Journal of Nephrology最新文献

{"title":"Functionality and sustainability of telemedicine for home-based management of patients with chronic kidney disease: the telemechron study.","authors":"Sara Jayousi, Martina Cinelli, Roberto Bigazzi, Stefano Bianchi","doi":"10.1007/s40620-025-02348-9","DOIUrl":"https://doi.org/10.1007/s40620-025-02348-9","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a global health concern, contributing to high morbidity, mortality, and cardiovascular risk. Intensive monitoring of clinical parameters and timely therapeutic interventions can improve disease management.</p><p><strong>Methods: </strong>This study developed and tested a telemonitoring system using wearable sensors and a smartphone app to support chronic kidney disease patients on dialysis or during pre-dialysis care. The system was evaluated for its feasibility and sustainability, analyzing the usability, patient adherence, and potential impact on healthcare outcomes. Eight patients tested the prototype.</p><p><strong>Results: </strong>Results showed that the overall protocol adherence rate was 8.8%, much lower than expected. Patients enrolled in pre-dialysis care demonstrated higher adherence compared to patients living with hemodialysis or peritoneal dialysis. While most users found the system intuitive, some reported that the time requested for measurements was excessive. Recommendations for further development include improving reminder notifications and using multi-parametric devices to streamline data collection.</p><p><strong>Conclusions: </strong>In patients with CKD, intensive remote monitoring could allow the acquisition of clinical data to facilitate achievement of clinical targets by timely therapeutic adjustments. However, long-term monitoring was not widely accepted. Further testing with larger samples and future refinements, integrating miniaturized wearable devices and AI-driven analytics, could enhance adherence and personalized care.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080931","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":"Pregnancy-related Acute Kidney injury (PrAKI): an observational study of 500 cases from a public hospital in South India.","authors":"Manjusha Yadla, Snigdha Bachalakuri, Sreekanth Burri, Vikram Kumar, Pathakala Sreenivas","doi":"10.1007/s40620-025-02404-4","DOIUrl":"https://doi.org/10.1007/s40620-025-02404-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pregnancy-related acute kidney injury (PrAKI) is a global issue with a significant impact on the society. High maternal and fetal mortality are reported with PrAKI. AKI can occur during antepartum or postpartum periods. In low-middle-income countries, common causes of PrAKI are sepsis and preeclampsia. We undertook this study to analyze the epidemiology and outcomes of pregnancy-related acute kidney injury in our region.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a retrospective study analyzing 500 cases of PrAKI between 2014 and 2024 in a tertiary care referral public hospital. The setting was Gandhi Medical College, Hyderabad, Telangana, India. Our center is a tertiary care, multidisciplinary hospital with dedicated maternal-child health facilities, with a total of 200 beds in a dedicated area with an exclusive maternal intensive care unit, where we provide bedside dialysis services. Referrals are from the whole state, which has a population of 40 million inhabitants, and from adjacent states. Data were collected from electronic case records. Incomplete case records were excluded from the study. We collected epidemiological data, clinical presentation, causes of PrAKI and the outcomes, and analyzed the epidemiology, etiology, and maternal and fetal outcomes of PrAKI. The study population included all pregnant patients referred for kidney services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included sequential cases of PrAKI referred between 2014 and 2024. The total number of patients included in the study was 500 after exclusion of incomplete records. The mean age of the patients was 25 ± 4 years. Most PrAKI were observed in the postpartum period 280/500 (56%), and 220 cases were antepartum (44%), of whom 188/220 cases presented in the third trimester. Only four patients had first-trimester PrAKI (0.8%), and 28 patients presented in the second trimester (5.6%). The majority of cases were in the third trimester and postpartum (93.6%). We grouped causes of PrAKI into four categories: preeclampsia, sepsis, the combination of preeclampsia and sepsis, and others. The preeclampsia group included 103 patients (20.6%), 129 patients (25.8%) were in the sepsis group, while the combination of preeclampsia and sepsis group included 169 patients (33.8%). Other causes included drugs, isolated postpartum hemorrhage, isolated abruption, and isolated Hemolysis, Elevated Liver enzymes, and Low Platelet counts (HELLP) syndrome. Antepartum hemorrhage was noted in 44% of cases, with isolation occurrence in 35 patients (7%), in combination with preeclampsia, sepsis, and preeclampsia + sepsis in 34.7%. Similarly, postpartum hemorrhage was seen in 39 patients (7.8%), with isolation occurrence in 19/500 (3.8%) and a combination occurrence in 20 patients (4%). About 102 patients had HELLP syndrome (20.4%). Isolated hemolysis was observed in 8/500 (1.6%) and, the combination with either preeclampsia/sepsis/both, was seen in 94 patients (18.8%). We di","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069812","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":"Barriers and facilitators for effective sick day guidance implementation.","authors":"Tristan Coppes, Daphne Philbert, Teun van Gelder, Marcel L Bouvy, Ellen S Koster","doi":"10.1007/s40620-025-02396-1","DOIUrl":"https://doi.org/10.1007/s40620-025-02396-1","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069863","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":"Current epidemiological overview of glomerulonephritis in Latin America: a systematic literature review.","authors":"Raphael Hemann Palma, Rafaela Gageiro Luchesi Soares, Gisele Meinerz, Elizete Keitel","doi":"10.1007/s40620-025-02418-y","DOIUrl":"https://doi.org/10.1007/s40620-025-02418-y","url":null,"abstract":"<p><strong>Background: </strong>Glomerulonephritis (GN) is a group of kidney disorders marked by glomerular damage, leading to proteinuria, hematuria, hypertension, and impaired kidney function. Despite advancements in diagnostics, kidney biopsy remains the gold standard for diagnosis. The prevalence of GN varies globally, with Latin America showing a significant increase in incidence rates.</p><p><strong>Methods: </strong>This systematic review adhered to PRISMA guidelines and included observational studies from PubMed, Embase, Cochrane, and SciELO databases. Studies were selected based on their focus on the prevalence of GN and its subtypes in Latin America from 2000 onward. The quality of the studies was assessed using the Newcastle-Ottawa Scale adapted for cross-sectional studies.</p><p><strong>Results: </strong>Following the search, a total of 4336 articles were screened. Of these, 49 underwent full-text review, and 35 met the inclusion criteria, encompassing 61,979 kidney biopsies analyzed across studies conducted in Latin America. The studies spanned a time frame of 1-35 years, with a mean age at biopsy ranging from 28 to 57 years. Focal Segmental Glomerulosclerosis (FSGS) and Lupus Nephrtis were the most frequent primary and secondary glomerulopathies. Nephrotic syndrome was the leading indication for biopsy, and electron microscopy was only reported in 17 studies. Few studies reported data on estimated glomerular filtration rate (eGFR), interstitial fibrosis, and tubular atrophy. Furthermore, subclassification of FSGS into primary and secondary forms was performed in only four studies. Most countries in Latin America reported kidney biopsy rates below 50 per million population per year (pmp/yr), substantially lower than those observed in high-income countries, where rates commonly exceed 100-200 pmp/yr.</p><p><strong>Conclusions: </strong>The epidemiology of glomerulonephritis in Latin America is heterogeneous, with marked regional differences and predominance of FSGS as the leading primary GN; however, data on primary FSGS (pFSGS) are lacking. Compared to high-income countries, most Latin American countries report significantly lower rates of kidney biopsies per million population, which, combined with limited diagnostic resources, may contribute to the underdiagnosis and potential misclassification of glomerular diseases.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075400","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":"The birth of an idea: organizing tailored solutions for uncommon journeys in maternal health.","authors":"Bianca Covella, Luigi Rossi","doi":"10.1007/s40620-025-02411-5","DOIUrl":"https://doi.org/10.1007/s40620-025-02411-5","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064873","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":"The effect of chronic kidney disease on the association of tricuspid regurgitation with overall survival : Insights from SHEBAHEART big data.","authors":"Ranel Loutati, Viana Copeland, Robert Klempfner, Sagit Ben-Zekry, Efrat Mazor-Dray, Paul Fefer, Israel Moshe Barbash, Victor Guetta, Amit Segev, Rafael Kuperstein, Elad Maor, Pazit Beckerman","doi":"10.1007/s40620-025-02377-4","DOIUrl":"https://doi.org/10.1007/s40620-025-02377-4","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a common comorbidity among patients with tricuspid regurgitation, yet its impact on tricuspid regurgitation outcomes is underexplored. This study examines how CKD affects the relationship between severe tricuspid regurgitation and overall survival.</p><p><strong>Methods: </strong>This is a retrospective cohort study of all adult patients (> 18 years old) evaluated at the Sheba Medical Center, between 2007 and 2022, who underwent transthoracic echocardiographic evaluation. It is based on the SHEBAHEART big data registry. Sheba Medical Center is the largest hospital in Israel with approximately 115,000 admissions per year. The echocardiographic reports together with the electronic medical records of all patients are the source for this study. Patients with missing creatinine data within one month of their echocardiography study, as well as those who underwent tricuspid regurgitation intervention, were excluded from the study. Patients were categorized into four groups, according to the presence and severity of tricuspid regurgitation and stratified by CKD stage. The primary outcome was all-cause mortality.</p><p><strong>Results: </strong>The study included 78,147 patients (median age 67, IQR 55-78), with 2989 (4%) having severe tricuspid regurgitation and 19,910 (25%) with an estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m². Over a median 4-year follow-up, 28,112 patients (36%) died. Both tricuspid regurgitation severity and CKD stage were associated with increased mortality risk (log-rank p < 0.001 for both). Adjusted models showed that compared to the none/trivial group, patients with mild, moderate, and severe tricuspid regurgitation had a 6%, 12%, and 35% higher risk of death, respectively (p < 0.001 for all). The association of tricuspid regurgitation with poor survival was CKD-dependent, with increased mortality risk of 56% vs. 23% among patients with eGFR < 60 vs. eGFR ≥ 60 (p for interaction < 0.001). The interaction analysis was no longer significant when right ventricular function was incorporated into the multivariable model. Subanalysis, limited to patients with isolated tricuspid regurgitation, yielded consistent results.</p><p><strong>Conclusions: </strong>The association between severe tricuspid regurgitation and poor survival is stronger in advanced CKD patients and may be modulated through right ventricular function.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064897","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 life cycle assessment of peritoneal dialysis procurement in Italy: environmental burden and opportunities for improvement.","authors":"James Larkin, Giulia Ligabue, Gaetano Alfano, Rodrigo Martínez Cadenas, Abass Fehintola, Ingeborg Steinbach, Aycan Yasar, Niccolo Morisi, Marta Arias-Guillen, Marialuisa Caiazzo, Gabriele Donati, Brett Duane","doi":"10.1007/s40620-025-02409-z","DOIUrl":"https://doi.org/10.1007/s40620-025-02409-z","url":null,"abstract":"<p><strong>Background: </strong>Procurement activities in healthcare, especially within nephrology, contribute significantly to the environmental footprint. In peritoneal dialysis (PD), procurement of consumables such as dialysis bags, tubing, and machines plays a critical role in driving environmental impacts. Previous studies, including those by the National Health Service (NHS), have shown that procurement can account for up to 72% of the healthcare sector's carbon emissions.</p><p><strong>Methods: </strong>A life cycle assessment (LCA) was conducted from April to July 2024 at the Nephrology Dialysis and Kidney Transplantation Unit of AOU Policlinico di Modena, Italy, in accordance with ISO 14040/14044 standards. The study focused on procurement-related environmental impacts in automated peritoneal dialysis (APD), based on a standard prescription of two 5L bags overnight and one 2L daytime dwell per day. Products were dismantled to assess materials and modelled using OpenLCA with the Ecoinvent v3.10 database. Transportation, manufacturing, and waste disposal were included within system boundaries.</p><p><strong>Results: </strong>The 5L Dialysate Bag (used twice daily) had the highest carbon footprint (1515 kg carbon dioxide equivalent [CO₂-eq/year]), followed by the 2L Bag (457 kg) and Automated Drainage System (286 kg). Primary drivers were long-distance transport, plastic production (especially polyethylene and PVC), and energy-intensive manufacturing. Although the 5L bags are used in greater quantities due to the APD prescription (typically two bags per night), it still showed a lower carbon footprint per litre of dialysate delivered (0.415 kg CO₂-eq/L) compared to the 2L bag (0.626 kg CO₂-eq/L). Smaller items like disinfectant sprays and medical kits contributed less individually but were used frequently. Across all categories, plastic production, packaging, electricity use, and incineration were key contributors.</p><p><strong>Conclusion: </strong>The environmental impact of PD procurement is concentrated in a few high-use, high-impact items. Reduction strategies should target material substitutions, modular product design, and lower-emission transport and energy use. Innovations such as local dialysate mixing, improved waste segregation, and increased recyclability could substantially reduce the environmental burden of PD.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064936","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":"Low physical function is a risk factor for mortality in non-dialysis-dependent chronic kidney disease patients.","authors":"Hellen Christina Neves Rodrigues, Amanda Goulart de Oliveira Sousa, Vitória Rodrigues Morais Preto, Letycia Netto de Paula Cunha, Samara Vieira de Oliveira, Mariana Ferreira Dos Santos, Nara Aline Costa","doi":"10.1007/s40620-025-02420-4","DOIUrl":"https://doi.org/10.1007/s40620-025-02420-4","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064871","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":"Dynamic functional examination of the peritoneal dialysis catheter using color Doppler ultrasound. In vitro technical evaluation and in vivo application.","authors":"Matthias Zeiler, Anastasia Mancini, Antonio Federico, Valentina Ramazzotti, Simona Silvestri, Leonardo Spatola, Stefano Santarelli, Antonio Granata","doi":"10.1007/s40620-025-02421-3","DOIUrl":"https://doi.org/10.1007/s40620-025-02421-3","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis catheter malfunction compromises dialysis adequacy. Standard imaging methods in the case of peritoneal catheter malfunction include abdominal X-ray, fluoroscopic catheter peritoneography, and computed tomography. Ultrasound has only recently been utilized to evaluate the intraperitoneal part of the catheter. In clinical routine, catheter function is assessed by the time needed to fill or drain a defined quantity of peritoneal dialysis fluid. Visual functional testing of the catheter can be performed by fluoroscopy or by contrast-enhanced ultrasound. We developed and tested a color Doppler ultrasound technique for dynamic imaging of the peritoneal catheter based on signal generation by dialysis fluid flow.</p><p><strong>Methods: </strong>The feasibility of the color Doppler approach was evaluated utilizing a phantom. Furthermore, the technique was applied in 28 peritoneal dialysis patients, most of whom presented peritoneal catheter malfunction.</p><p><strong>Results: </strong>Color Doppler examination improved the catheter visualization, especially in cases in which the catheter is embedded between the intestinal loops. Furthermore, this technique highlighted catheter side hole occlusions by adhesions or intraluminal thrombi. The examination can be performed either during filling or draining of dialysis fluid.</p><p><strong>Conclusions: </strong>The color Doppler ultrasound technique appears to be helpful in identifying problem-solving strategies in malfunctioning peritoneal catheters.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053809","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":"Treatment of recurrent IgA nephropathy after kidney transplantation with targeted-release budesonide - a case report.","authors":"Maximilian Packbiers, Annika Hahm, Theresa Riebeling, Jan Hinrich Bräsen, Roland Schmitt, Kevin Schulte","doi":"10.1007/s40620-025-02405-3","DOIUrl":"https://doi.org/10.1007/s40620-025-02405-3","url":null,"abstract":"<p><p>Immunoglobulin A nephropathy (IgAN) is one of the most common forms of primary glomerulonephritis which can lead to kidney failure requiring kidney replacement therapy via dialysis or transplantation. Unfortunately, IgAN can recur within the allograft. For treatment of primary IgAN, a targeted-release formulation of budesonide that acts specifically within the ileum can be used to prevent disease progression. The use of targeted-release budesonide in the setting of recurrent IgAN after transplantation has not yet been studied in detail. We here report a 28-year-old female with IgAN recurrence after transplantation, treated by targeted release budesonide for 9 months. Prior to treatment initiation in April 2023, estimated glomerular filtration rate (eGFR) drastically decreased, reaching  24 ml/min/1.73 m² within 10 months. With treatment, the eGFR decrease slowed down considerably (- 6 ml/min/1.73 m² within 12 months). The urine protein-to-creatinine-ratio (UPCR) likewise decreased from 4.55 g/g creatinine before therapy start to 1.30 g/g 12 months after therapy start. Despite episodes of poorly controlled hypertension and edema during treatment that were related to interruption of medications, blood pressure was stable at 122/77 mmHg after 9 months and 133/83 mmHg after 12 months. Compared to the beginning of the therapy, the patient lost 3 kg of body weight. There were no serious infections, nor was an increased susceptibility to infections observed. No other serious adverse events occurred. Although the patient experienced corticosteroid-related side effects, treatment was not interrupted. After therapy, the side effects subsided and the patient reports general wellbeing.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040493","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}