{"title":"2-Deoxy-2-[18F]Fluorosorbitol (18F-FDS) as a Potential PET Tracer for Renal Imaging and GFR Measurement: Comparative Assessment with 68Ga-EDTA and 99mTc-DTPA.","authors":"Humeyra Battal-Kaplan, Bilge Volkan-Salancı, Nezire Saygılı, Suleyman Can Ozturk, Suna Erdoğan","doi":"10.1093/joneph/aajag262","DOIUrl":"https://doi.org/10.1093/joneph/aajag262","url":null,"abstract":"<p><strong>Background: </strong>Accurate assessment of glomerular filtration rate (GFR) is critical for monitoring renal function. This study aims to evaluate its feasibility as a PET radiopharmaceutical for renal imaging and GFR assessment. Its novelty lies in the direct, head-to-head comparison with 68Ga-EDTA and 99mTc-DTPA to comprehensively assess the potential advantages and translational relevance of 18F-FDS for clinical GFR measurement.</p><p><strong>Methods: </strong>18F-FDS was synthesized via a reduction reaction, and its radiochemical purity was evaluated using radio-TLC. In vitro stability was assessed for up to 4 hours. Plasma protein and erythrocyte binding rates of 18F-FDS, 68Ga-EDTA, and 99mTc-DTPA were determined to evaluate their pharmacokinetic suitability for renal imaging. Dynamic and static renal imaging was performed in healthy male Wistar rats. Time-activity curves were generated to calculate Tmax, biological half-life (T1/2), normalized residual activity (NORA), and GFR.</p><p><strong>Results: </strong>18F-FDS was synthesized with a radiochemical purity exceeding 98% and demonstrated high in vitro stability over 4 hours. Plasma protein binding and erythrocyte of 18F-FDS was lower than for all radiopharmaceuticals. Dynamic small-animal imaging revealed rapid renal uptake and efficient urinary excretion for all agents. No statistically significant differences were observed in GFR values or kinetic parameters derived from 18F-FDS and 68Ga-EDTA imaging (p > 0.05).</p><p><strong>Conclusions: </strong>The favorable in vitro characteristics and renal kinetic profiles of 18F-FDS support their potential use as PET radiopharmaceuticals for renal imaging and GFR quantification. In particular, the low plasma protein binding and comparable GFR measurements suggest that 18F-FDS may serve as a promising alternative to established tracers for functional renal assessment.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194621","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}
Jingru Bi, Yilin Pan, Wenkai Guo, Pengcheng Ji, Yuansheng Xie
{"title":"Association of eGFR Discrepancy With Subsequent Frailty in Middle-Aged and Older Adults.","authors":"Jingru Bi, Yilin Pan, Wenkai Guo, Pengcheng Ji, Yuansheng Xie","doi":"10.1093/joneph/aajag261","DOIUrl":"https://doi.org/10.1093/joneph/aajag261","url":null,"abstract":"<p><strong>Background: </strong>Creatinine- and cystatin C-based estimated glomerular filtration rate estimates are influenced by different non-GFR determinants. Their difference (eGFRcys-eGFRcr) may therefore provide information beyond either marker alone. We examined its longitudinal association with frailty and exploratory indirect associations through grip strength.</p><p><strong>Methods: </strong>We analyzed 15,309 observations from 11,174 China Health and Retirement Longitudinal Study participants aged 45 years or older across 2011-2013 and 2015-2018. Standardized eGFR discrepancy was the exposure; follow-up outcomes were the 32-item Frailty Index and frailty (Frailty Index ≥0.25). Linear mixed models and generalized estimating equations accounted for repeated observations. Model 3 was primary; eGFRcys adjustment was a conditional sensitivity analysis.</p><p><strong>Results: </strong>Median age was 60.0 years, and 53.4% of participants were female. A 1-SD higher discrepancy was associated with a lower follow-up Frailty Index (β, -0.503; 95% CI, -0.678 to -0.328; P < 0.001) and lower odds of frailty (OR, 0.851; 95% CI, 0.804-0.900; P < 0.001). Associations persisted after eGFRcys adjustment. Exploratory three-wave analyses showed indirect associations through grip strength, not causal mediation.</p><p><strong>Conclusions: </strong>Higher eGFR discrepancy was longitudinally associated with lower subsequent frailty burden. Further studies are needed to clarify its clinical interpretation and underlying determinants.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182545","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}
Ashutosh Rath, Jitendra Singh Nigam, Immanuel Pradeep, Pallavi Prasad
{"title":"Prognostic utility of Oxford MEST-C classification for allograft failure in transplant IgA nephropathy: A systematic review and meta-analysis.","authors":"Ashutosh Rath, Jitendra Singh Nigam, Immanuel Pradeep, Pallavi Prasad","doi":"10.1093/joneph/aajag258","DOIUrl":"https://doi.org/10.1093/joneph/aajag258","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of Oxford MEST-C classification for predicting allograft loss in transplant IgAN remains inconsistent across studies due to transplant-specific challenges. This meta-analysis evaluates the prognostic value of each component of MEST-C as a predictor of allograft failure.</p><p><strong>Methods: </strong>A systematic search was performed in PubMed, Embase, Scopus, and the Cochrane Central through March 16, 2026, to identify studies reporting hazard ratios (HRs) for MEST-C scores and graft loss. Univariable and multivariable HRs were pooled using a random-effects model. Potential sources of heterogeneity were identified through sensitivity, subgroup, and meta-regression analyses.</p><p><strong>Results: </strong>The study included nine cohorts comprising 1,185 kidney transplant recipients. Pooled analyses showed that S, T, and C lesions were consistently associated with allograft loss, whereas the prognostic value of M and E lesions and the total MEST-C score was less consistent. Subgroup and meta-regression analyses identified geographic region, donor source, and cohort size as significant effect modifiers; however, given the limited number of studies, these associations remain exploratory and hypothesis-generating.</p><p><strong>Conclusion: </strong>This meta-analysis of retrospective cohort studies found that S, T, and C lesions were associated with allograft loss after adjustment in heterogeneous, study-specific models, whereas independent associations for M and E were inconsistent. The total MEST-C score showed univariable predictive value; however, limited multivariable pooling failed to confirm an independent association with graft loss. Its clinical utility requires robust prospective validation before routine reporting can be recommended.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182542","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}
Hani Al Wahidi, Baraa Habash, Yousef Khelfa, Reem A Mustafa
{"title":"Dialysis and renal transplantation in Gaza: a crisis of access in a war zone.","authors":"Hani Al Wahidi, Baraa Habash, Yousef Khelfa, Reem A Mustafa","doi":"10.1093/joneph/aajag161","DOIUrl":"10.1093/joneph/aajag161","url":null,"abstract":"<p><p>Since October 7th, 2023, the healthcare system in Gaza has suffered severe damage. Patients with chronic kidney diseases, particularly those needing dialysis, are among the most affected. This study aimed to summarize the impact of the war on patients with kidney failure. Data were collected by either visiting the dialysis centers or contacting them through phone calls and text messages. We found that the total number of patients had decreased from 1022 patients in late 2022 to 750 patients in late 2024. This decrease occurred despite new patients initiating dialysis between October 2023 and December 2024. The number of dialysis machines also decreased from 178 in 2022 to 109 in 2024, despite 35 new dialysis machines being supplied through the World Health Organization (WHO). Consumables, water, electricity, and other necessary resources became increasingly difficult to access. Al Rantisi hospital, the only hospital providing dialysis to 38 pediatric patients before October 2023, is no longer functioning and the surviving eight children are receiving dialysis using adult machines in other centers. This study underscores the pressing need for humanitarian action in Gaza and the need for global policies to protect vulnerable patients, including those with kidney failure.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1326-1329"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808738","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":"Nephrology in space: from fluid conservation to cosmic kidney disease.","authors":"Marco Pizzarelli, Francesco Pizzarelli","doi":"10.1093/joneph/aajag163","DOIUrl":"10.1093/joneph/aajag163","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1097-1100"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881021","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}
Seyed Mahdi Montazer, Amirali Asadi, Amirali Taghipour, Arshia Rajabi, Arshak Shabanian, Mehdi Daraei, Ali Bahmani, Mohammad Javad Bay, Mehdi Karimi
{"title":"Impact of HIF-prolyl hydroxylase inhibitors on VEGF expression and vascular adverse events in chronic kidney disease: a meta-analysis of 34 randomized controlled trials.","authors":"Seyed Mahdi Montazer, Amirali Asadi, Amirali Taghipour, Arshia Rajabi, Arshak Shabanian, Mehdi Daraei, Ali Bahmani, Mohammad Javad Bay, Mehdi Karimi","doi":"10.1093/joneph/aajag065","DOIUrl":"10.1093/joneph/aajag065","url":null,"abstract":"<p><p>Background Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are novel oral agents used to treat renal anemia in chronic kidney disease (CKD). While their erythropoietic effects are well-documented, the potential consequences of HIF-mediated vascular endothelial growth factor (VEGF) activation remain uncertain. This meta-analysis aimed to evaluate the effect of HIF-PHI therapy on VEGF levels and the risk of VEGF-related adverse outcomes in CKD patients. Methods We systematically analyzed 34 randomized controlled trials (RCTs) including 26 trials reporting VEGF levels and additional data on cancer, diabetic retinopathy, peripheral edema, and thrombosis. Subgroup analyses were performed based on drug type, treatment duration, dialysis status, trial phase, and comparator type. Results HIF-PHI treatment was associated with a modest but significant increase in VEGF levels (SMD = 0.23; 95% CI: 0.07-0.39) and a reproducible increase in peripheral edema risk (log RR = 0.22; 95% CI: 0.09-0.35). No significant associations were found for cancer, diabetic retinopathy, or thrombosis. Dialysis status moderated VEGF response, with greater elevation observed in dialysis-dependent patients. Conclusion HIF-PHIs modestly increase VEGF expression, with peripheral edema as the most consistent adverse signal. However, no evidence of oncologic or retinal harm was found in the short term. Long-term surveillance is recommended.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1129-1143"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562396","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}
Alice Sabatino, Sara Alibrandi, Tea Dovšak, Marianna Adinolfi, Giuseppe Regolisti, Enrico Fiaccadori, Umberto Maggiore, Ilaria Gandolfini
{"title":"Frailty in kidney transplant candidates is associated with reduced likelihood of transplantation.","authors":"Alice Sabatino, Sara Alibrandi, Tea Dovšak, Marianna Adinolfi, Giuseppe Regolisti, Enrico Fiaccadori, Umberto Maggiore, Ilaria Gandolfini","doi":"10.1093/joneph/aajag095","DOIUrl":"10.1093/joneph/aajag095","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation is the optimal treatment for kidney failure; however, it represents a major physiological stress. Frailty is a clinical syndrome also characterized by decreased physiological reserve and a reduced ability to cope with stressor events. The aim of this study was to assess the association between frailty status and the likelihood of undergoing kidney transplantation.</p><p><strong>Methods: </strong>This retrospective observational study included all kidney transplant candidates waitlisted at the Kidney Transplant Center of the Parma University Hospital, Italy, between July 2018 and February 2020. Frailty status was assessed using the Fried Frailty Phenotype. Frailty was defined as a Fried frailty phenotype score ≥3, while a score of 1 or 2 indicated a pre-frail condition. The Aalen-Johansen estimator was used to estimate the cumulative probability of transplantation and death/withdrawal according to frailty status (frail vs non-frail). Adjusted analyses were performed using Fine-Gray multivariable regression models.</p><p><strong>Results: </strong>Of the 171 patients enrolled, 39% were non-frail, 51% were pre-frail, and 10% were frail. Patients were followed for a median of 17 months; during this period, 42% underwent transplantation, whereas 6% died or were permanently removed from the waiting list. In adjusted analyses, frail and pre-frail patients combined had a 42% lower likelihood of undergoing transplantation compared with non-frail patients (SubHR 0.58, 95% CI 0.39-0.86; P = .006).</p><p><strong>Conclusions: </strong>Frailty among patients with advanced CKD on the kidney transplant waiting list was associated with a lower probability of undergoing transplantation.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1214-1221"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603835","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}
Kathrine Parker, John Hartemink, Satarupa Choudhuri, Albert Power, Jung Yin Tsang, Jecko Thachil, Sandip Mitra, Penny Lewis
{"title":"Development of best practice statements for anticoagulation in advanced kidney disease using the modified Delphi method.","authors":"Kathrine Parker, John Hartemink, Satarupa Choudhuri, Albert Power, Jung Yin Tsang, Jecko Thachil, Sandip Mitra, Penny Lewis","doi":"10.1093/joneph/aajag103","DOIUrl":"10.1093/joneph/aajag103","url":null,"abstract":"<p><strong>Background: </strong>Patients with advanced kidney disease (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2) are known to have an increased risk of venous thromboembolic events and increased likelihood of atrial fibrillation alongside an increased risk of bleeding. People with advanced kidney disease are often excluded from randomised controlled trials (RCTs) of anticoagulants, leaving gaps in the evidence base and practice variation. This study aimed to achieve consensus on anticoagulant use in advanced kidney disease to inform national prescribing guidance.</p><p><strong>Methods: </strong>A modified Delphi approach was used to achieve consensus on statements relating to anticoagulant use in advanced kidney disease. Three Delphi rounds were predefined, with two rounds of questionnaires followed by online discussion in round three. Panel members included UK experts from the fields of cardiology, nephrology and haematology, who were asked to rate 160 statements with appropriateness and consensus defined by RAND methodology.</p><p><strong>Results: </strong>Twenty-one experts completed rounds one and two of the Delphi. For round three, 11 experts joined a Microsoft Teams discussion. Following round three, there were 72 statements with consensus agreement for inclusion in the guideline, including dose reduction recommendations for therapeutic light molecular weight heparin (LMWH), recommendation for off-label apixaban use in non-valvular atrial fibrillation, and trough anti-Xa level monitoring with therapeutic LMWH. Forty-two statements with consensus disagreement for exclusion and 27 with unequivocal consensus. These statements could be used to develop research recommendations.</p><p><strong>Conclusion: </strong>This study has led to consensus agreement on a number of statements relating to anticoagulant use in advanced kidney disease in the UK that can be used in national guidance.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1238-1245"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712385","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}
Mohammed G Fetouh, Alaa Sabry, Mohammed A Fouda, Mona Abdulrahim
{"title":"Repeat kidney biopsy unmasks the transition from active inflammation to irreversible damage in lupus nephritis: longitudinal outcomes from a single-center cohort in Egypt.","authors":"Mohammed G Fetouh, Alaa Sabry, Mohammed A Fouda, Mona Abdulrahim","doi":"10.1093/joneph/aajag097","DOIUrl":"10.1093/joneph/aajag097","url":null,"abstract":"<p><strong>Background: </strong>Lupus nephritis (LN) is a serious complication of systemic lupus erythematosus, and repeat kidney biopsy has a potential value in monitoring disease progression and impact on treatment adjustments.</p><p><strong>Methods: </strong>We retrospectively analyzed 81 Egyptian LN patients who underwent two kidney biopsies at the Urology and Nephrology Center, Mansoura University, between January 2011 and April 2024. Indications included persistent proteinuria, active urinary sediment, or unexplained renal impairment. Demographic, clinical, laboratory, histological, and treatment data were collected. Pathology was assessed using the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification, activity and chronicity indices, and outcomes were analyzed by Cox regression.</p><p><strong>Results: </strong>At repeat biopsy, pathological transitions occurred in 48%. The transition toward more severe disease categories was frequent and included: Class I/II to III/IV: 7 of 10 patients, Class III to IV: 6 of 11 patients, Class III/IV + V to IV: all 3 patients, Class IV to VI: 5 of 49 patients, Class V to III/IV/VI: 6 of 8 patients. The activity index decreased (median 12→7, P < .001), while chronicity increased (2→4, P < .001). Treatment escalation was needed in 53.1% of patients. Over a median follow-up of 5.4 years, 56.8% progressed to kidney failure. Serum creatinine at both biopsies independently predicted kidney failure (Hazard ratio [HR] 1.24, P = .007; HR 1.22, P < .001). Shorter biopsy intervals were protective (HR 0.97, P < .001). At the second biopsy, chronicity index, glomerulosclerosis, and cellular crescents independently predicted kidney failure.</p><p><strong>Conclusion: </strong>Repeat biopsy is of pivotal importance in LN, unmasking critical histological transitions and shifts towards chronicity that can guide essential therapy changes and improve prognostication beyond clinical assessment alone.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1222-1229"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678475","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}
Antonio Granata, Rosario Maccarrone, Alessio Sturiale, Fabio Dipasqua, Francesco Amico
{"title":"The therapeutic potential of peritoneal dialysis in congenital heart diseases. A lesson for the clinical nephrologist.","authors":"Antonio Granata, Rosario Maccarrone, Alessio Sturiale, Fabio Dipasqua, Francesco Amico","doi":"10.1093/joneph/aajag110","DOIUrl":"10.1093/joneph/aajag110","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1322-1325"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148712684","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}