Background:Growing evidence suggests that high serum uric acid (SUA) levels are causally related to increased risk of chronic kidney disease (CKD). However, few studies have investigated the ...influence of elevated SUA levels on the incidence of kidney dysfunction and albuminuria separately in community-based populations.Methods and Results:A total of 2,059 community-dwelling Japanese subjects aged ≥40 years without CKD were followed for 5 years. CKD was defined as kidney dysfunction (estimated glomerular filtration rate <60 ml/min/1.73 m2) or albuminuria (urine albumin-creatinine ratio ≥30 mg/g). The odds ratio (OR) for the development of CKD was estimated according to quartiles of SUA (≤4.0, 4.1–4.9, 5.0–5.8, and ≥5.9 mg/dl). During the follow-up, 396 subjects developed CKD, of whom 125 had kidney dysfunction and 312 had albuminuria. The multivariable-adjusted risk of developing CKD increased with higher SUA levels (OR 1.00 reference for ≤4.0, 1.21 95% confidence interval, 0.84–1.74 for 4.1–4.9, 1.47 1.01–2.17 for 5.0–5.8, and 2.10 1.37–3.23 for SUA ≥5.9 mg/dl, respectively). Similarly, there were positive associations between SUA level and the adjusted risk of developing kidney dysfunction (OR 1.00 reference, 2.30 1.10–4.82, 2.81 1.34–5.88, and 3.73 1.65–8.44) and albuminuria (1.00 reference, 1.12 0.76–1.65, 1.35 0.90–2.03, and 1.81 1.14–2.87, respectively).Conclusions:Higher SUA levels were a significant risk factor for the development of both kidney dysfunction and albuminuria in a general Japanese population. (Circ J 2016; 80: 1857–1862)
Background
Although the number of elderly patients with chronic kidney disease (CKD) has increased, few studies have examined their prognosis.
Methods
The study design was a retrospective cohort ...study at a single centre. We evaluated 301 patients aged ≥75 years old with CKD stage G3a to G5. The primary endpoint was kidney failure with replacement therapy (KFRT) and secondary endpoints were all‐cause mortality and annual decline rates of estimated glomerular filtration rate (eGFR). The incidence of KFRT was estimated using the cumulative incidence method considering the competing risk of death. To identify the independent risk factors related to KFRT, multivariate Fine‐Gray regression model analysis were performed.
Results
The median age of the patients was 79 years and the median eGFR was 24.0 mL/min/1.73 m2 at baseline. Urinary protein was positive in 70% of patients. With a median follow‐up of 24.5 months, 35% of the patients developed KFRT and 9% died. Kidney survival significantly decreased according to the CKD stage at baseline. In patients without proteinuria, the cumulative incidence of KFRT increased in CKD stage G5 patients, while in patients with proteinuria, the incidence of KFRT increased from patients with CKD stage G3b. Multivariate Fine‐Gray regression model revealed that less aged, CKD stage G5, baseline data such as proteinuria, hypoalbuminemia, hyperphosphatemia, and hyperuricemia were independent risk factors for KFRT.
Conclusion
Elderly CKD patients with proteinuria need to be carefully monitored even at an early CKD stage because of the risk of developing KFRT.
Summary at a Glance
Our retrospective study in elderly CKD patients revealed the relationship between kidney outcome and baseline CKD stage was different according to proteinuria. In patients with proteinuria, risk for KFRT significantly increased in CKD Stage G3b, 4 and 5, while in those without proteinuria, it increased only in CKD Stage G5.
BK polyomavirus-associated nephropathy (BKPyVAN) has become a major cause of kidney dysfunction and graft loss in kidney transplant recipients. On rare occasion, polyomavirus has also been known to ...affect native kidneys of immunocompromised individuals. Only a small number of opportunistic infections have been reported in the carrier phase of human T-lymphotropic virus type 1 (HTLV-1). This is the first reported case of BKPyVAN in native kidneys of an HTLV-1 carrier.
A 61-year-old man was referred to our hospital from a primary care physician for work-up and treatment of pneumonia. He was diagnosed with Pneumocystis pneumonia and identified as a HTLV-1 carrier who had not yet developed adult T-cell leukemia (ATL). The pneumonia was successfully treated with sulfamethoxazole-trimethoprim. He had never been diagnosed with any kind of kidney dysfunction. Laboratory investigations showed a serum creatinine of 5.3 mg/dL, and urinary sediment showed cells with nuclear enlargement and inclusion bodies suggesting viral infection. The urinary Papanicolaou stain showed inclusions in swollen, ground-glass nuclei, typical of "decoy cells". Renal biopsy showed degeneration of tubules with epithelial enlargement, vacuolar degeneration, nuclear inclusion bodies, and detachment from the tubular basement membrane. Tubular nuclei showed positive staining positive for simian virus 40 large-T antigen. Polymerase chain reaction tests for BK polyomavirus DNA of both urine and plasma were positive. These findings confirmed a diagnosis of BKPyVAN. Intravenous immunoglobulin therapy did not improve renal function, necessitating maintenance hemodialysis therapy.
BKPyVAN should be considered when acute kidney injury occurs with opportunistic infection. HTLV-1 carriers can develop opportunistic infections even before the onset of ATL.
Background
Epidemiologic evidence has emerged to reveal an association of albuminuria and low estimated glomerular filtration rate (eGFR) with dementia, but the findings are inconsistent. In ...addition, there are limited studies addressing the association between albuminuria and Alzheimer disease (AD).
Methods and Results
A total of 1562 community‐dwelling Japanese subjects aged ≥60 years without dementia were followed up for 10 years. The outcomes were incidence of all‐cause dementia and its subtypes, namely, AD and vascular dementia (VaD). The hazard ratios for the outcomes were estimated according to urine albumin–creatinine ratio (UACR) and eGFR levels using a Cox proportional hazards model. During the follow‐up, 358 subjects developed all‐cause dementia (238 AD and 93 VaD). Higher UACR level was significantly associated with greater multivariable‐adjusted risks of all‐cause dementia (hazard ratios 95% confidence intervals: 1.00 reference, 1.12 0.78–1.60, 1.65 1.18–2.30, and 1.56 1.11–2.19 for UACR of ≤6.9, 7.0–12.7, 12.8–29.9, and ≥30.0 mg/g, respectively), AD (1.00 reference, 1.20 0.77–1.86, 1.75 1.16–2.64, and 1.58 1.03–2.41, respectively), and VaD (1.00 reference, 1.03 0.46–2.29, 1.94 0.96–3.95, and 2.19 1.09–4.38, respectively). On the other hand, lower eGFR level was marginally associated with greater risk of VaD, but not AD. Subjects with UACR ≥12.8 mg/g and eGFR of <60 mL/min per 1.73 m2 had 3.3‐fold greater risk of VaD than those with UACR <12.8 mg/g and eGFR of ≥60 mL/min per 1.73 m2.
Conclusions
Albuminuria is a significant risk factor for the development of both AD and VaD in community‐dwelling Japanese elderly. Moreover, albuminuria and low eGFR are mutually associated with a greater risk of VaD.
Abstract
Background and Aims
Vascular calcification is a risk factor for cardiovascular disease and mortality in dialysis and transplant patients. Previous studies have shown that coronary artery ...calcification correlates with cardiovascular mortality. However, it is not known whether vascular calcification of the abdominal aorta and common iliac artery (CIA) may impact clinical outcomes after kidney transplantation. The aim of this study was to identify the risk factors of vascular calcification after kidney transplantation.
Method
In this retrospective study, we assessed 100 patients who underwent kidney transplantation between 2008 and 2017. Of these, 62 patients received a computed tomography (CT) scan of the abdomen twice with an interval of at least 6 months. We examined the characteristics of vascular calcification of the abdominal aorta and iliac artery and divided the patients into three groups based on dialysis modality before transplantation: hemodialysis (HD group), peritoneal dialysis (PD group) and preemptive kidney transplantation (PEKT group). Then, we identified the risk factors for the progression of calcification. Abdominal aortic calcification was assessed based on the aortic calcification index (ACI), and calcification of CIA was assessed based on the maximal thickness of calcification.
Results
At baseline, abdominal aortic calcification was present in 66% of patients, and the median ACI was 10 0-30. Calcification of the CIA was present in 62% of patients, and maximal thickness of the CIA was 2.4 mm 0-4.6. The mean duration of follow-up was 68 ± 29 months, and the mean interval of CT was 40 ± 29 months. After kidney transplantation, the progression rate of ACI and maximal thickness of CIA were 1.6 ± 2.5 per year and 0.17 ± 0.41 mm per year, respectively. The maximal thickness of CIA calcification was significantly higher, and ACI tended to be higher in the HD group than in the PEKT group. Age, male gender, diabetes mellitus and dialysis vintage were the independent variables related to both ACI and maximal thickness of CIA calcification. The progression rates of ACI and maximal thickness of CIA were comparable among the three groups in terms of dialysis modality. Age and rejection within the first 6 months were independent risk factors for ACI progression, and diabetes mellitus was an independent risk factor for progression of maximal thickness of CIA. No significant association was found between the progression of vascular calcification and dialysis-related parameters, including dialysis modality and vintage.
Conclusion
This study suggests that dialysis vintage was the independent variable related to calcification of the abdominal aorta and common iliac artery, whereas dialysis modality was not a significant predictor of vascular calcification and its progression in these blood vessels.
A perioperative protocol that followed the JSDT guidelines for cardiac surgery in dialysis patients was developed to improve interprofessional collaboration and patient care. We evaluated the ...perioperative protocol and surgical complications at our hospital. The subjects were 128 patients who underwent cardiac surgery between January 2016 and December 2018, excluding those who underwent concomitant aortic surgery. The subjects were divided into two groups; i.e., into those who were (dialysis group) and were not (control group; i.e., non-dialysis group) on maintenance dialysis therapy. The dialysis and control group consisted of 29 and 99 patients, respectively. Aortic valve replacement and coronary artery bypass grafting were the most common forms of cardiac surgery, and they exhibited similar frequencies in both groups. There were 2 (7%) and 3 (3%) in-hospital deaths in the dialysis and control groups, respectively. The postoperative hospital stay was significantly longer in the dialysis group (30.7 days vs. 23.3 days), and the proportion of patients requiring unplanned extracorporeal circulation was significantly higher in the dialysis group (17% vs. 1%). However, among cases involving isolated coronary artery bypass grafting, the duration of the postoperative hospital stay and frequency of unscheduled extracorporeal circulation were comparable between the two groups. In valve operations involving dialysis patients, further examinations should be carried out in order to reduce the risk of unscheduled extracorporeal circulation and shorten the hospitalization period.
A 58-year-old Japanese male with chronic hepatitis C underwent kidney transplantation from an unrelated donor in October 1998. In December 2004, the patient was admitted for spontaneous bacterial ...peritonitis (SBP). Abdominal paracentesis and albumin transfusion were performed, but control of ascites was poor. A randomized, controlled study of patients with SBP showed that patients receiving cefotaxime with a high-volume albumin transfusion (50–75 g/50 kg) were significantly less likely to have irreversible renal failure and had lower mortality. Japan, however, relies on imports for 70% of its albumin formulations, which complicates high-volume albumin transfusion. Consequently, albumin transfusion is often limited to single treatments in the range of only 25 g (25%, 100 ml). A single cell-free and concentrated ascites reinfusion therapy (CART) treatment can reinfuse approximately 60 g of albumin, corresponding to a high-volume albumin transfusion capable of reducing the associated risk of infection or allergic reaction. Though this case was an SBP patient, after the ascites were found to be negative for endotoxins, CART was performed, and control of ascites was achieved without observation of fever, hypotension, or other adverse effects. CART provides greater supplementation of albumin than albumin transfusion and can be an effective modality of treatment for hypoalbuminemia in SBP patients if ascites are negative for endotoxins.
A 71-year-old man with advanced lung adenocarcinoma was treated with carboplatin, pemetrexed, and pembrolizumab in June 2020. Pemetrexed and pembrolizumab maintenance therapy were continued until ...November 2022. A fever and severe fatigue occurred in December 2022; however, the cause of the infection was inconclusive based on the patient's symptoms, imaging findings, and culture tests. Although the patient was administered antibiotics, his general condition worsened. Considering the possible diagnosis of immune-related cytokine release syndrome (CRS), the patient was administered prednisolone (1 mg/kg/day) and showed improvement. In conclusion, CRS can occur even long after the initial administration of immune checkpoint inhibitor therapy.A 71-year-old man with advanced lung adenocarcinoma was treated with carboplatin, pemetrexed, and pembrolizumab in June 2020. Pemetrexed and pembrolizumab maintenance therapy were continued until November 2022. A fever and severe fatigue occurred in December 2022; however, the cause of the infection was inconclusive based on the patient's symptoms, imaging findings, and culture tests. Although the patient was administered antibiotics, his general condition worsened. Considering the possible diagnosis of immune-related cytokine release syndrome (CRS), the patient was administered prednisolone (1 mg/kg/day) and showed improvement. In conclusion, CRS can occur even long after the initial administration of immune checkpoint inhibitor therapy.
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