RESUMEN
BACKGROUND: Urinary Dickkopf 3 (DKK3) excretion is a recently established biomarker of renal functional development. Its excretion into the peritoneal cavity has not been reported. We here studied DKK3 in peritoneal dialysis. METHODS: DKK3 was assessed in serum, urine and dialysate in a prevalent adult peritoneal dialysis cohort and its concentration analyzed in relation to creatinine and clinical characteristics. RESULTS: Highest DKK3 concentrations were found in serum, followed by urine. Dialysate concentrations were significantly lower. Dialysate DKK3 correlated with both other compartments. Serum, dialysate and urine values were stable during three months of follow-up. Continuous ambulatory dialysis (CAPD) but not cycler-assisted peritoneal dialysis (CCPD) volume-dependently increased peritoneal DKK3 in relation to creatinine. RAAS blockade significantly decreased urinary, but not serum or peritoneal DKK3. CONCLUSION: Our data provide a detailed characterization of DKK3 in peritoneal dialysis. They support the notion that the RAAS system is essential for renal DKK3 handling.
Asunto(s)
Proteínas Adaptadoras Transductoras de Señales , Diálisis Peritoneal , Humanos , Masculino , Femenino , Persona de Mediana Edad , Proteínas Adaptadoras Transductoras de Señales/metabolismo , Quimiocinas/sangre , Quimiocinas/metabolismo , Anciano , Adulto , Péptidos y Proteínas de Señalización Intercelular/metabolismo , Fallo Renal Crónico/terapia , Fallo Renal Crónico/metabolismo , Biomarcadores/sangre , Soluciones para Diálisis/metabolismo , Riñón/metabolismo , Peritoneo/metabolismo , Diálisis Peritoneal Ambulatoria Continua , Sistema Renina-Angiotensina/fisiología , Creatinina/orina , Creatinina/sangre , Creatinina/metabolismoRESUMEN
Infection with cytomegalovirus (CMV) with resistance to ganciclovir (GCV) is a therapeutic challenge in kidney transplant patients, because standard treatment options are nephrotoxic. We report the case of a kidney transplant recipient with GCV-resistant CMV disease, in whom letermovir, a novel inhibitor of CMV packaging, was administered off-label and prevented a relapse of disease once the CMV load was decreased by cidofovir. Furthermore, we observed significant drug interactions between letermovir and tacrolimus. LEARNING POINTS: Cytomegalovirus (CMV) disease with resistance to ganciclovir (GCV) is difficult to manage in transplant patients.Letermovir may become a new option for treatment and prophylaxis of GCV-resistant CMV infection, but assessment of treatment response is difficult.Letermovir may lead to drug interactions via CYP3A4.