NDT Plus - Advance Access

Lacking evidence for calcium-binding protein fetuin-A to be linked with chronic kidney disease-related pruritus (CKD-rP)

Mettang, T., Matterne, U., Roth, H. J., Weisshaar, E. — Fri, 06 Nov 2009 03:52:33 PST

Reversible proteinuria after adalimumab discontinuation in a patient with Crohn's disease

Katsanos, K. H., Theiakos, D., Vagias, I., Christodoulou, D., Tsianos, E. V. — Thu, 05 Nov 2009 01:49:05 PST

Severe hypogammaglobulinaemia and opportunistic infections after rituximab therapy in a renal transplant recipient

Kahveci, A., Asicioglu, E., Ari, E., Arikan, H., Tuglular, S., Ozener, C. — Thu, 05 Nov 2009 01:49:05 PST

Infectious complications are the leading causes of morbidity and mortality among renal transplant recipients. Hypogammaglobulinaemia may develop as a result of immunosuppressive therapy and is associated with an increased risk of opportunistic infections particularly in the 6-month post-transplant period. Rituximab, which is used for antibody-mediated rejection (AMR), may also contribute to the development of hypogammaglobulinaemia via B-cell depletion. Intravenous immunoglobulin replacement may be beneficial in this setting. With the following case report, we aim to increase the awareness of opportunistic infections and severe hypogammaglobulinaemia in renal transplant recipients treated with rituximab for acute AMR.

Haemodiafiltration--optimal efficiency and safety

Ledebo, I., Blankestijn, P. J. — Thu, 05 Nov 2009 01:49:04 PST

Haemodiafiltration (HDF) is the blood purification therapy of choice for those who want significant removal of uraemic solutes beyond the traditional range of small molecules. Combining diffusive and convective solute transport, a HDF treatment comprises the largest number of variables among blood purification therapies, and it is important to understand how they interact in order to optimize the therapy. This review discusses the parameters that determine the efficiency of HDF and how they can be controlled in the different forms of HDF and ‘HDF-like’ therapies practised today. The key to safe and effective HDF therapy is to have access to large volumes of high-quality fluids. Starting with ultrapure dialysis fluid, on-line preparation of a sterile, non-pyrogenic substitution solution can be made an integral part of the treatment, and we describe the necessary conditions for this. On-line HDF can provide the largest removal of the widest range of solutes among available dialysis therapies, and the potential clinical benefits of this are within practical reach for the increasing number of patients dialysed with high-flux membranes and ultrapure dialysis fluid.

A pilot in distress

Bennett, S., Mitsides, N., Dhaygude, A., Woywodt, A. — Tue, 03 Nov 2009 21:36:41 PST

Treat the patient not the lab value

Tolouian, R., Salameh, H. — Tue, 03 Nov 2009 21:36:40 PST

Problems of donor compatibility in a patient with sensitization to an alternate allelic variant of a 'self' HLA specificity

Koo, P., McKinley, K., Newstead, C., Clark, B. — Tue, 03 Nov 2009 21:36:39 PST

UK standards of deceased donor HLA typing and arrangements for reporting of recipient HLA antibody specificity can create a risk for ‘unexpected positive’ crossmatch that it is within the recipient centre's ability to avoid if high-confidence serum screening methods are in place. The case reported details investigations following an unexpected positive crossmatch due to an antibody directed against an allelic variant of a ‘self’ HLA specificity.

Kidney transplantation without reversal of warfarin

Mudge, D. W., Campbell, S. B., Ray, M. — Tue, 03 Nov 2009 21:36:38 PST

Some patients called for kidney transplantation are anticoagulated with warfarin for indications such as antiphospholipid syndrome, where the risk of thrombosis with reversal may be high. Traditionally, the approach has been reversal of warfarin and treatment perioperatively with intravenous unfractionated heparin. However, this may be complicated by either thrombosis or bleeding if the heparin dose is incorrect. We report the case of a peritoneal dialysis patient warfarinized for antiphospholipid syndrome who was successfully transplanted with an international normalized ratio of 2.1 with neither thrombosis nor bleeding. This may be an alternative to heparin for patients in whom anticoagulation must be maintained.

Successful treatment of spontaneous kidney graft decapsulation 18 years after renal transplantation: a case report

Myhre, H.-A., Oyen, O., Karbo, O., Midtvedt, K. — Tue, 03 Nov 2009 21:36:37 PST

Nutritional problems in adult patients with stage 5 chronic kidney disease on dialysis (both haemodialysis and peritoneal dialysis)

Heng, A.-E., Cano, N. J. M. — Mon, 19 Oct 2009 09:40:54 PDT

The EVEREST study: an international collaboration

Mon, 19 Oct 2009 09:40:52 PDT

Rates of initiation of renal replacement therapy (RRT), use of home modalities of treatment and patient outcomes vary considerably between countries. This paper reports the methods and baseline characteristics of countries participating in the EVEREST study (n = 46), a global collaboration examining the association between medical and non-medical factors and RRT incidence, modality mix and survival. Numbers of incident and prevalent patients were collected for current (2003–05) and historic (1983–85, 1988–90, 1993–95 and 1998–2000) periods stratified, where available, by age, gender, treatment modality and cause of end stage renal disease (diabetic versus non-diabetic). General population age and health indicators and national-level macroeconomic data were collected from secondary data sources. National experts provided primary data on renal service funding, resources and organization. The median (inter quartile range) RRT incidence per million of the population (pmp) was 130 pmp (102–167 pmp). The general population life expectancy at 60 was 22.1 years (19.7–23.1 years) and 6.9% had diabetes mellitus (5.4–9.0%). Healthcare spending as a percentage of gross domestic product was 8.1% (5.6–9.3%). Countries averaged nine dialysis facilities pmp (4–12 pmp), with 69.0% (43.9–99.0%) owned by the public or private not-for-profit sector. The number of nephrologists ranged from 0.5 to 48 pmp (median 12 pmp). The heterogeneity of EVEREST countries will enable modelling to examine the independent association between medical and non-medical factors on RRT epidemiology.

Colour Doppler twinkling in kidney stones: artefact or sign?

Andrulli, S., Turrin, A., Bigi, M. C., Ravani, P., Trinchieri, A., Locatelli, F. — Tue, 13 Oct 2009 21:19:55 PDT

The twinkling in colour Doppler images is created by a rapidly changing series of coloured horizontal bars that appear beyond the reflex surfaces. Spectral analyses show a typically rectangular time/velocity wave diagram, and an uncomfortably high-pitched audio signal saturates the echo system. The twinkling can be detected in the calcified areas of various tissues and is usually interpreted as an artefact; however, this report describes two cases suggesting that it may be valuable for the early diagnosis and follow-up of kidney stones. This observation may have important diagnostic, epidemiological and clinical implications.

Chronic kidney disease and end-stage renal disease--a review produced to contribute to the report 'the status of health in the European union: towards a healthier Europe'

Zoccali, C., Kramer, A., Jager, K. J. — Mon, 12 Oct 2009 22:36:26 PDT

The Report on the Status of Health in the European Union (EUGLOREH) is a project aimed at describing health problems in member states of the European Community. This project is an effort of more than 170 European experts and the collaboration of the health authorities or institutions from all EU Member States, major intergovernmental, International and European Organizations and Agencies. In this report, for the first time special emphasis is given to chronic diseases. Chronic kidney disease (CKD) is increasingly recognized as a major public health problem. However, with some notable exceptions, until now this disease has received scarce attention both at European level and at member states level. In 2007, the ERA-EDTA Registry was invited to contribute to EUGLOREH. The Registry made a major effort to gather published and unpublished information on the epidemiology of CKD and ESRD and to provide a comprehensive overview on CKD and ESRD in European countries. The review was completed in early 2008 and included into the final EUGLOREH published in the WEB as of 20 March 2009.

Mycotic aneurysm of the carotid artery in a chronic haemodialysis patient

Ko, W.-S., Chen, T.-H., Cheng, C.-Y. — Sat, 10 Oct 2009 03:43:50 PDT

Hypocomplementaemic immune complex tubulointerstitial nephritis

Gupta, A., Jothy, S., Somerville, P., Zaltzman, J. S. — Wed, 07 Oct 2009 07:23:42 PDT

We report a rare cause of rapidly progressive renal failure associated with low complement, positive ANA but negative anti DS-DNA. A renal biopsy demonstrated tubulointerstitial nephritis with positive immunoglobulin staining involving the interstitium and tubular basement membrane but glomerular sparing. A review of the literature and differential diagnosis are discussed.

Adrenal insufficiency in a haemodialysis patient

Suzuki, R., Morita, H., Nishiwaki, H., Yoshimura, A. — Tue, 06 Oct 2009 09:51:11 PDT

H1N1 infection and acute kidney injury in the critically ill

Trimarchi, H., Greloni, G., Campolo-Girard, V., Rosa-Diez, G. — Thu, 01 Oct 2009 21:44:49 PDT

Marked increase in bone formation markers after cinacalcet treatment by mechanisms distinct from hungry bone syndrome in a haemodialysis patient

Goto, S., Fujii, H., Matsui, Y., Fukagawa, M. — Wed, 30 Sep 2009 09:34:17 PDT

A 59-year-old female who was on dialysis due to diabetic nephropathy was referred to our hospital for severe hyperparathyroidism refractory to intravenous vitamin D receptor activator treatment. With subsequent cinacalcet hydrochloride treatment, parathyroid hormone (PTH) levels were only slightly suppressed. However, progressive increases were observed in serum alkaline phosphatase (ALP) and bone-specific alkaline phosphatase (BAP) levels with mild hypocalcaemia. A bone biopsy, obtained immediately before surgical parathyroidectomy after 3 months of cinacalcet treatment, revealed no disappearance of osteoclasts. These data suggest that cinacalcet hydrochloride treatment may induce a marked promotion of bone formation by mechanisms distinct from hungry bone syndrome that usually develops after parathyroidectomy.

Post-renal transplant calciphylaxis: treatment of hyperparathyroidism by percutaneous ethanol injection therapy and parathyroidectomy

Park, N. Y., Jung, Y. S., Rim, H. — Fri, 25 Sep 2009 06:50:33 PDT

Citrate anticoagulation for continuous renal replacement therapy (CRRT) in patients with acute kidney injury admitted to the intensive care unit

Davenport, A., Tolwani, A. — Fri, 25 Sep 2009 17:34:54 PDT

Continuous forms of renal replacement therapy (CRRT) have become established as the treatment of choice for supporting critically ill patients with acute kidney injury. Typically, these patients have activation of the coagulation cascades, peripheral mononuclear cells and platelets, but also a reduction in natural anticoagulants, and are therefore prothrombotic. For continuous modes of renal replacement therapy to be effective, in terms of both effective solute clearance and also fluid removal, the extracorporeal circuits must operate continuously. Thus, preventing clotting in the CRRT circuit is a key goal to effective patient management. As these patients may also be at increased risk of bleeding, regional anticoagulation with citrate is increasing in popularity, particularly following the introduction of commercially available CRRT machines and fluids specifically designed for citrate anticoagulation. Although regional anticoagulation with citrate provides many advantages over other systemic anticoagulants, excess citrate may lead to both metabolic complications, ranging from acidosis to alkalosis and may also potentially expose patients to electrolyte disturbances due to hyper- and hyponatraemia and hyper- and hypocalcaemia.

Turbid white urine

Vera, M., Molano, A., Rodriguez, P. — Fri, 25 Sep 2009 17:34:53 PDT

Turbid white urine ‘albinuria’ is defined as a urine discoloration described as milky or cloudy. One of the most frequent causes of turbid white urine is chyluria complicating filariasis (Table 1). The extant causes of albinuria are non parasitic and rare. Amongst their aetiologies stand excessive mineral sediment excretion such as calciuria and phosphaturia, massive pyuria and fungal infections, and rarely congenital malformations of the lymphatic vessels. Malingering is also possible, in patients adding milk to their urine. We observed a case of albinuria in which the diagnostic work up led to diagnosing an exceptional cause of chyluria in a patient living in a region of Colombia where filariasis is not endemic.

Thalidomide-induced heart block in a dialysis patient

Anwar, S., Chawathey, K., Holt, S. — Fri, 25 Sep 2009 17:34:53 PDT

A case of bilateral renal arterial thrombosis associated with cryocrystalglobulinaemia

Leung, N., Buadi, F. K., Song, K. W., Magil, A. B., Cornell, L. D. — Thu, 24 Sep 2009 14:31:34 PDT

Cryocrystalglobulinaemia is an extremely rare complication of monoclonal gammopathy. Its presentation has features of both type I and II cryoglobulinaemia. Although peripheral and digital ischaemia is common, visceral ischaemia is rare. When it does occur, it is usually associated with multiple myeloma and has an extremely poor prognosis. We present a case of bilateral renal artery thrombosis associated with cryocrystalglobulinaemia in a patient without myeloma. More unusual, the cryocrystal protein in this case was associated with fibrinogen, which may have led to increased propensity towards thrombosis. Although the patient was unable to recover his kidney function, he remained alive on dialysis 2 years after the incident. The patient did not have any further ischaemic event despite no definitive therapy. This case represents an unusual presentation for this rare disease.

The effect of spontaneous twin pregnancy on renal transplant function and haemodynamics

Cheung, C. K., Bhandari, S. — Wed, 23 Sep 2009 07:49:49 PDT

Spontaneous twin pregnancy is rare in renal transplant recipients, and confers a significant risk, in terms of both transplant dysfunction and fetal complications. Physiological changes in renal haemodynamics may assist in predicting a favourable outcome, but have not been previously reported in these circumstances. We present a case of a successful outcome for both mother and babies, and detail the effects of the pregnancy on transplant function and haemodynamics within the transplant kidney. Without beneficial circumstances, twin pregnancy may be a high risk in renal transplant recipients and may lead to a poor outcome for both transplant and fetuses.

Acute renal failure, systemic lupus erythematosus and thrombotic microangiopathy following treatment with beta-interferon for multiple sclerosis: case report and review of the literature

Hansen, T., New, D., Reeve, R., Donne, R., Stephens, W. — Tue, 22 Sep 2009 09:04:27 PDT

We report a man with type 1 diabetes mellitus, autoimmune hypothyroidism and a tentative diagnosis of multiple sclerosis. Following treatment with beta interferon, he developed systemic lupus erythematosus with pericarditis, pleural effusions, cerebral infarction associated with anti-phospholipid antibody and acute renal failure due to thrombotic microangiopathy. He responded well to immunosuppression and anticoagulation. These complications may represent the most severe autoimmune reaction to beta interferon reported to date.

Crescentic glomerulonephritis in a patient with advanced lung cancer during erlotinib therapy

Kurita, N., Mise, N., Fujii, A., Ikeda, S., Sugimoto, T. — Sat, 19 Sep 2009 04:06:21 PDT

C-peptide and combined kidney pancreas transplantation

Bhargava, R., Mitsides, N., Saif, I., MacDowall, P., Woywodt, A. — Sat, 19 Sep 2009 04:06:21 PDT

Hypokalaemia and the thyroid--is there a link?

de Carvalho, J. G. R., de Morais, A., Traple, F., Carvalho, M. — Sat, 19 Sep 2009 04:06:20 PDT

Peritubular capillary lesions in post-streptococcal acute glomerulonephritis

Usui, J., Ebihara, I., Kaneko, S., Kobayashi, M., Yamagata, K. — Sat, 19 Sep 2009 04:06:20 PDT

Biocompatibility of peritoneal dialysis solutions determined by genomics of human leucocytes: a cross-over study

Sat, 19 Sep 2009 04:06:20 PDT

Fibrillary glomerulonephritis with prevalent IgA deposition associated with undifferentiated connective tissue disease: A case report

Nebuloni, M., Genderini, A., Tosoni, A., Caruso, S., di Belgiojoso, G. B. — Sat, 19 Sep 2009 04:06:19 PDT

We described a 41-year-old female patient, who presented with proteinuria occurring 5 years after the onset of an undifferentiated connective tissue disease (UCTD). At renal biopsy, a pattern of focal necrotizing glomerulonephritis with mesangial and parietal deposition of the IgA, C3 and K chains was observed. Electron microscopy showed organized fibrillary deposits in mesangial, subendothelial, intramembranous and subepithelial sites. Fibrils were randomly arranged, had no hollow core and had a diameter ranging between 10 and 23 nm. This case showed a rare combination of fibrillary glomerulonephritis and prevalent IgA deposition, in the clinical context of UCTD.

The 'Double Dutch' Doppler

Mitsides, N., Maginnis, P., Woywodt, A. — Thu, 17 Sep 2009 11:43:28 PDT

A general overview of malnutrition in normal kidney function and in chronic kidney disease

Heng, A.-E., Cano, N. J. M. — Wed, 16 Sep 2009 09:52:22 PDT

'Stone'-blindness

Sundaram, M., Mohapatra, A., John, G. T. — Wed, 16 Sep 2009 09:52:21 PDT

The 2007 ERA-EDTA Registry Annual Report--a Precis

Stel, V. S., Kramer, A., Zoccali, C., Jager, K. J. — Fri, 11 Sep 2009 10:26:51 PDT

Promoting scientific collaboration and education in cardiovascular-renal medicine: EURECAM: An ERA-EDTA-based working group

Thu, 10 Sep 2009 11:06:46 PDT

Ectopic ossification in the cranial dura mater in dialysis patients with secondary hyperparathyroidism

Oyama, Y., Kazama, J. J., Fukagawa, M., Arakawa, Y., Ezuka, I. — Wed, 09 Sep 2009 03:38:37 PDT

We report the case of a 69-year-old woman with secondary hyperparathyroidism who underwent maintenance haemodialysis therapy for 17 years and who presented with severe dural calcification and right subdural haematoma. Her dura mater displayed a rock barnacle-like appearance, and cerebral superficial arteries adhered to the sclerotic lesions. On the microscopic observation, calcified tissue with a clear lamellar structure and osteopontin immunoreactivity was observed. Tartrate-resistant acid phosphatase immunoreactive polynucleated giant cells infiltrated around the tissue. Such morphological properties are specific to the calcified tissue formed through a bone formation-like mechanism that is often observed in arterial media in patients with chronic kidney disease.

A single-dose vancomycin application after standard protocol in peritoneal dialysis patients with recurrent peritonitis

Usta, M., Ersoy, A., Ucar, E. — Wed, 09 Sep 2009 05:51:59 PDT

The importance of prevention of calciphylaxis in patients who are at risk and the potential fallibility of calcimimetics in the treatment of calciphylaxis for patients with secondary hyperparathyroidism

Khalpey, Z., Nehs, M. A., ElBardissi, A. W., Semel, M., Tullius, S. G. — Tue, 08 Sep 2009 08:01:45 PDT

A 43-year-old African American with end-stage renal disease (ESRD) associated with membranous nephropathy and a previously failed renal transplant had received cinacalcet to treat his secondary hyperparathyroidism. Serum calcium and phosphorus levels remained within normal limits, and serum parathyroid levels had dropped significantly following treatment initiation. However, within 7 months, the patient experienced extensive necrotic bilateral medial thigh ulcers. These were biopsied and found to be a result of calciphylaxis. The patient ultimately required an urgent subtotal parathyroidectomy and recovered well with completely healed ulcers.

Occult hepatitis B virus infection in a Sicilian chronic dialysis population

Li Cavoli, G., Ferrantelli, A., Tralongo, A., Schillaci, O., Rotolo, U. — Thu, 03 Sep 2009 06:56:04 PDT

Nephrotic syndrome and renal failure as an unusual presentation of solid tumour

Bonkain, F., Ena, G., Depierreux, M., Debelle, F. D., Nortier, J. L. — Thu, 03 Sep 2009 06:56:03 PDT

Glomerular diseases may occur as primary manifestation of cancer, especially in patients older than 60 years. Among glomerulopathies, membranous nephropathy is preferentially associated with respiratory and gastrointestinal tract adenocarcinomas, whereas minimal change disease is most often seen in haematological malignancies. Though breast cancer is one of the most frequent malignancies in women, paraneoplastic glomerular disease is rarely observed. We describe the case of a 79-year-old female patient who presented with nephrotic syndrome and renal failure. Breast cancer was found. Pathological studies of kidney and breast biopsy revealed a minimal change disease and an infiltrating ductal carcinoma, respectively.

Calcification of the liver in a patient on renal replacement therapy diagnosed with systemic calciphylaxis

Ladino, M., Sadhu, S., Ortega, L. M. — Thu, 03 Sep 2009 06:56:02 PDT

Successful cinacalcet treatment of refractory secondary hyperparathyroidism due to multiple lung parathyroid adenomas

Sugi, O., Kimata, N., Miwa, N., Otsubo, S., Nitta, K., Akiba, T. — Tue, 01 Sep 2009 23:07:51 PDT

We describe a 56-year-old woman who presented with end-stage renal disease due to pregnancy-induced hypertension and secondary hyperparathyroidism (sHPT). She had started hemodialysis and underwent a subtotal parathyroidectomy (PTx). However, intact parathyroid hormone (iPTH) levels increased gradually. Eventually, she underwent a second PTx. However, therapy failed to significantly decrease iPTH levels. A third PTx was performed, but no pathological parathyroid tissue was found. Computed tomography scan indicated the presence of multiple ectopic lung nodules and 26 nodules were surgically removed from the left lung. Despite surgical treatment, iPTH levels remained high. Additional maxacalcitol failed to decrease iPTH levels, cinacalcet was then started. iPTH levels decreased and the cinacalcet dose could be reduced to maintenance doses of 60 mg/day. Throughout the 1.6 years of treatment, serum iPTH, alkaline phosphatase (ALP) and bone alkaline phosphatase (BAP) were normalized. As a consequence, bone pain gradually disappeared. Bone mineral density (BMD) was improved by administration of cinacalcet. In conclusion, cinacalcet was effective in this patient with refractory and inoperable sHPT. In addition, it improves their BMD and relieves bone pain.

Water balance disorders after neurosurgery: the triphasic response revisited

Hoorn, E. J., Zietse, R. — Mon, 31 Aug 2009 03:28:49 PDT

Water balance disorders after neurosurgery are well recognized, but detailed reports of the triphasic response are scarce. We describe a 55-year-old woman, who developed the triphasic response with severe hyper- and hyponatraemia after resection of a suprasellar meningioma. The case illustrates how sudden and dramatic the changes in water balance after neurosurgery can be. The biochemical profile suggested central diabetes insipidus and the syndrome of inappropriate antidiuretic hormone secretion. The underlying pathophysiology was further analysed using fractional excretions, measurements of renin, aldosterone and vasopressin and a metyrapone test. Diagnostic, therapeutic and preventive strategies for these intriguing but complex cases are proposed.

Adult-onset Still's disease associated with collapsing glomerulopathy

Wed, 26 Aug 2009 22:56:08 PDT

A young woman of African descent presented with fevers, arthralgia, lymphadenopathy and a skin rash. Modest proteinuria was also noted. The clinical picture suggested an acute HIV sero-conversion illness, and a renal biopsy showed a collapsing glomerulopathy compatible with that diagnosis. However, HIV serology proved persistently negative and a diagnosis of Adult Still's disease was subsequently made (by Yamaguchi criteria). Following steroid treatment, the patient's fever abated and her inflammatory markers returned to normal. Collapsing glomerulopathy is a rare but important complication of Adult Still's disease. Immunosuppressive treatment may be effective in improving renal outcome.

Recurrent intestinal bleeding treated by double-balloon endoscopy in haemodialysis patients

Yamazaki, O., Hanafusa, N., Yamada, A., Noiri, E., Fujita, T. — Wed, 26 Aug 2009 22:56:07 PDT

Gastrointestinal (GI) bleeding is a common and troublesome complication of end-stage renal disease (ESRD). Patients often have various lesions in the small bowel and in either upper or lower GI tracts. Recently developed double-balloon endoscopy (DBE) enables observation of the entire small intestine through a combination of anterograde and retrograde approaches. Moreover, DBE is useful not only for diagnosis of small intestinal lesions; it provides a mode of treating the disease. This article presents patients with several small intestinal diseases from our facility. Their bleeding sources were identified using DBE. We also report two representative cases of angiodysplasia that had been diagnosed and treated successfully using DBE. One case particularly underscored the usefulness of the combination of capsule endoscopy (CE) and DBE as an electively diagnostic approach for patients with GI bleeding. Small intestinal bleeding is often observable repeatedly in a single patient, as described for case 1. In such circumstances, DBE can treat the lesions successfully without surgical procedures. In this report, ESRD patients, in whom comorbid conditions made it difficult to perform surgical procedures, receive great benefit from DBE.

MPO-ANCA crescentic glomerulonephritis complicated by membranous nephropathy: MPO demonstrated in epimembranous deposits

Mon, 24 Aug 2009 22:09:37 PDT

An elderly woman presented with haematuria and proteinuria accompanied by elevated serum myeloperoxidase (MPO)-specific anti-neutrophil cytoplasmic antibodies (MPO-ANCA). A renal biopsy revealed mild mesangial proliferation with fibrocellular crescent formation and a membranous glomerular lesion. Immunofluorescence microscopy using FITC-labelled rabbit anti-human MPO antibodies revealed granular MPO deposition along the glomerular capillary walls (GCW) with a staining profile similar to that of glomerular IgG deposition. The one-year follow-up renal biopsy revealed minimal IgG and undetectable MPO deposition. Both MPO and MPO-ANCA might have been responsible for the IgG immune depositions along the GCW in this patient.

Improvement of cardiac function after kidney transplantation with dilated cardiomyopathy and long dialysis vintage

Mimura, I., Kawarazaki, H., Momose, T., Shibagaki, Y., Fujita, T. — Sun, 23 Aug 2009 23:56:12 PDT

Patients with long dialysis vintage have low cardiac output for various reasons. Although kidney transplantation is known to improve cardiac mortality, patients are sometimes evaluated as contraindicated for transplantation because of cardiac risk. We successfully performed kidney transplantation for a patient with a long dialysis vintage and dilated cardiomyopathy. Sequential ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) scintigraphy suggested that amelioration of uraemia improved cardiac function. Kidney transplantation for patients with severely impaired cardiac function is safe and effective under careful perioperative monitoring irrespective of dialysis vintage. Sequential ¹²³I-MIBG scintigraphy can be used as an evaluation tool for the improvement in cardiac function.

A case of adult atypical haemolytic uraemic syndrome related to anti-factor H autoantibodies successfully treated by plasma exchange, corticosteroids and rituximab

Lionet, A., Provot, F., Glowacki, F., Fremeaux-Bacchi, V., Hazzan, M. — Tue, 18 Aug 2009 00:42:53 PDT

Complement factor H auto-antibodies (CFH-ab) are a rare cause (6–10%) of atypical haemolytic uraemic syndrome (aHUS). All observations previously described were retrospective and occurred in children or teenagers. We report the first case of aHUS associated with anti-CFH antibodies in an adult patient who was successfully treated by plasma exchange, corticosteroids and rituximab.

Star fruit: simultaneous neurotoxic and nephrotoxic effects in people with previously normal renal function

Tue, 18 Aug 2009 00:42:52 PDT

Haematuria and hydronephrosis caused by Castleman's disease

Lee, T. H., Kim, W., Jeong, Y. B., Jang, K. Y., Park, S. K. — Tue, 11 Aug 2009 21:48:49 PDT

Isolated microalbuminuria as the first clinical presentation of Fabry disease in an adult heterozygous female

Tue, 11 Aug 2009 21:48:48 PDT

Fabry disease (FD) is a rare X-linked disorder characterized by low or absent activity of the lysosomal enzyme -glycosidase-A that leads to progressive accumulation of glycosphingolipids in different organs and tissues. Clinical manifestations vary from classic to atypical forms characterized by one prevalent organ involvement, and a renal variant has been described in men but not in women. However, little is known about renal manifestation in females affected by FD. We herein report a case of a 22-year-old female with isolated and persistent microalbuminuria as the only sign of FD. In light of the importance of early recognition and treatment of FD organ damage, this case should call for future studies to determine how to assess organ damage, investigate the existence of a ‘renal variant’ in FD female patients and determine when best to start enzyme replacement therapy (ERT).

Renal clear cell carcinoma emerging in a transplanted kidney 3 years after return to dialysis. Case report and review of the literature

Elazary, R., Schlager, A., Appelbaum, L., Zamir, G., Nir, I. — Mon, 10 Aug 2009 23:07:50 PDT

We present a female patient with end-stage renal disease who was referred to the emergency department with sudden, excruciating pain over the right lower abdomen and flank. Radiologic evaluation following admission revealed a mass, solid in nature, located at the upper pole of the transplanted kidney. The patient was treated with empiric antibiotics and analgesics, and her symptoms subsided over the course of the week. Based on the clinical course and radiological findings, a self-limiting, spontaneous haemorrhage was thought to be the cause of the patient's symptoms. Nevertheless, background malignancy could not be ruled out. Therefore, an interval, elective graft nephrectomy was scheduled. Pathology confirmed the diagnosis of renal clear cell carcinoma.

Renal involvement in Neimann-Pick Disease

Grafft, C. A., Fervenza, F. C., Semret, M. H., Orloff, S., Sethi, S. — Mon, 10 Aug 2009 23:07:49 PDT

We describe the renal biopsy findings in a 14-year-old girl with Neimann-Pick disease. The renal biopsy showed chronic changes involving all components of the parenchyma, including focal global glomerulosclerosis, tubular atrophy, interstitial fibrosis and vascular sclerosis. On light microscopy, significant findings included foamy podocytes, vacuolated tubular epithelial cells and collections of foam cells in the interstitium. Electron microscopy was confirmatory which showed myelin-like inclusions in podocytes, endothelial cells, tubular epithelial cells and small nerves. The findings are similar to Fabry's disease, except that small nerve involvement appears to be unique to Neimann Pick disease.

Secondary hyperoxaluria and urinary crystal casts after intestinal resection

Almeida, J. R., Lutz, F. B., de Carvalho, E. D., da Silva, P. R. A. — Fri, 07 Aug 2009 02:10:00 PDT

Refractory uraemic pleuropericarditis treated successfully with corticosteroid therapy

Lee, S.-Y., Hong, G.-y., Chung, J. G., Yang, D. H., Kim, H.-J. — Fri, 07 Aug 2009 09:30:38 PDT

Uraemic pleuritis and pericarditis are frequently observed in chronic renal failure patients and tend to improve with continued haemodialysis. However, certain cases have been reported that do not respond to continued haemodialysis alone. A 67-year-old female on long-term haemodialysis was diagnosed with uraemic pleuropericarditis and treated with intensive haemodialysis and given a non-steroidal anti-inflammatory drug to which she showed no response. We report a case of uraemic pleuropericarditis refractory to traditional therapy, which was treated successfully with corticosteroid therapy.

Metastatic pulmonary calcification in a patient with long dialysis vintage

Yazawa, M., Shibagaki, Y., Konno, Y., Yasuda, T., Kimura, K. — Fri, 07 Aug 2009 09:30:39 PDT

Nephrotic syndrome associated with immune thrombocytopenia revealing Kimura's disease in a non-Asian male

Noel, N., Meignin, V., Rosenstingl, S., Ronco, P., Boffa, J.-J. — Fri, 07 Aug 2009 02:09:59 PDT

We report the case of a young Caucasian man presenting with diffuse oedema and nephrotic syndrome. Clinical examination revealed multiple lymphadenopathies. Histological examination was consistent with the diagnosis of Kimura's disease. A renal biopsy showed focal segmental glomerulosclerosis. Immune thrombocytopenia and signs of humoral autoimmunity were discovered. Corticosteroid treatment induced remission of nephrotic syndrome but relapses occurred 12 and 18 months after onset of treatment while the patient was receiving 20 mg prednisone once a day. To our knowledge, this is the first case of Kimura's disease and nephrotic syndrome associated with B-cell autoreactivity.

Hereditary nephrogenic diabetes insipidus: a major conundrum during labour and delivery

Castillo, E., Magee, L. A., Bichet, D., Halperin, M. — Tue, 04 Aug 2009 04:20:15 PDT

Adherence to guideline recommendations for infection prophylaxis in peritoneal dialysis patients

Badve, S. V., Smith, A., Hawley, C. M., Johnson, D. W. — Sat, 01 Aug 2009 04:44:29 PDT

Late referral of patients with end-stage renal disease: an in-depth review and suggestions for further actions

Baer, G., Lameire, N., Van Biesen, W. — Wed, 29 Apr 2009 15:35:46 PDT

Late referral of patients with chronic kidney disease (CKD) is a known problem and a major challenge for practising nephrologists since decades. In this review we report about the reasons for late referral, its epidemiology and socioeconomic impact and the medical particularities of late referred patients. We furthermore highlight on the efforts which have been undertaken so far to avoid late referral and should be undertaken in future to face the ever growing numbers of chronic kidney disease patients.

Specific nutritional problems in acute kidney injury, treated with non-dialysis and dialytic modalities

Fiaccadori, E., Regolisti, G., Cabassi, A. — Wed, 11 Feb 2009 03:49:04 PST

Patients who develop AKI, especially in the intensive care unit (ICU), are at risk of protein–energy malnutrition, which is a major negative prognostic factor in this clinical condition. Despite the lack of evidence from controlled trials of its effect on outcome, nutritional support by the enteral (preferentially) and/or parenteral route appears clinically indicated in most cases of ICU-acquired AKI, independently of the actual nutritional status of the patient, in order to prevent deterioration in the nutritional state with all its known complications. Extrapolating from data in other conditions, it seems intrinsically unlikely that starvation of a catabolic patient is more beneficial than appropriate nutritional support by an expert team with the skills to avoid the potential complications of the enteral and parenteral nutrition methodologies. By the same token, it is ethically impossible to conduct a trial in which the control group undergoes prolonged starvation. The primary goals of nutritional support in AKI, which represents a well-known inflammatory and pro-oxidative condition, are the same as those for other critically ill patients with normal renal function, i.e. to ensure the delivery of adequate nutrition, to prevent protein–energy wasting with its attendant metabolic complications, to promote wound healing and tissue repair, to support immune system function, to accelerate recovery and to reduce mortality. Patients with AKI on RRT should receive a basic intake of at least 1.5 g/kg/day of protein with an additional 0.2 g/kg/day to compensate for amino acid/protein loss during RRT, especially when daily treatments and/or high efficiecy modalities are used. Energy intake should consist of no more than 30 kcal non-protein calories or 1.3 x BEE (Basal Energy Expenditure) calculated by the Harris–Benedict equation, with ~30–35% from lipid, as lipid emulsions. For nutritional support, the enteral route is preferred, although it often needs to be supplemented through the parenteral route in order to meet nutritional requirements.

Patients with primary membranous nephropathy lack auto-antibodies against LDL receptor, the homologue of megalin in human glomeruli

Sat, 31 Jan 2009 03:03:43 PST