Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia最新文献

{"title":"Organ allocation and transplant equity in Brazil: the hidden burden of HLA homozygosity and hypersensitization.","authors":"Augusto Cesar Soares Dos Santos Júnior, Evaldo Nascimento, Aline Regina da Cruz, Bernardo Vilela Nascimento, Raquel Aparecida Fabreti-Oliveira","doi":"10.1590/2175-8239-JBN-2025-0294en","DOIUrl":"10.1590/2175-8239-JBN-2025-0294en","url":null,"abstract":"<p><strong>Introduction: </strong>Kidney transplantation remains the most cost-effective treatment for end-stage renal disease (ESRD); however, persistent organ scarcity and immunological barriers contribute to prolonged waiting times and inequitable access. Human leukocyte antigen (HLA) sensitization and homozygosity represent major challenges inadequately addressed by previous allocation models.</p><p><strong>Objectives: </strong>This study aimed to assess the impact of HLA sensitization and HLA homozygosity on access to kidney transplantation in the regional sector of Minas Gerais.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of deceased-donor kidney transplant recipients and active candidates listed in the Brazilian National Transplant System (SNT) from January 2010 to August 2024 in a regional allocation sector of Minas Gerais. We assessed the impact of HLA sensitization and HLA-DRB1 homozygosity on access to transplantation, contextualizing the findings within recent national regulatory updates.</p><p><strong>Results: </strong>Of 2,907 patients analyzed, 1,794 (61.7%) underwent transplantation and 1,113 (38.3%) remained active on the waiting list. Diabetes mellitus (HR 1.177; p = 0.030) and blood groups A (HR 1.206; p < 0.001) and AB (HR 1.419; p = 0.002) were associated with increased access to transplantation. Higher levels of sensitization and HLA-DRB1 homozygosity were the strongest predictors of prolonged waiting time. These findings are consistent with inequities targeted by the Brazilian SNT regulatory revisions implemented in September 2025.</p><p><strong>Conclusion: </strong>Our results support recent Brazilian allocation reforms aimed at prioritizing hypersensitized and immunogenetically disadvantaged patients. Incorporating both the degree of sensitization and HLA-DR homozygosity into allocation algorithms represents a critical step toward improving equity in deceased-donor kidney transplantation.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 3","pages":"e20250294"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13183359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intestinal microbiota profile and inflammation in patients undergoing hemodialysis: a comparison between the Southern and Southeastern regions of Brazil.","authors":"Bruna R Paiva, Júnia Schultz, Fluvio Modolon, Jessyca S Brito, Marcelo Ribeiro-Alves, Alexandre Soares Rosado, Ludmila F M F Cardozo, Denise Mafra","doi":"10.1590/2175-8239-JBN-2025-0097en","DOIUrl":"10.1590/2175-8239-JBN-2025-0097en","url":null,"abstract":"<p><strong>Introduction: </strong>Exogenous lifestyle factors, such as different cultures, diets, and geo-graphic location, can alter the microbiota in patients with chronic kidney disease (CKD), which is closely related to inflammation. However, few studies have examined how these factors influence the composition of the microbiota. Thus, the objective of this study was to characterize and compare the intestinal microbiota profile and inflammation in CKD patients undergoing hemodialysis (HD) in the Southern and Southeastern regions of Brazil.</p><p><strong>Methods: </strong>Blood and stool samples were obtained from two groups of HD patients: one from the city of Blumenau (Southern region) and the other from the city of Rio de Janeiro (Southeastern region). Fecal DNA was extracted, and the V4 region of the bacterial 16S ribosomal RNA gene was sequenced. The fecal microbiome was analyzed using bioinformatic tools. Plasma concentrations of IL-6 and TNF-α were evaluated by ELISA.</p><p><strong>Results: </strong>Thirty patients were included in the study, with 14 individuals residing in the Southern region (group S) [50% male, 58 (13.5) years of age] and 16 individuals residing in the Southeastern region (group SE) [47.1% male, 57 (19) years of age]. The α- and β-diversity indices of the intestinal microbiota did not differ significantly between the groups. However, patients from the Southern region had higher plasma TNF-α (p = 0.008) and IL-6 (p = 0.003) levels than those from the Southeastern region.</p><p><strong>Conclusion: </strong>Although HD patients with CKD residing in the Southern and Southeastern regions present similar intestinal microbial patterns, patients from the Southern region had higher concentrations of inflammatory markers.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 3","pages":"e20250097"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13225290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EPI-DRC Brasil: When public health campaigns become scientific evidence - a new paradigm for global nephrology.","authors":"Geraldo Bezerra Silva Junior, Edison Souza","doi":"10.1590/2175-8239-JBN-2026-E010en","DOIUrl":"10.1590/2175-8239-JBN-2026-E010en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 3","pages":"e2026E010"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13366617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to kidney transplant referral in the state of Minas Gerais: nephrologists' perspectives.","authors":"Cristianne Medeiros Nogueira, Luiza Cunha Martins, Helady Sanders-Pinheiro","doi":"10.1590/2175-8239-JBN-2025-0215en","DOIUrl":"10.1590/2175-8239-JBN-2025-0215en","url":null,"abstract":"<p><strong>Background: </strong>In Brazil, there is a low percentage of patients on the waiting list for kidney transplantation (KT), even within a public health system with full coverage. Among the factors influencing referral, those related to the nephrologist are the least studied. We aimed to investigate the barriers to KT referral from the perspective of nephrologists in the state of Minas Gerais.</p><p><strong>Methods: </strong>Cross-sectional study of a convenience sample of active nephrologists. We collected data through an electronic survey, including demographic profile, education, professional profile, knowledge about indications (6) and contraindications (12), and clinical practice. Non-parametric analyses were performed.</p><p><strong>Results: </strong>The 77 nephrologists had a median age of 44.9 years (IQR 39-52) and a median of 12.5 years (IQR 3-23) of clinical practice; all had completed postgraduate training. The median number of expected responses regarding contraindications was 8 (IQR 6-9) out of 12, and 66.2% had more than 50% of correct responses. There were no significant associations with this pattern of responses (< 8). The nephrologists reported knowing the referral process and identified the presence of contraindications as the main cause for non-referral. Centers were public (54.5%) and non-academic (55.8%); 69.2% were located within < 100 km of a KT center, most offered KT as a treatment modality (80.4%), only 14.7% reported difficulties with pre-KT laboratory tests, and 21-40% of patients were reported to be listed (31.2%).</p><p><strong>Conclusion: </strong>We found knowledge gaps in KT contraindications and risk perception as causes for non-referral. Barriers related to centers and the health system were not reported. These findings support educational initiatives and greater integration between nephrology services and KT centers to enable referrals.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 3","pages":"e20250215"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to the letter: will non-invasive methods replace bone biopsy in patients with chronic kidney disease?","authors":"Mariana Fernandes Diz Lopes, Bernardo José Cardoso Fernandes, Maria Teresa Almeida E Sousa Martins da Rocha, Ricardo de Morais Pereira Neto","doi":"10.1590/2175-8239-JBN-2025-0385rpen","DOIUrl":"10.1590/2175-8239-JBN-2025-0385rpen","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 3","pages":"e20250385rp"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of sacubitril/valsartan in patients on peritoneal dialysis: a systematic review and meta-analysis.","authors":"Caio Lima da Silva, Pandora Eloa Oliveira Fonseca, Viviane Calice-Silva, Daniela Ponce, Paulo Novis Rocha, Maria Gabriela Guimarães","doi":"10.1590/2175-8239-JBN-2025-0318en","DOIUrl":"10.1590/2175-8239-JBN-2025-0318en","url":null,"abstract":"<p><strong>Background: </strong>Sacubitril/valsartan is a recommended medication for managing heart failure (HF). However, its role in peritoneal dialysis (PD) patients remains uncertain. We conducted this systematic review and singlearm meta-analysis to assess the efficacy and safety of sacubitril/valsartan in this population.</p><p><strong>Methods: </strong>We systematically searched PubMed, EMBASE, and Cochrane Central until December 2024 for randomized controlled trials (RCTs) and observational studies assessing changes in left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, systolic blood pressure (SBP), left atrial diameter (LAD), and left ventricular end-diastolic dimension (LVDd) with sacubitril/valsartan use in PD patients. Safety endpoints included hyperkalemia, hypotension, and angioedema. Statistical analyses were performed in R, using proportions for binary and mean differences (MDs) for continuous outcomes.</p><p><strong>Results: </strong>Nine studies were included, comprising 8 observational studies and 1 RCT, involving 343 PD patients. LVEF improved significantly (MD 5.22; 95% CI, 3.86 to 6.58; p < 0.0001; I2 = 38.9%). Sacubitril/valsartan reduced NT-proBNP levels (MD -5630.40; 95% CI, -9177.57 to -2083.23; p = 0.0019; I2 = 86%) and SBP (MD -14.59; 95% CI, -20.59 to -8.59; p < 0.0001; I2 = 93.5%). No statistically significant changes were noted in LAD (p = 0.0561) or LVDd (p = 0.1037). Hypotension and angioedema were rare events, whereas hyperkalemia showed a slight increase (11.94%).</p><p><strong>Conclusion: </strong>Sacubitril/valsartan was associated with improvements in cardiac function surrogates and blood pressure in PD patients with HF, with an overall acceptable safety profile despite a modest increase in hyperkalemia. These findings suggest potential benefit in this understudied population, though confirmation in adequately powered RCTs remains necessary.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 3","pages":"e20250318"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147616109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendations of the Brazilian Society of Nephrology for sustainable nephrology in Brazil.","authors":"Ana Flavia Moura, Cinthia Kruger Sobral Vieira, André Luiz Pimentel, Luis Claudio Santos Pinto, Fabiana Baggio Nerbass, Fátima Regina Veiga Tostes, Nandressa Dayana Mendes Riso, Rafael Barboza Trancoso, Talita Gavioli Salani, Ciro Bruno Silveira Costa, Patrícia Ferreira Abreu, José A Moura-Neto","doi":"10.1590/2175-8239-JBN-2026-0059en","DOIUrl":"10.1590/2175-8239-JBN-2026-0059en","url":null,"abstract":"<p><p>Climate change has increased the vulnerability of patients with non-dialysis chronic kidney disease (CKD) and those receiving kidney replacement therapy (KRT), who depend on healthcare systems that are highly sensitive to disruptions in electricity, potable water supply, and logistics. At the same time, KRT services are among those with the greatest environmental impact within the healthcare sector, characterized by high water and energy consumption and substantial generation of solid waste. In this context, the incorporation of sustainable practices has become an ethical, clinical, and strategic imperative. In 2023, the Brazilian Society of Nephrology (SBN) established the Committee on Sustainable Nephrology with the objective of developing national guidelines to reduce the environmental impact of kidney care services. After two years of work, the Committee developed ten recommendations structured across key domains, including education, environ-mental indicator monitoring, waste management, efficient use of resources, climate contingency planning, promotion of prevention and kidney transplantation, technological innovation, and sustainability certifications. These recommendations were discussed and approved at the 2nd Convention of the SBN Board of Directors and its Regional Chapters, achieving a 98.5% level of agreement. This document presents the consolidated recommendations, with the aim of supporting the implemen-tation of sustainable practices in kidney care services across the country and pro-moting an environmentally responsible, efficient nephrology practice aligned with the emerging challenges posed by climate change.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 3","pages":"e20260059"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"More than meets the eye: a case of tubulointerstitial nephritis and uveitis syndrome.","authors":"Telma Pais, Nadiesda Peres, Miguel Santos, Inês Leal, Joana Tavares, Sofia Jorge, José António Lopes, José Agapito Fonseca","doi":"10.1590/2175-8239-JBN-2026-0048en","DOIUrl":"10.1590/2175-8239-JBN-2026-0048en","url":null,"abstract":"<p><p>Tubulointerstitial nephritis with uveitis (TINU) syndrome is a rare oculorenal inflammatory disorder characterized by concurrent tubulointerstitial nephritis (TIN) and uveitis in the absence of an alternative systemic disease. We present a 57-year-old woman with acute kidney injury, euglycemic glycosuria, and simul-taneous non-granulomatous anterior uveitis. Kidney biopsy demonstrated eosinophil-rich chronic active tubuloin-terstitial nephritis with non-caseating granulomas. After excluding infectious, drug-induced, and systemic autoimmune etiologies, TINU syndrome was diagnosed. Corticosteroid therapy resulted in substantial renal function recovery. This case underscores the diagnostic reasoning required to identify TINU syndrome in adult patients and illustrates the structured clinicopathological approach that enables timely, evidence-based management.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 3","pages":"e20260048"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of donor-derived cell-free DNA for acute rejection in kidney allograft biopsies.","authors":"Mônica Rika Nakamura, Renato Demarchi Foresto, Vitoria Regina da Silva Gomes, Henrique Machado Proença, Lúcio Requião-Moura, José Medina-Pestana, Helio Tedesco-Silva","doi":"10.1590/2175-8239-JBN-2025-0285en","DOIUrl":"10.1590/2175-8239-JBN-2025-0285en","url":null,"abstract":"<p><strong>Objective: </strong>To determine the performance of donor-derived cell-free DNA (dd-cfDNA) as a noninvasive biomarker for the diagnosis of acute rejection in for-cause kidney transplant biopsies.</p><p><strong>Methods: </strong>This cross-sectional single-center study (between May 2021 and June 2022) included for-cause biopsies performed in kidney transplant recipients with acute graft dysfunction (AGD) or suboptimal graft function (SGF). dd-cfDNA levels were correlated with histological diagnosis according to the Banff 2022 classification.</p><p><strong>Results: </strong>Among 492 biopsies, 80.7% were performed for AGD and 19.3% for SGF. The distribution of histological phenotypes was 10.2% (category 1), 6.5% (category 2), 6.9% (category 3), 7.9% (category 4), 33.3% (category 5), and 35.2% (category 6). The respective median dd-cfDNA values were 0.25% (IQR 0.16-0.46), 1.88% (IQR 0.92-5.11), 0.45% (IQR 0.26-0.63), 0.51% (IQR 0.34-1.11), 0.27% (IQR 0.15-0.45), and 0.38% (IQR 0.23-0.64). Category 2 presented a higher median dd-cfDNA compared with the other groups (p < 0.001). The area under the curve (AUC) was 0.77 for acute rejection (categories 2 and 4), with a sensitivity of 50.7%, a specificity of 91.2%, a positive predictive value of 49.3%, a negative predictive value of 91.6%, and an accuracy of 85.4%. Similar results were observed in biopsies for AGD or SGF. The dd-cfDNA with the highest diagnostic performance for acute rejection was 0.81%, with optimal thresholds of 0.46% for AGD and 0.81% for SGF biopsies.</p><p><strong>Conclusion: </strong>In this cohort, dd-cfDNA showed moderate diagnostic performance for acute graft rejection and high negative predictive value. dd-cfDNA threshold diagnostic varied according to the type of for-cause biopsies (AGD or SGF).</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 3","pages":"e20250285"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13078818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in pediatric Wilms tumor imaging: diagnostic performance and the need for clinical oversight.","authors":"Andre Ramos Pastor, Jesus Ravines Layza","doi":"10.1590/2175-8239-JBN-2026-0083en","DOIUrl":"10.1590/2175-8239-JBN-2026-0083en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"48 3","pages":"e20260083"},"PeriodicalIF":1.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}