Kidney360最新文献

{"title":"Association of Transthyretin Val122Ile Variant with Kidney Outcomes in Community-Dwelling Black Adults: The REGARDS Cohort.","authors":"Soumya Khanna, Katharine L Cheung, Pankaj Arora, Marguerite R Irvin, Leslie A Lange, Titi Ilori, Mary Cushman, Akhil Pampana, Orlando M Gutierrez","doi":"10.34067/KID.0000000935","DOIUrl":"10.34067/KID.0000000935","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742428","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":"Optimizing Quality of Care for CKD in Sweden.","authors":"Anders Christensson, Karl-Göran Prütz","doi":"10.34067/KID.0000000940","DOIUrl":"https://doi.org/10.34067/KID.0000000940","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742429","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":"The Associations of Foot Process Effacement with Kidney Histopathologic Lesions and Disease Progression.","authors":"Marius Wittig, Ashish Verma, Andrea Bellavia, Sophia Rosan, Sophie E Claudel, Aditya Surapaneni, Ragnar Palsson, Anand Srivastava, Isaac E Stillman, Joel M Henderson, Laurence H Beck, Jeffrey B Hodgin, Morgan E Grams, Eugene P Rhee, Tobias B Huber, Sushrut S Waikar, Insa M Schmidt","doi":"10.34067/KID.0000000894","DOIUrl":"https://doi.org/10.34067/KID.0000000894","url":null,"abstract":"<p><strong>Background: </strong>Foot process effacement (FPE), a marker of podocyte injury observable via electron microscopy (EM), plays a key role in the pathophysiology of albuminuria and kidney disease progression. Whether FPE, as reported on kidney biopsies, is associated with histopathologic lesions and adverse clinical outcomes across a range of kidney diseases has not yet been explored.</p><p><strong>Methods: </strong>We developed semi-quantitative scores from free text pathologists' descriptions of FPE severity, using EM reports from 813 participants in the Boston Kidney Biopsy Cohort (BKBC), a prospective cohort study of individuals with biopsy-confirmed kidney disease. Logistic regression and accelerated failure time models were used to assess the associations of FPE severity with pathologist-adjudicated histopathologic lesions and progression to kidney failure, respectively. In exploratory analysis, we employed mediation analysis to decompose the total effect of FPE severity on kidney failure, exploring the role of measured albuminuria as a mediator in this pathway.</p><p><strong>Results: </strong>Fifty-six % of BKBC participants had no or mild FPE and 44% had moderate or severe FPE. After multivariable adjustment for age, race, sex, and eGFR, more severe mesangial expansion (OR 1.91, 95% CI 1.26 to 2.88, p=0.002) and more severe interstitial fibrosis/tubular atrophy (OR 1.60, 95% CI 1.09 to 2.33, p=0.015) were significantly associated with moderate or severe FPE. In the fully adjusted model, moderate or severe FPE was associated with a 2.7-fold higher hazard of progression to kidney failure compared to none or mild FPE (HR=2.66 (95% CI 1.91, 3.71, p<0.001). Mediation analysis showed that FPE affected kidney failure survival times through both direct effects and indirect (mediated) effects via albuminuria.</p><p><strong>Conclusions: </strong>FPE is associated not only with glomerular but also tubulointerstitial patterns of injury and may serve as a prognostic tool for assessing the risk of kidney disease progression.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742430","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":"Evaluation of a Protocol Managing the Cyclosporine and Nirmatrelvir/Ritonavir Interaction in Kidney Transplant Recipients.","authors":"Kyla Agtarap, Pierre Giguère, Marie-Josée Deschênes, Lacey DeVreese, Jessica McDougall, Stephanie Hoar, Swapnil Hiremath","doi":"10.34067/KID.0000000861","DOIUrl":"https://doi.org/10.34067/KID.0000000861","url":null,"abstract":"<p><strong>Background: </strong>Nirmatrelvir/ritonavir has emerged as a crucial treatment for managing COVID-19 infections but interacts with calcineurin inhibitors. This study aims to assess the application of a standardized protocol managing this drug-drug interaction, specifically with cyclosporine, since current evidence is limited.</p><p><strong>Methods: </strong>This retrospective study included recipients on cyclosporine undergoing therapy with nirmatrelvir/ritonavir between April 2022 and December 2023. As per protocol, cyclosporine doses were reduced by 80% and levels were measured two days after course completion. For subtherapeutic or therapeutic levels, cyclosporine dose was reinstated at 100%, with cyclosporine levels reassessed one week later. For supratherapeutic levels, the reduced dosage was maintained for an additional two days before being reinitiated at 100% of the baseline nirmatrelvir/ritonavir dose. Protocol adherence and clinical parameters such as cyclosporine levels, acute kidney injury episodes, hospitalization, and mortality were monitored up to 30-days after completion of nirmatrelvir/ritonavir therapy.</p><p><strong>Results: </strong>Thirty-five kidney transplant recipients met eligibility criteria. At baseline, 83% of recipients had therapeutic cyclosporine levels. At the first follow-up two days after completion of nirmatrelvir/ritonavir there was a greater proportion of recipients with subtherapeutic and supratherapeutic levels compared to baseline (20% vs 9% and 31% vs 9%), which had improved by the second follow-up at nine days after completion of nirmatrelvir/ritonavir (14% and 14%). Three recipients experienced acute kidney injury for reasons unrelated to COVID-19 treatment. There were 4 hospitalizations; none related to COVID-19 treatment. There was no graft rejection or death 30 days after completion of nirmatrelvir/ritonavir.</p><p><strong>Conclusions: </strong>Though cyclosporine levels outside therapeutic range were common immediately after completion of nirmatrelvir/ritonavir treatment, levels were restored rapidly. No clinically relevant safety events occurred within the 30-days. Adherence to the protocol is crucial when using nirmatrelvir/ritonavir in kidney transplant recipients.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715127","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":"Monoclonal Gammopathy in ANCA-Negative Pauci-immune Crescentic Glomerulonephritis: Is There an Association?","authors":"Maria J Vargas-Brochero, Alessia Buglioni, Poemlarp Mekraksakit, Charat Thongparyoon, António Inácio, Patricia Domingues, Fernando C Fervenza, Ladan Zand","doi":"10.34067/KID.0000000902","DOIUrl":"https://doi.org/10.34067/KID.0000000902","url":null,"abstract":"<p><strong>Background: </strong>In a small subset of patients with pauci-immune crescentic glomerulonephritis (PICGN), antinuclear cytoplasmic antibodies (ANCA) are not identified, and patients are referred to as having 'ANCA-negative' vasculitis. The cause of the disease in this subset of patients has remained elusive. We explored the role of monoclonal gammopathy (MG) in those with ANCA-negative PICGN.</p><p><strong>Methods: </strong>We conducted a retrospective study and identified patients with PICGN who had undergone ANCA and monoclonal testing. Those positive for ANCA were excluded.</p><p><strong>Results: </strong>We identified 14 patients with ANCA-negative vasculitis, of whom 8 (57%) tested positive for MG with a mean age of 60.3 ± 12.2 years, 75% female, and a mean serum creatinine of 4.3 ± 1.92 mg/dL. The most common monoclonal proteins were IgG (n=4, 50%) and Kappa (n=4, 50%). One patient had diagnosis of multiple myeloma. Most common extra-renal manifestations were skin rash (leukocytoclastic vasculitis (LCV)) and neuropathy. Kidney biopsy showed a higher degree of interstitial fibrosis and tubular atrophy compared to those without MG. The median follow-up time was 3.2 years, with 50% mortality in those with MG.</p><p><strong>Conclusions: </strong>Over 50% of the patients with ANCA-negative PICGN have MG, and patients present with more evidence of fibrosis on kidney biopsy, with higher mortality rate observed in our cohort Monoclonal proteins may trigger development of PICGN their specific role in the pathogenesis of this disease needs further investigation.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715128","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":"Urine Electrolyte to Predict Treatment Failure of Fluid Restriction in Syndrome of Inappropriate Antidiuresis: A Prospective Multicenter Study.","authors":"Kittiphan Chienwichai, Sirin Jiwakanon, Kamonrat Chaiviriyawong, Jananya Wattanakul, Warat Rojnsaengroung, Soravit Manasuth, Sorawat Sangkaew, Arunchai Chang, Pannawat Mongkolrattanakul","doi":"10.34067/KID.0000000912","DOIUrl":"https://doi.org/10.34067/KID.0000000912","url":null,"abstract":"<p><strong>Background: </strong>The syndrome of inappropriate antidiuresis (SIAD) is a common cause of hyponatremia in hospitalized patients, with fluid restriction (FR) as the first-line treatment. However, up to 50% of patients fail to respond to FR, highlighting the need for reliable predictors of treatment failure. Therefore, this study aimed to evaluate the predictive performance of urinary biomarkers, including the Furst equation (the ratio of the sum of urinary sodium and potassium concentrations to plasma sodium), urine osmolality, and urine output, in identifying non-responders to FR.</p><p><strong>Methods: </strong>This prospective multicenter cohort study was conducted at two medical centers in Thailand from September 2022 to June 2024 and included 79 hospitalized patients with SIAD. Response to FR was defined as an increase in serum sodium level of ≥3 mEq/L by Day 4, with no decrease in serum sodium levels at any point during the FR period. Predictive performance was assessed using sensitivity, specificity, and area under the curve (AUC) for each biomarker.Multivariable logistic regression analysis incorporating all urinary biomarkers was also performed.</p><p><strong>Results: </strong>Overall, 59% of patients failed to respond to FR by day 4, and adherence to FR was modest (72%). The Furst equation demonstrated the best predictive performance, with an optimal cut-off of 0.86 (sensitivity: 55.3%, specificity: 70.2%, AUC: 0.65). Combining the Furst equation with urine osmolality and urine output improved specificity to 91.0%, although sensitivity decreased to 32.3%. A multivariable logistic regression model achieved similar discrimination (AUC: 0.67) compared to the Furst equation alone.</p><p><strong>Conclusions: </strong>Although the Furst equation can identify non-responders to FR, its predictive performance is limited. Our findings suggest that other urinary biomarkers beyond the Furst equation may not improve overall predictive accuracy for predicting non-response to FR. These findings highlight the need for more effective predictive tools. Further studies are warranted to validate these results and optimize treatment strategies for SIAD.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715129","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":"Metabolic Acidosis and Cardiovascular Disease Risk in Children with CKD.","authors":"Denver D Brown, Jennifer Roem, Kimberly Reidy, Susan Furth, Bradley A Warady, Michal Melamed, Tammy Brady","doi":"10.34067/KID.0000000883","DOIUrl":"https://doi.org/10.34067/KID.0000000883","url":null,"abstract":"<p><strong>Background: </strong>The link between metabolic acidosis (MA) and cardiovascular disease (CVD) outcomes has been studied in adults but not in children with CKD where MA is a common and early finding. Using longitudinal blood pressure (BP) and cardiac measurement data, we evaluated whether low serum bicarbonate (a surrogate for MA) is associated with adverse CVD risk.</p><p><strong>Methods: </strong>This study used data from children 1 year of age and older with estimated glomerular filtration rates (eGFR) between 30-90 ml/min per 1.73m2 at enrollment into the Chronic Kidney Disease in Children (CKiD) study. Linear regression models were used to characterize the association between serum bicarbonate, resting and ambulatory BP measurements (ABPM), and indexed left ventricular mass measurements (LVMI). To compare BPs across children of different age/sex/height, BPs were indexed by dividing their average BP by the appropriate hypertensive threshold. Analyses allowed serum bicarbonate to be time varying and were adjusted for relevant demographic and clinical covariates.</p><p><strong>Results: </strong>The study population consisted of 936 children who contributed data from 2581 paired visits. All had resting BP, 674 had ABPM measurements, and 736 had LVMI measurements. In fully adjusted models, there was an association between lower serum bicarbonate and higher resting BP. Lower serum bicarbonate level was also associated with lower ABPM wake and sleep systolic indices, and a small but significant increase in LVMI, 0.02 (95% CI: 0.004, 0.05).</p><p><strong>Conclusions: </strong>We observed an association between MA and higher resting BP, lower ABPM, and higher LVMI. Future studies should address MA and CVD risk across the spectrum of CKD severity, incorporate additional assessments of CVD risk such as pulse wave velocity and carotid intima media thickness. Future studies should also test whether alkali therapy treatment, and the resolution of MA, mitigates these observed associations.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698862","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":"Interplay Between the Mineralocorticoid System, Inflammation, Hypertension and Kidney Disease.","authors":"Eviatar Fields, Ernesto L Schiffrin","doi":"10.34067/KID.0000000929","DOIUrl":"https://doi.org/10.34067/KID.0000000929","url":null,"abstract":"<p><p>Aldosterone, produced by adrenal glomerulosa cells, stimulated by angiotensin II (AngII), adrenocorticotrophin (ACTH) and potassium (K+), and inhibited by natriuretic peptides, plays a role in hypertension and CKD development and progression. Its effects are mediated by nuclear mineralocorticoid receptors (MRs) inducing genomic effects, and putatively by a membrane G-protein-coupled receptor which could be the G-protein-coupled estrogen receptor (GPER30), triggering non genomic actions. The classical effect of aldosterone is on the distal nephron to retain Na+ and water and excrete K+, contributing to electrolyte and extracellular volume control. However, aldosterone also acts by stimulating oxidative stress through different signaling pathways that include tyrosine kinases and mitogen-activated protein kinases to induce inflammation and fibrosis in blood vessels, the kidney and the heart. The actions of aldosterone also leads to endothelial dysfunction, which participates in its effects on target organs, including progression of hypertension. Blockade of MR or inhibition of aldosterone generation lowers blood pressure (BP) and protects target organs, reducing progression of CKD. All these actions are reviewed, with an emphasis on the effects on the kidney.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690590","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":"Outcomes of Initiating Peritoneal Dialysis versus Hemodialysis in Severe, Symptomatic Kidney Failure.","authors":"Guillermo García-García, Miguel Ibarra-Estrada, Jeffrey Perl, Magdalena Madero, César Murguía-Soto, Karla Hernández-Morales, Jahir R Camacho-Guerrero, Miguel A Pérez-Venegas, Edgar J Carmona-Morales, Alexa N Oseguera-Gonzalez, Martha K Franco-Garcia, Gael Chávez-Alonso, María F García-Peña, Juan A Gómez-Fregoso, Guillermo Navarro-Blackaller, M Luz Alcantar-Vallin, Gabriela Abundis-Mora, Ramón Medina-González, Alejandro Martínez Gallardo-González, Jonathan S Chávez-Iñiguez","doi":"10.34067/KID.0000000863","DOIUrl":"10.34067/KID.0000000863","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":"1373-1383"},"PeriodicalIF":3.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12407124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690591","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":"Implementation of a Kidney Screening Intervention to Improve Early CKD Detection in Adults with Diabetes.","authors":"Maggy Spolnik, Indika Mallawaarachchi, Binu Sharma, Michael Ellwood, Jennie Z Ma, Jason A Lyman, Julia J Scialla","doi":"10.34067/KID.0000000922","DOIUrl":"https://doi.org/10.34067/KID.0000000922","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidelines recommend that patients with diabetes mellitus (DM) are screened annually for kidney disease with estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). To improve screening, we implemented clinical decision support (CDS) at UVA Health in April 2022. This included: (1) auto-enrollment of primary care patients with DM in an electronic health record (EHR)-based health maintenance plan; and (2) prompting one-click ordering of the Kidney Profile (KP; panel including UACR and eGFR) or UACR alone, as needed.</p><p><strong>Methods: </strong>We assessed effectiveness of the CDS using an interrupted time series approach across 3 periods (pre-COVID-19 control: January 2019-February 2020; post-COVID-19 control: March 2021-April 2022; post-CDS: May 2022 to April 2023). All non-acute office and telehealth encounters in primary care for patients aged ≥22 years with DM, no coded diagnosis of CKD in the prior 4 years, and due for screening (i.e., not screened for CKD in past 365 days). Screening was assessed as orders placed for UACR within 30 days of the encounter and aggregated by calendar months.</p><p><strong>Results: </strong>There were 66,388 encounters (23,419 pre-COVID-19 control; 22,611 post-COVID-19 control; 20,358 post-CDS). The screening trend in both control periods was similar, therefore only the post-COVID-19 control was considered further. Demographics, encounter types, and clinic distribution were similar in the control and post-CDS periods. There was an immediate screening difference of 3.02% (95% CI, 0.37- 5.68; p=0.03) after the CDS, and screening acceleration with a difference in screening rate of 0.57% each month compared to 0.06% per month prior to the CDS (p<0.01). Results were similar if encounters for patients with prior CKD by laboratory criteria were removed.</p><p><strong>Conclusions: </strong>Roll out of CDS coincided with immediate and ongoing improvement in annual screening for CKD among adult patients with DM. These results suggest that simple CDS may be an effective intervention to promote CKD screening.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690589","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}