Prospective study of the effect of rituximab on kidney function in membranous nephropathy.

Background: Patients with membranous nephropathy (MN) and poor kidney function or active disease despite previous immunosuppression are underrepresented in clinical trials. It is unknown how effective rituximab is in this population.

Methods: This prospective, multi-centre, single-arm, real-world study of patients with active MN [urine protein-creatinine ratio (uPCR) >350 mg/mmol and serum albumin <30 g/L, or a fall in estimated glomerular filtration rate (eGFR) of at least 20% or more over at least 3 months] evaluated rituximab in those with contraindications to calcineurin inhibitors and cytotoxic therapy.

Do outcomes for patients with hospital-acquired Acute Kidney Injury (H-AKI) vary across specialties in England?

Background: Acute Kidney Injury (AKI) is a common and serious clinical syndrome. There is increasing recognition of heterogeneity in observed AKI across different clinical settings. In this analysis we have utilised a large national dataset to outline, for the first time, differences in burden of hospital acquired AKI (H-AKI) and mortality risk across different treatment specialities in the English National Health Service (NHS).

National recommendations to standardise acute kidney injury detection and alerting.

Background: National Health Service England issued a Patient Safety Alert in 2014 mandating all acute Trusts in England to implement Acute Kidney Injury (AKI) warning stage results and to do so using a standardised algorithm. In 2021, the Renal and Pathology Getting It Right First Time (GIRFT) teams found significant variation in AKI reporting across the UK. A survey was designed to capture information on the entire AKI detection and alerting process to investigate the potential sources of this unwarranted variation.

Centre variation in mortality following post-hospitalization acute kidney injury: analysis of a large national cohort.

Background: Routine monitoring of outcomes for patients with acute kidney injury (AKI) is important to drive ongoing quality improvement in patient care. In this study we describe the development of a case mix-adjusted 30-day mortality indicator for patients with post-hospitalization AKI (PH-AKI) across England to facilitate identification of any unwarranted centre variation in outcomes.

Methods: We utilized a routinely collected national dataset of biochemically detected AKI cases linked with national hospitals administrative and mortality data.

Development and validation of the first consensus gene-expression signature of operational tolerance in kidney transplantation, incorporating adjustment for immunosuppressive drug therapy.

Background: Kidney transplant recipients (KTRs) with "operational tolerance" (OT) maintain a functioning graft without immunosuppressive (IS) drugs, thus avoiding treatment complications. Nevertheless, IS drugs can influence gene-expression signatures aiming to identify OT among treated KTRs.

Methods: We compared five published signatures of OT in peripheral blood samples from 18 tolerant, 183 stable, and 34 chronic rejector KTRs, using gene-expression levels with and without adjustment for IS drugs and regularised logistic regression.

Anakinra in the treatment of protracted paradoxical inflammatory reactions in HIV-associated tuberculosis in the United Kingdom: a report of two cases.

Paradoxical reactions, including immune reconstitution inflammatory syndrome (IRIS), are common in patients co-infected with human immunodeficiency virus (HIV) and tuberculosis (TB). Paradoxical reactions may confer substantial morbidity and mortality, especially in cases of central nervous system (CNS) TB, or through protracted usage of corticosteroids. No high-quality evidence is available to guide management in this scenario.

Steroid regulation: An overlooked aspect of tolerance and chronic rejection in kidney transplantation.

Steroid conversion (HSD11B1, HSD11B2, H6PD) and receptor genes (NR3C1, NR3C2) were examined in kidney-transplant recipients with "operational tolerance" and chronic rejection (CR), independently and within the context of 88 tolerance-associated genes. Associations with cellular types were explored. Peripheral whole-blood gene-expression levels (RT-qPCR-based) and cell counts were adjusted for immunosuppressant drug intake.

Long- and short-term outcomes in renal allografts with deceased donors: A large recipient and donor genome-wide association study.

Improvements in immunosuppression have modified short-term survival of deceased-donor allografts, but not their rate of long-term failure. Mismatches between donor and recipient HLA play an important role in the acute and chronic allogeneic immune response against the graft. Perfect matching at clinically relevant HLA loci does not obviate the need for immunosuppression, suggesting that additional genetic variation plays a critical role in both short- and long-term graft outcomes.

Obesity modulates the association between systolic blood pressure and albuminuria.

Background: Obesity is associated with albuminuria and incident kidney disease. Increased vulnerability of the glomerular microcirculation to elevated systemic blood pressure is postulated to contribute to adverse effects of obesity on the kidney. We therefore hypothesized that obesity would modulate the association between systolic blood pressure (sBP) and albuminuria.

Renal artery sympathetic denervation: observations from the UK experience.

Background: Renal denervation (RDN) may lower blood pressure (BP); however, it is unclear whether medication changes may be confounding results. Furthermore, limited data exist on pattern of ambulatory blood pressure (ABP) response-particularly in those prescribed aldosterone antagonists at the time of RDN.

Methods: We examined all patients treated with RDN for treatment-resistant hypertension in 18 UK centres.

Modification of the relationship between blood pressure and renal albumin permeability by impaired excretory function and diabetes.

In animal models, reduced nephron mass impairs renal arteriolar autoregulation, increasing vulnerability of the remaining nephrons to elevated systemic blood pressure (BP). A feature of the resulting glomerular capillary hypertension is an increase in glomerular permeability. We sought evidence of a similar remnant nephron effect in human chronic kidney disease.

Defining the role of renal transplantation in the modern management of multiple myeloma and other plasma cell dyscrasias.

Plasma cell dyscrasias (PCD) are due to an abnormal proliferation of a single clone of plasma or lymphoplasmacytic cells leading to secretion of immunoglobulin (Ig) or an Ig fragment, causing the dysfunction of multiple organs. Median survival of these patients has significantly improved over the last decade due to availability of treatment options such as high-dose melphalan with autologous stem cell transplantation and novel anti-myeloma agents. Renal transplantation has not traditionally been considered in these patients due to the previously limited prognosis, along with concerns relating to disease recurrence affecting the renal allograft and increased infection susceptibility following renal transplant due to immunosuppression and the PCD itself.

Natural history of proteinuria in renal transplant recipients developing de novo human leukocyte antigen antibodies.

Background: The relationship between humoral rejection and human leukocyte antigen (HLA) antibodies is established. Proteinuria is the hallmark of glomerular injury. The relationship between HLA antibody and proteinuria was explored in renal transplant recipients developing de novo donor-specific antibodies (DSA) and nondonor-specific antibodies (NDSA).

Catheter access for hemodialysis defines higher mortality in late-presenting dialysis patients.

Background: This study explores the relationship between mortality and late presentation for dialysis, focusing on the role of catheter access for hemodialysis (HD).

Methods: We analyzed data from a cohort of 286 patients commencing dialysis in 2000-2001. Survival and factors associated with death were analyzed by univariate and multivariate analysis.

Quality of life following live donor renal transplantation: a single centre experience.

Background: The aim of this study was to examine the quality of life (QoL) of the live donor renal transplant (LDRTx) recipients pre- and post-transplantation and correlate with their pre-transplant (pre-Tx) dialysis status and immunosuppressive regimens post-transplantation (post-Tx).

Material/methods: 57 LDRTx recipients and 38 healthy individuals as controls participated in the study. The Kidney Transplant Questionnaire (KTQ) and the Medical Outcome Survey Short Form 36 (SF-36) questionnaires were used to assess QoL.

Transplant glomerulopathy: morphology, associations and mechanism.

Transplant glomerulopathy (TG) is a lesion with specific morphology and strong evidence of an immune mechanism. The incidence of TG is approximately 20% by 5 years after transplantation. TG is characterized by proteinuria, hypertension and declining graft function.

Injury to a transplanted kidney during caesarean section: a case report.

As fertility is restored after renal transplant, more female recipients of a renal transplant successfully complete pregnancies that are safe for the mother, the fetus, and the renal allograft. Although the transplanted kidney lies in one of the iliac fossae, normal vaginal delivery is not impeded by this positioning. Caesarean section is indicated in many scenarios, primarily for obstetric reasons, particularly when the transplanted kidney lies in a position where it could be injured.

Polycystic kidney disease is a risk factor for new-onset diabetes after transplantation.

Background: Data from matched historical cohort studies suggest that autosomal-dominant polycystic kidney disease (ADPKD) may be a risk factor for new-onset diabetes after transplantation (NODAT).

Method: A retrospective study of 429 renal allografts transplanted from 1990 through 2004 in nondiabetic patients was performed. A multivariate analysis of risk factors for NODAT was performed with focus on ADPKD.