Nephrology Now

Is There Any Reason to Stent Atherosclerotic Renal Artery Stenosis?

Nephrology Now editors — Fri, 20 Aug 2010 17:44:18 +0000

This is commentary on the ASTRAL study (Revascularization versus medical therapy for renal artery stenosis. N Engl J Med. 2009;361(20):1953-1962.) discusses trial findings, limitations and implications for practice.

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Revascularization versus Medical Therapy for Renal-Artery Stenosis
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Indications for renal revascularization—the landscape after the ASTRAL study

Nephrology Now editors — Fri, 20 Aug 2010 17:43:07 +0000

This review discusses the implications of the STAR and ASTRAL studies on management of atherosclerotic renovascular disease and highlight an important study in progress, CORAL. The authors summarize that “until completion of the CORAL study, it is prudent to restrict the endovascular intervention to only patients with tight RAS of the single functioning kidney or with bilateral lesions in patients with recurrent pulmonary oedema or when arterial hypertension is refractory to medication with rapid deterioration of kidney function.”

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Guidelines for the prevention and management of Mycobacterium tuberculosis infection and disease in adult patients with chronic kidney disease.

Nephrology Now editors — Fri, 20 Aug 2010 17:41:41 +0000

Theses guidelines have been prepared by British Thoracic Society Standards of Care Committee and Joint Tuberculosis Committee.

Free full text kindly provided through the British Thoracic Society website.

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Perioperative acute kidney injury: risk factors, recognition, management, and outcomes

Nephrology Now editors — Fri, 20 Aug 2010 17:40:05 +0000

This clinical review nicely summarizes how to manage acute kidney injury perioperatively, including recognizing and preventing common pitfalls in this setting.

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The CLEAR Study: A 5-day, 3-g Loading Dose of Mycophenolate Mofetil versus Standard 2-g Dosing in Renal Transplantation

Nephrology Now editors — Fri, 20 Aug 2010 17:38:44 +0000

Although mycophenolate mofetil (MMF) is prescribed at a standard dose for all patients, there are studies showing that there is a level of MMF exposure at which the risk of acute rejection is reduced. Some studies have compared therapeutic drug monitoring to fixed doses of MMF. In contrast, this open-label multicenter randomized controlled trial compared two different fixed doses of MMF in the first five days post-transplant. Higher MMF dosing early post-transplant showed a trend towards fewer acute rejection and graft loss at six months, but did not reach statistical significance.

Free full text kindly provided by the American Society of Nephrology.Related Articles:

Kidneys from Donors after Cardiac Death Provide Survival Benefit

Nephrology Now editors — Fri, 20 Aug 2010 17:36:28 +0000

Donation after cardiac death (DCD) has become an important new source of deceased donor kidneys, but is associated with a higher risk of delayed graft function, itself a risk factor for acute rejection, graft loss and death. In this cohort study, recipients of a DCD kidney had improved survival compared to patients who remained on dialysis and waited longer to receive a kidney from a neurologically-deceased donor. This study confirms that DCD kidneys provide good outcomes to patients.

Free full text kindly provided by the American Society of NephrologyRelated Articles:

High Dose Epoetin Beta in the First Weeks Following Renal Transplantation and Delayed Graft Function: Results of the Neo-PDGF Study

Nephrology Now editors — Fri, 20 Aug 2010 17:33:29 +0000

Erythropoietin has nephroprotective effects in a variety of animal models, including against ischemia-reperfusion injury, which is an important element of delayed graft function. In this multi-center randomized trial, patients were randomized to four doses of erythropoietin or placebo in the first two weeks post-transplant. There ws no difference in the rate of delayed graft function or eGFR at 1 month post-transplant between the two groups.

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Thrombotic Microangiopathy After Kidney Transplantation

Nephrology Now editors — Fri, 20 Aug 2010 17:32:29 +0000

Thrombotic microangiopathy (TMA) is a rare but serious post-transplant complication. It can occur de novo or recurrent, especially in patients with complement factor abnormalities. This paper reviews the causes and risk factors for TMA, as well as strategies for prevention and treatment.

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9th Annual Conference on Prevention in Renal Disease

Nephrology Now editors — Fri, 20 Aug 2010 17:31:13 +0000

Dear colleagues:

9th Annual Conference on Prevention in Renal Disease- Toronto – October 1st & 2nd, 2010.

September 6th is the DEADLINE for early registration and abstract submission.

As in the past we will provide 50 scholarships to fellows/residents who will register early.

For details of the program and on-line registration please visit: www.nephroprevention.com

- Dimitrios Oreopoulos

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Invitation to Participate in Study on Initiation of Dialysis in Acute Kidney Injury

Nephrology Now editors — Fri, 20 Aug 2010 17:28:49 +0000

Researchers at University of Cincinnati are conducting a research survey to examine factors that may affect the timing of initiation of dialysis in patients with acute kidney injury (aka: acute renal failure) in ICU patients. This survey can be accessed by clicking on the link provided below. The survey will take less than 10 – 15 minutes of your time. The responses are not identifiable, and are being collected for research purposes only.

Survey Link: http://www.surveymonkey.com/s/Dialysis_Initiation_in_AKI_in_ICU_Survey

Thank you, and your participation is greatly appreciated.

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Rituximab versus Cyclophosphamide in ANCA-Associated Renal Vasculitis

Nephrology Now editors — Tue, 20 Jul 2010 07:46:28 +0000

This RCT did not find that a rituximab-based regimen was superior to standard intravenous cyclophosphamide for severe ANCA-associated vasculitis.

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Rituximab versus Cyclophosphamide for ANCA-Associated Vasculitis

Nephrology Now editors — Tue, 20 Jul 2010 07:45:22 +0000

This non-inferiority trial finds that rituximab therapy was not inferior to daily cyclophosphamide treatment for induction of remission in severe ANCA-associated vasculitis and may be superior in relapsing disease.
See the associated editorial.

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Peritoneal Dialysis-Related Infections Recommendations: 2010 Update.

Nephrology Now editors — Tue, 20 Jul 2010 07:42:07 +0000

This update from the ISPD focuses on the treatment of exit-site & tunnel infections as well as peritonitis. Guidelines regarding prevention of PD-related infections will be covered in a separate ISPD position statement.

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Clinical Practice Guidelines For Peritoneal Access

Nephrology Now editors — Tue, 20 Jul 2010 07:41:14 +0000

This clinical practice guideline provides recommendations for best practice in creating peritoneal access.

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Daily oral sodium bicarbonate preserves glomerular filtration rate by slowing its decline in early hypertensive nephropathy

Nephrology Now editors — Tue, 20 Jul 2010 07:40:12 +0000

It has previously been demonstrated that oral sodium bicarbonate slows GFR decline in patients with low GFR. This 5-year RCT evaluated whether daily oral sodium bicarbonate slowed GFR decline in patients with hypertensive nephropathy with reduced but relatively preserved eGFR (mean 75 ml/min). The rate of eGFR decline was slower and eGFR was higher in patients given sodium bicarbonate than in those given placebo or sodium chloride. Both groups were treated with angiotensin-coverting enzyme inhibitors concurrently.

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High-dose renal replacement therapy for acute kidney injury: Systematic review and meta-analysis.

Nephrology Now editors — Tue, 20 Jul 2010 07:39:07 +0000

This meta-analysis examining high-dose renal replacement therapy in acute kidney injury did not show any improvement in patient survival or recovery of renal function.

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Trimethoprim-Sulfamethoxazole-Induced Hyperkalemia in Patients Receiving Inhibitors of the Renin-Angiotensin System: A Population-Based Study

Nephrology Now editors — Tue, 20 Jul 2010 07:37:57 +0000

This case control study suggests that older patients taking ACEIs or ARBs have a major increase in the risk of hyperkalemia-associated hospitalization when using trimethoprim-sulfamethoxazole.

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Switch to a Sirolimus-Based Immunosuppression in Long-Term Renal Transplant Recipients: Reduced Rate of (Pre-)Malignancies and Nonmelanoma Skin Cancer in a Prospective, Randomized, Assessor-Blinded, Controlled Clinical Trial

Nephrology Now editors — Tue, 20 Jul 2010 07:36:43 +0000

Early studies showed fewer new skin-cancers in patients randomized to sirolimus at the time of transplant. In this single-center trial, patients with a previous non-melanoma skin cancer were randomized to sirolimus or to continue on their current immunosuppression. There was fewer new skin cancers or premalignant lesions in the sirolimus group. This is a small study lasting only twelve months and speaks to the need for larger, longer trials.

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Everolimus Plus Reduced-Exposure CsA versus Mycophenolic Acid Plus Standard-Exposure CsA in Renal-Transplant Recipients

Nephrology Now editors — Tue, 20 Jul 2010 07:35:24 +0000

Everolimus is an mTOR inhibitor, in the same family as sirolimus. Previous studies combining mTOR inhibitors with usual dosing of calcineurin inhibitors showed worse renal function and graft survival, despite equal efficacy in preventing acute rejection as a calcineurin inhibitor/mycophenolic acid combination. In this RCT, everolimus at two different target levels was combined with low-dose cyclosporine and compared to usual-dose cyclosporine and mycophenolic acid. The everolimus combinations were non-inferior to cyclosporine and MPA for the primary endpoint of eGFR at twelve months post-transplant.

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Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Nephrology Now editors — Tue, 20 Jul 2010 07:34:19 +0000

Nephron mass plays an important role in providing adequate renal function, with loss of nephron mass a risk factor for later deterioration of renal function. In this study, a low ratio of the weight of the donor kidney before implantation to recipient weight was associated with worse long-term renal function and outcomes.

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