Frontiers in nephrology最新文献

{"title":"<i>Inside CKD</i>: a microsimulation modelling study projects the clinical and economic burden of chronic kidney disease in Hungary.","authors":"Lilla Szabó, Luca Adél Halmai, Erzsébet Ladányi, Juan Jose Garcia Sanchez, Salvatore Barone, Claudia Cabrera, Lise Retat, Laura Webber, István Wittmann, Boglárka Laczy","doi":"10.3389/fneph.2024.1458607","DOIUrl":"10.3389/fneph.2024.1458607","url":null,"abstract":"<p><strong>Objectives: </strong>The <i>Inside CKD</i> programme implemented a microsimulation modelling approach to project the clinical and economic burden of chronic kidney disease (CKD) between 2024 and 2027 in Hungary.</p><p><strong>Methods: </strong>Using the peer-reviewed <i>Inside CKD</i> microsimulation, a virtual Hungarian population was generated that was derived from national records, local demographic data and published epidemiological data. These inputs defined the likelihood of a change in health state for each individual as they progressed through the model in annual increments. Individual CKD status, including disease progression, cardiorenal complications and associated costs, was tracked annually to generate the population-level projections of the clinical and economic burden of CKD.</p><p><strong>Results: </strong>By 2027, people with CKD were projected to constitute 13.3% of the Hungarian national population. The prevalence of heart failure, myocardial infarction and stroke in people with CKD were projected to remain consistently high, reaching 323 447, 69 188 and 120 118 by 2027, respectively. Kidney replacement therapy cases were predicted to remain high at 20 515 in 2024 and 22 325 in 2027, with associated costs increasing from 71.4 billion HUF in 2024 to 79.6 billion HUF in 2027. Total annual healthcare costs associated with treating CKD were projected to constitute 5.4% of the overall national healthcare budget in 2027.</p><p><strong>Conclusions: </strong><i>Inside CKD</i> demonstrates that the future burden of CKD in Hungary will be substantial unless current management strategies change. The high prevalence of undiagnosed CKD and associated cardiorenal complications highlight the urgent need for policy interventions focused on early diagnosis and timely intervention to mitigate the future burden of CKD.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"4 ","pages":"1458607"},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11527778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570501","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":"Quantifying measurement uncertainty in renal transplant biopsy assessment.","authors":"Xavier Loizeau, Marina Romanchikova, Spencer A Thomas, Moulham Alsuleman, John O O Ayorinde, Gavin J Pettigrew","doi":"10.3389/fneph.2024.1458491","DOIUrl":"https://doi.org/10.3389/fneph.2024.1458491","url":null,"abstract":"<p><strong>Introduction: </strong>Renal transplant biopsies provide insights into graft health and support decision making. The current evidence on links between biopsy scores and transplant outcomes suggests there may be numerous factors affecting biopsy scores. Here we adopt measurement science approach to investigate the sources of uncertainty in biopsy assessment and suggest techniques to improve its robustness.</p><p><strong>Methods: </strong>Histological assessments, Remuzzi scores, biopsy processing and clinical variables are obtained from 144 repeat biopsies originating from 16 deceased-donor kidneys. We conducted sensitivity analysis to find the morphometric features with highest discriminating power and studied the dependencies of these features on biopsy and stain type. The analysis results formed a basis for recommendations on reducing the assessment variability.</p><p><strong>Results: </strong>Most morphometric variables are influenced by the biopsy and stain types. The variables with the highest discriminatory power are sclerotic glomeruli counts, healthy glomeruli counts per unit area, percentages of interstitial fibrosis and tubular atrophy as well as diameter and lumen of the worst artery. A revised glomeruli adequacy score is proposed to improve the robustness of the glomeruli statistics, whereby a minimum of 104 µm² of cortex tissue is recommended to keep type 1 and type 2 error probabilities below 0.15 and 0.2.</p><p><strong>Discussion: </strong>The findings are transferable to several biopsy scoring systems. We hope that this work will help practitioners to understand the sources of statistical uncertainty and improve the utility of renal biopsy.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"4 ","pages":"1458491"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11519413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549270","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":"Proceedings of a membrane update symposium: advancements, scientific insights, and future trends for dialysis membranes for enhanced clinical outcomes in end stage kidney disease patients.","authors":"Christoph Wanner, Raymond Vanholder, Alberto Ortiz, Andrew Davenport, Bernard Canaud, Peter J Blankestijn, Rosalinde Masereeuw, Jeroen Peter Kooman, Giuseppe Castellano, Dimitrios Stamatialis, Sandip Mitra, Muriel Grooteman, Viktoria Weber, Thomas Ebert, Amira Abdelrasoul, Sonja Steppan, Anna Rebecca Scheiwe, Peter Stenvinkel","doi":"10.3389/fneph.2024.1455260","DOIUrl":"https://doi.org/10.3389/fneph.2024.1455260","url":null,"abstract":"<p><strong>Purpose of symposium: </strong>From September 6 - 8 2022, the Life/2022 Membrane Symposium was held in Frankfurt, Germany, and transmitted live to a worldwide internet audience. The event was part of the Life/Nephrology Campus initiative, a continuous educational platform for the nephrology community to expand knowledge and share expertise on contemporary topics in chronic kidney disease. We describe recent questions and advances in the field, and we underline challenges in the care of dialysis patients and opportunities for integration of new findings into clinical practice to improve patient outcomes in end stage kidney disease patients.</p><p><strong>Topics: </strong>Most patients with kidney failure are on maintenance hemodialysis (MHD). The scientific program of the symposium was developed around topics about the role, functional determinants, technical aspects, limitations, and clinical implications of membranes presently in use. International experts with clinical or technical expertise as well as scientific recognition within the nephrology community were asked to prepare their presentations based on their own experiences, perceptions, opinions, and sources of information. The symposium devoted a major portion to discussing novel approaches for improving membranes and treatment quality, including updates on innovative concepts that may could potentially transform the landscape of kidney replacement therapy for chronic kidney disease patients in the future.</p><p><strong>Implications: </strong>The intent was to provide insights into current attention points for healthcare professionals new to the field of MHD, and to test a unique forum for continuing medical education integrating physician and patient experiences to promote changes in clinical practice. Furthermore, the symposium premiered a specifically developed mixed reality holographic 3D model to demonstrate recent dialyzer innovation diminishing protein fouling on membrane surfaces. As a continuous online educational platform for scientific exchange, this Life/2022 event provided online learning opportunities with on-demand content, with all symposium lectures freely available on <i>nephrologycampus.com</i>.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"4 ","pages":"1455260"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549269","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 utility of point-of-care ultrasound in critical care nephrology.","authors":"Rogério da Hora Passos, Uri Adrian Prync Flato, Paula Rodrigues Sanches, Carolina Moraes Pellegrino, Ricardo Luiz Cordioli, Bruno Caldin Silva, Felipe Galdino Campos, Dalton de Souza Barros, Fernanda Oliveira Coelho, Bruno de Arruda Bravim, Thiago Domingos Corrêa","doi":"10.3389/fneph.2024.1402641","DOIUrl":"https://doi.org/10.3389/fneph.2024.1402641","url":null,"abstract":"<p><p>Point-of-care ultrasonography (POCUS) is gaining heightened significance in critical care settings as it allows for quick decision-making at the bedside. While computerized tomography is still considered the standard imaging modality for many diseases, the risks and delays associated with transferring a critically ill patient out of the intensive care unit (ICU) have prompted physicians to explore alternative tools. Ultrasound guidance has increased the safety of invasive procedures in the ICU, such as the placement of vascular catheters and drainage of collections. Ultrasonography is now seen as an extension of the clinical examination, providing quick answers for rapidly deteriorating patients in the ICU. The field of nephrology is increasingly acknowledging the value of diagnostic point-of-care ultrasound (POCUS). By employing multi-organ POCUS, nephrologists can address specific queries that arise during the diagnosis and treatment of patients with acute kidney injury. This approach aids in ruling out hydronephrosis and offers immediate information on hemodynamics, thereby consolidating patient data and facilitating the development of personalized treatment strategies.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"4 ","pages":"1402641"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482338","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":"Renal hypouricemia type 2 with SLC2A9 compound heterozygous variants: a case report of recurrent acute kidney injury triggered by low-intensity exercise.","authors":"Niranjana Rekha Paladugu, Muralinath Vukkadala","doi":"10.3389/fneph.2024.1463913","DOIUrl":"https://doi.org/10.3389/fneph.2024.1463913","url":null,"abstract":"<p><p>Renal hypouricemia (RHUC) is a rare genetic disorder characterized by impaired uric acid reabsorption which leads to persistently low serum uric acid levels. This condition predisposes individuals to complications such as uric acid kidney stones and exercise-induced acute kidney injury (EIAKI). Although mutations in SLC22A12 and SLC2A9 are commonly implicated in RHUC, the precise pathophysiological mechanisms, particularly those contributing to AKI, remain incompletely understood. We report the case of a 30-year-old male who experienced recurrent episodes of EIAKI despite the absence of high-intensity exercise, suggesting the involvement of factors beyond the traditional risk. Genetic analysis confirmed the diagnosis of RHUC type 2 (RHUC2) and identified compound heterozygous variants of SLC2A9. Although these variants are not novel, this case contributes to the limited literature on RHUC2, particularly in male patients with recurrent EIAKI. These findings highlight the importance of maintaining a high index of suspicion for RHUC in cases of unexplained AKI, especially when recurrent episodes follow physical activity, and the need for targeted genetic testing for an accurate diagnosis. The genomic data related to this case are available in Mendeley Data: Vukkadala, Muralinath; Paladugu, Niranjana Rekha (2024), \"Renal hypouricemia,\" Mendeley Data, V2, doi: 10.17632/7z84mkdgn9.2.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"4 ","pages":"1463913"},"PeriodicalIF":0.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482337","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 public attention in acute kidney injury and continuous renal replacement therapy: trends analysis from 2004 to 2024.","authors":"Charat Thongprayoon, Wannasit Wathanavasin, Supawadee Suppadungsuk, Mohammad S Sheikh, Yasir H Abdelgadir, Jing Miao, Michael A Mao, Iasmina M Craici, Fawad Qureshi, Kianoush B Kashani, Wisit Cheungpasitporn","doi":"10.3389/fneph.2024.1472144","DOIUrl":"10.3389/fneph.2024.1472144","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) and the need for Continuous Renal Replacement Therapy (CRRT) are critically important health concerns. This study analyzes global and regional Internet search queries to understand public attention in AKI and CRRT over time.</p><p><strong>Methods: </strong>We used Google Trends™ to analyze search queries for AKI and CRRT from January 2004 to March 2024. The study examined global trends and detailed insights from the United States, including state-by-state breakdowns. We identified patterns, peaks of attention, and temporal trends in public attention, comparing regional variations across the US and top-ranking countries worldwide.</p><p><strong>Results: </strong>Global attention in AKI peaked in October 2022, with Portugal, Zambia, and Spain showing the highest regional attention. Within the United States, peak attention was in February 2008. Tennessee, Pennsylvania, and West Virginia were the top states that paid attention to AKI. Attention in CRRT peaked globally in March 2024. South Korea, Saudi Arabia, and Bahrain have led the global attention to CRRT. In the United States, peak attention was in April 2020. West Virginia, Tennessee, and Kentucky showed the highest state-specific attention in CRRT.</p><p><strong>Conclusions: </strong>This study reveals significant temporal and geographical variations in online search patterns for AKI and CRRT, suggesting evolving public attention to these critical health issues. This knowledge can guide the development of targeted public health initiatives, enhance medical education efforts, and help healthcare systems tailor their approach to improving awareness and outcomes in kidney health across diverse populations.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"4 ","pages":"1472144"},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11445180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367698","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":"Unraveling monoclonal gammopathy of renal significance: a mini review on kidney complications and clinical insights.","authors":"Mythri Shankar, Manjusha Yadla","doi":"10.3389/fneph.2024.1439288","DOIUrl":"https://doi.org/10.3389/fneph.2024.1439288","url":null,"abstract":"<p><p>Monoclonal gammopathy of renal significance (MGRS) is where kidney injury occurs due to the accumulation or effects of abnormal monoclonal proteins. These proteins, originating from non-cancerous or pre-cancerous plasma cells or B cells, deposit in specific areas of the kidney. Mechanisms contributing to MGRS include high levels of vascular endothelial growth factor secretion, autoantibodies targeting complement components, and targeting specific receptors leading to nephropathy. Kidney lesions in monoclonal gammopathy of renal significance (MGRS) are classified based on the presence of organized or nonorganized deposits, including fibrillar, microtubular, or crystal inclusions. Kidney biopsy is essential for confirming the diagnosis of MGRS by identifying monoclonal immunoglobulin deposits. Immunofluorescence helps determine the class of light and/or heavy chain involved in MGRS. The treatment approach is clone-directed and hence it depends on the presence of B cell clone or plasma cell clone or any detectable monoclonal protein. Chemotherapy targeting plasma cell or B cell malignancies and autologous hematopoietic cell transplantation may be used to manage MGRS. Kidney outcomes in MGRS patients strongly correlate with the hematologic response to chemotherapy.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"4 ","pages":"1439288"},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11424516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333849","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: IgA nephropathy: a nephrologist's challenge in 2023.","authors":"Fausta Catapano, Oliver Flossmann, Lucia Del Vecchio","doi":"10.3389/fneph.2024.1477350","DOIUrl":"https://doi.org/10.3389/fneph.2024.1477350","url":null,"abstract":"","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"4 ","pages":"1477350"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11422340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333848","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":"<i>De novo</i> and recurrent post-transplant membranous nephropathy cases show similar rates of concurrent antibody-mediated rejection.","authors":"Nikka Khorsandi, Hwarang Stephen Han, Raja Rajalingam, Jun Shoji, Anatoly Urisman","doi":"10.3389/fneph.2024.1438065","DOIUrl":"https://doi.org/10.3389/fneph.2024.1438065","url":null,"abstract":"<p><strong>Background: </strong>Membranous nephropathy (MN) can develop post-kidney transplant and is classified as a recurrent disease in patients with a history of MN in the native kidneys or as <i>de novo</i> disease in patients without such history. The mechanism of recurrent MN is thought to be like that of primary MN, but the mechanism of <i>de novo</i> MN is not well delineated. An association between <i>de novo</i> MN and antibody-mediated rejection (AMR) has been suggested.</p><p><strong>Methods: </strong>A search of the pathology database from our medical center identified 11 cases of recurrent and 15 cases of <i>de novo</i> MN, in which clinical and histologic findings were compared. No significant differences were identified in the demographic characteristics, serum creatinine and proteinuria trends, or rates of allograft failure between the recurrent and <i>de novo</i> MN groups.</p><p><strong>Results: </strong>Rates of concurrent AMR were high in both groups (36% and 40%, respectively) but not statistically different from each other. PLA2R immunofluorescence (IF) positivity was seen in 64% of recurrent MN cases compared to 33% of <i>de novo</i> MN cases, suggesting a higher incidence of PLA2R-positive <i>de novo</i> MN than previously reported. No significant histologic differences were identified in the initial biopsies from the two groups, except mean IgG intensity by IF was higher in the recurrent group, suggesting a higher load of immune complex deposits at diagnosis in this group.</p><p><strong>Conclusion: </strong>The findings do not provide support for a specific association between AMR and <i>de novo</i> MN, but whether there is a possible link between both forms of post-transplant MN and AMR remains an unanswered question.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"4 ","pages":"1438065"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11405159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302522","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: Management of patients with a failed kidney transplant: perspectives from transplant nephrologist, infectious disease, immunogenetics, oncology and transplant surgeons.","authors":"Phuong-Thu T Pham, Phuong-Chi T Pham","doi":"10.3389/fneph.2024.1455764","DOIUrl":"https://doi.org/10.3389/fneph.2024.1455764","url":null,"abstract":"","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"4 ","pages":"1455764"},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11358116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115658","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}