Nephrology, Dialysis, Transplantation

BACKGROUND: The diagnosis of antibody-mediated rejection (AMR) is reached using the Banff Classification for Allograft Pathology, which now includes gene expression analysis. In this study, we investigate the application of "Increased Expression Of Thoroughly Validated Gene Transcripts/Classifiers Strongly Associated With AMR" as a diagnostic criteria. METHOD: We used qRT-PCR for 10 genes associated with AMR in a retrospective cohort of 297 transplant biopsies, including biopsies that met the full diagnostic criteria for AMR, even without molecular data (AMR, n = 27); biopsies that showed features of AMR, but that would only meet criteria for AMR with increased transcripts (AMRsusp, n = 49) and biopsies that would never meet criteria for AMR (No-AMR, n = 221)...

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BACKGROUND: Current health-care models are ill-equipped for managing people with diabetes and chronic kidney disease (CKD). We evaluated the impact of a new diabetes and kidney disease service (DKS) on hospitalisation, mortality, clinical and patient relevant outcomes. METHODS: Longitudinal analyses of adult patients with diabetes and CKD (stages 3a to 5) were performed using outpatient and hospitalisation data from January 2015 to October 2018. Data was handled according to whether patients received the DKS intervention (n = 196) or standard care (n = 7511)...

BACKGROUND: Renal fibrosis is the strongest prognosis predictor of end-stage renal disease (ESRD) in chronic kidney disease (CKD). Diffusion kurtosis imaging (DKI) is a promising method of magnetic resonance imaging (MRI) successfully used to assess renal fibrosis in IgA nephropathy. This study first evaluated the long-term prognostic value of DKI in CKD patients. METHODS: Forty-two patients with CKD were prospectively enrolled, and underwent DKI on a clinical 3 T MR scanner...

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No abstract text is available yet for this article.

BACKGROUND AND OBJECTIVES: Whether mild to moderately low eGFR is associated with cognitive decline in older adults is not clear. We evaluated changes in cognition in relation to baseline eGFR in older adults participating in the Alzheimer's Disease Neuroimaging Initiative (ADNI). DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: This is a longitudinal secondary analysis of an established observational cohort. We used data from ADNI, an NIH funded, multicenter longitudinal observational study, which includes participants with and without cognitive impairment who were administered a comprehensive battery of neuropsychological tests every six months...

BACKGROUND: Fabry disease (FD), an X-linked lysosomal storage disorder caused by a deficiency in alfa-galactosidase A (α-Gal A) activity due to mutations in the GLA gene, has a prevalence of 0-1.69% in patients undergoing haemodialysis; however, its prevalence in patients with chronic kidney disease (CKD) Stages 1-5 is unknown. METHODS: Serum α-Gal A activity analysis and direct sequencing of GLA were used to screen for FD in 2122 male patients with CKD, including 1703 patients with CKD Stage 5D and 419 with CKD Stages 1-5...

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The overall diagnostic yield of massively parallel sequencing (MPS) based-tests in patients with chronic kidney disease (CKD) is around 30% for pediatric cases and 6-30% for adult cases. These figures should encourage nephrologists to frequently use genetic testing as a diagnostic means for their patients, but in reality several barriers appear to hinder the implementation of NGS diagnostics in routine clinical practice. In this paper, we aim to support the nephrologist to overcome these barriers. After a detailed discussion on the general items that are important to genetic testing in nephrology, namely (1) genetic testing modalities and their indications, (2) clinical information needed for high-quality interpretation of the genetic test, (3) clinical benefit of genetic testing and (4) genetic counselling, we will describe each of these items more specifically for the different groups of genetic kidney diseases and for CKD of unknown origin...

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Tertiary lymphoid tissues (TLTs) are inducible ectopic lymphoid tissues that develop at sites of chronic inflammation in non-lymphoid organs. Same as lymph nodes, TLTs initiate adaptive immune responses and coordinate local tissue immunity. Although virtually ignored for decades, TLTs have recently received a great deal of attention for their ability to influence disease severity, prognosis and response to therapy in various diseases including cancer, autoimmune disorders and infections. TLTs are also induced in kidneys of patients with several CKDs such as IgA nephropathy and lupus nephritis...

BACKGROUND: Peak severity of acute kidney injury (AKI) is associated with mortality in hospitalized pediatric patients. Other factors associated with AKI, such as number of AKI events, severity of AKI events, and time spent in AKI may also have associations with mortality. Characterization of these events could help to evaluate patient outcomes. METHODS: Pediatric inpatients (<19 years of age) from 2011-2019 who were not on maintenance renal replacement therapy and had least one serum creatinine (SCr) obtained during hospital admission were included...

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BACKGROUND: Chronic kidney disease is closely related to a high risk of death and disability, poor physical performance, and frailty. The main objective of this research was to analyse how intradialytic administration of a non-immersive virtual reality (VR) exercise program would affect physical function and adherence to exercise in these patients. METHODS: A total of 56 individuals participated in two 12-week periods in a crossover randomised controlled trial. Each patient underwent a functional capacity evaluation before and after each study period...

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BACKGROUND: Metabolic acidosis is a complication of chronic kidney disease (CKD) that increases risk of CKD progression, causes bone demineralization and muscle protein catabolism. Patients with diabetes are prone to metabolic acidosis and functional limitations that decrease quality of life. Veverimer, an investigational, non-absorbed polymer that binds and removes gastrointestinal hydrochloric acid, is being developed as treatment for metabolic acidosis. This post hoc subgroup analysis evaluated effects of veverimer on metabolic acidosis and physical function among patients with diabetes...

BACKGROUND: Few studies have examined the role of serum potassium concentrations [K+] variability on clinical outcomes is still poorly investigated. Aim of our study was to analyze the association between serum potassium concentrations ([K+]) disorders, with focus on [K+] variability, and mortality in a large, unselected cohort of hospitalized patients. METHODS: We performed a retrospective observational cohort study on the inpatient population admitted to Fondazione Policlinico Universitario A...

BACKGROUND: Metabolic acidosis occurs frequently in patients with kidney transplant and is associated with higher risk for and accelerated loss of graft function. To date, it is not known whether alkali therapy in these patients improves kidney function and whether acidosis and its therapy is associated with altered expression of proteins involved in renal acid-base metabolism. METHODS: We collected retrospectively kidney biopsies from 22 patients. Of these patients, 9 had no acidosis, 9 had metabolic acidosis (plasma HCO3- < 22 mmol/l), and 4 had acidosis and received alkali therapy...

BACKGROUND: Mortality risk is high soon after dialysis initiation in patients with kidney failure, and dialysis withdrawal is a major cause of early mortality, attributed to psychosocial or medical reasons. The temporal trends and risk factors associated with cause-specific early dialysis withdrawal within 12 months of dialysis initiation remain uncertain. METHODS: Using data from the Australian and New Zealand Dialysis and Transplant Registry, we examined the temporal trends and risk factors associated with mortality attributed to early psychosocial and medical withdrawals in incident adult dialysis patients in Australia between 2005 and 2018 using adjusted competing risk analyses...