Drugs and AKI.

Acute kidney injury is a common complication in hospitalized patients and is associated with substantially increased morbidity and mortality. Frequently, it is caused by impaired renal perfusion, ischemia and reperfusion injury, sepsis or urinary tract obstruction, but often its etiology is multifactorial. In this context, the contribution of nephrotoxic medications to the development of AKI plays an important role. This review begins with an attempt to evaluate the importance of drug-related acute kidney injury in general. Then, a selected list of 7 classes of drugs or compounds, namely aminoglycosides, aristolochic acid, cytostatic drugs, nonsteroidal anti-inflammatory drugs, osmotic agents, radiocontrast, and phosphate salts are discussed in depth, including their epidemiology, pathophysiology, clinical features and treatment. While not attempting to be exhaustive, this review attempts to provide an overview with additional in-depth information on certain classes of drugs that are either of general importance or have recently emerged in the literature.

Recovery of acute renal failure following bilateral renal artery angioplasty and stenting.

Atherosclerotic renovascular disease commonly coexists with chronic kidney disease, and its optimal management remains unsettled. In this case report, we describe a 75-year-old woman with chronic kidney disease and critical atherosclerotic bilateral renal artery stenosis, who presented with a hypertensive emergency and developed acute renal failure following antihypertensive treatment. Bilateral percutaneous transluminal renal angioplasties (PTRA) with stent placement were performed and resulted in immediate recovery of renal function. The existing literature on this impressive response to PTRA is reviewed and discussed.

Transient expression of the serotonin transporter in the developing mouse thalamocortical system.

The serotonin transporter was visualized in sections through the developing mouse thalamus by autoradiography of [3H]citalopram binding. In late gestation, a high density of transporter expression appeared in the ventrobasal thalamic complex and medial geniculate body. During the first postnatal week, binding in these areas decreased to low levels. A similar pattern of transient [3H]citalopram binding was observed in the somatosensory cortex, although the rise and decline of labeling occurred some days later. The density of the serotonergic innervation in the ventrobasal thalamic complex is known to be very low during the entire developmental period. Therefore, these data suggest that the serotonin transporter may be expressed transiently by thalamic neurons projecting to the cerebral cortex (as a "heterocarrier") which are capable of taking up serotonin in the somatosensory cortex. We propose that serotonin may act temporarily as a "false" transmitter in thalamocortical axons.

Cinacalcet treatment of primary hyperparathyroidism.

Although parathyroidectomy remains the only curative approach to most primary hyperparathyroidism cases, medical treatment with cinacalcet HCl has been proven to be a reasonable alternative for several patient subgroups. Cinacalcet almost always controls hypercalcemia and hypophosphatemia sufficiently. PTH levels are lowered, and cognitive parameters improve. While an increase in bone mineral density DEXA scan scores was not demonstrated in cinacalcet trials, the same applies to more than half of patients after parathyroidectomy. Medical therapy should be first choice in patients with hyperplasia in all glands rather than an isolated adenoma (10-15%), patients with persisting HPT following unsuccessful surgery or inoperable cases due to comorbidities, and patients detected in lab screens for hypercalcemia before developing symptoms who should be treated early but are usually reluctant to undergo surgery. Nephrolithiasis was not found to occur more frequently in cinacalcet trial groups, but urine calcium excretion as one major risk factor of this complication of primary HPT may increase on cinacalcet. Patients carrying the rs1042636 polymorphism of the calcium-sensing receptor gene respond more sensitively to cinacalcet and have a higher risk of calcium stone formation. Cinacalcet is usually administered twice daily but three or four doses per day should be discussed to mimic the beneficial pulsatile PTH-pattern.

Prenatal development of the serotonin transporter in mouse brain.

The prenatal development of the serotonin transporter was analyzed in mouse brain and spinal cord by autoradiographic localization of [3H]citalopram binding. Transporter expression started at embryonic day (E) 12 in two discontinuous bands in the anterior and posterior brainstem. Labeling extended cranially and caudally, reaching the basal diencephalon at E 13, the septal complex at E 15, and the cerebral cortex at E 16. The caudal extension of the labeling descended at the ventrolateral margin of the spinal cord and reached lumbar levels at E 14. At E 17-E 18, [3H]citalopram binding emerged in the striatum, amygdaloid area, ventrobasal thalamus, paraventricular and periventricular hypothalamic nuclei, and substantia nigra. The overall spatiotemporal expression pattern of the serotonin transporter in the mouse agrees with data on the immunohistochemical localization of serotonin in the rat embryo. These results suggest that serotonergic fibers have the equipment to engage in transmitter reuptake long before synapse formation, and that transporter expression might represent a prerequesite for the developmental functions exerted by serotonin.

Methylenetetrahydrofolate-reductase gene C677T variant and kidney-transplant survival.

UNLABELLED: BACKGROUND. Hyperhomocysteinaemia, a risk factor for atherosclerosis, is common in haemodialysis and renal-transplant patients. As atherosclerotic lesions in hyperhomocysteinaemia resemble those of chronic allograft injury, we examined the hypothesis that the C677T variant of the methylenetetrahydrofolate reductase (MTHFR) gene, which is linked to elevated plasma homocysteine levels in patients with renal failure, determines renal allograft survival. METHODS: DNA was prospectively collected from 336 patients undergoing renal transplantation in our clinic between 1988 and 1994 and their corresponding donors. Patient and allograft survival was analysed by blinded review of all case records over a follow-up period of 36 months. Additionally, we recruited 83 patients surviving with a functional kidney allograft for at least 10 years (mean: 156, range 120-240 months). MTHFR-C677T genotype was determined by a PCR-RFLP technique. The influence of genotype on transplant survival was analysed by Kaplan-Meyer life-table analysis and two-tailed global log-rank testing. RESULTS: Frequency of the MTHFR-C677T allele in the cohort group was identical in recipients (0.35) and donors (0.34), and comparable to that in the longterm allograft survivors (0.37). Furthermore, life-table analysis revealed a similar allograft survival over 36 months between the genotype groups (CC 74%, CT 69%, TT 75%). Other risk factors including donor and recipient age, hypertension, body-mass index, and number of rejection therapies were evenly distributed between the different genotype groups. CONCLUSIONS: These findings do not support the hypothesis that the C677T variant of the MTHFR gene is an important determinant of renal-transplant survival.

The possible role of myocardial biopsy in systemic sclerosis.

The histopathological features of heart involvement in systemic sclerosis (SSc) are not widely known. In internal and transplantation medicine, myocardial biopsies are increasingly used to diagnose cardiomyopathies including myocarditis. In two SSc patients presenting with dyspnoea with no evidence of pulmonary involvement, the cause of the compromised heart function was sought by myocardial biopsy. Immunohistological analysis revealed an increased number of CD3+ + T cells indicating myocarditis in one, and increased amounts of fibroblasts in both SSc patients. The authors think that myocardial involvement in SSc should be differentially evaluated and they propose the use of myocardial biopsies as a tool to distinguish between inflammatory and fibrotic forms of heart involvement in SSc patients.