American Journal of Kidney Diseases最新文献

{"title":"Joint Impact of Aldosterone and Low-Density Lipoprotein Cholesterol on Cardiovascular Risk in CKD.","authors":"Melinda Solomon, Anand Vaidya, Sushrut S Waikar, Ashish Verma","doi":"10.1053/j.ajkd.2026.06.009","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.06.009","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor Self-Esteem Before and After Living Kidney Donation.","authors":"Ruth Neumann, Jennifer B Arnold, Neil Boudville, Meaghan S Cuerden, Mary Amanda Dew, Christine Dipchand, Liane S Feldman, John S Gill, Martin Karpinski, Scott Klarenbach, Greg A Knoll, Charmaine Lok, Matthew Miller, Mauricio Monroy-Caudros, Kyla L Naylor, Chris Nguan, G V Ramesh Prasad, Jessica M Sontrop, Leroy Storsley, Katryna Stronks, Amit X Garg","doi":"10.1053/j.ajkd.2026.05.023","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.05.023","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Most living kidney donors report normal-to-high self-esteem before donation. Less is known about the longer-term effects of donation on self-esteem, whether certain pre-donation characteristics are associated with lower self-esteem after donation, or how changes in self-esteem are associated with changes in symptoms of depression and anxiety.</p><p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Setting & participants: </strong>Living kidney donors (n=941) were enrolled before donation from 12 Canadian and 5 Australian transplant centers between 2009 and 2014.</p><p><strong>Exposure: </strong>Living kidney donation.</p><p><strong>Outcomes: </strong>Self-reported self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES) before donation, 3 months after donation, and then annually for 5 years or until the last follow-up visit (possible scores range from 0-30, with higher scores indicating higher self-esteem). Donors also completed the Beck Depression and Anxiety Inventories at these timepoints.</p><p><strong>Analytical approach: </strong>Linear and modified Poisson regression models were used to examine whether pre-donation characteristics were associated with lower self-esteem after donation and if changes in self-esteem were associated with changes in symptoms of depression and anxiety.</p><p><strong>Results: </strong>Nearly all donors (98.6%) reported normal-to-high self-esteem before donating (928/941), and only 2-4% had low self-esteem in follow-up (RSES scores <15). On average, donors had a less than 1-point decrement in average self-esteem between pre-donation and follow-up measurements; while these changes were statistically significant, they were not clinically meaningful (all mean changes <5). Donors with RSES scores ≤20 before donation had an approximate 2-point increase in self-esteem in follow-up (P <0.001). More symptoms of depression before donation were associated with lower self-esteem scores 3 months after donation (P = 0.006). An increase in self-esteem scores after donation was associated with concurrent reductions in symptoms of depression and anxiety (P <0.001).</p><p><strong>Limitations: </strong>We did not examine the association of early recipient allograft failure or death with donor self-esteem.</p><p><strong>Conclusions: </strong>In this multicenter study of living kidney donors, nearly all donors reported normal-to-high self-esteem before donation and during five years of follow-up. On average, donors with lower self-esteem before donation had a modest increase in self-esteem after donation. Increases in self-esteem after donation were accompanied by modest reductions in symptoms of depression and anxiety.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"12-year Follow-up of a Family With CKD Caused by an mtDNA Variant.","authors":"Lanping Jiang, Zhanmei Zhou, Shaozhen Feng, Liutao Huang, Xinjin Zhou, Shicong Yang, Yaqiong Wang, Yaoling Huang, Xu Miao, Qinghua Liu, Yi Zhou, Haiping Mao, Xiao Yang, Qiongqiong Yang, Fengxian Huang, Huafeng Liu, Wei Chen, Jianwen Yu, Wenfang Chen, Qunying Guo","doi":"10.1053/j.ajkd.2026.05.022","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.05.022","url":null,"abstract":"<p><p>While a few studies have investigated renal manifestations associated with mitochondrial DNA (mtDNA) mutations, detailed renal histopathological changes and long-term outcomes remain poorly characterized. This study reported a family in which all the five siblings presented with hyperuricemia and chronic kidney disease (CKD); the proband died of kidney failure at 16 years of age, while both parents were unaffected. Renal histology from three siblings revealed multiple foci of sclerotic and atubular glomeruli, as well as focal tubular atrophy, making early pathological diagnosis challenging. Ten years later, whole-exome sequencing identified an m.616T>C mutation in the MT-TF gene of mtDNA, confirming the diagnosis of mitochondrial tubulointerstitial kidney disease and demonstrating mitochondrial abnormalities in the distal tubules and collecting duct. Over a 12-year follow-up period, one patient died of kidney failure, one required dialysis, two progressed from CKD stage G2 to G4, and one remained stable at CKD stage G3. This 12-year study of a family with MT-TF m.616T>C-associated mitochondrial tubulointerstitial kidney disease highlights the relative homogeneity of renal pathology alongside marked heterogeneity in long-term outcomes, despite an identical genetic background.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Understanding of Long-Term Living Kidney Donor Risks.","authors":"John S Gill, Darragh O'Donoghue","doi":"10.1053/j.ajkd.2026.05.021","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.05.021","url":null,"abstract":"<p><p>Expansion of living kidney donation is needed to meet the increasing global need for kidney replacement therapy. Advances in the understanding of post donation health outcomes have confirmed that living donation in carefully selected donors is associated with low absolute risk of kidney failure of 50 per 10,000 after 20 years. However, information about lifetime risks, heterogeneity of risk, and the long-term safety of donors with pre-donation or post-donation chronic kidney disease (CKD) risk factors remains incomplete. This uncertainty likely contributes to the global stagnation in living donor kidney transplantation. This review outlines the evolution of living kidney donor risk assessment including the exclusion of hyperfiltration injury as a significant contributor to kidney failure after donation and the importance of post-donation CKD risk factor and acute kidney injury as key determinants of post-donation kidney health. Given the low absolute risk of kidney failure the review will identify policy and practice considerations needed to safely expand living kidney donation. Dedicated funding for post donation care to ensure the optimal management of conditions that might compromise post donation kidney function, and to facilitate the ascertainment of information to better inform current and future living kidney donors should be prioritized.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148756909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood Pressure, Kidney Function, and Kidney Mortality Among Mexican Adults.","authors":"Doreen Zhu, Pablo Kuri-Morales, Rachel Wade, Natalie Staplin, Adrián Garcilazo-Ávila, Carlos González-Carballo, Raúl Ramirez-Reyes, Diego Aguilar-Ramirez, Colin Baigent, Fiona Bragg, Louisa Gnatiuc Friedrichs, William G Herrington, Michael Hill, Eirini Trichia, Michael Turner, Rory Collins, Richard Peto, Jaime Berumen, Jesus Alegre-Díaz, Jonathan R Emberson, Richard Haynes, Roberto Tapia-Conyer","doi":"10.1053/j.ajkd.2026.05.019","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.05.019","url":null,"abstract":"<p><strong>Rationale & objective: </strong>Chronic kidney disease (CKD) is a major cause of death in Mexico and blood pressure (BP) may be an important contributor. This study investigated the associations of BP with CKD, albuminuria, and death from kidney failure.</p><p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Setting & participants: </strong>133,470 adults aged ≥35 to <85 years without CKD or other chronic disease (except diabetes), recruited from two districts of Mexico City between 1998 and 2004, and who survived ≥5 years after recruitment. A random subset of 9198 underwent additional evaluation 2015-2019.</p><p><strong>Exposures: </strong>Systolic BP (SBP), diastolic BP (DBP) and hypertension (participant report of taking blood pressure lowering medication or BP ≥140/90 mm Hg).</p><p><strong>Outcomes: </strong>Kidney failure mortality during follow-up, and CKD (self-report and/or eGFR <60 mL/min/1.73m²) and albuminuria at the time of repeat clinical evaluation.</p><p><strong>Analytical approach: </strong>Multivariable Cox regression for the association of BP with kidney failure mortality and multivariable logistic regression for the association of baseline BP with CKD and albuminuria at the time of re-evaluation.</p><p><strong>Results: </strong>Among all participants, SBP showed a continuous \"log-linear\" association with kidney failure mortality; each 20 mm Hg lower SBP being associated with 24% lower risk at ages 40-84 years (kidney failure death hazard ratio [HR] 0.76, 95% confidence interval 0.69-0.84). The association was stronger among those without diabetes (HR 0.54, 0.45-0.69) than with diabetes (HR 0.90, 0.80-1.01) but the absolute excess risk associated with higher BP was similar in these subgroups. Hypertension accounted for 9% of kidney failure deaths. Among those re-evaluated, 6% had developed CKD and 25% had albuminuria. 20 mm Hg lower baseline SBP was associated with 24% lower odds of both CKD (odds ratio [OR] 0.76, 0.68-0.85) and albuminuria (OR 0.76, 0.68-0.84) at the time of re-evaluation. Results were similar for DBP.</p><p><strong>Limitations: </strong>Baseline urine samples were unavailable and kidney function trends over time could not be assessed.</p><p><strong>Conclusions: </strong>This large prospective study in Mexican adults highlights elevated BP as a major modifiable risk factor for kidney failure mortality, CKD, and albuminuria.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence for the Use of Steroidal Aldosterone Antagonists in Patients With Kidney Failure.","authors":"Panagiotis I Georgianos, Anastasios Kollias, Athanasios Roumeliotis, Vassilios Liakopoulos","doi":"10.1053/j.ajkd.2026.04.020","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.04.020","url":null,"abstract":"<p><p>Although mineralocorticoid receptor (MR) antagonism is a mechanistically plausible target of therapy in patients with kidney failure, prior small trials failed to elucidate the safety and efficacy of spironolactone and eplerenone in this population. More conclusive evidence was provided by the ALCHEMIST and ACHIEVE trials, in which spironolactone was not superior to placebo in improving cardiovascular outcomes in patients with kidney failure. The incidence of moderate hyperkalemia in these trials was higher with spironolactone than with placebo. Accordingly, the use of spironolactone or eplerenone for cardiovascular protection in this population is not justified by the currently available clinical-trial data.</p>","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148756791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Enabled Electrocardiography for Monitoring Serum Potassium Dynamics in Patients With Severe Hypokalemia.","authors":"Jhao-Jhuang Ding, Chin Lin, Wen-I Liao, Chen-Yi Liao, Wen-Fang Chiang, Chien-Chou Chen, Min-Hua Tseng, Chin-Sheng Lin, Shun-Neng Hsu, Chih-Chien Sung, Shih-Hua Lin","doi":"10.1053/j.ajkd.2026.05.020","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.05.020","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale & objective: &lt;/strong&gt;Severe hypokalemia requires prompt management and close surveillance. Although artificial intelligence-enabled electrocardiography (AI-ECG) rapidly detects severe hypokalemia, its application for monitoring serum potassium (K&lt;sup&gt;+&lt;/sup&gt;) dynamics during treatment remains unexplored. This study assessed AI-ECG performance in monitoring K&lt;sup&gt;+&lt;/sup&gt; changes during supplementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Multicenter retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting & participants: &lt;/strong&gt;191 adults with severe hypokalemia (Lab-K&lt;sup&gt;+&lt;/sup&gt; ≤2.5 mmol/L; matched ECG-K&lt;sup&gt;+&lt;/sup&gt; &lt;3.5 mmol/L) and ≥1 follow-up paired measurement within 24 hours of K&lt;sup&gt;+&lt;/sup&gt; supplementation at three teaching hospitals between September 2019 and August 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Tests compared: &lt;/strong&gt;Laboratory-measured K&lt;sup&gt;+&lt;/sup&gt; (Lab-K&lt;sup&gt;+&lt;/sup&gt;) and K&lt;sup&gt;+&lt;/sup&gt; estimated by ECG (ECG-K&lt;sup&gt;+&lt;/sup&gt;) overall and stratified by the etiology of hypokalemia (acute K&lt;sup&gt;+&lt;/sup&gt; shift vs. chronic K&lt;sup&gt;+&lt;/sup&gt; deficit).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Primary: agreement between paired ECG-K&lt;sup&gt;+&lt;/sup&gt; and Lab-K&lt;sup&gt;+&lt;/sup&gt;. Secondary: diagnostic accuracy and K&lt;sup&gt;+&lt;/sup&gt; trajectories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Analytical approach: &lt;/strong&gt;Linear mixed-effects models with patient-level random intercepts; repeated-measures correlation (rmcorr) and Bland-Altman plots; patient-level clustered bootstrapped ROC analysis for diagnostic accuracy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 191 patients, 156 (81.7%) had chronic K&lt;sup&gt;+&lt;/sup&gt; deficits (most commonly gastrointestinal disorders [n=47] or diuretic use [n=35]), and 35 (18.3%) had acute K&lt;sup&gt;+&lt;/sup&gt; shifts (most commonly thyrotoxic periodic paralysis [n=25]). The chronic K&lt;sup&gt;+&lt;/sup&gt; deficits group had more comorbidities and use of medications affecting K&lt;sup&gt;+&lt;/sup&gt;. ECG-K&lt;sup&gt;+&lt;/sup&gt; correlated strongly with Lab-K&lt;sup&gt;+&lt;/sup&gt; (rmcorr 0.847; 95% CI, 0.81-0.88; p&lt;0.001). The relationship was modified by hypokalemia etiology (interaction p&lt;0.0001) with a lower correlation in patients with chronic K&lt;sup&gt;+&lt;/sup&gt; deficits. The diagnostic accuracy of ECG-K&lt;sup&gt;+&lt;/sup&gt; with Lab-K&lt;sup&gt;+&lt;/sup&gt; ≤3.5 mmol/L was reflected by an AUC of 0.920; 95% CI, 0.863-0.961. It was higher in patients with acute K&lt;sup&gt;+&lt;/sup&gt; shift. ECG-K&lt;sup&gt;+&lt;/sup&gt; preceded Lab-K&lt;sup&gt;+&lt;/sup&gt; results by a mean of 52.5 minutes. Patients with acute K&lt;sup&gt;+&lt;/sup&gt; shift corrected approximately threefold faster than those with chronic K&lt;sup&gt;+&lt;/sup&gt; deficit (0.121 vs. 0.039 mmol/L/h). Rebound hyperkalemia was detected by ECG-K&lt;sup&gt;+&lt;/sup&gt; in two patients before laboratory confirmation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Retrospective design; treatment-protocol heterogeneity; limited inpatient medication granularity and potential selection bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;AI-ECG enables real-time, within-patient monitoring of serum K&lt;sup&gt;+&lt;/sup&gt; dynamics during treatment for severe hypokalemia, with superior","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Placental Versus Complement Biology in Postpartum Thrombotic Microangiopathy Attribution.","authors":"Tuncay Sahutoglu","doi":"10.1053/j.ajkd.2025.12.010","DOIUrl":"10.1053/j.ajkd.2025.12.010","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply to \"Placental Versus Complement Biology in Postpartum Thrombotic Microangiopathy Attribution\".","authors":"Daan P C van Doorn, Pieter van Paassen, Sjoerd A M E G Timmermans","doi":"10.1053/j.ajkd.2026.07.004","DOIUrl":"10.1053/j.ajkd.2026.07.004","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spectrum of Anti-Factor B-Associated Glomerular Diseases in Adults.","authors":"Romain Brousse, Julia Roquigny, Carine El Sissy, Moglie Le Quintrec, Marie-Sophie Meuleman, Anna Duval, Paula Vieira-Martins, Jean-Jacques Boffa, Maeva Massat, Eric Daugas, Rafik Mesbah, Emilie Cornec-Le Gall, Marie Essig, Anthony Corchia, Laurent Hudier, Simon Ville, David Ribes, Jean-Michel Halimi, Mary-Jane Guerry, Hélène Dobsziewicz, Florent Joly, Alexandre Karras, Lubka T Roumenina, Aude Servais, Jean-Paul Duong Van Huyen, Véronique Frémeaux-Bacchi, Sophie Chauvet","doi":"10.1053/j.ajkd.2026.06.007","DOIUrl":"https://doi.org/10.1053/j.ajkd.2026.06.007","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale & objective: &lt;/strong&gt;Autoantibodies targeting complement factor B (anti-FB) are among the most recently described alternative pathway anomalies. Although they have been strongly associated with post-infectious glomerulonephritis in children, the clinical phenotypes associated with such antibodies, along with their effects on the alternative pathway in adults, remain elusive and require further characterization, which was the goal of this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Retrospective case series.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting & participants: &lt;/strong&gt;Patients for whom anti-FB IgG was systematically detected by the French reference center for complement abnormalities between October 2017 and June 2020 and who underwent concurrent kidney biopsy confirming kidney disease were included as cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Seventy-one patients tested positive for anti-FB antibodies using ELISA and single-bead antigen assays in the setting of newly diagnosed biopsy-proven kidney disease. Detection of both anti-FB and anti-C3b autoantibodies occurred for 36/71 (51%) patients. In vitro, total purified IgG from these patients enhanced alternative pathway activity, with anti-FB titers being correlated with C3bB proconvertase formation (R&lt;sup&gt;2&lt;/sup&gt; = 0.40, p &lt; 0.001) and anti-C3b titers being correlated with C3bBb convertase stabilization (R&lt;sup&gt;2&lt;/sup&gt; = 0.46, p &lt; 0.001), suggesting distinct and potentially synergistic functional effects. Clinically, the most frequent diagnosis associated with anti-FB detection was infection-related glomerulonephritis (IR-GN) (46/71 - 65%), with higher anti-FB titers in patients with IR-GN compared to those with other diagnoses (median 791 [IQR 287-2000] vs. 326 [173-790] AU/mL; Hodges-Lehmann difference 354 AU/mL [95% CI: 58-1020]; p = 0.01). No difference was detected in anti-C3b titers between IR-GN and other diagnoses. Anti-FB antibodies became undetectable in 21 of 36 retested patients (58%); among the 10 patients with persistent detection beyond 3 months, 8 (80%) had uncontrolled infection. After a median follow-up of 12.5 (5-24) months, 18/67 (27%) patients experienced a major adverse kidney event (kidney failure or a sustained &gt;50 decline in eGFR below the baseline value).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Retrospective design, the series was enriched in alternative pathway anomalies due to reference center recruitment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Detection of anti-FB antibodies is strongly associated with infection-related glomerulonephritis in adult patients, highlighting an important mechanism of alternative pathway deregulation in such diseases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Antibodies targeting factor B, a key protein of the complement cascade, have been shown to activate the complement system and promote kidney inflammation. However, the clinical characteristics and outcomes of patients with such autoantibodies remain largely understudied, particular","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}