Adrenocorticotropic hormone analog use for podocytopathies.

BACKGROUND: Adrenocorticotropic hormone is being increasingly studied for treatment of various glomerulopathies, most notably membranous nephropathy. Less data are available regarding its use in idiopathic nephrotic syndrome (INS) secondary to minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS). We report here our experience with H.P. Acthar(®) Gel (repository corticotropin injection) as first-line or subsequent therapy in patients with INS. METHODS: Data were taken from three patients with MCD and ten patients with FSGS from around the US, who were treated with Acthar Gel as initial or subsequent therapy. Treatment was solely at the discretion of the primary nephrologist without a specific protocol. A complete response (CR) was defined as final urine protein-to-creatinine ratio <500 mg/g and a partial response (PR) as 50% decrease without rise of serum creatinine. Side effects and tolerability were noted. RESULTS: All three patients with MCD received Acthar Gel as second-line or later immunosuppressive (IS) therapy and all responded (one CR and two PRs). Two of the ten patients with FSGS received Acthar Gel as first-line IS therapy, while the other eight had failed multiple agents. Four of the ten patients with FSGS had responses, including two CRs and two PRs. The three patients with MCD tolerated therapy well without side effects. Five patients with FSGS tolerated therapy well, while five had various steroid-like side effects, resulting in therapy discontinuation in two patients. CONCLUSION: Acthar Gel is a viable alternative IS agent for treatment of INS in patients intolerant or resistant to conventional therapy. More data are needed to better define its appropriate place.

Emotional intelligence and acculturation / /Inteligencia emocional y aculturación

Investigaciones previas muestran que los emigrantes desarrollan diversos estilos de ajuste a una nueva cultura. El presente estudio se centra en dos cuestiones: (1) ¿Por qué algunos emigrantes prefieren un estilo de aculturación mientras otros adoptan otros? y (2) ¿Por qué algunos emigrantes revelan mayores niveles de ajuste que otros? En una muestra de 349 inmigrantes que vivían en Alemania (199 turcos y 150 norte-africanos), investigamos la influencia de la inteligencia emocional (IE) con la "Escala de inteligencia emocional percibida" (Trait-Meta Mood Scale, TMMS). Los estilos de aculturación fueron evaluados con la "Escala de actitudes de aculturación" (Acculturation Attitudes Scale, AAS) así como indicadores de comportamientos de aculturación. El ajuste fue evaluado con la "Escala de satisfacción con la vida" (Satisfaction with Life Scale, SWLS), la "Escala subjetiva de la felicidad" (Subjective Happiness Scale, SHS) y el "Inventario de depresión, de Beck" (Beck Depression Inventory, BDI) como un indicador de desajuste. Igualmente, evaluamos la injusticia y discriminación percibidas. Los hallazgos mostraron que la IE y sus subcomponentes estaban relacionados con formas beneficiosas de actitudes y comportamientos de aculturación. La IE afectaba a experiencias de aculturación tales como la discriminación y la injusticia percibidas así como a diversos indicadores de ajuste (AU)

Previous research has shown that migrants develop various styles to adjust to a new culture. The present study was concerned with two questions: (1) Why do some migrants prefer a particular acculturation style whereas others adopt a different one, and (2) why do some migrants reveal a higher level of adjustment than others? In a sample of 349 immigrants living in Germany (199 Turks and 150 North-Africans), we investigated the influence of emotional intelligence (EI) with the Trait-Meta-Mood Scale (TMMS). Acculturation styles were assessed with the Acculturation Attitudes Scale (AAS) as well as specific markers of acculturation behavior. Adjustment was captured by the Satisfaction with life scale (SWLS), the subjective happiness scale (SHS), and the Beck Depression Inventory (BDI) as an inverse marker. Additionally, we assessed perceived unfairness and discrimination. Findings show that EI and its subcomponents are related to beneficial forms of acculturation attitudes and acculturation behavior. EI was also shown to affect acculturation experiences, such as perceived discrimination and perceived unfairness, as well as a number of psychological adjustment variables

Safety and efficacy of transjugular renal biopsy performed by interventional nephrologists.

Obtaining renal tissue is often critical in the diagnosis and management of patients with renal disease of unknown etiology. Bleeding diathesis, liver disease, and obesity are common contraindications for percutaneous renal biopsy. In high-risk patients, transjugular renal biopsy is believed to be a safe and effective procedure. This study reports the experience of an academic interventional nephrology program with performing transjugular renal biopsy. We performed a retrospective observational study of 23 patients with either acute or chronic kidney disease with contraindications for percutaneous renal biopsy. All transjugular renal biopsies were performed by interventional nephrologists at our university. We studied the efficacy and safety of transjugular renal biopsy in these patients. Twenty out of 23 (87%) of the procedures yielded adequate tissue for pathologic diagnosis. Three (13%) patients required blood transfusions, none required coil embolization or nephrectomy, and there were no deaths. Even though performing transjugular renal biopsy requires considerable technical expertise and must be performed in an interventional radiology suite, it can be safely and effectively performed by well-trained interventional nephrologists to achieve pathological diagnosis.

Prophylaxis of hemodialysis graft thrombosis with fish oil: double-blind, randomized, prospective trial.

Diets enriched with fish oil may favorably affect the vascular perturbations underlying synthetic graft thrombosis. Therefore, these studies were designed to test the hypothesis that diets enriched with fish oil would decrease the incidence of thrombosis in newly constructed polytetrafluorethylene grafts. A double-blind, randomized trial was conducted. Twenty-four patients were randomized to receive 4000 mg of fish oil or 4000 mg of control oil. Both preparations were enriched with antioxidants and deodorized with peppermint. Patients began therapy within 2 wk after graft placement and were monitored for 12 mo or until thrombosis developed. With a permuted-block randomization schedule, 12 patients received fish oil and 12 patients received control oil. The primary patency rates at 365 d were 14.9% for the control group and 75.6% for the fish oil-treated group. Survival analysis revealed a significant difference between fish oil-treated and untreated patients (P < 0.03, Mantel-Cox test), with a power of 90%. Moreover, analysis of covariables, including age of > or =50 yr, gender, race, body weight, diabetes mellitus, bleeding times, and lipid profiles, indicated that this effect occurred principally as a result of fish oil administration. Importantly, fish oil treatment also decreased venous outflow resistance and systemic BP, compared with control values. Fish oils possess unique biologic properties that favorably affect the incidence of polytetrafluorethylene graft thrombosis, and they thus represent a potential treatment strategy for the prevention of access thrombosis.