Canadian Journal of Kidney Health and Disease最新文献

{"title":"Knowledge Translation in Glomerulonephritis: Successes in Translational Research From the Bench to Bedside.","authors":"Kevin Yau, Carol Wang, Rami Al Batran, Anne Macphee, Mary Beaucage, Janine F Farragher","doi":"10.1177/20543581231191839","DOIUrl":"10.1177/20543581231191839","url":null,"abstract":"<p><strong>Purpose of review: </strong>Glomerulonephritis refers to a rare group of diseases characterized by glomerular inflammation, which collectively are a common cause of kidney failure. Until recently, there was a lack of high-quality clinical trials to inform the care of patients with glomerulonephritides. We identified examples of successful translational research spanning from basic science to clinical applications, and highlight gaps in implementation science.</p><p><strong>Sources of information: </strong>The focus of our review was derived from discussions between health care professionals, researchers, and patient partners. We also performed literature searches pertaining to the treatment of glomerulonephritis in PubMed and Google Scholar.</p><p><strong>Methods: </strong>Examples of successful knowledge translation were generated through review of new evidence in the past 5 years and by iterative discussions by the authors. We then conducted a narrative review of several themes related to knowledge translation in glomerulonephritis. This was complemented by an interview with a patient partner to provide an example of a patient's perspective living with glomerulonephritis.</p><p><strong>Key findings: </strong>We summarized selected recent advances in glomerulonephritis and its knowledge translation in the following domains: (1) identification of auto-antibodies in membranous nephropathy and minimal change disease; (2) clinical trials of novel targeted therapies for IgA nephropathy and lupus nephritis, which have led to approval of new treatments; (3) developments in research networks and clinical trials in glomerulonephritis; (4) recognition of the importance in developing standardized patient reported outcome measures in clinical trials; and (5) barriers in knowledge translation including access to medication.</p><p><strong>Limitations: </strong>A systematic search of the literature and formal assessment of quality of evidence were beyond the scope of this review.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/de/10.1177_20543581231191839.PMC10457520.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10465636","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":"CENtral blood pressure Targeting: a pragmatic RAndomized triaL in advanced Chronic Kidney Disease (CENTRAL-CKD): A Clinical Research Protocol.","authors":"Rémi Goupil, Annie-Claire Nadeau-Fredette, Bhanu Prasad, Gregory L Hundemer, Rita S Suri, William Beaubien-Souligny, Mohsen Agharazii","doi":"10.1177/20543581231172407","DOIUrl":"10.1177/20543581231172407","url":null,"abstract":"<p><strong>Background: </strong>Emerging data favor central blood pressure (BP) over brachial cuff BP to predict cardiovascular and kidney events, as central BP more closely relates to the true aortic BP. Considering that patients with advanced chronic kidney disease (CKD) are at high cardiovascular risk and can have unreliable brachial cuff BP measurements (due to high arterial stiffness), this population could benefit the most from hypertension management using central BP measurements.</p><p><strong>Objective: </strong>To assess the feasibility and efficacy of targeting central BP as opposed to brachial BP in patients with CKD G4-5.</p><p><strong>Design: </strong>Pragmatic multicentre double-blinded randomized controlled pilot trial.</p><p><strong>Setting: </strong>Seven large academic advanced kidney care clinics across Canada.</p><p><strong>Patients: </strong>A total of 116 adults with CKD G4-5 (estimated glomerular filtration rate [eGFR] < 30 mL/min) and brachial cuff systolic BP between 120 and 160 mm Hg. The key exclusion criteria are 1) ≥ 5 BP drugs, 2) recent acute kidney injury, myocardial infarction, stroke, heart failure or injurious fall, 3) previous kidney replacement therapy.</p><p><strong>Methods: </strong>Double-blind randomization to a central or a brachial cuff systolic BP target (both < 130 mm Hg) as measured by a validated central BP device. The study duration is 12 months with follow-up visits every 2 to 4 months, based on local practice. All other aspects of CKD management are at the discretion of the attending nephrologist.</p><p><strong>Outcomes: </strong><i>Primary Feasibility</i>: Feasibility of a large-scale trial based on predefined components. <i>Primary Efficacy</i>: Carotid-femoral pulse wave velocity at 12 months. <i>Others</i>: Efficacy (eGFR decline, albuminuria, BP drugs, and quality of life); Events (major adverse cardiovascular events, CKD progression, hospitalization, mortality); Safety (low BP events and acute kidney injury).</p><p><strong>Limitations: </strong>May be challenging to distinguish whether central BP is truly different from brachial BP to the point of significantly influencing treatment decisions. Therapeutic inertia may be a barrier to successfully completing a randomized trial in a population of CKD G4-5. These 2 aspects will be evaluated in the feasibility assessment of the trial.</p><p><strong>Conclusion: </strong>This is the first trial to evaluate the feasibility and efficacy of using central BP to manage hypertension in advanced CKD, paving the way to a future large-scale trial.</p><p><strong>Trial registration: </strong>clinicaltrials.gov (NCT05163158).</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a1/87/10.1177_20543581231172407.PMC10164859.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10296452","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":"Double-Positive Anti-Glomerular Basement Membrane Antibody and Myeloperoxidase Antineutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis Post COVID-19 mRNA vaccine: A Case Series of 4 Patients.","authors":"Julie Anne Ting, Elena-Bianca Barbir, Susanna A McRae, Michael Schachter, Linda De Luca, Maziar Riazy, Adeera Levin","doi":"10.1177/20543581231153217","DOIUrl":"10.1177/20543581231153217","url":null,"abstract":"<p><strong>Rationale: </strong>Vaccines remain central to the management of COVID-19 pandemic, including the need for repeat doses of vaccines to boost immunity. There has been an accumulating case count of glomerulopathies temporally associated with COVID-19 vaccination. This case series presents 4 patients who developed double-positive anti-glomerular basement membrane antibody (anti-GBM) and myeloperoxidase (MPO) antineutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis after COVID-19 mRNA vaccination. This report contributes to our collective knowledge about the pathophysiology and clinical outcomes associated with this rare complication.</p><p><strong>Presenting concerns of the patient: </strong>Four patients developed nephritic syndrome within 1 to 6 weeks after receiving a COVID-19 mRNA vaccine (3 post Pfizer-BioNTech and 1 post Moderna vaccination). Three of the 4 patients also had hemoptysis.</p><p><strong>Diagnosis: </strong>Three of the 4 patients had double-positive serology, whereas the fourth patient had renal biopsy findings consistent with double-positive disease, although anti-GBM serology was negative. All patients had renal biopsy findings consistent with double-positive anti-GBM and ANCA-associated glomerulonephritis.</p><p><strong>Interventions: </strong>All 4 patients were treated with pulse steroids, cyclophosphamide, and plasmapheresis.</p><p><strong>Outcomes: </strong>Of the 4 patients, 1 demonstrated complete remission, 2 remained dialysis-dependent, and the fourth is deceased. Of the 2 patients who received repeat vaccination with COVID-19 mRNA vaccine, 1 patient had second serologic flare of anti-GBM in response to the vaccine.</p><p><strong>Novel findings: </strong>This case series reinforces growing evidence that COVID-19 mRNA vaccine-induced glomerulonephritis is a rare but real phenomenon. Dual ANCA and anti-GBM nephritis can present after the first dose of COVID-19 mRNA vaccine or after several administrations of the vaccine. We are the first to report cases of double-positive MPO ANCA and anti-GBM nephritis after Pfizer-BioNTech vaccination. To our knowledge, we are also the first to report outcomes of repeat COVID-19 vaccination in patients with de novo flare of ANCA and anti-GBM nephritis temporally associated with COVID-19 vaccination.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/3e/10.1177_20543581231153217.PMC9925863.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10740125","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":"Management of Type 2 Diabetic Kidney Disease in 2022: A Narrative Review for Specialists and Primary Care.","authors":"David Z I Cherney, Alan Bell, Louis Girard, Philip McFarlane, Louise Moist, Sharon J Nessim, Steven Soroka, Sara Stafford, Andrew Steele, Navdeep Tangri, Jordan Weinstein","doi":"10.1177/20543581221150556","DOIUrl":"10.1177/20543581221150556","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of review: &lt;/strong&gt;Kidney disease is present in almost half of Canadian patients with type 2 diabetes (T2D), and it is also the most common first cardiorenal manifestation of T2D. Despite clear guidelines for testing, opportunities are being missed to identify kidney diseases, and many Canadians are therefore not receiving the best available treatments. This has become even more important given recent clinical trials demonstrating improvements in both kidney and cardiovascular (CV) endpoints with sodium-glucose cotransporter 2 (SGLT2) inhibitors and a nonsteroidal mineralocorticoid receptor antagonist, finerenone. The goal of this document is to provide a narrative review of the current evidence for the treatment of diabetic kidney disease (DKD) that supports this new standard of care and to provide practice points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sources of information: &lt;/strong&gt;An expert panel of Canadian clinicians was assembled, including 9 nephrologists, an endocrinologist, and a primary care practitioner. The information the authors used for this review consisted of published clinical trials and guidelines, selected by the authors based on their assessment of their relevance to the questions being answered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Panelists met virtually to discuss potential questions to be answered in the review and agreed on 10 key questions. Two panel members volunteered as co-leads to write the summaries and practice points for each of the identified questions. Summaries and practice points were distributed to the entire author list by email. Through 2 rounds of online voting, a second virtual meeting, and subsequent email correspondence, the authors reached consensus on the contents of the review, including all the practice points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;It is critical that DKD be identified as early as possible in the course of the disease to optimally prevent disease progression and associated complications. Patients with diabetes should be routinely screened for DKD with assessments of both urinary albumin and kidney function. Treatment decisions should be individualized based on the risks and benefits, patients' needs and preferences, medication access and cost, and the degree of glucose lowering needed. Patients with DKD should be treated to achieve targets for A1C and blood pressure. Renin-angiotensin-aldosterone system blockade and treatment with SGLT2 inhibitors are also key components of the standard of care to reduce the risk of kidney and CV events for these patients. Finerenone should also be considered to further reduce the risk of CV events and chronic kidney disease progression. Education of patients with diabetes prescribed SGLT2 inhibitors and/or finerenone is an important component of treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;No formal guideline process was used. The practice points are not graded and are not intended to be viewed as having the weight of a clinical practice guideline or fo","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9884958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10639531","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":"Five Things to Know About Pruritus in Patients on Dialysis.","authors":"Bhanu Prasad, Maria Gagarinova, Aditi Sharma","doi":"10.1177/20543581221149620","DOIUrl":"10.1177/20543581221149620","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/62/dd/10.1177_20543581221149620.PMC9880569.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10582222","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":"Prevalence and Impact of BK Polyomavirus in the Ureters of Kidney Donors: Research Letter.","authors":"Chagnon Sarah-Jane,&nbsp;Yangfan Zhao,&nbsp;Lamontagne Bruno,&nbsp;Royal Virginie,&nbsp;Lamarche Caroline","doi":"10.1177/20543581231166478","DOIUrl":"https://doi.org/10.1177/20543581231166478","url":null,"abstract":"<p><strong>Background: </strong>More than 75% of the population is seropositive for BK polyomavirus (BKV), which remains quiescent in the urothelium in immunocompetent hosts. However, it can reactivate in kidney transplant recipients (KTRs), and up to 30% of them will develop BKV viremia in the 2 years following transplant, with a risk of developing BKV-associated nephropathy (BKVAN). Viral reactivation is associated with the level of immunosuppression, but there is currently no way to predict which patients are at high risk for reactivation.</p><p><strong>Objective: </strong>As BKV originates from kidney donors, our primary objective was to determine the prevalence of detectable BKV in donor ureters. Our secondary objective was to see if there is a correlation between the presence of BKV in donor urothelium and the development of BKV viremia and BKVAN in KTR.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Single-center academic kidney transplant program.</p><p><strong>Patients: </strong>Prospective sequential KTRs that received a kidney transplant between March 2016 and March 2017.</p><p><strong>Measurements: </strong>The presence of BKV in donor ureters was determined by TaqMan-based quantitative polymerase chain reaction (PCR; qPCR).</p><p><strong>Methods: </strong>We performed a prospective study which was done on 35 out of the 100 donors initially foreseen to take part in the study. During surgery, the distal part of donor ureter was kept and analyzed by qPCR (to establish the presence of BKV in the urothelium). The primary outcome was the development of BKV viremia in KTR over a period of 2 years after transplant. Secondary outcome was the development of BKVAN.</p><p><strong>Results: </strong>Out of 35 ureters analyzed, only one had a positive qPCR for BKV (2.86%, 95% confidence interval [CI]: [0.07-14.92]). Considering the primary objective would not be met, the study was interrupted after 35 specimens. After surgery, 9 recipients had a slow graft function and 4 had delayed graft function, one of which never recovered graft function. Over the 2-year follow-up, 13 patients developed BKV viremia, while 5 patients developed BKVAN. The patient who received a graft from a positive qPCR donor eventually developed BKV viremia and nephropathy.</p><p><strong>Limitations: </strong>The specimen analyzed was a distal rather than a proximal portion of the ureter. However, BKV replication is known to concentrate in the corticomedullary junction.</p><p><strong>Conclusion: </strong>BK polyomavirus prevalence in the distal part of donor ureters is lower than previously reported. It cannot be used as a predictor for the development of BKV reactivation and/or nephropathy.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10101211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9317629","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":"Determining the Longitudinal Serologic Response to COVID-19 Vaccination in the Chronic Kidney Disease Population: A Clinical Research Protocol.","authors":"Kevin Yau,&nbsp;Omosomi Enilama,&nbsp;Adeera Levin,&nbsp;Marc G Romney,&nbsp;Joel Singer,&nbsp;Peter Blake,&nbsp;Jeffrey Perl,&nbsp;Jerome A Leis,&nbsp;Robert Kozak,&nbsp;Hubert Tsui,&nbsp;Shelly Bolotin,&nbsp;Vanessa Tran,&nbsp;Christopher T Chan,&nbsp;Paul Tam,&nbsp;Miten Dhruve,&nbsp;Christopher Kandel,&nbsp;Jose Estrada-Codecido,&nbsp;Tyler Brown,&nbsp;Aswani Siwakoti,&nbsp;Kento T Abe,&nbsp;Queenie Hu,&nbsp;Karen Colwill,&nbsp;Anne-Claude Gingras,&nbsp;Matthew J Oliver,&nbsp;Michelle A Hladunewich","doi":"10.1177/20543581231160511","DOIUrl":"https://doi.org/10.1177/20543581231160511","url":null,"abstract":"<p><strong>Background: </strong>People living with chronic kidney disease (CKD) have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic, including higher rates of infection, hospitalization, and death. Data on responsiveness to COVID-19 vaccination strategies and immunogenicity are limited, yet required to inform vaccination strategies in this at-risk population.</p><p><strong>Objective: </strong>The objective of this study is to characterize the longitudinal serologic response to COVID-19 vaccination.</p><p><strong>Design: </strong>This is a prospective observational cohort study.</p><p><strong>Setting: </strong>Participating outpatient kidney programs within Ontario and British Columbia.</p><p><strong>Patients: </strong>Up to 2500 participants with CKD G3b-5D receiving COVID-19 vaccination, including participants receiving dialysis and kidney transplant recipients (CKD G1T-5T).</p><p><strong>Measurements: </strong>The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG antibodies (anti-spike, anti-receptor binding domain, anti-nucleocapsid) will be detected by ELISA (enzyme-linked immunosorbent assay) from serum or dried blood spot testing. In a subset of participants, neutralizing antibodies against novel variants of concern will be evaluated. Peripheral blood mononuclear cells will be collected for exploratory immune profiling of SARS-CoV-2 specific cellular immunity.</p><p><strong>Methods: </strong>Participants will be recruited prior to or following any COVID-19 vaccine dose and have blood sampled for serological testing at multiple timepoints: 1, 3, 6, 9, and 12 months post vaccination. When possible, samples will be collected prior to a dose or booster. Participants will remain in the study for at least 1 year following their last COVID-19 vaccine dose.</p><p><strong>Strengths and limitations: </strong>The adaptive design of this study allows for planned modification based on emerging evidence or rapid changes in public health policy surrounding vaccination. Limitations include incomplete earlier timepoints for blood collection due to rapid vaccination of the population.</p><p><strong>Conclusions: </strong>This large multicenter serologic study of participants living with kidney disease will generate data on the kinetics of SARS-CoV-2 immune response to vaccination across the spectrum of CKD, providing insights into the amplitude and duration of immunity conferred by COVID-19 vaccination and allowing for characterization of factors associated with immune response. The results of this study may be used to inform immunization guidelines and public health recommendations for the 4 million Canadians living with CKD.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/56/ea/10.1177_20543581231160511.PMC10028441.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9159210","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":"<i>Bartonella henselae</i> Infective Endocarditis: A Rare Cause of Pauci-Immune Necrotizing Glomerulonephritis-A Case Report.","authors":"Muhammad Asim Shahzad,&nbsp;Khawaja Talha Aziz,&nbsp;Stephen Korbet","doi":"10.1177/20543581221150554","DOIUrl":"https://doi.org/10.1177/20543581221150554","url":null,"abstract":"<p><strong>Rationale: </strong><i>Bartonella</i> sp. are the most common causes of culture-negative infective endocarditis (IE) cases in the United States. Although, infection-related glomerulonephritis can frequently mimic primary vasculitis due to pauci-immune pattern, majority of previously reported cases of <i>Bartonella henselae</i>-associated glomerulonephritis have immune-complex deposits on immunofluorescence. We present a rare case of <i>B henselae</i> IE-related pauci-immune necrotizing glomerulonephritis. Timely recognition of this atypical presentation led to appropriately directed medical therapy.</p><p><strong>Presenting concerns of the patient: </strong>A 33-year-old Caucasian male with a history of human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART), alcohol abuse, previous subarachnoid hemorrhage (SAH), and recent wisdom tooth extraction (on amoxicillin) was transferred from an outside hospital for further evaluation of severe headache. He was diagnosed with an SAH and right anterior cerebral artery mycotic aneurysm. The serum creatinine at the outside hospital was 292 umol/L (3.3 mg/dL) with a previously normal baseline around 2 years ago. The serum creatinine at our institution was 256 umol/L (3.0 mg/dL). The urinalysis demonstrated +100 protein, +3 blood and 29 red blood cells/high power field. The urine protein creatinine ratio (UPC) was 1.7 g/g. Serologic evaluation was positive for a low C4 10.2 mg/dL, elevated rheumatoid factor 40 IU/mL and an elevated proteinase 3 (PR-3) antineutrophilic cytoplasmic antibodies (ANCA Ab) 4.0 U/mL. A transesophageal echocardiogram (TEE) showed echo densities on both mitral and aortic valve. Blood cultures were negative. Further serologic evaluation was positive for <i>B henselae</i> IgG titer of 1:2560 (normal <1:320) with a negative IgM titer.</p><p><strong>Diagnoses: </strong>A percutaneous kidney biopsy revealed pauci-immune necrotizing glomerulonephritis, with 14/16 glomeruli globally sclerotic, and 2 glomeruli with active segmental necrotizing lesions. There was no evidence of immune-complex deposition on immunofluorescence or electron microscopy. Clinical findings were consistent with <i>B henselae</i> IE associated mycotic aneurysm and necrotizing glomerulonephritis.</p><p><strong>Intervention: </strong>Empiric treatment for an active glomerulonephritis with immunosuppressive agents was deferred on admission, given concern for an underlying infectious process and mycotic aneurysms in an HIV-positive patient. He received antibiotic treatment with doxycycline and ceftriaxone with gentamicin for synergy. Despite this, the mitral and aortic valve regurgitation worsened, and he developed congestive heart failure requiring aortic valve replacement and mitral valve repair. The explanted aortic valve was positive for <i>B henselae</i> by polymerase chain reaction (PCR) confirming the diagnosis of <i>B henselae</i> IE.</p><p><strong>Outcomes: </strong>Immunosupp","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/07/10.1177_20543581221150554.PMC9869233.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9178557","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":"Long-Term Outcomes for Living Kidney Donors With Early Guideline-Concordant Follow-up Care: A Retrospective Cohort Study.","authors":"Anisha Dhalla,&nbsp;Anita Lloyd,&nbsp;Krista L Lentine,&nbsp;Amit X Garg,&nbsp;Robert R Quinn,&nbsp;Pietro Ravani,&nbsp;Scott W Klarenbach,&nbsp;Brenda R Hemmelgarn,&nbsp;Uchenna Ibelo,&nbsp;Ngan N Lam","doi":"10.1177/20543581231158067","DOIUrl":"https://doi.org/10.1177/20543581231158067","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend that living kidney donors receive lifelong annual follow-up care to monitor kidney health. In the United States, the reporting of complete clinical and laboratory data for kidney donors has been mandated for the first 2 years post-donation; however, the long-term impact of early guideline-concordant care remains unclear.</p><p><strong>Objective: </strong>The primary objective of this study was to compare long-term post-donation follow-up care and clinical outcomes of living kidney donors with and without early guideline-concordant follow-up care.</p><p><strong>Design: </strong>Retrospective, population-based cohort study.</p><p><strong>Setting: </strong>Linked health care databases were used to identify kidney donors in Alberta, Canada.</p><p><strong>Patients: </strong>Four hundred sixty living kidney donors who underwent nephrectomy between 2002 and 2013.</p><p><strong>Measurements: </strong>The primary outcome was continued annual follow-up at 5 and 10 years (adjusted odds ratio with 95% confidence interval, _LCLaOR_UCL). Secondary outcomes included mean change in estimated glomerular filtration rate (eGFR) over time and rates of all-cause hospitalization.</p><p><strong>Methods: </strong>We compared long-term follow-up and clinical outcomes for donors with and without early guideline-concordant care, defined as annual physician visit and serum creatinine and albuminuria measurement for the first 2 years post-donation.</p><p><strong>Results: </strong>Of the 460 donors included in this study, 187 (41%) had clinical and laboratory evidence of guideline-concordant follow-up care throughout the first 2 years post-donation. The odds of receiving annual follow-up for donors without early guideline-concordant care were 76% lower at 5 years (aOR _0.180.24_0.32) and 68% lower at 10 years (aOR _0.230.32_0.46) compared with donors with early care. The odds of continuing follow-up remained stable over time for both groups. Early guideline-concordant follow-up care did not appear to substantially influence eGFR or hospitalization rates over the longer term.</p><p><strong>Limitations: </strong>We were unable to confirm whether the lack of physician visits or laboratory data in certain donors was due to physician or patient decisions.</p><p><strong>Conclusions: </strong>Although policies directed toward improving early donor follow-up may encourage continued follow-up, additional strategies may be necessary to mitigate long-term donor risks.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cf/23/10.1177_20543581231158067.PMC9983079.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10849430","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":"Risk Factors of AKI in Acute Respiratory Distress Syndrome: A Time-Dependent Competing Risk Analysis on Severe COVID-19 Patients.","authors":"Antoine Marchiset,&nbsp;Valerie Serazin,&nbsp;Omar Ben Hadj Salem,&nbsp;Claire Pichereau,&nbsp;Lionel Lima Da Silva,&nbsp;Siu-Ming Au,&nbsp;Christophe Barbier,&nbsp;Yann Loubieres,&nbsp;Jan Hayon,&nbsp;Julia Gross,&nbsp;Herve Outin,&nbsp;Matthieu Jamme","doi":"10.1177/20543581221145073","DOIUrl":"https://doi.org/10.1177/20543581221145073","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) is frequently observed in patients with COVID-19 admitted to intensive care units (ICUs). Observational studies suggest that cardiovascular comorbidities and mechanical ventilation (MV) are the most important risk factors for AKI. However, no studies have investigated the renal impact of longitudinal covariates such as drug treatments, biological variations, and/or MV parameters.</p><p><strong>Methods: </strong>We performed a monocentric, prospective, longitudinal analysis to identify the dynamic risk factors for AKI in ICU patients with severe COVID-19.</p><p><strong>Results: </strong>Seventy-seven patients were included in our study (median age: 63 [interquartile range, IQR: 53-73] years; 58 (75%) men). Acute kidney injury was detected in 28 (36.3%) patients and occurred at a median time of 3 [IQR: 2-6] days after ICU admission. Multivariate Cox cause-specific time-dependent analysis identified a history of hypertension (cause-specific hazard (CSH) = 2.46 [95% confidence interval, CI: 1.04-5.84]; <i>P</i> = .04), a high hemodynamic Sequential Organ Failure Assessment score (CSH = 1.63 [95% CI: 1.23-2.16]; <i>P</i> < .001), and elevated Paco₂ (CSH = 1.2 [95%CI: 1.04-1.39] per 5 mm Hg increase in Pco₂; <i>P</i> = .02) as independent risk factors for AKI. Concerning the MV parameters, positive end-expiratory pressure (CSH = 1.11 [95% CI: 1.01-1.23] per 1 cm H₂O increase; <i>P</i> = .04) and the use of neuromuscular blockade (CSH = 2.96 [95% CI: 1.22-7.18]; <i>P</i> = .02) were associated with renal outcome only in univariate analysis but not after adjustment.</p><p><strong>Conclusion: </strong>Acute kidney injury is frequent in patients with severe COVID-19 and is associated with a history of hypertension, the presence of hemodynamic failure, and increased Pco₂. Further studies are necessary to evaluate the impact of hypercapnia on increasing the effects of ischemia, particularly in the most at-risk vascular situations.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/07/87/10.1177_20543581221145073.PMC9834615.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10540464","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}