December 17, 2014

Hypertension

Weir MR.   Ann Intern Med.   2014 Dec 2;161(11)

This is a comprehensive clinical overview of hypertension.  Drawn from the ACP resources, it focusses on hypertension prevention, diagnosis, treatment, practice improvement, and patient information.    

Leave a Comment! Posted in Clinical Nephrology, Hypertension
December 17, 2014

Protein electrophoresis and immunofixation for the diagnosis of monoclonal gammopathies

Rajkumar SV, Kyle RA.   JAMA.   2014 Nov 26;312(20):2160-1

This case-based article from the JAMA Diagnostic Test Interpretation series and has an associated quiz.  It is designed to help the reader interpret diagnostic tests in the context of monoclonal gammopathies.

Leave a Comment! Posted in Clinical Nephrology, General Nephrology
December 17, 2014

Utility of renal biopsy in the clinical management of renal disease

Dhaun N, Bellamy CO, Cattran DC, Kluth DC.   Kidney Int.   2014 Dec;86(6):1268

This provocative article describes underutilization of kidney biopsies in the diagnosis and prognosis of renal disease.  The authors state that kidney biopsies can aid in the better management of patients with renal disease at all stages.

Leave a Comment! Posted in Clinical Nephrology, General Nephrology, Glomerulonephritis
December 17, 2014

An approach to cystic kidney diseases: the clinician’s view

Kurschat CE, Müller RU, Franke M, Maintz D, Schermer B, Benzing T.   Nat Rev Nephrol.   2014 Dec;10(12):687-699

This is a nice review on the clinical classification of cystic kidney diseases while new techniques are, including next-generation sequencing, are still under investigation.    

1 Comment Posted in Chronic Kidney Disease, Clinical Nephrology, General Nephrology
December 17, 2014

Survival advantage of lanthanum carbonate for hemodialysis patients with uncontrolled hyperphosphatemia

Komaba H, Kakuta T, Suzuki H, Hida M, Suga T, Fukagawa M.   Nephrol Dial Transplant.   2014 Nov 23;

This retrospective study of maintenance hemodialysis patients showed that treatment with lanthanum was independently associated with a reduction in all cause mortality in those patients with uncontrolled hyperphosphatemia.

Leave a Comment! Posted in Clinical Trial Results, Fluid & Electrolytes, General Nephrology, Hemodialysis
December 17, 2014

The Impact of Timing of Dialysis Initiation on Mortality in Patients with Peritoneal Dialysis

Kim HW, Kim SH, Kim YO, Jin DC, Song HC, Choi EJ, Kim YL, Kim YS, Kang SW, Kim NH, Yang CW, Kim YK.   Perit Dial Int.   2014 Oct 7;

A Korean cohort of 495 incident PD patients were analyzed with respect to the impact of timing of dialysis initiation on mortality.  The authors found that an eGFR < 5 mL/min/1.73m(2) at the initiation of PD was a significant risk factor for death, while an eGFR >10 mL/min/1.73m(2) at the initiation of PD was not […]

Leave a Comment! Posted in Chronic Kidney Disease, General Nephrology, Peritoneal Dialysis
November 16, 2014

Follow-up of Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes

Zoungas S, Chalmers J, Neal B, Billot L, Li Q, Hirakawa Y, Arima H, Monaghan H, Joshi R, Colagiuri S, Cooper ME, Glasziou P, Grobbee D, Hamet P, Harrap S, Heller S, Lisheng L, Mancia G, Marre M, Matthews DR, Mogensen CE, Perkovic V, Poulter N, Rodgers A, Williams B, MacMahon S, Patel A, Woodward M, ADVANCE-ON Collaborative Group.   N Engl J Med.   2014 Oct 9;371(15):1392-406

In this 6-year follow-up study of patients enrolled in ADVANCE, there was no evidence that intensive glucose control during the trial led to long-term benefits with respect to mortality or macrovascular events. Though event rates were small, there was a reduction in end-stage renal disease in those patients in the intensive glucose arm, hazard ratio 0.54; […]

Leave a Comment! Posted in Chronic Kidney Disease, Diabetes
November 16, 2014

Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis

Guillevin L, Pagnoux C, Karras A, Khouatra C, Aumaître O, Cohen P, Maurier F, Decaux O, Ninet J, Gobert P, Quémeneur T, Blanchard-Delaunay C, Godmer P, Puéchal X, Carron PL, Hatron PY, Limal N, Hamidou M, Ducret M, Daugas E, Papo T, Bonnotte B, Mahr A, Ravaud P, Mouthon L, French Vasculitis Study Group.   N Engl J Med.   2014 Nov 6;371(19):1771-80

In this RCT, patients with ANCA-associated vasculitis who achieved complete remission after a cyclophosphamide-glucocorticoid regimen were randomly assigned to receive intermittent rituximab (days 0 and 14 and at months 6, 12, and 18) or daily azathioprine until month 22.  Major relapse was less common in the rituximab arm than the azathioprine arm (5% vs 29%) […]

Leave a Comment! Posted in Vasculitis
November 16, 2014

Integration of Acid–Base and Electrolyte Disorders

Seifter JL.   N Engl J Med.   2014 Nov 6;371(19):1821-31

This review, appropriate for trainees and practicing physicians, provides an approach to the diagnosis of acid-base disorders.

Leave a Comment! Posted in Fluid & Electrolytes
November 16, 2014

Gestational Hypertension and Preeclampsia in Living Kidney Donors

Garg AX, Nevis IF, McArthur E, Sontrop JM, Koval JJ, Lam NN, Hildebrand AM, Reese PP, Storsley L, Gill JS, Segev DL, Habbous S, Bugeja A, Knoll GA, Dipchand C, Monroy-Cuadros M, Lentine KL, the DONOR Network.   N Engl J Med.   2014 Nov 14;

This retrospective cohort study showed an increased risk of gestational hypertension or preeclampsia in women who have been living kidney donors, 11% in donors vs 5% in non-donors (OR 2.4; 95% CI, 1.2 to 5.0; P=0.01).

Leave a Comment! Posted in Pregnancy and Hypertension/Renal Disease, Renal Transplantation
November 16, 2014

Blood Pressure in Early Autosomal Dominant Polycystic Kidney Disease

In patients with early PKD, dual blockage of the RAS system provided no advantage over ACE inhibitor alone.  Patients targeted to the standard blood pressure target (120/70 to 130/80 mm Hg) vs a low blood-pressure target (95/60 to 110/75 mm Hg) had reduced annual % increase in total kidney volume (6.6% vs. 5.6%, P=0.006) and more reduction in […]

Leave a Comment! Posted in Chronic Kidney Disease, Polycystic Kidney Disease
November 16, 2014

Successful Delivery of RRT in Ebola Virus Disease

Connor MJ Jr, Kraft C, Mehta AK, Varkey JB, Lyon GM, Crozier I, Ströher U, Ribner BS, Franch HA.   J Am Soc Nephrol.   2014 Nov 14;

This timely article describes the protocol used at Emory University Hospital to provide dialysis in a patient with Ebola virus and proposes clinical practice guidelines for acute dialysis in this infection.

Leave a Comment! Posted in Acute Kidney Injury, Clinical Nephrology, Critical Care
November 16, 2014

Perioperative Aspirin and Clonidine and Risk of Acute Kidney Injury

Garg AX, Kurz A, Sessler DI, Cuerden M, Robinson A, Mrkobrada M, Parikh CR, Mizera R, Jones PM, Tiboni M, Font A, Cegarra V, Gomez MF, Meyhoff CS, VanHelder T, Chan MT, Torres D, Parlow J, Clanchet Mde N, Amir M, Bidgoli SJ, Pasin L, Martinsen K, Malaga G, Myles P, Acedillo R, Roshanov PS, Walsh M, Dresser G, Kumar P, Fleischmann E, Villar JC, Painter T, Biccard B, Bergese S, Srinathan S, Cata JP, Chan V, Mehra B, Wijeysundera DN, Leslie K, Forget P, Whitlock R, Yusuf S, Devereaux PJ, POISE-2 Investigators.   JAMA.   2014 Dec 3;312(21):2254-64

In this sub-study of the POISE-2 study, neither ASA or clonidine reduced the risk of acute kidney injury after non-cardiac surgery. Of note, aspirin increased the risk of major bleeding (which was associated with a greater risk of acute kidney injury).  As well, clonidine increased the risk of clinically important hypotension (which was associated with […]

Leave a Comment! Posted in Acute Kidney Injury