Nefrologia最新文献

{"title":"Encuesta GLANCE: conocimiento e implementación de las recomendaciones del documento de GLOSEN para el diagnóstico y tratamiento de la nefritis lúpica","authors":"Manuel Macía ,&nbsp;Gema Fernández-Juárez ,&nbsp;Ana I. Ávila ,&nbsp;Mar Espino ,&nbsp;Mario Espinosa ,&nbsp;Xavier Fulladosa ,&nbsp;Clara García-Carro ,&nbsp;Marian Goicoechea ,&nbsp;Enrique Morales ,&nbsp;Luis F. Quintana ,&nbsp;Jorge E. Rojas-Rivera ,&nbsp;Manuel Praga","doi":"10.1016/j.nefro.2025.501354","DOIUrl":"10.1016/j.nefro.2025.501354","url":null,"abstract":"<div><div>In 2023, the Spanish Society of Nephrology's Glomerular Diseases Study Group (GLOSEN) published a consensus document containing the most pertinent information and clinical recommendations for the diagnosis, treatment, and follow-up of lupus nephritis (LN). GLANCE is a project that emerged from the need to evaluate the extent of knowledge and application of these GLOSEN recommendations in routine clinical practice for the management of LN. To achieve this, an online self-administered survey was conducted to gather opinions on the recommendations and assess their impact on clinical practice. Fifty-one Spanish nephrologists with more than three years of experience in managing LN and handling more than one LN patient per month, participated in the survey. All participants demonstrated a comprehensive understanding and high overall acceptance of the GLOSEN recommendations. However, discrepancies were noted regarding criteria for partial remission and relapse, as well as treatment goals during the initial months of progression, underscoring the need for a more detailed consensus. Other findings highlighted the limited number of nephrologists using specific scales to assess extrarenal manifestations and the tendency to extend immunosuppressive treatments beyond the recommended 3–5-year period outlined in the document. This emphasizes the necessity for further studies on the discontinuation of these drugs and their association with the risk of relapse in LN.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 9","pages":"Article 501354"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ravulizumab como alternativa en la microangiopatía trombótica inducida por gemcitabina: reporte de un caso clínico","authors":"Cristina Riaza Ortiz ,&nbsp;Marta Calvo Arévalo ,&nbsp;Marta Álvarez Nadal ,&nbsp;Antonio Casado ,&nbsp;Ana I. Sánchez-Fructuoso ,&nbsp;Clara García-Carro","doi":"10.1016/j.nefro.2025.501356","DOIUrl":"10.1016/j.nefro.2025.501356","url":null,"abstract":"<div><div>Thrombotic microangiopathy (TMA) is characterized by endotelial damage, microangiopathic hemolytic anemia, thrombocytopenia and organ damage, particularly renal. In oncology, TMA can be secondary to the cancer itself or related to oncological treatments. TMA associated with gemcitabine has a poor prognosis, with high mortality and complement activation plays a central role in its pathophisiology. While eculizumab has shown efficacy and improved outcomes in this condition, evidence regarding the use of ravulizumab remains scarce. We present the case of an 81-year-old woman with arterial hypertension and a history of left breast cancer treated with surgery and radiotherapy, currently diagnosed with stage <span>iv</span> left breast angiosarcoma treated with gemcitabine after progression on paclitaxel. She developed a hypertensive emergency, anemia (Hb 6.9<!--> <!-->g/dL), thrombocytopenia (68,000 platelets), impaired renal function (creatinine 1.64<!--> <!-->mg/dL) and elevated LDH (1,126 U/L). Suspecting gemcitabine-induced TMA, the treatment was discontinued and ravulizumab was initiated, resulting in rapid renal and hematological response. Oncological treatment with pazopanib was reintroduced, leading to recurrence of TMA. That treatment was suspended and another dose of ravulizumab was administered, with good response. TMA is a significant cause of morbidity and mortality in cancer patients, contributing to progression to chronic kidney disease and the discontinuation of oncological treatment. This case highlights the role of ravulizumab in gemcitabine-associated TMA, offering advantages in frail patients due to its longer half-life, reduced administration frequency and favorable outcomes.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 9","pages":"Article 501356"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From stage 1 to end-stage renal failure: Amyloid β42, amyloid β40, amyloid β42/40 ratio, p-tau181 and cognitive function relationship","authors":"Yasemin Coşkun Yavuz ,&nbsp;Zeynep Biyik ,&nbsp;Firdevs Sak ,&nbsp;Muslu Kazım Korez ,&nbsp;Sedat Abusoglu ,&nbsp;Lutfullah Altintepe","doi":"10.1016/j.nefro.2025.501357","DOIUrl":"10.1016/j.nefro.2025.501357","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>It was aimed to examine the relationship between cognitive impairment (CI) and Aβ40, 42, Aβ42/40 ratio and p-tau181 in chronic kidney disease (CKD) patients at all stages.</div></div><div><h3>Patients</h3><div>The patients were divided into four groups; control, the early stage CKD (stage 1–3), the advanced stage CKD (stage 4–5) and the hemodialysis group. All patients completed the MMSE and MoCA tests for CI. The Aβ40, Aβ42, p-tau181 levels of all participants were measured.</div></div><div><h3>Result</h3><div>The result of the MMSE was significantly lower in CKD group (<em>p</em> <!-->=<!--> <!-->0.005). There was a significant negative correlation between the MMSE and CKD stages (Spearman's <em>rho</em> <!-->=<!--> <!-->−0.29, <em>p</em> <!-->=<!--> <!-->0.001). The Aβ42 level was significantly lower in the hemodialysis patients. The highest Aβ40 level was observed in the hemodialysis patients, and the Aβ40 level was significantly higher in the advanced CKD group as compared to the early CKD patients and controls (<em>p</em> <!-->&lt;<!--> <!-->0.001). The Aβ42/40 ratio was low in the hemodialysis patients (<em>p</em> <!-->=<!--> <!-->0.001). There was a significant negative correlation between the MMSE and Aβ40 (Spearman's <em>rho</em> <!-->=<!--> <!-->0.18, <em>p</em> <!-->=<!--> <!-->.018), and a positive correlation between the MMSE and the Aβ42/40 ratio (Spearman's <em>rho</em> <!-->=<!--> <!-->−0.360, <em>p</em> <!-->&lt;<!--> <!-->.001). MoCA was negatively correlated with the Aβ40 levels (Spearman's <em>rho</em> <!-->=<!--> <!-->−0.185, <em>p</em> <!-->=<!--> <!-->.019). In the multiple analysis with the MMSE, it was determined high Aβ40 level was correlated with the low MMSE score.</div></div><div><h3>Conclusion</h3><div>It was found that there was a significant relationship between CI and the Aβ40 level in the CKD patients, that CI increased as the CKD stages progressed, that there was a significant negative correlation between the MMSE and MoCA tests and Aβ40, and there was a significant positive correlation between the MMSE and the Aβ42/Aβ40 ratio.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 9","pages":"Article 501357"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importancia de la codificación tras el diagnóstico de enfermedad renal crónica: del código N18.9 (CIE/ICD-10) al papel de los laboratorios clínicos","authors":"María Isabel Troya ,&nbsp;Jordi Bover ,&nbsp;Anna Cia Hidalgo ,&nbsp;Susana Malumbres ,&nbsp;Maya Sánchez-Bayá ,&nbsp;Elisabet Massó ,&nbsp;Verónica Coll-Brito ,&nbsp;Paula Anton-Pampols ,&nbsp;Iara da Silva ,&nbsp;Jordi Soler-Majoral ,&nbsp;Elisabeth Marcos ,&nbsp;Beatriz Moreiras Abril ,&nbsp;Noemí Pérez-León ,&nbsp;Marta Morera García ,&nbsp;Joan Pau Golf Zaragoza ,&nbsp;Xavier Jusmet Miguel ,&nbsp;Yolanda Lejardi Estevez ,&nbsp;Rosa López-Alarcón ,&nbsp;Ignacio Blanco ,&nbsp;Cristian Morales Indiano ,&nbsp;Jordi Ara","doi":"10.1016/j.nefro.2025.501410","DOIUrl":"10.1016/j.nefro.2025.501410","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 9","pages":"Article 501410"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respuesta a la carta al editor «Sarcopenia: la importancia de las fórmulas»","authors":"E. García-Menéndez,&nbsp;J. Portolés,&nbsp;A. Muñoz-Sánchez,&nbsp;A. Tato Ribera,&nbsp;C. Yuste Lozano,&nbsp;M. Ossorio González,&nbsp;P. López-Sánchez,&nbsp;D. Janeiro Marín","doi":"10.1016/j.nefro.2025.501390","DOIUrl":"10.1016/j.nefro.2025.501390","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 9","pages":"Article 501390"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel evidence on the management of HCV-associated glomerular disease","authors":"Fabrizio Fabrizi ,&nbsp;Maria F. Donato ,&nbsp;Carlo M. Alfieri ,&nbsp;Manuel A. Podestà ,&nbsp;Luca Nardelli ,&nbsp;Giuseppe Castellano","doi":"10.1016/j.nefro.2025.501349","DOIUrl":"10.1016/j.nefro.2025.501349","url":null,"abstract":"<div><div>Hepatitis C virus infection and chronic kidney disease are major public health issues globally and HCV plays activity in various organs and systems including kidneys. Recent large-scale epidemiological studies have highlighted the negative impact of HCV on the incidence and progression of chronic kidney disease in the adult general population of the western world. In addition, HCV-related glomerular disease is a well-known complication of chronic HCV and novel improvements concerning its management has been achieved. A novel systematic review with meta-analysis reported a strong relationship between HCV infection and higher risk of proteinuria in the general population. Twenty-three studies (<em>n</em> <!-->=<!--> <!-->198,967 unique patients) were identified and overall effect estimate was significant in cross-sectional (OR, 1.47, 95% CI, 1.3; 1.66) (<em>P</em> <!-->&lt;<!--> <!-->0.001) and longitudinal surveys (HR, 1.79, 95% CI, 1.17; 2.74) (<em>P</em> <!-->&lt;<!--> <!-->0.001). The treatment of HCV-related glomerular disease includes now antiviral (direct-acting antiviral agents, DAAs), immunosuppressive and symptomatic drugs. In addition to selective immunosuppression (rituximab, RTX), various combinations of all-oral interferon-free regimens provided with fast and pangenotypic activity is giving us the possibility to treat patients with HCV-related glomerular disease, with and without kidney impairment, and to obtain some clinical benefit. We have collected by a narrative review of the medical literature a cohort of patients (<em>n</em> <!-->=<!--> <!-->104) with HCV-related glomerular disease, the frequency of sustained viral response was 91% (90/99); complete or partial clinical response was found in 29% (<em>n</em> <!-->=<!--> <!-->30) or 42% (<em>n</em> <!-->=<!--> <!-->43), respectively. Recent evidence from a Spanish multicenter survey (<em>n</em> <!-->=<!--> <!-->139 patients with HCV-related mixed cryoglobulinemia) suggests that successful antiviral therapy lowers significantly 24-h proteinuria, promotes immunological response and improves kidney/patient survival. In conclusion, HCV-related glomerulonephritis remains a difficult-to-treat disease even though the extensive use of DAAs has changed the natural history of HCV and made this disease uncommon.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 9","pages":"Article 501349"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased serum phosphate concentration within the normal reference levels is associated with all-cause mortality in non-dialysis CKD patients: A five-year prospective cohort study","authors":"Ana Cerqueira ,&nbsp;Janete Quelhas-Santos ,&nbsp;Núria Paulo ,&nbsp;Claúdia Camila Dias ,&nbsp;Manuel Pestana","doi":"10.1016/j.nefro.2025.501352","DOIUrl":"10.1016/j.nefro.2025.501352","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Cardiovascular (CV) morbidity and mortality are markedly increased in non-dialysis patients with chronic kidney disease (CKD). Thus, the precise management of CV risk factors involved in CKD is crucial to improving outcomes. Serum phosphate (Pi) and FGF-23 levels have been linked with a higher risk of CV events in CKD. However, the exact thresholds of Pi and FGF-23, at which the risk of adverse events increases remain unknown.</div></div><div><h3>Materials and methods</h3><div>We evaluated the expression of intact FGF-23 (iFGF-23) and Pi in a non-dialysis CKD patient population (<em>n</em> <!-->=<!--> <!-->82; 42M:40F; median age 61 years) and investigated their association with CV and renal outcomes, in a five-year follow-up period.</div></div><div><h3>Results</h3><div>At baseline, the median estimated glomerular filtration rate (eGFR), iFGF-23, and Pi were 45<!--> <!-->mL/min/1.73<!--> <!-->m² (IQ 26.6–73.1), 69.9<!--> <!-->μg/mL (IQ 33–117) and 3.4<!--> <!-->mg/dL (IQ 3.3–3.9), respectively. Univariate analysis showed a strong association of both iFGF-23 and Pi with age, Charlson Comorbidity Index, hypertension, and diabetes. In addition, iFGF-23 and Pi were both associated with the composite outcome (major CV and cerebrovascular events – MACCEs, hospitalizations, and all-cause mortality) during follow-up. Moreover, Pi was independently associated with all-cause mortality during follow-up. The segmentation of the population in terciles, according to Pi (&lt;3<!--> <!-->mg/dL; 3–3.6<!--> <!-->mg/dL; ≥3.7<!--> <!-->mg/dL) within reference serum levels, showed a distribution of the fatality of 0%, 20% and 80% (<em>p</em> <!-->=<!--> <!-->0.034), respectively.</div></div><div><h3>Conclusions</h3><div>Our results reinforce the association of both iFGF-23 and Pi with composite CV outcomes in non-dialysis CKD patients and further suggest that Pi, within current reference levels, may behave as an independent risk factor for mortality in this population. It is suggested that reassessing Pi reference levels for early therapeutic intervention in this population may be justified.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 9","pages":"Article 501352"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sarcopenia: la importancia de las fórmulas","authors":"José Ignacio Minguela Pesquera,&nbsp;Iñigo Moina Eguren","doi":"10.1016/j.nefro.2025.501367","DOIUrl":"10.1016/j.nefro.2025.501367","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 9","pages":"Article 501367"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recomendaciones para la evaluación y tratamiento del paciente con diabetes y albuminuria. Papel del antagonismo mineralocorticoide no esteroideo","authors":"Juan Payán López ,&nbsp;Pedro Chinchurreta Capote ,&nbsp;Antonio Hormigo Pozo ,&nbsp;Luis Castilla-Guerra ,&nbsp;José Carlos Fernández-García ,&nbsp;Rosa Fernández Olmo ,&nbsp;María José Espigares Huete","doi":"10.1016/j.nefro.2025.501359","DOIUrl":"10.1016/j.nefro.2025.501359","url":null,"abstract":"<div><div>Patients with type<!--> <!-->2 diabetes mellitus (T2DM) have an increased risk of developing chronic kidney disease (CKD). CKD is defined by both a decline in glomerular filtration rate and the presence of albuminuria. Although the measurement of the urine albumin-to-creatinine ratio is recommended from the time of T2DM diagnosis and subsequently at least once a year, in clinical practice, this assessment is underutilized in many patients. The pathophysiology of diabetic kidney disease involves hemodynamic, metabolic, pro-inflammatory, and pro-fibrotic factors. Likewise, in cardio-reno-metabolic syndrome, excessive or dysfunctional adiposity plays a fundamental role, promoting the development of kidney disease, T2DM and cardiovascular disease. Therefore, its management requires a multifactorial approach that includes the use of renin-angiotensin-aldosterone system inhibitors (targeting hemodynamic factors), SGLT2 inhibitors (targeting both hemodynamic and metabolic factors), finerenone (with anti-inflammatory and anti-fibrotic effects), and GLP-1 receptor agonists with demonstrated renal benefits (targeting metabolic factors), with the aim of more effectively slowing CKD progression and reducing the risk of cardiovascular complications. In this review article, we propose strategies to facilitate the proper assessment and implementation of guideline-recommended treatment in patients with diabetes and albuminuria, presenting a ten-point framework to improve the comprehensive and collaborative management of these patients.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 9","pages":"Article 501359"},"PeriodicalIF":2.6,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145384310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tacrolimus formulations in de novo kidney transplantation: Evidence from a paired kidney study","authors":"Verónica López ,&nbsp;Juan Pablo Gámez ,&nbsp;Myriam León ,&nbsp;Juana Alonso-Titos ,&nbsp;Cristina Gutiérrez ,&nbsp;Carolina Polo ,&nbsp;Teresa Vázquez ,&nbsp;Pedro Ruiz-Esteban ,&nbsp;Domingo Hernández","doi":"10.1016/j.nefro.2025.501351","DOIUrl":"10.1016/j.nefro.2025.501351","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 8","pages":"Article 501351"},"PeriodicalIF":2.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}