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Article ; Online: Anti-neutrophil cytoplasmic antibody monitoring in vasculitis patients to predict relapse.

Schuster, Daniel D / Gillis, David / Wong, Richard C W / Kodituwakku, Aruna / Droney, Luke / Ranganathan, Dwarakanathan

International journal of rheumatic diseases

2023 Volume 26, Issue 9, Page(s) 1861–1865

MeSH term(s)	Humans ; Antibodies, Antineutrophil Cytoplasmic ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy ; Chronic Disease ; Recurrence
Chemical Substances	Antibodies, Antineutrophil Cytoplasmic
Language	English
Publishing date	2023-05-15
Publishing country	England
Document type	Letter
ZDB-ID	2426924-4
ISSN	1756-185X ; 1756-1841
ISSN (online)	1756-185X
ISSN	1756-1841
DOI	10.1111/1756-185X.14728
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Zs.A 6098: Show issues

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Article: Critical evaluation of cancer risks in glomerular disease.

Thet, Zaw / Lam, Alfred K / Ranganathan, Dwarakanathan / Aung, Soe Yu / Han, Thin / Khoo, Tien K

Translational oncology

2022 Volume 19, Page(s) 101376

Abstract: The increased cancer incidence in patients with glomerular disease can be secondary to an intrinsic immune dysfunction associated with the disease or/and extrinsic factors, especially immunosuppressants. The treatment for paraneoplastic glomerulopathy is ...

Abstract	The increased cancer incidence in patients with glomerular disease can be secondary to an intrinsic immune dysfunction associated with the disease or/and extrinsic factors, especially immunosuppressants. The treatment for paraneoplastic glomerulopathy is different from primary glomerular disease. Immunosuppressive therapy often used for primary glomerulopathy may aggravate concomitant cancers in patients with paraneoplastic glomerulopathy. In membranous nephropathy (MN), measurement of serum circulating autoantibodies against podocyte transmembrane glycoprotein M-type phospholipase A2 receptor (PLA2R) and thrombospondin type 1 domain-containing 7A (THSD7A), immunohistochemical staining of kidney tissue for glomerular PLA2R, THSD7A, neural epidermal growth factor-like 1 protein (NELL-1) and specific types of immunoglobulin G (IgG) may be useful adjuncts when screening for underlying malignancies. This review addresses overall cancer risks in individuals with glomerular diseases and employment of biomarkers available for MN. We propose a scheme of screening of cancers frequently reported in the setting of glomerular disease.
Language	English
Publishing date	2022-02-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2443840-6
ISSN	1936-5233
ISSN	1936-5233
DOI	10.1016/j.tranon.2022.101376
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Article ; Online: Comparison of skin cancer risk between renal transplant recipients and patients with glomerular diseases in rural Queensland.

Thet, Zaw / Lam, Alfred King-Yin / Ng, Shu-Kay / Aung, Soe Yu / Han, Thin / Ranganathan, Dwarakanathan / Newsham, Stephanie / Borg, Jennifer / Pepito, Christine / Khoo, Tien K

The Australian journal of rural health

2024 Volume 32, Issue 2, Page(s) 249–262

Abstract: Introudction: There is increased risk of skin cancer in patients with gloermular disease or those with renal transplant.: Objectives: To compare the risk of skin cancer between kidney recipients (KTRs) and patients with glomerular disease (GD).: ... ...

Abstract	Introudction: There is increased risk of skin cancer in patients with gloermular disease or those with renal transplant. Objectives: To compare the risk of skin cancer between kidney recipients (KTRs) and patients with glomerular disease (GD). Design: The cohort comprised patients with KTRs (n = 61) and GD (n = 51) in Central and Central West Queensland, Australia. A quantitative cohort study was undertaken to study the risk of skin cancer in rural communities between two subgroups of patients with kidney diseases in relationship to immunosuppression. Statistical analyses of the differences in incidence of skin cancers between the two groups were done by chi-square test, Fisher's exact test, independent t-test and McNemar's test. Findings: KTRs with non-melanoma skin carcinoma (NMSC) increased significantly after treatment with immunosuppressants (pre-transplantation, n = 11 [18.0%], post-transplantation, n = 28 [45.9%]; p < 0.001). There were no differences in number of patients with NMSC observed in the GD group (pre-diagnosis, n = 6 [11.8%], post-diagnosis, n = 7 [13.7%]; p = 1.000). Compared to the risks at 1 year post-immunosuppressants, the incidence of NMSC of KTRs increased significantly at 3 years (20.3% vs. 35.4%, p < 0.001) and 5 years (20.3% vs. 62.2%, p < 0.001) post-immunosuppressants, whereas the increased incidence of NMSC was observed only at 5 years (2.1% vs. 11.8%, p = 0.012) in the GD cohort. The mean cumulative number of NMSC in KTRs increased significantly at 3 years (p = 0.011), and 5 years (p = 0.001) post-immunosuppressants, compared to the risks at 1 year post-immunosuppressants, however, no differences were noted in the GD cohort. Discussion: Immunosuppressants increased the risk of NMSC in KTRs. The increased risk is likely dependent on the intensity and duration of immunosuppressants. Conclusion: In patients with a high risk of NMSC, reducing skin cancer risk should be considered in conjunction with the optimisation of treatment.
MeSH term(s)	Humans ; Queensland/epidemiology ; Kidney Transplantation ; Female ; Male ; Middle Aged ; Skin Neoplasms/epidemiology ; Adult ; Rural Population/statistics & numerical data ; Aged ; Cohort Studies ; Incidence ; Immunosuppressive Agents/therapeutic use ; Immunosuppressive Agents/adverse effects ; Risk Factors ; Transplant Recipients/statistics & numerical data
Chemical Substances	Immunosuppressive Agents
Language	English
Publishing date	2024-01-19
Publishing country	Australia
Document type	Journal Article ; Comparative Study
ZDB-ID	2069573-1
ISSN	1440-1584 ; 1038-5282
ISSN (online)	1440-1584
ISSN	1038-5282
DOI	10.1111/ajr.13081
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Article ; Online: Reducing non-melanoma skin cancer risk in renal transplant recipients.

Thet, Zaw / Lam, Alfred K / Ranganathan, Dwarakanathan / Aung, Soe Yu / Han, Thin / Khoo, Tien K

Nephrology (Carlton, Vic.)

2021 Volume 26, Issue 11, Page(s) 907–919

Abstract: With an increasing number of renal transplant recipients (RTRs) and improving patient survival, a higher incidence of non-melanoma skin cancer (NMSC) has been observed. NMSC in RTRs are often more numerous and biologically more aggressive than the ... ...

Abstract	With an increasing number of renal transplant recipients (RTRs) and improving patient survival, a higher incidence of non-melanoma skin cancer (NMSC) has been observed. NMSC in RTRs are often more numerous and biologically more aggressive than the general population, thus contributing towards an increase in morbidity and to a lesser degree, mortality. The resultant cumulative health and financial burden is a recognized concern. Proposed strategies in mitigating risks of developing NMSC and early therapeutic options thereof include tailored modification of immunosuppressants in conjunction with sun protection in all transplant patients. This review highlights the clinical and financial burden of transplant-associated skin cancers, carcinogenic mechanisms in association with immunosuppression, importance of skin cancer awareness campaign and integrated transplant skin clinic, and the potential role of chemoprotective agents. A scheme is proposed for primary and secondary prevention of NMSC based on the available evidence.
MeSH term(s)	Animals ; Anticarcinogenic Agents/therapeutic use ; Humans ; Immunocompromised Host ; Immunosuppressive Agents/adverse effects ; Incidence ; Kidney Transplantation/adverse effects ; Prognosis ; Protective Factors ; Risk Assessment ; Risk Factors ; Skin Neoplasms/immunology ; Skin Neoplasms/mortality ; Skin Neoplasms/prevention & control
Chemical Substances	Anticarcinogenic Agents ; Immunosuppressive Agents
Language	English
Publishing date	2021-07-28
Publishing country	Australia
Document type	Journal Article ; Review
ZDB-ID	1303661-0
ISSN	1440-1797 ; 1320-5358
ISSN (online)	1440-1797
ISSN	1320-5358
DOI	10.1111/nep.13939
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Zs.A 4822: Show issues

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Article ; Online: Cancer risks along the disease trajectory in antineutrophil cytoplasmic antibody associated vasculitis.

Thet, Zaw / Lam, Alfred K / Ranganathan, Dwarakanathan / Aung, Soe Yu / Khoo, Tien K

Clinical rheumatology

2020 Volume 39, Issue 9, Page(s) 2501–2513

Abstract: This review appraises the current literature on carcinogenic risks in anti-neutrophilic cytoplasmic autoantibody (ANCA) associated vasculitis (AAV). Patients with AAV are often at increased risk of developing non-melanoma skin carcinomas (NMSCs), ... ...

Abstract	This review appraises the current literature on carcinogenic risks in anti-neutrophilic cytoplasmic autoantibody (ANCA) associated vasculitis (AAV). Patients with AAV are often at increased risk of developing non-melanoma skin carcinomas (NMSCs), haematological malignancies, bladder, breast, lung, prostate, and colorectal carcinomas. Reported cancer incidence in these patients ranged from 10 to 26%. Cancer risks at the time of diagnosis of AAV and disease outcomes along the trajectory of AAV that may lead to chronic kidney disease (CKD); dialysis and transplantation are summarized. Inherent carcinogenic risks as part of immunosuppressive treatment in AAV are further detailed with considerations on specific malignancy risks of therapeutic agents used. Challenges that contribute to malignancy risk include a high relapse rate of AAV and prolonged exposure to immunosuppressants. The incidence of malignancy increases significantly after 5 years of immunosuppressant exposure though risks in the earlier years have also been described. Following renal transplantation, there is limited information available on risk of malignancy. Thoughtful use of immunosuppressants, modification of lifestyle, and environmental factors, as well as adopting appropriate cancer screening will likely influence malignancy risk in individuals with AAV.
MeSH term(s)	Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/epidemiology ; Antibodies, Antineutrophil Cytoplasmic ; Humans ; Immunosuppressive Agents/adverse effects ; Male ; Neoplasm Recurrence, Local ; Renal Dialysis
Chemical Substances	Antibodies, Antineutrophil Cytoplasmic ; Immunosuppressive Agents
Language	English
Publishing date	2020-03-26
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	604755-5
ISSN	1434-9949 ; 0770-3198
ISSN (online)	1434-9949
ISSN	0770-3198
DOI	10.1007/s10067-020-05055-x
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Zs.A 1740: Show issues

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Article ; Online: Phentermine induced acute interstitial nephritis.

Shao, Emily Ximin / Wilson, Gregory John / Ranganathan, Dwarakanathan

BMJ case reports

2017 Volume 2017

Abstract: Acute interstitial nephritis (AIN) has a number of medication-related aetiologies. Antibiotics, proton pump inhibitors and non-steroidal anti-inflammatory drugs are common causes; however, any medication has the potential to cause drug-induced AIN. We ... ...

Abstract	Acute interstitial nephritis (AIN) has a number of medication-related aetiologies. Antibiotics, proton pump inhibitors and non-steroidal anti-inflammatory drugs are common causes; however, any medication has the potential to cause drug-induced AIN. We report the first case of phentermine-induced AIN. A Caucasian woman aged 43 years presented with a 5-week history of lethargy, left-sided lower abdominal pain, nausea and vomiting. She had been taking phentermine for weight loss for 9 months and had recently ceased the medication. The patient underwent a renal biopsy that showed a predominantly lymphohistiocytic interstitial infiltrate with a moderate number of eosinophils consistent with AIN. Phentermine is increasingly used for weight loss in obese patients. This is the first case implicating phentermine as the causative agent for drug-induced AIN. While rare, phentermine-induced AIN is a possible adverse reaction of phentermine. Physicians and patients need to be aware of this risk.
MeSH term(s)	Adult ; Female ; Humans ; Nephritis, Interstitial/chemically induced ; Obesity/drug therapy ; Phentermine/adverse effects
Chemical Substances	Phentermine (C045TQL4WP)
Language	English
Publishing date	2017-03-09
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2017-219452
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Article ; Online: Clinical and economic burden of benign and malignant skin lesions in renal transplant recipients.

Thet, Zaw / Lam, Alfred K / Pham, Tony / Ng, Shu-Kay / Steel, Jason C / Sawhney, Sirena / Arellano, Carolina T / Aung, Soe Yu / Han, Thin / Ranganathan, Dwarakanathan / John, George / Pepito, Christina / Rautenberg, Tamlyn / Khoo, Tien K

Internal medicine journal

2023 Volume 53, Issue 11, Page(s) 2042–2049

Abstract: Background: Studies evaluating the economic burden of dermatological care in the transplant setting are currently not available in Australia.: Aims: To evaluate the clinical and economic burden of benign and malignant skin lesions in renal transplant ...

Abstract	Background: Studies evaluating the economic burden of dermatological care in the transplant setting are currently not available in Australia. Aims: To evaluate the clinical and economic burden of benign and malignant skin lesions in renal transplant recipients in Central Queensland. Methods: A bottom-up approach was used to determine the clinical burden and direct costs from patient-level Medicare data obtained from Service Australia for skin lesions. Results: Seventy-six percent of the renal transplant population in Central Queensland participated in this study. The median age was 57.0 years (standard deviation ± 13.6) and the majority (61.8%) of participants were men. The mean duration after transplant surgery was 99.9 months (interquartile range, 73.2-126.6 months). During a 2-year follow-up, 22 (40%) patients were diagnosed with benign skin lesions, 21 (38%) with nonmelanoma skin carcinoma (NMSC) and one (2%) with melanoma. There was a total of 231 visits to clinicians for diagnostic and therapeutic skin procedures and the direct costs to Medicare was $48 806 Australian Dollars (AUD) or $30 427 US Dollars (USD). Approximately 86% of the total direct costs was spent for nonNMSC and mean direct costs for NMSC was $763 AUD (or $476 USD). Conclusion: This Medicare data-based study provides further insight into the burgeoning clinical and economic burden of the care for benign and malignant skin lesions in the renal transplantation setting in Australia.
MeSH term(s)	Male ; Humans ; Aged ; Female ; Middle Aged ; Kidney Transplantation ; Carcinoma, Basal Cell/epidemiology ; Carcinoma, Squamous Cell/epidemiology ; Carcinoma, Squamous Cell/pathology ; Financial Stress ; Australia/epidemiology ; Risk Factors ; National Health Programs ; Skin Neoplasms/epidemiology ; Transplant Recipients
Language	English
Publishing date	2023-02-13
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2045436-3
ISSN	1445-5994 ; 1444-0903
ISSN (online)	1445-5994
ISSN	1444-0903
DOI	10.1111/imj.16024
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Zs.A 792: 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)
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Article ; Online: Vitamin D Deficiency in Chronic Kidney Disease: Recent Evidence and Controversies.

Franca Gois, Pedro Henrique / Wolley, Martin / Ranganathan, Dwarakanathan / Seguro, Antonio Carlos

International journal of environmental research and public health

2018 Volume 15, Issue 8

Abstract: Vitamin D (VD) is a pro-hormone essential for life in higher animals. It is present in few types of foods and is produced endogenously in the skin by a photochemical reaction. The final step of VD activation occurs in the kidneys involving a second ... ...

Abstract	Vitamin D (VD) is a pro-hormone essential for life in higher animals. It is present in few types of foods and is produced endogenously in the skin by a photochemical reaction. The final step of VD activation occurs in the kidneys involving a second hydroxylation reaction to generate the biologically active metabolite 1,25(OH)₂-VD. Extrarenal 1α-hydroxylation has also been described to have an important role in autocrine and paracrine signaling. Vitamin D deficiency (VDD) has been in the spotlight as a major public healthcare issue with an estimated prevalence of more than a billion people worldwide. Among individuals with chronic kidney disease (CKD), VDD prevalence has been reported to be as high as 80%. Classically, VD plays a pivotal role in calcium and phosphorus homeostasis. Nevertheless, there is a growing body of evidence supporting the importance of VD in many vital non-skeletal biological processes such as endothelial function, renin-angiotensin-aldosterone system modulation, redox balance and innate and adaptive immunity. In individuals with CKD, VDD has been associated with albuminuria, faster progression of kidney disease and increased all-cause mortality. Recent guidelines support VD supplementation in CKD based on extrapolation from cohorts conducted in the general population. In this review, we discuss new insights on the multifactorial pathophysiology of VDD in CKD as well as how it may negatively modulate different organs and systems. We also critically review the latest evidence and controversies of VD monitoring and supplementation in CKD patients.
MeSH term(s)	Animals ; Bone Density/physiology ; Diabetes Mellitus/epidemiology ; Diabetes Mellitus/physiopathology ; Dietary Supplements ; Disease Progression ; Endothelium/metabolism ; Humans ; Kidney/metabolism ; Muscle, Skeletal/metabolism ; Nutritional Status ; Oxidation-Reduction ; Parathyroid Hormone/physiology ; Prevalence ; Proteinuria/epidemiology ; Proteinuria/physiopathology ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/physiopathology ; Renin-Angiotensin System/physiology ; Vitamin D/metabolism ; Vitamin D Deficiency/epidemiology
Chemical Substances	Parathyroid Hormone ; Vitamin D (1406-16-2)
Language	English
Publishing date	2018-08-17
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph15081773
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Article ; Online: Bleeding Complications of Percutaneous Kidney Biopsy: Does Gender Matter?

Anpalahan, Aksharaa / Malacova, Eva / Hegerty, Katharine / Malett, Andrew / Ranganathan, Dwarakanathan / Healy, Helen G / Gois, Pedro Henrique Franca

Kidney360

2021 Volume 2, Issue 8, Page(s) 1308–1312

Abstract: The incidence of bleeding complications after percutaneous kidney biopsies is low.Female sex may be associated with a greater risk for bleeding complications after percutaneous kidney biopsies.This association and the plausible mechanisms require further ...

Abstract	The incidence of bleeding complications after percutaneous kidney biopsies is low.Female sex may be associated with a greater risk for bleeding complications after percutaneous kidney biopsies.This association and the plausible mechanisms require further evaluation in prospective study.
MeSH term(s)	Biopsy/adverse effects ; Female ; Hemorrhage/diagnosis ; Humans ; Kidney/pathology ; Prospective Studies ; Retrospective Studies
Language	English
Publishing date	2021-06-16
Publishing country	United States
Document type	Journal Article
ISSN	2641-7650
ISSN (online)	2641-7650
DOI	10.34067/KID.0002432021
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Article ; Online: Population Pharmacokinetics of Intraperitoneal Gentamicin and the Impact of Varying Dwell Times on Pharmacodynamic Target Attainment in Patients with Acute Peritonitis Undergoing Peritoneal Dialysis.

Farkas, Andras / Oikonomou, Katerina / Ghanbar, Mohammad / Villasurda, Phillip / Varghese, Julie / Lipman, Jeffrey / Sassine, Joseph / Ranganathan, Dwarakanathan / Roberts, Jason A

Antimicrobial agents and chemotherapy

2021 Volume 66, Issue 2, Page(s) e0167921

Abstract: While the use of intraperitoneal (i.p.) gentamicin is common in the treatment of peritoneal dialysis (PD)-related infections, the ability of these regimens to attain pharmacodynamic target indices of interest in blood and dialysate has not been widely ... ...

Abstract	While the use of intraperitoneal (i.p.) gentamicin is common in the treatment of peritoneal dialysis (PD)-related infections, the ability of these regimens to attain pharmacodynamic target indices of interest in blood and dialysate has not been widely reported. Pharmacokinetic (PK) data were obtained and analyzed from a multiple-dose PK study of i.p. gentamicin with 24 patients who received the drug at 0.6 mg/kg dose of body weight. The probability of target attainment (PTA) for indices of treatment success (i.p. peak/MIC ratio > 10) and toxicity (plasma area under the concentration-time curve [AUC] < 120 mg·h/L) was determined for 0.3- to 1.2-mg/kg i.p. regimens every 24 h for dwell times of 2 to 6 h and for the duration of a 2-week course. In the peritoneum, successful PTA was achieved by all of the simulated regimens up to an MIC of 1 mg/L and by doses equal to or greater than 0.6 mg/kg up to the MIC of 2 mg/L. At the susceptibility breakpoint of 4 mg/L, only the highest dose of 1.2 mg/kg is likely to provide adequate PTA. The probability of achieving exposure below the threshold of 120 mg·h/L in the daily AUC in plasma seems acceptable for all regimens at or below 0.6 mg/kg. Based on the model we developed, a gentamicin dose of 0.6 mg/kg is sufficient to treat organisms with an MIC of ≤2 mg/L without the risk of significant systemic exposure. The 1.2-mg/kg dose necessary to reach the pharmacodynamic target for efficacy at the clinical breakpoint of 4 mg/L is likely to produce early toxic levels of exposure that are expected to be detrimental to the renal system.
MeSH term(s)	Anti-Bacterial Agents/pharmacology ; Gentamicins/pharmacokinetics ; Gentamicins/therapeutic use ; Humans ; Peritoneal Dialysis/adverse effects ; Peritonitis/drug therapy ; Prospective Studies
Chemical Substances	Anti-Bacterial Agents ; Gentamicins
Language	English
Publishing date	2021-12-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	217602-6
ISSN	1098-6596 ; 0066-4804
ISSN (online)	1098-6596
ISSN	0066-4804
DOI	10.1128/AAC.01679-21
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