Statyny w chorobach nerek

Wskazania do stosowania statyn w przewlekłej chorobie nerek nie są całkowicie jasne. Do tej pory w żadnym badaniu randomizowanym nie potwierdzono ich korzystnego efektu u pacjentów ze schorzeniami nefrologicznymi, a niektóre dane wskazują nawet na ich niekorzystny wpływ. W poniższej pracy podsumowano obecny stan wiedzy na temat statyn w przewlekłej chorobie nerek, skupiając się na posiadanych dowodach klinicznych

Hiperkaliemia

Postęp w zakresie farmakoterapii niewydolności serca doprowadził do poprawy rokowania i jakości życia u wielu chorych na całym świecie. Spowodował jednak także wzrost częstości objawów niepożądanych stosowanego leczenia. Być może najważniejszym z tych objawów jest potencjalnie niebezpieczna dla życia chorych hiperkaliemia. W niniejszej pracy omówiono krótko przemianę potasu w organizmie (zwracając szczególną uwagę na nerki, główny narząd wydalający nadmiar tego jonu i chroniący przed hiperkaliemią), etiologię i diagnostykę różnicową przyczyn hiperkaliemii, objawy kliniczne i leczenie

Obrzęk szpiku u biorców przeszczepu nerki leczonych inhibitorami kalcyneuryny : opis przypadków

Background: Transient acute musculoskeletal pain syndrome occurs predominantly within the first several months after renal transplantation. Its pathogenesis is not well understood. The toxic effect of calcineurin inhibitors or steroids on bone metabolism has been suspected. Almost all reported cases were associated with the use of cyclosporin A. The pain typically involves distal part of lower extremities and arises in the feet, ankles, or knees. Case report: Two cases are presented of renal allograft recipients who developed severe lower-limb pain in the early period after transplantation while receiving calcineurin-inhibitor (cyclosporin A and tacrolimus). Results: We observed typical clinical and radiological symptoms. The final diagnosis was based on MRI scans. Relief from pain was observed during rest and elevation of the affected extremities. Clinical symptoms and MRI abnormalities resolved spontaneously within a few months

Comparable Renal Function at 6 Months with Tacrolimus Combined with Fixed-Dose Sirolimus or MMF: Results of a Randomized Multicenter Trial in Renal Transplantation

In a multicenter trial, renal transplant recipients were randomized to tacrolimus with fixed-dose sirolimus (Tac/SRL, N = 318) or tacrolimus with MMF (Tac/MMF, N = 316). Targeted tacrolimus trough levels were lower in the Tac/SRL group after day 14. The primary endpoint was renal function at 6 months using creatinine clearance (Cockcroft-Gault) and was comparable at 66.4 mL/min (SE 1.4) with Tac/SRL and at 65.2mL/min (SE 1.3) with Tac/MMF (completers). Biopsy-confirmed acute rejection was 15.1% (Tac/SRL) and 12.3% (Tac/MMF). In both groups, graft survival was 93% and patient survival was 99.0%. Premature withdrawal due to an adverse event was twice as high in the Tac/SRL group, 15.1% versus 6.3%. Hypercholesterolemia incidence was higher with Tac/SRL (P < .05) while CMV, leukopenia, and diarrhea incidences were higher with Tac/MMF (P < .05). The incidence of any antidiabetic treatment for >30 consecutive days in previously nondiabetic patients was 17.8%, Tac/SRL, and 24.8%, Tac/MMF. Evaluation at 6 months showed comparable renal function using tacrolimus/sirolimus and tacrolimus/MMF regimens

Safety of intravenous ferric carboxymaltose versus oral iron in patients with nondialysis-dependent CKD: an analysis of the 1-year FIND-CKD trial.

Background: The evidence base regarding the safety of intravenous (IV) iron therapy in patients with chronic kidney disease (CKD) is incomplete and largely based on small studies of relatively short duration. Methods: FIND-CKD (ClinicalTrials.gov number NCT00994318) was a 1-year, open-label, multicenter, prospective study of patients with nondialysis-dependent CKD, anemia and iron deficiency randomized (1:1:2) to IV ferric carboxymaltose (FCM), targeting higher (400-600 µg/L) or lower (100-200 µg/L) ferritin, or oral iron. A post hoc analysis of adverse event rates per 100 patient-years was performed to assess the safety of FCM versus oral iron over an extended period. Results: The safety population included 616 patients. The incidence of one or more adverse events was 91.0, 100.0 and 105.0 per 100 patient-years in the high ferritin FCM, low ferritin FCM and oral iron groups, respectively. The incidence of adverse events with a suspected relation to study drug was 15.9, 17.8 and 36.7 per 100 patient-years in the three groups; for serious adverse events, the incidence was 28.2, 27.9 and 24.3 per 100 patient-years. The incidence of cardiac disorders and infections was similar between groups. At least one ferritin level ≥800 µg/L occurred in 26.6% of high ferritin FCM patients, with no associated increase in adverse events. No patient with ferritin ≥800 µg/L discontinued the study drug due to adverse events. Estimated glomerular filtration rate remained the stable in all groups. Conclusions: These results further support the conclusion that correction of iron deficiency anemia with IV FCM is safe in patients with nondialysis-dependent CKD