We performed a variance components linkage analysis of renal function, measured as glomerular filtration rate (GFR), in 63 extended families with multiple members with type 2 diabetes. GFR was estimated from serum concentrations of cystatin C and creatinine in 406 diabetic and 428 nondiabetic relatives. Results for cystatin C were summarized because they are superior to creatinine results. GFR aggregates in families with significant heritability (h 2 ) in diabetic (h 2 ‫؍‬ 0.45, P < 1 ؋ 10 ؊5 ) and nondiabetic (h 2 ‫؍‬ 0.36, P < 1 ؋ 10 ؊3 ) relatives. Genetic correlation (r G ‫؍‬ 0.35) between the GFR of diabetic and nondiabetic relatives was less than one (P ‫؍‬ 0.01), suggesting that genes controlling GFR variation in these groups are different. Linkage results supported this interpretation. In diabetic relatives, linkage was strong on chromosome 2q (logarithm of odds [LOD] ‫؍‬ 4.1) and suggestive on 10q (LOD ‫؍‬ 3.1) and 18p (LOD ‫؍‬ 2.2). In nondiabetic relatives, linkage was suggestive on 3q (LOD ‫؍‬ 2.2) and 11p (LOD ‫؍‬ 2.1). When diabetic and nondiabetic relatives were combined, strong evidence for linkage was found only on 7p (LOD ‫؍‬ 4.0). In conclusion, partially distinct sets of genes control GFR variation in relatives with and without diabetes on chromosome 2q, possibly on 10q and 18p in the former, and on 7p in both. None of these genes overlaps with genes controlling variation in urinary albumin excretion. Diabetes 55: 3358 -3365, 2006

Prior studies report 9–27% of persons receiving a hematopoietic cell transplant develop arrhythmias, but the effect on outcomes is largely unknown. We reviewed data from 1177 consecutive patients {greater than or equal to}40 years old receiving a hematopoietic cell transplant at one center during 1999–2009. Transplant indication was predominately leukemia, lymphoma and multiple myeloma. Overall, 104 patients were found to have clinically significant arrhythmia: 43 prior to and 61 following transplant. Post-transplant arrhythmias were most frequently atrial fibrillation(N=30), atrial flutter(N=7) and supraventricular tachycardia(N=11). Subjects with an arrhythmia post-transplant were more likely to have longer median hospital stays (32 days vs 23, P=<.001,) a greater probability of an ICU admission (52% vs 7%; P<.001), more inhospital deaths (28% vs 3%, P<0.001), and more deaths within one year of transplant (41% vs 15%; P<0.001) than patients without arrhythmia at any time. In a multivariate model including age at transplant, diagnosis, history of pre-transplant arrhythmia, and transplant-related variables, post-transplant arrhythmia was associated with a greater risk of death within a year of transplant (OR 3.5, 95% CI: 2.1, 5.9; P < 0.001). Our data suggest arrhythmias after transplants are associated with significant morbidity and mortality. A prospective study of arrhythmia in the transplant setting is warranted.

A 49-year-old woman with sickle cell disease presented with one month of exertional dyspnea, weakness, and fever and was diagnosed with isolated pulmonic valve endocarditis secondary to methicillin-resistant Staphylococcus bacteremia in the setting of a peripherally inserted central venous catheter. Chest computerized tomography showed multiple bilateral pulmonary nodular opacities consistent with septic emboli. Transthoracic and transesophageal echocardiograms revealed a large echodensity on the pulmonic valve requiring vegetation excision and pulmonic valve repair. In conclusion, isolated pulmonic valve endocarditis is a rare cause of infective endocarditis that warrants a high index of clinical suspicion. Furthermore the management of patients with sickle cell disease and endocarditis requires special consideration.

Table. Patient demographics and out of pocket costs for first 3 months after allogeneic HCT Patient characteristics N 5 25 Median patient age (range) 44 (24-71) years Non-Hispanic White race 24 (96%) Residence >50 miles from HCT center 12 (48%) Needed temporary move to HCT center 12 (48%) Median annual pre-tax income at study enrollment (range) $65,000 (18,500-150,000) Household income reduced due to illness 20 (80%) Diagnosis Acute leukemia/MDS 22 (88%) Other 3 (12%) Donor type Related 10 (40%) Unrelated/UCB 15 (60%) Conditioning intensity Myeloablative 12 (48%) Non-myeloablative/RIC 13 (52%) Out-of-pocket costs N 5 15 Median costs (inter-quartile range)