Ocrelizumab is a recombinant humanized antibody targeted against CD‐20 molecule, which was approved for the treatment of relapsing and primary progressive multiple sclerosis. Common adverse events of ocrelizumab include infusion‐related reactions like rash, pruritus, and flushing. Late‐onset neutropenia (LON) is a rarely reported complication of ocrelizumab therapy. We report a case of severe late‐onset neutropenia in a patient with primary progressive multiple sclerosis treated with ocrelizumab with neutropenia occurring 3 months after the last dose received treated with empirical broad‐spectrum intravenous antibiotics and filgrastim. Severe late‐onset neutropenia is a rare unpredictable adverse event and outlines the importance of regular routine blood workup for detecting severe neutropenia early in its course.

In this systematic review and meta-analysis, we explored the utilization of cardiac magnetic resonance imaging (CMR) to detect fibrotic changes secondary to uremic cardiomyopathy during the early stages of chronic kidney disease (CKD) and in patients with end-stage kidney disease (ESKD). Uremic myocardial fibrosis can lead to arrhythmia and heart failure, and it is important to detect these changes. CMR offers a noninvasive way to characterize the severity of cardiac remodeling. A comprehensive search of multiple electronic databases was conducted. Studies were divided according to scanner field strength (1.5 or 3 Tesla). The random effects model was used to calculate the pooled mean, 95% confidence interval (CI), standard error, and standardized mean difference (SMD). The I2 statistic was used to assess the heterogeneity between study-specific estimates. The search retrieved 779 studies. From these, 20 studies met the inclusion criteria and had 642 CKD patients (mean age of 56.8 years; 65.2% males; mean estimated glomerular filtration rate (eGFR) of 33 mL/min/1.73 m2) and 658 ESKD patients on dialysis (mean age of 55.6 years; 63.3% males; mean dialysis duration of 3.47 years). CKD patients had an increased left ventricular mass index (LVMi) compared to controls, with an SMD of 0.37 (95% CI: 0.20-0.54; I2 0%; p-value <0.05). ESKD patients also had increased LVMi compared to controls, SMD 0.88 (95% CI: 0.35-1.41; I2 79.1%; p-value 0.001). Myocardial fibrosis assessment using T1 mapping showed elevated values; the SMD of native septal T1 values between CKD and controls was 1.099 (95% CI: 0.73-1.46; I2 33.6%; p-value <0.05), and the SMD of native septal T1 values between ESKD patients and controls was 1.12 (95% CI: 0.85-1.38; I2 33.69%; p-value <0.05). In conclusion, patients with CKD and ESKD with preserved left ventricular ejection fraction (LVEF) have higher LVMi and T1 values, indicating increased mass and fibrosis. T1 mapping can be used for the early detection of cardiomyopathy and as a risk stratification tool. Large, randomized trials are needed to confirm these findings and determine the effect of long-term dialysis on cardiac fibrosis.

Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) and systemic lupus erythematosus (SLE), though they share similar clinical characteristics, are distinguishable based on specific characteristics. The concomitant presentation of SLE and AAV as overlap syndrome is rare and makes the diagnosis challenging. Here, we describe a rare case of SLE and AAV overlaps presenting with hemorrhagic stroke as initial presentation, which has been reported only once before. The presence of several positive autoantibodies made the diagnosis challenging, but a kidney biopsy provided the definitive diagnosis and aided in initiating immunosuppressive therapy. The patient did not respond to standard initial surgical measures to lower elevated intracranial pressure and showed significant improvement to immunosuppressive therapy proving the temporal relationship. The authors of this case study aim to highlight the importance of considering SLE-AAV overlap in patients presenting with features similar to those described in the case report and intervening early, as delays in diagnosis can be fatal.

Background/Objectives: Patients with infective endocarditis (IE) are more susceptible to acute kidney injury (AKI). The presence of AKI increases in-hospital complications in these patients. Methods: The 2016–2020 National Inpatient Sample (NIS) database consisting of adult admissions with IE and AKI was utilized. The primary outcome was all-cause inpatient mortality. Secondary outcomes included fluid and electrolyte disorders, stroke, septic arterial embolism, septic shock, cardiogenic shock, valve surgery, vasopressor support, mechanical ventilation, length of stay (LOS), and total hospital charges. Results: Out of a total of 63,725 adult admissions with IE, 16,295 (25.5%) admissions had AKI. Patients with AKI were more likely to be males (63% vs. 57.6%, p < 0.001) and older (55.8 vs. 50.4, p < 0.001). A higher proportion of these patients were admitted to large hospitals (60.6 vs. 55.3%, p < 0.001) and urban teaching hospitals (81.9 vs. 75%, p < 0.001). Patients with AKI had higher LOS (17 ± 16.1 vs. 11.32 ± 11.7, p < 0.001) and hospital charges (USD 239,046.8 ± 303,977.3 vs. USD 124,857.6 ± 192,883.5, p < 0.001). Multivariable analysis showed higher odds of all-cause inpatient mortality (aOR: 2.22, 95% CI: 1.81–2.73, p < 0.001). They also had higher risk for fluid and electrolyte disorder (aOR: 2.31, 95% CI: 2.10–2.53, p < 0.001), septic arterial embolism (aOR: 1.61, 95% CI: 1.42–1.84, p < 0.001), septic shock (aOR: 3.78, 95% CI: 2.97–4.82, p < 0.001), cardiogenic shock (OR: 3.37, 95% CI: 2.65–4.28, p < 0.001), valve surgery (aOR: 1.52, 95% CI: 1.35–1.71, p < 0.001), vasopressor requirement (aOR: 1.99, 95% CI: 1.52–2.60, p < 0.001), and mechanical ventilation (aOR: 2.75, 95% CI: 2.33–3.24, p < 0.001). The association with stroke was elevated but not statistically significant. Conclusions: This large retrospective analysis demonstrated that patients with AKI and infective endocarditis had increased mortality, adverse hospital outcomes, increased LOS, and hospital costs.

Background: We investigated the rates of acute kidney injury (AKI) post robot‐assisted laparoscopic prostatectomy (RALP).Methods: A comprehensive search was conducted to identify studies that reported the rates of AKI post‐RALP. A random effects model was used, and the pooled rates of AKI were calculated.Results: We identified 10 studies with 60,937 patients to be included. The mean age was 65.1 years. The mean anaesthesia time was 234.3 min (95% CI: 177.8–290.9). The mean operation time was 212.2 min (95% CI: 188.7–235.6). The mean estimated blood loss was 314.1 mL (95% CI: 153–475.3). The mean intraoperative IV fluids administered were 1985 mL (95% CI: 1516.3–2453.7). The pooled rate of AKI post RALP was 7.2% (95% CI 19–23.9).Conclusions: The rates of AKI after RALP are significant. Further studies are needed to detect the risk factors for AKI and to determine the rates of chronic kidney disease post‐RALP.

Diagnosing suspected renal or hepatic infections in autosomal dominant polycystic kidney disease (ADPKD) is difficult. Although 18-fluorodeoxyglucose positron-emission tomography-computed tomography (¹⁸F-FDG PET-CT) is recommended to aid in the diagnosis, there is no consensus about its diagnostic accuracy. We aimed to investigate its diagnostic performance. To further assess this, we performed a meta-analysis. A comprehensive literature search screening of PubMed/MEDLINE, Embase, and Cochrane library databases through February 2024 was performed. Pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and C-reactive protein (CRP) were estimated using the random effects model. Heterogeneity between studies was estimated using Cochran Q and I2 statistics. A total of seven studies were included in the final analysis. The pooled sensitivity of ¹⁸F-FDG PET-CT in diagnosing kidney and hepatic cyst infection was 82.6% (95% CI: 73.8-88.9; I2 16.9%), specificity was 77.6% (95% CI: 66.7-85.7; I2 15.6%), PPV was 79.4% (95% CI: 62.4-89.9; I2 62.6%), and NPV was 81.3% (95% CI: 72.7-87.7; I2 0%). The mean CRP was 244.2 mg/L (95% CI: 209.1-279.1; I2 66%). The results showed that ¹⁸F-FDG PET-CT demonstrated excellent pooled diagnostic performance in diagnosing renal and hepatic cyst infections in ADPKD.