Clinical Kidney Journal最新文献

{"title":"Elevated RHAMM as a biomarker for predicting diabetic kidney disease in patients with type 2 diabetes.","authors":"Bingxue Qi, Yan Lou, Yongyue Zhu, Yang Chen, Shixin Yang, Fanjie Meng, Zhuo Pan, Shuangshuang Liu, Guanchi Yan, Xiaodan Lu, Li-Hao Huang","doi":"10.1093/ckj/sfae196","DOIUrl":"https://doi.org/10.1093/ckj/sfae196","url":null,"abstract":"<p><strong>Background: </strong>Diabetic kidney disease (DKD) poses a significant challenge globally as a complication of diabetes. Hyaluronan (HA), a critical non-sulfated glycosaminoglycan in the extracellular matrix, plays a pivotal role in the progression of DKD. This study assesses the predictive significance of HA's corresponding receptor, RHAMM (receptor for HA-mediated motility), in DKD pathogenesis in type 2 diabetes (T2DM) patients.</p><p><strong>Methods: </strong>Enzyme-linked immunosorbent assays were utilized to measure plasma and urine levels of HA, CD44 and RHAMM in 99 diabetic patients. Immunohistochemistry staining was employed to examine HA deposition, CD44 and RHAMM expressions from 18 biopsy-proven DKD patients. Spearman correlation analysis, linear regression and receiver operating characteristic (ROC) analysis were conducted to establish associations between plasma HA, CD44 and RHAMM levels, and clinical parameters in DKD patients with T2DM.</p><p><strong>Results: </strong>Elevated plasma and urine HA, CD44 and RHAMM levels were notably observed in the severe renal dysfunction group. Plasma RHAMM exhibited positive correlations with HA (r = 0.616, <i>P</i> < .001) and CD44 (r = 0.220, <i>P</i> < .001), and a negative correlation with estimated glomerular filtration rate (eGFR) (r = -0.618, <i>P</i> < .001). After adjusting for other potential predictors, plasma RHAMM emerged as an independent predictor of declining eGFR (β = -0.160, <i>P</i> < .05). Increased HA, CD44 and RHAMM levels in kidney biopsies of DKD patients were closely associated with heightened kidney injury. The ROC curve analysis highlighted an area under the curve (AUC) of 0.876 for plasma RHAMM, indicating superior diagnostic efficacy compared to CD44 in predicting DKD pathogenesis. The combined AUC of 0.968 for plasma RHAMM, HA and CD44 also suggested even greater diagnostic potential for DKD pathogenesis.</p><p><strong>Conclusion: </strong>These findings provide initial evidence that elevated RHAMM levels predict DKD pathogenesis in T2DM patients. The formation of a triple complex involving HA, CD44 and RHAMM on the cell surface shows promise as a targetable biomarker for early intervention to mitigate severe renal dysfunctions.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11267228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757530","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":"Association of retinal age gap with chronic kidney disease and subsequent cardiovascular disease sequelae: a cross-sectional and longitudinal study from UK biobank","authors":"Guanrong Wu, Xiayin Zhang, Grace A Borchert, Chunwen Zheng, Yingying Liang, Yaxin Wang, Zijing Du, Yu Huang, Xianwen Shang, Xiaohong Yang, Yijun Hu, Honghua Yu, Zhuoting Zhu","doi":"10.1093/ckj/sfae088","DOIUrl":"https://doi.org/10.1093/ckj/sfae088","url":null,"abstract":"Background Chronic kidney disease (CKD) increases the risk of cardiovascular disease (CVD) and is more prevalent in older adults. Retinal age gap, a biomarker of aging based on fundus images, has been previously developed and validated. This study aimed to investigate the association of retinal age gap with CKD and subsequent CVD complications. Methods A deep learning model was trained to predict the retinal age using 19 200 fundus images of 11 052 participants without any medical history at baseline. Retinal age gap, calculated as retinal age predicted minus chronological age, for the remaining 35 906 participants. Logistic regression models and Cox proportional hazards regression models were used for the association analysis. Results A total of 35 906 participants (56.75 ± 8.04 years, 55.68% female) were included in this study. In the cross-sectional analysis, each 1-year increase in retinal age gap was associated with a 2% increase in the risk of CKD prevalence (odds ratio: 1.02, 95% confidence interval [CI]: 1.01–1.04, P = 0.012). A longitudinal analysis of 35 039 participants demonstrated that 2.87% of them developed CKD in follow-up, and each 1-year increase in retinal age gap was associated with a 3% increase in the risk of CKD incidence (hazard ratio: 1.03, 95% CI: 1.01–1.05, P = 0.004). In addition, a total of 111 CKD patients (15.81%) developed CVD in follow-up, and each 1-year increase in retinal age gap was associated with a 10% increase in the risk of incident CVD (hazard ratio:1.10, 95% CI: 1.03–1.17, P = 0.005). Conclusions We found that retinal age gap was independently associated with the prevalence and incidence of CKD, and also associated with CVD complications in CKD patients. This supports the use of this novel biomarker in identifying individuals at high risk of CKD and CKD patients with increased risk of CVD.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141553272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary soluble PD-1 as a biomarker of Checkpoint Inhibitor induced acute tubulointerstitial nephritis","authors":"Francisco Gomez-Preciado, Laura Martinez-Valenzuela, Paula Anton-Pampols, Xavier Fulladosa, Marina Gomez Tena, Montserrat Gomà, María Jove, Ernest Nadal, Ana Merino-Ribas, Nadia Martin-Alemany, Josep María Cruzado, Joan Torras, Juliana Draibe","doi":"10.1093/ckj/sfae200","DOIUrl":"https://doi.org/10.1093/ckj/sfae200","url":null,"abstract":"Background Acute interstitial nephritis (AIN) related to Immune Checkpoint Inhibitors (ICI-AIN) has a not completely understood pathophysiology. Our objectives were to analyze possible biomarkers for the differentiation between acute tubular necrosis (ATN) and AIN, especially in cancer patients, and to study the participation of the immune checkpoint pathway in ICI-AIN. Methods We performed an observational study. We recruited patients with incident diagnosis of ICI-AIN (n=19). We measured soluble PD-1 (sPD-1), sPD-L1 and sPD-L2 in serum and urine at diagnosis and compared to patients with non ICI-related AIN (non-ICI AIN) (n=18) and ATN (n=21). The findings were validated in an independent cohort from another institution (n=30). Besides, we performed PD-L1 and PD-L2 immunostaining of kidney biopsies from patients with ICI-AIN and compared to patients with non-ICI AIN. Results Urinary sPD-1 (usPD-1) was higher in patients with AIN compared to ATN (p=0.03). Patients with AIN also showed higher serum sPD-1 (ssPD-1) than patients with ATN (p=0.021). In cancer patients, usPD-1 &amp;lt;129.3 pg/ml had a 71.43% sensitivity and 94.44% specificity to differentiate ATN from ICI-AIN, with a likelihood ratio of 12.86. In the external validation cohort, the same cutoff showed a sensitivity of 80%. In kidney biopsies, patients with ICI-AIN showed higher density of PD-L1 positive tubules than patients with non-ICI AIN (p=0.02). The proportion of patients having more than 2.64/mm2 PD-L2 positive tubules was higher among patients with ICI-AIN compared to non-ICI AIN (p=0.034). There was a positive correlation (p=0.009, r=0.72) between usPD-1 and the number of PD-L1 positive tubules. Conclusions UsPD-1 and ssPD-1 are higher in AIN than ATN. Moreover, there was a strong correlation between usPD-1 and renal tubular PD-L1 expression. Our findings suggest a role of usPD-1 as non-invasive biomarker to differentiate ICI-AIN from ATN, especially in cancer patients, which has been confirmed in an external validation cohort.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Acid and Heparin-Free Dialysis: The Regional Anticoagulation Approach","authors":"Flora Lefevre, Romain Vial, Sophie Grellier, Solène Bujon, Dammar Bouchouareb, Philippe Brunet, Violaine Scarfoglière, Thomas Robert","doi":"10.1093/ckj/sfae201","DOIUrl":"https://doi.org/10.1093/ckj/sfae201","url":null,"abstract":"Background and hypothesis In chronic intermittent hemodialysis, heparin is the standard anticoagulant as is the use of acid-containing dialysate. Regional anticoagulation (RA) with a calcium-free, citrate-containing dialysate has been developed. We compared RA using a calcium-free, citrate-free dialysate, routinely used in our centre, to systemic heparinization. Methods In a retrospective, observational, single-centre, cross-over study, we examined 15 patients undergoing chronic hemodialysis who were at high risk of bleeding and temporarily unable to use heparin. These patients received temporary treatment with RA involving calcium-free and citrate-free dialysate. We compared the dialysis session success rates during two distinct periods: standard heparinization and RA procedure with a calcium-free and citrate-free dialysate. Results In our study of 15 patients on chronic hemodialysis which compared 30 RA sessions to 28 heparin-based anticoagulation session, we observed a 100% success rate with a median session duration of 240 minutes in both RA and heparin groups. No early extracorporeal circulation (ECC) loss was reported. However, we noted significant differences in the post-dialysis ECC thrombosis scores, with higher Global Thrombosis Index (GTI) and higher membrane coagulation scores in the RA group (p &amp;lt; 0.007 and p &amp;lt; 0.02, respectively). No hypocalcaemia or hypercalcemia symptoms occurred. Median post-filter ionized calcium levels were 0.32 [0.29–0.39] mmol/L at 30 minutes and median patient ionized calcium levels was 1.19 [1.135–1.28] mmol/L at 60 minutes. No significant difference in per-dialysis arterial blood pressure was observed between groups. Conclusion Our study evaluated the RA approach using a calcium-free, citrate-free acetate dialysate in a chronic hemodialysis centre and found it effective. Although an acid-free dialysate was not used in this study, our findings suggest it could be the next frontier in the evolution of advanced dialysis techniques.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CA125 outperforms NT-proBNP in the prediction of maximum aerobic capacity in heart failure with preserved ejection fraction and kidney dysfunction","authors":"Gonzalo Núñez-Marín, Patricia Palau, Eloy Domínguez, Rafael de la Espriella, Laura López, Cristina Flor, Paloma Marín, Miguel Lorenzo, Gema Miñana, Vicent Bodí, Juan Sanchis, Julio Núñez","doi":"10.1093/ckj/sfae199","DOIUrl":"https://doi.org/10.1093/ckj/sfae199","url":null,"abstract":"Background Heart failure with preserved ejection fraction (HFpEF) often coexists with chronic kidney disease (CKD). Exercise intolerance is a major determinant of quality of life and morbidity in both scenarios. We aimed to evaluate the associations between NT-proBNP and CA125 with maximal aerobic capacity (peakVO2) in ambulatory HFpEF and whether these associations were influenced by kidney function. Methods This single-center study prospectively enrolled 133 patients with HFpEF who performed maximal cardiopulmonary exercise testing (CPET). Patients were stratified across glomerular filtration rate (eGFR) categories (&amp;lt;60 mL/min/1.73m2 vs. ≥60 mL/min/1.73m2). Results The mean age of the sample was 73.2 ± 10.5 years, and 56.4% were female. The median [p25-p75] of peakVO2 was 11.0 mL/Kg/min [9.0–13.0]. 67 (50.4%) patients displayed eGFR&amp;lt;60 ml/min/1.73m2. Those patients had higher levels of NT-proBNP and lower peakVO2, without differences in CA125. In the whole sample, NT-proBNP and CA125 were inversely correlated with peakVO2 (r=−0.43, P &amp;lt; 0.001 and r=−0.22, P = 0.010, respectively). After multivariate analysis, we found a differential association between NT-proBNP and peakVO2 across eGFR strata (p-value for interaction = 0.045). In patients with eGFR≥60 mL/min/1.73m2, higher NT-proBNP identified patients with poorer maximal functional capacity. In individuals with eGFR&amp;lt;60 mL/min/1.73m2, NT-proBNP was not significantly associated with peakVO2 (β-coefficient = 0.02, CI 95%:−0.19 to 0.23, P = 0.834). Higher CA125 was linear and significantly associated with worse functional capacity without evidence of heterogeneity across eGFR strata (p-value for interaction = 0.620). Conclusions In patients with stable HFpEF, NT-proBNP was not associated with maximal functional capacity when CKD was present. CA125 emerged as a useful biomarker for estimating effort intolerance in HFpEF irrespective of the presence of CKD.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond sarcopenia: frailty in chronic haemodialysis patients","authors":"Jean-Sébastien Souweine, Grégoire Pasquier, Marion Morena, Laure Patrier, Annie Rodriguez, Nathalie Raynal, Isabelle Ohresser, Racim Benomar, Maurice Hayot, Jacques Mercier, Farès Gouzi, Jean-Paul Cristol","doi":"10.1093/ckj/sfae069","DOIUrl":"https://doi.org/10.1093/ckj/sfae069","url":null,"abstract":"Background Frailty, characterized by vulnerability, reduced reserves, and increased susceptibility to severe events, is a significant concern in chronic hemodialysis (CHD) patients. Sarcopenia, corresponding to the progressive loss of muscle mass and strength, may contribute to frailty by reducing functional capacity, mobility, and autonomy. However, consensus lacks on optimal frailty bedside index for CHD patients. This study investigated the influence of frailty on CHD patient survival and explored the associated factors. Methods One hundred and thirty-five patients were enrolled from January to April 2019 and then followed up prospectively until April 2022. At inclusion, frailty was assessed by Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB) tests including gait speed, standing balance and lower limb muscle strength. Results From a total of 114 prevalent CHD patients [66% men, age 67.6+/−15.1 years], 30 died during the follow-up period of 23.7 (16.8–34.3) months. Deceased patients were older, had more comorbidities and a higher sarcopenia prevalence (P &amp;lt; 0.05). The TUG test and SPPB scores were significantly reduced in deceased patients [SPPB Total score: 7.2+/−3.3 vs 9.4+/−2.5; TUG time (8.7+/−5.8 vs 13.8+/−10.5 (P &amp;lt; 0.05)]. Multivariate analysis showed that a higher SPPB score (total value &amp;gt; 9) was associated with a lower mortality risk (HR = 0.83, 95% CI 0.74–0.92; P &amp;lt; 0.03). Each component of the SPPB test was also associated with mortality in univariate analysis but only the SPPB balance test remained protective against mortality in multivariate analysis. Higher age, lower handgrip strength and lower protein catabolic rate were associated with SPPB total scores &amp;lt; 9, SPPB balance score and TUG time &amp;gt;10 sec. Conclusions Screening for frailty is crucial in CHD patients, and incorporating SPPB, especially the balance test, provides valuable insights. Diminished muscle strength and inadequate protein intake negatively influence SPPB score and balance in CHD patients. An effective identification and management of frailty can therefore improve outcomes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03845452.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141551859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction in kidney function decline and risk of severe clinical events in agalsidase beta-treated Fabry disease patients: A matched analysis from the Fabry Registry","authors":"Julie L Batista, Ali Hariri, Manish Maski, Susan Richards, Badari Gudivada, Lewis A Raynor, Elvira Ponce, Christoph Wanner, Robert J Desnick","doi":"10.1093/ckj/sfae194","DOIUrl":"https://doi.org/10.1093/ckj/sfae194","url":null,"abstract":"Background Patients with Fabry disease (FD, α-galactosidase A deficiency or absence) accumulate glycosphingolipids, leading to progressive dysfunction of kidneys, heart and nervous system. Generalisable real-world outcomes following agalsidase beta treatment initiation outside trials are limited. We investigated the associations of long-term agalsidase beta treatment with estimated glomerular filtration rate (eGFR) changes over time and the risk of developing a composite clinical event in a matched analysis of treated and untreated patients with FD. Methods Agalsidase beta-treated adult patients (aged ≥16 years) from the Fabry Registry and adult untreated patients from a natural history cohort were matched 1:1 and X:X (with one occurrence and multiple occurrences of each untreated patient, respectively) by sex, phenotype, age and (for eGFR slope analysis) baseline eGFR. Outcomes included eGFR slope over 5 years and composite clinical event risk (cardiovascular, cerebrovascular or renal event, or death) over 10+ years. As a surrogate indicator of therapeutic response in paediatric patients, the percentage experiencing normalisation in plasma globotriaosylceramide (GL-3) from treatment initiation was assessed in patients aged 2 to &amp;lt;16 years. Results Overall, eGFR slopes for 1:1-matched untreated and treated adult patients (122 pairs [72.1% male]) were −3.19 and −1.47 mL/min/1.73 m2/y, respectively (reduction in rate of decline=53.9%, P=0.007); for X:X-matched (122 untreated/950 treated [59.4% male]) were −3.29 and −1.56 mL/min/1.73 m2/y, respectively (reduction in rate of decline=52.6%, P&amp;lt;0.001). Agalsidase beta treatment was associated with lower risk of clinical events, with hazard ratios of 0.41 (P=0.003) and 0.67 (P=0.008) for 1:1-matched and X:X-matched analyses, respectively. Plasma GL-3 declined markedly in paediatric patients and normalised in most within 6 months of treatment initiation. Conclusion Agalsidase beta treatment preserves kidney function and delays progression to severe clinical events among adult patients with FD. Plasma GL-3 levels analysed in paediatric patients showed normalisation of elevated pre-treatment levels in most patients.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of physical activity on surrogate markers of cardiovascular disease in the haemodialysis population","authors":"Katherine L Hull, Lucy Abell, Sherna F Adenwalla, Roseanne E Billany, Stephanie Burns, James O Burton, Darren Churchward, Matthew P M Graham-Brown, Laura J Gray, Patrick Highton, Courtney J Lightfoot, Rahma Said, Alice C Smith, Hannah M L Young, Daniel S March","doi":"10.1093/ckj/sfae198","DOIUrl":"https://doi.org/10.1093/ckj/sfae198","url":null,"abstract":"Background and hypothesis The haemodialysis population is sedentary with substantial cardiovascular disease risk. In the general population, small increases in daily step count associate with significant reductions in cardiovascular mortality. This study explores the relationship between daily step count and surrogate markers of cardiovascular disease, including left ventricular fraction (LVEF) and native T1 (a marker of diffuse myocardial fibrosis), within the haemodialysis population. Methods This was a post-hoc analysis of the association between daily step count and metabolic equivalent of task (MET) and prognostically important cardiac magnetic resonance imaging (CMR) parameters from the CYCLE-HD study (ISRCTN11299707). Unadjusted linear regression and multiple linear regression adjusted for age, body mass index, dialysis vintage, haemoglobin, hypertension and ultrafiltration volume were performed. Significant relationships were explored with natural cubic spline models with four degrees of freedom (five knots). Results 107 participants were included; 56.3 ± 14.1 years, 79 (73.8%) males. Median daily step count was 2558 (IQR 1054–4352). There were significant associations between: steps and LVEF (β = 0.292; P = 0.009); steps and native T1 (β = -0.245; P = 0.035). Further modelling demonstrated most of the increase in LVEF occurred up to 2,000 steps per day and there was an inverse dose-response relationship between steps and native T1, with the most pronounced reduction in native T1 between ∼2,500 and 6,000 steps per day. Conclusions These results suggest an association between daily step count and parameters of cardiovascular health in the haemodialysis population. These findings support the recommendations for encouraging physical activity but they are not the justification. Further research should evaluate whether a simple physical activity intervention improves cardiovascular outcomes in individuals receiving maintenance haemodialysis.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141551861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The successful use of rituximab in IgA nephropathy patients with podocytopathy: a case series","authors":"Mingfang Sun, Ling Wang, Xinghong Liu, Fei Xiao, Huanzi Dai","doi":"10.1093/ckj/sfae178","DOIUrl":"https://doi.org/10.1093/ckj/sfae178","url":null,"abstract":"Introduction IgA nephropathy (IgAN) with podocytopathy is a rare pathological type of glomerular disease. The use of rituximab (RTX) in the treatment of glomerular diseases has increased in recent decades, but the efficacy of rituximab in the treatment of patients with IgAN and podocytopathy has rarely been reported. Methods A single-centre retrospective study of IgAN patients with podocytopathy who were treated with RTX as second-line therapy was conducted at our centre from 2019 to 2022. The aim of this study was to investigate the efficacy and safety of RTX in IgAN patients with podocytopathy. Results Seven out of eight patients met the criteria for complete remission following RTX therapy. Only one patient experienced adverse events (infectious diarrhoea and pulmonary infection) and experienced relapse six months after RTX therapy. The maximum relapse-free time after RTX therapy was 20 months, while the maximum relapse-free time before RTX therapy was only 6 months. The number of relapses before RTX therapy (per year) was 1–4; moreover, seven patients did not relapse and maintained remission at the last follow-up despite steroid withdrawal after RTX therapy. Conclusion Overall, RTX effectively reduced proteinuria, increased the maximum relapse-free time, reduced the number of relapses per year and helped patients stop steroid use as soon as possible. RTX also helped most patients achieve clinical remission. RTX appears to be an effective and safe alternative for treating IgAN patients with podocytopathy with steroid dependence or frequent relapse.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141531735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Gout and Diabetic Kidney Disease on Renal Cancer Development in Korea","authors":"Seung Min Chung, Inha Jung, Da Young Lee, So Young Park, Ji Hee Yu, Jun Sung Moon, Ji A Seo, Kyungdo Han, Nan Hee Kim","doi":"10.1093/ckj/sfae171","DOIUrl":"https://doi.org/10.1093/ckj/sfae171","url":null,"abstract":"Background Chronic kidney disease (CKD) and gout are risk factors for renal cancer. We analyzed the effects of comorbid diabetic kidney disease and gout on renal cancer. Methods This retrospective cohort study enrolled 847 884 patients with type 2 diabetes (T2DM) who underwent health assessments provided by the Korean National Health Insurance Service in 2009. Based on CKD occurrence (glomerular filtration rate &amp;lt;60 mL/min/1.73 m2) and gout (two outpatient visits or one hospitalization within 5 years), patients were classified into four groups: CKD−Gout− (87.5%), CKD−Gout+ (2.5%), CKD+Gout− (9.3%), and CKD+Gout+ (0.7%). Patients with incident renal cancer (ICD code C64) were followed up until December 2018. Results Renal cancer was diagnosed in 2376 patients (0.3%). Renal cancer incidence increased in sequential order of CKD−Gout− (0.29/1000 person-years [PY], CKD+Gout− ≈ CKD−Gout+ (0.44 and 0.48/1000 PY, respectively), and CKD+Gout+ (1.14/1000 PY). Comorbid gout differently increased renal cancer risk depending on CKD occurrence (hazard ratio [HR] = 1.28, 95% CI: 1.04–1.58 among those without CKD; HR = 1.95, 95% CI 1.45–2.63 among those with CKD; p-for interaction = 0.024). The interaction was significant, particularly in men and patients with a shorter diabetes duration (&amp;lt;5 y) and lesser medication use (no insulin or &amp;lt; 3 classes of oral hypoglycemic agents). Conclusions CKD and gout individually contributed to renal cancer incidence, and the risk is further increased when gout coexists with CKD. Screening for gout and appropriate management of CKD at an early T2DM stage may be beneficial.","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141522657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}