Clinical and Experimental Nephrology最新文献

{"title":"Need for life cycle assessment of pharmaceuticals for kidney healthcare.","authors":"Kei Nagai, Keisuke Nansai","doi":"10.1007/s10157-025-02647-2","DOIUrl":"10.1007/s10157-025-02647-2","url":null,"abstract":"<p><strong>Purpose: </strong>Global warming is a known risk factor for chronic kidney disease (CKD), and both progression of the disease and its treatment place a burden on the environment. Life cycle assessment (LCA) is an established method for evaluating the global impact of manufactured products, from materials' procurement to disposal. We aimed to examine available reports of its application to pharmaceuticals.</p><p><strong>Methods: </strong>A narrative review focused on LCA studies of any pharmaceuticals according to disease area.</p><p><strong>Results: </strong>We identified the drug types used for treatment of 13 disease areas described in 51 previous LCA studies, classified using the MIDAS database. Among the drug types, anesthetics, inhalants, and antibiotics have received the most attention. However, LCA studies are lacking for the wide range of pharmaceuticals used in kidney healthcare, in the fields of dialysis therapy, treatment of end-stage kidney disease, and associated cardiovascular, metabolic, and endocrine diseases.</p><p><strong>Discussion: </strong>As the proportion of the population affected by CKD increases, there is a particular urgency for LCA research into drugs administered for their kidney protective effects, such as renin--angiotensin system inhibitors and sodium-glucose cotransporter 2 inhibitors. As sustainable practices in drug production and the ability to identify and choose effective drugs with low environmental impact require comprehensive LCA data, clinical physicians and pharmacists involved in kidney healthcare should collaborate with pharmaceutical companies to develop an LCA research system . Incorporating rating of environmental burden of each drug into daily practice is desirable for achieving sustainable kidney healthcare and reducing its environmental impacts.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"702-710"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal impact of extended-hours hemodialysis with a liberalized diet on nutritional status and survival outcomes: findings from the LIBERTY cohort.","authors":"Takahiro Imaizumi, Masaki Okazaki, Manabu Hishida, Shimon Kurasawa, Nobuhiro Nishibori, Yoshihiro Nakamura, Shigefumi Ishikawa, Katsuhiko Suzuki, Yuki Takeda, Yuhei Otobe, Toru Kondo, Fumika Kaneda, Hiroshi Kaneda, Shoichi Maruyama","doi":"10.1007/s10157-024-02602-7","DOIUrl":"10.1007/s10157-024-02602-7","url":null,"abstract":"<p><strong>Background: </strong>Protein-energy wasting (PEW), a unique weight loss linked to nutritional and metabolic abnormalities, is common in patients undergoing hemodialysis (HD) and associated with adverse outcomes. This study investigated whether extended-hours HD combined with a liberalized diet could overcome PEW and improve survival.</p><p><strong>Methods: </strong>The body mass index (BMI) and survival outcomes in patients undergoing extended-hours HD were evaluated for up to 8 years using data from the LIBeralized diet Extended-houRs hemodialysis Therapy (LIBERTY) cohort. Extended-hours HD was defined as weekly dialysis length ≥ 18 h.</p><p><strong>Results: </strong>The LIBERTY cohort included 402 patients who initiated extended-hours HD. An increase in the length and frequency of HD sessions was observed over time, with approximately 70% and 20% of patients undergoing extended-hours HD for > 21 h/week and > 3 sessions/week at 5 years, respectively. The BMI and percentage creatinine generation rate were maintained over time, with no substantial increase in the phosphorus and potassium levels. The estimated BMI initially increased, and thereafter plateaued over time in patients with a baseline BMI < 25 kg/m², whereas it decreased gradually in patients with a baseline BMI ≥ 25 kg/m² after several years from baseline. Ninety-one patients died, and 108 discontinued extended-hours HD during the median follow-up period of 6.2 years (interquartile range, 3.5-8.0), yielding a 5-year survival rate of 85%.</p><p><strong>Conclusions: </strong>Extended-hours HD with a liberalized diet may help achieve favorable survival outcomes and maintain nutritional status. Thus, it is a promising treatment option for managing PEW in patients undergoing HD.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"818-830"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between new-onset proteinuria and the volume of the non-donated kidney before and after donation in living kidney donors.","authors":"Masatomo Ogata, Takamasa Miyauchi, Kiyomi Osako, Naohiko Imai, Yuko Sakurai, Kazunobu Shinoda, Yugo Shibagaki, Masahiko Yazawa","doi":"10.1007/s10157-025-02633-8","DOIUrl":"10.1007/s10157-025-02633-8","url":null,"abstract":"<p><strong>Introduction: </strong>Some living kidney donors (LKDs) experience proteinuria after donation. Based on several studies, preoperative non-donated side kidney volume (pre-KV) and postoperative percentage change in preserved kidney hypertrophy (%PKH) are associated with proteinuria. This study explored the association of the combination of pre-KV and %PKH with new-onset proteinuria.</p><p><strong>Methods: </strong>This single-center, retrospective, observational study included eligible LKDs who underwent donor nephrectomy between January 2008 and July 2022 (N = 195). Among those, LKDs in whom KV and either urinary protein or albumin were obtained both pre-donation and 1 year post-donation were finally included (N = 70). The LKDs were assigned to four groups according to the mean body surface area-adjusted pre-KV and %PKH, and their association with the occurrence of proteinuria or albuminuria was investigated.</p><p><strong>Results: </strong>Among the 70 LKDs, mean age was 59.8 ± 7.9 years, and 50 (71.4%) were females. The mean preoperative estimated glomerular filtration rate, %PKH, and pre-KV was 78.0 ± 13.6 mL/min/1.73 m², 20.3 ± 7.0%, and 161.4 ± 24.1 cm³/1.73 m², respectively. During the 2.4 year follow-up period, there was no significant difference in the occurrence of proteinuria among the four groups (log-rank test, P = 0.111). However, after adjustment, the large pre-KV and small %PKH group had a significantly higher hazard ratio (HR) for proteinuria than the small pre-KV and large %PKH groups (adjusted HR 3.12, 95% confidence interval: 1.09-8.91, P = 0.033).</p><p><strong>Conclusions: </strong>Proteinuria is more likely to occur postoperatively in LKDs whose kidneys are already enlarged before donation and cannot appropriately hypertrophy.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"843-857"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autophagic stagnation: a key mechanism in kidney disease progression linked to aging and obesity.","authors":"Takeshi Yamamoto","doi":"10.1007/s10157-025-02653-4","DOIUrl":"10.1007/s10157-025-02653-4","url":null,"abstract":"<p><p>Autophagy, a critical intracellular degradation and recycling pathway mediated by lysosomes, is essential for maintaining cellular homeostasis through the quality control of proteins and organelles. Our research focused on the role of proximal tubular autophagy in the pathophysiology of aging, obesity, and diabetes. Using a novel method to monitor autophagic flux in kidney tissue, we revealed that age-associated high basal autophagy supports mitochondrial quality control and delays kidney aging. However, an impaired ability to upregulate autophagy under additional stress accelerates kidney aging. In obesity induced by a high-fat diet, lysosomal dysfunction disrupts autophagy, leading to renal lipotoxicity. Although autophagy is initially activated to repair organelle membranes and maintain proximal tubular cell integrity, this demand overwhelms lysosomes, resulting in \"autophagic stagnation\" characterized by phospholipid accumulation. Similar lysosomal phospholipid accumulation was observed in renal biopsies from elderly and obese patients. We identified TFEB-mediated lysosomal exocytosis as a mechanism to alleviate lipotoxicity by expelling accumulated phospholipids. Therapeutically, interventions such as the SGLT2 inhibitor empagliflozin and eicosapentaenoic acid restore lysosomal function and autophagic activity. Based on these findings, we propose a novel disease concept, \"Obesity-Related Proximal Tubulopathy.\" This study underscores autophagic stagnation as a key driver of kidney disease progression in aging and obesity, offering insights into the pathophysiology of kidney diseases and providing a foundation for targeted therapeutic strategies.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"711-719"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for surgery in children with ureteropelvic junction obstruction due to antenatally detected ınfantil hydronephrosis.","authors":"Mehmet Baha Aytac, Sule Ayas Ergul, Kenan Dogan, Neslihan Dincer Malkoc, Merve Aktas Ozgur, Cuneyd Ozkurkcugil, Kerem Teke, Busra Yaprak Bayrak, Zelal Ekinci, Kenan Bek","doi":"10.1007/s10157-025-02631-w","DOIUrl":"10.1007/s10157-025-02631-w","url":null,"abstract":"<p><strong>Background: </strong>Although the majority of cases with antenatally detected hydronephrosis (ANH) resolve during postnatal period; patients should be monitored for the risk of developing ureteropelvic junction obstruction (UPJO) which requires surgical intervention. We aimed to define independent risk factors for operation in whom diagnosis of UPJO was precisely proven with histopathological evidence.</p><p><strong>Methods: </strong>Medical files of 155 children (186 renal units) with anteroposterior pelvic diameter (APPD) ≥ 7 mm or ≥ 1SFU (Society of Fetal Urology) grade of pelvicalyceal dilatation were retrospectively investigated. Patients who underwent pyeloplasty and whose pathological examinations of resected ureteral samples confirmed obstruction, were compared to non-interventional group in terms of demographics, serum creatinine, APPD, SFU grade, cortical thickness and diuretic renogram. Multiple regression models were used to predict independent risk factors for pyeloplasty.</p><p><strong>Results: </strong>155 patients (186 renal units) were recruited for the study. Pyeloplasty was performed in 50(32.2%) patients. Increased APPD, T1/2 and Tmax values with low parenchymal thickness and DRF were demonstrated in operated patients compared to those who did not. Significant decrease in APPD and T1/2 values and also significant improvement in parenchymal thickness were observed in conservatively managed group. Multivariate analysis revealed high APPD measurements and time activity curve patterns to be associated with significantly increased likelihood of surgical intervention.</p><p><strong>Conclusions: </strong>There is still an ongoing debate on which screening method should be used for the accurate diagnosis of UPJO or the indications for surgical intervention. Baseline APPD and diuretic renogram curve were found to be significant in predicting surgery for UPJO.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"858-865"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of kidney function prediction: traditional statistical methods vs. deep learning techniques.","authors":"Mizuki Ohashi, Yuya Ishikawa, Satoshi Arai, Tomoharu Nagao, Kaori Kitaoka, Hajime Nagasu, Yuichiro Yano, Naoki Kashihara","doi":"10.1007/s10157-024-02616-1","DOIUrl":"10.1007/s10157-024-02616-1","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) represents a significant public health challenge, with rates consistently on the rise. Enhancing kidney function prediction could contribute to the early detection, prevention, and management of CKD in clinical practice. We aimed to investigate whether deep learning techniques, especially those suitable for processing missing values, can improve the accuracy of predicting future renal function compared to traditional statistical method, using the Japan Chronic Kidney Disease Database (J-CKD-DB), a nationwide multicenter CKD registry.</p><p><strong>Methods: </strong>From the J-CKD-DB-Ex, a prospective longitudinal study within the J-CKD-DB, we selected individuals who had at least two eGFR measurements recorded between 12 and 20 months apart (n = 22,929 CKD patients). We used the multiple linear regression model as a conventional statistical method, and the Feed Forward Neural Network (FFNN) and Gated Recurrent Unit (GRU)-D (decay) models as deep learning techniques. We compared the prediction accuracies of each model for future eGFR based on the existing data using the root mean square error (RMSE).</p><p><strong>Results: </strong>The RMSE values were 7.5 for multiple regression analysis, 7.9 for FFNN model, and 7.6 mL/min/1.73 m² for GRU-D model. In the subgroup analysis according to CKD stages, lower RMSE values were observed in higher stages for all models.</p><p><strong>Conclusion: </strong>Our result demonstrate the predictive accuracy of future eGFR based on the existing dataset in the J-CKD-DB-Ex. The accuracy was not improved by applying deep learning techniques compared to conventional statistical methods.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"745-752"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HDAC9-mediated deacetylation of CALML6 promotes excessive proliferation of glomerular mesangial cells in IgA nephropathy.","authors":"Xingxing Zhuang, Fei Xiao, Feihu Chen, Shoudong Ni","doi":"10.1007/s10157-024-02620-5","DOIUrl":"10.1007/s10157-024-02620-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study seeks to investigate the fundamental molecular processes through which histone deacetylase 9 (HDAC9) governs the proliferation of glomerular mesangial cells in the context of immunoglobulin A nephropathy (IgAN) and to identify novel targets for clinical research on IgAN.</p><p><strong>Methods: </strong>Data from high-throughput RNA sequencing for IgAN were procured from the Gene Expression Omnibus database to assess the expression profiles and clinical diagnostic significance of histone deacetylase family proteins (HDACs). Blood samples from 20 IgAN patients were employed in RT-qPCR analysis, and the spearman linear regression method was utilized to analyze the clinical correlation. The proliferation of glomerular mesangial cells (GMCs) under the influence of HDAC9 was examined using the 5-ethynyl-2'-deoxyuridine (EdU) assay. Proteins interacting with HDAC9 were predicted utilizing the STRING database. Immunoprecipitation and protein immunoblotting employing anti-acetylated lysine antibodies were conducted to determine the acetylation status of calmodulin-like protein 6 (CALML6).</p><p><strong>Results: </strong>Analysis of the GSE141295 dataset revealed a significant upregulation of HDAC9 expression in IgAN and the results of RT-qPCR demonstrated a substantial increase in HDAC9 expression in IgAN patients. Receiver operating characteristic (ROC) analysis indicated that the area under the curve (AUC) value for HDAC9 were 0.845 and Spearman correlation analysis showed that HDAC9 expression was positively correlated with blood levels of blood urea nitrogen (BUN) and serum creatinine (Crea). The EdU cell proliferation assay indicated that HDAC9 facilitated the excessive proliferation of GMCs. The STRING database and recovery experiments identified CALML6 as a downstream effector of HDAC9 in controlling abnormal GMC multiplication. Co-immunoprecipitation assays demonstrated that HDAC9 modulates CALML6 expression through acetylation modification.</p><p><strong>Conclusion: </strong>HDAC9 is markedly upregulated in IgAN, and it mediates the excessive proliferation of GMCs by regulating the deacetylation of CALML6.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"734-744"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A digest of the clinical practice guideline for pediatric idiopathic nephrotic syndrome 2020 updated: medical therapy.","authors":"Riku Hamada, Yoshitsugu Kaku, Aya Inaba, Hiroshi Kaito, Takahisa Kimata, Shuji Kondo, Mayumi Sako, Mai Sato, Keisuke Sugimoto, Seiji Tanaka, Yoshinobu Nagaoka, Kandai Nozu, Junya Hashimoto, Kenichiro Miura, Masaki Yamamoto, Fujimi Kawai, Shoichi Maruyama, Kenji Ishikura","doi":"10.1007/s10157-025-02636-5","DOIUrl":"10.1007/s10157-025-02636-5","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"691-701"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glomerular filtration of creatinine: expanding its clinical utility as a skeletal muscle mass index in non-dialysis CKD patients.","authors":"Shunsuke Yamada, Toshiaki Nakano","doi":"10.1007/s10157-025-02670-3","DOIUrl":"10.1007/s10157-025-02670-3","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"872-874"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring factors associated with Kidney Disease Quality of Life in patients with advanced chronic kidney disease: the Reach-J CKD cohort study.","authors":"Hironori Nakamura, Reiko Okubo, Michiko Kumagai, Mariko Anayama, Yasushi Makino, Katsuhiko Tamura, Masaki Nagasawa, Hirokazu Okada, Shoichi Maruyama, Junichi Hoshino, Takashi Wada, Ichiei Narita, Kunihiro Yamagata","doi":"10.1007/s10157-025-02628-5","DOIUrl":"10.1007/s10157-025-02628-5","url":null,"abstract":"<p><strong>Background: </strong>Although several studies have examined the Kidney Disease Quality of Life (KDQOL) in patients with chronic kidney disease (CKD), the factors associated with kidney-related symptoms have not been fully explored.</p><p><strong>Methods: </strong>This nationwide multicenter cohort study enrolled 2248 patients. To identify the factors associated with each item or the three KDQOL domains, such as burden of kidney disease, symptoms/problems of kidney disease, and impact of kidney disease on daily life, multiple regression analysis was performed using baseline data.</p><p><strong>Results: </strong>The study population had a mean age of 69.1 ± 12.6 years, comprised 64.7% men, and had mean estimated glomerular filtration rate (eGFR) of 23.2 ± 10.4 mL/min/1.73 m². Mean serum creatinine levels were 1.4 ± 0.2, 2.3 ± 0.5, and 4.5 ± 1.5 mg/dL for G3b, G4, and G5, respectively. The mean scores in the three KDQOL domains among CKD stages showed significantly decreasing trends. Of all the 11 symptoms assessed, 6 had scores that significantly decreased as the CKD stage progressed and 9 had scores that significantly decreased as the age category group increased. Multiple regression analysis revealed eGFR as a significantly associated factor for 5 of 11 symptoms. Age, body mass index, and comorbidities were also detected as significant factors for some symptoms.</p><p><strong>Conclusions: </strong>In addition to eGFR, several factors were associated with symptoms in patients with CKD. Nephrologists need to recognize renal dysfunction-specific symptoms and explore other plausible causes of nonspecific symptoms.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"765-776"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}