Scholars@Duke
Stephen Richard Smith

Stephen Richard Smith

Professor of Medicine
Medicine, Nephrology
stephen.smith@duke.edu
Duke Box 2747, Durham, NC 27710
2424 Erwin Rd., Suite 605, Durham, NC 27705
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Selected Publications

Albuminuria and Allograft Failure, Cardiovascular Disease Events, and All-Cause Death in Stable Kidney Transplant Recipients: A Cohort Analysis of the FAVORIT Trial.

Journal Article Am J Kidney Dis · January 2019 RATIONALE & OBJECTIVE: Cardiovascular disease (CVD) is common and overall graft survival is suboptimal among kidney transplant recipients. Although albuminuria is a known risk factor for adverse outcomes among persons with native chronic kidney disease, th ... Full text Link to item Cite

Serum Phosphorus and Risk of Cardiovascular Disease, All-Cause Mortality, or Graft Failure in Kidney Transplant Recipients: An Ancillary Study of the FAVORIT Trial Cohort.

Journal Article Am J Kidney Dis · September 2017 BACKGROUND: Mild hyperphosphatemia is a putative risk factor for cardiovascular disease [CVD], loss of kidney function, and mortality. Very limited data are available from sizable multicenter kidney transplant recipient (KTR) cohorts assessing the potentia ... Full text Link to item Cite

Heavy metal nephropathy: considerations for exposure analysis.

Journal Article Kidney Int · September 2017 Epidemiologic studies have yielded conflicting results regarding the role of heavy metal exposure in recent epidemics of chronic kidney disease (CKD). In this issue of Kidney International, Tsai et al. examined the combined effects of chromium, lead, and c ... Full text Link to item Cite

Rare hereditary COL4A3/COL4A4 variants may be mistaken for familial focal segmental glomerulosclerosis.

Journal Article Kidney Int · December 2014 Focal segmental glomerulosclerosis (FSGS) is a histological lesion with many causes, including inherited genetic defects, with significant proteinuria being the predominant clinical finding at presentation. Mutations in COL4A3 and COL4A4 are known to cause ... Full text Open Access Link to item Cite

BP, cardiovascular disease, and death in the Folic Acid for Vascular Outcome Reduction in Transplantation trial.

Journal Article J Am Soc Nephrol · July 2014 The optimal BP level in kidney transplant recipients remains uncertain. This post hoc analysis of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) trial cohort assessed associations of BP with a pooled cardiovascular disease (CVD) ... Full text Link to item Cite

IgG4-related tubulointerstitial nephritis associated with chronic lymphocytic leukemia.

Journal Article J Nephrol · 2013 BACKGROUND: Tubulointerstitial nephritis (TIN) is typically seen in association with drug exposure and infection or in autoimmune diseases such as Sjogren's syndrome or systemic lupus erythematosis. The recently described IgG4-related systemic diseases can ... Full text Link to item Cite

Detection of BK polyomavirus after kidney transplantation: a comparison of urine electron microscopy with plasma polymerase chain reaction.

Journal Article Clin Transplant · 2013 BK polyomavirus (BKV) infection continues to be a significant source of allograft dysfunction in kidney transplant recipients. The optimal screening method to detect BKV remains undetermined. In this retrospective analysis of 347 consecutive kidney transpl ... Full text Link to item Cite

Stress and coping in caregivers of patients awaiting solid organ transplantation.

Journal Article Clin Transplant · 2012 Featured Publication Caregivers for patients undergoing solid organ transplantation play an essential role in the process of transplantation. However, little is known about stress and coping among these caregivers. Six hundred and twenty-one primary caregivers of potential can ... Full text Link to item Cite

Homocysteine-lowering and cardiovascular disease outcomes in kidney transplant recipients: primary results from the Folic Acid for Vascular Outcome Reduction in Transplantation trial.

Journal Article Circulation · April 26, 2011 Featured Publication BACKGROUND: Kidney transplant recipients, like other patients with chronic kidney disease, experience excess risk of cardiovascular disease and elevated total homocysteine concentrations. Observational studies of patients with chronic kidney disease sugges ... Full text Link to item Cite

Predictors of survival after cardiac arrest in outpatient hemodialysis clinics.

Journal Article Clin J Am Soc Nephrol · May 2007 Cardiac arrest (CA) is the most common cause of death in hemodialysis patients, and factors that improve survival after arrest are unknown. This study sought to identify modifiable factors that are associated with survival after CA in hemodialysis clinics. ... Full text Link to item Cite

Renal Function Posttransplant

Journal Article · January 1, 2007 Full text Cite

Automated external defibrillators and survival from cardiac arrest in the outpatient hemodialysis clinic.

Journal Article J Am Soc Nephrol · January 2007 Featured Publication Automated external defibrillators (AED) have been recommended for use in outpatient dialysis clinics to improve outcomes from cardiac arrest, the most common cause of death in patients with ESRD. The effectiveness of this policy is unknown. The study cohor ... Full text Link to item Cite

Postinfectious glomerulonephritis in renal allograft recipients.

Journal Article Transplantation · November 15, 2006 Postinfectious glomerulonephritis (PIGN) is a rare etiology of de novo glomerulonephritis following kidney transplantation. To date, there have only been eight cases reported in the literature. We report an additional three patients transplanted at our ins ... Full text Link to item Cite

Donor polymorphisms in Toll-like receptor-4 influence the development of rejection after renal transplantation.

Journal Article Clin Transplant · 2006 Featured Publication BACKGROUND: Although innate immunity is crucial to host defense against pathogens, the extent to which innate immune mechanisms participate in the rejection of allogenic tissues in humans is unknown. We hypothesize that activation of innate immunity throug ... Full text Link to item Cite

Obesity predicts increased overall complications following pancreas transplantation.

Journal Article Transplant Proc · October 2005 PURPOSE: We sought to evaluate the role of recipient body mass index (BMI) on postoperative complications in patients receiving pancreas transplants. METHODS: A single-institution retrospective study of 145 consecutive patients undergoing either simultaneo ... Full text Link to item Cite

Acute renal failure after lung transplantation: incidence, predictors and impact on perioperative morbidity and mortality.

Journal Article Am J Transplant · June 2005 The incidence, predictors and clinical significance of acute renal failure (ARF) after lung transplantation are not well described. We retrospectively collected data on 296 patients transplanted at our center between April 1992 and December 2000; follow-up ... Full text Link to item Cite

Intravenous immunoglobulin and plasmapheresis in acute humoral rejection: experience in renal allograft transplantation.

Journal Article Hum Immunol · April 2005 Featured Publication Acute humoral rejection (AHR) in kidney transplantation is associated with higher rates of allograft loss when compared with acute cellular rejection (ACR). Treatment with intravenous immunoglobulin (IVIG) combined with plasmapheresis (PP) has been used re ... Full text Link to item Cite

Albuminuria and Allograft Failure, Cardiovascular Disease Events, and All-Cause Death in Stable Kidney Transplant Recipients: A Cohort Analysis of the FAVORIT Trial.

Journal Article Am J Kidney Dis · January 2019 RATIONALE & OBJECTIVE: Cardiovascular disease (CVD) is common and overall graft survival is suboptimal among kidney transplant recipients. Although albuminuria is a known risk factor for adverse outcomes among persons with native chronic kidney disease, th ... Full text Link to item Cite

Serum Phosphorus and Risk of Cardiovascular Disease, All-Cause Mortality, or Graft Failure in Kidney Transplant Recipients: An Ancillary Study of the FAVORIT Trial Cohort.

Journal Article Am J Kidney Dis · September 2017 BACKGROUND: Mild hyperphosphatemia is a putative risk factor for cardiovascular disease [CVD], loss of kidney function, and mortality. Very limited data are available from sizable multicenter kidney transplant recipient (KTR) cohorts assessing the potentia ... Full text Link to item Cite

Heavy metal nephropathy: considerations for exposure analysis.

Journal Article Kidney Int · September 2017 Epidemiologic studies have yielded conflicting results regarding the role of heavy metal exposure in recent epidemics of chronic kidney disease (CKD). In this issue of Kidney International, Tsai et al. examined the combined effects of chromium, lead, and c ... Full text Link to item Cite

Rare hereditary COL4A3/COL4A4 variants may be mistaken for familial focal segmental glomerulosclerosis.

Journal Article Kidney Int · December 2014 Focal segmental glomerulosclerosis (FSGS) is a histological lesion with many causes, including inherited genetic defects, with significant proteinuria being the predominant clinical finding at presentation. Mutations in COL4A3 and COL4A4 are known to cause ... Full text Open Access Link to item Cite

BP, cardiovascular disease, and death in the Folic Acid for Vascular Outcome Reduction in Transplantation trial.

Journal Article J Am Soc Nephrol · July 2014 The optimal BP level in kidney transplant recipients remains uncertain. This post hoc analysis of the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) trial cohort assessed associations of BP with a pooled cardiovascular disease (CVD) ... Full text Link to item Cite

IgG4-related tubulointerstitial nephritis associated with chronic lymphocytic leukemia.

Journal Article J Nephrol · 2013 BACKGROUND: Tubulointerstitial nephritis (TIN) is typically seen in association with drug exposure and infection or in autoimmune diseases such as Sjogren's syndrome or systemic lupus erythematosis. The recently described IgG4-related systemic diseases can ... Full text Link to item Cite

Detection of BK polyomavirus after kidney transplantation: a comparison of urine electron microscopy with plasma polymerase chain reaction.

Journal Article Clin Transplant · 2013 BK polyomavirus (BKV) infection continues to be a significant source of allograft dysfunction in kidney transplant recipients. The optimal screening method to detect BKV remains undetermined. In this retrospective analysis of 347 consecutive kidney transpl ... Full text Link to item Cite

Stress and coping in caregivers of patients awaiting solid organ transplantation.

Journal Article Clin Transplant · 2012 Featured Publication Caregivers for patients undergoing solid organ transplantation play an essential role in the process of transplantation. However, little is known about stress and coping among these caregivers. Six hundred and twenty-one primary caregivers of potential can ... Full text Link to item Cite

Homocysteine-lowering and cardiovascular disease outcomes in kidney transplant recipients: primary results from the Folic Acid for Vascular Outcome Reduction in Transplantation trial.

Journal Article Circulation · April 26, 2011 Featured Publication BACKGROUND: Kidney transplant recipients, like other patients with chronic kidney disease, experience excess risk of cardiovascular disease and elevated total homocysteine concentrations. Observational studies of patients with chronic kidney disease sugges ... Full text Link to item Cite

Predictors of survival after cardiac arrest in outpatient hemodialysis clinics.

Journal Article Clin J Am Soc Nephrol · May 2007 Cardiac arrest (CA) is the most common cause of death in hemodialysis patients, and factors that improve survival after arrest are unknown. This study sought to identify modifiable factors that are associated with survival after CA in hemodialysis clinics. ... Full text Link to item Cite

Renal Function Posttransplant

Journal Article · January 1, 2007 Full text Cite

Automated external defibrillators and survival from cardiac arrest in the outpatient hemodialysis clinic.

Journal Article J Am Soc Nephrol · January 2007 Featured Publication Automated external defibrillators (AED) have been recommended for use in outpatient dialysis clinics to improve outcomes from cardiac arrest, the most common cause of death in patients with ESRD. The effectiveness of this policy is unknown. The study cohor ... Full text Link to item Cite

Postinfectious glomerulonephritis in renal allograft recipients.

Journal Article Transplantation · November 15, 2006 Postinfectious glomerulonephritis (PIGN) is a rare etiology of de novo glomerulonephritis following kidney transplantation. To date, there have only been eight cases reported in the literature. We report an additional three patients transplanted at our ins ... Full text Link to item Cite

Donor polymorphisms in Toll-like receptor-4 influence the development of rejection after renal transplantation.

Journal Article Clin Transplant · 2006 Featured Publication BACKGROUND: Although innate immunity is crucial to host defense against pathogens, the extent to which innate immune mechanisms participate in the rejection of allogenic tissues in humans is unknown. We hypothesize that activation of innate immunity throug ... Full text Link to item Cite

Obesity predicts increased overall complications following pancreas transplantation.

Journal Article Transplant Proc · October 2005 PURPOSE: We sought to evaluate the role of recipient body mass index (BMI) on postoperative complications in patients receiving pancreas transplants. METHODS: A single-institution retrospective study of 145 consecutive patients undergoing either simultaneo ... Full text Link to item Cite

Acute renal failure after lung transplantation: incidence, predictors and impact on perioperative morbidity and mortality.

Journal Article Am J Transplant · June 2005 The incidence, predictors and clinical significance of acute renal failure (ARF) after lung transplantation are not well described. We retrospectively collected data on 296 patients transplanted at our center between April 1992 and December 2000; follow-up ... Full text Link to item Cite

Intravenous immunoglobulin and plasmapheresis in acute humoral rejection: experience in renal allograft transplantation.

Journal Article Hum Immunol · April 2005 Featured Publication Acute humoral rejection (AHR) in kidney transplantation is associated with higher rates of allograft loss when compared with acute cellular rejection (ACR). Treatment with intravenous immunoglobulin (IVIG) combined with plasmapheresis (PP) has been used re ... Full text Link to item Cite

Risk factors for BK polyomavirus nephritis in renal allograft recipients.

Journal Article Clin Transplant · August 2004 Featured Publication Recurrent episodes of acute rejection (AR) and/or the intense immunosuppression used for their treatment have been proposed as risk factors for BK nephritis (BKN; BK refers to the initials of the first patient from whom this polyomavirus was isolated). To ... Full text Link to item Cite

Massive gastrointestinal hemorrhage due to rupture of a donor pancreatic artery pseudoaneurysm in a pancreas transplant patient.

Journal Article Clin Transplant · February 2004 Enteric drainage of secretions by anastomosing the donor duodenum to the recipient's small bowel has become common in pancreatic transplantation. While it eliminates many problems, endoscopic access to the transplanted duodenum and pancreas is made difficu ... Full text Link to item Cite

The management of end stage renal disease in the recipients of extrarenal transplants

Conference AMERICAN JOURNAL OF TRANSPLANTATION · January 1, 2004 Link to item Cite

Chronic kidney disease after lung transplantation.

Conference AMERICAN JOURNAL OF TRANSPLANTATION · January 1, 2004 Link to item Cite

Post transplant erythrocytosis in hypercalcemic renal transplant recipients.

Journal Article Am J Transplant · July 2003 Featured Publication In vitro data suggest that calcium plays an important role in normal and disordered erythropoiesis. The purpose of this study is to determine whether there is an association between serum calcium, various hormone levels, and the development of post transpl ... Full text Link to item Cite

Beneficial effect of plasmapheresis and intravenous immunoglobulin on renal allograft survival of patients with acute humoral rejection.

Journal Article Transplantation · May 15, 2003 BACKGROUND: Acute humoral rejection (AHR) has been associated with enhanced graft loss. Our study compared the renal allograft survival of patients with AHR treated with plasmapheresis (PP) and intravenous immunoglobulin (IVIG) with allograft survival in p ... Full text Link to item Cite

Clinical significance of eosinophils in suspicious or borderline renal allograft biopsies.

Journal Article Clin Nephrol · May 2003 AIMS: Renal allograft biopsies play a critical role in renal transplantation. Acute rejection characterized by tubulitis and intimitis is of primary concern. There is an association between eosinophilic infiltrates and irreversible acute rejection; however ... Full text Link to item Cite

Declining influence of race on the outcome of living-donor renal transplantation.

Journal Article Am J Transplant · March 2002 Featured Publication A racial disparity in graft survival for renal transplant recipients has been documented for both cadaveric and living-donor transplants. In the present single-center study we analyzed graft survival by race for recipients of living-donor kidney transplant ... Full text Link to item Cite

Viral infections after renal transplantation.

Journal Article Am J Kidney Dis · April 2001 Viral infections are a leading cause of posttransplantation morbidity and mortality. A number of recent developments have altered our understanding and management of these disorders. The pathogenetic roles of several viruses, including human herpesviruses ... Full text Link to item Cite

Diagnosis and management of BK polyomavirus interstitial nephritis in renal transplant recipients.

Journal Article Transplantation · November 15, 1999 Featured Publication BACKGROUND: Interstitial nephritis caused by BK polyomavirus is a recognized complication of renal transplantation. A study of renal transplant recipients at Duke University Medical Center was undertaken to evaluate diagnostic modalities and assess clinica ... Full text Link to item Cite

Losartan in post-transplant erythrocytosis.

Journal Article Nephrol Dial Transplant · December 1996 Full text Link to item Cite

Proton-decoupled phosphorus-31 magnetic resonance spectroscopy in the evaluation of native and well-functioning transplanted kidneys.

Journal Article Acad Radiol · December 1996 RATIONALE AND OBJECTIVES: To evaluate whether decoupling improves signal-to-noise ratio and frequency resolution of in vivo kidney spectra, and to compare native and well-functioning transplant kidneys. METHODS: Proton decoupling in conjunction with three- ... Full text Link to item Cite

Predictors of prognosis and risk of acute renal failure in patients with Rocky Mountain spotted fever.

Journal Article Am J Med · December 1996 BACKGROUND: Acute renal failure has long been associated with severe Rocky Mountain spotted fever (RMSF). Despite many descriptions of the protean manifestations of this disease, relatively little is known concerning the risk factors for acute renal failur ... Full text Link to item Cite

Renal transplantation in adults with thrombotic thrombocytopenic purpura/haemolytic-uraemic syndrome.

Journal Article Nephrol Dial Transplant · September 1996 BACKGROUND: Thrombotic thrombocytopenic purpura/haemolytic-uraemic syndrome (TTP/HUS) is a rare cause of renal failure in adults. There is little data concerning the outcome of adult patients who receive a renal transplant for TTP/HUS: METHODS: We have car ... Link to item Cite

Clinical, biochemical and pathological predictors of poor response to intravenous cyclophosphamide in patients with proliferative lupus nephritis.

Journal Article Clin Nephrol · September 1996 BACKGROUND: Reports in the literature on the outcome of lupus nephritis (LN) treated with intravenous (i.v.) cyclophosphamide have varied considerably. Previous studies have suggested that less than 25% of patients with LN will progress to end stage renal ... Link to item Cite

Predictors of prognosis and risk of acute renal failure in Rocky Mountain spotted fever.

Journal Article JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY · September 1, 1996 Link to item Cite

No change in complication rate using spring-loaded gun compared to traditional percutaneous renal allograft biopsy techniques.

Journal Article Clin Nephrol · June 1996 The previous methods to biopsy renal allografts at our institution involved the use of the Franklin-Silverman or Tru-Cut needles. Unfortunately they had a significant rate of post biopsy bleeding secondary to deep penetration when excess force was used to ... Link to item Cite

Late withdrawal of cyclosporine in stable renal transplant recipients.

Journal Article Am J Kidney Dis · September 1995 Featured Publication The use of cyclosporine (CsA) in renal transplantation has been associated with an improvement in 1-year graft survival, but has not changed the rate of late graft loss. We sought to determine whether the intent to withdraw CsA late after renal transplanta ... Full text Link to item Cite

RENAL-TRANSPLANTATION IN ADULTS WITH THROMBOTIC THROMBOCYTOPENIC PURPURA HEMOLYTIC-UREMIC SYNDROME (TTP/HUS)

Journal Article JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY · September 1, 1995 Link to item Cite

Transmission of cancer with cadaveric donor organs.

Journal Article J Am Soc Nephrol · July 1995 A case is presented in which each of the recipients of a pair of cadaveric kidneys developed metastatic carcinoma. One of the recipients died, and the other demonstrated involution of metastatic deposits after graft nephrectomy and withdrawal of immunosupp ... Full text Link to item Cite

The renal manifestations and outcome of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome in adults.

Journal Article Nephrol Dial Transplant · 1995 Thrombotic thrombocytopenic purpura/Hemolytic uremic syndrome (TTP/HUS) is generally regarded to be a rare disease. The present study was undertaken to identify presenting features, prognostic variables, pathological features and outcome associated with TT ... Link to item Cite

Chronic thromboxane synthase inhibition with CGS 12970 in human cyclosporine nephrotoxicity.

Journal Article Transplantation · December 1993 CsA nephrotoxicity in rats is associated with an increase in renal thromboxane production. Treatment with selective thromboxane synthase inhibitors or receptor antagonists improves renal function in these animal models. In humans, it is unclear whether int ... Full text Link to item Cite

Effect of low-dose aspirin on thromboxane production and the antihypertensive effect of captopril.

Journal Article J Am Soc Nephrol · November 1993 Featured Publication Some of the antihypertensive effects of angiotensin-converting enzyme (ACE) inhibitors occur through nonangiotensin II-mediated mechanisms. One of these is through decreased kinin degradation, leading to enhanced production of vasodilator arachidonic acid ... Full text Link to item Cite

Potassium chloride lowers blood pressure and causes natriuresis in older patients with hypertension.

Journal Article J Am Soc Nephrol · February 1992 Epidemiologic surveys, experimental studies in animals, and clinical trials in young and middle-aged patients with hypertension indicate that dietary potassium lowers blood pressure. The mechanism of the antihypertensive effect is not well defined. Variati ... Full text Link to item Cite

Effects of thromboxane synthase inhibition with CGS 13080 in human cyclosporine nephrotoxicity.

Journal Article Kidney Int · January 1992 Cyclosporine is a potent immunosuppressive agent, however, its use is limited by nephrotoxicity. Increased production of the potent vasoconstrictor thromboxane A2 contributes to cyclosporine nephrotoxicity in animal models, but the role of thromboxane in h ... Full text Link to item Cite

Captopril renography in the diagnosis of renovascular disease.

Journal Article Am J Hypertens · December 1991 Several investigators have reported methods for the use of renal scintigraphy in the diagnosis of renal artery stenosis. We report the experience of Duke University Medical Center, and offer some suggestions for standardizing and optimizing the use of this ... Full text Link to item Cite

Racial differences in the incidence and progression of renal diseases.

Journal Article Kidney Int · November 1991 Featured Publication There is an excess incidence of ESRD treatment among non-White North Americans that is not completely explained by the racial prevalences of the underlying diseases, including hypertension, which can potentially cause renal disease. The racial difference i ... Full text Link to item Cite

Similar prevalence of renovascular hypertension in selected blacks and whites.

Journal Article Hypertension · May 1991 Renovascular hypertension is a potentially curable form of high blood pressure that is thought to be extremely rare among blacks. We demonstrate, however, that in a clinically selected population, the prevalence of renovascular hypertension is similar in b ... Full text Link to item Cite

THROMBOXANE SYNTHETASE INHIBITION IMPROVES FUNCTION OF HYDRONEPHROTIC RAT KIDNEYS

Journal Article AMERICAN JOURNAL OF PHYSIOLOGY · February 1, 1986 Link to item Cite