Phospholipase A2 Receptor Autoantibodies and Clinical Outcome in Patients with Primary Membranous Nephropathy

Journal of the American Society of Nephrology current issue Phospholipase A2 Receptor Autoantibodies and Clinical Outcome in Patients with Primary Membranous Nephropathy

Membranous nephropathy (MN) is the most common cause of nephrotic syndrome in adults, with an uncertain clinical outcome. The characterization of the phospholipase A₂ receptor (PLA₂R) as the major target antigen in primary MN and the detection of circulating autoantibodies in these patients is a major advance in understanding this disease. To test whether PLA₂R antibody levels reflect disease activity or clinical outcome, we performed a prospective multicenter study of 133 adult patients with primary MN and detectable serum PLA₂R antibodies who had not received immunosuppressive therapy. Patients were followed ≤24 months. PLA₂R antibody levels associated with clinical disease activity (proteinuria) in patients with immunosuppressive therapy (n=101) or supportive care (n=32). Within 3 months, immunosuppressive therapy led to a sustained 81% reduction in PLA₂R antibody levels paralleled by a 39% reduction in proteinuria. Patients who experienced remission of proteinuria after 12 months had significantly lower PLA₂R antibody levels at the time of study inclusion compared with patients with no remission. Patients with high PLA₂R antibody levels achieved remission of proteinuria significantly later than patients with low PLA₂R antibody levels. PLA₂R antibody levels fell over time in patients with spontaneous remission but remained elevated in patients who did not show a reduction in proteinuria. Multivariable Cox regression analysis confirmed PLA₂R antibody level as an independent risk factor for not achieving remission of proteinuria. We conclude that a decrease in PLA₂R antibody level is associated with a decrease of proteinuria in patients with primary MN.

http://jasn.asnjournals.org/cgi/content/short/25/6/1357?rss=1

Sent with Reeder

Enviado desde mi iPad

A Novel Treatment Regimen for BK Viremia

Transplantation - Current Issue A Novel Treatment Regimen for BK Viremia

BackgroundBK viremia, a prerequisite for BK virus nephropathy (BKVN), affects 5% to 16% of pediatric renal transplant recipients (PRTR). We evaluated the safety and efficacy of a novel approach to treating BK viremia using fluoroquinolones and leflunomide in PRTR. MethodsWe studied 230 PRTR at Mattel Children's Hospital, UCLA, who underwent renal transplantation between January 2003 and October 2010. Nineteen patients were found to have BK viremia. Ciprofloxacin was started when the BK viral load was greater than 625 copies/mL, and patients were switched to leflunomide if BK viral load did not decrease after 2 months of ciprofloxacin therapy. All patients underwent transplant kidney biopsy, and their estimated glomerular filtration rate (eGFR) and BK PCR was measured serially. The side effects of ciprofloxacin and leflunomide were recorded in each patient. ResultsThere was a significant decrease in BK viral load in patients treated with ciprofloxacin and leflunomide (P<0.001) with only a small reduction in immunosuppression. BK viremia was associated with a significantly decreased eGFR (P<0.001), and treatment with ciprofloxacin and leflunomide was associated with improved eGFR (P<0.001). This approach resulted in a BKVN rate of only 1%. ConclusionsThis analysis demonstrates for the first time that, used in a stepwise fashion, ciprofloxacin and leflunomide are effective and safe treatments for BK viremia in PRTR.


http://journals.lww.com/transplantjournal/Fulltext/2014/06150/A_Novel_Treatment_Regimen_for_BK_Viremia.15.aspx

Sent with Reeder

Enviado desde mi iPad

I'm sharing "Systematic Review and Meta-Analysis on Management of Hemodialysis Catheter-Related Bacteremia."

I thought you would be interested in this article.

Journal of the American Society of Nephrology : JASN 2014 May 22; Systematic Review and Meta-Analysis on Management of Hemodialysis Catheter-Related Bacteremia. Saima Aslam, Florin Vaida, Michele Ritter, Ravindra L Mehta PMID: 24854263

Sent using journal reader: Read by QxMD

Enviado desde mi iPad

Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies

Information sourced from BMJ:

BMJ 2014;348:g1903
[Free full-text BMJ article PDF | PubMed® abstract]

Research

Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies

Rajiv Chowdhury, Setor Kunutsor, Anna Vitezova, et al.

Correspondence to: R Chowdhury rajiv.chowdhury@phpc.cam.ac.uk or O H Franco o.franco@erasmusmc.nl

Abstract

Objective To evaluate the extent to which circulating biomarker and supplements of vitamin D are associated with mortality from cardiovascular, cancer, or other conditions, under various circumstances.

Design Systematic review and meta-analysis of observational studies and randomised controlled trials.

Data sources Medline, Embase, Cochrane Library, and reference lists of relevant studies to August 2013; [correspondence] with investigators. 

Study selection Observational cohort studies and randomised controlled trials in adults, which reported associations between vitamin D (measured as circulating 25-hydroxyvitamin D concentration or vitamin D supplement given singly) and [cause-specific] mortality outcomes.

Data extraction Data were extracted by two independent investigators, and a consensus was reached with involvement of a third. Study specific relative risks from 73 cohort studies (849 412 participants) and 22 randomised controlled trials (vitamin D given alone versus placebo or no treatment; 30 716 participants) were meta-analysed using random effects models and were grouped by study and population characteristics.

Results In the primary prevention observational studies, comparing bottom versus top thirds of baseline circulating 25-hydroxyvitamin D distribution, pooled relative risks were 1.35 (95% confidence interval 1.13 to 1.61) for death from cardiovascular disease, 1.14 (1.01 to 1.29) for death from cancer, 1.30 (1.07 to 1.59) for non-vascular, non-cancer death, and 1.35 (1.22 to 1.49) for all cause mortality. Subgroup analyses in the observational studies indicated that risk of mortality was significantly higher in studies with lower baseline use of vitamin D supplements. In randomised controlled trials, relative risks for all cause mortality were 0.89 (0.80 to 0.99) for vitamin D₃ supplementation and 1.04 (0.97 to 1.11) for vitamin D₂ supplementation. The effects observed for vitamin D₃supplementation remained unchanged when grouped by various characteristics. However, for vitamin D₂ supplementation, increased risks of mortality were observed in studies with lower intervention doses and shorter average intervention periods.

Conclusions Evidence from observational studies indicates inverse associations of circulating 25-hydroxyvitamin D with risks of death due to cardiovascular disease, cancer, and other causes. Supplementation with vitamin D₃ significantly reduces overall mortality among older adults; however, before any widespread supplementation, further investigations will be required to establish the optimal dose and duration and whether vitamin D₃ and D₂ have different effects on mortality risk.

© 2014 BMJ Publishing Group Ltd

The above message comes from BMJ, who is solely responsible for its content.

You have received this email because you requested follow-up information to an Epocrates DocAlert® Message. For more information about DocAlert® Messages, please click here.

—
Alberto Reino

I'm sharing "A systematic review of the role of C4d in the diagnosis of acute antibody-mediated rejection."

I thought you would be interested in this article.

Kidney International 2014 May 14; A systematic review of the role of C4d in the diagnosis of acute antibody-mediated rejection. Ruth Sapir-Pichhadze, Simon P Curran, Rohan John, Andrea C Tricco, Elizabeth Uleryk, Andreas Laupacis, Kathryn Tinckam, Banu Sis, Joseph Beyene, Alexander G Logan, S Joseph Kim PMID: 24827778

Sent using journal reader: Read by QxMD

Enviado desde mi iPad

Anemia Control in Kidney Transplant Recipients Using Once-Monthly Continuous Erythropoietin Receptor Activator: A Prospective, Observational Study

Journal of Transplantation - XXX Anemia Control in Kidney Transplant Recipients Using Once-Monthly Continuous Erythropoietin Receptor Activator: A Prospective, Observational Study

In a multicenter, prospective, observational study of 279 kidney transplant recipients with anemia, the efficacy and safety of once-monthly continuous erythropoietin receptor activator (C.E.R.A.) were assessed to a maximum of 15 months. The main efficacy variable was the proportion of patients achieving a hemoglobin level of 11-12 g/dL at each of visits between months 7 and 9. At study entry, 224 patients (80.3%) were receiving erythropoiesis stimulating agent (ESA) therapy including darbepoetin alfa (98), epoetin beta (61), and C.E.R.A. (45). The mean (SD) time between C.E.R.A. applications was 34.0 (11.9) days. Among 193 patients for whom efficacy data were available, mean (SD) hemoglobin was 11.1 (0.99) g/dL at study entry, 11.5 (1.1) g/dL at month 7, 11.6 (1.3) g/dL at month 9, and 11.4 (1.1) g/dL at month 15. During months 7–9, 20.7% of patients had all hemoglobin values within the range 11-12 g/dL and 64.8% were within 10–13 g/dL. Seven patients (2.5%) discontinued C.E.R.A. due to adverse events or serious adverse events. In this observational trial under real-life conditions, once-monthly C.E.R.A. therapy achieved stable hemoglobin levels in stable kidney transplant recipients with good tolerability, and with no requirement for any dose change in 43% of patients.


http://www.hindawi.com/journals/jtrans/2014/179705/

Sent with Reeder

Enviado desde mi iPad