A comprehensive description of kidney disease progression after acute kidney injury from a prospective, parallel-group cohort study.
Acute kidney injury (AKI) is associated with adverse long-term outcomes, but many studies are retrospective, focused on specific patient groups or lack adequate comparators. The ARID (AKI Risk in Derby) Study was a five-year prospective parallel-group cohort study to examine this. Hospitalized cohorts with and without exposure to AKI were matched 1:1 for age, baseline kidney function, and diabetes. Estimated glomerular filtration rate (eGFR) and the urinary albumin:creatinine ratio (uACR) were measured at three-months, one-, three- and five-years. (Source: Kidney International)
Source: Kidney International - August 20, 2023 Category: Urology & Nephrology Authors: Kerry L. Horne, Daniela Viramontes-H örner, Rebecca Packington, John Monaghan, Susan Shaw, Aleli Akani, Timothy Reilly, Thomas Trimble, Grazziela Figueredo, Nicholas M. Selby Tags: clinical investigation Source Type: research
Acute tubular injury in a patient with acetaminophen toxicity
A 31-year-old woman with a history of alcohol abuse presented with nonoliguric acute kidney injury, mild pancreatitis, and diarrhea. Her only medication was acetaminophen, 1 to 2 g every 4 to 6 hours for 4 days for abdominal pain. Admission blood pressure was 122/74 mm Hg with serum creatinine of 9.16 mg/dl (baseline, 0.5 mg/dl), requiring dialysis. Urine sediment was inactive. Blood ethanol was undetectable. Aspartate and alanine transaminases were>20,000 U/L and 3799 U/L, respectively. Creatine kinase level was normal. (Source: Kidney International)
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Zhe Ran S. Duan, Umesh Dalal, Vivette D ’Agati, Satoru Kudose Tags: Nephrology Image Source Type: research
Interstitial hemophagocytosis in hemophagocytic lymphohistiocytosis
A 36-year-old woman with systemic lupus erythematosus and Sj ögren syndrome—managed with prednisone (20 mg t.i.d.) and hydroxychloroquine (200 mg b.i.d.)—was admitted with fevers and pancytopenia. Pertinent laboratory values from initially performed testing can be found in Supplementary Table S1. A bone marrow biopsy showed evidence of hemophagocytosis. Infectious disease workup revealed the patient had latent tuberculosis. Examination was notable for fever (38.8 °C), a rash on the back, but no edema. (Source: Kidney International)
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Miroslav Sekulic, Dominick Santoriello, Avais Masud, Satoru Kudose Tags: Nephrology Image Source Type: research
Use of antibiotics as a therapeutic approach to prevent AKI-to-CKD progression
The microbiota plays important roles in the health and diseases of its host. Gharaie et al. demonstrated that antibiotic treatment, especially amoxicillin, facilitated the repair process from ischemic acute kidney injury despite postinjury administration through microbiota modulation. This commentary discusses the implications and limitations of the study’s findings for utilizing g ut microbiota modification with antibiotics as a novel therapeutic approach to prevent acute kidney injury–to–chronic kidney disease progression. (Source: Kidney International)
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Yu Kurata, Masaomi Nangaku Tags: Commentary Source Type: research
What should be the eGFR decline thresholds on kidney endpoints?
We have read with great interest the article by Heerspink et al.1 regarding the effects of newer kidney protective agents on renal endpoints. The authors analyze whether differences were present in the estimated glomerular filtration rate (eGFR) decline thresholds used in the studies that evaluated renal outcomes in the Canagliflozin and Renal Events in Dia betes with Established Nephropathy Clinical Evaluation (CREDENCE), Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD), Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (FIDELIO-DKD), and the St...
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Jorge Rico-Fontalvo, Tomas Rodriguez-Yanez, Miriam Machado, Maria Jose Soler Tags: Letter to the Editor Source Type: research
The authors reply
We thank Rico-Fontalvo et al. for their interest in our study.1 The goal of our study was to assess the effect of newer nephroprotective agents on endpoints defined by different estimated glomerular filtration rate (eGFR) decline thresholds (40%, 50%, and 57% eGFR decline) to inform the design of future trials of chronic k idney disease (CKD) progression. We therefore pooled data from 4 trials that recruited patients with CKD who were at high risk of progression, and we demonstrated that the relative effects of newer nephroprotective therapies appear to be generally similar across different eGFR decline thresholds. (Sour...
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Hiddo J.L. Heerspink, Niels Jongs, Brendon L. Neuen Tags: Letter to the Editor Source Type: research
The authors reply
We thank Xu et al. for their viewpoint on the benefits of glucagon-like peptide-1 (GLP-1) receptor agonists for preserving kidney function in type 2 diabetes.1 Their routine clinical practice data2 are reassuring and confirmatory of our clinical trial findings3 about the effects of a GLP-1 receptor agonist to sl ow loss of estimated glomerular filtration rate (eGFR). Both studies analyzed patients selected for type 2 diabetes, most of whom did not have chronic kidney disease (CKD).2,3 Collectively, these results raise the intriguing possibility that GLP-1 receptor agonists could have a primary prevention ro le, because e...
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Katherine R. Tuttle, Heidrun Bosch-Traberg, David Z.I. Cherney, Samy Hadjadj, Ofri Mosenzon, S øren Rasmussen, Stephen C. Bain Tags: Letter to the Editor Source Type: research
Routine care data and the benefits of GLP1 receptor agonists on slowing kidney function decline
In the analysis of SUSTAIN-6 (the Trial to Evaluate Cardiovascular and Other Long-term Outcomes With Semaglutide in Subjects With Type 2 Diabetes)/PIONEER-6 (the Trial Investigating the Cardiovascular Safety of Oral Semaglutide in Subjects With Type 2 Diabetes) trials by Tuttle et al.,1 semaglutide, a glucagon-like peptide-1 receptor agonist (GLP1-RA), was associated with a slower estimated glomerular filtration rate (eGFR) decline versus placebo, with a mean difference in eGFR slope of 0.59 ml/min per 1.73 m2 per year. (Source: Kidney International)
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Yang Xu, Anne-Laure Faucon, Edouard L. Fu, Juan Jesus Carrero Tags: Letter to the Editor Source Type: research
Finding the right context of use for molecular transplant diagnostics in kidney allograft biopsies
This study marks a milestone toward defining a valuable context for use for biopsy-based molecular transplant diagnostics. (Source: Kidney International)
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Michael Mengel, Mark Haas Tags: Commentary Source Type: research
Relative excess mortality risk after kidney transplantation: Eve ’s loss or Adam’s win?
We read with interest the recent study by Vinson et al.,1 which reveals that after kidney transplantation, females face a greater risk of excess mortality compared with males. This disparity of outcomes related to the biological sex appears to be confined to young patients. (Source: Kidney International)
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Friedrich A. von Samson-Himmelstjerna, Benedikt Kolbrink, Kevin Schulte Tags: Letter to the Editor Source Type: research
The authors reply
We appreciate the letter by von Samson-Himmelstjerna et al.1 regarding our recent article examining sex (biologic) differences in excess mortality after transplant.2 In their letter, the authors highlight important differences between excess and absolute mortality risk and raise the hypothesis that lower excess mortality in male than female transplant recipients may be due to male transplant recipients undertaking less risky behaviors than their healthy peers. We agree that this may contribute. However, existing evidence supports other explanations for the observed sex differences in excess mortality. (Source: Kidney International)
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Amanda J. Vinson, Bethany J. Foster Tags: Letter to the Editor Source Type: research
The Case | A patient with autosomal dominant polycystic kidney disease with an atypical kidney magnetic resonance image
A 30-year-old woman attended our clinic to confirm the diagnosis of autosomal dominant polycystic kidney disease (ADPKD). An abdominal ultrasound performed at the age of 18 years showed multiple hepatic and bilateral kidney cysts. (Source: Kidney International)
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Eleonora Riccio, Massimo Imbriaco, Aurora Daniele, Guido Iaccarino, Antonio Pisani Tags: Make Your Diagnosis Source Type: research
Tolerogenic dendritic cells: promising cell therapy for acute kidney injury
There is still no established treatment for acute kidney injury (AKI), and the intervention of AKI remains limited to supportive treatments. Li et al. demonstrated the mechanism by which immune tolerance by dendritic cell ameliorates AKI in a mouse ischemia-reperfusion injury model. The phase I/II clinical trials of tolerogenic dendritic cell therapy have been conducted for kidney transplantation, so it is expected to have potential as a cel l therapy for AKI in the future. (Source: Kidney International)
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Yasuna Nakamura, Tsuyoshi Inoue Tags: Commentary Source Type: research
Histology versus molecular surveillance: claims and evidence
Many novel biomarkers are targeting detection of subclinical rejection to challenge the need for and replace the cost of protocol biopsies. There are 2 separate questions: Can we safely and reliably replace a protocol biopsy with a noninvasive blood or urinary biomarker for immune surveillance of the transplanted organ? And: what is the role of protocol biopsy in the current era? Both approaches need comparison against the incumbent test, serial (delta) serum creatinine. (Source: Kidney International)
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Brian J. Nankivell, Jeremy R. Chapman Tags: Controversies in Nephrology Source Type: research
Urine trumps the protocol biopsy for subclinical rejection surveillance
Patient centricity is the focus of health care in the 21st century. We aim to create a healthier world where patients receive and providers deliver precise, tailored, cost-effective care. Nowhere is this more important than in the transplant field, where a functioning kidney transplant is the most desired and optimal treatment for end-stage kidney disease. Yet, limited organ availability and subclinical and incompletely diagnosed alloimmune injury result in persisting inflammation, scarring, and loss of functioning kidney tissue, leading to reduced graft survival. (Source: Kidney International)
Source: Kidney International - August 18, 2023 Category: Urology & Nephrology Authors: Minnie M. Sarwal, Maarten Naesens Tags: Controversies in Nephrology Source Type: research
