Journal of Nephrology最新文献

Background: The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and derived-neutrophil-to-lymphocyte ratio (d-NLR), which can be obtained from complete blood count, have gained attention due to their widespread availability and low cost of testing; they have recently been proposed as prognostic markers in various chronic diseases. The primary objective of our study was to investigate the potential prognostic role of inflammatory markers derived from blood cell counts regarding all-cause mortality in patients with kidney failure undergoing hemodialysis, and the use of such markers in risk stratification based on the type of vascular access used.

Methods: This retrospective study included 236 patients from the Nephrology Unit  of Trento. Demographic, anamnestic, clinical, and biochemical data, as well as total mortality, were collected. Neutrophil-to-lymphocyte ratio and the erythropoietin resistance index were calculated.

Results: The study cohort was divided into tertiles based on the neutrophil-to-lymphocyte ratio distribution. Patients in the third tertile exhibited significantly lower mean values of weight, serum albumin, serum iron, and transferrin, whereas mean erythropoietin resistance index values, and age were higher compared to those in the first and second tertiles, in which mortalilty was also higher. The area under the ROC curve (AUC) for neutrophil-to-lymphocyte ratio related to total mortality (AUC = 0.64) was wider than that for C-reactive protein (AUC = 0.61). Cox regression analysis suggested that neutrophil-to-lymphocyte ratio was independently associated with mortality, even after adjusting for confounding factors.

Conclusion: Our study suggests that neutrophil-to-lymphocyte ratio is a useful tool for the early risk stratification and management of patients with kidney failure.

Immunoglobulin A nephropathy (IgAN) is associated with liver diseases, including alcoholic cirrhosis. When IgAN occurs in patients with liver disease, it is referred to as secondary IgAN; however, the mechanisms underlying secondary IgAN remain unclear. Herein, we present a case report of IgAN in a patient with a history of alcoholic liver cirrhosis, who presented with hematuria and proteinuria. A kidney biopsy revealed diffuse subendothelial deposition and mild mesangial proliferation. Immunofluorescence showed strong positive signals for IgA and IgM in the glomerular capillaries. There were no restrictions between the kappa and lambda staining. Electron microscopy revealed electron-dense deposits in the mesangial and subendothelial kidney regions. Histological diagnosis confirmed IgAN, typically associated with alcoholism. Further examination revealed that galactose-deficient IgA1 antibodies had merged with IgA, and a positive staining for the apoptosis inhibitor of macrophage antibodies along the glomerular capillaries was observed. These findings suggest that primary IgAN and alcoholic cirrhosis-related IgAN may share a common underlying mechanism.

Background: The connection between gut dysbiosis and chronic kidney disease (CKD) has been recognized, but, the effect of dietary intake of live microbes on the prognosis of CKD is still unclear. This analysis examined the relationship of dietary live microbe intake with mortality among adults with CKD.

Methods: For this study, information was gathered from the National Health and Nutrition Examination Survey 1999-2018, which included 8725 adult participants with CKD. MedHi refers to the live microbial content of food beyond 10⁴ CFU/g. To elucidate the link between MedHi dietary live microbe intake and mortality from all-cause and cardiovascular disease (CVD), we implemented a weighted multivariate Cox regression analysis.

Results: In contrast to survivors, non-survivors had a lower intake of dietary live microbes. The findings from the multivariable model indicated a negative and linear relationship between an increment of 100 g in MedHi foods and reduced mortality from all-causes and CVD. Likewise, participants in the highest MedHi food group exhibited a 20% and 26% decreased risk of all-cause and CVD mortality, respectively, compared to those in the lowest MedHi food group. Stratified analyses conducted on various subgroups yielded consistent findings.

Conclusion: A significant inverse linear relationship was found between high dietary live microbe consumption and reduced all-cause and CVD mortality.

Background: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a monogenic disease having a prevalence of 1:400-1000 live births. Depending on kidney imaging, patients can be subdivided into Class 1 (typical) and Class 2 (atypical). The present study aims to provide better assessment of Class 2 patients to help define their family history, together with their clinical and radiological characteristics.

Methods: One hundred twenty-four PKD patients with abdominal Magnetic Resonance Imaging (MRI) for the staging of ADPKD, were retrospectively analyzed, aiming to focus on Class 2 ADPKD patients. Total kidney volume and total cyst volume were evaluated, while also assessing their clinical and genetic characteristics.

Results: Twelve patients fulfilled the Mayo criteria for Class 2 ADPKD (two Class 2B and ten Class 2A). Extrarenal involvement was observed in 66.7% of cases, but only two subjects presented an estimated Glomerular Filtration Rate (eGFR) < 60 mL/min/1.73 m². A positive family history for cystic disease was more frequent compared to other published cohorts. Only 8.3% tested positive for a likely pathogenic mutation in the PKD1 gene. Class 2B patients showed a lower height-adjusted total kidney volume, with a lower percentage of total cyst volume.

Conclusion: Based on our results, atypical ADPKD does not represent an uncommon condition, being present in about 10% of MRI-evaluated patients diagnosed with ADPKD. Genetic tests are frequently negative for PKD1/PKD2, and total cyst volume and residual tissue volume do not increase the prognostic value of MRI in patients with these radiological characteristics. Other tools are needed to better characterize their kidney prognosis.

Background: This umbrella review aimed to synthesise the existing evidence on sleep disturbances and sleep disorders in the adult chronic kidney disease (CKD) population.

Methods: A systematic search across five electronic databases. Reviews were grouped according to aspects of sleep and the focus of the review. The JBI critical appraisal checklist was used for quality assessment, and Preferred Reporting Items for Overviews of Reviews (PRIOR) guideline was used for reporting. The protocol was registered in the international registry PROSPERO (CRD42024527039).

Results: We identified 50 reviews covering three main aspects of sleep (sleep apnoea, restless legs syndrome and other sleep disturbances) across five focus areas (prevalence, interventions, health outcomes, determinants of sleep and patient experience). Most reviews reported on sleep disturbances (72%, 36 reviews) and focused on interventions (58%, 29 reviews). In contrast, evidence on sleep determinants and patient experience was limited. A high prevalence of sleep apnoea (49%), restless legs syndrome (27.2%) and other sleep disturbances (55%) was reported. Non-pharmacological interventions, including aromatherapy, dialysis, muscle relaxation, yoga, music, and nurse-led management, were found to improve sleep. However, this evidence was based on a single meta-analysis with few primary studies.

Conclusions: Despite the growing number of reviews on interventions to improve sleep, the evidence for their effectiveness is limited by the small number of primary studies and the high degree of overlap between reviews. Further research is needed to identify effective interventions. Additionally, qualitative studies exploring patients' perspectives on sleep are essential, as evidence in this area remains scarce.

A 3.5-year-old girl with genetically proven distal renal tubular acidosis presented with lethargy, after numerous episodes of vomiting and poor feeding. Laboratory investigations revealed severe metabolic acidosis, hypokalemia and a serum ammonia level of 515 mmol/L (normal range: 19-50 mmol/L). Despite treatment with sodium bicarbonate, potassium supplementation, sodium benzoate and carglumic acid, her condition required hemodialysis, which resulted in rapid improvement in clinical and metabolic parameters. Hyperammonemia in distal renal tubular acidosis results from impaired ammonium excretion and increased ammoniagenesis due to hypokalemia and chronic metabolic acidosis, particularly during metabolic decompensation. This case had the highest ever reported serum ammonia level in distal renal tubular acidosis with encephalopathic findings, necessitating hemodialysis treatment. Routine monitoring of serum ammonia levels in distal renal tubular acidosis patients during metabolic stress is essential.

Background: Assisted reproductive technology (ART) has significantly increased the rate of conception and live births in women with fertility problems. Having a kidney disease negatively affects a woman's reproductive health, making infertility a significant concern, and women with chronic kidney disease (CKD) are increasingly seeking treatment with assisted reproductive technology. The side effects of assisted reproductive technology are not fully known and its impact on kidney function, especially if a woman has undergone repeated treatments, is likewise not known.

Methods: This case series gathers all consecutive patients who were followed by the Mansoura University Hospital's Obstetric Nephrology Service or were admitted to its Nephrology and Gynecology Department during pregnancy with a diagnosis of acute or chronic kidney function impairment after conceiving with an assisted reproductive technology method, in the period from 2021 to 2024.

Results: Of the approximately 150 pregnancies referred to the Obstetric Nephrology Clinic, 6 were referred for acute or acute-on-chronic kidney function impairment, or nephrotic syndrome after conceiving via assisted reproductive technology. In one patient, CKD was overlooked and later progressed to kidney failure; one had probable CKD, but discontinued follow-up before confirmation; and one had a kidney malformation, diagnosed during pregnancy. All presented with early or very early severe hypertension and proteinuria, before 20 weeks, while preeclampsia and the hypertensive disorders of pregnancy are conventionally defined as developing after 20 weeks of gestation. Three had complete recovery postpartum, one progressed to kidney failure, while two were lost to follow-up.

Conclusion: Severe early-pregnancy kidney impairment after assisted reproductive technology is probably more frequent than previously reported. Assessment of kidney function after assisted reproductive technology should be mandatory, to make it possible for timely specialized kidney care to be given.

Patients with Diabetic Kidney Disease (DKD) suffer from various complications of diabetes mellitus, including autonomic neuropathy. Cardiac autonomic nervous system dysfunction is a common disorder in patients with diabetes mellitus and Chronic Kidney Disease (CKD), and is associated with an increased risk of arrhythmias and cardiovascular morbidity and mortality. Although the effects of exercise training have been thoroughly studied in different patient populations with CKD or diabetes mellitus, few studies have investigated the effects of exercise on cardiac autonomic nervous system activity in patients with DKD. This narrative review aims to summarize the evidence regarding the effects of exercise training on cardiac autonomic nervous system modulation in DKD patients.

Background: Pregnancy on dialysis is a rare and complex event, necessitating careful planning. Nurses play a vital role in the dialysis team, providing essential education and support to patients. This study aimed to explore nurses' knowledge and perspectives regarding pregnancy in dialysis patients.

Methods: An electronic survey was distributed to six dialysis centers in Saudi Arabia, spanning four regions. A total of 127 nurses participated, of whom 88.2% were hemodialysis (HD) nurses and 11.8% were peritoneal dialysis nurses. Survey responses were summarized using descriptive statistics, presented as percentages.

Results: Regarding the impact of kidney failure on reproductive health, only 53.5% of respondents recognized it as a cause of menstrual irregularities. However, 82.7% acknowledged that it reduces fertility, and 89% responded "yes" to the possibility of pregnancy while on dialysis, with 61.4% agreeing that female patients of reproductive age with kidney failure require contraception. Despite known limitations, 63% identified a pregnancy test as the preferred method for pregnancy confirmation. In terms of dialysis modality, 63% believed HD to be associated with a higher likelihood of pregnancy. Additionally, 79.5% selected renal transplantation as a measure to increase the likelihood of pregnancy. Regarding pregnancy risks, 89% agreed it poses both fetal and maternal risks. Finally, only 18.1% reported consistently discussing pregnancy-related topics with reproductive-age patients.

Conclusions: Nurses are essential to patient education in the dialysis setting. This study identifies potential knowledge gaps and proposes a framework of learning objectives on reproductive health to be integrated into nursing training.