Kidney360最新文献

{"title":"Female Reproductive Health in Kidney Disease.","authors":"Mahua Bhaduri, Ippokratis Sarris, Kate Bramham","doi":"10.34067/KID.0000001409","DOIUrl":"https://doi.org/10.34067/KID.0000001409","url":null,"abstract":"<p><p>Female reproductive health is an important yet frequently neglected component of care in women with CKD. As the global burden of CKD rises, increasing numbers of women of reproductive age are affected, with consequences across the reproductive lifespan, including fertility, menstruation, sexual function, contraception, pregnancy and menopause. CKD disrupts normal reproductive physiology through complex and multifactorial mechanisms. The hypothalamic-pituitary-ovarian axis is often affected in CKD. Loss of pulsatile gonadotrophin-releasing hormone (GnRH) secretion and hyperprolactinemia can lead to hormonal dysregulation and menstrual irregularities. Additional mechanisms contributing to reduced fertility include diminished ovarian reserve, altered endometrial receptivity and reproductive decision-making influenced by chronic illness. Chronic inflammation, a hallmark of CKD, may also negatively affect reproductive health. Together, these factors contribute to reduced fertility, menstrual abnormalities, premature menopause and sexual dysfunction; all of which can adversely affect quality of life and long-term health outcomes. Many nephrologists report feeling ill-equipped to counsel patients on reproductive decision-making, contraception and fertility preservation, highlighting an important gap in clinical care. The use of gonadotoxic therapies, such as cyclophosphamide, further complicates reproductive planning. Early counselling and consideration of fertility preservation strategies, including GnRH agonists and oocyte cryopreservation, are therefore important.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017227","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":"Women's Health Issues in Transplant.","authors":"Priyanka Jethwani, Arundati Rao","doi":"10.34067/KID.0000001406","DOIUrl":"https://doi.org/10.34067/KID.0000001406","url":null,"abstract":"<p><p>Women with ESKD experience unique issues in their journey towards, and after kidney transplant that impact their quality and longevity of life. Women have disparate access to transplantation and once transplanted, face reproductive challenges and increased gynecologic cancer risk. In addition, they are more susceptible to other systemic consequences of immunosuppression such as bone disease, urinary tract infections, cosmetic issues, and weight gain. They are also more likely to experience allograft loss than their male counterparts. This publication aims to provide a comprehensive review of each of these aspects of women's health post-transplant and raise awareness amongst professionals delivering care to female transplant recipients.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017308","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":"Kidney Consequences of Anti-Cancer Treatment for Female-Specific Cancers.","authors":"Emily M Moss, Mariya Rozenblit, Teresa Joseph","doi":"10.34067/KID.0000001206","DOIUrl":"https://doi.org/10.34067/KID.0000001206","url":null,"abstract":"<p><p>A greater understanding of cancer biology has paved the way for new anti-cancer treatment regimens. While these regimens show great promise in treatment of local and advanced cancers, they are associated with unique toxicities involving every organ system. In this review, we focus on the kidney-specific adverse effects of treatments targeted toward female-specific cancers including breast, endometrial, ovarian, uterine, vaginal and vulvar cancers. Drug regimens used for each subtype of cancer will be reviewed followed by their specific kidney-related toxicities. The most common renal adverse effects include acute kidney injury and electrolyte disorders. Glomerular disorders and thrombotic microangiopathies are present but less common.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017273","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":"Cardiovascular-Kidney-Metabolic Syndrome in Women: Bridging Nephrology and the Female Cardiometabolic Disparity.","authors":"Rebecca Kurian, Shiwani Mahajan, Menaka Sarav","doi":"10.34067/KID.0000001404","DOIUrl":"https://doi.org/10.34067/KID.0000001404","url":null,"abstract":"<p><p>The American Heart Association (AHA) introduced Cardiovascular-Kidney-Metabolic (CKM) syndrome to characterize a systemic disorder resulting from interconnected metabolic risks, CKD, and cardiovascular disease (CVD). The CKM Presidential Advisory outlines a five-stage framework (Stages 0-4) that categorizes individuals based on disease progression, risk, and opportunities for prevention or intervention. This framework is particularly significant for women, as sex-specific risk enhancers, including premature menopause and adverse pregnancy outcomes, influence CKM stage classification and long-term outcomes. The AHA PREVENT Scientific Statement presents PREVENT risk equations, which are sex-specific, race-neutral models designed to estimate absolute 10- and 30-year risk for total CVD, encompassing both atherosclerotic CVD and heart failure. These equations help clinical teams implement CVD prevention strategies and customize risk-reducing interventions. This review will focus on the impact of CKM syndrome in women, examine gaps in the current risk stratification and diagnostic strategy, and identify opportunities to improve prevention and management in this population.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017155","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":"Reframing Women's Health in Kidney Disease: Sex Differences, Gender Disparities, and Clinical Imperatives - Introduction to a Special Series.","authors":"Menaka Sarav, Ladan Golestaneh, Ursula C Brewster","doi":"10.34067/KID.0000001387","DOIUrl":"https://doi.org/10.34067/KID.0000001387","url":null,"abstract":"<p><p>Kidney disease has often been approached as affecting women and men similarly, yet important differences in sex-specific biology and gender-related social experiences shape risk, recognition, and treatment for women with CKD. Women more commonly have early-stage CKD but progress more slowly to kidney failure, a pattern influenced by hormonal factors and complicated by diagnostic practices that may delay detection. Evidence also suggests women receive lower-quality CKD care than men, including fewer nephrology referrals and lower use of guideline-recommended therapies. Pregnancy-related exposures, particularly adverse pregnancy outcomes such as preeclampsia, are associated with substantially increased long-term risk of CKD and ESKD, yet structured postpartum kidney follow-up is uncommon. Menopause may represent a key inflection point for CKD progression and bone health. Additional disparities affect transplant access, and cancer survivorship introduces underrecognized renal risks. This special series examines these life stages and clinical domains and outlines practice-relevant, sex- and gender-informed approaches to improve equity and outcomes.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017268","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":"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":"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}