Frontiers in nephrology最新文献

{"title":"Apolipoprotein L1 genetic testing, family history of hypertension, and kidney disease in a Midwestern U.S. cohort.","authors":"Krista L Lentine, 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","doi":"10.3389/fneph.2026.1771125","DOIUrl":"10.3389/fneph.2026.1771125","url":null,"abstract":"<p><strong>Background: </strong>Understanding how family history and genetic factors-particularly apolipoprotein L1 (<i>APOL1</i>) renal risk variants (RRVs)-contribute to kidney disease risk among Black individuals continues to evolve.</p><p><strong>Methods: </strong>In a cohort of prospectively enrolled Black adults who underwent <i>APOL1</i> genotyping and completed surveys at a Midwestern U.S. academic hospital (01/24/2019-03/21/2025; NCT05656261), we examined <i>APOL1</i> RRV distribution in relation to family history, baseline clinical factors, and 3-month renal function change.</p><p><strong>Results: </strong>Among 220 eligible participants, 17% (37/220) carried <i>APOL1</i> high-risk genotypes (two RRVs). Family history of hypertension alone was reported by 37% (81/220), kidney disease alone by 3% (6/220), and both by 49% (109/220). High-risk genotypes were more common among those with both hypertension and kidney disease in their family (18%) versus those without either (12%). High-risk <i>APOL1</i> genotype prevalence rose with increasing antihypertensive medication use (24% among those prescribed ≥4 agents) and was higher among individuals with lower race-free estimated glomerular filtration rate (eGFR) or albuminuria. Among 173 participants with eGFR values at 3-months, high-risk genotypes were more frequent among those with eGFR decline versus improvement (23% vs. 12%).</p><p><strong>Conclusion: </strong><i>APOL1</i> high-risk genotypes were more common among individuals with a family history of hypertension and/or kidney disease, greater medication burden, lower kidney function, and early eGFR decline. The partial overlap between genetic and familial risk underscores the complex interplay of inherited, clinical, and environmental factors. Continued study and integrative strategies are needed to refine kidney disease risk stratification, enhance early identification, and guide prevention and treatment in at-risk populations.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1771125"},"PeriodicalIF":2.9,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213265","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":"Long-term outcomes of tacrolimus conversion to sirolimus in kidney transplant recipients: an eight-year follow-up.","authors":"Ibrahim Tawhari, Sook Park, Fatmah Yamani, Bing Ho, Mohammed Javeed Ansari, Mohammed Tawhari, Joseph Leventhal, Lorenzo Gallon","doi":"10.3389/fneph.2026.1813146","DOIUrl":"10.3389/fneph.2026.1813146","url":null,"abstract":"<p><strong>Objective: </strong>Calcineurin inhibitors, such as tacrolimus, are associated with long-term nephrotoxicity and renal allograft dysfunction despite evidence of improved kidney transplantation outcomes. Consequently, minimizing calcineurin inhibitor exposure has attracted considerable interest. This study aimed to investigate the long-term outcomes of late conversion of tacrolimus to sirolimus in a steroid-free immunosuppressive regimen in kidney transplant recipients.</p><p><strong>Methods: </strong>We conducted an 8-year retrospective analysis of outcomes in 207 kidney transplant recipients enrolled in a previous randomized clinical trial, in which patients receiving maintenance therapy with tacrolimus and mycophenolate were randomized 2:1 at 6-12 months post-transplantation to conversion from tacrolimus to sirolimus or continuation of tacrolimus.</p><p><strong>Results: </strong>Over the 8-year post-transplant follow-up, the sirolimus cohort exhibited a superior and more preserved GFR compared to the tacrolimus cohort, with a total GFR change of -1.18 mL/min/1.73 m² (95% CI, -4.86 to 3.06) with sirolimus versus -9.57 mL/min/1.73 m² (95% CI, -16.92 to -7.26) with tacrolimus, with a between-group difference of -8.39 mL/min/1.73 m². The two groups did not significantly differ in terms of graft loss, patient survival, or <i>de novo</i> donor-specific antibody development. The sirolimus group showed a numerically but insignificantly elevated biopsy-proven acute rejection rate. Adverse effect profiles revealed that the sirolimus group was associated with significantly lower BK viremia and cancer rates, whereas other adverse events did not significantly differ between the groups.</p><p><strong>Conclusions: </strong>Delayed conversion from tacrolimus to sirolimus (≥6 months post-transplantation) was associated with long-term preserved estimated glomerular filtration rate without a significantly increased risk of renal allograft rejection or graft loss.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1813146"},"PeriodicalIF":2.9,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213202","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 resistive index and neonatal sequential organ failure assessment score as acute kidney injury risk predictors in preterm neonates with late-onset neonatal sepsis.","authors":"Abed Ricky H Sitompul, Tetty Yuniati, Fiva Aprilia Kadi, Aris Primadi, Dwi Prasetyo, Ahmedz Widiasta, Ekawati L Haksari, Harry G Nugraha, Antony A Adibrata","doi":"10.3389/fneph.2026.1734812","DOIUrl":"10.3389/fneph.2026.1734812","url":null,"abstract":"<p><strong>Aim: </strong>Neonatal acute kidney injury (AKI) is an independent predictor of mortality with serum creatinine (sCr) remaining the gold standard. However, by the time sCr increases, the kidney may already have lost part of its function. Late-onset neonatal sepsis (LONS) is a common trigger of AKI through inflammation and renal hypoperfusion. The renal resistive index (RRI) is a Doppler-derived marker of renal perfusion, and the neonatal sequential organ failure assessment (nSOFA) score reflects systemic organ dysfunction that may accompany sepsis-associated AKI. This study aimed to compare the diagnostic performance of the RRI and nSOFA scores for predicting AKI risk in preterm neonates with probable LONS, using the STARZ (Sethi Tibrewal Agarwal Raina waZir) score for risk stratification.</p><p><strong>Methods: </strong>This is a single-center prospective study that observed all neonates admitted to the neonatal intensive care unit (NICU) with probable LONS from July to August 2025 defined using the sepsis prediction score. Clinical and laboratory data included the STARZ score, RRI, and the nSOFA score, which were obtained at birth and a few times after the diagnosis of probable LONS based on the sepsis prediction score.</p><p><strong>Results: </strong>A total of 36 preterm neonates were included. Median RRI and STARZ scores increased during the course of LONS, while nSOFA scores significantly differed between high- and low-risk AKI groups on multiple time points. Birth weight <1, 357 g and congenital heart disease were significant risk factors. Receiver operating characteristic (ROC) analysis showed birth weight <1, 357 g [area under the curve (AUC), 0.708; sensitivity, 72.22%; and specificity, 77.78% (<i>p</i> = 0.026)] and nSOFA score >3 on day 7 [AUC, 0.724; sensitivity, 61.11%; and specificity, 77.78% (<i>p</i> = 0.01)]. Multivariate analysis confirmed nSOFA score >3 on day 7 as a strong independent predictor of high-risk AKI [odds ratio (OR), 10.01; 95% confidence interval (CI), 1.18-85.13].</p><p><strong>Conclusions: </strong>Serial nSOFA monitoring in preterm neonates with LONS may provide practical and accessible risk stratification for AKI and could support earlier identification of infants at high risk.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1734812"},"PeriodicalIF":2.9,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213288","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":"Coagulation is associated with renal function decline and chronic kidney disease in people living with HIV in South Africa.","authors":"Joel Choshi, Haskly Mokoena, Sihle E Mabhida, Brian T Flepisi, Helen C Steel, Kabelo Mokgalaboni, Wendy N Phoswa, Gerald Maarman, Bongani B Nkambule, Phiwayinkosi V Dludla, Sidney Hanser","doi":"10.3389/fneph.2026.1800778","DOIUrl":"10.3389/fneph.2026.1800778","url":null,"abstract":"<p><strong>Background: </strong>Chronic inflammation is a well-documented feature of human immunodeficiency virus (HIV) infection and is implicated in the progression of several comorbidities, including chronic kidney disease (CKD). Notably, chronic coagulation activation is another common phenomenon mediated by chronic inflammation among people living with HIV (PLWH) and has also been linked to CKD progression. However, the relationship between inflammation, coagulation and renal dysfunction remains underexplored in African populations with high HIV prevalence. This study investigated the association between systemic inflammation, coagulation activation and renal function among PLWH, particularly those receiving antiretroviral therapy (ART).</p><p><strong>Methods: </strong>In this cross-sectional study, 151 adults were enrolled, comprising 80 PLWH on ART, 27 PLWH not on ART, and 44 people not living with HIV (PNLWH). Inflammatory marker, C-reactive protein (CRP) and coagulation markers including fibrinogen and D-dimer, were measured and CKD stages were determined using estimated glomerular filtration rate (eGFR), which was calculated based on cystatin C (cystC) levels (eGFR_cystC).</p><p><strong>Results: </strong>In the overall PLWH cohort, D-dimer was significantly associated with reduced eGFR_cystC in both crude (<i>p</i> = 0.004) and adjusted analyses (<i>p</i> = 0.014), indicating poorer kidney function. Fibrinogen showed a significant association with reduced eGFR_cystC only after adjusting for confounders (<i>p</i> = 0.048). Among PLWH on ART, D-dimer remained independently associated with reduced eGFR_cystC, while fibrinogen showed an independent association after adjustment (β = -1.54, <i>p</i> = 0.031). Elevated fibrinogen levels were associated with an increased odds of CKD in the overall PLWH group (AOR = 1.12, 95% CI 1.00-1.23, <i>p</i> = 0.0 41), and elevated D-dimer levels were associated with increased odds of CKD among those on ART (AOR = 1.01, 95% CI 1.00-1.03, <i>p</i> = 0.045).</p><p><strong>Conclusion: </strong>The study reveals that both D-dimer and fibrinogen, key markers of coagulation are independently associated with renal function decline and risk of CKD in PLWH, particularly those on ART. These findings suggest that coagulation activation may be an early indicator of declining kidney function and increased risk of CKD in PLWH, potentially preceding overt systemic inflammation.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1800778"},"PeriodicalIF":2.9,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201368","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":"'…completely exhausted and weak, really drained.': a multinational qualitative interview study of healthcare provider, patient, and caregiver experiences of C3 glomerulopathy and primary (idiopathic) immune complex membranoproliferative glomerulonephritis diagnosis, burden and management.","authors":"Sayna Norouzi, Mingyi Huang, Carly Rich, Katie Gordon, Lucia Quintana-Gallardo, Ryan Naylor, Mona Amet, Laura Mirams, Elizabeth Holdsworth, Fernando Caravaca-Fontán","doi":"10.3389/fneph.2026.1770706","DOIUrl":"10.3389/fneph.2026.1770706","url":null,"abstract":"<p><strong>Introduction: </strong>C3 glomerulopathy (C3G) and primary (idiopathic) immune complex membranoproliferative glomerulonephritis (IC-MPGN) are rare progressive kidney diseases. Due to the rare nature of C3G/primary IC-MPGN, there is a paucity of real-world data on the diagnosis, management, and impact of the diseases on patients and caregivers. Our study used the direct experiences of healthcare professionals (HCPs), patients, and caregivers, to provide insight into the diagnosis/management of C3G/primary IC-MPGN and its burden on patients and caregivers.</p><p><strong>Methods: </strong>We conducted a multi-country, cross-sectional, semi-structured, qualitative interview study with HCPs, patients, and caregivers in France, Germany, Italy, Spain, the United Kingdom and the United States between July 2024-January 2025. Nephrologists or internal medicine specialists (France and Spain only) were eligible to participate if they managed at least one patient with a biopsy-confirmed C3G/primary IC-MPGN diagnosis. Patients and informal caregivers were recruited via HCPs, patient advocacy groups, online panels or social media and had to be aged ≥16 years and ≥18 years respectively. Thematic analysis was conducted to identify key response themes.</p><p><strong>Results: </strong>A total of 21 HCPs, 13 patients, and 8 caregivers were interviewed. HCPs and patients highlighted that milder symptoms often led to diagnostic delays with HCPs highlighting lack of disease recognition, difficulties accessing specialist care, and patient reluctance to receive a biopsy as barriers to timely diagnosis. Mental and physical fatigue/exhaustion were the most burdensome symptoms according to patients and caregivers, impacting all aspects of the patient's life. Patients stated that achieving disease stability was a key goal of treatment, however HCPs, patients, and caregivers all stated that treatment options at survey (prior to approval of iptacopan and pegcetacoplan) were limited, with dialysis being particularly burdensome to patients. HCPs were hopeful about future treatment options. Caregivers reported that they provided physical and psychological support and advocated for their patient. Caregiving had a substantial impact on the caregiver's mental wellbeing.</p><p><strong>Conclusions: </strong>Overall, C3G/primary IC-MPGN presented a substantial burden to patients and caregivers, with a need for timely diagnosis, psychological support for patients and caregivers, improved HCP-patient communication, and treatments which target the cause of C3G/primary IC-MPGN to stabilize the disease.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1770706"},"PeriodicalIF":2.9,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201302","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":"Use of oXiris^® vs standard AN69ST filters in sepsis-associated acute kidney injury requiring continuous renal replacement therapy: a retrospective matched cohort study.","authors":"David Yepes Gómez, Sara Moreno-Bedoya, Sofía Lohle-Rueda, Juan Rodrigo Moreno-Restrepo, María Palacio-Muñoz, Nicolás Gómez-Correa, Andrea Sierra Ramirez, María Camila Salazar Agudelo, Esteban Villegas-Arbeláez","doi":"10.3389/fneph.2026.1810007","DOIUrl":"10.3389/fneph.2026.1810007","url":null,"abstract":"<p><strong>Background: </strong>Sepsis-associated acute kidney injury (SA-AKI) is common in critically ill patients and carries high short-term mortality despite timely antimicrobials and organ support. Adsorptive hemofilters such as the oXiris^® membrane have been proposed as adjuncts during continuous renal replacement therapy (CRRT), but their patient-centered benefit remains uncertain.</p><p><strong>Methods: </strong>We performed a retrospective matched cohort study within a dynamic cohort of consecutive adults with septic shock and SA-AKI requiring CRRT in a tertiary ICU in Medellín, Colombia (November 2020 - May 2023). Exposure was the hemofilter used at CRRT initiation (oXiris^® vs standard AN69ST). Patients were matched 2:1 without replacement using nearest-neighbor propensity scores based on age, Sequential Organ Failure Assessment (SOFA) score at ICU admission, time from ICU admission to CRRT initiation, and infection source. The primary outcome was 28-day all-cause mortality from ICU admission. Secondary outcomes included ventilator-free days and ICU-free days at day 28, CRRT duration, and ICU length of stay. Prespecified sensitivity analyses excluded COVID-19 cases and used inverse probability of treatment weighting (IPTW). Exploratory analyses assessed early changes in SOFA, lactate, PaO2/FiO2, mean arterial pressure, vasopressor dose, and C-reactive protein.</p><p><strong>Results: </strong>After matching, 81 patients were included (53 standard filters and 28 oXiris^®); 3 oXiris^®- patients were unmatched. Twenty-eight-day mortality was 69.8% (37/53) with standard filters and 67.9% (19/28) with oXiris^®. The adjusted risk ratio (RR) for oXiris^® was 0.95 (95% CI, 0.71-1.28; P = 0.76), with an absolute risk difference of -2.0% (95% CI, -23.2% to 19.3%). After excluding COVID-19 cases (n = 61), the adjusted RR was 1.05 (95% CI, 0.71-1.54; P = 0.81). IPTW analyses were directionally similar but considered secondary. Early physiologic changes showed no clear between-group differences.</p><p><strong>Conclusions: </strong>In adults with septic shock and SA-AKI requiring CRRT, oXiris^® use was not associated with lower 28-day mortality compared with standard AN69ST filters. Secondary and exploratory finding should be interpreted cautiously given residual confounding and data limitations. Randomized trials with standardized protocols are needed to identify potential benefiting subgroups.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1810007"},"PeriodicalIF":2.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13201489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148045008","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":"Efficacy and safety of finerenone in chronic kidney disease stages 3-4 in diabetic and non-diabetic patients with an eGFR 20-60 mL/min: a prospective cohort study.","authors":"Hayder Aledan, Ammar Salih Abbood","doi":"10.3389/fneph.2026.1716452","DOIUrl":"10.3389/fneph.2026.1716452","url":null,"abstract":"<p><strong>Background: </strong>Finerenone, when added to the standard-of-care treatment for chronic kidney disease (CKD), can effectively slow its progression. While previous trials have primarily focused on patients with diabetic kidney disease and an estimated glomerular filtration rate (eGFR) above 25 ml/min, this study aimed to evaluate the efficacy and safety of finerenone in patients with CKD stage 3-4, encompassing both diabetic and non-diabetic patients with an eGFR ranging from 20 to 60 ml/min.</p><p><strong>Methods: </strong>This prospective cohort study included 180 patients with CKD stage 3-4, including diabetic and non-diabetic participants. These patients had an eGFR of 20-60 ml/min and an urinary albumin-to-creatinine ratio (UACR) higher than 30 mg/g. The study was conducted between January 2023 and June 2024 at the Basra Nephrology and Transplantation Center and Private Clinic.</p><p><strong>Results: </strong>Finerenone showed statistically significant improvements in eGFR and UACR over a one-year period among all patient groups, including the subgroup of non-diabetic patients and patients with an eGFR between 20 and 25 ml/min (P < 0.001). Importantly, finerenone did not elevate serum potassium levels. The study population had a mean age of 61.67 ± 13.37 years, 50.6% aweremen,78% awerewdiabetic,22% awerewnon-diabeticand 65 (36%) hhadFR of 20-25 ml/min.</p><p><strong>Conclusions: </strong>Finerenone is a safe and effective approach for slowing the progression of CKD in patients with an eGFR > 20 ml/min and moderately to severely increased albuminuria, regardless of diabetes status.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1716452"},"PeriodicalIF":2.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13194097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148019144","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":"A new perspective on the pathophysiology of kidney diseases: the intracellular complement system- \"complosome\".","authors":"Emre Leventoğlu, Sevcan A Bakkaloğlu","doi":"10.3389/fneph.2026.1741099","DOIUrl":"10.3389/fneph.2026.1741099","url":null,"abstract":"<p><p>The complement cascade is a vital component of the innate immune system. It consists of around 50 proteins, including circulating complement proteins and membrane-bound receptors. It operates through three main activation pathways: classical, lectin, and alternative. Dysregulation of the complement system is implicated in several kidney diseases, such as complement-mediated thrombotic microangiopathy, lupus nephritis (LN), C3 glomerulopathy and kidney transplantation. The complement system also extends beyond immune responses, influencing cellular processes through the \"complosome\" - an intracellular system that regulates metabolism, autophagy, and gene expression. This intracellular complement activity has been linked to kidney diseases, including glomerular and tubular injuries and renal cancer. As research progresses, targeting both extracellular and intracellular complement components holds promise for more effective treatments in complement -driven diseases. In this mini review, the role of the complement system in immune defense, the impact of the alternative pathway in kidney diseases, and the relationship between intracellular complement activity -complosome- and cellular functions have been discussed. Additionally, new approaches for the treatment of complement dysregulation have been explored.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1741099"},"PeriodicalIF":2.9,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13167706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful reintegration of a very elderly patient with rapidly progressive glomerulonephritis due to microscopic polyangiitis after multidisciplinary treatment: a case report.","authors":"Tatsuo Tsukamoto, Yui Fukuda, Kaoru Ohue, Atsuto Niwa, Sanae Ogura, Takuya Ishimura, Takaya Handa, Tomomi Endo, Takeshi Matsubara","doi":"10.3389/fneph.2026.1803876","DOIUrl":"10.3389/fneph.2026.1803876","url":null,"abstract":"<p><p>ANCA (anti-neutrophil cytoplasmic antibody)-associated vasculitis (AAV) is known to cause rapidly progressive renal dysfunction, as well as high mortality, especially in older patients. In Japan, a high prevalence of microscopic polyangiitis (MPA) with myeloperoxidase (MPO)-ANCA among older patients has been reported; however, standard immunosuppressive therapy does not always lead to improved outcomes in this population. Here we report the case of a 93-year-old woman who developed rapidly progressive glomerulonephritis (RPGN) due to MPA and successfully returned home after multidisciplinary treatment. She was transferred from another hospital because of antibiotic-refractory fever. Serological testing revealed MPO-ANCA positivity and a renal biopsy demonstrated crescentic glomerulonephritis. She was diagnosed with RPGN due to MPA and was initiated on standard glucocorticoid therapy, despite her advanced age. Because of severe disease activity complicated by diffuse alveolar hemorrhage, noninvasive positive pressure ventilation, rituximab, avacopan, and plasma exchange combined with hemodialysis were introduced. This multidisciplinary approach successfully induced remission of her AAV with partial recovery of renal function. After rehabilitation for mobilization, the patient was discharged home. She currently attends outpatient follow-up independently without assistance. Although very elderly patients are often excluded from clinical trials, resulting in limited evidence regarding the efficacy and safety of therapeutic agents, appropriately dose-adjusted multidisciplinary treatment based on overall clinical conditions may improve outcomes, even in this population.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1803876"},"PeriodicalIF":2.9,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13161105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147936154","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":"Telemonitoring post-renal transplantation and role of advanced practice nurses: a single center experience.","authors":"Delphine Bailly, Maher Abdessater, Ramy Touma Sawaya, Benoit Barrou, Sarah Drouin","doi":"10.3389/fneph.2026.1776371","DOIUrl":"10.3389/fneph.2026.1776371","url":null,"abstract":"<p><strong>Introduction: </strong>Telemonitoring has the potential to improve access to care and continuity of follow-up after kidney transplantation. Advanced practice nurses (APNs) play an increasingly important role in coordinating remote care pathways. This study evaluated patient experience with telemonitoring after renal transplantation, identified determinants of adherence, and clarified the role of APNs in this model.</p><p><strong>Methods: </strong>We conducted a single-center retrospective observational study including adult kidney transplant recipients enrolled in a telemonitoring program between April 2020 and April 2022. Patients were classified as active users (TOUCO), discontinued users (STOPCO), or never users (JAMCO). Satisfaction and experience were assessed through questionnaires. Platform activity and APN workload were analyzed using descriptive statistics.</p><p><strong>Results: </strong>Among 207 eligible patients, 110 responded to the survey (53%): 64 TOUCO (71%), 11 STOPCO (47%), and 35 JAMCO (37%). Active users reported high satisfaction with response time (89%), improved access to care (81%), and increased reassurance (75%). Ease of use (86%) and adequate information at enrollment were significantly associated with continued use. Major barriers included technical difficulties (≈80%) and loss of login credentials (>50%). During the study period, 5,214 platform events and more than 4,000 secure messages were recorded, reflecting sustained engagement. APNs required a mean workload of 3 hours per day to manage all active users on a daily basis.</p><p><strong>Conclusion: </strong>Telemonitoring after kidney transplantation is feasible and well accepted, improving perceived access to care and enhancing patient reassurance without measured clinical outcome differences. Adherence is driven primarily by organizational and technological factors rather than patient characteristics. APNs play a central role in ensuring continuity of care, triaging data, and maintaining patient engagement. Future studies should evaluate clinical outcomes and cost-effectiveness to support broader implementation.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"6 ","pages":"1776371"},"PeriodicalIF":2.9,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13104594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790568","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}