Salt-losing tubulopathy and chronic dermatitis
A 14-month-old girl presented with fever and generalized erythroderma. She had a history of polyhydramnios, premature birth (32 weeks), polyuria, and repeated episodes of volume depletion and dehydration with hypokalemic metabolic alkalosis and hypernatremia. The patient ’s parents were Romani and first cousins, and had had 3 previous preterm newborns from gestations with polyhydramnios, who died in the first 15 days of life. Laboratory work-up revealed low serum potassium of 3.35 mEq/l, 1.45 mg/dl serum magnesium with high fractional excretions of 15.5% and 10.6% , respectively, 9.2 mg/dl serum calcium, 0.62 mg/mg u...
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: Marta Fern ández-Fernández, Helena Gil-Peña, Eliecer Coto, Nélida García Pérez, Fernando Santos Tags: Nephrology Image Source Type: research
BK nephropathy with glomerular involvement
A 17-year-old patient 8 months after kidney transplant presented with BK viremia of 1.1 × 106 copies/ml and serum creatinine of 0.8 mg/dl. An allograft kidney biopsy was performed, which showed extensive interstitial inflammation and viral inclusions in the tubular epithelial cells. In addition, numerous viral inclusions were seen in the glomeruli. In situ hybridization study for th e BK virus confirmed the findings and was positive for the BK virus present in the tubular epithelium, the parietal epithelium of the Bowman's capsule, shedding cells in Bowman's space and based on the location also within podocytes...
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: Aishwarya Ravindran, Clifford E. Kashtan, Sanjeev Sethi Tags: Nephrology Image Source Type: research
The Case | A 69-year-old man with purpura and acute renal failure
A 69-year-old man was referred to our department because of acute renal failure. Three months prior, he was diagnosed with rectal adenocarcinoma, which was revealed by digestive bleeding and altered general status. The patient was treated by radiotherapy and chemotherapy using capecitabin. On admission, blood pressure was 105/70 mm Hg and temperature was 36°C. Skin examination showed bilateral leg edema and a striking purpura (Figure 1). Laboratory investigations revealed acute renal failure with increased serum creatinine at 409 μmol/l against 86 μmol/l 6 months before. (Source: Kidney International)
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: Pierre Isnard, Charlotte Debiais, Marion Rabant, Aude Servais, Geltrude Giura, Mohamad Zaidan, Marie-B énédicte Le Stang Tags: Make Your Diagnosis Source Type: research
Bones and the sex hormones
Sex hormones act in multiple ways to maintain a strong skeleton. In men, estrogen regulates cortical bone turnover, but testosterone maintains trabecular turnover. In normal men, sex hormone –binding protein is an independent risk factor for fractures. This led Aleksova and colleagues to measure the sex hormones and their binding protein in men receiving dialysis. Both higher sex hormone–binding globulin and higher total testosterone were associated with prevalent nonvertebral fract ures, adding another layer of complexity to renal osteodystrophy. (Source: Kidney International)
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: Radhika R. Narla, Susan M. Ott Tags: Commentary Source Type: research
Crossloads of metabolism and CKD
Sensitive and useful biomarkers for predicting chronic kidney disease (CKD) and its prognosis are urgently needed. Using a nontargeted metabolomic approach, Hu et al. explored an established CKD cohort, Modification of Diet in Renal Disease, as well as a validation cohort, African American Study of Kidney Disease and Hypertension. They identified 3 serum metabolites (ribonate, fumarate, and allantoin) significantly associated with mortality in CKD even afte r statistical adjustment by multiple clinical covariates including glomerular filtration rate and urinary protein. (Source: Kidney International)
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: Takehiro Suzuki, Takaaki Abe Tags: Commentary Source Type: research
The time for next-generation molecular genetic diagnostics in nephrology is now!
Global and disease-group genetic testing is replacing single-gene molecular diagnostics. Bullich et al. demonstrate that gene panel analysis can result in a high yield of genetic diagnoses in cystic and familial glomerular populations. As the complexity of defining specific inherited kidney diseases becomes more apparent, a broader role for panel-based genomic testing in nephrology is now warran ted. The resulting firm diagnosis can inform family planning decisions and aid prognostics and patient management. (Source: Kidney International)
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: Peter C. Harris Tags: Commentary Source Type: research
Is the peritoneal dialysis biocompatibility hypothesis dead?
The peritoneal dialysis (PD) biocompatibility hypothesis is that conventional PD solutions with high levels of glucose degradation products (GDPs), glucose and lactate, and low pH cause morphological and functional damage to the peritoneal membrane and that this damage may be attenuated by biocompatible solutions. Functional findings from randomized trials have not supported this hypothesis, and now new data from a large European pediatric peritoneal biopsy study provide a morphologic correlate for this. (Source: Kidney International)
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: Peter G. Blake Tags: Commentary Source Type: research
Young blood for old kidneys? More questions than answers so far
This study is an important first step using an interesting model, but many questions remain about how young blood reduces acute kidney injury in an older mouse. (Source: Kidney International)
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: Matthew Plotkin Tags: Commentary Source Type: research
Cutaneous calcification in patients with kidney disease is not always calciphylaxis
Calciphylaxis, also referred to as calcific uremic arteriolopathy, is a rare disorder that predominantly afflicts patients with end-stage renal disease. In this issue of Kidney International, a report describing histologic features of calciphylaxis questions the specificity of histologic findings typically considered to be characteristic of calciphylaxis. Validated diagnostic criteria are much needed for the clinical care and the investigational studies of patients with calciphylaxis. (Source: Kidney International)
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: Sagar U. Nigwekar, Rosalynn M. Nazarian Tags: Commentary Source Type: research
Presumed consent will not automatically lead to increased organ donation
The United Kingdom Parliament has proposed a consultation period as part of its plan to introduce presumed (also termed deemed) consent for organ donation in England. However, a Private Members ’ Bill (Organ Donation [Deemed Consent] Bill 2017–2019; available to view at https://services.parliament.uk/bills/2017-19/organdonationdeemedconsent.html) has already started the legislative process and recently passed its second reading in Parliament in February 2018. As it awaits a Public Bill Committee date, it could become the legislative conduit to introduce presumed consent across England. (Source: Kidney International)
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: Adnan Sharif Tags: Policy Forum Source Type: research
Could vagal tone increase explain the excess of bradycardia episodes during the last day of the long interdialytic interval?
We read with interest the paper by Roy-Chaudhury et al. assessing heart rate abnormalities in hemodialysis patients related to dialysis cycle.1 The marked increase in bradycardia episodes at the end of the long interdialytic interval is particularly interesting. Indeed, this result could be related to the excess of overall mortality and of sudden c ardiac death observed during the long interdialytic interval.2,3 (Source: Kidney International)
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: Paul Simon Pugliesi, Charles Guenancia, Yves Cottin, Jean Michel Rebibou Tags: Letter to the Editor Source Type: research
The Authors Reply
In their letter, Pugliesi et al.1 describe data demonstrating an increase in vagal tone during the long intradialytic interval. Given published data showing a direct correlation between vagal tone and fluid overload in hemodialysis patients,2 they propose that the increase in bradycardia at the end of the intradialytic interv al observed in the Monitoring in Dialysis Trial3—an effect most prominent during the long interval—is driven by excessive volume accumulation. (Source: Kidney International)
Source: Kidney International - July 19, 2018 Category: Urology & Nephrology Authors: David M. Charytan, Prabir Roy-Chaudhury Tags: Letter to the Editor Source Type: research
Sodium –glucose cotransporter 2 inhibition normalizes glucose metabolism and suppresses oxidative stress in the kidneys of diabetic mice
It is unclear whether long-term sodium –glucose cotransporter 2 (SGLT2) inhibition such as that during the treatment of diabetes has deleterious effects on the kidney. Therefore, we first sought to determine whether abnormal glucose metabolism occurs in the kidneys of 22-week-old BTBR ob/ob diabetic mice. Second, the cumulative effect of chronic SGLT2 inhibition by ipragliflozin and 30% calorie restriction, either of which lowered blood glucose to a similar extent, on renal glucose metabolism was evaluated. (Source: Kidney International)
Source: Kidney International - July 15, 2018 Category: Urology & Nephrology Authors: Shinji Tanaka, Yuki Sugiura, Hisako Saito, Mai Sugahara, Yoshiki Higashijima, Junna Yamaguchi, Reiko Inagi, Makoto Suematsu, Masaomi Nangaku, Tetsuhiro Tanaka Tags: Basic Research Source Type: research
Uromodulin is expressed in the distal convoluted tubule, where it is critical for regulation of the sodium chloride cotransporter NCC
Uromodulin, the most abundant protein in normal urine, is essentially produced by the cells lining the thick ascending limb. There it regulates the activity of the cotransporter NKCC2 and is involved in sodium chloride handling and blood pressure regulation. Conflicting reports suggested that uromodulin may also be expressed in the distal convoluted tubule (DCT) where its role remains unknown. Using microdissection studies combined with fluorescent in situ hybridization and co-immunostaining analyses, we found a significant expression of uromodulin in mouse and human DCT at approximately 10% of thick ascending limb express...
Source: Kidney International - July 11, 2018 Category: Urology & Nephrology Authors: Natsuko Tokonami, Tomoaki Takata, Jan Beyeler, Iris Ehrbar, Ayumi Yoshifuji, Erik I. Christensen, Johannes Loffing, Olivier Devuyst, Eric G. Olinger Tags: Basic Research Source Type: research
The Bowman ’s shield: a tribute to translational science and Detlef Schlöndorff
Crescentic glomerulonephritis is commonly characterized by prominent lymphocytic infiltration in and around Bowman ’s space. Previous studies have established a pathogenic role for CD4+ T cells in experimental crescentic glomerulonephritis, but the role of infiltrating cytotoxic CD8+ T cells has been difficult to elucidate. Although earlier studies suggested that CD8+ T-cell depletion ameliorates experimental glomerulonephritis,1,2 the injection of podocyte-specific CD8+ T cells failed to induce glomerulonephritis in healthy mice. (Source: Kidney International)
Source: Kidney International - July 10, 2018 Category: Urology & Nephrology Authors: David Harris, Christina M. Wyatt, Agnes B. Fogo, Pierre Ronco Tags: Nephrology Digest Source Type: research
A mouse model of pseudohypoaldosteronism type II reveals a novel mechanism of renal tubular acidosis
Pseudohypoaldosteronism type II (PHAII) is a genetic disease characterized by association of hyperkalemia, hyperchloremic metabolic acidosis, hypertension, low renin, and high sensitivity to thiazide diuretics. It is caused by mutations in the WNK1, WNK4, KLHL3 or CUL3 gene. There is strong evidence that excessive sodium chloride reabsorption by the sodium chloride cotransporter NCC in the distal convoluted tubule is involved. WNK4 is expressed not only in distal convoluted tubule cells but also in β−intercalated cells of the cortical collecting duct. (Source: Kidney International)
Source: Kidney International - July 7, 2018 Category: Urology & Nephrology Authors: Karen I. L ópez-Cayuqueo, Maria Chavez-Canales, Alexia Pillot, Pascal Houillier, Maximilien Jayat, Jennifer Baraka-Vidot, Francesco Trepiccione, Véronique Baudrie, Cara Büsst, Christelle Soukaseum, Yusuke Kumai, Xavier Jeunemaître, Juliette Hadchouel, Tags: Basic Research Source Type: research
Acute kidney injury complicating nephrotic syndrome of minimal change disease
Minimal change disease accounts for 70% to 90% of cases of nephrotic syndrome in children. It also causes nephrotic syndrome in adults, including patients older than age 60. Renal function is altered moderately in approximately 20% to 30% of patients because foot-process fusion impairs filtration of water and solutes. The glomerular filtration rate is reduced by approximately 20% to 30% and returns to baseline with remission of proteinuria. Over the past 50 years, a number of publications have reported cases of acute kidney injury occurring in approximately one-fifth to one-third of adult cases in the absence of prior or c...
Source: Kidney International - July 3, 2018 Category: Urology & Nephrology Authors: Alain Meyrier, Patrick Niaudet Tags: Review Source Type: research
Androgen exposure potentiates formation of intratubular communities and renal abscesses by Escherichia coli
Females across their lifespan and certain male populations are susceptible to urinary tract infections (UTI). The influence of female vs. male sex on UTI is incompletely understood, in part because preclinical modeling has been performed almost exclusively in female mice. Here, we employed established and new mouse models of UTI with uropathogenic Escherichia coli (UPEC) to investigate androgen influence on UTI pathogenesis. Susceptibility to UPEC UTI in both male and female hosts was potentiated with 5 α-dihydrotestosterone, while males with androgen receptor deficiency and androgenized females treated with the andr...
Source: Kidney International - July 2, 2018 Category: Urology & Nephrology Authors: Patrick D. Olson, Lisa K. McLellan, Teri N. Hreha, Alice Liu, Kelleigh E. Briden, Keith A. Hruska, David A. Hunstad Tags: Basic Research Source Type: research
The AGES-Reykjavik Study suggests that change in kidney measures is associated with subclinical brain pathology in older community-dwelling persons
Decreased glomerular filtration rate (GFR) and albuminuria may be accompanied by brain pathology. Here we investigated whether changes in these kidney measures are linked to development of new MRI-detected infarcts and microbleeds, and progression of white matter hyperintensity volume. The study included 2671 participants from the population-based AGES-Reykjavik Study (mean age 75, 58.7% women). GFR was estimated from serum creatinine, and albuminuria was assessed by urinary albumin-to-creatinine ratio. (Source: Kidney International)
Source: Kidney International - June 27, 2018 Category: Urology & Nephrology Authors: Sanaz Sedaghat, Jie Ding, Gudny Eiriksdottir, Mark A. van Buchem, Sigurdur Sigurdsson, M. Arfan Ikram, Osorio Meirelles, Vilmundur Gudnason, Andrew S. Levey, Lenore J. Launer Tags: Clinical Investigation Source Type: research
Use of extracorporeal treatments in the management of poisonings
Historically, the clinical application of extracorporeal treatments (ECTRs), such as hemodialysis or hemoperfusion, was first intended for poisoned patients. With time, ECTRs were used almost indiscriminately to facilitate the elimination of many poisons, albeit with uncertain clinical benefit. To determine the precise role of ECTRs in poisoning situations, multiple variables need to be considered including a careful risk assessment, the poison ’s characteristics including toxicokinetics, alternative treatments, the patient’s clinical status, and intricacies of available ECTRs, all of which are reviewed in this...
Source: Kidney International - June 26, 2018 Category: Urology & Nephrology Authors: Marc Ghannoum, Robert S. Hoffman, Sophie Gosselin, Thomas D. Nolin, Valery Lavergne, Darren M. Roberts Tags: Review Source Type: research
In this issue
Bullich and colleagues demonstrate a very high identification rate of disease-causing mutations in patients with cystic or glomerular kidney disease by next-generation sequencing of a panel of 140 genes. Molecular diagnosis was made in 78% of patients with cystic kidney disease and 62% of patients with glomerular disease. The key to this success rate was including only patients with a high likelihood of having a genetic disease. For cystic disease, adults had to have bilateral kidney cysts or at least 2 angiomyolipomas and a family history of cystic disease. (Source: Kidney International)
Source: Kidney International - June 25, 2018 Category: Urology & Nephrology Tags: In This Issue Source Type: research
Chambers et al. (Stem Cells. 2018;36:834–843; https://doi.org/10.1002/stem.2810) (Source: Kidney International)
Source: Kidney International - June 25, 2018 Category: Urology & Nephrology Tags: Journal Club Source Type: research
Lipstick obsession and red urine
A 28-year-old woman presented to the nephrology clinic with a 5-day history of passage of red-colored urine (Figure 1a) without dysuria flank pain, rigors, or chills. She denied any history of recent exposure to medications, beet intake, or coloring agents in food. On examination, the only noticeable feature was her bright-red lipstick (Figure 1b). Her blood count, serum creatinine, liver function, and urine t ests were normal. Her urine culture was sterile. On further questioning, she revealed that she would apply her lipstick 20 to 25 times a day and was finding it hard to overcome this obsession. (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Tajamul H. Mir, Maina Nisar Tags: Nephrology Image Source Type: research
The Case | Severe hypokalemia complicated by a syncope
An 84-year-old woman was admitted to the emergency department after a syncope at home. At admission, her neurological status was normal, blood pressure was 200/92 mm Hg, heart rate was 90 bpm, and glycemia was 138 mg/dl. An electrocardiogram showed many ventricular ectopic beats (Figure 1). The patient experienced another syncope, and electrocardiographic monitoring suggested ventricular tachycardia or Torsades de pointes. Blood tests revealed profound hypoka lemia, alkalosis, and mild hypernatremia (Table 1). (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Pierre-Florent Petit, Philippe Hantson, Michel Jadoul, Valentine Gillion Tags: Make Your Diagnosis Source Type: research
Electrocardiographic artifact due to an arteriovenous fistula
A 78-year-old man who had been undergoing hemodialysis for 5 years presented to our outpatient department because of chest discomfort at rest, which had developed the previous evening. His initial electrocardiogram, in which the left arm electrode happened to be placed near the anastomosis site of an arteriovenous fistula, revealed elevation of the late component of the T-wave and TP segment in leads I and aVL (Figure 1). It also revealed depression of the late component of the T-wave and TP segment in leads III, aVR, aVF, and V1–V6 (Figure 1). (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Hiroshi Osawa, Ryuji Kitahara, Hisao Saitoh, Tadashi Suzuki Tags: Nephrology Image Source Type: research
IgA nephropathy: new insights into the role of complement
Glomerular complement deposition is common in IgA nephropathy, and recent genome-wide association studies point to a role of complement factor H and complement factor H –related proteins in disease susceptibility. A number of recent studies have now documented elevated levels of some factor H–related proteins in IgA nephropathy, which might contribute to enhanced complement activation. (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: J ürgen Floege, Mohamed R. Daha Tags: Commentary Source Type: research
The net effect of ANCA on neutrophil extracellular trap formation
The formation of neutrophil extracellular traps induced by antineutrophil cytoplasmic autoantibodies has been implicated in the pathogenesis of antineutrophil cytoplasmic autoantibody –associated vasculitis. Kraaij et al. now provide evidence that excessive neutrophil extracellular trap formation in vitro induced by sera from patients with antineutrophil cytoplasmic autoantibody–associated vasculitis is associated with active disease but is not dependent on the presence of antineutrophil cytoplasmic autoantibodies. (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Peter Heeringa, Abraham Rutgers, Cees G.M. Kallenberg Tags: Commentary Source Type: research
Concerning cellular and molecular pathways of renal repair after acute kidney injury
The review by Kumar, though well written and beautifully illustrated,1 further strengthens conceptual errors regarding human acute kidney injury (AKI), that are based on the evaluation of a murine tissue destructive process in ischemia reperfusion models, which does not parallel the human situation. Warm ischemia reflow is almost never the basis for AKI in the native kidney,2 and in the transplant situation the human kidney is very resistant to complete cessation of blood flow. Furthermore, the anatomy of the murine kidney3 and its tubular molecular signature (anchor genes)4 are very different from those of the human. (Sou...
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Seymour Rosen, Samuel Heyman Tags: Letter to the Editor Source Type: research
The Author Replies
In their letter, Rosen and Heyman remind us of the widely appreciated morphological differences between human versus mice warm ischemia reflow –induced acute kidney injury (AKI), and highlight the lack of attention to distal tubule and vascular injury responses.1 First, it was clarified from the outset that the main focus of the basic science review was on the cellular and molecular pathways involved in renal repair leading to kidney fun ction recovery after AKI, and not on the immediate/early injury responses that contribute to the initiation of AKI syndrome. (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Sanjeev Kumar Tags: Letter to the Editor Source Type: research
Treating hepatitis C infection in patients with advanced CKD in the real world: time to refocus on what our real treatment goals should be
In this issue, Alric and colleagues demonstrate through real-world experience that grazoprevir-elbasvir is safe and effective for treating hepatitis C in advanced kidney disease patients with higher comorbidity burdens. This commentary highlights that this and similar studies have primarily focused on treatment safety and efficacy, rather than the clinical impact of viral eradication. Critical knowledge gaps including which patients to treat, and when, as well as potential management strategies that may improve outcomes, are discussed. (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Vishnu S. Potluri, Roy D. Bloom Tags: Commentary Source Type: research
Protein carbamylation: a key driver of vascular calcification during chronic kidney disease
Vascular calcification is a frequent complication of advanced chronic kidney disease. Protein carbamylation is implicated in the acceleration of vascular disease in chronic kidney disease, but the mechanisms are not clear. Mori et al. report that protein carbamylation exacerbates vascular calcification by decreasing ectonucleotide pyrophosphate/phosphodiesterase 1 expression, owing to carbamylation of mitochondrial proteins and oxidative stress. This provides new insight into the pathways responsible for cal cification in chronic kidney disease. (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Clare L. Hawkins Tags: Commentary Source Type: research
FGF23 effects on the heart —levels, time, source, and context matter
Fibroblast growth factor 23 (FGF23) has appeared as a hormone that is massively elevated in patients with chronic kidney disease. Whether FGF23 is a risk factor that associates with cardiac pathologies and cardiovascular mortality, as suggested by a variety of clinical studies, or additionally acts as a causative factor that induces cardiac injury, as more recently indicated by cell culture and animal studies, is under debate and the center of many ongoing experimental studies. (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Christian Faul Tags: Commentary Source Type: research
Glomerular permeability changes of albumin in isolated glomeruli do not mimic changes in albumin excretion in vivo in diseased states
The study by Desideri et al.1 investigates the changes in albumin permeability in isolated glomeruli treated by enzymatic removal of the endothelial glycocalyx, or treatment with plasma from human steroid-resistant nephrotic syndrome or in glomeruli from rats treated with streptozotocin for 4 weeks. In all cases these cha nges in albumin glomerular permeability were small (by a factor (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Wayne D. Comper Tags: Letter to the Editor Source Type: research
The Authors Reply
We described an isolated glomerular albumin permeability (Ps’alb) assay that robustly and sensitively measures c hanges in Ps’alb in various situations including diseases and disease-modifying interventions. We measured changes in Ps’alb up to 3.3-fold. However, Ps’alb in isolated glomeruli should not be expected to be linearly related to the total amount of albumin being filtered across all glomeruli in disease states. (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Sara Desideri, Karen L. Onions, Matthew J. Butler, C. Charles Michel, Simon C. Satchell, Andrew H.J. Salmon, Rebecca R. Foster Tags: Letter to the Editor Source Type: research
The estimated glomerular filtration rate graph: another tool in the management of patients with advanced chronic kidney disease
The risk assessment tool from the recent Kidney Disease: Improving Global Outcomes conference adds another prediction model for the risk of developing advanced chronic kidney disease and potential need for dialysis.1 None of the existing prediction models use a patient ’s rate of loss of estimated glomerular filtration rate (eGFR). Both current eGFR and the magnitude of past eGFR decline contribute substantially to the risk of end-stage renal disease.2 Furthermore, a graph of all previous eGFR values is an effective visual aid for shared decision-making and can be a useful predictor of when clinical events and treatm...
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Hugh C. Rayner, Steven Jay Rosansky Tags: Letter to the Editor Source Type: research
The analysis of hemoglobin A1c in dialysis patients should include the variables that reflect the erythrocyte turnover
Based on the findings that the levels of hemoglobin A1c (HbA1c) associated with the lowest mortality differed among dialysis racial groups, Hoshino et al. proposed the importance of domestic guidelines for glycemic control for dialysis patients.1 However, confounding factors owing to dialysis rather than race could have caused these differences because the same target level of HbA1c is used regardless of race for nondialysis patients. In dialysi s patients, these factors should be taken into account and HbA1c should be interpreted carefully. (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Masayuki Tanemoto Tags: Letter to the Editor Source Type: research
The Authors Reply
We thank Dr. Tanemoto for his comments1 on our article.2 He pointed out the potential importance of erythrocyte turnover as a confounding factor in the analysis of hemoglobin A1c (HbA1c) in dialysis patients. He hypothesizes that differences in erythrocyte turnover time could explain HbA1c differences among countries. He notes that the absence of an association between reticulocyte concentration (an indicator of erythrocyte turnover) and both hemoglobin concentration and erythropoietin-stimulating agent dose in his study of 72 dialysis patients suggests that the model variables used in our study may not have fully adjusted...
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Junichi Hoshino, Maria Larkina, Angelo Karaboyas, Brian Bieber, Yoshifumi Ubara, Kenmei Takaichi, Tadao Akizawa, Takashi Akiba, Shunichi Fukuhara, Ronald L. Pisoni, Akira Saito, Bruce M. Robinson Tags: Letter to the Editor Source Type: research
In This issue
Proliferative glomerulonephritis with monoclonal Ig deposits (PGNMIDs) is a monoclonal gammopathy of renal significance that is difficult to treat and has a poor prognosis. In a series of 19 patients with well-characterized PGNMID, Gumber et al., working with hematologists, found that a hematological approach to these patients was beneficial. An underlying paraprotein was found in 37% of cases and the (presumably) responsible B or plasma cell clone was found in one-third of patients. Clone-directed hematological protocols were used not only in these patients, but were also used empirically in patients ...
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Tags: In This Issue Source Type: research
Chimeric antigen receptor T (CAR T) cells: another cancer therapy with potential applications in kidney disease and transplantation?
The grand challenge in better treating immune conditions in nephrology, including transplantation and autoimmune kidney diseases, is to establish or re-establish tolerance. Such an outcome would cure the condition and obviate the need for ongoing immunosuppression. In addition, tolerogenic regimens might be both more specific and associated with fewer short- and long-term side effects, which are a major cause of morbidity and mortality in these conditions. In the past, the field of immunology has adapted treatment approaches from oncology, from cyclophosphamide in the 1960s to rituximab in the 2000s. (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: A. Richard Kitching, Juli Jaw Tags: Nephrology Digest Source Type: research
Turajlic et al. (Cell. 2018;173:581–594; https://doi.org/10.1016/j.cell.2018.03.057) (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Tags: Journal Club Source Type: research
Youthful systemic milieu alleviates renal ischemia-reperfusion injury in elderly mice
The incidence of acute kidney injury (AKI) is high in elderly people, and is difficult to prevent and treat. One of its major causes is renal ischemia-reperfusion injury (IRI). A young systemic environment may prevent the senescence of old organs. However, it is unknown whether a young milieu may reduce renal IRI in the elderly. To examine this question, bilateral renal IRI was induced in old (24 months) mice three weeks after parabiosis model establishment. At 24 hours after IRI, compared to old wild-type mice, the old mice with IRI had significantly damaged renal histology, decreased renal function, increased oxidative s...
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Dong Liu, Lide Lun, Qi Huang, Yichun Ning, Ying Zhang, Linna Wang, Zhiwei Yin, Yinping Zhang, Lihua Xia, Zhong Yin, Bo Fu, Guangyan Cai, Xuefeng Sun, Xiangmei Chen Tags: Basic Research Source Type: research
Enhanced activation of interleukin-10, heme oxygenase-1, and AKT in C5aR2-deficient mice is associated with protection from ischemia reperfusion injury–induced inflammation and fibrosis
In this study C5aR1 –/– and C5aR2–/– mice were compared to the wild type in a renal IRI model leading to renal fibrosis. C5a receptor expression, kidney morphology, inflammation, and fibrosis were measured in different mouse strains one, seven and 21 days after IRI. Renal perfusion was evaluated by functional m agnetic resonance imaging. (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Anja Thorenz, Katja Derlin, Christoph Schr öder, Lisa Dressler, Vijith Vijayan, Pooja Pradhan, Stephan Immenschuh, Anne Jörns, Frank Echtermeyer, Christine Herzog, Rongjun Chen, Song Rong, Jan Hinrich Bräsen, Cees van Kooten, Torsten Kirsch, Christian Tags: Basic Research Source Type: research
Chronic kidney disease and arrhythmias: highlights from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
Patients with chronic kidney disease (CKD) are predisposed to heart rhythm disorders, including atrial fibrillation (AF)/flutter, supraventricular tachycardias, ventricular arrhythmias, and sudden cardiac death (SCD). This population is also historically underrepresented in clinical trials of treatment for heart rhythm disorders.1 (Source: Kidney International)
Source: Kidney International - June 20, 2018 Category: Urology & Nephrology Authors: Christoph Wanner, Charles A. Herzog, Mintu P. Turakhia, Conference Steering Committee Tags: Nephrology Digest Source Type: research
DOPPS data suggest a possible survival benefit of renin angiotensin-aldosterone system inhibitors and other antihypertensive medications for hemodialysis patients
The benefits of renin angiotensin-aldosterone system inhibitors (RAASi) are well-established in the general population, particularly among those with diabetes, congestive heart failure (CHF), or coronary artery disease (CAD). However, conflicting evidence from trials and concerns about hyperkalemia limit RAASi use in hemodialysis patients, relative to other antihypertensive agents, including beta blockers and calcium channel blockers. Therefore, we investigated prescription patterns and associations with mortality for RAASi and other antihypertensive agents using data from the international Dialysis Outcomes and Practice P...
Source: Kidney International - June 13, 2018 Category: Urology & Nephrology Authors: Angelo Karaboyas, Hairong Xu, Hal Morgenstern, Francesco Locatelli, Michel Jadoul, Kosaku Nitta, Indranil Dasgupta, Francesca Tentori, Friedrich K. Port, Bruce M. Robinson Tags: Clinical Investigation Source Type: research