Can Helicobacter pylori Colonization Affect the Phosphate Binder Pill Burden in Dialysis Patients?

Phosphate binder pill (PBP) burden is a significant problem in dialysis patients. Phosphate absorption through the paracellular pathway increases in relatively acidic pH. In this study, we evaluated the effect of factors contributing to duodenal pH-Helicobacter pylori (HP), proton pump inhibitors (PPIs), and NaHCO3 capsules-on PBP burden. We evaluated 255 dialysis patients with gastric biopsies and excluded patients with low Kt/V, gastrectomy, and parathyroidectomy. Patients were divided into groups and subgroups regarding HP existence, use of PPI, or NaHCO3 capsules. HP+ group had significantly higher PBP burden and PBP equivalent doses (P < 0.001; both). HP+ subgroup not using daily PPIs or NaHCO3 capsules had the highest PBP burden and PBP equivalent doses (P < 0.001; both). HP- subgroups had similar PBP and PBP equivalent doses (P = 0.446 and P = 0.382; respectively). HP colonization might affect the PBP burden in dialysis patients due to a decrease of duodenal pH

Factors Affecting Bone Health in Kidney Transplant Recipients: Klotho Gene Single-Nucleotide Polymorphisms and Other Clinical Features

Objectives: Posttransplant bone diseases are a major cause of morbidity in kidney transplant recipients. We investigated the relationship between klotho gene single-nucleotide polymorphisms and bone diseases after kidney transplant. We also aimed to identify possible risk factors for development of bone disease. Materials and Methods: The study consisted of 251 kidney transplant recipients (164 men and 87 women) with minimum follow-up of 3 years after kidney transplant. Patients with prolonged immobilization, malignancy, parathyroidectomy, glomerular filtration rates less than 30 mL/min/1.73 m2, hypo-or hyperthyroidism, and treatment with drugs that affect bone metabolism were excluded. We investigated the relationship between 6 single-nucleotide polymor-phisms of the klotho gene (rs480780, rs211234, rs576404, rs211235, rs9536314, and rs1207568) and development of osteoporosis, avascular bone necrosis, and persistent hyperparathyroidism. Results: Longer dialysis treatment (odds ratio, 1.13; P = .002) and rs211235 single-nucleotide polymor-phism in the klotho gene (odds ratio, 9.87; P = .001 for GG genotype) were significantly associated with persistent hyperparathyroidism. A higher magnesium level was detected as a protective factor from development of persistent hyperparathyroidism (odds ratio, 0.19; P = .009). Persistent hyperparathyroidism was defined as a risk factor for development of osteopenia/osteoporosis (odds ratio, 2.76; P = .003) and avascular bone necrosis (odds ratio, 2.52; P = .03). Although the rs480780 (odds ratio, 8.73; P = .04) single-nucleotide polymorphism in the klotho gene was defined as a risk factor for development of osteopenia/osteoporosis, none of the klotho single-nucleotide polymorphisms was found to be associated with development of avascular bone necrosis. Conclusions: Persistent hyperparathyroidism could be an important indicator for development of bone disease in kidney transplant recipients. Also, some of the klotho gene single-nucleotide polymorphisms are associated with higher risk for bone disease after kidney transplant

Low Copeptin Levels in Patients With Intradialytic Hypotension

Intradialytic hypotension (IDH) is related to high morbidity and mortality. There is evidence that arginine-vasopressin (AVP) responses could play a role. Copeptin is a reliable biomarker of AVP. In this study, copeptin, aldosterone, epinephrine, and norepinephrine levels in patients with IDH were evaluated throughout a hemodialysis (HD) session and compared with the control group. The study includes 15 patients who were normotensive during HD and 15 patients with IDH with a minimum HD vintage of 1 year. Blood samples were collected before the initiation of an HD session (T-0), in the mid-session for control group, 30 min after mean arterial pressure drop for IDH patients (T-1), and at the end of the session (T-2). Groups had similar demographic features and health parameters, interdialytic weight gains, and ultrafiltration amounts. The IDH group had a mean arterial pressure decline of 39.9 (+/- 6.4) mm Hg. Copeptin levels of the control group increased an average of 79.9 (+/- 97.5) pmol/L at T-1 and an additional 24.8 (+/- 33.9) pmol/L at T-2. In the IDH group, copeptin level increases at T-1 and T-2 were 3.2 (+/- 5.5) pmol/L and 34 (+/- 44.6) pmol/L, respectively(.) Copeptin levels of the IDH group were significantly lower at T-1 (P < 0.001) and at the T-0-T-2 interval than control group (P = 0.05). In the control group, aldosterone levels distinctly decreased, and in the IDH group, aldosterone levels were elevated (P < 0.001). Small changes were detected in epinephrine and norepinephrine levels for both groups but did not reach significance (P = 0.6 and P = 0.3, respectively). Lower copeptin level alterations suggest inadequate AVP responses in patients with IDH

Is it possible to prevent contrast-induced nephropathy with dexpanthenol?

Derici, Mehmet Kursat/0000-0002-8260-7492; Ogut, Betul/0000-0002-1385-7324WOS: 000477631100016PubMed: 31190296PurposeContrast-induced nephropathy (CIN) is one of the side effects of diagnostic procedures. Oxidative stress plays an important role in CIN's pathophysiology. Dexpanthenol (Dexp) is a substance with antioxidant efficacy. We investigated the likely protective effects of dexpanthenol for CIN.MethodsTwenty-four Sprague-Dawley rats were divided randomly into four groups of 6 rats; control (group 1), Dexp (group 2), CIN (group 3) and Dexp+CIN (group 4). All rats were restricted of water moderately to facilitate of nephrotoxicity. Dexp was administered into the intraperitoneally at a dose of 500mg/kg for 5days in groups 2 and 4. The same amount of saline was applied via intraperitoneally to group 1 and 3. In CIN and Dexp+CIN groups, L-NAME (10mg/kg), tenoxicam (0.5mg/kg) and sodium amidotrizoate (10ml/kg) were administered on the 4th day via the tail vein for CIN. All rats were euthanized on the 6th day and samples for biochemical and pathological evaluations were collected.ResultsWhen the Dexp+CIN group and the CIN group were compared, it was found to be provide a significant decline at the level of acute tubular injury and necrosis in kidney biopsies by dexp. Furthermore Dexp significantly reduced the serum cystatin C (Cys-C) levels, not serum creatinine. There was no statistically significant difference between the groups in total oxidant and antioxidant levels.ConclusionsDexpanthenol did not have significant effect on oxidative stress of acute kidney injury on this rat model. However, it has ameliorated serum Cys-C levels and histopathological findings of CIN.Turkish Society of Hypertension and Kidney DiseaseThis study was supported by Turkish Society of Hypertension and Kidney Disease

Low Copeptin Levels in Patients With Intradialytic Hypotension

Intradialytic hypotension (IDH) is related to high morbidity and mortality. There is evidence that arginine-vasopressin (AVP) responses could play a role. Copeptin is a reliable biomarker of AVP. In this study, copeptin, aldosterone, epinephrine, and norepinephrine levels in patients with IDH were evaluated throughout a hemodialysis (HD) session and compared with the control group. The study includes 15 patients who were normotensive during HD and 15 patients with IDH with a minimum HD vintage of 1 year. Blood samples were collected before the initiation of an HD session (T-0), in the mid-session for control group, 30 min after mean arterial pressure drop for IDH patients (T-1), and at the end of the session (T-2). Groups had similar demographic features and health parameters, interdialytic weight gains, and ultrafiltration amounts. The IDH group had a mean arterial pressure decline of 39.9 (+/- 6.4) mm Hg. Copeptin levels of the control group increased an average of 79.9 (+/- 97.5) pmol/L at T-1 and an additional 24.8 (+/- 33.9) pmol/L at T-2. In the IDH group, copeptin level increases at T-1 and T-2 were 3.2 (+/- 5.5) pmol/L and 34 (+/- 44.6) pmol/L, respectively(.) Copeptin levels of the IDH group were significantly lower at T-1 (P < 0.001) and at the T-0-T-2 interval than control group (P = 0.05). In the control group, aldosterone levels distinctly decreased, and in the IDH group, aldosterone levels were elevated (P < 0.001). Small changes were detected in epinephrine and norepinephrine levels for both groups but did not reach significance (P = 0.6 and P = 0.3, respectively). Lower copeptin level alterations suggest inadequate AVP responses in patients with IDH

Combining clinical features and MEST-C score in IgA nephropathy may be a better determinant of kidney survival

Introduction. IgA nephropathy (IgAN) is a heterogeneous disease with highly variable clinical and histopathological features. We investigated the effects of Oxford classification and clinical features on renal survival in patients with IgAN.Methods. This retrospective observational study conducted from 2013 to 2017. Ninety-seven patients who were followed up more than six months were examined.Results. A total of 97 patients (68% male and median age 40 years) were enrolled in this study. 13% of patients developed end stage renal disease (ESRD) within the median of 37 months of follow-up. Need for renal replacement therapy at the time of diagnosis, serum creatinine level of higher than 1.97 mg/dl, serum albumin level less than 3.5 gr/dl, 24-hour urine protein level of higher than > 3.5 g/day, the percentage of glomerulosclerosis higher than 53%, T2 score and total MEST-C score higher than two were found to be significant predictors of development of ESRD. None of the clinical or histopathological features were found to be significant predictor of steroid treatment sensitivity except T1-2 scores.Conclusion. We think that IgA nephropathy is a heterogeneous disease that requires clinical and histopathological features to be evaluated together, but not individually, to determine renal survival.What is new. Iga nephropathy is a heterogeneous disease and modern pathologic classification systems is not enough to predict to prognosis. Histopathological features to be evaluated with clinical features, but not individually, to determine renal survival. Also glucocorticoid treatment response seems to be independent from clinical and histopathological features except T1-2 score

First Reported Case of Echinococcal Disease on a Renal Graft Successfully Treated With Albendazole.

Echinococcal disease is an endemic disease for eastern Mediterranean countries. Various types of kidney involvement have been reported. Here, we report the first case of echinococcal disease on a transplanted kidney in a patient who was successfully treated with albendazole alone. The patient (a 38-year-old female) was evaluated for elevated creatinine levels 7 months after receiving a living-donor allograft. Standard immunosuppression therapy protocols were applied. Tacrolimus level was normal, and the patient was compliant with treatment. Creatinine level was 1.91 mg/dL (baseline: 1.2 mg/dL); proteinuria level was 1300 mg/day. The graft was found to be normal, as evaluated with standard sonographic methods. A kidney biopsy was performed, which showed that part of the cortical parenchyme was infiltrated by echinococcal protoscolices with hooklets. Because there were no cysts present on the graft, we concluded that disease was at an early stage. The patient was given albendazole for 3 months. After therapy, all echinococcal structures disappeared. Her creatinine level dropped to baseline, and proteinuria resolved. Echinococcal disease can affect transplanted kidneys. Albendazole is a valuable treatment option for patients who are not candidates for surgical resection