Paul L. Kimmel

Myoglobin released during muscle injury can precipitate acute renal failure.1,2 There are many causes of rhabdomyolysis, including excessive exercise, “crush” injuries, seizures, infections, severe potassium and phosphate depletion, staphylococcal toxins, venoms, and licit and illicit drugs, including ethanol.2–4 Intoxication with the liqueur absinthe (derived from oil of wormwood) has not been associated with rhabdomyolysis or acute renal failure. We report the case of a patient who was hospitalized after drinking essential oil of wormwood purchased through the Internet. Case Report A 31-year-old man was found at home by his father in an agitated, incoherent, and disoriented state. Paramedics . . .

Although serum amylase and lipase levels have been studied extensively in patients with renal disease, there are fewer data regarding trypsinogen levels in patients with end-stage renal disease (ESRD) treated with different dialytic modalities. We therefore evaluated the blood concentrations of trypsinogen, amylase, and lipase in asymptomatic patients with chronic renal insufficiency (CRI) and ESRD, to determine whether treatment modality or renal handling of these enzymes is important in determining steady-state levels in asymptomatic patients with chronic renal disease. Mean trypsinogen concentration levels were higher in hemodialysis (HD) patients and patients with CRI compared with normal subjects when values in the different groups were compared. There was no difference in the mean trypsinogen levels between patients treated with HD and those with CRI, between patients treated with chronic ambulatory peritoneal dialysis (CAPD) and those treated with HD, or between CAPD patients and patients with CRI. The mean circulating trypsinogen concentration was elevated more frequently and to a higher level than amylase or lipase in patients with CRI and ESRD. HD treatment did not result in a lowering of mean circulating pancreatic enzyme levels. We propose that decreased peripheral clearance, pancreatic overproduction, increased release from the pancreas, or a combination of these mechanisms is responsible, at least in part, for the increased plasma concentration of trypsinogen in patients with CRI, rather than simply a decrease in renal clearance.

The HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis was a randomized, controlled trial funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Patients on hemodialysis suffering from chronic pain were randomly assigned to receive usual care or a 12-week pain coping skills training program delivered remotely by trained coaches followed by 12 weeks of skills reinforcement via interactive voice response. Patient advisors participated in all stages of the study, including study design and development of recruitment materials. During the trial, patient advisors met monthly as an Advisory Board. In addition, patient advisors participated in all Steering Committee meetings, including in-person meetings and biweekly remote meetings. Patient advisors were represented on all study committees, with particularly extensive involvement in the Recruitment and Retention Committee. Patient advisors made important contributions to study design and conduct. Their involvement was critical to the study's successful enrollment and retention of study participants. Patient advisors characterized their involvement positively. They attributed their satisfaction with the experience to their full integration into in all aspects of the study and their treatment as equal partners. Several patient advisors have subsequently taken on other research, patient advocacy, or leadership roles, facilitated in part through their participation in the HOPE Trial. This study details the ways patient advisors were enlisted and decided to participate; outlines their many contributions; describes their experience; and provides guidance on how researchers can successfully incorporate patient advisors into future studies.

There are several HIV-associated renal disease, the pathogenesis of which is intimately related to the viral infection. Patients' demographic characteristics and clinical syndrome analysis may provide clinical clues to the individual renal disease, but in cases where a precise diagnosis is necessary, a renal biopsy is the only definitive way to establish the diagnosis. The explosion of knowledge regarding the molecular biology of the HIV life cycle and its mechanisms of infection has provided us not only with insights into the causes of the renal diseases, but has allowed nephrologists to advance, in the course of a decade, from therapeutic nihilism to the ability to provide treatment for the early and later stages of several of these diseases. It is hoped that with better understanding of the pathogenesis of the spectrum of kidney diseases encountered in HIV-infected patients, and the initiation and completion of properly designed and controlled therapeutic trials, patients quality and length of life will be enhanced.