The interstitial expression of alpha-smooth muscle actin in glomerulonephritis is associated with renal function.

BACKGROUND: In a healthy kidney, contractile protein alpha-smooth muscle actin (ASMA) is immunohistochemically strongly expressed only in the blood vessels, while in pathological conditions it can be visualized in glomerular mesangial cells and interstitial myofibroblasts. The aim of this study was to explore the possible correlation between expression of ASMA in glomerulonephritis (GN) and indicators of renal function. MATERIAL/METHODS: We analyzed expression of ASMA in percutaneous renal biopsy of 142 adult and pediatric patients with GN and its correlation with blood pressure, serum creatinine, creatinine clearance and 24-hour urine protein at the time of biopsy. Immunoexpression of ASMA was analyzed quantitatively using computer-assisted morphometric analysis. Relative surface of ASMA expression in all glomeruli and interstitium was calculated for each patient. RESULTS: In adults and children, greater expression of ASMA in interstitium was associated with higher serum creatinine and reduced creatinine clearance. Conversely, greater ASMA expression in glomeruli was associated with normal or decreased serum creatinine in adults and increased creatinine clearance in children. In children, correlation was found between high blood pressure and ASMA expression in interstitium. CONCLUSIONS: We confirmed that interstitial expression of ASMA is associated with reduced renal function at time of biopsy. The connection of ASMA expression in glomeruli with lower serum creatinine and normal or increased creatinine clearance suggests a favorable role of this phenotypic change in glomerular filtration rate; further investigation is needed.

Life-threatening valproate overdose successfully treated with haemodialysis.

Valproate (VPA) poisoning is an increasing clinical problem. The most common finding in VPA overdose is the depression of the central nervous system, which may progress to coma and death. This type of poisoning is difficult to treat, as no antidote exists. This report describes a case with a 16-year-old girl who poisoned herself with valproate. Initial treatment included naloxone, but she did not respond. She became comatose, with serum VPA concentration of 1320 microg mL(-1). Three sessions of haemodialysis were performed, effectively eliminating VPA and decreasing the serum concentration. The patient regained consciousness and fully recovered.To our knowledge, this is the highest serum VPA concentration reported by now in children aged 16 or less. Haemodialysis has proved to be the treatment of choice for life-threatening acute VPA overdose in children.

["Sweet" hydrothorax--the early complication of CAPD: case report]. / "Slatki" hidrotoraks rana komplikacija lijecenja CAPD: prikaz bolesnika.

Hydrothorax is a rare or late complication of peritoneal dialysis (PD). As often patients are asymptomatic or with mild shortness of breath, hydrothorax is overlooked in many cases. The patient is 72-years old female who was hospitalized in 2005 with clinical and laboratory signs of end stage renal disease (ESRD). Peritoneal catheter was implanted by laparoscopic technique. First postimplantation washouts didn't provoke any symptoms. Shortness of breath appeared on the second day of CAPD and worsened next five days accompanied with right-sided chest pain. Chest X-ray showed massive right-sided pleural effusion which was complitely evacuated by thoracentesis. The laboratory findings showed simmilar glucose levels in dialysate and pleural fluid and normal glucose in serum. The treatment with CAPD was discontinued and later haemodialysis (HD) was commenced.