Publications by authors named "Juan Carlos Q Velez"

Background: Chronic kidney disease (CKD) frequency is increasing in patients with cirrhosis and these individuals often experience acute kidney injury (AKI). Direct comparisons of outcomes between AKI-only vs. AKI on CKD (AoCKD) among patients with cirrhosis are not well described.

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Article Synopsis
  • The study investigates the relationship between different causes of acute kidney injury requiring renal replacement therapy (AKI-RRT) and mortality in hospitalized patients with cirrhosis.
  • Conducted across multiple U.S. hospitals in 2019, the research included 2,063 patients, finding that 18.1% underwent AKI-RRT.
  • Results indicate that while patients with hepatorenal syndrome (HRS-AKI) received different treatment approaches compared to those with other causes of AKI, there was no significant difference in 90-day mortality risk between the two groups.
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Background: Hypertension (HTN) is a common side effect of tacrolimus (Tac), the first-line antirejection medication for kidney transplant recipients. The impact of immediate-release tacrolimus (Tac IR) dosed twice daily versus extended-release tacrolimus (Tac ER) dosed once daily on long-term blood pressure control in kidney transplant recipients remains understudied. This study aims to compare the use of Tac IR versus Tac ER in kidney transplant recipients and evaluate the effects of the different formulations on systolic blood pressure (SBP), diastolic blood pressure (DBP), and HTN crisis.

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Key Points: In our patients with FSGS, elevated proteinuria and progression to kidney failure (KF) were associated with a higher risk of cardiovascular disease/all-cause mortality events. In addition, elevated pre-KF proteinuria was associated with KF/all-cause mortality events. CKD stage, nephrotic syndrome, and cardiovascular disease event rates, as well as the incremental costs of these events, were high.

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Hepatorenal syndrome type 1 (HRS-1) is a unique form of acute kidney injury that affects individuals with decompensated cirrhosis with ascites. The primary mechanism leading to reduction of kidney function in HRS-1 is hemodynamic in nature. Cumulative evidence points to a cascade of events that led to a profound reduction in kidney perfusion.

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Article Synopsis
  • * Hepatorenal syndrome (HRS), a severe type of AKI specifically found in patients with advanced cirrhosis and ascites, has an especially high mortality rate, making early detection vital.
  • * In 2023, experts from the International Club of Ascites and the Acute Disease Quality Initiative met to create new diagnostic criteria for HRS-AKI and to establish better practices for treatment and follow-up care for these patients.
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A 72-year-old man with peripheral arterial disease, an atrophic left kidney, and prior right renal chimney stent as part of a complex endovascular abdominal aortic aneurysm repair presented to our emergency department with right flank pain and anuria resulting from right artery occlusion. His serum creatinine on admission was 7.5 mg/dL.

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  • A study on IgA nephropathy (IgAN) found that higher levels of proteinuria and progression to kidney failure (KF) significantly increased the risk of cardiovascular disease and mortality among patients.
  • The research analyzed data from adult patients with IgAN from 2007 to 2021, focusing on the relationship between protein levels and health outcomes using various statistical models.
  • Results indicated that patients with pre-KF status and high proteinuria were 1.8 times more likely to have cardiovascular events and over 2 times more likely to progress to kidney failure compared to those with lower protein levels.
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Key Points: Vacuolar casts are a distinct type of casts identifiable by urinary sediment microscopy. Identification of urinary vacuolar casts is associated with the presence of an advanced and severe form of a proteinuric glomerular disease.

Background: Identification of casts by urinary sediment microscopy is a valuable diagnostic clinical tool for the evaluation of kidney disease.

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Individuals with liver disease are susceptible to pathophysiological derangements that lead to kidney dysfunction. Patients with advanced cirrhosis and acute liver failure (ALF) are at risk of developing acute kidney injury (AKI). Hepatorenal syndrome type 1 (HRS-1, also called HRS-AKI) constitutes a form of AKI unique to the state of cirrhosis and portal hypertension.

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Simple renal cysts typically produce no symptoms or signs and are usually detected incidentally on imaging studies for unrelated causes. Massive renal cysts are very rare. A 77-year-old female with preexisting chronic kidney disease presented to our hospital for evaluation of hyperkalemia, abdominal distension, and right flank pain.

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Rationale & Objective: Among patients with IgA nephropathy (IgAN), proteinuria and decline in kidney function may be associated with increased economic burden. This study aimed to provide current information on the epidemiology and economic burden of IgAN in the United States.

Study Design: Retrospective cohort study.

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Background & Aims: Acute kidney injury (AKI) in cirrhosis is common and associated with high morbidity, but the incidence rates of different etiologies of AKI are not well described in the US. We compared incidence rates, practice patterns, and outcomes across etiologies of AKI in cirrhosis.

Methods: We performed a retrospective cohort study of 11 hospital networks, including consecutive adult patients admitted with AKI and cirrhosis in 2019.

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Key Points: Hepatorenal syndrome type 1 (HRS-1) is an often fatal, but potentially reversible, kidney failure in patients with decompensated cirrhosis. Treatment with terlipressin in patients with HRS-1 is associated with a reduction in the need for RRT.

Background: Hepatorenal syndrome type 1 (HRS-1)—also known as hepatorenal syndrome-AKI (HRS-AKI)—is a rapidly progressing and usually fatal, but potentially reversible, kidney failure occurring in patients with decompensated cirrhosis.

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Article Synopsis
  • IgA nephropathy (IgAN) and minimal change disease (MCD) are the most frequently reported glomerular diseases following COVID-19 vaccinations, especially mRNA vaccines, along with others like membranous nephropathy.
  • A global registry was created to collect anonymized data on patients with glomerular diseases suspected after vaccination, focusing on vaccination details, kidney function, and treatment outcomes.
  • Results show that while IgAN and MCD have a better chance of kidney function recovery and reduced proteinuria within 4–6 months post-vaccination, causality remains unproven despite a temporal link.
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Key Points: Raising the mean arterial pressure (MAP) during management of hepatorenal syndrome type 1 (HRS-1) is associated with improvement in kidney function, independently of baseline MAP or model for end-stage liver disease. Raising the MAP by 15 mm Hg or greater leads to greater reduction in serum creatinine in HRS-1. Norepinephrine use confers greater probability of improvement in kidney function in HRS-1 compared with midodrine/octreotide.

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Background: Evidence supporting venous thromboembolism (VTE) prophylaxis with direct oral anticoagulants (DOACs) in patients with nephrotic syndrome (NS) is limited to case reports.

Objective: The purpose of this study was to compare bleeding and thromboembolic events in this population.

Methods: A retrospective cohort study was conducted in adults with NS initiated on a DOAC or warfarin for VTE prophylaxis between January 2013 and July 2021 within the Ochsner Health System.

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Background: Over the past decade, nephrology has experienced a 43% decline in the number of fellowship applicants. Previous studies examining why residents choose a fellowship program cite lack of exposure as a main factor having an effect against a career in nephrology; however, no studies have surveyed the undergraduate population to inquire whether they recognize nephrology as a medical specialty compared with other medical specialties. We conducted a survey at a primarily undergraduate institution in the Southeast United States to test whether undergraduate students identified the word "nephrology.

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Background: Persistent hyperkalemia (hyperK) and hyperphosphatemia (hyperP) despite renal replacement therapy (RRT) was anecdotally reported in COVID-19 and acute kidney injury (AKI) requiring RRT (CoV-AKI-RRT). However, observation bias could have accounted for the reports. Thus, we systematically examined the rate and severity of hyperK and hyperP in patients with CoV-AKI-RRT in comparison with the pre-COVID-19 era.

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