American Journal of Kidney Diseases最新文献

{"title":"Pediatric Nephrology Practice in the United States: Survey of Pediatric Nephrology Division Directors","authors":"Priya S. Verghese , Amy Bobrowski , Caitlin Carter , Vikas R. Dharnidharka , Jyothsna Gattineni , Julie E. Goodwin , David B. Kershaw , Teri J. Mauch , Raoul Nelson , Mihail Subtirelu , Joseph Flynn , Daniel Feig","doi":"10.1053/j.ajkd.2025.01.025","DOIUrl":"10.1053/j.ajkd.2025.01.025","url":null,"abstract":"<div><h3>Rationale & Objectives</h3><div>Addressing the increasing demand for pediatric nephrology care is challenging because of increasing limitations in the size of this workforce. The objective of this study was to characterize the state of pediatric nephrology practices across the United States to inform possible strategies to address this shortfall.</div></div><div><h3>Study Design</h3><div>Cross-sectional survey.</div></div><div><h3>Setting & Participants</h3><div>The American Society of Pediatric Nephrology interest group comprised 92 pediatric nephrology division leaders of pediatric nephrology programs.</div></div><div><h3>Exposures</h3><div>Practice size defined by number of full-time equivalent (FTE) pediatric nephrologists.</div></div><div><h3>Outcomes</h3><div>The scope of inpatient and outpatient services related to dialysis and extracorporeal treatment, kidney transplant, procedures (kidney biopsy, ultrasound, ambulatory blood pressure monitoring), faculty roles, and funding for programmatic activities.</div></div><div><h3>Analytical Approach</h3><div>Descriptive and comparative statistics, including the χ<sup>2</sup> test, Fisher’s exact test, <em>t</em> test, and two-proportion <em>Z</em>-test, with significance defined at <em>P</em> <!--><<!--> <!-->0.05.</div></div><div><h3>Results</h3><div>Large programs had more outreach capacity, ancillary staffing, independent transplant programs, and on-site outpatient dialysis units and more diverse kidney replacement options. Smaller programs had fewer ambulatory patients and fewer inpatients per FTE pediatric nephrologists. Medium-sized programs had the highest inpatient and ambulatory volume per FTE pediatric nephrologists. Administrative support for transplant, dialysis, and fellowship programs was often limited.</div></div><div><h3>Limitations</h3><div>Granularity of data was limited. No assessment of trends was performed, and changes in faculty appointment type were not assessed.</div></div><div><h3>Conclusions</h3><div>Pediatric nephrologists in medium-sized programs had the highest volume of clinical work, and administrative support for transplant, dialysis, and fellowship programs was often insufficient in many programs. These findings may inform strategies to support pediatric nephrology programs and enhance the care they provide.</div></div><div><h3>Plain-Language Summary</h3><div>An imbalance exists between the increasing demand for services provided by pediatric nephrologists and the capacity of the pediatric nephrology workforce. The challenges of this imbalance are compounded by professional stress and burnout among pediatric nephrologists and a low level of interest in pediatric nephrology training. This study aimed to characterize the diverse pediatric nephrology practices across the United States by implementing a survey of the division heads of pediatric nephrology programs and classifying the findings into subgroups defined by the size of these programs. Pe","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"86 1","pages":"Pages 74-83"},"PeriodicalIF":9.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794448","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":"Renal Denervation in Loin Pain Hematuria Syndrome: A Pilot Randomized Controlled Trial.","authors":"Bhanu Prasad, Aarti Garg, Aditi Sharma, Francisco Garcia, Kunal Goyal, Mohammed Nayeemuddin","doi":"10.1053/j.ajkd.2025.01.024","DOIUrl":"10.1053/j.ajkd.2025.01.024","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":" ","pages":""},"PeriodicalIF":9.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794450","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":"IgM Variant of Proliferative Glomerulonephritis With Monoclonal Immunoglobulin Deposits: A Case Series","authors":"Lihong Bu , Anthony M. Valeri , Samar M. Said , Yi Zhu , Loren Herrera Hernandez , Reginald Gladish , Bhanu Prasad , Sanjeev Sethi , Nelson Leung , Samih H. Nasr","doi":"10.1053/j.ajkd.2025.01.009","DOIUrl":"10.1053/j.ajkd.2025.01.009","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Most deposits in proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) are of the IgG class. The IgM variant (PGNMID-IgM) is very rare, and data are mostly derived from single case reports or cases associated with B-cell lymphoproliferative disorders. We describe the clinicopathologic characteristics and outcomes among cases of PGNMID-IgM.</div></div><div><h3>Study Design</h3><div>Case series.</div></div><div><h3>Setting & Participants</h3><div>23 PGNMID-IgM cases identified from kidney pathology archives. PGNMID-IgM was defined by glomerulonephritis with glomerular granular monotypic IgM deposits after excluding cryoglobulinemic glomerulonephritis and intracapillary monoclonal deposits disease.</div></div><div><h3>Findings</h3><div>Seventy-eight percent of the cases were male, they had a median age of 72 years, and they had presented with proteinuria (median, 3.1<!--> <!-->g/day), hematuria (91%), and reduced estimated glomerular filtration rate (median serum creatinine, 1.9<!--> <!-->mg/dL). Hypocomplementemia was present in 31% of cases. The underlying hematologic condition for all cases was monoclonal gammopathy of renal significance (MGRS). Serum protein electrophoresis/serum immunofixation (SPEP/SIF) detected the nephropathic monoclonal immunoglobulin (MIg) in 27% of cases whereas matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) detected the nephropathic IgM in 4 of 7 tested patients. Kidney biopsy revealed membranoproliferative glomerulonephritis (83%) with nonorganized glomerular monotypic IgM (100%) and C3 deposition (96%), but C1q deposition was rare. Seventeen percent received symptomatic treatment alone, 17% received steroids alone, and 65% received other immunosuppressive therapy (mostly rituximab-based therapy). Follow-up (median, 40 months) was available for all patients. The median kidney and patient survivals were 44 and 158 months, respectively. Three patients underwent kidney transplantation, and all had recurrence, in 2 cases within a month.</div></div><div><h3>Limitations</h3><div>Small sample size, retrospective design, nonstandardized clinical management.</div></div><div><h3>Conclusions</h3><div>PGNMID-IgM mostly affects elderly men and is associated with MGRS with a low detection rate of the circulating nephropathic MIg on SPEP/SIF, which may be improved by MALDI-TOF. Kidney survival is guarded, with a high rate of early recurrence after transplant although overall survival is favorable. The pathogenesis remains unknown, but it likely involves local activation of alternative or lectin pathways of complement system by the monotypic IgM.</div></div><div><h3>Plain-Language Summary</h3><div>The IgM variant of proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID-IgM) is very rare, and data on its clinicopathologic and outcome characteristics are scanty. This study of 23 patients with PG","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 6","pages":"Pages 716-726.e1"},"PeriodicalIF":9.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727391","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":"G-089 The Great Impersonator: ANCA Vasculitis Presenting as Mastoiditis","authors":"","doi":"10.1053/j.ajkd.2025.02.090","DOIUrl":"10.1053/j.ajkd.2025.02.090","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 4","pages":"Page S29"},"PeriodicalIF":9.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143678983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"G-025 In-Hospital Outcomes of Critically Ill Older Adults with Acute Kidney Injury Receiving Dialysis: Findings from the Nationwide In-Patient Dataset (2018-2021)","authors":"","doi":"10.1053/j.ajkd.2025.02.026","DOIUrl":"10.1053/j.ajkd.2025.02.026","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 4","pages":"Page S9"},"PeriodicalIF":9.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143679177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"G-037 JC Polyomavirus Nephropathy: A Case Report","authors":"","doi":"10.1053/j.ajkd.2025.02.038","DOIUrl":"10.1053/j.ajkd.2025.02.038","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 4","pages":"Page S13"},"PeriodicalIF":9.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"G-051 Beneath the Surface: Podocyte Infolding Glomerulonephritis Emerging in the Wake of SLE","authors":"","doi":"10.1053/j.ajkd.2025.02.052","DOIUrl":"10.1053/j.ajkd.2025.02.052","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 4","pages":"Pages S17-S18"},"PeriodicalIF":9.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"G-075 Renal Vein Thrombosis as Initial Presentation of PLA2R-Positive NSAID-Associated Membranous Nephropathy","authors":"","doi":"10.1053/j.ajkd.2025.02.076","DOIUrl":"10.1053/j.ajkd.2025.02.076","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 4","pages":"Page S25"},"PeriodicalIF":9.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143678961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"G-068 Natural History of Renal Involvement of Fabry Disease in a Female Carrier","authors":"","doi":"10.1053/j.ajkd.2025.02.069","DOIUrl":"10.1053/j.ajkd.2025.02.069","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 4","pages":"Page S23"},"PeriodicalIF":9.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"G-039 Are We Ignoring the Urine Protein to Albumin Gap?","authors":"","doi":"10.1053/j.ajkd.2025.02.040","DOIUrl":"10.1053/j.ajkd.2025.02.040","url":null,"abstract":"","PeriodicalId":7419,"journal":{"name":"American Journal of Kidney Diseases","volume":"85 4","pages":"Page S14"},"PeriodicalIF":9.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}