Kidney Medicine最新文献

{"title":"Peritoneal Dialysis-Associated Peritonitis Rates in the Outpatient and Hospital Setting Among Incident Dialysis Patients With Medicare, 2009-2018.","authors":"Christopher Knapp, Shuling Li, Chuanyu Kou, James B Wetmore, Kirsten L Johansen","doi":"10.1016/j.xkme.2024.100931","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100931","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"100931"},"PeriodicalIF":3.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932293","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}

{"title":"Acute Kidney Injury Prognosis Prediction Using Machine Learning Methods: A Systematic Review.","authors":"Yu Lin, Tongyue Shi, Guilan Kong","doi":"10.1016/j.xkme.2024.100936","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100936","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Accurate estimation of in-hospital outcomes for patients with acute kidney injury (AKI) is crucial for aiding physicians in making optimal clinical decisions. We aimed to review prediction models constructed by machine learning methods for predicting AKI prognosis using administrative databases.</p><p><strong>Study design: </strong>A systematic review following PRISMA guidelines.</p><p><strong>Setting & study populations: </strong>Adult patients diagnosed with AKI who are admitted to either hospitals or intensive care units.</p><p><strong>Search strategy & sources: </strong>We searched PubMed, Embase, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health for studies published between January 1, 2014 and February 29, 2024. Eligible studies employed machine learning models to predict in-hospital outcomes of AKI based on administrative databases.</p><p><strong>Data extraction: </strong>Extracted data included prediction outcomes and population, prediction models with performance, feature selection methods, and predictive features.</p><p><strong>Analytical approach: </strong>The included studies were qualitatively synthesized with assessments of quality and bias. We calculated the pooled model discrimination of different AKI prognoses using random-effects models.</p><p><strong>Results: </strong>Of 3,029 studies, 27 studies were eligible for qualitative review. In-hospital outcomes for patients with AKI included acute kidney disease, chronic kidney disease, renal function recovery or kidney failure, and mortality. Compared with models predicting the mortality of patients with AKI during hospitalization, the prediction performance of models on kidney function recovery was less accurate. Meta-analysis showed that machine learning methods outperformed traditional approaches in mortality prediction (area under the receiver operating characteristic curve, 0.831; 95% CI, 0.799-0.859 vs 0.772; 95% CI, 0.744-0.797). The overlapping predictive features for in-hospital mortality identified from ≥6 studies were age, serum creatinine level, serum urea nitrogen level, anion gap, and white blood cell count. Similarly, age, serum creatinine level, AKI stage, estimated glomerular filtration rate, and comorbid conditions were the common predictive features for kidney function recovery.</p><p><strong>Limitations: </strong>Many studies developed prediction models within specific hospital settings without broad validation, restricting their generalizability and clinical application.</p><p><strong>Conclusions: </strong>Machine learning models outperformed traditional approaches in predicting mortality for patients with AKI, although they are less accurate in predicting kidney function recovery. Overall, these models demonstrate significant potential to help physicians improve clinical decision making and patient outcomes.</p><p><strong>Registration: </strong>CRD42024535965.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"100936"},"PeriodicalIF":3.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932273","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}

{"title":"\"The Heart of the Center\": Exploring the Role of the Patient Care Technician in US Dialysis Care.","authors":"Megan Urbanski, Emma Blythe, Alicia Hamblin, Alexis A Bender, Courtney Hoge, Clarica Douglas-Ajayi, Fran Rickenbach, Jessica Joseph, Kelli Collins Damron, Jennifer Craft Morgan, Bernard Jaar, Laura Plantinga","doi":"10.1016/j.xkme.2024.100934","DOIUrl":"10.1016/j.xkme.2024.100934","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Dialysis patient care technicians (PCTs) provide essential, frontline care for patients receiving in-center hemodialysis. We qualitatively explored perceptions of the PCT job role, responsibilities, and training among current PCTs, non-PCT dialysis staff, and patients receiving hemodialysis.</p><p><strong>Study design: </strong>Focus group study.</p><p><strong>Setting & participants: </strong>Discussions were conducted in March-May 2023 among US PCTs, non-PCT staff, and patients.</p><p><strong>Analytical approach: </strong>Thematic analysis was conducted using inductive and deductive strategies.</p><p><strong>Results: </strong>Seven focus groups (N = 36 participants) were conducted (3 with PCTs [n = 19], 2 with non-PCT staff [n = 6], and 2 with patients [n = 11]). Eight themes emerged: (1) value of PCT role is not reflected in job or organizational policies and structures; (2) PCTs play a flexible and often ill-defined role in dialysis clinics; (3) despite being in a position with high risk of burnout, PCTs find ways to persevere and provide high-quality care; (4) PCTs are often perceived as \"helpers\" or ancillary rather than an integral part of the dialysis care team; (5) PCT job training and qualifications are not standardized and often not commensurate with job expectations and responsibilities; (6) PCT-patient relationships are deeply valued, but boundaries can be fluid and become blurred because of the frequency and nature of dialysis care; (7) dialysis patients and staff are vulnerable to multilevel workplace safety issues; and (8) PCT-staff dynamics have a strong impact on employee morale, clinic efficiency, and patient satisfaction.</p><p><strong>Limitations: </strong>Non-English-speaking participants and physicians were excluded, limiting diversity in perspectives.</p><p><strong>Conclusions: </strong>PCTs play a multifaceted role in dialysis care that is highly valued among patients and staff but not always reflected in actual tasks performed by PCTs, training received by PCTs, or the respect afforded to PCTs. Our findings are actionable and can inform future intervention-based work aimed at improving the PCT role in US hemodialysis care.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"100934"},"PeriodicalIF":3.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907367","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}

{"title":"Spinal Cord Compression as the First Presentation of Primary Hyperoxaluria in a Patient With Kidney Failure: A Case Report and Literature Review.","authors":"Marwa Kliea, Mohammad Alsultan, Safaa Qatleesh, Yousef Haroun, Osama Abdul Aziz, Kassem Basha","doi":"10.1016/j.xkme.2024.100932","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100932","url":null,"abstract":"<p><p>A 50-year-old woman with kidney failure complained of back pain and an inability to walk. The medical history included hypothyroidism, nephrolithiasis, and resistant anemia aligned with several transfusions. The examination showed hepatosplenomegaly, lower limb weakness, absence of reflexes, and lack of sensations with a sensory level T6. Laboratory results showed hypercalcemia with suppression of parathyroid hormone levels. Magnetic resonance imaging showed vertebral fractures and mass-like lesions that compressed the spine at T4, T9, L4, and L5. Vertebral and bone marrow biopsies showed calcium oxalate (CaOx) depositions. Here, we reported a rare case of primary hyperoxaluria (PH) in a patient with kidney failure who presented with spinal cord compression caused by vertebral fractures and mass-like lesions. We summarized a literature review of PH patients with spinal cord compression, which showed only 3 cases. The multiorgan CaOx infiltration in this patient also caused resistant anemia, hepatosplenomegaly, extensive bone lesions, hypoparathyroidism, hypothyroidism, and hypercalcemia. The overdiagnosis of renal osteodystrophy and the negative family history could delay the diagnosis of PH in patients with kidney failure. Thus, clinicians should always consider PH in the differential diagnosis of kidney failure patients with stone events given that the early diagnosis of PH could be lifesaving.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"100932"},"PeriodicalIF":3.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932297","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}

{"title":"Establishing the Future Direction of Clinical Outcomes in C3 Glomerulopathy: Perspectives From a Patient and a Physician.","authors":"Anuja Java, Lindsey Fuller","doi":"10.1016/j.xkme.2024.100928","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100928","url":null,"abstract":"<p><p>Complement 3 glomerulopathy (C3G) is an ultra-rare glomerulonephritis caused by dysregulation of the alternative complement pathway. C3G has an estimated incidence of 1-3 cases per million people in the United States. Diagnosing C3G based solely on clinical and laboratory features is challenging because it mimics several other glomerular diseases; therefore, diagnosis requires a kidney biopsy. In the absence of disease-modifying therapies and optimal patient management strategies, C3G poses a significant physical and emotional burden on patients and caregivers. Common symptoms of glomerulonephritis include fatigue, edema, anxiety, and/or depression, which have profound effects on patients' daily lives. Approximately half of all patients progress to kidney failure within 10 years of diagnosis. Encouragingly, the treatment landscape in C3G is poised to change, with several targeted complement inhibitors in late-stage development. This perspectives article explores a patient's journey in C3G and discusses the current and future status of clinical outcomes and patient management from the viewpoints of a practicing nephrologist and a patient.</p>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"100928"},"PeriodicalIF":3.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932278","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}

{"title":"Diagnosing Oxalate Nephropathy on Kidney Biopsy Specimens.","authors":"Kenji Yamada, Mari Ikeda, Yoshinori Koyama, Kurumi Seki, Atsuro Kawaji, Tomohiko Inoue, Tomo Suzuki","doi":"10.1016/j.xkme.2024.100930","DOIUrl":"10.1016/j.xkme.2024.100930","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 1","pages":"100930"},"PeriodicalIF":3.2,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903326","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}

{"title":"Living Donor Candidates’ Self-reported Health and Health Perceptions and Completion of Donor Evaluation: A Cohort Study","authors":"Elaine Ku ,&nbsp;Sabrina Legaspi ,&nbsp;Timothy P. Copeland ,&nbsp;Deborah B. Adey ,&nbsp;Adrian M. Whelan ,&nbsp;Garrett R. Roll ,&nbsp;Charles E. McCulloch ,&nbsp;Brian K. Lee ,&nbsp;Kirsten L. Johansen","doi":"10.1016/j.xkme.2024.100909","DOIUrl":"10.1016/j.xkme.2024.100909","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Given the organ shortage in the United States, increasing living donation is vital to improving access to kidney transplantation, but many donor candidates do not complete the donor evaluation. Our objective was to understand potential living donors’ perceived health and its association with the likelihood of completing the donor evaluation process.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Potential donors’ self-reported health was ascertained using the Patient Reported Outcomes Measurement Information System (PROMIS) global physical and mental health and the Davies and Ware Health Perceptions surveys.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Potential living donors who expressed interest in donation at a single medical center were recruited prospectively between 2017 and 2022.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Donors' self-reported health and health perceptions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Completion of the donor evaluation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Adjusted linear and logistic regression models were used to examine the association between self-reported health and health perceptions with outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 1,347 individuals were included for study; 46% (N&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;613) were&lt;!--&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;40 years of age, 71% (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;951) were female, 22% (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;294) were of Hispanic ethnicity, and 16% (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;215) completed the donor evaluation. The mean PROMIS global physical health (17.0&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;1.9) and mental health (15.5&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;2.7) raw scores were higher among donor candidates proceeding to completion of the donor evaluation when compared with those who withdrew early in the process (16.3&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;2.2 for physical health and 14.9&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;3.1 for mental health). Every z-score change in the PROMIS physical health score was associated with 1.48-fold higher odds of completing the donor evaluation (95% CI, 1.19-1.85). Fully adjusted models incorporating the PROMIS scores for predicting the completion of donor evaluations had a c-statistic of 0.70. Potential donors’ Davies and Wares health perceptions did not predict the likelihood of completing the donor evaluation in fully adjusted models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Data are derived from a single center and may not generalize to the donor evaluation process at other transplant centers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Donor candidates’ self-reported physical health may serve as a predictor of the likelihood of completing the donor evaluation process and a potential avenue for future interventions.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;div&gt;This study was designed to understand the health perceptions of living donor candidates. We found that donor candidates’ self-reported physical health strongly predicted their lik","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 11","pages":"Article 100909"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554192","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}

{"title":"Hypokalemia in Peritoneal Dialysis: A Systematic Review and Meta-analysis of Prevalence, Treatment, and Outcomes","authors":"Changyuan Yang ,&nbsp;Xiaoxuan Hu ,&nbsp;Xitao Ling ,&nbsp;Cuixia Xiao ,&nbsp;Ruolan Duan ,&nbsp;Jiamei Qiu ,&nbsp;Qin Li ,&nbsp;Xindong Qin ,&nbsp;Jiahao Zeng ,&nbsp;La Zhang ,&nbsp;Haijing Hou ,&nbsp;Yu Peng ,&nbsp;Yuan Xu ,&nbsp;Jingxu Su ,&nbsp;Xusheng Liu ,&nbsp;Bengt Lindholm ,&nbsp;David W. Johnson ,&nbsp;Fuhua Lu ,&nbsp;Guobin Su","doi":"10.1016/j.xkme.2024.100923","DOIUrl":"10.1016/j.xkme.2024.100923","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Hypokalemia is common and potentially life-threatening in patients undergoing peritoneal dialysis (PD). However, the current literature has produced varying results. This study aimed to evaluate the prevalence and adverse outcomes of hypokalemia and the role of potassium supplementation in patients receiving PD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Systematic review and meta-analysis of randomized controlled trials and observational studies.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Study Populations&lt;/h3&gt;&lt;div&gt;Adults receiving maintenance PD.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Selection Criteria for Studies&lt;/h3&gt;&lt;div&gt;Studies that investigated the prevalence and adverse outcomes of hypokalemia and the effect of potassium supplementation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Extraction&lt;/h3&gt;&lt;div&gt;Two independent reviewers evaluated studies for eligibility and extracted relevant data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Random effects meta-analysis was conducted to pool hazard ratios (HRs) and 95% CIs for the outcomes of interest. The certainty of findings was rated according to the Grading of Recommendations Assessment, Development and Evaluation criteria.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 3,632 reports identified, 24 studies involving 60,313 participants met the inclusion criteria. The prevalence of hypokalemia was 37.9% (95% CI, 27.2%-52.7%), 17.7% (95% CI, 12.0%-25.9%), and 4.4% (95% CI, 1.9%-10.2%) in patients with potassium level&lt;!--&gt; &lt;!--&gt;&lt;4.0, 3.5, and 3.0&lt;!--&gt; &lt;!--&gt;mmol/L, respectively. Hypokalemia, according to the study’s definition, was associated with increased risks of all-cause mortality (HR, 1.49; 95% CI, 1.18-1.89), cardiovascular mortality (HR, 1.50; 95% CI, 1.19-1.88), and PD-associated peritonitis (HR, 1.42; 95% CI, 1.17-1.73). These associations were consistent but with low to very low certainty. The effect of correcting hypokalemia with potassium supplementation in patients undergoing PD remains uncertain.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Heterogeneity persisted across most of the examined subgroups, and observational studies preclude causation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Hypokalemia is common and portends poorer survival and a higher risk of peritonitis among patients undergoing PD. Further research into the optimal prevention and treatment strategies for hypokalemia is warranted to improve outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Registration&lt;/h3&gt;&lt;div&gt;Registered at PROSPERO with registration number CRD42022358236.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Hypokalemia is common and can be fatal in patients undergoing peritoneal dialysis (PD). The reported prevalence of hypokalemia in patients undergoing PD varies significantly across studies, and there is inconsistency regarding the relationship between hypokalemia and adverse outcomes. This systematic review and meta-analysis showed that hypokalemia is prevalent and associated with decreased survival rates and higher risk o","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100923"},"PeriodicalIF":3.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703304","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}

{"title":"Methotrexate Crystals on Electron Microscopy of Kidney Biopsy for Acute Kidney Injury","authors":"Diana Fang MD ,&nbsp;Noah Poznanski MD ,&nbsp;Lois J. Arend MD, PhD","doi":"10.1016/j.xkme.2024.100924","DOIUrl":"10.1016/j.xkme.2024.100924","url":null,"abstract":"<div><div>Acute kidney injury secondary to methotrexate therapy for hematologic malignancies is relatively uncommon. Methotrexate crystals in these cases are rarely seen on kidney biopsy, and in particular, their appearance in tissue prepared for transmission electron microscopy has not been described. A male patient with recurrent primary central nervous system lymphoma received high-dose methotrexate and rituximab for treatment. On day 2 of cycle 3, one day after the infusion of high-dose methotrexate, the patient was found to have high levels of serum methotrexate. Shortly after, he developed acute kidney injury. A kidney biopsy was performed, which showed methotrexate crystals only on tissue submitted for electron microscopy. To our knowledge, this is the first report to characterize methotrexate crystals on toluidine blue-stained thick sections and their ultrastructure on transmission electron microscopy.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100924"},"PeriodicalIF":3.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654936","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}

{"title":"Pediatric Acute Kidney Injury Care: A Qualitative Study of Clinicians","authors":"Anna E. Williams MD ,&nbsp;Erin B. Chang MPH ,&nbsp;Rasheed A. Gbadegesin MBBS, MD ,&nbsp;Clarissa J. Diamantidis MD, MHS","doi":"10.1016/j.xkme.2024.100925","DOIUrl":"10.1016/j.xkme.2024.100925","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100925"},"PeriodicalIF":3.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654937","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}