2 Minute Medicine ® - Otolaryngology (E.N.T.)

1. Reduction in time-weighted glomerular filtration rate (GFR) decline was significantly greater in Nefecon versus placebo. 2. Majority of adverse events were mild-to-moderate in nature with no treatment-related deaths. Evidence Rating Level: 1 (Excellent) Study Rundown : IgA nephropathy is a chronic immune-mediated kidney disease with marked proteinuria. Nefecon, a novel, targeted-release form of budesonide, is designed to inhibit galactose-deficient IgA1 (gd-IgA1) within the gastrointestinal tract, although little is currently known...

1. A secondary  analysis of a randomized clinical trial found that when correcting for fluid balance, AKI was more commonly diagnosed in extremely premature neonates.  2. A diagnosis of fluid-corrected AKI resulted in a significantly higher risk of requiring mechanical ventilation, longer hospital stay, and bronchopulmonary dysplasia (BPD). Evidence Rating Level: 1 (Excellent) Acute kidney injury (AKI) is a common condition in premature neonates, particularly those of extremely low gestational age. The potential complications of AKI do not exist solely in the short term; AKI in neonates also increases the risk of future chronic kidney disease...

1. For patients newly initiated on lithium or valproate, the absolute risks of chronic kidney disease (CKD) progression or acute kidney injury (AKI) were low and similar. 2. Higher cumulative exposure to lithium was associated with greater risk of CKD progression compared to valproate. 3. Higher median lithium levels were associated with increased risk of AKI in a dose-response relationship. EvidEnce Rating Level: 2 (Good) Study Rundown:  Lithium is used in the treatment of bipolar disorder, but has always been associated with concerns of nephrotoxicity, although the pathophysiology is not well understood...

1. Progression-free and overall survival was comparable in both the intervention and control groups. 2. Serious adverse events were more common among patients taking a combination of atezolizumab-cabozantinib than cabozantinib-only. Evidence Rating Level: 1 (Excellent) Study Rundown: Immune checkpoint inhibitors are first-line therapy for patients with metastatic renal cell carcinoma (MRCC); however, optimal management for patients with disease progression following therapy remains unknown. This randomized controlled trial aimed to assess whether the addition of atezolizumab to cabozantinib could delay disease progression and improve survival in patients with MRCC refractory to immune checkpoint inhibitor treatment...

1. In this prospective cohort study, there was a limited association between acute kidney injury (AKI) and worsening kidney function in patients with chronic kidney disease (CKD). 2. There was no significant decrease in estimated glomerular filtration rate (eGFR) after a mild to moderate AKI in patients with CKD.  Evidence Rating Level: 1 (Excellent) Study Rundown: AKI is typically considered a significant risk factor for the progression of loss of kidney function. However, in prior studies that examined this association, there were many methodological limitations...

1. For patients with IgA nephropathy (IgAN), long-term use of hydroxychloroquine demonstrated antiproteinuric effects compared to corticosteroids at 24 months.  Evidence Rating Level : 3 (Average) IgAN is the most common form of primary glomerulonephritis, occurring in 1 in 100 people worldwide, and can lead to end-stage renal disease. No specific treatment currently exists for IgAN, but corticosteroids (CS) are widely used as supportive treatment to maintain renal function in patients, despite their significant side effects...

1. Median progression-free survival in zolbetuximab group was greater than in the placebo group (10.6 months vs. 8.7 months). 2. There were significantly more serious adverse events in the Zolbetuximab group with nausea, vomiting, and decreased appetite being the most common symptoms. Evidence Rating Level: 1 (Excellent) Study Rundown: First-line treatment for gastric and gastro-esophageal adenocarcinoma includes chemotherapy including folinic acid, fluorouracil, and oxaliplatin regimen (FOLFOX). Zolbetuximab is a monoclonal antibody targeting claudin-18 isoform 2 (CLDN18...

1. Patients in sparsentan group reported a 50% reduction in proteinuria compared to 15% in the irbesartan group at week 36. 2. Complete remission of proteinuria was significantly higher in the sparsentan group. Evidence Rating Level: 1 (Excellent) Study Rundown: IgA nephropathy is the most common cause of primary glomerulonephritis worldwide. Although renin-angiotensin blockers (ARBs), such as irbesartan, have been primarily used for treatment, some patients continue to have persistent proteinuria. Sparsentan, a novel single-molecule, angiotensin II receptor antagonist, may have improved efficacy in patients with refractory proteinuria although existing trials suggest mixed results...

1. In bacteremic patients with complicated UTI, a 10-day course of typical antibiotics or a 7-day course of IV beta-lactams or highly available antibiotics were statistically similar to 14-day courses when comparing 30-day reinfection and antibiotic-resistant infection rates. Evidence Rating Level: 2 (Good) Urinary tract infections (UTIs) are the most common bacterial infections worldwide. Complicated UTIs (cUTIs) occur in the setting of pre-existing structural or functional abnormalities of the urinary tract (or any male patient with UTI), and generally have poorer outcomes...

1. Intradialytic exercise for a minimum of 60 minutes during thrice weekly dialysis sessions improved survival rates in adult patients who are receiving hemodialysis (HD). Evidence Rating Level :1 (Excellent) Chronic kidney disease is becoming increasingly prevalent worldwide, leading to an exponential increase in the number of individuals experiencing kidney failure requiring kidney-replacement therapy (KRT), which is primarily achieved through hemodialysis. Patients undergoing HD experience high rates of morbidity, and a mortality rate 10-30 times higher than those with normal kidney function...

1. In this target emulation trial, parathyroidectomy did not affect long-term renal function in adults with primary hyperparathyroidism (PHPT). 2. Patients with parathyroidectomy had no difference in the estimated glomerular filtration rate (eGFR) decline compared to those without parathyroidectomy. Evidence Rating Level: 1 (Excellent) Study Rundown: The definitive treatment for PHPT is parathyroidectomy to remove one or more abnormal parathyroid glands. However, observation for disease progression is an alternative that can be considered in patients without apparent end-organ damage related to PHPT...

1. Among patients undergoing maintenance dialysis, nearly half of patients valued comfort-focused care over life-prolonging care if they were to become seriously ill. 2. Patients who valued comfort-focused care were modestly associated with a greater probability of engagement in advance care planning but still received intensive care at the end of life, similar to the patients who favoured longevity-focused care. Evidence Rating Level: 2 (Good) Study Rundown: Patients undergoing maintenance dialysis are more likely to receive intensive care and die in hospital compared to other populations with serious illnesses...

1. In vascular access intervention therapy (VAIVT) for hemodialysis patients, patient factors for vessel rupture include lower BMI, fewer prior VAIVT procedures, and shorter access vintage. 2. Hemodynamic risk factors for vessel rupture found on ultrasound imaging include lower blood flow quantity, higher resistance index, and lower brachial artery flow volume. Evidence Rating Level: 2 (Good) Vascular access for hemodialysis patients, including arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs), can have high failure rates due to thrombosis or stenosis, with 1-year patency rates of 86% and 51% for AVF and AVG respectively...

1. In preclinical studies, inaxaplin selectively inhibited apolipoprotein L1 (APOL1) in vitro and reduced proteinuria in a APOL1 G2-homologous transgenic mouse model of proteinuric kidney disease. 2. In a following phase 2a clinical study, 13 participants treated with inaxaplin had a significant reduction in urinary protein-to-creatinine ratio at week 13. Evidence Rating Level: 3 (Average) Study Rundown: The presence of two APOL1 variants confers a higher risk for proteinuric chronic kidney disease. These toxic gain-of-function variants may enhance APOL1 channel function leading to podocyte damage...

1. Fewer patients in the hyperfractionation group reported grade 3 or worse late radiation-induced complications compared to the standard fractionation group. 2. 3-year overall survival was significantly increased in the hyperfractionation group. Evidence Rating Level: 1 (Excellent) Study Rundown: Nasopharyngeal carcinoma has a high prevalence with an increased risk of relapse following radical radiotherapy. There is limited evidence surrounding the use of a safer means of radiotherapy delivery without compromising the total radiation dose...

1. This randomized control trial found that febuxostat has a reno-protective effect that can reduce the incidence of contrast-induced acute kidney injury in chronic kidney disease stage 3 patients undergoing percutaneous coronary intervention   Evidence Rating Level: 1 (Excellent) Contrast-induced acute kidney injury (CI-AKI) is considered the third most common cause of AKI in hospitalized patients. Percutaneous coronary intervention (PCI) increases the incidence of CI-AKI, which is already gradually increasing...

1. In this randomized controlled trial, among patients with recurrent kidney stones, hydrochlorothiazide did not alter the risk of symptomatic or radiographic stone recurrence. 2. Hydrochlorothiazide was associated with an increased risk of adverse events as compared to placebo. Evidence Rating Level: 1 (Excellent) Study Rundown: Kidney stones are a common medical condition. In many patients, these stones can be recurrent, resulting in significant distress, impaired quality of life, and healthcare burden. Calcium oxalate and calcium phosphate comprise the most common forms of kidney stones, and hypercalciuria is the most common metabolic disturbance predisposing patients to kidney stones...

1. Risk of major adverse cardiac events increased amongst patients with a specific glomerular disease, including non-proliferative glomerulopathy, renal vascular disease and diabetic nephropathy. 2. Specific pathologic characteristics, including mesangial expansion and arteriolar sclerosis, were associated with an increased risk of major adverse cardiac events or death. Level of Evidence Rating: 2 (Good) Study Rundown: Chronic kidney disease is a known risk factor for major adverse cardiac events, although the relationship between the cardiac-renal system is not fully understood...

1. Disease-free survival in the placebo group was 50.7 months and was never reached in the intervention group; however, there were no significant differences. 2. 38% of patients in the intervention group reported grade 3-5 adverse events versus 10% in the placebo group which led to a greater proportion of treatment discontinuations in the former. Evidence Rating Level: 1 (Excellent) Study Rundown: Nephrectomy is currently the standard of care for patients with localized renal cell carcinoma (RCC). However, despite resection of the tumor, up to 40% of patients are known to relapse...