A cross-sectional immunosurveillance study of anti-EPO antibody levels in CRF patients receiving epoetin alfa in 5 Ontario Renal Centers.

BACKGROUND: Epoetin alfa (Eprex*; Johnson & Johnson, Manati, PR) has been used successfully to correct the anemia of chronic renal failure for more than 12 years. Anti-erythropoietin (anti-EPO) antibodies have been reported in a small number of patients, resulting in a blood disorder, pure red cell aplasia (PRCA). To evaluate the utility of a large-scale anti-EPO antibody screening program in patients with chronic kidney disease (CKD) administered epoetin alfa, a study involving 5 large renal centers in southern Ontario, Canada, was conducted. METHODS: More than 1,500 hemodialysis, peritoneal dialysis, and predialysis patients were screened for the prevalence of anti-EPO antibodies by means of a radioimmunoprecipitation (RIP) assay. Serum samples were drawn and shipped to PPD Development (Richmond, VA) for the immunoprecipitation assay. Serum EPO levels also were measured. All samples that tested positive or borderline for antibodies were sent to MDS Pharma Services (Montreal, Canada) for the neutralization assay. RESULTS: Of 1,531 samples tested, 1 patient tested low-positive and 3 borderline results were detected by means of RIP. PRCA previously was diagnosed in the patient with the low-positive antibody level; the patient was treated with cyclosporine and currently is being administered epoetin alfa with good response. The 3 patients with borderline antibody results manifested no clinical signs of PRCA. Neutralization assays performed on all 4 serum samples were negative for anti-EPO antibodies. CONCLUSION: Results from this surveillance study show that the prevalence of antibody to EPO in patients with CKD administered epoetin alfa in 5 Canadian renal centers is low, and the value of a large-scale antibody screening program for PRCA cannot be justified.

Riñones poliquisticos del adulto: informe de 54 casos / Polycystic Kidneys of the adult: report of 54 cases

Cincuenta y cuatro pacientes con diagnósticos de riñones poliquíticos del adulto confirmado mediante estudios radiológicos, ultrasonográficos y/o histopatológicos y complementados por la presencia de antecedentes y cuadro clínico, sugestivo fueron estudiados en el período comprendido entre 1962-84 en el INNSZ. Todos los pacientes fueron mayores de 20 años, 30 hombres (55%) y 24 mujeres (45%), con edades promedio al inicio de los síntomas de 38 años y de 42 años al establecimiento del diagnóstico. La sintomatología y datos de laboratorio predominantes fueron: hipertensión arterial (72%), hematuria (59%), dolor lumbar (57%), infección de vías urinarias (48%), proteinuria (61%) y anemia (35%). Desarrollaron insuficiencia renal crónica 29 pacientes (42.5%) a los 50 años de edad promedio y requierendo la mayoría tratamiento sustitutivo 2-3 años después de haber presentado niveles de creatinina sérica iguales o mayores de 2 mg/dl. En 19 pacientes (35%) se logró documentar la presencia de enfermedad poliquística asociada en otros órganos particularmente el hígado