Nierenzentrum Heidelberg

Amyloidosen sind Erkrankungen, bei denen sich unlsliche Proteinfibrillen extrazellulr in Organsystemen ablagern.tiologien, Manifestationsmuster und Therapieoptionen unterscheiden sich erheblich (Tab.1).Das Nervensystem kann frh und schwer betroffen sein. Welche wichtigen behandelbaren Amyloidosen gibt es?Die AL-Amyloidose ist eine Plasmazellerkrankung (v.a. monoklonale Gammopathie, seltener multiples Myelom oder B-Zell-Lymphom), bei der monoklonale Leichtketten das Amyloid bilden [1].Charakteristisch ist eine direkte Kardiotoxizitt der zirkulierenden freien Leichtketten als Hauptschdigungsmechanismus [2].Die kardiale Manifestation (75-80 %) ist prognosebestimmend [3].Zudem bestehen oft eine renale (65 %, Niereninsuffizienz, Proteinurie, Albuminurie) sowie seltener hepatische Beteiligung (ca.10-15 %), Weichteil-(z.B. periorbitale

ZusammenfassungHintergrundChronischer Pruritus ist ein klinisch heterogenes Symptom unterschiedlicher Dauer, Intensität oder Qualität. Bislang gibt es kein validiertes deutschsprachiges Instrument, das relevante Parameter systematisch erfragt. Mit Unterstützung der Arbeitsgemeinschaft Pruritusforschung (AGP) wurde 2008 ein Fragebogen zur Erfassung von chronischem Pruritus (AGP‐Fragebogen) entwickelt. Das im Nachgang überarbeitete und nun Deutscher Pruritusfragebogen genannte Instrument erfasst pruritus‐spezifische Parameter wie Lokalisation, Verlauf, Intensität und Qualität, anamnestische Daten zum allgemeinen Gesundheitszustand, soziodemografische Daten, Lebensqualität und Art der Bewältigung. Es soll in der vorgelegten Studie validiert werden.Patienten und MethodikDer Fragebogen wurde bei 366 Patienten mit chronischem Pruritus unterschiedlicher Ätiologien aus Deutschland (Universitätskliniken Heidelberg, Münster, Mainz, Erlangen, Gießen, Praxis Bad Bentheim, TU München, Nierenzentrum Wiesbaden), Österreich (Universitätsklinik Graz) und der Schweiz (Kantonsspital Aarau) eingesetzt.ErgebnisseDie Zuverlässigkeit bei wiederholtem Ausfüllen (Retest‐Reliabilität) bezüglich Lokalisation, Erstauftreten und Begleiterkrankungen wies hohe Werte für Cohens Kappa auf (>0,8). Die Angaben zur Retest‐Reliabilität der Prurituscharakteristika zeigten deutlich geringere Werte (<0,7). Bezüglich der Messbarkeit praktisch relevanter Veränderungen (Veränderungssensitivität) konnten mittlere bis starke Effektgrößen festgestellt werden (0,09–0.19). Eine statistisch signifikante Differenzierung der Pruritusätiologien anhand der erfassten Parameter gelang nicht.SchlussfolgerungenDer Deutsche Pruritusfragebogen erlaubt eine umfassende und strukturierte Erfassung patienten‐ und kliniker‐berichteter relevanter Dimensionen des chronischen Pruritus unterschiedlicher Ätiologien. Eine weitere Anpassung und Fortentwicklung soll erfolgen.

AimsEvaluate changes in haemodynamic markers as mediators of cardiovascular (CV) and kidney benefits with empagliflozin. MethodsPost-hoc analysis of EMPA-REG OUTCOME in patients with type 2 diabetes (T2D) and established CV disease receiving empagliflozin (10 and 25 mg) or placebo. Outcomes were CV death, hospitalisation for heart failure [HF], HF death, incident/worsening nephropathy, new onset macroalbuminuria, and the composite of sustained estimated glomerular filtration rate decline ≥40 % from baseline, renal replacement therapy or renal death. To be considered a mediator, changes in variable (pulse pressure, mean arterial pressure and cardiac workload) over time had to be (1) affected by active treatment, (2) associated with the outcome, and (3) adjustment for changes over time must reduce treatment effect versus an unadjusted analysis. Variables were evaluated in Cox regression analyses. ResultsPulse pressure, mean arterial pressure and cardiac workload were significantly reduced by empagliflozin vs placebo. Using change from baseline to Week 12 or sensitivity analyses (time-dependent updated mean and current change from baseline) of these CV parameters, only small impacts on empagliflozin effect on CV and kidney outcomes were shown. ConclusionsImprovements in haemodynamic parameters did not substantially mediate empagliflozin benefits on CV and kidney outcomes in patients with T2DM and established CV disease.

Abstract Background and Aims SARS-CoV-2mRNA vaccination related seroconversion rates are reduced in dialysis (DP) and kidney transplant patients (KTR). Recently, we demonstrated that established vaccination related immunity (via positive seroconversion) fades faster in DP and at a lesser extent in KTR compared to medical personnel (MP).[1] We hypothesized that a longer follow up period might be able to profoundly show immunity fading differences specific to different patient groups and identify strong fading risk factors that are relevant for patient management especially in vulnerable groups. Method We evaluated nine months follow up data in our observational Dia-Vacc study exploring specific cellular (interferon-γ release assay) or/and humoral immune responses after 2x SARS-CoV-2mRNA vaccination in 880 participants including healthy MP (125), DP (595), KTR (111), and apheresis patients (49-AP) with positive seroconversion (de novo IgA or IgG antibody positivity by ELISA) after eight weeks. Results Nine months after first vaccination, receptor binding domain (RBD) antibodies were still positive in 90 % of MP, 86 % of AP, but only 55 %/48 % of DP/KTR, respectively. Seroconversion remained positive in 100 % of AP and 99·2 % of MP, but 86 %/81 % of DP/KTR, respectively. Compared to MP, DP but not KTR or AP were at risk for a strong RBD decline, while KTR kept lowest RBD values over time (see Fig. 1 and Table 1). By multivariate analysis, BNT162b2mRNA versus 1273-mRNA vaccine type was an independent risk factor for a strong decline of RBD antibodies. Within the DP group, only time on dialysis was another (inverse) risk factor for the DP group. Compared to humoral immunity, T-cell immunity decline was less prominent. Conclusion While seroconverted KTR reach lowest RBD values over time, DP are at specific risk for a strong decline of RBD antibodies after successful SARS-CoV-2mRNA vaccination, which also depends on the vaccine type being used. Therefore, booster vaccinations for DP should be considered earlier compared to normal population.

Background.Kidney transplant recipients are at increased risk of SARS-CoV-2 infection and a more severe course of COVID-19.Methods.We conducted a quantitative serologic testing of antibodies specific for the wild type of SARS-CoV-2 and the Omicron variant of concern before and after a third-dose vaccination, either mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) in a cohort of 103 stable kidney transplant recipients (median [range] age, 58 [22–84] y, 57 men [55.3%]).Results.Third-dose vaccination increased the seroconversion rate from 57.3% to 71.8%. However, despite a marked rise of the antibody concentrations after the booster, 55.4% and 11.6% only formed neutralizing antibodies against the SARS-CoV-2 wild type and Omicron, respectively. Treatment with mycophenolic acid/mycophenolate mofetil (in strata of the dose quartiles), advanced age, and‚ above all‚ impaired renal function (eGFR <60 mL/min) adversely influenced the humoral immunity regarding seroconversion and inhibition of the wild type of SARS-CoV-2.Conclusions.Apart from immunosuppressive therapy, the humoral vaccination response is largely affected by nonmodifiable factors in kidney transplant recipients. With the currently leading and clinically easier Omicron variant, this puts into perspective the strategy to significantly enhance the protective efficacy of the available vaccines by reducing or temporarily stopping proliferation inhibitors, not least considering the inherent rejection risk with a possible deterioration of graft function.

A hemodynamically acting atherosclerotic renal artery stenosis of one or both main renal arteries (in rare cases also stenosis of a larger segment artery) with a lumen narrowing of at least 70%, can lead to a variety of diseases. In the case of unilateral stenosis it can lead to renovascular hypertension, in bilateral stenosis (or in a functional or actual solitary kidney with stenosis) also frequently to progressive renal insufficiency (ischemic kidney disease) and/or to acute lung edema (pulmonary flash edema). Previously often attempted causal revascularization procedures (angioplasty with and without stent placing, more rarely surgical revascularization) achieve a patency rate of over 90%; however, according to the results of randomized studies, the desired functional effects of catheter-based interventions, such as improved blood pressure adjustment or improved renal function and reduced overall survival, fell short of the expectations, so that an optimized pharmaceutical treatment is mostly prioritized. Patients with a critical stenosis and strongly pronounced clinical complications, such as recurrent pulmonary edema and progressive kidney failure, can benefit from such measures. Therefore, in individual cases it can be justifiable and also medically necessary in the sense of a last resort, to instigate a revascularization procedure. The meticulous selection of patients suitable for this procedure is essential for clinical success.