Serum fetuin-A and recurrent urolithiasis in young adults

Objective: Recurrence of urolithiasis is frequent. There are no reliable markers able to indicate recurrent stone former patients. Fetuin-A inhibits hydroxyapatite crystals formation and expansion. This study aims at evaluating whether serum fetuin-A may predict recurrent urolithiasis in young adults. Materials and methods: This is a multicentre study. Young adults patients with recurrent urolithiasis attending 3 urology clinics were enrolled from July 2011 to December 2012. Inclusion criteria were: age 18-40 years, presence of more than one kidney stone. Exclusion criteria were: diabetes mellitus, metabolic disorders, obesity, hypertension, cardiovascular disease, infection diseases. Controls were participants without history of urolithiasis and currently undetected stones. Routine biochemistry, serum concentration of oxalate, fetuin-A, and parathyroid hormone (PTH) were assessed; 24/h urinary excretion of creatinine, uric acid, calcium, sodium, phosphorus, potassium, magnesium, glucose, oxalate, amylase, and protein was measured. Kidney ultrasonography and plain X-ray examination was performed. Results: The total cohort was represented by 120 young adults participants (90 patients, and 30 controls). Clinical characteristics were not different between patients and controls. No significant differences were found in serum concentrations as well as in 24/h urinary excretion of recorded variables. No significant difference was found in serum concentration of fetuin-A (median 35.1 ± 18.62 SD Vs 35.12 ± 14.12, μg/ml; p = 0,908). Conclusions: The data of present study do not substantiate the hypothesis that serum fetuin-A may be a reliable predictor of recurrent urolithiasis in young adults

Effect of maintenance treatment with mycophenolate mofetil on chronic inflammatory status in proliferative lupus nephritis.

INTRODUCTION AND AIMS: Systemic Lupus Erythematosus (SLE) is associated with a high cardiovascular risk ascribed to a chronic inflammatory state. Conventional maintenance treatment consists of oral prednisone plus cyclophosphamide, azathioprine or cyclosporine A. The use of mycophenolate mofetil (MMF) has been recently proposed as a safe alternative to control disease activity. No data are available about any additional benefits on chronic inflammatory status. METHODS: A longitudinal study has been designed with 14 patients with proliferative lupus nephritis.(Figure 1) After diagnosis the patients underwent induction therapy and conventional maintenance treatment with oral cyclosporine A for one year. They were then switched to MMF and evaluated for 12 months. Disease activity index (SLEDAI 2K), antinuclear and anti double stranded DNA antibodies (Anti-dsDNA), renal function and proteinuria (expressed as urine Protein /Creatinine ratio) were measured in basal condition and every six months. Inflammatory status was also evaluated by measuring serum level of fibrinogen, C-reactive protein and uric acid. Interleukin 6 (IL-6) released by peripheral blood mononuclear cells was measured too. RESULTS: Disease activity: Both induction therapy and conventional maintenance therapy were able to decrease urine Protein/Creatinine ratio (P/C), though not reaching significance while treatment with MMF showed a significant decrease of P/C and increase of serum albumin levels (p < 0.001 vs basal values). Moreover MMF significantly decreased both SLEDAI-2K and Anti-dsDNA titer. (p < 0.001 vs basal values) No significant change has been showed in antinuclear antibodies, blood count, creatinine clearance, complement C3 and C4. Inflammatory status: Induction treatment and conventional maintenance treatment did not have effect on inflammatory markers, by contrast after 12 months of MMF therapy patients showed a significant decrease of serum levels of C-reactive protein, uric acid and IL-6 production were also significantly reduced (p<0.001 for IL-6), (Table 1). CONCLUSIONS: Maintenance therapy with prednisone and MMF is able to control disease activity and improve inflammatory status in patients with proliferative lupus nephritis. Behaviour of inflammatory markers all over the study (N=14) Basal Phase 1 Phase 2 Phase 3 Uric acid (mg/dl) 7.20±1.95 § 7.11±1.95 § 6.91±1.90* 5.98±1.42 CRP (mg/dl) 2.67±0.56* 2.22±0.35° 2.46±2.02* 0.70±0.59 IL-6 (pg/ml) 492.6±33.5 § 450.4±85.2 § 443.0±84.1 § 27.4±17.8 § §= p<0.001 vs MMF treatment. *=p<0.01 vs MMF treatment. °=p<0.05 vs MMF treatment Session: Poster: Clinical studies in CKD Close Windo

Combined use of noninvasive tests is useful in the initial diagnostic approach to a child with suspected inflammatory bowel disease

Objective: To assess the effectiveness of the combined use of fecal calprotectin (FC), anti-Saccharomyces cerevisiae antibody (ASCA), perinuclear staining antineutrophil antibody (pANCA), small intestinal permeability test (IP), and bowel wall ultrasonography measurement (BWUS) in the diagnostic work-up of children with suspected inflammatory bowel disease (IBD). Methods: All children referred for initial assessment of possible IBD were eligible. Patients with symptoms or signs (right-lower quadrant mass, perianal disease, or hematochezia) mandating a complete work-up for IBD were excluded. All enrolled patients underwent a clinical, laboratory, radiographic, and endoscopic evaluation including biopsy examinations. The immunoglobulin (Ig)G and IgA ASCA, IgG pANCA, FC, IP, and BWUS were tested in all patients at the initial assessment. Results: A final diagnosis of IBD was made in 27 patients: 17 Crohn disease and 10 ulcerative colitis. Eighteen children had other gastrointestinal diagnoses (8 functional bowel disorders, 5 food allergy-mediated diseases, 4 infectious enterocolitis, 1 familial Mediterranean fever). In patients with simultaneous abnormal values of FC, BWUS, and ASCA/pANCA, the estimated probability of having IBD was 99.47%. Patients with negative results on all tests had a 0.69% of probability of IBD. Conclusions: The incorporation of noninvasive diagnostic tests into the initial diagnostic approach may avoid unnecessary invasive procedures and facilitate clinical decision-making when the diagnosis of IBD in children is initially uncertain. © 2006 Lippincott Williams & Wilkins