WITHDRAWN: Endothelium in the allograft.

The paper entitled "Endothelium in the allograft" by Bryan N Becker et al, which was published online on 9 September 2009, has been withdrawn at the authors' request. Kidney International advance online publication, 9 September 2009; doi:10.1038/ki.2009.333.

Calciphylaxis responsive to lanthanum carbonate (FOSRENOL) therapy.

Calciphylaxis is a rare and debilitating vasculopathy predominantly seen in patients with renal failure. The proposed mechanism of injury is active vascular calcification with associated elevated parathyroid hormone, hypercalcemia, or hyperphosphatemia. With improved pharmacologic agents including non-calcium containing phosphate binders, vitamin D analogues, calcimimetics, and bisphosphonates, targeted therapy on the mineralization process has been tried with varied success. We report a case of biopsy-proven calciphylaxis in a patient with acute kidney injury requiring dialysis that had persistently elevated calcium-phosphorus product refractory to treatment. The patient, however, responded rapidly to the initiation of lanthanum carbonate therapy and modified dialysis. This is the first known case reported in the literature utilizing this new non-calcium-based phosphate binder in the setting of calciphylaxis.

Knowledge of phosphorus compared with other nutrients in maintenance dialysis patients.

OBJECTIVE: This study's objective was to assess knowledge of phosphorus compared with other nutrients in patients undergoing maintenance dialysis (MD). DESIGN: We compared knowledge of phosphorus vs. other nutrients important to the MD diet (potassium, sodium, and protein) in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). We further measured gender, age, education level, and functional health literacy to assess correlations in patient nutrient knowledge. Nutrient knowledge was measured using a 25-item Chronic Kidney Disease Knowledge Assessment Tool for Nutrition (CKDKAT-N), and functional health literacy was measured using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). SETTING AND PATIENTS: Patients received maintenance outpatient PD or HD at Wisconsin Dialysis, Inc. (Madison, WI). MAIN OUTCOME MEASURE: The main outcome measure was knowledge of phosphorus vs. knowledge of potassium, sodium, and protein. RESULTS: Forty-seven MD patients participated in the study (29 undergoing HD, 18 undergoing PD, 30 males, 17 females, average age of 58.6 (SD, 13.8) years, and average grade level of 1.4 (SD, 2.6) years of post-secondary education). Thirty-five participants had adequate health literacy, 4 had marginal health literacy, and 8 had inadequate health literacy. The CKDKAT-N scores ranged from 6-21 for 25 items, with a mean score of 13 (SD, 2.91). Knowledge of phosphorus compared with knowledge of other nutrients was poor (0.38 vs. 0.72, P = .003). In a comparison of HD vs. PD patient knowledge, both phosphorus (0.37 vs. 0.42, P = .231) and other nutrients (0.69 vs. 0.80, P = .115) were the same. CONCLUSION: Despite regular dietary instruction, patients undergoing MD have a poor knowledge of dietary phosphorus content, compared with knowledge of other nutrients important in chronic kidney disease. Interestingly, there was no difference in nutrition knowledge when comparing PD and HD patients, despite differences in education level and health literacy between groups.

Local television news reporting of kidney disease.

BACKGROUND: Local television is the primary news source for the majority of Americans. This study aims to describe how local news reports on kidney disease. METHODS: Using our searchable database of health-related late local news segments from 2002, we identified stories with the key words kidney, hypertension, blood pressure, or diabetes. This database is a representative sample of the late local news on 122 stations in the 50 largest US media markets, comprising 60% of the population. The content of each identified story was reviewed to determine whether it mentioned: (1) chronic kidney disease (CKD), (2) screening for kidney disease, or (3) kidney disease as a potential complication (for blood pressure- or diabetes-related stories). RESULTS: Only 2 of 1,799 database news stories (0.11%) included "kidney" as a summary key word; neither referred to CKD, screening, or complications of other diseases. Of 19 stories about hypertension or blood pressure (1.06% of all stories) and the 14 stories about diabetes (0.78% of all stories), none mentioned these criteria. CONCLUSION: Despite efforts to increase public awareness of and screening for CKD, local television news (the most important news source for a majority of Americans) did little to help achieve these goals. Further work will be needed to confirm whether this paucity of coverage varies over time and determine why so little attention is given to CKD. Educating physicians and public relations personnel who advocate for kidney disease about journalists' needs may be an important step to help advance public awareness of CKD.

Conflicting dietary advice for adhering to low-sodium and low-phosphorus diets.

OBJECTIVE: To elucidate conflicts that patients face when advised to limit multiple nutrients in their diet. DESIGN: We analyzed the phosphorus content of low-sodium foods compared with their regular-sodium content counterparts, and the sodium content of low-phosphorus foods compared with foods containing higher levels of phosphorus. Low-sodium and low-phosphorus foods were identified with the use of recommendations from National Kidney Foundation patient information Web sites. Content of sodium and phosphorus was quantified with use of the US Department of Agriculture (USDA) Nutrient Database. SETTING: Review and analysis of publicly available patient information Web sites and nutrient databases. MAIN OUTCOME MEASURE: Phosphorus content of low- versus regular-sodium-containing foods, and sodium content of low- versus high-phosphorus-containing foods. RESULTS: Of 47 low-sodium foods, 32 had identical phosphorus content--8 higher and 7 lower--compared with regular-sodium alternatives. Of 9 foods recommended as low-phosphorus alternatives to high-phosphorus choices, 4 had higher sodium content and 5 had lower, with considerable variability. However, choosing servings of 4 low-sodium alternatives could increase ingestion of phosphorus by up to 16% of recommended intake, and choosing servings of 4 low-phosphorus alternatives could increase ingestion of sodium by more than 20% of recommended intake. CONCLUSION: Adhering to a complex renal diet is extremely difficult for patients with chronic kidney disease. Balancing sodium and phosphorus restrictions is particularly challenging, especially as food choices low in one nutrient may not be low in the other. To help patients follow these diets, alternative methods of achieving dietary restrictions of multiple, often conflicting, components may be needed.

Karyomegalic tubulointerstitial nephritis--a case report.

Karyomegalic tubulointerstitial nephritis is a rare disease of uncertain etiology, which leads to progressive renal failure. Here, we report on a 39-year-old patient who presented with asymptomatic progressive decline of renal function. Two sequential renal biopsies demonstrated chronic tubulointerstitial nephritis with bizarre and dramatic enlargement of proximal tubule epithelial cell nuclei - the hallmark of karyomegalic nephritis. Clinical and pathologic findings of this case are discussed in light of the available literature. The morphologic changes in this disease are highly characteristic if the pathologist is aware of this entity.

Evaluation of eHealth web sites for patients with chronic kidney disease.

BACKGROUND: Chronic kidney disease (CKD) affects up to 19.2 million Americans, and untreated kidney disease can progress to kidney failure. Patient education is an important part of slowing disease progression, but the ability of health professionals to provide this education is limited by time constraints. To date, there have been no systematic evaluations of CKD eHealth Web sites. METHODS: Seven nonproprietary and 4 proprietary Web sites geared toward educating patients with CKD were identified by using the Internet to search for the terms "chronic kidney disease," "kidney disease," and "chronic renal failure." Web sites were evaluated according to (1) compliance with the principles of the Health on the Net (HON) Foundation Code of Conduct and (2) reading grade level. RESULTS: Nonproprietary sites were in compliance with an average of 5.2 principles, with a range of 3 to 8. Average compliance of proprietary Web sites with the HON Code of Conduct principles was 3.12, with a range of 2 to 4 (P = 0.021). Of nonproprietary Web sites, average reading grade level assessed by the Fry Readability Scale was greater than grade 14, with a range from grade 11 through graduate school. Of proprietary sites, average readability was grade 11, with a range from grades 7 through 16 (P = 0.575). CONCLUSION: The Internet has the potential to be a very powerful educational tool for patients with CKD. However, many easily accessed CKD public health Web sites do not comply with accepted standards for health Web sites and are written using language beyond the general public's reading comprehension.