Journal of Nephrology最新文献

Background: The estimation of glomerular filtration rate (eGFR) is essential in the early detection of diabetic nephropathy. We herein compare the performance of common eGFR formulas against a gold standard measurement of GFR in patients with diabetes mellitus.

Methods: GFR was measured in 93 patients with diabetes mellitus using iohexol clearance as the reference standard. The performance of the creatinine- and cystatin C-based EKFC formulas (2021, 2023) and the CKD-EPI formulas (2009, 2012) was compared against measured GFR.

Results: Sixty patients with type 2 diabetes mellitus and 33 patients with type 1 diabetes mellitus were included. The creatinine-based EKFC formula showed lower bias and higher accuracy than the CKD-EPI formula. No significant difference was observed between the cystatin C-based formulas. The combined creatinine- and cystatin C-based formulas had the highest accuracy and lowest bias. Body fat or diabetes type did not significantly influence the accuracy of the cystatin C-based formulas.

Conclusions: Our study demonstrated a slight advantage of the creatinine-based EKFC formula over the CKD-EPI formula in patients with diabetes. However, both for the CKD-EPI and the EKFC formula, the best performance was achieved by the combined creatinine- and cystatin C-based formulas.

Background: The KDIGO recommendation in acute kidney injury (AKI) patients requiring kidney replacement therapy is to deliver a Urea Kt/V of 1.3 for intermittent thrice weekly hemodialysis, and an effluent volume of 20-25 ml/kg/hour when using continuous renal replacement therapy (CRRT). Considering that prior studies have suggested equivalent outcomes when using CRRT-prolonged intermittent renal replacement therapy (PIRRT) effluent doses below 20 mL/kg/h, our group investigated the possible benefits of low effluent volume CRRT-PIRRT (12.5 ml/Kg/hour).

Methods: Thirty-six AKI patients that had been treated in the previous 12 months by CRRT-PIRRT with low effluent volume were included in the present retrospective observational study. The total effluent volume, derived from the formula [25 (or 12.5 ml) × kg body weight × 24], was administered over 24 h in CRRT and over 10 h in daily PIRRT. The control group consisted of the last 36 AKI patients previously treated with standard effluent volume CRRT (25 ml/kg/hour). Mortality within 90 days, shift from low effluent volume to standard effluent volume due to dialysis inadequacy, and remission of AKI were the end points. The two groups were homogeneous for age, sex, and sequential organ failure assessment (SOFA) score. Patients with AKI caused by metformin-induced lactic acidosis were excluded because they were treated with standard effluent volume CRRT until the lactic acidosis was corrected by subsequently reducing the effluent volume to 12.5 ml/kg/hour.

Results: The two groups were homogeneous as for baseline features. The UKt/V in the low effluent volume group was 0.51 ± 0.04 in CRRT and 0.50 ± 0.07 in PIRRT per session (Table 3). The UKt/V in the standard effluent volume group was 1.00 ± 0.02 in CRRT and 0.95 ± 0.05 in PIRRT per session. No differences were observed between the 2 groups regarding death from any cause at 90 days, and recovery of renal function. No patient was switched from low effluent volume to standard effluent volume due to inadequate control of uremic toxins. Serum creatinine at discharge from the hospital in patients with no KRT dependence was 2.1 ± 0.6 mg/dl in standard effluent volume and 1.9 ± 0.5 in low effluent volume (p = 0.37). All low effluent volume patients showed adequate metabolic, electrolyte, and acid-base profile control. In the low effluent volume group, the incidence of hypophosphatemia was lower than in the standard effluent volume group (5 vs 15, p = 0.003).

Conclusions: In this single-center retrospective study, low effluent volume CRRT-PIRRT was associated with similar outcomes to standard effluent volume CRRT-PIRRT, which is consistent with the results of prior observational studies. Randomized controlled studies comparing low effluent volume with standard effluent volume are needed.

Background: Hyperuricemia is a hallmark of gout and a suspected risk factor for the progression of chronic kidney disease (CKD). However, the impact of urate-lowering therapy on CKD progression is subject to debate. The objective of the present study was to describe the prevalence of inappropriate urate-lowering therapy prescriptions and evaluate the association between urate-lowering therapy prescription and the progression of kidney disease in patients with CKD.

Methods: CKD-REIN is a French, nationwide, prospective cohort of 3,033 nephrology outpatients with CKD (eGFR < 60 mL/min/1.73 m²). Prescriptions of urate-lowering therapy drugs (allopurinol or febuxostat) were recorded prospectively. The appropriateness of each prescription was evaluated according to the patient's kidney function at baseline and during follow-up. Propensity score-matched, cause-specific Cox proportional hazards regression models were used to assess the association between incident urate-lowering therapy use and CKD progression (defined as the initiation of kidney replacement therapy (KRT) but also in other ways).

Results: At baseline, 987 of the 3009 patients included in this study (median age: 69; men: 66%) were receiving urate-lowering therapy; 396 of these 987 patients were receiving an inappropriate prescription with regard to their kidney function. During a 5-year follow-up period, 70% of the 396 urate-lowering therapy prescriptions remained inappropriate. In the propensity score-matched cohort (n = 674), 136 patients started KRT. Compared with non- urate-lowering therapy use, urate-lowering therapy use was not significantly associated with a slowing in CKD progression, regardless of the definition used (HR_KRT 0.89, 95% CI 0.67-1.20).

Conclusions: Our real-world data emphasized the lack of reassessment of urate-lowering therapy prescriptions in patients with CKD. Urate-lowering therapy was not associated with a slowing of CKD progression.

Background: Renal functional reserve (RFR) measures the difference between the stimulated glomerular filtration rate (GFR) and the baseline GFR to detect early signs of renal functional decline. The protein load test (RFR-T) is the gold standard for RFR assessment but is a complicated procedure. Renal intraparenchymal resistance index (RRI) variation test (DRRI-T) is a non-invasive method to measure renal function reserve using ultrasound. A saline bag is used to induce renal vasodilation, and the DRRI is found by calculating the difference between baseline (without weight) and stress RRI (with weight). Normal DRRI-T is greater than 0.05.

Methods: Our study compared RFR-T and DRRI-T in 50 patients with normal kidney function. We evaluated anthropometric parameters, cardiovascular risk factors, and performed blood and urine tests. Patients were over 18 years old with an estimated GFR (eGFR) CKD-EPI > 60 mL/min/1.73 m². We excluded pregnant patients, those intolerant to milk protein, those with abnormal kidney ultrasound, or taking medication affecting intrarenal hemodynamics. We used Gwet's AC1 statistic to assess concordance between tests.

Results: Our study found moderate concordance (0.545 coefficient value, p-value < 0.001) between preserved RFR-T (≥ 15 mL/min/1.73 m²) and DRRI (VN > 0.05). Preserved RFR had a significant association with baseline eGFR. Age and sex have an impact on RFR. RFR deteriorates with age, leading to a significant decrease (p = 0.0220), which is more pronounced in women than men (p = 0.0350).

Conclusions: The Ultrasound test (DRRI-T) can measure RFR in just 10 min. This contrasts the gold standard method for estimating RFR, which involves a protein load test, takes a long time to execute, and requires numerous blood and urine samples, making it challenging for large-scale use. While the DRRI-T demonstrated moderate concordance with the protein load test, it did not meet the criteria to be considered a new gold standard test. We posit that it could serve as a valuable initial screening test, warranting further exploration alongside the more elaborate protein load test. Our study suggests that there may be differences between men and women in RFR changes and with regard to age, warranting further investigation on larger populations through ad hoc studies. Our work is among the first to offer original real-life experience in this field.

Background: One of the most common secondary glomerular diseases in children is IgA vasculitis-associated nephritis (IgAVN). Determining the best treatment for IgAVN based on current guidelines is controversial. The purpose of this study was to evaluate the efficacy of methylprednisolone pulse therapy in Chinese children with moderate and severe IgAVN.

Methods: We compared outcomes between 86 children with IgAVN who received methylprednisolone pulse therapy (40 patients) and those who did not (46 patients). Both groups of patients were monitored for a minimum of one year. Laboratory results including 24-h proteinuria, serum albumin, serum creatinine, and clinical symptoms including edema and adverse reactions were compared.

Results: The average age of the children in the group receiving methylprednisolone pulse therapy was 8.71 ± 2.71 years, while the average age in those who did not receive pulse therapy was 8.48 ± 3.02 years. Methylprednisolone pulse treatment resulted in a longer-lasting reduction in urinary protein levels and in reduced recurrence rates and increased remission rates at 3 and 6 months (methylprednisolone: 65% and 85% versus no methylprednisolone: 43.48% and 67.39%, respectively). The recurrence rate within one year also differed significantly between the two groups. Within one year, 25% of children receiving methylprednisolone pulse therapy relapsed, whereas 43.5% of children not receiving methylprednisolone pulse therapy relapsed.

Conclusions: In Chinese children with moderate to severe IgAVN, methylprednisolone pulse therapy achieved a significantly higher remission rate and a more rapid eGFR improvement than non-methylprednisolone pulse therapy. Prompt initiation of methylprednisolone pulse therapy for children diagnosed with moderate to severe IgAVN may therefore be recommended.

Background: Studies on renal vein thrombosis have been conducted as case reports or case series. The renal outcomes and mortality risk of renal vein thrombosis have not been fully established. We aimed to investigate the clinical characteristics, treatment modalities, and predictors of renal outcomes and mortality in patients with renal vein thrombosis in a large multicenter cohort.

Methods: We retrospectively assessed 182 patients with renal vein thrombosis diagnosed between January 2011 and May 2023 using either Doppler ultrasonography or computed tomography venography. The main outcomes analyzed were all-cause mortality, and worsening kidney function.

Results: We evaluated 182 patients comprising 76 males (41.8%) and 106 females (58.2%). Nephrotic syndrome was the most common cause (51.6%) followed by malignancy (33%) and post-trauma or surgery (11%). Kidney function worsened in 126 patients (69.2%). Acute kidney injury (AKI) was identified in 72 patients (39.6%), whereas 54 patients (29.7%) developed chronic kidney disease (CKD). Multivariate logistic regression showed that declining kidney function was reliably predicted by nephrotic syndrome (Odds ratio (OR): 6.41, P = 0.004), serum albumin (OR: 0.31, P = 0.003), and diabetes mellitus (OR: 14.04, P < 0.001). Eighty-two patients (45.1%) died while being monitored. Sepsis accounted for the majority of deaths (25.3%). Bilateral renal vein thrombosis (Hazard Ratio (HR): 5.61, P < 0.001), malignancy (HR: 6.15, P = 0.004), serum albumin (HR: 0.12, P < 0.001), hemoglobin (Hb) level (HR: 0.102, P < 0.001) and diabetes mellitus (HR: 2.42, P = 0.007) were all reliable predictors of all-cause mortality using multivariate Cox regression.

Conclusion: Renal vein thrombosis is associated with a higher risk of mortality and worsening kidney function. It is essential to promptly identify high risk patients and start early treatment to prevent unfavorable outcomes.

Background: Pregnancy-Related Acute Kidney Injury (PRAKI) is an important contributor to maternal-fetal morbidity and mortality. The burden of PRAKI in sub-Saharan Africa is not well documented. We conducted a systematic literature review and meta-analysis to estimate the prevalence of PRAKI in sub-Saharan Africa.

Methods: We systematically searched the literature published between January 2000 and May 2024 on PubMed, Embase, Scopus, and African Journals Online. We used a random-effects model to derive the pooled prevalence estimates and analysed trends in prevalence using weighted meta-regression. We assessed the quality of the included studies using the Joanna Briggs Institute critical appraisal tool and evaluated the presence of publication bias using Begg's rank correlation and Egger's test.

Results: Thirteen studies satisfied the inclusion criteria, with a total sample size of 5273 individuals, ranging between 46 and 1547 across the studies. The pooled prevalence of PRAKI was 15.6% (95% CI 11.5-20.1%) with significant heterogeneity in prevalence rates (heterogeneity chi-square: 179.2, p < 0.001, I²: 93.4%). We observed an increase in the trend of PRAKI at a rate of 0.8% per year, with insufficient evidence of a difference in prevalence over the years (p = 0.119).

Conclusion: Our findings show a high prevalence of PRAKI and suggest a rising trend in the prevalence of PRAKI within sub-Saharan Africa. Future studies should investigate interventions to improve access to, and the quality of, antenatal care services to reduce maternal-fetal morbidity and mortality.