Renal transplantation in a patient with Bartter syndrome and glomerulosclerosis

Bartter syndrome (BS) is a clinically and genetically heterogeneous inherited renal tube disorder characterized by renal salt wasting, hypokalemic metabolic alkalosis and normotensive hyperreninemic hyperaldosteronism. There have been several case reports of BS complicated by focal segmental glomerulosclerosis (FSGS). Here, we have reported the case of a BS patient who developed FSGS and subsequent end-stage renal disease (ESRD) and provided a brief literature review. The patient presented with classic BS at 3 months of age and developed proteinuria at 7 years. Renal biopsy performed at 11 years of age revealed a FSGS perihilar variant. Hemodialysis was initiated at 11 years of age, and kidney transplantation was performed at 16 years of age. The post-transplantation course has been uneventful for more than 3 years with complete disappearance of BS without the recurrence of FSGS. Genetic study revealed a homozygous p.Trp(TGG)610Stop(TGA) mutation in the CLCNKB gene. In summary, BS may be complicated by secondary FSGS due to the adaptive response to chronic salt-losing nephropathy, and FSGS may progress to ESRD in some patients. Renal transplantation in patients with BS and ESRD results in complete remission of BS

Long-term outcome of Bartter syndrome in 54 patients: A multicenter study in Korea

IntroductionBartter syndrome (BS) is a rare salt-wasting tubulopathy caused by mutations in genes encoding sodium, potassium, or chloride transporters of the thick ascending limb of the loop of Henle and/or the distal convoluted tubule of the kidney. BS is characterized by polyuria, failure to thrive, hypokalemia, metabolic alkalosis, hyperreninemia, and hyperaldosteronism. Potassium and/or sodium supplements, potassium-sparing diuretics, and nonsteroidal anti-inflammatory drugs can be used to treat BS. While its symptoms and initial management are relatively well known, long-term outcomes and treatments are scarce.MethodsWe retrospectively reviewed 54 Korean patients who were clinically or genetically diagnosed with BS from seven centers in Korea.ResultsAll patients included in this study were clinically or genetically diagnosed with BS at a median age of 5 (range, 0–271) months, and their median follow-up was 8 (range, 0.5–27) years. Genetic diagnosis of BS was confirmed in 39 patients: 4 had SLC12A1 gene mutations, 1 had KCNJ1 gene mutations, 33 had CLCNKB gene mutations, and 1 had BSND mutation. Potassium chloride supplements and potassium-sparing diuretics were administered in 94% and 68% of patients, respectively. The mean dosage of potassium chloride supplements was 5.0 and 2.1 mEq/day/kg for patients younger and older than 18 years, respectively. Nephrocalcinosis was a common finding of BS, and it also improved with age in some patients. At the last follow-up of 8 years after the initial diagnosis, 41% had short stature (height less than 3rd percentile) and impaired kidney function was observed in six patients [chronic kidney disease (CKD) G3, n = 4; CKD G5, n = 2].ConclusionBS patients require a large amount of potassium supplementation along with potassium-sparing agents throughout their lives, but tend to improve with age. Despite management, a significant portion of this population exhibited growth impairment, while 11% developed CKD G3–G5

Improvement of Lifetime Using Transition Metal-Incorporated SAPO-34 Catalysts in Conversion of Dimethyl Ether to Light Olefins

Transition metal (Mn, Fe, or Ni) incorporated SAPO-34 (MeAPSO-34) nanocatalysts were synthesized using a hydrothermal method to improve the catalytic lifetime in the conversion of dimethyl ether to light olefins (DTO). The structures of the synthesized catalysts were characterized using several methods including XRD, SEM, BET, 29Si-MAS NMR, and NH3-TPD techniques. Although the structure of the MeAPSO-34 catalysts was similar to that of the SAPO-34 catalyst, the amount of weak acid sites in all MeAPSO-34 catalysts was markedly increased and accompanied by differences in crystallinity and structural arrangement. The amount of weak acid sites decreased in the following order: NiAPSO-34 > FeAPSO-34 > MnAPSO-34 > SAPO-34 catalyst. The MeAPSO-34 catalysts, when used in the DTO reaction, maintained DME conversion above 90% for a longer time than the SAPO-34 catalyst, while also maintaining the total selectivity above 95% for light olefins. In addition, the NiAPSO-34 catalyst showed the longest catalytic lifetime; the lifetime was extended approximately 2-fold relative to the SAPO-34 catalyst. Therefore, the increase in the catalytic lifetime is related to the amount of weak acidic sites, and these sites are increased in number by incorporating transition metals into the SAPO-34 catalyst

Treatment of steroid-resistant pediatric nephrotic syndrome

Children who suffer from steroid-resistant nephrotic syndrome (SRNS) require aggressive treatment to achieve remission. When intravenous high-dose methylprednisolone fails, calcineurin inhibitors, such as cyclosporine and tacrolimus, are used as the first line of treatment. A significant number of patients with SRNS progress to end-stage renal disease if remission is not achieved. For these children, renal replacement therapy can also be problematic; peritoneal dialysis may be accompanied by significant protein loss through the peritoneal membrane, and kidney allograft transplantation may be complicated by recurrence of SRNS. Plasmapheresis and rituximab were initially used for treatment of recurrent SRNS after transplantation; these are now under consideration as rescue therapies for refractory SRNS. Although the prognosis of SRNS is complicated and unfavorable, intensive treatment in the early stages of the disease may achieve remission in more than half of the patients. Therefore, timely referral of pediatric SRNS patients to pediatric nephrology specialists for histological and genetic diagnosis and treatment is highly recommended

Incidentally Detected Situs Ambiguous in Adults

Situs ambiguous is rare congenital anomaly in adults. In 2 adult patients who admitted for different cardiac problems, situs ambiguous with polysplenia was detected. A 42-year-old male admitted for radio frequent catheter ablation of atrial fibrillation, and he had left-sided inferior vena cava (IVC), hepatic segment of IVC interruption with hemiazygos continuation, multiple spleens and intestinal malrotation. And in a 52-year-old female case who was hospitalized due to infective endocarditis after implanting pacemaker for sick sinus syndrome, multiple spleens, left-sided stomach, bilateral liver with midline gallbladder, and left-sided IVC were found. Those findings were consistent with situs ambiguous with polysplenia, but their features were distinctive

Diseño e implementación de un sistema RFID para seguimiento de personas dependientes en el hogar

Este Trabajo Final de Grado se basa en el estudio, diseño, montaje y evaluación de un sistema RFID (Radio Frequency IDentification) para el posicionamiento de personas dependientes dentro de edificios, a fin de proporcionar un servicio a sus habitantes. El primer paso es entender lo que son los sistemas RFID y estudiar casos de uso existentes. Después, se estudia el funcionamiento de los lectores RFID disponibles y las etiquetas (Tags) a rastrear; seguidamente se aprende a configurarlos y se diseña e implementa un programa que pueda establecer una comunicación con los equipos y gestionar los cálculos necesarios lo suficientemente rápido como para realizar un rastreo en tiempo real. Una vez conseguido esto, se busca el método de cálculo de distancias y de coordenadas lo más exacto posible y se corrigen los errores alcanzando la precisión necesaria. Para ello, se realizan continuamente pruebas de rastreo y posicionamiento tanto estáticos como en movimiento.In this final project a RFID (Radio Frequency IDentification) system is studied, designed, implemented and evaluated. The system aims to track and position dependent people in buildings, in order to provide different services to its inhabitants. Firstly, it is needed to understand what RFID systems are, and study real-life use cases. Later, the operation and configuration of the available RFID readers and tags is studied. Once this is accomplished, a computer program is designed and implemented. This computer program must communicate with the RFID equipment and perform the calculations fast enough so that it is possible to track items in real time. Afterwards, errors are corrected and the best formulas for calculating distances and coordinates are found, in order to facilitate the required results and precision. Throughout the process, the system is continuously tested with static and moving tracking and positioning.Catalá Adrama, L. (2015). Diseño e implementación de un sistema RFID para seguimiento de personas dependientes en el hogar. Universitat Politècnica de València. http://hdl.handle.net/10251/55170TFG