Progressive outer retinal necrosis in a renal transplant recipient: a rare treatment success

Renal transplant recipients (RTRs) are subject to a variety of opportunistic infections. We present a rare case of varicella zoster virus-derived progressive outer retinal necrosis in an RTR, who presented with painless visual blurring. This clinical entity heralds an extremely poor visual prognosis and is an important condition to consider in any immunocompromised host. Early diagnosis by aqueous fluid sampling and immediate institution of combined systemic and intravitreal antiviral therapy was successful in this individual.postprin

N-Acetyl-seryl-aspartyl-lysyl-proline Alleviates Renal Fibrosis Induced by Unilateral Ureteric Obstruction in BALB/C Mice

To expand the armamentarium of treatment for chronic kidney disease (CKD), we explored the utility of boosting endogenously synthesized N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP), which is augmented by inhibition of the angiotensin converting enzyme. Male BALB/c mice underwent unilateral ureteral ligation (UUO) or sham operation and received exogenously administered Ac-SDKP delivered via a subcutaneous osmotic minipump or Captopril treatment by oral gavage. Seven days after UUO, there were significant reductions in the expression of both collagen 1 and collagen 3 in kidneys treated with Ac-SDKP or Captopril, and there was a trend towards reductions in collagen IV, alpha-SMA, and MCP-1 versus control. However, no significant attenuation of interstitial injury or macrophage infiltration was observed. These findings are in contrary to observations in other models and underscore the fact that a longer treatment time frame may be required to yield anti-inflammatory effects in BALB/c mice treated with Ac-SDKP compared to untreated mice. Finding an effective treatment regimen for CKD requires fine-tuning of pharmacologic protocols.published_or_final_versio

Semi-individualised Chinese medicine treatment as an adjuvant management for diabetic nephropathy: a pilot add-on, randomised, controlled, multicentre, open-label pragmatic clinical trial

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Severe liver failure due to influenza A infection in a hemodialysis patient

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Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Diabetic Nephropathy: landmark clinical trials and tribulations

Diabetic nephropathy remains the most common cause of end-stage renal disease worldwide. The current standard of therapy for diabetic nephropathy involves stringent blood pressure control via blockade of the renin–angiotensin system and control of hyperglycemia. Despite these strategies, diabetic nephropathy is still seen to progress relentlessly. A pressing need for novel therapeutic agents has fueled endless basic science research projects and clinical trials in the quest for a more specific therapy. Throughout the process, only a handful of ancillary agents have shown experimental promise and even fewer have demonstrated an impact in human trials. This review article aims to summarize the available data from landmark studies for the main therapeutic approaches investigated

Prevalence and severity of sleep apnea in different stages of chronic kidney disease

Thursday Poster - CKD: Complications - 1: no. TH-PO631BACKGROUND: The prevalence and severity of sleep apnea in the non-dialysis chronic kidney disease (CKD) population have not been well characterized. A handful of studies performed to date have yielded highly variable prevalence rates due to cohort heterogeneity and inter-study inconsistencies in sleep apnea definition. This study sought to determine the association of sleep apnea with non-dialysis CKD by recruiting a uniform cohort to undertake overnight polysomnography (PSG). METHODS: 141 male Chinese CKD patients, aged 40 to 60 years old, were recruited to undergo overnight PSG. Height, weight, neck girth, estimated glomerular filtration rate, spot urinary protein excretion and Epworth sleepiness scale (ESS) score were collected at baseline. The prevalence and severity of both sleep apnea and associated nocturnal hypoxemia (NH) were determined across the full spectrum of non-dialysis CKD. RESULTS: The prevalence of sleep apnea (apnea-hypopnea index [AHI] ≥ 15) and NH (Sleep Heart Health Study arbitrary definition) was 35.5% and 10.6% respectively in this study population, which had a mean (± SD) age and BMI of 51.44 ± 6.05 y and 26.05 ± 4.22 kg/m2. The adjusted odds ratio (OR) for sleep apnea by body mass index (BMI) and proteinuria were 1.18 (95% confidence interval [CI] 1.02 - 1.37; P ≤ 0.05) and 2.60 (95% CI 2.56 - 2.61; P ≤ 0.05) respectively. The adjusted OR for median cohort oxygen desaturation index (ODI) by BMI and proteinuria were 1.23 (95% CI 1.05 - 1.45; P ≤ 0.05) and 2.60 (95% 2.56 - 2.61; P ≤ 0.05). However, no significant correlation between prevalence and severity of sleep apnea and NH with progressive renal deterioration was observed. Furthermore, an ESS score above 10 showed no significant mean difference in AHI and ODI when compared to a score below 10. CONCLUSIONS: Sleep apnea is prevalent in the Chinese non-dialysis CKD population and strongly correlated with BMI and proteinuria, but not renal function. The study results also indicate that ESS is an investigative tool that lacks discriminatory power in patients with renal insufficiency. This study supports the need to maintain high clinical vigilance for sleep apnea when attending to CKD patients with significant proteinuria.link_to_OA_fulltex