Previous studies that have assessed the association of pre-transplant antiphospholipase A2 receptor autoantibody (PLA2R-Ab) concentration with a recurrence of membranous nephropathy (rMN) post-kidney transplant have yielded variable results. We tested 16 consecutive transplant patients with a history of iMN for pre-transplant PLA2R-Ab. Enzyme-linked immunosorbent assay titers (Euroimmun, NJ, USA) >14 RU/mL were considered positive. A receiver operating characteristic (ROC) analysis was performed after combining data from Quintana et al. (n = 21; Transplantation February 2015) to determine a PLA2R-Ab concentration which could predict rMN. Six of 16 (37%) patients had biopsy-proven rMN at a median of 3.2 yr post-transplant. Of these, five of six (83%) had a positive PLA2R-Ab pre-transplant with a median of 82 RU/mL (range = 31-1500). The only patient who had rMN with negative PLA2R-Ab was later diagnosed with B-cell lymphoma. One hundred percent (n = 10) of patients with no evidence of rMN (median follow-up = five yr) had negative pre-transplant PLA2R-Ab. In a combined ROC analysis (n = 37), a pre-transplant PLA2R-Ab > 29 RU/mL predicted rMN with a sensitivity of 85% and a specificity of 92%. Pre-transplant PLA2R-Ab could be a useful tool for the prediction of rMN. Patients with rMN in the absence of PLA2R-Ab should be screened for occult malignancy and/or alternate antigens.

Cancer is a growing health problem worldwide. Common treatments include surgery, chemotherapy and radiation therapy. Systemic anti-cancer medications often result in an array of physical and psychological side effects. Supportive care assists patients with cancer in managing multidimensional symptoms that result from treatment or the illness itself. This review discusses supportive care and examines patient counselling and mind-diversion activities, which are safe and cost-effective strategies. Improving cancer patients' health and wellbeing should be encouraged in oncology nursing practice and by teaching students the knowledge and skills needed to provide supportive care.

A 58-year-old male with diabetes and chronic kidney disease presented with a history of malaise, fatigue, and sore throat. He also had experienced intermittent nausea, vomiting, and diarrhea over the prior 2 weeks and reported subjective fevers and chills. Physical examination was unremarkable. Basic metabolic panel demonstrated acute kidney injury (AKI).The patient was administered intravenous saline. A renal ultrasound demonstrated normal anatomy, and Clostridium difficile antigen was negative. He was started on ceftriaxone and metronidazole for bacterial intestinal overgrowth. Emesis and diarrhea improved after 24 hours of antibiotics; however, renal function continued to worsen. The patient developed volume overload and ultimately required hemodialysis. Transthoracic echocardiogram showed low normal left ventricular systolic function with a trivial pericardial effusion. Urinalysis revealed proteinuria, hematuria, and pyuria. Urine culture was negative. Complement 3 level was low at 47.6 mg/dL (lower limit 90 mg/dL). Complement 4 level was normal. Both erythrocyte sedimentation rate and C-reactive protein were markedly elevated. Antinuclear antibody, antineutrophil cytoplasmic antibody, anti-double-stranded DNA, anti-Ro, anti-La, and antiglomerular basement membrane antibody were negative. Serum protein electrophoresis and urine protein electrophoresis were negative. Creatinine kinase was within normal limits. Hepatitis B and C antibodies were nonreactive, as were HIV antibodies, rheumatoid factor, and cryoglobulins. Serum IgA was 582 mg/dL (upper limit 400 mg/dL) and IgG was 3190 mg/ dL (upper limit 1523 mg/dL). Antistreptolysin O titer was 2484 IU/mL (upper limit of normal 200 IU/mL). The patient was diagnosed with poststreptococcal glomerulonephritis and continued to tolerate dialysis well. Before discharge, the patient developed intractable hiccups. Chest X-ray revealed only resolving pulmonary edema. He was discharged with plans for outpatient chest and abdominal computed tomography (CT) to further evaluate his hiccups.The following day, he presented to the emergency department with acute dyspnea after routine hemodialysis. He had tachypnea and hypoxia that responded to supplemental oxygen. Systolic blood pressure decreased by 10 mm Hg with inspiration. Chest CT demonstrated a moderate pericardial effusion. A repeat transthoracic echocardiogram (online video) showed a pericardial effusion with right atrial and right ventricular diastolic collapse. The patient underwent urgent pericardiocentesis with removal of 700 mL of sanguineous fluid. Bacterial, fungal, mycobacterial cultures, and cytology were negative. His blood urea nitrogen was 39 mg/dL on re-presentation to the hospital. Nine months later, the patient has had no recurrence of pericardial effusion. He has recovered kidney function and no longer requires hemodialysis. DiscussionPericarditis in conjunction with nephritis presents as an interesting clinical picture, leading one to consider a robust list of differential diagnoses that includes autoim...

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