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Background: Infection is a rare complication of percutaneous renal biopsy (RB). However, the questionnaire included in the Kidney Biopsy Guidebook 2020 in Japan revealed that antibiotic prophylaxis (AP) was administered at about 60% of hospitals. The objective of this study was to evaluate whether it is possible to omit AP for RB., Methods: Patients aged ≥ 15 years were eligible. Three hundred and sixty-four patients were recruited at 6 hospitals. The patients were randomly assigned to receive either a single dose of intravenous cefazolin or no antibiotic prophylaxis. The primary outcome was the percentage of patients that exhibited positive urine cultures 3 or 4 days after the RB. The secondary outcomes were the percentage of patients who were diagnosed with pyelonephritis, puncture site infections (PSI), or an infection other than pyelonephritis or PSI within 30 days, and cefazolin-induced side effects., Results: With regard to the primary outcome, there was no statistically significant difference between the cefazolin group and the no AP group (2.9% versus 5.1%, p = 0.416). With regard to the secondary outcomes, only one patient (who belonged to no AP group) developed pyelonephritis. This patient underwent urinary catheterization. No PSI occurred. There were no significant intergroup differences in any secondary outcomes., Conclusion: This study revealed the incidence of post-percutaneous RB infections was minimal. Although the outcomes of this study did not lead to the conclusion that it is unnecessary to use AP for RB, the obtained data suggest that the effects of such AP may not be clinically significant., Competing Interests: Declarations. Conflict of interest: The authors declare the conflicts of interest. Ethical approval: All procedures performed in studies involving human participants were carried out in accordance with the ethical standards of the relevant institutional and/or national research committee (IRB approval number 1000) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: The study participants provided written informed consent., (© 2024. The Author(s), under exclusive licence to Japanese Society of Nephrology.)

One of the most common causes of peritoneal dialysis withdrawal is ultrafiltration failure which is characterized by peritoneal membrane thickening and fibrosis. Although previous studies have demonstrated the inhibitory effect of p38 MAPK inhibitors on peritoneal fibrosis in mice, it was unclear which specific cells contribute to peritoneal fibrosis. To investigate the role of p38 MAPK in peritoneal fibrosis more precisely, we examined the expression of p38 MAPK in human peritoneum and generated systemic inducible p38 MAPK knockout mice and macrophage-specific p38 MAPK knockout mice. Furthermore, the response to lipopolysaccharide (LPS) was assessed in p38 MAPK-knocked down RAW 264.7 cells to further explore the role of p38 MAPK in macrophages. We found that phosphorylated p38 MAPK levels were increased in the thickened peritoneum of both human and mice. Both chlorhexidine gluconate (CG)-treated systemic inducible and macrophage-specific p38 MAPK knockout mice ameliorated peritoneal thickening, mRNA expression related to inflammation and fibrosis, and the number of αSMA- and MAC-2-positive cells in the peritoneum compared to CG control mice. Reduction of p38 MAPK in RAW 264.7 cells suppressed inflammatory mRNA expression induced by LPS. These findings suggest that p38 MAPK in macrophages plays a critical role in peritoneal inflammation and thickening., (© 2024. The Author(s).)

Introduction: Hybrid dialysis is widely used in Japan. Although previous reports have shown the beneficial effects of hybrid dialysis, little is known about the daily change in peritoneal ultrafiltration volume in hybrid dialysis., Methods: A multicenter, cross-sectional study was conducted in 25 patients with hybrid dialysis. The primary outcome measure was the change in peritoneal ultrafiltration volume between after HD and before HD, according to PD prescription and PD holiday. The secondary outcome measure was the correlation between the difference in ultrafiltration volume and each factor., Results: The total ultrafiltration volume and the ultrafiltration volume of glucose dialysate after HD increased from 970 ± 408 to 1151 ± 480 (p < 0.01) and from 576 ± 392 to 750 ± 517 (p < 0.01), respectively, compared with before HD. In contrast, the ultrafiltration volume of icodextrin dialysate did not change (from 470 ± 204 to 494 ± 242, p = 0.40). The difference in total ultrafiltration volume was correlated with the difference in glucose dialysate ultrafiltration volume and hybrid duration, but not with the difference in icodextrin dialysate ultrafiltration volume and peritoneal dialysis duration., Conclusion: This study showed that the peritoneal ultrafiltration volume for glucose dialysate increased after HD compared with before HD in patients with hybrid dialysis, whereas that for icodextrin dialysate did not change., (© 2024 International Society for Apheresis and Japanese Society for Apheresis.)

Introduction: Clinically amyopathic dermatomyositis (CADM) with anti-melanoma differentiation-associated gene 5 (MDA5) antibody (Ab) with rapidly progressive interstitial lung disease (RP-ILD) is often refractory for intensive immunosuppression. In this study, we verified the effectiveness and safety of plasma exchange (PEx) for this lethal disease., Methods: We retrospectively examined the clinical course and adverse effect (AE) of 12 patients with anti-MDA5 Ab-positive CADM between January 2017 and December 2021 in our hospital., Results: Five out of six patients treated with simple PEx using fresh frozen plasma or 5% albumin survived with or without home oxygen therapy. Multiple PEx (15-20 times) were required to achieve satisfactory improvement as well as remission of CADM. The AEs caused by PEx were resolved using conventional methods., Conclusion: PEx might be a promising option for controlling the disease activity of anti-MDA5 Ab-positive CADM with severe RP-ILD and may contribute to better survival., (© 2024 International Society for Apheresis and Japanese Society for Apheresis.)

Introduction: A novel LDL (low-density lipoprotein) apheresis therapeutic option, Rheocarna, has garnered attention as an alternative therapy for chronic limb-threating ischemia (CLTI). Bradykinin-mediated vasodilation is involved in the effects of LDL apheresis and a decrease in blood pressure (BP), but the changes in bradykinin concentration during Rheocarna therapy are unknown., Methods: The study involved patients with CLTI treated with Rheocarna at our hospital, from April 2022 to August 2023., Results: After Rheocarna therapy, skin ulcers improved in 80% of the patients. Circuit coagulation was observed in two patients with high fibrinogen levels. A decrease in BP was observed at approximately the same time when the bradykinin concentration peaked. The peak bradykinin concentration in a patient undergoing hemodialysis at the same time was considerably lower than that in the other patients., Conclusion: This is the first report on the changes in bradykinin concentration under Rheocarna therapy., (© 2024 International Society for Apheresis and Japanese Society for Apheresis.)

BK polyomavirus (BKPyV) infection causes various diseases in immunocompromised patients. Cells from human lung and kidney were infected with BKPyV and treated with commercially available intravenous immunoglobulin G (IVIG). Its effects on BKPyV replication and spread of infection were investigated, focusing on administration timing. IVIG treatment 3 hours after infection suppressed BKPyV replication assessed by real-time PCR and expression of the viral capsid protein 1 and large T-antigen. IVIG effectively reduced the number of BKPyV-infected cells 2 weeks after infection in an antibody titer-dependent manner. Virus release in the culture supernatants was not influenced by IVIG treatment 6-80 hours and 3-9 days after infection. Collectively, IVIG did not affect viral release from infected cells but inhibited the spread of infection by neutralizing the released virus and blocking the new infected cell formation, indicating greater efficacy in early localized infection. BKPyV replication resumed in IVIG-treated cultures at 7 days after IVIG removal. Early prophylactic administration of IVIG is expected to reduce the growth and spread of BKPyV infection, resulting in the reduction of infected cell lesions and prevention of BKPyV-associated diseases., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)