Nefrologia最新文献

{"title":"The usual suspect or an unusual culprit? A case of catheter hypersensitivity in peritoneal dialysis","authors":"Catarina Veiga , Raquel Pinto , Joaquim Milheiro , Adriana Dias , Joana Abreu , Carla Lima , Cátia Pêgo , Tânia Sousa , Rita Cabral , Sérgio Lemos","doi":"10.1016/j.nefro.2025.501395","DOIUrl":"10.1016/j.nefro.2025.501395","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501395"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963348","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":"Tunelización en «U» para catéteres femorales tunelizados: ¿una alternativa funcional y reproducible?","authors":"Luis Rafael Álvarez Velázquez","doi":"10.1016/j.nefro.2025.501392","DOIUrl":"10.1016/j.nefro.2025.501392","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501392"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963247","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":"Isorhynchophylline protects against ferroptosis in diabetic nephropathy by activating Nrf2","authors":"Ting Yu ,&nbsp;Fengling Chen ,&nbsp;Bing You ,&nbsp;Xiaopan Zhang ,&nbsp;Yilin Wang ,&nbsp;Ying Huang ,&nbsp;Xiang Shao ,&nbsp;Bo Sun","doi":"10.1016/j.nefro.2025.501408","DOIUrl":"10.1016/j.nefro.2025.501408","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic nephropathy (DN) is a life-threatening complication of diabetes mellitus (DM) and the leading cause of end-stage renal disease. Ferroptosis, a novel iron-dependent mode of cell death, has been identified to participate in the pathogenesis of DN. Isorhynchophylline (IRN) is a tetracyclic indole oxide alkaloid present in <em>Uncaria rhynchophylla</em> (Rubiaceae), which shows protective effects against diabetic encephalopathy and acute kidney injury. Our study intends to determine whether IRN ameliorates DN progression through inhibiting ferroptosis.</div></div><div><h3>Methods</h3><div>The db/db diabetic mice and high glucose (HG)-stimulated human kidney tubular epithelial HK-2 cells were used to explore the potential therapeutic value of IRN <em>in vivo</em> and <em>in vitro</em>. Blood glucose levels, body weight, kidney weight, serum creatinine (SCr), blood urea nitrogen (BUN), and albumin-to-creatinine ratio (UACR) were detected to assess diabetic symptoms and renal functions in db/db mice. Hematoxylin–eosin (H&amp;E) and periodic acid-Schiff staining (PAS) staining were performed to observe renal pathohistological changes in diabetic mice. Iron contents as well as malondialdehyde (MDA) and glutathione (GSH) in mouse tissue homogenates and HK-2 cell supernatants were examined to assess iron accumulation and oxidative stress. The levels of ferroptosis-related proteins and Nrf2/HO-1 signaling-related proteins as well as Nrf2 nuclear translocation in mouse renal tissues and HK-2 cells were detected by western blotting and immunofluorescence staining.</div></div><div><h3>Results</h3><div>IRN administration alleviated diabetic symptoms and improved renal functions in diabetic mice. IRN mitigated renal histologic damage, including glomerular hypertrophy, mesangial matrix accumulation, capillary basement membrane thickening, and thylakoid stroma expansion in diabetic mice. IRN treatment inhibited ferroptosis in both diabetic mice and HG-induced HK-2 cells by reducing iron content and MDA levels, elevating GSH levels, upregulating the protein levels of FTH-1, GPX4, and SLC7A11, and downregulating the protein levels ofTFR-1 and NCOA4. Mechanistically, IRN treatment enhanced Nrf2 and HO-1 protein levels and Nrf2 nuclear translocation in renal tissues of diabetic mice and HG-exposed HK-2 cells.</div></div><div><h3>Conclusion</h3><div>IRN plays a renoprotective role in DN by suppressing ferroptosis, which might be ascribed to the Nrf2/HO-1 pathway activation, highlighting the potential therapeutic application of IRN for DN treatment.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501408"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963324","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":"Hemoadsorption with HA 380 as an adjuvant therapy in multiple myeloma","authors":"Ana Cunha ,&nbsp;Beatriz Gil Braga ,&nbsp;Sofia Sousa ,&nbsp;João Pimenta ,&nbsp;Bruno Fraga Dias ,&nbsp;Cristina Freitas ,&nbsp;Ana Castro","doi":"10.1016/j.nefro.2025.501369","DOIUrl":"10.1016/j.nefro.2025.501369","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501369"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963245","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":"Benefit of lipid control in chronic disease and diabetes: Beyond statins","authors":"Miguel Angel María-Tablado","doi":"10.1016/j.nefro.2025.02.003","DOIUrl":"10.1016/j.nefro.2025.02.003","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 101327"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963244","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":"Rationalized immunosuppressant dosing in kidney transplantation: Mycophenolate mofetil AUC monitoring and key updates on tacrolimus exposure","authors":"Sonia Sharma ,&nbsp;Ankur Gupta","doi":"10.1016/j.nefro.2025.501411","DOIUrl":"10.1016/j.nefro.2025.501411","url":null,"abstract":"<div><div>Kidney transplantation (KT) is the most effective treatment for end-stage kidney disease. With advancements in modern immunosuppression, graft survival rates for standard-risk recipients have significantly improved, reaching approximately 95% in the first year, 85% at five years, and 65% at 10 years. However, long-term outcomes remain challenging due to chronic graft loss and drug-related toxicities. Immunosuppressive drugs, with narrow therapeutic range of safety and efficacy, require drug-monitoring strategies to optimize outcomes. In KT, the standard triple maintenance regimen of tacrolimus, mycophenolate mofetil (MMF), and prednisolone is practiced and MMF is typically administered as a fixed-dose drug. However, evidence suggests that dosage adjustments based on concentration monitoring yield superior clinical outcomes. MMF, an ester prodrug of mycophenolic acid (MPA), necessitates area under the concentration curve (AUC) monitoring due to its complex pharmacokinetics and an exposure level of 30–60<!--> <!-->mg/L<!--> <!-->h is considered adequate for transplant recipients. However, fixed dosing practices continued, due to controversial evidence and lack of familiarity with AUC and monitoring techniques. AUC monitoring has also been proposed for tacrolimus, a calcineurin inhibitor (CNI), instead of routinely used trough concentration, particularly in “rapid metabolizers” who may experience higher peak concentrations and toxicities. To enhance transplant outcomes, a comprehensive understanding of AUC and relevance to immunosuppressant exposure is critical. This review will primarily focus on MPA AUC exposure in post-kidney transplant patients, explore and explain methods for AUC monitoring, and highlight recent developments in tacrolimus AUC monitoring.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501411"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963288","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":"Síndrome de HELIX en la infancia. Una claudinopatía con fenotipo de tubulopatía pierde sal con hipermagnesemia","authors":"Susana Enrique Madrid,&nbsp;Jesús Lucas García","doi":"10.1016/j.nefro.2025.501362","DOIUrl":"10.1016/j.nefro.2025.501362","url":null,"abstract":"<div><div>The thick ascending limb of the loop of Henle (TAL) reabsorbs approximately 30% of filtered NaCl through two mechanisms: transepithelial and paracellular reabsorption. The latter is carried out through a class of tight junction proteins known as claudins. A mutation in the gene encoding claudin-10 causes a rare salt-wasting tubular disorder with hypokalemic metabolic alkalosis. However, unlike Bartter syndrome and Gitelman disease, it usually presents with hypermagnesemia and extrarenal manifestations such as xerostomia, alacrima, and hypohidrosis with ichthyosis, known by the acronym HELIX syndrome.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501362"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963282","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":"Bacteriemias asociadas a catéter tunelizado: un enfoque basado en resultados a largo plazo","authors":"Marina Almenara-Tejederas ,&nbsp;Águeda López-de la Torre Molina ,&nbsp;María Jesús Moyano Franco ,&nbsp;Marina de Cueto-López ,&nbsp;Jesús Rodríguez-Baño ,&nbsp;Mercedes Salgueira-Lazo","doi":"10.1016/j.nefro.2025.501396","DOIUrl":"10.1016/j.nefro.2025.501396","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and objective&lt;/h3&gt;&lt;div&gt;Tunneled catheters (TC) have become an essential vascular access for hemodialysis, despite their association with increased morbidity and mortality, particularly due to infections. Existing studies assessing the optimal combination of prophylactic measures to prevent TC-related infections are limited by small sample sizes and short follow-up periods. The objectives of this study were to describe the clinical and demographic characteristics of patients with TC in our healthcare area, determine the incidence and etiology of TC-related bloodstream infections (TC-BSI), and analyze the impact of pre-implantation prophylactic measures and patient survival over a long-term follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and method&lt;/h3&gt;&lt;div&gt;We conducted a retrospective study including all patients with a TC implanted between 2005 and 2019 in a tertiary care hospital. Catheter implantation was performed by nephrologists following a protocol developed in collaboration with the Infectious Diseases Department. The protocol emphasized 3 main measures: screening and treatment of &lt;em&gt;Staphylococcus aureus&lt;/em&gt; carriers, chlorhexidine bathing prior to the procedure, and antibiotic prophylaxis. We collected clinical-demographic variables, catheter-related data, and details of TC-BSI episodes. Patients were followed from the time of TC insertion until the end of the study (December 31, 2020), loss to follow-up, or death.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Over the 14-year study period, 462 TCs were implanted in 381 patients (179 [55.1%] male; median age 67 [IQR 55-74] years; 154 [47.4%] with diabetes mellitus, 292 [89.9%] with hypertension, and 135 [41.5%] with cardiovascular disease). The internal jugular vein was the most common site of insertion (275; 84.6%). Two types of catheters were predominantly used: Palindrome® (192; 59.1%) and Hemoglyde® (102; 31.4%). A total of 85 TC-BSI episodes were recorded (0.36 per 1000 TC-days). The majority (71; 83.4%) were caused by Gram-positive organisms: &lt;em&gt;Staphylococcus epidermidis&lt;/em&gt; (36; 42.4%) and &lt;em&gt;S. aureus&lt;/em&gt; (24; 28.0%), including 3 methicillin-resistant strains. Over 80% of infections occurred after 6 months of catheter placement. Only four (4.7%) infections occurred within the first 30 days. During follow-up, 177 patients (54.4%) died. The most frequent cause of death was infection (55; 31.1%), although only 7 deaths occurred following a TC-BSI (2.1% of the study population).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The implementation of a dedicated protocol for TC implantation was associated with a low incidence of TC-BSI. These infections tended to present late and were predominantly caused by &lt;em&gt;S. epidermidis,&lt;/em&gt; a less virulent organism than &lt;em&gt;S. aureus.&lt;/em&gt; Among the preventive measures, systematic screening and decolonization of nasal &lt;em&gt;S. aureus&lt;/em&gt; carriers significantly reduced the incidence of TC-BSI caused by this pathogen, with no observed increase ","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501396"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963320","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 proteinuria to prediction: Reassessing biomarkers in type 2 diabetic nephropathy","authors":"Shashank Dokania,&nbsp;Parth Aphale,&nbsp;Himanshu Shekhar","doi":"10.1016/j.nefro.2025.501403","DOIUrl":"10.1016/j.nefro.2025.501403","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501403"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963350","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":"An approximation to the prevalence of focal segmental glomerulosclerosis: A systematic review of world literature over the past 32 years","authors":"Citlalli Orizaga-de-la-Cruz ,&nbsp;Francisco Alejandro Lagunas-Rangel ,&nbsp;Anel Gómez-García ,&nbsp;Venice Chávez-Valencia","doi":"10.1016/j.nefro.2025.501404","DOIUrl":"10.1016/j.nefro.2025.501404","url":null,"abstract":"<div><h3>Background</h3><div>Focal segmental glomerulosclerosis (FSGS) is a histopathological lesion characterized by scarring in specific sections of some glomeruli, accompanied by podocyte injury. Worldwide, the prevalence of FSGS and its temporal trends have not been sufficiently studied. However, some reports suggest an increase in the frequency of FSGS in recent decades. Understanding the epidemiology of FSGS is crucial for clinicians to improve diagnosis and treatment.</div></div><div><h3>Objective</h3><div>This study critically evaluates global prevalence trends of FSGS over the past 32 years (1992–2024), highlighting variations between countries through a systematic review.</div></div><div><h3>Methods</h3><div>A systematic search of Medline, Embase and ScienceDirect was conducted to identify relevant studies. The reliability of prevalence data was assessed by critical appraisal of selected publications.</div></div><div><h3>Results</h3><div>The prevalence of FSGS varies significantly between regions. East Asian countries have a relatively low prevalence, with a mean around 7%. In contrast, countries in South Asia, the Middle East and the Americas have a higher prevalence of around 18%. European countries show an intermediate prevalence of about 11%. African countries do not show a clear pattern, with high and low prevalence rates in different countries.</div></div><div><h3>Conclusions</h3><div>The prevalence of FSGS differs by geographic region and ethnicity. While South Asian countries have maintained a consistently low prevalence, other regions have experienced an increase in FSGS cases over time. This study improves the understanding of global patterns of FSGS, providing valuable epidemiological insights for clinicians and researchers.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 10","pages":"Article 501404"},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610412","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}