Nefrologia最新文献

{"title":"Clinicopathological characteristics and outcomes of patients with unexplained renal impairment: A single center study","authors":"Radwa A. Ellisy ,&nbsp;Effat A. Tony ,&nbsp;Wesam Ismail ,&nbsp;Rabab Radi ,&nbsp;Mohamed Ismail Seddik ,&nbsp;Essam M. Abdel Aziz","doi":"10.1016/j.nefro.2024.10.006","DOIUrl":"10.1016/j.nefro.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) is a growing health problem. About 20% of CKD patients have undetermined causes. Data describing histopathological patterns of unexplained impaired kidney functions in Egypt are lacking. We aimed to identify the clinicopathological characteristics and short-term outcomes of adult cases with unexplained impaired kidney functions.</div></div><div><h3>Methods</h3><div>We conducted a prospective study in Assiut University Hospital from August 2018 to May 2022. It included patients with unexplained elevated serum creatinine (serum creatinine<!--> <!-->&gt;<!--> <!-->115<!--> <!-->μmol/L) who underwent renal biopsies. Descriptive statistics were used to summarize data on patient demographics, histopathological patterns, and outcomes after three months. Clinical trial registration number: <span><span>NCT03586531</span><svg><path></path></svg></span>.</div></div><div><h3>Results</h3><div>Overall, 210 native renal biopsies were included in the analysis. Glomerular diseases were the most common pathological finding (<em>n</em> <!-->=<!--> <!-->88, 44.9%), amyloidosis and FSGS were the most prevalent glomerular pathology (15.2%, 14.3%, respectively). Chronic kidney disease of unknown etiology (CKDu) was diagnosed in 8.1% of the cases; histology suggestive of genetic origin was found in 2.5%, and LECT amyloidosis was found in 3.8% of the cases. Poor outcomes were observed in 43.6% of the patients i.e., renal replacement therapy or death. Treatment strategies were changed based on the biopsy findings in 86 patients (40%).</div></div><div><h3>Conclusion</h3><div>Amyloidosis and FSGS were the most common causes of unexplained renal impairment. CKDu is not uncommon in Egypt, and more preventive measures are needed. This study supports the irreplaceable role of renal biopsy in disease diagnosis, treatment decisions, and predicting prognosis even in advanced stages.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 3","pages":"Pages 249-258"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528853","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":"Validación multicéntrica de la fórmula Kidney Failure Risk Equation (KFRE) en pacientes españoles con enfermedad renal crónica avanzada","authors":"Beatriz Escamilla-Cabrera ,&nbsp;Marco Montomoli ,&nbsp;Maria Kislikova ,&nbsp;Verónica de la Espada ,&nbsp;Alazne Olarte-García ,&nbsp;Ana María García-Prieto ,&nbsp;Sara Piqueras-Sánchez ,&nbsp;Álvaro Álvarez López ,&nbsp;Lucía Rodríguez-Gayo ,&nbsp;Javier Centellas-Pérez ,&nbsp;Hilda Villafuerte ,&nbsp;Pedro Barrera Baena","doi":"10.1016/j.nefro.2025.02.004","DOIUrl":"10.1016/j.nefro.2025.02.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic kidney disease (CKD) is a prevalent condition that requires reliable tools to predict its progression to end-stage renal disease (ESRD). The KFRE equation, internationally validated, allows for estimating the risk of progression at 2 and 5 years. However, it has not been validated in the Spanish population. This study aims to evaluate the predictive capacity of the KFRE in a cohort of Spanish patients.</div></div><div><h3>Methods</h3><div>This is a multicenter, observational, and retrospective study conducted in patients with an estimated glomerular filtration rate (eGFR) &lt;<!--> <!-->30<!--> <!-->ml/min who were followed in nephrology clinics between January 2016 and 2021. A total of 602 patients with clinical and demographic data were included. The predictive capacity of the KFRE, in its 4-variable and 8-variable versions, was evaluated using Cox regression analysis and ROC curves.</div></div><div><h3>Results</h3><div>Of the 602 patients included, 60% were male. Diabetes was the main etiology. Among the patients who started renal replacement therapy (RRT), 37% did so within two years, and 70% began with hemodialysis. Patients who initiated RRT (50.6%) were younger, had a lower eGFR, and exhibited higher baseline albuminuria. The 4-variable KFRE equation showed an AUC of 0.7639 (95% CI: 0.71-0.81) and demonstrated superior accuracy compared to the 8-variable model.</div></div><div><h3>Conclusions</h3><div>The KFRE equation, particularly in its 4-variable version, proves to be useful in predicting the progression to ESRD in the Spanish population. However, recalibration is necessary to improve its accuracy in this context.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 5","pages":"Pages 388-396"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868870","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":"Enfermedad glomerular en enfermedad injerto versus huésped crónica","authors":"Leticia Peluffo ,&nbsp;Lucía Barceló ,&nbsp;Gabriela Otatti ,&nbsp;Andrés Urrestarazu ,&nbsp;Ruben Coitiño ,&nbsp;Cecilia Baccino ,&nbsp;Sofía San Román ,&nbsp;Agustín Noboa ,&nbsp;Jimena Cabrera ,&nbsp;Haydee Aunchaunya ,&nbsp;Fernanda Varela ,&nbsp;Cecilia Coelho ,&nbsp;Lucía Santini ,&nbsp;Eliana Cabrera ,&nbsp;Paula Gauronas ,&nbsp;Santiago Acle ,&nbsp;Oscar Noboa ,&nbsp;Ricardo Silvariño","doi":"10.1016/j.nefro.2025.02.002","DOIUrl":"10.1016/j.nefro.2025.02.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Allogeneic hematopoietic progenitor cell transplantation is a widely used procedure, and graft-versus-host disease (GVHD) is a common complication. Glomerular involvement due to GVHD is exceptional.</div></div><div><h3>Objective</h3><div>to describe the clinical and histopathological presentation of patients with glomerular disease secondary to GVHD.</div></div><div><h3>Materials and methods</h3><div>A retrospective review of the Uruguayan registry of glomerulopathies was conducted to identify renal biopsies from patients with confirmed GVHD.</div></div><div><h3>Results</h3><div>Seven patients were identified, 4<!--> <!-->male, with a median age of 41 years (range 8–58). The most common clinical and analytical presentation was nephrotic syndrome. Histopathological findings included membranous glomerulonephritis (4), segmental and focal sclerohyalinosis (1), membranoproliferative glomerulonephritis (1), and thrombotic microangiopathy (1). All patients were treated with corticosteroids in combination with immunosuppressors, most frequently mycophenolate mofetil and rituximab. Five patients achieved complete remission, one had partial remission, and one did not respond. The combination of corticosteroids with rituximab showed a good response rate in those presenting with podocytopathy in the renal biopsy.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 5","pages":"Pages 381-387"},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868859","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":"Mejora en la detección, diagnóstico y tratamiento temprano de la enfermedad renal crónica en España. Proyecto IntERKit","authors":"José Luis Górriz ,&nbsp;Fran Adán Gil ,&nbsp;Manuel A. Botana López ,&nbsp;Antonio Buño Soto ,&nbsp;Francisco José Campos Cabrera ,&nbsp;Angeles Cisneros ,&nbsp;Silvia Cobo Guerrero ,&nbsp;María Dolores Conejos ,&nbsp;Isabel Egocheaga Cabello ,&nbsp;M. Concepción Fernández Planelles ,&nbsp;Lisardo García-Matarín ,&nbsp;Natalia Jiménez ,&nbsp;Juan Carlos Julián Mauro ,&nbsp;David León Jiménez ,&nbsp;Daniel Martínez Gamote ,&nbsp;Pilar Mazón Ramos ,&nbsp;Alberto Ortiz ,&nbsp;Gemma Palau ,&nbsp;Julia Quevedo Rivera ,&nbsp;J. Emilio Sánchez-Álvarez ,&nbsp;Roser Vallés Fernández","doi":"10.1016/j.nefro.2025.02.001","DOIUrl":"10.1016/j.nefro.2025.02.001","url":null,"abstract":"<div><div>Chronic kidney disease (CKD) is a real public health problem. It is estimated that by 2040, approximately one in 5 adults will develop CKD, and by 2050 it will be the third cause of death in Spain. However, CKD is clearly underdiagnosed, with low screening figures in the population at risk, often delaying its identification to advanced stages of the disease, which worsens the prognosis of patients and increases the associated costs. In addition, drugs are now available that have been shown to reduce the progression of CKD and the risk of developing vascular complications. In this context, the early detection, diagnosis and initial management of CKD by health organizations should become a priority, as it would reduce the burden of the disease substantially. The IntERKit project arises with the aim of improving the early detection, diagnosis and initial management of CKD by promoting collaboration with health organizations, through tools easily implemented by these organizations. Since this pathology is oligo or paucisymptomatic in early stages, a proactive attitude is required from the health professional to detect, diagnose and treat this pathology early. Several publications have shown that, to date, both the detection of CKD and its initial management are not optimal. The IntERKit project provides healthcare organizations with a structured framework to optimize the early approach of CKD efficiently, achieving a real, measurable, sustainable and scalable impact, which can evolve depending on the results obtained.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 5","pages":"Pages 351-359"},"PeriodicalIF":2.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869004","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":"Etelcalcetide: What we know eight years since its approval","authors":"Pedro Freitas ,&nbsp;Luciano Pereira","doi":"10.1016/j.nefro.2024.09.004","DOIUrl":"10.1016/j.nefro.2024.09.004","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The impact of etelcalcetide on patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) has been studied since its introduction in 2016/2017. However, only a handful of studies reported clinically relevant outcomes. This narrative review aims to summarize the published data about etelcalcetide, focusing on biochemical, cardiovascular (CV) and bone endpoints, as well as adverse effects and all-cause mortality.</div></div><div><h3>Materials and methods</h3><div>A literature review of the use of etelcalcetide in hemodialysis patients with SHPT was conducted. Several sources were used, such as PubMed, Google Scholar and Cochrane Library.</div></div><div><h3>Results</h3><div>Regarding bone and mineral metabolism, etelcalcetide is effective in reducing serum levels of parathormone (PTH), calcium, phosphate and fibroblast growth factor 23 (FGF23). Preliminary data have highlighted its role in reducing bone turnover and improving mineralization and preservation of bone structure, indicating a possible positive impact on renal osteodystrophy. From a CV perspective, etelcalcetide is associated with a significant reduction in left ventricular hypertrophy. In addition, etelcalcetide reduces FGF23 and increases sclerostin serum levels. This data suggests a possible CV beneficial effect.</div></div><div><h3>Conclusions</h3><div>Etelcalcetide is effective in controlling SHPT. Promising data is available for some bone and surrogate cardiovascular endpoints, suggesting a possible beneficial effect. There is a lack of studies specifically designed to evaluate its role in reducing fractures, CV and all-cause mortality.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 2","pages":"Pages 116-134"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173298","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":"La litiasis renal en los reyes de la casa de Austria. ¿El primer caso conocido de pielonefritis xantogranulomatosa?","authors":"Víctor M. García Nieto ,&nbsp;Justo Hernández González ,&nbsp;Matilde Clara Gil Villena","doi":"10.1016/j.nefro.2024.10.002","DOIUrl":"10.1016/j.nefro.2024.10.002","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 2","pages":"Pages 187-188"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173306","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":"Evaluación del rol del equipo de coordinación de nefrología en la consulta externa específica de acceso vascular. ¿Qué podemos aportar de nuevo?","authors":"Néstor Fontseré ,&nbsp;Gaspar Mestres ,&nbsp;Xavi Yugueros ,&nbsp;Daniel Gil ,&nbsp;Carla Blanco ,&nbsp;Valentín Lozano ,&nbsp;Lidia María Rodas ,&nbsp;Arantxa Gelabert ,&nbsp;Paula Escarcena ,&nbsp;Rosa Ramos ,&nbsp;Francisco Maduell","doi":"10.1016/j.nefro.2024.08.002","DOIUrl":"10.1016/j.nefro.2024.08.002","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The key points of a monographic vascular access (VA) consultation are an adequate preoperative assessment, as well as a correct management and optimization of waiting lists. Our main objective of present study was to evaluate the degree of exploratory-dependent concordance in outpatient clinics regarding implanted VA, between nephrology and vascular surgery.</div></div><div><h3>Materials and methods</h3><div>We analyzed VA created or surgically repaired between 2021 and 2022. We compared the differences in the preoperative variables between the groups in which the assessments between the two teams were coincident and non-coincident, and the primary (PP) and secondary (PS) patencies during the follow-up period (Kapplan-Meier curves and Log-rank test, and Cox regression analysis). Significant <em>P</em>≤.05.</div></div><div><h3>Results</h3><div>A total of 605 VA creations or repairs were analyzed: 74 ligations (12.2%), 207 distal arterio-venous fistulaes (AVF) (34.3%), 237 proximal AVF (39.2%), 35 repairs (5.7%), 41 grafts (6.7%) and 11 others (1.9%). After an average waiting list time of 16.5<!--> <!-->±<!--> <!-->11.6 days, excluding ligations, adequate 1-month maturation was observed in 87.6% of cases. A total of 158 endovascular procedures and 17 surgical repairs were performed during postoperative follow-up. Primary (PP) and secondary (PS) patencies at 6, 12 and 24 months were PP: 76.2%, 64.9%, 57.5% and PS: 86.4%, 81.2%, 74.7%, respectively. Of the total number of procedures, nephrology obtained an adequate degree of agreement in 93.6% of the cases (kappa index: 0.886). The preoperative factors associated with greater discrepancies in assessments were age (<em>P</em>=.022) and arterial diameter (<em>P</em> =.032). The subgroup of non-matched assessments between nephrology and vascular surgery (39 cases) presented a similar PP (at 2 years: 59.2% vs 41.3%, <em>P</em> =.099) but worse PS (at 2 years: 76.6% vs 55.4%, <em>P</em> =.005).</div></div><div><h3>Conclusions</h3><div>No significant observer-dependent differences (nephrologist vs. vascular surgeon) were observed in decision-making regarding the surgical procedure to be performed (93.6% agreement), and discordant cases presented worse secondary patency. After specific training, the nephrology coordination team can make a proper optimisation of social and health resources by reserving referrals to vascular surgery for those cases of greater complexity.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 2","pages":"Pages 159-166"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173302","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":"Cistitis hemorrágica por adenovirus en receptora de trasplante renopancreático tratada con cidofovir intravesical","authors":"Víctor Joaquín Escudero-Saiz ,&nbsp;Judit Cacho ,&nbsp;Aileen Herceda ,&nbsp;Ángela González-Rojas ,&nbsp;Nuria Esforzado ,&nbsp;Pedro Ventura-Aguiar ,&nbsp;Marta Bodro ,&nbsp;Fritz Diekmann","doi":"10.1016/j.nefro.2024.09.003","DOIUrl":"10.1016/j.nefro.2024.09.003","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 2","pages":"Pages 182-184"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173304","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":"Nefritis lúpica: 10 cuestiones para pensar","authors":"Enrique Morales ,&nbsp;Maria Galindo","doi":"10.1016/j.nefro.2024.07.005","DOIUrl":"10.1016/j.nefro.2024.07.005","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 2","pages":"Pages 101-105"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173286","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":"Anosmia, dysgeusia and malnutrition in chronic kidney disease: A systematic review","authors":"Gaetano Ferrara ,&nbsp;Sara Morales Palomares ,&nbsp;Giuliano Anastasi ,&nbsp;Mauro Parozzi ,&nbsp;Lea Godino ,&nbsp;Domenica Gazineo ,&nbsp;Marco Sguanci ,&nbsp;Stefano Mancin","doi":"10.1016/j.nefro.2024.09.005","DOIUrl":"10.1016/j.nefro.2024.09.005","url":null,"abstract":"<div><div>Chronic kidney disease (CKD) is a prevalent health condition associated with numerous complications, including olfactory and taste dysfunction, and malnutrition. This systematic review focused on dysgeusia, smell disorders and malnutrition in CKD patients. The search included scientific databases such as PubMed, Cochrane Library, CINAHL, Scopus, and Web of Science, as well as sources of grey literature. Quality assessment and risk of bias were evaluated using JBI guidelines, while the certainty of evidence was assessed with the Oxford Centre methods. Seven studies were included: two focusing on anosmia and five on dysgeusia. Anosmia was associated with poorer nutritional status, and interventions such as intranasal theophylline showed promise in enhancing olfactory function. Dysgeusia studies highlighted the potential role of zinc deficiency in malnutrition among dialysis patients, with zinc supplementation showing mixed results to improve taste dysfunction. Taste alterations were correlated with upper gastrointestinal symptoms and malnutrition in CKD patients. The analysis of the interconnection between anosmia, dysgeusia, and malnutrition emerges as a crucial starting point for improving nutritional outcomes in chronic kidney disease (CKD) patients, emphasizing the need for accurate assessment and targeted therapeutic interventions to ensure better nutritional health and improved quality of life for these patients.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 2","pages":"Pages 106-115"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173297","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}