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Finally, Some Reason for Hope in Proteinuric Kidney Disease

Open Journal of Nephrology 2022年第3期12卷 241-248页

作者： Devin Teehan Christopher Tyburski Geoffrey Teehan lankenau medical center Wynnewood USA

Background: After years of predictable outcomes with limited tools to combat the ravages of proteinuric chronic kidney disease (CKD) associated with or without diabetes, exciting new options are available to slow the progression of CKD. Purpose: Focusing on sodium-glucose co-transporter 2 inhibitors (SGLT2), angiotensin receptor blockers (ARB), angiotensin converting enzyme inhibitors (ACE I), and new mineralocorticoid antagonists (MRA), this review examines how these agents compliment the standard of care in an attempt to educate and stimulate broader use of these agents. Methods: Using the search terms “mineralocorticoid antagonist, sodium glucose co-transporter 2 inhibitors, proteinuria, albuminuria, and diabetic kidney disease,” five randomized controlled clinical trials were identified and then analyzed in the context of the results found from the Irbesartan Diabetic Nephropathy Trial (IDNT). Two trials using SGLT2 and 2 using MRA were reviewed. Results: In the 2 SGLT2 trials renal outcomes were reduced by 30% - 39% among patients with estimated GFR ranging from roughly 25 - 90 mL/min. In the 2 MRA trials, renal outcomes fell by 13% - 18% among patients with estimated GFR ranging from 25 - 90 mL/min. In the IDNT, renal outcomes fell by 19%. Trial duration ranged from 28 - 41 months, and in all trials, the IDNT, Ace inhibitors (ACE I) and ARBs use was uniform. There is small overlap in the 5 trials in which both MRA and SGLT2 agents were used. Conclusions: Over a wide range of renal function, both MRA and SGLT2 inhibitors demonstrate outstanding efficacy in diabetic and non-diabetic (SGLT2) proteinuric kidney disease. Compared to the prior standard of care, these agents dramatically improve outcomes.

关键词： Chronic Kidney Disease Sodium-Glucose Co-Transporter 2 Inhibitors Mineralocorticoid Agonists Angiotensin Receptor Blockers Angiotensin Converting Enzyme Inhibitors

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Does Anemia Cause QT Prolongation in Patients wit Hematologic Disorders？

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Chinese medical Journal 2015年第24期128卷 3385-3386页

作者： Yu-Dong Fei Yi-Gang Li William Surkis Li Zhang Department of Cardiology Xinhua Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200092 China lankenau medical center Lankenau Institute for Medical Research Sydney Kimmel Medical College at Thomas Jefferson University Philadelphia PA USA

To the Editor： Patients with long QT syndrome have an increased risk of torsades de pointes, ventricular fibrillation, and sudden death. It has been reported in recent studies that sickle cell disease, a specific type of anemia, is associated with acquired long QT syndrome （ALQTS）, and reduced hemoglobin （Hgb） level is correlated with a longer QT interval in these patients.

关键词： QT syndrome increased risk Hematologic Disorders

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Correlation between Fibroscan and laboratory tests in non-alcoholic fatty liver disease/non-alcoholic steatohepatitis patients for assessing liver fibrosis

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World Journal of Hepatology 2022年第4期14卷 744-753页

作者： Layal Al Nanaf Mohammed Hussein Kamareddine Emilie Fayad Aniqa Hussain Said Farhat Department of Radiological Science American University of Science and TechnologyFaculty of Health SciencesBeirut 1100Lebanon Department of Internal Medicine Lankenau Medical CenterPhiladelphiaPA 19131United States Department of Radiology Saint George Hospital University Medical CenterBeirut 1100Lebanon Faculty of Medicine University of New South WalesSydney 2052Australia Department of Gastroenterology Saint George Hospital University Medical CenterBeirut 1100Lebanon

BACKGROUND Non-alcoholic fatty liver disease(NAFLD) is a spectrum of disease ranging from simple steatosis to non-alcoholic steatohepatitis(NASH), through to advanced fibrosis and cirrhosis. Many patients with NAFLD remain undiagnosed and recognizing those at risk is very crucial. Although liver biopsy is the gold standard method for diagnosing and staging NAFLD, non-invasive imaging and lab modalities are also very promising in diagnosing these *** To explore some of these non-invasive modalities in this context and assess how they hold up in terms of making a diagnosis while avoiding an invasive procedure like a liver *** This study was conducted on NAFLD/NASH patients(n = 73) who underwent Fibroscan examinations at Saint George Hospital University medical center over 17 mo in order to assess liver fibrosis. Obtained Fibroscan results were correlated to laboratory tests and calculated aspartate transaminase(AST)/alanine transaminase(ALT) ratio, AST platelet ratio index(APRI) score and Fibrosis-4 *** A significant age difference was observed across fibrosis stages of investigated patients. The mean stiffness score was 9.48 ± 11.77 KPa. A significant negative correlation was observed between ALT, AST, Albumin, gamma-glutamyl transferase, cholesterol, LDL, HDL, triglycerides, and ALP when compared across fibrosis stages. On the other hand, a significant positive correlation was found between Bilirubin, PT INR, partial thromboplastin time, glucose, and Platelet count when compared across fibrosis stages, in addition to AST/ALT ratio, APRI, and Fib-4 *** This study showed that Ultrasound alone is not efficient in the assessment of advancement of liver disease. Furthermore, the high positive relation between AST/ALT ratio, APRI and Fib-4 scores with fibrosis stages in NAFLD patients suggests that they could be used clinically in combination with Fibroscan to predict significant fibrosis and cirrhosis and to avoid liver biopsy.

关键词： Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Fibroscan Cirrhosis Hepatology

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J Wave Syndromes： A Decade of Progress

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Chinese medical Journal 2015年第7期128卷 969-975页

作者： Guo-Liang Li Lin Yang Chang-Cong Cui Chao-Feng Sun Gan-Xin Yan Department of Cardiovascular Medicine The First Affiliated Hospital Xi'an Jiaotong University College of Medicine Xi'an Shaanxi 710061 China Department of Cardiovascular Medicine Lankenau Medical Center and Lankenau Institute of Medical Research PA USA Department of Cardiovascular Medicine Jefferson Medical College of Thomas Jefferson University PA USA

Objective： The objective was to provide a brief history of J wave molecular, ionic, cellular mechanisms, and clinical features. We will clinical research for J wave syndromes. syndromes and to summarize our current understanding of their also discuss the existing debates and further direction in basic and Data Sources： The publications on key words of＂J wave syndromes＂, ＂early repolarization syndrome （ERS）＂, ＂Brugada syndrome （BrS）＂ and ＂ST-segment elevation myocardial infarction （STEMI）＂ were comprehensively reviewed through search of the PubMed literatures without restriction on the publication date. Study Selection： Original articles, reviews and other literatures concerning J wave syndromes, ERS, BrS and STEMI were selected. Results： J wave syndromes were firstly defined by Yah et al. in a Chinese journal a decade ago, which represent a spectrum of variable phenotypes characterized by appearance of prominent electrocardiographic J wave including ERS, BrS and ventricular fibrillation （VF） associated with hypothermia and acute STEMI. J wave syndromes can be inherited or acquired and are mechanistically linked to amplification of the transient outward current （I ）-mediated J waves that can lead to phase 2 reentry capable of initiating VF. Conclusions： J wave syndromes are a group of newly highlighted clinical entities that share similar molecular, ionic and cellular mechanism and marked by amplified J wave on the electrocardiogram and a risk of VF. The clinical challenge ahead is to identify the patients with J wave syndromes who are at risk for sudden cardiac death and determine the alternative therapeutic strategies to reduce mortality.

关键词： Brugada Syndrome Early Repolarization Syndrome J Wave Syndromes ST-Segment Elevation Myocardial Infarction Transient Outward Potassium Current

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Pharmacological Adjuvants to Limit Erythropoietin Stimulating Agents Exposure

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Open Journal of Nephrology 2012年第4期2卷 86-96页

作者： Iqbal Masood Geoffrey Teehan Department of Nephrology Lankenau Medical Center and Lankenau Institute for Medical Research Wynnewood USA

Anemia in chronic kidney disease (CKD) is common, causing morbidity and mortality, and is primarily due to reduced erythropoietin (EPO) release and, to a lesser degree, shortened red cell survival. Erythropoietin Stimulating Agents like epoetin Alfa and darbepoetin alpha are used commonly to treat this form of anemia. Recent evidence suggests increased morbidity and mortality associated with higher hemoglobin in the setting of these agents use. Whether these complications are due to higher dose of erythropoietin or its resistance (i.e. inflammation), or achieving a higher hemoglobin remains unclear. Tightening restrictions on these agents has led to increase interest in the use of non-ESA adjuvants to improve erythropoiesis. This review will highlight the most promising of these agents.

关键词： Anemia Chronic Kidney Disease (CKD) End Stage Renal Disease (ESRD) Erythropoiesis Stimulating Agents (ESA) Epoetin Alfa (EPO)

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Zinc and gastrointestinal disease

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World Journal of Gastrointestinal Pathophysiology 2014年第4期5卷 496-513页

作者： Sonja Skrovanek Katherine DiGuilio Robert Bailey William Huntington Ryan Urbas Barani Mayilvaganan Giancarlo Mercogliano James M Mullin lankenau Institute for medical Research Lankenau Medical CenterWynnewood PA 19096 United States Division of Gastroenterology Lankenau Medical Center Wynnewood PA 19096 United States The Department of Medicine Lankenau Medical Center Wynnewood PA 19096 United States

This review is a current summary of the role that both zinc deficiency and zinc supplementation can play in the etiology and therapy of a wide range of gastrointestinal diseases. The recent literature describing zinc action on gastrointestinal epithelial tight junctions and epithelial barrier function is described. Zinc enhancement of gastrointestinal epithelial barrier function may figure prominently in its potential therapeutic action in several gastrointestinal diseases.

关键词： Zinc Tight junction Nutrition Nutraceutical Micronutrient

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A Case of Type I Hepatorenal Syndrome Treated with Vasopressin

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Open Journal of Nephrology 2013年第3期3卷 135-138页

作者： Laura Connor Geoffrey Teehan Department of Internal Medicine Lankenau Medical Center Wynnewood USA Department of Nephrology Lankenau Medical Center Wynnewood USA

Hepatorenal syndrome (HRS) is a grave complication of end-stage liver disease and is associated with a very high mortality. This case report described a 42-year-old female with advanced alcohol-induced cirrhosis who developed HRS that was initially treated with Midodrine and Octreotide but renal function continued to deteriorate. Vasopressin therapy was added and HRS was successfully reversed. There are few data available on the use of vasopressin for HRS and this case supports its use in treatment of HRS, particularly in countries where the more widely studied Terlipressin is unavailable. This case also demonstrates that a patient failing one medical therapy for HRS may respond to an alternative or adjunctive therapy. Therefore, this should be attempted to increase the patient’s chance of survival.

关键词： Hepatorenal Syndrome Vasopressin

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Antihypertensive Therapy in Non-Diabetic Chronic Kidney Disease Associated with Proteinuria in Adults

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Open Journal of Nephrology 2013年第3期3卷 128-134页

作者： Khawar Maqsood Adeel Siddiqui Geoffrey Teehan Department of Medicine Baystate Medical Center Tufts University School of Medicine Springfield USA Department of Nephrology Lankenau Medical Center Lankenau Institute for Medical Research Wynnewood USA

Controlling blood pressure and reducing proteinuria are common goals in Chronic Kidney Disease associated with hypertension and proteinuria and lead to fewer cardiovascular outcomes. This review summarizes the availab... 详细信息

关键词： Hypertension Proteinuria Chronic Kidney Disease

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A Surviving Patient with Record High Creatinine

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Open Journal of Nephrology 2013年第4期3卷 217-219页

作者： Andrew C. Storm Naing L. Htike David A. Cohen Robert L. Benz Department of Internal Medicine Lankenau Medical Center Wynnewood USA Department of Internal Medicine The Johns Hopkins Hospital Baltimore USA Department of Nephrology Lankenau Medical Center Wynnewood USA Division Chief of Nephrology Lankenau Medical Center and Main Line Health and Lankenau Institute for Medical Research Wynnewood USA

Creatinine is a product of muscle protein breakdown cleared by the kidneys at a constant rate. The glomerular filtration rate is estimated based on serum creatinine. There is no definitive level of serum creatinine which is itself incompatible with human survival. We present the highest serum creatinine associated with survival based on a thorough review of the literature. A 34-year-old male patient with baseline serum creatinine of 1.2 mg/dl presented our emergency department with a six week history of new onset of uremic symptoms. His past medical history was unremarkable. On exam, he was in no distress. His BMI was 28. His exam was significant only for elevated blood pressure and asterixis. His peak serum creatinine was 53.9 mg/dl. The patient subsequently required maintenance hemodialysis and later changed to long-term peritoneal dialysis. To our knowledge, based on a thorough review of the literature using PubMed, Cochrane Database and the United States Renal Data System (USRDS), this is the highest level of serum creatinine ever reported. We conclude that serum creatinine itself is non-lethal. It is more likely that other electrolyte and retained metabolic abnormalities of renal failure frequently cause symptoms or death before creatinine toxicity, if such a level exists, creatinine has reached.

关键词： Survival Outcome Uremia Mortality Creatinine

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Primary adrenal Ewing sarcoma:A systematic review of the literature

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世界临床病例杂志 2023年第28期11卷 6782-6791页

作者： Dimitrios K Manatakis Ioannis Tsouknidas Emmanouil Mylonakis Nikolaos Tasis Maria Ioanna Antonopoulou Vasileios Acheimastos Aikaterini Mastoropoulou Dimitrios P Korkolis 2^(nd)Department of Surgery Athens Naval and Veterans HospitalAthens 11521Greece General Surgery Lankenau Medical CenterMain Line HealthWynnewoodPA 19096United States Department of Surgical Oncology St Savvas Cancer HospitalAthens 11522Greece Department of Surgery Naval Hospital of CreteChania 73200Greece Department of Pediatrics Stony Brook University HospitalStony BrookNY 11794United States

BACKGROUND Ewing sarcoma(ES)is a malignant neoplasm of neuroectodermal origin and is commonly observed in children and young *** musculoskeletal system is the main body system impacted and ES is rarely seen in the visceral organs particularly the adrenal *** To present a comprehensive review of primary adrenal ES,with emphasis on diagnosis,therapy and oncological *** A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses ***/MEDLINE,EMBASE and Google Scholar bibliographic databases were searched to identify articles from 1989 to 2022 and included patients with ES/primitive neuroectodermal tumor(PNET)of the adrenal ***,Google Scholar and EMBASE medical databases were searched,combining the terms“adrenal”,“ES”and“PNET”.Demographic,clinical,pathological and oncological data of patients were analyzed by SPSS version *** A total of 52 studies were included for review(47 case reports and 5 case series)with 66 patients reported to have primary adrenal *** age at diagnosis was 26.4±15.4 years(37.9%males,57.6%females,sex not reported in 3 cases).The most frequent complaint was abdominal/flank pain or discomfort(46.4%)followed by a palpable mass(25.0%),and the average duration of symptoms was 2.6±3.1 *** imaging modality of choice was computed tomography scan(81.5%),followed by magnetic resonance imaging(20.4%).Preoperative staging revealed that 17 tumors(27.9%)were metastatic and 14 patients had inferior vena cava or renal vein neoplastic thrombus at initial *** adrenalectomy was performed in the majority of cases(80.0%),of which 27.9%required more extensive *** invasive surgery was attempted in 8.2%of *** surgical resection was achieved in 89.4%of the *** therapy was administered to 32 patients,in the form of chemotherapy(62.5%),radiotherapy(3.1%)or combination(34.4%).Median overall s

关键词： Ewing sarcoma Primary adrenal tumor Adrenalectomy

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