Abstract

Introduction

Methods

Results

Case 1

Case 2

Case 3

Case 4

Case 5

Case 6

Case 7

Discussion

Conclusion

References

Acknowledgements

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Abstract

Background
Steroid-resistant nephrotic syndrome (SRNS), commonly caused by focal segmental glomerulosclerosis (FSGS), is associated with progression to stage 5 chronic kidney disease, requirement for kidney replacement therapy and a risk of disease recurrence post-kidney transplantation. Ofatumumab (OFA) is a fully humanised monoclonal antibody to CD20, with similar mechanisms of action to rituximab (RTX).

Methods
We report a case series of seven UK patients (five paediatric, two adult), all of whom developed FSGS recurrence after kidney transplantation and received OFA as part of their therapeutic intervention. All also received concomitant plasmapheresis. The 2-year outcome of these seven patients is reported, describing clinical course, kidney function and proteinuria.

Results
Four patients (all paediatric) achieved complete urinary remission with minimal proteinuria 12 months post-treatment. Three of those four also had normal graft function. Two patients showed partial remission—brief improvement to non-nephrotic proteinuria (197 mg/mmol) in one patient, maintained improvement in kidney function (estimated glomerular filtration rate 76 ml/min/1.73 m2) in the other. One patient did not demonstrate any response.

Conclusions
OFA may represent a useful addition to therapeutic options in the management of FSGS recurrence post-transplantation, including where RTX has shown no benefit. Concomitant plasmapheresis in all patients prevents any definitive conclusion that OFA was the beneficial intervention.

Introduction
Steroid-resistant nephrotic syndrome (SRNS) is defined as proteinuria > 200 mg/mmol creatinine, hypoalbuminaemia and clinical oedema with no remission of proteinuria following 4 weeks of high-dose (2 mg/kg) corticosteroids, or subsequent loss of steroid responsiveness over time. In childhood, focal segmental glomerulosclerosis (FSGS) is the most common histological finding in SRNS. Progression to stage 5 chronic kidney disease (CKD 5) and requirement for kidney replacement therapy is common in FSGS—43–94% of patients enter CKD 5 within 10 years of diagnosis, depending on immunosuppressant response [1].

Abstract

Background
There are limited population-wide trend data on kidney failure and kidney replacement therapy (KRT) in people with diabetes. We conducted a retrospective cohort study to report incidence trends of kidney failure and KRT and related mortality in people with diabetes in Hong Kong between 2002 and 2015.

Methods
We used territory-wide electronic medical records including laboratory, diagnostic and procedural data to identify people with kidney failure and KRT. We used Joinpoint regression models to estimate the average annual percent change (AAPC) of kidney failure and KRT incidence for entire study period, and annual percent change (APC) for each linear trend segment, along with 1-year and 5-year mortality rates.

Findings
During 4.9 million person-years of follow-up of 712,222 people with diabetes, 31,425 developed kidney failure, among whom 23.0% (n=7,233) received KRT. The incidence of kidney failure declined by 46.8% from 2002 to 2007 (APC: -11.6, 95% CI: -16.3, -6.7), then flattened from 2007 to 2015 (APC: -0.9, 95% CI: -3.1, 1.3). The incidence of KRT remained constant (AAPC: -1.6, 95% CI: -4.4, 1.2). The 1-year mortality rates declined statistically significantly after both kidney failure and KRT. The 5-year mortality rates declined after kidney failure but the decline was not statistically significant after KRT.

Interpretation
The findings of our study highlight the importance of developing new strategies to prevent a looming epidemic of kidney failure in people with diabetes in Hong Kong.

1. Introduction

Kidney failure is a major contributor to chronic disability, impaired quality of life and premature death in people with diabetes[1], [2], [3] . In recent estimates, between 40% and 50% of people newly initiating kidney replacement therapy (KRT) had underlying diabetes4,5 . In Hong Kong, the proportion of people entering KRT attributable to diabetes has increased from 26.2% in 1996 to 49.6% in 20136. The rapidly rising worldwide burden of diabetes in the past 20 years has contributed to increased number of people at high risk of kidney failure and related morbidity and mortality7,8. In the United States, population surveillance revealed a decline in the incidence of kidney failure with KRT in people with diabetes across a 20-year period between 1990 and 2010 which levelled off after 20109,10. In Germany, the incidence of KRT in people with diabetes was stable between 2002 and 201611, whilst that in Australia, increased between 2002 and 201312. Population-wide studies reporting trends in incidence of kidney failure among people with diabetes in Asia are sparse. Understanding the epidemiology of kidney failure in people with diabetes allows us to evaluate the quality of diabetes care, to develop approaches to primary and secondary prevention of kidney disease, and to plan health services to address unmet needs.

1. Introduction

2. Methods

3. Results

4. Discussion

Acknowledgements

References

Abstract

Aims: To investigate levels and changes in diabetes distress over the course of the PRIORITY (Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In people with TYpe 2 diabetes and normoalbuminuria) randomised controlled trial of screening for diabetic kidney disease (DKD) risk among people with type 2 diabetes (T2D) at a specialist diabetes clinic in Denmark.

Methods: Of 436 trial participants with T2D, 216 were invited to complete the 17-item diabetes distress scale at the time of screening (T1, n = 180), immediately after receiving the screening results at 6–8 weeks (T2, n = 169), and at 12 months follow up (T3, n = 107). Linear mixed models were used to explore changes in diabetes distress.

Results: No significant changes in diabetes distress were observed between the time of screening, receiving results, and at 12 months. Changes in diabetes distress were not influenced by diabetes empowerment, sense of coherence, or perceived support for diabetes self-management.

Conclusions: In contrast to previous studies demonstrating that screening programmes can have negative psychological consequences, our findings indicate that participating in this screening programme for DKD does not influence emotional burden or physician-related distress among people with T2D

Introduction

People with diabetes have increased mortality and morbidity. Diabetes-related complications include macrovascular complications such as cardiovascular disease and microvascular complications such as nephropathy, neuropathy, and retinopathy, which are associated with lower quality of life and high healthcare costs.1 Identification and appropriate treatment of people with type 2 diabetes mellitus (T2D) at high risk of developing diabetes-related complications are core disease management activities.

Identification of people at risk of diabetic kidney disease (DKD) typically occurs through screening for albuminuria and kidney function at routine visits when people are still without symptoms of DKD.3 However, the urinary proteomics classifier CKD273 has been suggested as an improved marker for early identification of people at high risk of DKD compared to traditional methods.4 The clinical multicentre intervention trial PRIORITY (Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In people with TYpe 2 diabetes and normoalbuminuria) used this method to screen for future risk of DKD in people with T2D and normal kidney function.

The SARS-CoV-2 (Covid-19) coronavirus pandemic is evolving very quickly and means a special risk for both immunosuppressed and comorbid patients. Knowledge about this growing infection is also increasing although many uncertainties remain, especially in the kidney transplant population. This manuscript presents a proposal for action with general and specific recommendations to protect and prevent infection in this vulnerable population such as kidney transplant recipients.

Introduction

On December 31, 2019, the Wuhan Health Commission reported about groups of people with pneumonia who were epidemiologically linked to a seafood and live animal market in Wuhan, China.1 The etiology was identified as a new coronavirus, with a supposed zoonotic origin. The virus has been recently named the coronavirus of severe acute respiratory syndrome type 2 (SARS-CoV-2) and the disease has been called Coronavirus Disease 2019 (COVID-19).2 So far, there is uncertainty regarding the transmission capacity of the virus. Recent studies show the presence of a high viral load in the oropharynx at early stages of the disease, which increases the concern about the high risk of infectivity during incubation periods or with only mild symptoms.3 The average incubation period has been estimated to be 5–6 days, with a range of 1–14 days. In over 80% of cases the symptoms ofthe disease are mild (fever, cough, expectoration, general malaise), while approximately 20% may have serious clinical manifestations (pneumonia and other clinical complications) that require hospital admission. Pregnant women, newborns, the elderly, immunocompromised and patients with comorbidities such as diabetes mellitus, hypertension and cardiovascular disease, are more to be infected by COVID19, and they are more likely to suffer severe illness that often requires to be admitted to ICU. The impact of COVID-19 on chronic kidney disease has been scantily reported.4 Current mortality rate in China is 3.9% of the cases confirmed by the lab, which is very similar to that of Spain 3.7% (data as of March 16, 2020).5 However, it is still premature to establish the true mortality rate in our country

1. Introduction

2. Materials and methods

3. Results

4. Discussion

Acknowledgments

Appendix A. Supplementary data

Research Data

References

Abstract

Background: The understanding for the impact of petrochemical pollutants exposure on renal functions is limited. Objectives: Our study examined the associations between renal functions and pollutants exposure in adult residents living in the vicinity of a petrochemical industry. Methods: We recruited 2069 adult residents near a big petrochemical complex in Taiwan in 2009e2012, and they were categorized into high exposure (HE) and low exposure (LE) groups based on their address to source by 10 km radius. Study subjects were measured the urinary levels of arsenic, cadmium, mercury, thallium, and 1-hydroxypyrene (1-OHP). The estimated glomerular filtration rate (eGFR) was calculated using the Taiwanese Chronic Kidney Disease Epidemiology Collaboration equation, and the chronic kidney disease (CKD) prevalence and risks were defined according to KDIGO 2012 guidelines. Adjusted generalized linear and logistic regression models were applied to evaluate the associations between petrochemical exposure and renal functions. Results: Subjects in the HE areas had significantly lower eGFR, higher CKD prevalence, and higher levels of urinary arsenic, cadmium, mercury, thallium and 1-OHP. The closer to complex and high exposure group of study subjects were significantly associated with the decrease in eGFR, higher ORs for CKD and high-intermediate risk of CKD. In addition, the study subjects who had two-fold urinary arsenic and 1- OHP levels were significantly with decreased 0.68 and 0.49 ml/min/1.73 m2 of eGFR, respectively. Conclusions: Residing closer and higher arsenic and polycyclic aromatic hydrocarbon exposure were associated with the renal impairment and risks of CKD among the residential population near the petrochemical industry.

Introduction

Since the late 20th century, morbidity and mortality rates for Chronic Kidney Disease (CKD) has skyrocketed (GBD 2013 Mortality and Causes of Death Collaborators, 2015). The global disease burden for CKD now accounts for a prevalence of approximately 11e13% of the adult population worldwide (Hill et al., 2016). Detection of CKD in its early stages prevents progression into End-Stage Renal Disease, which requires a validated index for assessing kidney function. The Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guideline suggests that reduced glomerular filtration rate (GFR) is an accurate indicator of kidney damage (KDIGO, 2013), which is also a predictor of elevated all-cause mortality risk (Matsushita et al., 2010). Common estimating GFR (eGFR) equations are derived from plasma creatinine levels and have been adjusted for populations across the world to further account for demographic differences (Chen et al., 2014; Levey et al., 2009).

1- Introduction

2- Materials and methods

3- Results

4- Discussion

5- Conclusion

References

Abstract

Background and purpose
There is a need to investigate the effects of pilates exercises on the quality of life (QOL) of patients with chronic kidney diseases (CKD). The purpose of this study was to determine the effect of pilates exercises on the QOL of CKD patients.
Materials and methods
For this randomized controlled clinical trial, we enrolled 50 CKD patients. The participants were randomly assigned to experimental (n = 25) and control (n = 25) groups. Modified classical pilates exercises were performed by the experimental group three times a week over a 12-week period. The Quality of Life Short Form (KDQOL-SF) questionnaire was completed by all participants at the beginning of the trial and two months after completion of the intervention. Data analysis was conducted using Chi-square, independent t-test, and paired t-test.
Results
There were significant increases in the scores of QOL dimensions in the experimental group after the intervention (p ≤ 0.05). Comparison of the mean differences at the beginning and two months after the study in the two groups showed that the scores related to QOL dimensions in the experimental group were significantly greater than the control group (p ≤ 0.05).
Conclusion
The findings indicated the pilates exercises can be valuable for improvement of CKD patients’ QOL.

Introduction

Chronic kidney diseases (CKD) lead to permanent kidney damages. These damages and their serious consequences threaten the health of the affected individuals. The incidence, prevalence, and mortality rates related to CKD and end stage renal disease (ESRD) are universally increasing [1–3]. Additionally, the number of patients with CKD is rapidly increasing in Iran. This number increased from 6% of the population in 2012 to 17% in 2015 [4]. Patients endure multiple health conditions, including decreased cardio-respiratory fitness, muscle force, and physical performance [1–3]. These conditions may contribute to emotional and social problems and functional limitations [5]. The physical, mental, and emotional problems associated with CKD, combined with therapeutic procedures and adjustments in lifestyles, such as changes in diet and medications [6], lead to a decrease in patients’ quality of life (QOL) [7]. With advances in medical interventions and increasing the number of patients surviving from chronic health conditions and their lifespan, QOL is increasingly emphasized among healthcare providers for management of chronic diseases [7]. QOL is a multidimensional concept and includes subjective and objective dimensions, such as physical, emotional, social, and mental dimensions [8]. While evidence revealed that problems associated with chronic diseases and their treatments led to a decrease in QOL of patients [8–10], other studies indicated that physical activity was effective in disease prevention and management as well as improvement of QOL [9–11]. In a meta-analysis of multiple clinical trials, Cheema et al. reported that exercise increased muscular strength and QOL in CKD patients [12]. Inversely, in a systematic review, Koufaki et al. indicated that physical inactivity decreased CKD patients’ physical functioning and QOL and increased their morbidity [13]. Tsai et al. (2017) indicated that regular physical training has significant effects on CKD patients’ QOL [14]. Other studies also showed aerobic exercise to be effective in improving QOL and decreasing depression and anxiety in CKD patients [10,15,16].

مقاله سال 2016

مقدمه. ما اجرای قیمت گذاری مبتنی بر فعالیت دارای زمان را برای رقابت درمانهای توده های کلیوی کوچک در مرکز ارجاع دانشگاهی گزارش میکنیم.

روشها. برای استفاده از قیمت گذاری مبتنی بر فعالیت دارای زمان، ما یک نقشه ی فرایند را ایجاد کردیم که رئوس مطالب مراحل درمان توده های کلیوی کوچک را خلاصه میکند. آنگاه هزینه های تامین هر منبع را به ازای هر واحد زمانی استنتاج نمودیم. این روش که به صورت نرخ هزینه ی تولید با حداکثر ظرفیت شناخته شده است شامل تجهیزات و استهلاک آنها (مثلا قیمت به ازای هر دقیقه میز اتاق عمل)، پرسنل و فضا (مثلا هزینه به ازای هر دقیقه اجاره ی فضای بیمارستان) میشود. قیمت گذاری مبتنی بر فعالیت دارای زمان به صورت جمع تولیدات برای هر مداخله تعریف شد.

نتایج. نفرکتومی (برش گرده) جزئی لاپراسکوپی با کمک رباط، گران ترین درمان برای توده های کلیوی کوچک محسوب میشد. این روش 69.7% از ارزانترین نفرکتومی رادیکالی لاپراسکوپی شرایط بیمار بستری ($17,841.79 در مقابل $10,514.05) هزینه برتر بود. هزینه های تجهیزات برای نفرکتومی رادیکالی لاپراسکوپی نسبت به نفرکتومی جزئی باز بیشتر بود. در عین حال برای نفرکتومی رادیکالی لاپراسکوپی در مقابل نفرکتومی جزئی باز، نرخ هزینه ی ظرفیت پرسنل پایین تر به خاطر زمان اتاق عمل سریعتر (195.2 در مقابل 217.3 دقیقه، 0.001= P) و مدت زمان بستری شدن کوتاهتر (2.4 در مقابل 3.7 روز، 0.13= P)، جزء محرکهای اصلی در پایین آوردن هزینه ها محسوب میشدند. قطع عضو از بدن به طریق رادیو فرکانسی، 48.4% از نفرکتومی رادیکالی لاپراسکوپی ارزانتر بود (5,093.83 دلار در مقابل 10,514.05 دلار) که به طور وسیعی با جلوگیری از هزینه های بستری شدن صورت میپذیرد. بیوپسی کلیوی به میزان 3.5% در مقابل 12.2% در هزینه های کلی نفروکتومی جزئی لاپراسکوپی به کمک رباط در مقابل قطع عضو رادیو فرکانسی هم بخشی داشت اما ممکن است سبب پایش فعال مضاعف گردد.