Kidney360最新文献

{"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}

{"title":"Global Perspective on Kidney Transplantation: Portugal.","authors":"Miguel Bigotte Vieira, Carla Nicolau, Cristina Jorge, Aníbal Ferreira","doi":"10.34067/KID.0000001427","DOIUrl":"https://doi.org/10.34067/KID.0000001427","url":null,"abstract":"","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081369","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":"Rapid Genome and Exome Sequencing as a First-Line Diagnostic Tool for Hospitalized Pediatric Kidney Disease Patients.","authors":"Jonathan Marquez, Abbey A Scott, Lukas Kruidenier, Penny Chow, Jennifer C Hayek, Anita E Beck, Margaret P Adam, James T Bennett, Ian A Glass, Katrina M Dipple, Tara L Wenger, Elizabeth D Nguyen, Alexandra C Keefe","doi":"10.34067/KID.0000001385","DOIUrl":"https://doi.org/10.34067/KID.0000001385","url":null,"abstract":"<p><strong>Background: </strong>Previous efforts have demonstrated the utility of exome sequencing approaches in improving diagnosis and management of kidney diseases with underlying genetic etiologies. Rapid clinical genome sequencing is increasingly used as a first line clinical diagnostic modality in the inpatient setting, yet its utility for individuals with kidney disease has not been examined.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of pediatric inpatients with structural kidney abnormalities, pathological microscopic kidney abnormalities, and/or laboratory evidence of kidney disease who underwent rapid clinical genome or exome sequencing while hospitalized at a single tertiary pediatric center over a 42-month period. Diagnostic yield and the impact of genetic diagnoses on inpatient clinical management were assessed.</p><p><strong>Results: </strong>We identified 77 pediatric patients who met the study criteria, ranging in age from 1 day to 17 years at time of testing. Genetic variants considered explanatory or likely explanatory of the patient's phenotype were identified in 47% (36/77) of cases. Results spanned monogenic disorders caused by single nucleotide variants to multi-gene disorders ranging from large deletions or duplications, with explanatory findings across three defined categories (macroscopic, microscopic, and other). Among individuals given a genetic diagnosis, 92% (33/36) had results that were clinically actionable beyond disease-specific guidance, resulting in modifications to clinical management including targeted laboratory evaluations, imaging studies, subspecialty referrals, and initiation of gene-targeted therapies.</p><p><strong>Conclusions: </strong>Rapid exome or genome sequencing for pediatric inpatients with kidney disease yielded a diagnosis in 47% of cases, with high rates of actional clinical impact during the initial hospital admission.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081415","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 Polycystic Kidney Disease Cyst Transcriptome Defined by Integrating Spatial, Single Nuclear, and Bulk Transcriptomics.","authors":"Muhammad Ibrahim Khan, Jielu Hao Robichaud, Humayra Afrin, Fouad T Chebib, Peter C Harris, Navin R Gupta","doi":"10.34067/KID.0000001371","DOIUrl":"https://doi.org/10.34067/KID.0000001371","url":null,"abstract":"<p><strong>Background: </strong>Autosomal dominant polycystic kidney disease (ADPKD) has been transcriptionally profiled at single cellular resolution, yet dissociation eliminated cyst-defining morphology to preclude a retrograde analysis of the cyst transcriptome. Transcriptional profiling of dissected ADPKD cysts has demonstrated size-based transcriptional heterogeneity, impossible to define in prior single cell analysis, but sampling was neither single cell nor comprehensive to limit downstream transcriptional analysis.</p><p><strong>Methods: </strong>10X Genomics Visium spatial transcriptomics of an autosomal dominant polycystic kidney disease patient sample morphologically recognizes cysts to spatially characterize their ligand-receptor engagement, the signaling pathways of cystic transformation, and candidate cystic anchor genes that are specific and sensitive for cystic epithelia. Anchor gene validation in single nuclear RNA sequencing and cyst bulk RNA sequencing enhanced resolution, extended to cysts of variable size, and corroborated across ADPKD samples, prior to confirmatory confocal microscopy for protein-level localization.</p><p><strong>Results: </strong>The polycystic kidney disease interactome may be enriched for vscular endothelial growth inhibitor-mediated hypoxia, fibrotic extracellular matrix, and proinflammatory transforming growth factor-β (TGF-β), tumor necrosis factor, and interferon-γ signaling. Enhanced ligand-receptor engagement between cysts and fibroblasts suggests Osteopontin and Macrophage migration inhibitory factor signals emanate from cysts and TWEAK, Tenascin-C, and Pleiotrophin signals into cysts. Cystic principal cells, standardized to non-cystic counterparts, implicates Hippo (YAP/TAZ), transforming growth factor-β (TGF-β/SMAD3), and mammalian target of rapamycin (mTORC2/SGK1) signaling in cystic transformation, while pathway analysis newly implicates nicotinic acetylcholine, cadherin, toll-like, and cholecystokinin receptor signaling. Top DEGs of cystic principal cells, interrogated for their specificity for cysts and their consistency across individual samples of single cell and cyst bulk RNA-seq, prioritizes musculin as a cystic anchor gene.</p><p><strong>Conclusions: </strong>Spatial transcriptomics morphologically and transcriptionally characterizes the polycystic kidney disease transcriptome. Ligand-receptor, pathway, and reactome analyses may provide clinically-relevant disease associations that inform mechanistic studies in animal and organoid models. Integrating spatial, single nuclear, and cyst bulk RNA-seq spatially recognizes cysts at single cell resolution, while accounting for size-based heterogeneity of cysts.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075182","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":"Online Kidney Transplant Information in the United States: A National Readability Analysis of Transplant Center Websites.","authors":"Olena Holub, Divya Randhawa, Rebecca Allen, Aditya S Pawar, Keren Ladin, Devin Eckhoff, Alexei Nakonechnyi","doi":"10.34067/KID.0000001401","DOIUrl":"https://doi.org/10.34067/KID.0000001401","url":null,"abstract":"<p><strong>Background: </strong>Clear information is essential for patients navigating kidney transplantation, yet patient-facing materials may be difficult to understand. Patient education guidelines recommend reading levels near a sixth-grade level to support comprehension across diverse populations. This study evaluated readability of patient-directed content on United States kidney transplant center websites.</p><p><strong>Methods: </strong>Patient-facing webpages from United States kidney transplant programs were identified using a previously assembled national dataset. Website text was extracted and processed to isolate patient-directed educational content, excluding non-English pages and pages with fewer than five sentences. Readability was assessed using validated indices, including the Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook (SMOG), Gunning Fog Index, and a pretrained transformer-based readability model. Summary statistics characterized reading difficulty and proportion of webpages exceeding recommended levels.</p><p><strong>Results: </strong>A total of 92,461 English-language webpages from 194 transplant center websites were included. Median readability exceeded recommended levels across measures. At the webpage level, the median SMOG score was 14.69 (interquartile range, 13.01-16.63); >99% of webpages exceeded the recommended sixth-grade level, 98% exceeded tenth-grade level, 86% exceeded twelfth-grade level, and 61% exceeded fourteenth-grade level. Among the 144 eligible hosts, the median SMOG score was 14.92 (interquartile range, 14.11-15.45). Similar patterns were observed across the Flesch-Kincaid Grade Level, Gunning Fog Index, and transformer-based readability model, demonstrating consistent findings across methods.</p><p><strong>Conclusions: </strong>Patient-facing kidney transplant center websites were written at reading levels substantially exceeding recommended standards. This widespread, modifiable barrier in transplant center communication may limit patients' ability to understand transplant-related information.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075237","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":"Symptom Burden and Clinical Clues in Gitelman Syndrome and Pseudo-Gitelman Syndrome.","authors":"Yuta Inoki, Tomoko Horinouchi, Atsushi Kondo, Asahi Yamamoto, Shuhei Aoyama, Yuka Kimura, Hiroaki Hanafusa, Tomohiko Yamamura, Nana Sakakibara, China Nagano, Shingo Ishimori, Kandai Nozu","doi":"10.34067/KID.0000001384","DOIUrl":"https://doi.org/10.34067/KID.0000001384","url":null,"abstract":"<p><strong>Background: </strong>Gitelman syndrome and pseudo-Gitelman syndrome share overlapping biochemical abnormalities, complicating clinical differentiation and genetic testing allocation. While Gitelman syndrome impairs health-related quality of life (QOL), the comparable burden in pseudo-Gitelman syndrome remains unclear. We compared QOL burden and symptom profiles between individuals with genetically confirmed Gitelman syndrome and those classified as pseudo-Gitelman syndrome.</p><p><strong>Methods: </strong>We evaluated 128 participants aged ≥10 years referred for genetic testing due to suspected Gitelman syndrome (hypokalemia and metabolic alkalosis). Participants were divided into a Gitelman syndrome subgroup (genetically confirmed biallelic SLC12A3 variants; n=66) and a pseudo-Gitelman syndrome subgroup (no disease-causing variants; n=62). Seventy controls were frequency-matched to Gitelman syndrome by age and sex. QOL and clinical manifestations were assessed using a structured 21-item questionnaire covering taste, urinary, muscle, and nonspecific symptom domains. To limit false-positive findings from multiple comparisons, P values were adjusted using the Benjamini-Hochberg procedure; the resulting adjusted P values (q values) <0.05 were considered statistically significant.</p><p><strong>Results: </strong>Total QOL scores indicated significant and comparable impairment in both the Gitelman syndrome and pseudo-Gitelman syndrome subgroups versus controls (both q <0.001), with no significant difference between the affected groups (q = 0.33). Despite similar overall burdens, specific clinical features differed between the groups. Nocturnal enuresis scores were higher in Gitelman syndrome group than in pseudo-Gitelman syndrome group and controls (both q < 0.001); 50% of Gitelman syndrome participants reported persistence at least until elementary school entry. The taste-related domain was higher in Gitelman syndrome group than in pseudo-Gitelman syndrome group (q = 0.01), but no individual taste item differed after correction.</p><p><strong>Conclusions: </strong>Individuals with pseudo-Gitelman syndrome experienced QOL impairment comparable to those with genetically confirmed Gitelman syndrome. However, the severity and duration of nocturnal enuresis and overall taste-related symptom burden were prominent descriptive features of Gitelman syndrome. Systematic symptom assessment may contribute to a more comprehensive clinical characterization of individuals with suspected Gitelman syndrome.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030834","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":"Prevalence of Undertreated CKD among Hospital Inpatients: A Prospective Cross-Sectional Study.","authors":"Lucinda Wynter, Brendan Smyth, John Saunders, Carmen Moroney, Lilijana Gorringe, Kylie Turner, Sreeram Venugopal, Leyla Aouad, Lisa Tientstra, Rowena Monteverde, Amy Kang, George Mangos, Shaundeep Sen, Melanie Wyld, Sarah Norris, Steve Chadban","doi":"10.34067/KID.0000001323","DOIUrl":"https://doi.org/10.34067/KID.0000001323","url":null,"abstract":"<p><strong>Background: </strong>CKD affects 14% of adults in Australia and is frequently under-recognised or diagnosed in late stages when opportunities to prevent progression to kidney failure have been missed. Existing early identification programs target primary care or specific high-risk populations. Hospitalisation may present an opportunity to identify undertreated CKD. We hypothesise that there is a high prevalence of undertreated stage 3b-5 CKD among patients admitted to teaching hospitals in Sydney, Australia.</p><p><strong>Methods: </strong>We prospectively identified all adult patients with an eGFR < 45ml/min/1.73m2 admitted to hospital under a non-nephrology service, in six metropolitan hospitals from two health districts of Sydney, Australia, between March 2024-Feb 2025 inclusive. To identify those mostly likely to benefit from guideline directed medical therapy (GDMT) for CKD, we excluded those >80 years of age, pregnant, diagnosed with dementia, nursing home residents, who had a life-expectancy less than 2 years, or who had acute kidney injury. We extracted demographic, co-morbidity and medication data from the electronic medical record.</p><p><strong>Results: </strong>Among 77,447 patients, 11,243 (14.5%) had an eGFR < 45ml/min/1.73m2 on admission. After exclusions, 956 patients (1.2%) were included in the study. Median age was 75 years (IQR: 70,78), and participants had multiple co-morbidities including hypertension (78.1%), diabetes (40.7%), obesity (46.8%), coronary artery disease (34.6%) and heart failure (22.1%). CKD was documented in 24.2% and 5.8% had a urine albumin:creatinine (UACR) result available. Medications on admission included SGLT2 inhibitors (18.5%), renin-angiotensin blockers (52.1%), and statins (63.2%).</p><p><strong>Conclusions: </strong>Hospital admission represents a unique opportunity to identify undiagnosed and/or undertreated patients with mid to late-stage CKD. Interventions designed to detect and better manage this population warrant further investigation.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030829","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}