Which out-of-office measurement technique should be used for diagnosing hypertension in prehypertensives?

Hypertension (HT) is diagnosed with high office blood pressure (BP), although confirmation with the addition of out-of-office measurements is currently recommended. However, insufficient data are available concerning the use of out-of-office BP measurement techniques for the diagnosis of HT in the prehypertensive population. The aim of the present study was to determine which out-of-office measurements yielded earlier and more frequent detection of development of HT in prehypertensive patients. Two hundred seven prehypertensive patients under monitoring in the Cappadocia cohort were included in the study. Office BP was measured five times at 1-min intervals, followed by 24-h ambulatory BP monitoring (24-h ABPM). Home BP measurement (HBPM) was performed five times, at the same times in the morning and evening, at 1-min intervals for 1 week. The same procedure was carried out at 4-6-month intervals for ~2 years. HT was diagnosed in 25.6% of subjects, masked HT in 11.1%, and white coat HT in 2.9%, while 23.7% remained prehypertensive and 36.7% became normotensive. Briefly, 56.6% of the patients with HT were diagnosed with office plus 24-h ABPM, 13.2% with office plus HBPM, and 30.2% with office plus HBPM and 24-h ABPM. Office with 24-h ABPM yielded statistically significantly more diagnoses (p < 0.001). In conclusion, our prospective observational study evaluated the usefulness of out-of-office BP measurements in confirming diagnosis of HT in prehypertensive patients. The findings show that 24-h ABPM detected HT earlier and more frequently in this high-risk population

Impact of medium cut-off membranes on S100A12 and soluble receptor for advanced glycation end products

Introduction: Of the most remarkable molecules associated with atherosclerosis and the cardiovascular outcome are S100A12 (10,379.5 Da) and soluble receptor for advanced glycation end products (sRAGE-42,803 Da) in the hemodialysis (HD) population. We designed a study investigating the effects of the medium cut-off (MCO) dialyzers focusing on S100A12 and sRAGE in HD patients compared with low-flux and high-flux dialyzers. Methods: This single-site, prospective, observational study comprises age and sex-matched HD groups (low-flux, high-flux, and MCO). Blood samples were drawn at baseline (predialysis and postdialysis) and the sixth month (predialysis). Results: Groups had similar demographic features and laboratory parameters. Baseline S100A12 levels of the groups were similar [34.3 (±66.5), 30.9 (±42.7), and 40.6 (±29.6); p = 0.13]. Compared to their baseline, the sixth-month S100A12 levels were constant in low-flux and high-flux group and significantly lower in MCO group (p = 0.16, p = 0.33, and p = 0.004). Baseline sRAGE levels of the groups were similar at baseline [2.8 (±0.8), 2.7 (±0.6), and 2.6 (±0.7); p = 0.65], and the sixth-month [2.9 (±0.5), 2.4 (±0.7), and 2.4 (±0.8); p = 0.24]. sRAGE levels remained constant in all groups [p = 0.84, p = 0.13, and p = 0.39]. S100A12/sRAGE ratio at baseline and sixth month was constant in low-flux [22.3 (±63.7) and 18.1 (±24.8); p = 0.17] and high-flux groups [11.9 (±15.3) and 13.1 (±5.8); p = 0.26], the ratio decreased significantly in MCO group [16.5 (±11.6) to 7.8 (±5.5); p = 0.03]. Conclusion: Our study suggests that prolonged use of MCO dialyzers is associated with better S100A12 and sRAGE levels. Long-term studies with larger samples are needed to understand the effects of a better S100A12-sRAGE profile provided by MCO dialyzers on HD patients' cardiovascular outcomes

Dirençli Nefrotik Sendromlarda Ofatumumab Deneyimi

Dirençli Nefrotik Sendromlarda Ofatumumab DeneyimiBurak Özbaş1, Özant Helvacı1, Ülver Derici1, Selim Turgay Arınsoy1, 1Gazi Üniversitesi Tıp Fakültesi, Nefroloji, AnkaraGiriş: Dirençli Kronik Lenfositik Lösemi/Lenfoma’da kullanılmak üzere geliştirilen bir Anti-CD20 monoklonal antikor olan Ofatumumab’la ilgili olarakRitüksimab direnci veya allerjisi öyküsü olan Lupus nefriti, Fokal SegmentalGlomerüloskleroz (FSGS) ve Minimal Değişiklik Hastalığı ile takipli hastalarda kullanıldığında olumlu sonuçlar alındığına dair yayınlar mevcuttur.Biz bu bildiride benzer endikasyonlarda Ofatumumab tedavisi verdiğimizhastalarımızın sonuçlarını paylaşmayı amaçladık.Yöntem: Her ikisi de biyopsi tanılı olan, birisi post-transplant nüks etmişRitüksimab dirençli FSGS, diğeri de Ritüksimab allerji öyküsü olan primerMembranöz Glomerulonefrit (MGN) tanılarıyla takip ettiğimiz nefrotik düzeyde proteinürisi olan iki hastamıza 700 mg/1,73 m² dozundan 2 haftaarayla Ofatumumab verildi. Yanıt değerlendirilmesi amacıyla 0, 3 ve 6. aydaCD19 (+) B lenfosit düzeylerine, böbrek fonksiyon testlerine, 24 saatlik idrarda protein miktarlarına bakılması planlandı. Hastalardan tedavi öncesihepatit belirteçleri, EBV/CMV DNA görüldü. Akciğer grafileri muhtemelenfeksiyonlar açısından incelendi ve profilaktik haftada 3 gün 400/80 mgko-trimoksazol verildi.Bulgu: FSGS ile takipli 41 yaşındaki erkek hastanın tedavi öncesi kan üreazotu (BUN) 21 mg/dl, serum kreatinin 1,43 mg/dl, glomerüler filtrasyonhızı (eGFR) 60,4 mL/dk/1.73m², serum albümin düzeyi 2,2 g/dl, 24 saatlikidrarda protein 8,1 gr ve CD19(+) B-Lenfosit oranı %2,5 geldi. Tedavinin 3.ayında bakılan BUN 20 mg/dl, serum kreatinin düzeyi 1,4 mg/dl, eGFR 62mL/dk/1.73m², serum albümin düzeyi 3 g/dl, 24 saatlik idrarda protein 8,5gr ve CD19(+) B-Lenfosit oranı %1 geldi. MGN ile takipli olan 19 yaşındakierkek hastanın ise tedavi öncesi BUN 38 mg/dl, serum kreatinin düzeyi 2,48mg/dl, eGFR 36 mL/dk/1.73m², serum albümin düzeyi 2,6 g/dl, 24 saatlikidrarda protein 13,6 gr iken, CD19(+) B-Lenfosit oranı %7,5 geldi. 3. aydabakılan BUN 37 mg/dl, serum kreatinin düzeyi 2,41 mg/dl, eGFR 37 mL/dk/1.73m², serum albümin düzeyi 3,4 g/dl, 24 saatlik idrarda protein 14,1gr ve CD19(+) B-Lenfosit oranı %1 geldi. Hastalarda infüzyona bağlı herhangi bir allerjik reaksiyon gelişmezken, MGN ile takipli hasta solunum yoluenfeksiyonu nedeniyle parenteral antibiyotik tedavisi aldı.Sonuç: Anti-CD20 bazlı tedavilerde yanıt 6.aya kadar gecikebilmekle beraber, bizim hastalarımızda 3.ayın sonunda proteinüride anlamlı azalma henüz görülmemiştir. Olası nedenler olarak ilaç dozunun yetersizliği ve tedaviöncesi GFR kaybının başlaması gösterilebilir. Ofatumumab’ın daha yüksekdozda ve henüz GFR kaybının başlamamış olduğu hastalarda uygulanmasıdurumunda olumlu yanıt alınabilmesi olasıdır.Anahtar Kelimeler: Ofatumumab, Nefrotik Sendrom</p

Hipertansiyon ve Böbrek Hastalıkları Çalışma ve Derlemeler

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Coeliac crisis mimicking nephrotic syndrome in a post-partum patient

Background: Coeliac crisis is a life-threatening presentation of coeliac disease. Severe diarrhoea, weight loss, electrolyte imbalances and malnutrition are prominent features. Although mainly a disease of childhood, it can on the rare occasion be diagnosed in adults. Case presentation: A 25-year-old female with severe generalised oedema, lower extremity weakness, hypokalemia and profound hypoalbuminemia was referred with an initial diagnosis of nephrotic syndrome. Three months previously she had given birth to a healthy child following an uneventful pregnancy. She did not have proteinuria. She had a history of diarrhoea with gluten-containing food since childhood but lacked a formal diagnosis of coeliac disease. A duodenal biopsy confirmed the suspected diagnosis. Coeliac crisis was diagnosed with life-threatening multisystem involvement. Introduction of a gluten-free diet abolished all disease symptoms and ameliorated laboratory parameters at six months’ follow-up. Conclusion: Coeliac crisis is a rare, yet dangerous presentation of coeliac disease in adults. As this case suggests, it can present with generalised oedema and hypoalbuminemia mimicking nephrotic syndrome. Rapid diagnosis is the key to successful treatment

Unexpected Late Response to Ofatumumab in Adult Post-Transplantation Recurrent Focal Segmental Glomerulosclerosis, Case Report

© 2022 Elsevier Inc.Background: Idiopathic focal segmental glomerulosclerosis is an important cause of kidney failure in adults, which is associated with a high risk of disease recurrence after transplantation. Plasmapheresis, rituximab, immunoadsorption, and high-dose cyclosporine are used to treat post-transplant recurrent focal segmental glomerulosclerosis (rFSGS). However, the response rate is variable, and few options remain for unresponsive patients. Case Report: We present a 44-year-old man with an early post-transplant rFSGS. After peritransplant plasmapheresis, rituximab, and abatacept treatments failed, we employed ofatumumab. After 9 months without apparent benefit, we observed an unexpected partial remission thereafter, without severe side effects. Furthermore, remission has been sustained in 30-month follow-up. Conclusions: We believe ofatumumab can be considered an alternative for patients with plasmapheresis and rituximab-resistant post-transplant rFSGS

Association between calcitriol and paricalcitol with oxidative stress in patients with hemodialysis

Background: The pathophysiological basis of chronic kidney disease and its complications, including cardiovascular disease, are associated with chronic inflammation and oxidative stress. We investigated the effects of active vitamin D (calcitriol) and synthetic vitamin D analog (paricalcitol) on oxidative stress in hemodialysis patients. Methods: This cross-sectional study was composed of 83 patients with a minimum hemodialysis vintage of one year. Patients with a history of any infection, malignancy, and chronic inflammatory disease were excluded. Oxidative markers (total oxidant and antioxidant status) and inflammation markers (C-reactive protein and interleukin-6) were analyzed. Results: A total of 47% (39/83) patients were using active or analog vitamin D. Total antioxidant status was significantly higher in patients with using active or analog vitamin D than those who did not use (p = 0.006). Whereas, total oxidant status and oxidative stress index were significantly higher in patients with not using vitamin D when compared with the patients who were using vitamin D preparation (p = 0.005 and p = 0.004, respectively). On the other hand, total antioxidant status, total oxidant status, and oxidative stress index were similar between patients who used active vitamin D or vitamin D analog (p = 0.6; p = 0.4 and p = 0.7, respectively). Conclusion: The use of active or selective vitamin D analog in these patients decreases total oxidant status and increases total antioxidant status. Also, paricalcitol is as effective as calcitriol in decreasing total oxidant status and increasing total antioxidant status in patients with chronic kidney disease