Nephrology News

• Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: a meta-analysis.
  Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: a meta-analysis.

  This systematic review of 52 RCTs looked at the clinical efficacy and harms related to erythropoeisis-stimulating agents in the treatment of anemia related to cancer or chemotherapy (not renal failure). The study shows that ESAs improve quality of life and decrease blood transfusions, but with increased the risk of death and serious adverse events. The authors recommend that ESAs should not be used routinely as an alternative to blood transfusions in these patients.

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• In brief
  In brief

  In brief

  Nature Reviews Nephrology 5, 366 (2009). doi:10.1038/nrneph.2009.85

  TransplantationOutcomes of third renal transplants are similar to those of primary transplants, according to a study published in Transplantation. Despite the technical and immunological obstacles associated with retransplantation, Horovitz and colleagues found that 1-year and 5-year patient and graft survival of individuals receiving

• Malacoplakia presenting with obstructive nephropathy with bilateral ureter involvement
  Malacoplakia presenting with obstructive nephropathy with bilateral ureter involvement

  Malacoplakia presenting with obstructive nephropathy with bilateral ureter involvement

  Nature Reviews Nephrology 5, 418 (2009). doi:10.1038/nrneph.2009.86

  Authors: Lorin M. Sanchez, Sean I. Sanchez & James L. Bailey

  Background. A 48-year-old woman with chronic urinary tract infections presented with uremia. Imaging studies revealed bilateral hydronephrosis and segmental ureteral thickening.Investigations. Physical examination, urine and blood analysis, radiography of the chest, chest CT, abdominal and pelvis CT, renal ultrasonography, cystoscopy, anterograde pyelogram,

• Daclizumab versus antithymocyte globulin in high-immunological-risk renal transplant recipients.
  Daclizumab versus antithymocyte globulin in high-immunological-risk renal transplant recipients.

  Previous comparisons of IL-2 receptor antibodies and thymoglobulin compared either low-risk patients, or patients at high risk due to long cold ischemia times. This trial enrolled patients at high immunologic risk (mean peak PRA around 70%). Thymoglobulin reduced the risk of biopsy-proven acute rejection, but this trial was not powered to look at differences in graft or patient survival.

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• CJASN: Study highlights long term kidney impairment associated with contrast nephropathy.
  CJASN: Study highlights long term kidney impairment associated with contrast nephropathy.
  CJASN: To investigate the issue, Richard Solomon, MD (University of Vermont), and his colleagues studied 294 patients with kidney disease who were exposed to contrast agents during cardiac angiography. Patients in the CARE (Cardiac Angiography in REnally Impaired Patients) trial were randomly divided to receive one of two contrast agents: iopamidol or iodixanol. After following patients for at least one year, the researchers found that 92 (31%) of the patients experienced negative health effects. Thirty-eight (13%) of the patients experienced a major event, such as death, stroke, heart attack, or end-stage renal disease. Individuals who developed contrast-induced kidney injuries had twice as many long-term negative health effects compared with patients whose kidneys were not damaged. In the absence of contrast-induced kidney injury, there was no difference in the incidence of long-term negative health effects between patients taking iopamidol or iodixanol. However, the investigators found that patients taking iopamidol had reduced incidences of both kidney damage and long-term negative effects. These parallel decreased incidences support the theory that contrast-induced kidney injury causes long-term negative effects.
• Successful Treatment of Membranous Glomerulonephritis with Rituximab in Calcineurin Inhibitor-Dependent Patients
  Successful Treatment of Membranous Glomerulonephritis with Rituximab in Calcineurin Inhibitor-Dependent Patients

  Background and objectives: Calcineurin inhibitors (CNIs) induce remission of proteinuria in most nephrotic patients with membranous glomerulonephropathy (MGN). However, 60% of patients become treatment dependent and are at risk of chronic nephrotoxicity. The aim of this study was to evaluate the efficacy of rituximab in patients with long-term dependence on CNIs.

  Design, setting, participants, and measurements: Thirteen patients with MGN, normal renal function, and proven dependence on CNIs, despite previous treatment with other immunosuppressant drugs, received a single trial of four weekly doses of rituximab (375 mg/m²). Outcome measures were the percentage of patients with CNI withdrawal and no evidence of relapse and the percentage of patients with complete or partial remission 30 mo after CNI withdrawal.

  Results: After rituximab, proteinuria decreased significantly (2.5 ± 0,76 basal versus 0.85 ± 0.17 at 6 mo; P = .0003). CNIs and other immunosuppressant drugs could be withdrawn in all patients with no evidence of relapse. After CNI withdrawal, GFR increased significantly (90.3 ± 15 basal to 106.4 ± 20 at 3 mo with a mean increase of 15.3% [range 0–20]). Three patients suffered a relapse of nephrotic proteinuria 19, 23, and 28 mo after rituximab treatment; all were successfully treated with a second course of rituximab. At 30 mo, all patients were in remission.

  Conclusions: In patients with MGN with long-term CNI dependence, rituximab can be an effective tool to overcome dependence on CNI, thus avoiding the risk of nephrotoxicity related to the chronic exposure to these drugs.