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1. B-Type Natriuretic Peptide in the Critically Ill with Acute Kidney Injury

Author

Massimo de Cal, Mikko Haapio, Dinna N. Cruz, Paolo Lentini, Andrew A. House, Ilona Bobek, Grazia M. Virzì, Valentina Corradi, Flavio Basso, Pasquale Piccinni, Angela D'Angelo, Jamie W. Chang, Mitchell H. Rosner, and Claudio Ronco

Subjects
Diseases of the genitourinary system. Urology, RC870-923
Abstract

Introduction. Acute kidney injury (AKI) is common in the intensive care unit (ICU) and associated with poor outcome. Plasma B-type natriuretic peptide (BNP) is a biomarker related to myocardial overload, and is elevated in some ICU patients. There is a high prevalence of both cardiac and renal dysfunction in ICU patients. Aims. To investigate whether plasma BNP levels in the first 48 hours were associated with AKI in ICU patients. Methods. We studied a cohort of 34 consecutive ICU patients. Primary outcome was presence of AKI on presentation, or during ICU stay. Results. For patients with AKI on presentation, BNP was statistically higher at 24 and 48 hours than No-AKI patients (865 versus 148 pg/mL; 1380 versus 131 pg/mL). For patients developing AKI during 48 hours, BNP was statistically higher at 0, 24 and 48 hours than No-AKI patients (510 versus 197 pg/mL; 552 versus 124 pg/mL; 949 versus 104 pg/mL). Conclusion. Critically ill patients with AKI on presentation or during ICU stay have higher levels of the cardiac biomarker BNP relative to No-AKI patients. Elevated levels of plasma BNP may help identify patients with elevated risk of AKI in the ICU setting. The mechanism for this cardiorenal connection requires further investigation.

Published
2011
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2. 16th International Conference on Dialysis. Advances in Chronic Kidney Disease 2014. January 22-25, 2014, Caesars Palace, Las Vegas, Nev.: Abstracts

Author

Jeroen P. Kooman, Giovanni Tripepi, Albert Power, Ralf Schindler, Margaret Nevin, Aileen Grassmann, Michael Etter, Adam Tashman, Ewa Żukowska-Szczechowska, Chi-Hung Cheng, Yuedong Wang, Mathias Schaller, Marianna Bellantoni, Giovannella Baggio, Claudia Barth, Annalisa Salari, Yosef S. Haviv, Flavio Basso, Neill Duncan, Marina Loucaidou, Judy Weintraub, Giancarlo Bombonato, Grazia Maria Virzì, Len A. Usvyat, Magdalena Mokrejsova, Adrian Guinsburg, Shang-Feng Tsai, Cristina Marelli, Ya-Wen Chuang, Stephan Thijssen, Olaf Boenisch, Alessandra Brendolan, Lina Minazzato, Simon Beagle, Claire Edwards, Michiel G. H. Betjes, Umberto Cillo, Piero Amodio, Druck Reinhardt Druck Basel, Franklin W. Maddux, Frank M. van der Sande, Peter Kotanko, Kuo-Hsiung Shu, Giacomo Zanus, Ted Toffelmire, Nicolle H.R. Litjens, Ruud W. J. Meijers, Mary Carter, Seema K Singh, Dinna N. Cruz, Anna Clementi, Sonya Day, Werner Beck, Tung-Min Yu, Eva Pazourkova, Reinhold Deppisch, Sami Schiff, Runolfur Palsson, Inga Bayh, Vladimir Tesar, Ying-Chih Lo, Daniele Neri, Richard Corbett, Anna Giuliani, Sampson Antwi, Olafur Skuli Indridason, Allen R. Nissenson, Claudia Torino, Carmine Zoccali, Alessandra Brocca, Shih-Ting Huang, Vincenzo Cantaluppi, Massimo de Cal, Ales Horinek, Daniele Marcelli, Sachin S Soni, Peter Choi, Satz Mengensatzproduktion, Laura Scatizzi, Pasquale Piccinni, Francesca Mallamaci, Antonio Granata, Marie Korabecna, Ming-Ju Wu, F. Klefisch, Olof Viktorsdottir, Damien Ashby, Daniel Zickler, Cheng-Hsu Chen, Giovanna Berdin, Giorgio Vescovo, Grzegorz Wystrychowski, Gero von Gersdorff, Claudio Ronco, Giacomo Mason, C. Kneis, Caroline Williams, Marzena Wjewodzka, Stephen McMurray, Tonino Bianco, Terry Ketchersid, Rocco Tripepi, Nathan W. Levin, John Callegari, and Charles D. Pusey

Subjects
Gerontology, medicine.medical_specialty, Las vegas, business.industry, General surgery, medicine.medical_treatment, Hematology, General Medicine, medicine.disease, Nephrology, medicine, business, Dialysis, Kidney disease
Published
2013
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3. Fluid Management in the Intensive Care Unit: Bioelectrical Impedance Vector Analysis as a Tool to Assess Hydration Status and Optimal Fluid Balance in Critically Ill Patients

Author

Sonya Day, Anna Giuliani, Flavio Basso, Pasquale Piccinni, Dinna N. Cruz, Giovanna Berdin, Grazia Maria Virzì, Marzena Wjewodzka, Alessandra Brendolan, Claudio Ronco, and Giacomo Mason

Subjects
Male, medicine.medical_specialty, Critical Care, Critical Illness, Fluid management, law.invention, law, Intensive care, Electric Impedance, medicine, Humans, Prospective Studies, Risk factor, Intensive care medicine, Aged, Hydration status, Balance (ability), Aged, 80 and over, Critically ill, business.industry, Hematology, General Medicine, Middle Aged, Water-Electrolyte Balance, Intensive care unit, body regions, Intensive Care Units, Treatment Outcome, Nephrology, Fluid Therapy, Female, business, Bioelectrical impedance analysis
Abstract

Background: Fluid balance disorders are a relevant risk factor for morbidity and mortality in critically ill patients. Volume assessment in the intensive care unit (ICU) is thus of great importance, but there are currently few methods to obtain an accurate and timely assessment of hydration status. Our aim was to evaluate the hydration status of ICU patients via bioelectric impedance vector analysis (BIVA) and to investigate the relationship between hydration and mortality. Methods: We evaluated 280 BIVA measurements of 64 patients performed daily in the 5 days following their ICU admission. The observation period ranged from a minimum of 72 h up to a maximum of 120 h. We observed the evolution of the hydration status during the ICU stay in this population, and analyzed the relationship between mean and maximum hydration reached and mortality - both in the ICU and at 60 days - using logistic regression. Results: A state of overhydration was observed in the majority of patients (70%) on admission, which persisted during the ICU stay. Patients who required continuous renal replacement therapy (CRRT) were more likely to be overhydrated starting from the 2nd day of observation. Logistic regression showed a strong and significant correlation between mean/maximum hydration reached and mortality, both independently and correcting for severity of prognosis. Conclusions: Fluid overload measured by BIVA is a frequent condition in critically ill patients - whether or not they undergo CRRT - and a significant predictor of mortality. Hence, hydration status should be considered as an additional prognosticator in the clinical management of the critically ill patient. Key Messages: (i) On the day of ICU admittance, patients showed a marked tendency to overhydration (>70% of total). This tendency was more pronounced in patients on CRRT. (ii) Hyperhydration persisted during the ICU stay. Patients who underwent CRRT showed significantly higher hyperhydration from the 2nd day of hospitalization. (iii) Nonsurvivors showed worse hyperhydration patterns in comparison to survivors in logistic univariate analysis (p < 0.05). This relationship between hydration and mortality is confirmed even when controlling for the effect of a worse prognosis approximated by any of three ICU scoring systems (APACHE II, SAPS II and SOFA). Mean and maximum hydration levels present a stronger correlation with mortality than with mean and maximum cumulative fluid balance reached during the observation period.

Published
2013
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4. Contents Vol. 36, 2013

Author

Jeroen P. Kooman, Daniel Zickler, Sachin S Soni, Olaf Boenisch, Yosef S. Haviv, Simon Beagle, Werner Beck, Michael Etter, Runolfur Palsson, Kuo-Hsiung Shu, Annalisa Salari, Dinna N. Cruz, Claudia Barth, Vincenzo Cantaluppi, Giovanni Tripepi, Laura Scatizzi, Marie Korabecna, Tonino Bianco, Giancarlo Bombonato, Grazia Maria Virzì, Len A. Usvyat, Charles D. Pusey, Satz Mengensatzproduktion, Ying-Chih Lo, Shang-Feng Tsai, Shih-Ting Huang, Neill Duncan, Caroline Williams, Stephan Thijssen, Damien Ashby, Cheng-Hsu Chen, Grzegorz Wystrychowski, Cristina Marelli, Chi-Hung Cheng, Giorgio Vescovo, Olafur S. Indridason, Flavio Basso, Giacomo Zanus, Yuedong Wang, Judy Weintraub, Eva Pazourkova, Ales Horinek, Marzena Wjewodzka, Nathan W. Levin, Adrian Guinsburg, Ewa Żukowska-Szczechowska, Magdalena Mokrejsova, Claudia Torino, Frank M. van der Sande, Marianna Bellantoni, Massimo de Cal, Nicolle H.R. Litjens, Vladimir Tesar, Peter Choi, Francesca Mallamaci, Claire Edwards, Mathias Schaller, Daniele Marcelli, Terry Ketchersid, Antonio Granata, Pasquale Piccinni, Marina Loucaidou, Claudio Ronco, Ming-Ju Wu, Lina Minazzato, F. Klefisch, Ya-Wen Chuang, Mary Carter, Giacomo Mason, Druck Reinhardt Druck Basel, Alessandra Brocca, Ralf Schindler, Margaret Nevin, Piero Amodio, Rocco Tripepi, Franklin W. Maddux, Inga Bayh, Ted Toffelmire, Sampson Antwi, Sonya Day, Giovanna Berdin, Ruud W. J. Meijers, Stephen McMurray, John Callegari, Sami Schiff, Gero von Gersdorff, Michiel G. H. Betjes, Allen R. Nissenson, Reinhold Deppisch, Olof Viktorsdottir, Alessandra Brendolan, Anna Clementi, C. Kneis, Umberto Cillo, Daniele Neri, Seema K Singh, Tung-Min Yu, Anna Giuliani, Carmine Zoccali, Peter Kotanko, Aileen Grassmann, Richard Corbett, Albert Power, Adam Tashman, and Giovannella Baggio

Subjects
Nephrology, Hematology, General Medicine
Published
2013
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5. Sonographic findings in the diagnosis of HIV-associated tuberculosis: image quality and inter-observer agreement in FASH vs. remote-FASH ultrasound

Author

Flavio Basso, Martin P. Grobusch, Enrico Brunetti, Saskia Janssen, Tom Heller, Maria Teresa Giordani, Graduate School, Amsterdam institute for Infection and Immunity, Amsterdam Public Health, and Infectious diseases

Subjects
Adult, Male, medicine.medical_specialty, Tuberculosis, Image quality, Inter observer agreement, MEDLINE, Human immunodeficiency virus (HIV), Health Informatics, medicine.disease_cause, Sensitivity and Specificity, Young Adult, medicine, Humans, Young adult, Aged, Ultrasonography, Observer Variation, AIDS-Related Opportunistic Infections, business.industry, Ultrasound, Middle Aged, medicine.disease, Telemedicine, Videoconferencing, Female, Radiology, business
Published
2013
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6. Comparison and reproducibility of techniques for fluid status assessment in chronic hemodialysis patients

Author

Federico Nalesso, Flavio Basso, Claudio Ronco, Alessandra Brendolan, Catarina Teixeira, Sabrina Milan Manani, Dinna N. Cruz, and Monica Zanella

Subjects
Bioelectrical impedance analysis, Hemodialysis patients, medicine.medical_specialty, Pathology, medicine.drug_class, Urology, B-type natriuretic peptide, Fluid assessment, Inferior vena cava diameter, Ultrasound lung comets, Cardiology and Cardiovascular Medicine, Inferior vena cava, Internal medicine, medicine, Natriuretic peptide, Chronic hemodialysis, Expiration, Original Paper, Reproducibility, business.industry, Ultrasound, Status assessment, medicine.vein, Cardiology, business
Abstract

Background: Several methods have been developed to assess the hydration status in chronic hemodialysis (HD) patients. The aim of this study was to compare body bioimpedance spectroscopy (BIS) with ultrasound (US) lung comet score (ULCs), B-type natriuretic peptide (BNP) and inferior vena cava diameter (IVCD) by US for the estimation of dry weight before and after HD and to analyze all methods in terms of fluid status variations induced by HD. An additional aim of this study was to establish the interoperator reproducibility of these methods. Methods: Two nephrologists evaluated BIS, ULCs, IVCD during inspiration (min) and expiration (max), the inferior vena cava collapsibility index (IVCCI) as well as BNP before and after HD in 30 patients. The same operators measured BIS, ULCs and IVCD in 28 HD patients in a blinded fashion. Results: There was a significant reduction in BIS, ULCs, IVCD and BNP after HD (p < 0.001), but a less significant reduction in IVCCI (p = 0.13). There was a significant correlation between BIS and ULCs, BNP and indexed IVCD (IVCDi)min (p < 0.05) before and after HD, and between BIS and IVCDimax only before HD. Conclusion: All methods were able to describe hyperhydration before and after HD, except for IVCCI after HD. All techniques correlated with BIS before HD. After HD, ULCs correlated better with BIS than IVCD in terms of evaluation of fluid status. It could be expected that the ULCs can give a real-time evaluation of interstitial water. The reproducibility of the measurement of BIS, IVCD and ULCs between the two operators was high.

Published
2013

8. Antioxidant dialytic approach with vitamin E-coated membranes

Author

Anthi, Panagiotou, Federico, Nalesso, Monica, Zanella, Alessandra, Brendolan, Massimo, de Cal, Dinna, Cruz, Flavio, Basso, Matteo, Floris, Anna, Clementi, and Claudio, Ronco

Subjects
Oxidative Stress, Renal Dialysis, Humans, Vitamin E, Membranes, Artificial, Antioxidants
Abstract

Oxidative stress is prevalent in dialysis patients and has been implicated in the pathogenesis of anemia and cardiovascular disease. Vitamin E-coated membranes are low-flux dialyzers consisting of a multilayer membrane with liposoluble vitamin E on the blood surface allowing direct contact with free oxygen radicals to be scavenged on the membrane site. The antioxidant properties of these membranes have an important clinical benefit because of reducing oxygen stress and inflammation may contribute to an improvement of hemoglobin levels, lower recombinant human erythropoietin dose and better anemia management, and at the same time may have a favorable impact on cardiovascular complications.

Published
2011

9. Body Composition and Heart Rate Variability to Achieve Dry Weight and Tolerance

Author

C. Ronco, Manuela Ferrario, Alessandra Brendolan, Flavio Basso, D. Cruz, Francesco Garzotto, Ciro Tetta, Matteo Floris, Federico Nalesso, Ulrich Moissl, Monica Zanella, Maria G. Signorini, S. Cerrutti, and Anna Clementi

Subjects
medicine.medical_specialty, Poor prognosis, business.industry, medicine.medical_treatment, Autonomic nervous system, Blood pressure, Internal medicine, Cardiology, medicine, Heart rate variability, In patient, Hemodialysis, Stage (cooking), business, Hydration status
Abstract

Autonomic dysfunction in patients with end- stage renal disease is associated with poor prognosis. Heart rate variability (HRV), determined by the standard deviation of the normal R- R interval, has been reported to be a useful evaluation of cardiac autonomic modulation. The relationship between HRV and hydration status (HS) can be analyzed by whole body bioimpedance spectroscopy. This allows a classification of patients according the combination of HS with predialysis systolic blood pressure. Differences in HRV can be studied in patients with high over hydration, but normal or low blood pressure, with respect to fluid-overloaded/hypertensive patients and normohydrated/normotensive patients. In conclusion, the assessment of the autonomic nervous system response to the hemodialysis treatment in end- stage renal disease patients, classified according to a reliable and quantitative measurement of their fluid overload, could permit better management of both arterial blood pressure and HS.

Published
2011
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10. Antioxidant Dialytic Approach with Vitamin E-Coated Membranes

Author

Flavio Basso, Anthi Panagiotou, Claudio Ronco, Federico Nalesso, Monica Zanella, Alessandra Brendolan, Matteo Floris, Massimo de Cal, Anna Clementi, and Dinna N. Cruz

Subjects
Vitamin, medicine.medical_specialty, Antioxidant, business.industry, Anemia, medicine.medical_treatment, Vitamin E, Inflammation, medicine.disease_cause, medicine.disease, chemistry.chemical_compound, Membrane, Endocrinology, chemistry, Erythropoietin, Internal medicine, medicine, medicine.symptom, business, Oxidative stress, medicine.drug
Abstract

Oxidative stress is prevalent in dialysis patients and has been implicated in the pathogenesis of anemia and cardiovascular disease. Vitamin E-coated membranes are low-flux dialyzers consisting of a multilayer membrane with liposoluble vitamin E on the blood surface allowing direct contact with free oxygen radicals to be scavenged on the membrane site. The antioxidant properties of these membranes have an important clinical benefit because of reducing oxygen stress and inflammation may contribute to an improvement of hemoglobin levels, lower recombinant human erythropoietin dose and better anemia management, and at the same time may have a favorable impact on cardiovascular complications.

Published
2011
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11. International Survey on the Management of Acute Kidney Injury in Critically Ill Patients: Year 2007

Author

Zaccaria Ricci, Flavio Basso, Claudio Ronco, and Dinna N. Cruz

Subjects
Nephrology, medicine.medical_specialty, Critical Illness, medicine.medical_treatment, urologic and male genital diseases, Peritoneal dialysis, Internal medicine, medicine, Humans, Rifle, Renal replacement therapy, Intensive care medicine, Dialysis, Mechanical ventilation, business.industry, Acute kidney injury, Hematology, General Medicine, Acute Kidney Injury, medicine.disease, female genital diseases and pregnancy complications, Renal Replacement Therapy, Creatinine, Emergency medicine, Hemodialysis, business
Abstract

Introduction: Several aspects of acute kidney injury (AKI) management, including medical approaches to AKI patients and the optimal form of renal replacement therapy (RRT), remain a matter of debate. Subjects and Methods: The responses of 440 participants to a questionnaire on several points of AKI management, submitted during the 4th International Course on Critical Care Nephrology in June 2007, were analyzed. Results: The most common answer to the definition of AKI was the use of the RIFLE criteria (55%), followed by the presence of oligoanuria (24%). Responders seemed to preferentially start dialysis within a creatinine range from 2.3–3.4 mg/dl (28%) to 3.4–4.5 mg/dl (26%) and with a urine output level of 150–200 ml/12 h (43%). About 30% of responders showed that they would prescribe dialysis only in case of severe fluid overload (requiring mechanical ventilation and/or causing impaired skin integrity). Continuous RRT is used by most specialists (86%), followed by intermittent hemodialysis (65%), sustained low-efficiency dialysis (28%) and peritoneal dialysis (30%). The preferred RRT dosage was ‘35 ml/kg/h’ (46%) but 37% of responders did not explicitly answer this critical question. Bleeding, hypotension, filter clotting, vascular access and sepsis treatment were the most frequent complications and concerns of RRT. Conclusions: New classifications such as the RIFLE criteria did improve the well-known uncertainty about the definition of AKI. Awareness of the prescription and standardization of an adequate treatment dose seemed to have increased in recent years, even if there is still a significant level of uncertainty on this specific issue. Several concerns and RRT complications, such as bleeding and anticoagulation strategies, still need further exploration and development.

Published
2010

12. Oxidative stress and 'monocyte reprogramming' after kidney transplant: A longitudinal study

Author

Paolo Lentini, Sandra Silva, Valentina Corradi, Federico Nalesso, Claudio Ronco, D. Dissegna, Volker Goepel, Flavio Basso, Massimo de Cal, Stefano Chiaramonte, and Dinna N. Cruz

Subjects
Adult, Male, medicine.medical_specialty, Longitudinal study, Inflammation, Kidney, Kidney Function Tests, urologic and male genital diseases, medicine.disease_cause, Kidney transplant, Monocytes, Tacrolimus, Internal medicine, medicine, Humans, Longitudinal Studies, Prospective Studies, Renal Insufficiency, Immunosuppression Therapy, business.industry, Monocyte, HLA-DR Antigens, Hematology, General Medicine, Middle Aged, Mycophenolic Acid, medicine.disease, Kidney Transplantation, female genital diseases and pregnancy complications, Uremia, Oxidative Stress, Endocrinology, medicine.anatomical_structure, Nephrology, Immunology, Cyclosporine, Female, medicine.symptom, business, Reprogramming, Immunosuppressive Agents, Oxidative stress, Kidney disease
Abstract

Uremia has been implicated in increased oxidative stress (OS) and decreased monocyte HLA-DR expression in chronic kidney disease (CKD) patients. Thus, one would expect normalization of these parameters after successful kidney transplant (KTx). Our aim was to describe patterns of OS and HLA-DR expression after KTx and to explore the effect of renal function and different immunosuppression regimens. 30 KTx patients (20 male; 48 ± 11 years) were enrolled and compared with 20 healthy controls. We measured advanced oxidation protein products (AOPP) and the percentage of monocytes expressing HLA-DR (%DR+) before (preKTx) and after KTx (on days 2, 30, 90, 180 and after 1 year). Compared to controls, patients had a higher preKTx AOPP (152.6 vs. 69.3 µmol/l; p < 0.001). AOPP decreased at 48 h after KTx, achieving values similar to controls. Thereafter, it increased again and remained significantly higher compared to controls, returning to preKTx levels at 90 days. Prior to KTx there was a trend for lower %DR+ in KTx patients compared to controls (96 vs. 98%; NS). Following KTx, patients had a lower %DR+ in the 1st month; then it gradually returned to preKTx levels during the 1st year; at no time did it reach a value similar to controls. Cyclosporine (CyA)-treated patients had a significantly higher AOPP (161.5 vs. 99.5 µmol/l; p = 0.03) and a lower %DR+ (91.7 vs. 96.4; p < 0.05) at 30 days than patients on tacrolimus (FK). Patients on mycophenolate mofetil (MMF) showed a low AOPP (106.9 vs. 168.1 µmol/l; p = 0.05) and a high %DR+ (96.7 vs. 88.2%; p = 0.001) than those on everolimus. After 3 months, CyA-treated patients had a non-significant increase in AOPP levels, whereas those on FK showed a decrease (p < 0.05) as did those treated with MMF (p < 0.05). Successful KTx reduced but did not normalize AOPP, suggesting ongoing OS, perhaps due to persistent mild renal dysfunction and the effects of immunosuppression. HLA-DR expression remained low after KTx, which may be a possible contributing factor to infectious complications after transplantation. Immunosuppressive agents appear to have diverse effects on OS and HLA-DR expression.

Published
2008

13. Acknowledgement to the Reviewers

Author

Inga Bayh, Sampson Antwi, Reinhold Deppisch, Alessandra Brocca, Daniele Neri, Judy Weintraub, Damien Ashby, Giovanna Berdin, Yosef S. Haviv, Runolfur Palsson, Cheng-Hsu Chen, Neill Duncan, Gero von Gersdorff, Aileen Grassmann, Cristina Marelli, Terry Ketchersid, Caroline Williams, Vladimir Tesar, Daniele Marcelli, Lina Minazzato, Nathan W. Levin, Claudia Barth, Ewa Żukowska-Szczechowska, Piero Amodio, Anna Giuliani, Satz Mengensatzproduktion, C. Kneis, Flavio Basso, Adrian Guinsburg, Marzena Wjewodzka, Frank M. van der Sande, Ying-Chih Lo, Shang-Feng Tsai, Anna Clementi, Nicolle H.R. Litjens, Shih-Ting Huang, Seema K Singh, John Callegari, Grzegorz Wystrychowski, Claire Edwards, Alessandra Brendolan, Stephan Thijssen, Ruud W. J. Meijers, Rocco Tripepi, Tung-Min Yu, Michael Etter, Umberto Cillo, Ales Horinek, Carmine Zoccali, Stephen McMurray, Simon Beagle, Tonino Bianco, Daniel Zickler, Richard Corbett, Claudia Torino, Massimo de Cal, Charles D. Pusey, Chi-Hung Cheng, Yuedong Wang, Olafur S. Indridason, Mathias Schaller, Werner Beck, Druck Reinhardt Druck Basel, Kuo-Hsiung Shu, Albert Power, Pasquale Piccinni, Mary Carter, Michiel G. H. Betjes, Olof Viktorsdottir, Peter Choi, Claudio Ronco, Giacomo Mason, Vincenzo Cantaluppi, Giovanni Tripepi, Francesca Mallamaci, Ya-Wen Chuang, Ming-Ju Wu, Laura Scatizzi, Eva Pazourkova, Peter Kotanko, F. Klefisch, Sonya Day, Magdalena Mokrejsova, Sami Schiff, Allen R. Nissenson, Marianna Bellantoni, Antonio Granata, Olaf Boenisch, Marina Loucaidou, Sachin S Soni, Dinna N. Cruz, Giorgio Vescovo, Giacomo Zanus, Annalisa Salari, Giancarlo Bombonato, Grazia Maria Virzì, Len A. Usvyat, Jeroen P. Kooman, Marie Korabecna, Ralf Schindler, Margaret Nevin, Franklin W. Maddux, Ted Toffelmire, Adam Tashman, and Giovannella Baggio

Subjects
Medical education, medicine.medical_specialty, Nephrology, business.industry, Acknowledgement, Immunology, Alternative medicine, medicine, Hematology, General Medicine, business
Published
2013
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14. Cardiovascular complications - 3

Author

Carolyn van Eps, Simon J. Davies, Ercan Ok, Gillian McNaught, Mireille Griuncelli, Brian Haluska, Sima Abedi Azar, M.G. Signorini, Mehmet Ozkahya, Ioan Mihai Patiu, Abbes Benmaadi, Paul E. Barre, Christelle Loridon, agri Agirgün, Sendogan Aker, Kultigin Turkmen, Jose M. Valdivielso, Numan Gorgulu, Bhupinder Virk, Erik Serné, Zhaohui Ni, Muhammad Shahed Ahmed, Demetra Bacharaki, Helen Jefferies, Siu-Fai Lui, Christopher W. McIntyre, Qin Wang, Crina Rusu, Devrim Bozkurt, Xuemei Li, Brigitte Schiller, Mehmet Haberal, Hong Xu, Eric Illouz, Robert J. Unwin, Grigore Dogaru, Christos Bantis, Kitae Bang, Silvio Henrique Barberato, Eva Castañer, Meral Kayıkçıoğlu, Yasemin Erten, Angela Yee-Moon Wang, Kateri Champagne, Zac Varghese, Maani Hakimi, M.-Pau Valenzuela, Tiziano Lusenti, Iris H.S. Chan, Emily P. McQuarrie, Cian Chan, Serkan Saygi, Hamad Dheir, Xiong Ruan, Yvo Smulders, Muriel P.C. Grooteman, Peter Kotanko, Christina Lam, Sara Panizo, Katrin Ivens, Bogdan Ghigolea, M Espinoza, Abdul Rashid Qureshi, Grant Heatlie, David C. Wheeler, Marta Palomo, Musa Bali, Qiangwen Pan, Mei Wang, Lucia del Vecchio, Monica Zanella, Hari Nair, Aleix Cases, Leanne Jeffries, Huseyin Toz, Biju John, Pinar Ozen, Philip Harvey, Thomas Marwick, Diana Moldovan, Sonia Cillero, Simona Stancu, Menso J. Nubé, Heike Ziebart, Xiaohong Fan, Peter Stenvinkel, Flavio Basso, Jonas Axelsson, Lorelei Betancourt, Ezio degli Esposti, Jianling Tao, Ana Dambiski, A. Salim, Abdullah Ozkok, Janine Jeffries, Carmel M. Hawley, Attilio Losito, Peter Heering, Navdeep Tangri, Mümtaz Yilmaz, lver Derici, Stephan Thijssen, David W. Johnson, Liou Cao, Aluisio Barbosa Carvalho, Johann Nicholas, Petya Valcheva, Maria Aparecida da Glória, Abdulkadir Unsal, Tsu-Wang Shen, Andréa E.M. Stinghen, R. John Kimoff, James O. Burton, Juan F. Navarro, Henry J. Dargie, Tracey Steedman, Sofia Kalogeropoulou, Francisco Valdes, Yan Zhang, Kadriye Altiok Reis, Ülkem Yakupoglu, Helio V. Cassi, Gines Escolar, Dittmar Böckler, Ashley Holt, Luciana Piekala, Fernando González, Ebru Sevinc, Sunna Snaedal, Massimo de Cal, Spiros Katsoudas, Yu-Hsien Lai, Gulay Asci, Yu Ting Tan, Anette Melk, Xavier Gallardo, Isabel Rodriguez, Nicole M. Isbel, Rüya Mutluay, Milica Bozic, Maribel Diaz-Ricart, Demetrios Vlahakos, Luminita Voroneanu, Nadezda Koleganova, Marie Luise Gross, Sergio G. Bucharles, Elvira Fernandez, Fotis Panou, Ozlem Cigerli, Nicholas M. Selby, Alessandra Brendolan, Dimitrios Kremastinos, Jochen G. Raimann, Jill T. Norman, Adrian Covic, Sonja Steppan, John F. Moorhead, Christina Schwandt, F. Wenzelburger, Philip Reis, Te-Chao Fang, K. Vithlani, Maria C. Cardoso, Hue Danh Thang, Fabio Branco, Eduardo Lorca, Federico Nalesso, Manel Vera, Gabriel Mircescu, Dinna N. Cruz, Mohammad Kazem Tarzamni, Mustafa Cirit, Juan Jesus Carrero, M. Ferrario, Betina Gruber, Blai Coll, Sahng Lee, Mukremin Uysal, Alan Jardine, Mohammadreza J. Nakhjavani, Kyung Jin Lee, Patrick B. Mark, Indranil Dasgupta, John E. Sanderson, Huseyin Oflaz, Nurhan Ozdemir, Jesus Calviño, Patricia Molina, Guy Rostoker, Carlos Zavala, L. C. Rump, Peter Bárány, Sukru Sindel, Jutta Passlick-Deetjen, Mario Timio, Eveline Lee, Yang Sun, Joanna R. Powell, Sameena Iqbal, C.F. Wong, Seong Suk Kim, Fatma Ayerden Ebinç, Bang-Gee Hsu, José Rocha Faria-Neto, Elise Tanigushi, Jiaqi Qian, Sevim Gönen, Panagyota Flevari, Anja Kruse, Stephen G. John, Xuewang Li, Yong Zeng, Christopher W.K. Lam, Remus Orasan, Turgay Arinsoy, Sumi Sun, Eva Parisi, Pedro Villaverde, Alan G. Jardine, Tamer Sakaci, Carmen Caldararu, Ilie Barb, Olof Heimbürger, Alaattin Yildiz, P. Pai, Geert Jan Tangelder, S. Cerutti, Mirela Liana Gliga, K. Rafalia, Rajan K. Patel, Thais Lopez, Karl Thomaseth, Joan-Carles Martinez, Guangli Ge, Soner Duman, Manuel Garcia, Martin Zeier, Claudio Ronco, Shan Mou, Piet M. ter Wee, Kay B. Tan, Yasar Caliskan, John Moran, Roberto Pecoits-Filho, Chih-Hsien Wang, Mustafa Demirturk, Alexandre Varela, Nicola Kuhr, Kim M. Kloske, Paolo Lentini, Zhenni Guo, Jaume Almirall, Rafel Valls, C. McCoy, Mhairi K. Sigrist, Fulgencio Navalon, Ceyla Konca, Luis E. Becker, Nadia Martin, Goffredo del Rosso, Steven C. Campbell, Elisa Mieko Suemitsu Higa, Young Sook Lee, Nathan W. Levin, Fatih Kircelli, Alessandra Sturani, Stefanie M. Bode-Boeger, Francesco Garzotto, Dionyssios Leftheriotis, David W. Mudge, Kenneth B. Christopher, Jan T. Kielstein, Violeta Roman, Mirela Gherman, Limeng Chen, Bengt Lindholm, and Sheila Doss

Subjects
Transplantation, medicine.medical_specialty, Nephrology, business.industry, Medicine, business, Intensive care medicine
Published
2009
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15. Oxidative Stress and ‘Monocyte Reprogramming’ after Kidney Transplant: A Longitudinal Study.

Author

Massimo de Cal, Sandra Silva, Dinna Cruz, Flavio Basso, Valentina Corradi, Paolo Lentini, Federico Nalesso, Daniela Dissegna, Volker Goepel, Stefano Chiaramonte, and Claudio Ronco

Subjects
UREMIA, OXIDATIVE stress, KIDNEY diseases, OXIDATION, CYCLOSPORINE, TACROLIMUS, IMMUNOSUPPRESSION
Abstract

AbstractUremia has been implicated in increased oxidative stress (OS) and decreased monocyte HLA-DR expression in chronic kidney disease (CKD) patients. Thus, one would expect normalization of these parameters after successful kidney transplant (KTx). Our aim was to describe patterns of OS and HLA-DR expression after KTx and to explore the effect of renal function and different immunosuppression regimens. 30 KTx patients (20 male; 48 ± 11 years) were enrolled and compared with 20 healthy controls. We measured advanced oxidation protein products (AOPP) and the percentage of monocytes expressing HLA-DR (DR+) before (preKTx) and after KTx (on days 2, 30, 90, 180 and after 1 year). Compared to controls, patients had a higher preKTx AOPP (152.6 vs. 69.3 μmol/l; p < 0.001). AOPP decreased at 48 h after KTx, achieving values similar to controls. Thereafter, it increased again and remained significantly higher compared to controls, returning to preKTx levels at 90 days. Prior to KTx there was a trend for lower DR+ in KTx patients compared to controls (96 vs. 98; NS). Following KTx, patients had a lower DR+ in the 1st month; then it gradually returned to preKTx levels during the 1st year; at no time did it reach a value similar to controls. Cyclosporine (CyA)-treated patients had a significantly higher AOPP (161.5 vs. 99.5 μmol/l; p = 0.03) and a lower DR+ (91.7 vs. 96.4; p < 0.05) at 30 days than patients on tacrolimus (FK). Patients on mycophenolate mofetil (MMF) showed a low AOPP (106.9 vs. 168.1 μmol/l; p = 0.05) and a high DR+ (96.7 vs. 88.2; p = 0.001) than those on everolimus. After 3 months, CyA-treated patients had a non-significant increase in AOPP levels, whereas those on FK showed a decrease (p < 0.05) as did those treated with MMF (p < 0.05). Successful KTx reduced but did not normalize AOPP, suggesting ongoing OS, perhaps due to persistent mild renal dysfunction and the effects of immunosuppression. HLA-DR expression remained low after KTx, which may be a possible contributing factor to infectious complications after transplantation. Immunosuppressive agents appear to have diverse effects on OS and HLA-DR expression.Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Published
2008
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