Renal Relevant Radiology

Rahbari-Oskoui, Frederic F.; Mittal, Ankush; Mittal, Pardeep; Chapman, Arlene B.

doi:10.2215/cjn.08940813

Cited by 57 publications

(40 citation statements)

References 52 publications

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“…Furthermore, HtTKV serves as a better predictor than baseline age, serum creatinine, BUN, urinary albumin, or monocyte chemotactic protein-1 excretion for the onset of renal insufficiency (25,26). (11,16,44).…”

Section: Analyses Of Abdominal Magnetic Resonance Imagingmentioning

confidence: 99%

Pravastatin Therapy and Biomarker Changes in Children and Young Adults with Autosomal Dominant Polycystic Kidney Disease

Klawitter¹,

McFann²,

Pennington³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Disease-specific treatment options for autosomal dominant polycystic kidney disease are limited. Clinical intervention early in life is likely to have the greatest effect. In a 3-year randomized doubleblind placebo-controlled phase 3 clinical trial, the authors recently showed that pravastatin decreased heightcorrected total kidney volume (HtTKV) progression of structural kidney disease over a 3-year period. However, the underlying mechanisms have not been elucidated.Design, setting, participants, & measurements Participants were recruited nationally from July 2007 through October 2009. Plasma and urine samples collected at baseline, 18 months, and 36 months from 91 pediatric patients enrolled in the above-mentioned clinical trial were subjected to mass spectrometry-based biomarker analysis. Changes in biomarkers over 3 years were compared between placebo and pravastatin-treated groups. Linear regression was used to evaluate the changes in biomarkers with the percent change in HtTKV over 3 years.Results Changes in plasma concentrations of proinflammatory and oxidative stress markers (9-hydroxyoctadecadienoic acid, 13-hydroxyoctadecadienoic acid, and 15-hydroxyeicosatetraenoic acid [HETE]) over 3 years were significantly different between the placebo and pravastatin-treated groups, with the pravastatin group showing a lower rate of biomarker increase. Urinary 8-HETE, 9-HETE, and 11-HETE were positively associated with the changes in HtTKV in the pravastatin group.Conclusions Pravastatin therapy diminished the increase of cyclooxygenase-and lipoxygenase-derived plasma lipid mediators. The identified biomarkers and related molecular pathways of inflammation and endothelial dysfunction may present potential targets for monitoring of disease severity and therapeutic intervention of autosomal dominant polycystic kidney disease.

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Section: Analyses Of Abdominal Magnetic Resonance Imagingmentioning

confidence: 99%

Pravastatin Therapy and Biomarker Changes in Children and Young Adults with Autosomal Dominant Polycystic Kidney Disease

Klawitter¹,

McFann²,

Pennington³

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Hypertension is common in ADPKD; between 31% of affected women and 46% of affected men are hypertensive by age 40 years, and 50%-60% of patients are hypertensive, despite normal renal function (12,13). These data underscore the relevance of the disease itself, not the presence of reduced GFR as the key mediator of hypertension, and suggest that vascular abnormalities in ADPKD may be responsible for this early hypertensive phenotype.…”

Section: Pathogenesis Of Hypertension In Early Pkd: Clinical Implicatmentioning

confidence: 87%

A Young Patient with a Family History of Hypertension

Peixoto¹

2014

Clinical Journal of the American Society of Nephrology

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The evaluation of causes of hypertension in young adults with a family history of hypertension needs to be methodical to identify potentially treatable causes. Renal-and renovascular imaging and measurement of plasma aldosterone and plasma renin activity are at the core of this evaluation in most patients. Pertinent aspects of hypertension in autosomal dominant polycystic kidney disease are discussed with a focus on the role of the endothelium in mediating early hypertension and a review of treatment strategies. Finally, the possibility that autosomal dominant polycystic kidney disease and primary aldosteronism are connected beyond coincidence is explored; evidence to support it is scant, although there is a likely role for aldosterone excess and the resultant hypokalemia in promoting cyst growth.Clin J Am Soc Nephrol 9: 2164-2172, 2014. doi: 10.2215/CJN.02240314 Case PresentationA 36-year-old white man presented for the evaluation of hypertension, hypokalemia, and biochemical evidence of aldosterone excess. His hypertension was first diagnosed at 22 years of age while in the military, and we do not have records of his evaluation at that time. He reported that he had BP levels in the 150/100-mmHg range and that his weight at that time was approximately 180 lb (body mass index [BMI] approximately 24.5 kg/m 2 ). He was treated with lisinopril with prompt and sustained achievement of BP control.He left the military when he was 26 years old, and his new physician performed an evaluation of his hypertension. He was asymptomatic. He reported a family history of hypertension starting in early adulthood in his brother, mother, one maternal uncle, and maternal grandfather. He was not aware of any history of strokes, kidney disease, endocrine tumors, or hypokalemia, although he had been estranged from his parents since early childhood, and therefore, the information about his family was not complete.His BP was 128/84 mmHg. Other than being overweight (218 lb; BMI529.4 kg/m 2

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“…Intracystic bleeding is a potential complication of cysts and is part of the differential diagnosis of a cyst infection [18,23] . However, the panel concluded that it is not necessary to exclude a cyst bleeding to diagnose cyst infection and therefore should not be included as diagnostic criterion.…”

Section: Discussionmentioning

confidence: 99%

International Multi-Specialty Delphi Survey: Identification of Diagnostic Criteria for Hepatic and Renal Cyst Infection

Lantinga

Darding

Sévaux

et al. 2016

Nephron

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Background: Cyst infection is one of the complications of autosomal dominant polycystic kidney disease and polycystic liver disease. The diagnosis is typically made on a mix of clinical, laboratory and imaging abnormalities but the importance of individual items is uncertain. We aimed to perform a Delphi survey amongst physicians to achieve consensus on diagnostic criteria. Methods: We retrieved diagnostic items from the literature and conducted physician and patient interviews. All items were combined to create the online questionnaire. Participants rated each item during 3 consecutive rounds. Items were rated for diagnostic helpfulness for hepatic and renal cyst infection on a 9-point scale with anchors, from extremely unimportant (n = 1) to extremely important (n = 9). We determined consensus with the disagreement index. The median rating of each item was calculated and categorized into inappropriate (≤3.4), uncertain (3.5-6.4) or appropriate (≥6.5). By combining all items that reached an appropriate consensus rating, we developed a diagnostic algorithm based on expert consensus. Results: We invited 58 physicians to participate in the survey. In total, 35 (60%) responded to round 1 of which 91% (n = 32) and 86% (n = 30) responded to round 2 and 3, respectively. The final panel included 23 nephrologists, 5 hepatologists, a nuclear medicine specialist and an infectious disease physician from 11 countries (male 67%, mean age 47 ± 11 years, median clinical experience 21 years). The panel rated the diagnostic helpfulness of 59 potential items. Ultimately, 22 hepatic and 26 renal items were rated appropriate, including positive blood cultures and fluorodeoxyglucose positron-emission CT imaging. Ultrasonography and absence of intracystic bleeding were amongst those deemed uncertain or inappropriate. Subsequently, by combining items rated appropriate, we developed a clinical tool to diagnose hepatic and renal cyst infection. Conclusions: We identified diagnostic items for hepatic and renal cyst infection and developed an expert-based diagnostic algorithm, which may aid physicians in the diagnostic work-up. A prospective study is necessary to validate this algorithm.

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Renal Relevant Radiology

Cited by 57 publications

References 52 publications

Pravastatin Therapy and Biomarker Changes in Children and Young Adults with Autosomal Dominant Polycystic Kidney Disease

Pravastatin Therapy and Biomarker Changes in Children and Young Adults with Autosomal Dominant Polycystic Kidney Disease

A Young Patient with a Family History of Hypertension

International Multi-Specialty Delphi Survey: Identification of Diagnostic Criteria for Hepatic and Renal Cyst Infection

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