Protected: Risk Factors for Stroke in Patients with Nephrotic Syndrome: Experience from Two Centers in Poland

Posted on Scarica PDF

Michael Kitlinski

DOI: 10.69097/41-05-2024-10

Michael Kitlinski1,3, Zbigniew Heleniak MD PhD1, Aleksander Och1, Piotr Tylicki1, Justyna Fercho MD2, Tomasz Liberek MD PhD1, Tomasz Stompór MD PhD4, Tomasz Szmuda MD PhD2, Alicja Dębska-Ślizień MD PhD1

1 Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
2 Department of Neurosurgery, Medical University of Gdansk, Poland
3 Department of Translational Medicine, Clinical Research Centre, Lund Univeristy, Malmö, Sweden
4 Department of Nephrology, Hypertension and Internal Medicine, University of Warmia and Mazury in Olsztyn, 10-516 Olsztyn, Poland

Corresponing author:
Michael Kitlinski
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, 80-210 Gdansk
Marii Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland
Tel: +46 722 41 48 41
email: michael.kitlinski@gumed.edu.pl

 

Abstract

Objective. Patients with nephrotic syndrome (NS) have an increased risk of developing acute ischemic stroke (aIS) and intracranial hemorrhage (ICH). However, the informations on the risk factors for these outcomes are unknown. The aim of this study was therefore to determine the risk factors for stroke among patients with NS.
Methods. A multicentric retrospective cohort of patients who developed aIS or ICH, following a diagnosis of NS between 2010 and 2021 was assembled. NS patients who did not develop stroke at follow-up were assembled as non-matched controls from the same study period. Cox regression yielding a hazard ratio (HR) with a 95% confidence interval was applied to investigate the potential risk factors for stroke among patients with NS. A meta-analysis on the current litterature was also performed.
Results. With a mean follow-up of 6 years, a total of 45 patients with NS were included of which 14 were diagnosed with aIS and 4 with ICH at follow-up. Significant risk factors for stroke in patients with NS were diabetes mellitus (DM) (HR 2.85, 95%CI 1.10-7.49; p-value = 0.03), diabetic nephropathy (HR 2.74, 95% CI 1.06-7.07; p-value = 0.038) smoking (HR 8.29, 95% CI 2.20-31.2; p-value = 0.002), prior arterial thromboembolic events (ATEs) (HR 2.86, 95% CI 1.09-7.53: p-value = 0.03) and age > 55 years old (HR 4.84, 95% CI 1.48-15.8; p-value = 0.009). Administration of low molecular weight heparin (LMWH) (HR 0.88, 95% CI 0.22-3.43; p-value = 0.848) did not affect the risk-estimates for developing stroke in patients with NS. Meta-analysis including 1091 patients revealed prior ATEs, diabetes, hypertension and smoking to be risk factors for ATEs among patients with NS.
Conclusion. In this study we found older age, DM, prior ATEs and smoking to increase the risk of developing stroke in patients with NS, while notably LMWH had no protective effects. Our findings may serve as an aid for physicians in managing and identifying high-risk patients for stroke in this subpopulation.

Keywords: Nephrotic syndrome, Stroke, Thromboembolism, Risk factors

This content is password protected. To view it please enter your password below:

Risk Factors for Idiopathic Nephrotic Syndrome Relapse in Pediatric Age

Posted on Scarica PDF

Luca Pecoraro

DOI: 10.69097/41-04-2024-04

Luca Pecoraro1, Germana Longo2, Mattia Parolin2, Enrico Vidal2, Nadia Antonucci3, Valeria Silecchia2, Maria Sangermano2, Elisa Benetti2

1 Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
2 Pediatric Nephrology, Department of Women's and Children's Health, Padua University Hospital, 35122 Padua, Italy
3 Indipendent Statistician

Corresponding Author:
Luca Pecoraro
Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy.
E-mail address: luca.pecoraro@aovr.veneto.it

 

Abstract

Introduction. Eighty percent of children with primitive nephrotic syndrome (NS) will have at least one relapse in their life. Specific risk factors could be associated with a higher incidence of relapses and a worse prognosis. This study aims to deepen the demographic and onset-related risk factors in children with known diagnosis of primitive NS attending the Pediatric Nephrology Unit of the University Hospital of Padua.
Methods. Observational, descriptive study of all children (1-11 years old) with a known diagnosis of Primitive NS who attended our Pediatric Nephrology Unit between 1 January 2002 and 31 March 2023.
Results. 49 patients were involved. 79.5% had at least one episode of NS relapse during their lifetime. 69.4% were classified as frequently relapsing or steroid-dependent NS. The relapse risk factor “non-Western ethnicity” was related to a worse prognosis and steroid-dependent NS classification (p = 0.041). The onset-related risk factor “thrombocytosis” appears to be related to a better prognosis (p = 0.03).
Conclusion. The relapse risk factors “non-Western ethnicity” and “thrombocytosis” are characterized by worse and better prognosis, respectively. This evidence could support the follow-up of primitive NS in pediatric age.

Keywords: nephrotic syndrome relapse, risk factors, ethnicity, thrombocytosis

Introduction

Eighty percent of children with primitive nephrotic syndrome (NS) will have at least one relapse in their life. Among these, fifty percent will be affected by frequently relapsing or steroid-dependent NS [1]. It is very difficult to predict NS relapses. At the same time, it is historically known that fifty percent of treated patients are affected by relapses in the first 6 months [2]. Moreover, it is demonstrated that more relapses are associated with a worse prognosis [1]. Several studies demonstrated that specific risk factors for NS relapses could be associated with a higher incidence of NS relapses. On the one hand, demographic risk factors, such as male sex, atopy, rural background, low socioeconomic status, and non-Western ethnicity, are involved. On the other hand, onset NS-related risk factors are associated with more relapses, such as age < 5 years, reduced serum albumin and serum total protein, reduced nutritional status, remission no sooner than two weeks of steroid therapy, concurrent infectious episode, poor compliance in steroid therapy [4, 8]. This study aims to deepen the demographic and onset-related risk factors for NS relapse in children with known diagnosis of primitive NS attending the Pediatric Nephrology Unit of the University Hospital of Padua. 

La visualizzazione dell’intero documento è riservata a Soci attivi, devi essere registrato e aver eseguito la Login con utente e password.

New strategies for prevention and early diagnosis of iodinated contrast-induced nephropathy: a systematic review

Posted on Scarica PDF

Rosario Maccarrone

Rosario Maccarrone1, Luca Di Lullo2, Mauro Forcella3, Antonio Bellasi4, Antonio Granata5

1 U.O.C. di Nefrologia e Dialisi, P.O. “San Giovanni di Dio”, Agrigento, Italia
2 U.O.C. di Nefrologia e Dialisi, P.O. “L. Parodi – Delfino”, Colleferro, Roma, Italia
3 S.C. Nefrologia e Dialisi a direzione Universitaria, Azienda Ospedaliero-Universitaria OO.R.R., Foggia, Italia
4 Unità di Ricerca, Innovazione e Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italia
5 U.O.C. di Nefrologia e Dialisi – A.O. “Cannizzaro”, Catania, Italia

Corrispondenza a:
Rosario Maccarrone
UOC di Nefrologia e Dialisi, P.O. "San Giovanni di DIO" - Agrigento
C/da Consolida, 92100 Agrigento, Italia
Fax/Tel number: +393465185754
e-mail address: rosario.maccarrone88@gmail.com

 

Abstract

Iodinated contrast-induced nephropathy is one of the most feared complications of percutaneous coronary interventions and is associated with increased cardio-vascular mortality and a faster progression towards end stage renal disease. The effects of the iodinated contrast medium on intra-renal hemodynamics and its direct cytotoxic action on proximal tubular cells contribute synergistically to the pathophysiology of renal damage. Since the therapeutic options are extremely limited, the rapid identification of risk factors and the timely implementation of preventive strategies are mandatory to reduce the incidence of iodinated contrast-induced nephropathy. To date, the criteria for defining and staging contrast medium nephropathy are still based on the increase of serum creatinine and/or contraction of diuresis, which are lacking in specificity and therefore do not allow early diagnosis. The aim of this review is to report the latest evidence on the pathophysiological mechanisms that contribute to renal damage by iodinated contrast medium, on the risk stratification tools and on the new early biomarkers of contrast-induced nephropathy, while also focusing on the most validated prevention strategies.

 

Keywords: contrast medium, nephropathy, risk factors, early diagnosis, prevention

Sorry, this entry is only available in Italian.

Introduzione

La nefropatia da mezzo di contrasto iodato (Contrast Induced Nephropathy – CIN) rappresenta la terza causa di danno renale acuto (Acute Kidney Injury – AKI) acquisita durante un ricovero ospedaliero. La CIN ha un impatto nettamente sfavorevole sull’outcome del paziente, in quanto si associa ad un’elevata incidenza di eventi cardio-vascolari, una ridotta sopravvivenza sia nel breve che nel medio-lungo termine e a un prolungamento dei tempi di ospedalizzazione, con importanti ripercussioni sulla spesa sanitaria. Un recente studio retrospettivo condotto su 11.249 pazienti sottoposti ad angiografia coronarica ha inoltre dimostrato che lo sviluppo di CIN correla con una progressione più rapida verso l’insufficienza renale cronica [1,2]. Questi dati dipendono non solo dal numero sempre più crescente di procedure radiologiche eseguite per fini diagnostici e/o terapeutici, ma soprattutto dalle caratteristiche demografiche dell’utenza che beneficia di tali procedure: nella maggior parte dei casi, infatti, si tratta di pazienti anziani affetti da una o più comorbilità, (ad es., scompenso cardiaco cronico, ipertensione arteriosa, diabete mellito, malattia renale cronica – MRC – preesistente, etc.,), che correlano con un aumentato rischio di CIN rispetto alla popolazione generale [3]. Sebbene l’associazione tra esposizione a mezzo di contrasto (MDC) e tossicità renale sia nota dagli anni ’60, ad oggi non vi è accordo in letteratura sulle modalità di definizione e stadiazione della CIN, che si basano ancora su parametri, quali la creatininemia e la diuresi, privi di specificità e che non consentono una diagnosi precoce. Negli ultimi anni il tema della tossicità renale da MDC è stato oggetto di nuovi studi in ambito nefrologico, cardiologico e radiologico, che hanno consentito di acquisire importanti conoscenze sulla fisiopatologia, i fattori di rischio e le strategie di prevenzione della CIN. Lo scopo della presente review è stato quello di riesaminare le ultime evidenze sui meccanismi fisiopatologici che concorrono al danno renale da MDC, sugli strumenti di stratificazione del rischio e sui nuovi biomarkers precoci di CIN, focalizzando altresì l’attenzione sulle strategie preventive maggiormente validate in letteratura. 

La visualizzazione dell’intero documento è riservata a Soci attivi, devi essere registrato e aver eseguito la Login con utente e password.