Infection-Associated Glomerulonephritis.

The nephritic syndrome has been associated with a wide variety of infections, spanning many organisms and myriad clinical presentations. Infection-associated glomerulonephritis is challenging to diagnose given the many confounding factors linking kidney injury to infection; however, urine microscopy can assist in identifying abnormal cellular elements suggestive of glomerulonephritis. Kidney biopsy remains the gold standard for diagnosing the underlying pathologic lesion. Treatment of infection-associated glomerulonephritis centers around aggressive and complete treatment of the underlying infectious driver. It is often hard to know exactly when immunosuppression may be required in addition to treating the infection.

The effect of acute hydration on body composition assessed by multi-frequency and single-frequency bioelectrical impedance.

BACKGROUND: Multi-frequency bioelectrical impedance (MF-BIA) provides an estimate of total body water. However, it is unknown if MF-BIA detects body water increases due to acute hydration, thus affecting the validity of MF-BIA body composition measurements. The purpose of this study was to compare the effects of pre-testing fluid ingestion on body composition estimation using single-frequency bioelectrical impedance (SF-BIA) and MF-BIA. METHODS: Thirty-nine subjects (20 male, 19 female) were tested for body composition using DXA, SF-BIA and MF-BIA before and after consumption of 2 L of water. RESULTS: Hydration significantly increased fat percentage in men and women for MF-BIA (+2.1±0.7% for men, +2.6±0.7% for women) and SF-BIA (+1.3±0.7% for men, +2.1±0.9% for women). Additionally, hydration significantly increased fat-free mass (FFM) for DXA (+1.4±0.8 kg for men, +1.7±0.4 kg for women) and SF-BIA (+0.5±0.6 kg) in men. Hydration significantly increased fat mass (FM) for all modes (DXA +0.3±0.3 kg, MF-BIA +2.0±0.7 kg, SF-BIA +1.3±0.6 kg) in males, and only for MF-BIA (+2.2±0.3 kg) and SF-BIA (+1.7±0.5 kg) in females. Increases in FM were highest for MF-BIA for both males and females. Total body water was unchanged in males and significantly decreased with acute hydration in females. CONCLUSIONS: MF-BIA improperly categorizes increased mass due to acute hydration as fat mass, resulting in an increase in measured body fat percentage. These findings confirm the need to standardize hydration status for body composition measurements using MF-BIA.

A Primary Care Intervention to Increase HIV Pre-Exposure Prophylaxis (PrEP) Uptake in Patients with Syphilis.

Identifying candidates for HIV pre-exposure prophylaxis (PrEP) is a barrier to improving PrEP uptake in priority populations. Syphilis infection is an indication for PrEP in all individuals and can be easily assessed by primary care providers (PCP) and health systems. This retrospective study evaluated the impact of a multidisciplinary provider outreach intervention on PrEP uptake in patients with a positive syphilis test result in a safety-net hospital-based primary care practice. The PCPs of PrEP-eligible patients with a positive syphilis result were notified via the electronic medical record (EMR) about potential PrEP eligibility and institutional HIV PrEP resources. Rates of PrEP offers and prescriptions were compared in the pre (8/1/2018-12/31/2018, n = 60) and post (1/1/2019-5/31/2019, n = 86) intervention periods. Secondary analyzes evaluated receipt of appropriate syphilis treatment and contemporaneous screening for HIV, gonorrhea, and chlamydia. No significant differences in the overall proportion of patients offered (15% vs 19%) and prescribed (7% vs 5%) PrEP were observed between the pre- and post-periods. Overall, 7% of positive tests represented infectious syphilis. The rate of appropriate syphilis treatment was equivalent (57% vs 56%) and contemporaneous screening for other sexually transmitted infections was suboptimal across the entire study period. Although any positive syphilis test may be an easily abstracted metric from the EMR, this approach was inclusive of many patients without current HIV risk and did not increase PrEP uptake significantly. Future research into population health approaches to increase HIV prevention should focus on patients with infectious syphilis and other current risk factors for incident HIV infection.

Diabetic Kidney Disease.

Diabetic kidney disease (DKD) is the most common cause of chronic kidney disease in the United States. Approximately 30% to 40% of individuals with diabetes mellitus develop DKD, and the presence of DKD significantly elevates the risk for morbidity and mortality. Understanding of DKD has grown in recent years. This review describes the pathogenesis of DKD and expands on evidence-based strategies for DKD management, integrating traditional approaches for hyperglycemia, hypertension, and albuminuria management with emerging therapeutic options. Given the public health burden of DKD, it is essential to prioritize prevention, recognition, and management of DKD in the primary care setting.