Socioeconomic deprivation adversely affects health outcomes, including those after kidney transplantation. Retrospective studies, including 92,844 patients in the US and 19,103 and 621 in 2 UK cohorts, reported higher mortality and graft rejection among deprived individuals. The persistence of these disparities in the UK, despite having universal health care, suggests that insurance coverage alone does not eliminate inequities. Whether similar patterns exist in Belgium remains unclear.
Methods
We studied 1891 kidney transplant recipients (2004–2021) at University Hospitals Leuven, by assessing socioeconomic deprivation using the Belgian Index of Multiple Deprivation (BIMD). The outcomes were all-cause graft failure, graft failure, mortality, and rejection, analyzed with Cox and competing risks models.
Results
Socioeconomic deprivation was associated with all-cause graft failure in univariable analysis (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.00–1.14, P = 0.043), but not after adjustment (adjusted HR [aHR]: 1.03, 95% CI: 0.97–1.10, P = 0.315). No significant associations were observed for graft failure (aHR: 1.04, 95% CI: 0.94–1.15, P = 0.467) or mortality (aHR: 1.04, 95% CI: 0.96–1.13, P = 0.366). In contrast, rejection risk differed significantly across deprivation groups (P = 0.030), driven by higher rates of T-cell–mediated rejection (TCMR) (aHR: 1.08, 95% CI: 1.00–1.16, P = 0.036), whereas antibody-mediated rejection (AMR) showed no association (aHR: 1.00, 95% CI: 0.88–1.15, P = 0.984).
Conclusion
Socioeconomic deprivation in Belgium was associated with rejection, specifically TCMR, and univariably with all-cause graft failure. We lacked evidence of associations with graft failure or mortality separately. These findings suggest that universal health care may mitigate some adverse posttransplantation outcomes because of socioeconomic deprivation. Future studies should evaluate whether deprivation affects access to transplantation itself.
社会经济剥夺对健康结果有不利影响，包括肾移植后的健康结果。回顾性研究，包括美国92844例患者和英国2组19103例和621例患者，报告了贫困人群更高的死亡率和移植排斥反应。尽管拥有全民医疗保健，但这些差距在英国持续存在，这表明仅靠保险覆盖并不能消除不平等。比利时是否也存在类似的模式尚不清楚。方法采用比利时多重剥夺指数（BIMD）评估社会经济剥夺，对2004-2021年在鲁汶大学医院接受肾移植的1891例患者进行研究。结果是全因移植物衰竭、移植物衰竭、死亡率和排斥反应，用Cox和竞争风险模型进行分析。结果在单变量分析中，社会经济剥夺与全因移植物失败相关（风险比[HR]: 1.07, 95%可信区间[CI]: 1.00-1.14, P = 0.043），但校正后无相关（校正后的HR [aHR]: 1.03, 95% CI: 0.97-1.10, P = 0.315）。移植失败（aHR: 1.04, 95% CI: 0.94-1.15, P = 0.467）或死亡率（aHR: 1.04, 95% CI: 0.96-1.13, P = 0.366）无显著相关性。相比之下，不同剥夺组的排斥风险差异显著（P = 0.030），这是由更高的t细胞介导的排斥反应（TCMR）率（aHR: 1.08, 95% CI: 1.00 - 1.16, P = 0.036）驱动的，而抗体介导的排斥反应（AMR）没有关联（aHR: 1.00, 95% CI: 0.88-1.15, P = 0.984）。结论：比利时的社会经济剥夺与排异反应有关，特别是TCMR，并且与全因移植失败有关。我们缺乏单独与移植物衰竭或死亡率相关的证据。这些发现表明，全民医疗保健可能会减轻由于社会经济剥夺而导致的一些移植后不良后果。未来的研究应该评估剥夺是否会影响移植本身。
{"title":"Socioeconomic Deprivation and Kidney Transplant Outcomes","authors":"Lukas Ponette , Karolien Wellekens , Priyanka Koshy , Arthur Vranken , Thomas Vanhoutte , Dirk Kuypers , Maarten Naesens , Maarten Coemans","doi":"10.1016/j.ekir.2025.10.024","DOIUrl":"10.1016/j.ekir.2025.10.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Socioeconomic deprivation adversely affects health outcomes, including those after kidney transplantation. Retrospective studies, including 92,844 patients in the US and 19,103 and 621 in 2 UK cohorts, reported higher mortality and graft rejection among deprived individuals. The persistence of these disparities in the UK, despite having universal health care, suggests that insurance coverage alone does not eliminate inequities. Whether similar patterns exist in Belgium remains unclear.</div></div><div><h3>Methods</h3><div>We studied 1891 kidney transplant recipients (2004–2021) at University Hospitals Leuven, by assessing socioeconomic deprivation using the Belgian Index of Multiple Deprivation (BIMD). The outcomes were all-cause graft failure, graft failure, mortality, and rejection, analyzed with Cox and competing risks models.</div></div><div><h3>Results</h3><div>Socioeconomic deprivation was associated with all-cause graft failure in univariable analysis (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.00–1.14, <em>P</em> = 0.043), but not after adjustment (adjusted HR [aHR]: 1.03, 95% CI: 0.97–1.10, <em>P</em> = 0.315). No significant associations were observed for graft failure (aHR: 1.04, 95% CI: 0.94–1.15, <em>P</em> = 0.467) or mortality (aHR: 1.04, 95% CI: 0.96–1.13, <em>P</em> = 0.366). In contrast, rejection risk differed significantly across deprivation groups (<em>P</em> = 0.030), driven by higher rates of T-cell–mediated rejection (TCMR) (aHR: 1.08, 95% CI: 1.00–1.16, <em>P</em> = 0.036), whereas antibody-mediated rejection (AMR) showed no association (aHR: 1.00, 95% CI: 0.88–1.15, <em>P</em> = 0.984).</div></div><div><h3>Conclusion</h3><div>Socioeconomic deprivation in Belgium was associated with rejection, specifically TCMR, and univariably with all-cause graft failure. We lacked evidence of associations with graft failure or mortality separately. These findings suggest that universal health care may mitigate some adverse posttransplantation outcomes because of socioeconomic deprivation. Future studies should evaluate whether deprivation affects access to transplantation itself.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 2","pages":"Article 103667"},"PeriodicalIF":5.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.ekir.2025.10.028
Fernando Caravaca-Fontán , Fadi Fakhouri , Christoph Licht , Matthew C. Pickering , Franz Schaefer , Edwin Wong
Introduction
C3 glomerulopathy (C3G) and primary immune complex–mediated membranoproliferative glomerulonephritis (IC-MPGN) are rare kidney diseases driven by complement dysregulation. Proteinuria is a commonly used clinical end point in trials involving these conditions. However, its recognition as a validated end point by regulatory bodies remains limited, despite growing evidence supporting its prognostic value as a surrogate biomarker for the development of kidney failure. The aim of this study was to establish consensus on the clinical relevance of proteinuria as a prognostic and treatment end point in C3G and primary IC-MPGN.
Methods
A 2-round modified Delphi process was conducted, informed by literature review and expert input. A steering committee composed of 4 European nephrologists, 1 Canadian nephrologist, and 1 European rheumatologist developed 31 statements covering the following 3 domains: (i) treatment efficacy end points, (ii) current assessment end points, and (iii) the role of proteinuria. Statements formed part of an online survey using a 4-point Likert scale, distributed to a broader panel of nephrologists and kidney pathologists across Europe.
Results
Fifty-one and 50 responses were received in rounds 1 and 2. Of the 31 statements, 29 reached consensus (≥ 75% agreement). Key consensus points included the following: (i) reduction in proteinuria preserves long-term kidney function and is a treatment goal; (ii) longitudinal monitoring of proteinuria, alongside other markers is valuable for guiding treatment; (iii) a ≥ 50% proteinuria reduction over 6 months indicates meaningful therapeutic benefit; and (iv) proteinuria < 1 g/d is associated with improved outcomes.
Conclusion
This study demonstrates consensus supporting proteinuria as a meaningful treatment end point for C3G and primary IC-MPGN.
{"title":"Delphi Consensus on Surrogate End Points in C3 Glomerulopathy and Primary Immune Complex–Mediated Membranoproliferative Glomerulonephritis","authors":"Fernando Caravaca-Fontán , Fadi Fakhouri , Christoph Licht , Matthew C. Pickering , Franz Schaefer , Edwin Wong","doi":"10.1016/j.ekir.2025.10.028","DOIUrl":"10.1016/j.ekir.2025.10.028","url":null,"abstract":"<div><h3>Introduction</h3><div>C3 glomerulopathy (C3G) and primary immune complex–mediated membranoproliferative glomerulonephritis (IC-MPGN) are rare kidney diseases driven by complement dysregulation. Proteinuria is a commonly used clinical end point in trials involving these conditions. However, its recognition as a validated end point by regulatory bodies remains limited, despite growing evidence supporting its prognostic value as a surrogate biomarker for the development of kidney failure. The aim of this study was to establish consensus on the clinical relevance of proteinuria as a prognostic and treatment end point in C3G and primary IC-MPGN.</div></div><div><h3>Methods</h3><div>A 2-round modified Delphi process was conducted, informed by literature review and expert input. A steering committee composed of 4 European nephrologists, 1 Canadian nephrologist, and 1 European rheumatologist developed 31 statements covering the following 3 domains: (i) treatment efficacy end points, (ii) current assessment end points, and (iii) the role of proteinuria. Statements formed part of an online survey using a 4-point Likert scale, distributed to a broader panel of nephrologists and kidney pathologists across Europe.</div></div><div><h3>Results</h3><div>Fifty-one and 50 responses were received in rounds 1 and 2. Of the 31 statements, 29 reached consensus (≥ 75% agreement). Key consensus points included the following: (i) reduction in proteinuria preserves long-term kidney function and is a treatment goal; (ii) longitudinal monitoring of proteinuria, alongside other markers is valuable for guiding treatment; (iii) a ≥ 50% proteinuria reduction over 6 months indicates meaningful therapeutic benefit; and (iv) proteinuria < 1 g/d is associated with improved outcomes.</div></div><div><h3>Conclusion</h3><div>This study demonstrates consensus supporting proteinuria as a meaningful treatment end point for C3G and primary IC-MPGN.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 2","pages":"Article 103671"},"PeriodicalIF":5.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.ekir.2025.10.025
Katherine Rizzolo , Jesse D. Schold , Samantha M. Noreen , Alice Toll , Neil R. Powe , Lilia Cervantes
Introduction
Noncitizens, especially those with undocumented immigration status, have major barriers to solid organ transplantation though they donate organs in the United States (US). However, the quality and use of organs donated by noncitizens has not been described. The aim of this study was to elucidate the characteristics of organs donated by noncitizens in the US.
Methods
In this cross-sectional study, we used Organ Procurement and Transplantation Network (OPTN) data examining US deceased organ donors (≥ 1 organ transplanted) between January 1, 2015 and December 31, 2020, stratified by reported citizenship status. To assess differences between groups, analysis of variance (normally distributed) or Kruskal-Wallis (nonnormally distributed) tests were used for continuous variables after testing for normality via the Shapiro-Wilk test and chi-square tests were used for categorical variables. The Benjamini-Hochberg procedure was used to adjust for multiple comparisons.
Results
Noncitizens accounted for 3.1% of the donor population from 2015 to 2020. Compared with US citizens, noncitizens were older with higher proportions of male sex and O blood type (P < .001, for all). By state, New Jersey (9.5%), Texas (6.7%), and New York (6.1%) had the highest number of noncitizen residents who were organ donors by. Deceased noncitizen donors had a much lower rate of consent for donation compared with US citizens.
Conclusion
Our study demonstrates that noncitizens are donating healthy, viable organs to the US donor pool that are largely being received by US citizens. Given that noncitizens are donating organs to US, policy initiatives are needed to improve equity in access to transplantation receipt for this population.
{"title":"Citizenship Status and Deceased Organ Donation in the USA","authors":"Katherine Rizzolo , Jesse D. Schold , Samantha M. Noreen , Alice Toll , Neil R. Powe , Lilia Cervantes","doi":"10.1016/j.ekir.2025.10.025","DOIUrl":"10.1016/j.ekir.2025.10.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Noncitizens, especially those with undocumented immigration status, have major barriers to solid organ transplantation though they donate organs in the United States (US). However, the quality and use of organs donated by noncitizens has not been described. The aim of this study was to elucidate the characteristics of organs donated by noncitizens in the US.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, we used Organ Procurement and Transplantation Network (OPTN) data examining US deceased organ donors (≥ 1 organ transplanted) between January 1, 2015 and December 31, 2020, stratified by reported citizenship status. To assess differences between groups, analysis of variance (normally distributed) or Kruskal-Wallis (nonnormally distributed) tests were used for continuous variables after testing for normality via the Shapiro-Wilk test and chi-square tests were used for categorical variables. The Benjamini-Hochberg procedure was used to adjust for multiple comparisons.</div></div><div><h3>Results</h3><div>Noncitizens accounted for 3.1% of the donor population from 2015 to 2020. Compared with US citizens, noncitizens were older with higher proportions of male sex and O blood type (<em>P</em> < .001, for all). By state, New Jersey (9.5%), Texas (6.7%), and New York (6.1%) had the highest number of noncitizen residents who were organ donors by. Deceased noncitizen donors had a much lower rate of consent for donation compared with US citizens.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates that noncitizens are donating healthy, viable organs to the US donor pool that are largely being received by US citizens. Given that noncitizens are donating organs to US, policy initiatives are needed to improve equity in access to transplantation receipt for this population.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 2","pages":"Article 103668"},"PeriodicalIF":5.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.ekir.2025.10.023
Marc G. Vervloet , Charlotte Tu , Sammantha Fuller , James Fotheringham , Ronald L. Pisoni , Thilo Schaufler , Despina Ruessmann , Roberto Pecoits-Filho , Angelo Karaboyas
Introduction
Chronic kidney disease (CKD)-associated pruritus (CKD-aP) is a common and distressing symptom among dialysis patients, negatively affecting patient-reported outcomes (PROs) such as sleep and mental health. Despite its high prevalence, the evolution, incidence, and long-term impact of CKD-aP remains poorly understood. This study examined the cumulative incidence of new-onset CKD-aP among patients on hemodialysis (HD), identified its key predictors, and assessed associations between CKD-aP severity and PROs.
Methods
In this prospective, multicenter cohort study, incident and prevalent HD patients from 6 European countries were followed over 18 months, with assessments every 3 months. Patients completed an electronic PRO (ePRO) survey, including the Kidney Disease Quality of Life Short Form 36-Item short-form survey itchy skin item and measures of fatigue, sleep, depression, and general health. Sankey diagrams and Spearman’s correlations were used to describe pruritus evolution. Cox and linear regression models were used to identify predictors of moderate-to-severe pruritus and examined associations with PROs.
Results
Among 747 patients, the 18-month cumulative incidence of moderate-to-severe pruritus was 52%. Baseline–to–follow-up correlations for pruritus severity declined over time, though short-term correlations remained strong. Sociodemographic and clinical characteristics were minimally predictive of incident pruritus. Compared with those without pruritus, patients with incident pruritus reported higher fatigue (+0.7 [0.1–1.4]) and lower sleep quality scores (−1.0 [−1.6 to −0.5]). Similar patterns were observed for persistent versus resolved pruritus.
Conclusion
CKD-aP is a prevalent and fluctuating symptom in patients on HD. Its association with poorer fatigue and sleep outcomes highlights the importance of ongoing monitoring and targeted management to improve patient well-being.
{"title":"Longitudinal Trajectories of CKD-Associated Pruritus","authors":"Marc G. Vervloet , Charlotte Tu , Sammantha Fuller , James Fotheringham , Ronald L. Pisoni , Thilo Schaufler , Despina Ruessmann , Roberto Pecoits-Filho , Angelo Karaboyas","doi":"10.1016/j.ekir.2025.10.023","DOIUrl":"10.1016/j.ekir.2025.10.023","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic kidney disease (CKD)-associated pruritus (CKD-aP) is a common and distressing symptom among dialysis patients, negatively affecting patient-reported outcomes (PROs) such as sleep and mental health. Despite its high prevalence, the evolution, incidence, and long-term impact of CKD-aP remains poorly understood. This study examined the cumulative incidence of new-onset CKD-aP among patients on hemodialysis (HD), identified its key predictors, and assessed associations between CKD-aP severity and PROs.</div></div><div><h3>Methods</h3><div>In this prospective, multicenter cohort study, incident and prevalent HD patients from 6 European countries were followed over 18 months, with assessments every 3 months. Patients completed an electronic PRO (ePRO) survey, including the Kidney Disease Quality of Life Short Form 36-Item short-form survey itchy skin item and measures of fatigue, sleep, depression, and general health. Sankey diagrams and Spearman’s correlations were used to describe pruritus evolution. Cox and linear regression models were used to identify predictors of moderate-to-severe pruritus and examined associations with PROs.</div></div><div><h3>Results</h3><div>Among 747 patients, the 18-month cumulative incidence of moderate-to-severe pruritus was 52%. Baseline–to–follow-up correlations for pruritus severity declined over time, though short-term correlations remained strong. Sociodemographic and clinical characteristics were minimally predictive of incident pruritus. Compared with those without pruritus, patients with incident pruritus reported higher fatigue (+0.7 [0.1–1.4]) and lower sleep quality scores (−1.0 [−1.6 to −0.5]). Similar patterns were observed for persistent versus resolved pruritus.</div></div><div><h3>Conclusion</h3><div>CKD-aP is a prevalent and fluctuating symptom in patients on HD. Its association with poorer fatigue and sleep outcomes highlights the importance of ongoing monitoring and targeted management to improve patient well-being.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 1","pages":"Pages 86-93"},"PeriodicalIF":5.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.ekir.2025.10.020
David Kavanagh , Gema Ariceta , Marina Vivarelli , Franz Schaefer , Fernando Caravaca-Fontán , Véronique Frémeaux-Bacchi , Fadi Fakhouri , Christoph Licht , Matthew C. Pickering
C3 glomerulopathy (C3G) and primary (idiopathic) immune complex membranoproliferative glomerulonephritis (IC-MPGN) are rare kidney diseases characterized by dysregulation of the complement system and progressive deposition of C3 and its breakdown products in the glomeruli, ultimately leading to kidney failure in up to 50% of patients within 10 years. Until recently, standard approaches to treatment included supportive measures common to many kidney diseases and immunosuppression to mitigate inflammation, rather than specific therapies addressing the underlying C3 dysregulation. However, recent advances in targeted complement inhibitor therapy have been made in these diseases with positive results from phase 3 clinical trials of both the factor B inhibitor, iptacopan (in adults with native kidney C3G) and the C3/C3b inhibitor, pegcetacoplan (in adults and adolescents with native or posttransplant C3G or primary IC-MPGN). In this review, we summarize what is known and what questions still remain regarding the effect of complement inhibitors on widely accepted surrogate end points for efficacy in C3G/primary IC-MPGN (proteinuria, estimated glomerular filtration rate [eGFR], and kidney biopsy histology). Additional controversies, including candidate patient populations, optimal treatment duration, and how best to monitor patients on complement inhibitor therapy are also discussed, in an effort to prepare the nephrology community for innovative therapeutic options for patients whose long-term prognosis has generally been dismal.
{"title":"Current and Emerging Therapies for C3 Glomerulopathy and Primary (Idiopathic) Immune Complex Membranoproliferative Glomerulonephritis","authors":"David Kavanagh , Gema Ariceta , Marina Vivarelli , Franz Schaefer , Fernando Caravaca-Fontán , Véronique Frémeaux-Bacchi , Fadi Fakhouri , Christoph Licht , Matthew C. Pickering","doi":"10.1016/j.ekir.2025.10.020","DOIUrl":"10.1016/j.ekir.2025.10.020","url":null,"abstract":"<div><div>C3 glomerulopathy (C3G) and primary (idiopathic) immune complex membranoproliferative glomerulonephritis (IC-MPGN) are rare kidney diseases characterized by dysregulation of the complement system and progressive deposition of C3 and its breakdown products in the glomeruli, ultimately leading to kidney failure in up to 50% of patients within 10 years. Until recently, standard approaches to treatment included supportive measures common to many kidney diseases and immunosuppression to mitigate inflammation, rather than specific therapies addressing the underlying C3 dysregulation. However, recent advances in targeted complement inhibitor therapy have been made in these diseases with positive results from phase 3 clinical trials of both the factor B inhibitor, iptacopan (in adults with native kidney C3G) and the C3/C3b inhibitor, pegcetacoplan (in adults and adolescents with native or posttransplant C3G or primary IC-MPGN). In this review, we summarize what is known and what questions still remain regarding the effect of complement inhibitors on widely accepted surrogate end points for efficacy in C3G/primary IC-MPGN (proteinuria, estimated glomerular filtration rate [eGFR], and kidney biopsy histology). Additional controversies, including candidate patient populations, optimal treatment duration, and how best to monitor patients on complement inhibitor therapy are also discussed, in an effort to prepare the nephrology community for innovative therapeutic options for patients whose long-term prognosis has generally been dismal.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 1","pages":"Pages 17-31"},"PeriodicalIF":5.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145802289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.ekir.2025.10.022
Julien Dang , Stanislas Faguer , Noémie Jourde-Chiche , Vincent Javaugue , Frank Bridoux , Bénédice Puissant , Xavier Heim , Jean-Jacques Boffa , Hélène François , Yanis Tamzali , Evangéline Pillebout , Eric Daugas , Renato Monteiro , Laurent Daniel , Kévin Chevalier , Vincent Audard , Margaux Van Wynsberghe , Dominique Guerrot , Mathieu Legendre , Sébastien Sanges , Mohamad Zaidan
Introduction
Cryofibrinogen-associated nephropathy (CFN) is a very rare disease. Only few data are available about the clinicopathological presentation and treatment outcomes.
Methods
Patients with cryofibrinogenemia (CF) diagnosed in French expert laboratories, and kidney biopsy findings suggestive of CFN (pauci-immune membranoproliferative glomerulonephritis [MPGN], thrombotic microangiopathy [TMA] and/or indirect signs of ischemia) were retrospectively included. Estimated glomerular filtration rate (eGFR), urinary protein-to-creatinine ratio (UPCR), and specific treatments were collected. Renal response (RR) was defined as a reduction of UPCR to < 0.5 g/g (or decrease > 50% if > 3 g/g at baseline) and an improvement of eGFR > 30% (if < 60 ml/min per 1.73 m2 and acute kidney injury (AKI) at baseline).
Results
Among 2545 patients with CF, 232 (9%) underwent kidney biopsy, and only 28 (1%) had histological findings suggestive of CFN. Ten patients (36%) were female, and median age was 62 (interquartile range [IQR]: 49–71) years. eGFR at diagnosis was 21 (14–44) ml/min per 1.73 m2. Median UPCR was 3.30 (IQR: 1.52–4.85) g/g. AKI (78%) and nephrotic syndrome (41%) were frequent. Nine patients had an essential form, whereas 19 had a secondary form. MPGN was the most frequent pattern, with double contours (57%), nodular mesangial sclerosis (30%), mesangial (41%), endocapillary (56%) and extracapillary (11%) hypercellularity, and interstitial immune infiltration (41%). Thrombi were found in 43% of cases. Strikingly, 58% of the secondary forms were associated with a monoclonal gammopathy (MG). Patients with MG had more frequent skin manifestations (P = 0.002), endocapillary (P = 0.002), interstitial (P = 0.041) infiltration, and capillary thrombi (P = 0.012), and tended to have more frequent complement activation (P = 0.14). Sixty percent of patients were treated with various regimens of immunosuppressants (IS). After a mean follow-up of 476 (± 92) days, 65% of patients had an RR. Higher baseline eGFR (P = 0.04) and use of IS (P = 0.03) were predictive of RR. B-cell or plasma-cell depletion was effective in most cases associated with MG (80%).
Conclusion
Our study, to the best of our knowledge, described for the first time the prevalence and the clinicopathological spectrum of CFN, which might be a very rare and underrecognized form of MG of renal significance presenting with pauci-immune MPGN ot TMA. IS are effective in most cases.
{"title":"Clinicopathological Spectrum and Treatment Outcomes of Cryofibrinogen-Associated Nephropathies","authors":"Julien Dang , Stanislas Faguer , Noémie Jourde-Chiche , Vincent Javaugue , Frank Bridoux , Bénédice Puissant , Xavier Heim , Jean-Jacques Boffa , Hélène François , Yanis Tamzali , Evangéline Pillebout , Eric Daugas , Renato Monteiro , Laurent Daniel , Kévin Chevalier , Vincent Audard , Margaux Van Wynsberghe , Dominique Guerrot , Mathieu Legendre , Sébastien Sanges , Mohamad Zaidan","doi":"10.1016/j.ekir.2025.10.022","DOIUrl":"10.1016/j.ekir.2025.10.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Cryofibrinogen-associated nephropathy (CFN) is a very rare disease. Only few data are available about the clinicopathological presentation and treatment outcomes.</div></div><div><h3>Methods</h3><div>Patients with cryofibrinogenemia (CF) diagnosed in French expert laboratories, and kidney biopsy findings suggestive of CFN (pauci-immune membranoproliferative glomerulonephritis [MPGN], thrombotic microangiopathy [TMA] and/or indirect signs of ischemia) were retrospectively included. Estimated glomerular filtration rate (eGFR), urinary protein-to-creatinine ratio (UPCR), and specific treatments were collected. Renal response (RR) was defined as a reduction of UPCR to < 0.5 g/g (or decrease > 50% if > 3 g/g at baseline) and an improvement of eGFR > 30% (if < 60 ml/min per 1.73 m<sup>2</sup> and acute kidney injury (AKI) at baseline).</div></div><div><h3>Results</h3><div>Among 2545 patients with CF, 232 (9%) underwent kidney biopsy, and only 28 (1%) had histological findings suggestive of CFN. Ten patients (36%) were female, and median age was 62 (interquartile range [IQR]: 49–71) years. eGFR at diagnosis was 21 (14–44) ml/min per 1.73 m<sup>2</sup>. Median UPCR was 3.30 (IQR: 1.52–4.85) g/g. AKI (78%) and nephrotic syndrome (41%) were frequent. Nine patients had an essential form, whereas 19 had a secondary form. MPGN was the most frequent pattern, with double contours (57%), nodular mesangial sclerosis (30%), mesangial (41%), endocapillary (56%) and extracapillary (11%) hypercellularity, and interstitial immune infiltration (41%). Thrombi were found in 43% of cases. Strikingly, 58% of the secondary forms were associated with a monoclonal gammopathy (MG). Patients with MG had more frequent skin manifestations (<em>P</em> = 0.002), endocapillary (<em>P</em> = 0.002), interstitial (<em>P</em> = 0.041) infiltration, and capillary thrombi (<em>P</em> = 0.012), and tended to have more frequent complement activation (<em>P</em> = 0.14). Sixty percent of patients were treated with various regimens of immunosuppressants (IS). After a mean follow-up of 476 (± 92) days, 65% of patients had an RR. Higher baseline eGFR (<em>P</em> = 0.04) and use of IS (<em>P</em> = 0.03) were predictive of RR. B-cell or plasma-cell depletion was effective in most cases associated with MG (80%).</div></div><div><h3>Conclusion</h3><div>Our study, to the best of our knowledge, described for the first time the prevalence and the clinicopathological spectrum of CFN, which might be a very rare and underrecognized form of MG of renal significance presenting with pauci-immune MPGN ot TMA. IS are effective in most cases.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 1","pages":"Pages 129-140"},"PeriodicalIF":5.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/j.ekir.2025.10.027
Charles Ronsin , François Jouret , Simon Ville , Jihad Abdelmalki , Grégoire Couvrat-Desvergnes , Léo Drapeau , Raphael Gaisne , Benjamin Gaborit , Caroline Charlier , Mohamad Zaidan , Renaud Snanoudj , Magali Giral , Jacques Dantal , Bertrand Knebelmann , Julien Dang
Introduction
Liver cyst infection is a rare and severe complication of the liver cysts associated with autosomal dominant polycystic kidney disease (ADPKD), and evidence-based data for optimal management is lacking. We conducted a multicentric retrospective study to investigate the treatment and outcomes of liver cyst infection.
Methods
Liver cyst infection was either defined by (i) C-reactive protein levels ≥ 50 mg/l and suspicion at computed tomography (CT) scan, 18Fluorodeoxyglucose (18FDG) positron-emission tomography (PET) CT, magnetic resonance imaging (MRI); or (ii) proven by cyst puncture. We studied the determinants of treatment failure (persistent infection with requirement for antibiotic therapy change, cyst drainage, and hepatectomy), relapse (< 2 months) and recurrence (> 2 months) of liver cyst infection after antibiotics discontinuation.
Results
Sixty-two patients and 112 episodes were included. At least 1 microorganism was identified in 70 of 112 episodes (63%), mainly Escherichia coli in 36 of 70of cases (51%). E coli was resistant to third generation cephalosporin, fluoroquinolone, or cotrimoxazole in 13%, 16%, and 34%, respectively. Treatment failure and relapse occurred in 30 of 112 episodes (27%). Antibiotic therapy duration ≥ 14 days was a protective factor for treatment failure or relapses (odds ratio [OR] = 0.03, 95% confidence interval [CI]: 0–0.23], P = 0.006). Recurrence occurred in 24 of 62 patients (38%), within 1 year for 15 patients (24%) after the first episode. An antibiotic therapy duration ≥ 28 days was identified as a protective factor (OR = 0.12, 95% CI: 0.02–0.65], P = 0.021). Conversely, a history of renal cyst infection significantly increased the risk of recurrence within 1 year (OR = 9.22 95% CI: 1.28–99.55], P = 0.04).
Conclusion
Treatment failure or relapse or recurrence of liver cyst infection both occurred in one-third of cases, and are associated with a shorter antibiotic therapy duration < 28 days.
{"title":"Liver Cyst Infection Outcomes in Patients With ADPKD","authors":"Charles Ronsin , François Jouret , Simon Ville , Jihad Abdelmalki , Grégoire Couvrat-Desvergnes , Léo Drapeau , Raphael Gaisne , Benjamin Gaborit , Caroline Charlier , Mohamad Zaidan , Renaud Snanoudj , Magali Giral , Jacques Dantal , Bertrand Knebelmann , Julien Dang","doi":"10.1016/j.ekir.2025.10.027","DOIUrl":"10.1016/j.ekir.2025.10.027","url":null,"abstract":"<div><h3>Introduction</h3><div>Liver cyst infection is a rare and severe complication of the liver cysts associated with autosomal dominant polycystic kidney disease (ADPKD), and evidence-based data for optimal management is lacking. We conducted a multicentric retrospective study to investigate the treatment and outcomes of liver cyst infection.</div></div><div><h3>Methods</h3><div>Liver cyst infection was either defined by (i) C-reactive protein levels ≥ 50 mg/l and suspicion at computed tomography (CT) scan, <sup>18</sup>Fluorodeoxyglucose (<sup>18</sup>FDG) positron-emission tomography (PET) CT, magnetic resonance imaging (MRI); or (ii) proven by cyst puncture. We studied the determinants of treatment failure (persistent infection with requirement for antibiotic therapy change, cyst drainage, and hepatectomy), relapse (< 2 months) and recurrence (> 2 months) of liver cyst infection after antibiotics discontinuation.</div></div><div><h3>Results</h3><div>Sixty-two patients and 112 episodes were included. At least 1 microorganism was identified in 70 of 112 episodes (63%), mainly <em>Escherichia coli</em> in 36 of 70of cases (51%). <em>E coli</em> was resistant to third generation cephalosporin, fluoroquinolone, or cotrimoxazole in 13%, 16%, and 34%, respectively. Treatment failure and relapse occurred in 30 of 112 episodes (27%). Antibiotic therapy duration ≥ 14 days was a protective factor for treatment failure or relapses (odds ratio [OR] = 0.03, 95% confidence interval [CI]: 0–0.23], <em>P</em> = 0.006). Recurrence occurred in 24 of 62 patients (38%), within 1 year for 15 patients (24%) after the first episode. An antibiotic therapy duration ≥ 28 days was identified as a protective factor (OR = 0.12, 95% CI: 0.02–0.65], <em>P</em> = 0.021). Conversely, a history of renal cyst infection significantly increased the risk of recurrence within 1 year (OR = 9.22 95% CI: 1.28–99.55], <em>P</em> = 0.04).</div></div><div><h3>Conclusion</h3><div>Treatment failure or relapse or recurrence of liver cyst infection both occurred in one-third of cases, and are associated with a shorter antibiotic therapy duration < 28 days.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 1","pages":"Pages 94-105"},"PeriodicalIF":5.7,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-03DOI: 10.1016/j.ekir.2025.10.029
Arvind Madan , Rajesh Yalavarthy , Dong Ki Kim , Ju-Young Moon , Inwhee Park , Sreedhar Mandayam , Frank Cortazar , Sung Gyun Kim , Amanda Enstrom , Heather Thomas , Jiahua Li , Stanford L. Peng , Yih-Chieh Chen , Jason Sanders , Ogo Egbuna , James Tumlin
Introduction
Povetacicept is an inhibitor of B-cell activating factor (BAFF) and A proliferation–inducing ligand (APRIL), 2 cytokines central to the pathogenesis of autoimmune glomerulonephritis. Both BAFF and APRIL promote B-cell and plasma cell survival and function. APRIL primarily supports plasma cell survival and function, whereas BAFF regulates early pathogenic B-cell development, activates pathogenic T cells and innate immune cells, and contributes to mesangial cell proliferation and podocyte injury.
Methods
Our phase 1 and 2, open-label study evaluated povetacicept in adult participants with IgA nephropathy (IgAN) or primary membranous nephropathy (pMN), all with estimated glomerular filtration rate (eGFR) of ≥ 30 ml/min per 1.73 m2. The primary objective was safety. Secondary objectives included change from baseline in urine protein-to-creatinine ratio (UPCR), eGFR, galactose-deficient IgA1 (Gd-IgA1) (IgAN), antiphospholipase A2 receptor autoantibody (aPLA2R; pMN), and clinical remission (with hematuria resolution for IgAN).
Results
Povetacicept was administered subcutaneously every 4 weeks (Q4W) to 54 participants with IgAN (21 received 80 mg, 33 received 240 mg) and 10 with pMN (all received 80 mg). In this interim analysis, participants with IgAN on 80 mg had a 64% mean 24-hour UPCR decrease (95% confidence interval: –76 to –48) from baseline (1.3 g/g to 0.5 g/g; 65% with UPCR < 0.5 g/g) with stable eGFR at week 48. Early decline in Gd-IgA1 at week 12 (57%), continued at week 48 (77%). Approximately 90% achieved hematuria resolution and 53% achieved clinical remission. Efficacy outcomes were similar with 240 mg povetacicept. Participants with pMN had an 82% mean 24-hour UPCR decrease (95% confidence interval: –92 to –60) from baseline (3.8 g/g to 0.7 g/g) with stable eGFR. Early decline in aPLA2R at week 12 (73%), continued at week 48 (83%) with 100% in immunologic remission (40% achieved complete remission; 100% achieved partial remission). Povetacicept was generally safe and well-tolerated for IgAN and pMN.
Conclusion
Povetacicept had substantial, sustained UPCR reductions with stable eGFR, significant Gd-IgA1 reductions, hematuria resolution, clinical remission, with favorable safety in IgAN. Similar results were observed in pMN. By inhibiting both BAFF and APRIL, povetacicept targets the underlying cause of disease and has potential to provide a significant therapeutic advancement for autoimmune glomerular diseases.
{"title":"Povetacicept for IgA Nephropathy and Primary Membranous Nephropathy","authors":"Arvind Madan , Rajesh Yalavarthy , Dong Ki Kim , Ju-Young Moon , Inwhee Park , Sreedhar Mandayam , Frank Cortazar , Sung Gyun Kim , Amanda Enstrom , Heather Thomas , Jiahua Li , Stanford L. Peng , Yih-Chieh Chen , Jason Sanders , Ogo Egbuna , James Tumlin","doi":"10.1016/j.ekir.2025.10.029","DOIUrl":"10.1016/j.ekir.2025.10.029","url":null,"abstract":"<div><h3>Introduction</h3><div>Povetacicept is an inhibitor of B-cell activating factor (BAFF) and A proliferation–inducing ligand (APRIL), 2 cytokines central to the pathogenesis of autoimmune glomerulonephritis. Both BAFF and APRIL promote B-cell and plasma cell survival and function. APRIL primarily supports plasma cell survival and function, whereas BAFF regulates early pathogenic B-cell development, activates pathogenic T cells and innate immune cells, and contributes to mesangial cell proliferation and podocyte injury.</div></div><div><h3>Methods</h3><div>Our phase 1 and 2, open-label study evaluated povetacicept in adult participants with IgA nephropathy (IgAN) or primary membranous nephropathy (pMN), all with estimated glomerular filtration rate (eGFR) of ≥ 30 ml/min per 1.73 m<sup>2</sup>. The primary objective was safety. Secondary objectives included change from baseline in urine protein-to-creatinine ratio (UPCR), eGFR, galactose-deficient IgA1 (Gd-IgA1) (IgAN), antiphospholipase A2 receptor autoantibody (aPLA2R; pMN), and clinical remission (with hematuria resolution for IgAN).</div></div><div><h3>Results</h3><div>Povetacicept was administered subcutaneously every 4 weeks (Q4W) to 54 participants with IgAN (21 received 80 mg, 33 received 240 mg) and 10 with pMN (all received 80 mg). In this interim analysis, participants with IgAN on 80 mg had a 64% mean 24-hour UPCR decrease (95% confidence interval: –76 to –48) from baseline (1.3 g/g to 0.5 g/g; 65% with UPCR < 0.5 g/g) with stable eGFR at week 48. Early decline in Gd-IgA1 at week 12 (57%), continued at week 48 (77%). Approximately 90% achieved hematuria resolution and 53% achieved clinical remission. Efficacy outcomes were similar with 240 mg povetacicept. Participants with pMN had an 82% mean 24-hour UPCR decrease (95% confidence interval: –92 to –60) from baseline (3.8 g/g to 0.7 g/g) with stable eGFR. Early decline in aPLA2R at week 12 (73%), continued at week 48 (83%) with 100% in immunologic remission (40% achieved complete remission; 100% achieved partial remission). Povetacicept was generally safe and well-tolerated for IgAN and pMN.</div></div><div><h3>Conclusion</h3><div>Povetacicept had substantial, sustained UPCR reductions with stable eGFR, significant Gd-IgA1 reductions, hematuria resolution, clinical remission, with favorable safety in IgAN. Similar results were observed in pMN. By inhibiting both BAFF and APRIL, povetacicept targets the underlying cause of disease and has potential to provide a significant therapeutic advancement for autoimmune glomerular diseases.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 1","pages":"Pages 106-116"},"PeriodicalIF":5.7,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of cyclophosphamide with corticosteroids for the management of membranous nephropathy (MN) is associated with significant safety concerns. Several retrospective studies suggest that a lower dose may effectively induce remission in participants with MN. This randomized trial assessed whether the lower dose of cyclical cyclophosphamide/corticosteroids was noninferior to the standard dose in patients with MN.
Methods
We randomly assigned 114 participants (32 women and 82 men) to receive either the low dose (prednisolone, 0.5 mg/kg/d during months 1, 3, and 5 along with oral cyclophosphamide, 1.0–1.5 mg/kg/d during months 2, 4, and 6) or the standard-dose cyclophosphamide/corticosteroids (methylprednisolone, 1 g/d for 3 days, followed by prednisolone, 0.5 mg/kg/d during months 1, 3, and 5, along with oral cyclophosphamide, 2.0–2.5 mg/kg/d during months 2, 4, and 6). The primary outcome was complete remission (CR) or partial remission (PR) of proteinuria between months 6 and 24.
Results
A total of 57 participants were randomized into each group. The mean age was 41.53 ± 12.29 years; median proteinuria, mean serum albumin, and creatinine levels were respectively 6.83 g/d (interquartile range: 5.02–10.15), 2.34 ± 0.58 g/dl, and 0.92 ± 0.26 mg/dl and were comparable between groups. In the intention-to-treat (ITT) analysis, 45 participants (78.94%) in the low-dose group and 50 participants (87.71%) in the standard-dose group achieved the primary outcome (treatment difference: −8.78%, 97.5% confidence interval [CI]: lower limit −22%) and met the criteria for noninferiority (P = 0.009). Forty-five (78.94%) and 55 (96.49%) participants receiving the low-dose and standard-dose cyclophosphamide/corticosteroids, respectively, experienced at least 1 adverse event (difference: −17.54%, 97.5% CI: lower limit −29.1%).
Conclusion
The results suggest that low-dose cyclophosphamide/corticosteroids may be as effective as the standard dose of cyclical cyclophosphamide/corticosteroids in achieving proteinuria remission in MN.
{"title":"Randomized Controlled Trial on the Efficacy of Reduced-Dose Cyclical Corticosteroids and Cyclophosphamide in Primary Membranous Nephropathy","authors":"Raja Ramachandran , Prabhat Chauhan , Joyita Bharati , Manisha Sahay , Indranil Ghosh , Vivek Sood , Thakur Sain , Prabhjot Kaur , Vinod Kumar , Arun Prabhahar , Ritambhra Nada , Jasmine Sethi , Smita Divyaveer , Manish Rathi , Harbir Kohli , Vivekanand Jha","doi":"10.1016/j.ekir.2025.08.018","DOIUrl":"10.1016/j.ekir.2025.08.018","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of cyclophosphamide with corticosteroids for the management of membranous nephropathy (MN) is associated with significant safety concerns. Several retrospective studies suggest that a lower dose may effectively induce remission in participants with MN. This randomized trial assessed whether the lower dose of cyclical cyclophosphamide/corticosteroids was noninferior to the standard dose in patients with MN.</div></div><div><h3>Methods</h3><div>We randomly assigned 114 participants (32 women and 82 men) to receive either the low dose (prednisolone, 0.5 mg/kg/d during months 1, 3, and 5 along with oral cyclophosphamide, 1.0–1.5 mg/kg/d during months 2, 4, and 6) or the standard-dose cyclophosphamide/corticosteroids (methylprednisolone, 1 g/d for 3 days, followed by prednisolone, 0.5 mg/kg/d during months 1, 3, and 5, along with oral cyclophosphamide, 2.0–2.5 mg/kg/d during months 2, 4, and 6). The primary outcome was complete remission (CR) or partial remission (PR) of proteinuria between months 6 and 24.</div></div><div><h3>Results</h3><div>A total of 57 participants were randomized into each group. The mean age was 41.53 ± 12.29 years; median proteinuria, mean serum albumin, and creatinine levels were respectively 6.83 g/d (interquartile range: 5.02–10.15), 2.34 ± 0.58 g/dl, and 0.92 ± 0.26 mg/dl and were comparable between groups. In the intention-to-treat (ITT) analysis, 45 participants (78.94%) in the low-dose group and 50 participants (87.71%) in the standard-dose group achieved the primary outcome (treatment difference: −8.78%, 97.5% confidence interval [CI]: lower limit −22%) and met the criteria for noninferiority (<em>P</em> = 0.009). Forty-five (78.94%) and 55 (96.49%) participants receiving the low-dose and standard-dose cyclophosphamide/corticosteroids, respectively, experienced at least 1 adverse event (difference: −17.54%, 97.5% CI: lower limit −29.1%).</div></div><div><h3>Conclusion</h3><div>The results suggest that low-dose cyclophosphamide/corticosteroids may be as effective as the standard dose of cyclical cyclophosphamide/corticosteroids in achieving proteinuria remission in MN.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 11","pages":"Pages 3785-3795"},"PeriodicalIF":5.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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