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  1. Article: Efficacy and Safety of the Use of SGLT2 Inhibitors in Patients on Incremental Hemodialysis: Maximizing Residual Renal Function, Is There a Role for SGLT2 Inhibitors?

    De La Flor, José C / Villa, Daniel / Cruzado, Leónidas / Apaza, Jacqueline / Valga, Francisco / Zamora, Rocío / Marschall, Alexander / Cieza, Michael / Deira, Javier / Rodeles, Miguel

    Biomedicines

    2023  Volume 11, Issue 7

    Abstract: SGLT-2i are the new standard of care for diabetic kidney disease (DKD), but previous studies have not included patients on kidney replacement therapy (KRT). Due to their high risk of cardiovascular, renal complications, and mortality, these patients ... ...

    Abstract SGLT-2i are the new standard of care for diabetic kidney disease (DKD), but previous studies have not included patients on kidney replacement therapy (KRT). Due to their high risk of cardiovascular, renal complications, and mortality, these patients would benefit the most from this therapy. Residual kidney function (RKF) conveys a survival benefit and cardiovascular health among hemodialysis (HD) patients, especially those on incremental hemodialysis (iHD). We retrospectively describe the safety and efficacy of SGLT2i regarding RKF preservation in seven diabetic patients with different clinical backgrounds who underwent iHD (one or two sessions per week) during a 12-month follow-up. All patients preserved RKF, measured as residual kidney urea clearance (KrU) in 24 h after the introduction of SGLT2i. KrU levels improved significantly from 4.91 ± 1.14 mL/min to 7.28 ± 1.68 mL/min at 12 months (
    Language English
    Publishing date 2023-07-06
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2720867-9
    ISSN 2227-9059
    ISSN 2227-9059
    DOI 10.3390/biomedicines11071908
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: An Unusual Case of Seronegative Cryoglobulinemic Glomerulonephritis with Dominant Organized IgA Deposits Associated with Staphylococcal Infection: Casual or Causal Relationship?

    De La Flor Merino, José C / Apaza, Jacqueline / Díaz, Francisco / Sandoval, Edna / Valga, Francisco / Villa, Daniel / Marschall, Alexander / Abascal, María Luisa / Rivas, Andrea / Cieza, Michael

    Glomerular diseases

    2023  Volume 3, Issue 1, Page(s) 140–147

    Abstract: Introduction: Cryoglobulinemia refers to the presence of cryoglobulins (CGs) in the serum, encompassing a group of diseases caused by the type of circulating GC. Cryoglobulinemic glomerulonephritis (CryoGN) is the principal manifestation of renal ... ...

    Abstract Introduction: Cryoglobulinemia refers to the presence of cryoglobulins (CGs) in the serum, encompassing a group of diseases caused by the type of circulating GC. Cryoglobulinemic glomerulonephritis (CryoGN) is the principal manifestation of renal involvement. The diagnosis may be challenging because the hallmark of cryoglobulinemia is the detection of CG in the serum. However, cases of CryoGN without serological evidence of CGs are not uncommon in clinical practice, often diagnosed by anatomopathological findings in the renal biopsy.
    Case presentation: We report the case of an 86-year-old male who developed renal impairment, nephritic syndrome, and nephrotic-range proteinuria, without serological evidence of CGs, associated with staphylococcal bacteremia without apparent focus. Renal biopsy and pathological examination showed a membranoproliferative glomerulonephritis pattern with CD61-negative pseudothrombi. Immunofluorescence microscopy showed atypical IgA-dominant deposits. Electron microscopy revealed amorphous subendothelial and mesangial deposits and organized electrodense deposits within capillary loops (pseudothrombi) with microtubular substructure measuring 20-40 nm in thickness. These findings were consistent with seronegative CryoGN and microtubular organized atypical IgA-dominant deposits.
    Discussion: In this report, we discuss the clinical, analytical, and histopathological findings of a rare case of CryoGN without serological evidence of CGs. Regarding the etiology that triggered the glomerular disease in our patient, we conducted an exhaustive study in order to determine the underlying cause of CryoGN. At the time of biopsy, the patient had an active staphylococcal bacteremia. There are reports that postulate that staphylococcal antigens drive activation of immune system and in consequence, could cause this rare form of IgA-dominant glomerulonephritis with cryoglobulinemic features. After ruling out other causes of cryoglobulinemia, we discuss a plausible causal relationship of the staphylococcal infection in the pathogenesis of CryoGN in our patient.
    Language English
    Publishing date 2023-07-03
    Publishing country Switzerland
    Document type Case Reports
    ISSN 2673-3633
    ISSN (online) 2673-3633
    DOI 10.1159/000531737
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: An Exceptional Case of Light Chain Only Variant of Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits Secondary to Chronic Lymphocytic Leukemia: A Case Report and Review of the Literature.

    De La Flor, José C / Apaza, Jacqueline / Díaz, Francisco / Sandoval, Edna / Linares, Tania / Marschall, Alexander / Núñez, Patricia / Rivas-Nieto, Andrea Cecilia / Ruiz, Elisa

    Case reports in nephrology

    2022  Volume 2022, Page(s) 9207282

    Abstract: We present the case of an 86-year-old Caucasian male with an 11-year history of low-grade chronic lymphocytic leukemia (CLL) presenting with nephrotic syndrome (NS). Renal biopsy findings showed a diffuse mesangial and endocapillary proliferative ... ...

    Abstract We present the case of an 86-year-old Caucasian male with an 11-year history of low-grade chronic lymphocytic leukemia (CLL) presenting with nephrotic syndrome (NS). Renal biopsy findings showed a diffuse mesangial and endocapillary proliferative glomerulonephritis (GN) lesion with fine granular deposits, consistent with a rare morphologic variant of proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID)-lambda light chain (LC) only. Monthly combination therapy of rituximab (500 mg/m
    Language English
    Publishing date 2022-10-19
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2627652-5
    ISSN 2090-665X ; 2090-6641
    ISSN (online) 2090-665X
    ISSN 2090-6641
    DOI 10.1155/2022/9207282
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Early renal graft function deterioration in recipients with preformed anti-MICA antibodies: partial contribution of complement-dependent cytotoxicity.

    Sánchez-Zapardiel, Elena / Castro-Panete, María José / Mancebo, Esther / Morales, Pablo / Laguna-Goya, Rocío / Morales, José María / Apaza, Jacqueline / de Andrés, Amado / Talayero, Paloma / Paz-Artal, Estela

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

    2016  Volume 31, Issue 1, Page(s) 150–160

    Abstract: Background: We previously reported that preformed anti-MHC class I-related chain A (MICA) antibodies increase the risk for renal graft rejection and enhance the deleterious effect of PRA(+) status early after transplantation.: Methods: We studied 727 ...

    Abstract Background: We previously reported that preformed anti-MHC class I-related chain A (MICA) antibodies increase the risk for renal graft rejection and enhance the deleterious effect of PRA(+) status early after transplantation.
    Methods: We studied 727 kidney recipients. Days to reach optimal serum creatinine level, estimated glomerular filtration rate (eGFR) at Month 3 and chronic kidney disease (CKD) stages were recorded. Anti-MICA specificities and C1q binding were tested by solid-phase assay. Complement-dependent cytotoxicity (CDC) and flow cytometry (FC) cross-matches with HeLa and PMA/CD28-T-blasts were performed.
    Results: PRA(+)MICA(+) recipients exhibited longer time to reach optimal serum creatinine level after transplantation (P = 0.005) and had the lowest eGFR at Month 3 (P = 0.006). PRA(+)MICA(+) status independently increased the risk for CKDT stage 5 at Month 3 [hazard ratio (HR) 4.92, P = 0.030]. Pre-transplant anti-MICA antibodies were polyspecific and showed stronger reactions when coexisting with anti-HLA antibodies (mean standard fluorescent intensity 112 157 ± 44 426 in HLA(+)MICA(+) sera versus 49 680 ± 33 116 in HLA(-)MICA(+) sera, P = 0.0006). Anti-AYVE supereplet reactivity was significantly higher in HLA(+)MICA(+) versus HLA(-)MICA(+) patients (P < 0.001) and significantly superior than anti-CMGWS supereplet within HLA(+)MICA(+) patients (P = 0.001). Three of 13 anti-MICA(+) pre-transplant sera were positive for the C1q binding assay; one of them (serum 3) exclusively recognized AYVE supereplet with a strong reactivity against MICA*027 antigen (same as MICA*008). Anti-MICA antibodies in anti-HLA-absorbed serum 3 bound native MICA molecules in MICA*008(+) HeLa and PMA/CD28-T-blasts and mediated cell death by activating complement.
    Conclusion: Preformed anti-MICA antibodies may occasionally be cytotoxic by fixing and activating complement. This way they might contribute to worse early kidney graft function.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Antibody Specificity ; Antibody-Dependent Cell Cytotoxicity ; Autoantibodies/blood ; Autoantibodies/immunology ; Complement Activation ; Female ; Glomerular Filtration Rate ; Graft Rejection/blood ; Graft Rejection/epidemiology ; Graft Rejection/immunology ; HeLa Cells ; Histocompatibility Antigens Class I/immunology ; Humans ; Kidney/immunology ; Kidney/physiopathology ; Kidney Transplantation ; Male ; Middle Aged ; Proportional Hazards Models ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/immunology ; Renal Insufficiency, Chronic/surgery ; Retrospective Studies ; Transplantation, Homologous ; Treatment Outcome
    Chemical Substances Autoantibodies ; Histocompatibility Antigens Class I ; MHC class I-related chain A
    Language English
    Publishing date 2016-01
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 90594-x
    ISSN 1460-2385 ; 0931-0509
    ISSN (online) 1460-2385
    ISSN 0931-0509
    DOI 10.1093/ndt/gfv308
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2198: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 329: Show issues

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  5. Article ; Online: Harmful effect of preformed anti-MICA antibodies on renal allograft evolution in early posttransplantation period.

    Sánchez-Zapardiel, Elena / Castro-Panete, María J / Castillo-Rama, Marcela / Morales, Pablo / Lora-Pablos, David / Valero-Hervás, Diana / Ruiz-García, Raquel / Apaza, Jacqueline / Talayero, Paloma / Andrés, Amado / Morales, José M / Paz-Artal, Estela

    Transplantation

    2013  Volume 96, Issue 1, Page(s) 70–78

    Abstract: Background: Pretransplantation anti-major histocompatibility complex class I chain-related molecule A (MICA) sensitization is an uncommon event and its role on kidney graft evolution is not completely defined.: Methods: A retrospective study of ... ...

    Abstract Background: Pretransplantation anti-major histocompatibility complex class I chain-related molecule A (MICA) sensitization is an uncommon event and its role on kidney graft evolution is not completely defined.
    Methods: A retrospective study of patients transplanted between 2005 and 2011 in our center (n=727) was performed. Recipients were classified in four groups, according either to multiplexed flow cytometry-recorded anti-human leukocyte antigen (HLA) and anti-MICA antibodies or to percent panel-reactive antibody (PRA; by complement-dependent cytotoxicity) and anti-MICA antibodies.
    Results: In the total cohort, 52 (7.15%) patients had preformed anti-MICA antibodies, and these were not related with anti-HLA, previous transplantations, or recipient female sex (potential pregnancies). Kaplan-Meier curves showed global allograft survival differences (P=0.042) mostly due to pronounced decrease in PRA+MICA+ group early after transplantation. Biopsy-proven allograft rejection rate increased after month 12 in PRA+MICA- group and was higher early after transplantation in PRA+MICA+ group (P=0.033). In paired comparisons, rejection incidence was superior in PRA+MICA- versus PRA-MICA- patients (17% vs. 7%; P=0.007) at 24 months, confirming the widely reported deleterious effect of PRA+ status, but at 3 months rejection was higher in PRA+MICA+ versus PRA-MICA- patients (14% vs. 2%; P=0.009). Among patients categorized according anti-HLA and anti-MICA antibodies, the most striking difference in rejection was observed at 3 months (8% in HLA-MICA+ vs. 2% in HLA-MICA- patients; P=0.032). In the multivariate analysis, HLA-MICA+ status at 3 months independently conferred the highest risk for rejection (odds ratio, 5.07; P=0.049).
    Conclusions: Pretransplantation sensitization against MICA and HLA are independent events. Preformed anti-MICA antibodies independently increase risk for kidney rejection and enhance the deleterious effect of PRA+ status early after transplantation.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Graft Rejection/epidemiology ; Graft Rejection/immunology ; Graft Survival/immunology ; HLA Antigens/immunology ; Histocompatibility Antigens Class I/immunology ; Humans ; Isoantibodies/blood ; Isoantibodies/immunology ; Kidney Transplantation/immunology ; Male ; Middle Aged ; Multivariate Analysis ; Pregnancy ; Retrospective Studies ; Risk Factors ; Transplantation, Homologous ; Waiting Lists ; Young Adult
    Chemical Substances HLA Antigens ; Histocompatibility Antigens Class I ; Isoantibodies ; MHC class I-related chain A
    Language English
    Publishing date 2013-07-15
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 208424-7
    ISSN 1534-6080 ; 0041-1337
    ISSN (online) 1534-6080
    ISSN 0041-1337
    DOI 10.1097/TP.0b013e3182943506
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 488: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 509: Show issues

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