On the May 2019 Cover: America’s city with the first public park, the first public school, the first subway system, and yes, the first chocolate factory, will host the National Kidney Foundation’s Spring Clinical Meetings on May 8-12, 2019. Physicians, pharmacists, advanced practitioners, dietitians, technicians, social workers, and trainees will gather in historic Boston for this multidisciplinary conference where participants will enjoy interactive case discussions, hands-on workshops, and thought-provoking research presentations. A selection of abstracts to be presented at #NKFClinicals is available here.

The photograph “Boston’s Back Bay” is by Robbie Shade, released under CC BY 2.0 license.

Fasting Urinary Osmolality, CKD Progression, and Mortality: A Prospective Observational Study by Nahid Tabibzadeh et al

From the authors: The evaluation of chronic kidney disease (CKD) and estimating its prognosis rely on assessments of glomerular filtration rate (GFR), albuminuria, and, when available, glomerular histology. Reductions of kidney function not directly related to GFR often accompany CKD and may be important markers of disease severity. Urinary concentrating ability is one such function that we explored as an independent risk factor for progression of CKD. Our study found that urinary concentrating ability was not only impaired in CKD, but that this impairment was associated with worse renal outcomes (faster GFR decline and a more rapid rate of end-stage kidney disease requiring dialysis or kidney transplantation). These results might pave the way for non-invasively assessing non-glomerular kidney damage and tubular dysfunction that are potentially useful prognostic factors in the setting of CKD.

DOI: 10.1053/j.ajkd.2018.12.024

Editorial Urinary Concentration Ability: Time to Bring the Tubules to the Table by Ke Wang and Bryan Kestenbaum [FREE]

Neighborhood Social Context and Kidney Function Over Time: The Multi-Ethnic Study of Atherosclerosis by Margaret T. Hicken et al [FREE Temporarily]

DOI: 10.1053/j.ajkd.2018.10.015

Editorial CKD Progression: Teasing Out Contributions of Elements in the Human Exposome by Neil Powe [FREE]

Allocation of the Highest Quality Kidneys and Transplant Outcomes Under the New Kidney Allocation System by Supreet Sethi et al [FREE Temporarily]

From the authors: Highly sensitized candidates have benefited greatly from policy changes enacted by the Kidney Allocation System (KAS) in 2014 and have experienced a dramatic increase in access to transplantation. We studied trends in utilization of the highest quality kidneys (defined as kidney donor profile index [KDPI] <20%) versus other kidneys following implementation of KAS and investigated whether KDPI impacts clinical outcomes differently for sensitized and non-sensitized candidates. There was a four-fold increase in utilization of lower KDPI kidneys in highly sensitized candidates after implementation of KAS, while there was no change in utilization of high KDPI kidneys. We also found that KDPI has a similar relationship with patient survival and graft loss across all levels of recipient allosensitization. The transplant community should examine the impact of the redistribution of higher quality kidneys away from less sensitized recipients.

DOI: 10.1053/j.ajkd.2018.12.036

Image: Pixabay / geralt-9301

Blog Post The New Kidney Allocation System: How Is It Performing? by Andrew Malone [FREE]

In the Literature Molecular Structure of the PKD Protein Complex Finally Solved by Owen M. Woodward and Terry Watnick [FREE]

This editorial briefly summarizes a recent paper by Su et al published in Science and discusses the implications of the study for nephrologists.

The polycystin 1 (PC1)/PC2 complex. (A) Topology of the polycystin proteins. PC1/polycystic kidney disease 1 (PKD1) in red with the amino-terminal domain (NTD) and carboxy-terminal domain/voltage gated ion channel fold (CTD/VGIC) labeled. The missing amino- and carboxy-termini of PC1 and PC2 are indicated in pink. (B, C) Visualization of the Su et al cryo-EM structure of the PC1/PC2 heteromeric channel complex.25 (B) Top down view of the 1+3 stoichiometry of PC1+PC2 assembly, with the NTD S1-S6 of PC1 interdigitating with the homologous VGIC folds of PC2. (C) Bottom up view of the PC1/PC2 complex pore and activation gate with the acidic negatively charged residues of the PC2 trimer highlighted in orange and the incongruous positively charged residues found in the PC1 S6 highlighted in yellow. Figure 1 from Woodward and Watnick, AJKD, © National Kidney Foundation.

Quiz Patient With Lethargy and Hypercalcemia by Ethan Bernstein et al [FREE]

A 52-year-old man was admitted to a Veterans Affairs hospital with lethargy. His medical history was most notable for major depressive disorder complicated by 4 previous suicide attempts, polysubstance abuse, and poorly controlled insulin-dependent diabetes mellitus. During the past decade, he had several admissions for suicidality and intoxication. He lives in an apartment where he is seen every other day by a visiting nurse for assistance with medications. Two days before admission, he was noted by the visiting nurse to be in his usual state of health. On the morning of admission, the visiting nurse went to his home and rang the doorbell several times with no answer. Given his previous history of suicide attempts, she called emergency services; emergency medical technicians broke down his door and found him unconscious and incontinent of urine.

On arrival to the emergency department, he was afebrile and hemodynamically stable and had a respiratory rate of 18 breaths/min. On examination, he was lethargic and oriented to self only and had dry mucous membranes. Urine toxicology screen and serum overdose panel results were negative; findings from computed tomography of the head were unremarkable.

What is the likely cause of the patient’s lethargy? What studies should be undertaken to evaluate further his condition? Answers and discussion.

Copyright: prapass/ 123RF Stock Photo

CALL FOR SUBMISSIONS Do you have a case that could test our readers’ acumen in resolving a diagnostic or therapeutic dilemma? Consider submitting it as a Quiz! Instructions here.

Don’t miss the abstracts from the upcoming NKF Spring Clinical Meetings in the May 2019 issue, and visit the AJKD booth to pick up complimentary copies of the Journal!