Nephrotic syndrome and prophylactic anticoagulation

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Risks for arterial and venous thromboembolic events in nephrotic syndrome are increased with severe hypoalbuminemia and especially in patients with membranous nephropathy. If the risk of bleeding is perceived to be low, it would be reasonable to initiate prophylactic anticoagulation early in diagnosis for patients with membranous nephropathy who have serum albumin levels <2 to 2.5 g/dl. For those at high risk of bleeding, it may be prudent to avoid anticoagulation. In those with intermediate risk of bleeding, prophylaxis for those with serum albumin levels <2 would be considered reasonable. Aspirin may be an alternative in those who have higher albumin levels, and/or if there is a high perceived risk of arterial or venous thromboembolic events with high bleeding risk. Further increased risk of venous thromboembolic events with immobility, obesity, malignancy, recent surgery, pregnancy, medications, central venous catheters, or genetic predisposition would decrease the threshold to start prophylaxis.

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Over 850 million people worldwide have some form of kidney disease

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On a world scale, the total number of individuals with chronic kidney disease (CKD), acute kidney injury (AKI), and those on renal replacement therapy (RRT) exceeds 850 million, a truly concerning figure that is twice the estimated number of people with diabetes worldwide and >20 times higher than the number of individuals affected by AIDS/HIV worldwide. Thus kidney diseases are one of the most common diseases worldwide.

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Measured vs. estimated glomerular filtration rate

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Initial and confirmatory tests are needed to develop a final assessment of true GFR. GFR evaluation might be improved by more complete implementation of current recommendations and by further research to improve the accuracy of mGFR and eGFR.

Evaluation of glomerular filtration rate (GFR) is central to the assessment of kidney function in medical practice, research and public health. Measured GFR (mGFR) remains the reference standard, but the past 20 years have seen major advances in estimated GFR (eGFR). Both eGFR and mGFR are associated with error compared with true GFR. eGFR is now recommended by clinical practice guidelines, regulatory agencies and public health agencies for the initial evaluation of GFR, with measured GFR (mGFR) typically considered an important confirmatory test, depending on how accurate the assessment of GFR needs to be for application to the clinical, research or public health setting. Initial and confirmatory tests are needed to develop a final assessment of true GFR. GFR evaluation might be improved by more complete implementation of current recommendations and by further research to improve the accuracy of mGFR and eGFR.

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Forty‐five years on home hemodialysis: “Miracles happen to those who believe in them”

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In a recently published paper authors reported an exceptional case of extreme survival for a 62‐year‐old Caucasian female with end‐stage renal disease who has been exclusively on home hemodialysis for a total of 45 years. One single physician provided for her outpatient nephrology care for almost the entire duration of her illness. Throughout this period, her life bore witness to the evolving technology of dialysis accesses, platforms, and evolution of home hemodialysis in its entirety. Such excesses of survival on home dialysis are rare, but should provide encouragement and hope for physicians and patients alike.

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Diabetic kidney disease and podocyte lipotoxicity

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Although diabetic kidney disease has long been regarded as a microvascular complication of diabetes, reduced podocyte number was also shown to correlate strongly with albuminuria and loss of eGFR.

Hyperglycemia-induced metabolic alterations, including changes in energy utilization and mitochondrial dysfunction, play critical roles in diabetic kidney disease (DKD) initiation. Although DKD has long been regarded as a microvascular complication of diabetes, reduced podocyte number was also shown to correlate strongly with albuminuria and loss of glomerular filtration rate (GFR) in Pima Native Americans with type 2 diabetes.

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Intranasal desmopressin reduces bleeding complications during renal biopsies and serum sodium levels in CKD patients

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In patients with renal dysfunction not requiring hemodialysis, desmopressin reduces overall renal biopsy-related bleeding complications, especially minor complications such as perinephric hematomas.

In patients with renal dysfunction not requiring hemodialysis, desmopressin reduces overall renal biopsy-related bleeding complications, especially minor complications such as perinephric hematomas. However, the use of desmopressin is associated with anasymptomatic decrease in serum sodium concentrations, more so in patients with preexisting low serum sodium levels.

Find the paper in the CKJ here