Predictors of CKD and rate of decline in eGFR in the elderly: A case-cohort study.

We wanted to examine the predictors of annual estimated glomerular filtration rate (eGFR) decline during a five-year follow-up in elderly individuals with pre-existing chronic kidney disease (CKD) stage 3 or greater (defined as baseline eGFR of less than 60 ml/min per 1.73 m2 or a urinary albumin-to-creatinine ratio > 30 mg/g), and to examine the difference in risk factors when compared to a co-hort without CKD. Our research team identified 599 patients who were 65 years of age or older with and without CKD stage 3 or greater at baseline. Data regarding various predictors such as age, sex, race, proteinuria, medication use, contrast exposure, acute kidney injury episodes, coronary artery disease, congestive heart failure, dyslipidemia, gout etc. were obtained. Semi-partial correlations were used to determine the fac-tors providing the largest unique contribution to the overall variability in eGFR. Semi-partial correlations identified age, proteinuria, and intravenous contrast ex-posure as the most significant predictors of eGFR decline in this population. Overall, patients in the pre-existing CKD cohort were more likely to be older, Af-rican American and with co-morbidities like diabetes, hypertension, etc. In this group, the unadjusted rate of decline in eGFR varied from 0.5% to 8.3% per year. This study identifies important risk factors for eGFR decline in the population aged > 65 years. It also concludes that each episode of acute kidney injury, wheth-er related to contrast or other nephrotoxins, increases the risk for CKD progression and eGFR decline in the elderly.

Diagnosis and successful surgical management of posterior nutcracker syndrome in a patient with loin pain hematuria.

The syndrome of loin pain hematuria in the absence of stones is poorly understood but must be considered in the differential diagnosis for patients with clinical manifestations resembling nephrolithiasis. A 22-year-old white female with a 4-year history of left flank pain and hematuria underwent an extensive workup with normal renal ultrasound and cystourethroscopies. CT scan and MRI revealed a retro-aortic left renal vein. Posterior nutcracker syndrome was considered the most likely diagnosis. The patient underwent a left laparoscopic nephrectomy with auto-transplantation in the right iliac fossa. She developed azotemia shortly after, which resolved and since then has become asymptomatic.

Impact of statins on cardiovascular outcomes in renal transplant recipients: a systematic review.

Patients with chronic kidney disease including renal transplant recipients (RTRs) have a markedly higher prevalence of cardiovascular disease than the general population. Many trials have established the role of statins in the prevention of cardiovascular mortality, not only by decreasing the low density lipoprotein-cholesterol levels but also by their pleotropic effects. These data from the general population may not be applicable to RTRs as these patients have different cardiovascular risk profiles. Till date, only a few prospective, randomized trials have assessed the use of statins in RTRs with regards to cardiovascular outcomes. The Assessment of Lescol in Renal Transplant trial, the largest trial so far, suggested that dyslipidemia management with statins in RTRs is associated with a significant reduction in the incidence of cardiac death and nonfatal myocardial infarction (although differences in the combined primary end point were not statistically significant). The current guidelines from National Kidney Foundation for managing dyslipidemia in RTRs recommend managing all chronic kidney disease patients as a coronary heart disease equivalent. The task group for drafting these guidelines concluded that based on the currently available evidence, additional studies may be needed in RTRs to confirm and extend the results of Assessment of Lescol in Renal Transplant trial.

Cardiorenal syndrome: A literature review.

The incidence of cardiorenal syndrome is increasing; however, its pathophysiology and effective management are still not well understood. For many years, diuretics have been the mainstay of treatment for cardiorenal syndrome, although a significant proportion of patients develop resistance to diuretics and even deteriorate while on diuretics. Trials on different ways to counteract diuretic resistance and newer treatment modalities, such as nesiritide, arginine vasopressin receptor antagonists, adenosine receptor antagonists and ultrafiltration, have shown promising results.