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Cardionephrology from the point of view of the cardiologist: no more agree to disagree—getting to ‘yes’ for every patient
Alexandru Burlacu, Peter A McCullough, Adrian Covic
doi : 10.1093/ckj/sfab092
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 1995–1999
Whether one wants to or not, interactions between the heart and the kidneys exist and manifest nevertheless. Both from theoretical and clinical perspectives, it seems the need for a subspecialty of cardionephrology seems justified. Our editorial is a cardiologist perspective on the article by Diez and Ortiz published in Clinical Kidney Journal related to the ‘need for a cardionephrology subspecialty’. We analysed the historical similarities of the emergence of already ingrained clinical fields with the current needs in the cardionephrology sector. We motivated our approach based on novel cardiovascular diagnostic and therapeutic developments and significant pathophysiological differences from a cardiological perspective, accounting for the foundation of a novel sustainable medical field. One of the sensitive issues we also addressed was the operationality and applicability of the principles. We answered with some examples from high-risk debatable contexts the question of where a cardionephrologist should be integrated. Clarifying the operationality aspects would be a positive shift towards improving guidelines adherence in managing complex patients. In conclusion, we underline that the necessity of a cardionephrologist must be addressed from an operational and scientific perspective, with the ultimate goal of reducing mortality and complications in cardiorenal patients.
Kidney involvement in multisystem inflammatory syndrome in children: a pediatric nephrologist’s perspective
Sidharth Kumar Sethi, Abhyuday Rana, Harsha Adnani, Mignon McCulloch, Khalid Alhasan, Azmeri Sultana, Rama Safadi, Nirav Agrawal, Rupesh Raina
doi : 10.1093/ckj/sfab073
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2000–2011
The initial report of the multisystem inflammatory syndrome in children (MIS-C) was from the UK in April 2020; since then, cases have been reported worldwide. Renal involvement has been seen commonly, ranging from 10% to 46%. Kidney involvement following severe acute respiratory syndrome coronavirus 2 infection in children with MIS-C is more common than initially thought and is associated with higher morbidity and mortality. There are several reports of a direct viral tropism of coronavirus disease 2019 and MIS-C-associated renal damage. This study’s objective was to systematically review the current understanding of kidney involvement in children suffering from MIS-C. Based on our systemic literature search, 19 studies have either partially or fully discussed kidney involvement in MIS-C patients. Furthermore, we discuss the multifactorial pathogenesis contributing to acute kidney injury (AKI) development in MIS-C. The current review gives a pediatric nephrologist’s perspective of the renal involvement in MIS-C, the incidence of AKI, the pathophysiology of AKI in MIS-C and the proposed therapeutic regimens available, including the need for kidney replacement therapy for a child with AKI associated with MIS-C. As the disease is rapidly evolving, more detailed clinical prospective studies are required to understand MIS-C and its role in AKI better.
Immune checkpoint inhibitor use in patients with end-stage kidney disease: an analysis of reported cases and literature review
Abhijat Kitchlu, Kenar D Jhaveri, Ben Sprangers, Motoko Yanagita, Rimda Wanchoo
doi : 10.1093/ckj/sfab090
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2012–2022
Immune checkpoint inhibitors (ICIs), immunomodulatory antibodies that are used to enhance the immune system, have substantially improved the prognosis of patients with advanced malignancy. As the use of ICI therapy becomes increasingly widespread across different types of cancer, their use in patients receiving dialysis is likely to increase. In this review we summarize the current literature on the use of ICIs in end-stage kidney disease (ESKD) patients and provide aggregate data from reported cases and series. Based on available pharmacological information, ICIs require no dosing adjustment in ESKD patients. Analysis of the reported cases in the literature demonstrates a similar incidence of immune-related adverse events in patients with ESKD receiving dialysis as compared with the general population (49%). Severe reactions graded as 3 and 4 have been seen in 15 patients (16%). As such, it is important that these patients are monitored very closely for immune-related adverse events; however, the risk of these adverse events should not preclude patients on dialysis from receiving these therapies. Cancer remission (complete and partial) was seen in close to 30% of patients, stable disease was seen in 28% and progression of disease in ?36%. One-third of the patients died. Urothelial and renal cell cancer represented approximately half of all treated cancers and accounted for ?50% of all deaths reported. Additional data in the dialysis population with the use of ICIs and involvement in prospective studies are needed to better assess outcomes, particularly within specific cancer types.
Gitelman syndrome and ectopic calcification in the retina and joints
Yeji Ham, Heather Mack, Deb Colville, Philip Harraka, Judy Savige
doi : 10.1093/ckj/sfab034
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2023–2028
Gitelman syndrome is a rare inherited renal tubular disorder with features that resemble thiazide use, including a hypokalemic metabolic alkalosis, hypomagnesemia, hypocalciuria and a low or normal blood pressure, hyperreninemia and hyperaldosteronism. Treatment is primarily correction of the potassium and magnesium levels. The diagnosis is confirmed with genetic testing but Gitelman syndrome is often not suspected. However, the association with ectopic calcification in the retina, blood vessels and chondrocalcinosis in the joints is a useful pointer to this diagnosis. Bilateral symmetrical whitish deposits of calcium pyrophosphate are visible superotemporally on ophthalmoscopy and retinal photography but are actually located beneath the retina in the sclerochoroid. Optical coherence tomography is even more sensitive for their detection. These deposits increase in size with time, but the rate of progression slows with long-term correction of the hypomagnesemia. Calcification may be complicated by atrophy of the overlying retina and visual loss. The deposits often correlate with ectopic calcification in the aorta and coronary and cerebral vessels. Chondrocalcinosis occurs in the large joints such as the knees. Ectopic calcification in Gitelman syndrome indicates the need for more aggressive management of Mg levels. Calcification is much less common in Bartter syndrome, which itself is rarer and associated less often with hypomagnesemia.
The complexity of sleep disorders in dialysis patients
Sunny Eloot, Els Holvoet, Clement Dequidt, Sarah-Jane Maertens, Floris Vanommeslaeghe, Wim Van Biesen
doi : 10.1093/ckj/sfaa258
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2029–2036
Dialysis patients experience a high burden of physical and emotional symptoms directly affecting their sleep and quality of life. In this study, objective and subjective measurements to quantify sleep were performed, compared with those of healthy controls, and associated with burden of comorbidity and uraemic toxicity.
Renoprotective role of bariatric surgery in patients with established chronic kidney disease
Enrique Morales, Esteban Porrini, Marina Martin-Taboada, Sergio Luis-Lima, Roc?o Vila-Bedmar, Ignacio Gonz?lez de Pablos, Pilar G?mez, El?as Rodr?guez, Lucia Torres, Borja Lanz?n, Ana Elena Rodr?guez, Mar?a Ma?z, Gema Medina-G?mez, Manuel Praga
doi : 10.1093/ckj/sfaa266
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2037–2046
Bariatric surgery (BS) has been postulated as the most effective measure for weight reduction. Weight loss improves metabolic parameters and exerts changes in renal function that lead to the amelioration of absolute or relative glomerular hyperfiltration, a condition that may be renoprotective in the long term. However, few studies have demonstrated the influence of BS in patients with severe obesity and chronic kidney disease (CKD). Our objective was to analyse the evolution of renal function, adipose tissue–derived molecules and inflammatory parameters in patients with CKD after BS.
Sirolimus in renal transplant recipients with malignancies in Germany
Marcel G Naik, Wolfgang Arns, Klemens Budde, Fritz Diekmann, Frank Eitner, Wilfried Gwinner, Nils Heyne, Jan Steffen Jürgensen, Christian Morath, Udo Riester, Katharina M Heller, Michael Fischereder for the German Sirolimus Study Group
doi : 10.1093/ckj/sfaa262
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2047–2058
Renal transplant recipients have an increased cancer risk. The mammalian target of rapamycin inhibitor sirolimus (SRL) has immunosuppressive and antitumour activities but knowledge about its use in recipients with cancer is limited.
Low dialysis potassium bath is associated with lower mortality in end-stage renal disease patients admitted to hospital with severe hyperkalemia
Tripti Singh, Sayee Alagasundaramoorthy, Andrew Gregory, Brad C Astor, Laura Maursetter
doi : 10.1093/ckj/sfaa263
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2059–2063
Hyperkalemia is a modifiable risk factor for sudden cardiac death, a leading cause of mortality in hemodialysis (HD) patients. The optimal treatment of hyperkalemia in hospitalized end-stage renal disease (ESRD) patients is nonexistent in literature, which has prompted studies from outpatient dialysis to be extrapolated to inpatient care. The goal of this study was to determine if low-potassium dialysate 1 mEq/L is associated with higher mortality in hospitalized ESRD patients with severe hyperkalemia (serum potassium >6.5?mmol/L).
Choice of dialysis modality among patients initiating dialysis: results of the Peridialysis study
James Heaf, Maija Heiro, Aivars Petersons, Baiba Vernere, Johan V Povlsen, Anette Bagger S?rensen, Naomi Clyne, Inge Bumblyte, Alanta Zilinskiene, Else Randers, Niels L?kkegaard, Mai Ots-Rosenberg, Stig Kjellevold, Jan Dominik Kampmann, Bj?rn Rogland, Inger Lagreid, Olof Heimburger, Bengt Lindholm
doi : 10.1093/ckj/sfaa260
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2064–2074
In patients with end-stage kidney disease (ESKD), home dialysis offers socio-economic and health benefits compared with in-centre dialysis but is generally underutilized. We hypothesized that the pre-dialysis course and institutional factors affect the choice of dialysis modality after dialysis initiation (DI).
Eculizumab discontinuation in atypical haemolytic uraemic syndrome: TMA recurrence risk and renal outcomes
Gema Ariceta, Fadi Fakhouri, Lisa Sartz, Benjamin Miller, Vasilis Nikolaou, David Cohen, Andrew M Siedlecki, Gianluigi Ardissino
doi : 10.1093/ckj/sfab005
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2075–2084
Eculizumab modifies the course of disease in patients with atypical haemolytic uraemic syndrome (aHUS), but data evaluating whether eculizumab discontinuation is safe are limited.
Fumaric acid ester-induced renal Fanconi syndrome: evidence of mitochondrial toxicity
Elizabeth R Wan, Keith Siew, Lauren Heptinstall, Stephen B Walsh
doi : 10.1093/ckj/sfaa270
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2085–2089
Fumaric acid esters (FAEs) are used to treat chronic plaque psoriasis. Fumarate is a crucial component of the Krebs cycle and mitochondrial function. Proximal tubule cells have high energy demands and rely on aerobic respiration. Proximal tubular dysfunction can cause renal Fanconi syndrome and acute kidney injury. We sought to better understand the mechanism for this in the context of FAE therapy.
The histopathological spectrum of kidney biopsies in patients with thymoma and myasthenia gravis: a report of 24 biopsies from a single institution
Akira Takahashi, Takamasa Miyauchi, Narihito Tatsumoto, Mercury Y Lin, Jean Hou, Toshiki Doi, Takao Masaki, Michifumi Yamashita
doi : 10.1093/ckj/sfaa276
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2090–2100
Nephropathy in patients with thymic diseases such as thymoma and myasthenia gravis (MG) is rare and has been described mostly as isolated case reports. Here we evaluate a series of kidney biopsies from patients with thymoma and/or MG from a single institution in order to better define the spectrum and relative frequencies of thymic disease–associated nephropathies.
Proteinuria and venous thromboembolism in pregnancy: a population-based cohort study
Ayub Akbari, Elizabeth Kunkel, Sarah E Bota, Ziv Harel, Gregoire Le Gal, Conor Cox, Gregory L Hundemer, Mark Canney, Edward Clark, David Massicotte-Azarniouch, Anan Bader Eddeen, Greg Knoll, Manish M Sood
doi : 10.1093/ckj/sfaa278
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2101–2107
Pregnancy-associated venous thromboembolism (VTE) is associated with high morbidity and mortality. Identification of risk factors of VTE may lead to improved maternal and foetal outcomes. Proteinuria confers a pro-thrombotic state, however, its association with VTE in pregnancy remains unknown. We set out to assess the association of proteinuria and VTE during pregnancy.
Serum phosphorus and calcium levels, and kidney disease progression in immunoglobulin A nephropathy
Guizhen Yu, Jun Cheng, Yan Jiang, Heng Li, Xiayu Li, Jianghua Chen
doi : 10.1093/ckj/sfab002
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2108–2113
Disorders of calcium and phosphorus metabolism have been reported to be associated with all-cause and cardiovascular mortality in patients requiring long-term dialysis therapy. However, its role in disease progression is not well established in patients without dialysis, especially in immunoglobulin A (IgA) nephropathy. We aim to evaluate the association of serum phosphorus and calcium and progression of IgA nephropathy.
Vitamin K supplementation and arterial calcification in dialysis: results of the double-blind, randomized, placebo-controlled RenaKvit trial
Karin Levy-Schousboe, Marie Frimodt-M?ller, Ditte Hansen, Christian Daugaard Peters, Krista Dybtved Kj?rgaard, Jens Dam Jensen, Charlotte Strandhave, Hanne Elming, Carsten Toftager Larsen, Hanne Sandstr?m, Claus Lohman Brasen, Anne Schmedes, Jonna Skov Madsen, Niklas Rye J?rgensen, Jens Br?ndum Fr?kj?r, Niels Erik Frandsen, Inge Petersen, Peter Marckmann
doi : 10.1093/ckj/sfab017
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2114–2123
Arterial calcification is associated with cardiovascular mortality in dialysis patients. Active matrix Gla protein (MGP) is a vitamin K-dependent inhibitor of arterial calcification. Elevated plasma concentrations of inactive MGP, i.e. dephosphorylated-uncarboxylated MGP (dp-ucMGP), are prevalent in dialysis patients. MGP inactivity might contribute to arterial calcification. We investigated whether vitamin K supplementation had an effect on arterial calcification in chronic dialysis patients.
Can SARS-CoV-2 be found in the effluent from peritoneal dialysis patients?
Alexandre Candellier, Eric Goffin
doi : 10.1093/ckj/sfab099
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2124–2126
Antibody response to SARS-CoV-2 mRNA BNT162b2 vaccine in kidney transplant recipients and in-centre and satellite centre haemodialysis patients
Dominique Bertrand, Mélanie Hanoy, Stéphane Edet, Veronique Lemée, Mouad Hamzaoui, Charlotte Laurent, Lebourg Ludivine, Isabelle Etienne, Mathilde Lemoine, Dorian Nezam, Sophie Candon, Jean-Christophe Plantier, Frank Le Roy, Dominique Guerrot
doi : 10.1093/ckj/sfab100
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2127–2128
High response rate to BNT162b2 mRNA COVID-19 vaccine among self-care dialysis patients
Hélène Georgery, Arnaud Devresse, Jean-Cyr Yombi, Leila Belkhir, Julien De Greef, Anais Scohy, Nada Kanaan, Benoit Kabamba, Johann Morelle, Eric Goffin
doi : 10.1093/ckj/sfab101
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2129–2131
Low rates of humoral response to BNT162b2 SARS-CoV-2 vaccination in patients with immune-mediated kidney diseases treated with rituximab
Nathalie Demoulin, Anaïs Scohy, Valentine Gillion, Nathalie Godefroid, Michel Jadoul, Johann Morelle
doi : 10.1093/ckj/sfab102
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2132–2133
Twice-weekly hemodialysis in the time of COVID-19: a multicenter study in prevalent patients
Esteban Siga, Carlos Cusumano, Mariano Garcia, Ana Cusumano
doi : 10.1093/ckj/sfab115
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Pages 2134–2135
Erratum to: Effect of linagliptin versus placebo on cardiovascular and kidney outcomes in nephrotic-range proteinuria and type 2 diabetes (t2d): the carmelina randomised controlled trial
Christoph Wanner, Mark E Cooper, Odd Erik Johansen, Robert Toto, Julio Rosenstock, Darren K McGuire, Steven E Kahn, Egon Pfarr, Sven Schnaidt, Maximilian von Eynatten, Jyothis T George, Nicholas D Gollop, Nikolaus Marx, John H Alexander, Bernard Zinman, Vlado Perkovic on behalf of the CARMELINA investigators
doi : 10.1093/ckj/sfab104
Clinical Kidney Journal, Volume 14, Issue 9, September 2021, Page 2136
