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Melamine-related kidney stones and renal toxicity

Dalal RP; Goldfarb DS
Several well-documented outbreaks of melamine poisoning have occurred in both animals and humans during the past 7 years, which led to the identification of melamine and cyanuric acid as nephrotoxins. This Review provides an overview of the known experimental and observational data (including toxicology, epidemiology, and pathology) concerning melamine contamination of foodstuffs, both alone and in combination with cyanuric acid. The various renal effects of ingestion of these compounds in both animals and humans are described, and a hypothesis on the mechanism of formation of melamine-based kidney stones is presented. Finally, the public health measures taken in the wake of the melamine contamination events are discussed
PMID: 21423252
ISSN: 1759-507x
CID: 130410

The hemodialysis machine: where the nephrologists and toxicologists meet [Editorial]

Goldfarb, David S; Harbord, Nikolas B; Winchester, James F
PMID: 21531320
ISSN: 1548-5609
CID: 131966

Have advances in extracorporeal removal techniques changed the indications for their use in poisonings?

Garlich, Fiona M; Goldfarb, David S
During the past 25 years, numerous changes have taken place in the use of hemodialysis as a therapeutic modality. Advances in technologies and a progression in our collective understanding of the pharmacokinetics of certain xenobiotics have resulted in alterations in the indications, effectiveness, and safety of hemodialysis. However, these changes have not necessarily been reflected in the current published data regarding treatment of intoxications. Reported clearance rates often reflect what was achievable in the 1970s and 1980s, and more recent reports are frequently lacking. Our goal in this review is to summarize the changes in hemodialysis and in other extracorporeal removal technologies and highlight the effects of these changes on the current indications for hemodialysis of the poisoned patient. Changes in dialysis performance that are reviewed in this article include the use of high-efficiency and high-flux dialysis membranes, improved hemodynamic stability because of ultrafiltration control, and the use of bicarbonate as a source of base. We review the indications for hemodialysis for removal of specific toxins, including vancomycin, methotrexate, carbamazepine, and valproic acid
PMID: 21531323
ISSN: 1548-5609
CID: 131967

Tailoring L-cystine crystallization through molecular design [Meeting Abstract]

Rimer, Jeffrey D.; An, Zhihua; Zhu, Zina; Lee, Michael H.; Goldfarb, David S.; Wesson, Jeffrey A.; Ward, Michael D.
ISI:000291982801645
ISSN: 0065-7727
CID: 135213

The Use of Extracorporeal Techniques in Acute Acetaminophen (Paracetamol) Poisoning [Meeting Abstract]

Holubek, W. J.; Kemp, B. O.; Goldfarb, D. S.; Nelson, L. S.; Hoffman, R. S.
ISI:000289628600221
ISSN: 1556-3650
CID: 131938

Hemodialysis Clearance of Glyphosate Following a Life-threatening Ingestion of Glyphosate-Containing Herbicide [Meeting Abstract]

Garlich, F. M.; Goldman, M.; Pepe, J.; Nelson, L. S.; Allan, M. J.; Goldstein, D. A.; Goldfarb, D. S.; Hoffman, R. S.
ISI:000289628600291
ISSN: 1556-3650
CID: 131941

Prevalence of contraindications and prescription of pharmacologic therapies for gout

Keenan, Robert T; O'Brien, William R; Lee, Kristen H; Crittenden, Daria B; Fisher, Mark C; Goldfarb, David S; Krasnokutsky, Svetlana; Oh, Cheongeun; Pillinger, Michael H
BACKGROUND: Patients with gout have comorbidities, but the impact of these comorbidities on treatment has not been studied. METHODS: A total of 575 patients with gout were stratified according to certainty of diagnosis according to International Classification of Diseases, 9th Revision, Clinical Modification code alone (cohort I), American College of Radiology criteria (cohort II), and crystal diagnosis (cohort III). Comorbid conditions were defined according to International Classification of Diseases, 9th Revision, Clinical Modification codes, and stratified as either moderate or severe. Drug contraindications were defined as moderate or strong, based on Food and Drug Administration criteria and severity of disease. RESULTS: The most common comorbidity was hypertension (prevalence 0.89). The presence of comorbidities resulted in a high frequency of contraindications to approved gout medications. More than 90% of patients had at least 1 contraindication to nonsteroidal anti-inflammatory drugs. Many patients demonstrated multiple contraindications to 1 or more gout medications. Frequently, patients were prescribed medications to which they harbored contraindications. The prevalence of patients prescribed colchicine despite having at least 1 strong contraindication was 30% (cohort I), 37% (cohort II), and 39.6% (cohort III). CONCLUSION: Patients with gout typically harbor multiple comorbidities that result in contraindications to many of the medications available to treat gout. Frequently, despite contraindications to gout therapies, patients are frequently prescribed these medications
PMID: 21295195
ISSN: 1555-7162
CID: 122694

Vitamin d repletion does not increase calcium excretion among patients with kidney stones [Meeting Abstract]

Gupta M.; Korets R.; Leaf D.E.; Taylor E.N.; Tang J.; Asplin J.R.; Goldfarb D.S.; Curhan G.C.
INTRODUCTION: Many clinicians are reluctant to treat vitamin D deficiency in kidney stone formers because of the theoretical risk of increasing urinary calcium (UCa) excretion and the risk of calcium stone recurrence. Purpose: We report on the effect of vitamin D repletion on UCa among stone-formers.Methods: Patients were recruited from three metabolic stone clinics. Enrollment criteria included: 1)history of nephrolithiasis; 2)UCa between 150 and 400 mg/day; 3)serum 25-hydroxyvitamin D (25(OH)D) level less than 30 ng/ml. Patients were given oral ergocalciferol 50,000 IU weekly for 8 weeks. Serum and 24-hour urine tests were repeated after 8 weeks.RESULTS: 30 patients were enrolled and 29 completed the study. Vitamin D repletion resulted in no significant change in UCa excretion [table 1]. Other urinary parameters were similarly unchanged. Subgroup analysis on the basis of initial 25OHD and parathyroid hormone levels (Table presented) revealed no change in UCa excretion in any subgroup. No patient experienced any side effects, including kidney stone recurrence, while taking vitamin D.CONCLUSIONS: Among stone-formers with vitamin D deficiency and moderate levels of hypercalciuria, vitamin D repletion does not appear to increase UCa excretion. Vitamin D therapy, if indicated, should not be withheld on the basis of prior stone disease
EMBASE:70585410
ISSN: 0892-7790
CID: 141792

Metabolic Investigations: When and in Whom

Chapter by: Goldfarb, David S
in: URINARY TRACT STONE DISEASE by Rao, PN; Preminger, GM; Kavanagh, JP [Eds]
NEW YORK : SPRINGER, 2011
pp. 659-665
ISBN:
CID: 2338502

Diet, but not oral probiotics, effectively reduces urinary oxalate excretion and calcium oxalate supersaturation

Lieske, John C; Tremaine, William J; De Simone, Claudio; O'Connor, Helen M; Li, Xujian; Bergstralh, Eric J; Goldfarb, David S
We examined the effect of a controlled diet and two probiotic preparations on urinary oxalate excretion, a risk factor for calcium oxalate kidney stone formation, in patients with mild hyperoxaluria. Patients were randomized to a placebo, a probiotic, or a synbiotic preparation. This tested whether these probiotic preparations can increase oxalate metabolism in the intestine and/or decrease oxalate absorption from the gut. Patients were maintained on a controlled diet to remove the confounding variable of differing oxalate intake from food. Urinary oxalate excretion and calcium oxalate supersaturation on the controlled diet were significantly lower compared with baseline on a free-choice diet. Neither study preparation reduced urinary oxalate excretion nor calcium oxalate supersaturation. Fecal lactobacilli colony counts increased on both preparations, whereas enterococcal and yeast colony counts were increased on the synbiotic. Total urine volume and the excretion of oxalate and calcium were all strong independent determinants of urinary calcium oxalate supersaturation. Hence, dietary oxalate restriction reduced urinary oxalate excretion, but the tested probiotics did not influence urinary oxalate levels in patients on a restricted oxalate diet. However, this study suggests that dietary oxalate restriction is useful for kidney stone prevention
PMCID:3923490
PMID: 20736987
ISSN: 1523-1755
CID: 138137