Kidney360最新文献

{"title":"Collapsing Glomerulopathy and Thrombotic Microangiopathy after Chimeric Antigen Receptor T Cell Therapy.","authors":"Katherine Quiñones, Ryan Song, Anthony Chang, Benjamin A Derman, Marco Bonilla","doi":"10.34067/KID.0000001394","DOIUrl":"https://doi.org/10.34067/KID.0000001394","url":null,"abstract":"<p><p>Chimeric antigen receptor T-cell (CAR-T) therapy is increasingly used in hematologic malignancies but can be complicated by immune-mediated toxicities, including acute kidney injury, which is typically attributed to hemodynamic factors or acute tubular injury. Glomerular diseases in this setting are exceedingly rare, with only isolated case reports in the literature. We report a 65-year-old African American man with relapsed multiple myeloma who developed AKI with nephrotic-range proteinuria following BCMA-directed CAR-T therapy, in the context of cytokine release syndrome and immune effector cell-associated hemophagocytic lymphohistiocytosis syndrome. Kidney biopsy demonstrated, the coexistence of collapsing glomerulopathy and biopsy-proven thrombotic microangiopathy, suggesting combined podocyte and endothelial injury. The patient was managed with supportive measures and immunomodulatory therapy targeting systemic inflammation, resulting in improvement in kidney function and significant reduction in proteinuria alongside a sustained oncologic response. Recognition of nephrotic-range proteinuria or persistent kidney dysfunction after CAR-T therapy should prompt consideration of immune effector cell-associated glomerulopathy and evaluation with kidney biopsy when appropriate.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Sleep Disturbance among Patients on Hemodialysis: Patient and Health Care Provider Perspectives.","authors":"Linlin Mu, Jiahui Zhang, Pei Chen, Wenzhe Hua, Guanchen Xiao, Lei Zhang, Xiaowei Pu, Bingqian Zhu","doi":"10.34067/KID.0000001370","DOIUrl":"https://doi.org/10.34067/KID.0000001370","url":null,"abstract":"<p><strong>Background: </strong>Sleep disturbance is highly prevalent among patients on hemodialysis, severely impairing their quality of life and clinical outcomes. Sleep management in this population is particularly challenging, as it is shaped by complex interactions between patient experiences and clinical practices. The aim of this study was to explore experiences related to the management of sleep disturbance from dual perspectives from patients and healthcare providers.</p><p><strong>Methods: </strong>This study employed a qualitative research design, using a phenomenological approach. Nineteen patients on hemodialysis and 24 healthcare providers were recruited via purposive sampling from September 2025 and January 2026. One-on-one semi-structured interviews were conducted following an interview guide. The interviews lasted around 60 minutes. Data analyses were informed by Colaizzi's method.</p><p><strong>Results: </strong>Four themes with 13 subthemes emerged: 1) Patients revealed their experiences of living with sleep disturbance; 2) Both patients and healthcare providers used various strategies managing sleep disturbance, in which hypnotic medication was the primary approach, while traditional Chinese medicine (e.g., Tuina) and non-pharmacological approaches served as complementary alternatives; 3) Common barriers included insufficient clinical attention, perceived inevitability, and low patient engagement, healthcare providers also revealed unique systemic barriers; 4) Enabling factors for future sleep management included shared patient-provider interest, social support for the patients, and existing hospital resources.</p><p><strong>Conclusions: </strong>While a range of strategies have been tried to manage sleep disturbance among patients on hemodialysis, significant barriers persist. Nevertheless, the enabling factors offered a foundation for developing more integrated sleep management programs.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finerenone Added to Renin-Angiotensin System- and Sodium-Glucose Cotransporter 2 Inhibition in Patients with Alport Syndrome: A Two-Center Case Series.","authors":"Jan Boeckhaus, Fang Wang, Jie Ding, Sima Jami, Yanqin Zhang, Oliver Gross","doi":"10.34067/KID.0000001342","DOIUrl":"https://doi.org/10.34067/KID.0000001342","url":null,"abstract":"<p><strong>Background: </strong>Alport syndrome is a common hereditary glomerular kidney disease characterized by a high risk of kidney failure. Despite renin-angiotensin system- (RASi) and SGLT2 inhibitors (SGLT2i), a subset of patients experience rapid decline in kidney function. Preclinical data in Alport mice suggest that the nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone could provide additional nephroprotection. This case series evaluates the changes in albuminuria and the safety of finerenone as part of a triple-therapy regimen in individuals with Alport syndrome.</p><p><strong>Methods: </strong>In this retrospective, two-center observational case series, ten male individuals with Alport syndrome received finerenone (10 mg/day) in addition to baseline-therapy with RASi (100%) and SGLT2i (90%). Clinical parameters - including estimated glomerular filtration rate (eGFR), albuminuria, and serum potassium were analyzed over a mean follow-up period of 9 ± 5 months.</p><p><strong>Results: </strong>Median albuminuria showed a non-significant decrease of 33% during follow-up, from 3506 [IQR 1645-4304] to 2346 [1858-2792] mg/g creatinine (p = 0.21). Median eGFR declined from 50 [47-112] to 43 [32-116] mL/min/1.73m2 (p = 0.03) and continued to decline in a subgroup of five individuals, who were followed for 12 months. Hyperkalemia occurred in half of the individuals, necessitating the use of potassium binders in two cases. Finerenone was discontinued in two individuals due to rapid decline of eGFR. No serious adverse events were observed.</p><p><strong>Conclusions: </strong>This real-world case series provides preliminary evidence that adding finerenone to baseline therapy with RASi and SGLT2i is feasible and may offer additional albuminuria reduction in Alport syndrome. However, the notable eGFR decline and the relevant incidence of hyperkalemia underscore the necessity for vigilant clinical monitoring. While multimodal nephroprotection remains a promising tool to delay disease progression, these real-world observations provide pilot data to inform the design of future large-scale prospective trials in patients with Alport syndrome.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Residual Kidney Function on Convection Volume Targets in Hemodiafiltration.","authors":"Usama Butt, Ken Farrington, Sivakumar Sridharan, Eunice Doctolero, Chadd Javier, May Reyes, Enric Vilar","doi":"10.34067/KID.0000001289","DOIUrl":"https://doi.org/10.34067/KID.0000001289","url":null,"abstract":"<p><strong>Background: </strong>Adoption of Haemodiafiltration is increasing as the preferred modality of haemodialysis. Current haemodiafiltration practice relies on achieving 'High Convection Volume' (HiCV) (≥23 Litres or ≥21L/1.73m2 Body surface area) without individualisation. Enhanced clearance of middle molecules such as β2Microglobulin (β2M) may be a driver of the benefits attributed to haemodiafiltration. Understanding the relationship of convection volume with β2M removal and the impact of residual kidney function on this relationship could allow individualisation of haemodiafiltration based on residual kidney function.</p><p><strong>Methods: </strong>We examined the relationships of delivered convection volume, pre-dialysis and post-dialysis β2M levels and β2M reduction ratio (β2M-RR) in 274 adults receiving maintenance hemodiafiltration in relation to a single dialysis session. We also evaluated the impact of residual kidney function on these relationships. Residual kidney function was estimated as glomerular filtration rate (GFR) - the average of urea and creatinine clearances obtained from interdialytic urine collections.</p><p><strong>Results: </strong>Pre-dialysis β2M had no relationship with convection volume and was determined largely by GFR. Post-dialysis β2M and β2M-RR were closely related to delivered convection volume (Adjusted R2 0.545 and 0.561 respectively, p < 0.001). Body surface area adjusted HiCV related better to β2M removal parameters than unadjusted HiCV. The strength of association between HiCV and post-dialysis β2M and β2MRR was higher at lower GFR and was maximum in anuric patients. At GFR >2ml/min the relationship between HiCV and β2M removal parameters was not statistically significant. β2MRR level corresponding to HiCV was ≥75%, for post-dialysis β2M it was ≤7.5 mg/L in anuric and ≤5.5 mg/L in uric patients. Achieving HiCV or equivalent β2M levels ensured achieving minimum target urea clearance (spKt/Vurea >1.2).</p><p><strong>Conclusions: </strong>Achieving HiCV was most impactful in removing β2M in anuric patients. Impact was less at GFR > 2ml/min. This suggests the prospect of individualising convection volume based on residual kidney function.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obinutuzumab Compared to Cyclosporine with Steroids for the Treatment of Primary Membranous Nephropathy: A Propensity Score-Matched Analysis.","authors":"Xiaofan Hu, Muyin Zhang, Lili Xu, Jing Xu, Chenni Gao, Xialian Yu, Xiao Li, Hong Ren, Weiming Wang, Jingyuan Xie","doi":"10.34067/KID.0000001317","DOIUrl":"https://doi.org/10.34067/KID.0000001317","url":null,"abstract":"<p><strong>Background: </strong>To compare the efficacy and safety profiles of obinutuzumab or cyclosporine combined with steroid in treating primary membranous nephropathy.</p><p><strong>Methods: </strong>This retrospective study included patients with primary membranous nephropathy treated at Shanghai Ruijin Hospital between January 2020 and June 2023. Patients received either obinutuzumab or cyclosporine combined with corticosteroid and were followed for at least 24 months unless relapse or treatment failure occurred. Propensity score matching (PSM, ratio: 1:1) based on age, sex, degree of proteinuria, eGFR, serum albumin and PLA2R antibody was applied to pair patients receiving Obinutuzumab with those receiving cyclosporine combined with corticosteroid. The primary outcome was defined as the combination of partial remission and complete remission at 24 months. Logistic regression model and Kaplan-Meier curves were applied to compare the efficacy of two treatments.</p><p><strong>Results: </strong>After PSM, 30 patients receiving obinutuzumab and 30 patients receiving cyclosporine with corticosteroid were included in the study. By 24 months, a higher proportion of patients in the obinutuzumab group reached the primary endpoints compared to those treated with cyclosporine combined with corticosteroid. (Obinutuzumab vs. Cyclosporine: 86 % vs. 54 %, P=0.01; HR:5.42, 95%CI:1.49-19.69, P=0.01). Relapses of nephrotic syndrome were less frequent in the obinutuzumab group than in the cyclosporine group (Obinutuzumab vs. Cyclosporine: 15% vs. 52%, P=0.01; HR:0.16, 95%CI: 0.04-0.60, P=0.01). Obinutuzumab induced a faster immunologic remission at 6 months (Obinutuzumab vs. Cyclosporine: 91% vs. 59%, P<0.01; HR: 7.22, 95% CI: 1.40-37.25, P=0.02) and maintained a better persistent immunologic remission at 24 months [Obinutuzumab vs. Cyclosporine: 95% vs. 45%, P<0.01; HR: 24.44, 95%CI: 2.73-219.09, P<0.01]. Both treatment regimens were generally well-tolerated. The incidence of infection was lower in the obinutuzumab group than in the cyclosporine combined with corticosteroid group (Obinutuzumab vs. Cyclosporine: 23% vs. 50%, P=0.03).</p><p><strong>Conclusions: </strong>Our study demonstrated that obinutuzumab is associated with higher remission rates at 24 months, faster immunological remission and less infections than cyclosporine combined with corticosteroids in the treatment of PMN.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterogeneity of Nephrotoxic Risk Across Medication Classes and Combinations in Hospitalized Adults.","authors":"Yaohua Wang, Casey G Hardin, Mary Vaughan-Sarrazin, Melissa Swee, Masaaki Yamada, Michael Tabet, Jason Misurac, Brian C Lund, W Nick Street, Diana I Jalal, Benjamin R Griffin","doi":"10.34067/KID.0000001346","DOIUrl":"https://doi.org/10.34067/KID.0000001346","url":null,"abstract":"<p><strong>Background: </strong>Drug-associated acute kidney injury (DA-AKI) is common among hospitalized patients receiving multiple medications. Nephrotoxicity is often treated as a binary categorization, but AKI risk likely varies across medication classes and combinations. We sought to characterize class-specific AKI associations and evaluate whether medication-class interactions associate with DA-AKI prediction.</p><p><strong>Methods: </strong>This retrospective observational study included adults admitted to the University of Iowa from 2014-2023 who met high nephrotoxin exposure criteria, defined as receipt of ≥3 concurrent potentially nephrotoxic medications. The primary outcome was stage 2/3 AKI within 7 days of initial high-nephrotoxin exposure. Models adjusted for demographics, comorbidities, admission diagnosis, laboratory values, and vital signs at index exposure. Generalized estimating equation logistic models were used to estimate medication-class associations and test 66 two-way class interactions. XGBoost models were used to explore nonlinear and higher-order exposure patterns.</p><p><strong>Results: </strong>We evaluated 66,977 admissions with high-nephrotoxin exposure from 42,558 patients, with stage 2/3 AKI developing in 3,309 (5%). Adjusted odds ratios ranged from 0.74 (95% CI 0.64-0.87) for NSAID exposure to 1.71 (95% CI 1.55-1.88) for piperacillin-tazobactam, indicating substantial heterogeneity in class-specific associations with AKI. Among 66 medication-class pairs tested, 9 (14%) remained statistically significant after multiple-comparison adjustment. Inclusion of medication class and pairwise terms was associated with increased GEE discrimination from ROC-AUC 0.73 to 0.76 and PR-AUC 0.16 to 0.17. XGBoost achieved ROC-AUC 0.78 and PR-AUC 0.20, suggesting additional nonlinear or higher-order exposure patterns.</p><p><strong>Conclusions: </strong>Among hospitalized adults with high nephrotoxin exposure, medication class composition and pairwise exposure patterns were associated with subsequent stage 2/3 AKI. These findings support evaluation of weighted nephrotoxin surveillance frameworks incorporating medication class, combinations, and clinical context.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden and Risk Factors for Staphylococcus aureus-Related Sepsis among US Dialysis Patients: A Retrospective Claims-Based Cohort Study.","authors":"Sammantha B Fuller, Dongyu Wang, Brian Bieber, Sabada Dube, Roberto Pecoits-Filho, Jillian Schrager, Sylvia Taylor, Sudhir Venkatesan, Catia Ferreira, Angelo Karaboyas","doi":"10.34067/KID.0000001335","DOIUrl":"https://doi.org/10.34067/KID.0000001335","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving dialysis, particularly those on hemodialysis with central venous catheters (CVC), are at higher risk of bloodstream infections, often caused by Staphylococcus aureus. After years of declining CVC prevalence, pandemic-related shifts in dialysis practices led to higher CVC use and increased concern regarding contemporary infection risk. This study used national data spanning pre-, intra-, and post-pandemic periods to determine current rates and risk factors for S. aureus-related sepsis in the US dialysis population.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using Centers for Medicare & Medicaid Services claims and United States Renal Data System data from 2016 through 2023 for adults >18 years of age receiving maintenance dialysis. S. aureus-related sepsis was identified using ICD-10 codes A41.01 and A41.02. Event rates per 100 patient-years (PY) were calculated for first and multiple events, stratified by demographic and clinical characteristics. Cox regression was used to identify risk factors.</p><p><strong>Results: </strong>CVC use rose from 16% in 2016 to 24% in 2023. S. aureus-related sepsis incidence was 3.3 per 100 PY for first events and 4.1 per 100 PY for multiple events. First-event rates were higher among HD recipients using CVCs (8.4) versus those with arteriovenous fistulas (2.0) or peritoneal dialysis recipients (1.0). Rates were elevated in younger patients, males, and those with diabetes, heart failure, or immunosuppressive conditions. In adjusted models, catheter use (vs. fistulas) was strongly associated with S. aureus-related sepsis (hazard ratio: 4.24, 95% confidence interval: 4.15 to 4.33).</p><p><strong>Conclusions: </strong>S. aureus-related sepsis remains a substantial burden among US dialysis patients, especially among CVC users, presenting a persistent challenge for the nephrology community in the context of rising CVC prevalence post-pandemic. Despite modest overall declines since 2016, persistent high rates underscore the need for targeted prevention, particularly optimizing vascular access and managing high-risk subgroups.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic Disparities in Access to CKD Randomized Clinical Trials in the United States.","authors":"Parth Dhamelia, Omar Darwish, Dharmik Jadvani, Hashane K Abeyagunawardene, Lauren Tong, Clare C Brown, John M Arthur, Nishank Jain","doi":"10.34067/KID.0000001375","DOIUrl":"https://doi.org/10.34067/KID.0000001375","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nephrology's Onboarding Challenge May Reflect a Workforce Challenge.","authors":"Juliano Alhaddad, Georges Nakhoul","doi":"10.34067/KID.0000001386","DOIUrl":"10.34067/KID.0000001386","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":"7 9","pages":"1928-1929"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Newly Designed Expedited Allocation Pathways Cannot Be Expected to Rely on Data That Do Not Currently Exist.","authors":"Cameron D Ekanayake, Syed A Husain, Miko E Yu, Joel T Adler, Chetan Sree Muppavarapu, Jesse D Schold, Sumit Mohan","doi":"10.34067/KID.0000001213","DOIUrl":"10.34067/KID.0000001213","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"2134-2137"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147529730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}