Clinical Outcomes and Histological Patterns in Oxalate Nephropathy due to Enteric and Nonenteric Risk Factors

<b><i>Introduction:</i></b> Current knowledge of risk factors and renal histologic patterns of oxalate nephropathy (ON) not due to primary hyperoxaluria (PH) has been limited to small case series and case reports. Thus, we analyzed and compared clinical risk factors, histologic characteristics, and renal outcomes of patients with biopsy-confirmed ON among a cohort of patients with enteric and nonenteric risk factors. <b><i>Methods:</i></b> A clinical data repository of native kidney pathology reports from 2009 to 2020 at all Mayo Clinic sites was used to identify 421 ON cases. <b><i>Results:</i></b> After excluding cases in transplanted kidneys or due to PH, 64 cases remained. Enteric risk factors were present in 30 and nonenteric in 34. Roux-en-Y gastric bypass (17) and pancreatic insufficiency (6) were most common in the enteric hyperoxaluria group. In the nonenteric group, vitamin C (7) and dietary oxalate (7) were common, while no apparent risk was noted in 16. Acute kidney injury (AKI) stage III at the time of diagnosis was present in 60%, and 40.6% required dialysis. Patients in the nonenteric group had more interstitial inflammation (<i>p</i> = 0.01), and a greater number of tubules contained intratubular calcium oxalate (CaOx) crystals (<i>p</i> = 0.001) than the nonenteric group. Patients in the enteric group were more likely to have baseline chronic kidney disease (CKD) (<i>p</i> = 0.02) and moderate-to-severe tubulointerstitial fibrosis and atrophy (IFTA) (OR 3.49, <i>p</i> = 0.02). After a median follow-up of 10 months, 39% were dialysis dependent, 11% received a kidney transplant, and 32% died. On univariate analysis, &#x3e;10 tubules with CaOx crystals, baseline CKD, and AKI requiring dialysis correlated with the risk of dialysis, transplant, or death. On multivariate analysis, only AKI requiring dialysis correlated with adverse renal outcomes. <b><i>Conclusion:</i></b> This is the largest cohort study of ON not due to PH. Histologic features differ in patients with enteric versus nonenteric risks. Patients in the enteric group are more likely to have baseline CKD and significant IFTA, while patients in the nonenteric group were more likely to have a greater number of tubules with CaOx crystals and corresponding interstitial inflammation. AKI requiring dialysis at the time of diagnosis was the single most significant predictor of adverse renal outcome.

New Information Technologies in Retrospective Epidemiological Analysis Carried out at the Level of the Russian Federation Constituent Entity: the Astrakhan Region as an Example

Retrospective epidemiological analysis as regards infectious and parasitic diseases in the Astrakhan Region was carried out using the methods of complex multi-dimensional data analysis - OLAP. It was elucidated that application of the OLAP cube technologies enabled to facilitate complex retrospective analysis of epidemiological data in the context of different groups of infectious and parasitic diseases. It became possible by means of automation of calculations and use of qualitatively new methods in formation of database profiles. Enterobiasis and acute enteric infections of unidentified etiology were shown to be the most significant in epidemiological and social relation among the enteric group diseases.

AN ENTERIC CORONAVIRUS IN A 3-DAY-OLD DIARRHEIC FOAL

ABSTRACT Coronaviruses are of special interest in diarrhea of horses, once they cause disease in foals and in the adult. This study aimed to evaluate the existence of coronavirus, rotavirus, protozoa and bacteria in stool of a 3-day old foal suffering from acute diarrhea. A nested PCRassay for the RNA-dependent RNA-polymerase gene was applied to coronavirus detection and PAGE, sucrose flotation test and classical bacteriology for rotavirus, protozoa and bacteria detection, respectively. An enteric group II coronavirus was found with no concurrent infections. The role of coronavirus in this clinical case is discussed, as well as possible transmission routes.

Quantification of Bacterial Groups within Human Fecal Flora by Oligonucleotide Probe Hybridization

ABSTRACT To investigate the population structure of the predominant phylogenetic groups within the human adult fecal microbiota, a new oligonucleotide probe designated S-G-Clept-1240-a-A-18 was designed, validated, and used with a set of five 16S rRNA-targeted oligonucleotide probes. Application of the six probes to fecal samples from 27 human adults showed additivity of 70% of the total 16S rRNA detected by the bacterial domain probe. The Bacteroidesgroup-specific probe accounted for 37% ± 16% of the total rRNA, while the enteric group probe accounted for less than 1%.Clostridium leptum subgroup and Clostridium coccoides group-specific probes accounted for 16% ± 7% and 14% ± 6%, respectively, while Bifidobacterium andLactobacillus groups made up less than 2%.

Outbreak of Nosocomial Infections Due to Extended-Spectrum β-Lactamase-Producing Strains of Enteric Group 137, a New Member of the Family Enterobacteriaceae Closely Related toCitrobacter farmeri and Citrobacter amalonaticus

A member of the Enterobacteriaceae initially identified as Kluyvera cryocrescens by the MicroScan Gram-Negative Combo 13 panel caused an outbreak of nosocomial infections in four patients (pneumonia, n = 2; urinary tract infection,n = 1; wound infection, n = 1) and urinary tract colonization in one patient. When the strains were tested by the Enteric Reference Laboratory of the Centers for Disease Control and Prevention, biochemical results were most compatible withYersinia intermedia, Kluyvera cryocrescens, andCitrobacter farmeri but identification scores were low and test results were discrepant. However, when the biochemical test profile was placed in the computer database as a new organism, all strains were identified as the organism with high identification scores (0.999968 to 0.999997) and no discrepant test results. By 16S rRNA sequence analysis the organism clustered most closely with, but was distinct from, Citrobacter farmeri and Citrobacter amalonaticus. Based on its unique biochemical profile and rRNA sequence, this organism is designated Enteric Group 137. Restriction endonuclease analysis and taxonomic antibiograms of strains causing the outbreak demonstrated a single clone of Enteric Group 137, and antibiotic susceptibility testing revealed the presence of extended-spectrum β-lactamase (ESBL) resistance. Enteric Group 137 appears to be a new opportunistic pathogen that can serve as a source of ESBL resistance in the hospital.

The isolation, from a prosthetic device site, of a rare bacterium belonging to CDC enteric group 58

We describe a gram-negative bacterium that belongs to a group tentatively classified at the Centres for Disease Control as CDC Enteric Group 58. It was recovered from bone at the site of internal fixation plates in a left forearm following a traumatic fracture. This is a rare isolate and, in this case, it was not associated with systemic signs of infection. Biochemical identification of the isolate is described.Key words: enteric group CDC58, osteomyelitis, internal fixation A.O. plate.