospital treatment during acute hantavirus infection. Comprehensive statistical models were developed to estimate the probability of polyuria. Results: The median age at diagnosis was 47 years (interquartile range, IQR 40-59) and 48% of the patients developed polyuria with a urinary output of 5,100 ml/day (IQR 4,200-7,300). The hospital stay was significantly longer in the polyuric group compared to the nonpolyuric group [8 days (IQR 6-10) vs. 6 days (IQR 5-8); p = 0.04]. Using logistic regression analysis, male gender (odds ratio, OR = 1.6; 95% confidence interval, CI 1.05-2.58; p = 0.03), oliguria/anuria during NE (OR = 2.56; 95% CI 1.65-4.01; p < 0.001), severe AKI (OR = 1.87; 95% CI 1.22-2.9; p < 0.001), and hematuria (OR = 1.78; 95% CI 1.02-3.15; p = 0.04) were significantly associated with the development of polyuria. In a multivariate model, the probability of polyuria was 0.19 (SEM ± 0.05) in female patients presenting with mild/moderate AKI without anuria/oliguria. Conclusions: Almost 50% of hospitalized NE patients developed polyuria, which was associated with a prolonged hospital stay. The probability of the development of polyuria was lowest in female patients with mild/moderate, non-oliguric/anuric AKI. © 2014 S. Karger AG, Basel.
Collapse
Affiliation(s)
- Joerg Latus
- Division of Nephrology, Department of Internal Medicine, Robert Bosch Hospital, Stuttgart, Germany
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Seeger H, Braun N, Latus J, Alscher MD, Fritz P, Edenhofer I, Biegger D, Lindenmeier M, Wüthrich RP, Segerer S. Platelet-derived growth factor receptor-β expression in human peritoneum. Nephron Clin Pract 2014; 128:178-84. [PMID: 25376624 DOI: 10.1159/000368241] [Citation(s) in RCA: 5] [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] [Received: 02/19/2014] [Accepted: 08/15/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Simple peritoneal fibrosis and encapsulating peritoneal sclerosis (EPS) are important lesions in the peritoneum of patients on peritoneal dialysis (PD). We have previously described a population of podoplanin-positive myofibroblasts in peritoneal biopsies from patients with EPS. Platelet-derived growth factor receptor-β (PDGFRβ) is a marker of pericytes, and PDGFs might be involved in the fibrotic response of the peritoneum. This study aimed to describe PDGFRβ in the human peritoneum. METHODS In this retrospective analysis, we localized PDGFRβ in peritoneal biopsies from patients with EPS (n = 6) and patients on PD without signs of EPS (n = 5), and compared them with normal peritoneum (n = 4) and peritoneum from uremic patients (n = 5). Consecutive sections were stained for smooth-muscle actin (SMA) and podoplanin. Slides were scored semiquantitatively by 2 observers blinded to the diagnosis. RESULTS PDGFRβ was expressed by cells of arterial walls in all biopsies. A prominent population of PDGFRβ-positive cells was present in the normal peritoneum, which were SMA negative on consecutive sections. In patients on PD, a high number of PDGFRβ were also positive for SMA. In EPS, the majority of podoplanin-positive cells were positive for PDGFRβ. In peritoneal biopsies from normal and uremic patients, the expression of SMA was mainly restricted to cells of arterial walls. Podoplanin expression was restricted to lymphatic vessels in normal peritoneum, in uremic patients, and in patients on PD without EPS. CONCLUSIONS As podoplanin-positive myofibroblasts express PDGFRβ, these cells might be related to pericytes (rather than other sources of fibroblasts). PDGFRβ might turn out to be a therapeutic target in EPS.
Collapse
Affiliation(s)
- Harald Seeger
- Division of Nephrology, University Hospital, University of Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Thalhammer C, Segerer S, Augustoni M, Jacomella V, Clemens RK, Wüthrich RP, Amann-Vesti BR, Husmann M. Acute effects of haemodialysis on central venous and arterial pressure characteristics. Nephrology (Carlton) 2014; 20:91-5. [PMID: 25346188 DOI: 10.1111/nep.12356] [Citation(s) in RCA: 4] [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: 10/19/2014] [Indexed: 11/28/2022]
Abstract
AIM Haemodynamic stability of patients during haemodialysis (HD) sessions is of pivotal importance and accurate determination of dry weight remains a challenge. Little information is available about central venous and aortic pressure during dialysis. In this pilot study we used a non-invasive technique to describe the changes in central venous pressure (CVP) during dialysis. METHODS An ultrasound-assisted pressure-manometer was used at the cephalic vein during haemodialysis to quantify CVP. Central aortic pressure changes were assessed as aortic augmentation index and subendocardial viability ratio. Bioimpedance was applied to measure total body water, as well as extracellular and intracellular water before and after HD. Measurements were performed prior during and after 1 and 2 h on HD. RESULTS Ten patients were included with a median age of 72 years (23-82). Haemodialysis reduced the weight by 2.0 kg, corresponding to a measured decrease in total body water of 1.9 L. The mean CVP showed a significant decrease (9.0-0.8 cmH₂O; P = 0.0005) during dialysis. The significant drop in CVP was found during the first hour (9-2.8 cmH₂O). Starting and stopping dialysis was reflected by a reduction of 2.6 cmH₂O and a rise of 2.8 cmH₂O (n.s.). Aortic augmentation index decreased from 26.1% to 21.0% (n.s.). Subendocardial viability ratio increased from 126% to 156% (P < 0.05) during HD, and decreased to 139% direct after HD (n.s.). CONCLUSION This is the first study that illustrates a prominent reduction of CVP during the first hour of haemodialysis. Non-invasive CVP measurement is feasible during haemodialysis and adds another piece in the puzzle of factors involved in haemodynamic stability.
Collapse
|