Significance Statement: Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. More than 1500 patients were collated in an international longitudinal study to revise the ANCA kidney risk score. The score showed satisfactory performance, mimicking the original study (Harrell's C=0.779). In the development cohort of 959 patients, no additional parameters aiding the tool were detected, but replacing the GFR with creatinine identified an additional cutoff. The parameter interstitial fibrosis and tubular atrophy was modified to allow wider access, risk points were reweighted, and a fourth risk group was created, improving predictive ability (C=0.831). In the validation, the new model performed similarly well with excellent calibration and discrimination (n=480, C=0.821). The revised score optimizes prognostication for clinical practice and trials. Background: Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. A retrospective international longitudinal cohort was collated to revise the ANCA renal risk score. Methods: The primary end point was ESKD with patients censored at last follow-up. Cox proportional hazards were used to reweight risk factors. Kaplan–Meier curves, Harrell's C statistic, receiver operating characteristics, and calibration plots were used to assess model performance. Results: Of 1591 patients, 1439 were included in the final analyses, 2:1 randomly allocated per center to development and validation cohorts (52% male, median age 64 years). In the development cohort (n=959), the ANCA renal risk score was validated and calibrated, and parameters were reinvestigated modifying interstitial fibrosis and tubular atrophy allowing semiquantitative reporting. An additional cutoff for kidney function (K) was identified, and serum creatinine replaced GFR (K0: 450 µmol/L=11 points). The risk points for the percentage of normal glomeruli (N) and interstitial fibrosis and tubular atrophy (T) were reweighted (N0: >25%=0, N1: 10%–25%=4, N2: <10%=7, T0: none/mild or <25%=0, T1: ≥ mild-moderate or ≥25%=3 points), and four risk groups created: low (0–4 points), moderate (5–11), high (12–18), and very high (21). Discrimination was C=0.831, and the 3-year kidney survival was 96%, 79%, 54%, and 19%, respectively. The revised score performed similarly well in the validation cohort with excellent calibration and discrimination (n=480, C=0.821). Conclusions: The updated score optimizes clinicopathologic prognostication for clinical practice and trials.

Objectives: Lymphocele is a well-known postoperative surgical complication after kidney transplant. In this study, our aim was to analyze incidence, risk factors, and outcomes of posttransplant lymphocele in a large cohort. Materials and Methods: This observational study included 395 consecutive patients (219 males and 176 females) who underwent kidney transplant procedures from 183 living and 212 deceased donors in our center between January 2007 and 2014. A lymphocele was diagnosed with ultrasonography. Results: The incidence of lymphoceles in our cohort was 31.9% (n = 126). There were no significant differences with regard to body mass indexes, age of donors, deceased donor ratios, acute rejection episodes, and history of abdominal surgery between those with and without lymphoceles. The pretransplant serum albumin levels (3.29 +/- 0.67 vs 3.48 +/- 0.69 g/dL; P = .009) in the lymphocele group and diabetes mellitus ratios (15.9% vs 4.5%; P < .001) in the nonlymphocele group were lower than levels shown in the other group. The lymphocele ratio in patients who received cyclosporine was higher than that shown in patients who did not received it (37.5% vs. 27.4%; P = .032). There was no difference in lymphocele incidence between patients who were taking and those who were not taking mammalian target of rapamycin inhibitors, mycophenolate mofetil, or mycophenolate sodium. In regression analysis, presence of diabetes mellitus, transplant from deceased donors, older age of donors, and lower albumin levels were independent risk factors for posttransplant lymphocele occurrence. Conclusions: Posttransplant lymphocele was a relatively common surgical complication in our cohort. We concluded that diabetes mellitus, use of kidneys from deceased donors, older donor age, and hypoalbuminemia were independent risk factors for lymphocele development.

Background: Mushroom poisoning causes common gastrointestinal symptoms such as nausea and vomiting and is a well-known reason for acute hepatic failure. Acute kidney injury is a less common clinical presentation in mushroom poisoning. Recently, nephrotoxicity called Amanita nephrotoxic syndrome has been defined, caused by several Amanita mushrooms. It is characterized by moderate hepatotoxicity and oligoanuric acute kidney injury, which may require hemodialysis. Case presentation: Case 1 was a 51-year-old female patient who was hospitalized with oliguria, nausea, and vomiting after eating mushrooms, required hemodialysis due to acute kidney injury, and developed pulmonary hemorrhage during her follow-up. Case 2 was a 55-year-old male patient who was hospitalized with anuria, nausea, and vomiting after eating mushrooms, required hemodialysis due to acute kidney injury, and developed acute coronary syndrome during his follow-up. Case 3 was a 59-year-old male patient who was hospitalized with oliguria, nausea, and vomiting after eating mushrooms, required hemodialysis due to acute kidney injury, and developed moderate hepatotoxicity during his follow-up. All cases were hospitalized at the same time interval with similar clinical features. Acute kidney injury was the initial presentation of all the cases, and they had only mild transaminase elevation with normal INR levels. They all required hemodialysis, and kidney injury was fully recovered. Conclusions: Mushroom consumption must be questioned in acute kidney injury patients of unknown etiology where mushrooms are habitual despite deleterious consequences.

The activation of the sympathetic nervous system, which usually leads to a swift surge in blood pressure in the morning hours (MBPS) may be the cause of left ventricular hypertrophy (LVH) and endot...