Journal of Nephrology最新文献

Background: We evaluated the proportion of Type 2 diabetes (T2D) patients with chronic kidney disease (CKD) participating in the AMD (Association of Medical Diabetologists) Annals initiative who met the eligibility criteria for phase III-studies on finerenone, showing its renal and cardiovascular benefits.

Methods: This analysis involved all T2D patients seen in 2019 in 282 diabetes centers in Italy, for whom data on kidney function (estimated glomerular filtration rate and albuminuria) were available. Data are presented separately for different scenarios, covering the population with main eligibility criteria for inclusion in the FIDELIO-DKD and FIGARO-DKD trials.

Results: Among 343,037 T2D patients involved in the analysis, 5.4% met the eligibility criteria of the FIDELIO-DKD study (13.3% if we consider the population with fundus data) and 22.3% met those of the FIGARO-DKD trial. Overall, 110,000 (33%) patients were eligible for treatment with finerenone, with a male prevalence, an average age of 71 years, and good control of the main risk factors (HbA1c 7.3%; BP 138/76 mmHg; LDL-c 87 mg/dl), albeit with large percentages of not well controlled patients (50% with SBP > 140 mmHg; > 30% with LDL-c > 100 mg/dl). Over 12% were on sodium/glucose cotransporter 2 inhibitors or glucagon-like peptide 1 receptor agonists. Based on the event rate from the FIDELITY pooled analysis, the number of potentially avoidable events was 21.7 per 1000 eligible patients for the cardiovascular composite outcome and 16.7 for the renal outcome.

Conclusions: This analysis showed that approximately 33% of patients with T2D present the main eligibility criteria for treatment with finerenone and could therefore benefit from it in the near future.

Background: A comprehensive evaluation of potential living kidney donors is crucial to ensure their short and long-term safety. We explored differences in kidney biochemical indicators, blood pressure measurements, and glucose control pre- and post-kidney donation between women with pre-diabetes and those with normal glucose levels.

Methods: We performed a prospective cohort study at West Bank and Gaza University hospitals between 2016 and 2022. Differences in sociodemographic and clinical factors that were collected from the participants' medical records between women with pre-diabetes and without diabetes, pre- and post-donation, were assessed using the chi-square test for categorical variables and the Mann-Whitney U test for variables with skewed distribution. Trained nurses performed anthropometric measurements and drew fasting blood samples at various time points from one year before donation to five years after donation.

Results: Altogether, 114 female kidney donors (57 with pre-diabetes) aged 27-45 years (median = 35.7, IQR = 5.6) were included in the study. The post-donation median Body Mass Index (BMI) remained higher in women with pre-diabetes (35.02) than in those without diabetes (29.34) five years after donation, (P < 0.001). The 24 h protein, diastolic, and systolic blood pressure levels were significantly higher among women with pre-diabetes than among those without diabetes five years after donation, (P < 0.001). The median estimated glomerular filtration rate (eGFR) was significantly lower in pre-diabetic women (78.2 ml/min/1.73 m²) compared with the non-diabetic participants (87.9 ml/min/1.73 m²) five years after donation, (P < 0.001).

Conclusions: Pre-diabetic donors showed an increased risk of adverse outcomes, including hypertension, impaired oral glucose tolerance test, worsening kidney function, and proteinuria. Our findings underscore the importance of maintaining regular check-ups and follow-ups in particular in pre-diabetic kidney donors.

Idiopathic inflammatory myopathies represent a spectrum of autoimmune disorders primarily characterized by muscle inflammation. While renal involvement in idiopathic inflammatory myopathies has historically been considered rare, recent findings indicate a prevalence of approximately 21-23%. Renal manifestations in idiopathic inflammatory myopathies are generally secondary to acute renal injury from rhabdomyolysis or, more rarely, occur through autoimmune mechanisms leading to glomerulonephritis. Here, we present the case of a 21-year-old male diagnosed with idiopathic inflammatory myopathy positive for anti-Jo antibodies and concurrent C3 glomerulonephritis, which improved following Rituximab therapy. The description of this case provides insights for future research into the role of alternative complement pathway dysregulation in idiopathic inflammatory myopathy-associated C3 glomerulopathy.

According to the 10th edition of the IDF Diabetes Atlas, 537 million people suffered from diabetes in 2021, and this number will increase by 47% by 2045. It is estimated that even 30-40% of these individuals may develop diabetic kidney disease (DKD) in the course of diabetes. DKD is one of the most important complications of diabetes, both in terms of impact and magnitude. It leads to high morbidity and mortality, which subsequently impacts on quality of life, and it carries a high financial burden. Diabetic kidney disease is considered a complex and heterogeneous entity involving disturbances in vascular, glomerular, podocyte, and tubular function. It would appear that hypoxia-inducible factors (HIF)-1 and HIF-2 may be important players in the pathogenesis of this disease. However, their exact role is still not fully investigated. In this article, we summarize the current knowledge about HIF signaling and its role in DKD. In addition, we focus on the possible effects of nephroprotective drugs on HIF expression and activity in various tissues.

Longitudinal cohort studies are pivotal in medical research for understanding disease progression over time. These studies track a group of individuals across multiple time points, enabling the identification of risk factors and the evaluation of interventions. Traditional methods like linear mixed models, generalized estimating equations, and survival analysis often fall short in capturing the complex, non-linear patterns of disease progression. Trajectory analysis, a statistical technique that identifies distinct paths within longitudinal data, offers a more nuanced approach. This review delves into the methodological foundations of trajectory analysis, including data preparation, model selection, parameter estimation, model evaluation, and interpretation. It highlights the advantages of trajectory analysis, such as its ability to capture heterogeneity, handle various data types, and enhance predictive power. The application of trajectory analysis in nephrology, particularly in chronic kidney disease and diabetic nephropathy, demonstrates its utility in identifying distinct subgroups with different disease trajectories. Studies have shown that trajectory analysis can uncover patterns of renal function decline and proteinuria progression, providing insights that inform personalized treatment strategies. Despite its strengths, trajectory analysis requires advanced statistical knowledge, computational resources, and large sample sizes, which can be barriers for some researchers. Nevertheless, its ability to reveal complex disease patterns and improve predictive accuracy makes it a valuable tool in longitudinal studies. This review underscores the potential of trajectory analysis to enhance our understanding of disease progression and improve patient outcomes in nephrology and beyond.

Background: Management of pediatric chronic kidney disease (CKD) is complex for affected youth and their families. Treatment requires a high level of family engagement to successfully manage medical appointments, inpatient hospital stays, and daily medication regimens. Health literacy has been identified as a possible contributor to health inequities and unsuccessful chronic disease management. This study sought to explore the perceived health literacy, health-related internet use, and provider trust of children with CKD and their caregivers compared to those without chronic health conditions to inform clinical care.

Methods: Caregivers and children completed self-report surveys during routine specialty nephrology and general pediatrics clinic visits. In total, 85 caregivers and 46 youth participated. Statistical analyses included exploration of distributional properties, population differences, and group differences based on self-reported perceived health literacy.

Results: Caregiver demographics did not significantly vary across samples. Patient demographics varied significantly across samples with regard to ethnicity. Internet use to find health information was low across samples, and caregivers of children without chronic health conditions endorsed significantly higher perceived health literacy compared to caregivers of children with CKD.

Conclusions: Implications for practice include consideration of health literacy when treating children with CKD and patient preparedness for transition to adult care.