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Clinical Nephrology

Linda Shavit, Shuli Silberman, Rachel Tauber, Ofer Merin, Daniel Bitran, Daniel Fink
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a less invasive treatment modality for patients with severe aortic valve stenosis (AS) who are at a higher risk if they have surgery. Preoperative chronic kidney disease (CKD) influences outcomes of cardiac surgery and is associated with a higher mortality and more complicated hospital course. The aims of our study were to evaluate the comparative outcomes of TAVI versus surgical aortic valve replacement (SAVR) in geriatric patients with preoperative CKD...
May 24, 2018: Clinical Nephrology
Wenyan Zhou, Zhaohui Ni, Minfang Zhang
BACKGROUND: Fabry disease may coexist with various glomerular diseases, including IgA nephropathy, focal segmental glomerulosclerosis, etc. In this study, we report a rare case of Fabry disease associated with membranous nephropathy (MN). CASE PRESENTATION: A 30-year-old man with nephrotic proteinuria, normal renal function, and no other extrarenal manifestations underwent a renal biopsy in February 2017. Light microscopy and immunofluorescence indicated MN (stage 1)...
May 24, 2018: Clinical Nephrology
Anunciación González-López, Angel Chocarro-Martinez, Alvaro Nava-Rebollo
No abstract text is available yet for this article.
May 11, 2018: Clinical Nephrology
Ezra Gabbay, Yehudit Zangi, Alon Bnayah, Jawad Atrash, Itzchak Slotki, Linda Shavit
BACKGROUND: The factors that determine prognosis in elderly patients with dialysis-requiring acute kidney injury (AKI-D) is uncertain. The purpose of this study was to examine predictors of in-hospital mortality in these patients. MATERIALS AND METHODS: A retrospective, single-center study of hospitalized patients ≥ 70 years old with AKI-D. Clinical and demographic variables were compared between survivors and non-survivors, independent predictors of hospital mortality were identified by logistic regression...
May 11, 2018: Clinical Nephrology
Jian-Rao Lu, Hai-Yan Han, Jing Hu, Chuan-Fu Zhang, Jie Chen, Xiu-Feng Chen, Xin-Hua Wang, Rong-Hua Pan
OBJECTIVE: Renal fibrosis generally results in renal failure during the end stage of chronic renal diseases. There are many cell factors including E-cadherin, α-SMA, and TGF-β1 influencing deposition of extracellular matrix and leading to renal fibrosis. As the most important and widely-used therapy for various diseases in China for thousands of years, traditional Chinese medicine (TCM) provides a novel treatment for renal fibrosis. For clinical application, we explore the effect of Bu-Shen-Huo-Xue formula (BSHX), a traditional Chinese herbal formula, on E-cadherin and α-SMA in rats with 5/6 nephrectomy...
May 11, 2018: Clinical Nephrology
Masahiro Okabe, Tsuyoshi Takamura, Akiko Tajiri, Nobuo Tsuboi, Masahiro Ishikawa, Makoto Ogura, Ryuji Ohashi, Takashi Oda, Takashi Yokoo
Infection-related glomerulonephritis (IRGN) is rarely complicated with eosinophil infiltration into the glomerulus. Here we report a case of eosinophilic proliferative glomerulonephritis related with infection. A 70-year-old man with respiratory symptoms displayed hypereosinophilia, hypocomplementemia, impaired renal function, and nephrotic syndrome. Renal biopsy revealed endocapillary proliferative glomerulonephritis with immunostaining for immunoglobulin G and complement 3, and subepithelial hump-like electron-dense deposits, thus fulfilling the criteria for IRGN...
April 27, 2018: Clinical Nephrology
Tanjala T Gipson
BACKGROUND: Tuberous sclerosis complex (TSC) is a multisystem disorder that results in tumor growth in various organs. TSC can affect the kidneys in the form of renal angiomyolipomas and cysts that can lead to chronic kidney disease. CASE PRESENTATION: A 38-year-old woman was referred to Kennedy Krieger Institute for comprehensive TSC management. Before referral, the patient had gone most of her life without a definite diagnosis of TSC despite visually-prominent signs such as forehead plaques, facial angiofibromas, and ungual fibromas...
April 27, 2018: Clinical Nephrology
Hanne Skou Jørgensen, Simon Winther, Laust Dupont, Morten Bøttcher, Lars Rejnmark, Ellen-Margrethe Hauge, My Svensson, Per Ivarsen
BACKGROUND: Sclerostin, a bone-derived protein, has been linked to cardiovascular calcifications in chronic kidney disease (CKD). The aim of this study was to investigate the associations between sclerostin and mineral and bone disorder in CKD, specifically whether sclerostin levels could predict cardiovascular event, fracture, or all-cause mortality. MATERIALS AND METHODS: Kidney transplantation candidates (n = 157) underwent computed tomography scans of the chest, abdomen, and pelvis...
April 27, 2018: Clinical Nephrology
Yan Zhu, Fenfen Peng, Yihua Chen, Wenjing Chen, Weidong Zhou, Peilin Li, Hongxin Niu, Haibo Long
OBJECTIVES: The association between mean platelet volume/platelet count ratio (MPV/PC) and mortality has been demonstrated in various populations but not in peritoneal dialysis (PD) patients. This study investigated the association between MPV/PC and all-cause and cardiovascular mortality in PD patients. MATERIALS AND METHODS: In this single-center retrospective cohort study, 338 patients who underwent incident PD from January 2006 to June 2014 and had baseline MPV/PC were enrolled and followed until June 30, 2015...
April 27, 2018: Clinical Nephrology
Benson Ku, Steven Fishbane
INTRODUCTION: In patients with late-stage chronic kidney disease (LS-CKD, estimated glomerular filtration rate (eGFR) < 30 mL/min) there is a high prevalence of congestive heart failure (CHF). We have observed a cyclical nature in the "cardiorenal syndrome" in LS-CKD, not previously described. The purpose of this article is to describe the syndrome and review its characteristics. MATERIALS AND METHODS: Patients enrolled in the Northwell Health Healthy Transitions in Late Stage Kidney Disease Program (HT) were followed, all with eGFR 0 - 30 mL/min...
April 27, 2018: Clinical Nephrology
Yumi Yamada, Toshinori Ueno, Taisuke Irifuku, Ayumu Nakashima, Shigehiro Doi, Tatsuo Ichinohe, Takao Masaki
Multicentric Castleman disease (MCD) is a rare systemic lymphoproliferative disorder and is infrequently associated with renal complications that include amyloid A (AA) amyloidosis. Although it has been reported that patients with MCD and amyloidosis usually have a poor prognosis, recently, tocilizumab, a humanized anti-interleukin-6 receptor antibody, has emerged as an effective and specific treatment for AA amyloidosis secondary to chronic inflammatory disorders. Here we report a case of an MCD patient with secondary AA renal amyloidosis who was successfully treated with tocilizumab...
April 27, 2018: Clinical Nephrology
Jumpei Hasegawa, Junichi Hoshino, Akinari Sekine, Noriko Hayami, Tatsuya Suwabe, Keiichi Sumida, Koki Mise, Toshiharu Ueno, Masayuki Yamanouchi, Ryo Hazue, Naoki Sawa, Kenichi Ohashi, Takeshi Fujii, Kenmei Takaichi, Yoshifumi Ubara
BACKGROUND: Antithyroid drugs such as propylthiouracil and methimazole have been reported to cause antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), but little is known about long-term outcomes. MATERIALS AND METHODS: We identified AAV patients who underwent renal biopsy and retrospectively assessed their clinical and histological findings. Patients with AAV who had received propylthiouracil or methimazole were defined as having antithyroid drug-associated AAV (ATD-AAV), and the other patients were defined as having primary AAV...
April 12, 2018: Clinical Nephrology
Orit Shimon, Hefziba Green, Noa Eliakim-Raz, Benaya Rozen-Zvi, Haim Ben-Zvi, Iris Zohar, Jihad Bishara, Dafna Yahav
BACKGROUND: Bloodstream infections (BSIs) are an important cause of hospitalizations and mortality among hemodialysis (HD) patients. Epidemiology of these infections is changing, with increasing rates of Gram-negative pathogens, including resistant ones. Few studies have focused on the characteristics and outcomes of these infections. OBJECTIVE: We aimed to document the causative pathogens of BSIs in HD patients and their clinical outcomes during 2008 - 2015, and to compare risk factors, clinical features, appropriateness of therapy, and outcomes between patients with Gram-negative vs...
April 12, 2018: Clinical Nephrology
Oded Volovelsky, Katja M Gist, Tara C Terrell, Michael R Bennett, David S Cooper, Jeffrey A Alten, Stuart L Goldstein
AIMS: Acute kidney injury (AKI) occurs in 30 - 40% of children after cardiac surgery (CS) and is associated with poor prognosis. Fibroblast growth factor 23 (FGF23) is a bone-derived hormone with a pivotal role in phosphorus and vitamin D metabolism. We assessed FGF23 as an early marker for severe AKI (sAKI) in infants after CS. MATERIALS AND METHODS: Samples were previously collected in a multicenter observational study from children after CS. Serum FGF23 (n = 41) and urine AKI biomarker levels (n = 35) were assessed 4 - 8 hours after bypass...
April 10, 2018: Clinical Nephrology
Tuncay Sahutoglu, Tamer Sakaci
BACKGROUND: Blood pressure variability (BPV) has been associated with increased morbidity and mortality. There are a few studies that reported worse outcomes of chronic kidney disease (CKD) with greater visit-to-visit BPV (VVV), but data with ambulatory blood pressure monitoring (ABPM) is scarce. MATERIALS AND METHODS: Ambulatory hypertensive CKD (stage 2 - 4) patients (> 18 years old) with complete 24 hours of ABPM study (SpaceLabs), who were followed up between January 2012 and December 2016, were retrospectively analyzed for the baseline characteristics and outcomes of CKD...
April 10, 2018: Clinical Nephrology
Prameela Banoth, Kunal Chaudhary
Hypertension and proteinuria in pregnant women are most commonly signs of preeclampsia which develops after 20 weeks of gestation. There are rare incidences of uncontrolled hypertension and nephrotic range proteinuria even in the first trimester of pregnancy which can be indicators of severe underlying fetal and placental abnormalities rather than preeclampsia. A G2P0 30-year-old Caucasian woman was admitted to University Hospital for the incidental finding of severe hypertension and proteinuria during her regular prenatal checkup at 14 weeks...
April 10, 2018: Clinical Nephrology
John R Prowle
In 2017, models of care in the best institutions around the world are no longer at the extremes discussed above. In the UK, intensivists with specialist renal interest and, not uncommonly, joint specialist training in nephrology are able to provide clinical expertise, devise more flexible RRT protocols, and provide liaison with specialist renal services without compromising speed and integration of RRT into integrated organ support. Similarly, in nephrology-led care, renal specialists are becoming more subspecialized, with acute nephrology physicians and nurses having a much greater presence in the ICU and integration with the ICU team during the management and follow-up of critically ill patients with advanced AKI...
April 10, 2018: Clinical Nephrology
Jorge Cerdá, Ashita Tolwani, Paul Palevsky
Nephrologists play a key role in the management of the critically ill patient requiring CRRT. Having clear organizational guidelines, open collaboration, and cross-enrichment is the approach most likely to lead to the best patient outcomes.
April 10, 2018: Clinical Nephrology
Javier A Neyra, Stuart L Goldstein
Two essential elements to provide effective RRT to critically ill patients with AKI in the ICU are: 1) the multidisciplinary interplay among intensivists, nephrologists, pharmacists, nurses, nutritionists, and other key members of the acute-care team for personalized therapy (i.e., RRT candidacy, timing of RRT initiation, RRT goals for solute control, RRT goals for fluid removal/regulation, renal recovery evaluation, RRT de-escalation, etc.) and 2) the iterative assessment and adjustment of RRT goals according to the clinical status of the patient...
April 10, 2018: Clinical Nephrology
Masatoshi Mune, Harumi Uto-Kondo, Iwao Iteya, Yoshiyuki Fujii, Saiko Ikeda, Katsunori Ikewaki
BACKGROUND AND AIMS: Patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD) have been shown to be at increased risk for cardiovascular disease (CVD). Decreased high-density lipoprotein cholesterol (HDL-C) and impaired cholesterol efflux capacity (CEC) have been reported in such patients, and effects of vitamin E supplementation on HDL functions are poorly understood. Therefore, the present study aimed to investigate effects of vitamin E supplementation on HDL and endothelial functions in ESKD patients undergoing HD...
April 9, 2018: Clinical Nephrology
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