The Impact of an Education Intervention to Improve Blood Pressure Control among Black Non-Hispanic Patients and Hispanic Patients with Chronic Kidney Disease.

This project examined the effect of an educational intervention on blood pressure control among minority patients with chronic kidney disease (CKD). Adherence to a low-sodium diet is crucial for blood pressure control. It is also vital to assess food insecurity to improve diet adherence, especially among high-risk underrepresented populations. Participants were recruited from a public hospital renal clinic. Knowledge and food access was assessed using CKD and food insecurity questionnaires. Food frequency and 24-hour 3-day food diaries were completed and analyzed. Eighteen patients were enrolled (Black, non-Hispanic = 66.6%, Hispanic = 27.7%, uninsured = 33.3%, and Medicaid recipients = 27.7%). Eighty-nine percent of participants screened positive for food insecurity and received vouchers for healthy food from a food depository. Paired t tests showed statistically significant increase in knowledge (p < 0.00) and self-efficacy, and systolic blood pressure improved post-intervention. This study suggests that Black non-Hispanic and Hispanic patients with CKD have limited access to healthy food and consume higher sodium. Patient education, screening for food insecurity, and access to a food depository enhanced adherence to low sodium diet and improved blood pressure control.

Case report: a man with untreated rheumatoid arthritis, cryoglobulinemic vasculitis, membranous nephropathy and pulmonary sarcoidosis.

BACKGROUND: Glomerular involvement in rheumatoid arthritis has been known to be associated with treatment side effects from medications and secondary amyloidosis. However, limited basic science and clinical studies have been performed to address the potential disease specific immune-mediated mechanisms causing secondary glomerular pathology, its various types of presentation, and the potential treatments. CASE PRESENTATION: A 41-year-old man with chronic active rheumatoid arthritis presented with nephrotic syndrome and was found to have membranous nephropathy with eosinophilic intracapillary thrombi on renal biopsy. Proteinuria persisted despite complete withdrawal from non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDs). Throughout the disease course, he developed cryoglobulinemic vasculitis and pulmonary sarcoidosis, both of which achieved clinical resolution with glucocorticoids. However, only partial improvement was observed in proteinuria with treatment of steroids and Rituximab. CONCLUSION: Our case presented a unique and complicated clinical phenotype of active rheumatoid arthritis, with clinical features of cryoglobulinemic vasculitis, histopathologic features of membranous and cryoglobulinemic nephropathy in the absence of DMARDs use, as well as pulmonary sarcoidosis. We speculate that there is a wider spectrum of glomerular disease in patients with untreated rheumatoid arthritis. In addition, the potential association between rheumatoid arthritis and cryoglobulinemic vasculitis should probably be revisited and requires further studies to elucidate the underlying mechanisms and treatment options.

Peptiduria: a potential early predictor of diabetic kidney disease.

BACKGROUND: To protect the kidney effectively with medication in type 2 diabetics, it is crucial to identify such at-risk patients early for treatment. We investigated whether peptiduria precedes proteinuria (the earliest urinary marker in our model), and thereby serve as an early predictor of diabetic nephropathy. METHODS: A longitudinal study was performed in a rat model of diabetic nephropathy. Peptides, defined as degradation products of proteins of < 13 kD size, were quantified by a previously validated method using a combination of Lowry and Biorad protein assays. Peptides in urine were also confirmed by chromatographically separating low molecular weight fractions from urine and quantifying albumin fragments in these fractions by enzyme immunoassay. Also, the mechanism of peptiduria was addressed by measuring acid phosphatase, a marker of lysosomal activity, in urine and on kidney sections (histochemically). RESULTS: In rats with diabetic nephropathy, proteinuria occurred after 12 weeks of diabetes, while peptiduria occurred as early as 2 weeks after diabetes. Peptiduria was confirmed by showing that the chromatographically separated low molecular weight fractions of urine containing albumin fragments is in proportion to the level of peptiduria. The time course of peptiduria paralleled the increase in urinary acid phosphatase suggesting that the mechanism of early peptiduria could be due to upregulation of lysosomal enzyme activity in the tubules. CONCLUSIONS: Our results showing that peptiduria precedes proteinuria in diabetic nephropathy provide a compelling rationale to perform a prospective human clinical trial to investigate whether peptiduria can serve as an early predictor of diabetic nephropathy.

Antibiotic catheter locks in the treatment of tunneled hemodialysis catheter-related blood stream infection.

We prospectively examined the efficacy of systemic antibiotics and antibiotic catheter locks for the treatment of tunneled hemodialysis catheter related blood stream infections (CRBSI). Patients with clinical signs of tunnel or metastatic infection were excluded. All patients with suspected CRBSI were treated empirically with systemic antibiotics at the onset of symptoms before final culture and susceptibility results were available. Once the organism was identified, antibiotics treatment was tailored and antibiotic catheter locks were instilled after each dialysis treatment. Clearance of infection was documented by negative surveillance cultures after completion of antibiotic course. Out of 46 episodes of CRBSI; 16 were due to gram positive organisms, 22 were due to gram negative organisms, and 8 were polymicrobial (≥2 organisms) infections. 19 cases required removal of dialysis catheter. Antibiotic lock protocol was successful for eradicating infection in 27 of 46 episodes (59%). The likelihood of a clinical cure was identical in both gram-positive and gram-negative infections (63% and 62% respectively). Antibiotic lock protocol remains an option in the treatment of clinically stable patients with CRBSI; however, success rate of this protocol in eradicating the infection is modest.

Relationships between physical activity and other health-related measures using state-based prevalence estimates.

Background: Both physical activity and muscle-strengthening activity have known relationships with other health-related variables such as alcohol and tobacco use, diet, and health-related quality of life (HRQOL). The purpose of this study was to explore and quantify the associations between physical activity measures and health-related variables at the higher state level. Methods: This cross-sectional study used data from the 2017 and 2019 Behavioral Risk Factor Surveillance System surveys. State-based prevalence (%) estimates were computed for meeting physical activity guidelines (PA), meeting muscle-strengthening activity guidelines (MS), both PA and MS (MB), drinking alcohol (D1), heavy alcohol drinking (HD), fruit consumption (F1), vegetable consumption (V1), good self-rated health (GH), overweight (OW), obesity (OB), current smoking (SN), and smokeless tobacco use (SL). Descriptive statistics, correlation coefficients, and data visualization methods were employed. Results: Strongest associations were seen between PA and F1 (2017: r=0.717 & 2019: r=0.695), MS and OB (2017: r=-0.781 & 2019: r=-0.599), PA and GH (2017: r=0.631 & 2019: r=0.649), PA and OB (2017: r=-0.645 & 2019: r=-0.763), and MB and SN (2017: r=-0.713 & 2019: r=-0.645). V1 was associated only with PA (2017: r=0.335 & 2019: r=0.357) whereas OW was not associated only with PA. Canonical correlation analysis showed the physical activity variables were directly related (r c=0.884, P<0.001) to the health variables. Conclusion: This study used high-level data to support the many known relationships between PA measures and health-related variables.

Peripheral artery disease and CKD: a focus on peripheral artery disease as a critical component of CKD care.

The incidence of peripheral artery disease (PAD) is higher in patients with chronic kidney disease (CKD) than in the general population. PAD is a strong independent risk factor for increased cardiovascular disease mortality and morbidity, including limb amputation, in persons with CKD. Diagnosis of PAD in patients with CKD may be challenging in the absence of classic intermittent claudication or the presence of atypical leg symptoms. In addition, pedal artery incompressibility may decrease the accuracy of ankle-brachial index measurement, the most common PAD diagnostic tool. Alternative methods such as toe-brachial index should be used if clinical suspicion persists despite a normal ankle-brachial index value. Aggressive risk-factor modification, including treatment of diabetes, hyperlipidemia, and hypertension and smoking cessation, should be mandatory in all patients. Treatment of all individuals with PAD should include antiplatelet medications and prescribed supervised exercise programs and/or cilostazol for individuals with claudication symptoms. Preventive foot care measures and a multidisciplinary approach involving podiatrists and vascular and wound care specialists should be used to reduce amputations. Revascularization for critical limb ischemia is associated with poor outcomes in patients with CKD with PAD. Future investigation is recommended to evaluate the benefit of earlier treatment strategies in this high cardiovascular disease risk population with CKD.

Stem cells from foreign body granulation tissue accelerate recovery from acute kidney injury.

BACKGROUND: In previous studies, we obtained mesenchymal stem cells called granulation tissue stem cells (GTSC) from a regenerating granulation tissue created by placing a foreign body in the subcutaneous tissue of rats. Here, we used GTSC to ameliorate ischemia/reperfusion-induced acute kidney injury (AKI) in rats. METHODS: In two groups of Fischer rats, we induced ischemia/reperfusion injury. Group 1 (treated rats) received one intravenous injection of GTSC 3 h after injury; Group 2 (control rats) received vehicle. Both groups were subsequently studied by renal function tests, kidney histology and immunohistochemistry. RESULTS: At 24 and 48 h after injury, plasma creatinine and blood urea nitrogen were significantly lower in the treated rats as compared to control rats. The levels remained low and declined to near baseline levels by Day 4 in the treated group. At the cortico-medullary region, the treated rats showed significantly higher renal tubular cell proliferation and less tubular cell apoptosis. Histological analysis of the kidney for tubular dilatation, necrosis, congestion and casts was not significantly different in the two groups. To understand the mechanism of the GTSC effect, messenger RNA levels of several growth and immune modulatory factors were quantified in cultured GTSC and compared with those in cultured glomerular epithelial cell (GEC; a non-stem cell line). GTSC had 2- to 8-fold higher expression of FGF2, HGF, IGF-1, vascular endothelial growth factor (growth factors) and IL-4, IL-6 (anti-inflammatory factors) than GEC. CONCLUSIONS: Administration of GTSC accelerates recovery in rats with ischemia/reperfusion-induced AKI. This effect may be mediated by the paracrine action of growth and immune-suppressive factors secreted by these cells.

Initial Assessment of a Brief Health, Fitness, and Spirituality Survey for Epidemiological Research: A Pilot Study.

Background: Not many population-based health studies include items to assess both fitness and spirituality concepts. Therefore, the purpose of this study was to examine initial data of a brief health, fitness, and spirituality survey for epidemiological research. Methods: This first phase pilot study used data from N = 56 adults 18+ years of age via electronic questionnaire. Measures of general health, fitness, physical activity (PA), body mass index (BMI), religiosity, and happiness were assessed. Reliability analyses were employed for PA, religiosity, and happiness scales. Validity coefficients were computed to evaluate convergence between scale scores and related measures. Finally, difference in health was examined between different levels of fitness to evaluate known groups discrimination. Results: Respondents were middle-aged (Mean = 50.5 yr, SD = 14.3), majority white (69.5%, SD = 6.2), with relatively low BMI (Mean = 25.3, SD = 5.3). All three scales showed internal consistency reliability of α = 0.93, α = 0.89, and KR-20 = 0.56 for religiosity, happiness, and PA, respectively. Furthermore, scores converged (ps < 0.05) between fitness and PA (r = 0.43), health (r = 0.66), BMI (r = -0.28), and happiness (r = 0.25). Finally, health scores were significantly greater for high fitness versus low fitness in both male (p < 0.001) and female (p = 0.015) populations. Conclusion: Results from this study indicate that a brief health, fitness, and spirituality survey can reliably measure its intended traits. A single-item of self-assessed fitness in particular has promise for large scale epidemiological research.

Development and Validation of a Deep Learning Model to Quantify Interstitial Fibrosis and Tubular Atrophy From Kidney Ultrasonography Images.

Importance: Interstitial fibrosis and tubular atrophy (IFTA) is a strong indicator of decline in kidney function and is measured using histopathological assessment of kidney biopsy core. At present, a noninvasive test to assess IFTA is not available. Objective: To develop and validate a deep learning (DL) algorithm to quantify IFTA from kidney ultrasonography images. Design, Setting, and Participants: This was a single-center diagnostic study of consecutive patients who underwent native kidney biopsy at John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, between January 1, 2014, and December 31, 2018. A DL algorithm was trained, validated, and tested to classify IFTA from kidney ultrasonography images. Of 6135 Crimmins-filtered ultrasonography images, 5523 were used for training (5122 images) and validation (401 images), and 612 were used to test the accuracy of the DL system. Kidney segmentation was performed using the UNet architecture, and classification was performed using a convolution neural network-based feature extractor and extreme gradient boosting. IFTA scored by a nephropathologist on trichrome stained kidney biopsy slide was used as the reference standard. IFTA was divided into 4 grades (grade 1, 0%-24%; grade 2, 25%-49%; grade 3, 50%-74%; and grade 4, 75%-100%). Data analysis was performed from December 2019 to May 2020. Main Outcomes and Measures: Prediction of IFTA grade was measured using the metrics precision, recall, accuracy, and F1 score. Results: This study included 352 patients (mean [SD] age 47.43 [14.37] years), of whom 193 (54.82%) were women. There were 159 patients with IFTA grade 1 (2701 ultrasonography images), 74 patients with IFTA grade 2 (1239 ultrasonography images), 41 patients with IFTA grade 3 (701 ultrasonography images), and 78 patients with IFTA grade 4 (1494 ultrasonography images). Kidney ultrasonography images were segmented with 91% accuracy. In the independent test set, the point estimates for performance matrices showed precision of 0.8927 (95% CI, 0.8682-0.9172), recall of 0.8037 (95% CI, 0.7722-0.8352), accuracy of 0.8675 (95% CI, 0.8406-0.8944), and an F1 score of 0.8389 (95% CI, 0.8098-0.8680) at the image level. Corresponding estimates at the patient level were precision of 0.9003 (95% CI, 0.8644-0.9362), recall of 0.8421 (95% CI, 0.7984-0.8858), accuracy of 0.8955 (95% CI, 0.8589-0.9321), and an F1 score of 0.8639 (95% CI, 0.8228-0.9049). Accuracy at the patient level was highest for IFTA grade 1 and IFTA grade 4. The accuracy (approximately 90%) remained high irrespective of the timing of ultrasonography studies and the biopsy diagnosis. The predictive performance of the DL system did not show significant improvement when combined with baseline clinical characteristics. Conclusions and Relevance: These findings suggest that a DL algorithm can accurately and independently predict IFTA from kidney ultrasonography images.

Deep learning model to predict the need for mechanical ventilation using chest X-ray images in hospitalised patients with COVID-19.

OBJECTIVES: There exists a wide gap in the availability of mechanical ventilator devices and their acute need in the context of the COVID-19 pandemic. An initial triaging method that accurately identifies the need for mechanical ventilation in hospitalised patients with COVID-19 is needed. We aimed to investigate if a potentially deteriorating clinical course in hospitalised patients with COVID-19 can be detected using all X-ray images taken during hospitalisation. METHODS: We exploited the well-established DenseNet121 deep learning architecture for this purpose on 663 X-ray images acquired from 528 hospitalised patients with COVID-19. Two Pulmonary and Critical Care experts blindly and independently evaluated the same X-ray images for the purpose of validation. RESULTS: We found that our deep learning model predicted the need for mechanical ventilation with a high accuracy, sensitivity and specificity (90.06%, 86.34% and 84.38%, respectively). This prediction was done approximately 3 days ahead of the actual intubation event. Our model also outperformed two Pulmonary and Critical Care experts who evaluated the same X-ray images and provided an incremental accuracy of 7.24%-13.25%. CONCLUSIONS: Our deep learning model accurately predicted the need for mechanical ventilation early during hospitalisation of patients with COVID-19. Until effective preventive or treatment measures become widely available for patients with COVID-19, prognostic stratification as provided by our model is likely to be highly valuable.

Correlates and predictors of physical inactivity among Tennessee adults.

The purpose of this study was to investigate the sociodemographic predictors and health-related correlates of no leisure-time physical activity (LTPA) in a representative sample of Tennessee adults. Data from 5024 adults participating in the 2008 Tennessee Behavioral Risk Factor Surveillance System (BRFSS) were used for the analysis. Overall, 28.9 percent of Tennessee adults (26.2 percent of men and 31.4 percent of women) reported no LTPA. The sociodemographic predictors of no LTPA were age, race, and education. No LTPA was a useful predictor of health status markers such as self-report health, obesity, smoking, and cardiovascular disease. This study found that selected sociodemographic characteristics were adequate predictors of no LTPA among Tennessee adults. Also, the absence of LTPA was found to be a significant predictor of health status.

Health-Related Quality of Life, Depressive Symptoms, and Kidney Transplant Access in Advanced CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.

RATIONALE & OBJECTIVE: Among individuals with chronic kidney disease (CKD), poor self-reported health is associated with adverse outcomes including hospitalization and death. We sought to examine the association between health-related quality-of-life (HRQoL) and depressive symptoms in advanced CKD and subsequent access to the kidney transplant waiting list. STUDY DESIGN: Prospective cohort study. SETTING & POPULATION: 1,676 Chronic Renal Insufficiency Cohort (CRIC) study participants with estimated glomerular filtration rates ≤ 30 mL/min/1.73 m2 at study entry or during follow-up. EXPOSURES: HRQoL ascertained by 5 scales of the Kidney Disease Quality of Life-36 Survey (Physical Component Summary [PCS], Mental Component Summary, Symptoms, Burdens, and Effects), with higher scores indicating better HRQoL, and depressive symptoms ascertained using the Beck Depression Inventory. OUTCOMES: Time to kidney transplant wait-listing and time to pre-emptive wait-listing. ANALYTIC APPROACH: Time-to-event analysis using Cox proportional hazards regression. RESULTS: During a median follow-up of 5.1 years, 652 (39%) participants were wait-listed, of whom 304 were preemptively wait-listed. Adjusted for demographics, comorbid conditions, estimated glomerular filtration rate slope, and cognitive function, participants with the highest scores on the Burden and Effects scales, respectively, had lower rates of wait-listing than those with the lowest scores on the Burden (wait-listing adjusted hazard ratio [aHR], 0.70; 95% CI, 0.57-0.85; P < 0.001) and Effects scales (wait-listing aHR, 0.74; 95% CI, 0.59-0.92; P = 0.007). Participants with fewer depressive symptoms (ie, Beck Depression Inventory score < 14) had lower wait-listing rates than those with more depressive symptoms (aHR, 0.81; 95% CI, 0.66-0.99; P = 0.04). Participants with lower Burden and Effects scale scores and those with higher Symptoms and PCS scores had higher pre-emptive wait-listing rates (aHR in highest tertile of PCS relative to lowest tertile, 1.58; 95% CI, 1.12-2.23; P = 0.01). LIMITATIONS: Unmeasured confounders. CONCLUSIONS: Self-reported health in late-stage CKD may influence the timing of kidney transplantation.

Grip Strength and Health-Related Quality of Life in U.S. Adult Males.

BACKGROUND: A need exists for a population-based evaluation of muscular strength in terms of its association with health-related quality of life (HRQOL) in males. Therefore, the purpose of this study was to examine the relationship between grip strength and HRQOL in a representative sample of U.S. men. METHODS: This study used data from adult males 20+ years of age participating in the 2013-2014 National Health and Nutrition Examination Survey. Grip strength (kg) was measured in both hands using a handgrip dynamometer. HRQOL was assessed by a single question asking participants to rate their general health. Additionally, measures of moderate-to-vigorous physical activity (PA), body mass index, waist circumference, TV time, sedentary time, and smoking were assessed. Multiple linear regression modeling for complex samples was used to examine the effect of HRQOL on grip strength while controlling for confounding variables. RESULTS: Overall, males with good HRQOL (Mean = 47.5 kg, SE = 0.31) had significantly greater grip strength than males with poor HRQOL (Mean = 44.5 kg, SE = 0.51, p < 0.001). In fully adjusted models, males with good HRQOL had greater grip strength (slope = 2.5 kg, SE = 0.57, p = 0.001) than their poor HRQOL counterparts. Additionally, HRQOL was a significant predictor of grip strength in male adults who did not meet PA guidelines but not in those who did meet PA guidelines. CONCLUSION: Results from this study indicate that muscular strength and HRQOL are related in U.S. men. Furthermore, the muscular strength and HRQOL relationship appears to remain in adult males who do not meet PA guidelines.

The effect of resistance training on health-related quality of life in older adults: Systematic review and meta-analysis.

Background: Resistance training (RT) is recommended as part of our national physical activity guidelines which includes working all major muscle groups on two or more days a week.Older adults can gain many health benefits from RT, such as increased muscle strength,increased muscle mass, and maintenance of bone density. Additionally, certain dimensions of health-related quality of life (HRQOL) have been shown to improve in older adults due to RT intervention. The purpose of this study was to use systematic review and meta-analytic techniques to examine the effect of RT on HRQOL in older adults. Methods: A systematic review of current studies (2008 thru 2017) was conducted using PubMed. Studies were included if they used a randomized controlled design, had RT as an intervention, measured HRQOL using the SF-36/12 assessment, and included adults 50+ years of age. Eight dimension scores (physical functioning, bodily pain, physical role function, general health, mental health, emotional role function, social function, and vitality) and two summary scores (physical component and mental component) were extracted. Ten meta-analyses were performed using standardized mean effect sizes and random effects models. Study quality,moderator and sensitivity analyses were conducted. Results: A total of 16 studies were included in the analyses with a mean Physiotherapy Evidence Database (PEDro) score of 4.9 (SD=1.0). Among the mental health measures, RT had the greatest effect on mental health (Effect size [ES]=0.64, 95% CI: 0.30-0.99, I2=79.7). Among the physical health measures, RT had the largest effect on body pain (ES=0.81, 95% CI: 0.26-1.35, I2=85.9).Initially, RT did not significantly affect measures of emotional role function, social function or physical role function. However, after removing a single study, RT significantly increased all HRQOL measures. Conclusion: The meta-analytic evidence presented in this research clearly supports the promotion of RT in improving HRQOL in older adults.

Intermittent pneumatic compression in patients with ESRD. A systematic review.

INTRODUCTION: Patients with end-stage renal disease (ESRD) experience frequent hemodialysis (HD) complications. Intradialytic hypotension (IDH) is a common complication presenting in approximately between 20 and 50% of HD sessions. Available interventions such as volume replacement or vasoactive medications are associated with significant side effects. Intermittent pneumatic compression (IPC) has been proposed as a feasible intervention for the prevention of IDH, treatment of peripheral arterial disease and venous ulcers. These devices apply intermittent pressure to the legs improving arterial blood flow, mobilization of pooled blood with an increase in venous return increasing the effective circulatory volume. Our goal was to identify the published clinical evidence on whether IPC has a circulatory benefit and is it well-tolerated among patients receiving HD. METHODS: We conducted a systematic review to identify studies assessing the efficacy and safety of IPC in patients with ESRD. Our primary outcome was IDH. Secondary outcomes such as HD comfort, ultrafiltration volume, and physical activity were collected. No restrictions where used and we included all observational and interventional studies. Two reviewers performed screening and study quality assessment. FINDINGS: We included seven studies. Out of the seven studies, five addressed IDH, and the rest were included for secondary outcomes such as physical capacity and HD comfort. In one randomized crossover trial comparing exercise against IPC, 21 patients were randomized to 3 different arms (no intervention, cycling, IPC) a decrease in the rates of IDH with IPC was described (43%, 38%, and 24% respectively P = 0.014). The smaller studies corroborated these results. All studies where at high risk of bias. DISCUSSION: IPC might offer significant benefits for patients undergoing HD not limited to prevention of IDH but also improvement of hemodialysis comfort and physical capacity. However, our results should be interpreted in the context of its limitations.

Should beta-blockers be used to control hypertension in people with chronic kidney disease?

Activation of the sympathetic nervous system is common in patients with chronic kidney disease, plays an important role in the genesis of hypertension, the rate of decrease of renal function, and is associated with the increased cardiovascular morbidity and mortality seen in these patients. beta-blockers are potent antihypertensive agents but differ in their hemodynamic effects on renal function. The cardioselective beta-blockers such as atenolol and metoprolol are known to retard the progression of renal diseases, but to a lesser degree compared with blockers of the renin-angiotensin-aldosterone system. However, the newer vasodilating beta-blockers such as carvedilol and nebivolol have different effects on renal hemodynamics and function primarily because of its greater adjunctive alpha1-blocking activity. Carvedilol decreases renal vascular resistance and prevents reductions in the glomerular filtration rate and renal blood flow in patients with hypertension with or without impaired kidney function. In addition, carvedilol may retard progression of albuminuria, and provide cardiorenal protection in chronic kidney disease patients with hypertension, congestive heart failure, and at high risk for sudden cardiac death.

Bilateral emphysematous pyelonephritis in a patient with no known risk factors.

Emphysematous pyelonephritis (EPN) is a rare life-threatening necrotizing infection of the kidney and perirenal space with gas formation. It is usually unilateral and affects patients with a risk factor such as diabetes or urinary obstruction. In the past, most patients required nephrectomy, and in bilateral cases long-term dialysis was inevitable. We present here the unusual case of a patient who developed bilateral EPN in the absence of any known risk factor. He was managed conservatively, required dialysis and bilateral nephrostomies, but eventually recovered completely.

Meeting Recommended Levels of Physical Activity in Relation to Preventive Health Behavior and Health Status Among Adults.

OBJECTIVES: The purpose of this study was to examine the relationship of meeting the recommended levels of physical activity (PA) with health status and preventive health behavior in adults. METHODS: A total of 5630 adults 18 years of age or older were included in this study. PA was assessed using a series of questions that categorized activities based on their metabolic equivalent values and then categorized individuals based on the reported frequency and duration of such activities. Participants reporting 150 minutes or more of moderate-intensity PA per week were considered to have met the PA guidelines. Multiple logistic regression was used to model the relationships between meeting PA guidelines and health status and preventive health behavior, while controlling for confounding variables. RESULTS: Overall, 53.9% (95% confidence interval [CI], 51.9 to 55.9%) of adults reported meeting the recommended levels of PA. Among adults with good general health, 56.9% (95% CI, 54.7 to 59.1%) reported meeting the recommended levels of PA versus 43.1% (95% CI, 40.9 to 45.3%) who did not. Adults who met the PA guidelines were significantly more likely not to report high cholesterol, diabetes, chronic obstructive pulmonary disease, arthritis, asthma, depression, or overweight. Furthermore, adults meeting the PA guidelines were significantly more likely to report having health insurance, consuming fruits daily, consuming vegetables daily, and not being a current cigarette smoker. CONCLUSIONS: In this study, we found meeting the current guidelines for PA to have a protective relationship with both health status and health behavior in adults. Health promotion programs should focus on strategies that help individuals meet the current guidelines of at least 150 minutes per week of moderate-intensity PA.

Sex differences in the physical inactivity and health-related quality of life relationship among rural adults.

Background: The purpose of this study was to investigate the relationship between physical inactivity (PIA) and health-related quality of life (HRQOL) in rural adults and examine the extent to which sex differences exist in this relationship. Methods: A total of 5617 adults 18 years of age and older who indicated residing in a rural county was included in this analysis. PIA status was assessed by questions regarding recreational physical activity during the previous month. Five HRQOL measures (physical health, mental health, inactivity health, general health, & unhealthy days) were used as primary outcome variables. PIA and HRQOL prevalence estimates were computed with 95% CIs. Multiple logistic regression was used to obtain odds ratios (ORs) and 95% CIs adjusted for age, ethnicity, and income. Results: Physically inactive rural adults were significantly more likely to report poor HRQOL in all overall crude models with ORs ranging from 1.59 to 2.16. Additionally, sex-by-PIA interactions were significant across all crude HRQOL models with ORs ranging from 2.27 to 3.08 and 1.56 to 2.42 for women and men, respectively. Sex differences were maintained in fully adjusted models, except for mental health and inactivity health with ORs ranging from 1.80 to 2.58 and 1.41 to 1.79 for women and men, respectively. Conclusion: Results from this study show that PIA is a strong predictor of poor HRQOL even after controlling for confounding variables. Furthermore, physically inactive rural women appear more likely to report poor levels of HRQOL than physically inactive rural men.