Pub Date : 2024-08-14DOI: 10.1016/j.xkme.2024.100892
Lei Jiang , Suxia Wang , Ying Tan , Tao Su
<div><h3>Rationale & Objective</h3><p>Postpartum renal cortical necrosis (postpartum RCN) is a severe form of obstetric acute kidney injury. This study aimed to identify clinicopathologic features in Chinese postpartum RCN cases to determine how pathologic findings may contribute to the treatment and prognosis.</p></div><div><h3>Study Design</h3><p>Single-center, case series.</p></div><div><h3>Setting & Participants</h3><p>Twelve patients with postpartum RCN had kidney biopsies at Peking University First Hospital between 2014 and 2021. The diagnosis of postpartum RCN was made according to typical magnetic resonance imaging or pathologic features. Clinical, laboratory, and pathologic data were compared between patients with estimated glomerular filtration rate<!--> <!--><30 (poor outcome) and<!--> <!-->≥30<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> after 6 months.</p></div><div><h3>Observations</h3><p>All patients with postpartum RCN presented with stage 3 acute kidney injury attributed to a probable atypical hemolytic uremic syndrome. Pregnancy terminations occurred at a median gestational age of 35.5 weeks. Kidney biopsy was performed from 18 days to 4 months from delivery. On biopsy, hemoglobin, platelet count, and lactate dehydrogenase levels had been restored to 137<!--> <!-->g/L, 214 ×<!--> <!-->10<sup>9</sup>/L, and 231.50<!--> <!-->±<!--> <!-->65.01<!--> <!-->U/L, respectively. Four patients exhibited poor outcome, demonstrating higher schistocyte count, serum creatinine, and mean arterial pressure at onset. Pathologically, glomerular segmental sclerosis was prevalent. The “not otherwise specified” variant was the most common type, followed by collapsing variant, cellular variant, and tip variant. Patients with poor kidney outcome had more glomerular coagulative necrosis, capillary thrombosis, extensive cortical coagulative necrosis, and pronounced arteriole/artery lesions including increased interlobular arteriole intimal edema and fibrin thrombosis, but a lower occurrence of segmental sclerosis.</p></div><div><h3>Limitations</h3><p>Limited sample size and retrospective design.</p></div><div><h3>Conclusions</h3><p>We identified key pathologic features in patients with postpartum RCN and atypical hemolytic uremic syndrome, highlighting the necessity for more effective therapeutic options. There is a clear demand for noninvasive biomarkers that can accurately track disease progression and inform treatment duration for long-term outcomes improvement.</p></div><div><h3>Plain-Language Summary</h3><p>Our study investigated postpartum renal cortical necrosis (RCN) in 12 Chinese women, a severe form of kidney injury that occurs after childbirth, often linked to atypical hemolytic uremic syndrome (aHUS). We aimed to identify clinical and pathologic features to improve treatment and predict patient outcomes. The women experienced stage 3 acute kidney injury, with kidney biopsies revealing various degrees of glomerular and vascular dam
{"title":"Postpartum Renal Cortical Necrosis: A Case Series","authors":"Lei Jiang , Suxia Wang , Ying Tan , Tao Su","doi":"10.1016/j.xkme.2024.100892","DOIUrl":"10.1016/j.xkme.2024.100892","url":null,"abstract":"<div><h3>Rationale & Objective</h3><p>Postpartum renal cortical necrosis (postpartum RCN) is a severe form of obstetric acute kidney injury. This study aimed to identify clinicopathologic features in Chinese postpartum RCN cases to determine how pathologic findings may contribute to the treatment and prognosis.</p></div><div><h3>Study Design</h3><p>Single-center, case series.</p></div><div><h3>Setting & Participants</h3><p>Twelve patients with postpartum RCN had kidney biopsies at Peking University First Hospital between 2014 and 2021. The diagnosis of postpartum RCN was made according to typical magnetic resonance imaging or pathologic features. Clinical, laboratory, and pathologic data were compared between patients with estimated glomerular filtration rate<!--> <!--><30 (poor outcome) and<!--> <!-->≥30<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> after 6 months.</p></div><div><h3>Observations</h3><p>All patients with postpartum RCN presented with stage 3 acute kidney injury attributed to a probable atypical hemolytic uremic syndrome. Pregnancy terminations occurred at a median gestational age of 35.5 weeks. Kidney biopsy was performed from 18 days to 4 months from delivery. On biopsy, hemoglobin, platelet count, and lactate dehydrogenase levels had been restored to 137<!--> <!-->g/L, 214 ×<!--> <!-->10<sup>9</sup>/L, and 231.50<!--> <!-->±<!--> <!-->65.01<!--> <!-->U/L, respectively. Four patients exhibited poor outcome, demonstrating higher schistocyte count, serum creatinine, and mean arterial pressure at onset. Pathologically, glomerular segmental sclerosis was prevalent. The “not otherwise specified” variant was the most common type, followed by collapsing variant, cellular variant, and tip variant. Patients with poor kidney outcome had more glomerular coagulative necrosis, capillary thrombosis, extensive cortical coagulative necrosis, and pronounced arteriole/artery lesions including increased interlobular arteriole intimal edema and fibrin thrombosis, but a lower occurrence of segmental sclerosis.</p></div><div><h3>Limitations</h3><p>Limited sample size and retrospective design.</p></div><div><h3>Conclusions</h3><p>We identified key pathologic features in patients with postpartum RCN and atypical hemolytic uremic syndrome, highlighting the necessity for more effective therapeutic options. There is a clear demand for noninvasive biomarkers that can accurately track disease progression and inform treatment duration for long-term outcomes improvement.</p></div><div><h3>Plain-Language Summary</h3><p>Our study investigated postpartum renal cortical necrosis (RCN) in 12 Chinese women, a severe form of kidney injury that occurs after childbirth, often linked to atypical hemolytic uremic syndrome (aHUS). We aimed to identify clinical and pathologic features to improve treatment and predict patient outcomes. The women experienced stage 3 acute kidney injury, with kidney biopsies revealing various degrees of glomerular and vascular dam","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524001031/pdfft?md5=384ac10f418f779e7eb6cf2cc390cb8e&pid=1-s2.0-S2590059524001031-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1016/j.xkme.2024.100890
Jimin Hwang , Kwanghyun Kim , Josef Coresh , Lesley A. Inker , Morgan E. Grams , Jung-Im Shin
<div><h3>Rationale & Objective</h3><p>In 2021, the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) updated the creatinine-based estimated glomerular filtration rate (eGFR) equation and removed the coefficient for race. The development and validation of this equation involved binarizing race into African American and non-African American, involving few Asian participants. This study aimed to examine the difference between the 2021 equation and the previous 2009 equation on CKD prevalence estimates in 2 Asian populations.</p></div><div><h3>Study Design</h3><p>Observational study using 2 national surveys.</p></div><div><h3>Setting & Participants</h3><p>Participants from the 2019 Korea National Health and Nutrition Survey and participants self-reported as Asian from the 2011-2020 US National Health and Nutrition Survey.</p></div><div><h3>Exposure</h3><p>eGFR using 2009 and 2021 CKD-EPI creatinine equation.</p></div><div><h3>Outcomes</h3><p>Prevalence of CKD (eGFR<!--> <!--><60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> or urine albumin-creatinine ratio<!--> <!-->≥30<!--> <!-->mg/g).</p></div><div><h3>Analytical Approach</h3><p>Sampling-weighted prevalence estimated using the 2009 and 2021 equations as well as the percentage of individuals with CKD G3+<!--> <!-->using the 2009 equation being reclassified as not having CKD G3+<!--> <!-->using the 2021 equation.</p></div><div><h3>Results</h3><p>The prevalence of CKD estimated using the 2021 equation was 9.75% (95% confidence intervals [CI], 8.80-10.80%) in Koreans and 11.60% (95% CI, 10.23-13.13%) in US Asians. The prevalence of CKD estimated using the 2021 equation was slightly lower than that using the 2009 equation in both Korean and US Asian populations by 0.63% (95% CI, 0.44-0.90%) and 0.84% (95% CI, 0.52-1.34%), respectively. Furthermore, 32.8% and 30.2% of Koreans and US Asians with CKD G3-5, respectively, estimated using the 2009 equation were reclassified as not having CKD G3-5 when the eGFR was calculated using the 2021 equation.</p></div><div><h3>Limitations</h3><p>Measured GFR was not available.</p></div><div><h3>Conclusions</h3><p>Use of the 2021 CKD-EPI creatinine equation leads to a small decrease in CKD prevalence in both Korean and US Asian populations, and of similar magnitude, resulting in significant reclassification among those originally classified as having CKD G3+.</p></div><div><h3>Plain-Language Summary</h3><p>The 2009 serum creatinine-based kidney function estimating equation used demographic information including race. Because race is a social construct, race was eliminated in the new equation developed in 2021. As race was categorized into African American and non-African American during its development, this study examined the impact of the 2021 equation in 2 distinct Asian populations (Koreans and US Asians) using 2 national datasets. We found that the prevalence of chronic kidney disease (CKD) estimated using the 2021 equation was slightly lo
{"title":"Estimated GFR in the Korean and US Asian Populations Using the 2021 Creatinine-Based GFR Estimating Equation Without Race","authors":"Jimin Hwang , Kwanghyun Kim , Josef Coresh , Lesley A. Inker , Morgan E. Grams , Jung-Im Shin","doi":"10.1016/j.xkme.2024.100890","DOIUrl":"10.1016/j.xkme.2024.100890","url":null,"abstract":"<div><h3>Rationale & Objective</h3><p>In 2021, the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) updated the creatinine-based estimated glomerular filtration rate (eGFR) equation and removed the coefficient for race. The development and validation of this equation involved binarizing race into African American and non-African American, involving few Asian participants. This study aimed to examine the difference between the 2021 equation and the previous 2009 equation on CKD prevalence estimates in 2 Asian populations.</p></div><div><h3>Study Design</h3><p>Observational study using 2 national surveys.</p></div><div><h3>Setting & Participants</h3><p>Participants from the 2019 Korea National Health and Nutrition Survey and participants self-reported as Asian from the 2011-2020 US National Health and Nutrition Survey.</p></div><div><h3>Exposure</h3><p>eGFR using 2009 and 2021 CKD-EPI creatinine equation.</p></div><div><h3>Outcomes</h3><p>Prevalence of CKD (eGFR<!--> <!--><60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> or urine albumin-creatinine ratio<!--> <!-->≥30<!--> <!-->mg/g).</p></div><div><h3>Analytical Approach</h3><p>Sampling-weighted prevalence estimated using the 2009 and 2021 equations as well as the percentage of individuals with CKD G3+<!--> <!-->using the 2009 equation being reclassified as not having CKD G3+<!--> <!-->using the 2021 equation.</p></div><div><h3>Results</h3><p>The prevalence of CKD estimated using the 2021 equation was 9.75% (95% confidence intervals [CI], 8.80-10.80%) in Koreans and 11.60% (95% CI, 10.23-13.13%) in US Asians. The prevalence of CKD estimated using the 2021 equation was slightly lower than that using the 2009 equation in both Korean and US Asian populations by 0.63% (95% CI, 0.44-0.90%) and 0.84% (95% CI, 0.52-1.34%), respectively. Furthermore, 32.8% and 30.2% of Koreans and US Asians with CKD G3-5, respectively, estimated using the 2009 equation were reclassified as not having CKD G3-5 when the eGFR was calculated using the 2021 equation.</p></div><div><h3>Limitations</h3><p>Measured GFR was not available.</p></div><div><h3>Conclusions</h3><p>Use of the 2021 CKD-EPI creatinine equation leads to a small decrease in CKD prevalence in both Korean and US Asian populations, and of similar magnitude, resulting in significant reclassification among those originally classified as having CKD G3+.</p></div><div><h3>Plain-Language Summary</h3><p>The 2009 serum creatinine-based kidney function estimating equation used demographic information including race. Because race is a social construct, race was eliminated in the new equation developed in 2021. As race was categorized into African American and non-African American during its development, this study examined the impact of the 2021 equation in 2 distinct Asian populations (Koreans and US Asians) using 2 national datasets. We found that the prevalence of chronic kidney disease (CKD) estimated using the 2021 equation was slightly lo","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524001018/pdfft?md5=850b159bd4b7cfb283e0456b06f7620a&pid=1-s2.0-S2590059524001018-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1016/j.xkme.2024.100893
Carina M. Flaherty , Aditya Surapaneni , Jesse C. Seegmiller , Josef Coresh , Morgan E. Grams , Shoshana H. Ballew
<div><h3>Rationale & Objective</h3><p>The prevalence of chronic kidney disease (CKD) is known to increase with age; however, creatinine may be a less reliable filtration marker in older adults. Few studies have investigated the prevalence and progression of CKD using different filtration markers for estimating glomerular filtration rate (GFR).</p></div><div><h3>Study Design</h3><p>A prospective observational cohort study.</p></div><div><h3>Setting & Participants</h3><p>6,393 White and African American participants aged 65-100 years from the Atherosclerosis Risk in Communities Study (ARIC) at Visit 5, followed longitudinally at Visits 6 and 7.</p></div><div><h3>Exposure and Outcome</h3><p>The eGFR was estimated either by creatinine (eGFRcr), cystatin C (eGFRcys), creatinine and cystatin C (eGFRcr-cys), or using creatinine, cystatin C, and β-2-microglobulin (eGFRcr-cys-b2m). CKD progression was defined as 30% decline in eGFR at follow-up visits.</p></div><div><h3>Analytical Approach</h3><p>Logistic regression models, adjusted for sex, race and study center, diabetes, blood pressure, body mass index, prevalent cardiovascular disease, and heart failure.</p></div><div><h3>Results</h3><p>At Visit 5, the mean age in the study population was 75.8 years, and the mean eGFR ranged from 71.2 to 61.2<!--> <!-->mL/min/1.73m<sup>2</sup> using eGFRcr or eGFRcys, respectively. The proportion with eGFR<!--> <!--><<!--> <!-->60<!--> <!-->mL/min/1.73m<sup>2</sup> was lowest with eGFRcr and highest with eGFRcys for all age groups, and prevalence increased with age for all markers. For example, the prevalence of eGFRcr<!--> <!--><<!--> <!-->60<!--> <!-->mL/min/1.73m<sup>2</sup> in ages 70-74 years ranged from 15% to 21% and in ages 85-89 years ranged from 38% to 46% at the different visits. The proportion with a 30% eGFR decline over a mean of 8 years in people who were originally aged 65-69 years ranged from 9% (eGFRcr)-18% (eGFRcys). More people with eGFRcr<!--> <!-->≥<!--> <!-->60<!--> <!-->mL/min/1.73m<sup>2</sup> were reclassified to<!--> <!--><<!--> <!-->60<!--> <!-->mL/min/1.73m<sup>2</sup> when using eGFRcys (33%) compared with eGFRcr-cys (12%) or eGFRcr-cys-b2m (18%). The proportion with 30% eGFR decline was lowest with eGFRcr and highest with eGFRcys, with greater incidence in older age groups for all markers.</p></div><div><h3>Limitations</h3><p>No direct measurement of GFR. Not all participants survived or attended subsequent follow-up visits.</p></div><div><h3>Conclusions</h3><p>The prevalence and progression of CKD increase with age, but estimates vary with the filtration marker used. The eGFRcr gave the lowest estimate of CKD at 15% for people aged 65-69 years at Visit 5 while eGFRcys gave the highest estimates of CKD at 26% for that same population.</p></div><div><h3>Plain Language Summary</h3><p>The study examines different filtration markers for glomerular filtration rate (GFR) equations in older adults. Filtration markers can be aff
{"title":"CKD Prevalence and Incidence in Older Adults Using Estimated GFR With Different Filtration Markers: The Atherosclerosis Risk in Communities Study","authors":"Carina M. Flaherty , Aditya Surapaneni , Jesse C. Seegmiller , Josef Coresh , Morgan E. Grams , Shoshana H. Ballew","doi":"10.1016/j.xkme.2024.100893","DOIUrl":"10.1016/j.xkme.2024.100893","url":null,"abstract":"<div><h3>Rationale & Objective</h3><p>The prevalence of chronic kidney disease (CKD) is known to increase with age; however, creatinine may be a less reliable filtration marker in older adults. Few studies have investigated the prevalence and progression of CKD using different filtration markers for estimating glomerular filtration rate (GFR).</p></div><div><h3>Study Design</h3><p>A prospective observational cohort study.</p></div><div><h3>Setting & Participants</h3><p>6,393 White and African American participants aged 65-100 years from the Atherosclerosis Risk in Communities Study (ARIC) at Visit 5, followed longitudinally at Visits 6 and 7.</p></div><div><h3>Exposure and Outcome</h3><p>The eGFR was estimated either by creatinine (eGFRcr), cystatin C (eGFRcys), creatinine and cystatin C (eGFRcr-cys), or using creatinine, cystatin C, and β-2-microglobulin (eGFRcr-cys-b2m). CKD progression was defined as 30% decline in eGFR at follow-up visits.</p></div><div><h3>Analytical Approach</h3><p>Logistic regression models, adjusted for sex, race and study center, diabetes, blood pressure, body mass index, prevalent cardiovascular disease, and heart failure.</p></div><div><h3>Results</h3><p>At Visit 5, the mean age in the study population was 75.8 years, and the mean eGFR ranged from 71.2 to 61.2<!--> <!-->mL/min/1.73m<sup>2</sup> using eGFRcr or eGFRcys, respectively. The proportion with eGFR<!--> <!--><<!--> <!-->60<!--> <!-->mL/min/1.73m<sup>2</sup> was lowest with eGFRcr and highest with eGFRcys for all age groups, and prevalence increased with age for all markers. For example, the prevalence of eGFRcr<!--> <!--><<!--> <!-->60<!--> <!-->mL/min/1.73m<sup>2</sup> in ages 70-74 years ranged from 15% to 21% and in ages 85-89 years ranged from 38% to 46% at the different visits. The proportion with a 30% eGFR decline over a mean of 8 years in people who were originally aged 65-69 years ranged from 9% (eGFRcr)-18% (eGFRcys). More people with eGFRcr<!--> <!-->≥<!--> <!-->60<!--> <!-->mL/min/1.73m<sup>2</sup> were reclassified to<!--> <!--><<!--> <!-->60<!--> <!-->mL/min/1.73m<sup>2</sup> when using eGFRcys (33%) compared with eGFRcr-cys (12%) or eGFRcr-cys-b2m (18%). The proportion with 30% eGFR decline was lowest with eGFRcr and highest with eGFRcys, with greater incidence in older age groups for all markers.</p></div><div><h3>Limitations</h3><p>No direct measurement of GFR. Not all participants survived or attended subsequent follow-up visits.</p></div><div><h3>Conclusions</h3><p>The prevalence and progression of CKD increase with age, but estimates vary with the filtration marker used. The eGFRcr gave the lowest estimate of CKD at 15% for people aged 65-69 years at Visit 5 while eGFRcys gave the highest estimates of CKD at 26% for that same population.</p></div><div><h3>Plain Language Summary</h3><p>The study examines different filtration markers for glomerular filtration rate (GFR) equations in older adults. Filtration markers can be aff","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524001043/pdfft?md5=a377c6f30283bec15957b30a7df1f840&pid=1-s2.0-S2590059524001043-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1016/j.xkme.2024.100891
Elmar Pieterse , Jakko van Ingen , Wilbert van der Meijden
Immunosuppressive therapy after kidney transplantation is associated with an increased risk for the development of opportunistic infections, such as Pneumocystisjirovecii pneumonia (PJP). Belatacept, a selective costimulatory blocker that prevents T cell activation, was previously suggested to be a potential risk factor for PJP development in kidney transplant recipients. We present 2 cases of kidney transplant patients with PJP discovered unexpectedly during a diagnostic work-up for fever of unknown origin. Both patients lacked typical clinical findings such as hypoxia, ground-glass pattern on computed tomography, or suggestive biochemical alterations such as high lactate dehydrogenase levels or hypercalcemia. PJP should therefore be included in the differential diagnosis when evaluating fever in kidney transplant recipients receiving belatacept, even in the absence of typical pulmonary and laboratory findings.
肾移植后的免疫抑制治疗与机会性感染（如肺孢子菌肺炎（PJP））的发病风险增加有关。贝拉替塞（Belatacept）是一种能阻止 T 细胞活化的选择性成本刺激阻断剂，以前曾被认为是肾移植受者发生 PJP 的潜在风险因素。我们介绍了两例肾移植患者，他们在诊断不明原因发热时意外发现了 PJP。这两名患者都没有典型的临床表现，如缺氧、计算机断层扫描显示磨玻璃样，或提示性生化改变，如乳酸脱氢酶水平过高或高钙血症。因此，在评估接受贝拉替塞的肾移植受者的发热时，即使没有典型的肺部和实验室检查结果，也应将 PJP 列入鉴别诊断。
{"title":"Pneumocystis jirovecii Pneumonia in Kidney Transplant Recipients Receiving Belatacept: A Report of Two Cases With Atypical Presentations","authors":"Elmar Pieterse , Jakko van Ingen , Wilbert van der Meijden","doi":"10.1016/j.xkme.2024.100891","DOIUrl":"10.1016/j.xkme.2024.100891","url":null,"abstract":"<div><p>Immunosuppressive therapy after kidney transplantation is associated with an increased risk for the development of opportunistic infections, such as <em>Pneumocysti</em><em>s</em> <em>jirovecii</em> pneumonia (PJP). Belatacept, a selective costimulatory blocker that prevents T cell activation, was previously suggested to be a potential risk factor for PJP development in kidney transplant recipients. We present 2 cases of kidney transplant patients with PJP discovered unexpectedly during a diagnostic work-up for fever of unknown origin. Both patients lacked typical clinical findings such as hypoxia, ground-glass pattern on computed tomography, or suggestive biochemical alterations such as high lactate dehydrogenase levels or hypercalcemia. PJP should therefore be included in the differential diagnosis when evaluating fever in kidney transplant recipients receiving belatacept, even in the absence of typical pulmonary and laboratory findings.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259005952400102X/pdfft?md5=c39d4d1e13a37b952b2d4130f622e620&pid=1-s2.0-S259005952400102X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.xkme.2024.100888
Chintan V. Shah MD
{"title":"Role of Glucagon in the Effects of SGLT2 Inhibition on Potassium and Magnesium Homeostasis","authors":"Chintan V. Shah MD","doi":"10.1016/j.xkme.2024.100888","DOIUrl":"10.1016/j.xkme.2024.100888","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000992/pdfft?md5=2d2e4c187dd58bc8d77c849762fe78e1&pid=1-s2.0-S2590059524000992-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142039206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.xkme.2024.100889
Alvin G. Kwon , Hanny Sawaf , Gilda Portalatin , Shruti Shettigar , Leal C. Herlitz , Tariq Shafi , Hong Liang , Adam Kabuka , Scott Cohen , Surafel K. Gebreselassie , Shane A. Bobart
<div><h3>Rationale & Objectives</h3><p>Diabetic kidney disease (DKD) is a significant complication of diabetes mellitus, often leading to kidney failure. The absence of well-defined factors prevents distinguishing DKD from non-diabetic kidney disease (non-DKD; alternative primary diagnosis identified on kidney biopsy).</p></div><div><h3>Study Design</h3><p>Retrospective cohort study.</p></div><div><h3>Setting & Participants</h3><p>This study assessed 1,242 patients with a history of diabetes from the Cleveland Clinic Kidney Biopsy Epidemiology Project between January 2015 and September 2021.</p></div><div><h3>Exposure</h3><p>Proteinuria, retinopathy, A1c levels, and estimated glomerular filtration rate.</p></div><div><h3>Outcomes</h3><p>Non-DKD, defined as an alternative primary diagnosis identified on kidney biopsy other than DKD.</p></div><div><h3>Analytical Approach</h3><p>Multivariate logistic regression model with backward elimination method.</p></div><div><h3>Results</h3><p>At the time of biopsy, the median (IQR) age was 63 (53-71 years) years, and 58.8% were men. The median hemoglobin A1c value was 6.7% (6.0%-8.1%), and the median serum creatinine level was 2.5 (1.6-3.9<!--> <!-->mg/dL) mg/dL. Among 1,242 patients, 462 (37.2%) had DKD alone, and 780 (62.8%) had non-DKD. Among those with non-DKD, the most common diagnoses were focal segmental glomerulosclerosis (24%), global glomerulosclerosis otherwise not specified (13%), acute tubular necrosis (9%), IgA nephropathy (8%), antineutrophil cytoplasmic antibody vasculitis (7%), and membranous nephropathy (5%). Factors associated with having non-DKD on biopsy were having no retinopathy (vs retinopathy) (adjusted odds ratio [aOR], 3.98; 95% CI, 2.69-5.90), lower A1c levels (<7% vs<!--> <!-->≥7%) (aOR, 3.08; 95% CI, 2.16-4.39), higher estimated glomerular filtration rate (≥60 vs<!--> <!--><60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>) (aOR, 2.39; 95% CI 1.28-4.45), microalbuminuria (<300 vs macroalbuminuria<!--> <!-->≥300 [mg/g]) (aOR; 2.94; 95% CI, 1.84-4.72), and lower protein-creatinine ratio on random urine sample (<3 vs<!--> <!-->≥3<!--> <!-->mg/mg) (aOR; 1.80; 95% CI, 1.24-2.61).</p></div><div><h3>Limitations</h3><p>Selection bias of clinically indicated biopsies, not protocol biopsies, which likely represent a ceiling (maximum) for non-DKD.</p></div><div><h3>Conclusions</h3><p>Among patients with diabetes undergoing kidney biopsy, 63% have findings in addition to DKD on biopsy. We identified clinical parameters associated with non-DKD in the setting of diabetes. This provides valuable information for clinicians when kidney biopsy should be considered among patients with diabetes to capture all etiologies of proteinuria and kidney dysfunction.</p></div><div><h3>Plain-Language Summary</h3><p>Our study aimed to better understand when to perform kidney biopsies in patients with diabetes. Often, nephrologists diagnose diabetes-related kidney disease based on clinical pa
{"title":"Kidney Biopsy Findings Among Patients With Diabetes in the Cleveland Clinic Kidney Biopsy Epidemiology Project","authors":"Alvin G. Kwon , Hanny Sawaf , Gilda Portalatin , Shruti Shettigar , Leal C. Herlitz , Tariq Shafi , Hong Liang , Adam Kabuka , Scott Cohen , Surafel K. Gebreselassie , Shane A. Bobart","doi":"10.1016/j.xkme.2024.100889","DOIUrl":"10.1016/j.xkme.2024.100889","url":null,"abstract":"<div><h3>Rationale & Objectives</h3><p>Diabetic kidney disease (DKD) is a significant complication of diabetes mellitus, often leading to kidney failure. The absence of well-defined factors prevents distinguishing DKD from non-diabetic kidney disease (non-DKD; alternative primary diagnosis identified on kidney biopsy).</p></div><div><h3>Study Design</h3><p>Retrospective cohort study.</p></div><div><h3>Setting & Participants</h3><p>This study assessed 1,242 patients with a history of diabetes from the Cleveland Clinic Kidney Biopsy Epidemiology Project between January 2015 and September 2021.</p></div><div><h3>Exposure</h3><p>Proteinuria, retinopathy, A1c levels, and estimated glomerular filtration rate.</p></div><div><h3>Outcomes</h3><p>Non-DKD, defined as an alternative primary diagnosis identified on kidney biopsy other than DKD.</p></div><div><h3>Analytical Approach</h3><p>Multivariate logistic regression model with backward elimination method.</p></div><div><h3>Results</h3><p>At the time of biopsy, the median (IQR) age was 63 (53-71 years) years, and 58.8% were men. The median hemoglobin A1c value was 6.7% (6.0%-8.1%), and the median serum creatinine level was 2.5 (1.6-3.9<!--> <!-->mg/dL) mg/dL. Among 1,242 patients, 462 (37.2%) had DKD alone, and 780 (62.8%) had non-DKD. Among those with non-DKD, the most common diagnoses were focal segmental glomerulosclerosis (24%), global glomerulosclerosis otherwise not specified (13%), acute tubular necrosis (9%), IgA nephropathy (8%), antineutrophil cytoplasmic antibody vasculitis (7%), and membranous nephropathy (5%). Factors associated with having non-DKD on biopsy were having no retinopathy (vs retinopathy) (adjusted odds ratio [aOR], 3.98; 95% CI, 2.69-5.90), lower A1c levels (<7% vs<!--> <!-->≥7%) (aOR, 3.08; 95% CI, 2.16-4.39), higher estimated glomerular filtration rate (≥60 vs<!--> <!--><60<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup>) (aOR, 2.39; 95% CI 1.28-4.45), microalbuminuria (<300 vs macroalbuminuria<!--> <!-->≥300 [mg/g]) (aOR; 2.94; 95% CI, 1.84-4.72), and lower protein-creatinine ratio on random urine sample (<3 vs<!--> <!-->≥3<!--> <!-->mg/mg) (aOR; 1.80; 95% CI, 1.24-2.61).</p></div><div><h3>Limitations</h3><p>Selection bias of clinically indicated biopsies, not protocol biopsies, which likely represent a ceiling (maximum) for non-DKD.</p></div><div><h3>Conclusions</h3><p>Among patients with diabetes undergoing kidney biopsy, 63% have findings in addition to DKD on biopsy. We identified clinical parameters associated with non-DKD in the setting of diabetes. This provides valuable information for clinicians when kidney biopsy should be considered among patients with diabetes to capture all etiologies of proteinuria and kidney dysfunction.</p></div><div><h3>Plain-Language Summary</h3><p>Our study aimed to better understand when to perform kidney biopsies in patients with diabetes. Often, nephrologists diagnose diabetes-related kidney disease based on clinical pa","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524001006/pdfft?md5=a748a5930494396e027ef5001d3c92aa&pid=1-s2.0-S2590059524001006-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142158124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-10DOI: 10.1016/j.xkme.2024.100887
Bangchen Wang , Micah Schub , David I. Ortiz-Melo , Laura Barisoni
Paraneoplastic cast nephropathy, a rare cause of acute kidney injury, is most commonly observed in cases of multiple myeloma and is characterized by the formation of intratubular casts composed of monoclonal light chains. Nonmonoclonal paraneoplastic cast nephropathy has also been reported in patients with pancreatic acinar cell carcinoma or prolactinoma. In this case report, we present a case of polyclonal cast nephropathy in a patient with metastatic acinar cell carcinoma. We aim to emphasize the significance of recognizing this uncommon complication in patients with solid tumors and to discuss the diagnostic challenges and potential pathophysiology of this unique condition.
{"title":"Paraneoplastic Cast Nephropathy Associated With Pancreatic Acinar Cell Carcinoma: A Kidney Biopsy Teaching Case","authors":"Bangchen Wang , Micah Schub , David I. Ortiz-Melo , Laura Barisoni","doi":"10.1016/j.xkme.2024.100887","DOIUrl":"10.1016/j.xkme.2024.100887","url":null,"abstract":"<div><p>Paraneoplastic cast nephropathy, a rare cause of acute kidney injury, is most commonly observed in cases of multiple myeloma and is characterized by the formation of intratubular casts composed of monoclonal light chains. Nonmonoclonal paraneoplastic cast nephropathy has also been reported in patients with pancreatic acinar cell carcinoma or prolactinoma. In this case report, we present a case of polyclonal cast nephropathy in a patient with metastatic acinar cell carcinoma. We aim to emphasize the significance of recognizing this uncommon complication in patients with solid tumors and to discuss the diagnostic challenges and potential pathophysiology of this unique condition.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000980/pdfft?md5=2f10ac95f0d8f62b5b593f65610018be&pid=1-s2.0-S2590059524000980-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142172691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1016/j.xkme.2024.100886
Kuo-Chin Hung MD , Chia-Ter Chao MD, PhD
{"title":"Frailty May Mediate the Relationship Between Depressive Symptoms, Antidepressant Use, and Mortality in Patients With Chronic Kidney Disease","authors":"Kuo-Chin Hung MD , Chia-Ter Chao MD, PhD","doi":"10.1016/j.xkme.2024.100886","DOIUrl":"10.1016/j.xkme.2024.100886","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000979/pdfft?md5=c7b548bd0d16049fefc3366dd35a4994&pid=1-s2.0-S2590059524000979-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142039205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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