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Fernández P, Alaye ML, Chiple MEG, Arteaga JD, Douthat W, Fuente JDL, Chiurchiu C. Glomerulopathies after vaccination against COVID-19. Four cases with three different vaccines in Argentina. Nefrologia 2023; 43:655-657. [PMID: 36437205 PMCID: PMC9691444 DOI: 10.1016/j.nefroe.2021.09.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/19/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Pehuén Fernández
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina.
| | - María Luján Alaye
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - María Emilia García Chiple
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina; Servicio de anatomía patológica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Javier De Arteaga
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina; Fundación Nefrológica de Córdoba, Córdoba, Argentina
| | - Walter Douthat
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina; Fundación Nefrológica de Córdoba, Córdoba, Argentina
| | - Jorge De La Fuente
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina; Fundación Nefrológica de Córdoba, Córdoba, Argentina
| | - Carlos Chiurchiu
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina; Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina; Fundación Nefrológica de Córdoba, Córdoba, Argentina
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Barratt J, Lafayette R, Kristensen J, Stone A, Cattran D, Floege J, Tesar V, Trimarchi H, Zhang H, Eren N, Paliege A, Rovin BH, Karl A, Losisolo P, Trimarchi H, Hoyos IG, Lampo MG, Monkowski M, De La Fuente J, Alvarez M, Stoppa D, Chiurchiu C, Novoa PA, Orias M, Barron MB, Giotto A, Arriola M, Cassini E, Maldonado R, Dionisi MP, Ryan J, Toussaint N, Luxton G, Peh CA, Levidiotis V, Francis R, Phoon R, Fedosiuk E, Toropilov D, Yakubtsevich R, Mikhailova E, Bovy C, Demoulin N, Hougardy JM, Maes B, Speeckaert M, Laurin LP, Barbour S, Masse M, Hladunewich M, Reich H, Cournoyer S, Tennankore K, Barbour S, Lv J, Liu Z, Wang C, Li S, Luo Q, Ni Z, Yan T, Fu P, Cheng H, Liu B, Lu W, Wang J, Chen Q, Wang D, Xiong Z, Chen M, Xu Y, Wei J, Pai P, Chen L, Rehorova J, Maixnerova D, Safranek R, Rychlik I, Hruby M, Makela S, Vaaraniemi K, Ortiz F, Alamartine E, Daroux M, Cartery C, Vrtovsnik F, Serre JE, Stamellou E, Vielhauer V, Hugo C, Budde K, Otte B, Nitschke M, Ntounousi E, Boletis I, Papagianni A, Goumenos D, Stylianou K, Zermpala S, Esposito C, Cozzolino MG, Viganò SM, Gesualdo L, Nowicki M, Stompor T, Kurnatowska I, Kim SG, Kim YL, Na KR, Kim DK, Kim SH, Porras LQ, Garcia ER, Pamplona IA, Segarra A, Goicoechea M, Fellstrom B, Lundberg S, Hemmingsson P, Guron G, Sandell A, Chen CH, Tokgoz B, Duman S, Altiparmak MR, Ergul M, Maxwell P, Mark P, McCafferty K, Khwaja A, Cheung CK, Hall M, Power A, Kanigicherla D, Baker R, Moriarty J, Mohamed A, Aiello J, Canetta P, Ayoub I, Robinson D, Thakar S, Mottl A, Sachmechi I, Fischbach B, Singh H, Mulhern J, Kamal F, Linfert D, Rizk D, Wadhwani S, Sarav M, Campbell K, Coppock G, Luciano R, Sedor J, Avasare R, Lau WL. Results from part A of the multi-center, double-blind, randomized, placebo-controlled NefIgArd trial, which evaluated targeted-release formulation of budesonide for the treatment of primary immunoglobulin A nephropathy. Kidney Int 2023; 103:391-402. [PMID: 36270561 DOI: 10.1016/j.kint.2022.09.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [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: 07/01/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
The therapeutic potential of a novel, targeted-release formulation of oral budesonide (Nefecon) for the treatment of IgA nephropathy (IgAN) was first demonstrated by the phase 2b NEFIGAN trial. To verify these findings, the phase 3 NefigArd trial tested the efficacy and safety of nine months of treatment with Nefecon (16 mg/d) versus placebo in adult patients with primary IgAN at risk of progressing to kidney failure (ClinicalTrials.gov: NCT03643965). NefIgArd was a multicenter, randomized, double-blind, placebo-controlled two-part trial. In Part A, 199 patients with IgAN were treated with Nefecon or placebo for nine months and observed for an additional three months. The primary endpoint for Part A was 24-hour urine protein-to-creatinine ratio (UPCR) after nine months. Secondary efficacy outcomes evaluated included estimated glomerular filtration rate (eGFR) at nine and 12 months and the UPCR at 12 months. At nine months, UPCR was 27% lower in the Nefecon group compared with placebo, along with a benefit in eGFR preservation corresponding to a 3.87 ml/min/1.73 m2 difference versus placebo (both significant). Nefecon was well-tolerated, and treatment-emergent adverse events were mostly mild to moderate in severity and reversible. Part B is ongoing and will be reported on later. Thus, NefIgArd is the first phase 3 IgA nephropathy trial to show clinically important improvements in UPCR and eGFR and confirms the findings from the phase 2b NEFIGAN study.
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Affiliation(s)
- Jonathan Barratt
- College of Medicine Biological Sciences and Psychology, University of Leicester, Leicester, UK
| | - Richard Lafayette
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California, USA
| | | | | | - Daniel Cattran
- Division of Nephrology, Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Floege
- Department of Nephrology and Clinical Immunology, Rheinisch Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - Vladimir Tesar
- Department of Nephrology, 1st School of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Hernán Trimarchi
- Nephrology Service, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Necmi Eren
- Department of Nephrology, Kocaeli University, Kocaeli, Turkey
| | - Alexander Paliege
- Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Brad H Rovin
- Division of Nephrology, the Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
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Fernández P, Alaye ML, Chiple MEG, Arteaga JD, Douthat W, Fuente JDL, Chiurchiu C. Glomerulopathies after vaccination against COVID-19. Four cases with three different vaccines in Argentina. Nefrologia 2021; 43:S0211-6995(21)00205-8. [PMID: 34728874 PMCID: PMC8553382 DOI: 10.1016/j.nefro.2021.09.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pehuén Fernández
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - María Luján Alaye
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - María Emilia García Chiple
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
- Servicio de anatomía patológica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Javier De Arteaga
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
- Fundación Nefrológica de Córdoba, Córdoba, Argentina
| | - Walter Douthat
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
- Fundación Nefrológica de Córdoba, Córdoba, Argentina
| | - Jorge De La Fuente
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
- Fundación Nefrológica de Córdoba, Córdoba, Argentina
| | - Carlos Chiurchiu
- Servicio de nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
- Fundación Nefrológica de Córdoba, Córdoba, Argentina
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Luján P, Chiurchiu C, Capra R, de Arteaga J, de la Fuente J, Douthat W. Post-kidney donation glomerular filtration rate measurement and estimation. Nefrologia 2021; 41:191-199. [PMID: 36165380 DOI: 10.1016/j.nefroe.2020.07.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 07/10/2020] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Long-term consequences associated with kidney donation are controversial. Pre- and post-donation glomerular filtration rates (GFRs) are determinants of renal and cardiovascular risk weighting. In Latin America, there is limited experience in evaluating kidney function using GFR measurement techniques in kidney donors. The MDRD 4-variable and CKD-EPI equations are considered reasonable options. The objective of this study was to evaluate the performance of the MDRD and CKD-EPI equations in post-nephrectomy GFR dynamics in kidney donors. MATERIALS AND METHODS A prospective cohort study with GFR measurement and estimation in 189 kidney donors who underwent nephrectomy between 2007 and 2016 at the Hospital Privado Universitario de Córdoba [Private University Hospital of Córdoba] in Córdoba, Argentina. GFRs were evaluated before and after nephrectomy by iothalamate clearance determined by HPLC and by the MDRD and CKD-EPI equations for estimating GFR. Two groups were formed for this study: Group 1 (n=107), with an evaluation time subsequent to GFR stabilization (3 months) of up to 5 years, and Group 2 (n=82), with an evaluation time of 5-10 years following donation. Measured GFR (mGFR) was assessed by iothalamate clearance determined by HPLC. RESULTS Renal compensation values were 61.9% (52.0%-71.1%) and 75.6% (64.9%-84.4%) for Group 1 (n=107) and Group 2 (n=82), respectively. MDRD underestimated the GFR in 3.2% (90ml/min/1.73m2) and 38.6% (60ml/min/1.73m2) compared to the mGFR, and CKD-EPI underestimated the GFR in 2.6% (90ml/min/1.73m2) and 13.8% (60ml/min/1.73m2). Diagnostic performance was evaluated with a ROC curve (mGFR<60ml/min/1.73m2) for MDRD (ABC=0.66; CI: 0.59-0.73; sensitivity: 98.7%; specificity: 63.3%) and for CKD-EPI (ABC=0.79 CI: 0.73-0.85; sensitivity: 96.9%; specificity: 76.4%. Estimated GFR (eGFR) showed poor performance for estimating the glomerular filtration rate in the post-nephrectomy follow-up of donors over 50 years of age. CONCLUSIONS Equations for estimating GFRs showed poor performance for long-term follow-up of post-nephrectomy GFRs. Measuring GFRs to determine kidney function is recommended in the screening and follow-up of some donors under the current selection criteria.
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Affiliation(s)
- Pablo Luján
- Laboratorio de Bioquímica Clínica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
| | - Carlos Chiurchiu
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Raúl Capra
- Laboratorio de Bioquímica Clínica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Javier de Arteaga
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Jorge de la Fuente
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Walter Douthat
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
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Borgogno P, Fernández P, Douthat W, de Arteaga J, Damonte JC, Giacomi V, de la Fuente J, Chiurchiu C. [ABO incompatible living donor kidney transplantation in a center in Córdoba, Argentina]. Medicina (B Aires) 2021; 81:986-995. [PMID: 34875598] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
The ABO incompatible (ABOi) living donor (LD) kidney transplant allows increasing the number of donors and reducing the time on the waiting list. The objectives of this study were to compare graft survival, patient survival, rejection risk factors and complications during the first year p ost-transplantation in patients who received an ABOi LD kidney transplant between 2014 and 2019 in our institution, matched according to sex, age and immunological risk with a control group of ABO compatible (ABOc) LD kidney transplants in the same period. Thirteen patients were included in each group. No significant differences were found between ABOi and ABOc in the incidence of delayed graft function (n = 0 vs. 1), bleeding (0 vs. 0), infections (13 vs. 13), cellular rejection (1 vs. 3) and humoral rejection (4 vs. 3) in the first year after transplantation. The rejection rate in ABOi do not seem to be related to blood incompatibility. No risk factors associated with rejection were found. Overall survival of patients was 100% in both groups, and graft survival was 92.3% in ABOi and 100% in ABOc (p = 1). ABOi kidney transplantation is an adequate feasible option in our environment for those who do not have compatible donors.
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Affiliation(s)
- Pamela Borgogno
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Argentina. E-mail:
- Universidad Católica de Córdoba, Argentina
| | - Pehuén Fernández
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Argentina
- Universidad Católica de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Argentina
| | - Walter Douthat
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Argentina
- Universidad Católica de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Argentina
| | - Javier de Arteaga
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Argentina
- Universidad Católica de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Argentina
| | - Juan Carlos Damonte
- Servicio de Hematología y Criobiología, Hospital Privado Universitario de Córdoba, Argentina
| | - Virginia Giacomi
- Servicio de Hematología y Criobiología, Hospital Privado Universitario de Córdoba, Argentina
| | - Jorge de la Fuente
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Argentina
- Universidad Católica de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Argentina
| | - Carlos Chiurchiu
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Argentina
- Universidad Católica de Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Argentina
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Fernández P, Douthat W, Castellano M, Cardozo G, Garay G, de Arteaga J, Chiurchiu C, de la Fuente J. Biomarkers of bone and mineral disorders (FGF-23, fetuin-A) and vascular calcification scores as predictive tools for cardiovascular death in dialysis patients, at 10 years of follow-up. Medicina (B Aires) 2021; 81:191-197. [PMID: 33906137] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Cardiovascular disorders represent the leading cause of death in dialysis patients. Alterations of bone and mineral metabolism (BMM) and vascular calcifications play a fundamental role in it. The objective of this study was to evaluate the predictive role on cardiovascular mortality of the measurement of biomarkers of BMM and vascular calcifications. A prospective cohort study was performed. All prevalent patients on chronic dialysis in September 2009 at our institution, who completed the total of the complementary studies, were studied. BMM biomarkers were measured (FGF 23, fetuin A, PTH, calcium and phosphorus) and the vascular calcifications were evaluated using the Kauppila and Adragao scores. Follow-up was carried out until 1/1/2019, death or transplant. Of the 30 patients included, 7 (23.3%) died due to cardiovascular causes. The follow-up time was 44.1 ± 30.4 (range = 1.4-112) months. The Adragao score was the only predictive variable of long-term cardiovascular mortality (area under the curve = 0.82; 95% CI 0.64-0.94; p < 0.001). The best cut-off point was 5 (sensitivity = 85.7%; specificity = 78.3%). It was also an independent risk factor for cardiovascular mortality adjusted for age, diabetes mellitus, coronary heart disease, aortic calcifications, time spent on dialysis and follow-up time (adjusted OR = 1.77; 95% CI = 1.06-2.96; p = 0.028). The vascular calcifications quantified from the Adragao score were the only independent predictor of long-term cardiovascular mortality. This score represents a simple, useful and superior tool to the biomarkers of BMM.
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Affiliation(s)
- Pehuén Fernández
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina. E-mail:
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Walter Douthat
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Mauro Castellano
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - Gabriela Cardozo
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - Gabriela Garay
- Laboratorio de Química Clínica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Javier de Arteaga
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - Carlos Chiurchiu
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - Jorge de la Fuente
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
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Luján P, Chiurchiu C, Capra R, de Arteaga J, de la Fuente J, Douthat W. Post-kidney donation glomerular filtration rate measurement and estimation. Nefrologia 2020; 41:191-199. [PMID: 33339672 DOI: 10.1016/j.nefro.2020.07.012] [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: 09/25/2019] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Long-term consequences associated with kidney donation are controversial. Pre- and post-donation glomerular filtration rates (GFRs) are determinants of renal and cardiovascular risk weighting. In Latin America, there is limited experience in evaluating kidney function using GFR measurement techniques in kidney donors. The MDRD 4-variable and CKD-EPI equations are considered reasonable options. The objective of this study was to evaluate the performance of the MDRD and CKD-EPI equations in post-nephrectomy GFR dynamics in kidney donors. MATERIALS AND METHODS A prospective cohort study with GFR measurement and estimation in 189 kidney donors who underwent nephrectomy between 2007 and 2016 at the Hospital Privado Universitario de Córdoba [Private University Hospital of Córdoba] in Córdoba, Argentina. GFRs were evaluated before and after nephrectomy by iothalamate clearance determined by HPLC and by the MDRD and CKD-EPI equations for estimating GFR. Two groups were formed for this study: Group 1 (n=107), with an evaluation time subsequent to GFR stabilization (3 months) of up to 5 years, and Group 2 (n=82), with an evaluation time of 5-10 years following donation. Measured GFR (mGFR) was assessed by iothalamate clearance determined by HPLC. RESULTS Renal compensation values were 61.9% (52.0%-71.1%) and 75.6% (64.9%-84.4%) for Group 1 (n=107) and Group 2 (n=82), respectively. MDRD underestimated the GFR in 3.2% (90ml/min/1.73m2) and 38.6% (60ml/min/1.73m2) compared to the mGFR, and CKD-EPI underestimated the GFR in 2.6% (90ml/min/1.73 m2) and 13.8% (60ml/min/1.73 m2). Diagnostic performance was evaluated with a ROC curve (mGFR<60ml/min/1.73 m2) for MDRD (ABC=0.66; CI: 0.59-0.73; sensitivity: 98.7%; specificity: 63.3%) and for CKD-EPI (ABC=0.79 CI: 0.73-0.85; sensitivity: 96.9%; specificity: 76.4%. Estimated GFR (eGFR) showed poor performance for estimating the glomerular filtration rate in the post-nephrectomy follow-up of donors over 50 years of age. CONCLUSIONS Equations for estimating GFRs showed poor performance for long-term follow-up of post-nephrectomy GFRs. Measuring GFRs to determine kidney function is recommended in the screening and follow-up of some donors under the current selection criteria.
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Affiliation(s)
- Pablo Luján
- Laboratorio de Bioquímica Clínica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
| | - Carlos Chiurchiu
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Raúl Capra
- Laboratorio de Bioquímica Clínica, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Javier de Arteaga
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Jorge de la Fuente
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Walter Douthat
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba y Carrera de posgrado de Nefrología, Universidad Católica de Córdoba, Córdoba, Argentina
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Latzke AB, Fernández P, Chiurchiu C, Sarmantano D, De Arteaga J, Douthat W, De la Fuente J. [Recurrent atypical hemolytic uremic syndrome after renal transplantation: treatment with eculizumab]. Medicina (B Aires) 2018; 78:119-122. [PMID: 29659362] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a rare entity. It is characterized by a thrombotic microangiopathy (nonimmune hemolytic anemia, thrombocytopenia, and acute renal failure), with a typical histopathology of thickening of capillary and arteriolar walls and an obstructive thrombosis of the vascular lumen. The syndrome is produced by a genetic or acquired deregulation of the alternative pathway of the complement system, with high rates of end stage renal disease, post-transplant recurrence, and high mortality. Mutations associated with factor H, factor B and complement C3 show the worst prognosis. Even though plasma therapy is occasionally useful, eculizumab is effective both for treatment and prevention of post-transplant recurrence. We describe here an adult case of congenital aHUS (C3 mutation) under preventive treatment with eculizumab after renal transplantation, with neither disease recurrence nor drug-related adverse events after a 36-months follow-up.
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Affiliation(s)
- Ana B Latzke
- Servicio de Nefrología, Programa de Trasplantes Renales, Hospital Privado Universitario de Córdoba, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina. E-mail:
| | - Pehuén Fernández
- Servicio de Nefrología, Programa de Trasplantes Renales, Hospital Privado Universitario de Córdoba, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina
| | - Carlos Chiurchiu
- Servicio de Nefrología, Programa de Trasplantes Renales, Hospital Privado Universitario de Córdoba, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina
| | - Daniela Sarmantano
- Servicio de Nefrología, Programa de Trasplantes Renales, Hospital Privado Universitario de Córdoba, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina
| | - Javier De Arteaga
- Servicio de Nefrología, Programa de Trasplantes Renales, Hospital Privado Universitario de Córdoba, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina
| | - Walter Douthat
- Servicio de Nefrología, Programa de Trasplantes Renales, Hospital Privado Universitario de Córdoba, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina
| | - Jorge De la Fuente
- Servicio de Nefrología, Programa de Trasplantes Renales, Hospital Privado Universitario de Córdoba, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina
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9
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Fernández P, De Arteaga J, Douthat W, Chiurchiu C, De La Fuente J. Hydrocele Caused by Peritoneal Fluid Leakage Through Inguinal Canal. Perit Dial Int 2017; 37:348-349. [PMID: 28512168 DOI: 10.3747/pdi.2017.00015] [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: 11/15/2022] Open
Affiliation(s)
- P Fernández
- Department of Nephrology and Peritoneal Dialysis Unit, Hospital Privado Universitario de Córdoba, Postgraduate Course of Nephrology, Universidad Católica de Córdoba, Fundación Nefrológica de Córdoba, Córdoba, Argentina
| | - J De Arteaga
- Department of Nephrology and Peritoneal Dialysis Unit, Hospital Privado Universitario de Córdoba, Postgraduate Course of Nephrology, Universidad Católica de Córdoba, Fundación Nefrológica de Córdoba, Córdoba, Argentina
| | - W Douthat
- Department of Nephrology and Peritoneal Dialysis Unit, Hospital Privado Universitario de Córdoba, Postgraduate Course of Nephrology, Universidad Católica de Córdoba, Fundación Nefrológica de Córdoba, Córdoba, Argentina
| | - C Chiurchiu
- Department of Nephrology and Peritoneal Dialysis Unit, Hospital Privado Universitario de Córdoba, Postgraduate Course of Nephrology, Universidad Católica de Córdoba, Fundación Nefrológica de Córdoba, Córdoba, Argentina
| | - J De La Fuente
- Department of Nephrology and Peritoneal Dialysis Unit, Hospital Privado Universitario de Córdoba, Postgraduate Course of Nephrology, Universidad Católica de Córdoba, Fundación Nefrológica de Córdoba, Córdoba, Argentina
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10
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Fernández P, Chiurchiu C, de Arteaga J, Douthat W, Campazzo M, Lujan P, de la Fuente J. Filtrado glomerular estimado por fórmulas en pacientes obesos. Nefrología Latinoamericana 2017. [DOI: 10.1016/j.nefrol.2017.03.002] [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: 11/28/2022] Open
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11
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Fernández P, Núñez S, De Arteaga J, Chiurchiu C, Douthat W, De La Fuente J. [Inadequate doses of hemodialysis. Predisposing factors, causes and prevention]. Medicina (B Aires) 2017; 77:111-116. [PMID: 28463216] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
Patients receiving sub-optimal dose of hemodialysis have increased morbidity and mortality. The objectives of this study were to identify predisposing factors and causes of inadequate dialysis, and to design a practical algorithm for the management of these patients. A cross-sectional study was conducted. Ninety patients in chronic hemodialysis at Hospital Privado Universitario de Córdoba were included, during September 2015. Twenty two received sub-optimal dose of hemodialysis. Those with urea distribution volume (V) greater than 40 l (72 kg body weight approximately) are 11 times more likely (OR = 11.6; CI 95% = 3.2 to 51.7, p < 0.0001) to receive an inadequate dose of hemodialysis, than those with a smaller V. This situation is more frequent in men (OR = 3.5; 95% CI 1.01-15.8; p = 0.0292). V greater than 40 l was the only independent predictor of sub-dialysis in the multivariate analysis (OR = 10.3; 95% CI 2.8-37; p < 0.0004). The main cause of suboptimal dialysis was receiving a lower blood flow (Qb) than the prescribed (336.4 ± 45.8 ml/min vs. 402.3 ± 28.8 ml/min respectively, p < 0.0001) (n = 18). Other causes were identified: shorter duration of the session (n = 2), vascular access recirculation (n = 1), and error in the samples (n = 1). In conclusion, the only independent predisposing factor found in this study for sub-optimal dialysis is V greater than 40 l. The main cause was receiving a slower Qb than prescribed. From these findings, an algorithm for the management of these patients was developed.
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Affiliation(s)
- Pehuén Fernández
- Servicio de Nefrología, Unidad de Hemodiálisis, Hospital Privado Universitario de Córdoba, Carrera de Postgrado de Nefrología, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina. E-mail:
| | - Silvana Núñez
- Servicio de Nefrología, Unidad de Hemodiálisis, Hospital Privado Universitario de Córdoba, Carrera de Postgrado de Nefrología, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina
| | - Javier De Arteaga
- Servicio de Nefrología, Unidad de Hemodiálisis, Hospital Privado Universitario de Córdoba, Carrera de Postgrado de Nefrología, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina
| | - Carlos Chiurchiu
- Servicio de Nefrología, Unidad de Hemodiálisis, Hospital Privado Universitario de Córdoba, Carrera de Postgrado de Nefrología, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina
| | - Walter Douthat
- Servicio de Nefrología, Unidad de Hemodiálisis, Hospital Privado Universitario de Córdoba, Carrera de Postgrado de Nefrología, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina
| | - Jorge De La Fuente
- Servicio de Nefrología, Unidad de Hemodiálisis, Hospital Privado Universitario de Córdoba, Carrera de Postgrado de Nefrología, Universidad Católica de Córdoba, Instituto Universitario de Ciencias Biomédicas de Córdoba, Fundación Nefrológica de Córdoba, Argentina
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12
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Freiberg M, Chiurchiu C, Capra R, Eckhardt A, De La Fuente J, Douthat W, De Arteaga J, Massari PU. [Associated factors and clinical implications of post transplant renal anemia]. Medicina (B Aires) 2013; 73:136-140. [PMID: 23570761] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
A considerable percentage of patients exhibit anemia post kidney transplant. Its origin is multifactorial and the main causes involved depend on the post transplant period considered. We studied in a group of 134 consecutive patients the associated factors and the clinical implications of "late anemia" (6 months post transplant). Multiple regression analysis showed that post transplant oliguria and acute rejection episodes were significantly associated with anemia. Graft survival at 36 months was significantly reduced in the anemic group (83 % versus 96%, p < 0.01). No differences in patients survival or rate of cardiovascular events were observed. We concluded that anemia at 6 months post transplant is independently and significantly associated with events that reduced functioning renal mass and kidney survival.
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Affiliation(s)
- Mónica Freiberg
- Laboratorio de Hematología, Servicio de Bioquímica Clínica, Centro Médico de Córdoba, Fundación Nefrológica de Córdoba.
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13
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Ruggenenti P, Lauria G, Iliev IP, Fassi A, Ilieva AP, Rota S, Chiurchiu C, Barlovic DP, Sghirlanzoni A, Lombardi R, Penza P, Cavaletti G, Piatti ML, Frigeni B, Filipponi M, Rubis N, Noris G, Motterlini N, Ene-Iordache B, Gaspari F, Perna A, Zaletel J, Bossi A, Dodesini AR, Trevisan R, Remuzzi G. Effects of Manidipine and Delapril in Hypertensive Patients With Type 2 Diabetes Mellitus. Hypertension 2011; 58:776-83. [DOI: 10.1161/hypertensionaha.111.174474] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To assess whether angiotensin-converting enzyme inhibitors and third-generation dihydropyridine calcium channel blockers ameliorate diabetic complications, we compared glomerular filtration rate (GFR; primary outcome), cardiovascular events, retinopathy, and neuropathy in 380 hypertensive type 2 diabetics with albuminuria <200 mg/min included in a multicenter, double-blind, placebo-controlled trial (DEMAND [Delapril and Manidipine for Nephroprotection in Diabetes]) and randomized to 3-year treatment with manidipine/delapril combination (10/30 mg/d; n=126), delapril (30 mg/d; n=127), or placebo (n=127). GFR was centrally measured by iohexol plasma clearance. Median monthly GFR decline (interquartile range [IQR]) was 0.32 mL/min per 1.73 m
2
(IQR: 0.16–0.50 mL/min per 1.73 m
2
) on combined therapy, 0.36 mL/min per 1.73 m
2
(IQR: 0.18–0.53 mL/min per 1.73 m
2
) on delapril, and 0.30 mL/min per 1.73 m
2
(IQR: 0.12–0.50 mL/min per 1.73 m
2
) on placebo (
P
=0.87 and
P
=0.53 versus combined therapy or delapril, respectively). Similar findings were observed when baseline GFR values were not considered for slope analyses. Albuminuria was stable in the 3 treatment groups. The hazard ratio (95% CI) for major cardiovascular events between combined therapy and placebo was 0.17 (0.04–0.78;
P
=0.023). Among 192 subjects without retinopathy at inclusion, the hazard ratio for developing retinopathy between combined therapy and placebo was 0.27 (0.07–0.99;
P
=0.048). Among 200 subjects with centralized neurological evaluation, the odds ratios for peripheral neuropathy at 3 years between combined therapy or delapril and placebo were 0.45 (0.24–0.87;
P
=0.017) and 0.52 (0.27–0.99;
P
=0.048), respectively. Glucose disposal rate decreased from 5.8±2.4 to 5.3±1.9 mg/kg per min on placebo (
P
=0.03) but did not change on combined or delapril therapy. Treatment was well tolerated. In hypertensive type 2 diabetic patients, combined manidipine and delapril therapy failed to slow GFR decline but safely ameliorated cardiovascular disease, retinopathy, and neuropathy and stabilized insulin sensitivity.
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Affiliation(s)
- Piero Ruggenenti
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Giuseppe Lauria
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Ilian Petrov Iliev
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Anna Fassi
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Aneliya Parvanova Ilieva
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Stefano Rota
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Carlos Chiurchiu
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Drazenka Pongrac Barlovic
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Angelo Sghirlanzoni
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Raffaella Lombardi
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Paola Penza
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Guido Cavaletti
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Maria Luisa Piatti
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Barbara Frigeni
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Marco Filipponi
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Nadia Rubis
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Greta Noris
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Nicola Motterlini
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Bogdan Ene-Iordache
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Flavio Gaspari
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Annalisa Perna
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Jelka Zaletel
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Antonio Bossi
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Alessandro Roberto Dodesini
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Roberto Trevisan
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
| | - Giuseppe Remuzzi
- From the Mario Negri Institute for Pharmacological Research (P.R., I.P.I., A.F., A.P.I., S.R., C.C., N.R., G.N., N.M., B.E.-I., F.G., A.P., G.R.), Clinical Research Center for Rare Diseases “Aldo e Cele Daccò,” Ranica, Bergamo, Italy; Unit of Nephrology (P.R., S.R., G.R.), Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy; Neuromuscular Diseases Unit (G.L., A.S., R.L., P.P.), Istituto Di Ricovero e Cura a Carattere Scientifico Foundation “Carlo Besta” Neurological Institute, Milan,
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Chiurchiu C, Riva V, Bürgesser M, de Arteaga J, Douthat W, de la Fuente J, de Diller A, Massari P. Expanded Criteria Donors, Histological Scoring, and Prolonged Cold Ischemia: Impact on Renal Graft Survival. Transplant Proc 2011; 43:3312-4. [DOI: 10.1016/j.transproceed.2011.09.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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15
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de Arteaga J, Ledesma F, Garay G, Chiurchiu C, de la Fuente J, Douthat W, Massari P, Terryn S, Devuyst O. High-dose steroid treatment increases free water transport in peritoneal dialysis patients. Nephrol Dial Transplant 2011; 26:4142-5. [PMID: 21940485 DOI: 10.1093/ndt/gfr533] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The water channel aquaporin-1 (AQP1) is the molecular counterpart of the ultrasmall pore that mediates free water transport during peritoneal dialysis (PD). Proof-of-principle studies performed in rats have shown that treatment with corticosteroids upregulates the expression of AQP1 in the peritoneal capillaries, causing a significant increase in free water transport. Whether such a beneficial effect could be observed in end-stage renal disease patients treated by PD remains unknown. Peritoneal transport parameters were evaluated in three patients on PD, shortly before and after living-donor renal transplantation and treatment with high-dose methylprednisolone (1.0-1.2 g/m(2)). As compared with pre-transplantation values, the post-transplantation test revealed an ∼2-fold increase in the sodium sieving and ultrasmall pore ultrafiltration volume, suggesting an effect on AQP1 water channels. In contrast, there was no change in the parameters of small solute transport. The direct involvement of AQP1 in these changes is suggested by the expression of glucocorticoid receptors in the human peritoneum and the presence of conserved glucocorticoid response elements in the promoter of the human AQP1 gene.
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Affiliation(s)
- Javier de Arteaga
- Servicio de Nefrologia, Hospital Privado de Cordoba, Universidad Catolica de Cordoba, Cordoba, Argentina
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16
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Douthat WG, Cardozo G, Garay G, Orozco S, Chiurchiu C, de la Fuente J, de Arteaga J, Massari PU. Use of percutaneous ethanol injection therapy for recurrent secondary hyperparathyroidism after subtotal parathyroidectomy. Int J Nephrol 2011; 2011:246734. [PMID: 21716690 PMCID: PMC3118542 DOI: 10.4061/2011/246734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 03/31/2011] [Accepted: 04/04/2011] [Indexed: 01/19/2023] Open
Abstract
We evaluated the efficacy of percutaneous ethanol injection therapy (PEIT) as a therapeutic option for recurrence of secondary hyperparathyroidism after subtotal parathyroidectomy in ESRD patients. Six patients underwent PEIT. A mean of 1.3 ± 0.8 ethanol injections was performed. Nodular volume was 1.5 ± 1.7 cm3, and 2.8 ± 2.8 cm3 of ethanol was injected per patient. After ethanol injection PTH decreased significantly (1897 ± 754 to 549 ± 863 pg/mL (P < .01)). There was also a reduction in serum calcium, phosphorus and calcium-phosphorus product. A positive and significant correlation was found between nodular volume with ethanol injected and time from parathyroidectomy. Only one patient required hospitalization due to severe hypocalcaemia. In other two cases, local discomfort and temporary mild dysphonia were registered. PEIT is an effective treatment to control recurrences of secondary hyperparathyroidism postsubtotal parathyroidectomy.
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Affiliation(s)
- Walter G Douthat
- Bone and Mineral Metabolism Section, Renal Service, Hospital Privado-Centro Médico de Córdoba, Postgraduate School of Nephrology, Catholic University of Córdoba, Naciones Unidas 346, 5016 Córdoba, Argentina
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17
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Chiurchiu C, de Alvarellos T, Sanchez A, Cortiñas D, Douthat W, de la Fuente J, de Arteaga J, Massari PU. Thrombophilic mutations: no association with thrombotic events in renal transplant recipients. Transplant Proc 2010; 42:282-3. [PMID: 20172331 DOI: 10.1016/j.transproceed.2009.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Factor V Leiden and mutation of prothrombin gene G20210A have been associated with poor results in the early post-kidney transplantation period. Its long-term importance in stable patients has yet to be evaluated. We studied the prevalence of these inherited mutations and their relationship to thrombotic events in 82 Argentine renal transplant recipients with adequate long-term kidney function. In aggregate, 7.2% of patients were carriers of these mutations; however, their presence did not show any association with thrombotic events or renal function alterations. The routine evaluation for these mutations does not seem to be cost-effective in renal transplant patients.
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Affiliation(s)
- C Chiurchiu
- Hospital Privado Centro-Médico de Córdoba, Córdoba, Argentina.
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18
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Vogt L, Chiurchiu C, Chadha-Boreham H, Danaietash P, Dingemanse J, Hadjadj S, Krum H, Navis G, Neuhart E, Parvanova AI, Ruggenenti P, Woittiez AJ, Zimlichman R, Remuzzi G, de Zeeuw D. Effect of the Urotensin Receptor Antagonist Palosuran in Hypertensive Patients With Type 2 Diabetic Nephropathy. Hypertension 2010; 55:1206-9. [DOI: 10.1161/hypertensionaha.109.149559] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The urotensin system has been hypothesized to play an important role in the pathophysiology of diabetic nephropathy. In this multicenter, randomized, double-blind, placebo-controlled, 2-period crossover study, the effects of the urotensin receptor antagonist palosuran on urinary albumin excretion and blood pressure in hypertensive patients with type 2 diabetic nephropathy treated with a single blocker of the renin-angiotensin-aldosterone system were assessed. Patients with 24-hour albuminuria >0.5 and <3.0 g, systolic blood pressure >135 and <170 mm Hg, and/or diastolic blood pressure >85 and <110 mm Hg received both palosuran 125 mg BID and placebo for 4 weeks each. Fifty-four patients (20% women; mean age: 61.6 years, blood pressure: 155/84 mm Hg, and albuminuria: 1016 mg per 24 hours) were included in the per-protocol analysis. Palosuran did not affect albuminuria, blood pressure, glomerular filtration rate, or renal plasma flow significantly. These results question whether urotensin receptor antagonism represents a new treatment strategy in this high-risk patient population.
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Affiliation(s)
- Liffert Vogt
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Carlos Chiurchiu
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Harbajan Chadha-Boreham
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Parisa Danaietash
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Jasper Dingemanse
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Samy Hadjadj
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Henry Krum
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Gerjan Navis
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Eric Neuhart
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Aneliya I. Parvanova
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Piero Ruggenenti
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Arend Jan Woittiez
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Reuven Zimlichman
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Giuseppe Remuzzi
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
| | - Dick de Zeeuw
- From the University Medical Center (L.V., G.N., D.d.Z.), University of Groningen, Groningen, The Netherlands; Academic Medical Center (L.V.), University of Amsterdam, Amsterdam, The Netherlands; Clinical Research Center for Rare Diseases “Aldo e Cele Daccò” Mario Negri (L.V., C.C., A.I.P., P.R., G.R.), Institute for Pharmacological Research Villa Camozzi, Ranica (Bergamo), Italy; Actelion Pharmaceuticals Ltd (H.C.-B., P.D., J.D., E.N.), Allschwil, Switzerland; Centre Hospitalier Universitaire
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Pernasetti MM, Chiurchiu C, Fuente JDL, Arteaga JD, Douthat W, Bardosy C, Zarate A, Massari PU. [Renal abnormalities in HIV infected patients]. Medicina (B Aires) 2010; 70:247-253. [PMID: 20529774] [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: 05/29/2023] Open
Abstract
Several renal complications may occur during HIV infection, especially in advanced stages related to HIV, to other infectious agents and/or drugs. Little is known about the prevalence of renal diseases that may occur as a complication of or related to HIV infection in asymptomatic patients. This is a single center cross-sectional study of asymptomatic HIV(+) patients referred to a nefrology care service at an Argentine hospital to look for the presence of renal abnormalities. Fifty two consecutive patients were studied between April and November 2008. Patients underwent plasma and urine analysis, ultrasound, and kidney biopsy as needed. Mean age was 39.9 +/- 10.6 years, 88% were male, time from HIV diagnosis 53.2 +/- 41.2 months (2-127); 71% had HIV-disease and 77% were on antiretroviral therapy. Mean plasma HIV-RNA copies number was 7.043 +/- 3.322 and CD4+ cell count: 484 +/- 39. Pathologic findings in urine analysis were present in 30.7% of patients: albuminuria 16.6%, microscopic hematuria 11.5%, hypercalciuria 10.8% and crystalluria 6%. Mean glomerular filtration rate was 102.2 +/- 22.95 ml/min (34-149) and 41% of patients could be classified in stages 1 to 3 of chronic kidney disease. Renal abnormalities prevaled in older patients without relationship with presence of HIV-disease. Two patients were biopsied and the findings included: tubulointerstitial nephritis with presence of crystal deposition in one and IgA nephropathy in the other. No HIV-associated nephropathy was detected. The broad spectrum and the high prevalence of lesions found in this series suggest that asymptomatic HIV-infected patients should routinely undergo renal evaluation.
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Affiliation(s)
- María Marta Pernasetti
- Servicio de Nefrología y Carrera de Posgrado, Universidad Católica de Córdoba, Argentina
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Bittar J, Arenas P, Chiurchiu C, de la Fuente J, de Arteaga J, Douthat W, Massari PU. Renal transplantation in high cardiovascular risk patients. Transplant Rev (Orlando) 2009; 23:224-34. [DOI: 10.1016/j.trre.2009.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Chiurchiu C, Garces N, Garay G, Holtz R, Douthat W, de Arteaga J, Capra R, Massari PU. [Usefulness of equations based on serum cystatin C concentration in the study of renal function]. Medicina (B Aires) 2007; 67:136-42. [PMID: 17593597] [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: 05/16/2023] Open
Abstract
Serum creatinine is an insensitive marker to identify early changes in glomerular filtration rate (GFR), for this reason alternative methods to estimate renal function result of great clinical importance. Forty-one patients were studied using creatinine clearance modified with cimetidina (Clcrc) as surrogate of GFR, cystatin C-based equations (i.e. Larsson and Hoek formulas), Cockroft-Gault and MDRD abbreviated equations. In the whole group, as well as in those patients with serum creatinine < or =1.2 mg/dl--but reduced renal function: Clcrc 62.01 +/- 17.33 ml/ min/1.73 m(2)-, Larsson and Hoek equations showed higher correlations and lower bias than creatinine-based formulas. Abbreviated MDRD equation showed good performance just in those patients with evident alteration of renal function (serum creatinine > 1.2 mg/dl). We concluded that in patients with different stages of renal function, cystatin C-based equations detect reduction of renal function earlier than the serum creatinine-based formulas.
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Affiliation(s)
- Carlos Chiurchiu
- Servicio de Nefrologia, Hospital Privado Centro Médico de Córdoba, Córdoba, Argentina
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Ruggenenti P, Chiurchiu C, Abbate M, Perna A, Cravedi P, Bontempelli M, Remuzzi G. Rituximab for Idiopathic Membranous Nephropathy: Who Can Benefit? Clin J Am Soc Nephrol 2006; 1:738-48. [PMID: 17699281 DOI: 10.2215/cjn.01080905] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [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: 11/23/2022]
Abstract
Rituximab effectively reduces proteinuria in patients with idiopathic membranous nephropathy (IMN), but response to treatment may vary from patient to patient. The association between baseline clinical, laboratory, and histology covariates and proteinuria reduction was evaluated retrospectively by multiple linear regression analysis at 3 mo after rituximab therapy in 14 patients with IMN with proteinuria > 3.5 g/24 h while on angiotensin-converting enzyme inhibition for at least 6 mo and no previous remissions. The association strength was expressed by standardized beta coefficients (SbetaC). Glomerular (SbetaC = 0.48, P = 0.049) and tubulointerstitial (TI) scores (SbetaC = 0.61, P = 0.003) predicted the outcome. Among glomerular and TI score components, tubular atrophy (SbetaC = 0.59, P = 0.003) and interstitial fibrosis (SbetaC = 0.60, P = 0.001) were significantly associated with 3-mo proteinuria. Urinary protein excretion decreased from 9.1 +/- 4.0 to 4.6 +/- 3.5 g/24 h (P < 0.001) in eight patients with TI score 1.7 but did not change in six with a score > or = 1.7. Nine additional patients with IMN then were allocated prospectively to rituximab treatment on the basis of a TI score < 1.7. Three-month proteinuria decreased in all patients from 8.9 +/- 5.3 to 4.9 +/- 3.9 g/24 h (P < 0.001) and serum albumin increased from 2.2 +/- 0.6 to 2.8 +/- 0.5 mg/dl (P < 0.01). Changes in serum albumin and cholesterol were inversely correlated (P < 0.02, r = -0.44). Rituximab achieved CD20 and CD19 depletion in all patients. In patients with IMN and nephrotic proteinuria despite angiotensin-converting enzyme inhibition therapy, renal biopsy findings may help in predicting response to rituximab and defining selection criteria for randomized trials that aim to assess the risk/benefit profile of B cell target therapy as compared with aspecific immunosuppressants and/or conservative therapy alone.
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Affiliation(s)
- Piero Ruggenenti
- Clinical Research Center for Rare Diseases Aldo & Cele Daccò, Mario Negri Institute for Pharmacological Research, Via Gavazzeni, 11, 24125 Bergamo, Italy.
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Parvanova A, Chiurchiu C, Ruggenenti P, Remuzzi G. Inhibition of the renin-angiotensin system and cardio-renal protection: focus on losartan and angiotensin receptor blockade. Expert Opin Pharmacother 2005; 6:1931-42. [PMID: 16144512 DOI: 10.1517/14656566.6.11.1931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/05/2022]
Abstract
Angiotensin II plays a central role in the pathogenesis and progression of proteinuric nephropathies and related cardiovascular complications. Losartan is a selective non-peptide angiotensin Type 1-receptor blocker (ARB) with unique uricosuric effect, not shared by other ARBs. Losartan has demonstrated renoprotective effects in animals and humans with diabetic and non-diabetic renal diseases similar to those of angiotensin-converting enzyme inhibitors, with a lower incidence of dry cough and angioneurotic oedema. A reduced incidence of cerebrovascular events and diabetes has been reported in hypertensive patients with left ventricular hypertrophy on losartan therapy compared with patients treated with atenolol. Whether ARBs have superior cardioprotective effects, compared with other blood pressure medications, is still unknown. Combined angiotensin-converting enzyme inhibitor and ARB therapy improves renal outcomes in non-diabetic nephropathies more than single drug renin-angiotensin system inhibition. Whether this also applies to diabetic nephropathy and related cardiovascular outcomes is still unknown.
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Affiliation(s)
- Aneliya Parvanova
- Clinical Research Centre for Rare Diseases Aldo e Cele Daccò, Villa Camozzi, Mario Negri Institute for Pharmacological Research, 24125 Bergamo, Italy
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Chiurchiu C, Remuzzi G, Ruggenenti P. Angiotensin-converting enzyme inhibition and renal protection in nondiabetic patients: the data of the meta-analyses. J Am Soc Nephrol 2005; 16 Suppl 1:S58-63. [PMID: 15938036 DOI: 10.1681/asn.2004110968] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [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: 01/13/2023] Open
Abstract
ESRD represents a major health problem. The number of patients who enter kidney replacement programs has increased at an average of 7% per year in the past 10 yr. A large number of experimental and clinical studies have demonstrated that chronic nephropathies share common pathogenic mechanisms that contribute to renal disease progression, even independent of the original cause. Clinical studies found a significant correlation between the extent of urinary protein excretion and the rate of GFR decline in both diabetic and nondiabetic chronic nephropathies. Randomized trials, in particular the Ramipril Efficacy In Nephropathy (REIN) study, also showed that treatments that reduce proteinuria (namely angiotensin-converting enzyme [ACE] inhibitors) are renoprotective and limit progression to ESRD. Meta-analyses of randomized clinical trials also evaluated the role of proteinuria and of ACE inhibition therapy in chronic renal disease progression. Their findings were consistent with those of the REIN study and confirmed in larger series of patients the predictive value of proteinuria and the renoprotective effect of proteinuria reduction by ACE inhibition therapy. Thus, the meta-analyses may confirm and extend previous findings generated by randomized clinical trials. Conceivably, well-designed studies in properly selected and carefully monitored patients who are at increased risk continue to be the best approach to test novel hypotheses. The meta-analyses, however, represent a valuable tool to evaluate the consistency and generalizability of trial results to larger cohorts of patients.
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Affiliation(s)
- Carlos Chiurchiu
- Mario Negri Institute for Pharmacological Research, Bergamo, Italy
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Abstract
About two thirds of patients on renal replacement therapy irreversibly lose their kidney function because of progressive nephropathies, such as diabetic nephropathy and nondiabetic chronic renal disease. Halting the progression of these patients to end-stage renal disease (ESRD) is instrumental to substantially decrease the need and cost for renal replacement therapy. A large number of experimental studies have demonstrated that chronic nephropathies share common pathogenic mechanisms that contribute to renal disease progression, even independently of the original etiology. Actually, a variety of insults may result in a common pathway of systemic hypertension, increased glomerular pressure and protein ultrafiltration, glomerular and tubular protein overload, chronic inflammation and, ultimately, scarring. Experimental and clinical data converge to indicate that in chronic renal disease increased protein traffic is nephrotoxic, proteinuria predicts disease progression, and proteinuria reduction is renoprotective. Initial clinical trials, mostly in patients with no or mild proteinuria, failed to demonstrate that ACE inhibition therapy is renoprotective in nondiabetic chronic nephropathies. Consistently, meta-analyses based on data generated by these trials failed to detect a specific, blood pressure-independent, renoprotective effect of ACE inhibition therapy. The Ramipril Efficacy In Nephropathy (REIN) study found that ACE inhibitors, by reducing urinary proteins, may contribute to improve the outcome of nondiabetic renal disease, and reduce the risk of progression to ESRD by about 50%. Cumulative meta-analyses, including the REIN study results, confirmed and extended these findings. Thus, well-designed trials in properly selected and carefully monitored study populations continue to be the best approach to test the efficacy of novel treatments. The meta-analyses may help confirming the consistency of these findings and their generalizability to larger cohorts of patients.
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Affiliation(s)
- Giuseppe Remuzzi
- Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
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Botta C, Salamano M, Colautti M, Palchik V, Pérez B, Traverso M, Da Costa M, Ferrara M, Pérez González R, Rubinich T, Basurto I, Bencomo B, Chiurchiu C, Zenclussen S. [Economic management of institutional pharmacies of the city of Rosario. Quality indicators proposal]. Farm Hosp 2004; 28:327-33. [PMID: 15504090] [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: 05/01/2023] Open
Abstract
OBJECTIVE To compare structures, procedures and results of the pharmaceutical management of institutional pharmacies in the city of Rosario (Argentina), to define the current situation and thus recommend changes. METHOD Descriptive study, using a questionnaire and quality indicators of an Accreditation Program of Hospital Pharmacies. Evaluated dimensions: selection, acquisition, reception, storage and stock control of drugs and medical devices. Data was collected for a one-year-period in order to obtain indicators. After tabulation, data was discussed in meetings with all the pharmacists that participate in this study, in order to evaluate the situation and propose changes for the Pharmacies, as well as to evaluate the Program based on usefulness of these indicators. RESULTS The general results illustrate how each institution has different health policies. 43.2% of indicators were answered, 67.6% reached standard values. CONCLUSIONS This work allowed for an exhaustive analysis of the current situation. The pharmacists made proposals and unified criteria in order to obtain an improved use of the economic resources of each institution.
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Affiliation(s)
- C Botta
- Servicio de Farmacia, Hospital Doctor Roque Sánz Peña, Argentina.
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Chiurchiu C, Remuzzi G. [Thrombotic microangiopathy]. Nefrologia 2003; 23 Suppl 3:13-20. [PMID: 12901186] [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: 03/04/2023] Open
Affiliation(s)
- C Chiurchiu
- Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo, Italy.
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Ruggenenti P, Chiurchiu C, Brusegan V, Abbate M, Perna A, Filippi C, Remuzzi G. Rituximab in idiopathic membranous nephropathy: a one-year prospective study. J Am Soc Nephrol 2003; 14:1851-7. [PMID: 12819245 DOI: 10.1097/01.asn.0000071511.35221.b3] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.5] [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: 01/20/2023] Open
Abstract
Currently available monoclonal antibodies against the B cell surface antigen CD20 have been employed to explore whether specific inhibition of B cells may help improve the outcome of idiopathic membranous nephropathy (IMN) and may avoid the side effects of steroids and immunosuppressants. This prospective, observational study evaluated the 1-yr outcome of eight IMN patients with persistent (>6 mo) urinary protein excretion > 3.5 g/24 h given four weekly infusions of the anti-CD20 antibody rituximab (375 mg/m(2)). At 3 and 12 mo, proteinuria significantly decreased from mean (+/- SD) 8.6 +/- 4.2 to 4.3 +/- 3.3 (-51%, P < 0.005) and 3.0 +/- 2.5 (-66%, P < 0.005) g/24 h, albumin fractional clearance from 2.3 +/- 2.1 to 1.2 +/- 1.7 (-47%, P < 0.05) and 0.5 +/- 0.6 (-76%, P < 0.003), and serum albumin concentration increased from 2.7 +/- 0.5 to 3.1 +/- 0.3 (+21%, P < 0.05) and 3.5 +/- 0.4 (+41%, P < 0.05) mg/dl. At 12 mo, proteinuria decreased to < or =0.5 g/24 h or < or =3.5 g/24 h in two and three patients, respectively. Proteinuria decreased in the remaining patients by 74%, 44%, and 41%, respectively. Body weight, diastolic BP, and serum cholesterol progressively decreased in parallel with an improvement of edema in all patients. Renal function stabilized (Delta1/creatinine: +0.002 +/- 0.007). CD20 B lymphocytes fell below normal ranges up to study-end. No patient had major drug-related events or major changes in other laboratory parameters. Rituximab thus promotes sustained disease remission in patients otherwise predicted to progress to ESRD, and it is safe. The long-term risk/benefit profile of this novel, disease-specific approach seems much more favorable to that of commonly employed immunosuppressive drugs.
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Affiliation(s)
- Piero Ruggenenti
- Aldo & Cele Daccò Clinical Research Center for Rare Diseases and Negri Bergamo Laboratories, Mario Negri Institute for Pharmacological Research, Via Gavazzeni 11, 24125 Bergamo, Italy
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Chiurchiu C, Ruggenenti P, Remuzzi G. Thrombotic microangiopathy in renal transplantation. Ann Transplant 2003; 7:28-33. [PMID: 12221901] [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: 02/26/2023] Open
Abstract
The term thrombotic microangiopathy (TMA) encompasses syndromes of thrombocytopenia, microangiopathic haemolytic anaemia, neurologic deficits, renal dysfunction and variable signs of organ impairment. Childhood cases of TMA with predominant renal failure are usually referred as Haemolytic Uremic Syndrome (HUS), and adult cases with major neurological involvement as Thrombotic Thrombocytopenic Purpura (TTP). Exotoxins, produced in most cases by E. Coli O 157:H7, have been related to diarrhea associated HUS(D + HUS). Anticancer (mitomycin), immunosuppressive drugs (cyclosporin, tacrolimus and OKT3) and as well as some antiplatelet agents (ticlopidine, clopidrogel) have been associated with both HUS and TTP. Defective factor H or vWF protease activity have been found with familiar and recurrent forms. Endothelial damage and dysfunction is most likely the initial event of the pathogenic process that eventually leads to platelet aggregation, microvascular thrombosis and tissue ischemia. TMA may occur de novo in the native kidneys of patients who received a non-kidney transplant or in the transplanted kidney of patients who progressed to ESRD because of a disease other than HUS. Calcineurin inhibitors and vascular rejection are most often involved in these cases. The disease may also recur on the transplanted kidney in patients who progressed to ESRD because of HUS/TTP. The risk of postransplant recurrence is negligible for D + HUS but is close to 100% in familial/recurrent forms associated with low C3 and decreased factor H bioavailability or activity. Withdrawal or treatment of precipitating factors are the most effective approach. Plasma therapy is usually attempted with the rationale to limit the microangiopathic process, but its efficacy for improving graft survival is unproven. The outcome of recurrent forms is almost invariably poor.
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Affiliation(s)
- Carlos Chiurchiu
- Department of Kidney Research, Mario Negri Institute for Pharmacological Research, Bergamo, Italy
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Chiurchiu C, Firrincieli A, Santostefano M, Fusaroli M, Remuzzi G, Ruggenenti P. Adult nondiarrhea hemolytic uremic syndrome associated with Shiga toxin Escherichia coli O157:H7 bacteremia and urinary tract infection. Am J Kidney Dis 2003; 41:e4.1 - e4.4. [PMID: 12500215 DOI: 10.1053/ajkd.2003.50022] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [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: 11/11/2022]
Abstract
About 15% of children with Shiga toxin (Stx) producing Escherichia coli (STEC) primarily of serotype O157:H7, gastrointestinal infection, and watery or bloody diarrhea, may develop hemolytic uremic syndrome (D+ HUS). Usually D+ HUS is not complicated by bacteremia and patients recover spontaneously without antibiotic treatment. We report here an adult case of a STEC O157:H7 urinary tract infection complicated by bacteremia and HUS that was not preceded by diarrhea (D- HUS). Cases of D- HUS need to be carefully examined for foci other than the gastrointestinal tract, and patients with E coli bacteremia should receive early antibiotic treatment as would any patient with sepsis.
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Affiliation(s)
- Carlos Chiurchiu
- Clinical Research Center for Rare Diseases Aldo e Cele Daccò, Mario Negri Institute for Pharmacological Research, Villa Camozzi-Ranica, Bergamo, Italy.
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Abstract
Treatments for idiopathic membranous nephropathy, a common cause of nephrotic syndrome, can be very toxic. In view of the pathogenic potential of B cells in this disease, we studied the effects of four weekly infusions of rituximab (375 mg/m(2)-- the monoclonal antibody to B-cell antigen CD20--in eight patients who had idiopathic membranous nephropathy with persistent nephrotic syndrome. At weeks 4 and 20, urinary protein decreased from mean (SE) 8.6 g/24 h (1.4) to 3.8 (0.8) and 3.7 (0.9), respectively (p<0.0001). At week 20, albuminuria and albumin fractional clearance decreased by 70% and 65%, and serum albumin increased by 31%. CD20 B lymphocytes fell below normal ranges up to study end. The short-term risk-benefit profile of rituximab seems more favourable to that of any other immunosuppressive drug used to treat idiopathic membranous nephropathy.
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Affiliation(s)
- Giuseppe Remuzzi
- Ospedali Riuniti Di Bergam, Unit of Nephrology and Dialysis, Aldo and Cele Daccò Clinical Research Centre for Diseases, Mario Negri Institute for Parmacological Research, Via Gavazzeni 1124125, Bergamo, Italy.
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Mas V, Alvarellos T, Chiurchiu C, Camps D, Massari P, de Boccardo G. Hepatitis C virus infection after renal transplantation: viral load and outcome. Transplant Proc 2001; 33:1791-3. [PMID: 11267514 DOI: 10.1016/s0041-1345(00)02682-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- V Mas
- Molecular Diagnostic Lab, Hospital Privado, Córdoba, Argentina
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