Nefrologia最新文献

{"title":"Global Burden of Disease Study based analysis on hypertension-attributable chronic kidney disease: Disease burden and Quality of Care Index across countries, regions, and globally, 1990–2021","authors":"Wenjie Shi ,&nbsp;Yan Zhou ,&nbsp;Qiaolan Wei ,&nbsp;Jiajia Wu ,&nbsp;Chunqin Zhu","doi":"10.1016/j.nefro.2026.501493","DOIUrl":"10.1016/j.nefro.2026.501493","url":null,"abstract":"<div><h3>Background</h3><div>As populations age and hypertension prevalence rises, the burden of hypertension-attributable chronic kidney disease (CKD) keeps aggregating and varies across regions. A systematic assessment of how disease burden and care quality change over time becomes a prerequisite for sound prevention and control policies.</div></div><div><h3>Objective</h3><div>To describe temporal changes and geographical distributions of hypertension-attributable CKD's burden and quality of care across countries, regions, and globally from 1990 to 2021.</div></div><div><h3>Methods</h3><div>Data were obtained from the Global Burden of Disease Study 2021. Temporal trends in disease burden and Quality of Care Index (QCI) were analyzed using the estimated annual percentage change (EAPC). Spearman correlation analysis and cross-national inequality analysis were conducted to explore QCI health inequality related to the Socio-demographic Index (SDI).</div></div><div><h3>Results</h3><div>From 1990 to 2021, global age-standardized incidence and mortality rates of hypertension-attributable CKD increased by 22.30% and 29.21%, respectively. Age-standardized disability-adjusted life-years rate (ASDR) reached 128.41 per 100,000, up 19.15% over 31 years, whereas the QCI declined. Men had higher ASDR and QCI than women. SDI was negatively correlated with ASDR and positively correlated with QCI. Global health inequalities persisted: low-SDI regions (e.g., sub-Saharan Africa) faced heavier burdens and poorer care quality, whereas high-SDI regions such as Eastern Europe and High-income Asia Pacific displayed lower ASDR and higher QCI, indicating better disease management.</div></div><div><h3>Conclusions</h3><div>Global burden of hypertension-attributable CKD continues to rise while care quality declines, with low-SDI countries facing the greatest challenges. Enhanced hypertension prevention, improved CKD management, equitable resource allocation, and global health equity initiatives, with a focus on improving global quality of care, are needed.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 5","pages":"Article 501493"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147801994","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":"Bloqueo del complemento: promesas terapéuticas y retos pendientes en la práctica clínica","authors":"Gema Fernández-Juárez ,&nbsp;Javier Azores-Moreno ,&nbsp;Lina León-Machado ,&nbsp;Irene Vázquez-Raso ,&nbsp;María Soriano-Guillén ,&nbsp;Ana Mendoza ,&nbsp;María Maldonado ,&nbsp;Begoña Rivas Becerra ,&nbsp;Cristina Vega Cabrera ,&nbsp;Amir Shabaka","doi":"10.1016/j.nefro.2025.501464","DOIUrl":"10.1016/j.nefro.2025.501464","url":null,"abstract":"<div><div>Understanding of the complement system in glomerulopathies has advanced significantly, revealing that this system —beyond its role in innate immunity— is a key mediator of kidney injury across a wide spectrum of nephropathies, from those driven by immune complexes to those caused by primary dysregulation of the alternative pathway.</div><div>The introduction of complement inhibitors, such as C5 blockade with eculizumab, marked a milestone: in aHUS it significantly improved renal function and patient survival, and in paroxysmal nocturnal hemoglobinuria it reduced thrombotic complications, achieving survival rates comparable to the general population. These advances have spurred the extension of this approach to other nephropathies and the development of new anti-complement agents.</div><div>However, the heterogeneity of complement dysregulation among glomerulopathies —and even among patients with the same disease— limits the application of a uniform therapeutic strategy. This scenario calls for a more precise characterization of the underlying pathophysiological mechanisms and the identification of critical points of intervention in each clinical context.</div><div>Currently, inhibitors targeting both proximal and terminal steps of the cascade are being investigated to achieve more individualized therapies, although challenges remain, such as the lack of reliable biomarkers, uncertainty regarding optimal treatment duration, scarcity of disease-specific trials, high costs, and the integration of these agents with immunosuppressive regimens.</div><div>The aim of this review is to analyze the role of the complement system in glomerulopathies and to summarize current and future therapeutic advances, with particular emphasis on the challenges and opportunities on the path toward more personalized medicine.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 4","pages":"Article 501464"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584877","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":"Nuevas estrategias para empoderar a los pacientes con enfermedad renal crónica en el control de fósforo (Empower-PHOS)","authors":"María Dolores Arenas Jiménez ,&nbsp;María Delgado García de Polavieja ,&nbsp;Soraya Escribano ,&nbsp;Julia Audije-Gil ,&nbsp;María Luz Sánchez-Tocino ,&nbsp;Fernando Henríquez-Palop ,&nbsp;Gloria Antón Pérez ,&nbsp;Delfina Yetman ,&nbsp;Mónica Pereira ,&nbsp;Pablo Molina ,&nbsp;María Auxiliadora Bajo ,&nbsp;María Jesús Lloret ,&nbsp;Aina Quilis ,&nbsp;Carlos Fernández ,&nbsp;Camino García Monteavaro ,&nbsp;Lina María León ,&nbsp;Ana Botella ,&nbsp;Judith Ballart ,&nbsp;Alba Durbá ,&nbsp;Karina Furaz ,&nbsp;Fabiola Dapena Bielva","doi":"10.1016/j.nefro.2026.501488","DOIUrl":"10.1016/j.nefro.2026.501488","url":null,"abstract":"<div><h3>Introduction</h3><div>Serum phosphorus (P) control in hemodialysis (HD) remains a major challenge, largely influenced by phosphate binder adherence and patient engagement. Structured educational strategies may enhance self-care and improve clinical outcomes.</div></div><div><h3>Objective</h3><div>To evaluate the effectiveness of a patient-centered educational intervention for phosphorus control in hemodialysis.</div></div><div><h3>Material and methods</h3><div>Multicenter, prospective, randomized clinical trial including patients with hyperphosphatemia or high binder requirements, allocated to an intervention group (structured education<!--> <!-->+<!--> <!-->Empower-PHOS tool) or a control group (standard care). Serum P, binder dose, and adherence (SMAQ) were assessed at baseline and at 3, 6, and 12 months.</div></div><div><h3>Results</h3><div>Both groups were comparable at baseline. A total of 122 patients from 14 centers were enrolled. The intervention group achieved significant reductions in serum P at 3 months (from 6.1 to 5.4<!--> <!-->mg/dl; <em>P</em>&lt;.001) and at 12 months (from 6.2 to 5.2<!--> <!-->mg/dl; <em>P</em>=.010), without changes in the number of pills or daily binder dose. Improvements were observed in both adherent and non-adherent patients, with particularly notable reductions among the latter (from 6.4<!--> <!-->±<!--> <!-->1.2 to 5.8<!--> <!-->±<!--> <!-->1.2<!--> <!-->mg/dl; <em>P</em>=.015). Adherence according to SMAQ did not change significantly.</div></div><div><h3>Conclusions</h3><div>A structured, patient-centered educational intervention improved phosphorus control in hemodialysis, even among patients with low baseline adherence, without increasing the pharmacological burden. These findings support the integration of personalized educational strategies as a key component in the comprehensive management of hyperphosphatemia in routine hemodialysis practice.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 4","pages":"Article 501488"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584879","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":"A very rare case report with INF2 gene mutation related sporadic FSGS and response to treatment","authors":"Kübra Kaynar ,&nbsp;İbrahim Erbay ,&nbsp;Hakan Ertan ,&nbsp;Beyhan Güvercin ,&nbsp;Sevdegül Aydın Mungan ,&nbsp;Neslihan Cinkara","doi":"10.1016/j.nefro.2025.501466","DOIUrl":"10.1016/j.nefro.2025.501466","url":null,"abstract":"<div><div>Focal segmental glomerulosclerosis (FSGS) is classified into three forms: primary, secondary, and genetic FSGS. Genetic FSGS is defined as sporadic or familial types. The mutations in the gene inverted formin (INF)2 are mostly encountered in familial genetic FSGS cases. A 29-year-old female patient without any parental consanguinity and family history of kidney disease, who had nephrotic syndrome with inactive urine sedim and normal glomerular filtration rate was diagnosed as kidney biopsy-proven FSGS. She had partial remission under treatment of prednisone and cyclosporine. The patient was re-evaluated due to presence of relapse in proteinuria during her pregnancy. Genetic analysis revealed a heterozygous missense variant (NM_022489.4:c.653G&gt;A; p.R218Q) in the <em>INF2</em> gene. This case report presents a young female patient with sporadic FSGS induced by <em>INF2</em> mutation.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 4","pages":"Article 501466"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584880","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":"New insights into the evolution of serum calprotectin and urinary CD163 in ANCA-associated vasculitis during remission: An exploratory study","authors":"Laura Martinez Valenzuela ,&nbsp;Paula Anton Pàmpols ,&nbsp;Francisco Gómez Preciado ,&nbsp;Gema Fernandez-Juarez ,&nbsp;Xavier Fulladosa Oliveras ,&nbsp;Josep Maria Cruzado ,&nbsp;Joan Torras Ambrós ,&nbsp;Juliana Draibe","doi":"10.1016/j.nefro.2025.501472","DOIUrl":"10.1016/j.nefro.2025.501472","url":null,"abstract":"<div><h3>Background and aims</h3><div>ANCA-associated vasculitis (AAV) is a rare autoimmune disease that causes inflammation of small blood vessels, often leading to organ damage, particularly in the kidneys. Biomarkers like calprotectin and CD163 have been proposed as indicators of disease activity and inflammation. This study aims to analyze the dynamics of calprotectin and usCD163 during stable remission.</div></div><div><h3>Methods</h3><div>This retrospective observational study included AAV patients in remission receiving rituximab as maintenance therapy. Seventeen patients were included, with 78 samples available for analysis. Serum calprotectin and usCD163 levels were measured using ELISA, and clinical data were collected from electronic medical records.</div></div><div><h3>Results</h3><div>Seventeen AAV patients in remission were analyzed. usCD163 and serum calprotectin levels showed a significant positive correlation (<em>p</em> <!-->=<!--> <!-->0.005). Both biomarkers correlated with CRP, and usCD163 also correlated with ESR. Levels of both biomarkers were higher within 6 months after a disease flare. During follow-up, mean biomarker levels were higher in patients who later relapsed, though only usCD163 reached statistical significance (<em>p</em> <!-->=<!--> <!-->0.05). Calprotectin levels were significantly higher in patients who had received rituximab less than three months prior compared to those treated 9–12 months earlier (<em>p</em> <!-->=<!--> <!-->0.031).</div></div><div><h3>Conclusions</h3><div>suCD163 and serum calprotectin may serve as biomarkers for disease activity and relapse in AAV. Their correlation with renal function outcomes and higher levels in patients who relapsed suggest that they might be useful to measure persistent immune activity. Further studies are needed to explore their role in predicting flares and guiding personalized treatment strategies.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 4","pages":"Article 501472"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584828","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":"Association between neutrophil-to-platelet ratio and acute kidney injury among patients undergoing cardiac surgery: An analysis based on Medical Information Mart for Intensive Care","authors":"Mingwu Tian ,&nbsp;Liqiang Yuan ,&nbsp;Zhi Wen,&nbsp;Jianqiang Wu,&nbsp;Zheng Wang,&nbsp;Jian Guo,&nbsp;Changxue Wu","doi":"10.1016/j.nefro.2025.501470","DOIUrl":"10.1016/j.nefro.2025.501470","url":null,"abstract":"<div><h3>Background</h3><div>An increase in neutrophils and a decrease in platelets have been correlated with a heightened risk of acute kidney injury (AKI) following cardiac surgery.</div><div>However, the combined metric of neutrophil-to-platelet ratio (NPR) and its association with post-surgery AKI risk has not yet been investigated.</div></div><div><h3>Objective</h3><div>To explore the relationship between NPR and AKI risk within seven days following cardiac surgery.</div></div><div><h3>Methods</h3><div>Data were downloaded from Medical Information Mart for Intensive Care, including patients after cardiac surgery. Both univariate and multivariate logistic regression models were employed to explore association between NPR and AKI risk within seven days post-operatively. A restricted cubic spline was employed to evaluate non-linear nature of this association. Subgroup analyses were performed to examine variations across different cohorts.</div></div><div><h3>Results</h3><div>1702 patients were included, with an AKI incidence of 20.21% within the postoperative seven-day period. Logistic regression analysis revealed that, in fully adjusted models, the highest tertile (T3, NPR<!--> <!-->≥<!--> <!-->7.453) was significantly associated with an elevated AKI risk within seven days post-surgery (OR<!--> <!-->=<!--> <!-->1.500, 95%CI: 1.086–2.076, <em>P</em> <!-->=<!--> <!-->0.014). There was no significant non-linear relationship between NPR and AKI risk (<em>P</em>-overall<!--> <!-->=<!--> <!-->&lt;0.001, <em>P</em>-non-linear<!--> <!-->=<!--> <!-->0.468). Notably, a significant interaction was observed in the subgroup receiving platelet transfusion (<em>P</em> interaction<!--> <!-->=<!--> <!-->0.005).</div></div><div><h3>Conclusion</h3><div>In adults undergoing cardiac surgery, an elevated NPR was linked to higher AKI risk. This finding offers a novel marker for the early identification of patients at high risk for AKI post-surgery.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 4","pages":"Article 501470"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584847","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":"Comment on “Relationship between macrophage phenotype and kidney survival in patients with lupus nephritis”","authors":"Sidra Javed","doi":"10.1016/j.nefro.2025.501449","DOIUrl":"10.1016/j.nefro.2025.501449","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 4","pages":"Article 501449"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584849","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":"Trasplante renal de donante vivo, situación actual y perspectivas futuras. ¿Podemos hacer más?","authors":"Esther González Monte,&nbsp;Eduardo Gutiérrez Martínez,&nbsp;Hernando Trujillo Cuellar,&nbsp;Natalia Polanco Fernández,&nbsp;Ana Hernández Vicente,&nbsp;Ángel Sevillano Prieto,&nbsp;Lucia Rodríguez Gayo,&nbsp;Enrique Morales Ruiz,&nbsp;Amado Andrés Belmonte,&nbsp;Julio Pascual Santos","doi":"10.1016/j.nefro.2025.501471","DOIUrl":"10.1016/j.nefro.2025.501471","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 4","pages":"Article 501471"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584875","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":"Respond to “Relationship between macrophage phenotype and kidney survival in patients with lupus nephritis”","authors":"Ozcan Uzun ,&nbsp;Cihan Heybeli","doi":"10.1016/j.nefro.2026.501509","DOIUrl":"10.1016/j.nefro.2026.501509","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 4","pages":"Article 501509"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584829","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":"A case of “summer hypokalemia” revealing adult-diagnosed cystic fibrosis","authors":"Taha Enes Cetin ,&nbsp;Veysel Baran Tomar ,&nbsp;Yagmur Eken ,&nbsp;Ozant Helvacı ,&nbsp;Galip Guz","doi":"10.1016/j.nefro.2025.501445","DOIUrl":"10.1016/j.nefro.2025.501445","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 4","pages":"Article 501445"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147584848","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}