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Clinical Kidney Journal

Kevin Barton, T Keefe Davis, Bess Marshall, Alexis Elward, Neil H White
Posaconazole is an antifungal therapy reported to cause incident hypertension. Hypokalemia is also a known side effect. The combination of hypertension and hypokalemia suggests mineralocorticoid excess. We present the case of a 15-year-old adolescent male with hypertensive urgency while on prophylactic posaconazole therapy for a combined immunodeficiency. We identify the mechanism of posaconazole-induced hypertension to be inhibition of the 11β-hydroxylase enzyme, resulting in elevated levels of the mineralocorticoid receptor activator deoxycorticosterone...
October 2018: Clinical Kidney Journal
Maria Dolores Sanchez-Niño, Alberto Ortiz
Drug-induced hypertension offers the opportunity to further understand pathways involved in the regulation of blood pressure. Posaconazole is an antifungal agent known to induce hypertension and hypokalaemia. In recent months, a flurry of reports has unravelled the metabolic processes involved. In this issue of CKJ , Barton K, Davis TK, Marshall B et al. Posaconazole-induced hypertension and hypokalemia due to inhibition of the 11β-hydroxylase enzyme. Clin Kidney J 2018; 11: 691-693 present convincing evidence of 11β-hydroxylase inhibition resulting in a biochemical syndrome resembling genetic congenital adrenal hyperplasia and characterized by high 11-deoxycorticosterone and 11-deoxycortisol levels as well as androgen levels...
October 2018: Clinical Kidney Journal
William L Whittier, Casey Gashti, Samuel Saltzberg, Stephen Korbet
Background: The safety and adequacy are established for the native percutaneous renal biopsy (PRB) but no prospective studies exist that directly compare these with transplant PRB. Methods: From 1995 to 2015, 1705 adults underwent percutaneous native [native renal biopsy (NRB)] or transplant renal biopsy (TRB) by the Nephrology service. Real-time ultrasound and automated biopsy needles (NRB, 14 or 16 gauge; TRB, 16 gauge) were used. Patients were observed for 24 h (NRB) or 8 h (TRB) post-procedure...
October 2018: Clinical Kidney Journal
Stephen M Korbet, Casey N Gashti, Joni K Evans, William L Whittier
Background: Percutaneous renal biopsy (PRB) of native kidneys (NKs) to better understand and treat acute kidney injury (AKI) is being advocated, but little is known about the risk of complications. Methods: We performed a retrospective study of PRB of NKs in 955 adults from 1991 to 2015 at an academic medical center with real-time ultrasound and automated biopsy needles. Patients undergoing PRB for evaluation of AKI ( n = 160) were compared with 795 patients biopsied for other reasons (not-AKI) for postbiopsy complications [need for transfusion of packed red blood cells (PRBCs), an interventional radiologic or surgical procedure, readmission or death]...
October 2018: Clinical Kidney Journal
Jennifer S Lees, Emily P McQuarrie, Bruce Mackinnon
To obtain truly informed consent, we must be able to advise our patients accurately about the relative risk and benefit of any treatment plan. Percutaneous renal biopsy remains the gold standard investigation in the evaluation of intrinsic renal disease. There have been significant improvements in practice over the past decades with regards to percutaneous renal biopsy. Across centres, we appear now to have reached agreement on many aspects of this procedure, such as the need for blood pressure control, avoidance of coagulopathy, use of spring-loaded needles under direct imaging guidance and a need to monitor for complications...
October 2018: Clinical Kidney Journal
Ana García-Prieto, Almudena Vega, Tania Linares, Soraya Abad, Nicolás Macías, Inés Aragoncillo, Esther Torres, Andrés Hernández, Diego Barbieri, José Luño
Background: Online haemodiafiltration (OL-HDF) has been shown to reduce all-cause mortality versus conventional haemodialysis (HD); however, it is not always available. In these situations, a novel class of membranes with a higher pore size, medium cut-off (MCO) dialysers, could be promising. The aim of this study is to evaluate the efficacy of an MCO dialyser in the removal of small and medium-size molecules and compare it with standard high-flux (HF) dialysers in HD and OL-HDF. Methods: In this crossover study, 18 prevalent HD patients were studied in three single mid-week dialysis treatments during three consecutive weeks as follows: first week with OL-HDF with a standard HF dialyser, second week with conventional HD with a standard HF dialyser and third week with conventional HD with an MCO dialyser...
October 2018: Clinical Kidney Journal
Wihib Gebregeorgis, Zeenat Yousuf Bhat, Nishigandha Pradhan, Stephen D Migdal, Lakshminarayanan Nandagopal, Reddy Singasani, Tehmina Mushtaq, Ronald Thomas, Yahya M Osman Malik
Background: The Dt/V obtained by using ionic dialysance (D) as a surrogate for urea clearance (K) is a well-validated adjunct measure of hemodialysis adequacy, with a variable level of correlation with urea-based Kt/V. However, this correlation has not been examined based on patients' body size and ultrafiltration (UF) volume during the dialysis session. Methods: Simultaneous evaluations of online Dt/V and single-pool variable-volume urea Kt/V were made. Patients were categorized into three subgroups based on their weight (<60, 60-80 and ≥80 kg), body mass index (<25, 25-30 and >30 kg/m2 ) and UF volume (<1...
October 2018: Clinical Kidney Journal
Gunjeet Kaur, Shankar Prinja, Raja Ramachandran, Pankaj Malhotra, Krishan Lal Gupta, Vivekanand Jha
Introduction: Nearly 220000 patients are diagnosed with end-stage renal disease (ESRD) every year, which calls for an additional demand of 34 million dialysis sessions in India. The government of India has announced a National Dialysis Programme to provide for free dialysis in public hospitals. In this article we estimate the overall cost of performing hemodialysis (HD) in a tertiary care hospital. Second, we assess the catastrophic impact of out-of-pocket expenditures (OOPEs) for HD on households and its determinants...
October 2018: Clinical Kidney Journal
Esther Leenen, Lars Neumann, Ana Harth, Achim Jörres, Alexander Weidemann
Peripheral arterial disease and diabetic foot syndrome are common comorbidities in dialysis patients. These conditions are treated with intermittent vacuum therapy in order to increase angiogenesis and perfusion. Some devices encase the lower extremities up to the abdomen. Here we report the case of a patient who had performed peritoneal dialysis for 2 years without complications. Following postoperative intermittent vacuum therapy, he presented with extensive catheter leakage. Ultimately the patient had to be switched to haemodialysis and the catheter had to be removed...
October 2018: Clinical Kidney Journal
Mihran V Naljayan, Farshid Yazdi, Efrain Reisin
Background: Urgent-start peritoneal dialysis (USPD) was designed to avoid temporary hemodialysis initiation with a hemodialysis catheter. In these patients, PD is initiated within 2 weeks of catheter placement, but typically these prescriptions utilize automated peritoneal dialysis (APD) with a cycler. Manual exchanges have not been reported previously for USPD. We hypothesize that using multiple, low-volume manual exchanges, patients will have similar rates of peritonitis, exit-site infection (ESI), pericatheter leaks and discontinuation of PD in the first 3 months after initiation...
October 2018: Clinical Kidney Journal
Denis Fouque, Hubert Roth, Bernadette Darné, Jean-Louis Bouchet, Eric Daugas, Tilman B Drüeke, Thierry Hannedouche, Guillaume Jean, Gérard M London
Background: The aim of the third French Phosphorus and Calcium Observatory (Photo-Graphe® 3) was to assess the achievement of international Kidney Disease: Improving Global Outcomes (KDIGO) recommendations on optimal serum phosphate, calcium and parathyroid hormone (PTH) levels and possible associations with mortality in patients with chronic kidney disease (CKD). Methods: This was a prospective, observational study conducted with nephrologists in France who were selected using a clustering approach...
October 2018: Clinical Kidney Journal
Claire Harris, Mercedeh Kiaii, Wynnie Lau, Myriam Farah
Background: Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a rare but life-threatening condition predominately occurring in patients with end-stage renal disease on dialysis. In the absence of randomized clinical trials to guide management, clinicians must rely on observational data. We have previously reported the outcomes of our multi-intervention management in seven patients and now present a larger series of patients with extended follow-up. Methods: We performed a retrospective analysis of all patients diagnosed with CUA at a single academic center between 2008 and 2017...
October 2018: Clinical Kidney Journal
Robert Davies
Chronic kidney disease (CKD) is a growing burden on people and on healthcare for which the diagnostics are niether disease-specific nor indicative of progression. Biomarkers are sought to enable clinicians to offer more appropriate patient-centred treatments, which could come to fruition by using a metabolomics approach. This mini-review highlights the current literature of metabolomics and CKD, and suggests additional factors that need to be considered in this quest for a biomarker, namely the diet and the gut microbiome, for more meaningful advances to be made...
October 2018: Clinical Kidney Journal
Kanyarat Boonprasert, David A Vesey, Glenda C Gobe, Ronnatrai Ruenweerayut, David W Johnson, Kesara Na-Bangchang, Soisungwan Satarug
Background: Exposure to cadmium (Cd) has been associated with the development of hypertension, especially in women, but the mechanism of such an association is not understood. We hypothesize that Cd exposure alters renal production of 20-hydroxyeicosatetraenoic acid (20-HETE), which plays an indispensable role in renal salt balance and blood pressure control. Methods: We examined long-term Cd exposure in relation to urinary 20-HETE excretion levels, tubular dysfunction and blood pressure measures, using data from a population-based, cross-sectional study that included 115 normotensive and 110 hypertensive women, 33-55 years of age, who lived in Cd contamination areas in Thailand...
October 2018: Clinical Kidney Journal
Rimda Wanchoo, Carolina Bernabe Ramirez, Jacqueline Barrientos, Kenar D Jhaveri
Chronic lymphocytic leukemia (CLL) is the most commonly diagnosed adult leukemia in the USA and Western Europe. Kidney disease can present in patients with CLL as a manifestation of the disease process such as acute kidney injury with infiltration or with a paraneoplastic glomerular disease or as a manifestation of extra renal obstruction and tumor lysis syndrome. In the current era of novel targeted therapies, kidney disease can also present as a complication of treatment. Tumor lysis syndrome associated with novel agents such as the B-cell lymphoma 2 inhibitor venetoclax and the monoclonal antibody obinutuzumab are important nephrotoxicities associated with these agents...
October 2018: Clinical Kidney Journal
Marion Delafosse, Cécile Teuma, Patrick Miailhes, Mathilde Nouvier, Maud Rabeyrin, Denis Fouque
Extra-pulmonary tuberculosis is frequently located in the kidneys and, in such cases, could be associated with a granulomatous interstitial nephritis. Granulomas are not always detected, especially in human immunodeficiency virus (HIV)-positive patients. We report here a case of tubulointerstitial nephritis without granulomas in an HIV-negative patient. Since all laboratory tests failed to isolate Mycobacterium tuberculosis in the kidney, a targeted biopsy guided by positron emission tomography-computed tomography was performed on a mediastinal node, revealing a positive culture...
October 2018: Clinical Kidney Journal
Nicole L Veltri, Michelle Hladunewich, Arrti Bhasin, Jocelyn Garland, Benjamin Thomson
Background: De novo antineutrophil cytoplasmic antibody-associated vasculitis typically arises in post-reproductive years, but can occur during pregnancy. Concerns of treatment-related teratogenicity persist, while efficacy and safety of new therapies including intravenous immunoglobulin (IVIG) and rituximab are uncertain. There remains a paucity of maternal, fetal and pregnancy outcome data in these women, and therefore a lack of guidance on safe treatment for clinicians. Methods: We conducted a systematic review of the literature and a local, retrospective chart review of women with de novo antibody-associated vasculitis (AAV) in pregnancy...
October 2018: Clinical Kidney Journal
Manjuri Sharma, Arunima Mahanta, Anup Kumar Barman, P J Mahanta
Background: Children with nephrotic syndrome (NS) are at risk for the development of acute kidney injury (AKI) through a variety of mechanisms.The frequency of NS hospitalizations complicated by AKI has almost doubled in the last decade. Children with AKI have longer hospital length of stay and increased need for intensive care unit admission. The main objectives of this study were to determine the incidence, clinical characteristics, risk factors and short-term outcome of AKI in children hospitalized with NS...
October 2018: Clinical Kidney Journal
Bart De Moor, Johan F Vanwalleghem, Quirine Swennen, Koen J Stas, Björn K I Meijers
Renal stimulation tests document the dynamic response of the glomerular filtration rate (GFR) after a single or a combination of stimuli, such as an intravenous infusion of dopamine or amino acids or an oral protein meal. The increment of the GFR above the unstimulated state has formerly been called the renal functional reserve (RFR). Although the concept of a renal reserve capacity has not withstood scientific scrutiny, the literature documenting renal stimulation merits renewed interest. An absent or a blunted response of the GFR after a stimulus indicates lost or diseased nephrons...
October 2018: Clinical Kidney Journal
Hannah Beckwith, Martyn Kingsbury, Jo Horsburgh
Increasing concerns about recruitment and retention of junior doctors have led to renewed interest in how and when trainees choose their specialties. To our knowledge, no study has yet reported what attracts UK applicants to nephrology nor how clinicians develop vocational interests or make occupational choices. With this in mind, we sought to explore the motivation behind current nephrologist's career choices in the UK. We interviewed 11 nephrologists using a semi-structured face-to-face approach and used interpretative phenomenological analysis to conduct and analyse the interviews...
October 2018: Clinical Kidney Journal
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