Journal of Nephrology最新文献

Background: Glomerular diseases are a major contributor to chronic kidney disease (CKD) and kidney failure worldwide. The prevalence and spectrum of these diseases vary substantially across geographic regions, reflecting differences in genetic predisposition, environmental exposures, and healthcare practices. Although numerous kidney biopsy registries have been established globally, synthesizing their findings is required. The present systematic review aimed to integrate data from national and regional kidney biopsy registries to evaluate the global distribution of biopsy-proven glomerular diseases.

Methods: A comprehensive search was performed using MEDLINE, Embase, Scopus, Cochrane Library, and Google Scholar databases. Studies were eligible if they reported original data from kidney biopsy registries in adult patients undergoing native kidney biopsy, with histopathological diagnoses of primary or secondary glomerulonephritis.

Results: Thirty-nine studies met the inclusion criteria. IgA nephropathy was the most common primary glomerular disease worldwide, with exceptionally high prevalence in East Asia (up to 35.8%) and moderate prevalence in Europe (up to 20%). Membranous nephropathy and focal segmental glomerulosclerosis showed marked regional variability, with focal segmental glomerulosclerosis predominating in North and South America (over 20%). Among secondary glomerular diseases, lupus nephritis was more prevalent in South America, diabetic nephropathy in North America, and vasculitis-related glomerulonephritis in Europe and North America, with lower rates in Asia.

Conclusions: Our findings support the critical role of biopsy registries in nephrology research and emphasize the need for international harmonization of biopsy protocols and diagnostic standards. Integrating histological, clinical, and molecular data constitutes a key step to advancing precision nephrology globally.

Background: Haemodialysis (HD) has a significant environmental footprint due to its high resource consumption  and waste generation. A key component is dialysate production, which typically involves mixing water, bicarbonate, and a single-use acid concentrate bag for each session. An alternative method is the central delivery of acid concentrate, prepared on-site using dry powder formulations. This study compares the environmental impact of these two delivery systems, focusing on waste reduction, elimination of single-use plastic, and decreased transport-related emissions.

Methods: A detailed life cycle assessment (LCA) was carried out using OpenLCA and the Ecoinvent v3.1 database to compare the traditional acid concentrate bag system with the central delivery system (Granumix, Fresenius, Germany). Data on material inputs, energy use, waste generation, and transportation were collected. Flow diagrams captured the full life cycle of each method, and various environmental indicators were analysed, including climate change, acidification, and ecotoxicity.

Results: The Granumix system demonstrated considerably lower environmental impact than traditional bag use. It reduced climate change potential by 30% (CO₂-equivalent) and freshwater ecotoxicity by 15%. Additional benefits were observed in acidification, resource use, and overall emissions, indicating the system's broader environmental advantages.

Conclusions: The central delivery of acid concentrate using the Granumix system is a more sustainable option for HD, significantly reducing environmental burdens across several categories. These findings underscore the value of adopting innovative delivery models to make essential healthcare treatments more environmentally sustainable.

Background: Glomerulonephritis (GN) is a group of kidney disorders marked by glomerular damage, leading to proteinuria, hematuria, hypertension, and impaired kidney function. Despite advancements in diagnostics, kidney biopsy remains the gold standard for diagnosis. The prevalence of GN varies globally, with Latin America showing a significant increase in incidence rates.

Methods: This systematic review adhered to PRISMA guidelines and included observational studies from PubMed, Embase, Cochrane, and SciELO databases. Studies were selected based on their focus on the prevalence of GN and its subtypes in Latin America from 2000 onward. The quality of the studies was assessed using the Newcastle-Ottawa Scale adapted for cross-sectional studies.

Results: Following the search, a total of 4336 articles were screened. Of these, 49 underwent full-text review, and 35 met the inclusion criteria, encompassing 61,979 kidney biopsies analyzed across studies conducted in Latin America. The studies spanned a time frame of 1-35 years, with a mean age at biopsy ranging from 28 to 57 years. Focal Segmental Glomerulosclerosis (FSGS) and Lupus Nephrtis were the most frequent primary and secondary glomerulopathies. Nephrotic syndrome was the leading indication for biopsy, and electron microscopy was only reported in 17 studies. Few studies reported data on estimated glomerular filtration rate (eGFR), interstitial fibrosis, and tubular atrophy. Furthermore, subclassification of FSGS into primary and secondary forms was performed in only four studies. Most countries in Latin America reported kidney biopsy rates below 50 per million population per year (pmp/yr), substantially lower than those observed in high-income countries, where rates commonly exceed 100-200 pmp/yr.

Conclusions: The epidemiology of glomerulonephritis in Latin America is heterogeneous, with marked regional differences and predominance of FSGS as the leading primary GN; however, data on primary FSGS (pFSGS) are lacking. Compared to high-income countries, most Latin American countries report significantly lower rates of kidney biopsies per million population, which, combined with limited diagnostic resources, may contribute to the underdiagnosis and potential misclassification of glomerular diseases.

Background: Hypertension and left ventricular (LV) hypertrophy (LVH) are common in autosomal recessive polycystic kidney disease (ARPKD). We examined clinical determinants of LV mass in children with ARPKD.

Methods: Retrospective study of patients with ARPKD with available echocardiogram data. Casual blood pressure (BP) percentiles, 24-h ambulatory BP monitor (ABPM) parameters, antihypertensive medications, and estimated glomerular filtration rate (eGFR) within 6 months of echocardiogram were collected. Outcomes included LV mass Z-score, LV mass index [LVMI in g/m^2.7 and g/(m^2.16 + 0.09)], and LVH.

Results: Thirty patients with ARPKD (median age 7.2 years [IQR 3.4, 12.8]) had echocardiograms, 28 had casual BPs, 11 had ABPMs, and 93% were on antihypertensives. LVH occurred in 23% based on LVMI in g/m^2.7 > 95th percentile, and in 50% based on LVMI > 45 g/(m^2.16 + 0.09). Younger age correlated with higher number of antihypertensives (ρ = - 0.46, P = 0.014) and higher casual systolic and diastolic BP percentiles (r = - 0.74, P < 0.001; r = - 0.81, P < 0.001). After adjusting for age, sex, and eGFR, LV mass was not significantly associated with casual BP or ABPM, except for a negative association between LV mass Z-score and casual diastolic BP percentile (β coefficient - 0.31, P = 0.04). After adjusting for age, sex, and casual BP, both LVMI [in g/m^2.7 and g/(m^2.16 + 0.09)] and LV mass Z-score were significantly negatively associated with eGFR (β -1.08, P = 0.003; β -0.79, P = 0.007; and β -0.07, P = 0.01, respectively).

Conclusions: Young children with ARPKD have a higher burden of hypertension. LV mass was unexpectedly not significantly associated with BP but was negatively associated with eGFR.

Background: The associations between biochemical indicators of osteocalcin and bone health are fairly well established in adults through observational studies. In this context, our objective was to assess serum level of uncarboxylated osteocalcin (uOC) and its relation to the incidence of bone fractures other bone health indices in children with CKD.

Methods: We enrolled 102 patients classified into two groups: group A: CKD without KRT; group B: CKD on regular HD. The patients were followed throughout the study period. The study's endpoint was either the occurrence of a bone fracture or the conclusion of the study period. Another 22 healthy individuals were involved as a control group. We measured uOC and various indicators of bone health including bone-specific alkaline phosphatase (BAP) on the same day of the fracture or at the end of the study period.

Results: uOC was found significantly higher in CKD children in comparison to the control group (p <0.001). Moreover, its level was significantly higher in the HD group compared to CKD without KRT group (p = 0.047). In patients with fractures, uOC and BAP were significantly higher compared with patients without fractures (p < 0.001 and 0.019, respectively). By logistic regression analysis, uOC was the only predictor of bone fractures (p = 0.027, OR = 1.011).

Conclusion: Elevated uOC levels were observed in children with CKD who experienced fractures, and these levels showed a correlation with BAP. Furthermore, uOC appears to be a reliable indicator of bone fractures in this population.

Background: Ultrasound (US) is an increasingly utilized imaging technique in nephrology,  for diagnostic and interventional applications. In spite of growing interest, its implementation across Italian nephrology centers remains poorly documented. To address this gap, a cross-sectional study was conducted to explore the modalities of the training of expert nephrologists and current practices of diagnostic and interventional US procedures  performed by nephrologists in Italy.

Methods: We developed a 24-question electronic survey that collected data on (1) participants' background (years in US practice and certification), (2) type of US examinations performed (B-mode US, echo color Doppler studies, echocardiography, arteriovenous fistula [AV] assessment, US in peritoneal dialysis, and contrast-enhanced US), and (3) US-guided interventional procedures (kidney biopsies, central venous catheter [CVC] placements, and AV fistula [AVF] complications).

Results: Questionnaires were returned by 115 nephrology units across Italy. Only 39% of respondents held formal US certification, and 65% stated they wished to attend US courses. Renal and urinary tract US was performed in 90% of respondent centers, followed by AV fistula echo color Doppler in 72%. However, advanced applications such as lung US or echocardiography were carried out in only 32% and 12% of centers, respectively. Regarding US-guided procedures, nephrologists performed CVC placements in 64% of responding centers and kidney biopsies in 37%.

Conclusions: This survey showed that US is widely used in Italian nephrology centers for renal and urinary tract imaging, AVF assessment, and CVC insertion. However, it also revealed a strong interest among nephrologists in further enhancing their US competencies through structured training programs, which should be promoted to improve the performance and diffusion of US in nephrology care.