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Ito M, Emami-Naini A, Keyvandarian N, Moeinzadeh F, Mortazavi M, Taheri S, Io K, Nishino T, Obata Y, Kitamura M, Abe S, Koji T, Kohno S, Wakabayashi K, Hamada C, Nakano T, Kanda R, Io H, Horikoshi S, Tomino Y, Korte MR, Braun N, Habib SM, Goffin E, Summers A, Heuveling L, Betjes MGH, Lambie M, Bankart J, Johnson D, Mactier R, Phillips-Darby L, Topley N, Davies S, Liu FX, Leipold R, Arici M, Farooqui U, Cho KH, Do JY, Kang SH, Park JW, Yoon KW, Jung SY, Sise C, Rutherford P, Kovacs L, Konings S, Pestana M, Zimmermann J, Cramp H, Stein D, Bang K, Shin JH, Jeong J, Kim JH, Matsuo N, Maruyama Y, Nakao M, Tanno Y, Ohkido I, Hayakawa H, Yamamoto H, Yokoyama K, Hosoya T, Iannuzzella F, Corradini M, Belloni L, Stefani A, Parmeggiani M, Pasquali S, Svedberg O, Stenvinkel P, Qureshi AR, Barany P, Heimburger O, Leurs P, Anderstam B, Waniewski J, Antosiewicz S, Baczynski D, Galach M, Wankowicz Z, Prabhu M, Subhramanyam SV, Nayak KS, Hwang JC, Jiang MY, Lu YH, Wang CT, Santos C, Rodriguez-Carmona A, Perez Fontan M, Schaefer B, Macher-Goeppinger S, Bayazit A, Sallay P, Testa S, Holland-Cunz S, Querfeld U, Warady BA, Schaefer F, Schmitt CP, Guney I, Turkmen K, Yazici R, Aslan S, Altintepe L, Yeksan M, Kocyigit I, Sipahioglu M, Orscelik O, Unal A, Celik A, Abbas S, Zhu F, Tokgoz B, Dogan A, Oymak O, Kotanko P, Levin N, Sanchez-Gonzalez MC, Gonzalez-Casaus ML, Gonzalez-Parra E, Albalate M, Lorenzo V, Torregrosa V, Fernandez E, de la Piedra C, Rodriguez M, Zeiler M, Monteburini T, Agostinelli RM, Marinelli R, Santarelli S, Bermond F, Bagnis C, Marcuccio C, Soragna G, Bruno M, Vitale C, Marangella M, Martino F, Scalzotto E, Rodighiero MP, Crepaldi C, Ronco C, Seferi S, Rroji M, Likaj E, Barbullushi M, Thereska N, Kim EJ, Han JH, Koo HM, Doh FM, Kim CH, Ko KI, Lee MJ, Oh HJ, Han SH, Yoo TH, Choi KH, Kang SW, Uzun S, Karadag S, Yegen M, Gursu M, Ozturk S, Aydin Z, Sumnu A, Cebeci E, Atalay E, Kazancioglu R, Alscher D, Fritz P, Latus J, Kimmel M, Biegger D, Lindenmeyer M, Cohen CD, Wuthrich RP, Segerer S, Braun N, Kim YK, Kim HW, Song HC, Choi EJ, Yang CW, Matsuda A, Tayama Y, Ogawa T, Iwanaga M, Okazaki S, Hatano M, Kiba T, Shimizu T, Hasegawa H, Mitarai T, Dratwa M, Collart F, Verger C, Tayama Y, Hasegawa H, Takayanagi K, Iwashita T, Shimizu T, Noiri C, Kiba T, Ogawa T, Inamura M, Nakamura S, Matsuda A, Kato H, Mitarai T, Unal A, Sipahioglu MH, Kocyigit I, Elmali F, Tokgoz B, Oymak O, Zhang X, Ma J, Giuliani A, Blanca-Martos L, Nayak Karopadi A, Mason G, Crepaldi C, Ronco C, Santos MT, Fonseca I, Santos O, Rocha MJ, Carvalho MJ, Cabrita A, Rodrigues A, Scabbia L, Domenici A, Apponi F, Tayefeh Jafari M, Sivo F, Falcone C, Punzo G, Mene P, Yildirim T, Yilmaz R, Azak A, Altindal M, Turkmen E, Arici M, Altun B, Duranay M, Erdem Y, Buyukbakkal M, Eser B, Yayar O, Ercan Z, Kali A, Erdogan B, Haspulat A, Merhametsiz O, Yildirim T, Ulusal-Okyay G, Akdag SI, Ayli MD, Pietrzycka A, Miarka P, Chowaniec E, Sulowicz W, Lutwin M, Gaska M, Paciorek A, Karadag S, Gursu M, Ozturk S, Aydin Z, Uzun S, Sumnu A, Cebeci E, Atalay E, Kazancioglu R. Peritoneal dialysis - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lopez-Hellin J, Cantarell C, Jimeno L, Sanchez-Fructuoso A, Puig-Gay N, Guirado L, Vilariño N, Gonzalez-Roncero FM, Mazuecos A, Lauzurica R, Burgos D, Plumed JS, Jacobs-Cacha C, Jimenez C, Fernandez A, Fernandez-Alvarez P, Torregrosa V, Nieto JL, Meseguer A, Alonso A. A form of apolipoprotein a-I is found specifically in relapses of focal segmental glomerulosclerosis following transplantation. Am J Transplant 2013; 13:493-500. [PMID: 23205849 DOI: 10.1111/j.1600-6143.2012.04338.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/21/2012] [Accepted: 10/13/2012] [Indexed: 01/25/2023]
Abstract
Recurrence of idiopathic focal segmental glomerulosclerosis (FSGS) following kidney transplantation occurs in a large percentage of patients. Accurate prediction of recurrence and elucidation of its pathogenesis are major therapeutic goals. To detect differential proteins related to FSGS recurrence, proteomic analysis was performed on plasma and urine samples from 35 transplanted idiopathic FSGS patients, divided into relapsing and nonrelapsing. Several proteins were detected increased in urine of relapsing FSGS patients, including a high molecular weight form of apolipoprotein A-I, named ApoA-Ib, found exclusively in relapsing patients. This finding was verified by Western blot individually in the 35 patients and validated in an independent group of 40 patients with relapsing or nonrelapsing FSGS, plus two additional groups: FSGS-unrelated patients showing different proteinuria levels (n = 30), and familial FSGS transplanted patients (n = 14). In the total of 119 patients studied, the ApoA-Ib form was detected in 13 of the 14 relapsing FSGS patients, and in one of the 61 nonrelapsing patients. Only one of the 30 patients with FSGS-unrelated proteinuria tested positive for ApoA-Ib, and was not detected in familial patients. Urinary ApoA-Ib is associated with relapses in idiopathic FSGS and warrants additional investigation to determine its usefulness as biomarker of relapse following transplantation.
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Affiliation(s)
- J Lopez-Hellin
- Kidney Pathophysiology, CIBBIM-Nanomedicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
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Fliser D, Shilo V, Covic A, Besarab A, Provenzano R, Duliege AM, Chen M, Tong S, Francisco C, Gao HY, Polu K, De Francisco AL, Macdougall I, Macdougall I, Schiller B, Locatelli F, Wiecek A, Francisco C, Tang H, Tong S, Chen M, Duliege AM, Polu K, Mayo M, Covic A, Macdougall I, Macdougall I, Casadevall N, Stead R, Taal M, Faller B, Karras A, Chen M, Tong S, Duliege AM, Rowell R, Polu K, Eckardt KU, Locatelli F, Dusilova Sulkova S, Arnaud S, Bruno P, Arnaud G, Dorina V, Eric A, Gerard M, Cases A, Portoles JM, Calls J, Martinez Castelao A, Sanchez-Guisande D, Segarra A, Tsubakihara Y, Tsubakihara Y, Saito A, Saito A, Saito A, Tsubakihara Y, Martinez-Castelao A, Martinez-Castelao A, Cases A, Fort J, Bonal J, Fulladosa X, Galceran JM, Torregrosa V, Coll E, Minutolo R, Cozzolino M, DI Iorio B, Polito P, Santoro D, Manenti F, Nappi F, Feriozzi S, Conte G, De Nicola L, Mikhail A, Provenzano R, Schiller B, Besarab A, Francisco C, Gao HY, Daley R, Tong S, Mayo M, Yang A, Polu K, Macdougall I, Wiecek A, Schiller B, Canaud B, Locatelli F, Yang A, Chen M, Polu K, Francisco C, Gao HY, Tong S, Duliege AM, Provenzano R, Locatelli F, Locatelli F, Provenzano R, Besarab A, Rath T, Yang A, Mayo M, Francisco C, Macdougall I, Bartnicki P, Baj Z, Majewska E, Rysz J, Fievet P, Assem M, Brazier F, Xu X, Soltani ON, Demontis R, Barsan L, Stancu S, Stancu S, Stanciu A, Capusa C, Petrescu L, Zugravu A, Mircescu G, Malyszko JM, Levin-Iaina N, Malyszko J, Glowinska I, Koc-Zorawska E, Slotki I, Mysliwiec M, Mircescu G, Mircescu G, Capusa C, Stancu S, Barsan L, Grabowski D, Blaga V, Dumitru D, Pchelin I, Shishkin A, Kus T, Usalan C, Tiryaki O, Chin HJ, Chae DW, Kim S, Bertram H, Keller F, Rumjon A, Wood C, Wilson P, Khakoo S, Chai MO, Macdougall IC, Nuria GF, Maria Asuncion F, Jose Maria MG, Carmen C, Paloma Leticia MM, Francisco Javier L, Moniek DG, De Goeij M, Yvette M, Diana G, Friedo D, Nynke H, Lezaic V, Miljkovic B, Petkovic N, Maric I, Vucicevic K, Simic Ogrizovic S, Djukanovic L, Cases A, Martinez-Castelao A, Fort A, Bonal J, Fulladosa X, Galceran JM, Torregrosa V, Coll E, DI Giulio S, DI Giulio S, Galle J, Kiss I, Herlitz H, Wirnsberger G, Claes K, Suranyi M, Guerin A, Winearls C, Addison J, D'souza M, Froissart M, Garrido P, Garrido P, Teixeira M, Costa E, Rodrigues-Santos P, Parada B, Belo L, Alves R, Teixeira F, Santos-Silva A, Reis F, Winearls C, Winearls C, DI Giulio S, Galle J, Kiss I, Herlitz H, Wirnsberger G, Claes K, Suranyi M, Guerin A, Addison J, D'souza M, Fouqueray B, Floris M, Conti M, Cao R, Pili G, Melis P, Matta V, Murgia E, Atzeni A, Binda V, Angioi A, Peri M, Pani A, Besarab A, Belo D, Diamond S, Martin E, Sun C, Lee T, Saikali K, Franco M, Leong R, Neff T, Yu KHP, Tiranathanagul K, Praditpornsilpa K, Katavetin P, Kanjanabuch T, Avihingsanon Y, Tungsanga K, Eiam-Ong S, Macdougall IC, Casadevall N, Percheson P, Potamianou A, Foucher A, Fife D, Vercammen E. Renal anaemia - CKD 1-5. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Riegersperger M, Plischke M, Steiner-Boker S, Seidinger D, Winkelmayer W, Sunder-Plassmann G, Vlahovic P, Vlahovic P, Cvetkovic T, Djordjevic V, Velickovic-Radovanovic R, Stefanovic N, Ignjatovic A, Sladojevic N, Cademartori V, Massarino F, Parodi EL, Russo R, Sofia A, Fontana I, Viviani GL, Garibotto G, Mai M, Mai W, Taner B, Wadei H, Prendergast M, Gonwa T, Martin J, Martin J, Aurore S, Aline CS, Nicolas M, Manolie M, Catherine S, Eric A, Christophe M, Brakemeier S, Liefeldt L, Glander P, Waiser J, Lachmann N, Schonemann C, Zukunft B, Illigens P, Schmidt D, Wu K, Rudolph B, Neumayer HH, Budde K, Pallardo Mateu L, Gavela Martinez E, Sancho Calabuig A, Crespo Albiach J, Beltran Catalan S, Gavela Martinez E, Kanter Berga J, Kimura T, Yagisawa T, Ishikawa N, Sakuma Y, Hujiwara T, Nukui A, Yashi M, Duraes J, Malheiro J, Fonseca I, Rocha A, Martins LS, Almeida M, Dias L, Castro-Henriques A, Cabrita A, Mai M, Mai W, Wadei H, Prendergast M, Gonwa T, Volpe A, Quaglia M, Menegotto A, Fenoglio R, Izzo C, Airoldi A, Terrone C, Stratta P, Ahmed B, Mireille K, Nilufer B, Annick M, Karl Martin W, Anh-Dung H, Dimitri M, Philippe M, Judith R, Daniel A, Liefeldt L, Glander P, Glander P, Lan Y, Schmidt D, Heine C, Budde K, Neumayer HH, Schmidt D, Glander P, Glander P, Budde K, Neumayer HH, Liefeldt L, Quaglia M, Quaglia M, Capone V, Izzo C, Menegotto A, Fenoglio R, Airoldi A, Stratta P, Grace B, Clayton P, Cass A, Mcdonald S, Yagisawa T, Yagisawa T, Yashi M, Kimura T, Nukui A, Fujiwara T, Sakuma Y, Ishikawa N, Iwabuchi T, Muraishi O, Torregrosa V, Barros X, Martinez de Osaba MJ, Paschoalin R, Campistol JM, Hassan R, El-Hefnawy A, Soliman S, Shokeir A, Cobanoglu Kudu A, Gungor O, Kircelli F, Altinel E, Asci G, Ozbek SS, Toz H, Ok E, Sandrini S, Setti G, Valerio F, Possenti S, Torrisi I, Polanco N, Garcia-Puente L, Gonzalez Monte E, Morales E, Gutierrez E, Bengoa I, Hernandez A, Caballero J, Morales JM, Andres A, Sgarlato V, Sgarlato V, Comai G, La Manna G, Moretti I, Grandinetti V, Martelli D, Scolari MP, Stefoni S, Valentini C, Valentini C, Persici E, La Manna G, Cappuccilli ML, Sgarlato V, Liviano D'arcangelo G, Fabbrizio B, Carretta E, Mosconi G, Scolari MP, Feliciangeli G, Grigioni FW, Stefoni S, Apicella L, Guida B, Vitale S, Garofalo G, Russo L, Maresca I, Rossano R, Memoli B, Carrano R, Federico S, Sabbatini M, Carta P, Zanazzi M, DI Maria L, Caroti L, Miejshtri A, Tsalouchos A, Bertoni E, Sezer S, Erkmen Uyar M, Colak T, Bal Z, Tutal E, Kalaci G, Ozdemir Acar FN, Jacquelinet C, Bayat S, Pernin V, Portales P, Szwarc I, Garrigue V, Vetromile F, Delmas S, Eliaou JF, Mourad G, Huber L, Huber L, Slowinski T, Naik M, Glander P, Liefeldt L, Schmidt D, Neumayer HH, Budde K, Nakai K, Fujii H, Kono K, Goto S, Ishimura T, Takeda M, Fujisawa M, Nishi S, Pereira Paschoalin R, Paschoalin R, Torregrosa JV, Barros Freiria X, Duran Rebolledo CE, Sanchez Escuredo A, Sole M, Campistol JM, Youssouf S, Tabbasm F, Bell R, Al-Jayyousi R, Warwick G, Grall A, Treguer L, Essig M, Lecaque C, Noel N, Buchler M, Bertrand D, Rivalan J, Braun L, Villemain F, Hurault de Ligny B, Totet A, Pestourie N, Toubas D, Nevez G, Le Meur Y, Nour el Houda B, Mustapha H, Wafaa F, Inass L, Rambabova Bushljetikj I, Rambabova Bushljetikj I, Masin-Spasovska J, Spasovski G, Popov Z, Sikole A, Ivanovski N, Raimundo M, Guerra J, Teixeira C, Santana A, Silva S, Mil Homens C, Gomes Da Costa A, Loredo D, Cleres M, Gondolesi G, Gutierrez LM, Fortunato RM, Descalzi V, Raffaele P. Transplantation - clinical II. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Patrier L, Dupuis AM, Granger Vallee A, Chenine L, Leray-Moragues H, Chalabi L, Morena M, Canaud B, Cristol JP, Akizawa T, Fukuhara S, Fukagawa M, Onishi Y, Yamaguchi T, Hasegawa T, Kido R, Kurokawa K, Vega O, Usvyat L, Rosales L, Thijssen S, Levin N, Kotanko P, An WS, Son YK, Kim SE, Kim KH, Han JY, Bae HR, Park Y, Passlick-Deetjen J, Kroczak M, Buschges-Seraphin B, Covic AC, Ponce P, Marzell B, Schulze F, de Francisco ALM, Esteve V, Junque A, Duarte V, Fulquet M, Saurina A, Pou M, Salas K, Macias J, Sanchez Ramos A, Lavado M, Ramirez de Arellano M, Del Valle E, Negri AL, Ryba J, Peri P, Puddu M, Bravo M, Rosa Diez G, Crucelegui S, Sintado L, Bevione PE, Canalis M, Fradinger E, Marini A, Marelli C, Schiller A, Covic A, Schiller O, Roman V, Andrei C, Berca S, Ivacson Z, Anton C, Raletchi C, Sezer S, Tutal E, Bal Z, Erkmen Uyar M, Ozdemir Acar FN, Lessard M, Ouimet D, Leblanc M, Nadeau-Fredette AC, Bell R, Lafrance JP, Pichette V, Vallee M, Solak Y, Atalay H, Torun B, Tonbul Z, Lacueva J, Santamaria C, Bordils A, Vicent C, Fernandez M, Casado M, Karakan S, Sezer S, Tutal E, Ozdemir Acar N, Ishimura E, Okuno S, Tsuboniwa N, Ichii M, Yamakawa T, Shoji S, Inaba M, Lomonte C, Derosa C, Libutti P, Teutonico A, Chimienti D, Antonelli M, Bruno A, Cocola S, Basile C, Petrucci I, Giovannini L, Samoni S, Colombini E, Cupisti A, Meola M, Stancu S, Zugravu A, Stanescu B, Barbulescu C, Anghel C, Cinca S, Petrescu L, Mircescu G, Hung PH, Chiang PC, Jong IC, Hsiao CY, Hung KY, Tentori F, Karaboyas A, Sen A, Hecking M, Bommer J, Depner T, Akiba T, Port FK, Robinson BM, Basile C, Libutti P, Di Turo AL, Vernaglione L, Casucci F, Losurdo N, Teutonico A, Lomonte C, Sanadgol H, Baiani M, Mohanna M, Basile C, Libutti P, Di Turo AL, Casucci F, Losurdo N, Teutonico A, Vernaglione L, Lomonte C, Negri AL, Del Valle EE, Zanchetta MB, Nobaru M, Silveira F, Puddu M, Barone R, Bogado CE, Zanchetta JR, Mlot-Michalska M, Grzegorzewska AE, Fedak D, Kuzniewski M, Janda K, Krzanowski M, Pawlica D, Kusnierz-Cabala B, Solnica B, Sulowicz W, Novotna H, vara F, Polakovic V, Sedlackova E, Marzell B, Kaufmann P, Merello JI, Mora J, Crespo A, Arens HJ, Passlick-Deetjen J, Takahashi T, Ogawa H, Kitajima Y, Sato Y, Cayabyab S, Mallari J, Kikuchi H, Nakayama H, Saito N, Shimada H, Miyazaki S, Sakai S, Suzuki M, Gonzalez E, Torregrosa V, Cannata J, Gonzalez MT, Arenas MD, Montenegro J, Rios F, Mora J, Moreno R, Muniz ML, Copley JB, Smyth M, Poole L, Wilson R. Bone disease in CKD 5D. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oppenheimer F, De la Fuente V, Esforzado N, Revuelta I, Cofan F, Torregrosa V, Ricart MJ, Campistol JM. CALCINEURIN-FREE IMMUNOSUPPRESSION IN NON-HEART-BEATING DONOR KIDNEY TRANSPLANT RECIPIENTS. Transplantation 2010. [DOI: 10.1097/00007890-201007272-00552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sánchez-Fructuoso A, Ruiz San Millán JC, Rengel M, Morales JM, Beneyto I, Torregrosa V, Cantarell C. RENAL FUNCTION IMPROVEMENT IN PATIENTS WITH MAINTENANCE IMMUNOSUPPRESSION WHO INITIATE ENTERIC-COATED MYCOPHENOLATE SODIUM (EC-MPS). Transplantation 2008. [DOI: 10.1097/01.tp.0000331767.05298.b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lorenzo Sellares V, Torregrosa V. [Changes in mineral metabolism in stage 3, 4, and 5 chronic kidney disease (not on dialysis)]. Nefrologia 2008; 28 Suppl 3:67-78. [PMID: 19018742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
UNLABELLED With progression of chronic kidney disease (CKD), disorders of mineral metabolism appear. The classic sequence of events begins with a deficit of calcitriol synthesis and retention of phosphorus. As a result of this, serum calcium decreases and parathyroid hormone (PTH) is stimulated, producing in the bone the high turnover (HT) bone disease known as osteitis fibrosa while on the other extreme we find the forms of low turnover (LT) bone disease. Described later and initially associated with aluminum intoxication, these diseases are now seen primarily in older and/or diabetic patients, who in a uremic setting have relatively low levels of PTH to maintain normal bone turnover. Osteomalacia is also included in this group, which after the disappearance of aluminum intoxication is rarely observed. LT forms of hyperparathyroidism facilitate the exit of calcium (Ca) and phosphorus (P) from bone, whereas the adynamic bone limits the incorporation of Ca and P into bone tissue. Therefore, both forms facilitate the availability of Ca and P, which ends up being deposited in soft tissues such as arteries. The link between bone disease and vascular calcifications in CKD is now a well-established phenomenon. 2. Diagnostic strategies Calcium, Phosphorus They have little capacity to predict underlying bone disease, but their regular measurement is decisive for therapeutic management of the patient, especially in the dose titration stages of intestinal phosphorus binders, vitamin D analogs or calcimimetics. Ideally, Ca++ should be used, but total Ca is routinely used. It is recommended to adjust albumin levels in the event of hypoalbuminemia (for each g/dL of decrease in albumin, total serum Ca decreases 0.9 mg/dL). The following formula facilitates rapid calculation of corrected total calcium: Corrected total Ca (mg/dL) = total Ca (mg/dL) + 0.8 [4-albumina (g/dL)]. Parathyroid hormone "Intact" PTH is the biochemical parameter that best correlates with bone histology (levels measured with the Allegro assay from Nichols Institute Diagnostics, no longer available). Various assays are currently available that use antibodies against different fragments of the molecule, but they have significant intermethod variability and have not been validated. A whole PT assay (1-84) is currently unavailable. A consensus to establish uniform criteria for PTH measurement remains to be established. During the dose titration stages of intestinal phosphorus binders, vitamin D analogs or calcimimetics, more frequent measurement may be required based on clinical judgment. Calcifediol (25(OH)D3) It is important to maintain adequate levels of 25(OH)D3 (> 30 ng/mL), since they will be the substrate for production of 1- 25(OH)2 D3, and their deficiency aggravates hyperthyroidism. Determining 25(OH)D3 levels every 6-12 months is a recommended guideline. Other markers of bone turnover (osteocalcin, total and bone alkaline phosphate, free pyridolines in serum, and C-terminal telopeptide of collagen) do not improve the predictive power of PTH and therefore their systematic use is not justified. Radiologic studies Radiologic studies are of little diagnostic utility, because biochemical changes precede radiologic changes. Systematic radiologic evaluation of the skeleton in asymptomatic patients is not justified at present. They are useful as the first step in the study to detect vascular calcifications and amyloidosis due to b2-microglobulin and in symptomatic and at risk patients to detect vertebral fractures. Bone densitometry: Dual energy x-ray absorptiometry (DEXA) is the standard method to determine bone mineral density (usually in the femoral neck and vertebrae). It provides information on changes in bone mineral content, but not on the type of underlying bone disease. It is useful for follow-up of bone mass or for the study of bone mass changes in the same patient. Its value as a predictor of the risk of fracture has not been demonstrated in patients on kidney replacement therapy or with advanced chronic kidney disease. It is indicated in patients with fractures or risk factors for osteoporosis. Bone biopsy: The "gold standard" for diagnosis of bone disease. With improved knowledge of the value of noninvasive parameters, its use is infrequent. INDICATIONS Pathological fractures in the presence or absence of minor trauma. Symptomatic patients in the presence of incongruent clinical parameters. A typical case is the presence of unexplained hypercalcemia from systemic disease, with inconclusive serum PTH values (between 120-450 pg/mL as an estimated range). Evaluation and follow-up of cardiovascular calcifications There are no consensuated clinical practice guidelines for the evaluation and follow-up of extraosseal calcifications in CKD. The clinical tools for evaluation and follow-up of cardiovascular disease are used based on clinical judgment. The periodicity of follow-up has not been established . 3. Recommended biochemical values The biochemical values recommended in clinical practice guidelines for the evaluation of bone mineral metabolism are summarized in Figure 3. The recommended PTH values do not fully coincide with the K/DOQI guidelines. The wide variability in PTH values depending on the assays used has led us to expand the recommended PTH range in stage 3 and 4 CKD. 4. Treatment 4.1. Diet. The recommended diet for the patient with CKD is traditionally based on protein restriction and phosphorus restriction for control of mineral metabolism. A favorable circumstance is that there is a close relationship between protein and phosphorus intake. In CKD stages 3, 4 and 5, it is recommended to restrict phosphorus intake to between 0.8-1 g/day when serum levels of phosphorus and PTH are above the recommended range. This is approximately equivalent to a diet of 50-60 g of protein. This reasonable antiproteinuric strategy that also restricts phosphorus intake is nutritionally safe. What should we tell them to eat? In a practical and oversimplified way, we recommend the following daily intake: Animal proteins: 1 serving (100-120 g), dairy products: 1 serving (equivalent to 200-240 mL of milk or 2 yoghourts), bread, cereals, pastas (1 cup of pasta, rice or legumes + some bread or cookies), vegetables and fruits relatively freely, but with moderation. 4.2. Medication Vitamin D supplements should be provided if serum levels are less than 30 ng/mL. In Spain, vitamin D3 (cholecalciferol) is marketed as Vitamin D3 Berenguer 2,000 IU/mL of solution. Combinations of calcium with cholecalciferol are also available. Most of the dosage forms contain approximately 500 mg of Ca+ and 400 IU of cholecalciferol. Alternatively, calcifediol (25(OH)D3), as Hidroferol 100 mcg/mL, has been used, although the dose range is very variable and has not been established. 4.3. Phosphorus binders. Use if hyperphosphatemia occurs. Start with calcium-containing phosphorus binders (calcium carbonate or calcium acetate), which also provide calcium if dietary intake is inadequate. Do not exceed 1.5 g of Ca++ per day. The most used are calcium carbonate and calcium acetate. Calcium acetate shows a similar binding potency to calcium carbonate but with a lesser calcium overload, and thus would have certain advantages as well as its greater effect at different pH ranges. However, gastric intolerance is more frequent with this dosage form. Aluminum hydroxide may sometimes be required to control phosphoremia or the occurrence of hypercalcemia. Serum aluminum values should be maintained below 30 mcg/L. Avoid use for longer than 6 months and daily doses greater than 1.5 g. Sevelamer is associated with an increased risk of acidosis and has not been approved for use in predialysis stages. Lanthanum carbonate has been recently marketed in Spain, although its indication for use in the predialysis stage of CKD is still not approved. 4.4. Vitamin D derivatives. Indicated when PTH levels are elevated. A prerequisite for their use is that Ca and P serum levels are adequately controlled. Vitamin D derivates available in Spain are 1,25(OH)2D3 (Calcitriol)and 1a(OH)D3 (a-Calcidiol). Doses should be titrated until PTH levels are normalized. Phosphate binder doses often need to be increased because these vitamin D derivatives increase intestinal absorption of calcium and phosphorus. Low doses do not cause hypercalcemia or hyperphosphatemia and do not worsen the course of renal function. Recommended doses: Calcitriol 0.25 mcg every 48 hours and alpha-Calcidiol 0.50 mcg every 48 hours. Soon to be available on the Spanish market is the oral dosage form of paricalcitol (recommended initial dose of 1 mcg/24 h), with a lesser hypercalcemic and hyperphosphoremic effect. Clinical use of calcimimetics in the predialysis state is not yet recommended and is currently under investigation.
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9
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Brunet M, Crespo M, Millán O, Serón D, Torregrosa V, Jiménez O, Moreso F, Martorell J, Grinyo JM, Oppenheimer F. Pharmacokinetics and pharmacodynamics in renal transplant recipients under treatment with cyclosporine and Myfortic. Transplant Proc 2007; 39:2160-2. [PMID: 17889124 DOI: 10.1016/j.transproceed.2007.07.003] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Efficacious prophylaxis of acute rejection episodes (ARE) requires adequate exposure to each component of the immunosuppressive treatment from the first days after renal transplantation. The aim of the present study was to evaluate the correlation between cyclosporine (CsA) and mycophenolic acid (MPA) exposure based upon pharmacokinetics (PK) and pharmacodynamics (PD) and 6-month biopsy-proven acute rejection (BPAR) episodes and chronic allograft nephropathy on 6 month protocol biopsies. PATIENTS AND METHODS We examined twenty-two first or second de novo renal transplant recipients treated with steroids, Sandimmune Neoral (CsA) and Myfortic (720 mg twice a day). PK (C0, C2, and AUC(0-12h)) for both drugs were determined on days 7, 90, and 180. Calcineurin activity, interleukin-2 and interferon-gamma synthesis as well as %CEM were tested at days 7 and 180. CsA dosages were adjusted by C2 monitoring. Collected data included: BPAR during the first 6 months and Banff histological parameters on the 6-month protocol biopsies. RESULTS Eighteen of 22 patients completed 1 year follow-up under treatment. The 6-month BPAR was 18% (4/22). Six-month protocol biopsies in 50% of 14 recipients showed chronic allograft nephropathy 1. At day 7, CsA C2 and AUC median values were 138 ng/mL and 6377 ng x h/mL, while C0 MPA was 1.0 microg/mL and AUC = 23.9 microg x h/mL. CsA C2 medians at 3 and 6 months were 1468 and 1720 ng/mL. MPA-AUC reached therapeutic targets at 3 months (32.3 microg x h/mL) and was 48.3 microg x h/mL at 6 months. Patients with BPAR showed lower CsA AUC (P = .06) and a significantly lower baseline inhibition of calcineurin activity (P < .005) than patients with no BPAR. An increase in mesangial matrix in 6-month protocol biopsies correlated with higher CsA C2 (P = .01). All biomarkers evaluated were significantly inhibited compared with the standard population. CONCLUSIONS When Myfortic is administered together with CsA, it is advisable to begin with higher doses (720 mg x 3 days) to reach adequate PK targets and improve BPAR rates. To prevent chronic allograft nephropathy, lower CsA C2 should be targeted from 3 months.
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Affiliation(s)
- M Brunet
- Pharmacology Department (CDB), Hospital Clinic Barcelona, Barcelona, Spain.
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10
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Linares L, Cervera C, Cofán F, Ricart MJ, Esforzado N, Torregrosa V, Oppenheimer F, Campistol JM, Marco F, Moreno A. Epidemiology and Outcomes of Multiple Antibiotic–Resistant Bacterial Infection in Renal Transplantation. Transplant Proc 2007; 39:2222-4. [PMID: 17889144 DOI: 10.1016/j.transproceed.2007.06.061] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mutiresistant bacterial infections are an emerging problem in the nosocomial setting. Our objectives were to describe the incidence, outcome, and risk factors for acquisition of multiresistant bacteria among renal transplant recipients. METHODS We prospectively followed patients undergoing kidney transplantation over a 3-year period. We collected demographic features, underlying chronic diseases, and main transplant characteristics and complications. Multiple antibiotic resistance was defined for the most important bacteria: Enteric gram-negative bacilli resistant to betalactamics, cephalosporins, and quinolones; Staphylococcus aureus resistant to methicillin, cotrimoxazole, and clindamcin; Enterococcus spp resistant to ampicillin and quinolones; nonfermentator bacilli resistant to all antibiotics except aminoglycosides and collistin. RESULTS Overall, 416 patients included 65 double transplants (62 kidney-pancreas and three kidney-liver) of mean age 48.5 years, and 57% men. Infection with multiresistant bacteria was observed in 58 patients (14%). Most frequent multiresistant bacteria were: Escherichia coli (n = 33), Klebsiella spp (n = 15), Citrobacter spp (n = 8), Enterobacter spp (n = 5), Morganella morganii (n = 2), Pseudomonas aeruginosa (n = 16), Acinetobacter baumanii (n = 2), Enterococcus spp (n = 9) and methicillin-resistant S. aureus (MRSA, n = 2). Age greater than 50 years, hepatitis C virus infection, double kidney-pancreas transplantation, requirement for posttransplant hemodialysis, surgical reoperation, and requirement for nephrostomy were independent variables associated with multiresistant bacterial infection. Most used antibiotics for treatment were: carbapenems (65%), amikacin (12%), linezolid, piperacillin-tazobactam, vancomycin, collistin, and fosfomycin. Infection with multiresistant bacteria was associated with a worse prognosis (graft loss or death, 19% vs 8%, P = .009). CONCLUSIONS The incidence of infection with multiresistant bacteria in our renal transplant cohort was high, being most frequently cephalosporin-resistant enteric gram-negative bacilli and multiresistant P aeruginosa. Methicillin-resistant S. aureus incidence was low. Infection with multiresistant bacteria conferred a worse prognosis.
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Affiliation(s)
- L Linares
- Infectious Diseases Service, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
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11
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Cofan F, Rosich E, Arias M, Torregrosa V, Oppenheimer F, Campistol JM. Quality of Life in Renal Transplant Recipients Following Conversion From Mycophenolate Mofetil to Enteric-Coated Mycophenolate Sodium. Transplant Proc 2007; 39:2179-81. [PMID: 17889130 DOI: 10.1016/j.transproceed.2007.07.012] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Tolerance to immunosuppresant treatment has considerable impact on adherence to therapy and on the outcome of renal transplantation. Recent data indicate better gastrointestinal tolerance to enteric-coated mycophenolate sodium (EC-MPS) than to the classic mycophenolate mofetil (MMF) formulation. AIM This study assessed the effect of conversion therapy from MMF to EC-MPS on gastrointestinal tolerance and quality of life in renal transplant recipients. METHODS This open observational study analyzed the outcomes of conversion from MMF to EC-MPS among renal transplant patients with gastrointestinal complaints. At baseline (B) and at 8 weeks postconversion patients were assessed by the Gastrointestinal Quality of Life Index (GIQLI) questionnaire as well as by clinical evaluation (acute rejection, infection) and analytical determinations. RESULTS We analyzed 18 recipients of cadaveric renal transplants of mean age of 54 +/- 9 years including 61% men and one retransplant. Our patients had stable renal function with mean creatinine of 1.9 +/- 0.7 mg/dL. Baseline treatment included cyclosporine-MMF-prednisone (33%) or FK-MMF-prednisone (66%). Bioequivalent conversion was carried out at 50 +/- 29 months posttransplantation. Conversion to EC-MPS resulted in an improvement in overall quality of life (total score: baseline 106.61 vs 8 weeks 116.89; P < .01). Improvements were observed in the following GIQLI subscales: gastrointestinal symptoms (3.12 vs 3.48, P < .001), physical function (2.54 vs 2.76, P = .003), medical treatment (2.17 vs 2.50, P = .031), and emotion (3.08 vs 3.39, P = .001). No changes were observed in the social function subscale. The hemogram and renal function remained stable; there were no episodes of rejection or infection. CONCLUSION Conversion from MMF to an EC-MPS formulation was associated with improvements in gastrointestinal complaints and quality of life among renal transplant recipients.
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Affiliation(s)
- F Cofan
- Renal Transplant Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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12
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Lorenzo V, Alvarez A, Torres A, Torregrosa V, Hernández D, Salido E. Presentation and role of transplantation in adult patients with type 1 primary hyperoxaluria and the I244T AGXT mutation: Single-center experience. Kidney Int 2006; 70:1115-9. [PMID: 16912707 DOI: 10.1038/sj.ki.5001758] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Primary hyperoxaluria type 1 (PH1) is a rare genetic disorder characterized by allelic and clinical heterogeneity. We aim to describe the presentation and full single-center experience of the management of PH1 patients bearing the mutation described in our community (I244T mutation+polymorphism P11L). Since 1983, 12 patients with recurrent renal lithiasis have been diagnosed with PH1 and renal failure in the Canary Islands, Spain. Diagnostic confirmation was based on the presence of oxalosis in undecalcified bone or kidney allograft biopsy, reduced alanine:glyoxylate aminotransferase activity in liver biopsy, and blood DNA analysis. Patients underwent different treatment modalities depending on individual clinical circumstances and therapeutic possibilities at the time of diagnosis: hemodialysis, isolated kidney, simultaneous liver-kidney, or pre-emptive liver transplantation. In all cases, the presentation of advanced renal disease was relatively late (>13 years) and no cases were reported during lactancy or childhood. The eight patients treated with hemodialysis or isolated kidney transplantation showed unfavorable evolution leading to death over a variable period of time. In contrast, the four patients undergoing liver transplantation (three liver+kidney and one pre-emptive liver alone) showed favorable long-term allograft and patient survival (up to 12 years follow-up). In conclusion, in this PH1 population, all bearing the I244T mutation, the development of end-stage renal disease was distinctive during late adolescence or adulthood. Our long-term results support pre-emptive liver transplantation at early stages of renal failure, and kidney-liver transplantation for those with advanced renal disease.
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Affiliation(s)
- V Lorenzo
- Nephrology Section, Hospital Universitario de Canarias, Santa Cruz de Tenerife, La Laguna, Spain.
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13
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Hernández D, Alvarez A, Torres A, Oppenheimer F, Cobo M, González-Posada J, Jiménez A, Lorenzo V, Torregrosa V. Cardiovascular risk profile in nondiabetic renal transplant patients: cyclosporine versus tacrolimus. Transplant Proc 2003; 35:1727-9. [PMID: 12962773 DOI: 10.1016/s0041-1345(03)00630-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Calcineurin inhibitors (CIs) contribute to cardiovascular risk (CR) in renal transplant (RT) patients. However, the CR profile in RT patients without preexistent diabetes is not well known. We compared CR factors in 191 nondiabetic RT recipients with functioning grafts beyond 1 year, receivingly either CsA (Neoral; n=100) or tacrolimus (Tac; n= 91). Clinical data and pretransplant CR profiles were similar in both groups. There were no differences in acute rejection episodes and graft survival rates during follow-up. The overall proportions of posttransplant diabetes (9% versus 6%), and of hypertension (73% vs 63%) were similar in both groups. Hyperlipidemia was more frequent in the CsA group (58% vs 31%; P=.0001). The cholesterol levels in the CsA group showed at 3 months (232+/-47 vs 202+/-42 m/dL; P=.0001), 6 months (232+/-49 vs 205+/-41 mg/dL; P=.0001), and 12 months (217+/-50 vs 202+/-40 mg/dL; P=.028), despite receiving a greater proportion of lipid-lowering drugs (49% vs 15%; P=.0001). Logistic regression analysis showed that CsA was an independent predictor of posttransplant hyperlipidemia (OR: 5.8, CI 95%; 3.3-10.7; P=.0001) as were age, female gender, pretransplant dyslipidemia, and body mass index (BMI). Interestingly, an interaction was observed between pretransplant BMI and CIs: Among pretransplant normal weight patients (BMI <25 kg/m2), CsA produced a greater incidence of hyperlipidemia than tacrolimus (58% vs 23%; P=.0001) while not among patients who were overweight (BMI >25 kg/m2: pretransplant 58% vs 42%; P=.341). In conclusion, CsA confers a higher risk of hyperlipidemia after RT in nondiabetic patients, particularly those with normal pretransplant weight.
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Affiliation(s)
- D Hernández
- Nephrology Section, Hospital Universitario de Canarias, Tenerife Transplant Unit, Hospital Clinic, Barcelona, Spain.
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14
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Wagner PD, Masanés F, Wagner H, Sala E, Miró O, Campistol JM, Marrades RM, Casademont J, Torregrosa V, Roca J. Muscle angiogenic growth factor gene responses to exercise in chronic renal failure. Am J Physiol Regul Integr Comp Physiol 2001; 281:R539-46. [PMID: 11448858 DOI: 10.1152/ajpregu.2001.281.2.r539] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patients with chronic renal failure (CRF) have impaired exercise capacity even after erythropoietin treatment. We recently showed that although this is explained in part by reduced convective O(2) delivery to muscles, there is also an impairment of O(2) transport from muscle capillaries to the mitochondria. Given the importance of the capillary surface area for capillary mitochondrial O(2) transport and reports of reduced capillarity in CRF, we hypothesized that the angiogenic gene response to exercise is impaired in such patients. Six patients with CRF and six control subjects matched for age, size, and sedentary lifestyle exercised on a single occasion for 1 h at similar work intensities averaging 50% of maximal capacity. Exercise was confined to the knee extensors of a single leg by means of a specially designed leg-kick ergometer. A percutaneous biopsy of the quadriceps was taken within 30 min of cessation of exercise and compared with a similar biopsy done at different times without any prior exercise for 24 h. Conventional Northern blots were prepared and probed for vascular endothelial growth factor (VEGF; the major putative angiogenic growth factor for muscle), basic fibroblast growth factor (bFGF), and transforming growth factor (TGF)-beta(1). Data during both rest and exercise were successfully obtained in four subjects of each group. We also assessed muscle capillarity and mitochondrial oxidative capacity to relate to these changes. Mitochondrial oxidative capacity was normal, whereas capillary number per fiber was 12% lower than in normal subjects. VEGF mRNA abundance was increased after exercise by about one order of magnitude, with no reduction in response in CRF. For bFGF and TGF-beta(1), exercise elicited no response in either group. Reduced muscle capillarity in CRF does not, therefore, stem from reduced transcription of VEGF. To the extent that VEGF is important to exercise-induced angiogenesis in muscle, we suspect a posttranscriptional aberration in this response occurs in CRF to explain reduced capillarity.
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Affiliation(s)
- P D Wagner
- Department of Medicine, Section of Physiology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
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15
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Badenas C, Torra R, Pérez-Oller L, Mallolas J, Talbot-Wright R, Torregrosa V, Darnell A. Loss of heterozygosity in renal and hepatic epithelial cystic cells from ADPKD1 patients. Eur J Hum Genet 2000; 8:487-92. [PMID: 10909847 DOI: 10.1038/sj.ejhg.5200484] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is one of the commonest genetic diseases in man, affecting 1:1000 individuals in the Caucasian population. It is caused by mutations in the PKD1 or PKD2 genes. Recently, controversial data regarding the mutational mechanism underlying cyst initiation have been reported: genetic analyses have shown that second somatic mutations may lead to cyst formation (detected as microsatellite loss of heterozygosity, LOH, and point mutations), but immunohistochemical studies show strong immunoreactivity for polycystin in some cysts. In order to further characterise this matter we have analysed 211 cysts from seven different patients for LOH, we have detected a 13.3% LOH for PKD1. This loss was specific to PKD1 as no LOH was detected when other chromosomal regions were studied. Whenever linkage analysis has been possible, it has been proved that the lost allele corresponded to the wild-type. Our data supports previous results in the two-hit theory for ADPKD due to the large number of cysts studied. ADPKD would occur through a recessive cellular mechanism. The probability of cyst development would depend on the probability of mutation in the second allele. The different phenotypical expression of the same mutation reported in ADPKD could be due to the different tendency of inactivation in the second allele in each individual.
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MESH Headings
- Cells, Cultured
- Chromosome Mapping
- Chromosomes, Human, Pair 16/genetics
- Chromosomes, Human, Pair 3/genetics
- Chromosomes, Human, Pair 4/genetics
- Cysts/genetics
- Cysts/pathology
- DNA/analysis
- DNA/blood
- Epithelium/pathology
- Genes, Recessive
- Humans
- Liver Diseases/genetics
- Liver Diseases/pathology
- Loss of Heterozygosity
- Membrane Proteins/genetics
- Mutation
- Pedigree
- Polycystic Kidney, Autosomal Dominant/genetics
- Polycystic Kidney, Autosomal Dominant/pathology
- Polymorphism, Single-Stranded Conformational
- Proteins/genetics
- TRPP Cation Channels
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Affiliation(s)
- C Badenas
- Department of Nephrology, Hospital Clinic, Institut d'Investigacions BiomMèdiques August Pi i Sunyer, University of Barcelona, Spain
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16
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Almaden Y, Hernandez A, Torregrosa V, Canalejo A, Sabate L, Fernandez Cruz L, Campistol JM, Torres A, Rodriguez M. High phosphate level directly stimulates parathyroid hormone secretion and synthesis by human parathyroid tissue in vitro. J Am Soc Nephrol 1998; 9:1845-52. [PMID: 9773785 DOI: 10.1681/asn.v9101845] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Phosphate retention plays an important role in the pathogenesis of secondary hyperparathyroidism in patients with renal failure. In in vitro studies, high extracellular phosphate levels directly stimulate PTH secretion in rat and bovine parathyroid tissue. The present study evaluates the effect of high phosphate levels on the secretion of PTH and the production of prepro PTH mRNA in human hyperplastic parathyroid glands. The study includes parathyroid glands obtained from patients with primary adenomas and from hemodialysis and kidney-transplant patients with diffuse and nodular secondary hyperplasia. The experiments were performed in vitro using small pieces of parathyroid tissue. The ability of high calcium levels to decrease PTH secretion was less in adenomas than in secondary hyperplasia; among the secondary hyperplasia, nodular was less responsive to an increase in calcium than diffuse hyperplasia. In diffuse hyperplasia, PTH secretion was increased in response to 3 and 4 mM phosphate compared with 2 mM phosphate, despite a high calcium concentration in the medium; prepro PTH mRNA levels increased after incubation in 4 mM phosphate. Similar results were obtained with nodular hyperplasia, except that the elevation of PTH secretion in response to 3 mM phosphate did not attain statistical significance. In adenomas, high calcium concentrations (1.5 mM) did not result in inhibition of PTH secretion, independent of the phosphate concentration, and the prepro PTH mRNA was not significantly increased by high phosphate levels. In conclusion, first, the PTH secretory response to an increase in calcium concentration is less in nodular than diffuse hyperplasia; second, high phosphate levels directly affect PTH secretion and gene expression in patients with advanced secondary hyperparathyroidism.
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Affiliation(s)
- Y Almaden
- Unidad de Investigación, Servicio de Nefrologia Hospital Universitario Reina Sofia, Cordoba, Spain
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17
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Vidal-Sicart S, Pons F, Sabater L, Torregrosa V, Fuster D, Herranz R. Tc-99m sestamibi planar and SPECT imaging of a retrotracheal parathyroid adenoma. Clin Nucl Med 1998; 23:250-1. [PMID: 9554204 DOI: 10.1097/00003072-199804000-00018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- S Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clinic, University of Barcelona, Spain
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18
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Almirall J, Torregrosa V, Arrizabalaga P, Cases A, Oliva J. [Intravenous calcitriol in the treatment of the refractory secondary hyperparathyroidism of terminal chronic kidney failure]. Med Clin (Barc) 1994; 102:325-8. [PMID: 8164458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND In advanced cases of secondary hyperparathyroidism (HPT) in terminal chronic renal failure, the oral treatment of calcitriol is not possible due to the development of hypercalcemia. It has been demonstrated that calcitriol directly inhibits the secretion of parathormone (PTH), independently of calcium. Therefore the intravenous administration of high and intermittent doses of calcitriol (ivVD) has been proposed as an alternative treatment for resistant HPT. METHODS The response of PTHi to treatment over 6 months with ivVD was evaluated in 18 patients with moderate-severe HPT resistant to the classical schedules. RESULTS An important decrease was observed in the PTHi values (basal: 698 +/- 277 pg/ml, end of treatment: 272 +/- 200; p < 0.05). Alkaline phosphatase values followed a parallel course (basal: 476 +/- 286 U/l, end of treatment: 301 +/- 276 U/l, p < 0.05). Fifty-five percent of the patients presented hypercalcemia at some time (Ca > or = 11.5 mg/dl) being controlled by a decrease in the doses of calcitriol or calcium in dialysis fluid. No response was observed in 3 patients (17%) with treatment being discontinued due to presentation of uncontrollable hypercalcemia. CONCLUSIONS The administration of intravenous calcitriol at high and intermittent doses is effective in a considerable number of patients with hyperparathyroidism resistant to the classical oral schedules. Its use may avoid surgical parathyroidectomy in some cases.
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Affiliation(s)
- J Almirall
- Unidad de Nefrología, Consorci Hospitalari de Parc Taulí, Sabadell, Barcelona
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19
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Andreu J, Campistol JM, Oppenheimer F, Torregrosa V, Ricart MJ, Vilardell J, Carretero P. Cyclosporine monotherapy as primary immunosuppression in renal transplantation--five-year experience. Transplant Proc 1994; 26:337-40. [PMID: 8109006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J Andreu
- Renal Transplant Unit, Hospital Clinic, Barcelona, Spain
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20
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Torregrosa V, De la Torre M, Campistol JM, Oppenheimer F, Ricart MJ, Vilardell J, Andreu J. Interaction of fluconazole with ciclosporin A. Nephron Clin Pract 1992; 60:125-6. [PMID: 1738408 DOI: 10.1159/000186724] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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