Clinical and Military Outcomes of Kidney Diseases Diagnosed in Active Duty Service Members.

Introduction: Renal biopsy is a valuable tool for determining diagnosis, management, and prognosis of intrinsic kidney diseases. Indications for biopsy depend on the clinical presentation. Within the military, renal biopsies also enable medical review boards to make military service fitness assessments after diagnosis of a kidney disease.

A Healthy Active Duty Soldier with an Elevated Serum Creatinine.

Creatine products and sports supplements are widely used by active duty soldiers. These products are associated with both acute renal failure and elevated serum creatinine levels without renal injury. We present a case involving an active duty, 26-year-old Caucasian soldier who was evaluated in our clinic for elevated creatinine levels.

Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy.

Background: The global epidemiology of end-stage kidney disease (ESKD) reflects each nation's unique genetic, environmental, lifestyle, and sociodemographic characteristics. The response to ESKD, particularly regarding kidney replacement therapy (KRT), depends on local disease burden, culture, and socioeconomics. Here, we explore geographic variation and global trends in ESKD incidence and prevalence and examine variations in KRT modality, practice patterns, and mortality.

Detection of PLA2R Autoantibodies before the Diagnosis of Membranous Nephropathy.

Background: Circulating serum autoantibodies against the M-type phospholipase A2 receptor (PLA2R-AB) are a key biomarker in the diagnosis and monitoring of primary membranous nephropathy (MN). However, little is known about the appearance and trajectory of PLA2R-AB before the clinical diagnosis of MN.

Methods: Using the Department of Defense Serum Repository, we analyzed PLA2R-AB in multiple, 1054 longitudinal serum samples collected before diagnosis of MN from 134 individuals with primary MN, 35 individuals with secondary MN, and 134 healthy volunteers.

Association of Race and Poverty With Mortality Among Nursing Home Residents on Maintenance Dialysis.

Objectives: The association of race, ethnicity, and socioeconomic factors with survival rates of nursing home (NH) residents with treated end-stage renal disease (ESRD) is unclear. We examined whether race/ethnicity, ZIP code-level, and individual-level indicators of poverty relate to mortality of NH residents on dialysis.

Design: Retrospective cohort study.

A Case Report of Acute Renal Failure as a Result of Light-Chain-Mediated Acute Tubular Interstitial Nephritis in a 30-Year-Old Combat Veteran.

We present a 30-year-old combat veteran with an unclear exposure history, with multiple deployments who was later diagnosed with acute renal failure as a result of light-chain deposition disease. Despite a drastic decline in kappa light chains following chemotherapy; his renal function worsened, and he progressed to end-stage renal disease, requiring hemodialysis. Light-chain-mediated acute tubular interstitial nephritis is an uncommon type of monoclonal gammopathy of renal significance presenting with acute renal failure without significant glomerular disease.

Dialysate-induced hypocalcemia presenting as acute intradialytic hypotension: A case report, safety review, and recommendations.

Intradialytic hypotension is the most common complication associated with hemodialysis. We describe a case of severe intradialytic hypotension during routine chronic dialysis, the presenting symptom of hypocalcemia due to a procedural error involving a zero calcium liquid acid dialysate concentrate. Although human factors were the root cause of this event, we discuss physical and procedural controls that may help to minimize the risk of human error.

Rhabdomyolysis in a Sickle Cell Trait Positive Active Duty Male Soldier.

Exertional rhabdomyolysis is a complication of sickle cell trait (SCT) likely first reported in the military population over 40 years ago. Although commonly a benign condition, numerous studies and case reports have identified SCT positive patients to be at increased risk for rhabdomyolysis, compartment syndrome and sudden cardiac death. We report a recent case of an SCT positive African American active duty male Soldier who suffered exertional rhabdomyolysis following an Army Physical Fitness Test.

Effects of Traumatic Amputation on β-Trace Protein and β2-Microglobulin Concentrations in Male Soldiers.

Background: Serum creatinine (SCr) levels are decreased following traumatic amputation, leading to the overestimation of glomerular filtration rate (GFR). β-Trace protein (BTP) and β2-microglobulin (B2M) strongly correlate with measured GFR and have not been studied following amputation. We hypothesized that BTP and B2M would be unaffected by traumatic amputation.

Possible potassium chlorate nephrotoxicity associated with chronic matchstick ingestion.

We present a case of a 48-year-old active duty male soldier with a history of chronic exposure to potassium chlorate, later diagnosed with chronic interstitial nephritis. He reported regular matchstick consumption to prevent chigger (Trombicula autumnalis) bites, amounting to ∼5.8 g of potassium chlorate over 3 years.

Discovery of a symptomatic left anomalous coronary artery from the opposite sinus and postoperative considerations.

This is the case of an 18 year old active duty soldier with symptoms of exertional chest pressure and syncope who was found to have anomalous origin of the left main coronary artery (LMCA) from the right coronary cusp (RCC) traveling partially between the great vessels before taking a septal approach between the left ventricular outflow tract (LVOT) and the right ventricular outflow tract (RVOT). Anomalous origin of coronary arteries is a rare condition that carries an increased risk of angina, myocardial ischemia, and sudden cardiac death (SCD). Surgical treatment of such anomalies with both high and lower risk features can be challenging, and traditional benefit from surgical correction may not be achieved due to complex anatomy.

A simple device to monitor flexion and lateral bending of the lumbar spine.

Monitoring compliance with exercise and motivating patients with lower back pain to perform prescribed exercise regimens are considerable tasks. The objective of this study was to develop and test a low-cost device that can be used by a patient at home to both record and provide real-time biofeedback of lumbar position in the midsagittal and frontal planes during exercises. Our device utilizes strain gages on a thin stainless steel beam to measure lumbar flexion-extension and an optical mouse sensor attached to the end of the blade to measure lateral bending.