Correction to: An adolescent male with acute kidney injury: answers.

The authors regret that the name of the author Randall Craver was incorrectly rendered as "Randall Carver." The original article has been corrected.

Correction to: An adolescent male with acute kidney injury: questions.

The authors regret that the name of the author Randall Craver was incorrectly rendered as "Randall Carver." The original article has been corrected.

Pregnancy and Family Planning in Women With Kidney Disease.

Introduction: Females with kidney disease are at increased risk for pregnancy complications. Few studies have examined pregnancy perspectives of people with kidney disease. Our objective was to examine kidney patients' perspectives on family planning. Methods: We conducted an online survey of female patients with kidney disease from the University of Colorado Hospital between the ages of 18 and 50 years from August to October 2022. The survey asked questions on previous and current pregnancies with kidney disease, family planning, and reproductive health discussions with their nephrologists. Perspectives on how kidney disease influences pregnancies were also explored. Results: A total of 136 participants completed the survey. The majority of participants were White (71.3%) with a mean (SD) age of 37 ± 10 years. The majority of participants self-characterized their kidney disease as moderate (n = 57, 43.5%) with 16 participants (12.2%) receiving dialysis. Fifty-two participants (38.5%) experienced a pregnancy with a diagnosis of kidney disease, which were largely planned (n = 33, 61.1%). The majority of participants were able to conceive within 6 months (64.8%). Nearly half of participants reported that kidney disease influenced their family planning decisions with the majority (n = 91, 66.5%) believing that kidney disease increased their risk for pregnancy complications. More than half of participants never discussed the health risks of a potential pregnancy (54.0%), desire to have children (58.0%), pregnancy prevention (57.0%), and/or optimizing their health prior to pregnancy (68.1%) with their nephrologist. Conclusion: Although kidney disease influenced family planning decisions, few participants had family planning discussions with their nephrologists.

A National Survey of Pregnancy and Parenthood Among Nephrology Trainees: A Focus on Nephrology Fellowship.

BACKGROUND: National and international policies on parental leave for physician trainees are inconsistent. Physician trainees, including nephrology fellows, may be at higher risk of pregnancy complications. Physician trainees face barriers in meeting their breastfeeding goals and in finding childcare due to nontraditional work hours with extended or unpredictable shifts. Here, we examine awareness of current policies in United States (US) nephrology fellowship programs regarding parental leave, pregnancy/breastfeeding accommodations, and fellows' perspectives on family planning. METHODS: An anonymous, on-line survey of US nephrology fellows was undertaken from June 9 to August, 24, 2023. RESULTS: One hundred twenty nephrology fellows submitted the survey. A majority of fellow respondents were unaware of parental leave policies of their training programs (63%), Accreditation Council for Graduate Medical Education (ACGME) (75%), and/or American Board of Medical Specialties(ABMS) (75%). Forty two percent were unaware of the duration of parental leave at their program. Nearly 45% of all respondents were unsure if their program limited night shifts or shifts greater than 24 hours for pregnant trainees. Forty three percent reported they were unsure of lactation accommodations, and 40% were unsure of access to subsidized childcare. When fellows received work accommodations for pregnancy or parenthood, their work obligations were largely covered by co-fellows (60%) or attendings (38%). Over 60% of fellows agreed or strongly agreed that they would avoid a pregnancy in fellowship due to concern they would have to extend their training. Of the 40 fellows who chose to pursue pregnancy or parenthood during medical training, 75% did not change their career plans as a result. CONCLUSIONS: Most nephrology fellows were unaware of parental leave policies and pregnancy/lactation accommodations. While the topic itself has a broad impact to all physician trainees, there is need for improved awareness about national and local program policies among trainees across individual nephrology programs.

Mdm4 controls ureteric bud branching via regulation of p53 activity.

The antagonism between Mdm2 and its close homolog Mdm4 (also known as MdmX) and p53 is vital for embryogenesis and organogenesis. Previously, we demonstrated that targeted disruption of Mdm2 in the Hoxb7+ ureteric bud (Ub) lineage, which gives rise to the renal collecting system, causes renal hypodysplasia culminating in perinatal lethality. In this study, we examine the unique role of Mdm4 in establishing the collecting duct system of the murine kidney. Hoxb7Cre driven loss of Mdm4 in the Ub lineage (UbMdm4-/-) disrupts branching morphogenesis and triggers UB cell apoptosis. UbMdm4-/- kidneys exhibit abnormally dilated Ub tips while the medulla is hypoplastic. These structural alterations result in secondary depletion of nephron progenitors and nascent nephrons. As a result, newborn UbMdm4-/- mice have hypo-dysplastic kidneys. Transcriptional profiling revealed downregulation of the Ret-tyrosine kinase pathway components, Gdnf, Wnt11, Sox8, Etv4 and Cxcr4 in the UbMdm4-/- mice relative to controls. Moreover, the expression levels of the canonical Wnt signaling members Axin2 and Wnt9b are downregulated. Mdm4 deletion upregulated p53 activity and p53-target gene expression including Cdkn1a (p21), Gdf15, Ccng1, PERP, and Fas. Germline loss of p53 in UbMdm4-/- mice largely rescues kidney development and terminal differentiation of the collecting duct. We conclude that Mdm4 plays a unique and vital role in Ub branching morphogenesis and collecting system development.

Severe Acute Kidney Injury With Significant Uremia in an Infant Found to Have Inferior Vena Cava, Bilateral Renal Vein, and Bilateral Renal Artery Thromboses.

BACKGROUND: Common neonatal etiologies of acute kidney injury (AKI) include renal vein and inferior vena cava thromboses, maternal use of nonsteroidal antiinflammatory drugs, and congenital renal disease. The incidence of renal vein thrombosis is estimated to be 0.5 per 1,000 neonatal intensive care unit admissions, with approximately half of cases extending to the inferior vena cava and with unilateral disease being significantly more common than bilateral. Data on abdominal venous thromboembolism in pediatric patients are limited, and the clinical presentation of renal vein thrombosis can vary, although most patients have at least one of the three cardinal signs: hematuria, thrombocytopenia, or abdominal mass. CASE REPORT: We present the case of a 5-month-old female transferred to our pediatric intensive care unit from an outside hospital with AKI and significant uremia (creatinine 6.01 mg/dL, blood urea nitrogen >200 mg/dL) secondary to inferior vena cava, bilateral renal vein, and bilateral renal artery thromboses. The patient was started on a heparin drip and subsequently underwent mechanical thrombectomy of her inferior vena cava and right renal vein in addition to site-directed tissue plasminogen activator to her renal veins, renal arteries, and inferior vena cava. Following the procedure, she developed severe coagulopathy and became hemodynamically labile. The coagulopathy was corrected, but further anticoagulation to prevent further thrombus propagation was not sustainable in the face of ongoing bleeding and hemodynamic instability, so the decision to withdraw mechanical support was made. CONCLUSION: Because of the varied presentations of renal vein thrombosis and because prompt intervention significantly improves survival and renal outcomes, a high index of suspicion is warranted when risk factors and any of the three cardinal features of renal vein thrombosis are present.