Glomerular podocytes are known to regulate proteinuria and podocyturia correlated with proteinuria. Podocyturia, the urinary excretion of viable podocytes (glomerular epithelial cells), has been associated with proteinuria in preeclampsia. This study is the first to investigate the time course alterations of podocyturia in patients with preeclampsia (11 cases) and normotensive pregnant women (45 cases). Urinalysis was performed at 35 weeks of gestation, 4 days after delivery, and 1 month after delivery. In patients with preeclampsia, podocyturia was evident at 35 weeks of gestation and 4 days after delivery, while proteinuria had already decreased at 4 days after delivery. At 1 month after delivery, almost no patients exhibited podocyturia. In control cases, proteinuria was not significant throughout the study period. However, 9 of the 45 controls exhibited transient and mild podocyturia at 4 days after delivery without proteinuria or hypertension. Statistics indicated a correlation between urinary podocyte number and blood pressure, but not with proteinuria. In conclusion, podocyturia in preeclampsia is transient and almost synchronous with heavy proteinuria. The results suggest that acute podocyte loss implicates podocyturia as the possible mechanism of proteinuria in women with preeclampsia.

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abstract. Measuring the levels of the plasma free metanephrines (PFMs) represents a recently developed and promising test for the diagnosis of pheochromocytoma in the United States and Europe. As this test has not yet been evaluated in Japan, it is necessary to evaluate the diagnostic efficacy of measuring the levels of PFMs compared with the standard measurement of the urinary excretion of metanephrines (uMNs) whose reliability is well established to detect of pheochromocytoma. A total of 101 Japanese subjects clinically suspected of having pheochromocytoma in were included in this study. Subsequently, we prospectively measured the PFMs levels in all patients, compared with those of biochemical markers of the catecholamine secretion and metabolisms in the plasma and urine. All subjects with adrenal tumors underwent tumor excision. Data were available for 84 of the 101 patients, 47 of whom had histopathologically proven pheochromocytoma and 37 were finally diagnosed with non-pheochromocytoma. The results of comparisons in the accuracy of measurement for diagnosis of pheochromocytoma between PFMs and the urinary excretion of metanephrines (uMNs) were 0.980 VS 0.951 for AUC of receiver operatorating characteristic (ROC) curve, 0.957 VS 0.894 for sensitivity, and 0.973 VS 0.946 for specificity, respectively. Although the differences were small, the results of our study definitely demonstrated that measurement of PFMs was not inferior to standard urinary metanephrines (uMNs) measurement, which is established to be the most reliable biochemical method to detect pheochromocytoma. This study clearly shows measuring the PFMs levels to be a reliable and efficient method for diagnosing pheochromocytoma in Japanese patients, as demonstrated in previous reports.

These findings indicate that severe endothelial cell dysfunction during the acute phase of glomerular TMA leads to podocyte loss.

Conclusions:Octogenarian heart transplant recipients have a higher risk of cancer and bone abnormalities compared to heart transplant recipients in their 60-70s. Despite their many medical problems, these patients are survivors for whom natural selection has been kind.Purpose: While race is a risk factor for poor long-term outcomes after heart transplantation, little data exists examining the impact of socioeconomic status. Methods and Materials: We linked data from the UNOS/SRTR 1995-2009 with 2000 US Census data. A previously validated measure of socioeconomic status (SES) was calculated using 8 census variables for each patient based on zip code and race. Patients were stratified into three groups: low SES (score -30 to -2.1, n ϭ 10,441), medium SES (score -2.14 to 5.5, nϭ20,874), and high SES (score 5.5 to 23.4, nϭ10,438). Outcomes were compared between groups. Results: Lower SES patients had poorer long-term survival on the waitlist (p ϭ 0.0014) and were less likely to receive a transplant (p Ͻ0.0001). Following transplantation, 30-day mortality was unaffected by SES, but 1-year mortality was higher in the lowSES group (odds ratio 1.14, 95%CI 1.05-1.24). Long-term survival was significantly decreased by lower SES (Figure, p Ͻ 0.0001). Patients in the low SES had a higher incidence of rejection (hazard ratio 1.1, 95%CI 1.0-1.2) and were more likely to be poorly compliant with medications (1.6, 1.3-1.9). In a Cox proportional hazard model, both low SES (hazard ratio 1.4, 95%CI 1.3-1.5) and mid SES (1.1, 1.0-1.2) were associated with decreased long-term survival after transplantation. Cause of graft failure did not differ significantly.Conclusions: While early mortality is not affected by SES, long-term mortality is significantly poorer among waitlisted and transplanted patients from disadvantaged backgrounds. Improvements in long-term post-transplant care among disadvantaged patients are essential to mitigating striking disparities in outcomes.Purpose: Provision of palliative and end-of-life care is of special importance for patients awaiting lung transplantation. However, lung transplant program practices may be at odds with palliative care principles. We examined perceived barriers to delivery of palliative care to lung transplant candidates and sought strategies to improve such care. Methods and Materials:An anonymized e-mail questionnaire was sent to all members of the American College of Chest Physicians Transplant NetWork and of the Pulmonary Council of the ISHLT. It included demographic and practice-related questions, questions about barriers to palliative care of lung transplant candidates, availability of services and utility of strategies to improve palliative care. Transplant program practitioners were eligible for this study. Results: There were 158 eligible responses. Respondents were in practice 11.3 (Ϯ9) years. 70% were pulmonologists, 17% surgeons and 13% other care providers, including coordinators and nurse practitioners. Barriers that were considered at least moderate by Ͼ50% of respondents ...

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