Frontiers in nephrology最新文献

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Characterization of patients with IgA nephropathy with and without associated minimal change disease. 伴有或不伴有微小病变的IgA肾病患者的特征
Frontiers in nephrology Pub Date : 2023-01-01 DOI: 10.3389/fneph.2023.1105933
Wei-Yi Guo, Li-Jun Sun, Hong-Rui Dong, Guo-Qin Wang, Xiao-Yi Xu, Wen-Rong Cheng, Zhi-Rui Zhao, Nan Ye, Yun Liu, Hong Cheng
{"title":"Characterization of patients with IgA nephropathy with and without associated minimal change disease.","authors":"Wei-Yi Guo,&nbsp;Li-Jun Sun,&nbsp;Hong-Rui Dong,&nbsp;Guo-Qin Wang,&nbsp;Xiao-Yi Xu,&nbsp;Wen-Rong Cheng,&nbsp;Zhi-Rui Zhao,&nbsp;Nan Ye,&nbsp;Yun Liu,&nbsp;Hong Cheng","doi":"10.3389/fneph.2023.1105933","DOIUrl":"https://doi.org/10.3389/fneph.2023.1105933","url":null,"abstract":"<p><strong>Introduction: </strong>Immunoglobulin A nephropathy (IgAN) presents various clinical manifestations and pathological phenotypes. Approximately 5% of patients with IgAN present with early onset nephrotic syndrome, mild mesangial lesions, and diffuse foot process effacement of podocytes, which resemble minimal change disease (MCD). These patients are defined as MCD-IgAN. Whether MCD-IgAN is a special type of IgAN or simply MCD accompanied by IgA deposition remains controversial.</p><p><strong>Methods: </strong>A total of 51 patients diagnosed with MCD-IgAN at Beijing Anzhen Hospital from January 2010 to September 2022 were recruited. The clinical and pathological characteristics of IgA-MCD were analyzed. Patients with IgAN but without MCD (non-MCD-IgAN) and healthy participants were enrolled as controls. Galactose-deficient immunoglobulin A1 (Gd-IgA1) and complement C3 were detected both in the circulation and in renal tissues.</p><p><strong>Results: </strong>We found that the levels of serum Gd-IgA1 were lower in participants with MCD-IgAN than in those with non-MCD-IgAN, but higher than in healthy participants. Gd-IgA1 was rarely deposited in the glomeruli of participants with MCD-IgAN, with a positive rate of only 13.7% (7/51); in contrast, the positive rate in participants with non-MCD-IgAN was 82.4% (42/51). Among renal Gd-IgA1-positive patients, Gd-IgA1 and immunoglobulin A (IgA) colocalized along the glomerular mesangial and capillary areas. Interestingly, we found that the circulating levels of complement C3 were significantly higher in participants with MCD-IgAN than in participants with non-MCD-IgAN. In addition, the intensity of C3c in glomeruli in participants with MCD-IgAN was significantly weaker than in participants with non-MCD-IgAN.</p><p><strong>Conclusions: </strong>Our study suggests that, in MCD-IgAN, most of the IgA that is deposited on glomeruli is not the same pathogenic Gd-IgA1 as found in general IgAN. Complement activation both in the circulation and in the renal locality was much weaker in MCD-IgAN than in non-MCD-IgAN. Our study suggests that IgAN with MCD might be MCD with coincidental IgA deposition.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1105933"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10179973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hedgehog-GLI mediated control of renal formation and malformation. 刺猬- gli介导的肾脏形成和畸形的控制。
Frontiers in nephrology Pub Date : 2023-01-01 DOI: 10.3389/fneph.2023.1176347
Dina Greenberg, Robert D'Cruz, Jon L Lacanlale, Christopher J Rowan, Norman D Rosenblum
{"title":"Hedgehog-GLI mediated control of renal formation and malformation.","authors":"Dina Greenberg,&nbsp;Robert D'Cruz,&nbsp;Jon L Lacanlale,&nbsp;Christopher J Rowan,&nbsp;Norman D Rosenblum","doi":"10.3389/fneph.2023.1176347","DOIUrl":"https://doi.org/10.3389/fneph.2023.1176347","url":null,"abstract":"<p><p>CAKUT is the leading cause of end-stage kidney disease in children and comprises a broad spectrum of phenotypic abnormalities in kidney and ureter development. Molecular mechanisms underlying the pathogenesis of CAKUT have been elucidated in genetic models, predominantly in the mouse, a paradigm for human renal development. Hedgehog (Hh) signaling is critical to normal embryogenesis, including kidney development. Hh signaling mediates the physiological development of the ureter and stroma and has adverse pathophysiological effects on the metanephric mesenchyme, ureteric, and nephrogenic lineages. Further, disruption of Hh signaling is causative of numerous human developmental disorders associated with renal malformation; Pallister-Hall Syndrome (PHS) is characterized by a diverse spectrum of malformations including CAKUT and caused by truncating variants in the middle-third of the Hh signaling effector GLI3. Here, we outline the roles of Hh signaling in regulating murine kidney development, and review human variants in Hh signaling genes in patients with renal malformation.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1176347"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10179978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
A randomized controlled trial of preemptive rituximab to prevent recurrent focal segmental glomerulosclerosis post-kidney transplant (PRI-VENT FSGS): protocol and study design. 预防性利妥昔单抗预防肾移植后复发局灶节段性肾小球硬化(PRI-VENT FSGS)的随机对照试验:方案和研究设计
Frontiers in nephrology Pub Date : 2023-01-01 DOI: 10.3389/fneph.2023.1181076
Michelle N Rheault, Sandra Amaral, Margret Bock, Eileen Tsai Chambers, Blanche Chavers, Mireile El Ters, Rouba Garro, Rasheed Gbadegesin, Amit Govil, Lyndsay Harshman, Hatem Amer, David K Hooper, Ajay K Israni, Samy Riad, Junichiro Sageshima, Ron Shapiro, Michael Seifert, Jodi Smith, Randall Sung, Christie P Thomas, Qi Wang, Priya S Verghese
{"title":"A randomized controlled trial of preemptive rituximab to prevent recurrent focal segmental glomerulosclerosis post-kidney transplant (PRI-VENT FSGS): protocol and study design.","authors":"Michelle N Rheault,&nbsp;Sandra Amaral,&nbsp;Margret Bock,&nbsp;Eileen Tsai Chambers,&nbsp;Blanche Chavers,&nbsp;Mireile El Ters,&nbsp;Rouba Garro,&nbsp;Rasheed Gbadegesin,&nbsp;Amit Govil,&nbsp;Lyndsay Harshman,&nbsp;Hatem Amer,&nbsp;David K Hooper,&nbsp;Ajay K Israni,&nbsp;Samy Riad,&nbsp;Junichiro Sageshima,&nbsp;Ron Shapiro,&nbsp;Michael Seifert,&nbsp;Jodi Smith,&nbsp;Randall Sung,&nbsp;Christie P Thomas,&nbsp;Qi Wang,&nbsp;Priya S Verghese","doi":"10.3389/fneph.2023.1181076","DOIUrl":"https://doi.org/10.3389/fneph.2023.1181076","url":null,"abstract":"<p><strong>Background: </strong>Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage kidney disease requiring kidney transplantation and can recur in the allograft in 30-80% of recipients resulting in reduced graft survival. Plasmapheresis has shown efficacy in treating some cases of recurrent FSGS but isolated plasmapheresis has not demonstrated efficacy in preventing recurrent FSGS. Rituximab has had anecdotal success in preventing recurrence in a single center study but has not been studied in combination with plasmapheresis for preventing FSGS recurrence.</p><p><strong>Methods: </strong>We are conducting a randomized, controlled, multicenter clinical trial of adult and pediatric kidney transplant recipients with primary FSGS to assess whether plasmapheresis in combination with rituximab prevents recurrent disease post-transplantation.</p><p><strong>Discussion: </strong>Rituximab combined with plasmapheresis is a promising, novel therapy to prevent recurrent FSGS, a disease with limited therapeutic options and no consensus guidelines for prevention or treatment.</p><p><strong>Clinical trial registration: </strong>https://clinicaltrials.gov/ct2/show/NCT03763643, identifier NCT03763643.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1181076"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10171639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Plant-derived compounds for treating autosomal dominant polycystic kidney disease. 植物源性化合物治疗常染色体显性多囊肾病。
Frontiers in nephrology Pub Date : 2023-01-01 DOI: 10.3389/fneph.2023.1071441
Jieting Zhang, Jiaxin Chen, Jing Xu, Cheng Xue, Zhiguo Mao
{"title":"Plant-derived compounds for treating autosomal dominant polycystic kidney disease.","authors":"Jieting Zhang,&nbsp;Jiaxin Chen,&nbsp;Jing Xu,&nbsp;Cheng Xue,&nbsp;Zhiguo Mao","doi":"10.3389/fneph.2023.1071441","DOIUrl":"https://doi.org/10.3389/fneph.2023.1071441","url":null,"abstract":"<p><p>Autosomal dominant polycystic kidney disease (ADPKD), the most common monogenic hereditary kidney disease, is the fourth leading cause of end-stage kidney disease worldwide. In recent years, significant progress has been made in delaying ADPKD progression with different kinds of chemical drugs, such as tolvaptan, rapamycin, and somatostatin. Meanwhile, numerous plant-derived compounds have been investigated for their beneficial effects on slowing ADPKD progression. Among them, saikosaponin-d, <i>Ganoderma</i> triterpenes, curcumin, ginkgolide B, steviol, resveratrol, <i>Sparganum stoloniferum</i> Buch.-Ham, <i>Cordyceps sinensis</i>, triptolide, quercitrin, naringin, cardamonin, gambogic acid, and olive leaf extract have been found to retard renal cyst development by inhibiting cell proliferation or promoting cell apoptosis in renal cyst-lining epithelial cells. Metformin, a synthesized compound derived from French lilac or goat's rue (<i>Galega officinalis</i>), has been proven to retard the progression of ADPKD. This review focuses on the roles and mechanisms of plant-derived compounds in treating ADPKD, which may constitute promising new therapeutics in the future.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1071441"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10551190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Frailty as a dynamic process in a diverse cohort of older persons with dialysis-dependent CKD. 衰弱是透析依赖性CKD老年人不同队列中的动态过程。
Frontiers in nephrology Pub Date : 2023-01-01 DOI: 10.3389/fneph.2023.1031338
Nancy G Kutner, Rebecca Zhang
{"title":"Frailty as a dynamic process in a diverse cohort of older persons with dialysis-dependent CKD.","authors":"Nancy G Kutner,&nbsp;Rebecca Zhang","doi":"10.3389/fneph.2023.1031338","DOIUrl":"https://doi.org/10.3389/fneph.2023.1031338","url":null,"abstract":"<p><p>This study examines frailty status evolution observed in a two-year follow-up of a cohort of older persons (age ≥65) with chronic kidney disease (CKD) undergoing maintenance hemodialysis (HD) treatment. Frailty, a geriatric syndrome that connotes a state of low physiologic reserve and vulnerability to stressors, is associated with increased risk for multiple adverse health outcomes in studies of persons with CKD as well as older persons in the general population. The Fried frailty index defines frailty as the presence of 3 or more of 5 indicators-recent unintentional weight loss, slowed gait speed, decreased muscle strength, self-reported exhaustion, and low physical activity. In the seminal work by Fried and colleagues, persons who were characterized by 1-2 of the Fried index criteria were termed \"pre-frail\" and considered at risk for subsequently becoming frail, potentially providing insight regarding intervention targets that might slow or prevent individuals' transition from pre-frail to frail status. Other less frequently studied types of transitions may also be informative, including \"recovery or reversion\" (improvement) by people whose longitudinal assessments indicate movement from frailty to prefrailty or robust, or from prefrailty to robust. These status changes are also a potential source of insights relevant for prevention or remediation of frailty, but research focusing on the various ways that individuals may transition between frailty states over time remains limited, and no previous research has examined varying patterns of frailty status evolution in an older cohort of persons with dialysis-dependent CKD. In a study cohort of dialysis-dependent older persons, we characterized patterns of frailty status evolution by age, sex, race/ethnicity, and treatment vintage; by longitudinal profiles of non-sedentary behavior; and by self-report indicators relevant for dimensions emphasized in the Age-Friendly 4Ms Health System (What Matters, Mobility, Mentation). Our study suggests that strategies to promote resiliency among older persons with dialysis-dependent CKD can be informed not only by frailty status transition that indicates improvement over time but also by older adults' maintenance of (stable) robust status over time, and we concur that inclusion of both frailty and resilience measures is needed in future longitudinal studies and clinical trials.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1031338"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10179972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Insulin and the kidneys: a contemporary view on the molecular basis. 胰岛素与肾脏:分子基础的当代观点。
Frontiers in nephrology Pub Date : 2023-01-01 DOI: 10.3389/fneph.2023.1133352
Rodrigo Daza-Arnedo, Jorge Rico-Fontalvo, Gustavo Aroca-Martínez, Tomás Rodríguez-Yanez, María Cristina Martínez-Ávila, Amilkar Almanza-Hurtado, María Cardona-Blanco, Carlos Henao-Velásquez, Jorge Fernández-Franco, Mario Unigarro-Palacios, Carolina Osorio-Restrepo, Isabella Uparella-Gulfo
{"title":"Insulin and the kidneys: a contemporary view on the molecular basis.","authors":"Rodrigo Daza-Arnedo,&nbsp;Jorge Rico-Fontalvo,&nbsp;Gustavo Aroca-Martínez,&nbsp;Tomás Rodríguez-Yanez,&nbsp;María Cristina Martínez-Ávila,&nbsp;Amilkar Almanza-Hurtado,&nbsp;María Cardona-Blanco,&nbsp;Carlos Henao-Velásquez,&nbsp;Jorge Fernández-Franco,&nbsp;Mario Unigarro-Palacios,&nbsp;Carolina Osorio-Restrepo,&nbsp;Isabella Uparella-Gulfo","doi":"10.3389/fneph.2023.1133352","DOIUrl":"https://doi.org/10.3389/fneph.2023.1133352","url":null,"abstract":"<p><p>Insulin is a hormone that is composed of 51 amino acids and structurally organized as a hexamer comprising three heterodimers. Insulin is the central hormone involved in the control of glucose and lipid metabolism, aiding in processes such as body homeostasis and cell growth. Insulin is synthesized as a large preprohormone and has a leader sequence or signal peptide that appears to be responsible for transport to the endoplasmic reticulum membranes. The interaction of insulin with the kidneys is a dynamic and multicenter process, as it acts in multiple sites throughout the nephron. Insulin acts on a range of tissues, from the glomerulus to the renal tubule, by modulating different functions such as glomerular filtration, gluconeogenesis, natriuresis, glucose uptake, regulation of ion transport, and the prevention of apoptosis. On the other hand, there is sufficient evidence showing the insulin receptor's involvement in renal functions and its responsibility for the regulation of glucose homeostasis, which enables us to understand its contribution to the insulin resistance phenomenon and its association with the progression of diabetic kidney disease.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1133352"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10179974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
External ureteric stent versus internal double J stent in kidney transplantation: a retrospective analysis on the incidence of urological complications and urinary tract infections. 输尿管外支架与肾移植内双J支架:泌尿系统并发症和尿路感染发生率的回顾性分析。
Frontiers in nephrology Pub Date : 2023-01-01 DOI: 10.3389/fneph.2023.1130672
Ietje T Hazenberg, Stephanie J M Middelkoop, Anoek A E de Joode, Juliette D Rabbeljee, Robert A Pol, Benjamin H J Doornweerd, Jan-Stephan F Sanders, Coen A Stegeman
{"title":"External ureteric stent versus internal double J stent in kidney transplantation: a retrospective analysis on the incidence of urological complications and urinary tract infections.","authors":"Ietje T Hazenberg,&nbsp;Stephanie J M Middelkoop,&nbsp;Anoek A E de Joode,&nbsp;Juliette D Rabbeljee,&nbsp;Robert A Pol,&nbsp;Benjamin H J Doornweerd,&nbsp;Jan-Stephan F Sanders,&nbsp;Coen A Stegeman","doi":"10.3389/fneph.2023.1130672","DOIUrl":"https://doi.org/10.3389/fneph.2023.1130672","url":null,"abstract":"<p><strong>Introduction: </strong>Urologic complications (UCs) and urinary tract infections (UTIs) are common after kidney transplantation. Intraoperative stent placement at the vesicoureteric anastomosis reduces UC risk, but increases UTI risk.</p><p><strong>Methods: </strong>In 2014 our stenting protocol changed from external ureteric stent (ES) to internal double J stent (DJ). We retrospectively studied the occurrence of UCs and UTIs in relation to ES or DJ in 697 kidney recipients.</p><p><strong>Methods: </strong>An ES was used in 403 patients (57.8%), in 294 (42.2%) a DJ. ES was removed 7-12 days and DJ 3-4 weeks post-operative. Induction immunosuppression was the same in both groups. Primary outcomes at 6 months follow-up were UC (urinary leakage/ureter stenosis) and UTI; they were related to stenting procedure and clinical and transplant characteristics. The incidence of UCs was similar for ES (8.4%) and DJ (6.8%), p=0.389. ES use was a significant risk factor for UTI (OR 1.69 (1.15-2.50), p=0.008). Post-transplant hospitalization was significantly shorter in the DJ group. Despite more acute rejection episodes with ES (ES/DJ: 16.4%/6.1%, p<0.001), no clinical relevant differences in graft outcomes existed.</p><p><strong>Discussion: </strong>A DJ is, compared to ES, associated with a lower incidence of UTIs and comparable occurrence of UCs and is therefore the preferred technique for stenting the vesicoureteric anastomosis.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1130672"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10551192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk factors for infection in patients with a failed kidney allograft on immunosuppressive medications. 免疫抑制药物治疗的异体肾移植失败患者感染的危险因素。
Frontiers in nephrology Pub Date : 2023-01-01 DOI: 10.3389/fneph.2023.1149116
Lauren Ogawa, Omer E Beaird, Joanna M Schaenman
{"title":"Risk factors for infection in patients with a failed kidney allograft on immunosuppressive medications.","authors":"Lauren Ogawa,&nbsp;Omer E Beaird,&nbsp;Joanna M Schaenman","doi":"10.3389/fneph.2023.1149116","DOIUrl":"https://doi.org/10.3389/fneph.2023.1149116","url":null,"abstract":"<p><p>Patients with a failing kidney allograft are often continued on immunosuppression (IS) to preserve residual kidney function and prevent allosensitization. It has been previously accepted that maintaining patients on immunosuppressive therapy results in an increased risk of infection, hospitalization, and mortality. However, as the management of IS in patients with a failed kidney allograft continues to evolve, it is important to review the data regarding associations between infection and specific immunosuppression regimens. We present a review of the literature of failed kidney allograft management and infection risk, and discuss practices for infection prevention. Fifteen studies, published from 1995 to 2022, which investigated the experience of patients with failed allograft and infection, were identified. Infection was most commonly documented as a general event, but when specified, included infections caused by <i>Candida</i>, <i>Mycobacterium tuberculosis</i>, and <i>Aspergillus.</i> In addition, the definition of reduced \"IS\" varied from decreased doses of a triple drug regimen to monotherapy, whereas others did not specify which medications patients were receiving. Despite attempts at lowering net immunosuppression, patients with failed allografts remain at risk of acquiring opportunistic and non-opportunistic infections. Although opportunistic infections secondary to IS are expected, somewhat surprisingly, it appears that the greatest risk of infection may be related to complications of dialysis. Therefore, mitigating strategies, such as planning for an arteriovenous (AV) fistula over a hemodialysis catheter placement, may reduce infection risk. Additional studies are needed to provide more information regarding the types and timing of infection in the setting of a failed kidney allograft. In addition, more data are needed regarding specific medications, doses, and timing of taper of IS to guide future patient management and inform strategies for infection surveillance and prophylaxis.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1149116"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10533789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Digital health technology to support care and improve outcomes of chronic kidney disease patients: as a case illustration, the Withings toolkit health sensing tools. 数字卫生技术支持护理和改善慢性肾脏疾病患者的结果:作为一个案例说明,Withings工具包健康感知工具。
Frontiers in nephrology Pub Date : 2023-01-01 DOI: 10.3389/fneph.2023.1148565
Bernard Canaud, Jeroen Kooman, Andrew Davenport, David Campo, Eric Carreel, Marion Morena-Carrere, Jean-Paul Cristol
{"title":"Digital health technology to support care and improve outcomes of chronic kidney disease patients: as a case illustration, the Withings toolkit health sensing tools.","authors":"Bernard Canaud,&nbsp;Jeroen Kooman,&nbsp;Andrew Davenport,&nbsp;David Campo,&nbsp;Eric Carreel,&nbsp;Marion Morena-Carrere,&nbsp;Jean-Paul Cristol","doi":"10.3389/fneph.2023.1148565","DOIUrl":"https://doi.org/10.3389/fneph.2023.1148565","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) is a major burden in dialysis-dependent chronic kidney disease (CKD5D) patients. Several factors contribute to this vulnerability including traditional risk factors such as age, gender, life style and comorbidities, and non-traditional ones as part of dialysis-induced systemic stress. In this context, it appears of utmost importance to bring a closer attention to CVD monitoring in caring for CKD5D patients to ensure early and appropriate intervention for improving their outcomes. Interestingly, new home-used, self-operated, connected medical devices offer convenient and new tools for monitoring in a fully automated and ambulatory mode CKD5D patients during the interdialytic period. Sensoring devices are installed with WiFi or Bluetooth. Some devices are also available in a cellular version such as the Withings Remote Patient Monitoring (RPM) solution. These devices analyze the data and upload the results to Withings HDS (Hybrid data security) platform servers. Data visualization can be viewed by the patient using the Withings Health Mate application on a smartphone, or with a web interface. Health Care Professionals (HCP) can also visualize patient data <i>via</i> the Withings web-based RPM interface. In this narrative essay, we analyze the clinical potential of pervasive wearable sensors for monitoring ambulatory dialysis patients and provide an assessment of such toolkit digital medical health devices currently available on the market. These devices offer a fully automated, unobtrusive and remote monitoring of main vital functions in ambulatory subjects. These unique features provide a multidimensional assessment of ambulatory CKD5D patients covering most physiologic functionalities, detecting unexpected disorders (i.e., volume overload, arrhythmias, sleep disorders) and allowing physicians to judge patient's response to treatment and recommendations. In the future, the wider availability of such pervasive health sensing and digital technology to monitor patients at an affordable cost price will improve the personalized management of CKD5D patients, so potentially resulting in improvements in patient quality of life and survival.</p>","PeriodicalId":73091,"journal":{"name":"Frontiers in nephrology","volume":"3 ","pages":"1148565"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10237264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Editorial: Global excellence in nephrology: Asia and Australasia. 社论:全球卓越肾病学:亚洲和澳大拉西亚。
Frontiers in nephrology Pub Date : 2023-01-01 DOI: 10.3389/fneph.2023.1248728
Cheng Xue, Mingxi Li, Suxia Wang
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