International Journal of Nephrology and Renovascular Disease最新文献

Objective: This study aims to evaluate the diagnostic efficacy of shear wave elastography (SWE) and super-resolution imaging (SRI) in detecting moderate-to-severe renal fibrosis (MSRF) among patients with chronic kidney disease (CKD).

Methods: In this prospective study, 202 CKD patients who underwent SWE and SRI prior to renal biopsy were enrolled. Based on pathological findings, patients were categorized into a mild renal fibrosis group (n=107) and an MSRF group (n=95). LASSO logistic regression was employed to identify independent risk factors for MSRF. Four diagnostic models-isolated, series, parallel, and integrated-were developed by combining elasticity values from SWE and vascular density values from SRI. Additionally, a nomogram incorporating clinical parameters and ultrasound composite parameters was constructed to assess MSRF in CKD patients.

Results: LASSO and subsequent logistic regression analysis revealed that age, diabetes history, estimated glomerular filtration rate (eGFR), elasticity, and vascular density were independently associated with MSRF. The integrated model, utilizing a logistic algorithm, demonstrated superior diagnostic performance with an area under the curve (AUC) of 0.83 (P < 0.001), sensitivity of 80.4%, and specificity of 75.8%, outperforming all other models. Furthermore, the nomogram, which integrated clinical factors and ultrasound composite parameters, exhibited excellent predictive performance (AUC = 0.878, 95% CI 0.782-0.974). Calibration and decision curve analyses confirmed the model's robust calibration and clinical utility.

Conclusion: The integration of SWE-derived elasticity and SRI-derived vascular density significantly enhances the diagnostic accuracy for MSRF in CKD patients. This comprehensive approach offers a promising non-invasive strategy for assessing renal fibrosis severity.

Purpose: This study aimed to compare the surgical outcomes of robotic-assisted pyelolithotomy (RAPL) and mini-percutaneous nephrolithotomy (mini-PCNL) specifically in older adults with renal stones more than 2cm. We hypothesized that robotic-assisted pyelolithotomy (RAPL) is a safe and effective approach for managing large renal stones (>2 cm) in older adults.

Patients and methods: We retrospectively analyzed 605 patients aged 50-80 years who underwent either RAPL (n=31) or mini-PCNL (n=574) for renal stones >2 cm at Chang Gung Memorial Hospital, Taiwan, between December 2016 and November 2023. Patients were selected based on predefined inclusion and exclusion criteria. Key outcomes measured included stone-free rate, complication rate, hospital stay duration, and re-intervention rates. All patients were followed for at least one year postoperatively.

Results: RAPL patients exhibited a longer total operative time (165.2 vs 127.4 minutes, p = 0.016) but experienced significantly shorter hospital stays (1.8 vs 4.0 days, p < 0.001), lower complication rates (6.5% vs 27.7%, p < 0.05), and higher SFRs (90.3% vs 60.8%, p < 0.001). Blood transfusion, postoperative discomfort, and re-intervention rates were also markedly lower in the RAPL group.

Conclusion: For older patients with large renal stones, RAPL is a promising alternative to mini-PCNL, offering better stone clearance, fewer complications, and quicker recovery. Its minimally invasive, tissue-sparing approach benefits those at higher postoperative risk.

Introduction: Patients with Chronic Kidney Disease (CKD) undergoing regular hemodialysis experience various metabolic changes, including premature aging marked by increased prevalence of frailty. Beta-2 microglobulin (B2M), a uremic toxin whose concentration significantly increases in hemodialysis patients, has emerged as a potential biomarker of frailty. Previous evidence suggests potential link between B2M and frailty in older adults. However, data on its relationship with frailty in hemodialysis patients remains limited.

Purpose: To determine the relationship between B2M concentration and frailty in hemodialysis patients.

Patients and methods: This is a cross-sectional study utilizing primary data from hemodialysis patients at Rumah Sakit Cipto Mangunkusumo (RSCM), employing a total sampling method. Beta-2 microglobulin was measured using the Enzyme-Linked Fluorescent Assay (ELFA) method. Frailty was assessed using the Frailty Index 40-item. Medical history was obtained from medical records and interviews. Chi-square tests were performed to determine the relationship between B2M and frailty. Multivariate analysis was conducted to determine variables that affect frailty.

Results: A total of 79 subjects participated in the study. The median B2M concentration was 32.8 (IQR 29.8-36.77). Higher B2M concentration showed a trend toward increased frailty prevalence (PR of 4.83, 95% CI 0.69-33.81, p = 0.113). The final multivariate analysis showed that sarcopenia (PR 5.37; 95% CI 2.88-10.04) was strongly and consistently associated with frailty prevalence.

Conclusion: Higher B2M showed a trend towards increased frailty prevalence; however, this association is not statistically significant. Sarcopenia is a significant factor influencing the prevalence of frailty in hemodialysis patients.

Aim: Phospholipase A2 receptor 1 (PLA2R1) is often overexpressed in 70% of primary membranous nephropathy (PMN) patients, with serum PLA2R1 antibodies and podocyte PLA2R1 antigens serving as key diagnostic markers. However, a minority of patients test positive for only the PLA2R1 antigen and negative for PLA2R1 antibodies, presenting distinct characteristics. This study investigated the underlying features and mechanisms in PLA2R1 antigen-positive PMN patients.

Methods: 26 patients' information was screened for analysis. And the effects of PLA2R1 overexpression on human podocytes (HPCs) was studied through cell experiments.

Results: Clinical observations revealed that the median age of the 26 patients was 48.5 years, and the median onset time was 135 days. There was a significant negative correlation between blood albumin and antigen intensity. Cell studies demonstrated that PLA2R1 overexpression inhibited the proliferation and viability of HPCs. RNA sequencing and FACS assays revealed that PLA2R1 overexpression arrests HPCs at the S and G2/M phases.

Conclusion: PLA2R1 overexpression affects the course of the PMN by inhibiting the podocyte cycle. This study suggests that PLA2R1-related PMN pathogenesis could involve an additional immune response, offering insights into PMN treatment development.

Purpose: Adherence to treatment regimens is crucial to enhance the clinical outcomes of patients with End-Stage Renal Disease (ESRD). In Yemen, there is a gap in information about this issue. Hence, this study aimed to assess the adherence and associated factors of ESRD patients to the four adherence domains, including HD session attendance, medication, dietary modification, and fluid management.

Patients and methods: A descriptive cross-sectional study of ESRD patients was conducted. End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ) was used to collect data through face-to-face interviews. The scoring system was used. The mean of the gained scores was calculated and divided by expected maximum scores and the resulting percentage was used to rank the level of adherence as good ≥ 83%, moderate ≥58- <83% and poor <58%). Non-parametric tests to assess the mean differences with selected variables at p-value <0.005.

Results: The overall (mean ±SD) scores of 393 patients for the four adherence domains (HD, medication, fluid restrictions, and dietary recommendations) were 933.5+210 indicating an overall moderate level of adherence. Good adherence to HD and moderate adherence to medication, diet and fluids were observed (88.5%, 76.7%, 61.9%, and 61.6%, respectively). Significantly higher mean scores among patients with urban residency (941.8 vs 869.4, p=0.03), HD duration < 5 years (949.2 vs 908.0, p=0.02), the overall perception of treatment (956.7 vs 653.3, p=<0.001), patients who had a perception of medication (942.0 vs 734.3, p=0.002), fluid restriction (958.9 vs 727.3, p=<0.001), and diet recommendations (969.8 vs 715.2, p=<0.001). Significantly lower mean scores were observed among patients who had not received counseling regarding the importance of dietary and fluid restriction (962.8 vs 920.5, p=0.02) and (965.6 vs 919.0, p=0.02, respectively).

Discussion: This study is the first in our country to provide baseline information on adherence toward different treatment domains and their associated factors among patients with ESRD. The adherence level among patients with ESRD was moderate in general and good for HD. There was a significant association between adherence and residency, HD duration, overall perception of treatment, perception of medication, fluid and dietary restrictions, and poor counseling. Regular counseling should be provided to enhance adherence levels. A multicenter study is recommended to assess the causal relationship between adherence and the factors affecting adherence.

Introduction: Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a rare plasma cell dyscrasia. Growth differentiation factor-15 (GDF-15) is related with renal function, but few studies have focused on it in renal impairment of POEMS syndrome.

Objective: To evaluate the potential of circulating GDF-15 concentration as a biomarker for renal function in POEMS syndrome.

Methods: 150 Chinese patients, diagnosed with POMES syndrome, were enrolled and divided into three subgroups according to their chemotherapy stage. All the patients' medical records were retrospectively analyzed and plasma VEGF and GDF-15 were measured using ELISA kits. Treatment-naïve patients were followed up for 13±6 months.

Results: Plasma GDF-15 concentration positively correlated with serum creatinine (r=0.4048; P<0.0001), blood urea nitrogen (r=0.3302; P<0.0001), risk stratification (r=0.3949; P<0.0001), while negatively correlating with eGFR (r=-0.5057; P<0.0001) and albumin (r=-0.3800; P=0.0014). GDF-15>547.8 pg/mL provided an AUC of 0.8541 in diagnosing renal impairment (eGFR<60mL/min/1.73m²) in POEMS syndrome. With a prevalence of renal impairment of 16.7%, GDF-15>547.8 pg/mL showed a prominent NPV (94.9%) for the diagnosis of renal impairment in POEMS syndrome. Moreover, treatment-naïve patients with serous effusion had higher plasma GDF-15 concentration (P=0.0004) and lower eGFR (P=0.0001) than those without serous effusion. Noteworthy, baseline GDF-15 was positively correlated with ΔeGFR (r=0.4694, P=0.0044).

Conclusion: Circulating GDF-15 concentration is associated with serous effusion, renal function and risk stratification, while a plasma GDF-15 < 547.8 pg /mL can help rule out renal impairment in POEMS syndrome. Baseline plasma GDF-15 is associated with renal remission after chemotherapy.

Background: Mitsugumin 53 (MG53) plays a protective role against kidney diseases and cardiovascular diseases, but its mechanism of action is unclear. We speculate that the prevention of cardiovascular disease by MG53 may be associated with the inhibition of vascular calcification. This study was performed with the aim of investigating the potential association between the MG53 level and abdominal aortic calcification (AAC) in patients undergoing hemodialysis (HD).

Methods: A total of 263 patients undergoing HD and 65 age- and sex-matched healthy individuals were included. The patient serum MG53 level was measured by enzyme-linked immunosorbent assay (ELISA), and the abdominal aortic calcification score (ACCs) was calculated using lateral abdominal radiography parameters. The laboratory and demographic data were collected at baseline.

Results: The serum MG53 levels in HD patients were significantly lower than those in healthy individuals [24.9 (IQR: 16.1-40.1) vs 43.5 (IQR: 23.7-74.4) pg/mL, P < 0.001]. In addition, HD patients with AAC presented markedly lower serum MG53 levels than those without AAC [22.0 (IQR: 15.3-32.6) vs 26.9 (IQR: 16.8-44.2) pg/mL, p=0.024]. Furthermore, multiple logistic regression analysis indicated that lower serum MG53 levels, an older age, a longer dialysis vintage, a higher serum total carbon dioxide (TCO₂), and a higher serum phosphorus were independent risk factors for AAC in HD patients.

Conclusion: Our results demonstrate for the first time a correlation between lower serum MG53 levels and an increased risk of AAC in patients undergoing HD. In addition, an older age, a longer dialysis vintage, the presence of metabolic acidosis and higher serum phosphorus levels are independent risk factors for AAC in HD patients.

Objective: Patients with chronic kidney disease (CKD) and coronary artery disease (CAD) had a poor prognosis. Indicators derived from complete blood count (CBC), like neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), Systematic Inflammation Response Index (SIRI), systemic immune-inflammation index (SII) and Pan-Immune-Inflammation Value (PIV) had prognostic significance. But which one performed best in patients with CKD and CAD was still unclear.

Methods: CKD Patients with CAD admitted to ICU were retrospectively included. Patients with sepsis, connective tissue disease, tumor and receiving glucocorticoids were excluded. The primary endpoints encompassed in-hospital mortality and 30-day mortality.

Results: The study comprised 694 participants, with 60 patients died during hospitalization, and another 15 died in 30-day follow-up period. Both the admission level and maximal level of CBC-derived indicators were higher in the deceased group. ROC curve analysis demonstrated that maximal NLR had the highest AUCs - 0.795 for in-hospital mortality and 0.754 for 30-day mortality prediction. Furthermore, Net Reclassification Improvement (NRI) and Integrated Discrimination Improvement (IDI) analyses further confirmed that adding maximal NLR to the base model, which included traditional risk factors, significantly improved both NRI and IDI (p < 0.05 for both).

Conclusion: The maximum of NLR was with the best predictive value for in-hospital mortality and 30-day mortality in ICU patients with CAD and CKD. Predicting prognosis based on dynamic changes of NLR is more worthy of attention.

[This corrects the article DOI: 10.2147/IJNRD.S485409.].

Background: IgA nephropathy (IgAN) is the leading primary glomerulonephritis globally, with many patients advancing to end-stage renal disease. Proteinuria is a key predictor of renal function decline in IgAN, yet the best method for long-term assessment is unclear. This study explores the relationship between time-weighted average proteinuria (TWAP), a novel metric of cumulative proteinuria exposure, and renal function decline in IgAN patients.

Methods: This single-center retrospective cohort study encompassed 549 patients with biopsy-confirmed primary IgAN from Shenzhen Second People's Hospital from 2011 to 2023. TWAP served as the primary exposure variable, calculated using the protein-creatinine ratio values, while changes in estimated glomerular filtration rate (eGFR) constituted the primary outcome. Covariates included age, sex, blood pressure, and mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T), and crescents (C) (known as the Oxford Classification MEST-C score system). The associations between TWAP and eGFR trajectories were analyzed using Generalized Additive Mixed Models.

Results: In patients with baseline eGFR 15-60 mL/min/1.73m², higher TWAP levels correlated with accelerated eGFR decline. Compared to TWAP < 0.3 g/g, TWAP 0.3-0.5 g/g, 0.5-1 g/g, and ≥1 g/g were associated with additional annual eGFR declines of 2.04 (95% CI: -3.72 to -0.35), 3.38 (95% CI: -5.12 to -1.65), and 4.04 (95% CI: -6.61 to -1.47) mL/min/1.73m²/year, respectively. For eGFR ≥60 mL/min/1.73m², only TWAP ≥1 g/g significantly accelerated eGFR decline 5.70 (95% CI: -6.84 to -4.55) mL/min/1.73m²/year.

Conclusion: TWAP significantly predicts renal function decline in IgAN, especially in patients with pre-existing renal dysfunction. Maintaining TWAP below 0.3 g/g may significantly slow disease progression, emphasizing the importance of stringent proteinuria control in IgAN management.