Clinical Kidney Journal最新文献

{"title":"When should the nephrologist think about genetics in patients with glomerular diseases?","authors":"Roser Torra, Xoana Barros, Montserrat Díaz-Encarnación, Leonor Fayos, Mónica Furlano, Melissa Pilco, Marc Pybus, Amir Shabaka, Elizabeth Viera, Elisabet Ars","doi":"10.1093/ckj/sfaf044","DOIUrl":"10.1093/ckj/sfaf044","url":null,"abstract":"<p><p>This review discusses the significance of genetics in diagnosing glomerular diseases. Advances in genetic testing, particularly next-generation sequencing, have improved the accessibility and accuracy of diagnosing monogenic diseases, allowing for targeted gene panels and whole-exome/genome sequencing to identify genetic variants associated with glomerular diseases. Key indicators for considering a genetic cause include the age of onset, extrarenal features, family history, and inconclusive kidney biopsy results. Early-onset diseases, for instance, have a higher likelihood of being genetically caused, while extrarenal manifestations can also suggest an underlying genetic condition. A thorough family history can reveal patterns of inheritance that point to monogenic causes, although complexities like incomplete penetrance, skewed X inactivation and mosaicism can complicate the assessment. Also, autosomal recessive conditions imply asymptomatic parents, making genetic suspicion less likely, while <i>de novo</i> mutations can occur without any family history, further obscuring genetic assessment. Focal segmental glomerulosclerosis (FSGS) is characterized by podocyte injury and depletion, presenting in various forms, including primary, genetic, and secondary FSGS. Accurate classification of FSGS patients based on clinical and histological features is essential for guiding treatment decisions, optimizing therapeutic plans, avoiding unnecessary immunosuppression, and predicting relapse risk after kidney transplantation. Overall, a clinicopathological approach, enriched by genetic testing, offers a precise framework for diagnosis and management in glomerular diseases. Future directions for research and clinical practice include potential advancements in genetic testing and personalized medicine, which could further improve diagnostic precision and individualized treatment strategies.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf044"},"PeriodicalIF":3.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital physical activity intervention via the Kidney BEAM platform in patients with polycystic kidney disease: a randomized controlled trial.","authors":"Juliet Briggs, Elizabeth Ralston, Thomas J Wilkinson, Christy Walklin, Emmanuel Mangahis, Hannah M L Young, Ellen M Castle, Roseanne E Billany, Elham Asgari, Sunil Bhandari, Kate Bramham, James O Burton, Jackie Campbell, Joseph Chilcot, Vashist Deelchand, Alexander Hamilton, Mark Jesky, Philip A Kalra, Kieran McCafferty, Andrew C Nixon, Zoe L Saynor, Maarten W Taal, James Tollitt, David C Wheeler, Jamie Macdonald, Sharlene A Greenwood","doi":"10.1093/ckj/sfaf041","DOIUrl":"10.1093/ckj/sfaf041","url":null,"abstract":"<p><strong>Background: </strong>In people living with polycystic kidney disease (PKD), physical inactivity may contribute to poor health-related quality of life (HRQoL). To date, no research has elucidated the impact of a PKD-specific physical activity programme on HRQoL and physical health. This substudy of the Kidney BEAM Trial evaluated the impact of a PKD-specific 12-week educational and physical activity digital health intervention for people living with PKD.</p><p><strong>Methods: </strong>This study was a mixed-methods, single-blind, randomized waitlist-controlled trial. Sixty adults with a diagnosis of PKD were randomized 1:1 to the intervention or a waitlist control group. Primary outcome was difference in the Kidney Disease QoL Short Form 1.3 Mental Component Summary (KDQoL-SF1.3 MCS) between baseline and 12 weeks. Six participants completed individualized semi-structured interviews.</p><p><strong>Results: </strong>All 60 individuals (mean 53 years, 37% male) were included in the intention-to-treat analysis. At 12 weeks, there was a significant difference in mean adjusted change in KDQoL MCS score between the intervention group and waitlist control [4.2 (95% confidence interval 1.0-7.4) arbitrary units, <i>P =</i> .012]. Significant between-group differences in KDQoL subscales-burden of kidney disease (<i>P</i> = .034), emotional wellbeing (<i>P</i> = .001) and energy/fatigue (<i>P</i> = .001)-were also achieved. There was no significant between-group difference in KDQoL PCS scores (<i>P</i> = .505). Per-protocol analyses revealed significant between group differences in the PAM-13 patient activation score (<i>P</i> = .010) and body mass (<i>P</i> = .027). Mixed-methods analyses revealed key influences of the programme, including opportunities for peer support and to build on new skills and knowledge, as well as the empowerment and self-management.</p><p><strong>Conclusion: </strong>A PKD-specific digital health educational and physical activity intervention is acceptable and has the potential to improve HRQoL. Further research is needed to better understand how specific education and lifestyle management may help to support self-management behaviour.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf041"},"PeriodicalIF":3.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monkeypox infection in kidney transplant recipients.","authors":"Ola Suliman, Mohammad Joomye, Henry H L Wu, Rajkumar Chinnadurai","doi":"10.1093/ckj/sfaf048","DOIUrl":"10.1093/ckj/sfaf048","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf048"},"PeriodicalIF":3.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ERA Registry Figure of the month Patient survival on dialysis and kidney transplantation.","authors":"Vianda S Stel, Alberto Ortiz, Anneke Kramer","doi":"10.1093/ckj/sfaf051","DOIUrl":"https://doi.org/10.1093/ckj/sfaf051","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 2","pages":"sfaf051"},"PeriodicalIF":3.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does low-dose spironolactone increase cardiovascular protection in patients with chronic kidney disease?","authors":"Clara García-Carro, Pantelis Sarafidis","doi":"10.1093/ckj/sfaf038","DOIUrl":"10.1093/ckj/sfaf038","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf038"},"PeriodicalIF":3.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms and treatment of obesity-related hypertension-Part 2: Treatments.","authors":"Aneliya Parvanova, Manuela Abbate, Elia Reseghetti, Piero Ruggenenti","doi":"10.1093/ckj/sfaf035","DOIUrl":"10.1093/ckj/sfaf035","url":null,"abstract":"<p><p>Hypertension is a frequent comorbidity of obesity that significantly and independently increases the risk of cardiovascular and renal events. Obesity-related hypertension is a major challenge to the healthcare system because of the rapid increase in obesity prevalence worldwide. However, its treatment is still not specifically addressed by current guidelines. Weight loss (WL) <i>per se</i> reduces blood pressure (BP) and increases patient responsiveness to BP-lowering medications. Thus, a weight-centric approach is essential for the treatment of obesity-related hypertension. Diet and physical activity are key components of lifestyle interventions for obesity-related hypertension, but, in real life, their efficacy is limited by poor long-term patient adherence and frequently require pharmacotherapy implementation to achieve target BP. In this context, first-generation anti-obesity drugs such as orlistat, phentermine/topiramate, and naltrexone/bupropion are poorly effective, whereas second-generation incretin receptor agonists, including the GLP-1 receptor agonists liraglutide and semaglutide, and in particular the dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) co-agonist tirzepatide, substantially contribute to effective WL and BP control in obesity. SGLT2 inhibitors are weak body weight and BP-lowering medications, but clearly synergize the benefits of these medications. Bariatric surgery remains the gold standard treatment for severe \"pathological\" obesity and related life-threatening complications. Renal denervation is a valuable rescue treatment for drug-resistant hypertension, commonly related to obesity. Integrating a multifaceted weight-based approach with other strategies, such as antihypertensive drugs and renal denervation, could specifically target the main neuro-hormonal and renal pathophysiological mechanisms of obesity-related hypertension, including sympathetic-nervous and renin-angiotensin-aldosterone systems overactivity, salt retention, and volume expansion. This comprehensive strategy can provide a personalized algorithm for managing hypertension in obesity within the context of \"precision medicine\" principles.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf035"},"PeriodicalIF":3.9,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of obinutuzumab in rituximab-refractory membranous nephropathy and minimal change disease.","authors":"Zewei Chen, Dechao Xu, Shuangcheng Wu, Wenyu Liu, Jianxiang Wu, Shengqiang Yu, Bing Dai, Zhiguo Mao, Xiang Gao","doi":"10.1093/ckj/sfaf039","DOIUrl":"10.1093/ckj/sfaf039","url":null,"abstract":"<p><strong>Background: </strong>Obinutuzumab, a new-generation anti-CD20 monoclonal antibody, was originally developed to overcome resistance to rituximab in B-cell malignancies. There is limited research regarding the use of obinutuzumab in patients with rituximab-refractory membranous nephropathy (MN) and minimal change disease (MCD).</p><p><strong>Methods: </strong>A retrospective analysis was performed at Changzheng Hospital from September 2022 to September 2024, and screened patients with rituximab-refractory MN or MCD. Participants were treated because they were refractory to rituximab and consented to receive infusions of obinutuzumab. Primary outcomes were defined as complete remission (CR, proteinuria <0.3 g/d) or partial remission (PR, proteinuria <3.5 g/d with a ≥50% reduction). Secondary outcome was immunological remission in patients with phospholipase A2 receptor (PLA2R)-related MN.</p><p><strong>Results: </strong>Seven patients with MN and five with MCD were included in the cohort. Among patients with MN, six of seven (86%) achieved at least PR, of whom two patients reached CR with a median time to first remission (either PR or CR) of 8.0 months. Among patients with positive serum anti-PLA2R antibodies at baseline, all achieved an immunological response. No patients experienced a relapse during the follow-up period. Among patients with MCD, all patients achieved a CR with the median time of 1.0 months. Patients who were steroid-dependent or immunosuppressant-dependent were able to taper their medications in the short term without experiencing relapse. No treatment-related severe adverse events were reported.</p><p><strong>Conclusions: </strong>Our study demonstrated that obinutuzumab represents a promising alternative therapeutic option for the management of rituximab-refractory MN and MCD.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf039"},"PeriodicalIF":3.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative localization of parathyroid glands in secondary hyperparathyroidism: correlations between 99mTc-MIBI-SPECT/CT, ultrasound, and pathological characteristics.","authors":"Binghan Li, Xiaoli Zhao, Sha Luo, Qi Zhong, Hanxue Zhao, Chengxiang Du, Guojuan Zhang","doi":"10.1093/ckj/sfaf040","DOIUrl":"10.1093/ckj/sfaf040","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between imaging findings and histopathological characteristics of parathyroid glands in patients with secondary hyperparathyroidism (SHPT).</p><p><strong>Methods: </strong>Seventy-four glands from 21 patients with SHPT who underwent parathyroidectomy were evaluated for their pathological characteristics. The detection rates of parathyroid glands using ultrasound (US) and 99Tc-MIBI-SPECT/CT (MIBI) were compared. Glands were classified as either US-positive or US-negative, and MIBI-positive or MIBI-negative. Morphological and pathological differences between the positive and negative groups were systematically analysed.</p><p><strong>Results: </strong>The detection rates for parathyroid glands were 71% with US, 65% with MIBI, and 82% when combining both methods. US and MIBI showed similar localization accuracy in SHPT (<i>P</i> = .38). MIBI-positive glands had significantly larger oxyphil nodules compared with MIBI-negative glands (area: 10.92 mm² vs 3.09 mm², <i>P</i> < .01; area proportion: 61% vs 30%, <i>P</i> = .002), while no significant differences were found in chief nodules. The US-positive group had fewer and smaller chief nodules (number: 2 vs 9, <i>P</i> = .005; area: 1.53 mm² vs 11.08 mm², <i>P</i> = .033) and a higher percentage of oxyphil nodules (74% vs 33%, <i>P</i> = .003) compared with the US-negative group. Thirteen glands undetected by both US and MIBI had smaller oxyphil nodule areas (3.59 vs 13.24 mm²) and lower oxyphil nodule area percentages (25% vs 68%). These pathological features, including adipose infiltration, intra-gland haemorrhage, cyst formation, and calcification, showed no correlation with the gland's imaging results.</p><p><strong>Conclusion: </strong>US and MIBI had similar value in preoperative localization of SHPT. Parathyroid glands with more and larger oxyphil nodules were more likely to be detected by both MIBI and US.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf040"},"PeriodicalIF":3.9,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"T1 mapping magnetic resonance imaging predicts decline of kidney function.","authors":"Aurélie Huber, Ibtisam Aslam, Lindsey Crowe, Menno Pruijm, Thomas de Perrot, Sophie de Seigneux, Jean-Paul Vallée, Lena Berchtold","doi":"10.1093/ckj/sfaf032","DOIUrl":"10.1093/ckj/sfaf032","url":null,"abstract":"<p><strong>Background: </strong>Renal cortical interstitial fibrosis, typically assessed by biopsy, is crucial for kidney function prognosis. Magnetic resonance imaging (MRI) is a promising method to assess fibrosis non-invasively. Diffusion-weighted (DW) MRI correlates with renal fibrosis and predicts kidney function decline in chronic kidney disease (CKD) and kidney allograft patients. This study evaluates whether T1 and T2 mapping predict kidney function decline and if their simultaneous use enhances the predictive power of a DW-MRI-based model.</p><p><strong>Methods: </strong>We prospectively included 197 patients (42 CKD, 155 allograft kidneys). Each underwent a biopsy followed by multiparametric MRI without contrast within 1 week. Over a median follow-up of 2.2 years, laboratory parameters were recorded. The primary endpoint was a rapid decline in kidney function [glomerular filtration rate (GFR) reduction >30%] or replacement therapy initiation. The ability of T1 and T2 mapping sequences to predict poor renal outcome was examined using multivariable Cox regression models, incorporating MRI-derived parameters, estimated GFR (eGFR) and proteinuria.</p><p><strong>Results: </strong>Renal outcome occurred in 54 patients after a median of 1.1 years (interquartile range 0.9-2.1). Univariable survival analysis showed cortical T1 was associated with poor renal outcome {hazard ratio [HR] 3.02 [95% confidence interval (CI) 1.44-6.33]}, while T2 sequences had no significant predictive value. Adding cortical T1 to the established model (ΔADC, eGFR, proteinuria) did not improve the HR [from 4.62 (95% CI 1.56-13.67) to 4.36 (95% CI 1.46-13.02)] and marginally increased Harrell's C-index (0.77 to 0.79). Adjusting the regression model for ΔT2 yielded no enhancement in predictive power.</p><p><strong>Conclusions: </strong>Cortical T1 is strongly associated with poor renal outcome but did not enhance prognostic power of the DW-MRI-based model.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf032"},"PeriodicalIF":3.9,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic vs non-genetic kidney disease: prognosis insights from a multi-cohort study.","authors":"Ahmet Burak Dirim, Roser Torra","doi":"10.1093/ckj/sfaf033","DOIUrl":"10.1093/ckj/sfaf033","url":null,"abstract":"","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"18 3","pages":"sfaf033"},"PeriodicalIF":3.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}