Kidney Medicine最新文献

{"title":"Renal-Limited Thrombotic Microangiopathy in Infants: A Case Series","authors":"Haiyan Wang, Shuting Luo, Sijin Wang, Nisi Zhang, Yong Cai, Min Li, Haixia Wei, Zhihui Yue, Liangzhong Sun","doi":"10.1016/j.xkme.2026.101426","DOIUrl":"10.1016/j.xkme.2026.101426","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Thrombotic microangiopathy (TMA), an intractable disease, can present in a renal-limited mode. Data on infantile-onset renal-limited TMA (RL-TMA) is lacking. This study describes 5 cases of RL-TMA in infants.</div></div><div><h3>Study Design</h3><div>Case series.</div></div><div><h3>Setting & Participants</h3><div>Five patients with infantile-onset RL-TMA who were admitted and/or followed up at Nanfang Hospital, Southern Medical University, from January 2024 to June 2025.</div></div><div><h3>Analytical Approach</h3><div>Clinical data of 5 patients were collected. Amino acid conservation was analyzed by Clustal Omega, the secondary structure of the mutants was predicted by PolyPhen-2 and PHYRE2, and tertiary structure was predicted by AlphaFold3 and ChimeraX.</div></div><div><h3>Results</h3><div>All patients presented with acute nephritic syndrome with hematuria and proteinuria with onset in infancy, but without hemolytic anemia or thrombocytopenia. Corticosteroid treatment was attempted in 3 patients with no response. Renal pathology revealed microthrombi; segmental endothelial cells that swelled with widening of the subendothelial gap and/or mesangiolysis were observed. <em>C3</em> heterozygous missense variant (c.2184 C>T, p.Cys728X), <em>CD46</em> homozygous variant c.614A>G (p.Glu205Gly), and <em>CFI</em> heterozygous variant c.610A>G (p.Met204Val) were detected in 3 patients, respectively. Possible activation of alternative complement pathway (AP) was indicated in all 4 tested patients. Complete remission was achieved in 2 patients, and partial response was observed in another 2 patients who received eculizumab therapy. The patient who harbored the <em>CFI</em> variation and did not receive eculizumab therapy progressed to kidney failure at 11 months of age.</div></div><div><h3>Limitations</h3><div>Functional verification of genetic variants of <em>C3</em>, <em>CD46</em> and <em>CFI</em> in this study were not implemented. AP activation-related factors were not checked in patient 5.</div></div><div><h3>Conclusions</h3><div>RL-TMA can occur in infancy, which has not been reported previously. Activation of the AP may be the common cause of infantile-onset RL-TMA. Its diagnosis and therapy are challenging. Promising outcomes can be achieved with eculizumab therapy.</div></div><div><h3>Plain-Language Summary</h3><div>In this study, 5 infants presented with acute nephritic syndrome with apparent and persistent hematuria, which is uncommon in congenital/idiopathic nephrotic syndrome. Renal pathology revealed thrombotic microangiopathy (TMA) changes, but hemolytic anemia or thrombocytopenia were absent in these patients. By exclusion of infectious diseases and immune-mediated renal diseases, and with the test results of alternative complement pathway components and genetic sequencing, a possible diagnosis of complement-mediated renal-limited TMA was considered. Rapid improvement was achieved ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 8","pages":"Article 101426"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13416628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620752","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":"Response to the Letter by Tsuboi and Sasaki: “Integrating Podocyte Biology into the Two-Stage Remission Model”","authors":"Rutger J. Maas MD, PhD, Bartholomeus T. van den Berge MSc","doi":"10.1016/j.xkme.2026.101437","DOIUrl":"10.1016/j.xkme.2026.101437","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 8","pages":"Article 101437"},"PeriodicalIF":4.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13416654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148620755","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":"Uric Acid and Chronic Kidney Disease","authors":"Srinath Yadlapalli ,&nbsp;Divya K. Nekkalapudi ,&nbsp;Jay B. Wish","doi":"10.1016/j.xkme.2026.101411","DOIUrl":"10.1016/j.xkme.2026.101411","url":null,"abstract":"<div><div>The prevalence of hyperuricemia is high among people with chronic kidney disease (CKD), increasing significantly as kidney disease progresses. Whether this is an association or a cause-and-effect relationship remains controversial. While evidence strongly supports the treatment of symptomatic hyperuricemia in people with CKD, the evidence supporting the treatment of asymptomatic hyperuricemia is mixed. Some studies show that treatment retards CKD progression, while others do not. In this review, we discussed uric acid metabolism, its association with CKD, and the use of uric acid-lowering agents. We also examined studies conducted to determine whether treating hyperuricemia is beneficial. We hope to provide nephrologists with the knowledge and confidence to confront hyperuricemia, specifically addressing management of asymptomatic hyperuricemia, the differences among society guidelines worldwide, which urate-lowering drugs should be chosen, the role of non-pharmacological therapy in patients with CKD, and the need to minimize the use of medications that may increase uric acid levels.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101411"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295559","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":"Cardiorenal Syndrome and Depressive Symptoms: Exploring the Mood-Kidney Link With Heart Failure Risk in a Post-hoc Analysis of SPRINT","authors":"Sydney E. Hartsell,&nbsp;Stavros G. Drakos,&nbsp;Robert E. Boucher,&nbsp;Amara Sarwal,&nbsp;James C. Fang,&nbsp;Guo Wei,&nbsp;Augustine Takyi,&nbsp;George Bissada,&nbsp;Jincheng Shen,&nbsp;Srinivasan Beddhu","doi":"10.1016/j.xkme.2026.101390","DOIUrl":"10.1016/j.xkme.2026.101390","url":null,"abstract":"<div><h3>Rationale &amp; Objective</h3><div>Depression is a potential pathophysiologic pathway in type 4 cardiorenal syndrome, ie chronic kidney disease (CKD) resulting in chronic heart failure (HF). We investigated whether depressive symptoms and CKD are independent predictors of HF and whether they augment HF risk when they present together.</div></div><div><h3>Study Design</h3><div>A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)</div></div><div><h3>Setting &amp; Participants</h3><div>Participants with baseline Patient Health Questionnaire-9 (PHQ-9) data and without baseline HF (N =8,930)</div></div><div><h3>Predictors</h3><div>Depressive symptom severity (baseline PHQ-9 0, 1-4, and 5-27) and CKD (estimated glomerular filtration rate of &lt; 60 mL/min/1.73m²)</div></div><div><h3>Outcome</h3><div>Incident HF events (pre-specified adjudicated secondary SPRINT outcome)</div></div><div><h3>Analytical Approach</h3><div>Multivariable Cox proportional hazards regression models and generalized linear models related PHQ-9 and CKD status to HF events on relative and absolute scales.</div></div><div><h3>Results</h3><div>PHQ-9 scores of 0, 1-4, and ≥ 5 were present in 3,086 (34.6%), 3,775 (42.3%), and 2,069 (23.2%) participants, respectively and baseline CKD in 2,155 (24%). There were 177 HF events over 33,358 person-years. In a multivariable Cox regression model, both CKD (HR 1.60; 95% CI, 1.13-2.28) and PHQ-9 ≥ 5 (HR vs PHQ-9 = 0: 1.92; 95% CI, 1.24-2.98) were independent HF risk factors. In another Cox model, compared to those with PHQ-9 = 0 and no CKD, those with both CKD and PHQ-9 ≥5 had 3.45 times the hazard of HF (HR 3.45, 95% CI 1.70, 7.03) with other subgroups in between. There was no evidence of a synergistic interaction, but they appeared to be additive. Results were largely consistent on the absolute risk scale.</div></div><div><h3>Limitations</h3><div>Bias from post-hoc observational use of data, clinical trial selection bias</div></div><div><h3>Conclusions</h3><div>Both CKD and depressive symptoms are independent and additive risk factors for HF. Patients with both CKD and a higher burden of depressive symptoms are at greater risk of HF.</div></div><div><h3>Plain-Language Summary</h3><div>This is a post-hoc analysis of the Systolic Blood Pressure Intervention Trial that asked whether chronic kidney disease and depressive symptoms were associated with a particularly high risk of heart failure when present together. Depressive symptom severity was measured with a validated questionnaire. We found that chronic kidney disease and depressive symptoms were both independent heart failure risk factors and are additive but not synergistic for the risk of heart failure. These findings add to our understanding of cardiorenal pathophysiology.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101390"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352410","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":"Perspectives of Caregivers of Kidney Transplant Recipients and Transplant Candidates About Kidneys From Donors With Hepatitis C Virus Infection","authors":"Matthew D. Kearney ,&nbsp;Caroline S. O’Brien ,&nbsp;Sabrina A. Emms ,&nbsp;Eugenia I. Manrique ,&nbsp;Barbara Gonzalez Alarcon ,&nbsp;Ella N. Pokrifka ,&nbsp;Adam Mussell ,&nbsp;David S. Goldberg ,&nbsp;Peter P. Reese","doi":"10.1016/j.xkme.2026.101410","DOIUrl":"10.1016/j.xkme.2026.101410","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Kidneys from deceased donors with active hepatitis C virus infection (HCV-RNA+) are commonly transplanted into HCV-negative recipients, yet little is known about the perspectives of their caregivers. This study’s objective was to better understand caregiver experiences about the transplantation of HCV-RNA+ donor organs, with particular attention to caregiver educational needs and perception of risks.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Cross-sectional study at 2 centers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;We conducted a qualitative study of 20 adult caregivers of patients in the THINKER-NEXT trial, in which patients consented to receive kidney transplant offers from HCV-RNA+ donors. At the time of the interview, participants were either providing support to waitlisted patients or to recipients of HCV-RNA+ donor kidneys.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Semistructured interviews explored caregiver knowledge, concerns, and experiences related to HCV infection and transplantation. Transcripts were coded thematically using an iterative, consensus-based approach.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Caregivers described 4 central themes: 1) patient and caregiver dynamics shaped transplant decisions and caregiving responsibilities; 2) knowledge and attitudes about HCV influenced acceptability of organs with HCV, with initial concerns often offset by the desire to avoid dialysis; 3) privacy, stigma, and the strength of social support networks influenced willingness to disclose transplant details; and 4) cautious optimism and uncertainty in preparing for life after transplant. Many caregivers expressed a need for clearer guidance on HCV risk, caregiver safety, and posttransplant care.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Transferability may be limited because participants were caregivers of clinical trial participants at academic medical centers.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Caregivers were supportive of transplantation from donors with HCV infection. However, they identified gaps in education and posttransplant support. Integrating caregiver perspectives into education, particularly about infectious risk mitigation and caregiver safety, may better enable patients and caregivers to thrive after transplant. These insights are particularly relevant as practices evolve toward transplanting organs with diverse infectious risks, including xeno-organs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;Some kidney transplants come from donors with infections such as hepatitis C virus (HCV) infections, but little is known about the experiences of caregivers of patients considering these organs. This study explored the experiences of 20 caregivers who had received kidney transplants or were on the waiting list. All the patients had received kidney transplants from donors with active HCV infection or had agreed to consider offers of kidneys from donors with HCV","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101410"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148349630","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":"Dihydropyridine Calcium Channel Blocker Therapy and Risk of CKD Progression in Type 2 Diabetes Treated With Renin Angiotensin System Inhibitors and SGLT2 Inhibitors: A Real-World Retrospective Cohort Study","authors":"Timna Agur ,&nbsp;Tali Steinmetz ,&nbsp;Shira Goldman ,&nbsp;Boris Zingerman ,&nbsp;Dana Bielopolski ,&nbsp;Eviatar Nesher ,&nbsp;Ittai Fattal ,&nbsp;Eshcar Meisel ,&nbsp;Benaya Rozen-Zvi","doi":"10.1016/j.xkme.2026.101394","DOIUrl":"10.1016/j.xkme.2026.101394","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Optimal antihypertensive therapy with renoprotective effects is essential to slow diabetic kidney disease progression. We evaluated the impact of dihydropyridine calcium channel blockers on kidney outcomes in patients with type 2 diabetes receiving guideline-directed renin angiotensin system inhibitors and sodium/glucose cotransporter 2 inhibitors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design, Participants, &amp; Settings&lt;/h3&gt;&lt;div&gt;A retrospective cohort study using Clalit Health Services (2016-2021).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Adults with type 2 diabetes treated with both renin angiotensin system inhibitors and sodium/glucose cotransporter 2 inhibitors were categorized into dihydropyridine calcium channel blockers group (renin angiotensin system inhibitors + dihydropyridine calcium channel blockers, with or without other agents) or a dihydropyridine calcium channel blocker–free group (renin angiotensin system inhibitors ± other antihypertensives excluding dihydropyridine calcium channel blockers).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;div&gt;The primary outcome was a major adverse kidney event (MAKE; defined as ≥40% estimated glomerular filtration rate decline or progression to kidney failure). Secondary outcomes included initiation of renal replacement therapy and all-cause mortality. Safety outcomes included hospitalizations and acute kidney injury.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Inverse probability of treatment weighting was applied to balance baseline characteristics.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We included 31,031 patients with type 2 diabetes treated with both sodium/glucose cotransporter 2 inhibitors and renin angiotensin system inhibitors. A total of 12,172 (60.8%) received dihydropyridine calcium channel blockers, and 18,859 (39.2%) received dihydropyridine calcium channel blocker–free therapy. Median follow-up was 1,260 days. Overall, 482 patients experienced MAKE, and 2,064 patients died. Dihydropyridine calcium channel blocker use was associated with a higher risk of MAKE compared with dihydropyridine calcium channel blocker-free therapy (weighted HR, 1.33; 95% CI, 1.03-1.73; &lt;em&gt;P&lt;/em&gt; = 0.03), which remained significant after accounting for competing risk of death (HR, 1.39; 95% CI, 1.13-1.7; &lt;em&gt;P&lt;/em&gt; = 0.002). Dihydropyridine calcium channel blocker use was not significantly associated with all-cause mortality or safety outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The observational design is subject to residual confounding and did not allow for full characterization of medication exposure.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In patients with type 2 diabetes treated with renin angiotensin system inhibitors and sodium/glucose cotransporter 2 inhibitors, concomitant therapy with dihydropyridine calcium channel blockers was associated with a higher risk of adverse kidney outcomes. These findings may help inform clinicians when weighing the potential risks and be","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101394"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352558","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":"Evolving Comorbidity Burden and Clinical Characteristics in Peritoneal Dialysis: A 17-Year Nationwide Study","authors":"Anne-Sophie Lavedrine,&nbsp;Annabel Boyer,&nbsp;Thierry Lobbedez,&nbsp;Clémence Béchade,&nbsp;Antoine Lanot","doi":"10.1016/j.xkme.2026.101392","DOIUrl":"10.1016/j.xkme.2026.101392","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Peritoneal dialysis (PD) is a home-based kidney replacement therapy for patients with kidney failure associated with numerous benefits, but it remains underused. As chronic kidney disease becomes a growing public health concern, understanding the evolving clinical profile of PD patients is essential. There is limited information available on the temporal trends in patients’ comorbid conditions within this population. The study aimed to describe changes in the prevalence of comorbid conditions among PD patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;We conducted a retrospective multicenter study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;We used data from the French Peritoneal Dialysis Registry, including 15,982 patients who initiated PD in France between 2002 and 2018.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure(s) or Predictor(s)&lt;/h3&gt;&lt;div&gt;Calendar year of PD initiation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome(s)&lt;/h3&gt;&lt;div&gt;Prevalence of high comorbidity burden, clinical profile, and care delivery characteristics at PD initiation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;We aimed to assess temporal trends in outcomes of interest among incident PD patients using Cox regression models with robust variance estimation, adjusting for confounders identified through directed acyclic graphs, and accounting for potential nonlinear effects of PD start year.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The proportion of patients over 85 years increased over time (prevalence ratio [PR], 1.44; 95% CI, 1.25-1.67), as did diabetes prevalence (PR, 1.16; 95% CI, 1.08-1.25). Conversely, the proportion of patients with Charlson Comorbidity Index [CCI] ≥ 2 declined (PR, 0.89; 95% CI, 0.85-0.94), as did those requiring assistance (PR, 0.90; 95% CI, 0.85-0.95) and those considered ineligible for a kidney transplantation (PR, 0.63; 95% CI, 0.60-0.66).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;The retrospective design limited causal inference and CCI may not capture all health dimensions relevant to PD patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The proportion of diabetes and older patients increased over time, whereas CCI, the proportion of patients uneligible for a kidney transplantation, and the requirement of assistance decreased, reflecting an evolving profile of PD patients.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-language Summary&lt;/h3&gt;&lt;div&gt;Peritoneal dialysis (PD) is a home-based treatment for people with kidney failure, but it remains underused. The characteristics of patients starting this treatment may have changed over time. Using data from a national French registry, we examined how the health profiles of patients beginning PD have evolved. We found that patients starting PD are increasingly older and more likely to have diabetes. At the same time, fewer patients have a high overall burden of other medical conditions, need assistance with dialysis, or are considered ineligible for kidney transplantation. These results show that the pr","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101392"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352535","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":"I-131 Use in Patients With Kidney Failure Receiving Dialsyis: Therapeutic Challenges and Evidence From Literature","authors":"Abhirami Das ,&nbsp;Zachary Peckham ,&nbsp;Byron May ,&nbsp;Antoni Kafrouni Gerges ,&nbsp;Sarika N. Rao ,&nbsp;Sandhya Manohar","doi":"10.1016/j.xkme.2026.101407","DOIUrl":"10.1016/j.xkme.2026.101407","url":null,"abstract":"<div><div>Radioactive iodine (¹³¹I) therapy is widely used in the treatment of differentiated thyroid cancer and hyperthyroidism. However, its use in patients with kidney failure treated with hemodialysis presents unique challenges due to impaired renal clearance, prolonged systemic retention, and logistical barriers to safe delivery. In this multicenter retrospective case series, we identified 5 patients with kidney failure on maintenance hemodialysis who received ¹³¹I therapy. We discuss in this paper our experience, modified dosing, and carefully timed dialysis that were used to optimize safety and efficacy. All patients tolerated therapy without hematologic toxicity or radiation-related complications. Underlying thyroid disease was adequately addressed, and no secondary malignancies were observed during follow-up. We also described a comprehensive literature review of similar cases and revealed significant variation in dosing strategies and dialysis timing but emphasized the importance of interdisciplinary coordination and adherence to radiation safety principles. Our findings support the feasibility and short-term safety of ¹³¹I therapy in select dialysis-dependent patients when individualized dosing and dialysis planning are implemented. Further prospective studies are needed to develop standardized protocols and refine timing strategies to optimize outcomes in this high-risk population.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101407"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352491","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 Biopsy of a Patient With Double Positive Antiglomerular Basement Membrane and Myeloperoxidase-antineutrophil Cytoplasmic Antibodies","authors":"Kei Kono,&nbsp;Naoki Sawa,&nbsp;Masayuki Yamanouchi,&nbsp;Yuki Oba,&nbsp;Hiroki Mizuno,&nbsp;Akinari Sekine,&nbsp;Noriko Inoue,&nbsp;Kiho Tanaka,&nbsp;Eiko Hasegawa,&nbsp;Tatsuya Suwabe,&nbsp;Takehiko Wada,&nbsp;Yukako Shintani-Domoto,&nbsp;Kenichi Ohashi,&nbsp;Yoshifumi Ubara","doi":"10.1016/j.xkme.2026.101373","DOIUrl":"10.1016/j.xkme.2026.101373","url":null,"abstract":"<div><div>We report on an 82-year-old woman who developed rapidly progressive renal failure and whose serum creatinine level increased from 1.46-7.18 mg/dL over a 3-week period. Tests for antiglomerular basement membrane (anti-GBM) antibodies (136 U/mL) and myeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA; 161 IU/mL) were both positive. Kidney biopsy revealed acute-phase lesions of necrotizing crescentic glomerulonephritis with fibrin deposition in 28 of 33 glomeruli. This finding was consistent with anti-GBM glomerulonephritis. Concentric necrotic lesions with fibrin deposition were seen from the intima to the media and extended from the interlobular arteries to the arterioles, and loss of elastic lamella continuity and extensive inflammatory cell infiltration were also observed in the surrounding areas. Tubulointerstitial nephritis with tubulitis and peritubular capillaritis was observed in extensive areas of the tubulointerstitium. Five global sclerotic glomeruli, tubular atrophy, and interstitial fibrosis were seen. The findings were consistent with MPO-ANCA–positive microscopic polyangiitis, which features a mixture of acute and chronic lesions. Hemodialysis was initiated, followed by steroid treatment. Six months later, she died and was found at autopsy to have metastatic endometrial cancer. We hypothesized that the positivity for anti-GBM antibodies and MPO-ANCA and the malignant tumor may have been related.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101373"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345721","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":"Systematic Evaluation of Plasma and Urine Metabolites to Predict the Risk of Adverse Kidney-related Outcomes in Chronic Kidney Disease: The GCKD Study∗","authors":"Elena Butz,&nbsp;Inga Steinbrenner,&nbsp;Ulla T. Schultheiss,&nbsp;Charlotte Behning,&nbsp;Harald Binder,&nbsp;Helena Hansmann,&nbsp;Wolfram Gronwald,&nbsp;Peter J. Oefner,&nbsp;Elke Schaeffner,&nbsp;Kai-Uwe Eckardt,&nbsp;Anna Köttgen,&nbsp;Peggy Sekula,&nbsp;GCKD Investigators","doi":"10.1016/j.xkme.2026.101409","DOIUrl":"10.1016/j.xkme.2026.101409","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;div&gt;Accurate risk prediction of adverse kidney-related outcomes in individuals with chronic kidney disease (CKD) is essential to guide personalized treatment. Plasma and urine metabolites may individually or jointly improve prediction beyond clinically established prognostic factors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;Prospective German CKD cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;div&gt;5,217 individuals with predominantly CKD stage G3 at baseline and 6.5-year follow-up data (IQR, 6.5-6.5).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure(s) or Predictor(s)&lt;/h3&gt;&lt;div&gt;Baseline metabolite levels measured using untargeted mass spectrometry: plasma (N=5,144; 1,096 metabolites) and urine (N=5,088; 1,129 metabolites).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome(s)&lt;/h3&gt;&lt;div&gt;(i) Kidney failure (KF): kidney replacement therapy or death by untreated KF; (ii) composite kidney endpoint (CKE): KF, ≥ 40% estimated glomerular filtration rate (eGFR) decline, or eGFR &lt; 15 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;div&gt;Time-to-event analysis using subdistribution hazard models with component-wise boosting for metabolite selection. The predictive performance of metabolite models was compared to benchmark models, including established prognostic factors.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Several individual metabolites improved KF risk prediction beyond established prognostic factors (age, sex, eGFR, and urinary albumin-to-creatinine ratio). For example, adding plasma pseudouridine increased the area under the receiver operating characteristic curve (AUC) for KF at year 6 by 0.012 (95% CI, 0.005-0.018).&lt;/div&gt;&lt;div&gt;Multimetabolite models for KF (mean, 36 metabolites) showed good performance, declining for more distant time points: AUC values were ≥ 0.89 at year 2 and ≥ 0.85 at year 6. Some metabolites, such as plasma N2,N5-diacetylornithine and urine 1-palmitoyl-2-oleoyl-GPC (16:0/18:1), were selected more often than others. Overall, multimetabolite models demonstrated modest, partially significant improvements over clinical models, and were comparable to other suggested prognostic models of KF. Results for the CKE were similar.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;div&gt;Single-point, semiquantitative metabolite measurements.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;While certain metabolites improved the prediction of adverse kidney-related outcomes, added value was limited. However, prognostic metabolites may reflect relevant CKD-related metabolic pathways. Further research is warranted to refine prognostic models and explore the biological relevance of identified metabolites.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;div&gt;This study examined whether measuring small molecules (metabolites) in blood and urine can improve the prediction of kidney failure risk in more than 5,000 people with chronic kidney disease over 6 years. Some metabolites slightly improved risk prediction beyond common clinical f","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 7","pages":"Article 101409"},"PeriodicalIF":4.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345759","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}