Kidney Medicine最新文献

{"title":"APOL1 High-Risk Genotypes and Kidney Disease Risk in Middle-Aged Black Adults: More Questions Than Answers","authors":"Orlando M. Gutiérrez","doi":"10.1016/j.xkme.2024.100842","DOIUrl":"10.1016/j.xkme.2024.100842","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100842"},"PeriodicalIF":3.9,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000530/pdfft?md5=54380f6f9db2beabd25c9ccf34caf2c9&pid=1-s2.0-S2590059524000530-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141032853","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":"Antibrush Border Antibody Disease: A Case Series","authors":"Michelle Pengshung ,&nbsp;Vivek Charu ,&nbsp;Megan L. Troxell ,&nbsp;Shreeram Akilesh ,&nbsp;Kelly D. Smith ,&nbsp;J. Ashley Jefferson","doi":"10.1016/j.xkme.2024.100841","DOIUrl":"10.1016/j.xkme.2024.100841","url":null,"abstract":"<div><p>Antibrush border antibody (ABBA) disease is a rare cause of kidney disease characterized by progressive renal tubular injury associated with immune complex deposition along the basement membranes of the proximal tubule and circulating autoantibodies to brush border antigens. Several antigens have been identified as targets of autoantibodies in this disease, including low-density lipoprotein receptor related protein 2 (LRP2), cubilin, and amnionless proteins. We present 9 patients from 2 academic medical centers and describe the clinicopathologic characteristics and outcome data. All patients presented with acute kidney injury and proteinuria. Pathology confirmed immune complex deposition along proximal tubular basement membranes in all patients, but the majority (6/8) also showed segmental glomerular subepithelial immune complexes. Two of 3 patients treated with rituximab demonstrated stabilization of kidney function; 1 of these patients had mantle cell lymphoma. One patient with lung cancer showed stabilization of disease after treatment of the malignancy. The remaining patients progressed to end-stage kidney disease with either conservative therapy (3 patients) or immunosuppression with glucocorticoids (2 patients). This series highlights the poor prognosis of ABBA disease, but a potential benefit of anti-B cell therapy or treatment of an underlying malignancy in some cases.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 7","pages":"Article 100841"},"PeriodicalIF":3.9,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000529/pdfft?md5=2ef0e5fa2d5c6c5c74deccdb243d9b86&pid=1-s2.0-S2590059524000529-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141048768","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":"SGLT2 Inhibitor Use for Treatment of Hypocitraturia in a Distal Renal Tubular Acidosis","authors":"Stefan Scherr ,&nbsp;Sara H. Ksiazek ,&nbsp;Christoph Schwarz ,&nbsp;Marcus D. Säemann","doi":"10.1016/j.xkme.2024.100839","DOIUrl":"10.1016/j.xkme.2024.100839","url":null,"abstract":"<div><p>5-Amino salicylic acid (5-ASA) is a known culprit for the development of tubulointerstitial nephritis. Together with impaired kidney function, tubulointerstitial nephritis can lead to specific tubular malfunctions including distal renal tubular acidosis. Distal renal tubular acidosis is an acid-base disorder in which acid secretion in the distal part of the renal tubular system is decreased. Patients with distal renal tubular acidosis are predisposed to recurrently form calcium phosphate kidney stones. This results from the inability to acidify the urine properly as well as from a decreased citrate concentration in the urine, which is another pathognomonic feature of distal renal tubular acidosis. We present the case of a man in his late 40s with Crohn’s disease who developed tubulointerstitial nephritis associated with 5-ASA leading to the development of distal renal tubular acidosis and recurrent calcium phosphate nephrolithiasis. After steroid therapy and partial recovery of kidney function, we observed an increase of citraturia in response to treatment with dapagliflozin, potentially indicating beneficial effects of sodium/glucose cotransporter 2 inhibition on the recurrence of calcium phosphate stone disease in interstitial nephritis-induced distal tubular acidosis.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 7","pages":"Article 100839"},"PeriodicalIF":3.9,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000505/pdfft?md5=abd716ee101896c7809ecd2730e6c62b&pid=1-s2.0-S2590059524000505-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141040076","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":"Dialysis Patient With a Unique Rash","authors":"Alissa Cyriac ,&nbsp;Steven L. Allen ,&nbsp;Sophia Cyriac ,&nbsp;Kenar D. Jhaveri","doi":"10.1016/j.xkme.2024.100838","DOIUrl":"10.1016/j.xkme.2024.100838","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 7","pages":"Article 100838"},"PeriodicalIF":3.9,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000499/pdfft?md5=a4f928f733ccdfc17ec0b598d4d1cf22&pid=1-s2.0-S2590059524000499-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141056326","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":"Volume and Body Composition in Hemodialysis Patients: A Bioimpedance Study Assessing Differences by Sex","authors":"Sebastian Mussnig MD ,&nbsp;Janosch Niknam MD ,&nbsp;Christoph Matthias ,&nbsp;Susanne Widmer ,&nbsp;Dilara Gülmez ,&nbsp;Simon Krenn MD ,&nbsp;Matthias Lorenz MD ,&nbsp;Charles Chazot PhD ,&nbsp;Peter Wabel PhD ,&nbsp;Daniel Schneditz PhD ,&nbsp;Manfred Hecking PhD","doi":"10.1016/j.xkme.2024.100837","DOIUrl":"10.1016/j.xkme.2024.100837","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 7","pages":"Article 100837"},"PeriodicalIF":3.9,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000487/pdfft?md5=b2721d16bbe6c2fa06c1b8fd3bcc1bdc&pid=1-s2.0-S2590059524000487-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029929","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 in Inflammatory Bowel Disease Patients: A Nationwide Comparative Analysis","authors":"Manish K. Saha ,&nbsp;Susan L. Hogan ,&nbsp;Ronald J. Falk ,&nbsp;Edward L. Barnes ,&nbsp;Yichun Hu ,&nbsp;Abhijit V. Kshirsagar ,&nbsp;Carolyn T. Thorpe","doi":"10.1016/j.xkme.2024.100836","DOIUrl":"10.1016/j.xkme.2024.100836","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;About 25%-40% of patients with inflammatory bowel disease (IBD) may have extraintestinal manifestations, mainly involving the liver, skin, and joints. Kidney involvement in patients with IBD has been reported, but there are no estimates of its prevalence in population-based studies in the United States. We compared the frequency of acute kidney injury (AKI) among hospitalizations with IBD with that among hospitalizations with collagen vascular diseases and hospitalizations with neither condition.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;Retrospective, population-based cohort study.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;AKI and AKI requiring dialysis.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;Regression models were used to compare the occurrence of AKI among groups. Inverse probability of treatment weighting was applied to balance groups on covariates.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The final sample comprised 5,735,804 hospitalizations, including 57,121 with IBD, 159,930 with collagen vascular diseases, and 5,518,753 with neither IBD nor collagen vascular diseases. AKI was observed in 13%, 15%, and 12.2% of hospitalizations with IBD, collagen vascular diseases, and the general population, respectively. When adjusting for demographic, hospital, and clinical characteristics using inverse probability of treatment weighting, hospitalizations with IBD had higher odds of being diagnosed with AKI than both those with collagen vascular diseases (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.27-1.38) and the general population (OR, 1.27; 95% CI, 1.23-1.31) and also had higher odds of being diagnosed with AKI requiring dialysis than those with collagen vascular diseases (OR, 1.59; 95% CI, 1.31-1.94) or than the general population (OR, 1.45; 95% CI, 1.25-1.68).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;Cross-sectional analysis, underreporting of International Classification of Diseases codes, and analyses relevant to in-hospital stays only.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;The prevalence and risk of AKI among hospitalizations with IBD is greater than that of hospitalizations with collagen vascular diseases and the general population. Coexisting kidney disease should be considered among patients with a known diagnosis of IBD.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain Language Summary&lt;/h3&gt;&lt;p&gt;As a nephrologist, we have evaluated many patients with inflammatory bowel disease with various forms of kidney disease, both inflammatory and noninflammatory. Based on a multitude of factors, we have always wondered if there are shared immune mechanisms between the gut and kidney that could explain the underlying inflammation in both organs. In addition, based on recent studies of other autoimmune/inflammatory diseases, there is growing interest in the role of the gut microbiome (microorganisms that reside in our g","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 7","pages":"Article 100836"},"PeriodicalIF":3.9,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000475/pdfft?md5=592a6b011520efa07b2ef4839389995a&pid=1-s2.0-S2590059524000475-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054146","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":"Remdesivir and Kidney and Cardiovascular Outcomes in COVID-19 Patients With Reduced GFR","authors":"James E. Dinulos BA ,&nbsp;Qiyu Wang MD ,&nbsp;Sophia Zhao MD, PhD ,&nbsp;Duru Cosar BS ,&nbsp;Ritu Seethapathy MBBS ,&nbsp;Joshua D. Long BA ,&nbsp;Ian Strohbehn BA ,&nbsp;Meghan E. Sise MD, MS","doi":"10.1016/j.xkme.2024.100835","DOIUrl":"10.1016/j.xkme.2024.100835","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 7","pages":"Article 100835"},"PeriodicalIF":3.9,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000463/pdfft?md5=fd2a8b278591e2a70a44221d011c4654&pid=1-s2.0-S2590059524000463-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029856","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":"Concurrent Crystalline Light-Chain Proximal Tubulopathy and Membranous Nephropathy: A Case Report and Literature Review","authors":"Huizi Zhang,&nbsp;Chunyun Zhang,&nbsp;Hua Su","doi":"10.1016/j.xkme.2024.100816","DOIUrl":"10.1016/j.xkme.2024.100816","url":null,"abstract":"<div><p>Light-chain proximal tubulopathy (LCPT) is typically characterized by the intracytoplasmic deposition of light chains within the proximal tubular epithelial cells, which is usually classified into crystalline and noncrystalline subgroups. Membranous nephropathy (MN) is a common glomerular disease characterized by diffused subepithelial electron-dense deposits along the capillary loop accompanied by the effacement and microvillus transformation of the foot process. Here, we report a biopsy-confirmed case of a concurrence of LCPT with crystals (κ light chains restricted) and antigen-undetermined MN in a male patient. The patient presented with low-molecular-weight proteinuria, increased serum creatinine levels, and incomplete Fanconi syndrome. To our knowledge, this is the first report of a concurrence of LCPT and independent MN of unknown target antigens, which may enrich our recognition of monoclonal gammopathy of renal significance with synchronous MN.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 5","pages":"Article 100816"},"PeriodicalIF":3.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259005952400027X/pdfft?md5=74522a17a26efdef59315401ba1bcb33&pid=1-s2.0-S259005952400027X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140408240","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":"Sparsentan for Focal Segmental Glomerulosclerosis in the DUET Open-Label Extension: Long-term Efficacy and Safety","authors":"Kirk N. Campbell ,&nbsp;Loreto Gesualdo ,&nbsp;Edward Murphy ,&nbsp;Michelle N. Rheault ,&nbsp;Tarak Srivastava ,&nbsp;Vladimir Tesar ,&nbsp;Radko Komers ,&nbsp;Howard Trachtman","doi":"10.1016/j.xkme.2024.100833","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100833","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;Sparsentan is a novel, non-immunosuppressive, single-molecule, dual endothelin angiotensin receptor antagonist (DEARA) examined in the ongoing phase 2 DUET trial for focal segmental glomerulosclerosis (FSGS). In the DUET 8-week double-blind period, sparsentan resulted in greater proteinuria reduction versus irbesartan. We report the long-term efficacy and safety of sparsentan during the open-label extension over more than 4 years.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;Patients were examined from their first sparsentan dose (double-blind period or open-label extension) through 4.6 years.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;Patients with FSGS, excluding secondary FSGS.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Intervention&lt;/h3&gt;&lt;p&gt;Sparsentan (200, 400, and 800&lt;!--&gt; &lt;!--&gt;mg/d).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcomes&lt;/h3&gt;&lt;p&gt;Urinary protein-creatinine ratio, FSGS partial remission endpoint (urinary protein-creatinine ratio&lt;!--&gt; &lt;!--&gt;≤1.5&lt;!--&gt; &lt;!--&gt;g/g and&lt;!--&gt; &lt;!--&gt;&gt;40% reduction from baseline), estimated glomerular filtration rate, and blood pressure approximately every 12 weeks. Treatment-emergent adverse events by year and cases/100 patient-years.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;109 patients were enrolled; 108 received&lt;!--&gt; &lt;!--&gt;≥1 sparsentan dose; 103 entered the open-label extension (68 sparsentan, 35 irbesartan during the double-blind period). Sparsentan was ongoing in 45/108 patients (41.7%); median time to treatment discontinuation was 3.9 years (95% CI, 2.6-5.2). Mean percent proteinuria reduction from baseline was sustained through follow-up. Achieving partial remission within 9 months of first sparsentan dose (52.8% of patients) versus not achieving (47.2%) was associated with significantly slower rate of estimated glomerular filtration rate decline over the entire treatment period (−2.70 vs&lt;!--&gt; &lt;!--&gt;−6.56; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.03) and in the first 2 years (−1.69 vs&lt;!--&gt; &lt;!--&gt;−6.46; &lt;em&gt;P&lt;/em&gt; &lt;!--&gt;=&lt;!--&gt; &lt;!--&gt;0.03). The most common treatment-emergent adverse events (&gt;9 cases/100 patient-years) were headache, peripheral edema, upper respiratory infection, hyperkalemia, and hypotension. Peripheral edema and hypotension declined from year 1 (13.9% and 15.7% of patients, respectively) to&lt;!--&gt; &lt;!--&gt;≤4% in years&lt;!--&gt; &lt;!--&gt;≥2. There were no cases of heart failure and no patient deaths.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;The open-label extension does not include a comparison group.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Long-term sparsentan treatment showed sustained proteinuria reduction and a consistent safety profile.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;p&gt;There is substantial unmet clinical need for safe and effective treatments for focal segmental glomerulosclerosis (FSGS), a kidney lesion with varied causes. Sparsentan is being studied for treatment of FSGS and targets 2 important pathways (endothelin-1 and angiotensin II) that lead to the loss of kidney function. In the 8-week randomized, doubl","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100833"},"PeriodicalIF":3.9,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259005952400044X/pdfft?md5=8ec98911908bcf19a9cbaea2a2968e87&pid=1-s2.0-S259005952400044X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141083992","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":"Urine Biomarkers of Kidney Tubule Health and Risk of Incident CKD in Persons Without Diabetes: The ARIC, MESA, and REGARDS Studies","authors":"Jonathan G. Amatruda ,&nbsp;Ronit Katz ,&nbsp;Casey M. Rebholz ,&nbsp;Mark J. Sarnak ,&nbsp;Orlando M. Gutierrez ,&nbsp;Sarah J. Schrauben ,&nbsp;Jason H. Greenberg ,&nbsp;Josef Coresh ,&nbsp;Mary Cushman ,&nbsp;Sushrut Waikar ,&nbsp;Chirag R. Parikh ,&nbsp;Jeffrey R. Schelling ,&nbsp;Manasi P. Jogalekar ,&nbsp;Joseph V. Bonventre ,&nbsp;Ramachandran S. Vasan ,&nbsp;Paul L. Kimmel ,&nbsp;Joachim H. Ix ,&nbsp;Michael G. Shlipak ,&nbsp;CKD Biomarkers Consortium","doi":"10.1016/j.xkme.2024.100834","DOIUrl":"https://doi.org/10.1016/j.xkme.2024.100834","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Rationale &amp; Objective&lt;/h3&gt;&lt;p&gt;Tubulointerstitial damage is a feature of early chronic kidney disease (CKD), but current clinical tests capture it poorly. Urine biomarkers of tubulointerstitial health may identify risk of CKD.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;Prospective cohort (Atherosclerosis Risk in Communities [ARIC]) and case-cohort (Multi-Ethnic Study of Atherosclerosis [MESA] and Reasons for Geographic and Racial Differences in Stroke [REGARDS]).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Setting &amp; Participants&lt;/h3&gt;&lt;p&gt;Adults with estimated glomerular filtration rate (eGFR) ≥60&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt; and without diabetes in the ARIC, REGARDS, and MESA studies.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposures&lt;/h3&gt;&lt;p&gt;Baseline urine monocyte chemoattractant protein-1 (MCP-1), alpha-1-microglobulin (α1m), kidney injury molecule-1, epidermal growth factor, and chitinase-3-like protein 1.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Outcome&lt;/h3&gt;&lt;p&gt;Incident CKD or end-stage kidney disease.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Analytical Approach&lt;/h3&gt;&lt;p&gt;Multivariable Cox proportional hazards regression for each cohort; meta-analysis of results from all 3 cohorts.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;872 ARIC participants (444 cases of incident CKD), 636 MESA participants (158 cases), and 924 REGARDS participants (488 cases) were sampled. Across cohorts, mean age ranged from 60&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;10 to 63&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;8 years, and baseline eGFR ranged from 88&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;13 to 91&lt;!--&gt; &lt;!--&gt;±&lt;!--&gt; &lt;!--&gt;14&lt;!--&gt; &lt;!--&gt;mL/min/1.73&lt;!--&gt; &lt;!--&gt;m&lt;sup&gt;2&lt;/sup&gt;. In ARIC, higher concentrations of urine MCP-1, α1m, and kidney injury molecule-1 were associated with incident CKD. In MESA, higher concentration of urine MCP-1 and lower concentration of epidermal growth factor were each associated with incident CKD. In REGARDS, none of the biomarkers were associated with incident CKD. In meta-analysis of all 3 cohorts, each 2-fold increase α1m concentration was associated with incident CKD (HR, 1.19; 95% CI, 1.08-1.31).&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Limitations&lt;/h3&gt;&lt;p&gt;Observational design susceptible to confounding; competing risks during long follow-up period; meta-analysis limited to 3 cohorts.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;In 3 combined cohorts of adults without prevalent CKD or diabetes, higher urine α1m concentration was independently associated with incident CKD. 4 biomarkers were associated with incident CKD in at least 1 of the cohorts when analyzed individually. Kidney tubule health markers might inform CKD risk independent of eGFR and albuminuria.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Plain-Language Summary&lt;/h3&gt;&lt;p&gt;This study analyzed 3 cohorts (ARIC, MESA, and REGARDS) of adults without diabetes or prevalent chronic kidney disease (CKD) to determine the associations of 5 urinary biomarkers of kidney tubulointerstitial health with incident CKD, independent of traditional measures of kidney health. Meta-analysis of results from all 3 cohorts suggested that higher baseline levels of urine alpha-1-microglobulin were ","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"6 6","pages":"Article 100834"},"PeriodicalIF":3.9,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000451/pdfft?md5=9677af2a2936700dedd06ff7f9bd6d04&pid=1-s2.0-S2590059524000451-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077780","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}