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Clinical Nephrology

Raymond T Krediet, Anouk T N van Diepen, Annemieke M Coester, Dirk G Struijk
Ultrafiltration failure in long-term peritoneal dialysis patients is a well-known and important, but poorly-explained complication of the treatment. Transcapillary ultrafiltration consists mainly of small-pore fluid transport and partly of free-water transport. The former is to a large extent dependent on the hydrostatic pressure gradient and on the number of perfused peritoneal microvessels. Free-water transport depends mainly on the crystalloid osmotic gradient. A longitudinal analysis of peritoneal transport has shown a dramatic decrease of net ultrafiltration and small-pore fluid transport after 4 years of peritoneal dialysis...
November 15, 2018: Clinical Nephrology
Hannelore Sprenger-Mähr, Emanuel Zitt, Afschin Soleiman, Karl Lhotta
BACKGROUND: Antiglomerular basement membrane (anti-GBM) antibody disease is a rare condition causing pulmonary hemorrhage and necrotizing glomerulonephritis (pulmonary renal syndrome). CASE: We report a 30-year-old woman who presented with life-threatening pulmonary hemorrhage and an active urinary sediment, with normal glomerular filtration rate in the 13th week of pregnancy. Anti-GBM antibodies in serum were negative, but perinuclear antineutrophil cytoplasmatic antibodies (p--ANCA) were detected...
November 15, 2018: Clinical Nephrology
Ryan Mullane, Eric Langewisch, Marius Florescu, Troy Plumb
Systemic capillary leak syndrome (SCLS) is a disorder characterized by increased vascular permeability with intermittent acute episodes of profound capillary leak that may result in hypotension or shock. A rarely described chronic form of SCLS (cSCLS) presents as refractory edema, with pleural and/or pericardial effusions and hypoalbuminemia. These entities are differentiated by massive and periodic episodes of capillary leak, which can result in shock in SCLS, and chronic refractory edema in cSCLS. The etiologies of these disorders are poorly understood, but both acute and chronic forms often present with an associated monoclonal gammopathy...
November 15, 2018: Clinical Nephrology
Junko Yabuuchi, Junichi Hoshino, Hiroki Mizuno, Yuko Ozawa, Akinari Sekine, Masahiro Kawada, Keiichi Sumida, Rikako Hiramatsu, Noriko Hayami, Masayuki Yamanouchi, Eiko Hasegawa, Tatsuya Suwabe, Naoki Sawa, Takeshi Fujii, Kenichi Ohashi, Kenmei Takaichi, Yoshifumi Ubara
OBJECTIVES: In lupus nephritis, the immune complex plays a very important role in kidney disease progression, and immunoglobulin G subclass 3 (IgG3) may play an important role in endothelial damage as lupus nephropathy progresses. We evaluated the association between IgG3 positivity and lupus nephritis activity. MATERIALS AND METHODS: We identified 71 biopsies taken from 57 patients who had lupus nephritis with enough tissue to allow light and immunofluorescence microscopy...
November 15, 2018: Clinical Nephrology
Angelito F Yango, Bernard V Fischbach, Richard Ruiz, Steven Mudrovich, Goran Klintmalm
Membranoproliferative glomerulonephritis is known to recur after kidney transplantation and may lead to allograft loss. Although an optimal treatment has not been determined, B-cell targeted therapies are now increasingly used as first-line agents, based on growing data showing antibodies as key players in the pathogenesis of membranoproliferative glomerulonephritis. Here, we report a case of recurrent immune complex-mediated membranoproliferative glomerulonephritis 3 years after a living-donor kidney transplant...
November 15, 2018: Clinical Nephrology
Shiyue Zhao, Xueyan Zhu, Qi Li, Bai Zhu, Yangwei Wang, Wenpeng Cui, Xiaoxi Zhou, Yan Lou, Jing Sun, Lining Miao
AIM: Successful catheter implantation is highly essential for delivering effective peritoneal dialysis (PD). The aim of the present study was to describe a newly developed, minimally invasive percutaneous technique for providing safe, timely, and effective peritoneal catheter insertion and assess the long-term outcome. MATERIALS AND METHODS: 100 PD catheters were placed in 100 consecutive patients by a nephrologist using the modified percutaneous technique with a special trocar, from August 1, 2010 to December 31, 2011...
November 15, 2018: Clinical Nephrology
Sheron Latcha, Andrew J Plodkowski, Junting Zheng, Edgar A Jaimes
AIMS: The proinflammatory milieu in cancer patients may expose them to increased risk for acute kidney injury (AKI) after IV contrast (CON). The aims of this study were to determine: (1) the rates of AKI after CON and noncontrast (NC) CT scans in cancer inpatients, (2) if rates differed among cancer subtypes, and (3) whether recent chemotherapy, comorbid conditions, or nephrotoxins increase AKI after CON. MATERIALS AND METHODS: Retrospective data was collected on adults who had received a CON or NC CT from January 1, 2012 to December 30, 2014...
November 12, 2018: Clinical Nephrology
Jawed Akhtar, Vijaya Kumar Gorantla, Peter D Snell, Barry M Wall
The current case report describes a chronic hemodialysis patient presenting with painful penile ulceration that was clinically and histologically proven to be related to calcific uremic arteriolopathy. The patient subsequently developed severe upper gastrointestinal bleeding that was both endoscopically and histologically shown to be due to acute esophageal necrosis (AEN), also known as necrotizing esophagitis and "black esophagus". AEN is a rare condition characterized by diffuse necrosis of the esophageal mucosa...
November 12, 2018: Clinical Nephrology
Haili Wang, Haiyan Jing, Zhixin Cao, Qingwei Liu
No abstract text is available yet for this article.
October 29, 2018: Clinical Nephrology
Julia Vogd, Agnes Hackl, Sandra Habbig, Felix Lechner, Abdelaziz Akarkach, Lutz T Weber, Rasmus Ehren
Childhood steroid-dependent (SDNS) and frequently relapsing (FRNS) nephrotic syndromes often require long-term immunosuppressive therapy to maintain remission. Successful discontinuation of maintenance therapy remains to be a challenge with these children. In the following article, we report our experience on patients after discontinuation of steroid-sparing immunosuppressive maintenance therapy (IT). Thereby, we retrospectively reviewed all patients between 2006 and 2016 with a relapsing course of steroid-sensitive nephrotic syndrome (SDNS or FRNS) treated with steroid-sparing maintenance immunosuppressive medication...
October 26, 2018: Clinical Nephrology
Berivan Ganidagli, Huseyin Nacar, Yusuf Selcuk Yildiz, Hasan Dagli, Ertugrul Erken, Orcun Altunoren, Ozkan Gungor
BACKGROUNDS AND AIMS: Cardiovascular calcification is an important cause of morbidity and mortality in hemodialysis (HD) patients. Vascular and valvular calcification are indicators of increased tissue calcification. The relationship of osteopontin (OPN) - which is known as a vascular calcification inhibitor - and fibroblast growth factor-23 (FGF-23) - which its related to vascular calcification, as recently shown - to valvular calcification is unknown. In this cross-sectional study, we examined the relationship between heart valve calcification, serum OPN, and FGF-23 levels...
October 26, 2018: Clinical Nephrology
Samer Mohandes, Anjali Satoskar, Lee Hebert, Isabelle Ayoub
The etiology of pulmonary renal syndrome can be broadly divided into infectious and autoimmune (predominantly ANCA vasculitis). The importance of timely differentiating between them stems from the deleterious effects of their respective treatment if misdiagnosed. Serology and tissue evaluation by pathology are employed to aid in this, however, in rare cases, this can be difficult. We present a case of infectious endocarditis that presented with pulmonary renal syndrome but had positive ANCA serology and a pauci-immune glomerulonephritis picture on kidney biopsy that posed diagnostic difficulty...
October 26, 2018: Clinical Nephrology
Justin B Ziemba, Rishab Gurnani, Wesley W Ludwig, Michael A Gorin, John Asplin, Brian R Matlaga
AIMS: Preventing kidney stone recurrence relies on detecting and modifying urine chemistry abnormalities. The assumption is that an abnormality is due to a global metabolic defect present in both kidneys. However, we hypothesize that clinically significant unilateral defects may exist. We aimed to identify these patients by sampling urine from each renal unit. MATERIALS AND METHODS: Adults undergoing retrograde upper urinary tract surgery were eligible for inclusion...
October 26, 2018: Clinical Nephrology
Nolubabalo Unati Nqebelele, Caroline Dickens, Therese Dix-Peek, Raquel Duarte, Saraladevi Naicker
Variants in apolipoprotein L1 (APOL1) gene were shown to be associated with higher rates of nondiabetic kidney disease in black patients compared with white patients. Frequencies of these variants differ substantially in African populations, suggesting that their contribution to kidney disease might differ. We determined the frequency and association of APOL1 risk alleles with markers of kidney disease in black South Africans with hypertension-attributed chronic kidney disease (CKD) and their first-degree relatives...
October 26, 2018: Clinical Nephrology
Bofeng Su, Qiankun Zhang, Jin Lv
BACKGROUND: Cryptococcal meningitis (CM) is a rare condition in patients with primary nephrotic syndrome (PNS). Here, we describe the clinical characteristics, possible risk factors, and outcomes of eleven patients with PNS and CM. MATERIALS AND METHODS: A systematic review of medical records from 11 patients with PNS and CM admitted to the First Affiliated Hospital of Wenzhou Medical University from April 2005 to April 2015 was performed. A total of 30 cases were randomly selected as controls from PNS inpatients without infection during the same period...
October 19, 2018: Clinical Nephrology
Yunan Zhou, Matthias Hellberg, Evangelia Kouidi, Asterios Deligiannis, Peter Höglund, Naomi Clyne
BACKGROUND: Abdominal aortic calcification (AAC) is an established risk factor for cardiovascular events in patients with chronic kidney disease (CKD). We hypothesized that AAC is associated with a decline in glomerular filtration rate (GFR) as well as with some other cardiovascular risk factors. MATERIALS AND METHODS: This is a cross-sectional analysis of baseline data from a randomized controlled clinical trial (RENEXC). A total of 151 patients (aged 66 ± 14 years) with an average measured GFR (mGFR) of 22...
October 12, 2018: Clinical Nephrology
Nicolas Keller, Pierrick Le Borgne, Arnaud Bernhard, Thierry Hannedouche, Thierry Krummel
No abstract text is available yet for this article.
September 21, 2018: Clinical Nephrology
Roy O Mathew, Janani Rangaswami, Jennifer B Othersen, Bo Cai, Arif Asif, Mandeep S Sidhu, Sripal Bangalore
AIMS: The influence of community acute kidney injury on patients with myocardial infarction has not been explored. The Veterans Affair electronic health system was analyzed to test the hypothesis that patients who have myocardial infarction complicated by community acute kidney injury have higher short- and long-term mortality and cardiovascular outcomes than those who do not suffer acute kidney injury. MATERIALS AND METHODS: Odd ratios were calculated for in-hospital mortality...
September 20, 2018: Clinical Nephrology
Zay Htet, Mahdi Althaf, Mahzuz Karim
Hepatitis E virus (HEV) is gaining recognition as an important but under-recognized pathogen, particularly in immunocompromised individuals. It should be considered as a potential differential diagnosis in such patients presenting with acute hepatitis. We report a case of a kidney-pancreas transplant recipient who developed acute liver dysfunction; this was found to be due to HEV infection acquired through consumption of undercooked pork. His immunosuppression was cautiously reduced, and his liver biochemistry and viral PCR gradually normalized without the need for additional antiviral therapy...
September 20, 2018: Clinical Nephrology
Nestor Oliva-Damaso, Eduardo Baamonde-Laborda, Elena Oliva-Damaso, Juan Payan, Alberto Marañes, Nicanor Vega-Diaz, Jose Carlos Rodriguez-Perez
INTRODUCTION: Low pre-hemodialysis (pre-HD) serum sodium or hyponatremia is associated with higher mortality. Pre-HD serum sodium can be more stable over time with low fluctuation compared to other serum parameters. MATERIALS AND METHODS: We examined variation of pre-HD serum sodium in 24 months and after this point examined all-cause mortality in a cohort of 261 patients followed-up for 48.8 (standard deviation (SD) = 19.1) months. 6,221 determinations of pre-HD serum sodium were made and corrected for glucose concentrations...
September 20, 2018: Clinical Nephrology
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