Contribution of polyclonal free light chain deposition to tubular injury.

Introduction: Excretion of monoclonal free light chains (MFLC) beyond the renal threshold can cause kidney injury, but evidence for polyclonal free light chains (PFLC)-mediated injury is limited. We aimed to study the degree of PFLC deposition in the proximal tubules of chronic kidney disease (CKD) and hypothesized that excess deposition may contribute to tubular injury.

Methods: In this retrospective study, immunohistochemical staining to assess the degree of FLC deposition, periodic acid-Schiff staining for the degree of tubular brush border injury and trichrome staining for interstitial fibrosis were evaluated.

Primary cilia metaplasia in renal transplant biopsies with acute tubular injury.

Primary cilia are hair-like organelles singly distributed along the apical surface of proximal and distal nephron tubules as mechanosensors. The goal of this study was to use electron microscopy to systemically evaluate cilia changes in acute tubular injury (ATI) from both transplant and native renal biopsies. Three groups of cases were included: control group 1-native biopsies without major changes in renal tubules; study group 2-native biopsies with prominent ATI; and study group 3-renal transplant biopsies with prominent ATI (delayed renal function group).

Body composition modifications in patients under low protein diets.

Objective: To review the effect of low protein diets on body composition in patients with chronic kidney disease.

Methods: A selected literature review of body composition methods applicable to clinical practice, and a chronological appraisal of relevant studies using low and very low protein diets chosen for their major emphasis on nutritional status and body composition were used for the present study.

Results: Body composition methods were categorized by compartments, techniques, ease of use, clinical applicability, advantages, and disadvantages.

Primary nonfunction of renal allograft secondary to acute oxalate nephropathy.

Primary nonfunction (PNF) accounts for 0.6 to 8% of renal allograft failure, and the focus on causes of PNF has changed from rejection to other causes. Calcium oxalate (CaOx) deposition is common in early allograft biopsies, and it contributes in moderate intensity to higher incidence of acute tubular necrosis and poor graft survival.

Adjuvant role of p53 immunostaining in detecting BK viral infection in renal allograft biopsies.

BK virus infection is a significant threat to renal transplant outcome. Detecting viral infection in renal transplant biopsies using SV40 staining is less than ideal. SV40 antibody reacts with the large T-antigen of BK virus only at the early phases of infection and can miss cells in later stages of infection.

Anemia management with darbepoetin-alfa in outpatient hemodialysis patients switched from epoetin-alfa: a community hospital experience.

Epoetin-alfa (EA) and darbepoetin-alfa (DA) are agents for treating anemia in dialysis patients. In September 2005, our free-standing outpatient hemodialysis center (community-hospital based) implemented an interchange from EA to DA. Since then, all hemodialysis patients receive DA as the preferred agent.

Dietary sodium intake and arterial blood pressure.

We sought to summarize major recent studies in the field of dietary sodium intake and arterial blood pressure, and discuss the following trials. INTERSALT: Sodium intake correlates with the rise in blood pressure with age, but not with the prevalence of hypertension. The population study identified a minimal impact of sodium intake on blood pressure (0.

Hypoalbuminaemia--a marker of cardiovascular disease in patients with chronic kidney disease stages II-IV.

Unlabelled: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD) patients. Serum albumin, a negative acute-phase reactant and marker for underlying inflammation and/or malnutrition, is an independent predictor of CVD and mortality in CKD VI patients. Such an association in patients with less severe CKD is not well established.

Metabolic and nutritional complications of renal transplantation.

Renal transplantation is the gold standard therapy for patients with end-stage renal disease. However, renal transplantation is associated with various metabolic and nutritional complications. This review focuses primarily on factors that have a significant impact on cardiovascular disease, namely, hyperlipidemia, posttransplant diabetes mellitus, and hyperhomocysteinemia.

Prospective nutritional surveillance using bioelectrical impedance in chronic kidney disease patients.

Malnutrition is a well-known risk factor influencing survival in chronic maintenance dialysis patients. Chronic kidney disease (CKD) patients are also predisposed to malnutrition because of dietary restrictions and the catabolic effects of uremia. Therefore, a significant degree of malnutrition may be present before the initiation of renal replacement therapy.

Determinants of coronary vascular calcification in patients with chronic kidney disease and end-stage renal disease: a systematic review.

Background: Vascular calcification (VC) is a recognized process involved in senescence and atherosclerosis. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are conditions associated with metabolic disorders related to soft tissue calcification.

Methods: We performed a systematic review of the literature confined to patients with CKD or ESRD with clinical observations of VC.

Optimal dialysis for the end-stage renal disease patient with cardiovascular disease.

The increasing incidence and prevalence of end-stage renal disease (ESRD) that requires renal replacement therapy has placed a focus on the dialysis procedure itself with respect to its hemodynamic and cardiovascular complications. More than 50% of patients with ESRD will die of cardiovascular disease (CVD). A considerable contribution to cardiovascular events occurs with the dialysis procedure itself.

Best method for estimating urea volume of distribution: comparison of single pool variable volume kinetic modeling measurements with bioimpedance and anthropometric methods.

The urea volume of distribution (Vurea) is a key component of the Kt/V parameter calculated during urea kinetic modeling. The Vurea parameter has been approximated empirically using total body water (TBW) estimates derived from anthropometric formulas or measured by bioelectric impedance analysis (BIA). The author compared TBW values derived using various anthropometric formulas (Watson, Hume, Randall, Tzamaloukas, Chertow) and BIA to the Vurea parameter calculated using three point variable volume single pool urea kinetic modeling.

Hypoalbuminemia is a marker of overhydration in chronic maintenance patients on dialysis.

Hypoalbuminemia is an important risk factor for increased morbidity and mortality in patients on dialysis. Hypoalbuminemia is usually attributed to malnutrition or a state of chronic inflammation. However, hypoalbuminemia could result from hemodilution caused by chronic volume expansion.

Body composition analysis by bioelectrical impedance in chronic maintenance dialysis patients: comparisons to the National Health and Nutrition Examination Survey III.

Objective: To compare bioelectrical impedance analysis derived parameters in chronic maintenance dialysis patients to those obtained in National Health and Nutrition Examination Survey (NHANES) III.

Design: Cross-sectional nutritional surveillance study.

Setting: Hospital-based, not-for-profit chronic maintenance dialysis center.

Impedance vector distribution by sex, race, body mass index, and age in the United States: standard reference intervals as bivariate Z scores.

Bioelectrical impedance measurements were collected in the Third National Health and Nutrition Examination Survey (NHANES III), but their results have not been published. In the NHANES III population, resistance (R) and reactance (Xc) values at 50-kHz frequency were obtained with a Valhalla Scientific meter (model 1990B; San Diego, CA, USA). The RXc graph method was used to identify bivariate pattern distributions of mean vectors (95% confidence ellipses by sex, race, age, and body mass index [BMI]), and individual impedance vectors (50%, 75%, and 95% tolerance ellipses).