Calprotectin is a contributor to and potential therapeutic target for vascular calcification in chronic kidney disease

Vascular calcification is an important risk factor for cardiovascular (CV) mortality in patients with chronic kidney disease (CKD). It is also a complex process involving osteochondrogenic differentiation of vascular smooth muscle cells (VSMCs) and abnormal deposition of minerals in the vascular wall. In an observational, multicenter European study, including 112 patients with CKD from Spain and 171 patients on dialysis from France, we used serum proteome analysis and further validation by ELISA to identify calprotectin, a circulating damage-associated molecular pattern protein, as being independently associated with CV outcome and mortality. This was confirmed in an additional cohort of 170 patients with CKD from Sweden, where increased serum calprotectin concentrations correlated with increased vascular calcification. In primary human VSMCs and mouse aortic rings, calprotectin exacerbated calcification. Treatment with paquinimod, a calprotectin inhibitor, as well as pharmacological inhibition of the receptor for advanced glycation end products and Toll-like receptor 4 inhibited the procalcifying effect of calprotectin. Paquinimod also ameliorated calcification induced by the sera of uremic patients in primary human VSMCs. Treatment with paquinimod prevented vascular calcification in mice with chronic renal failure induced by subtotal nephrectomy and in aged apolipoprotein E-deficient mice as well. These observations identified calprotectin as a key contributor of vascular calcification, and increased circulating calprotectin was strongly and independently associated with calcification, CV outcome, and mortality in patients with CKD. Inhibition of calprotectin might therefore be a promising strategy to prevent vascular calcification in patients with CKD.

Functional status of chronic renal replacement therapy in elderly patients--comparison between hemodialysis and peritoneal dialysis

Nowadays, nephrologists are confronted with an increasing number of elderly patients diagnosed with end-stage renal disease (ESRD) in need of dialysis. The benefits of renal replacement therapy are uncertain in this group of patients. Most studies show that the quality of life and survival of elderly dialyzed patients are worse than in younger patients because of multiple comorbidities. Functional status is an important aspect of the quality of life, a strong predictor of survival and a determinant of the health care systems costs.

METHOD

In the present research, we compare the change in the functional status--appreciated with the MDS-ADL score--in a cohort of hemodialyzed versus peritoneal dialyzed elderly patients (> 65 years) during a period of 3 years after starting dialysis treatment.

RESULTS

At the time of initiating dialysis, the median minimum data set of activities of daily living (MDS-ADL) score in hemodialysis (HD) elderly patients was 4.04 and in continuous ambulatory peritoneal dialysis (CAPD) group was 6.27 (the median MDS-ADL score at the moment of starting dialysis was statistically significant higher in peritoneal group than in hemodialysis elderly group).

CONCLUSIONS

The results conclude that elderly treated with peritoneal dialysis have a better evolution of functional status than hemodialyzed elderly patients do.

Comparative evolution of hemodialysis vs. peritoneal dialysis in elderly

The prevalence of treated patients with end-stage renal disease (ESRD) has considerably increased in the last decade mainly in the elderly age groups. The type of optimal mode of dialysis therapy in elderly is difficult to establish and most studies comparing hemodialysis and peritoneal dialysis in elderly failed to demonstrate the superiority of one therapy versus the other. The present article uses Charlson Co morbidity Index to compare evolution of an elderly population in HD versus PD.

MATERIAL AND METHODS

Nondiabetic patients (> 65 years) who initiated dialysis therapy for ESRD during January 2006-December 2007.

RESULTS

In HD group, the median CCI calculated 6 month before initiating dialysis therapy was 5.87, with limits between 3 and 11. At the time of initiating dialysis, the median CCI was 6.55 (limits 3-11). In peritoneal dialysis group, CCI evaluated 6 months before initiating dialysis had a median value of 7.38, with limits between 3 and 11. At the time of initiating dialysis procedure, the median CCI was 7.72.

CONCLUSIONS

This study demonstrates that PD is, in the majority of situations, a better option for dialysis in elderly.

[The role of ultrasonography exam in orbital-ocular tumors]

Ophthalmology is one of the specialties that have particularly benefited from the contribution of ultrasonography exam as a method of investigation. Ultrasonography is very much essential for diagnostic to complement other clinical and laboratory investigations, providing images in real time. The basic principle of diagnostic ultrasound is to study and to interpret the changes they undergo when crossing ultrasonic waves diverse biological properties different sound, and such injuries can be traced in the dynamics or can be documented on photographic paper and thus can diagnose correct certain eye diseases. The indications for performing ultrasound consist in: measurement of distances and volumes, examine difficult or inaccessible case of opaque media; ophthalmoscopic view of a mass lesion, examine the orbit or optic nerve. The advantages of ultrasound for orbital-ocular tumors are represented by the fact that ultrasound is a noninvasive method, safe, well tolerated, less expensive that the advantage of determining the position and distance from structures ocular tumor. High frequency ultrasound provides excellent resolution of 0-1 to 0.01 mm, and serial scans allow tracking progress and measuring lesion diameters tumor while allowing monitoring and evaluation of stereotactic radiation treatments applied to small tumors. In conclusion ultrasound allows not only early diagnosis of eye tumors, but accurate assessment of the proposed therapy and of the evolution of detected mass lesions or tumors.

Infective endocarditis--a forgotten cause for heart insufficiency in elderly. Case report

Right heart infective endocarditis in an elderly patient with no previous known risk factors is a very rare situation (even if subacute infective endocarditis has the same chance of occurrence at either a young person, or an elderly patient). We present the case of a 75-years old patient, with no previous cardiac history, addressed to our clinic with nonspecific septic symptoms associated with an edematous syndrome. The patient was treated for right heart valve infective endocarditis; a particularity may be the fact not all Duke criteria were respected. Iatrogeny was involved, our patient having administered a 7-day antibiotic treatment before hospital addressing. The therapeutic probe was positive: excellent evolution under treatment. Few cases of infective endocarditis of the tricuspid valve were reported worldwide, in which the source of infection was unknown in about 80% of cases. In two pediatric cases reported, tricuspid endocarditis was caused by Staphylococcus aureus septicemia following upper respiratory infection. This may also occur in adult cases. Further investigations should be carried out in the future to elucidate the source of infection. Isolated right-sided endocarditis should be included in the differential diagnosis of patients with febrile syndrome, respiratory symptoms and predisposing disease, even when they do not have a pacemaker and are not intravenous-drug users (IVDU).

Serial echocardiographic changes in patients on hemodialysis: an evaluation of guideline implementation

BACKGROUND

Few studies have addressed the description of serial changes in left ventricular mass (LVM) and relevant risk factors. All these studies were initiated before the implementation of EBPG or K/DOQI guidelines. The aims of our study were to prospectively describe trends in left ventricular (LV) structure and function, evaluate risk factors for progression of LVM derived from serial echocardiographic measurements starting January 2003, 6 months after full implementation of EBPG in our unit.

METHODS

One hundred seventy-six patients were enrolled at baseline, between 1 January 2003 and 1 October 2004; 33 patients were excluded from analysis due to poor echocardiographic window, 14 patients died and 26 were transplanted or transferred during the follow-up period of minimum 12 months. One hundred and three patients were included in the final analysis (mean age 51 years, mean follow-up 24.1 +/- 14.4 months). Echocardiography was performed at inclusion and at the end of study. Biochemical, blood pressure (BP) and medication data were collected and the means of monthly values were used.

RESULTS

At baseline, 86.4% of the patients had left ventricular hypertrophy (LVH) (56.3% concentric hypertrophy, 30.1% eccentric hypertrophy, 6.8% concentric remodeling and only 6.8% normal LV geometry), 25.6% had systolic dy-sfunction and 50.5% had abnormal LV volume index (LVVI). Similar data were recorded at follow-up (82.5%, 44.7%, 37.9%, 7.7%, 9.7%, and 19.5%, respectively). Baseline left ventricular mass index (LVMI) significantly correlated with hemoglobin (Hb) and total protein level. LVMI at follow-up correlated to Hb, SBP, PP, mean level of serum phosphate, calcium x phosphate product and cholesterol. Independent predictors for LVMI (multiple regressions) were anemia and mineral metabolism markers. In our population, 62.1% of the patients had a regression of LVMI, with a mean decrease in LVMI of 12 g/m 2 (1.7 +/- 11.7 g/m 2 /month) over more than 12 months of guideline implementation. Regressors had a significant improvement of anemia, serum phosphate level and calcium x phosphate product (p<0.05).

CONCLUSION

Our study suggests that a holistic interventional approach, targeting various pathogenic mechanisms, as per guidelines, can elicit at least a partial regression in LV structural and functional abnormalities in hemodialysis patients.

[Epidemiology of biopsy-proven renal disease in Romania: data from a regional registry in north-eastern Romania]

Unlike Western European countries, data on the epidemiological biopsy-proven renal disease in Eastern Europe is scarce. We aimed to analyze retrospectively the main histological renal findings, over a 10-year (1995-2004) period, in a large tertiary nephrology referral center in North-Eastern (N-E) Romania, serving a population of 4.7 million inhabitants. Clinical and biological data were also collected and correlated with histological findings. 336 renal biopsies were finally analyzed. The distribution of major clinical syndromes was: nephrotic syndrome (52%), followed by acute renal failure (19%), mild-to-moderate chronic renal failure (17%), nephritic syndrome (8%) and asymptomatic urinary abnormalities. 56.6% and 32.2% were primary and secondary glomerulopathies (GN), respectively, whereas vascular nephropathies and tubulointerstitial nephritis accounted for only 3.6 and 2% of the diagnoses. Overall, membranoproliferative (MPGN) (38%) and mesangioproliferative (MesGN) GN's (19%) were the most common primary glomerulopathies. A progressive significant decrease in the incidence of MPGN and an increase in MesGN over time were seen in our center. Analyzing other Romanian regional data, also a geographical "shift" in the prevalence of the most common primitive GN's from Eastern (E) to Western (W) Romania, similar to the N to S gradients across Europe was noted: there is a high prevalence of MPGN in the E, and a high prevalence of MesGN (including IgA nephropathy) in W Romania. These important differences in the prevalence of the most common primary GN's in E Romania may be due to lower income, education, and infrastructure levels. This hypothesis is strengthening by the higher prevalence of post-infectious and, possible, vasculitis-related GN in E Romania.

Plasma renin activity in hyperthermic rats

Heating rats exposed 30' to a 40 degrees C environmental temperature increases plasma renin activity (PRA). Propranolol as such decreased PRA, but heating propranolol-treated rats induced also an increased PRA. Hexamethonium increases PRA, that increases additionally when rats are heated. It may be concluded that increased PRA by heating is produced by other ways as catecholamine response and stimulation of beta-receptors, despite the important sympatho-adrenergic reaction that occurred in this circumstance [6], [13], probably by a decreased glomerular filtration rate and consequently that of Na in macula densa. Hyperthermia produced also an important plasma aldosterone increased concentration.