Anti-PLA2R antibodies (Ab) are a diagnostic and prognostic biomarker in primary membranous nephropathy (PMN). We assessed the relationship between the levels of anti-PLA2R Ab at diagnosis and different variables related to disease activity and prognosis in a western population of PMN patients. Forty-one patients with positive anti-PLA2R Ab from three nephrology departments in Israel were enrolled. Clinical and laboratory data were collected at diagnosis and after one year of follow-up, including serum anti-PLA2R Ab levels (ELISA) and glomerular PLA2R deposits on biopsy. Univariable statistical analysis and permutation-based ANOVA and ANCOVA tests were performed. The median [(interquartile range (IQR)) age of the patients was 63 [50–71], with 28 (68%) males. At the time of diagnosis, 38 (93%) of the patients had nephrotic range proteinuria, and 19 (46%) had heavy proteinuria (≥8 gr/24 h). The median [IQR] level of anti-PLA2R at diagnosis was 78 [35–183] RU/mL. Anti-PLA2R levels at diagnosis were correlated with 24 h proteinuria, hypoalbuminemia and remission after one year (p = 0.017, p = 0.003 and p = 0.034, respectively). The correlations for 24 h proteinuria and hypoalbuminemia remained significant after adjustment for immunosuppressive treatment (p = 0.003 and p = 0.034, respectively). Higher levels of anti-PLA2R Ab at diagnosis in patients with active PMN from a western population are associated with higher proteinuria, lower serum albumin and remission one year after the diagnosis. This finding supports the prognostic value of anti-PLA2R Ab levels and their possible use in stratifying PMN patients.

Peritoneal dialysis is a feasible, cost-effective, home-based treatment of renal replacement therapy, based on the dialytic properties of the peritoneal membrane. As compared with hemodialysis, peritoneal dialysis is cheaper, survival rate is similar, residual kidney function is better preserved, fluid and solutes are removed more gradually and continuously leading to minimal impact on hemodynamics, and risks related to a vascular access are avoided. Those features of peritoneal dialysis are useful to treat refractory congestive heart failure patients with fluid overload. It was shown that in such patients, peritoneal dialysis improves functional status and quality of life, reduces hospitalization rate, and may decrease mortality rate. High levels of serum proinflammatory cytokines and fibrosis markers, among other factors, play an important part in congestive heart failure pathogenesis and progression. We demonstrated that those levels decreased following peritoneal dialysis treatment in refractory congestive heart failure patients. The exact mechanism of beneficial effect of peritoneal dialysis in refractory congestive heart failure is currently unknown. Maintenance of fluid balance, leading to resetting of neurohumoral activation towards a more physiological condition, reduced remodeling due to the decrease in mechanical pressure on the heart, decreased inflammatory cytokine levels and oxidative stress, and a potential impact on uremic toxins could play a role in this regard. In this paper, we describe the unique characteristics of the peritoneal membrane, principals of peritoneal dialysis and its role in heart failure patients.

Background: The diagnosis of peritonitis among peritoneal dialysis (PD) patients is based on clinical presentation, dialysis effluentwhite blood cell (WBC) count, and dialysis effluent culture. Peritoneal fluid WBC count is very important in the initial diagnosis of peritonitis.The purpose of this work was to determine the optimal number of peritoneal WBCs with different clinical presentations at admissionto define PD-related peritonitis.Methods: Medical records of chronic PD patients who underwent work-up for suspected peritonitis between 2008 and 2019 were reviewedretrospectively. Results of all peritoneal WBC count tests during this period were collected. Clinical manifestations and follow-up analysis of each peritoneal WBC count were performed.Results: The peritoneal WBC count cutoff of 100/μL recommended by International Society for Peritoneal Dialysis provided specificityof only 35%. Increasing peritoneal WBC count cutoff to 150, 200, and 250/μL provided sensitivity around 98% and gradually increasingspecificity. The chi-square automatic interaction detector model of statistical analysis determined that peritoneal WBC count below230/μL combined with absence of inflammatory markers (fever, increased C-reactive protein) ruled out peritonitis with 99.8%sensitivity. Peritoneal fluid WBC count cutoff of 230/μL provided specificity of 89% and good positive and negative likelihood scoresof 8.3 and 0.03, respectively. Peritoneal fluid polymorphonuclear count has lower discriminating ability for peritonitis compared toperitoneal fluid WBC count.Conclusion: Increasing peritoneal fluid WBC count cutoff to 230/μL in suspected PD-related peritonitis could improve specificity withoutcompromising the sensitivity of the test.

Evidence on the association between dialysis facility accessibility and mortality in small countries is limited. This study evaluated the association between travel distance and one- and two-year mortality among Israeli end-stage renal disease (ESRD) patients. Data were obtained from the National Renal Replacement Therapy Registry, encompassing all Israeli ESRD patients aged ≥ 45 years who initiated hemodialysis in 2010–2021. Sociodemographic (age, sex, population group), treatment-related (hospital/community treatment, primary renal disease, incident-year cohort), and geographic (residency socioeconomic and peripherality indices) data were collected. Travel distances from the most recent address to the initial treating facility were categorized into three groups based on the 50th and 90th percentiles, excluding outliers (> 100 km). Adjusted Cox regressions assessed associations between travel distances and mortality, with incident-year cohort-specific models evaluating temporal hazard variations. Analyses included 15,606 patients. The long-distance group (> 26.39 km) was characterized by younger age, Arab ethnicity, peripheral residence, and lower socioeconomic status. Compared to the short-distance group (≤ 6.80 km), the hazard ratios (HRs) in the intermediate-distance group (> 6.80 and ≤ 26.39 km) were 1.216 (1.106–1.337) for one-year and 1.181 (1.093–1.275) for two-year mortality. In the long-distance group, the HRs were 1.718 (1.460–2.021) for one-year and 1.554 (1.351–1.787) for two-year mortality ( P-for-trend between travel distances <.001). Sensitivity and temporal analyses confirmed consistent associations across incident-year cohorts, alternative cut-offs, and outlier inclusion. The association between travel distance and mortality highlights the need to improve geographic accessibility to healthcare to reduce inequities, especially for life-sustaining chronic treatments such as hemodialysis.

Extreme swing of phosphor from severe hyperphosphatemia to severe hypophosphatemia in a patient with blast crisis of myeloid origin was the result of imbalance between massive apoptosis of leukemic cells in the context of spontaneous tumor lysis syndrome and massive production of leukemic cells with only 1% of blast in peripheral blood. The mutated p53 protein suggested acting as oncogene in the presented case and possibly affecting phosphor status.