Volume 3 Issue 1
Review Article: Diagnosis and Treatment Status and Progress of Autosomal Dominant Polycystic Kidney Disease
Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the most common inherited kidney disease in the clinic. The incidence of ADPKD is approximately 1/2500 according to the report of latest European study, and almost 10% of the disease patient eventually requires Renal Replacement Therapy (RRT). Bilateral and progressive cyst formation in the kidneys, impaired renal parenchyma and End-Stage Renal Disease (ESRD) are the main clinical manifestation. Although ADPKD predominately affects the kidney, cystic phenotypes or disease lesions also can be seen in other organs and tissues, including the cystic liver, cardiovascular defects and brain aneurysm. ADPKD is a heterogenic disease which is resulted from the mutations of PKD1 and PKD2 genes. Although both disease causal genes have been identified and cloned for decades, lack of effective and less side-effect treatment still challenge vast clinicians. This review will center on current advances of ADPKD treatment in which several potential therapies for delaying or halting the disease progression have been discussed. These recent achievements of translational researches will bring hope to cure the disease in the clinic.
Cite this Article: Li A. Diagnosis and Treatment Status and Progress of Autosomal Dominant Polycystic Kidney Disease. Int J Nephrol Ther. 2017;3(1): 040-045.
Published: 27 November 2017
Case Report: Klebsiella pneumoniae Peritonitis could be a Potential Risk Factor for Portal Vein Thrombosis in Patients on Peritoneal Dialysis: a Case Report
Hassan Bin Attique, Attiya Haroon, Snehal Naik, Charan Singh and Ruchir Trivedi*
According to National Kidney Foundation data, more than 660, 000 Americans are being treated for End Stage Renal Disease (ESRD). Treatment options for ESRD include dialysis and renal transplant. Both Hemodialysis (HD) and Peritoneal Dialysis (PD) have similar efficacies and survival outcomes that represent therapeutic equipoise. PD is a home-based dialysis modality with distinct lifestyle advantages. Peritonitis is the leading complication of PD with 1 episode occurring in every 32.7 months. Gram-negative peritonitis constitutes 0.16 episodes/year; with Klebsiella (K) species identified in 5.2% of culture-positive peritonitis cases. Infection associated hypercoagulability has been well described with systemic infections; but not with localized PD associated peritonitis. We present a rare case of K. pneumoniae peritonitis in an ESRD patient secondary to Autosomal Dominant Polycystic Kidney Disease (ADPKD) on PD complicated with Portal Vein Thrombosis (PVT). We also discuss possible etiologies involved in the pathogenesis of thrombosis.
Cite this Article: Attique HB, Haroon A, Naik S, Singh C, Trivedi R. Klebsiella Pneumoniae Peritonitis could be a Potential Risk Factor for Portal Vein Thrombosis in Patients on Peritoneal Dialysis: a Case Report. Int J Nephrol Ther. 2017;3(1): 035-038.
Published: 15 September 2017
Can Huzmeli* and Ferhan Candan
IgA Nephropathy (IgAN) is the most common primary glomerulonephritis and a leading cause of chronic kidney disease and renal failure. Environmental and genetic factors play a role in the pathogenesis of IgAN. The immunopathogenesis of this disease is described as a multi - "hit" process. Renal biopsy is required for diagnosis. The immunofluorescence staining is characterized by a dominant IgA deposition. It is often clinically presenting with hematuria. In IgAN patients, proteinuria and renal dysfunction are less common. Conservative treatment, corticosteroids and immunosuppressives are commonly used in the treatment of IgAN.
Keywords: IgA nepropathy; Proteinuria; Treatment
Cite this Article: Huzmeli C, Candan F. IgA Nephropathy with Proteinuria and Renal Dysfunction. Int J Nephrol Ther. 2017;3(1): 027-034.
Published: 08 September 2017
Research Article: IgA Nephritis: A comparison of Oxford and Traditional Histological Scores and the Correlation with Clinical Indices in a Southeast Asian population
Keng T. Woo*, Cynthia C. Lim, Marjorie WY. Foo, Hwai L. Loh, Yok M. Chin, Jason CJ. Choo, Puay H. Tan, Lina HL. Choong, Han K.Tan, Kok S. Wong, Choong M. Chan
Background: The Oxford Classification of IgAN was developed in 2009. Subsequent validation studies found that M and E lesions were less predictive of ESRD. Varying reproducibility and lack of sufficient clinical relevance have since then resulted in several larger studies like the VALIGA study which addressed some of the shortcomings of the Oxford Classification. We had previously reported on a 30 year follow up study of 102 patients with IgA nephritis (IgAN) to validate the Oxford Classification and we showed that E and S lesions of the Oxford MEST were predictive of patients likely to develop renal failure during the initial 5 years of the disease whereas M and T scores were predictive of late renal failure as shown in our 30 years follow up of these patients. In this follow up study we explore how we could expand the relevant histological features of the MEST score as well as include some clinical indices to make the Oxford Classification more relevant clinically.
Methods: In the present study we compare the Traditional Histological Scores with the Oxford Classification scores as predictors of disease progression to End Stage Renal Disease (ESRD) as well as their correlation with various clinical indices. This is a comparison based on the predictive and prognostic values of the individual histological scores from both classifications as well as to ascertain their association with other histological scores like crescents, global sclerosis and arterial thickening of blood vessels. We also correlated these histological scores with clinical indices like urinary RBC, proteinuria and eGFR to determine the clinical value of each histological score.
We analyzed our data with a Covariance Analysis Model (ANOVA).
Results: We have shown through the use of 3 sets of data (Cox regression, Correlation tests and Cumulative renal survival graphs) that the 4 Oxford scores identify very similar prognostic indicators of disease progression and ESRD with the Traditional scores. Three other histological indices, crescents, global sclerosis and arterial intimal thickening, irrespective of whether linked to Oxford or Traditional scores, both sets of data, provide very similar correlations with one another as well as the clinical indices of RBC, eGFR but not TUP. These were further supported by similarly comparable results between the Oxford and the Traditional scores for the various prognostic histological and clinical indices as shown by data from Cox regression and cumulative renal survival graphs.
Conclusion: To secure an accurate prognostic index of ESRD in IgAN we need to widen the scope of the MEST scores and include other traditional scores like crescents, global sclerosis and arterial intimal thickening of blood vessels as well as clinical indices like urinary RBC, proteinuria and GFR. Our data showed, regarding β2 microglobulin, a significant statistical difference in post dialytic value matched for hemoconcentration (p-value = 0.0473) between MID and PRE techniques in favour of MID, and a better trend (without statistical significance) than POST. Finally our study showed, confirming medical literature reports, that mid-dilution hemodiafiltration leads to an albumin loss greater than what occurred in pre and post-dilution hemodiafiltration techniques.
Keywords: ESRF; CKD; Glomerular Disease
Cite this Article: Woo KT, Lim CC, Foo MWY, Loh HL, Chin YM, et al. IgA Nephritis: A comparison of Oxford and Traditional Histological Scores and the Correlation with Clinical Indices in a Southeast Asian population. Int J Nephrol Ther. 2017;3(1): 014-026.
Published: 31 May 2017
Short Communication: Mid-Dilution Hemodiafiltration Compared to Pre- and Post-Dilution Hemodiafiltration: A Study Preparatory to a Prospective Randomized Trial
Simone Brardi* and Ennio Duranti
Background: The aim of this pilot study was to compare the three currently available on-line hemodiafiltration techniques: Mid-Dilution (MID), Post-Dilution (POST) and Pre-Dilution (PRE) concerning middle molecular solute removal and tolerability in reference to intradialytic stability of hemodynamic parameters as well as patient wellness.
Materials and methods: We enrolled 6 patients suffering from end stage Chronic Kidney Failure (mean age: 56 ± 18 years; 5 men, 1 woman) on regular thrice weekly hemodialysis treatment. All of them were anuric and had well functioning native AV fistulas for blood access. Every patient underwent three consecutive treatment periods of five weeks each, with the three above mentioned techniques. At the end of the five weeks, during the first and last dialytic session of the week, we performed a thorough hematochemical evaluation. We distributed patients in three groups following a crossover; Latin squares design, randomly assigning them to the sequence. In order to make comparable these three techniques, differing in substitution flow and technical features of the hemodiafilters, we made the duration of dialysis treatment and substitution flow fit to reach a Kt/V single pool equal or higher than 1.3.
We analyzed our data with a Covariance Analysis Model (ANOVA).
Results: All three study subsets (with the three methods) were accomplished without significant intradialytic adverse effects. Blood pressure values maintained steady across the study, not differing from the usual values of enrolled patients.
Our data showed, regarding β2 microglobulin, a significant statistical difference in post dialytic value matched for hemoconcentration (p-value = 0.0473) between MID and PRE techniques in favour of MID, and a better trend (without statistical significance) than POST. Finally our study showed, confirming medical literature reports, that mid-dilution hemodiafiltration leads to an albumin loss greater than what occurred in pre and post-dilution hemodiafiltration techniques.
Discussion and conclusion: Our study is to be considered a pilot one, being performed in a small sample of patients with the aim of a larger clinical trial, but our first results showed that MID is a technique, being better in removing β2 microglobulin than PRE and having a better trend even compared to POST. Furthermore, the 3 techniques showed the same good tolerability.
Cite this Article: Brardi S, Duranti E. Mid-Dilution Hemodiafiltration Compared to Pre- and Post-Dilution Hemodiafiltration: A Study Preparatory to a Prospective Randomized Trial. Int J Nephrol Ther. 2017;3(1): 007-013.
Published: 17 February 2017
Short Communication: High Sensitive Troponin T has an Incremental Value in Estimation of Cardiovascular Risk in Chronic Kidney Disease
Anna V. Olah*, Timea Szalko, Eszter Szantho, Eva Varga, Janos Matyus, Jozsef Varga
Relative risk of cardiovascular morbidity is increased in Chronic Kidney Disease (CKD). According to current KDIGO guideline cardiovascular risk can be estimated from Glomerular Filtration Rate (GFR) and proteinuria.
Aims: First aim was to evaluate renal score, is it enough to estimate cardiovascular risk in CKD. Then we checked whether high sensitive Troponin T (hsTnT) has an incremental value to predict cardiovascular risk in CKD.
Methods: Clinical cardiovascular score was established according to the Framingham study: age, BMI, blood pressure, lipids, patient history (diabetes mellitus, myocardial infarction, stroke). Renal severity scores (1-4) were determined from GFR and urinary albumin/creatinine or protein/creatinine. Biochemical parameters were determined by Cobas 6000.
Results: Results in Study A (n:20) Mean of GFR decreased (66 ± 12 vs. 47 ± 16 ml/min/1.73 m2) and renal score impaired (2.5 ± 1.1 vs. 3 ± 0.9) during four years. Clinical cardiovascular score was proportional to the renal score: clinical score was 21.8 ± 9.8 at renal score <3.5 and 29.2 ± 6.7 at renal score >3.5 (p:0.09). Proteinuria has prognostic value in lipid lowering therapy: atherogenic non-HDL was reducible from 3.62 ± 0.75 to 2.92 ± 0.63 mmol/ L without proteinuria. In Study B (n:21) mean of clinical cardiovascular score was 21.5 ± 2.1 at moderate renal damage and 27.4 ± 9.2 at severe renal damage. Mean of hsTnT was also lower (14.8 ± 11.3) at renal scores 1-2 compared to hsTnT (32.8 ± 20.9 ng/ L) at renal scores 3-4. Individual hsTnT correlated with clinical scores (R = 0.655, P < 0.001).
Conclusions: Impairment of renal score indicates higher cardiovascular risk. Permanent moderate elevation of hsTnT refers to increased cardiovascular risk, which has incremental value in the treatment of CKD.
Cite this Article: Olah AV, Szalko T, Szantho E, Varga E, Matyus J, et al. High Sensitive Troponin T has an Incremental Value in Estimation of Cardiovascular Risk in Chronic Kidney Disease. Int J Nephrol Ther. 2017;3(1): 001-006.
Published: 27 January 2017
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