Nephrology (Carlton, Vic.)最新文献

{"title":"Exploring Lung Fluid Dynamics in Haemodialysis With Remote Dielectric Sensing.","authors":"Wen-Hsin Wen, Yi-Ju Tsai, Fan-Chi Chang, Ying-Chou Wang, Chun-Ta Huang","doi":"10.1111/nep.70095","DOIUrl":"https://doi.org/10.1111/nep.70095","url":null,"abstract":"<p><strong>Aim: </strong>Pulmonary congestion is a common complication in haemodialysis patients, significantly contributing to cardiac events and mortality. Traditional methods for assessing fluid status lack sensitivity and specificity, necessitating the development of more reliable techniques. Remote dielectric sensing (ReDS) offers rapid, non-invasive, and quantitative lung fluid measurements, potentially aiding fluid management in this population.</p><p><strong>Methods: </strong>In this prospective cross-sectional study, patients on chronic maintenance haemodialysis were invited to participate between March and June 2022. ReDS measurements were performed immediately before and after haemodialysis to assess pulmonary congestion, defined as ReDS values exceeding 35%. Ultrafiltration volumes, intradialytic hypotension, and associated risk factors were analysed.</p><p><strong>Results: </strong>Among 58 analysed haemodialysis patients (mean age 76 years; 43% male), 48% exhibited pulmonary congestion pre-haemodialysis (mean ReDS: 37%), with 33% remaining congested post-haemodialysis despite a 4% average reduction. Ultrafiltration volumes averaged 1.4 L and showed a weak correlation with ReDS changes (Pearson's r = 0.309, p = 0.018). Intradialytic hypotension occurred in 21% of patients and was associated with hypoalbuminaemia (75% vs. 46%; p = 0.070), and was less common in hypertensive individuals (50% vs. 78%; p = 0.072). ReDS measurements did not predict intradialytic hypotension.</p><p><strong>Conclusion: </strong>ReDS is a valuable tool for assessing pulmonary congestion in haemodialysis patients, detecting fluid overload both before and after sessions. Pulmonary congestion often persists despite achieving dry weight, highlighting the need for precise fluid management. While ReDS shows promise for clinical use, further longitudinal studies are essential to validate its prognostic value and refine its application in haemodialysis care.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 7","pages":"e70095"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Treatment of Growing Renal Angiomyolipomas With Low-Dose Everolimus in a School-Aged Child With Tuberous Sclerosis Complex.","authors":"Satoshi Senoo, Shoichiro Kanda, Keiichi Takizawa, Hiroshi Terashima, Yuko Kajiho, Yutaka Harita","doi":"10.1111/nep.70069","DOIUrl":"10.1111/nep.70069","url":null,"abstract":"<p><p>Renal angiomyolipomas (AMLs) are a common renal manifestation in tuberous sclerosis complex (TSC), occurring in 50%-85% of cases. Even in asymptomatic individuals, treatment is often initiated based on AML size, with mTOR inhibitors being the primary medical therapy. AMLs tend to enlarge with age, and treatment during school age is rare. Secondary AML shrinkage in paediatric TSC patients has been reported who received everolimus for subependymal giant cell astrocytomas (SEGA) or epilepsy, but studies on its direct use for AMLs in paediatric cases remain limited. A 9-year-old girl born to a mother with TSC was diagnosed at birth due to cardiac rhabdomyomas, cortical tubers, and Shagreen patches. At the age of 4, ultrasound detected multiple AMLs in both kidneys, with the largest lesions measuring 2.3 cm in the right kidney and 1.6 cm in the left. By the age of 7, MRI showed further growth to 4.8 cm. Despite the absence of symptoms, the risk of haemorrhage led to treatment initiation. Everolimus was started at 1.0 mg/day (1.3 mg/m²/day), significantly lower than the standard 4.5 mg/m²/day. Trough levels remained below the target range, yet AMLs showed a shrinking tendency, with MRI at age 9 revealing a reduction in the largest AML to 2.4 cm. Stomatitis occurred intermittently, but no serious adverse effects were observed. This case suggests that low-dose everolimus can effectively reduce AML size while minimising adverse effects, highlighting its potential as a treatment option for AMLs in paediatric TSC patients.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 7","pages":"e70069"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12237548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability in Dialysis Access Over Time and Across Centres in Australia and New Zealand: Effect of Centre- and Patient-Related Factors on Dialysis Access Quality Indicators.","authors":"Adam G Steinberg, Nigel D Toussaint, Christopher E Davies, Nicholas A Gray, Stephen P McDonald","doi":"10.1111/nep.70076","DOIUrl":"10.1111/nep.70076","url":null,"abstract":"<p><strong>Aim: </strong>The Australian and New Zealand Society of Nephrology (ANZSN) established a quality indicator (QI) program to measure performance and reduce variation of nephrology care. This program relies on registry data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). ANZDATA also conducts surveys to ascertain more granular characteristics of participating nephrology units to better understand variation in practice. This study assessed ANZDATA and nephrology unit surveys to determine patient- and centre-level factors that may account for variation in dialysis access QIs.</p><p><strong>Methods: </strong>Dialysis access QIs were evaluated over a 5-year period using ANZDATA (2016-2020). Patient characteristics were derived from the same period and dataset. Centre characteristics were determined from the 2020-unit binational survey. Statistical analysis involved multivariable regression with fixed effects for patient- and centre-characteristics and a random effect by centre.</p><p><strong>Results: </strong>Wide variation was seen across dialysis access QIs. Using multivariable regression, patient-level characteristics associated with definitive dialysis access at commencement of dialysis included male gender and body mass index decreasing from 30 kg/m². Centres with a home haemodialysis nurse and a 'peritoneal dialysis (PD) first policy' were associated with higher rates of definitive dialysis access. There was also a progressive relationship with the number of full-time equivalent (FTE) medical staff if the unit already had an FTE greater than 10. Inclusion of centre-level variables reduced the variance in the model by 68%.</p><p><strong>Conclusion: </strong>This study demonstrates certain patient- and centre-level characteristics are associated with definitive dialysis access at the commencement of dialysis in Australia and New Zealand. Interventional trials for PD first programmes and different models of care for vascular access are needed.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 7","pages":"e70076"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19-Related Collapsing Glomerulopathy and Thrombotic Microangiopathy in Kidney Transplant Recipients: A Case Report and Literature Review.","authors":"Xiaoyu Li, Xin Xu, Xin Zhang, Suxia Wang, Wenke Han, Cheng Shen, Jian Lin","doi":"10.1111/nep.70096","DOIUrl":"10.1111/nep.70096","url":null,"abstract":"<p><p>We present a case of collapsing glomerulopathy (CG) and thrombotic microangiopathy (TMA) associated with COVID-19 in an Asian kidney transplant recipient who does not have the APOL1 gene variant, and we conduct a literature review. The patient presented with progressive renal function decline following a negative COVID-19 nucleic acid test, accompanied by TMA manifestations such as thrombocytopenia and peripheral blood schistocytes. The renal biopsy conducted after plasma exchange revealed collapsing focal segmental glomerulosclerosis, along with acute tubulointerstitial nephritis and minor microangiopathic changes. The patient underwent cyclic eculizumab therapy and ultimately died of acute pulmonary embolism. Our findings indicate that kidney transplant recipients still may experience severe renal impairment even after testing negative for COVID-19 nucleic acid. COVID-19 can not only directly damage transplanted kidneys, but also indirectly harm transplanted kidneys by causing the release of cytokines and inflammation. COVID-19-related TMA and CG may be a continuous pathological process, and prolonged TMA may lead to the development of CG with a worse prognosis. It is also possible that CG and TMA coexist when patients present with acute kidney injury (AKI). Therefore, even a mild COVID-19 infection can have serious consequences for kidney transplant recipients. Vigilance for TMA and CG should be maintained in the presence of AKI of unknown cause.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 7","pages":"e70096"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sporadic Apolipoprotein A-II Amyloidosis With Familial Renal Failure: A Mutation-Negative Case and Comprehensive Literature Review.","authors":"Liping Lin, Hongyu Qiu, Yanhua You","doi":"10.1111/nep.70091","DOIUrl":"https://doi.org/10.1111/nep.70091","url":null,"abstract":"<p><p>We report a 32-year-old man who presented with proteinuria and a family history of renal failure. A renal biopsy revealed amyloid deposit in the glomeruli, renal interstitium, and arterioles. An abdominal fat aspirate was also positive for amyloid deposition. Following comprehensive evaluation, both acquired monoclonal immunoglobulin light chain amyloidosis (AL-type) and reactive amyloid A amyloidosis (AA-type) were excluded. Mass spectrometry analysis of the renal amyloid material indicated the presence of apolipoprotein A-II (ApoAII) amyloidosis. However, genetic sequencing did not identify any mutation in the coding sequence of ApoA-II. We discuss the rarity, aetiology, diagnosis, and management of apolipoprotein A-II amyloidosis.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 7","pages":"e70091"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Estimated Glomerular Filtration Rate Decline Rate to Optimise Timing of Pre-Emptive Arteriovenous Fistula Creation for Chronic Kidney Disease Patients.","authors":"Panuwat Chuemor, Kittipan Rerkasem, Apichat Tantraworasin, Jiraporn Khorana, Theerachai Thammathiwat","doi":"10.1111/nep.70029","DOIUrl":"https://doi.org/10.1111/nep.70029","url":null,"abstract":"<p><strong>Aim: </strong>Establishing a functional pre-emptive arteriovenous fistula (pAVF) before the commencement of haemodialysis requires careful patient selection and precise timing. Our study aimed to create an eGFR (estimated glomerular filtration rate) slope-based prediction model to estimate the time before the onset of haemodialysis for individual patients.</p><p><strong>Methods: </strong>In this prognostic prediction study, we retrospectively analysed past eGFR data from chronic kidney disease patients who underwent pAVF surgery at Naresuan University Hospital and Maharaj Nakorn Chiangmai Hospital in Thailand.</p><p><strong>Results: </strong>Seventy-one patients who underwent pAVF creation between January 1st, 2016, and December 31st, 2022, were included. 75% achieved successful AVF cannulation for their initial haemodialysis, with 5% not needing dialysis. Past eGFR decline rate (eGFRr), eGFR at referral for AVF (eGFRbase), age ≥ 80 years systolic blood pressure, body mass index, and serum calcium levels have been identified as significant factors in estimating the time remaining before the initiation of haemodialysis (Tr). The model estimates the probability of successful pAVF use versus the need for a catheter at the first haemodialysis session. The model's discriminative performance, evaluated via area under the receiver operating characteristic curve (AuROC), yielded a value of 0.96 (95% CI: 0.92, 1.00) and reliable results as confirmed by the calibration plot.</p><p><strong>Conclusion: </strong>Our prediction model helps estimate Tr for individual patients, enabling timely referral for creation of a pAVF. Implementation in clinical practice has the potential to enhance the utilisation of pAVF and reduce the risk of catheter-dependent haemodialysis. However, a prospective validation study is required to confirm the accuracy of the model before its clinical application.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 7","pages":"e70029"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Readmissions for All-Causes and Fluid Overload in Severely Reduced Kidney Function Not Requiring Dialysis-A Retrospective Cohort Study.","authors":"Zheng Xi Kog, Jiashen Cai, Li Choo Ng, Zhihua Huang, Lydia Lim, Felicia Loo, Hanis Bte Abdul Kadir, Jia Liang Kwek, Jason Choo, Lina Choong, Chieh Suai Tan, Cynthia C Lim","doi":"10.1111/nep.70071","DOIUrl":"https://doi.org/10.1111/nep.70071","url":null,"abstract":"<p><strong>Aim: </strong>Chronic kidney disease is associated with frequent readmissions for ambulatory-sensitive conditions such as fluid overload. There is a paucity of literature to identify individuals at high risk of fluid overload or all-cause readmissions.</p><p><strong>Methods: </strong>We performed a single-centre retrospective cohort study involving 783 patients with an estimated glomerular filtration rate of 11-30 mL/min/1.73 m² hospitalised for fluid overload between 2015 and 2017. Multivariable logistic regression analysis was performed to evaluate associations between the 30-day fluid overload-related and all-cause readmissions and various sociodemographic factors, comorbidities and healthcare utilisation.</p><p><strong>Results: </strong>The 30-day readmission rate for fluid overload and all causes were 10.6% and 26.8%, respectively. Fluid overload readmissions were associated with atherosclerotic cardiovascular disease (ASCVD; adjusted odds ratio [aOR] 1.81, 95% CI 1.08-3.03), atrial fibrillation (AF; aOR 1.93, 95% CI 1.13-3.30), higher serum potassium (aOR 1.61, 95% CI 1.14-2.26) and use of high-dose intravenous furosemide during the index hospitalisation (aOR 1.66, 95% CI 1.02-2.67). In contrast, prior nephrology consult (aOR, 0.51, 95% CI 0.29-0.89) and renin-angiotensin system (RAS) blocker prescription at discharge (aOR 0.61, 95% CI 0.38-0.99) were associated with reduced risk of readmission for fluid overload. More frequent emergency department visits (aOR 1.21, 95% CI 1.04-1.40) and higher LACE score (aOR 1.09, 95% CI 1.01-1.18) were independently associated with 30-day readmission for all causes. Hypertension (aOR 0.62, 95% CI 0.42, 0.93), antidepressant use (aOR 0.40, 95% CI 0.16-0.99) and statin prescription at discharge (aOR 0.53, 95% CI 0.35-0.81) were associated with reduced risk for all-cause readmissions.</p><p><strong>Conclusion: </strong>Factors related to comorbidity burden (ASCVD, AF, more frequent emergency department visits and higher LACE score) and disease severity (higher serum potassium and need for high-dose intravenous furosemide) can identify individuals at increased risk of readmission. Further research is required to evaluate the impact of modifiable factors (nephrology consult, RAS blocker prescription at discharge and statin prescription at discharge) to reduce fluid overload-related and all-cause readmissions.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 7","pages":"e70071"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Changes and Predictive Value of the Renal Resistive Index in the General Population.","authors":"Bente Ponsaerts, Evangelos Ntalianis, Everton J Santana, František Sabovčik, Amaryllis Van Craenenbroeck, Maarten Naesens, Tatiana Kuznetsova, Nicholas Cauwenberghs","doi":"10.1111/nep.70068","DOIUrl":"10.1111/nep.70068","url":null,"abstract":"<p><strong>Aim: </strong>Haemodynamic imaging markers like the renal-resistive index (RRI) provide insights into cardiovascular-renal interactions. However, longitudinal epidemiological data on the RRI's natural history, correlates and predictive value are lacking. We investigated factors associated with longitudinal RRI changes (ΔRRI) and its predictive value for cardiovascular events in the community.</p><p><strong>Methods: </strong>In this prospective observational community-based cohort study, 594 adults underwent renal ultrasonography for RRI assessment and were followed for major cardiovascular disease incidence for 9.1 ± 2.3 years. A subset of 135 (22.7%) had a second RRI measurement after 8.1 ± 1.6 years. Stepwise regression identified clinical correlates of ΔRRI, while multivariable Cox models assessed the association between major cardiovascular events and baseline RRI.</p><p><strong>Results: </strong>Over 8 years, mean RRI increased from 0.60 ± 0.05 to 0.63 ± 0.06 (p < 0.001). Greater ΔRRI was independently associated with older age, higher pulse pressure and diabetes mellitus at baseline and with greater increase in pulse pressure during follow-up. Baseline RRI was associated with major cardiovascular events in univariate analysis, but this association was mostly explained by age and was no longer significant after adjustment for confounders (p = 0.51). Neither the highest RRI tertile (HR: 1.22 (0.51 to 2.94), p = 0.65) nor an RRI above 0.70 (HR: 1.39 (0.70 to 2.76), p = 0.35) predicted major cardiovascular events after full adjustment.</p><p><strong>Conclusion: </strong>This study provides the first longitudinal description of the RRI's natural history in a general adult population. RRI increased stronger over time with ageing, higher pulsatility and diabetes mellitus. However, its limited predictive value for cardiovascular events disfavours its use for risk stratification in the community.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 7","pages":"e70068"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asian Pacific Society of Nephrology Clinical Practice Guideline on Diabetic Kidney Disease-2025 Update.","authors":"Adrian Liew, Sunita Bavanandan, Chuan-Ming Hao, Soo Kun Lim, Narayan Prasad, Manisha Sahay, Paweena Susantitaphong, Veena Roberts, Eranga Wijewickrama, Muh Geot Wong, Sydney C W Tang","doi":"10.1111/nep.70030","DOIUrl":"10.1111/nep.70030","url":null,"abstract":"","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 Suppl 2 ","pages":"3-56"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12238925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salmonella, a Rare Cause of Peritoneal Dialysis-Associated Peritonitis in a Cancer Patient.","authors":"Cynthia Chang, Humam Hazim, Scott Jones","doi":"10.1111/nep.70075","DOIUrl":"https://doi.org/10.1111/nep.70075","url":null,"abstract":"<p><p>Salmonella is a rare causative organism of peritoneal dialysis-related peritonitis. We describe the case of a 55-year-old man with cancer who presented with relapsing Salmonella peritonitis requiring catheter removal. This case report highlights the importance of prolonged antibiotics for cancer patients, particularly with Salmonella infections, and the possibility of catheter reinsertion following Salmonella peritonitis.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"30 7","pages":"e70075"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}