Hello everyone,
If (like me!) you find it hard to set time aside to keep up to speed with recent publications and medical journals listen up! I have decided that I will send round a monthly bulletin with very brief summaries of the more interesting and relevant research articles from a selection of high impact nephrology journals 😎
Hopefully, this will help to generate ideas for projects and research within the department as well as help drive some evidence based change in practice (in addition to our targeted EBM sessions!)
As we are coming into May I have whizzed through the Jan-Apr 2024 issues and summarised really all of the interesting and relevant papers I could find. It means this first bulletin is a bit of a bumper edition, but future bulletins will be far briefer! All articles are linked for further reading for anyone interested 🤓
Joe
Highlights 💡
- Recommendations from the Ramadan and Kidney (RaK) Diseases taskforce on managing fasting during Ramadan including recommendations about safety and rules for early termination of fast
- A BDB organ from a donor in their mid-30’s was implanted into highly sensitised boy on haemodialysis for 4 years following the loss of his first graft. At 10 months he remains dialysis-free with stable function
- A case from one a UK transplant centre challenging the conventions of suitable organ donatio
Interesting insights and oddities 🧐
Sulfamethoxazole-induced crystal nephropathy: characterization and prognosis in a case series
- Co-trimoxazole (when used at high doses) may cause a crystalline nephropathy and promote AKI via its metabolite N-acetyl-sulfamethoxazole (especially in acidic urine!)
SGLT2 Inhibitors and False Positive Toxicology Tests
- SGLT2 inhibitors may cause false positivity for alcohol on urine toxicology due to bacterial fermentation of urinary glucose!
Outcome 10 years after STEC-HUS: importance of long-term follow-up
- Of 138 patients followed for 10 years 66% had no renal sequelae
- The remaining 34% had reduced GFR (24%), proteinuria (23%) or hypertension (17%)
- 17 patients with normal parameters at 1 year subsequently developed renal sequelae and the risk was higher in those needing acute dialysis
Chronic kidney disease
- A physical activity and emotional well-being self-management digital health intervention for people with CKD which offers live physical activity session, educational blogs, videos and peer support.
- This pilot study lays the groundwork for the upcoming RCT.
Mental health and professional outcomes in parents of children with chronic kidney disease
- Parents of children with CKD perceived deterioration of their own health (47%), reduced work on a structural basis (40%). Higher levels of stress, anxiety, and depression correlated with a negative perception of own health, more child medical comorbidities and school absence.
Inaxaplin for Proteinuric Kidney Disease in Persons with Two APOL1 Variants
- People with apolipoprotein L1 (APOL1) gain-of-function mutations are at high risk of the development of rapidly progressive, proteinuric nephropathy.
- Targeted inhibition of APOL1 channel function with inaxaplin reduced proteinuria in participants with two APOL1 variants and FSGS (with a mean change from baseline UPCR of -47.6% by 13 weeks!)
Transplantation
- Of 31 transplant recipients who developed BK-viruria/DNAemia, 18 cleared BK with immunosuppression alone. A further 12 cleared BK within 6m of high dose IViG
- No patients developed BK nephropathy during the study
Enzymatic conversion of human blood group A kidneys to universal blood group O
- Two enzymes (FpGalNAc deacetylase and FpGalactosaminidae) are used to convert blood group A antigens to the “universal” O-type with 80% antigen loss in 2 hours!
- Furthermore, treated kidneys do no bind circulating anti-A antibodies or activate classical completment pathways in ex-vivo models of ABO incompatible transplantation
Dialysis
- No association between intradialytic hypotension and mortality in 2-year follow-up of 1199 adolescents and young people aged 10-21.
Use of ClearGuard caps in paediatric hemodialysis patients
- This trial compared ClearGuard (chlorhexidine impregnated catheter cap) using and non-ClearGuard using units from the Standardising Care to Improve Outcomes in Pediatric Endstage Kidney Disease (SCOPE) collaboration in the US
- From 2020 there was a decreased in the rate of haemodialysis catheter associated blood stream infections from 1.18 to 0.23 infections per 100 patient months (vs 0.41) in ClearGuard using centers
Cystinosis
- Fibrosing colonopathy was identified in four patients within 12-31 months of using Procysbi. One case required resection of the strictured colon and a diverting ileostomy. Two cases were diagnosed by histopathology.
- Extended-release formulations (Procysbi! See above rare side effect!) reduce hospital stays, improve nutritional status and growth. Could enhance tolerability and compliance
Nephrotic syndrome
ANCA in children with nephrotic syndrome treated with levamisole: a cross-sectional cohort study
- 42% of children with FRNS/SDNS receiving levamisole for >36 months developed ANCA positivity (89% pANCA, 3% cANCA, 8% both)
- 81% were asymptomatic and 16% had rash. None had reduced GFR or abnormal urinalysis
- ANCA positivity appears to resolve by 18 months of levamisole cessation
- Very small study numbers
- MMF was associated with higher relapse rate in the induction period but by 12 months the relapse rate and relapse-free intervals between the groups were similar. MMF had a higher infection rate.
- Larger multicenter studies are underway looking into non-inferiority of MMF vs steroids
Growth in children with nephrotic syndrome: a post hoc analysis of the NEPTUNE study
- Steroid dose was associated with lower height z-score, while rituximab use was associated with higher height z-score
The Significance of Haematuria in Podocytopathies
- Haematuria is associated with higher risk of worse kidney-related outcomes and lower rate of reaching proteinuria remission in minimal change disease, FSGS and membranous nephropathy
Congenital abnormalities
Antimicrobial prophylaxis for vesicoureteral reflux: which subgroups of children benefit the most?
- This study reanalysed data from the RIVUR (children with vesicoureteral reflux) trial which had previously found that antimicrobial prophylaxis reduced the risk of UTI by 50% with a Number Needed to Treat of 10.
- The following subgroups were identified with a NNT of </= to 5: grade 4 VUR, bowel-bladder dysfunction, and febrile index UTI associated with either bowel-bladder dysfunction or grade 4 VUR
- Breakthrough UTI and renal impairment at diagnosis of first UTI are risk factors for new renal scarring in children with VUR
- The degree of VUR was not found to be significant