Brief Description: This article is a Canadian Society of Nephrology commentary on KDIGO guidelines for adult glomerulonephritis, including ANCA vasculitis, lupus nephritis, and IgA nephropathy. It provides contextualized practice points for Canadian clinicians, addressing challenges in guideline implementation, therapy access, and resource variability, aiming to support evidence-informed care for patients with glomerular diseases in Canada. |
Brief Description: Over one-third of Canadians with hypertension do not meet BP targets despite available treatments. Renal sympathetic nerve denervation (RDN), a newly approved minimally invasive procedure, shows promise in lowering BP and has a good safety profile. However, its effects are modest, there’s no method to identify responders, and cardiovascular endpoint data is lacking. With no clear funding models in Canada, RDN should be reserved for patients with resistant or severe hypertension after excluding secondary causes. It should be performed collaboratively by hypertension specialists and interventionalists through shared decision-making with patients. |
Brief description: This population-based study analyzed kidney biopsy data in Saskatchewan (2002–2018) to examine trends and geographic differences in glomerular disease (GD). Among 1,372 confirmed cases, GD incidence significantly increased from 4.6 to 13.6 per 100,000 population. Rural areas had higher incidence rates than urban areas and demonstrated greater progression to dialysis. A geographic cluster of lupus nephropathy was also identified. The findings highlight rising GD burden and important rural–urban disparities in kidney health outcomes. |
Brief description: This economic evaluation used data from the STARRT-AKI randomized trial to compare accelerated versus standard initiation of kidney replacement therapy (KRT) in critically ill patients with acute kidney injury. Using a state-transition model with four health states, the study found that standard initiation was more expensive but produced more quality-adjusted life-years (QALYs). In the Canadian context, standard initiation appeared cost-effective, although results were sensitive to long-term cost assumptions and regional variation in dialysis dependence. |
Brief description: In this multicentre cohort of 442 adults with advanced non-dialysis CKD, frailty prevalence varied widely depending on the assessment method, with poor agreement between claims-based and measured tools. Despite this, most frailty definitions were associated with higher risks of hospitalization and mortality, supporting their use to identify high-risk CKD patients for targeted interventions. |
Brief description: This large-scale proteomics study mapped virus–host protein interactions across SARS-CoV-2 ancestral and variant strains in organ-specific cells. It identified novel mechanisms of immune evasion and clotting abnormalities and developed peptide inhibitors that blocked viral replication, highlighting potential therapeutic targets. |
Brief description: This case series of 23 patients describes the rare IgM variant of PGNMID, predominantly affecting elderly men with monoclonal gammopathy of renal significance (MGRS). Kidney biopsies showed membranoproliferative glomerulonephritis with monotypic IgM and C3 deposits. Detection of nephropathic IgM in serum was low with conventional methods but improved with MALDI-TOF. Most patients received immunosuppressive therapy, highlighting the importance of early recognition and tailored treatment. |
Brief description: This pilot randomized trial of 151 dialysis patients with atrial fibrillation tested the feasibility of apixaban, warfarin, or no anticoagulation. Recruitment and follow-up were successful, with low stroke and manageable bleeding events, demonstrating feasibility for a larger definitive trial to determine optimal anticoagulation strategies in this high-risk population. |
Brief description: In this feasibility RCT of 13 patients with LPHS on opioids, renal denervation (RDN) improved pain compared with sham, with no adverse events. The study demonstrates the feasibility and potential efficacy of RDN in this rare pain syndrome. |
Brief description: Development or progression of CKD occurred in almost 40% of patients after an episode of severe AKI. Among 401 survivors of severe AKI, 39% experienced CKD progression, independent of accelerated versus standard KRT initiation, highlighting the need for dedicated kidney follow-up post-AKI. |
Brief description: Among critically ill patients with severe acute kidney injury who lack emergent indications for renal replacement therapy, a strategy of preemptive RRT initiation does not lead to improved outcomes. However, for patients with persistent AKI and without urgent indications for RRT, the safety of prolonged delays in RRT initiation is unclear. We sought to assess the association between progressively longer delays in RRT initiation and clinical outcomes. Secondary analysis of STARRT-AKI showed that among patients without urgent indications, delaying RRT did not increase 90-day mortality, supporting the safety of individualized timing. |
Brief description: A concise overview of depression in hemodialysis patients, highlighting prevalence, risk factors, screening, and management strategies. It discusses the high prevalence of depressive symptoms, key risk factors, and challenges in diagnosis. The paper highlights the importance of regular screening and outlines evidence-based strategies for managing depression to improve patient well-being and quality of life. |
Brief description: Among patients with severe acute kidney injury (AKI) admitted to the ICU in high-income countries, regional practice variations for fluid balance (FB) management, timing, and choice of renal replacement therapy (RRT) modality may be significant. Total mean FB to a maximum of 14 days was +7199 mL in North America, +5641 mL in Europe, and +2211 mL in ANZ (p < 0.001). The median time to RRT initiation among patients allocated to the standard strategy was longest in Europe compared with North America and ANZ (p < 0.001; p < 0.001). Among STARRT-AKI trial centers, significant regional practice variation exists regarding FB, timing of initiation of RRT, and initial use of continuous RRT. After adjustment, such practice variation was associated with lower ICU and hospital stay and 90-day mortality among ANZ patients compared with other regions. |
Brief description: The International Society of Nephrology Global Kidney Health Atlas charts the availability and capacity of kidney care globally. In North America and the Caribbean region, the Atlas can identify opportunities for kidney care improvement, particularly in Caribbean countries where structures for systematic data collection are lacking. In this third iteration, respondents from 12 of 18 countries in the region reported a 2-fold higher than the global median prevalence of dialysis and transplantation, and a 3-fold higher than the global median prevalence of dialysis centers. The peritoneal dialysis prevalence was lower than the global median, and transplantation data were missing from 6 of the 10 Caribbean countries. Kidney failure was identified as a governmental priority more commonly than chronic kidney disease or acute kidney injury. In this generally affluent region, patients have better access to kidney replacement therapy and chronic kidney disease-related services than in much of the world. Important steps to improve kidney care in the region include increased emphasis on preventive care, a focus on home-based modalities and transplantation, and solutions to train and retain specialized allied health professionals. |
Brief description: The purpose of this narrative review is to offer health care providers guidance on how to effectively identify, assess, and treat patients with CKD-associated pruritus, to reduce symptom burden and improve patient-important outcomes, such as quality of life (QoL). This narrative review provides pragmatic guidance addressing: (1) methods for screening CKD-associated pruritus, (2) assessing severity, (3) management of CKD-associated pruritus, and (4) suggested areas for future research. The panel developed a 3-pillar framework for proactive assessment and severity scoring in CKD-aP: systematic screening for CKD-associated pruritus (pillar 1), assessment of pruritus intensity (pillar 2), and understanding the impact of CKD-associated pruritus on the patient’s QoL (pillar 3). Management of CKD-associated pruritus can include ensuring optimization of dialysis adequacy and achieving mineral metabolism targets (ie, calcium, phosphate, and parathyroid hormone). |
Brief description: Frailty is associated with a higher risk of death among kidney transplant candidates. Currently, available frailty indices are often based on clinical impression, physical exam, or an accumulation of deficits across domains of health. In this paper, we investigate a clustering-based approach that partitions the data based on similarities between individuals to generate phenotypes of kidney transplant candidates. We present a clustering-based phenotyping approach, where we investigated two clustering approaches i.e. neural network-based Self-Organizing Maps (SOM) with hierarchical clustering, and KAMILA (KAy-means for MIxed LArge data sets). Our clustering results partition the individuals across 3 distinct clusters. Clusters were used to generate and study feature-level phenotypes of each group. |
Brief description: Although isolated hematuria (IH) is a common occurrence, the reported prevalence of loin pain hematuria syndrome (LPHS) is 1 in 10,000. We are the first group to conduct a detailed evaluation of physical traits, associated comorbidities, and family genomic links. Phenotyping is the first step in gaining a deeper understanding of disease characteristics. The next logical step will be to interrogate the genes that encode the filtration barrier. By linking phenotypes to genotypes, we hope to establish a more comprehensive clinical picture and help aid decision-making. |
Brief description: Glomerulonephritis (GN) is a group of rare kidney diseases that is increasingly being managed with higher cost immunosuppressive (IS) agents in Canada. Ontario Health’s Ontario Renal Network (ORN) oversees the management and delivery of GN services in the province. Stakeholder surveys previously conducted by ORN identified that both clinicians and patients do not perceive access to GN medications as comprehensive or timely. The program conducted a focused jurisdictional scan among 7 provinces to inform ORN initiatives to improve access to GN medications. Specifically, the program examined clinician experience with GN access, public drug coverage criteria, and timelines for public coverage for select IS agents (ie, tacrolimus, cyclosporine, mycophenolate mofetil [MMF], mycophenolate sodium, rituximab, and eculizumab) used to manage GN in adults who live in Canada. |
Brief description: Loin pain hematuria syndrome (LPHS) is a poorly understood clinical syndrome characterized by hematuria and either unilateral or bilateral severe kidney pain in the absence of identifiable urological disease. We outline our study protocol to investigate genetic variants in the glomerular endothelium and basement membrane as potential contributors to glomerular hematuria in LPHS. We will also evaluate variants in candidate genes in pain pathways. We anticipate that the results from this study will identify new directions for an investigation into the molecular mechanisms underlying LPHS pathophysiology. |
Brief description: Emerging data favor central blood pressure (BP) over brachial cuff BP to predict cardiovascular and kidney events, as central BP more closely relates to true aortic BP. The CENTRAL-CKD trial is the first to evaluate the feasibility and efficacy of using central BP measurements to guide management in patients with advanced CKD. This study could provide the basis and justification to conduct a large scale with clinically meaningful endpoints and patient-reported outcome measures and has the potential to ultimately change how we manage hypertension in this important high-risk population. |
Brief description: Loin pain hematuria syndrome (LPHS) is a rare clinical syndrome characterized by severe pain localized to the kidney in the absence of identifiable urinary tract disease. We sought to assess the histopathological features on kidney biopsy in 14 patients with loin pain hematuria, and specifically, to evaluate the correlation of GBM alterations by electron microscopy with hematuria. Kidney biopsy histology and sequencing of the type VI collagen genes in our cohort of 14 patients did not provide additional clues to the mechanism of hematuria or pain in patients with LPHS. |
Brief description: Restless legs syndrome (RLS) is a sensorimotor disorder resulting in irresistible urges to move the legs and feet. Despite being termed restless legs, urges can occur in other locations (arms, neck, face torso, etc), although involvement of the legs is essential for diagnosis. The pathophysiology of RLS in people with kidney impairment is not well understood. This paper describes five important things about restless legs syndrome in patients on dialysis. |
Brief description: Chronic kidney disease-associated pruritus is defined as itching directly related to kidney disease, without any other comorbid condition to explain the itching. Dialysis Outcomes and Practice Patterns Study (DOPPS) reported that most patients (~65%) on hemodialysis (HD) experience pruruitis, with 37% being moderately bothered and 7% being extremely bothered. Pruritus can be debilitating and has been associated with decreased recovery time post-sessions, insomnia, reduced quality of life, depression, missed HD sessions, and withdrawal from dialysis. It is underreported with 17% of symptomatic patients not reporting symptoms to healthcare providers, and it is underappreciated by healthcare professionals in HD units. In this paper, we talked about the five important things about Pruritus in patients on dialysis. |
Brief description: Kidney transplantation (KT) is the optimal treatment for kidney failure and is associated with better quality of life and survival relative to dialysis. However, knowledge of the current capacity of countries to deliver KT is limited. This study reports on findings from the 2018 International Society of Nephrology Global Kidney Health Atlas survey, specifically addressing the availability, accessibility, and quality of KT across countries and regions. the growing global burden of chronic kidney disease (CKD) and kidney failure dictates the need for this study and for future studies that estimate the capacity for KT across countries and regions, especially given the stagnation in the supply of living organ donors, the under-utilization of deceased donor organs, and the financial constraints of dialysis therapies. |
Brief description: Acute kidney injury (AKI) is a common feature of critical illness, and up to 10–15% of patients admitted to ICU receive renal replacement therapy (RRT). In the STARRT-AKI (Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury) trial, accelerated RRT initiation did not reduce the risk of 90-day mortality in critically ill adults with AKI without an urgent indication for RRT. However, whether patients at higher risk of progressive AKI and destined to require RRT would benefit from an accelerated RRT initiation strategy remains unknown. Using data from the STARRT-AKI trial, we sought to derive a model to predict baseline risk of RRT initiation among critically ill adults with AKI randomized to the standard strategy and estimate whether such risk modifies the effect of an accelerated RRT strategy on mortality. |
Brief description: Patients with CKD exhibit heterogeneity in their rates of progression to kidney failure. The kidney failure risk equation (KFRE) has been shown to accurately estimate progression to kidney failure in adults with CKD. Our objective was to determine health care utilization patterns of patients on the basis of their risk of progression. Integration of KFRE in risk-based treatment pathways that guide the intensity of CKD care may improve health system and patient outcomes. |
Brief description: Synthetic adrenocorticotropic hormone (Tetracosactide) has been used in the treatment of refractory glomerular diseases. Literature surrounding the use of this medication is limited to small case series and there is conflicting data on the rate of adverse events associated with this medication. Our case series found a higher rate of adverse events than previously reported with synthetic ACTH. Appropriate assessment of comorbidities and immunosuppression history should be made when considering this treatment. |
Brief description: Intradialytic hypertension is a paradoxical rise in blood pressure (BP) that occurs specifically during the hemodialysis (HD) procedure. Persistent intradialytic hypertension (>10 mm Hg rise in SBP) is reported to occur in 15% to 30% of patients treated with HD, and is associated with twofold to fourfold increased risks of hospitalization, all-cause mortality, and cardiovascular mortality. This paper highlights the five important things about Intradialytic Hypertension. |
Brief description: Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. This Bayesian reanalysis of the STARRT-AKI trial showed that there is a very low probability that an accelerated KRT strategy will lead to a clinically important improvement in 90-day all-cause mortality. |
Brief description: When chronic kidney disease progresses to the end stage, kidney replacement therapy (dialysis or kidney transplantation) or conservative kidney management (planned, holistic, patient centred care for those with stage 5 chronic kidney disease) is required. This study provides a synopsis of the preparedness and capacity of health systems worldwide to meet the challenges of end stage kidney disease and associated health and economic impacts. It also gives a snapshot of the current capacity to deliver care for end stage kidney disease globally, by geographical region and income group, providing evidence to guide policy and practice, and enabling monitoring of progress. |
Brief description: Most fracture risk assessments in dialysis populations are based on measurements of T scores and FRAX. Frailty and falls are well-established predictors of fracture in chronic kidney disease (CKD) and non-CKD populations. However, there is a paucity of data to the additional contributions of frailty status and a history of falls in assessing the relationship with fracture in HD population. Present study adds to the emerging literature that both T scores and FRAX scores are associated with fracture in patients on HD. This is the first study to our knowledge that looked at the independent contribution of frailty and falls in addition to T scores and FRAX in assessing for fractures in patients on HD. |
Brief description: In this Canadian longitudinal observational multi-center study we found that the definition of the frailty construct is important, as there is limited agreement between frailty definitions. Patients diagnosed as frail using the objective Fried frailty phenotype were more likely to die, and patients considered frail by nurses and physicians were more likely to choose in-center hemodialysis for kidney replacement therapy. These findings suggest that the methods used to diagnose or define frailty are important in determining its utility as for clinical decision making. |
Brief description: In this Canadian longitudinal observational multi-center study we found that higher levels of physical activity were associated with about 50% lower all-cause mortality in the advanced CKD population. These findings are consistent with a potential benefit from maintained physical activity as patients approach kidney failure. |
Brief description: Given the shortage of donor kidneys, patients in need of a kidney transplant often find themselves on long waitlists, and candidates for kidney transplant waitlists undergo extensive clinical evaluations. One clinical variable of interest is frailty, which is defined as a state of increased vulnerability due to degeneration in multiple systems. This study revealed that the prevalence of frailty ranged from 15% according to clinical scale frailty (CSF) to 38% according to frailty index (FI). The different frailty assessment tools had variable levels of agreement, suggesting that the instruments measure different aspects of frailty. Furthermore, frailty as measured with CSF and FI predicted shorter times to death or withdrawal from the transplantation waitlist. |
Brief description: The International Society of Nephrology established the Global Kidney Health Atlas project to define the global capacity for kidney replacement therapy and conservative kidney care, and this second iteration was to describe the availability, accessibility, quality, and affordability of kidney failure care worldwide. This report presents results for the International Society of Nephrology North America and the Caribbean region. Relative to other regions, the North America and Caribbean region had better infrastructure and funding for health care and more health care workers relative to the population. |
Brief description: Peritoneal dialysis (PD) is an underutilized, therapeutic option to in-center hemodialysis (HD), given its similar survival and clinical efficacy but provides lifestyle benefits and cost savings. We conducted a cross-sectional survey of 740 prevalent in-center HD patients within the province of Saskatchewan, Canada, from June 2018 to January 2019. Around 366 (49%) patients agreed to participate in the study. The questionnaire was designed to capture patients’ perceived barriers to PD. The results of this study will be used to address the barriers and to improve PD utilization in the province. |
Brief description: Given the shortage of donor kidneys, patients in need of a kidney transplant often find themselves on long waitlists, and candidates for kidney transplant waitlists undergo extensive clinical evaluations. One clinical variable of interest is frailty, which is defined as a state of increased vulnerability due to degeneration in multiple systems. The protocol for this multicentre study was published in 2020. This study is focussed on addressing the additional impact of frailty on patients waitlisted for transplant. |
Brief description: Loin Pain Hematuria Syndrome (LPHS) is a poorly understood clinical condition characterized by severe pain localized to the kidney but in the absence of identifiable urinary tract disease. There is no consensus on optimal treatment strategies for LPHS. Case reports and series have shown renal denervation via catheter-based radiofrequency ablation to be an effective therapeutic option for the treatment of LPHS. To determine whether catheter-based renal denervation is a meaningful addition to the treatment options in these often-difficult-to-treat LPHS patients, a randomized clinical trial is needed. Prior to conducting a definitive trial that focuses on patient outcomes, ensuring the feasibility of undertaking such a trial is required. We plan to conduct a single center randomized control feasibility trial designed to determine viability and provide framework and direction for a larger trial. |
Brief description: Home hemodialysis (HHD) is an underutilized, therapeutic option to in-center hemodialysis (HD), given its similar survival and clinical efficacy but provides lifestyle benefits and cost savings. We conducted a cross-sectional survey of 740 prevalent in-center HD patients within the province of Saskatchewan, Canada, from June 2018 to January 2019. Around 366 (49%) patients agreed to participate in the study. The questionnaire was designed to capture patients’ perceived barriers to HHD. The results of this study will be used to address the barriers and to improve HHD utilization in the province. |
Brief description: Acute kidney injury is a common complication in patients admitted to an intensive care unit and is associated with a high risk of death or major complications. In this multinational trial, we compared the effect of two strategies (accelerated initiation vs. standard initiation of renal replacement therapy) in critically ill patients with acute kidney injury. An accelerated strategy did not result in a lower mortality at 90 days than a standard strategy. |
Brief description: Erythropoiesis-stimulating agents including epoetin alfa have been a mainstay of anemia management in patients with chronic kidney disease. Although the standard practice has been to administer epoetin alfa to patients on hemodialysis (HD) intravenously (IV), subcutaneous (SQ) epoetin alfa is longer acting and achieve the same target hemoglobin level to be maintained at a reduced dose and cost. We showed that administering epoetin alfa SQ in HD patients led to a 30.51% reduction in dose and 25% reduction in cost while achieving equivalent hemoglobin levels. Given the cost sparing advantages without compromising care while achieving comparable hemoglobin levels, HD units should consider converting to SQ mode of administration. The results of this study have the potential of saving $2.1million in dialysis patients annually. |
Brief description: The prevalence of frailty is disproportionately increased in patients with chronic kidney disease (CKD) in comparison with non-CKD counterparts and is the highest in patients on hemodialysis (HD). While the cross-sectional measurement of frailty on HD has been associated with adverse clinical events, there is a paucity of data on longitudinal assessment of frailty and its relationship to outcomes. In this study, we showed that frailty and prefrailty was almost ubiquitous and had significant association with morbidity, quality of life, mood and cognition |
Brief description: Obesity is recognized as an independent risk factor for chronic kidney disease through multiple direct and indirect biological pathways. Bariatric surgery is a proven, effective method for sustained weight loss. However, there is a relative paucity of data on the impact of bariatric surgery on renal outcomes. We show that bariatric surgery significantly decreased weight and consequently improved renal and metabolic outcomes (eGFR, ACR, fasting glucose, cholesterol, and triglycerides) in patients with elevated BMI. |
Brief description: Patients on home dialysis therapies experience technique failure, which is associated with morbidity and mortality. Reasons for technique failure are complex, and often related to functional decline in the patient or caregiver. Frailty is associated with an increased risk of adverse health outcomes. We investigated the impact of frailty on technique failure and mortality in a prospective cohort of patients on home dialysis therapies. Objective and subjective measures of frailty are associated with a more than 2-fold higher risk of technique failure or death in patients undergoing home dialysis. Assessing frailty as part of the clinical evaluation for home dialysis therapies may be useful for prognostication and clinical management. |
Brief description: Immune checkpoint inhibitors are novel oncological medications, current classes of which include monoclonal antibodies that target inhibitory receptors cytotoxic T lymphocyte-associated antigen 4 (CTLA-4), programmed death 1 protein (PD-1) and programmed death-ligand 1. While they are novel in their ability to treat cancer, they also have a unique spectrum of immune-related adverse events. Renal-related immune adverse events, though rare, are an increasingly recognised clinical entity. We present the case of a 67-year-old man with acute kidney injury after the second cycle of combination anti-CTLA-4 and anti-PD-1 antibodies for metastatic cutaneous melanoma. A renal biopsy was performed, which demonstrated severe acute interstitial nephritis. The culprit medications were held, and he was treated with steroids. With immunosuppression, creatinine improved to pre-treatment values. |
Brief description: Mitochondrial protein (MP) assemblies undergo alterations during neurogenesis, a complex process vital in brain homeostasis and disease. Yet which MP assemblies remodel during differentiation remains unclear. Here, using mass spectrometry-based co-fractionation profiles and phosphoproteomics, we generated mitochondrial interaction maps of human pluripotent embryonal carcinoma stem cells and differentiated neuronal-like cells, which presented as two discrete cell populations by single-cell RNA sequencing. The resulting networks, encompassing 6,442 high-quality associations among 600 MPs, revealed widespread changes in mitochondrial interactions and site-specific phosphorylation during neuronal differentiation. By leveraging the networks, we show the orphan C20orf24 as a respirasome assembly factor whose disruption markedly reduces respiratory chain activity in patients deficient in complex IV. We also find that a heme-containing neurotrophic factor, neuron-derived neurotrophic factor [NENF], couples with Parkinson disease-related proteins to promote neurotrophic activity. The results provide insights into the dynamic reorganization of mitochondrial networks during neuronal differentiation and highlights mechanisms for MPs in respirasome, neuronal function, and mitochondrial diseases. |
Brief description: Studies have shown that measurement of areal bone mineral density by dual-energy x-ray absorptiometry (DXA) predicts fractures in patients with chronic kidney disease (CKD). However, whether fracture risk prediction through bone mineral density (BMD) is enhanced due to the assessment of biochemical markers of chronic kidney disease and mineral and bone disease (CKD-MBD) or clinical risk factors is not clear. We hypothesized that in a select cohort of patients managed in a CKD clinic, that combining T-with biochemical markers would optimize fracture discrimination than using DXA alone. Our findings confirmed that BMD predicts fracture. The addition of cross-sectional CKD-MBD parameters and clinical risk factors to BMD did not add to fracture prediction. Prospective studies should investigate the utility of longitudinal biochemical markers on improving fracture risk assessment. |
Brief description: A case report on a 44-year-old female with an initial presentation with distal renal tubular acidosis (RTA) after she presented with hypokalaemia and normal anion gap acidosis. This case is unique in that distal RTA was the presenting clinical manifestation of Sjögren’s syndrome. We hope that a consideration for Sjögren’s syndrome is made in patients with seemingly idiopathic RTA. |
Brief description: Central aortic blood pressures and arterial stiffness are better indicators of cardiovascular outcomes than brachial blood pressures. However, their response to renal denervation (RDN) in patients with Stage 3 and Stage 4 chronic kidney disease has not yet been examined. To evaluate the impact of RDN on central blood pressures, brachial (office and ambulatory) blood pressures, arterial stiffness, glomerular filtration rate, 24-hour urine protein, and selective cardiac parameters observed on echocardiograms. Our study demonstrates that there was a significant improvement in office blood pressures from baseline to 6 months, maintained to 24 months. There was a numerical improvement in central pressures, and pulse wave velocity at 6 and 24 months, with no sustained changes noted in 24-hour blood pressure. Kidney function remained at or near baseline throughout the 24 months of observation. |
Brief description: Crystalglobulinemia is an extremely rare complication of monoclonal gammopathy. We report a 49-year-old female who presented with acute kidney injury, microhematuria, and non-nephrotic range proteinuria. Kidney biopsy revealed a membranoproliferative pattern of injury, and numerous crystals were noted in the glomerular capillaries on electron microscopy. Based on the biopsy, a diagnosis of crystalglobulinemia was made. On serum protein electrophoresis, there was presence of a monoclonal band, which was too small to quantify. Urine immunofixation was negative. Patient was treated with cyclophosphamide, bortezomib, and dexamethasone regime and made a remarkable renal recovery. |
Brief description: Hypertension on renal replacement therapy is best managed by optimizing goal weight, tight fluid control, salt restriction, increased dialysis times/frequency, decreasing sodium in the dialysate and transitioning to home hemodialysis. We reported a 61-year-old female with end-stage renal disease secondary to polycystic kidney disease (PKD) complicated by intradialytic hypertension (IDH). This case highlighted the need for interrogating the renal arteries radiologically for a potential cause in difficult to control IDH and comments on the association between PKD and fibromuscular dysplasia that has not yet been reported. |
Brief description: A case report on a 53-year-old male of Aboriginal descent with end-stage renal disease due to diabetes who underwent insertion of a peritoneal dialysis (PD) catheter. Five weeks after PD catheter insertion, he started to notice a painful ulcer surrounded by a bed of erythema. The catheter was removed, and an elliptical biopsy was taken, which ruled out infection, malignancy, and vasculitis. The patient was diagnosed with a rare, chronic inflammatory condition – Pyoderma gangrenosum (PG). This is the first reported case of PG occurring at the exit site of a PD catheter. |
Brief description: We present a 77-year-old Caucasian woman who presented with nephrotic-range proteinuria, microhematuria, renal impairment, and extremely elevated blood pressure. Renal biopsy revealed fibrillary deposits in the mesangium and glomerular basement membrane consistent with fibrillary glomerulopathy (FGN), with crescentic changes and thrombotic microangiopathy (TMA). We could not identify any radiological, clinical, or laboratory evidence of autoimmune disorders, lymphoproliferative disorders, and malignancy. Five months after presentation, she gradually progressed to requiring renal replacement therapy and is currently on maintenance hemodialysis. Crescentic changes in FGN, though rare, have been previously described, but the concurrent presence of TMA has never been previously reported. |
Brief description: IgG4-related disease is a newly described entity that can affect nearly any organ, including the kidneys, where it usually manifests as tubulointerstitial nephritis (IgG4-TIN). Here, we describe the first case of recurrent IgG4-TIN in a young patient concomitant with chronic active antibody mediated rejection five years after kidney transplant. Recurrent IgG4-TIN could be diagnosed by the characteristic histopathologic features and increased IgG4-positive plasma cells. Despite maintenance immunosuppression, this disease may recur in the kidney allograft. |
Brief description: We discuss a 31-year-old male who presented to the emergency room with a five-week history of dyspnea, chest pain, and right upper quadrant abdominal pain. Chest X-ray revealed a pleural opacity in the right lower hemothorax. Computed tomography (CT) of the chest showed a lytic rib lesion corresponding to the pleural lesion and multiple lytic lesions throughout the skeleton. This paper emphasizes that MM, though rare, should be in the differential diagnosis of acute kidney injury, as in this young adult. |
Brief description: A 77-year-old female was admitted to the hospital for an evaluation of congestive heart failure. Her immunoglobulin G (IgG) level was 18.4g/L and serum-free kappa level was 92.3 mg/L. The immunofixation of urine revealed monoclonal IgG kappa (1.97 g/d). Her kidney biopsy subsequently confirmed the diagnosis of immunoglobulin light chain (AL) amyloidosis. During the course of investigations, it was incidentally noted that she had a mass on her right kidney, which on biopsy was identified as renal cell carcinoma (RCC). This case deals with the rare situation of AL amyloidosis existing with a solid organ carcinoma and the therapeutic dilemma of treating two unrelated conditions involving the kidneys. |
Brief description: Synthetic adrenocorticotropic hormone (ACTH) has been demonstrated to be effective in patients with membranous nephropathy, minimal change disease and some histological subtypes of focal segmental glomerulosclerosis. Its clinical impact in patients with IgA nephropathy is currently unclear. This study illustrates that ACTH is an effective agent that is well tolerated with minimal side effects and can be used as an alternative to prednisone in patients with IgA nephropathy. |
Brief description: Percutaneous insertion of a peritoneal dialysis (PD) catheter has inherent risks of complications, more so if done “blind” (without fluoroscopy and ultrasound guidance). Despite the perceived disadvantages, there are very few reported cases of mechanical complications after PD catheter insertion. This case illustrates the need for prophylactic Foley catheterization in individuals at high risk for a distended bladder either as a consequence of a mechanical obstruction from an enlarged prostate or due to a neurogenic bladder while undergoing “blind” percutaneous placement. |
Brief description: We summarize the case of an 81-year-old Caucasian female who presented to her family physician with signs and symptoms of nephrotic syndrome following a brief exposure to quinine. This case report proposes that the use of quinine has an association with, and may be causal for, the development of minimal change disease. As this is yet an unreported adverse effect, this paper seeks to increase the knowledge of the varied and numerous effects of quinine. |
Brief description: Loin pain hematuria syndrome (LPHS) is characterized by severe unilateral or bilateral loin pain that suggests a renal origin but occurs in the absence of identifiable or relevant urinary tract disease. Hematuria can either be microscopic or macroscopic, but the renal abnormalities responsible for the hematuria are unexplained. Debilitating pain refractory to conventional pain medications is the main cause of morbidity. We conducted a single-arm, single-center study. Twelve patients between the ages of 21 and 62 years (11 female, 1 male) with LPHS underwent endovascular ablation of the renal nerves between July 2015 and November 2016, using the Vessix renal denervation system. We conclude that renal denervation is associated with a considerable improvement in pain, disability, quality of life, and mood. Our results suggest that percutaneous catheter-based delivery of radiofrequency energy is a safe, rapid treatment option that should be considered in all patients with LPHS. |
Brief description: Cardiac risk assessment for asymptomatic patients awaiting renal transplantation is controversial. Patients awaiting renal transplantation in Southern Saskatchewan from 2005 to 2015 were retrospectively reviewed. Patients underwent cardiac risk stratification with stress myocardial perfusion scan. Patients awaiting renal transplantation in Saskatchewan with abnormal myocardial perfusion scans were not at greater risk of death or coronary events. |
Brief description: Mitochondrial protein (MP) dysfunction has been linked to neurodegenerative disorders (NDs); however, the discovery of the molecular mechanisms underlying NDs has been impeded by the limited characterization of interactions governing MP function. Here, using mass spectrometry (MS)-based analysis of 210 affinity-purified mitochondrial (mt) fractions isolated from 27 epitope-tagged human ND-linked MPs in HEK293 cells, we report a high-confidence MP network including 1,964 interactions among 772 proteins (>90% previously unreported). Our results identify mechanisms for ND-linked MPs and expand the human mt interaction landscape |
Brief description: Central aortic blood pressures and arterial stiffness are better indicators of cardiovascular outcomes than brachial blood pressures. However, their response to renal denervation (RDN) in patients with stage 3 and stage 4 chronic kidney disease (CKD) has not yet been examined. To evaluate the impact of RDN on central blood pressures, brachial (office and ambulatory) blood pressures, arterial stiffness in fifty consecutive patients with stage 3 or stage 4 CKD and resistant hypertension, with no radiological or laboratory evidence of secondary causes of hypertension were recruited from the multidisciplinary CKD clinic. Our study shows a preferential decrease in central blood pressures and improvements in cardiac parameters on echocardiograms post RDN, this may influence the way in which blood pressures are managed in clinics and offices. |
Brief description: We report a 57-year-old woman with end-stage renal disease (ESRD) on maintenance peritoneal dialysis (PD), who presented to the emergency room (ER) by ambulance with complaints of confusion and altered sensorium for 48 hours. She had been reviewed in a walk-in clinic 72 hours earlier and had been prescribed the standard 1000 mg three times per day of valacyclovir for an acute attack of shingles instead of 500 mg once a day on ESRD. In the ER, she received further 500 mg of intravenous acyclovir as herpes encephalitis was clinically suspected. CT of the brain and lumbar puncture were non-contributory to the diagnosis. Valacyclovir and acyclovir were discontinued when the diagnosis of valacyclovir-associated neurotoxicity became clinically evident. As the patient’s Glasgow Coma Scale declined, we intensified her PD regimen from one to six exchanges per day and 24 hours later there was a significant neurological improvement. |
Brief description: A 64-year-old female patient presented to the emergency department with a 3-week history of persistent nausea and vomiting. Her serum creatine prior to admission was 118 µmol/L and on presentation was elevated to 420 µmol/L. On clinical history, she indicated that 3 weeks prior, she had been initiated on a cyclooygenase-2 (COX-2) inhibitor, celecoxib, for her osteoarthritis of her knees. This report provides further evidence that COX-2 inhibitors are associated with AIN. |
Brief description: Loin pain hematuria syndrome (LPHS) is a painful and incapacitating condition that typically affects young women. In this report, we describe the successful use of endovascular renal nerve ablation in this population. Four women with LPHS and intractable pain unresponsive to conservative measures underwent endovascular ablation of the renal nerves using the Vessix renal denervation system. We showed that percutaneous catheter-based renal nerve ablation with radiofrequency energy may be a treatment option for some patients with LPHS. |
Brief description: Chronic kidney disease (CKD) affects more than one third of older adults and is a strong risk factor for vascular disease and cognitive impairment. Cognitive impairment can have detrimental effects on the quality of life through decreased treatment adherence and poor nutrition and results in increased costs of care and early mortality. Our multicenter, cross-sectional, prospective cohort study including 385 patients with CKD stages G4-G5 uncovered a high rate of unrecognized cognitive impairment in an advanced CKD population. This impairment is global, affecting all aspects of cognition and is likely vascular in nature. |
Brief description: A 33-year-old Caucasian man was admitted to the hospital with chest pain and hypertensive urgency. Physical examination revealed widespread arterial bruits and his resistant hypertension was considered to be a consequence of bilateral renal artery stenosis and he subsequently underwent sequential stenting of his renal arteries leading to improvement in blood pressure and reduction in the number of antihypertensive medications. |
Brief description: A healthy 47-year-old man initially presented with symptoms of body rash, myalgias, dark urine, nausea, and vomiting. Acute kidney injury, and positive urine analysis for blood and protein warranted a kidney biopsy, which revealed microthrombi in the kidney vasculature, suggestive of thrombotic microangiopathy. Serology revealed positive parvovirus B19 IgM antibodies and biopsy tests revealed a viral genome on PCR. Despite plasma exchanges and treatment with rituximab, renal function continued to deteriorate to end-stage renal disease. |
Brief description: Frailty, a manifestation of unsuccessful aging, is highly prevalent in people with chronic kidney disease (CKD) and is associated with comorbid conditions in cross-sectional studies. Longitudinal studies investigating the progression of frailty in those with advanced non-dialysis CKD are lacking. We collected data from 600 participants over 2 years to determine the natural history, prevalence of perceived and measured frailty, and its association with dialysis treatment choices and adverse outcomes in patients with advanced CKD. |
Brief description: The nonhomologous end-joining (NHEJ) pathway is essential for the preservation of genome integrity, as it efficiently repairs DNA double-strand breaks (DSBs). Previous biochemical and genetic investigations have indicated that, despite the importance of this pathway, the entire complement of genes regulating NHEJ remains unknown. To address this, we employed a plasmid-based NHEJ DNA repair screen in budding yeast (Saccharomyces cerevisiae) using 369 putative nonessential DNA repair-related components as queries. Among the newly identified genes associated with NHEJ deficiency upon disruption are two spindle assembly checkpoint kinases, Bub1 and Bub2. Both observation of resulting phenotypes and chromatin immunoprecipitation demonstrated that Bub1 and -2, either alone or in combination with cell cycle regulators, are recruited near the DSB, where phosphorylated Rad53 or H2A accumulates. Large-scale proteomic analysis of Bub kinases phosphorylated in response to DNA damage identified previously unknown kinase substrates on Tel1 S/T-Q sites. Moreover, Bub1 NHEJ function appears to be conserved in mammalian cells. 53BP1, which influences DSB repair by NHEJ, colocalizes with human BUB1 and is recruited to the break sites. Thus, while Bub is not a core component of NHEJ machinery, our data support its dual role in mitotic exit and promotion of NHEJ repair in yeast and mammals. |
Brief description: Acute kidney injury (AKI) after cardiac surgery is associated with an increased risk of mortality. Preoperative risk scores can identify patients at risk for AKI and facilitate preventive strategies. Currently, validated risk scores are used to predict AKI requiring dialysis (AKI-D); less is known about whether these tools predict less severe forms of AKI. We evaluated the Cleveland Clinic scoring tool in predicting both AKI-D and less severe stages of AKI for 2316 patients post-cardiac surgery. The patients were recruited from Regina Qu’Appelle Health Region (RQHR) from 2007 to 2011. We found a greater level of risk on the Cleveland tool was associated with a higher risk of Stage 3 AKI. |
Brief description: A female patient in her late 60s with end-stage renal disease secondary to Wegener’s granulomatosis presented with a 2-day history of fever, nausea, somnolence, and purple-coloured exudative plaques on her forehead and index finger. Skin biopsy revealed neutrophilic dermal infiltrates, leading to the diagnosis of Sweet’s syndrome, and prednisone (1 mg/kg) was initiated. The patient’s condition improved over 12 h, and she was discharged 5 days later. |
Brief description: A 40-year-old female with a history of glue sniffing and intravenous drug use presented to the hospital with a week’s history of feeling generally unwell. She was subsequently diagnosed with renal tubular acidosis type 1, secondary to toluene exposure from glue sniffing, and was treated with intravenous fluids and potassium replacement and discharged home with oral potassium citrate and advised to stop her inhalant use. |
