Unspecified Kidney Research Articles

Understanding barriers and outcomes of unspecified (non-directed altruistic) kidney donation from both professional’s and patient’s perspectives: research protocol for a national multicentre mixed-methods prospective cohort study

IntroductionLiving donation accounts for over one-third of all kidney transplants taking place in the UK.1 The concept of anonymously donating a kidney to a stranger (non-directed altruistic or unspecified kidney...

Accuracy of kidney cancer diagnosis and histological subtype within cancer registry data.

606 Background: Cancer registries are the mainstay for population-based cancer statistics including incidence and cancer type. In Canada, each province captures this data in provincial registries including the Nova Scotia Cancer Registry (NSCR).The goal of this study was to describe data from the NSCR about method of diagnosis and kidney cancer (KC) pathology and compare it to the actual pathology reports to determine the accuracy of diagnosis and histological subtype assignment. Methods: This retrospective analysis included patients with KC in the NSCR with an ICD-10-CM code C64.9 (malignant neoplasm of unspecified kidney, except renal pelvis) within the largest provincial metropolitan area from 2006-2010. Method of KC diagnosis (clinical, radiologic, histology, or autopsy) was recorded as was the pathological diagnosis based on WHO classification. All non-clear cell KC (nonccKC) diagnosis from the registry were compared to the actual pathology report (and pathology re-review when necessary) for comparison. Results: 733 pts make up the study cohort. 81.2% of patients were diagnosed based on nephrectomy, 11.5% on radiography, 6.5 % biopsy, and 0.8% autopsy. By registry data 53.1% had clear cell, 20.2% KC not otherwise specified (NOS), 12.7% papillary, 3.8% chromophobe, and many other nonccKC. By pathology reports, 62.2% had clear cell, 13.4% papillary, 4.4% chromophobe, only 2% KC NOS (because most radiological diagnosis were classified this way). A large number of pathological diagnoses make up the other nonccKC and discrepancies between registry data and pathology reports will be described and compared in detail. Conclusions: Registry data is commonly used to report cancer statistics. Registry data may not be accurate for the true incidence of KC since 11.5% were based on radiology alone. Clear cell KC made up 53% of registry diagnosis but 62% on pathology report review. Although papillary and chromophobe incidence did not vary a lot, other types of nonccKC did. This registry data did not differentiate between papillary type I and II. NonccKC should not be considered one entity. One must be aware of the gaps in registry data for KC statistics including overall diagnosis, clear cell and nonccKC subtypes.

Seriously ill patients as living unspecified kidney donors: rationale and justification.

Between 2000 and December 2013, 106 live donor nephrectomies from anonymous living-donors were performed at the Erasmus MC Rotterdam; five of the donors (5.4%) had a life-threatening disease. The aim of the present report is to give the rational and justification for this procedure. All five donors underwent the national standard living-donor screening procedure. Additionally, motivation to donate and psychologic stability were assessed by a psychologist using in-depth interview techniques and a psychologic complaints questionnaire. Post-donor nephrectomy follow-up consisted of standard questionnaires and clinical check-ups. One patient had cerebral and caudal ependymomas, one had severe and progressive emphysema, two had Huntington's disease and one had a grade 2 oligodendroglioma. The psychologic screening revealed genuine motivation, adequate risk perception, and normal sense of reality. No contraindications for donation were found. The five donor nephrectomies made nine kidney transplantations possible. All donors were satisfied with the donation procedure. Three donors died during follow-up (0.6-4.9 years) as a result of their disease. In the absence of apparent additional health risks, medical, and psychologic contraindications, we consider it ethically justified to accept an offer from a cognitively competent patient with a life-threatening disease in view of their self-reported satisfaction during follow-up. Although based on a limited number of patients, we conclude that a stricter psychologic screening for seriously ill donors compared to healthy unspecified anonymous donors to unspecified patients is not necessary.

Motivations, outcomes, and characteristics of unspecified (nondirected altruistic) kidney donors in the United Kingdom.

Unspecified (nondirected altruistic) kidney donation is becoming increasingly common in the United Kingdom. Questions regarding motivation and characteristics of these donors persist, alongside concerns about regret and long-term psychosocial outcomes. The aims of this study were to compare psychosocial and physical outcomes in unspecified kidney donors (UKDs) versus specified kidney donors (SKDs). We performed a cross-sectional study, in which a detailed assessment of psychosocial outcomes was made using validated questionnaires. Additional questions specific to donation were also asked, including questions regarding motivation, regret, and anonymity. One hundred ninety responses were received from 296 participants studied (110 UKDs [74.3%] vs. 80 SKDs [54.1%], P<0.001). Unspecified kidney donors were older (54 years vs. 44 years; P<0.001), predominantly white (99.1% vs. 78.5%; P<0.001), and donated more recently (1.3 years vs. 2.6 years; P<0.001). There was no difference in psychiatric history or personality type, or current depression, anxiety, stress, self-esteem, or well-being between the groups (P>0.05). Unspecified kidney donors were more engaged in other altruistic behaviours (P<0.001). There was no difference in physical outcomes, although UKDs recovered quicker (P<0.001). Regret was low (3.7% UKDs vs. 7.5% SKDs; P=0.078). This study has demonstrated that UKDs have comparable physical and psychosocial outcomes to SKDs. These favorable outcomes may be, in part, because of the rigorous evaluation process which currently includes a mental health assessment. We conclude that the program can continue to expand safely across the United Kingdom.

Familial Risks of Kidney Failure in Sweden: A Nationwide Family Study

BackgroundThe value of family history as a risk factor for kidney failure has not been determined in a nationwide setting.AimThis nationwide family study aimed to determine familial risks for kidney failure in Sweden.MethodsThe Swedish multi-generation register on 0–78-year-old subjects were linked to the Swedish patient register and the Cause of death register for 1987–2010. Individuals diagnosed with acute kidney failure (n = 10063), chronic kidney failure (n = 18668), or unspecified kidney failure (n = 3731) were included. Kidney failure patients with cystic kidney disease, congenital kidney and urinary tract malformations, urolithiasis, and rare inherited kidney syndromes, and hyperoxaluria were excluded. Standardized incidence ratios (SIRs) were calculated for individuals whose parents/siblings were diagnosed with kidney failure compared to those whose parents or siblings were not.ResultsThe concordant (same disease) familial risks (sibling/parent history) were increased for chronic kidney failure SIR = 2.02 (95% confidence interval, CI 1.90–2.14) but not for acute kidney failure SIR = 1.08 (95% CI 0.94–1.22) and for unspecified kidney failure SIR = 1.25 (95% CI 0.94–1.63). However, the discordant (different disease) familial risk for acute kidney failure SIR = 1.19 (95% CI 1.06–1.32) and unspecified kidney failure SIR = 1.63 (95% CI 1.40–1.90) was significantly increased in individuals with a family history of chronic kidney failure. The familial risk for chronic kidney failure was similar for males SIR = 2.04 (95% CI 1.90–2.20) and females SIR = 1.97 (95% CI 1.78–2.17). Familial risks for chronic kidney failure were highest at age of 10–19 years SIR = 6.33 (95% CI 4.16–9.22).ConclusionsThe present study shows that family history is an important risk factor for chronic kidney failure but to a lower degree for acute kidney failure and unspecified kidney failure.

Unspecified Live Kidney Donation By Urological Patients.

Introduction: Unspecified live kidney donations (anonymous donations) have been successfully implemented in our live donor kidney transplantation (KT) program. Amongst them were patients referred to us by urologists. They were diagnosed with a urological condition for which a nephrectomy was indicated as treatment, but renal function was not impaired. As autotransplantation has a considerable risk of complications, and has no benefit for patients with normal renal function, unspecified kidney donation can be considered. Methods: We retrospectively searched all clinical data of our live kidney donation program from 1994-2013. We identified all unspecified kidney donors and their recipients (n=93). Among those, six were referred to us as potential donors with pre-existing urological disorders requiring nephrectomy. They all underwent state of the art donor screening. We examined the clinical course of these donors and outcome in the recipients. Results: Of 6 patients, 5 had an indication for nephrectomy because of therapy-resistant loin pain and 1 insisted on a nephrectomy, after iatrogenic ureter injury during a leiomyoma resection. Of the 5 patients treated for loin pain, 1 previously had an infarction of a small part of the kidney, 1 had persistent pain after stone extraction. All laparoscopic donor nephrectomies were performed without major complications (median hospital stay 4 days) and all patients treated for pain were free of complaints after surgery (median follow up 20 months). Six unspecified donors enabled 8 KTs (2 domino-paired). In the recipients, there was one early death due to cardiac arrest, in a patient with pre-existent cardiac failure. All remaining recipients but one had excellent graft function with a mean follow up of 6 years. Discussion: There is no published data on transplanting kidneys from live donors with urological complications. Obviously, these potential unspecified donors should meet all criteria for live kidney donation. Our data show that when nephrectomy is indicated as treatment for selected urological conditions, the kidney can be donated anonymously, with excellent results in both donors and recipients.

Seriously Ill Patients as Living Unspecified Kidney Donors.

Background From 2000-2014, 106 kidney donor nephrectomies from unspecified donors were performed at our center which resulted in 178 kidney transplants by performing domino paired procedures. Five of these donors (4,7 %) had a life-threatening disease. Methods All five donors underwent the hospital's standard pre-transplantation donor screening procedure. Additionally, motivation to donate and psychological stability were assessed by a psychologist using in depth interview techniques and a psychological complaints questionnaire. Post donor nephrectomy follow-up consisted of self-report questionnaires and hospital visits. Results One patient had cerebral and caudal ependymomas, one had severe and progressive emphysema, two had Huntington's disease and one had a grade 2 oligodendroglioma. The psychological screening revealed genuine motivation, adequate risk perception, and normal sense of reality. The five donor nephrectomies made 9 kidney transplantations possible. All donors were satisfied with the donation procedure. Three donors died during follow-up as a result of their disease. Conclusion Patients with a life-threatening disease may have a genuine motivation to become an unspecified living kidney donor. In the absence of medical and psychological contra-indications and in view of their self-reported satisfaction with the donation we feel it ethically justified to accept their offer.

Spatial distribution of unspecified chronic kidney disease in El Salvador by crop area cultivated and ambient temperature.

Chronic kidney disease of unknown etiology is occurring in various geographic areas worldwide. Cases lack typical risk factors associated with chronic kidney disease, such as diabetes and hypertension. It is epidemic in El Salvador, Central America, where it is diagnosed with increasing frequency in young, otherwise-healthy male farmworkers. Suspected causes include agrochemical use (especially in sugarcane fields), physical heat stress, and heavy metal exposure. To evaluate the geographic relationship between unspecified chronic kidney disease (unCKD) and nondiabetic chronic renal failure (ndESRD) hospital admissions in El Salvador with the proximity to cultivated crops and ambient temperatures. Data on unCKD and ndESRD were compared with environmental variables, crop area cultivated (indicator of agrochemical use) and high ambient temperatures. Using geographically weighted regression analysis, two model sets were created using reported municipal hospital admission rates are per thousand population for unCKD 2006-2010 and rates of ndESRD 2005-2010 [corrected]. These were assessed against local percent of land cultivated by crop (sugarcane, coffee, corn, cotton, sorghum, and beans) and mean maximum ambient temperature, with Moran's indices determining data clustering. Two-dimensional geographic models illustrated parameter spatial distribution. Bivariate geographically weighted regressions showed statistically significant correlations between percent area of sugarcane, corn, cotton, coffee, and bean cultivation, as well as mean maximum ambient temperature with both unCKD and ndESRD hospital admission rates. Percent area of sugarcane cultivation had greatest statistical weight (p ≤ 0.001; Rp2 = 0.77 for unCKD). The most statistically significant multivariate geographically weighted regression model for unCKD included percent area of sugarcane, cotton and corn cultivation (p ≤ 0.001; Rp2 = 0.80), while, for ndESRD, it included the percent area of sugarcane, corn, cotton and coffee cultivation (Rp2 = 0.52). Univariate unCKD and ndESRD Moran's I (0.20 and 0.33, respectively) indicated some degree of clustering. Ambient temperature did not improve multivariate geographically-weighted regression models for unCKD or ndESRD. Local bivariate Moran's indices with relatively high positive values and statistical significance (0.3-1.0, p ≤0.05) indicated positive clustering between unCKD hospital admission rates and percent area of sugarcane as well as cotton cultivation. The greatest positive response for clustering values did not consistently plot near the highest temperatures; there were some positive clusters in regions of lower temperatures. Clusters of ndESRD were also observed, some in areas of relatively low chronic kidney disease incidence in western El Salvador. High temperatures do not appear to strongly influence occurrence of unCKDu proxies. CKDu in El Salvador may arise from proximity to agriculture to which agrochemicals are applied, especially in sugarcane cultivation. The findings of this preliminary ecological study suggest that more research is needed to assess and quantify presence of specific agrochemicals in high-CKDu areas.

Unspecified Kidney Donation—A Review of Principles, Practice and Potential

Unspecified kidney donation is an emerging resource to bridge the gap between supply and demand of kidneys for transplantation. However, uncertainty remains among both the transplantation community and lay public with regard to the intention, motivation, and legitimacy of such donors. Even within programs that use unspecified kidney donors, there is a lack of consensus regarding how to optimize the potential of the gifted kidney (and indirectly potentiate the altruistic benefit for the donor). Despite emerging guidance on how to work up unspecified donors, centers have adopted individualized unspecified donor pathways with regards to assessment, evaluation, and use. There are a variety of models for unspecified kidney donation, ranging from donation directly to deceased-donor waiting lists to benefit one recipient or chain transplantations occurring simultaneously (domino-paired donation) or nonsimultaneously (extended altruistic donor chains) to benefit many. After a brief exploration on the basis of altruism, this review will discuss the assessment, evaluation, and reported outcomes associated with unspecified kidney donation. It will also critique current utilization models and highlight some unresolved controversies. The aim is to highlight the principles, practice, and potential of unspecified kidney donation to bridge the current disparate international practice.

Understanding donation experiences of unspecified (altruistic) kidney donors

Kidney donation from a living donor to an unknown recipient has been legal in the UK since 2006. Yet there is little research into the experiences of unspecified kidney donors (UKDs) in interaction with the health care systems. This article explores the experiences of 14 UKDs recruited through four regional transplant co-ordinating centres in England. At interview, they were invited to share their donation stories and discuss the antecedents, social, and psychological processes involved. Interviews were audio-taped and transcribed. Transcripts were analysed using a grounded theory approach employing a constant comparison methodology. Themes emerging from the data were named to form categories organized around the central focus of the research, forming an analytical story of UKDs' experiences. Two major categories emerged: 'connected to others' and 'uneasy negotiations with others'. 'Connected to others' encompasses the motivations and psychological and social consequences of UKD. 'Uneasy negotiations with others' refer to the concerns and conflicts that arose during the donation process. This study highlights the importance of social relationships on the process and outcomes of UKD. These UKDs report both intra- and interpersonal benefits from donation. The donation process, however, also created interpersonal stress, and conflicting messages about the acceptability of their donation were experienced in UKDs' personal lives and in their interactions with health care services. Findings are discussed with reference to the wider literature on UKD and altruism and in relation to implications for clinical practice. What is already known on this subject? Unspecified living kidney donation is an under-researched area with only three research papers published worldwide that report on the motivations and experiences of donors. These studies indicate that donors endorse pro-social values and receive positive interpersonal and intrapersonal benefits from donation. What does this study add? UKDs' experiences are made explicit and provide a framework for future research. Social connections (capital) are an important precursor to and outcome from donation. Assumptions of pathological motivations were encountered by donors in their personal life and within the NHS.

Occupational risk factors for kidney cancer: a cohort study in Sweden

Although many studies have examined the associations between occupational exposures and kidney cancer, the evidence is not consistent. To examine the risk of occupational exposures on kidney cancer, we carried out a follow-up study on the economically active Swedish population, based on the latest update of the Swedish Family-Cancer Database. We calculated standardized incidence ratios (SIR) and 95% confidence intervals (CIs) for different occupational groups, adjusted for age, period, and socioeconomic status. The reference group was all the economically active population. An increased risk of renal parenchymal cancer was observed for miners and quarry workers, drivers, sales agents, transport workers, and public safety and protection workers among men, and launderers and dry cleaners among women. Significantly increased SIRs of renal pelvical cancer were also observed for the food manufacture workers among men, and journalists and shoe and leather industry workers among women. Male forestry workers, smelters, and metal foundry workers had increased risk for unspecified kidney cancer. Although smoking may explain some of these results, exposure to gasoline, diesel, their exposure products, some metal and chemicals in shoe and leather works, and dry-cleaning products may be associated with kidney cancer.

Pre-operative screening: criteria for referring to anaesthetists.

Nurses assess patients pre-operatively using screening questionnaires and locally-developed protocols. Our objectives were to determine which questions might identify patients who should be seen by an anaesthetist before the day of surgery. A review of the literature and a preliminary questionnaire to establish questions to be tested was followed by a modified, two-round Delphi questionnaire to determine the level of agreement by anaesthetists. There was agreement for referring patients who gave a positive response to questions that query: restricted exercise tolerance; previous anaesthetic problems; family history of anaesthetic problem; pathology affecting neck movement; angina; arrhythmia; heart failure; asthma; epilepsy; insulin-dependent diabetes mellitus; liver disease and unspecified kidney disease. There was equivocal agreement on questions that report a myocardial infarction over one year ago, cerebrovascular accident, non insulin-dependent diabetes mellitus and thyroid disease. Nurses should use these criteria during pre-operative assessment to decide the timing of evaluation by an anaesthetist.

Fatal Cutaneous and Visceral Infection in a Rottweiler Dog Associated with a Sarcocystis-Like Protozoon

A 10-month-old male Rottweiler dog from Ottawa, Illinois, had persistent diarrhea for 2 months. After the diarrhea stopped, the dog developed multiple cutaneous abscesses all over its body, particularly in the hind limbs. The limbs were swollen, hot, and painful. A skin biopsy was fixed in 10% formalin solution. The dog died, and the carcass was frozen until necropsy. No other history was available. Portions of liver, unspecified lymph node, lungs, kidney, and skin from the frozen-thawed carcass were fixed in 10% formalin solution. Paraffin-embedded sections of tissues were cut at 5 pm and stained with hematoxylin and eosin (HE). Paraffin-embedded sections from the biopsy specimens of skin were deparaffinized and reacted with Toxoplasma gondii antiserum and Neospora caninum antiserum with an avidinbiotin complex (ABC) immunohistochemical staining method? To further identify the protozoon, biopsy specimens of skin were deparaffinized and processed for transmission electronmicroscopy. Severe necrotizing fibrinosuppurative dermatitis was evident in the sections of skin (Figs. 1, 2). Numerous neutrophils, fewer eosinophils and macrophages, and abundant edema and fibrin expanded extensive areas of deep dermis and occasionally extended into superficial dermis and subcutaneous fat. Multifocal areas of dermal connective tissue and rare hair follicles were necrotic. Capillaries and venules were markedly congested. Many of them contained fibrin thrombi, and the walls of some were disrupted and infiltrated by neutrophils. Hemorrhage had occurred in some areas. A focally extensive area of epidermal necrosis and ulceration overlain by a fibrinohemorrhagic crust was present. A 1-cm-diameter focus of necrosis and fibrinosuppurative inflammation was present in the lung. Alveolar septa in this area were necrotic. Numerous neutrophils, fewer macrophages, and abundant fibrin filled alveoli and expanded re-