Frontiers in nephrology最新文献

{"title":"Causes of nephrotic syndrome in Sweden: The relevance of clinical presentation and demographics.","authors":"Anneli Jönsson,&nbsp;Thomas Hellmark,&nbsp;Mårten Segelmark,&nbsp;Anna Forsberg,&nbsp;Karl Dreja","doi":"10.3389/fneph.2023.1026864","DOIUrl":"https://doi.org/10.3389/fneph.2023.1026864","url":null,"abstract":"<p><strong>Background: </strong>Many pathological processes can disrupt the integrity of the glomerular capillary wall and cause a massive leakage of protein, resulting in nephrotic syndrome (NS). Clinical parameters such as age, sex, renal function, presence of diabetes, and how NS is defined influence the spectrum of underlying diseases. In this study, we examine how these parameters interact.</p><p><strong>Methods: </strong>Age, sex, hematuria, proteinuria, plasma creatinine plasma albumin levels, and final diagnosis were retrieved for all adult patients with NS as an indication for biopsy and/or massive albuminuria in conjunction with low plasma albumin from the biopsy module of the Swedish Renal Registry (SRR) between 2014 and 2019. A basic calculator was developed to demonstrate the importance of clinical presentation in relation to the likelihood of having a specific diagnosis.</p><p><strong>Results: </strong>A total of 913 unique patients were included in the study. Diabetic nephropathy (DN) and membranous nephropathy (MN) (both found in 17% of patients) were the most common diagnoses. With a stringent definition of NS, MN and minimal change nephropathy (MCN) increased in proportion. Among the cohort as a whole, MCN was the most frequent diagnosis in women and those < 50 years of age (found in 21% and 17%, respectively). In the case of patients aged between 50 and 70 years, those with chronic kidney disease stage 4, and those with negative dipstick tests for hematuria, the most common underlying disease was DN (in 23%, 30%, and 21% of cases, respectively). Among those with high-grade hematuria (dipstick grade 3 or 4), membranoproliferative glomerulonephritis was the most common diagnosis (14%), closely followed by IgA nephropathy (13%). Focal segmental glomerulosclerosis (9.7%) was less common than in many comparable studies.</p><p><strong>Conclusion: </strong>Clinical parameters have a profound impact on the likelihood of different diagnoses in adult patients with NS. Differences in clinical practice and study inclusion criteria may be more important than genetic background and environmental factors when explaining differences between studies in different parts of the world.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1026864"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10534198","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":"Impact of cardiac surgery associated acute kidney injury on 1-year major adverse kidney events.","authors":"Alícia Molina Andújar,&nbsp;Victor Joaquin Escudero,&nbsp;Gaston J Piñeiro,&nbsp;Alvaro Lucas,&nbsp;Irene Rovira,&nbsp;Purificación Matute,&nbsp;Cristina Ibañez,&nbsp;Miquel Blasco,&nbsp;Luis F Quintana,&nbsp;Elena Sandoval,&nbsp;Marina Chorda Sánchez,&nbsp;Eduard Quintana,&nbsp;Esteban Poch","doi":"10.3389/fneph.2023.1059668","DOIUrl":"https://doi.org/10.3389/fneph.2023.1059668","url":null,"abstract":"<p><strong>Background: </strong>The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and the risk of chronic kidney disease (CKD) has been found to be higher in these patients compared to the AKI-free population. The aim of our study was to assess the risk of major adverse kidney events (MAKE) [25% or greater decline in estimated glomerular filtration rate (eGFR), new hemodialysis, and death] after cardiac surgery in a Spanish cohort and to evaluate the utility of the score developed by Legouis D et al. (CSA-CKD score) in predicting the occurrence of MAKE.</p><p><strong>Methods: </strong>This was a single-center retrospective study of patients who required cardiac surgery with cardiopulmonary bypass (CPB) during 2015, with a 1-year follow-up after the intervention. The inclusion criteria were patients over 18 years old who had undergone cardiac surgery [i.e., valve substitution (VS), coronary artery bypass graft (CABG), or a combination of both procedures].</p><p><strong>Results: </strong>The number of patients with CKD (eGFR < 60 mL/min) increased from 74 (18.3%) to 97 (24%) within 1 year after surgery. The median eGFR declined from 85 to 82 mL/min in the non-CSA-AKI patient group and from 73 to 65 mL/min in those with CSA-AKI (<i>p</i> = 0.024). Fifty-eight patients (1.4%) presented with MAKE at the 1-year follow-up. Multivariate logistic regression analysis showed that the only variable associated with MAKE was CSA-AKI [odds ratio (OR) 2.386 (1.31-4.35), <i>p</i> = 0.004]. The median CSA-CKD score was higher in the MAKE cohort [3 (2-4) vs. 2 (1-3), p < 0.001], but discrimination was poor, with a receiver operating characteristic curve (AUC) value of 0.682 (0.611-0.754).</p><p><strong>Conclusion: </strong>Any-stage CSA-AKI is associated with a risk of MAKE after 1 year. Further research into new measures that identify at-risk patients is needed so that appropriate patient follow-up can be carried out.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1059668"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10551196","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":"The evolution of social media in nephrology education: A mini-review.","authors":"Mythri Shankar,&nbsp;Matthew A Sparks","doi":"10.3389/fneph.2023.1123969","DOIUrl":"https://doi.org/10.3389/fneph.2023.1123969","url":null,"abstract":"<p><p>Social media is defined as \"a group of Internet-based applications that build on the ideological and technological foundations of Web 2.0, that allow the creation and exchange of user-generated content\". Social media can be used in medical education to enhance knowledge sharing among peer groups and the public in general. The internet revolutionized learning by allowing easier dissemination of knowledge that did not depend on printing and physical distribution of books, journals, or magazines. According to a report from 2018, 95% of students have access to smartphones and 45% are online at any given time. Social media platforms are powerful tools to spread knowledge by the way of stories, videos, and educational games. Both formal and informal learning can be achieved with the use of social media. The microblogging website Twitter has become a popular social media platform by many in medical education including the nephrology community. Twitter, for example, is used to build communities, discuss journal articles, inform the community of conferences, share infographics and visual abstracts of original research work. As an example, it can be difficult for women in nephrology to connect and travel to make a physical presence. The use of social media allows women to connect <i>via</i> webinars and Women in Nephrology (WIN) India live Twitter chats. Thus, social media can help facilitate networking and collaboration with nephrologists all over the world. Social media has limitations as well. Insensitive posts can have a detrimental effect on one's career. A survey has shown that increased use of social media can contribute to addiction, anxiety, diminished self-esteem, and even depression. Hence, in order to effectively use social media to contribute positively to one's career, we recommend considering the positive and negative aspects of social media.This review will discuss the various social media platforms and how they have been applied to nephrology education.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1123969"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10178380","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":"Relation of early-stage renal insufficiency and cardiac structure and function in a large population of asymptomatic Asians: a cross-sectional cohort analysis.","authors":"Pei-Chen Wu,&nbsp;Kuo-Tzu Sung,&nbsp;Jiun-Lu Lin,&nbsp;Ta-Chuan Hung,&nbsp;Yau-Huei Lai,&nbsp;Cheng-Huang Su,&nbsp;Hung-I Yeh,&nbsp;Chih-Jen Wu,&nbsp;Chung-Lieh Hung","doi":"10.3389/fneph.2023.1071900","DOIUrl":"https://doi.org/10.3389/fneph.2023.1071900","url":null,"abstract":"<p><strong>Background: </strong>Few studies have addressed early-stage kidney disease and preclinical cardiac structural and functional abnormalities from a large-scale Asian population. Further, the extent to which measures of myocardial function and whether these associations may vary by testing various formulas of renal insufficiency remains largely unexplored.</p><p><strong>Objective: </strong>To explore the associations among renal function, proteinuria, and left ventricular (LV) structural and diastolic functional alterations.</p><p><strong>Design: </strong>A cross-sectional, retrospective cohort study.</p><p><strong>Setting: </strong>Registered data from a cardiovascular health screening program at MacKay Memorial Hospital from June 2009 to December 2012.</p><p><strong>Participants: </strong>Asymptomatic individuals.</p><p><strong>Measurements: </strong>Renal function was evaluated in terms of estimated glomerular filtration rate (eGFR) by both MDRD and CKD-EPI formulas and severity of proteinuria, which were further related to cardiac structure, diastolic function (including LV e' by tissue Doppler), and circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) level.</p><p><strong>Results: </strong>Among 4942 participants (65.8% men, mean age 49.4 ± 11.2 years), the mean CKD-EPI/MDRD eGFR was 90.6 ± 15.7 and 88.5 ± 16.9 ml/min/1.73m², respectively. Lower eGFR, estimated either by the MDRD or CKD-EPI method, and higher proteinuria were significantly associated with lower LV e' and higher NT-proBNP (all p<0.05) even after adjusting for clinical covariates. In general, lower eGFR estimated by CKD-EPI and MDRD displayed similar impacts on worsening e' and NT-proBNP, rather than E/e', in multivariate models. Finally, lower LV e' or higher composite diastolic score, rather than E/e', demonstrated remarkable interaction with eGFR level estimated by either CKD-EPI or MDRD on circulating NT-proBNP level (p _{interaction <}0.05).</p><p><strong>Limitations: </strong>Proteinuria was estimated using a urine dipstick rather than more accurately by the urine protein-to-creatinine ratio. Also, pertaining drug history and clinical hard outcomes were lacking.</p><p><strong>Conclusion: </strong>Both clinical estimate of renal insufficiency by eGFR or proteinuria, even in a relatively early clinical stage, were tightly linked to impaired cardiac diastolic relaxation and circulating NT-proBNP level. Elevation of NT-proBNP with worsening renal function may be influenced by impaired myocardial relaxation.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1071900"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10533791","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":"Editorial: Women in onconephrology: 2022.","authors":"Ala Abudayyeh,&nbsp;Sabine Karam","doi":"10.3389/fneph.2023.1240195","DOIUrl":"https://doi.org/10.3389/fneph.2023.1240195","url":null,"abstract":"COPYRIGHT © 2023 Abudayyeh and Karam. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Editorial PUBLISHED 01 August 2023 DOI 10.3389/fneph.2023.1240195","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1240195"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10533792","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":"Treatment of membranous nephropathy: Perspectives on current and future therapies.","authors":"Monarch Shah,&nbsp;Andrew DeLaat,&nbsp;Corey Cavanaugh","doi":"10.3389/fneph.2023.1110355","DOIUrl":"https://doi.org/10.3389/fneph.2023.1110355","url":null,"abstract":"<p><p>Primary membranous nephropathy remains one of the most frequent causes of nephrotic syndrome in adults. It is an autoimmune disorder in which auto-antibodies target antigens at the podocytes cell membrane-basement membrane interface. Our understanding of membranous nephropathy has expanded dramatically as of late. After the initial discovery of the phospholipase A2 receptor auto-antibody in 2009, eight more antigens have been discovered. These discoveries have led to refinement in our understanding of the pathogenesis, diagnosis, and natural history of primary membranous nephropathy. Now, many experts advocate for redefining primary membranous nephropathy based on antigen, potentially shedding the primary and secondary nomenclature. Recently, therapies for primary membranous have also expanded. Immunosuppressive therapies like cyclophosphamide and rituximab, which primarily target B-cells, remain the cornerstone of therapy. However, there is still significant room for improvement, as many as 30-40% do not respond to this therapy according to recent trials. Additionally, drugs targeting complement, and other novel therapies are also under investigation. In this review we will discuss the available therapies for primary membranous nephropathy in light of recent clinic trials like GEMRITUX, MENTOR, RI-CYCLO, and STARMEN, as well as management strategies. While the last 10 years have seen a boom in our mechanistic understanding of this ever-diversifying disease, we are likely to see a similar boom in the therapeutic options in the years to come.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1110355"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10551191","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":"Systematic review of externally validated machine learning models for predicting acute kidney injury in general hospital patients.","authors":"Marina Wainstein,&nbsp;Emily Flanagan,&nbsp;David W Johnson,&nbsp;Sally Shrapnel","doi":"10.3389/fneph.2023.1220214","DOIUrl":"https://doi.org/10.3389/fneph.2023.1220214","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is one of the most common and consequential complications among hospitalized patients. Timely AKI risk prediction may allow simple interventions that can minimize or avoid the harm associated with its development. Given the multifactorial and complex etiology of AKI, machine learning (ML) models may be best placed to process the available health data to generate accurate and timely predictions. Accordingly, we searched the literature for externally validated ML models developed from general hospital populations using the current definition of AKI. Of 889 studies screened, only three were retrieved that fit these criteria. While most models performed well and had a sound methodological approach, the main concerns relate to their development and validation in populations with limited diversity, comparable digital ecosystems, use of a vast number of predictor variables and over-reliance on an easily accessible biomarker of kidney injury. These are potentially critical limitations to their applicability in diverse socioeconomic and cultural settings, prompting a need for simpler, more transportable prediction models which can offer a competitive advantage over the current tools used to predict and diagnose AKI.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1220214"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10551197","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":"Editorial: The multidisciplinary focus on vascular access in patients with end-stage renal disease.","authors":"Edwin Castillo Velarde","doi":"10.3389/fneph.2023.1244073","DOIUrl":"https://doi.org/10.3389/fneph.2023.1244073","url":null,"abstract":"COPYRIGHT © 2023 Castillo Velarde. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Editorial PUBLISHED 14 August 2023 DOI 10.3389/fneph.2023.1244073","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1244073"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10178385","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":"Rethink nutritional management in chronic kidney disease care.","authors":"Fangyue Chen,&nbsp;Krit Pongpirul","doi":"10.3389/fneph.2023.1108842","DOIUrl":"https://doi.org/10.3389/fneph.2023.1108842","url":null,"abstract":"COPYRIGHT © 2023 Chen and Pongpirul. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Opinion PUBLISHED 27 January 2023 DOI 10.3389/fneph.2023.1108842","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1108842"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237268","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":"Editorial: Dialysis and the age-friendly health system initiative.","authors":"Dipal M Patel,&nbsp;C Barrett Bowling,&nbsp;Laura C Plantinga,&nbsp;Bernard G Jaar","doi":"10.3389/fneph.2023.1170566","DOIUrl":"https://doi.org/10.3389/fneph.2023.1170566","url":null,"abstract":"COPYRIGHT © 2023 Patel, Bowling, Plantinga and Jaar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. TYPE Editorial PUBLISHED 14 March 2023 DOI 10.3389/fneph.2023.1170566","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1170566"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10534197","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}