Patients with endocarditis may have various forms of renal impairment; the most commonly encountered being bacterial infection-associated glomerulonephritis and renal infarction by septic emboli.

This is the case of a 68-years-old patient who presented with acute left upper limb ischemia and right lumbar pain. The history revealed acute rheumatic fever in childhood with cardiac involvement (mitral and aortic valve disease, permanent atrial fibrillation), chronic kidney disease and multiple episodes of acute right upper limb ischemia (despite adequate oral anticoagulation) treated conservatively. Thromboendarterectomy was performed in the vascular surgery department. Afterwards the patient was transferred to the nephrology department due to the suspicion of renal infarction. The raising creatinine indicated an acute kidney injury on top of the chronic kidney disease. Transesophageal echocardiography identified images suggestive of vegetation on mitral and aortic valves, spontaneous contrast in the left atrium but without intracavitary thrombosis, fissured atheromatous plaque on the ascending thoracic aorta. As possible causes of renal impairment were considered: renal infarction by thromboemboli originating in the left atrium or by septic emboli from valve vegetation, endocarditis-associated Glomerulonephritis and renal atheroembolism. Renal scintigraphy provided no useful information. Computed tomography without contrast did not reveal areas of renal infarction. The patient refused both Computed tomography angiography (for fear of contrast nephrotoxicity) and valve replacement surgery. Clinical evolution was stationary under antibiotherapy (for endocarditis), high dose statin, besides the previously prescribed treatment with oral anticoagulants, beta blockers, angiotensin converting enzyme inhibitors, dihydropyridine, calcium channel blockers digitalis.

Human podocytes (hPC) are crucial for renal structural integrity and function. Loss of hPC plays an important role in pathogenesis of various renal disorders. Bisphenol A (BPA) is widely used in various everyday goods. Due to its potential cytotoxic activities, especially in the cardio-renal system, alternatives were used for “BPA-free” manufacturing, such as bisphenol S (BPS).Similar to BPA, BPS exhibits estrogenic activities and was suggested to induce cardiotoxic effects. In contrast to BPA, the renal impact of BPS is unknown so far. Here, we performed a comparative analysis of the effects of BPS and BPA on hPC viability and protein expression.

Functional assays were used for cell viability measurement and expression was characterized via real-time PCR and Western blotting in hPC. We found that BPA and BPS (0.01 µM - 1000 µM) differentially affect hPC viability as well as expression of nephrin, protein kinase B, podoplanin and nuclear factor ‘kappa-light-chainenhancer’ of activated B - cells p65 subunit RelA in renal cells in a dose-dependent manner. Inhibition of protein kinase B, RelA, or podoplanin, respectively, were also shown to reduce hPC viability. Moreover, 10 µM BPA but not BPS, induced interleukin-1 beta and Bcl-2-associated death promoter expression in hPC. Here, we provide first novel findings about potential cytotoxic effects of BPS on renal cells. Moreover, we show that BPA’s nephrotoxic impact on hPC viability and protein expressions were much stronger than that of BPS in this study.

A well-functioning Arteriovenous Fistula (AVF) has been shown to be the best modality for vascular access in patients with End-Stage Renal Disease (ESRD) that require haemodialysis (HD). A mature AVF has lower incidence of thrombosis and stenosis compared to the other two modalities; Arteriovenous Grafts (AVGs) and Central Venous Catheters (CVCs). That translates into prolonged patency rates and lower risk for infection. However, it has been reported that around 20% - 50% of fistulae fail to mature into a useable access for haemodialysis. Non-maturation remains a major concern with as many as one third of first time created fistulae expected to fail. Intimal hyperplasia induced by altered biomechanical forces plays an integral role in stenosis within an AVF. The aim of this review is to give an analysis of the factors implicated in the process of AVF maturation.

Arteries of end-stage renal disease patients are characterized by accelerated atherosclerosis and chronically progressive arterial stiffening. The acute effects of hemodialysis sessions on arterial properties have been less intensively studied, with contradictory results. The aim of this study was therefore to assess arterial properties throughout a hemodialysis session and to compare patients dialyzed at stable body weight with those undergoing ultrafiltration.

We measured Cartoid-Radial (CR) and Carotid-Femoral (CF) Pulse wave velocity (PWV) and the central systolic augmentation index corrected for heart rate (AIx) in 13 hemodialysis patients undergoing Ultrafiltration (UF) and 8 patients dialyzed at Stable Body Weight (SW).

No significant differences were noted between the groups for AIx, PWV and their changes. When the arterial properties of both groups were analyzed together, median cr-PWV increased slightly (from 8.6 [8.0-9.4] before to 9.8 m/sec [8.7-10.7] after hemodialysis, p=0.09), cf-PWV did not change (from 10.3 [8.8-13.1] to 10.1 m/sec [9.4- 14.4], p=0.7) and AIx decreased significantly (from 28 [20.3-35] to 24.3% [19.3-31.3], p=0.02). However, large individual fluctuations occurred in arterial properties throughout hemodialysis in each group. Independently of ultrafiltration, important changes in arterial wall properties occur during hemodialysis, which may partly account for the heterogeneous hemodynamic responses observed during dialysis sessions.

Purpose: The objective of this review is to evaluate the role of calcifediol among the currently available vitamin D products in treating secondary hyperparathyroidism in chronic kidney disease. Calcifediol studies in healthy patients will also be reviewed.

Methods: A literature search was performed in the PubMed database using the search terms calcifediol, 25-hydroxyvitamin D3, and 25D3. Limits were set to include clinical trials phases I-IV, controlled clinical trials, randomized controlled trials, or comparative studies in human subjects in the English language within the past 5 years. Studies were included if calcifediol was compared to cholecalciferol in terms of their ability to increase vitamin D serum concentrations.

Findings: Four studies met the inclusion criteria above and were included in this review. Calcifediol has been shown to replete vitamin D stores more rapidly than cholecalciferol. Calcifediol has also been found to decrease serum concentrations of intact parathyroid hormones in patients with secondary hyperparathyroidism in chronic kidney disease.

Implications: Calcifediol is a new vitamin D receptor activator that can be used in chronic kidney disease patients not on dialysis for rapid correction of serum vitamin D concentrations. Further studies are necessary to examine its effectiveness and role in therapy compared to other agents in this class.