Performance of estimated glomerular filtration rate equations in Black living kidney donor candidates.

INTRODUCTION: New estimated glomerular filtration rate (eGFR) equations using serum creatinine and/or cystatin C have been derived to eliminate adjustment by perceived Black ancestry. We sought to analyze the performance of newer eGFR equations among Black living kidney donor candidates. METHODS: Black candidates (n = 64) who had measured iothalamate GFR between January 2015 and October 2021 were included, and eGFR was calculated using race adjusted (eGFRcr2009 and eGFRcr-cys2012) and race unadjusted (eGFRcys2012, eGFRcr2021, and eGFRcr-cys2021) CKD-EPI equations. Bias and accuracy were calculated. RESULTS: The eGFRcr2021 equation had a negative bias of 9 mL/min/1.73 m2 , while other equations showed a modest positive bias. Accuracy within 10% and 30% was greatest using the eGFRcr-cys2021 equation. With the eGFRcr2021 equation, 9.4% of donors with an mGFR > 80 mL/min/1.73 m2 were misclassified as having an eGFR < 80 mL/min/1.73 m2 . eGFR was also compared among 18 kidney donors at 6-24 months post-donation. Post-donation, the percentage of donors with an eGFR < 60 mL/min/1.73 m2 was 44% using the eGFRcr2021 equation compared to 11% using the eGFRcr-cys2021 equation. CONCLUSION: The CKD-EPICr2021 equation appears to underestimate true GFR in Black living donor candidates. Alternatively, compared to CKD-EPICr2021, the CKD-EPICr-CysC2021 equation appears to perform with less bias and improved accuracy.

Early post-transplant cutaneous bacillary angiomatosis in a kidney recipient: Case report and review of the literature.

Bacillary angiomatosis (BA) is an uncommon systemic disease caused by Bartonella henselae (BH) or Bartonella quintana (BQ) that occurs primarily in immunocompromised hosts. Few cases of BA recipients have been reported in adult solid transplant recipients over the years, with most cases presenting years after transplant. We describe a case of a kidney transplant recipient who developed cutaneous BA very early in the post-transplant period despite not having any exposures. Retrospective testing of donor and recipient's serum was performed and raised the concern for possible donor-derived infection. A literature review encompassing 1990 to present was also performed in order to better understand the clinical presentation, diagnostics and therapeutic approach of this unusual disease. Combined serology, histopathology and molecular testing (polymerase chain reaction [PCR]) were useful in diagnosing BA in our patient as serology alone might be unreliable. Macrolides or doxycycline for at least 3 months is the recommended therapeutic strategy; however, the optimal duration of treatment is not well established in transplant recipients. In our patient, we decided to use doxycycline for 1 year due to gradual resolution of lesions and ongoing immunosuppression. Patient responded successfully without any documented relapse.

Vessel Preservation in Chronic Kidney Disease.

Chronic kidney disease (CKD) is a major noncommunicable disorder and has become the 9th leading cause of death in the United States. Most patients with CKD in the United States choose hemodialysis as their treatment of choice. A functioning arteriovenous access is essential to reduce dependence on central venous catheters. An arteriovenous fistula (AVF), though the preferred access, has a major limitation with a high primary maturation failure rate. A functioning AVF requires well-preserved vessels, both arteries and veins, along with an acceptable cardiac pump function. Vessel preservation is crucial from a surgeon's perspective to create an AVF but is also relevant for maturation. More recently, concerns regarding the sequelae of transradial approach for percutaneous cardiac interventions have been raised. Educating and empowering the patient is the first step, but equally important is to educate all caregivers involved in providing care to a patient with advanced CKD. The current review evaluates the strategies used to preserve peripheral veins, central veins, and peripheral arteries.

Cephalic Tetanus: A Case Report In 68-Year-Old Man.

Cephalic tetanus is an emergency condition, which is commonly observed in child age group here we report a case of 68-year-old man with the complain of right sided weakness for one day, associated with difficulty in breathing and speech, history of fall also present, case was diagnosed as cephalic tetanus. Here we report a case of cephalic tetanus in an elderly patient.