End-stage kidney disease patient evaluation of the Australian 'My Kidneys, My Choice' decision aid
Conclusions
Preliminary MKDA assessment revealed high patient acceptance and usability. Patients had equitable knowledge of all treatment options but experienced higher post-worries levels than anticipated. (Source: CKJ: Clinical Kidney Journal)
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Fortnum, D., Grennan, K., Smolonogov, T. Tags: PATIENT EDUCATION Source Type: research
Performance of a brief survey to assess health literacy in patients receiving hemodialysis
Conclusions
The BHLS demonstrates evidence of construct validity among ESRD patients. Furthermore, health literacy was associated with kidney knowledge, supporting it as a potential intervention target to improve outcomes among patients with lower health literacy. (Source: CKJ: Clinical Kidney Journal)
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Cavanaugh, K. L., Osborn, C. Y., Tentori, F., Rothman, R. L., Ikizler, T. A., Wallston, K. A. Tags: PATIENT EDUCATION Source Type: research
Hydrochlorothiazide reduces urinary calcium excretion in a child with Lowe syndrome
There is a growing recognition that children with Lowe syndrome are at risk of nephrocalcinosis and nephrolithiasis from hypercalciuria. Increased fluid intake and correction of metabolic acidosis have remained the focus for intervention but are not always successful. Thiazide diuretics, which reduce urinary calcium excretion, have not been used in these children, due to concerns that (i) they may not work as a result of the underlying tubular abnormalities and (ii) their risk may outweigh the potential benefits they have to offer. Herein we report a child with Lowe syndrome who was successfully treated with thiazides in m...
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Butani, L. Tags: CALCIUM IN RARE DISEASE Source Type: research
The hypercalcaemia of CYP24A1 inactivation: new ways to improve diagnosis and treatment
This case report presents fluoconazole efficacy to reduce hypercalcaemia and increased urinary calcium excretion in a patient with nephrocalcinosis after a long history of recurrent renal stones caused by a loss-of-function mutation of the CYP24A1 gene. The CYP24A1 gene codes for a key enzyme in the vitamin D endocrine system that protects against vitamin D toxicity by degrading the circulating excess of both 1,25-dihydroxyvitamin D, the hormonal form of vitamin D, and its precursor, 25-hydroxyvitamin D. In order to expedite the identification of this rare disorder and improve therapies to avoid its progression to nephroca...
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Dusso, A. S., Gomez-Alonso, C., Cannata-Andia, J. B. Tags: CALCIUM IN RARE DISEASE Source Type: research
Successful treatment of hypercalcaemia associated with a CYP24A1 mutation with fluconazole
We present a case where this biochemical pattern was seen and mutations in CYP24A1 were confirmed. We were able to successfully control serum calcium levels and reduce urinary calcium excretion by treatment with low-dose fluconazole, which inhibits vitamin D-synthesizing enzymes (including 25-hydroxylases and 1-α-hydroxylase) thereby reducing levels of 1,25–dihydroxy vitamin D. (Source: CKJ: Clinical Kidney Journal)
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Sayers, J., Hynes, A. M., Srivastava, S., Dowen, F., Quinton, R., Datta, H. K., Sayer, J. A. Tags: CALCIUM IN RARE DISEASE Source Type: research
Timing of eculizumab therapy for C3 glomerulonephritis
Eculizumab is an anti-C5 antibody that inhibits C5 cleavage and prevents the generation of the terminal complement complex C5b-9. Eculizumab is licensed to treat paroxysmal nocturnal haemoglobinuria or atypical haemolytic uraemic syndrome (aHUS). Clinical trials are ongoing for C3 glomerulopathy. Given the unfamiliarity of physicians with these rare diseases and the variability of clinical presentation, a delayed initiation of eculizumab therapy is common. Thus, the question arises as to what extent improvement of kidney function may be expected when patients have been dialysis dependent for weeks or months already when ec...
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Rodriguez-Osorio, L., Ortiz, A. Tags: GLOMERULAR NEPHROPATHIES Source Type: research
Eculizumab-induced reversal of dialysis-dependent kidney failure from C3 glomerulonephritis
C3 glomerulopathy (C3G) is characterized by C3 deposits with minimal immunoglobulin deposition caused by alternative complement pathway dysregulation. Unfortunately, no therapeutic intervention has consistently improved outcomes for patients with C3G. Eculizumab, a monoclonal antibody to C5, is currently the only approved complement-specific agent with some efficacy in the treatment of C3 glomerulonephritis (C3GN). Here, we describe a patient with acute crescentic C3GN with no identified complement mutation or family history of renal disease who required dialysis for 6 months. Five months after initiation of eculizumab, sh...
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Inman, M., Prater, G., Fatima, H., Wallace, E. Tags: GLOMERULAR NEPHROPATHIES Source Type: research
Membranous nephropathy in autologous hematopoietic stem cell transplant: autologous graft-versus-host disease or autoimmunity induction?
With the increasing utility of hematopoietic stem cell transplantation (SCT) as a treatment for cancer and noncancerous disorders, more challenges and complications associated with SCT have emerged. Renal injury immediately after transplant is common and well understood, but long-term renal injury is becoming more evident. Chronic graft-versus-host disease (GVHD) is a known long-term complication of SCT, and membranous nephropathy (MN) is emerging as the most common cause of SCT-associated glomerular pathology. In this case report, we present a patient who developed features of anti-PLA2R antibody-negative MN following aut...
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Abudayyeh, A., Truong, L. D., Beck, L. H., Weber, D. M., Rezvani, K., Abdelrahim, M. Tags: GLOMERULAR NEPHROPATHIES Source Type: research
Glomerular IgG subclasses in idiopathic and malignancy-associated membranous nephropathy
Conclusions
We have found that the absence of glomerular IgG4 and PLA2R is common in patients with malignancy-associated MN. In our material, IgG2 could not be used as a marker of underlying malignant disease. Finally, neither IgG1 nor IgG3 seems to be involved in the pathogenesis of MN. (Source: CKJ: Clinical Kidney Journal)
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Lonnbro-Widgren, J., Ebefors, K., Molne, J., Nystrom, J., Haraldsson, B. Tags: GLOMERULAR NEPHROPATHIES Source Type: research
A review of the re-emergence of adrenocorticotrophic hormone therapy in glomerular disease, more than a drug of last resort?
We describe a patient with severe nephrosis and advanced chronic kidney disease with idiopathic membranous nephropathy resistant to conventional immunosuppressive therapies that achieved lasting remission with ACTH therapy. We explore the literature showing the extra renoprotective effects which might explain the response of proteinuric renal diseases to this treatment. (Source: CKJ: Clinical Kidney Journal)
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Goldsmith, C. J., Hammad, S. Tags: GLOMERULAR NEPHROPATHIES Source Type: research
Renovascular acute renal failure precipitated by extracorporeal shock wave lithotripsy for pancreatic stones
We describe the case of a 73-year-old woman with a solitary functioning kidney who presented an acute-onset anuria and renovascular renal failure the day after ESWL. We speculate that vascular calcifications in the area targeted by shock waves played a critical role in renal artery obstruction in the present case. (Source: CKJ: Clinical Kidney Journal)
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Cecere, N., Goffette, P., Deprez, P., Jadoul, M., Morelle, J. Tags: ACUTE KIDNEY INJURY Source Type: research
Proximal tubular dysfunction and kidney injury associated with tenofovir in HIV patients: a case series
Conclusions
Urinary phosphate wasting is a sensitive marker for TDF-induced proximal tubulopathy and is associated with unrecognized and permanent renal function decline. Tubular dysfunction can develop after years of TDF therapy in those with normal kidney function at the time of drug initiation. This suggests that continuing vigilance be maintained in all those on TDF. (Source: CKJ: Clinical Kidney Journal)
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Waheed, S., Attia, D., Estrella, M. M., Zafar, Y., Atta, M. G., Lucas, G. M., Fine, D. M. Tags: ACUTE KIDNEY INJURY Source Type: research
Acute kidney injury associated with androgenic steroids and nutritional supplements in bodybuilders
Four bodybuilders who injected anabolic steroids and ingested commercial protein (78–104 g/day) and creatine (15 g/day) products presented with serum creatinine levels between 229.84 and 335.92 µmol/L (2.6–3.8 mg/dL). Renal biopsies revealed acute tubular necrosis. Four weeks after discontinuing injections and supplements, serum creatinine was in the normal range and estimated glomerular filtration rate > 1.00 mL/s (60 mL/min), including two patients with biopsies showing >30% interstitial fibrosis and tubular atrophy. The findings highlight a risk for acute and potentially chronic kidney injury amo...
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Almukhtar, S. E., Abbas, A. A., Muhealdeen, D. N., Hughson, M. D. Tags: ACUTE KIDNEY INJURY Source Type: research
From the nephrologist's point of view: diversity of causes and clinical features of acute kidney injury
Acute kidney injury (AKI) is a clinical syndrome with multiple entities. Although AKI implies renal damage, functional impairment or both, diagnosis is solely based on the functional parameters of serum creatinine and urine output. The latest definition was provided by the Kidney Disease Improving Global Outcomes (KDIGO) working group in 2012. Independent of the underlying disease, and even in the case of full recovery, AKI is associated with an increased morbidity and mortality. Awareness of the patient's individual risk profile and the diversity of causes and clinical features of AKI is pivotal for optimization of prophy...
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Bienholz, A., Wilde, B., Kribben, A. Tags: ACUTE KIDNEY INJURY Source Type: research
Observation of microbubbles during standard dialysis treatments
Conclusions
Microbubbles are a general side effect of HD; origin and pathophysiologic consequences of this phenomenon are not well understood, and deserve further study. (Source: CKJ: Clinical Kidney Journal)
Source: CKJ: Clinical Kidney Journal - July 27, 2015 Category: Urology & Nephrology Authors: Wagner, S., Rode, C., Wojke, R., Canaud, B. Tags: HAEMODIALYSIS Source Type: research
