Poemlarp Mekraksakit

Key Points: Our study found a high prevalence of monoclonal gammopathy (MG) in patients diagnosed with ANCA-negative pauci-immune crescentic GN. Patients with MG showed a higher degree of fibrosis on kidney biopsy than those without MG with higher mortality rate. Our data suggest an association between MG and ANCA-negative pauci-immune crescentic GN, emphasizing this population's need for MG testing and monitoring. Background: In a small subset of patients with pauci-immune crescentic GN (PICGN), ANCA are not identified, and patients are referred to as having ANCA-negative vasculitis. The cause of the disease in this subset of patients has remained elusive. We explored the role of monoclonal gammopathy (MG) in those with ANCA-negative PICGN. Methods: We conducted a retrospective study and identified patients with PICGN who had undergone ANCA and monoclonal testing. Those positive for ANCA were excluded. Results: We identified 14 patients with ANCA-negative vasculitis, of whom eight (57%) tested positive for MG with a mean age of 60.3±12.2 years, 75% were female, and with a mean serum creatinine of 4.3±1.92 mg/dl. The most common monoclonal proteins were IgG ( n =4, 50%) and kappa ( n =4, 50%). One patient had diagnosis of multiple myeloma. Most common extra-renal manifestations were skin rash (leukocytoclastic vasculitis) and neuropathy. Kidney biopsy showed a higher degree of interstitial fibrosis and tubular atrophy compared with those without MG. The median follow-up time was 3.2 years, with 50% mortality in those with MG. Conclusions: More than 50% of the patients with ANCA-negative PICGN have MG, and patients present with more evidence of fibrosis on kidney biopsy, with higher mortality rate observed in our cohort. Monoclonal proteins may trigger the development of PICGN; their specific role in the pathogenesis of this disease needs further investigation.

Background: ChatGPT is a novel tool that allows people to engage in conversations with an advanced machine learning model. ChatGPT's performance in the US Medical Licensing Examination is comparable with a successful candidate's performance. However, its performance in the nephrology field remains undetermined. This study assessed ChatGPT's capabilities in answering nephrology test questions. Methods: Questions sourced from Nephrology Self-Assessment Program and Kidney Self-Assessment Program were used, each with multiple-choice single-answer questions. Questions containing visual elements were excluded. Each question bank was run twice using GPT-3.5 and GPT-4. Total accuracy rate, defined as the percentage of correct answers obtained by ChatGPT in either the first or second run, and the total concordance, defined as the percentage of identical answers provided by ChatGPT during both runs, regardless of their correctness, were used to assess its performance. Results: A comprehensive assessment was conducted on a set of 975 questions, comprising 508 questions from Nephrology Self-Assessment Program and 467 from Kidney Self-Assessment Program. GPT-3.5 resulted in a total accuracy rate of 51%. Notably, the employment of Nephrology Self-Assessment Program yielded a higher accuracy rate compared with Kidney Self-Assessment Program (58% versus 44%; P < 0.001). The total concordance rate across all questions was 78%, with correct answers exhibiting a higher concordance rate (84%) compared with incorrect answers (73%) (P < 0.001). When examining various nephrology subfields, the total accuracy rates were relatively lower in electrolyte and acid-base disorder, glomerular disease, and kidney-related bone and stone disorders. The total accuracy rate of GPT-4's response was 74%, higher than GPT-3.5 (P < 0.001) but remained below the passing threshold and average scores of nephrology examinees (77%). Conclusions: ChatGPT exhibited limitations regarding accuracy and repeatability when addressing nephrology-related questions. Variations in performance were evident across various subfields.

Literature reviews are valuable for summarizing and evaluating the available evidence in various medical fields, including nephrology. However, identifying and exploring the potential sources requires focus and time devoted to literature searching for clinicians and researchers. ChatGPT is a novel artificial intelligence (AI) large language model (LLM) renowned for its exceptional ability to generate human-like responses across various tasks. However, whether ChatGPT can effectively assist medical professionals in identifying relevant literature is unclear. Therefore, this study aimed to assess the effectiveness of ChatGPT in identifying references to literature reviews in nephrology. We keyed the prompt “Please provide the references in Vancouver style and their links in recent literature on… name of the topic” into ChatGPT-3.5 (03/23 Version). We selected all the results provided by ChatGPT and assessed them for existence, relevance, and author/link correctness. We recorded each resource’s citations, authors, title, journal name, publication year, digital object identifier (DOI), and link. The relevance and correctness of each resource were verified by searching on Google Scholar. Of the total 610 references in the nephrology literature, only 378 (62%) of the references provided by ChatGPT existed, while 31% were fabricated, and 7% of citations were incomplete references. Notably, only 122 (20%) of references were authentic. Additionally, 256 (68%) of the links in the references were found to be incorrect, and the DOI was inaccurate in 206 (54%) of the references. Moreover, among those with a link provided, the link was correct in only 20% of cases, and 3% of the references were irrelevant. Notably, an analysis of specific topics in electrolyte, hemodialysis, and kidney stones found that >60% of the references were inaccurate or misleading, with less reliable authorship and links provided by ChatGPT. Based on our findings, the use of ChatGPT as a sole resource for identifying references to literature reviews in nephrology is not recommended. Future studies could explore ways to improve AI language models’ performance in identifying relevant nephrology literature.

Introduction: Posttransplant anemia is a common finding after kidney transplantation. A previous meta-analysis reported an association between anemia and graft loss. However, data on cardiovascular outcomes have not yet been reported. Objective: We conducted an updated meta-analysis to examine the association between posttransplant anemia and outcomes after transplantation including cardiovascular mortality in adult kidney transplant recipients. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to November 2021. Data from each study were combined using the random-effects model. Generic inverse variance method of DerSimonian and Laird was employed to calculate the risk ratios and 95% CIs. Results: Seventeen studies from August 2006 to April 2019 were included (16 463 kidney transplantation recipients). Posttransplant anemia was associated with overall mortality (pooled risk ratio = 1.72 [1.39, 2.13], I² = 56%), graft loss (pooled risk ratio = 2.28 [1.77, 2.93], I² = 94%), cardiovascular death (pooled risk ratio = 2.06 [1.35, 3.16], I² = 0%), and cardiovascular events (pooled risk ratio = 1.33 [1.10, 1.61], I² = 0%). Early anemia (≤6 months), compared with late anemia (>6 months), has higher risk of overall mortality and graft loss with a pooled risk ratio of 2.63 (95% CI 1.79-3.86; I² = 0%) and 2.96 (95% CI 2.29-3.82; I² = 0%), respectively. Discussion: In addition to increased risk of graft loss, our updated meta-analysis demonstrated that posttransplant anemia was significantly associated with poor outcomes after kidney transplantation including overall mortality, graft loss, cardiovascular death, and cardiovascular events. Future studies are required to assess the effects of treatment strategies for posttransplant anemia on posttransplant outcomes including cardiovascular mortality.

Granulomatosis with polyangiitis (GPA) is a rare small-vessel vasculitis associated with high mortality without appropriate treatment. Acute ST-elevation myocardial infarction (STEMI) has been reported as an atypical presentation of GPA. We report a case of STEMI, shortly followed by subacute in-stent thrombosis with extensive thrombus burden in a 53-year-old male patient with undiagnosed GPA. After aggressive treatment with triple therapy consisting of aspirin, clopidogrel and rivaroxaban, He started to have haemoptysis. Despite the discontinuation of aspirin, he ended up with massive haemoptysis and acute respiratory failure necessitating endotracheal intubation. CT of the chest revealed bilateral ground-glass opacities consistent with diffuse alveolar haemorrhage. Extensive workup revealed positive antiproteinase 3 antibodies; hence, a diagnosis of GPA was made. He was treated with induction therapy consisting of methylprednisolone, mycophenolate mofetil, cyclophosphamide and rituximab, leading to a gradual improvement in his clinical conditions and subsequent extubation.

Fungal empyema is an uncommon condition associated with high morbidity and mortality. Aspergillus empyema thoracis is rare and is usually associated with preexisting chronic empyema, pulmonary tuberculosis, or rupture of aspergilloma cavity. This case describes a healthy 20-year-old man presenting with chronic intractable back pain and constitutional symptoms for 6 months who was eventually diagnosed with Aspergillus empyema thoracis, complicated by empyema necessitans extending into multiple ribs and paravertebral areas. He was treated with surgical decortication, chest tube drainage, and systemic antifungal agents. The diagnostic difficulties of fungal empyema thoracis are highlighted.

Messenger RNA vaccines are the main COVID-19 vaccines authorized for use in the United States. Side effects are typically minor and transient. We report a case series of four subjects with an acute myocarditis-like illness following mRNA COVID-19 vaccination who were hospitalized at our hospital in Lubbock, Texas. Three patients were young men who presented with acute chest pain after the second dose of the mRNA-1273 vaccine. Another patient was a 53-year-old white woman who presented with acute left arm pain 3 days after the first dose of the mRNA-1273 vaccine. She was later found to have acute decompensated heart failure, and endomyocardial biopsy revealed eosinophilic injury–mediated myocarditis.

Background Post-transplant erythrocytosis (PTE) can occur in up to 10-16% after kidney transplant (KT). However, the post-transplant outcomes of recipients with PTE in the literature were conflicting. We performed systematic review and meta-analysis of published studies to evaluate risk factors of PTE as well as outcomes of recipients who developed PTE compared to controls. Methods A literature search was conducted evaluating all literature from existence through February 2, 2021, using MEDLINE and EMBASE. Data from each study were combined using the random-effects model. (PROSPERO: CRD42021230377) Results Thirty-nine studies from July 1982 to January 2021 were included (7,099 KT recipients). The following factors were associated with PTE development: male gender (pooled RR=1.62 [1.38, 1.91], I²=39%), deceased-donor KT (pooled RR=1.18 [1.03, 1.35], I²=32%), history of smoking (pooled RR=1.36 [1.11, 1.67], I²=13%), underlying polycystic kidney disease (PKD) (pooled RR=1.56 [1.21, 2.01], I²=44%), and pretransplant dialysis (pooled RR=1.6 [1.02, 2.51], I²=46%). However, PTE was not associated with outcomes of interest, including overall mortality, death-censored graft failure, and thromboembolism. Conclusion Our meta-analysis demonstrates that male gender, deceased-donor KT, history of smoking, underlying PKD, and pretransplant dialysis were significantly associated with developing PTE. However, with proper management, PTE has no impact on prognosis of KT patients.

Very-low-carbohydrate diets or ketogenic diets are frequently used for weight loss in adults and as a therapy for epilepsy in children. The incidence and characteristics of kidney stones in patients on ketogenic diets are not well studied. Methods: A systematic literature search was performed, using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from the databases’ inception through April 2020. Observational studies or clinical trials that provide data on the incidence and/or types of kidney stones in patients on ketogenic diets were included. We applied a random-effects model to estimate the incidence of kidney stones. Results: A total of 36 studies with 2795 patients on ketogenic diets were enrolled. The estimated pooled incidence of kidney stones was 5.9% (95% CI, 4.6–7.6%, I2 = 47%) in patients on ketogenic diets at a mean follow-up time of 3.7 +/− 2.9 years. Subgroup analyses demonstrated the estimated pooled incidence of kidney stones of 5.8% (95% CI, 4.4–7.5%, I2 = 49%) in children and 7.9% (95% CI, 2.8–20.1%, I2 = 29%) in adults, respectively. Within reported studies, 48.7% (95% CI, 33.2–64.6%) of kidney stones were uric stones, 36.5% (95% CI, 10.6–73.6%) were calcium-based (CaOx/CaP) stones, and 27.8% (95% CI, 12.1–51.9%) were mixed uric acid and calcium-based stones, respectively. Conclusions: The estimated incidence of kidney stones in patients on ketogenic diets is 5.9%. Its incidence is approximately 5.8% in children and 7.9% in adults. Uric acid stones are the most prevalent kidney stones in patients on ketogenic diets followed by calcium-based stones. These findings may impact the prevention and clinical management of kidney stones in patients on ketogenic diets.