Clinical nephrology最新文献

{"title":"Are Your Kidneys Ok? Detect early to protect kidney health.","authors":"Joseph A Vassalotti, Anna Francis, Augusto Cesar Soares Dos Santos, Ricardo Correa-Rotter, Dina Abdellatif, Li-Li Hsiao, Stefanos Roumeliotis, Agnes Haris, Latha A Kumaraswami, Siu-Fai Lui, Alessandro Balducci, Vassilios Liakopoulos","doi":"10.5414/CNWKDEdi25","DOIUrl":"10.5414/CNWKDEdi25","url":null,"abstract":"<p><p>Early identification of kidney disease can protect kidney health, prevent kidney disease progression and related complications, reduce cardiovascular disease risk and decrease mortality. We must ask <i>\"Are your kidneys ok?\"</i>, using serum creatinine to estimate kidney function and urine albumin to assess for kidney and endothelial damage. Evaluation for causes and risk factors for chronic kidney disease (CKD) includes testing for diabetes and measurement of blood pressure and body mass index. This World Kidney Day we assert that case-finding in high-risk populations, or even populationlevel screening, can decrease the burden of kidney disease globally. Early-stage CKD is asymptomatic, simple to test for, and recent paradigm shifting CKD treatments such as sodium glucose co-transporter-2 inhibitors dramatically improve outcomes and favor the cost-benefit analysis for screening or case-finding programs. Despite this, numerous barriers exist, including resource alloca-Editorial tion, healthcare funding, healthcare infrastructure, and healthcare-professional and population awareness of kidney disease. Coordinated efforts by major kidney nongovernmental organizations to prioritize the kidney health agenda for governments and aligning early detection efforts with other current programs will maximize efficiencies.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198405","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":"Resolution of acute kidney injury following intensive dialysis for oxalate nephropathy.","authors":"John R Roth, Alessia Buglioni, Neera K Dahl","doi":"10.5414/CN111664","DOIUrl":"10.5414/CN111664","url":null,"abstract":"<p><p>Oxalate nephropathy refers to the deposition of calcium oxalate crystals within the renal parenchyma. The subsequent tubular-interstitial inflammation results in acute kidney injury and/or chronic kidney disease. This condition occurs in the setting of hyperoxaluria or increased urinary excretion of oxalate. Enteric hyperoxaluria is an increasingly recognized cause of secondary hyperoxaluria in which fat malabsorption promotes increased absorption of dietary oxalate. In the context of increasing utilization of bariatric procedures to address obesity, those who have undergone biliopancreatic diversions represent a growing subset of patients who later develop oxalate nephropathy. Presently, management options for affected individuals are limited to dietary interventions, and renal outcomes are poor. We present a case of stage III acute kidney injury from oxalate nephropathy in a bariatric patient who demonstrated renal recovery after decreasing serum oxalate levels through an early, intensive dialysis regimen.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198408","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":"C3 glomerulopathy and acute kidney injury after mRNA-1273 (Moderna) COVID-19 vaccine and genetical analysis.","authors":"Ming-Yuan Victor Chao, Ching-Hsiu Peng, Fu-Pang Chang, Yi-Chun Wang","doi":"10.5414/CN111570","DOIUrl":"10.5414/CN111570","url":null,"abstract":"<p><p>The emergence of glomerular diseases following COVID-19 vaccination, particularly with mRNA vaccines, has sparked significant interest in the scientific community. We present the genetic analysis of a case involving a 51-year-old female who developed C3 glomerulopathy following her 3^rd dose of the mRNA-1273 (Moderna) COVID-19 vaccine. Through comprehensive whole-genome exome sequencing, we identified a missense mutation in the SLC12A3 gene, along with other genetic variations, which may provide insights into the molecular mechanisms underpinning vaccine-associated glomerulopathies. This case underscores the importance of exploring genetic predispositions when encountering adverse reactions to mRNA vaccines, particularly those affecting the complement pathway and glomerulopathies.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198406","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":"Clinical manifestations and prognosis of immune-mediated membranous nephropathy concurrent with other glomerulonephritides: A retrospective Chinese cohort analysis.","authors":"Zhe Li, Shuhua Zhu, Ke Zuo, Dacheng Chen, Weibo Le, Feng Xu, Xia Wang","doi":"10.5414/CN111627","DOIUrl":"10.5414/CN111627","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to analyze the clinical and prognostic differences in immune-mediated membranous nephropathy (MN) concurrent with other forms of glomerulonephritis.</p><p><strong>Materials and methods: </strong>A retrospective cohort study at Jinling Hospital from 2015 to 2023 included patients with PLA2R antibody levels ≥ 14RU/mL who underwent renal biopsy. Those with immune-mediated MN and concurrent glomerulonephritides were compared to a control group with isolated MN diagnosed in 2015.</p><p><strong>Results: </strong>Concurrent glomerulonephritis was found in 5.53% of the MN cohort, including 61 patients with IgA nephropathy (IgAN-MN), 49 with diabetic nephropathy (DN-MN), and 131 with focal segmental glomerulosclerosis (FSGS-MN). Compared to the control group, those with IgAN-MN showed increased severity of glomerular injury yet had a reduced degree of interstitial fibrosis. The DN-MN group exhibited intensified glomerular damage; however, no significant difference was observed in the extent of tubulointerstitial damage. Additionally, the FSGS-MN group displayed more severe damage to both glomerular and tubulointerstitial structures. Both the DN-MN group and the FSGS-MN group exhibited a significantly lower complete remission rate compared to the control group. The renal endpoint event rates were 29.51% for IgAN-MN, 46.94% for DN-MN, and 33.59% for FSGS-MN, which were all significantly higher than the 18.99% rate in the control group.</p><p><strong>Conclusion: </strong>Patients with MN who test positive for serum Anti-PLA2R antibodies may present with other forms of glomerulonephritis. The prognostic outcomes of MN in the presence of concurrent IgAN, DN, or FSGS are notably poorer than those of isolated MN. Renal biopsy is valuable for definitive diagnosis and prognostic evaluation.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198407","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":"Prediction and phenotyping of long COVID in kidney transplant recipients: A cross-sectional study.","authors":"Ivan Zahradka, Vojtech Petr, Istvan Modos, Katarina Jakubov, Lukas Dolezal, Szabolcs Kalina, Ondrej Viklicky","doi":"10.5414/CN111584","DOIUrl":"10.5414/CN111584","url":null,"abstract":"<p><strong>Aims: </strong>The aim was to describe the epidemiology, phenotyping, and risk factors of long COVID (LC) in a well-defined cohort of kidney transplant recipients (KTRs) using a novel LC diagnostic method based on self-reported symptoms.</p><p><strong>Materials and methods: </strong>We conducted a cross-sectional study using an electronic survey to inquire about persisting symptoms following COVID-19. KTRs who survived COVID-19 up to February 8, 2023, were considered for inclusion, and 596 KTRs were enrolled. A brief 35-question screening questionnaire was used. A novel statistical approach based on the factor analysis method was used to make LC diagnosis and identify its clinical phenotypes.</p><p><strong>Results: </strong>LC was identified in 33.7% of KTRs who responded to the survey. Male sex (OR 0.69, 95% CI 0.48 - 1.0, p = 0.047), more severe COVID-19 (OR 2.48, 95% CI 1.58 - 3.92, p < 0.001), higher body mass index (OR 1.04, 95% CI 1.0 - 1.08, p = 0.031), and corticosteroids (OR 2.8, 95% CI 1.23 - 7.09, p = 0.02) were independently associated with LC development. Eight LC phenotypes were identified based on symptom clustering: fatigue (32.4% of all KTRs), psychiatric (15.9%), cardiovascular (6%), ophthalmic (13.8%), cognitive (17.8%), fibromyalgia-like (11.1%), integumental (10.6%), and malnutritional (6%). The rate of LC was similar in those who had COVID-19 less/more than a year since responding to the survey.</p><p><strong>Conclusion: </strong>A novel method for determining LC diagnosis and its phenotyping was used in a large cohort of KTRs, which showed that a third of KTRs who responded to the survey developed LC after COVID-19. This method may improve diagnosis and future research of LC.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"366-376"},"PeriodicalIF":1.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of chronic kidney disease-associated pruritus on quality of life in hemodialysis and non-dialysis patients: A cross-sectional study.","authors":"Abdullah Ucar, Mevlut Tamer Dincer, Safak Mirioglu, Siddik Keskin, Cebrail Karaca","doi":"10.5414/CN111649","DOIUrl":"10.5414/CN111649","url":null,"abstract":"<p><strong>Aims: </strong>Chronic kidney disease-associated pruritus (CKD-aP) is a common and distressing symptom, particularly in hemodialysis (HD) patients, significantly impacting their quality of life. This study aimed to investigate the effects of CKD-aP frequency and severity on quality of life in both HD and non-HD stage 3 - 5 CKD patients.</p><p><strong>Materials and methods: </strong>This cross-sectional case-control study was conducted from January to May 2024. Pruritus was assessed using the 5-D itch scale, and quality of life was evaluated with the World Health Organization Quality of Life Scale-Short Form (WHOQoL-BREF) questionnaire. Correlations between pruritus severity and patient characteristics were analyzed.</p><p><strong>Results: </strong>The study involved 169 patients, comprising 80 non-HD stage 3 - 5 CKD patients and 89 HD patients, with a mean age of 55.2 ± 16.7 years. Pruritus was significantly more prevalent in the HD group than in the non-HD group (61.8 vs. 41.3%, p = 0.008). HD patients had more pruritic body areas and higher 5-D itch scale scores (0 (0 - 8.5) vs. 0 (0 - 3.75), p = 0.002; 9.3 (8.0 - 14.8) vs. 8.0 (8.0 - 10.3), p = 0.003). In the HD group, pruritus was associated with lower quality of life in the psychological health, social relationships, and environment domains of the WHOQoL-BREF questionnaire (50.0 (35.4 - 58.3)% vs. 54.2 (42.7 - 66.7)%, p = 0.027; 50.0 (33.3 - 58.3)% vs. 50.0 (41.6 - 66.7)%, p = 0.046; 53.1 (40.6 - 65.5)% vs. 56.3 (50.0 - 68.8)%, p = 0.026, respectively). Pruritus also correlated with lower hemoglobin levels, higher serum creatinine levels, and poorer overall quality of life in both groups, with female sex and erythropoiesis-stimulating agent use as significant contributing factors.</p><p><strong>Conclusion: </strong>Pruritus significantly impairs the quality of life in HD patients.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109977","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":"Efficacy and safety of repositioning malfunctioning peritoneal dialysis catheters with fluoroscopically guided guidewire manipulation.","authors":"Ron Cheuk Lau Wong, Eric Wai Pan Cheung, Agnes Wong, Brian Kar Ho Lee, Ka King Cheng, Danny Hing Yan Cho","doi":"10.5414/CN111605","DOIUrl":"https://doi.org/10.5414/CN111605","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of fluoroscopic-guided repositioning of peritoneal dialysis (PD) catheter using guidewire manipulation in our center in Hong Kong.</p><p><strong>Materials and methods: </strong>All patients underwent fluoroscopic-guided PD catheter repositioning in our institution between November 1, 2017 to December 31, 2022 were reviewed. Patients fulfilling the selection criteria were identified, with their clinical notes, relevant radiological reports, interventional images, and operative records retrospectively reviewed. The success rate was evaluated, with the technical success defined as improved free contrast flow or return of continuous steady stream after test injection of normal saline immediately after repositioning; clinical success defined as functional peritoneal dialysis catheter at 30 days post-repositioning. Logistic regression models were applied to evaluate the variables associated with successful manipulation. Post-manipulation complications and the PD time gained after successful manipulation were also reviewed.</p><p><strong>Results: </strong>46 patients were identified and 54 procedures were performed over the study period. 35 of the interventions (64.8%) resulted in technical success, and 25 cases (46.3%) resulted in clinical success. The median extra PD time gained after successful manipulation was 619 days (IQR, 313.5 - 1,007; range, 110 - 1,872). The median for number of days of hospital stay after the procedure was 2.5 days (IQR, 2 - 5; range, 1 - 65). Seven cases (13.0%) developed immediate complications, with most cases being peritonitis (n = 5), and all were successfully treated with intraperitoneal antibiotics. There was no associated mortality.</p><p><strong>Conclusion: </strong>Fluoroscopic-guided repositioning of the PD catheter was found to be a useful and safe treatment option for malfunctioning PD catheter and could potentially spare patients from the conventional operative intervention.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143980290","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":"Central blood volume and cardiac output index predict all-cause and cardiovascular mortality in chronic hemodialysis patients.","authors":"Chung-Kuan Wu, Li-Juan Lin, Chew-Teng Kor, Chia Lin Wu","doi":"10.5414/CN111484","DOIUrl":"https://doi.org/10.5414/CN111484","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the effect of central blood volume (CBV) and cardiac output index (COI) on the all-cause and cardiovascular mortality in chronic hemodialysis (CHD) patients.</p><p><strong>Materials and methods: </strong>Adult CHD patients with functional arteriovenous access at the hemodialysis center of a medical center between January 1, 2003, and December 31, 2014, were recruited in this retrospective observational study. The primary and secondary endpoints were all-cause and cardiovascular mortality. Cumulative incidences of all-cause and cardiovascular mortality during the follow-up period were estimated and compared using the Kaplan-Meier method and log-rank test. Logistic regression and Cox proportional hazards models were used to calculate odds and hazard ratios.</p><p><strong>Results: </strong>A total of 390 CHD patients were enrolled, including 34 patients with early mortality. The early mortality group had a higher CBV than the survival group. CBV and COI were independently associated with all-cause and cardiovascular mortality. Low COI (< 3 L/min/m2) and high CBV (≥ 1.25 L) independently predicted long-term all-cause and cardiovascular mortality. The highest risks of all-cause and cardiovascular mortality were observed in patients with low COI and high CBV, followed by high COI and high CBV and then low COI and low CBV. Mortality was the lowest in those with high COI and low CBV.</p><p><strong>Conclusion: </strong>CBV and COI are important factors for predicting death in CHD patients. Those with low COI and high CBV had the worst outcomes.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966788","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":"Atypical hemolytic uremic syndrome associated with acute pancreatitis.","authors":"Kunxiao Zhao, Jie Feng, Qiongzhen Lin, Ying Lei","doi":"10.5414/CN111660","DOIUrl":"https://doi.org/10.5414/CN111660","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977330","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":"Malnutrition and short-term mortality in hospitalized general medical patients with acute kidney injury: A prospective observational study.","authors":"Vishal Choudhary, Surendran Deepanjali","doi":"10.5414/CN111715","DOIUrl":"https://doi.org/10.5414/CN111715","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a common condition present at admission to hospital in a proportion of general medical patients and it contributes to mortality. Presence of associated malnutrition could worsen the prognosis. We aimed to study the prevalence of malnutrition in patients with community-acquired AKI requiring hospitalization and its association with short-term (in-hospital and 1-month post-discharge) mortality, admission to the intensive care unit (ICU) and length of hospitalization (LOH).</p><p><strong>Materials and methods: </strong>We did a prospective observational study including adult general medical patients who had AKI at admission; patients with chronic kidney disease were excluded. We calculated the Charlson Comorbidity Index (CCI) and Sequential Organ Failure Assessment Score (SOFA). Nutritional assessment was done using Subjective Global Assessment (SGA) and also Prognostic Nutritional Index (PNI). Clinical course and vital status at 1 month after discharge was noted. Predictors of mortality were identified using logistic regression.</p><p><strong>Results: </strong>We recruited 230 patients. The median (interquartile range (IQR)) age was 51 (40 - 64) years; 171 (74.3%) were males. Based on admission creatinine, 60 (26%) were in Kidney Disease Improving Global Outcomes (KDIGO) stage 1, 82 (35.6%) in stage 2, and 88 (38.3%) in stage 3. We found that 132 (57.4%) belonged to SGA category A, 77 (33.5%) to SGA B, and 21 (9.1%) to SGA C. The median (IQR) PNI was 36.3 (30 - 46.6). The short-term mortality was 59 (25.6%). Multivariable analysis showed that male sex (adjusted OR (aOR) (2.75 (1.08 - 6.98); p = 0.033), higher CCI (aOR 1.43 (1.18 - 1.74); p < 0.001), higher SOFA scores (aOR 1.36 (1.19 - 1.55); p < 0.001), and SGA C category (aOR 4.4 (1.39 - 14.03); p = 0.012) to be associated with mortality, while AKI due to underlying infections was associated with survival (aOR 0.38 (0.18 - 0.78); p = 0.008). There was no association of malnutrition with ICU admission or LOH. PNI did not predict mortality.</p><p><strong>Conclusion: </strong>About 10% of patients with community-acquired AKI had severe malnutrition, and it independently predicts mortality. Male sex, higher CCI, and higher SOFA scores were also associated with mortality. AKI associated with infections has a better prognosis.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967980","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}