Kidney Medicine最新文献

{"title":"Urinary Oxalate Excretion During Pregnancy in Primary Hyperoxaluria Type 1: A Report of 4 Cases","authors":"Jing Miao ,&nbsp;Ramila A. Mehta ,&nbsp;Andrea Kattah ,&nbsp;Suzanne M. Norby ,&nbsp;John C. Lieske ,&nbsp;Dawn S. Milliner","doi":"10.1016/j.xkme.2024.100824","DOIUrl":"10.1016/j.xkme.2024.100824","url":null,"abstract":"<div><p>Primary hyperoxaluria (PH) is a rare genetic disorder characterized by excessive oxalate production because of specific gene defects. PH1 is the most prevalent type, causing recurrent kidney stone disease and often leading to chronic kidney disease and kidney failure. Our previous study suggested that pregnancy did not adversely affect kidney function in female patients with PH. In this study, we identified 4 PH1 cases with urinary oxalate (UOx) measurements during pregnancy from the Rare Kidney Stone Consortium and Oxalosis and Hyperoxaluria Foundation PH registry to investigate UOx levels during pregnancy in patients with PH1. The PH Registry is approved by the Institutional Review Board of Mayo Clinic (Rochester, MN). All 4 showed a decrease in UOx during pregnancy when compared with before pregnancy and after delivery. These findings contrast with those of the general population, in which the UOx tends to increase during pregnancy because of a simultaneous physiological increase in the glomerular filtration rate. Elucidating the mechanism underlying reduced UOx during pregnancy in PH1 could suggest novel PH therapies. These findings could also affect the clinical management and have implications regarding the safety of withholding novel PH1-directed molecular therapies that currently have uncertain safety profiles during pregnancy. We highlight the need for additional data on urinary changes in patients with PH and other populations while pregnant to clarify changes in UOx throughout pregnancy.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000359/pdfft?md5=73a5ee830a46c3856615d37d3421b04a&pid=1-s2.0-S2590059524000359-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Kidney Injury and Subsequent Kidney Failure With Replacement Therapy Incidence in Older Adults With Advanced CKD: A Cohort Study of US Veterans","authors":"Danira Medunjanin ,&nbsp;Bethany J. Wolf ,&nbsp;Roberto Pisoni ,&nbsp;David J. Taber ,&nbsp;John L. Pearce ,&nbsp;Kelly J. Hunt","doi":"10.1016/j.xkme.2024.100825","DOIUrl":"10.1016/j.xkme.2024.100825","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>Advanced age is a major risk factor for chronic kidney disease (CKD) development, which has high heterogeneity in disease progression. Acute kidney injury (AKI) hospitalization rates are increasing, especially among older adults. Previous AKI epidemiologic analyses have focused on hospitalized populations, which may bias results toward sicker populations. This study examined the association between AKI and incident kidney failure with replacement therapy (KFRT) while evaluating age as an effect modifier of this relationship.</p></div><div><h3>Study Design</h3><p>Retrospective cohort study.</p></div><div><h3>Setting &amp; Participants</h3><p>24,133 Veterans at least 65 years old with incident CKD stage 4 from 2011 to 2013.</p></div><div><h3>Exposures</h3><p>AKI, AKI severity, and age.</p></div><div><h3>Outcomes</h3><p>KFRT and death.</p></div><div><h3>Analytical Approach</h3><p>The Fine-Gray competing risk regression was used to model AKI and incident KFRT with death as a competing risk. A Cox regression was used to model AKI severity and death.</p></div><div><h3>Results</h3><p>Despite a nonsignificant age interaction between AKI and KFRT, a clinically relevant combined effect of AKI and age on incident KFRT was observed. Compared with our oldest age group without AKI, those aged 65-74 years with AKI had the highest risk of KFRT (subdistribution HR [sHR], 14.9; 95% CI, 12.7-17.4), whereas those at least 85 years old with AKI had the lowest (sHR, 1.71; 95% CI, 1.22-2.39). Once Veterans underwent KFRT, their risk of death increased by 44%. A 2-fold increased risk of KFRT was observed across all AKI severity stages. However, the risk of death increased with worsening AKI severity.</p></div><div><h3>Limitations</h3><p>Our study lacked generalizability, was restricted to ever use of medications, and used inpatient serum creatinine laboratory results to define AKI and AKI severity.</p></div><div><h3>Conclusions</h3><p>In this national cohort, advanced age was protective against incident KFRT but not death. This is likely explained by the high frequency of deaths observed in this population (51.1%). Nonetheless, AKI and younger age are substantial risk factors for incident KFRT.</p></div><div><h3>Plain Language Summary</h3><p>Older adults are at risk of acute kidney injury (AKI) and subsequent nonrecovery from AKI, resulting in long-term dialysis. Hospitalized patients have often been used in the past to study AKI. This could lead to biased conclusions when inferring from sicker populations. That is why we created a national cohort of 24,133 Veterans at least 65 years old with incident chronic kidney disease (CKD) stage 4 to examine the relationship between AKI and age and subsequent kidney failure with replacement therapy (KFRT). The data have showed that AKI and younger age are substantial risk factors for incident KFRT. As for older age, it appears to be protective against KFRT but not death. This is likely ex","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000360/pdfft?md5=053368f03f34f71c9c2f30ed6622d81a&pid=1-s2.0-S2590059524000360-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140777873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factor B Inhibition with Iptacopan in Recurrent C3 Glomerulopathy Following Kidney Transplant: A Report of Two Cases","authors":"Víctor J. Escudero-Saiz ,&nbsp;Ángela Gonzalez ,&nbsp;Adriana García-Herrera ,&nbsp;Ana B. Larque ,&nbsp;Andrew S. Bomback ,&nbsp;Laura Morantes ,&nbsp;Marta Martínez-Chillarón ,&nbsp;Júlia Ollé ,&nbsp;Elena Guillén ,&nbsp;Marc Xipell ,&nbsp;Alicia Molina-Andújar ,&nbsp;Diana Rodríguez ,&nbsp;Elena Cuadrado ,&nbsp;Judit Cacho ,&nbsp;Carolt Arana ,&nbsp;Núria Esforzado ,&nbsp;Carla Bastida ,&nbsp;Esteban Poch ,&nbsp;Fritz Diekman ,&nbsp;David Cucchiari ,&nbsp;Miquel Blasco","doi":"10.1016/j.xkme.2024.100823","DOIUrl":"10.1016/j.xkme.2024.100823","url":null,"abstract":"<div><p>C3 glomerulopathy is a rare disease caused by fluid phase dysregulation of the alternative complement pathway. Currently, treatment depends on clinical and histological severity and includes nephroprotection, unspecific immunosuppression, and terminal complement blockers (C5), without having an etiological treatment approved. C3 glomerulopathy has high recurrence rates after kidney transplantation with a high risk of graft loss. Fortunately, new molecules are being developed that specifically target the proximal alternative complement pathway, such as iptacopan, a factor B inhibitor that showed promising results in native kidneys and cases of transplant recurrence in a phase 2 clinical trial. We present 2 “real-world” cases of C3 glomerulopathy recurrence in kidney allografts treated with iptacopan, with initial excellent clinical response and safety profile, especially with early introduction. We also present follow-up biopsies that showed no C3 deposition during factor B inhibition. Our cases suggest that proximal blockade of the alternative complement pathway can be effective and safe in the treatment of C3 glomerulopathy recurrence in kidney transplantation, bringing other questions such as dual blockade (eg, in C3 and C5), the optimal patient profile to benefit from factor B inhibition or treatment duration and its potential use in other forms of membranoproliferative glomerulonephritis (eg, immune complex-mediated).</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000347/pdfft?md5=b44683c9a22345d8860e8aacf690c347&pid=1-s2.0-S2590059524000347-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140784489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pretransplant Treatment to Avoid Recurrent Membranous Nephropathy in a Kidney Transplant Recipient: A Case Report","authors":"Erik L. Lum ,&nbsp;Jonathan E. Zuckerman ,&nbsp;Lama Abdelnour ,&nbsp;Jennifer Terenzini ,&nbsp;Gurbir Singh ,&nbsp;Suphamai Bunnapradist","doi":"10.1016/j.xkme.2024.100822","DOIUrl":"10.1016/j.xkme.2024.100822","url":null,"abstract":"<div><p>Kidney transplant candidates with high anti–M-type phospholipase A2 receptor antibody activity may be at increased risk for early postkidney transplant recurrence and allograft loss. Pretransplant treatment to induce serological remission may be warranted to improve allograft survival. In this case report, a patient seeking their third kidney transplant, who lost 2 prior living donor transplants from early recurrent membranous nephropathy, underwent pretransplant treatment for membranous nephropathy with serological remission and no evidence of recurrent disease.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000335/pdfft?md5=d3c1b89f91dbce73ccd3cf483f24a0e1&pid=1-s2.0-S2590059524000335-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"23NaMRI Assessed Cyst Sodium Concentration in Polycystic Kidney Disease to Identify Cyst Metabolic Activity: A Proof of Concept Study","authors":"Sandrine Lemoine MD, PhD ,&nbsp;Alireza Akbari PhD ,&nbsp;Christopher W. McIntyre MD, PhD","doi":"10.1016/j.xkme.2024.100820","DOIUrl":"10.1016/j.xkme.2024.100820","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000311/pdfft?md5=e17dc9ac5310362bbe139fda111ca146&pid=1-s2.0-S2590059524000311-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140767254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Recognizing Pain in Patients With Autosomal Dominant Polycystic Kidney Disease","authors":"Paul Geertsema ,&nbsp;Ruud Stellema ,&nbsp;Niek F. Casteleijn","doi":"10.1016/j.xkme.2024.100821","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100821","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000323/pdfft?md5=0652c7dea5f9ce7a0d088be96ceccd32&pid=1-s2.0-S2590059524000323-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140605915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deprescribing in Dialysis: Operationalizing “Less is More” Through a Multimodal Deprescribing Intervention","authors":"Madhusudan Vijayan ,&nbsp;Dinushika Mohottige","doi":"10.1016/j.xkme.2024.100819","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100819","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259005952400030X/pdfft?md5=e2bab604ce60210e9d412dc1904df102&pid=1-s2.0-S259005952400030X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140640943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine Ratio","authors":"Avry Chagnac ,&nbsp;Allon N. Friedman","doi":"10.1016/j.xkme.2024.100804","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100804","url":null,"abstract":"<div><p>An increased urinary albumin excretion rate is an important early risk factor for chronic kidney disease and other major outcomes and is usually measured using the urinary albumin-creatinine ratio (ACR). Obesity is highly prevalent in the general and chronic kidney disease populations and is an independent risk factor for moderately increased albuminuria (henceforth, moderate albuminuria). In this review, we describe how the ACR was developed and used to define moderate albuminuria. We then investigate how biases related to urinary creatinine excretion are introduced into the ACR measurement and how the use of the 30-mg/g threshold decreases the performance of the test in populations with higher muscle mass, with a primary focus on why and how this occurs in the obese population. The discussion then raises several strategies that can be used to mitigate such bias. This review provides a comprehensive overview of the medical literature on the uses and limitations of ACR in individuals with obesity and critically assesses related issues. It also raises into question the widely accepted 30-mg/g threshold as universally adequate for the diagnosis of moderate albuminuria. The implications of our review are relevant for clinicians, epidemiologists, and clinical trialists.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000153/pdfft?md5=14d758b1eb4a07ee87875ebf6b6ede72&pid=1-s2.0-S2590059524000153-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140341524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Validation of the Kidney Failure Risk Equation Among Urban Community-Based Chinese Patients With CKD","authors":"Ling Pan ,&nbsp;Jinwei Wang ,&nbsp;Yang Deng ,&nbsp;Yexiang Sun ,&nbsp;Zhenyu Nie ,&nbsp;Xiaoyu Sun ,&nbsp;Chao Yang ,&nbsp;Guohui Ding ,&nbsp;Ming-Hui Zhao ,&nbsp;Yunhua Liao ,&nbsp;Luxia Zhang","doi":"10.1016/j.xkme.2024.100817","DOIUrl":"10.1016/j.xkme.2024.100817","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>The Kidney Failure Risk Equations have been proven to perform well in multinational databases, whereas validation in Asian populations is lacking. This study sought to externally validate the equations in a community-based chronic kidney disease cohort in China.</p></div><div><h3>Study Design</h3><p>A retrospective cohort study.</p></div><div><h3>Setting &amp; Participants</h3><p>Patients with and estimated glomerular filtration rate (eGFR) &lt; 60<!--> <!-->mL/min/1.73<!--> <!-->m² dwelling in an industrialized coastal city of China.</p></div><div><h3>Exposure</h3><p>Age, sex, eGFR, and albuminuria were included in the 4-variable model, whereas serum calcium, phosphate, bicarbonate, and albumin levels were added to the previously noted variables in the 8-variable model.</p></div><div><h3>Outcome</h3><p>Initiation of long-term dialysis treatment.</p></div><div><h3>Analytical Approach</h3><p>Model discrimination, calibration, and clinical utility were evaluated by Harrell’s C statistic, calibration plots, and decision curve analysis, respectively.</p></div><div><h3>Results</h3><p>A total of 4,587 participants were enrolled for validation of the 4-variable model, whereas 1,414 were enrolled for the 8-variable model. The median times of follow-up were 4.0 (interquartile range: 2.6-6.3) years for the 4-variable model and 3.4 (2.2-5.6) years for the 8-variable model. For the 4-variable model, the C statistics were 0.750 (95% CI: 0.615-0.885) for the 2-year model and 0.766 (0.625-0.907) for the 5-year model, whereas the values were 0.756 (0.629-0.883) and 0.774 (0.641-0.907), respectively, for the 8-variable model. Calibration was acceptable for both the 4-variable and 8-variable models. Decision curve analysis for the models at the 5-year scale performed better throughout different net benefit thresholds than the eGFR-based (&lt;30<!--> <!-->mL/min/1.73<!--> <!-->m²) strategy.</p></div><div><h3>Limitations</h3><p>A large proportion of patients lack albuminuria measurements, and only a subset of population could provide complete data for the 8-variable equation.</p></div><div><h3>Conclusions</h3><p>The kidney failure risk equations showed acceptable discrimination and calibration and better clinical utility than the eGFR-based strategy for incidence of kidney failure among community-based urban Chinese patients with chronic kidney disease.</p></div><div><h3>Plain-Language Summary</h3><p>Accurate and reliable risk evaluation of chronic kidney disease (CKD) prognosis can be helpful for physicians to make decisions concerning treatment opportunity and therapeutic strategy. The kidney failure risk equation is an outstanding model for predicting risk of kidney failure among patients with CKD. However, the equation is lacking validation among Chinese populations. In the current study, we demonstrated that the equation had good discrimination among an urban community-based cohort of patients with","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000281/pdfft?md5=e3746bf0072de8cf7641cb8f9de6a004&pid=1-s2.0-S2590059524000281-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Replacement Therapy Use at End-of-Life Among Critically Ill Chinese and Non-Hispanic White Americans: A Single-Center Study","authors":"Seba Babroudi MD ,&nbsp;Joshua Hyun Bin Whang BA ,&nbsp;Avery C. Glover MD, MBA ,&nbsp;Tamara Vesel MD ,&nbsp;David A. Drew MD, MS","doi":"10.1016/j.xkme.2024.100818","DOIUrl":"10.1016/j.xkme.2024.100818","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000293/pdfft?md5=424bdbe950e9b5f204aa3a4fded2bb2b&pid=1-s2.0-S2590059524000293-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}