Erythrocyte Sedimentation Rate in Patients with Renal Insufficiency and Renal Replacement Therapy.

BACKGROUND: Determination of the erythrocyte sedimentation rate (ESR) is a simple diagnostic tool for estimating systemic inflammation. It remains unclear whether ESR is influenced by renal disease or renal replacement therapy (RRT). OBJECTIVE: To report the incidence and extent of ESR elevations in patients with chronic kidney disease (CKD) and the possible impact of RRT. METHODS: We performed a single-center, retrospective study in inpatients with or without renal disease and in those with RRT, comparing ESR levels and other laboratory and clinical information. RESULTS: A total of 203 patients were included. On average, ESR was elevated (mean [SD], 51.7 [34.6] mm/h), with no statistically significant difference between the patient groups. Only those receiving PD showed significantly higher ESR (78.3 [33.1] mm/h; P < .001). CONCLUSIONS: ESR testing can be used without restriction in patients with CKD and in patients undergoing hemodialysis and who have received kidney transplantation; however, this measurement should be monitored carefully in patients with PD.

Kidney Hypertrophy in Living Kidney Donors and Their Corresponding Recipients.

BACKGROUND: In this long-term study we compared kidney volume changes and function between living kidney donors and their corresponding recipients via magnetic resonance imaging after 3 to 8 years post transplantation. METHODS: For measurement of the kidney volume in magnetic resonance imaging images we used 3DSlicer. Statistical analysis was performed via t test and correlation. RESULTS: A profound volume increase was observed in both transplanted and orthotopic kidney. The volume increase of the orthotopic kidneys was with 58 cm³ ± 23.8 cm³ SD (41%) greater than in the corresponding transplanted kidneys with 43 cm³ ± 36.9 cm³ SD (30%). CONCLUSIONS: This study detected a persistent volume increase in both orthotopic and transplanted kidneys after donation. Neither significant increases of hypertension or proteinuria were observable or could be correlated to renal hypertrophy.

Phenprocoumon based anticoagulation is an underestimated factor in the pathogenesis of calciphylaxis.

BACKGROUND: Calciphylaxis is a life threatening complication in renal patients. Of great importance is the identification of concomitant factors for calciphylaxis. Due to the variability of clinical presentation the evaluation of such factors may be obscured when calciphylaxis diagnosis is based just on clinical features. We aimed to characterize associated factors only in patients with calciphylaxis proven by histomorphological parameters in addition to clinical presentation. METHODS: In a single center retrospective study we analyzed 15 patients in an 8 year period from 2008 to 2016. Only patients with clinical features and histomorphological proof of calciphylaxis were included. Criteria for histological diagnosis of calciphylaxis were intimal hyperplasia, micro thrombi or von Kossa stain positive media calcification. RESULTS: The mean age of patients was 64.8 years. Nine patients (60%) were female; 12 (80%) were obese with a Body-Mass-Index (BMI) > 30 kg/m2; 3 (20%) had no renal disease; 12 (80%) had CKD 4 or 5 and 10 (66.7%) had end-stage renal disease (ESRD). One-year mortality in the entire cohort was 73.3%. With respect to medication history, the majority of patients (n = 13 (86.7%)) received vitamin K antagonists (VKA); 10 (66.7%) were treated with vitamin D; 6 (40%) had oral calcium supplementation; 5 (33.3%) had been treated with corticosteroids; 12 (80%) were on proton pump inhibitors (PPI); 13 (86.7%) patients had a clinical proven hyperparathyroidism. Ten (66.7%) patients presented with hypoalbuminemia at diagnosis. CONCLUSIONS: The evaluation of biopsy proven calciphylaxis demonstrates that especially treatment with vitamin K antagonists and liver dysfunction are most important concomitant factors in development of calciphylaxis. As progression and development of calciphylaxis are chronic rather than acute processes, early use of DOACs instead of VKA might be beneficial and reduce the incidence of calciphylaxis.