Our faculty research broadens the knowledge of kidney disease.

Characteristics and Outcomes of Patients with Anti-Glomerular Basement Membrane Antibody Disease and Anti-Neutrophil Cytoplasmic Antibodies

 Percy G. Balderia*, Nicole Andeen, Jonathan A. Jefferson

It is unclear whether patients with Anti-Glomerular Basement Membrane (GBM) disease and Anti-Neutrophil Cytoplasmic Antibodies (ANCA), so called “Double-Positive” (DP), have a different clinical presentation and outcome compared to patients with anti-GBM antibody disease alone. This study describes the clinical and histologic characteristics as well as the patient and renal outcomes of DP patients at the University of Washington compared to patients with anti-GBM antibody disease alone.

APOL1 Kidney Risk Variants and Cardiovascular Disease: An Individual Participant Data Meta-Analysis

Morgan E. Grams, Aditya Surapaneni, Shoshana H. Ballew, Lawrence J. Appel, Eric Boerwinkle, L. Ebony Boulware, Teresa K. Chen, Josef Coresh, Mary Cushman, Jasmin Divers, Orlando M. Gutiérrez, Marguerite R. Irvin, Joachim H. Ix, Jeffrey B. Kopp, Lewis H. Kuller, Carl D. Langefeld, Michael S. Lipkowitz, Kenneth J. Mukamal, Solomon K. Musani, Rakhi P. Naik, Nicholas M. Pajewski, Carmen A. Peralta, Adrienne Tin, Christina L. Wassel, James G. Wilson, Cheryl A. Winkler, Bessie A. Young, Neil A. Zakai, Barry I. Freedman

Two variations in the apo L1 gene (APOL1) common in West African and African American populations are strongly associated with development of ESKD. Studies evaluating whether these APOL1 kidney-risk variants increase the risk of cardiovascular disease have had inconsistent results. The authors conducted a two-stage meta-analysis of individual participant data from eight large cohorts with data on APOL1 kidney-risk variants. The analysis included 21,305 blacks and assessed the relationship between APOL1 kidney-risk variants and several types of cardiovascular disease and death.

ANCA-Associated Vasculitis: Core Curriculum 2020

Geetha, D., Jefferson, J.A.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of disorders characterized by inflammation and destruction of small- and medium-sized blood vessels and the presence of circulating ANCA. This article in AJKD’s Core Curriculum in Nephrology series provides a detailed review of the epidemiology, pathogenesis, diagnosis, and advances in the management of AAV.

Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis

Emily L. Cooper , Yanmei Xie , Hanh Nguyen , Pamela S. Brewster , Haden Sholl , Megan Sharrett , Kaili Ren , Tian Chen , Katherine R. Tuttle , Steven T. Haller , Kenneth Jamerson , Timothy P. Murphy , Ralph B. D'Agostino Sr , Joseph M. Massaro , William Henrich , Christopher J. Cooper , Donald E. Cutlip , Lance D. Dworkin , Joseph I. Shapiro

Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Patients enrolled in the medical therapy–only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline (RD) in estimated glomerular filtration rate (eGFR), defined as a ≥30% decrease from baseline to either 3 months, 6 months, or both.

Association of functional and structural social support with chronic kidney disease among African Americans: The Jackson Heart Study

Rasheeda K. Hall, Clemontina A. Davenport, Mario Sims, Cathleen Colón-Emeric, Tiffany Washington, Jennifer St. Clair Russell, Jane Pendergast, Nrupen Bhavsar, Julia Scialla, Crystal C. Tyson, Wei Wang, Yuan-I Min, Bessie Young, L. Ebony Boulware, Clarissa J. Diamantidis 

There is limited evidence on the relationship between social support and renal outcomes in African Americans. We sought to determine the association of social support with prevalent chronic kidney disease (CKD) and kidney function decline in an African American cohort. We also examined whether age modifies the association between social support and kidney function decline.

Differences in proximal tubular solute clearance across common etiologies of chronic kidney disease

Wang K, Zelnick LR, Hoofnagle AN, Chen Y, de Boer IH, Himmelfarb J, Kestenbaum B

Diverse CKD etiologies have distinct pathological mechanisms that may differentially impact the kidney tubules. Little is known regarding how tubular function changes with varying kidney disease types. We used targeted mass spectrometry to quantify paired serum and urine concentration of 11 solutes of proximal tubular secretion in 223 patients from an outpatient CKD cohort.

Attitudes toward Peritoneal Dialysis among Peritoneal Dialysis and Hemodialysis Medical Directors: Are We Preaching to the Right Choir?

Jenny I. Shen, Martin J. Schreiber, Junhui Zhao, Bruce M. Robinson, Ronald L. Pisoni, Rajnish Mehrotra, Matthew J. Oliver, Tadashi Tomo, Kriang Tungsanga, Isaac Teitelbaum, Arshia Ghaffari, Mark Lambie and Jeffrey Perl

Worldwide, only 10% of the approximately 1.7 million patients on dialysis are treated with home-based peritoneal dialysis (PD); the majority receive facility-based hemodialysis (HD), although most patients prefer PD when educated about their options.

Rituximab or cyclosporine in the treatment of membranous nephropathy

Fernando C. Fervenza, Gerald B. Appel, Sean J. Barbour, Brad H. Rovin, Richard A. Lafayette, Nabeel Aslam, Jonathan A. Jefferson, Patrick E. Gipson, Dana V. Rizk, John R. Sedor, James F. Simon, Ellen T. McCarthy, et al., for the MENTOR Investigators

B-cell anomalies play a role in the pathogenesis of membranous nephropathy. B-cell depletion with rituximab may therefore be noninferior to treatment with cyclosporine for inducing and maintaining a complete or partial remission of proteinuria in patients with this condition.

Implementing the European Renal Best Practice Guidelines suggests that prediction equations work well to differentiate risk of end-stage renal disease vs. death in older patients with low estimated glomerular filtration rate

Hallan SI, Rifkin DE, Potok OA, Katz R, Langlo KA, Bansal N, Ix JH

Recent European guidelines suggest using the kidney failure risk equation (KFRE) and mortality risk equation for kidney disease (MREK) to guide decisions on whether elderly patients with chronic kidney disease should be referred early for dialysis preparation. However, the concurrent use of the two risk equations has not been validated. To do so we evaluated 1,188 individuals over five years with estimated glomerular filtration rate (eGFR) under 45ml/min/1.73m2 and age over 65 years from the Norwegian population based HUNT study. Forty-two patients started renal replacement therapy and 462 died as their first clinical event. The KFRE was well calibrated (mean risk estimate 4.9% vs observed 3.5%) with high diagnostic accuracy (C-statistics 0.93).

Assessment of Self-reported Prognostic Expectations of People Undergoing Dialysis United States Renal Data System Study of Treatment Preferences (USTATE)

Ann M. O’Hare, Manjula Kurella Tamura, Danielle C. Lavallee, Elizabeth K. Vig, Janelle S. Taylor, Yoshio N. Hall, Ronit Katz, J. Randall Curtis, Ruth A. Engelberg

What are the prognostic expectations of people undergoing dialysis, and how do these relate to their treatment goals and preferences? In this cross-sectional survey study of 996 patients receiving maintenance dialysis at nonprofit facilities in 2 US metropolitan areas, most of the respondents were either uncertain about prognosis or had a prognostic expectation of more than 10 years. In adjusted analyses, these groups were less likely than those with a prognostic expectation of fewer than 5 years to report having documented their treatment preferences and to value comfort over life extension, and more likely to want cardiopulmonary resuscitation and mechanical ventilation.