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Article ; Online: A Prospective Study of Eplerenone in the Treatment of Patients with Glomerulonephritis

Marios Papasotiriou / Georgia Andrianna Georgopoulou / Adamantia Mpratsiakou / Theodoros Ntrinias / Georgios Lyras / Dimitrios S. Goumenos / Evangelos Papachristou

Biomedicines, Vol 11, Iss 12, p

2023 Volume 3340

Abstract: Background: High aldosterone levels contribute to kidney disease progression, while spironolactone in combination with ACEi or ARBs can potentially reduce proteinuria and ameliorate kidney function deterioration. However, evidence on the impact of ... ...

Abstract	Background: High aldosterone levels contribute to kidney disease progression, while spironolactone in combination with ACEi or ARBs can potentially reduce proteinuria and ameliorate kidney function deterioration. However, evidence on the impact of eplerenone in patients with glomerulonephritis is scarce. Methods: In this prospective observational study, we assessed the effects of eplerenone in patients with biopsy-proven glomerulonephritis who were already treated with ACEi or ARBs. Patients received either eplerenone (25 mg daily) on top of ACEi or ARBs or standard treatment alone. Proteinuria (24 h total protein excretion), kidney function, blood pressure and serum K + levels were assessed at 3, 6 and 12 months after the initiation of treatment. Results: Sixty-six patients were included in the study. Eplerenone was administered in 30 patients, while 36 received only ACEi or ARB. Proteinuria decreased from 1768 to 1152 mg/24 h after 1 year of eplerenone treatment, while it remained stable in controls. Eplerenone showed significant impact on proteinuria in those with baseline proteinuria of >1000 mg/24 h. Patients who received eplerenone showed a reduction in systolic blood pressure, while eGFR and serum K + levels remained stable. Conclusions: Addition of eplerenone has a beneficial effect on proteinuria in patients with glomerulonephritis and significant baseline proteinuria.
Keywords	eplerenone ; glomerulonephritis ; proteinuria ; blood pressure ; Biology (General) ; QH301-705.5
Subject code	616 ; 610
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Conservative management, immunosuppressive treatment or both for patients with primary immunoglobulin A nephropathy?

Dimitrios S. Goumenos

Nephrology Reviews, Vol 2, Iss 1, Pp e13-e

2010 Volume 13

Abstract: Immunoglobulin A nephropathy (IgAN) is the most commonly encountered primary glomerulonephritis and it usually follows an indolent clinical course. However, hypertensive patients with proteinuria and renal insufficiency at presentation and patients with ... ...

Abstract	Immunoglobulin A nephropathy (IgAN) is the most commonly encountered primary glomerulonephritis and it usually follows an indolent clinical course. However, hypertensive patients with proteinuria and renal insufficiency at presentation and patients with severe histological involvement are at high risk to develop end-stage renal failure. Patients with normal renal function, mild proteinuria (<1 g/24h) and mild histopathological involvement need only observation, whereas patients with heavy proteinuria, impaired renal function and moderate to severe histopathological involvement are usually treated with immunosuppressive drugs. Angiotensin converting enzyme (ACE) inhibitors are used in patients with arterial hypertension and/or proteinuria 1-2 g/24h. Corticosteroids are indicated in patients with heavy proteinuria (>3 g/24h) and in progressive disease despite treatment with ACE inhibitors. Combinations of corticosteroids and cytotoxic drugs are saved for patients with IgA nephropathy and a rapidly progressive course. Fish oil might be an alternative to corticosteroids in cases with renal insufficiency and chronic histological lesions.
Keywords	Diseases of the genitourinary system. Urology ; RC870-923 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Urology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610
Publishing date	2010-11-01T00:00:00Z
Publisher	PAGEPress Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Conservative management, immunosuppressive treatment or both for patients with primary immunoglobulin A nephropathy?

Dimitrios S. Goumenos

Nephrology Reviews, Vol 2, Iss 2, Pp e13-e

2010 Volume 13

Abstract	Immunoglobulin A nephropathy (IgAN) is the most commonly encountered primary glomerulonephritis and it usually follows an indolent clinical course. However, hypertensive patients with proteinuria and renal insufficiency at presentation and patients with severe histological involvement are at high risk to develop end-stage renal failure. Patients with normal renal function, mild proteinuria (<1 g/24h) and mild histopathological involvement need only observation, whereas patients with heavy proteinuria, impaired renal function and moderate to severe histopathological involvement are usually treated with immunosuppressive drugs. Angiotensin converting enzyme (ACE) inhibitors are used in patients with arterial hypertension and/or proteinuria 1-2 g/24h. Corticosteroids are indicated in patients with heavy proteinuria (>3 g/24h) and in progressive disease despite treatment with ACE inhibitors. Combinations of corticosteroids and cytotoxic drugs are saved for patients with IgA nephropathy and a rapidly progressive course. Fish oil might be an alternative to corticosteroids in cases with renal insufficiency and chronic histological lesions.
Keywords	Diseases of the genitourinary system. Urology ; RC870-923 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Urology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	610
Publishing date	2010-07-01T00:00:00Z
Publisher	PAGEPress Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Case Report

Paraskevi Pavlakou / Marios Papasotiriou / Theodoros Ntrinias / Alexandra Kourakli / Adamantia Bratsiakou / Dimitrios S. Goumenos / Evangelos Papachristou

Frontiers in Medicine, Vol

Kidney Transplantation in a Patient With Acquired Agammaglobulinemia and SLE. Issues and Challenges

2021 Volume 8

Abstract: Lupus nephritis in the context of Systemic Lupus Erythematosus (SLE) is characterized by an unpredicted course with remissions and flare-ups. Among others, it remains a significant cause of end-stage kidney disease (ESKD) in relatively young patients. ... ...

Abstract	Lupus nephritis in the context of Systemic Lupus Erythematosus (SLE) is characterized by an unpredicted course with remissions and flare-ups. Among others, it remains a significant cause of end-stage kidney disease (ESKD) in relatively young patients. Therapeutic regimens with newer immunosuppressive agents have been introduced in order to control SLE clinical manifestations more efficiently and limit organ damage induced by immune complex formation and sustained inflammation. Treatment is usually long-term, and the cumulative impact of immunosuppression is expressed through the increased frequency of infections and neoplasms. However, if the observed immunity dysregulation is secondary and pharmaceutically induced or there is a pre-existing, primary immunodeficiency that shares common pathogenetic pathways with SLE's autoimmunity is not always clear. Herein, we present the case of a 39-year-old woman, that reached ESKD due to lupus nephritis. After an upper respiratory cytomegalovirus (CMV) infection and concomitant CMV reactivations the investigation revealed significant immunodeficiency. Not long after the initiation of intravenous immunoglobulin (IVIG) administration, patient received a cadaveric kidney transplant. IVIG was continued along with standard immunosuppression so that both recurrent infections and allograft rejection are avoided. Patient is closely monitored, and her post-transplant course is remarkably satisfying so far. ESKD patients with immunodeficiency syndromes should not be excluded by definition from kidney transplantation.
Keywords	kidney transplantation ; immunodeficiency ; systemic lupus erythematosus ; hypogammaglobulinemia ; intravenous immunoglobulin ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2021-03-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Membranoproliferative glomerulonephritis in a patient with chronic brucellosis

Simella Provatopoulou / Marios Papasotiriou / Evangelos Papachristou / Hariklia Gakiopoulou / Markos Marangos / Dimitrios S. Goumenos

Kidney Research and Clinical Practice, Vol 37, Iss 3, Pp 298-

2018 Volume 303

Abstract: Brucellosis is the most common zoonotic disease in Greece, with an endemic distribution and can affect any organ. Infiltration of the renal parenchyma causes acute and chronic interstitial nephritis with granulomas, whereas renal glomeruli are rarely ... ...

Abstract	Brucellosis is the most common zoonotic disease in Greece, with an endemic distribution and can affect any organ. Infiltration of the renal parenchyma causes acute and chronic interstitial nephritis with granulomas, whereas renal glomeruli are rarely affected. The disease has been sporadically reported, and it causes various histopathologic patterns. Herein, we describe the case of a 39-year-old stock breeder with a history of recurrent episodes of bacteremia caused by Brucella melitensis over a period of 3 years. Two months after the last episode of bacteremia, he presented with mild renal insufficiency, nephrotic range proteinuria, and microscopic hematuria. A renal biopsy revealed membranoproliferative glomerulonephritis with a pattern of focal-segmental nodular sclerosis and moderate tubulointerstitial fibrosis. The patient received antimicrobial and corticosteroid therapy with partial remission of the nephrotic syndrome.
Keywords	Brucellosis ; Membranoproliferative glomerulonephritis ; Nephrotic syndrome ; Internal medicine ; RC31-1245 ; Specialties of internal medicine ; RC581-951
Subject code	616
Language	English
Publishing date	2018-09-01T00:00:00Z
Publisher	The Korean Society of Nephrology
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Validation of the International IgA Nephropathy Prediction Tool in the Greek Registry of IgA Nephropathy

Marios Papasotiriou / Maria Stangou / Dimitris Chlorogiannis / Smaragdi Marinaki / Dimitrios Xydakis / Erasmia Sampani / Georgios Lioulios / Eleni Kapsia / Synodi Zerbala / Maria Koukoulaki / Georgios Moustakas / Stavros Fokas / Evangelia Dounousi / Anila Duni / Antonia Papadaki / Nikolaos Damianakis / Dimitra Bacharaki / Kostas Stylianou / Hariklia Gakiopoulou /

George Liapis / Georgios Sakellaropoulos / Evangelos Papachristou / Ioannis Boletis / Aikaterini Papagianni / Dimitrios S. Goumenos

Frontiers in Medicine, Vol

2022 Volume 9

Abstract: BackgroundImmunoglobulin A nephropathy (IgAN) is among the commonest glomerulonephritides in Greece and an important cause of end-stage kidney disease (ESKD) with an insidious chronic course. Thus, the recently published International IgAN prediction ... ...

Abstract	BackgroundImmunoglobulin A nephropathy (IgAN) is among the commonest glomerulonephritides in Greece and an important cause of end-stage kidney disease (ESKD) with an insidious chronic course. Thus, the recently published International IgAN prediction tool could potentially provide valuable risk stratification and guide the appropriate treatment module. This study aimed to externally validate this prediction tool using a patient cohort from the IgAN registry of the Greek Society of Nephrology.MethodsWe validated the predictive performance of the two full models (with or without race) derived from the International IgAN Prediction Tool study in the Greek Society of Nephrology registry of patients with IgAN using external validation of survival prediction models (Royston and Altman). The discrimination and calibration of the models were tested using the C-statistics and stratified analysis, coefficient of determination (RD2) for model fit, and the regression coefficient of the linear predictor (βPI), respectively.ResultsThe study included 264 patients with a median age of 39 (30–51) years where 65.2% are men. All patients were of Caucasian origin. The 5-year risk of the primary outcome (50% reduction in estimated glomerular filtration rate or ESKD) was 8%. The RD2 for the full models with and without race when applied to our cohort was 39 and 35%, respectively, and both were higher than the reported RD2 for the models applied to the original validation cohorts (26.3, 25.3, and 35.3%, respectively). Harrel's C statistic for the full model with race was 0.71, and for the model without race was 0.70. Renal survival curves in the subgroups (<16th, ~16 to <50th, ~50 to <84th, and >84th percentiles of linear predictor) showed adequate separation. However, the calibration proved not to be acceptable for both the models, and the risk probability was overestimated by the model.ConclusionsThe two full models with or without race were shown to accurately distinguish the highest and higher risk patients from ...
Keywords	IgAN prediction tool ; IgAN disease progression ; chronic kidney disease ; immunosuppression ; ACE inhibitors ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Treatment of IgA nephropathy based on the severity of clinical and histological features

Pantelitsa Kalliakmani / Dimitrios Komninakis / Miltiadis Gerolymos / Marios Papasotiriou / Eirini Savvidaki / Dimitrios S Goumenos

Saudi Journal of Kidney Diseases and Transplantation, Vol 26, Iss 3, Pp 516-

2015 Volume 525

Abstract: Immunoglobulin A (IgA) nephropathy (IgAN) represents a common glomerular disease treated by various therapeutic regimens. We studied 50 IgAN patients to determine the effect of different regimens selected according to severity of the disease on the ... ...

Abstract	Immunoglobulin A (IgA) nephropathy (IgAN) represents a common glomerular disease treated by various therapeutic regimens. We studied 50 IgAN patients to determine the effect of different regimens selected according to severity of the disease on the clinical outcome of patients over a follow-up period of five years. Patients with normal renal function and proteinuria <1 g/24-h received no treatment (Group A, n = 6). Thοse with normal renal function, proteinuria >1 g/24-h and mild to moderate histological lesions received angiotensin-converting enzyme inhibitors (ACEi) and corticosteroids (Group B, n = 23). Patients with baseline serum creatinine (Scr) <2.5 mg/dL, proteinuria >3.5 g/24-h and severe histological lesions received ACEi, corticosteroids and other immunosuppressive drugs (Group C, n = 18). Finally, patients with Scr >2.5 mg/dL, glomerulosclerosis and tubulointerstitial fibrosis received ACEi and fish oil (Group D, n = 3). Doubling of baseline Scr was observed in nine (18%) patients; two (8.7%) patients from Group B, five (27.7%) patients from Group C and two (66.7%) patients from Group D. Of the seven (14%) patients who reached end-stage renal disease, one (4.3%) patient was from Group B, four (21.0%) patients were from Group C and two (66.7%) patients were from Group D. Reduction of proteinuria was observed in all (100%) patients from Group B and in 15 (83.3%) patients from Group C. Adverse reactions occurred in three of 18 (16%) patients treated with immunosuppressive drugs. The choice of therapeutic regimen used in the treatment of patients with IgAN could be based on the severity of clinical and histological involvement in order to achieve the maximum effect with the least of adverse reactions.
Keywords	Medicine ; R
Subject code	610 ; 616
Language	English
Publishing date	2015-01-01T00:00:00Z
Publisher	Wolters Kluwer Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Investigation of clinical interaction between omeprazole and tacrolimus in CYP3A5 non-expressors, renal transplant recipients

Paraskevi F Katsakiori / Eirini P Papapetrou / Dimitrios S Goumenos

Therapeutics and Clinical Risk Management, Vol 2010, Iss default, Pp 265-

2010 Volume 269

Abstract: Paraskevi F Katsakiori1, Eirini P Papapetrou2, Dimitrios S Goumenos3, George C Nikiforidis4, Christodoulos S Flordellis1Departments of 1Pharmacology, 3Internal Medicine-Nephrology, 4Medical Physics, School of Medicine, University of Patras, Rion, Greece; ...

Abstract	Paraskevi F Katsakiori1, Eirini P Papapetrou2, Dimitrios S Goumenos3, George C Nikiforidis4, Christodoulos S Flordellis1Departments of 1Pharmacology, 3Internal Medicine-Nephrology, 4Medical Physics, School of Medicine, University of Patras, Rion, Greece; 2Center for Cell Engineering, Molecular Pharmacology and Chemistry Program, Memorial Sloan-Kettering Cancer Center, New York, NY, USABackground: As proton pump inhibitors share CYP3A4 enzyme with tacrolimus for their hepatic elimination, they potentially affect its pharmacokinetics, most prominently in patients with CYP2C19 or CYP3A5 gene mutations. Our aim was to investigate the impact of omeprazole on tacrolimus pharmacokinetics in CYP3A5 non-expressors, kidney transplant recipients.Methods: Twelve patients (five males/seven females) were observed for 175 ± 92.05 days. Omeprazole (20 mg pos) was administrated for 75.83 ± 45.17 days. Immunosuppressant regimen consisted of tacrolimus (n = 12), methylprednisolone (n = 10), mycophenolate mofetil (n = 11), azathioprine (n = 1), and everolimus (n = 2). Patient’s body weight, coadministered drugs, and tacrolimus trough levels were monitored. Aspartate and alanine aminotransferase, γ-glutamyltransferase, and bilirubin were used for evaluating hepatic function. Tacrolimus kinetics were estimated with daily dose, concentration, dose adjusted concentration, and volume of distribution with and without coadministration of omeprazole. CYP3A5 genotyping was performed with PCR followed by restriction fragment length polymorphism analysis. Statistical analysis was performed with Prism 4 software (GraphPad Software, Inc).Results: No statistically significant difference was observed in tacrolimus kinetics and hepatic function during coadministration of omeprazole.Conclusion: Our results let us propose that there is no need for more frequent therapeutic drug monitoring of tacrolimus when coadministrated with omeprazole in CYP3A5 nonexpressors, though prospective studies with more patients and longer observation period are needed to confirm these findings.Keywords: CYP3A5, omeprazole, renal transplantation, tacrolimus
Keywords	Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2010-06-01T00:00:00Z
Publisher	Dove Medical Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Tacrolimus and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors

Paraskevi F Katsakiori / Eirini P Papapetrou / Dimitrios S Goumenos / George C Nikiforidis / Christodoulos S Flordellis

Indian Journal of Pharmacology, Vol 43, Iss 4, Pp 385-

An interaction study in CYP3A5 non-expressors, renal transplant recipients

2011 Volume 388

Abstract: Objectives: Atherosclerosis is a significant factor affecting long-term outcome in renal transplant recipients. Studies have been conducted to determine the pharmacogenomic pathways involved in statin efficacy, efficiency, and adverse effect likelihood. ... ...

Abstract	Objectives: Atherosclerosis is a significant factor affecting long-term outcome in renal transplant recipients. Studies have been conducted to determine the pharmacogenomic pathways involved in statin efficacy, efficiency, and adverse effect likelihood. However, little is known about the influence of statins on tacrolimus kinetics. The aim of this study was to investigate possible pharmacological interactions between tacrolimus and statins in CYP3A5 non-expressors, renal transplant recipients. Materials and Methods: Twenty-four patients, treated with tacrolimus (n=24), methylprednisolone (n=24), and mycophenolate mofetil (n=19)/azathioprine (n=1)/everolimus (n=4), participated in the study. After an observation time of 112±36 days, statins, namely, atorvastatin (n=12), simvastatin (n=8), pravastatin (n=2), or fluvastatin (n=2), were administered for additional 101±34 days. DNA was extracted from whole blood sample and polymerase chain reaction followed by restriction fragment length polymorphism analysis was used for CYP3A5 genotyping. Student′s t-test and Mann-Whitney test were used to test the significance of difference in variables that passed or did not pass Kolmogorov′s normality test, respectively. Results: No statistically significant difference was observed in tacrolimus daily dose, concentration, concentration/dose ratio, and volume of distribution before and during the administration of statins. Statistically significant decrease in serum cholesterol was observed after initiation of statins. Renal and hepatic function remained unchanged and no skeletal muscle abnormalities were reported. Conclusions: The results of this study show that tacrolimus and statins do not interact in terms of efficacy, efficiency, and adverse effect likelihood. No significant clinical interaction or effect was observed, even with the use of atorvastatin or simvastatin, which are metabolized by CYP3A4 such as tacrolimus.
Keywords	CYP3A5 ; pharmacokinetics ; renal transplantation ; statin ; tacrolimus ; Therapeutics. Pharmacology ; RM1-950 ; Medicine ; R
Subject code	616
Language	English
Publishing date	2011-01-01T00:00:00Z
Publisher	Medknow Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Factors affecting the long-term response to tacrolimus in renal transplant patients

Paraskevi F. Katsakiori, Eirini P. Papapetrou, George C. Sakellaropoulos, Dimitrios S. Goumenos, George C. Nikiforidis, Christodoulos S. Flordellis

International Journal of Medical Sciences, Vol 7, Iss 2, Pp 94-

Pharmacokinetic and pharmacogenetic approach

2010 Volume 100

Abstract: Background: The aim of our study was to determine the impact of CYP3A5*1 and CYP3A5*3 on the kinetics of tacrolimus in renal transplant recipients. Material and methods: Forty kidney recipients were selected to participate. Maintenance scheme consisted ... ...

Abstract	Background: The aim of our study was to determine the impact of CYP3A51 and CYP3A53 on the kinetics of tacrolimus in renal transplant recipients. Material and methods: Forty kidney recipients were selected to participate. Maintenance scheme consisted of tacrolimus, a purine inhibitor and a steroid. CYP3A5 genotyping was performed with PCR and RFLP. Pharmacokinetic model was developed with Linear Regression and General Linear Model repeated measures approach. The impact of sex, CYP3A51 allele, age at transplantation, hepatic and renal function on tacrolimus kinetics was examined. Results: The frequency of CYP3A53/3 and CYP3A51/3 genotype was 35/40 and 5/40, respectively. No CYP3A51/1 was detected. CYP3A51 variant was associated with significant lower TAC dose adjusted concentration at 3, 6, 12 and 36 months after transplantation. Hepatic and renal function showed a significant effect on tacrolimus dose adjusted concentration 3 months after transplantation (p=0.000 and 0.028, respectively). Sex did not show a significant impact on tacrolimus kinetics. Carriers of CYP3A51 allele had lower predicted measures for tacrolimus dose adjusted concentration and higher predicted measures for volume of distribution. Conclusion: We proved that CYP3A51 carriers need higher tacrolimus dose than CYP3A5*3 homozygotes to achieve the target blood concentration.
Keywords	Medicine ; R
Subject code	616
Language	English
Publishing date	2010-01-01T00:00:00Z
Publisher	Ivyspring International Publisher
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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