Chaudhry Adeel Ebad

Background Treatment for bladder cancer includes radical cystectomy (RC) and urinary diversion; RC is associated with long-term morbidity, kidney impairment and mortality. Aim To identify risk factors associated with postoperative long-term kidney function and mortality. Methods Retrospective study of patients with RC and urinary diversion in Beaumont Hospital from 1996 to 2016. We included patients who had follow-up at least 2 years post-procedure. We assessed estimated glomerular filtration rate (eGFR) preoperatively and yearly post-procedure, dialysis commencement and mortality. Cox and Fine-Gray regression analyses were applied; p-value < 0.05 was considered significant. Results We included 264 patients, median age 68.3 years, 73.7% males. The most common diagnosis was bladder cancer 93.3%, TNM stages T ≥ 2 75.9%, N ≥ 1 47.6% and M1 28%. The median eGFR preoperative was 65.8 ml/min/1.73m² and after 2 years 58.2 ml/min/1.73m² (p: 0.009); 5.3% required chronic dialysis and 32.8% had a decrease > 10 ml/min/1.73m². Risk factors associated with ESKD and start dialysis included younger age (HR: 0.90, CI 95% 0.87–0.94) and lower pre-operative eGFR (HR: 0.97, CI 95% 0.94–1.00). Overall mortality was 43.2% and 54.1% at 5 and 10 years, respectively; risk factors were older age (HR: 1.04, CI 95% 1.02–1.06), tumour stage T ≥ 2 (HR: 2.22, CI 95% 1.39–3.54) and no chemotherapy (HR: 1.72, CI 95% 1.18–2.51). Limitations include retrospective design, absence of control group and single centre experience. Conclusions Patients with RC are at risk of progressive kidney function deterioration and elevated mortality and the main risk factors associated were age and preoperative eGFR. Regular monitoring of kidney function will permit early diagnosis and treatment.

Background. The role of kidney volume measurement in predicting the donor and recipient kidney function is not clear. Methods. We measured kidney volume bilaterally in living kidney donors using CT angiography and assessed the association with the donor remaining kidney and recipient kidney (donated kidney) function at 1 year after kidney transplantation. Donor volume was categorized into tertiles based on lowest, middle, and highest volume. Results. There were 166 living donor and recipient pairs. The mean donor age was 44.8 years (SD10.8), and donor mean BMI was 25.5 (SD2.9). The recipients of living donor kidneys were 64 male and had a mean age of 43.5 years (SD13.3). Six percent of patients experienced an episode of cellular rejection and were maintained on dialysis for a mean of 18 months (1332) prior to transplant. Kidney volume was divided into tertiles based on lowest, middle, and highest volume. Kidney volume median (range) in tertiles 1, 2, and 3 was 124 (89135ml), 155 (136164ml), and 184 (165240ml) with donor eGFR ml/min (adjusted for body surface area expressed as ml/min/1.73m²) at the time of donation in each tertile, 109 (93129), 110 (92132), and 101ml/min (84117). The median (IQR) eGFR in tertiles 1 to 3 in kidney recipients at 1 year after donation was 54 (4467), 62 (5075), and 63ml/min (5879), respectively. The median (IQR) eGFR in tertiles 1 to 3 in the remaining kidney of donors at 1 year after donation was 59 (5366), 65 (5772), and 65ml/min (5673), respectively. Conclusion. Bigger kidney volume was associated with better eGFR at 1 year after transplant in the recipient and marginally in the donor remaining kidney.

Leptospirosis is an exceptionally rare infectious disease in the Republic of Ireland. Leptospirosis can present with or mimic thrombotic microangiopathies (TTP/HUS). A 48-year-old male presented to a peripheral hospital with a short history of diarrhoea, anaemia, hyperbilirubinemia, raised lactate dehydrogenase, thrombocytopenia, and severe acute kidney injury and was transferred to our tertiary care kidney centre. A form of acute thrombotic microangiopathy (TMA) was suspected. However, no schistocytes were seen on the blood film, and the reticulocyte count was depressed. A kidney biopsy was performed before initiating any potential treatment which revealed acute interstitial nephritis (AIN). Leptospirosis was considered and subsequently serologically confirmed. The patient was managed with antimicrobials and supportive therapy. Acute kidney injury is common in leptospirosis and is often due to AIN. Initial presentation can mimic TMA; however, a differential diagnosis of leptospirosis should be considered even in nonendemic areas due to re-emergence of the disease.