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Clinical Nephrology

Farrukh M Koraishy, Benjamin Bowe, Yan Xie, Hong Xian, Ziyad Al-Aly
BACKGROUND: Chronic kidney disease (CKD) is associated with increased all-cause mortality. How non-traditional risk factors modify the mortality risk associated with CKD has not been studied. We approached this question using elevated monocyte count, which is associated with increased risk of death in the general population; however, there is very limited data in CKD. MATERIALS AND METHODS: A national cohort of 1,706,589 U.S. veterans without end-stage renal disease (ESRD) was followed over a median of 9...
July 5, 2018: Clinical Nephrology
Mary B Avendt, Michael D Taylor, Mark M Mitsnefes
Assessment of cardiovascular structure and dysfunction is imperative as cardiovascular disease (CVD) is a major cause of morbidity and mortality in pediatric patients with end-stage renal disease (ESRD). Cardiac magnetic resonance allows for accurate measurement of myocardial volumes, global function, and regional deformation (strain). We studied 38 patients aged from 11 to 26 years: 10 on hemodialysis (HD), 10 on peritoneal dialysis (PD), and 18 post renal transplantation (RT). First, we found no difference in the amount of left ventricular hypertrophy among the three cohorts, but we did find uncontrolled hypertension and black race to be independently associated with increased normalized left ventricular mass...
July 5, 2018: Clinical Nephrology
Susie L Hu, Priyanka Joshi, Mark Kaplan, Judy Lefkovitz, Dominique S Michaud
BACKGROUND: Active vitamin D and cinacalcet, a treatment for secondary hyperparathyroidism and also with potential anti-inflammatory properties, have been associated with lower risk of death among dialysis patients. Vitamin D has also been described to decrease proteinuria in CKD patients. This study aims to assess the relationship of vitamin D and cinacalcet with survival and residual renal function preservation among peritoneal dialysis patients. MATERIALS AND METHODS: In a retrospective peritoneal dialysis cohort of 581 subjects, we assessed if vitamin D and cinacalcet therapy are associated with increased risk of death and residual renal function loss using Kaplan-Meier analysis and Cox proportional hazard analysis...
June 29, 2018: Clinical Nephrology
Julia Thumfart, Steffen Wagner, Anuradha Jayanti, Dominik Müller, Wolfgang Pommer
AIMS: Intensified hemodialysis (HD) programs have been developed to overcome the shortcomings of conventional HD. However, there are no data on the implementation of intensified HD programs into routine care. Therefore, we investigated the attitude of nephrologists towards intensified HD, its penetrance into clinical practice, and barriers to implementation. MATERIALS AND METHODS: We performed an online survey within the German Society of Nephrology on the beliefs and attitudes towards intensified HD...
June 22, 2018: Clinical Nephrology
Catherine Mao, Bobby Chacko
Contrast-associated nephropathy (CAN) is an extensively studied but equally controversial sequela of intravascular contrast use. Despite this, there is still significant debate about its definition and thus incidence, the impact of route of contrast administration, and ultimately, what constitutes appropriate clinical practice in light of risks. While guidelines cannot replace clinical judgment, without consensus either enthusiastic withholding of contrast from necessary procedures or its administration despite increased risk may be deleterious to patient outcomes...
June 22, 2018: Clinical Nephrology
George Vasquez-Rios, Hani Alkhankan, Boutros Peter Sawaya, Javier A Neyra
INTRODUCTION: Methanol intoxication is an infrequent cause of poisoning in the United Sates. It can present with prominent stroke-like features and acute kidney injury. Despite the life-threatening nature of this condition, it is poorly identified by clinicians. We aim to present a case of rapidly progressive mental decline and renal involvement, discuss a diagnostic work-up and provide a critical review on therapeutic strategies. CASE PRESENTATION: A 24-year-old patient presented to the emergency department with acute encephalopathy and diffuse muscular rigidity...
June 22, 2018: Clinical Nephrology
David Massicotte-Azarniouch, Sean Barbour, Paula Blanco, Edward G Clark
Membranous nephropathy (MN) is a common cause of nephrotic syndrome. Rarely, it can present with rapidly-progressive renal failure and hematuria. While this may be due to lupus nephritis, superimposed anti-glomerular basement membrane (GBM) disease, or antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, there have been rare reports of anti-GBM - and ANCA-negative crescentic glomerulonephritis presenting in primary membranous nephropathy (pMN). We present the case of a patient with long-standing pMN who developed acute deterioration of renal function and was found to have a flare of MN along with crescentic glomerulonephritis (GN) despite a negative serum ANCA, anti-GBM, and antinuclear antibody (ANA) work-up...
June 22, 2018: Clinical Nephrology
Xiao Huang, Zheng Tang, Xiaomei Wu, Lihua Zhang, Wenjing Fan, Haitao Zhang, Weixin Hu, Zhihong Liu
AIMS: To investigate the renal pathological characteristics, renal outcomes and risk factors in lupus nephritis (LN) patients qualified as familial systemic lupus erythematosus (SLE). MATERIALS AND METHODS: Patients with biopsy-proven LN of familial SLE were enrolled. The clinical, laboratory, and pathological data of familial patients were analyzed and compared with those of sporadic SLE patients. The renal prognosis and risk factors were also assessed. RESULTS: 68 biopsy-proven familial SLE patients with LN were investigated...
June 22, 2018: 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
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
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
Wei Zhou, Weifeng Hu, Guofeng Han, Huiling Wang, Jinyuan Zhang, Changlin Mei
BACKGROUND: Residual renal function (RRF) is a crucial factor that plays an important role in peritoneal dialysis (PD) patients, but whether RRF influences the quality of life (QOL) of PD patients is still controversial. The aims of this study were to explore the effects of RRF on QOL in patients with continuous ambulatory peritoneal dialysis (CAPD) and analyze the related factors that might affect patients' QOL. MATERIALS AND METHODS: All 120 adult patients in this study received regular CAPD treatment for at least 3 months...
August 2018: Clinical Nephrology
Fady Ghali, Lawrence M Dagrosa, Rachel A Moses, Michal Ursiny, Brian H Eisner, Vernon M Pais
PURPOSE: We sought to describe patterns of factitious urinary stone submission over time by investigating a contemporary stone analysis database and comparing two distinct time points. MATERIALS AND METHODS: We retrospectively reviewed a single stone analysis lab database at two time points, 1990 and 2010, and compared total incidence of factitious stone submission, as well as gender patterns and type of factitious stone submitted. RESULTS: A total of 27,014 stones were analyzed, 16,216 (60%) from 1990 and 10,798 (40%) from 2010 with a decrease in total incidence from 2...
August 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...
July 2018: Clinical Nephrology
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