Kidney Dis Research Articles

The Long-Term Follow-up and Support for Living Organ Donors: A Center-Based Initiative Founded on Developing a Community of Living Donors.

Transplant professionals recognize that the long-term follow-up of living organ donors is a priority, yet there has been no implemented solution to this problem. This critical gap is essential, because the transplant field is now emphasizing living donation as a means to address the organ shortage. We detail our living donor initiative, which sets several priorities we recognize as fundamental to persons who have donated organs at our transplant center. This intervention attempts to mitigate the donor and center factors that are known to contribute to the lack of long-term follow-up. Beyond that, our goals are aimed at providing ongoing engagement, wellness, clinical data accrual, laboratory follow-up, and social support for our living donors, in continuity. Our ultimate goal is to nurture the development of local living donor community networks by providing social engagement for current and past donors, which also serves as a platform for greater population education on the societal importance of living donation. This initiative is based on joint recognition by our transplant team and our hospital leadership that supporting the long-term welfare of living donors is essential to accomplishing the goal of expanding living donor transplantation. The transplant team and hospital missions are aligned, and both contribute resources to the initiative.

AIUM Practice Parameter for the Performance of Ultrasound Vascular Mapping for Preoperative Planning of Dialysis Access

AIUM Practice Parameter for the Performance of Ultrasound Vascular Mapping for Preoperative Planning of Dialysis Access

Elevated fibroblast growth factor-23 and risk of cardiovascular disease or mortality in the general population: A meta-analysis

Elevated fibroblast growth factor-23 and risk of cardiovascular disease or mortality in the general population: A meta-analysis

Retraction Notice to "Kidney Function and Rate of Bone Loss at the Hip and Spine: The Canadian Multicentre Osteoporosis Study" [Am J Kidney Dis. 55(2):291-299

Retraction Notice to "Kidney Function and Rate of Bone Loss at the Hip and Spine: The Canadian Multicentre Osteoporosis Study" [Am J Kidney Dis. 55(2):291-299

Anti-LG3 Antibodies Aggravate Renal Ischemia-Reperfusion Injury and Long-Term Renal Allograft Dysfunction.

Pretransplant autoantibodies to LG3 and angiotensin II type 1 receptors (AT1R) are associated with acute rejection in kidney transplant recipients, whereas antivimentin autoantibodies participate in heart transplant rejection. Ischemia-reperfusion injury (IRI) can modify self-antigenic targets. We hypothesized that ischemia-reperfusion creates permissive conditions for autoantibodies to interact with their antigenic targets and leads to enhanced renal damage and dysfunction. In 172 kidney transplant recipients, we found that pretransplant anti-LG3 antibodies were associated with an increased risk of delayed graft function (DGF). Pretransplant anti-LG3 antibodies are inversely associated with graft function at 1 year after transplantation in patients who experienced DGF, independent of rejection. Pretransplant anti-AT1R and antivimentin were not associated with DGF or its functional outcome. In a model of renal IRI in mice, passive transfer of anti-LG3 IgG led to enhanced dysfunction and microvascular injury compared with passive transfer with control IgG. Passive transfer of anti-LG3 antibodies also favored intrarenal microvascular complement activation, microvascular rarefaction and fibrosis after IRI. Our results suggest that anti-LG3 antibodies are novel aggravating factors for renal IRI. These results provide novel insights into the pathways that modulate the severity of renal injury at the time of transplantation and their impact on long-term outcomes.

Chronic kidney disease from screening, detection, and awareness, to prevention.

Chronic kidney disease from screening, detection, and awareness, to prevention.

Oral Anticoagulants and Renal Impairment: The Convoluting Dilemma

Oral Anticoagulants and Renal Impairment: The Convoluting Dilemma

Measuring residual renal function in dialysis patients: can we dispense with 24-hour urine collections?

Residual renal function is associated with improved survival and quality of life for dialysis patients. Whereas residual renal function is monitored in peritoneal dialysis patients, many hemodialysis centers simply concentrate on achieving dialyzer urea clearance targets. Accurately quantifying residual renal function from urine collections is arduous. Thus, there is a clinical need to develop alternative methods of assessing residual renal function based on serum testing, especially for patients receiving less than thrice weekly dialysis.

Timing of Pregnancy After Kidney Transplantation and Risk of Allograft Failure.

The optimal timing of pregnancy after kidney transplantation remains uncertain. We determined the risk of allograft failure among women who became pregnant within the first 3 posttransplant years. Among 21 814 women aged 15-45 years who received a first kidney-only transplant between 1990 and 2010 captured in the United States Renal Data System, n = 729 pregnancies were identified using Medicare claims. The probability of allograft failure from any cause including death (ACGL) at 1, 3, and 5 years after pregnancy was 9.6%, 25.9%, and 36.6%. In multivariate analyses, pregnancy in the first posttransplant year was associated with an increased risk of ACGL (hazard ratio [HR]: 1.18; 95% confidence interval [CI] 1.00, 1.40) and death censored graft loss (DCGL) (HR:1.25; 95% CI 1.04, 1.50), while pregnancy in the second posttransplant year was associated with an increased risk of DCGL (HR: 1.26; 95% CI 1.06, 1.50). Pregnancy in the third posttransplant year was not associated with an increased risk of ACGL or DCGL. These findings demonstrate a higher incidence of allograft failure after pregnancy than previously reported and that the increased risk of allograft failure extends to pregnancies in the second posttransplant year.

Characterization of mRNA Expression in Mouse Renal Vasculature and Glomerulus Using Laser Capture Microdissection

The Centers for Disease Control and Prevention estimated that 29.1 million people, or 9.3% of the population, in the United States had diabetes in 2012. Diabetic nephropathy, one form of kidney disease, accounted for 44% of the new cases of kidney disease in the United States in 2011. The relationship between diabetes and the development of nephropathy is complex and not fully understood. Understanding the underlying molecular changes that occur in a diabetic kidney is vital in understanding the pathogenesis of diabetic nephropathy. Alterations in both renal vascular function and glomerular filtration in diabetic patients have been shown previously, but a protocol to examine the molecular changes that occur specifically at the glomerulus and renal vasculature has not been well established. The aim of this study was to establish a protocol that allows for the investigation of changes in gene expression of factors involved in glomerular filtration. We specifically looked at elucidating a method for studying gene expression of renal vasculature smooth muscle and glomeruli podocyte. The developed protocol was centered upon collected high quality RNA from structure specific regions in the kidney. Our protocol begins with tissue collection. Left and right kidneys were collected from a male C57BL/6 mouse (Charles River Laboratories) and embedded in Optimal Cutting Temperature Compound (Sakura). The tissue was sectioned by cryostat into 10μm sagittal sections. The tissue sections were placed onto polyethylene naphthalate membrane slide (Zeiss) and immediately placed into −20°C‐cold acetone for 2 min. The slide is then transferred into a fresh aliquot of cold acetone for an additional 2 min. Following the acetone fixation, the slide is air dried for 5 min. The tissue then undergoes staining using 1% cresyl violet acetate prepared in 75% ethanol in diethylpyrocarbonate treated H2O. The staining procedure involves rehydrating the tissue in serial dilutions of ethanol prior to staining with the 1% cresyl violet acetate solution. After staining, the tissue is dehydrated in increasing concentrations of ethanol, followed by clearing in xylene. The stained tissue is allowed to air dry for at least 15 minutes before beginning laser capture microdissection. Laser capture microdissection was performed using the Zeiss PALM Microbeam system. Cells of interest, either renal vasculature or glomeruli, were dissected and collected into AdhesiveCap 200 clear tubes (Zeiss). The target amount of tissue area collected was between 75,000–100,000 μm2. RNA collection was performed using RNeasy Micro Kit (Qiagen) and quantification was performed using NanoDrop 2000 (Thermo Scientific). cDNA was synthesized using Superscript III reverse transcriptase (Invitrogen) and Oligo‐dT primers (Invitrogen). PCR was performed using Platinum Taq DNA Polymerase (Invitrogen). Primers for the housekeeping gene ribosomal protein S15 (S15, 361 base pairs (bp)), alpha 2 smooth muscle actin (α‐SMA, 538 bp) gene, and Wilms Tumor 1 (WT‐1, 107 bp) gene, as vascular smooth muscle and glomeruli markers, respectively. The PCR products were run on 2% agarose gel at 100V for 60 min. The results showed expression of all three genes in the respective tissue types and determined our protocol is robust for determination of gene expression in mouse renal vasculature and glomeruli. This protocol can be applied in the study of gene expression in the diabetic kidney to understand the development of diabetic nephropathy.Support or Funding InformationThe National Institutes of Health grants R01DK085031 and R25DK098104

Quiz Page March 2016: A 60-Year-Old Man With Fever, Night Sweats, and Acute Kidney Injury

Quiz Page March 2016: A 60-Year-Old Man With Fever, Night Sweats, and Acute Kidney Injury

New Medications for the Treatment of Diabetes

New Medications for the Treatment of Diabetes

Chronic kidney disease and atrial fibrillation as components of the cardiorenal continuum

The paper discusses the present-day idea on a relationship between atrial fibrillation and chronic kidney dis~ase, the specific features of therapeutic policy, and the place of antithrombotic therapy in particular."Based on the results of population-based studies,the authors set forth the specific features of cardiac arrhythmias concurrent with kidney injury, as well as promising directions to optimize management schemes for this category of patients.

Hemodialysis Facility Variation in Hospitalization and Transfusions Using Medicare Claims: The DOPPS Practice Monitor for US Dialysis Care

Hemodialysis Facility Variation in Hospitalization and Transfusions Using Medicare Claims: The DOPPS Practice Monitor for US Dialysis Care

Medical Nutrition Therapy for Chronic Kidney Disease in Pregnancy: A Case Report

Medical Nutrition Therapy for Chronic Kidney Disease in Pregnancy: A Case Report

Update on Peritoneal Dialysis: Core Curriculum 2016

Update on Peritoneal Dialysis: Core Curriculum 2016

The Authors Reply

We thank Dr Biblaki et al.1Biblaki D. Filopoulous V. Vlassopoulous D. Icodextrin skin rash incidence.Kidney Int. 2015; https://doi.org/10.1038/ki.2015.40Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar for their comments on our case of exfoliative dermatitis related to icodextrin.2Almiani M. Kohn O. Severe exfoliative skin rash with icodextrin.Kidney Int. 2014; 86: 449Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Indeed there is high variability in the reported incidence of icodextrin-related rash. The incidence of 10% quoted in our case report was based on a review of 840 patients (icodextrin 493, dextrose 347) from three randomized controlled studies.3Wolfson M. Orginc F. Mujais S. Review of clinical trial experience with icodextrin.Kidney Int. 2002; 62: S46-S52Abstract Full Text Full Text PDF Scopus (28) Google Scholar Whereas several publications have reported no rashes related to icodextrin,4Lin A. Qian J. Li X. et al.Randomized controlled trial of icodextrin versus glucose containing peritoneal dialysis fluid.Clin J Am Soc Nephrol. 2009; 4: 1799-1804Crossref PubMed Scopus (48) Google Scholar others have found an even higher incidence.5Wolfson M. Piraino B. Hamburger R.J. et al.A randomized controlled trial to evaluate the efficacy and safety of icodextrin in peritoneal dialysis.Am J Kidney Dis. 2002; 40: 1055-1065Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar High variability between studies on the reported incidence of rash is also noted in the control dextrose groups, from 1 to 11.6%.4Lin A. Qian J. Li X. et al.Randomized controlled trial of icodextrin versus glucose containing peritoneal dialysis fluid.Clin J Am Soc Nephrol. 2009; 4: 1799-1804Crossref PubMed Scopus (48) Google Scholar, 5Wolfson M. Piraino B. Hamburger R.J. et al.A randomized controlled trial to evaluate the efficacy and safety of icodextrin in peritoneal dialysis.Am J Kidney Dis. 2002; 40: 1055-1065Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar Factors accounting for variability are likely the reporting criteria and sample size, the genetic background of the study participants, and concomitant medications and exposures among others. Exfoliative dermatitis occurs in a minority of patients exposed to icodextrin, a fraction of those presenting with a rash, and has a strong temporal relationship to icodextrin exposure. It manifests early in the course of therapy and resolves within days of icodextrin discontinuation. The review by Cho et al.6Cho Y. Johnson D.W. Badve S. et al.Impact of icodextrin on clinical outcomes in peritoneal dialysis: a systematic review of randomized controlled trials.Nephrol Dial Transplant. 2013; 28: 1899-1907Crossref PubMed Scopus (66) Google Scholar excluded exfoliative dermatitis because of inconsistent reporting across trials.

Glomerular Diseases Dependent on Complement Activation, Including Atypical Hemolytic Uremic Syndrome, Membranoproliferative Glomerulonephritis, and C3 Glomerulopathy: Core Curriculum 2015

Complement is part of the innate immune system and plays a fundamental role in the clearance of immune complexes and cell debris. The main effector mechanisms of complement activation are induction of inflammatory response and phagocytosis and cell lysis. However, complement activation is a double-edged sword and has the potential to damage self-tissues. In order to avoid self-damage, there is an absolute need for strict control by fluid-phase and membrane-bound regulatory proteins. Thus, an underperforming regulatory system (due to either genetic or acquired abnormalities) can shift the balance between regulation and activation toward the latter and lead to tissue injury in response to otherwise innocuous stimuli. Deposition of both actived complement fragments from plasma in glomeruli and complement locally produced and activated in the kidney may contribute to many kidney disorders, including lupus nephritis, postinfectious glomerulonephritis, membranous nephropathy, antineutrophil cytoplasmic antibody vasculitis, and anti–glomerular basement membrane (anti-GBM) glomerulonephritis. Interest in the complement system has been boosted in the past 15 years by the discovery that rare devastating kidney diseases, including atypical hemolytic uremic syndrome (aHUS) and membranoproliferative glomerulonephritis (MPGN), are disorders of complement regulation. Additional Readings » Nangaku M. Complement regulatory proteins in glomerular diseases. Kidney Int. 1998;54(5):1419-1428. » Ricklin D, Hajishengallis G, Yang K, et al. Complement: a key system for immune surveillance and homeostasis. Nat Immunol. 2010;11(9):785-797. » Thurman JM. Complement in kidney disease: core curriculum 2015. Am J Kidney Dis. 2015;65(1):156-168. » Vieyra MB, Heeger PS. Novel aspects of complement in kidney injury. Kidney Int. 2010;77(6):495-499.

Water Treatment, Preventive Measures and the Chronic Kidney Disease in the Farming Community in Sri Lanka

Whilst being accountable for an increasing trend in mortality and morbidity, Chronic Kidney Dis¬ease of unknown aetiology (CKDu) has become a severe burden in Sri Lanka. Even though there is no sound evidence to clarify the aetiology of CKDu, it will be worthwhile to seek out the possible measures to minimize the prevalence of the disease. Hence, this study was intended to examine the impact of water treatment and preventive measures on CKDu. Data were collected from the farm¬ing community who applies agrochemicals. Both a probit and a Logit regression were carried out to check whether there is any relationship between CKDu and related variables such as consump¬tion of treated water and adopting safety precautions. Results reveal that age, being a male, using deep wells as a source of drinking water, and long term medication increases the probability of getting the disease while, both preventive measures and water treatment significantly reduce this probability. Therefore, ensuring an adequate supply of treated water, especially for the severely affected villages is vital. Furthermore, both government and non-government institutions should work responsibly to increase the awareness of CKDu and safety precautions, in order to save the future generation.The Journal of Agricultural Sciences, vol.10, No 2, May 2015, pp. 98-108

A First Description of Prune Belly Syndrome in Central Africa

Prune belly syndrome (PBS) is a rare congenital disease that was first described by Frohlich in 1839, and the name PBS was coined by Osler in 1901. PBS is characterized by deficient abdominal wall musculature, hypotonia, urinary tract dilatation, and bilateral intra-abdominal testes. PBS has been rarely reported in sub-Saharan Africa. The majority of pediatricians will rarely encounter a patient with PBS in their clinical practice. This article presents a case of a neonate seen in our institution (University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo) presenting with PBS.