International Journal of Nephrology and Renovascular Disease最新文献

{"title":"CHA₂DS₂-VASc, a Simple Clinical Score Expanding Its Boundaries to Predict Contrast-Induced Acute Kidney Injury After Primary Percutaneous Coronary Interventions.","authors":"Rajesh Kumar,&nbsp;Mahesh Kumar Batra,&nbsp;Sanam Khowaja,&nbsp;Ali Ammar,&nbsp;Ashok Kumar,&nbsp;Jehangir Ali Shah,&nbsp;Jawaid Akbar Sial,&nbsp;Tahir Saghir,&nbsp;Musa Karim","doi":"10.2147/IJNRD.S347303","DOIUrl":"https://doi.org/10.2147/IJNRD.S347303","url":null,"abstract":"<p><strong>Objective: </strong>Promising results of CHA₂DS₂-VASc score have been reported for the prediction of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, data of its predictive strength in the context of primary PCI are not available. Therefore, in this study, we have assessed predictive value of CHA₂DS₂-VASc score for CI-AKI after primary PCI.</p><p><strong>Methods: </strong>This analytical cross-sectional study was conducted between January 2021 and June 2021 at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Inclusion criteria of the study was consecutive adult patients who had undergone primary PCI. Baseline CHA₂DS₂-VASc score was calculated, and either a 25% or 0.5 mg/dL increase in post-procedure serum creatinine level as compared to baseline level was categorized as CI-AKI.</p><p><strong>Results: </strong>A total of 691 patients were included, of which 82.1% (567) were male. CI-AKI after primary PCI was observed in 63 (9.1%) patients, out of which 66.7% (42) of patients had CHA₂DS₂-VASc score of ≥2. The area under the curve (AUC) for the score was 0.725 [0.662 to 0.788] with a sensitivity and specificity of 66.7% [63.1% to 70.2%] and 66.7% [53.7% to 78.1%], respectively, at a cut-off value of ≥2. In multivariable analysis, left ventricular ejection fraction ≤30% and CHA₂DS₂-VASc ≥2 were found to be independent predictors with adjusted odds ratios of 2.19 [1.06-4.5] and 2.13 [1.13-4.01], respectively.</p><p><strong>Conclusion: </strong>CHA₂DS₂-VASc score has a good predictive value for the prediction of CI-AKI after primary PCI. Criteria of CHA₂DS₂-VASc ≥2 can be used for the risk stratification of CI-AKI after primary PCI.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"14 ","pages":"495-504"},"PeriodicalIF":2.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/a4/ijnrd-14-495.PMC8725833.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39799386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors of Pulmonary Hypertension in Patients on Hemodialysis: A Single Center Study.","authors":"Shankar Prasad Nagaraju,&nbsp;Mohan V Bhojaraja,&nbsp;Ganesh Paramasivam,&nbsp;Ravindra Attur Prabhu,&nbsp;Dharshan Rangaswamy,&nbsp;Indu Ramachandra Rao,&nbsp;Srinivas Vinayak Shenoy","doi":"10.2147/IJNRD.S346184","DOIUrl":"https://doi.org/10.2147/IJNRD.S346184","url":null,"abstract":"<p><strong>Introduction: </strong>Pulmonary hypertension (PH) is an underestimated cardiovascular consequence and a mortality predictor in patients on hemodialysis (HD). Thus, we studied its prevalence, risk factors, association with inflammation/oxidative stress, and cardiac changes in HD patients.</p><p><strong>Methods: </strong>This was a single-center cross-sectional observational study conducted at a tertiary care hospital. Patients aged >18 years on hemodialysis for at least three months were included and divided into those with and without PH; patients with secondary causes for PH were excluded. Clinical characteristics, HD-related factors, lab parameters (C-reactive protein and malondialdehyde with thiol assay were used as markers of inflammation and oxidative stress, respectively), and echocardiography details were compared. PH was defined as a mean pulmonary artery pressure of >25 mmHg at rest, and it was further divided as mild (25-40 mmHg), moderate (40-60 mmHg), and severe (>60 mmHg).</p><p><strong>Results: </strong>Of 52 patients, 28 patients had PH (mild 24, moderate 4, and none had severe PH) with prevalence of 54%. No difference was found in clinical characteristics, dialysis-related factors, biochemical parameters including inflammation (C-reactive protein; <i>p</i>=0.76), or oxidative stress (thiol; <i>p</i>=0.36 and MDA; <i>p</i>=0.46) between the groups. When compared to individuals without PH, HD patients with PH exhibited significantly more mitral regurgitation (<i>p</i>=0.002).</p><p><strong>Conclusion: </strong>Hemodialysis patients have a high prevalence of PH. PH was significantly associated with the presence of mitral regurgitation on echocardiography. Our study did not find differences in traditional risk factors, HD-related factors, and inflammation/oxidative markers between the groups with and without PH.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"14 ","pages":"487-494"},"PeriodicalIF":2.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fc/95/ijnrd-14-487.PMC8713877.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39791630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Citrate-Acidified Dialysate on Intact Parathyroid Hormone in Prevalent Hemodialysis Patients: A Matched Retrospective Cohort Study.","authors":"Linda H Ficociello,&nbsp;Meijiao Zhou,&nbsp;Claudy Mullon,&nbsp;Michael S Anger,&nbsp;Robert J Kossmann","doi":"10.2147/IJNRD.S340028","DOIUrl":"https://doi.org/10.2147/IJNRD.S340028","url":null,"abstract":"<p><strong>Background: </strong>It has been proposed that substituting citrate-acidified dialysate (CAD) solutions for acetate-acidified dialysate (AAD) could improve hemodynamics and dialysis tolerance and reduce the requirement for systemic anticoagulation. Citrate chelates ionized calcium, but long-term effects of CAD use during maintenance hemodialysis have not been well studied. While many studies of the effects of CAD on serum calcium and intact parathyroid hormone (iPTH) have been short-term or have been limited by sample size, we aimed to determine if there are any long-term (i.e., 6-month) changes from pre-dialysis iPTH levels when patients are switched from AAD to CAD.</p><p><strong>Methods: </strong>This retrospective cohort study compared various clinical parameters, including pre-dialysis iPTH and serum calcium as well as single pool Kt/V, from eligible patients who received in-center hemodialysis thrice-weekly in geographically matched CAD (n=3) or AAD clinics (n=12). CAD clinics were defined as clinics converting from AAD to CAD if >85% of the patients were prescribed CAD after implementation of CAD within the clinic.</p><p><strong>Results: </strong>Pre-dialysis iPTH was not significantly different from baseline to 6-month follow-up within either CAD or AAD clinics. Moreover, the mean change from baseline to month 6 in iPTH between patients (n=142) in CAD clinics (-17 pg/mL) and patients (n=671) in AAD clinics (13 pg/mL) was similar (<i>p</i> = 0.24). Likewise, the differences in the mean change in serum calcium concentrations and dialysis adequacy (single pool Kt/V) were not significant between CAD and AAD clinics. For subgroups of patients who were never prescribed cinacalcet or calcium-based phosphate binders, there were no significantly different categorical shifts in iPTH between CAD and AAD clinics.</p><p><strong>Conclusion: </strong>Similar trends in single pool Kt/V, iPTH, and serum calcium levels were observed in clinics that switched from AAD to CAD versus the geographically matched AAD clinics. These results support CAD as a potential alternative to AAD in hemodialysis.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"14 ","pages":"475-486"},"PeriodicalIF":2.0,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a1/a3/ijnrd-14-475.PMC8714465.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39791629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Prevalence of Chronic Kidney Disease Among People Living with Hypertension in Rural Sierra Leone: A Cross-Sectional Study.","authors":"Chiyembekezo Kachimanga, Anu Jegede Williams, Musa Bangura, Marta Lado, Sahr Kanawa, Daniel Lavallie, Michael Mhango, Haja Isatta Wurie, Marta Patiño Rodriguez","doi":"10.2147/IJNRD.S342099","DOIUrl":"10.2147/IJNRD.S342099","url":null,"abstract":"<p><strong>Introduction: </strong>Currently, there are no data on prevalence and associated risk factors of chronic kidney disease (CKD) among patients with hypertension in rural Sierra Leone.</p><p><strong>Purpose: </strong>To estimate the prevalence and associated risk factors of CKD in rural Sierra Leone.</p><p><strong>Patients and methods: </strong>A cross-sectional study of hypertension patients aged between 18 and 75 years attending a non-communicable disease clinic at Koidu Government Hospital, Kono District, Sierra Leone was conducted between February and December 2020. Using systematic random sampling, a structured questionnaire, which comprised of questions on social demographic characteristics and past and current clinical history, was administered followed by measurement of creatinine and urinary protein and glucose. Estimated glomerular filtration rate (eGFR) was estimated using CKD-epidemiology formula without race as a factor. Baseline eGFR between 60-89 min/mL/1.73m² and <60 min/mL/1.73m² defined reduced eGFR and renal impairment, respectively. Estimated GFR less than 60 min/mL/1.73m² measured two times at least 3 months apart was used to define CKD.</p><p><strong>Results: </strong>Ninety-six percent (n = 304) patients out of 317 patients were included in the study. Among all included patients, only 3.9% (n = 12) had eGFR of 90 min/mL/1.73m² and above. The prevalence of renal impairment and CKD was 52% (158/304, CI 46.2-57.7) and 29.9% (91/304, CI 24.8-34.5), respectively. In adjusted logistic regression analysis, currently taking herbal medications as treatment of hypertension (OR 4.11 (CI 1.14-14.80), p = 0.03) and being overweight and/or obese (OR 2.16 (CI 1.24-3.78), p < 0.001) was associated with CKD. Additionally, receiving some education was associated with a 48% (OR 0.52 (CI 0.29-0.91), p = 0.02) reduced likelihood of CKD.</p><p><strong>Conclusion: </strong>The prevalence of renal impairment and CKD is high among hypertensive patients in rural Sierra Leone. CKD was associated with current history of taking herbal medications and being overweight and/or obese. Additionally, CKD was associated with reduced likelihood in patients who received some education.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"14 ","pages":"459-474"},"PeriodicalIF":2.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/d7/ijnrd-14-459.PMC8710521.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39791628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanism of Action and Efficacy of Immunosupressors in Lupus Nephritis.","authors":"Mario E Alamilla-Sanchez,&nbsp;Miguel A Alcala-Salgado,&nbsp;Cesar D Alonso-Bello,&nbsp;Gandhy T Fonseca-Gonzalez","doi":"10.2147/IJNRD.S335371","DOIUrl":"https://doi.org/10.2147/IJNRD.S335371","url":null,"abstract":"<p><p>Approximately 70% of the patients with systemic lupus erythematosus will have clinical evidence of kidney damage during their evolution. Patients with impaired renal function at onset and those with recurrent flares have a poor prognosis. Understanding the mechanism of action of immunosuppressants is essential for proper prescription. Steroids inhibit the DNA sequence that promotes the release of inflammatory cytokines. Phosphoramide mustard, metabolite of cyclophosphamide, cross-link with the DNA, causing the aggregation of an alkyl group, causing cell death. Mycophenolate inhibits inosine monophosphate dehydrogenase, prevents de novo synthesis of guanine, inducing cell arrest in S phase. Azathioprine blocks the synthesis of purines and induces apoptosis. Calcineurin inhibitors prevent the dephosphorylation of NFAT and reduce the production of interleukin 2. Antimalarials alter the enzymatic release of lysosomes by increasing intravesicular pH. The mechanism of action of rituximab is related to complement-dependent cytotoxicity and the elimination of anti-CD20-labeled B cells. Progress in the knowledge and management of low doses of steroids may change the current paradigm and reduce the frequency of related adverse events. Mycophenolate seems to be a better choice than cyclophosphamide for induction, it is also preferred over azathioprine as a maintenance immunosuppressive agent, although azathioprine is preferred in women with a desire for conception, those pregnant, or with low resources. For treatment-resistant cases, tacrolimus, rituximab or belimumab may be effective. Ongoing clinical trials with new drugs offer promising results.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"14 ","pages":"441-458"},"PeriodicalIF":2.0,"publicationDate":"2021-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/49/81/ijnrd-14-441.PMC8675090.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39826560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profiling Biomarkers in HIV Glomerular Disease - Potential for the Non-Invasive Diagnosis of HIVAN?","authors":"Saraladevi Naicker,&nbsp;Therese Dix-Peek,&nbsp;Roland Manfred Klar,&nbsp;Glendah Kalunga,&nbsp;Pulane Mosiane,&nbsp;Caroline Dickens,&nbsp;Raquel Duarte","doi":"10.2147/IJNRD.S331484","DOIUrl":"https://doi.org/10.2147/IJNRD.S331484","url":null,"abstract":"<p><strong>Background: </strong>There is a wide spectrum of kidney pathology in human immunodeficiency virus (HIV) infection, affecting all structures of the kidney. The histology of HIV chronic kidney disease (CKD) is diverse, ranging from HIV-associated nephropathy (HIVAN) to focal glomerulosclerosis (FSGS), HIV-immune complex disease (HIV-ICD), other glomerulopathies and tubulo-interstitial nephritis. Definitive diagnosis is by kidney biopsy, an invasive procedure. However, serum and urinary biomarkers may be useful in predicting the histological diagnosis of HIVAN.</p><p><strong>Purpose: </strong>We wished to determine the utility of serum and urinary biomarkers in predicting the histological diagnosis of HIVAN.</p><p><strong>Patients and methods: </strong>We measured neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, transforming growth factor (TGF)-β isoforms and bone morphogenetic protein (BMP)-7 in the serum and urine in patients with different histological forms of HIV glomerular disease.</p><p><strong>Results: </strong>In HIVAN, we demonstrated increased levels of serum cystatin C and increased levels of serum and urinary NGAL. Urinary TGF-β1 and TGF-β2 levels were elevated in HIV-positive patients with CKD but were not significantly different in the different HIV histologies, while urinary BMP-7 levels were elevated in minimal change disease.</p><p><strong>Conclusion: </strong>This study confirmed the presence of increased serum and urinary biomarkers of tubular injury in patients with HIVAN, and increased urinary biomarkers of fibrosis in HIV CKD, and may indicate their value as a non-invasive diagnostic tool for the diagnosis of HIVAN.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"14 ","pages":"427-440"},"PeriodicalIF":2.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/59/92/ijnrd-14-427.PMC8668162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39733800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Acute Interstitial Nephritis After Two Doses of the BNT162b2 SARS-CoV-2 Vaccine.","authors":"Filipe S Mira,&nbsp;Jóni Costa Carvalho,&nbsp;Patrícia Amaral de Almeida,&nbsp;Ana Carolina Pimenta,&nbsp;Iolanda Alen Coutinho,&nbsp;Carolina Figueiredo,&nbsp;Luís Rodrigues,&nbsp;Vítor Sousa,&nbsp;Emanuel Ferreira,&nbsp;Helena Pinto,&nbsp;Luís Escada,&nbsp;Ana Galvão,&nbsp;Rui Alves","doi":"10.2147/IJNRD.S345898","DOIUrl":"https://doi.org/10.2147/IJNRD.S345898","url":null,"abstract":"<p><strong>Background: </strong>The development of vaccines to prevent COVID-19 breakouts came with highly positive results but some unexpected side effects. Rare side effects have been seen with the BNT162b2 SARS-CoV 2 vaccine.</p><p><strong>Case presentation: </strong>We present the case of a 45-year-old female patient who developed an acute kidney injury needing urgent hemodialysis one week after the second administration of the BNT162b2 SARS-CoV 2 vaccine. She developed a macular rash on her lower limbs and palms as well. A kidney biopsy was performed 10 days after vaccine inoculation, diagnosing acute interstitial nephritis and acute tubular necrosis with cellular casts. The patient was treated with three corticosteroid pulses followed by daily prednisolone. We witnessed clinical improvement 4 days after the initial corticosteroid treatment with progressive recovery of kidney function and hemodialysis withdrawal. After 2 weeks, the patient had recovered her kidney function. Immunophenotyping was performed, diagnosing a hypersensitivity to the vaccine and the polyethylene glycol excipient.</p><p><strong>Conclusion: </strong>Patients may develop acute reactions to vaccines. In this case, symptoms seem to correlate significantly with its inoculation and, although this case had a favourable outcome, these side effects must be made aware for clinicians and patients.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"14 ","pages":"421-426"},"PeriodicalIF":2.0,"publicationDate":"2021-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9f/76/ijnrd-14-421.PMC8650829.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39709609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Treatments from Inhibition of the Intestinal Sodium-Hydrogen Exchanger 3.","authors":"Csaba P Kovesdy,&nbsp;Adebowale Adebiyi,&nbsp;David Rosenbaum,&nbsp;Jeffrey W Jacobs,&nbsp;L Darryl Quarles","doi":"10.2147/IJNRD.S334024","DOIUrl":"https://doi.org/10.2147/IJNRD.S334024","url":null,"abstract":"<p><p>Plasma membrane sodium-hydrogen exchangers (NHE) transport Na⁺ into cells in exchange for H⁺. While there are nine isoforms of NHE in humans, this review focuses on the NHE3 isoform, which is abundantly expressed in the gastrointestinal tract, where it plays a key role in acid-base balance and water homeostasis. NHE3 inhibition in the small intestine results in luminal sodium and water retention, leading to a general decrease in paracellular water flux and diffusional driving force, reduced intestinal sodium absorption, and increased stool sodium excretion. The resulting softer and more frequent stools are the rationale for the development of tenapanor as a novel, first-in-class NHE3 inhibitor to treat irritable bowel syndrome with constipation. NHE3 also has additional therapeutic implications in nephrology. Inhibition of intestinal NHE3 also lowers blood pressure by reducing intestinal sodium absorption. Perhaps, the most novel effect is its ability to decrease intestinal phosphate absorption by inhibiting the paracellular phosphate absorption pathway. Therefore, selective pharmacological inhibition of NHE3 could be a potential therapeutic strategy to treat not only heart failure and hypertension but also hyperphosphatemia. This review presents an overview of the molecular and physiological functions of NHE3 and discusses how these functions translate to potential clinical applications in nephrology.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"14 ","pages":"411-420"},"PeriodicalIF":2.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ac/0a/ijnrd-14-411.PMC8646223.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39705125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of High Dose Active Vitamin D Therapy on the Development of Hypocalcemia After Subtotal Parathyroidectomy in Patients on Chronic Dialysis.","authors":"Malina Grube,&nbsp;Frank Weber,&nbsp;Anna Lena Kahl,&nbsp;Andreas Kribben,&nbsp;Nils Mülling,&nbsp;Walter Reinhardt","doi":"10.2147/IJNRD.S334227","DOIUrl":"https://doi.org/10.2147/IJNRD.S334227","url":null,"abstract":"<p><strong>Background: </strong>The period after parathyroidectomy (PTx) in dialysis patients is characterized by periods of severe hypocalcemia. This study aims to investigate the effect of high doses of active vitamin D immediately after PTx on the development of hypocalcemia.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 111 patients with secondary hyperparathyroidism receiving subtotal PTx between 2010 and 2019. A high dose group \"HDG\" (n = 67) receiving 12 µg alfacalcidol in combination with 8.550 mg calcium acetate per day, which was then adapted according to lab values, was compared with a low dose group \"LDG\" (n = 44) receiving up to 4 µg alfacalcidol per day. The laboratory values were recorded up to ten weeks postoperatively.</p><p><strong>Results: </strong>The assumed drops in parathyroid hormone (PTH) and calcium were observed in both groups after PTx. We observed significantly lower calcium values in the LDG between days 4 and 18 postoperatively than in the HDG (<i>p</i> < 0.001). The proportion of severe hypocalcemia after PTx (total calcium <1.5 mmol/l) in the HDG was 8.5% on day 1 and 47% on day 4 in the LDG. Intravenous calcium requirements were significantly lower in the HDG (7.6%) than in the LDG (45.7%; <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>The period after PTx in dialysis patients is characterized by an expected drop in PTH and calcium within the first days. Ongoing high turnover is observed in the 2nd and 3rd week after PTx. Administering high doses of alfacalcidol combined with calcium acetate diminishes the episodes of severe hypocalcemia and the need for intravenous calcium.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"14 ","pages":"399-410"},"PeriodicalIF":2.0,"publicationDate":"2021-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/61/1d/ijnrd-14-399.PMC8594789.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39904467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Clustering of Antiglomerular Basement Membrane Disease in COVID-19 Pandemic: A Case Series.","authors":"Rakesh Sebastian,&nbsp;Jegan Arunachalam,&nbsp;Manorajan Rajendran","doi":"10.2147/IJNRD.S333894","DOIUrl":"https://doi.org/10.2147/IJNRD.S333894","url":null,"abstract":"<p><p>Anti-glomerular basement membrane disease (anti-GBM) affects mainly kidneys and lungs. It requires aggressive immunosuppressive treatment. Since the emergence of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), there has been an increased number of new cases of anti-GBM disease presenting as rapidly progressive glomerulonephritis (RPGN). The causal relationship is still speculative. We report a case series of four patients affected with COVID-19 infection presenting later with anti-GBM disease.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"14 ","pages":"393-398"},"PeriodicalIF":2.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dc/61/ijnrd-14-393.PMC8570721.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39693466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}