The survival advantage observed among peritoneal dialysis patients early on after dialysis initiation has been largely attributed to residual renal function (RRF) preservation due to higher baseline residual function and fewer comorbidities. We hypothesize that a rapid decline in RRF is associated with higher risk of anuria and mortality. In a retrospective cohort study of 581 subjects on peritoneal dialysis with longitudinal prevalent data, we assessed whether RRF change over time, in addition to baseline RRF, increased risk of mortality and anuria using Kaplan-Meier analysis and Cox proportional hazard analysis to control for known risk factors. Rapid RRF decline (≥ 0.09 decline) over a 12-month period was associated with a 2.6-fold increase in the risk of death (hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.66 - 4.07, compared with < 0.09 decline) and a 2-fold increase in anuria (HR 2.06, 95% CI 1.24 - 3.42). Each quartile of increasing severity of RRF decline over a 12-month period increased risk incrementally for death (2 quartile: HR 3.04, CI 1.26 - 7.34; 3 quartile: HR 4.01, CI 1.71 - 9.83; 4 quartile HR 5.78, CI 2.10 - 15.9) and generally for anuria (quartiles with HR 5.72 - 7.21). The escalating risk of mortality and anuria was greater for those with diabetes mellitus. In conclusion, rapid decline in RRF over a 12-month period increased the risk of mortality and likewise anuria, beyond previously established risk factors for mortality and anuria. The impact on mortality and RRF preservation was particularly severe for those with diabetes mellitus.

The association between malignancy and glomerular disease has been appreciated for decades [Baschinsky et al., Am J Kidney Dis 2000;36:E24]. Several types of glomerular injury in patients with cancer have been recognized [Morikawa et al., CEN Case Rep 2013;2:158-164; Baschinsky et al., Am J Kidney Dis 2000;36:E24]. The most common association is between nephrotic syndrome and carcinoma [Baschinsky et al., Am J Kidney Dis 2000;36:E24]. We report a case of anti-neutrophil cytoplasmic antibody-negative crescentic glomerulonephritis associated with lung cancer. To the best of our knowledge, only 1 other case of ANCA-negative pauci-immune crescentic glomerulonephritis associated with lung cancer has been reported [Baschinsky et al., Am J Kidney Dis 2000;36:E24].

Introduction. The most commonly seen glomerular disease in HIV infected patients is HIV-associated nephropathy (HIVAN); however, a multitude of other nephropathies can occur in HIV infection with an almost equal cumulative frequency. We report an unusual case of a patient with clinical and histological evidence of HIVAN in which the diagnosis was initially confounded by the finding of an elevated serum anti-glomerular basement membrane (anti-GBM) antibody. Case Presentation. We present a case of a 27-year-old African American female with a history of schizophrenia, cocaine abuse, and HIV infection who upon admission to our hospital was found to have severe acute kidney injury requiring hemodialysis. Urine studies revealed nephrotic range proteinuria and a serological workup was positive for anti-GBM antibody elevation with a value of 91 units (normal: 0–20 units). A renal biopsy revealed HIVAN with no evidence of crescentic glomerulonephritis or anti-GBM disease. Conclusion. This case highlights the need for careful interpretation of anti-GBM antibody tests in HIV infected patients with kidney disease and, in particular, the need for biopsy confirmation of the diagnosis prior to starting therapy. More research is needed to study the prognostic correlation between the degree of anti-GBM antibody elevation in HIVAN and disease severity.