Kidney Diseases最新文献

{"title":"Mitophagy Regulates Kidney Diseases.","authors":"Xiaolu Fan, Linlin Wu, Fengqi Wang, Dong Liu, Xufeng Cen, Hongguang Xia","doi":"10.1159/000541486","DOIUrl":"10.1159/000541486","url":null,"abstract":"<p><strong>Background: </strong>Mitophagy is a crucial process involved in maintaining cellular homeostasis by selectively eliminating damaged or surplus mitochondria. As the kidney is an organ with a high dynamic metabolic rate and abundant mitochondria, it is particularly crucial to control mitochondrial quality through mitophagy. Dysregulation of mitophagy has been associated with various renal diseases, including acute and chronic kidney diseases, and therefore a better understanding of the links between mitophagy and these diseases may present new opportunities for therapeutic interventions.</p><p><strong>Summary: </strong>Mitophagy plays a pivotal role in the development of kidney diseases. Upregulation and downregulation of mitophagy have been observed in various kidney diseases, such as renal ischemia-reperfusion injury, contrast-induced acute kidney injury, diabetic nephropathy, kidney fibrosis, and several inherited renal diseases. A growing body of research has suggested that PINK1 and Parkin, the main mitophagy regulatory proteins, represent promising potential therapeutic targets for kidney diseases. In this review, we summarize the latest insights into how the progression of renal diseases can be mitigated through the regulation of mitophagy, while highlighting their performance in clinical trials.</p><p><strong>Key message: </strong>This review comprehensively outlines the mechanisms of mitophagy and its role in numerous kidney diseases. While early research holds promise, most mitophagy-centered therapeutic approaches have yet to reach the clinical application stage.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"10 6","pages":"573-587"},"PeriodicalIF":3.2,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813427","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":"Glomerular Hematuria as a Predictor of Renal Prognosis in Malignant Hypertension Patients with Thrombotic Microangiopathy: A Propensity Score-Matched Analysis of a Biopsy-Based Cohort Study.","authors":"Zhaocai Zhou, Wanxin Shi, Shengyou Yu, Jianwen Yu, Naya Huang, Zhong Zhong, Fengxian Huang, Wei Chen, Feng He, Jianbo Li","doi":"10.1159/000541332","DOIUrl":"10.1159/000541332","url":null,"abstract":"<p><strong>Introduction: </strong>Malignant hypertension (mHTN) is a hypertensive emergency. Thrombotic microangiopathy (TMA) is a widespread complication of mHTN. Few studies have evaluated whether glomerular hematuria provides prognostic information for renal dysfunction in patients with mHTN-associated TMA.</p><p><strong>Methods: </strong>This observational cohort study included 292 patients with mHTN-associated TMA based on renal biopsy. Propensity-score matching (PSM) analysis was conducted to adjust for clinical characteristics in a comparison between with and without glomerular hematuria. Cox regression was employed to identify risk factors for renal prognosis.</p><p><strong>Results: </strong>A total of 70 patients with glomerular hematuria were compared to 222 patients with non-glomerular hematuria. After PSM, 67 pairs of patients with mHTN-associated TMA were matched. Patients with glomerular hematuria exhibited lower serum albumin levels, higher 24-h proteinuria, and a higher prevalence of glomerular sclerosis than those with non-glomerular hematuria. Glomerular hematuria was independently associated with deteriorated renal function compared with non-glomerular hematuria (HR: 0.51; 95% CI: 0.29-0.89, <i>p</i> = 0.019). This association remained significant after PSM (HR: 0.51; 95% CI: 0.28-0.91, <i>p</i> = 0.022). Additionally, glomerular hematuria was independently associated with renal replacement therapy (RRT) (HR: 3.14; 95% CI: 2.06-5.66, <i>p</i> < 0.001). This difference remained significant after PSM comparison (HR: 2.41; 95% CI: 1.34-4.33, <i>p</i> = 0.003). Furthermore, despite intensive blood pressure control, patients with glomerular hematuria experienced a higher incidence of RRT and a poorer recovery in renal function, specifically a 25% reduction of creatinine levels, compared to patients with non-glomerular hematuria.</p><p><strong>Conclusion: </strong>Glomerular hematuria is significantly associated with an increased risk of adverse renal outcomes in patients with mHTN-associated TMA.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"10 6","pages":"479-491"},"PeriodicalIF":3.2,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812954","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":"The Bone-Vascular Axis: A Key Player in Chronic Kidney Disease Associated Vascular Calcification.","authors":"Yingjing Shen, Chen Yu","doi":"10.1159/000541280","DOIUrl":"10.1159/000541280","url":null,"abstract":"<p><strong>Background: </strong>The bone-vascular axis plays a key role in the pathogenesis of vascular calcification (VC) in patients with chronic kidney disease (CKD). Understanding and managing the role of the bone-vascular axis in CKD-mineral and bone disorder (CKD-MBD) is critical for preventing and treating associated complications, including osteoporosis, arterial calcification, and cardiovascular diseases. This study aimed to comprehensively summarize the role of bone metabolism markers in uremic VC.</p><p><strong>Summary: </strong>The skeleton, as an endocrine organ, can regulate systemic metabolic processes by secreting various bioactive substances. These molecules can induce the transdifferentiation of vascular smooth muscle cells, promoting their transition to other functional states, thereby affecting vascular growth and remodeling.</p><p><strong>Key messages: </strong>The prevalence of VC in individuals with CKD is notably high. CKD-associated VC is characterized by the widespread accumulation of hydroxyapatite within the arterial media, which occurs as a result of the transformation of smooth muscle cells into osteoblastic smooth muscle cells under the influence of uremic toxins. Osteoblasts and osteoclasts in bone tissue secrete mineral metabolic proteins, which can influence neighboring cells, primarily vascular smooth muscle cells, through paracrine signaling. Both circulating and osteocytic sclerostin can exert a protective effect by inhibiting wingless/integrated (WNT)-induced calcification. The therapeutic goal for CKD-MBD is to reduce production of sclerostin by decreasing the osteogenic transdifferentiation of vascular smooth muscle cells. Calciprotein particles act as a physiological agent for delivering calcium-phosphate the bone and inducing fibroblast growth factor-23 expression in osteoblasts.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"10 6","pages":"545-557"},"PeriodicalIF":3.2,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813577","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":"Identification of Renal Ischemia-Reperfusion Injury Subtypes and Predictive Model for Graft Loss after Kidney Transplantation Based on Programmed Cell Death-Related Genes.","authors":"Jing Ji, Yuan Ma, Xintong Liu, Qingqing Zhou, Xizi Zheng, Ying Chen, Zehua Li, Li Yang","doi":"10.1159/000540158","DOIUrl":"10.1159/000540158","url":null,"abstract":"<p><strong>Introduction: </strong>Ischemia-reperfusion injury (IRI) is detrimental to kidney transplants and may contribute to poor long-term outcomes of transplantation. Programmed cell death (PCD), a regulated cell death form triggered by IRI, is often indicative of an unfavorable prognosis following transplantation. However, given the intricate pathophysiology of IRI and the considerable variability in clinical conditions during kidney transplantation, the specific patterns of cell death within renal tissues remain ambiguous. Consequently, accurately predicting the outcomes for transplanted kidneys continues to be a formidable challenge.</p><p><strong>Methods: </strong>Eight Gene Expression Omnibus datasets of biopsied transplanted kidney samples post-IRI and 1,548 PCD-related genes derived from 18 PCD patterns were collected in our study. Consensus clustering was performed to identify distinct IRI subtypes based on PCD features (IRI PCD subtypes). Differential enrichment analysis of cell death, metabolic signatures, and immune infiltration across these subtypes was evaluated. Three machine learning algorithms were used to identify PCD patterns related to prognosis. Genes associated with graft loss were screened for each PCD type. A predictive model for graft loss was constructed using 101 combinations of 10 machine learning algorithms.</p><p><strong>Results: </strong>Four IRI subtypes were identified: PCD-A, PCD-B, PCD-C, and PCD-D. PCD-A, characterized by high enrichment of multiple cell death patterns, significant metabolic paralysis, and immune infiltration, showed the poorest prognosis among the four subtypes. While PCD-D involved the least kind of cell death patterns with the features of extensive activation of metabolic pathways and the lowest immune infiltration, correlating with the best prognosis in the four subtypes. Using various machine learning algorithms, 10 cell death patterns and 42 PCD-related genes were identified as positively correlated with graft loss. The predictive model demonstrated high sensitivity and specificity, with area under the curve values for 0.5-, 1-, 2-, 3-, and 4-year graft survival at 0.888, 0.91, 0.926, 0.923, and 0.923, respectively.</p><p><strong>Conclusion: </strong>Our study explored the comprehensive features of PCD patterns in transplanted kidney samples post-IRI. The prediction model shows great promise in forecasting graft loss and could aid in risk stratification in patients following kidney transplantation.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"10 6","pages":"450-467"},"PeriodicalIF":3.2,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813416","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":"The Pathogenesis of Nephrotic Syndrome: A Perspective from B Cells.","authors":"Shifan Zhu, Jiayu Zhang, Langping Gao, Qing Ye, Jianhua Mao","doi":"10.1159/000540511","DOIUrl":"10.1159/000540511","url":null,"abstract":"<p><strong>Background: </strong>Nephrotic syndrome is a special type of chronic kidney disease, the specific pathogenesis of which remains unclear. An increasing number of studies have suggested that B cells play an important role in the pathogenesis of nephrotic syndrome.</p><p><strong>Summary: </strong>Idiopathic nephrotic syndrome is a common kidney disease in children. While previously believed to be primarily caused by T-cell disorders, recent research has shifted its focus to B cells. Studies have shown that B cells play a significant role in the pathogenesis of NS, potentially even more so than T cells. This article provides a comprehensive review of the involvement of B cells in the development of idiopathic nephrotic syndrome.</p><p><strong>Key messages: </strong>B cells are involved in the pathogenesis of nephrotic syndrome by producing autoantibodies and various cytokines.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"10 6","pages":"531-544"},"PeriodicalIF":3.2,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813594","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":"Development and Validation of a Machine Learning-Based Prognostic Model for IgA Nephropathy with Chronic Kidney Disease Stage 3 or 4.","authors":"Zixian Yu, Xiaoxuan Ning, Yunlong Qin, Yan Xing, Qing Jia, Jinguo Yuan, Yumeng Zhang, Jin Zhao, Shiren Sun","doi":"10.1159/000540682","DOIUrl":"10.1159/000540682","url":null,"abstract":"<p><strong>Introduction: </strong>Immunoglobulin A nephropathy (IgAN) patients with lower estimated glomerular filtration rate (eGFR) and higher proteinuria are at a higher risk for end-stage kidney disease (ESKD) and their prognosis is still unclear. We aim to develop and validate prognostic models in IgAN patients with chronic kidney disease (CKD) stage 3 or 4 and proteinuria ≥1.0 g/d.</p><p><strong>Methods: </strong>Patients who came from Xijing Hospital, spanning December 2008 to January 2020 were divided into training and test cohorts randomly, with a ratio of 7:3, achieving ESKD and death as study endpoints. Created prediction models for IgAN patients based on 66 clinical and pathological characteristics using the random survival forests (RSF), survival support vector machine (SSVM), eXtreme Gradient Boosting (XGboost), and Cox regression models. The concordance index (C-index), integrated Brier scores (IBS), net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to evaluate discrimination, calibration, and risk classification, respectively.</p><p><strong>Results: </strong>A total of 263 patients were enrolled. The median follow-up time was 57.3 months, with 124 (47.1%) patients experiencing combined events. Age, blood urea nitrogen, serum uric acid, serum potassium, glomeruli sclerosis ratio, hemoglobin, and tubular atrophy/interstitial fibrosis were identified as risk factors. The RSF model predicted the prognosis with a C-index of 0.871 (0.842, 0.900) in training cohort and 0.810 (0.732, 0.888) in test cohort, which was higher than the models built by SSVM model (0.794 [0.753, 0.835] and 0.805 [0.731, 0.879], respectively), XGboost model (0.840 [0.797, 0.883] and 0.799 [0.723, 0.875], respectively) and Cox regression (0.776 [0.727, 0.825] and 0.793 [0.713, 0.873], respectively). NRI and IDI showed that the RSF model exhibited superior performance than the Cox model.</p><p><strong>Conclusion: </strong>Our model introduced seven risk factors that may be useful in predicting the progression of IgAN patients with CKD stage 3 or 4 and proteinuria ≥1.0 g/d. The RSF model is applicable for identifying the progression of IgAN and has outperformed than SSVM, XGboost, and Cox models.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"10 6","pages":"436-449"},"PeriodicalIF":3.2,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812583","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":"The Hippo Coactivator TAZ Exacerbates Cisplatin-Induced Acute Renal Injury.","authors":"Xian Xue, Xingwen Zhu, Lu Zhou, Xiaoli Sun, Mengru Gu, Yan Liang, Mengzhu Tan, Qing Hou, Sudan Wang, Chunsun Dai","doi":"10.1159/000540973","DOIUrl":"10.1159/000540973","url":null,"abstract":"<p><strong>Introduction: </strong>Transcriptional coactivator with PDZ-binding motif (TAZ), a Hippo signaling pathway effector, maintains the balance of cell proliferation, differentiation, and death. However, the role of TAZ in tubular cell survival and acute kidney injury (AKI) remains largely unknown.</p><p><strong>Methods: </strong>We used the RNA-seq database, Western blot, and immunohistochemistry to examine TAZ expression in kidneys from cisplatin-induced AKI. We generated tubular-specific TAZ knockout mice to assess the role of TAZ in cisplatin-induced renal toxicity. Immunoprecipitation-mass spectrometry followed standard procedures.</p><p><strong>Results: </strong>TAZ was activated in tubular cells in kidneys injected with cisplatin. Conditional deletion of TAZ in tubular cells confers ferroptosis resistance and protects kidneys from cisplatin-induced AKI, whereas overexpression of TAZ(S89A) exacerbates cisplatin-induced ferroptosis. Inhibition of ferroptosis with ferrostatin-1 potently preserves renal function and alleviates morphological injury and tubular cell ferroptosis induced by cisplatin. Mechanistically, in a PPARδ-dependent manner, but not TEAD, TAZ reduces the expression of glutathione peroxidase 4 (GPX4), thus exacerbating cisplatin-induced ferroptosis.</p><p><strong>Conclusions: </strong>Our findings show that cisplatin-induced AKI and tubular cell ferroptosis are mediated by TAZ-PPARδ interaction through regulation of GPX4, highlighting TAZ as a potential therapeutic candidate for AKI.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"10 6","pages":"421-435"},"PeriodicalIF":3.2,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813590","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":"Rivaroxaban for Thromboembolism Prophylaxis in Patients with Nephrotic Syndrome: A Single-Arm, Prospective Study.","authors":"Meng Wei, Xue Wu, Liteng Wang, Zhichun Gu, Yuanmao Tu, Lihua Zhang, Jiong Zhang, Honglang Xie, Qing Zhou, Yanan Chu, Zhen Cheng, Guohua Zhou, Qinxin Song","doi":"10.1159/000540107","DOIUrl":"10.1159/000540107","url":null,"abstract":"<p><strong>Introduction: </strong>Thromboembolism is a recognized complication of nephrotic syndrome (NS). Evidence supporting the use of rivaroxaban to prevent NS-related thrombosis is limited and controversial. This study aimed to explore the impact of NS on rivaroxaban pharmacokinetics and to collect observational data on the efficacy and safety of rivaroxaban as primary thromboprophylaxis in patients with NS.</p><p><strong>Methods: </strong>This prospective study analyzed 141 patients with NS who received rivaroxaban (10 mg/day) for thromboprophylaxis. High-performance liquid chromatography-tandem mass spectrometry was used to measure the trough and peak plasma concentrations (C_trough and C_max) of rivaroxaban. The influence of clinical and genetic factors on these concentrations was examined using multivariate logistic regression.</p><p><strong>Results: </strong>The median C_max and C_trough were 68.5 ng/mL (interquartile range [IQR], 31.7-105.5 ng/mL) and 4.4 ng/mL (IQR, 1.2-11.9 ng/mL), respectively. The incidence of thromboembolic events (TEs) was 12.8%, while that of bleeding events was 14.2%, although all were classified as minor. Albumin level was the most significant factor affecting C_max (ρ = 0.55; <i>p</i> < 0.001) and was also significantly associated with TEs (0.81; 0.71-0.91 per 1.0 g/dL increase; <i>p</i> = 0.001) and bleeding risks (1.11; 1.03-1.19 per 1.0 g/dL increase; <i>p</i> = 0.008). Single nucleotide polymorphisms in the <i>ABCB1</i> gene significantly influenced C_trough but were not associated with clinical outcomes.</p><p><strong>Conclusion: </strong>Hypoalbuminemia significantly affects the pharmacokinetics of rivaroxaban in NS patients. A dose-adjustment strategy based on rivaroxaban concentrations, accounting for variable albumin levels, may improve the safety and efficacy of thromboprophylaxis in this population.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"10 5","pages":"346-358"},"PeriodicalIF":3.2,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468949","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":"Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis in China: Epidemiology, Management, Prognosis, and Outlook.","authors":"Su-Fang Chen, Zhi-Ying Li, Ming-Hui Zhao, Min Chen","doi":"10.1159/000540514","DOIUrl":"10.1159/000540514","url":null,"abstract":"<p><strong>Background: </strong>Increasing evidence indicates that clinicopathologic phenotypes and ANCA serotypes may differ ethnically and geographically. This review highlights the progress in the prevalence, pathogenesis, management, and outcomes of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in China.</p><p><strong>Summary: </strong>AAV is not rare in China. Cumulative evidence has demonstrated a significant preponderance of microscopic polyangiitis (MPA) and myeloperoxidase (MPO)-ANCA AAV in China. Even in patients with granulomatosis with polyangiitis (GPA), there is a predominance of MPO-ANCA over proteinase 3 (PR3)-ANCA, presenting a unique subset. The pathogenesis of AAV is multifactorial, with the role of complement activation being highlighted during recent years. Treatment strategies for AAV in China have also been refined recently. A rapid tapering of glucocorticoids to minimize exposure has been recommended by the Chinese guidelines. Along with a better understanding of the disease, B cell-targeted therapy and complement-targeted therapy are developing. A considerable number of patients in China received rituximab treatment and achieved remission. However, infection risk and associated mortality still remain concerns. Therefore, less rituximab exposure should be considered and evaluated in Chinese AAV patients. Prognostic factors have been reviewed. Of note, along with improved outcomes, there is an increase of cardiovascular and malignant-related death, warranting specific care. Recently, a modified renal risk score model has been validated for early risk prediction in Chinese AAV patients. Moreover, emerging biomarkers for AAV, including complement components, have been identified in Chinese patients.</p><p><strong>Key messages: </strong>There is a preponderance of MPA and MPO-ANCA in China. Treatment strategies for Chinese AAV patients generally align with those in western countries, and to some extent, less aggressive. Prognostic factors and emerging biomarkers for AAV in China have been identified. Further challenges include optimizing interventions, minimizing treatment-related comorbidities, improving disease monitoring, and enhancing life qualities of AAV patients.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"10 5","pages":"407-420"},"PeriodicalIF":3.2,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468948","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":"Treatment of Membranous Nephropathy in Chinese Patients: Comparison of Rituximab and Intravenous Cyclophosphamide with Steroids.","authors":"Xiaofan Hu, Hong Ren, Jing Xu, Chenni Gao, Yifan Wu, Yan Ouyang, Li Lin, Xiao Li, Na Liu, Weiming Wang, Jingyuan Xie, Nan Chen","doi":"10.1159/000540548","DOIUrl":"10.1159/000540548","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies have shown that rituximab (RTX) and cyclic oral corticosteroid-cyclophosphamide (CTX) regimens have similar effects on primary membranous nephropathy (PMN). However, no studies have compared RTX with an intravenous CTX regimen, which is more commonly used in China and requires fewer cumulative CTX doses.</p><p><strong>Methods: </strong>We prospectively assigned 141 PMN patients with baseline proteinuria ≥4 g/24 h, serum albumin <30 g/L, and eGFR ≥30 mL/min × 1.73 m² despite at least 3 months of treatment with ACEI and/or ARB to the RTX group (375 mg/m² per injection per week × 4 injections) or to the CTX group (prednisone 0.8 mg/kg/day and intravenous CTX 500 mg/m² per month until the total dose reached 6-8 g). The primary endpoint was defined as a combination of partial remission or complete remission at 12 months.</p><p><strong>Results: </strong>By the end of 12 months, 43 of 70 patients (61.43%) in the RTX group and 54 of 71 patients (76.06%) in the CTX group reached the primary endpoint (<i>p</i> = 0.06). Significantly fewer patients in the RTX group achieved complete remission than the CTX group (14.29% vs. 33.80%, <i>p</i> = 0.01). The adverse events rate was similar between the RTX group and the CTX group (28.57% vs. 40.85%, <i>p</i> = 0.13). In subgroup analysis, we found that fewer patients from the RTX group achieved the primary endpoint than the CTX group (48.65% vs. 74.29%, <i>p</i> = 0.03) among patients with massive proteinuria (urine protein ≥8 g/24 h). During the observational phase, 61 patients in the RTX group and 58 in the CTX group completed 24 months of follow-up, exhibiting similar remission rates (RTX vs. CTX: 75.41% vs. 68.97%, <i>p</i> = 0.54).</p><p><strong>Conclusions: </strong>Our results show that the intravenous CTX regimen has similar safety and efficacy with higher rates of early complete remission than RTX in the treatment of PMN patients.</p>","PeriodicalId":17830,"journal":{"name":"Kidney Diseases","volume":"10 5","pages":"359-368"},"PeriodicalIF":3.2,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468951","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}