ADVANCED NEPHROLOGY: NEPHROLOGY FOR THE CONSULTANT

The University of California. San Diego School of Medicine, Department of Medicine, Division of Nephrobogy, is sponsoring a conference on “Advanced Nephrobogy: Nephnobogy for the Consultant” February 1-3, 1996 at the Hyatt Regency on the Bay. San Diego. CA. Credits: 17 hours ofAMA Category I for 3-day course. Registration fee: Physician in Practice, $375.00; Resident/Fellow, $ 1 75.00. For more information, please contact: Shirley Kolkey. Course Coordinator, 1660 Hotel Circle North #220, San Diego. CA 92108. Phone: 619-299-6673; Fax: 619-299- 6675.

FOURTH INTERNATIONAL CONFERENCE ON GERIATRIC NEPHROLOGY AND UROLOGY

The Fourth International Conference on Geriatric Nephrobogy and Urology will be held at the Chelsea Inn, Toronto, on April 19-2 1 , 1996. Those interested please contact: Dr. D.G. Oreopoulos, The Toronto Hospital-Western Division, 399 Bathunst Street, Toronto, Ontario, Canada M5T 258; Telephone: 416-603-7974; FAX: 416-603- 8127.

RENAL DIALYSIS ACCESS SYMPOSIUM

The Dialysis Access V Symposium. sponsored by the Department of Surgery. Ohio State University. will be held May 9-10. 1996, at the WestIn La Paloma, Tucson, AZ. The chairmen are Ronald M. Ferguson. MD, and Mitchell L. Henry. MD. CME Credits: 10-12 hours (to be confirmed). Contact: ACCESS Medical Group. Ltd. . 3880 RID Salem Lake Drive, Suite A, Long Grove, IL 60047-7676; Tel: 708-550-0090; FAX: 708-550-0095.

ISPD 98, SEOUL

The Eighth Congress of the International Society for Peritoneal Dialysis (ISPD) will be held in Seoul, Korea, on August 23-26, 1998. For further information, contact Dr. Hi Bahl Lee, Hyonam Kidney Laboratory, Soon Chun Hyang University. 657 Hannam Dong. Yongsan Koo, Seoul 140-743, Korea. Telephone: 82-2-709-9 1 7 1 ; FAX: 82-2-792-58 1 2; E-mail: hbbee(/konea.com; Internet:http: / /korea.com.

1686 Volume 6 . Number 6 ‘ 1995 ACKNOWLEDGEMENT OF MANUSCRIPT CONSULTANTS JASN VOLUME 6 Peer review of another’s work is a responsibility of those who wish to publish material of their own. It is with pleasure and deep gratitude that I publicly acknowledge those who have advised the editorial staff during the past 6 months. Jared J. Grantham, M.D. Editor, JASN

Hanna Abboud William Couser Todd Ing Sharon Moe Paul A. Abraham Allen Cowley Michael Insana M. Monestier Dale Abrahamson Benjamin Cowley Peter Ivanovich Alvin Moss Christine Abrass Patricia Craven Harriet Iwamoto Karl Nath Sharon Adler Andrey Cybulsky Richard Johnson Eric Neilson Seth Alper Vivette DAgati Pedro Jose Sanjay Nigam William W. Anderson Thomas Daniel Barry Kahan Karl Noiph Sharon Andreoll Gabriel Danovitch Andrew Kahn Edward Nord Giuseppe Andres John T. Daugirdas Yashpal Kanwar Aklnlou Ojo Dennis Andress Connie Davis Andre Kaplan Jean Olson Gerald Appel William Deen Bernard Kaplan Emil Paganini Raymond Ardallbou Vincent Dennis Clifford Kashtan Patrick Parfrey George Arnoff Thomas Depner Bertram L. Kasiske Thomas Parker Robert C. Atkins F. W. M. de Rooij William Keane York Pei Morrel Avram Jonathan Diamond P. G. Kerr Brian Pereira Nazneed Aziz Jose A. Diaz-Buxo Prakesh Keshaviah Jeffrey Perrone Andrew Balnes Janice Douglas Ramesh Khanna Terry Phillips George Bakris Francis Dumler Paul Killen Friedrich Port Barbara Balbermann Johanna Dwyer Paul Kimmel George Porter James Balow Franklin Epstein Paul Kbotman Jerome Porush Robert H. Barth Alan Erslev Franklyn Knox Jerry Powell Daniel Bathe Andrew Evan Donald Kohan Francesco Pugliese Christine Baylis Benita Falkner Hikaru Koide Darryl Quarles Roy Baynes Robin Felder Valentina Kon Richard Quigg William Beierwaltes Susan Feliner Ulla Kopp Lorraine Racusen William Bennett Arnold Felsenfeld Lorraine Krauss Leopoldo Ralj Suzanne Bergman Richard Fine Wilhelm Kriz Carolyn Rankin Anatole Beserab Gregory Fink Andrzej S. Krolewski V. K. Rao Margaret Bia Roy First Dean Kujubu Garry Reams Daniel Bichet Jurgen Fboege RaJiv Kumar Giuseppe Remuzzi Peter C. Blake Agnes Fogo H. Moo Kwon Luis Reuss M. Donald Blaufox Barry Freedman N. Lamiere Bengt Rippe Wendy Bloembergen Peter Friedman KaI Lau Eberhard Ritz Joseph Bonventre Patricia Gabow J. Michael Lazarus Alan Robinson Wayne Border Laurie J. Garred Derek LeRoith Mark Rosenberg Diego Brancaccio Jeffrey Garvin Andrew Levey Stephen Rostand Robert A. Branch Karen Gaudio Elliot Levy Brad Rovin D. Craig Brater Gregory Germino Edmund Lewis Peter Rumore William Braun Stephen Gluck John Leypoldt Steven Sacks Sylvie Breton Thomas Golper Yeong Hau Lien Robert Safirstein Josephine Brlggs Frank Gotch Stuart Linas Khashayar Sakhaee John Brown Barney Graham Alfred Linker Isidro Salusky Maurice Burg Joey P. Granger Michael Llnshaw Jeffrey Sands James Burke Tom Greene Francisco Liach John Savlil John C. Burnett James Greenwald Thomas Lohmeier Virginia Savin James P. Calvet Gerald Groggel James Lohr Cheryl Scheid Vito Campese Carlotta Groves Gerhard Lonnemann Jurgen Schnermann Barbara Carpenter Mark Hans Michael Madalo George Schreiner Oscar Carretero Raymond Hakim Hartmut Malluche Robert Schnier D. S. Cattran Dallas Hall Anil Mandal Gerald Schulman J. Michael Cecka Lee Hamm Kenneth Margulies Pamela Schultz James Chan Joseph Handler Kevin Martin Steve Schwab Arlene Chapman Aviad Haramati Robert Maser John Sedor Bernard Charra Lee Hebert Michael Mauer Sudhir Shah Russell Chesney Lee Henderson David McCarron Joseph Shapiro Alfred Cheung William Henrich James T. McCarthy Kumar Sharma Robert Chevalier Jean Holley Kevin McCarthy Donald Sherrard Edward Chin Clifford Holmes William McClellan Norman Siegel Thomas Coffman John Hornberger Ravindra Mehta Curt Sigmund Arthur Cohen Thomas Hostetter Alfred Michael Fred Silva Barbara Cole Donald Hricik Edgar Milford Michael Simonson Allan Collins Michael Humphreys Judith Miller Ashok Singh Fernando Cosio Alp lkIzler William Mitch Barry Skikne

Journal of the American Society of Nephrology 1687 Eduardo Slatopolsky Vicente Torres Michael Watson David Wilson Lynwood Smith Robert Toto Karl T. Weber James Winchester Kim Solez Karl Tryggvason Joel Weinberg David Windus Robert Star Jaime Uribarri Edward Weinman Gerald Wolf Michael Steffes R. Vanholder Matthew Weir Gunter Wolf Richard Sterns Steven Vas Larry Welling Elaine Worcester John Stokes J. 0. Verbalis Andrew Whelton N. Yanagawa William Stone James Wade Thomas Wiegmann Telzo Yoshimura Jack Strandhoy Bradley Warady Christopher Wilcox Richard Zager Bauer Sumpio Richard Ward Barry Wilkes Reza Zarnegar ManIkkam Suthanthiran David Warnock Hibbard Williams Mark Zeidel Jonathan Tolins Michael Warnock Emily Wilson Fuad Ziyadeh

1688 Volume#{243} . Number#{243} ‘ 1995 VOLUME 6 AUTHOR INDEX

Adey.D.B.. 171 Bowen. P. A.. 1 Cruz,l., 1418 Ghiggeri. G. M.. 1262 Agarwal,A.. 1160 Boyle. D. H.. 1418 Cui,X., 1216 Ghigo, D., 1278 Agosti. S. J.. 1445 Boyle,P.. 126 Gianoglio, B., 1278 Agostini. P.. 1170 Braidoffi. P.. 1262 Daemen, M. J. A. P.. 1625 Gibel. L. J., 198 AlAhdal.M.. 1439 Brancaccio. D.. 1262 Daina. E., 257 Gillett,N., 1511 Albouze. G.. 1634 Brandst#{227}tter.E., 1613 Danovitch, G. M., 1 Gisinger, J., 1434 Alfurayh. 0.. 1439 Breuning. M. H.. 1670 Davidow, C., 1242 Glauber, M., 1291 Aljama. P.. 1586 Breyer. J. A.. 1523 Davis. C. L.. 1250 Gold. L. I.. 286 Allen. B. J.. 82 Briggs.J.P.. 154 DeFranco, P. E.. 295 Goldstein. D. J., 1468 Alleyne.S.. 1418 Brody.M.. 1511 Deicher.R., 1592 Goldstein. M.. 1410 Allon,M., 1134 Brown, E. M.. 1530 Deng.A.. 1197 Gomez-Villamandos, J, C.. Al Meshari. K.. 1439 Burdmann. E. A., 1186 De Nicola. L.. 1451 1586 Alpers, C. E., 1 186 Burkhart. K. M.. 1655 Deray.G.. 1661 Gonzalez, J., 75 Alto.A.. 1578 Busch. A. E.. 1547 Deutsch, A., 102 Gotch. F., 1578 Ambrus.C.M.. 1271 DeVol,E., 1439 Gottlieb, M. N., 75 Amore.A.. 1278 Diamond, J. R., 1170 Graefe,U., 121 Caillette, A., 68 Amuchastegui. C. S.. 257 Dieplinger. H., 110 Grantham, J. J., 1242 Carracedo, J.. 1586 Ando. A.. 95 Dombrouski, J,, 1284 Greene, J. H., 1386 Carrier, H., 68 Andoh. 1. F.. 1186 Douvdevani, A., 207 Gretch. D. P.. 220 Caterson, R. J., 82 Ankorina, I.. 1223 Dresner, I. G., 126 Griffin. M. D.. 248 Chaimovifz, C.. 207 Anthone, P.. 1271 Dumler, F., 1463 Groggel.G.C.. 171 Chaimovitzch, C. , 102 Anthone.S.. 1271 Durand.J.. 1209 Gr#{252}nfeld.J. P., 1634 Arese.M.. 1278 Chan,C., 1511 Guerini, E., 257 Chan,J.C.M., 126 Arruda, J. A. L., 1202 Elledge, L., 198 Gunwar, S. . 1178 Auinger. M.. 110 Chandler, W. L., 1250 Gusmano, 1.. 1262 Chang. P. C.. 1670 Ellis. D.. 1 170 Avner. E. D. , 269 Engels. K.. 1476 Ayass.W.. 82 Chen,Y-F., 1209 Chen,Y-M.. 1392 Epstein. F. H.. 1459 Haag-Weber. M.. 1592 Haas.M., 1434 Chertow. G. M.. 75. 1685 Estremadoyro. L.. 1463 Hakim, R. M., 139, 1319, 1386 Bachmann. J.. 121 Chesher. D. W.. 1607 Hall. E. S.. 1256 Badr.K.. 1300 Cheung. A. K.. 214 Faber, M.. 192 Baldinger. C.. 1613 Chevalier, P. L., 1498 Farina, D., 126 Handler, J. S., 1559 Haneda.M., 1504 Baluarte.H.J.. 126 Chiang. H-S.. 1392 Fariyike. B., 1360 Hansen, P. A.. 242 Baranyi, L., 234 Chinchilli. V. M., 126 Farmer. B.. 242 Haragsim. L. . 295 Barber.G.. 1304 Chonko.A.M.. 1178 Farquhar, M. G.. 35, 61 Harris. D. C. H.. 1607 Bans. B. A., 242 Chopra. S.. 1304 Feld,L.G.. 126 Harris. D. H., 214 Barn, V. M., 1347 Choukroun,G., 1634 Felsenfeld, A. J.. 1371 Harris,P.C., 1125 Barros, E. J. G., 1151 Christophe. J-L., 1634 Fern#{225}ndez,E.. 132 Hatch,M.. 1313 Basner. ft. 192 Clanciaruso, B., 1451 Fernandez. M., 1445 Hawkins, K. L.. 198 Bastani, B., 295 Cieza.J.. 1463 Ferrazzi, P.. 1291 Haxelmans, S.. 1223 Baverel, G., 68 Cirina. P.. 1278 Ferrier, B.. 68 Fink,J.C., 1655 Hebert. L. A., 136 Baylis. C.. 1 197. 1476 Clark. B. A. , 1459 Hebert,S.C., 1530 Beathard. G. A.. 1619 Coggi.G.. 1262 Foreman, J. W. , 269 Henrich, W. L.. 242 Belloffi. V.. 1262 Cohen. A. H., 286 Fouque. D. , 1427 Bennett. W. M., 1186 Cohen.D.J., 1342 Franceschini. N.. 1186 Hill,S., 1379 Benson. L. L.. 269 Cohen.G.. 1592 Fransen, R.. 1491 Hoeks, A. P. G., 1625 Hoffman.E.J.. 1284 Bergmans. D. C. J. J., 1625 College. J.. 75 Freel,P.W., 1313 Bergstralh. E. J.. 248 Combarnous, F., 1427 Fujibayashi. M.. 95 Hofstra. L.. 1625 Holub. B.. 1242 BergstrOm. J.. 1329 Conis.J.M..214 Fujita, V.. 220 H#{244}rl,W.H.. 1592 Berl,T., 242 Conjard, A., 68 Fujiwara, V., 95 Bia. M. J.. 1 Conlon. P. J.. 54 Fukushi, K.. 220 Huang.W.. 75 Hudson.B.G.. 1178 Biber, J., 1547 Conte,G., 1451 Hughes,J., 1125 Bittle, P. A. . 1445 Contreras, G. , 1354 Gallieni, M.. 1262 Hugo.C.. 1186 Blakely. P. . 48 Cooper,M.A.. 1655 Garberi. A., 1262 Hutchison, F. N., 1216 Bloembergen. W. E.. 177, 184 Coppo,R., 1278 Garcia. N. H.. 89 Bonaudo. R.. 1278 Coresh.J.. 1379 Gardner, M., 242 Hyver. 1.. 1552 Bontempelli. M.. 1291 Costamagna. C., 1278 Garvin. J. L.. 89 Border, W. A., 286 Couser. W. G.. 1 186. 1197 Gaspari, F., 257 Ibels, L. S.. 82

Borr#{244}s.M.. 132 Cowley. B. D.. Jr., 1679 Gaston, R. S.. 1 lijima, K. , 264 Bover.J.. 1371 Crary,G.S., 1295 Geberth,S., 1643 lkizler. 1. A.. 1386

Journal of the American Society of Nephrology 1689 Author Index

lmai. E., 95. 1674 Leichtman, A. B.. 165 Murphy. K. J., 1 Qiu,C.. 1476 lnuma, H. , 220 Leunissen, K. M. L., 1625 Qiu.V-V.. 1202 lsobe, K-i., 234 Levin. N. W.. 1360. 1578 Nagauker-Shriker. 0.. 102 Qunibi, W., 1439 ltakura.Y.. 1634 Levin.P.. 1578 Nakamura. H., 264 ltem.C.. 1661 Levy. P.. 102 Nakanishi, K.. 264 Pabb.H.. 1445 lzumi,M., 1674 Lew. N. L.. 75 Nast, C. C., 286 Pabkin,P., 1511 Leypoldt. J. K.. 214 Nath.K.A., 1160 Raidt,H.. 121 Jacobs,C., 1661 Li. J. P. , 295 Naylor. C. D.. 1410 Pambausek, M.. 1643 Jacquiaud. C.. 1661 Liano.F.. 144 Neilson,E.G., 1178 Ramirez,G., 1445 James. S. H., 1541 Lien, V-H. H., 1541 Pamirez, P.. 1586 Nevarez. M. , 198 Jamison. P.. 1552 lJmacher, M. C.. 1347 Neyer.U.. 110 Ramos, E. L..1 Jara,A.. 1371 Ling,J.. 75 Nigam.S.K.. 1151 Papoport. J.. 207 Jaudon. M-C. . 1661 Lipman. M. L.. 281 Nishikage, H.. 234 Paton, P., 1427 Johnson, G. P., 1682 Uewellyn-Thomas. H.. 1410 Nishio, H.. 264 Raymond.F.. 1661 1552 Johnson. P. J.. 220. 1186 Lohe,A., Nissim, I.. 269. 269 Peichert, L. J. M., 1666 Joly. M-O., 1427 Lombardozzi. S., 1170 Noble. N. A., 286 Peitinger. J.. 1 10 Lowne. E. G.. 75 G.. 257. 1291 Jungers. P.. 1634 Nomura. A.. 234 Pemuzzi. Lu.L.H.. 1511 Nonoguchi. H.. 1565 Pibeiro.E., 1151 Kaizuka. M. . 220 Luger.A.. 1434 Norling. L. L.. 1498 Richardson. P. M. A.. 1410 Kalluri, P.. 1 178 Lundin. P. A., 1 Piedl.M.. 1434 Kamada. 1.. 95. 1674 Piezler, P.. 121 Oberbauer, P., 1434 Kaneko, 1., 95 Macadam, C., 82 PftZ.E., 1643 Ochi, S., 1674 Kaplan. B. S.. 1401 Macon,E.J.. 1256 Roberts. J.. II, 1300 Odeh, P. M.. 1284 Kasiske, B. L.. 1 , 1295 MacPherson. B. P.. 171 Rodriguez, M., 1371, 1586 O’Donnell. M. P.. 1295 Katz, S. A.. 1295 Mahony, J. F.. 82 Roithinger. F. X., 1613 Ogborn, M. P.. 1649 Kaufman, A. M., 1578 Mai,B., 1592 Rotellar, C. , 136 Okada. H., 234 Kawachi, H., 1468 Majkowski, N. L. . 1309 Roth.T., 192 Okada, N., 234 Kaye. M.. 273 Malhotra. D.. 198 Ruffenach. S. J.. 1541 Onodera. K., 220 Keane,W.F.,1295 Man. N. K.. 1634 Ruggenenti. P.. 257. 1291 001, B. S., 1342 Keck, J. K.. 1230 Martin. M.. 68 Ruiz. 0. 5.. 1202 S.. 1209 Kerjaschki. D.. 35. 61 Martin-Malo. A.. 1586 Oparil. Rupp.J.C.. 1679 Kessie,G., 1439 Marumo.F., 1565 Orchard. 1. J., 1170 Russo, D., 1451 Kikkawa. P.. 1504 Mason.N.. 1284 Orlando. P. A.. 35. 61 Ortu#{241}o,J., 144 Killen, P. D.. 165 Matas.A.J.. 1160 Saddler, M. C.. 198 Osawa. H.. 220 Kim.D.. 1410 Matsuo. S.. 234 Sado, V., 264 1360 Kimmel. P. L.. 1418 Maffhie,J.P., 1684 Osheroff. P., Sadoun. P.. 1661 King.A.J.. 1304 Mauer, S. M., 1160 Saiphoo.C., 1410

Klrchgatterer. A. . 1613 Mauger. E. A., 177, 184 Pahl,M., 1371 Saito,A., 35 Kitagawa. K.. 264 Maxwell, M. P.. 1230 Pais. B.. 132 Salahudeen, A.. 1300 Kitamura, H.. 1674 Mayer, G., 1434, 1643 Pardo,V.. 1354 Salant. D. J., 1468 Kltslaar. P. J. E. H. M.. 1625 McAdams,C.. 1401 Parker. P. A., 1386 Sandstrom, D. J.. 1468 Kleta, R.. 1223 McAteer. J. A., 1230 Parnell, S. L., 1578 Sano, K.. 264 Koene. P. A. P.. 1666 McCauley. J.. 1170 Pascual,J.. 144 Sareen.S., 1649 Kohli,R., 1271 McDonald. B. P.. 48 Patel.J.A., 1284 Sasaki.S.. 1565

Konforty. A. . 207 McDonald. G. B.. 1655 Pavlakis. M.. 281 Sasaki. 1. . 220 K#{244}nig.P..110 McDowell, K. A., 1498 Pennock, V., 82 Sawaya.B.P.. 154 Koomans. H. A., 1491 McQuillan. P. F.. 1230 Peral,B., 1125 Sayegh.M.H.. 1143 Koya.D.. 1504 Memoli.B.. 1451 Pereira. B. J. G.. 1304 Schlaffer, E.. 1223

Kramar. P.. 1613 Mendelssohn, D. C., 1410 Perella. C. . 1304 Schmitz, P. G.. 295 Kronenberg. F., 110 Mendley. S. P.. 1309 Perico. N., 257, 1291 Schneditz. D., 1360 Kwon, H. M., 1559 Meng,Q.C., 1209 Perugini. L.. 1278 Schnermann,J., 154 Mercado. A.. 1354 Peters. D. J. M.. 1670 Schuster,A., 1547 Lai.J-S.. 1392 Mm. I., 1271 Peterson, P. A., 1418 Sena, P.. 198 Lan.C.. 1392 Minutolo. P., 1451 Pichler. P. H.. 1186 Senni,M., 1291 Lang,F.. 1547 Mlyata. M., 220 Pintado,O., 1586 Shaheen,A.M., 1511 Lang,U.. 110 Montoliu.J.. 132 Pinter,G., 110 Shankland. S. J., 1186 Langer. K.. 121 Moran. A., 207 Polaschegg. H. D.. 1578 Shany.S.. 102 Larson. 1. 5.. 248 Morgan, K., 198 Pollock. C. A., 82 Sharma. M.. 1242 Laville. M.. 1427 Moriyama. 1., 95. 1674 Port, F. K., 177, 184 Sherbotie, J. P., 1401 Lazarus. J. M.. 75. 1319 Morrow.J.. 1300 Pratt,R., 1552 Shigeta.V.. 1504

Leblond. V.. 1661 Mosconi, L. . 257 Preston, A. S., 1559 Shihab. F. S., 286 Leboff. M. S.. 75 Mulkerrin. E.. 1459 Pribasnig.A.. 110 Shikano. T.. 1504 LeBouc.Y.. 1427 Murata. G. H.. 198 Prince, H. N.. 1578 Silver. S. M.. 1600 Lee,S-H., 1392 Murer, H.. 1547 Prischl. F. C.. 1613 Simmens. S. J.. 1418

1690 Volume 6 ‘ Number 6 . ]995 Author Index

Simon.D., 198 Tanner. G. A.. 1230 Wagner. C. A., 1547 Vamamoto, T., 286 Sims,S., 136 Tedder, T. F., 1445 Waldegger. S., 1547 Vamauchi, A., 1559. 1674 Singer. P. A.. 1410 Teehan, B. P.. 139 Wallner, M., 1613 Vang, B-J., 1392 Singh.l.. 165 Tepel.M.. 121 Walser, M.. 1379 Ve.M.. 1242 Smith. S. P.. 54 Terada.V.. 1565 Wang, L-J..1202 Veh,l., 1552 Smoyer. W. E.. 1401 Thiel.E. C., 1410 Ward,C.J., 1125 Vokoyama. K.. 1674 Snodgrass, B., 1304 Thomson, S. C., 1482 Waugh, D. A.. 82 Voshida, F. . 234 Soucie,J.M..1256 Thornhill, B. A., 1498 Weber,M., 1178 Voshikawa, N., 264 Togawa. M.. 1504 Webster, S. K., 1216 Sovero, V.. 1463 Voung.B.A.. 1186 Spital, A., 1682 Tomita,K., 1565 Weihs, K. L., 1418 Vuill, E.. 1607 Stadler,A., 1271 Tordoir, J. H. M., 1625 Welage, L. S., 1284 Vulzari, P., 207 Stadler, I., 1271 Trachtman, H., 126 Wellons, M., 269 Vunis,E.J., 1170 Stahl, P. A. K.. 224 Tsai, T-J.. 1392 Wetzels,J.F.M., 1666 Stepanski. E.. 192 Tsunoda, S.. 220 Wheeler, D. C.. 1468 Steuer, P. P.. 214 Turka,L.A.. 1143 Wilcox, C. S., 1347 Stier, E., 1643 Tzamaloukas. A. H.. 198, 1519 Wilcox,G.E..1541 Zager.R.A., 1655 Stivelman, J, C.. 1256 Wilmore, D. W. , 75 Zebrowski, B.. 75 Stoos. B. A.. 89 Ueda, N.. 95. 1674 Wilner, K. D.. 242 Zech. P.. 1427 Strom, 1. B.,281 Uldall, P. P., 1410 Wilson.C.B.. 1178 Zeier,M., 1643 Stuart,R.O., 1151 Umana.W.O., 1418 Wingard. P. L.. 1386 Zidek,W., 121 Sugimoto. 1.. 1504 Utermann.G.. 110 Wolf, G., 224 Ziyadeh, F. N., 224 Suffon.L., 1661 Wolfe, P. A.. 177, 184 Zlotnik. M. . 102 Swan, S. K., 1295 Vaamonde, C. A.. 1354 Wood.B.. 198 Zoni,U., 1262 Swartz, P. D., 1284 Vallon, V., 1482 Zorick. F. . 192 Sweeney, W., 269 van Dijk. M. A.. 1670 Xia, C., 95 Vaziri. N. D.. 1313 Takayama. M., 1565 Veis, J. H., 1418 Vamabe, H., 220 Tamura, N., 220 Vladutiu, A., 1271 Vamada, T.. 1565

Journal of the American Society of Nephrology 1691 VOLUME 6 SUBJECT INDEX

Absorptiometry. dual-energy x-ray. nutritional assessment. 75 receptor antagonist. losartan, blood pressure reduced by. ACE inhibitor. diabetic nephropathy affected by, 1523 1295 Acetaminophen. renal failure due to, acute. 48 stimulatory effect, mechanisms of, 1202 Acidification Angiotensin-converting enzyme intracellular, peritoneal macrophage inhibition mediated antiproteinuric action, kinin necessary for, 1216 by. 207 gene polymorphism. proteinuria patients, 1674 proximal tubule, angiotensin II stimulation of, 1202 Anorexia, uremic, 1329 Acidosis Anti-GBM antibodies, 1178 diarrhea causing. elderly patients. 1463 Antibasement membrane disease. autoantigen. a3 chain of hemodialysis. phosphate clearance and calcification risk type IV collagen. 1178 Antibody, basement membrane, antiglomerular. nephrotic affected by. 1607 tubular. renal. hypokalemic. 295 syndrome related to. 1541 Antibody assay, hepatitis, C. 1439 Activation. I cell. 1143 Adenosine. renal sodium handling related to. 1491 Anticoagulation. continuous hemofiltration with, pediatric. 1401 Advance directive. hemodlalysis patient. lIfe-sustaining treat- Antifungal agent. fluconazole. pharmacokinetics. renal fail- ment preferences related to, 1410 ure. 242 Aggregation. cell. hemodialysis membrane-induced. 1586 Antigenic complex, Heymann nephritis. megalin (gp330) and Aging. hyperkalemia in, aldosterone responses to. 1459 RAP, 35 Albumin. serum Antigenic epitope, megalin. passive Heymann nephritis in- nutrition measured by. 1386 duced by, 61 protein malnutrition indicated by. 1319. 1329 Antinatriuresis. renal nerve-mediated, adenosine related to, Albuminuria, 1295 1491 Albuterol. hyperkalemia treatment. 1134 Antiproteinuric action. angiotensin-converting enzyme, kinin Aldosterone. hyperkalemia affecflng. elderly humans. necessaryfor. 1216 healthy. 1459 Apnea. sleep. peritoneal dialysis. continuous ambulatory. 192 Allograft. renal Apolipoprotein(a). phenotype, ESRD treated by dialysis. 110 dysfunction. acute, cholesterol emboli presenting as. 165 Apolipoprotein E. homozygosity. atypical hyperlipidemia and T cell receptor transcript expression. intragraft, 281 nephropathy associated with, 1170 uremic syndrome. hemolytic. recurrent. 1160 Apoptosis, cell, hemodialysis membrane-induced, 1586 cr2-Adrenoceptors. nitric oxide inhibition response deter- Arborization, collecting system. developing. 1151 mined by. rat glomerulus and proximal tubule. 1482 Arsenate. phosphate transport affected by. 1547 a3 Chain. type IV collagen. antibasement membrane dis- Atheroemboli, posttransplantation. kidney, 165 ease and Goodpasture syndrome. 1178 Atherosclerosis. 1 10. 121 a5(IV) Collagen chain gene. mutation. hematurla. nonfamil- Autoantigen, cr3 chain of type IV collagen. antibasement al, 264 membrane disease and Goodpasture syndrome. 1178 Alport syndrome. 264 Autocrine growth factor. 95 Aluminum overload. desferrioxamine treatment of. immobi- Autonomic reflex. cardiovascular. exercise improving. 1392 lized, 1271 Amiloride, 89 Barorefiex, normal, blood pressure fluctuation with, 1347 Amino acid. 1379 Betaine. uptake of. protein kinase activators inhibiting. 1559 Infusion of, 1434 Bicarbonate Amphotericin B. nephrotoxicily, membrane properties. al- intravenous. hyperkalemia treatment, 1134 tered, 154 modeling. acidosis corrected by, hemodialysis. 1607 Amyloidosis. dialysis-related. kappa and lambda light chain Binding proteins, insulin-like growth factor-i , low-protein diet deposition in amyloid filaments, 1262 affecting. chronic renal failure. 1427 Analgesic abuse. renal papillary necrosis. clinical experi- Binge drinking, NSAID use with, renal failure after, 1682 ence. 248 Biocompatibility. dialysis membrane, 1278 Anasarca, renal failure with. acute, 1541 Bloelectrical impedance analysis. nutritional assessment. Anergy. 1143 maintenance hemodialysis patients. 75 Aneurysm. intracranial. polycystic kidney disease linked to Bioimpedance, single frequency measurement of, total chromosome 4. 1670 body water and body cell mass predicted with. 1682 Angiotensin. peptides. renal, dietary salt effects. 1209 Biopsy. renal, transplant. thromboelastography for bleeding Angiotensin II prediction. 1240 cyclosporine nephropathy, pathogenesis of. 1186 Bleeding lnterleukln-#{243} release stimulated by, cultured mouse me- prediction of. thromboelastography for. posifransplant re- sangial cells, 95 nal biopsy, 1250 Na+/H+ exchange regulation. cortical collecting duct. subarachnoid, polycystic kidney disease linked to chromo- 1223 some 4, 1670

1692 Volume 6 . Number 6 . 1995 Subject Index

Blood pressure Cholesterol, emboli, allograft dysfunction mimicked by. 165 children with renal insufficiency, 126 Chromatography, liquid, high-performance, 1209 diabetic nephropathy affected by, 1523 Chromosome 4, polycystlc kidney disease linked to, intracra- extreme fluctuation. central origin. 1347 nial aneurysms in, 1670 glomerular. pregnancy. 1197 Cimino-Brescia fistula, patency of, 1613 losartan reducing. 1295 Citric acid. heated. dialyzer reprocessing with. 1578 renal failure influenced by. ADPKD. 1634 Clearance, phosphate. acidosis affecting. hemodialysis. Blood volume, circulating, determination of, 214 1607 Body water. total. bioimpedance measurement predicting, Clinical practice guidelines, renal transplant candidate eval- 1682 uatlon, 1 Bone. calcium efflux from, 273 Cloning. positional. 1125 Bone marrow, transplantation of Coagulation. thromboelastography for bleeding prediction. enzymuria after. correlate of hepatorenal syndrome. 1655 1240 renal function after, long-term. 1661 Collagen, type IV. antibasement membrane disease and Bosentan. receptor antagonist. 1476 Goodpasture syndrome. 1178 Bradykinin. 1216 Collagen chain, gene, mutation in, hematuria, nonfamilial, Brain. osmolytes in. organic. cerebral edema after rapid 264 dialysis not related to. 1600 Collecting duct Breathing. diaphragmatic. hemodialysis patients. quality of cortical. life improved by. 1392 Na+/H+ exchange regulation, 1223 Bud. ureteric, branching tubulogenesis of. 1151 sodium reabsorption inhibited in, 89 vacuolar H+-ATPase pump, absence of, 295 Ca2+-sensing receptor. cloned, renal function related to. Collecting system. development of. epithelial tubulogenesis 1530 related to, 1151 Cadaver. organ donation. cancer transmission. 54 Complement biosynthesis. impaired, nephritis patient, 1342 Calcification, acidosis affecting, hemodialysis, 1607 Complement regulatory protein, glomerulonephritis affected Calcium by. mesangial. 234 bone. Compliance efflux from, hypocalcemia related to, 273 fluid restriction, peritoneal dialysis patients. 198 mobilization of, 132 quality of life related to, hemodialysis patients. 1418 extracellular concentration. renal function related to. 1530 Contrast medium intake, children with renal insufficiency. 126 nonradloactive, plasma clearance of, glomerular filtration set point of, 1371 rate measured by. 257 Calphostin. C, 1504 renal hemodynamics and tubular function affected by. Cancer chronic renal failure. 1451 death caused by, dialysis-treated patients, 184 Cotransporfer. Na-HCO3, renal, regulation of. 1202 transmission of. cadaveric donor organs causing. 54 Creatinine. 1379 Cartridge, desferrioxamine, immobilized, aluminum overload clearance of, 242 treatment, 1271 generation of. over-predicted, noncompliance indicated Cause of death. hemodlalysis versus perltoneal dialysis, 184 by. 1519 CD28. T cell accessory molecule, 1143 transport of, adults versus children, 1309 Cell Crescents, glomerulonephritis with. fibrillary. 171 aggregation and apoptosis. hemodialysis membrane-in- Cyclosporine duced, 1586 nephropathy, pathogenesis of, roles of angiotensin II and tubular epithelial, renal, 1300 osteopontin, 1186 Cell mass. body. bioimpedance measurement predicting. nephrotoxicity. 1160 1682 posttransplantation. kidney, 165 Cell stretch-proliferation hypothesis. renal cyst enlargement. Cyst in vitro test of. 1230 fluid, lipid secretagogue. ADPKD. 1242 Cellulose dialyzer, in vitro hemodialysis with. cytokine produc- renal. enlargement of. cell stretch-proliferation hypothesis tion during. 1304 of. 1230 Cellulose triacetate hemodlalyzer. vancomycin pharmaco- Cystine, renal tubule cell loaded with, metabolic studies of, kinetics influenced by, 1284 269 Centre for Bioethics Living Will, 1410 Cystinosis, model of, cystine dimethylester. 269 Cerebrovascular disease. death caused by. dialysis-treated Cytokine. 95 patients. 184 production of, in vitro hemodialysis. 1304 Chemotherapy, high-dose, renal function after, 1661 Cytolysis, renal tubular epithelial cell. hydrogen peroxide Children induction of. 1300 hemofiltration in, continuous, determinants of survi”al in. 1401 Death renal insufficiency. growth failure, 126 cause, hemodialysis versus peritoneal dialysis. 184 Chloride, secretion, ADPKD, 1242 rate, hemodialysis versus peritoneal dialysis. 177 Cholera, diarrhea caused by, electrolyte disturbances In, Depression, hemodialysis patients, quality of life related to, elderly patients. 1463 1418

Journal of the American Society of Nephrology 1693 Subject Index

Desferrioxamine, immobilized, cartridge with, aluminum over- Enzyme load treatment, 1271 angiotensin-converting Diabetes mellitus, 110 antiproteinuric action, kinin necessary for, 1216 renal papillary necrosis, clinical experience, 248 gene polymorphism, proteinuria patients. 1674

type 1 . nephropathy. medical management. 1523 energy metabolism. muscle fiber, chronic renal failure af- Diadenosine polyphosphates, Na+/H+ exchange regula- fecting, 68 tion, cortical collecting duct, 1223 Enzymuria, bone marrow transplantation preceding. corre- Dialysate late of hepatorenal syndrome. 1655 low-calcium. parathormone secretions stimulated by, 132 Epinephrine, hyperkalemia treatment, 1134 perttoneal. macrophage inhibition, 207 Epithelium, renal, tubulogenesis in, 1 151 Dialysis. see also Hemodialysis Epitope access graft, thrombosed, thrombolysis versus surgery, 1619 antigenic, megalin, passive Heymann nephritis induced by, amyloldosis related to, kappa and lambda light chain 61 deposition in amyloid filaments, 1262 nephritogenic. RAP, 61 complicatIons of. 1278 Equilibration test countercurrent, continuous hemofiltration with, pediatric. peritoneal. 198 1401 age differences. 1309 initiation, objective criteria, 1319 Ethics, medical, advance directives for hemodialysis pa- rapid, cerebral edema after, brain organic osmolytes not tients, 1410 related to, 1600 Exchange. Na+/H+, regulation in cortical collecting duct. survival on. 1223 chronic renal failure patients, diet affecting. 1379 Excretion, urinary. j32-microglobulin, membranous nephropa- inner-city facility. large. 1256 thy patients, renal outcome predicted by. 1666 Dialyzer. cellulose. in vitro hemodialysis with, cytokine pro- Exercise. breathing-coordinated, hemodialysis patients ben- duction during. 1304 efitted by, 1392 Dialyzer reprocessing. citric acid for, heated, 1578 Diarrhea. cholera-caused, electrolyte disturbances in. elderly F2-lsoprostane. production of, aminosteroid-inhlbitable, hy- patients. 1463 drogen peroxide induction of, 1300 Diet Fanconi syndrome. 269 low-protein Fibronectin, extradomain A positive. 286 insulin-like growth factor-i and Its binding proteins during, Fibrosis, interstitial, 1 186 chronic renal failure. 1427 Filament, amyloid, kappa and lambda light chain deposition membranous nephropathy treated by. 136 in. dialysis-related amyloidosis, 1262 supplemented. predialysis, 1379 Filter. life span, pediatric continuous hemofiltration treat- protein intake. modification of, polycystic kidney disease ment, 1401 ameliorated by. rat. 1649 Fish oil, renal injury and hyperlipidemia ameliorated by. focal Disequilibrium syndrome. dialysis. 1600 glomerulosclerosis rat model, 1468 Disinfection, dialyzer, citric acid for, heated, 1578 Fistula, arteriovenous, 1613 Divalent mineral metabolism. children. 126 anastomotic intimal hyperplasia in, initial high flow velocity Drug abuse. analgesic, renal papillary necrosis, clinical expe- related to, 1625 rience. 248 Fluconazole, pharmacokinetics, renal failure, 242 Drug overdose, acetaminophen, renal failure due to, 48 Fluid Dual-energy x-ray absorptiometry. nutritional assessment, 75 cyst. lipid secretagogue, ADPKD. 1242 Duct, cortical collecting. sodium reabsorption inhibited in, 89 secretion. ADPKD, 1242 Fluid overload. pediatric continuous hemofiltration treat- ment, 1401 Edema, cerebral, rapid dialysis preceding. 1600 Fluid restriction. noncompliance, peritoneal dialysis patients. Editorial, continuous ambulatory peritoneal dialysis-quo va- 198 dis?, 139 Fluid retention, symptomatic. peritoneal dialysis, continuous, Elderly 198 electrolyte disturbances in, diarrhea causing. 1463 Formaldehyde. cellulose dialyzer reprocessed with, 1304 healthy. hyperkalemia in, aldosterone responses to. 1459 FxiA model, Heymann nephritis, passive. 1197 renal failure In. acute. 144 Electrolytes. disturbances in, diarrhea causing, elderly pa- G protein, angiotensin II stimulation of, 1202 tients.1463 Gender. renal failure influenced by. ADPKD, 1634 Emboli, cholesterol, allograft dysfunction mimicked by. 165 Gene. collagen chain. mutation in. hematuria, nonfamilial, Endothelin. 1565 264 pressor actions modulated by. nitric oxide blockade, 1476 Gene expression. insulin-like growth factor-i system, renal, tyrosine phosphorylation stimulated by, p125 focal adhe- rat. 1511 sion kinase, mesangial cell. 1504 Gene polymorphism, angiotensin I-converting enzyme, pro- Energy metabolism. muscle fiber, chronic renal failure affect- teinuria patients, 1674 ing, 68 Glomerular basement membrane, 264 Enlargement. renal cyst. cell stretch-proliferation hypothesis Glomerular fittration rate. iohexol plasma clearance as mea- of. 1230 sure of, nonradioactive, 257

1694 Volume 6 . Number 6 . 1995 Subject Index

Glomerular growth. 224 hematocrit monitoring during. blood volume determined Glomerular sclerosis, 1295 by, 214 Glomerulonephritis. 95. 1178 hepatitis C virus infection in, 1439 crescentic , membranous glomerulonephropathy with, immunoglobulin light chains, polymorphonuclear leuko- acute renal failure due to. 1541 cyte function affected by, 1592 fibrillary, hypocomplementemia with, 171 maintenance membranoproliferative, hepatitis C infection, Japan. 220 nutritional assessment, bioelectrical impedance analysis. membranous. 61 75 mesangial. complement regulatory protein affecting, 234 prognostic marker, total body nitrogen, 82 Glomerulonephropathy. membranous membrane glomerular hemodynamic effects of late pregnancy. 1197 blood exposure to, nitric oxide production enhanced by, renal failure in, acute. 1541 1278 Glomerulopathy. immunotactoid, 171 cell aggregation and apoptosis induced by, 1586 Glomerulosclerosis. 224 mortality. 177 apolipoprotein E homozygosity with, 1170 nutrition and mortality. 1329 focal. rat model of. fish oil ameliorating renal injury and parathyroid hormone secretion , dynamics. 1371 hyperlipidemia in, 1468 prosthetic arteriovenous fistulas for. anastomotic intimal focal segmental, open renal biopsy revealing, 1354 hyperplasia in, initial high flow velocity related to, 1625 Glomerulus. nitric oxide inhibition in, a2-adrenoceptors deter- quality of life, 1418 mine response to, 1482 L-selectin (CD 62L) in. soluble and leukocyte. 1445 Glucose. transport of. adults versus children, 1309 survival. inner-city facility, large. 1256 Glycoprotein, sulfated, mRNA, abnormal expression of, AD- treatment preferences, life-sustaining. advance directives PKD, rat, 1679 related to, 1410 Goodpasture syndrome, autoantigen. a3 chain of type IV urea clearance during. intercompartmental, 1360 collagen, 1178 vascular access, patency of, 1613 Graft vascular disease risk, hyperhomocysteinemia , 121 access. dialysis. thrombosed . thrombolysis versus surgery, Hemodialyzer. cellulose triacetate. vancomycin pharmaco- 1619 kinetics influenced by, 1284 heart, rejection of, acute, 1291 Hemodynamics polytetrafluoroethylene, patency of. 1613 glomerular. late pregnancy, 1197 Growth factor renal, contrast media affecting, chronic renal failure, 1451 epidermal. abnormal expression of, ADPKD. rat. 1679 Hemofiltration, continuous. pediatric. determinants of survival insulin-like. in, 1401 binding proteins of, low-protein diet affecting. chronic Hepatitis C renal failure, 1427 glomerulonephritis. membranoproliferative, Japan. 220 nutrition measured by. 1386 renal, genes encoding, 1511 virus infection. hemodialysis patients. 1439 Hepatorenal syndrome, veno-occlusive disease-induced, tubulogenesis and branching enhanced by, 1151 1655 Growth failure, children with renal insufficiency. 126 Growth hormone Heymann nephritis deficiency of, adult, 1434 antigenic complex. megalin (gp330) and RAP, 35 human, recombinant, prolonged substitution of, renal passive functional reserve affected by, 1434 accelerated, Fx1A model, 1197 Guanosine monophosphate, cyclic. 1498 megalin antigenic epitope inducing. 61 Guanylyl cyclase activity. glomerular soluble, ureteral ob- Homozygosity, apolipoprotein E. atypical hyperlipidemia and struction increased by. unilateral, 1498 nephropathy associated with. 1170 Hormone. see Growth hormone, Parathormone, Parathyroid hormone Heart, transplantation of, intrathymic injection of donor cells Host immune deficiency. immune complex nephritis. 1342 to prevent rejection. 1291 Hydration. diarrhea treated by. elderly patients, 1463 Hematocrit. continuously monitored, blood volume deter- Hydrogen peroxide, aminosteroid-inhibitable F2-isoprostane mined by. 214 production and cytolysis induced by, renal tubular Hematuria. nonfamilial. a5(lV) collagen chain gene muta- epithelial cells, 1300 tion. 264 1 a Hydroxyvitamin D3. superoxide generation elevated by. Hemodialysis. see also Dialysis mononuclear phagocyte, 102 acidosis in, phosphate clearance and calcification risk Hypercalcemia. hypocalciuric. familial, 1530 affected by, 1607 Hyperglycemia, 198 breathing-coordinated exercise during, quality of life im- Hyperhomocysteinemia , vascular disease risk, hemodialysis proved by. 1392 patients, 121 cause of death, 184 Hyperkalemia cytokine production during, 1304 aldosterone responses to. elderly humans. healthy. 1459 dialyzer reprocessing, citric acid for, heated, 1578 ESRD, mechanisms and management. 1134 ESRD treated by. lipoprotein phenotypes in, 110 Hyperlipidemia fluconazole pharmacokinetics. 242 atypical. apolipoprotein E homozygosity with, 1170

Journal of the American Society of Nephrology 1695 Subject Index

fish oil ameliorating. focal glomerulosclerosis rat model. Keto acids, 1379 1468 supplementation with. bow-protein diet with, insulin-like Hyperparathyroidism growth factor-i and its binding proteins during. 1427 secondary Kidney. see also Renal hemodialysis patients with. parathyroid hormone secre- aging. changes. 144 tion dynamics in, 1371 angiotensin peptides in, dietary salt effects, 1209 low-calcium dialysate worsening. 132 cadaveric, cancer transmission due to, 54 severe. neonatal. 1530 cystic, complexity, 1125 Hyperplasia. intimal, anastomotic. prosthetic arteriovenous development of, branching. 1151 fistulas for hemodialysis. 1625 rat. natriuretic peptide B receptor and C-type natriuretic Hypertension. 1209 peptide in. 1552 capillary. glomerular. pregnancy. 1197 tubular epithebial cells. 1300 children. 126 Kidney transplantation. see Transplantation. kidney primary. familial. ADPKD prognosis in. 1643 Kinetics. mononuclear phagocyte. 102 severe, hypotension alternating with, 1347 Kinin, angiotensin-converting enzyme antiproteinuric action Hypoalbuminemia. 1379 dependent on, 1216 Hypoaldosteronism, elderly, 1459 Hypocalcemia Lambda light chain, amyloid filament deposition. dialysis- parathyroid hormone secretion dynamics in. 1371 related amyloidosis. 1262 phosphate load preceding. reduced calcium effiux from Leukocyte bone, 273 injection of, intrathymic. 1291 Hypocomplementemia. glomerulonephritis with. fibrillary. 171 polymorphonuclear, immunogbobulin light chains affect- Hypotension. profound. hypertension alternating with. 1347 ing. 1592 Hypothesis, cell stretch-proliferation. renal cyst enlargement, surface L-selectin, hemodialysis patient, 1445 In vitro test of, 1230 Light chain Hypovolemia, dialysis-induced, 214 immunoglobulin. hemodialysis patient, polymorphonuclear leukocyte function affected by, 1592 Immune deficiency. host, immune complex nephritis. 1342 kappa and lambda, amyloid filament deposition. dialysis- Immunoblot assay. recombinant. 1439 related amyloidosis. 1262 lmmunocytochemistry. 295 Lipid peroxidation. 1300 Immunoglobulin Lipid secretagogue, cyst fluid, ADPKD. 1242 M. 1439 Lipoprotein(a). phenotype, ESRD treated by dialysis. 110 production of, defective, nephritis patient. 1342 Liverfailure, 1655 Immunoglobulin light chains. hemodialysis patient, polymor- Living will. see Advance directive phonuclear leukocyte function affected by. 1592 Losartan. 1498 lmmunosuppression. T cell costimulatory pathways, 1143 blood pressure reduced by, 1295 Impedance analysis. bioelectrical. nutritional assessment. Lymphomonocyte. dialysis membrane interaction with. 1278 maintenance hemodialysis patients. 75 Infection Macrophage, 1342 death caused by. dialysis-treated patients. 184 infiltration of. 1 186 hepatitis C. glomerulonephritis. membranoproliferative. Ja- peritoneal, dialysate inhibiting. 207 pan. 220 Madin-Darby canine kidney. 1230. 1242 Inhibition. peritoneal macrophage. peritoneal dialysate. 207 Malnutrition Inhibitor. angiotensin I-converting enzyme. susceptibility to, chronic renal failure patient, 1386 proteinuria patients, 1674 dialysis initiation, prognosis. 1319 Injection, Intrathymic. donor cell. 1291 protein-energy. maintenance hemodialysis. 1329 Insomnia, peritoneal dialysis. conlinuous ambulatory. 192 MAPK-K and MAP-K, nephron segment. rat, 1565 Insulin, intravenous. hyperkalemia treatment, 1134 Matrix protein. expression of. kidney transplant rejection, 286 Interleukin, 1304 MDCK cell. myo-inositol and betaine uptake in. protein ki- release from mesanglal cells, angiotensin II stimulating, 95 nase activators inhibiting, 1559 Inulin. renal clearance. glomerular filtration rate measured Medical directive. see Advance directive by. 257 Megalin (gp330) lohexol. nonradloactive. plasma clearance of, glomerular antigenic complex. Heymann nephritis. 35 filtration rate measured by. 257 antigenic epitope. passive Heymann nephritis induced by. Irradiation. total body, renal function after, 1661 61 Membrane Japan. hepatitis C infection and membranoproliferative gb- dialysis, 1278 merulonephrltis. 220 hemodialysis. cell aggregation and apoptosis induced by. 1586 Kallikrein. 1216 permeability. altered, 154 Kappa light chain, amyloid filament deposition. dialysis-re- Mesangial cell lated amyloidosis, 1262 interleukin-o release from, angiotensin II stimulating, 95 Kegel’s exercise, hemodialysis patients. quality of life im- p125 focal adhesion kinase, tyrosine phosphorylation of. proved by. 1392 endothelin-i stimulation of, 1504

1696 Volume 6 . Number 6 . 1995 Subject Index

transforming growth factor-p expression , atrial natriuretic low-protein diet. 136 peptide stimulating, 224 toxic, 269 Metabolism Nephrosis, minimal change, 220 energy. muscle fiber, chronic renal failure affecting, 68 Nephrotic syndrome, 1216 mineral, divalent, 126 acute renal failure with, differential diagnosis. 1541 renal tubule cells, cystine-loaded. 269 ADPKD, 1354 urate, chronic experimental renal insufficiency affecting. apolipoprotein E homozygosity with, 1170 1313 fish oil ameliorating, focal glomerubosclerosis rat model, Microcirculation, peripheral. breathing-coordinated exercise 1468 improving. 1392 32-microglobulin urinary excretion in. 1666 132-Microglobulin. urinary excretion of. membranous ne- Nephrotoxicity. amphotericin B. membrane properties. al- phropathy patients, renal outcome predicted by. 1666 tered, 154 Milan normotensive rat model, focal glomerubosclerosis, fish Nitric oxide oil ameliorating renal injury and hyperlipidemia in, 1468 blockade, acute systemic, pressor actions of, endothelin Mineral metabolism. divalent, children. 126 modulating. 1476 Model, cell membrane and regional blood flow, two pool enhanced production of. blood-dialysis membrane inter- urea kinetic, 1360 action for, 1278 Monocbonal antibody, 234 inhibition, a2-adrenoceptors determine response to, rat Monocyte gbomerulus and proximal tubule, 1482 activation of, 1586 sodium reabsorption inhibited by. cortical collecting duct, function, aberrant, 1342 89 Morphogenesis, branching. epithelial tubulogenesis through, Nitrogen, total body, prognostic marker. maintenance he- 1151 modialysis. 82 Mortality Noncompliance, CAPD, test for, excess of estimated over- dialysis predicted creatinine generation. 1519 chronic renal failure patients, diet affecting, 1379 NSAID use. binge drinking with, renal failure after, 1682 inner-city facility. large, 1256 Nutrition, chronic renal failure patient. 1386 hemodialysis patients, nutrition related to, 1329 Nutritional assessment hemodialysis versus peritoneal dialysis. 177 bioelectrical impedance analysis, maintenance hemodial- Muscle fiber. energy metabolism, chronic renal failure affect- ysis patients, 75 ing, 68 total body nitrogen. maintenance dialysis, 82 Mutation, a5(lV) collagen chain gene, hematuria, nonfamil- Nutritional status, dialysis survival related to, inner-city facility. ial, 264 1256 myo-lnositol. uptake of. protein kinase activators inhibiting. 1559 Occlusion, vascular graft, 1619 Myocardial infarction, acute, death caused by. dialysis- Omega-3 fatty acids. renal injury and hyperlipidemia ame- treated patients. 184 liorated by, focal glomerulosclerosis rat model. 1468 Organ donation, cadaveric, cancer transmission due to, 54 Na+/H+ exchange, regulation in cortical collecting duct, Osmolytes 1223 compatible. 1559 Na-HCO3 cotransporter, renal, regulation of, 1202 organic. brain, cerebral edema after rapid dialysis not Natriuresis, direct, adenosine related to, 1491 related to, 1600 Natriuretic peptide, B receptor and C-type, rat kidney, 1552 Osteopontin, cycbosporine nephropathy, pathogenesis of, Necrosis. papillary, renal, clinical experience, 248 1186 Nephritis Overdose, acetaminophen. renal failure due to. 48

anti-Thy-i . 234 Overload, aluminum, desferrioxamine treatment of, immobi- immune complex, host immune deficiency, 1342 lized, 1271 lupus, 220 Oxidase cytosolic factor P47, vitamin D affecting. 102 Nephritogenic epitope. RAP. 61 Oxygen free radicals, 1300 Nephron. kidney. number of. 1151 Nephron segment, rat, Raf-i-K (kinase). MAPK-K, MAP-K. and p125 focal adhesion kinase, tyrosine phosphorylation of. 56-K in, regulation of, 1565 endothelin-i stimulation of, mesangial cell. 1504 Nephron transport. nitric oxide effects, 89 Papillary necrosis, renal, clinical experience, 248 Nephropathy Parathormone, secretion of, low-calcium dialysate stimulat- apolipoprotein E homozygosity with. 1170 ing. 132 contrast media-induced, chronic renal failure, 1451 Parathyroid gland, 1530 cycbosporine, pathogenesis of, roles of angiotensin II and activity of, hypocalcemia with, 273 osteopontin. 1186 Parathyroid hormone

diabetes mellitus. type 1 . medical management. 1523 secretion dynamics, hemodialysis patient. 1371 immunoglobulin A, 220 secretion of, low-calcium dialysate affecting. 132 membranous, 220 Parenteral nutrition, intradialytic. 1329 Heymann nephritis as model. 35 Patency, vascular access, hemodialysis patients, 1613 idiopathic. renal outcome in, 132-microglobulin urinary Pathogenesis. nephropathy. cycbosporine, roles of angioten- excretion predicting, 1666 sin II and osteopontin. 1186

Journal of the American Society of Nephrology 1697 Subject Index

Pathway. costimulatory. T cell, 1143 Polycystin. cell-matrix communication, role in, 1125 Peptide Polymerase chain reaction, 1565 angiotensin. renal, dietary salt effects, 1209 Polymorphism, gene. angiotensin I-converting enzyme. pro- natriuretic teinuria patients, 1674 atrial. transforming growth factor-a expression. 224 Potassium, increased B receptor and C-type. rat kidney. 1552 aldosterone responses to, elderly humans, healthy. 1459 Perfusion, peripheral. delayed transport due to. experimental ESRD. 1134 models showing. 1360 Pregnancy. late, gbomerular hemodynamic effects, 1197 Peritoneal dialysis Prognosis ambulatory. continuous, 82, 207 ADPKD. hypertension affecting. familial primary, 1643 death risk, 139 renal failure, acute, elderly patient. 144 ESRD treated by. lipoprotein phenotypes in. 110 vascular access patency, hemodialysis patients, 1613 fluid retention in, 198 Prognostic marker. total body nitrogen, maintenance hemo- immunoglobulin light chains, polymorphonuclear leuko- dialysis. 82 cyte function affected by. 1592 Proliferation, cell. renal cystic disease, 1230 noncompliance In, test for. excess of estimated over- Prostaglandins. 1300 predicted creatinine generation. 1519 Prosthesis, arteriovenous fistula, anastomotic intimal hyper- sleep disorders. 192 plasia in, 1625 cause of death, 184 Protein cycling. continuous, fluid retention in, 198 complement regulatory. glomerulonephritis affected by, mortality. 177 mesangial. 234 peritoneal equilibration test curves in, adults versus chil- dietary, restriction. 1319 dren, 1309 insulin-like growth factor-binding. 1511 Peritoneal equilibration test. age differences. 1309 Protein intake, dietary Peritonitis, 198 modification of, polycystic kidney disease ameliorated by, Permeability, membrane, altered, 154 rat, 1649 Phagocyte. mononuclear, 1a hydroxyvitamin D3 treatment renal failure influenced by. ADPKD, 1634 of. elevated superoxide generation due to. 102 spontaneous. chronic renal failure progression related to, Pharmacokinetics 1386 fluconazole. renal failure, 242 Protein kinase, 1504 vancomycin. cellulose triacetate hemodialyzer influence activators. myo-inositol and betaine uptake inhibited by. on. 1284 MDCK cell. 1559 Phenotype. Iipoprotein(a) and apolipoprotein(a). ESRD Protein restriction treated by dialysis. 110 dietary Pheochromocyfoma, blood pressure fluctuation without, chronic renal failure patient. 1386 1347 diabetic nephropathy affected by. 1523 Phosphate insulin-like growth factor-i and its binding proteins during, acute load, hypocalcemia after, 273 chronic renal failure, 1427 clearance of, acidosis affecting. hemodialysis. 1607 predialysis, survival related to, 1379 transport. 1547 Proteinuria. 1216 Phosphodiesterase. 1498 angiotensin I-converting enzyme inhibitors in. 1674 Phospholipase C. inhibitor, 1202 low-protein diet for, 136 Phosphonoformic acid, phosphate transport affected by. massive, pregnancy, 1197 1547 nephrotic syndrome with, renal disease accelerated by. Phosphoramidon. 1476 1354 Phosphorus, intake, children with renal insufficiency, 126 Proton pump. 295 Pituitary. dysfunction of, 1434 Proximal tubule, nitric oxide inhibition in, a2-adrenoceptors PKD1 gene. location, 1125 determine response to, 1482 Plasma clearance. iohexol. nonradioactive. gbomerular filtra- Pump. H+-ATPase. vacuolar, absence of, 295 tion rate measured by. 257 Plasmapheresis, intensive, 1160 Quality of life Plasminogen activator inhibitor. 286 hemodialysis patients. 1418 Polycystic kidney disease breathing-coordinated exercise benefitting. 1392 amelioration of, dietary protein intake modification for. rat. 1649 Race, children with renal insufficiency, 126 autosomal dominant Raf-i-K (kinase). nephron segment, rat, 1565 epidermal growth factor and sulfated glycoprotein RAP. see Receptor-associated protein SGP-2 mRNA in. 1679 Rat lipid secretagogue in cyst fluid of, 1242 spontaneously hypertensive. 1209 nephrotic syndrome in. 1354 Zucker. obese. 1295 primary defect. identification and analysis. 1125 Rat model. Milan normotensive, focal gbomerulosclerosis. fish renal failure in, progression of, 1634 oil ameliorating renal injury and hyperlipidemia in, 1468 renal prognosis In. hypertension affecting. 1643 Rebound, vancomycin serum concentration, postdialysis. chromosome 4 linked, Intracranial aneurysms in, 1670 1284

1698 Volume 6 ‘ Number 6 #{149}1995 Subject Index

Receptor bone marrow transplantation survivors, long-term. 1661 Ca2-sensing. cloned, renal function related to, 1530 calcium effects on, extracellular, 1530 insulin-like growth factor-i , 151 1 impairment of, rapid. 1354 natriuretic peptide. rat kidney. 1552 minimal, hypocalcemia with, 273 Receptor antagonist, angiotensin II, losartan, blood pressure Renal functional reserve, recombinant human growth hor- reduced by. 1295 mone substitution affecting. prolonged. growth hor- Receptor-associated protein mone-deficient adults, 1434 Heymann nephritis antigenic complex, 35 Renal injury nephritogenic epitope. 61 fish oil ameliorating. focal glomerulosclerosis rat model, Recirculation, two pool urea kinetic models studying. 1360 1468 Reflex, autonomic, intact. extreme blood pressure fluctuation losartan not affecting, 1295 with, 1347 Renal insufficiency Rehabilitation, hemodialysis patients, quality of life related to, children, growth failure, 126 1418 chronic experimental. urate metabolism affected by. 1313 Rejection Renal nerve. antinatriuresis mediated by, adenosine rebated allograft. acute, 1160 to. 1491 heart, intrathymic injection of donor cells to prevent, 1291 Renal papillary necrosis, clinical experience, 248 kidney transplant. 281 Renal sodium handling. adenosine rebated to. 1491 renal allograft. 286 Renal toxicity, amphotericin B. 154 Renal biopsy, transplant, thromboelastography for bleeding Renal tubular acidosis, hypokalemic, 295 prediction. 1240 Renal tubule cell, cystine-loaded. metabolic studies of, 269 Renal cyst. enlargement of, cell stretch-proliferation hypoth- Renalin. cellulose diabyzer reprocessed with, 1304 esis of, 1230 Renin-angiotensin system. 1209, 1295 Renal cystic disease, cell stretch-proliferation hypothesis of, Reprocessing, dialyzer, 1304 1230 citric acid for, heated, 1578 Renal disease Reserve, renal functional. prolonged recombinant human end-stage growth hormone substitution affecting. growth hor- cause of death. 184 mone-deficient adults, 1434 diabetic nephropathy. medical management, 1523 Restless legs syndrome, peritoneal dialysis, continuous ambu- dialysis survival, inner-city facility, 1256 latory, 192 hyperkalemia in, mechanisms and management. 1134 Reverse transcription. 1565 lipoprotein(a) and apolipoprotein(a) phenotypes in. 110 Ribonucleic acid, messenger. sulfated glycoprotein SGP-2. mortality, 177 abnormal expression of, ADPKD, rat, 1679 peritoneal dialysis treatment. continuous ambulatory. sleep disorders in, 192 56-K. nephron segment. rat, 1565 progression to, 1354 Salt, dietary. angiotensin peptides affected by, 1209 quality of life during. 1418 Salt restriction, noncompliance, peritoneal dialysis patients, progressive. dialysis initiation. 1319 198 Renal failure Sclerosis. see also Glomeruboscberosis acute, 1655 tuberous, polycystic kidney disease with, childhood, 1125 acetaminophen ingestion causing. 48 Secretagogue. lipid. cyst fluid, ADPKD. 1242 binge drinking and NSAID use causing. 1682 Secretion elderly patient, 144 parathormone, low-calcium dialysate stimulating, 132 membranous glomerulonephropathy, crescentic gb- parathyroid hormone, hemodialysis patient, 1371 merulonephritis causing. 1541 L-Sebectin (CD 62L). surface, soluble and leukocyte. hemodi- pediatric continuous hemofiltration treatment, 1401 alysis patient. 1445 prerenal. 144 Sickle cell disease, renal papillary necrosis, clinical experi- chronic ence. 248 children, growth failure, 126 Sj#{244}gren’ssyndrome. 295 contrast media in, renal hemodynamics and tubular Sleep disorder, peritoneal dialysis, ambulatory. continuous, function affected by. 1451 192 dialysis initiation, 1319 Social support. hemodialysis patients. 1418 diet affecting, supplemented low-protein predialysis. Sodium 1379 conservation of, intact, extreme blood pressure fluctuation dietary protein intake modification for, 1649 with, 1347 insulin-like growth factor-i and its binding proteins during. flux, 89 low-protein diet affecting. 1427 handling, renal, adenosine related to, 1491 muscle fiber energy metabolism affected by. 68 intake, children with renal insufficiency, 126 progression of, spontaneous dietary protein intake dur- reabsorption. nitric oxide inhibiting. cortical collecting ing. 1386 duct, 89 fluconazobe, pharmacokinetics. 242 Somatomedin, 1511 hyperhomocysteinemia, vascular disease risk, 121 Staurosporine. 1504 progression of, ADPKD, 1634 Substitution therapy, recombinant human growth hormone, Renal function 1434

Journal of the American Society of Nephrology 1699 Subject Index

Superoxide generation. elevated, mononuclear phagocyte, Tubulogenesis, epithelial. branching morphogenesis effect- la hydroxyvitamin D3 treatment. 102 ing. 1151 Surface L-selectin (CD 62L), soluble and beukocyte, hemodi- Tububointerstitial disease, 1295 alysis patient. 1445 Tubulointerstitium, renal, physiology of, diet altering. 1649 Survival Tumor necrosis factor. 207 dialysis Tyrosine phosphorylation. p125 focal adhesion kinase, endo- chronic renal failure patients. diet affecting. 1379 thelin-i stimulation of, mesangial cell, 1504 inner-city facility. large. 1256 pediatric continuous hemofiltration. determinants of, 1401 Ultrafiltration continuous hemofiltration with. pediatric. 1401 T cell peritoneal. inadequate, 198 costimulatory pathway. 1143 Urate. metabolism of, chronic experimental renal insuffi- receptor, transcript expression. intragraft. renal albograft, ciency affecting, 1313 281 Urea Thrombectomy. dialysis access graft. 1619 brain-to-plasma gradient. dialysis disequilibrium syndrome Thromboelasfography. bleeding prediction wfth. posttrans- related to. 1600 plant renal biopsy, 1250 clearance of. intercompartmentab, hemodialysis. 1360 Thrombolysis. dialysis access graft, 1619 rebound of, Iwo pool urea kinetic models studying. 1360 Thymic tolerance. intrathymic Injection of donor cells to Uremia. 68, 273 prevent rejection. 1291 symptoms. dialysis initiation, 1319 Tolerance induction. T cell costimulatory pathways, 1143 Uremic syndrome. hemobytic. recurrent, 1160 Total body nitrogen. prognostic marker. maintenance hemo- Ureteral obstruction. unilateral, guanylyl cyclase activ’rty in- dialysis. 82 creased by. glomerubar soluble. 1498 Toxicity, aluminum. desferrioxamine treatment of, immobi- Uricase, activity of, renal insufficiency affecting. 1313 llzed, 1271 Urinary sodium. chronic renal failure patients. 1451 Transcript expression, T cell receptor. intragraft. renal ab- Urinary tract infection. renal papillary necrosis, clinical expe- lograft. 281 rience, 248 Transcription, reverse, 1565 Urinary tract obstruction, renal papillary necrosis. clinical Transforming growth factor-3 expression experience. 248 atrial natriuretic peptide stimulating, 224 matrix protein. kidney transplant rejection. 286 Vacuobar H+-ATPase pump. collecting duct, absence of, 295 Transplantation Vancomycin. pharmacokinetics of, cellulose triacetate he- bone marrow modialyzer influence on. 1284 enzymuria after. correlate of hepatorenal syndrome, Vascular access, patency of, hemodialysis patients, 1613 1655 Vascular disease, risk of. hemodiabysis patients. hyperhomo- renal function after, long-term. 1661 cysteinemia and, 121 heart, intrathymic injection of donor cells to prevent rejec- Vascubopathy. posffransplantation, kidney. 165 tion, 1291 Vasoactive peptide. 95, 1504 kidney Vasoconstriction. nephrotoxicily, amphotericin B. 154 allograft dysfunction after. cholesterol embobi presenting Vasodilation, 1498 as, 165 Vasopressin. Na+/H+ exchange regulation. cortical collect- biopsy, thromboebastography for bleeding prediction. ing duct, 1223 1240 Velocity, prosthetic arteriovenous fistula, anastomotic intimal cancer transmission, cadavenc donor organs causing, hyperplasia in. 1625 54 Veno-occlusive disease, hepatorenab syndrome induced by. candidate evaluation. clinical practice guidelines. 1 1655

rejection. 281 . 286 Virus. hepatitis C infection. hemodialysis patients. 1439 uremic syndrome. hemolytic. recurrent, 1160 Vitamin D. superoxide generation elevated by. mononuclear T cell coslimulatory pathway. 1143 phagocyte. 102 Transport, P. electrogenic, human renal brush border Na+/P1 transporter, 1547 Water diuresis. chronic renal failure patients. 1451 Tubular acidosis. renal. hypokabemic. 295 Well-being. psychological. hemodiabysis patients. 1418 Tubular function, contrast media affecting, chronic renal Withdrawal, dialysis, death caused by, 184 failure. 1451 Tubular necrosis, acute. 144 Xanthine oxidase. activity of. renal insufficiency affecting. acetaminophen causing. 48 1313

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Patients should be advised to take Neoral on a consistent schedule with regard o time e ay and NoiL#{174} SoftGelatin Capsules (cyc!osporine capsulesfor microemulsion) relation to meals. NoiL Oral Solution(cyclosporine oral solutionfor microemulsion) Laboratory Tests: Renal and liver functions should be assessed repeatedly by measuremen ‘f BUN, serum creatinine, serum bilirubin, and liver enzymes. Caution: Federal law prohibits dispensing without prescription. BRIEF SUMMARY: Please ee package insert for full prescribing information. Drug Interactions: All of the individual drugs cited below are well substantiated to inferac: with cyclosporine. WARNING: Only physicians experienced in immunosuppressive therapy and management of organ Drugs That May Potentiate Renal Dysfunction trl!1JitlP!I1tiffltIiiitiIilj’rifflt’NoriI5rin t-iciiinilicni thvHIPmniin facilities equipped and staffed with adequate laboratory and supportive medical resources. The Anlibiottct ______Anttfungal ______Gasfrontttsftna! Agents physician responsible for maintenance therapy should have complete information requisite for the gentamicin cimetidine follow-up of the patient. tobramycin B ranitidine NeoraP may be administered with other immunosuppressive agents. Increased susceptibility to in vancomycin Attti’inflatttstatory Drugs Itttrtttutostippressizxs fection and the possible development oflymphoma and other neoplasms may resultfrom the degree trimethoprim with sulfamethoxazole tacrolimus of immunosuppression. A?tti?tt’oplastics on melphalan Neoral Soft Gelatin Capsules (cyclosporine capsules for microemulsion) and Neoral Oral Solution (cyclosporine oral solution for microemulsion) have increased bioax’ailabilily in comparison to Careful monitoring of renal function should be practiced when NeoraP is used with nephrotoxic drugs. Sandimmune Soft Gelatin Capsules (cyclosporine capsules. USP) and Sandimmune’ Oral Solution Drugs That Alter Cyclosporine Levels: Cyclosporine is extensively metabolized. Cyclosporine concentra- (cyclosporine oral solution, USP). Neoralr and Sondimmune are not bioequivalent and cannot be tions may be influenced by drugs that affect microsomal enzymes. particularly cvtochrome P454) Ill-A. used interchangeably without physician supervision. It is recommended that cyclosporine blood Substances that inhibit this enzyme could decrease metabolism and increase cvclosporine concentrations. concentrations be monitored in patients taking Neoral’ and that dose adjustments be made in order Substances that are inducers ofcytochrome P-450 activity could increase metabolism and decrease to avoid toxicity’ due to high concentrations and possible organ rejection due to low concentrations. cyclosporine concentrations. Monitoring ofcirculating cvclosporine concentrations and appropriate For a given trough concentration, cyclosporine exposure will be greater with Neoralv than with NeoraP dosage adjustment are essential when these drugs are used concomitantly. Sondimmune. Ita patient who is receiving exceptionally high doses ofSandimmune’ is converted to Neorair, particular caution should be exercised. Comparison otblood concentrations in the pub’ Drugs That 1nczra Cyclosporine Concentrations lished literature with blood concentrations obtained using current assays must be done with detailed Calcium Cha,tne) Anfifuitga! Antibtotics Gluccvorttcouis Other Drugs knowledgeoftheassay methodsemployed. Blxkers fluconazole ithmycin methylprednisolone allopurinol INDICATIONS AND USAGE: Neoral! is indicated for the prophylaxis oforgan rejection in kidne diltiazem itraconazole ervthromycin bromocriptine liver. and heart allogeneic transplants. NeoraP has been used in combination with azathioprine and nicardipine ketoconazole danazol corticosteroids. verapamil meloclopramide CONTRAINDICATIONS: Neoral is contraindicated in patients with a hypersensitivity to cycloporine Drugs That Q.ccraac Cyclosporine Concentrations or to any ofthe ingredients of the formulation. Antihtotics Anttco,n’tdsartts Other Drugs WARNINGS: (See boxed WARNINGS) nafcillin carbamazepine octreotide Cyclosporine, the active ingredient of Neoral5, can cause nephrotoxicity and hepatotoxicit when used in rifampin phenobarbttal ticlopidine high doses. phenytoin It is not unusual for serum creatinine and BUN levels to be elevated during cyclosporine therapy. These elevations in renal transplant patients do not necessarily indicate rejection. and each patient must be fully Rifabutin is known to increase the metabolism of other drugs metabolized by the cyfochrome P.450 sys- evaluated before dosage adjustment is initiated. tern. The interaction between rifahutin and cyclosporine has not been studied. Care should be exercised when these two drugs are administered concomitantly. Based on the historical Sandimmune experience with oral solution, nephrotoxicity associated with cyclosporine had been noted in 25% ofcases of renal transplantation, 38% ofcases ofcardiac transplan. Other Drug Interactions: Reduced clearance of prednisolone. digoxin. and lovastatin has been observed tation. and 37% ofcases ofliver transplantation. Mild nephrotoicity was generally noted 2-3 months when these drugs are administered with cyclosporine. In addition, a decrease in the apparent volume of after renal transplant and consisted ofan arrest in the fall ofthe pre-operative elevations of BUN and distribution ofdigoxin has been reported after cyclosporine administration. Severe digitalis toxicity has creatinine at a range of 35-45 mg/dl and 2.0.2.5 mg/dl respectively. These elevations were often respon- been seen within days of starting cyclosporine in several patients taking digoxin. Cyclosporine should sive to cyclosporine dosage reduction. not be used with potassium-sparing diuretics because hyperkalemia can occur. During treatment with cyclosporine. vaccination may be less effective. The use oflive vaccines should be avoided. Myositis has More overt nephrotoxicity was seen early after transplantation and was characterized by a rapidly rising BUN and creatinine. Since these events are similar to renal rejection episodes. care must be taken to occurred with concomitant lovastatin, frequent gingival hyperplasia with nifedipine. and convulsions with high methylprednisolone. Further information on drugs that have been to interact differentiate between them. This form of nephrotoxicitv is usually responsive to cyclosporine dosage dose reported with cyclosporine is available from Sandoz Pharmaceuticals Corporation. reduction. Although specific diagnostic criteria which reliably differentiate renal graft rejection from drug toxicity Carcinogenesis. Mutagenesis. and Impairment of Fertility: Cyclosponne gave no evidence of mutagenic have not been found, a number of parameters have been significantly associated with one or the other. It or teratogenic effects in appropriate test systems. Only at dose levels toxic to dams, were adverse effects should be noted however, that up to 20% of patients may have simultaneous nephrotoxicity and rejection. seen in reproduction studies in rats. (See Pregnancv A form of a cyclosporine-associated nephropathv is characterized by serial deterioration in renal unction Carcinogenicity studies were carried out in male and female rats and mice. In the 75-week mouse study. and morphologic changes in the kidneys. From % to 15% of transplant recipients who have received evidence ofa statistically significant trend was found for lymphocytic lymphomas in females, and the cyclosporine will fail to show a reduction in rising serum creatinine despite a decrease or discontinuation incidence of hepatocetlular carcinomas in mid-dose males significantly exceeded the control value. In the ofcyclosponne therapy. Renal biopsies from these patients will demonstrate one or several of the tot- 24-month rat study. pancreatic islet cell adenomas significantly exceeded the control rate in the low dose lowing alterations: tubular vacuolization, tubular microcalcifications. peritubular capillary congestion. level. Doses used in the mouse and rat studies were 0.01 to 0.16 times the clinical maintenance dose. The arteriolopathy. and a striped form of interstitial fibrosis with tubular atrophy. Though none ofthese mor- hepatocellular carcinomas and pancreatic islet cell adenomas were not dose related. phologic changes is entirely specific. a diagnosis ofcyclosporine-associated structural nephrotoxicitv No impairment in fertility was demonstrated in studies in male and female rats. requires evidence ofthese findings. Cyclosporine has not been found to be mutagenic/genotoxic in the Ames Test, the V79-HGPRT Test, the When considering the development ofcyclosporme-associated nephropathy. it is noteworthy that several micronucleus test in mice and Chinese hamsters, the chromosome-aberration tests in Chinese hamster authors have reported an association between the appearance of interstitial fibrosis and higher cumulative bone-marrow, the mouse dominant lethal assay. and the DNA-repair test in sperm from treated mice. doses or persistently high circulating trough levels ofcyclosponne. This is particularly true during the A recent study analyzing sister chromatid exchange (SCE) induction by cvclosporine using human first 6 posttransplant months when the dosage tends to be highest and when, in kidney recipients. the lymphocytes in vitro gave indication ofa positive effect (i.e., induction ofSCE), at high concentrations organ appears to be most vulnerable to the toxic effects ofcyclosporine. Among other contributing factors in this system. to the development of interstitial fibrosis in these patients are prolonged perfusion time, warm ischemia An increased incidence of malignancy is a recognized complication of immunosuppresslon in recipients time, as well as episodes of acute toxicity. and acute and chronic rejection. The reversibility of interstitial oforgan transplants. The most common forms of neoplasms are non-Hodgkin’s lymphoma and carci- fibrosis and its correlation to renal function have not yet been determined. Reversibility ol arteriolopathy nomas ofthe skin. The risk of malignancies in cyclosporine recipients is higher than in the normal, healthy has been reported after stopping cvclosporine or lowering the dosage. population but similar to that in patients receiving other immunosuppressive therapies. Reduction or dis- Impaired renal function at any time requires close monitoring. and frequent dosage adjustment may be continuance of immunosuppression may cause the testons to regress. indicated. Pregnancy: Pregnancy Category C. Cyclosporine has been shown to be embryo’ and fetotoxic in rats and In the event of severe and unremitting rejection, when rescue therapy with pulse steroids and monoclonal rabbits following oral administration at maternally toxic doses. Fetal toxicity was noted in rats at 0.8 and antibodies fail to reverse the rejection episode. it may be preferable to switch to alternative immunosup- rabbits at 5.4 times the human maintenance dose of 6.0 mg/kg. where dose corrections are based on body pressive therapy rather than increase the Neoral! dose to excessive levels. surface area. Cclosporine was embryo- and fetotoxic as indicated by increased pre- and postnatal mor- Occasionally patients have developed a syndrome ofthrombocytopenia and microangiopathic hemolytic tality and reduced fetal weight togetlter with related skeletal retardations. anemia which may result in graft failure. The vasculopathy can occur in the absence of rejection and is There are no adequate and syell’controlled studies in pregnant women. Neoral should be used during accompanied by avid platelet consumption within the graft as demonstrated by Indium Ill labeled #{149}pt-egtiancyonly if the potential benefit ustifies the potential risk to the fetus. platelet studies. Neither the pathogenesis nor the management ofthis syndrome is clear. Though resolu- tion has occurred after reduction or discontinuation ofcyclosporine and 1) administration of streptokinase The following data retresent the reported outcomes of 116 pregnancies in women receiving cyclosporine and hepann or 2) plasmapheresis. this appears to depend upon early detection with Indium Ill labeled during pregnancy, 90 /., of whom were transplant patients, and most of whom received cyclosporine platelet scans. (See ADVERSE REACTIONS) throughout the entire gestational period. The only consistent patterns of abnormality were premature birth (gestational period of 28 to 36 weeks) and low birth weight for gestational age. Sixteen fetal losses Significant hyperkalemia (sometimes associated with hyperchloremic metabolic acidosis) and hyper- occurred. Most of the pregnancies (85 of 100) were complicated by disorders, including pre’eclampsia. uricemia have been seen occasionally in individual patients. eclampsia, prematurelabor. abruptio placentae. oligohydramnios. Rh incompatibility and fetoplacental Hepatotoxidty associated with cyclosporine use had been noted in 4’. ofcases of renal transplantation. dysfunction. Preterm delivery occurred in 47%. Seven malformations were reported in 5 viable infants 7”,, ofcases olcardiac transplantation, and 4/ ofcases ofliver transplantation. This was usually noted and in 2 cases offetal loss. Twenty’eight percent of the infants were small for gestational age. Neonatal during the first month oftherapy when high doses ofcyclosporine were used and consisted of elevations complications occurred in 27”.. Therefore, the risks and benefits of using NeoraP during pregnancy of hepatic enzymes and bilirubin. The chemistry elevations usually decreased with a reduction in dosage. should be carefully weighed. As in patients receiving other immunosuppressants. those patients receiving cyclosporine are at increased Nursing Mothers: Since cyclosporine is excreted in human milk, nursingshould be avoided. risk for development of tymphomas and other malignancies. particularly those ofthe skin. The increased risk appears related to the intensity and duration ofimmunosuppression rather than to the use of specific Pediatric Use: Although no adequate and well controlled studies have been completed in children, pa- agents. Because of the danger of oversuppression of the immune system resulting in increased risk of tents as young as one year ofage have received Neoralv with no unusual adverse effects. infection or malignancy. a treatment regimen containing multiple immunosuppressants should be used ADVERSE REACTIONS: The principal adverse reactions ofcvclosporine therapy are renal dysfunction. with caution. tremor, hirsutism, hypertension, and gum hyperplasia. Hypertension, which is usually mild to moderate, There have been reports ofconvulsions in adult and pediatric patients receiving cvclosporine, particularly may occur in approximately SO of patients following renal transplantation and in most cardiac trans in combination with high dose methylprednisolone. plant patients. Care should be taken in using cyclosporine with nephrotoxic drugs. (Ste PRECAUTIONS) Glomerxilar capillary thrombosis has been found in patients treated with cyclosponne and may progress Because NeoraP is not bioequivalent to Sandixnmune, conversion from NeoraP to Sandimmune using a to graft failure. The pathologic changes resemble those seen in the hemolytic’uremic syndrome and include 1:1 ratio (mg/kg/day) may result in lower cyclosporine blood concentrations. Conversion from Neoral to thrombosis ofthe renal microvasculature, with platelet-fibrin thrombi occluding glomerular capillaries Sandimmunv- should be made with increased monitoring to avoid the potential of underdosing. and afferent arterioles, microangiopathic hemolytic anemia, thrombocytopenia. and decreased renal function. Similar findings have been observed when other immunosuppressives have been employed PRECAUTIONS: General: Cyclosporine is the active ingredient of Neoralx. Hypertension is a common posttransplantation. Hypomagnesemia has been reported in some, but not all, patients exhibiting consul- side effect ofcyclosporine therapy. (See ADVERSE REACTIONS) Mild or moderate hypertension ts sions while on cyclosporine therapy. Although magnesium-depletion studies in normal subjects sugest encountered more frequently than severe hypertension and the incidence decreases over time. Anti- that hypomagnesemia is associated with neurologic disorders, multiple factors, including hypertension. hypertensive therapy may be required. Control ofblood pressure can be accomplished with any of the high dose methylprednisolone. hypocholesterolemia. and nephrotoxicity associated with high plasma common antihypertensive agents. However, since cyclosporine may cause hyperkalemia. potassium. concentrations ofcyclosporine appear to be related to the neurological manifestations of cyclosporine sparing diuretics should not be used. Calcium antagonists can be effective agents in treating cyclosporine- toxicity. associated hypertension. However, care should be taken since interference with cyclosporine metabolism may require a dosage adjustment. (Set Drug Interactwns) In controlled studies, the nature, severity and incidence of the adverse events that were observed in 493 transplanted patients treated with Neoral were comparable with those observed in 208 transplanted During treatment with cyclosporine. vaccination may be less effective; and the use tf live attenuated patients who receixed Sandimmune in these same studies when the dosage ofthe two drugs was ad’ vaccines should be avoided. justed to achieve the same cyclosporine blood trough concentrations. Information for Patients: Patient. should be advised that any change of cyclosponne formulation The following reactions occurred in 2”. or less of Sandimmune-treated patients: allergic reactions, should be made cautiously and only under physician supervision because it may result in the need anemia, anorexia, confusion, conjunctivitis, edema, fever, brittle fingernails. gastritis. hearing loss, for a change In dosage. hiccups, hyperglycemia. muscle pain. peptic ulcer. thrombocytopenia. tinnitus. The following reactions Patients should be informed of the necessity of repeated laboratory tests while they are receiving the occurred rarely: anxiety, chest pain, constipation, depression. hair breaking, bematuria, Joint pain. drug. Patients should be advised ofthe potential risks during pregnancy and informed ofthe increased lethargy. mouth sores, myocardial infarction, night sweats, pancreatitis. pruritus. swallowing difficulty, risk of neoplasia. tingling. upper (‘.1 bleeding, visual disturbance. weakness, weight loss Patients should be given careful dosage instructions. Neoralr Oral Solution (cyclosporine oral solution for Increased susceptibility to infection and the possible development of lymphoma and other neoplasms microemulsion) should be diluted, preferably with orange or apple juice that is at room temperature. may result from the degree of immunosuppression. Grapefruit and grapefruit juice affect metabolism ofcyclosporine and should be avoided. The combination of Neorat Oral Solution (cyclosporine oral solution for microemulsion) with milk can be unpalatable. Sandoz Pharmaceuticals Corporation, East Hanover, New Jersey 07936 SEPTEMBER 1995 38371902