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Article: Better late than never: Diagnosis of recurrent atypical hemolytic uremic syndrome.

Aaltonen, Sari / Räisänen-Sokolowski, Anne / Kaartinen, Kati

2023 Volume 100, Issue 1, Page(s) 41–44

Abstract: Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) comprising microangiopathic hemolytic anemia, consumptive thrombocytopenia, and end-organ damage. Risk of end-stage renal disease is increased as HUS usually ... ...

Abstract	Atypical hemolytic uremic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA) comprising microangiopathic hemolytic anemia, consumptive thrombocytopenia, and end-organ damage. Risk of end-stage renal disease is increased as HUS usually manifests in native and transplanted kidneys. In transplants, while de novo disease can be seen, recurrent disease is more common. The etiology is variable, being either primary or secondary. aHUS often constitutes a diagnostic and therapeutic challenge, which may lead to a considerable delay in the diagnosis and treatment. During the last decades, great progress has been made in understanding the mechanisms and therapeutic options of this devastating condition. We present a case of a 50-year-old female who received her first kidney transplant from her mother at the age of 9 years. She experienced recurrent losses of transplants, and only after the loss of her fourth transplant did the diagnosis of aHUS become evident.
MeSH term(s)	Female ; Humans ; Child ; Middle Aged ; Atypical Hemolytic Uremic Syndrome/diagnosis ; Atypical Hemolytic Uremic Syndrome/therapy ; Atypical Hemolytic Uremic Syndrome/etiology ; Kidney ; Thrombotic Microangiopathies/complications ; Anemia, Hemolytic ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/etiology ; Kidney Failure, Chronic/surgery
Language	English
Publishing date	2023-04-27
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	185101-9
ISSN	0301-0430
ISSN	0301-0430
DOI	10.5414/CN111047
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Zs.A 873: Show issues

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Article ; Online: The effect of a single closed-circuit rebreather decompression dive in extremely cold water to cardiac function.

Tuominen, Laura J / Tuohinen, Suvi / Lundell, Richard V / Räisänen-Sokolowski, Anne K / Wuorimaa, Tomi

European journal of applied physiology

2024

Abstract: Purpose: Dive-induced cardiac and hemodynamic changes are caused by various mechanisms, and they are aggravated by cold water. Therefore, aging divers with pre-existing cardiovascular conditions may be at risk of acute myocardial infarction, heart ... ...

Abstract	Purpose: Dive-induced cardiac and hemodynamic changes are caused by various mechanisms, and they are aggravated by cold water. Therefore, aging divers with pre-existing cardiovascular conditions may be at risk of acute myocardial infarction, heart failure, or arrhythmias while diving. The aim of this study was to assess the effect of a single decompression CCR dive in arctic cold water on cardiac function in Finnish technical divers. Methods: Thirty-nine divers performed one identical 45 mfw CCR dive in 2-4 °C water. Hydration and cardiac functions were assessed before and after the dive. Detection of venous gas embolization was performed within 120 min after the dive. Results: The divers were affected by both cold-water-induced hemodynamic changes and immersion-related fluid loss. Both systolic and diastolic functions were impaired after the dive although the changes in cardiac functions were subtle. Venous inert gas bubbles were detected in all divers except for one. Venous gas embolism did not affect systolic or diastolic function. Conclusion: A single trimix CCR dive in arctic cold water seemed to debilitate both systolic and diastolic function. Although the changes were subtle, they appeared parallel over several parameters. This indicates a real post-dive deterioration in cardiac function instead of only volume-dependent changes. These changes are without a clinical significance in healthy divers. However, in a population with pre-existing or underlying heart problems, such changes may provoke symptomatic problems during or after the dive.
Language	English
Publishing date	2024-01-08
Publishing country	Germany
Document type	Journal Article
ZDB-ID	124793-1
ISSN	1439-6327 ; 1432-1025 ; 0301-5548 ; 1439-6319
ISSN (online)	1439-6327 ; 1432-1025
ISSN	0301-5548 ; 1439-6319
DOI	10.1007/s00421-023-05392-0
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Uc I Zs.195: Show issues

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Article ; Online: Diagnostic and Prognostic Comparison of Immune-Complex-Mediated Membranoproliferative Glomerulonephritis and C3 Glomerulopathy.

Kovala, Marja / Seppälä, Minna / Räisänen-Sokolowski, Anne / Meri, Seppo / Honkanen, Eero / Kaartinen, Kati

Cells

2023 Volume 12, Issue 5

Abstract: Membranoproliferative glomerulonephritis (MPGN) is subdivided into immune-complex-mediated glomerulonephritis (IC-MPGN) and C3 glomerulopathy (C3G). Classically, MPGN has a membranoproliferative-type pattern, but other morphologies have also been ... ...

Abstract	Membranoproliferative glomerulonephritis (MPGN) is subdivided into immune-complex-mediated glomerulonephritis (IC-MPGN) and C3 glomerulopathy (C3G). Classically, MPGN has a membranoproliferative-type pattern, but other morphologies have also been described depending on the time course and phase of the disease. Our aim was to explore whether the two diseases are truly different, or merely represent the same disease process. All 60 eligible adult MPGN patients diagnosed between 2006 and 2017 in the Helsinki University Hospital district, Finland, were reviewed retrospectively and asked for a follow-up outpatient visit for extensive laboratory analyses. Thirty-seven (62%) had IC-MPGN and 23 (38%) C3G (including one patient with dense deposit disease, DDD). EGFR was below normal (≤60 mL/min/1.73 m
MeSH term(s)	Adult ; Humans ; Glomerulonephritis, Membranoproliferative/pathology ; Prognosis ; Retrospective Studies ; Glomerulonephritis/pathology ; Kidney Diseases ; Paraproteins
Chemical Substances	Paraproteins
Language	English
Publishing date	2023-02-23
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2661518-6
ISSN	2073-4409 ; 2073-4409
ISSN (online)	2073-4409
ISSN	2073-4409
DOI	10.3390/cells12050712
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Article: Decompression illness in Finnish technical divers: a follow-up study on incidence and self-treatment.

Tuominen, Laura J / Sokolowski, Sofia / Lundell, Richard V / Räisänen-Sokolowski, Anne K

Diving and hyperbaric medicine

2023 Volume 52, Issue 2, Page(s) 78–84

Abstract: Introduction: Technical diving is increasing in popularity in Finland, and therefore the number of decompression illness (DCI) cases is also increasing among technical divers. Although hyperbaric oxygen treatment (HBOT) remains the standard of care, ... ...

Abstract	Introduction: Technical diving is increasing in popularity in Finland, and therefore the number of decompression illness (DCI) cases is also increasing among technical divers. Although hyperbaric oxygen treatment (HBOT) remains the standard of care, there are anecdotal reports of technical divers treating mild DCI symptoms themselves and not seeking a medical evaluation and possible recompression therapy. This study aimed to make an epidemiologic inventory of technical diving-related DCI symptoms, to establish the incidence of self-treatment and to determine the apparent effectiveness of different treatment methods. Methods: A one-year prospective survey with online questionnaires was conducted. Fifty-five experienced and highly trained Finnish technical divers answered the survey and reported their diving activity, DCI symptoms, symptom treatment, and treatment outcome. Results: Of the reported 2,983 dives, 27 resulted in symptoms of DCI, which yielded an incidence of 91 per 10,000 dives in this study. All of the reported DCI symptoms were mild, and only one diver received HBOT. The most common self-treatments were oral hydration and rest. First aid oxygen (FAO Conclusions: The incidence of self-treated DCI cases was 27 times higher than that of HBO-treated DCI cases. There is a need to improve divers' awareness of the importance of FAO
MeSH term(s)	Decompression/adverse effects ; Decompression Sickness/epidemiology ; Decompression Sickness/etiology ; Decompression Sickness/therapy ; Diving/adverse effects ; Finland/epidemiology ; Follow-Up Studies ; Humans ; Incidence ; Prospective Studies
Language	English
Publishing date	2023-06-30
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2237920-4
ISSN	1833-3516
ISSN	1833-3516
DOI	10.28920/dhm52.2.74-84
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Zs.A 4375: Show issues

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Article: Prolonged syncope with multifactorial pulmonary oedema related to dry apnoea training: Safety concerns in unsupervised dry static apnoea.

Valdivia-Valdivia, Juan M / Räisänen-Sokolowski, Anne / Lindholm, Peter

Diving and hyperbaric medicine

2021 Volume 51, Issue 2, Page(s) 210–215

Abstract: Many competitive breath-hold divers use dry apnoea routines to improve their tolerance to hypoxia and hypercapnia, varying the amount of prior hyperventilation and lung volume. When hyperventilating and exhaling to residual volume prior to starting a ... ...

Abstract	Many competitive breath-hold divers use dry apnoea routines to improve their tolerance to hypoxia and hypercapnia, varying the amount of prior hyperventilation and lung volume. When hyperventilating and exhaling to residual volume prior to starting a breath-hold, hypoxia is reached quickly and without too much discomfort from respiratory drive. Cerebral hypoxia with loss of consciousness (LOC) can easily result. Here, we report on a case where an unsupervised diver used a nose clip that is thought to have interfered with his resumption of breathing after LOC. Consequently, he suffered an extended period of severe hypoxia, with poor ventilation and recovery. He also held his breath on empty lungs; thus, trying to inhale created an intrathoracic sub-atmospheric pressure. Upon imaging at the hospital, severe intralobular pulmonary oedema was noted, with similarities to images presented in divers suffering from pulmonary barotrauma of descent (squeeze, immersion pulmonary oedema). Describing the physiological phenomena observed in this case highlights the risks associated with unsupervised exhalatory breath-holding after hyperventilation as a training practice in competitive freediving.
MeSH term(s)	Apnea/etiology ; Breath Holding ; Diving/adverse effects ; Humans ; Male ; Pulmonary Edema/etiology ; Syncope
Language	English
Publishing date	2021-06-16
Publishing country	Australia
Document type	Case Reports
ZDB-ID	2237920-4
ISSN	1833-3516
ISSN	1833-3516
DOI	10.28920/dhm51.2.210-215
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Zs.A 4375: Show issues

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Article: Vascular Occlusion in Kidney Biopsy Is Characteristic of Clinically Manifesting Thrombotic Microangiopathy.

Kovala, Marja / Seppälä, Minna / Kaartinen, Kati / Meri, Seppo / Honkanen, Eero / Räisänen-Sokolowski, Anne

Journal of clinical medicine

2022 Volume 11, Issue 11

Abstract: Thrombotic microangiopathy (TMA) can sometimes manifest only histologically. Our aim was to retrospectively compare biopsy-proven adult TMA patients showing only histological (h-TMA) or both histological and clinical (c-TMA) TMA in 2006-2017. All native ... ...

Abstract	Thrombotic microangiopathy (TMA) can sometimes manifest only histologically. Our aim was to retrospectively compare biopsy-proven adult TMA patients showing only histological (h-TMA) or both histological and clinical (c-TMA) TMA in 2006-2017. All native kidney biopsies with TMA were included. Biopsies were re-evaluated by light and electron microscopy, and immunofluorescence. Clinical characteristics, laboratory variables, and treatments were recorded from the electronic medical database. Patients were categorized into h-TMA and c-TMA and these groups were compared. In total, 30 biopsy-proven cases among 7943 kidney biopsies were identified and, of these, 15 had h-TMA and 15 c-TMA. Mean follow-up was 6.3 y, and 73.3% had secondary hemolytic uremic syndrome (HUS) and the rest were atypical HUS. Patient characteristics, treatments, and kidney, and patient survival in the groups were similar. Statistically significant differences were found in histological variables. Vascular myxoid swelling and vascular onion-skinning were almost exclusively detected in c-TMA and, thus, vascular occlusive changes indicate clinically apparent rather than merely histological TMA. In addition, regardless of clinical presentation, kidney and patient survival times were similar in the patient groups highlighting the importance of a kidney biopsy in the case of any kidney-related symptoms.
Language	English
Publishing date	2022-05-31
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11113124
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Article: Delayed treatment for decompression illness: factors associated with long treatment delays and treatment outcome.

Sokolowski, Sofia A / Räisänen-Sokolowski, Anne K / Tuominen, Laura J / Lundell, Richard V

Diving and hyperbaric medicine

2022 Volume 52, Issue 4, Page(s) 271–276

Abstract: Introduction: Effectiveness of delayed hyperbaric oxygen treatment (HBOT) for decompression illness (DCI) and factors affecting treatment delays have not been studied in large groups of patients.: Methods: This retrospective study included 546 DCI ... ...

Abstract	Introduction: Effectiveness of delayed hyperbaric oxygen treatment (HBOT) for decompression illness (DCI) and factors affecting treatment delays have not been studied in large groups of patients. Methods: This retrospective study included 546 DCI patients treated in Finland in the years 1999-2018 and investigated factors associated with recompression delay and outcome. Treatment outcome was defined as fully recovered or presence of residual symptoms on completion of HBOT. The symptoms, use of first aid oxygen, number of recompression treatments needed and characteristics of the study cohort were also addressed. Results: Delayed HBOT (> 48 h) remained effective with final outcomes similar to those treated within 48 h. Cardio-pulmonary symptoms were associated with a shorter treatment delay (median 15 h vs 28 h without cardiopulmonary symptoms, P < 0.001), whereas mild sensory symptoms were associated with a longer delay (48 vs 24 h, P < 0.001). A shorter delay was also associated with only one required HBOT treatment (median 24 h vs 34 h for those requiring multiple recompressions) ( P = 0.002). Tinnitus and hearing impairment were associated with a higher proportion of incomplete recoveries (78 and 73% respectively, P < 0.001), whereas a smaller proportion of cases with tingling/itching (15%, P = 0.03), nausea (27%, P = 0.03), motor weakness (33%, P = 0.05) and visual disturbances (36%, P = 0.04) exhibited residual symptoms. Patients with severe symptoms had a significantly shorter delay than those with mild symptoms (median 24 h vs 36 h respectively, P < 0.001), and a lower incidence of complete recovery. Conclusions: Delayed HBOT remains an effective and useful intervention. A shorter delay to recompression is associated with fewer recompressions required to achieve recovery or recovery plateau.
MeSH term(s)	Humans ; Decompression Sickness/therapy ; Decompression Sickness/diagnosis ; Time-to-Treatment ; Retrospective Studies ; Hyperbaric Oxygenation ; Treatment Outcome ; Decompression
Language	English
Publishing date	2022-12-15
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2237920-4
ISSN	1833-3516
ISSN	1833-3516
DOI	10.28920/dhm52.4.271-276
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Zs.A 4375: Show issues

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Article ; Online: The Case | Refractory anemia in a patient undergoing dialysis.

Kaartinen, Kati / Schenk, Päivi / Räisänen-Sokolowski, Anne / Dunkel, Johannes / Marttila, Anu / Huuskonen, Mika / Varmavuo, Ville

Kidney international

2023 Volume 105, Issue 1, Page(s) 211–212

MeSH term(s)	Humans ; Renal Dialysis/adverse effects ; Anemia, Refractory
Language	English
Publishing date	2023-11-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	120573-0
ISSN	1523-1755 ; 0085-2538
ISSN (online)	1523-1755
ISSN	0085-2538
DOI	10.1016/j.kint.2023.08.017
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Zs.A 797: Show issues

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Article ; Online: Expected impact of MRI-targeted biopsy interreader variability among uropathologists on ProScreen prostate cancer screening trial: a pre-trial validation study.

Hietikko, Ronja / Mirtti, Tuomas / Kilpeläinen, Tuomas P / Tolonen, Teemu / Räisänen-Sokolowski, Anne / Nordling, Stig / Hannus, Jill / Laurila, Marita / Taari, Kimmo / Tammela, Teuvo L J / Autio, Reija / Natunen, Kari / Auvinen, Anssi / Rannikko, Antti

World journal of urology

2024 Volume 42, Issue 1, Page(s) 217

Abstract: Purpose: Prostate cancer (PCa) histology, particularly the Gleason score, is an independent prognostic predictor in PCa. Little is known about the inter-reader variability in grading of targeted prostate biopsy based on magnetic resonance imaging (MRI). ...

Abstract	Purpose: Prostate cancer (PCa) histology, particularly the Gleason score, is an independent prognostic predictor in PCa. Little is known about the inter-reader variability in grading of targeted prostate biopsy based on magnetic resonance imaging (MRI). The aim of this study was to assess inter-reader variability in Gleason grading of MRI-targeted biopsy among uropathologists and its potential impact on a population-based randomized PCa screening trial (ProScreen). Methods: From June 2014 to May 2018, 100 men with clinically suspected PCa were retrospectively selected. All men underwent prostate MRI and 86 underwent targeted prostate of the prostate. Six pathologists individually reviewed the pathology slides of the prostate biopsies. The five-tier ISUP (The International Society of Urological Pathology) grade grouping (GG) system was used. Fleiss' weighted kappa (κ) and Model-based kappa for associations were computed to estimate the combined agreement between individual pathologists. Results: GG reporting of targeted prostate was highly consistent among the trial pathologists. Inter-reader agreement for cancer (GG1-5) vs. benign was excellent (Model-based kappa 0.90, Fleiss' kappa κ = 0.90) and for clinically significant prostate cancer (csPCa) (GG2-5 vs. GG0 vs. GG1), it was good (Model-based kappa 0.70, Fleiss' kappa κ 0.67). Conclusions: Inter-reader agreement in grading of MRI-targeted biopsy was good to excellent, while it was fair to moderate for MRI in the same cohort, as previously shown. Importantly, there was wide consensus by pathologists in assigning the contemporary GG on MRI-targeted biopsy suggesting high reproducibility of pathology reporting in the ProScreen trial.
MeSH term(s)	Male ; Humans ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/pathology ; Early Detection of Cancer ; Reproducibility of Results ; Retrospective Studies ; Prostate-Specific Antigen ; Biopsy ; Magnetic Resonance Imaging/methods ; Neoplasm Grading ; Image-Guided Biopsy
Chemical Substances	Prostate-Specific Antigen (EC 3.4.21.77)
Language	English
Publishing date	2024-04-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	380333-8
ISSN	1433-8726 ; 0724-4983
ISSN (online)	1433-8726
ISSN	0724-4983
DOI	10.1007/s00345-024-04898-2
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Zs.A 1832: Show issues

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Article: Very Low Frequency of Pathological Findings in One-year Protocol Biopsies of Uneventful Standard Risk Kidney Transplant Recipients: Results From the Nordic Protocol Biopsy Study.

Helanterä, Ilkka / Dörje, Christina / Ortiz, Fernanda / Varberg Reisæter, Anna / Hammarström, Clara / Lauronen, Jouni / Räisänen-Sokolowski, Anne / Haugen, Anders Johan / Lempinen, Marko / Åsberg, Anders / Mjøen, Geir

Transplantation direct

2024 Volume 10, Issue 5, Page(s) e1621

Abstract: Background: The clinical significance of kidney transplant protocol biopsies has been debated. We studied the frequency of borderline changes and T cell-mediated rejection (TCMR) in 1-y protocol biopsies in standard risk kidney transplant recipients.: ...

Abstract	Background: The clinical significance of kidney transplant protocol biopsies has been debated. We studied the frequency of borderline changes and T cell-mediated rejection (TCMR) in 1-y protocol biopsies in standard risk kidney transplant recipients. Methods: Consecutive non-HLA-sensitized recipients of kidney transplants between 2006 and 2017, who underwent a protocol biopsy at 1 y in 2 national transplant centers were studied retrospectively (N = 1546). Donor-specific HLA antibodies (DSAs), graft function (plasma creatinine), and proteinuria were measured at the time of 1-y protocol biopsy. The occurrence of subclinical acute TCMR (i2t2v0 or higher) or borderline changes suspicious of TCMR (i1t1v0 or higher) in the protocol biopsy was studied, together with frequency of findings causing changes in the composite score iBox. Results: Subclinical acute TCMR was detected in 30 of 1546 (1.9%) of the protocol biopsies, and borderline or TCMR in 179 of 1546 (12%). Among patients with no history of acute rejection, and no proteinuria or DSA, TCMR was detected in only 1 of 974 (0.1%) and borderline or TCMR in only 48 of 974 (4.9%) patients at 1 y. In the absence of proteinuria (<30 mg/g, or equivalent as measured with a negative dipstick proteinuria) or DSA, or history of acute rejection, only 50 of 974 (5.1%) biopsies showed any lesions significant for the iBox score. Conclusions: The likelihood of pathological findings in 1-y protocol biopsies in non-HLA-sensitized patients without previous immunological events is low. Clinical usefulness of protocol biopsies seems limited in these patients.
Language	English
Publishing date	2024-04-11
Publishing country	United States
Document type	Journal Article
ISSN	2373-8731
ISSN	2373-8731
DOI	10.1097/TXD.0000000000001621
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