IntroductionBoth cCTX/GCs and CNIs are recommended as first-line agents in the management of PMN. The present study is an extended report of patients randomized to receive TAC/GCs or cCTX/GCs at 2 years post randomization.MethodsSeventy patients enrolled in the clinical trial Tacrolimus Combined With Corticosteroids Versus Modified Ponticelli Regimen in Treatment of Idiopathic Membranous Nephropathy: Randomized Control Trial were followed quarterly between 12 and 24 months. At the end of 24 months, 3 patients were lost to follow-up.ResultsAt 18 months, 66% and 89% (P = 0.04) were in remission in TAC/GCs and cCTX/GCs groups, respectively. At 18 and 24 months, 60% and 86% (P = 0.03) of cases were in remission in the TAC/GCs and cCTX/GCs groups, respectively. At 18 months, 57% and 83% (P = 0.03) of the patients in TAC/GCs and cCTX/GCs groups were in remission without need of any additional immunosuppression (persistent remission) and, at 24 months, 43% and 80% (P = 0.002) were in persistent remission in TAC/GCs and cCTX/GCs groups, respectively. Relapse rate after any remission was 40% and 6.7% in TAC/GCs and cCTX/GCs groups, respectively (P = 0.007). There was an association of aPLA2R titers with remission or resistance (P = 0.006) in relapsing PMN. The significant decrease in eGFR after 12 months of TAC/GCs therapy normalized at 18 and 24 months.DiscussionAt 2 years after randomization, relapse rates are higher for TAC/GCs compared with cCTX/GCs in PMN patients. Thus, cCTX/GCs are better than TAC/GCs in the longer term in PMN patients.

Extranasal S. aureus carriage is as significant a risk factor as nasal carriage for staphylococcal infections in patients on HD through catheters. The study is limited by lack of molecular phenotyping.

BackgroundAbsolute necessity in acute kidney injury (AKI) and ignorance in chronic kidney disease (CKD) make the use of un-cuffed, non-tunneled catheters an indispensable vascular access for hemodialysis. Although these catheters should be inserted under radiological guidance, it may not be feasible in certain circumstances. The aim of the present study was to evaluate safety and outcome of non-imaging assisted insertion of these catheters in internal jugular vein (IJV) for hemodialysis.MethodsWe analyzed 233 attempts of non-imaging assisted un-cuffed, non-tunneled IJV catheterization at our center. The immediate insertion complications, duration of use, rate and type of infection and other complications were assessed.ResultsOut of the 233 attempts, 223 (213-right, 10-left) were successful. The most common indication was AKI (n = 127, 54.5%), followed by CKD (n = 99, 42.5%). Successful catheterization at first attempt was achieved in 78.9%. Insertion complications were noted in 12.8% and included arterial puncture (5.2%), hematoma (3.0%) and malposition (2.1%). Amongst 219 catheters followed for 4825 days, the mean duration of use was 22 days. Catheter related infections occurred in 42 patients with an incidence of 8.7 per 1000 catheter days. Bacteraemia was present in 10/36 cases (27.7%), positive catheter tip cultures in 71.4% cases and staphylococcal species were the most common organism. Cumulative hazard analysis by Cox regression revealed a linear increase in the risk for infection with each week.ConclusionNon-imaging assisted insertion of uncuffed, non-tunneled catheters is associated with slightly higher rate of insertion complication but comparable outcome in terms of infection rate or days of use.