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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Megjegyzések:Immunosuppression (IS) is often withdrawn in patientswith end stage renal disease secondary to a failed renalallograft, and this can lead to an accelerated loss ofresidual renal function (RRF).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 Hemodialysiswas initiated via tunneled dialysis catheter(TDC) and IS was gradually withdrawn.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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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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3.

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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