David Tovbin | Technion - Israel Institute of Technology (original) (raw)

Papers by David Tovbin

Research paper thumbnail of Elevated Neutrophil Gelatinase Lipocalin Levels Are Associated With Increased Oxidative Stress in Hemodialysis Patients

Journal of Clinical Medicine Research, 2018

Background: Administration of intravenous iron is an essential treatment of anemia in hemodialysi... more Background: Administration of intravenous iron is an essential treatment of anemia in hemodialysis patients, but it may lead to oxidative stress and increased morbidity and mortality. There is evidence that neutrophil gelatinase-associated lipocalin (NGAL) is protective against oxidative stress and thus the aim of the present study was to investigate the relationship between plasma NGAL and advanced oxidative protein products (AOPP) in hemodialysis patients treated with intravenous iron. Methods: In a prospective study, 47 hemodialysis patients (mean age 63 years, SD = 13.6; 40% women) were enrolled from two separate hospitals. Oxidative stress was induced by an intravenous administration of 100 mg iron saccharate 0.5 h after the start of dialysis. Blood samples were drawn at the beginning of the dialysis, 0.5 h after iron administration and at the end of dialysis. NGAL levels were measured from the first blood sample, AOPP levels were measured from all blood samples. Results: Our results showed that higher NGAL and AOPP levels at the beginning of the dialysis, prior to iron administration, significantly predicted higher levels of AOPP toward the end of dialysis, (β = 0.355, SE = 0.054, P = 0.035; β = 0.297, SE = 0.159, P = 0.043, respectively). Conclusions: Our results suggest that higher level of NGAL is a risk factor for oxidative stress, as measured by AOPP levels, in dialysis patients receiving intravenous iron. Our findings could identify dialysis patients who are at higher risk from iron supplementation via measurement of NGAL levels.

Research paper thumbnail of Adriamycin nephropathy: a model to study effects of pregnancy on renal disease in rats

American Journal of Physiology-Renal Physiology, 1992

The influence of pregnancy on the evolution of primary renal disease is still a matter of controv... more The influence of pregnancy on the evolution of primary renal disease is still a matter of controversy. Hypertension and derangement of renal function may occur. The pathophysiology of these complications is poorly understood. In the present study, we assessed the influence of pregnancy on the evolution of adriamycin (Adr) nephropathy. Four groups of animals were studied: 1) control virgin rats (C), 2) normal pregnant rats (NP), 3) virgin rats with nephropathy (Adr), and 4) pregnant rats with nephropathy (Adr-P). Inulin clearance measured at the end of pregnancy in awake rats was similar in NP (1.68 +/- 0.20 ml/min) and C (1.39 +/- 0.03 ml/min). In Adr-P rats, it tended to decrease (1.22 +/- 0.7 vs. 1.93 +/- 0.44 ml/min in Adr rats). Mean arterial pressure was increased in Adr-P rats (137 +/- 2.5 vs. 95 +/- 3.2 mmHg in NP; P < 0.001). Urinary protein excretion was 216 +/- 61 mg/day in Adr-P compared with 28.7 +/- 18 mg/day in Adr (P < 0.001). A significant increase in the glome...

Research paper thumbnail of Dialytic Approach in Hemodialysis (HD) Patients with Hydrocephalus

Biomedical Journal of Scientific & Technical Research, 2019

Research paper thumbnail of Unilateral Acute Renal Cortical Necrosis

Clinical Nuclear Medicine, 2000

Bilateral acute cortical necrosis is a rare form of acute renal failure characterized by necrosis... more Bilateral acute cortical necrosis is a rare form of acute renal failure characterized by necrosis of the renal cortex and sparing of the medulla. Little information on the imaging presentation of bilateral acute renal cortical necrosis is available. The enhanced CT appearance is pathognomonic and diagnostic. The unilateral presentation of acute cortical necrosis is extremely rare, and no imaging methods have been described. The authors chose to apply scintigraphic evaluation to this unique condition complementary to CT to confirm the diagnosis. Mercaptoacetylglycine (T3) was selected to assess tubular damage, in contrast to the pure glomerular agent DTPA. Evidence of some tubular function and clear delineation of the shrunken kidney was found. Conversely, in the DTPA study the kidney was not visualized. A DMSA scan was performed for assessment of viability of the renal cortex and showed a photopenic halo around the small area of the viable cortex of the upper pole. The halo sign represents a cortical loss. The visualization of the upper pole as evidence of cortical viability as a consequence of collateral blood flow from capsular vessels was seen on angiography. Radiographic and scintigraphic correlation of this rare condition may be an effective means to confirm the diagnosis and to establish the extent of involvement. However, contrast CT remains the preferred method in the diagnosis of acute cortical necrosis.

Research paper thumbnail of Hypercapnia in Hemodialysis (HD)

Annals of Urology & Nephrology, 2019

Research paper thumbnail of Clinical and

Background. Gadolinium (Gd) magnetic resonance imaging (MRI) contrast agents are considered to be... more Background. Gadolinium (Gd) magnetic resonance imaging (MRI) contrast agents are considered to be safe in patients with impaired renal function. Our study investigates a mechanism of severe iron intoxication with lifethreatening serum iron levels in a haemodialysis patient following MRI with Gd-diethylenetriaminepentaacetic acid (Gd-DTPA) administration. His previous history was remarkable for multiple blood transfusions and biochemical evidence of iron overload. We hypothesized that Gd-DTPA may have an iron-mobilizing effect in specific conditions of iron overload combined with prolonged exposure to the agent. Methods. For the in vitro study, Gd-DTPA was added to mice liver homogenate and iron metabolism parameters were measured after incubation in comparison with the same samples incubated with saline only. For the in vivo study, an experimental model of acute renal failure in iron-overloaded rats was designed. Previously iron-overloaded and normally fed rats underwent bilateral nephrectomy by renal pedicle ligation, followed by Gd-DTPA or saline injection. Iron and iron saturation levels were checked before and 24 h after Gd-DTPA or vehicle administration. Results. Significant mobilization of iron from mice liver tissue homogenate in mixtures with Gd in vitro was seen in the control (saline) and in the experimental (Gd) groups (513"99.1 vs 1117.8"360.8 mgudl, respectively; P-0.05). Administration of Gd-DTPA to ironoverloaded rats after renal pedicle ligation caused marked elevation of serum iron from baseline 143"3.4 to 570"8 mgudl (P-0.0001). There were no changes of the named parameter, either in iron-overloaded anuric rats after saline injection or in normal diet uraemic animals, following Gd-DTPA administration. Conclusions. The combination of iron overload and lack of adequate clearance of Gd chelates may cause massive liberation of iron with dangerous elevation of free serum iron. It is highly recommended that after Gd contrast study, end-stage renal disease patients with probable iron overload should undergo prompt and intensive haemodialysis for prevention of this serious complication.

Research paper thumbnail of Ultrapure Dialysis Water: Is it really pure?

The Israel Medical Association journal : IMAJ, 2019

Research paper thumbnail of Bile Salts, Hypotension and Obstructive Jaundice

Clinical Science, 1984

1. We have examined the effects of bile duct ligation on vascular and extravascular smooth muscle... more 1. We have examined the effects of bile duct ligation on vascular and extravascular smooth muscle responsiveness to noradrenaline and tyramine using isolated rat hindlimb perfusion, and portal vein and vas deferens preparations. 2. Bile duct ligation reduced the contractile responses to noradrenaline of vascular and extra-vascular smooth muscle. 3. Exposure of smooth muscle to some bile salts caused a reduction in contractility. 4. This effect was dependent upon bile salt type and concentration. 5. These studies in vitro suggest that the reduced total peripheral resistance and hypotension seen in obstructive jaundice cannot be explained by a spasmolytic effect of some of the bile salts on smooth muscle.

Research paper thumbnail of Relative importance and interrelations between psychosocial factors and individualized quality of life of hemodialysis patients

Quality of Life Research, 2003

Since quality of life (QOL) of hemodialysis (HD) patients is low and frequently difficult to impr... more Since quality of life (QOL) of hemodialysis (HD) patients is low and frequently difficult to improve by medical therapy, it is important to identify psychosocial correlates and life-domains important for HD patients' QOL. Our hypothesis was that psychosocial factors reflecting appraisal, external and internal resources/impediments correlate with QOL and compensate for adverse effects of disease-related variables on QOL. Forty-eight chronic

Research paper thumbnail of Severe hypoglycemia in a patient with acute renal failure due to tumor lysis syndrome

The Israel Medical Association journal : IMAJ, 2002

Research paper thumbnail of Hemodialysis (HD) Dialysate Potassium

Annals of Urology & Nephrology, 2019

Extremes of serum potassium levels in the general population, cardiac patients and hemodialysis (... more Extremes of serum potassium levels in the general population, cardiac patients and hemodialysis (HD) patients may be critical. Thus, dialysate potassium concentration needs to be individualized to the patients by a standardized approach of the nephrologists. Our goals are to avoid or minimize pre-HD hyperkalemia, post-HD hypokalemia and high intradialytic dialysate-plasma K gradient, in order to moderate the high mortality and morbidity in HD patients and improve their compromised quality of life (QOL). However, dialysate K is frequently not individualized.

Research paper thumbnail of Correcting Acidosis during Hemodialysis: Current Limitations and a Potential Solution

Seminars in dialysis, 2016

The deleterious catabolic and pro-inflammatory effects of acidosis in hemodialysis (HD) patients ... more The deleterious catabolic and pro-inflammatory effects of acidosis in hemodialysis (HD) patients and the importance of its correction for limiting mineral bone disease (MBD) are well known. Although oral base therapy could be a solution for correcting acidosis in HD patients, it increases their already enormous medication load and sodium intake; this approach is not used commonly. Therefore, we need to rely more on correcting acidosis during the HD procedure, which is difficult to achieve, in part, because HD is an intermittent therapy. The currently used fixed dialysate bicarbonate concentrations are associated with pre-HD acidosis and intra-dialytic alkalosis. We suggest that a decreasing dialysate bicarbonate concentration from an initially high concentration be considered as a means of correcting acidosis with limited intra-dialytic alkalosis. Some evidence, as well as theoretical considerations, supports such an approach.

Research paper thumbnail of Pregnancy outcomes in patients with Alport syndrome

Archives of Gynecology and Obstetrics, 2015

To analyze the maternal and obstetric outcomes of patients with Alport syndrome. We describe the ... more To analyze the maternal and obstetric outcomes of patients with Alport syndrome. We describe the pregnancy course of 8 pregnancies of three family members with the autosomal dominant (the rarest) form of Alport syndrome. We also analyzed 10 previously reported pregnancies with other Alport mutations in order to explore risk factors for unfavorable obstetric outcomes and maternal renal deterioration. In 13 pregnancies (72 %), renal function did not deteriorate permanently. All of these women had pre-pregnancy mild chronic kidney disease (CKD stage G1). In all of them, only a transient increase in proteinuria was recorded and in one case there was a transient decrease in the estimated glomerular filtration rate. In four other pregnancies (22 %), renal function deteriorated following pregnancy. All of them were complicated with pre-eclampsia. One woman had pre-pregnancy CKD-G2A3 and chronic hypertension. Two women had CKD-G1A3 of whom one had pre-pregnancy proteinuria near the nephrotic range. In the fourth case, renal function deterioration was reported without information on the exact pre-pregnancy renal function. In the last case, CKD-G2 was reported after pregnancy without information on CKD stage prior to pregnancy. Severe proteinuria did not imply a permanent renal function deterioration if it developed during pregnancy. Ten pregnancies ended with preterm birth (56 %). Two stillbirths were reported (11 %); however, only one was attributed to maternal health deterioration. Data regarding pregnancy outcomes in Alport syndrome is limited. The outcome seems favorable when pre-pregnancy kidney function is normal or near normal and when chronic hypertension/pre-eclampsia is absent.

Research paper thumbnail of Intraocular pressure during haemodialysis: a review

Eye, 2004

Objectives Although several works in the past have examined the effect of haemodialysis (HD) on i... more Objectives Although several works in the past have examined the effect of haemodialysis (HD) on intraocular pressure (IOP), reported findings, theories, and conclusions are very different. The objectives of this article are to resume the reported evidence of IOP changes during HD, to review the proposed hypothesis of HD influence on IOP, and to determine if ophthalmic examination is imperative in HD patients. Methods We analysed the peer-reviewed English literature and selected all possible relevant articles. Results The influence of HD on IOP is not clear, and even in recent studies opposite findings can be found. Conclusions Future studies are needed to clarify the effects of HD on IOP. In patients with glaucoma or with predisposed narrow angles, or eyes with impaired aqueous outflow, the possibility of acute IOP rise during HD could be much more frequent than in normal patients. So in these patients, a more strict ophthalmic scheduled examination seems to be feasible.

Research paper thumbnail of Severe hypoglycemia in a patient with acute renal failure due to tumor lysis syndrome

The Israel Medical Association Journal Imaj, Oct 1, 2002

Research paper thumbnail of Post-reperfusion rapidly progressive glomerulonephritis in post-transplant IgA nephropathy

Journal of Nephrology, 2004

Rapidly progressive glomerulonephritis (RPGN) is a rare occurrence in IgA nephropathy (IgAN) in r... more Rapidly progressive glomerulonephritis (RPGN) is a rare occurrence in IgA nephropathy (IgAN) in renal transplant patients on immunosuppressive therapy. RPGN post ischemia-reperfusion has not been previously reported. We report a 62 year old male patient on azathioprine therapy, 9 years after left cadaveric renal transplantation due to end stage renal disease of unknown etiology, who presented with progressive deterioration in renal function and hematuria. Renal biopsy was consistent with IgAN. Duplex and CT scan demonstrated a decreased renal graft perfusion, due to severe atherosclerosis and stenosis of iliac arteries. The patient underwent left axilo-femoral bypass graft surgery with improvement in kidney graft perfusion and function. However, few weeks later, patient presented with pulmonary edema and advanced renal failure and he was initiated on hemodialysis. Repeated renal biopsy demonstrated crescentic GN. To the best of our knowledge, this is the first report of RPGN following reversal of ischemia and reperfusion. There was no evidence for atherembolic disease which is not uncommon after vascular surgery and it has been reported to be rarely associated to crescentic GN. Theoretical explanations for exacerbation of IgAN to crescentic GN, following successful reperfusion, could be enhancement of capillary damage, inflammation and oxidative stress. Putative mechanisms for these phenomena may be interaction of reperfusion-induced hyperfiltration, high intraglomerular capillary pressure, oxidative stress, increased polymorphonucler cells infiltration and inflammation; the presence of IgA immune deposits and azathioprine metabolites, both can also be associated to enhancement of oxidative stress.

Research paper thumbnail of Lymphomatous infiltration of the kidney associated with glomerulopathy presenting as acute renal failure

The Israel Medical Association Journal Imaj, Aug 1, 2001

1. Isr Med Assoc J. 2001 Jul;3(7):541-3. Lymphomatous infiltration of the kidney associated with ... more 1. Isr Med Assoc J. 2001 Jul;3(7):541-3. Lymphomatous infiltration of the kidney associated with glomerulopathy presenting as acute renal failure. Feldman L, Basok A, Kachko L, Tovbin D. Department of Nephrology, Soroka ...

Research paper thumbnail of Role of Haptoglobin Phenotype in End-Stage Kidney Disease

Nephron Experimental Nephrology, 2004

Background: We recently reported that haptoglobin (Hp) phenotype 1-1 is protective against the de... more Background: We recently reported that haptoglobin (Hp) phenotype 1-1 is protective against the development of nephropathy in normal creatinine diabetics. In the present study, we sought to determine if Hp phenotype also plays a role in renal deterioration by determining Hp phenotypes in a consecutive series of patients with chronic renal failure (CRF) in hemodialysis (HD) and predialysis clinics. Methods: Three hundred and ninety-two patients on HD for less than 2 years and 182 predialysis patients (creatinine clearance time [CCT] &lt;35 ml/min) were subjected to Hp phenotyping. Age, gender and presence of diabetes or hypertension were recorded. Patients were stratified according to age (above and below 60 years) and severity of renal dysfunction (CRF or HD). Results: We observed a markedly lower prevalence of the Hp 1-1 phenotype in HD patients under 60 years of age compared to patients with CRF or compared to the general population. This was not due to differences in the threshold for dialysis initiation among patients with different Hp types or to decreased survival of patients with Hp 1-1 prior to entering HD. In HD patients 60 years and over, Hp 1-1 prevalence was increased, as observed with other diseases in this age group. Conclusions: The prevalence of Hp 1-1 is decreased in HD patients less than 60 years of age. This may be due to a fundamental difference in the rate of renal deterioration in patients with different Hp types. In addition, Hp 1-1 may provide a protective effect against mortality in elderly patients.

Research paper thumbnail of Iron-mobilizing properties of the gadolinium-DTPA complex: clinical and experimental observations

Background. Gadolinium (Gd) magnetic resonance ima- ging (MRI) contrast agents are considered to ... more Background. Gadolinium (Gd) magnetic resonance ima- ging (MRI) contrast agents are considered to be safe in patients with impaired renal function. Our study investi- gates a mechanism of severe iron intoxication with life- threatening serum iron levels in a haemodialysis patient following MRI with Gd-diethylenetriaminepentaacetic acid (Gd-DTPA) administration. His previous history was remarkable for multiple blood transfusions and biochemical evidence

Research paper thumbnail of Spectrum of mycobacterial infections: tuberculosis and Mycobacterium other than tuberculosis in dialysis patients

The Israel Medical Association journal : IMAJ, 2007

Patients with end-stage renal disease are at high risk of mycobacterial infection. To analyze the... more Patients with end-stage renal disease are at high risk of mycobacterial infection. To analyze the difficulties in reaching an accurate diagnosis of tuberculosis in dialysis patients. We conducted a retrospective follow-up of patients who attended our peritoneal and hemodialysis units during the 10 year period 1995-2005. Our dialysis unit diagnosed 10 cases of tuberculosis caused by Mycobacterium tuberculosis and 9 cases of Mycobacterium other than tuberculosis. In the former group, five patients had Mycobacterium in the sputum, which was diagnosed by intraabdominal mass biopsy in one, culture of the gastric juices in one, and pleural fluid culture or pleural biopsy in three. One of these patients was suffering from pleural TB as well as Potts disease. Of the patients with Mycobacterium other than tuberculosis, five were diagnosed by sputum cultures, three by urine cultures and one in peritoneal fluid. Differences in treatment and outcome were also reviewed. The diagnosis of TB in di...

Research paper thumbnail of Elevated Neutrophil Gelatinase Lipocalin Levels Are Associated With Increased Oxidative Stress in Hemodialysis Patients

Journal of Clinical Medicine Research, 2018

Background: Administration of intravenous iron is an essential treatment of anemia in hemodialysi... more Background: Administration of intravenous iron is an essential treatment of anemia in hemodialysis patients, but it may lead to oxidative stress and increased morbidity and mortality. There is evidence that neutrophil gelatinase-associated lipocalin (NGAL) is protective against oxidative stress and thus the aim of the present study was to investigate the relationship between plasma NGAL and advanced oxidative protein products (AOPP) in hemodialysis patients treated with intravenous iron. Methods: In a prospective study, 47 hemodialysis patients (mean age 63 years, SD = 13.6; 40% women) were enrolled from two separate hospitals. Oxidative stress was induced by an intravenous administration of 100 mg iron saccharate 0.5 h after the start of dialysis. Blood samples were drawn at the beginning of the dialysis, 0.5 h after iron administration and at the end of dialysis. NGAL levels were measured from the first blood sample, AOPP levels were measured from all blood samples. Results: Our results showed that higher NGAL and AOPP levels at the beginning of the dialysis, prior to iron administration, significantly predicted higher levels of AOPP toward the end of dialysis, (β = 0.355, SE = 0.054, P = 0.035; β = 0.297, SE = 0.159, P = 0.043, respectively). Conclusions: Our results suggest that higher level of NGAL is a risk factor for oxidative stress, as measured by AOPP levels, in dialysis patients receiving intravenous iron. Our findings could identify dialysis patients who are at higher risk from iron supplementation via measurement of NGAL levels.

Research paper thumbnail of Adriamycin nephropathy: a model to study effects of pregnancy on renal disease in rats

American Journal of Physiology-Renal Physiology, 1992

The influence of pregnancy on the evolution of primary renal disease is still a matter of controv... more The influence of pregnancy on the evolution of primary renal disease is still a matter of controversy. Hypertension and derangement of renal function may occur. The pathophysiology of these complications is poorly understood. In the present study, we assessed the influence of pregnancy on the evolution of adriamycin (Adr) nephropathy. Four groups of animals were studied: 1) control virgin rats (C), 2) normal pregnant rats (NP), 3) virgin rats with nephropathy (Adr), and 4) pregnant rats with nephropathy (Adr-P). Inulin clearance measured at the end of pregnancy in awake rats was similar in NP (1.68 +/- 0.20 ml/min) and C (1.39 +/- 0.03 ml/min). In Adr-P rats, it tended to decrease (1.22 +/- 0.7 vs. 1.93 +/- 0.44 ml/min in Adr rats). Mean arterial pressure was increased in Adr-P rats (137 +/- 2.5 vs. 95 +/- 3.2 mmHg in NP; P < 0.001). Urinary protein excretion was 216 +/- 61 mg/day in Adr-P compared with 28.7 +/- 18 mg/day in Adr (P < 0.001). A significant increase in the glome...

Research paper thumbnail of Dialytic Approach in Hemodialysis (HD) Patients with Hydrocephalus

Biomedical Journal of Scientific & Technical Research, 2019

Research paper thumbnail of Unilateral Acute Renal Cortical Necrosis

Clinical Nuclear Medicine, 2000

Bilateral acute cortical necrosis is a rare form of acute renal failure characterized by necrosis... more Bilateral acute cortical necrosis is a rare form of acute renal failure characterized by necrosis of the renal cortex and sparing of the medulla. Little information on the imaging presentation of bilateral acute renal cortical necrosis is available. The enhanced CT appearance is pathognomonic and diagnostic. The unilateral presentation of acute cortical necrosis is extremely rare, and no imaging methods have been described. The authors chose to apply scintigraphic evaluation to this unique condition complementary to CT to confirm the diagnosis. Mercaptoacetylglycine (T3) was selected to assess tubular damage, in contrast to the pure glomerular agent DTPA. Evidence of some tubular function and clear delineation of the shrunken kidney was found. Conversely, in the DTPA study the kidney was not visualized. A DMSA scan was performed for assessment of viability of the renal cortex and showed a photopenic halo around the small area of the viable cortex of the upper pole. The halo sign represents a cortical loss. The visualization of the upper pole as evidence of cortical viability as a consequence of collateral blood flow from capsular vessels was seen on angiography. Radiographic and scintigraphic correlation of this rare condition may be an effective means to confirm the diagnosis and to establish the extent of involvement. However, contrast CT remains the preferred method in the diagnosis of acute cortical necrosis.

Research paper thumbnail of Hypercapnia in Hemodialysis (HD)

Annals of Urology & Nephrology, 2019

Research paper thumbnail of Clinical and

Background. Gadolinium (Gd) magnetic resonance imaging (MRI) contrast agents are considered to be... more Background. Gadolinium (Gd) magnetic resonance imaging (MRI) contrast agents are considered to be safe in patients with impaired renal function. Our study investigates a mechanism of severe iron intoxication with lifethreatening serum iron levels in a haemodialysis patient following MRI with Gd-diethylenetriaminepentaacetic acid (Gd-DTPA) administration. His previous history was remarkable for multiple blood transfusions and biochemical evidence of iron overload. We hypothesized that Gd-DTPA may have an iron-mobilizing effect in specific conditions of iron overload combined with prolonged exposure to the agent. Methods. For the in vitro study, Gd-DTPA was added to mice liver homogenate and iron metabolism parameters were measured after incubation in comparison with the same samples incubated with saline only. For the in vivo study, an experimental model of acute renal failure in iron-overloaded rats was designed. Previously iron-overloaded and normally fed rats underwent bilateral nephrectomy by renal pedicle ligation, followed by Gd-DTPA or saline injection. Iron and iron saturation levels were checked before and 24 h after Gd-DTPA or vehicle administration. Results. Significant mobilization of iron from mice liver tissue homogenate in mixtures with Gd in vitro was seen in the control (saline) and in the experimental (Gd) groups (513"99.1 vs 1117.8"360.8 mgudl, respectively; P-0.05). Administration of Gd-DTPA to ironoverloaded rats after renal pedicle ligation caused marked elevation of serum iron from baseline 143"3.4 to 570"8 mgudl (P-0.0001). There were no changes of the named parameter, either in iron-overloaded anuric rats after saline injection or in normal diet uraemic animals, following Gd-DTPA administration. Conclusions. The combination of iron overload and lack of adequate clearance of Gd chelates may cause massive liberation of iron with dangerous elevation of free serum iron. It is highly recommended that after Gd contrast study, end-stage renal disease patients with probable iron overload should undergo prompt and intensive haemodialysis for prevention of this serious complication.

Research paper thumbnail of Ultrapure Dialysis Water: Is it really pure?

The Israel Medical Association journal : IMAJ, 2019

Research paper thumbnail of Bile Salts, Hypotension and Obstructive Jaundice

Clinical Science, 1984

1. We have examined the effects of bile duct ligation on vascular and extravascular smooth muscle... more 1. We have examined the effects of bile duct ligation on vascular and extravascular smooth muscle responsiveness to noradrenaline and tyramine using isolated rat hindlimb perfusion, and portal vein and vas deferens preparations. 2. Bile duct ligation reduced the contractile responses to noradrenaline of vascular and extra-vascular smooth muscle. 3. Exposure of smooth muscle to some bile salts caused a reduction in contractility. 4. This effect was dependent upon bile salt type and concentration. 5. These studies in vitro suggest that the reduced total peripheral resistance and hypotension seen in obstructive jaundice cannot be explained by a spasmolytic effect of some of the bile salts on smooth muscle.

Research paper thumbnail of Relative importance and interrelations between psychosocial factors and individualized quality of life of hemodialysis patients

Quality of Life Research, 2003

Since quality of life (QOL) of hemodialysis (HD) patients is low and frequently difficult to impr... more Since quality of life (QOL) of hemodialysis (HD) patients is low and frequently difficult to improve by medical therapy, it is important to identify psychosocial correlates and life-domains important for HD patients' QOL. Our hypothesis was that psychosocial factors reflecting appraisal, external and internal resources/impediments correlate with QOL and compensate for adverse effects of disease-related variables on QOL. Forty-eight chronic

Research paper thumbnail of Severe hypoglycemia in a patient with acute renal failure due to tumor lysis syndrome

The Israel Medical Association journal : IMAJ, 2002

Research paper thumbnail of Hemodialysis (HD) Dialysate Potassium

Annals of Urology & Nephrology, 2019

Extremes of serum potassium levels in the general population, cardiac patients and hemodialysis (... more Extremes of serum potassium levels in the general population, cardiac patients and hemodialysis (HD) patients may be critical. Thus, dialysate potassium concentration needs to be individualized to the patients by a standardized approach of the nephrologists. Our goals are to avoid or minimize pre-HD hyperkalemia, post-HD hypokalemia and high intradialytic dialysate-plasma K gradient, in order to moderate the high mortality and morbidity in HD patients and improve their compromised quality of life (QOL). However, dialysate K is frequently not individualized.

Research paper thumbnail of Correcting Acidosis during Hemodialysis: Current Limitations and a Potential Solution

Seminars in dialysis, 2016

The deleterious catabolic and pro-inflammatory effects of acidosis in hemodialysis (HD) patients ... more The deleterious catabolic and pro-inflammatory effects of acidosis in hemodialysis (HD) patients and the importance of its correction for limiting mineral bone disease (MBD) are well known. Although oral base therapy could be a solution for correcting acidosis in HD patients, it increases their already enormous medication load and sodium intake; this approach is not used commonly. Therefore, we need to rely more on correcting acidosis during the HD procedure, which is difficult to achieve, in part, because HD is an intermittent therapy. The currently used fixed dialysate bicarbonate concentrations are associated with pre-HD acidosis and intra-dialytic alkalosis. We suggest that a decreasing dialysate bicarbonate concentration from an initially high concentration be considered as a means of correcting acidosis with limited intra-dialytic alkalosis. Some evidence, as well as theoretical considerations, supports such an approach.

Research paper thumbnail of Pregnancy outcomes in patients with Alport syndrome

Archives of Gynecology and Obstetrics, 2015

To analyze the maternal and obstetric outcomes of patients with Alport syndrome. We describe the ... more To analyze the maternal and obstetric outcomes of patients with Alport syndrome. We describe the pregnancy course of 8 pregnancies of three family members with the autosomal dominant (the rarest) form of Alport syndrome. We also analyzed 10 previously reported pregnancies with other Alport mutations in order to explore risk factors for unfavorable obstetric outcomes and maternal renal deterioration. In 13 pregnancies (72 %), renal function did not deteriorate permanently. All of these women had pre-pregnancy mild chronic kidney disease (CKD stage G1). In all of them, only a transient increase in proteinuria was recorded and in one case there was a transient decrease in the estimated glomerular filtration rate. In four other pregnancies (22 %), renal function deteriorated following pregnancy. All of them were complicated with pre-eclampsia. One woman had pre-pregnancy CKD-G2A3 and chronic hypertension. Two women had CKD-G1A3 of whom one had pre-pregnancy proteinuria near the nephrotic range. In the fourth case, renal function deterioration was reported without information on the exact pre-pregnancy renal function. In the last case, CKD-G2 was reported after pregnancy without information on CKD stage prior to pregnancy. Severe proteinuria did not imply a permanent renal function deterioration if it developed during pregnancy. Ten pregnancies ended with preterm birth (56 %). Two stillbirths were reported (11 %); however, only one was attributed to maternal health deterioration. Data regarding pregnancy outcomes in Alport syndrome is limited. The outcome seems favorable when pre-pregnancy kidney function is normal or near normal and when chronic hypertension/pre-eclampsia is absent.

Research paper thumbnail of Intraocular pressure during haemodialysis: a review

Eye, 2004

Objectives Although several works in the past have examined the effect of haemodialysis (HD) on i... more Objectives Although several works in the past have examined the effect of haemodialysis (HD) on intraocular pressure (IOP), reported findings, theories, and conclusions are very different. The objectives of this article are to resume the reported evidence of IOP changes during HD, to review the proposed hypothesis of HD influence on IOP, and to determine if ophthalmic examination is imperative in HD patients. Methods We analysed the peer-reviewed English literature and selected all possible relevant articles. Results The influence of HD on IOP is not clear, and even in recent studies opposite findings can be found. Conclusions Future studies are needed to clarify the effects of HD on IOP. In patients with glaucoma or with predisposed narrow angles, or eyes with impaired aqueous outflow, the possibility of acute IOP rise during HD could be much more frequent than in normal patients. So in these patients, a more strict ophthalmic scheduled examination seems to be feasible.

Research paper thumbnail of Severe hypoglycemia in a patient with acute renal failure due to tumor lysis syndrome

The Israel Medical Association Journal Imaj, Oct 1, 2002

Research paper thumbnail of Post-reperfusion rapidly progressive glomerulonephritis in post-transplant IgA nephropathy

Journal of Nephrology, 2004

Rapidly progressive glomerulonephritis (RPGN) is a rare occurrence in IgA nephropathy (IgAN) in r... more Rapidly progressive glomerulonephritis (RPGN) is a rare occurrence in IgA nephropathy (IgAN) in renal transplant patients on immunosuppressive therapy. RPGN post ischemia-reperfusion has not been previously reported. We report a 62 year old male patient on azathioprine therapy, 9 years after left cadaveric renal transplantation due to end stage renal disease of unknown etiology, who presented with progressive deterioration in renal function and hematuria. Renal biopsy was consistent with IgAN. Duplex and CT scan demonstrated a decreased renal graft perfusion, due to severe atherosclerosis and stenosis of iliac arteries. The patient underwent left axilo-femoral bypass graft surgery with improvement in kidney graft perfusion and function. However, few weeks later, patient presented with pulmonary edema and advanced renal failure and he was initiated on hemodialysis. Repeated renal biopsy demonstrated crescentic GN. To the best of our knowledge, this is the first report of RPGN following reversal of ischemia and reperfusion. There was no evidence for atherembolic disease which is not uncommon after vascular surgery and it has been reported to be rarely associated to crescentic GN. Theoretical explanations for exacerbation of IgAN to crescentic GN, following successful reperfusion, could be enhancement of capillary damage, inflammation and oxidative stress. Putative mechanisms for these phenomena may be interaction of reperfusion-induced hyperfiltration, high intraglomerular capillary pressure, oxidative stress, increased polymorphonucler cells infiltration and inflammation; the presence of IgA immune deposits and azathioprine metabolites, both can also be associated to enhancement of oxidative stress.

Research paper thumbnail of Lymphomatous infiltration of the kidney associated with glomerulopathy presenting as acute renal failure

The Israel Medical Association Journal Imaj, Aug 1, 2001

1. Isr Med Assoc J. 2001 Jul;3(7):541-3. Lymphomatous infiltration of the kidney associated with ... more 1. Isr Med Assoc J. 2001 Jul;3(7):541-3. Lymphomatous infiltration of the kidney associated with glomerulopathy presenting as acute renal failure. Feldman L, Basok A, Kachko L, Tovbin D. Department of Nephrology, Soroka ...

Research paper thumbnail of Role of Haptoglobin Phenotype in End-Stage Kidney Disease

Nephron Experimental Nephrology, 2004

Background: We recently reported that haptoglobin (Hp) phenotype 1-1 is protective against the de... more Background: We recently reported that haptoglobin (Hp) phenotype 1-1 is protective against the development of nephropathy in normal creatinine diabetics. In the present study, we sought to determine if Hp phenotype also plays a role in renal deterioration by determining Hp phenotypes in a consecutive series of patients with chronic renal failure (CRF) in hemodialysis (HD) and predialysis clinics. Methods: Three hundred and ninety-two patients on HD for less than 2 years and 182 predialysis patients (creatinine clearance time [CCT] &lt;35 ml/min) were subjected to Hp phenotyping. Age, gender and presence of diabetes or hypertension were recorded. Patients were stratified according to age (above and below 60 years) and severity of renal dysfunction (CRF or HD). Results: We observed a markedly lower prevalence of the Hp 1-1 phenotype in HD patients under 60 years of age compared to patients with CRF or compared to the general population. This was not due to differences in the threshold for dialysis initiation among patients with different Hp types or to decreased survival of patients with Hp 1-1 prior to entering HD. In HD patients 60 years and over, Hp 1-1 prevalence was increased, as observed with other diseases in this age group. Conclusions: The prevalence of Hp 1-1 is decreased in HD patients less than 60 years of age. This may be due to a fundamental difference in the rate of renal deterioration in patients with different Hp types. In addition, Hp 1-1 may provide a protective effect against mortality in elderly patients.

Research paper thumbnail of Iron-mobilizing properties of the gadolinium-DTPA complex: clinical and experimental observations

Background. Gadolinium (Gd) magnetic resonance ima- ging (MRI) contrast agents are considered to ... more Background. Gadolinium (Gd) magnetic resonance ima- ging (MRI) contrast agents are considered to be safe in patients with impaired renal function. Our study investi- gates a mechanism of severe iron intoxication with life- threatening serum iron levels in a haemodialysis patient following MRI with Gd-diethylenetriaminepentaacetic acid (Gd-DTPA) administration. His previous history was remarkable for multiple blood transfusions and biochemical evidence

Research paper thumbnail of Spectrum of mycobacterial infections: tuberculosis and Mycobacterium other than tuberculosis in dialysis patients

The Israel Medical Association journal : IMAJ, 2007

Patients with end-stage renal disease are at high risk of mycobacterial infection. To analyze the... more Patients with end-stage renal disease are at high risk of mycobacterial infection. To analyze the difficulties in reaching an accurate diagnosis of tuberculosis in dialysis patients. We conducted a retrospective follow-up of patients who attended our peritoneal and hemodialysis units during the 10 year period 1995-2005. Our dialysis unit diagnosed 10 cases of tuberculosis caused by Mycobacterium tuberculosis and 9 cases of Mycobacterium other than tuberculosis. In the former group, five patients had Mycobacterium in the sputum, which was diagnosed by intraabdominal mass biopsy in one, culture of the gastric juices in one, and pleural fluid culture or pleural biopsy in three. One of these patients was suffering from pleural TB as well as Potts disease. Of the patients with Mycobacterium other than tuberculosis, five were diagnosed by sputum cultures, three by urine cultures and one in peritoneal fluid. Differences in treatment and outcome were also reviewed. The diagnosis of TB in di...