Kidney360最新文献

{"title":"Apelin Inhibits Cyst Growth and Improves Kidney Function in Mice with Polycystic Kidney Disease.","authors":"Duuamene Nyimanu, Anubhav Chakraborty, Stephen C Parnell, Darren P Wallace, Alan S L Yu","doi":"10.34067/KID.0000001403","DOIUrl":"https://doi.org/10.34067/KID.0000001403","url":null,"abstract":"<p><strong>Background: </strong>Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited disorder marked by numerous renal cysts that impair kidney function, with about half of affected individuals progressing to kidney failure by midlife. Patients exhibit reduced circulating apelin, a ligand of the apelin receptor known to regulate cardiovascular function including hypertension. We tested whether diminished apelin signaling contributes to cystogenesis and if exogenous apelin receptor activation can improve disease outcomes.</p><p><strong>Methods: </strong>Plasma samples from children and young adults with ADPKD and age- and sex-matched healthy controls were analyzed for circulating apelin peptides. To assess direct cystic effects, primary ADPKD renal epithelial cells were grown as 3D collagen-embedded cysts and treated with apelin agonists. Male and female Pkd1RC/RC; Pkd2+/- (PKD) mice were treated for 27 days with apelin agonists, vehicle, or the vasopressin receptor antagonist, mozavaptan. Kidney and heart weight ratios, BUN, renal cAMP, and kidney transcriptional profiles were evaluated.</p><p><strong>Results: </strong>Circulating apelin peptides were significantly reduced in ADPKD patients despite normal kidney function (eGFR, BUN, and creatinine). In vitro, both apelin and the small molecule apelin receptor agonist, azelaprag, inhibited cyst growth. Apelin and mozavaptan reduced kidney weight, cystic index, blood urea nitrogen and renal cAMP in PKD mice, whereas azelaprag did not. Apelin downregulated expression of genes associated with cyst progression, including Lcn2 (Ngal), Postn, and Havcr1 (Kim-1). Mozavaptan, but not apelin, induced diuresis and reduced urinary concentration.</p><p><strong>Conclusions: </strong>Apelin receptor activation by exogenous apelin inhibited cAMP synthesis and cyst growth and improved kidney function in an orthologous mouse model of ADPKD. We propose that the apelin receptor may be a potential therapeutic target in ADPKD.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111601","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 Concurrent Antibody-Mediated Rejection and BK Polyomavirus Nephropathy After Kidney Transplantation: Successful Treatment Using CD38 Blockade.","authors":"Shuyang Traub, Thomas Menter, Stefan Schaub, Matthias Diebold","doi":"10.34067/KID.0000001422","DOIUrl":"https://doi.org/10.34067/KID.0000001422","url":null,"abstract":"<p><p>The coexistence of antibody-mediated rejection (AMR) and BK polyomavirus-associated nephropathy (BKPyVAN) represents a major therapeutic challenge after kidney transplantation. Whereas treatment of AMR typically requires intensification of immunosuppression, management of BKPyVAN relies on reduction of immunosuppressive therapy to restore antiviral immune control. We report a kidney transplant recipient who developed active AMR with de novo donor-specific antibodies and concurrent BKPyVAN 12 weeks after transplantation. Given ongoing BKPyV replication, recent infectious complications, and concerns regarding further escalation of conventional immunosuppressive therapy, the patient was treated with pulse methylprednisolone followed by anti-CD38 therapy using daratumumab. Treatment resulted in recovery of allograft function, disappearance of donor-specific antibodies, and complete histological resolution of AMR. BKPyV replication subsequently declined and ultimately resolved without recurrent rejection. This case highlights CD38 blockade as a potential therapeutic option in selected patients with concomitant AMR and BKPyVAN. However, given the concurrent administration of corticosteroids and optimization of maintenance immunosuppression, these findings should be regarded as hypothesis-generating.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111585","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":"Patient-Centered Observations of Outpatient Hemodialysis: An Exploratory Systems Approach to Understanding Infection Prevention Using Human Factors.","authors":"Brian Nguyen, Laurie Wolf, Matthew Jesso, Alan S Kliger, Renee E Garrick, Kerry A Leigh, Shannon Novosad, Nicole Gualandi, Stephanie Booth, Sarah Henrickson Parker","doi":"10.34067/KID.0000001366","DOIUrl":"https://doi.org/10.34067/KID.0000001366","url":null,"abstract":"<p><strong>Background: </strong>Infection remains the second leading cause of death in patients with ESKD on hemodialysis. This exploratory analysis sought to characterize interruptions and non-routine events (NREs), in the outpatient dialysis setting, with particular interest in the relationships between interruptions and NREs and infection prevention and control (IPC) activities.</p><p><strong>Methods: </strong>We conducted a mixed-methods, observational, exploratory study of 45 patients and their dialysis teams across four U.S. dialysis facilities (99 total outpatient hemodialysis treatments hours observed). Structured observations were focused on the team surrounding an individual patient for the duration of their dialysis session using a modified Line Operations Safety Audit (LOSA) approach. Quantitative analyses were conducted.</p><p><strong>Results: </strong>A technician simultaneously caring for four patients can experience a median of 64 interruptions, or 16 per patient (range 3-50) during their treatment time. The phases with greatest risk of infection (i.e., connection, disconnection) had a significantly higher time required to complete (with NRE: connection 14:37, disconnection 13:41; without NRE: connection 7:32, disconnection 8:18). Thirty-seven of 45 patients experienced at least one NRE during clinical care, defined as a patient-related clinical event (e.g., long clotting time) or an operational variation (e.g., transportation problem). Findings are exploratory in nature and provide support for future hypothesis generation and testing.</p><p><strong>Conclusions: </strong>Interruptions and NREs were frequent in the outpatient dialysis work system, and connection and disconnection times were longer when an NRE was present. Since these disruptions occurred during phases that include IPC-related activities, they may introduce competing demands that could challenge consistent adherence, though adherence was not directly measured. These exploratory findings may inform the design of workflows and processes that better support IPC and patient safety in the outpatient dialysis setting.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111629","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":"Early Time-Restricted Feeding Mitigates Insulin Resistance and Proteinuria in Prepubertal Obese Dahl Salt-Sensitive Rats.","authors":"Sautan Mandal, Ubong S Ekperikpe, Anukool A Bhopatkar, Krystle M Hughes, Madison J Patterson, Lana E Evans, Ngoc H Hoang, Kristin S Edwards, Denise C Cornelius, Jan M Williams","doi":"10.34067/KID.0000001359","DOIUrl":"https://doi.org/10.34067/KID.0000001359","url":null,"abstract":"<p><strong>Background: </strong>Previous studies from our laboratory have shown that hyperinsulinemia and insulin resistance (IR) are elevated in obese Dahl salt-sensitive (SS) leptin receptor mutant (SSLepRmutant) rats compared to SS rats before puberty. Clinical studies suggest that time-restricted feeding improves insulin sensitivity and is considered beneficial in obese patients. Therefore, the current study examined whether time-restricted feeding improves IR and reduces renal injury in obese SSLepRmutant rats prior to puberty.</p><p><strong>Methods: </strong>Four-week-old SS and SSLepRmutant rats were given either ad libitum access to food for 24 hours (control) or 8 hours each day during their active phase time-restricted feeding for 4 weeks. Metabolic parameters, insulin sensitivity, renal function and injury, proximal tubular SGLT2 expression, inflammation, and mitochondrial bioenergetics were assessed at the end of the study.</p><p><strong>Results: </strong>Body weight and food intake were significantly elevated in SSLepRmutant compared to SS rats, and time-restricted feeding did not affect either parameter. Fasting blood glucose levels were normal (≤120 mg/dL) in all groups. HOMA-IR (marker of IR) was significantly elevated in SSLepRmutant rats versus SS rats, and time-restricted feeding significantly reduced HOMA-IR only in SSLepRmutant rats. Proteinuria was significantly higher in SSLepRmutant rats vs SS rats (361±32 vs. 17±4 mg/day, respectively), and time-restricted feeding markedly reduced proteinuria in SSLepRmutant rats (144±19 mg/day). We observed a 2-fold increase in GFR in SSLepRmutant rats compared to SS rats indicating renal hyperfiltration. Time-restricted feeding prevented renal hyperfiltration in SSLepRmutant rats. Renal tubular sodium-glucose cotransporter 2 (SGLT2) expression was markedly increased in SSLepRmutant rats relative to SS rats and was notably reduced by time-restricted feeding in the SSLepRmutant rats. When measuring mitochondrial function, there was a tendency of OCR to be reduced in SSLepRmutant rats compared to SD rats, indicating impaired mitochondrial function, but time-restricted feeding significantly increased baseline OCR in SSLepRmutant rats.</p><p><strong>Conclusions: </strong>Overall, these data suggest that time-restricted feeding reduces proteinuria by potentially improving insulin sensitivity and tubular mitochondrial function indicating TRF could be of great potential in obese children with early signs of renal injury.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111595","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":"Superimposed FSGS Lesions Worsen Kidney Prognosis in Diabetic Nephropathy.","authors":"Maria J Vargas-Brochero, Miriam Machado, Daniela Valencia, Sana Abouzahir, Marta Casal Moura, Sanjeev Sethi, Maria José Soler","doi":"10.34067/KID.0000001358","DOIUrl":"https://doi.org/10.34067/KID.0000001358","url":null,"abstract":"<p><strong>Background: </strong>Diabetic nephropathy is one of the leading causes of kidney failure worldwide. However, the impact of histopathological lesions like focal and segmental glomerulosclerosis (FSGS) on kidney survival has been insufficiently evaluated. This study aimed to assess the effect of FSGS lesions on kidney outcomes in patients with diabetic nephropathy.</p><p><strong>Methods: </strong>We conducted a retrospective study of patients with biopsy-confirmed DN between 2010 and 2022. Exclusion criteria included kidney failure at presentation, primary glomerulopathies, metastatic cancer, pregnancy, organ transplantation, or inadequate follow-up. The primary outcome was progression to kidney failure. Kidney survival was analyzed using Kaplan-Meier methods, and predictors of kidney failure were identified through Cox regression.</p><p><strong>Results: </strong>A total of 67 patients met inclusion criteria. Mean age was 62 years; 57% were male, and 55% had FSGS lesions. Compared with those without FSGS, affected patients were more likely to be of non-White ethnicity (p=0.009), had higher urine albumin-to-creatinine ratios (p=0.01), greater interstitial fibrosis and tubular atrophy (p=0.009), and higher prevalence of class IV DN (p=0.04). 26 patients (39%) progressed to kidney failure. One-year kidney survival was 87% (95% CI: 79-95%), with poorer outcomes in the FSGS group (p=0.04). In multivariable analysis, FSGS (HR 2.9; 95% CI 1.18-7.12), stroke (HR 5.02; 95% CI 1.80-14.05), and serum albumin (HR 0.34; 95% CI 0.18-0.62) were independently associated with kidney failure.</p><p><strong>Conclusion: </strong>Superimposed FSGS in diabetic nephropathy is associated with a higher risk of progression to kidney failure. These findings highlight the prognostic importance of histopathological evaluation in diabetic kidney disease.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111624","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":"Variation in Living Donor Evaluation and Acceptance across the United States.","authors":"Sandra Amaral, Timothy Copeland, Charles E McCulloch, Matthew R Weir, Patrick Ahearn, Barry I Freedman, Arpita Basu, Amy D Waterman, Kirsten L Johansen, Ahmed A Y Awan, Jason Lee, Jonathan D Savant, Elaine Ku","doi":"10.34067/KID.0000001400","DOIUrl":"https://doi.org/10.34067/KID.0000001400","url":null,"abstract":"<p><strong>Background: </strong>Variability exists in acceptance of living kidney donor candidates across the US. This study sought to quantify the extent to which this variation is driven by donor candidate ancestry, transplant centers and providers.</p><p><strong>Methods: </strong>Using a retrospective cohort study of living donor candidates who completed donor evaluation across nine US transplant centers, we examined the Kidney Failure Risk Projection (KFRP) model (estimating donor risk of ESKD at 15 years) as a proxy of the threshold for donor acceptance. Mixed linear models clustered by transplant center and provider were used to relate donor ancestry to center decisions.</p><p><strong>Results: </strong>Among 1888 living donor candidates (median age 42 years, 62% women), 39% Black candidates were accepted to donate versus 45% Hispanic and 56% White candidates (p<0.001). KFRP scores were extremely low, with median risk of 0.13% (IQR 0.06-0.27). Accounting for the 15-year KFRP score in adjusted models, the odds of donor acceptance were higher for White candidates (OR 1.46; 95% CI 1.13-1.88) compared with Hispanic (referent) and Black candidates (OR 0.74; 95% CI 0.53-1.04). White donor candidates declined for donation had a higher KFRP score by 0.08% versus Hispanic and Black candidates (p<0.05). In mixed models, residual variability in donor acceptance was observed at the transplant center (SD 0.08% in the KFRP score) and provider levels (SD 0.04%) for those accepted as donors, without variability by donor ancestry.</p><p><strong>Conclusions: </strong>In this cohort, although fewer Black donor candidates were accepted for donation versus White and Hispanic candidates, accepted candidates had extremely low risk of developing ESKD within 15 years, regardless of ancestry. Variability across providers and transplant centers was observed, but absolute differences in their threshold of acceptance (or non-acceptance) were small. Our findings suggest that disparities in living donor access by donor ancestry are not explained by differences in system-level variations in practice.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111661","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 Cigarette Smoking among Living Donors on Kidney Transplant Graft Survival.","authors":"Machi Kaneko McBee, Daniel J Tancredi, Lavjay Butani","doi":"10.34067/KID.0000001402","DOIUrl":"https://doi.org/10.34067/KID.0000001402","url":null,"abstract":"<p><strong>Background: </strong>Current evidence on the impact of living donor smoking on kidney transplant outcomes is conflicting. This study aimed to evaluate the association between living donor smoking history and graft survival. We hypothesized that any donor smoking history is associated with increased risk of graft loss, but this risk is attenuated with donor smoking cessation, lower pack-year history and longer duration of smoking abstinence.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Organ Procurement and Transplantation Network database, including 88,490 individuals who underwent living donor kidney-only transplantation between June 2004 and June 2022. The exposure was living donor smoking history (ever vs never, former vs active, pack-year history, years of abstinence)The primary outcome was all-cause graft loss, analyzed using multivariable Cox proportional hazard models. Secondary outcomes of delayed graft function and first year acute rejection were analyzed using multivariable logistic regression.</p><p><strong>Results: </strong>Recipients of organs from donors with any smoking history had an increased risk of all-cause graft loss (HR: 1.13 [1.09-1.16], p<0.001) and first year acute rejection (OR: 1.18 [1.11-1.25], p<0.001). Compared to never smokers, both active and prior smoking in the donor was associated with a higher hazard of graft loss (HR:1.19 [1.13-1.25] and 1.10 [1.07-1.14], respectively, both p<0.001), with higher hazard in active vs. prior (p=0.02). Grafts from donors with >20 pack-year smoking history experienced the highest risk of graft loss (HR: 1.29 [1.21-1.37], p<00.1), delayed graft function (OR: 1.24 [1.03-1.49], p=0.001), and acute rejection (OR: 1.31 [1.16-1.50], p<0.001).</p><p><strong>Conclusions: </strong>Cigarette smoking in living kidney donors is associated with modest increase in a risk for all-cause graft loss, with the greatest risk observed among recipients of grafts from donors with a significant pack-year smoking history.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111524","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":"Global Perspective on Glomerular Diseases in Australia.","authors":"Jack Rycen, Dharmenaan Palamuthusingam, Eoin Daniel O'Sullivan, Sarah Thang, Shaun Chandler, Kate J Robson, Monica Suet Ying Ng","doi":"10.34067/KID.0000001435","DOIUrl":"https://doi.org/10.34067/KID.0000001435","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111582","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":"Nutcracker Syndrome: The Nephrologist's Perspective.","authors":"Jose Arriola-Montenegro, Wisit Cheungpasitporn, Thom W Rooke, Heraldur Bjarnason, Marie C Hogan","doi":"10.34067/KID.0000001434","DOIUrl":"https://doi.org/10.34067/KID.0000001434","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111537","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":"Utilization of Health Care Resources for Kidney Care between 2014-2024: Telangana Perspective.","authors":"Manjusha Yadla, Priyadarshini John, Brian Rifkin","doi":"10.34067/KID.0000001433","DOIUrl":"https://doi.org/10.34067/KID.0000001433","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111618","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}