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Individualized Isonatremic and Hyponatremic Dialysate Improves Blood Pressure in Patients with Intradialytic Hypertension: A Prospective Cross-Over Study with 24-h Ambulatory Blood Pressure Monitoring

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Open Journal of Nephrology 2020年第2期10卷 144-157页

作者： Tom Robberechts Mandelina Allamani Xavier Galloo karl martin wissing Patricia Van Der Niepen Department of Nephrology and Hypertension Universitair Ziekenhuis Brussel VUB Brussels Belgium

Background. Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the effects of individually adjusted isonatremic and hyponatremic dialysate on intradialytic and interdialytic blood pressure in patients with intradialytic hypertension. Methods. We enrolled 11 patients with intradialytic hypertension in a prospective randomized cross-over study, with 4 treatment periods of different dialysate sodium concentrations. Period 1 (run-in) and 3 (wash-out) were standardized at 140 mEq/L;period 2 and 4 with iso- or hyponatremic sodium dialysate. Blood pressure was recorded each dialysis session, and 24-hour ambulatory blood pressure monitoring was performed at the end of each treatment period. Results. Isonatremic and hyponatremic dialysate were associated with significantly lower pre- and post-dialysis blood pressure as compared to baseline 140 mEq/L dialysate (predialysis 148.3 ± 24.7/67.7 ± 12.0 and 144.4 ± 16.5/68.8 ± 13.3 vs. 158.0 ± 18.3/75.6 ± 11.4 mmHg, resp p = 0.04 and 0.007 for systolic and p = 0.004 and 0.04 for diastolic blood pressure;postdialysis 154.2 ± 25.5/76.6 ± 14.1 and 142.5 ± 20.7/73.0 ± 12.9 vs. 159.1 ± 21.6/80.3 ± 12.1 mmHg, resp NS and p = 0.01 for systolic and NS and p = 0.04 for diastolic blood pressure). Postdialysis and 24 h systolic blood pressure tended to be lower with hyponatremic compared to isonatremic dialysate. Conclusion. Individually tailoring dialysate sodium concentration, based on the sodium set-point of each patient, resulted in a lower pre- and post-dialysis blood pressure in patients with intradialytic hypertension. 24 h blood pressure values tended to be lower as well with hyponatremic dialysate.

关键词： Intradialytic Hypertension Ambulatory Blood Pressure Monitoring Dialysate Sodium Concentration

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The Diagnostic and Therapeutic Challenges of Fabry Nephropathy—A Review of the Literature, Illustrated by a Clinical Case

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Open Journal of Nephrology 2023年第4期13卷 349-368页

作者： Stefan Van Cauwelaert Caroline Geers Dominique Vandervelde Esther Scheirlynck Alexander Gheldof karl-martin wissing Department of Nephrology and Arterial Hypertension Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium Department of Pathology Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium Department of Nephrology H&ocircpitaux Iris-Sud (HIS) Brussels Belgium Department of Cardiology Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium Department of Medical Genetics Universitair Ziekenhuis Brussel (UZ Brussel) Vrije Universiteit Brussel (VUB) Brussels Belgium

Fabry Disease (FD) is a rare lysosomal storage disorder characterized by α-galactosidase A (α-Gal A) enzyme deficiency, resulting in glycosphingolipid accumulation. Its clinical spectrum ranges from severe classical to milder nonclassical or late-onset phenotypes. Renal involvement, termed Fabry Nephropathy (FN), can vary from mild proteinuria to kidney failure. FN diagnosis, especially in nonclassical cases with a genetic Variant of Unknown Significance (VUS) in the GLA gene, poses challenges. Measurement of plasma lyso-Gb3 levels is gaining importance in FN diagnosis, while renal biopsy with electron microscopy remains the gold standard in equivocal cases. Treatment options include Enzyme Replacement Therapy (ERT) and chaperone therapy, demanding careful candidate selection due to high treatment costs. Research has predominantly focused on classical FD, revealing modest treatment benefits. However, evidence for treating patients, especially females, with milder nonclassical or late-onset phenotypes is scarce, emphasizing the necessity for placebo-controlled clinical trials in these subgroups. Meanwhile, participation in global FD registries can improve our understanding of disease management. Case Presentation: A woman in her late sixties presented with moderate chronic kidney disease, mild proteinuria, and microscopic hematuria. Her family history included a prevalence of renal, cardiac and cerebrovascular diseases. Kidney biopsy revealed characteristic myelin figures and zebra bodies in podocytes, strongly suggestive of FN. Genetic analysis identified a VUS in the GLA gene (c.655A > C, ***219Leu), introducing diagnostic uncertainty. Further investigations revealed severe cardiac involvement. Considering the recurring difficulty presented by the finding of a VUS in the GLA gene during FN assessments, along with the uncertainty regarding the need for treatment in nonclassical or late-onset FD phenotypes, especially in women, this case becomes a central focus for

关键词： Fabry Disease Fabry Nephropathy Variants of Unknown Significance Diagnosis Treatment Selection Lysosomal Storage Disorder α-Galactosidase A Glycosphingolipid Accumulation Enzyme Replacement Therapy Migalastat

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The Diagnostic and Therapeutic Challenges of Fabry Nephropathy—A Review of the Literature, Illustrated by a Clinical Case

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Open Journal of Nephrology（肾脏病） 2023年第4期

作者： Stefan Van Cauwelaert Caroline Geers Dominique Vandervelde Esther Scheirlynck Alexander Gheldof karl-martin wissing

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园林绿化中的雨水管理

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技术与市场（园林工程） 2005年第3期 24-26页

作者： Nico wissing 欧洲园林建设协会(ELCA)

一、合理的设计方式主要围绕雨水利用这一思想进行设计.例如可以建造开放的引水渠,引导雨水流向,排出多余的水分(图一).而如今,愈演愈烈的洪水灾害,究其原因之一就是因为没有对雨水进行适当的疏通.

关键词：园林绿化雨水管理设计方式景观建设美学价值屋顶花园

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胎儿期有轻、中度肾盂扩张婴儿的远期临床结果:新生儿明显泌尿系统疾病的超声筛查

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世界核心医学期刊文摘（儿科学分册） 2005年第4期1卷 40-41页

作者： Ismaili K. Avni F. E. wissing K. M. Hall M. 贺莉 Hop. Univ. des Enf. -Reine Fabiola Dept. Perinatal Pediat. Nephrology 15 Avenue J. J. CROCQ 1020 Brussels Belgium

目的:评价胎儿期有轻、中度肾盂扩展的婴儿的远期结果,并且确定新生儿超声检查在识别明显的泌尿系统疾病的预测价值。试验设计:这是一个前瞻性研究。对213例出生前有轻、中度肾盂扩张的婴幼儿随访至2岁。在出生后5d、1月、3月、6月、1年... 详细信息

目的:评价胎儿期有轻、中度肾盂扩展的婴儿的远期结果,并且确定新生儿超声检查在识别明显的泌尿系统疾病的预测价值。试验设计:这是一个前瞻性研究。对213例出生前有轻、中度肾盂扩张的婴幼儿随访至2岁。在出生后5d、1月、3月、6月、1年和2年做肾脏超声检查。所有婴幼儿均接近膀胱尿道造影剂拍片检查。结果:213例中,130例(61%)

关键词：肾盂扩张胎儿期超声筛查泌尿系统疾病出生后膀胱尿道造影剂出生前 neonatal 超声检查

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