Varicella-zoster immune globulin (VZIG), an immunoglobulin prepared from normal donor plasma selected for high titer of antibody to varicella-zoster virus (VZV), and zoster immune globulin (ZIG), prepared from the plasma of donors convalescing from herpes zoster, were compared in a double-blind, randomized clinical trial to determine their relative efficacy in protecting immunosuppressed children from severe varicella. VZV infection occurred in 49 (60.4%) of 81 recipients of VZIG and in 57 (68.6%) of 83 recipients of ZIG. These rates and the clinical severity of varicella were not significantly different; however, the subclinical infection rate was significantly higher in ZIG recipients (31.3% vs. 16.0%). This difference was accounted for by a subgroup of patients receiving immunosuppressive therapy for nonneoplastic diseases. Doubling the dose of VZIG administered reduced the rate of subclinical infection. These data indicate that VZIG can be used to protect immunosuppressed children from severe chicken pox.

Indoxyl sulphate is one of many potential protein bound uremic toxins. This review explores the mechanisms behind elevated indoxyl sulphate levels in renal impairment; the effects this may have on the organism; and methods that may lower these elevated levels. ABSTRACT:In the last decade, chronic kidney disease (CKD), defined as reduced renal function (glomerular filtration rate (

Field study revealed great differences in the biological productivity of two adjacent areas of a Michigan trout stream resulting from the entrance of domestic sewage into the stream between the two areas. Monthly samples were collected from the two areas to determine the seasonal cycles in abundance of bottom fauna, feeding habits of the trout, and coefficient of condition of the brown trout.In the less productive area upstream, a paucity of food of aquatic origin caused a sharp decline in condition of the fish, a reduction in the quantity of food per stomach, and a shift to a diet containing a considerable portion of terrestrial organisms.In the more productive area downstream (which, throughout the year, had a greater volume of bottom fauna than the unproductive area) trout maintained a significantly higher and much less variable coefficient of condition, their stomachs contained more food in midsummer and did not show the increase in terrestrial foods.

Indoxyl sulfate (IS) is a protein-bound uremic toxin that accumulates in patients with declining kidney function. Although generally thought of as a consequence of declining kidney function, emerging evidence demonstrates direct cytotoxic role of IS on endothelial cells and cardiomyocytes, largely through the expression of pro-inflammatory and pro-fibrotic factors. The direct toxicity of IS on human kidney proximal tubular epithelial cells (PTECs) remains a matter of debate. The current study explored the effect of IS on primary cultures of human PTECs and HK-2, an immortalized human PTEC line. Pathologically relevant concentrations of IS induced apoptosis and increased the expression of the proapoptotic molecule Bax in both cell types. IS impaired mitochondrial metabolic activity and induced cellular hypertrophy. Furthermore, statistically significant upregulation of pro-fibrotic (transforming growth factor-β, fibronectin) and pro-inflammatory molecules (interleukin-6, interleukin-8, and tumor necrosis factor-α) in response to IS was observed. Albumin had no influence on the toxicity of IS. The results of this study suggest that IS directly induced a pro-inflammatory and pro-fibrotic phenotype in proximal tubular cells. In light of the associated apoptosis, hypertrophy, and metabolic dysfunction, this study demonstrates that IS may play a role in the progression of chronic kidney disease.

Cabozantinib is a multi-tyrosine kinase inhibitor used for the treatment of various solid-organ tumours. It was recently approved as a first- and second-line therapeutic for the management of advanced/metastatic renal cell carcinoma based on the results of two randomised controlled trials. The phase III METEOR trial compared cabozantinib against everolimus as a second- or greater line therapy and found benefits in progression-free and overall survival, and the phase II CABOSUN trial compared cabozantinib against sunitinib as a first-line therapeutic and found benefits in terms of progression-free survival. This review briefly summarises how cabozantinib fits into current treatment paradigms for the management of advanced renal cell carcinoma.

No abstract

Risk factors for CKD after nephrectomy generally relate to worse baseline health, or likelihood of undergoing radical nephrectomy. Surgeons in rural centres and hospitals with low caseloads may benefit from formalized integration with specialist centers for continued professional development and case-conferencing, to assist in management decisions.

Background Withdrawal from dialysis is an increasingly common cause of death in patients with end-stage kidney disease (ESKD). As most published reports of dialysis withdrawal have been outside the Oceania region, the aims of this study were to determine the frequency, temporal pattern and predictors of dialysis withdrawal in Australian and New Zealand patients receiving chronic haemodialysis. Methods This study included all people with ESKD in Australia and New Zealand who commenced chronic haemodialysis between 1 January 1997 and 31 December 2016, using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Competing risk regression models were used to identify predictors of dialysis withdrawal mortality, using non-withdrawal cause of death as the competing risk event. Results Among 40 447 people receiving chronic haemodialysis (median age 62 years, 61% male, 9% Indigenous), dialysis withdrawal mortality rates increased from 1.02 per 100 patient-years (11% of all deaths) during the period 1997–2000 to 2.20 per 100 patient-years (32% of all deaths) during 2013–16 (P < 0.001). Variables that were significantly associated with a higher likelihood of haemodialysis withdrawal were older age {≥70 years subdistribution hazard ratio [SHR] 1.77 [95% confidence interval (CI) 1.66–1.89]; reference 60–70 years}, female sex [SHR 1.14 (95% CI 1.09–1.21)], white race [Asian SHR 0.56 (95% CI 0.49–0.65), Aboriginal and Torres Strait Islander SHR 0.83 (95% CI 0.74–0.93), Pacific Islander SHR 0.47 (95% CI 0.39–0.68), reference white race], coronary artery disease [SHR 1.18 (95% CI 1.11–1.25)], cerebrovascular disease [SHR 1.15 (95% CI 1.08–1.23)], chronic lung disease [SHR 1.13 (95% CI 1.06–1.21)] and more recent era [2013–16 SHR 3.96 (95% CI 3.56–4.48); reference 1997–2000]. Conclusions Death due to haemodialysis withdrawal has become increasingly common in Australia and New Zealand over time. Predictors of haemodialysis withdrawal include older age, female sex, white race and haemodialysis commencement in a more recent era.