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Deleersnijder D, Laurens W, De Meester J, Cleenders E, Dendooven A, Lerut E, De Vriese AS, Dejagere T, Helbert M, Hellemans R, Koshy P, Maes B, Pipeleers L, Van Craenenbroeck AH, Van Laecke S, Vande Walle J, Couttenye MM, Meeus G, Sprangers B, De Rycke A, Bogaert AM, Woestenburg A, Denys B, Maes B, Peeters D, Vanbelleghem H, Donck J, Scharpé J, De Clippeleir N, Colson A, Meyvis K, Vandepitte K, Reyns LM, Peeters J, Decupere M, Helbert M, Zeegers M, Neirynck N, Bernaert P, Dejagere T, Lemahieu W, Sprangers B, Pipeleers L, Hellemans R, Van Laecke S, Knops N, Levtchenko E, Walle JV, Karamaria S, Van Hoeck K, Trouet D, Mauel R, Dendooven A, Hoorens A, Van Dorpe J, Praet M, Geers C, Lerut E, Koshy P, Roskams T, Aydin S, Siozopoulou V, Schelfhout AM, De Raeve H, Steenkiste E, Dedeurwaerdere F, Dalle I, Cokelaere K, Deloose S, De Paepe P, Van Eyken P. Clinicopathological characteristics and disease chronicity in native kidney biopsies in Flanders. Clin Kidney J 2022; 16:125-137. [PMID: 36726429 PMCID: PMC9871845 DOI: 10.1093/ckj/sfac208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
Background The Flemish Collaborative Glomerulonephritis Group (FCGG) registry provides complete population data on kidney disease epidemiology in the region of Flanders (Belgium), as it captures all native kidney biopsies performed in its population of 6.5 million inhabitants. Methods From 2017 until 2019, 2054 adult kidney biopsies were included from 26 nephrology centers (one biopsy per patient). Data on nephrotic and nephritic syndrome were available in 1992 and 2026 biopsies, respectively. In a subgroup of 898 biopsies containing ≥10 glomeruli from 2018 to 2019, disease chronicity was graded using the Mayo Clinic Chronicity Score (MCCS). The association between clinical variables and MCCS was determined using simple and multiple linear regression models. Results Nephrotic syndrome (present in 378 patients, 19.0%) was most frequently caused by minimal change disease in younger patients (18-44 years), membranous nephropathy in older patients (45-74 years) and amyloidosis in the elderly (>75 years). Nephritic syndrome (present in 421 patients, 20.8%) was most frequently caused by immunoglobulin A nephropathy (IgAN) in younger patients (18-64 years) and ANCA-associated vasculitis (AAV) in older patients (>64 years). AAV and IgAN were the most frequent underlying diagnoses in biopsies in which crescents were identified. In multivariable analysis, acute and chronic kidney disease and diagnoses of diabetic kidney disease, nephrosclerosis and hyperoxaluria/hypercalcemic nephropathy were associated with the highest MCCS increases. Conclusions The FCGG registry validates data from previous Western European registries and provides a snapshot of disease chronicity in the whole biopsied Flemish population.
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Affiliation(s)
| | | | - Johan De Meester
- Department of Nephrology and Dialysis, VITAZ Hospital, Sint-Niklaas, Belgium
| | - Evert Cleenders
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Amélie Dendooven
- Division of Pathology, University Hospital Ghent, Ghent, Belgium,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
| | - Evelyne Lerut
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - An S De Vriese
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium,Department of Nephrology and Infectious Diseases, AZ Sint-Jan, Brugge, Belgium
| | - Tom Dejagere
- Department of Nephrology, Jessa Hospital, Hasselt, Belgium
| | - Mark Helbert
- Department of Nephrology, ZNA Middelheim Hospital, Antwerp, Belgium
| | - Rachel Hellemans
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium,Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Priyanka Koshy
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Bart Maes
- Department of Nephrology, AZ Delta, Roeselare, Belgium
| | - Lissa Pipeleers
- Department of Nephrology, University Hospital Brussels, Brussels, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium,Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
| | - Steven Van Laecke
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium,Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Marie M Couttenye
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium,Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Gert Meeus
- Department of Nephrology, AZ Groeninge Hospital, Kortrijk, Belgium
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2
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Dirix M, Philipse E, Vleut R, Hartman V, Bracke B, Chapelle T, Roeyen G, Ysebaert D, Van Beeumen G, Snelders E, Massart A, Leyssens K, Couttenye MM, Abramowicz D, Hellemans R. OUP accepted manuscript. Clin Kidney J 2022; 15:1100-1108. [PMID: 35664264 PMCID: PMC9155241 DOI: 10.1093/ckj/sfac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Ester Philipse
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Rowena Vleut
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Vera Hartman
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Bart Bracke
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Thierry Chapelle
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Geert Roeyen
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Dirk Ysebaert
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Gerda Van Beeumen
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Department of Hepatobiliary, Transplantation and Endocrine Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Erik Snelders
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Annick Massart
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Katrien Leyssens
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
| | - Marie M Couttenye
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Rachel Hellemans
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
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3
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Wijtvliet VPWM, Ariën KK, Abrams S, Couttenye MM, Mestrez F, Mariën J, De Winter BY, Van Damme P, Pipeleers L, Wissing KM, Abramowicz D, Ledeganck KJ. mRNA-1273 vaccine (Moderna): a better option than BNT162b2 (Pfizer) in kidney transplant recipients and dialysis patients? Nephrol Dial Transplant 2021; 37:799-803. [PMID: 34888697 DOI: 10.1093/ndt/gfab352] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Veerle P W M Wijtvliet
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Steven Abrams
- Department of Epidemiology and Social Medicine, Global Health Institute, University of Antwerp, Antwerp, Belgium.,I-BioStat, Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | - Marie M Couttenye
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | - Fabienne Mestrez
- Department of Nephrology-Dialysis, University Hospital (CHU) Ambroise Paré, Mons, Belgium
| | - Joachim Mariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Evolutionary Ecology Group, Department of Biology, University of Antwerp, Antwerp, Belgium
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Lissa Pipeleers
- Department of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Karl Martin Wissing
- Department of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Daniel Abramowicz
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Department of Nephrology and Hypertension, Antwerp University Hospital, Edegem, Belgium
| | - Kristien J Ledeganck
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
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De Meester J, De Bacquer D, Naesens M, Meijers B, Couttenye MM, De Vriese AS. Incidence, Characteristics, and Outcome of COVID-19 in Adults on Kidney Replacement Therapy: A Regionwide Registry Study. J Am Soc Nephrol 2021; 32:385-396. [PMID: 33154174 PMCID: PMC8054894 DOI: 10.1681/asn.2020060875] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/23/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection disproportionally affects frail, elderly patients and those with multiple chronic comorbidities. Whether patients on RRT have an additional risk because of their specific exposure and complex immune dysregulation is controversial. METHODS To describe the incidence, characteristics, and outcomes of SARS-CoV-2 infection, we conducted a prospective, multicenter, region-wide registry study in adult patients on RRT versus the general population from March 2 to May 25, 2020. This study comprised all patients undergoing RRT in the Flanders region of Belgium, a country that has been severely affected by coronavirus disease 2019 (COVID-19). RESULTS At the end of the epidemic wave, crude and age-standardized cumulative incidence rates of SARS-CoV-2 infection were 5.3% versus 2.5%, respectively, among 4297 patients on hemodialysis, and 1.4% versus 1.6%, respectively, among 3293 patients with kidney transplants (compared with 0.6% in the general population). Crude and age-standardized cumulative mortality rates were 29.6% versus 19.9%, respectively, among patients on hemodialysis, and 14.0% versus 23.0%, respectively, among patients with transplants (compared with 15.3% in the general population). We found no excess mortality in the hemodialysis population when compared with mean mortality rates during the same 12-week period in 2015-2019 because COVID-19 mortality was balanced by lower than expected mortality among uninfected patients. Only 0.18% of the kidney transplant population died of SARS-CoV-2 infection. CONCLUSIONS Mortality associated with SARS-CoV-2 infection is high in patients on RRT. Nevertheless, the epidemic's overall effect on the RRT population remained remarkably limited in Flanders. Calculation of excess mortality and age standardization provide a more reliable picture of the mortality burden of COVID-19 among patients on RRT.
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Affiliation(s)
- Johan De Meester
- Division of Nephrology, Dialysis and Hypertension, AZ Nikolaas Hospital, Sint-Niklaas, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Maarten Naesens
- Division of Nephrology and Kidney Transplantation, UZ Leuven, Leuven, Belgium
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Bjorn Meijers
- Division of Nephrology and Kidney Transplantation, UZ Leuven, Leuven, Belgium
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Marie M. Couttenye
- Department of Nephrology, Antwerp University Hospital and Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - An S. De Vriese
- Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge, Brugge, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
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5
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Mertens B, Verhofstede S, Abramowicz D, Couttenye MM. A surprising journey into the conversion of urinary protein creatinine ratio to urinary albumin creatinine ratio as needed in the Kidney Failure Risk Equation. Clin Kidney J 2021; 14:1481-1482. [PMID: 33959276 PMCID: PMC8087137 DOI: 10.1093/ckj/sfaa201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Daniel Abramowicz
- University of Antwerp, Belgium.,Department of Nephrology, Antwerp University Hospital, Belgium
| | - Marie M Couttenye
- University of Antwerp, Belgium.,Department of Nephrology, Antwerp University Hospital, Belgium
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6
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Téblick A, Philipse E, Vleut R, Massart A, Couttenye MM, Bracke B, Hartman V, Chapelle T, Roeyen G, Ysebaert DK, Abramowicz D, Hellemans R. "Does Perioperative Patient Perfusion Obviate the Need for Kidney Machine Perfusion?" A Retrospective Analysis of Patients Receiving a Kidney From "Donation After Circulatory Death" Donors. Transplant Proc 2020; 52:2923-2929. [PMID: 32591137 DOI: 10.1016/j.transproceed.2020.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delayed graft function (DGF) remains a clinically relevant problem in the post-transplant period, especially in patients with a renal graft from a "donation after cardiac death" (DCD) donor. Controversy exists around the optimal perioperative fluid therapy in such patients. These patients may benefit from a perioperative saline loading fluid protocol, which may reduce the risk of DGF. METHODS We compared 2 cohorts of patients who underwent a renal transplantation with a graft from a DCD donor. From January 2003 until December 2012, patients (N = 46) were hemodynamically managed at the discretion of the care-giving physician, without a preoperative fluid administration protocol (first study period). From January 2015 until March 2019 (N = 26), patients received saline loading before, during, and after kidney transplantation according to a well-defined saline loading fluid protocol (second study period). The relationship between the use of this perioperative fluid protocol and DGF was analyzed using univariable and multivariable logistic regression models. RESULTS DGF occurred in 11 of 46 (24%) patients in the first study period and in 1 of 26 (4%) in the second study period (P < .05). In a multivariable model, correcting for cold ischemia time and Kidney Donor Risk Index, the use of a saline loading fluid protocol in the perioperative phase was nearly significantly associated with a decrease in DGF (P = .07). CONCLUSION In our DCD transplant population, DGF rates were low. Our data further strongly suggest that implementation of a perioperative saline loading fluid protocol was independently associated with a lower risk of DGF.
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Affiliation(s)
- Arno Téblick
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium.
| | - Ester Philipse
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Rowena Vleut
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Annick Massart
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Marie M Couttenye
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Bart Bracke
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vera Hartman
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Thiery Chapelle
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Geert Roeyen
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Dirk K Ysebaert
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Rachel Hellemans
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
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7
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Michalak M, Wouters K, Fransen E, Hellemans R, Van Craenenbroeck AH, Couttenye MM, Bracke B, Ysebaert DK, Hartman V, De Greef K, Chapelle T, Roeyen G, Van Beeumen G, Emonds MP, Abramowicz D, Bosmans JL. Prediction of delayed graft function using different scoring algorithms: A single-center experience. World J Transplant 2017; 7:260-268. [PMID: 29104860 PMCID: PMC5661123 DOI: 10.5500/wjt.v7.i5.260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/23/2017] [Accepted: 05/05/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To compare the performance of 3 published delayed graft function (DGF) calculators that compute the theoretical risk of DGF for each patient.
METHODS This single-center, retrospective study included 247 consecutive kidney transplants from a deceased donor. These kidney transplantations were performed at our institution between January 2003 and December 2012. We compared the occurrence of observed DGF in our cohort with the predicted DGF according to three different published calculators. The accuracy of the calculators was evaluated by means of the c-index (receiver operating characteristic curve).
RESULTS DGF occurred in 15.3% of the transplants under study. The c index of the Irish calculator provided an area under the curve (AUC) of 0.69 indicating an acceptable level of prediction, in contrast to the poor performance of the Jeldres nomogram (AUC = 0.54) and the Chapal nomogram (AUC = 0.51). With the Irish algorithm the predicted DGF risk and the observed DGF probabilities were close. The mean calculated DGF risk was significantly different between DGF-positive and DGF-negative subjects (P < 0.0001). However, at the level of the individual patient the calculated risk of DGF overlapped very widely with ranges from 10% to 51% for recipients with DGF and from 4% to 56% for those without DGF. The sensitivity, specificity and positive predictive value of a calculated DGF risk ≥ 30% with the Irish nomogram were 32%, 91% and 38%.
CONCLUSION Predictive models for DGF after kidney transplantation are performant in the population in which they were derived, but less so in external validations.
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Affiliation(s)
- Magda Michalak
- Department of Nephrology-Hypertension, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Kristien Wouters
- Department of Medical Statistics, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, B-2610 Wilrijk, Belgium
| | - Rachel Hellemans
- Department of Nephrology-Hypertension, Antwerp University Hospital, B-2650 Edegem, Belgium
| | | | - Marie M Couttenye
- Department of Nephrology-Hypertension, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Bart Bracke
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Dirk K Ysebaert
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Vera Hartman
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Kathleen De Greef
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Thiery Chapelle
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Geert Roeyen
- Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Gerda Van Beeumen
- Department of Nephrology-Hypertension, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Marie-Paule Emonds
- Histocompatibility and Immunogenetic Laboratory, Belgian Red Cross-Flanders, 2800 Mechelen, Belgium
| | - Daniel Abramowicz
- Department of Nephrology-Hypertension, Antwerp University Hospital, B-2650 Edegem, Belgium
| | - Jean-Louis Bosmans
- Department of Nephrology-Hypertension, Antwerp University Hospital, B-2650 Edegem, Belgium
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8
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Georgieva LA, Gielis EM, Hellemans R, Van Craenenbroeck AH, Couttenye MM, Abramowicz D, Van Beeumen G, Siozopoulou V, Van Rosmalen M, Bracke B, Hartman V, De Greef K, Roeyen G, Chapelle T, Ysebaert D, Bosmans JL. Single-Center Case Series of Donor-Related Malignancies: Rare Cases With Tremendous Impact. Transplant Proc 2017; 48:2669-2677. [PMID: 27788799 DOI: 10.1016/j.transproceed.2016.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/26/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Donor-related malignancy is a rare complication of organ transplantation. METHODS In this case series, we discuss three cases of donor-related cancers in kidney transplant recipients who were registered in our center between 1979 and 2015. They account for an incidence of 0.29% of donor-related malignancies of a total of 1015 transplanted kidney grafts (deceased and living donors). The three cases that we describe presented in different ways and with different severity, although the response to the initiated treatment was comparable. RESULTS All three patients not only survived their cancer episode but also had a complete oncological remission and underwent successful second kidney transplantation, accounting for a 100% survival rate in our small cohort. CONCLUSIONS Despite the very low incidence of this complication, transplant clinicians must be aware of the occurrence of donor-related malignancies when selecting a donor and should be able to diagnose and treat a case of donor-related cancer.
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Affiliation(s)
- L A Georgieva
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - E M Gielis
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; University of Antwerpen, Wilrijk, Belgium
| | - R Hellemans
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - A H Van Craenenbroeck
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; University of Antwerpen, Wilrijk, Belgium
| | - M M Couttenye
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; University of Antwerpen, Wilrijk, Belgium
| | - D Abramowicz
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; University of Antwerpen, Wilrijk, Belgium
| | - G Van Beeumen
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - V Siozopoulou
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium
| | | | - B Bracke
- Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - V Hartman
- Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - K De Greef
- University of Antwerpen, Wilrijk, Belgium; Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - G Roeyen
- Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - T Chapelle
- Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - D Ysebaert
- University of Antwerpen, Wilrijk, Belgium; Department of Hepatobiliary, Endocrine, and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium
| | - J L Bosmans
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; University of Antwerpen, Wilrijk, Belgium.
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9
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Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, Hoymans VY, Verpooten GA, Vrints CJ, Couttenye MM. Impaired vascular function contributes to exercise intolerance in chronic kidney disease. Nephrol Dial Transplant 2016; 31:2064-2072. [PMID: 27540045 DOI: 10.1093/ndt/gfw303] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/03/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Exercise intolerance is an important feature in patients with chronic kidney disease (CKD) and is prognostic for both increased morbidity and mortality. Little is known about the underlying mechanisms in predialysis CKD. This study aimed to gain more insight into the role of vascular dysfunction in the exercise intolerance of predialysis CKD. In addition, vascular-related microRNAs (miRNAs)-as epigenetic regulators of exercise capacity-were analysed. METHODS Sixty-three patients with CKD stages 1-5 and 18 healthy controls were included. Peak oxygen consumption (VO2peak) was determined by cardiopulmonary exercise testing, endothelial function by flow-mediated dilation (FMD) and arterial stiffness by carotid-femoral pulse wave velocity (PWV). Plasma miRNA levels (miR-21, miR-126, miR-146a, miR-150 and miR-210) were quantified by quantitative RT-PCR. RESULTS VO2peak was already impaired in mild CKD (stages 1-3A) and significantly correlated with estimated glomerular filtration rate (eGFR; r = 0.525, P < 0.001). Likewise, both FMD and PWV were significantly correlated with eGFR (r = 0.319, P = 0.007 and r = -0.365, P = 0.001, respectively). In multiple regression analysis, PWV remained one of the strongest independent determinants of VO2peak (β = -0.301, P = 0.01). Of the studied miRNA, circulating levels of miR-146a and miR-150 correlated with eGFR, PWV and VO2peak, but the association with the latter was lost when correcting for PWV. CONCLUSIONS Arterial stiffness contributes to the observed reduced aerobic capacity in predialysis CKD, independent of age, haemoglobin levels and endothelial function and represents a promising therapeutic target for improving exercise capacity in this population. Future work is required to elucidate why higher circulating levels of miR-146a and miR-150 are associated with impaired renal function and increased arterial stiffness.
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Affiliation(s)
- Amaryllis H Van Craenenbroeck
- Department of Nephrology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.,Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Edegem, Belgium
| | - Emeline M Van Craenenbroeck
- Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Katrijn Van Ackeren
- Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium
| | - Vicky Y Hoymans
- Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium
| | - Gert A Verpooten
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Edegem, Belgium
| | - Christiaan J Vrints
- Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Marie M Couttenye
- Department of Nephrology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
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Van Craenenbroeck AH, Ledeganck KJ, Van Ackeren K, Jürgens A, Hoymans VY, Fransen E, Adams V, De Winter BY, Verpooten GA, Vrints CJ, Couttenye MM, Van Craenenbroeck EM. Plasma levels of microRNA in chronic kidney disease: patterns in acute and chronic exercise. Am J Physiol Heart Circ Physiol 2015; 309:H2008-16. [PMID: 26475583 DOI: 10.1152/ajpheart.00346.2015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/15/2015] [Indexed: 12/29/2022]
Abstract
Exercise training is an effective way to improve exercise capacity in chronic kidney disease (CKD), but the underlying mechanisms are only partly understood. In healthy subjects (HS), microRNA (miRNA or miR) are dynamically regulated following exercise and have, therefore, been suggested as regulators of cardiovascular adaptation to exercise. However, these effects were not studied in CKD before. The effect of acute exercise (i.e., an acute exercise bout) was assessed in 32 patients with CKD and 12 age- and sex-matched HS (study 1). miRNA expression in response to chronic exercise (i.e., a 3-mo exercise training program) was evaluated in 40 CKD patients (study 2). In a subgroup of study 2, the acute-exercise induced effect was evaluated at baseline and at follow-up. Plasma levels of a preselected panel miRNA, involved in exercise adaptation processes such as angiogenesis (miR-126, miR-210), inflammation (miR-21, miR-146a), hypoxia/ischemia (miR-21, miR-210), and progenitor cells (miR-150), were quantified by RT-PCR. Additionally, seven miRNA involved in similar biological processes were quantified in the subgroup of study 2. Baseline, studied miRNA were comparable in CKD and HS. Following acute exercise, miR-150 levels increased in both CKD (fold change 2.12 ± 0.39, P = 0.002; and HS: fold change 2.41 ± 0.48 P = 0.018, P for interaction > 0.05). miR-146a acutely decreased in CKD (fold change 0.92 ± 0.13, P = 0.024), whereas it remained unchanged in HS. Levels of miR-21, miR-126, and miR-210 remained unaltered. Chronic exercise did not elicit a significant change in the studied miRNA levels. However, an acute exercise-induced decrease in miR-210 was observed in CKD patients, only after training (fold change 0.76 ± 0.15). The differential expression in circulating miRNA in response to acute and chronic exercise may point toward a physiological role in cardiovascular adaptation to exercise, also in CKD.
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Affiliation(s)
- Amaryllis H Van Craenenbroeck
- Laboratory of Cellular and Molecular Cardiology, Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium;
| | - Kristien J Ledeganck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Katrijn Van Ackeren
- Cardiovascular Diseases, Department of Translational Pathophysiological Research, University of Antwerp, Antwerp, Belgium
| | - Angelika Jürgens
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Vicky Y Hoymans
- Laboratory of Cellular and Molecular Cardiology, Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; Cardiovascular Diseases, Department of Translational Pathophysiological Research, University of Antwerp, Antwerp, Belgium
| | - Erik Fransen
- StatUA Center for Statistics, University of Antwerp, Antwerp, Belgium; and
| | - Volker Adams
- Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Gert A Verpooten
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Christiaan J Vrints
- Laboratory of Cellular and Molecular Cardiology, Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; Cardiovascular Diseases, Department of Translational Pathophysiological Research, University of Antwerp, Antwerp, Belgium
| | - Marie M Couttenye
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
| | - Emeline M Van Craenenbroeck
- Laboratory of Cellular and Molecular Cardiology, Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; Cardiovascular Diseases, Department of Translational Pathophysiological Research, University of Antwerp, Antwerp, Belgium
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11
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Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, Vrints CJ, Conraads VM, Verpooten GA, Kouidi E, Couttenye MM. Effect of Moderate Aerobic Exercise Training on Endothelial Function and Arterial Stiffness in CKD Stages 3-4: A Randomized Controlled Trial. Am J Kidney Dis 2015; 66:285-96. [PMID: 25960303 DOI: 10.1053/j.ajkd.2015.03.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/05/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence of a beneficial effect of exercise training on mediators of vascular disease is accumulating in chronic kidney disease (CKD), but its effect on vascular function in vivo still has to be established. The present study was designed to investigate whether a formal aerobic exercise training program improves peripheral endothelial function in patients with CKD stages 3 to 4. STUDY DESIGN Randomized controlled trial with a parallel-group design. SETTING & PARTICIPANTS 48 patients with CKD stages 3 to 4 without established cardiovascular disease were randomly assigned to either an exercise training program or usual care. 40 patients completed the study (exercise training, 19; usual care, 21). INTERVENTION The 3-month home-based aerobic training program consisted of 4 daily cycling sessions of 10 minutes each at a target heart rate, calculated as 90% of the heart rate achieved at the anaerobic threshold. Patients in the usual-care group were given standard therapy. OUTCOMES The primary outcome was peripheral endothelial function. Secondary outcomes were aerobic capacity, arterial stiffness, numbers of endothelial (EPCs) and osteogenic progenitor cells (OPCs), migratory function of circulatory angiogenic cells, and health-related quality of life. MEASUREMENTS Endothelial function was assessed with flow-mediated dilation of the brachial artery, aerobic capacity by peak oxygen uptake (VO(2peak)), arterial stiffness by carotid-femoral pulse wave velocity, numbers of EPCs and OPCs by flow cytometry, circulatory angiogenic cell function by an in vitro migratory assay, and quality of life by the Kidney Disease Quality of Life-Short Form questionnaire. RESULTS Exercise training significantly improved VO(2peak) and quality of life, but not in vivo vascular function (flow-mediated dilation and carotid-femoral pulse wave velocity) or cellular markers for vascular function (EPC and OPC count and circulatory angiogenic cell migratory function). LIMITATIONS Short duration and intermittent nature of the exercise intervention. CONCLUSIONS In patients with CKD stages 3 to 4 without overt cardiovascular disease, 3 months of aerobic exercise training improved VO(2peak) and quality of life, without altering endothelial function or arterial stiffness.
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Affiliation(s)
- Amaryllis H Van Craenenbroeck
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Edegem, Belgium.
| | - Emeline M Van Craenenbroeck
- Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium; Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Katrijn Van Ackeren
- Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium
| | - Christiaan J Vrints
- Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium; Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Viviane M Conraads
- Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium; Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Gert A Verpooten
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Edegem, Belgium
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marie M Couttenye
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
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Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, Hoymans VY, Verpooten GA, Vrints CJ, Couttenye MM. SP444IMPAIRED VASCULAR FUNCTION CONTRIBUTES TO EXERCISE INTOLERANCE IN CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv194.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Van Craenenbroeck AH, Ledeganck KJ, Van Ackeren K, Hoymans VY, Fransen E, De Winter BY, Verpooten GA, Vrints CJ, Couttenye MM, Van Craenenbroeck EM. SP443PLASMA LEVELS OF MICRORNA IN CHRONIC KIDNEY DISEASE: PATTERNS IN ACUTE EXERCISE AND EXERCISE TRAINING. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv194.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abramowicz D, Michalak M, De Greef K, Hellemans R, Wouters K, Couttenye MM, Ysebaert DK, Chapelle T, Roeyen G, Bracke B, Hartman V, Bosmans JL. FP847WHAT IS THE PREDICTIVE VALUE OF DELAYED GRAFT FUNCTION CALCULATORS IN KIDNEY TRANSPLANTATION? Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv185.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Van Craenenbroeck AH, Van Craenenbroeck EM, Kouidi E, Vrints CJ, Couttenye MM, Conraads VM. Vascular effects of exercise training in CKD: current evidence and pathophysiological mechanisms. Clin J Am Soc Nephrol 2014; 9:1305-18. [PMID: 24832091 PMCID: PMC4078973 DOI: 10.2215/cjn.13031213] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cardiovascular disease remains the main cause of morbidity and mortality in patients with CKD, an observation that cannot be explained by the coexistence of traditional risk factors alone. Recently, other mechanisms, such as alterations in nitric oxide bioavailability, impaired endothelial repair mechanisms, inflammation, and oxidative stress (all characteristic in CKD), have gained much attention as mediators for the increased cardiovascular risk. Regular physical training is a valuable nonpharmacological intervention for primary and secondary prevention of cardiovascular disease. Likewise, the benefits of exercise training on exercise capacity and quality of life are increasingly recognized in patients with CKD. Furthermore, exercise training could also influence potential reversible mechanisms involved in atherosclerosis and arteriosclerosis. After discussing briefly the general concepts of vascular disease in CKD, this review provides an overview of the current evidence for the effects of exercise training at both clinical and preclinical levels. It concludes with some practical considerations on exercise training in this specific patient group.
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Affiliation(s)
- Amaryllis H Van Craenenbroeck
- Departments of Nephrology and Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium; and
| | - Emeline M Van Craenenbroeck
- Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium; and Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Evangelia Kouidi
- School of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christiaan J Vrints
- Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium; and Cardiology, Antwerp University Hospital, Edegem, Belgium
| | | | - Viviane M Conraads
- Laboratory for Molecular and Cellular Cardiology, University of Antwerp, Edegem, Belgium; and Cardiology, Antwerp University Hospital, Edegem, Belgium
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16
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Ledeganck KJ, De Winter BY, Van den Driessche A, Jürgens A, Bosmans JL, Couttenye MM, Verpooten GA. Magnesium loss in cyclosporine-treated patients is related to renal epidermal growth factor downregulation. Nephrol Dial Transplant 2013; 29:1097-102. [PMID: 24353324 DOI: 10.1093/ndt/gft498] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cyclosporine (CsA) treatment is associated with hypomagnesaemia due to a renal Mg(2+) leak. In animal studies a role for the Mg(2+) channel TRPM6 localized in the distal convoluted tubule and stimulated by epidermal growth factor (EGF) is suggested. We hypothesize that CsA-induced hypomagnesaemia is due to a renal magnesium leak, also in patients, resulting from a downregulation of the renal EGF production, thereby inhibiting the activation of TRPM6. METHODS Renal transplant patients treated with CsA (n = 55) and 35 chronic kidney disease (CKD) patients were included. At three time points, with an interval of at least 1 month, blood and urine samples were taken to determine creatinine, Mg(2+), sodium and EGF. RESULTS Serum Mg(2+) was significantly lower in the CsA group versus the CKD group with significantly more CsA-treated patients developing hypomagnesaemia. Although the fractional excretion (FE) Mg(2+) did not differ significantly between the two groups, subanalysis of the patients with hypomagnesaemia showed a significantly higher FE Mg(2+) in CsA-treated patients compared with CKD patients (P = 0.05). The urinary EGF excretion was significantly decreased in the CsA group and was a predictor of the FE Mg(2+) in the two groups. Serum sodium was significantly decreased in the CsA group simultaneously with an increased FE Na(+). CONCLUSIONS In CsA-treated patients, the association of a low urinary EGF excretion and a decreased renal Mg(2+) reabsorption is in accordance with in vitro and animal studies. In the whole study population, log urinary EGF excretion is an independent predictor of the FE Mg(2+), supporting the role of EGF in magnesium reabsorption.
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Affiliation(s)
- Kristien J Ledeganck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
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17
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Janssen van Doorn K, Dirinck E, Verpooten GA, Couttenye MM. Complement factor H mutation associated with membranoproliferative glomerulonephritis with transformation to atypical haemolytic uraemic syndrome. Clin Kidney J 2013; 6:216-219. [PMID: 25006455 PMCID: PMC4086369 DOI: 10.1093/ckj/sfs190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 12/30/2012] [Indexed: 01/19/2023] Open
Abstract
A patient with a history of haemolytic anaemia and membranoproliferative glomerulonephritis type 1 since childhood developed relapsing atypical haemolytic uraemic syndrome (aHUS) at the age of 18. Despite several episodes of relapsing aHUS, she was successfully treated with plasmapheresis. aHUS is strongly associated with disorders of the complement pathway. Diagnostic work-up of the patient revealed normal serum values of complement factor H, I, B and membrane cofactor protein (MCP). Genetic analysis showed a homozygous mutation in the factor H gene. Extraordinarily, the homozygous mutation in this patient causes a normal amount but hypothetically functionally defective factor H in the plasma.
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Affiliation(s)
- Karin Janssen van Doorn
- Department of Nephrology-Hypertension , Antwerp University Hospital , Edegem, Antwerpen , Belgium
| | - Eveline Dirinck
- Department of Nephrology-Hypertension , Antwerp University Hospital , Edegem, Antwerpen , Belgium
| | - Gert A Verpooten
- Department of Nephrology-Hypertension , Antwerp University Hospital , Edegem, Antwerpen , Belgium ; Laboratory of Experimental Medicine and Paediatrics , Faculty of Medicine and Health Sciences , University of Antwerp , Antwerpen , Belgium
| | - Marie M Couttenye
- Department of Nephrology-Hypertension , Antwerp University Hospital , Edegem, Antwerpen , Belgium
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Abstract
Anaphylactic and anaphylactoid reactions related to haemodialysis have been increasingly described for almost 3 decades. The majority of these cases used to occur with ethylene oxide sterilized, and complement-activating cellulose membranes. However, a considerable number of publications have focused on polyacrylonitrile AN69 high flux membranes, angiotensin converting enzyme inhibitors and iron as other important causes of potentially severe haemodialysis-related anaphylactoid reactions. Clinical manifestations vary considerably and generally do not allow differentiation between IgE-mediated anaphylaxis and anaphylactoid reactions (e.g. from nonspecific mediator release). Successful management of these patients requires multidisciplinary approach and involves prompt recognition and treatment by the attending physician, and identification of the offending agent(s) with subsequent avoidance of the incriminated compound(s). This review focuses on some major causes of anaphylactoid and anaphylactic reactions during haemodialysis. Special consideration is given to the therapeutic and diagnostic approach.
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Affiliation(s)
- D G Ebo
- Department of Immunology, Allergology and Rheumatology, University Antwerpen, UA, Campus Drie Eiken, Antwerpen, Belgium
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Jorens PG, Demey HE, Schepens PJC, Coucke V, Verpooten GA, Couttenye MM, Van Hoof V. Unusual D‐Lactic Acid Acidosis from Propylene Glycol Metabolism in Overdose. ACTA ACUST UNITED AC 2004; 42:163-9. [PMID: 15214621 DOI: 10.1081/clt-120030942] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To report a case of D-lactic acid acidosis owing to massive oral ingestion of propylene glycol. CASE REPORT A 72-year old man with known congestive failure was admitted to the ICU with encephalopathy. Twelve hours prior to admission he had erroneously ingested a large amount of propylene glycol (PG). The laboratory revealed high anion gap (anion gap = 27 meq/l) acidosis (arterial pH = 7.16) and an increased osmolal gap. Toxicological analysis revealed a low serum propylene glycol level. Biochemical analysis indicated that very high amounts of D-lactic acid (up to 110 mmol/l), but not of the usual type of L-lactic acid, were responsible for the metabolic acidosis. Hemodialysis was initiated and associated with a decline of both the acidosis and D-lactic acid levels. The patient regained conciousness. CONCLUSION Ingestion of massive doses of propylene glycol, previously not reported as a cause of D-lactic acidosis, should be added to the differential diagnosis of this rare condition.
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Affiliation(s)
- Philippe G Jorens
- Department of Intensive Care Medicine, University Hospital of Antwerp, Edegem, Belgium.
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D'Haese PC, Schrooten I, Goodman WG, Cabrera WE, Lamberts LV, Elseviers MM, Couttenye MM, De Broe ME. Increased bone strontium levels in hemodialysis patients with osteomalacia. Kidney Int 2000; 57:1107-14. [PMID: 10720963 DOI: 10.1046/j.1523-1755.2000.00938.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In this study, we report on the association between increased bone strontium levels and the presence of osteomalacia in end-stage renal failure patients treated by hemodialysis. METHODS We performed a histologic examination and determined the strontium content and strontium/calcium ratios in bone biopsies of 100 hemodialysis patients recruited from various centers all over the world. Aside from the bone strontium concentration, the bone aluminum content was assessed. The bone zinc concentration, a nonrelevant element for bone toxicity, was also measured. RESULTS Bone strontium levels and bone strontium/calcium ratios were increased in subjects with osteomalacia when compared with those with the other types of renal osteodystrophy. Bone strontium and bone calcium levels correlated with each other. The slope of the linear regression curve correlating these parameters was much steeper in the osteomalacic group (Y = 2.22X - 120) as compared with the other types of renal osteodystrophy (Y = 0.52X - 5.7). Within the group of patients with osteomalacia, bone strontium levels also significantly correlated with the bone aluminum content (r = 0.72, P = 0.018). No such correlation was found for the other types of renal osteodystrophy. The bone zinc concentration of subjects with normal renal function did not differ significantly from the values noted for the various types of renal osteodystrophy taken as separate groups, nor could increased bone zinc concentrations be associated with a particular bone lesion. CONCLUSIONS Our data demonstrate an association between osteomalacia and increased bone strontium concentrations in dialysis patients. Further studies are warranted to establish whether strontium plays either a primary, secondary, or contributive role in the development of the latter type of renal osteodystrophy.
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Affiliation(s)
- P C D'Haese
- Department of Nephrology-Hypertension, University of Antwerp, P/a University Hospital Antwerp, Edegem, Belgium.
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Abstract
Renal failure inevitably leads to metabolic bone disease. Low turnover disease or adynamic bone disease (ABD) is characterized by a low number of osteoblasts with normal or reduced numbers of osteoclasts. Mineralization proceeds at a normal rate, resulting in normal or decreased osteoid thickness. Recently, it became clear that the relative contribution of the various types of renal osteodystrophy (ROD) to the spectrum of the histologic picture in renal failure patients underwent profound changes during the last 25 years. At the moment, the exact physiopathological mechanisms behind ABD are not yet elucidated, and thus the reason(s) for its increasing prevalence remains poorly understood. A number of epidemiological and experimental data suggest a multifactorial pathophysiologic process, in which hypoparathyroidism and suppression of the osteoblast are the main actors. Compared to adynamic bone disease, osteomalacia has now become a much rarer disease (around 4%), at least in Western countries. On the other hand, recent studies indicate that this particular bone disease entity might still regularly occur in less developed countries. Osteomalacia originates from a direct effect on the mineralization process. With this type of renal bone disease, the effects of secondary hyperparathyroidism on bone are overridden by a number of metabolic abnormalities that finally result in a defective bone mineralization, as occurs, for instance, when the lag time between osteoid deposition and its mineralization is increased. The relationship between exogenous and endogenous vitamin D deficiency (mainly calcitriol) and the histologic finding of osteomalacia in uremic patients is well known. Recent data showed distinctly lowered 25-(OH) vitamin D3 levels in the presence of unaffected calcitriol concentrations in patients with osteomalacic lesions, as assessed radiologically by the presence of Looser's zones. Recently, we found that bone strontium levels were increased in patients with osteomalacia as compared to all other types of ROD. Strontium accumulation appeared to originate mainly from the use of strontium-contaminated dialysate, which resulted from the addition of strontium-containing acetate-based concentrates. Evidence for a causal role of the element in the development of a mineralization defect could be tested experimentally by adding strontium to drinking water in a chronic renal failure rat model.
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Affiliation(s)
- M M Couttenye
- Department of Nephrology, University of Antwerp, Belgium
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D'Haese PC, Couttenye MM, Lamberts LV, Elseviers MM, Goodman WG, Schrooten I, Cabrera WE, De Broe ME. Aluminum, iron, lead, cadmium, copper, zinc, chromium, magnesium, strontium, and calcium content in bone of end-stage renal failure patients. Clin Chem 1999; 45:1548-56. [PMID: 10471660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Little is known about trace metal alterations in the bones of dialysis patients or whether particular types of renal osteodystrophy are associated with either increased or decreased skeletal concentrations of trace elements. Because these patients are at risk for alterations of trace elements as well as for morbidity from skeletal disorders, we measured trace elements in bone of patients with end-stage renal disease. METHODS We analyzed bone biopsies of 100 end-stage renal failure patients enrolled in a hemodialysis program. The trace metal contents of bone biopsies with histological features of either osteomalacia, adynamic bone disease, mixed lesion, normal histology, or hyperparathyroidism were compared with each other and with the trace metal contents of bone of subjects with normal renal function. Trace metals were measured by atomic absorption spectrometry. RESULTS The concentrations of aluminum, chromium, and cadmium were increased in bone of end-stage renal failure patients. Comparing the trace metal/calcium ratio, significantly higher values were found for the bone chromium/calcium, aluminum/calcium, zinc/calcium, magnesium/calcium, and strontium/calcium ratios. Among types of renal osteodystrophy, increased bone aluminum, lead, and strontium concentrations and strontium/calcium and aluminum/calcium ratios were found in dialysis patients with osteomalacia vs the other types of renal osteodystrophy considered as one group. Moreover, the concentrations of several trace elements in bone were significantly correlated with each other. Bone aluminum was correlated with the time on dialysis, whereas bone iron, aluminum, magnesium, and strontium tended to be associated with patient age. Bone trace metal concentrations did not depend on vitamin D intake nor on the patients' gender. CONCLUSIONS The concentration of several trace elements in bone of end-stage renal failure patients is disturbed, and some of the trace metals under study might share pathways of absorption, distribution, and accumulation. The clinical significance of the increased/decreased concentrations of several trace elements other than aluminum in bone of dialysis patients deserves further investigation.
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Affiliation(s)
- P C D'Haese
- Department of Nephrology-Hypertension, University of Antwerp, B-2650 Edegem, Belgium
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Couttenye MM, D'Haese PC, De Broe ME. What considerations should we give to adynamic bone disease? Int J Artif Organs 1998; 21:687-92. [PMID: 9894742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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24
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D'Haese PC, Couttenye MM, De Broe ME. Osteodystrophy in chronic renal failure patients. Saudi J Kidney Dis Transpl 1998; 9:397-415. [PMID: 18408310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- P C D'Haese
- Department of Nephrology and Hypertension, University of Antwerp, Belgium
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Couttenye MM, D'Haese PC, Deng JT, Van Hoof VO, Verpooten GA, De Broe ME. High prevalence of adynamic bone disease diagnosed by biochemical markers in a wide sample of the European CAPD population. Nephrol Dial Transplant 1997; 12:2144-50. [PMID: 9351080 DOI: 10.1093/ndt/12.10.2144] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Adynamic bone disease (ABD) has been described in the current dialysis population to have an unexpectedly high prevalence. Moreover, it is clearly more prevalent in CAPD patients, compared to haemodialysis patients. Recently we demonstrated that both a low (< or = 27 U/1) level of bone alkaline phosphatase (BAP) as determined by an optimized agarose gel electrophoretic technique and a low (< or = 150 pg/ml ) level of iPTH are good markers of ABD with sensitivities of 78.1% and 80.6% and specificities of 86.4% and 76.2% respectively. METHODS In this study (n = 212), the prevalence of ABD in the European CAPD population was evaluated by means of these biochemical markers. Clinical data on the patients included were recorded at the moment of blood sampling. In patients under CAPD treatment for longer than 9 months, we calculated an index of calcium exposure through PD fluid. RESULTS In this population with a low exposure to aluminium, the prevalence of ABD as indicated by either a low level of BAP or PTH was 43%. The following risk factors could be identified: advanced age, shorter time on renal replacement therapy, male gender, and high calcium content of PD fluid. The index of calcium exposure was significantly higher in the patients with low BAP and low iPTH levels compared to those with either BAP > or = 27 U/1 or iPTH > 150 pg/ml. The latter finding gives further support to the hypothesis that a high calcium load administered to renal failure patients may lead to 'oversuppressed' parathyroids in ABD. In a subgroup of patients with a high level of BAP associated with a low iPTH level a profile previously shown to be associated in the presence of aluminium overload, significantly higher serum aluminium levels were noted. suggesting that even in patients with low exposure to aluminium, this element still can affect bone metabolism. CONCLUSION A high prevalence of ABD--as diagnosed by biochemical markers--was observed in the European CAPD population. A number of risk factors could be put forward. The aetiology and pathogenesis of this type of renal osteodystrophy remain to be elucidated, but appear, however, to be multifactorial.
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Affiliation(s)
- M M Couttenye
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
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Smans KA, Van Landeghem FG, D'Haese PC, Couttenye MM, De Broe ME. Is there a link between erythropoietin therapy and adynamic bone disease? Nephrol Dial Transplant 1996; 11:1248-9. [PMID: 8672017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- K A Smans
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
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27
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Couttenye MM, D'Haese PC, Van Hoof VO, Lemoniatou E, Goodman W, Verpooten GA, De Broe ME. Low serum levels of alkaline phosphatase of bone origin: a good marker of adynamic bone disease in haemodialysis patients. Nephrol Dial Transplant 1996; 11:1065-72. [PMID: 8671970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adynamic bone disease was recently described to be increasingly prevalent in the dialysis population. At present the diagnosis of this type of renal osteodystrophy can only be made by bone histomorphometry. We assessed the value of different biochemical serum markers in the diagnosis of adynamic bone disease. METHODS In 103 haemodialysis patients a bone biopsy was performed after double tetracycline labelling, and the serum levels of intact PTH, osteocalcin, and the bone isoenzyme of alkaline phosphatase were determined. Bone alkaline phosphatase was measured by an optimized agarose gel electrophoretic method, recently shown to have a high accuracy, precision and reproducibility, also in the lower range. RESULTS In 38 (37%) of the patients the diagnosis of adynamic bone disease was histologically established. Constructing receiver operator curves optimal cut-off levels for the diagnosis of adynamic bone disease were determined, being <=27 U/litre for the bone isoenzyme of alkaline phosphatase, <=14 microg/litre for osteocalcin and <=150 pg/ml for intact PTH. Concentrations of bone alkaline phosphatase or intact PTH below these cut-off levels, were shown to be the best performing tests in the detection of adynamic bone disease as indicated by a sensitivity of 78.1 and 80.6% and a specificity of 86.4 and 76.2% respectively. Applying Bayes' theorema, it was calculated that in the current haemodialysis population in which a prevalence of adynamic bone disease up to 35% has been described, the positive predictive values for the proposed cut-off values are 75% for bone alkaline phosphatase, 65% for intact PTH and 55% for osteocalcin. Moreover, in this population, levels of bone alkaline phosphatase and intact PTH below the optimal cut-off excluded hyperparathyroid bone disease. CONCLUSION In view of the relative easy and accurate methodology for bone alkaline phosphatase determination, the closer physiological link with osteoblast function and the lesser expense for its determination we suggest that this marker is a useful tool in the non-invasive diagnosis of the adynamic type of bone disease in the individual patient.
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Affiliation(s)
- M M Couttenye
- Department of Nephrology-Hypertension, University of Antwerp, p/a University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem/ Antwerpen, Belgium
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28
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Couttenye MM, Jurgens A, Lamberts LV, Verpooten GA, D'Haese PC, De Broe ME. Determination of ionized calcium: evaluation of sampling and storage procedures. Clin Chem 1996. [DOI: 10.1093/clinchem/42.3.468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- M M Couttenye
- Dept. of Nephrology-Hypertension, Univ. of Antwerp, Belgium
| | - A Jurgens
- Dept. of Nephrology-Hypertension, Univ. of Antwerp, Belgium
| | - L V Lamberts
- Dept. of Nephrology-Hypertension, Univ. of Antwerp, Belgium
| | - G A Verpooten
- Dept. of Nephrology-Hypertension, Univ. of Antwerp, Belgium
| | - P C D'Haese
- Dept. of Nephrology-Hypertension, Univ. of Antwerp, Belgium
| | - M E De Broe
- Dept. of Nephrology-Hypertension, Univ. of Antwerp, Belgium
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29
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Ebo DG, DeClerck LS, Stevens WJ, Ieven M, Ursi D, Van Goethem JW, Couttenye MM. Herpes zoster myelitis occurring during treatment for systemic lupus erythematosus. J Rheumatol 1996; 23:548-50. [PMID: 8833001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A woman with systemic lupus erythematosus (SLE) presented with a zoster eruption. Transverse myelitis developed at the site of the dermatomal distribution of the rash. SLE and varicella zoster virus (VZV) can both cause myelitis, and are difficult to differentiate. The topographic association between the cutaneous and the neurological involvement suggesting VZV myelitis was confirmed by polymerase chain reaction (PCR) for VZV in the cerebrospinal fluid. This case illustrates the potential role of the selective amplification of VZV DNA in cerebrospinal fluid to diagnose central neurological complications associated with VZV. The value of magnetic resonance imaging of the spinal cord in the evaluation of patients with myelitis is emphasized.
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Affiliation(s)
- D G Ebo
- Department of Immunology, Allergology, and Rheumatology, University of Antwerp, Belgium
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30
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Couttenye MM, Jurgens A, Lamberts LV, Verpooten GA, D'Haese PC, De Broe ME. Determination of ionized calcium: evaluation of sampling and storage procedures. Clin Chem 1996; 42:468-9. [PMID: 8598117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M M Couttenye
- Dept. of Nephrology-Hypertension, Univ. of Antwerp, Belgium
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31
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Abstract
Aluminium accumulation in serum and tissues is a well-known complication in patients with chronic renal failure, and retention of the element in bone has been implicated in the pathogenesis of the so-called aluminium-related bone disease (ARBD). Regular serum aluminium monitoring remains mandatory to detect patients and centres at risk for aluminium intoxication. Early recognition of ARBD however requires a desferrioxamine (DFO) test in combination with a serum iPTH measurement. Definite diagnosis of ARBD is made by histological examination of a bone biopsy. Once ARBD has been identified DFO treatment should be initiated and all potential sources of aluminium exposure eliminated. In order to minimize the risk for DFO-related cerebral, auditory and visual side-effects, and siderophore-mediated opportunistic infections the chelator should be used at low doses (5 mg/kg) and administered widely spaced (once weekly) following well-defined strategies of administration.
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Affiliation(s)
- P C D'Haese
- Department of Nephrology/Hypertension, University of Antwerp, Belgium
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32
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D'Haese PC, Couttenye MM, Goodman WG, Lemoniatou E, Digenis P, Sotornik I, Fagalde A, Barsoum RS, Lamberts LV, De Broe ME. Use of the low-dose desferrioxamine test to diagnose and differentiate between patients with aluminium-related bone disease, increased risk for aluminium toxicity, or aluminium overload. Nephrol Dial Transplant 1995; 10:1874-84. [PMID: 8592597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Aiming at a safe method in the diagnosis of aluminium-related bone disease (ARBD)/aluminium overload the low-dose desferrioxamine (DFO) test was developed. In a multicentre study histological and histochemical data and aluminium bulk analysis of bone biopsies of 77 dialysis patients were correlated with the results of both the 5 mg/kg and 10 mg/kg DFO tests. METHODS ARBD was considered to be present when > 15% of the bone surface was positively stained for aluminium and the bone formation rate was below 220 microns 2/mm2/day. Patients in which the Aluminon staining was positive (> 0%) were considered at an increased risk for aluminium toxicity independent of the type of renal osteodystrophy. Patients were considered aluminium overloaded when the bone aluminium content was > 15 micrograms/g wet weight and/or the Aluminon staining was positive (> 0%). RESULTS Using the proposed criteria 15 patients were found to have ARBD; 13 of them presenting with a serum iPTH below 150 ng/l. In conjunction with an iPTH measurement the DFO test had a more than acceptable sensitivity and specificity in the diagnosis of ARBD. The test was considered positive when a post-DFO serum aluminium increment (delta sA1) above 50 micrograms/l (5 mg/kg) or 70 micrograms/l (10 mg/kg) together with a serum iPTH below 150 ng/l was found. Using these cut-off levels the 5 and 10 mg/kg tests in the diagnosis of ARBD had a sensitivity of 87% and a specificity of 95% and 92% respectively whereas the predictive value for a positive test for the population under study was 80% (5 mg/kg). Not a single patient with a serum iPTH > 650 ng/l had a positive staining (> 0%) even when the bone aluminium level was elevated (> 15 micrograms/g wet weight). In the detection of patients at risk for aluminium toxicity delta sA1 thresholds of 50 micrograms/l (5 mg/kg) and 70 micrograms/l (10 mg/kg) in combination with a serum iPTH < 650 ng/l had a sensitivity of 92% and specificity of 86% and 84% respectively. In the clinical setting of aluminium overload, threshold delta sA1 levels of 50 micrograms/l (5 mg/kg) and 70 micrograms/l (10 mg/kg) had a sensitivity of 91% and a specificity of 95% and 90% respectively. CONCLUSIONS The low-dose DFO test is a reliable test for the detection of aluminium overload; however, it is not specific enough to differentiate between ARBD, increased risk of aluminium toxicity, and aluminium overload unless it is used in combination with a serum iPTH measurement. In conjunction with a serum iPTH measurement it is an important tool in the differential diagnosis and may avoid the necessity of a bone biopsy in the majority of patients. Data obtained in the present study have allowed us to update the strategies for monitoring, diagnosis and patient follow-up proposed at the Consensus Conference on Diagnosis and Treatment of Aluminium Overload in End-Stage Renal Failure; Paris, 1992.
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Affiliation(s)
- P C D'Haese
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
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33
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Van Hoof VO, Martin M, Blockx P, Prove A, Van Oosterom A, Couttenye MM, De Broe ME, Lepoutre LG. Immunoradiometric method and electrophoretic system compared for quantifying bone alkaline phosphatase in serum. Clin Chem 1995. [DOI: 10.1093/clinchem/41.6.853] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Agarose electrophoresis (Isopal, Beckman) and an immunoradiometric assay (IRMA) involving specific monoclonal antibodies (Ostase, Hybritech), two methods for the quantification of serum bone alkaline phosphatase (ALP, EC 3.1.3.1), a marker of osteoblastic activity, were compared in 293 patients: 79 with end-stage renal failure treated with hemodialysis and 214 with malignant disease. Overall correlation between the two methods was good (r = 0.92), except (a) for low values of bone ALP and (b) in some samples with high total liver ALP activity--both due to considerable cross-reactivity of the anti-bone ALP antibodies of the Ostase kit with liver ALP. This interference was not constant and was not evenly distributed across all concentrations of bone ALP. Low bone ALP determined with the IRMA (< or = 5 micrograms/L) was confirmed by electrophoresis (< or = 21 U/L), but bone ALP activity determined by electrophoresis to be low (< or = 21 U/L) was not correlated with the IRMA results. After standardizing our results by computing z-values for bone ALP, delta z (= zOstase - zIsopal) was significantly correlated with liver ALP activity (r = 0.73, P < 0.0001). We conclude that the IRMA for quantifying bone ALP is acceptable as a screening method. However, when high values for bone ALP are found with the Ostase method, confirmation by electrophoresis remains mandatory to rule out cross-reactivity with high amounts of liver ALP. For detecting low bone ALP activities, electrophoresis remains the method of choice.
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Affiliation(s)
- V O Van Hoof
- Department of Clinical Chemistry, University Hospital Antwerp, Edegem, Belgium
| | - M Martin
- Department of Clinical Chemistry, University Hospital Antwerp, Edegem, Belgium
| | - P Blockx
- Department of Clinical Chemistry, University Hospital Antwerp, Edegem, Belgium
| | - A Prove
- Department of Clinical Chemistry, University Hospital Antwerp, Edegem, Belgium
| | - A Van Oosterom
- Department of Clinical Chemistry, University Hospital Antwerp, Edegem, Belgium
| | - M M Couttenye
- Department of Clinical Chemistry, University Hospital Antwerp, Edegem, Belgium
| | - M E De Broe
- Department of Clinical Chemistry, University Hospital Antwerp, Edegem, Belgium
| | - L G Lepoutre
- Department of Clinical Chemistry, University Hospital Antwerp, Edegem, Belgium
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34
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Van Hoof VO, Martin M, Blockx P, Prove A, Van Oosterom A, Couttenye MM, De Broe ME, Lepoutre LG. Immunoradiometric method and electrophoretic system compared for quantifying bone alkaline phosphatase in serum. Clin Chem 1995; 41:853-7. [PMID: 7768003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Agarose electrophoresis (Isopal, Beckman) and an immunoradiometric assay (IRMA) involving specific monoclonal antibodies (Ostase, Hybritech), two methods for the quantification of serum bone alkaline phosphatase (ALP, EC 3.1.3.1), a marker of osteoblastic activity, were compared in 293 patients: 79 with end-stage renal failure treated with hemodialysis and 214 with malignant disease. Overall correlation between the two methods was good (r = 0.92), except (a) for low values of bone ALP and (b) in some samples with high total liver ALP activity--both due to considerable cross-reactivity of the anti-bone ALP antibodies of the Ostase kit with liver ALP. This interference was not constant and was not evenly distributed across all concentrations of bone ALP. Low bone ALP determined with the IRMA (< or = 5 micrograms/L) was confirmed by electrophoresis (< or = 21 U/L), but bone ALP activity determined by electrophoresis to be low (< or = 21 U/L) was not correlated with the IRMA results. After standardizing our results by computing z-values for bone ALP, delta z (= zOstase - zIsopal) was significantly correlated with liver ALP activity (r = 0.73, P < 0.0001). We conclude that the IRMA for quantifying bone ALP is acceptable as a screening method. However, when high values for bone ALP are found with the Ostase method, confirmation by electrophoresis remains mandatory to rule out cross-reactivity with high amounts of liver ALP. For detecting low bone ALP activities, electrophoresis remains the method of choice.
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Affiliation(s)
- V O Van Hoof
- Department of Clinical Chemistry, University Hospital Antwerp, Edegem, Belgium
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35
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Abstract
In renal transplant patients hepatitis B infection is associated with a higher morbidity and mortality. Therefore, we investigated the immunogenicity of an enhanced vaccination scheme with a recombinant DNA hepatitis B vaccine in renal allograft recipients. Injections of 40 micrograms were given at months 0, 1, 2 and 6. Conversion rate (anti-HBS antibody titre > 10 mIU ml-1) was only 36%. On the other hand, in patients vaccinated before transplantation, a booster injection of 40 micrograms was highly successful, resulting in a rise of antibody titre > 10 mIU ml-1 in 86%. In view of the poor vaccination results after transplantation, we strongly recommend hepatitis B vaccination prior to transplantation.
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Affiliation(s)
- A F Lefebure
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
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36
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De Broe ME, D'Haese PC, Couttenye MM, Van Landeghem GF, Lamberts LV. New insights and strategies in the diagnosis and treatment of aluminium overload in dialysis patients. Nephrol Dial Transplant 1993; 8 Suppl 1:47-50. [PMID: 8389021 DOI: 10.1093/ndt/8.supp1.47] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- M E De Broe
- Department of Nephrology-Hypertension, University of Antwerp, Belgium
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VanMaele RG, De Bock L, Van Schil PE, Ysebaert DK, Willocx PM, Couttenye MM, Vereycken HA, De Leersnijder DG. Limited acute dissections of the abdominal aorta. Report of five cases. J Cardiovasc Surg (Torino) 1992; 33:298-304. [PMID: 1601911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Within a two year period, the diagnosis of acute dissection of a segment of the abdominal aorta was made in five cases without aneurysmal dilation or leakage and with virtually no ischaemia. All patients presented with an atypical painful abdominal syndrome and the diagnosis was made by computed tomography. Only one patient, suffering persistent pain was treated by resection and graft interposition of the infrarenal aorta. All the others were treated conservatively and kept under close follow-up. Two of them died from intercurrent disease. The remaining three patients are doing well after 30 and 42 months conservative treatment and 43 months after surgery respectively. A non-complicated dissection of the abdominal aorta must be considered in the differential diagnosis of atypical painful abdominal syndromes. In cases of persistent pain, progression, ischaemia, aneurysmal dilatation or leakage, surgical treatment is mandatory. In uncomplicated cases conservative treatment is recommended, similar to the principles of management for dissections of the descending thoracic aorta.
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Affiliation(s)
- R G VanMaele
- Department of Surgery, Antwerp University Hospital and Medical School, Belgium
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39
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Zachée P, Staal GE, Rijksen G, De Bock R, Couttenye MM, De Broe ME. Pyruvate kinase deficiency and delayed clinical response to recombinant human erythropoietin treatment. Lancet 1989; 1:1327-8. [PMID: 2566852 DOI: 10.1016/s0140-6736(89)92718-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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40
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de Clerck LS, Couttenye MM, de Broe ME, Stevens WJ. Acquired immunodeficiency syndrome mimicking Sjögren's syndrome and systemic lupus erythematosus. Arthritis Rheum 1988; 31:272-5. [PMID: 3348828 DOI: 10.1002/art.1780310216] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We describe a patient in whom the diagnosis of transfusion-associated acquired immunodeficiency syndrome (AIDS) was delayed because her clinical symptoms were similar to those of systemic lupus erythematosus and Sjögren's syndrome and because of a false-negative result on a Western blot test for human immunodeficiency virus. The importance of using different diagnostic tests for AIDS and the pitfalls in diagnosing AIDS in patients who appear to have connective tissue disease are discussed.
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Affiliation(s)
- L S de Clerck
- Department of Immunology, University Hospital Antwerp, Belgium
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41
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Abstract
Acute renal failure occurred in a patient with a carcinoid syndrome whenever he developed a flushing episode. Renal biopsy performed during one of these oliguric episodes did not reveal any lesions which could explain this reversible form of renal insufficiency. Urinary indices were not conclusive. Alteration of intrarenal hemodynamics by vasoactive compounds is proposed to be the causative mechanism of this relapsing acute oliguric renal failure.
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Affiliation(s)
- M M Couttenye
- Department of Nephrology-Hypertension, University Hospital Antwerp, Edegem, Belgium
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42
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Couttenye MM, De Clerck NM, Herman AG, Brutsaert DL. Effects of prostacyclin on the contractile performance of cardiac muscle. Arch Int Pharmacodyn Ther 1982; 256:161-2. [PMID: 7046668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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43
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Abstract
The properties of relaxation, particular the sensitivity of relaxation to load, were analyzed in isolated intact atrial muscle and in manually dissected, detergent-treated cellular preparations from cat, dog, and rat atria. Force and length traces under increasing afterloads and following load clamps were obtained using an electromagnetic lever-force transducer system for the intact muscles and a capacitance transducer system for the cellular preparations. In both types of preparations, the time course of relaxation was hardly affected by the load or by alterations in load (load clamps), unlike intact mammalian ventricular muscle. This load independence of relaxation, which was hardly influenced by variations of initial muscle length, resembled relaxation in intact frog ventricular muscle and in detergent-treated mammalian ventricular single cells. As relaxation of these ventricular preparations with poorly developed (frog) or absent (detergent-treated single cells) calcium-sequestering systems was shown to be governed by the dissipation of activation, these results suggest a similar control mechanism for relaxation in mammalian atrial muscle. Furthermore, load independence of relaxation of mammalian atrial muscle in late diastole may promote optimal filling of the ventricle.
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