Nephrology (Carlton, Vic.)最新文献

{"title":"Impact of Quality Indicators on Transplant Access: A Prospective Cohort Study in Australian Dialysis Patients.","authors":"Rebecca Ling, Christopher E Davies, Tia Mark, Stephen P McDonald, David J Goodman","doi":"10.1111/nep.70277","DOIUrl":"10.1111/nep.70277","url":null,"abstract":"<p><strong>Aim: </strong>In 2012, the Australian state of Victoria introduced a 6-monthly reportable renal quality indicator (QI) for the proportion of patient's waitlisted or pre-emptively transplanted by set time points after beginning kidney replacement therapy (KRT). This prospective cohort study aimed to determine if the QI influenced timeliness of transplant waitlisting for Victorians, compared to the rest of Australia as a control group.</p><p><strong>Methods: </strong>Patients aged 18-70 commencing KRT between 2007 and 2020 were extracted from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) and divided into three time eras. The primary outcome was the percentage of patients waitlisted or transplanted at 6, 12 and 24 months from starting KRT. Given the systematic disadvantage reported, specific analysis was performed to examine the QI's effect on Aboriginal and Torres Strait Islander people living in Victoria.</p><p><strong>Results: </strong>Of 25 836 (14.7% Indigenous) patients starting dialysis, one third (8587, 5.7% Indigenous) were listed for transplant. Following implementation of the QI, the proportion of Victorian patients waitlisted within 6, 12 and 24-months of starting KRT increased (adjusted OR [aOR] 1.85, 1.67 and 1.55 respectively; all p < 0.001). There was no significant change in Australian (non-Victorian) rates at 6 and 12 months but a small increase was observed at 24 months.</p><p><strong>Conclusion: </strong>Following introduction of the Victorian renal QI, the proportion of Victorian patients waitlisted at key timepoints improved more than patients in Australian states without QIs.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"31 9","pages":"e70277"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907863","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":"Haematuria-Guided Therapy in Immunoglobulin A Nephropathy: From Biological Activity to Treatment Selection.","authors":"Zhujun Wang, Yi Lu","doi":"10.1111/nep.70282","DOIUrl":"10.1111/nep.70282","url":null,"abstract":"","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"31 9","pages":"e70282"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964234","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":"Thai Transplant Care Practice Guideline on Immunosuppressive Therapy for Adult Kidney Transplantation.","authors":"Suwasin Udomkarnjananun, Napun Sutharattanapong, Nuttasith Larpparisuth, Korntip Phonphok, Tanun Ngamvichchukorn, Peenida Skulratanasak, Pitchamon Inkong, Suwikran Wongpraphairot, Opas Traitanon, Piyavadee Homkrailas, Kajohnsak Noppakun, Natavudh Townamchai","doi":"10.1111/nep.70268","DOIUrl":"10.1111/nep.70268","url":null,"abstract":"<p><p>The Thai Transplantation Society developed these clinical practice guidelines to establish a comprehensive standard for immunosuppressive therapy in adult kidney transplantation. While rooted in evidence-based medicine, the objective of this document extends beyond local application, serving as a practical model for low-to-middle-income countries, particularly within the Asia-Pacific and Southeast Asian regions, where specific genetic profiles and resource limitations require tailored management strategies. This publication addresses a critical need in the field, as there has been no updated comprehensive international consensus on immunosuppression since the KDIGO Clinical Practice Guideline in 2009, over 17 years ago. These guidelines bridge this gap by synthesizing modern clinical data with practical applicability. The scope of the guidelines is extensive, covering all aspects of immunosuppression usage including induction, maintenance, therapeutic drug monitoring, and the treatment of rejection. Uniquely, this document addresses specific challenges relevant to resource-limited settings, offering protocols for cost reduction through the use of generic drugs and the co-administration of cytochrome P450 3A4 and 3A5 inhibitors to minimize dosage requirements. Furthermore, it provides distinct guidance for immunosuppression in special clinical settings, including management during periods of fasting, pregnancy, and malignancy. This guideline ultimately benefits clinicians by offering a pragmatic, updated reference that balances therapeutic efficacy with economic sustainability.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"31 Suppl 2 ","pages":"e70268"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083682","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":"Magnesium in Kidney Care: Context Before Correction.","authors":"Yoshitaka Furuto, Daiki Yoshino, Akio Namikawa, Dai Sato, Yuko Shibuya","doi":"10.1111/nep.70278","DOIUrl":"10.1111/nep.70278","url":null,"abstract":"","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"31 9","pages":"e70278"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901859","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":"Clinical Predictors of Non-Diabetic Glomerular Disease in Type 2 Diabetic Patients With Nephrotic-Range Proteinuria.","authors":"Sittipath Tirasattayapitak, Kanin Thammavaranucupt, Kavee Limbutara, Nitcha Suphatheerawatr, Wanjak Pongsittisak, Chutima Chavanisakun, Nontawat Benjakul, Solos Jaturapisanukul","doi":"10.1111/nep.70275","DOIUrl":"10.1111/nep.70275","url":null,"abstract":"<p><strong>Aim: </strong>Nephrotic-range proteinuria in patients with Type 2 diabetes mellitus (T2DM) may result from diabetic nephropathy or non-diabetic glomerular disease (NDGD). Kidney biopsy risks and limited accessibility complicate patient selection. We aimed to identify predictors of NDGD and develop a score to guide biopsy decisions.</p><p><strong>Methods: </strong>We conducted a single-center retrospective study of T2DM patients undergoing native kidney biopsy for nephrotic-range proteinuria at a tertiary hospital in Thailand between 2014 and 2022. Biopsy findings were classified according to the presence or absence of NDGD. Independent predictors were identified using multivariable logistic regression, and a weighted clinical prediction score was derived. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>Among 289 patients, 142 (49.1%) had NDGD with or without concomitant DN. The most frequent diagnosis was IgA nephropathy. Independent predictors of NDGD included older age, shorter duration of T2DM, absence of diabetic retinopathy, absence of prior hypertension, higher estimated glomerular filtration rate, and hematuria. Higher haemoglobin was retained in the prediction model despite its borderline statistical association. The prediction score demonstrated good discrimination (AUROC, 0.85; 95% confidence interval, 0.80-0.89). At a threshold of ≥ 3 points, the score had 96.5% sensitivity and 40.8% specificity, whereas a threshold of ≥ 7 points had 66.9% sensitivity and 84.4% specificity.</p><p><strong>Conclusion: </strong>NDGD is common among T2DM patients with nephrotic-range proteinuria. The proposed clinical prediction score showed good discrimination in this cohort but requires external validation before it can be used to support biopsy decision-making in clinical practice.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"31 9","pages":"e70275"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868435","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":"Renally Generated Ammonia as a Cause of Hyperammonaemic Non-Hepatic Encephalopathy.","authors":"Victoria E Nkunu, Kevin Y L Mak, Kuldeep Dodia, Fraulein D Morales, Alicia K J Chan, R Todd Alexander, Peter M Hwang","doi":"10.1111/nep.70281","DOIUrl":"10.1111/nep.70281","url":null,"abstract":"<p><p>Encephalopathy with high ammonia levels is most commonly associated with cirrhosis or urea cycle disorders, but it can also result from renal ammoniagenesis when renal excretion of ammonium is impaired. In the literature, this has been shown to occur in the presence of (1) urinary diversion to a segment of intestine; (2) urea-splitting microorganism overgrowth in the bladder or (3) renal tubular acidosis. However, hyperammonaemic encephalopathy can still occur without any of these overt factors. We present the case of a 76-year-old male who developed two episodes of hyperammonaemic encephalopathy in the setting of high output ileostomy. The first instance occurred with acute kidney injury (AKI) in the setting of post-operative sepsis, with vomiting causing hypokalaemia and metabolic alkalosis that subsequently evolved into normal anion gap metabolic acidosis (NAGMA). The patient recovered but presented months later with AKI, NAGMA and elevated ammonia. This resolved with fluids and bicarbonate replacement. Hypokalaemia, acidosis, corticosteroids and aldosterone stimulate renal ammoniagenesis. In some patients, renal ammonium excretion is sufficient under baseline conditions but not with decreased renal perfusion and increased ammoniagenesis. In such situations, impaired excretion of renally generated ammonium is suggested by elevated serum ammonia level accompanied by more-positive-than-expected urine anion gap in the setting of hypokalaemia or acidosis. Identifying patients who might benefit from immediate correction of these factors is important to permit attempts to suppress renal ammoniagenesis.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"31 9","pages":"e70281"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979369","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":"Successful Control of Late-Onset Nephrotic Syndrome in FN1-Associated Fibronectin Glomerulopathy: A 17-Year Clinical Course.","authors":"Nobuhiro Kanazawa, Masayuki Iyoda, Kazuki Abe, Taihei Suzuki, Yoko Shirai, Kenichiro Miura, Kazuho Honda, Hirokazu Honda","doi":"10.1111/nep.70273","DOIUrl":"10.1111/nep.70273","url":null,"abstract":"<p><p>Fibronectin glomerulopathy (FNG) is a rare renal disorder characterized by excessive glomerular fibronectin deposition, often associated with variants in the fibronectin 1 (FN1) gene. Clinically, FNG presents with proteinuria, hematuria, and hypertension, and may progress to end-stage kidney disease. However, its long-term clinical course and optimal management remain incompletely defined. We report a sporadic case of FNG in a 26-year-old woman carrying an FN1 variant, c.2918A > G (NM_212482.4). Seventeen years after initial detection of proteinuria, she developed nephrotic syndrome with generalized edema. Supportive therapy, including renin-angiotensin system inhibitors and diuretics, was insufficient, and prednisolone and cyclosporine A were initiated for management of nephrotic syndrome. The patient subsequently achieved partial remission, with urinary protein decreasing to < 1 g/gCr and no major adverse events. During tapering of immunosuppression, a sodium-glucose cotransporter 2 (SGLT2) inhibitor was added as adjunct therapy. This case suggests a potential role for immunosuppressive therapy in management of late-onset nephrotic syndrome associated with FNG, with SGLT2 inhibition potentially contributing to maintenance of remission.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"31 9","pages":"e70273"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868545","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":"Tubulointerstitial Nephritis With Uveitis (TINU) Syndrome: A Case Series and Review of Literature.","authors":"Weaam Ali, Nidhi Agrawal, Smeeta Sinha, Dimitrios Poulikakos, Jamil Choudhury, Constantina Chrysochou","doi":"10.1111/nep.70271","DOIUrl":"10.1111/nep.70271","url":null,"abstract":"<p><p>Tubulointerstitial nephritis with uveitis (TINU) syndrome is a rare disorder characterised by the simultaneous or sequential occurrence of acute tubulointerstitial nephritis and uveitis, in the absence of systemic disease. Its true prevalence is likely underestimated, as renal and ocular manifestations may not appear concurrently. We conducted a retrospective case series of patients diagnosed with TINU at a single tertiary centre between 2016 and 2025. Clinical, biochemical, histopathological and ophthalmological data were reviewed. Long-term renal and ocular outcomes were assessed. Ten patients (female:male 6:4) were identified, with a median age at diagnosis of 41 years (range 15-67). Renal disease preceded uveitis in 60% of cases, with a mean interval of 5.6 months. At presentation, 70% had serum creatinine > 200 μmol/L and one patient required transient dialysis. All renal biopsies demonstrated tubulointerstitial nephritis with preserved glomeruli. All patients were treated with systemic corticosteroids, with topical therapy for uveitis. Renal relapse occurred in 60% of patients, often during steroid tapering, and required prolonged corticosteroid therapy or mycophenolate mofetil. At final follow-up (median 44 months), 50% had chronic kidney disease (eGFR < 60 mL/min). Relapsing disease was more frequent in females and patients under 18 years. At last follow-up, mean serum creatinine was 89 μmol/L, with 50% of patients having CKD G3a. Ophthalmologic data (n = 6) showed bilateral anterior uveitis in all cases, with intermediate involvement in three. Two developed steroid-induced intraocular hypertension. Ocular relapse occurred in six patients and frequently paralleled renal disease activity. We herein report one of the longest median follow-up durations (44 months) among biopsy-proven cohorts of interstitial nephritis. Our cohort spans a broader age range (15-67 years) than traditionally described with an adult predominance. Despite a 60% relapse rate, response to steroids and immunosuppression was good. Proteinuria at presentation was noted in individuals who developed subsequent CKD supporting the need for follow up and proteinuria management where relevant.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"31 9","pages":"e70271"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841880","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":"Self-Reported Sleep Duration After Kidney Transplantation Requires Medication-Aware Interpretation.","authors":"Wei Chu Chun, Lien-Chung Wei","doi":"10.1111/nep.70284","DOIUrl":"10.1111/nep.70284","url":null,"abstract":"","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"31 9","pages":"e70284"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964210","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":"Peritoneal Dialysis for End-Stage Kidney Disease due to Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS): A Case Report.","authors":"Zi Chan, Ka Lok Chan, Chi Kwan Lam, Wai Ping Law, Wai Lun Will Pak, Yick Hei Wong, Sunny Sze Ho Wong","doi":"10.1111/nep.70283","DOIUrl":"10.1111/nep.70283","url":null,"abstract":"<p><p>We report a 23-year-old male with kidney failure secondary to childhood Focal Segmental Glomerulosclerosis who presented with sepsis, severe lactic acidosis, and encephalopathy. Following stabilization of the acute condition with Continuous Veno-Venous Hemofiltration, a diagnosis of Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes (MELAS) was confirmed by muscle biopsy and the identification of the m.3243A>G mutation. This case highlights the diagnostic difficulties of this rare disease and the challenges in selecting a long-term renal replacement therapy. Specifically, the use of lactate-buffered peritoneal dialysis fluids in these patients remains controversial. In our case, the patient demonstrated poor tolerance to intermittent haemodialysis due to MELAS-associated cardiomyopathy. However, despite theoretical concerns regarding lactate load, steady-state serum lactate remained stable on Continuous Ambulatory Peritoneal Dialysis (CAPD), and the patient achieved good functional recovery. We conclude that while acute decompensation requires aggressive management, CAPD is a feasible long-term dialysis modality for patients with kidney failure secondary to MELAS.</p>","PeriodicalId":520716,"journal":{"name":"Nephrology (Carlton, Vic.)","volume":"31 9","pages":"e70283"},"PeriodicalIF":1.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972953","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}