American Journal of Kidney Diseases最新文献

{"title":"A Case of Severe Acute Kidney Injury Due to an Antibiotic-Loaded Cement Spacer for Infected Knee Arthroplasty.","authors":"Evan Finger, Larab Giniyani, Yevgeniy A Korshunov, Jordan L Rosenstock","doi":"10.1053/j.ajkd.2024.07.012","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.07.012","url":null,"abstract":"<p><p>The treatment for periprosthetic joint infection frequently involves the placement of a high-dose antibiotic-loaded bone cement spacer (ALCS) into the debrided joint. Typical antibiotics in the spacer include aminoglycosides and vancomycin. It has been believed that systemic absorption of intraarticular antibiotics would be low and early experience suggested that the risk of acute kidney injury (AKI) from ALCS was minimal. However, recent case reports and case series have suggested a risk of acute kidney injury due to antibiotic absorption, though confounding factors are common. We report a case of severe AKI requiring hemodialysis with extremely high systemic tobramycin levels after the placement of an ALCS with increased dosing of antibiotics after previous failure to resolve a periprosthetic joint infection with a prior ALCS. There was no concomitant use of intravenous nephrotoxic antibiotics nor other confounding factors. Despite dialysis, the patient needed urgent removal of the ALCS to control tobramycin levels with subsequent resolution of the AKI. This case highlights the potentially serious nephrotoxicity of ALCS's, the importance of antibiotic type and dosing, and the value of close monitoring after ALCS placement, especially in a patient with chronic kidney disease.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Suitability and Willingness for Living Kidney Donation Among Older Adults.","authors":"Cédric Villain, Natalie Ebert, Richard J Glassock, Nina Mielke, Tim Bothe, Muhammad Helmi Barghouth, Anna Pöhlmann, Anne-Katrin Fietz, John S Gill, Elke Schaeffner","doi":"10.1053/j.ajkd.2024.07.010","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.07.010","url":null,"abstract":"<p><strong>Rationale & objective: </strong>The benefits of kidney transplantation compared to treatment with dialysis, including in older adult, are primarily limited by the number of donated kidneys. We studied the potential to expand the use of older living kidney donors.</p><p><strong>Study design: </strong>Secondary analysis of the Berlin Initiative Study, a population-based cohort.</p><p><strong>Setting: </strong>& Participants: 2069 adults aged ≥70 years in Germany.</p><p><strong>Exposures: </strong>Age and sex.</p><p><strong>Outcomes: </strong>Suitability for living donation assessed by the absence of kidney-related exclusions for donation including albuminuria and low estimated glomerular filtration rate (eGFR) as well as absence of other medical exclusions. Willingness for living and deceased kidney donation assessed by participant survey.</p><p><strong>Analytical approach: </strong>Descriptive analysis.</p><p><strong>Results: </strong>Among the 2069 participants (median age 80 years, 53% women, median eGFR 63 ml/min/1.73m²), 93% had ≥1 medical contraindication for living donation at study entry unrelated to eGFR or albuminuria. Using two published eGFR and albuminuria thresholds for donor acceptance, 38% to 54% of participants had kidney-related exclusions for donation. Among the 5% to 6% of participants with neither medical nor kidney-related exclusions for living donation at baseline, 11% to 12% remained suitable for donation during 8 years of follow-up. Willingness for living or deceased donation was high (73% and 60%, respectively).</p><p><strong>Limitations: </strong>GFR was not measured and medical exclusions unrelated to eGFR and albuminuria were assessed using a cohort database complemented by claims data.</p><p><strong>Conclusions: </strong>One in twenty older adults were potentially suitable for living kidney donation and willingness for living donation was high. Further studies are warranted to define the feasibility of expanding living kidney donation among older adults.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urea to Treat Hyponatremia Due to Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Systematic Review and Meta-Analysis.","authors":"Subhash Chander, Roopa Kumari, Abhi Chand Lohana, Zubair Rahaman, Om Parkash, Sheena Shiwlani, Yaqub Nadeem Mohammed, Hong Yu Wang, Hao Chi, Wenchy Tan, Sanjay Kirshan Kumar, Fnu Sindhu","doi":"10.1053/j.ajkd.2024.07.011","DOIUrl":"10.1053/j.ajkd.2024.07.011","url":null,"abstract":"<p><strong>Rationale & objective: </strong>The use of urea to treat hyponatremia related to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) has not been universally adopted due to questions about effectiveness, safety, and tolerability. This systematic review and meta-analysis of observational studies addresses these questions.</p><p><strong>Study design: </strong>This PRISMA-guided study examined published research across 4 electronic databases.</p><p><strong>Study populations: </strong>Patients with SIADH-related hyponatremia.</p><p><strong>Selection criteria: </strong>Clinical trials and observational studies reporting at least 1 outcome related to serum sodium concentration, symptom resolution, or adverse effects after oral or nasogastric urea administration.</p><p><strong>Data extraction: </strong>Data extraction was performed independently by 2 reviewers using a standardized form recording study characteristics, participant demographics, intervention details, and treatment outcomes.</p><p><strong>Analytical approach: </strong>A meta-analysis was conducted using the restricted maximum likelihood method for the random effects model to assess the effect of urea treatment on serum sodium and serum urea compared with other treatment modalities. Subgroup analyses were conducted based on treatment duration and SIADH severity.</p><p><strong>Results: </strong>Urea treatment significantly increased serum sodium (mean difference [MD], 9.08 [95% CI, 7.64-10.52], P<0.01) and urea (MD, 31.66 [95% CI, 16.05-47.26], P<0.01) in patients with SIADH, albeit with significantly high heterogeneity. Subgroup analysis based on the treatment duration showed a significant rise in the serum sodium level after 24 hours and 2, 5, 7, and 14 days, as well as after 1 year of treatment. Greater increases in serum sodium levels after treatment with urea occurred in patients with severe (<120 mEq/L) (MD, 18.04 [95% CI, 13.68-22.39]) than with moderate (120-129 mEq/L) (MD, 7.86 [95% CI, 6.78-8.94]) or mild (130-135 mEq/L) (MD, 8.00 [95% CI, 7.31-8.69]) SIADH-induced hyponatremia. Urea treatment was comparable to fluid restriction (MD, 0.81 [95% CI, -0.93 to 2.55], P = 0.4) and vaptans (MD, -1.96 [95% CI, -4.59 to 0.66], P=0.1) but superior to no treatment (MD, 7.99 [95% CI, 6.25-9.72], P<0.01). Urea was associated with minor adverse events, with poor palatability being the most common.</p><p><strong>Limitations: </strong>As no randomized controlled trials investigating urea as a treatment for hyponatremia were identified for inclusion, these analyses were based on observational studies.</p><p><strong>Conclusions: </strong>Urea is safe and effective for managing SIADH-induced hyponatremia. These finding suggest that urea may be a useful treatment modality in resource-limited settings or when other treatments are contraindicated or poorly tolerated.</p><p><strong>Trial registration: </strong>Registered at PROSPERO with study number CRD42024511685.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142370735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Patterns of Ankle-Brachial Index and Their Association With Progression of CKD in Patients With Type 2 Diabetes and Elevated Body Mass Index.","authors":"Mengyi Liu, Yanjun Zhang, Yuanyuan Zhang, Panpan He, Chun Zhou, Ziliang Ye, Sisi Yang, Xiaoqin Gan, Fan Fan Hou, Xianhui Qin","doi":"10.1053/j.ajkd.2024.06.024","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.06.024","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Ankle-brachial index (ABI) is used to screen for vascular complications in the setting of diabetes. This study sought to examine the relationship of longitudinal ABI data and chronic kidney disease (CKD) progression in patients with type 2 diabetes (T2D) and elevated body mass index (BMI).</p><p><strong>Study design: </strong>A post-hoc analysis of the Look AHEAD trial.</p><p><strong>Setting & participants: </strong>This study included 3,631 participants in the Look AHEAD trial with a baseline glomerular filtration rate (eGFR) >60 ml/min/1.73 m².</p><p><strong>Exposures: </strong>Average ABI and average annual change in ABI were calculated based on annual ABI measurements during the first 4 years of the study.</p><p><strong>Outcome: </strong>CKD progression, defined as kidney failure requiring maintenance dialysis or the occurrence of eGFR<60 ml/min/1.73 m² with a drop of ≥30% at a follow-up visit relative to the first eGFR measurement.</p><p><strong>Analytical approach: </strong>Restricted cubic spline and Cox proportional hazards models were fit to estimate associations and to explore non-linearity.</p><p><strong>Results: </strong>Over a median follow-up of 10.1 years, 1,051 participants developed CKD progression. There was a reversed J-shaped relationship of CKD progression with average ABI (when ABI <1.17: HR (per SD decrement), 1.23; 95%CI, 1.06-1.42; when ABI ≥ 1.17: HR (per SD increment), 1.10; 95%CI, 1.00-1.22) and average annual change in ABI (when change in ABI <-0.007: HR (per SD decrement), 1.37; 95%CI, 1.12-1.66; when change in ABI ≥-0.007: HR (per SD increment), 1.13; 95%CI, 1.03-1.24).</p><p><strong>Limitations: </strong>Observational study, potential unmeasured confounding.</p><p><strong>Conclusions: </strong>Low and high average ABI, even at clinically normal values, as well as decreasing and increasing average annual ABI, were associated a higher risk of CKD progression in patients with T2D and elevated BMI. Monitoring ABI and its changes over time may facilitate CKD risk stratification in patients with T2D.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-plasmapheresis Approaches for Managing Severe Renal Thrombotic Microangiopathy: A Report of 7 Cases.","authors":"Marie Frimat, Mehdi Maanaoui, Nora Schwotzer, Celine Lebas, Arnaud Lionet, Sylvain Dubucquoi, Viviane Gnemmi, Fadi Fakhouri, François Provôt","doi":"10.1053/j.ajkd.2024.06.022","DOIUrl":"10.1053/j.ajkd.2024.06.022","url":null,"abstract":"<p><p>C5-blockers are the established treatment for complement-mediated hemolytic uremic syndrome (CM-HUS). However, CM-HUS, lacking a definitive test, prompts plasma exchanges as a common first-line therapy, pending further assessments, despite complications and limited evidence in this indication. Recent experts' opinion endorses C5-blockers as the initial treatment for severe renal thrombotic microangiopathy (TMA). This retrospective, single-center study reports a series of 7 patients treated with a plasmapheresis-free approach. All patients presented with severe renal TMA symptoms and low French score and received prompt 900mg eculizumab within a median of 9 hours from admission. Hematological recovery was rapid, and renal function improved in 6 patients within 6.5 days, with a median hospital stay of 16 days. No rescue plasmapheresis was used. We report 7 cases of an early C5-blocker and plasmapheresis-free strategy in severe renal TMA suspicious for CM-HUS, demonstrating promising initial results. Clinical trials are needed to confirm the efficacy and safety of this approach. Addressing the high cost of C5-blocking therapies and exploring cost-effective alternatives is also crucial for broader implementation and accessibility in targeted therapies for adult renal TMA.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free Hormone Theory of Vitamin D Can Be an Important Alternative Consideration.","authors":"Chia-Ter Chao","doi":"10.1053/j.ajkd.2024.06.023","DOIUrl":"10.1053/j.ajkd.2024.06.023","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Genetic Testing in Nephrology: Core Curriculum 2024","authors":"","doi":"10.1053/j.ajkd.2024.05.011","DOIUrl":"10.1053/j.ajkd.2024.05.011","url":null,"abstract":"<div><div>Implementation of clinical genetic testing into the routine diagnostic workup of patients with kidney disorders can improve care when employed with proper patient selection. Due to advances in technology, testing with curated gene panels associated with kidney diseases are commercially available, are relatively inexpensive, and have quick turnaround time. While this may reduce barrier to entry, their adoption into routine nephrology care may be hindered when practitioners do not have comfort and experience ordering or interpreting these tests. Identifying patients who may have a monogenic etiology of their kidney disease will increase the diagnostic yield of testing, avoid unnecessary use of resources, and reduce anxiety around unclear or secondary findings. Genetic testing can end one’s diagnostic odyssey and help identify other family members at risk. Additionally, obtaining a genetic result can aid diagnostic precision, enhance understanding of disease, and may allow for alterations in treatment plans and screening for extrarenal manifestations of disease as well as clarify prognosis and aid in family planning. In this Core Curriculum, using a case-based approach, we highlight these and other topics in clinical genetic testing to enhance utilization in the general nephrology patient population.</div></div>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucagon-like Peptide-1 Receptor Agonists: New Evidence of Kidney and Cardiovascular Protection From the FLOW and SELECT Trials.","authors":"Maarten W Taal, Nicholas M Selby","doi":"10.1053/j.ajkd.2024.08.002","DOIUrl":"10.1053/j.ajkd.2024.08.002","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum regarding “Low Birth Weight and Kidney Function in Middle-Aged Men and Women: The Netherlands Epidemiology of Obesity Study” (Am J Kidney Dis. 2019;74(6):751-760)","authors":"","doi":"10.1053/j.ajkd.2024.08.001","DOIUrl":"10.1053/j.ajkd.2024.08.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":9.4,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0272638624009417/pdfft?md5=45ff21988e11ccd974b8682f7b7d9f9e&pid=1-s2.0-S0272638624009417-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142276871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of Nephrin Autoantibodies Signals New Chapter for Glomerular Disease.","authors":"Clara J Fischman,Lawrence B Holzman","doi":"10.1053/j.ajkd.2024.09.001","DOIUrl":"https://doi.org/10.1053/j.ajkd.2024.09.001","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":null,"pages":null},"PeriodicalIF":13.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}