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1.

001-es BibID:BIBFORM061605
Első szerző:Agarwal, Mohit
Cím:Severe Symptomatic Hypocalcemia after Denosumab Administration in an End-Stage Renal Disease Patient on Peritoneal Dialysis with Controlled Secondary Hyperparathyroidism / Mohit Agarwal, Éva Csongrádi, Christian A. Koch, Luis A. Juncos, Vonda Echols, Mihály Tapolyai, Tibor Fülöp
Dátum:2013
Megjegyzések:We report the 1st case of severe, symptomatic hypocalcemia after denosumab (RANKLinhibitor) treatment in a peritoneal dialysis patient with secondary hyperparathyroidismand osteoporosis. A 58-year-old Caucasian female has been receiving chronicambulatory peritoneal dialysis for four years secondary to polycystic kidney disease.Laboratory studies revealed: albumin-corrected calcium 9.0 mg/dL, phosphorus 5 mg/dL,alkaline phosphatase (ALP) 58 U/L [normal, 40-105], albumin 3.4 gm/dL [normal, 3.6-5.4]and intact parathyroid hormone (PTH) 315 pg/mL [normal, 40-72]. Marked osteoporosiswas noted on the DXA scan, preventing her from renal transplantation considerations.She had failed conventional medical treatment, including per os calcium, monthlyergocalciferol (50,000 units/month), activated vitamin-D analog (doxercalciferol) andrenal-failure adjusted alendronate (70 mg twice a month). She was started onsubcutaneous denosumab 60 mg every 6 months. After her first dose, she developed aprogressive drop of calcium, phosphorus, bicarbonate and magnesium, in spite ofmassive escalation of doxercalciferol and calcium supplementation. Hypocalcemianadired at 6.3 mg/dL with symptomatic tetany, requiring a brief hospitalizationapproximately 7 weeks after denosumab treatment. Her elevated PTH rose furthertransiently (647 pg/mL), along with ALP (123 U/L). Bone-mineral parameters normalizedapproximately 3 months after denosumab administration. The observed phenomenonresembled the phenotype of "hungry bone syndrome" observed after surgicalparathyroidectomy.Conclusion: Treatment decisions based on bone densitometry results alone are nottransposable between patients with or without end-stage renal disease. Denosumab maylead to critical hypocalcemia in dialysis patients and further aggravate existing secondaryhyperparathyroidism.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:British Journal of Medicine & Medical Research. - 3 : 4 (2013), p. 1398-1406. -
További szerzők:Csongrádi Éva (1969-) (szakorvos) Koch, Christian A. Juncos, Luis A. Echols, Vonda Tapolyai Mihály (1968-) (nefrológus) Fülöp Tibor (1957-) (kardiológus)
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2.

001-es BibID:BIBFORM061606
Első szerző:Avusula, Ramachandram (orvos)
Cím:Bacterial Peritonitis Following Esophagogastroduodenoscopy in a Patient on Peritoneal Dialysis / Ramachandram Avusula, Michael Shoemaker-Moyle, Minesh B. Pathak, Éva Csongrádi, Tibor Fülöp,
Dátum:2013
Megjegyzések:Aims: To recognize the importance of considering perforation of viscus in thedifferential of peritonitis after upper gastrointestinal endoscopy in peritoneal dialysispatients and to address the potential benefit of antibiotic prophylaxis in PD patientsundergoing upper GI procedures.Presentation of Case: We report the case of a 54-year-old African American femalewith end-stage renal disease on peritoneal dialysis presenting with generalizedabdominal pain, along with nausea and vomiting. Peritoneal fluid revealed a WBC countof 1,499/mm3. Two days earlier, she had undergone an esophagogastroduodenoscopywith biopsy. Broad spectrum antibiotics were started to treat possible peritonitis.Surgical exploration revealed no perforation but murky peritoneal fluid was noted andgram stain showed mixed flora (both gram negative and gram positive rods); however,blood and peritoneal fluid culture grew only Streptococcus pneumoniae.Discussion and Conclusion: An occult perforation, which may not be obvious to thenaked eye or signs of contrast extravasation can occur afteresophagogastroduodenoscopy with manipulations and can lead to peritonitis, especiallyin high-risk patients such as those with end-stage renal disease on peritoneal dialysis.To our knowledge, this is the first reported case of mixed peritonitis attributable tosuspected micro-perforation after esophagogastroduodenoscopy. Whether preprocedureantibiotics are warranted to decrease the occurrence of infectiouscomplications in PD patients undergoing upper gastrointestinal procedures remainsuncertain and not well studied. The prompt recognition of possible mixed bacterialinfection remains essential after these procedures.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:British Journal of Medicine & Medical Research. - 3 : 3 (2013), p. 784-789. -
További szerzők:Shoemaker-Moyle Michael (orvos) Pathak, Minesh B. (orvos) Csongrádi Éva (1969-) (szakorvos) Fülöp Tibor (1957-) (kardiológus)
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3.

001-es BibID:BIBFORM061633
Első szerző:Brar, Manmeet
Cím:Cytomegalovirus colitis in a critically ill, dialysis-dependent acute kidney injury patient without immunosupressive therapy / Manmeet Brar, Kenneth Kokko, Eva Csongradi, Bela Kanyicska, Tibor Fulop
Dátum:2012
ISSN:0272-6386
Tárgyszavak:Orvostudományok Klinikai orvostudományok idézhető absztrakt
Megjelenés:American Journal Of Kidney Diseases 59 : 4 (2012), p. 39. -
További szerzők:Kokko, Kenneth (orvos) Csongrádi Éva (1969-) (szakorvos) Kanyicska Béla (tudományos segédmunkatárs) Fülöp Tibor (1957-) (kardiológus)
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4.

001-es BibID:BIBFORM061611
Első szerző:Csongrádi Éva (szakorvos)
Cím:Pathogenetic factors in obesity contributing to the development of heart failure / Éva Csongrádi, Attila Juhász, Zsuzsa Varga, Ildikó Seres, László Bajnok, Miklós Káplár, Tibor Fülöp, Attila Kertész, Zsolt Karányi, György Paragh
Dátum:2007
ISSN:0307-0565
Tárgyszavak:Orvostudományok Klinikai orvostudományok idézhető absztrakt
Megjelenés:International Journal Of Obesity 31 (2007), S62. -
További szerzők:Juhász Attila (1970-) (szakorvos, klinikai mikrobiológus) Varga Zsuzsa (1951-) (biokémikus, nephrológus) Seres Ildikó (1954-) (biokémikus) Bajnok László (1961-) (belgyógyász) Káplár Miklós (1965-) (belgyógyász, diabetológus) Fülöp Tibor (1957-) (kardiológus) Kertész Attila Béla (1973-) (kardiológus) Karányi Zsolt (1961-) (biostatisztikus, bioinformatikus) Paragh György (1953-) (belgyógyász)
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5.

001-es BibID:BIBFORM061604
Első szerző:Csongrádi Éva (szakorvos)
Cím:The Efficacy of Intravenous versus Subcutaneous Recombinant Erythropoietin in Obese African-African Patients in a Southeast U.S. Dialysis Cohort / Éva Csongrádi, Michael Shoemaker-Moyle, Lajos Zsom, Catherine Wells, Zsolt Lengvárszky, Mihály Tapolyai, Tibor Fülöp
Dátum:2014
Megjegyzések:Aims: To correct renal anemia, subcutaneous (SC) route of recombinant humanerythropoietin (rhuEPO) administration has been associated with increased efficacy anddecreased dose requirements, when compared with intravenous (IV) route. The effect ofobesity as a potential modifier during rhuEPO administration has not been well explored.Study Design: Single-center, Longitudinal Cohort Study.Place and Duration of Study: University of Mississippi Medical Center OutpatientDialysis Unit, between February and November of 2009.Methodology: We performed IV to SC rhuEPO conversion for 86 in-center dialysispatients and, following a six-month equilibration period, we monitored outcomes over aperiod of three months. We obtained baseline demographic parameters, calculated BodyMass Index (BMI) and monitored iron saturation, ferritin, hemoglobin (Hgb) along withrhuEPO requirements. Patients were divided into 3 categories based on BMI [<25 (n=27),25-35 (n=38), >35 (n= 21) kg/m2]. Results are reported either as percents, means with SDor median with 25-75% interquartile range, as appropriate.Results: The cohort was all African-American, 48.8% male, aged 54.7 (13.3) years andBMI calculated at 29.9 (7.4) kg/m2. Baseline iron saturation was 24 (10.6)%, ferritinmeasured 641 (277) ng/mL. Hgb remained unchanged during the observation period:11.1 (1.3) vs. 11.2 (1.3) gm/dL. Initial rhuEPO weekly dose for the entire cohort was19,729 (17,448) Units/week (U/week); final dose 17,482 (14,860) U/week, with closecorrelation between initial and final doses (r: 0.653, P<0.0001). Weekly rhuEPO doseremained virtually unchanged in BMI categories 1 and 2 [13,927 (10,938) vs. 13,297(10,247) U/week; 20,684 (15,788) vs. 20,997 (17.917)] (P=NS for both) but decreased inthe category 3: 25,459 (24,403) vs. 16,444 (12,749) (P=0.081). However, BMI had noindependent effect in linear regression modeling with multiple covariates (age, BMI, ironsaturation, ferritin) included.Conclusion: Obesity may affect relative efficacy of rhuEPO conversion; additionalstudies may be needed.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:British Journal of Medicine & Medical Research. - 4 : 1 (2014), p. 184-193. -
További szerzők:Shoemaker-Moyle Michael (orvos) Zsom Lajos (1968-) (belgyógyász, nefrológus) Wells Catherine (tudományos segédmunkatárs) Lengvárszky Zsolt (matematikus informatikus) Tapolyai Mihály (1968-) (nefrológus) Fülöp Tibor (1957-) (kardiológus)
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6.

001-es BibID:BIBFORM061592
Első szerző:Elmahi, Nadear (orvos)
Cím:Residual renal function in peritoneal dialysis with failed allograft and minimum immunosuppression / Nadear Elmahi, Éva Csongrádi, Kenneth Kokko, Jack R. Lewin, Jamie Davison, Tibor Fülöp
Dátum:2013
ISSN:2220-3230
Megjegyzések:Immunosuppression (IS) is often withdrawn in patientswith end stage renal disease secondary to a failed renalallograft, and this can lead to an accelerated loss ofresidual renal function (RRF). As maintenance of RRFappears to provide a survival benefit to peritoneal dialysis(PD) patients, it is not clear whether this benefit ofmaintaining RRF in failed allograft patients returning toPD outweigh the risks of maintaining IS. A 49 year-oldCaucasian male developed progressive allograft failurenine years after living-donor renal transplantation. Hemodialysiswas initiated via tunneled dialysis catheter(TDC) and IS was gradually withdrawn. Two weeksafter IS withdrawal he developed a febrile illness,which necessitate removal of the TDC and conversionto PD. He was maintained on small dose of tacrolimus(1 mg/d) and prednisone (5 mg/d). Currently (1 yearlater) he is doing exceedingly well on cycler-assisted PD.Residual urine output ranges between 600-1200 mL/d.Total weekly Kt/V achieved 1.82. RRF remained wellpreserved in this patient with failed renal allograft withminimal immunosuppressive therapy. This strategy willneed further study in well-defined cohorts of PD patientswith failed allografts and residual RRF to determineefficacy and safety.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:World Journal of Transplantation. - 3 : 2 (2013), p. 26-29. -
További szerzők:Csongrádi Éva (1969-) (szakorvos) Kokko, Kenneth (orvos) Lewin, Jack R. Davison Jamie (orvos) Fülöp Tibor (1957-) (kardiológus)
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7.

001-es BibID:BIBFORM061607
Első szerző:Farah Musa, A.R.
Cím:Cytomegalovirus colitis in a critically ill, dialysis-dependent, acute kidney injury patient without immunosuppressive therapy / Farah Musa A.R., Fülöp T., Kokko K., Kanyicska B., Lewin J. R., Csongrádi É.
Dátum:2015
Megjegyzések:BACKGROUND:Historically, cytomegalovirus (CMV) infection in immunocompetent patients has been considered to have a relatively indolent and self-limited course, not warranting specific treatment.CASE PRESENTATION:We are presenting a 72-year-old African-American male transferred to our intensive care unit (ICU) with methicillin-resistant Staphylococcus aureus bacteremia, respiratory failure, and dialysis-dependent acute kidney injury. While he recovered from bacteremia, he remained difficult to wean from respiratory support, had labile blood pressure, and manifested persistent diarrhea. Stool antigen testing for C. difficile colitis returned repeatedly negative. Flexible sigmoidoscopy described diffuse ulceration, attributed to ischemic colitis. The colon biopsy specimen, however, described tissue-invasive cytomegalovirus (CMV) infection. Polymerase chain reaction (PCR) testing confirmed viremia with 8,900 copies/mL viral DNA. Human immunodeficiency virus antibody and PCR testing were both negative. Absolute lymphocyte count varied between 80 and 450/mm3 during the admission. After IV ganciclovir initiation, diarrhea and respiratory failure resolved, while renal function recovered to the patient'??s baseline.CONCLUSION:The combination of critical illness and recent bacteremia likely represented a state of profound immunosuppression in this formerly healthy patient. CMV colitis may be under-diagnosed in sick ICU patients with renal failure and otherwise unexplained diarrhea. Serum PCR testing may aid the diagnosis.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:Clinical nephrology 84 : 1 (2015), p. 44-49. -
További szerzők:Fülöp Tibor (1957-) (kardiológus) Kokko, K. Kanyicska Béla (tudományos segédmunkatárs) Lewin, Jack R. Csongrádi Éva (1969-) (szakorvos)
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8.

001-es BibID:BIBFORM061609
Első szerző:Ferguson, Lee M.
Cím:Recurring Extracorporeal Circuit Clotting During Continuous Renal Replacement Therapy in Fungal Sepsis / Ferguson, Lee M., Dreisbach, Albert W., Csongrádi, Éva, Juncos, Luis A., Fulop, Tibor
Dátum:2013
ISSN:0002-9629
Megjegyzések:The relative effectiveness of anticoagulation strategies during continuous renal replacement therapy (CRRT) may vary according to the clinical circumstances. In this study, the case of a 46-year-old man who developed fungal mediastinitis with the pathogen Scedosporium prolificans after coronary bypass surgery is reported. Numerous debridements and multiple antifungal agents were not effective in this patient. Miltefosine, a non-Food and Drug Administration-approved agent, was started after institutional review board request and approval. CRRT was initiated with regional citrate anticoagulation (RCA) for clinical sepsis with acute kidney injury. Subsequently, crescendo clotting of the extracorporeal circuit (ECC) occurred. Multiple interventions, including escalating RCA, adding increasing heparin to RCA and exchanging the dialysis catheter, were not effective. Argatroban anticoagulation was started without further ECC clotting, and the patient recovered from both acute kidney injury and septic shock, despite continued miltefosine administration. Sepsis may contribute to recurrent ECC clotting. Argatroban, a direct thrombin inhibitor, had a disproportionate effectiveness to maintain ECC patency in this patient.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:American Journal Of The Medical Sciences. - 345 : 3 (2013), p. 256-258. -
További szerzők:Dreisbach, Albert W. Csongrádi Éva (1969-) (szakorvos) Juncos, Luis A. Fülöp Tibor (1957-) (kardiológus)
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9.

001-es BibID:BIBFORM061591
Első szerző:Fülöp Tibor (kardiológus)
Cím:Recalcitrant hypoglycemia resolved with 2.5% dextrose containing replacement fluid during hemodiafiltration / Fülöp Tibor, Iboaya, Benahili U., Avusula, Ramachandram, Csongrádi Éva, Juncos, Luis A.
Dátum:2013
ISSN:0886-022X
Megjegyzések:A 52-year-old African American male was admitted with acute kidney injury (AKI) four days afterrenal cryotherapy. He was started on continuous veno-venous hemodiafiltration (CVVHDF)immediately but his subsequent course was complicated by recurrent hypoglycemia, poorlyresponding to conventional therapy. To address the recalcitrant hypoglycemia, we changed thereplacement fluid to 5% dextrose in water with 150 mEq/L of sodium bicarbonate, Y-connectedwith 0.9% sodium chloride at a global rate of 2000 mL/hr, with resolution of refractoryhypoglycemia. A modified CVVHDF employing hyperglycemic solution can be a valuableaddition in treatment of AKI complicated by severe refractory hypoglycemia
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Acute kidney injury
continuous renal replacement therapy
hemodiafiltration
hypoglycemia
glipizide
sulfonylurea
Megjelenés:Renal Failure. - 35 : 7 (2013), p. 1035-7. -
További szerzők:Iboaya, Benahili U. (orvos) Avusula, Ramachandram (orvos) Csongrádi Éva (1969-) (szakorvos) Juncos Luis A. (orvos)
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10.

001-es BibID:BIBFORM061600
Első szerző:Fülöp Tibor (kardiológus)
Cím:Resolution of C1q deposition but not of the clinical nephrotic syndrome after immunomodulating therapy in focal sclerosis / Tibor Fülöp, Éva Csongrádi, Anna A. Lerant, Matthew Lewin, Jack R. Lewin
Dátum:2015
Megjegyzések:Background: The natural evolution of C1q nephropathy (C1qNP) during immunosuppressivetreatment is relatively little studied or understood.Case Presentation: A 30 year-old Caucasian female was referred to us for further managementof biopsy-proven C1qNP and severe nephrotic syndrome. Serologic work-up remainednegative, including complement C3 and C4 levels and repeated testing for antinuclearantibodies. A renal biopsy revealed minimal change nephropathy vs. focal sclerosis onlight microscopy and C1qNP on immunopathology. She has failed trials of high-dose oralprednisone, mycophenolate mofetil 1,500 mg twice a day and a subsequent regimen ofmonthly IV cyclophosphamide 750 mg ? 9 cycles. She also received the maximum toleratedangiotensin-converting enzyme inhibitor and spironolactone therapy. Random urine proteinto-creatinine (UPC) ratio predicted proteinuria in the range between 5-35 gm/day, whileserum creatinine rose progressively from 1.0 mg/dL to 1.4 mg/dL (to convert to ?mol/L,multiply by 88.4). A decision was made to repeat renal biopsy to reassess the underlyinghistology. The biopsy revealed focal sclerosis but no C1q deposition.Conclusions: Our case illustrates at least two points: first, an established pathologic diagnosisdoes not obviate the need for repeated renal biopsy later on, should diagnostic uncertaintypersist. Second, histological diagnoses may evolve over time, especially in a patient receivingactive and powerful immune-modulating treatment. In our case, the clinical nephrosis didnot change with immunosuppressive therapy while C1q deposition ceased, making this latterentity likely the immunologically mediated process.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:Journal of Nephropathology. - 4 : 2 (2015), p. 54-58, -
További szerzők:Csongrádi Éva (1969-) (szakorvos) Lerant, Anna (orvos) Lewin, Matthew (orvos) Lewin, Jack R.
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11.

001-es BibID:BIBFORM061608
Első szerző:Fülöp Tibor (kardiológus)
Cím:The safety and efficacy of bedside removal of tunneled hemodialysis catheters by nephrology trainees / Fülöp Tibor, Tapolyai Mihály, Qureshi, Naseem A., Beemidi, Vikram R., Gharaibeh, Kamel A., Hamrahian, S. Mehrdad, Szarvas, Tibor, Kovesdy, Csaba P., Csongrádi, Éva
Dátum:2013
ISSN:0886-022X
Megjegyzések:BACKGROUND:Some nephrologists remove tunneled hemodialysis catheters (TDC) at the bedside, but this practice has never been formally studied. Our hypothesis was that bedside removal of TDC is a safe and effective procedure affording prompt removal, including in cases of suspected infection.METHODS:We reviewed our consecutive 3-year experience (2007-2009) with bedside TDC removal at the University of Mississippi Renal Fellowship Program. Data were collected on multiple patients and procedure-related variables, success and complication rates. Association between clinical characteristics and biomarkers of inflammation and myocardial damage was examined using correlation coefficients.RESULTS:Of 55 inpatient TDC removals (90.9% from internal jugular location), 50 (90.9%) were completed without hands-on assistance from faculty. Indications at the time of removal included bacteremia, fever or clinical sepsis with hemodynamic instability or respiratory failure. All procedures were successful, with no cuff retention noted; one patient experienced prolonged bleeding which was controlled with local pressure. Peak C-reactive protein (available in 63.6% of cohort) was 12.9???8.4?mg/dL (reference range: <0.49) and median troponin-I (34% available) was 0.534?ng/mL (IQR 0.03-0.9) (reference range: <0.034) and they did not correlate with each other. Abnormal troponin-I was associated with proven bacteremia (p?<?0.05) but not with systolic and diastolic BP or clinical sepsis.CONCLUSION:Our results suggest that bedside removal of TDC remains a safe and effective procedure regardless of site or indications. Accordingly, TDC removal should be an integral part of competent Nephrology training.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:Renal Failure. - 35 : 9 (2013), p. 1264-1268, -
További szerzők:Tapolyai Mihály (1968-) (nefrológus) Qureshi, Naseem A. Beemidi, Vikram R. (orvos) Gharaibeh, Kamel A. (orvos) Hamrahian, S. Mehrdad (orvos) Szarvas Tibor (matematikus informatikus) Kovesdy Csaba P. (orvos) Csongrádi Éva (1969-) (szakorvos)
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12.

001-es BibID:BIBFORM068276
Első szerző:Gharaibeh, Kamel A. (orvos)
Cím:Pulmonary embolization with tunneled hemodialysis catheter-associated blood stream infection : the perils of systemic anticoagulation / Kamel A. Gharaibeh, Éva Csongrádi, Michael Shoemaker-Moyle, Anna Lerant, Mihály Tapolyai, Tibor Fülöp
Dátum:2012
Megjegyzések:A 35-year old African-American male withend-stage renal disease on hemodialysisthrough a tunneled dialysis catheter (TDC) presentedwith fever, diffuse aches and generalizeddistress. Blood cultures (BC) wereobtained and empirical broad-spectrum antibiotictherapy started. After urgent renal dialysis,TDC was pulled at the bedside. Chest computedtomography (CT) diagnosed pulmonaryembolism and systemic i.v. heparin was initiated.BC grew Gram positive cocci (methicillinsensitiveS. aureus) and cardiac echocardiogramconfirmed acute bacterial endocarditis.Due to declined mental status, CT imaging wasobtained revealing massive intracranial hemorrhageleading to the patient's death. Furtherchest CT review revealed only hemodynamicallynon-significant pulmonary emboli in somesegmental and subsegmental arteries.Pulmonary embolization may be an expectedoccurrence with removal of infected TDC; systemicanticoagulation may not be warranted insuch cases and may lead to catastrophicintracranial hemorrhage. This case draws ourattention to the perils of rigid adherence to protocoland the failure of considering the needs ofspecial patient cohorts and individualized care.
Tárgyszavak:Orvostudományok Egészségtudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:Nephrology Reviews. - 4 : 2 (2012), p. 73-75. -
További szerzők:Csongrádi Éva (1969-) (szakorvos) Shoemaker-Moyle Michael (orvos) Lerant, Anna (orvos) Tapolyai Mihály (1968-) (nefrológus) Fülöp Tibor (1957-) (kardiológus)
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