Older adults in the United States often receive kidney therapies that do not align with their goals. Palliative care (PC) specialists are experts in assisting patients with the goals of care discussions and decision support, yet views and experiences of older patients who have received PC while contemplating kidney therapy decisions and their nephrologists remain unexplored. We evaluated the acceptability of CKD-EDU, a PC-based kidney therapy decision support intervention for adults ≥75 years of age.
Qualitative study.
Two trained research coordinators interviewed patients and nephrologists participating in the CKD-EDU study.
Three coders analyzed the qualitative data using a thematic analysis approach to identify salient themes pertaining to intervention acceptability.
Patients (n = 19; mean age: 80 years) viewed the PC intervention favorably, noting PC physicians' excellent communication skills, whole-person care, and decision-making support, including comprehension of prognostic information. Nephrologists (n = 24; mean age) welcomed PC assistance in decision making, support for conservative kidney management, and symptom management; a minority voiced concerns about third-party involvement in their practice.
Single-center study.
Overall, patients and nephrologists generally found the PC intervention to be acceptable. Future testing of the current PC-based decision support intervention in a larger randomized controlled trial for older people navigating kidney therapy decisions is needed.
Literature on the acceptability of palliative care for kidney therapy decision making for older adults is scarce. This qualitative study establishes the acceptability of a palliative care (PC)-based kidney therapy decision support pilot intervention among older adults with advanced chronic kidney disease (CKD). Both patients and nephrologists found the intervention acceptable. Future testing of this PC-based intervention in an adequately powered randomized controlled trial for older individuals navigating kidney therapy decisions is needed.
We evaluated the metabolic differences between pure and impure uric acid stone formers in this retrospective study of uric acid kidney stone formers diagnosed between 1996 and 2021.
Demographics and medical history were compared by χ2 tests. Twenty-four-hour urine chemistries were compared using logistic regressions while controlling for demographics and comorbid conditions.
Patients from Yale Urology and Nephrology Clinics with a documented kidney stone analysis containing uric acid were included. In total, 4,294 kidney stone formers had a stone analysis, and 722 (16.8%) contained uric acid. Patients with all stone analyses 50% uric acid were allocated to the pure group, while patients with ≥1 stone analysis <50% uric acid were allocated to the impure group.
Among kidney stone formers, the prevalence of uric acid nephrolithiasis was 16.8%. Pure uric acid stone formers were more likely to be older, heavier, and were 1.5 times more likely to have chronic kidney disease. When controlling for age, sex, race, ethnicity, and body mass index, pure uric acid stone formers had lower urinary pH and lower urine citrate normalized for creatinine. Additionally, they had a higher protein catabolic rate, urine urea nitrogen, and urine sulfur normalized for creatinine, all markers of dietary protein intake. These findings persisted after controlling for chronic kidney disease.
This is a retrospective study from a single center.
Pure uric acid stone formation is more common with diminished kidney function; however, after controlling for kidney function, pure uric acid stone formation is associated with protein intake, suggesting that modifying protein intake may reduce risk.
Antiglomerular basement membrane (GBM) disease has a poor prognosis. The rapid detection of serum anti-GBM antibody using an enzyme immunoassay, which has a high sensitivity and specificity, leads to an early diagnosis and improved prognosis. We report a case of acute kidney injury with false-positive anti-GBM antibody. A man in his early fifties underwent aortic arch replacement using bovine serum albumin (BSA)-containing surgical adhesion. After intravenous administration of vancomycin for a fever, he developed acute kidney injury without an abnormal urinalysis, and his anti-GBM antibody titer (fluorescence enzyme immunoassay [FEIA]) was 70.4 IU/mL. A kidney biopsy showed acute tubular injury and minor glomerular abnormalities without immunoglobulin G deposits, suggesting no evidence of anti-GBM glomerulonephritis. Consistent with the false-positive anti-GBM antibody test results, anti-GBM antibody determined using a chemiluminescent enzyme immunoassay was negative. A serum sample showed crossbinding to the FEIA plate from which the GBM antigen was removed. This finding indicated a nonspecific reaction to BSA, which contains a coating solution for the FEIA plate. This reaction was likely caused by anti-BSA antibody produced using BSA-containing surgical adhesion. Our findings suggest emerging challenges in diagnosing anti-GBM disease. Nephrologists must remain vigilant regarding false-positive anti-GBM antibody test results, particularly in cases evaluated with immunoassays that contain BSA.
People with sickle cell disease experience a high incidence of chronic kidney disease and end-stage kidney disease, secondary to tubular and glomerular effects of vaso-occlusion-induced hypoxia. Because of concerns of suboptimal kidney function, sickle cell donors are usually not considered for kidney donation, even if the rest of the parameters are acceptable for organ donation. A significant gap exists between the number of organ donors and the number of candidates waiting for a kidney transplant in the United States. To bridge the gap, we need to consider using nontraditional donors. We report kidney transplant outcomes in 6 recipients from 4 sickle cell kidney donors. Intracranial hemorrhage and sepsis were the causes of the death in donors, and no donor was in sickle cell crisis at the time of donation. None of the recipients experienced delayed graft function, and all recipients achieved excellent allograft function. The earliest allograft failure was at 27 months in a recipient who developed early acute rejection, while the longest follow-up was 10 years with adequate kidney function. In conclusion, given the shortage of kidneys for transplantation and demonstrated good outcomes, we propose that kidneys from sickle cell donors can be safely used.
Membranous nephropathy (MN) recurs in some kidney allograft patients, and recurrence increases graft failure rates. We present a unique case of recurrent MN in first and second allografts showing glomerular capillary wall-positivity for complement receptor 1 (CR1) consistent with immunoglobulin G (IgG). A man in his late 20s developed MN and started hemodialysis. MN recurred and caused graft loss after the first transplantation and recurred again soon after the second transplantation. The IgG subclass staining was almost consistently negative for IgG4 and phospholipase A2 receptor (PLA2R)-staining was negative. Recurrent MN of unknown etiology was considered. Mass spectrometry demonstrated that CR1 had increased in the transplanted kidney biopsies. Immunohistochemistry and immunofluorescence studies demonstrated CR1 colocalized with IgG along glomerular capillaries in this case, whereas CR1 was localized in podocytes with no colocalization of IgG in a control case of PLA2R-associated MN. Correlative light and immunoelectron microscopy showed localization of CR1 at the interface between electron-dense deposits and podocytes. Collectively, this case demonstrated a unique enhancement and localization of CR1. MN with enhancement of CR1 has not been reported to date. CR1 may be a candidate causative antigen in this case of recurrent MN, although further study is needed to investigate the pathogenesis of CR1.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：