HIV-positive adults are at risk for various kidney diseases, and apolipoprotein 1 (APOL1) high-risk genotypes increase this risk. This study aimed to determine the prevalence and ethnic distribution ...of APOL1 risk genotypes among a cohort of HIV-positive Nigerian adults and explore the relationship between APOL1 risk variant status with albuminuria and estimated glomerular filtration rate (eGFR). We conducted a cross-sectional study among 2 458 persons living with HIV who attended an HIV clinic in northern Nigeria and had received antiretroviral therapy for a minimum of six months. We collected two urine samples four-eight weeks apart to measure albumin excretion, and blood samples to measure eGFR and determine APOL1 genotype. The frequency of APOL1 high-risk genotype was 6.2%, which varied by ethnic group: Hausa/Fulani (2.1%), Igbo (49.1%), and Yoruba (14.5%). The prevalence of microalbuminuria (urine/albumin creatinine ratio 30– 300 mg/g) was 37%, and prevalence of macroalbuminuria (urine/albumin creatinine ratio over 300 mg/g) was 3%. The odds of microalbuminuria and macroalbuminuria were higher for participants with the APOL1 high-risk genotype compared to those carrying the low-risk genotype (adjusted odds ratio 1.97, 95% confidence interval 1.37-2.82 and 3.96, 1.95-8.02 respectively). APOL1 high-risk genotype participants were at higher risk of having both an eGFR under 60 ml/min/1.73m2 and urine/albumin creatinine ratio over 300 mg/g (5.56, 1.57-19.69). Thus, we found a high proportion of HIV-positive, antiretroviral therapy-experienced, and largely virologically suppressed adults had microalbuminuria. Hence, although the high-risk APOL1 genotype was less prevalent than expected, it was strongly associated with some level of albuminuria.
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A 32-year-old male presented with hypertensive emergency and features of thrombotic microangiopathy. He underwent a kidney biopsy after renal dysfunction persisted despite clinical improvement ...otherwise. The kidney biopsy was performed with direct ultrasound guidance. The procedure was complicated by hematoma formation and persistent turbulent flow on color Doppler concerning for ongoing bleeding. Serial point of care ultrasounds of the kidney with color flow Doppler were used to monitor the size of the hematoma and determine if there was evidence of ongoing bleeding. These serial ultrasounds showed stable hematoma size, resolution of biopsy-associated Doppler signal and prevented further invasive interventions.
Metcalfe’s Law states that the value of a network is proportional to the square of the number of connected users.1 So, networks with few users provide low value and each additional user increases the ...value of the network exponentially. This law makes it particularly difficult for newer, smaller networks to grow because they are low value due to their low population. At the beginning of the decade (circa 2010), nephrology social media was a new, small network. At that time, a core group of bloggers envisioned a large network of engaged and academically minded nephrologists participating in an active, multifaceted, always-on conversation to provide support, answer questions, discuss journal articles, and share resources. To promote this vision and entice nephrologists to participate, they presented at hospital-wide grand rounds, resident teaching rounds, and national meetings.2 Convincing individuals to sign up for a social media account with the intention of professional use was difficult, but even if a person successfully signed up to Twitter, new users would not know what to do, where to look for like-minded nephrologists, or how to engage with peers. Beyond the issue of how to use social media was the fundamental problem that the value proposition of the nephrology social network was low due to its limited size and activity.
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