International Journal of Nephrology and Renovascular Disease最新文献

Introduction: Limited data exist regarding treatment patterns and symptom burden of patients with anemia of chronic kidney disease (CKD) in the Middle East, South Africa, and Türkiye.

Methods: This real-world study explored clinical characteristics, symptom burden, and treatment patterns of patients with anemia of CKD living in the Middle East, South Africa, and Türkiye. Physician and patient perceptions of treatment were captured via cross-sectional surveys; patients' clinical characteristics were recorded by retrospective review of medical records.

Results: Data were collected from 1788 patients and 217 physicians. A high proportion of patients had never received treatment for their anemia (n = 701, 39.2%); the most common treatment was erythropoietin-stimulating agents (ESAs) + intravenous iron (n = 457, 50.3%). High symptom burden was reported, with lack of energy being the most common symptom (n = 394, 75.6% treated and n = 133, 59.9% non-treated patients). Patients' self-reported symptom burden was higher than physician-reported burden; less agreement was seen for non-dialysis-dependent (NDD) patients (kappa = 0.193, standard deviation [SD]: 0.081) than dialysis-dependent (DD) patients (kappa = 0.442, SD: 0.103). Median hemoglobin thresholds that physicians reported using for initiating treatment (NDD: <10.5 [interquartile range, 9.5-12.0] g/dL; DD: <9.3 [9.0-10.0] g/dL) were higher than actual test levels at treatment initiation (NDD: 9.2 [8.7-10.0] g/dL; DD: 9.0 [8.1-10.0] g/dL).

Conclusion: Treatment inertia is apparent despite high symptom burden in the Middle East, South Africa, and Türkiye, and disagreement was seen in physician and patient perspectives on symptomology. Improved awareness of this disagreement may help facilitate physician-patient dialogue to improve patient experience.

Background: Acute kidney injury (AKI) is common in critically ill children in the PICU, with incidence rates from 2.5% to 58%, impacting mortality and hospital duration. Early AKI detection is vital, but conventional hemodynamic monitoring often lacks specificity. This study investigates the relationship between the inferior vena cava/aortic (IVC/Ao) ratio and serum lactate levels as non-invasive indicators of renal hemodynamics and tissue perfusion in children. Understanding these parameters could improve early diagnosis, aid clinical decisions, and enhance outcomes for pediatric AKI patients, offering an accessible monitoring method for clinicians.

Methods: This cross-sectional study involved 48 pediatric patients aged 5-18 years showing Pediatric Early Warning Score (PEWS) ≥3 and diagnosed with renal disorders. Patients were admitted to the emergency department, high care unit, PICU, and pediatric ward at Dr. Hasan Sadikin Hospital, Bandung, between May and August 2023. AKI was diagnosed using pRIFLE or KDIGO criteria. The IVC/Ao ratio was assessed via transabdominal USG, and serum lactate levels were measured. Spearman correlation analysis was conducted to assess their relationship.

Results: The median (IQR) IVC/Ao ratio was 0.91 (0.70-1.10), and serum lactate levels were 1.5 (1.1-2.4) mmol/L. Spearman correlation analysis revealed a negative correlation between the IVC/Ao ratio and serum lactate (rho = -0.65, p < 0.001).

Conclusion: A decrease in the IVC/Ao ratio correlates with an increase in serum lactate levels in children with AKI.

Purpose: Social determinants of health have been related with kidney diseases and their outcomes. Financial toxicity (FT) refers to the negative impact of health care costs on clinical conditions. This scoping review aimed to evaluate the literature linking FT with renal diseases.

Patients and methods: We Included all studies analyzing FT and renal disease recorded in PubMed, Embase and Google Scholar between 2013 and 2023. The research question was formulated with reference to the acronym PCC (Problem, Concept and Contest). For each included study, we considered the study design, the population and main results from different populations with distinct renal conditions and the results were summarized in four tables.

Results: Socioeconomic deprivation was the main cause of FT, and the majority of studies on the relationship between FT and chronic kidney disease (CKD) were conducted in the USA (4 studies evaluated the pediatric population and 6 studies included adults). Three studies reported the impact of FT on nephrolithiasis, and 3 studies analyzed the link between FT and renal tumors. The methods used for detecting FT differed and were based on consultations, questionnaires, expenditures and database records analysis. The COmprehensive Score for financial Toxicity (COST) questionnaire was used in 7 studies (43%), and the prevalence of FT was reported to be high in children and adults.

Conclusion: Although the quality of the selected study is limited, due to different populations investigated and heterogeneity in detecting FT, the latter seems to be a frequent finding in people with renal disease. Health care professionals should recognize socioeconomic deprivation as the major cause of FT. Detecting FT could help in prioritizing patient-centered care in populations with renal diseases through the development of strategies aimed at improving care for people with kidney diseases.

Approximately one in five patients with systemic lupus erythematosus (SLE) has disease-onset during childhood (cSLE). Lupus nephritis is more common in cSLE than adult-onset SLE and is associated with significant and increased morbidity and mortality. In this article, we review lupus nephritis in cSLE, including pathogenesis, diagnosis, biomarkers, and management through PUBMED search between July and December 2024. Diagnosis of lupus nephritis is made in 93% of cSLE patients during the first 2 years of disease. The majority of patients have active disease in other organs, and nephrotic range proteinuria and hypertension is frequently observed at diagnosis. Class III and IV are observed in over 50% of renal biopsies and progression to end-stage renal disease varies across cohorts. Major progress made in recent years includes adjustment of the proportion of fibrous crescents when scoring nephritis in cSLE to better discriminate kidney disease outcomes, and development of non-invasive biomarkers to identify renal disease activity and damage. It is anticipated that accurate non-invasive biomarkers will foster multicenter studies and help identify new treatment approaches to improve outcomes in cSLE nephritis.

Chronic kidney disease-associated pruritus (CKD-aP) is a frequent and distressing problem for individuals with chronic kidney disease (CKD) and end-stage renal disease. It affects around 20% of those with CKD and 40% of those with end-stage renal disease. Despite its clear association with poorer psychosocial and medical outcomes, it is often underreported by patients and frequently remains unnoticed by healthcare providers. This is likely due to uncertainty regarding its diagnosis and treatment. Most commonly, CKD-aP could be screened with questionnaires like the KDQoL-36 and WI-NRS, chosen for their simplicity and ease of use. Prior treatment studies of CKD-aP were mostly limited by noncontrolled design and small sample size. First CKD-aP medication - difelikefalin a powerful, new therapeutic option was approved by Federal Drug Administration (FDA) in 2021 and European Medicines Agency (EMA) in 2022. Recent expert opinions, clinical trials and metanalysis identified difelikefalin and gabapentinoids as medications of choice in treatment of CKD-aP. All these findings improved current understanding and management of this condition.

Introduction: Acute lobar nephronia (ALN) is a focal renal infection without liquefaction, historically regarded as rare in the pediatric population, yet recent literature suggests it may be under-diagnosed, which may result in the formation of renal abscess and future renal scarring.

Methods: The clinical presentation, investigations, treatment and long-term outcomes of 5 patients diagnosed with ALN was described and literature review was conducted by reviewing publications in PubMed using the keywords "acute lobar nephronia" and "pediatric".

Results: Three patients were males, aged 1 to 11 years. The primary complaint in all cases was fever, accompanied by significantly elevated inflammatory markers. Upon presentation, none of the patients exhibited pyuria on urinalysis, and all had sterile blood and urine cultures. Diagnosis was based on CT scans for three patients and renal sonography for two. Main findings included hyperechogenic renal parenchyma, and hypodense localized parenchyma. Treatment consisted of broad-spectrum intravenous antibiotics, administered for 7 to 12 days and additional 1 week course with amoxicillin-clavulanate, resulting in similar defervescence times across all patients. None of the patients demonstrated recurrence and none had renal pathology upon repeated renal sonography and upon DMSA scintigraphy.

Discussion: Clinical suspicion for ALN should arise in cases of abdominal pain and markedly increased inflammatory markers. It"s crucial to note that the absence of pyuria and negative culture results should not exclude ALN diagnosis, underscoring the need for a high index of suspicion in the pediatric population.

Background:  Previous studies have established a correlation between gut microbiota, metabolites, and diabetic nephropathy (DN). However, the inherent limitations of observational studies, including reverse causality and confounding factors, made this relationship uncertain.

Methods: In this study, we compiled summary statistics from a genome-wide association study (GWAS) conducted on gut microbiota, metabolites, and DN. We employed a two-sample Mendelian randomization (MR) approach, utilizing inverse variance weighted (IVW), MR-Egger, weighted median, and weighted mode methods.

Results:  We detected the protective nature of genetically predicted representatives from the family Bacteroidaceae (OR: 0.716, 95% CI: 0.516-0.995, p = 0.046), family Victivallaceae (OR: 0.871, 95% CI: 0.772-0.982, p = 0.026), genus Bacteroides (OR: 0.716, 95% CI: 0.516-0.995, p = 0.046), genus Coprococcus 2 (OR: 0.745, 95% CI: 0.576-0.963, p = 0.025), and genus Lactococcus (OR: 0.851, 95% CI: 0.730-0.992, p = 0.039) against the development of DN. Conversely, we identified a positive correlation between the incidence of DN and entities, such as Phylum Bacteroidetes (OR: 1.427, 95% CI: 1.085-1.875, p = 0.011), class Bacteroidia (OR: 1.304, 95% CI: 1.036-1.641,p = 0.024), order Bacteroidales (OR: 1.304, 95% CI: 1.035-1.641, p = 0.028), genus Catenibacterium (OR: 1.312, 95% CI: 1.079-1.594, p = 0.006), genus Lachnoclostridium (OR: 1.434, 95% CI: 1.129-1.821, p = 0.003), and genus Parasutterella (OR: 1.270, 95% CI: 1.070-1.510, p = 0.006). In our analysis, none of the gut metabolites demonstrated a causal relationship with DN.

Conclusion:  Our results substantiated the potential causal association between specific gut microbiota and DN. Therefore, our study offers novel insight into the mechanisms underlying DN. This finding provides a theoretical foundation for the future development of targeted strategies for the prevention and treatment of DN.

Purpose and motivation: Chronic kidney disease (CKD) is a major global public health problem with eventual progression to end-stage renal disease which tends to increase kidney stiffness. Shear wave elastography (SWE) is a recently developed ultrasound based technique which can be used to assess tissue stiffness noninvasively. The aim of this study was to evaluate the potential diagnostic value of SWE to assess renal parenchymal stiffness in CKD and its correlation with estimated glomerular filtration rate (eGFR), which may be used as a marker for detecting and staging CKD.

Materials and methods: The study protocol was approved by the Institutional ethics Committee at Kasturba medical college, Manipal and written informed consent was obtained from all participants. The study included 93 control subjects and 108 patients with CKD. SWE imaging was performed to assess renal cortical stiffness, as measured by the Young's modulus (YM). Correlations between SWE and conventional ultrasound parameters with age, serum creatinine, eGFR and serum urea were analysed using Pearson's correlation coefficient (p ≤ 0.05) and receiver operating characteristic (ROC) curves were derived.

Results: The diagnostic performance of SWE correlated with serum creatinine levels and eGFR. We found a statistically significant difference in kidney stiffness values between healthy individuals and CKD patients. The Spearman correlation coefficient revealed moderate negative linear correlation between the YM measurements and eGFR. We obtained a YM measurement cut-off value of 4.43 kPa, a value less than or equal to this suggested a no diseased kidney. This yielded sensitivity and specificity of 92.6% and 80.6%, respectively, with an AUROC of 0.92.

Conclusion: Our results demonstrated that shear wave elastography may provide a low-cost, non-invasive method for the morphological assessment and progression of the disease status in chronic kidney disease patients with CKD.

Background: Chorea is rare in maintenance dialysis patients but seriously affects the quality of life, and there are few previous reports of this condition. We report two patients undergoing regular hemodialysis for end-stage renal disease, both of whom presented with progressively intensified involuntary limb movements, but originating from different etiologies.

Case presentation: We report two patients undergoing regular hemodialysis for end-stage renal disease who presented with progressively intensified involuntary limb movements. Treatment with sedatives alone proved ineffective in both cases. Through differential diagnosis, one patient was diagnosed with diabetic striatopathy and managed with intensive glycemic control, while the other was found to have uremic metabolic encephalopathy and treated with a combination of hemodialysis and hemoperfusion. Subsequently the patients' symptoms improved significantly.

Conclusion: Choreiform movements in hemodialysis patients arise from a variety of etiologies. These two cases suggested the susceptibility to the onset of chorea in the early stage of maintenance hemodialysis.

Introduction: Chronic kidney disease affects the quality of life of people with diabetes mellitus, increases cardiovascular risk, and has high social costs.

Objective: To determine associated factors for chronic kidney disease in people with diabetes mellitus type 2.

Material and methods: Retrospective cohort study with 371 patients evaluated in primary care for diabetes mellitus. Information on age, sex, disease duration, comorbidity and laboratory results was obtained. Patients of both sexes attended between 2022 and 2024 were included. Patients with other renal diseases or referrals were excluded. Logistic regression analysis was performed to identify associated factors.

Results: Males (p = 0.014), age >60 years, (p = 0.01) uncontrolled diabetes (HbA1C >7.99%±1.84) and disease duration over 20 years (p = 0.02) are associated factors for chronic kidney disease (CKD). HbA1c had significant differences between those with and those without CKD. The most frequent comorbidities are arterial hypertension (70%), dyslipidemia (43%), overweight/obesity (44%) and anemia (31%). CKD stage G2 is the most frequent (45%). One hundred percent of patients in G1 and G2 CKD stages have an elevated microalbuminuria/creatinuria rate, and 13% of patients between G3a and G4 stages have this rate within normal values. Most patients receive nephroprotection with ARA II and ACEIs.

Conclusion: It is important to screen for kidney disease in patients with diabetes mellitus type 2 who are male, over 60 years of age, with uncontrolled HbA1c and prolonged disease duration, as well as to treat comorbidities and nephroprotection regardless of the stage of chronic kidney disease.