Nefrologia最新文献

{"title":"Life-threatening haemorrhage from a right superior phrenic artery pseudoaneurysm in a peritoneal dialysis patient","authors":"Julian Delicata , Elena Farrugia , Reuben Formosa , Kelvin Cortis , Emanuel Farrugia","doi":"10.1016/j.nefro.2024.09.008","DOIUrl":"10.1016/j.nefro.2024.09.008","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 2","pages":"Pages 185-186"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173305","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":"Long-term outcomes after AKI in hospitalized patients with COVID-19","authors":"Bernardo Marques da Silva ,&nbsp;Joana Gameiro ,&nbsp;Joana Lei Teixeira ,&nbsp;Cláudia Costa ,&nbsp;Carolina Branco ,&nbsp;João Oliveira ,&nbsp;João Bernardo ,&nbsp;Filipe Marques ,&nbsp;José Agapito Fonseca ,&nbsp;José António Lopes","doi":"10.1016/j.nefro.2024.08.003","DOIUrl":"10.1016/j.nefro.2024.08.003","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Acute kidney injury (AKI) is frequent in hospitalized patients and contributes to adverse short- and long-term outcomes. We aimed to evaluate the association of AKI and long-term adverse renal events and mortality in a cohort of patients hospitalized with COVID-19.</div></div><div><h3>Material and methods</h3><div>Single-center and retrospective study of hospitalized patients admitted to a Dedicated Unit for COVID-19 at Centro Hospitalar Universitário Lisboa Norte, Portugal, between March 2020 and October 2020. AKI was defined and classified according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification, using SCr criteria. The analyzed outcomes were development of major adverse kidney events (MAKE), major adverse renal cardiovascular events (MARCE), and mortality over a two-year follow-up period.</div></div><div><h3>Results</h3><div>From the included 409 patients, AKI occurred in 60.4% (<em>n</em> <!-->=<!--> <!-->247). Within two years after discharge, 31.8% (<em>n</em> <!-->=<!--> <!-->130) of patients had an eGFR<!--> <!-->&lt;<!--> <!-->60<!--> <!-->mL/min/1.73<!--> <!-->m² and/or a 25% decrease on eGFR and 1.7% (<em>n</em> <!-->=<!--> <!-->7) of patients required RRT, 6.1% (<em>n</em> <!-->=<!--> <!-->25) of patients had CV events and 27.9% (<em>n</em> <!-->=<!--> <!-->114) of patients died. The incidence of MAKE was 60.9% (<em>n</em> <!-->=<!--> <!-->249), and MARCE was 62.6% (<em>n</em> <!-->=<!--> <!-->256). On a multivariate analysis, older age (adjusted HR 1.02 (95% CI: 1.01–1.04), <em>p</em> <!-->=<!--> <!-->0.008), cardiovascular disease (adjusted HR 2.22 (95% CI: 1.24–3.95), <em>p</em> <!-->=<!--> <!-->0.007), chronic kidney disease (adjusted HR 5.15 (95% CI: 2.22–11.93), <em>p</em> <!-->&lt;<!--> <!-->0.001), and AKI (adjusted HR 1.76 (95% CI: 1.12–2.78), <em>p</em> <!-->=<!--> <!-->0.015) were independent predictors of MAKE. Older age (adjusted HR 1.06 (95% CI: 1.04–1.08), <em>p</em> <!-->&lt;<!--> <!-->0.001) and neoplasia (adjusted HR 4.88 (95% CI: 2.37–10.04), <em>p</em> <!-->&lt;<!--> <!-->0.001) were independent predictors of mortality.</div></div><div><h3>Conclusions</h3><div>In this cohort of hospitalized patients with COVID-19, AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and/or mortality after hospital discharge.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 2","pages":"Pages 150-158"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173301","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":"Estudio genético en adultos con glomeruloesclerosis focal y segmentaria","authors":"Melissa Pilco-Terán ,&nbsp;Amir Shabaka ,&nbsp;Mónica Furlano ,&nbsp;Ana Tato Ribera ,&nbsp;Isabel Galán Carrillo ,&nbsp;Eduardo Gutiérrez ,&nbsp;Roser Torra ,&nbsp;Gema Fernández-Juárez ,&nbsp;en representación del Grupo de Trabajo de Enfermedades Renales Hereditarias (GTERH) y Grupo de Trabajo de Enfermedades Glomerulares de la Sociedad Española de Nefrología (GLOSEN)","doi":"10.1016/j.nefro.2024.09.006","DOIUrl":"10.1016/j.nefro.2024.09.006","url":null,"abstract":"<div><div>Focal segmental glomerulosclerosis (FSGS) is a histological pattern of injury that derives from various pathological processes that affect podocytes, resulting in loss of selectivity of the glomerular filtration membrane, proteinuria and the development of renal failure that progresses to end-stage kidney disease in a significant number of patients. The classification proposed by the 2021 KDIGO guidelines divides FSGS into four categories: primary, secondary, genetic, and FSGS of undetermined cause, thus facilitating its diagnosis and management. Genetic causes of FSGS present significant clinical variability, complicating their identification. Genetic testing is crucial to identify FSGS of genetic cause. The prevalence of genetic FSGS is significant in children and considerable in adults, highlighting the importance of early diagnosis to avoid unnecessary treatments and facilitate genetic counselling. Massive sequencing techniques have revolutionized genetic diagnosis, allowing the identification of more than 60 genes responsible for podocyte damage. This document proposes clinical recommendations for carrying out genetic studies in adults with FSGS, highlighting the need for a correct classification for adequate therapeutic planning and improvement of results in clinical trials.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 2","pages":"Pages 135-149"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173299","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":"Unveiling the antiurolithiatic potentiality of two benzene sulfonamide derivatives against ethylene glycol-induced renal calculi","authors":"Ahmed M. Elgendy ,&nbsp;Mohamed S. Nafie ,&nbsp;Zohour I. Nabil ,&nbsp;Nahla S. El-Shenawy ,&nbsp;Heba N. Gad El-Hak","doi":"10.1016/j.nefro.2024.09.007","DOIUrl":"10.1016/j.nefro.2024.09.007","url":null,"abstract":"<div><h3>Objective</h3><div>Oxidative stress and inflammation play crucial roles in the onset of kidney injury and crystal formation caused by hyperoxaluria. Indapamide is a potent medication for treating renal calculi, but it has severe side effects such as hypokalemia, hypercalcemia, and hyperuricemia. Therefore, it is advisable to explore alternative treatments that do not have these side effects. The study aimed to reveal the antiurolithiatic potential of two benzene sulfonamide derivatives (SBCl and SBF; A and B, respectively) against ethylene glycol-induced kidney stones.</div></div><div><h3>Methods</h3><div>The rats were divided into two main groups: the first group consisted of 20 rats with induced kidney stones, and the second group included 15 control rats. This division enabled a comparative analysis between rats with kidney stones and those without, offering insights into the effects of kidney stone induction on various physiological parameters and biochemical markers. The effectiveness of benzene sulfonamide derivatives (compounds A and B) was assessed in rats with induced kidney stones. The treatment was given orally by gavage for 21 days, administered every 48<!--> <!-->h after inducing kidney stones with 0.12<!--> <!-->ml of 5% ethylene glycol (EG).</div></div><div><h3>Results</h3><div>The influence of compounds A and B on electrolytes, biochemical, antioxidant, and inflammatory reactions in induced kidneys underscores their potential therapeutic advantages in alleviating the advancement of kidney stone disease and related complications.</div></div><div><h3>Conclusion</h3><div>Both compounds were found to possess equal effectiveness in inhibiting the complications of stone formation. However, SBCl-EG showed superior antioxidant and inflammatory parameters effects compared to SBF-EG. Our study's findings underscore the potential benefits of derivatives in treating nephrolithiasis and related oxidative disorders, highlighting their superior effects on antioxidant and inflammatory responses compared to standard treatments.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 2","pages":"Pages 167-181"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143173303","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":"Review and practical excursus on the comparison between traditional statics methods and Classification And Regression Tree (CART) in real-life data: Low protein diet compared to Mediterranean diet in patients with chronic kidney disease","authors":"Vincenzo Calabrese ,&nbsp;Daniela Metro ,&nbsp;Angela Alibrandi ,&nbsp;Domenico Maviglia ,&nbsp;Valeria Cernaro ,&nbsp;Veronica Maressa ,&nbsp;Elisa Longhitano ,&nbsp;Guido Gembillo ,&nbsp;Domenico Santoro","doi":"10.1016/j.nefro.2025.01.009","DOIUrl":"10.1016/j.nefro.2025.01.009","url":null,"abstract":"<div><div>The Classification and Regression Tree (CART) is a supervised learning approach useful used to segment the space of and the predictors/features space into smaller homogeneous regions that are, represented in a decision tree. It computes the selection of features automatically, in contrast to traditional statistic methods. In this review, we compared CART to traditional statistics in patients who did not attempt a diet to patients who followed a low-protein diet (LPD) or the Mediterranean diet in chronic kidney disease (CKD) patients, and we analyzed them using linear regression and CART methods. In our example, diet adherence proved to be the factor with the greatest impact on renal function decline, but CART failed to detect significant differences between LPD and Mediterranean diet. Similar results were found using traditional statics, but CART gave a model with the proportion of the explained outcome by the model (<em>R</em>²) higher by about 20%, thus a stronger model. In addition, CART allows quick and easy identification of the variables affecting the outcome with a simple visual representation through the decision tree, increasing the interpretability of the results. In summary, no difference in the impact of variables has been detected with the two methods, but CART gave us a more detailed model with a faster and easier interpretation.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 4","pages":"Pages 279-284"},"PeriodicalIF":2.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724482","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":"Renal involvement due to pigment casts in a patient with sickle cell disease, not everything is focal and segmental glomerulosclerosis","authors":"Lina M. Garzón ,&nbsp;Edgar H. Dominguez ,&nbsp;Nancy Janeth Vargas ,&nbsp;Luz M. Mejía","doi":"10.1016/j.nefro.2025.01.008","DOIUrl":"10.1016/j.nefro.2025.01.008","url":null,"abstract":"<div><div>Sickle cell disease, is a genetic disorder caused by a mutation in the HBB gene, affecting the β-globin and resulting in the formation of sickle hemoglobin. The disease can affect the kidney through various mechanisms, including vaso-occlusion, ischemia–reperfusion, endothelial dysfunction, and hemolysis-induced renal injury. This article describes the case of a 41-year-old woman with sickle cell disease who presented with a hemolytic crisis, developed acute kidney injury (AKI), 8<!--> <!-->g of proteinuria in 24<!--> <!-->h, and required renal support therapy. A renal biopsy was performed, revealing focal segmental glomerulosclerosis (FSGS), severe acute tubular necrosis, interstitial fibrosis with moderate tubular atrophy, and pigment casts. Thus, histochemistry was performed with a positive reaction for iron with evidence of intraluminal and cytoplasmic granular deposits in the proximal tubules compatible with hemosiderin and negative for hemoglobin. The case of this patient with sickle cell disease and AKI illustrates the importance of considering hemoglobin cast nephropathy as a potential cause.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 5","pages":"Pages 410-414"},"PeriodicalIF":2.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868872","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":"Caracterización de variantes recurrentes de UMOD (p.C255Y y p.Q316P) en una cohorte gallega: correlación genotipo-fenotipo e implicaciones clínicas","authors":"Eloísa Sánchez-Cazorla ,&nbsp;Borja Temes-Álvarez ,&nbsp;Pilar Oliveros-Martínez ,&nbsp;Pedro Fortes-González ,&nbsp;María García-Murias ,&nbsp;Ana Barcia de la Iglesia ,&nbsp;Noa Carrera ,&nbsp;Miguel Ángel García-González ,&nbsp;Grupo GalERH","doi":"10.1016/j.nefro.2025.01.007","DOIUrl":"10.1016/j.nefro.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div>The <em>UMOD</em> gene encodes the uromodulin protein, which plays a crucial role in renal function. Genetic alterations affecting its correct function are mainly related to Autosomal Dominant Tubulointerstitial Kidney Disease (ADTKD), progressive renal failure and hyperuricaemia, among other variable clinical phenotypes. In the Galician population there are recurrent mutations in this gene, this study aims to phenotypically characterise the recurrent variants to improve the prognosis and management strategies of affected patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted with 37 patients from 15 families carrying recurrent variants in <em>UMOD</em> (p.C255Y and p.Q316P, from transcript NM_001008389.3) in a Galician population characterised by high genetic conservation. Clinical data were collected, including renal function, hyperuricemia, hypertension and presence of renal cysts. Genomic analyses were performed by NGS and Sanger sequencing, variant classification were conducted according to ACMG guidelines. Statistical comparisons were performed using Mann-Whitney, Chi-square and Fisher tests, with Benjamini-Hochberg correction for multiple testing.</div></div><div><h3>Results</h3><div>The cohort included 28 carriers of p.C255Y and 9 of p.Q316P. Both variants affect highly conserved domains with low tolerance to amino acid changes, which alters protein function and has clinical effects in patients. Hyperuricaemia was observed in 76% of p.C255Y carriers and 50% of p.Q316P carriers, while only the first variant was associated with episodes of gout. Renal cysts and hypertension were identified in about half of the patients, independently of variant type. Kaplan-Meier curves suggested an earlier progression to hyperuricaemia and advanced chronic kidney disease (CKD) in p.C255Y carriers, although without reaching statistical significance.</div></div><div><h3>Conclusions</h3><div>Recurrent <em>UMOD</em> mutations in a Galician cohort revealed shared clinical features, including hyperuricemia and CKD progression, with phenotypic variability influenced by age and additional genetic modifiers. The findings highlight the prognostic value of genotype-phenotype correlations and the need for tailored clinical management in ADTKD patients.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 5","pages":"Pages 369-380"},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869006","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":"In response to optimizing osteoporosis management in CKD patients","authors":"Jordi Bover ,&nbsp;Carlos Gómez-Alonso ,&nbsp;Enrique Casado ,&nbsp;Juan Francisco Navarro-González","doi":"10.1016/j.nefro.2025.01.006","DOIUrl":"10.1016/j.nefro.2025.01.006","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 4","pages":"Pages 346-348"},"PeriodicalIF":2.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724503","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":"Enfermedad de Castleman y afectación renal: ¿hablamos de causalidad? Revisión de una serie de casos","authors":"Gloria García Conejo ,&nbsp;Ana María Romera Segorbe ,&nbsp;Lucía González López ,&nbsp;Pedro Fernández Migallón Pacheco ,&nbsp;Sara Anaya Fernández ,&nbsp;Paz Castro Fernández ,&nbsp;Luis Javier Yuste Domínguez","doi":"10.1016/j.nefro.2025.01.004","DOIUrl":"10.1016/j.nefro.2025.01.004","url":null,"abstract":"<div><div>Castleman's disease is a rare lymphoproliferative disorder of uncertain etiology. There are 3 histopathological patterns with different clinical manifestations, from localized adenopathies and benign clinical course to systemic manifestations of worse prognosis and high risk of developing into malignant processes.</div><div>The following are cases of Castleman's disease with renal involvement treated in the Nephrology Service of the General University Hospital of Ciudad Real, between 2017 and 2024. We describe the clinical evolution and therapeutic management of each of them.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 4","pages":"Pages 337-343"},"PeriodicalIF":2.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724501","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":"Severe hyperchloremic metabolic acidosis with SGLT2 inhibitors in patients with urinary diversion","authors":"Carolina Gomes,&nbsp;João Barbosa Barroso,&nbsp;Ana Isabel Oliveira,&nbsp;Sofia Guerreiro Cruz,&nbsp;Liliana Cunha,&nbsp;Ana Azevedo","doi":"10.1016/j.nefro.2024.12.010","DOIUrl":"10.1016/j.nefro.2024.12.010","url":null,"abstract":"<div><div>Urinary diversion after cystectomy using autologous intestinal segments has been the gold standard treatment in several urinary tract diseases. The most frequent metabolic consequence is hyperchloremic metabolic acidosis, due to ammonium hydrogen and chloride ions absorption in exchange for the excretion of bicarbonate and sodium ions in the bowel conduit.</div><div>Sodium-glucose co-transporter-2 (SGLT2) inhibitors are a class of antihyperglycemic agents that block the reabsorption of filtered glucose in the renal proximal convoluted tubules, promoting greater urinary glucose and sodium excretion.</div><div>The authors describe two cases of patients with bowel conduit and mild/severe hyperchloremic metabolic acidosis, after starting SGLT2 inhibitors. Both were presented with mild acute kidney injury, moderate hyperglycemia, normal ketoacids, normal lactate and normal anion gap. Clinical and laboratory normalization were reached after this drug was withdrawn and fluid support therapy was applied.</div><div>We hypothesize that SGLT2 inhibitors could exacerbate chronic hyperchloremic metabolic acidosis in these patients, by enhance sodium loss and volume depletion, subsequent acute kidney injury (AKI), increase renal chloride elimination due to sodium loss and subsequent chloride/bicarbonate bowel exchange. Rebound hyperglycemia due to bowel absorption and bicarbonate renal elimination through Na+−H+exchanger 3 (NHE3) suppression, could also contribute. This association needs further investigation.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 5","pages":"Pages 397-400"},"PeriodicalIF":2.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868860","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}