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Clinical Nephrology
Journal Prestige (SJR): 0.535

Citation Impact (citeScore): 1
Number of Followers: 8

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ISSN (Print) 0301-0430
Published by Dustri-Verlag

[3 journals]

Diffuse "background" monoclonal light chain staining on kidney biopsies in
the absence of electron-dense deposits - putting it into perspective: A
retrospective cohort study.
- Authors: Satoskar AA; Alsanani A, Brodsky SV, Cassol C, Prosek J, Kandukurti K, Ayoub I, Khan A, Devarakonda S, Nadasdy T
  Abstract: Related Articles Diffuse "background" monoclonal light chain staining on kidney biopsies in the absence of electron-dense deposits - putting it into perspective: A retrospective cohort study. Clin Nephrol. 2020 Dec;94(6):307-317
  Authors : Satoskar AA, Alsanani A, Brodsky SV, Cassol C, Prosek J, Kandukurti K, Ayoub I, Khan A, Devarakonda S, Nadasdy T
  BACKGROUND: Pathologic diagnosis of monoclonal gammopathy (MIg)-associated kidney disease requires specific morphologic and immunofluorescence (IF) findings with deposits on electron microscopy. We have encountered kidney biopsies showing only diffuse "background" monoclonal light chain staining, without characteristic morphologic or ultrastructural findings. Such staining is often overlooked if weak, or over-diagnosed as MIg-associated kidney disease if strong, causing dilemma over the need for immediate clone-directed therapy. We performed a clinicopathologic study to better understand its significance.
  MATERIALS AND METHODS: Database search revealed 32 such cases over 12 years. Demographic, laboratory, and pathology data were retrieved along with a mean follow-up of 13 months.
  RESULTS: 15/32 (47%) patients did have active myeloma on hematologic testing (without myeloma casts) warranting immediate clone-directed therapy; but 11/32 (34%) did not develop active myeloma; 3/32 (9%) did not even have detectable paraprotein; 3/32 (9%) were lost to follow-up. Importantly, strong background light chain staining was seen even in some non-myeloma biopsies and conversely, weak staining was seen in some myeloma biopsies, complicating diagnosis.
  CONCLUSION: It is important to recognize and document this finding in the biopsy report, but by itself, it should not be classified as MIg-associated kidney disease even in the face of strong staining intensity. A thorough hematologic work-up is critically important to unmask underlying active myeloma, which many patients may have. But equally important is to avoid inadvertent clone-directed therapy in patients who do not have active myeloma despite the background monoclonal staining. A protocol for periodic monitoring with hematologic and renal parameters to watch for possible malignant transformation is recommend for timely implementation of therapy to minimize renal damage.
  PMID: 33094731 [PubMed - indexed for MEDLINE]
Long-term renal outcomes of IgA nephropathy presenting with different
levels of proteinuria.
- Authors: Ai Z; Zhou Q, Huang F, Yang Q, Yu X
  Abstract: Related Articles Long-term renal outcomes of IgA nephropathy presenting with different levels of proteinuria. Clin Nephrol. 2020 Dec;94(6):290-296
  Authors : Ai Z, Zhou Q, Huang F, Yang Q, Yu X
  AIMS: Proteinuria is a strong prognostic factor in IgA nephropathy (IgAN). However, the risk threshold of proteinuria for kidney disease progression remains in debate. This study aimed to evaluate the risk of different levels of proteinuria on renal outcomes in Chinese patients with IgAN.
  MATERIALS AND METHODS: Patients with biopsy-proven primary IgAN were recruited and divided into four groups based on their proteinuria levels: ≤ 0.30 g/d, 0.31 - 0.50 g/d, 0.51 - 1.00 g/d, and> 1.00 g/d. The primary outcomes were composed by doubling of baseline serum creatinine (Scr) and end-stage renal disease (ESRD, defined as eGFR 1.00 g/d (HR = 14.56, p 1.00 g/d (HR = 13.03, p 1.00 g/d (HR = 8.20, p 1.00 g/d (HR = 6.04, p = 0.001) exhibited a markedly increased risk of ESRD.
  CONCLUSION: Patients with proteinuria levels> 0.30 g/d already have a higher risk of doubling of baseline Scr, suggesting the necessity of early intervention in patients presenting with minimal proteinuria.
  PMID: 32990213 [PubMed - indexed for MEDLINE]
Non-obstructive coronary angiogram findings prior to kidney
transplantation do not predict post-transplant cardiac events.
- Authors: Aziz F; Dhingra R, Anders M, Parajuli S, Mandelbrot D, Djamali A
  Abstract: Related Articles Non-obstructive coronary angiogram findings prior to kidney transplantation do not predict post-transplant cardiac events. Clin Nephrol. 2020 Dec;94(6):273-280
  Authors : Aziz F, Dhingra R, Anders M, Parajuli S, Mandelbrot D, Djamali A
  BACKGROUND: This study aimed to determine the risk factors associated with cardiac events 1 year after transplant in kidney transplant recipients (KTRs).
  MATERIAL AND METHODS: We analyzed the incidence of cardiac events in all KTRs transplanted at our center between 01/2000 and 12/2016, who had non-obstructive cardiac catheterization findings at their pre-transplant evaluation.
  RESULTS: We identified 141 patients with non-obstructive pre-transplant cardiac catheterization. 83 patients (59%) had cardiac events 1 year after the kidney transplant during a mean follow-up of 7.3 ± 5.3 years. Multivariate Cox regression analysis determined dialysis ≥ 1 year (HR = 2.27, 95% Cl 1.41 - 3.67, p = 0.001), body mass index (BMI) ≥ 35 kg/m2 at time of transplant (HR = 2.24, 95% Cl 1.43 - 3.52, p = 0.0004), tacrolimus trough ≥ 7 ng/mL at 1 year post-transplant (HR = 4.24, 95% Cl 1.95 - 9.22, p = 0.0003), and HBA1-c ≥ 7% at 1 year post-transplant (HR = 1.71, 95% Cl 1.09 - 2.70, p = 0.02) as significant predictors of cardiac events 1 year post-transplant. In unadjusted Kaplan-Meier analysis, any cardiac event post-transplant was associated with a significant risk of death or graft loss (p = 0.02).
  CONCLUSION: Dialysis duration, morbid obesity, diabetes control, and tacrolimus levels may represent modifiable risk factors to reduce cardiac events in kidney transplant recipients with non-obstructive cardiac catheterization findings at the time of transplant.
  PMID: 32909547 [PubMed - indexed for MEDLINE]
Cancer surveillance imaging: Does repeated iodinated contrast exposure
impact long-term kidney function'
- Authors: Heinen J; Hsu M, Selby LV, Russo AE, Nash GM, Jaimes EA, Shingarev R
  Abstract: Related Articles Cancer surveillance imaging: Does repeated iodinated contrast exposure impact long-term kidney function? Clin Nephrol. 2020 Dec;94(6):281-289
  Authors : Heinen J, Hsu M, Selby LV, Russo AE, Nash GM, Jaimes EA, Shingarev R
  BACKGROUND: Contrast-induced nephropathy is a well-recognized acute complication in cancer patients, but the long-term effects of repeated contrast exposure are not known. We analyzed the association of the number of contrast-enhanced computed tomography (CECT) examinations and other clinical factors with decline in estimated glomerular filtration rate (eGFR) in colorectal cancer survivors.
  MATERIALS AND METHODS: We retrospectively queried a prospective surgical colorectal cancer database to identify patients with stage I or II cancer who underwent resection in 2007 - 2013 and were alive for at least 3 years. eGFR was calculated before and 3 years after the surgery with ≥ 20% decline relative to baseline defined as significant and used as the primary outcome. The association of clinical factors with the primary outcome was analyzed using logistic regression.
  RESULTS: Only 256 patients with the median follow-up of 65 months had sufficient clinical data for analysis. Median eGFR decline at follow-up was 3.0 mL/min/1.73m2 or 4% change from baseline. 47 patients (18%) had ≥ 20% reduction in eGFR, which was not associated with the number of CECT examinations. Multivariable analysis demonstrated that increasing age (OR, 1.03; 95% CI, 1.00 - 1.06), presence of diabetes (OR, 2.33; 95% CI, 1.18 - 4.61), and longer operation time (OR, 1.04; 95% CI, 1.01 - 1.07) were independently associated with a higher likelihood of ≥ 20% eGFR decline at 3 years.
  CONCLUSION: Older age, diabetes, and longer operating time, but not cumulative contrast exposure were found to be associated with worse long-term renal outcomes following surgical resection in patients with early-stage colorectal cancer who survived 3 years.
  PMID: 32870145 [PubMed - indexed for MEDLINE]