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Article ; Online: Amyloidosis and the Kidney: An Update.

Nader, Ralph / Angel-Korman, Avital / Havasi, Andrea

2023 Volume 42, Issue 6, Page(s) 151343

Abstract: Various types of systemic amyloidosis can wreak havoc on the architecture and functioning of the kidneys. Amyloidosis should be suspected in patients with worsening kidney function, proteinuria, and multisystem involvement, but isolated kidney ... ...

Abstract	Various types of systemic amyloidosis can wreak havoc on the architecture and functioning of the kidneys. Amyloidosis should be suspected in patients with worsening kidney function, proteinuria, and multisystem involvement, but isolated kidney involvement also is possible. Confirming the amyloidosis type and specific organ dysfunction is of paramount importance to select the appropriately tailored treatment and aim for better survival while avoiding treatment-associated toxicities. Amyloid renal staging in light chain amyloidosis amyloidosis helps inform prognosis and risk for end-stage kidney disease. Biomarker-based staging systems and response assessment guide the therapeutic strategy and allow the timely identification of refractory or relapsing disease so that patients can be switched to salvage therapy. Kidney transplantation is a viable option for selected patients with amyloidosis. Because of the complex nature of the pathophysiology and treatment of amyloidosis, a multidisciplinary team-based approach should be used in the care of these patients.
MeSH term(s)	Humans ; Kidney ; Amyloidosis/therapy ; Kidney Transplantation/adverse effects ; Kidney Failure, Chronic ; Proteinuria/etiology
Language	English
Publishing date	2023-05-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	604652-6
ISSN	1558-4488 ; 0270-9295
ISSN (online)	1558-4488
ISSN	0270-9295
DOI	10.1016/j.semnephrol.2023.151343
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Article: The Relationship between Hypertension and Cancer.

Angel-Korman, Avital / Rapoport, Vladimir / Leiba, Adi

The Israel Medical Association journal : IMAJ

2022 Volume 24, Issue 3, Page(s) 165–169

Abstract: Background: Hypertension and cancer are both common due to the aging of the population and the advances in medical treatment which result in increased survival of cancer patients today. More patients with cancer; therefore, present with hypertension, ... ...

Abstract	Background: Hypertension and cancer are both common due to the aging of the population and the advances in medical treatment which result in increased survival of cancer patients today. More patients with cancer; therefore, present with hypertension, which is attributed to different factors, including genetics and age as well as the type of tumor and cancer-related treatments. Given the increased cardiovascular and mortality risk related to hypertension, it is important to appropriately identify and treat hypertension, particularly in the population of vulnerable cancer patients. In this article we discuss the epidemiology, different etiologies, and approaches to the management of hypertension in cancer patients.
MeSH term(s)	Aging ; Humans ; Hypertension/epidemiology ; Hypertension/etiology ; Neoplasms/complications ; Neoplasms/epidemiology ; Neoplasms/therapy
Language	English
Publishing date	2022-03-28
Publishing country	Israel
Document type	Journal Article ; Review
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article ; Online: Kidney Transplantation in Systemic Amyloidosis.

Angel-Korman, Avital / Havasi, Andrea

Transplantation

2020 Volume 104, Issue 10, Page(s) 2035–2047

Abstract: The present review discusses current developments and outcomes of renal transplantation in systemic amyloidosis. Amyloidosis can wreak havoc on the architecture and functioning of the kidneys, leading to end-stage renal disease. In recent years, the ... ...

Abstract	The present review discusses current developments and outcomes of renal transplantation in systemic amyloidosis. Amyloidosis can wreak havoc on the architecture and functioning of the kidneys, leading to end-stage renal disease. In recent years, the available treatments, especially for light-chain amyloidosis but also for several of the underlying inflammatory diseases that cause amyloid A amyloidosis have expanded leading to prolonged survival albeit frequently with renal failure. At the same time, there are also increasing numbers of patients diagnosed with one of the inherited forms of amyloidosis for which currently there is no targeted treatment available and, in some cases, renal failure is unavoidable. Due to the complex nature of the pathophysiology and treatment of these diseases, it can be very challenging for the clinician to determine whether or not it is appropriate to refer an affected individual for kidney transplantation. Determining eligibility criteria, as well as peritransplant and posttransplant management, requires a multidisciplinary approach with close monitoring and follow-up.
MeSH term(s)	Amyloid Neuropathies, Familial/complications ; Amyloid Neuropathies, Familial/diagnosis ; Amyloid Neuropathies, Familial/mortality ; Clinical Decision-Making ; Humans ; Immunoglobulin Light-chain Amyloidosis/complications ; Immunoglobulin Light-chain Amyloidosis/diagnosis ; Immunoglobulin Light-chain Amyloidosis/mortality ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/etiology ; Kidney Failure, Chronic/mortality ; Kidney Failure, Chronic/surgery ; Kidney Transplantation/adverse effects ; Kidney Transplantation/mortality ; Risk Assessment ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	2020-03-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000003170
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Article ; Online: Comparison of blood pressure measurements on the bare and sleeved arms - what does it uncover?

Tal-Ben Ishay, Rotem / Leiba, Adi / Rappoprt, Vladimir / Angel-Korman, Avital / Katzir, Zeev

Blood pressure monitoring

2023 Volume 29, Issue 1, Page(s) 31–34

Abstract: Accurate office blood pressure (BP) measurement remains crucial in diagnosing and managing hypertension. In this study, we aimed to compare BP measurements done over a bare arm versus a sleeved arm, while controlling all other possible sources of ... ...

Abstract	Accurate office blood pressure (BP) measurement remains crucial in diagnosing and managing hypertension. In this study, we aimed to compare BP measurements done over a bare arm versus a sleeved arm, while controlling all other possible sources of variance. We collected BP measurements of 100 hypertensive patients visiting a nephrology and hypertension clinic between January 2019 and December 2023. Measurements were taken by a single operator and according to the updated guidelines. BP measurements were performed first with one arm bare, and the other arm sleeved, with measurements taken simultaneously. Then, measurements were again taken simultaneously after exposing the arm which was first sleeved, and dressing the arm which was bare at first. A nonparametric Wilcoxon test was performed to compare each patient's measurements on each arm. No statistically significant differences were found between the sleeved and the bare arm measurements, with one exception of SBP measured on the left arm (slightly lower SBP on the bare arm). While looking at the absolute value of differences, the median difference was impressive with a 7-8 mmHg systolic difference and 5.5 mmHg diastolic difference. Our study revealed a robust and unpredicted effect of clothing on BP; in some patients, BP was increased while in others decreased. Therefore, we believe there is importance in measuring BP on bare skin, regardless of clothing or sleeve type.
MeSH term(s)	Humans ; Blood Pressure ; Clothing ; Blood Pressure Determination ; Hypertension/diagnosis
Language	English
Publishing date	2023-06-19
Publishing country	England
Document type	Journal Article
ZDB-ID	1324472-3
ISSN	1473-5725 ; 1359-5237
ISSN (online)	1473-5725
ISSN	1359-5237
DOI	10.1097/MBP.0000000000000660
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Article ; Online: An electrolyte flip flop - a patient with chronic hyperkalemic acidosis presenting with severe hypokalemic alkalosis

Angel-Korman, Avital / Biton, Rey / Rappoprt, Vladimir / Hausmann, Michael / Leiba, Adi

Heliyon. 2022 Dec., v. 8, no. 12 p.e12607-

2022

Abstract: A 76-year-old man was evaluated in our emergency department (ED) for right toe swelling and pain. His initial ED workup revealed volume overload, uncontrolled hypertension, slow atrial fibrillation, refractory hypokalemia, mixed metabolic alkalosis and ... ...

Abstract	A 76-year-old man was evaluated in our emergency department (ED) for right toe swelling and pain. His initial ED workup revealed volume overload, uncontrolled hypertension, slow atrial fibrillation, refractory hypokalemia, mixed metabolic alkalosis and respiratory acidosis, with a normal plasma pH, and hypernatremia. His medical chart revealed long standing hyperkalemia and metabolic acidosis, related to his diabetic kidney disease. We hypothesized that a short course of daily SPS ingestion (Sodium Polystyrene Sulfonate, “Kayexalate”) was the sole etiology for the compound electrolyte abnormalities and the electrolyte “flip flop”. SPS ingestion can cause hypokalemia by excessive potassium binding in the gut. SPS exchanging potassium for sodium caused excessive sodium retention leading to hypernatremia, hypertension and volume overload. Volume overload worsened his chronic obstructive sleep apnea and yielded respiratory acidosis. Finally hypokalemia by itself was the main trigger for generation and maintenance of metabolic alkalosis. Urinary electrolytes, and renin and aldosterone levels taken at the ED ruled out primary aldosteronism and renal potassium and hydrogen loss. The patient's potassium was replenished by both PO and IV routes. He was treated for his volume overload and hypertension with furosemide. Spironolactone and amiloride, potassium sparing diuretics, were cautiously given only during his hypokalemic phase. His plasma sodium and potassium levels, blood pressure and volume status gradually improved. “Kayexalate” effect should be suspected in a patient presenting with unexplained hypokalemia and alkalosis, accompanied by volume overload rather than volume depletion, developing shortly after SPS ingestion. ED doctors should specifically ask CKD or ESRD patients on SPS, as it otherwise can skip the medication reconciliation process.
Keywords	acidosis ; aldosterone ; alkalosis ; atrial fibrillation ; blood pressure ; digestive system ; drug therapy ; electrolytes ; etiology ; furosemide ; hydrogen ; hyperkalemia ; hypertension ; hypokalemia ; ingestion ; kidney diseases ; pH ; pain ; patients ; polystyrene sulfonic acid ; potassium ; renin ; sleep apnea ; sodium ; spironolactone ; Sodium polystyrene sulphonate ; Hypernatremia
Language	English
Dates of publication	2022-12
Publishing place	Elsevier Ltd
Document type	Article ; Online
Note	Use and reproduction
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2022.e12607
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Resistant hypertension is associated with an increased cardiovascular risk compared to patients controlled on a similar multi-drug regimen.

Leiba, Adi / Yekutiel, Naama / Chodick, Gabriel / Wortsman, Joshua / Angel-Korman, Avital / Weinreb, Baruch

Journal of human hypertension

2022 Volume 37, Issue 7, Page(s) 542–547

Abstract: The long-term risk associated with resistant hypertension compared to other phenotypes of hypertension is still unclear. We aimed to assess cardiovascular and renal outcomes over 10 years of follow-up of patients with uncontrolled resistant hypertension ( ...

Abstract	The long-term risk associated with resistant hypertension compared to other phenotypes of hypertension is still unclear. We aimed to assess cardiovascular and renal outcomes over 10 years of follow-up of patients with uncontrolled resistant hypertension (uRH) compared to a similarly treated (≥ 3 medication classes including a diuretic) and adherent group whose blood pressure is under control. This retrospective cohort study utilized the computerized database of Maccabi Healthcare Services, a state-mandated health provider covering 25% of the Israeli population. Clinical outcomes were assessed using Cox regression multivariable analyses. A total of 1487 patients (50% males, mean age at baseline = 68.3 ± 10.4 years) were included in the uRH cohort and 1343 patients (50% males, 66.2 ± 10.6 years) in the controlled hypertension reference group (Controlled hypertension on multi drug regimen- CH-MDR). After adjusting for age, sex, BMI and patients' comorbidities, uRH was associated with a Hazard Ratio of 1.35 (95% CI: 1.08-1.69) for incidence of ischemic heart disease, 1.51 (1.06-2.16) for secondary cardiovascular events, and 1.36 (1.00-1.86) for risk of stroke or transient ischemic attack compared to the reference group. Patients with uRH were found to have more hospitalization days (mean, 4.2 vs. 3 days per year, p < 0.001), and more emergency room visits (83.3% vs. 77%, p < 0.001). Overall, uRH was associated with a 19% (95% CI 11% to 29%) increase in direct healthcare expenditures during the first year of follow-up. uRH is associated with a substantial increased risk of both cardiovascular and cerebrovascular events, when compared to similarly treated hypertensive patients whose blood pressure is under control.
MeSH term(s)	Male ; Humans ; Female ; Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Retrospective Studies ; Risk Factors ; Hypertension/diagnosis ; Hypertension/drug therapy ; Hypertension/epidemiology ; Blood Pressure ; Stroke/epidemiology ; Heart Disease Risk Factors ; Antihypertensive Agents/adverse effects
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2022-08-23
Publishing country	England
Document type	Journal Article
ZDB-ID	639472-3
ISSN	1476-5527 ; 0950-9240
ISSN (online)	1476-5527
ISSN	0950-9240
DOI	10.1038/s41371-022-00749-y
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: [COVID-19, THE KIDNEY AND HYPERTENSION].

Angel-Korman, Avital / Brosh, Tal / Glick, Karina / Leiba, Adi

Harefuah

2020 Volume 159, Issue 4, Page(s) 231–234

Abstract: Introduction: COVID-19, is a new corona virus of the Beta Coronavirus genus which originated in bats. The virus first emerged in China in December 2019 and has rapidly spread since to other areas worldwide. The World Health Organization (WHO) has ... ...

Abstract	Introduction: COVID-19, is a new corona virus of the Beta Coronavirus genus which originated in bats. The virus first emerged in China in December 2019 and has rapidly spread since to other areas worldwide. The World Health Organization (WHO) has therefore recently declared it as the source of a pandemic. The disease caused by the virus manifests in most cases as a lower respiratory tract infection leading to fever, cough and dyspnea, while more severe cases can led to respiratory failure and/or multi organ failure. COVID-19 enters the human cell using the ACE2, an enzyme abundant in renal tubular epithelial cells. Theoretically, this may be significant in several ways: acute kidney injury (AKI) as well as proteinuria and/or microhematuria could be associated with the penetration of COVID-19 into the cells. Moreover, medications based on RAAS inhibition, such and ACE inhibitors and ARBs, upregulate the enzyme ACE2 and could therefore hypothetically explain the high prevalence of hypertension and diabetes reported as previous diagnoses in severe cases. In the setting of chronic kidney disease, the risk of infection with COVID-19 is not clear at this time. However, hemodialysis patients represent a unique group of patients, mostly elderly and immunocompromised, for whom dialysis is a life-saving treatment which cannot be stopped. Hence, the COVID-19 pandemic has presented a complex medical and logistic challenge for the medical staff in hospital and community based dialysis units.
MeSH term(s)	Acute Kidney Injury/complications ; Acute Kidney Injury/etiology ; Aged ; Angiotensin-Converting Enzyme 2 ; Betacoronavirus ; COVID-19 ; China ; Coronavirus Infections/complications ; Coronavirus Infections/epidemiology ; Humans ; Hypertension/complications ; Kidney/physiology ; Pandemics ; Peptidyl-Dipeptidase A/metabolism ; Pneumonia, Viral/complications ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Vulnerable Populations
Chemical Substances	Peptidyl-Dipeptidase A (EC 3.4.15.1) ; ACE2 protein, human (EC 3.4.17.23) ; Angiotensin-Converting Enzyme 2 (EC 3.4.17.23)
Keywords	covid19
Language	Hebrew
Publishing date	2020-04-29
Publishing country	Israel
Document type	News
ZDB-ID	953872-0
ISSN	0017-7768
ISSN	0017-7768
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Article ; Online: The utility of repeat kidney biopsy in systemic immunoglobulin light chain amyloidosis.

Angel-Korman, Avital / Jaberi, Aala / Sanchorawala, Vaishali / Havasi, Andrea

Amyloid : the international journal of experimental and clinical investigation : the official journal of the International Society of Amyloidosis

2019 Volume 27, Issue 1, Page(s) 17–24

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Adult ; Aged ; Biopsy ; Female ; Humans ; Immunoglobulin Light Chains ; Immunoglobulin Light-chain Amyloidosis/pathology ; Immunoglobulin Light-chain Amyloidosis/therapy ; Kidney/pathology ; Male ; Middle Aged ; Plaque, Amyloid/pathology ; Plaque, Amyloid/therapy ; Proteinuria/pathology ; Proteinuria/therapy ; Retrospective Studies
Chemical Substances	Immunoglobulin Light Chains
Language	English
Publishing date	2019-10-09
Publishing country	England
Document type	Clinical Trial ; Journal Article ; Video-Audio Media
ZDB-ID	1205246-2
ISSN	1744-2818 ; 1350-6129
ISSN (online)	1744-2818
ISSN	1350-6129
DOI	10.1080/13506129.2019.1672650
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Article: [covid-19, the Kidney and Hypertension]

Angel-Korman, Avital / Brosh, Tal / Glick, Karina / Leiba, Adi

Harefuah

Abstract: INTRODUCTION: COVID-19, is a new corona virus of the Beta Coronavirus genus which originated in bats. The virus first emerged in China in December 2019 and has rapidly spread since to other areas worldwide. The World Health Organization (WHO) has ... ...

Abstract	INTRODUCTION: COVID-19, is a new corona virus of the Beta Coronavirus genus which originated in bats. The virus first emerged in China in December 2019 and has rapidly spread since to other areas worldwide. The World Health Organization (WHO) has therefore recently declared it as the source of a pandemic. The disease caused by the virus manifests in most cases as a lower respiratory tract infection leading to fever, cough and dyspnea, while more severe cases can led to respiratory failure and/or multi organ failure. COVID-19 enters the human cell using the ACE2, an enzyme abundant in renal tubular epithelial cells. Theoretically, this may be significant in several ways: acute kidney injury (AKI) as well as proteinuria and/or microhematuria could be associated with the penetration of COVID-19 into the cells. Moreover, medications based on RAAS inhibition, such and ACE inhibitors and ARBs, upregulate the enzyme ACE2 and could therefore hypothetically explain the high prevalence of hypertension and diabetes reported as previous diagnoses in severe cases. In the setting of chronic kidney disease, the risk of infection with COVID-19 is not clear at this time. However, hemodialysis patients represent a unique group of patients, mostly elderly and immunocompromised, for whom dialysis is a life-saving treatment which cannot be stopped. Hence, the COVID-19 pandemic has presented a complex medical and logistic challenge for the medical staff in hospital and community based dialysis units.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #32307955
Database	COVID19

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Article: Critical Stepwise Decline of Antibodies against SARS-CoV-2 among Chronic Hemodialysis Patients 180 Days Post Comirnaty Vaccine.

Levin-Iaina, Nomy / Angel-Korman, Avital / Leiba, Adi / Peres, Esther / Bryk, Gabriel / Rapoport, Vladimir / Katzir, Zeev / Yagil, Yoram / Brosh-Nissimov, Tal

The Israel Medical Association journal : IMAJ

2022 Volume 24, Issue 5, Page(s) 317–319

Abstract: Background: The reduced immune response of maintenance hemodialysis patients to coronavirus disease 2019 (COVID-19) vaccines is a major concern.: Objectives: To analyze the late (6 months after full vaccination) antibody response and compare it to ... ...

Abstract	Background: The reduced immune response of maintenance hemodialysis patients to coronavirus disease 2019 (COVID-19) vaccines is a major concern. Objectives: To analyze the late (6 months after full vaccination) antibody response and compare it to early post-vaccination titer. Methods: We conducted a multicenter prospective study of 13 hemodialysis units in Israel. Results: We demonstrated that the low titers observed among ESRD patients 2-3 months after vaccination with the Comirnaty vaccine (median 63.8 AU/ml) declined to critically lower values 6 months after full vaccination. (Mediananti S antibodies, 31 AU/ml). Seropositivity significantly declined among hemodialysis patients from 89% to 74% (P < 0.0001), although it did not significantly change among controls. Conclusions: We recommend all patients on hemodialysis receive a booster COVID-19 vaccine 6 months after the second dose.
MeSH term(s)	Antibodies, Viral ; BNT162 Vaccine ; COVID-19/prevention & control ; COVID-19 Vaccines ; Humans ; Prospective Studies ; Renal Dialysis ; SARS-CoV-2 ; Vaccination ; Vaccines
Chemical Substances	Antibodies, Viral ; COVID-19 Vaccines ; Vaccines ; BNT162 Vaccine (N38TVC63NU)
Language	English
Publishing date	2022-05-21
Publishing country	Israel
Document type	Journal Article ; Multicenter Study
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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