Urinary levels of epidermal growth factor, interleukin-6 and monocyte chemoattractant protein-1 may act as predictor markers of renal function outcome in immunoglobulin A nephropathy.

AIM: Urinary cytokine excretion may reflect histological changes in immunoglobulin A nephropathy (IgAN), and their measurement can give information about disease outcome. METHODS: Thirty-three IgAN patients were prospectively followed for 5.6 +/- 3.1 years. Urinary levels of monocyte chemoattractant protein-1 (MCP-1), interleukin (IL)-6 and epidermal growth factor (EGF) were measured at diagnosis and repeated 1 year later for IL-6 and EGF. RESULTS: Urinary MCP-1 and IL-6 levels were increased significantly, while EGF excretion reduced in IgAN patients, compared to controls. IL-6 urinary levels showed significant positive correlation with chronic histological lesions. Patients were classified into five groups, according to the Haas classification system. MCP-1 and IL-6 urinary levels were increased, whereas EGF levels were reduced in the progression of staging. EGF urinary excretion was a strong predictor factor of disease outcome, significantly correlated with creatinine clearance at time of diagnosis (r = 0.5, P = 0.005), and at the end of follow up (r = 0.6, P = 0.001). Urinary EGF levels measured a year later could predict long-term outcome better, and a cut of 0.05 pg/mg urine creatinine levels could distinguish between progressors and non-progressors. CONCLUSION: Urinary MCP-1, IL-6 and EGF levels may represent histology in IgAN. EGF excretion can be a predictive marker and its serial measurements may give information about disease outcome and the effect of treatment.

A case report of osteomyelitis pubis in a hemodialysis patient with diabetes mellitus.

Osteomyelitis pubis is a rare form of osteomyelitis. Known risk factors are urogynecologic surgery, trauma caused by sport activities, pelvic malignancy and intravenous drug use. Immunocompromised patients, including hemodialysis patients, and those with diabetes are also susceptible to infection. Particularly in the hemodialysis population, the use of intravenous catheters frequently results in bacteremia and metastatic infectious complications such as osteomyelitis. We describe the first case of osteomyelitis pubis in a woman on chronic maintenance hemodialysis with diabetes mellitus.

Psoas abscess in a dialysis patient with dialysis-related amyloidosis.

Psoas abscess is an infrequent clinical entity which poses diagnostic and therapeutic challenges. Few cases have been reported in chronic hemodialysis patients. We describe a case of psoas abscess in a dialysis patient with dialysis-related amyloidosis, successfully treated with percutaneous drainage and parenteral antibiotics.

Nocturnal hypertension is associated with an exacerbation of the endothelial damage in preeclampsia.

BACKGROUND: Non-dipping pattern of circadian blood pressure in preeclampsia is associated with an increased risk of cardiovascular disease. The pathogenetic mechanisms of this relationship are still unclear. We investigated whether non-dipping in preeclampsia could relate to endothelial activation or damage. METHODS: Participants, 20 women with normal pregnancy (mean age 29.9 +/- 5.7 years) and 31 women with preeclampsia (mean age 29.1 +/- 5.1 years), underwent 24-hour ambulatory blood pressure monitoring. Plasma levels of von Willebrand factor (vWf), marker of endothelial damage and of soluble adhesion molecules (sVCAM-1, sICAM-1), and markers of endothelial activation were determined using commercially available enzyme-linked immunoassays. RESULTS: Based on whether the nocturnal mean arterial pressure (MAP) relative to the daytime MAP declined by less than 10%, 21 women with preeclampsia were categorized as non-dippers. Compared to healthy pregnant women, patients with preeclampsia showed significantly enhanced levels of vWf (206.9 +/- 40.6 vs. 123 +/- 24 IU/dl;p<0.01) and sVCAM-1 (2,269 +/- 426 vs.1,159.8 +/- 340 ng/ml; p < 0.01). In addition, significantly higher levels of vWf (224.5 +/- 34.9 vs. 170 +/- 23 IU/dl; p < 0.01) and sVCAM-1 (2,405 +/- 421.4 vs. 1,983 +/- 276.7 ng/ml; p = 0.007) were determined, when women with preeclampsia and nocturnal hypertension (non-dippers) were compared to dippers. The results were similar even after adjustment for severity of preeclampsia. In contrast, neither preeclampsia nor dipping status had an effect on sICAM-1 levels. CONCLUSION: Nocturnal hypertension in preeclampsia is associated with elevated levels of molecules related to endothelial damage. Endothelial damage is a recognized pathogenetic factor for atherosclerosis and history of preeclampsia is a risk factor for cardiovascular disease. In this context, possible clinical implications of our findings deserve further investigation.

Haemodialysis patients with sleep apnoea syndrome experience increased central adiposity and altered muscular composition and functionality.

BACKGROUND: Sleep apnoea frequently affects patients with end-stage renal disease. However, it is still unclear whether or to what extent sleep disorders may affect functional capacity and quality of life in haemodialysis patients. We tested the hypothesis that apneic dialysis patients due to the lack of restorative sleep will have a further reduced functional capacity and further compromised quality of life compared to their non-apneic counterparts. METHODS: Forty-three clinically stable haemodialysis patients (13 F, 56.6+/-19.4 years) were examined. After polysomnographic analysis, patients were divided in two groups according to their calculated apnoea hypopnoea index (AHI; cutoff 5). Primary outcomes were intergroup differences in the following: (1) physical capacity and muscle performance, assessed by functional tests, (2) quality of life, assessed by the SF-36, (3) body composition, measured by DEXA and (4) muscle composition and size, as well as (5) visceral (VAT) and subcutaneous (SAT) adipose tissue, calculated by computed tomography. RESULTS: Twenty-two patients had AHI >5 (4 F, AHI=28.8+/-22.3). The adjusted analysis for age, BMI and years in dialysis therapy, showed that the low-AHI group (N=21, 9 F, AHI=1.8+/-1.3) had better functional capacity, and performed better in muscle strength and endurance tests compared to the high-AHI group. There were no differences in lean body mass and % total body fat between groups, however, values for VAT, VAT/TAT ratio and thigh muscles' fat infiltration were increased in the high-AHI group. VAT correlated with BMI (r=0.682, P=0.001), functional capacity (r=0.558, P=0.001) apnoea hypopnoea index (r=0.530, P=0.001). There were no statistical significant differences in quality of life between the two groups. To further account for age and BMI differences, a subgroup of patients was matched by age, sex and BMI (N=10/group). In the matched analysis, all the above statistical differences remained, between the low-AHI and high-AHI groups. CONCLUSIONS: Haemodialysis patients with sleep apnoea syndrome demonstrate poorer functional capacity, physical performance and muscle composition, compared to non-apneic dialysis patients. Overall, sleep apnoea appears to partly contribute to the total diminished functional capacity of haemodialysis patients.