BackgroundSecondary systemic amyloidosis (SSA) is a rare but severe complication of inflammatory bowel disease (IBD). We aimed to evaluate the clinical characteristics, predictors of complications, and in-hospital mortality of patients with Crohn’s disease (CD) and Ulcerative colitis (UC) who develop SSA.MethodsUsing the National Inpatient Sample, we identified patients hospitalized for IBD and SSA between 2004 and 2012. Using multivariate logistic regression, patients with CD were compared with those with UC regarding the presence or absence of SSA. IBD patients without SSA were matched in a 2:1 ratio with those with SSA using propensity matching. We analyzed the hospitalization trends of SSA in CD and UC patients using Pearson’s χ2 test. Analyses were performed using SAS version 9.3.ResultsAmong the 302,548 patients with CD and 174,057 patients with UC hospitalized between 2004 and 2012, we identified 47 (0.02%) and 36 (0.02%) cases of SSA, respectively. We noted rising annual hospitalization trends for both CD and UC patients with or without SSA. In-hospital mortality was significantly higher for both the UC+SSA group (16.7% vs. 2.1%, P<0.0001) and the CD+SSA group (6.4% vs. 1.0%, P=0.0001) before propensity matching. However, this difference was not seen for either UC+SSA (17.1% vs. 7.1%, P=0.11) or CD+SSA (6.8% vs. 2.3%, P=0.20) after matching.ConclusionsSSA rarely affects IBD patients, but when it does, it is associated with increased rates of infection, severe sepsis, and multi-organ system involvement. Despite this, SSA does not affect in-hospital mortality in IBD patients. Further studies are needed to explore this association.

BackgroundSome nephrologists have advocated an individualized approach to the prescription of bicarbonate hemodialysis. However, the utility of monthly serum bicarbonate levels for guiding and evaluating such treatment decisions has not been evaluated. We sought to define the variability of these measurements and to determine factors that are associated with month-to-month variability in pre-dialysis serum bicarbonate.MethodsWe examined the monthly variability in serum bicarbonate measurements among 181 hemodialysis patients admitted to a free-standing dialysis unit in the Bronx, NY from 1/1/2008-6/30/2012. All patients were treated with a uniform bicarbonate dialysis prescription (bicarbonate 35 mEq/L, acetate 8 mEq/L). Pre-dialysis serum bicarbonate values were obtained from monthly laboratory reports. Month-to-month variability was defined using a rolling measurement for each time point.ResultsOnly 34 % of high serum bicarbonate values (>26 mEq/L) remained high in the subsequent month, whereas 60 % converted to normal (22–26 mEq/L). Of all low values (<22 mEq/L), 41 % were normal the following month, while 58 % remained low. Using the mean 3-month bicarbonate, only 29 % of high values remained high in the next 3-month period. In multivariable-adjusted longitudinal models, both low and high serum bicarbonate values were associated with greater variability than were normal values (β = 0.12 (95 % CI 0.09–0.15) and 0.24 (0.18 to 0.29) respectively). Variability decreased with time, and was significantly associated with age, phosphate binder use, serum creatinine, potassium, and normalized protein catabolic rate.ConclusionsMonthly pre-dialysis serum bicarbonate levels are highly variable. Even if a clinician takes no action, approximately 50 % of bicarbonate values outside a normal range of 22–26 mEq/L will return to normal in the subsequent month. The decision to change the bicarbonate dialysis prescription should not be based on a single bicarbonate value, and even a 3-month mean may be insufficient.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0206-2) contains supplementary material, which is available to authorized users.

Drug-resistant hypertension (RH) remains a significant and common cardiovascular risk despite the availability of multiple potent antihypertensive medications. Uncontrolled resistant hypertension contributes substantially to excessive cardiovascular and renal morbidity and mortality. Clinical and experimental evidence suggest that sympathetic nervous system over-activity is the main culprit for the development and maintenance of drug-resistant hypertension. Both medical and interventional strategies, targeting the sympathetic over-activation, have been designed in patients with hypertension over the past few decades. Minimally invasive, catheter-based, renal sympathetic denervation (RDN) and carotid baroreceptor activation therapy (BAT) have been extensively evaluated in patients with RH in clinical trials. Current trial outcomes, though at times impressive, have been mostly uncontrolled trials in need of validation. Device-based therapy for drug-resistant hypertension has the potential to provide alternative treatment options to certain groups of patients who are refractory or intolerant to current antihypertensive medications. However, more research is needed to prove its efficacy in both animal models and in humans. In this article, we will review the evidence from recent renal denervation, carotid baroreceptor stimulation therapy, and newly emerged central arteriovenous anastomosis trials to pinpoint the weak links, and speculate on potential alternative approaches.

Cirrhotic patients with ESRD and ascites who undergo PD have a significantly lower mortality than those who are started on HD. However PD is rarely initiated for ESRD in cirrhotic patients with ascites during hospitalization in the United States. Due to the potential advantages of PD, nephrologists should encourage PD when selecting dialysis modality in this subgroup of patients whenever possible.

Weekend AP admissions develop more severe complications requiring intensive care. Despite this, there was no weekend effect for in-hospital mortality for AP-related admissions.

BackgroundEpilepsy and seizures are commonly reported among the neurological manifestations of Antiphospholipid Syndrome (APS).ObjectivesTo discuss the epidemiological, pathophysiological, laboratory, clinical, radiological, and therapeutic aspects of epilepsy/seizures in APS/ antiphospholipid antibody (aPL)-positive patients.MethodsWe searched the literature through Google Scholar and PubMed for all publications reporting on the epidemiology, pathogenesis, laboratory, imaging and associated clinical findings, and management of epilepsy/seizures in APS/aPL-positive patients. The following keywords were used: antiphospholipid, Hughes syndrome, anticardiolipin, lupus anticoagulant, anti-β2-glycoprotein I, partial, complex, generalized, and idiopathic epilepsy, seizure, and convulsion. All reports published between 1971 and 2015 were included.ResultsTemporal lobe epilepsy is particularly prominent in many APS cases. The prevalence of epilepsy/seizures in APS patients is approximately 8%, which is nearly 10 times the prevalence of epilepsy in the general population (0.5–1%). The pathogenesis is complex and may involve micro-thrombosis and/or immune-mediated neuronal damage. The association of seizures with aPL is more significant in the presence of SLE. Seizure patients with positive aPL tend to develop thrombocytopenia and livedo racemosa more frequently than those without aPL. The presence of SLE and the presence of neurological symptoms significantly correlate with the presence of white matter changes on MRI. In contrast, the correlation between aPL positivity and the presence of white matter changes is very weak. However, MRI can be normal in more than 30–40% of patients. New MRI techniques can better elucidate the pathology of brain damage in neuro-APS. The theurapeutic management of epileptic APS patients relies on anti-epileptic treatment and anticoagulant agents when there is evidence of a thrombotic event. The anti-thrombotic benefit of hydroxychloroquine and statins is supported by several studies.ConclusionsMRI remains the imaging modality of choice. aPL testing is recommended in young patients presenting with atypical seizures and multiple hyper-intensity lesions on brain MRI in the absence of other possible conditions. In the absence of consensual recommendations, the decision of lifelong anticoagulation in epileptic APS patients is discussed on a case-by-case basis.Disclosure of InterestNone declared

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