Anemia treatment with darbepoetin alpha in pregnant female with chronic renal failure: report of two cases.

Pregnancy is a rare finding in females with CRF. It is well known that in these cases pregnancy worsens the renal function and accelerates the beginning of dialysis therapy. Pregnancies in uremic females are complicated by a worsening of anemia as well as hypertension, fluid imbalance, electrolyte difficulties, malnutrition, polyhydramnios and preterm labor or sudden intrauterine death. The use of erythropoiesis stimulating agents (ESA) allows a better hematocrit control. Data concerning anemia treatment in pregnants with CRF and data regarding the use of ESA in these patients is scarce. We report two cases of anemia treatment with darbepoetin alpha in pregnant women with CRF in predialysis period and during the hemodialysis therapy. Both patients during the darbepoetin treatment did not require any blood transfusions and at 32nd and 37th weeks of pregnancy delivered healthy infants. The high darbepoetin doses did not cause any side effects, were well tolerated and safe for both gravida and fetus. The effective anemia treatment in pregnants with CRF improves the prognosis for a successful pregnancy.

Increased serum levels of troponin I and lesions in coronary angiography in hemodialysed patients.

PURPOSE: Calcium-phosphate disorders are a frequent finding in HD patients, and, in some cases, may cause an abnormal coronary calcification. Some of the HD patients have increased serum cTnI level without evidence of acute coronary syndrome. The aim of this study was to determine if there is a correlance between increased cTnI levels and presence of stenotic changes in coronary arteries in asymptomatic HD patients. MATERIAL AND METHODS: In 13 of 119 HD patients (M:F 10:3) a coronary angiography was performed. The mean age of the patients was 53 years (33-76) and the mean HD duration was 55 months (3-156). cTnI was analyzed by AxSYM system and, subsequently, by VIDAS system. RESULTS: A constant or intermittent elevation of cTnI was detected in 5 of 13 patients. In 10 of 13 pts a critical stenosis of at least 1 coronary artery was found. A critical stenosis was found in 4 of 5 cTnI (+) patients and in 6 of 8 cTnI (-) patients. An excess calcification of coronaries was observed in 7 patients, including 1 cTnI positive patient with no evidence of coronary stenosis. CONCLUSIONS: 1. The elevation of cTnI in asymptomatic HD patients is observed when there is: (I) excess calcification accompanied by a critical stenosis of at least 1 coronary artery, (II) a critical stenosis of 2 or more coronaries with no evidence of calcification. 2. We suggest that excess cardiovascular calcification in HD patients may be one of the major factors responsible for the troponin release.