Publications by authors named "K L Swanson"

895 Publications

Cytomegalovirus nephritis in kidney transplant recipients: Epidemiology and outcomes of an uncommon diagnosis.

Transpl Infect Dis 2021 Jul 29. Epub 2021 Jul 29.

Division of Nephrology, Department of Medicine, University of Wisconsin, Madison, WI, 53705, United States.

Background: Data on epidemiology and outcomes of cytomegalovirus (CMV) nephritis in kidney transplant patients are limited, due to the rarity of this condition.

Methods: A retrospective review of all kidney transplant recipients (KTR, n = 6490) and biopsy-proven CMV nephritis between 1/1997 and 12/2020 was performed.

Results: The prevalence of CMV nephritis was low: 13/6490 (0.2%). The diagnosis was made at a median of 7.0 months (range 2.6-15.6 months) after transplant. 6/13 (46%) patients were CMV (D+/R-). Median CMV DNA load at biopsy was 446,000 IU/mL (range 58,200 to 6,460,000 IU/mL). Main biopsy features were CMV glomerulitis (n = 7/13, 54%) followed by CMV tubulointerstitial nephritis (6/13; 46%). Mean eGFR at biopsy (22.7 ± 12 mL/min/1.73 m ) was significantly decreased compared to baseline eGFR (38.7 ± 18.5 mL/min/1.73 m , p = 0.02). The vast majority 11/13 (85%) experienced graft failure including 5/13 (38%) death-censored. 5/13 (38%) patients were diagnosed with acute rejection: 3 had concurrent acute rejection and 2 had rejection within 3 months of index biopsy, respectively. Patients with tubulointerstitial CMV nephritis were significantly more likely to have rejection at the time of biopsy (50% vs 0%, p <0.05) compared to those with glomerular CMV nephritis. There were no significant differences between these groups in terms of eGFR at all time points, death, graft failure, immunosuppression changes or rejection after biopsy.

Conclusion: CMV nephritis is rare but appears to be associated with poor patient/allograft outcomes. Early identification and timely treatment of CMV infection may prevent end organ involvement and improve patient and allograft-related outcomes. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/tid.13702DOI Listing
July 2021

Transplant kidney biopsy for proteinuria with stable creatinine: Findings and outcomes.

Clin Transplant 2021 Jul 22. Epub 2021 Jul 22.

Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

Introduction: Little is known aboutbiopsy findings and outcomes when kidney transplant recipients (KTRs) undergo biopsy for isolated proteinuria with stable serum creatinine (SCr).

Methods: We analyzed all KTRs who underwent biopsy for isolated proteinuria with stable SCr between January 2016 and June 2020. Patients were divided into three groups based on the biopsy findings: Active Rejection (AR), Glomerulonephritis (GN), and Other.

Results: A total of 130 KTRs fulfilled our selection criteria; 38 (29%) in the AR group, 26 (20%) in the GN group, and 66 (51%) in the Other group. Most baseline characteristics were similar between the groups. In multivariate analysis, higher HLA mismatch (HR per mismatch: 1.30; 95% CI:1.06-1.59; P = .01) and male gender (HR: .45; 95% CI .23-.89; P = .02) were associated with AR. There was no significant correlation between the degree of proteinuria and rejection (r = .05, P = .58) or GN (r = .07, P = .53). Graft survival was also similar between the groups. Likely due to the early diagnosis without a significant rise in SCr, outcomes were similar among all three groups.

Conclusion: Routine monitoring for proteinuria followed by a biopsy and appropriate management may help to identify early acute graft injury and prevent graft failure.
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http://dx.doi.org/10.1111/ctr.14436DOI Listing
July 2021

Michelle's Story: The Complexity of Patient Care in a Family Medicine Residency Clinic.

Ann Fam Med 2021 Jul-Aug;19(4):362-364

Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.

Family medicine covers all ages and specializes in chronic disease management as well as acute care medicine. As the health of the population continues to grow in complexity, treating patients appropriately and efficiently is imperative to improving health outcomes and managing health care costs. Family medicine physicians are uniquely poised to provide this type of care. A patient story plus a look at the patients seen over the course of a day within a family medicine residency clinic explores the complexity of care and the ability of family medicine physicians to provide the necessary care. Taking a close look at who comes through our door on a particular day highlights 3 points: primary care physicians are seeing patients with an increasing complexity of needs, our society is witnessing an extreme increase in patients suffering with mental health problems and substance use disorders, and addressing social determinants of health must be part of the solution.
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http://dx.doi.org/10.1370/afm.2652DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282289PMC
July 2021

Physical Activity Patterns of Free Living Dogs Diagnosed with Osteoarthritis.

J Anim Sci 2021 Jul 3. Epub 2021 Jul 3.

Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA.

Osteoarthritis (OA) affects about 90% of dogs > 5 yr of age in the US, resulting in reduced range of motion, difficulty climbing and jumping, reduced physical activity, and lower quality of life. Our objective was to use activity monitors to measure physical activity and identify how activity counts correlate with age, body weight (BW), body condition score (BCS), serum inflammatory markers, veterinarian pain assessment, and owner perception of pain in free-living dogs with OA. The University of Illinois Institutional Animal Care and Use Committee approved the study and owner consent was received prior to experimentation. Fifty-six client-owned dogs (mean age = 7.8 yr; mean BCS = 6.1) with clinical signs and veterinary diagnosis of OA wore HeyRex activity collars continuously over a 49-d period. Blood samples were collected on d 0 and 49, and dog owners completed canine brief pain inventory (CBPI) and Liverpool osteoarthritis in dogs (LOAD) surveys on d 0, 21, 35, and 49. All data were analyzed using SAS 9.3 using repeated measures and R Studio 1.0.136 was used to generate Pearson correlation coefficients between data outcomes. Average activity throughout the study demonstrated greater activity levels on weekends. It also showed that 24-h activity spiked twice daily, once in the morning and another in the afternoon. Serum C-reactive protein concentration was lower (P < 0.01) at d 49 compared to d 0. Survey data indicated lower (P < 0.05) overall pain intensity and severity score on d 21, 35 and 49 compared to d 0. BW was correlated with average activity counts (p=0.02; r=-0.12) and run activity (p=0.10; r=-0.24). Weekend average activity counts were correlated with owner pain intensity scores (p=0.0813; r=-0.2311), but weekday average activity count was not. Age was not correlated with total activity count, sleep activity, or run activity, but it was correlated with scratch (p=0.03; r=-0.10), alert (p=0.03; r=-0.13) and walk (p=0.09; r=-0.23) activities. Total activity counts and activity type (sleep, scratch, alert, walk, run) were not correlated with pain scored by veterinarians, pain intensity or severity scored by owners, or baseline BCS. Even though the lack of controls and/or information on the individual living conditions of dogs resulted in a high level of variability in this study, our data suggest that the use of activity monitors have the potential to aid in the management of OA and other conditions affecting activity (e.g., allergy; anxiety).
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http://dx.doi.org/10.1093/jas/skab204DOI Listing
July 2021

Pre-transplant bariatric surgery is not associated with an increased risk of infection after kidney transplant.

Transpl Int 2021 Jun 24. Epub 2021 Jun 24.

Division of Nephrology, Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin, USA.

Obesity has become increasingly prevalent in those seeking transplant for treatment of end-stage renal disease (ESRD). While those who are obese maintain the survival benefit of kidney transplant over dialysis, obesity is associated with negative outcomes after solid organ transplant. [1] Many transplant programs have target weight or body-mass index (BMI) requirements for listing, making weight a significant barrier to transplantation [2-5].
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http://dx.doi.org/10.1111/tri.13958DOI Listing
June 2021
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