Journal of Nephrology最新文献

{"title":"The prognostic reasoning system for chronic kidney disease progression (PROGRES-CKD) may help improve waiting list management for outpatient nephrology services in a second-level public hospital in Italy.","authors":"Paolo Fabbrini, Federico Pieruzzi, Francesco Bellocchio, Raul Casana Eslava, Jordi Silvestre Llopis, Kevin Morillo Navarro, Paola Ferraresi, Len Usvyat, John Larkin, Jaroslav Rosemberg, Stefano Stuard, Luca Neri","doi":"10.1007/s40620-025-02222-8","DOIUrl":"https://doi.org/10.1007/s40620-025-02222-8","url":null,"abstract":"<p><strong>Background: </strong>The management of patients with non-dialysis dependent chronic kidney disease (NDD-CKD) is challenging due to coexisting diseases, competing risks and uncertainties around optimal transition planning. Such clinical challenges are further exacerbated by physician shortage, coupled with rising service demands, which may hinder timely medical access due to long waiting times. Accurate progression risk assessment may help optimize resource allocation and adapting care based on individual patients' needs. This study validated the Prognostic Reasoning System for Chronic Kidney Disease Progression (PROGRES-CKD) in an Italian public hospital and compared its potential impact on waiting list optimization against physician-based protocols.</p><p><strong>Methods: </strong>First we first validated PROGRES-CKD by assessing its accuracy in predicting kidney replacement therapy (KRT) initiation within 6 months and 24 months in a historical cohort of patients treated at the San Gerardo Hospital (Italy) between 01-01-2015 and 31-12-2019. In a second study we compared PROGRES-CKD to attending nephrologists' prognostic ratings and simulated their potential impact on a waiting list management protocol.</p><p><strong>Results: </strong>We included 2005 patients who underwent 11,757 outpatient nephrology visits in 4 years. Most visits occurred for NDD-CKD stage 4 patients; the incidence of KRT onset was 10.8 and 9.32/100 patient-years at the 6 and 24-month prediction horizon cohorts, respectively. PROGRES-CKD demonstrated high accuracy in predicting KRT initiation at 6 and 24 months (AUROC = 0.88 and AUROC = 0.85, respectively). Nephrologists' prognostic performance was highly operator-dependent, albeit always significantly lower than PROGRES-CKD. In the simulation exercise, allocation based on PROGRES-CKD resulted in more follow-up visits for patients progressing to end-stage kidney disease (ESKD) and fewer visits for non-progressing patients, compared to allocation determined by nephrologists' prognosis.</p><p><strong>Conclusions: </strong>PROGRES-CKD showed high accuracy in a real-world application. Waiting list simulation suggests that PROGRES-CKD may enable more efficient allocation of resources.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515876","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":"Changes in serum creatinine during and after pregnancy in female patients with or without chronic kidney disease: an observational study in UK primary care data.","authors":"Carole A Marxer, Julie M Paik, Min Zhuo, Rishi J Desai, Katrina Wilcox Hagberg, Susan S Jick, Christoph R Meier, Julia Spoendlin","doi":"10.1007/s40620-025-02208-6","DOIUrl":"https://doi.org/10.1007/s40620-025-02208-6","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515871","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":"Quality and sources of food and water consumed by people with chronic kidney disease of unknown etiology in Sri Lanka: a systematic review.","authors":"Nivedha Uthayarajan, K L T D Jayawardene, Ishanka Weerasekara","doi":"10.1007/s40620-024-02174-5","DOIUrl":"https://doi.org/10.1007/s40620-024-02174-5","url":null,"abstract":"<p><strong>Background: </strong>Prevalence data indicates that chronic kidney disease (CKD) affects approximately 15% of people worldwide, and chronic kidney disease of unknown etiology (CKDu) is highly prevalent in Sri Lanka. Food and water contamination are factors that were suggested as associated with CKDu. This systematic review aimed to summarize evidence on the patterns in quality and sources of food and water consumed by people with CKDu in Sri Lanka.</p><p><strong>Methods: </strong>MEDLINE, EMBASE, PsycINFO, and SLJOL databases were searched from inception to August 2024 for studies investigating the quality and sources of food and water consumed by the people with CKDu in Sri Lanka. Studies assessing children below 18 years, pregnant women and dialysis patients were excluded. Studies not specifically investigating CKDu were likewise excluded from the review. Two independent reviewers completed the screening, and the conflicts were resolved by consensus. Extracted data were presented as a narrative summary.</p><p><strong>Results: </strong>Of 1067 studies, 57 were eligible for the final analysis. Commonly investigated food sources were contaminated with heavy metals, while water sources were contaminated with heavy metals, toxic anions and cations, agrochemicals, fertilizers, herbicides, glyphosate, and aminomethylphosphonic acid (AMPA).</p><p><strong>Conclusion: </strong>Nephrotoxic heavy metals and fluoride contamination alter the quality of food and water, and pose high risks with regard to the kidney function of the people in Sri Lanka. Appropriate strategies to reduce the contamination of heavy metals, agrochemicals, and major ions that afftect the quality of water and food, should be implemented to lower the burden of CKDu in Sri Lanka.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515874","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":"A survey on the association between patient activation and quality of life among patients with chronic kidney disease in Japan.","authors":"Daiki Kobayashi, Misa Ganse, Toshio Shinoda, Chieko Hamada, Shigeko Hara, Atsushi Aikawa, Yasuhiko Iino, Yasuhiro Komatsu","doi":"10.1007/s40620-025-02235-3","DOIUrl":"https://doi.org/10.1007/s40620-025-02235-3","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the association of health-related quality of life (HRQOL) with, and level of, patient activation among patients with chronic kidney disease (CKD) in Japan.</p><p><strong>Methods: </strong>We conducted a cross-sectional observational study using a questionnaire targeting patients with CKD across Japan from 2021 to 2023. The primary outcome was low HRQOL assessed using the short form 8 (SF-8). The risk of low HRQOL was evaluated by patient activation (using the Patient Activation Measure 13 (PAM-13)).</p><p><strong>Results: </strong>In total, 1427 patients with CKD were included in this study. Mean age was 61.9 (standard deviation (SD) 12.7) years and 891 (62.4%) were men. Among the participants, 948 (66.4%) were treated without dialysis or kidney transplantation, 304 (21.3%) underwent hemodialysis, 72 (5.1%) underwent peritoneal dialysis, and 103 (7.2%) underwent kidney transplantation. Regarding patient activation, those belonging to higher activation groups were less likely to have low physical HRQOL compared with those belonging to lower activation groups (adjusted odds ratio (OR) 0.73, 95% confidence interval (CI) 0.55-0.96 for medium; adjusted OR 0.53, 95% CI 0.41-0.70 for high; adjusted OR 0.42, 95% CI 0.29-0.61 for the highest activation group). When stratified by type of treatment for CKD, among participants with kidney transplantation the highest activation group tended to have more low mental HRQOL participants compared with the low activation group (adjusted OR 2.44, 95% CI 0.51-12.5).</p><p><strong>Conclusion: </strong>Among Japanese patients with CKD, lower patient activation is associated with lower physical and mental HRQOL in a dose-dependent manner. However, the highest activation may be associated with low mental HRQOL among patients undergoing kidney transplantation.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492419","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":"Obinutuzumab in Rituximab-resistant and recurrent membranous nephropathy: a case-series.","authors":"Krita Sridharan, Basu Gopal, Scott Wilson, Alan Pham, Holly Hutton","doi":"10.1007/s40620-025-02224-6","DOIUrl":"https://doi.org/10.1007/s40620-025-02224-6","url":null,"abstract":"<p><strong>Background: </strong>Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults, with high risk of progression to end-stage kidney disease when untreated. Rituximab is commonly used in its treatment however many patients do not respond. Obinutuzumab is a novel anti-CD20 monoclonal antibody for which there is increasing observational evidence in treatment-resistant membranous nephropathy. The majority of evidence for its use relates to anti-phospholipase A2 receptor-(PLA2R) associated membranous nephropathy.</p><p><strong>Methods: </strong>This was a single-centre case-series of all patients at a tertiary nephrology centre in Melbourne, Australia, treated with Obinutuzumab for membranous nephropathy, between January 2023 and June 2024. All patients who received Obinutuzumab were included in this case-series, irrespective of PLA2R status.</p><p><strong>Results: </strong>Out of 5 patients with treatment-resistant membranous nephropathy, 3 had PLA2R-associated membranous nephropathy which had previously been refractory to, or relapsed on Rituximab therapy. All 3 patients with PLA2R-positive membranous nephropathy achieved complete immunological and clinical remission after receiving Obinutuzumab. The case of secondary PLA2R-negative membranous nephropathy only achieved partial remission after Obinutuzumab before unexpectedly dying from another cause. The case of recurrent PLA2R-associated membranous nephropathy in a renal allograft did not respond to Obinutuzumab.</p><p><strong>Conclusion: </strong>This case-series supports the existing evidence in favour of Obinutuzumab for treatment-resistant PLA2R-associated membranous nephropathy. To our knowledge it is the first reported use of Obinutuzumab in sarcoidosis-associated membranous nephropathy.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468409","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":"Glomerular galactose-deficient IgA1 and apoptosis inhibitor of macrophage staining in secondary IgA nephropathy associated with alcoholic cirrhosis.","authors":"Yukako Umezawa, Ryosuke Aoki, Daisuke Ichikawa, Yusuke Suzuki, Tomo Suzuki","doi":"10.1007/s40620-025-02213-9","DOIUrl":"https://doi.org/10.1007/s40620-025-02213-9","url":null,"abstract":"<p><p>Immunoglobulin A nephropathy (IgAN) is associated with liver diseases, including alcoholic cirrhosis. When IgAN occurs in patients with liver disease, it is referred to as secondary IgAN; however, the mechanisms underlying secondary IgAN remain unclear. Herein, we present a case report of IgAN in a patient with a history of alcoholic liver cirrhosis, who presented with hematuria and proteinuria. A kidney biopsy revealed diffuse subendothelial deposition and mild mesangial proliferation. Immunofluorescence showed strong positive signals for IgA and IgM in the glomerular capillaries. There were no restrictions between the kappa and lambda staining. Electron microscopy revealed electron-dense deposits in the mesangial and subendothelial kidney regions. Histological diagnosis confirmed IgAN, typically associated with alcoholism. Further examination revealed that galactose-deficient IgA1 antibodies had merged with IgA, and a positive staining for the apoptosis inhibitor of macrophage antibodies along the glomerular capillaries was observed. These findings suggest that primary IgAN and alcoholic cirrhosis-related IgAN may share a common underlying mechanism.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408827","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":"Relationship between dietary consumption of live microbes with mortality in adults with chronic kidney disease.","authors":"Jianxin Han, Huan Zhang, Xinchun Li, Yumei Tang, Yunfei Du, Haiyan Zhang, Dan Liao","doi":"10.1007/s40620-025-02212-w","DOIUrl":"https://doi.org/10.1007/s40620-025-02212-w","url":null,"abstract":"<p><strong>Background: </strong>The connection between gut dysbiosis and chronic kidney disease (CKD) has been recognized, but, the effect of dietary intake of live microbes on the prognosis of CKD is still unclear. This analysis examined the relationship of dietary live microbe intake with mortality among adults with CKD.</p><p><strong>Methods: </strong>For this study, information was gathered from the National Health and Nutrition Examination Survey 1999-2018, which included 8725 adult participants with CKD. MedHi refers to the live microbial content of food beyond 10⁴ CFU/g. To elucidate the link between MedHi dietary live microbe intake and mortality from all-cause and cardiovascular disease (CVD), we implemented a weighted multivariate Cox regression analysis.</p><p><strong>Results: </strong>In contrast to survivors, non-survivors had a lower intake of dietary live microbes. The findings from the multivariable model indicated a negative and linear relationship between an increment of 100 g in MedHi foods and reduced mortality from all-causes and CVD. Likewise, participants in the highest MedHi food group exhibited a 20% and 26% decreased risk of all-cause and CVD mortality, respectively, compared to those in the lowest MedHi food group. Stratified analyses conducted on various subgroups yielded consistent findings.</p><p><strong>Conclusion: </strong>A significant inverse linear relationship was found between high dietary live microbe consumption and reduced all-cause and CVD mortality.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408838","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":"Hyperammonemic encephalopathy requiring hemodialysis in a child with distal renal tubular acidosis.","authors":"Behruz Huseynli, Emine Akkuzu, Bahar Büyükkaragöz, Sevcan A Bakkaloğlu","doi":"10.1007/s40620-025-02218-4","DOIUrl":"https://doi.org/10.1007/s40620-025-02218-4","url":null,"abstract":"<p><p>A 3.5-year-old girl with genetically proven distal renal tubular acidosis presented with lethargy, after numerous episodes of vomiting and poor feeding. Laboratory investigations revealed severe metabolic acidosis, hypokalemia and a serum ammonia level of 515 mmol/L (normal range: 19-50 mmol/L). Despite treatment with sodium bicarbonate, potassium supplementation, sodium benzoate and carglumic acid, her condition required hemodialysis, which resulted in rapid improvement in clinical and metabolic parameters. Hyperammonemia in distal renal tubular acidosis results from impaired ammonium excretion and increased ammoniagenesis due to hypokalemia and chronic metabolic acidosis, particularly during metabolic decompensation. This case had the highest ever reported serum ammonia level in distal renal tubular acidosis with encephalopathic findings, necessitating hemodialysis treatment. Routine monitoring of serum ammonia levels in distal renal tubular acidosis patients during metabolic stress is essential.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365099","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":"Severe kidney dysfunction after assisted reproductive technology: a case series suggesting the need for higher awareness of risks.","authors":"Eman Nagy, Rasha Shemies, Mohamed Taman, Nagy Sayed-Ahmed, Giorgina Barbara Piccoli","doi":"10.1007/s40620-025-02226-4","DOIUrl":"https://doi.org/10.1007/s40620-025-02226-4","url":null,"abstract":"<p><strong>Background: </strong>Assisted reproductive technology (ART) has significantly increased the rate of conception and live births in women with fertility problems. Having a kidney disease negatively affects a woman's reproductive health, making infertility a significant concern, and women with chronic kidney disease (CKD) are increasingly seeking treatment with assisted reproductive technology. The side effects of assisted reproductive technology are not fully known and its impact on kidney function, especially if a woman has undergone repeated treatments, is likewise not known.</p><p><strong>Methods: </strong>This case series gathers all consecutive patients who were followed by the Mansoura University Hospital's Obstetric Nephrology Service or were admitted to its Nephrology and Gynecology Department during pregnancy with a diagnosis of acute or chronic kidney function impairment after conceiving with an assisted reproductive technology method, in the period from 2021 to 2024.</p><p><strong>Results: </strong>Of the approximately 150 pregnancies referred to the Obstetric Nephrology Clinic, 6 were referred for acute or acute-on-chronic kidney function impairment, or nephrotic syndrome after conceiving via assisted reproductive technology. In one patient, CKD was overlooked and later progressed to kidney failure; one had probable CKD, but discontinued follow-up before confirmation; and one had a kidney malformation, diagnosed during pregnancy. All presented with early or very early severe hypertension and proteinuria, before 20 weeks, while preeclampsia and the hypertensive disorders of pregnancy are conventionally defined as developing after 20 weeks of gestation. Three had complete recovery postpartum, one progressed to kidney failure, while two were lost to follow-up.</p><p><strong>Conclusion: </strong>Severe early-pregnancy kidney impairment after assisted reproductive technology is probably more frequent than previously reported. Assessment of kidney function after assisted reproductive technology should be mandatory, to make it possible for timely specialized kidney care to be given.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365213","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":"Nurses' knowledge and perspectives on pregnancy among dialysis patients.","authors":"Ghada Ankawi","doi":"10.1007/s40620-025-02232-6","DOIUrl":"https://doi.org/10.1007/s40620-025-02232-6","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy on dialysis is a rare and complex event, necessitating careful planning. Nurses play a vital role in the dialysis team, providing essential education and support to patients. This study aimed to explore nurses' knowledge and perspectives regarding pregnancy in dialysis patients.</p><p><strong>Methods: </strong>An electronic survey was distributed to six dialysis centers in Saudi Arabia, spanning four regions. A total of 127 nurses participated, of whom 88.2% were hemodialysis (HD) nurses and 11.8% were peritoneal dialysis nurses. Survey responses were summarized using descriptive statistics, presented as percentages.</p><p><strong>Results: </strong>Regarding the impact of kidney failure on reproductive health, only 53.5% of respondents recognized it as a cause of menstrual irregularities. However, 82.7% acknowledged that it reduces fertility, and 89% responded \"yes\" to the possibility of pregnancy while on dialysis, with 61.4% agreeing that female patients of reproductive age with kidney failure require contraception. Despite known limitations, 63% identified a pregnancy test as the preferred method for pregnancy confirmation. In terms of dialysis modality, 63% believed HD to be associated with a higher likelihood of pregnancy. Additionally, 79.5% selected renal transplantation as a measure to increase the likelihood of pregnancy. Regarding pregnancy risks, 89% agreed it poses both fetal and maternal risks. Finally, only 18.1% reported consistently discussing pregnancy-related topics with reproductive-age patients.</p><p><strong>Conclusions: </strong>Nurses are essential to patient education in the dialysis setting. This study identifies potential knowledge gaps and proposes a framework of learning objectives on reproductive health to be integrated into nursing training.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255776","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}