Chronic kidney disease is a progressive, incurable condition that involves a gradual loss of kidney function. While there are no non-invasive biomarkers available to determine whether individuals are susceptible to developing chronic kidney disease, small RNAs within urinary exosomes have recently emerged as a potential candidate to use for assessing renal function. Ultracentrifugation is the gold standard for urinary exosome isolation. However, extravesicular small RNA contamination can occur when isolating exosomes from biological fluids using ultracentrifugation, which may lead to misidentifying the presence of certain small RNA species in human urinary exosomes. Therefore, we characterized human urinary exosomal preparations isolated by ultracentrifugation alone, or via ultracentrifugation followed by size exclusion chromatography (SEC) column-purification. Using nanoparticle tracking analysis, we identified SEC fractions containing robust amounts of exosome-sized particles, that we further characterized using immunoblotting. When compared to exosomal preparations isolated by ultracentrifugation only, SEC fractionated exosomal preparations showed higher levels of the exosome-positive marker CD81. Moreover, while the exosome-negative marker calnexin was undetectable in SEC fractionated exosomal preparations, we did observe calnexin detection in the exosomal preparations isolated by ultracentrifugation alone, which implies contamination in these preparations. Lastly, we imaged SEC fractionated exosomal preparations using transmission electron microscopy to confirm these preparations contained human urinary exosomes. Our results indicate that combining ultracentrifugation and SEC column-purification exosome isolation strategies is a powerful approach for collecting contaminant-free human urinary exosomes and should be considered when exosomes devoid of contamination are needed for downstream applications.

The early detection of chronic kidney disease (CKD) is key to reducing the burden of disease and rising costs of care. This need has spurred interest in finding new biomarkers for CKD. Ideal bi-omarkers for CKD should be: easy to measure; stable; reliably detected, even when interfering substances are present; site-specific based on the type of injury (tubules vs. glomeruli); and its changes in concentration should correlate with disease risk or outcome. Currently, no single can-didate biomarker fulfills these criteria effectively, and the mechanisms underlying kidney fibrosis are not fully understood; however, there is growing evidence in support of microRNA-mediated pro-cesses. Specifically, urinary exosomal microRNAs may serve as biomarkers for kidney fibrosis. In-creasing incidences of obesity and the recognition of obesity-associated CKD have increased interest in the interplay of obesity and CKD. In this review, we provide: (1) an overview of the current scope of CKD biomarkers within obese individuals to elucidate the genetic pathways unique to obesi-ty-related CKD; (2) a review of microRNA expression in obese individuals with kidney fibrosis in the presence of comorbidities, such as diabetes mellitus and hypertension; (3) a review of thera-peutic processes, such as diet and exercise, that may influence miR-expression in obesity-associated CKD; (4) a review of the technical aspects of urinary exosome isolation; and (5) future areas of research.

A 7-year-old girl presented with lymphadenopathy and bruising suggestive of leukemia. Complete blood count was significant for white blood cell count of 479,000/mm³. Basic metabolic panel sent via pneumatic tube system was significant for potassium > 10 mEq/L. The stat venous blood gas potassium level was 4.6 mEq/L. A 12-lead-ECG showed sinus tachycardia without peaked T-waves. It was determined that this was pseudohyperkalemia associated with significant hyperleukocytosis. This brief report discusses rare causes of pseudohyperkalemia that can be overlooked, and details the postulated mechanisms for pseudohyperkalemia in the setting of hyperleukocytosis.

Introduction: Since the US Medical Licensing Examination (USMLE) Step 1 became Pass/Fall in 2022, medical students competing for residency spots must distinguish themselves with alternative criteria. Research experiences and output offer valuable skill development and objective metrics to support competitive residency applications. Objective: We describe the methodological development of a structured program to support, enhance, and track medical student research efforts at the University of South Carolina School of Medicine Greenville, explain the implementation of the program, and summarize initial program outcomes. Methods: The Student Opportunities for Academic Achievement Through Research in Greenville (SOARinG) Program was established to serve as a centralized hub for rising second year medical student research. The program matched medical students with mentored research projects scheduled during the summer following first-year coursework. The program included a required weekly seminar series on research basics and current biomedical literature. SOARinG culminated with a student research symposium for which students submitted abstracts and presented a poster or a talk. Quantitative and qualitative program outcomes of student and mentor satisfaction with the program were measured through surveys. Results and Discussion: The program was successfully implemented in summers 2021 and 2022. Most students (80– 95%) in each class engaged in mentored summer research projects. Students reported overall satisfaction with research projects and mentor support. Overall, 69% of students rated their overall research experience in the program as extremely good or very good. Each student submitted an abstract and presented at the program’s symposium or alternate research venue. Overall, 97% of research mentors reported that students were adequately prepared for summer research and suggested that students would benefit from additional skills-specific research training. Conclusion: The SOARinG Program provided a formalized process for tracking and showcasing medical student research and allowed for increased student participation in research. Additionally, each participating student produced objective research output, thus enhancing future residency applications.

Objectives: Pediatric hypertension (HTN) requires accurate, timely diagnosis, and management to prevent long-term adverse cardiac events. Our health system's adherence to the American Academy of Pediatrics best practice guidelines (AAP 2017) was noted to be suboptimal, including gaps in blood pressure (BP) screening, repeat BP measurements after an elevated BP, and documentation. A quality improvement (QI) project was conducted to improve adherence to the guideline among children aged 3–18 years at systemwide pediatric primary care clinics from June 2024 through December 2024. Design: The QI project was evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Education on accurate BP measurement and AAP guidelines were delivered in primary care clinics within one Southeast health system. Data were extracted from electronic health records 4 times: preintervention, midpoint, postintervention, and 6-month follow-up. Results: Reach: Participating clinics cared for 9781 children, representing 25.27% of the system's population. Effectiveness: Repeat BP measurement after an elevated BP significantly improved from 5.58% preintervention to 11.22% at follow-up, peaking at 17.29% postintervention ( P < 0.01). Overall BP screening rates remained stable over time but significantly improved in clinics providing care for both adults and children. The proportion of elevated BP among boys significantly decreased from preintervention to postintervention, whereas no significant changes were observed among girls. Adoption: Approximately three-quarters (73.33%) of invited clinics participated in the QI project. Implementation: Staff education on accurate BP measurements was the most used implementation strategy across participating clinics (100%). Maintenance: BP screening rates remained stable, and repeated BP measurements were partially sustained at 6-month follow-up. Conclusions: This QI project improved adherence to AAP guidelines by increasing accurate BP measurement, primarily through staff education. Further research should explore strategies to improve long-term adherence to pediatric HTN guidelines and address BP measurement challenges in children under the age of 5.