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  1. Article ; Online: The Management of Gout in Renal Disease.

    Estiverne, Christopher / Mount, David B

    Seminars in nephrology

    2021  Volume 40, Issue 6, Page(s) 600–613

    Abstract: Gout, a debilitating inflammatory arthritis, currently affects more than 9 million Americans. Hyperuricemia, the laboratory abnormality associated with the development of gout, also occurs in a significant number of patients with chronic kidney disease ( ... ...

    Abstract Gout, a debilitating inflammatory arthritis, currently affects more than 9 million Americans. Hyperuricemia, the laboratory abnormality associated with the development of gout, also occurs in a significant number of patients with chronic kidney disease (CKD), a condition that affects approximately 14% of the US population. Several recent studies have attempted to provide a definitive link between the presence of hyperuricemia and progression of CKD; however, the treatment of asymptomatic hyperuricemia in CKD is not supported by recent randomized controlled trials. The pharmacology of acute gout flares and urate lowering is complicated in patients who also have evidence of CKD, primarily because of an increased risk of medication toxicity. Recipients of kidney transplants are particularly at risk of debilitating gout and medication toxicity. We review the available data linking CKD, gout, and hyperuricemia, providing practice guidelines on managing gout in CKD patients and kidney transplant recipients. We advocate for much greater involvement of nephrologists in the management of gout in renal patients.
    MeSH term(s) Allopurinol/therapeutic use ; Febuxostat/therapeutic use ; Gout/complications ; Gout/drug therapy ; Gout Suppressants/therapeutic use ; Humans ; Hyperuricemia/complications ; Hyperuricemia/drug therapy
    Chemical Substances Gout Suppressants ; Febuxostat (101V0R1N2E) ; Allopurinol (63CZ7GJN5I)
    Language English
    Publishing date 2021-03-07
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 604652-6
    ISSN 1558-4488 ; 0270-9295
    ISSN (online) 1558-4488
    ISSN 0270-9295
    DOI 10.1016/j.semnephrol.2020.12.007
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  2. Article ; Online: Molecular Pathophysiology of Uric Acid Homeostasis.

    Estiverne, Christopher / Mandal, Asim K / Mount, David B

    Seminars in nephrology

    2021  Volume 40, Issue 6, Page(s) 535–549

    Abstract: Uric acid, the end product of purine metabolism, plays a key role in the pathogenesis of gout and other disease processes. The circulating serum uric acid concentration is governed by the relative balance of hepatic production, intestinal secretion, and ... ...

    Abstract Uric acid, the end product of purine metabolism, plays a key role in the pathogenesis of gout and other disease processes. The circulating serum uric acid concentration is governed by the relative balance of hepatic production, intestinal secretion, and renal tubular reabsorption and secretion. An elegant synergy between genome-wide association studies and transport physiology has led to the identification and characterization of the major transporters involved with urate reabsorption and secretion, in both kidney and intestine. This development, combined with continued analysis of population-level genetic data, has yielded an increasingly refined mechanistic understanding of uric acid homeostasis as well as greater understanding of the genetic and acquired influences on serum uric acid concentration. The continued delineation of novel and established regulatory pathways that regulate uric acid homeostasis promises to lead to a more complete understanding of uric acid-associated diseases and to identify new targets for treatment.
    MeSH term(s) Genome-Wide Association Study ; Gout/genetics ; Homeostasis ; Humans ; Organic Anion Transporters/genetics ; Uric Acid
    Chemical Substances Organic Anion Transporters ; Uric Acid (268B43MJ25)
    Language English
    Publishing date 2021-03-07
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 604652-6
    ISSN 1558-4488 ; 0270-9295
    ISSN (online) 1558-4488
    ISSN 0270-9295
    DOI 10.1016/j.semnephrol.2020.12.006
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  3. Article ; Online: Estimated GFR With Cystatin C and Creatinine in Clinical Practice: A Retrospective Cohort Study.

    Gottlieb, Eric Raphael / Estiverne, Christopher / Tolan, Nicole V / Melanson, Stacy E F / Mendu, Mallika L

    Kidney medicine

    2023  Volume 5, Issue 3, Page(s) 100600

    Abstract: Rationale & objective: Estimation of glomerular filtration rate (eGFR) and staging of chronic kidney disease (CKD) are essential to guide management. Although creatinine is routinely used, a recent national task force recommended the use of cystatin C ... ...

    Abstract Rationale & objective: Estimation of glomerular filtration rate (eGFR) and staging of chronic kidney disease (CKD) are essential to guide management. Although creatinine is routinely used, a recent national task force recommended the use of cystatin C for confirmation. The objective of this study was to examine the following parameters: (1) how cystatin C correlates with creatinine eGFR; (2) how it indicates differences in CKD staging; and (3) how it may affect kidney care delivery.
    Study design: Retrospective observational cohort study.
    Setting & participants: 1,783 inpatients and outpatients who had cystatin C and creatinine levels drawn within 24 hours at Brigham Health-affiliated clinical laboratories.
    Predictors: Serum creatinine levels, basic clinical/sociodemographic variables, and reasons for ordering cystatin C from a structured partial chart review.
    Analytical approach: Univariate and multivariable linear and logistic regression.
    Results: Cystatin C-based eGFR was very strongly correlated with creatinine-based eGFR (Spearman correlation ρ = 0.83). Cystatin C eGFR resulted in a change to a later CKD stage in 27%, an earlier stage in 7%, and no change in 66% of patients. Black race was associated with a lower likelihood of change to a later stage (OR, 0.53; 95% CI [0.36, 0.75]; P < 0.001), whereas age (OR per year OR, 1.03; 95% CI [1.02, 1.04]; P < 0.001) and Elixhauser score (OR per point OR, 1.22; 95% CI [1.10, 1.36]; P < 0.001) were associated with a higher likelihood of change to a later stage.
    Limitations: Single center, no direct measurement of clearance for comparison, and inconsistent self-identification of race/ethnicity.
    Conclusions: Cystatin C eGFR correlates strongly with creatinine eGFR but can have a substantial effect on CKD staging. As cystatin C is adopted, clinicians must be informed on this impact.
    Language English
    Publishing date 2023-01-18
    Publishing country United States
    Document type Journal Article
    ISSN 2590-0595
    ISSN (online) 2590-0595
    DOI 10.1016/j.xkme.2023.100600
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  4. Article ; Online: Safety and Diagnostic Yield of Protocolized Percutaneous Kidney Biopsies in Mechanically Ventilated Patients With Acute Kidney Injury.

    Estiverne, Christopher / McMahon, Gearoid M / Mount, David B / Bianchi, Giada / Pierce, Carol Daddio / Hakim, Hasna / Rennke, Helmut G / Czarnecki, Peter G

    Kidney international reports

    2023  Volume 8, Issue 6, Page(s) 1255–1259

    Language English
    Publishing date 2023-03-20
    Publishing country United States
    Document type Journal Article
    ISSN 2468-0249
    ISSN (online) 2468-0249
    DOI 10.1016/j.ekir.2023.03.007
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  5. Article: Genetic and Physiological Effects of Insulin on Human Urate Homeostasis.

    Mandal, Asim K / Leask, Megan P / Estiverne, Christopher / Choi, Hyon K / Merriman, Tony R / Mount, David B

    Frontiers in physiology

    2021  Volume 12, Page(s) 713710

    Abstract: Insulin and hyperinsulinemia reduce renal fractional excretion of urate (FeU) and play a key role in the genesis of hyperuricemia and gout, via uncharacterized mechanisms. To explore this association further we studied the effects of genetic variation in ...

    Abstract Insulin and hyperinsulinemia reduce renal fractional excretion of urate (FeU) and play a key role in the genesis of hyperuricemia and gout, via uncharacterized mechanisms. To explore this association further we studied the effects of genetic variation in insulin-associated pathways on serum urate (SU) levels and the physiological effects of insulin on urate transporters. We found that urate-associated variants in the human insulin (INS), insulin receptor (INSR), and insulin receptor substrate-1 (IRS1) loci associate with the expression of the insulin-like growth factor 2, IRS1, INSR, and ZNF358 genes; additionally, we found genetic interaction between
    Language English
    Publishing date 2021-08-02
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2564217-0
    ISSN 1664-042X
    ISSN 1664-042X
    DOI 10.3389/fphys.2021.713710
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  6. Article: Trends and outcomes of the use of percutaneous native kidney biopsy in the United States: 5-year data analysis of the Nationwide Inpatient Sample.

    Al Turk, Ahmad A / Estiverne, Christopher / Agrawal, Pratik R / Michaud, Jennine M

    Clinical kidney journal

    2017  Volume 11, Issue 3, Page(s) 330–336

    Abstract: Background: Despite an inordinate share of health care resources being utilized by patients with kidney disease, morbidity and mortality in these patients remain high. Although renal biopsy is an intervention to identify potential treatment-modifiable ... ...

    Abstract Background: Despite an inordinate share of health care resources being utilized by patients with kidney disease, morbidity and mortality in these patients remain high. Although renal biopsy is an intervention to identify potential treatment-modifiable causes of disease, large-scale data studying the safety and outcomes of percutaneous native kidney biopsy in hospitalized patients are lacking.
    Methods: We queried the Nationwide Inpatient Sample database from 2008 to 2012 and identified all hospital admissions during which a percutaneous renal biopsy was performed. Patients <18 years of age or with a transplanted kidney were excluded. Data regarding associated renal pathology and procedure-related complications were collected and analyzed. Outcomes studied were length of stay, mortality and cost adjusted for inflation.
    Results: A total of 118 064 hospital admissions were included in our analysis. The most common complications reported after percutaneous kidney biopsy were packed red blood cell transfusion (261/1000 cases), hematuria (129/1000 cases) and bleeding (78/1000 cases). Patients had an overall mortality of 1.8%. The mean length of stay for each hospitalization was 10.65 days, with a significant difference between elective and nonelective admissions (6.3 versus 11.7; P < 0.01). The average cost per hospitalization was US$22 917 after adjusting for inflation, again with a significant difference between elective and nonelective admissions (15 168 versus 24 780; P < 0.01).
    Conclusion: Overall, percutaneous renal biopsy is considered a safe procedure; however, our study based on a national database demonstrates a relatively higher complication rate as compared with the limited prior available studies.
    Language English
    Publishing date 2017-10-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 2655800-2
    ISSN 2048-8513 ; 2048-8505
    ISSN (online) 2048-8513
    ISSN 2048-8505
    DOI 10.1093/ckj/sfx102
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  7. Article ; Online: Remdesivir in Patients With Estimated GFR <30 ml/min per 1.73 m

    Estiverne, Christopher / Strohbehn, Ian A / Mithani, Zain / Hirsch, Jamie S / Wanchoo, Rimda / Goyal, Pranisha Gautam / Lee Dryden-Peterson, Scott / Pearson, Jeffrey C / Kubiak, David W / Letourneau, Alyssa R / Bhattacharyya, Roby / Jhaveri, Kenar D / Sise, Meghan E

    Kidney international reports

    2020  Volume 6, Issue 3, Page(s) 835–838

    Language English
    Publishing date 2020-11-27
    Publishing country United States
    Document type Journal Article
    ISSN 2468-0249
    ISSN (online) 2468-0249
    DOI 10.1016/j.ekir.2020.11.025
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  8. Article ; Online: Lupus nephritis: an update.

    Imran, Tasnim F / Yick, Frederick / Verma, Suneet / Estiverne, Christopher / Ogbonnaya-Odor, Chinonye / Thiruvarudsothy, Srikanth / Reddi, Alluru S / Kothari, Neil

    Clinical and experimental nephrology

    2016  Volume 20, Issue 1, Page(s) 1–13

    Abstract: Lupus nephritis (LN) is an inflammatory condition of the kidneys that encompasses various patterns of renal disease including glomerular and tubulointerstitial pathology. It is a major predictor of poor prognosis in patients with systemic lupus ... ...

    Abstract Lupus nephritis (LN) is an inflammatory condition of the kidneys that encompasses various patterns of renal disease including glomerular and tubulointerstitial pathology. It is a major predictor of poor prognosis in patients with systemic lupus erythematosus (SLE). Genetic factors, including several predisposing loci, and environmental factors, such as EBV and ultraviolet light, have been implicated in the pathogenesis. It carries a high morbidity and mortality if left untreated. Renal biopsy findings are utilized to guide treatment. Optimizing risk factors such as proteinuria and hypertension with renin-angiotensin receptor blockade is crucial. Immunosuppressive therapy is recommended for patients with focal or diffuse proliferative lupus nephritis (Class III or IV) disease, and certain patients with membranous LN (Class V) disease. Over the past decade, immunosuppressive therapies have significantly improved long-term outcomes, but the optimal therapy for LN remains to be elucidated. Cyclophosphamide-based regimens, given concomitantly with corticosteroids, have improved survival significantly. Even though many patients achieve remission, the risk of relapse remains considerably high. Other treatments include hydroxychloroquine, mycofenolate mofetil, and biologic therapies such as Belimumab, Rituximab, and Abatacept. In this paper, we provide a review of LN, including pathogenesis, classification, and clinical manifestations. We will focus, though, on discussion of the established as well as emerging therapies for patients with proliferative and membranous lupus nephritis.
    MeSH term(s) Biological Products/adverse effects ; Biological Products/therapeutic use ; Disease Progression ; Drug Therapy, Combination ; Humans ; Immunosuppressive Agents/adverse effects ; Immunosuppressive Agents/therapeutic use ; Lupus Nephritis/diagnosis ; Lupus Nephritis/drug therapy ; Lupus Nephritis/mortality ; Recurrence ; Remission Induction ; Risk Factors ; Treatment Outcome
    Chemical Substances Biological Products ; Immunosuppressive Agents
    Language English
    Publishing date 2016-02
    Publishing country Japan
    Document type Journal Article ; Review
    ZDB-ID 1338768-6
    ISSN 1437-7799 ; 1342-1751
    ISSN (online) 1437-7799
    ISSN 1342-1751
    DOI 10.1007/s10157-015-1179-y
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