Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The 39th Annual Meeting of the American Society of Nephrology was held in San Diego, California, U.S.A., November 16-19, 2006. This meeting offered the latest findings in basic and clinical nephrology science and was attended by around 13,000 nephrologists from around the world. Recent data on anemia management in chronic kidney disease (CKD) patients and the results with new drugs for the treatment of renal anemia that are under development, such as the continuous erythropoietin receptor activator (CERA) or Hematide were presented. The more recent results of the Dialysis Outcomes and Practice Patterns Study (DOPPS), a large multinational, prospective observational study in hemodialysis patients were also discussed. The additional antiproteinuric effects of high doses of angiotensin AT(1) receptor antagonists in patients with diabetic nephropathy were demonstrated. Recent studies that evaluated the efficacy and safety of new immunosuppressive strategies with low doses or without calcineurin inhibitors in renal transplant recipients were also reviewed during the congress.
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PMID:The latest advances in kidney diseases and related disorders. 1763 41

Sirolimus is an immunosuppressive agent that offers potentially significant benefits for young transplant patients facing life-long treatment. Its action of reducing cell proliferation may reduce the risk of chronic allograft nephropathy and posttransplant neoplasia. Twenty-nine children were converted from calcineurin inhibitors to sirolimus after renal transplantation and followed for a minimum of 12 months. Glomerular filtration increased transiently in those converted before 12 months after transplantation but not in those converted later, when chronic histological changes had developed. Mild acute rejection occurred after conversion in 10%, and side effects led to cessation of sirolimus in 31%. Anemia occurred in 55% of patients and responded well to darbepoetin. Most side effects (anemia, hypercholesterolemia, mouth ulcers, and myalgias) became less severe with time. The number of antihypertensive drugs required decreased significantly on sirolimus. Although side effects are frequent on sirolimus, in the majority of children, they are mild enough to allow the patient to continue taking the drug, and for these children the long-term benefits are potentially valuable.
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PMID:Early experience with conversion to sirolimus in a pediatric renal transplant population. 1767 99

Similar to adults, CKD may persist after pediatric RTx. Clinical and laboratory parameters were analyzed retrospectively in 23 RTx recipients (13 males, age 11.9 +/- 5.2 yr), initially treated with prednisone, calcineurin inhibitor (TAC = 18, cyclosporine neoral = 5), and MMF at four months post-RTx (T1) and at 3.4 +/- 2.8 yr post-RTx (T2). Mean (+/-s.d.) cystatin C GFR (mL/min/1.73 m(2)) was 72 +/- 19 at T1 and 70 +/- 22 at T2 (NS). At T2, CKD stage I was present in five patients (22%), stage II in eight patients (35%), and stage III in 10 patients (43%). At T2, calcineurin inhibitors were utilized in 19, MMF in 13, and SIR in 13 patients. The prevalence of hypertension was 69% at T1 and 87% at T2 (p = NS). Anemia was diagnosed in 61% at T1 and 69% at T2 with average therapeutic MMF (2.78 +/- 1.3 mg/mL) and SIR (7.62 +/- 2.3 mg/mL) trough levels. Hypercholesterolemia was detected in 44.0% at T1 and 47% at T2. Bone disease was diagnosed in 26.0% at T1 and 21.7% at T2. Mean height Z-scores were -1.0 +/- 1.2 (T1) and -1.0 +/- 1.59 (T2, NS), with 21% at T1 and 30% at T2 below two SDS. We observed suboptimal growth, hypertension, hypercholesterolemia, bone disease, and anemia in a significant proportion of transplanted children.
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PMID:Complications of chronic kidney disease in children post-renal transplantation - a single center experience. 1818 92

The 40th Annual Meeting of the American Society of Nephrology was held in San Francisco, California, U.S.A., October 31-November 5, 2007. This meeting offered the latest findings in basic and clinical nephrology science and was attended by more than 11,000 nephrologists and related scientists from around the world. Recent data on the results of new drugs for the treatment of renal anemia that are under development, such as the continuous erythropoietin receptor activator (CERA), Hematidetrade mark, or the orally active prolyl hydroxylase inhibitors (FG-2216, FG-4592) were presented. The effect of clopidogrel on arteriovenous fistula patency and suitability, and the effects of the use of high-flux membranes on mortality in incident hemodialysis patients were also shown. The renoprotective effects of high doses of candesartan in chronic kidney disease patients with proteinuria or the additional antiproteinuric effects of aliskiren on top of angiotensin AT(1) receptor antagonism in patients with diabetic nephropathy were demonstrated. Recent studies that evaluated the efficacy and safety of new immunosuppressive strategies without calcineurin inhibitors in renal transplant recipients were also reviewed during the congress.
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PMID:The latest advances in kidney diseases and related disorders. 1830 99

Acute and especially chronic renal failure (CRF) are relatively common and important risk factor for morbidity and mortality in patients after heart, lung, liver or intestine transplantation. Numerous factors contribute to the development of CRF in this group of patients, like treatment with calcineurin inhibitors and other nephrotoxic drugs in the perioperative period, hemodynamical changes during and after the surgery, preexistent renal disease, hypertension, diabetes mellitus, dyslipidemia and anemia. Pretransplant evaluation of renal function is mandatory to predict which patients have increased risk for development of CRF. In the posttransplantation course it is necessary to timely diagnose and treat renal failure, while patients with insufficient renal function have 4.55-fold increased risk of death compared to patients with normal renal function. Special problem is diagnostic approach to patients with suspected chronic renal disease who are candidates for transplantation of other parenhimatose organs. Diagnostic value of serum creatinine and estimation of renal function based on its value is very limited. Gold diagnostic standard is radioisotope estimation of glomerular filtration, but this method is not widely available. It seems that this problem may be solved with the use of cystatin C, but this approach needs to be validated in large studies. Numerous different immunosuppressive drugs available on the market enable individualization of immunosuppression. Different drugs combinations may have less nephrotoxic potential, but one must be careful because of the possible risk of organ rejection with the change of immunosuppression. Use of angiotensin convertase enzyme inhibitors and/or angiotensin receptor blockers, statins with drugs for control of hyperglycemia, may prevent or postpone development of CRF. Although technical advances of contemporary hemodialysis machines and peritoneal dialysis equipment enable well tolerated dialysis even in critically ill patients, renal transplantation remains the method of choice for treatment of patients with transplanted parenhimatous organ that developed CRF.
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PMID:[Chronic renal failure after heart, lung, liver, or intestine transplantation]. 1857 34

Although multifactorial anemia is common following orthotopic liver transplantation (OLT), the late introduction of sirolimus (SRL) has been associated with high rates of anemia, whose pathogenic mechanisms have not been fully studied. Herein we have described a case of severe anemia in an HIV+ OLT patient who was switched from calcineurin inhibitors (CNI) to SRL due to severe nephrotoxicity. After 22 weeks of SRL, hemoglobin levels dropped 4 g/dL to a nadir of 6.5 g/dL. After discarding other causes for anemia, we concluded that it displayed the features of anemia of a chronic inflammatory state (ACIS): decreased mean corpuscular volume (MCV), low serum iron despite high ferritinemia, and elevated fibrinogen and C-reactive protein (CRP) levels. SRL trough levels were never above the therapeutic range. After blood transfusions and erythropoietin (EPO) use, SRL was maintained within the lower range of therapeutic levels, with significant improvement in renal function. As described among kidney transplant recipients, SRL-related anemia in this HIV+ patient with CNI nephrotoxicity after OLT showed features of ACIS. Blood transfusions and EPO use allowed SRL maintenance.
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PMID:Severe sirolimus-related inflammatory state anemia in an HIV+ liver transplant patient with calcineurin inhibitor renal insufficiency: a case report. 1910 Apr 99

Over the course of 15 years the use of sirolimus, a macrocyclic lactone, has evolved from an adjunct to calcineurin inhibitors (CNI) to the foundation of therapy due to the drug's unique properties: First, it displays synergistic pharmacodynamic interactions with CNI. Even among high immunologic risk patients, this regimen attenuates the risk of acute allograft rejection episodes when used in combination with cyclosporine or tacrolimus. Indeed >80% reduction in CNI exposure de novo yields better long-term renal function than full cyclosporine (CsA) doses, a useful tradeoff, despite the augmented occurrence of lymphoceles and impaired wound healing. Second, by inhibiting mammalian target of rapamycin (mTOR), it exerts profound anti-neoplastic effects reducing the incidence and mediating the regression of tumors displaying PTEN-deletions and/or Akt-activations in transplant and non-transplant patients. Third, it is relatively non-nephrotoxic although it may exacerbate that property of CNI agents. Fourth, it allows prompt withdrawal of steroid therapy. Fifth, it displays reduced rates of cytomegalovirus, and BK virus infections. The major adverse reactions can generally be controlled with countermeasure therapy. Myelosuppressive effects, which tend to be transient (unless sirolimus is combined with mycophenolic acid), are readily amenable to treatment with granulocyte colony stimulating factor for leukopenia, interleukin 11 for thrombocytopenia and erythropoietin for anemia. Combinations of statins and fibrates represent effective countermeasure therapy for hypercholesterolemia and hypertriglyceridemia, respectively. Idiosyncratic reactions include hypoxemic pulmonary toxicity, refractory edema and diarrhea. Thus, sirolimus represents the vanguard of a new class of maintenance agents for immunosuppression.
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PMID:Fifteen years of clinical studies and clinical practice in renal transplantation: reviewing outcomes with de novo use of sirolimus in combination with cyclosporine. 1910 Aug 99

Cardiovascular disease (CVD) accounts for 35% to 50% of deaths among renal transplant recipients. Beside the atherogenic risk factors related to hemodialysis, renal function, and use of immunosuppressive agents, other relevant risk factors for CVD include acute rejection episodes, microalbuminuria (muAlb), diabetes, arterial hypertension, lipid disorders, inflammatory triggers, hyperhomocysteinemia, anemia, erythrocytosis, obesity, and hyperuricemia. We studied the prevalence of risk factors and the impact of various drugs on CVD among 103 renal transplant recipients with measured glomerular filtration rates showing values >45 mL/min. We measured uric acid, triglycerides (TG), low-density lipoprotein (LDL)/high-density lipoprotein (HDL) LDL/HDL ratio, homocysteine (HOMO), insulin resistance, muAlb, C-reactive protein (CRP), and fibrinogen. Subsequently, patients were divided into 8 groups based on the immunosuppressive protocol to evaluate its impact on CVD risk factors. Insulin resistance and hyperhomocysteinemia were present in >2/3 of patients. Considering the impact of protocols, the combination of cyclosporine (CsA) + everolimus (EVL) resulted in the most favorable profile in terms of reduction of hyperuricemia, hyperlipidemia, and hyperhomocysteinemia. Insulin resistance tended to be more frequent among patients treated with protocols including calcineurin inhibitors (CNI) and steroids. The prevalence of hyperhomocyteinemia was similar among patients on CsA and on tacrolimus (Tac). Sirolimus (SRL) was associated with higher levels of HOMO. The combination of CNI and proliferative signal inhibitors (PSI) seemed to be the most promising one to reduce the impact of CVD risk factors. The reduction in CVD morbidity can improve expectancy and quality of life, as well as graft function and survival among renal transplant patients.
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PMID:Immunosuppressive agents and metabolic factors of cardiovascular risk in renal transplant recipients. 1946 May 10

Cardiovascular disease and kidney disease seem to be lethally synergistic, both approaching the level of epidemics. Patients with cardiovascular disease often have impaired kidney function; on the other hand, cardiovascular disease is the single best predictor of mortality among patients with chronic kidney disease. The risk in a patient with moderately impaired renal function is comparable in magnitude to that of a patient with diabetes mellitus. The aim of this study was to assess risk factors for kidney dysfunction among 162 prevalent heart transplant (OHT) recipients (127 males and 22 females). Stages of chronic kidney disease were defined according to Kidney Disease Outcomes Quality Initiative guidelines using the estimated glomerular filtration rate (GFR). Mean serum creatinine in this population was 1.70 +/- 1.08 mg/dL (range, 0.54-9.34). The mean age was 54 +/- 14 years and the average time after transplantation was 106 +/- 52 months (range, 10-210). Mean GFR was 62.92 +/- 31.04 mL/min (Cockcroft-Gault formula), 55.38 +/- 26.74 mL/min (MDRD), and 62.62 +/- 35.61 mL/min (creatinine clearance). Estimated GFR, creatinine clearance, and serum creatinine correlated upon univariate analysis with hemoglobin, red blood cell count, age, time after transplantation, ejection fraction, N-terminal prohormone brain natriuretic peptide, and use of calcineurin inhibitors. Upon multiple regression analysis predictors of kidney function (GFR) were age (beta value, -0.47; P < .001), time after transplantation (beta value, -0.22; P = .03), and hemoglobin (beta value, 0.31; P = .03), explaining 51% of the variation among GFR values in this group. When GFR was substituted with creatinine clearance, the results were similar. Among heart transplant recipients, kidney function was predominantly dependent on age and time after transplantation (both nonmodifiable causes), as well as anemia (which may be modified).
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PMID:Predictors of kidney dysfunction in heart transplant recipients. 1985 19

Thrombotic microangiopathy (TMA) in renal transplantation (RTX) generally develops during treatment with calcineurin inhibitors. We present a RTX case that developed TMA under everolimus treatment. A 40-year-old woman received a kidney allograft from her 77-year-old mother. She initially received tacrolimus, mycophenolate mofetil and steroids. She was discharged with a creatinine level of 2.2 mg/dl after treatment for a cellular rejection attack within the first two weeks after transplantation. Later on, tacrolimus was replaced with everolimus. One year later, she presented with fever and increased creatinine level (4 mg/dl), anemia and thrombocytopenia. Her peripheral blood smear revealed signs of microangiopathic hemolysis. Bone marrow examination revealed an increased number of megakaryocytes. We diagnosed the case as TMA and initiated plasma exchange, I.V. pulse steroid treatment and stopped everolimus. This approach improved laboratory and clinic abnormalities. The development of TMA after treatment with everolimus and the exclusion of other possible causes suggested TMA associated with proliferating signal inhibitors (PSIs) in our case.
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PMID:Thrombotic thrombocytopenic purpura associated with everolimus use in a renal transplant patient. 2049 69


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