Solid-organ transplant recipients can maintain peripheral immunity for up to 6 months after SARS-CoV-2 infection—especially with greater clinical severity—reports a pre-proof paper in Kidney International.
The researchers evaluated serologic and functional T-cell and B-cell immune memory against major immunogenic SARS-CoV-2 antigens. The cross-sectional study included two groups of COVID-19 convalescent patients: 53 solid-organ transplant recipients (38 kidney recipients) and 49 immunocompetent patients.
In both groups, patients were classified as having severe COVID-19, requiring hospitalization and supplemental oxygen; mild COVID-19, not requiring hospitalization; or asymptomatic infection. Immunologic assessments included SARS-CoV-2-specific serologic memory and immunoglobulin G (IgG)-producing memory B cells
In the United States, diabetes is the leading cause of kidney failure, and the prevalence of diabetes among American Indians and Alaskan Natives (AIs/ANs) is one of the highest among any racial and ethnic group. In the United States, diabetes accounts for 69% of new cases of end stage renal disease (ESRD; diabetes-associated ESRD [ESRD-D]) among the AI/AN population (1).
The roots of this disparity began in the 1950s and 1960s, when the epidemic of diabetes among the AI/AN population was soon followed by a dramatic increase in diabetic kidney disease and subsequent kidney failure, first described in
According to 2019 Association of American Medical Colleges (AAMC) data, international medical graduates (IMGs) comprise 23% of all actively practicing doctors in the United States (1). In nephrology, that number rises to 51% and in the coming years, is expected to grow, given that IMGs now make up nearly 60% of trainees entering the specialty. In the most recent fellowship match (appointment year [AY] 2022), 38% of all matched applicants were non-US IMGs, and most are likely to be on visas (2). The growing number of IMGs on visas (J-1 and H1-B; Table 1)
For patients with chronic kidney disease (CKD), discontinuing renin-angiotensin-aldosterone system inhibitors (RAASi) during episodes of hyperkalemia is associated with increased mortality and cardiovascular events, reports a pre-proof paper in the American Journal of Kidney Diseases.
The retrospective study included data on adult CKD patients with new episodes of RAASi-related hyperkalemia with a serum potassium level 5.5 mM or higher. Drawn from Canadian provincial databases, the analysis included 7200 patients in Manitoba and 71,290 patients in Ontario. The mean ages were 72.39 and 79.48 years, respectively. Several types of comorbidity were more frequent in the Manitoba cohort.
Historically, there has been low use of palliative care in patients with acute kidney injury (AKI), even when requiring kidney replacement therapy, but does this trend hold true in patients with AKI who also have COVID-19? That's the question posed by a recent study in CJASN that analyzed New York University (NYU) Langone Health's electronic health data of COVID-19 hospitalizations between March 2, 2020, and August 25, 2020.
“This research is important because palliative care is often an untapped resource that can help patients and families cope with difficult situations. Serious acute illness is an overwhelming time for
In December 2019, when Chinese authorities alerted the World Health Organization of cases of pneumonia in Wuhan City, for which they were unable to identify a known cause, little did we know that this was just the tip of the iceberg that would leave us with (to quote a Lin-Manuel Miranda song title in “Hamilton”) a “world turned upside down.”
None of us signed up for this. There was a realistic fear of death to health care workers who were already taxed beyond what anyone could imagine. They may have questioned, “Will my patient die because of a bed or
In a procedure designed to closely mimic a human-to-human kidney transplant, Jayme Locke, MD, MPH, director of the Division of Transplantation at The University of Alabama, Birmingham, and her colleagues tested the safety and feasibility of transplanting a genetically engineered pig kidney into a human patient with a non-functioning brain.
The results were reported in January 2022 and showed that the genetically modified pig kidneys did not trigger a hyper-rejection reaction, could support human blood pressure, and could produce urine (1). The procedure was one of a string of recent attempts to test the potential of using pig
Built on innovation, nephrology is a specialty of many firsts: from developing organ replacement therapies to advocating successfully for government support of lifesaving dialysis to removing race from a commonly used clinical algorithm. If asked in 2019, I would have declared nephrology the epitome of visionary leadership: determined to solve the most complex medical and social justice issues globally and inspired by a passion for patients.
Today, I view things somewhat differently. During the past 2 years, our specialty has demonstrated some of the most effective crisis leadership in medicine. When this column publishes, we may be past the worst
Renal cell and non-renal cell carcinomas associated with von Hippel−Lindau (VHL) disease show evidence of response to the hypoxia-inducible factor inhibitor belzutifan, reports a study in The New England Journal of Medicine.
The phase 2, open-label trial included 61 adults with VHL disease, with diagnosis based on the presence of germ- line VHL alterations and at least one renal cell carcinoma measuring at least 10 mm. All patients were treated with belzutifan, a novel oral hypoxia-inducible factor 2α (HIF-2α) inhibitor, at a dose of 120 mg/day. Complete or partial objective responses were assessed by an independent radiology review
A third dose of the COVID-19 vaccine achieves protective antibody levels in nearly 40% of kidney transplant recipients without a previous immune response, reports a study in JAMA Internal Medicine (1).
The single-center, single-blind randomized trial included 201 kidney transplant recipients who did not develop SARS-CoV-2 spike protein antibodies after two doses of the mRNA vaccine. Patients were assigned to either a heterologous vaccination strategy using an Ad26COVS1 viral vector vaccine or a homologous strategy with a third dose of an mRNA vaccine, either BNT162b2 or mRNA-1273. The main endpoint was seroconversion to detectable levels of SARS-CoV-2 spike