This Month in AJKD

Article Outline

• Liver Cysts in ADPKD
• Pregnancy and CKD
• Acid-Base and Electrolyte Teaching Case: Inherited Hypomagnesemia
• World Kidney Forum: Looking at the Urine
• Copyright

Back to Article Outline

Liver Cysts in ADPKD 

See Takei et al, pages 744-752; Torres, pages 725-728; and Egbuna et al, pages 851-853.

Liver cysts in ADPKD can cause substantial morbidity. Liver cysts can be treated with surgical interventions, including liver transplantation, cyst fenestration, and partial liver resection. In this issue, Takei et al describe an alternative approach. They performed a non-surgical procedure, hepatic transcatheter arterial embolization, in 30 patients (22 of whom were on dialysis). In 29 of 30 patients, both total liver volume and intrahepatic cyst volume decreased (liver volume: 7,882 ± 2,916 to 6,041 ± 2,282 cm³; intrahepatic cyst volume: 6,677 ± 2,978 to 4,625 ± 2,299 cm³ [P < 0.0001 for both]) with no serious complications. This technique appears to be a feasible alternative for some patients. An accompanying editorial by Torres discusses the variety of treatments available for polycystic liver disease. In addition, a case report by Egbuna et al describes a patient with rupture of an infected liver cyst into the pericardium.

• 
  • View Large Image
  • Download to PowerPoint

Back to Article Outline

Pregnancy and CKD 

See Imbasciati et al, pages 753-762 and Lindheimer and Davison, pages 729-731.

Pregnancy in women with chronic kidney disease (CKD) stages 1-2 is generally successful and usually does not alter the course of kidney disease. More information is needed about the effects of pregnancy in women with moderate to severe CKD (stages 3-4). In this issue, Imbasciati et al report on a prospective multicenter cohort study of 49 women with a glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m². Although the overall mean GFR after delivery was lower than before conception (30 ± 13.8 versus 35 ± 12.2 mL/min/1.73 m²) the rate of GFR decline did not change (0.55 ± 0.8 versus 0.50 ± 0.3 mL/min/mo). In women with both a GFR less than 40 mL/min/1.73 m² and proteinuria greater than 1 g/d before conception, maternal and fetal outcomes were worse than in women with either GFR 40 to 60 mL/min/1.73 m² or proteinuria less than 1 g/d, including more rapid GFR loss after delivery compared with before conception (1.17 ± 1.23 versus 0.55 ± 0.39 mL/min/mo; difference, 0.62 mL/min/mo; 95% CI, 0.27 to 0.96 mL/min/mo); shorter time to dialysis or GFR halving (N = 20; hazard ratio, 5.2; 95% CI, 1.7 to 15.9); and low birth weight (N = 29; odds ratio, 5.1; 95% CI, 1.03 to 25.6). In an accompanying editorial, Lindheimer et al provide a historical context for this research and call for collaboration between nephrologists and obstetricians in carrying out further prospective studies.

• 
  • View Large Image
  • Download to PowerPoint

Back to Article Outline

Acid-Base and Electrolyte Teaching Case: Inherited Hypomagnesemia 

See Izzedine et al, pages 862-864.

Given the interest in and importance of acid-base and electrolyte disorders, AJKD has developed a new feature designed to educate clinicians about acid-base and electrolyte pathophysiology and the interpretation of serum and urine chemistries in clinical practice. In this issue, Izzedine et al present the first Acid-Base and Electrolyte Teaching Case, involving a man with kidney failure due to recurrent nephrolithiasis, passages of oxalate stones, hypercalciuria, and hypomagnesemia. After ruling out primary hyperoxaluria and Dent disease (neither cause hypomagnesemia), the authors narrow their potential diagnoses to isolated renal magnesium loss, Gitelman syndrome and autosomal recessive familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC). The final diagnosis of FHHNC was confirmed when mutational analysis of the CLDN16 (claudin 16) gene found a specific mutation exclusive to FHHNC. The figure shown to the right is a renal section stained with anti paracellin-1 (PCLN-1) (green) and anti Tamm-Horsfall protein (THP) (red) demonstrating localization of PCLN-1 to the tight junctions of the thick ascending limb of Henle.

• 
  • View Large Image
  • Download to PowerPoint

• Image courtesy of Dr Richard Lifton.

Back to Article Outline

World Kidney Forum: Looking at the Urine 

See Eknoyan, pages 865-872.

In AJKD’s second World Kidney Forum, Dr Garabed Eknoyan provides a fascinating account of the development of the study of urine, from its roots as a primarily visual science to the chemical analysis now employed in urology, endocrinology, and nephrology. Beginning with Babylonian, Greek, and Byzantine medicine, Eknoyan’s comprehensive survey cites the works of Hippocrates and Avicenna, among many others, discusses the abuses of uroscopy in the Middle Ages by traveling physicians, and covers the ground-breaking developments in the 19th and 20th centuries, including numerous interesting stories along the way. Eknoyan concludes by discussing the renaissance in urinalysis currently under way as proteomic profiling and detection of biomarkers in the urine promises to further extend the merits of looking at the urine.

• 
  • View Large Image
  • Download to PowerPoint