Kidney Research and Clinical Practice最新文献

{"title":"Erythropoiesis-stimulating agent responsiveness and hemoglobin variability is associated with fat tissue index in hemodialysis patients with darbepoetin-alfa treatment: a prospective observational cohort study.","authors":"Hyokyeong Yu, Dong-Jin Oh, Do Hyoung Kim","doi":"10.23876/j.krcp.24.070","DOIUrl":"https://doi.org/10.23876/j.krcp.24.070","url":null,"abstract":"<p><strong>Background: </strong>Although the introduction of erythropoietin-stimulating agents (ESAs) has led to better clinical outcomes in patients undergoing hemodialysis (HD), fluctuations in hemoglobin (Hb) levels, known as Hb variability, are frequently observed. However, only a few studies have evaluated the association between Hb variability and nutritional status in patients undergoing HD.</p><p><strong>Methods: </strong>In this prospective study conducted between March 1, 2020, and June 1, 2022, we included 109 patients aged over 20 years undergoing HD and receiving darbepoetin. We checked the average NESP (darbepoetin-alfa; Kyowa Kirin Korea Co., Ltd.) dose weekly and nutritional parameters such as body mass index (BMI), fat tissue index (FTI), and lean tissue index obtained by body composition monitoring. Additionally, the ESA resistance index (ERI) and the coefficient of variation of Hb (Hb-CV) were evaluated.</p><p><strong>Results: </strong>In this study, the mean age of the patients was 64.0 ± 11.9 years, and 55.0% were male. Mean Hb was 10.7 ± 1.3 g/dL. Patients were categorized into three groups according to the ERI or Hb-CV tertiles. The highest ERI tertile was associated with lower Hb levels, BMI, and FTI. The highest Hb-CV tertile was associated with lower BMI and FTI. In multiple linear regression analysis, FTI was negatively associated with ERI (β = -0.218, p = 0.01) and Hb-CV (β = -0.181, p = 0.04).</p><p><strong>Conclusion: </strong>These findings suggest that FTI is negatively associated with ERI and Hb-CV, and that ESAs responsiveness and Hb variability are associated with FTI in patients undergoing HD with darbepoetin treatment.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of extracellular vesicles in kidney disease progression.","authors":"Ran Kim, Tae Min Kim","doi":"10.23876/j.krcp.24.201","DOIUrl":"https://doi.org/10.23876/j.krcp.24.201","url":null,"abstract":"<p><p>Extracellular vesicles (EVs) are nanosized membranous particles released by nearly all cell types, playing a crucial role in mediating cell-to-cell communication. The molecular profile of EVs often reflects that of their originating cells, rendering them valuable for therapeutic and diagnostic purposes. The kidney comprises various cell types, and urinary EVs are predominantly produced from tubular, glomerular, and urinary bladder cells. Within the nephron, EVs produced from the upper segments, such as glomerular tufts and proximal tubules, can be taken up by their downstream counterparts, thereby altering the physiology of recipient cells. Recent studies have demonstrated that this proximal-distal intra-nephron crosstalk via EVs is crucial for normal kidney physiology. Additionally, EVs from interstitial cells (e.g., fibroblasts and macrophages) have been demonstrated to mediate the exacerbation of kidney damage. This review provides up-to-date findings on the function of renal EVs during the progression of renal diseases. Furthermore, we discussed future directions to use the clinical potential of renal EVs as an early biomarker for renal disorders.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between obstructive sleep apnea and albuminuria in Korean adults: a nationwide populationbased study.","authors":"Yeojin Yu, Kyungdo Han, Kyu-Na Lee, Jung Hun Koh, Young Sun Shin, Jeong Min Cho, Minsang Kim, Min Woo Kang, Seong Geun Kim, Sehyun Jung, Semin Cho, Hyuk Huh, Eunjeong Kang, Sehoon Park, Yaerim Kim, Kwon Wook Joo, Dong Ki Kim, Soojin Lee","doi":"10.23876/j.krcp.24.159","DOIUrl":"https://doi.org/10.23876/j.krcp.24.159","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) is a sleep disorder associated with an increased risk of cardiovascular and metabolic complications. Albuminuria, an early marker of kidney damage, is a proposed risk factor for OSA and its adverse outcomes. The study explored the association between OSA and albuminuria in Korean adults.</p><p><strong>Methods: </strong>We screened participants from the cross-sectional Korean National Health and Nutrition Examination Survey (2019- 2021). The study included participants aged 40 years and older who completed the STOP-BANG questionnaire, a tool used to assess the OSA risk. Albuminuria was defined as a urine albumin-to-creatinine ratio ≥30 mg/g Cr. The participants were categorized based on albuminuria presence and severity. A multivariate logistic regression analysis examined the association between albuminuria and OSA.</p><p><strong>Results: </strong>This study included 10,923 participants. Participants with albuminuria had significantly higher STOP-BANG scores than those without. Moreover, albuminuria remained strongly associated with an increased risk of OSA (odds ratio, 2.01; 95% confidence interval, 1.66-2.43), after multivariate adjustment. This association was more pronounced as albuminuria severity increased. Participants with high STOP-BANG scores were more likely to have albuminuria (odds ratio, 2.51; 95% confidence interval, 1.89-3.31), highlighting the bidirectional relationship between albuminuria and OSA.</p><p><strong>Conclusion: </strong>The present study demonstrated a significant association between albuminuria and an elevated risk of OSA. These findings underscore the importance of early screening for OSA in patients with albuminuria, particularly in those with additional metabolic risk factors, to improve their long-term outcomes.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interobserver agreement analysis among renal pathologists in classification of lupus nephritis using a digital pathology image dataset: after a third evaluation.","authors":"Ju Yeon Pyo, Nara Jeon, Su-Jin Shin, Minsun Jung, Beom Jin Lim, Minseob Eom, Sung-Eun Choi","doi":"10.23876/j.krcp.24.185","DOIUrl":"https://doi.org/10.23876/j.krcp.24.185","url":null,"abstract":"<p><strong>Background: </strong>Lupus nephritis is well-known for low concordance in classification. Furthermore, there has been no agreement analysis among Korean renal pathologists regarding lupus nephritis. Inconsistent diagnosis leads to confusion and increases medical costs, as well as failure of appropriate therapeutic interventions. This study aimed to assess the level of agreement among Korean renal pathologists regarding classification.</p><p><strong>Methods: </strong>Representative glomerular images from patients diagnosed with lupus nephritis were obtained from five hospitals. Twenty-five questions were formulated, and multiple-choice questions with 14 options, consisting of characteristic histopathological findings of lupus nephritis were provided. Three rounds of surveys were conducted and educational sessions were conducted before the second and third surveys.</p><p><strong>Results: </strong>The agreement was calculated using Fleiss' κ and the means for each round of questions were as follows: Survey 1, 0.42 (range, 0.18-0.61), Survey 2, 0.42 (range, 0.19-0.64), and Survey 3, 0.47 (range, 0.23-0.65). Although κ after the first education session showed no significant difference compared to the initial κ (p = 0.95), after the second education session, κ increased significantly compared to the initial κ (p < 0.001). The κ for each item generally increased with each education session, but they were not statistically significant (p = 0.46, p = 0.17). Additionally, the rankings of agreement, for each item, were relatively consistent.</p><p><strong>Conclusion: </strong>This study conducted an interobserver agreement analysis of Korean pathologists for lupus nephritis, with the goal of increasing agreement through education. Although the education increased overall agreement, items like \"mesangial hypercellularity,\" \"endocapillary hypercellularity,\" and \"neutrophils and/or karyorrhexis\" remained inconsistent attributable to innate subjectivity and ineffective education.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The overlooked tool: Kidney biopsy in progressive renal decline of type 2 diabetes patients","authors":"Sang Youb Han","doi":"10.23876/j.krcp.24.999","DOIUrl":"10.23876/j.krcp.24.999","url":null,"abstract":"","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of kidney response over hematologic response in predicting kidney outcome in amyloid light-chain amyloidosis.","authors":"Sungmi Kim, Jinyoung Yang, Kyungho Lee, Junseok Jeon, Sang Eun Yoon, Darae Kim, Jin-Oh Choi, Seok Jin Kim, Kihyun Kim, Jung Eun Lee","doi":"10.23876/j.krcp.24.111","DOIUrl":"https://doi.org/10.23876/j.krcp.24.111","url":null,"abstract":"<p><strong>Background: </strong>Light chain amyloidosis, characterized by amyloid fibril deposition in multiple organs, often leads to progression to endstage kidney disease. This study aimed to identify predictors of kidney survival in patients with kidney amyloidosis, focusing on hematologic and kidney response.</p><p><strong>Methods: </strong>This retrospective study included 138 patients diagnosed with kidney amyloidosis between 2011 and 2019. Palladini criteria were applied to categorize kidney stage and kidney response based on initial glomerular filtration rate and proteinuria, and their changes after treatment. Hematologic response was assessed based on the 2012 International Society of Amyloidosis criteria. Deep hematologic response was defined as the achievement of at least a very good partial response.</p><p><strong>Results: </strong>Overall, 17 (12.3%) progressed to end-stage kidney disease. Multivariable analysis, considering baseline characteristics, revealed that stage II had an increased risk of end-stage kidney disease compared to stage I (hazard ratio, 3.75; 95% confidence interval [CI], 1.38-10.15; p = 0.01). Compared to kidney response, the risk of end-stage kidney disease increased by 8.42 (95% CI, 1.72-41.35; p = 0.01) and 7.36 (95% CI, 1.25-43.33; p = 0.03) times in stable disease and kidney progression at 6 months, respectively, whereas deep hematologic response showed no association with kidney outcome. Kidney survival was longer in patients with deep hematologic response and kidney response than in those with only hematologic response (p = 0.004).</p><p><strong>Conclusion: </strong>The study underscores the importance of kidney response over hematologic response in predicting end-stage kidney disease and emphasizes the need to assess treatment endpoints, considering organ response alongside hematologic response.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the podocyte-protective effect of sodium-glucose cotransporter-2 inhibitors.","authors":"Buchun Jiang, Zhiwen Cheng, Dongjie Wang, Fei Liu, Jingjing Wang, Haidong Fu, Jianhua Mao","doi":"10.23876/j.krcp.24.144","DOIUrl":"https://doi.org/10.23876/j.krcp.24.144","url":null,"abstract":"<p><p>The renoprotective effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors in both diabetic and nondiabetic nephropathy are widely recognized due to results from randomized controlled trials notably the DAPA-CKD and EMPA-KIDNEY trials. Research exploring the mechanisms of renoprotection indicates that SGLT2 inhibitors exert protective effects on podocytes by enhancing autophagy and stabilizing the structure of podocytes and basement membranes. Furthermore, reductions in lipotoxicity, oxidative stress, and inflammation have been confirmed with SGLT2 inhibitor treatment. Recent clinical studies have also begun to explore the effects of SGLT2 inhibitors on nondiabetic podocytopathies, such as focal segmental glomerulosclerosis. In this review, we summarize clinical and laboratory studies that focus on the podocyte-protective effects of SGLT2 inhibitors, exploring the potential for broader applications of this novel therapeutic agent in kidney disease.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined nutcracker syndrome and glomerulonephritis in pediatric patients: a single-center retrospective case series.","authors":"So Hyun Ki, Min Hwa Son, Hyung Eun Yim","doi":"10.23876/j.krcp.24.178","DOIUrl":"https://doi.org/10.23876/j.krcp.24.178","url":null,"abstract":"<p><strong>Background: </strong>Nutcracker syndrome (NCS) has been reported to coexist with various glomerulonephritis (GN). This study investigated clinical features of NCS combined with GN in a pediatric case series and the possible relationship between these two conditions.</p><p><strong>Methods: </strong>Clinical and pathologic findings of 15 children with NCS and biopsy-proven GN were analyzed. NCS was diagnosed with renal Doppler ultrasonography, abdominal computed tomography, and/or magnetic resonance imaging. Glomerular lesions were divided into two pathological categories: minor glomerular abnormalities (MGAs) and definite GN.</p><p><strong>Results: </strong>Mean age of all patients was 11 ± 3.36 years and mean follow-up duration was 53.8 ± 29.3 months. Chief complaint was proteinuria with or without hematuria. During follow-up, five patients developed left kidney enlargement. Abnormal levels in immunological tests were revealed in 10 patients. Extrarenal symptoms including gonadal varicocele, splenic cyst, syncope, and anemia were found in seven patients. On kidney biopsy, seven patients had MGAs and eight children showed definite GN (one case of focal GN, one case of mesangial proliferative GN, one case of focal segmental glomerulosclerosis, two cases of immunoglobulin A [IgA] vasculitis nephritis, and three cases of IgA nephropathy). While the MGA group showed a higher proportion of isolated proteinuria and a lower estimated glomerular filtration rate (eGFR) at the last visit, there were no differences in age, clinical features of NCS, extrarenal symptoms, immunological tests, and eGFR decline rate between the two groups.</p><p><strong>Conclusion: </strong>NCS may be associated with the presence of various GN. The causal relationship between NCS and GN should be further investigated.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of glomerulonephritis with dominant C1q precipitation compared to corresponding glomerulonephritis without C1q staining on immunofluorescent examination.","authors":"Ji Young Ryu, Giae Yun, Eun-Jeong Kwon, Hyung Eun Son, Kipyo Kim, Sang-Ho Lee, Kyung Pyo Kang, Young-Joo Kwon, Ho Jun Chin","doi":"10.23876/j.krcp.23.238","DOIUrl":"https://doi.org/10.23876/j.krcp.23.238","url":null,"abstract":"<p><strong>Background: </strong>The clinical significance and renal outcomes of C1q nephropathy (C1qN) are unclear; therefore, the implications of C1qN as a new pathological entity are uncertain. We compared the clinical characteristics of glomerulonephritis reclassified into cases that meet the definition of C1qN and glomerulonephritis not included in the definition of C1qN.</p><p><strong>Methods: </strong>In total, 21,697 patients who underwent native kidney biopsy at 18 hospitals throughout Korea between 1979 and 2018 were retrospectively enrolled. A total of 77 patients were selected from the group that met the definition of C1qN after reclassification; however, six patients were excluded because of secondary systemic disease. Data on outcomes, incidences of end-stage renal disease (ESRD), and mortality were collected from the hospital records, the Korean Society of Nephrology's ESRD registry, and Statistics of Korea and were then unified based on Korean ethnicity. Characteristics of pathological findings classified into C1qN, without C1q stain, and with nondominant C1q stain that did not fulfill the criteria for C1qN were compared.</p><p><strong>Results: </strong>No differences in clinicopathological findings and incidence of ESRD were evident (matched by age and sex) between glomerulonephritis cases reclassified into the group that met the definition of C1qN and those without C1q staining. Decreased proteinuria in patients with membranous nephropathies reclassified into the group that met the definition of C1qN was the only significant finding. Immunoglobulins showed higher intensity on immunofluorescence staining of the group that met the definition of C1qN. Additionally, C3 intensity was higher in reclassified immunoglobulin A nephropathy and membranous nephropathies.</p><p><strong>Conclusion: </strong>Overall, reclassification into the group that met the definition of C1qN did not indicate a different clinicopathological identity. C1q activation and presumed classical complement pathway activation in kidney tissues in C1qN could not be confirmed. Hence, further studies are needed.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating osteoprotegerin and progression of coronary artery calcification in patients with chronic kidney disease: the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD).","authors":"Sang Heon Suh, Tae Ryom Oh, Hong Sang Choi, Chang Seong Kim, Eun Hui Bae, Seong Kwon Ma, Kook-Hwan Oh, Tae-Hyun Yoo, Soo Wan Kim","doi":"10.23876/j.krcp.24.039","DOIUrl":"10.23876/j.krcp.24.039","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery calcification (CAC) is a surrogate of cardiovascular events in patients with chronic kidney disease (CKD). To establish the role of circulating osteoprotegerin (OPG) as a cardiovascular biomarker in patients with CKD, we investigated whether an increase in serum OPG levels is associated with the risk of CAC progression.</p><p><strong>Methods: </strong>A total of 1,130 patients with CKD stage 1 to predialysis 5 were divided into quartiles according to serum OPG levels (Q1 to Q4). The coronary artery calcium score (CACS) was assessed at baseline and at the 4-year follow-up visit. CAC progression was defined as an increase in the CACS of more than 200 Agatston units over 4 years.</p><p><strong>Results: </strong>Serum OPG levels were positively correlated with the CACS at baseline (R = 0.240, p < 0.001) and at the 4-year follow-up visit (R = 0.280, p < 0.001) as well as with changes in the CACS for 4 years (R = 0.270, p < 0.001) based on scatter plot analysis. Binary logistic regression analysis demonstrated that the risk of CAC progression was significantly increased in Q4 compared with Q1 (adjusted odds ratio, 3.706; 95% confidence interval, 1.154-11.902). Penalized spline curve analysis revealed a linear association between serum OPG levels and the risk of CAC progression.</p><p><strong>Conclusion: </strong>An increase in circulating OPG levels was associated with the risk of CAC progression in patients with predialysis CKD.</p>","PeriodicalId":17716,"journal":{"name":"Kidney Research and Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}