Kidney Medicine最新文献

{"title":"B-Cell Depletion in Glomerular Diseases: Not Always as Safe as We May Think","authors":"Decimo Silvio Chiarenza ,&nbsp;Enrico E. Verrina ,&nbsp;Carolina Bigatti ,&nbsp;Gianluca Caridi ,&nbsp;Agnese Spennacchio ,&nbsp;Xhuliana Kajana ,&nbsp;Massimiliano De Bortoli ,&nbsp;Paolo Cravedi ,&nbsp;Andrea Angeletti","doi":"10.1016/j.xkme.2026.101268","DOIUrl":"10.1016/j.xkme.2026.101268","url":null,"abstract":"<div><div>B-cell depletion with the chimeric anti-CD20 monoclonal antibody rituximab has revolutionized the treatment of glomerular diseases. Obinutuzumab, a type II glycoengineered anti-CD20 humanized monoclonal antibody, is increasingly being employed as an alternative to rituximab in the management of difficult-to-treat cases, due to deeper and more persistent B-cell depletion. However, its safety profile, especially in pediatric and young adults with glomerular diseases, remains to be fully elucidated.</div><div>Herein, we report 3 patients who developed severe hematologic toxicity after obinutuzumab infusion. Two patients with steroid-dependent nephrotic syndrome developed severe neutropenia (grade 4) at 4-6 weeks after obinutuzumab administration. Both cases were complicated by infections requiring antibiotic therapy, and 1 patient also required granulocyte colony-stimulating factor support. The third child, affected by membranous nephropathy, developed persistent normocytic anemia, necessitating chronic treatment with erythropoiesis-stimulating agents.</div><div>Cytopenia has been described in patients receiving obinutuzumab for the treatment of hematologic malignancies and in subjects with rheumatological conditions. In these conditions, obinutuzumab is often associated with other immune-targeting compounds. Herein, we show that such complication can occur also individuals with glomerular diseases receiving obinutuzumab as the sole treatment. This element should carefully considered when evaluating this treatment, especially for young patients.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101268"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165835","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":"Gender-related and Age-related Disparities in Prevalence of the Cardiovascular-Kidney-Metabolic Syndrome Among US Adults From 1999-2020: An Analysis of the NHANES Survey","authors":"Zhejia Tian ,&nbsp;Samira Soltani ,&nbsp;Johann Bauersachs ,&nbsp;Kai M. Schmidt-Ott ,&nbsp;Anette Melk ,&nbsp;Bernhard M.W. Schmidt","doi":"10.1016/j.xkme.2025.101234","DOIUrl":"10.1016/j.xkme.2025.101234","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objectives&lt;/h3&gt;&lt;div&gt;The cardiovascular-kidney-metabolic (CKM) syndrome is defined as the intricate interplay among metabolic risks, chronic kidney disease (CKD) and the cardiovascular system. The deteriorating CKM syndrome contributes to untimely morbidity and mortality. We aim to characterize gender- and age-related disparities in the prevalence of CKM syndrome over the last 2 decades.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A cross-sectional population-based survey.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;A total of 32,848 US adults participating in the NHANES survey from 1999 to 2020.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;div&gt;Gender, age (18-44, 45-64, and ≥65), and period (1999-2002, 2003-3008, 2009-2014, and 2015-2020).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Prevalence of CKM stages.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical approach&lt;/h3&gt;&lt;div&gt;Sample weights and Taylor series linearization method were applied to estimate prevalence and standard errors representative of the noninstitutionalized US adult population. For trend analysis across cycles, survey-weighted logistic regression was employed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Young women aged &lt; 45 years were classified more often, but with decreasing prevalence, in stages without CKM defining factors (22.7% of women vs 13.5% of men) and more often in stages with cardiovascular organ damage (13.4% of women vs 6.5% of men). Elderly women were increasingly classified in stages with cardiovascular organ damage over the last 20 years, reaching the same prevalence as men in the most recent period (25.3 % [95% CI, 20.0 %-30.6 %] of women vs 30.5 [95% CI, 25.7-35.3%] of men aged &gt; 65 years).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;NHANES data allow for assessing CKM stages with cardiovascular organ damage mainly based on self-reporting during interviews.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;We demonstrate an increasing proportion of women in advanced CKM stages over the last 20 years. Whereas the overrepresentation of younger women in the low-risk stages almost disappeared, elderly women in the last period showed almost the same risk of being in stages with cardiovascular organ damage as elderly men. Our analysis highlights an urgent need of preventive measures especially tailored to women.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-language Summary&lt;/h3&gt;&lt;div&gt;Cardiovascular-kidney-metabolic (CKM) syndrome describes the combined impact of heart, kidney, and metabolic health on overall well-being. We examined its prevalence among US adult population and explored differences between women and men across different age groups, using data from over 32,000 adults collected from 1999 to 2020. The results showed that younger women under 45 years were previously more likely to be in the low-risk group; however, this advantage has declined over the past 20 years. Among older adults (over 65 years), women had a comparable risk to men for organ damage associated with cardiovascular-kid","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101234"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081234","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":"Open-label Randomized Controlled Trial of Controlled-release Formulation Budesonide in Indian Proteinuric IgA Nephropathy Patients","authors":"Pradeep Das,&nbsp;Arpita Ray Chaudhury,&nbsp;Saugat Dasgupta,&nbsp;Koushik Bhattacharya,&nbsp;Atanu Pal,&nbsp;Dipankar Sircar,&nbsp;Debabrata Sen","doi":"10.1016/j.xkme.2025.101166","DOIUrl":"10.1016/j.xkme.2025.101166","url":null,"abstract":"<div><h3>Introduction</h3><div>IgA nephropathy (IgAN) in India is reported to have an onset at a younger age with faster progression to kidney failure requiring replacement therapy, where safe immunosuppression may improve the outcome. The gut-renal connection and multihit pathogenesis of IgAN targeted by an oral targeted-release formulation of budesonide available in the Western world showed that the molecule is safe and effective. In this study, we aimed to assess the safety and efficacy of oral controlled-release budesonide preparation in Indian patients with IgAN.</div></div><div><h3>Methods</h3><div>We report a single-center open-label randomized controlled trial conducted in a tertiary care hospital in Eastern India, where adult patients with biopsy-proven IgAN with proteinuria &gt; 1 g and estimated glomerular filtration rate (eGFR) &gt; 45 mL/min/1.73 m² were included after they had completed a run-in phase of 6 months with a maximized dose of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker. 53 patients were randomized to the control (26, only therapy angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, standard-of-care [SOC]) and intervention arms (27, 18 mg budesonide daily on top of SOC). The primary outcome was efficacy evaluation in terms of change in proteinuria and eGFR in the intervention arm; secondary outcomes mainly included treatment-emergent adverse events.</div></div><div><h3>Results</h3><div>All baseline parameters, including blood pressure, glycemic status, 24-hour urine protein levels, and eGFR, were comparable in both arms. At the end of 9 months, the mean 24-hour proteinuria was lower (<em>P</em>-value &lt; 0.001) and the mean eGFR was significantly better (<em>P</em>-value &lt; 0.001) in the intervention arm receiving budesonide plus SOC than in the control arm receiving only SOC. The total incidence of treatment-emergent adverse events was similar across both groups.</div></div><div><h3>Conclusions</h3><div>Controlled-release budesonide may be considered an effective and safe disease-specific therapy in Indian patients with IgAN.</div></div><div><h3>Plain-Language Summary</h3><div>The need for safe, effective and cost-friendly immunosuppression for IgA nephropathy in India had inspired this randomized controlled study in a subset of IgAN patients with eGFR &gt;45 ml/min and proteinuria&gt; 1 gm/day, where the intervention arm received 18 mg of controlled released budesonide on top of SOC that includes maximised ACEI /ARB and the other arm received SOC only. Controlled released budesonide was safe and well tolerated and satisfied the need for significant proteinuria reduction and eGFR improvement, the two important surrogate markers of long term outcome in IgA nephropathy. It may be considered as safe cost-friendly alternative of TRF budesonide formulation, proved effective in similar clinical scenario of Western world.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101166"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326640","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 Analysis of a Novel Pathogenic Glycine Amidinotransferase Mutant in Hereditary Fanconi Syndrome","authors":"Shunsuke Takayanagi ,&nbsp;Keita P. Mori ,&nbsp;Youngna Kang ,&nbsp;Mitsugu Araki ,&nbsp;Shigeyuki Matsumoto ,&nbsp;Yukari Sagae ,&nbsp;Nana Sakakibara ,&nbsp;Tomoko Horinouchi ,&nbsp;Yoshiaki Higashi ,&nbsp;Tomomi Endo ,&nbsp;Eri Muso ,&nbsp;Kandai Nozu ,&nbsp;Yasushi Okuno ,&nbsp;Motoko Yanagita ,&nbsp;Takeshi Matsubara ,&nbsp;Tatsuo Tsukamoto","doi":"10.1016/j.xkme.2026.101267","DOIUrl":"10.1016/j.xkme.2026.101267","url":null,"abstract":"<div><div>The mutant glycine amidinotransferase (GATM) protein polymerizes into a characteristic crystal, resulting in mitochondrial dysfunction in proximal tubules and Fanconi syndrome with progressive kidney failure. We identified a novel hereditary Fanconi syndrome characterized by mutant GATM proteins in a Japanese family, the first in Asia. Kidney biopsies exhibited typical histological features, confirmed by immunofluorescent staining with anti-GATM and anti-ATP synthase β subunit (ATPB) antibodies and electron microscopy. Quantitative immunofluorescence analysis showed a significant correlation between ATPB and GATM–ATPB colocalization, suggesting mitochondrial pathogenicity of the mutant. Previously reported GATM mutations, clustered in the fourth of 5 β-sheets of the GATM protein, are assumed to have increased adhesive properties, changing the β-sheet from its original dimeric form to a unique polymerization. Targeted panel sequencing showed a novel mutation (Q268E) in the <em>GATM</em> gene (NM_001482.3: c.802C&gt;G), distinct from this sheet. Because conventional methods failed to detect the significance, we employed an advanced molecular dynamics approach—hypersound-perturbed molecular dynamics simulations. This analysis effectively demonstrated that the Q268E mutation enhanced conformational flexibility of region-spanning residues that are spatially positioned between the mutated site and the sheet, leading to the pathological polymerization of the mutant protein. This simulation offers valuable insights into the pathological mechanisms of abnormal protein conformation.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101267"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147355560","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":"Multifactorial Predictors of Renal Outcomes in Alport Syndrome: Integrating Genetic, Clinical, and Cystic Phenotypes","authors":"Zhuo-ran Song ,&nbsp;Yang Li ,&nbsp;Zhi-ying Liu ,&nbsp;Meng-shi Li ,&nbsp;Yu-qing Chen ,&nbsp;Ji-cheng Lv ,&nbsp;Xu-jie Zhou ,&nbsp;Hong Zhang","doi":"10.1016/j.xkme.2026.101264","DOIUrl":"10.1016/j.xkme.2026.101264","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Alport syndrome is an inherited kidney disease with significant clinical heterogeneity. This study aims to explore risk factors affecting the prognosis and investigates the relationship between kidney cysts and clinical manifestations in patients with Alport syndrome.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;A single-center retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;A total of 179 patients diagnosed with Alport syndrome in Peking University First Hospital.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Predictors&lt;/h3&gt;&lt;div&gt;Clinical characteristics (renal manifestations and extrarenal features), genetic patterns, and the presence of kidney cysts.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;Kidney failure with replacement therapy or chronic kidney disease stage 3b.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Kaplan-Meier survival analysis, Cox proportional hazards models, logistic regression models, and linear mixed models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In this Chinese adult Alport syndrome cohort, we identified several prognostic risk factors, including baseline serum creatinine (HR, 3.15; 95% CI, 1.95-5.08), proteinuria (HR, 1.29; 95% CI, 1.01-1.65), earlier diagnostic age (HR, 1.30; 95% CI, 1.16-1.45), male sex (HR, 3.00; 95% CI, 1.05-8.54), eye and ear impairment (HR, 19.49; 95% CI, 2.52-150.67), and inheritance mode (X-linked or autosomal recessive) (HR, 5.46; 95% CI, 1.47-20.30). Notably, 33.5% of patients with Alport syndrome presented with kidney cysts, compared with only 12.8% in the matched IgA nephropathy cohort (&lt;em&gt;P&lt;/em&gt; &lt; 0.001). The presence of kidney cysts was associated with older age and faster estimated glomerular filtration rate (eGFR) decline, independent of inheritance patterns. In patients aged less than 40 years, those with kidney cysts exhibited significantly worse renal function (median eGFR, 72 vs 108 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;; &lt;em&gt;P&lt;/em&gt; = 0.002) and a nearly 2-fold faster decline in eGFR slope.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Selection bias, absence of time-varying cyst observations, and limitations in generalizability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Our study reveals that kidney cysts are associated with severe clinical manifestations in Alport syndrome, particularly in younger patients. This finding highlights the importance of monitoring kidney cysts in patients with Alport syndrome and suggests their potential role as a prognostic indicator.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Alport syndrome, an inherited kidney disease, varies widely in severity, but the risk factors affecting outcomes and the role of kidney cysts remain unclear. We analyzed the medical records of 179 patients with Alport syndrome and found that more urinary protein, younger age at diagnosis, male sex, eye/ear impairment, and specific genetic patterns increased risks. Kidney cysts were common in patients with Alport syndrome and were linked to fa","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101264"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147326672","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":"An Unusual Case of 5-Oxoproline Acidosis","authors":"Nils Müller,&nbsp;Anne Krüger,&nbsp;Alexander Reshetnik","doi":"10.1016/j.xkme.2025.101236","DOIUrl":"10.1016/j.xkme.2025.101236","url":null,"abstract":"<div><div>Although metabolic acidosis is a common phenomenon, its differential diagnoses include a variety of rare conditions. Among the causes of high anion gap metabolic acidosis is an accumulation of 5-oxoproline or pyroglutamic acid. It is commonly understood that development can occur in the context of high-dose paracetamol intake and either relevant clinical risk factors or comedication with flucloxacillin or oxacillin. As a rare condition, it has become well-known only to specialized clinicians. We reported a case of high anion gap metabolic acidosis caused by 5-oxoproline in a middle-aged male treated only with high-dose flucloxacillin. Our patient had neither a history of paracetamol use nor classical risk factors to a degree, making the development of 5-oxoproline/pyroglutamic acidosis plausible. Although there have been plenty of case reports of this condition because of the coadministration of paracetamol/acetaminophen and flucloxacillin/oxacillin, to our knowledge, this is only the second published case of 5-oxoproline acidosis without paracetamol use, making it either highly unusual or potentially underdiagnosed. Therefore, we suggest considering 5-oxoproline/pyroglutamic acidosis when evaluating the etiology of metabolic acidosis in patients on high-dose flucloxacillin/oxacillin, even without a history of concomitant or previous paracetamol exposure or other classical risk factors.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101236"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081364","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":"Composite Primary Outcomes in Nephrology Clinical Trials","authors":"Steven Fishbane MD,&nbsp;Pratap Upadrista MBBS,&nbsp;Hitesh H. Shah MD","doi":"10.1016/j.xkme.2025.101231","DOIUrl":"10.1016/j.xkme.2025.101231","url":null,"abstract":"<div><div>Composite study endpoints have made it possible to reduce the sample size and lower the cost of certain clinical trials. In nephrology trials, the use of composite endpoints has led to opportunities but has also created challenges in the interpretation of study results. In this perspective, we review how composite outcomes work and why there are risks attendant to their use. We also provide examples of the use of composite outcomes from specific nephrology trials and certain problems that resulted.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101231"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081367","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":"How Far Is a Kidney Willing to Go? Kidney Transplant Outcomes Based on Distance Donor Kidney Travels to Transplant Centers","authors":"Nakul Datta ,&nbsp;Ahad Qureshi ,&nbsp;Mahsa Ebadyrad ,&nbsp;Phuong-Thu Thi Pham ,&nbsp;Anum Hamiduzzaman ,&nbsp;Afshin Pirzadeh ,&nbsp;Alexis Velazquez ,&nbsp;Suphamai Bunnapradist ,&nbsp;Erik L. Lum","doi":"10.1016/j.xkme.2026.101262","DOIUrl":"10.1016/j.xkme.2026.101262","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objectives&lt;/h3&gt;&lt;div&gt;There are growing concerns over inequities and inequality in deceased-donor kidney access. The current allocation system emphasizes distance from the kidney donor, resulting in geographic disparities in kidney transplantation. Increasing the priority radius for deceased-donor kidneys may improve access; however, increasing the distance a kidney travels increases cold ischemia time and may result in worse allograft outcomes. We examined whether donor kidney travel distance is associated with posttransplant outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;A total of 210,698 deceased-donor kidney transplants performed in the United States from 2000-2020 that were identified in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Distances were grouped ≤ 50, 50-200, 200-500, 500-1,000, 1,000-2,000, and &gt;2,000 nautical miles from the transplant center.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;The primary outcome was death-censored graft survival. Secondary outcome measures were delayed graft function, primary nonfunction, and posttransplant serum creatinine levels.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;The Cox regression model with the Breslow method for ties was used to analyze survival data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 210,698 deceased-donor kidney transplants were used in our analysis, and 15,147 kidney transplant recipients were eligible for the multivariable proportional hazard model. In total, 3,488 kidney transplant recipients experienced graft failure at 10 years. Geographic distance demonstrated no significant association with death-censored graft survival (hazard ratios [HRs] of 1.05, 1.11, 1.14, 1.03, and 0.80). Higher kidney donor profile index scores, recipient age, and presence of diabetes were associated with increased graft failure (HR, 1.52, 1.01, and 1.46, respectively). Preemptive transplant was associated with a reduced risk of graft failure (HR, 0.83).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Our study lacked organ discard rates and a limited number of high-kidney donor profile index scores and donations after cardiac death at longer distances.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Donor kidney travel distance was not associated with reduced long-term graft survival. Expanding allocation radius or implementing a national sharing system may improve equity in access without compromising outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Where a patient lives determines how long they have to wait for a deceased-donor kidney transplant. Currently, deceased-donor kidneys are prioritized for patients listed within 250 nautical miles of the deceased donor’s location. Our research examined whether the distance a kidney is transported results in worse organ survival. Our analysis of 2 deca","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101262"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147399571","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":"Response to Letter by Ito and Mori","authors":"Hongwei Zhao MD","doi":"10.1016/j.xkme.2026.101307","DOIUrl":"10.1016/j.xkme.2026.101307","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101307"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147399971","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":"When Hepatitis B Virus-Associated Glomerulonephritis Mimics Lupus Nephritis: A Case of Adult-Onset Disease With Full-House Pattern","authors":"Kei Kono ,&nbsp;Naoki Sawa ,&nbsp;Hiroki Mizuno ,&nbsp;Yuki Oba ,&nbsp;Noriko Inoue ,&nbsp;Akinari Sekine ,&nbsp;Kiho Tanaka ,&nbsp;Masayuki Yamanouchi ,&nbsp;Eiko Hasegawa ,&nbsp;Tatsuya Suwabe ,&nbsp;Satoshi Saitoh ,&nbsp;Takeshi Fujii ,&nbsp;Yutaka Takazawa ,&nbsp;Kenichi Ohashi ,&nbsp;Takehiko Wada ,&nbsp;Yoshifumi Ubara","doi":"10.1016/j.xkme.2026.101256","DOIUrl":"10.1016/j.xkme.2026.101256","url":null,"abstract":"<div><div>Although membranous nephritis represents the classic presentation of hepatitis B virus--associated glomerulonephritis (HBV-GN) in children, adult cases can exhibit quite different features. In 1992, a 41-year-old man with recurrent nephrotic syndrome since 20 years was admitted for renal evaluation and underwent kidney biopsy. Light microscopy showed periodic acid methenamine silver staining with spike formation consistent with membranous nephropathy. However, electron microscopy demonstrated large electron-dense deposits distributed throughout subepithelial, subendothelial, and mesangial areas—an unusual pattern. Immunofluorescence showed a complete “full-house” pattern with positive staining for immunoglobulin (Ig)G (IgG2-IgG4), IgA, IgM, C3, C4, and C1q along the glomerular basement membrane. These findings initially suggested lupus nephritis, but comprehensive autoimmune testing proved negative, including antinuclear antibodies and anti--double-stranded DNA antibodies, with no characteristic clinical manifestations. Further evaluation showed positive serum HBV e antigen and DNA polymerase. Crucially, tissue immunostaining confirmed HBV e antigen deposition along the glomerular basement membrane, with high-magnification electron microscopy revealing virus-like particles, establishing the diagnosis of HBV-GN. Unlike the typical membranous pattern seen in pediatric HBV-GN, this adult case demonstrated lupus-like features with diverse glomerular lesions. To our knowledge, this represents the first English-language publication of this diagnostically challenging case, highlighting the need for heightened awareness of atypical adult HBV-GN presentations.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 3","pages":"Article 101256"},"PeriodicalIF":3.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147399972","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}