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Background Measuring temperature has always been a key observation in the diagnosis of infection. No studies have examined the usefulness of measuring temperature at the wrist to detect infection. Aim We sought to determine whether a watch measuring wrist temperature could accurately identify patients who are infected. Methods Prospective cross-sectional pilot study of temperature monitoring in an unselected patients in a tertiary referral adult nephrology unit. Results One hundred and four data recording sessions revealed 88 useful data sets, with recording failures in the others. Patients were retrospectively classified as having no infection (Group A, n = 60), clinically diagnosed infection with less than 24 h of treatment with antibiotics (Group B, n = 5), and clinically diagnosed infection with greater than 24 h on antibiotics (Group C, n = 23). There was a significantly higher average maximum temperature in Group B (mean (SEM)) 38°C (0.6) compared with Groups A (36.1°C (0.1)) and C (36.3°C (0.3)). Based on receiver operating characteristics (ROC) a cut-off temperature of ≥37.5°C gave sensitivity 80% and specificity 98%. Mean electrodermal activity was significantly higher in Groups B and C. Conclusions ROC of peripheral skin temperature measurements suggest that such a device may identify many patients requiring treatment for infection. This proof of principle study showed value in using a wearable device in the detection of infection and its potential as an early warning or monitoring device.

Tenofovir disoproxil fumarate (TDF) is a common antiretroviral utilised in the treatment of human immunodeficiency virus (HIV) and hepatitis B infections. It is associated with the development of tubulotoxicity and tubulopathies, and is not recommended in the treatment of patients with baseline chronic kidney disease. Until now, guidelines have suggested frequent monitoring of serum biochemistry to detect the development of such complications. In recent trials, a new prodrug formulation of tenofovir alafenamide (TAF) has been shown to exhibit less tubular toxicity than its counterpart due to a lower serum concentration of its metabolites. In this article, we share our experience with two patients who developed tubulotoxicity following the commencement of TDF-based regimens in HIV, and its improvement following its change to TAF, and review the available literature regarding tenofovir-based nephrotoxicity.

Aim Percutaneous renal biopsy is often essential for providing reliable diagnostic and prognostic information for people with suspected kidney disease, however the procedure can lead to complications and concerns among patients. This study aims to identify and integrate patient priorities and perspectives into the Kidney Health Australia - Caring for Australasians with Renal Impairment clinical practice guidelines for renal biopsy, to ensure patient-relevance. Methods We convened a workshop, consisting of three simultaneous focus groups and a plenary session, with 10 patients who had undergone a renal biopsy and seven caregivers. Topics and outcomes prioritized by patients and their caregivers were compared to those identified by the guideline working group, which was comprised of seven nephrologists. Transcripts and flipcharts were analyzed thematically to identify the reasons for participants' choices. Results In total, 34 topics/outcomes were identified, 14 of which were common to the list of 28 previously identified by the guideline working group. Most of the new topics identified by patients/caregivers were related to communication and education, psychosocial support, and self-management. We identified five themes underpinning the reasons for topic and outcome selection: alleviating anxiety and unnecessary distress, minimizing discomfort and disruption, supporting family and caregivers, enabling self-management, and protecting their kidney. A new topic on patient care and education was added to the guideline as a result. Conclusions Patient and caregiver involvement in developing guidelines on renal biopsy ensured that their concerns and needs for education, psychosocial support, and self-management were explicitly addressed; enabling a patient-centred approach to renal biopsies.

To determine the correlation between the spot albumin-to-creatinine (ACR) ratio and protein-to-creatinine ratio (PCR) in pregnancy and if either test is predictive of adverse pregnancy outcome.Prospective consecutive cohort study in a single tertiary centre examining 181 patients undergoing proteinuria screening after 20weeks of pregnancy. A spot PCR and ACR was performed on the first void of the day. Comparison was with linear and logistic regression and ROC curve. Optimal values for the ACR were obtained and compared to a PCR value of 30mg/mmol with respect to adverse pregnancy outcomes.Birth weight10th centile, preterm birth32 and37weeks, placental abruption, caesarean section, induction of labour, fetal death in utero or neonatal death, Apgar score5 at 1min and/or 5min, pulmonary oedema, sustained blood pressure170/110mmHg, magnesium infusion or labetalol infusion during labour.254 tests were performed. The ACR and PCR were highly correlated (r=0.95, p0.001) and the area under ROC curve was 0.98. An ACR of 13.4mg/mmol corresponded to a PCR of 30mg/mmol. Neither was more predictive of adverse pregnancy outcome nor was the level of proteinuria.The ACR is not inferior to nor does it perform better than the PCR in screening for proteinuria in pregnancy. Clinicians should use the test with which they are more familiar and may wish to assess local laboratory costs and methods in their selection.

Rarely, peritoneal dialysis (PD) is complicated by a hydrothorax, often referred to as a pleural effusion, that commonly occurs early after starting PD and is usually right-sided. We illustrate three cases of atypical hydrothorax presenting in PD patients. Case 1 is a 72-year-old lady with left-sided pleuroperitoneal communication confirmed on nuclear imaging. Case 2 is a 50-year-old lady who presented with right-sided pleuroperitoneal leak which occurred 11 months after commencement of PD. The last case is a 64-year-old man with congestive cardiac failure secondary to ischemic heart disease who had recurrent right-sided pleural effusion despite multiple pleural drainage. He continued on PD with no drainage problems. Pleuroperitoneal leaks need to be excluded even in patients presenting with left-sided effusion and in those who present late after commencement of PD. World J Nephrol Urol. 2015;4(4):256-259 doi: http://dx.doi.org/10.14740/wjnu227w

Background/Aims: Chronic kidney disease (CKD) is a major health issue worldwide. The aim of this study was to explore factors associated with CKD progression in Australian nephrology practices. Methods: This was a retrospective study utilising an electronic medical record (EMR), Audit4 (Software for Specialists, Australia). The baseline visit was defined as the first entry into the EMR. The primary outcome was the rate of change in estimated glomerular filtration rate (eGFR). Results: 1,328 patients were included with a mean eGFR at baseline of 37.4 ± 0.7 ml/min/1.73 m2, a mean follow-up of 17.7 months and a mean annual rate of change in eGFR of –0.84 ± 0.26 ml/min/1.73 m2. Univariate analysis demonstrated that women, smokers, and patients prescribed erythropoiesis-stimulating agents (ESA) had a significantly more rapid decline in eGFR (p = 0.007, 0.033, and 0.003, respectively). On multivariate analysis: gender, age, prescription of ESA and phosphate binders, and baseline eGFR were significantly associated with CKD progression (p = 0.003, 0.004, Conclusions: This study identifies potential factors associated with CKD progression in a population referred to nephrologists, but current data quality may result in bias. Implementation of changes in the format of data collection is required so that busy clinicians record essential information to enable this to become a more accurate and reliable research tool.

Objectives The incidence of preeclampsia (PE) is markedly increased in Type 1 diabetes (T1DM). Premature delivery (PD) and small-for-gestational age (SGA) infants are common consequences of PE. Infants of T1DM mothers also have increased risks of hypoglycemia, jaundice and macrosomia, and hence NICU/SCN admission rates are high. Methods This is a retrospective cohort study of antenatal factors predictive of maternal and fetal outcome in Type 1 diabetic women, managed at the Royal Women’s Hospital 2000–2011. Data from 246 eligible pregnancies of 147 Type 1 diabetic women were analyzed. Results Pregnancies affected by PE (n = 37, 15%) had higher rates of PD n = 17 (46%) vs n = 52 (25%), p = 0.009; lower vaginal delivery rates n = 2 (5%) vs n = 67 (32%), p Conclusions This series confirms a higher incidence of PE in T1DM with attendant complications of preterm birth. There is a higher rate of SCN and NICU admission which is likely accounted for by hypoglycemia, jaundice (whose rates were not significantly affected by the presence or absence of PE) and prematurity; this is significantly higher in infants whose gestation was complicated by PE. Macrosomia rates did not vary significantly between PE and non-PE groups but may have contributed to lower vaginal delivery rates. The SGA sample size (n = 3) was too small for meaningful analysis. Disclosures I. Idel: None. L. McMahon: None. B. Chen: None. D. Liew: None. F. Cullinane: None. V. Levidiotis: None. P. de Crespigny: None. S. Hopkins: None. S. Hunter-Smith: None. A. Nankervis: None.