Publications by authors named "Alexander Kirsch"

Article Synopsis
  • * The main issue resulting from vitamin D toxicity is hypercalcemia, which can be difficult to treat and can stem from various causes, including genetic mutations and excessive intake.
  • * The manuscript discusses possible treatments for vitamin D toxicity, highlighting the use of systemic corticosteroids as effective after traditional methods fail, as well as alternative options that could limit steroid side effects.
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Vancomycin is a widely used glycopeptide antibiotic with the need for therapeutic drug monitoring to avoid renal toxicity. We report a case of severe vancomycin-associated anuric acute kidney injury managed with successful drug-removal by hemodialysis (HD) using different types of dialyzers. Medium cut-off (MCO) and high-flux dialyzers were effective in drug removal.

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  • Cytomegalovirus (CMV) infection negatively impacts kidney transplant success, with risks influenced by the serostatus of both the donor and recipient.
  • CD8 T cells are essential for controlling CMV, and this study examined changes in these cells and CMV occurrence in 65 kidney transplant patients over one year.
  • Findings showed that intermediate risk recipients were more likely to develop CMV, and pre-transplant levels of a specific CD8 T cell subset (FoxP3CD25) could help predict who might get infected after the transplant.
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  • Vaccination hesitancy among patients on chronic hemodialysis has increased during the COVID-19 pandemic, highlighting the need for strategies to address concerns and improve vaccination rates.
  • A study involving 347 hemodialysis patients in Austria found that older patients preferred information from dialysis physicians, while younger patients were more likely to rely on online sources for vaccine information.
  • Although 86% of patients expressed a desire to complete vaccinations, only 39% felt adequately informed about the vaccination plan, indicating a significant gap in knowledge that needs to be addressed.
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  • Over the last few decades, strategies have been developed to improve the removal of retained molecules in patients with kidney failure, helping them tolerate fluid removal better and live longer.
  • The effectiveness of these treatments depends on how individual patient factors interact with the characteristics of the devices used and the treatment plans prescribed.
  • This article reviews various blood purification techniques, highlighting their unique features and how they aim to enhance patient care in nephrology.
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  • Carbohydrate-deficient transferrin (CDT) and the Anttila-Index are biomarkers that may indicate heavy alcohol use and could predict delirium and mortality in critically ill patients.
  • In a study of 343 ICU patients, 35% experienced delirium, with those affected showing significantly higher levels of CDT and Anttila-Index upon admission.
  • Higher CDT and Anttila-Index levels were linked to both the occurrence of delirium and longer duration of delirium, as well as increased hospital mortality risk.
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Introduction: Although adherence to immunosuppressive medication is the key factor for long-term graft survival today, 20-70% of transplant recipients are non-adherent to their immunosuppressive medication.

Objective: A prospective, randomized, controlled single-center feasibility study was designed to evaluate the impact of a step guided multicomponent interprofessional intervention program for patients after kidney or liver transplantation on adherence to their immunosuppressive medication in daily clinical practice.

Materials And Methods: The intervention consisted of group therapy and daily training as well as individual sessions in a step guided approach.

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Coronavirus disease 2019 (COVID-19)-induced metabolic alterations have been proposed as a source for prognostic biomarkers and may harbor potential for therapeutic exploitation. However, the metabolic impact of COVID-19 in hemodialysis (HD), a setting of profound a priori alterations, remains unstudied. To evaluate potential COVID-19 biomarkers in end-stage kidney disease (CKD G5), we analyzed the plasma metabolites in different COVID-19 stages in patients with or without HD.

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Rapid progressive glomerulonephritis (GN) often leads to end-stage kidney disease, driving the need for renal replacement therapy and posing a global health burden. Low-dose cytokine-based immunotherapies provide a new strategy to treat GN. IL-15 is a strong candidate for the therapy of immune-mediated kidney disease since it has proven to be tubular-protective before.

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We report a case of a patient double-seropositive for anti-glomerular basement membrane (anti-GBM) and anti-neutrophil cytoplasmic antibodies (ANCA) who reported retrosternal chest pain during a regular hemodialysis session associated with ST-segment depression in electrocardiogram and an increase of serum high-sensitivity troponin T. Urgent coronary angiography excluded obstructive coronary artery disease, suggesting the diagnosis of ischemia with non-obstructive coronary arteries. This case illustrates an unusual presentation of cardiovascular involvement in a patient with double-positive ANCA/anti-GBM disease, emphasizing the possible relevance of coronary microvascular dysfunction and the need for close cardiovascular follow-up in this patient population.

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Background: Hyperkalemia is a common complication in cardiorenal patients treated with agents interfering with renal potassium (K+) excretion. It frequently leads to discontinuation of potentially life-saving medication, which has increased the importance of K+ monitoring. Non-invasive means to detect hyperkalemia are currently unavailable, but would be of potential use for therapy guidance.

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Article Synopsis
  • Hemodialysis (HD) patients may experience similar or lower mortality rates than non-HD patients when hospitalized with COVID-19, potentially due to their unique immune responses shaped by chronic inflammation.
  • A study involving 64 COVID-19 patients (31 HD, 33 non-HD) found that certain immune markers, like Th1 and Th17 cytokine levels, behaved differently in HD patients compared to non-HD patients during the disease.
  • The data suggests that HD patients have a distinct immune profile, with increased memory T cells, which may help them avoid severe symptoms of COVID-19 despite their underlying health issues.
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Background: The number of dialysis patients is steadily increasing. Associated comorbidities include impaired bone and mineral metabolism, termed chronic kidney disease-mineral and bone disorder (CKD-MBD), leading to a high fracture risk, increased morbidity and mortality and impaired quality of life. While the bone density is assessed with dual-energy X‑ray absorptiometry (DXA), the trabecular bone score (TBS) captures the image texture as a potential index of skeletal microarchitecture.

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Background: The COVID-19 pandemic has major implications on kidney transplant recipients (KTRs) since they show increased mortality due to impaired immune responses to SARS-CoV-2 infection and a reduced efficacy of SARS-CoV-2 vaccination. Surprisingly, dialysis patients have shown superior seroconversion rates after vaccination compared to KTRs. Therefore, we investigated peripheral blood B cell (BC) composition before and after kidney transplantation (KT) and aimed to screen the BC compartment to explain impaired antibody generation.

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Co-stimulation is a prerequisite for pathogenic activity in T cell-mediated diseases and has been demonstrated to achieve tolerance in organ-specific autoimmunity as a therapeutic target. Here, we evaluated the involvement of the tumor necrosis factor family members CD30 and OX40 in immune-complex mediated kidney disease. In vitro stimulation and proliferation studies were performed with CD4 cells from wild type and CD30/OX40 double knock-out (CD30OX40) mice.

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