Kidney Medicine最新文献

{"title":"Proneurotensin/Neuromedin N and Risk of Incident CKD and Other Kidney Outcomes in Community-Living Individuals: The REGARDS Study","authors":"Alexander L. Bullen ,&nbsp;Alma Fregoso-Leyva ,&nbsp;Ronit Katz ,&nbsp;Dorothy Leann Long ,&nbsp;Katharine L. Cheung ,&nbsp;Suzanne E. Judd ,&nbsp;Orlando M. Gutierrez ,&nbsp;Joachim H. Ix ,&nbsp;Mary Cushman ,&nbsp;Dena E. Rifkin","doi":"10.1016/j.xkme.2024.100831","DOIUrl":"10.1016/j.xkme.2024.100831","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>Plasma proneurotensin/neuromedin N (pro-NT/NMN) is a precursor of neurotensin, a tridecapeptide linked with type 2 diabetes mellitus and other comorbid conditions associated with kidney disease. Whether pro-NT/NMN is directly associated with incident chronic kidney disease (CKD), and whether that association differs by race, is uncertain. We evaluated whether pro-NT/NMN levels were associated with increased risk of kidney outcomes.</p></div><div><h3>Study Design</h3><p>Prospective cohort.</p></div><div><h3>Setting &amp; Participants</h3><p>Participants in Biomarker Mediators of Racial Disparities in Risk Factors, a nested cohort from the REasons for Geographic And Racial Differences in Stroke study, with available stored serum and urine samples from baseline and second visits for biomarker measurement.</p></div><div><h3>Exposure</h3><p>Baseline log-transformed pro-NT/NMN.</p></div><div><h3>Outcomes</h3><p>Incident CKD, progressive estimated glomerular filtration rate (eGFR) decline, incident albuminuria, and incident kidney failure within median follow-up time of 9.4 years.</p></div><div><h3>Analytical Approach</h3><p>Logistic regression.</p></div><div><h3>Results</h3><p>Among 3,914 participants, the mean<!--> <!-->±<!--> <!-->SD age was 64<!--> <!-->±<!--> <!-->8 (SD) years, 48% were women, and 51% were Black. Median baseline eGFR was 90 (IQR, 77-102) mL/min/1.73<!--> <!-->m². Each SD higher of pro-NT/NMN was associated with 9% higher odds of progressive eGFR decline (OR, 1.09; 95% CI, 1.00-1.20). There was no association observed with incident CKD (OR, 1.10; 95% CI, 0.96-1.27), incident albuminuria (OR, 1.08; 95% CI, 0.96-1.22), or incident kidney failure (OR, 1.10; 95% CI, 0.83-1.46). There were no differences in results by race or sex.</p></div><div><h3>Limitations</h3><p>Single measurement of pro-NT/NMN and limited generalizability.</p></div><div><h3>Conclusions</h3><p>Higher pro-NT/NMN was associated with progressive eGFR decline but no other manifestations of kidney disease incidence.</p></div><div><h3>Plain-Language Summary</h3><p>Neurotensin is a peptide secreted by the small intestine in response to a meal. Higher levels of neurotensin and its stable precursor, proneurotensin/neuromedin N (pro-NT/NMN), have been associated with cardiovascular disease and type 2 diabetes mellitus, important risk factors for the development of kidney disease. Whether pro-NT/NMN is directly associated with kidney outcomes has been less studied and has been done so in largely homogenous cohorts of White participants. Using the REasons for Geographic And Racial Differences in Stroke study, we followed Black and White participants and evaluated the risk of developing kidney outcomes. We found that elevated levels of pro-NT/NMN were associated with kidney function decline. Pro-NT/NMN may help individuals who may benefit from closer monitoring of kidney function.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100831"},"PeriodicalIF":3.9,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000426/pdfft?md5=7ad0c198c6834e8031d4d4ea5f9aeb6e&pid=1-s2.0-S2590059524000426-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775618","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":"Cystatin C Use for CKD Detection in the Veterans Health Administration System: A Qualitative Study of Barriers and Facilitators","authors":"Julio A. Lamprea-Montealegre ,&nbsp;Abigail Shapiro ,&nbsp;Natalie A.B. Bontrager ,&nbsp;Dena E. Rifkin ,&nbsp;Simerjot K. Jassal ,&nbsp;Lucile Parker Gregg ,&nbsp;Sankar D. Navaneethan ,&nbsp;Krista Navarra ,&nbsp;Michael G. Shlipak ,&nbsp;Michelle M. Estrella ,&nbsp;Virginia Wang","doi":"10.1016/j.xkme.2024.100830","DOIUrl":"10.1016/j.xkme.2024.100830","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;The measurement of cystatin C has been recommended to enhance chronic kidney disease (CKD) detection and risk stratification in clinical practice. This study gathered insights into the perceptions and experiences of clinical staff regarding the use of cystatin C in CKD detection within the Veterans Health Administration (VHA) system.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;A qualitative approach was employed to explore barriers and facilitators of clinical staff regarding the use of cystatin C in CKD detection within the VHA system. The Organizational Theory of Implementation Effectiveness informed the development of a semistructured interview guide.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;Health care providers, nurses, and clinical pharmacists from the VHA systems in San Francisco, San Diego, and Houston were interviewed between October 2021 and May 2022.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;p&gt;Participants' experiences with cystatin C testing.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;Perceived barriers and facilitators to cystatin C testing.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;Participant responses from individual interviews were analyzed by a multidisciplinary team using rapid qualitative analysis methods.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Fourteen in-depth interviews were conducted across the 3 VHA systems. Ten of 11 providers worked in primary care. Five key barriers to using cystatin C for CKD detection were identified. These included lack of patient awareness of CKD testing, lack of provider awareness about cystatin C, knowledge barriers about cystatin C testing, unclear roles and ownership of CKD detection, and lack of clinic support to enhance CKD detection. Suggested interventions to overcome these barriers included educational and training programs, improved clinic workflows, and electronic health record aids to support CKD detection and use of cystatin C.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;The results may not be generalizable to other health care systems outside the VHA.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;The findings indicate a need for targeted interventions such as educational and training programs, improved clinical workflows, and electronic health record aids to address barriers limiting the use of cystatin C in clinical practice for enhanced CKD detection.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;p&gt;This study assessed how clinical staff at the Veterans Health Administration (VHA) feel about using a test called cystatin C to help detect chronic kidney disease (CKD) earlier and more accurately. The research team spoke to healthcare providers, nurses, and clinical pharmacists in San Francisco, San Diego, and Houston between October 2021 and May 2022. We conducted 14 detailed interviews to understand the challenges and opportunities in using cystatin C for CKD detection. We found that participants often lacked awareness of CKD and the benefits of testing with cystatin C. There","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100830"},"PeriodicalIF":3.9,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000414/pdfft?md5=f62bce0ebf263264571fdc25971176cc&pid=1-s2.0-S2590059524000414-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766276","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":"Hemodiafiltration versus Hemodialysis in End-Stage Kidney Disease: A Systematic Review and Meta-Analysis","authors":"Maria Gabriela Motta Guimarães ,&nbsp;Fernanda Pinheiro Martin Tapioca ,&nbsp;Naiara Rodrigues dos Santos ,&nbsp;Fernanda Pitta do Carmo Tourinho Ferreira ,&nbsp;Luiz Carlos Santana Passos ,&nbsp;Paulo Novis Rocha","doi":"10.1016/j.xkme.2024.100829","DOIUrl":"10.1016/j.xkme.2024.100829","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><p>The use of hemodiafiltration (HDF) as a kidney replacement therapy (KRT) in patients with end-stage kidney disease (ESKD) has sparked a debate regarding its advantages over conventional hemodialysis (HD). The present study aims to shed light on this controversy by comparing mortality rates and cause-specific deaths between ESKD patients receiving HDF and those undergoing HD.</p></div><div><h3>Study Design</h3><p>Systematic review and meta-analysis of randomized controlled trials (RCTs). The search was conducted using PubMed, EMBASE, and Cochrane Central on July 1, 2023.</p></div><div><h3>Setting &amp; Participants</h3><p>Adult patients with ESKD on regular KRT.</p></div><div><h3>Exposure</h3><p>Studies with participants undergoing HDF.</p></div><div><h3>Outcomes</h3><p>Primary outcomes were all-cause mortality, cardiovascular (CV) mortality, deaths related to infections, and kidney transplant. We also evaluated the endpoints for deaths related to malignancy, myocardial infarction, stroke, arrhythmias, and sudden death.</p></div><div><h3>Analytical Approach</h3><p>We included RCTs evaluating HDF versus HD. Crossover trials and studies with overlapping populations were excluded. Two authors independently extracted the data following predefined search criteria and quality assessment. The risk of bias was assessed with Cochrane’s RoB2 tool.</p></div><div><h3>Results</h3><p>We included 5 RCTs with 4,143 patients, of which 2,078 (50.1%) underwent HDF, whereas 2,065 (49.8%) were receiving HD. Overall, HDF was associated with a lower risk of all-cause mortality (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.73-0.91; <em>P</em> <!-->&lt;<!--> <!-->0.001; I² <!-->=<!--> <!-->7%) and a lower risk of CV-related deaths (RR, 0.75; 95% CI, 0.61-0.92; <em>P</em> <!-->=<!--> <!-->0.007; I² <!-->=<!--> <!-->0%). The incidence of infection-related deaths was also significantly different between therapies (RR, 0.69; 95% CI, 0.50-0.95; <em>P</em> <!-->=<!--> <!-->0.02; I² <!-->=<!--> <!-->26%).</p></div><div><h3>Limitations</h3><p>In individual studies, the HDF groups achieved varying levels of convection volume.</p></div><div><h3>Conclusions</h3><p>Compared with those undergoing HD, patients receiving HDF experienced a reduction in all-cause mortality, CV mortality, and infection-related mortality. These results provide compelling evidence supporting the use of HDF as a beneficial intervention in ESKD patients undergoing KRT.</p></div><div><h3>Registration</h3><p>Registered at PROSPERO: CRD42023438362.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100829"},"PeriodicalIF":3.9,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000402/pdfft?md5=e3c3711e7e84ef736a4090316fd2ad24&pid=1-s2.0-S2590059524000402-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140763663","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":"Complementary and Alternative Medicine Use and Glomerular Disease: A Contemporary Case Series","authors":"Prem Kumar Devaraju ,&nbsp;Jayalakshmi Seshadri ,&nbsp;Chelvamalai Muthukumaran Balasubramanian ,&nbsp;Anila Abraham Kurien ,&nbsp;Guhan Senthilkumaran ,&nbsp;Vaishanavi Devi Rajarathinam ,&nbsp;Vijayakumar Stanlybai Jibia ,&nbsp;Vinoj Murugesan ,&nbsp;Tanuj Moses Lamech ,&nbsp;Dineshkumar Thanigachalam ,&nbsp;Sakthirajan Ramanathan ,&nbsp;Sheik Sulthan Alavudeen ,&nbsp;Shivakumar Dakshinamoorthy ,&nbsp;Seenivasan Mookaiah ,&nbsp;Natarajan Gopalakrishnan","doi":"10.1016/j.xkme.2024.100827","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100827","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;Complementary and alternative medicine (CAM) intake is widely prevalent in many parts of India. Heavy metals are known ingredients in some of these formulations. We studied the spectrum of glomerular diseases in patients using CAM.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;Case series.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;Patients with proteinuria or unexplained acute kidney injury, who underwent a kidney biopsy between May 2021 and September 2022, and who provided a history of recent CAM intake were included in the study. For patients enrolled prospectively, blood and urine samples were analyzed using mass spectrometry for the presence of mercury, lead, arsenic and cadmium. The CAM formulation, when available, was analyzed using inductively coupled plasma-optical emission spectroscopy.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Twenty-eight patients were enrolled in the study, with a median duration of CAM intake of 4 months (interquartile range, 2-6 months). Heavy metal screening was performed in 17 patients, of whom 15 had elevated urine mercury levels, 10 had elevated blood mercury levels, and 1 had elevated blood and urine arsenic levels. Of the 6 CAM formulations that were analyzed, all had high levels of mercury. Kidney biopsy findings were membranous nephropathy (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;19), minimal change disease (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;8), and mesangial proliferative glomerulonephritis (n&lt;!--&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;1). Of the 19 patients with membranous nephropathy, 14 were associated with neural epidermal growth factor-like protein 1 (NELL-1). With conservative management alone, 17 patients achieved complete remission.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;Not all patients underwent blood and urine mercury testing, and only 6 patients provided the CAM samples for analysis. Furthermore, occupational and residential exposure to mercury could not be excluded.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;The most common kidney pathology noted in our study was membranous nephropathy, which was predominantly associated with neural epidermal growth factor-like protein 1. A significant proportion of the patients recovered completely after withdrawal of the offending agent and initiation of renin-angiotensin system blockade.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;p&gt;Complementary and alternative medicine (CAM) intake is widely prevalent in many parts of India, and heavy metals are known ingredients in some of these formulations. We describe the clinical spectrum of kidney disease, among patients who had recently ingested CAM. All patients underwent a kidney biopsy, and the most common finding was an entity called “NELL-1-associated membranous nephropathy,” which is known to be associated with heavy metal toxicity and CAM intake. Of 17 patients screened for such heavy metals, 15 had greater-than-permissible levels of mercury. Furthermore, 6 patients provided the CAM formulations that they had consumed for anal","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100827"},"PeriodicalIF":3.9,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000384/pdfft?md5=bae3d83b99a9605c9c8068d2e6b34e8b&pid=1-s2.0-S2590059524000384-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141068721","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":"A Review of Focal Segmental Glomerulosclerosis Classification With a Focus on Genetic Associations","authors":"Marco Bonilla ,&nbsp;Orhan Efe ,&nbsp;Haresh Selvaskandan ,&nbsp;Edgar V. Lerma ,&nbsp;Nasim Wiegley","doi":"10.1016/j.xkme.2024.100826","DOIUrl":"10.1016/j.xkme.2024.100826","url":null,"abstract":"<div><p>Focal segmental glomerulosclerosis (FSGS) defines a distinct histologic pattern observed in kidney tissue that is linked to several distinct underlying causes, all converging on the common factor of podocyte injury. It presents a considerable challenge in terms of classification because of its varied underlying causes and the limited correlation between histopathology and clinical outcomes. Critically, precise nomenclature is key to describe and delineate the pathogenesis, subsequently guiding the selection of suitable and precision therapies. A proposed pathomechanism-based approach has been suggested for FSGS classification. This approach differentiates among primary, secondary, genetic, and undetermined causes, aiming to provide clarity. Genetic FSGS from monogenic mutations can emerge during childhood or adulthood, and it is advisable to conduct genetic testing in cases in which there is a family history of chronic kidney disease, nephrotic syndrome, or resistance to treatment. Genome-wide association studies have identified several genetic risk variants, such as those in apolipoprotein L1 (<em>APOL1</em>), that play a role in the development of FSGS. Currently, no specific treatments have been approved to treat genetic FSGS; however, interventions targeting underlying cofactor deficiencies have shown potential in some cases. Furthermore, encouraging results have emerged from a phase 2 trial investigating inaxaplin, a novel small molecule APOL1 channel inhibitor, in <em>APOL1</em>-associated FSGS.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100826"},"PeriodicalIF":3.9,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000372/pdfft?md5=94cd3108604d30cd53491d9615f30ee9&pid=1-s2.0-S2590059524000372-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140784394","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":"APOL1 Kidney Risk Variants and Long-Term Kidney Function in Healthy Middle-Aged Black Individuals: The Atherosclerosis Risk in Communities (ARIC) Study","authors":"Mona D. Doshi ,&nbsp;Lihua Li ,&nbsp;Abhijit S. Naik ,&nbsp;Christie P. Thomas","doi":"10.1016/j.xkme.2024.100828","DOIUrl":"10.1016/j.xkme.2024.100828","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;The effect of apolipoprotein L1(&lt;em&gt;APOL1)&lt;/em&gt; genotype on future risk of kidney disease among middle-aged individuals with good kidney function is not well established.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;Longitudinal cohort study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;In total, 5,886 healthy individuals (45-64 years old) enrolled in the Atherosclerosis Risk in Communities study with creatinine-based estimated glomerular filtration rate&lt;!--&gt; &lt;!--&gt;≥&lt;!--&gt; &lt;!--&gt;80&lt;!--&gt; &lt;!--&gt;mL/min who would be suitable kidney donors.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;p&gt;Race and &lt;em&gt;APOL1&lt;/em&gt; genotype.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;Creatinine- and cystatin C-based estimated glomerular filtration rate (eGFRcr-cys) using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) 2021 equation, urinary albumin-creatinine ratio (UACR), proportion with chronic kidney disease (CKD) 3a or worse, end-stage kidney disease (ESKD), and death.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;Participants grouped based on race and &lt;em&gt;APOL1&lt;/em&gt; genotype. Compared eGFRcr-cys and UACR across groups. Multinomial logistic regression models were used compare odds of CKD. Kaplan–Meier survival curves were created to compare rates of ESKD and death at last follow-up.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;There were 5,075 Whites (86%), 701 Blacks carrying the low-risk &lt;em&gt;APOL1&lt;/em&gt; genotype (12%), and 110 Blacks carrying the high-risk A&lt;em&gt;POL1&lt;/em&gt; genotype (2%). The mean age at baseline was 53&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;6 years. At 10 years, White participants had lower eGFRcr-cys than low-risk and high-risk groups (89&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;16 vs 91&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;16 and 92&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;15&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;, respectively; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001). At 25 years, White participants continued to have lower eGFRcr-cys than the low-risk group (70&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;18 vs 72&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;19&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.001) but not compared with the high-risk &lt;em&gt;APOL1&lt;/em&gt; genotype (67±23&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;). There was no difference in UACR among groups at 10 and 25 years (&lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.87 and 0.91, respectively). The odds of developing CKD stage 3a or worse were not different between low-risk and high-risk &lt;em&gt;APOL1&lt;/em&gt; group in both unadjusted and adjusted models (&lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.26 and &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.39, respectively). At last follow-up,&lt;!--&gt; &lt;!--&gt;&lt;5% developed ESKD, and 45% of individuals either died or reached ESKD with no difference in outcomes between the groups.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;Low ascertainment because of death and long follow-up.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Among middle-aged individuals, &lt;em&gt;APOL1&lt;/em&gt; genotype does not appear to be a major driver of future risk of kidney disease.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100828"},"PeriodicalIF":3.9,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000396/pdfft?md5=03c5acaccdbaa3b7d1081f33c667e315&pid=1-s2.0-S2590059524000396-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794290","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":"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":"6 6","pages":"Article 100824"},"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":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;Retrospective cohort study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;24,133 Veterans at least 65 years old with incident CKD stage 4 from 2011 to 2013.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;p&gt;AKI, AKI severity, and age.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;KFRT and death.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;Our study lacked generalizability, was restricted to ever use of medications, and used inpatient serum creatinine laboratory results to define AKI and AKI severity.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;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.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;p&gt;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":"6 6","pages":"Article 100825"},"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":"6 6","pages":"Article 100823"},"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":"6 6","pages":"Article 100822"},"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}