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Koubar SH, Garcia-Rivera A, Mohamed MMB, Hall JE, Hall ME, Hassanein M. Underlying Mechanisms and Treatment of Hypertension in Glomerular Diseases. Curr Hypertens Rep 2024; 26:119-130. [PMID: 37982994 DOI: 10.1007/s11906-023-01287-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE OF REVIEW This review aims to explore the underlying mechanisms that lead to hypertension in glomerular diseases and the advancements in treatment strategies and to provide clinicians with valuable insights into the pathophysiological mechanisms and evidence-based therapeutic approaches for managing hypertension in patients with glomerular diseases. RECENT FINDINGS In recent years, there have been remarkable advancements in our understanding of the immune and non-immune mechanisms that are involved in the pathogenesis of hypertension in glomerular diseases. Furthermore, this review will encompass the latest data on management strategies, including RAAS inhibition, endothelin receptor blockers, SGLT2 inhibitors, and immune-based therapies. Hypertension (HTN) and cardiovascular diseases are leading causes of mortality in glomerular diseases. The latter are intricately related with hypertension and share common pathophysiological mechanisms. Hypertension in glomerular disease represents a complex and multifaceted interplay between kidney dysfunction, immune-mediated, and non-immune-mediated pathology. Understanding the complex mechanisms involved in this relationship has evolved significantly over the years, shedding light on the pathophysiological processes underlying the development and progression of glomerular disease-associated HTN, and is crucial for developing effective therapeutic strategies and improving patients' outcomes.
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Affiliation(s)
- Sahar H Koubar
- Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Alejandro Garcia-Rivera
- Department of Nephrology. Hospital General Regional 46, Instituto Mexicano del Seguro Social, Guadalajara, Mexico
| | - Muner M B Mohamed
- Department of Nephrology, Ochsner Health System, New Orleans, LA, USA
- Ochsner Clinical School, The University of Queensland, Brisbane, QLD, Australia
| | - John E Hall
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
- Mississippi Center for Obesity Research, University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael E Hall
- Division of Cardiovascular Disease, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mohamed Hassanein
- Division of Nephrology and Hypertension, Department of Medicine, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS, USA.
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Davison SN, Pommer W, Brown MA, Douglas CA, Gelfand SL, Gueco IP, Hole BD, Homma S, Kazancıoğlu RT, Kitamura H, Koubar SH, Krause R, Li KC, Lowney AC, Nagaraju SP, Niang A, Obrador GT, Ohtake Y, Schell JO, Scherer JS, Smyth B, Tamba K, Vallath N, Wearne N, Zakharova E, Zúñiga C, Brennan FP. Conservative kidney management and kidney supportive care: core components of integrated care for people with kidney failure. Kidney Int 2024; 105:35-45. [PMID: 38182300 DOI: 10.1016/j.kint.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 01/07/2024]
Abstract
Integrated kidney care requires synergistic linkage between preventative care for people at risk for chronic kidney disease and health services providing care for people with kidney disease, ensuring holistic and coordinated care as people transition between acute and chronic kidney disease and the 3 modalities of kidney failure management: conservative kidney management, transplantation, and dialysis. People with kidney failure have many supportive care needs throughout their illness, regardless of treatment modality. Kidney supportive care is therefore a vital part of this integrated framework, but is nonexistent, poorly developed, and/or poorly integrated with kidney care in many settings, especially in low- and middle-income countries. To address this, the International Society of Nephrology has (i) coordinated the development of consensus definitions of conservative kidney management and kidney supportive care to promote international understanding and awareness of these active treatments; and (ii) identified key considerations for the development and expansion of conservative kidney management and kidney supportive care programs, especially in low resource settings, where access to kidney replacement therapy is restricted or not available. This article presents the definitions for conservative kidney management and kidney supportive care; describes their core components with some illustrative examples to highlight key points; and describes some of the additional considerations for delivering conservative kidney management and kidney supportive care in low resource settings.
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Affiliation(s)
- Sara N Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Wolfgang Pommer
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany; Kuratorium für Dialyse und Nierentransplantation, Neu-Isenburg, Germany
| | - Mark A Brown
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; School of Clinical Medicine, University of New South Wales, Kogarah, Australia
| | - Claire A Douglas
- Department of Renal Medicine, Ninewells Hospital, Dundee, Scotland, UK
| | - Samantha L Gelfand
- Division of Renal (Kidney) Medicine, Department of Psychosocial Oncology and Palliative Care, Brigham and Women's Hospital, Boston, Massachusetts, USA; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Irmingarda P Gueco
- Section of Nephrology, The Medical City, Pasig City, National Capital Region, Philippines
| | - Barnaby D Hole
- Department of Population Health, University of Bristol, Bristol, UK
| | - Sumiko Homma
- Department of Nephrology, Koga Red Cross Hospital, Koga, Ibaraki, Japan
| | - Rümeyza T Kazancıoğlu
- Division of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Harumi Kitamura
- Department of Clinical Quality Management, Osaka University Hospital, Osaka, Japan
| | - Sahar H Koubar
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rene Krause
- Division of Interdisciplinary Palliative Care and Medicine, Department of Family Community and Emergency Care, University of Cape Town, Cape Town, South Africa
| | - Kelly C Li
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; School of Clinical Medicine, University of New South Wales, Kogarah, Australia
| | - Aoife C Lowney
- Department of Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland; Department of Palliative Medicine, Cork University Hospital, Cork, Ireland; Department of Palliative Medicine, University College Cork, Cork, Ireland
| | - Shankar P Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Abdou Niang
- Nephrology Department, Cheikh Anta Diop University, Dakar, Senegal
| | - Gregorio T Obrador
- Department of Biostatistics and Public Health, Universidad Panamericana School of Medicine, Mexico City, Mexico
| | | | - Jane O Schell
- Section of Palliative Care and Medical Ethics, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jennifer S Scherer
- Department of Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Brendan Smyth
- Department of Renal Medicine, St George Hospital, Kogarah, Australia; School of Clinical Medicine, University of New South Wales, Kogarah, Australia; National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Kaichiro Tamba
- Division of Palliative Care Medicine, Juchi Medical School University Hospital, Tochigi, Japan
| | - Nandini Vallath
- Department of Palliative Medicine, St Johns National Academy of Health Sciences, Bengaluru, India
| | - Nicola Wearne
- Division of Nephrology and Hypertension, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Carlos Zúñiga
- Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Frank P Brennan
- Kuratorium für Dialyse und Nierentransplantation, Neu-Isenburg, Germany; Department of Renal Medicine, St George Hospital, Kogarah, Australia
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Hoteit M, Al-Masry A, Elbejjani M, Aoun M, Abu-Dargham R, Medawar W, Abou Zeinab H, Farhood L, Koubar SH. Sleepiness and Health-Related Quality of Life Among Kidney Transplant Recipients in a Low-Middle Income Country: A Cross-Sectional Study. Transpl Int 2023; 36:11547. [PMID: 38020749 PMCID: PMC10647915 DOI: 10.3389/ti.2023.11547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023]
Abstract
This study aims to describe daytime sleepiness and health-related quality of life (HRQoL) among Lebanese kidney transplant (KT) recipients and to examine the medical, psychosocial and transplant factors related to them. It is a cross-sectional multi-center study involving KT recipients >18 years. Daytime sleepiness was assessed using ESS Questionnaire. HRQoL was measured using the SF-36 questionnaire. Social support was self-reported. A multivariable regression analysis evaluated factors associated with daytime sleepiness and HRQoL in our sample. 118 patients were recruited over a 2 years period. Excessive daytime sleepiness was prevalent in 12.7%. It was associated with Diabetes Mellitus (OR 3.97, 95% CI 0.94-16.81, p = 0.06) and obesity (OR 1.13, 95% CI 1.02, 1.27, p = 0.02). Social support and higher eGFR were associated with better scores on the MCS (β 24.13 p < 0.001 and β 0.26 p < 0.01) and the PCS (β 15.48 p < 0.01 and β 0.22 P 0.02). Conversely, depression and hospitalization were negatively associated with the MCS (β -27.44, p < 0.01 and β -9.87, p < 0.01) and the PCS (β -0.28.49, p < 0.01 and β -10.37, p < 0.01).
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Affiliation(s)
- Mayssaa Hoteit
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Ahmad Al-Masry
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Martine Elbejjani
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | - Mabel Aoun
- AUB Santé, Lorient, France
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | | | - Walid Medawar
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Hilal Abou Zeinab
- Division of Nephrology and Hypertension, Hammoud University Hospital, Saida, Lebanon
| | - Laila Farhood
- School of Nursing, American University of Beirut, Beirut, Lebanon
- Psychiatry Department, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Sahar H. Koubar
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN, United States
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Kawam L, Medawar W, Koubar SH. An Unusual Kidney Biopsy Finding in a Patient with Nephrotic Syndrome. Kidney360 2023; 4:117-118. [PMID: 36700914 PMCID: PMC10101616 DOI: 10.34067/kid.0000000000000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/25/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Lamees Kawam
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Walid Medawar
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sahar H. Koubar
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota
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Jdiaa SS, Walsh SB, Bockenhauer D, Fakhredine SW, Koubar SH. The hypokalemia mystery: distinguishing Gitelman and Bartter syndromes from 'pseudo-Bartter syndrome'. Nephrol Dial Transplant 2021; 37:29-30. [PMID: 32494811 DOI: 10.1093/ndt/gfaa100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sara S Jdiaa
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Stephen B Walsh
- Division of Nephrology and Hypertension, University College London, London, UK
| | - Detlef Bockenhauer
- Division of Nephrology and Hypertension, University College London, London, UK
| | - Sara W Fakhredine
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sahar H Koubar
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Koubar SH, Sayegh MH. Introduction: Conflict Nephrology Revisited. Semin Nephrol 2020; 40:338-340. [PMID: 32800284 DOI: 10.1016/j.semnephrol.2020.06.002] [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] [Indexed: 11/19/2022]
Affiliation(s)
| | - Mohamed H Sayegh
- American University of Beirut, Beirut, Lebanon; Harvard Medical School, Boston, MA
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Jdiaa SS, Gebrael DI, Koubar SH. Right Arm Pain and Swelling in an End-Stage Kidney Disease Patient. Kidney360 2020; 1:714-715. [PMID: 35372935 PMCID: PMC8815564 DOI: 10.34067/kid.0001242020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Sara S. Jdiaa
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Diala I. Gebrael
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sahar H. Koubar
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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8
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9
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Rteil A, Kazma JM, El Sawda J, Gharamti A, Koubar SH, Kanafani ZA. Clinical characteristics, risk factors and microbiology of infections in patients receiving chronic hemodialysis. J Infect Public Health 2020; 13:1166-1171. [PMID: 32276873 DOI: 10.1016/j.jiph.2020.01.314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/09/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The infectious complications in hemodialysis patients are still among the main reasons for their increased morbidity and mortality. The possible reasons behind this might be due to impairments in the host defense mechanisms, comorbidities, invasive procedures and pathogenicity of the infecting organisms. With the increased incidence of bacteremia in hemodialysis patients and the overt use of antibiotics, we have witnessed a rise in the number of new multidrug resistant (MDR) strains in those patients. AIM We aim to determine the epidemiology, risk factors and complications of infections in patients receiving chronic hemodialysis, particularly bloodstream infections. METHODS This is a retrospective case-control study involving patients undergoing hemodialysis at a tertiary care center. We studied the prevalence of infectious complications among those patients as well as the responsible agent in each respective infectious episode and the risk factors associated with bacteremia. FINDINGS 46.6% of the studied population had at least one documented episode of infection. The most common were blood and respiratory infections (33.2% and 32.7% respectively). Among patients with bacteremia, coagulase-negative Staphylococcus was the predominant pathogen (49% of cases), followed by Staphylococcus aureus and Escherichia coli. Mortality was higher in patients who had MDR bacteremia, and in those who had mechanical ventilation or intensive care unit (ICU) admission. CONCLUSION Due to the alarming increase in the incidence of infection among hemodialysis patients and its strong association with mortality, further studies are needed to look for risk factors associated with infection and for ways to control those risk factors.
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Affiliation(s)
- Ali Rteil
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jamil M Kazma
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jack El Sawda
- Divison of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amal Gharamti
- Divison of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sahar H Koubar
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina A Kanafani
- Divison of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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Abstract
INTRODUCTION Systemic lupus erythematosus affects 4.8-78.5 people per 100,000 worldwide, 90% of whom are females. Geography and ethnicity have been shown to significantly affect the prevalence and natural history of the disease. Lupus nephritis affects around half of patients with systemic lupus erythematosus. Data about systemic lupus erythematosus and lupus nephritis in the Middle East are still scarce. In this study, we aimed to describe the characteristics of systemic lupus erythematosus and lupus nephritis at a tertiary care center in Lebanon. METHODS This is a retrospective chart review of all biopsy-proven lupus nephritis patients admitted to the American University of Beirut medical center between January 2000 and December 2018. Patients above 12 years of age who had any International Society of Nephrology/Renal Pathology Society (ISN/RPS) class of lupus nephritis on their renal biopsy were included in the study. RESULTS The study included 55 patients with lupus nephritis. Upon presentation of systemic lupus erythematosus, the most common clinical feature was arthritis, seen in 83% of patients, followed by anemia (82%) and malar rash (48%). In total 93% had positive ANA, 89% had positive anti-dsDNA and 98% of patients had proteinuria. The most common ISN/RPS class of lupus nephritis in our series was IV (49%). At the time of the biopsy 15% of patients underwent dialysis. At 6 months, 11/27 had complete remission, 6/27 had partial remission and 10/27 had no remission. At 1 year, 8/23 had complete remission, 4/23 had partial remission and 11/23 had no remission. During the study period, 15 out of 35 patients available for analysis had chronic kidney disease (CKD) and six out of 34 patients developed end-stage kidney disease requiring renal replacement therapy. In comparison to other series in the region, our series had more males affected, higher creatinine at the time of biopsy and greater degree of proteinuria. CONCLUSION Our study provided insight on the demographics, characteristics, and outcomes of lupus nephritis in Lebanon. Interestingly, male gender was present in a quarter of patients. This warrants further investigation and confirmation. We are hoping to expand this experience into a national prospective registry to further characterize this entity in our region.
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Affiliation(s)
- S H Koubar
- Division of Nephrology, American University of Beirut Medical Center, Beirut, Lebanon
| | - J Kort
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Kawtharani
- Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Chaaya
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - M Makki
- Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - I Uthman
- Division of Rheumatology, American University of Beirut Medical Center, Beirut, Lebanon
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Lakkis B, El Chediak A, Hashash JG, Koubar SH. Severe ketoacidosis in a patient with spinal muscular atrophy. CEN Case Rep 2018; 7:292-295. [PMID: 29978296 DOI: 10.1007/s13730-018-0345-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/19/2018] [Indexed: 01/01/2023] Open
Abstract
Spinal muscular atrophy (SMA) is a genetic neuromuscular disease characterized by progressive muscle weakness and atrophy. We report a case of a 36-year-old man with SMA type 3 who presented to our emergency department with epigastric pain and vomiting. He was found to have severe ketoacidosis on laboratory evaluation. The patient's symptoms and ketoacidosis resolved after dextrose infusion and a relatively small amount of sodium bicarbonate infusion. Given the severity of the ketosis that seemed inconsistent with moderate starvation alone, we postulate that there must have been other contributing factors besides moderate starvation that might explain the severity of acidosis in this particular patient. These factors include low muscle mass, disturbed fatty acid metabolism, hormonal imbalances and defective glucose metabolism. Ketoacidosis is an under-recognized entity in patients with neuromuscular diseases and requires a high index of suspicion for prompt diagnosis and management.
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Affiliation(s)
- Bassel Lakkis
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Alissar El Chediak
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Jana G Hashash
- Division of Gastroenterology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sahar H Koubar
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
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Koubar SH, Qannus AA, Medawar W, Abu-Alfa AK. Hungry bone syndrome two weeks after starting cinacalcet: a call for caution. CEN Case Rep 2017; 7:21-23. [PMID: 29124559 DOI: 10.1007/s13730-017-0284-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022] Open
Abstract
Cinacalcet is an effective and safe alternative to parathyroidectomy in end stage renal disease (ESRD) patients with secondary hyperparathyroidism. Hypocalcemia is a known complication of treatment that is usually readily reversible upon discontinuation of the drug. It rarely manifests severely and symptomatically requiring hospital admission. We present the case of a 55 year old man with severe, symptomatic and prolonged hypocalcemia that occurred 2 weeks after starting cinacalcet. Cinacalcet induced a state of pharmacological parathyroidectomy with subsequent hungry bone syndrome. Serum calcium returned to normal range after 4 weeks of stopping the drug while receiving high doses of elemental calcium and vitamin D receptor activation therapy (VDRA).
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Affiliation(s)
- Sahar H Koubar
- Division of Nephrology, Department of Internal Medicine, American University of Beirut, Riad El Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon.
| | - Abd Assalam Qannus
- Division of Nephrology, Department of Internal Medicine, Maine Medical Center, Maine, USA
| | - Walid Medawar
- Division of Nephrology, Department of Internal Medicine, American University of Beirut, Riad El Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Ali K Abu-Alfa
- Division of Nephrology, Department of Internal Medicine, American University of Beirut, Riad El Solh, P.O. Box 11-0236, Beirut, 1107 2020, Lebanon
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13
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Aoun M, Koubar SH, Antoun L, Tamim H, Makki M, Chelala D. Reduction of intracerebral hemorrhage in hemodialysis patients after reducing aspirin use: A quality-assurance observational study. PLoS One 2017; 12:e0185847. [PMID: 28968454 PMCID: PMC5624631 DOI: 10.1371/journal.pone.0185847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 09/20/2017] [Indexed: 12/16/2022] Open
Abstract
There is so far no international consensus concerning the prescription of antithrombotic agents in hemodialysis patients. It is not clear yet why they cause more bleeding in some patients and are beneficial in others. We therefore tried to find out what triggers bleeding in this population. This is an observational before-and-after study that included all patients undergoing hemodialysis in our center between 2005 and 2015. We divided the study into two phases: phase one (125 patients) where aspirin was used without restrictions and phase two (110 patients) where aspirin was avoided in severe hypertension and primary prevention. We aimed to assess the differential occurrence of intracerebral hemorrhage between the two phases and the cardiovascular mortality of patients whether on aspirin or not. Bleeding events occurred in 12.8% of patients in phase one and 13.6% in phase two (p = 0.85). Seven out of 125 patients (6%) in phase one experienced intracerebral hemorrhage and none in phase two. Intracerebral hemorrhage was significantly increased in those with the combination of aspirin and severe hypertension (p = 0.003). Aspirin and acenocoumadin were significantly associated with total bleeding (OR = 3.81 and 4.85 with p = 0.005 and 0.001 respectively). Cardiovascular mortality did not differ between phase one and two whether patients were on aspirin or not (p = 0.45 and 0.31 respectively). Minimizing aspirin use in hemodialysis patients with severe hypertension reduced intracerebral bleeding without a significant difference in cardiovascular mortality.
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Affiliation(s)
- Mabel Aoun
- Department of Nephrology, Saint-Georges Hospital, Ajaltoun, Lebanon
- Department of Nephrology, Saint-Joseph University, Beirut, Lebanon
- * E-mail:
| | - Sahar H. Koubar
- Department of Internal Medicine, Division of Nephrology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Leony Antoun
- Department of Internal Medicine, Holy Spirit University, Kaslik, Lebanon
| | - Hani Tamim
- Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maha Makki
- Biostatistics Unit, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dania Chelala
- Department of Nephrology, Saint-Joseph University, Beirut, Lebanon
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Zakka K, Bitar M, Lakkis B, Koubar SH. Induced vomiting for attention seeking and secondary gain: An unusual cause of pseudo-resistant hypertension. JRSM Open 2017; 8:2054270417717667. [PMID: 28811906 PMCID: PMC5542088 DOI: 10.1177/2054270417717667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In patients with complex psychosocial history presenting with resistant hypertension, observed therapy should be implemented early on to avoid unnecessary investigations and delayed diagnosis.
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Affiliation(s)
- Katerina Zakka
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Mohamad Bitar
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Bassel Lakkis
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Sahar H Koubar
- Department of Internal Medicine/Division of Nephrology, American University of Beirut, Beirut 1107 2020, Lebanon
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Koubar SH, Estrella MM, Warrier R, Moore RD, Lucas GM, Atta MG, Fine DM. Rhabdomyolysis in an HIV cohort: epidemiology, causes and outcomes. BMC Nephrol 2017; 18:242. [PMID: 28716131 PMCID: PMC5512985 DOI: 10.1186/s12882-017-0656-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/05/2017] [Indexed: 11/23/2022] Open
Abstract
Background The Literature on rhabdomyolysis in the HIV-positive population is sparse and limited. We aimed to explore the incidence, patient characteristics, etiologies and outcomes of rhabdomyolysis in a cohort of HIV-positive patients identified through the Johns Hopkins HIV clinical registry between June 1992 and April 2014. Methods A retrospective analysis of 362 HIV-positive patients with non-cardiac CK elevation ≥1000 IU/L was performed. Both inpatients and outpatients were included. Incidence rate and potential etiologies for rhabdomyolysis were ascertained. The development of acute kidney injury (AKI, defined as doubling of serum creatinine), need for dialysis, and death in the setting of rhabdomyolysis were determined. Logistic regression was used to evaluate the association of peak CK level with the development of AKI. Results Three hundred sixty two cases of rhabdomyolysis were identified in a cohort of 7079 patients with a 38,382 person years follow-up time. The incidence rate was nine cases per 1000 person-years (95% CI: 8.5–10.5). Infection was the most common etiology followed by compression injury and drug/alcohol use. One-third of cases had multiple potential etiologies. AKI developed in 46% of cases; 20% of which required dialysis. Thirteen percent died during follow-up. After adjustment, AKI was associated with higher CK (OR 2.05 for each 1-log increase in CK [95% CI: 1.40–2.99]), infection (OR 5.48 [95% CI 2.65–11.31]) and higher HIV viral load (OR 1.22 per 1-log increase [95% CI: 1.03–1.45]). Conclusion Rhabdomyolysis in the HIV-positive population has many possible causes and is frequently multifactorial. HIV-positive individuals with rhabdomyolysis have a high risk of AKI and mortality.
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Affiliation(s)
- Sahar H Koubar
- Department of Medicine/Division of Nephrology, American University of Beirut Medical Center and School of Medicine, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
| | - Michelle M Estrella
- Kidney Health Research Collaborative, San Francisco VA Medical Center and University of California, 4150 Clement St., 111A1, San Francisco, California, CA, 94121, USA
| | - Rugmini Warrier
- Lincoln Nephrology & Hypertension, Lincoln, 7441 O St., Suite 304, Nebraska, 68510, USA
| | - Richard D Moore
- Department of Medicine/Division of Infectious Diseases, Johns Hopkins University Hospital and School of Medicine, 1830 E. Monument St., Room 435A, Baltimore, MD, 21287, USA
| | - Gregory M Lucas
- Department of Medicine/Division of Infectious Diseases, Johns Hopkins University Hospital and School of Medicine, 1830 E. Monument St., Room 435A, Baltimore, MD, 21287, USA
| | - Mohamed G Atta
- Department of Medicine/Division of Nephrology, Johns Hopkins University Hospital and School of Medicine, 1830 E. Monument Street - Suite 416, Baltimore, MD, 21205, USA
| | - Derek M Fine
- Department of Medicine/Division of Nephrology, Johns Hopkins University Hospital and School of Medicine, 1830 E. Monument Street - Suite 416, Baltimore, MD, 21205, USA
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