Hypertriglyceridemia and chronic kidney disease (CKD) are known risk factors for cardiovascular disease. However, treatment with statins, which control low-density lipoprotein cholesterol levels, increases the risk of estimated glomerular filtration rate (eGFR) reduction. Although conventional fibrates, such as bezafibrate (Beza-F) and fenofibrate (Feno-F), are the mainstay for hypertriglyceridemia treatment, they may be associated with a risk of increased serum creatinine level and renal dysfunction. Pemafibrate (Pema) is pharmacologically defined as a selective peroxisomal proliferator-activated receptor α modulator which is excreted in bile and not likely to cause renal dysfunction. We evaluated the efficacy and safety of switching from Beza-F or Feno-F to Pema in CKD patients with hypertriglyceridemia. We recruited 47 CKD patients with hypertriglyceridemia who were receiving Beza-F, Feno-F, or eicosapentaenoic acid (EPA) but were switched to Pema from 2018 to 2021. A retrospective analysis of renal function and lipid profiles was performed before and 24 weeks after switching. CKD patients switching from EPA to Pema were used as study control. The effect of Pema on hypertriglyceridemia was equivalent to that of Beza-F or Feno-F. However, after switching to Pema, eGFR showed a marked average improvement of 10.2 mL/min/1.73 m2 (P < .001). Improvement in eGFR and levels of n-acetyl-β-d-glucosaminidase and β-2-microglobulin was observed only in cases of switching from Beza-F or Feno-F but not from EPA. Although Beza-F and Feno-F are useful medications for the treatment of hypertriglyceridemia, these are associated with a high risk of renal dysfunction. We also found that the deterioration in eGFR due to Beza-F or Feno-F is reversible with drug withdrawal and may not increase the risk for long-term renal dysfunction. We suggest that Pema may be an effective and safe treatment for hypertriglyceridemia in CKD patients.
Here we report a case of TAFRO syndrome developed after the COVID-19 mRNA vaccination. Universal vaccination is important, however, the possibility of various complications after COVID-19 vaccination, including TAFRO syndrome, should be considered.
Preeclampsia is a complicat ion of pregnancy. With preeclampsia, the patients show high blood pressure and high levels of proteinuria. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had previously been in the standard range. If the patients left untreated, preeclampsia can lead to serious complications for both the mother and baby. Meanwhile, focal segmental glomerulosclerosis (FSGS) is also need to be discriminated in pregnant women with massive proteinuria.A 32-year-old woman has not been recognized hypertension, and has never been pointed out any urinary abnormality in a medical checkup. Her blood pressure gradually increased at 30 weeks of gestation. At 34 weeks gestation, blood pressure was 180/108 mmHg with medication, and she was detected proteinuria. Even after delivery, massive proteinuria (13.7 mg/gCr) was detected without microscopic hematuria. Then, renal biopsy was performed for definitive diagnosis. Histological findings showed focal endotheliosis of the glomeruli and double contour in which are the typical histological findings for preeclampsia.High levels of proteinuria after delivery is important index for medical treatment. Present case was diagnosed as preeclampsia by renal biopsy resulted in keep antihypertensive treatment without any immunosuppressant. The histological implication on our clinical management of preeclampsia may be profound for understanding of strict control of blood pressure during perinatal period.
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