KDOQI US Commentary on the 2021 KDIGO Clinical Practice Guideline for the Management of Glomerular Diseases.

The KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases represents the first update to this set of recommendations since the initial set of KDIGO guideline recommendations was published in 2012. The pace of growth in our molecular understanding of glomerular disease has quickened and a number of newer immunosuppressive and targeted therapies have been introduced since the original set of guideline recommendations, making such an update necessary. Despite these updates, many areas of controversy remain.

The lupus nephritis classification: lost in translation.

Purpose Of Review: The ISN/RPS lupus nephritis classification is in the process of undergoing a revision. It has lost its way and morphed from a classification based on pathophysiology of disease into a staging system based on the extent of spread and prognosis.

Recent Findings: There are multiple different pathophysiologic processes that contribute to lupus nephritis.

IgA Nephropathy with Crescents: A Single-Center Experience.

Introduction: The presence of crescents in IgA nephropathy (IgAN) has been associated with a poor prognosis. We assess the prognosis of crescents in our patients with IgAN.

Methods: IgAN was diagnosed in 73 patients biopsied at Rush University Medical Center from 1992 to 2020, and crescents were seen in 26 (36%).

Percutaneous Renal Biopsy Using an 18-Gauge Automated Needle Is Not Optimal.

Background: As percutaneous renal biopsies (PRBs) are increasingly performed by radiologists, an increase in the use of 18-gauge automated needle stands to compromise adequacy. We compare the adequacy and safety of PRB with 14-, 16-, and 18-gauge automated needles.

Methods: PRB of native (N-592) and transplant (T-1,023) kidneys was performed from January 2002 to December 2019 using real-time ultrasound.

Bisphosphonate Versus Bisphosphonate and Calcitonin for the Treatment of Moderate to Severe Hypercalcemia of Malignancy.

Background: Historically, intravenous (IV) bisphosphonates with calcitonin are the treatment of choice for hypercalcemia of malignancy. However, evidence is lacking.

Objective: The objective of this study was to compare the use of bisphosphonate versus bisphosphonate with calcitonin for moderate to severe hypercalcemia of malignancy.

Single-dose sodium polystyrene sulfonate for hyperkalemia in chronic kidney disease or end-stage renal disease.

Background: The use of sodium polystyrene sulfonate (SPS) for the treatment of hyperkalemia lacks sufficient efficacy data in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD); however, use remains widespread. Recent evidence suggests that this population may be at risk for serious gastrointestinal adverse effects with SPS. We conducted a single-center retrospective cohort study.

Changing Trends in the Performance of Percutaneous Renal Biopsy from Nephrologist to Interventional Radiologist: A Single-Center Experience.

Background: Percutaneous renal biopsy of native kidneys (PRB) has been an integral part of the practice of nephrology. However, over the past 30 years, PRB has transitioned from a procedure performed only by nephrologists to interventional radiologists (IRs). We surveyed practicing nephrologists completing training in our program to determine the clinical practice patterns of PRB.

Comparison of native and transplant kidney biopsies: diagnostic yield and complications.

Background: The safety and adequacy are established for the native percutaneous renal biopsy (PRB) but no prospective studies exist that directly compare these with transplant PRB.

Methods: From 1995 to 2015, 1705 adults underwent percutaneous native [native renal biopsy (NRB)] or transplant renal biopsy (TRB) by the Nephrology service. Real-time ultrasound and automated biopsy needles (NRB, 14 or 16 gauge; TRB, 16 gauge) were used.

Risk of percutaneous renal biopsy of native kidneys in the evaluation of acute kidney injury.

Background: Percutaneous renal biopsy (PRB) of native kidneys (NKs) to better understand and treat acute kidney injury (AKI) is being advocated, but little is known about the risk of complications.

Methods: We performed a retrospective study of PRB of NKs in 955 adults from 1991 to 2015 at an academic medical center with real-time ultrasound and automated biopsy needles. Patients undergoing PRB for evaluation of AKI ( = 160) were compared with 795 patients biopsied for other reasons (not-AKI) for postbiopsy complications [need for transfusion of packed red blood cells (PRBCs), an interventional radiologic or surgical procedure, readmission or death].

Comparison of luteolysis and timed artificial insemination pregnancy rates after administration of PGF in the muscle or the ischiorectal fossa in cattle.

Prostaglandin F (PGF) is commonly injected intramuscularly (IM) in female cattle in synchronization protocols. A novel site for administration of PGF that improves beef quality assurance is the ischiorectal fossa (IRF). The objective of this study was to determine whether administration of PGF in the IRF results in a similar physiological response to an intramuscular injection.

Administration of recombinant bovine somatotropin prior to fixed-time artificial insemination and the effects on fertility, embryo, and fetal size in beef heifers.

Our objectives were to determine the effects of the administration of recombinant bovine somatotropin (bST) at the initiation of a fixed-time AI (TAI) protocol on concentrations of plasma IGF-1, follicle diameter, embryo/fetal size, and pregnancy rates in replacement beef heifers. Four hundred and fourteen Angus-based beef heifers were enrolled in a completely randomized design at 4 locations from January to July of 2016. All heifers were exposed to the 7-d CO-Synch + controlled internal drug release (CIDR) protocol where they received a 100-µg injection of GnRH and a CIDR insert on day -9, 25 mg of PGF2α at CIDR removal on day -2, followed by a 100-µg injection of GnRH and TAI 54 ± 2 h later on day 0.

Hemoglobinuric acute kidney injury in a patient with a kinked prosthetic aortic graft .

Acute kidney injury (AKI) due to intravascular hemolysis has been well described in paroxysmal nocturnal hemoglobinuria (PNH) and in cardiac valvular dysfunction. However, reported cases of hemoglobinuric AKI from prosthetic aortic grafts are sparse. We present a case of microangiopathic hemolytic anemia and hemoglobinuric AKI presenting 9 days after repair of an ascending aortic dissection with a prosthetic graft.

McArdle disease: a "pediatric" disorder presenting in an adult with acute kidney injury.

Rhabdomyolysis is characterized by the acute breakdown of skeletal muscle, resulting in the release of muscle cell contents, subsequent myoglobinuria, and in severe cases, acute renal failure. A number of etiologies have been identified in acute rhabdomyolysis, in which drugs and trauma account for the majority of cases. One etiological category that is commonly overlooked in the adult population is an underlying genetic defect.

Reset Osmostat: The Result of Chronic Desmopressin Abuse?

A reset osmostat as a cause of hyponatremia can be found in a variety of clinical settings, including pulmonary and neurologic diseases, as well as in physiologic circumstances such as pregnancy. This teaching case describes a 72-year-old white man with a long-standing history of self-medicating with desmopressin acetate (DDAVP) who presented with profound hyponatremia. On discontinuation of DDAVP treatment, he was found to have a reset osmostat.

The Impact of Baseline Serum Creatinine on Complete Remission Rate and Long-Term Outcome in Patients with Severe Lupus Nephritis.

Background/aim: We assess the impact of serum creatinine at baseline on complete remission rate and long-term outcome in severe lupus nephritis (SLN).

Methods: A total of 86 adult patients with SLN [International Society of Nephrology/Renal Pathology Society (ISN/RPS) class IV lesions] were evaluated based on baseline serum creatinine levels (≤1.0, 1.

We Perform Surveillance for Arteriovenous Graft Stenosis.

Successful hemodialysis is dependent on high unimpeded blood flow. Arteriovenous grafts are notorious for access stenosis, a precursor for access thrombosis. Access surveillance techniques are available and in observational studies have been superior to clinical monitoring for the detection of access stenosis and subsequent prevention of thrombosis in arteriovenous grafts.

Estrous synchronization strategies to optimize beef heifer reproductive performance after reproductive tract scoring.

Three experiments comparing four estrous synchronization protocols were conducted to determine estrous expression rate and artificial insemination pregnancy rate (AI-PR) in heifers with a range (1-5) of reproductive tract scores (RTSs). At enrollment (Day 0), 1783 Angus cross beef heifers from six locations were given body condition score and RTS. The four protocols were: (1) HRTS-DPGF group-heifers with RTS 5 received prostaglandin F2α (PGF; Dinoprost 25 mg; im) on Days 0 and 14; (2) HRTS-CIDR-PGF group-heifers with RTS 5 received a CIDR (1.

Clinical factors influencing the decision to transfuse after percutaneous native kidney biopsy.

Background: Transfusion of erythrocytes is the most common intervention after a complicated percutaneous renal biopsy (PRB). Anemia is considered to be a leading risk factor for bleeding following a PRB, and based on recent studies of transfusions in hospitalized patients, many institutions are restricting the threshold for erythrocyte transfusion to a lower hemoglobin concentration (Hgb). The purpose of this study is to analyze factors that influence the transfusion decision after a PRB, and to determine whether anemia is truly a risk factor for bleeding or anemic patients are simply more likely to receive a transfusion because of their already lower pre-PRB Hgb.

Adequacy and complication rates with 14- vs. 16-gauge automated needles in percutaneous renal biopsy of native kidneys.

In performing percutaneous renal biopsy (PRB) of native kidneys, an increasing use of 16-gauge automated biopsy needles has been observed. We compare the adequacy and safety of PRBs in adults performed with a 14-gauge (n = 82) vs. 16-gauge (n = 55) automated needle using real-time ultrasound (US) from 1/2010 to 12/2013.

Percutaneous renal biopsy of native kidneys: a single-center experience of 1,055 biopsies.

Background: Percutaneous renal biopsy (PRB) of native kidneys is an essential tool in the diagnosis and management of renal disease. We report one of the largest single-center experiences on the success and safety of the procedure.

Methods: From June 1983 to March 2012, 1,055 adults underwent PRB using real-time ultrasound guidance and 14-gauge biopsy needles.

Fertility in Angus cross beef cows following 5-day CO-Synch + CIDR or 7-day CO-Synch + CIDR estrus synchronization and timed artificial insemination.

The present study determined whether a 5-day CO-Synch + controlled internal drug release (CIDR) protocol with two doses of PGF2α would improve timed artificial insemination (AI) pregnancy rate compared with 7-day CO-Synch + CIDR protocol in beef cows. Angus cross beef cows (N = 1817) at 12 locations were randomly assigned to 5-day CO-Synch + CIDR or 7-day CO-Synch + CIDR groups. All cows received 100 μg of GnRH and a CIDR insert on Day 0.

Complications of the percutaneous kidney biopsy.

Percutaneous kidney biopsy is an integral part of a nephrologist's practice. It has helped to define nephrology as a subspecialty. When indicated, it is a necessary procedure to help patients, as it allows for diagnostic, prognostic, and therapeutic information.