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Article ; Online: Severe symptomatic hyponatremia due to cerebral salt wasting syndrome in a patient with traumatic head injury and Dandy-Walker malformation of the brain.

Liangos, Orfeas / Madias, Nicolaos E

Clinical nephrology. Case studies

2021 Volume 9, Page(s) 4–10

Abstract: Cerebral salt wasting (CSW) is an uncommon cause of hyponatremia characterized by extracellular volume depletion, high urine sodium concentration and osmolality, and low serum uric acid concentration in association with central nervous system (CNS) ... ...

Abstract	Cerebral salt wasting (CSW) is an uncommon cause of hyponatremia characterized by extracellular volume depletion, high urine sodium concentration and osmolality, and low serum uric acid concentration in association with central nervous system (CNS) disease. Distinguishing CSW from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), a much more common form of hyponatremia in this setting, can be challenging because both present with identical laboratory features. However, treatment of CSW and SIADH differs, making a correct diagnosis important. Here we present a case of CSW in a 75-year-old man in whom severe hyponatremia and volume depletion were discovered in the setting of traumatic head injury and Dandy-Walker malformation of the brain, a rare congenital brain malformation. Treatment with intravenous normal saline and later oral salt supplementation and fludrocortisone was successful.
Language	English
Publishing date	2021-02-19
Publishing country	Germany
Document type	Case Reports
ISSN	2196-5293
ISSN (online)	2196-5293
DOI	10.5414/CNCS110146
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Article: Hospital-acquired acute kidney injury: a proposed patient safety indicator.

Liangos, Orfeas / Jaber, Bertrand L

Hospital practice (1995)

2021 Volume 49, Issue 4, Page(s) 252–254

Abstract: Patient safety, which includes adverse event reporting and routine collection of outcome measures, has become an increasingly important aspect of inpatient care worldwide. In the United States, the National Quality Forum leads the effort in developing ... ...

Abstract	Patient safety, which includes adverse event reporting and routine collection of outcome measures, has become an increasingly important aspect of inpatient care worldwide. In the United States, the National Quality Forum leads the effort in developing such measures for use in payment and public reporting programs. However, choosing and prioritizing events to serve as patient safety indicators is difficult in a dynamically changing and complex healthcare environment. In this perspective, we propose that hospital-acquired acute kidney injury (HA-AKI), for example, contrast-induced and postoperative AKI, should be added to existing, more traditional measures, such as surgical site infections and patient falls. The article highlights the significance of HA-AKI as a common complication resulting from a multitude of diagnostic and therapeutic procedures, how it lends itself well to measuring patient safety, and how reporting of this complication can contribute to further improvement of patient safety and overall quality of care.
MeSH term(s)	Acute Kidney Injury/epidemiology ; Acute Kidney Injury/prevention & control ; Clinical Protocols ; Contrast Media/adverse effects ; Evaluation Studies as Topic ; Humans ; Iatrogenic Disease ; Patient Safety/standards ; Postoperative Complications/epidemiology ; Quality Indicators, Health Care/standards ; Risk Factors ; United States
Chemical Substances	Contrast Media
Language	English
Publishing date	2021-06-14
Publishing country	England
Document type	Editorial
ZDB-ID	2570453-9
ISSN	2377-1003 ; 2154-8331 ; 8750-2836
ISSN (online)	2377-1003
ISSN	2154-8331 ; 8750-2836
DOI	10.1080/21548331.2021.1935262
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Book ; Thesis: Autoradiographische Untersuchung zur pränantalen Entwicklung des Serotonintransporters im ZNS der Maus

Liangos, Orfeas

1996

Author's details	vorgelegt von Orfeas Liangos
Language	German
Size	50 S. : Ill.
Document type	Book ; Thesis
Thesis / German Habilitation thesis	Berlin, Freie Univ., Diss., 1996
HBZ-ID	HT007485485
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Article ; Online: Bone Biopsy Results in Chronic Kidney Disease: a Single-Center Experience.

Liangos, Orfeas / Kirchhoff, Silvia / Buchholz, Joachim / Ketteler, Markus

Kidney & blood pressure research

2018 Volume 43, Issue 4, Page(s) 1222–1230

Abstract: Background/aims: Although bone histology remains the diagnostic standard in renal osteodystrophy (ROD), biomarkers are used more commonly. Data comparing bone biopsy results and biomarkers of bone metabolism remain sparse.: Methods: This is a single- ... ...

Abstract	Background/aims: Although bone histology remains the diagnostic standard in renal osteodystrophy (ROD), biomarkers are used more commonly. Data comparing bone biopsy results and biomarkers of bone metabolism remain sparse. Methods: This is a single-center retrospective analysis of bone biopsy results (105) stratified by renal function, compared with intact parathyroid hormone (iPTH), bone-specific alkaline phosphatase (BAP) and other biomarkers. We tested associations with high-turnover ostitis fibrosa (OF) and mixed uremic osteodystrophy (MUO), i.e. classes I and III according to Delling's classification. Results: 37% of patients had CKD stage 3-5 not on dialysis (CKD NOD) and 50% CKD stage 5 requiring haemodialysis (CKD 5D). iPTH was significantly higher in CKD 5D with high-turnover ROD, 26 (18) versus 8 (9) pmol/l (p< 0.001). BAP showed no association. In CKD NOD, high-turnover ROD was associated with elevated iPTH, 32 (44) versus 8 (11) pmol/l (p=0.001), and BAP, 39 (32) versus 16 (7) U/l (p=0.01). iPTH achieved receiver operator characteristic (ROC) areas under the curve (AUC) of 0.83 (P=0.003) and 0.91 (P=0.019) for high-turnover ROD among CKD 5D and CKD NOD patients, respectively. An iPTH cutoff of 12.8 (CKD 5D) and 13.5 pmol/l (CKD NOD) reached sensitivities and specificities of 0.83, 0.91 and 1.00, 0.91, respectively. In CKD NOD, BAP achieved an AUC of 0.93 (P=0.013) and with a cutoff at 19.8 U/l a sensitivity and specificity of 1.00, 0.91, respectively. Conclusion: In CKD 5D patients, high-turnover ROD was associated with elevated iPTH at a low cutoff but not with BAP. The same diagnosis in CKD NOD was associated both with iPTH and BAP.
MeSH term(s)	Aged ; Aged, 80 and over ; Alkaline Phosphatase/blood ; Biopsy ; Bone and Bones/pathology ; Chronic Kidney Disease-Mineral and Bone Disorder/blood ; Female ; Humans ; Male ; Middle Aged ; Parathyroid Hormone/blood ; Renal Dialysis ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/therapy ; Retrospective Studies
Chemical Substances	Parathyroid Hormone ; Alkaline Phosphatase (EC 3.1.3.1)
Language	English
Publishing date	2018-08-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1326018-2
ISSN	1423-0143 ; 1420-4096
ISSN (online)	1423-0143
ISSN	1420-4096
DOI	10.1159/000492249
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Article ; Online: Treating hyperphosphatemia - current and advancing drugs.

Ketteler, Markus / Liangos, Orfeas / Biggar, Patrick H

Expert opinion on pharmacotherapy

2016 Volume 17, Issue 14, Page(s) 1873–1879

Abstract: Introduction: Hyperphosphatemia is a hallmark of advanced chronic kidney disease (CKD) and associated with adverse outcomes. Preclinical and epidemiological studies strongly support a causal relationship between hyperphosphatemia and mortality as well ... ...

Abstract	Introduction: Hyperphosphatemia is a hallmark of advanced chronic kidney disease (CKD) and associated with adverse outcomes. Preclinical and epidemiological studies strongly support a causal relationship between hyperphosphatemia and mortality as well as cardiovascular complications, especially including vascular, valvular and soft-tissue calcifications. Thus, appropriate phosphate lowering is considered to play a major role in health and longevity of CKD patients. In this respect, phosphate binders are the most powerful therapeutic option, while dietary phosphate restriction and intensified dialysis are valuable supportive approaches. Areas covered: Pubmed was the primary research platform. This search focused on novel phosphate lowering compounds, including iron-containing binders and phosphate transport inhibitors, which have just become available or are in the approval process. Further, additional reports on effective strategies to counteract the adverse consequences of resistant hyperphosphatemia were also collected. Expert opinion: New iron-containing drugs may offer advantages, including iron supplementation, low pill burden and high efficacy. Phosphate transport inhibitors possess a high potential as add-on compounds in patients with insufficient phosphate binder therapy. One unsolved question remains at what CKD stage to start therapeutically counteracting phosphate retention.
MeSH term(s)	Chelating Agents/therapeutic use ; Humans ; Hyperphosphatemia/drug therapy ; Iron/therapeutic use ; Phosphates/metabolism ; Renal Dialysis ; Renal Insufficiency, Chronic/drug therapy
Chemical Substances	Chelating Agents ; Phosphates ; Iron (E1UOL152H7)
Language	English
Publishing date	2016-10
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2001535-5
ISSN	1744-7666 ; 1465-6566
ISSN (online)	1744-7666
ISSN	1465-6566
DOI	10.1080/14656566.2016.1220538
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Article: Vitamin K1 and progression of cardiovascular calcifications in hemodialysis patients: the VitaVasK randomized controlled trial.

Saritas, Turgay / Reinartz, Sebastian / Krüger, Thilo / Ketteler, Markus / Liangos, Orfeas / Labriola, Laura / Stenvinkel, Peter / Kopp, Christoph / Westenfeld, Ralf / Evenepoel, Pieter / Siepmann, Robert / Wied, Stephanie / Hilgers, Ralf-Dieter / Schurgers, Leon / Floege, Jürgen

Clinical kidney journal

2022 Volume 15, Issue 12, Page(s) 2300–2311

Abstract: Background: Cardiovascular calcifications are prevented by matrix Gla protein (MGP), a vitamin K-dependent protein. Haemodialysis patients exhibit marked vitamin K deficiency. The randomized, prospective, open-label, multicentre VitaVasK trial analysed ... ...

Abstract	Background: Cardiovascular calcifications are prevented by matrix Gla protein (MGP), a vitamin K-dependent protein. Haemodialysis patients exhibit marked vitamin K deficiency. The randomized, prospective, open-label, multicentre VitaVasK trial analysed whether vitamin K1 supplementation reduces progression of coronary artery calcifications (CACs) and thoracic aortic calcifications (TACs). Methods: Patients with pre-existing CACs were randomized to continue on standard care or to additionally receive 5 mg of vitamin K1 orally thrice weekly. Hierarchically ordered primary endpoints were progression of TAC and CAC in computed tomography scans at 18 months. Linear mixed effects models with repeated measures at baseline and 12 and 18 months assessed treatment effects after adjusting for study site. Results: Of 60 randomized patients, 20 dropped out for reasons unrelated to vitamin K1, resulting in 23 control and 17 vitamin K1 patients. The trial was stopped early due to slow recruitment. At 18 months, the average TAC progression was 56% lower in the vitamin K1 compared with the control group (p = .039). CAC significantly progressed within the control group, but not within the vitamin K1 group. Average progression at 18 months was 68% lower in the vitamin K1 compared to the control group ( Conclusion: Vitamin K1 intervention is a potent, safe and cost-effective approach to correct vitamin K deficiency and to potentially reduce cardiovascular calcification in this high-risk population.
Language	English
Publishing date	2022-08-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2655800-2
ISSN	2048-8513 ; 2048-8505
ISSN (online)	2048-8513
ISSN	2048-8505
DOI	10.1093/ckj/sfac184
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Article: Bone Biopsy Results in Chronic Kidney Disease: a Single-Center Experience

Liangos, Orfeas / Kirchhoff, Silvia / Buchholz, Joachim / Ketteler, Markus

Kidney and Blood Pressure Research

2018 Volume 43, Issue 4, Page(s) 1222–1230

Abstract: Background/Aims: Although bone histology remains the diagnostic standard in renal osteodystrophy (ROD), biomarkers are used more commonly. Data comparing bone biopsy results and biomarkers of bone metabolism remain sparse. Methods: This is a single- ... ...

Institution	Department of Nephrology, Klinikum Coburg, Coburg, Germany Faculty of Medicine, University of Wuerzburg, Wuerzburg, Germany Professor of Medicine, University of Split Medical School, Split, Croatia
Abstract	Background/Aims: Although bone histology remains the diagnostic standard in renal osteodystrophy (ROD), biomarkers are used more commonly. Data comparing bone biopsy results and biomarkers of bone metabolism remain sparse. Methods: This is a single-center retrospective analysis of bone biopsy results (105) stratified by renal function, compared with intact parathyroid hormone (iPTH), bone-specific alkaline phosphatase (BAP) and other biomarkers. We tested associations with high-turnover ostitis fibrosa (OF) and mixed uremic osteodystrophy (MUO), i.e. classes I and III according to Delling’s classification. Results: 37% of patients had CKD stage 3-5 not on dialysis (CKD NOD) and 50% CKD stage 5 requiring haemodialysis (CKD 5D). iPTH was significantly higher in CKD 5D with high-turnover ROD, 26 (18) versus 8 (9) pmol/l (p< 0.001). BAP showed no association. In CKD NOD, high-turnover ROD was associated with elevated iPTH, 32 (44) versus 8 (11) pmol/l (p=0.001), and BAP, 39 (32) versus 16 (7) U/l (p=0.01). iPTH achieved receiver operator characteristic (ROC) areas under the curve (AUC) of 0.83 (P=0.003) and 0.91 (P=0.019) for high-turnover ROD among CKD 5D and CKD NOD patients, respectively. An iPTH cutoff of 12.8 (CKD 5D) and 13.5 pmol/l (CKD NOD) reached sensitivities and specificities of 0.83, 0.91 and 1.00, 0.91, respectively. In CKD NOD, BAP achieved an AUC of 0.93 (P=0.013) and with a cutoff at 19.8 U/l a sensitivity and specificity of 1.00, 0.91, respectively. Conclusion: In CKD 5D patients, high-turnover ROD was associated with elevated iPTH at a low cutoff but not with BAP. The same diagnosis in CKD NOD was associated both with iPTH and BAP.
Keywords	CKD-MBD ; Biomarkers ; Renal osteodystrophy ; Chronic renal failure ; Hyperparathyroidism
Language	English
Publishing date	2018-08-02
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Original Paper ; This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
ZDB-ID	1326018-2
ISSN	1423-0143 ; 1420-4096
ISSN (online)	1423-0143
ISSN	1420-4096
DOI	10.1159/000492249
Database	Karger publisher's database

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Article: Atypical case of AL amyloidosis with urinary erythrocyte casts.

Liangos, Orfeas / Buettner-Herold, Maike / Ketteler, Markus / Madias, Nicolaos E

Clinical nephrology. Case studies

2015 Volume 3, Page(s) 19–24

Abstract: We present the case of a 73-year-old man who developed an acute, severe febrile illness with multiorgan dysfunction, featuring renal failure, nephrotic-range proteinuria, microhematuria, and a skin rash. Numerous erythrocyte casts were found on urine ... ...

Abstract	We present the case of a 73-year-old man who developed an acute, severe febrile illness with multiorgan dysfunction, featuring renal failure, nephrotic-range proteinuria, microhematuria, and a skin rash. Numerous erythrocyte casts were found on urine microscopy. Typically, the finding of urinary erythrocyte casts indicates the presence of an underlying glomerular inflammatory disease. However, on renal biopsy, only amyloid light-chain (AL) amyloidosis and tubular injury were the predominant findings with no signs of glomerular or vascular inflammation. Photomicrographs of urinary sediment as well as renal biopsy histopathology of the presented case are shown. The unusual combination of findings, is then discussed in light of the existing literature on renal amyloidosis as well as erythrocyte casts in conditions other than glomerulonephritis.
Language	English
Publishing date	2015-09-23
Publishing country	Germany
Document type	Case Reports
ISSN	2196-5293
ISSN	2196-5293
DOI	10.5414/CNCS108640
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Article ; Online: FGF23 antagonism: the thin line between adaptation and maladaptation in chronic kidney disease.

Ketteler, Markus / Biggar, Patrick H / Liangos, Orfeas

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

2013 Volume 28, Issue 4, Page(s) 821–825

Abstract: For more than 10 years, we have been convinced by overwhelming epidemiological evidence with a high biological plausibility that hyperphosphataemia imposes one of the most sustained cardiovascular and mortality risks on patients suffering from chronic ... ...

Abstract	For more than 10 years, we have been convinced by overwhelming epidemiological evidence with a high biological plausibility that hyperphosphataemia imposes one of the most sustained cardiovascular and mortality risks on patients suffering from chronic kidney disease (CKD). With the discovery of the fibroblast growth factor-23 (FGF23)/klotho axis, we not only gained a new and mechanistic understanding of phosphate handling of the body, we also felt that novel therapeutic strategies may arise counteracting the deleterious consequences of phosphate retention, dysregulation and maldistribution. Two recent experimental studies shed additional and important light on what we can expect from such new insights. Faul et al. showed us that FGF23 excess may directly induce left ventricular hypertrophy (LVH) and that FGF-receptor antagonism ameliorates CKD-induced LVH in rats. Shalhoub et al. demonstrated that FGF23 antibodies successfully ameliorated the development and progression of most features of secondary hyperparathyroidism in a rat model of CKD, however, at the expense of hyperphosphataemia, progressive vascular calcification and death. Such studies not only help to continuously improve our understanding, but also especially sharpen our perception of how thin the line may be between adaptation and maladaptation in chronic disease scenarios.
MeSH term(s)	Animals ; Cardiovascular Diseases/etiology ; Cardiovascular Diseases/metabolism ; Cardiovascular Diseases/prevention & control ; Fibroblast Growth Factors/antagonists & inhibitors ; Fibroblast Growth Factors/metabolism ; Humans ; Rats ; Renal Insufficiency, Chronic/complications
Chemical Substances	fibroblast growth factor 23 ; Fibroblast Growth Factors (62031-54-3)
Language	English
Publishing date	2013-04
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	90594-x
ISSN	1460-2385 ; 0931-0509
ISSN (online)	1460-2385
ISSN	0931-0509
DOI	10.1093/ndt/gfs557
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Article: Multiple organ dysfunction syndrome in children with sepsis: role of genetic factors.

Liangos, Orfeas / Jaber, Bertrand L

Seminars in nephrology

2008 Volume 28, Issue 5, Page(s) 499–509

Abstract: This review summarizes current knowledge on the impact of genetic markers on susceptibility, severity, and outcome of acute inflammatory disorders in children, with a special focus on systemic infections. A 14-year-old child with Neisseria meningitides ... ...

Abstract	This review summarizes current knowledge on the impact of genetic markers on susceptibility, severity, and outcome of acute inflammatory disorders in children, with a special focus on systemic infections. A 14-year-old child with Neisseria meningitides bacteremia, complicated by septic shock and multiple organ dysfunction, is discussed as an exemplary case, and linked to the application of genetic epidemiology and the study of common disorders in children. The current pertinent literature is comprehensively reviewed and limitations and future directions are discussed.
MeSH term(s)	Biomarkers/metabolism ; Child ; Genetic Predisposition to Disease ; Humans ; Multiple Organ Failure/etiology ; Multiple Organ Failure/genetics ; Multiple Organ Failure/metabolism ; Polymorphism, Genetic ; Prognosis ; Sepsis/complications ; Sepsis/metabolism
Chemical Substances	Biomarkers
Language	English
Publishing date	2008-09
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	604652-6
ISSN	1558-4488 ; 0270-9295
ISSN (online)	1558-4488
ISSN	0270-9295
DOI	10.1016/j.semnephrol.2008.05.011
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