Immune checkpoint inhibitors (ICPis) have transformed the landscape of oncology, and they are now approved for the treatment of over one dozen different types of cancer. ICPis block immune checkpoints—the “brakes” of the immune system—and therefore activate cytotoxic T-cells to eliminate cancer cells. However, enhancement of T-cell activity also leads to autoimmune toxicities or immune-related adverse events (irAEs), which can affect multiple organ systems, including the kidneys. ICPi-associated acute kidney injury (ICPi-AKI) can have major repercussions, including discontinuation from therapy and prolonged courses of immunosuppression.
Recently, Gupta et al. (1) conducted a multicenter study of 429 cases of
An analysis of a large cohort of patients with autosomal-dominant polycystic kidney disease (ADPKD) adds new knowledge about risk factors for intracranial aneurysm (IA), including an increase in IA risk for women after menopause, according to a pre-proof paper in Nephrology Dialysis Transplantation.
The cross-sectional, population-based study included 2449 patients with ADPKD (median age, 55 years) from 26 nephrology centers in western France. On genetic analysis in 2386 patients, 67.6% had PKD1 pathogenic variants, and 19.0% had PKD2 pathogenic variants. The researchers analyzed the frequency of diagnosis of ruptured and unruptured IA, along with
The prevalence of malignancy in patients with membranous nephropathy (MN) ranges from 4% to 10% (1, 2). In adults, MN is the most common cause of nephrotic syndrome outside of diabetes and is well described but not well studied in patients with cancer.
In a recent article by Thet and colleagues (3) in Translational Oncology, the authors impart on an update on cancer risks in patients with a glomerular diseases. Thet et al. (3) used MN as a prototype to understand malignancy-related glomerular disease. Malignancy-related MN is a disease of
Peripheral arterial disease (PAD) is three times as prevalent in patients with chronic kidney disease (CKD) compared with their non-CKD counterparts (1). This increased susceptibility has been attributed to the uremic milieu; however, specific mechanisms remain unknown. Recently, in the Journal of Clinical Investigation, Arinze and colleagues (2) shed new light on the detrimental impact of dietary and gut-converted, tryptophan-based uremic toxins (indoxyl sulfate and its metabolites) on neovascularization in PAD.
In a series of elegant studies, the investigators demonstrated that serum from patients with uremia, as well as indoxyl sulfate alone, induced a
Cancer is a worldwide epidemic that has increased its prevalence exponentially over the last decades. In 2020, 19.3 million new cases of cancer were diagnosed, and there were 10 million deaths from cancer worldwide (1). Cancer patients are susceptible to chemotherapy and immunotherapy treatments that can cause renal complications, such as acute kidney injury (secondary to glomerular disease, acute interstitial nephritis, or acute tubular necrosis), electrolyte disorder, proteinuria, and others (2). Additionally, a higher prevalence of cancer has been demonstrated in patients with chronic kidney disease from various types, those with a kidney transplant, and patients
Important decisions about diagnosing kidney disease, managing drug dosing, and considering kidney replacement therapy rely on an accurate estimation of the glomerular filtration rate (GFR), especially in patients with cancer (1, 2). Despite its continued use, the Cockcroft-Gault equation (3), originally created to assess kidney function based on serum creatinine in 1976, has significant limitations that may be even greater in patients with cancer who have sarcopenia. To address this, Costa E Silva and colleagues (4) compared the measured GFR using chromium-51-labeled ethylenediamine tetraacetic acid (51Cr-EDTA) clearance in 1200 patients
In April 2022, the Office of Management and Budget released the annual President's Budget for fiscal year (FY) 2023. The President's Budget is a non-binding request to Congress that describes the priorities of the current administration. In the words of President Biden, “Don't tell me what you value. Show me your budget, and I will tell you what you value.”
The priorities of the current administration are clear. For the Department of Health and Human Services, the budget prioritizes “tackling the COVID-19 pandemic, expanding access to care, addressing health disparities, strengthening behavioral health, and promoting the well-being of children, families,
Pseudo-electrolyte disorders are laboratory artifacts, and failure to recognize this entity can lead to inadvertent treatment. The hallmark of pseudo-electrolyte disorders is that the patient does not exhibit classic signs or symptoms of the underlying electrolyte abnormality. This should prompt clinicians to rule out pseudo-electrolyte disorders before initiating therapy. Here, we highlight pseudo-electrolyte disorders seen in onconephrology practice.
A falsely low sodium level is seen in conditions that reduce the water content of a given volume of plasma, such as 1) severe hyperproteinemia due to paraproteinemia, hypergammaglobulinemia, or intravenous immunoglobulin (IVIG) administration; 2) severe hyperlipidemia due to
Pooja Amarapurkar, Pooja Kalantri, Levard Roberts, and Jose Navarrete
Sickle cell disease and sickle cell trait are associated with several kidney abnormalities. The inner medullary environment of the kidney with low oxygen tension, hyperosmolarity, and acidemia is an ideal setup for hemoglobin polymerization and sickling. Repeated hemolysis, vaso-occlusive episodes, subsequent reperfusion injury, oxidative stress, and inflammation lead to acute and chronic kidney disease (CKD) (1, 2). The various kidney manifestations of sickle cell disease are summarized in Table 1.
Kidney manifestations of sickle cell disease
Glomerular hyperfiltration and lower mean arterial pressure occur in early years of life. With advancing age,
Chronic hypertension occurs in at least 2% of pregnancies in the United States and is associated with high rates of preeclampsia and other adverse pregnancy outcomes. There is ongoing debate over treatment strategies: Continuing antihypertensive therapy during pregnancy reduces the risk of severe hypertension but has not previously been shown to improve maternal, fetal, or neonatal outcomes.
Findings from a new trial reported in The New England Journal of Medicine suggest that pregnancy outcomes are improved by antihypertensive therapy for women with mild chronic hypertension, with a blood pressure target of less than 140/90 mm Hg.