Patient Survival Between Hemodialysis and Peritoneal Dialysis Among End-Stage Renal Disease Patients Secondary to Myeloperoxidase-ANCA-Associated Vasculitis

BackgroundA significant proportion of anti-neutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis eventually progresses to end-stage renal disease (ESRD) thus requiring long-term dialysis. There is no consensus about which dialysis modality is more recommended for those patients with associated vasculitis (AAV-ESRD). The primary objective of this study was to compare patient survival in patients with AAV-ESRD treated with hemodialysis (HD) or peritoneal dialysis (PD).MethodsThis double-center retrospective cohort study included dialysis-dependent patients who were treated with HD or PD. Clinical data were collected under standard format. The Birmingham vasculitis activity score (BVAS) was used to evaluate disease activity at diagnosis and organ damage was assessed using the vasculitis damage index (VDI) at dialysis initiation.ResultsIn total, 85 patients were included: 64 with hemodialysis and 21 with peritoneal dialysis. The patients with AAV-PD were much younger than the AAV-HD patients (48 vs. 62, P < 0.01) and more were female (76.2 vs. 51.6%, P = 0.05). The laboratory data were almost similar. The comorbidities, VDI score, and immuno-suppressive therapy at dialysis initiation were almost no statistical difference. Patient survival rates between HD and PD at 1 year were 65.3 vs. 90% (P = 0.062), 3 year were 59.6 vs. 90% (P < 0.001), and 5 years were 59.6 vs. 67.5% (P = 0.569). The overall survival was no significant difference between the two groups (P = 0.086) and the dialysis modality (HD or PD) was not shown to be an independent predictor for all-cause death (hazard ratio (HR) 0.73; 95% confidence interval (CI) 0.31–1.7; P = 0.473). Cardio-cerebrovascular events were the main cause of death among AAV-HD patients while infection in patients with AAV-PD.ConclusionThese results provide real-world data that the use of either hemodialysis or peritoneal dialysis modality does not affect patient survival for patients with AAV-ESRD who need long-term dialysis.

Unplanned Hemodialysis Initiation and Low Geriatric Nutritional Risk Index Scores are Associated with End-Stage Renal Disease Outcomes

Background Patients with end-stage renal disease (ESRD) have low nutritional status, presenting a high mortality risk. The geriatric nutritional risk index (GNRI) is a predictive marker of malnutrition. However, it is unclear whether the association between unplanned hemodialysis (HD) and GNRI scores is related to mortality. Methods The 180 patients who underwent HD at our hospital were divided into two groups: unplanned initiation with a central venous catheter (CVC; n=73) or planned initiation with prepared vascular access (n=107). Results There were no significant differences in sex, age, malignant tumor, hypertension, and vascular disease, while there were significant differences in time from the first visit to HD initiation (0 vs. 7 times, p=0.012) and days between the first visit and HD (12 vs. 186 days, p<0.001). The CVC insertion group had significantly lower GNRI scores at initiation (85.5 vs. 98.8, p<0.001). The adjusted hazard ratios were 4.115 and 3.077 for the GNRI scores and frequency, respectively. Three-year survival was significantly lower in the CVC + low GNRI group (p<0.0001). GNRI after 1 month was significantly inferior in the CVC insertion group. Conclusions Inadequate general management due to late referral to the nephrology department is a risk factor for patients with ESRD.

Seroprevalence of Leptospirosis in Suspected High Risk Sudanese Patients; A Pilot Exploratory Study

BackgroundThe extent of leptospirosis is unknown in Sudan and it might be mistaken for other more common febrile infectious diseases. Leptospirosis might also be associated with renal diseases that are common in Sudan. We intended to explore the existence of human leptospirosis in suspected high risk patients in Khartoum, Sudan, via sero-screening random febrile patients and those undergoing renal dialysis.MethodsThis is a pilot exploratory study that was conducted in 6 months period from April to September of 2013. Hospitals were selected conveniently following a non-random sampling approach. A total of 119 febrile patients (with or without definitive diagnosis) and patients under renal dialysis were included and their serum specimens, clinical and demographic data were collected. Sera were screened qualitatively for the existence of anti-leptospiral IgM antibodies using rapid lateral flow immunosorbent assay. Ethical clearance and official permissions were obtained.ResultsOut of the total 119 patients, 57 (47.9%) had end stage renal disease and were under dialysis at Renal Dialysis Unit in Asbab Charity Hospital in Bahri, 47 (39.5%), were febrile with unknown origin attending the Tropical Medicine Hospital in Omdurman, and 15 (12.6%) were febrile and were diagnosed as having malaria or typhoid and attended Yastabshiron Medical Centre and Bashauer Teaching Hospital. The overall prevalence of anti-leptospiral IgM antibodies among all 119 screened patients was 7%. The prevalence among the 57 with end stage renal disease was 9%, and among the 47 with fever of unknown origin was 6%. The prevalence among the 15 with fever of known origin (diagnosed as malaria or typhoid) was 0%. Almost all positive patients had recurring episodes of fever, are in close contact with livestock, were farmers and have natural untreated source for drinking water.ConclusionLeptospirosis is probably a common febrile condition and can be easily considered as one of the major causes of chronic kidney disease affecting people in this country. A national sero-screening for leptospirosis among those living in high risk geographical areas and those at occupational risk is highly recommended.

PAX2 Mutation-Related Renal Hypodysplasia: Review of the Literature and Three Case Reports

Paired box 2 (PAX2)-related disorder is an autosomal dominant genetic disorder associated with kidney and eye abnormalities and can result in end stage renal disease (ESRD). Despite reported low prevalence of PAX2 mutations, the prevalence of PAX2 related disorders may have been underestimated in past studies. With improved genetic sequencing techniques, more genetic abnormalities are being detected than ever before. Here, we report three patients from two families with PAX2 mutations identified within 1 year. Two patients were adults with chronic kidney disease and were followed for decades without correct diagnoses, including one with ESRD who had even undergone kidney transplant. The third patient was a neonate in whom PAX2-related disorder manifested as oligohydramnios, coloboma, and renal failure that progressed to ESRD within 1 year after birth. The phenotypes of PAX2 gene mutation were shown to be highly variable, even within the same family. Early detection promoted genetic counseling and guided clinical management. The appropriate time point for genetic study is an important issue. Clinicians must be more alert for PAX2 mutation when facing patients with congenital kidney and urinary tract anomalies, chronic kidney disease of unknown etiology, involvement of multiple systems, and/or a family history of renal disease.

Single-Cell RNA Sequencing Reveals Heterogeneity Among Adult Mouse, Primate and Human Kidney Cells

Multiple studies have been performed to map the kidney landscape of human and rodent, along with the development of sequencing technique. Although rodent disease models have been widely applied, many disadvantages also exist. Non-human primates (NHPs) are considered as the closest experimental animals to humans and show great advantages in the construction of animal models of human disease. Therefore, a comprehensive understanding of the heterogeneity and homogeneity between human and multiple animal kidney cells is important for further establishing animal models of human renal disease. Here, we generated the first single-cell transcriptome data of normal adult cynomolgus monkey kidney using 10x Genomics scRNA-seq platform. Then, we further performed an in-depth comparison across species at the single-cell level, and our analysis indicated that the gene expression of adult primate kidney cells showed a better correlation with human kidney than mouse kidney. Furthermore, our results demonstrated that the cellular localization of GWAS-identified renal disease genes showed differences across species. The cellular localization of blood pressure associated genes in human displayed similarity to cynomolgus monkey. This study provided a reliable reference for further studies associated with renal diseases on NHPs. In addition, our results also provided a novel insight into the choice of renal disease animal model and a detailed explanation for close genetic relationship between NHPs and human at a single cell level.