Journal of Nephrology最新文献

{"title":"Proenkephalin (PENK): a functional biomarker in chronic kidney diseases - hope or just a new bystander?","authors":"Wiktoria Grycuk, Zuzanna Jakubowska, Jolanta Małyszko","doi":"10.1007/s40620-025-02268-8","DOIUrl":"10.1007/s40620-025-02268-8","url":null,"abstract":"<p><p>Proenkephalin has recently emerged as a promising biomarker of kidney function which improves the early detection of acute kidney injury (AKI) compared to creatinine-based methods. Plasma Proenkephalin concentrations have shown a correlation with glomerular filtration rate (GFR) as assessed by gold standard methods. Previous studies have demonstrated its association with adverse clinical outcomes in various settings, including sepsis, heart failure, kidney transplantation, and chronic kidney disease (CKD). Additionally, in healthy individuals, elevated Proenkephalin concentrations have been linked to a decline in GFR and an increased risk of developing CKD. While evidence suggests that Proenkephalin may be a more accurate tool for assessing glomerular filtration and detecting AKI, recent research has primarily focused on subjects with preserved kidney function, leaving its value in CKD patients less explored. Given the heterogeneity and high risk of rapid renal deterioration in patients with chronically impaired kidney function, a reliable biomarker should retain its ability to reflect kidney function in both CKD and AKI settings. This review summarizes the current evidence on Proenkephalin in patients with chronic kidney diseases.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1785-1795"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997507","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":"Metabolic dysregulation in regulatory T cells from patients with immune-mediated glomerular diseases.","authors":"Johan Noble, Zuzana Macek-Jilkova, Philippe Saas, Paolo Malvezzi, Miguel Fribourg, Leonardo V Riella, Mario Perez Arnedo, Joaquin Manrique, Paolo Cravedi","doi":"10.1007/s40620-025-02306-5","DOIUrl":"10.1007/s40620-025-02306-5","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"2009-2012"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in renal function testing in patients with dementia: a repeated cross-sectional analysis in Australian general practice.","authors":"Saad Alhumaid, Woldesellassie M Bezabhe, Mackenzie Williams, Gregory M Peterson","doi":"10.1007/s40620-025-02256-y","DOIUrl":"10.1007/s40620-025-02256-y","url":null,"abstract":"<p><strong>Background: </strong>There is little published evidence regarding the extent to which renal function testing is performed in older Australians, particularly those with dementia.</p><p><strong>Objectives: </strong>To examine the prevalence and temporal trends in renal function testing and the factors associated with renal function testing in patients with dementia using Australian general practice data.</p><p><strong>Methods: </strong>Ten consecutive cross-sectional analyses were performed to evaluate the proportion of patients aged ≥ 65 years with a recorded diagnosis of dementia, along with matched controls, who had renal function tests using estimated glomerular filtration rate (eGFR) within the twelve months of each year from 2011 to 2020.</p><p><strong>Results: </strong>Before matching, 24,701 patients (59.2% females) with, and 72,105 patients (59.2% females) without, a recorded diagnosis of dementia were included. Over the study period, renal function testing increased in both groups, although less for the patients with dementia; from 38.6% (95% CI 37.1-40.0%) in 2011 to 41.9% (95% CI 41-42.9%; p for trend < 0.001) in 2020 in the dementia group, and 49% (95% CI 47.6-50.5%) to 60.4% (95% CI 59.5-61.4%; p for trend < 0.001) in the matched controls. Younger patients with dementia (< 85 years of age), males, and those with more general practitioner visits in the preceding 12 months, hypertension, diabetes, chronic kidney disease, osteoporosis, or pain were most likely to have renal function testing.</p><p><strong>Conclusion: </strong>Rates of renal function testing in primary care patients with dementia in Australia were significantly lower than for matched controls, and improved only marginally between 2011 and 2020.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1855-1863"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The complexity of kidney disease secondary to collagen IV variants: insights into phenotypic variability from a large Sicilian pedigree.","authors":"Elisa Longhitano, Giulia Margherita Brach Del Prever, Claudia Spinella, Valeria Bracciamà, Vincenzo Calabrese, Antonio Amoroso, Giovanni Conti, Giuseppe Remuzzi, Thorsten Wiech, Marina Noris, Silvia Deaglio, Domenico Santoro","doi":"10.1007/s40620-025-02321-6","DOIUrl":"10.1007/s40620-025-02321-6","url":null,"abstract":"<p><strong>Background: </strong>Collagen type IV (COL IV) is a crucial component of basement membranes, including the glomerular basement membrane (GBM), essential for kidney function. COL4A3, COL4A4, and COL4A5 variants lead to a broad spectrum of kidney disorders. This paper investigates the clinical and genetic characteristics of a large Sicilian family with COL4A gene abnormalities.</p><p><strong>Methods: </strong>Starting from a male patient with digenic Alport Syndrome, we collected clinical data through genealogical research and performed genetic analyses on nineteen members of his family. Kidney biopsies were available for three of them.</p><p><strong>Results: </strong>We identified variants in COL4A5 and COL4A3 genes. Clinical and histological manifestations varied widely, even among individuals with the same variant, highlighting the remarkable phenotypic heterogeneity of collagen IV-related nephropathies.</p><p><strong>Conclusions: </strong>Our findings underscore the pivotal role of genetic testing in guiding clinical management and advancing the understanding of collagen IV-related kidney diseases. Moreover, this study emphasizes the need for further research to elucidate the intricate interplay between genetic variants and histological and clinical phenotypes, thereby paving the way for personalized therapeutic approaches in collagen IV-associated nephropathies.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1901-1908"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302264","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":"Simple: those who need help should be helped.","authors":"Giorgina B Piccoli","doi":"10.1007/s40620-025-02447-7","DOIUrl":"10.1007/s40620-025-02447-7","url":null,"abstract":"","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1759-1760"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124777","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":"Learning from the implementation phase of the new French capitation payment model for chronic kidney disease care: a qualitative study.","authors":"Maxime Raffray, Arnaud Campéon, Damien Bricard, Estelle Augé, Denis Raynaud, Cécile Couchoud, Luc Frimat, Sahar Bayat","doi":"10.1007/s40620-025-02284-8","DOIUrl":"10.1007/s40620-025-02284-8","url":null,"abstract":"<p><strong>Background: </strong>France introduced a new payment model for care providers of patients with Chronic Kidney Disease (CKD) Grades 4 and 5: the CKD-Capitation Payment model. The model aims to financially incentivise multidisciplinary care for patients. We performed a qualitative study among participating providers to identify obstacles and facilitators of the model implementation as well as the initial benefits and potential policy improvements.</p><p><strong>Methods: </strong>From March to July 2023, we collected data through semi-structured interviews with medical and managerial staff of facilities participating in the new model in France. We purposely selected a sample of facilities based on ownership status and CKD-Capitation Payment model activity data, including the number of patients reported. We performed a thematic analysis of the interview transcripts.</p><p><strong>Results: </strong>We interviewed 22 staff from 14 facilities. Interviews revealed that adapting the information systems to the model requirements was a major obstacle to implementation, undermining efficient medical time allocation and data quality. Securing facility management support and organising the care amid workforce shortages were additional obstacles. Despite these challenges, staff reported positively on the model, noting the increased time spent by nurses with patients and the assertion of dietitians' role. Interviewees reported the need for greater flexibility in visit requirements to better align with patient needs.</p><p><strong>Conclusions: </strong>This study demonstrates how the new capitation payment model introduced in France can enable multidisciplinary and coordinated care for patients with CKD. However, supporting facilities in adopting interoperable information systems and increasing the flexibility of the model appear essential for long-term adoption.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1877-1887"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018102","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":"Supporting people with chronic kidney disease to self-manage their condition: understanding the lived experiences, needs and requirements, and barriers and facilitators.","authors":"Courtney J Lightfoot, Thomas J Wilkinson, Matthew P M Graham-Brown, Alice C Smith","doi":"10.1007/s40620-025-02349-8","DOIUrl":"10.1007/s40620-025-02349-8","url":null,"abstract":"<p><strong>Background: </strong>Self-management has been identified as an essential component in the effective management of patients with chronic kidney disease (CKD). To effectively develop interventions that support patients with CKD to self-manage, it is crucial to understand their experiences and the factors that may influence their ability to self-manage. This study explored awareness, attitudes and participation with self-management in people living with non-dialysis CKD to understand factors influencing self-management behaviours.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 22 individuals living with non-dialysis CKD. Topics explored included perspectives and experiences of self-management, health and lifestyle behaviours, healthcare professional support, and self-management support, including future interventional approaches. Data were audio recorded and transcribed verbatim. Thematic analysis was used to analyse the data and to identify and report themes.</p><p><strong>Results: </strong>Six themes were identified encompassing perspectives, barriers and facilitators of self-management: \"perceptions and experiences of (self-)managing CKD\", \"perceived needs and requirements for self-management education and support\", \"knowledge and capability-related factors\", \"skills and opportunity-related factors\", \"confidence and motivational-related factors\" and \"social support\".</p><p><strong>Conclusion: </strong>Participants perceived that their CKD was not a significant problem, given the lack of concern from their doctor. Despite reporting a lack of awareness and understanding of CKD and its management, participants expressed interest in learning more and implementing appropriate self-management strategies. It was perceived that information and support were provided when it was almost too late, and not when it could potentially have the greatest impact. Perceived barriers and facilitators must be considered when developing interventions to support self-management for people with CKD.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1969-1984"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618637","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":"Long-term outcomes following acute kidney injury in individuals with pre-existing chronic kidney disease: a systematic review and meta-analysis.","authors":"Xingmu Wang, Jianling He, Yaoqin Wang","doi":"10.1007/s40620-025-02373-8","DOIUrl":"https://doi.org/10.1007/s40620-025-02373-8","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is linked to a heightened risk of progressing to chronic kidney disease (CKD) in individuals exhibiting normal baseline kidney function. However, the extent of such association in individuals with pre-existing CKD or renal impairment has been insufficiently investigated. Hence, we performed an extensive literature review and meta-analysis of the literature.</p><p><strong>Methods: </strong>Articles published on PubMed, Embase, and Cochrane (up to December 2, 2024) were searched for post-hoc analyses/sub-analysis of randomized controlled trials (RCTs) or observational studies that evaluated the association between AKI insult and long-term progression or overall death in individuals with pre-existing CKD or kidney dysfunction. All selected articles incorporated odds ratio (OR), hazard ratio (HR), or relative risk (RR) statistics along with data for assessing the association. Pooled RRs and 95% confidence intervals (CI) were derived utilizing random-effects models, notwithstanding the heterogeneity evaluated by I² statistic. The protocol was not registered at PROSPERO or SRDR.</p><p><strong>Results: </strong>Ultimately, 39 studies with an aggregate of 332,198 participants were determined to be eligible for inclusion. Of them, 28 studies were included in an analysis of CKD progression risk, and 27 studies were incorporated in the analysis of all-cause mortality. Individuals who have experienced AKI were at  elevated risk for progression of CKD (HR 2.36, 95% CI 1.96-2.85) and all-cause mortality (1.58, 1.38-1.81) with significant heterogeneity. Subgroup and sensitivity analyses supported the findings. For both outcomes, gradient of risk was observed as the AKI stage increased. For all-cause mortality, the risk magnitude was modified by the clinical environment.</p><p><strong>Conclusions: </strong>A history of AKI is correlated with heightened risks of CKD progression and overall death in patients with pre-existing CKD. Future research should be focused on the frequency of AKI episodes, the restoration of kidney function according to the different timeframe, and the impact of concomitant proteinuria on prognosis in these patients.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957876","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":"Cross-lagged analysis in nephrology.","authors":"Carmine Zoccali, Giovanni Tripepi, Graziella D'Arrigo","doi":"10.1007/s40620-025-02319-0","DOIUrl":"10.1007/s40620-025-02319-0","url":null,"abstract":"<p><p>Cross-lagged analysis is a statistical method employed to examine directional relationships between variables over time, making it especially valuable for addressing causality challenges in clinical research. This method is essential for comprehending complex bidirectional relationships, such as stress and immunity, dietary habits and metabolic conditions, or medication adherence and health outcomes. By analyzing longitudinal data, cross-lagged analysis establishes temporal precedence, tests reciprocal influences, and controls for confounding variables, thereby enhancing causal inferences. In nephrology, this approach can be beneficial for studying the interaction between acute kidney injury (AKI) and chronic kidney disease (CKD), clarifying whether AKI episodes accelerate CKD progression or if pre-existing CKD increases susceptibility to AKI. It also illuminates the relationship between CKD and cardiovascular diseases, investigating whether CKD exacerbates heart failure or vice versa while considering shared risk factors like hypertension and diabetes. Furthermore, cross-lagged analysis can elucidate the kidney-brain connection by examining whether CKD leads to cognitive decline through mechanisms such as uremic toxin accumulation or if neurological dysfunction worsens kidney outcomes through sympathetic overactivation. Cross-lagged analysis accommodates latent variables and measurement errors, allowing researchers to explore how variables interact over time. This method provides a strong framework for understanding dynamic relationships in nephrology, offering critical insights to guide interventions and advance knowledge of disease progression mechanisms.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1773-1783"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285026","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":"Hyperbilirubinemia-associated kidney injury: a retrospective analysis of clinical features, risk factors, and mortality.","authors":"Nabil Abu-Amer, Margarita Kunin, Orit Erman, Olga Kukuy, Sharon Mini, Abhijat Kitchlu, Pazit Beckerman","doi":"10.1007/s40620-025-02328-z","DOIUrl":"10.1007/s40620-025-02328-z","url":null,"abstract":"<p><strong>Background: </strong>Hyperbilirubinemia-associated acute kidney injury (AKI) is characterized by kidney dysfunction in the context of severe hyperbilirubinemia. The proposed pathogenesis involves direct bile acid toxicity and obstructive tubular cast formation. Even though there are typical morphological findings at the kidney biopsy, the risk factors and clinical features of hyperbilirubinemia-associated AKI remain poorly understood.</p><p><strong>Methods: </strong>This is a retrospective cohort study that included 1183 patients admitted with total bilirubin levels above 10 mg/dl. We assessed the clinical characteristics and risk factors of hyperbilirubinemia-associated AKI after excluding patients with AKI due to other medical conditions. Risk factors for hyperbilirubinemia-associated AKI were assessed using logistic regression analysis. Survival among patients with hyperbilirubinemia-associated AKI and other groups was compared using the Kaplan-Meier method.</p><p><strong>Results: </strong>Eighty-eight patients (7.4%) developed hyperbilirubinemia-associated AKI, while 255 (21.5%) developed non-hyperbilirubinemia associated AKI. Patients with hyperbilirubinemia-associated AKI had a lower baseline estimated glomerular filtration rate (P < 0.001). Chronic kidney disease, congestive heart failure, serum bilirubin > 20 mg/dL, male sex, and older age were associated with a higher risk of developing hyperbilirubinemia-associated AKI. Renal recovery occurred at a median of 4.1 days following a decrease in serum bilirubin to a median nadir of 4.19 mg/dL (IQR 1.4-6.8). The survival of patients with hyperbilirubinemia-associated AKI was significantly lower than that of patients with AKI due to other causes (P < 0.001).</p><p><strong>Conclusion: </strong>The diagnosis of hyperbilirubinemia-associated AKI should be considered in all patients with hyperbilirubinemia and AKI. Lowering bilirubin levels may result in AKI resolution even when no definitive treatment for hyperbilirubinemia is available.</p>","PeriodicalId":16542,"journal":{"name":"Journal of Nephrology","volume":" ","pages":"1927-1935"},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784483","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}