Frontiers in nephrology最新文献

{"title":"Age-specific impact of different immunosuppressive regimens on kidney transplant outcomes: clinical evidence from the scientific registry of transplant recipients.","authors":"Lina Maria Serna-Higuita, Sarah Kalmbach, Anja Schork, Nils Heyne, Sandra Beer-Hammer, Silvio Nadalin, Peter Martus, Alfred Königsrainer, Moritz Schmelzle, Markus Quante","doi":"10.3389/fneph.2026.1886887","DOIUrl":"10.3389/fneph.2026.1886887","url":null,"abstract":"<p><strong>Background: </strong>Although older kidney transplant recipients have a higher risk of side effects leading to infection and malignancies, the impact of different immunosuppressive regimens on clinical outcomes in this group remains unclear.</p><p><strong>Methods: </strong>Retrospective cohort study analyzing data from the Scientific Registry of Transplant Recipients database. Kidney transplant recipients were categorized according to age categories (18-64 and >65 years) and immunosuppressive maintenance regimens: tacrolimus/mycophenolate mofetil (Tac-MMF), Tac/mTOR-inhibitor (Tac-mTORi), cyclosporin/MMF (CsA-MMF) and mTORi-MMF. The primary endpoint was overall survival.</p><p><strong>Results: </strong>Among the 112, 952 patients analyzed, overall survival rates at 2-, 3- and 5-years post-transplant were 95.6%, 93.7% and 87.6% respectively. No significant differences in the risk of mortality, graft loss or acute rejection were observed between patients treated with Tac-mTORi and those receiving Tac-MMF. Furthermore, no significant interactions were found between the maintenance immunosuppressive regimens and recipient age groups. Regarding kidney function, younger patients on the Tac-mTORi compared with Tac-MMF regimen exhibited a lower mean eGFR throughout the follow-up period compared to those on Tac-MMF. In contrast to this younger cohort, older patients treated with Tac-mTORi did not experience a significant additional decline in renal function.</p><p><strong>Conclusion: </strong>In this study, Tac-mTORi and Tac-MMF showed comparable results regarding patient survival, graft survival and rejection rates. Because older patients remain at higher risk for drug-related side effects, including infections, metabolic disorders and malignancies, these results highlight the critical need for individually immunosuppressive regimens in older transplant recipients and warrant further prospective validation.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1886887"},"PeriodicalIF":2.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852030","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 hematuria on long term kidney outcomes in adults with immunoglobulin A nephropathy: a systematic literature review and meta-analysis.","authors":"Joel Iff, Ankit Shah, Rajeshwari Nair, Mirko Fillbrunn, Ogo Egbuna, Manish Maski, Rui Huang, Dumingu Aparna Gomes, Edward Tuttle, Whitney Longstaff, Janice Stricker-Shaver, Beth Barber","doi":"10.3389/fneph.2026.1899597","DOIUrl":"10.3389/fneph.2026.1899597","url":null,"abstract":"<p><strong>Introduction: </strong>Hematuria is the most common clinical manifestation of Immunoglobulin A nephropathy (IgAN) and has been associated with adverse long-term kidney outcomes, although its prognostic significance has not been clearly established. This systematic literature review and meta-analysis aimed to evaluate whether hematuria is a prognostic marker of long-term kidney outcomes.</p><p><strong>Methods: </strong>A search of PubMed/MEDLINE and Embase (January 2005 to June 2025) identified studies assessing persistent or single-timepoint measurement of microhematuria or macrohematuria in relation to kidney outcomes. Studies meeting predefined criteria were qualitatively synthesized, and those with comparable outcome definitions were included in meta-analyses using random-effects models.</p><p><strong>Results: </strong>Forty-three studies were included in the systematic literature review, of which 15 study entries from 13 publications were included in meta-analyses. Across studies, persistent microhematuria was consistently associated with worse long-term kidney outcomes. In pooled analyses, microhematuria (both persistent and single-timepoint measurements) was associated with an increased risk of end-stage kidney disease or related outcomes (hazard ratio [HR] 2.33, 95% confidence interval [CI] 1.94-2.80), with a stronger and consistent association observed for persistent microhematuria (HR 2.57, 95% CI 1.94-3.41). Single-timepoint measurement of microhematuria showed a nonsignificant directional association with substantial variability across studies, whereas macrohematuria (predominantly measured at a single timepoint) was associated with improved kidney outcomes (HR 0.56, 95% CI 0.37-0.83).</p><p><strong>Discussion: </strong>These findings support persistent microhematuria as a strong and consistent predictor of kidney failure in IgAN, substantiating its role as a clinically relevant prognostic marker.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1899597"},"PeriodicalIF":2.9,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835240","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":"Development and validation of a routine urinalysis-based risk stratification model for IgA nephropathy in a multicenter real-world hospital population.","authors":"Chi Wang, Wan He, QingYuan Zheng, Yuan Zhong, Meng Tang, ChunYing Zhang, Yong He","doi":"10.3389/fneph.2026.1826486","DOIUrl":"10.3389/fneph.2026.1826486","url":null,"abstract":"<p><strong>Background: </strong>IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Routine urinalysis is universally accessible but underutilized for IgAN risk stratification. This study aimed to develop and validate a urinalysis-based risk stratification model for IgAN in a multicenter real-world hospital population.</p><p><strong>Methods: </strong>This retrospective multicenter study was based on routine urinalysis records from 8 hospitals. A total of 354 patients had biopsy-confirmed primary IgAN, and 18,002 controls had no documented IgAN diagnosis after electronic medical record (EMR) review. The dataset was randomly divided into a training cohort (70%) and a hold-out validation cohort (30%). LASSO penalized logistic regression was used for variable selection. Model performance was evaluated by discrimination, calibration, and decision curve analysis (DCA). Bootstrap validation with 1000 resamplings was performed. An 8-variable simplified model was additionally developed.</p><p><strong>Results: </strong>LASSO regression selected 13 variables for the primary full model. The primary model achieved an AUC of 0.849 (95% CI: 0.824-0.873) in the training cohort and 0.861 (95% CI: 0.833-0.890) in the validation cohort. Calibration was good in the training cohort (Brier score = 0.017), while moderate calibration deviation was observed in the validation cohort (Brier score = 0.020). The model yielded a high negative predictive value (>0.99). The 8-variable simplified model retained favorable discrimination with a validation AUC of 0.840.</p><p><strong>Conclusions: </strong>This routine urinalysis-based model may serve as an accessible laboratory-based risk stratification tool for identifying patients with relatively low or elevated predicted probability of IgAN in real-world hospital settings. It should be interpreted as an adjunct to clinical evaluation rather than as a stand-alone diagnostic test or replacement for renal biopsy.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1826486"},"PeriodicalIF":2.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820582","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":"Immunoglobulin replacement therapy in antineutrophil cytoplasmic antibody-associated vasculitis with rituximab-associated hypogammaglobulinemia: infection outcomes and disease course in a retrospective cohort.","authors":"Matthew Gross, Aditi Singh, Raj Roshan, Antoine Azar, Duvuru Geetha","doi":"10.3389/fneph.2026.1861999","DOIUrl":"https://doi.org/10.3389/fneph.2026.1861999","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether immunoglobulin replacement therapy (IgR), initiated for infection prophylaxis in patients with ANCA-associated vasculitis (AAV) receiving rituximab, is associated with changes in infection burden, disease activity, and the ability to de-escalate immunosuppression.</p><p><strong>Methods: </strong>We performed a retrospective single-center study of 16 patients with AAV treated with rituximab who developed secondary hypogammaglobulinemia (IgG <600 mg/dL) and subsequently received IgR between 2014 and 2024. Patients receiving IgR for primary immunodeficiency were excluded. Data collected included demographics, ANCA serotype, relapse history, infection burden, immunosuppressive regimen, and serum IgG levels before and after IgR. Primary outcomes were infections and disease relapse before versus after IgR initiation. Secondary outcomes included changes in serum IgG and rituximab use.</p><p><strong>Results: </strong>Prior to IgR, mean IgG was 287 ± 98 mg/dL, 14/14 patients tested had impaired vaccine responses, and 13/16 (81%) experienced recurrent or severe infections. Seven patients (44%) had at least one disease relapse while on rituximab maintenance. After IgR, mean IgG increased to 1018 ± 234 mg/dL, with normalization in 14/15 (93%). Recurrent or severe infections decreased to 1/16 (6%). Following IgR initiation, no disease relapses were observed during a median follow-up of 29.0 months (IQR 14.5-61.4; range 2.8-127.8), despite rituximab discontinuation in 10 patients and dose-interval extension in the remaining 6 patients. IgR was discontinued in 3 patients without relapse.</p><p><strong>Conclusion: </strong>In this cohort of AAV patients with rituximab-associated hypogammaglobulinemia, IgR demonstrated improved immunoglobulin levels and reduced infection burden and was associated with sustained disease remission despite immunosuppression de-escalation. Further studies are needed to determine whether IgR influences disease activity in AAV.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1861999"},"PeriodicalIF":2.9,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802380","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":"Hepatitis E virus infection in kidney transplant recipients: a pilot cross-sectional study of serological markers and allograft function in Northern Serbia.","authors":"Sonja B Golubović, Jelena D Stojčević Maletić, Lada V Petrović, Tamaš R Petrović, Violeta V Knežević, Maja S Ružić","doi":"10.3389/fneph.2026.1864349","DOIUrl":"10.3389/fneph.2026.1864349","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis E virus (HEV) is an emerging cause of chronic hepatitis and extrahepatic disease in solid organ transplant recipients. Data on kidney transplant populations, particularly in endemic regions, remain limited. This pilot study aimed to quantify the prevalence of HEV exposure and active infection in kidney transplant recipients and examine associations between HEV markers and allograft function.</p><p><strong>Methods: </strong>In this single-centre cross-sectional pilot study, 25 adult kidney transplant recipients (mean age 48.9 ± 14.4 years, median 13.0 years post-transplant) with available HEV serology and/or RNA testing were included. Clinical data, liver enzymes, estimated glomerular filtration rate (eGFR, mL/min/1.73 m²), and urinary albumin-to-creatinine ratio were obtained from medical records; allograft function was categorised as better versus worsening based on longitudinal clinical and laboratory trends documented in medical records. HEV exposure and active infection were assessed using anti-HEV IgG and IgM antibodies (Euroimmun ELISA; reactive ≥ 1.1, borderline 0.8-1.1, negative < 0.8) and HEV RNA in serum and stool.</p><p><strong>Results: </strong>Anti-HEV antibodies were present in 19/25 (76%) patients; HEV RNA was detected in 2/25 (8%) patients, with concurrent serum and stool positivity confirmed in both cases. eGFR data were available in 15 patients (60%). IgG serostatus was not associated with eGFR differences, but IgM-positive recipients had significantly lower eGFR (median 35.5 vs 57.5 mL/min/1.73 m²; p = 0.018; Cliff's δ = 0.74) and higher liver enzyme activity. In an exploratory regression model (n = 15), anti-HEV IgM positivity was associated with approximately 29.8 mL/min/1.73 m² lower eGFR (R² = 0.50), though this estimate is hypothesis-generating given the small sample. Anti-HEV IgM was the strongest individual predictor of worsening graft function (OR = 3.00; 95% CI 0.37-24.5).</p><p><strong>Conclusions: </strong>In this endemic setting, kidney transplant recipients showed high HEV seroprevalence and an exploratory association between IgM positivity and impaired allograft function. These hypothesis-generating findings support targeted HEV evaluation-including RNA testing-in kidney transplant recipients with unexplained graft dysfunction or mild transaminase elevation in an endemic South-Eastern European setting. Larger longitudinal studies with kidney biopsies are needed to define the renal impact of HEV and determine whether anti-HEV IgM may serve as a risk-stratification marker.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1864349"},"PeriodicalIF":2.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726981","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 effect of nurse-led bladder training on urinary tract outcomes after kidney transplantation.","authors":"G Albertema, A C P Boskma, B H Meppelink, J M Vonk, S J L Bakker, A Ozyilmaz, M F C De Jong","doi":"10.3389/fneph.2026.1830698","DOIUrl":"10.3389/fneph.2026.1830698","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal bladder function is crucial for kidney transplant success. Bladder training could help prevent dysfunction and complications, yet evidence-based guidelines for bladder training methods are limited. This study evaluates two protocols: standard hourly training versus tailored to preoperative urine output, assessing urinary tract outcomes.</p><p><strong>Methods: </strong>This pre-post study used data from the TransplantLines data and biobank on kidney transplant patients admitted in 2019 (standard bladder training) and 2022 (new protocol) to a Dutch academic hospital. Standard bladder training involved hourly urination with regular post-void residual checks, whereas the new protocol adjusted urination frequency and scan schedules based on preoperative urine output. Logistic regression analyses were performed to evaluate the following outcomes: residual urine volume > 100ml, urinary tract infection or re-catheterization within three months post-transplantation.</p><p><strong>Results: </strong>The analysis included 211 patients (70% male, mean age 55, n=100 standard protocol, n=111 new protocol). Multivariate analysis showed no differences between the protocols in the investigated outcomes. A significant interaction between protocol and age on re-catheterization was found suggesting higher re-catheterization risk in older patients under the new protocol.</p><p><strong>Discussion: </strong>The revised protocol might promote patient well-being and simultaneously improve nurse working conditions.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1830698"},"PeriodicalIF":2.9,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13461544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727162","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":"Analysis of risk factors for adverse outcomes in HIV/AIDS patients with ESRD undergoing hemodialysis: a cohort study.","authors":"Guohai Wei, Zhenghong Huang, Lizhen Feng, Qing Wang, Zhenkun Zhang, Bo Chen","doi":"10.3389/fneph.2026.1818921","DOIUrl":"10.3389/fneph.2026.1818921","url":null,"abstract":"<p><strong>Background: </strong>Infection is the second leading cause of death and hospitalization in hemodialysis (HD) patients. The occurrence of infections in HIV/AIDS patients with End-Stage Renal Disease (ESRD) undergoing maintenance hemodialysis is influenced by patient characteristics and related treatment regimens. Currently, there is limited data both domestically and internationally on the risk factor analysis for adverse outcome following infections in HIV/AIDS patients with ESRD receiving maintenance hemodialysis. This study aims to identify the risk factors associated with adverse outcomes following infections during hemodialysis in patients with HIV/AIDS and ESRD.</p><p><strong>Methods: </strong>In this retrospective cohort study, we evaluated the 9-month treatment outcomes of 70 HIV/AIDS patients with ESRD and concurrent infections undergoing maintenance hemodialysis at a hospital in Guangxi between January 2019 and December 2024. The patients were divided into adverse outcome group(defined as mortality or severe complications leading to prolonged hospitalization) and survival group. Data analysis was performed using IBM SPSS Statistics version 26.0, with statistical significance set at <i>P</i> ≤ 0.05, to identify adverse outcome risk factors for concurrent infections in HIV/AIDS patients with ESRD.</p><p><strong>Results: </strong>Among the 70 enrolled patients, the age ranged from 11 to 86 years. Adverse outcomes occurred in 48 cases (68.57%), while 22 patients (31.43%) survived without severe events. Multivariate analysis identified low-level hemoglobin(HB)(OR 0.952(95%CI 0.908,0.998),<i>P</i> = 0.042) and platelet (PLT)(OR 0.987(95%CI 0.975,1.000),<i>P</i> = 0.046).</p><p><strong>Conclusion: </strong>Adverse outcomes are common among HIV/AIDS patients with ESRD who develop infections during maintenance hemodialysis. Low hemoglobin and low platelet levels are significant risk factors for poor prognosis in this patient population. Early identification and management of these hematologic abnormalities may help improve clinical outcomes.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1818921"},"PeriodicalIF":2.9,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13454224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708677","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":"Research advances on acute kidney injury and brain dysfunction.","authors":"Min Li, Xiaohui Liao, Jingyang Ran","doi":"10.3389/fneph.2026.1867473","DOIUrl":"10.3389/fneph.2026.1867473","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is a prevalent critical clinical condition primarily characterized by a sharp deterioration of renal function within 48 hours. Accumulating clinical evidence has demonstrated that AKI predisposes patients to multisystem complications, among which renal-brain axis dysfunction is well recognized. This condition manifests as delirium, coma and stroke, also elevates the risk of chronic cognitive impairment, dementia and depression. Such complications not only increase short-term all-cause mortality but also severely impair the long-term quality of life in survivors, thereby placing a substantial socioeconomic burden on global healthcare systems. Current mechanistic investigations into AKI-associated brain dysfunction have predominantly centered on canonical pathological pathways, including systemic inflammatory response, oxidative stress, hippocampal neuronal injury, uremic toxin accumulation and others. Emerging evidence indicates that insulin resistance (IR) is highly prevalent in AKI patients and closely correlated with the pathophysiological progression of AKI. We will discuss the specific role of IR in AKI-induced cognitive impairment. Additionally, this review highlights the prospective application of combined multimodal neuroimaging and machine learning algorithms. By integrating readily available multidimensional clinical data, the establishment of early risk prediction models for AKI-related brain dysfunction can facilitate timely identification and precise intervention for high-risk populations. Furthermore, we elaborate the therapeutic potential of targeted anti-inflammatory strategies and natural bioactive compounds in ameliorating AKI-associated brain dysfunction. Collectively, this review provides novel insights for the development of optimized, safe and effective clinical interventions in the future.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1867473"},"PeriodicalIF":2.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686939","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":"Inflammation, infection, and immune dysregulation in chronic kidney disease: translational and epidemiological perspectives.","authors":"Aminu Shittu","doi":"10.3389/fneph.2026.1919658","DOIUrl":"10.3389/fneph.2026.1919658","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) represents a growing global health challenge associated with substantial morbidity, mortality, and healthcare burden. Although metabolic and haemodynamic factors, particularly diabetes mellitus and hypertension, remain major contributors, increasing evidence demonstrates that persistent inflammation and immune dysregulation are central mechanisms influencing CKD initiation, progression, and complications. The renal immune microenvironment consists of complex interactions among resident kidney cells, infiltrating immune cells, inflammatory mediators, and molecular signalling networks that regulate tissue repair, fibrosis, and disease outcomes. Persistent activation of innate and adaptive immune responses promotes cytokine release, oxidative stress, endothelial dysfunction, and maladaptive tissue remodelling, contributing to progressive loss of kidney function. Infectious diseases and altered host-microbiome interactions may further amplify systemic inflammation and immune imbalance, particularly in vulnerable populations. Advances in immunology and molecular medicine have identified inflammatory biomarkers and immune-related pathways with potential applications in early detection, risk stratification, and targeted interventions. This Mini Review synthesizes current evidence linking inflammation, infection, and immune dysregulation with CKD progression, highlighting translational opportunities and epidemiological perspectives. Integrating mechanistic insights with population-level evidence may accelerate precision approaches for improving CKD prevention, monitoring, and therapeutic outcomes.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1919658"},"PeriodicalIF":2.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681341","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":"Beyond the test: patient-reported concerns and worries regarding kidney conditions and <i>APOL1</i> genetic testing among Black patients.","authors":"Rengin Elsurer Afsar, Bryan Clair, Aliza Anwar Memon, John C Edwards, Kana N Miyata, Baris Afsar, Mark Schnitzler, Huiling Xiao, Amber Carriker, Fadee Abu Al Rub, Chi-Yuan Hsu, Anthony N Muiru, Barry I Freedman, Marie D Philipneri, Yasar Caliskan, Krista L Lentine","doi":"10.3389/fneph.2026.1815147","DOIUrl":"10.3389/fneph.2026.1815147","url":null,"abstract":"<p><strong>Background: </strong>Apolipoprotein L1 (<i>APOL1</i>) renal risk variants (RRVs) contribute to the increased risk of kidney disease among Black Americans, but use of genetic testing may be limited by patient concerns regarding clinical implications and effects on family.</p><p><strong>Methods: </strong>Black adults were prospectively enrolled for <i>APOL1</i> genotyping, surveys, and clinical record review beginning in January 2019 at a Midwestern U.S. medical center (NCT05656261). Patient-reported concerns about kidney conditions and potential worry related to having an <i>APOL1</i> high-risk genotype were analyzed at baseline and 3-months.</p><p><strong>Results: </strong>Among 200 participants enrolled with completed 3-month follow-up as of January 2025, 17.5% (35/200) carried an <i>APOL1</i> high-risk genotype (2 RRVs). At baseline, concern about kidney conditions was common: 39% reported being extremely concerned, 34% very concerned, 12% somewhat concerned, 10% a little concerned, and 6% not concerned at all. Higher baseline concern was observed among women and those with a family history of both kidney disease and hypertension. At 3 months, concern levels were unchanged in 45% of participants, decreased in 36%, and increased in 19%. <i>APOL1</i> high-risk genotypes were more common in those with an increase, compared to a decrease, in kidney concern at follow-up (29% vs 11%; P = 0.02). Worry related to having an <i>APOL1</i> high-risk genotype declined over time, from 14% at baseline to 8% at 3 months.</p><p><strong>Conclusion: </strong>In this prospective cohort, patient-reported concerns about kidney conditions were common and generally stable, with higher levels observed in certain subgroups. Although <i>APOL1</i> high-risk genotypes were more common among participants whose kidney concerns increased than among those whose concerns decreased, overall patient-reported worry about genetic risk declined. These findings may help inform patient education and counseling surrounding <i>APOL1</i> testing.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1815147"},"PeriodicalIF":2.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681379","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}