Kidney Medicine最新文献

{"title":"Utility of Activated Partial Thromboplastin Time Screening in Prospective Living Kidney Donors: A Single Center Cohort Study","authors":"Lucy S. Wang BA , Emily Ertmann BS , Eli Feldman BA , Meredith Kossoff BS , Brian Lu BS , John C. Lin BS, AB , Allyson Pishko MD, MSCE , Robert Redfield MD , Amanda Leonberg-Yoo MD , Adam Cuker MD, MS","doi":"10.1016/j.xkme.2024.100951","DOIUrl":"10.1016/j.xkme.2024.100951","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100951"},"PeriodicalIF":3.2,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131345","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":"Is Amanita phalloides Nephrotoxicity due to Mitochondrial Toxicity?","authors":"Jules Weinhard ,&nbsp;Justine Serre ,&nbsp;Perrine Frère ,&nbsp;Clovis Adam ,&nbsp;Marie Camille Lafargue ,&nbsp;David Buob ,&nbsp;Cédric Rafat","doi":"10.1016/j.xkme.2024.100952","DOIUrl":"10.1016/j.xkme.2024.100952","url":null,"abstract":"<div><div><em>Amanita phalloides</em>-related kidney toxicity is poorly documented and remains to be elucidated. Herein, we describe the case of a 43-year old patient who presented with severe liver failure following the ingestion of <em>Amanita phalloides</em>. Although liver injury subsided following the administration of N-acetyl cystein and silibinin, the patient subsequently developed KDIGO stage 3 acute kidney injury. Histopathological examination of the kidney displayed moderate tubular injury characterized by dilated tubular lumens and flattening of the tubular epithelium on optic microscopy. Electron microscopy showed mitochondrial changes including swelling and decreased number of cristae. Immunofluorescence for the key mitochondrial protein TOM20 found significantly decreased expression compared with ischemic acute tubular injury. Despite these changes, histoenzymology showed preserved succinate cytochrome c oxidase (COX) expression, suggesting that mitochondrial complex IV function was maintained. Our findings suggest that <em>Amanita phalloides</em> elicits acute tubular injury via mitochondrial damage, possibly through a pathway that spares COX function.</div></div><div><h3>Plain-Language Summary</h3><div>Kidney damage caused by Amanita phalloides (death cap mushroom) is not well understood. We report the case of a 43-year-old patient who experienced severe liver failure after eating this mushroom. While treatment with N-acetyl cysteine and silibinin improved the liver damage, the patient later developed severe kidney injury. Tests on the kidney showed damage to its tubules inside, with changes in their structure under a microscope. Closer examination revealed that the energy-producing parts of the cells, called mitochondria, were swollen and had fewer folds (cristae), which are essential for energy production. However, one key mitochondrial function, involving an enzyme called complex IV, appeared to be unaffected.This case suggests that the death cap mushroom may harm kidneys by damaging mitochondria in a way that leaves certain functions intact.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100952"},"PeriodicalIF":3.2,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131175","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":"Pregnancy in Women Receiving Maintenance Dialysis","authors":"Cristina Popa ,&nbsp;Priyadarshini John ,&nbsp;Prasoon Verma ,&nbsp;Sehrish Ali ,&nbsp;Silvi Shah","doi":"10.1016/j.xkme.2024.100950","DOIUrl":"10.1016/j.xkme.2024.100950","url":null,"abstract":"<div><div>Women with kidney failure experience pathophysiological changes that frequently result in disruption of the hypothalamic-pituitary-ovarian axis. Because of these hormonal disturbances, women with kidney disease often experience oligomenorrhea, amenorrhea, sexual dysfunction, and infertility. Preconception counseling, partnered with the early identification and optimal management of risk factors, such as hypertension and discontinuation of teratogenic medications, should be pursued for females contemplating conception. Pregnancy in women receiving maintenance dialysis is associated with a high risk of adverse maternal and fetal outcomes and should be managed by a multidisciplinary team of providers. In this review article, we discuss pregnancy incidence, pregnancy outcomes, and management of pregnancy among women receiving maintenance dialysis.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 3","pages":"Article 100950"},"PeriodicalIF":3.2,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143131176","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}

{"title":"Insulin Resistance in Hypercalciuric Calcium Kidney Stone Patients","authors":"Megan Prochaska ,&nbsp;Gloria Adeola ,&nbsp;Noah Vetter ,&nbsp;Raghavendra G. Mirmira ,&nbsp;Fredric Coe ,&nbsp;Elaine Worcester","doi":"10.1016/j.xkme.2024.100922","DOIUrl":"10.1016/j.xkme.2024.100922","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rational &amp; Objective&lt;/h3&gt;&lt;div&gt;Diabetes and uric acid kidney stones are strongly associated. Patients with calcium kidney stones also have higher risk of developing diabetes compared with nonkidney stone patients yet this has not been further investigated. We aimed to characterize insulin resistance in calcium kidney stone patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Observational.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Population&lt;/h3&gt;&lt;div&gt;This study was performed in the University of Chicago Clinical Research Center. Kidney stone patients (N&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;42) were selected for having idiopathic hypercalciuria and calcium stones with no other medical conditions, and controls (N&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;27) were healthy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;All participants presented to the Clinical Research Center in a fasting state and at least 2 timed fasting blood and urine collections were collected before a fixed breakfast. Six additional timed blood and urine collections were performed after breakfast.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;We compared fasting and fed indices of insulin resistance between the groups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytic Approach&lt;/h3&gt;&lt;div&gt;We used &lt;em&gt;t&lt;/em&gt; tests and multivariable linear regression models. A sensitivity analysis removing all patients who had ever been on a thiazide diuretic was also performed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In separate multivariable linear models, kidney stone patients had higher fasting serum insulin levels (24 (3-46&lt;!--&gt; &lt;!--&gt;pmol/L), &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.03) and higher homeostatic model of insulin resistance (HOMA-IR) (1.0 (0.2-1.8), &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.02). In separate multivariable linear models, kidney stone patients had higher fed serum glucose levels (10 (2-18&lt;!--&gt; &lt;!--&gt;mg/dL), &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.01). Results were similar in a sensitivity analysis removing all patients who had ever been on a thiazide diuretic. There were no differences in urine composition based on HOMA-IR levels.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Single institution. Small sample size limited subanalyses by different calcium stone types.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Calcium kidney stone patients without diabetes or other medical conditions demonstrated signs of insulin resistance compared with healthy matched controls.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Diabetes is strongly associated with kidney stones, particularly uric acid kidney stones. However, patients who form calcium kidney stones may also have an increased risk of developing diabetes, but this has not been further explored. We collected markers of insulin resistance in otherwise healthy patients with calcium kidney stones and healthy control volunteers to evaluate for early signs of insulin resistance in patients with calcium kidney stones. Compared to healthy control participants, we found that patients with calcium kidney stones are more likely to have ins","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100922"},"PeriodicalIF":3.2,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654847","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":"Circulating Protein and Metabolite Correlates of Histologically Confirmed Diabetic Kidney Disease","authors":"Carolina Lopez-Silva ,&nbsp;Aditya Surapaneni ,&nbsp;Insa M. Schmidt ,&nbsp;Dhairya Upadhyay ,&nbsp;Anand Srivastava ,&nbsp;Ragnar Palsson ,&nbsp;Isaac E. Stillman ,&nbsp;Eugene P. Rhee ,&nbsp;Sushrut S. Waikar ,&nbsp;Morgan E. Grams","doi":"10.1016/j.xkme.2024.100920","DOIUrl":"10.1016/j.xkme.2024.100920","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Diabetic kidney disease (DKD) is one of the leading causes of end-stage kidney disease globally. We aim to identify proteomic and metabolomic correlates of histologically confirmed DKD that may improve our understanding of its pathophysiology.</div></div><div><h3>Study Design</h3><div>A cross-sectional study.</div></div><div><h3>Setting &amp; Participants</h3><div>A total of 434 Boston Kidney Biopsy Cohort participants.</div></div><div><h3>Predictors</h3><div>Histopathological diagnosis of DKD on biopsy.</div></div><div><h3>Outcomes</h3><div>Proteins and metabolites associated with DKD.</div></div><div><h3>Analytical Approach</h3><div>We performed linear regression to identify circulating proteins and metabolites associated with a histopathological diagnosis of DKD (n<!--> <!-->=<!--> <!-->81) compared with normal or thin basement membrane (n<!--> <!-->=<!--> <!-->27), and other kidney diseases without diabetes (n<!--> <!-->=<!--> <!-->279). Pathway enrichment analysis was used to explore biological pathways enriched in DKD. Identified proteins were assessed for their discriminative ability in cases of DKD versus a distinct set of 48 patients with diabetes but other kidney diseases.</div></div><div><h3>Results</h3><div>After adjusting for age, sex, estimated glomerular filtration, and albuminuria levels, there were 8 proteins and 1 metabolite that differed between DKD and normal/thin basement membrane, and 84 proteins and 11 metabolites that differed between DKD and other kidney diseases without diabetes. Five proteins were significant in both comparisons: C-type mannose receptor 2, plexin-A1, plexin-D1, renin, and transmembrane glycoprotein NMB. The addition of these proteins improved discrimination over clinical variables alone of a histopathological diagnosis of DKD on biopsy among patients with diabetes (change in area under the curve 0.126; <em>P</em> <!-->=<!--> <!-->0.008).</div></div><div><h3>Limitations</h3><div>A cross-sectional approach and lack of an external validation cohort.</div></div><div><h3>Conclusions</h3><div>Distinct proteins and biological pathways are correlated with a histopathological diagnosis of DKD.</div></div><div><h3>Plain-Language Summary</h3><div>In the following study, we aimed to identify proteins, metabolites, and biological pathways that are associated with a diagnosis of diabetic kidney disease on biopsy. After adjusting for demographic characteristics and baseline renal function, we identified 5 proteins that were significantly associated with diabetic kidney disease, both in comparison to individuals without kidney disease and those with nondiabetic kidney disease: C-type mannose receptor 2, plexin-A1, plexin-D1, renin, and transmembrane glycoprotein NMB. We also found that these proteins may enhance our ability to distinguish between diabetic kidney disease and other causes of kidney disease in a group of patients with diabetes.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100920"},"PeriodicalIF":3.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142654846","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":"Perceptions of Palliative Care Among Patients With Kidney Allograft Dysfunction: A Qualitative Study","authors":"Cameron E. Comrie ,&nbsp;Katherine He ,&nbsp;Jolene Wong ,&nbsp;Anil K. Chandraker ,&nbsp;Naoka Murakami ,&nbsp;Joshua R. Lakin ,&nbsp;Amanda J. Reich","doi":"10.1016/j.xkme.2024.100917","DOIUrl":"10.1016/j.xkme.2024.100917","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Nearly half of kidney transplant recipients develop allograft failure within 10 years of transplantation and experience high mortality, significant symptom burden, and complex communication challenges. These patients may benefit from palliative care, but palliative care is infrequently provided in this population. This study explores palliative care perceptions and needs among patients with poorly functioning and declining kidney allografts.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A qualitative study using semistructured interviews.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;Adult kidney transplant recipients with a glomerular filtration rate of&lt;!--&gt; &lt;!--&gt;&lt;20&lt;!--&gt; &lt;!--&gt;mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt; followed at a single transplant center were interviewed from April 2022 to November 2022.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;An interdisciplinary team, including nephrology, palliative care, and surgery, conducted a thematic analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Twelve participants (3 women, 9 men; 9 White, 2 Black, and 1 Hispanic patient) were interviewed. The median age of participants was 59 (IQR 48-73). At 6 months postinterview, 7 participants had resumed dialysis, 1 participant had been retransplanted, and 1 participant was deceased. Most participants had not heard of palliative care and those who had equated it with end-of-life care. Participants reported that emotional distress, particularly pervasive concern about the worsening of their kidney disease, was their most significant priority related to unmet palliative care needs. They also desired more discussion with their care team about future quality of life and lifespan. Participants described high trust in their transplant teams, suggesting that palliative care integration with these teams would be well-received.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Limitations include recruitment from a single institution, lack of subject familiarity with palliative care, and limited racial and ethnic diversity among participants.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Patients with declining kidney allografts have heterogeneous, unmet palliative care needs, including emotional symptoms and a desire for better prognostic awareness. Our results suggest that patients are largely unaware of palliative care and may benefit from practice models in which transplant teams integrate palliative care education and timely palliative care engagement.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Nearly half of patients with kidney transplants experience failure of their transplant within a decade, leading to high mortality, significant symptoms, and communication challenges. Palliative care can help address these issues but is not frequently provided to these patients. We interviewed 12 patients whose kidney transplants were no longer working well to understand their perspectives on palliative care and palliative care needs. Mo","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 12","pages":"Article 100917"},"PeriodicalIF":3.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703324","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}