Kidney International Reports最新文献

{"title":"Pregnancy Among Women Receiving Chronic Dialysis in France (2006–2020)","authors":"","doi":"10.1016/j.ekir.2024.05.008","DOIUrl":"10.1016/j.ekir.2024.05.008","url":null,"abstract":"<div><h3>Introduction</h3><p>In women receiving chronic dialysis, fertility is impaired. The objectives of this study were to estimate the incidence rate of pregnancies among women of childbearing age (15–50 years) receiving chronic dialysis from 2006 to 2020 in France, to describe the pregnancy outcomes and renal management during pregnancy.</p></div><div><h3>Methods</h3><p>This national observational, retrospective study was based on data from the French REIN registry matched with the National Health Data System.</p></div><div><h3>Results</h3><p>Over the period 2006 to 2020 in France, 348 pregnancies were identified in 240 women receiving chronic dialysis. The overall incidence of pregnancy was 11.1, 95% confidence interval (CI) (9.9–12.3) cases per 1000 person-years. Hemodialysis was the predominant modality during pregnancy. Main maternal complications were preeclampsia (<em>n</em> = 19) and gestational diabetes (<em>n</em> = 11). The most obstetric complications were premature rupture of membranes (<em>n</em> = 14) and polyhydramnios (<em>n</em> = 5). These pregnancies resulted in 174 (50%) abortions (&lt;22 weeks), including 104 elective abortions (29.9%), 44 miscarriages (12.6%), 17 therapeutic abortions (4.9%), 5 ectopic pregnancies (1.4%), and 4 hydatidiform moles (1.2%). The remaining 174 (50%) pregnancies with deliveries (≥22 weeks) resulted in 166 live births (70 full-term [42.2%], 96 preterm births [57.8%]), and 8 stillbirths. Median gestational age was 36 weeks (32–38) for 174 deliveries.</p></div><div><h3>Conclusion</h3><p>There have been improvements in maternal and fetal outcomes regarding pregnancy on chronic dialysis. However, our study shows a significant proportion of elective abortions. Better fertility management of women receiving chronic dialysis is advised by contraception or by pregnancy planning and early multidisciplinary follow-up.</p></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468024924017169/pdfft?md5=edf671a9d35c9bb14ae2c10fc5581751&pid=1-s2.0-S2468024924017169-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141023286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and Evaluation of a National Multidisciplinary Kidney Genetics Clinic Network Over 10 Years","authors":"","doi":"10.1016/j.ekir.2024.04.068","DOIUrl":"10.1016/j.ekir.2024.04.068","url":null,"abstract":"<div><h3>Introduction</h3><p>Diagnostic genomic sequencing is the emerging standard of care in nephrology. There is a growing need to scale up the implementation of genomic diagnostics nationally to improve patient outcomes.</p></div><div><h3>Methods</h3><p>This pragmatic study provided genomic or genetic testing to patients with suspected monogenic kidney disease through a national network of kidney genetics clinics (KGCs). We sought to evaluate the experiences of implementing genomic diagnostics across Australia and associated diagnostic outcomes between 2013 and 2022.</p></div><div><h3>Results</h3><p>We successfully established and expanded a nationwide network of 20 clinics as of 2022; concurrently developing laboratory, research, and education programs to scale the clinical application of genomics in nephrology. We report on an Australian cohort of 1506 kidney patients, of whom 1322 received their test results. We assessed barriers to implementation in the nephrology context, and where possible, applied real-time solutions to improve clinical processes over 10 years.</p></div><div><h3>Conclusion</h3><p>Developing a multidisciplinary kidney genetics model across multiple health services nationally was highly successful. This model supported optimal care of individuals with monogenic kidney disease in an economically responsible way. It has continued to evolve with technological and service developments and is now set to scale further as genomic testing for kidney patients transitions to health care system funding.</p></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468024924017066/pdfft?md5=66bd0ae00ac4699adc4b6b6a69337a4b&pid=1-s2.0-S2468024924017066-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathologic Features of IgG4-Related Kidney Disease","authors":"","doi":"10.1016/j.ekir.2024.05.011","DOIUrl":"10.1016/j.ekir.2024.05.011","url":null,"abstract":"<div><h3>Introduction</h3><p>IgG4-related disease (IgG4-RD) is a systemic immune-mediated disease that can involve nearly any organ. IgG4-RD can affect the kidney in different disease patterns, collectively referred to as IgG4-related kidney disease (IgG4-RKD).</p></div><div><h3>Methods</h3><p>We conducted a tissue-based cohort study with clinicopathological correlation in 125 patients with IgG4-RKD.</p></div><div><h3>Results</h3><p>The mean age at biopsy (<em>n</em> = 120) or nephrectomy (<em>n</em> = 5) was 63 years; 80% were male. One hundred eighteen patients (94%) had IgG4-related tubulointerstitial nephritis (IgG4-TIN); 20 patients (16%) had IgG4-related membranous glomerulonephritis (IgG4-MGN; 13 with concurrent IgG4-TIN). The primary clinical indication for biopsy/nephrectomy was acute or chronic renal failure in 78%, proteinuria in 17%, and mass lesion(s) in 15% (with overlap in primary indication). Fifty-two percent patients (41/79) had abnormal radiographic findings, including masses in 30% (24/79). All patients with IgG4-MGN had proteinuria. Extrarenal involvement by IgG4-RD was present in 79%. Median serum creatinine at presentation was 2.5 mg/dl (range 0.7–12). Serum IgG and/or IgG4 was increased in 91% (53/58); hypocomplementemia was present in 56% (43/77). Light microscopy showed plasma cell–rich interstitial nephritis in all cases of IgG4-TIN. Ninety-two percent of patients showed increased IgG4+ plasma cells. Seven percent showed an acute interstitial nephritis (AIN) pattern, and 5% showed non-necrotizing arteritis. Tubular basement membrane immune deposits were present in 83% of IgG4-TIN. Treatment information was available for 71 patients; 62 were treated with immunosuppression. Of those with elevated creatinine, 72% (41/57) showed a treatment response.</p></div><div><h3>Conclusion</h3><p>This largest tissue-based series more clearly defines the disease phenotype of IgG4-RKD.</p></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468024924017194/pdfft?md5=41ea2d4887cc8388f4e4c8e078c6079d&pid=1-s2.0-S2468024924017194-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141030907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal and Extrarenal Phenotypes in Patients With HNF1B Variants and Chromosome 17q12 Microdeletions","authors":"","doi":"10.1016/j.ekir.2024.05.007","DOIUrl":"10.1016/j.ekir.2024.05.007","url":null,"abstract":"<div><h3>Introduction</h3><p>Hepatocyte nuclear factor 1-beta (<em>HNF1B</em>) gene variants or the chromosome 17q12 deletion (17q12del) represent the most common monogenic cause of developmental kidney disease. Although neurodevelopmental disorders have been associated with the 17q12del, specific genotype-phenotype associations with respect to kidney function evolution have not yet been fully defined. Here, we aimed to determine whether 17q12del or specific <em>HNF1B</em> variants were associated with kidney survival in a large patient population with <em>HNF1B</em> disease.</p></div><div><h3>Methods</h3><p>This was a retrospective observational study involving 521 patients with <em>HNF1B</em> disease from 14 countries using the European Reference Network for rare kidney diseases with detailed information on the <em>HNF1B</em> genotype (<em>HNF1B</em> variants or the 17q12del). Median follow-up time was 11 years with 6 visits per patient. The primary end point was progression to chronic kidney disease (CKD) stage 3 (estimated glomerular filtration rate [eGFR] &lt; 60 ml/min per 1.73 m²). Secondary end points were the development of hypomagnesemia or extrarenal disorders, including hyperuricemia and hyperglycemia.</p></div><div><h3>Results</h3><p>Progression toward CKD stage 3 was significantly delayed in patients with the 17q12del compared to patients with <em>HNF1B</em> variants (hazard ratio [HR]: 0.29, 95% confidence interval [CI]: 0.19–0.44, <em>P</em> &lt; 0.001). Progression toward CKD stage 3 was also significantly delayed when <em>HNF1B</em> variants involved the HNF1B Pit-1, Oct-1, and Unc-86 homeodomain (POU_h) DNA-binding and transactivation domains rather than the POU-specific domain (POU_s) DNA-binding domain (HR: 0.15 [95% CI: 0.06–0.37), <em>P</em> &lt; 0.001 and HR: 0.25 (95% CI: 0.11–0.57), <em>P</em> = 0.001, respectively). Finally, the 17q12del was positively associated with hypomagnesemia and negatively associated with hyperuricemia, but not with hyperglycemia.</p></div><div><h3>Conclusion</h3><p>Patients with the 17q12del display a significantly better kidney survival than patients with other <em>HNF1B</em> variants; and for the latter, variants in the POU_s DNA-binding domain lead to the poorest kidney survival. These are clinically relevant <em>HNF1B</em> kidney genotype-phenotype correlations that inform genetic counseling.</p></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468024924017157/pdfft?md5=bec6f212babd1567bf07c4f89366675c&pid=1-s2.0-S2468024924017157-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141051196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor Perceptions and Preferences of Telemedicine and In-Person Visits for Living Kidney Donor Evaluation","authors":"","doi":"10.1016/j.ekir.2024.05.009","DOIUrl":"10.1016/j.ekir.2024.05.009","url":null,"abstract":"<div><h3>Introduction</h3><p>Living kidney donor evaluation is a lengthy and complex process requiring in-person visits. Access to transplant centers, travel costs, lost wages, and dependent care arrangements are barriers to willing donors initiating evaluation. Telemedicine can help streamline and epedite the evaluation process. We aimed to deeply understand donor experiences and preferences using hybrid telemedicine video/in-person visits to ease access to donor evaluation or counseling.</p></div><div><h3>Methods</h3><p>We conducted in-depth, semistructured interviews with donors or donor candidates who completed their evaluation through telemedicine/in-person, or in-person only visits at a tertiary transplant center between November 27, 2019 and March 1, 2021. Enrollment continued until data saturation was reached (interviews with 20 participants) when no new information emerged from additional interviews. Transcripts were analyzed using inductive thematic analysis.</p></div><div><h3>Results</h3><p>Eight themes were identified as follows: (i) reducing financial and logistical burdens (minimizing travel time and travel-related expenses), (ii) enhancing flexibility with scheduling (less time off work and child or family caregiver arrangements), (iii) importance of a walkthrough and establishing shared understanding, (iv) supporting information with technology and visual aids, (v) key role of the coordinator, (vi) preferred visit by provider role (meeting donor surgeon in-person to create rapport and engaging primary care provider in donor evaluation/follow-up), (vii) comparing modality differences in human connection, and (viii) opportunity for family and support network engagement (allowing loved ones to be involved in telemedicine visits irrespective of geographic locations and pandemic restrictions).</p></div><div><h3>Conclusion</h3><p>Telemedicine/in-person hybrid model can make donor evaluation more accessible and convenient. Our findings help inform about determinants that influence the adoption of telemedicine to initiate donor evaluation to motivate willing donors. In addition, our results call for policy and legislation that support telemedicine services for living donor kidney transplantation across states.</p></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468024924017170/pdfft?md5=f8e3bb98c131984cd492ceefd8ab93f6&pid=1-s2.0-S2468024924017170-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Intervention, Big Savings: The Future of CKD Management in Thailand","authors":"","doi":"10.1016/j.ekir.2024.06.035","DOIUrl":"10.1016/j.ekir.2024.06.035","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468024924018126/pdfft?md5=d457ea5f2dd6bf4756c9d6ef2f307442&pid=1-s2.0-S2468024924018126-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141547465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Issues Related to Early Screening Programs in Low Resource Settings","authors":"","doi":"10.1016/j.ekir.2024.06.024","DOIUrl":"10.1016/j.ekir.2024.06.024","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S246802492401800X/pdfft?md5=6eefaaca7e936804a0269736924b90fa&pid=1-s2.0-S246802492401800X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141779749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Prolonged SARS-CoV-2 Dosing Interval in Hemodialysis Patients","authors":"","doi":"10.1016/j.ekir.2024.04.072","DOIUrl":"10.1016/j.ekir.2024.04.072","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468024924018047/pdfft?md5=e0af725b6592253fcc9740bd048c0a47&pid=1-s2.0-S2468024924018047-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141553159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated Exposure to Air Pollutants Accelerates Primary Glomerular Disease Progression","authors":"","doi":"10.1016/j.ekir.2024.05.013","DOIUrl":"10.1016/j.ekir.2024.05.013","url":null,"abstract":"<div><h3>Introduction</h3><p>Environmental contributors to kidney disease progression remain elusive. We explored how residential air pollution affects disease progression in patients with primary glomerulopathies.</p></div><div><h3>Methods</h3><p>Nephrotic Syndrome Study Network (NEPTUNE) and CureGlomerulonephropathy (CureGN) participants with residential census tract data and ≥2 years of follow-up were included. Using Cox proportional hazards models, the associations per doubling in annual average baseline concentrations of total particulate matter with diameter ≤2.5 μm (PM_2.5) and its components, black carbon (BC), and sulfate, with time to ≥40% decline in estimated glomerular filtration rate (eGFR) or kidney failure were estimated. Serum tumour necrosis factor levels and kidney tissue transcriptomic inflammatory pathway activation scores were used as molecular markers of disease progression.</p></div><div><h3>Results</h3><p>PM_2.5, BC, and sulfate exposures were comparable in NEPTUNE (<em>n</em> = 228) and CureGN (<em>n</em> = 697). In both cohorts, participants from areas with higher levels of pollutants had lower eGFR, were older and more likely self-reported racial and ethnic minorities. In a fully adjusted model combining both cohorts, kidney disease progression was associated with PM_2.5 (adjusted hazard ratio 1.55 [95% confidence interval: 1.00–2.38], <em>P</em> = 0.0489) and BC (adjusted hazard ratio 1.43 [95% confidence interval: 0.98–2.07], <em>P</em> = 0.0608) exposure. Sulfate and PM_2.5 exposure were positively correlated with serum tumour necrosis factor (TNF) (<em>P</em> = 0.003) and interleukin-1β levels (<em>P</em> = 0.03), respectively. Sulfate exposure was also directly associated with transcriptional activation of the TNF and JAK-STAT signaling pathways in kidneys (r = 0.55–0.67, <em>P</em>-value &lt;0.01).</p></div><div><h3>Conclusion</h3><p>Elevated exposure to select air pollutants is associated with increased risk of disease progression and systemic inflammation in patients with primary.</p></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468024924017364/pdfft?md5=e6da6bdcc9af77916739da53d1218ab0&pid=1-s2.0-S2468024924017364-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141133691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allogeneic CD4 T Cells Sustain Effective BK Polyomavirus-Specific CD8 T Cell Response in Kidney Transplant Recipients","authors":"","doi":"10.1016/j.ekir.2024.04.070","DOIUrl":"10.1016/j.ekir.2024.04.070","url":null,"abstract":"<div><h3>Introduction</h3><p>BK polyomavirus-associated nephropathy (BKPyVAN) is a significant complication in kidney transplant recipients (KTRs), associated with a higher level of plasmatic BK polyomavirus (BKPyV) replication and leading to poor graft survival.</p></div><div><h3>Methods</h3><p>We prospectively followed-up with 100 KTRs with various degrees of BKPyV reactivation (no BKPyV reactivation, BKPyV-DNAuria, BKPyV-DNAemia, and biopsy-proven BKPyVAN [bp-BKPyVAN], 25 patients per group) and evaluated BKPyV-specific T cell functionality and phenotype.</p></div><div><h3>Results</h3><p>We demonstrate that bp-BKPyVAN is associated with a loss of BKPyV-specific T cell proliferation, cytokine secretion, and cytotoxic capacities. This severe functional impairment is associated with an overexpression of lymphocyte inhibitory receptors (programmed cell death 1 [PD1], cytotoxic T lymphocyte-associated protein 4, T cell immunoreceptor with Ig and ITIM domains, and T cell immunoglobulin and mucin domain-containing-3), highlighting an exhausted-like phenotype of BKPyV-specific CD4 and CD8 T cells in bp-BKPyVAN. This T cell dysfunction is associated with low class II donor-recipient human leukocyte antigen (HLA) divergence. In contrast, in the context of higher class II donor-recipient HLA (D/R-HLA) divergence, allogeneic CD4 T cells can provide help that sustains BKPyV-specific CD8 T cell responses. <em>In vitro</em>, allogeneic HLA-mismatched CD4 T cells rescue BKPyV-specific CD8 T cell responses.</p></div><div><h3>Conclusion</h3><p>Our findings suggest that in KTRs, allogeneic CD4 T cells can help to maintain an effective BKPyV-specific CD8 T cell response that better controls BKPyV replication in the kidney allograft and may protect against BKPyVAN.</p></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S246802492401708X/pdfft?md5=cce0aef5975f8d64061749a67c3e86be&pid=1-s2.0-S246802492401708X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}