scholarly journals Long-term kidney function in children with Wilms tumour and constitutional WT1 pathogenic variant

2021 ◽  
Author(s):  
Maria Pia Falcone ◽  
Kathryn Pritchard-Jones ◽  
Jesper Brok ◽  
William Mifsud ◽  
Richard D. Williams ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Kidney Function ◽  
Kidney Failure ◽  
Patient Survival ◽  
Pathogenic Variant ◽  
International Studies ◽  
Wilms Tumour ◽  
Increased Risk

Abstract Background Wilms tumour (WT) survivors, especially patients with associated syndromes or genitourinary anomalies due to constitutional WT1 pathogenic variant, have increased risk of kidney failure. We describe the long-term kidney function in children with WT and WT1 pathogenic variant to inform the surgical strategy and oncological management of such complex children. Methods Retrospective analysis of patients with WT and constitutional WT1 pathogenic variant treated at a single centre between 1993 and 2016, reviewing genotype, phenotype, tumour histology, laterality, treatment, patient survival, and kidney outcome. Results We identified 25 patients (60% male, median age at diagnosis 14 months, range 4–74 months) with WT1 deletion (4), missense (2), nonsense (8), frameshift (7), or splice site (4) pathogenic variant. Thirteen (52%) had bilateral disease, 3 (12%) had WT-aniridia, 1 had incomplete Denys-Drash syndrome, 11 (44%) had genitourinary malformation, and 10 (40%) had no phenotypic anomalies. Patient survival was 100% and 3 patients were in remission after relapse at median follow-up of 9 years. Seven patients (28%) commenced chronic dialysis of which 3 were after bilateral nephrectomies. The overall kidney survival for this cohort as mean time to start of dialysis was 13.38 years (95% CI: 10.3–16.4), where 7 patients experienced kidney failure at a median of 5.6 years. All of these 7 patients were subsequently transplanted. In addition, 2 patients have stage III and stage IV chronic kidney disease and 12 patients have albuminuria and/or treatment with ACE inhibitors. Four patients (3 frameshift; 1 WT1 deletion) had normal blood pressure and kidney function without proteinuria at follow-up from 1.5 to 12 years. Conclusions Despite the known high risk of kidney disease in patients with WT and constitutional WT1 pathogenic variant, nearly two-thirds of patients had sustained native kidney function, suggesting that nephron-sparing surgery (NSS) should be attempted when possible without compromising oncological risk. Larger international studies are needed for accurate assessment of WT1genotype-kidney function phenotype correlation.

scholarly journals Preeclampsia and the risk of chronic kidney disease: a national registry-based cohort study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
P M Barrett ◽  
F P McCarthy ◽  
M Evans ◽  
M Kublickas ◽  
I J Perry ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Absolute Risk ◽  
Population Based ◽  
National Registry ◽  
Medical Birth Register ◽  
Increased Risk ◽  
History Of

Abstract Background Preeclampsia is associated with increased risk of future cardiovascular disease, but evidence for associations with chronic kidney disease (CKD) has been inconsistent to date. We aimed to measure associations between preeclampsia and long-term CKD in a population-based sample of parous women, and to identify whether the risk differs by CKD subtype. Methods Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Preeclampsia was the main exposure of interest and was treated as a time-dependent variable. The primary outcome was maternal CKD, and this was classified into 5 subtypes: hypertensive, diabetic, glomerular/proteinuric, tubulo-interstitial, other/non-specific CKD. Cox proportional hazard regression models were used for analysis. Women with pre-pregnancy comorbidities were excluded. Results The dataset included 1,924,591 unique women who had 3,726,819 singleton pregnancies. The median follow-up was 20.7 (interquartile range 9.9-30.0) years. Overall, 90,964 women (4.7%) experienced preeclampsia and 18,146 (0.9%) developed CKD. Women who had preeclampsia had higher risk of developing any CKD during follow-up (aHR 1.88, 95% CI 1.79-1.98). The risk differed by CKD subtype, and was higher for hypertensive CKD (aHR 3.76, aHR 3.09-4.57), diabetic CKD (aHR 3.45, 95% CI 2.83-4.21) and glomerular/proteinuric CKD (aHR 2.08, 95% CI 1.90-2.29). Women who had preterm preeclampsia, recurrent preeclampsia, or preeclampsia complicated by pre-pregnancy obesity were also at greater risk of any CKD. Conclusions Women with a history of preeclampsia are at increased risk of long-term CKD. The risk is most marked for hypertensive CKD, diabetic CKD, and glomerular/proteinuric CKD. The absolute risk of CKD related to preeclampsia is substantial, and these women may warrant systematic renal monitoring in the years following delivery. Key messages Preeclampsia is an independent predictor of long-term risk of chronic kidney disease in otherwise healthy parous women. Women with a history of preeclampsia may warrant systematic renal monitoring through additional blood pressure, blood glucose, and proteinuria checks.

Increased Risk for EBV-Lymphoma after Allogeneic Hsct in Adult Lymphoma Patients?A Retrospective Study of Reduced Compared to Myeloablative Conditioning.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5116-5116
Author(s):  
Hans G. Hagglund ◽  
Mats Brune ◽  
Gunnar Oberg ◽  
Hans Hagberg ◽  
Niklas Theorin ◽  
...  
Keyword(s):  
Patient Survival ◽  
Group Versus ◽  
Myeloablative Conditioning ◽  
Term Survival ◽  
Allogeneic Hsct ◽  
Increased Risk ◽  
Unrelated Donors ◽  
Causes Of Deaths

Abstract The aim of this study was to compare the outcome of allogeneic HSCT after myeloablative versus reduced intensity conditioning (RIC) for lymphoma. From January 1984 to June 2004, 87 patients underwent HSCT for lymphoma (including 41 patients with RIC, all grafted after May 1998). The diagnoses were 15 and 24 aggressive, 18 and 17 indolent and 8 and 5 HD lymphomas, in the RIC and myeloablative groups, respectively. There were 64 males and 23 females. The median age was 40 (16–61). The donors were 3 identical twins, 55 related and 29 unrelated donors. The conditioning was based on chemotherapy only in 32 and 8 and irradiation in combination with chemotherapy in 9 and 38 patients (p<0.001), in the RIC and myeloablative groups, respectively. Immunosuppression consisted of MTX and CsA in 68, CsA and MMF in 10, MTX or CsA in 4, T-cell depletion in 2 and 3 patients had no prophylaxis. In the RIC group the median age was significantly higher 49 (25–61) years than in the myeloablative group 38 (16–53) years (p<0.001). PBSC was used in 36 (88%) patients in the RIC group versus 17 (37%) (p<.001) in the myeloablative group. The causes of deaths were 11 infections, 10 relapses, 6 EBV-lymphomas, 6 related to toxicity and 3 to GVHD and 1 renal cancer. Conclusions: Long term survival was seen in more than 50 % of patients with relapsing lymphoma after allogeneic HSCT. EBV lymphoma was the cause of death in 7% of the patients. The patient survival, TRM and relapse outcomes were similar after RIC and myeloablative conditioning but each subgroup is small. In the RIC group the patients were older, grafted in more advanced disease and the follow up shorter compared to the myeloablative group, therefore the results must be interpreted with care. Results RIC Myeloablative p GVHD (absolute incidence) Acute II-IV 43% 16% ns Chronic 32% 57% 0.06 Outcome (2-years probability) TRM 25% 39% ns Relapse 21% 16% ns Patient survival 61% 54% ns

Delayed Chronic Kidney Disease (CKD) after Hematopoietic Cell Transplantation (HCT).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 552-552
Author(s):  
Andrea R. Carter ◽  
Michael Choi ◽  
Can-Lan Sun ◽  
Liton Francisco ◽  
Stephen J. Forman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Unrelated Donor ◽  
Transplant Recipients ◽  
Increased Risk ◽  
Autologous Hct ◽  
One Year

Abstract Exposure to pre-transplant nephrotoxic agents, total body irradiation (TBI), and presence of chronic graft-versus-host disease (cGVHD) have been identified as risk factors for developing CKD after HCT. However, small sample size, short follow-up post-HCT, and varying definitions of CKD have precluded a precise estimation of the magnitude of risk and associated risk factors. The aim of the current study was to describe the incidence and risk factors associated with the development of delayed CKD in HCT survivors. Eligible subjects underwent HCT for hematological malignancies or severe aplastic anemia at City of Hope, survived at least one year post-transplant, and were free of CKD at one year post-HCT. Information on pre-transplant therapeutic exposures and post-transplant CKD was obtained via medical record abstraction. All CKD cases were defined according to the National Kidney Foundation’s definition based on glomerular filtration rate (GFR) values. The endogenous filtration marker creatinine was used to estimate GFR values. CKD was defined as a sustained elevation of serum creatinine which infer a GFR of less than 60 mL/min/1.73 m2 for 3 months or longer. The equation used to calculate GFR was as follows: GFR = 186 x (Pcr) −1.154 x (age) − 0.203 (x 0.742 if female) (x 1.210 if African American). Totally, 1,546 eligible subjects were identified (median age at HCT of 34.4, median length of follow-up 6.2 years; autologous HCT in 718 patients [46%], related donor HCT in 726 patients [47%], and unrelated donor HCT in 102 patients [7%]; 59% of subjects (n=913) were male). A total of 65 patients were identified with CKD, resulting in a cumulative incidence of 3.6% [95% confidence interval (CI), 2.6% to 4.6%] at five years post–HCT and 4.8% at 10 years (autologous HCT: 2.9% at five years; matched sibling HCT: 4.1%; matched unrelated donor HCT: 10.5%, p<0.05). In allogeneic transplant recipients, older age at HCT (RR per increase of five years, 1.34; 95% CI, 1.30 to 1.38), prophylaxis/treatment of GvHD with cyclosporine and/or tacrolimus (RR, 4.32; 95% CI, 1.25 to 14.89), and a primary diagnosis of Multiple Myeloma (RR=5.38, 95% CI=1.79 to 16.15) were associated with increased risk. For autologous transplant recipients, older age at HCT was associated with increased risk (RR per increase of five years, 1.33; 95% CI, 1.29 to 1.38). Of note, use of TBI, and chemotherapeutic agents for conditioning, and a history of fungal infection were not associated with risk of delayed CKD development. This study describes the magnitude of risk of delayed chronic kidney disease in a large cohort of long-term survivors of autologous and allogeneic HCT, as well as identifies high risk groups in this population, thus setting the stage for appropriate long-term follow-up of the vulnerable sub–groups. Incidence of Chronic Kidney Disease in 1+ Year Survivors of HCT Incidence of Chronic Kidney Disease in 1+ Year Survivors of HCT Incidence of Chronic Kidney Disease in 1+ Year Survivors of HCT (by Type of Transplant) Incidence of Chronic Kidney Disease in 1+ Year Survivors of HCT (by Type of Transplant)

scholarly journals Impaired Fasting Glucose and Chronic Kidney Disease, Albuminuria, or Worsening Kidney Function: A Secondary Analysis of SPRINT

2019 ◽  
Vol 104 (9) ◽  
pp. 4024-4032 ◽  
Author(s):  
Miguel Bigotte Vieira ◽  
João Sérgio Neves ◽  
Lia Leitão ◽  
Rute Baeta Baptista ◽  
Rita Magriço ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Function ◽  
Impaired Fasting Glucose ◽  
Proportional Hazards ◽  
Fasting Glucose ◽  
Secondary Analysis ◽  
Composite Outcome

Abstract Purpose Diabetes mellitus is a risk factor for the development and progression of chronic kidney disease (CKD). However, the association of prediabetes with adverse kidney outcomes is uncertain. Methods We performed a secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), including 9361 participants without diabetes at baseline. We categorized participants according to fasting glucose level as having impaired fasting glucose [≥100 mg/dL (≥5.6 mmol/L)] or normoglycemia [&lt;100 mg/dL (&lt;5.6 mmol/L)]. Unadjusted and adjusted proportional hazards models were fitted to estimate the association of impaired fasting glucose (vs normoglycemia) with a composite outcome of worsening kidney function [≥30% decrease in estimated glomerular filtration rate (eGFR) to &lt;60 mL/min/1.73 m2 in participants without baseline CKD; ≥50% decrease in eGFR or need for long-term dialysis/kidney transplantation in participants with CKD] or incident albuminuria (doubling of urinary albumin/creatinine ratio from &lt;10 mg/g to &gt;10 mg/g). These outcomes were also evaluated separately and according to CKD status at baseline. Results Participants’ mean age was 67.9 ± 9.4 years, 35.5% were female, and 31.4% were black. The median follow-up was 3.3 years, and 41.8% had impaired fasting glucose. Impaired fasting glucose was not associated with higher rates of the composite outcome [hazard ratio (HR): 0.97; 95% CI: 0.8 to 1.16], worsening kidney function (HR: 1.02; 95% CI: 0.75 to 1.37), or albuminuria (HR: 0.98; 95% CI: 0.78 to 1.23). Similarly, there was no association of impaired fasting glucose with outcomes according to baseline CKD status. Conclusions Impaired fasting glucose at baseline was not associated with the development of worsening kidney function or albuminuria in participants of SPRINT.

scholarly journals Prognosis and long-term outcomes of acute kidney injury due to snake envenomation

2019 ◽  
Vol 13 (4) ◽  
pp. 564-570 ◽  
Author(s):  
P S Priyamvada ◽  
Challa Jaswanth ◽  
Bobby Zachariah ◽  
Satish Haridasan ◽  
Sreejith Parameswaran ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Function ◽  
Cox Regression ◽  
Kidney Injury ◽  
Case Definitions ◽  
Snake Envenomation ◽  
Long Term Follow Up

Abstract Background Snakebite is a common occupational hazard in tropical countries. To date, the literature on snakebite-related acute kidney injury (AKI) has been limited by retrospective study designs, lack of uniformity in case definitions of AKI and limited follow-up. This study aims to identify the in-hospital outcomes and long-term changes in kidney function that follow haemotoxic envenomation. Methods All adult patients admitted with AKI following haemotoxic envenomation from January 2016 to June 2017 were recruited and followed up until July 2018. Predictors of in-hospital mortality was assessed. Long-term follow-up data on kidney function were collected from survivors. Results In total, 184 patients with haemotoxic envenomation and AKI were recruited. The mean age of the subjects was 42.2 years [95% confidence interval (CI) 40.3–44.7]. The majority were male (71.2%). The mortality of patients with haemotoxic envenomation was 21.5%. The mortality was considerably higher in patients with Kidney Disease: Improving Global Outcomes (KDIGO) Stage 3 AKI [relative risk (RR) 4.45 (95% CI 1.14–17.42)] and those who met KDIGO urine output criteria [RR 20.45 (95% CI 2.84–147.23)]. A Cox regression model identified mechanical ventilation [odds ratio (OR) 5.59 (95% CI 2.90–10.81)], hypotension [OR 2.48 (95% CI 1.31–4.72)] and capillary leak syndrome [OR 2.02 (95% CI 1.05–3.88)] as independent predictors of mortality. Long-term follow-up data were available for 73 patients. A total of 21 patients (28.7%) developed adverse renal outcomes (glomerular filtration rate &lt;60 mL/min/1.73 m2, urine albumin excretion &gt;30 mg/g and new-onset hypertension or prehypertension). Conclusions AKI resulting from snake envenomation is associated with considerable risk of mortality. The greater the AKI stage the greater the likelihood of mortality. One-third of patients with AKI developed long-term complications like chronic kidney disease, prehypertension and hypertension over the follow-up period.

scholarly journals Long-term health outcomes of people with reduced kidney function in the UK: A modelling study using population health data

PLoS Medicine ◽  
2020 ◽  
Vol 17 (12) ◽  
pp. e1003478
Author(s):  
Iryna Schlackow ◽  
Claire Simons ◽  
Jason Oke ◽  
Benjamin Feakins ◽  
Christopher A. O’Callaghan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Kidney Disease ◽  
Health Outcomes ◽  
Kidney Function ◽  
Medication Use ◽  
Policy Model ◽  
The Uk ◽  
Reduced Kidney Function

Background People with reduced kidney function have increased cardiovascular disease (CVD) risk. We present a policy model that simulates individuals’ long-term health outcomes and costs to inform strategies to reduce risks of kidney and CVDs in this population. Methods and findings We used a United Kingdom primary healthcare database, the Clinical Practice Research Datalink (CPRD), linked with secondary healthcare and mortality data, to derive an open 2005–2013 cohort of adults (≥18 years of age) with reduced kidney function (≥2 measures of estimated glomerular filtration rate [eGFR] <90 mL/min/1.73 m2 ≥90 days apart). Data on individuals’ sociodemographic and clinical characteristics at entry and outcomes (first occurrences of stroke, myocardial infarction (MI), and hospitalisation for heart failure; annual kidney disease stages; and cardiovascular and nonvascular deaths) during follow-up were extracted. The cohort was used to estimate risk equations for outcomes and develop a chronic kidney disease–cardiovascular disease (CKD–CVD) health outcomes model, a Markov state transition model simulating individuals’ long-term outcomes, healthcare costs, and quality of life based on their characteristics at entry. Model-simulated cumulative risks of outcomes were compared with respective observed risks using a split-sample approach. To illustrate model value, we assess the benefits of partial (i.e., at 2013 levels) and optimal (i.e., fully compliant with clinical guidelines in 2019) use of cardioprotective medications. The cohort included 1.1 million individuals with reduced kidney function (median follow-up 4.9 years, 45% men, 19% with CVD, and 74% with only mildly decreased eGFR of 60–89 mL/min/1.73 m2 at entry). Age, kidney function status, and CVD events were the key determinants of subsequent morbidity and mortality. The model-simulated cumulative disease risks corresponded well to observed risks in participant categories by eGFR level. Without the use of cardioprotective medications, for 60- to 69-year-old individuals with mildly decreased eGFR (60–89 mL/min/1.73 m2), the model projected a further 22.1 (95% confidence interval [CI] 21.8–22.3) years of life if without previous CVD and 18.6 (18.2–18.9) years if with CVD. Cardioprotective medication use at 2013 levels (29%–44% of indicated individuals without CVD; 64%–76% of those with CVD) was projected to increase their life expectancy by 0.19 (0.14–0.23) and 0.90 (0.50–1.21) years, respectively. At optimal cardioprotective medication use, the projected health gains in these individuals increased by further 0.33 (0.25–0.40) and 0.37 (0.20–0.50) years, respectively. Limitations include risk factor measurements from the UK routine primary care database and limited albuminuria measurements. Conclusions The CKD–CVD policy model is a novel resource for projecting long-term health outcomes and assessing treatment strategies in people with reduced kidney function. The model indicates clear survival benefits with cardioprotective treatments in this population and scope for further benefits if use of these treatments is optimised.

P0621IDENTIFYING PATIENTS WHO NEED LONG TERM FOLLOW UP AFTER RECEIVING RENAL SUPPORT ON ITU

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Naomi Edney ◽  
Daniel Adlington ◽  
Coralie Bingham ◽  
Christopher Mulgrew ◽  
Richard Oram
Keyword(s):  
Primary Care ◽  
Renal Function ◽  
Kidney Disease ◽  
Post Discharge ◽  
Icu Stay ◽  
Increased Risk ◽  
Icu Discharge ◽  
Ckd Stage

Abstract Background and Aims The incidence of acute kidney injury (AKI) is between 20-50% in a critically ill population. AKI is associated with increased risk of chronic kidney disease (CKD), end stage kidney disease (ESKD) and death. 30% of patients on ICU with AKI will have pre-existing CKD1. Arrangements for renal follow up of patients who develop AKI whilst on ICU vary between centres. We aimed to review the renal function pre admission and at one and two years after discharge for all patients who received renal replacement therapy (RRT) with haemofiltration or haemodialysis on ICU during 2016. We reviewed how many were under renal follow up and aimed to identify techniques to improve follow up if required. Method We reviewed electronic records of all patients who received RRT on the ICU during 2016. We assessed demographic details, renal function, details of ICU stay and co morbidities. We excluded patients who died on ICU or received RRT for non-renal indications. Patients who were not under renal follow up were offered a single renal clinic at 2 years (2018) after their ICU discharge. In 2019 we set up a monthly electronic alert to the renal team for all patients who have received haemofiltration on ICU. Each patient’s case was reviewed and either renal follow up arranged or letter sent to primary care and the patient to ensure a 1 year post discharge renal function check to risk stratify them. Results 64 patients received RRT therapy in ICU in 2016 of whom 20 died during their ICU stay and 4 received RRT for non-renal indications. 40 patients were included in further analysis. The median (IQR, range) age was 60(49.5-69.5, 20-87) years. 21/40(53%) were admitted to ICU for sepsis and 8/40(20%) had CKD (defined by eGFR&lt;60), and 6/40(15%) had ESKD, (5 on haemodialysis, 1 transplanted) prior to admission. 33% had diabetes and 64% had vascular disease. 7 were known to the renal team prior to admission and 14/40 (35%) underwent renal follow up post discharge. Excluding those on RRT prior to admission, median (IQR, range) pre-admission eGFR was 82 (55-&gt;90, 30-&gt;90). 3 patients were discharged on RRT. The majority of patients who were discharged from hospital off RRT met eGFR criteria for CKD stage 3, data available for 30, median eGFR 56 (range: 10-&gt;90, IQR: 26-83), N=16/30(54%), p=0.01 compared to pre ICU stay had CKD stage 3 by eGFR criteria. By one year 2 of 3 patients were still on RRT. The majority of patients from hospital off RRT still met eGFR criteria for CKD stage 3, data available for 29, median eGFR 57 (range: 14-&gt;90, IQR: 39-77), N=15/29(52%) had CKD stage 3 by eGFR criteria. By 2 years, data available for 19, median GFR was 51 (range: 12-&gt;90, IQR: 32-86) with 11/19 (57%) meeting CKD stage 3 eGFR. Discharge eGFR was moderately correlated with 2 year follow up eGFR (r=0.49, p=0.03) and post discharge CKD stage 3 did not predict future CKD stage 3 (p=0.35) whereas eGFR at 1 year post discharge was much more strongly correlated with final follow up eGFR (spearman’s r=0.95, p&lt;0.0001) and CKD stage 3 at 1 year predicted CKD at 2 years (p=0.003). Of those with CKD stage 3 at 2 years 5/11 (45%) were followed up in a renal clinic. In 2019, 34 electronic notifications were received. Primary care notified of 11 patients to ensure renal function measured at 1 year. 7 patients died, 8 patients already know to the renal team, 6 patients had new renal follow made at discharge and 2 patients had follow up under other medical specialities. Conclusion eGFR at 1 year post discharge from ICU is the best predictor of long term CKD and this could be used to target patients who need continued renal follow up. Electronic notifications from ICU can help accomplish this.

Serum Free Light Chains Identify Patients With Monoclonal Gammopathy At Increased Risk Of Developing Renal Disease

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1876-1876 ◽  
Author(s):  
Lawrence R. Johnson ◽  
Gerald C. Miller ◽  
Spencer R. Stout
Keyword(s):  
Renal Function ◽  
Kidney Disease ◽  
Renal Impairment ◽  
Renal Disease ◽  
Kidney Function ◽  
Monoclonal Gammopathy ◽  
Normal Kidney ◽  
Serum Free ◽  
Increased Risk

Abstract Background Monoclonal gammopathy (MG) is frequently associated with kidney disease (monoclonal gammopathy of renal significance; MGRS). International guidelines recommend the use of the serum free light chain (FLC) assay when screening for monoclonal gammopathies; an abnormal FLC ratio and an elevation of at least one FLC isotype indicates an Ig LC clone. However it is not known if, in patients with normal kidney function, the presence of a FLC clone predisposes to the future development of kidney disease. Patients and Methods A 22485 patient database with multiple laboratory tests and up to 15-year follow up (Regional Medical Laboratory, Tulsa, OK, USA) was analysed. There were 425 confirmed MG patients with no progression to multiple myeloma. Median age was 72 years (22-97 years) and M/F ratio was 177/248. FLC kappa and lambda were measured nephelometrically with Freelite® (The Binding Site Ltd, Birmingham, UK). Baseline was defined on the first available FLC measurement; this was available at inception in 258 (61%) patients and during follow-up in 167 (39%) patients. 128 patients with MG and an eGFR <60ml/min/1.75m2 and/or a clinical diagnosis of renal disease (ICD9 code) prior to and up to 100 days after baseline were excluded from the analysis. Statistical analyses, including Receiver Operating Characteristics (ROC) to identify monoclonal FLC (iFLC) cut-off were carried out using SPSS v21. Results 297 (of 425) patients had a MG with normal renal function at baseline; 118 (40%) patients had an abnormal FLC ratio (88 kappa, median: 35.5 (7.7-2675) mg/L; 30 lambda, median: 83.6 (0.9-3552) mg/L). 21/297 (7%) patients developed renal impairment during the course of follow up (median: 852 (114-2388) days); 15/21 (71%) had monoclonal FLC production. In these patients there was no association between iFLC (median: 47.8 (0.9-3552) mg/L) and creatinine (median: 0.9 (0.5-1.5) mg/dL) levels (p=0.3966). Time to renal impairment (TTRI) was significantly shorter for patients with an abnormal v normal FLC ratio (75% TTRI: 1261 days v not reached (NR), hazard ratio (HR): 5.31; p<0.001). Age between groups was similar (median: 68 (22-97) v 72 (39-92) years; p=0.0544). In 118 patients withan abnormal FLC ratio, Cox regression analysis identified iFLC concentrations as being associated with the development of impaired renal function (p=0001). Furthermore, patients with iFLC>100mg/L (n=25) were at a significantly increased risk of developing renal impairment compared with patients with iFLC<100mg/L (n=93) (75% TTRI: 874 days v NR, respectively; HR: 6.10; p<0.001). Conclusions These results indicate that the presence of an Ig LC clone is associated with an increased risk of people with MG and normal kidney function progressing to renal disease. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

2021 ◽  
Author(s):  
John R. Prowle ◽  
Lui G. Forni ◽  
Max Bell ◽  
Michelle S. Chew ◽  
Mark Edwards ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Baseline Risk ◽  
Major Surgery ◽  
Increased Risk

AbstractPostoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

scholarly journals Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

2021 ◽  
Author(s):  
Shinwan Kany ◽  
Johannes Brachmann ◽  
Thorsten Lewalter ◽  
Ibrahim Akin ◽  
Horst Sievert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial Appendage ◽  
Systemic Embolism ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
History Of ◽  
One Year ◽  
The One

Abstract Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. Methods Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality. Graphic abstract

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