Effect of Twice-Yearly Denosumab on Prevention of Bone Mineral Density Loss in De Novo Kidney Transplant Recipients: A Randomized Controlled Trial.

We conducted an open-label, prospective, randomized trial to assess the efficacy and safety of RANKL inhibition with denosumab to prevent the loss of bone mineral density (BMD) in the first year after kidney transplantation. Ninety kidney transplant recipients were randomized 1:1 2 weeks after surgery to receive denosumab (60 mg at baseline and 6 months) or no treatment. After 12 months, total lumbar spine areal BMD (aBMD) increased by 4.6% (95% confidence interval [CI] 3.3-5.9%) in 46 patients in the denosumab group and decreased by -0.5% (95% CI -1.8% to 0.9%) in 44 patients in the control group (between-group difference 5.1% [95% CI 3.1-7.0%], p < 0.0001). Denosumab also increased aBMD at the total hip by 1.9% (95% CI, 0.1-3.7%; p = 0.035) over that in the control group at 12 months. High-resolution peripheral quantitative computed tomography in a subgroup of 24 patients showed that denosumab increased volumetric BMD at the distal tibia and radius (all p < 0.05). Biomarkers of bone turnover (C-terminal telopeptide of type I collagen, procollagen type I N-terminal propeptide) markedly decreased with denosumab (all p < 0.0001). Episodes of cystitis and asymptomatic hypocalcemia occurred more often with denosumab, whereas graft function, rate of rejections, and incidence of opportunistic infections were similar. In conclusion, denosumab increased BMD in the first year after kidney transplantation but was associated with more frequent episodes of urinary tract infection.

[Chronic kidney disease in the general practitioner's office]. / Chronische Niereninsuffizienz in der Hausarztpraxis.

People suffer increasingly from arterial hypertension and/or diabetes mellitus. These two diseases represent the most frequent causes leading to chronic kidney disease. The assessment of renal function by means of formulas serves as a basis for further decision making regarding the management of patients with chronic kidney disease. On one hand, the therapy focuses on the treatment of the underlying illness as well as possible, acute and reversible causes of renal dysfunction. On the other hand, the therapy includes measures to decelerate the progression of chronic kidney disease (nephroprotection) and to correct its associated complications (renal hypertension, renal anemia, secondary hyperparathyroidism). If these therapeutic measures are applied timely (ideally as of CKD stage 3 with glomerular filtration rate <60 ml/min) and in close collaboration with a nephrologist, end stage renal disease can be delayed by several years.

[Will broken glass bring luck?]. / Bringen Scherben Glück?

A 56 year old female patient presented to the emergency room because of a progressive, painful swelling of her thigh, clinically suspected to be a haematoma. Trauma was denied. Ultrasonography revealed a hyperechogenic structure, which appeared to be an intramuscular foreign body on computed tomography. Intraoperatively, a large piece of glass was found. Glass foreign bodies can be detected by x-rays with a high sensitivity. The threshold to order x-ray for the detection of glass foreign bodies should be low.

[Subacute weakness of the lower limbs]. / Subakute Beinschwäche.

Complete and isolated herniation of the urinary bladder is extremely rare, and the consecutive appearance of bilateral urethral obstruction and renal failure is even rarer. We report about a 73 year old male presenting with massive nausea and muscular weakness. On physical examination he showed a giant inguinal hernia with involvement of the entire bladder along with evidence of bilateral hydronephrosis. His serum creatinine and potassium levels were markedly elevated most likely leading to his presenting symptoms of azotemia (nausea) and hyperkalemia (weakness). After transscrotal drainage and decompression of the bladder, a transurethral catheter was inserted. After gaining full renal recovery, the hernia was repaired successfully performing the Lichtenstein procedure.