Hermann Kathrein

Apolipoprotein(a) phenotypes predict the risk for carotid atherosclerosis in patients with end-stage renal disease.

Several studies have demonstrated that atherosclerotic complications are the major cause of morbidity and mortality in hemodialysis patients. High lipoprotein(a) [Lp(a)] plasma concentrations are an independent risk factor for atherosclerosis. Patients with end-stage renal disease (ESRD) have elevated plasma concentrations of Lp(a), which are not explained by size variation at the apolipoprotein(a) [apo(a)] gene locus. The aim of our study was to investigate whether Lp(a) concentrations and/or apo(a) phenotypes are predictive of the degree of atherosclerosis in the extracranial carotid arteries in ESRD patients. Of 167 patients, 108 showed atherosclerotic plaques (65%). Univariate analysis showed that the plaque-affected group was significantly older and had a higher frequency of angina pectoris, previous myocardial infarction, or cerebrovascular accident. Furthermore, this group included significantly more patients with low-molecular-weight apo(a) isoforms (26.9% versus 8.5%, P < .005) and had significantly higher mean Lp(a) plasma concentrations (29.3 +/- 31.0 versus 19.7 +/- 25.7 mg/dL, P < .05). Lp(a) plasma concentration increased significantly with the number of affected arterial sites, from 19.7 mg/dL in patients without plaques to 40.1 mg/dL in patients with seven or eight affected sites. In patients with low-molecular-weight phenotypes, significantly more arterial sites were affected (3.62 versus 2.08, P < .001). Multivariate regression analysis showed that age, angina pectoris, and the apo(a) phenotype were the only significant predictors of the degree of atherosclerosis. We conclude that, besides age, the apo(a) phenotype is the best predictor of carotid atherosclerosis in ESRD patients and may be used for assessment of general atherosclerosis risk in this patient group.

DETERIORATION OF PRIMARY BILIARY CIRRHOSIS DURING TREATMENT WITH URSODEOXYCHOLIC ACID

now ongoing in Europe and overseas (Dr Falk, Falk Foundation, personal communication). UDCA was introduced for the dissolution of radiolucent gallstones in the 1970s and is available on prescription in many European countries. As no treatment for PBC has so far been found to be effective, an increasing number of physicians are prescribing UDCA for desperate cases of PBC because of the drug’s supposedly low toxicity.! To add a word of caution when using UDCA in PBC, we would report the following

LDL‐unbound apolipoprotein(a) and carotid atherosclerosis in hemodialysis patients

High lipoprotein{a) [Lp(a)] plasma concentrations, which are genetically determined by apo(a) size polymorphism, are directly associated with an increased risk for atherosclerosis. Patients with end‐stage renal disease (ESRD), who show an enormous prevalence of cardiovascular disease, have elevated plasma concentrations of Lp(a). In recent studies we were able to show that apo(a) size polymorphism is a better predictor for carotid atherosclerosis and coronary artery disease in hemodialysis patients than concentrations of Lp(a) and other lipoproteins. Less than 5% of apo(a) in plasma exists in a low‐density lipoprotein (LDL)‐unbound form. This “free” apo(a) consists mainly of disintegrated apo(a) molecules of different molecular weight, ranging from about 125 to 360 kDa. LDL‐unbound apo(a) molecules are elevated in patients with ESRD. The aim of this study was therefore to investigate whether the LDL‐unbound form of apo(a) contributes to the prediction of carotid atherosclerosis in a group of 153 hemodialysis patients. The absolute amount of LDL‐unbound apo(a) showed a trend to increasing values with the degree of carotid atherosclerosis, but the correlation of Lp(a) plasma concentrations with atherosclerosis was more pronounced. In multivariate analysis the two variables were related to neither the presence nor the degree of atherosclerosis. Instead, the apo(a) phenotype took the place of Lp(a) and LDL‐unbound apo(a). After adjustment for other variables, the odds ratio for carotid atherosclerosis in patients with a low molecular weight apo(a) phenotype was about 5 (p < 0.01). This indicates a strong association between the apo(a) phenotype and the prevalence of carotid atherosclerosis. Finally, multivariate regression analysis revealed age, angina pectoris and the apo(a) phenotype as the only significant predictors of the degree of atherosclerosis in these patients. In summary, it seems that LDL‐unbound apo(a) levels do not contribute to the prediction of carotid atherosclerosis in hemodialysis patients. However, this does not mean that “free”, mainly disintegrated, apo(a) has no atherogenic potential.

Ultrasonography in Wilson Disease

Excerpt To the editor: The hepatic manifestations of Wilson disease can mimic acute, self-limited hepatitis, rarely progressing to fulminant liver failure or chronic liver disease. The rate of prog...

β2-Microglobulin: a prognostic parameter for graft survival after renal transplantation

Abstract The determination of β 2 -microglobulin has recently been proposed as a promising diagnostic method to monitor the state of renal allografts. Elevated levels of β 2 MG in the serum and/or urine allow the substantiation of the diagnosis of an acute graft rejection and are helpful in distinguishing acute tubular necrosis from a rejection reaction (1). In this paper, the usefulness of β 2 MG serum levels is evaluated, not only during the immediate post-operation phase but also for the long-term prognosis of renal allografts. The immunosuppression treatment included methylprednisolone and azathioprine in all the presented patients. The data indicate that a rapid normalization of β 2 MGSL within 6 days, even if the decrease is interrupted by reelevation due to acute rejection episodes or inflammatory diseases, represents a good longterm prognosis for kidney allografts.

Ultrasound in transition – sonographers and student sonographers in Austria

Ultrasound pioneers come from many different countries and from various areas of specialization so that the organization of US is highly heterogeneous in medical fields in Europe as well as around the world [1, 2]. This is also reflected in the scientific representation of US that is traditionally organized in AT, DE, and CH in large interdisciplinary US societies (Austrian Society of Ultrasound in Medicine (ÖGUM), German Society of Ultrasound in Medicine (DEGUM), Swiss Ultrasound Society in Medicine (SGUM)). US is an integrative part of the student curriculum of Austrian medical universities and also an integrative part of physician training in many areas of specialization in accordance with the “new” training regulations from 2015.

Use of Donor-Specific T-Cell Lines for Monitoring of Human Allograft Recipients

Donor-specific and highly cytotoxic T-cell lines (TCL) as well as lectin-induced TCL were established from pretransplant lymphocytes of 6 cadaveric renal allograft recipients. These TCL were used in the 125I-staphylococcus protein A assay to detect IgG antibodies in pre- and posttransplant sera of these patients preferentially binding to autologous donor-specific TCL. Such antibodies were detected in pretransplant sera from 4 of these 6 allograft recipients. Antibody levels in these 4 patients and in 1 additional case who became positive after transplantation further increased during acute cellular rejection episodes. They disappeared after successful treatment but remained elevated until transplantectomy for treatment of irreversible rejection in 1 case. IgG antibodies binding to autologous lectin-induced TCL were detected in only 1 patient and exhibited a pattern clearly different from those binding to donor-reactive TCL. Although attempts to define the antigenic specificity of the autoantibodies binding to donor-specific TCL by genetical and biochemical means has remained unsuccessful so far, the demonstration of their relationship to in vivo expansion of donor-reactive immune cells deserves further attention.

Evaluation of spontaneous lymphocyte proliferation by single cell autoradiography in human allograft recipients

Spontaneous lymphocyte proliferation was studied in 22 patients receiving cadaveric renal transplants before and at various times after grafting. Prophylactic immunosuppression consisted of CyA and prednisone. Spontaneous lymphocyte proliferation was evaluated in a total of 500 single cell autoradiographs after short term in vitro incubation with [3H]TdR. In 13 patients without clinical problems a transitory increase of lymphocyte labeling indices to approximately five times the pretransplant levels was observed. The failure to detect such increments in two patients receiving optimally matched grafts suggested that this early proliferative lymphocyte peak might be caused by in vivo recognition of major histocompatibility antigens. Much higher labeling indices were detected in close temporary association with acute cellular rejection (4 cases), severe infections and withdrawal of CyA (3 cases) and venous thrombosis (1 case). Only moderately elevated numbers of spontaneously proliferating lymphocytes were seen in one patient with a reversible vascular rejection episode. It appears that assessment of spontaneous lymphocyte proliferation is capable of discriminating on a quantitative level between patients with and without clinical problems such as acute cellular rejection and infection.