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Article ; Online: Biomarkers in acute kidney injury

Mark Canney / Edward G. Clark / Swapnil Hiremath

The Journal of Clinical Investigation, Vol 133, Iss

On the cusp of a new era?

2023 Volume 13

Abstract: The field of nephrology has been slow in moving beyond the utilization of creatinine as an indicator for chronic kidney disease and acute kidney injury (AKI). Early diagnosis and establishment of etiology, in particular, are important for treatment of ... ...

Abstract	The field of nephrology has been slow in moving beyond the utilization of creatinine as an indicator for chronic kidney disease and acute kidney injury (AKI). Early diagnosis and establishment of etiology, in particular, are important for treatment of AKI. In the setting of hospital-acquired AKI, tubular injury is more common, but acute interstitial nephritis (AIN) has a more treatable etiology. However, it is likely that AIN is under- or misdiagnosed due to current strategies that largely rely on clinical gestalt. In this issue of the JCI, Moledina and colleagues made an elegant case for the chemokine called C-X-C motif ligand 9 (CXCL9) as a biomarker of AIN. The authors used urine proteomics and tissue transcriptomics in patients with and without AIN to identify CXCL9 as a promising, noninvasive, diagnostic biomarker of AIN. These results have clinical implications that should catalyze future research and clinical trials in this space.
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	American Society for Clinical Investigation
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Kidney function, cardiovascular outcomes and survival of living kidney donors with hypertension

Greg Knoll / Risa Shorr / Kevin D Burns / Swapnil Hiremath / Ann Bugeja / Mariam Eldaba / Sumaiya Ahmed / Edward G Clark

BMJ Open, Vol 12, Iss

a systematic review protocol

2022 Volume 12

Abstract: Introduction Hypertension has been considered a contraindication for living kidney donation in the past. Since transplantation from living kidney donors remains the best modality for kidney failure, there is now an increased acceptance of living kidney ... ...

Abstract	Introduction Hypertension has been considered a contraindication for living kidney donation in the past. Since transplantation from living kidney donors remains the best modality for kidney failure, there is now an increased acceptance of living kidney donors with hypertension. However, the safety of this practice for the cardiovascular and kidney health of the donor is unclear. We will conduct a systematic review to summarise and synthesise the existing literature on this topic.Methods and analysis A systematic review of prospective randomised and non-randomised and retrospective studies will be conducted. MEDLINE, EMBASE, Cochrane CENTRAL and EBM reviews published from January 1946 to December 2021 will be reviewed. Primary outcome will be the difference in the survival, major adverse cardiovascular events, estimated glomerular filtration rate of 45 mL/min or less and development of end-stage kidney failure, between living kidney donors with and without hypertension. Study screening, selection, and data extraction will be performed by two independent reviewers. Studies must fulfil all eligibility criteria for inclusion into the systematic review and meta-analysis. The Risk of Bias in Non-Randomised studies tool will be used to assess bias.Ethics and dissemination No ethical approval is required for this systematic review. The results of this review will be disseminated in a peer-reviewed, open-access journal to ensure access to all stakeholders in kidney transplantation and to inform clinical guidelines on the evaluation and follow-up care of living kidney donor candidates.PROSPERO registration number CRD42022300119.
Keywords	Medicine ; R
Subject code	306
Language	English
Publishing date	2022-12-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: CSN COVID-19 Rapid Review Program

Edward G. Clark / Swapnil Hiremath / Steven D. Soroka / Ron Wald / Matthew A. Weir

Canadian Journal of Kidney Health and Disease, Vol

Management of Acute Kidney Injury

2020 Volume 7

Abstract: Purpose: Severe acute kidney injury (AKI) is a potential complication of COVID-19-associated critical illness. This has implications for the management of COVID-19-associated AKI and the resulting increased need for kidney replacement therapy (KRT) in ... ...

Abstract	Purpose: Severe acute kidney injury (AKI) is a potential complication of COVID-19-associated critical illness. This has implications for the management of COVID-19-associated AKI and the resulting increased need for kidney replacement therapy (KRT) in the intensive care unit (ICU) and elsewhere in the hospital. The Canadian Society of Nephrology COVID-19 Rapid Review Team has sought to collate and synthesize currently available resources to inform ethically justifiable decisions. The goal is the provision of the best possible care for the largest number of patients with kidney disease while considering how best to ensure the safety of the health care team. Information sources: Local, provincial, national, and international guidance and planning documents related to the COVID-19 pandemic; guidance documents available from nephrology and critical care-related professional organizations; recent journal articles and preprints related to the COVID-19 pandemic; expert opinion from nephrologists from across Canada. Methods: A working group of kidney specialist physicians was established with representation from across Canada. Kidney physician specialists met via teleconference and exchanged e-mails to refine and agree on the proposed suggestions in this document. Key findings: (1) Nephrology programs should work with ICU programs to plan for the possibility that up to 30% or more of critically ill patients with COVID-19 admitted to ICU will require kidney replacement therapy (KRT). (2) Specific suggestions pertinent to the optimal management of AKI and KRT in patients with COVID-19. These suggestions include, but are not limited to, aspects of fluid management, KRT vascular access, and KRT modality choice. (3) We describe considerations related to ensuring adequate provision of KRT, should resources become scarce during the COVID-19 pandemic. Limitations: A systematic review or meta-analysis was not conducted. Our suggestions have not been specifically evaluated in the clinical environment. The local context, including how the provision of acute KRT is organized, may impede the implementation of many suggestions. Knowledge is advancing rapidly in the area of COVID-19 and suggestions may become outdated quickly. Implications: Given that most acute KRT related to COVID-19 is likely to be required initially in the ICU setting, close collaboration and planning between critical care and nephrology programs is required. Suggestions may be updated as newer evidence becomes available.
Keywords	Diseases of the genitourinary system. Urology ; RC870-923 ; covid19
Language	English
Publishing date	2020-07-01T00:00:00Z
Publisher	SAGE Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Outcomes after toxic alcohol poisoning

Carol Wang / Daniel Samaha / Swapnil Hiremath / Lindsey Sikora / Manish M. Sood / Salmaan Kanji / Edward G. Clark

Systematic Reviews, Vol 7, Iss 1, Pp 1-

a systematic review protocol

2018 Volume 7

Abstract: Abstract Background Toxic alcohols have been implicated in accidental ingestions and intentional exposures. Recognition of toxic alcohol poisoning is challenging. The main treatment modalities include antidotes with alcohol dehydrogenase inhibitors and ... ...

Abstract	Abstract Background Toxic alcohols have been implicated in accidental ingestions and intentional exposures. Recognition of toxic alcohol poisoning is challenging. The main treatment modalities include antidotes with alcohol dehydrogenase inhibitors and dialysis. Current guidelines exist for both methanol and ethylene glycol intoxication. However, treatment consensus related to other toxic alcohols is limited. Furthermore, uncertainties regarding thresholds for when to initiate antidotes and dialysis persist. As a consequence, variations exist in the interventions utilized for management of all toxic alcohol poisonings. To our knowledge, no prior systematic review of clinical outcomes of toxic alcohols exists. The objective of this study is to summarize existing evidence on short- and long-term outcomes of patients following toxic alcohol poisonings, including methanol, ethylene glycol, isopropanol, propylene glycol, and diethylene glycol. Methods A literature search in PubMed, MEDLINE, and EMBASE will be performed based on pre-determined criteria. There will be no restrictions on publication dates or languages. The search will be supplemented by manual scan of bibliographies of eligible studies and gray literature assessment. Observational studies and clinical trials will be included in this review. Once eligible studies have been selected based on pre-specified criteria, two investigators will extract relevant data independently and perform quality assessment per validated tools. A pooled analysis of mortality and short- and long-term secondary outcomes will be performed. Pre-specified subgroup analyses will be performed according to the type of toxic alcohol intoxication, mode of renal replacement therapy, and medical interventions received. A meta-analysis will be performed if three or more studies with similar populations, type of toxic alcohol poisoning, and outcome measures, as well as adequate quality, are identified. This review will be reported according to the recommendations of the Preferred Reporting ...
Keywords	Toxic alcohol ; Intoxication ; Poisoning ; Extracorporeal treatment ; Dialysis ; Antidotes ; Medicine ; R
Language	English
Publishing date	2018-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Safety Lapses Prior to Initiation of Hemodialysis for Acute Kidney Injury in Hospitalized Patients

Adrianna Douvris / Khalid Zeid / Swapnil Hiremath / Pierre Antoine Brown / Manish M. Sood / Rima Abou Arkoub / Gurpreet Malhi / Edward G. Clark

Journal of Clinical Medicine, Vol 7, Iss 10, p

A Patient Safety Initiative

2018 Volume 317

Abstract: Background: Safety lapses in hospitalized patients with acute kidney injury (AKI) may lead to hemodialysis (HD) being required before renal recovery might have otherwise occurred. We sought to identify safety lapses that, if prevented, could reduce the ... ...

Abstract	Background: Safety lapses in hospitalized patients with acute kidney injury (AKI) may lead to hemodialysis (HD) being required before renal recovery might have otherwise occurred. We sought to identify safety lapses that, if prevented, could reduce the need for unnecessary HD after AKI; Methods: We conducted a retrospective observational study that included consecutive patients treated with HD for AKI at a large, tertiary academic center between 1 September 2015 and 31 August 2016. Exposures of interest were pre-specified iatrogenic processes that could contribute to the need for HD after AKI, such as nephrotoxic medication or potassium supplement administration. Other outcomes included time from AKI diagnosis to initial management steps, including Nephrology referral; Results: After screening 344 charts, 80 patients were included for full chart review, and 264 were excluded because they required HD within 72 h of admission, were deemed to have progression to end-stage kidney disease (ESKD), or required other renal replacement therapy (RRT) modalities in critical care settings such as continuous renal replacement therapy (CRRT) or sustained low efficiency dialysis (SLED). Multiple safety lapses were identified. Sixteen patients (20%) received an angiotensin converting enzyme inhibitor or angiotensin receptor blocker after AKI onset. Of 35 patients with an eventual diagnosis of pre-renal AKI due to hypovolemia, only 29 (83%) received a fluid bolus within 24 h. For 28 patients with hyperkalemia as an indication for starting HD, six (21%) had received a medication associated with hyperkalemia and 13 (46%) did not have a low potassium diet ordered. Nephrology consultation occurred after a median (IQR) time after AKI onset of 3.0 (1.0–5.7) days; Conclusions: Although the majority of patients had multiple indications for the initiation of HD for AKI, we identified many safety lapses related to the diagnosis and management of patients with AKI. We cannot conclude that HD initiation was avoidable, but, improving safety ...
Keywords	acute kidney injury ; patient safety ; hemodialysis ; Medicine ; R
Subject code	616
Language	English
Publishing date	2018-10-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The impact of measuring split kidney function on post-donation kidney function

Kelly C Harper / Jean-Paul Salameh / Natasha Akhlaq / Matthew D F McInnes / Victoria Ivankovic / Mahdi H Beydoun / Edward G Clark / Wanzhen Zeng / Brian D M Blew / Kevin D Burns / Manish M Sood / Ann Bugeja

PLoS ONE, Vol 16, Iss 7, p e

A retrospective cohort study.

2021 Volume 0253609

Abstract: Background Studies have reported agreement between computed tomography (CT) and renography for the determination of split kidney function. However, their correlation with post-donation kidney function remains unclear. We compared CT measurements with ... ...

Abstract	Background Studies have reported agreement between computed tomography (CT) and renography for the determination of split kidney function. However, their correlation with post-donation kidney function remains unclear. We compared CT measurements with renography in assessment of split kidney function (SKF) and their correlations with post-donation kidney function. Methods A single-centre, retrospective cohort study of 248 donors from January 1, 2009-July 31, 2019 were assessed. Pearson correlations were used to assess post-donation kidney function with renography and CT-based measurements. Furthermore, we examined high risk groups with SKF difference greater than 10% on renography and donors with post-donation eGFR less than 60 mL/min/1.73m2. Results 62% of donors were women with a mean (standard deviation) pre-donation eGFR 99 (20) and post-donation eGFR 67 (22) mL/min/1.73m2 at 31 months of follow-up. Post-donation kidney function was poorly correlated with both CT-based measurements and renography, including the subgroup of donors with post-donation eGFR less than 60 mL/min/1.73m2 (r less than 0.4 for all). There was agreement between CT-based measurements and renography for SKF determination (Bland-Altman agreement [bias, 95% limits of agreement] for renography vs: CT volume, 0.76%, -7.60-9.15%; modified ellipsoid,1.01%, -8.38-10.42%; CC dimension, 0.44%, -7.06-7.94); however, CT missed SKF greater than 10% found by renography in 20 out 26 (77%) of donors. Conclusions In a single centre study of 248 living donors, we found no correlation between CT or renography and post-donation eGFR. Further research is needed to determine optimal ways to predict remaining kidney function after donation.
Keywords	Medicine ; R ; Science ; Q
Subject code	616
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Saline versus albumin fluid for extracorporeal removal with slow low-efficiency dialysis (SAFER-SLED)

Edward G. Clark / Lauralyn McIntyre / Tim Ramsay / Alan Tinmouth / Greg Knoll / Pierre-Antoine Brown / Irene Watpool / Rebecca Porteous / Kaitlyn Montroy / Sophie Harris / Jennifer Kong / Swapnil Hiremath

Pilot and Feasibility Studies, Vol 5, Iss 1, Pp 1-

study protocol for a pilot trial

2019 Volume 6

Abstract: Abstract Background Critically ill patients frequently develop acute kidney injury that necessitates renal replacement therapy (RRT). At some centers, critically ill patients who are hemodynamically unstable and require RRT are treated with slow low- ... ...

Abstract	Abstract Background Critically ill patients frequently develop acute kidney injury that necessitates renal replacement therapy (RRT). At some centers, critically ill patients who are hemodynamically unstable and require RRT are treated with slow low-efficiency dialysis (SLED). Unfortunately, hypotension is a frequent complication that occurs during SLED treatments and may limit the recovery of kidney function. Hypotension may also limit the amount of fluid that can be removed by ultrafiltration with SLED. Fluid overload can be exacerbated as a consequence, and fluid overload is associated with increased mortality. Occasionally, intravenous albumin fluid is given to prevent or treat low blood pressure during SLED. The intent of doing so is to increase the colloid oncotic pressure in the circulation to draw in extravascular fluid, increase the blood pressure, and enable more aggressive fluid removal with ultrafiltration. Nonetheless, there is little evidence to support this practice and theoretical reasons why it may not be especially effective at augmenting fluid removal in critically ill patients. At the same time, albumin fluid is expensive. As such, we present a protocol for a study to assess the feasibility of a randomized controlled trial evaluating the use of albumin fluid versus saline in critically ill patients receiving SLED. Methods This study is a single-center, double-blind, and randomized controlled pilot trial with two parallel arms. It involves randomly assigning patients receiving SLED treatment in the ICU to receive either albumin (25%) boluses or normal saline fluid boluses (placebo) to prevent and treat low blood pressure. Discussion The results of this pilot trial will help with planning a larger trial comparing the efficacy of the interventions in achieving fluid removal in critically ill patients with AKI on SLED. They will establish whether enough participants would participate in a larger study and accept the study procedures. Trial registration This trial is registered on ...
Keywords	Albumin ; Saline fluid ; Acute kidney injury ; Dialysis ; Low blood pressure ; SLED treatment ; Medicine (General) ; R5-920
Subject code	532
Language	English
Publishing date	2019-05-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Hemodialysis Access Choice

Andrea Mazarova / Swapnil Hiremath / Manish M. Sood / Edward G. Clark / Pierre Antoine Brown / Ann L. Bugeja / Grant L. England / Deborah Zimmerman

Health Literacy Research and Practice, Vol 1, Iss 3, Pp e136-e

Impact of Health Literacy

2017 Volume 144

Abstract: Background: Hemodialysis patients need to make decisions about vascular access and diet that they may not fully understand. In this study, we hypothesized that patients with low health literacy are likely to choose a central venous catheter (CVC) and ... ...

Abstract	Background: Hemodialysis patients need to make decisions about vascular access and diet that they may not fully understand. In this study, we hypothesized that patients with low health literacy are likely to choose a central venous catheter (CVC) and have higher serum potassium (K), serum phosphate (P), and inter-dialysis weight gains (IDWG). Objective: Primarily, the study sought to describe the health literacy of patients treated with hemodialysis in a Canadian tertiary care center. The secondary objective was to describe the association between health literacy and permanent vascular access choice, hyperkalemia, hyperphosphatemia, and IDWG. Methods: Adult patients receiving hemodialysis for more than 6 months were included. Health literacy was assessed with the Newest Vital Sign (NVS) test. Vascular access type and reasons for CVC use were determined. Serum K, P, and IDWG were collected retrospectively for 6 months. Student's t test and logistic regression were used to determine the association between health literacy (NVS score < 4 versus ≥ 4) and CVC choice, hyperkalemia, hyperphosphatemia, and high IDWG. Key Results: Fifty-six patients were involved. The average NVS score was 2.9. Overall, 66% of the patients had a CVC; one-third had chosen this access themselves. Poor control of K, P, and IDWG was experienced by 27%, 55%, and 36% of patients, respectively. The average NVS score was lower for patients choosing a CVC (p = .001), but not different for those with higher K, P, or IDWG. None of the patients who chose a CVC had adequate health literacy (NVS ≥ 4). Conclusions: Patients with low health literacy, who are eligible for both surgically created vascular access (fistula or graft) and CVC, are more likely to refuse fistula/graft creation compared to patients with adequate health literacy. Different educational strategies for such patients may help in appropriate decision-making.
Keywords	hemodialysis ; health literacy ; patient education ; public health ; Public aspects of medicine ; RA1-1270
Subject code	616
Language	English
Publishing date	2017-09-01T00:00:00Z
Publisher	SLACK Incorporated
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Systemic mycoplasmosis with dystocia and abortion in a North American bison (Bison bison) herd

Register, Karen B / Edward G. Clark / Jennifer L. Davies / Jessie D. Trujillo / José Perez-Casal / M. Claire Windeyer / Murray R. Woodbury / Patrick H. Burrage

Journal of veterinary diagnostic investigation. , v. 25, no. 4

2013

Abstract: The current study describes a fatal Mycoplasma bovis infection in a North American bison (Bison bison) cow and her aborted fetus in a herd suffering unusual mortality associated with dystocia and abortion. Postmortem evaluation of the subject case found ... ...

Abstract	The current study describes a fatal Mycoplasma bovis infection in a North American bison (Bison bison) cow and her aborted fetus in a herd suffering unusual mortality associated with dystocia and abortion. Postmortem evaluation of the subject case found severe caseonecrotic bronchopneumonia, chronic fibrinous pleuritis and pulmonary sequestra, foci of caseous necrosis in the kidneys, and necrotizing endometritis and placentitis. Histologic findings in the maternal tissues include endometrial and placental necrotizing vasculitis and changes in the lung similar to those previously described for M. bovis–associated pneumonia in feedlot bison. Gross and microscopic lesions were not observed in the fetus. Maternal lung, uterus, kidney, and placenta as well as fetal lung and kidney were positive for M. bovis by polymerase chain reaction (PCR) as were the Mycoplasma-like colonies cultured from these tissues. The presence of M. bovis in maternal and fetal tissues was further demonstrated using nucleic acid extracts in a pan-Mycoplasma SYBR Green PCR assay targeting the 16S-23S ribosomal RNA spacer region with post-PCR dissociation curve analysis and sequencing of the resulting amplicons. Immunohistochemistry (IHC) testing on maternal lung and uterine caruncle was strongly positive for M. bovis antigen. A variety of methods, including culture, PCR, and IHC, failed to identify other bacterial or viral pathogens in any of the tissues evaluated. These data are the first to implicate M. bovis as a cause of placentitis and abortion in bison.
Keywords	abortion (animals) ; bacterial antigens ; bison ; bronchopneumonia ; cows ; dystocia ; endometritis ; feedlots ; fetus ; herds ; immunohistochemistry ; kidneys ; lungs ; mortality ; Mycoplasma bovis ; mycoplasmosis ; necrosis ; pathogens ; placenta ; polymerase chain reaction ; ribosomal RNA ; uterus ; vasculitis ; wildlife diseases
Language	English
Dates of publication	2013-07
Size	p. 541-545.
Publishing place	SAGE Publications
Document type	Article
ZDB-ID	287603-6
ISSN	1943-4936 ; 1040-6387
ISSN (online)	1943-4936
ISSN	1040-6387
DOI	10.1177/1040638713495029
Database	NAL-Catalogue (AGRICOLA)

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Article: Porcine Postweaning Multisystemic Wasting Syndrome in Korean Pig: Detection of Porcine Circovirus 2 Infection by Immunohistochemistry and Polymerase Chain Reaction

Choi, Changsun / Chanhee Chae / Edward G. Clark

Journal of veterinary diagnostic investigation. , v. 12, no. 2

2000

Abstract: This report describes the first diagnosis of porcine circovirus (PCV) infection in weaned pigs with postweaning multisystemic wasting syndrome in Korea by immunohistochemistry and polymerase chain reaction. The most unique lesions were multifocal ... ...

Abstract	This report describes the first diagnosis of porcine circovirus (PCV) infection in weaned pigs with postweaning multisystemic wasting syndrome in Korea by immunohistochemistry and polymerase chain reaction. The most unique lesions were multifocal granulomatous inflammation affecting lymph nodes, liver, and spleen, characterized by infiltrates of epithelioid macrophages and multinucleated giant cells. Circoviral antigen was detected in formalin-fixed sections and was usually present in large, round, dendritic cells in the white pulp of spleen and remnants of follicles in lymph nodes. Lymphoid follicles in the tonsils also contained PCV antigen. A 530–bp DNA fragment of circovirus was successfully amplified from all tested lymph nodes, liver, and spleen.
Keywords	animal tissues ; histopathology ; immunohistochemistry ; polymerase chain reaction ; Porcine circovirus ; swine ; swine diseases ; Korea ; South Korea
Language	English
Dates of publication	2000-03
Size	p. 151-153.
Publishing place	SAGE Publications
Document type	Article
ZDB-ID	287603-6
ISSN	1943-4936 ; 1040-6387
ISSN (online)	1943-4936
ISSN	1040-6387
DOI	10.1177/104063870001200209
Database	NAL-Catalogue (AGRICOLA)

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