Nephron最新文献

{"title":"Association of donor age and impaired renal function with graft survival after deceased donor kidney transplantation: Insights from Japanese national registry data.","authors":"Shunta Hori, Mitsuru Tomizawa, Kuniaki Inoue, Tatsuo Yoneda, Akira Tachibana, Yuki Oda, Kenta Onishi, Yosuke Morizawa, Daisuke Gotoh, Yasushi Nakai, Makito Miyake, Nobumichi Tanaka, Kiyohide Fujimoto","doi":"10.1159/nef/adtag011","DOIUrl":"https://doi.org/10.1159/nef/adtag011","url":null,"abstract":"<p><strong>Introduction: </strong>The persistent shortage of deceased kidney donors in Japan underscores the importance of optimizing donor selection. However, evidence regarding transplant outcomes from donors with impaired renal function remains limited.</p><p><strong>Methods: </strong>This retrospective study used data from the Japan Organ Transplant Network to evaluate 549 adult recipients of deceased donor kidney transplantation from brain-dead donors performed between 2001 and 2022. Death-censored graft survival served as the primary endpoint. Prognostic donor factors were identified, and these variables were incorporated into a nomogram for risk estimation.</p><p><strong>Results: </strong>The median donor age was 50 years, with median serum creatinine concentrations of 0.88 mg/dL at hospital admission and 0.74 mg/dL at organ procurement. Overall, graft survival at 1 year exceeded 90%, including recipients of kidneys from older donors or donors with impaired renal function. In contrast, graft outcomes were less favorable when procurement serum creatinine exceeded 6 mg/dL or donor age was ≥70 years. Younger donors with impaired renal function generally showed favorable outcomes, whereas older donors experienced poorer graft survival despite preserved renal function.</p><p><strong>Conclusions: </strong>Kidneys from donors with impaired renal function may represent an acceptable transplant option, particularly when obtained from younger donors. By contrast, advanced donor age remained associated with less favorable graft outcomes despite preserved renal function. These findings may contribute to more informed donor assessment and clinical decision-making in deceased donor kidney transplantation.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112423","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":"Reply to the Letter Titled \"Collapsing Focal Segmental Glomerulosclerosis after Kidney Transplantation has Heterogenous Associations\".","authors":"Hikaru Uematsu, Hideyo Oguchi, Noriyuki Kounoue, Tetuo Mikami, Naobumi Tochigi, Masaki Muramatsu, Yoshihiro Itabashi, Junya Hashimoto, Yuko Hamasaki, Ken Sakai","doi":"10.1159/nef/adtag010","DOIUrl":"https://doi.org/10.1159/nef/adtag010","url":null,"abstract":"","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112414","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":"The contemporary CKD patient under stable nephrology care: Albuminuria classes and related first-line nephroprotective therapy.","authors":"Luca De Nicola, Chiara Ruotolo, Federica Marzano, Roberto Minutolo","doi":"10.1159/nef/adtag012","DOIUrl":"https://doi.org/10.1159/nef/adtag012","url":null,"abstract":"","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112454","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":"CKDu and Heat Stress Nephropathy Across Eras: Regional Heterogeneity, Occupational Evidence, and Prevention in a Warming World.","authors":"Lucas Maciel de Almeida Corrêa, Luiggi Kevin Virgino Brandão, Gabriel Rian Mazur, Clara Belo Gamon Santiago, Alexandre de Assis Barbosa, Ivan Felipe Dutra Júnior, Gabriel Costa de Santana, Yan Roberth Delmiro Silva, Letícia Esteves Dante","doi":"10.1159/nef/adtag008","DOIUrl":"https://doi.org/10.1159/nef/adtag008","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease of uncertain etiology (CKDu), increasingly framed as heat stress nephropathy (HSN) in endemic settings, has evolved from a regional enigma into a climate-health concern. Affecting young workers outside the diabetes-hypertension axis, it shows how heat, labor, dehydration, and social vulnerability converge on the kidney. CKDu/HSN is best approached as heterogeneous kidney disease phenotypes: occupational heat stress is strongly supported in Mesoamerica and selected populations, whereas co-exposures, water insecurity, vulnerability, and genetic or developmental susceptibility may modify risk elsewhere.</p><p><strong>Summary: </strong>This review traces CKDu/HSN from agricultural communities to its relevance as a nephrology and public-health priority. We discuss the shift from unstable definitions and geographic labels toward a clinicopathologic and policy framework. Available data support a layered model in which recurrent heat exposure, dehydration, workload, subclinical acute kidney injury, tubular stress, endogenous fructogenesis, oxidative injury, and co-exposures may contribute with different weights across settings. However, human causal validation remains incomplete, and CKDu should not be treated as a single etiologic diagnosis. We synthesize biomarker and histopathologic evidence supporting a tubulointerstitial phenotype and examine how climate change is expanding heat-related kidney risk.</p><p><strong>Key messages: </strong>CKDu/HSN has preventable and measurable components at the intersection of climate, work, and kidney health. The strongest interventional evidence comes from occupational programs, water-rest-shade or rest-shade-hydration-hygiene strategies in sugarcane workers, including the Adelante Initiative, which improved kidney-related outcomes without clear loss of operational viability. Nephrology must translate this evidence into prevention, early detection, resilient kidney care, and climate-conscious planning.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025637","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":"Collapsing Focal Segmental Glomerulosclerosis after Kidney Transplantation Has Heterogeneous Associations.","authors":"Autumn LaRocque, Richard Ugarte, Ujwal Gautam, Amit Singh, Abdolreza Haririan, Cinthia B Drachenberg","doi":"10.1159/nef/adtag009","DOIUrl":"10.1159/nef/adtag009","url":null,"abstract":"","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002356","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":"Effect of Ambient Temperature on Kidney Function.","authors":"Kaushik Mondal, Pinaki Mukhopadhyay, Anirban Ganguli","doi":"10.1159/nef/adtag002","DOIUrl":"10.1159/nef/adtag002","url":null,"abstract":"<p><strong>Background: </strong>Extreme ambient temperatures - particularly occupational heat stress - are a major driver of renal dysfunction in resource-limited settings. Such exposures heighten the risk of nephrolithiasis and acute kidney injury (AKI), contributing substantially to global morbidity.</p><p><strong>Summary: </strong>This review outlines the impact of rising environmental temperatures on renal physiology and the risk of heat-related AKI, chronic kidney disease of uncertain etiology (CKDu), and nephrolithiasis. Prolonged heat exposure promotes water and electrolyte losses, reduces renal perfusion, and activates oxidative and inflammatory pathways, culminating in heat stress nephropathy or CKDu in vulnerable agricultural populations.</p><p><strong>Key messages: </strong>(1) Extreme temperatures disrupt renal homeostasis via distinct mechanisms: heat stress induces water and electrolyte losses, hypoperfusion, oxidative stress, and inflammation, whereas cold stress provokes vasoconstriction, cold diuresis, and potential ischemic injury. (2) Sustained thermal stress impairs glomerular filtration and tubular function, increasing susceptibility to AKI, nephrolithiasis, and long-term renal dysfunction. (3) Elderly individuals, patients with CKD, and agricultural workers exposed to extreme weather represent high-risk groups due to limited physiologic reserve, inadequate hydration, and concurrent medication use that blunts renal adaptive responses to temperature variation.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983244","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":"Sequential Liraglutide and Setmelanotide Therapy in Bardet-Biedl Syndrome: Metabolic and Renal Outcomes in a Real-World Case Report and Literature Review.","authors":"Tommaso Pasquariello, Floriana Secondulfo, Anna Rita Roscini, Elisabetta Nardi, Enrico Prosperi, Giovambattista Capasso, Alessandra Perna, Miriam Zacchia","doi":"10.1159/nef/adtag006","DOIUrl":"10.1159/nef/adtag006","url":null,"abstract":"<p><strong>Introduction: </strong>Bardet-Biedl syndrome (BBS) is a syndromic ciliopathy characterized by multiple clinical features, including obesity and kidney disease. Therapeutic options remain limited. Setmelanotide, a melanocortin-4 receptor (MC4R) agonist, is approved for obesity in BBS, but real-world data in adults are scarce. This case highlights the synergistic metabolic and nephroprotective effects of a sequential therapeutic strategy combining a glucagon-like peptide-1 receptor agonist and an MC4R agonist.</p><p><strong>Case presentation: </strong>We report the case of a 37-year-old male with genetically confirmed BBS due to compound heterozygous likely pathogenic BBS10 variants presenting with obesity, insulin resistance, dyslipidemia, albuminuria, and metabolic dysfunction-associated steatotic liver disease. Treatment with liraglutide induced modest weight loss (-3.4%, BMI 35.2→34 kg/m2) and improved urinary albumin-to-creatinine ratio (uACR) and liver enzymes levels within 8 months. Following discontinuation of liraglutide, setmelanotide therapy was subsequently initiated. After 12 months of treatment, the patient achieved a 10.5% weight loss compared with baseline (BMI 35.2→31.5 kg/m2), normalization of liver transaminases, reduced liver stiffness, and sustained improvement in uACR, while eGFR remained stable. Fasting insulin and HOMA-IR improved. Metformin, statin, and fenofibrate were discontinued, though fenofibrate was later reintroduced for hypertriglyceridemia. Two interventional studies (n≃10-40, 3-52 weeks) similarly reported consistent reduction in metabolic syndrome burden (METs-Z-BMI-score), liver steatosis, stiffness, and enzymes, while renal biomarkers showed stabilization or improvement, supporting potential hepatoprotective and reno-protective effects.</p><p><strong>Conclusion: </strong>Setmelanotide treatment was associated with clinically meaningful weight loss and improvements in liver, kidney, and metabolic parameters in this adult patient with BBS. This case supports the potential role of setmelanotide in the multidisciplinary management of BBS and highlights the need for further studies to better define its effects beyond weight reduction.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977241","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":"Diurnal Urine Sodium Excretion and Nighttime Blood Pressure: The Timing Dimension of Salt Consumption.","authors":"Artemios G Karagiannidis, Marieta P Theodorakopoulou, Fotini Iatridi, Pantelis Sarafidis","doi":"10.1159/nef/adtag007","DOIUrl":"10.1159/nef/adtag007","url":null,"abstract":"<p><strong>Background: </strong>Blood pressure (BP) exhibits a well-established circadian rhythm under physiological conditions, with a nocturnal decline of approximately 10-20% relative to daytime levels (nocturnal dipping). Disruption of this pattern, manifested as nocturnal hypertension and/or impaired BP dipping, is common and strongly associated with adverse cardiovascular and renal outcomes in various populations. Apart from BP, renal sodium handling also follows a specific circadian pattern with predominant daytime excretion.</p><p><strong>Summary: </strong>Increasing evidence indicates that disrupted diurnal urine sodium excretion, manifesting as impaired daytime and/or increased nighttime natriuresis, contributes to abnormal BP phenotypes, leading to elevated nighttime BP and impaired BP dipping. This review outlines the physiological mechanisms influencing diurnal sodium excretion and examines the pathophysiologic background of the relationship between disrupted diurnal sodium excretion and nighttime BP. In addition, it summarizes the evidence derived from clinical studies in various populations that evaluate the associations of daytime and nighttime urine sodium excretion with BP and especially nighttime BP and discusses their implications for everyday practice.</p><p><strong>Key messages: </strong>Disrupted diurnal sodium excretion is closely associated with nocturnal hypertension and impaired BP dipping. Nighttime BP is a strong predictor of cardiovascular and renal risk and should be routinely assessed. Combined evaluation of ambulatory BP and timed urine sodium excretion may improve risk stratification and guide individualized management strategies.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956177","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":"Phosphate Storm in Chronic Kidney Disease-Mineral and Bone Disorder: Practical Clinical Strategies for Vascular Calcification Control.","authors":"Hang Zhao, Lu Li, Hao Wu, Jie Wang, Jie Zhou, Shiyu Zhang, Shasha Li","doi":"10.1159/nef/adtag004","DOIUrl":"10.1159/nef/adtag004","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a major contributor to cardiovascular mortality in CKD patients, with vascular calcification (VC) as a key predictor of adverse outcomes. Current phosphate management effectively lowers serum phosphate but fails to halt VC progression, highlighting a fundamental limitation of relying solely on serum phosphate monitoring. The underlying mechanisms linking phosphate control to calcification remain incompletely understood, and specific guidance for integrating novel therapeutic strategies is lacking.</p><p><strong>Summary: </strong>This narrative review synthesizes evidence from mechanistic studies and clinical trials (PubMed, 2006-2025) relevant to CKD-MBD management. Hyperphosphatemia drives VC through impaired renal excretion, upregulated intestinal phosphate absorption, and FGF-23 resistance. A critical gap identified is that conventional binders do not adequately address intracellular phosphate overload in vascular smooth muscle cells, where activation of osteogenic pathways occurs despite normalized serum levels. The \"phosphate storm\" concept - characterized by post-dialysis rebounds, postprandial peaks, and enhanced calciprotein particle formation - is introduced to better capture the deleterious kinetics of phosphate imbalance. Emerging evidence suggests that multitargeted strategies combining tenapanor with conventional binders, vitamin K2, and magnesium may reduce intestinal absorption and counteract cellular uptake, but the molecular basis of these diverse responses remains unresolved and long-term cardiovascular outcome data are lacking.</p><p><strong>Key messages: </strong>Phosphate-lowering therapy may be considered when serum phosphate exceeds 3.9 mg/dL or FGF-23 is elevated, though this threshold requires clinical validation. Tenapanor-based multitargeted regimens show promise in overcoming limitations of conventional treatments. Multimodal monitoring incorporating FGF-23, dp-ucMGP, and VC assessment, alongside a triad balance approach for serum phosphate, magnesium, and calcium, represents an exploratory framework requiring prospective validation.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944462","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":"Reassembly of Human Kidney Organoids after Dissociation.","authors":"Suzanne de Vetten, Annelot Klaassen, Dominique Y Veldhoen, Thierry P P van den Bosch, Sander S Korevaar, Ingrid M Garrelds, Jan A H Danser, Jeroen van de Peppel, Sebastiaan Heidt, Martin J Hoogduijn","doi":"10.1159/nef/adtag003","DOIUrl":"10.1159/nef/adtag003","url":null,"abstract":"<p><strong>Introduction: </strong>Human-induced pluripotent stem cell (iPSC)-derived kidney organoids have emerged as a valuable model for studying kidney development and disease. Phenotypically, these organoids resemble kidneys of gestational week 12. Embryonic kidneys have the capacity to reassemble after dissociation, which offers the possibility to study the effect of introducing additional cell types or gene expression modification through transfection of dissociated organoids before reassembly. We examined whether human iPSC-derived kidney organoids share the property of embryonic kidneys to reassemble after dissociation. This would open new research avenues with human kidney organoids.</p><p><strong>Methods: </strong>Human iPSC-derived kidney organoids were dissociated into single cells by TrypLE Select and reaggregated by centrifugation. Organoids were collected 4 and 7 days after reaggregation, and immunostaining was performed to assess structural organization. Restoration of endocrine activity was assessed by measurement of renin production. As a proof of principle, dissociated organoids were transfected with a GFP-expressing plasmid, and expression was monitored in reaggregated organoids.</p><p><strong>Results: </strong>Kidney organoids displayed the capacity to reassemble proximal and distal tubular structures, demonstrated by reappearance of villin-1+ and E-cadherin+ structures. Podocalyxin glomerular structures reappeared sparsely after dissociation. Reassembled organoids responded to forskolin with renin secretion, albeit at a lower level than non-dissociated organoids. Dissociated organoids that were transfected with a GFP plasmid at the cell suspension stage showed robust GFP expression after reassembly.</p><p><strong>Conclusion: </strong>Human kidney organoids partially reassemble after dissociation. Dissociation and reassembly of kidney organoids offers a novel tool for kidney organoid research that allows the introduction of exogenous cell types or transfection of kidney organoid cells.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1"},"PeriodicalIF":2.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920631","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}