Journal of Nephrology最新文献

{"title":"Epidemiology, trajectories and outcomes of acute kidney injury among hospitalized patients: a large retrospective multicenter cohort study.","authors":"Esra Adiyeke, Yuanfang Ren, Shmuel Fogel, Parisa Rashidi, Mark Segal, Elizabeth A Shenkman, Azra Bihorac, Tezcan Ozrazgat-Baslanti","doi":"10.1007/s40620-025-02234-4","DOIUrl":"https://doi.org/10.1007/s40620-025-02234-4","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a clinical syndrome affecting almost one-fifth of hospitalized patients, as well as over half of the patients who are admitted to the intensive care unit (ICU). Stratifying AKI patients into groups based on severity and duration would facilitate targeted efforts for treating AKI.</p><p><strong>Methods: </strong>In a retrospective, multicenter longitudinal cohort study of 2,187,254 hospital encounters from 935,679 patients who were admitted between 2012 and 2020 to health centers in the OneFlorida + Network, we analyzed the impact of AKI trajectories (i.e. rapidly reversed AKI, persistent AKI with renal recovery, and persistent AKI without renal recovery) on patients' clinical outcomes, including hospital, 30-day, 1-year, and 3-year mortality, kidney replacement therapy, new chronic kidney disease (CKD) within 90 days or 1-year of discharge, CKD progression within 1-year of discharge, resource utilization, hospital disposition, and major complications during hospitalization.</p><p><strong>Results: </strong>Among all encounters, 14% of patients had AKI, of whom 63%, 21%, and 16% had Stage 1, 2, and 3, respectively, as the worst AKI stage. The fraction of patients with persistent AKI was 31%. Patients with AKI had worse clinical outcomes and increased resource utilization compared to patients without the condition. One-year mortality was 5 times greater for patients with persistent AKI compared to those without AKI.</p><p><strong>Conclusions: </strong>Persistent AKI was associated with prolonged hospitalization, increased ICU admission and greater mortality compared to the other groups. This may emphasize the critical need for devising strategies targeting effective management of AKI and prevention of persisting AKI.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670223","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":"Targeting autophagy in autoimmune glomerular diseases.","authors":"Ponticelli Claudio, Moroni Gabriella","doi":"10.1007/s40620-025-02267-9","DOIUrl":"https://doi.org/10.1007/s40620-025-02267-9","url":null,"abstract":"<p><p>Autophagy is a natural process whereby damaged or dying parts of a cell are eliminated and recycled. The term autophagy usually refers to macroautophagy, which is one of three types of autophagy, alongside microautophagy and chaperone-mediated autophagy. Autophagy is activated by adenosine monophosphate-activated protein kinase (AMPK) and inhibited by mammalian target of rapamycin (mTOR) through their interference with Unc-51-like kinase 1 (ULK1). Dysregulated autophagy is deeply involved in autoimmune glomerular diseases. Upregulated autophagy can induce inflammation and activate innate and adaptive immunity. However, autophagy may also exert a protective role on podocytes, enhance endothelial cell function, and preserve proximal tubular epithelial cells during ischemic or endotoxic acute kidney injury (AKI). Hydroxychloroquine (HCQ) can downregulate increased autophagy and is widely used in lupus nephritis. HCQ causes alkalinization, which results in vacuolization of lysosomes and inhibition of their functions. By inhibiting autophagic activity, HCQ may reduce inflammation and innate immunity, inhibit the activation of T cells, restore the T helper 17/T regulator balance, restrict the production of pro-inflammatory cytokines, and modulate co-stimulatory molecules. This reduces the risk of flares, spares the dosage of glucocorticoids, improves lupus activity, and prevents the thrombotic effects of anti-phospholipid antibodies. Recent studies showed that HCQ can also reduce proteinuria in IgA nephropathy (IgAN) and membranous nephropathy (MN). Drugs that improve mitochondrial function or enhance autophagy, such as metformin, sodium-glucose co-transporter 2 (SGLT2) inhibitors or mTOR inhibitors, may exert protective effects on podocytes and reduce proteinuria in MN or focal segmental glomerulosclerosis (FSGS).</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663753","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":"Trends in renal function testing in patients with dementia: a repeated cross-sectional analysis in Australian general practice.","authors":"Saad Alhumaid, Woldesellassie M Bezabhe, Mackenzie Williams, Gregory M Peterson","doi":"10.1007/s40620-025-02256-y","DOIUrl":"https://doi.org/10.1007/s40620-025-02256-y","url":null,"abstract":"<p><strong>Background: </strong>There is little published evidence regarding the extent to which renal function testing is performed in older Australians, particularly those with dementia.</p><p><strong>Objectives: </strong>To examine the prevalence and temporal trends in renal function testing and the factors associated with renal function testing in patients with dementia using Australian general practice data.</p><p><strong>Methods: </strong>Ten consecutive cross-sectional analyses were performed to evaluate the proportion of patients aged ≥ 65 years with a recorded diagnosis of dementia, along with matched controls, who had renal function tests using estimated glomerular filtration rate (eGFR) within the twelve months of each year from 2011 to 2020.</p><p><strong>Results: </strong>Before matching, 24,701 patients (59.2% females) with, and 72,105 patients (59.2% females) without, a recorded diagnosis of dementia were included. Over the study period, renal function testing increased in both groups, although less for the patients with dementia; from 38.6% (95% CI 37.1-40.0%) in 2011 to 41.9% (95% CI 41-42.9%; p for trend < 0.001) in 2020 in the dementia group, and 49% (95% CI 47.6-50.5%) to 60.4% (95% CI 59.5-61.4%; p for trend < 0.001) in the matched controls. Younger patients with dementia (< 85 years of age), males, and those with more general practitioner visits in the preceding 12 months, hypertension, diabetes, chronic kidney disease, osteoporosis, or pain were most likely to have renal function testing.</p><p><strong>Conclusion: </strong>Rates of renal function testing in primary care patients with dementia in Australia were significantly lower than for matched controls, and improved only marginally between 2011 and 2020.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663758","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":"Regional citrate anticoagulation for continuous renal replacement therapy: a prospective study in a resource-limited intensive care unit from Vietnam.","authors":"Dai Quang Huynh, Hien Thi Thu Huynh, Ngan Hoang Kim Trieu, An Hoang Tran, Hieu Trung Kieu, Thao Thi Ngoc Pham, Hai Ngoc Truong, Phuoc Van Dang","doi":"10.1007/s40620-025-02255-z","DOIUrl":"https://doi.org/10.1007/s40620-025-02255-z","url":null,"abstract":"<p><strong>Background: </strong>Regional citrate anticoagulation has advantages over systemic heparin in prolonging filter life and decreasing bleeding risk during continuous renal replacement therapy (CRRT). However, implementing regional citrate anticoagulation in resource-limited intensive care units (ICU) remains challenging due to potential adverse events and the absence of standardized protocols. This study aims to evaluate the efficacy and safety of regional citrate anticoagulation in CRRT for critically ill patients in low-resource settings.</p><p><strong>Methods: </strong>This single-center, prospective cohort study enrolled critically ill patients with acute kidney injury (AKI) requiring CRRT at a resource-limited ICU in Vietnam. Patients received either regional citrate anticoagulation or heparin anticoagulation. Primary outcomes included filter lifespan and adverse events; secondary outcomes were renal recovery and in-hospital mortality rate.</p><p><strong>Results: </strong>One hundred twenty-one patients were enrolled, 42 in the citrate group and 79 in the heparin group. The citrate group had a significantly longer filter lifespan (median 56 h versus 31 h; p < 0.001) and a lower rate of premature (< 24 h) filter clotting (4.8% versus 27.2%, p < 0.001). The hemorrhage rate was 6.4% in the citrate group versus 12.9% in the heparin group (p = 0.162). However, hypomagnesemia occurred more frequently in the citrate group (58.7% versus 23.1%, p < 0.001). No significant differences in renal recovery or hospital mortality were observed between groups.</p><p><strong>Conclusion: </strong>Regional citrate anticoagulation effectively maintained filter patency and proved to be safe for CRRT in a resource-limited ICU. Further studies are needed to establish standardized protocols for regional citrate anticoagulation in this setting to minimize citrate-related adverse events.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648797","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":"ANCA renal risk score to predict kidney outcomes in an Australian cohort: a single-centre experience.","authors":"Lisa Paxton, Emily Schembri, Benjamin Hunt, Anthony Longano, Lawrence P McMahon, Limy Wong","doi":"10.1007/s40620-025-02276-8","DOIUrl":"https://doi.org/10.1007/s40620-025-02276-8","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634238","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":"Lesson for the clinical nephrologist: glucagon-like peptide-1 receptor agonists (GLP-1 RA) in a patient with obesity and diabetic kidney disease on peritoneal dialysis.","authors":"Pavlo Yavorskiy, Silvio Borrelli, Katherine Esposito, Maria Ida Maiorino, Michela Petrizzo, Luca De Nicola, Carlo Garofalo","doi":"10.1007/s40620-025-02247-z","DOIUrl":"https://doi.org/10.1007/s40620-025-02247-z","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624987","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":"Hemoadsorption and plasma adsorption: two current options for the 3rd dimension of dialysis purification.","authors":"Niccolò Morisi, Gaetano Alfano, Marco Ferrarini, Camilla Ferri, Francesco Fontana, Marco Ballestri, Gabriele Donati","doi":"10.1007/s40620-025-02257-x","DOIUrl":"https://doi.org/10.1007/s40620-025-02257-x","url":null,"abstract":"<p><p>The adsorption technique has opened a new frontier in the field of purification through hemodialysis. This technique has proved to be effective in removing uremic toxins previously deemed inaccessible due to their size or charge, as well as to their molecular interactions with blood proteins. In this context, this review provides a detailed explanation of the role of Polyester-polymer alloy (PEPA®) membranes and hemodiafiltration with endogenous reinfusion. The polyester-polymer alloy membrane is a three-layered dialysis membrane with adsorbent properties, representing an innovative approach to engineering the filter membrane to achieve adsorbent characteristics while maintaining biocompatibility with blood. Haemodiafiltration with endogenous reinfusion is a technique where a first filter separates plasma water from blood, then plasma water is led to a sorbent cartridge. After contact with the sorbent, the purified plasma water reconstitutes the whole blood, which is led to a second filter where diffusion takes place. Both techniques are efficacious in removing middle-molecular weight molecules and protein-bound toxins, and have a role in reducing inflammation and erythropoietin resistance. However, the additional clinical advantage of adsorption is partially offset by lack of selectivity in the absorption process, potentially resulting in the loss of micro- and macronutrients or drugs. Therefore, further studies are encouraged to evaluate the impact of absorption on patient outcomes and clinical applicability in certain medical conditions.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615763","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":"Identification of conserved gene expression changes across common glomerular diseases by spatial transcriptomics.","authors":"Jeong Min Cho, Minji Kang, Sehoon Park, Jaeik Oh, Hyunah Ku, Ha Yeon Shin, Jung Hun Koh, Semin Cho, Yaerim Kim, Soojin Lee, Yong Chul Kim, Seung Seok Han, Kwon-Wook Joo, Yon Su Kim, Seung Hee Yang, Kyung Chul Moon, Hajeong Lee, Hyun Je Kim, Dong Ki Kim","doi":"10.1007/s40620-025-02233-5","DOIUrl":"https://doi.org/10.1007/s40620-025-02233-5","url":null,"abstract":"<p><strong>Background: </strong>Glomerular diseases encompass a group of kidney diseases that may share common gene expression pathways. Here, we analyzed glomerular-specific gene expression profiles across various glomerular diseases.</p><p><strong>Methods: </strong>We performed spatial transcriptomic profiling using formalin-fixed paraffin-embedded kidney biopsy specimens of controls and patients with five types of glomerular diseases using the GeoMx Digital Spatial Profiler. Disease-representative glomerular regions of interest (ROIs) were configured, probed with oligonucleotide barcodes linked with target complimentary sequence. The UV-cleaved barcodes were amplified to generate libraries and subsequently sequenced. Common differentially expressed genes across glomerular diseases were identified and Gene Ontology annotation was performed using the ToppGene suite.</p><p><strong>Results: </strong>The mean age of patients with glomerular diseases and kidney donors was 49.5 ± 12.2 and 49.5 ± 9.8 years, respectively. A total of 35 differentially expressed genes were consistently downregulated in glomeruli across the disease compared to the control, while none of the differentially expressed genes were consistently upregulated. Twelve of 35 downregulated differentially expressed genes, including the two hub genes JUN and FOS, were annotated with molecular function Gene Ontology terms related to DNA-binding transcription factor activity. The annotated biological process Gene Ontology terms included response to lipid-related (17/35 differentially expressed genes), response to steroid hormone (12/35 differentially expressed genes), or cell cycle regulation (10/35 differentially expressed genes). Xenium and immunofluorescence staining confirmed the reduced expression of JUN, ZFP36, and KLF9 in intraglomerular cells of glomerular diseases.</p><p><strong>Conclusions: </strong>Identifying common differentially expressed genes by spatial transcriptomic analysis provides insights into the underlying molecular mechanisms of glomerular diseases and may lead to novel assessment or therapeutic strategies.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605191","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":"Validation of the acute kidney injury \"Standardized Clinical Assessment and Management Plan\" (SCAMP) Spanish translation to guide initiation of kidney replacement therapy.","authors":"Enrique José Antonio Robiou-Vivero, Mallika Lakshmi Mendu, Rafael Valdez-Ortiz, Lucía Monserrat Pérez-Navarro, Juan Carlos Díaz-Núñez","doi":"10.1007/s40620-025-02249-x","DOIUrl":"https://doi.org/10.1007/s40620-025-02249-x","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) occurs in up to 50% of critically ill patients, often requiring kidney replacement therapy (KRT). The ideal time to start KRT is not fully standardized, and evidence stands controversial at this point. The overall prognosis of patients may be linked to the timing of KRT initiation. The AKI Standardized Clinical Assessment and Management Plan (SCAMP) tool supported the identification of a strategy to guide KRT decision making and improve clinical outcomes. However, its applicability is limited by the lack of validated translations to other languages.</p><p><strong>Methods: </strong>We carried out a validation study of the Spanish-translated version of SCAMP, based on translation and cultural adaptation of Health Measurement Tools Guidelines. We developed a Spanish-translated version of SCAMP which was revised for clarity, relevance, and sufficiency of questions by an independent evaluator and applied to a standardized clinical case for validation by 105 practitioners.</p><p><strong>Results: </strong>We assessed reliability, internal consistency, content and construct validity and feasibility of the performed translation. The Spanish translated AKI-SCAMP meets the criteria for reliability (Cronbach's alpha 0.75). Corrected item-total correlations revealed 18 variables with correlations < 0.3, necessitating individual domain analyses to determine which item needed modifications. Construct validity was evaluated through Main Component Analysis, identifying five optimal components, explaining 84.86% variance.</p><p><strong>Conclusions: </strong>The Spanish translation of the AKI-SCAMP meets the criteria for reliability, reproducibility, content, and construct validity. This study demonstrated feasibility, as perceived by the evaluating physicians and robust psychometric characteristics in most items, allowing for its application across Spanish-speaking healthcare systems.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605193","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":"Development and validation of a prediction model for 90-day mortality among critically ill patients with AKI undergoing CRRT.","authors":"Tingting Wang, Sha Xu, Yufei Yuan, Wenbin Guo, Hongliang Zhang, Jiajun Sun","doi":"10.1007/s40620-025-02237-1","DOIUrl":"https://doi.org/10.1007/s40620-025-02237-1","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is frequent among intensive care unit (ICU) patients and is linked with high morbidity and mortality. In the absence of specific pharmacological treatments for AKI, continuous renal replacement therapy (CRRT) is a primary treatment option. This study aimed to develop and validate a predictive model for 90-day mortality in critically ill patients with AKI undergoing CRRT.</p><p><strong>Methods: </strong>Clinical data from DATADRYAD were used. We randomly divided 1121 adult patients receiving CRRT for AKI into training (80%, n = 897) and validation (20%, n = 224) cohorts. A nomogram prediction model was developed using Cox proportional hazards regression with the training set, and was validated internally. Model performance was evaluated based on calibration, discrimination, and clinical utility.</p><p><strong>Results: </strong>The model, incorporating seven predictors-SOFA score, serum creatinine, blood urea nitrogen, albumin levels, Charlson comorbidity index, mean arterial pressure at CRRT initiation, and phosphate levels 24 h after CRRT initiation-demonstrated robust performance. It achieved a C-index of 0.810 in the training set and 0.794 in the validation set.</p><p><strong>Conclusions: </strong>We developed and validated a predictive model based on seven key clinical predictors, showing excellent performance in identifying high-risk patients for 90-day mortality in AKI patients undergoing CRRT.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585917","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}