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Background. Shiga toxin-producing, enteroaggregative Escherichia coli was responsible for the 2011 outbreak of haemolytic uraemic syndrome (HUS). The present single-centre, observational study describes the 1-year course of the disease with an emphasis on kidney function. Outcome data after 1 year are associated with treatment and patient characteristics at onset of HUS. Methods. Patients were treated according to a standardized approach of supportive care, including a limited number of plasmapheresis. On top of this treatment, patients with severe HUS (n = 35) received eculizumab, a humanized anti-C5 monoclonal antibody inhibiting terminal complement activation. The per-protocol decision--to start or omit an extended therapy with eculizumab accompanied by azithromycin--separated the patients into two groups and marked Day 0 of the prospective study. Standardized visits assessed the patients' well-being, kidney function, neurological symptoms, haematological changes and blood pressure. Results. Fifty-six patients were regularly seen during the followup. All patients had survived without end-stage renal disease. Young(er) age alleviated restoring kidney function after acute kidney injury even in severe HUS. After 1 year, kidney function was affected with proteinuria [26.7%; 95% confidence interval (CI) 13.8-39.6], increased serum creatinine (4.4%, CI 0.0-10.4), increased cystatin C (46.7%, CI 32.1-61.3) and reduced (<90 mL/ min) estimated glomerular filtration rate (46.7%, CI 32.1-61.3). Nine of the 36 patients without previous hypertension developed de novo hypertension (25%, CI 10.9-39.1). All these patients had severe HUS. Conclusions. Although shiga toxin-producing Escherichia coli (STEC)-HUS induced by O104:H4 was a life-threatening acute disease, follow-up showed a good recovery of organ function in all patients. Whereas kidney function recovered even after longer duration of dialysis, chronic hypertension developed after severe HUS with neurological symptoms and could not be prevented by the extended therapy. [ABSTRACT FROM AUTHOR]

Background: More than 50% of patients with advanced breast cancer develop bone metastases that may lead to multiple complications such as pathological fractures, bone pain or hypercalcaemia. The standard treatment, besides endocrine, targeted-therapy or chemotherapy, is the use of bisphosphonates. However, one of their main adverse side-effects is bisphosphonate-induced nephrotoxicity. The mechanism by which the latter occurs is not well-understood, although emerging evidence suggests that the effect of bisphosphonates on the kidney may differ between agents., Patients and Methods: The aim of this evaluation was to compare the renal toxicity of 6 mg ibandronate i.v. versus 4 mg zoledronic acid i.v. over a period of six months in women with breast cancer and bone metastases. A prospective randomized trial was carried out to examine specific kidney and other parameters (α1- and β2-microglobulin, albumin, α2-macroglobulin, IgG and C-reactive protein (CRP) generated from spontaneous urine samples from 17 patients of each group., Results: We were unable to find any significant difference between the two treatment groups with regard to renal toxicity. All patients, independently of the applied bisphosphonate, experienced only temporary renal dysfunction without any evidence of irreversible damage in terms of acute nephrotoxicity during the study period. α1-Microglobulin, a marker for proximal tubular damage, in particular, was not differently elevated in either group., Conclusion: Both applied bisphosphonates were found to be well-tolerated and safe with regard to renal toxicity during a six-month treatment period in patients with otherwise healthy kidneys having advanced breast cancer and bone metastases., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background: Treatment-resistant hypertension is a common problem in an outpatient setting and often results in hospital admission. Non-identified secondary hypertension, hypertensive nephrosclerosis and non-compliance are major reasons for treatment resistance., Case Report: A 75-year old woman was admitted to the emergency room because of a hypertensive crisis with alleged treatment-resistant hypertension and progressive headache. Two months ago, renal artery stenosis had been ruled out and a diagnosis of hypertensive cardiomyopathy was established. On admission, the patient had a blood pressure of 210/100 mmHg despite an antihypertensive treatment with nine different drugs. Further investigations ruled out secondary hypertension due to an endocrine cause but were consistent with hypertensive nephrosclerosis. With a supervised drug intake the blood pressure was rather normal to hypotensive, resulting in the need for significant reduction of the antihypertensive medication. The apparent discrepancies were discussed in detail with the patient who finally admitted a previous inconsistent intake of the antihypertensive drugs. Following thorough training and education on the purpose of continued antihypertensive therapy, the patient could be discharged with a normotensive blood pressure profile., Conclusions: Therapy of treatment-resistant hypertension should always consider non-compliance and secondary hypertension as possible reason.

Purpose: To compare image quality and diagnostic accuracy of carbon dioxide (CO2) and iodinated contrast medium as a contast medium in renal transplant artery angiography., Material and Methods: In this prospective, non-randomized, intra-individual study, we examined 17 patients. Digital subtraction angiography (DSA) was performed first with CO2 to find the optimal projection. Then at least one confirming run was performed with CM ("gold standard"). The quality of the angiographic studies with CO2 and CM and their diagnostic accuracy were compared. Blood creatinine levels were monitored during three days after angiography., Results: Three of four renal transplant artery stenoses were diagnosed correctly with CO2. The false-negative CO2 angiography was due to poor contrast. There were no false-positive results with CO2. Regardless the inferior image quality of CO2 angiography, its positive predictive value was 100%. Renal function was not compromised., Conclusion: The primary use of CO2 as a contrast medium for the angiographic evaluation of renal transplant arteries is feasible and practical. It reduces the amount of CM needed. However, in order to confirm the diagnosis, at least one additional series with CM should be performed.