Journal of Nephrology最新文献

{"title":"Hidden glyoxylic acid in hair straightening products: a forensic lesson for the nephrologist.","authors":"David De Saint Gilles, Sabrina Khelil, Jennifer Kervadec, Ellie Tang, Emmanuel Letavernier","doi":"10.1093/joneph/aajag071","DOIUrl":"10.1093/joneph/aajag071","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1314-1317"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252042","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 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}

{"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}

{"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}

{"title":"Efficacy and safety of finerenone with or without combination therapy in patients with non-diabetic chronic kidney disease: a real-world observational study.","authors":"Yanli Fang, Yun Shao, Xinyi Lin, Qihui Xu, Yu Shang, Mingli Chen, Siyi Chen, Yinqiu Lv, Jianna Zhang, Huidi Zhang","doi":"10.1093/joneph/aajag094","DOIUrl":"10.1093/joneph/aajag094","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the efficacy and safety of finerenone, with or without combination therapy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) or renin-angiotensin system inhibitors (RASi), in Chinese patients with non-diabetic chronic kidney disease (non-diabetic CKD) at different follow-up time points.</p><p><strong>Methods: </strong>Patients with non-diabetic CKD who received finerenone treatment from March 2023 to August 2025 were retrospectively enrolled. According to the treatment regimens, patients were divided into four groups: finerenone monotherapy group (without SGLT2i or RASi), finerenone + SGLT2i group, finerenone + RASi group, and finerenone + SGLT2i + RASi group. The main evaluated indicators included urine albumin-to-creatinine ratio (UACR), urine protein-to-creatinine ratio (UPCR), serum creatinine (Scr), estimated glomerular filtration rate (eGFR), and serum potassium (K+) levels.</p><p><strong>Results: </strong>A total of 483 patients were enrolled in this study, including 229 males (47.41%); baseline UACR was 520.1 (interquartile range [IQR], 259.2-993.9) mg/g. After receiving finerenone treatment for 18 months, the UACR decreased by 69.18%. During the study period, the change in eGFR remained stable, with only 2.48% of patients experiencing an eGFR decline >30%. Hyperkalemia occurred in only 6 patients (1.24%), indicating a good safety profile during the medication period.</p><p><strong>Conclusion: </strong>Finerenone can effectively reduce proteinuria in patients with non-diabetic CKD. Dual or triple combination therapy demonstrated more pronounced effects, with an overall favorable safety profile. Nevertheless, careful monitoring of short-term changes in eGFR and serum K+ levels remains essential during finerenone therapy.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1206-1213"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603910","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":"Compact green dialysis: circular economy approach to advancing sustainability in resource-limited health-care settings.","authors":"Eason Chang, Lim Jo Anne","doi":"10.1093/joneph/aajag050","DOIUrl":"10.1093/joneph/aajag050","url":null,"abstract":"<p><strong>Background: </strong>Hemodialysis is highly water-intensive, with conventional reverse osmosis systems discarding approximately 40%-70% of treated water as reject waste. Although high-recovery reverse osmosis upgrades can mitigate these losses, they are often associated with substantial capital investment. Existing green dialysis models also require considerable physical space and, when combined with additional labor costs, are frequently unsustainable, thereby limiting their feasibility across many dialysis units.</p><p><strong>Objective: </strong>To evaluate the design and performance of a compact aquaponic reuse system using existing legacy dialysis reverse osmosis reject water, and to compare it with a previous larger-scale model.</p><p><strong>Methods: </strong>A reuse system was implemented within a 39.6 m² corridor adjacent to a dialysis unit. Reject water from a reverse osmosis system was channeled to aquaculture tanks and subsequently to hydroponic columns. Performance indicators included fish survival, vegetable yield, labor demand, water-reuse efficiency, economic outcomes, and comparison with an earlier 310 m² system.</p><p><strong>Results: </strong>Fish survival was 90% with 180 kg/year yield, while hydroponics produced 90 kg/year. Compared with the earlier model, the compact system used a 7.8-fold smaller footprint yet achieved 2.5-fold higher water-reuse efficiency, 2.3-4.7-fold higher fish biomass, and 7.3-14.7-fold higher crop yield per square meter. Labor requirements were approximately 3-fold lower and operating costs 2.5-fold lower, while net annual surplus was 8.2-fold higher with a 2-fold faster payback period.</p><p><strong>Conclusions: </strong>This compact platform demonstrated that dialysis reverse osmosis reject water can be safely and productively reused within a confined footprint while delivering higher efficiency than a larger-scale model.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1144-1150"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497668","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":"Combination therapy with mineralocorticoid receptor antagonists and SGLT2 inhibitors in chronic kidney disease: an updated meta-analysis.","authors":"Hisashi Kamido, Masashi Hasebe, Chen-Yang Su, Naoki Sawa, Satoshi Yoshiji","doi":"10.1093/joneph/aajag136","DOIUrl":"10.1093/joneph/aajag136","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1299-1301"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794338","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":"Medical student reliance on artificial intelligence in nephrology education.","authors":"Amrit Kirpalani, Peter Zhan Tao Wang","doi":"10.1093/joneph/aajag033","DOIUrl":"10.1093/joneph/aajag033","url":null,"abstract":"<p><strong>Background: </strong>Large language models such as ChatGPT are increasingly used in medical education and may influence student learning and decision-making. Despite strong performance on factual recall, limitations in clinical reasoning raise concerns about how learners engage with artificial intelligence (AI)-generated recommendations, particularly in challenging domains such as renal physiology, where foundational understanding underpins clinical application.</p><p><strong>Methods: </strong>Fifty-seven first-year medical students completed 24 multiple-choice questions during a pediatric nephrology and urology case-based learning session. Each clinical question was paired with a corresponding foundational science question and presented in random order. Students answered individually, reviewed a ChatGPT-generated answer (deliberately correct or incorrect), and then re-answered the question. Change-to-match behavior was recorded. Response-level analyses used generalized estimating equation logistic regression to account for repeated measures within students, with sensitivity analyses adjusting for item difficulty.</p><p><strong>Results: </strong>A total of 1357 paired responses were analyzed. Students changed their answers to match ChatGPT in 22.3% of cases. Change-to-match behavior was more frequent for foundational than clinical questions (24.1% vs. 20.4%). After adjusting for clustering and item difficulty, foundational question type remained associated with greater likelihood of change-to-match behavior (odds ratio [OR] 1.57, 95% confidence interval [CI] 1.08-2.29). Incorrect-to-correct answer changes exceeded correct-to-incorrect changes, resulting in a modest net improvement in accuracy.</p><p><strong>Conclusions: </strong>Medical students selectively relied on AI-generated recommendations, particularly when uncertain and when engaging with foundational content. These findings suggest that reliance on AI is context-dependent and highlight the importance of domain-sensitive AI literacy in nephrology education.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1158-1164"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455450","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 autosomal road.","authors":"Tarek Zieneldien","doi":"10.1093/joneph/aajag178","DOIUrl":"10.1093/joneph/aajag178","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1330"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818670","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":"Longitudinal changes in cardiorenal risk scores after SGLT2 inhibitor initiation in patients with CKD with and without type 2 diabetes.","authors":"Irene Capelli, Daniele Vetrano, Danilo Ribichini, Michele Provenzano, Sasha Albertini, Sabrina Berti, Ilirjana Sanfilippo, Valentina Vicennati, Uberto Pagotto, Gaetano La Manna, Giuseppe Cianciolo","doi":"10.1093/joneph/aajag105","DOIUrl":"10.1093/joneph/aajag105","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have become the standard of care in managing chronic kidney disease (CKD) and heart failure (HF), both in patients with and without type 2 diabetes mellitus (T2DM). Nonetheless, identifying those at persistent high cardiovascular (CV) and renal risk remains critical.</p><p><strong>Methods: </strong>We conducted a retrospective, 1:1 propensity-matched cohort study involving 132 CKD patients (66 with T2D and 66 without). Participants were followed for 12 months after SGLT2i initiation. Cardiovascular and renal risk were assessed using three validated tools-PREVENT, SCORE2 with CKD Add-on (SCORE2-CKD), and Kidney Failure Risk Equation (KFRE)-calculated at baseline and at 12-month follow-up. Changes in risk scores were analyzed, and logistic regression was used to identify predictors of improvement.</p><p><strong>Results: </strong>After 12 months, PREVENT scores declined significantly in the diabetic subgroup (Δ -2.95, P = .001), whereas non-diabetic patients showed no significant change (Δ -0.80, P = .396). SCORE2-CKD also decreased in diabetics (Δ -3.85, 95% CI -4.35 to -3.35, P = .023) but unexpectedly increased in non-diabetic patients (Δ + 3.25, P = .044). Importantly, individuals at higher baseline risk exhibited the most pronounced declines in both PREVENT and SCORE2-CKD. KFRE-derived renal risk decreased significantly in both groups. Across the entire cohort, variation in estimated glomerular filtration rate (eGFR) and proteinuria were independent predictors of CV risk-score improvement.</p><p><strong>Conclusions: </strong>In this real-world CKD cohort, SGLT2 inhibitor initiation was associated with favorable changes in renal risk scores and with changes in cardiovascular risk estimates, particularly among patients with diabetes and at higher baseline risk. These findings should be interpreted as exploratory changes in predicted risk rather than as evidence of reduction in observed cardiovascular events.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1246-1256"},"PeriodicalIF":2.6,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722362","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}