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The Impact of Age and Body Composition on the Agreement between Estimated and Measured GFR in Heart Transplant Recipients. 年龄和身体成分对心脏移植受者估计和测量的 GFR 之间一致性的影响。
IF 2.3 4区 医学
Nephron Pub Date : 2024-09-14 DOI: 10.1159/000540530
Mads Hornum, Morten Buus Jørgensen, Lærke Marie Sidenius Nelson, Bo Feldt-Rasmussen, Kasper Rossing, Esteban Porrini, Peter Oturai, Finn Gustafsson
{"title":"The Impact of Age and Body Composition on the Agreement between Estimated and Measured GFR in Heart Transplant Recipients.","authors":"Mads Hornum, Morten Buus Jørgensen, Lærke Marie Sidenius Nelson, Bo Feldt-Rasmussen, Kasper Rossing, Esteban Porrini, Peter Oturai, Finn Gustafsson","doi":"10.1159/000540530","DOIUrl":"10.1159/000540530","url":null,"abstract":"<p><strong>Background: </strong>Estimated GFR (eGFR) has shown poor agreement with measured GFR (mGFR) in several populations. We investigated the impact of age and body composition on the accuracy and precision of eGFR in heart transplant (HTx) recipients.</p><p><strong>Methods: </strong>In a longitudinal, observational, retrospective study design, patients receiving first-time HTx with at least one registered mGFR value within 15 months after HTx and a corresponding plasma creatinine were included. GFR was measured by 51Cr-EDTA and eGFR calculated by creatinine-based CKD-EPI formula.</p><p><strong>Results: </strong>A total of 150 patients with a total of 723 mGFR measurements were included. During the first year after HTx, mean weight increased by 4.2 kg (CI: 3.2 to 5.1) followed by an annual decrease of 0.35 kg/year (Cl: -0.05 to 0.74). mGFR increased by 7.5 mL/min (Cl: 3.2 to 11.8) the first year but was stable hereafter (0.0 mL/min/year; CI: -1.0 to 1.0). The initial weigh gain and increase in mGFR were most pronounced in patients &lt;45 years. Neither eGFR adjusted nor unadjusted for BSA detected the initial increase in mGFR. At 1 year after HTx, limits of agreement on the Bland-Altman plot were -37.2 to 33.1 mL/min with a bias of -2.1 mL/min (Cl: -5.0 to 0.9). In patients &lt;45 years, eGFR significantly overestimated mGFR by 7.1 mL/min (Cl: 1.0 to 13.2) and showed a significant lower precision than patients &gt;45 years. There was no effect of BMI class, weight, BSA, or change in BMI class on the difference between eGFR and mGFR.</p><p><strong>Conclusion: </strong>eGFR is, on average, accurate but imprecise in HTx patients. The agreement is affected by age but not body composition.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291736","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}
引用次数: 0
Efficacy and Safety of Telitacicept in IgA Nephropathy: A Retrospective, Multicenter Study. 泰利他赛治疗 IgA 肾病的疗效和安全性:一项回顾性多中心研究。
IF 2.3 4区 医学
Nephron Pub Date : 2024-09-09 DOI: 10.1159/000540326
Lijun Liu, Yimeng Liu, Juan Li, Chen Tang, Huiming Wang, Cheng Chen, Haibo Long, Xiaowen Chen, Guolan Xing, Jingru Cheng, Jianbo Liang, Xuan Peng, Liang Wang, Sijia Shao, Yongqiang Lin, Tianmu Chen, Ying Tang, Shizhong Shen, Lingyun Sun, Henglan Wu, Yuan Yu, Xuanyi Du, Hong Liu, Liyu He, Hong Liu, Meixing Ye, Wei Chen, Qiong Wen, Hong Zhang, Hongmin Cao, Jing Yuan, Hong Chen, Ming Wang, Jicheng Lv, Hong Zhang
{"title":"Efficacy and Safety of Telitacicept in IgA Nephropathy: A Retrospective, Multicenter Study.","authors":"Lijun Liu, Yimeng Liu, Juan Li, Chen Tang, Huiming Wang, Cheng Chen, Haibo Long, Xiaowen Chen, Guolan Xing, Jingru Cheng, Jianbo Liang, Xuan Peng, Liang Wang, Sijia Shao, Yongqiang Lin, Tianmu Chen, Ying Tang, Shizhong Shen, Lingyun Sun, Henglan Wu, Yuan Yu, Xuanyi Du, Hong Liu, Liyu He, Hong Liu, Meixing Ye, Wei Chen, Qiong Wen, Hong Zhang, Hongmin Cao, Jing Yuan, Hong Chen, Ming Wang, Jicheng Lv, Hong Zhang","doi":"10.1159/000540326","DOIUrl":"10.1159/000540326","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy of telitacicept treatment in reducing proteinuria in patients with IgA nephropathy (IgAN) was indicated in a phase II clinical trial with small sample size. In this study, we conducted a large multicenter retrospective study to explore the efficacy and safety of telitacicept in patients with IgAN.</p><p><strong>Methods: </strong>This study recruited patients with IgAN from 19 sites from China who were treated with telitacicept and had been followed up at least once or with side effect reported, since April 1, 2021, to April 1, 2023. The primary outcomes of the study were the changing in proteinuria and eGFR over time.</p><p><strong>Results: </strong>A cohort of 97 patients with IgAN who were treated with telitacicept were recruited, with a median follow-up duration of 3 months. The median baseline proteinuria was 2.3 [1.3, 3.9] g/day and eGFR was 45.0 [26.8, 73.7] mL/min/1.73 m2. There was a significant reduction of proteinuria at 2, 4, 6 months when compared with baseline (2.3 [1.5, 4.1] vs. 1.5 [0.8, 2.3] g/day; 2.3 [1.1, 3.7] vs. 1.1 [0.6, 1.9] g/day; 2.1 [1.0, 2.7] vs. 0.9 [0.5, 1.7] g/day, all p values &lt;0.01). The level of eGFR were comparable between at the baseline and 2, 4, 6 months of follow-up time (41.5 [29.7, 72.0] vs. 42.5 [28.8, 73.3] mL/min/1.73 m2; 41.0 [26.8, 67.7] vs. 44.7 [31.0, 67.8] mL/min/1.73 m2; 33.7 [24.0, 58.5] vs. 32.6 [27.8, 57.5] mL/min/1.73 m2, all p values &gt;0.26). Telitacicept was well tolerated in the patients.</p><p><strong>Conclusions: </strong>This study indicates that telitacicept alone or on top of steroids therapy can significantly and safely reduce proteinuria in patients with IgAN. The long-term kidney protection still needs to be confirmed in large phase III trial.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291732","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}
引用次数: 0
Acute Renal Infarction: A 12-Year Retrospective Analysis. 急性肾梗塞:12 年回顾性分析
IF 2.3 4区 医学
Nephron Pub Date : 2024-09-09 DOI: 10.1159/000541333
Sheldon Greenberg, Kundan Jana, Kalyana Janga, Meng-Hsun Lee, Mary Lockwood
{"title":"Acute Renal Infarction: A 12-Year Retrospective Analysis.","authors":"Sheldon Greenberg, Kundan Jana, Kalyana Janga, Meng-Hsun Lee, Mary Lockwood","doi":"10.1159/000541333","DOIUrl":"10.1159/000541333","url":null,"abstract":"<p><strong>Introduction: </strong>Acute renal infarction (ARI) is a relatively rare and underdiagnosed condition. Presenting symptoms are nonspecific, and imaging is the mainstay for diagnosis. This study attempts to characterize the profile of patients with ARI and identify possible risk factors.</p><p><strong>Methods: </strong>All inpatients admitted with diagnosis of ARI between 2010 and 2022 were included in this single-center retrospective observational study. Patients with chronic renal infarction, iatrogenic causes, and without radiographic evidence of ARI were excluded. Clinical, laboratory, and radiological findings of patients were collected. Patients were grouped into three groups based on probable etiology: cardiovascular, hypercoagulable disorders, and idiopathic, and analyzed.</p><p><strong>Results: </strong>Eighty-five patients were included. Mean age of patients was 61.6 ± 17.54 years. Cardiovascular group had the highest number of patients (49.4%) of which atrial fibrillation was the most common etiology (59.5%). Malignancy was the most common etiology in the hypercoagulable disorder group (69.3%). Patients in the idiopathic group were significantly younger and had higher mean body mass index than the other 2 groups at presentation. Smokers had 9 times higher risk of renal infarction in cardiovascular group and 1.7 times higher risk in hypercoagulable when compared to the idiopathic group. 48.2% of patients developed renal infarction though they were on antiplatelets/anticoagulants.</p><p><strong>Conclusion: </strong>ARI is a rare and often underdiagnosed condition that can have residual renal dysfunction. It is important to consider ARI as a differential especially in young patients with risk factors even if they are on anticoagulation medication.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291731","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}
引用次数: 0
Preferences for Advance Care Planning in Patients with End-Stage Kidney Disease: A Cross-Sectional Survey among Nephrology Healthcare Providers in a Tertiary Care Center in India. 终末期肾病患者对预先护理计划的偏好:在印度一家三级医疗中心的肾科医疗服务提供者中开展的横断面调查。
IF 2.3 4区 医学
Nephron Pub Date : 2024-09-09 DOI: 10.1159/000541347
Bharathi Naik, Arun Ghoshal, Anuja Damani, Pankaj Singhai, Ravindra Prabhu Attur, Naveen Salins, Ajith M Nayak, Shankar Prasad Nagaraju
{"title":"Preferences for Advance Care Planning in Patients with End-Stage Kidney Disease: A Cross-Sectional Survey among Nephrology Healthcare Providers in a Tertiary Care Center in India.","authors":"Bharathi Naik, Arun Ghoshal, Anuja Damani, Pankaj Singhai, Ravindra Prabhu Attur, Naveen Salins, Ajith M Nayak, Shankar Prasad Nagaraju","doi":"10.1159/000541347","DOIUrl":"10.1159/000541347","url":null,"abstract":"<p><strong>Introduction: </strong>Advance care planning (ACP) is essential in managing patients with end-stage kidney disease (ESKD), yet its integration into clinical practice remains limited, particularly in low- and middle-income countries. This study explores the preferences, attitudes and perceived barriers of nephrology healthcare providers toward ACP for patients with ESKD in a tertiary care center in India.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among nephrology healthcare providers at a tertiary care center in India. The survey, developed from literature reviews and pretested, covered demographics, ACP knowledge and attitudes, current practices, and perceived barriers and facilitators. Data collection occurred from September 2022 to March 2023. Quantitative data were analyzed descriptively, and qualitative data through thematic analysis.</p><p><strong>Results: </strong>A total of 50 healthcare providers participated. While 36% acknowledged the importance of ACP, only 8% routinely engaged in ACP discussions. Major barriers included inadequate training (22%), lack of awareness about the importance of discussing ACP among stakeholders (20%), cultural barriers (18%), lack of time (14%), and the absence of institutional protocols for discussion on ACP (14%). Additional barriers included instances where families withhold health information from patients due to fear of losing hope (16%) and patient/family discomfort in discussing ACP (12%). Providers expressed a need for structured ACP protocols and educational programs.</p><p><strong>Conclusion: </strong>Despite recognizing its importance, ACP is underutilized in the care of patients with ESKD in India. Addressing the identified barriers through targeted interventions may enhance ACP practices and improve patient outcomes.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291735","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}
引用次数: 0
Lipophagy and Mitophagy in Renal Pathophysiology. 肾脏病理生理学中的噬脂性和噬丝性。
IF 2.3 4区 医学
Nephron Pub Date : 2024-08-23 DOI: 10.1159/000540688
Nicolas Dupont, Fabiola Terzi
{"title":"Lipophagy and Mitophagy in Renal Pathophysiology.","authors":"Nicolas Dupont, Fabiola Terzi","doi":"10.1159/000540688","DOIUrl":"10.1159/000540688","url":null,"abstract":"<p><strong>Background: </strong>The lysosomal autophagic pathway plays a fundamental role in cellular and tissue homeostasis, and its deregulation is linked to human pathologies including kidney diseases. Autophagy can randomly degrade cytoplasmic components in a nonselective manner commonly referred to as bulk autophagy. In contrast, selective forms of autophagy specifically target cytoplasmic structures such as organelles and protein aggregates, thereby being important for cellular quality control and organelle homeostasis.</p><p><strong>Summary: </strong>Research during the past decades has begun to elucidate the role of selective autophagy in kidney physiology and kidney diseases.</p><p><strong>Key messages: </strong>In this review, we will summarize the knowledge on lipophagy and mitophagy, two forms of selective autophagy important in renal epithelium homeostasis, and discuss how their deregulations contribute to renal disease progression.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056124","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}
引用次数: 0
Severe Leptospirosis with Acute Kidney Injury: A Case Description and Literature Review. 重症钩端螺旋体病并发急性肾损伤--病例描述和文献综述。
IF 2.3 4区 医学
Nephron Pub Date : 2024-08-05 DOI: 10.1159/000540300
Clara Daschner, Anna-Sophie Schübler, Matthias Jung, Niklas Ayasse, Gökhan Yücel, Faeq Husain-Syed, Jan Leipe, Bernhard K Krämer, Babak Yazdani
{"title":"Severe Leptospirosis with Acute Kidney Injury: A Case Description and Literature Review.","authors":"Clara Daschner, Anna-Sophie Schübler, Matthias Jung, Niklas Ayasse, Gökhan Yücel, Faeq Husain-Syed, Jan Leipe, Bernhard K Krämer, Babak Yazdani","doi":"10.1159/000540300","DOIUrl":"10.1159/000540300","url":null,"abstract":"<p><strong>Introduction: </strong>Leptospirosis is a globally transmitted zoonotic disease caused by Leptospira spp., a highly mobile, obligate aerobic, spiral-shaped bacteria. Described first by Adolf Weil in 1886, leptospirosis in Germany is rare, leading to a delayed diagnosis due to diverse symptoms. Most cases are mild, but severe forms, like Weil's disease, cause life-threatening complications such as fever, jaundice, hemoptysis, and acute kidney injury (AKI). The aim of this work was to provide a literature review of leptospirosis with renal manifestation based on a case report.</p><p><strong>Case presentation: </strong>We report the case of an 81-year-old male patient with initially unclear oliguric AKI, bilateral pulmonary infiltrates, and jaundice. After excluding common AKI causes, the expanded patient history suggested possible rat contact in his chicken coop. Finally, we serologically identified an infection with Leptospira spp. by positive IgM, proving that the illness was compatible with classical Weil's disease. The patient underwent temporary hemodialysis and antibiotic treatment with intravenous penicillin G for 2 weeks. Under therapy, the AKI, hyperbilirubinemia, and clinical condition of the patient improved. The patient was discharged after 2 weeks. In the following controls, slightly impaired kidney function was observed, indicating a progress of his chronic kidney disease (CKD).</p><p><strong>Conclusion: </strong>Although leptospirosis is rare, there are some cases with a fulminant course. Impairment of renal function often correlates with severity of the disease requiring antibiotic treatment. In some cases, AKI progresses to CKD demonstrating the need to raise awareness for leptospirosis.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893865","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}
引用次数: 0
Systems Biology and Novel Biomarkers for the Early Detection of Diabetic Kidney Disease. 用于早期检测糖尿病肾病的系统生物学和新型生物标记物。
IF 2.3 4区 医学
Nephron Pub Date : 2024-07-29 DOI: 10.1159/000540307
Priscila Villalvazo, Carlos Villavicencio, Marina Gonzalez de Rivera, Beatriz Fernandez-Fernandez, Alberto Ortiz
{"title":"Systems Biology and Novel Biomarkers for the Early Detection of Diabetic Kidney Disease.","authors":"Priscila Villalvazo, Carlos Villavicencio, Marina Gonzalez de Rivera, Beatriz Fernandez-Fernandez, Alberto Ortiz","doi":"10.1159/000540307","DOIUrl":"10.1159/000540307","url":null,"abstract":"<p><p>Diabetic kidney disease is the most common driver of chronic kidney disease (CKD)-associated mortality and kidney replacement therapy. Despite recent therapeutic advances (sodium glucose co-transporter 2 [SGLT2] inhibitors, finerenone), the residual kidney and mortality risk remains high for patients already diagnosed of having CKD (i.e., estimated glomerular filtration rate &lt;60 mL/min/1.73 m2 or urinary albumin:creatinine ratio &gt;30 mg/g). The challenge for the near future is to identify patients at higher risk of developing CKD to initiate therapy before CKD develops (primary prevention of CKD) and to identify patients with CKD and high risk of progression or death, in order to intensify therapy. We now discuss recent advances in biomarkers that may contribute to the identification of such high-risk individuals for clinical trials of novel primary prevention or treatment approaches for CKD. The most advanced biomarker from a clinical development point of view is the urinary peptidomics classifier CKD273, that integrates prognostic information from 273 urinary peptides and identifies high-risk individuals before CKD develops.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792891","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}
引用次数: 0
Predicting outcomes after transplantation of deceased donor kidneys of marginal quality within the Eurotransplant service area. 预测欧洲移植服务区内质量不佳的已故捐献者肾脏移植后的效果。
IF 2.3 4区 医学
Nephron Pub Date : 2024-07-24 DOI: 10.1159/000540304
Florian G Scurt, Carl L Fischer-Fröhlich, Angela Ernst, Peter R Mertens, Jan U Becker, Christos Chatzikyrkou
{"title":"Predicting outcomes after transplantation of deceased donor kidneys of marginal quality within the Eurotransplant service area.","authors":"Florian G Scurt, Carl L Fischer-Fröhlich, Angela Ernst, Peter R Mertens, Jan U Becker, Christos Chatzikyrkou","doi":"10.1159/000540304","DOIUrl":"https://doi.org/10.1159/000540304","url":null,"abstract":"<p><strong>Introduction: </strong>Kidneys of marginal quality are increasingly being used to overcome the shortage of donor organs. However, accurate prediction of outcome is needed to optimise the use of these kidneys. We aimed to test the performance of a recently proposed score consisting of delayed graft function (DGF), renal function recovery (RFR), and glomerular filtration rate (GFR) &lt;30 ml/min per 1.73 m2 90 days after transplantation for risk assessment of patient and graft survival.</p><p><strong>Material and methods: </strong>A total of 221 adult brain death donors with marginal kidneys, transplanted into 223 recipients within Eurotransplant were included in the analysis. Multivariable Cox proportional hazards models were constructed to assess death-censored and all-cause censored graft failure and recipient mortality at one and three years.</p><p><strong>Results: </strong>Recipients with DGF had a higher risk of death-censored graft loss (HR, 95%CIs: 3.058 (1.195 - 7.825)). Recipients with a GFR &lt;30ml/min/1.73m² at 90 days after transplantation had a higher risk of death censored and all-cause graft failure (HR, 95%CIs: 2.122 (1.129-3.990 and 2.122 (1.129 - 3.990)). None of the three components of the proposed score was associated with a higher risk of mortality.</p><p><strong>Conclusion: </strong>DGF and eGFR &lt;30 ml/min/1.73m² but not RFR at 90 days predicted graft failure after transplantation of marginal kidneys. However, no combination of these factors was able to predict short-term patient and graft survival.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759975","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}
引用次数: 0
Burden of Chronic Kidney Disease of Undetermined Aetiology (CKDu) in a Tertiary Care Public Hospital in North India. 印度北部一家三级公立医院病因未明的慢性肾病(CKDu)的负担。
IF 2.3 4区 医学
Nephron Pub Date : 2024-07-22 DOI: 10.1159/000539317
Indradip Maity, Hemchand Sati, Geetika Singh, Dipankar Bhowmik, Sanjay Kumar Agarwal, Soumita Bagchi
{"title":"Burden of Chronic Kidney Disease of Undetermined Aetiology (CKDu) in a Tertiary Care Public Hospital in North India.","authors":"Indradip Maity, Hemchand Sati, Geetika Singh, Dipankar Bhowmik, Sanjay Kumar Agarwal, Soumita Bagchi","doi":"10.1159/000539317","DOIUrl":"10.1159/000539317","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease of undetermined aetiology (CKDu) is an important public health problem. Indian data are mostly based on studies from rural regions in south and east India. We examined the burden and profile of CKDu in patients attending a tertiary care hospital in north India.</p><p><strong>Methods: </strong>We assessed records of consecutive new CKD patients registered in a nephrology clinic from January 2015 to June 2022. Patients were classified as having CKDu based on predefined inclusion and exclusion criteria. Clinical and laboratory parameters at presentation and kidney biopsy when done were noted.</p><p><strong>Results: </strong>Records of 32,369 patients with CKD were screened, and 29,663 were included (2,706 excluded due to inadequate data). A total of 370 (1.2%) patients were categorized as CKDu. Mean age was 41 ± 14.7 years, 58.1% being male. Of them, 158 (42.7%) patients were in CKD stage 3, 89 (24.1%) in stage 4, 84 (22.7%) in stage 5, and 39 (10.5%) were dialysis dependent at presentation; 232 (62.7%) patients had proteinuria &lt;0.5 gm/day and 138 (37.3%) between 0.5 and 1 gm/day. Renal histology was available for 65 CKDu patients: 62 had chronic tubulointerstitial nephritis (CTIN) and 3 had non-specific changes.</p><p><strong>Conclusion: </strong>When defined using strict criteria with intensive diagnostic workup, burden of CKDu is low in our hospital-based cohort of CKD patients. CTIN is the predominant histopathological finding in kidney biopsy.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534862","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}
引用次数: 0
Impact of Renin-Angiotensin System Blockade on Mortality and Allograft Loss among Renal Transplant Recipients: A Systematic Review and Meta-Analysis. 肾素-血管紧张素系统阻断对肾移植受者死亡率和异体移植损失的影响:系统回顾与元分析》。
IF 2.3 4区 医学
Nephron Pub Date : 2024-07-22 DOI: 10.1159/000540305
Chin-Wei Kung, Yi-Chih Lin, Chi-Shin Tseng, Yu-Hsiang Chou
{"title":"Impact of Renin-Angiotensin System Blockade on Mortality and Allograft Loss among Renal Transplant Recipients: A Systematic Review and Meta-Analysis.","authors":"Chin-Wei Kung, Yi-Chih Lin, Chi-Shin Tseng, Yu-Hsiang Chou","doi":"10.1159/000540305","DOIUrl":"10.1159/000540305","url":null,"abstract":"<p><strong>Introduction: </strong>The blockade of the renin-angiotensin system (RAS) has a beneficial effect on reducing the levels of proteinuria and blood pressure in patients with chronic kidney disease (CKD) and reduces the risk of developing end-stage kidney disease in CKD patients. Nonetheless, a debate persists regarding the impact of RAS inhibitors on outcomes such as mortality and graft survival in renal transplant patients. To assess the effect of RAS inhibitors on graft recipients in the past decade, we conducted a systematic review and meta-analysis.</p><p><strong>Methods: </strong>We searched Embase, PubMed, and the Cochrane Central Register of Clinical Trials from January 1, 2012, to August 1, 2022. We included 14 articles, comprising 5 randomized controlled trials (RCTs) and 9 cohort studies, including 45,377 patients. These studies compared patient or graft survival between an RAS inhibitor treatment arm and a control arm.</p><p><strong>Results: </strong>The meta-analysis revealed that RAS blockade was significantly associated with lower mortality in cohort studies (risk ratio [RR] = 0.66, 95% confidence interval [CI]: 0.55-0.79), reduced allograft loss in cohort studies (RR = 0.62, 95% CI: 0.54-0.71), and significant changes in systolic blood pressure in RCTs. Subgroup analysis of the groups of interest (interventions involving RAS blockade, follow-up period of ≥5 years) showed consistently reduced mortality (RR = 0.67, 95% CI: 0.56-0.81) and reduced allograft loss (RR = 0.61, 95% CI: 0.54-0.70).</p><p><strong>Conclusions: </strong>Our results demonstrated that the application of RAS blockade among renal transplant recipients was associated with lower mortality and allograft loss in cohort studies but not in RCTs. More powered clinical trials are needed to evaluate the effects of RAS blockade in renal transplant recipients.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620421","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}
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