Background: Membranous nephropathy (MN) is an immune complex-mediated disease. Massive proteinuria can lead to Fanconi syndrome, clinically manifesting as renal glycosuria. The prevalence and prognosis of M-type phospholipase A2 receptor (PLA2R)-related MN with renal glycosuria remain unknown.
Materials and methods: Patients diagnosed with PLA2R-related MN with renal glycosuria were reviewed, and the control group comprised patients with MN without renal glycosuria who were randomly selected at a ratio of 1 : 3.
Results: 50 patients diagnosed with PLA2R-related MN with renal glycosuria from January 2015 to January 2020 were included, with a prevalence of 2.3%. Compared with patients without renal glycosuria, those with renal glycosuria exhibited greater proteinuria, lower estimated glomerular filtration rate (eGFR), and higher use of diuretics, anticoagulants, antibiotics, traditional Chinese medicine, and tacrolimus within 3 months prior to renal biopsy (all p < 0.05). Histologically, patients with renal glycosuria exhibited more severe pathological stages, acute/chronic tubulointerstitial lesions, and tubulointerstitial inflammation (all p < 0.05). Of the 10 patients treated with rituximab (RTX), proteinuria remission was maintained in 6 (60%) patients, and urine glucose remission was achieved in 5 of these 6 patients (83.3%). Multivariate Cox regression analysis showed that renal glycosuria and age > 50 years were independent risk factors for end-stage renal disease (ESRD) or a 30% reduction in the eGFR in patients with PLA2R-related MN.
Conclusion: PLA2R-related MN patients with renal glycosuria presented with more severe clinicopathological manifestations and worse prognoses. Nephrotoxic drugs should be administered rationally, and RTX should be considered as a promising treatment option.
{"title":"Clinicopathological features and outcomes of PLA2R-related membranous nephropathy with renal glycosuria.","authors":"Piao Zhang, Feng Xu, Xumeng Liu, Ziyun Hu, Dandan Liang, Shaoshan Liang, Xiaodong Zhu, Fan Yang, Caihong Zeng","doi":"10.5414/CN111362","DOIUrl":"10.5414/CN111362","url":null,"abstract":"<p><strong>Background: </strong>Membranous nephropathy (MN) is an immune complex-mediated disease. Massive proteinuria can lead to Fanconi syndrome, clinically manifesting as renal glycosuria. The prevalence and prognosis of M-type phospholipase A2 receptor (PLA2R)-related MN with renal glycosuria remain unknown.</p><p><strong>Materials and methods: </strong>Patients diagnosed with PLA2R-related MN with renal glycosuria were reviewed, and the control group comprised patients with MN without renal glycosuria who were randomly selected at a ratio of 1 : 3.</p><p><strong>Results: </strong>50 patients diagnosed with PLA2R-related MN with renal glycosuria from January 2015 to January 2020 were included, with a prevalence of 2.3%. Compared with patients without renal glycosuria, those with renal glycosuria exhibited greater proteinuria, lower estimated glomerular filtration rate (eGFR), and higher use of diuretics, anticoagulants, antibiotics, traditional Chinese medicine, and tacrolimus within 3 months prior to renal biopsy (all p < 0.05). Histologically, patients with renal glycosuria exhibited more severe pathological stages, acute/chronic tubulointerstitial lesions, and tubulointerstitial inflammation (all p < 0.05). Of the 10 patients treated with rituximab (RTX), proteinuria remission was maintained in 6 (60%) patients, and urine glucose remission was achieved in 5 of these 6 patients (83.3%). Multivariate Cox regression analysis showed that renal glycosuria and age > 50 years were independent risk factors for end-stage renal disease (ESRD) or a 30% reduction in the eGFR in patients with PLA2R-related MN.</p><p><strong>Conclusion: </strong>PLA2R-related MN patients with renal glycosuria presented with more severe clinicopathological manifestations and worse prognoses. Nephrotoxic drugs should be administered rationally, and RTX should be considered as a promising treatment option.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"273-284"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To construct and apply a risk screening and intervention system for malnutrition in peritoneal dialysis patients based on the Omaha System.
Materials and methods: A total of 75 peritoneal dialysis patients were randomly divided into control (38 cases) and intervention group (37 cases). The control group received routine operation training and health education, and the intervention group implemented a nutritional management plan based on the Omaha System. The modified quantitative subjective comprehensive nutritional scale (MQSGA) score, kidney disease dietary compliance attitude (RAAQ) and behavior (RABQ) score, body mass index (BMI), serum albumin (ALB), prealbumin (PA), and hemoglobin (Hb) were observed.
Results: Before intervention, there was no significant difference in these indicators between the two groups (p > 0.05). After 6 months, the MQSGA score in the intervention group was significantly lower than that in the control group (p < 0.05). RAAQ score and RABQ score in the intervention group were higher than those in the control group and (p < 0.05), and the nutritional indicators in the intervention group, such as BMI, ALB, PA, and Hb, were higher than those in the control group (p < 0.05).
Conclusion: A nutritional management plan based on the Omaha System can help improve the nutrition condition of peritoneal dialysis patients, and improve the dietary compliance of chronic kidney disease patients.
{"title":"Use of the Omaha System nursing model on nutritional status outcomes in peritoneal dialysis patients.","authors":"Cen Zhang, Ruo Zhuang, Xiao-Lei Chen, Xiao-Dong Cao, Meng-Ting Xue","doi":"10.5414/CN111385","DOIUrl":"10.5414/CN111385","url":null,"abstract":"<p><strong>Objective: </strong>To construct and apply a risk screening and intervention system for malnutrition in peritoneal dialysis patients based on the Omaha System.</p><p><strong>Materials and methods: </strong>A total of 75 peritoneal dialysis patients were randomly divided into control (38 cases) and intervention group (37 cases). The control group received routine operation training and health education, and the intervention group implemented a nutritional management plan based on the Omaha System. The modified quantitative subjective comprehensive nutritional scale (MQSGA) score, kidney disease dietary compliance attitude (RAAQ) and behavior (RABQ) score, body mass index (BMI), serum albumin (ALB), prealbumin (PA), and hemoglobin (Hb) were observed.</p><p><strong>Results: </strong>Before intervention, there was no significant difference in these indicators between the two groups (p > 0.05). After 6 months, the MQSGA score in the intervention group was significantly lower than that in the control group (p < 0.05). RAAQ score and RABQ score in the intervention group were higher than those in the control group and (p < 0.05), and the nutritional indicators in the intervention group, such as BMI, ALB, PA, and Hb, were higher than those in the control group (p < 0.05).</p><p><strong>Conclusion: </strong>A nutritional management plan based on the Omaha System can help improve the nutrition condition of peritoneal dialysis patients, and improve the dietary compliance of chronic kidney disease patients.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"264-272"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: Patient education is crucial for preventing chronic kidney disease (CKD) progression, but adequate educational time is not always available in standard nephrology outpatient clinics. However, usefulness of educational materials provided by healthcare providers in educational settings has been reported. This study aimed to compare the efficacy of pamphlet and video materials in increasing CKD knowledge at a nephrology clinic using waiting time.
Materials and methods: 44 CKD stage 3 - 5 patients were randomly assigned to either pamphlet or video education group, receiving a single session during an outpatient visit. We evaluated the objective CKD knowledge score, perceived kidney disease knowledge score, self-care scores, and amount of estimated salt intake before and after the educational intervention.
Results: In both groups, the educational intervention significantly increased objective and perceived CKD knowledge scores (p < 0.001). No significant differences in increase in total knowledge scores between both groups were observed; however, different educational effects were observed in several individual knowledge items such as urinary protein and CKD stages. In both groups, self-care scores and amount of estimated salt intake did not change significantly before and after the intervention, but amount of estimated salt intake significantly decreased in patients with a history of dietary guidance (p = 0.044).
Conclusion: A single educational session with simple materials during outpatient waiting time at the nephrology clinic visit significantly improved patients' CKD knowledge, and suitable educational methods may differ according to knowledge items. Furthermore, patients who receive dietary guidance with specific instructions might exhibit salt reduction behavior through the use of educational materials.
{"title":"Comparison of the efficacy of educational materials for chronic kidney disease during outpatient waiting time.","authors":"Maiko Kimura, Daisuke Honda, Mizuyo Okura, Yuki Shiko, Yohei Kawasaki, Masashi Aizawa, Katsuhiko Asanuma","doi":"10.5414/CN111413","DOIUrl":"10.5414/CN111413","url":null,"abstract":"<p><strong>Aim: </strong>Patient education is crucial for preventing chronic kidney disease (CKD) progression, but adequate educational time is not always available in standard nephrology outpatient clinics. However, usefulness of educational materials provided by healthcare providers in educational settings has been reported. This study aimed to compare the efficacy of pamphlet and video materials in increasing CKD knowledge at a nephrology clinic using waiting time.</p><p><strong>Materials and methods: </strong>44 CKD stage 3 - 5 patients were randomly assigned to either pamphlet or video education group, receiving a single session during an outpatient visit. We evaluated the objective CKD knowledge score, perceived kidney disease knowledge score, self-care scores, and amount of estimated salt intake before and after the educational intervention.</p><p><strong>Results: </strong>In both groups, the educational intervention significantly increased objective and perceived CKD knowledge scores (p < 0.001). No significant differences in increase in total knowledge scores between both groups were observed; however, different educational effects were observed in several individual knowledge items such as urinary protein and CKD stages. In both groups, self-care scores and amount of estimated salt intake did not change significantly before and after the intervention, but amount of estimated salt intake significantly decreased in patients with a history of dietary guidance (p = 0.044).</p><p><strong>Conclusion: </strong>A single educational session with simple materials during outpatient waiting time at the nephrology clinic visit significantly improved patients' CKD knowledge, and suitable educational methods may differ according to knowledge items. Furthermore, patients who receive dietary guidance with specific instructions might exhibit salt reduction behavior through the use of educational materials.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"285-294"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin J Murray, Abhilash Koratala, Ariadna Perez-Sanchez, Terry Lund, Anthony Andrade, Steven M Gorbatkin, John M Duch, Sandipani Sandilya, Jorge Lamarche, Michael J Mader, Elizabeth K Haro, Nilam J Soni, Robert Nathanson
Background: Point-of-care ultrasound (POCUS) can improve diagnostic accuracy, reduce procedural complications and enhance physician-patient interactions in nephrology. Currently, there is limited knowledge about how practicing nephrologists are using POCUS.
Objective: This study aimed to characterize current POCUS use, training needs, and barriers to use among nephrology groups.
Materials and methods: A prospective observational study of all Veterans Affairs (VA) medical centers was conducted between August 2019 and March 2020 using a web-based survey sent to all chiefs of staff and nephrology specialty chiefs.
Results: Chiefs of staff (n = 130) and nephrology chiefs (n = 79) completed surveys on facility- and service-level POCUS use (response rates of 100% and 77%, respectively). Current diagnostic or procedural POCUS use was reported by 41% of nephrology groups, and the most common POCUS applications were central line insertion (28%) and assessment of urinary retention (23%), hydronephrosis (18%), volume status (15%), and bladder (14%). Lack of training was the most common barrier (72%), and most nephrology groups (65%) desired POCUS training. Limited access to ultrasound equipment and POCUS training were barriers reported by 54% and 18% of groups, respectively.
Conclusion: A minority of nephrology groups currently use common POCUS applications including evaluation of urinary retention, hydronephrosis, and volume status. The most common barriers to POCUS use in nephrology were lack of trained providers and ultrasound equipment. Investment in POCUS training and infrastructure is needed to expand and standardize POCUS use in nephrology.
{"title":"Current use, training, and barriers in point-of-care ultrasound in nephrology: A national survey of VA medical centers.","authors":"Kevin J Murray, Abhilash Koratala, Ariadna Perez-Sanchez, Terry Lund, Anthony Andrade, Steven M Gorbatkin, John M Duch, Sandipani Sandilya, Jorge Lamarche, Michael J Mader, Elizabeth K Haro, Nilam J Soni, Robert Nathanson","doi":"10.5414/CN111464","DOIUrl":"10.5414/CN111464","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) can improve diagnostic accuracy, reduce procedural complications and enhance physician-patient interactions in nephrology. Currently, there is limited knowledge about how practicing nephrologists are using POCUS.</p><p><strong>Objective: </strong>This study aimed to characterize current POCUS use, training needs, and barriers to use among nephrology groups.</p><p><strong>Materials and methods: </strong>A prospective observational study of all Veterans Affairs (VA) medical centers was conducted between August 2019 and March 2020 using a web-based survey sent to all chiefs of staff and nephrology specialty chiefs.</p><p><strong>Results: </strong>Chiefs of staff (n = 130) and nephrology chiefs (n = 79) completed surveys on facility- and service-level POCUS use (response rates of 100% and 77%, respectively). Current diagnostic or procedural POCUS use was reported by 41% of nephrology groups, and the most common POCUS applications were central line insertion (28%) and assessment of urinary retention (23%), hydronephrosis (18%), volume status (15%), and bladder (14%). Lack of training was the most common barrier (72%), and most nephrology groups (65%) desired POCUS training. Limited access to ultrasound equipment and POCUS training were barriers reported by 54% and 18% of groups, respectively.</p><p><strong>Conclusion: </strong>A minority of nephrology groups currently use common POCUS applications including evaluation of urinary retention, hydronephrosis, and volume status. The most common barriers to POCUS use in nephrology were lack of trained providers and ultrasound equipment. Investment in POCUS training and infrastructure is needed to expand and standardize POCUS use in nephrology.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"257-263"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martina Cacciapuoti, Lucia Federica Stefanelli, Lorenzo A Calò
{"title":"The unsolved Gitelman's syndrome paradox and the hypomagnesemia/albuminuria relationship in type 2 diabetics.","authors":"Martina Cacciapuoti, Lucia Federica Stefanelli, Lorenzo A Calò","doi":"10.5414/CN111527","DOIUrl":"10.5414/CN111527","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yinna Wang, Kenneth R Phelps, Darren E Gemoets, Elvira O Gosmanova
Background: If Ccr is creatinine clearance, a surrogate for glomerular filtration rate (GFR), the serum potassium concentration (Ks) is the sum of EK/Ccr and TRK/Ccr, which are amounts of potassium excreted and (net) reabsorbed per volume of filtrate (Ks = EK/Ccr + TRK/Ccr). We investigated changes in EK/Ccr, TRK/Ccr, and Ks through the stages of chronic kidney disease (CKD).
Materials and methods: We performed a retrospective study of 452 patients with CKD stages G1 - 5. Simultaneous measurements of serum and urine potassium and creatinine concentrations (Ks, Ku, crs, and cru) were used to calculate 1,007 individual values of EK/Ccr and TRK/Ccr as Ku×crs/cru and Ks - EK/Ccr, respectively. Mean values of EK/Ccr and TRK/Ccr were determined in CKD stages G1 - 5. Within each stage, means of the ratios were also ascertained in subsets with hyperkalemia (Ks > 5.1 mmol/L), normokalemia (Ks 3.8 - 5.1 mmol/L), and hypokalemia (Ks < 3.8 mmol/L).
Results: In comparison to values in CKD stages G1 - 2, EK/Ccr rose and TRK/Ccr fell in each higher stage. Decrements in TRK/Ccr equaled increments in EK/Ccr in G3a and G3b, and Ks remained stable. In G4 - 5, the ascent of EK/Ccr exceeded the decline in TRK/Ccr, and Ks rose accordingly. Within each CKD stage, EK/Ccr was remarkably similar in the three kalemic subsets; consequently, differences in TRK/Ccr were the sole source of differences in Ks.
Conclusion: EK/Ccr rises and TRK/Ccr falls through the stages of CKD. Ks remains stable in stages G3a - 3b in association with equal and opposite changes in EK/Ccr and TRK/Ccr. In stages G4 - 5, Ks increases progressively because EK/Ccr rises more than TRK/Ccr falls. Within each CKD stage, differences in TRK/Ccr account entirely for differences in Ks among hyper-, normo-, and hypokalemic subsets. Causes of variability of TRK/Ccr require additional investigation.
{"title":"Determinants of the serum potassium concentration in chronic kidney disease.","authors":"Yinna Wang, Kenneth R Phelps, Darren E Gemoets, Elvira O Gosmanova","doi":"10.5414/CN111490","DOIUrl":"10.5414/CN111490","url":null,"abstract":"<p><strong>Background: </strong>If C<sub>cr</sub> is creatinine clearance, a surrogate for glomerular filtration rate (GFR), the serum potassium concentration (K<sub>s</sub>) is the sum of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub>, which are amounts of potassium excreted and (net) reabsorbed per volume of filtrate (K<sub>s</sub> = E<sub>K</sub>/C<sub>cr</sub> + TR<sub>K</sub>/C<sub>cr</sub>). We investigated changes in E<sub>K</sub>/C<sub>cr</sub>, TR<sub>K</sub>/C<sub>cr</sub>, and K<sub>s</sub> through the stages of chronic kidney disease (CKD).</p><p><strong>Materials and methods: </strong>We performed a retrospective study of 452 patients with CKD stages G1 - 5. Simultaneous measurements of serum and urine potassium and creatinine concentrations (K<sub>s</sub>, K<sub>u</sub>, cr<sub>s</sub>, and cr<sub>u</sub>) were used to calculate 1,007 individual values of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub> as K<sub>u</sub>×cr<sub>s</sub>/cr<sub>u</sub> and K<sub>s</sub> - E<sub>K</sub>/C<sub>cr</sub>, respectively. Mean values of E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub> were determined in CKD stages G1 - 5. Within each stage, means of the ratios were also ascertained in subsets with hyperkalemia (K<sub>s</sub> > 5.1 mmol/L), normokalemia (K<sub>s</sub> 3.8 - 5.1 mmol/L), and hypokalemia (K<sub>s</sub> < 3.8 mmol/L).</p><p><strong>Results: </strong>In comparison to values in CKD stages G1 - 2, E<sub>K</sub>/C<sub>cr</sub> rose and TR<sub>K</sub>/C<sub>cr</sub> fell in each higher stage. Decrements in TR<sub>K</sub>/C<sub>cr</sub> equaled increments in E<sub>K</sub>/C<sub>cr</sub> in G3a and G3b, and K<sub>s</sub> remained stable. In G4 - 5, the ascent of E<sub>K</sub>/C<sub>cr</sub> exceeded the decline in TR<sub>K</sub>/C<sub>cr</sub>, and K<sub>s</sub> rose accordingly. Within each CKD stage, E<sub>K</sub>/C<sub>cr</sub> was remarkably similar in the three kalemic subsets; consequently, differences in TR<sub>K</sub>/C<sub>cr</sub> were the sole source of differences in K<sub>s</sub>.</p><p><strong>Conclusion: </strong>E<sub>K</sub>/C<sub>cr</sub> rises and TR<sub>K</sub>/C<sub>cr</sub> falls through the stages of CKD. K<sub>s</sub> remains stable in stages G3a - 3b in association with equal and opposite changes in E<sub>K</sub>/C<sub>cr</sub> and TR<sub>K</sub>/C<sub>cr</sub>. In stages G4 - 5, K<sub>s</sub> increases progressively because E<sub>K</sub>/C<sub>cr</sub> rises more than TR<sub>K</sub>/C<sub>cr</sub> falls. Within each CKD stage, differences in TR<sub>K</sub>/C<sub>cr</sub> account entirely for differences in K<sub>s</sub> among hyper-, normo-, and hypokalemic subsets. Causes of variability of TR<sub>K</sub>/C<sub>cr</sub> require additional investigation.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jan A Jochims, Babak Yazdani, Bernd Krüger, Zoran V Popovic, Bernhard K Krämer
Systemic COVID-19 disease is associated with a variety of organ involvement in infected patients. A rarely reported complication is the induction of complement-mediated thrombotic microangiopathy (TMA). TMA is an extremely rare pathological condition that results in thrombosis in capillaries and small arterioles, due to an endothelial injury. It is often combined with thrombocytopenia, Coombs-negative hemolytic anemia, and end-organ damage. This case involves a patient who was admitted to our hospital for the purpose of diagnosis and treatment of acute kidney injury (AKIN 3) with severe proteinuria after a preceding SARS-CoV-2 infection. A 77-year-old male patient had COVID-19 pneumonia in January 2021 with the need of high-flow oxygen therapy in the intensive care unit. In March 2021, he was hospitalized again due to elevated serum creatinine levels and proteinuria. The patient exhibited normal vital parameters. A renal biopsy showed severe TMA. A diagnosis of COVID-19-associated TMA was made, and treatment with high-dose glucocorticoid therapy and plasma exchange was initiated. Additionally, therapy with eculizumab was established. Unfortunately, the kidney failure was initially progressive, so that hemodialysis (HD) was temporarily necessary. In May 2021, kidney function recovered to an estimated glomerular filtration rate of ~ 30 mL/min/1.73m2 corresponding to chronic kidney disease stage 3bA3 - 4A3. COVID-19-associated TMA is an extremely rare disease. TMA may be a possible long-term complication with the risk of end-stage renal disease if not properly diagnosed and treated.
{"title":"Post-COVID-19 complement-mediated TMA: A case report.","authors":"Jan A Jochims, Babak Yazdani, Bernd Krüger, Zoran V Popovic, Bernhard K Krämer","doi":"10.5414/CN111217","DOIUrl":"10.5414/CN111217","url":null,"abstract":"<p><p>Systemic COVID-19 disease is associated with a variety of organ involvement in infected patients. A rarely reported complication is the induction of complement-mediated thrombotic microangiopathy (TMA). TMA is an extremely rare pathological condition that results in thrombosis in capillaries and small arterioles, due to an endothelial injury. It is often combined with thrombocytopenia, Coombs-negative hemolytic anemia, and end-organ damage. This case involves a patient who was admitted to our hospital for the purpose of diagnosis and treatment of acute kidney injury (AKIN 3) with severe proteinuria after a preceding SARS-CoV-2 infection. A 77-year-old male patient had COVID-19 pneumonia in January 2021 with the need of high-flow oxygen therapy in the intensive care unit. In March 2021, he was hospitalized again due to elevated serum creatinine levels and proteinuria. The patient exhibited normal vital parameters. A renal biopsy showed severe TMA. A diagnosis of COVID-19-associated TMA was made, and treatment with high-dose glucocorticoid therapy and plasma exchange was initiated. Additionally, therapy with eculizumab was established. Unfortunately, the kidney failure was initially progressive, so that hemodialysis (HD) was temporarily necessary. In May 2021, kidney function recovered to an estimated glomerular filtration rate of ~ 30 mL/min/1.73m<sup>2</sup> corresponding to chronic kidney disease stage 3bA3 - 4A3. COVID-19-associated TMA is an extremely rare disease. TMA may be a possible long-term complication with the risk of end-stage renal disease if not properly diagnosed and treated.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"232-237"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: BK polyomavirus infection is a challenging complication of renal transplantation. The management is not standardized and is based on reports from transplantation centers' experiences, usually with small sample sizes. Therefore, we aimed to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients.
Materials and methods: Our study was carried out with the participation of 30 transplantation centers from all regions of Turkey. Only cases with allograft biopsy-proven BKVN were included in the study.
Results: 13,857 patients from 30 transplantation centers were screened, and 207 BK nephropathy cases were included. The mean age was 46.4 ± 13.1 years, and 146 (70.5%) patients were male. The mean time to diagnosis of BK nephropathy was 15.8 ± 22.2 months after transplantation. At diagnosis, the mean creatinine level was 1.8 ± 0.7 mg/dL, and the mean estimated glomerular filtration rate was 45.8 ± 19.6 mL/min/1.73m2. In addition to dose reduction or discontinuation of immunosuppressive drugs, 18 patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), 5 patients with cidofovir plus IVIG, and 12 patients with leflunomide plus IVIG. None of the patients receiving leflunomide or leflunomide plus IVIG had allograft loss. During follow-up, allograft loss occurred in 32 (15%) out of 207 patients with BK nephropathy.
Conclusion: BKVN is still a frequent cause of allograft loss in kidney transplantation and is not fully elucidated. The results of our study suggest that leflunomide treatment is associated with more favorable allograft outcomes.
{"title":"Biopsy-proven BK virus nephropathy in renal transplant recipients: A multi-central study from Turkey (BK-TURK STUDY).","authors":"Ozkan Gungor, Hamad Dheir, Mahmud Islam, Huseyin Toz, Abdulmecit Yildiz, Ayse Sinangil, Erhan Tatar, Gulay Asci, Ozkan Ulutas, Eda Altun, Orcun Altunoren, Suheyla Apaydin, Alparslan Ersoy, Berfu Korucu, Seda Safak, Ulver Derici, Saliha Yildirim, Nurhan Seyahi, Seyda Gul Ozcan, Kadir Gokhan Atilgan, Mehmet Deniz Ayli, Caner Cavdar, Ozcan Uzun, Rahmi Yilmaz, Arda Erdut, Mustafa Sevinc, Umut Kasapoğlu, Ismail Kocyigit, Cihan Uysal, Kultigin Turkmen, Hakan Ozer, Arzu Velioglu, Ebru Ok, Bulent Kaya, Zulfikar Yilmaz, Oktay Ozkan, Egemen Cebeci, Kenan Turgutalp, Meltem Gursu, Enver Yuksel, Necmi Eren, Erkan Dervisoglu, Fatma Betul Guzel, Gursel Yildiz, Serkan Bakirdogen, Ayca Inci, Can Sevinc, Aydin Turkmen","doi":"10.5414/CN111300","DOIUrl":"10.5414/CN111300","url":null,"abstract":"<p><strong>Aim: </strong>BK polyomavirus infection is a challenging complication of renal transplantation. The management is not standardized and is based on reports from transplantation centers' experiences, usually with small sample sizes. Therefore, we aimed to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients.</p><p><strong>Materials and methods: </strong>Our study was carried out with the participation of 30 transplantation centers from all regions of Turkey. Only cases with allograft biopsy-proven BKVN were included in the study.</p><p><strong>Results: </strong>13,857 patients from 30 transplantation centers were screened, and 207 BK nephropathy cases were included. The mean age was 46.4 ± 13.1 years, and 146 (70.5%) patients were male. The mean time to diagnosis of BK nephropathy was 15.8 ± 22.2 months after transplantation. At diagnosis, the mean creatinine level was 1.8 ± 0.7 mg/dL, and the mean estimated glomerular filtration rate was 45.8 ± 19.6 mL/min/1.73m<sup>2</sup>. In addition to dose reduction or discontinuation of immunosuppressive drugs, 18 patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), 5 patients with cidofovir plus IVIG, and 12 patients with leflunomide plus IVIG. None of the patients receiving leflunomide or leflunomide plus IVIG had allograft loss. During follow-up, allograft loss occurred in 32 (15%) out of 207 patients with BK nephropathy.</p><p><strong>Conclusion: </strong>BKVN is still a frequent cause of allograft loss in kidney transplantation and is not fully elucidated. The results of our study suggest that leflunomide treatment is associated with more favorable allograft outcomes.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"202-211"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ursula Alchabab, Razane El Hajj Chehade, Chloe Kharsa, Rebecca Kassab, Serena Maria Dib, Dania Chelala, Jenny Hawi, Celine Boueri, Hiba Azar, Serge Finianos, Ibrahim Abdo, Chadia Beaini, Mabel Aoun
Background: It is still uncertain whether vitamin intake is associated with better quality of life in hemodialysis patients. This study aims to assess the association between the quantity of supplemented vitamins and health-related quality of life (HRQoL) in this population.
Materials and methods: This cross-sectional study included all patients on chronic hemodialysis from three units. Vitamins and micronutrients assessed were B1, B6, B12, C, D, folic acid, menaquinone, carnitine, zinc, and coenzyme Q10. Quality of life scores included the 8 domains of SF-36 and the 11 domains of the Kidney Disease Quality of Life (KDQOL). Bivariate analysis compared two groups of patients divided based on the median of vitamin intake. Spearman Rho test assessed the correlation between number of vitamins and different dimensions of HRQoL.
Results: A total of 183 patients were included. Median number of vitamins supplemented was 2 (1,3); 112 patients had an intake of ≤ 2 vitamins, and 71 patients were taking > 2 vitamins. There was a significant association between higher vitamin intake and the burden of kidney disease that remained significant in the multivariable analysis (p = 0.03), but no correlation between the number of vitamins (0 - 13) and different HRQoL scores. Sub-analyses of each category of vitamins showed no significant difference in HRQoL scores except for Vitamin B and staff encouragement (p = 0.01) and for multivitamins and quality of social interaction (p = 0.03).
Conclusion: A higher number of vitamins in hemodialysis patients is associated with an increased perception of the burden of kidney disease. Interventional studies are needed to assess whether selective vitamin supplementation in case of deficiencies is associated with better quality of life.
{"title":"Association of vitamin intake with health-related quality of life in hemodialysis patients.","authors":"Ursula Alchabab, Razane El Hajj Chehade, Chloe Kharsa, Rebecca Kassab, Serena Maria Dib, Dania Chelala, Jenny Hawi, Celine Boueri, Hiba Azar, Serge Finianos, Ibrahim Abdo, Chadia Beaini, Mabel Aoun","doi":"10.5414/CN111306","DOIUrl":"10.5414/CN111306","url":null,"abstract":"<p><strong>Background: </strong>It is still uncertain whether vitamin intake is associated with better quality of life in hemodialysis patients. This study aims to assess the association between the quantity of supplemented vitamins and health-related quality of life (HRQoL) in this population.</p><p><strong>Materials and methods: </strong>This cross-sectional study included all patients on chronic hemodialysis from three units. Vitamins and micronutrients assessed were B1, B6, B12, C, D, folic acid, menaquinone, carnitine, zinc, and coenzyme Q10. Quality of life scores included the 8 domains of SF-36 and the 11 domains of the Kidney Disease Quality of Life (KDQOL). Bivariate analysis compared two groups of patients divided based on the median of vitamin intake. Spearman Rho test assessed the correlation between number of vitamins and different dimensions of HRQoL.</p><p><strong>Results: </strong>A total of 183 patients were included. Median number of vitamins supplemented was 2 (1,3); 112 patients had an intake of ≤ 2 vitamins, and 71 patients were taking > 2 vitamins. There was a significant association between higher vitamin intake and the burden of kidney disease that remained significant in the multivariable analysis (p = 0.03), but no correlation between the number of vitamins (0 - 13) and different HRQoL scores. Sub-analyses of each category of vitamins showed no significant difference in HRQoL scores except for Vitamin B and staff encouragement (p = 0.01) and for multivitamins and quality of social interaction (p = 0.03).</p><p><strong>Conclusion: </strong>A higher number of vitamins in hemodialysis patients is associated with an increased perception of the burden of kidney disease. Interventional studies are needed to assess whether selective vitamin supplementation in case of deficiencies is associated with better quality of life.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"192-201"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Estelle Taki, Stephanie Wirtshafter, Abdallah S Geara
Mixed cryoglobulinemia is a small vessel vasculitis associated with viral infections, mainly hepatitis C virus, however, other important causes include lymphoproliferative and autoimmune disorders. Influenza vaccine-induced cryoglobulinemia has been rarely reported. A 68-year-old male presented on three occasions following influenza vaccination with purpuric rash and lower extremities swelling. His lab work showed mixed cryoglobulins. On his most recent presentation, in addition to the purpura, he presented with thrombocytopenia and nephritic syndrome. A kidney biopsy showed endocapillary proliferative glomerulonephritis with organized deposits, consistent with mixed type cryoglobulinemic glomerulonephritis. The patient was treated with rituximab infusion with progressive improvement of the acute kidney injury (AKI) and complete recovery. It is unclear why cryoglobulins are produced as a response to a vaccination, but this association is important to be aware of for prompt monitoring and treatment.
{"title":"Influenza vaccination-associated cryoglobulinemic vasculitis.","authors":"Estelle Taki, Stephanie Wirtshafter, Abdallah S Geara","doi":"10.5414/CN111383","DOIUrl":"10.5414/CN111383","url":null,"abstract":"<p><p>Mixed cryoglobulinemia is a small vessel vasculitis associated with viral infections, mainly hepatitis C virus, however, other important causes include lymphoproliferative and autoimmune disorders. Influenza vaccine-induced cryoglobulinemia has been rarely reported. A 68-year-old male presented on three occasions following influenza vaccination with purpuric rash and lower extremities swelling. His lab work showed mixed cryoglobulins. On his most recent presentation, in addition to the purpura, he presented with thrombocytopenia and nephritic syndrome. A kidney biopsy showed endocapillary proliferative glomerulonephritis with organized deposits, consistent with mixed type cryoglobulinemic glomerulonephritis. The patient was treated with rituximab infusion with progressive improvement of the acute kidney injury (AKI) and complete recovery. It is unclear why cryoglobulins are produced as a response to a vaccination, but this association is important to be aware of for prompt monitoring and treatment.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"244-247"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}