No abstract

The records of 151 patients receiving long-term dialysis for an average of 66 months were reviewed to determine the incidence of malignancy. Nine cancers were found among 148 male patients. 8 of these 9 patients were smokers. This finding is significantly higher than expected (3.6 cases, p < 0.0137) for exposure-specific and age-specific controls of the same sex.

Chronic kidney disease is common after hematopoietic cell transplant. We prospectively measured urinary albumin to creatinine ratios (ACR) in 142 patients. Total (intact) monomeric albumin was determined by liquid chromatography of untreated urine samples collected weekly to day 100 after transplant. Albuminuria was defined as ACR (mg/g creatinine) >30 and proteinuria as ACR >300. Cox and logistic regressions analyses evaluated ACR as a risk factor for clinical events. The prevalence of albuminuria at baseline, day 100 and 1 year was 37%, 64% and 50%, respectively. Proteinuria occurred in 4% of patients at baseline, 15% at day 100 and 4% at 1 year. Characteristics associated with albuminuria include age, gender, donor type, hypertension and sinusoidal obstruction syndrome. Albuminuria was associated with an increased risk of acute GVHD and bacteremia, but not acute kidney injury. Albuminuria at day 100 was associated with chronic kidney disease at 1 year (OR= 4.0; 95%CI 1.1–14.6). Non-relapse mortality risk was elevated (HR=6.8; 95%CI 1.1–41.5) among patients with overt proteinuria at day 100. Albuminuria occurs frequently after HCT and correlates with acute GVHD, bacteremia, hypertension and progression of renal disease. Proteinuria at day 100 is associated with an 6-fold increased risk of non-relapse mortality by one year post transplant.

Intracellular free (cytosolic) calcium has been reported to be increased in the platelets of patients with essential hypertension. We investigated the possibility that the high cytosolic calcium concentration may be caused by a circulating plasma factor, by incubating platelets from normotensive subjects with plasma ultrafiltrates from patients with essential hypertension. The cytosolic calcium concentration in normal platelets increased after incubation with plasma from patients with untreated hypertension (80 +/- 15 percent [+/- SEM]) or from patients in whom hypertension was well controlled by calcium-influx blockers (129 +/- 33 percent). In contrast, the cytosolic calcium concentration was unchanged after incubation with plasma from normotensive subjects. When platelets from the patients were incubated with plasma from the controls, cytosolic calcium in platelets decreased by more than 30 percent, into the normal range (P less than 0.01). These data demonstrate that plasma from patients with essential hypertension contains a substance that increases the cytosolic calcium concentration in platelets. Cytosolic calcium is a trigger for vascular smooth-muscle-cell contraction, and if the plasma factor acts on these cells as it acts on platelets, it may be responsible for the increased peripheral vascular resistance associated with hypertension.