Clinical nephrology最新文献

{"title":"Use of bisphosphonates in chronic kidney disease is associated with cardiovascular death.","authors":"Kathleen A Borghoff, Agnes E Ounda, Melissa L Swee, Saket Girotra, Amal A Shibli-Rahhal, Patrick Ten Eyck, Diana I Jalal, Anna J Jovanovich","doi":"10.5414/CN111428","DOIUrl":"10.5414/CN111428","url":null,"abstract":"<p><strong>Background and objectives: </strong>Chronic kidney disease (CKD) is associated with increased cardiovascular risk, which may be mediated by vascular calcification. Based on evidence that bisphosphonates inhibit vascular calcification, we hypothesized use of bisphosphonates in CKD would be associated with lower incident cardiovascular disease (CVD), CVD-related mortality, and all-cause mortality.</p><p><strong>Materials and methods: </strong>This was a longitudinal observational study including 2,593 Framingham Offspring participants. We used propensity score-adjusted Cox regression models to determine the association between bisphosphonate use and outcomes: time to incident CVD, time to CVD-related mortality, and time to all-cause mortality. The data were stratified by presence or absence of CKD, defined as estimated glomerular filtration rate < 60 mL/min/1.73m². The propensity score included age, sex, hypertension, smoking status, diabetes, total cholesterol, high-density lipoprotein, and self-reported history of fracture.</p><p><strong>Results: </strong>In unadjusted and propensity score-adjusted analyses, those with CKD using bisphosphonates had a trend toward increased incident CVD risk (adjusted hazard ratio (HR) 1.66 (95% CI, 93 - 2.97)) compared to those with CKD not using bisphosphonates. Those with CKD using bisphosphonates also had increased risk of cardiovascular mortality in the propensity score-adjusted model (adjusted HR 2.20 (95% CI, 1.12 - 4.32)). There was no significant association between bisphosphonate use and all-cause mortality in participants with CKD. Among individuals without CKD, bisphosphonate use was significantly associated with an increase in all-cause mortality in the propensity-score adjusted analysis (adjusted HR 1.59 (95% CI, 1.27 - 1.98)). However, there was no significant association between bisphosphonate use and incident CVD events (adjusted HR 0.85 95% CI, 0.63 - 1.16) or CVD-related death (adjusted HR 0.70 (95% CI 0.36 - 1.37) in those without CKD.</p><p><strong>Conclusion: </strong>Contrary to our hypothesis, bisphosphonate use was associated with a trend toward increased incident CVD and a two-fold higher risk of CVD mortality in CKD.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"5-11"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614747","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":"The incidence and prevalence of immunoglobulin A nephropathy in the United States.","authors":"Marc DeCongelio, Sarah N Ali, Martina Furegato, Sandipan Bhattacharjee, Ancilla W Fernandes","doi":"10.5414/CN111489","DOIUrl":"10.5414/CN111489","url":null,"abstract":"<p><strong>Aims: </strong>Reliable national estimates for the incidence and prevalence of immunoglobulin A nephropathy (IgAN) in the United States (U.S.) are needed. We performed a national survey with pathologists and used insurance claims data to estimate IgAN frequency nationwide.</p><p><strong>Materials and methods: </strong>An online survey with pathologists was conducted between November and December 2021 to obtain data on the number and types of biopsies evaluated and the proportion with IgAN confirmed. Biopsy data were extrapolated to two different claims databases to estimate incidence and prevalence. Results were validated against a separate dataset of electronic health records.</p><p><strong>Results: </strong>A total of 43 pathologists from across U.S. regions reported evaluating a mean of 169 kidney biopsies (standard deviation 179.1) in the past 12 months. Of the 7,267 total biopsies evaluated, 632 (8.7%) were IgAN. Based on the respective claims databases, annual incidence rates of 2.1 and 2.2 per 100,000 and prevalence rates of 59.9 and 62.7 per 100,000 were estimated. Results from the validation dataset were similar, with an incidence of 1.9 per 100,000 and prevalence of 54.2 per 100,000.</p><p><strong>Conclusion: </strong>This study estimated incidence and prevalence of IgAN. Extrapolating the findings to the U.S. population for 2021, total prevalence was 198,887 - 208,184 persons.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"19-25"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667458","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":"Spontaneous remission of de novo membranous nephropathy in post-allogeneic hematopoietic stem cell transplantation patients: A report of two cases.","authors":"Wai Lun Will Pak, Ann Jakubowski, Miguel-Angel Perales, Claudia Michelle Brauer Obrador, Steven Salvatore, Surya Seshan, Ilya Glezerman","doi":"10.5414/CN111431","DOIUrl":"10.5414/CN111431","url":null,"abstract":"<p><p>Membranous nephropathy (MN) is one of the most common de novo glomerular diseases developing in patients after allogeneic hematopoietic stem cell transplantation (HSCT). Most authors have used immunosuppression for its treatment to target the underlying immune-mediated processes, akin to graft-versus-host disease, but the optimal management is currently unclear. Limited reports in the literature described the use of a conservative approach with success, particularly in cases with lower risks of progression, such as non-nephrotic-range proteinuria or early reduction of proteinuria by 6 months. We report two cases of post-HSCT MN with moderate risk features, namely prolonged durations of nephrotic-range proteinuria, that spontaneously resolved with conservative treatment. Patient 1 was of advanced age and in an immunocompromised state, while patient 2 was in need of a greater graft-versus-disease effect from the donor's immune system, which necessitated a balance between the risk of immunosuppression and the risk of progressive kidney function loss. These cases demonstrated that conservative treatment can be a reasonable approach in selected patients with post-HSCT MN, including those with moderate risk.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"370-374"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999509","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":"Impact of depression on clinical outcomes of peritoneal dialysis: A systematic review and meta-analysis.","authors":"Meiling Xu, Wei Zhang","doi":"10.5414/CN111454","DOIUrl":"10.5414/CN111454","url":null,"abstract":"<p><strong>Objective: </strong>Depression has become a highly prevalent mental disorder around the globe. With a large number of end-stage renal disease patients taking up peritoneal dialysis (PD), a substantial number of PD patients with concomitant depression are expected to be treated in the future. However, the effects of depression on outcomes of PD are unclear. This review systematically examines the effect of depression on mortality, technique survival, or peritonitis in PD patients.</p><p><strong>Materials and methods: </strong>Studies comparing outcomes of PD patients with and without depression and published on Google Scholar, Embase, Web of Science, and PubMed till February 5, 2024 were included.</p><p><strong>Results: </strong>Eleven studies were eligible; 5 studies reported data on mortality. Pooled analysis showed that depression was not a significant predictor of mortality in PD patients (HR: 1.22 95% CI: 0.86, 1.72). Only 2 studies reported analyzable data on technique survival and 3 studies on peritonitis. Meta-analysis found no statistically significant effect of depression on technique survival (OR: 1.28 95% CI: 0.38, 4.35) and peritonitis (OR: 1.89 95% CI: 0.82, 4.33). Qualitative analysis of remaining studies also suggested no effect of depression on patient and technique survival.</p><p><strong>Conclusion: </strong>Depression may not be an independent predictor of patient and technique survival in PD patients. Data on the risk of peritonitis is conflicting and needs to be investigated further.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"333-342"},"PeriodicalIF":1.1,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139502","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":"Clinicopathological features and outcomes of PLA2R-related membranous nephropathy with renal glycosuria.","authors":"Piao Zhang, Feng Xu, Xumeng Liu, Ziyun Hu, Dandan Liang, Shaoshan Liang, Xiaodong Zhu, Fan Yang, Caihong Zeng","doi":"10.5414/CN111362","DOIUrl":"10.5414/CN111362","url":null,"abstract":"<p><strong>Background: </strong>Membranous nephropathy (MN) is an immune complex-mediated disease. Massive proteinuria can lead to Fanconi syndrome, clinically manifesting as renal glycosuria. The prevalence and prognosis of M-type phospholipase A2 receptor (PLA2R)-related MN with renal glycosuria remain unknown.</p><p><strong>Materials and methods: </strong>Patients diagnosed with PLA2R-related MN with renal glycosuria were reviewed, and the control group comprised patients with MN without renal glycosuria who were randomly selected at a ratio of 1 : 3.</p><p><strong>Results: </strong>50 patients diagnosed with PLA2R-related MN with renal glycosuria from January 2015 to January 2020 were included, with a prevalence of 2.3%. Compared with patients without renal glycosuria, those with renal glycosuria exhibited greater proteinuria, lower estimated glomerular filtration rate (eGFR), and higher use of diuretics, anticoagulants, antibiotics, traditional Chinese medicine, and tacrolimus within 3 months prior to renal biopsy (all p < 0.05). Histologically, patients with renal glycosuria exhibited more severe pathological stages, acute/chronic tubulointerstitial lesions, and tubulointerstitial inflammation (all p < 0.05). Of the 10 patients treated with rituximab (RTX), proteinuria remission was maintained in 6 (60%) patients, and urine glucose remission was achieved in 5 of these 6 patients (83.3%). Multivariate Cox regression analysis showed that renal glycosuria and age &gt; 50 years were independent risk factors for end-stage renal disease (ESRD) or a 30% reduction in the eGFR in patients with PLA2R-related MN.</p><p><strong>Conclusion: </strong>PLA2R-related MN patients with renal glycosuria presented with more severe clinicopathological manifestations and worse prognoses. Nephrotoxic drugs should be administered rationally, and RTX should be considered as a promising treatment option.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"273-284"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888644","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":"Idiopathic nodular glomerulosclerosis: A case report and literature review.","authors":"Huan Yang, Ying Li, Zhenkun He, Yunjuan Liao, Chunrui Yang, ShanShan Dong","doi":"10.5414/CN111382","DOIUrl":"10.5414/CN111382","url":null,"abstract":"<p><p>This paper reports a 49-year-old male patient with a long-term smoking history who developed renal insufficiency and proteinuria in the range of nephropathy without diabetes. Renal biopsy showed nodular glomerulosclerosis with vitreous degeneration of arterioles and moderate and severe proliferation of glomerular mesangial cells and matrix. The patient was diagnosed with idiopathic nodular glomerulosclerosis. After treatment with angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) drugs, the level of albuminuria decreased rapidly, and renal function remained stable. The clinical manifestations and pathological features of 122 cases of idiopathic nodular glomerulosclerosis reported from 1999 to August 2023 were analyzed, retrospectively.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"312-320"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906114","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":"Use of the Omaha System nursing model on nutritional status outcomes in peritoneal dialysis patients.","authors":"Cen Zhang, Ruo Zhuang, Xiao-Lei Chen, Xiao-Dong Cao, Meng-Ting Xue","doi":"10.5414/CN111385","DOIUrl":"10.5414/CN111385","url":null,"abstract":"<p><strong>Objective: </strong>To construct and apply a risk screening and intervention system for malnutrition in peritoneal dialysis patients based on the Omaha System.</p><p><strong>Materials and methods: </strong>A total of 75 peritoneal dialysis patients were randomly divided into control (38 cases) and intervention group (37 cases). The control group received routine operation training and health education, and the intervention group implemented a nutritional management plan based on the Omaha System. The modified quantitative subjective comprehensive nutritional scale (MQSGA) score, kidney disease dietary compliance attitude (RAAQ) and behavior (RABQ) score, body mass index (BMI), serum albumin (ALB), prealbumin (PA), and hemoglobin (Hb) were observed.</p><p><strong>Results: </strong>Before intervention, there was no significant difference in these indicators between the two groups (p > 0.05). After 6 months, the MQSGA score in the intervention group was significantly lower than that in the control group (p < 0.05). RAAQ score and RABQ score in the intervention group were higher than those in the control group and (p < 0.05), and the nutritional indicators in the intervention group, such as BMI, ALB, PA, and Hb, were higher than those in the control group (p < 0.05).</p><p><strong>Conclusion: </strong>A nutritional management plan based on the Omaha System can help improve the nutrition condition of peritoneal dialysis patients, and improve the dietary compliance of chronic kidney disease patients.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"264-272"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281354","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":"Comparison of the efficacy of educational materials for chronic kidney disease during outpatient waiting time.","authors":"Maiko Kimura, Daisuke Honda, Mizuyo Okura, Yuki Shiko, Yohei Kawasaki, Masashi Aizawa, Katsuhiko Asanuma","doi":"10.5414/CN111413","DOIUrl":"10.5414/CN111413","url":null,"abstract":"<p><strong>Aim: </strong>Patient education is crucial for preventing chronic kidney disease (CKD) progression, but adequate educational time is not always available in standard nephrology outpatient clinics. However, usefulness of educational materials provided by healthcare providers in educational settings has been reported. This study aimed to compare the efficacy of pamphlet and video materials in increasing CKD knowledge at a nephrology clinic using waiting time.</p><p><strong>Materials and methods: </strong>44 CKD stage 3 - 5 patients were randomly assigned to either pamphlet or video education group, receiving a single session during an outpatient visit. We evaluated the objective CKD knowledge score, perceived kidney disease knowledge score, self-care scores, and amount of estimated salt intake before and after the educational intervention.</p><p><strong>Results: </strong>In both groups, the educational intervention significantly increased objective and perceived CKD knowledge scores (p < 0.001). No significant differences in increase in total knowledge scores between both groups were observed; however, different educational effects were observed in several individual knowledge items such as urinary protein and CKD stages. In both groups, self-care scores and amount of estimated salt intake did not change significantly before and after the intervention, but amount of estimated salt intake significantly decreased in patients with a history of dietary guidance (p = 0.044).</p><p><strong>Conclusion: </strong>A single educational session with simple materials during outpatient waiting time at the nephrology clinic visit significantly improved patients' CKD knowledge, and suitable educational methods may differ according to knowledge items. Furthermore, patients who receive dietary guidance with specific instructions might exhibit salt reduction behavior through the use of educational materials.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"285-294"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139501","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":"Current use, training, and barriers in point-of-care ultrasound in nephrology: A national survey of VA medical centers.","authors":"Kevin J Murray, Abhilash Koratala, Ariadna Perez-Sanchez, Terry Lund, Anthony Andrade, Steven M Gorbatkin, John M Duch, Sandipani Sandilya, Jorge Lamarche, Michael J Mader, Elizabeth K Haro, Nilam J Soni, Robert Nathanson","doi":"10.5414/CN111464","DOIUrl":"10.5414/CN111464","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) can improve diagnostic accuracy, reduce procedural complications and enhance physician-patient interactions in nephrology. Currently, there is limited knowledge about how practicing nephrologists are using POCUS.</p><p><strong>Objective: </strong>This study aimed to characterize current POCUS use, training needs, and barriers to use among nephrology groups.</p><p><strong>Materials and methods: </strong>A prospective observational study of all Veterans Affairs (VA) medical centers was conducted between August 2019 and March 2020 using a web-based survey sent to all chiefs of staff and nephrology specialty chiefs.</p><p><strong>Results: </strong>Chiefs of staff (n = 130) and nephrology chiefs (n = 79) completed surveys on facility- and service-level POCUS use (response rates of 100% and 77%, respectively). Current diagnostic or procedural POCUS use was reported by 41% of nephrology groups, and the most common POCUS applications were central line insertion (28%) and assessment of urinary retention (23%), hydronephrosis (18%), volume status (15%), and bladder (14%). Lack of training was the most common barrier (72%), and most nephrology groups (65%) desired POCUS training. Limited access to ultrasound equipment and POCUS training were barriers reported by 54% and 18% of groups, respectively.</p><p><strong>Conclusion: </strong>A minority of nephrology groups currently use common POCUS applications including evaluation of urinary retention, hydronephrosis, and volume status. The most common barriers to POCUS use in nephrology were lack of trained providers and ultrasound equipment. Investment in POCUS training and infrastructure is needed to expand and standardize POCUS use in nephrology.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"257-263"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906113","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":"Post-COVID-19 complement-mediated TMA: A case report.","authors":"Jan A Jochims, Babak Yazdani, Bernd Krüger, Zoran V Popovic, Bernhard K Krämer","doi":"10.5414/CN111217","DOIUrl":"10.5414/CN111217","url":null,"abstract":"<p><p>Systemic COVID-19 disease is associated with a variety of organ involvement in infected patients. A rarely reported complication is the induction of complement-mediated thrombotic microangiopathy (TMA). TMA is an extremely rare pathological condition that results in thrombosis in capillaries and small arterioles, due to an endothelial injury. It is often combined with thrombocytopenia, Coombs-negative hemolytic anemia, and end-organ damage. This case involves a patient who was admitted to our hospital for the purpose of diagnosis and treatment of acute kidney injury (AKIN 3) with severe proteinuria after a preceding SARS-CoV-2 infection. A 77-year-old male patient had COVID-19 pneumonia in January 2021 with the need of high-flow oxygen therapy in the intensive care unit. In March 2021, he was hospitalized again due to elevated serum creatinine levels and proteinuria. The patient exhibited normal vital parameters. A renal biopsy showed severe TMA. A diagnosis of COVID-19-associated TMA was made, and treatment with high-dose glucocorticoid therapy and plasma exchange was initiated. Additionally, therapy with eculizumab was established. Unfortunately, the kidney failure was initially progressive, so that hemodialysis (HD) was temporarily necessary. In May 2021, kidney function recovered to an estimated glomerular filtration rate of ~ 30 mL/min/1.73m² corresponding to chronic kidney disease stage 3bA3 - 4A3. COVID-19-associated TMA is an extremely rare disease. TMA may be a possible long-term complication with the risk of end-stage renal disease if not properly diagnosed and treated.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"232-237"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751294","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}