Spyridon Arampatzis

Melatonin secretion is impaired in women with preeclampsia and an abnormal circadian blood pressure rhythm

Abstract Non-dipping circadian blood pressure (BP) is a common finding in preeclampsia, accompanied by adverse outcomes. Melatonin plays pivotal role in biological circadian rhythms. This study investigated the relationship between melatonin secretion and circadian BP rhythm in preeclampsia. Cases were women with preeclampsia treated between January 2006 and June 2007 in the University Hospital of Larissa. Volunteers with normal pregnancy, matched for chronological and gestational age, served as controls. Twenty-four hour ambulatory BP monitoring was applied. Serum melatonin and urine 6-sulfatoxymelatonin levels were determined in day and night time samples by enzyme-linked immunoassays. Measurements were repeated 2 months after delivery. Thirty-one women with preeclampsia and 20 controls were included. Twenty-one of the 31 women with preeclampsia were non-dippers. Compared to normal pregnancy, in preeclampsia there were significantly lower night time melatonin (48.4 ± 24.7 vs. 85.4 ± 26.9 pg/mL, p < 0.001) levels. Adjustment for circadian BP rhythm status ascribed this finding exclusively to non-dippers (p < 0.01). Two months after delivery, in 11 of the 21 non-dippers both circadian BP and melatonin secretion rhythm reappeared. In contrast, in cases with retained non-dipping status (n = 10) melatonin secretion rhythm remained impaired: daytime versus night time melatonin (33.5 ± 13.0 vs. 28.0 ± 13.8 pg/mL, p = 0.386). Urinary 6-sulfatoxymelatonin levels were, overall, similar to serum melatonin. Circadian BP and melatonin secretion rhythm follow parallel course in preeclampsia, both during pregnancy and, at least 2 months after delivery. Our findings may be not sufficient to implicate a putative therapeutic effect of melatonin, however, they clearly emphasize that its involvement in the pathogenesis of a non-dipping BP in preeclampsia needs intensive further investigation.

Simultaneous clinical resolution of focal segmental glomerulosclerosis associated with chronic lymphocytic leukaemia treated with fludarabine, cyclophosphamide and rituximab

BackgroundAlthough renal involvement in advanced haematological malignancies is common, glomerulonephritis associated with lymphoproliferative disorders is rare, and the related pathogenetic mechanisms are still poorly understood. We present a rare case of chronic lymphocytic leukaemia(CLL)-associated focal segmental glomerulosclerosis with nephrotic-range proteinuria.Case presentationA 53-year-old Caucasian man, previously healthy, with no history of hypertension, alcohol use or smoking presented with rapid weight gain, massive peripheral oedema, and hypertension. Laboratory findings included a white blood cell count of 49,800 cells/mm3 with an absolute lymphocyte count of 47,000 cells/mm3, serum albumin of 2.3 g/dL, urea 65 mg/dL, and creatinine 1.5 mg/dL. A 24-hour urine collection contained 7.1 g protein and significant haematuria. A peripheral blood smear showed mature lymphocytosis and smudge cells. Diagnostic imaging showed mild paraaortic lymphadenopathy with no renal abnormalities. Bone marrow aspiration and trephine biopsy showed diffuse and focal infiltration with B-CLL lymphocytes. Percutaneous renal biopsy revealed total sclerosis in 3/21(14%) of the glomeruli and focal and segmental solidification and sclerosis in 4/21 (19%) glomeruli. A regimen of fludarabine, cyclophosphamide and rituximab was successful in inducing remission of the CLL and clinical resolution of the nephritic-range proteinuria.ConclusionsA multidisciplinary approach to monitor both the malignancy and the glomerular lesions is crucial for the optimal management of paraneoplastic glomerulonephritis. Although chemotherapy with fludarabine, cyclophosphamide and rituximab successfully treated CLL-associated nephrotic syndrome in our patient, further studies are required to confirm efficacy in this setting.

The effect of a previous created distal arteriovenous-fistula on radial bone DXA measurements in prevalent renal transplant recipients

Background Accelerated bone loss occurs rapidly following renal transplantation due to intensive immunosuppression and persistent hyperparathyroidism. In renal transplant recipients (RTRs) due to the hyperparathyroidism the non-dominant forearm is often utilized as a peripheral measurement site for dual-energy x-ray absorptiometry (DXA) measurements. The forearm is also the site of previous created distal arteriovenous fistulas (AVF). Although AVF remain patent long after successful transplantation, there are no data available concerning their impact on radial bone DXA measurements. Methods In this cross-sectional study we performed DXA in 40 RTRs with preexisting distal AVF (RTRs-AVF) to assess areal bone mineral density (aBMD) differences between both forearms (three areas) and compared our findings to patients with chronic kidney disease (CKD, n = 40), pre-emptive RTRs (RTRs-pre, n = 15) and healthy volunteers (n = 20). In addition, we assessed relevant demographic, biochemical and clinical aspects. Results We found a marked radial asymmetry between the forearms in RTRs with preexisting AVF. The radial aBMD at the distal AVF forearm was lower compared to the contralateral forearm, resulting in significant differences for all three areas analyzed: the Rad-1/3: median (interquartile range) in g/cm2, Rad-1/3: 0.760 (0.641–0.804) vs. 0.742 (0.642, 0.794), p = 0.016; ultradistal radius, Rad-UD: 0.433 (0.392–0.507) vs. 0.420 (0.356, 0.475), p = 0.004; and total radius, Rad-total: 0.603 (0.518, 0.655) vs. 0.599 (0.504, 0.642), p = 0.001). No such asymmetries were observed in any other groups. Lower aBMD in AVF forearm subregions resulted in misclassification of osteoporosis. Conclusions In renal transplant recipients, a previously created distal fistula may exert a negative impact on the radial bone leading to significant site-to-site aBMD differences, which can result in diagnostic misclassifications.

Giant kidneys: Correspondence

A 44 year-old previously healthy, Caucasian, male bodybuilder presented with mild oedema of lower extremities and exercise intolerance. The patient had no prescription medications, acknowledged regular use of various nutritional supplements but strongly denied current use of any anabolic substances. Urinalysis revealed proteinuria (1.8 g/day), and abdominal ultrasound showed massive bilateral nephromegaly (Fig. 1a (right), b (left kidney)) and mild hepatomegaly. Light microscopic examination of the kidney biopsy displayed focal segmental glomerulosclerosis (FSGS) with collapsing features. Because of his cardiomegaly and symptoms of congestive heart failure, a transthoracic echocardiography was performed followed by cardiac MRI, which showed a decreased cardiac ejection fraction (24%) with severe eccentric left ventricular hypertrophy and dilated cardiomyopathy. Other causes of organomegaly including amyloidosis were excluded based on laboratory and histopathological findings. Finally, the patient admitted that he had been using androgenic steroids (AASs), including nandrolone for more than a decade. Stopping AASs, decreasing exercise and starting a reninangiotensin system blockade, resulted in partial remission of proteinuria without cardiac function improvement. Abuse of AASs has been linked to cardiomyopathy and secondary forms of FSGS, potentially by direct toxic effects on cardiomyocytes and glomerular cells as well as post-adaptive glomerular changes and cell hypertrophy.

Perilipin-1 in Hemodialyzed Patients: Association With History of Coronary Heart Disease and Lipid Profile

Perilipin‐1 surrounds lipid droplets in both adipocytes and in atheroma plaque foam cells and controls access of lipases to the lipid core. In hemodialysis (HD) patients, dyslipidemia, malnutrition, inflammation and atherosclerosis are common. Thirty‐six HD patients and 28 healthy volunteers were enrolled into the study. Ten HD patients suffered from coronary heart disease (CHD). Perilipin‐1, triglycerides, total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol (HDL‐C), body mass index, albumin, geriatric nutritional risk index, normalized protein catabolic rate, interleukin‐6 (IL‐6) and tumor necrosis factor‐α (TNF‐α) were measured. Perilipin‐1 did not differ between HD patients and healthy volunteers. IL‐6 and TNF‐α were higher in HD patients. The evaluated nutritional markers and the markers of inflammation did not differ between HD patients with high perilipin‐1 levels and HD patients with low perilipin‐1 levels. Regarding the lipid profile, only HDL‐C differed between HD patients with high perilipin‐1 levels and HD patients with low perilipin‐1 levels, and it was higher in the first subgroup. Perilipin‐1 was significantly higher in HD patients without CHD. Perilipin‐1 is detectable in the serum of HD patients and it is associated with increased HDL‐C and decreased incidence of CHD.

Distal renal tubular acidosis (dRTA) and bone histomorphometry.

published a series of small studies from Thailand—where the incidence of dRTA is very high—on bone histology and bone mineral density before and after correction of acidosis in dRTA patients. They demonstrated that low bone mass levels, suppressed bone formation rates, and osteoblastic and osteoclastic activity were common findings in such patients. Correction of chronic metabolic acidosis with alkaline therapy resulted in a marked increase in bone formation. A further study from the same group showed different degrees of impaired bone matrix mineralization in dRTA patients and that alkaline therapy increased bone mass through the restoration of bone mineral balance. 4 1. Sakhaee K, Maalouf NM, Kumar R et al. Nephrolithiasis-associated bone