Pub Date : 2024-11-14eCollection Date: 2024-01-01DOI: 10.2147/IJNRD.S503952
Abdulrahman Naser
{"title":"Risk Factors of Pulmonary Hypertension in Patients on Hemodialysis; Mitral Regurgitation is a Classic Cause of Secondary Pulmonary Hypertension [Letter].","authors":"Abdulrahman Naser","doi":"10.2147/IJNRD.S503952","DOIUrl":"10.2147/IJNRD.S503952","url":null,"abstract":"","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"287-288"},"PeriodicalIF":2.1,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666974","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}
Background: Acute kidney injury (AKI) is a serious complication following high-dose methotrexate (HD-MTX) treatment, despite established preventive measures. This study presents a case report and a retrospective review of patients treated with HD-MTX, aiming to identify risk factors for AKI and propose a modified treatment protocol.
Methods: We report a case of a 43-year-old man with diffuse large B-cell lymphoma who developed severe AKI after HD-MTX therapy. Additionally, a retrospective review of 70 patients receiving HD-MTX at our institution was conducted to identify predictors of AKI. Serum methotrexate levels were analyzed to determine their significance in predicting AKI.
Results: The index patient developed methotrexate intoxication and severe AKI despite receiving standard prophylactic measures, requiring temporary hemodialysis. The retrospective review identified serum methotrexate levels as a significant predictor of AKI (OR 11.84, 95% CI: 2.62-53.53, p = 0.001). Higher initial serum methotrexate levels correlated with the development of AKI.
Conclusion: Timely measurement of serum methotrexate levels is crucial in managing and preventing AKI in patients undergoing HD-MTX therapy. Based on our findings, we propose a modified HD-MTX treatment protocol to reduce the incidence of AKI. This includes earlier serum methotrexate level monitoring and adjustments in urine alkalization and leucovorin dosing strategies.
背景:急性肾损伤(AKI)是大剂量甲氨蝶呤(HD-MTX)治疗后的一种严重并发症,尽管已制定了预防措施。本研究对接受 HD-MTX 治疗的患者进行了病例报告和回顾性研究,旨在确定急性肾损伤的风险因素,并提出修改后的治疗方案:我们报告了一例 43 岁的弥漫大 B 细胞淋巴瘤男性患者,他在接受 HD-MTX 治疗后出现了严重的 AKI。此外,我们还对本院接受 HD-MTX 治疗的 70 名患者进行了回顾性研究,以确定 AKI 的预测因素。对血清甲氨蝶呤水平进行了分析,以确定其在预测 AKI 方面的意义:结果:尽管采取了标准预防措施,指标患者还是出现了甲氨蝶呤中毒和严重的 AKI,需要进行临时血液透析。回顾性研究发现,血清甲氨蝶呤水平是预测 AKI 的重要指标(OR 11.84,95% CI:2.62-53.53,p = 0.001)。初始血清甲氨蝶呤水平越高,发生 AKI 的几率越大:结论:及时测量血清甲氨蝶呤水平对于管理和预防接受 HD-MTX 治疗的患者发生 AKI 至关重要。根据我们的研究结果,我们提出了一个经过修改的 HD-MTX 治疗方案,以降低 AKI 的发生率。这包括提前监测血清甲氨蝶呤水平,调整尿碱化和亮菌甲素的剂量策略。
{"title":"Serum Methotrexate Level Predicts Acute Kidney Injury After High-Dose Methotrexate: A Case Report and Single-Center Experience.","authors":"Pao-Wen Yen, Hsing-Yu Lin, Chien-Chih Wu, Tai-Chung Huang, Shang-Ju Wu, Szu-Yu Pan, Kuan-Yu Hung","doi":"10.2147/IJNRD.S487368","DOIUrl":"https://doi.org/10.2147/IJNRD.S487368","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a serious complication following high-dose methotrexate (HD-MTX) treatment, despite established preventive measures. This study presents a case report and a retrospective review of patients treated with HD-MTX, aiming to identify risk factors for AKI and propose a modified treatment protocol.</p><p><strong>Methods: </strong>We report a case of a 43-year-old man with diffuse large B-cell lymphoma who developed severe AKI after HD-MTX therapy. Additionally, a retrospective review of 70 patients receiving HD-MTX at our institution was conducted to identify predictors of AKI. Serum methotrexate levels were analyzed to determine their significance in predicting AKI.</p><p><strong>Results: </strong>The index patient developed methotrexate intoxication and severe AKI despite receiving standard prophylactic measures, requiring temporary hemodialysis. The retrospective review identified serum methotrexate levels as a significant predictor of AKI (OR 11.84, 95% CI: 2.62-53.53, p = 0.001). Higher initial serum methotrexate levels correlated with the development of AKI.</p><p><strong>Conclusion: </strong>Timely measurement of serum methotrexate levels is crucial in managing and preventing AKI in patients undergoing HD-MTX therapy. Based on our findings, we propose a modified HD-MTX treatment protocol to reduce the incidence of AKI. This includes earlier serum methotrexate level monitoring and adjustments in urine alkalization and leucovorin dosing strategies.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"277-285"},"PeriodicalIF":2.1,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620481","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}
Pub Date : 2024-11-01eCollection Date: 2024-01-01DOI: 10.2147/IJNRD.S502317
Elanda Fikri
{"title":"Decarbonisation of Kidney Care in the United Arab Emirates: A Roadmap to an Environmentally Sustainable Care [Letter].","authors":"Elanda Fikri","doi":"10.2147/IJNRD.S502317","DOIUrl":"10.2147/IJNRD.S502317","url":null,"abstract":"","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"275-276"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583005","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}
Pub Date : 2024-10-29eCollection Date: 2024-01-01DOI: 10.2147/IJNRD.S489455
Yi Yu, Ricong Xu, Zhijian Li, Qijun Wan
Primary membranous nephropathy (PMN) is one of the prevalent pathological types of adult primary nephrotic syndrome. Pathogenic autoantibodies targeting podocyte antigens such as phospholipase A2 receptor (PLA2R) lead to the disease. Patients frequently experience notable adverse effects when treated with conventional immunosuppressive therapies. Rituximab (RTX), a mouse/human monoclonal antibody, selectively depletes B cells and leads to a decrease in the antibody levels in the circulation, which helps to alleviate membranous nephropathy. Various RTX dosage regimens have been applied globally in the PMN treatment with satisfactory effects. Nevertheless, the optimal dosage of RTX has yet to be determined. This article reviews the application of different doses of RTX in the management of PMN so far.
{"title":"Different Dosage Regimens of Rituximab in Primary Membranous Nephropathy Treatment: A Systematic Review.","authors":"Yi Yu, Ricong Xu, Zhijian Li, Qijun Wan","doi":"10.2147/IJNRD.S489455","DOIUrl":"10.2147/IJNRD.S489455","url":null,"abstract":"<p><p>Primary membranous nephropathy (PMN) is one of the prevalent pathological types of adult primary nephrotic syndrome. Pathogenic autoantibodies targeting podocyte antigens such as phospholipase A2 receptor (PLA2R) lead to the disease. Patients frequently experience notable adverse effects when treated with conventional immunosuppressive therapies. Rituximab (RTX), a mouse/human monoclonal antibody, selectively depletes B cells and leads to a decrease in the antibody levels in the circulation, which helps to alleviate membranous nephropathy. Various RTX dosage regimens have been applied globally in the PMN treatment with satisfactory effects. Nevertheless, the optimal dosage of RTX has yet to be determined. This article reviews the application of different doses of RTX in the management of PMN so far.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"265-273"},"PeriodicalIF":2.1,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568834","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}
Background: Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease, and podocytopathy is an early manifestation of DKD characterized by the urinary excretion of podocyte-specific proteins, such as nephrin and podocin. Asymmetric dimethylarginine (ADMA)-a biomarker of endothelial dysfunction-is associated with progressive kidney dysfunction. However, the mechanism of endothelial dysfunction in DKD progression is unclear. The aim of this study was to investigate the correlations of ADMA levels with nephrin, podocin, and the podocin:nephrin ratio (PNR) in DKD patients.
Methods: A cross-sectional study of 41 DKD outpatients was performed in two hospitals in Jakarta from April-June 2023. The collected data included the subjects' characteristics, histories of disease and medication, and relevant laboratory data. Serum ADMA was measured using liquid chromatography, while urinary podocin and nephrin were measured using the enzyme-linked immunosorbent assay (ELISA) method. A correlation analysis was performed to evaluate the correlation of ADMA with nephrin, podocin, and PNR. Regression analysis was performed to determine confounding factors.
Results: The mean value of ADMA was 70.2 (SD 17.2) ng/mL, the median for nephrin was 65 (20-283 ng/mL), and the median of podocin was 0.505 (0.433-0.622) ng/mL. ADMA correlated significantly with nephrin (r = 0.353, p = 0.024) and PNR (r = -0.360, p = 0.021), but no correlation was found between ADMA and podocin (r = 0.133, p = 0.409). The multivariate analysis showed that body mass index was a confounding factor.
Conclusion: This study revealed weak positive correlations between ADMA and urinary nephrin and between ADMA and PNR. No correlation was found between ADMA and urinary podocin.
{"title":"Correlation of Asymmetric Dimethylarginine With Podocytopathy Markers in Diabetic Kidney Disease Patients.","authors":"Pringgodigdo Nugroho, Riahdo Juliarman Saragih, Aida Lydia, Muhadi Muhadi, Harry Isbagio, Hamzah Shatri, Carissa Cornelia Chundiawan, Fidel Hermanto","doi":"10.2147/IJNRD.S476395","DOIUrl":"10.2147/IJNRD.S476395","url":null,"abstract":"<p><strong>Background: </strong>Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease, and podocytopathy is an early manifestation of DKD characterized by the urinary excretion of podocyte-specific proteins, such as nephrin and podocin. Asymmetric dimethylarginine (ADMA)-a biomarker of endothelial dysfunction-is associated with progressive kidney dysfunction. However, the mechanism of endothelial dysfunction in DKD progression is unclear. The aim of this study was to investigate the correlations of ADMA levels with nephrin, podocin, and the podocin:nephrin ratio (PNR) in DKD patients.</p><p><strong>Methods: </strong>A cross-sectional study of 41 DKD outpatients was performed in two hospitals in Jakarta from April-June 2023. The collected data included the subjects' characteristics, histories of disease and medication, and relevant laboratory data. Serum ADMA was measured using liquid chromatography, while urinary podocin and nephrin were measured using the enzyme-linked immunosorbent assay (ELISA) method. A correlation analysis was performed to evaluate the correlation of ADMA with nephrin, podocin, and PNR. Regression analysis was performed to determine confounding factors.</p><p><strong>Results: </strong>The mean value of ADMA was 70.2 (SD 17.2) ng/mL, the median for nephrin was 65 (20-283 ng/mL), and the median of podocin was 0.505 (0.433-0.622) ng/mL. ADMA correlated significantly with nephrin (<i>r</i> = 0.353, <i>p</i> = 0.024) and PNR (<i>r</i> = -0.360, <i>p</i> = 0.021), but no correlation was found between ADMA and podocin (<i>r</i> = 0.133, <i>p</i> = 0.409). The multivariate analysis showed that body mass index was a confounding factor.</p><p><strong>Conclusion: </strong>This study revealed weak positive correlations between ADMA and urinary nephrin and between ADMA and PNR. No correlation was found between ADMA and urinary podocin.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"255-264"},"PeriodicalIF":2.1,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500442","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}
Pub Date : 2024-10-15eCollection Date: 2024-01-01DOI: 10.2147/IJNRD.S481121
Stephen Geoffrey Holt, Erik Koornneef, Ali Abdul Kareem Al Obeidli, Luke Hubbert, Lindsay Nicholson
Chronic kidney disease (CKD) remains a major public health burden and a leading cause of mortality worldwide and in the United Arab Emirates (UAE). Alongside its clinical and humanistic burden, CKD care is associated with a significant carbon footprint. In this narrative review, we present an overview of the carbon footprint of current CKD treatments and the results of an analysis estimating the carbon footprint of CKD treatments in the UAE. Using the life cycle assessment (LCA) method and local data from the published national reports and inventory sources, we estimated that haemodialysis leads to greenhouse gas (GHG) emissions of ~12.8 tons of CO2 equivalents (CO2eq) per person in the UAE annually. Thus, the decarbonisation of CKD care is crucial in establishing an environmentally sustainable healthcare system. We propose a framework to decarbonise CKD care in the UAE that tackles the carbon footprint of CKD care in the UAE by focusing on three main pillars: Delaying early CKD and slowing its progression; reducing anthropogenic emissions from CKD and dialysis care by promoting best practices and eco-friendly technologies; and enhancing access to kidney transplantation. Such approaches are relevant not only for the UAE but also for global healthcare systems aiming towards net-zero emissions.
{"title":"Decarbonisation of Kidney Care in the United Arab Emirates: A Roadmap to an Environmentally Sustainable Care.","authors":"Stephen Geoffrey Holt, Erik Koornneef, Ali Abdul Kareem Al Obeidli, Luke Hubbert, Lindsay Nicholson","doi":"10.2147/IJNRD.S481121","DOIUrl":"10.2147/IJNRD.S481121","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) remains a major public health burden and a leading cause of mortality worldwide and in the United Arab Emirates (UAE). Alongside its clinical and humanistic burden, CKD care is associated with a significant carbon footprint. In this narrative review, we present an overview of the carbon footprint of current CKD treatments and the results of an analysis estimating the carbon footprint of CKD treatments in the UAE. Using the life cycle assessment (LCA) method and local data from the published national reports and inventory sources, we estimated that haemodialysis leads to greenhouse gas (GHG) emissions of ~12.8 tons of CO<sub>2</sub> equivalents (CO<sub>2</sub>eq) per person in the UAE annually. Thus, the decarbonisation of CKD care is crucial in establishing an environmentally sustainable healthcare system. We propose a framework to decarbonise CKD care in the UAE that tackles the carbon footprint of CKD care in the UAE by focusing on three main pillars: Delaying early CKD and slowing its progression; reducing anthropogenic emissions from CKD and dialysis care by promoting best practices and eco-friendly technologies; and enhancing access to kidney transplantation. Such approaches are relevant not only for the UAE but also for global healthcare systems aiming towards net-zero emissions.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"241-253"},"PeriodicalIF":2.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465397","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}
Pub Date : 2024-10-05eCollection Date: 2024-01-01DOI: 10.2147/IJNRD.S476344
Ali AlSahow, Bassam Bulbanat, Bassam Alhelal, Khaldoun Alhumoud, Ahmad Alkharaza, Torki Alotaibi, Heba Alrajab, Anas Alyousef, Fatimah Hadi
Introduction: Hyperkalemia is common in heart failure (HF) patients on renin angiotensin aldosterone inhibitors (RAASi), in chronic kidney disease (CKD), and in hemodialysis, and it negatively impacts their management. New potassium binders, such as sodium zirconium cyclosilicate (SZC), are effective in management of acute and chronic hyperkalemia. However, guidelines inconsistencies and lack of standardized treatment protocols are hindering proper and wider use of such agents. Therefore, an expert panel from Kuwait developed a consensus statement to address hyperkalemia management in acute settings, in HF, in CKD, and in hemodialysis.
Methods: A three-step modified Delphi method was adopted to develop the present consensus, which consisted of two rounds of voting and in-between a virtual meeting. Twelve experts from Kuwait participated in this consensus. Statements were developed and shared with experts for voting. A meeting was held to discuss statements that did not reach consensus at the first round and then the remaining statements were shared for final voting.
Results: The consensus consists of 44 statements involving an introduction to and the management of hyperkalemia in acute settings, HF, CKD, and hemodialysis. Thirty-six statements approved unanimously in the first vote. In the second vote, four statements were removed and four were approved after editing.
Conclusion: Hyperkalemia management lacks standardized definitions, treatment thresholds and consistent guidelines and laboratory practices. This consensus is in response to lack of standardized treatment in the Arabian Gulf, and it aims to establish guidance on hyperkalemia management for healthcare practitioners in Kuwait and highlight future needs.
{"title":"Management of hyperkalemia: Expert consensus from Kuwait - a Modified Delphi Approach.","authors":"Ali AlSahow, Bassam Bulbanat, Bassam Alhelal, Khaldoun Alhumoud, Ahmad Alkharaza, Torki Alotaibi, Heba Alrajab, Anas Alyousef, Fatimah Hadi","doi":"10.2147/IJNRD.S476344","DOIUrl":"10.2147/IJNRD.S476344","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperkalemia is common in heart failure (HF) patients on renin angiotensin aldosterone inhibitors (RAASi), in chronic kidney disease (CKD), and in hemodialysis, and it negatively impacts their management. New potassium binders, such as sodium zirconium cyclosilicate (SZC), are effective in management of acute and chronic hyperkalemia. However, guidelines inconsistencies and lack of standardized treatment protocols are hindering proper and wider use of such agents. Therefore, an expert panel from Kuwait developed a consensus statement to address hyperkalemia management in acute settings, in HF, in CKD, and in hemodialysis.</p><p><strong>Methods: </strong>A three-step modified Delphi method was adopted to develop the present consensus, which consisted of two rounds of voting and in-between a virtual meeting. Twelve experts from Kuwait participated in this consensus. Statements were developed and shared with experts for voting. A meeting was held to discuss statements that did not reach consensus at the first round and then the remaining statements were shared for final voting.</p><p><strong>Results: </strong>The consensus consists of 44 statements involving an introduction to and the management of hyperkalemia in acute settings, HF, CKD, and hemodialysis. Thirty-six statements approved unanimously in the first vote. In the second vote, four statements were removed and four were approved after editing.</p><p><strong>Conclusion: </strong>Hyperkalemia management lacks standardized definitions, treatment thresholds and consistent guidelines and laboratory practices. This consensus is in response to lack of standardized treatment in the Arabian Gulf, and it aims to establish guidance on hyperkalemia management for healthcare practitioners in Kuwait and highlight future needs.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"227-240"},"PeriodicalIF":2.1,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390465","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}
Pub Date : 2024-10-04eCollection Date: 2024-01-01DOI: 10.2147/IJNRD.S473616
Cyntia Camilo Franco Borges Zago, Bruna de Freitas Oliveira, Giovanna Uehara, Ana Laura Carvalho da Silva, Laura Penna Rocha, Fabiano Bichuette Custódio, Liliane Silvano Araújo, Crislaine Aparecida da Silva, Marlene Antônia Reis, Juliana Reis Machado
Purpose: In the kidneys, Systemic Lupus Erythematosus leads to Lupus Nephritis (LN), a form of glomerulonephritis. There is evidence that patients with LN may present activation of specific pathways for podocyte injury. This injury can occur through different mechanisms such as loss of podocyte adhesion to the glomerular basement membrane, cell death or dedifferentiation. Podocyturia with consequent podocytopenia has been described in some nephropathies such as LN, highlighting the importance of studying podocyte injuries in this condition. Evaluating in situ morphological characteristics of podocytes becomes relevant for a better understanding of the processes involved in their pathogenesis. This study investigated podocytes in different classes of LN in renal biopsies performed by the Kidney Research Center at the Federal University of Triângulo Mineiro.
Patients and methods: Twenty control cases and 29 biopsy cases diagnosed with LN were selected, divided according to the histopathological classes of the disease. Podocyte density was assessed through immunohistochemistry for Wilms tumor 1 protein and the evaluation of foot process effacement was performed by transmission electron microscopy.
Results: Podocyte density was lower in the LN and this reduction was observed in all analyzed classes when compared to the control group. More foot process effacement was observed in the LN group, with more effacement in classes I/II and class IV compared to the control group. The class IV group showed more foot process effacement than the class III group and presented higher proteinuria levels compared to the classes I/II group. A strong, positive, and significant correlation was observed between the activity index and foot process effacement in the class IV group.
Conclusion: Podocytes play an important role in the development of LN, and possibly, injuries to these cells are more closely related to the inflammatory/diffuse proliferative cellular process developed in class IV LN.
目的:在肾脏中,系统性红斑狼疮会导致狼疮性肾炎(LN),这是一种肾小球肾炎。有证据表明,狼疮肾炎患者可能会出现荚膜细胞损伤的特定途径激活。这种损伤可通过不同的机制发生,如荚膜细胞失去与肾小球基底膜的粘附力、细胞死亡或脱分化。一些肾病(如淋巴结核)中出现了荚膜细胞尿和随之而来的荚膜细胞减少症,这凸显了研究这种情况下荚膜细胞损伤的重要性。评估荚膜细胞的原位形态特征有助于更好地了解其发病过程。本研究调查了 Triângulo Mineiro 联邦大学肾脏研究中心进行的肾活检中不同类型 LN 中的荚膜细胞:研究选择了 20 例对照病例和 29 例确诊为 LN 的活检病例,并根据疾病的组织病理学分类进行了划分。通过Wilms肿瘤1蛋白的免疫组织化学方法评估荚膜细胞密度,并通过透射电子显微镜评估足突脱出情况:结果:与对照组相比,淋巴结核患者的荚膜细胞密度较低,而且在所有分析级别中都能观察到这种降低。与对照组相比,LN 组观察到更多的足突脱出,I/II 级和 IV 级脱出更多。与 I/II 级组相比,IV 级组比 III 级组有更多的足突脱出,蛋白尿水平也更高。在 IV 级组,观察到活动指数和足突脱出之间存在较强的正相关性:结论:荚膜细胞在 LN 的形成过程中起着重要作用,这些细胞的损伤可能与 IV 级 LN 的炎症/弥漫性增生细胞过程有更密切的关系。
{"title":"Influence of Podocyte Injury on the Development of Class IV Lupus Nephritis.","authors":"Cyntia Camilo Franco Borges Zago, Bruna de Freitas Oliveira, Giovanna Uehara, Ana Laura Carvalho da Silva, Laura Penna Rocha, Fabiano Bichuette Custódio, Liliane Silvano Araújo, Crislaine Aparecida da Silva, Marlene Antônia Reis, Juliana Reis Machado","doi":"10.2147/IJNRD.S473616","DOIUrl":"https://doi.org/10.2147/IJNRD.S473616","url":null,"abstract":"<p><strong>Purpose: </strong>In the kidneys, Systemic Lupus Erythematosus leads to Lupus Nephritis (LN), a form of glomerulonephritis. There is evidence that patients with LN may present activation of specific pathways for podocyte injury. This injury can occur through different mechanisms such as loss of podocyte adhesion to the glomerular basement membrane, cell death or dedifferentiation. Podocyturia with consequent podocytopenia has been described in some nephropathies such as LN, highlighting the importance of studying podocyte injuries in this condition. Evaluating in situ morphological characteristics of podocytes becomes relevant for a better understanding of the processes involved in their pathogenesis. This study investigated podocytes in different classes of LN in renal biopsies performed by the Kidney Research Center at the Federal University of Triângulo Mineiro.</p><p><strong>Patients and methods: </strong>Twenty control cases and 29 biopsy cases diagnosed with LN were selected, divided according to the histopathological classes of the disease. Podocyte density was assessed through immunohistochemistry for Wilms tumor 1 protein and the evaluation of foot process effacement was performed by transmission electron microscopy.</p><p><strong>Results: </strong>Podocyte density was lower in the LN and this reduction was observed in all analyzed classes when compared to the control group. More foot process effacement was observed in the LN group, with more effacement in classes I/II and class IV compared to the control group. The class IV group showed more foot process effacement than the class III group and presented higher proteinuria levels compared to the classes I/II group. A strong, positive, and significant correlation was observed between the activity index and foot process effacement in the class IV group.</p><p><strong>Conclusion: </strong>Podocytes play an important role in the development of LN, and possibly, injuries to these cells are more closely related to the inflammatory/diffuse proliferative cellular process developed in class IV LN.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"215-225"},"PeriodicalIF":2.1,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390464","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}
Background: Malnutrition inflammation score (MIS) is an instrument for assessing the nutritional status of stage 5 CKD patients, while simplified creatinine index (SCI) is used to assess muscle mass indirectly.
Purpose: This study aims to analyse the correlation between SCI and MIS, as well as determine the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients on maintenance HD.
Methods: This research was an analytical observational study with a cross-sectional study approach. The 132 research subjects were stage 5 CKD patients at the HD Unit of RSUP Dr. Hasan Sadikin Bandung. The research used the Rank-Spearman test with SPSS for correlative bivariate analysis. The area under the curve (AUC) on the receiver operating characteristic (ROC) curve was analysed to find the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients.
Results: Sixty-three subjects (47.7%) were classified as good nutrition and 69 subjects (52.3%) as poor nutrition. The average SCI value in this study was 24.5 mg/kg/day ± SD 3.2 mg/kg/day, with a median MIS value was 6. This study showed a significant negative correlation between SCI and MIS (r = -0.586, p < 0.001). The optimal SCI cut-off from the ROC curve analysis value was ≤ 24.53 mg/kg/day (sensitivity = 76.8%; specificity = 79.4%).
Conclusion: A negative correlation existed between SCI and MIS, with an SCI value ≤ 24.53 indicating poor nutritional status in stage 5 CKD patients on maintenance HD. SCI can be used as a predictor of malnutrition at a lower cost and easier.
{"title":"Simplified Creatinine Index as Predictor of Malnutrition in Stage 5 Chronic Kidney Disease Patients on Maintenance Haemodialysis.","authors":"Ria Bandiara, Davin Takaryanto, Rizky Andhika, Afiatin Makmun, Rudi Supriyadi, Lilik Sukesi","doi":"10.2147/IJNRD.S465294","DOIUrl":"10.2147/IJNRD.S465294","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition inflammation score (MIS) is an instrument for assessing the nutritional status of stage 5 CKD patients, while simplified creatinine index (SCI) is used to assess muscle mass indirectly.</p><p><strong>Purpose: </strong>This study aims to analyse the correlation between SCI and MIS, as well as determine the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients on maintenance HD.</p><p><strong>Methods: </strong>This research was an analytical observational study with a cross-sectional study approach. The 132 research subjects were stage 5 CKD patients at the HD Unit of RSUP Dr. Hasan Sadikin Bandung. The research used the Rank-Spearman test with SPSS for correlative bivariate analysis. The area under the curve (AUC) on the receiver operating characteristic (ROC) curve was analysed to find the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients.</p><p><strong>Results: </strong>Sixty-three subjects (47.7%) were classified as good nutrition and 69 subjects (52.3%) as poor nutrition. The average SCI value in this study was 24.5 mg/kg/day ± SD 3.2 mg/kg/day, with a median MIS value was 6. This study showed a significant negative correlation between SCI and MIS (r = -0.586, p < 0.001). The optimal SCI cut-off from the ROC curve analysis value was ≤ 24.53 mg/kg/day (sensitivity = 76.8%; specificity = 79.4%).</p><p><strong>Conclusion: </strong>A negative correlation existed between SCI and MIS, with an SCI value ≤ 24.53 indicating poor nutritional status in stage 5 CKD patients on maintenance HD. SCI can be used as a predictor of malnutrition at a lower cost and easier.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"205-213"},"PeriodicalIF":2.1,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11296508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889207","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}
Pub Date : 2024-07-24eCollection Date: 2024-01-01DOI: 10.2147/IJNRD.S461028
Evi Diana Omar, Hasnah Mat, Ainil Zafirah Abd Karim, Ridwan Sanaudi, Fairol H Ibrahim, Mohd Azahadi Omar, Muhd Zulfadli Hafiz Ismail, Vivek Jason Jayaraj, Bak Leong Goh
Purpose: This study aimed to identify the best-performing algorithm for predicting Acute Kidney Injury (AKI) necessitating dialysis following cardiac surgery.
Patients and methods: The dataset encompassed patient data from a tertiary cardiothoracic center in Malaysia between 2011 and 2015, sourced from electronic health records. Extensive preprocessing and feature selection ensured data quality and relevance. Four machine learning algorithms were applied: Logistic Regression, Gradient Boosted Trees, Support Vector Machine, and Random Forest. The dataset was split into training and validation sets and the hyperparameters were tuned. Accuracy, Area Under the ROC Curve (AUC), precision, F-measure, sensitivity, and specificity were some of the evaluation criteria. Ethical guidelines for data use and patient privacy were rigorously followed throughout the study.
Results: With the highest accuracy (88.66%), AUC (94.61%), and sensitivity (91.30%), Gradient Boosted Trees emerged as the top performance. Random Forest displayed strong AUC (94.78%) and accuracy (87.39%). In contrast, the Support Vector Machine showed higher sensitivity (98.57%) with lower specificity (59.55%), but lower accuracy (79.02%) and precision (70.81%). Sensitivity (87.70%) and specificity (87.05%) were maintained in balance via Logistic Regression.
Conclusion: These findings imply that Gradient Boosted Trees and Random Forest might be an effective method for identifying patients who would develop AKI following heart surgery. However specific goals, sensitivity/specificity trade-offs, and consideration of the practical ramifications should all be considered when choosing an algorithm.
目的:本研究旨在确定预测心脏手术后需要透析的急性肾损伤(AKI)的最佳算法:数据集包括马来西亚一家三级心胸中心 2011 年至 2015 年间的患者数据,数据来源于电子健康记录。广泛的预处理和特征选择确保了数据的质量和相关性。应用了四种机器学习算法:逻辑回归、梯度提升树、支持向量机和随机森林。数据集被分成训练集和验证集,并对超参数进行了调整。评估标准包括准确度、ROC 曲线下面积(AUC)、精确度、F 值、灵敏度和特异性。整个研究过程严格遵守了数据使用和患者隐私的伦理准则:梯度提升树的准确率(88.66%)、AUC(94.61%)和灵敏度(91.30%)最高,表现最佳。随机森林的 AUC(94.78%)和准确率(87.39%)都很高。相比之下,支持向量机的灵敏度(98.57%)较高,特异度(59.55%)较低,但准确度(79.02%)和精确度(70.81%)较低。通过逻辑回归,灵敏度(87.70%)和特异度(87.05%)保持平衡:这些研究结果表明,梯度提升树和随机森林可能是识别心脏手术后发生 AKI 患者的有效方法。不过,在选择算法时应考虑具体目标、灵敏度/特异性权衡以及实际影响。
{"title":"Comparative Analysis of Logistic Regression, Gradient Boosted Trees, SVM, and Random Forest Algorithms for Prediction of Acute Kidney Injury Requiring Dialysis After Cardiac Surgery.","authors":"Evi Diana Omar, Hasnah Mat, Ainil Zafirah Abd Karim, Ridwan Sanaudi, Fairol H Ibrahim, Mohd Azahadi Omar, Muhd Zulfadli Hafiz Ismail, Vivek Jason Jayaraj, Bak Leong Goh","doi":"10.2147/IJNRD.S461028","DOIUrl":"10.2147/IJNRD.S461028","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify the best-performing algorithm for predicting Acute Kidney Injury (AKI) necessitating dialysis following cardiac surgery.</p><p><strong>Patients and methods: </strong>The dataset encompassed patient data from a tertiary cardiothoracic center in Malaysia between 2011 and 2015, sourced from electronic health records. Extensive preprocessing and feature selection ensured data quality and relevance. Four machine learning algorithms were applied: Logistic Regression, Gradient Boosted Trees, Support Vector Machine, and Random Forest. The dataset was split into training and validation sets and the hyperparameters were tuned. Accuracy, Area Under the ROC Curve (AUC), precision, F-measure, sensitivity, and specificity were some of the evaluation criteria. Ethical guidelines for data use and patient privacy were rigorously followed throughout the study.</p><p><strong>Results: </strong>With the highest accuracy (88.66%), AUC (94.61%), and sensitivity (91.30%), Gradient Boosted Trees emerged as the top performance. Random Forest displayed strong AUC (94.78%) and accuracy (87.39%). In contrast, the Support Vector Machine showed higher sensitivity (98.57%) with lower specificity (59.55%), but lower accuracy (79.02%) and precision (70.81%). Sensitivity (87.70%) and specificity (87.05%) were maintained in balance via Logistic Regression.</p><p><strong>Conclusion: </strong>These findings imply that Gradient Boosted Trees and Random Forest might be an effective method for identifying patients who would develop AKI following heart surgery. However specific goals, sensitivity/specificity trade-offs, and consideration of the practical ramifications should all be considered when choosing an algorithm.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"197-204"},"PeriodicalIF":2.1,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787970","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}