[Analysis of the spectrum of nephropathies over 24 years in a West German center based on native kidney biopsies]. / Analyse des Nephropathiespektrums über 24 Jahre in einem westdeutschen Zentrum anhand von Eigennierenbiopsien.

PURPOSE: The aim of the study was to analyze the occurrence of primary and secondary glomerulopathies as well as tubulointerstitial nephropathies over time and to assess potential changes in the disease spectrum. PATIENTS AND METHODS: The authors retrospectively analyzed all kidney biopsies performed in their institution between 1983 and 2006 as well as the clinical data at the time of biopsy. RESULTS: Between January 1983 and December 2006, 359 native kidney biopsies with sufficient material for histological analysis were performed (218 men, 141 women; mean age 51.8 years). A mean of nine glomeruli per biopsy were obtained. Mean serum creatinine at the time of biopsy was 3.3 mg/dl. The most common indication for biopsy was nephrotic syndrome (31%), followed by renal insufficiency (29%) and proteinuria (14%). Primary glomerulopathies were found in 51%, secondary glomerulopathies in 28%, tubulointerstitial renal diseases in 9%, and vascular renal diseases in 12%. Among the primary glomerulopathies, IgA nephropathy was the most common diagnosis (26%), followed by mesangioproliferative glomerulonephritis (17%), membranous glomerulonephritis (16%), minimal change disease (14%), focal segmental glomerulosclerosis (FSGS; 13%), rapidly progressive glomerulonephritis (RPGN; 8%), and membranoproliferative glomerulonephritis (7%). Among the secondary glomerulopathies, the heterogeneous group of autoimmune diseases (26%) and diabetic nephropathy (25%) dominated. Comparing the period from 1983 to 1994 with 1995 to 2006, a decrease in primary FSGS from 16% to 9% as well as in RPGN from 14% to 1% was noticed, while among the secondary forms, autoimmune diseases with renal involvement increased from 14% to 31%. CONCLUSION: In the own patient population changes in the spectrum of primary and secondary glomerulopathies can be observed over time. Thereby, the distribution pattern of the various glomerulonephritides largely corresponds to the distribution described for other West European countries. An increase in the incidence of primary FSGS, as observed in non-European countries, could not be demonstrated.

Identification of central venous hemodialysis catheter-related infection by a semiquantitative culture method.

BACKGROUND: Central venous hemodialysis catheter-related infection is a major cause of morbidity and mortality in the hemodialysis (HD) population. Due to an impaired immune response, symptoms and signs of infection may not be obvious, and thus bacteremia is often diagnosed and treated protractedly. In contrast, induction of the acute phase response is frequently observed in HD patients even without infection. Moreover, positive catheter cultures may result from contamination, asymptomatic colonization or infection. The aim of the present study was to compare the number of colonies from HD catheter tips, with symptoms and signs of infection in HD patients. METHODS: In a 10-year, single-center study, 53 HD patients (29 men, 24 women; mean age 66 +/- 10 years) who had their dialysis catheters removed were divided into 3 groups according to the number of colonies growing after rolling the catheter tip across blood agar (group I: <15 colonies [n=22], II: 15-50 colonies [n=15], III: >50 colonies [n=16]). RESULTS: The maximum white blood cell (WBC) count did not differ significantly between patients with low- and high-density colonization (group I: 11.746 +/- 9.680 WBC/microL vs. group III: 13.479 +/- 6.252 WBC/microL, p=NS) while maximum C-reactive protein (CRP) levels were higher in patients with high-density colonization (group I: 8.6 +/- 6.8 vs. group III: 19.2 +/- 12.2 mg/dL, p<0.05). Density of bacterial colonization was associated with the maximum body temperature (group I: 37.6 degrees C +/- 1.1 degrees C vs. 38.7 degrees C +/- 0.9 degrees C, p<0.05). Moreover patients with high-density colonization showed increased bacteremia (group I: 33% vs. group III: 93%, p<0.01) as well as an increased mortality due to septicemia (group I: 9% vs. group III: 50%, p<0.01). Patients of group II exhibited intermediate values in all analyses. CONCLUSION: The semiquantitative culture technique can help to differentiate between contamination and infection of central venous HD catheters and provides important prognostic information in dialysis patients.