International Journal of Nephrology The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. NT-proBNP, Cardiometabolic Risk Factors, and Nutritional Status in Hemodialysis Patients Sun, 17 Sep 2017 10:01:16 +0000 Background. We aimed to evaluate the association between NT-proBNP and malnutrition in HD patients while taking into account the four established categories of parameters for diagnosis of protein energy wasting (PEW). Methods. A cross-sectional study was performed in Afro-Caribbean dialysis patients. One component in each of the 4 categories for the wasting syndrome was retained: serum albumin ≤ 38 g/L, BMI ≤ 23 Kg/m2, serum creatinine ≤ 818 µmol/L, and normalized protein catabolic rate (nPCR) ≤ 0.8 g/kg/day. NT-proBNP was assessed using a chemiluminescence immunoassay. Two multivariate logistic regression models were performed to determine the parameters associated with high NT-proBNP concentrations. Results. In 207 HD patients, 16.9% had PEW (at least three components). LVEF lower than 60% was found in 13.8% of patients. NT-proBNP levels ranged from 125 to 33144 pg/mL. In model 1, high levels of NT-proBNP (≥6243 pg/mL) were independently associated with PEW OR 14.2 (3.25–62.4), male gender 2.80 (1.22–6.57), hsCRP > 5 mg/L 3.90 (1.77–8.57), and dialysis vintage > 3 years 3.84 (1.35–10.8). In model 2, LVEF OR was 0.93 (0.88–0.98). NT-proBNP concentrations were significantly higher when the PEW component number was higher. Conclusion. In dialysis patients, high NT-proBNP levels must draw attention to cardiac function but also to nutritional status. Jacques Ducros, Laurent Larifla, Henri Merault, and Lydia Foucan Copyright © 2017 Jacques Ducros et al. All rights reserved. Denosumab for Male Hemodialysis Patients with Low Bone Mineral Density: A Case-Control Study Tue, 22 Aug 2017 00:00:00 +0000 Denosumab increases bone mineral density (BMD) in patients not receiving hemodialysis therapy. However, limited data are available in the literature concerning the use of denosumab in hemodialysis patients. We treated male hemodialysis patients with low radius BMD with denosumab therapy for 1 year and evaluated its effect on radius BMD. Seventeen patients were treated with denosumab 60 mg every 6 months, and 20 patients were not treated with denosumab (control group). At seven days, the mean corrected calcium level decreased from  mg to  mg (), and mean serum phosphorus decreased from  mg/dl to  mg/dl (). At 1 month, the corrected calcium and serum phosphorus levels were  mg/dl and  mg/dl, respectively. At 1 year, BMD increased by 2.6%  ± 4.4% in the denosumab group and decreased by 4.5%  ± 7.7% in the control group (). In our observational study, denosumab therapy represents an effective treatment for male dialysis patients with low BMD. Hiroya Takami, Kazunori Washio, and Hiromichi Gotoh Copyright © 2017 Hiroya Takami et al. All rights reserved. Sleep Parameters in Short Daily versus Conventional Dialysis: An Actigraphic Study Thu, 17 Aug 2017 07:51:48 +0000 Previous studies have observed worse sleep quality in patients undergoing conventional dialysis as compared to daily dialysis. Our aim was to compare the sleep parameters of patients undergoing daily or conventional dialysis using an objective measure (actigraphy). This cross-sectional study was performed in three dialysis centers, including a convenience sample (nonprobability sampling) of 73 patients (36 patients on daily hemodialysis and 37 patients on conventional hemodialysis). The following parameters were evaluated: nocturnal total sleep time (NTST), expressed in minutes; wake time after sleep onset (WASO), expressed in minutes; number of nighttime awakenings; daytime total sleep time (DTST), expressed in minutes; number of daytime naps; and nighttime percentage of sleep (% sleep). The Mini-Mental State Examination and the Beck Depression Inventory were also administered. The mean age was 53.4  ±  17.0 years. After adjustment of confounding factors using multiple linear regression analysis, no difference in actigraphy parameters was detected between the groups: NTST (), WASO (), % sleep (), awakenings (), naps (), and DTST (). Different from previous studies employing qualitative analysis, the present assessment did not observe an influence of hemodialysis modality on objective sleep parameters in chronic renal patients. Ludimila D’Avila e Silva Allemand, Otávio Toledo Nóbrega, Juliane Pena Lauar, Joel Paulo Russomano Veiga, and Einstein Francisco Camargos Copyright © 2017 Ludimila D’Avila e Silva Allemand et al. All rights reserved. Analysis of T Cell Subsets in Adult Primary/Idiopathic Minimal Change Disease: A Pilot Study Tue, 15 Aug 2017 08:25:19 +0000 Aim. To characterise infiltrating T cells in kidneys and circulating lymphocyte subsets of adult patients with primary/idiopathic minimal change disease. Methods. In a cohort of 9 adult patients with primary/idiopathic minimal change recruited consecutively at disease onset, we characterized (1) infiltrating immune cells in the kidneys using immunohistochemistry and (2) circulating lymphocyte subsets using flow cytometry. As an exploratory analysis, association of the numbers and percentages of both kidney-infiltrating immune cells and the circulating lymphocyte subsets with kidney outcomes including deterioration of kidney function and proteinuria, as well as time to complete clinical remission up to 48 months of follow-up, was investigated. Results. In the recruited patients with primary/idiopathic minimal change disease, we observed (a) a dominance of infiltrating T helper 17 cells and cytotoxic cells, comprising cytotoxic T cells and natural killer cells, over Foxp3+ Treg cells in the renal interstitium; (b) an increase in the circulating total CD8+ T cells in peripheral blood; and (c) an association of some of these parameters with kidney function and proteinuria. Conclusions. In primary/idiopathic minimal change disease, a relative numerical dominance of effector over regulatory T cells can be observed in kidney tissue and peripheral blood. However, larger confirmatory studies are necessary. Francisco Salcido-Ochoa, Susan Swee-Shan Hue, Doreen Haase, Jason Chon Jun Choo, Nurhashikin Yusof, Reiko Lixiang Li, John Carson Allen Jr., Jabed Iqbal, Alwin Hwai Liang Loh, and Olaf Rotzschke Copyright © 2017 Francisco Salcido-Ochoa et al. All rights reserved. The Role of Sodium Bicarbonate in the Management of Some Toxic Ingestions Tue, 08 Aug 2017 10:29:23 +0000 Adverse reactions to commonly prescribed medications and to substances of abuse may result in severe toxicity associated with increased morbidity and mortality. According to the Center for Disease Control, in 2013, at least 2113 human fatalities attributed to poisonings occurred in the United States of America. In this article, we review the data regarding the impact of systemic sodium bicarbonate administration in the management of certain poisonings including sodium channel blocker toxicities, salicylate overdose, and ingestion of some toxic alcohols and in various pharmacological toxicities. Based on the available literature and empiric experience, the administration of sodium bicarbonate appears to be beneficial in the management of a patient with the above-mentioned toxidromes. However, most of the available evidence originates from case reports, case series, and expert consensus recommendations. The potential mechanisms of sodium bicarbonate include high sodium load and the development of metabolic alkalosis with resultant decreased tissue penetration of the toxic substance with subsequent increased urinary excretion. While receiving sodium bicarbonate, patients must be monitored for the development of associated side effects including electrolyte abnormalities, the progression of metabolic alkalosis, volume overload, worsening respiratory status, and/or worsening metabolic acidosis. Patients with oliguric/anuric renal failure and advanced decompensated heart failure should not receive sodium bicarbonate. Aibek E. Mirrakhimov, Taha Ayach, Aram Barbaryan, Goutham Talari, Romil Chadha, and Adam Gray Copyright © 2017 Aibek E. Mirrakhimov et al. All rights reserved. Malignancy in Membranous Nephropathy: Evaluation of Incidence Sun, 16 Jul 2017 00:00:00 +0000 Background. Membranous nephropathy (MN) can be associated with malignancy. However, the relative risk for malignancy remains unclear. It has been reported that higher numbers of inflammatory cells seen in the glomeruli at biopsy correlate with the occurrence of malignancy in patients with MN and might be used to direct screening. Methods. We examined the occurrence of malignancy in 201 MN patients in Auckland, New Zealand. We also examined the pathology of renal biopsies from 17 MN patients with malignancies and compared the number of inflammatory cells per glomerulus with matched control patients with MN but no malignancy. Results. 40 malignancies were identified in 37 patients, 28 of which occurred after the MN diagnosis. The standardized incidence ratio (SIR) was 2.1 (95% CI, 1.3–2.85) which was similar between patients ≥ 60 years and those <60 years. The median number of inflammatory cells per glomerulus did not differ between MN patients with and without malignancy at 1.86 (IQR, 1.17–2.7) and 2.07 (IQR, 1.17–3.65), respectively (p value 0.56). Conclusions. The relative risk of malignancy in MN patients was similar across different age groups. The number of inflammatory cells per glomerulus did not differentiate between MN patients with and without malignancies. Basil Alnasrallah, John F. Collins, and L. Jonathan Zwi Copyright © 2017 Basil Alnasrallah et al. All rights reserved. Comparative Performance of Creatinine-Based Estimated Glomerular Filtration Rate Equations in the Malays: A Pilot Study in Tertiary Hospital in Malaysia Sun, 18 Jun 2017 09:22:23 +0000 Aim. To validate the accuracy of estimated glomerular filtration rate (eGFR) equations in Malay population attending our hospital in comparison with radiolabeled measured GFR. Methods. A cross-sectional study recruiting volunteered patients in the outpatient setting. Chromium EDTA (51Cr-EDTA) was used as measured GFR. The predictive capabilities of Cockcroft-Gault equation corrected for body surface area (CGBSA), four-variable Modification of Diet in Renal Disease (4-MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations were calculated. Results. A total of 51 subjects were recruited with mean measured GFR 42.04 (17.70–111.10) ml/min/1.73 m2. Estimated GFR based on CGBSA, 4-MDRD, and CKD-EPI were 40.47 (16.52–115.52), 35.90 (14.00–98.00), and 37.24 (14.00–121.00), respectively. Higher accuracy was noted in 4-MDRD equations throughout all GFR groups except for subgroup of GFR ≥ 60 ml/min/1.73 m2 where CGBSA was better. Conclusions. The 4-MDRD equation seems to perform better in estimating GFR in Malay CKD patients generally and specifically in the subgroup of GFR < 60 ml/min/1.73 m2 and both BMI subgroups. Maisarah Jalalonmuhali, Ng Kok Peng, and Lim Soo Kun Copyright © 2017 Maisarah Jalalonmuhali et al. All rights reserved. End-Stage Kidney Failure in Oman: An Analysis of Registry Data with an Emphasis on Congenital and Inherited Renal Diseases Thu, 08 Jun 2017 00:00:00 +0000 Globally, end-stage kidney disease (ESKD) is a huge burden on health care systems. The aims of this study were to perform a comprehensive epidemiological and etiological report of ESKD patients commencing RRT in Oman with an emphasis on genetic causes and inherited kidney disease. All newly registered Omani patients with ESKD commencing RRT from 2001 until 2015 (,922) were analysed using the RRT register in Oman. All potentially genetic or inherited causes of ESKD were reviewed. In Oman, ESKD is more prevalent in males (57.1%) than females (42.9%) with a median age of incident ESKD of 53 years. Diabetic nephropathy was the most prevalent cause of ESKD (46%), followed by hypertensive nephropathy (19%), glomerulonephritis (15%), and inherited kidney disease (5%). For patients less than 20 years of age inherited kidney disease accounted for 32.5% of cases. Of this cohort with inherited renal disease, 40.3% had autosomal dominant polycystic kidney disease, 11.5% had congenital anomalies of the kidney and urinary tract, 9.4% had Alport syndrome, and 7.2% had autosomal recessive polycystic kidney disease. This study represents a comprehensive population-based epidemiological and etiological report of ESKD patients in Oman commencing RRT. Inherited kidney disease was the leading cause of paediatric ESKD. Intisar Al Alawi, Issa Al Salmi, Adhra Al Mawali, Yacoub Al Maimani, and John A. Sayer Copyright © 2017 Intisar Al Alawi et al. All rights reserved. Gum Arabic Reduces C-Reactive Protein in Chronic Kidney Disease Patients without Affecting Urea or Indoxyl Sulfate Levels Sun, 14 May 2017 06:55:31 +0000 Introduction. Gum Arabic (GA) is a complex polysaccharide with proven prebiotic properties and potentially beneficial systemic effects. Methods. We randomly allocated 36 chronic kidney disease (CKD) patients to receive 10, 20, or 40 grams daily of GA for four weeks and studied the systemic effects of this intervention. Results. Thirty participants completed the study with baseline glomerular filtration rate  mL/min/1.7 m2. In contrast to previous observations, we found no effect on serum urea or creatinine levels. GA supplementation was associated with a small but statistically significant drop in serum sodium level ( to  mmol/L, = 0.002) without affecting other electrolytes, urine volume, or indoxyl sulfate (IS) levels. GA supplementation was also associated with a significant drop in C-reactive protein (CRP) level ( to  ng/mL, = 0.02) even in patients who received only 10 g/day ( to  ng/mL, = 0.03). Conclusions. Supplementing the diet of CKD patients with 10–40 g/day of GA significantly reduced CRP level which could have a positive impact on these patients’ morbidity and mortality. This trial is registered with Saudi Clinical Trial Registry number 15011402. Sarra Elamin, Mariam J. Alkhawaja, Amina Y. Bukhamsin, Mohamed A. S. Idris, Muntasir M. Abdelrahman, Nasrulla K. Abutaleb, and Abdulrahman A. Housawi Copyright © 2017 Sarra Elamin et al. All rights reserved. R229Q Polymorphism of NPHS2 Gene in Group of Iraqi Children with Steroid-Resistant Nephrotic Syndrome Wed, 26 Apr 2017 00:00:00 +0000 Background. The polymorphism R229Q is one of the most commonly reported podocin sequence variations among steroid-resistant nephrotic syndromes (SRNS). Aim of the Study. We investigated the frequency and risk of this polymorphism among a group of Iraqi children with SRNS and steroid-sensitive nephrotic syndrome (SSNS). Patients and Methods. A prospective case control study which was conducted in Al-Imamein Al-Kadhimein Medical City, spanning the period from the 1st of April 2015 to 30th of November 2015. Study sample consisted of 54 children having NS, divided into 2 groups: patients group consisted of 27 children with SRNS, and control group involved 27 children with SSNS. Both were screened by real time polymerase chain reaction for R229Q in exon 5 of NPHS2 gene. Results. Molecular study showed R229Q polymorphism in 96.3% of SRNS and 100% of SSNS. There were no phenotypic or histologic characteristics of patients bearing homozygous R229Q polymorphism and the patients with heterozygous R229Q polymorphism. Conclusion. Polymorphism R229Q of NPHS2 gene is prevalent in Iraqi children with SRNS and SSNS. Further study needs to be done, for other exons and polymorphism of NPHS2 gene in those patients. Shatha Hussain Ali, Rasha Kasim Mohammed, Hussein Ali Saheb, and Ban A. Abdulmajeed Copyright © 2017 Shatha Hussain Ali et al. All rights reserved. Expression of uPAR in Urinary Podocytes of Patients with Fabry Disease Mon, 24 Apr 2017 00:00:00 +0000 Background. Despite enzyme replacement therapy, Fabry nephropathy still progresses. Podocyturia is an irreversible event that antedates proteinuria and leads to chronic renal failure. We evaluated a potential mechanism of podocyte detachment via the expression of the urokinase-type Plasminogen Activator Receptor (uPAR) in urinary podocytes of Fabry patients. Methods. This is a cross-sectional study that included controls () and Fabry patients () either untreated () or treated with agalsidase-β (). Variables. Variables are estimated glomerular filtration rate (eGFR), urinary protein : creatinine ratio, and urinary uPAR+ podocyte : creatinine ratio. uPAR mRNA expression in response to lyso-Gb3, a bioactive glycolipid accumulated in Fabry disease, was studied in cultured human podocytes. Results. Controls and Fabry patients had similar age, gender, and renal function. Urinary uPAR+ podocytes were higher in patients than in controls. Untreated patients were significantly younger; had more females, and presented lower urinary protein : creatinine ratios and significantly higher urinary uPAR+ podocytes than treated subjects. In treated patients, urinary uPAR+ podocytes correlated with urinary protein : creatinine ratio (; ). Lyso-Gb3 at concentrations found in the circulation of Fabry patients increased uPAR expression in cultured podocytes. Conclusions. Urinary podocytes expressing uPAR are increased in Fabry patients, especially in untreated patients. The potential contribution of uPAR expression to podocyte detachment merits further studies. Hernán Trimarchi, Romina Canzonieri, Amalia Schiel, Juan Politei, Cristian Costales-Collaguazo, Aníbal Stern, Matías Paulero, Tatiana Rengel, Lara Valiño-Rivas, Mariano Forrester, Fernando Lombi, Vanesa Pomeranz, Romina Iriarte, Alexis Muryan, Alberto Ortiz, María Dolores Sanchez-Niño, and Elsa Zotta Copyright © 2017 Hernán Trimarchi et al. All rights reserved. Febuxostat Attenuates Renal Damage besides Exerting Hypouricemic Effect in Streptozotocin-Induced Diabetic Rats Wed, 19 Apr 2017 00:00:00 +0000 Aim. In this study, we aimed to investigate the effects of febuxostat, a novel inhibitor of xanthine oxidase (XO), on renal damage in streptozotocin- (STZ-) induced diabetic rats. Methods. Diabetes was induced by the intraperitoneal injection of STZ in male Sprague-Dawley rats. Sham-injected rats served as controls. The control and diabetic rats were treated with and without febuxostat for 8 weeks, respectively. Fasting blood and 24-h urine samples were collected every 4 weeks. Rat livers were extracted for detecting gene expression, content, and bioactivity of XO. Results. Diabetic rats showed significantly increased serum uric acid (SUA), serum creatinine (SCr), and urea nitrogen (BUN) levels. Daily urinary albumin (UAE), uric acid (UUA), and creatinine (UCr) excretion were also significantly increased in these rats. In diabetic rats, at week 8, febuxostat decreased SUA by 18.9%, while UAA was increased by 52.0%. However, UCr and urinary urea nitrogen (UUN) levels remained unchanged, while SCr and BUN levels decreased by >30% in these rats. Although hepatic gene expression, content, and activity of XO increased significantly in diabetic rats, febuxostat only slightly decreased its content. Conclusions. Febuxostat significantly attenuated renal damage in STZ-induced diabetic rats in addition to exerting hypouricemic effect. Jianmin Ran, Gang Xu, Huixuan Ma, Hailing Xu, Yan Liu, Rongshao Tan, Ping Zhu, Jun Song, and Gancheng Lao Copyright © 2017 Jianmin Ran et al. All rights reserved. Incidence and Risk Factors for Early Acute Kidney Injury in Nonsurgical Patients: A Cohort Study Tue, 11 Apr 2017 00:00:00 +0000 Introduction. Detecting acute kidney injury (AKI) in the first days of hospitalization could prevent potentially fatal complications. However, epidemiological data are scarce, especially on nonsurgical patients. Objectives. To determine the incidence and risk factors associated with AKI within five days of hospitalization (EAKI). Methods. Prospective cohort of patients hospitalized in the Internal Medicine Department. Results. A total of 16% of 400 patients developed EAKI. The associated risk factors were prehospital treatment with nephrotoxic drugs (2.21 OR; 95% CI 1.12–4.36, ), chronic kidney disease (CKD) in stages 3 to 5 (3.56 OR; 95% CI 1.55–8.18, ), and venous thromboembolism (VTE) at admission (5.05 OR; 95% CI 1.59–16.0, ). The median length of hospital stay was higher among patients who developed EAKI (8 [IQR 5–14] versus 6 [IQR 4–10], ) and was associated with an increased requirement for dialysis (4.87 OR 95% CI 2.54 to 8.97, ) and in-hospital death (3.45 OR; 95% CI 2.18 to 5.48, ). Conclusions. The incidence of EAKI in nonsurgical patients is similar to the worldwide incidence of AKI. The risk factors included CKD from stage 3 onwards, prehospital treatment with nephrotoxic drugs, and VTE at admission. EAKI is associated with prolonged hospital stay, increased mortality rate, and dialysis requirement. Javier Enrique Cely, Elkin José Mendoza, Carlos Roberto Olivares, Oscar Julián Sepúlveda, Juan Sebastián Acosta, Rafael Andrés Barón, and Juan José Diaztagle Copyright © 2017 Javier Enrique Cely et al. All rights reserved. Renal Function and Death in Older Women: Which eGFR Formula Should We Use? Wed, 29 Mar 2017 00:00:00 +0000 Background. The Berlin Initiative Study (BIS) eGFR equations were developed specifically for aged populations, but their predictive validity compared to standard formulae is unknown in older women. Methods. In a prospective study of 1289 community-dwelling older women (mean age 79.5 years), we compared the performance of the BIS1 SCr-based equation to the CKD- and the BIS2 SCr- and Scysc-based equation to the CKD- to predict cardiovascular and all-cause mortality. Results. Prevalence of specific eGFR category (i.e., ≥75, 60–74, 45–59, and <45) according to eGFR equation was 12.3%, 38.4%, 37.3%, and 12.0% for BIS1; 48.3%, 27.8%, 16.2%, and 7.8% for CKD-; 14.1%, 38.6%, 37.6%, and 9.6% for BIS2; and 33.5%, 33.4%, 22.0%, and 11.1% for CKD-, respectively. Over years, 667 (51.8%) women died. For each equation, women with eGFR <45 were at increased risk of mortality compared to eGFR ≥75 [adjusted HR (95% CI): BIS1, 1.5 (1.1–2.0); CKD-, 1.7 (1.3–2.2); BIS2, 2.0 (1.4–2.8); CKD-, 1.8 (1.4–2.3); p-trend <0.01]. Net reclassification analyses found no material difference in discriminant ability between the BIS and CKD-EPI equations. Results were similar for cardiovascular death. Conclusions. Compared to CKD-EPI, BIS equations identified a greater proportion of older women as having CKD but performed similarly to predict mortality risk. Thus, the BIS equations should not replace CKD-EPI equations to predict risk of death in older women. Muna T. Canales, Terri Blackwell, Areef Ishani, Brent C. Taylor, Allyson Hart, Rebecca J. Beyth, and Kristine E. Ensrud Copyright © 2017 Muna T. Canales et al. All rights reserved. Factors Predicting Renal Function Outcome after Augmentation Cystoplasty Mon, 06 Mar 2017 09:20:01 +0000 We determined the cause of renal deterioration after augmentation cystoplasty (AC). Twenty-nine adult patients with refractory bladder dysfunction and who underwent ileocystoplasty from 2004 to 2015 were studied. Patients with a decline in glomerular filtration rate (GFR) after augmentation were reviewed. The primary outcome was to determine the factors that might lead to deterioration of estimated GFR. Median follow-up was years. Significant bladder capacity, end filling pressure, and bladder compliance were achieved from median to  ml (), to  cm H2O (), and to (), respectively. Renal function remained stable and improved in 22 () patients from median eGFR to  ml/min/1.73 m2 (). Significant deterioration was found in 7 () patients from median eGFR to (). The causes of renal deterioration were noncompliance to self-catheterization (2 patients), posterior urethral valve/dysplastic kidneys (2 patients), and reflux/infection (2 patients). On multivariate analysis, recurrent pyelonephritis (OR 3.87, ) and noncompliance (OR 30.78, ) were significant. We concluded that AC is not the cause of progression to end-stage renal disease in patients with renal insufficiency. Shahbaz Mehmood, Raouf Seyam, Sadia Firdous, and Waleed Mohammad Altaweel Copyright © 2017 Shahbaz Mehmood et al. All rights reserved. Forecasting the Incidence and Prevalence of Patients with End-Stage Renal Disease in Malaysia up to the Year 2040 Tue, 28 Feb 2017 07:12:21 +0000 Background. The incidence of patients with end-stage renal disease (ESRD) requiring dialysis has been growing rapidly in Malaysia from 18 per million population (pmp) in 1993 to 231 pmp in 2013. Objective. To forecast the incidence and prevalence of ESRD patients who will require dialysis treatment in Malaysia until 2040. Methodology. Univariate forecasting models using the number of new and current dialysis patients, by the Malaysian Dialysis and Transplant Registry from 1993 to 2013 were used. Four forecasting models were evaluated, and the model with the smallest error was selected for the prediction. Result. ARIMA (0, 2, 1) modeling with the lowest error was selected to predict both the incidence (RMSE = 135.50, MAPE = 2.85, and MAE = 87.71) and the prevalence (RMSE = 158.79, MAPE = 1.29, and MAE = 117.21) of dialysis patients. The estimated incidences of new dialysis patients in 2020 and 2040 are 10,208 and 19,418 cases, respectively, while the estimated prevalence is 51,269 and 106,249 cases. Conclusion. The growth of ESRD patients on dialysis in Malaysia can be expected to continue at an alarming rate. Effective steps to address and curb further increase in new patients requiring dialysis are urgently needed, in order to mitigate the expected financial and health catastrophes associated with the projected increase of such patients. Mohamad Adam Bujang, Tassha Hilda Adnan, Nadiah Hanis Hashim, Kirubashni Mohan, Ang Kim Liong, Ghazali Ahmad, Goh Bak Leong, Sunita Bavanandan, and Jamaiyah Haniff Copyright © 2017 Mohamad Adam Bujang et al. All rights reserved. Childhood Nephrotic Syndrome Management and Outcome: A Single Center Retrospective Analysis Thu, 23 Feb 2017 07:13:15 +0000 There is a paucity of information on outpatient management and risk factors for hospitalization and complications in childhood nephrotic syndrome (NS). We described the management, patient adherence, and inpatient and outpatient usage of 87 pediatric NS patients diagnosed between 2006 and 2012 in the Atlanta Metropolitan Statistical Area. Multivariable analyses were performed to examine the associations between patient characteristics and disease outcome. We found that 51% of the patients were treated with two or more immunosuppressants. Approximately half of the patients were noted to be nonadherent to medications and urine protein monitoring. The majority (71%) of patients were hospitalized at least once, with a median rate of 0.5 hospitalizations per patient year. Mean hospital length of stay was 4.0 (3.8) days. Fourteen percent of patients experienced at least one serious disease complication. Black race, frequently relapsing/steroid-dependent and steroid-resistant disease, and the first year following diagnosis were associated with higher hospitalization rates. The presence of comorbidities was associated with longer hospital length of stay and increased risk of serious disease complications. Our results highlight the high morbidity and burden of NS and point to particular patient subgroups that may be at increased risk for poor outcome. Chia-shi Wang, Jia Yan, Robert Palmer, James Bost, Mattie Feasel Wolf, and Larry A. Greenbaum Copyright © 2017 Chia-shi Wang et al. All rights reserved. Focused Real-Time Ultrasonography for Nephrologists Thu, 02 Feb 2017 00:00:00 +0000 We propose that renal consults are enhanced by incorporating a nephrology-focused ultrasound protocol including ultrasound evaluation of cardiac contractility, the presence or absence of pericardial effusion, inferior vena cava size and collapsibility to guide volume management, bladder volume to assess for obstruction or retention, and kidney size and structure to potentially gauge chronicity of renal disease or identify other structural abnormalities. The benefits of immediate and ongoing assessment of cardiac function and intravascular volume status (prerenal), possible urinary obstruction or retention (postrenal), and potential etiologies of acute kidney injury or chronic kidney disease far outweigh the limitations of bedside ultrasonography performed by nephrologists. The alternative is reliance on formal ultrasonography, which creates a disconnect between those who order, perform, and interpret studies, creates delays between when clinical questions are asked and answered, and may increase expense. Ultrasound-enhanced physical examination provides immediate information about our patients, which frequently alters our assessments and management plans. Matthew J. Kaptein and Elaine M. Kaptein Copyright © 2017 Matthew J. Kaptein and Elaine M. Kaptein. All rights reserved. Apolipoprotein C-I Levels Are Associated with the Urinary Protein/Urinary Creatinine Ratio in Pediatric Idiopathic Steroid-Sensitive Nephrotic Syndrome: A Case Control Study Mon, 30 Jan 2017 11:01:49 +0000 Humoral factors may cause idiopathic steroid-sensitive nephrotic syndrome (ISSNS). In the present study, we analyzed serum proteins using mass spectrometry (MS) to identify proteins associated with the pathophysiology of pediatric ISSNS. We collected serial serum samples from 33 children during each ISSNS phase; Phase A1 is the acute phase prior to steroid treatment (STx), Phase A2 represents the remission period with STx, and Phase A3 represents the remission period after completion of STx. Children with normal urinalyses (Group B) and children with a nephrotic syndrome other than ISSNS (Group C) served as controls. No significant differences in urinary protein/urinary creatinine (UP/UCr) ratios were observed between the children with phase A1 ISSNS and Group C. We used surface-enhanced laser desorption/ionization time of flight MS for sample analysis. Four ion peaks with a mass-to-charge ratio (m/z) of 6,444, 6,626, 8,695, and 8,915 were significantly elevated during ISSNS Phase A1 compared to Phase A2, Phase A3, and Group C. The intensity of an m/z of 6,626 significantly correlated with the UP/UCr ratio and an m/z of 6,626 was identified as apolipoprotein C-I (Apo C-I). Apo C-I levels correlate with the UP/UCr ratio in pediatric ISSNS. Our findings provide new insights into the pathophysiology of ISSNS. Jun Odaka, Takahiro Kanai, Takane Ito, Takashi Saito, Jun Aoyagi, Hiroyuki Betsui, and Takanori Yamagata Copyright © 2017 Jun Odaka et al. All rights reserved. Clinical Utility of Urinary β2-Microglobulin in Detection of Early Nephropathy in African Diabetes Mellitus Patients Mon, 30 Jan 2017 07:35:19 +0000 Background. Studies have indicated that diabetic tubulopathy may occur earlier than glomerulopathy, therefore providing a potential avenue for earlier diagnosis of diabetic nephropathy. Urinary beta-2-microglobulin (β2m) was investigated in this study as a potential biomarker in the detection of early nephropathy in type 2 diabetics. Methods. One hundred and two diabetic subjects and 103 controls that met the inclusion criteria had data (sociodemographic, medical history, physical examination, and laboratory) collected. Urinary β2m levels and urinary albumin concentration (UAC) were determined. Results. Elevated urinary β2m was more frequent among the diabetics (52%, 95% CI: 42.1–61.8%) than among the controls (32%, 95% CI: 22.9–41.2%). The frequency of microalbuminuria was higher in the diabetics (35.3%, 95% CI: 25.9–44.7%) than in the controls (15.5%, 95% CI: 8.4–22.6%). There was a positive correlation between urinary β2m and UAC (rho = 0.38, ). Multivariate analysis showed BMI (OR: 1.23, 95% CI: 1.05–1.45), eGFR (OR: 0.97, 95% CI: 0.94–0.99), and presence of microalbuminuria (OR: 3.94, 95% CI: 1.32–11.77) as independent predictors of elevated urinary beta-2-microglobulin among the diabetics. Conclusion. Urinary β2m may be useful, either as a single test or as a component of a panel of tests, in the early detection of diabetic nephropathy. U. E. Ekrikpo, E. E. Effa, E. E. Akpan, A. S. Obot, and S. Kadiri Copyright © 2017 U. E. Ekrikpo et al. All rights reserved. Assessing the Association between Serum Ferritin, Transferrin Saturation, and C-Reactive Protein in Northern Territory Indigenous Australian Patients with High Serum Ferritin on Maintenance Haemodialysis Tue, 24 Jan 2017 00:00:00 +0000 Objective. To determine the significance of high serum ferritin observed in Indigenous Australian patients on maintenance haemodialysis in the Northern Territory, we assessed the relationship between ferritin and transferrin saturation (TSAT) as measures of iron status and ferritin and C-reactive protein (CRP) as markers of inflammation. Methods. We performed a retrospective cohort analysis of data from adult patients (≥18 years) on maintenance haemodialysis (>3 months) from 2004 to 2011. Results. There were 1568 patients. The mean age was 53.9 (11.9) years. 1244 (79.3%) were Indigenous. 44.2% () were male. Indigenous patients were younger (mean age [52.3 (11.1) versus 57.4 (15.2), ]) and had higher CRP [14.7 mg/l (7–35) versus 5.9 mg/l (1.9–17.5), ], higher median serum ferritin [1069 µg/l (668–1522) versus 794.9 µg/l (558.5–1252.0), ], but similar transferrin saturation [26% (19–37) versus 28% (20–38), ]. We observed a small positive correlation between ferritin and TSAT (, ), no correlation between ferritin and CRP ( = 0.001, ), and positive association between high serum ferritin and TSAT (), Indigenous ethnicity (), urea reduction ratio (), and gender () after adjustment in mixed regression analysis. Conclusion. Serum ferritin and TSAT may inadequately reflect iron status in this population. The high ferritin was poorly explained by inflammation. Sandawana William Majoni, Paul D. Lawton, Federica Barzi, Alan Cass, and Jaquelyne T. Hughes Copyright © 2017 Sandawana William Majoni et al. All rights reserved. High Serum Alkaline Phosphatase, Hypercalcaemia, Race, and Mortality in South African Maintenance Haemodialysis Patients Thu, 12 Jan 2017 09:24:31 +0000 Objective. To determine the association between serum total alkaline phosphatase (TAP) and mortality in African maintenance haemodialysis patients (MHD). Patients and Methods. The study enrolled a total of 213 patients on MHD from two dialysis centers in Johannesburg between January 2009 and March 2016. Patients were categorized into a low TAP group (≤112 U/L) versus a high TAP group (>112 U/L) based on a median TAP of 112 U/L. Results. During the follow-up period of 7 years, there were 55 (25.8%) deaths. After adjusting for cofounders such as age, other markers of bone disorder, and comorbidity (diabetes mellitus), patients in the high TAP group had significantly higher risk of death compared to patients in the low TAP group (hazard ratio, 2.50; 95% CI 1.24–5.01, P = 0.01). Similarly, serum calcium >2.75 mmol/L was associated with increased risk of death compared to patients within levels of 2.10–2.37 mmol/L (HR 6.34, 95% CI 1.40–28.76; P = 0.02). The HR for death in white patients compared to black patients was 6.88; 95% CI 1.82–25.88; P = 0.004. Conclusion. High levels of serum alkaline phosphatase, hypercalcaemia, and white race are associated with increased risk of death in MHD patients. Bala Waziri, Raquel Duarte, and Saraladevi Naicker Copyright © 2017 Bala Waziri et al. All rights reserved. Serum Endocan Levels Associated with Hypertension and Loss of Renal Function in Pediatric Patients after Two Years from Renal Transplant Mon, 19 Dec 2016 11:34:16 +0000 Endocan is an important biomarker of inflammation and endothelial dysfunction that increases in association with several chronic diseases. Few published data have described the role of endocan in pediatric renal transplant (RT) patients. We evaluated the endocan concentrations in 62 children who underwent renal transplantation and assessed their relationships with the patients’ blood pressure and loss of renal function. The endocan levels were significantly elevated in the pediatric RT patients who had hypertension and a loss of renal function. We determined positive correlations between the endocan concentrations and the hemodynamic variables (systolic blood pressure: ; ; pulse pressure: ; ). The endocan levels were inversely correlated with the estimated glomerular filtration rate (; ). An endocan cutoff concentration of 7.0 ng/mL identified pediatric RT patients who had hypertension and a loss of renal function with 100% sensitivity and 75% specificity. In conclusion, the endocan concentrations were significantly elevated in pediatric RT patients who had both hypertension and a loss of renal function. The correlations between the endocan levels and the hemodynamic variables and the markers of renal function strengthen the hypothesis that it is an important marker of cardiorenal risk. Livia Victorino de Souza, Vanessa Oliveira, Aline Oliveira Laurindo, DelmaRegına Gomes Huarachı, Paulo Cesar Koch Nogueira, Luciana de Santis Feltran, José Osmar Medina-Pestana, and Maria do Carmo Franco Copyright © 2016 Livia Victorino de Souza et al. All rights reserved. The Role of Renal Replacement Therapy in the Management of Pharmacologic Poisonings Wed, 30 Nov 2016 12:21:14 +0000 Pharmacologic toxicities are common and range from mild to life-threatening. The aim of this study is to review and update the data on the role of renal replacement therapy (RRT) in the management of various pharmacologic poisonings. We aim to provide a focused review on the role of RRT in the management of pharmacological toxicities. Relevant publications were searched in MEDLINE with the following search terms alone or in combination: pharmacologic toxicity, hemodialysis, hemofiltration, renal replacement therapy, toxicology, poisonings, critical illness, and intensive care. The studies showed that a pharmacologic substance should meet several prerequisites to be deemed dialyzable. These variables include having a low molecular weight (<500 Da) and low degree of protein binding (<80%), being water-soluble, and having a low volume of distribution (<1 L/kg). RRT should be strongly considered in critically ill patients presenting with toxic alcohol ingestion, salicylate overdose, severe valproic acid toxicity, metformin overdose, and lithium poisoning. The role of RRT in other pharmacologic toxicities is less certain and should be considered on a case-by-case basis. Aibek E. Mirrakhimov, Aram Barbaryan, Adam Gray, and Taha Ayach Copyright © 2016 Aibek E. Mirrakhimov et al. All rights reserved. Overview of Pregnancy in Renal Transplant Patients Wed, 30 Nov 2016 12:16:39 +0000 Kidney transplantation offers best hope to women with end-stage renal disease who wish to become pregnant. Pregnancy in a kidney transplant recipient continues to remain challenging due to side effects of immunosuppressive medication, risk of deterioration of allograft function, risk of adverse maternal complications of preeclampsia and hypertension, and risk of adverse fetal outcomes of premature birth, low birth weight, and small for gestational age infants. The factors associated with poor pregnancy outcomes include presence of hypertension, serum creatinine greater than 1.4 mg/dL, and proteinuria. The recommended maintenance immunosuppression in pregnant women is calcineurin inhibitors (tacrolimus/cyclosporine), azathioprine, and low dose prednisone; and it is considered safe. Sirolimus and mycophenolate mofetil should be stopped 6 weeks prior to conception. The optimal time to conception continues to remain an area of contention. It is important that counseling for childbearing should start as early as prior to getting a kidney transplant and should be done at every clinic visit after transplant. Breast-feeding is not contraindicated and should not be discouraged. This review will help the physicians in medical optimization and counseling of renal transplant recipients of childbearing age. Silvi Shah and Prasoon Verma Copyright © 2016 Silvi Shah and Prasoon Verma. All rights reserved. Decreased Serum 25-hydroxyvitamin D Level Causes Interventricular Septal Hypertrophy in Patients on Peritoneal Dialysis: Cardiovascular Aspects of Endogenous Vitamin D Deficiency Sun, 27 Nov 2016 09:12:57 +0000 Introduction. In the present study, we aimed to analyze the relation of vitamin D with echocardiographic indexes in patients with end stage renal disease (ESRD) receiving renal replacement therapy (RRT). Methods. A total of 98 patients, 64 patients on hemodialysis (HD) (29F/35M, mean age 56.75 ± 18.63 years) and 34 age matched patients on peritoneal dialysis (PD) (21F/13M, mean age 58.11 ± 10.63 years), with similar duration of ESRD and RRT were enrolled into this cross-sectional study. Echocardiographic examination was performed after dialysis session at normovolemic status. Fasting blood samples were obtained before dialysis session. Results. Patients on PD and female patients in both groups had significantly lower level of 25-OH-D3 level when compared to patients on HD or male patients (p: 0.0001 and p: 0.0001). When all participants were considered, there was no significant association between 25-OH-D3 and echocardiographic parameters; however, in patients on PD, a significant negative correlation was determined between 25-OH-D3 and diastolic blood pressure, interventricular septal hypertrophy (ISH), and left ventricular mass index (LVMI) (r: −0.424, p: 0.012; r: −0.508, p: 0.004; r: 0.489, p: 0.04, resp.). Conclusion. Low serum 25-hydroxyvitamin D levels is associated with ISH and LVMI in PD patients. Bennur Esen, Irfan Sahin, Ahmet Engin Atay, Emel Saglam Gokmen, Ozlem Harmankaya Kaptanogullari, Mürvet Yılmaz, Suat Hayri Kucuk, Serdar Kahvecioglu, and Nurhan Seyahi Copyright © 2016 Bennur Esen et al. All rights reserved. Automated Fluid Management for Treatment of Rhabdomyolysis Thu, 24 Nov 2016 07:43:10 +0000 Purpose. Fluid therapy aimed at increasing urine output is a commonly employed strategy to prevent acute kidney injury (AKI) in critically ill patients with rhabdomyolysis. Automated fluid management has the potential to optimise urine output while avoiding fluid accumulation in rhabdomyolysis patients. Methods. In a single centre clinical service evaluation we compared a convenience sample of critically ill adults with rhabdomyolysis treated with automated fluid management using the RenalGuard® device to patients managed with manual fluid adjustment following our standard rhabdomyolysis protocol. Primary outcome was number of hours with urine output >2 mL/kg during first 48 h of therapy. Results. Eight patients treated with RenalGuard were compared to 28 patients treated with manual fluid management. Number of hours of target urine output was greater in the RenalGuard versus the Standard group (176/312 (56.4%) versus 534/1305 (40.9%); ). Urine output was significantly higher in the first 24 h in the RenalGuard group (median (IQR) 4033 mL (3682–7363) versus 2913 mL (2263–4188 mL); ). Fluid balance, electrolyte, diuretics, and bicarbonate use were comparable between groups. Conclusions. Automated fluid management resulted in a higher urine output more quickly in the treatment of rhabdomyolysis. Further research is needed to analyse the effect of diuresis-matched hydration for the prevention of AKI in rhabdomyolysis. Christian M. Beilstein, John R. Prowle, and Christopher J. Kirwan Copyright © 2016 Christian M. Beilstein et al. All rights reserved. Acute Kidney Injury in Diabetes Mellitus Tue, 15 Nov 2016 07:10:24 +0000 Diabetes mellitus (DM) significantly increases the overall morbidity and mortality, particularly by elevating the cardiovascular risk. The kidneys are severely affected as well, partly as a result of intrarenal athero- and arteriosclerosis but also due to noninflammatory glomerular damage (diabetic nephropathy). DM is the most frequent cause of end-stage renal disease in our society. Acute kidney injury (AKI) remains a clinical and prognostic problem of fundamental importance since incidences have been increased in recent years while mortality has not substantially been improved. As a matter of fact, not many studies particularly addressed the topic “AKI in diabetes mellitus.” Aim of this article is to summarize AKI epidemiology and outcomes in DM and current recommendations on blood glucose control in the intensive care unit with regard to the risk for acquiring AKI, and finally several aspects related to postischemic microvasculopathy in AKI of diabetic patients shall be discussed. We intend to deal with this relevant topic, last but not least with regard to increasing incidences and prevalences of both disorders, AKI and DM. D. Patschan and G. A. Müller Copyright © 2016 D. Patschan and G. A. Müller. All rights reserved. Characteristics of the Relationship of Kidney Dysfunction with Cardiovascular Disease in High Risk Patients with Diabetes Thu, 03 Nov 2016 13:30:47 +0000 We aimed at comparing the relationship of reduced estimated glomerular filtration rate (eGFR) with cardiovascular disease (CVD) and mortality between high risk patients with and without type 2 diabetes mellitus (T2DM). The cross-sectional study evaluated 16,298 participants (1,627 T2DM) acutely admitted to hospital. The longitudinal study comprised 7,508 patients (673 with diabetes and 6,835 without). eGFR was categorized into 6 stages from >90 to <15 mL/min/1.73 m2. Kidney dysfunction was defined by an eGFR < 60 mL/min/1.73 m2. Patients with T2D showed a higher prevalence of CVD (37.9% versus 23.6%; ) and kidney dysfunction (25% versus 13.2%; ) than in the general population. An association with CVD was found with eGFR stages from 30 to 90 mL/min/1.73 m2 in T2D and from <15 to 90 mL/min/1.73 m2 in general population, in whom the association of eGFR with coronary heart disease was in an inverse relationship ( for trend). Survival, in diabetes, was lower () but not associated with kidney dysfunction. Conclusions. In a high risk population, patients admitted to hospital, the relationship of kidney function with CVD is different between T2D and the general population. Competing mortality and the presence of other major risk factors in diabetes may be responsible for this difference. Attilio Losito, Loretta Pittavini, Ivano Zampi, and Elena Zampi Copyright © 2016 Attilio Losito et al. All rights reserved. Acute Kidney Injury in Hematopoietic Stem Cell Transplantation: A Review Thu, 03 Nov 2016 09:24:50 +0000 Hematopoietic stem cell transplantation (HSCT) is a highly effective treatment strategy for lymphoproliferative disorders and bone marrow failure states including aplastic anemia and thalassemia. However, its use has been limited by the increased treatment related complications, including acute kidney injury (AKI) with an incidence ranging from 20% to 73%. AKI after HSCT has been associated with an increased risk of mortality. The incidence of AKI reported in recipients of myeloablative allogeneic transplant is considerably higher in comparison to other subclasses mainly due to use of cyclosporine and development of graft-versus-host disease (GVHD) in allogeneic groups. Acute GVHD is by itself a major independent risk factor for the development of AKI in HSCT recipients. The other major risk factors are sepsis, nephrotoxic medications (amphotericin B, acyclovir, aminoglycosides, and cyclosporine), hepatic sinusoidal obstruction syndrome (SOS), thrombotic microangiopathy (TMA), marrow infusion toxicity, and tumor lysis syndrome. The mainstay of management of AKI in these patients is avoidance of risk factors contributing to AKI, including use of reduced intensity-conditioning regimen, close monitoring of nephrotoxic medications, and use of alternative antifungals for prophylaxis against infection. Also, early identification and effective management of sepsis, tumor lysis syndrome, marrow infusion toxicity, and hepatic SOS help in reducing the incidence of AKI in HSCT recipients. Vinod Krishnappa, Mohit Gupta, Gurusidda Manu, Shivani Kwatra, Osei-Tutu Owusu, and Rupesh Raina Copyright © 2016 Vinod Krishnappa et al. All rights reserved.