Relationship between renal function and renal volume in autosomal dominant polycystic kidney disease: cross-sectional study.

OBJECTIVE: To determine in patients with autosomal dominant polycystic kidney disease the relationship between total renal volume (the sum of both kidneys, TRV) as measured by magnetic resonance and renal function; and its behaviour according to sex and the presence of arterial hypertension, hypercholesterolaemia and hyperglycemia. METHOD: Cross-sectional study including patients with autosomal dominant polycystic kidney disease who underwent periodic reviews at Nephrology external consultations at Hospital de las Nieves de Granada, and who underwent an magnetic resonance to estimate renal volume between January 2008 and March 2011. RESULTS: We evaluated 67 patients (59.7% women, average age of 48±14.4 years) and found a significant positive association between TRV and serum creatinine or urea, which was reversed compared with estimated glomerular filtration by MDRD-4 and Cockcroft-Gault. Women showed an average serum creatinine level and a significantly lower TRV level compared with males. Subgroups affected by arterial hypertension and hyperuricemia presented average values for serum creatinine and urea, higher for TRV and lower for estimated glomerular filtration. The hypercholesterolaemia subgroup showed higher average values for urea and lower for estimated glomerular filtration, without detecting significant differences compared with TRV. CONCLUSION: The volume of polycystic kidneys measured by magnetic resonance is associated with renal function, and can be useful as a complementary study to monitor disease progression. The presence of arterial hypertension, hyperuricemia or hypercholesterolaemia is associated with a poorer renal function.

Efecto hipolipemiante de Sevelamer en el paciente urémico / Hypolipidemic effect of sevelamer in the uremic patient

Antecedentes. Sevelarmer es un quelante de fósforo indicado en el tratamiento de la hiperfosforemia urémica. Estudios recientes reportan un efecto hipolipemiante que añade un valor adicional a esta molécula. Con este estudio pretendemos evaluar el efecto de sevelamer sobre el perfil lipídico y su seguridad. Métodos. Estudiamos de manera retrospectiva pacientes urémicos estables en hemodiálisis. Cada paciente participó con uno o más registros, clasificados en tres grupos según el tratamiento recibido: grupo 1, registro de pacientes tratados con sevelamer durante más de 3 meses; grupo 2, registro de pacientes no tratados con estatina ni sevelamer, y aquellos registro procedentes de pacientes antes de iniciar tratamiento con sevelamer; y grupo 3, registros de pacientes tratados con alguna estatina durante más de 3 meses. Recogimos los efectos adversos achacables a sevelamer. Trimestralmente registramos datos relativos al tratamiento fosfo-cálcico, perfil lipídico sérico, y un amplio perfil de seguridad de laboratorio. Resultados. Los valores medios de colesterol total y colesterol LDL séricos fueron significativamente inferiores en el grupo 1 respecto a los grupos 2 y3. El nivel sérico medio de triglicéridos fue semejante en los tres grupos y la variación en valor absoluto de colesterol HDL medio resultó pequeña. No registramos efectos adversos por sevelamer. El perfil de seguridad de laboratorio fue favorable y semejante en los tres grupos, si bien el valor medio de proteína C reactiva sérica en el grupo 1 fue significativamente inferior respecto a los otros. Conclusiones. Este estudio confirma el valor hipolipemiante de sevelamer en pacientes urémicos y sugiere un perfil pleiotrópico de efectos beneficiosos sobre la enfermedad arteriosclerótica de los pacientes en diálisis

Background. Sevelamer is a phosphorus binder indicated in the treatment of uremic hyperphosphoremia. Recent studies report a hypolipidemic effect adding futher value to this molecule. With this study, we aim to assess the effect of sevelamer on the lipid profile and its safety. Methods. We retrospectively studied stable uremic patients in hemodialysis. Each patient participated with one or more record entries, classified in three groups according to the treatment received: group 1, record entries of patients treated with sevelamer for more than 3 months; group 2, record entries of patients not treated with statin or sevelamer, and those record entries of patients prior to beginning treatment with sevelamer; and group 3, record entries of patients treated with any statin for more than 3 months. Adverse effects attributable to sevelamer were collected. On a quarterly basis, data relating to phosphocalcium treatment, serum lipid profile, and a broad laboratory safety profile were recorded. Results. Mean serum total cholesterol and LDL cholesterol values were significantly lower in group 1 with regard to groups 2 and 3. The mean serum triglyceride level was similar in the three groups, and the change in the mean HDL cholesterol absolute value was minute. No adverse effects due to sevelamer were recorded. The laboratory safety profile was favorable and similar in the three groups, although the mean serum C-reactive protein in group 1 was significantly lower with regard to the other groups. Conclusions. This study confirms the hypolipidemic value of sevelamer in uremic patients and suggests a pleiotropic profile of beneficial effects on arteriosclerotic diseases of patients in dialysis

Influence of age, sex, and hepatitis C virus infection on peripheral blood lymphocyte subsets in stable kidney transplantation.

BACKGROUND: Young age and hepatitis C virus infection (HCVI) are believed to be risk factors in kidney transplantation recipients. The first group is treated empirically with an intensive immunosuppressive regimen, because it is considered to have high immune alloreactivity. The other cohort usually receives a less intensive regimen to avoid excessive immunosuppressive effects. Our aim was to investigate the influence of age, sex, and HCVI on immune status in stable kidney transplant recipients through measurement of peripheral blood lymphocyte subsets. METHODS: Absolute CD3+, CD3+, CD4+, CD3+, CD8+, CD19+, CD16+ CD3- lymphocyte counts and CD4/CD8 ratios were assessed at five time points in 65 stable kidney allograft patients over 12 months. The subsets were compared according to age, sex, and HCVI of the recipients. RESULTS: An inverse association was observed between recipient age and absolute CD19+ and CD3+ CD4+ lymphocyte counts, which was significant at all time points with respect to CD19+ counts, and at three time points with respect to CD3+ CD4+ counts. A significant positive association was observed between recipient age and absolute CD3- CD16+ lymphocyte counts at three time points. Female recipients showed significantly lower CD3+ CD8+ counts and significantly higher CD4/CD8 ratios than male recipients at four time points. HCVI recipients showed significantly lower CD16+ CD3- counts at four time points. CONCLUSIONS: We observed links between immune status and age, sex and HCVI in stable kidney transplant recipients that could offer new insights into recommendations for maintenance immunosuppression.

Effect of mycophenolate mofetil regimen on peripheral blood lymphocyte subsets in kidney transplant recipients.

BACKGROUND AND AIMS: There is growing evidence of the effects of immunosuppressive agents on "immune targets" in renal transplantation. Immunological monitoring could indirectly measure the suppressive effect of these drugs and guide early preventive interventions in transplant recipients. Due to the selective antiproliferative effect of mycophenolate mofetil (MMF) on lymphocytes, our goal was to determine whether MMF modulates peripheral blood lymphocyte subsets (PBLS) in kidney allograft patients. METHODS: We assessed absolute CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD19(+), CD16(+)CD3(-) PBLS counts and CD4/CD8 ratios for 12 months in three groups of kidney allograft patients stratified according to maintenance immunosuppressive regimen: group A (n = 31), which started MMF with prednisone (P) + cyclosporine A (CyA), and two control groups, B (n = 19) and C (n = 15) on P + CyA + azathioprine (Aza) and P + CyA regimens, respectively. We compared intra- and intergroup lymphocyte counts and ratios. RESULTS: Intergroup comparisons showed a significant reduction in all PBLS in group A (CD19(+) from 3 months and other subsets from 6 months), whereas there were no significant changes in PBLS in the other group analyses or comparisons. CONCLUSIONS: Our findings suggest that (1) MMF modulates all PBLS in kidney allograft patients, causing a progressive reduction occurring earlier in CD19(+), and (2) we can rule out that these changes were caused by the "natural immunological evolution" of the transplantation. These results could offer a new method for immunological monitoring of transplant patients.