Frontiers in nephrology最新文献

Managing the failing renal allograft: navigating a complex topography. 处理失败的同种异体肾移植：导航复杂的地形。

Frontiers in nephrology Pub Date : 2025-06-05 eCollection Date: 2024-01-01 DOI: 10.3389/fneph.2024.1223114

Elizabeth A Kendrick

{"title":"Managing the failing renal allograft: navigating a complex topography.","authors":"Elizabeth A Kendrick","doi":"10.3389/fneph.2024.1223114","DOIUrl":"10.3389/fneph.2024.1223114","url":null,"abstract":"Recipients of kidney transplants often outlive the function of the renal allograft will need ESRD management. Patients face a higher risk of mortality in the period of transition from failing allograft to dialysis. Long term risk of cardiovascular complications and risk of infections and cancer with use of long-term immune suppression contribute to poor outcomes. Patients with failing transplants appear to have poorer control of CKD complications and are more likely to initiate hemodialysis using a catheter. Outcomes of peritoneal dialysis in the setting of the failing allograft in general are equivalent to hemodialysis. Management of these patients in transplant center clinics specifically focused on patients with failing allografts may have benefit, but maximal utility has yet to be demonstrated. Patients with failed transplants can have a survival benefit with retransplant, even in older patients. There may not be a benefit to retransplant in patients older than 70 years of age. Patients with failing renal grafts should be assessed as to whether they are potential candidates for retransplant prior to needing to start dialysis to allow for identification of a living kidney donor or to be listed as soon a possible on the kidney transplant wait list as to minimize the wait time on dialysis. Decisions regarding reduction of immunosuppression once the patient has started dialysis should be made with guidance from the transplant center in the context of patient-centric factors such as candidacy for retransplant and minimizing complications of long-term immunosuppression.","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"4 ","pages":"1223114"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334575","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}

引用次数: 0

Association between lactate dehydrogenase to albumin ratio and ICU mortality in patients with acute kidney injury: a retrospective cohort study. 乳酸脱氢酶与白蛋白比值与急性肾损伤患者ICU死亡率的关系：一项回顾性队列研究。

Frontiers in nephrology Pub Date : 2025-06-02 eCollection Date: 2025-01-01 DOI: 10.3389/fneph.2025.1583913

Jianting Gao, Huizhen Chen, Yiyi Wu, Chang Xu, Yan Jin

{"title":"Association between lactate dehydrogenase to albumin ratio and ICU mortality in patients with acute kidney injury: a retrospective cohort study.","authors":"Jianting Gao, Huizhen Chen, Yiyi Wu, Chang Xu, Yan Jin","doi":"10.3389/fneph.2025.1583913","DOIUrl":"10.3389/fneph.2025.1583913","url":null,"abstract":"Background: Acute kidney injury (AKI) is a prevalent and severe medical condition that is frequently observed in the intensive care unit (ICU). Although numerous biomarkers have been identified to predict the prognosis of AKI, the lactate dehydrogenase to albumin ratio [LDH/ALB ratio (LAR)] has not been extensively investigated. The principal objective of this study was to assess the relationship between LAR and all-cause mortality in patients with AKI.Methods: A total of 6,831 AKI patients were included in this study, divided into survival (n = 5,152) and non-survival groups (n = 1,679). The association between LAR and mortality was examined through restricted cubic spline (RCS) analysis and Cox regression analysis. Subgroup analysis was used to search for interactive factors. Additionally, the prognostic capability of LAR was further evaluated using receiver operating characteristic (ROC) curve analysis.Results: The LAR was remarkably higher in the non-survival group (p < 0.001). RCS indicated a non-linear correlation between LAR and ICU death (p for non-linearity < 0.001). A LAR of 10.4 was used as the cutoff point to generate the high-LAR and low-LAR subgroups, and the Kaplan-Meier curves revealed that the ICU cumulative survival rate for patients with AKI was significantly lower in the high-LAR group (log-rank p < 0.001). The LAR's prediction of ICU mortality in AKI patients yielded an area under the ROC curve of 0.65.Conclusion: Our research suggests that LAR monitoring may be promising as a prognostic marker among patients with AKI. Higher LAR is associated with greater ICU mortality.","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"5 ","pages":"1583913"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12171449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318866","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}

引用次数: 0

Festschrift in honor of Dr. Jeffrey Hymes. 为了纪念杰弗里·海姆斯博士。

Frontiers in nephrology Pub Date : 2025-05-28 eCollection Date: 2025-01-01 DOI: 10.3389/fneph.2025.1585713

Terry Ketchersid, Dinesh K Chatoth, Robert J Kossmann, Chance Mysayphonh, Peter Kotanko, Franklin W Maddux

引用次数: 0

Incidence of the Triple Whammy Phenomenon among Cardiovascular diseases patients in Saudi Arabia and awareness among healthcare professionals. 沙特阿拉伯心血管疾病患者三重打击现象的发生率和保健专业人员的认识。

Frontiers in nephrology Pub Date : 2025-05-27 eCollection Date: 2025-01-01 DOI: 10.3389/fneph.2025.1494459

Mohammad Bonyan Alsobaie, Lubna Alsheikh

{"title":"Incidence of the Triple Whammy Phenomenon among Cardiovascular diseases patients in Saudi Arabia and awareness among healthcare professionals.","authors":"Mohammad Bonyan Alsobaie, Lubna Alsheikh","doi":"10.3389/fneph.2025.1494459","DOIUrl":"10.3389/fneph.2025.1494459","url":null,"abstract":"Cardiovascular diseases are a leading cause of mortality in Saudi Arabia, accounting for approximately 42% of deaths. The \"triple whammy\" phenomenon-which combines angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, diuretics, and non-steroidal anti-inflammatory drugs-increases the risk of acute kidney injury, particularly in hypertensive patients. This study, which was conducted in small-scale hospitals in Jeddah from 2017 to 2022, assessed the incidence of the triple whammy phenomenon and the awareness of healthcare professionals of this condition. Of 5,654 patient records, 1,899 met the inclusion criteria, with 2.7% experiencing the triple whammy. A survey of 56 healthcare professionals revealed 75% unawareness, with pharmacists and dentists being the most affected. Access to over-the-counter non-steroidal anti-inflammatory drugs and gaps in training likely drive the incidence and awareness deficits. This phenomenon can lead to acute kidney injury, with mortality rates as high as 50%-80% in critically ill patients, and imposes significant costs, representing 5% of hospital budgets and 1% of the overall health expenditure. Interventions including education, pharmacist roles, and non-steroidal anti-inflammatory drug regulation are proposed. Limitations include the small-scale focus and the low survey sample, necessitating national studies to accurately measure incidence and to improve patient safety.","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"5 ","pages":"1494459"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268028","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}

引用次数: 0

The impact of renal dysfunction after critical illness on the management of cancer. 危重症后肾功能不全对癌症治疗的影响。

Frontiers in nephrology Pub Date : 2025-05-22 eCollection Date: 2025-01-01 DOI: 10.3389/fneph.2025.1597253

Thiago Gomes Romano, Rodrigo Chaves, Izabela Sinara Alves, Henrique Palomba

{"title":"The impact of renal dysfunction after critical illness on the management of cancer.","authors":"Thiago Gomes Romano, Rodrigo Chaves, Izabela Sinara Alves, Henrique Palomba","doi":"10.3389/fneph.2025.1597253","DOIUrl":"10.3389/fneph.2025.1597253","url":null,"abstract":"A 67-year-old male patient with limited-stage diffuse large B-cell lymphoma was on an R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy regimen. His Eastern Cooperative Oncology Group (ECOG) Performance Scale score was zero, indicating functional independence for activities of daily living. The patient was admitted to the intensive care unit (ICU) with septic shock in the presence of febrile neutropenia progressing to acute kidney injury, hypoxemic respiratory failure, and systemic arterial hypotension, in addition to the already established hematological dysfunction with thrombocytopenia. During his 32-day ICU stay, he required invasive mechanical ventilation, renal replacement therapy (RRT) and vasopressor drugs, with a focus on control of the infection. The patient was discharged from the ICU with sarcopenia and a serum creatinine level of 2.3 mg/dL, indicating a clearance rate of 24 ml/min/1.73 m2. Oxygen supplementation was needed. What impact did critical illness, more specifically renal dysfunction, have on the planning of onco-hematological treatment in this patient?","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"5 ","pages":"1597253"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236029","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}

引用次数: 0

Treatment burden in glomerular diseases: advances and challenges in immunosuppressive therapy. 肾小球疾病的治疗负担：免疫抑制治疗的进展和挑战。

Frontiers in nephrology Pub Date : 2025-05-01 eCollection Date: 2025-01-01 DOI: 10.3389/fneph.2025.1545373

Mythri Shankar, Tanuj Moses Lamech

{"title":"Treatment burden in glomerular diseases: advances and challenges in immunosuppressive therapy.","authors":"Mythri Shankar, Tanuj Moses Lamech","doi":"10.3389/fneph.2025.1545373","DOIUrl":"https://doi.org/10.3389/fneph.2025.1545373","url":null,"abstract":"Glomerular diseases represent a significant global health challenge, complicated by the intricate management required for their treatment. We examine the treatment burden associated with the immunosuppressive therapies used to manage these conditions, focusing on the efficacy, side effects, and financial implications of commonly used medications such as glucocorticoids, mycophenolate mofetil (MMF), cyclophosphamide, calcineurin inhibitors and Rituximab. Immunosuppressive treatments, while effective in controlling disease activity, can result in a variety of adverse effects ranging from gastrointestinal symptoms and bone marrow suppression to increased infection risks, necessitating careful monitoring and dose adjustments to mitigate these risks. Hence, the need for a balanced approach in therapy management, incorporating regular monitoring and potential dose modifications to enhance patient outcomes while minimizing side effects. Additionally, these treatments have an economic impact, particularly in lower-income regions where access to medication and the cost of medication can limit patient outcomes. There have been certain advancements in treatment modalities, such as the use of enteric-coated formulations and tailored dosing schedules, which aim to improve drug tolerability and adherence. By addressing these critical aspects, we aim to shed light on the ongoing challenges and developments in the management of glomerular diseases, emphasizing the need for continued research and innovation in therapeutic strategies to reduce the overall treatment burden and improve the quality of life for affected individuals.","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"5 ","pages":"1545373"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082517","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}

引用次数: 0

Efficacy and safety of rituximab for membranous nephropathy in adults: a meta-analysis of RCT. 利妥昔单抗治疗成人膜性肾病的疗效和安全性：一项RCT荟萃分析。

Frontiers in nephrology Pub Date : 2025-04-29 eCollection Date: 2025-01-01 DOI: 10.3389/fneph.2025.1548679

Baike Mao, Jiahui Han, Jia Wang, Kan Ye

{"title":"Efficacy and safety of rituximab for membranous nephropathy in adults: a meta-analysis of RCT.","authors":"Baike Mao, Jiahui Han, Jia Wang, Kan Ye","doi":"10.3389/fneph.2025.1548679","DOIUrl":"10.3389/fneph.2025.1548679","url":null,"abstract":"Background: Membranous nephropathy (MGN) represents a significant challenge in nephrology, with Rituximab emerging as a potential therapeutic intervention.Methods: A comprehensive systematic review was conducted using PubMed, EMBASE, and Web of Science databases, focusing exclusively on randomized controlled trials (RCTs) from January 2002 to November 2024. Stringent eligibility criteria were applied, including studies with at least ten participants, with data extracted by two independent reviewers. The meta-analysis utilized fixed and random effects models to assess Rituximab's efficacy and safety across multiple outcome measures.Results: The meta-analysis revealed nuanced findings across different follow-up periods. At 6 months, complete remission rates showed non-significant odds ratios ranging from 2.12 to 2.48. By 12 months, the pooled odds ratio was 0.8085 (95% CI: 0.2238-2.9213), with complete remission rates varying between 13.8% and 19.4%. Notably, at 24 months, the common effects model demonstrated a statistically significant odds ratio of 5.0792 (95% CI: 2.2609-11.4107, p < 0.0001). Proteinuria reduction showed consistent improvement, with a median difference of 4.3225. Adverse event analysis indicated a relatively low risk, with an odds ratio of 0.9706 (95% CI: 0.5781-1.6297).Conclusion: Rituximab demonstrates potential efficacy in treating MGN, with promising long-term outcomes and a favorable adverse event profile.","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"5 ","pages":"1548679"},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013732","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}

引用次数: 0

Real-world challenges associated with the use of four common systemic glucocorticoids in a United States IgAN cohort. 在美国IgAN队列中使用四种常见系统性糖皮质激素的现实挑战

Frontiers in nephrology Pub Date : 2025-04-24 eCollection Date: 2025-01-01 DOI: 10.3389/fneph.2025.1574239

Giancarlo Pesce, Mit Patel, Gaelle Gusto, Ananth Kadambi, Aastha Chandak, Terri Madison

{"title":"Real-world challenges associated with the use of four common systemic glucocorticoids in a United States IgAN cohort.","authors":"Giancarlo Pesce, Mit Patel, Gaelle Gusto, Ananth Kadambi, Aastha Chandak, Terri Madison","doi":"10.3389/fneph.2025.1574239","DOIUrl":"https://doi.org/10.3389/fneph.2025.1574239","url":null,"abstract":"Objectives: To understand the difference in adverse events (AEs), healthcare resource utilization (HCRU), and kidney failure rates in immunoglobulin A nephropathy (IgAN) patients who initiated systemic glucocorticoid (SGC) treatment compared with those who did not.Methods: The overall cohort was selected from patients with IgAN (ICD-10 codes N02.8 and N04.1) identified in the TriNetX Dataworks database between January 2011 and May 2022. New initiators of dexamethasone, prednisone, prednisolone, or methylprednisolone (SGC cohort) were propensity score (PS) matched 1:1 with patients who did not receive SGC (non-SGC cohort) based on their characteristics at diagnosis. The index date was the date of SGC initiation; for the non-SGC cohort, a pseudo-index date was assigned using the same lag from diagnosis to index date as their PS-matched pairs. Patients with kidney failure before the index/pseudo-index date and their 1:1 PS-matched pairs were excluded.Results: The final analysis was conducted in 802 patients (401 PS-matched pairs, mean age 41.2 years, 55% male). Median duration of follow-up was 3.5 and 3.1 years for the SGC and non-SGC cohorts, respectively. Compared with the non-SGC cohort, patients in the SGC cohort had greater frequency of several AEs, including severe infections, greater annualized HCRU and costs, and greater incidence of kidney failure.Conclusions: This study found that SGC therapy may increase adverse reactions and HCRU in IgAN patients, while comparatively providing no beneficial effects on preserving kidney function.","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"5 ","pages":"1574239"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12058894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036241","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}

引用次数: 0

Editorial: Kidney and heart cross-talk. 社论：肾与心的串扰。

Frontiers in nephrology Pub Date : 2025-04-11 eCollection Date: 2025-01-01 DOI: 10.3389/fneph.2025.1598135

Nicoletta Mancianti, Marta Calatroni, Giacomo Deferrari, Edoardo La Porta

引用次数: 0

Editorial: Case reports in nephrology. 社论：肾内科病例报告。

Frontiers in nephrology Pub Date : 2025-04-07 eCollection Date: 2025-01-01 DOI: 10.3389/fneph.2025.1595978

Xuefei Tian, Leopoldo Ardiles, Clay A Block

引用次数: 0