Role of Paricalcitol in Modulating the Immune Response in Patients with Renal Disease

Introduction. The aim was to highlight the existence of a relationship between vitamin D deficiency, chronic inflammation, and proteinuria, by measuring neutrophil gelatinase associated lipocalin (NGAL) and common inflammatory markers after administration of paricalcitol, a vitamin D analog, in vivo and in vitro. Methods. 40 patients with end-stage chronic kidney disease (CKD) and secondary hyperparathyroidism and 40 healthy subjects were enrolled. Serum calcium, phosphorus, 25(OH)-vitamin D, parathyroid hormone (PTH), erythrocyte sedimentation rate, high-sensitivity C-reactive protein, interleukin-(IL-) 17, IL-6, IL-1 , interferon-gamma (IFN-), tumor necrosis factor-alpha (TNF-), plasmatic and urinary NGAL, and 24 h albuminuria and proteinuria were measured before and 24 h after an intravenous bolus of paricalcitol (5 mcg). Human peripheral blood mononuclear cells were isolated and stimulated with phytohaemagglutinin. NGAL, IL-1 , IL-17, IL-6, TNF-, and IFN-were measured in the culture medium and in the 24 h urine collection. Results. 25(OH)-vitamin D was lower in CKD than in controls ( < 0.0001), while inflammatory markers were higher in CKD group ( < 0.0001). In vivo and in vitro studies showed a downregulation of NGAL, IL-17, IL-6, IL-1 , TNF-, and IFN-after paricalcitol administration ( < 0.0001). Conclusions. 25(OH)-vitamin D regulates immune and inflammatory processes. Further studies are needed to confirm these data in order to improve the treatment of CKD patients

The relationship between coping, emotion regulation, and quality of life of patients on dialysis

Previous studies have investigated constructs that facilitate adaptation to chronic disease and improve quality of life and constructs that lead to psychopathological complications. The purpose of this research is to investigate the impact of coping and emotional regulation on the quality of life of patients on dialysis. Three questionnaires were administered to 78 patients on dialysis: Coping Orientations to Problems Experienced, Short Form (36), and Cognitive Emotion Regulation Questionnaire. Regressions analyses indicated that age, Rumination, Positive Refocusing, Avoidance Strategies, Approach to the Problem, and Transcendent Orientation predicted Physical Health. With regard to Mental Health, the predictors were gender, Self-Blame, Acceptance, Rumination, Positive Reappraisal, Catastrophizing, Avoidance Strategies, and Transcendent Orientation. This study confirms the relationship between emotional regulation, coping, and quality of life. The results highlight the need for total care of the patients, including an assessment of both physical state and psychological functioning in order to promote total well-being

Have We New Therapeutic Strategies in the Treatment of Renovascular Nephropathy?

Renal artery stenosis (RAS) is a cause of hypertension and ischemic nephropathy. The incidence of this disorder is probably less than 1% in patients with mild hypertension, but rises to as high as 10 to 40% in patients with acute, severe or refractory hypertension. Significant RAS can be caused by atheromatous plaques, or due to fibromuscular dysplasia (FMD). Atherosclerotic lesions are present in almost 7% of adults older than 65 years and up to 50% of patients presenting with diffuse atherosclerotic disease. In contrast to atherosclerosis, FMD most often affects women under the age of 50 and typically involves the distal main renal artery or the intrarenal branches. The optimal treatment for RAS is not yet established. Based on recent trials, we reviewed the literature on pharmacological and endovascular treatment of atherosclerotic RAS and ischemic nephropathy

An uncommon presentation of an uncommon nephropathy: the karyomegalic interstitial nephritis

Karyomegalic interstitial nephritis (KIN) is a rare and certainly underdiagnosed nephropathy. It is characterized by a peculiar histological picture of interstitial nephritis associated with the presence of hyperchromatic, abnormally enlarged nuclei of tubular epithelial cells. KIN has an uncertain etiology, but should be suspected in young patients in the second or third decade of life presenting with progressive renal failure, proteinuria and/or hematuria and a history of recurrent respiratory infections. In these cases, the diagnosis should be suspected and confirmed by a renal biopsy. Herein, we report a case of KIN with atypical clinical presentation in a young patient with progressive kidney failure without proteinuria or hematuria or history of recurrent respiratory infections

Preoperative statins improve recovery of renal function but not by an anti-inflammatory effect: observational study in 69 elderly patients undergoing cardiac surgery

BACKGROUND: Older subjects, including those with normal renal function, have an increased risk of acute kidney injury. Preoperative statin therapy has been reported to improve renal outcome after cardiac surgery and to reduce inflammatory response to cardiopulmonary bypass. No study has hitherto evaluated whether the positive effect of pretreatment with statins on postoperative renal outcome is due to their positive effect on inflammatory burst in elderly patients undergoing myocardial revascularization using cardiopulmonary bypass. METHODS: Sixty-nine consecutive elderly patients to undergo isolated coronary artery bypass were enrolled and divided in two groups according to preoperative statin therapy (statin group n = 39) or not (no-statin group n = 30). Primary end-points of this study were the incidence of postoperative acute kidney injury defined by Acute Kidney Injury Network (AKIN) criteria, of acute renal failure needing renal replacement therapy, and the rate of complete recovery of kidney function. Secondary outcomes were perioperative changes of inflammatory and anti-inflammatory cytokines (IL-1β, IL-2, IL-6, IL-8, IL-10 and TNF-α serum level). RESULTS: Incidence of acute kidney injury was similar between the two groups within 2 days after surgery (statin group 18/30 vs. no-statin group 18/39 P = 0.25). However, statin patients showed significantly higher glomerular filtration rate at 10th postoperative day than no-statin patients (statin group 80 ± 31.1 ml/min vs. no-statin group 59.2 ± 29.5 ml/min, P = 0.006). No significant difference in cytokine levels was observed, except for a higher IL-10 release in no-statin group at 24 h after surgery (statin group 130.22 ± 174.37 pg/ml vs. no-statin group 273.422 ± 351.52 pg/ml, P = 0.03). CONCLUSIONS: In elderly patients, preoperative statin treatment allows better recovery of renal function following cardiopulmonary bypass but not by an anti-inflammatory effect

Is it feasible to improve the duration and the efficiency of Ramipril anti-proteinuric response?

BACKGROUND: Ramipril administered once daily is characterized by an attenuation of its pharmacological activity in the following 24 hours, whose effects on antiproteinuric activity have not yet been investigated.METHODS: The antiproteinuric efficacy of Ramipril has been evaluated in a cross-over study in 20 patients with renal disease, proteinuria and hypertension (GFR50 mL / min, proteinuria <3 g / day; SBP/DBP 150/90 mmHg). Proteinuria was measured over 24 hours on three consecutive urine collections (morning, afternoon and night) in the absence of antiproteinuric drugs and after ten days of treatment with single morning administration of Ramipril 2.5 mg or Ramipril 10 mg.RESULTS: At baseline: mean proteinuria was not significantlychanged over the course of the three urinary collections (88 7.2 mg/h in the morning of 80 10.5 mg/h in the afternoon and 81 10.1 mg/hr during the night). After Ramipril 2.5 mg/day: slight reduction in mean proteinuria, with no significant differences between collections (80 11 mg/h in the morning, 69 7.4 mg/h in the afternoon and 75 9.1 mg/h during the night). After Ramipril 10 mg/day: afternoon and night values of proteinuria were significantly reduced compared to baseline; noctural proteinuria was significantly lower than morning value (51 7.5 mg/h vs. 81 10 mg/h, p <0.05).CONCLUSION: The antiproteinuric effectiveness of Ramipril tends to decrease significantly over the 24hours after a single daily administration. An increase and/or division of Ramipril dose might help to stabilize and to maximizeits antiproteinuric effectiveness