Canadian Journal of Kidney Health and Disease

Lanktree, Matthew B.; Ashawasega, Nick; Bevilacqua, Micheli; Bichet, Daniel G; Bollée, Guillaume; Brown, Pierre-Antoine; Girard, Louis; Goodyer, Paul; Hingwala, Jay; Lemaire, Mathieu; McFarlane, Philip; Moist, Louise; Pei, York; Proulx, Normand; Schott, Clara; Soroka, Steven; Vlasschaert, Caitlyn; Watkins, Nicholas; Alam, Ahsan

doi: 10.1177/20543581261455635pmid: 42257014

Purpose of review1) Provide a Canadian perspective on the 2025 Kidney Disease Improving Global Outcomes (KDIGO) Autosomal Dominant Polycystic Kidney Disease (ADPKD) guidelines; 2) identify challenges and nuances in applying these guidelines in Canada; 3) highlight shifts in expert practice points for Canadian care providers; 4) outline opportunities for research, knowledge translation, and quality improvement in Canada.Sources of informationThe KDIGO 2025 Clinical Practice Guideline Update for the management of ADPKD, as well as a survey and discussion by Canadian experts in ADPKD.MethodsThe co-chairs invited stakeholders from the Canadian ADPKD community to ensure national representation, including adult and pediatric clinicians, trainees, a genetic counselor, and a patient partner with an Indigenous perspective. Members were surveyed to identify key practice points. Subgroups reviewed issues and drafted discussion topics. All members reviewed the final draft.Key FindingsThe committee commented on recommendations with nuance for Canadian practitioners, especially on multidisciplinary care, challenges with genetic testing, and the use of CKD therapies like sodium-glucose transport protein 2 (SGLT2) inhibitors in ADPKD.LimitationsThe committee relied on the evidence summaries produced by KDIGO and the experience and knowledge of committee members. The committee did not replicate or update the systematic reviews.

DeBusschere, Alex; Lunney, Meaghan; Reid, Sonja; Verdin, Nancy; Love, Shannan; Crysdale, Gillian; Thompson, Stephanie; Nicholas, David; Boulton, Tiffany; Schick-Makaroff, Kara; Jenstad, Lorienne; Straus, Sharon; Holroyd-Leduc, Jayna; Donald, Maoliosa; Sullivan, Patti-Jo; Howarth, Tanis; Evans, Julie; Tonelli, Marcello

Fernández‐García, Oscar A.; Co, Justin; Suandork, Tanya; Leeies, Murdoch; Doucette, Karen Elizabeth

doi: 10.1177/20543581261463456pmid: N/A

BackgroundCanadian regulatory standards require the label increased risk donor (IRD) be applied to donors with risk factors for hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus infection (HIV). This study aimed to assess trends in the rate of IRD and specific donor risk factors over time as well as the association with donor screening results for HBV, HCV and HIV.MethodsThis was a retrospective study of deceased organ donors at 2 Canadian centers (University of Alberta Hospital and Transplant Manitoba) encompassing an overlapping period between 2013 and 2022. The proportion of IRD donations over time were analyzed with trend analysis. Trends for risk factors and their association with donor screening results were explored.ResultsOverall, 332 of 1491 (22.3%) donors were categorized as IRD. A significant rising trend of IRD donors was documented for Alberta. Any donor drug use and overdose as cause of death increased during the study period and were strongly associated with HCV infection (OR 18.03 (6.34-51.2) p<0.001 and OR 6.48 (3.32-12.65) p<0.001). Donors classified as men who had sex with men (MSM) did not have an increased risk of HBV, HCV or HIV. Answers to some questions on the donor risk history were “I don’t know” in up to 20% of specific questionnaire items.ConclusionsOur study demonstrates a rising proportion of IRD organ donations in 2 Canadian transplant centers. The regulatory requirements include variables not associated with HBV/HCV/HIV and do not capture others associated with risk in this cohort. The proportion of “I don’t know” responses on the donor risk assessment highlights its limitations. This data may inform donor risk assessment in the Canadian setting and highlights the changing epidemiology of HBV/HCV/HIV in organ donors.

Landsberg, Adina; Marzolf, Dale E.; Walker, Simon R.; Cheema, Kim; Harrison, Tyrone G.

doi: 10.1177/20543581261454486pmid: 42293166

Anti-neutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) and primary focal segmental glomerulosclerosis (FSGS) are distinct glomerular diseases that rarely occur together. When present concurrently, they may produce overlapping nephritic and nephrotic features that complicate diagnosis and management. We report a case of a 63-year-old man who presented with four weeks of progressive anasarca and several months of cognitive changes, blurry vision, and paresthesia. Investigations demonstrated nephrotic-range proteinuria (8.25 g per day), hypoalbuminemia, hematuria, acute kidney injury, and hypertension. Kidney biopsy demonstrated two concurrent pathologies: FSGS with complete podocyte foot process effacement and pauci-immune glomerulonephritis with focal active crescents. Serology confirmed proteinase 3 antibody (PR3)-ANCA positivity, establishing active AAV alongside primary FSGS. Treatment included pulse intravenous methylprednisolone followed by oral prednisone and rituximab for induction and maintenance of AAV. Because nephrotic syndrome persisted, calcineurin inhibitor therapy was initiated for steroid-resistant FSGS (cyclosporine followed by tacrolimus). Adjunctive antiproteinuric therapies included renin-angiotensin system blockade, sodium-glucose cotransporter-2 inhibition, and later a nonsteroidal mineralocorticoid antagonist. The patient eventually achieved partial remission with resolution of his nephrotic syndrome and undetectable PR3 titers. After 2.5 years of follow-up, kidney function stabilized at an estimated glomerular filtration rate (eGFR) of 29 mL/min/1.73 m2 with persistent urine albumin-to-creatinine ratio (ACR) of 163 mg/mmol despite maximal antiproteinuric therapy. Long-term complications included diabetes mellitus related to immunosuppression. This case illustrates the rare coexistence of primary FSGS and PR3-positive AAV requiring simultaneous treatment, with differing responses to therapy. It highlights the challenges of assessing treatment response in dual glomerular pathology while balancing aggressive immunosuppression against systemic toxicity. Incorporation of the patient perspective in this case report highlights the lived experience and burden of managing concurrent FSGS and AAV.

Tannar, Bryn; Al-Hellawi, Hareth; Sontrop, Jessica M.; Acedillo, Rey R.; Al-Jaishi, Ahmed A.; Anderson, Sierra; Bagga, Amit; Berry, David; Beaubien, Eliot; Blake, Peter G.; Bohm, Clara; Brown, Pierre Antoine; Bueti, Joe; Chan, Christopher T.; Cote, Brenden; Cowan, Andrea C.; Day, Nicole E.; Dev, Varun; Dhruve, Miten; Gregor, Laura;