Journal of Nephrology最新文献

{"title":"Beyond the gift: exploring mental health and quality of life after kidney donation in a resource limited country.","authors":"Muhammad Junaid Tahir, Zoha Aftab, Zahid Nabi","doi":"10.1007/s40620-025-02217-5","DOIUrl":"10.1007/s40620-025-02217-5","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplant is a life changing treatment. It improves the quality of life and ideally restores the kidney function of recipients. However, it also poses challenges, especially for the donors. Pakistan is a resource-limited country and donors have to face some specific social and cultural challenges. Knowledge about the donor's mental health and quality of life after donation is limited. This study aims to explore the mental health and quality of life after kidney donation.</p><p><strong>Methods: </strong>The study was retrospective and cross-sectional, carried out between August and December 2023. One hundred donors from a single center were selected through convenience sampling. Two questionnaires, namely the Beck Depression Inventory and Satisfaction with life scale were employed during an interview with donors. Data were analyzed using SPSS- 27.</p><p><strong>Results: </strong>Overall, 70 females and 30 males participated. Only 9 donors (9%), reported significant disturbance in their mental health, amongst which 2 were males and 7 were females. Of note, two recipients of their donation passed away, while another experienced graft failure. Insomnia and tiredness were significant contributors to the donors' inability to work, with a reported percentage of 25%. In addition, dissatisfaction with life was reported by 8 donors only. There was no significant association between depression and satisfaction with life and age, marital and education status and time since transplant. Only status of the graft in the recipient was associated with an impact on the donor's mental health. Thirteen donors exhibited depression post-nephrectomy, with 4% experiencing mild disturbance and 9% showing major mood disturbances including borderline clinical depression and moderate depression. Notably, none of the donors had test scores indicating extreme depression.</p><p><strong>Conclusion: </strong>Kidney donation has no severe impact in terms of mental health and quality of life in donors. Apart from the status of the graft, none of the demographic characteristics had a significant impact on the mental health of donors.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1209-1217"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029464","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":"Simultaneous or sequential kidney-liver transplantation in primary hyperoxaluria.","authors":"Maria Arena, Raffaella Labbadia, Andrea Cappoli, Gionata Spagnoletti, Francesca Diomedi Camassei, Francesco Emma, Marco Spada, Isabella Guzzo","doi":"10.1007/s40620-024-02109-0","DOIUrl":"10.1007/s40620-024-02109-0","url":null,"abstract":"<p><strong>Background: </strong>Primary hyperoxaluria type 1 is responsible for pediatric kidney failure in 1 to 2% of cases. Novel therapies based on RNA interference are changing the natural history of the disease. However, for those who do progress to kidney failure, and for patients living in countries that cannot afford these expensive therapies, liver-kidney transplantation may remain the only efficient therapy.</p><p><strong>Methods: </strong>The aim of the study was to evaluate the outcome of patients with primary hyperoxaluria type 1 who received simultaneous or sequential liver-kidney transplantation. We retrospectively evaluated 10 patients, five of whom received a simultaneous transplantation, and five underwent sequential transplantation, with a median postponement of the kidney transplantation of 8 months (range 4-20). Among the patients, 5 were from medium-low income countries.</p><p><strong>Results: </strong>Median follow up was 3.2 years (range 1.6-11). Median estimated glomerular filtration rate at 6 and 12 months was 81.2 (range: 45.7-108.8) and 79.3 ml/min/1.73m² (range 54.7-112.1) in patients who underwent simultaneous transplantation, and 45.7 (range 34.5-86.7) and 38.3 ml/min/1.73m² (range 29.9-77.5) in those with sequential transplantation (p:NS). Biopsies performed at 6 and 12 months showed precipitation of calcium oxalate crystals in 7 patients, demonstrating the recurrence of deposition despite the delay between liver and kidney transplantation. No differences in kidney function or in post-transplant renal oxalate precipitation were observed between patients that underwent bilateral nephrectomy and those who did not. As of their most recent follow up, none of the patients has lost their kidney graft.</p><p><strong>Conclusions: </strong>Our study shows that by adapting the transplant strategy to individual cases, patients with primary hyperoxaluria type 1 can be successfully treated.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1191-1199"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391154","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":"Leukopenia early after kidney transplantation: a switch from mycophenolate to mTOR inhibitor appears safe and feasible and improves viral control in a high-risk population.","authors":"Elena Rho, Pascal Bohraus, Britta George, Seraina von Moos, Thomas Schachtner","doi":"10.1007/s40620-024-02111-6","DOIUrl":"10.1007/s40620-024-02111-6","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1253-1255"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467971","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":"Lupus-like manifestations after allogenic hematopoietic stem cell transplantation: a rare case of chronic graft-versus-host disease.","authors":"Jing Yang, Liyin Zhang, Wengang Sha, Shaojun Liu, Lei Shen","doi":"10.1007/s40620-024-01988-7","DOIUrl":"10.1007/s40620-024-01988-7","url":null,"abstract":"<p><p>Chronic graft-versus-host disease (GvHD) is the leading cause of late death in allogenic hematopoietic stem cell transplantation recipients, of which the kidney is a potential target. In this article, we report an extremely rare case of chronic GvHD, characterized by immune complex-mediated diffuse proliferative glomerulonephritis and various autoantibodies detected in the serum; it is the first case of lupus-like chronic GvHD reported to date. The patient responded well to intensive immunosuppressive therapy and reached complete remission. Mycophenolate mofetil was more effective than tacrolimus in this case, suggesting that treatment of kidney diseases associated with chronic GvHD should be based on pathogenesis and pathological patterns.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1239-1244"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889500","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 prognostic reasoning system for chronic kidney disease progression (PROGRES-CKD) may help improve waiting list management for outpatient nephrology services in a second-level public hospital in Italy.","authors":"Paolo Fabbrini, Federico Pieruzzi, Francesco Bellocchio, Raul Casana Eslava, Jordi Silvestre Llopis, Kevin Morillo Navarro, Paola Ferraresi, Len Usvyat, John Larkin, Jaroslav Rosemberg, Stefano Stuard, Luca Neri","doi":"10.1007/s40620-025-02222-8","DOIUrl":"10.1007/s40620-025-02222-8","url":null,"abstract":"<p><strong>Background: </strong>The management of patients with non-dialysis dependent chronic kidney disease (NDD-CKD) is challenging due to coexisting diseases, competing risks and uncertainties around optimal transition planning. Such clinical challenges are further exacerbated by physician shortage, coupled with rising service demands, which may hinder timely medical access due to long waiting times. Accurate progression risk assessment may help optimize resource allocation and adapting care based on individual patients' needs. This study validated the Prognostic Reasoning System for Chronic Kidney Disease Progression (PROGRES-CKD) in an Italian public hospital and compared its potential impact on waiting list optimization against physician-based protocols.</p><p><strong>Methods: </strong>First we first validated PROGRES-CKD by assessing its accuracy in predicting kidney replacement therapy (KRT) initiation within 6 months and 24 months in a historical cohort of patients treated at the San Gerardo Hospital (Italy) between 01-01-2015 and 31-12-2019. In a second study we compared PROGRES-CKD to attending nephrologists' prognostic ratings and simulated their potential impact on a waiting list management protocol.</p><p><strong>Results: </strong>We included 2005 patients who underwent 11,757 outpatient nephrology visits in 4 years. Most visits occurred for NDD-CKD stage 4 patients; the incidence of KRT onset was 10.8 and 9.32/100 patient-years at the 6 and 24-month prediction horizon cohorts, respectively. PROGRES-CKD demonstrated high accuracy in predicting KRT initiation at 6 and 24 months (AUROC = 0.88 and AUROC = 0.85, respectively). Nephrologists' prognostic performance was highly operator-dependent, albeit always significantly lower than PROGRES-CKD. In the simulation exercise, allocation based on PROGRES-CKD resulted in more follow-up visits for patients progressing to end-stage kidney disease (ESKD) and fewer visits for non-progressing patients, compared to allocation determined by nephrologists' prognosis.</p><p><strong>Conclusions: </strong>PROGRES-CKD showed high accuracy in a real-world application. Waiting list simulation suggests that PROGRES-CKD may enable more efficient allocation of resources.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1219-1227"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The hidden emotional costs of giving life: preserving donors' mental health and quality of life after living kidney donation.","authors":"Xavier Torres, David Paredes-Zapata, Ignacio Revuelta","doi":"10.1007/s40620-025-02291-9","DOIUrl":"10.1007/s40620-025-02291-9","url":null,"abstract":"<p><p>Kidney living donation remains the best treatment available for kidney failure. Most living donors report positive personal outcomes, such as enhanced life satisfaction and personal growth. However, mental health challenges have also been documented. The study by Tahir, Aftab and Nabi (J Nephrol https://doi.org/10.1007/s40620-025-02217-5 , 2025) call the attention to a small subset of living donors who may experience significant depression symptoms and occasionally suicidal ideation after donation, particularly when the recipient dies or suffers severe graft failure with a return to dialysis. As observed in the previous studies, only donors whose recipients experienced negative outcomes reported mood alterations or life dissatisfaction (Menjivar et al., Transpl Int 31(12):1332-1344, 2018). These rare post-donation risk scenarios justify a careful mental evaluation to identify psychological vulnerabilities or a history of difficulties in managing and coping with stressful situations. These adverse outcomes appear more likely in donors with pre-donation physical and/or psychological vulnerabilities, in those with a complicated surgical recovery after donation, and in cases where recipients experience poor physical or psychological outcomes. Moreover, cases of graft failure or recipient death might significantly increase donor's likelihood of depression and anxiety, Despite the generally low incidence of psychosocial problems after donation, there have been calls for a more structured and routine follow-up assessment to further mitigate risks and ensure equitable mental health safety for all kidney donors.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1139-1141"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Galileo-an Artificial Intelligence tool for evaluating pre-implantation kidney biopsies.","authors":"Albino Eccher, Vincenzo L'Imperio, Liron Pantanowitz, Giorgio Cazzaniga, Fabio Del Carro, Stefano Marletta, Giovanni Gambaro, Antonella Barreca, Jan Ulrich Becker, Stefano Gobbo, Vincenzo Della Mea, Federico Alberici, Fabio Pagni, Angelo Paolo Dei Tos","doi":"10.1007/s40620-024-02094-4","DOIUrl":"10.1007/s40620-024-02094-4","url":null,"abstract":"<p><strong>Background: </strong>Pre-transplant procurement biopsy interpretation is challenging, also because of the low number of renal pathology experts. Artificial intelligence (AI) can assist by aiding pathologists with kidney donor biopsy assessment. Herein we present the \"Galileo\" AI tool, designed specifically to assist the on-call pathologist with interpreting pre-implantation kidney biopsies.</p><p><strong>Methods: </strong>A multicenter cohort of whole slide images acquired from core-needle and wedge biopsies of the kidney was collected. A deep learning algorithm was trained to detect the main findings evaluated in the pre-implantation setting (normal glomeruli, globally sclerosed glomeruli, ischemic glomeruli, arterioles and arteries). The model obtained on the Aiforia Create platform was validated on an external dataset by three independent pathologists to evaluate the performance of the algorithm.</p><p><strong>Results: </strong>Galileo demonstrated a precision, sensitivity, F1 score and total area error of 81.96%, 94.39%, 87.74%, 2.81% and 74.05%, 71.03%, 72.5%, 2% in the training and validation sets, respectively. Galileo was significantly faster than pathologists, requiring 2 min overall in the validation phase (vs 25, 22 and 31 min by 3 separate human readers, p < 0.001). Galileo-assisted detection of renal structures and quantitative information was directly integrated in the final report.</p><p><strong>Conclusions: </strong>The Galileo AI-assisted tool shows promise in speeding up pre-implantation kidney biopsy interpretation, as well as in reducing inter-observer variability. This tool may represent a starting point for further improvements based on hard endpoints such as graft survival.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1163-1169"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report with literature review: long-term follow-up of kidney autotransplantation in fibromuscular dysplasia.","authors":"Bulent Demirelli, Dilek Barutcu Atas, Ayhan Dinckan, Feyyaz Baltacıoglu, Mehmet Koc","doi":"10.1007/s40620-024-02105-4","DOIUrl":"10.1007/s40620-024-02105-4","url":null,"abstract":"<p><p>Fibromuscular dysplasia is a rare, idiopathic, systemic, non-inflammatory, and non-atherosclerotic vascular disease that primarily affects young women. It often presents as renal artery stenosis. Fibromuscular dysplasia can induce tissue damage in the post-stenotic kidney. Treatment options include antihypertensive therapy, surgical revascularization, and transluminal angioplasty with stent implantation. However, kidney autotransplantation is an alternative when these treatments are not feasible. This study presents a case report of a 22-year-old woman with fibromuscular dysplasia, highlighting the long-term success of kidney autotransplantation and reviewing the related literature. A multidisciplinary approach was employed in the treatment of this patient presenting with intermittent headaches, hypertension, and acute kidney disease, and who was diagnosed with fibromuscular dysplasia. She underwent left aorta-renal bypass and right autotransplantation. Following the procedure, her serum creatinine level decreased from 2.74 to 1.1 mg/dL, with an eight-year follow-up confirming the favorable outcome. Renal artery stenosis is a significant contributor to secondary hypertension, with fibromuscular dysplasia being a rare cause. While medical and interventional treatments are usually effective, complex cases may necessitate alternative approaches. Kidney autotransplantation, albeit uncommon, is an effective option for patients who are unresponsive to conventional therapies. This case demonstrates the successful management of fibromuscular dysplasia-associated renovascular hypertension via kidney autotransplantation, resulting in controlled blood pressure and preserved kidney function. In conclusion, kidney autotransplantation represents a valuable therapeutic option for severe renal artery stenosis caused by fibromuscular dysplasia, particularly when percutaneous procedures are impractical.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1245-1251"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467966","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":"Clinical characteristics and outcomes of kidney transplantation in autosomal dominant polycystic kidney disease patients.","authors":"Jin Hyeog Lee, Jiyeon Myung, Sujin Gang, Hyun Jin Ryu, Nam Joon Yi, Jaeseok Yang","doi":"10.1007/s40620-024-02101-8","DOIUrl":"10.1007/s40620-024-02101-8","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation (KT) is the best kidney replacement treatment for autosomal dominant polycystic kidney disease (ADPKD). We aimed to investigate the clinical characteristics and outcomes of KT in ADPKD patients compared to those in non-ADPKD patients.</p><p><strong>Methods: </strong>We retrospectively analyzed KT recipients in two Korean transplantation centers from 2005 to 2020. Propensity score-matching and Cox regression analysis were used to assess the clinical outcomes of ADPKD compared to non-ADPKD and identify prognostic factors influencing outcomes in ADPKD.</p><p><strong>Results: </strong>Among a total of 4452 KT patients, 189 (4.2%) were ADPKD patients. Median age at transplantation was 53.0 and 47.0 in ADPKD and non-ADPKD patients, respectively. In both groups, living-donor KT was more common than deceased-donor KT. The ADPKD group had a 4.09-fold higher risk of post-transplant diabetes mellitus and a 1.65-fold higher risk of post-transplant infection compared to the non-ADPKD group; however, subjects with ADPKD had similar risk of rejection, graft failure, and mortality. In the ADPKD group, kidney volume decreased after KT, irrespective of kidney volume status (Mayo classification), while the size of hepatic cysts increased. Neither kidney volume nor nephrectomy of native kidneys were associated with risk of infection, graft failure, or mortality in the ADPKD group.</p><p><strong>Conclusions: </strong>ADPKD patients have a higher risk of post-transplant diabetes mellitus and infection than non-ADPKD patients, with no significant impact of kidney volume or nephrectomy on post-transplant outcomes.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1171-1181"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567320","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":"Post-transplant IgA nephropathy: a rapidly evolving field of kidney transplant medicine.","authors":"Mehmet Kanbay, Lasin Ozbek, Mustafa Guldan, Sidar Copur, Jonathan Barratt","doi":"10.1007/s40620-024-02149-6","DOIUrl":"10.1007/s40620-024-02149-6","url":null,"abstract":"<p><p>IgA nephropathy is the commonest pattern of primary glomerular disease in the world, with high rates of progression to kidney failure. As IgA nephropathy commonly causes kidney failure at a young age, kidney transplantation is commonly used to treat kidney failure. However, high rates of recurrent disease in the allograft remain a common management challenge. The prevalence of post-transplant recurrence approaches 15% at ten years post-transplant and is associated with poor allograft function and high rates of allograft loss. Post-transplant IgA nephropathy has also been described de novo in some case series. Treatment of recurrent IgA nephropathy has been challenging but with the rapid growth of new treatments for IgA nephropathy it is likely that many of these treatments will, over time, transition to the treatment of recurrent disease. In this narrative review, our aim is to evaluate post-transplant IgA nephropathy in terms of epidemiology, risk factors, underlying pathophysiology, diagnosis and management strategies.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1143-1152"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142676039","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}