Kidney360最新文献

{"title":"Trichosporon austroamericanum Infection After Kidney Transplantation: A Six Case Series Revealing a Newly Recognized Pathogen with Allograft Tropism.","authors":"Justine Solignac, Tristan Legris, Amélie Poiré, Laurent Daniel, Marion Gully, Julie Bruno, Estelle Menu, Jacques Sevestre, Romain Boissier, Catherine Sartor, Stéphane Ranque, Valérie Moal","doi":"10.34067/KID.0000001340","DOIUrl":"https://doi.org/10.34067/KID.0000001340","url":null,"abstract":"<p><p>Trichosporon austroamericanum, described in 2024, closely related to T. inkin, expands the spectrum of Trichosporon species that cause life-threatening infections in immunocompromised patients, particularly solid organ transplant recipients. We describe the first case series of Trichosporon austroamericanum infections at kidney transplant (KT) surgical sites between 2022 and 2025 in Marseille, including two involving granulomatous kidney allograft infiltration, a previously unreported complication. Five patients presented with inflammatory surgical wounds and abscesses at the KT site within 6 to 16 weeks after KT. Four patients were successfully treated with surgical drainage and voriconazole. Two developed severe invasive infection with allograft fungal infiltration. The first developed fungemia and recurrent abdominal abscesses; the infection progressed despite therapy, with emerging multidrug resistance, ultimately resulting in death. The second presented with a late infection, 11 months post-KT, characterized by mycotic arteritis and septic emboli, requiring emergency transplantectomy. Despite 6 months of azole therapy, treatment was discontinued for severe hepatotoxicity progressing to cirrhosis, and the patient subsequently died from septic shock with acute-on-chronic liver failure. Environmental investigations identified a possible operating theatre contamination, although a definitive source could not be established. These cases highlight the pathogenic potential of T. austroamericanum, presenting as KT site infection, with possible allograft infiltration. Management should include early antifungal therapy-voriconazole as first-line for at least 4 weeks-combined with surgical debridement, and if possible, immunosuppression reduction.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002198","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":"Characterizing the Transcriptional Features that Underlie Established Injury and Disease Progression in Diabetic Kidney Disease.","authors":"Paraish S Misra, Shukai Huang, Lauren Caldwell, Xiaolin He, Tianzhou Zhang, Adriana Krizova, Kevin D Burns, Richard E Gilbert, Jeffrey L Wrana, Darren A Yuen","doi":"10.34067/KID.0000001319","DOIUrl":"https://doi.org/10.34067/KID.0000001319","url":null,"abstract":"<p><strong>Background: </strong>Diabetes is the leading cause of kidney failure in the developed world. Despite its importance, the molecular events driving the pathogenesis of diabetic kidney disease (DKD) remain incompletely understood. We thus sought to employ transcriptional profiling of kidney biopsy tissue to uncover relationships between transcriptional features and clinical parameters related to established kidney injury and disease progression.</p><p><strong>Methods: </strong>Using bulk RNA-seq, we comprehensively explored the human diabetic kidney transcriptome in the largest cohort of patients with DKD to be transcriptionally profiled to date. These data were combined with clinical indices of established injury (estimated glomerular filtration rate (eGFR), urinary albumin to creatinine ratio, interstitial fibrosis, and glomerulosclerosis) and disease progression (rate of eGFR decline and progression to end-stage kidney disease), and integrated with previously published mouse and human datasets to better delineate the transcriptional features that characterize this disease.</p><p><strong>Results: </strong>We profiled 50 diabetic kidney and 13 healthy control biopsies, identifying a global transcriptional signature of human diabetic kidney disease, which included nearly universal upregulation of NNMT and CD209, and downregulation of DUSP1. We next correlated the diabetic kidney transcriptome with parameters associated with established DKD injury, which we used to derive a molecular index of disease stage in DKD. Finally, using both the rate of eGFR decline and documented progression to kidney failure, we observed a novel association between slower progression of kidney disease and expression of genes related to intercalated cell functional identity, such as FOXI1 and subunits of the V-ATPase proton pump.</p><p><strong>Conclusions: </strong>In addition to shedding light on the molecular events underpinning its pathogenesis, our data will serve as a valuable resource to help accelerate the discovery of improved diagnostics and therapeutics for DKD.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983106","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":"Survival Outcomes with High-Volume Hemodiafiltration Versus High-Flux Hemodialysis in Incident Patients: A Multicenter Analysis Propensity Score Matched Study from the Argentine NEFRA Network.","authors":"Marcelo H Puddu, Marcelo D Ferder, Bernard Canaud","doi":"10.34067/KID.0000001333","DOIUrl":"https://doi.org/10.34067/KID.0000001333","url":null,"abstract":"<p><strong>Background: </strong>High-volume online hemodiafiltration has been associated with better outcomes compared with high-flux hemodialysis, but evidence from Latin America has been limited.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter cohort study including patients who initiated chronic dialysis between 01-Jan-2020 and 30-Sep-2022 across 84 clinics currently operated by NEFRA Medical Care. Patients receiving peritoneal dialysis, pediatric patients, and those with fewer than 90 days on dialysis were excluded to reduce early modality-instability bias and ensure sufficient time for treatment modality classification. The primary outcome was all-cause survival comparing hemodiafiltration with high-flux hemodialysis in the propensity score-matched cohort. Secondary and exploratory outcomes evaluated survival by delivered substitution volume and vascular access type. Propensity score matching used age, sex, diabetes, vascular access, and baseline laboratory values. Survival was estimated using Kaplan-Meier methods and compared using the log-rank test.</p><p><strong>Results: </strong>After matching, 1154 patients were included, with 577 per group. For the primary outcome, mean survival was longer with hemodiafiltration than with high-flux hemodialysis (1446 versus 1231 days; log-rank P < 0.001). For the secondary outcome, survival differed by substitution volume (log-rank P < 0.001), with the longest survival among patients receiving high-volume hemodiafiltration. In exploratory analyses, survival differed by vascular access type (log-rank P < 0.001), with the most favorable survival among patients receiving hemodiafiltration with an arteriovenous fistula.</p><p><strong>Conclusions: </strong>In this Argentine incident cohort, hemodiafiltration was associated with longer survival than high-flux hemodialysis. Higher substitution volume and arteriovenous fistula use were associated with the most favorable outcomes. Findings should be interpreted considering the observational design and potential residual confounding.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920251","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":"Prognostication of 90-day Kidney Function Recovery in Dialysis-Dependent Acute Kidney Injury from Outpatient Hemodialysis Records.","authors":"Seda Babroudi, Carolien C H M Maas, Hocine Tighiouart, Daniel E Weiner, Javier A Neyra, David M Kent, Ronald Sanders, Harold J Manley, Eduardo K Lacson, Charuhas V Thakar, David A Drew","doi":"10.34067/KID.0000001354","DOIUrl":"10.34067/KID.0000001354","url":null,"abstract":"<p><strong>Background: </strong>Prognostic uncertainty regarding kidney function recovery for individuals with acute kidney injury receiving outpatient dialysis (AKI-D) may delay appropriate care (e.g., placement of permanent dialysis access). Accordingly, we developed and internally validated a prediction model prognosticating recovery in dialysis-dependent AKI at 90 days from time of outpatient dialysis initiation.</p><p><strong>Methods: </strong>Using a national cohort of 2,544 incident outpatient in-center hemodialysis patients with AKI-D, we developed and internally validated a multivariable Cox proportional hazards model. The primary outcome was kidney function recovery to dialysis independence within 90 days of outpatient dialysis initiation. Candidate predictor variables included demographic, clinical, laboratory, and dialysis characteristics readily available in the electronic health record as part of usual outpatient dialysis care. We derived a parsimonious model using backward stepwise selection. Uniform shrinkage was employed to mitigate overfitting. Model performance was assessed through calibration and discrimination measured by Uno's C-index. Internal-external cross validation was employed to evaluate model performance and generalizability across geographic regions.</p><p><strong>Results: </strong>Among 2,544 individuals with AKI-D, 776 patients (cumulative incidence 34%, 95% confidence interval [CI]: [32% - 36%]) recovered kidney function within 90-days of outpatient dialysis initiation with median time-to-recovery (IQR) of 30 (26, 33) days. Ten predictor variables were retained in the final model, with the three most important predictors of kidney function recovery being: 1) serum creatinine; 2) interdialytic weight change; and 3) male sex. Internal-external cross validation suggested good generalizability across the geographical regions. The optimism-corrected Uno's C-index was 0.69 (95% CI, 0.67-0.71), with good calibration across regions.</p><p><strong>Conclusions: </strong>We developed and internally validated a multivariable Cox proportional hazards model that prognosticates 90-day kidney function recovery among patients with AKI-D in the first week of outpatient dialysis. Model performance measures were acceptable despite relying solely on predictor variables available as part of usual outpatient dialysis care.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920244","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 ProTreg21 Protocol: Phase I/IIa Regulatory T cell Therapy Clinical Trial in Deceased-Donor Kidney Transplantation.","authors":"Leila Amini, Jaspal Kaeda, Frank Konietschke, Brigitta Globke, Enrico Fritsche, Andy Roemhild, Daniel Kaiser, Anett Sefrin, Levent Akyuez, Philipp Haber, Paul Ritschl, Mira Choi, Isabel Michaela Lichy, Irena Goranova, Hans-Dieter Volk, Robert Öllinger, Petra Reinke","doi":"10.34067/KID.0000001349","DOIUrl":"https://doi.org/10.34067/KID.0000001349","url":null,"abstract":"<p><strong>Background: </strong>Long-term maintenance immunosuppression post kidney transplantation is associated with infection, malignancy, cardiovascular morbidity, and chronic nephrotoxicity. Adoptive autologous regulatory T-cell therapy may permit safer immunosuppression minimisation, but experience in deceased kidney transplantation remains limited.</p><p><strong>Methods: </strong>ProTreg21 is a single-centre, open-label, controlled phase I/IIa trial using a 3+3 single-ascending-dose design. Eligible adults aged 18-70 years undergoing primary deceased- donor kidney transplantation will receive low-dose rabbit anti-thymocyte globulin (Thymoglobulin; 1.5 mg/kg on days 0 and 1) and standard of care immunosuppression. In addition, participants in the investigational arm will receive a single infusion of ex-vivo expanded autologous polyclonal regulatory T cells (Treg02) at ascending doses of 0.5 × 106, 1 × 106, 3 × 106 cells/kg on day 16 (±2 days). The primary objective is to evaluate safety and tolerability; the primary endpoint is a protocol-defined Treg02 related defined dose-limiting toxicity within 14 days after infusion. Feasibility and longer-term safety will be secondary outcomes, whereas biopsy proven acute rejection, graft function, infection, malignancy, immunosuppression reduction, and immune biomarkers through week 60 will be exploratory outcomes.</p><p><strong>Results: </strong>Here we describe the approved trial protocol; no trial results are reported.</p><p><strong>Conclusions: </strong>ProTreg21 will establish whether Treg02 can be manufactured and administered safely following deceased donor kidney transplantation and will provide exploratory data to inform subsequent efficacy trials.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920182","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 Albumin-to-Creatinine Ratio Reveals Kidney Disease Improving Global Outcomes Risk Reclassification in Cardiovascular-Kidney-Metabolic-Era Community Screening.","authors":"Xiaomeng Mi, Suting Xiong, Wenshu Luo, Mingyang Ni, Wenguo Xu, Fang Yao, Wenchao Xu","doi":"10.34067/KID.0000001352","DOIUrl":"https://doi.org/10.34067/KID.0000001352","url":null,"abstract":"<p><strong>Background: </strong>Community cardiovascular-risk programs often rely on urine dipstick testing and eGFR. How often urine albumin-to-creatinine ratio (UACR) identifies kidney-risk signals missed by these pathways is uncertain.</p><p><strong>Methods: </strong>We conducted a cross-sectional screening-pathway analysis of the 2025 follow-up visit from a community cardiovascular high-risk project in Changzhou, China. Among 3,097 operationally eligible year-12 participants, 2,010 had first-morning void specimens with calculable UACR; 1,863 with complete UACR, eGFR, and baseline covariates were included in reclassification and strategy analyses. Elevated UACR was defined as >=30 mg/g; conventional screening as eGFR <60 ml/min per 1.73 m2 or dipstick-positive proteinuria.</p><p><strong>Results: </strong>Among 2,010 participants with calculable UACR, mean age was 67 years and 923 (46%) were female. Elevated UACR was present in 737 (37%). Dipstick protein positivity had sensitivity of 34% (95% CI, 30%-37%) and specificity of 95%; 490 of 737 UACR-positive participants (66%) were dipstick-negative. Overall, 438 participants were dipstick-negative, had eGFR >=60 ml/min per 1.73 m2, and had UACR >=30 mg/g, representing 59% of elevated-UACR cases. Among 1,552 complete-case participants not flagged by conventional screening, 438 (28%) were reclassified to UACR A2/A3 and 34 (2%) to KDIGO high risk.</p><p><strong>Conclusions: </strong>In this cardiovascular high-risk community follow-up cohort, adding first-morning UACR to eGFR/dipstick screening identified substantial screening-detected albuminuria and changed KDIGO risk classification. In similar high-risk follow-up programs, quantitative UACR may be considered earlier than dipstick/eGFR-only pathways, while abnormal single-visit results require confirmation.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912698","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":"Use of Telemedicine and Surrogate Health Outcomes in In-Center Hemodialysis.","authors":"Jingbo Niu, Omar Rosales, Abiodun Oluyomi, Susie Q Lew, Glenn M Chertow, Wolfgang C Winkelmayer, Kevin F Erickson","doi":"10.34067/KID.0000001368","DOIUrl":"https://doi.org/10.34067/KID.0000001368","url":null,"abstract":"<p><strong>Background: </strong>In March 2020, responding to the COVID-19 pandemic, US public health emergency waivers enabled kidney care providers (nephrologists and advanced practice providers) to substitute face-to-face in-center hemodialysis visits with telemedicine encounters.</p><p><strong>Methods: </strong>We merged an electronic health records database from dialysis patients at clinics owned by DaVita Inc. with Medicare claims-based records. We identified dialysis patients in the first six months of the pandemic. Kidney care providers were divided into those who used telemedicine frequently (above median) versus less frequently (below median) during the first three months of the pandemic. In multivariable regression models controlling for patient, kidney care provider, dialysis facility, and geographic characteristics, and the value of each outcome prior to the pandemic, we examined associations among telemedicine use by kidney care providers and hemodialysis-related surrogate health outcomes.</p><p><strong>Results: </strong>We identified 782 kidney care providers who saw patients at DaVita facilities from 4/2020-9/2020. Higher intensity (vis-à-vis telemedicine) kidney care providers documented the use of telemedicine in 86% (Standard Deviation (SD) 16%) of patients in the first three months of the pandemic, while lower intensity providers documented its use in 15% (SD 13%) of patients. Higher telemedicine use was associated with a 0.7% (95% confidence interval (CI), 0.1%-1%) reduction in the absolute probability of having a serum albumin <3.5 g/dl and a 1% (CI 0.2%-3%) reduction in the absolute probability of having a serum phosphate >5.5 mg/dl. Telemedicine use was not significantly associated with outcomes related to anemia management targets, blood pressure, dialysis efficiency, interdialytic weight gain, and dialysis prescription changes.</p><p><strong>Conclusions: </strong>Patients of providers who used telemedicine more frequently had slightly better surrogate outcomes in nutritional parameters, but not in other dialysis-related health outcomes. These findings suggest that telemedicine can be employed for in-center hemodialysis visits without compromising conventional metrics of the quality of hemodialysis care.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912786","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":"Functional Kidney Stress Testing with Multiparametric Magnetic Resonance Imaging and Oral Protein Loading.","authors":"T Corina Margain, Emily Powell, Jiachen Wang, Adam Bush","doi":"10.34067/KID.0000001395","DOIUrl":"https://doi.org/10.34067/KID.0000001395","url":null,"abstract":"<p><strong>Background: </strong>This prospective feasibility study evaluated a noninvasive kidney stress test using multiparametric MRI combined with an oral protein challenge to assess the renal blood flow response during renal functional reserve activation in healthy adults.</p><p><strong>Methods: </strong>Seventeen healthy participants underwent baseline and postprandial MRI at 30-60, 60-90, and 90-120 minutes following oral ingestion of animal protein (0.7 g/kg). MRI measurements included renal blood flow, T2* mapping, kidney volume, and cortical thickness. A subset of participants underwent a plant-based protein control experiment and test-retest studies at short- and long-term intervals. Changes from baseline were assessed using paired statistical tests, and reproducibility was evaluated using intraclass correlation coefficients.</p><p><strong>Results: </strong>After ingestion of animal protein ingestion there was a significant increase in renal blood flow at all postprandial time points (mean change: +11 ± 6%, p < 0.001), with an early response observed within 30-60 minutes. Cortical T2* showed a modest increase (+5 ± 9%, p = 0.03), whereas the other parameters remained unchanged. No significant changes were observed following plant-based protein ingestion. Test-retest analysis demonstrated good reproducibility of the renal blood flow response to acute stress (ICC = 0.81).</p><p><strong>Conclusions: </strong>Multiparametric MRI combined with oral protein loading provides a feasible, noninvasive approach to assess renal functional reserve. The renal blood flow response is robust, reproducible and can be captured within 60 minutes of scan time. This imaging-based stress test offers a practical alternative to traditional methods and may enable early detection of impaired kidney function.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912615","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":"Validation of Prognostic Tools for Autosomal Dominant Polycystic Kidney Disease Progression in a Multiethnic South African Cohort ​.","authors":"Cedric Xavier M Kapche, Alain Assounga","doi":"10.34067/KID.0000001357","DOIUrl":"https://doi.org/10.34067/KID.0000001357","url":null,"abstract":"<p><strong>Background: </strong>Risk stratification in Autosomal Dominant Polycystic Kidney Disease (ADPKD) is essential for selecting candidates for disease-modifying therapies. However, established prognostic tools such as the Mayo Imaging Classification and Predicting Renal Outcome in Polycystic Kidney Disease (PROPKD) score rely on magnetic resonance imaging (MRI) and genotyping, which are often unavailable in resource-limited settings. Furthermore, these tools lack validation in African populations. We evaluated the utility of pragmatic, accessible prognostic markers in a multi-ethnic South African cohort.</p><p><strong>Methods: </strong>In this retrospective cohort study of 276 adults with ADPKD, we assessed two prognostic tools: a Modified PROPKD score (range 0-5; derived solely from age, sex, hypertension, and urological events, excluding genotype) and ultrasound-measured kidney length. The primary outcome was progression to End-Stage Kidney Disease (ESKD).</p><p><strong>Results: </strong>This was an ethnically diverse population (54% Black, 33% Indian/Asian, 8% White), mostly females. In multivariable Cox regression, the Modified Clinical PROPKD score strongly predicted ESKD (High-risk category: HR 4.34, 95% CI 2.88-6.71; p < 0.001), as did kidney length >16.5 cm (HR 1.87, 95% CI 1.32-2.64; p < 0.001). The Modified Clinical PROPKD score demonstrated moderate discriminative ability (AUC 0.66), numerically outperforming kidney length (AUC 0.61). The score's predictive performance was highest in Black patients (AUC 0.78) compared to White patients (AUC 0.51).</p><p><strong>Conclusions: </strong>A Modified PROPKD score was an independent predictor of ADPKD progression. Its superior performance in Black African patients supports that clinical phenotypes, particularly early-onset hypertension, are potent markers of disease severity in this demographic.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912777","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":"Metformin-Associated Lactic Acidosis and Relative Euglycemic Ketoacidosis Precipitated by a Glucagon-Like Peptide-1 Receptor Agonist: A Case Report and Literature Review.","authors":"Harsha Adnani, Zoya Ladiwala, Melinda Lee, Ami Patel, Joshua King, Matthew R Weir","doi":"10.34067/KID.0000001379","DOIUrl":"https://doi.org/10.34067/KID.0000001379","url":null,"abstract":"<p><p>Metformin-associated lactic acidosis (MALA) is an uncommon but often fatal complication of metformin therapy (incidence less than 10 per 100,000 patient-years; with a 30-50% mortality). MALA most commonly occurs with acute kidney injury, which impairs metformin excretion and inhibits mitochondrial complex I, shifting pyruvate metabolism toward lactate production. Euglycemic diabetic ketoacidosis (euDKA), classically defined as DKA with glucose below 250 mg/dL, is increasingly recognized not only with sodium-glucose cotransporter-2 (SGLT2) inhibitors but also with glucagon-like peptide-1 receptor agonists (GLP-1 RA) through appetite suppression, vomiting, and reduced intake. Concurrent MALA and ketoacidosis with relative euglycemia is exceedingly rare, with no published synthesis of such cases to guide recognition or management. We present a case of severe MALA with ketoacidosis and relative euglycemia in a 59-year-old woman with type 2 diabetes on metformin and tirzepatide, managed successfully with emergent sequential hemodialysis and high-dose continuous venovenous hemodiafiltration. We also review reported MALA cases with GLP-1 RA use to identify shared precipitants, risk factors, and outcomes. The key lesson is that, in patients on metformin and a GLP-1 RA, gastrointestinal side effects can precipitate MALA, while a disproportionately low glucose can mask the accompanying ketoacidosis. Recognizing this pattern demands early measurement of serum beta-hydroxybutyrate and prompt initiation of renal replacement therapy.</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":"148891897","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}