Vancomycin Adsorption During in vitro Model of Hemoperfusion with HA380 Cartridge.

INTRODUCTION: A critical point for using blood purification during sepsis may be the potential interaction with antimicrobial therapy, the mainstay of sepsis treatment. The aim of our study was to investigate the vancomycin removal during hemoperfusion (HP) using HA380 cartridge. METHODS: This is an experimental study, in which 500 mL of solution was circulated in a closed-circuit (blood flow of 250 mL/min) simulating HP ran using HA380. Vancomycin was added to reach a through concentration or a very high concentration to evaluate the removal ratio (RR) during 120 min of HP. Comparison between blood-crystalloid solution and balanced solution was performed by using Kruskal-Wallis test. The kinetics of vancomycin removal and the adsorption isotherm were evaluated. RESULTS: We found a complete removal of vancomycin at baseline through concentration of 23.0 ± 7.4 mg/L. Using extremely high concentration (baseline 777.0 ± 62.2 mg/L), RR was 90.1 ± 0.6% at 5 min and 99.2 ± 0.6% at 120 min. No difference in terms of RR was found between blood-crystalloid mixture and balanced solution. The kinetics of the vancomycin reduction followed an exponential decay. Repeated boluses (total amount of 2,000 mg) resulted in cumulative adsorption of 1,919.4 mg with RR of 96.6 ± 1.4%, regardless of the amount injected (100 vs. 500 mg). Vancomycin adsorption onto HA380 followed the Langmuir isotherm model. CONCLUSIONS: A considerable amount of vancomycin was rapidly removed during in vitro HP with HA380. Clinical studies are needed to determine whether this may lead to underdosing. Drug therapeutic monitoring is highly recommended when using HA380 for blood purification in patients receiving vancomycin.

Gadolinium-based contrast media exposure and the possible risk of subclinical kidney damage: a pilot study.

PURPOSE: We performed a pilot study to evaluate the feasibility of future research about the presence of subclinical kidney damage after Gadolinium-based contrast media exposure. The future study aims to understand which are the behaviors of two markers of kidney damage, such as urinary NephroCheck (NC) and/or neutrophil gelatinase-associated lipocalin (NGAL). Specifically, after GBCM exposure, NC urinary detection should identify proximal tubule damage while NGAL urinary detection should be related to distal tubule damage. METHODS: We performed a pilot study in patients who had Gadolinium exposure. The feasibility of future study is reached when at least 90% of candidates completed the pilot study. In each patient, we tested urinary NC and NGAL levels 24 h before magnetic resonance imaging (MRI) and 12-24 h after the exposure. Furthermore, we evaluated the administration of other nephrotoxic agents, the presence of comorbidity, and kidney function by S-creatinine and urine protein before the MRI. RESULTS: We enrolled 35 candidates of whom 33 patients completed all study procedures. Our population had a mean age of 60.7 ± 14.8 years with normal kidney function with a median S-creatinine equal to 0.7 mg/dl (Interquartile range [IQR] 0.6-0.91). Urinary NC levels increased from 0.21 ng2/ml2 (IQR 0.11-0.4) before MRI to 0.34 ng2/ml2 (IQR 0.16-0.86) (p = 0.005). Conversely, we did not appreciate any significant modification in urinary NGAL (p = 0.53). CONCLUSION: Our pilot study seems adequate in terms of feasibility and encourages us to focus our future research on renal proximal tubule, as the principal site of subclinical kidney damage after Gadolinium exposure.

Renal oncocytoma in a kidney transplant patient: the imaging features on contrast-enhanced ultrasonography (CEUS): a case report.

Renal oncocytoma is an infrequently reported renal neoplasm, often asymptomatic, which usually behaves as a benign entity and is identified accidentally on radiological imaging. Transplant patients under long-term immunosuppressive drugs have a high prevalence of cancers, such as skin cancers, lymphoproliferative disorders, and renal carcinomas. We present a case report of an asymptomatic renal oncocytoma in a kidney transplant recipient presenting persistent hematuria. The features of computed tomography and contrast-enhanced ultrasound (CEUS) are presented. This was the first time we used CEUS in a transplant kidney recipient presenting a renal mass, allowing the real-time visualization of contrast-enhancement patterns during all vascular phases for the differential diagnosis of renal tumors. Although the pattern of intense vascularization could mislead to an early judgment as a malignant lesion, it could help to exclude other renal lesions without inducing nephrotoxicity.

Renal oncocytoma in a kidney transplant patient: the imaging features on contrast-enhanced ultrasonography (CEUS): a case report / Oncocitoma renal em paciente transplantado: achados de imagem na ultrassonografia com contraste

Abstract Renal oncocytoma is an infrequently reported renal neoplasm, often asymptomatic, which usually behaves as a benign entity and is identified accidentally on radiological imaging. Transplant patients under long-term immunosuppressive drugs have a high prevalence of cancers, such as skin cancers, lymphoproliferative disorders, and renal carcinomas. We present a case report of an asymptomatic renal oncocytoma in a kidney transplant recipient presenting persistent hematuria. The features of computed tomography and contrast-enhanced ultrasound (CEUS) are presented. This was the first time we used CEUS in a transplant kidney recipient presenting a renal mass, allowing the real-time visualization of contrast-enhancement patterns during all vascular phases for the differential diagnosis of renal tumors. Although the pattern of intense vascularization could mislead to an early judgment as a malignant lesion, it could help to exclude other renal lesions without inducing nephrotoxicity.

Resumo O oncocitoma renal é uma neoplasia renal raramente relatada, muitas vezes assintomática, que geralmente se comporta como uma entidade benigna e é identificada acidentalmente em imagens radiológicas. Pacientes transplantados em regimes imunossupressores de longa duração apresentam alta prevalência de neoplasias tais como câncer de pele, distúrbios linfoproliferativos e carcinomas renais. Apresentamos o relato de um caso de oncocitoma renal assintomático em receptor de transplante renal com hematúria persistente. São apresentados os achados de imagens de tomografia computadorizada e ultrassonografia (US) com contraste. Foi a primeira vez que utilizamos a US com contraste em um receptor de transplante renal que apresentava massa renal, permitindo a visualização em tempo real dos padrões de realce do contraste em todas as fases vasculares para o diagnóstico diferencial dos tumores renais. Embora o padrão de vascularização intensa possa induzir uma avaliação precoce de lesão maligna, o exame ajuda a excluir outras lesões renais sem induzir nefrotoxicidade.