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Diaz-Garcia J.D.,National Polytechnic Institute of Mexico | Gallegos-Villalobos A.,IIS Fundacion Jimenez Diaz. UAM | Gonzalez-Espinoza L.,IIS Fundacion Jimenez Diaz. UAM | Sanchez-Nino M.D.,IdiPAZ | Villarrubia J.,Hospital Ramon y Cajal
Nature Reviews Nephrology

In 2005, the oral iron chelator deferasirox was approved by the FDA for clinical use as a first-line therapy for blood-transfusion-related iron overload. Nephrotoxicity is the most serious and frequent adverse effect of deferasirox treatment. This nephrotoxicity can present as an acute or chronic decrease in glomerular filtration rate (GFR). Features of proximal tubular dysfunction might also be present. In clinical trials and observational studies, GFR is decreased in 30-100% of patients treated with deferasirox, depending on dose, method of assessment and population studied. Nephrotoxicity is usually nonprogressive and/or reversible and rapid iron depletion is one of several risk factors. Scarce data are available on the molecular mechanisms of nephrotoxicity and the reasons for the specific proximal tubular sensitivity to the drug. Although deferasirox promotes apoptosis of cultured proximal tubular cells, the trigger has not been well characterized. Observational studies are required to track current trends in deferasirox prescription, assess the epidemiology of deferasirox nephrotoxicity in routine clinical practice, explore the effect on outcomes of various monitoring and dose-adjustment protocols and elucidate the long-term consequences of the different features of nephrotoxicity. Deferasirox nephrotoxicity can be more common in the elderly; thus, specific efforts should be dedicated to investigate the effect of deferasirox use in this group of patients. © 2014 Macmillan Publishers Limited. All rights reserved. Source

Gracia-Iguacel C.,IIS Fundacion Jimenez Diaz | Gonzalez-Parra E.,IIS Fundacion Jimenez Diaz | Gonzalez-Parra E.,Autonomous University of Madrid | Rodriguez-Osorio L.,IIS Fundacion Jimenez Diaz | And 8 more authors.
Journal of Bone and Mineral Metabolism

Both parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) are phosphaturic hormones. These hormones should increase in response to phosphate excess. However, they also regulate serum calcium; PTH increases serum calcium concentration and FGF23 suppresses renal production of calcitriol, favoring hypocalcemia. We report the case of an 83-year-old woman with hyperphosphatemia and hypocalcemia resulting from phosphate-containing enemas. PTH and calcitriol increased in response to hypocalcemia, and FGF23 increased in response to hyperphosphatemia. Unexpectedly, peak FGF23 did not coincide with peak serum phosphate. Rather, peak FG23 was observed only after severe hypocalcemia was partially corrected with exogenous calcium administration, even though serum phosphate had been already decreasing for 32 h. Correction of severe hypocalcemia was thus associated with peak FGF23 values and with a precipitous decrease in PTH. Peak FGF23 was followed by an accelerated decrease in serum phosphate and significant phosphaturia. This clinical report is consistent with experimental data in rats showing a blunted FGF23 response to high phosphate in the presence of severe hypocalcemia. Thus, complementary experimental and clinical data suggest that partial correction of severe hypocalcemia is required for optimal FGF23-mediated phosphaturia, which takes place despite correction of PTH levels. We believe this the first human report suggesting blunting of the FGF23 response to high phosphate by severe hypocalcemia. © 2013 The Japanese Society for Bone and Mineral Research and Springer Japan. Source

Elewa U.,IIS Fundacion Jimenez Diaz UAM FRIAT | Sanchez-Nino M.D.,IdiPAZ | Martin-Cleary C.,IIS Fundacion Jimenez Diaz UAM FRIAT | Fernandez-Fernandez B.,IIS Fundacion Jimenez Diaz UAM FRIAT | And 2 more authors.
International Urology and Nephrology

End-stage renal disease patients suffer a syndrome of accelerated aging characterized by a 10- to 100-fold increase in cardiovascular and all-cause mortality when compared to age-matched controls. No specific therapeutic interventions have been shown to improve this dismal outcome. Inflammation, chronic kidney disease-mineral and bone disorder (CKD-MBD) and other biomarkers predict outcome in observational studies. However, we lack clinical trials that address the role of these biomarkers in risk stratification and therapeutic decision making. Biomarkers may also provide insights into the pathophysiology of disease and identify novel therapeutic targets. Inflammation emerges as a prime potential target for intervention. Thus, CKD-MBD biomarkers, asymmetrical dimethyl arginine and tri-iodothyronine have a link to inflammation. Interleukin-6 (IL-6) is one of the inflammation biomarkers with highest predictive value for outcome in ESRD. Biologicals targeting IL-6 are approved for the treatment of chronic inflammatory conditions such as rheumatoid arthritis. Furthermore, trials are underway to test IL-6 targeting potential to decrease cardiovascular injury in non-CKD patients. In this regard, targeting IL-1 was recently shown to decrease systemic inflammation in hemodialysis patients. The success of these trials will likely influence future studies on biomarker targeting in CKD. © 2012 Springer Science+Business Media, B.V. Source

Sanchez-Nino M.D.,IdiPAZ | Ortiz A.,REDINREN | Ortiz A.,Autonomous University of Madrid
Nephrology Dialysis Transplantation

Systemic lupus erythematosus (SLE) is characterized by autoantibodies that mediate tissue injury. However, the pathogenesis of SLE remains poorly understood and available therapeutic approaches are not fully satisfactory. Belimumab, a monoclonal antibody that neutralizes B-cell activating factor (BAFF), was the first drug approved to treat SLE in more than 50 years. However, it is not labelled for use in severe lupus nephritis. Recently, a novel high-throughput multiplex protein microarray platform to profile circulating immunoglobulin G (IgG) autoantibodies in SLE patients identified IgG autoantibodies against several cytokines and growth factors at higher titres in SLE patients than in controls. The presence of autoantibodies to BAFF was validated in a subset of SLE patients by enzyme-linked immunosorbent assay. Low levels of anti-BAFF autoantibodies were also present in healthy controls. The association of anti-BAFF reactivity to clinical features and response to therapy was not addressed. However, preliminary data suggested an association to an interferon- responsive mRNA signature, itself associated with severity. Functional studies disclosed a neutralizing activity of autoantibodies against BAFF. These findings raise new questions regarding the role of BAFF in SLE and the functional and therapeutic significance of anti-BAFF and anti-cytokine autoantibodies. © The Author 2014. Source

Sanchez-Nino M.D.,IdiPAZ | Ruiz-Ortega M.,Autonomous University of Madrid | Egido J.,Autonomous University of Madrid | Ortiz A.,Autonomous University of Madrid
International Urology and Nephrology

Unilateral ureteral obstruction is a popular experimental model of renal injury. However, the study of the kidney response to urinary tract obstruction is only one of several advantages of this model. Unilateral ureteral obstruction causes subacute renal injury characterized by tubular cell injury, interstitial inflammation and fibrosis. For this reason, it serves as a model both of irreversible acute kidney injury and of events taking place during human chronic kidney disease. Being a unilateral disease, it is not useful to study changes in global kidney function, but has the advantage of a low mortality and the availability of an internal control (the non-obstructed kidney). Experimental unilateral ureteral obstruction has illustrated the molecular mechanisms of apoptosis, inflammation and fibrosis, all three key processes in kidney injury of any cause, thus providing information beyond obstruction. Recently this model has supported key concepts on the role in kidney fibrosis of epithelial-mesenchymal transition, tubular epithelial cell G2/M arrest, the anti-Aging hormone Klotho and renal innervation. We now review the experimental model and its contribution to identifying novel therapeutic targets in kidney injury and fibrosis, independently of the noxa. © 2013 Springer Science+Business Media Dordrecht. Source

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