Five uremic patients with hemodynamically significant pericardial effusion, which did not respond... more Five uremic patients with hemodynamically significant pericardial effusion, which did not respond to conservative treatment (intractable effusion) or tamponade, were treated with instillation into the pericardial sac of a nonabsorbable steroid, triamcinolone hexacetonide, and with intermittent drainage. This was done by insertion of a drainage catheter into the pericardial space under direct vision by subxiphoid pericardiotomy performed under local anesthesia. All patients responded well to the procedure, and immediate relief of the symptoms was achieved. No complications of the procedure were observed, and the drainage catheters were removed 48 to 72 h thereafter. Two patients died of unrelated causes--1 month and 3 years after the events. Two other patients are still alive and on a hemodialysis program, and one has a functioning kidney graft. During the 3 to 8 years of follow-up, no recurrent pericarditis was observed, and no constrictive pericarditis developed in any patient.
Erythropoietin (EPO) is a well-known hematopoietic factor and a major determinant of tissue oxyge... more Erythropoietin (EPO) is a well-known hematopoietic factor and a major determinant of tissue oxygenation. EPO receptors have been identified on a wide variety of non-erythroid cell types including human central nervous system and peripheral nervous system of animal models. The presence or function of EPO receptors in human peripheral nervous system is unknown. By examining nerve segments from radicular and autonomic nerves using immunohistochemical methods, we demonstrated the presence of EPO receptors on myelin sheath of radicular nerves in the human peripheral nervous system.
Background: Cigarette smoking is a well-known risk factor for the development of endothelial dysf... more Background: Cigarette smoking is a well-known risk factor for the development of endothelial dysfunction and the progression of atherosclerosis. Oxidative stress and inflammation have recently been implicated in endothelial dysfunction. Objectives: To assess the concomitant contribution of polymorphonuclear leukocytes to systemic oxidative stress and inflammation in cigarette smokers. Methods: The study group comprised 41 chronic cigarette-smoking, otherwise healthy males aged 45.0 +/- 11.5 (range 31-67 years) and 41 male non-smokers aged 42.6 +/- 11.3 (range 31-65) who served as the control group. The potential generation of oxidative stress was assessed by measuring the rate of superoxide release from separated, phorbol 12-myristate 13-acetate-stimulated PMNL and by plasma levels of reduced (GSH) and oxidized (GSSG) glutathione. Inflammation was estimated indirectly by: a) determining the in vitro survival of PMNL, reflecting cell necrosis; b) in vivo peripheral PMNL counts, reflecting cell recruitment; and c) plasma alkaline phosphatase levels, indicating PMNL activation and degranulation. Results: PMA-stimulated PMNL from cigarette smokers released superoxide at a faster rate than PMNL from the controls. Smokers had decreased plasma GSH and elevated GSSG levels. In vitro incubation of control and smokers' PMNL in sera of smokers caused necrosis, while control sera improved smoker PMNL survival. Smokers' PMNL counts, although in the normal range, were significantly higher than those of controls. Plasma ALP levels in smokers were significantly higher than in controls and correlated positively with superoxide release and PMNL counts. Conclusions: Our study shows that PMNL in smokers are primed in vivo, contribution concomitantly to systemic oxidative stress and inflammation that predispose smokers to endothelial dysfunction, and explains in part the accelerated atherosclerosis found in smokers.
Mul ti ple myeloma and re nal fail ure due to rhabdomyolysis Ab stract. Case re port of a 70-year... more Mul ti ple myeloma and re nal fail ure due to rhabdomyolysis Ab stract. Case re port of a 70-year-old woman with the di ag no sis of mul ti ple myeloma and acute re nal fail ure due to rhabdomyolysis (RDM) that was caused from the de po si tion of k light chain in mus cle fi bers. In ad di tion, the de po si tion was found in the liver.
Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/journals/nef/nef_bk.htm 246 Hemophagocytic Syndrome in a Patient with Hashimoto's Thyroiditis and Membranous Nephritis
Twenty patients undergoing intermittent peritoneal dialysis (IPD) and 20 patients on hemodialysis... more Twenty patients undergoing intermittent peritoneal dialysis (IPD) and 20 patients on hemodialysis (HD) for end-stage kidney disease underwent Holter ECG monitoring for a continuous 24-h period, starting prior to the onset of dialysis and continuing until several hours after it. Clinically significant ventricular arrhythmias were found in only 2 of 20 patients in the HD group; no such ventricular arrhythmias were observed in the IPD group. Supraventricular arrhythmias were equally prevalent in both groups. Thus, the differences between IPD and HD are not great and it seems that HD is, at most, a mild arrhythmogenic procedure. However, in patients with proven heart disease or signs of left ventricular hypertrophy, peritoneal dialysis (intermittent or continuous ambulatory) appears to be preferable to HD.
<p><b>(A)</b> An averaged MS spectrum of albumin isolated from 5 healthy contro... more <p><b>(A)</b> An averaged MS spectrum of albumin isolated from 5 healthy controls (HC) before and after <i>in-vitro</i> reduction. <b>(B)</b> An averaged MS spectrum of HSA isolated from 5 hemodialysis patients (HD) before and after <i>in-vitro</i> reduction. Peak numbers are described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177799#pone.0177799.t001" target="_blank">Table 1</a>. (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177799#pone.0177799.s001" target="_blank">S1 File</a>).</p
INTRODUCTION Serum levels of β2-microglobulin (b2M) are significantly higher in patients with end... more INTRODUCTION Serum levels of β2-microglobulin (b2M) are significantly higher in patients with end stage renal failure undergoing hemodialysis (HD) and its accumulation accelerates Dialysis Related Amyloidosis (DRA). In HD patients low-flux dialysis, intravenous (IV) iron (administered for the treatment of anemia) affects ß2M removal during dialysis. IV iron also affects the oxidation of plasma proteins, including b2M. AIMS To examine the effect of intravenous iron therapy on ß2M levels and oxidation in HD patients treated with high-flux compared with low-flux dialyzers. METHODS Sixteen HD patients on chronic maintenance IV iron therapy were studied. Half of the patients were allocated to high-flux and half to low-flux dialysis. After five weeks, each patient was assigned to the second dialyzer. After two weeks of treatment with each dialyzer, blood samples were taken and serum levels of β2M were measured. In addition, the hematocrit and iron status were measured. Part of the samples...
A session of hemodialysis (HD) is accompanied by an increase in oxidative stress (OS). Measures o... more A session of hemodialysis (HD) is accompanied by an increase in oxidative stress (OS). Measures of OS could serve as a good model for evaluating in vivo oxidation and provide a way to validate new therapeutic platforms, provided the measure of OS is sensitive enough to pick up treatment induced changes. Oxidation-reduction potential (ORP), a global measure of all oxidant and antioxidant activity, was compared to two other measures of OS to determine if pre-treatment with oral pomegranate juice (PJ) could reduce the OS induced by HD. Methods: 15 hemodialysis (HD) patients with and without PJ were studied. Measures of OS included: ORP, advanced oxidation protein products (AOPP), and myeloperoxidase (MPO). OS was determined in blood samples drawn before and after a dialysis session. All samples were frozen at-80oC until analyzed. Results: All three OS measures found increases in oxidative stress post-dialysis (p< 0.05): ORP (mV) 174.3±15 (pre) to 196.0±17.1(post); AOPP(μM) 175.8±69.0 (pre) to 232.1±93.0 (post); MPO (ng/ml) 6.6±4.9 (pre) to 15.1±11.7(post); PJ treatment caused a decrease in the differences pre to post dialysis, ORP measures revealed a significantly smaller increase post-dialysis after PJ treatment, while there were no more significant differences between pre to post values in MPO and AOPP. Further analyses revealed that longer dialysis vintage (> 40 months) had higher ORP values both pre and post-dialysis compared to shorter dialysis vintage (<40 months), and that PJ had its greatest reducing effect in the longer dialysis vintage. Conclusions: ORP is a sensitive method to identify slight changes in OS. By measuring ORP, it was possible to observe reductions in OS after dialysis as a result of pre-treatment with PJ. This effect was most prominent in the longer vintage patients. ORP provided a robust indicator of OS that could be used to identify the benefits of intervention like PJ, for use in HD.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology, Jan 3, 2015
Patients with severe or progressive idiopathic membranous nephropathy (IMN) should receive immuno... more Patients with severe or progressive idiopathic membranous nephropathy (IMN) should receive immunosuppressive therapy (IST). Alkylating agents, corticosteroids and cyclosporine (CsA) may be associated with substantial adverse effects and high relapse rates. To determine whether CsA is effective for long-term remission in the treatment of IMN with moderate to high risk for progression to renal failure, when given in a dosage of 3.5 mg/kg/day for 18 months, then tapered gradually to a maintenance dose of 0.35--0.70 mg/k/day within 6 months and continued for 5.5 years. The long term effectiveness of our CsA regimen in 33 incident nephrotic IMN patients was determined retrospectively. Daily proteinuria, serum albumin and creatinine clearance were compared before starting therapy (time 0) and at 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 years. At the end of 18 months, 84.8% of patients treated with CsA were in remission; 78.8% maintained long term remission for 10 years. All patients with com...
Pregnancies in women suffering from advanced chronic renal failure are frequently associated with... more Pregnancies in women suffering from advanced chronic renal failure are frequently associated with deterioration of maternal renal function, premature births and low birth weights. Prophylactic dialysis is sometimes instituted since this intervention ameliorates the uremic milieu and improves maternal status and fetal uterine environment. This report describes a successful pregnancy and delivery in a hypertensive woman with advanced chronic renal failure due to polycystic kidney disease without accelerating the natural deterioration of renal function and without instituting prophylactic dialysis. The infant was delivered at full term with a normal birth weight. Thirty months after delivery, growth and development of the child were normal and the rate of deterioration of maternal renal function, assessed by 1/creatinine, was unaffected by pregnancy. Conservative management and effective control of blood pressure may be sufficient to achieve successful pregnancy outcome when women with...
<p><sup>**</sup><i>P</i> < 0.01, <sup>*</sup>P < ... more <p><sup>**</sup><i>P</i> < 0.01, <sup>*</sup>P < 0.05, HC vs. HD before reduction vs. after reduction (n = 8). (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177799#pone.0177799.s001" target="_blank">S1 File</a>).</p
Five uremic patients with hemodynamically significant pericardial effusion, which did not respond... more Five uremic patients with hemodynamically significant pericardial effusion, which did not respond to conservative treatment (intractable effusion) or tamponade, were treated with instillation into the pericardial sac of a nonabsorbable steroid, triamcinolone hexacetonide, and with intermittent drainage. This was done by insertion of a drainage catheter into the pericardial space under direct vision by subxiphoid pericardiotomy performed under local anesthesia. All patients responded well to the procedure, and immediate relief of the symptoms was achieved. No complications of the procedure were observed, and the drainage catheters were removed 48 to 72 h thereafter. Two patients died of unrelated causes--1 month and 3 years after the events. Two other patients are still alive and on a hemodialysis program, and one has a functioning kidney graft. During the 3 to 8 years of follow-up, no recurrent pericarditis was observed, and no constrictive pericarditis developed in any patient.
Erythropoietin (EPO) is a well-known hematopoietic factor and a major determinant of tissue oxyge... more Erythropoietin (EPO) is a well-known hematopoietic factor and a major determinant of tissue oxygenation. EPO receptors have been identified on a wide variety of non-erythroid cell types including human central nervous system and peripheral nervous system of animal models. The presence or function of EPO receptors in human peripheral nervous system is unknown. By examining nerve segments from radicular and autonomic nerves using immunohistochemical methods, we demonstrated the presence of EPO receptors on myelin sheath of radicular nerves in the human peripheral nervous system.
Background: Cigarette smoking is a well-known risk factor for the development of endothelial dysf... more Background: Cigarette smoking is a well-known risk factor for the development of endothelial dysfunction and the progression of atherosclerosis. Oxidative stress and inflammation have recently been implicated in endothelial dysfunction. Objectives: To assess the concomitant contribution of polymorphonuclear leukocytes to systemic oxidative stress and inflammation in cigarette smokers. Methods: The study group comprised 41 chronic cigarette-smoking, otherwise healthy males aged 45.0 +/- 11.5 (range 31-67 years) and 41 male non-smokers aged 42.6 +/- 11.3 (range 31-65) who served as the control group. The potential generation of oxidative stress was assessed by measuring the rate of superoxide release from separated, phorbol 12-myristate 13-acetate-stimulated PMNL and by plasma levels of reduced (GSH) and oxidized (GSSG) glutathione. Inflammation was estimated indirectly by: a) determining the in vitro survival of PMNL, reflecting cell necrosis; b) in vivo peripheral PMNL counts, reflecting cell recruitment; and c) plasma alkaline phosphatase levels, indicating PMNL activation and degranulation. Results: PMA-stimulated PMNL from cigarette smokers released superoxide at a faster rate than PMNL from the controls. Smokers had decreased plasma GSH and elevated GSSG levels. In vitro incubation of control and smokers' PMNL in sera of smokers caused necrosis, while control sera improved smoker PMNL survival. Smokers' PMNL counts, although in the normal range, were significantly higher than those of controls. Plasma ALP levels in smokers were significantly higher than in controls and correlated positively with superoxide release and PMNL counts. Conclusions: Our study shows that PMNL in smokers are primed in vivo, contribution concomitantly to systemic oxidative stress and inflammation that predispose smokers to endothelial dysfunction, and explains in part the accelerated atherosclerosis found in smokers.
Mul ti ple myeloma and re nal fail ure due to rhabdomyolysis Ab stract. Case re port of a 70-year... more Mul ti ple myeloma and re nal fail ure due to rhabdomyolysis Ab stract. Case re port of a 70-year-old woman with the di ag no sis of mul ti ple myeloma and acute re nal fail ure due to rhabdomyolysis (RDM) that was caused from the de po si tion of k light chain in mus cle fi bers. In ad di tion, the de po si tion was found in the liver.
Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/journals/nef/nef_bk.htm 246 Hemophagocytic Syndrome in a Patient with Hashimoto's Thyroiditis and Membranous Nephritis
Twenty patients undergoing intermittent peritoneal dialysis (IPD) and 20 patients on hemodialysis... more Twenty patients undergoing intermittent peritoneal dialysis (IPD) and 20 patients on hemodialysis (HD) for end-stage kidney disease underwent Holter ECG monitoring for a continuous 24-h period, starting prior to the onset of dialysis and continuing until several hours after it. Clinically significant ventricular arrhythmias were found in only 2 of 20 patients in the HD group; no such ventricular arrhythmias were observed in the IPD group. Supraventricular arrhythmias were equally prevalent in both groups. Thus, the differences between IPD and HD are not great and it seems that HD is, at most, a mild arrhythmogenic procedure. However, in patients with proven heart disease or signs of left ventricular hypertrophy, peritoneal dialysis (intermittent or continuous ambulatory) appears to be preferable to HD.
<p><b>(A)</b> An averaged MS spectrum of albumin isolated from 5 healthy contro... more <p><b>(A)</b> An averaged MS spectrum of albumin isolated from 5 healthy controls (HC) before and after <i>in-vitro</i> reduction. <b>(B)</b> An averaged MS spectrum of HSA isolated from 5 hemodialysis patients (HD) before and after <i>in-vitro</i> reduction. Peak numbers are described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177799#pone.0177799.t001" target="_blank">Table 1</a>. (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177799#pone.0177799.s001" target="_blank">S1 File</a>).</p
INTRODUCTION Serum levels of β2-microglobulin (b2M) are significantly higher in patients with end... more INTRODUCTION Serum levels of β2-microglobulin (b2M) are significantly higher in patients with end stage renal failure undergoing hemodialysis (HD) and its accumulation accelerates Dialysis Related Amyloidosis (DRA). In HD patients low-flux dialysis, intravenous (IV) iron (administered for the treatment of anemia) affects ß2M removal during dialysis. IV iron also affects the oxidation of plasma proteins, including b2M. AIMS To examine the effect of intravenous iron therapy on ß2M levels and oxidation in HD patients treated with high-flux compared with low-flux dialyzers. METHODS Sixteen HD patients on chronic maintenance IV iron therapy were studied. Half of the patients were allocated to high-flux and half to low-flux dialysis. After five weeks, each patient was assigned to the second dialyzer. After two weeks of treatment with each dialyzer, blood samples were taken and serum levels of β2M were measured. In addition, the hematocrit and iron status were measured. Part of the samples...
A session of hemodialysis (HD) is accompanied by an increase in oxidative stress (OS). Measures o... more A session of hemodialysis (HD) is accompanied by an increase in oxidative stress (OS). Measures of OS could serve as a good model for evaluating in vivo oxidation and provide a way to validate new therapeutic platforms, provided the measure of OS is sensitive enough to pick up treatment induced changes. Oxidation-reduction potential (ORP), a global measure of all oxidant and antioxidant activity, was compared to two other measures of OS to determine if pre-treatment with oral pomegranate juice (PJ) could reduce the OS induced by HD. Methods: 15 hemodialysis (HD) patients with and without PJ were studied. Measures of OS included: ORP, advanced oxidation protein products (AOPP), and myeloperoxidase (MPO). OS was determined in blood samples drawn before and after a dialysis session. All samples were frozen at-80oC until analyzed. Results: All three OS measures found increases in oxidative stress post-dialysis (p< 0.05): ORP (mV) 174.3±15 (pre) to 196.0±17.1(post); AOPP(μM) 175.8±69.0 (pre) to 232.1±93.0 (post); MPO (ng/ml) 6.6±4.9 (pre) to 15.1±11.7(post); PJ treatment caused a decrease in the differences pre to post dialysis, ORP measures revealed a significantly smaller increase post-dialysis after PJ treatment, while there were no more significant differences between pre to post values in MPO and AOPP. Further analyses revealed that longer dialysis vintage (> 40 months) had higher ORP values both pre and post-dialysis compared to shorter dialysis vintage (<40 months), and that PJ had its greatest reducing effect in the longer dialysis vintage. Conclusions: ORP is a sensitive method to identify slight changes in OS. By measuring ORP, it was possible to observe reductions in OS after dialysis as a result of pre-treatment with PJ. This effect was most prominent in the longer vintage patients. ORP provided a robust indicator of OS that could be used to identify the benefits of intervention like PJ, for use in HD.
Minerva urologica e nefrologica = The Italian journal of urology and nephrology, Jan 3, 2015
Patients with severe or progressive idiopathic membranous nephropathy (IMN) should receive immuno... more Patients with severe or progressive idiopathic membranous nephropathy (IMN) should receive immunosuppressive therapy (IST). Alkylating agents, corticosteroids and cyclosporine (CsA) may be associated with substantial adverse effects and high relapse rates. To determine whether CsA is effective for long-term remission in the treatment of IMN with moderate to high risk for progression to renal failure, when given in a dosage of 3.5 mg/kg/day for 18 months, then tapered gradually to a maintenance dose of 0.35--0.70 mg/k/day within 6 months and continued for 5.5 years. The long term effectiveness of our CsA regimen in 33 incident nephrotic IMN patients was determined retrospectively. Daily proteinuria, serum albumin and creatinine clearance were compared before starting therapy (time 0) and at 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10 years. At the end of 18 months, 84.8% of patients treated with CsA were in remission; 78.8% maintained long term remission for 10 years. All patients with com...
Pregnancies in women suffering from advanced chronic renal failure are frequently associated with... more Pregnancies in women suffering from advanced chronic renal failure are frequently associated with deterioration of maternal renal function, premature births and low birth weights. Prophylactic dialysis is sometimes instituted since this intervention ameliorates the uremic milieu and improves maternal status and fetal uterine environment. This report describes a successful pregnancy and delivery in a hypertensive woman with advanced chronic renal failure due to polycystic kidney disease without accelerating the natural deterioration of renal function and without instituting prophylactic dialysis. The infant was delivered at full term with a normal birth weight. Thirty months after delivery, growth and development of the child were normal and the rate of deterioration of maternal renal function, assessed by 1/creatinine, was unaffected by pregnancy. Conservative management and effective control of blood pressure may be sufficient to achieve successful pregnancy outcome when women with...
<p><sup>**</sup><i>P</i> < 0.01, <sup>*</sup>P < ... more <p><sup>**</sup><i>P</i> < 0.01, <sup>*</sup>P < 0.05, HC vs. HD before reduction vs. after reduction (n = 8). (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177799#pone.0177799.s001" target="_blank">S1 File</a>).</p
Uploads
Papers by batya kristal