Hypokalemic rhabdomyolysis: a rare manifestation of primary aldosteronism

Rhabdomyolysis is a rare presentation of hypokalemia, although muscle weakness is a well-known manifestation of hypokalemia. Primary aldosteronism is characterized by hypertension, suppressed plasma renin activity, increased aldosterone excretion and hypokalemia with metabolic alkalosis. Rhabdomyolysis is not common in primary aldosteronism. We present here a 40-year-old woman presenting with rhabdomyolysis accompanied by severe hypokalemia as heralding symptom of primary aldosteronism

Fluctuations of estimated glomerular filtration rate outside kidney disease improving global outcomes diagnostic criteria for acute kidney injury in end-stage liver disease outpatients and outcome postliver transplantation

Background. Renal dysfunction in end-stage liver disease (ESLD) results fromsystemic conditions that affect both liver and kidney with activation of vasoconstrictor systems. In this setting, estimated glomerular filtration rate (eGFR) may undergo variations often outside Kidney Disease Improving Global Outcomes criteria for acute kidney injury (AKI) diagnosis, whose meaning is not clear. The aim of this study was to evaluate eGFR variations in ESLD outpatients listed for liver transplant (liver Tx) and the association with post-Tx outcome. Methods. Fifty-one patients with ESLD were retrospectively evaluated from listing to transplant (L-Tx time), intraoperatively (Tx time), and up to 5 years post-Tx time. Variations between the highest and the lowest eGFR occurring in more than 48 hours, not satisfying Kidney Disease Improving Global Outcomes guideline, were considered as fluctuations (eGFR-F). Fluctuations of eGFR greater than 50%were defined as eGFR drops (DeGFR). Early graft dysfunction, AKI within 7 days, chronic kidney disease, and short- and long-term patient survivals were considered as outcomes. Results. All patients presented eGFR-F, whereas DeGFR were observed in 18 (35.3%) of 51 (DeGFR+ group). These patients presented higher levels of Model for End-stage Liver Disease score, pre-Tx bilirubin and significantly greater incidence of post-Tx AKI stages 2 to 3 compared with patients without drops (DeGFR−). DeGFR was the only independent predictive factor of the occurrence of post-Tx AKI. The occurrence of AKI post-Tx was associated with the development of chronic kidney disease at 3 months and 5 years post-Tx. Conclusions. Drops of eGFR are more frequently observed in patients with a worse degree of ESLD and are associated with a worse post-Tx kidney outcome

Screening and confirmation analysis of stimulants, narcotics and beta-adrenergic agents in human urine by hydrophilic interaction liquid chromatography coupled to mass spectrometry

The chromatographic behaviour of 44 polar compounds (23 beta-adrenergic agents, 11 stimulants, 4 narcotics and 6 phenolalkylamines) included in the list of prohibited substances and methods of the World Anti-Doping Agency, has been investigated under hydrophilic interaction liquid chromatography conditions by application of different mobile phase compositions (percentage of the organic solvent, type and amount of mobile phase additive and ionic strength) and column temperatures. Detection of analytes was performed by a triple quadrupole mass spectrometer in positive ionization mode and selected reaction monitoring acquisition mode after liquid/liquid extraction. Data collected using as stationary phase type-B silica materials from different producers, showed that the best chromatographic conditions in terms of peak shape, selectivity and chromatographic retention were obtained using an initial percentage of acetonitrile of 90%, a column temperature of 35 degrees C, a mobile phase pH of 4.5 and ammonium acetate (5 mM) and acetic acid (0.1%) as mobile phase additives. The selected chromatographic conditions were used to develop screening and confirmation analytical procedures to detect polar compounds in human urine for antidoping purpose. The developed methods were validated in terms of specificity, matrix effect, linearity, precision, accuracy, sensitivity, robustness and repeatability of retention times and relative ion abundances. Such methods offer attractive alternatives and considerable advantages over traditional approaches especially for the analysis of the phenolalkylamines. (C) 2011 Elsevier B.V. All rights reserved

A rapid analytical method for the detection of plasma volume expanders and mannitol based on the urinary saccharides and polyalcohols profile

A screening procedure specifically developed for the detection of saccharides and polyalcohols in human urine in the framework of doping control analysis is presented. The proposed method, set-up, and validated to detect the abuse of dextran, hydroxyethyl starch and mannitol as a doping practice in sport, involves only one enzymatic hydrolysis step and the direct injection into a liquid chromatography-tandem mass spectrometry (LC-MS/MS) system

A mass spectrometric approach for the study of the metabolism of clomiphene, tamoxifen and toremifene by liquid chromatography time-of-flight spectroscopy

In this paper, we discuss the capabilities of liquid chromatography coupled to mass spectrometry with a time-of-flight system with accurate mass measurement for the detection and characterisation of drug metabolites in biological samples for anti-doping purpose. Urinary excretion samples of three selective oestrogen receptor modulators (SERMs) with a common triphenylethylene structure: clomiphene, toremifene and tamoxifen, obtained after oral administration of a single dose of each drug, were analysed using a time-of-flight system, after automatic tuning and calibration of the equipment, in positive full scan mode using an electrospray ionisation source. Following this approach we detected most of all significant metabolites reported by others and postulated new metabolites, especially for toremifene, have been characterised: N-demethyl-3-hydroxy-4-methoxy-toremifene and 3-hydroxy-4-methoxy-toremifene; in addtion to this, in the urinary excretion samples of toremifene some metabolites, without the characteristic chlorine isotope pattern, discarded in previous studies, that are also metabolites of tamoxifen, were identified. The lack of certified reference materials does not allow an accurate determination of the limit of detection (LODs) of all metabolites; however, an estimation taking into account the response factor of similar compounds allows to estimate that all metabolites are clearly detectable in a range of concentration comprised between 10 ng mL-1 and 30 ng mL-1. © IM Publications LLP 2008 All rights reserved

A simplified procedure for the analysis of formoterol in human urine by liquid chromatography-electrospray tandem mass spectrometry: Application to the characterization of the metabolic profile and stability of formoterol in urine

Since 1992, formoterol is included in the prohibited list of doping substances and methods, presently reviewed and updated by the World Anti-Doping Agency. Recently a threshold value of 40ng/mL has been established to differentiate between the prohibited (oral) and the permitted (inhalatory) administration of formoterol to athletes. This paper considers the urinary excretion profile of formoterol and its main metabolites after inhalation of different doses of two of the most used medicaments, available in Italy, containing formoterol fumarate bihydrate (12 and 36μg twice a day of Foradil® or 9 and 27μg twice a day of Symbicort®), focusing also on the effects, on the measured levels of formoterol, of potential alteration processes (thermal and/or microbiological) that may take place after the collection of the urine samples. Urine sample preparation included an enzymatic hydrolysis and a dilution step. Detection of analytes was performed by a newly developed and validated direct LC-ESI-MS/MS procedure, using a triple quadrupole mass spectrometer under positive ion electro-spray ionization conditions and selected reaction monitoring acquisition mode. The results showed the capability and suitability of the direct LC-ESI-MS/MS analysis for the quantitative confirmation analysis of formoterol in urine samples. The data from the analysis of the urine samples obtained in the excretion studies showed that formoterol is excreted mainly as unmodified drug and to a lesser degree as O-demethylated metabolite. The urinary levels of formoterol (40-60%) and its metabolites (O-demethylated metabolite 5-25%; glucuronide metabolites 25-40%) vary significantly depending both on the administered drug formulation and the subject tested. The maximum urinary concentration reached in this study was 15ng/mL (free+glucuronide), that is significantly lower than the threshold value fixed to report an adverse analytical finding. Finally, our results also showed that formoterol is stable for at least 4 weeks in urine samples correctly collected and stored. © 2013 Elsevier B.V

Drug-drug interactions and masking effects in sport doping: influence of miconazole administration on the urinary concentrations of endogenous anabolic steroids

We have investigated the influence of oral miconazole administration on the urinary concentrations of endogenous anabolic androgenic steroids of doping relevance, specifically considering all these compounds routinely monitored in doping control analysis, in the framework of the steroidalmodule of the ‘‘athlete biologicalpassport’’, and other steroids, including dehydroepiandrosterone, 5a-dihydrotestosterone, and the hydroxylated metabolites recently proposed as additional markers of the intake of testosteronerelated steroids (16a-hydroxy-androsterone, 16a-hydroxyetiocholanolone, 6b-hydroxy-androsterone, 6b-hydroxy-etiocholanolone, 7a-hydroxy-dehydroepiandrosterone, and 7bhydroxy-dehydroepiandrosterone). Urinary concentrations of the final metabolic products of the glucocorticoid biosynthetic pathways (11b-hydroxy-androsterone and 11b-hydroxy-etiocholanolone, the formerly used as an endogenous reference compound for the gas chromatography–combustion-isotope ratio mass spectrometry confirmation analysis) were also monitored. Two healthy Caucasian volunteers exhibiting physiologically high testosterone/epitestosterone ratios and elevated concentrations of the main target steroids were selected for the study. Miconazole was administered orally (500 mg/day) for 1 week. Multiple urine samples were collected for 1 week before and during the treatment, and analyzed according to a validated analytical procedure based on gas chromatography–electron ionization-mass spectrometry in selected ion monitoring mode. Our results indicated that oral administration of miconazole decreased the urinary concentrations of androsterone, and to a lesser extent, of etiocholanolone (both detected as the sum of free and glucuronated steroids), and consequently the androsterone/testosterone and androsterone/etiocholanolone ratios. Furthermore, the urinary concentrations of 16a-hydroxy-etiocholanolone, 16a-hydroxy-androsterone, 7b-hydroxy-dehydroepiandrosterone, 6b-hydroxy-etiocholanolone, 7a-hydroxy-dehydroepiandrosterone, 6b-hydroxy-androsterone, 11b-hydroxy-androsterone, and 11b-hydroxy-etiocholanolone were significantly suppressed. This evidence suggests the potential intake of miconazole whenever the urinary steroid profile is characterized by abnormally low concentrations of the above-mentioned steroids

A multi-targeted liquid chromatography-mass spectrometry screening procedure for the detection in human urine of drugs non-prohibited in sport commonly used by the athletes

This work presents an analytical method for the simultaneous analysis in human urine of 38 pharmacologically active compounds (19 benzodiazepine-like substances, 7 selective serotonin reuptake inhibitors, 4 azole antifungal drugs, 5 inhibitors of the phosphodiesterases type 4 and 3 inhibitors of the phosphodiesterase type 5) by liquid-chromatography coupled with tandem mass spectrometry. The above substances classes include both the most common "non banned" drugs used by the athletes (based on the information reported on the "doping control form") and those drugs who are suspected to be performance enhancing and/or act as masking agents in particular conditions. The chromatographic separation was performed by a reverse-phase octadecyl column using as mobile phases acetonitrile and ultra-purified water, both with 0.1% formic acid. The detection was carried out using a triple quadrupole mass spectrometric analyser, positive electro-spray as ionization source and selected reaction monitoring as acquisition mode. Sample pre-treatment consisted in an enzymatic hydrolysis followed by a liquid-liquid extraction in neutral field using tert-butyl methyl-ether. The analytical procedure, once developed, was validated in terms of sensitivity (lower limits of detection in the range of 1-50 ng mL(-1)), specificity (no interferences were detected at the retention time of all the analytes under investigation), recovery (≥60% with a satisfactory repeatability, CV % lower than 10), matrix effect (lower than 30%) and reproducibility of retention times (CV% lower than 0.1) and of relative abundances (CV% lower than 15). The performance and the applicability of the method was evaluated by analyzing real samples containing benzodiazepines (alprazolam, diazepam, zolpidem or zoplicone) or inhibitors of the phosphodiesterases type 5 (sildenafil or vardenafil) and samples obtained incubating two of the phosphodiesterases type 4 studied (cilomilast or roflumilast) with pooled human liver microsomes. All the parent compounds, together with their main phase I metabolites, were clearly detected using the analytical procedures here developed

ANCA-Negative Paucimmune Glomerulonephritis and Glomerular Recovery: Possible Role of Mesenchymal Stem Cells in a 69 Year-Old Patient

BACKGROUND: Pauci-immune crescentic glomerulonephritis is one of the most common causes of rapidly progressive glomerulonephritis, usually associated with anti-neutrophil cytoplasmic antibody (ANCA) but a minority of patients lack ANCAs. To date no effective treatments have been addressed for ANCA-negative glomerulonephritis despite several studies describe the possibility to adopt pharmacologic therapies. Cellular, molecular and preclinical studies demonstrate that mesenchymal stem cells (MSCs) contribute to glomerular cell turnover and repair and might represent a new therapeutic approach for ANCA-negative glomerulonephritis. AIM: In our study we presented a case report of a patient with ANCA-negative pauci-immune glomerulonephritis in order to underlie the growing need of an alternative therapy for glomerular diseases. MATERIALS AND METHODS: We report the case of a 69 year-old woman who presented to our department with diarrhea, vomiting and increased serum creatinine levels. At the First Aid Department, renal ultrasonography excluded dilatations of urinary tract and since the occurrence of progressive dyspnea, anuria and severe hypertension renal replacement therapy was started. RESULTS: A second kidney Doppler ultrasonography showed hyperechoic parenchyma, reduced thickness and increased resistive index. Urinalysis revealed persistent active sediment and proteinuria. Autoimmunity profile showed C3, IgE and IgM increased levels. Renal biopsy was performed showing diffuse extracapillary proliferative glomerulonephritis with negative Immunofluorescence (IF). ANCA test was negative for a second time by both IF analysis and antigen-specific ELISA. The diagnosis was ANCA-negative glomerulonephritis and steroid bolus was administered, improving urinary sediment and proteinuria but not glomerular filtration rate. DISCUSSION: Our data demonstrated that pharmacological treatment of ANCA-negative glomerulonephritis correlated with poor response and is not effective, pointing out the importance of new therapeutic options for this disease. In this regard MCSs may represent a valid alternative in the treatment of ANCA-negative glomerulonephritis. CONCLUSIONS: MSCs may provide an effective therapeutic option in glomerular diseases and future studies should be performed in order to pave the way for this cell-based therapy