A pragmatic, open-label, randomized controlled trial of Plasma-Lyte-148 versus standard intravenous fluids in children receiving kidney transplants (PLUTO).
Acute electrolyte and acid-base imbalance is experienced by many children following kidney transplant. This is partly because doctors give very large volumes of artificial fluids to keep the new kidney working. When severe, fluid imbalance can lead to seizures, cerebral edema and death. In this pragmatic, open-label, randomized controlled trial, we randomly assigned (1:1) pediatric kidney transplant recipients to Plasma-Lyte-148 or standard of care perioperative intravenous fluids (predominantly 0.45% sodium chloride and 0.9% sodium chloride solutions). (Source: Kidney International)
Source: Kidney International - October 30, 2023 Category: Urology & Nephrology Authors: Wesley N. Hayes, Emma Laing, Rosemary Brown, Laura Silsby, Laura Smith, Helen Thomas, Fotini Kaloyirou, Rupa Sharma, James Griffiths, Helen Hume-Smith, Stephen D. Marks, Nicos Kessaris, Martin Christian, Jan Dudley, Mohan Shenoy, Michal Malina, Mordi Muor Tags: clinical trial Source Type: research
Exploiting the neonatal crystallizable fragment receptor to treat kidney disease
The neonatal crystallizable fragment receptor (FcRn) was initially discovered as the receptor that allowed passive immunity in newborns by transporting maternal IgG through the placenta and enterocytes. Since its initial discovery, FcRn has been found to exist throughout all stages of life and in many different cell types. Beyond passive immunity, FcRn is necessary for intrinsic albumin and IgG recycling and is important for antigen processing and presentation. Given its multiple important roles, FcRn has been used in many disease treatments including a new class of agents that were developed to inhibit FcRn for the treatm...
Source: Kidney International - October 27, 2023 Category: Urology & Nephrology Authors: James F. Dylewski, George Haddad, Judith Blaine Tags: Review Source Type: research
Exploiting the neonatal Fc receptor to treat kidney disease
The neonatal Fc receptor (FcRn) was initially discovered as the receptor that allowed passive immunity in newborns by transporting maternal IgG through the placenta and enterocytes. Since its initial discovery, FcRn has been found to exist throughout all stages of life and in many different cell types. Beyond passive immunity, FcRn is necessary for intrinsic albumin and IgG recycling and is important for antigen processing and presentation. Given its multiple important roles, FcRn has been utilized in many disease treatments including a new class of agents that were developed to inhibit FcRn for treatment of a variety of a...
Source: Kidney International - October 27, 2023 Category: Urology & Nephrology Authors: James F. Dylewski, George Haddad, Judith Blaine Tags: review Source Type: research
A central role for mesangial cells in the initiation of diabetic nephropathy
More than 35 years ago, it was postulated that mesangial cells represent a special form of microvascular pericytes that “not only occupy a central anatomical position in the glomerulus but may also deserve this role functionally.”1 Accumulating clinical and experimental evidence has since demonstrated the important functional properties of mesangial cells in kidney homeostasis, as they provide key structural supp ort for glomerular capillary loops, regulate capillary flow, and play an essential role in mediating glomerular crosstalk. (Source: Kidney International)
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Zhengying Fang, Kyung Lee, John Cijiang He Tags: Nephrology Digest Source Type: research
“Nailing” chronicity in kidney disease
An 80-year-old woman presented with a 2-week history of vomiting and failure to thrive. The results of laboratory testing revealed a serum creatinine level of 10 mg/dl. The patient was not known to the hospital, and no previous serum creatinine level was available. The presence of distinctive nail changes on physical examination (Figure 1) guided the diagnosis toward a chronic progressive kidney disease, confirmed later by the presence of bilateral atrophic kidneys on abdomen ultrasound. (Source: Kidney International)
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Najat I. Joubran, Helena P. Salem Tags: Nephrology Image Source Type: research
A rare combination of hydronephrosis, megaureter, and hyperphosphatasia
A female term-born infant presented with muscular hypotonia, brachydactyly, and dysmorphic features, such as deep-seated ears, submucosal cleft palate, and hypertelorism (Supplementary Figure S1). She developed acute kidney injury and abdominal distention, without meconium evacuation for 48 hours. Moreover, laboratory findings showed a 5-fold increase in alkaline phosphatase levels (normal range, 1.61–5.3 μkat/l), without liver or bone metabolism disorder. Abdominal magnetic resonan ce imaging revealed bilateral dysplastic multicystic kidneys with right-sided massive hydronephrosis and bilateral megaureters with ectop...
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Lea Maria Merz, Julia Hentschel, Christian Roth, Manuela Siekmeyer, Katalin Dittrich, Friederike Petzold Tags: Nephrology Image Source Type: research
The Case | Acute kidney injury after a party
A 34-year-old patient (Mahoran) with no medical history presented to the emergency department with diffuse abdominal and lumbar pain, myalgia, and nausea. Recent history revealed only the consumption of alcohol and soft drinks 2 days before the onset of symptoms. He was exposed to still water and trash in his job. He never traveled out of France since he migrated 10 years ago. (Source: Kidney International)
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Thibault Letellier, Jeremy Debraux, Jimmy Grellier, Romain Collot, Gr égoire Couvrat-Desvergnes, Anne Moreau, Awena Le Fur Tags: Make Your Diagnosis Source Type: research
Is hemodiafiltration superior to hemodialysis in patients with kidney failure?
Hemodiafiltration and hemodialysis are 2 accepted therapies for patients with end-stage kidney disease (ESKD), although the former is more commonly favored in Europe, whereas the latter is the primary treatment available in the United States. A prior pooled analysis of participant-level data from 4 randomized, controlled trials involving 2793 participants suggested a survival benefit for hemodiafiltration compared with hemodialysis, especially when a convection volume was delivered at a high dose, with a putative threshold of at least 23 L per session in postdilution mode. (Source: Kidney International)
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Tilman B. Dr üeke, T. Alp Ikizler Tags: Nephrology Digest Source Type: research
The authors reply
We thank Szili-Torok et al.1 for their interest in our study, in which we showed that a set of machine learning (ML) models does not outperform a validated Cox-based prediction system (CBPS) in predicting kidney-allograft failure. (Source: Kidney International)
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Agathe Truchot, Marc Raynaud, Alexandre Loupy Tags: Letter to the Editor Source Type: research
Machine learning: it takes more than select models to draw general conclusions
We read with great interest the article by Truchot et al., in which the authors compared the performance of a select subset of machine learning (ML) models with their previously developed and commercially promoted Cox-based prognostication system (iBox). They concluded that, in general, ML models do not outperform the Cox-based prognostication system measured by Harrell's concordance index, discrimination, and calibration.1 It is important to realize that this conclusion is only valid for the limited number of ML models tested, and thus does not necessarily apply to the broader field of ML (Figure 1). (Source: Kidney International)
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Tamas Szili-Torok, Uwe J.F. Tietge, Max J. Verbeek, Stephan J.L. Bakker, Martin H. de Borst Tags: Letter to the Editor Source Type: research
Corrigendum to “Successful kidney-alone transplantation in a patient with PH1 on combination RNA-interference therapy.” Kidney International, 2023;104:203–204
DOI of original article: 10.1016/j.kint.2023.04.009 (Source: Kidney International)
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Elisabeth L. Metry, Lisa J. Deesker, Sander F. Garrelfs, Michiel J.S. Oosterveld, Kerensa M. Beekman, Elisabeth A.M. Cornelissen, Linda Koster-Kamphuis, Jaap W. Groothoff Tags: Corrigendum Source Type: research
The authors reply
Wei et al.1 argue that the observed outcome differences in our study addressing use of diuretics and calcium channel blockers (CCBs) on top of renin-angiotensin system inhibitors2 might be explained by residual confounding. Although this is a limitation of any observational study, including ours, we do n ot believe their concerns are likely to invalidate our findings. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend maximum-tolerated renin-angiotensin system inhibitor dose for these patients. (Source: Kidney International)
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Anne-Laure Faucon, Juan-Jes ús Carrero Tags: Letter to the Editor Source Type: research
Initiation of diuretics or calcium channel blockers on the top of renin-angiotensin system inhibitors on kidney outcome: which is better?
We appreciate the study performed by Faucon et al.1 and have read it with great interest. The authors conducted a nationwide, well-matched cohort study involving 5875 patients with nondialysis chronic kidney disease (CKD) stage 3–5. The study found that using a diuretic rather than a calcium channel blocker on top of renin-angiotensin system inhibitor (RASi) might improve kidney outcomes (CKD progression) without compromising cardioprotection. RASi is widely recognized as the first-line antihypertensive drug for patients with CKD,2 but there is no optimal recommendation for the choice of second-line antihypertensive th...
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Shiyuan Wei, Licong Su, Qi Gao Tags: Letter to the Editor Source Type: research
Predicting pediatric kidney disease progression —are 3 variables all you need?
Accurate estimation of chronic kidney disease (CKD) progression risk is vital for clinical decision-making. Existing risk equations lack validation in pediatric CKD populations. Ng et al. developed new risk equations using the CKD in Children and European Study Consortium for Chronic Kidney Disorders Affecting Pediatric Patients cohorts. The elementary model, incorporating estimated glomerular filtration rate, urine protein-creatinine ratio, and diagnosis, exhibited excellent d iscrimination and calibration at external validation. (Source: Kidney International)
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Clarkson R. Crane, Pranav S. Garimella, Georg Heinze Tags: Commentary Source Type: research
The latest model has just arrived! A new experimental mouse model of PLA2R1-associated membranous nephropathy
Much akin to the explosion in number of known target antigens in membranous nephropathy, there has been a rapid expansion in the availability of animal models involving the first 2 antigens discovered in adult disease, phospholipase A2 receptor and thrombospondin type 1 domain-containing 7A. In this issue, Tomas et al. describe a novel mouse model of phospholipase A2 receptor–associated membranous nephropathy that shows great promise for investigating molecular mechanisms of disease and as an experimental system for testing existing and emerging therapies. (Source: Kidney International)
Source: Kidney International - October 18, 2023 Category: Urology & Nephrology Authors: Laurence H. Beck Tags: Commentary Source Type: research
