American Journal of Medical and Clinical Research & Reviews

Different Equations for Combined Chronic Kidney Disease and Cardiovascular Risk

Anita L R Saldanha — 2026-04-01

Assessment of combined risk in chronic kidney disease and cardiovascular disease requires the use of multiple complementary tools, as no single model captures all relevant outcomes. Traditional cardiovascular risk scores, such as the Framingham Risk Score and the Atherosclerotic Cardiovascular Disease Risk Estimator, incorporate factors including age, sex, cholesterol levels, blood pressure, diabetes, and smoking. However, both have important limitations in chronic kidney disease, as kidney dysfunction is either not included or only indirectly considered, leading to underestimation of cardiovascular risk. The QRISK3 model represents a more suitable alternative for this population because it directly incorporates chronic kidney disease and proteinuria, along with additional variables such as body mass index and comorbidities, resulting in more accurate cardiovascular risk prediction. For renal outcomes, the Kidney Failure Risk Equation is the most widely validated tool, using demographic and laboratory parameters to estimate progression to end stage kidney disease, although it does not predict cardiovascular events. Combined models, such as those developed by the Chronic Kidney Disease Prognosis Consortium, integrate kidney function and albuminuria to predict both mortality and cardiovascular outcomes. Similarly, the Kidney Disease Improving Global Outcomes classification system provides a practical framework by combining estimated glomerular filtration rate and albuminuria to stratify risk of progression, cardiovascular events, and death. Biomarker-based approaches incorporating natriuretic peptides and troponin further enhance prediction, particularly for heart failure. Overall, optimal management requires an integrated approach combining cardiovascular and renal risk tools to improve prognostic accuracy and guide therapy.

Streptococcus anginosus Bacteremia with Hepatic Abscess After Biliary Stent Exchange in a Patient with Relapsed Lymphoma: A Case Report

Kyaw Zaw Lin — 2026-04-05

A 46-year-old woman with a history of relapsed and transformed lymphoma, including marginal zone lymphoma (MZL), Hodgkin lymphoma, and subsequent transformation to diffuse large B-cell lymphoma (DLBCL) with hepatic involvement, presented with Streptococcus anginosus bacteremia and suspected hepatic abscesses following recent biliary instrumentation. She had previously undergone multiple lines of therapy, most recently chimeric antigen receptor T-cell (CAR-T) therapy with axicabtagene ciloleucel in July 2025, achieving an initial complete metabolic response.

Her clinical course was complicated by chronic obstructive cholestasis requiring biliary stent placement and serial endoscopic retrograde cholangiopancreatography (ERCP) procedures. Following a recent ERCP with stent exchange and lymph node biopsy in March 2026, she presented with fever and chills and was found to have S. anginosus bacteremia. Imaging demonstrated hepatic lesions consistent with abscesses in the setting of pneumobilia and biliary stenting.

She was treated with intravenous ceftriaxone, resulting in rapid clinical and laboratory improvement, including resolution of leukocytosis and clearance of blood cultures. Although interventional radiology–guided drainage was recommended, the patient declined invasive management and opted for prolonged intravenous antibiotic therapy. She was discharged with a plan for 4–6 weeks of ceftriaxone via peripherally inserted central catheter, along with antiviral and hepatoprotective prophylaxis.

This case underscores the risk of infectious complications, including bacteremia and hepatic abscess formation, in immunocompromised patients undergoing repeated biliary interventions, and highlights the role of conservative management in select patients.