November 10, 2015

Randomized Trial on Efficacy of Mycophenolate Mofeti versus Tacrolimus in Maintaining Remission in Children with Steroid Resistant Nephrotic Syndrome

These are results as presented at the 2015 American Society of Nephrology Kidney Week. In children with steroid resistant nephrotic syndrome who were successfully put into remission, maintenance therapy with MMF 750-1000 mg/m2was compared to tacrolimus 0.1-0.15 mg/kg/day. The primary endpoint of preserved complete or partial remission was achieved in 90.3% of the tacrolimus arm […]

Leave a Comment! Posted in General Nephrology
November 10, 2015

Empagliflozin and Clinical Outcomes in Patients with Type 2 Diabetes and Chronic Kidney Disease

These are results as presented at the 2015 American Society of Nephrology Kidney Week. The effect of empagliflozin vs placebo on cardiovascular events and death was recently reported in the NEJM in Sep 2015, and shown to significantly reduce both the composite cardiovascular primary endpoint and death. During Kidney Week, the renal outcome of new […]

Leave a Comment! Posted in Chronic Kidney Disease, Diabetes, General Nephrology
November 10, 2015

A Randomized Trial of Intensive versus Standard Blood-Pressure Control

In this RCT, a intensive BP target of less than 120 mm Hg was compared to a standard target of less than 140 mm Hg. The primary outcome (a composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes) was reduced (1.65% per year vs. 2.19% per year; HR […]

Leave a Comment! Posted in Hypertension
September 21, 2015

Corticosteroids in IgA Nephropathy: A Retrospective Analysis from the VALIGA Study

Tesar V, Troyanov S, Bellur S, Verhave JC, Cook HT, Feehally J, Roberts IS, Cattran D, Coppo R, VALIGA study of the ERA-EDTA Immunonephrology Working Group.   J Am Soc Nephrol.   2015 Sep;26(9):2248-58

This retrospective study assessed 1147 patients with IgA nephropathy from the European Validation Study of the Oxford Classification of IgAN (VALIGA) cohort.  From this group as well a propensity matched cohort, the authors concluded that corticosteroids reduced proteinuria and the rate of renal function decline and increased renal survival even in patients with an eGFR < 50 […]

Leave a Comment! Posted in Chronic Kidney Disease, Glomerulonephritis
September 21, 2015

Risk of Adverse Pregnancy Outcomes in Women with CKD

Piccoli GB, Cabiddu G, Attini R, Vigotti FN, Maxia S, Lepori N, Tuveri M, Massidda M, Marchi C, Mura S, Coscia A, Biolcati M, Gaglioti P, Nichelatti M, Pibiri L, Chessa G, Pani A, Todros T.   J Am Soc Nephrol.   2015 Aug;26(8):2011-22

With the increasing prevalence of CKD in pregnancy, it is important that both physicians and patients are aware of the risks.  In this Torino-Cagliari Observational Study (TOCOS), 504 pregnancies in women with CKD were compared with 836 low-risk pregnancies in women without CKD.  There were multiple pregnancy outcomes that were studied and divided into “general” […]

Leave a Comment! Posted in Chronic Kidney Disease, Pregnancy and Hypertension/Renal Disease
September 21, 2015

Effect of Neutral-pH, Low–Glucose Degradation Product Peritoneal Dialysis Solutions on Residual Renal Function, Urine Volume, and Ultrafiltration: A Systematic Review and Meta-Analysis

Yohanna S, Alkatheeri AM, Brimble SK, McCormick B, Iansavitchous A, Blake PG, Jain AK.   Clin J Am Soc Nephrol.   2015 Aug 7;10(8):1380-8

This meta-analysis of eleven trials of 643 patients used a random effects model to evaluate the effect of peritoneal dialysate with neutral-pH, low-glucose degradation products on residual renalfunction, urine volume, peritoneal ultrafiltration, and peritoneal small-solute transport (dialysate to plasma creatinine ratio).  The results show a positive effect on preservation of residual renal function and greater urine volumes only.  However, the authors rightly conclude more studies are needed […]

Leave a Comment! Posted in Clinical Nephrology, Peritoneal Dialysis, Residual Renal Function
September 21, 2015

A nephrology guide to reading and using systematic reviews of observational studies

Ravani P, Ronksley PE, James MT, Strippoli GF.   Nephrol Dial Transplant.   2015 Oct;30(10):1615-21

This review may help the discerning reader to better understand how to critically interpret systemic review of observational studies.

Leave a Comment! Posted in Clinical Nephrology
September 21, 2015

An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry)

Nadeau-Fredette AC, Hawley CM, Pascoe EM, Chan CT, Clayton PA, Polkinghorne KR, Boudville N, Leblanc M, Johnson DW.   Clin J Am Soc Nephrol.   2015 Aug 7;10(8):1397-407

This Australia and New Zealand Dialysis and Transplantation Registry database study compared patient and technique survival between patients on home hemodialysis with those on peritoneal dialysis.  Overall, on every level that was assessed home hemodialysis was associated with better outcomes than peritoneal dialysis, including 5 year survival (85% vs 44%, respectively; log-rank P<0.001).  Patients eligible for both modalities may benefit from this […]

Leave a Comment! Posted in Clinical Nephrology, Clinical Trial Results, Hemodialysis, Peritoneal Dialysis
September 21, 2015

Randomized Trial of Bicarbonate or Saline Study for the Prevention of Contrast-Induced Nephropathy in Patients with CKD

Solomon R, Gordon P, Manoukian SV, Abbott JD, Kereiakes DJ, Jeremias A, Kim M, Dauerman HL, BOSS Trial Investigators.   Clin J Am Soc Nephrol.   2015 Sep 4;10(9):1519-24

Sodium bicarbonate vs sodium chloride has always plagued those of us trying to prevent acute contrast nephropathy.  This prospective, double-blind, multicenter randomized clinical trial of 391 with eGFR < 45 ml/min were randomized to either infusion.  There was no difference in the primary composite outcome of mortality, dialysis, or a sustained 20% reduction in eGFR at 6 months […]

Leave a Comment! Posted in Acute Kidney Injury, Clinical Nephrology, Contrast Nephropathy
September 21, 2015

Glomerular Diseases Dependent on Complement Activation, Including Atypical Hemolytic Uremic Syndrome, Membranoproliferative Glomerulonephritis, and C3 Glomerulopathy: Core Curriculum 2015

Noris M, Remuzzi G.   Am J Kidney Dis.   2015 Aug;66(2):359-75

Another great core curriculum that reviews glomerular diseases dependent on complement activation that will benefit both attendings and trainees.

Leave a Comment! Posted in AJKD Core Curriculum, Clinical Nephrology, Glomerulonephritis
September 21, 2015

Peri-procedural management of patients taking oral anticoagulants

Daniels PR.   BMJ.   2015 Jul 14;351:h2391

Nephrology patients often require many procedures.  It is important that their physicians know how to mitigate the risks of anticoagulation therapy especially in the era of novel agents.  This article will help guide physician to better provide peri-procedural management of oral anticoagulation therapy.

Leave a Comment! Posted in General Nephrology, Review
September 21, 2015

Electrolyte and Acid–Base Disturbances in Patients with Diabetes Mellitus

Palmer BF, Clegg DJ.   N Engl J Med.   2015 Aug 6;373(6):548-59

This review nicely summarizes electrolyte and acid-base base abnormalities and their management in patients with diabetes.

Leave a Comment! Posted in Clinical Nephrology, Diabetes, Fluid & Electrolytes, General Nephrology
July 13, 2015

Transplant Immunology and Immunosuppression: Core Curriculum 2015

Hricik DE.   Am J Kidney Dis.   2015 Jun;65(6):956-66

This is a nice summary of transplant immunology and immunosuppression.

Leave a Comment! Posted in AJKD Core Curriculum