Nefrologia最新文献

{"title":"Cuando la proteinuria no es lo que parece: un cambio de paradigma en el abordaje diagnóstico","authors":"José María Peña Porta, Javier Peña Vicente de Vera, Axenia Babara, Jerson Alvarado Zelaya, Byron Fabricio Vásquez Macías, Ana María Villigua Zambrano, Pablo Iñigo Gil","doi":"10.1016/j.nefro.2026.501575","DOIUrl":"10.1016/j.nefro.2026.501575","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 7","pages":"Article 501575"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148694292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Del mimetismo clínico al diagnóstico certero: nefropatía asociada a COL4A4 oculta tras poliquistosis renal","authors":"María del Mar del Águila García,&nbsp;Antonio M. Poyatos Andújar,&nbsp;Ana I. Morales García,&nbsp;María del Carmen Velázquez de Castro del Pino,&nbsp;María José Espigares Huete,&nbsp;Rafael J. Esteban de la Rosa","doi":"10.1016/j.nefro.2026.501577","DOIUrl":"10.1016/j.nefro.2026.501577","url":null,"abstract":"<div><div>Type IV collagen related nephropathy caused by heterozygous variants in the <em>COL4A3</em> or <em>COL4A4</em> genes shows a wide phenotypic variability, with asymptomatic individuals being relatively common. A cystic phenotype in these cases is uncommon and rarely presents with nephromegaly mimicking autosomal dominant polycystic kidney disease (ADPKD).</div><div>We report a family with hereditary kidney disease showing an autosomal dominant inheritance pattern and marked phenotypic variability. Some family members were diagnosed with urate nephropathy, others met the Ravine-Pei criteria for ADPKD, and others were labeled as having chronic kidney disease of unknown etiology; five progressed to renal replacement therapy.</div><div>The proband, who presented with bilateral renal cysts fulfilling ADPKD criteria, along with microhematuria and non-nephrotic proteinuria, tested negative for <em>PKD1</em> and <em>PKD2</em> variants after sequential genetic analysis. Meanwhile, another family member studied for persistent microhematuria and non-nephrotic proteinuria underwent a renal biopsy that revealed thinning of the glomerular basement membrane on electron microscopy, suggesting Alport syndrome. Genetic testing in both individuals identified the c.735<!--> <!-->+<!--> <!-->2T<!--> <!-->&gt;C (p?) variant in the <em>COL4A4</em> gene, classified as likely pathogenic due to its disruption of a splicing site.</div><div>This case illustrates the phenotypic heterogeneity of heterozygous <em>COL4A4</em>-related Alport syndrome and highlights the importance of implementing genetic testing in the differential diagnosis of hereditary kidney disorders to prevent diagnostic delays with potential clinical consequences.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 7","pages":"Article 501577"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148694293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-glomerular basement membrane disease: A contemporary case series from a large university hospital center","authors":"Ana Catarina Oliveira,&nbsp;Rafael Figueiredo,&nbsp;Rafael Correia,&nbsp;Altin Ndrio,&nbsp;Ricardo Neto,&nbsp;Bernardo Faria,&nbsp;Luís Mendonça,&nbsp;João Frazão","doi":"10.1016/j.nefro.2026.501522","DOIUrl":"10.1016/j.nefro.2026.501522","url":null,"abstract":"<div><h3>Introduction</h3><div>Anti-glomerular basement membrane disease (anti-GBM) is a rare autoimmune disorder characterized by autoantibodies targeting antigens in the glomerular and alveolar basement membranes, often leading to rapidly progressive glomerulonephritis and pulmonary hemorrhage. Contemporary real-world data on clinical presentation and long-term renal outcomes remain scarce. This study aims to examine the clinical and pathological features, as well as renal survival and long-term outcomes, in patients with anti-GBM disease.</div></div><div><h3>Study design</h3><div>Retrospective single-center case series.</div></div><div><h3>Methods</h3><div>All patients diagnosed with anti-GBM disease at a major Portuguese university hospital between 2003 and 2023 were included. Anti-GBM disease was defined as a compatible clinical presentation plus positive anti-GBM antibodies in circulation and/or biopsy-proven anti-GBM disease. Demographic, clinical, laboratory and therapeutic data were reviewed.</div></div><div><h3>Results</h3><div>Twenty-seven patients were included (mean age 58.7<!--> <!-->±<!--> <!-->22.0 years; 59.3% female). Renal involvement was universal and severe (mean serum creatinine 11.95<!--> <!-->±<!--> <!-->10.18<!--> <!-->mg/dL), with 92.6% requiring renal replacement therapy (RRT) at presentation. Alveolar hemorrhage occurred in 33.3% patients. Anti-GBM antibodies were detected in 92.6%; 29.6% were also ANCA-positive. Kidney biopsy (<em>n</em> <!-->=<!--> <!-->15) showed crescentic glomerulonephritis in 80% with a mean crescent burden of 60.9% and a median of 0% normal glomeruli (IQR 0–1). Most patients (92%) received immunosuppressive therapy, and 68% were treated with the standard combination of corticosteroids, cyclophosphamide, and plasma exchange. Renal recovery was limited: only 5 patients (18.5%) who required RRT at presentation recovered renal function, and 66.7% progressed to end-stage kidney disease (ESKD). Higher baseline serum creatinine, a lower proportion of normal glomeruli, and crescentic involvement &gt;40% were significantly associated with ESKD. One- and five-year patient survival were 85.2% and 74.1%, respectively. No relapses occurred.</div></div><div><h3>Conclusions</h3><div>Anti-GBM disease in this Portuguese cohort presented predominantly with severe acute kidney injury requiring RRT and was associated with poor renal recovery despite guideline-directed therapy. Histologic preservation of normal glomeruli and baseline kidney function were strongly associated with renal outcomes. These findings underscore the need for earlier recognition and timely referral, as well as the development of more effective targeted therapies for this severe glomerular disease.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 7","pages":"Article 501522"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148694291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External cuff shaving for peritoneal dialysis exit-site infections: A center experience and proposed management algorithm","authors":"Ana Rita Almeida,&nbsp;Lígia Catarina Ribeiro,&nbsp;Maria João Carvalho,&nbsp;Joana Tavares,&nbsp;Anabela Rodrigues","doi":"10.1016/j.nefro.2026.501505","DOIUrl":"10.1016/j.nefro.2026.501505","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 7","pages":"Article 501505"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148694294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium zirconium cyclosilicate for renin–angiotensin–aldosterone system inhibitor therapy optimization: A systematic review and meta-analysis with meta-regression","authors":"Hamlet Ghukasyan,&nbsp;David Abraham Batista da Hora,&nbsp;Syeda Rubab Fatima,&nbsp;Kauê Abreu Chagas,&nbsp;Taguhi Hayrapetyan,&nbsp;Juan Casas Todolí,&nbsp;Marina Llopis Sanchis,&nbsp;Felemez Arslan","doi":"10.1016/j.nefro.2026.501532","DOIUrl":"10.1016/j.nefro.2026.501532","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Renin–angiotensin–aldosterone system inhibitors (RAASi) are essential in chronic kidney disease (CKD) and heart failure (HF) management but may increase the risk of hyperkalemia (HK). Sodium zirconium cyclosilicate (SZC), a novel potassium binder, may enable sustained RAASi use and dose optimization. This meta-analysis evaluated the association between SZC therapy and RAASi maintenance and optimization.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Embase, Cochrane, and Web of Science from inception until August 2025 for RCTs, observational studies and post-hoc analyses comparing SZC with placebo or standard care in RAASi-treated patients with HK (PROSPERO registration: CRD42024603403). Six studies (3 RCTs, 3 observational; <em>n</em> <!-->=<!--> <!-->79,956 patients) with 3–12 months follow-up were included. Primary outcomes were: RAASi maintenance, up-titration, and discontinuation/down-titration. Subgroup analyses and comparator-stratified analyses were performed. An exploratory meta-regression was conducted to evaluate potassium reduction magnitude and RAASi maintenance association.</div></div><div><h3>Results</h3><div>SZC was associated with a higher likelihood of RAASi maintenance (RR 1.26; 95% CI 1.14–1.40; <em>I</em>² <!-->=<!--> <!-->77%) and up-titration (RR 1.47; 95% CI 1.20–1.80), and with a lower risk of discontinuation or down-titration (RR 0.56; 95% CI 0.46–0.68). Subgroup analyses showed consistent benefits in patients with baseline potassium &gt;5.0<!--> <!-->mEq/L and in RCT-only analyses. The exploratory meta-regression revealed a statistically significant ecological association between the magnitude of potassium reduction and RAASi maintenance (<em>p</em> <!-->=<!--> <!-->0.002).</div></div><div><h3>Conclusion</h3><div>SZC was associated with improved maintenance and optimization of RAASi therapy, while reducing the risk of down-titration or discontinuation. Randomized trials powered for cardiovascular and renal endpoints are needed to determine whether SZC use translates into improved patient outcomes.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 7","pages":"Article 501532"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148694299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new chapter for Nefrología: Merging into a single English-language journal","authors":"Enrique Morales,&nbsp;Joaquin Manrique","doi":"10.1016/j.nefro.2026.501616","DOIUrl":"10.1016/j.nefro.2026.501616","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 7","pages":"Article 501616"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148694354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From convection to disruption: The next step in dialysis for protein-bound toxins","authors":"Néstor Rodriguez-Chitiva,&nbsp;Jordi Soler-Majoral,&nbsp;Marina Urrutia-Jou,&nbsp;Miquel Gómez Umbert,&nbsp;Gregorio Romero-González,&nbsp;Fredzzia Graterol-Torres,&nbsp;Jordi Bover,&nbsp;Gonzalo Ramírez Guerrero,&nbsp;Claudio Ronco","doi":"10.1016/j.nefro.2026.501558","DOIUrl":"10.1016/j.nefro.2026.501558","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 7","pages":"Article 501558"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148694300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney replacement therapy as a key performance indicator for population health. A call to action by REDYT, ALCER, EKPF, S.E.N. and RICORS2040-renal","authors":"Alberto Ortiz,&nbsp;Emilio Sánchez,&nbsp;Juan Carlos Julián,&nbsp;Daniel Gallego,&nbsp;Borja Quiroga","doi":"10.1016/j.nefro.2026.501537","DOIUrl":"10.1016/j.nefro.2026.501537","url":null,"abstract":"<div><div>The 2023 Spanish Registry of Dialysis and Transplantation (REDYT) real data exceeded previous estimates and forecasts for the prevalence of kidney replacement therapy (KRT). This trend will continue as the baby boom generation reaches the age of peak incidence of chronic kidney disease (CKD) and KRT. REDYT disclosed heterogeneity in clinical practice regarding initiation of KRT in the very elderly across Autonomous Communities, which should lead to benchmarking studies that dissect the drivers and outcomes. REDYT also disclosed an inverse correlation between KRT incidence/prevalence and life expectancy. That is, a lower need for KRT may be considered a key performance indicator of better overall societal health. This is not unexpected, as the main consequence of CKD is accelerated biological aging and kidney health is a key component of cardiovascular-kidney-metabolic (CKM) health. Spanish health authorities should follow the lead of international organizations, such as the 2025 World Health Organization (WHO) kidney health resolution, the associated United Nations political statement, the KDIGO guidance on the prevention of CKD and maintenance of kidney health, and the European Renal Association holistic ABCDE approach to cardiovascular-kidney-metabolic health. These organizations emphasize prevention and early treatment, identifying albuminuria as an actionable diagnostic criterion for CKD. Albuminuria drives interventions that improve cardiovascular-metabolic outcomes and may delay KRT by almost three decades. As deaths from CKD will soon overcome those from colorectal cancer, integrating albuminuria-based CKD screening into colorectal cancer screening programs for baby boomers has the potential to stem the tide of KRT and improve societal health.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 7","pages":"Article 501537"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148694295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resilience and gender differences in patients with end-stage renal disease receiving hemodialysis: A cross-sectional study","authors":"Gloria M. Zaragoza Fernández,&nbsp;José C. De La Flor,&nbsp;Verónica Fernández Abreu,&nbsp;Elisa Iglesias Castellano,&nbsp;Rafael Jose Esteban de la Rosa,&nbsp;Rafael Fernández Castillo","doi":"10.1016/j.nefro.2026.501534","DOIUrl":"10.1016/j.nefro.2026.501534","url":null,"abstract":"<div><h3>Introduction</h3><div>End-stage renal disease and hemodialysis impose substantial physical and emotional demands that compromise patients’ psychological well-being. Psychological resilience – the capacity to adapt positively to chronic adversity – plays a protective role, yet its sociodemographic and gender-related determinants remain poorly characterized in hemodialysis populations.</div></div><div><h3>Objective</h3><div>To evaluate psychological resilience in adults receiving maintenance hemodialysis and to examine its association with gender, educational level, and clinical variables.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted in 55 hemodialysis patients at the Gómez Ulla Central Defense Hospital (Madrid, Spain). Sociodemographic and clinical data were collected, and resilience was assessed using the 14-item Resilience Scale (RS-14). Statistical analyses included independent-samples <em>t</em>-tests, Spearman's correlations, and multiple linear regression.</div></div><div><h3>Results</h3><div>Patients reported moderate resilience levels (mean<!--> <!-->=<!--> <!-->74.02, SD<!--> <!-->=<!--> <!-->13.99). Men showed significantly higher resilience than women (77.74 vs. 67.50; <em>p</em> <!-->=<!--> <!-->0.008). Educational attainment correlated positively with resilience (<em>ρ</em> <!-->=<!--> <!-->0.307; <em>p</em> <!-->=<!--> <!-->0.023). In the multivariate model, gender and education together explained 22% of the variance in resilience scores (<em>R</em>² <!-->=<!--> <!-->0.22), while clinical variables showed no significant associations.</div></div><div><h3>Conclusions</h3><div>This preliminary study suggests that gender and educational level may influence psychological resilience in patients undergoing hemodialysis. These associations should be interpreted with caution due to the small, single-center sample and the absence of key psychosocial and contextual variables. Larger, adequately powered multicenter studies incorporating multidimensional gender measures and broader sociodemographic indicators are needed to clarify the mechanisms shaping resilience in ESRD. Tailored psychosocial interventions may help strengthen emotional adaptation in vulnerable groups.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 7","pages":"Article 501534"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148694351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Documento de posicionamiento del Grupo de Anemia de la SEN: una lectura crítica y adaptada de las guías de anemia KDIGO 2026 a la realidad española","authors":"Jose Portolés,&nbsp;Elisabeth Coll,&nbsp;M. Jesús Puchades,&nbsp;Jose J. Broseta,&nbsp;Borja Quiroga,&nbsp;Diana Rodríguez,&nbsp;M. Auxiliadora Bajo,&nbsp;Jose Luis Merino,&nbsp;Raquel Ojeda,&nbsp;Patricia de Sequera,&nbsp;Julio Pascual,&nbsp;Aleix Cases","doi":"10.1016/j.nefro.2026.501576","DOIUrl":"10.1016/j.nefro.2026.501576","url":null,"abstract":"<div><div>Anemia in chronic kidney disease (CKD) remains highly prevalent and is strongly associated with increased cardiovascular morbidity, mortality, and impaired quality of life. The Anemia Working Group of the Spanish Society of Nephrology reviews the KDIGO 2026 anemia guideline, structured into 4 chapters, integrating national epidemiological data and the regulatory framework of the Spanish National Health System to contextualize its implementation.</div><div>The guideline introduces substantial updates, particularly in iron therapy strategies, the role of hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), and the systematic assessment of treatment resistance. Iron deficiency is reclassified as “systemic deficiency” or “iron-restricted erythropoiesis”, reinforcing a proactive intravenous iron approach in hemodialysis, supported by the PIVOTAL trial. Broader thresholds for initiating iron therapy in non-dialysis CKD are proposed, although uncertainties persist regarding upper ferritin and transferrin saturation limits. The guideline emphasizes individualized selection of the administration route and recommends withholding iron during systemic infections. Notably, treatment of marked iron deficiency without anemia is now considered.</div><div>Erythropoiesis-stimulating agents remain first-line therapy once alternative causes are excluded and iron deficiency corrected. Hemoglobin targets remain<!--> <!-->&lt;<!--> <!-->11.5<!--> <!-->g/dL, with individualized initiation between 8.5 and 10<!--> <!-->g/dL depending on cardiovascular risk, symptoms, and transfusion needs, with slightly lower thresholds in dialysis (≤<!--> <!-->9-10<!--> <!-->g/dL). The guideline stresses using the lowest effective erythropoiesis-stimulating agent or HIF-PHI dose, with adjustments every 4 weeks. HIF-PHIs, such as roxadustat, are reserved for non-dialysis CKD when erythropoiesis-stimulating agents are unsuitable, given potential risks and limited long-term data. Finally, Patient Blood Management strategies are promoted to reduce transfusions, particularly in kidney transplant candidates.</div><div>This position statement underscores the importance of adapting international recommendations to Spanish clinical practice, prioritizing safety, individualized care, and shared decision-making.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 7","pages":"Article 501576"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148694353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}