NEJM â Collection Updates for Kidney Disease

PERSPECTIVE: Erythropoiesis-Stimulating Agents â Time for a Reevaluation

Thu, 21Â JanÂ 2010 00:00:00 -05:00

Epoetin alfa was approved in 1989 by the Food and Drug Administration (FDA) for the treatment of anemia associated with chronic kidney disease âto elevate or maintain the red blood...

CLINICAL PRACTICE: Stage IV Chronic Kidney Disease

Hanna Abboud, M.D., and William L. Henrich, M.D. — Thu, 07Â JanÂ 2010 00:00:00 -05:00

A 54-year-old woman with an 11-year history of type 2 diabetes presents for care. She was first noted to have proteinuria 4 years earlier; her serum creatinine level then was...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2009 â A 46-Year-Old Woman with Chronic Renal Failure, Leg Swelling, and Skin Changes

Daniela Kroshinsky, M.D., Jonathan Kay, M.D., and Rosalynn M. Nazarian, M.D. — Thu, 26Â NovÂ 2009 00:00:00 -05:00

A 46-year-old woman was referred to a rheumatologist at this hospital because of swelling of the legs and skin changes.

The patient had been in her usual state of health until...

REVIEW ARTICLE: Use of Diuretics in Patients with Hypertension

Michael E. Ernst, Pharm.D., and Marvin Moser, M.D. — Thu, 26Â NovÂ 2009 00:00:00 -05:00

Thiazide diuretics became available in the late 1950s and were the first effective oral antihypertensive agents with an acceptable side-effect profile.12 A half-century later, thiazides remain important medications for the...

EDITORIAL: Treatment of Anemia in Chronic Kidney Disease â Strategies Based on Evidence

Philip A. Marsden, M.D. — Thu, 19Â NovÂ 2009 00:00:00 -05:00

Anemia associated with chronic kidney disease and end-stage renal disease is due, in large part, to reduced production of renal erythropoietin and abnormalities in extracellular-fluid volume homeostasis.1 Moreover, anemia and...

ORIGINAL ARTICLE: A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease

Thu, 19Â NovÂ 2009 00:00:00 -05:00

Background: Anemia is associated with an increased risk of cardiovascular and renal events among patients with type 2 diabetes and chronic kidney disease. Although darbepoetin alfa can effectively increase hemoglobin...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2009 â A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Dr. Peter P. Moschovis (Medicine and Pediatrics): A 60-year-old man with diabetes mellitus and a history of renal transplantation was admitted to this hospital because of mental-status changes, diarrhea, renal...

CLINICAL PRACTICE: Renal-Artery Stenosis

Lance D. Dworkin, M.D., and Christopher J. Cooper, M.D. — Thu, 12Â NovÂ 2009 00:00:00 -05:00

A 73-year-old former smoker with a history of hypertension and dyslipidemia presents to the emergency department with shortness of breath. His blood pressure is 160/75 mm Hg, heart rate 60...

ORIGINAL ARTICLE: Revascularization versus Medical Therapy for Renal-Artery Stenosis

The ASTRAL Investigators — Thu, 12Â NovÂ 2009 00:00:00 -05:00

Background: Percutaneous revascularization of the renal arteries improves patency in atherosclerotic renovascular disease, yet evidence of a clinical benefit is limited.

Methods: In a randomized, unblinded trial, we assigned 806 patients...

EDITORIAL: Antimicrobial Prophylaxis for Urinary Tract Infection in Children

Alejandro Hoberman, M.D., and Ron Keren, M.D., M.P.H. — Thu, 29Â OctÂ 2009 00:00:00 -05:00

Approximately one third of children who have a urinary tract infection â the most frequent serious bacterial infection in young febrile children â have vesicoureteral reflux, a congenital condition in...

ORIGINAL ARTICLE: Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children

Thu, 29Â OctÂ 2009 00:00:00 -05:00

Background: Antibiotics are widely administered to children with the intention of preventing urinary tract infection, but adequately powered, placebo-controlled trials regarding efficacy are lacking. This study from four Australian centers...

IMAGES IN CLINICAL MEDICINE: Thoracic Kidney

Yoshitaka Doi, M.D., Ph.D. and Akihiko Sakamoto, M.D., Ph.D. — Thu, 22Â OctÂ 2009 00:00:00 -05:00

A 74-year-old man with diabetes and hypertension was referred to our hospital for evaluation of a mass in the right side of the chest, identified on a radiograph (Panel A,...

EDITORIAL: Blood-Pressure Control and Delay in Progression of Kidney Disease in Children

Julie R. Ingelfinger, M.D. — Thu, 22Â OctÂ 2009 00:00:00 -05:00

Many children with chronic kidney disease, even those in whom the disease is discovered very early, ultimately lose renal function; some ultimately progress to stage 5 chronic kidney disease (end-stage...

EDITORIAL: Renal Support in Acute Kidney Injury â How Much Is Enough?

Paul M. Palevsky, M.D. — Thu, 22Â OctÂ 2009 00:00:00 -05:00

Decrements in kidney function occur in more than two thirds of hospitalized patients with critical illness,1 and severe acute kidney injury complicates the care of more than 5% of patients...

REVIEW ARTICLE: Atypical HemolyticâUremic Syndrome

Marina Noris, Ph.D., and Giuseppe Remuzzi, M.D. — Thu, 22Â OctÂ 2009 00:00:00 -05:00

The hemolyticâuremic syndrome is characterized by nonimmune hemolytic anemia, thrombocytopenia, and renal impairment.1 The disorder occurs most frequently in children under the age of 5 years, with an annual incidence...

ORIGINAL ARTICLE: Strict Blood-Pressure Control and Progression of Renal Failure in Children

The ESCAPE Trial Group — Thu, 22Â OctÂ 2009 00:00:00 -05:00

Background: Although inhibition of the reninâangiotensin system delays the progression of renal failure in adults with chronic kidney disease, the blood-pressure target for optimal renal protection is controversial. We assessed...

ORIGINAL ARTICLE: Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients

The RENAL Replacement Therapy Study Investigators — Thu, 22Â OctÂ 2009 00:00:00 -05:00

Background: The optimal intensity of continuous renal-replacement therapy remains unclear. We conducted a multicenter, randomized trial to compare the effect of this therapy, delivered at two different levels of intensity,...

CORRESPONDENCE: Loss of Independence in Patients Starting Dialysis at 80 Years of Age or Older

Thu, 15Â OctÂ 2009 00:00:00 -05:00

To the Editor: We report a negative effect of initiation of dialysis on independent living by patients 80 years of age or older. Using a single-center, retrolective cohort study design...

EDITORIAL: Dialysis in Frail Elders â A Role for Palliative Care

Robert M. Arnold, M.D., and Mark L. Zeidel, M.D. — Thu, 15Â OctÂ 2009 00:00:00 -05:00

The methods and availability of dialysis and transplantation have improved, and patients who are beginning to undergo dialysis have become sicker and more debilitated than in the past.1 Increased numbers...

ORIGINAL ARTICLE: Functional Status of Elderly Adults before and after Initiation of Dialysis

Thu, 15Â OctÂ 2009 00:00:00 -05:00

Background: It is unclear whether functional status before dialysis is maintained after the initiation of this therapy in elderly patients with end-stage renal disease (ESRD).

Methods: Using a national registry of...

CORRESPONDENCE: Indigenous Australians and Living Kidney Donation

Natasha M. Rogers, M.D., Paul D. Lawton, M.D., and Matthew D. Jose, M.D., Ph.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

To the Editor: Indigenous Australians comprise 2.5% of the total population of Australia, but like other minority groups worldwide, rates of chronic kidney disease are higher among this indigenous group...

IMAGES IN CLINICAL MEDICINE: Staghorn Calculus

Shanmugasundaram Rajaian, M.D. and Nitin Sudhakar Kekre, M.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

A 58-year-old man presented with a 1-year history of dysuria. His medical history was notable for recurrent pyelonephritis on the right side. Evaluation at this time revealed staghorn calculus (Panel...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2009 â A 77-Year-Old Man with Recurrent Transitional-Cell Carcinoma of the Ureter

Thu, 24Â SepÂ 2009 00:00:00 -05:00

Dr. Donald S. Kaufman: A 77-year-old man with a history of transitional-cell carcinoma of the right ureter was seen in the multidisciplinary urologic oncology clinic of this hospital because of...

REVIEW ARTICLE: Renal Failure in Cirrhosis

Pere GinÃ¨s, M.D., and Robert W. Schrier, M.D. — Thu, 24Â SepÂ 2009 00:00:00 -05:00

Renal failure is a challenging complication of cirrhosis12 and is one of the most important risk factors when liver transplantation is being considered. Patients with cirrhosis and renal failure are...

CORRESPONDENCE: Renal Sympathetic-Nerve Ablation for Uncontrolled Hypertension

Thu, 27Â AugÂ 2009 00:00:00 -05:00

To the Editor: The renal sympathetic nerves have been identified as a major contributor to the complex pathophysiology of hypertension in both experimental models and in humans.1 Patients with essential...

IMAGES IN CLINICAL MEDICINE: Retinal Detachment in Malignant Hypertension

Iqbal Tajunisah, F.R.C.S. and Dinesh Kumar Patel, M.S. (Ophthal.) — Thu, 27Â AugÂ 2009 00:00:00 -05:00

A 37-year-old woman with no previous medical conditions presented with a 3-day history of headache and blurry vision. Her blood pressure was elevated, at 220/150 mm Hg, and visual acuity...

BOOK REVIEW:

Thu, 20Â AugÂ 2009 00:00:00 -05:00

Many fields in medicine intersect, thereby promoting clinical and research collaborations. Nephrology and endocrinology encompass a number of common topics; indeed, some departments and practices are joint ventures that include...

CLINICAL PROBLEM-SOLVING: A Hard Diagnosis

Thu, 06Â AugÂ 2009 00:00:00 -05:00

A 56-year-old woman presented to the emergency room with a 4-week history of malaise. During that time, her primary physician had ordered basic laboratory studies, which were normal except for...

IMAGES IN CLINICAL MEDICINE: Stent-Associated Urinary Calculi

Jovo Bogdanovic, M.D. and Jasenko Djozic, M.D., Ph.D. — Thu, 06Â AugÂ 2009 00:00:00 -05:00

A 54-year-old man was referred because of a 6-month history of lower urinary tract symptoms, microhematuria, and dull pain in the right flank. He had undergone shock-wave lithotripsy for the...

BOOK REVIEW:

Thu, 23Â JulÂ 2009 00:00:00 -05:00

A decade ago, a textbook linking the human genome and diseases of the kidney would have contained more questions than answers. This is probably the first textbook dedicated to the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2009 â A 13-Year-Old Boy with Headache, Nausea, Seizures, and Hypertension

Thu, 23Â JulÂ 2009 00:00:00 -05:00

A 13-year-old boy was admitted to the hospital because of headache, nausea, seizures, renal failure, and hypertension.

The patient had been well until approximately 3 weeks earlier, when intermittent left-sided headaches...

IMAGES IN CLINICAL MEDICINE: Air in the Urinary Tract

Chih-Cheng Lu, M.D. and Tse-Chou Cheng, M.D. — Thu, 23Â JulÂ 2009 00:00:00 -05:00

A 53-year-old woman was admitted to the hospital for evaluation of a 1-week history of lower abdominal pain and dysuria. She was afebrile. Plain abdominal radiography showed air throughout the...

ORIGINAL ARTICLE: Thrombomodulin Mutations in Atypical HemolyticâUremic Syndrome

Thu, 23Â JulÂ 2009 00:00:00 -05:00

Background: The hemolyticâuremic syndrome consists of the triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. The common form of the syndrome is triggered by infection with Shiga toxinâproducing bacteria...

CORRESPONDENCE: Anti-CTLA4 AntibodyâInduced Lupus Nephritis

Fouad Fadel, M.D., Khalil El Karoui, M.D., and Bertrand Knebelmann, M.D., Ph.D. — Thu, 09Â JulÂ 2009 00:00:00 -05:00

To the Editor: A 64-year-old man with a history of metastatic melanoma was admitted to our hospital for the nephrotic syndrome in 2006. In 2005, subcutaneous metastases had been diagnosed,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2009 â A 61-Year-Old Woman with Abdominal Pain, Weight Loss, and Renal Failure

Eric G. Neilson, M.D., and Alton B. Farris, M.D. — Thu, 09Â JulÂ 2009 00:00:00 -05:00

Dr. Anna Greka (Renal Unit): A 61-year-old woman was admitted to this hospital because of abdominal pain, weight loss, and an elevated level of serum creatinine. She had been well...

EDITORIAL: Diabetes Complications and the ReninâAngiotensin System

Thu, 02Â JulÂ 2009 00:00:00 -05:00

The hypothesis that inhibition of the reninâangiotensin system may be effective in preventing diabetic nephropathy was based on a large body of evidence.1 Positive findings from studies in animal models...

EDITORIAL: Human Idiopathic Membranous Nephropathy â A Mystery Solved?

Richard J. Glassock, M.D. — Thu, 02Â JulÂ 2009 00:00:00 -05:00

Just over 50 years ago, the late David Jones1 identified (using the periodic acidâSchiff and methenamine silver stains) the unique glomerular pathologic features of membranous nephropathy, thus distinguishing it from...

REVIEW ARTICLE: Rhabdomyolysis and Acute Kidney Injury

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Rhabdomyolysis â literally, the dissolution of striped (skeletal) muscle â is characterized by the leakage of muscle-cell contents, including electrolytes, myoglobin, and other sarcoplasmic proteins (e.g., creatine kinase, aldolase, lactate...

ORIGINAL ARTICLE: Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Background: Nephropathy and retinopathy remain important complications of type 1 diabetes. It is unclear whether their progression is slowed by early administration of drugs that block the reninâangiotensin system.

Methods: We...

ORIGINAL ARTICLE: M-Type Phospholipase A Receptor as Target Antigen in Idiopathic Membranous Nephropathy

Thu, 02Â JulÂ 2009 00:00:00 -05:00

Background: Idiopathic membranous nephropathy, a common form of the nephrotic syndrome, is an antibody-mediated autoimmune glomerular disease. Serologic diagnosis has been elusive because the target antigen is unknown.

Methods: We performed...

CORRESPONDENCE: B-CellâDepleting Induction Therapy and Acute Cellular Rejection

Thu, 18Â JunÂ 2009 00:00:00 -05:00

To the Editor: B-cell depletion is an effective treatment for a number of autoimmune diseases in which B cells were not previously considered to be important, such as multiple sclerosis.1...

BOOK REVIEW:

Thu, 28Â MayÂ 2009 00:00:00 -05:00

A search in PubMed for publications that address pediatric nephrology, pediatric critical care, acute kidney injury, and acute dialysis yields more than 1000 publications in the past 15 years, with...

EDITORIAL: Antiplatelet Therapy and Vascular-Access Patency

Charmaine E. Lok, M.D. — Thu, 21Â MayÂ 2009 00:00:00 -05:00

Current predictions estimate that by the year 2020, more than 750,000 people in the United States alone will have end-stage renal disease and over 500,000 will require hemodialysis.1 The success...

ORIGINAL ARTICLE: Effect of Dipyridamole plus Aspirin on Hemodialysis Graft Patency

Thu, 21Â MayÂ 2009 00:00:00 -05:00

Background: Arteriovenous graft stenosis leading to thrombosis is a major cause of complications in patients undergoing hemodialysis. Procedural interventions may restore patency but are costly. Although there is no proven...

EDITORIAL: Membrane Physiology â Bridging the Gap between Medical Disciplines

Markus Bleich, M.D. — Thu, 07Â MayÂ 2009 00:00:00 -05:00

The general separation between medical disciplines has, for decades, been a strange tradition. For example, neurologists and nephrologists have each had their defined patient groups, and many are barely interested,...

ORIGINAL ARTICLE: Epilepsy, Ataxia, Sensorineural Deafness, Tubulopathy, and Mutations

Thu, 07Â MayÂ 2009 00:00:00 -05:00

Background: Five children from two consanguineous families presented with epilepsy beginning in infancy and severe ataxia, moderate sensorineural deafness, and a renal salt-losing tubulopathy with normotensive hypokalemic metabolic alkalosis. We...

IMAGES IN CLINICAL MEDICINE: Chvostek's Sign and Carpopedal Spasm

Ganesh Athappan, M.D. and Venkatesh Kumar Ariyamuthu, M.D. — Thu, 30Â AprÂ 2009 00:00:00 -05:00

A 35-year-old man presented with a 2-day history of cramps and paresthesias in the arms, predominantly involving the fingers. This presentation was preceded by a bout of viral gastroenteritis 1...

CORRECTION:

Thu, 30Â AprÂ 2009 00:00:00 -05:00

Multidisciplinary Management of Lung Cancer (January 22, 2004;350:379-92) N Engl J Med 2004January22 350 11 379392 . In Table 4 (page 387), in the Conclusions or Results column, the therapeutic...

BOOK REVIEW:

Thu, 23Â AprÂ 2009 00:00:00 -05:00

The field of pediatric nephrology emerged in the early 1950s, largely because of the remarkable success of glucocorticoid therapy for childhood nephrotic syndrome and the use of percutaneous renal biopsies...

CORRESPONDENCE: Outcome of Renal Transplantation from Very Old Donors

Thu, 02Â AprÂ 2009 00:00:00 -05:00

To the Editor: The use of kidneys from elderly donors may permit more transplantations, but it has been associated with poorer outcomes than transplantations performed with kidneys from younger donors.1...

EDITORIAL: Sunset for Statins after AURORA?

Giovanni F.M. Strippoli, Ph.D., and Jonathan C. Craig, Ph.D. — Thu, 02Â AprÂ 2009 00:00:00 -05:00

Reducing mortality from cardiovascular disease among patients undergoing dialysis is a global public health challenge. The past 10 years have seen trials of many interventions designed to improve survival and...

ORIGINAL ARTICLE: Rosuvastatin and Cardiovascular Events in Patients Undergoing Hemodialysis

Thu, 02Â AprÂ 2009 00:00:00 -05:00

Background: Statins reduce the incidence of cardiovascular events in patients at high cardiovascular risk. However, a benefit of statins in such patients who are undergoing hemodialysis has not been proved.

Methods:...

CORRESPONDENCE: Melamine and Nephrolithiasis in Children in Taiwan

Thu, 12Â MarÂ 2009 00:00:00 -05:00

To the Editor: The adverse renal effects of melamine-tainted formula have raised international concern. To address public concerns about melamine, the department of health in Taiwan initiated services to screen...

CORRESPONDENCE: Ultrasonographic Evaluation of Melamine-Exposed Children in Hong Kong

Thu, 12Â MarÂ 2009 00:00:00 -05:00

To the Editor: The recent melamine contamination of infant formula and milk products in China placed thousands of children in China and neighboring regions at risk for renal-stone formation and...

EDITORIAL: Melamine, Powdered Milk, and Nephrolithiasis in Chinese Infants

Craig B. Langman, M.D. — Thu, 12Â MarÂ 2009 00:00:00 -05:00

Melamine, a synthetic nitrogenous product found in many industrial goods and even in fertilizer destined for use in growing crops for human consumption, was recently found to have been added...

ORIGINAL ARTICLE: A Nonsimultaneous, Extended, Altruistic-Donor Chain

Thu, 12Â MarÂ 2009 00:00:00 -05:00

We report a chain of 10 kidney transplantations, initiated in July 2007 by a single altruistic donor (i.e., a donor without a designated recipient) and coordinated over a period of...

ORIGINAL ARTICLE: Melamine-Contaminated Powdered Formula and Urolithiasis in Young Children

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Background: A recent epidemic of melamine contamination of baby formula in China has been associated with the development of urinary tract stones, though the clinical manifestations and predisposing factors are...

ORIGINAL ARTICLE: C3 Polymorphisms and Allograft Outcome in Renal Transplantation

Thu, 26Â FebÂ 2009 00:00:00 -05:00

Background: Complement activation plays a role in the development of chronic allograft nephropathy, a common cause of late allograft loss. The role of two complement component 3 (C3) allotypes, called...

CORRESPONDENCE: Eculizumab for Congenital Atypical HemolyticâUremic Syndrome

Ralph A. Gruppo, M.D. and Russell P. Rother, Ph.D. — Thu, 29Â JanÂ 2009 00:00:00 -05:00

To the Editor: Atypical hemolyticâuremic syndrome of infancy is a rare disorder that is associated with thrombotic microangiopathy and acute renal failure. It often involves complement dysregulation.12 Plasma infusions have...

CORRESPONDENCE: Eculizumab for Atypical HemolyticâUremic Syndrome

Thu, 29Â JanÂ 2009 00:00:00 -05:00

To the Editor: Atypical hemolyticâuremic syndrome is a disease of uncontrolled complement activation associated with a high mortality rate, and most cases progress to end-stage renal disease.1 About 50% of...

EDITORIAL: Cautious Optimism Concerning Long-Term Safety of Kidney Donation

Jane C. Tan, M.D., Ph.D., and Glenn M. Chertow, M.D., M.P.H. — Thu, 29Â JanÂ 2009 00:00:00 -05:00

Kidney transplantation remains the preferred therapeutic option for patients with end-stage renal disease (ESRD), since survival and health-related quality of life are better after kidney transplantation than after dialysis therapy....

ORIGINAL ARTICLE: Long-Term Consequences of Kidney Donation

Thu, 29Â JanÂ 2009 00:00:00 -05:00

Background: The long-term renal consequences of kidney donation by a living donor are attracting increased appropriate interest. The overall evidence suggests that living kidney donors have survival similar to that...

BOOK REVIEW:

Thu, 22Â JanÂ 2009 00:00:00 -05:00

Since the first successful kidney transplant was performed â on identical twins in Boston in 1954 â kidney transplantation has become the indicated therapy for end-stage renal disease. During the...

EDITORIAL: Organ Procurement and Perfusion before Transplantation

Stefan G. Tullius, M.D., Ph.D., and Guillermo GarcÃa-CardeÃ±a, Ph.D. — Thu, 01Â JanÂ 2009 00:00:00 -05:00

Organ transplantation is one of the great success stories of modern medicine. Living-donor kidney transplantations between identical twins during the early 1950s first demonstrated the overall feasibility of this procedure...

ORIGINAL ARTICLE: Machine Perfusion or Cold Storage in Deceased-Donor Kidney Transplantation

Thu, 01Â JanÂ 2009 00:00:00 -05:00

Background: Static cold storage is generally used to preserve kidney allografts from deceased donors. Hypothermic machine perfusion may improve outcomes after transplantation, but few sufficiently powered prospective studies have addressed...

ORIGINAL ARTICLE: A Syndrome with Congenital Neutropenia and Mutations in

Thu, 01Â JanÂ 2009 00:00:00 -05:00

Background: The main features of severe congenital neutropenia are the onset of severe bacterial infections early in life, a paucity of mature neutrophils, and an increased risk of leukemia. In...

CORRESPONDENCE: Cardiac Amyloidosis with the Mutation of the Fibrinogen A Î±-Chain

Georges Mourad, M.D., Jean-Philippe Delabre, M.D., and ValÃ©rie Garrigue, M.D. — Thu, 25Â DecÂ 2008 00:00:00 -05:00

To the Editor: Proteinuria developed in a 48-year-old man in 2003. His mother had died 10 years earlier from renal amyloidosis. Laboratory tests showed isolated nephrotic-range proteinuria (urinary protein excretion,...

ORIGINAL ARTICLE: Azathioprine or Methotrexate Maintenance for ANCA-Associated Vasculitis

Thu, 25Â DecÂ 2008 00:00:00 -05:00

Background: Current standard therapy for Wegener's granulomatosis and microscopic polyangiitis combines corticosteroids and cyclophosphamide to induce remission, followed by a less toxic immunosuppressant such as azathioprine or methotrexate for maintenance...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Proteinuria and Immunity â An Overstated Relationship?

Peter W. Mathieson, Ph.D. — Thu, 04Â DecÂ 2008 00:00:00 -05:00

Proteinuria is a cardinal sign of kidney disease, a prognostic marker, and an independent risk factor for cardiovascular disease. It is the earliest sign of renal complications of diabetes, obesity,...

REVIEW ARTICLE: Uric Acid and Cardiovascular Risk

Daniel I. Feig, M.D., Ph.D., Duk-Hee Kang, M.D., and Richard J. Johnson, M.D. — Thu, 23Â OctÂ 2008 00:00:00 -05:00

An association of gout with hypertension, diabetes, kidney disease, and cardiovascular disease has been observed since the late 19th century. Early investigators, such as Frederick Mahomed, Alexander Haig, and Nathan...

BOOK REVIEW:

Thu, 16Â OctÂ 2008 00:00:00 -05:00

Lawrence Henderson's simple equation, H+=KÃHA/Aâ, which describes the dynamic equilibrium that occurs when weak acids are in solution, was a revolutionary breakthrough that changed forever the way clinicians evaluate and...

CORRESPONDENCE: Long-Term Results of Rabbit Antithymocyte Globulin and Basiliximab Induction

Daniel C. Brennan, M.D. and Mark A. Schnitzler, Ph.D. — Thu, 16Â OctÂ 2008 00:00:00 -05:00

To the Editor: In our recently reported prospective, randomized, international clinical trial comparing rabbit antithymocyte globulin and basiliximab in renal transplantation (ClinicalTrials.gov number, NCT00235300),1 we observed that induction treatment with...

BOOK REVIEW:

Thu, 09Â OctÂ 2008 00:00:00 -05:00

Renal-cell carcinoma actually comprises a heterogeneous group of diseases with varying clinical presentations, all of which require a multidisciplinary approach to treatment, with contributions from urologists, pathologists, medical oncologists, radiologists,...

CLINICAL PROBLEM-SOLVING: Variations on a Theme

Thu, 02Â OctÂ 2008 00:00:00 -05:00

A 57-year-old man presented to the emergency department with a 2-week history of progressive dyspnea with exertion, edema of the upper and lower legs, a nonproductive cough, and scant hemoptysis....

CLINICAL PRACTICE: Autosomal Dominant Polycystic Kidney Disease

Jared J. Grantham, M.D. — Thu, 02Â OctÂ 2008 00:00:00 -05:00

Autosomal dominant polycystic kidney disease is an inherited systemic disorder with major renal manifestations and, in some cases, abnormalities in the liver, the pancreas, the brain, the arterial blood vessels,...

EDITORIAL: Renal PhosphateâTransporter Regulatory Proteins and Nephrolithiasis

Moshe Levi, M.D., and Sophia Breusegem, Ph.D. — Thu, 11Â SepÂ 2008 00:00:00 -05:00

Nephrolithiasis is a common disorder, and idiopathic hypercalciuria is the most frequent metabolic disorder associated with nephrolithiasis.1 Several studies have shown that subjects with idiopathic hypercalciuria have phosphaturia or renal...

ORIGINAL ARTICLE: Mutations and Responsiveness of Renal Parathyroid Hormone

Thu, 11Â SepÂ 2008 00:00:00 -05:00

Impaired renal phosphate reabsorption, as measured by dividing the tubular maximal reabsorption of phosphate by the glomerular filtration rate (TmP/GFR), increases the risks of nephrolithiasis and bone demineralization. Data from...

CORRESPONDENCE: Scrotal Cutaneous Side Effects of Sunitinib

Thu, 28Â AugÂ 2008 00:00:00 -05:00

To the Editor: Sunitinib is an oral, multitargeted kinase that blocks the receptors for vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and stem-cell factor (c-kit). Sunitinib was approved...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2008 â A 64-Year-Old Man with Abdominal Pain, Nausea, and an Elevated Level of Serum Creatinine

Theodore I. Steinman, M.D., Anthony E. Samir, M.D., and Lynn D. Cornell, M.D. — Thu, 28Â AugÂ 2008 00:00:00 -05:00

A 64-year-old man was admitted to the hospital because of abdominal pain, nausea, and an elevated level of serum creatinine. The patient had been in his usual state of health...

ORIGINAL ARTICLE: Brain-Derived Neurotrophic Factor and Obesity in the WAGR Syndrome

Thu, 28Â AugÂ 2008 00:00:00 -05:00

Background: Brain-derived neurotrophic factor (BDNF) has been found to be important in energy homeostasis in animal models, but little is known about its role in energy balance in humans. Heterozygous,...

CORRESPONDENCE: Age, Renal Tubular Phosphate Reabsorption, and Serum Phosphate Levels in Adults

Massimo Cirillo, M.D., Carolina Ciacci, M.D., and Natale G. De Santo, M.D. — Thu, 21Â AugÂ 2008 00:00:00 -05:00

To the Editor: A relation between age and serum phosphate levels in adults has been recognized since 1969.1 We used data from the Gubbio Population Study to analyze serum phosphate...

EDITORIAL: Preeclampsia â A Glimpse into the Future?

Ravi Thadhani, M.D., M.P.H., and Caren G. Solomon, M.D., M.P.H. — Thu, 21Â AugÂ 2008 00:00:00 -05:00

Preeclampsia, a disorder of pregnancy characterized by elevated blood pressure and proteinuria, complicates approximately 5% of pregnancies.1 Although several risk factors for this condition are well recognized, including nulliparity, extremes...

ORIGINAL ARTICLE: Preeclampsia and the Risk of End-Stage Renal Disease

Thu, 21Â AugÂ 2008 00:00:00 -05:00

Background: It is unknown whether preeclampsia is a risk marker for subsequent end-stage renal disease (ESRD).

Methods: We linked data from the Medical Birth Registry of Norway, which contains data on...

CORRESPONDENCE: AntiâGlomerular Basement Membrane Disease after Alemtuzumab

Thu, 14Â AugÂ 2008 00:00:00 -05:00

To the Editor: Alemtuzumab (Campath-1H) is a humanized anti-CD52 monoclonal antibody, the administration of which causes profound B- and T-lymphocyte depletion. It is licensed for use in the treatment of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2008 â A 43-Year-Old Man with Fatigue and Lesions in the Pituitary and Cerebellum

John A. Mills, M.D., R. Gilberto Gonzalez, M.D., Ph.D., and Ronald Jaffe, M.D. — Thu, 14Â AugÂ 2008 00:00:00 -05:00

Dr. Flavia V. Castelino (Rheumatology, Allergy, and Immunology): A 43-year-old man was seen in the neuro-oncology clinic of this hospital because of fatigue and lesions in the pituitary and cerebellum...

EDITORIAL: FGF-23 and Outcomes Research â When Physiology Meets Epidemiology

Chi-yuan Hsu, M.D., M.Sc. — Thu, 07Â AugÂ 2008 00:00:00 -05:00

In this issue of the Journal, GutiÃ©rrez and colleagues report the results of a study, conducted with an efficient nested caseâcohort design, that showed that among patients who were beginning...

ORIGINAL ARTICLE: Fibroblast Growth Factor 23 and Mortality among Patients Undergoing Hemodialysis

Thu, 07Â AugÂ 2008 00:00:00 -05:00

Background: Fibroblast growth factor 23 (FGF-23) is a hormone that increases the rate of urinary excretion of phosphate and inhibits renal production of 1,25-dihydroxyvitamin D, thus helping to mitigate hyperphosphatemia...

BOOK REVIEW:

Thu, 24Â JulÂ 2008 00:00:00 -05:00

In the past half-century, life expectancy has increased considerably. As a result, we need to develop a more comprehensive understanding of aging than we have now. Whether in health or...

EDITORIAL: Reducing Antibody Levels in Patients Undergoing Transplantation

Ron Shapiro, M.D. — Thu, 17Â JulÂ 2008 00:00:00 -05:00

The advent of solid-organ transplantation for the treatment of patients with end-stage organ failure has been one of the most exciting medical advances in the late 20th and early 21st...

ORIGINAL ARTICLE: Rituximab and Intravenous Immune Globulin for Desensitization during Renal Transplantation

Thu, 17Â JulÂ 2008 00:00:00 -05:00

Background: Few options for transplantation currently exist for patients highly sensitized to HLA. This exploratory, open-label, phase 1â2, single-center study examined whether intravenous immune globulin plus rituximab could reduce anti-HLA...

IMAGES IN CLINICAL MEDICINE: Digital Verrucae

Nektarios I. Lountzis, M.D. and Omar Rahman, M.D. — Thu, 10Â JulÂ 2008 00:00:00 -05:00

A 34-year-old woman underwent renal transplantation for chronic idiopathic glomerulonephritis, and 4 years later small verrucae developed on her distal fingertips. Over the course of 11 years after transplantation, during...

IMAGES IN CLINICAL MEDICINE: Bilateral Kidney Calcifications

Andres Serrano, M.D. and Daniel Batlle, M.D. — Thu, 03Â JulÂ 2008 00:00:00 -05:00

A 37-year-old man was referred for evaluation of distal renal tubular acidosis. Laboratory evaluation revealed a serum potassium level of 3.3 mmol per liter, a bicarbonate level of 16 mmol...

EDITORIAL: Dialysis in Acute Kidney Injury â More Is Not Better

Joseph V. Bonventre, M.D., Ph.D. — Thu, 03Â JulÂ 2008 00:00:00 -05:00

Acute kidney injury is associated with morbidity and mortality rates of more than 50% in critically ill patients, despite the potential for recovery of renal function and many advances in...

IMAGES IN CLINICAL MEDICINE: Renal Osteodystrophy of the Palate

Yahya Daneshbod, M.D. — Thu, 03Â JulÂ 2008 00:00:00 -05:00

A 20-year-old man who had had idiopathic end-stage renal failure since he was 12 years of age and who was undergoing dialysis once weekly (with stable serum electrolyte, blood urea...

ORIGINAL ARTICLE: Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury

The VA/NIH Acute Renal Failure Trial Network — Thu, 03Â JulÂ 2008 00:00:00 -05:00

Background: The optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury is controversial.

Methods: We randomly assigned critically ill patients with acute kidney injury and failure of...

EDITORIAL: Glycemic Targets and Cardiovascular Disease

William T. Cefalu, M.D. — Thu, 12Â JunÂ 2008 00:00:00 -05:00

Cardiovascular disease in patients with diabetes is clearly associated with the degree of hyperglycemia, as measured clinically with the use of glycated hemoglobin.123 However, there remains an unanswered question in...

EDITORIAL: Intensive Glycemic Control in the ACCORD and ADVANCE Trials

Robert G. Dluhy, M.D., and Graham T. McMahon, M.D., M.M.Sc. — Thu, 12Â JunÂ 2008 00:00:00 -05:00

Diabetes is associated with a reduced lifespan, largely as a consequence of cardiovascular disease.123 Although diabetes significantly increases the risk of cardiovascular events,1 the relative increase in events for each...

ORIGINAL ARTICLE: Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes

The ADVANCE Collaborative Group — Thu, 12Â JunÂ 2008 00:00:00 -05:00

Background: In patients with type 2 diabetes, the effects of intensive glucose control on vascular outcomes remain uncertain.

Methods: We randomly assigned 11,140 patients with type 2 diabetes to undergo either...

EDITORIAL: Aliskiren and Dual Therapy in Type 2 Diabetes Mellitus

Julie R. Ingelfinger, M.D. — Thu, 05Â JunÂ 2008 00:00:00 -05:00

The discovery 110 years ago that crude kidney extract elicited a pressor reaction provided the first evidence of the existence of the reninâangiotensinâaldosterone system, a major vasoactive system,1 and the...

ORIGINAL ARTICLE: Aliskiren Combined with Losartan in Type 2 Diabetes and Nephropathy

Thu, 05Â JunÂ 2008 00:00:00 -05:00

Background: Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries. We evaluated the renoprotective effects of dual blockade of the reninâangiotensinâaldosterone system by adding treatment with...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2008 â A 63-Year-Old Man with Metastatic Renal-Cell Carcinoma

Thu, 29Â MayÂ 2008 00:00:00 -05:00

A 63-year-old man was admitted to this hospital because of a mass in the left kidney and pulmonary nodules. The patient had been well until approximately 5 months before admission,...

IMAGES IN CLINICAL MEDICINE: Hemoglobinuria with Malaria

Martin Tombe, M.D. — Thu, 24Â AprÂ 2008 00:00:00 -05:00

An otherwise healthy 30-year-old man had been ill for 2 days when he presented with a temperature of 39Â°C and reported passing dark urine (his case was noted in Bhatt...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Activated Protein C and Diabetic Nephropathy

Richard E. Gilbert, M.D., and Philip A. Marsden, M.D. — Thu, 10Â AprÂ 2008 00:00:00 -05:00

Medical students are taught that endothelial dysfunction is relevant to the pathophysiology of diabetic microvascular disease, especially the glomerular defects that are characteristic of diabetic nephropathy. The facts, however, belie...

ORIGINAL ARTICLE: Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events

The ONTARGET Investigators — Thu, 10Â AprÂ 2008 00:00:00 -05:00

Background: In patients who have vascular disease or high-risk diabetes without heart failure, angiotensin-convertingâenzyme (ACE) inhibitors reduce mortality and morbidity from cardiovascular causes, but the role of angiotensin-receptor blockers (ARBs)...

IMAGES IN CLINICAL MEDICINE: Crystalluria from Acyclovir Use

William J. Mason, M.D. and Hilary H. Nickols, M.D., Ph.D. — Thu, 27Â MarÂ 2008 00:00:00 -05:00

A 60-year-old man infected with the human immunodeficiency virus (HIV) (CD4 count of 450 per cubic millimeter and HIV viral load of <50 copies per milliliter) who had HIV-associated dementia...

IMAGES IN CLINICAL MEDICINE: Green Urine

Piero Stratta, M.D. and Maria Cristina Barbe, M.D. — Thu, 13Â MarÂ 2008 00:00:00 -05:00

A 76-year-old man with renal failure from nephroangiosclerosis received a kidney transplant from a deceased donor. The transplant was functioning well when the patient underwent a radical laryngopharyngoesophagectomy, with colopharyngeal...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2008 â A 33-Year-Old Man with Fever, Abdominal Pain, and Pancytopenia after Renal Transplantation

Thu, 13Â MarÂ 2008 00:00:00 -05:00

Dr. Robert B. Den (Medicine): A 33-year-old man was admitted to this hospital because of fever, abdominal pain, and pancytopenia.

The patient had received a cadaveric renal allograft 15 years earlier...

ORIGINAL ARTICLE: VEGF Inhibition and Renal Thrombotic Microangiopathy

Thu, 13Â MarÂ 2008 00:00:00 -05:00

The glomerular microvasculature is particularly susceptible to injury in thrombotic microangiopathy, but the mechanisms by which this occurs are unclear. We report the cases of six patients who were treated...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2008 â A 17-Year-Old Girl with Chest Pain and Hemoptysis

Thu, 28Â FebÂ 2008 00:00:00 -05:00

Dr. Mary Shannon Fracchia (Pediatrics): A 17-year-old girl was transferred to this hospital because of chest pain and hemoptysis. She had been well except for mild asthma until 4 months...

REVIEW ARTICLE: Systemic Lupus Erythematosus

Anisur Rahman, Ph.D., and David A. Isenberg, M.D. — Thu, 28Â FebÂ 2008 00:00:00 -05:00

To the clinician, systemic lupus erythematosus is important because it is a potentially fatal disease that is easily confused with many other disorders. To the immunologist, lupus is intriguing because...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2008 â A 46-Year-Old Woman with Renal Failure and Stiffness of the Joints and Skin

Thu, 21Â FebÂ 2008 00:00:00 -05:00

Dr. Nancy Cibotti-Granof (Medicine): A 46-year-old woman with end-stage renal disease was seen by a rheumatology consultant because of stiffness of her joints and skin.

The patient had been well except...

ORIGINAL ARTICLE: Hepatitis E Virus and Chronic Hepatitis in Organ-Transplant Recipients

Thu, 21Â FebÂ 2008 00:00:00 -05:00

Hepatitis E virus (HEV) is considered an agent responsible for acute hepatitis that does not progress to chronic hepatitis. We identified 14 cases of acute HEV infection in three patients...

IMAGES IN CLINICAL MEDICINE: Renal Failure from Vitamin C after Transplantation

Brian J. Nankivell, M.D., Ph.D. and Karumathil M. Murali, M.D. — Thu, 24Â JanÂ 2008 00:00:00 -05:00

A 31-year-old woman with bilateral nephrectomy due to bleeding angiomyolipomas from tuberous sclerosis received a kidney transplant with good early graft function. Irreversible, oliguric renal allograft failure soon developed from...

EDITORIAL: Immunosuppressive Therapy and Tolerance of Organ Allografts

Thomas E. Starzl, M.D., Ph.D. — Thu, 24Â JanÂ 2008 00:00:00 -05:00

In this issue of the Journal, three articles describe several organ-transplant recipients in whom allografts have maintained good function for up to 5 years without immunosuppressive treatment.123 In two articles...

ORIGINAL ARTICLE: Tolerance and Chimerism after Renal and Hematopoietic-Cell Transplantation

Thu, 24Â JanÂ 2008 00:00:00 -05:00

We describe a recipient of combined kidney and hematopoietic-cell transplants from an HLA-matched donor. A post-transplantation conditioning regimen of total lymphoid irradiation and antithymocyte globulin allowed engraftment of the donor's...

ORIGINAL ARTICLE: HLA-Mismatched Renal Transplantation without Maintenance Immunosuppression

Thu, 24Â JanÂ 2008 00:00:00 -05:00

08012430.xml 08012430.xml 08012430.xml 08012430.xml Five patients with end-stage renal disease received combined bone marrow and kidney transplants from HLA single-haplotype mismatched living related donors, with the use of a...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2008 â A 38-Year-Old Woman with Postpartum Visual Loss, Shortness of Breath, and Renal Failure

Thu, 17Â JanÂ 2008 00:00:00 -05:00

Dr. Esperance A. Schaefer (Medicine): A 38-year-old woman was admitted to the hospital, because of blurred vision and shortness of breath, 2 weeks after a cesarean section had been performed...

EDITORIAL: Efficacy of Sirolimus in Treating Tuberous Sclerosis and Lymphangioleiomyomatosis

Elahna Paul, M.D., Ph.D., and Elizabeth Thiele, M.D., Ph.D. — Thu, 10Â JanÂ 2008 00:00:00 -05:00

Owing to their immunosuppressive and antiproliferative effects, sirolimus (also called rapamycin) and related drugs are being evaluated as part of many transplant immunosuppresion regimens, as well as for a plethora...

IMAGES IN CLINICAL MEDICINE: Spontaneous Pneumothorax in Tuberous Sclerosis

Rajeev L. Narayan, M.D. — Thu, 10Â JanÂ 2008 00:00:00 -05:00

A 28-year-old woman with tuberous sclerosis presented with sudden onset of dyspnea and discomfort in the right chest and back. On examination she had tachycardia, tachypnea, and hypoxia, with an...

ORIGINAL ARTICLE: Sirolimus for Angiomyolipoma in Tuberous Sclerosis Complex or Lymphangioleiomyomatosis

Thu, 10Â JanÂ 2008 00:00:00 -05:00

Background: Angiomyolipomas in patients with the tuberous sclerosis complex or sporadic lymphangioleiomyomatosis are associated with mutations in tuberous sclerosis genes resulting in constitutive activation of the mammalian target of rapamycin...

ORIGINAL ARTICLE: Mutations and Hereditary Angiopathy, Nephropathy, Aneurysms, and Muscle Cramps

Thu, 27Â DecÂ 2007 00:00:00 -05:00

Background: COL4A3, COL4A4, and COL4A5 are the only collagen genes that have been implicated in inherited nephropathies in humans. However, the causative genes for a number of hereditary multicystic kidney...

EDITORIAL: Balancing Efficacy and Toxicity in Kidney-Transplant Immunosuppression

Alan B. Leichtman, M.D. — Thu, 20Â DecÂ 2007 00:00:00 -05:00

Although protocols differ among transplantation centers, most immunosuppressive strategies for kidney-transplant recipients are built on two core practices: delivery of immunosuppression in two phases, usually termed induction and maintenance, and...

IMAGES IN CLINICAL MEDICINE: Calcinosis Associated with Renal Failure

Robert A. Cohen, M.D. and Samir M. Parikh, M.D. — Thu, 20Â DecÂ 2007 00:00:00 -05:00

A 36-year-old woman presented with painless, subcutaneous nodules that had developed during the previous 5 months on her buttocks, shoulders, and left wrist (Panel A). Her medical history was notable...

ORIGINAL ARTICLE: Reduced Exposure to Calcineurin Inhibitors in Renal Transplantation

Thu, 20Â DecÂ 2007 00:00:00 -05:00

Background: Immunosuppressive regimens with the fewest possible toxic effects are desirable for transplant recipients. This study evaluated the efficacy and relative toxic effects of four immunosuppressive regimens.

Methods: We randomly assigned...

IMAGES IN CLINICAL MEDICINE: Aneurysmal Arteriovenous Fistula

Kim Sinnamon, M.B. and Robert Mullan, M.D. — Thu, 11Â OctÂ 2007 00:00:00 -05:00

A 50-year-old man had a 30-year history of end-stage renal disease associated with idiopathic membranoproliferative glomerulonephritis. His medical history included immune thrombocytopenic purpura, with platelet counts that were persistently less...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2007 â A 41-Year-Old Man with Abdominal Pain and Elevated Serum Creatinine

Hamid Rabb, M.D., and Robert B. Colvin, M.D. — Thu, 11Â OctÂ 2007 00:00:00 -05:00

A 41-year-old man was admitted to this hospital because of abdominal pain, nausea, and an elevated serum creatinine level. He had been in good health until 6 days before admission,...

IMAGES IN CLINICAL MEDICINE: Purple Urine

Jooyun Lee, M.D. — Thu, 27Â SepÂ 2007 00:00:00 -05:00

A 76-year-old male nursing home resident with dementia and end-stage renal disease who was undergoing hemodialysis was admitted to the hospital after a syncopal episode that occurred during dialysis. Torsades...

EDITORIAL: Will MICA Glitter for Recipients of Kidney Transplants?

Willy Albert Flegel, M.D. — Thu, 27Â SepÂ 2007 00:00:00 -05:00

Renal transplantation as the treatment of choice for end-stage renal failure is associated with excellent short-term results. The 1-year patient-survival rate is 96%, and the 1-year allograft-survival rate is more...

IMAGES IN CLINICAL MEDICINE: Calciphylaxis with Arterial Calcification

Jonathan Z. Li, M.D. and William Huen, M.D. — Thu, 27Â SepÂ 2007 00:00:00 -05:00

A 53-year-old woman with diabetes mellitus and end-stage renal disease who was undergoing hemodialysis presented with fever, painful finger necrosis, and nonhealing ulceration of the legs. Hand radiographs showed no...

REVIEW ARTICLE: Uremia

Timothy W. Meyer, M.D., and Thomas H. Hostetter, M.D. — Thu, 27Â SepÂ 2007 00:00:00 -05:00

Medical progress has altered the course and thus the definition of uremia, which once encompassed all the signs and symptoms of advanced kidney failure. Hypertension due to volume overload, hypocalcemic...

ORIGINAL ARTICLE: Antibodies against MICA Antigens and Kidney-Transplant Rejection

Thu, 27Â SepÂ 2007 00:00:00 -05:00

Background: Good HLA-A, HLA-B, and HLA-DR matches do not guarantee rejection-free renal transplantation. Some kidney transplants fail despite such matches, suggesting that other antigens might be targets for rejection. Major-histocompatibility-complex...

IMAGES IN CLINICAL MEDICINE: âMaltese Crossesâ in the Nephrotic Syndrome

Martin Sedlacek, M.D. and Anton C. Schoolwerth, M.D. — Thu, 23Â AugÂ 2007 00:00:00 -05:00

A 66-year-old man presented with edema, which had developed over the previous month. The urinary sediment showed fatty casts (Panel A), with typical âMaltese crossesâ under polarized light (Panel B),...

REVIEW ARTICLE: Normotensive Ischemic Acute Renal Failure

J. Gary Abuelo, M.D. — Thu, 23Â AugÂ 2007 00:00:00 -05:00

Acute renal failure is defined as a rapid decrease in the glomerular filtration rate, occurring over a period of minutes to days. Because the rate of production of metabolic waste...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2007 â A 60-Year-Old Man with Fever, Odynophagia, Weight Loss, and Rash

Thu, 16Â AugÂ 2007 00:00:00 -05:00

Dr. Sheila F. Mitsuma (Department of Medicine): A 60-year-old man was admitted to this hospital because of fever, odynophagia, weight loss, and rash.

He had been well until 5 months earlier,...

IMAGES IN CLINICAL MEDICINE: Asymptomatic Bladder Stones

Yahya Daneshbod, M.D. — Thu, 09Â AugÂ 2007 00:00:00 -05:00

A healthy 26-year-old driver had routine laboratory tests performed to renew his driver's license. Hematuria (3+) was incidentally noted. He reported having had no urinary tract symptoms. Abdominal radiography of...

IMAGES IN CLINICAL MEDICINE: Nephrogenic Fibrosing Dermopathy

Vesna D. Garovic, M.D. and Katherine E. Helgen, M.D. — Thu, 12Â JulÂ 2007 00:00:00 -05:00

A 70-year-old man was admitted to the hospital for evaluation of thickening of the skin. Four years earlier, he had undergone kidney transplantation for hypertension-induced end-stage renal disease. Two months...

IMAGES IN CLINICAL MEDICINE: Endogenous Endophthalmitis

Elizabeth H. Burgess, M.D. and Luis Fernando Mora Vieira, M.D. — Thu, 12Â JulÂ 2007 00:00:00 -05:00

A 57-year-old man who had end-stage renal disease was admitted to the hospital because of infection of a left-upper-extremity fistula. Vancomycin was started empirically, and blood cultures grew methicillin-resistant Staphylococcus...

IMAGES IN CLINICAL MEDICINE: Saddle Nose Deformity

Sandeep Chauhan, M.D. and Sanjay D'Cruz, M.D., D.M. — Thu, 28Â JunÂ 2007 00:00:00 -05:00

A 44-year-old man presented with intermittent epistaxis, fever, and polyarthralgias of 2 months' duration. For the previous week, he had had puffiness of the face and reduced urinary output. On...

EDITORIAL: Advances in the Treatment of Amyloidosis

S. Vincent Rajkumar, M.D., and Morie A. Gertz, M.D. — Thu, 07Â JunÂ 2007 00:00:00 -05:00

All forms of amyloidosis are characterized by the deposition of extracellular fibrils in various tissues. These fibrils are the result of the misfolding of a protein from its normal Î±-helical...

ORIGINAL ARTICLE: Natural History and Outcome in Systemic AA Amyloidosis

Thu, 07Â JunÂ 2007 00:00:00 -05:00

Background: Deposition of amyloid fibrils derived from circulating acute-phase reactant serum amyloid A protein (SAA) causes systemic AA amyloidosis, a serious complication of many chronic inflammatory disorders. Little is known...

ORIGINAL ARTICLE: Eprodisate for the Treatment of Renal Disease in AA Amyloidosis

Thu, 07Â JunÂ 2007 00:00:00 -05:00

Background: Amyloid A (AA) amyloidosis is a complication of chronic inflammatory conditions that develops when proteolytic fragments of serum amyloid A protein (SAA) are deposited in tissues as amyloid fibrils....

EDITORIAL: Alternative-Pathway Therapy for Hyperammonemia

Vivian E. Shih, M.D. — Thu, 31Â MayÂ 2007 00:00:00 -05:00

Ammonia is a toxic compound produced in the body from the catabolism of amino acids and protein. Hyperammonemia can damage muscle and brain.1 The body converts ammonia to urea in...

ORIGINAL ARTICLE: Survival after Treatment with Phenylacetate and Benzoate for Urea-Cycle Disorders

Thu, 31Â MayÂ 2007 00:00:00 -05:00

Background: The combination of intravenous sodium phenylacetate and sodium benzoate has been shown to lower plasma ammonium levels and improve survival in small cohorts of patients with historically lethal urea-cycle...

ORIGINAL ARTICLE: Temsirolimus, Interferon Alfa, or Both for Advanced Renal-Cell Carcinoma

Thu, 31Â MayÂ 2007 00:00:00 -05:00

Background: Interferon alfa is widely used for metastatic renal-cell carcinoma but has limited efficacy and tolerability. Temsirolimus, a specific inhibitor of the mammalian target of rapamycin kinase, may benefit patients...

IMAGES IN CLINICAL MEDICINE: The Sign of LeserâTrÃ©lat

Saadettin Kilickap, M.D. and Basak Yalcin, M.D. — Thu, 24Â MayÂ 2007 00:00:00 -05:00

A healthy 65-year-old man presented with a 4-month history of left flank pain and nocturia. Dermatologic examination revealed multiple eruptive seborrheic keratoses, which he reported had developed over the previous...

CLINICAL PRACTICE: The Syndrome of Inappropriate Antidiuresis

David H. Ellison, M.D., and Tomas Berl, M.D. — Thu, 17Â MayÂ 2007 00:00:00 -05:00

A 62-year-old woman noted an unpleasant, sweet taste in her mouth. She otherwise felt well and was taking no medications. Because dysgeusia is a rare manifestation of hyponatremia, her serum...

REVIEW ARTICLE: Sodium and Potassium in the Pathogenesis of Hypertension

Horacio J. AdroguÃ©, M.D., and Nicolaos E. Madias, M.D. — Thu, 10Â MayÂ 2007 00:00:00 -05:00

Hypertension affects approximately 25% of the adult population worldwide, and its prevalence is predicted to increase by 60% by 2025, when a total of 1.56 billion people may be affected.1...

IMAGES IN CLINICAL MEDICINE: Duplication of the Inferior Vena Cava

Junaid Masood, F.R.C.S., M.Sc. and Jayanta M. Barua, M.D., F.R.C.S. — Thu, 03Â MayÂ 2007 00:00:00 -05:00

A 68-year-old man with hypertension presented with vague abdominal pain. Ultrasonography of the abdomen showed a renal mass in the left kidney. A computed tomographic scan of the abdomen showed...

IMAGES IN CLINICAL MEDICINE: Bilateral Superior Vena Cava

Andrew C. Fry, M.R.C.P. and Paul Warwicker, F.R.C.P. — Thu, 03Â MayÂ 2007 00:00:00 -05:00

A 67-year-old man receiving hemodialysis because of kidney failure resulting from renovascular disease was admitted to the hospital for revision of dialysis access. Six months earlier, a dual-chamber, permanent pacemaker...

IMAGES IN CLINICAL MEDICINE: Pulmonary and Peritoneal Ossification

Phillip H. Kuo, M.D., Ph.D. and Myung Soo Shin, M.D., D.Sc. — Thu, 26Â AprÂ 2007 00:00:00 -05:00

A 20-year-old man, who had long-standing end-stage renal disease and was receiving peritoneal dialysis, presented with fever and abdominal pain. The patient began peritoneal dialysis at the age of 4...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 12-2007 â A 56-Year-Old Woman with Renal Failure after HeartâLung Transplantation

Nelson B. Goes, M.D., and Robert B. Colvin, M.D. — Thu, 19Â AprÂ 2007 00:00:00 -05:00

A 56-year-old woman with a history of primary pulmonary hypertension and heart and lung transplantation was admitted to the hospital because of renal failure.

When the patient was approximately 43 years...

IMAGES IN CLINICAL MEDICINE: Bright Green Serum

Helen Bailey, M.D. and Alan H.B. Wu, Ph.D. — Thu, 15Â MarÂ 2007 00:00:00 -05:00

A 49-year-old woman was admitted to the hospital for evaluation of abdominal pain. Her hospital course was complicated by contrast-mediumâinduced renal failure requiring dialysis. She subsequently underwent resection of an...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2007 â A 59-Year-Old Woman with Diabetic Renal Disease and Nonhealing Skin Ulcers

Thu, 08Â MarÂ 2007 00:00:00 -05:00

Dr. Maha R. Farhat (Medicine): A 59-year-old woman was admitted to the hospital because of a nonhealing ulcer on the right heel and painful ulcers on the right thigh and...

IMAGES IN CLINICAL MEDICINE: Floating Kidneys

Patrick O. Myers, M.D. and Gilles Chassot, M.D. — Thu, 08Â MarÂ 2007 00:00:00 -05:00

A 48-year-old man with multiple myeloma and a history of a repaired umbilical hernia and four thromboembolic events was admitted for cramping abdominal pain associated with back pain and a...

IMAGES IN CLINICAL MEDICINE: A Hearty Finding

Marie E. Peddinghaus, M.D. and Nedjema Sustento-Reodica, M.D. — Thu, 15Â FebÂ 2007 00:00:00 -05:00

A 54-year-old man presented to the emergency room with a 1-week history of influenza-like symptoms. He had undergone renal transplantation 12 years earlier for diabetic nephropathy. Laboratory evaluations were notable...

PERSPECTIVE: Concurrent Sentences â Dialysis in the State Penitentiary

Thu, 11Â JanÂ 2007 00:00:00 -05:00

I was driving the last desolate stretch of road to the state penitentiary, headed to visit patients undergoing dialysis. I was well outside my comfort zone of the university transplantation...

PERSPECTIVE: Medicare and Erythropoietin

Thu, 04Â JanÂ 2007 00:00:00 -05:00

Since Medicare coverage of care for end-stage renal disease (ESRD) was implemented in 1973, dialysis treatments paid for by the federal government have extended the lives of hundreds of thousands...

IMAGES IN CLINICAL MEDICINE: Arterial Microaneurysms in Polyarteritis Nodosa

Chandan Jyoti Das, M.D. and Ghan Shyam Pangtey, M.D. — Thu, 14Â DecÂ 2006 00:00:00 -05:00

A 19-year-old man presented with a 10-month history of Raynaud's phenomenon, fever, abdominal pain, and hypertension. On examination, he had multiple subcutaneous nodules on his forehead, and his blood pressure...

CLINICAL PROBLEM-SOLVING: Sum of the Parts

Thu, 07Â DecÂ 2006 00:00:00 -05:00

A 36-year-old Pakistani woman presented to the emergency room with a 10-day history of a nonproductive cough, dyspnea, and fever. She reported having no night sweats and no contact with...

EDITORIAL: Vasopressin Antagonists â Progress and Promise

Thu, 16Â NovÂ 2006 00:00:00 -05:00

Hyponatremia is the most common in-hospital electrolyte disorder that a physician encounters. Its management has been the subject of numerous studies and reviews. In patients with chronic heart failure or...

EDITORIAL: Correction of Anemia â Payoffs and Problems

Giuseppe Remuzzi, M.D., and Julie R. Ingelfinger, M.D. — Thu, 16Â NovÂ 2006 00:00:00 -05:00

Anemia develops in most patients with chronic kidney disease, historically often requiring transfusion, with obvious risks. With the advent of recombinant erythropoietin in the late 1980s, it became possible to...

IMAGES IN CLINICAL MEDICINE: Fibromuscular Dysplasia of the Renal Artery

Christoph Caliezi, M.D. and Peter Reber, M.D. — Thu, 16Â NovÂ 2006 00:00:00 -05:00

During a routine preoperative checkup before a planned hysterectomy, a healthy 31-year-old woman was noted to have an elevated blood pressure of 230/130 mm Hg, mild headache without chest pain,...

ORIGINAL ARTICLE: Tolvaptan, a Selective Oral Vasopressin V-Receptor Antagonist, for Hyponatremia

Thu, 16Â NovÂ 2006 00:00:00 -05:00

Background: Hyponatremia (serum sodium concentration, <135 mmol per liter) is a predictor of death among patients with chronic heart failure and cirrhosis. At present, therapy for acute and chronic hyponatremia...

ORIGINAL ARTICLE: Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease

Thu, 16Â NovÂ 2006 00:00:00 -05:00

Background: Anemia, a common complication of chronic kidney disease, usually develops as a consequence of erythropoietin deficiency. Recombinant human erythropoietin (epoetin alfa) is indicated for the correction of anemia associated...

ORIGINAL ARTICLE: Normalization of Hemoglobin Level in Patients with Chronic Kidney Disease and Anemia

Thu, 16Â NovÂ 2006 00:00:00 -05:00

Background: Whether correction of anemia in patients with stage 3 or 4 chronic kidney disease improves cardiovascular outcomes is not established.

Methods: We randomly assigned 603 patients with an estimated glomerular...

EDITORIAL: Rabbit Antithymocyte Globulin or Basiliximab for Induction Therapy?

Michelle A. Josephson, M.D. — Thu, 09Â NovÂ 2006 00:00:00 -05:00

In this issue of the Journal, Brennan et al.1 compare the safety and efficacy of two induction therapies commonly used in kidney transplantation: rabbit antithymocyte globulin and basiliximab. Induction refers...

ORIGINAL ARTICLE: Rabbit Antithymocyte Globulin versus Basiliximab in Renal Transplantation

Thu, 09Â NovÂ 2006 00:00:00 -05:00

Background: Induction therapy reduces the frequency of acute rejection and delayed graft function after transplantation. A rabbit antithymocyte polyclonal antibody or basiliximab, an interleukin-2 receptor monoclonal antibody, is most commonly...

IMAGES IN CLINICAL MEDICINE: Arteriovenous Fistula on CT Angiography

Marc Laureys, M.D. — Thu, 05Â OctÂ 2006 00:00:00 -05:00

A 62-year-old man with diabetes and end-stage renal disease, for which an arteriovenous fistula had been placed in the left arm 11 months earlier for hemodialysis, presented with a possible...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2006 â A 59-Year-Old Man with Masses in Both Kidneys

Thu, 14Â SepÂ 2006 00:00:00 -05:00

Dr. Donald S. Kaufman (Division of Medical Oncology): A 59-year-old man was admitted to this hospital for evaluation of bilateral renal masses. Approximately 6 months before this admission, abdominal ultrasonography...

IMAGES IN CLINICAL MEDICINE: Radiographic Appearance of Lanthanum

Simon Cerny, M.D. and Ulrich Kunzendorf, M.D. — Thu, 14Â SepÂ 2006 00:00:00 -05:00

An 82-year-old man with hypertension, coronary artery disease, congestive heart failure, chronic constipation, degenerative joint disease of the hips, and a 5-year history of hemodialysis for end-stage renal disease presented...

REVIEW ARTICLE: Intensive Care of Patients with HIV Infection

Thu, 13Â JulÂ 2006 00:00:00 -05:00

Antiretroviral therapy has increased the life expectancy of patients who are infected with the human immunodeficiency virus (HIV) and has reduced the incidence of illnesses associated with the acquired immunodeficiency...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 20-2006 â An 84-Year-Old Man with Staphylococcal Bacteremia and Renal Failure

Thu, 29Â JunÂ 2006 00:00:00 -05:00

Dr. Alec D. Weisberg (Medicine): An 84-year-old man was transferred to this hospital because of staphylococcal bacteremia and renal failure. Two weeks before admission, fever, chills, nausea, vomiting, shortness of...

ORIGINAL ARTICLE: -Acetylcysteine and Contrast-Induced Nephropathy in Primary Angioplasty

Thu, 29Â JunÂ 2006 00:00:00 -05:00

Background: Patients with acute myocardial infarction undergoing primary angioplasty are at high risk for contrast-mediumâinduced nephropathy because of hemodynamic instability, the need for a high volume of contrast medium, and...

REVIEW ARTICLE: Assessing Kidney Function â Measured and Estimated Glomerular Filtration Rate

Thu, 08Â JunÂ 2006 00:00:00 -05:00

Many organizations recommend the use of equations that estimate the glomerular filtration rate (GFR) to facilitate the detection, evaluation, and management of chronic kidney disease.1234567891011 Indeed, many clinical laboratories already...

EDITORIAL: Imaging Progression in Polycystic Kidney Disease

Ronald Perrone, M.D. — Thu, 18Â MayÂ 2006 00:00:00 -05:00

Autosomal dominant polycystic kidney disease (ADPKD), a condition characterized by massively enlarged kidneys containing fluid-filled cysts, profoundly affects those who inherit one of the known genes that cause the disease....

ORIGINAL ARTICLE: Volume Progression in Polycystic Kidney Disease

Thu, 18Â MayÂ 2006 00:00:00 -05:00

Background: Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive enlargement of cyst-filled kidneys.

Methods: In a three-year study, we measured the rates of change in total kidney volume, total...

EDITORIAL: Influence of Graft Characteristics on the Outcome of Kidney Transplantation

Jean-Paul Soulillou, M.D., and Magali Giral, M.D. — Thu, 11Â MayÂ 2006 00:00:00 -05:00

The characteristics of renal allografts before transplantation present a multifaceted puzzle that in large part predetermines the outcome of kidney transplantation. Compatibility at the major-histocompatibility-complex (MHC) loci, the age of...

ORIGINAL ARTICLE: Influence of Donor C3 Allotype on Late Renal-Transplantation Outcome

Thu, 11Â MayÂ 2006 00:00:00 -05:00

Background: The complement system has a critical role in both the innate and the adaptive immune responses. In humans, C3 exists as two main allotypes, F (fast) and S (slow),...

CLINICAL PRACTICE: Thrombotic Thrombocytopenic Purpura

James N. George, M.D. — Thu, 04Â MayÂ 2006 00:00:00 -05:00

A 40-year-old obese black woman has had weakness and epigastric pain for several weeks and diarrhea and vomiting for four days. She does not appear acutely ill; physical examination is...

ORIGINAL ARTICLE: Feasibility of Treating Prehypertension with an Angiotensin-Receptor Blocker

Thu, 20Â AprÂ 2006 00:00:00 -05:00

Background: Prehypertension is considered a precursor of stage 1 hypertension and a predictor of excessive cardiovascular risk. We investigated whether pharmacologic treatment of prehypertension prevents or postpones stage 1 hypertension.

Methods:...

IMAGES IN CLINICAL MEDICINE: Pseudoclubbing

Afshin Farzaneh-Far, M.D., Ph.D. — Thu, 13Â AprÂ 2006 00:00:00 -05:00

A 36-year-old man was referred for further evaluation after having changes in his fingers that were initially thought to be due to clubbing (Panels A and B). He had a...

IMAGES IN CLINICAL MEDICINE: Bilateral Renal-Vein Thrombosis Associated with the Nephrotic Syndrome

Surat Phonsombat, M.D. and Marshall L. Stoller, M.D. — Thu, 30Â MarÂ 2006 00:00:00 -05:00

A 61-year-old woman whose medical history was notable for hypertension and type 2 diabetes reported a two-day history of increasing dull pain in the right flank and nonbloody, bilious vomiting....

REVIEW ARTICLE: Hereditary Proteinuria Syndromes and Mechanisms of Proteinuria

Thu, 30Â MarÂ 2006 00:00:00 -05:00

The inherited forms of proteinuria comprise a heterogeneous group of rare renal diseases in which glomerular dysfunction and proteinuria are prominent. Despite the rarity of hereditary proteinuria syndromes, genetic, biochemical,...

ORIGINAL ARTICLE: Prevalence of Monoclonal Gammopathy of Undetermined Significance

Thu, 30Â MarÂ 2006 00:00:00 -05:00

Background: The prevalence of monoclonal gammopathy of undetermined significance (MGUS), a premalignant plasma-cell disorder, among persons 50 years of age or older has not been accurately determined. We used sensitive...

PERSPECTIVE: Chronic Kidney Disease in the Developing World

Thu, 09Â MarÂ 2006 00:00:00 -05:00

The attention being paid globally to chronic kidney disease is attributable to five factors: the rapid increase in its prevalence, the enormous cost of treatment, recent data indicating that overt...

PERSPECTIVE: The Growing Burden of Chronic Kidney Disease in Pakistan

Thu, 09Â MarÂ 2006 00:00:00 -05:00

A Pakistani tailor, the sole breadwinner for a family of eight, had received diagnoses of type 2 diabetes and hypertension at 31 years of age. For the next 15 years,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2006 â A 47-Year-Old Man with Altered Mental Status and Acute Renal Failure

J. Kimo Takayesu, M.D., M.Sc., Hasan Bazari, M.D., and Michael Linshaw, M.D. — Thu, 09Â MarÂ 2006 00:00:00 -05:00

A 47-year-old man was transferred to the emergency department of this hospital at 10 a.m. on a day in early June because of altered mental status and acute renal failure....

REVIEW ARTICLE: Management of Crush-Related Injuries after Disasters

Thu, 09Â MarÂ 2006 00:00:00 -05:00

Disasters can rarely be anticipated, much less prevented. After both natural disasters (e.g., earthquakes, hurricanes, tornadoes, and landslides) and man-made catastrophes (e.g., wars, mining accidents, and terrorist attacks), injuries to...

IMAGES IN CLINICAL MEDICINE: A Medical Mystery â Concentric Calcification

Dong Hoon Daniel Kim, M.D. and Victor L. Yu, M.D. — Thu, 02Â FebÂ 2006 00:00:00 -05:00

An elderly man reported having recurrent hematuria over a period of two years. He had undergone transurethral resection of the prostate because of benign prostatic hypertrophy two years earlier. He...

EDITORIAL: Maximizing the Success of Transplantation with Kidneys from Older Donors

Francis L. Delmonico and James F. Burdick — Thu, 26Â JanÂ 2006 00:00:00 -05:00

In this issue of the Journal, Remuzzi et al.1 report on the important challenge of maximizing success when transplanting kidneys from older donors while minimizing poor outcomes due to the...

CLINICAL PRACTICE: Preventing Nephropathy Induced by Contrast Medium

Brendan J. Barrett, M.B., and Patrick S. Parfrey, M.D. — Thu, 26Â JanÂ 2006 00:00:00 -05:00

A 71-year-old man with type 2 diabetes and hypertension is referred for coronary angiography. His medications include metformin and a thiazide. Before the angiogram, his serum creatinine level is 1.8...

ORIGINAL ARTICLE: Long-Term Outcome of Renal Transplantation from Older Donors

Thu, 26Â JanÂ 2006 00:00:00 -05:00

Background: Long-term survival of kidney grafts from older donors is inferior to that of grafts from younger donors. We sought to determine whether selecting older kidneys according to their histologic...

EDITORIAL: Optimizing ACE-Inhibitor Therapy for Chronic Kidney Disease

Lee A. Hebert, M.D. — Thu, 12Â JanÂ 2006 00:00:00 -05:00

In this issue of the Journal, Hou and colleagues1 present data indicating that the use of benazepril, an angiotensin-convertingâenzyme (ACE) inhibitor, is feasible and beneficial in patients with advanced chronic...

ORIGINAL ARTICLE: Efficacy and Safety of Benazepril for Advanced Chronic Renal Insufficiency

Thu, 12Â JanÂ 2006 00:00:00 -05:00

Background: Angiotensin-convertingâenzyme inhibitors provide renal protection in patients with mild-to-moderate renal insufficiency (serum creatinine level, 3.0 mg per deciliter or less). We assessed the efficacy and safety of benazepril in...

CLINICAL PROBLEM-SOLVING: Needle in a Haystack

Krishna R. Polu, M.D., and Myles Wolf, M.D., M.M.Sc. — Thu, 05Â JanÂ 2006 00:00:00 -05:00

A 63-year-old man presented to the emergency department because of shortness of breath that had begun the evening before, after he had gone to bed, and worsened progressively during the...

IMAGES IN CLINICAL MEDICINE: Urinary Calcium Oxalate Crystals in Ethylene Glycol Intoxication

Jose Morfin, M.D. and Andrew Chin, M.D. — Thu, 15Â DecÂ 2005 00:00:00 -05:00

A 73-year-old man presented with a self-inflicted stab wound to the abdomen. A plasma ethanol level of 27 mg per deciliter was found on preliminary toxicologic screening; the results of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 38-2005 â A 29-Year-Old Pregnant Woman with the Nephrotic Syndrome and Hypertension

Thu, 15Â DecÂ 2005 00:00:00 -05:00

A 29-year-old pregnant woman with systemic lupus erythematosus was admitted to the hospital because of renal failure at 20 weeks 6 days of gestation.

The patient, a native of Panama, had...

IMAGES IN CLINICAL MEDICINE: Deforming Gout

Gonzalo Pacheco, M.D. and Javier A. Cavallasca, M.D. — Thu, 08Â DecÂ 2005 00:00:00 -05:00

An 80-year-old man with a 30-year history of gout was referred to the rheumatology clinic for further treatment. He had received colchicine and urate-lowering drugs intermittently over the previous several...

EDITORIAL: Febuxostat â Treatment for Hyperuricemia and Gout?

Larry W. Moreland, M.D. — Thu, 08Â DecÂ 2005 00:00:00 -05:00

Gout is a relatively common cause of legendary, severe pain as well as tophi, joint deformities, and nephropathy. Unlike most noninfectious diseases, frequently a pharmacologic âcureâ for gout is attained....

REVIEW ARTICLE: Renal-Cell Carcinoma

Herbert T. Cohen, M.D., and Francis J. McGovern, M.D. — Thu, 08Â DecÂ 2005 00:00:00 -05:00

In the United States, renal cancer is the 7th leading malignant condition among men and the 12th among women, accounting for 2.6 percent of all cancers.1 05120829.xml About 2 percent...

ORIGINAL ARTICLE: Febuxostat Compared with Allopurinol in Patients with Hyperuricemia and Gout

Thu, 08Â DecÂ 2005 00:00:00 -05:00

Background: Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase, is a potential alternative to allopurinol for patients with hyperuricemia and gout.

Methods: We randomly assigned 762 patients with gout and...

EDITORIAL: Rejection â More Than the Eye Can See

Terry B. Strom, M.D. — Thu, 01Â DecÂ 2005 00:00:00 -05:00

In comparing current clinical outcomes in renal transplantation with those of 30 years ago,1 graft failure from immunologic factors and death from opportunistic infection in the first year after transplantation...

ORIGINAL ARTICLE: Messenger RNA for in the Urine of Renal-Allograft Recipients

Thu, 01Â DecÂ 2005 00:00:00 -05:00

Background: The outcome of renal transplantation after an episode of acute rejection is difficult to predict, even with an allograft biopsy.

Methods: We studied urine specimens from 36 subjects with acute...

EDITORIAL: Mycophenolate Mofetil for Lupus Nephritis

W. Joseph McCune, M.D. — Thu, 24Â NovÂ 2005 00:00:00 -05:00

Systemic lupus erythematosus is a chronic, life-threatening disease that predominantly affects women of childbearing age. Its pathogenesis includes autoantibody-mediated organ damage and antiphospholipid-antibodyâmediated hypercoagulability. Among patients who have lupus the...

ORIGINAL ARTICLE: Mycophenolate Mofetil or Intravenous Cyclophosphamide for Lupus Nephritis

Thu, 24Â NovÂ 2005 00:00:00 -05:00

Background: Since anecdotal series and small, prospective, controlled trials suggest that mycophenolate mofetil may be effective for treating lupus nephritis, larger trials are desirable.

Methods: We conducted a 24-week randomized, open-label,...

IMAGES IN CLINICAL MEDICINE: Renal Colic

Gauthier Raynal, M.D. and Kamal Achkar, M.D. — Thu, 10Â NovÂ 2005 00:00:00 -05:00

A 57-year-old man was referred to our hospital because of an acute onset of right flank pain. An intravenous urogram showed normal excretion from the left kidney, a calculus in...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2005 â A 60-Year-Old Man with Skin Lesions and Renal Insufficiency

Jonathan Kay, M.D., and Robert T. McCluskey, M.D. — Thu, 13Â OctÂ 2005 00:00:00 -05:00

A 60-year-old man was evaluated in the rheumatology clinic because of a rash and worsening renal function.

He had been well until three months earlier, when he began to have fatigue...

PERSPECTIVE: Lethal Levels

Andrew J. Cohen, M.D., Ochsner Clinic Foundation, New Orleans — Thu, 13Â OctÂ 2005 00:00:00 -05:00

On Tuesday, August 31, in the wake of Hurricane Katrina, Sylvester Donaldson (not his real name) landed at the emergency room of the Ochsner Clinic Foundation in New Orleans, desperately...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 28-2005 â A 42-Year-Old Man with Weight Loss, Weakness, and a Rash

Myles Wolf, M.D., M.M.Sc., Henry Rose, M.D., and R. Neal Smith, M.D. — Thu, 15Â SepÂ 2005 00:00:00 -05:00

A 42-year-old man was admitted to another hospital because of weight loss, hematuria, hemoptysis, weakness, and a rash.

He had been well until three years earlier, when his family had moved...

ORIGINAL ARTICLE: Costimulation Blockade with Belatacept in Renal Transplantation

Thu, 25Â AugÂ 2005 00:00:00 -05:00

Background: Renal transplantation is the standard of care for patients with end-stage renal disease. Although maintenance immunosuppression with calcineurin inhibitors yields excellent one-year survival, it is associated over the long...

CLINICAL PROBLEM-SOLVING: A Fractured Diagnosis

Thu, 04Â AugÂ 2005 00:00:00 -05:00

A 44-year-old woman came to the emergency department because of pain in her right thigh shortly after she had a minor fall. A right femoral-neck fracture was diagnosed, and she...

PERSPECTIVE: Risks and Benefits to the Living Donor

Julie R. Ingelfinger, M.D. — Thu, 04Â AugÂ 2005 00:00:00 -05:00

In the five decades since the first renal transplantation from a living donor took place, in 1954, donating a kidney has become common; according to the Organ Procurement and Transplantation...

ORIGINAL ARTICLE: Atorvastatin in Patients with Type 2 Diabetes Mellitus Undergoing Hemodialysis

Thu, 21Â JulÂ 2005 00:00:00 -05:00

Background: Statins reduce the incidence of cardiovascular events in persons with type 2 diabetes mellitus. However, the benefit of statins in such patients receiving hemodialysis, who are at high risk...

IMAGES IN CLINICAL MEDICINE: Calcific Arteriopathy

France Joyal, M.D. and Pascal Margaroli, M.D. — Thu, 30Â JunÂ 2005 00:00:00 -05:00

A 38-year-old man who had undergone renal and pancreatic transplantation five years earlier was referred because of acral gangrene of both hands. The patient also had type 1 diabetes and...

IMAGES IN CLINICAL MEDICINE: Mixed Cryoglobulinemia

Gary Josephsen, M.D. — Thu, 23Â JunÂ 2005 00:00:00 -05:00

A 38-year-old woman presented with increasing abdominal fullness and a new rash on the lower extremities. She had a history of chronic hepatitis C infection, for which she had been...

EDITORIAL: Chronic Kidney Disease in the Elderly â How to Assess Risk

Lesley A. Stevens, M.D., and Andrew S. Levey, M.D. — Thu, 19Â MayÂ 2005 00:00:00 -05:00

Chronic kidney disease is an important problem in the elderly and is associated with a high risk of kidney failure, cardiovascular disease, and death.12 The disorder is indicated either by...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2005 â An 80-Year-Old Man with Shortness of Breath, Edema, and Proteinuria

Thu, 19Â MayÂ 2005 00:00:00 -05:00

An 80-year-old man was admitted to the hospital because of shortness of breath, pleural effusions, and edema of the legs.

Atrial fibrillation had developed seven years earlier, with bradycardia and syncope,...

ORIGINAL ARTICLE: Cystatin C and the Risk of Death and Cardiovascular Events among Elderly Persons

Thu, 19Â MayÂ 2005 00:00:00 -05:00

Background: 05051931.xml 05051931.xml Cystatin C is a serum measure of renal function that appears to be independent of age, sex, and lean muscle mass. We compared creatinine and cystatin C...

IMAGES IN CLINICAL MEDICINE: Improvement in Hypertensive Retinopathy after Treatment of Hypertension

Mark W.J. Strachan, M.D. and John A. McKnight, M.D. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

A 34-year-old woman presented with a short history of headache and blurred vision. Her corrected visual acuity was 20/30 and N24 in the left eye and 20/20 and N5 in...

CLINICAL PROBLEM-SOLVING: Clear as Mud

Daniel R. Kaul, M.D., Scott A. Flanders, M.D., and Sanjay Saint, M.D., M.P.H. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

A 17-year-old boy presented to his primary care physician, reporting four days of low back pain, a temperature as high as 40Â°C, headache, diffuse myalgias, and vomiting. The patient had...

ORIGINAL ARTICLE: Nephrogenic Syndrome of Inappropriate Antidiuresis

Thu, 05Â MayÂ 2005 00:00:00 -05:00

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common cause of hyponatremia. We describe two infants whose clinical and laboratory evaluations were consistent with the presence of SIADH,...

PERSPECTIVE: Hyperactive Vasopressin Receptors and Disturbed Water Homeostasis

Nine V.A.M. Knoers, M.D., Ph.D. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

Regulation of water homeostasis is of vital importance for all terrestrial organisms. In most mammals, including humans, the maintenance of water balance is critically dependent on water intake, the sensation...

ORIGINAL ARTICLE: Hyponatremia among Runners in the Boston Marathon

Thu, 14Â AprÂ 2005 00:00:00 -05:00

Background: Hyponatremia has emerged as an important cause of race-related death and life-threatening illness among marathon runners. We studied a cohort of marathon runners to estimate the incidence of hyponatremia...

PERSPECTIVE: Marathon Maladies

Benjamin D. Levine, M.D., and Paul D. Thompson, M.D. — Thu, 14Â AprÂ 2005 00:00:00 -05:00

Patriots' Day, a Massachusetts holiday commemorating the Revolutionary War Battles of Lexington and Concord, is also the date of the annual Boston Marathon, a 42-km footrace. It was first run...

IMAGES IN CLINICAL MEDICINE: Uremic Frost

Stephen R. Walsh, M.D.C.M. and Nereida A. Parada, M.D. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

A 57-year-old woman with hypertension and chronic renal insufficiency who had refused dialysis for two years was found in respiratory distress after one week of upper respiratory symptoms due to...

EDITORIAL: Immunosuppressive Drugs and the Risk of Cancer after Organ Transplantation

Jacques Dantal, M.D., Ph.D., and Jean-Paul Soulillou, M.D. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

Improvements in immunosuppressive therapy during the past decade have brought us closer to the day when long-term acceptance of organ allografts will be routine. These achievements, however, have run up...

ORIGINAL ARTICLE: Sirolimus for Kaposi's Sarcoma in Renal-Transplant Recipients

Thu, 31Â MarÂ 2005 00:00:00 -05:00

Background: Recipients of organ transplants are susceptible to Kaposi's sarcoma as a result of treatment with immunosuppressive drugs. Sirolimus (rapamycin), an immunosuppressive drug, may also have antitumor effects.

Methods: We stopped...

IMAGES IN CLINICAL MEDICINE: Renal Papillary Necrosis Unmasking Sickle Cell Disease

Michalis Voulgarelis, M.D., Ph.D. and Panayiotis D. Ziakas, M.D., Ph.D. — Thu, 24Â MarÂ 2005 00:00:00 -05:00

A 26-year-old healthy Greek woman was evaluated because of new-onset painless hematuria. The physical examination was unremarkable. Laboratory data were notable for a hemoglobin concentration of 7.6 g per deciliter...

EDITORIAL: Agonistic Autoantibodies and Rejection of Renal Allografts

Julie R. Ingelfinger, M.D. — Thu, 10Â FebÂ 2005 00:00:00 -05:00

Allograft rejection remains a major problem in renal transplantation, despite the substantial improvements in post-transplantation management that now result in fewer acute rejection episodes and better overall survival.1 Rejection can...

ORIGINAL ARTICLE: Angiotensin II Type 1âReceptor Activating Antibodies in Renal-Allograft Rejection

Thu, 10Â FebÂ 2005 00:00:00 -05:00

Background: Antibodies against HLA antigens cause refractory allograft rejection with vasculopathy in some, but not all, patients.

Methods: We studied 33 kidney-transplant recipients who had refractory vascular rejection. Thirteen had donor-specific...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 40-2004 â A 42-Year-Old Woman with Long-Standing Hematuria

David J.R. Steele, M.D., and Paul J. Michaels, M.D. — Thu, 30Â DecÂ 2004 00:00:00 -05:00

A 42-year-old woman visited the nephrology clinic for an evaluation of chronic microscopic hematuria.

Microscopic hematuria had been detected 14 years earlier during an episode of cystitis. She subsequently had several...

REVIEW ARTICLE: Immunosuppressive Drugs for Kidney Transplantation

Philip F. Halloran, M.D., Ph.D. — Thu, 23Â DecÂ 2004 00:00:00 -05:00

The central issue in organ transplantation remains suppression of allograft rejection. Thus, development of immunosuppressive drugs is the key to successful allograft function. Immunosuppressive agents are used for induction (intense...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2004 â A 68-Year-Old Man with End-Stage Renal Disease and Thickening of the Skin

Thu, 18Â NovÂ 2004 00:00:00 -05:00

Dr. Amin Fazeli (Dermatology): A 68-year-old man was evaluated in this hospital by a dermatologist because of progressive thickening of the skin of the arms and legs.

The patient had had...

IMAGES IN CLINICAL MEDICINE: Staghorn Renal-Cell Carcinoma

Lorenzo G. Luciani, M.D. and Lucio Luciani, M.D. — Thu, 11Â NovÂ 2004 00:00:00 -05:00

A 72-year-old woman with a history of hematuria presented with a three-month history of weight loss and anorexia. Computed tomography (Panel A) and ultrasonography showed a solid mass infiltrating the...

ORIGINAL ARTICLE: Angiotensin-Receptor Blockade versus ConvertingâEnzyme Inhibition in Type 2 Diabetes and Nephropathy

Thu, 04Â NovÂ 2004 00:00:00 -05:00

Background: Few studies have directly compared the renoprotective effects of angiotensin IIâreceptor blockers and angiotensin-convertingâenzyme (ACE) inhibitors in persons with type 2 diabetes.

Methods: In this prospective, multicenter, double-blind, five-year study,...

ORIGINAL ARTICLE: Preventing Microalbuminuria in Type 2 Diabetes

Thu, 04Â NovÂ 2004 00:00:00 -05:00

Background: The multicenter double-blind, randomized Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) was designed to assess whether angiotensin-convertingâenzyme inhibitors and non-dihydropyridine calcium-channel blockers, alone or in combination, prevent microalbuminuria in subjects...

PERSPECTIVE: Treating Diabetic Nephropathy â Are There Only Economic Issues?

William E. Mitch, M.D. — Thu, 04Â NovÂ 2004 00:00:00 -05:00

Economic issues sometimes seem to be the primary considerations in discussions of treatment for nephropathy in patients with type 2 diabetes. But in the end, the economics of treatment are...

EDITORIAL: Election 2004

Thu, 23Â SepÂ 2004 00:00:00 -05:00

No event provides stronger evidence of democracy at work than a national election campaign in which the incumbent must defend his or her past record and future plans. The open...

ORIGINAL ARTICLE: Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and Hospitalization

Thu, 23Â SepÂ 2004 00:00:00 -05:00

Background: End-stage renal disease substantially increases the risks of death, cardiovascular disease, and use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are...

ORIGINAL ARTICLE: Relation between Renal Dysfunction and Cardiovascular Outcomes after Myocardial Infarction

Thu, 23Â SepÂ 2004 00:00:00 -05:00

Background: The presence of coexisting conditions has a substantial effect on the outcome of acute myocardial infarction. Renal failure is associated with one of the highest risks, but the influence...

IMAGES IN CLINICAL MEDICINE: Bilateral Renal Arteriovenous Malformation

Enrico Minetti, M.D. and Alberto Montoli, M.D. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

A 43-year-old woman presented with dyspnea on moderate exertion and bilateral flank bruits. The patient had no history of trauma. Echocardiography revealed left ventricular hypertrophy and an enlarged inferior vena...

EDITORIAL: Bare-Bones Fact â Children Are Not Small Adults

Laura K. Bachrach, M.D. — Thu, 26Â AugÂ 2004 00:00:00 -05:00

Diagnostic and therapeutic guidelines used for children are commonly extrapolated from studies conducted in adults. There are potential dangers in assuming that children will have the same response to disease...

ORIGINAL ARTICLE: Long-Term, High-Dose Glucocorticoids and Bone Mineral Content in Childhood Glucocorticoid-Sensitive Nephrotic Syndrome

Thu, 26Â AugÂ 2004 00:00:00 -05:00

Background: Glucocorticoids suppress bone formation, impair growth, and induce obesity. We determined the effects of long-term treatment with glucocorticoids on bone mineral content in children with glucocorticoid-sensitive nephrotic syndrome, a...

REVIEW ARTICLE: Managing Hyperkalemia Caused by Inhibitors of the ReninâAngiotensinâAldosterone System

Biff F. Palmer, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

Angiotensin-convertingâenzyme (ACE) inhibitors and angiotensin-receptor blockers are used commonly in clinical practice to treat hypertension and decrease cardiovascular events in high-risk patients. A side effect of such therapy is the...

ORIGINAL ARTICLE: Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study

Thu, 05Â AugÂ 2004 00:00:00 -05:00

Background: The Randomized Aldactone Evaluation Study (RALES) demonstrated that spironolactone significantly improves outcomes in patients with severe heart failure. Use of angiotensin-convertingâenzyme (ACE) inhibitors is also indicated in these patients....

PERSPECTIVE: Treatment of Heart Failure with Spironolactone â Trial and Tribulations

John J.V. McMurray, M.D., and Eileen O'Meara, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

The application of evidence based on the results of clinical trials is a key aim of modern medical practice. Viewed from that perspective, the findings of Juurlink and colleagues in...

REVIEW ARTICLE: Acute Renal Failure and Sepsis

Robert W. Schrier, M.D., and Wei Wang, M.D. — Thu, 08Â JulÂ 2004 00:00:00 -05:00

Acute renal failure occurs in approximately 19 percent of patients with moderate sepsis, 23 percent with severe sepsis, and 51 percent with septic shock when blood cultures are positive (Table...

ORIGINAL ARTICLE: Long-Term Survival of Children with End-Stage Renal Disease

Thu, 24Â JunÂ 2004 00:00:00 -05:00

Background: Although renal-replacement therapy for children with end-stage renal disease has been used for several decades, data on patients' long-term survival are sparse.

Methods: We examined the long-term survival of all...

PERSPECTIVE: Pediatric Renal-Replacement Therapy â Coming of Age

Dawn S. Milliner, M.D. — Thu, 24Â JunÂ 2004 00:00:00 -05:00

Before the middle of the 20th century, the prospect that a child with end-stage renal disease (ESRD) would reach adulthood was essentially nil. Once dialysis and transplantation became available, that...

CLINICAL PROBLEM-SOLVING: Index of Suspicion

Uptal D. Patel, M.D., Harry Hollander, M.D., and Sanjay Saint, M.D., M.P.H. — Thu, 06Â MayÂ 2004 00:00:00 -05:00

A 26-year-old woman with end-stage renal disease from primary membranoproliferative glomerulonephritis presented with a two-week history of intermittent fever, with temperatures as high as 39Â°C. She had received her second...

REVIEW ARTICLE: Fibromuscular Dysplasia

David P. Slovut, M.D., Ph.D., and Jeffrey W. Olin, D.O. — Thu, 29Â AprÂ 2004 00:00:00 -05:00

Fibromuscular dysplasia is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects the renal and internal carotid arteries but has been described in almost every arterial bed in the body...

PERSPECTIVE: Exchanging Kidneys â Advances in Living-Donor Transplantation

Francis L. Delmonico, M.D. — Thu, 29Â AprÂ 2004 00:00:00 -05:00

This year marks the 50th anniversary of the first successful kidney transplantation from a living donor to his identical twin. Over the ensuing five decades, kidney transplantation has progressed from...

EDITORIAL: Fooling the Parathyroid Gland â Will There Be Health Benefits?

Gary Curhan, M.D., Sc.D. — Thu, 08Â AprÂ 2004 00:00:00 -05:00

In people with a reduced glomerular filtration rate, the serum parathyroid hormone level is often secondarily elevated as a result of reduced serum levels of calcium and 1,25-dihydroxyvitamin D3 and...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2004 â A Boy with Rash, Edema, and Hypertension

Michael J. Somers, M.D., Ghaleb H. Daouk, M.D., and Robert T. McCluskey, M.D. — Thu, 08Â AprÂ 2004 00:00:00 -05:00

A 12-year-old boy was admitted to the hospital because of hypertension and edema, and because the results of urinalysis were abnormal.

Fourteen days before admission, cough and nasal congestion, followed by...

ORIGINAL ARTICLE: Cinacalcet for Secondary Hyperparathyroidism in Patients Receiving Hemodialysis

Thu, 08Â AprÂ 2004 00:00:00 -05:00

Background: Treatment of secondary hyperparathyroidism with vitamin D and calcium in patients receiving dialysis is often complicated by hypercalcemia and hyperphosphatemia, which may contribute to cardiovascular disease and adverse clinical...

ORIGINAL ARTICLE: Salt Wasting and Deafness Resulting from Mutations in Two Chloride Channels

Thu, 25Â MarÂ 2004 00:00:00 -05:00

Inherited kidney disorders associated with salt wasting, hypokalemia, and metabolic alkalosis (Bartter's syndrome) are clinically classified into several variants1: classic Bartter's syndrome,2 Gitelman's variant of Bartter's syndrome,3 and antenatal Bartter's...

PERSPECTIVE: Reabsorption of Sodium Chloride â Lessons from the Chloride Channels

Daniel G. Bichet, M.D., and T. Mary Fujiwara, M.Sc. — Thu, 25Â MarÂ 2004 00:00:00 -05:00

Under normal conditions, most of the sodium chloride filtered by the kidney (often more than 99 percent) is reabsorbed, and one can think of the tubular functions that permit this...

ORIGINAL ARTICLE: Sequential Therapies for Proliferative Lupus Nephritis

Thu, 04Â MarÂ 2004 00:00:00 -05:00

Background: Long-term therapy with cyclophosphamide enhances renal survival in patients with proliferative lupus nephritis; however, the beneficial effect of cyclophosphamide must be weighed against its considerable toxic effects.

Methods: Fifty-nine patients...

EDITORIAL: Maintenance Therapy for Lupus Nephritis â Something Old, Something New

James E. Balow, M.D., and Howard A. Austin III, M.D. — Thu, 04Â MarÂ 2004 00:00:00 -05:00

From a historical perspective, there are few diseases for which the cause, natural history, and response to treatment have been as complex or difficult to define as those of systemic...

CLINICAL PRACTICE: Acute Renal Colic from Ureteral Calculus

Joel M.H. Teichman, M.D. — Thu, 12Â FebÂ 2004 00:00:00 -05:00

A 39-year-old man reports an eight-hour history of colicky pain in the right lower quadrant radiating to the tip of his penis. He had previously had a kidney stone, which...

ORIGINAL ARTICLE: Effect of Changing the Priority for HLA Matching on the Rates and Outcomes of Kidney Transplantation in Minority Groups

Thu, 05Â FebÂ 2004 00:00:00 -05:00

Background: HLA typing and the time a patient has spent on the waiting list are the primary criteria used to allocate cadaveric kidneys for transplantation in the United States. Candidates...

PERSPECTIVE: Weighing Optimal Graft Survival through HLA Matching against the Equitable Distribution of Kidney Allografts

Jon J. van Rood, M.D., Ph.D. — Thu, 05Â FebÂ 2004 00:00:00 -05:00

At almost exactly the same time that Dr. David Willard, whose letter to the editor appears in this issue of the Journal (page 624), received three skin grafts in order...

REVIEW ARTICLE: Polycystic Kidney Disease

Patricia D. Wilson, Ph.D. — Thu, 08Â JanÂ 2004 00:00:00 -05:00

Polycystic kidney diseases are a leading cause of end-stage renal failure and a common indication for dialysis or renal transplantation. Recent advances have led to insights into mechanisms underlying the...

ORIGINAL ARTICLE: The Long-Term Effect of Doxazosin, Finasteride, and Combination Therapy on the Clinical Progression of Benign Prostatic Hyperplasia

Thu, 18Â DecÂ 2003 00:00:00 -05:00

Background: Benign prostatic hyperplasia is commonly treated with alpha-adrenergicâreceptor antagonists (alpha-blockers) or 5Î±-reductase inhibitors. The long-term effect of these drugs, singly or combined, on the risk of clinical progression is...

ORIGINAL ARTICLE: The Natural History of Chronic Allograft Nephropathy

Thu, 11Â DecÂ 2003 00:00:00 -05:00

Background: With improved immunosuppression and early allograft survival, chronic allograft nephropathy has become the dominant cause of kidney-transplant failure.

Methods: We evaluated the natural history of chronic allograft nephropathy in a...

PERSPECTIVE: Chronic Allograft Nephropathy

Robert B. Colvin, M.D. — Thu, 11Â DecÂ 2003 00:00:00 -05:00

Long-term survival of kidney transplants (renal allografts) has changed little during the past decade, despite dramatic improvements in short-term survival. Most late renal allograft loss, other than that associated with...

IMAGES IN CLINICAL MEDICINE: Choroidal Metastasis from Renal-Cell Carcinoma

Sathish Srinivasan, F.R.C.S.Ed., M.R.C.Ophth. and David G. Gray, M.R.C.P. — Thu, 04Â DecÂ 2003 00:00:00 -05:00

A 38-year-old man presented to the ophthalmology department with a four-week history of defective central vision in his right eye. Examination of the fundus of the right eye showed two...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Forestalling Fibrosis

Julie R. Ingelfinger, M.D. — Thu, 04Â DecÂ 2003 00:00:00 -05:00

The concept that certain medications may protect the injured kidney from the progressive fibrosis that leads to end-stage renal disease has gained support since initial reports that interfering with angiotensin...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2003 â A 79-Year-Old Man with Coronary Artery Disease, Peripheral Vascular Disease, End-Stage Renal Disease, and Abdominal Pain and Distention

Peter B. Kelsey, M.D., Steven Chen, M.D., and Gregory Y. Lauwers, M.D. — Thu, 27Â NovÂ 2003 00:00:00 -05:00

A 79-year-old man was admitted to the hospital because of occlusion at a vascular access site in the right forearm for hemodialysis and worsening intermittent claudication.

There was a history of...

IMAGES IN CLINICAL MEDICINE: Fabry's Disease

Jeffrey B. Kopp, M.D. and Raphael Schiffmann, M.D. — Thu, 20Â NovÂ 2003 00:00:00 -05:00

A 30-year-old man had severe neuropathic pain that affected his hands and feet. Examination of his skin showed angiokeratomas that were particularly prominent in the groin and on the back...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 36-2003 â A 68-Year-Old Woman with Impaired Renal Function

Ajay K. Singh, M.B., B.S., M.R.C.P., and Robert B. Colvin, M.D. — Thu, 20Â NovÂ 2003 00:00:00 -05:00

A 68-year-old woman was admitted to the hospital because of impaired renal function. One month earlier, she had had difficulty breathing and had felt as though she had a fever;...

ORIGINAL ARTICLE: The Prevention of Radiocontrast-AgentâInduced Nephropathy by Hemofiltration

Thu, 02Â OctÂ 2003 00:00:00 -05:00

Background: Nephropathy induced by exposure to radiocontrast agents, a possible complication of percutaneous coronary interventions, is associated with significant in-hospital and long-term morbidity and mortality. Patients with preexisting renal failure...

PERSPECTIVE: Invasive Cardiovascular Procedures â Optimizing Patient Safety

John W. Hirshfeld, Jr., M.D. — Thu, 02Â OctÂ 2003 00:00:00 -05:00

Invasive cardiovascular procedures offer many patients substantial diagnostic and therapeutic benefits. Vascular angioplasty, electrophysiological ablation procedures, and transjugular intrahepatic portosystemic shunt procedures are among the important therapeutic procedures that provide...

IMAGES IN CLINICAL MEDICINE: Ectopic Calcinosis

Yoshiaki Nishioka, M.D. and Masanobu Miyazaki, M.D. — Thu, 18Â SepÂ 2003 00:00:00 -05:00

A 52-year-old man who had been receiving hemodialysis for 11 years had severe secondary hyperparathyroidism. His serum level of intact parathyroid hormone was 1489 pg per milliliter. His bone mineral...

EDITORIAL: The Growing Problem of Chronic Renal Failure after Transplantation of a Nonrenal Organ

Colm Magee, M.D., M.P.H., and Manuel Pascual, M.D. — Thu, 04Â SepÂ 2003 00:00:00 -05:00

The clinical introduction of the immunosuppressive drug cyclosporine in the early 1980s revolutionized the field of organ transplantation. The adoption of cyclosporine-based immunosuppressive regimens dramatically improved survival among patients who...

ORIGINAL ARTICLE: Chronic Renal Failure after Transplantation of a Nonrenal Organ

Thu, 04Â SepÂ 2003 00:00:00 -05:00

Background: Transplantation of nonrenal organs is often complicated by chronic renal disease with multifactorial causes. We conducted a population-based cohort analysis to evaluate the incidence of chronic renal failure, risk...

ORIGINAL ARTICLE: Neoadjuvant Chemotherapy plus Cystectomy Compared with Cystectomy Alone for Locally Advanced Bladder Cancer

Thu, 28Â AugÂ 2003 00:00:00 -05:00

Background: Despite aggressive local therapy, patients with locally advanced bladder cancer are at significant risk for metastases. We evaluated the ability of neoadjuvant chemotherapy to improve the outcome in patients...

REVIEW ARTICLE: Molecular Mechanisms of Amyloidosis

Giampaolo Merlini, M.D., and Vittorio Bellotti, M.D., Ph.D. — Thu, 07Â AugÂ 2003 00:00:00 -05:00

The amyloidoses constitute a large group of diseases in which misfolding of extracellular protein has a prominent role. This dynamic process, which occurs in parallel with or as an alternative...

EDITORIAL: Paricalcitol as Compared with Calcitriol in Patients Undergoing Hemodialysis

Tilman B. DrÃ¼eke, M.D., and David A. McCarron, M.D. — Thu, 31Â JulÂ 2003 00:00:00 -05:00

Secondary hyperparathyroidism, a common consequence of chronic kidney disease, results from abnormal regulation of calcium and phosphate homeostasis. Three factors are central to its development. The first, reduced renal synthesis...

IMAGES IN CLINICAL MEDICINE: Massive Calcification in Pseudohypoparathyroidism

Tominaga Shimizu, M.D. and Teiji Takeda, M.D. — Thu, 31Â JulÂ 2003 00:00:00 -05:00

A 55-year-old man with a 24-year history of pseudohypoparathyroidism type 2 presented with a mass in the right buttock and reported difficulty walking. At the time of diagnosis, he had...

ORIGINAL ARTICLE: Survival of Patients Undergoing Hemodialysis with Paricalcitol or Calcitriol Therapy

Thu, 31Â JulÂ 2003 00:00:00 -05:00

Background: Elevated calcium and phosphorus levels after therapy with injectable vitamin D for secondary hyperparathyroidism may accelerate vascular disease and hasten death in patients undergoing long-term hemodialysis. Paricalcitol, a new...

ORIGINAL ARTICLE: A Randomized Trial of Bevacizumab, an AntiâVascular Endothelial Growth Factor Antibody, for Metastatic Renal Cancer

Thu, 31Â JulÂ 2003 00:00:00 -05:00

Background: Mutations in the tumor-suppressor gene VHL cause oversecretion of vascular endothelial growth factor by clear-cell renal carcinomas. We conducted a clinical trial to evaluate bevacizumab, a neutralizing antibody against...

PERSPECTIVE: The von HippelâLindau Protein, Vascular Endothelial Growth Factor, and Kidney Cancer

Daniel J. George, M.D., and William G. Kaelin, Jr., M.D. — Thu, 31Â JulÂ 2003 00:00:00 -05:00

Early in the 20th century, it was hypothesized that solid tumors secrete factors, now referred to as angiogenic factors, that induce angiogenesis â the formation of new blood vessels â...

CLINICAL PRACTICE: Acute Uncomplicated Urinary Tract Infection in Women

Stephan D. Fihn, M.D., M.P.H. — Thu, 17Â JulÂ 2003 00:00:00 -05:00

A 28-year-old woman telephones her physician to report dysuria and urinary urgency during the preceding three days. She has had several previous urinary tract infections, including three during the past...

IMAGES IN CLINICAL MEDICINE: Emphysematous Cystitis

Satoshi Asada, M.D. and Tatsuya Kawasaki, M.D. — Thu, 17Â JulÂ 2003 00:00:00 -05:00

A 76-year-old woman with a history of diabetes mellitus and myocardial infarction presented with abdominal pain. A plain radiograph (Panel A) showed an air and soft-tissue doughnut sign in the...

EDITORIAL: Predicting Outcomes after Renal Transplantation â New Tools and Old Tools

Philip A. Marsden, M.D. — Thu, 10Â JulÂ 2003 00:00:00 -05:00

More than 90 percent of renal allografts transplanted today will still be functioning one year from now. This rate represents a remarkable improvement over one-year graft-survival rates of 70 percent...

ORIGINAL ARTICLE: Molecular Heterogeneity in Acute Renal Allograft Rejection Identified by DNA Microarray Profiling

Thu, 10Â JulÂ 2003 00:00:00 -05:00

Background: The causes and clinical course of acute rejection vary, and it is not possible to predict graft outcome reliably on the basis of available clinical, pathological, and genetic markers....

ORIGINAL ARTICLE: The Renal Arterial Resistance Index and Renal Allograft Survival

Thu, 10Â JulÂ 2003 00:00:00 -05:00

Background: Most renal transplants fail because of chronic allograft nephropathy or because the recipient dies, but no reliable factor predicting long-term outcome has been identified. We tested whether a renal...

REVIEW ARTICLE: Alport's Syndrome, Goodpasture's Syndrome, and Type IV Collagen

Thu, 19Â JunÂ 2003 00:00:00 -05:00

Basement membranes form a complex surface on which epithelial cells reside. These membranes provide morphogenic cues that determine the fate of cells, the polarization of subcellular constituents, and the location...

CLINICAL PRACTICE: Microscopic Hematuria

Robert A. Cohen, M.D., and Robert S. Brown, M.D. — Thu, 05Â JunÂ 2003 00:00:00 -05:00

An otherwise healthy 48-year-old woman is found to have microscopic hematuria (5 red cells per high-power field) on a urinalysis performed by a life insurance company. No other laboratory abnormalities...

ORIGINAL ARTICLE: Regression of Microalbuminuria in Type 1 Diabetes

Thu, 05Â JunÂ 2003 00:00:00 -05:00

Background: In the present study, we aimed to determine the frequency of a significant reduction in urinary albumin excretion and factors affecting such reduction in patients with type 1 diabetes...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2003 â A 35-Year-Old Man with Early Dysfunction of a Second Renal Transplant

Mohamed H. Sayegh, M.D., and Robert B. Colvin, M.D. — Thu, 13Â MarÂ 2003 00:00:00 -05:00

A 35-year-old man with end-stage renal disease and a history of failed renal transplantation was admitted to the hospital for another transplantation.

When the patient was 10 years old, diabetes mellitus...

IMAGES IN CLINICAL MEDICINE: Calcified Left Ventricular Aneurysm

Byron K. Lee, M.D. and J. Edwin Atwood, M.D. — Thu, 06Â MarÂ 2003 00:00:00 -05:00

A 70-year-old man with a history of a myocardial infarction, hormone-refractory metastatic prostate cancer, and chronic renal insufficiency presented with chest pain. Electrocardiography revealed atrial fibrillation and ST-segment elevation in...

EDITORIAL: Contrast-AgentâInduced Acute Renal Dysfunction â Is Iodixanol the Answer?

Carl M. Sandler, M.D. — Thu, 06Â FebÂ 2003 00:00:00 -05:00

In this issue of the Journal, Aspelin et al.1 report findings from a prospective, randomized, double-blind trial that compared iodixanol, a third-generation, iso-osmolar, dimeric, nonionic iodinated contrast agent, with iohexol,...

ORIGINAL ARTICLE: Nephrotoxic Effects in High-Risk Patients Undergoing Angiography

Thu, 06Â FebÂ 2003 00:00:00 -05:00

Background: The use of iodinated contrast medium can result in nephropathy. Whether iso-osmolar contrast medium is less nephrotoxic than low-osmolar contrast medium in high-risk patients is uncertain.

Methods: We conducted a...

ORIGINAL ARTICLE: Peritoneal Dialysis and Epithelial-to-Mesenchymal Transition of Mesothelial Cells

Thu, 30Â JanÂ 2003 00:00:00 -05:00

Background: During continuous ambulatory peritoneal dialysis, the peritoneum is exposed to bioincompatible dialysis fluids that cause denudation of mesothelial cells and, ultimately, tissue fibrosis and failure of ultrafiltration. However, the...

EDITORIAL: Increased Body Lead Burden â Cause or Consequence of Chronic Renal Insufficiency?

Philip A. Marsden, M.D. — Thu, 23Â JanÂ 2003 00:00:00 -05:00

Greek physicians first recognized the association between exposure to lead and disease over two millennia ago. The sources of lead have changed since ancient times, but exposure is still largely...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 3-2003 â A 36-Year-Old Man with Renal Failure, Hypertension, and Neurologic Abnormalities

Jonathan S. Coblyn, M.D., and Robert T. McCluskey, M.D. — Thu, 23Â JanÂ 2003 00:00:00 -05:00

A 36-year-old, right-handed man was admitted to the hospital because of seizures and severe hypertension.

The patient had an 18-year history of intravenous drug abuse, including abuse of heroin and cocaine...

ORIGINAL ARTICLE: Environmental Lead Exposure and Progression of Chronic Renal Diseases in Patients without Diabetes

Thu, 23Â JanÂ 2003 00:00:00 -05:00

Background: Previous research suggests that environmental lead exposure correlates with age-related decreases in renal function.

Methods: Two hundred two patients with chronic renal insufficiency (indicated by a serum creatinine level between...

EDITORIAL: Imaging Studies for Childhood Urinary Infections

F. Bruder Stapleton, M.D. — Thu, 16Â JanÂ 2003 00:00:00 -05:00

The question of whether to obtain imaging studies after a urinary tract infection in a child is a challenging one. The potential long-term morbidity associated with repeated bouts of pyelonephritis...

ORIGINAL ARTICLE: Imaging Studies after a First Febrile Urinary Tract Infection in Young Children

Thu, 16Â JanÂ 2003 00:00:00 -05:00

Background: Guidelines from the American Academy of Pediatrics recommend obtaining a voiding cystourethrogram and a renal ultrasonogram for young children after a first urinary tract infection; renal scanning with technetium-99mâlabeled...

PERSPECTIVE: Is Microanatomy Destiny?

Julie R. Ingelfinger, M.D. — Thu, 09Â JanÂ 2003 00:00:00 -05:00

Dissecting the pathogenesis of primary, or âessential,â hypertension has proved elusive. In recent years, the hypothesis that having relatively fewer nephrons renders an otherwise healthy person more susceptible to renal...

IMAGES IN CLINICAL MEDICINE: Page Kidney

Guilherme H.M. Oliveira, M.D. and Alexander Schirger, M.D. — Thu, 09Â JanÂ 2003 00:00:00 -05:00

A 23-year-old man presented with a two-month history of hypertension. At 18 years of age, he had sustained an injury to the left flank while playing college football. His blood...

ORIGINAL ARTICLE: Nephron Number in Patients with Primary Hypertension

Thu, 09Â JanÂ 2003 00:00:00 -05:00

Background: A diminished number of nephrons has been proposed as one of the factors contributing to the development of primary hypertension.

Methods: To test this hypothesis, we used a three-dimensional stereologic...

EDITORIAL: Success and Challenge in Dialysis Therapy

Thu, 19Â DecÂ 2002 00:00:00 -05:00

The 2002 Albert Lasker Award for Clinical Medical Research was awarded to Willem J. Kolff and Belding H. Scribner for their pioneering work in the development of hemodialysis.12 As the...

ORIGINAL ARTICLE: Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis

Thu, 19Â DecÂ 2002 00:00:00 -05:00

Background: The effects of the dose of dialysis and the level of flux of the dialyzer membrane on mortality and morbidity among patients undergoing maintenance hemodialysis are uncertain.

Methods: We undertook...

CLINICAL PRACTICE: Nondiabetic Kidney Disease

Andrew S. Levey, M.D. — Thu, 07Â NovÂ 2002 00:00:00 -05:00

A 66-year-old man without diabetes has worsening high blood pressure, to 160/100 mm Hg. He has a serum creatinine level of 1.8 mg per deciliter (159 Î¼mol per liter), an...

IMAGES IN CLINICAL MEDICINE: End-Stage Autosomal Dominant Polycystic Kidney Disease

James A. Brown, M.D. — Thu, 07Â NovÂ 2002 00:00:00 -05:00

Figure 1. A 45-year-old man with autosomal dominant polycystic kidney disease presented to the urology clinic for consideration of bilateral nephrectomy as treatment for severe abdominal pain and distention. Magnetic...

REVIEW ARTICLE: Renal Dysfunction Complicating the Treatment of Hypertension

Biff F. Palmer, M.D. — Thu, 17Â OctÂ 2002 00:00:00 -05:00

Treatment of hypertension in patients with normal renal function does not generally cause renal dysfunction. By contrast, in patients with hypertension and chronic renal insufficiency, it is not uncommon for...

ORIGINAL ARTICLE: Nephrolithiasis and Osteoporosis Associated with Hypophosphatemia Caused by Mutations in the Type 2a SodiumâPhosphate Cotransporter

Thu, 26Â SepÂ 2002 00:00:00 -05:00

Background: Epidemiologic studies suggest that genetic factors confer a predisposition to the formation of renal calcium stones or bone demineralization. Low serum phosphate concentrations due to a decrease in renal...

EDITORIAL: NPT2a â The Key to Phosphate Homeostasis

Thu, 26Â SepÂ 2002 00:00:00 -05:00

Phosphate leads two lives â an ancient intracellular one and a more recent extracellular one. Inside cells, phosphate has a structural role in nucleic acids and phospholipids, forms high-energy ester...

EDITORIAL: Peritoneal Dialysis in Acute Renal Failure â Why the Bad Outcome?

Thu, 19Â SepÂ 2002 00:00:00 -05:00

In contrast to the situation of patients receiving maintenance dialysis, in which information from large, standardized data bases may give us insight into potential management strategies, when it comes to...

ORIGINAL ARTICLE: Hemofiltration and Peritoneal Dialysis in Infection-Associated Acute Renal Failure in Vietnam

Thu, 19Â SepÂ 2002 00:00:00 -05:00

Background: In some parts of the world, peritoneal dialysis is widely used for renal replacement in acute renal failure. In resource-rich countries, it has been supplanted in recent years by...

ORIGINAL ARTICLE: Increase in Nocturnal Blood Pressure and Progression to Microalbuminuria in Type 1 Diabetes

Thu, 12Â SepÂ 2002 00:00:00 -05:00

Background: Patients with type 1 diabetes mellitus and microalbuminuria often have elevated blood pressure while they are asleep, but it is not known whether the elevation develops concomitantly with microalbuminuria...

PERSPECTIVE: Ambulatory Blood-Pressure Monitoring as a Predictive Tool

Thu, 12Â SepÂ 2002 00:00:00 -05:00

Although some patients with type 1 diabetes mellitus have complications, such as diabetic nephropathy, many do not. Thus, a simple, noninvasive method of identifying those at highest â and lowest...

REVIEW ARTICLE: IgA Nephropathy

James V. Donadio, M.D., and Joseph P. Grande, M.D., Ph.D. — Thu, 05Â SepÂ 2002 00:00:00 -05:00

IgA nephropathy is a relatively newly recognized disease, first described by Berger and Hinglais in 1968.1 It is now generally known to be the most common form of primary glomerulonephritis...

IMAGES IN CLINICAL MEDICINE: Sclerosing Peritonitis during Continuous Ambulatory Peritoneal Dialysis

Colin Church, M.B., Ch.B. and Brian Junor, M.D. — Thu, 05Â SepÂ 2002 00:00:00 -05:00

Figure 1. A 45-year-old man who was receiving long-term continuous ambulatory peritoneal dialysis for renal failure presented with a two-month history of colicky abdominal pain, weight loss, and vomiting. The...

EDITORIAL: Nephrogenic Adenomas as Renal Tubular Outposts

Thu, 29Â AugÂ 2002 00:00:00 -05:00

Nephrogenic adenomas, which are rare intraurothelial lesions that occur in the bladder, ureter, or urethra, most often present with hematuria or discomfort on voiding. Some patients have no symptoms at...

ORIGINAL ARTICLE: Derivation of Nephrogenic Adenomas from Renal Tubular Cells in Kidney-Transplant Recipients

Thu, 29Â AugÂ 2002 00:00:00 -05:00

Background: Nephrogenic adenomas are benign, tumor-like lesions within the urothelial mucosa of the urinary tract that are not uncommon in renal-transplant recipients. We investigated the origin of nephrogenic adenomas in...

EDITORIAL: O157:H7 â Piecing Together the Jigsaw Puzzle

Thu, 22Â AugÂ 2002 00:00:00 -05:00

Nineteen years ago, the first report of two outbreaks of hemorrhagic colitis linked with Escherichia coli O157:H7 infection was published in the Journal.1 Both outbreaks were associated with hamburger consumption,...

REVIEW ARTICLE: Thrombotic Microangiopathies

Joel L. Moake, M.D. — Thu, 22Â AugÂ 2002 00:00:00 -05:00

The thrombotic microangiopathies are microvascular occlusive disorders characterized by systemic or intrarenal aggregation of platelets, thrombocytopenia, and mechanical injury to erythrocytes. In thrombotic thrombocytopenic purpura, systemic microvascular aggregation of platelets...

ORIGINAL ARTICLE: An Outbreak of O157:H7 Infections among Visitors to a Dairy Farm

Thu, 22Â AugÂ 2002 00:00:00 -05:00

Background: Outbreaks of Escherichia coli O157:H7 infections have involved direct transmission from animals and their environment to humans. We describe an outbreak among visitors to a Pennsylvania dairy and petting...

EDITORIAL: BK Virus Nephropathy â Polyomavirus Adding Insult to Injury

Thu, 15Â AugÂ 2002 00:00:00 -05:00

Viruses are particularly troublesome pathogens in transplant recipients. Viral infections enhance susceptibility to opportunistic infection both by causing tissue injury and by contributing to systemic immunosuppression.1 Such infections increase the...

ORIGINAL ARTICLE: Prospective Study of Polyomavirus Type BK Replication and Nephropathy in Renal-Transplant Recipients

Thu, 15Â AugÂ 2002 00:00:00 -05:00

Background: Nephropathy associated with the polyomavirus type BK (BKV) nephropathy has emerged as a cause of allograft failure linked to immunosuppressive regimens containing tacrolimus or mycophenolate mofetil. The presence of...

EDITORIAL: Donors without a Heartbeat

Thu, 25Â JulÂ 2002 00:00:00 -05:00

Kidney transplantation offers patients with end-stage renal disease a significant survival advantage as compared with dialysis.12 Despite the success of kidney transplantation, however, fewer than 9000 cadaveric kidneys are transplanted...

REVIEW ARTICLE: Cystinosis

William A. Gahl, M.D., Ph.D., Jess G. Thoene, M.D., and Jerry A. Schneider, M.D. — Thu, 11Â JulÂ 2002 00:00:00 -05:00

Cystinosis is an autosomal recessive disorder with an estimated incidence of 1 case per 100,000 to 200,000 live births. The gene for cystinosis, CTNS, was mapped to chromosome 17p13 in...

ORIGINAL ARTICLE: Risk of Renal Allograft Loss from Recurrent Glomerulonephritis

Thu, 11Â JulÂ 2002 00:00:00 -05:00

Background: Recurrent glomerulonephritis is a known cause of renal allograft loss; however, the incidence of this complication is poorly defined. We determined the incidence, timing, and relative importance of allograft...

ORIGINAL ARTICLE: Antenatal Membranous Glomerulonephritis Due to AntiâNeutral Endopeptidase Antibodies

Thu, 27Â JunÂ 2002 00:00:00 -05:00

Membranous glomerulonephritis, a major cause of the nephrotic syndrome and chronic renal insufficiency, is associated with a wide spectrum of infections, cancers, autoimmune diseases, and drugs. The condition is characterized...

ORIGINAL ARTICLE: Troponin T Levels in Patients with Acute Coronary Syndromes, with or without Renal Dysfunction

Thu, 27Â JunÂ 2002 00:00:00 -05:00

Background: Among patients with suspected acute coronary syndromes, cardiac troponin T levels have prognostic value. However, there is concern that renal dysfunction may impair the prognostic value, because cardiac troponin...

EDITORIAL: Hypertension, Angiotensin II, and Oxidative Stress

Thu, 20Â JunÂ 2002 00:00:00 -05:00

Renovascular hypertension is a potentially curable form of secondary hypertension generally due to either atherosclerosis or fibromuscular dysplasia of one or both renal arteries.12 The critical element promoting hypertension in...

ORIGINAL ARTICLE: Endothelial Function and Oxidative Stress in Renovascular Hypertension

Thu, 20Â JunÂ 2002 00:00:00 -05:00

Background: It has been reported that renovascular hypertension activates the reninâangiotensin system, leading to an increase in oxidative stress. We sought to determine whether renal-artery angioplasty improves endothelial dysfunction in...

EDITORIAL: Sporadic Cases of Hereditary Systemic Amyloidosis

Thu, 06Â JunÂ 2002 00:00:00 -05:00

The systemic amyloidoses comprise a spectrum of acquired and hereditary diseases caused by the deposition of characteristic fibrillar material in various organs and tissues throughout the body. These fibrils are...

ORIGINAL ARTICLE: Misdiagnosis of Hereditary Amyloidosis as AL (Primary) Amyloidosis

Thu, 06Â JunÂ 2002 00:00:00 -05:00

Background: Hereditary, autosomal dominant amyloidosis, caused by mutations in the genes encoding transthyretin, fibrinogen A Î±-chain, lysozyme, or apolipoprotein A-I, is thought to be extremely rare and is not routinely...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 15-2002 â A 53-Year-Old Man with a Myocardial Infarct and Thromboses after Coronary-Artery Bypass Grafting

William C. Aird and Eugene J. Mark — Thu, 16Â MayÂ 2002 00:00:00 -05:00

A 53-year-old man was admitted to the hospital because of a myocardial infarction.

The patient had been well until three months earlier, when he began to have increasingly severe exertional dyspnea,...

CLINICAL PRACTICE: Nephropathy in Patients with Type 2 Diabetes

Giuseppe Remuzzi, M.D., Arrigo Schieppati, M.D., and Piero Ruggenenti, M.D. — Thu, 11Â AprÂ 2002 00:00:00 -05:00

A 60-year-old man was found to have type 2 diabetes mellitus two months ago. He has a serum creatinine level of 1.5 mg per deciliter (133 Î¼mol per liter); a...

REVIEW ARTICLE: Subtle Acquired Renal Injury as a Mechanism of Salt-Sensitive Hypertension

Thu, 21Â MarÂ 2002 00:00:00 -05:00

In 1856 Ludwig Traube1 proposed a role of the kidney in the pathogenesis of hypertension on the basis that hypertension and vascular disease were often associated with chronic Bright's disease....

REVIEW ARTICLE: Strategies to Improve Long-Term Outcomes after Renal Transplantation

Thu, 21Â FebÂ 2002 00:00:00 -05:00

After cyclosporine and muromonab-CD3 (OKT3 monoclonal antibody) were introduced into clinical practice in the early 1980s, one-year survival rates for renal allografts improved from approximately 60 percent to between 80...

ORIGINAL ARTICLE: Use of a Conjugate Vaccine in Patients Receiving Hemodialysis

Thu, 14Â FebÂ 2002 00:00:00 -05:00

Background: In patients with decreased resistance to infection, Staphylococcus aureus is a major cause of bacteremia and its complications. The capsular polysaccharides are essential for the pathogenesis of and immunity...

EDITORIAL: Daily Hemodialysis â Will Treatment Each Day Improve the Outcome in Patients with Acute Renal Failure?

Thu, 31Â JanÂ 2002 00:00:00 -05:00

The mortality rate among hospitalized patients with acute renal failure is high and has not changed substantially since dialysis was introduced several decades ago.1 Although it might be argued that...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2002 â A 75-Year-Old Man with Acute Renal Failure Five Months after Cystoprostatectomy and Urethrectomy for Carcinoma

Hasan Bazari, M.D.,and Shamila Mauiyyedi, M.D. — Thu, 31Â JanÂ 2002 00:00:00 -05:00

A 75-year-old man was admitted to the hospital because of acute renal failure.

He had undergone cystoprostatectomy and urethrectomy with construction of an ileal conduit five months earlier because of prostatic...

ORIGINAL ARTICLE: Daily Hemodialysis and the Outcome of Acute Renal Failure

Helmut Schiffl, M.D., Susanne M. Lang, M.D., and Rainald Fischer, M.D. — Thu, 31Â JanÂ 2002 00:00:00 -05:00

Background: Intermittent hemodialysis is widely used as renal-replacement therapy in patients with acute renal failure, but an adequate dose has not been defined. We performed a prospective study to determine...

ORIGINAL ARTICLE: Comparison of Two Diets for the Prevention of Recurrent Stones in Idiopathic Hypercalciuria

Thu, 10Â JanÂ 2002 00:00:00 -05:00

Background: A low-calcium diet is recommended to prevent recurrent stones in patients with idiopathic hypercalciuria, yet long-term data on the efficacy of a low-calcium diet are lacking. Recently, the efficacy...

PERSPECTIVE: Diet and Kidney Stones

Thu, 10Â JanÂ 2002 00:00:00 -05:00

Kidney and bladder stones cause excruciating pain, tend to recur, and are distressingly common. Roughly 10 percent of persons in the United States will have at least one stone in...

EDITORIAL: Recurrent Hypercalciuric Nephrolithiasis â Does Diet Help?

Thu, 10Â JanÂ 2002 00:00:00 -05:00

Kidney stones have a lifetime incidence of up to 13 percent in North America.1 In the United States, this disorder was responsible for an estimated 1.32 million visits to physicians...

EDITORIAL: The HemolyticâUremic Syndrome â Toxin, Thrombin, and Thrombosis

Thu, 03Â JanÂ 2002 00:00:00 -05:00

The term âhemolyticâuremic syndromeâ was coined by Gasser et al. in 19551 to describe a devastating illness consisting of acute renal failure accompanied by nonimmune hemolytic anemia and thrombocytopenia. Although...

ORIGINAL ARTICLE: Prothrombotic Coagulation Abnormalities Preceding the HemolyticâUremic Syndrome

Thu, 03Â JanÂ 2002 00:00:00 -05:00

Background: The hemolyticâuremic syndrome is a thrombotic complication of Escherichia coli O157:H7 infection. It is not known whether the coagulation abnormalities precede, and potentially cause, this disorder.

Methods: In 53 children...

EDITORIAL: Rational Use of Analgesic and Antiinflammatory Drugs

Thu, 20Â DecÂ 2001 00:00:00 -05:00

âTake two aspirin and call me in the morningâ? Clinical decision making is no longer so straightforward. Millions of patients take analgesic and antiinflammatory medications regularly. The reasons are simple:...

ORIGINAL ARTICLE: Acetaminophen, Aspirin, and Chronic Renal Failure

Thu, 20Â DecÂ 2001 00:00:00 -05:00

Background: Several epidemiologic studies have demonstrated an association between heavy consumption of nonnarcotic analgesics and the occurrence of chronic renal failure, but it is unclear which is the cause and...

IMAGES IN CLINICAL MEDICINE: Acute Myoglobinuric Renal Failure

Harald D. Rupprecht, M.D. and Regine Riess, M.D. — Thu, 13Â DecÂ 2001 00:00:00 -05:00

Figure 1. A 26-year-old man had sudden fever and chills with severe muscle pain and weakness in his legs and pectoral muscles while mountaineering in the Andes. He was brought...

EDITORIAL: Removing the Primary Tumor after the Cancer Has Spread

Thu, 06Â DecÂ 2001 00:00:00 -05:00

Most patients who die of cancer die because of metastatic disease, and therefore removal of the primary tumor in patients who already have evidence of metastasis seems illogical, at least...

IMAGES IN CLINICAL MEDICINE: Renal-Cell Carcinoma Extending into the Vena Cava and Right Side of the Heart

Robert P. Hunsaker, M.D. and James R. Stone, M.D. — Thu, 06Â DecÂ 2001 00:00:00 -05:00

Figure 1. An obese 82-year-old woman with a history of hypertension and type 2 diabetes mellitus had had dyspnea on exertion and swelling of her legs for three to four...

ORIGINAL ARTICLE: Nephrectomy Followed by Interferon Alfa-2b Compared with Interferon Alfa-2b Alone for Metastatic Renal-Cell Cancer

Thu, 06Â DecÂ 2001 00:00:00 -05:00

Background: The value of nephrectomy in metastatic renal-cell cancer has long been debated. Several nonrandomized studies suggest a higher rate of response to systemic therapy and longer survival in patients...

ORIGINAL ARTICLE: BK-Related Polyomavirus Vasculopathy in a Renal-Transplant Recipient

Thu, 25Â OctÂ 2001 00:00:00 -05:00

Polyomaviruses typically infect a single species and limited types of tissue. Examples include the human BK and JC viruses and simian virus 40 (SV40). These three viruses are approximately 70...

ORIGINAL ARTICLE: A Comparison of the Survival of Shipped and Locally Transplanted Cadaveric Renal Allografts

Thu, 25Â OctÂ 2001 00:00:00 -05:00

Background: The effect on allograft survival of the shipment of cadaveric renal allografts from one organ-procurement organization to another is uncertain.

Methods: Using data from the Organ Procurement and Transplantation Network...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2001 â A 77-Year-Old Man with Rheumatoid Arthritis and Acute Dyspnea and Renal Failure

Helen M. Hollingsworth, M.D. and Eugene J. Mark, M.D. — Thu, 18Â OctÂ 2001 00:00:00 -05:00

A 77-year-old man was transferred to this hospital because of worsening bilateral air-space disease and acute renal failure.

He had stopped smoking 30 years before admission. He had mild chronic obstructive...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2001 â A 70-Year-Old Woman with End-Stage Renal Disease and Cutaneous Ulcers

Daniel T. Baran, M.D., and Gary St.A. Letts, M.D. — Thu, 11Â OctÂ 2001 00:00:00 -05:00

A 70-year-old woman was admitted to the hospital because of dyspnea and multiple cutaneous ulcers.

The patient had a history of long-standing type 2 diabetes mellitus as well as an old...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2001 â A 22-Year-Old Man with Hyperthyroidism, Fever, Abdominal Pain, and Arthralgia

Mahboob U. Rahman, M.D., Ph.D, Chieh-Min Fan, M.D., and Hyon K. Choi, M.D. — Thu, 27Â SepÂ 2001 00:00:00 -05:00

A 22-year-old man was admitted to the hospital because of fever, abdominal pain, diarrhea, and polyarthralgia.

The patient had been well until two years before admission, when a tremor developed and...

EDITORIAL: Prevention of End-Stage Renal Disease Due to Type 2 Diabetes

Thu, 20Â SepÂ 2001 00:00:00 -05:00

The prevalence of end-stage renal disease is increasing at an alarming rate. In 2000, chronic kidney failure developed in over 90,000 people in the United States; the current population of...

ORIGINAL ARTICLE: The Effect of Irbesartan on the Development of Diabetic Nephropathy in Patients with Type 2 Diabetes

Thu, 20Â SepÂ 2001 00:00:00 -05:00

Background: Microalbuminuria and hypertension are risk factors for diabetic nephropathy. Blockade of the reninâangiotensin system slows the progression to diabetic nephropathy in patients with type 1 diabetes, but similar data...

ORIGINAL ARTICLE: Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy

Thu, 20Â SepÂ 2001 00:00:00 -05:00

Background: Diabetic nephropathy is the leading cause of end-stage renal disease. Interruption of the reninâangiotensin system slows the progression of renal disease in patients with type 1 diabetes, but similar...

ORIGINAL ARTICLE: Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes

Thu, 20Â SepÂ 2001 00:00:00 -05:00

Background: It is unknown whether either the angiotensin-IIâreceptor blocker irbesartan or the calcium-channel blocker amlodipine slows the progression of nephropathy in patients with type 2 diabetes independently of its capacity...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2001 â Hypertensive Encephalopathy with Impaired Renal Function in a 67-Year-Old Woman with Polymyositis

Joseph H. Korn, M.D., and Shamila Mauiyyedi, M.D. — Thu, 23Â AugÂ 2001 00:00:00 -05:00

A 67-year-old woman was initially admitted to this hospital because of hypertensive encephalopathy.

The patient had been well until one month before admission, when she became weak and began to have...

ORIGINAL ARTICLE: Defective Urinary Concentrating Ability Due to a Complete Deficiency of Aquaporin-1

Thu, 19Â JulÂ 2001 00:00:00 -05:00

Aquaporin-1, the archetypal water-channel protein,1 was initially identified in red cells and renal proximal tubular epithelium.2 The gene for aquaporin-1 (AQP1) on chromosome 7 colocalizes with the Colton blood-group antigen,34...

ORIGINAL ARTICLE: Neointimal and Tubulointerstitial Infiltration by Recipient Mesenchymal Cells in Chronic Renal-Allograft Rejection

Thu, 12Â JulÂ 2001 00:00:00 -05:00

Background: Tissue remodeling depends on mesenchymal cells (fibroblasts and myofibroblasts) and is a prominent feature of chronic renal-transplant rejection. It is not known whether the mesenchymal cells that participate in...

ORIGINAL ARTICLE: Nephropathy and Establishment of a Renal Reservoir of HIV Type 1 during Primary Infection

Thu, 28Â JunÂ 2001 00:00:00 -05:00

Human immunodeficiency virus type 1 (HIV-1)âassociated nephropathy is the chief cause of chronic renal disease in patients with HIV-1 infection and is now the third leading cause of end-stage renal...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 11-2001 â Rapidly Progressive Renal Failure in a 35-Year-Old Woman with Systemic Lupus Erythematosus

Cecil H.Coggins, Robert T. McCluskey — Thu, 12Â AprÂ 2001 00:00:00 -05:00

A 35-year-old woman was admitted to the hospital because of rapidly worsening renal failure.

Twelve years before admission, she had received a diagnosis of systemic lupus erythematosus, manifested by Raynaud's syndrome,...

EDITORIAL: Immune Monitoring for Rejection of Kidney Transplants

Thu, 29Â MarÂ 2001 00:00:00 -05:00

Kidney transplantation is the best treatment for patients with end-stage renal disease. The first six months after a technically successful transplantation is, however, often complicated by episodes of renal dysfunction...

ORIGINAL ARTICLE: Effect of the Use or Nonuse of Long-Term Dialysis on the Subsequent Survival of Renal Transplants from Living Donors

Thu, 08Â MarÂ 2001 00:00:00 -05:00

Background: The effect on allograft survival of the transplantation of kidneys from living donors without the previous initiation of long-term dialysis is controversial.

Methods: Using data from the U.S. Renal Data...

EDITORIAL: Is Liver Fibrosis Reversible?

Thu, 08Â FebÂ 2001 00:00:00 -05:00

Cirrhosis represents a late stage of progressive scarring in chronic liver disease. It begins with subendothelial or pericentral fibrosis (hepatic fibrosis) and progresses to panlobular fibrosis with nodule formation (cirrhosis)....

REVIEW ARTICLE: Renal-Artery Stenosis

Robert D. Safian, M.D., and Stephen C. Textor, M.D. — Thu, 08Â FebÂ 2001 00:00:00 -05:00

Primary diseases of the renal arteries often involve the large renal arteries, whereas secondary diseases are frequently characterized by small-vessel and intrarenal vascular disease. In this article, we will concentrate...

IMAGES IN CLINICAL MEDICINE: Captopril-Augmented Renal Scan

Atsuo Goto, M.D. and Nobuo Kawauchi, M.D. — Thu, 08Â FebÂ 2001 00:00:00 -05:00

Figure 1. A 22-year-old woman had had hypertension for one year. Her only symptom was an occasional headache. Examination revealed a blood pressure of 148/110 mm Hg, a vascular bruit...

ORIGINAL ARTICLE: Use of Doppler Ultrasonography to Predict the Outcome of Therapy for Renal-Artery Stenosis

Thu, 08Â FebÂ 2001 00:00:00 -05:00

Background: Prospectively identifying patients whose renal function or blood pressure will improve after the correction of renal-artery stenosis has not been possible. We evaluated whether a high level of resistance...

EDITORIAL: Hemodialysis as an Artificial Lung in Sleep Apnea

Thu, 11Â JanÂ 2001 00:00:00 -05:00

In 1959, O'Brien, Baxter, and Teschan, with the help of medical corpsmen at Brooke Army Medical Center, demonstrated that daily hemodialysis for up to 22 days promoted survival in 13...

ORIGINAL ARTICLE: Improvement of Sleep Apnea in Patients with Chronic Renal Failure Who Undergo Nocturnal Hemodialysis

Patrick J. Hanly, M.D., and Andreas Pierratos, M.D. — Thu, 11Â JanÂ 2001 00:00:00 -05:00

Background: Sleep apnea is common in patients with chronic renal failure and is not improved by either conventional hemodialysis or peritoneal dialysis. With nocturnal hemodialysis, patients undergo hemodialysis seven nights...

REVIEW ARTICLE: Renal Transplantation in Black Americans

Carlton J. Young, M.D., and Robert S. Gaston, M.D. — Thu, 23Â NovÂ 2000 00:00:00 -05:00

Despite remarkable social changes in the United States during the past century, issues related to race and ethnic background continue to permeate public discourse regarding health care.12 The influence of...

SPECIAL ARTICLE: Racial Disparities in Access to Renal Transplantation â Clinically Appropriate or Due to Underuse or Overuse?

Thu, 23Â NovÂ 2000 00:00:00 -05:00

Background: Despite abundant evidence of racial disparities in the use of surgical procedures, it is uncertain whether these disparities reflect racial differences in clinical appropriateness or overuse or underuse of...

ORIGINAL ARTICLE: Obesity, Hypertension, and the Risk of Kidney Cancer in Men

Thu, 02Â NovÂ 2000 00:00:00 -05:00

Background: Obesity and hypertension have been implicated as risk factors for the development of renal-cell cancer.

Methods: We examined the health records of 363,992 Swedish men who underwent at least one...

EDITORIAL: Treatment of Lupus Nephritis â A Work in Progress

Thu, 19Â OctÂ 2000 00:00:00 -05:00

Until the pathogenesis of nephritis due to systemic lupus erythematosus has been unraveled, optimal treatment for patients with this disease will remain an elusive goal. When the causes of lupus...

ORIGINAL ARTICLE: Transmission of by Organ Transplantation

Thu, 19Â OctÂ 2000 00:00:00 -05:00

Histoplasmosis may occur either after primary infection or after reactivation of latent infection, and its incidence among immunocompromised persons, including recipients of organ transplants, is increasing.123 A variety of infectious...

ORIGINAL ARTICLE: Efficacy of Mycophenolate Mofetil in Patients with Diffuse Proliferative Lupus Nephritis

Thu, 19Â OctÂ 2000 00:00:00 -05:00

Background: The combination of cyclophosphamide and prednisolone is effective for the treatment of severe lupus nephritis but has serious adverse effects. Whether mycophenolate mofetil can be substituted for cyclophosphamide is...

ORIGINAL ARTICLE: Twelve Years' Experience with National Sharing of HLA-Matched Cadaveric Kidneys for Transplantation

Thu, 12Â OctÂ 2000 00:00:00 -05:00

Background: In October 1987, the United Network for Organ Sharing (UNOS) established a national kidney-sharing program to increase the number of HLA-matched transplantations. Since then, over 7500 cadaveric kidneys have...

ORIGINAL ARTICLE: Effect of Growth Hormone Treatment on the Adult Height of Children with Chronic Renal Failure

Thu, 28Â SepÂ 2000 00:00:00 -05:00

Background: Growth hormone treatment stimulates growth in short children with chronic renal failure. However, the extent to which this therapy increases final adult height is not known.

Methods: We followed 38...

ORIGINAL ARTICLE: Regression of Metastatic Renal-Cell Carcinoma after Nonmyeloablative Allogeneic Peripheral-Blood Stem-Cell Transplantation

Thu, 14Â SepÂ 2000 00:00:00 -05:00

Background: Since allogeneic stem-cell transplantation can induce curative graft-versus-leukemia reactions in patients with hematologic cancers, we sought to induce analogous graft-versus-tumor effects in patients with metastatic renal-cell carcinoma by means...

IMAGES IN CLINICAL MEDICINE: Renal-Vein Thrombosis

Gerald J. Matthews, M.D. and Suelyn Hall, M.D. — Thu, 07Â SepÂ 2000 00:00:00 -05:00

Figure 1. A 42-year-old man with a history of non-insulin-dependent diabetes presented with acute right-flank pain. He was afebrile, and an examination revealed tenderness of the right upper quadrant. The...

SOUNDING BOARD: Nondirected Donation of Kidneys from Living Donors

Thu, 10Â AugÂ 2000 00:00:00 -05:00

The transplantation of organs from living donors has always involved a balancing of the physical risks and psychological benefits to the donor against the benefits to the recipient. Early in...

EDITORIAL: Acetylcysteine and Nephrotoxic Effects of Radiographic Contrast Agents â A New Use for an Old Drug

Thu, 20Â JulÂ 2000 00:00:00 -05:00

Nephrotoxicity of radiographic contrast agents is an important cause of acute renal failure even when measures are taken to reduce these toxic effects. Such toxic effects prolong hospital stays, add...

ORIGINAL ARTICLE: Prevention of Radiographic-Contrast-AgentâInduced Reductions in Renal Function by Acetylcysteine

Thu, 20Â JulÂ 2000 00:00:00 -05:00

Background: Radiographic contrast agents can cause a reduction in renal function that may be due to reactive oxygen species. Whether the reduction can be prevented by the administration of antioxidants...

ORIGINAL ARTICLE: Urothelial Carcinoma Associated with the Use of a Chinese Herb ()

Thu, 08Â JunÂ 2000 00:00:00 -05:00

Background: Chinese-herb nephropathy is a progressive form of renal fibrosis that develops in some patients who take weight-reducing pills containing Chinese herbs. Because of a manufacturing error, one of the...

REVIEW ARTICLE: Hyponatremia

Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 136 mmol per liter. Whereas hypernatremia always denotes hypertonicity, hyponatremia can be associated with low,...

IMAGES IN CLINICAL MEDICINE: Xanthogranulomatous Pyelonephritis

Bruno Van Vlem, M.D. and Jean-Marie Billiouw, M.D. — Thu, 25Â MayÂ 2000 00:00:00 -05:00

Figure 1. An 86-year-old woman with a several-year history of recurrent urinary tract infections presented with vague abdominal symptoms. Physical examination disclosed right-flank tenderness. She had an Escherichia coli urinary...

REVIEW ARTICLE: Hypernatremia

The serum sodium concentration and thus serum osmolality are closely controlled by water homeostasis, which is mediated by thirst, arginine vasopressin, and the kidneys.1 A disruption in the water balance...

ORIGINAL ARTICLE: Coronary-Artery Calcification in Young Adults with End-Stage Renal Disease Who Are Undergoing Dialysis

Thu, 18Â MayÂ 2000 00:00:00 -05:00

Background: Cardiovascular disease is common in older adults with end-stage renal disease who are undergoing regular dialysis, but little is known about the prevalence and extent of cardiovascular disease in...

EDITORIAL: Nephropathy Due to Polyomavirus Type BK

Thu, 04Â MayÂ 2000 00:00:00 -05:00

Polyomavirus type BK (BK virus) is a nonenveloped virus with circular, double-stranded DNA that has 70 percent homology with simian virus 40. It was first recognized as a member of...

ORIGINAL ARTICLE: Testing for Polyomavirus Type BK DNA in Plasma to Identify Renal-Allograft Recipients with Viral Nephropathy

Thu, 04Â MayÂ 2000 00:00:00 -05:00

Background: Reactivation of polyomavirus type BK (BK virus) is increasingly recognized as a cause of severe renal-allograft dysfunction. Currently, patients at risk for nephropathy due to infection with the BK...

EDITORIAL: Renal Angioplasty for Lowering Blood Pressure

Thu, 06Â AprÂ 2000 00:00:00 -05:00

The great economist Joseph Schumpeter regarded creative destruction as an indispensable element of economic progress. In a similar vein, the report by van Jaarsveld et al.1 in this issue of...

ORIGINAL ARTICLE: The Effect of Balloon Angioplasty on Hypertension in Atherosclerotic Renal-Artery Stenosis

Thu, 06Â AprÂ 2000 00:00:00 -05:00

Background: Patients with hypertension and renal-artery stenosis are often treated with percutaneous transluminal renal angioplasty. However, the long-term effects of this procedure on blood pressure are not well understood.

Methods: We...

ORIGINAL ARTICLE: Improved Graft Survival after Renal Transplantation in the United States, 1988 to 1996

Thu, 02Â MarÂ 2000 00:00:00 -05:00

Background: The introduction of cyclosporine has resulted in improvement in the short-term outcome of renal transplantation, but its effect on the long-term survival of kidney transplants is not known.

Methods: We...

ORIGINAL ARTICLE: Retinopathy and Nephropathy in Patients with Type 1 Diabetes Four Years after a Trial of Intensive Therapy

Thu, 10Â FebÂ 2000 00:00:00 -05:00

Background: Among patients with type 1 diabetes mellitus, intensive therapy (with the aim of achieving near-normal blood glucose and glycosylated hemoglobin concentrations) markedly reduces the risk of microvascular complications as...

IMAGES IN CLINICAL MEDICINE: Type I Primary Hyperoxaluria

Bahar Bastani, M.D. and George Nahass, M.D. — Thu, 23Â DecÂ 1999 00:00:00 -05:00

Figure 1. A plain abdominal film (Panel A) revealed diffuse renal calcification in a 22-year-old woman with end-stage renal disease. After two months of regular hemodialysis, skin bullae and livedo...

IMAGES IN CLINICAL MEDICINE: Cystine Crystals in Fanconi's Syndrome

Jaswant K. Singh, M.D. and Mary F. Kusior, M.D. — Thu, 09Â DecÂ 1999 00:00:00 -05:00

Figure 1. A 37-year-old man died of massive gastrointestinal bleeding from esophageal varices caused by biopsy-proved cirrhosis due to hepatitis C virus. He had been given a diagnosis of Fanconi's...

IMAGES IN CLINICAL MEDICINE: Cystine Crystals in Fanconi's Syndrome

Jaswant K. Singh, M.D. and Mary F. Kusior, M.D. — Thu, 09Â DecÂ 1999 00:00:00 -05:00

Figure 1. A 37-year-old man died of massive gastrointestinal bleeding from esophageal varices caused by biopsy-proved cirrhosis due to hepatitis C virus. He had been given a diagnosis of Fanconi's...

EDITORIAL: A Survival Advantage for Renal Transplantation

Thu, 02Â DecÂ 1999 00:00:00 -05:00

There is virtual unanimity that the optimal treatment for most patients with end-stage renal disease is renal transplantation. However, unlike the case for liver, heart, and lung transplantation, for which...

ORIGINAL ARTICLE: Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant

Thu, 02Â DecÂ 1999 00:00:00 -05:00

Background: The extent to which renal allotransplantation â as compared with long-term dialysis â improves survival among patients with end-stage renal disease is controversial, because those selected for transplantation may...

EDITORIAL: Quality and Equity in Dialysis and Renal Transplantation

Thu, 25Â NovÂ 1999 00:00:00 -05:00

The Medicare End Stage Renal Disease (ESRD) Program began in 1973. Over the past 26 years, it has illustrated both the benefits of modern, high-technology medicine and the problems associated...

SPECIAL ARTICLE: The Effect of Patients' Preferences on Racial Differences in Access to Renal Transplantation

Thu, 25Â NovÂ 1999 00:00:00 -05:00

Background: In the United States, black patients undergo renal transplantation less often than white patients, but few studies have directly assessed the association between race and patients' preferences with respect...

SPECIAL ARTICLE: Effect of the Ownership of Dialysis Facilities on Patients' Survival and Referral for Transplantation

Thu, 25Â NovÂ 1999 00:00:00 -05:00

Background: More than 200,000 patients with end-stage renal disease undergo dialysis in the United States each year, about two thirds in for-profit centers. Economic pressures, such as the decline in...

IMAGES IN CLINICAL MEDICINE: Brown Tumor in End-Stage Renal Disease

George M. Nassar, M.D. and Juan Carlos Ayus, M.D. — Thu, 25Â NovÂ 1999 00:00:00 -05:00

Figure 1. A 62-year-old man with end-stage renal disease from hypertensive nephrosclerosis that had been treated by hemodialysis for 14 years presented to the emergency room with a productive cough...

IMAGES IN CLINICAL MEDICINE: Gangrene and Type I Cryoglobulinemia in Multiple Myeloma

Lorenzo Cirasino, M.D. and Pier Remigio Barbano, M.D. — Thu, 18Â NovÂ 1999 00:00:00 -05:00

Figure 1. A 57-year-old woman was admitted because of ischemia of the feet (Panel A). A monoclonal IgG- Î» gammopathy and type I cryoglobulinemia (cryocrit, 13.8 percent) were found in...

ORIGINAL ARTICLE: Alloimmune Thrombocytopenia after Organ Transplantation

Thu, 11Â NovÂ 1999 00:00:00 -05:00

Transplanted organs, particularly livers and kidneys, carry passenger lymphocytes that can transmit autoimmune diseases1 or initiate alloimmune disorders2 in the recipient. We recently treated three unrelated patients who each received...

EDITORIAL: The Allocation of Cadaveric Kidneys

Thu, 04Â NovÂ 1999 00:00:00 -05:00

With the discovery of cyclosporine and antiâT-cell antibodies and the successful application of HLA matching, short-term and long-term graft-survival rates for cadaveric kidney transplants have improved dramatically. Nonetheless, there are...

SPECIAL ARTICLE: The Economic Implications of HLA Matching in Cadaveric Renal Transplantation

Thu, 04Â NovÂ 1999 00:00:00 -05:00

Background: The potential economic effects of the allocation of cadaveric kidneys on the basis of tissue-matching criteria are controversial. We analyzed the economic costs associated with the transplantation of cadaveric...

REVIEW ARTICLE: Nephropathy in Patients with Type 2 Diabetes Mellitus

Eberhard Ritz, M.D., and Stephan Reinhold Orth, M.D. — Thu, 07Â OctÂ 1999 00:00:00 -05:00

In the not-so-distant past, type 2 diabetes mellitus was thought to be a relatively benign condition, at least in the elderly, with relatively little effect on life expectancy or renal...

IMAGES IN CLINICAL MEDICINE: Emphysematous Pyelonephritis

Mohamad Ali S. Eloubeidi, M.D., M.H.S. — Thu, 02Â SepÂ 1999 00:00:00 -05:00

Figure 1. A 47-year-old woman with obesity and poorly controlled diabetes mellitus presented with a five-day history of fever, dysuria, and left-flank pain refractory to intravenous antibiotics and intravenous fluids....

EDITORIAL: Intravenous Albumin for Spontaneous Bacterial Peritonitis in Patients with Cirrhosis

Thu, 05Â AugÂ 1999 00:00:00 -05:00

Patients with cirrhosis and ascites are often on the brink of renal failure. Their renal function is vulnerable because of the poorly understood, complex hemodynamic abnormalities that occur in advanced...

ORIGINAL ARTICLE: Effect of Intravenous Albumin on Renal Impairment and Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis

Thu, 05Â AugÂ 1999 00:00:00 -05:00

Background: In patients with cirrhosis and spontaneous bacterial peritonitis, renal function frequently becomes impaired. This impairment is probably related to a reduction in effective arterial blood volume and is associated...

IMAGES IN CLINICAL MEDICINE: von HippelâLindau Disease

David J.A. Goldsmith, F.R.C.P. and Philip Thomas, F.R.C.S. — Thu, 17Â JunÂ 1999 00:00:00 -05:00

Figure 1. Evaluation of a 35-year-old man with recent headache and unsteadiness and a history of blindness of the left eye for two years revealed normal blood pressure and renal...

ORIGINAL ARTICLE: Valacyclovir for the Prevention of Cytomegalovirus Disease after Renal Transplantation

Thu, 13Â MayÂ 1999 00:00:00 -05:00

Background: Cytomegalovirus (CMV) disease is a major complication of organ transplantation. We hypothesized that prophylactic treatment with valacyclovir would reduce the risk of CMV disease.

Methods: A total of 208 CMV-negative...

EDITORIAL: Sympathetic Overactivity in Hypertensive Patients with Chronic Renal Disease

Thu, 29Â AprÂ 1999 00:00:00 -05:00

It is not clear why blood pressure increases in patients with chronic renal failure. The most widely advanced explanation is that such increases are due to extracellular volume expansion caused...

IMAGES IN CLINICAL MEDICINE: Indinavir Crystalluria

Jack W. Tsao, M.D., D.Phil. and Scott C. Kogan, M.D. — Thu, 29Â AprÂ 1999 00:00:00 -05:00

Figure 1. A 33-year-old man with hemophilia and the acquired immunodeficiency syndrome had a six-hour history of severe right-sided flank pain and right-lower-quadrant pain accompanied by nausea, vomiting, and anorexia....

ORIGINAL ARTICLE: Reduction of Sympathetic Hyperactivity by Enalapril in Patients with Chronic Renal Failure

Thu, 29Â AprÂ 1999 00:00:00 -05:00

Background: Inhibition of angiotensin-converting enzyme (ACE) reduces the risk of cardiovascular problems in patients with chronic renal failure. This effect may be due in part to a decrease in sympathetic...

REVIEW ARTICLE: Genetic Disorders of Renal Electrolyte Transport

Thu, 15Â AprÂ 1999 00:00:00 -05:00

In the 1950s and 1960s, several inherited disorders of fluid and electrolyte metabolism were described in which the principal disturbance appeared to be a specific functional defect in the renal...

IMAGES IN CLINICAL MEDICINE: Malignant Hypertension

Mark A. Perazella, M.D. and Rex L. Mahnensmith, M.D. — Thu, 31Â DecÂ 1998 00:00:00 -05:00

Figure 1. A 41-year-old woman with blurred vision and dyspnea was found to have severe hypertension (blood pressure, 240/125 mm Hg in both arms) and grade IV hypertensive retinopathy. Laboratory...

REVIEW ARTICLE: Primary Aldosteronism

Arunabha Ganguly, M.D. — Thu, 17Â DecÂ 1998 00:00:00 -05:00

Primary aldosteronism resulting from an adrenocortical adenoma (aldosteronoma), as described by Conn,1 is one of a few potentially curable forms of hypertension. Aldosteronoma is the most common cause of primary...

ORIGINAL ARTICLE: The Effect of Tolerance to Noninherited Maternal HLA Antigens on the Survival of Renal Transplants from Sibling Donors

Thu, 03Â DecÂ 1998 00:00:00 -05:00

Background: During pregnancy and nursing, a baby's developing immune system is intimately exposed to the mother's antigens. To determine whether this exposure is of clinical benefit to patients who later...

REVIEW ARTICLE: Pathophysiology of Progressive Nephropathies

Giuseppe Remuzzi, M.D., and Tullio Bertani, M.D. — Thu, 12Â NovÂ 1998 00:00:00 -05:00

In patients with renal diseases characterized by proteinuria, the initial insult to the kidney is usually followed by a progressive decline in the glomerular filtration rate. This decline has been...

ORIGINAL ARTICLE: Seasonal Changes in Blood Pressure in Patients with End-Stage Renal Disease Treated with Hemodialysis

Background: Many factors contribute to the regulation of blood pressure. The role of climate has received relatively little attention.

Methods: During a four-year period, we determined the influence of climate on...

ORIGINAL ARTICLE: Transmission of Human Herpesvirus 8 Infection from Renal-Transplant Donors to Recipients

Thu, 05Â NovÂ 1998 00:00:00 -05:00

Background: Human herpesvirus 8 (HHV-8) has been detected in all forms of Kaposi's sarcoma, including transplantation-associated Kaposi's sarcoma. To investigate the possibility of transmission of HHV-8 through allografts, we measured...

REVIEW ARTICLE: Care of Patients Undergoing Hemodialysis

Onyekachi Ifudu, M.B., B.S. — Thu, 08Â OctÂ 1998 00:00:00 -05:00

The objectives in caring for patients who are undergoing hemodialysis include providing sufficient dialysis, ensuring adequate nutrition, maintaining vascular access, correcting hormonal deficiencies, minimizing hospitalization, and prolonging life while enhancing...

REVIEW ARTICLE: Glomerulonephritis

Donald E. Hricik, M.D., Moonja Chung-Park, M.D., and John R. Sedor, M.D. — Thu, 24Â SepÂ 1998 00:00:00 -05:00

Diseases involving the renal glomeruli are encountered frequently in clinical practice and are the most common causes of end-stage renal disease worldwide. In the United States alone, glomerular diseases accounted...

IMAGES IN CLINICAL MEDICINE: Human Immunodeficiency Virus Nephropathy and Intraglomerular Cryptococcus Neoformans

Andrea Veatch, M.D. and Steven H. Dikman, M.D. — Thu, 24Â SepÂ 1998 00:00:00 -05:00

Figure 1. A 24-year-old man with the acquired immunodeficiency syndrome presented in May 1997 with proteinuria and renal insufficiency. The most recent assessment of viral burden revealed a human immunodeficiency...

EDITORIAL: Chronic Renal Failure â A Vasculopathic State

Thu, 17Â SepÂ 1998 00:00:00 -05:00

Chronic renal insufficiency (defined by a serum creatinine concentration of 1.5 to 3.0 mg per deciliter [133 to 265 Î¼mol per liter]), chronic renal failure (serum creatinine concentration, >3.0 mg...

REVIEW ARTICLE: Protection of AcidâBase Balance by pH Regulation of Acid Production

Virginia L. Hood, M.B., B.S., M.P.H., and Richard L. Tannen, M.D. — Thu, 17Â SepÂ 1998 00:00:00 -05:00

Under normal physiologic conditions, acidâbase balance is maintained by renal excretion of hydrogen ions generated during the metabolism of dietary protein and other metabolic processes. In normal subjects, these so-called...

ORIGINAL ARTICLE: Poor Long-Term Survival after Acute Myocardial Infarction among Patients on Long-Term Dialysis

Charles A. Herzog, M.D., Jennie Z. Ma, Ph.D., and Allan J. Collins, M.D. — Thu, 17Â SepÂ 1998 00:00:00 -05:00

Background: Cardiovascular disease is common in patients on long-term dialysis, and it accounts for 44 percent of overall mortality in this group. We undertook a study to assess long-term survival...

EDITORIAL: Erythropoietin for End-Stage Renal Disease

Thu, 27Â AugÂ 1998 00:00:00 -05:00

Currently, there are approximately 200,000 patients with end-stage renal disease in the United States who require dialysis therapy to stay alive, and dialysis is initiated in nearly 70,000 new patients...

ORIGINAL ARTICLE: The Effects of Normal as Compared with Low Hematocrit Values in Patients with Cardiac Disease Who Are Receiving Hemodialysis and Epoetin

Thu, 27Â AugÂ 1998 00:00:00 -05:00

Background: In patients with end-stage renal disease, anemia develops as a result of erythropoietin deficiency, and recombinant human erythropoietin (epoetin) is prescribed to correct the anemia partially. We examined the...

ORIGINAL ARTICLE: Subcutaneous Compared with Intravenous Epoetin in Patients Receiving Hemodialysis

Thu, 27Â AugÂ 1998 00:00:00 -05:00

Background: Several studies have suggested that if recombinant human erythropoietin (epoetin) is administered subcutaneously rather than intravenously, a lower dose may be sufficient to maintain the hematocrit at a given...

REVIEW ARTICLE: Nitric Oxide as a Mediator of Hemodynamic Abnormalities and Sodium and Water Retention in Cirrhosis

Pierre-Yves Martin, M.D., Pere GinÃ¨s, M.D., and Robert W. Schrier, M.D. — Thu, 20Â AugÂ 1998 00:00:00 -05:00

A decade ago, it was proposed that peripheral arterial vasodilation was an important event in the pathophysiology of ascites formation in patients with cirrhosis.1 At the same time, nitric oxide...

REVIEW ARTICLE: Hypokalemia

F. John Gennari, M.D. — Thu, 13Â AugÂ 1998 00:00:00 -05:00

A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. When defined as a value of less than 3.6 mmol of potassium per liter,...

REVIEW ARTICLE: Diuretic Therapy

D. Craig Brater, M.D. — Thu, 06Â AugÂ 1998 00:00:00 -05:00

Diuretic drugs are widely used for the treatment of patients with edema. Among these drugs, loop diuretics such as furosemide are perhaps the most frequently prescribed, and their clinical pharmacology...

REVIEW ARTICLE: Natriuretic Peptides

Ellis R. Levin, M.D., David G. Gardner, M.D., and Willis K. Samson, Ph.D. — Thu, 30Â JulÂ 1998 00:00:00 -05:00

In 1981, de Bold and his colleagues made the seminal observation that infusion of extracts of atrial tissue into rats caused a copious natriuresis.1 This then led to the isolation...

ORIGINAL ARTICLE: Reversal of Lesions of Diabetic Nephropathy after Pancreas Transplantation

Thu, 09Â JulÂ 1998 00:00:00 -05:00

Background: In patients with type 1 diabetes mellitus who do not have uremia and have not received a kidney transplant, pancreas transplantation does not ameliorate established lesions of diabetic nephropathy...

EDITORIAL: Pancreas Transplantation and Diabetic Complications

Thu, 09Â JulÂ 1998 00:00:00 -05:00

Hyperglycemia is an important factor in the development and progression of the complications of diabetes mellitus. In this issue of the Journal, Fioretto et al. report that pancreas transplantation reverses...

IMAGES IN CLINICAL MEDICINE: Tuberous Sclerosis

Alan D. Salama, M.D. and Charles D. Pusey, M.D. — Thu, 25Â JunÂ 1998 00:00:00 -05:00

Figure 1. A 16-year-old girl presented with right-sided loin pain, anemia, and severe hypotension. Ultrasonographic scanning revealed multiple highly reflective lesions of various sizes consistent with the presence of angiomyolipomas...

REVIEW ARTICLE: Dialysis Therapy

Stephen Pastan, M.D., and James Bailey, M.D. — Thu, 14Â MayÂ 1998 00:00:00 -05:00

The population with end-stage renal disease (ESRD) in the United States is composed of more than 200,000 patients who undergo dialysis and 70,000 patients with functioning kidney transplants.1 With the...

IMAGES IN CLINICAL MEDICINE: Calcified Mass in a Patient on Long-Term Hemodialysis

Piotr Lazowski, M.D. and David S. Goldfarb, M.D. — Thu, 14Â MayÂ 1998 00:00:00 -05:00

Figure 1. A 46-year-old man with end-stage renal disease due to diabetic nephropathy had been undergoing hemodialysis for almost two years. Fourteen months after beginning dialysis, he reported pain below...

EDITORIAL: Metastatic Renal-Cell Carcinoma: What Causes Occasional Dramatic Regressions?

Thu, 30Â AprÂ 1998 00:00:00 -05:00

Renal-cell carcinoma constitutes about 2 percent of all cancers, and its incidence is steadily rising. The sporadic form of the disease usually presents in the fifth, sixth, or seventh decade...

IMAGES IN CLINICAL MEDICINE: Renal-Cell Carcinoma

Jeffrey S. Sykes, M.D. and Thomas G. McCarter, Jr., M.D. — Thu, 30Â AprÂ 1998 00:00:00 -05:00

Figure 1. Progressive painless swelling of the right leg developed in an 81-year-old woman. Duplex scanning of the legs showed no evidence of venous thrombosis. Ventilationâperfusion scanning of the lungs...

IMAGES IN CLINICAL MEDICINE: Echocardiographic Detection of a Renal-Cell Carcinoma

Lori Bray Croft, M.D. and Martin E. Goldman, M.D. — Thu, 30Â AprÂ 1998 00:00:00 -05:00

Figure 1. A 59-year-old man with hypertension presented with a three-month history of fatigue and progressive shortness of breath. Physical examination revealed mild jaundice, tachypnea, tachycardia, bibasilar rales, and mild...

ORIGINAL ARTICLE: Recombinant Human Interleukin-2, Recombinant Human Interferon Alfa-2a, or Both in Metastatic Renal-Cell Carcinoma

Thu, 30Â AprÂ 1998 00:00:00 -05:00

Background: Recombinant human interleukin-2 (aldesleukin) and recombinant human interferon alfa can induce notable tumor regression in a limited number of patients with metastatic renal-cell carcinoma. We conducted a multicenter, randomized...

ORIGINAL ARTICLE: Interferon Gamma-1b Compared with Placebo in Metastatic Renal-Cell Carcinoma

Thu, 30Â AprÂ 1998 00:00:00 -05:00

Background: Most trials of immunomodulators in metastatic renal-cell carcinoma have been uncontrolled and subject to selection bias. The objective of this blinded, placebo-controlled study was to compare overall response rates,...

REVIEW ARTICLE: The Nephrotic Syndrome

Stephan R. Orth, M.D., and Eberhard Ritz, M.D. — Thu, 23Â AprÂ 1998 00:00:00 -05:00

The nephrotic syndrome is defined by a urinary protein level exceeding 3.5 g per 1.73 m2 of body-surface area per day. At the turn of the century, clinicians distinguished a...

ORIGINAL ARTICLE: Liver Failure and Death after Exposure to Microcystins at a Hemodialysis Center in Brazil

Thu, 26Â MarÂ 1998 00:00:00 -05:00

Background: Hemodialysis is a common but potentially hazardous procedure. From February 17 to 20, 1996, 116 of 130 patients (89 percent) at a dialysis center (dialysis center A) in Caruaru,...

REVIEW ARTICLE: Acute Oliguria

Saulo Klahr, M.D., and Steven B. Miller, M.D. — Thu, 05Â MarÂ 1998 00:00:00 -05:00

Acute oliguria (excretion of less than 400 ml of urine per day) is often the earliest sign of impaired renal function and poses a diagnostic and management challenge to the...

IMAGES IN CLINICAL MEDICINE: Electrocardiographic Changes of Hyperkalemia

Jeffrey T. Kuvin, M.D. — Thu, 05Â MarÂ 1998 00:00:00 -05:00

Figure 1. A 42-year-old woman with end-stage renal disease from recurrent nephrolithiasis was admitted to the hospital for placement of an arteriovenous fistula for permanent hemodialysis access. While she was...

REVIEW ARTICLE: Analgesic Nephropathy

Marc E. De Broe, M.D., Ph.D., and Monique M. Elseviers, Ph.D. — Thu, 12Â FebÂ 1998 00:00:00 -05:00

Classic analgesic nephropathy is a slowly progressive disease resulting from the daily use for many years of mixtures containing at least two antipyretic analgesics and usually caffeine or codeine (or...

ORIGINAL ARTICLE: Transplantation of Kidneys from Donors Whose Hearts Have Stopped Beating

Thu, 22Â JanÂ 1998 00:00:00 -05:00

Background: Attempts have recently been made to expand the number of cadaveric kidneys available for transplantation by using kidneys from donors without heartbeats in addition to those from brain-dead donors...

ORIGINAL ARTICLE: Interleukin-2âReceptor Blockade with Daclizumab to Prevent Acute Rejection in Renal Transplantation

Thu, 15Â JanÂ 1998 00:00:00 -05:00

Background: Monoclonal antibodies that block the high-affinity interleukin-2 receptor expressed on alloantigen-reactive T lymphocytes may cause selective immunosuppression. Daclizumab is a genetically engineered human IgG1 monoclonal antibody that binds specifically...

ORIGINAL ARTICLE: Poison on Line â Acute Renal Failure Caused by Oil of Wormwood Purchased through the Internet

Steven D. Weisbord, M.D., Jeremy B. Soule, M.D., and Paul L. Kimmel, M.D. — Thu, 18Â SepÂ 1997 00:00:00 -05:00

Myoglobin released during muscle injury can precipitate acute renal failure.12 There are many causes of rhabdomyolysis, including excessive exercise, âcrushâ injuries, seizures, infections, severe potassium and phosphate depletion, staphylococcal toxins,...

IMAGES IN CLINICAL MEDICINE: HIV-Associated Nephropathy

S.Y. Tan, M.D. and P.J. O'Donnell, F.R.C.Path. — Thu, 11Â SepÂ 1997 00:00:00 -05:00

Figure 1. A previously healthy bisexual man presented with the nephrotic syndrome and acute renal failure. The serum creatinine concentration was 7.8 mg per deciliter (693 Î¼mol per liter), the...

REVIEW ARTICLE: Continuous Hemofiltration in the Treatment of Acute Renal Failure

L.G. Forni, M.B., Ph.D., and P.J. Hilton, M.D. — Thu, 01Â MayÂ 1997 00:00:00 -05:00

Acute renal failure that requires renal-replacement therapy is a relatively common condition, with an annual incidence of at least 30 cases per 1 million population.1 Historically, the replacement of renal...

EDITORIAL: Acute Renal Failure â The Promise of New Therapies

Thu, 20Â MarÂ 1997 00:00:00 -05:00

Acute tubular necrosis is common in acutely ill hospitalized patients, with mortality rates exceeding 50 percent.1 The regenerative capacity of kidneys damaged by acute tubular necrosis is substantial, and minimizing...

ORIGINAL ARTICLE: Anaritide in Acute Tubular Necrosis

Thu, 20Â MarÂ 1997 00:00:00 -05:00

Background: Atrial natriuretic peptide, a hormone synthesized by the cardiac atria, increases the glomerular filtration rate by dilating afferent arterioles while constricting efferent arterioles. It has been shown to improve...

ORIGINAL ARTICLE: Treatment of Ostial Renal-Artery Stenoses with Vascular Endoprostheses after Unsuccessful Balloon Angioplasty

Thu, 13Â FebÂ 1997 00:00:00 -05:00

Background: Percutaneous transluminal renal angioplasty is a safe and effective treatment for nonostial stenoses of the renal arteries, but it has proved to be disappointing for ostial stenoses. Therefore, we...

ORIGINAL ARTICLE: Clinical and Biochemical Abnormalities in People Heterozygous for Hemochromatosis

Thu, 12Â DecÂ 1996 00:00:00 -05:00

Background: Ten percent of whites are heterozygous for the HLA-linked hemochromatosis mutation. We performed a cross-sectional analysis of 1058 genotyped heterozygotes to define the effects of age and sex on...

EDITORIAL: Initiation and Progression of Diabetic Nephropathy

Thu, 28Â NovÂ 1996 00:00:00 -05:00

A clinical diagnosis of diabetic nephropathy can be made in a patient with diabetes on the basis of persistent albuminuria (>300 mg per 24 hours), the presence of diabetic retinopathy,...

ORIGINAL ARTICLE: Development and Progression of Renal Disease in Pima Indians with Non-Insulin-Dependent Diabetes Mellitus

Thu, 28Â NovÂ 1996 00:00:00 -05:00

Background: Non-insulin-dependent diabetes mellitus (NIDDM) is a major cause of end-stage renal disease. However, the course and determinants of renal failure in this type of diabetes have not been clearly...

REVIEW ARTICLE: Renal-Cell Carcinoma

Robert J. Motzer, M.D., Neil H. Bander, M.D., and David M. Nanus, M.D. — Thu, 19Â SepÂ 1996 00:00:00 -05:00

Renal-cell carcinoma is characterized by a lack of early-warning signs (which results in a high proportion of patients with metastases), diverse clinical manifestations, and resistance to radiotherapy and chemotherapy, and...

EDITORIAL: and the HemolyticâUremic Syndrome

Thu, 29Â AugÂ 1996 00:00:00 -05:00

The hemolyticâuremic syndrome is characterized by nonimmune hemolytic anemia, thrombocytopenia, and acute renal failure.1 Extrarenal manifestations, particularly neurologic signs, may be present, indicating that the disease process is not limited...

ORIGINAL ARTICLE: HemolyticâUremic Syndrome in a Six-Year-Old Girl after a Urinary Tract Infection with Shiga-ToxinâProducing O103:H2

Thu, 29Â AugÂ 1996 00:00:00 -05:00

In the United States, the hemolyticâuremic syndrome of childhood typically follows gastrointestinal infection with Escherichia coli O157:H7.123 It is presumed that the absorption from the gastrointestinal tract of Shiga toxins...

EDITORIAL: Pregnancy and Renal Disease

Thu, 25Â JulÂ 1996 00:00:00 -05:00

Of all the medical disorders that add risk to pregnancy, renal disease has long ranked among those most feared by physicians. Not only are the renal and vascular manifestations of...

ORIGINAL ARTICLE: Outcome of Pregnancy in Women with Moderate or Severe Renal Insufficiency

David C. Jones, M.D., and John P. Hayslett, M.D. — Thu, 25Â JulÂ 1996 00:00:00 -05:00

Background: Pregnant women with mild preexisting renal disease have relatively few complications of pregnancy, but the risks of maternal and obstetrical complications in women with moderate or severe renal insufficiency...

REVIEW ARTICLE: Angiotensin Receptors and Their Antagonists

Theodore L. Goodfriend, M.D., Mary E. Elliott, Ph.D., and Kevin J. Catt, M.D. — Thu, 20Â JunÂ 1996 00:00:00 -05:00

Angiotensins are peptide hormones derived from the protein precursor angiotensinogen by the sequential actions of proteolytic enzymes (Figure 1). The classic pathway of angiotensin synthesis includes a reaction catalyzed by...

ORIGINAL ARTICLE: Infection with Hepatitis GB Virus C in Patients on Maintenance Hemodialysis

Thu, 06Â JunÂ 1996 00:00:00 -05:00

Background: A recently discovered non-AâE hepatitis virus has been designated hepatitis GB virus C (HGBV-C), but little is known about its mode of transmission and its clinical manifestations. We studied...

REVIEW ARTICLE: Acute Renal Failure

Ravi Thadhani, M.D., Manuel Pascual, M.D., and Joseph V. Bonventre, M.D., Ph.D. — Thu, 30Â MayÂ 1996 00:00:00 -05:00

Acute renal failure is characterized by a deterioration of renal function over a period of hours to days, resulting in the failure of the kidney to excrete nitrogenous waste products...

ORIGINAL ARTICLE: Effect of the Angiotensin-ConvertingâEnzyme Inhibitor Benazepril on the Progression of Chronic Renal Insufficiency

Thu, 11Â AprÂ 1996 00:00:00 -05:00

Background: Drugs that inhibit angiotensin-converting enzyme slow the progression of renal insufficiency in patients with diabetic nephropathy. Whether these drugs have a similar action in patients with other renal diseases...

EDITORIAL: Idiopathic Focal Segmental Glomerulosclerosis â New Lessons from Kidney Transplantation

Thu, 04Â AprÂ 1996 00:00:00 -05:00

The study of renal allografts has provided insight into the pathogenesis of renal diseases.1 In patients with some disorders, such as Liddle's syndrome (in which long-standing hypertension may severely impair...

ORIGINAL ARTICLE: Circulating Factor Associated with Increased Glomerular Permeability to Albumin in Recurrent Focal Segmental Glomerulosclerosis

Thu, 04Â AprÂ 1996 00:00:00 -05:00

Background: Heavy proteinuria and progressive renal injury recur after transplantation in up to 40 percent of patients with renal failure caused by idiopathic focal segmental glomerulosclerosis. A circulating factor may...

ORIGINAL ARTICLE: Anemia, Dialysis, and Dollars

Thu, 15Â FebÂ 1996 00:00:00 -05:00

The association of anemia with renal failure was noted by Richard Bright 160 years ago.1 Anemia develops early in the course of renal failure, becomes prominent as the disease progresses,...

ORIGINAL ARTICLE: The Intensity of Hemodialysis and the Response to Erythropoietin in Patients with End-Stage Renal Disease

Onyekachi Ifudu, M.B., B.S., Joseph Feldman, Dr.P.H., and Eli A. Friedman, M.D. — Thu, 15Â FebÂ 1996 00:00:00 -05:00

Background: Anemia (characterized by a hematocrit of 30 percent or lower) persists in 40 to 60 percent of patients treated for end-stage renal disease with maintenance hemodialysis, despite concomitant erythropoietin...

ORIGINAL ARTICLE: Blood Pressure and End-Stage Renal Disease in Men

Thu, 04Â JanÂ 1996 00:00:00 -05:00

Background: End-stage renal disease in the United States creates a large burden for both individuals and society as a whole. Efforts to prevent the condition require an understanding of modifiable...

NEJM â Collection Updates for Kidney Disease

PERSPECTIVE: Erythropoiesis-Stimulating Agents â Time for a Reevaluation

CLINICAL PRACTICE: Stage IV Chronic Kidney Disease

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2009 â A 46-Year-Old Woman with Chronic Renal Failure, Leg Swelling, and Skin Changes

REVIEW ARTICLE: Use of Diuretics in Patients with Hypertension

EDITORIAL: Treatment of Anemia in Chronic Kidney Disease â Strategies Based on Evidence

ORIGINAL ARTICLE: A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2009 â A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

CLINICAL PRACTICE: Renal-Artery Stenosis

ORIGINAL ARTICLE: Revascularization versus Medical Therapy for Renal-Artery Stenosis

EDITORIAL: Antimicrobial Prophylaxis for Urinary Tract Infection in Children

ORIGINAL ARTICLE: Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children

IMAGES IN CLINICAL MEDICINE: Thoracic Kidney

EDITORIAL: Blood-Pressure Control and Delay in Progression of Kidney Disease in Children

EDITORIAL: Renal Support in Acute Kidney Injury â How Much Is Enough?

REVIEW ARTICLE: Atypical HemolyticâUremic Syndrome

ORIGINAL ARTICLE: Strict Blood-Pressure Control and Progression of Renal Failure in Children

ORIGINAL ARTICLE: Intensity of Continuous Renal-Replacement Therapy in Critically Ill Patients

CORRESPONDENCE: Loss of Independence in Patients Starting Dialysis at 80 Years of Age or Older

EDITORIAL: Dialysis in Frail Elders â A Role for Palliative Care

ORIGINAL ARTICLE: Functional Status of Elderly Adults before and after Initiation of Dialysis

CORRESPONDENCE: Indigenous Australians and Living Kidney Donation

IMAGES IN CLINICAL MEDICINE: Staghorn Calculus

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2009 â A 77-Year-Old Man with Recurrent Transitional-Cell Carcinoma of the Ureter

REVIEW ARTICLE: Renal Failure in Cirrhosis

CORRESPONDENCE: Renal Sympathetic-Nerve Ablation for Uncontrolled Hypertension

IMAGES IN CLINICAL MEDICINE: Retinal Detachment in Malignant Hypertension

BOOK REVIEW:

CLINICAL PROBLEM-SOLVING: A Hard Diagnosis

IMAGES IN CLINICAL MEDICINE: Stent-Associated Urinary Calculi

BOOK REVIEW:

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2009 â A 13-Year-Old Boy with Headache, Nausea, Seizures, and Hypertension

IMAGES IN CLINICAL MEDICINE: Air in the Urinary Tract

ORIGINAL ARTICLE: Thrombomodulin Mutations in Atypical HemolyticâUremic Syndrome

CORRESPONDENCE: Anti-CTLA4 AntibodyâInduced Lupus Nephritis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2009 â A 61-Year-Old Woman with Abdominal Pain, Weight Loss, and Renal Failure

EDITORIAL: Diabetes Complications and the ReninâAngiotensin System

EDITORIAL: Human Idiopathic Membranous Nephropathy â A Mystery Solved?

REVIEW ARTICLE: Rhabdomyolysis and Acute Kidney Injury

ORIGINAL ARTICLE: Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes

ORIGINAL ARTICLE: M-Type Phospholipase A Receptor as Target Antigen in Idiopathic Membranous Nephropathy

CORRESPONDENCE: B-CellâDepleting Induction Therapy and Acute Cellular Rejection

BOOK REVIEW:

EDITORIAL: Antiplatelet Therapy and Vascular-Access Patency

ORIGINAL ARTICLE: Effect of Dipyridamole plus Aspirin on Hemodialysis Graft Patency

EDITORIAL: Membrane Physiology â Bridging the Gap between Medical Disciplines

ORIGINAL ARTICLE: Epilepsy, Ataxia, Sensorineural Deafness, Tubulopathy, and Mutations

IMAGES IN CLINICAL MEDICINE: Chvostek's Sign and Carpopedal Spasm

CORRECTION:

BOOK REVIEW:

CORRESPONDENCE: Outcome of Renal Transplantation from Very Old Donors

EDITORIAL: Sunset for Statins after AURORA?

ORIGINAL ARTICLE: Rosuvastatin and Cardiovascular Events in Patients Undergoing Hemodialysis

CORRESPONDENCE: Melamine and Nephrolithiasis in Children in Taiwan

CORRESPONDENCE: Ultrasonographic Evaluation of Melamine-Exposed Children in Hong Kong

EDITORIAL: Melamine, Powdered Milk, and Nephrolithiasis in Chinese Infants

ORIGINAL ARTICLE: A Nonsimultaneous, Extended, Altruistic-Donor Chain

ORIGINAL ARTICLE: Melamine-Contaminated Powdered Formula and Urolithiasis in Young Children

ORIGINAL ARTICLE: C3 Polymorphisms and Allograft Outcome in Renal Transplantation

CORRESPONDENCE: Eculizumab for Congenital Atypical HemolyticâUremic Syndrome

CORRESPONDENCE: Eculizumab for Atypical HemolyticâUremic Syndrome

EDITORIAL: Cautious Optimism Concerning Long-Term Safety of Kidney Donation

ORIGINAL ARTICLE: Long-Term Consequences of Kidney Donation

BOOK REVIEW:

EDITORIAL: Organ Procurement and Perfusion before Transplantation

ORIGINAL ARTICLE: Machine Perfusion or Cold Storage in Deceased-Donor Kidney Transplantation

ORIGINAL ARTICLE: A Syndrome with Congenital Neutropenia and Mutations in

CORRESPONDENCE: Cardiac Amyloidosis with the Mutation of the Fibrinogen A Î±-Chain

ORIGINAL ARTICLE: Azathioprine or Methotrexate Maintenance for ANCA-Associated Vasculitis

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Proteinuria and Immunity â An Overstated Relationship?

REVIEW ARTICLE: Uric Acid and Cardiovascular Risk

BOOK REVIEW:

CORRESPONDENCE: Long-Term Results of Rabbit Antithymocyte Globulin and Basiliximab Induction

BOOK REVIEW:

CLINICAL PROBLEM-SOLVING: Variations on a Theme

CLINICAL PRACTICE: Autosomal Dominant Polycystic Kidney Disease

EDITORIAL: Renal PhosphateâTransporter Regulatory Proteins and Nephrolithiasis

ORIGINAL ARTICLE: Mutations and Responsiveness of Renal Parathyroid Hormone

CORRESPONDENCE: Scrotal Cutaneous Side Effects of Sunitinib

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2008 â A 64-Year-Old Man with Abdominal Pain, Nausea, and an Elevated Level of Serum Creatinine

NEJM â Collection Updates for Kidney Disease

PERSPECTIVE: Erythropoiesis-Stimulating Agents â Time for a Reevaluation

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 37-2009 â A 46-Year-Old Woman with Chronic Renal Failure, Leg Swelling, and Skin Changes

EDITORIAL: Treatment of Anemia in Chronic Kidney Disease â Strategies Based on Evidence

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2009 â A 60-Year-Old Male Renal-Transplant Recipient with Renal Insufficiency, Diabetic Ketoacidosis, and Mental-Status Changes

EDITORIAL: Renal Support in Acute Kidney Injury â How Much Is Enough?

REVIEW ARTICLE: Atypical HemolyticâUremic Syndrome

EDITORIAL: Dialysis in Frail Elders â A Role for Palliative Care

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 30-2009 â A 77-Year-Old Man with Recurrent Transitional-Cell Carcinoma of the Ureter

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 23-2009 â A 13-Year-Old Boy with Headache, Nausea, Seizures, and Hypertension

ORIGINAL ARTICLE: Thrombomodulin Mutations in Atypical HemolyticâUremic Syndrome

CORRESPONDENCE: Anti-CTLA4 AntibodyâInduced Lupus Nephritis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 21-2009 â A 61-Year-Old Woman with Abdominal Pain, Weight Loss, and Renal Failure

EDITORIAL: Diabetes Complications and the ReninâAngiotensin System

EDITORIAL: Human Idiopathic Membranous Nephropathy â A Mystery Solved?

CORRESPONDENCE: B-CellâDepleting Induction Therapy and Acute Cellular Rejection

EDITORIAL: Membrane Physiology â Bridging the Gap between Medical Disciplines

CORRESPONDENCE: Eculizumab for Congenital Atypical HemolyticâUremic Syndrome

CORRESPONDENCE: Eculizumab for Atypical HemolyticâUremic Syndrome

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Proteinuria and Immunity â An Overstated Relationship?

EDITORIAL: Renal PhosphateâTransporter Regulatory Proteins and Nephrolithiasis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 27-2008 â A 64-Year-Old Man with Abdominal Pain, Nausea, and an Elevated Level of Serum Creatinine

EDITORIAL: Preeclampsia â A Glimpse into the Future?

CORRESPONDENCE: AntiâGlomerular Basement Membrane Disease after Alemtuzumab

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2008 â A 43-Year-Old Man with Fatigue and Lesions in the Pituitary and Cerebellum

EDITORIAL: FGF-23 and Outcomes Research â When Physiology Meets Epidemiology

EDITORIAL: Dialysis in Acute Kidney Injury â More Is Not Better

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 17-2008 â A 63-Year-Old Man with Metastatic Renal-Cell Carcinoma

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 8-2008 â A 33-Year-Old Man with Fever, Abdominal Pain, and Pancytopenia after Renal Transplantation

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 7-2008 â A 17-Year-Old Girl with Chest Pain and Hemoptysis

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 6-2008 â A 46-Year-Old Woman with Renal Failure and Stiffness of the Joints and Skin

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2008 â A 38-Year-Old Woman with Postpartum Visual Loss, Shortness of Breath, and Renal Failure

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 31-2007 â A 41-Year-Old Man with Abdominal Pain and Elevated Serum Creatinine

IMAGES IN CLINICAL MEDICINE: âMaltese Crossesâ in the Nephrotic Syndrome

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 25-2007 â A 60-Year-Old Man with Fever, Odynophagia, Weight Loss, and Rash

IMAGES IN CLINICAL MEDICINE: The Sign of LeserâTrÃ©lat