BMC Nephrology最新文献

{"title":"Association between iron metabolism and acute kidney injury in cardiac surgery with cardiopulmonary bypass: a retrospective analysis from two datasets.","authors":"Qian Li, Hong Lv, Yuye Chen, Jingjia Shen, Jia Shi, Chenghui Zhou","doi":"10.1186/s12882-024-03857-8","DOIUrl":"https://doi.org/10.1186/s12882-024-03857-8","url":null,"abstract":"<p><strong>Objective: </strong>We sought to explore the linear or nonlinear relationship between preoperative iron metabolism and acute kidney injury following cardiac surgery (CSA-AKI) with cardiopulmonary bypass (CPB).</p><p><strong>Methods: </strong>Patients who underwent cardiac surgery with CPB between December 2018 and April 2021 were retrospectively collected from Fuwai Hospital and Medical Information Mart for Intensive Cared dataset (MIMIC-IV). The measurements of iron metabolism included serum iron (SI), serum ferritin (SF), transferrin (TRF), transferrin saturation (TS), and total iron binding capacity (TIBC). Logistic regression and restricted cubic spline (RCS) were used for linear and nonlinear analysis. The primary outcome was postoperative AKI with 48 h after cardiac surgery.</p><p><strong>Results: </strong>Of 10,639 patients screened (2420 in Fuwai Hospital and 8219 in MIMIC-IV dataset),1488 eligible patients were enrolled for the final analysis (Fuwai Hospital: n = 744, MIMIC-IV: n = 744).The incidence of AKI was 25.7% and 56.5%, respectively. Logistic regression showed that the levels of TRF (odds ratio (OR) = 1.53,95%CI:1.01-2.14, p = 0.012) and TIBC (OR = 1.05,95%CI:1.02-1.07, p < 0.001) were independent risk factor for AKI. Moreover, in the spline models adjusted with age (median:56), female, and history of diabetes, a significant statistical difference was observed between SI, SF, TRF, TS, TIBC (p for nonlinear < 0.05) and AKI in the Fuwai Hospital dataset. Additionally, the levels of SI (p for nonlinear 0.0364),SF (p for nonlinear 0.0461) were also in non-linear relationship with AKI in the MIMIC-IV dataset.</p><p><strong>Conclusion: </strong>Iron metabolism markers (SI, SF, TS, TRF, and TIBC) displayed a nonlinear relationship with AKI by the RCS model (adjusted by age, gender, and history of diabetes). Notably, the MIMIC-IV dataset, which includes elderly patients, also demonstrated a nonlinear relationship between SI, SF and AKI. These findings highlight the potential therapeutic value of targeting proteins related to iron metabolism in patients with AKI.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"416"},"PeriodicalIF":2.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Emphysematous pyelonephritis caused by Raoultella ornithinolytica: a case report.","authors":"Meng Sun, Xiaobao Wei, Xinyu Xiang, Ting Zhang, Yiwen Zhang, Jiayi Miao, Juanyu Wei, Wei Cao, Qing Yao, Lin Zhu, Ying Zhou, Liyuan Zhang","doi":"10.1186/s12882-024-03858-7","DOIUrl":"https://doi.org/10.1186/s12882-024-03858-7","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"415"},"PeriodicalIF":2.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of anaemia and iron deficiency with health-related quality of life in patients with chronic kidney disease stage G3b-5 in Japan: sub analysis of the Reach-J CKD cohort study.","authors":"Reiko Okubo, Tomohiro Ohigashi, Masahide Kondo, Ryoya Tsunoda, Hirayasu Kai, Chie Saito, Junichi Hoshino, Hirokazu Okada, Ichiei Narita, Shoichi Maruyama, Takashi Wada, Kunihiro Yamagata","doi":"10.1186/s12882-024-03849-8","DOIUrl":"https://doi.org/10.1186/s12882-024-03849-8","url":null,"abstract":"<p><strong>Background: </strong>Iron deficiency is a major contributor to anaemia in chronic kidney diseases. The association of anaemia and iron deficiency with health-related quality of life in Japanese patients with non-dialysis chronic kidney disease has not been examined. In this study, we evaluated anaemia and iron deficiency in patients with chronic kidney disease G3b-5 and examined their associations with health-related quality of life.</p><p><strong>Methods: </strong>This nationwide cohort study included 2,249 patients with advanced chronic kidney disease receiving nephrologist care from 31 representative facilities throughout Japan; they were randomly selected through stratification by region and facility size and aligned with the Chronic Kidney Disease Outcomes and Practice Patterns Study. Using baseline patient data, we assessed the association of anaemia and iron deficiency with health-related quality of life, employing the 36-item Kidney Disease Quality of Life Questionnaire.</p><p><strong>Results: </strong>The mean mental and physical component summary scores for all patients were 49 and 47, respectively. Patients with haemoglobin levels < 10 g/dL had worse three kidney disease subscale, mental component summary, physical component summary, and subdomain scores than those with haemoglobin levels > 12 g/dL. Patients with absolute iron deficiency (TSAT < 20% and ferritin < 100 ng/mL) had worse three kidney disease subscale and mental component summary scores than those with functional iron deficiency (TSAT < 20% and ferritin ≥ 100 ng/mL).</p><p><strong>Conclusions: </strong>Japanese patients with chronic kidney disease G3b-5 with anaemia or absolute iron deficiency had worse health-related quality of life. Our results provide clinical evidence of renal anaemia in Japan and will be useful for international comparisons.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"414"},"PeriodicalIF":2.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between chronic kidney disease and cardiovascular disease risk factors in elderly: results from the first phase of Fasa and Shahedieh cohort studies.","authors":"Fatemeh Zarshenas, Azizallah Dehghan, Masoud Mirzaei","doi":"10.1186/s12882-024-03566-2","DOIUrl":"10.1186/s12882-024-03566-2","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is associated with increased cardiovascular disease (CVD) risk factors and morbidity in the elderly population. This study aimed to examine the association between CKD and CVD risk factors in the elderly population of Fasa and Yazd (Shahdieh), Iran, using the data from the enrolment phase of Fasa and Shahedieh cohort studies.</p><p><strong>Methods: </strong>We conducted a cross-sectional analytical study using data from Fasa and Shahedieh cohort studies, which enrolled 1487 and 1507 participants aged over 60 years, respectively. We collected data on demographic and clinical variables, kidney problems, and CVD from the two studies. We estimated the glomerular filtration rate (eGFR) using the modification of diet in renal disease (MDRD) formula and considered values less than 60 ml/min/1.73 m2 as CKD. We used independent t-tests, Spearman's correlation coefficient, chi-square, one-way analysis of variance, and logistic regression to analyze the data. We performed the analyses using SPSS V. 22.0 software and set the significance level at 0.05.</p><p><strong>Results: </strong>The overall prevalence of CKD was 41.9%; 25.7% in women and 16.2% in men. The prevalence of CKD based on reported kidney problems was 1.7%, of which 54.7% were in stage 3 of CKD. Compared to participants in the early stages of CKD, participants in advanced stages had a higher prevalence of diabetes (p < 0.001), hypertension (p < 0.001), ischemic heart disease (IHD) (p < 0.001), and myocardial infarction (p < 0.001). In addition, participants in higher stages of CKD were more obese, had lower physical activity, smoked more, and consumed more opium (p < 0.001).</p><p><strong>Conclusion: </strong>Our study showed that more than half of the patients were in stage three CKD, which is an advanced stage of this disease. Diabetes Melitus, hypertension, dyslipidemia, IHD, and myocardial infarction were more prevalent in patients than others. These findings demonstrate the importance of screening for CKD in patients with diabetes mellitus and hypertension. The results also suggest that lifestyle modification and prevention strategies are needed to reduce the burden of CKD and CVD in this population.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"413"},"PeriodicalIF":2.2,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The advance of single cell transcriptome to study kidney immune cells in diabetic kidney disease.","authors":"Mengjia Wang, Fang Yao, Ning Chen, Ting Wu, Jiaxin Yan, Linshan Du, Shijie Zeng, Chunyang Du","doi":"10.1186/s12882-024-03853-y","DOIUrl":"10.1186/s12882-024-03853-y","url":null,"abstract":"<p><p>Diabetic kidney disease (DKD) is a prevalent microvascular complication of diabetes mellitus and a primary cause of end-stage renal disease (ESRD). Increasing studies suggest that immune cells are involved in regulating renal inflammation, which contributes to the progression of DKD. Compared with conventional methods, single-cell sequencing technology is more developed technique that has advantages in resolving cellular heterogeneity, parallel multi-omics studies, and discovering new cell types. ScRNA-seq helps researchers to analyze specifically gene expressions, signaling pathways, intercellular communication as well as their regulations in various immune cells of kidney biopsy and urine samples. It is still challenging to investigate the function of each cell type in the pathophysiology of kidney due to its complex and heterogeneous structure and function. Here, we discuss the application of single-cell transcriptomics in the field of DKD and highlight several recent studies that explore the important role of immune cells including macrophage, T cells, B cells etc. in DKD through scRNA-seq analyses. Through combing the researches of scRNA-seq on immune cells in DKD, this review provides novel perspectives on the pathogenesis and immune therapeutic strategy for DKD.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"412"},"PeriodicalIF":2.2,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative study on outcomes of ABO-incompatible kidney transplants between robot-assisted vs. open surgery-propensity score-matched analysis: a retrospective cohort study.","authors":"Jin-Myung Kim, Hye Eun Kwon, Youngmin Ko, Joo Hee Jung, Hyunwook Kwon, Young Hoon Kim, Sung Shin","doi":"10.1186/s12882-024-03842-1","DOIUrl":"10.1186/s12882-024-03842-1","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted kidney transplantation (RAKT) is increasingly being adopted worldwide. Despite this growing interest, there remains a notable gap in the literature, especially concerning its effectiveness in immunologically high-risk patients compared to conventional open kidney transplantation (OKT). This study investigates the viability and success of RAKT in comparison with OKT, particularly for recipients with ABO incompatibility (ABOi).</p><p><strong>Methods: </strong>This retrospective, single-center study included 239 living-donor transplants between October 2020 and February 2023, with 210 patients undergoing ABOi-OKT and 29 undergoing ABOi-RAKT. A composite of biopsy-proven acute rejection (BPAR), graft failure, and the development of de novo donor-specific antibodies was analyzed through univariate and multivariate models. Propensity score matching (PSM) was utilized to ensure a balanced comparison between the two groups. Following PSM, a total of 131 cases in the OKT group and 26 cases in the RAKT group were analyzed.</p><p><strong>Results: </strong>After PSM, the mean recipient age was 48.56 years for OKT and 47.96 years for RAKT. Both groups had comparable one-year (RAKT: 92.4%, OKT: 93.1%) and two-year BPAR-free survival rates (RAKT: 92.4%, OKT: 91.9%). Mean estimated glomerular filtration rate values were similar at 12 months post-transplant (RAKT: 62.15 ml/min/1.73 m², OKT: 64.53 ml/min/1.73 m²). Operative times were significantly longer for RAKT (291.42 vs. 150.81 min, p < 0.001), while cold ischemic time was also longer for RAKT (119.77 vs. 47.22 min, p < 0.001). Hospital stays were shorter for RAKT (median 6 vs. 8 days, p < 0.001). There was no significant difference in the composite outcome of BPAR, graft failure, and de novo donor-specific antibodies between the two groups (HR 0.858, 95% CI: 0.180-4.096, p = 0.848).</p><p><strong>Conclusions: </strong>RAKT is a safe and effective alternative to OKT in ABOi patients, demonstrating similar perioperative outcomes, graft survival rates, and renal function. The application of ropensity score matching analysis strengthens the reliability of these findings, confirming RAKT's viability for high-risk kidney transplant recipients.</p><p><strong>Trial registration: </strong>The clinical trial associated with this study was registered on 2024-02-24 with the Clinical Trial Number NCT06287008|| https://www.</p><p><strong>Clinicaltrials: </strong>gov/ ).</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"410"},"PeriodicalIF":2.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment discontinuation in adults with atypical hemolytic uremic syndrome (aHUS): a qualitative study of international experts' perspectives with associated cost-consequence analysis.","authors":"Evi Germeni, Jacie Cooper, Andrew Briggs, Jeffrey Laurence","doi":"10.1186/s12882-024-03770-0","DOIUrl":"10.1186/s12882-024-03770-0","url":null,"abstract":"<p><strong>Background: </strong>Atypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening thrombotic microangiopathy (TMA) related to congenital mutations impeding control of the alternative pathway of complement. Following approval of the complement C5 inhibitor eculizumab by the European Medicines Agency and the US Food and Drug Administration, initial guidelines suggested lifelong therapy. Yet, growing evidence indicates that discontinuation of eculizumab, or its long-acting form ravulizumab, is possible for many patients. This mixed-methods study sought to explore international experts' perspectives and experiences related to treatment duration in adult patients with aHUS, while also estimating the financial and potential health consequences of early discontinuation.</p><p><strong>Methods: </strong>Between January and December 2023, we conducted 10 qualitative interviews with experts in the treatment of aHUS, based upon which we constructed a quantitative decision tree, designed to estimate time on treatment and treatment- and disease-related adverse events.</p><p><strong>Results: </strong>Thematic analysis of the interview data identified four main themes: (1) Concerns and prior experience; (2) High-risk vs. low-risk groups; (3) Patient preference and adherence; and (4) Funding for monitoring and re-treatment. Although most interviewees were in favour of considering treatment discontinuation for many patients (citing the high cost, burden, and potential side effects of lifelong treatment as key reasons), a prior negative experience of discontinuation seemed to make others more reluctant to stop. Deciding which patients required lifelong treatment and which not involved consideration of a wide range of factors, including patient- and system-related factors. Cost-consequence analysis demonstrated the financial savings associated with early treatment discontinuation at the expense of increased risk of recurrent TMA events. Close monitoring for these events had the potential to minimise any long-term injury, primarily renal, with an estimated one event per 100 patient years. For patients at high risk of TMA and with poor adherence to monitoring, rates of renal injury rose to three events per 100 patient years.</p><p><strong>Conclusions: </strong>aHUS treatment protocols are changing globally in response to new clinical evidence. Against this backdrop, our mixed-methods study provides compelling evidence on the complexity of factors influencing treatment discontinuation decisions in aHUS, as well as the financial and health consequences of early discontinuation.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"411"},"PeriodicalIF":2.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of karyomegalic interstitial nephritis without FAN1 mutations in the setting of brentuximab, ifosfamide, and carboplatin exposure.","authors":"Matthew Leong, Tiane Dai, Lili Tong, Cynthia C Nast","doi":"10.1186/s12882-024-03689-6","DOIUrl":"10.1186/s12882-024-03689-6","url":null,"abstract":"<p><strong>Background: </strong>Karyomegalic interstitial nephritis (KIN) is a rare renal diagnosis associated with both genetic and medication etiologies. The primary gene associated with KIN is the FAN1 gene which encodes a protein responsible for DNA interstrand repair. Common medication triggers of KIN are chemotherapeutic agents, especially those which disrupt DNA structure such as carboplatin. Despite overlap between these mechanisms, it has not clearly been established if medication usage requires an underlying genetic predisposition for triggering KIN or if medications alone are sufficient. This ambiguous pathogenesis can make it difficult to appropriately assess risk of KIN development when starting patients on one of the known KIN-inducing therapies. Additionally, brentuximab vedotin, an antibody-drug conjugate directed against CD30, has not been previously implicated in KIN development.</p><p><strong>Case presentation: </strong>We present a 49-year-old woman previously diagnosed with metastatic Hodgkin's lymphoma who was treated with doxorubicin, bleomycin, vinblastine, and dacarbazine, then 3 cycles of ifosfamide, carboplatin, etoposide, all of which were discontinued due to side effects. Following an episode of acute kidney injury, the serum creatinine was 1.09 mg/dL. She then received 2 doses of brentuximab, the serum creatinine rose, and the drug was discontinued. Kidney biopsy done 2 months after brentuximab and 5 months following ifosfamide therapies showed karyomegalic interstitial nephritis. Genetic evaluation showed no FAN1 gene mutations. The patient was started on pembrolizumab; no steroids were given due to concerns about interference with lymphoma immunotherapy. She remains with stable disease and stable chronic kidney disease.</p><p><strong>Conclusions: </strong>This case presents a patient who developed KIN with a progressively rising serum creatinine after ifosfamide, carboplatin and brentuximab treatment. Although ifosfamide and carboplatin have known associations with the development of KIN, this case raises the possibility that brentuximab, which has a different mechanism of action, also may be associated with KIN. Additionally, the genetic findings demonstrate that drug-induced KIN can develop in the absence of FAN1 mutations, a finding not previously reported.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"409"},"PeriodicalIF":2.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study protocol of the ALMA-CKD trial; an electronic triggering decision-support system to improve the detection, recognition, and management of patients with chronic kidney disease in primary care.","authors":"Jacob Andersson-Emad, Arvid Thunholm, Stephen Nash, Marie Evans, Sara Lind Af Hageby, Johan Ärnlöv, Marie Hilderman, Martin Forseth, Arvid Sjölander, Stefan H Jacobson, Juan Jesus Carrero","doi":"10.1186/s12882-024-03852-z","DOIUrl":"10.1186/s12882-024-03852-z","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a global health problem affected by under-recognition and under-treatment in primary care settings. Electronic clinical decision support (CDS) triggering systems have the potential to improve detection and management of people with CKD by assisting clinicians in adhering to guideline recommendations. We aimed to test whether an electronic CDS triggering system would improve the detection, recognition, and management of patients with CKD in primary care.</p><p><strong>Method/design: </strong>This is a pragmatic cluster-randomized controlled trial where 66 primary healthcare centers from the Stockholm Region, Sweden were randomized 1:1 to receive either a new expanded CDS-triggering system offering kidney-specific advice or to continue with their current CDS-triggering system. The expanded CDS system reminds and provides practical facilitators of the processes of CKD screening, recognition with a diagnosis, management and referral to specialist care. The trial duration is 24 months and it is embedded into the Stockholm CREAtinine measurements (SCREAM) project, a repository of healthcare data from the region, which minimizes disturbances with healthcare praxis due to the trial and makes it fully pragmatic. The primary outcomes are the number of eligible patients screened for creatinine and albuminuria once annually and the re-testing of these labs within 6 months in patients with abnormal eGFR or albuminuria. Secondary outcomes are the proportions of issued clinical diagnoses among those fulfilling criteria, proportions of patients with significant albuminuria receiving prescribed nephroprotective medications, proportions of accepted referrals to nephrologist care among those fulfilling criteria and proportion of referrals for ultrasound of the kidneys.</p><p><strong>Discussion: </strong>Prior pragmatic trials of CDS-systems in CKD has shown an improvement in quality indicators primarily in patients already diagnosed with CKD. This study expands this evidence by focusing on the process of screening, identification, monitoring and diagnostic work-up.</p><p><strong>Conclusion: </strong>This pragmatic trial will assess the value of CDS for improved adherence to CKD guidelines in primary care.</p><p><strong>Clinicaltrials: </strong>gov registration: NCT06386172, submitted 2024-04-23.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"408"},"PeriodicalIF":2.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sirolimus-induced pulmonary toxicity without recurrence more than 8 years after everolimus replacement in a renal transplant patient with recurrent skin SCC: a case report.","authors":"Golsa Ghasemi, Shahrzad Shahidi","doi":"10.1186/s12882-024-03661-4","DOIUrl":"10.1186/s12882-024-03661-4","url":null,"abstract":"<p><strong>Background: </strong>Interstitial Pneumonitis (IP) is one of the pulmonary complications associated with mammalian Target of Rapamycin-Inhibitors (mTOR-Is). Sirolimus and everolimus belong to mTOR-Is. According to studies, IP is caused by both.</p><p><strong>Case presentation: </strong>This is a case report in a kidney transplant recipient. We want to present a case of IP after 50 months of sirolimus consumption. Sirolimus was discontinued, and cyclosporine was started. Thirty-seven months later, everolimus was prescribed as an alternative to cyclosporine due to the recurrence of skin Squamous Cell Carcinoma (SCC). Fortunately, no respiratory manifestations were seen after more than 8 years of everolimus consumption.</p><p><strong>Conclusions: </strong>In conclusion, in cases with sirolimus-induced IP, discontinuation of sirolimus and replacement with everolimus are recommended after resolving clinical symptoms and pulmonary lesions.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"406"},"PeriodicalIF":2.2,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}