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Implementing the Nurse-Led Optimization of Volume and Blood Pressure - Enabling at Multi-Levels Using Technology Program for Chronic Kidney Disease: A Prospective Cohort Study.
IF 2.3 4区 医学
Nephron Pub Date : 2025-02-03 DOI: 10.1159/000543948
Zhihua Huang, Li Choo Ng, Irene Mok, Chieh Suai Tan, Cynthia Ciwei Lim
{"title":"Implementing the Nurse-Led Optimization of Volume and Blood Pressure - Enabling at Multi-Levels Using Technology Program for Chronic Kidney Disease: A Prospective Cohort Study.","authors":"Zhihua Huang, Li Choo Ng, Irene Mok, Chieh Suai Tan, Cynthia Ciwei Lim","doi":"10.1159/000543948","DOIUrl":"10.1159/000543948","url":null,"abstract":"<p><strong>Background: </strong>Fluid overload is a common manifestation of chronic kidney disease (CKD) and is associated with increased hospitalizations and death. However, severe symptomatic fluid overload is potentially preventable with early recognition of mild fluid overload and timely institution of appropriate pharmacotherapy and fluid restriction. We implemented and evaluated the outcomes of a nurse-led clinic that incorporated objective fluid volume assessment using body impedance analysis (BIA) into structured patient education and action plan coaching to patients with CKD and fluid overload.</p><p><strong>Methods: </strong>This was a single-center prospective pre-post-implementation study of adults who participated in the program between August 2022 and April 2024. Patients were eligible if they had CKD not requiring dialysis and had fluid overload and/or systolic blood pressure (BP) >160 mm Hg or diastolic BP >100 mm Hg. The clinical effectiveness outcomes were symptoms and signs of fluid overload and improvement in BP. The patient-reported effectiveness outcomes were chronic disease self-management assessed using the Partner in Health (PIH) questionnaire and health-related quality of life assessed by the EuroQOL-5 Dimension (EQ5D5L) survey. The clinical safety outcomes were (1) hypotension with systolic BP <90 mm Hg and (2) worsening kidney function.</p><p><strong>Results: </strong>Among 107 patients referred to the nurse-led program, 96 attended the first visit. Median age was 68.5 (IQR 60.2, 77.3) years, and eGFR was 21.6 (14.0, 39.7) mL/min/1.73 m2. Almost all participants (93.8%) had symptoms of fluid overload within the past 1 month before the first review. BIA was performed for 52 (54.2%) patients, and the median overhydration was 2.4 (1.3, 3.6) L. The second and third visits were attended by 38 (39.6%) and 28 (29.2%) patients, respectively. For these 28 patients at program completion, symptoms and signs of fluid overload were less frequent and systolic BP (137 [121, 143] vs. 151 [132, 166] mm Hg, p = 0.03) and self-management (PIH score 96 [89, 104] vs. 72 [57, 88], p = 0.001) had improved compared to their baseline visit. EQ5D5L scores were significantly different. None experienced hypotension (systolic BP <90 mm Hg), and kidney function did not change significantly during follow-up.</p><p><strong>Conclusion: </strong>A nurse-led program that incorporated objective fluid volume assessment, structured patient education, and action plan coaching for patients with CKD and fluid overload improved the BP and self-management of those who completed the program.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-13"},"PeriodicalIF":2.3,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123128","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
Understanding the Support Needs of People with Autosomal Dominant Polycystic Kidney Disease: A Qualitative Phenomenological Descriptive Study.
IF 2.3 4区 医学
Nephron Pub Date : 2025-01-28 DOI: 10.1159/000543269
Katrine Schmidt Rasmussen, Dinah Sherzad Khatir, Henrik Birn, Selina Emilie Poulsen, Jeanette Finderup
{"title":"Understanding the Support Needs of People with Autosomal Dominant Polycystic Kidney Disease: A Qualitative Phenomenological Descriptive Study.","authors":"Katrine Schmidt Rasmussen, Dinah Sherzad Khatir, Henrik Birn, Selina Emilie Poulsen, Jeanette Finderup","doi":"10.1159/000543269","DOIUrl":"https://doi.org/10.1159/000543269","url":null,"abstract":"<p><strong>Introduction: </strong>Autosomal dominant polycystic kidney disease (ADPKD) is a prevalent hereditary kidney disease and the fourth most common cause of kidney failure. Patients may be aware of their condition from an early age or discover it unexpectedly, with varying levels of familial knowledge about the disease. This chronic condition presents significant challenges for healthcare professionals. The study aimed to investigate how people with ADPKD experience their participation in a dedicated ADPKD clinic and to investigate their support needs in managing their disease in everyday life.</p><p><strong>Methods: </strong>A qualitative phenomenological descriptive study was conducted, involving semi-structured telephone interviews with patients who attended a newly established dedicated ADPKD clinic between March and April 2023. The data were analyzed using Malterud's principles of systematic text condensation.</p><p><strong>Results: </strong>In total, 18 out of 22 patients agreed to participate in the interviews. Six themes emerged from the interviews. Participants expressed feelings of uncertainty about their future and highlighted the necessity for personalized care tailored to their individual circumstances. They reported challenges in coping with emotions associated with the disease and sought assistance in making difficult decisions. Maintaining control over their health and illness was a significant theme, alongside a desire for increased knowledge about their condition.</p><p><strong>Conclusion: </strong>Our study supports existing knowledge in this area. In this study, the participants experienced satisfaction with the dedicated ADPKD clinic, feeling well informed, listened to, and more at ease after the check-up. Investing in a dedicated ADPKD clinic could help alleviate the uncertainty that many people with ADPKD experience.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-8"},"PeriodicalIF":2.3,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059700","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
The Cost and Outcomes of Using Multidisciplinary Care Program in the Care of Adult Patients with Advanced Chronic Kidney Disease.
IF 2.3 4区 医学
Nephron Pub Date : 2025-01-25 DOI: 10.1159/000542882
Jia Liang Kwek, Li Chang Ang, Lydia Wei Wei Lim, Su Hooi Teo, Cynthia Ciwei Lim, Xiaohui Xin, Li Choo Ng, Marjorie Wai Yin Foo, Chieh Suai Tan, Jason Chon Jun Choo
{"title":"The Cost and Outcomes of Using Multidisciplinary Care Program in the Care of Adult Patients with Advanced Chronic Kidney Disease.","authors":"Jia Liang Kwek, Li Chang Ang, Lydia Wei Wei Lim, Su Hooi Teo, Cynthia Ciwei Lim, Xiaohui Xin, Li Choo Ng, Marjorie Wai Yin Foo, Chieh Suai Tan, Jason Chon Jun Choo","doi":"10.1159/000542882","DOIUrl":"10.1159/000542882","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to compare the direct healthcare cost and outcomes of a multidisciplinary care (MDC) program versus usual care for patients with advanced chronic kidney disease (CKD) in Singapore.</p><p><strong>Methods: </strong>A retrospective study of patients with an estimated glomerular filtration rate (eGFR) less than 20 mL/min/1.73 m2, attending the MDC program or the usual care clinic in a tertiary hospital from 2016 to 2019. The usual care group was matched to the MDC group using propensity score matching based on age, gender, baseline eGFR, and diabetes mellitus. The primary outcome was the rate of emergent long-term kidney replacement therapy (KRT) initiation and the direct healthcare cost incurred from eGFR for less than 20 mL/min/1.73 m2 for the initiation of long-term KRT.</p><p><strong>Results: </strong>There were 280 patients in each group. The MDC group had a lower rate of emergent KRT initiation than the usual care group (33.3 vs. 55.7 events per 100 patient-year, p = 0.003), shorter length of hospitalization stay (8.0 vs. 16.5 days per year, p = 0.004), lower number of emergency department visits (0.7 vs. 1.2 visits per year, p = 0.005), and higher number of renal clinic visits (14.5 vs. 13.0 visits per year, p = 0.009). The healthcare cost was lower in the MDC group than in the usual care group (SGD USD 18,408.83 (USD 13,664.51) vs. SGD USD 28,734.43 (USD 21,329.00) per patient-year, p = 0.016).</p><p><strong>Conclusion: </strong>The MDC program for patients with advanced CKD in Singapore was associated with lower rate of emergent KRT initiation, shorter hospitalization stay, lower number of emergency department visit, and lower healthcare cost.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-9"},"PeriodicalIF":2.3,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663998","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
Personalized Care in CKD: Moving Beyond Traditional Biomarkers.
IF 2.3 4区 医学
Nephron Pub Date : 2025-01-23 DOI: 10.1159/000543640
Thomas McDonnell, Rosamonde E Banks, Maarten W Taal, Nicolas Vuilleumier, Philip A Kalra
{"title":"Personalized Care in CKD: Moving Beyond Traditional Biomarkers.","authors":"Thomas McDonnell, Rosamonde E Banks, Maarten W Taal, Nicolas Vuilleumier, Philip A Kalra","doi":"10.1159/000543640","DOIUrl":"10.1159/000543640","url":null,"abstract":"<p><strong>Background: </strong>Traditional biomarkers, such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR), have long been central to chronic kidney disease (CKD) diagnosis and management, leading to a standardized CKD classification system. However, these biomarkers are non-specific and fail to capture the heterogeneity within CKD and the nuances of an individual's disease mechanism, limiting personalized treatment approaches. There is an increasing need for novel biomarkers that reflect the diverse pathophysiological processes underlying CKD progression, enabling more precise risk prediction and treatment strategies.</p><p><strong>Summary: </strong>This review examines the limitations of current CKD biomarkers and classification systems, highlighting the need for a precision medicine approach. While traditional markers like eGFR and uACR are foundational, they inadequately capture CKD's complexity. Emerging biomarkers offer insights into specific disease processes, such as inflammation, oxidative stress, fibrosis, and tubular injury, which are crucial for personalized care. The article discusses the potential benefits of integrating these novel biomarkers into clinical practice, including more accurate risk prediction, tailored treatments, and personalized clinical trial designs, as well as the barriers to their implementation. Furthermore, advancements in multi-omics and high-throughput techniques offer opportunities to identify novel causative proteins with druggable targets, pushing CKD care towards greater precision.</p><p><strong>Key messages: </strong>Current CKD classification systems, based on non-specific biomarkers, fail to capture CKD's heterogeneity. Incorporating biomarkers reflecting diverse pathophysiological mechanisms can enhance risk prediction, customized treatments, and personalized clinical trials. High-throughput multi-omic techniques present a promising path towards precision medicine in nephrology.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-19"},"PeriodicalIF":2.3,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029225","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
Prospective Evaluation of Remote Software Based Surveillance Supplementing Clinical Monitoring for Haemodialysis Vascular Access. 基于远程软件监测补充血液透析血管通路临床监测的前瞻性评价。
IF 2.3 4区 医学
Nephron Pub Date : 2025-01-20 DOI: 10.1159/000543609
Alshymaa Rafiek Eltahan, Zulfikar Pondor, Rosemary L Donne, David Lewis, Maharajan Raman, Jan Cowperthwaite, Marinela Liliana Resiga, Paul Hinchliffe, Jazzle Lim, Paula Gleave, Jonathan Allsopp, Dimitrios Poulikakos
{"title":"Prospective Evaluation of Remote Software Based Surveillance Supplementing Clinical Monitoring for Haemodialysis Vascular Access.","authors":"Alshymaa Rafiek Eltahan, Zulfikar Pondor, Rosemary L Donne, David Lewis, Maharajan Raman, Jan Cowperthwaite, Marinela Liliana Resiga, Paul Hinchliffe, Jazzle Lim, Paula Gleave, Jonathan Allsopp, Dimitrios Poulikakos","doi":"10.1159/000543609","DOIUrl":"10.1159/000543609","url":null,"abstract":"<p><strong>Background: </strong>Efficient arteriovenous vascular access (VA) surveillance is vital for early identification of dysfunctional access, allowing timely intervention to prevent thrombosis. This study compares the efficacy of adding remote software surveillance to standard clinical care across our units.</p><p><strong>Methods: </strong>We conducted a 12-month prospective study on maintenance haemodialysis (HD) patients using Vasc-Alert software technology to assist clinical decision-making in 2 satellite HD units (group 1) and standard care in the remaining 3 HD units (group 2). Patients with Vasc-Alert-derived high Access Risk Score (ARS) (≥7) underwent clinical assessment and were referred for fistulogram based on relevant Kidney Disease Outcome Quality Initiative (KDOQI) criteria. Data on referrals for fistulogram, subsequent VA events, access abandonment, and complication-free days-extended (CFD-extended) were collected. VA survival analysis of post-intervention primary patency rate at 3 and 6 months was conducted.</p><p><strong>Results: </strong>There were 23 (28.1%) pre-emptive correction of stenosis and 6 (7.3%) thrombosis episodes in group 1, compared to 40 (19.5%) and 21 (10.2%) in group 2 (p value 0.155, 0.587), respectively). Among the thrombotic episodes, 83% of cases in group 1 had been detected during surveillance and referred for diagnostic fistulogram ± angioplasty but developed thrombosis while awaiting elective intervention compared to 19% in group 2 (p = 0.004). Median time from fistulogram request to thrombosed VA was 26 days (interquartile range: 21-42 days). Group 1 exhibited better post-intervention primary patency rates and longer CFD compared to group 2 (p value <0.001, 0.002, respectively).</p><p><strong>Conclusion: </strong>Incorporating Vasc-Alert technology into VA clinical surveillance pathway was associated with improved early detection of high-risk VA, higher primary patency rates, and longer CFD-extended compared to standard of care. Improving elective interventional radiology capacity for timely intervention (<3 weeks from referral) is crucial to materialise the benefits of enhanced surveillance in preventing acute thrombosis.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-9"},"PeriodicalIF":2.3,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008763","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
Chronic Kidney Disease in Diabetes: Is Fish Oil the Answer? 慢性肾病糖尿病:鱼油是答案吗?
IF 2.3 4区 医学
Nephron Pub Date : 2025-01-18 DOI: 10.1159/000543588
Luigi Gnudi
{"title":"Chronic Kidney Disease in Diabetes: Is Fish Oil the Answer?","authors":"Luigi Gnudi","doi":"10.1159/000543588","DOIUrl":"10.1159/000543588","url":null,"abstract":"","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-6"},"PeriodicalIF":2.3,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008760","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
GlomCon Hawaii: The First International Hybrid Glomerular Diseases Conference. 夏威夷:第一届国际混合性肾小球疾病会议。
IF 2.3 4区 医学
Nephron Pub Date : 2025-01-18 DOI: 10.1159/000543592
Niloufar Ebrahimi, Zohreh Gholizadeh Ghozloujeh, Ali Poyan Mehr, Harish Seethapathy, Kate Robson, Dia R Waguespack, Rica Mae Pitogo, Sayna Norouzi
{"title":"GlomCon Hawaii: The First International Hybrid Glomerular Diseases Conference.","authors":"Niloufar Ebrahimi, Zohreh Gholizadeh Ghozloujeh, Ali Poyan Mehr, Harish Seethapathy, Kate Robson, Dia R Waguespack, Rica Mae Pitogo, Sayna Norouzi","doi":"10.1159/000543592","DOIUrl":"10.1159/000543592","url":null,"abstract":"","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-6"},"PeriodicalIF":2.3,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008761","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
Mendelian Randomization Analysis Reveals a Causal Relationship between Membranous Nephropathy and the Gut Microbiome. 孟德尔随机分析揭示膜性肾病与肠道微生物群之间的因果关系。
IF 2.3 4区 医学
Nephron Pub Date : 2025-01-16 DOI: 10.1159/000543606
Dunlu Yuan, Yuelong Chen, Hongyun Zheng, Guiqun Liu, Qing Yang, Ling Chen, Qing Li
{"title":"Mendelian Randomization Analysis Reveals a Causal Relationship between Membranous Nephropathy and the Gut Microbiome.","authors":"Dunlu Yuan, Yuelong Chen, Hongyun Zheng, Guiqun Liu, Qing Yang, Ling Chen, Qing Li","doi":"10.1159/000543606","DOIUrl":"10.1159/000543606","url":null,"abstract":"<p><strong>Introduction: </strong>With the increasing prevalence of membranous nephropathy (MN), the gut microbiome (GM) is increasingly implicated in its cause, yet the intricate mechanisms remain unclear. Whether changes in the diversity and richness of gut microbial populations among MN patients contribute to disease prevalence is still unanswered, necessitating further exploration into the potential causative link between the GM and MN.</p><p><strong>Methods: </strong>We conducted a comprehensive bidirectional mendelian randomization (MR) study. We selected 211 bacterial taxa using genome-wide association study (GWAS) data provided by the MiBioGen consortium, while GWAS data relevant to MN were obtained from ebi-a-GCST010005. The inverse-variance weighted (IVW) method was the primary technique used to delineate the causal relationship between exposures and outcomes. To confirm the robustness of our results, we used additional methods, including MR-Egger, weighted median, simple mode, and weighted mode. Sensitivity analyses included tests for pleiotropy, heterogeneity, and leave-one-out sensitivity to ensure the integrity of our conclusions. Finally, reverse MR analyses were conducted to assess the likelihood of reverse causality.</p><p><strong>Results: </strong>Using various analytical methods, including the IVW approach, MR-Egger, weighted median, simple mode, and weighted mode, our study identified six microbial taxa with a statistically significant causal link to MN, as indicated by p values <0.05. The implicated taxa are Butyrivibrio (OR = 1.25, 95% CI: 1.001-1.565, p = 0.048), Butyricicoccus (OR = 2.15, 95% CI: 1.005-4.621, p = 0.048), Catenibacterium (OR = 1.49, 95% CI: 1.043-2.134, p = 0.028), Ruminiclostridium 5 (OR = 1.78, 95% CI: 1.140-2.763, p = 0.03), Ruminococcaceae UCG-003 (OR = 1.78, 95% CI: 1.140-2.763, p = 0.011), and Bacillales (OR = 1.52, 95% CI: 1.135-2.025, p = 0.005). Each of these taxa has been established as a risk factor for MN. Notably, Ruminococcaceae UCG-003 and Bacillales were identified as having a bidirectional causal relationship with the disease.</p><p><strong>Conclusion: </strong>Our MR study has revealed a causal link between six microbial taxa and MN, highlighting their potential involvement in the disease's development. These findings represent an initial step into this complex field and underscore the need for more in-depth research.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-13"},"PeriodicalIF":2.3,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008762","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
Recurrence of Glomerular Diseases after Kidney Transplantation: What Do We Know New? 肾移植后肾小球疾病的复发:我们有什么新发现?
IF 2.3 4区 医学
Nephron Pub Date : 2025-01-08 DOI: 10.1159/000543268
Emilio Rodrigo, Lara Belmar, José Luis Pérez-Canga
{"title":"Recurrence of Glomerular Diseases after Kidney Transplantation: What Do We Know New?","authors":"Emilio Rodrigo, Lara Belmar, José Luis Pérez-Canga","doi":"10.1159/000543268","DOIUrl":"10.1159/000543268","url":null,"abstract":"<p><strong>Background: </strong>The recurrence of primary glomerulonephritis (GN) following kidney transplantation poses a significant threat to graft survival. To enhance kidney transplant outcomes, we must lessen the burden of recurrence. In recent years, there has been progress in understanding the incidence, risk factors for recurrence, pathophysiology, biomarkers, and therapeutics, making it worthwhile to conduct an update on primary GN that may recur following kidney transplantation.</p><p><strong>Summary: </strong>We conducted a narrative review of the literature on the novel discoveries of primary GN that can recur following kidney transplantation. To summarize, developing a broad consensus on recurrence diagnosis would greatly advance our understanding, and its development would be a valuable collaborative effort. The key risk factors for recurrence have been better understood, particularly in individuals with complement-related or monoclonal gammopathy-related recurrent membranoproliferative GN. Furthermore, we can identify better recurrent IgA nephropathy patients who are more likely to experience graft loss. New biomarkers for membranous nephropathy (anti-PLA2R-Ab) and focal and segmental glomerulosclerosis (anti-nephrin-Ab) can assist in identifying and monitoring patients at risk of recurrence. Regarding therapy, the focal and segmental glomerulosclerosis consensus will enhance recurrence treatment. Some complement inhibitors and anti-CD38 monoclonal antibodies are already promising in treating and healing recurrent C3 glomerulopathy and focal and segmental glomerulosclerosis, respectively. Finally, new drugs developed specifically to treat IgA nephropathy in the native kidney will also change the outcome of IgA nephropathy recurrence.</p><p><strong>Key messages: </strong>Although there has been progress in understanding the recurrence of primary GN following kidney transplantation, a worldwide effort should be undertaken to gather research that will allow for improved diagnosis, monitoring, and management of these patients.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"1-12"},"PeriodicalIF":2.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952054","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 : 2025-01-01 Epub 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 <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 >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":" ","pages":"1-10"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","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}
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