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1. Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Adler, Sharon G., Alpers, Charles E., Ayoub, Isabelle, Bagga, Arvind, Barbour, Sean J., Barratt, Jonathan, Chan, Daniel T.M., Chang, Anthony, Choo, Jason Chon Jun, Cook, H. Terence, Coppo, Rosanna, Fervenza, Fernando C., Fogo, Agnes B., Fox, Jonathan G., Glassock, Richard J., Harris, David, Hodson, Elisabeth M., Hogan, Jonathan J., Hoxha, Elion, Iseki, Kunitoshi, Jennette, J. Charles, Jha, Vivekanand, Johnson, David W., Kaname, Shinya, Katafuchi, Ritsuko, Kitching, A. Richard, Lafayette, Richard A., Li, Philip K.T., Liew, Adrian, Lv, Jicheng, Malvar, Ana, Maruyama, Shoichi, Mejía-Vilet, Juan Manuel, Mok, Chi Chiu, Nachman, Patrick H., Nester, Carla M., Noiri, Eisei, O'Shaughnessy, Michelle M., Özen, Seza, Parikh, Samir M., Park, Hyeong-Cheon, Peh, Chen Au, Pendergraft, William F., Pickering, Matthew C., Pillebout, Evangéline, Radhakrishnan, Jai, Rathi, Manish, Ronco, Pierre, Smoyer, William E., Tang, Sydney C.W., Tesař, Vladimír, Thurman, Joshua M., Trimarchi, Hernán, Vivarelli, Marina, Walters, Giles D., Wang, Angela Yee-Moon, Wenderfer, Scott E., Wetzels, Jack F.M., Rovin, Brad H., Caster, Dawn J., Cattran, Daniel C., Gibson, Keisha L., Moeller, Marcus J., Roccatello, Dario, Cheung, Michael, Wheeler, David C., Winkelmayer, Wolfgang C., and Floege, Jürgen

Published
2019
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2. Management and treatment of glomerular diseases (part 1): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Adler, Sharon G., Alpers, Charles E., Ayoub, Isabelle, Bagga, Arvind, Barratt, Jonathan, Caster, Dawn J., Chan, Daniel T.M., Chang, Anthony, Choo, Jason Chon Jun, Cook, H. Terence, Coppo, Rosanna, Fervenza, Fernando C., Fogo, Agnes B., Fox, Jonathan G., Gibson, Keisha L., Glassock, Richard J., Harris, David, Hodson, Elisabeth M., Hoxha, Elion, Iseki, Kunitoshi, Jennette, J. Charles, Jha, Vivekanand, Johnson, David W., Kaname, Shinya, Katafuchi, Ritsuko, Kitching, A. Richard, Lafayette, Richard A., Li, Philip K.T., Liew, Adrian, Lv, Jicheng, Malvar, Ana, Maruyama, Shoichi, Mejía-Vilet, Juan Manuel, Moeller, Marcus J., Mok, Chi Chiu, Nester, Carla M., Noiri, Eisei, O'Shaughnessy, Michelle M., Özen, Seza, Parikh, Samir M., Park, Hyeong-Cheon, Peh, Chen Au, Pendergraft, William F., Pickering, Matthew C., Pillebout, Evangéline, Radhakrishnan, Jai, Rathi, Manish, Roccatello, Dario, Ronco, Pierre, Smoyer, William E., Tesař, Vladimír, Thurman, Joshua M., Trimarchi, Hernán, Vivarelli, Marina, Walters, Giles D., Wang, Angela Yee-Moon, Wenderfer, Scott E., Floege, Jürgen, Barbour, Sean J., Cattran, Daniel C., Hogan, Jonathan J., Nachman, Patrick H., Tang, Sydney C.W., Wetzels, Jack F.M., Cheung, Michael, Wheeler, David C., Winkelmayer, Wolfgang C., and Rovin, Brad H.

Published
2019
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6. Predicting outcome in acute interstitial nephritis: a case series examining the importance of histological parameters

Author

Rankin, Alastair J., Cannon, Emma, Gillis, Keith, Crosby, Jana, Mark, Patrick B., Geddes, Colin C., Fox, Jonathan G., Mackinnon, Bruce, McQuarrie, Emily, and Kipgen, David

Abstract

Background:\ud The clinical significance of common histological parameters in acute interstitial nephritis (AIN) is uncertain. We aimed to evaluate the utility of histology in predicting clinical outcomes in patients with AIN.\ud \ud Methods and results:\ud Adult renal biopsies yielding a diagnosis of AIN between 2000 and 2015 were re‐examined. Patients were divided into groups based on: 1) the percentage of non‐fibrotic cortex containing inflammation (NFI‐score), (NFI‐1=0‐24%, NFI‐2=25‐74%, NFI‐3=75‐100%), and 2) the percentage of cortex containing tubular atrophy (TA score), (TA1=0‐9%, TA2=10‐24%, TA3=25‐100%). The primary outcome was a composite of ≥50% reduction in serum creatinine (sCr) or an eGFR >60 ml/min/1.73m2 1‐year post‐biopsy. From a total of 2817 native renal biopsies, there were 120 patients with AIN and adequate data for analysis. Of these, 66 (56%) achieved the primary outcome. On univariable logistic regression, NFI‐3 was associated with a 16 times increased likelihood of achieving the primary outcome compared to NFI‐1 (OR 16 (95% CI 5.2‐50)). In contrast, TA3 were associated with a 90% reduced likelihood of achieving the primary outcome compared to TA1 (OR=0.10 (95%CI 0.0‐0.3)). Maximal clinical utility was achieved by combining TA and NFI into a single prognostic ‘TANFI’ score, which had an independent predictive effect on the primary outcome in a multivariable regression model consisting of age, sex, baseline sCr and identified drug cause.\ud \ud Conclusions:\ud In patients with biopsy‐proven AIN, a lower percentage of cortical tubular atrophy and, paradoxically, a higher percentage of inflammation in non‐fibrosed cortex were associated with an increased likelihood of a positive clinical outcome.

Published
2020

18. Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Rovin, Brad H., primary, Caster, Dawn J., additional, Cattran, Daniel C., additional, Gibson, Keisha L., additional, Hogan, Jonathan J., additional, Moeller, Marcus J., additional, Roccatello, Dario, additional, Cheung, Michael, additional, Wheeler, David C., additional, Winkelmayer, Wolfgang C., additional, Floege, Jürgen, additional, Adler, Sharon G., additional, Alpers, Charles E., additional, Ayoub, Isabelle, additional, Bagga, Arvind, additional, Barbour, Sean J., additional, Barratt, Jonathan, additional, Chan, Daniel T.M., additional, Chang, Anthony, additional, Choo, Jason Chon Jun, additional, Cook, H. Terence, additional, Coppo, Rosanna, additional, Fervenza, Fernando C., additional, Fogo, Agnes B., additional, Fox, Jonathan G., additional, Glassock, Richard J., additional, Harris, David, additional, Hodson, Elisabeth M., additional, Hoxha, Elion, additional, Iseki, Kunitoshi, additional, Jennette, J. Charles, additional, Jha, Vivekanand, additional, Johnson, David W., additional, Kaname, Shinya, additional, Katafuchi, Ritsuko, additional, Kitching, A. Richard, additional, Lafayette, Richard A., additional, Li, Philip K.T., additional, Liew, Adrian, additional, Lv, Jicheng, additional, Malvar, Ana, additional, Maruyama, Shoichi, additional, Mejía-Vilet, Juan Manuel, additional, Mok, Chi Chiu, additional, Nachman, Patrick H., additional, Nester, Carla M., additional, Noiri, Eisei, additional, O'Shaughnessy, Michelle M., additional, Özen, Seza, additional, Parikh, Samir M., additional, Park, Hyeong-Cheon, additional, Peh, Chen Au, additional, Pendergraft, William F., additional, Pickering, Matthew C., additional, Pillebout, Evangéline, additional, Radhakrishnan, Jai, additional, Rathi, Manish, additional, Ronco, Pierre, additional, Smoyer, William E., additional, Tang, Sydney C.W., additional, Tesař, Vladimír, additional, Thurman, Joshua M., additional, Trimarchi, Hernán, additional, Vivarelli, Marina, additional, Walters, Giles D., additional, Wang, Angela Yee-Moon, additional, Wenderfer, Scott E., additional, and Wetzels, Jack F.M., additional

Published
2019
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19. Management and treatment of glomerular diseases (part 1): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Author

Floege, Jürgen, primary, Barbour, Sean J., additional, Cattran, Daniel C., additional, Hogan, Jonathan J., additional, Nachman, Patrick H., additional, Tang, Sydney C.W., additional, Wetzels, Jack F.M., additional, Cheung, Michael, additional, Wheeler, David C., additional, Winkelmayer, Wolfgang C., additional, Rovin, Brad H., additional, Adler, Sharon G., additional, Alpers, Charles E., additional, Ayoub, Isabelle, additional, Bagga, Arvind, additional, Barratt, Jonathan, additional, Caster, Dawn J., additional, Chan, Daniel T.M., additional, Chang, Anthony, additional, Choo, Jason Chon Jun, additional, Cook, H. Terence, additional, Coppo, Rosanna, additional, Fervenza, Fernando C., additional, Fogo, Agnes B., additional, Fox, Jonathan G., additional, Gibson, Keisha L., additional, Glassock, Richard J., additional, Harris, David, additional, Hodson, Elisabeth M., additional, Hoxha, Elion, additional, Iseki, Kunitoshi, additional, Jennette, J. Charles, additional, Jha, Vivekanand, additional, Johnson, David W., additional, Kaname, Shinya, additional, Katafuchi, Ritsuko, additional, Kitching, A. Richard, additional, Lafayette, Richard A., additional, Li, Philip K.T., additional, Liew, Adrian, additional, Lv, Jicheng, additional, Malvar, Ana, additional, Maruyama, Shoichi, additional, Mejía-Vilet, Juan Manuel, additional, Moeller, Marcus J., additional, Mok, Chi Chiu, additional, Nester, Carla M., additional, Noiri, Eisei, additional, O'Shaughnessy, Michelle M., additional, Özen, Seza, additional, Parikh, Samir M., additional, Park, Hyeong-Cheon, additional, Peh, Chen Au, additional, Pendergraft, William F., additional, Pickering, Matthew C., additional, Pillebout, Evangéline, additional, Radhakrishnan, Jai, additional, Rathi, Manish, additional, Roccatello, Dario, additional, Ronco, Pierre, additional, Smoyer, William E., additional, Tesař, Vladimír, additional, Thurman, Joshua M., additional, Trimarchi, Hernán, additional, Vivarelli, Marina, additional, Walters, Giles D., additional, Wang, Angela Yee-Moon, additional, and Wenderfer, Scott E., additional

Published
2019
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20. Successful use of cisplatin to treat metastatic seminoma during cisplatin-induced acute renal failure

Author

Fox, Jonathan G., Kerr, David J., Soukop, Michael, Farmer, John G., and Allison, Marjorie E.M.

Subjects
Germ cell tumors, Acute renal failure -- Care and treatment, Acute renal failure -- Causes of, Cisplatin -- Adverse and side effects, Health
Abstract

Cisplatin is a potent chemotherapeutic agent that plays a key role in many cancer treatments. Unfortunately, it has many potentially serious side effects which often limit the amount of cisplatin that can be administered. One of these side effects is kidney toxicity. Usually, acute kidney failure resulting from cisplatin treatment indicates that the drug must be halted. However, the case of a 34-year-old man revealed that this may not necessarily be so. The patient developed abdominal pain and weight loss, and was found to have a large tumor in his back. Biopsy revealed the tumor to be a seminoma, a tumor that develops in men from germ cells. Cisplatin is generally the chemotherapeutic agent of choice for seminoma. The patient's tumor was measurably shrinking 41 days after the start of treatment when he developed septicemia. (Septicemia results from bacteria in the blood and, in this case, was most likely the result of a rectal biopsy.) The patient rapidly developed acute kidney failure which was believed to be due to the combined effects of cisplatin and septicemia. Intermittent dialysis was required. Ninety-three days after the start of cisplatin treatment, ultrasonic images revealed the recurrence of the cancer, as well as the appearance of a new tumor mass. It was decided to return the patient to cisplatin therapy while simultaneously placing him on dialysis. Mannitol and intravenous saline were administered in an effort to protect the kidneys from further damage during treatment. The patient was able to achieve a complete remission as a result of the cisplatin treatment and remains free of disease after three years. The patient's kidneys have recovered to useful function. While it would be unwise to generalize on the basis of this one observation, this case does illustrate that, when the patient's life may be at stake, acute kidney failure does not necessarily preclude further, and ultimately successful, treatment with cisplatin. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1991

24. Assessment of active tubulointerstitial nephritis in non-scarred renal cortex improves prediction of renal outcomes in patients with IgA nephropathy.

Author

Rankin, Alastair J, Kipgen, David, Geddes, Colin C, Fox, Jonathan G, Milne, Gordon, Mackinnon, Bruce, and McQuarrie, Emily P

Subjects
IGA glomerulonephritis, SCHOENLEIN-Henoch purpura, NEPHRITIS, KIDNEY cortex
Abstract

Highlights from the article: Method to score percentage of non-atrophic renal cortex containing active tubulointerstitial inflammation (ATIN) in All adult patients with a native renal biopsy diagnosis of IgAN between 2010 and 2015 in a unit serving 1.5 million people Within our centre, ATIN was significantly associated with renal outcome in patients with IgAN, independently Patients received immunosuppression had ATIN on biopsy, of.

Published
2019
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25. Association between urinary sodium, creatinine, albumin, and long term survival in chronic kidney disease

Author

McQuarrie, Emily P., Traynor, Jamie P., Taylor, Alison H., Freel, E. Marie, Fox, Jonathan G., Jardine, Alan G., and Mark, Patrick

Subjects
urologic and male genital diseases
Abstract

Dietary sodium intake is associated with hypertension and cardiovascular risk in the general population. In patients with chronic kidney disease, sodium intake has been associated with progressive renal disease, but not independently of proteinuria. We studied the relationship between urinary sodium excretion and urinary sodium:creatinine ratio and mortality or requirement for renal replacement therapy in chronic kidney disease. Adults attending a renal clinic who had at least one 24-hour urinary sodium measurement were identified. 24-hour urinary sodium measures were collected and urinary sodium:creatinine ratio calculated. Time to renal replacement therapy or death was recorded. 423 patients were identified with mean estimated glomerular filtration rate of 48ml/min/1.73m2. 90 patients required renal replacement therapy and 102 patients died. Mean slope decline in estimated glomerular filtration rate was -2.8ml/min/1.73m2/year. Median follow-up was 8.5 years. Patients who died or required renal replacement therapy had significantly higher urinary sodium excretion and urinary sodium:creatinine but the association with these parameters and poor outcome was not independent of renal function, age and albuminuria. When stratified by albuminuria, urinary sodium:creatinine was a significant cumulative additional risk for mortality, even in patients with low level albuminuria. There was no association between low urinary sodium and risk, as observed in some studies. This study demonstrates an association between urinary sodium excretion and mortality in chronic kidney disease, with a cumulative relationship between sodium excretion, albuminuria and reduced survival. These data support reducing dietary sodium intake in chronic kidney disease but further study is required to determine the target sodium intake.

Published
2014

27. Factors influencing withdrawal from dialysis: a national registry study

Author

Findlay, Mark D., primary, Donaldson, Ken, additional, Doyle, Arthur, additional, Fox, Jonathan G., additional, Khan, Izhar, additional, McDonald, Jackie, additional, Metcalfe, Wendy, additional, Peel, Robert K., additional, Shilliday, Ilona, additional, Spalding, Elaine, additional, Stewart, Graham A., additional, Traynor, Jamie P., additional, and Mackinnon, Bruce, additional

Published
2016
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28. The role of sodium thiosulphate in the treatment of calciphylaxis

Author

Smith, James R, Findlay, Mark D, Geddes, Colin C, and Fox, Jonathan G

Subjects
sodium thiosulphate, calciphylaxis, Calcific uraemic arteriolopathy
Abstract

Calciphylaxis is a rare but important cause of severe morbidity, which predominantly affects patients with advanced chronic kidney disease. It is associated with mortality in excess of 50% at one year, and this has changed little over the last 20 years despite advances in our understanding of its underlying pathophysiology, and evolving treatment strategies. Sodium thiosulphate has played a prominent role in the treatment of calciphylaxis since its first use in 2004, with reports of success both in improving the severe pain associated with the condition and in the healing of calciphylaxis lesions. The literature documenting the use of sodium thiosulphate in the treatment of calciphylaxis is reviewed here, along with a detailed summary of case reports and case series. While there is reason to be optimistic with regard to the efficacy of sodium thiosulphate within a multifaceted and multidisciplinary approach to treatment, there is clearly much yet to be learned

Published
2012

30. Multiple socioeconomic deprivation and impact on survival in patients with primary glomerulonephritis.

Author

McQuarrie, Emily P., Mackinnon, Bruce, Bell, Samira, Fleming, Stewart, McNeice, Valerie, Stewart, Graham, Fox, Jonathan G., and Geddes, Colin C.

Subjects
TREATMENT of glomerulonephritis, SOCIOECONOMIC factors, TREATMENT effectiveness
Abstract

Background: The impact of multiple socio-economic deprivation on patient outcomes in primary renal diseases is unknown. We aimed to assess whether risk of death or requiring renal replacement therapy (RRT) in patients with primary glomerulonephritis (GN) was higher in patients living in an area of multiple socio-economic deprivation. Methods: Patients undergoing native renal biopsy between 2000 and 2014 were identified. Baseline demographics, postcode at time of biopsy, follow-up blood pressure, proteinuria and time to death or RRT were recorded. The Scottish Index of Multiple Deprivation (SIMD) is a multidimensional model used to measure deprivation based on postcode. Using SIMD, patients were separated into tertiles of deprivation. Results: A total of 797 patients were included, 64.2% were male with mean age of 54.1 (standard deviation 17.0) years. Median follow-up was 6.3 (interquartile range 3.7-9.4) years during which 174 patients required RRT and 185 patients died. Patients in the most deprived tertile of deprivation were significantly more likely to die than those in the least deprived tertile [hazard ratio (HR) 2.2, P < 0.001], independent of age, baseline serum creatinine and blood pressure. They were not more likely to require RRT (P = 0.22). The increased mortality risk in the most deprived tertile was not uniform across primary renal diseases, with the association being most marked in focal segmental glomerulosclerosis (HR 7.4) and IgA nephropathy (HR 2.7) and absent in membranous nephropathy. Conclusion:We have demonstrated a significant independent 2-fold increased risk of death in patients with primary GN who live in an area of multiple socio-economic deprivation at the time of diagnosis as compared with those living in less deprived areas. [ABSTRACT FROM AUTHOR]

Published
2017
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31. The Authors Reply

Author

McQuarrie, Emily P., primary, Mackinnon, Bruce, additional, McNeice, Valerie, additional, Fox, Jonathan G., additional, and Geddes, Colin C., additional

Published
2014
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37. Venous Thromboembolism in Primary Nephrotic Syndrome - Is the Risk High Enough to Justify Prophylactic Anticoagulation?

Author

Rankin, Alastair J., McQuarrie, Emily P., Fox, Jonathan G., Geddes, Colin C., and MacKinnon, Bruce

Abstract

Background:The reported incidence of venous thromboembolism (VTE) in patients with nephrotic syndrome (NS) varies widely, as does the approach to prophylactic anticoagulation. We aimed to assess the incidence of VTE in patients with primary NS in order to inform a sample size calculation to determine if a future clinical trial will ever be feasible. Methods:All adults undergoing native renal biopsy for NS between 2008 and 2013 yielding a diagnosis of primary glomerulonephritis were identified. Baseline serum albumin, urine protein:creatinine ratio, estimated glomerular filtration rate, date of biopsy and histological diagnosis were recorded. Episodes of objectively verified VTE were identified using the electronic patient record. Sample size calculations were performed based on 2 independent samples with a dichotomous outcome and to achieve a power of 80% and p < 0.05. Results:Two hundred six patients were included of which 60% were male and mean age at biopsy was 55 years (SD 19). Median follow-up was 2.9 years (interquartile range (IQR) 1.6-4.7). Fourteen (6.8%) patients suffered VTE. Median time to diagnosis of VTE from renal biopsy was 36 days (IQR -22 to 178), with 6 VTEs occurring prior to biopsy and 1 during remission. In a total of 270 patient years of NS, there were 7 VTE that could potentially have been avoided if anticoagulation was given for the duration of NS, that is, 2.6% risk per year of NS; this risk was highest for patients with minimal change nephropathy at 13.3% per year of NS, compared to 0.65% per year of NS for those with idiopathic membranous nephropathy. Assuming a 75% reduction in the incidence of VTE with prophylactic anticoagulation, 972 participants would be required for a future clinical trial to have 80% power. Conclusions:Patients with primary NS are at an increased risk of VTE. The timing of VTE means that only half of episodes would be targeted by prophylactic anticoagulation. Given the low frequency of events, a well-powered clinical trial would be challenging to achieve.

Published
2017
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40. Association between urinary sodium, creatinine, albumin, and long-term survival in chronic kidney disease.

Author

McQuarrie EP, Traynor JP, Taylor AH, Freel EM, Fox JG, Jardine AG, and Mark PB

Subjects
Adult, Aged, Aged, 80 and over, Albuminuria complications, Albuminuria mortality, Disease Progression, Female, Humans, Kidney physiopathology, Male, Middle Aged, Renal Insufficiency, Chronic complications, Albuminuria urine, Creatinine urine, Renal Insufficiency, Chronic mortality, Renal Insufficiency, Chronic urine, Sodium urine
Abstract

Dietary sodium intake is associated with hypertension and cardiovascular risk in the general population. In patients with chronic kidney disease, sodium intake has been associated with progressive renal disease, but not independently of proteinuria. We studied the relationship between urinary sodium (UNa) excretion and UNa to creatinine ratio and mortality or requirement for renal replacement therapy in chronic kidney disease. Adult patients attending a renal clinic who had ≥1 24-hour UNa measurement were identified. Twenty-four-hour UNa measures were collected and UNa to creatinine ratio calculated. Time to renal replacement therapy or death was recorded. Four hundred twenty-three patients were identified with mean estimated glomerular filtration rate of 48 mL/min per 1.73 m(2). Ninety patients required renal replacement therapy and 102 patients died. Mean slope decline in estimated glomerular filtration rate was -2.8 mL/min per 1.73 m(2) per year. Median follow-up was 8.5 years. Patients who died or required renal replacement therapy had significantly higher UNa excretion and UNa to creatinine ratio, but the association with these parameters and poor outcome was not independent of renal function, age, and albuminuria. When stratified by albuminuria, UNa to creatinine ratio was a significant cumulative additional risk for mortality, even in patients with low-level albuminuria. There was no association between low UNa and risk, as observed in some studies. This study demonstrates an association between UNa excretion and mortality in chronic kidney disease, with a cumulative relationship between sodium excretion, albuminuria, and reduced survival. These data support reducing dietary sodium intake in chronic kidney disease, but additional study is required to determine the target sodium intake., (© 2014 American Heart Association, Inc.)

Published
2014
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41. How to measure renal function in clinical practice.

Author

Traynor J, Mactier R, Geddes CC, and Fox JG

Subjects
Biomarkers blood, Contrast Media, Creatinine metabolism, Cystatin C, Cystatins blood, Glomerular Filtration Rate, Humans, Inulin blood, Kidney Diseases physiopathology, Kidney Function Tests, Predictive Value of Tests, Radioisotopes, Urea blood, Kidney Diseases diagnosis
Published
2006
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