Nephrology Dialysis Transplantation最新文献

{"title":"Psoriasis associates with increased risk for kidney transplant rejection.","authors":"Rashi Agrawal, Jennifer L Waller, Stephanie L Baer, Wendy B Bollag","doi":"10.1093/ndt/gfaf047","DOIUrl":"10.1093/ndt/gfaf047","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Psoriasis is a common immune-mediated skin disorder with additional manifestations due to systemic inflammation. Patients with psoriasis have an increased risk of end-stage renal disease (ESRD) requiring either dialysis or renal transplant; however, the relationship between psoriasis and renal allograft failure has not been established.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the United States Renal Data System to analyze the association between psoriasis and graft failure (occurring more than 2 weeks after the transplant). We compared transplant failure rates in ESRD patients with a psoriasis diagnosis prior to the initial transplant versus transplanted ESRD patients without a psoriasis diagnosis. From 2004 to 2019, a total of 151 272 renal transplant patients aged 18-100 and meeting exclusion and inclusion criteria were identified; in this cohort, 1105 ESRD patients had International Classification of Diseases (ICD)-9 and -10 claim codes for psoriasis prior to their renal transplant.</p><p><strong>Results: </strong>Logistic regression modeling was used to examine possible confounders of psoriasis on graft failure. Kaplan-Meier estimates indicated that renal transplant patients with psoriasis had reduced graft survival over time compared with those without psoriasis. In addition, Cox proportional hazard analysis, controlling for demographics and clinical risk factors, showed a significantly increased hazard ratio for renal allograft failure for patients with a diagnosis of psoriasis.</p><p><strong>Conclusions: </strong>The systemic inflammation and immune-mediated pathophysiology underlying psoriasis could underlie the association between psoriasis and the increased risk of renal transplant failure.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1756-1763"},"PeriodicalIF":5.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global access to management of primary hyperoxaluria: a survey on behalf of OxalEurope, G&K Working Group of the ERA and ESPN.","authors":"Lisa J Deesker, Laila Oubram, Reham Almardini, Michelle A Baum, M Bonilla-Felix, Lucile Figueres, Sander F Garrelfs, Jaap W Groothoff, Pépé M Ekulu, Roman-Ulrich Müller, Michiel J S Oosterveld, Shen Qian, John A Sayer, Neveen Soliman, Shabbir H Moochhala, Justine Bacchetta","doi":"10.1093/ndt/gfaf035","DOIUrl":"10.1093/ndt/gfaf035","url":null,"abstract":"<p><strong>Background: </strong>Primary hyperoxaluria (PH) is a rare disorder with significant morbidity and mortality if left untreated. Given the rarity, global inequities in diagnostics and treatment are expected. Recently introduced RNA interference therapeutics (RNAi) have dramatically changed the outcome for PH patients, potentially disproportionately affecting low-resource regions. Understanding these disparities is crucial for implementing measures to ensure equitable healthcare access for PH patients worldwide. This study aims to evaluate the current global health situation for PH patients upon the introduction of targeted therapeutics.</p><p><strong>Methods: </strong>An international cross-sectional questionnaire study was conducted among healthcare providers involved in PH care. Responses were gathered between March 2023 and April 2024 and distributed by e-mail via various international nephrology networks. Meta-analysis (mixed random effects model with inverse-variance weighting) was used to analyze data and adjust for subgroup differences.</p><p><strong>Results: </strong>We gathered 136 responses from 57 countries, representing all World Bank regions. Overall access to genetic analysis diagnostics was 82% (confidence interval 77%-91%) and to urinary oxalate measurement 97% (93%-100%). Significant differences (P < .05) between low- and high-income countries were found for most diagnostics including genetic testing, plasma oxalate, plasma and urinary glycolate. Conservative therapies (e.g. pyridoxine and alkalinizing agents) were highly available globally (98% and 95%), but significant differences in access to peritoneal dialysis, and kidney and liver transplantation were reported (P < .05). Access to the RNAi therapeutic lumasiran was limited to high- and middle-income countries, with 53% (40%-66%) of all countries having access (78% high-income versus 56% middle-income). Even in high-income countries, RNAi was not always accessible.</p><p><strong>Conclusions: </strong>We found global disparities in access to optimal management of PH patients, disproportionately affecting low-income countries, but even existing between high-income countries. These results may provide support for initiatives to improve the outcome of PH patients worldwide in an era of new targeted therapeutic treatments.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1688-1697"},"PeriodicalIF":5.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of SGLT2 inhibition on insulin use in CKD and type 2 diabetes: insights from the CREDENCE trial.","authors":"Bryony Beal, Luke Buizen, Emily K Yeung, Lauren Heath, Lauren Houston, David Z I Cherney, Meg Jardine, Carol Pollock, Clare Arnott, Sradha S Kotwal, Hiddo J L Heerspink, Vlado Perkovic, Brendon L Neuen","doi":"10.1093/ndt/gfaf044","DOIUrl":"10.1093/ndt/gfaf044","url":null,"abstract":"<p><strong>Background: </strong>Insulin is a mainstay treatment for diabetes, but its use is associated with weight gain and hypoglycaemia. Data on the effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on insulin use in people with chronic kidney disease (CKD) are limited.</p><p><strong>Methods: </strong>We conducted a post hoc analysis of the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation trial. Effects of canagliflozin versus placebo on insulin use (initiation, dose intensification, reduction and discontinuation) in people with CKD and type 2 diabetes were evaluated using Cox regression models. The primary outcome was insulin initiation or a >25% insulin dose intensification (in those not receiving and receiving insulin at baseline, respectively). Effects on kidney, cardiovascular and safety outcomes by baseline insulin use were also assessed.</p><p><strong>Results: </strong>Among 4401 participants, 2884 (65.5%) were receiving insulin at baseline; these participants were more likely to have lower estimated glomerular filtration rate, higher albuminuria and a longer duration of diabetes (all P < .001). Over a median on-treatment period of 2.0 years, canagliflozin reduced the need for insulin initiation or a >25% dose intensification by 19% compared with placebo {hazard ratio [HR] 0.81 [95% confidence interval (CI) 0.71-0.93]}, irrespective of baseline kidney function or albuminuria (both P-interaction > .10). Sustained insulin dose reductions of >50% were achieved more frequently with canagliflozin than placebo [HR 1.49 (95% CI 1.15-1.91)], although no difference in insulin discontinuation was observed between treatment arms. Effects of canagliflozin on kidney, cardiovascular and safety outcomes were consistent regardless of baseline insulin use (all P-interaction > .05).</p><p><strong>Conclusions: </strong>In CKD and type 2 diabetes, canagliflozin reduces insulin use with consistent effects regardless of baseline kidney function. This supports the use of canagliflozin in people with CKD, not only for end-organ protection, but also to improve glycaemic control and reduce exposure to insulin and its associated adverse effects.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1727-1735"},"PeriodicalIF":5.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale and design of the Renal Lifecycle trial assessing the effect of dapagliflozin on cardiorenal outcomes in severe chronic kidney disease.","authors":"Wisanne M Bakker, Hiddo J L Heerspink, Stefan P Berger, Christoph Wanner, Sunil V Badve, Clare Arnott, Alferso C Abrahams, Joost C van den Born, Tim C van Faassen, Carlo A J M Gaillard, Mariëlle A C J Gelens, Jose L Górris, Marc H Hemmelder, Lily Jakulj, Rob C M van Kruijsdijk, Dirk R J Kuypers, Peter van der Meer, Jeroen B van der Net, Heleen H Nijmeijer, Marc G Vervloet, Aiko P J de Vries, Michael Walsh, Angela Y Wang, Ron T Gansevoort","doi":"10.1093/ndt/gfaf046","DOIUrl":"10.1093/ndt/gfaf046","url":null,"abstract":"<p><strong>Background: </strong>Several clinical trials have shown beneficial effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on kidney disease progression and cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD) with and without type 2 diabetes mellitus. However, some subgroups of patients with CKD have been excluded from participation in these trials, such as patients with severely impaired kidney function, patients on dialysis and kidney transplant recipients.</p><p><strong>Methods: </strong>The Renal Lifecycle trial (NCT05374291) is a pragmatic, international, multicentre, investigator-initiated, randomized, placebo-controlled clinical trial planned to enrol ≈1500 patients with an estimated glomerular filtration rate (eGFR) ≤25 ml/min/1.73 m2, on haemodialysis or peritoneal dialysis or after a kidney transplant and an eGFR ≤45 ml/min/1.73 m2, who will be randomized 1:1 to receive either dapagliflozin 10 mg once daily or matching placebo.</p><p><strong>Results: </strong>The primary endpoint is a composite of heart failure hospitalization, all-cause mortality or, for those not on dialysis, kidney failure (start of dialysis >1 month, receiving a kidney transplant or death due to kidney failure). The trial is event driven, indicating that it will end after 468 first primary endpoint events have occurred, with a power of 80% and an α of 0.05 to detect a 25% relative risk reduction assuming an annual 12.5% incidence of the primary outcome. The secondary endpoints include a separate analysis of the incidence of each component of the primary endpoint in the overall trial population as well as the incidence of the combined primary endpoint in each of the three subgroups of patients. Other (exploratory) endpoints are efficacy, safety, tolerability, health-related quality of life and cognition.</p><p><strong>Conclusion: </strong>The Renal Lifecycle trial aims to investigate the effects of the SGLT2 inhibitor dapagliflozin compared with placebo on the incidence of kidney failure, heart failure, mortality and safety in three subgroups of patients with advanced CKD.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1746-1755"},"PeriodicalIF":5.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early compensatory increase in single-kidney estimated GFR after unilateral nephrectomy is associated with a lower long-term risk of estimated GFR decline.","authors":"Jessica van der Weijden, Faizan Mazhar, Edouard L Fu, Marco van Londen, Marie Evans, Stefan P Berger, Martin H De Borst, Juan J Carrero","doi":"10.1093/ndt/gfaf026","DOIUrl":"10.1093/ndt/gfaf026","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>A more pronounced short-term increase in single-kidney GFR (ΔskGFR) has been associated with better long-term kidney function in living kidney donors. Whether this also applies to non-donors is unknown. We evaluated whether ΔskGFR is associated with long-term risk of eGFR decline in individuals undergoing unilateral nephrectomy.</p><p><strong>Methods: </strong>This study included 1777 participants from the SCREAM cohort who underwent radical unilateral nephrectomy in Stockholm between 2006 and 2021. The ΔskGFR was calculated as the early (1-6 months) post-nephrectomy eGFR minus 50% of the pre-nephrectomy eGFR. Multivariable Cox regression was used to study the association between Δsk-GFR and the subsequent risk of progressive eGFR decline, defined as composite of an eGFR decline >30% compared to the early (6 months) post-nephrectomy eGFR or kidney failure.</p><p><strong>Results: </strong>Mean age at nephrectomy was 68 ± 11 years, 40% were female, 92% had kidney cancer, and median (IQR) pre-nephrectomy eGFR was 76 (61-89) ml/min/1.73 m2. Median Δsk-GFR was 11 (7-20) ml/min/1.73 m2. Pre-nephrectomy determinants of Δsk-GFR were age (inverse association) and pre-nephrectomy eGFR (positive association). During a median follow-up of 5 years (range 0.6-15 years), 178 participants developed progressive eGFR decline. Individuals with a Δsk-GFR above the median had a lower rate of progressive eGFR decline (adjusted HR: 0.58, 95% CI: 0.42-0.80), compared to those with a Δsk-GFR below the median, independent of baseline eGFR and age.</p><p><strong>Conclusions: </strong>A stronger increase in single-kidney eGFR early after unilateral nephrectomy was associated with a lower long-term risk of progressive eGFR decline. Evaluation of Δsk-GFR could help identify patients at higher risk of progressive kidney function decline following unilateral nephrectomy.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1680-1687"},"PeriodicalIF":5.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute kidney injury, acute kidney disease and chronic kidney disease: challenges and research perspectives.","authors":"Carmine Zoccali, Norbert Lameire, Claudio Ronco, Nicholas Carlson, Stanislas Faguer, Nicholas Selby, Marlies Ostermann, Francesca Mallamaci, Raymond Vanholder","doi":"10.1093/ndt/gfaf090","DOIUrl":"10.1093/ndt/gfaf090","url":null,"abstract":"<p><p>Acute kidney injury (AKI) and chronic kidney disease (CKD) are interconnected, with AKI often leading to CKD and vice versa. Despite research advances, their causal relationship in clinical settings remains unclear. Inflammation, oxidative stress and maladaptive repair are key factors in AKI's progression to CKD. AKI episodes may hasten CKD progression, influenced by demographics, comorbidities and treatment factors like blood pressure control. This underscores the need for careful management to prevent long-term damage. Prospective cohort studies addressing confounding factors are essential to understanding AKI's impact on CKD. These studies should use precise definitions and measurements to clarify causal pathways and risk factors. Investigating asymptomatic AKI in the general population and CKD patients could offer insights into progression mechanisms and prevention strategies. Understanding the interplay of AKI and CKD is crucial for developing interventions and improving outcomes, making it a scientific and public health priority.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1650-1658"},"PeriodicalIF":5.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel, dominant disease mechanism of distal renal tubular acidosis with specific variants in ATP6V1B1.","authors":"Myrte Daenen, Marguerite Hureaux, Emma Ashton, Francesca Becherucci, Ian Berry, Marcus Benz, Anna Bjerre, Andrew Buckton, Richard Caswell, Celia Duff-Farrier, Samantha Hayward, Joseph Mcallister, Anna Moczulska, Viviana Palazzo, Caroline Platt, Hitesh Prajapati, Moin A Saleem, Karl-Peter Schlingmann, Telma Francisco, Marcin Zaniew, Francesco Emma, Detlef Bockenhauer","doi":"10.1093/ndt/gfaf016","DOIUrl":"10.1093/ndt/gfaf016","url":null,"abstract":"<p><strong>Background: </strong>ATP6V1B1 encodes a subunit of the vacuolar H+-ATPase and pathogenic variants are associated with autosomal recessive distal renal tubular acidosis (dRTA) with deafness. Heterozygous variants predicted to affect a specific amino acid, Arg394, have been recurrently reported in dRTA but their significance has been unclear. We hypothesized that these variants are associated with a dominant disease mechanism.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of cases identified in our genetic laboratories and through European nephrology organizations. Data regarding demographics, clinical presentation, laboratory findings, hearing and imaging studies of kidneys were collected from the index patient and, if available, from other family members. The potential disease mechanism was investigated through structural modelling in silico.</p><p><strong>Results: </strong>Twenty index patients in total were included, of which 19 carried the variant c.1181G>A; p.(Arg394Gln) and one c.1180C>G; p.(Arg394Gly). In seven families, more than one member was affected and the variant segregated with the disease in those with available information (15 affected, 6 unaffected), except for the unaffected mother of 2 affected children, who was mosaic. In no patient was a second causative variant in trans identified. In eight sporadic patients and one affected parent, the variant was confirmed to be de novo. Both variants are absent in gnomAD. Sensorineural hearing loss was reported in 8 of the 22 patients with available information. Structural modelling supports a crucial role for Arg394 in nucleotide binding.</p><p><strong>Conclusion: </strong>We provide strong evidence for the pathogenicity of heterozygous variants affecting Arg394 and thus a novel inheritance modus for ATP6V1B1-associated dRTA. Clinically, this form differs from the recessive one by the lower prevalence of hearing loss. The prominent position of Arg394 in the nucleotide binding fold of the H+-ATPase structure is consistent with a dominant negative mechanism. Our findings inform the diagnosis and management of patients with dRTA and variants of Arg394.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1531-1537"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Haemodiafiltration versus high-flux haemodialysis-a Consensus Statement from the EuDial Working Group of the ERA.","authors":"Yuri Battaglia, Rukshana Shroff, Björn Meijers, Ionut Nistor, Gaetano Alfano, Casper Franssen, Valerie Luyckx, Vassilios Liakopoulos, Alessandro Mantovani, Federica Baciga, Federica Caccia, Claudia Momentè, Andrew Davenport, Peter J Blankestijn, Adrian Covic, Christian Combe, Carlo Basile","doi":"10.1093/ndt/gfaf024","DOIUrl":"10.1093/ndt/gfaf024","url":null,"abstract":"<p><p>Haemodialysis (HD) is a life-saving therapy for individuals with kidney failure. Post-filter haemodiafiltration (HDF) and high-flux HD are the most widely used treatment modalities. To date, five randomized controlled trials (RCTs) have been performed that compare all-cause and cardiovascular (CV) mortality between HDF and low- or high-flux HD in adults receiving maintenance dialysis for at least 1 year. RCTs, meta-analyses and pooled individual patient data analyses have been published on this topic. However, all of them are limited by the heterogeneity of inclusion criteria and significant methodological shortcomings, including informative selection bias and the exclusion of poorly performing patients from the HDF arm after randomization. Given this background, the European Dialysis Working Group of the European Renal Association presents a Consensus Statement on HDF and high-flux HD, addressing three key outcomes: survival, health-related quality of life, and biochemical endpoints. A separate section is dedicated to paediatric patients. We searched five large electronic databases to identify parallel or cross-over RCTs comparing HDF with high-flux HD on pre-defined outcome measures. Using a mini-Delphi method, we developed 22 key consensus points by combining meta-analyses, clinical experience, and expert opinion. They aim to inform and assist in decision making and are not intended to define a standard of care. The key summary point is that HDF appears to be associated with improved overall and CV survival, provided high convection volumes are achieved. The generalizability of these findings to the entire dialysis population depends on the patient's overall health and requires further study.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1590-1614"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PLA2R autoantibodies, a multifaceted biomarker in nephrotic syndrome and membranous nephropathy.","authors":"Omar Ragy, Wessam Abass, Durga Anil K Kanigicherla, Bethany Shinkins, Janine Bestall, Natalie King, Paul Brenchley, Alison Smith, Patrick Hamilton","doi":"10.1093/ndt/gfaf012","DOIUrl":"10.1093/ndt/gfaf012","url":null,"abstract":"<p><p>The phospholipase A2 receptor antibody (PLA2R-Ab) test is a valuable first-line diagnostic tool for primary membranous nephropathy (MN), helping to identify PLA2R-related MN and potentially eliminating the need for a kidney biopsy in some individuals. By reducing the reliance on biopsies, the test streamlines diagnosis and improves patient care. However, determining the optimal PLA2R measurement method and cut-off is critical to maximizing the benefits of the test and minimizing any harms. A systematic review and meta-analysis were performed to evaluate serum- and urine-based biomarkers for distinguishing between PLA2R-related MN and non-PLA2R MN. Searches were conducted in databases including Medline, Embase, Cochrane Library, Scopus, Web of Science, International HTA Database and ClinicalTrials.gov. The methodology followed Cochrane-recommended guidelines for systematic reviews and meta-analyses, and the QUADAS-2 tool was utilized to assess the overall risk of bias. Ninety-one studies met the eligibility criteria for inclusion in the review. Of these, 38 studies reporting the accuracy of the PLA2R-Ab test using the EUROIMMUN enzyme-linked immunosorbent assay (ELISA) method and 27 using the EUROIMMUN immunofluorescence (IF) method were suitable for meta-analysis. The pooled sensitivity and specificity of EUROIMMUN ELISA at a cut-off value of 20 RU/mL were 0.64 [95% confidence interval (CI) 0.56-0.72] and 94.7% (95% CI 90.5-97.1%), respectively. The pooled sensitivity and specificity of EUROIMMUN IF at a threshold of 1:10 was 0.69 (95% CI 0.637-0.739) and 0.98 (95% CI 0.931-0.994), respectively. Risk of bias was higher for studies evaluating the IF compared with ELISA test. We also explored whether the timing of the index test had an impact on the pooled diagnostic accuracy results; no significant differences were found. By evaluating the specificity and sensitivity of EUROIMMUN ELISA PLA2R-Ab and IF, we demonstrate that at ELISA levels ≥20 RU/mL, alongside thorough secondary screening, a kidney biopsy may be unnecessary. However, lower or negative levels still warrant a biopsy.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1458-1469"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low birth weight and chronic kidney disease with progression to kidney failure in children.","authors":"Fu-Shun Yen, James Cheng-Chung Wei, Wan-Yin Cheng, Chi-Ting Huang, Yi-Ling Wu, Suan-Heoh Teh, Chii-Min Hwu, Chih-Cheng Hsu","doi":"10.1093/ndt/gfaf018","DOIUrl":"10.1093/ndt/gfaf018","url":null,"abstract":"<p><strong>Background: </strong>It is unclear whether low birth weight (LBW), preterm birth and small for gestational age (SGA) could synergistically cause chronic kidney disease (CKD) and end-stage kidney disease (ESKD). This cohort study was conducted to examine their individual and combined impacts on the development of CKD and ESKD in childhood.</p><p><strong>Methods: </strong>From the Taiwan Maternal and Child Health Database, we identified 1 477 128 newborns born between 1 January 2009 and 31 December 2016. We used a multivariable Cox regression model to assess the excess risk of CKD and ESKD in children with LBW/preterm/SGA. They were followed from birth until the occurrence of outcomes or until 31 December 2018, with an average follow-up of 5.78 years.</p><p><strong>Results: </strong>This study included 1 361 071 infants with birth weight ≥2500 g (92.14%), 104 855 infants with low birth weight (1500 g to <2500 g) (7.10%), 6843 infants with very low birth weight (1000 g to <1500 g) (0.46%) and 4349 infants with extremely low birth weight (<1000 g) (0.29%). The multivariable-adjusted model showed that male infants with low birth weight were associated with an increased risk of CKD [adjusted hazard ratio (aHR) 1.20, 95% confidence interval (CI) 1.08-1.32] and ESKD (aHR 1.64, 95% CI 1.37-1.97). Female infants with LBW had an increased risk of CKD (aHR 1.18, 95% CI 1.06-1.32) and ESKD (aHR 1.31, 95% CI 1.09-1.58) than those without LBW. In addition to LBW, infants with preterm or SGA condition also had a significantly and synergistically increased risk of CKD and ESKD compared with full-term infants.</p><p><strong>Conclusion: </strong>We found children with LBW, preterm birth or SGA had a significantly increased risk of CKD and ESKD compared with children without intrauterine growth restriction.</p>","PeriodicalId":19078,"journal":{"name":"Nephrology Dialysis Transplantation","volume":" ","pages":"1550-1558"},"PeriodicalIF":5.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}