Kidney International Reports最新文献

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Dynamic Uric Acid Changes and Outcomes in CKD in the African American Study of Kidney Disease and Hypertension 非裔美国人肾病和高血压研究中慢性肾病的动态尿酸变化和结局

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ekir.2025.09.051

Priyadarshini John , Diana Jalal

引用次数: 0

First Report of Daratumumab Therapy in Refractory THSD7A-Positive Membranous Nephropathy Daratumumab治疗难治性thsd7a阳性膜性肾病的首次报道

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ekir.2025.09.054

David Ribes , Stanislas Faguer

引用次数: 0

Furosemide Stress Test Use in Children at Risk for Acute Kidney Injury 速尿压力试验在急性肾损伤危险儿童中的应用

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ekir.2025.09.029

Imogen Clover-Brown , Giovanni Ceschia , Katja M. Gist , Denise C. Hasson , Kelli A. Krallman , Stephen W. Standage , Stuart L. Goldstein , Natalja L. Stanski

Introduction

The furosemide stress test (FST) is used to assess urine flow rate (UFR) after a furosemide bolus. FST predicts severe acute kidney injury (AKI) and renal replacement therapy (RRT) receipt in adults, with limited data in pediatric intensive care unit (PICU) patients. We implemented AKI risk stratification using the renal angina index (RAI) with urine neutrophil gelatinase-associated lipocalin (uNGAL) to guide FST in high-risk children but have not evaluated outcomes.

Methods

We combined 2 prospective, observational studies of high AKI risk PICU patients (RAI+: ≥ 8, uNGAL+: ≥ 150 ng/ml). We compared patients who underwent FST (≥ 0.75 mg/kg i.v. furosemide) in the first week versus those who did not, and FST responders (≥ 3 ml/kg/h UFR over 4 hours) versus nonresponders. We examined UFR’s predictive performance for new or persistent severe AKI or RRT receipt 2 days later.

Results

Of 273 RAI+/uNGAL+ patients, 112 (41%) underwent FST, 60 (54%) were nonresponders. FST patients had higher admission uNGAL and AKI stage. Nonresponders received FST earlier, had higher AKI stage, and higher incidence of new or persistent severe AKI (89% vs. 37%, P < 0.001) and RRT receipt (43% vs. 8%, P < 0.001) 2 days later. UFR predicted new or persistent severe AKI (area under the receiver operating curve [ROC; AUROC]: 0.89; 95% confidence interval [CI]: 0.82–0.95, P < 0.001) with optimal cutoff < 4 ml/kg/h (positive predictive value [PPV]: 83%, negative predictive value [NPV]: 82%), and RRT receipt (AUROC: 0.84; 95% CI: 0.76–0.93, P < 0.001]) with optimal cutoff < 1 ml/kg/h (PPV: 68%, NPV: 86%). UFR predicted RRT receipt in patients with stage 3 AKI with similar test characteristics.

Conclusion

FST is used inconsistently in high AKI risk children but has prognostic utility for new or persistent severe AKI, including RRT receipt, independent of AKI stage.

尿速负荷试验（FST）用于评价尿速后尿流率（UFR）。FST预测成人严重急性肾损伤（AKI）和肾脏替代治疗（RRT）接受情况，但儿科重症监护病房（PICU）患者的数据有限。我们使用肾性心绞痛指数（RAI）和尿中性粒细胞明胶酶相关脂钙素（uNGAL）对高危儿童进行AKI风险分层，以指导FST，但尚未评估结果。方法结合2项前瞻性、观察性研究，研究对象为AKI高危PICU患者（RAI+:≥8,uNGAL+:≥150 ng/ml）。我们比较了在第一周接受FST治疗（≥0.75 mg/kg静脉注射呋塞米）的患者与未接受FST治疗的患者，以及FST应答者（≥3ml /kg/h UFR超过4小时）与无应答者。我们在2天后检查了UFR对新发或持续性严重AKI或接受RRT的预测性能。结果273例RAI+/uNGAL+患者中，112例（41%）行FST， 60例（54%）无反应。FST患者的入院uNGAL和AKI分期较高。无应答者较早接受FST治疗，AKI分期较高，2天后新发或持续严重AKI的发生率较高（89%对37%，P < 0.001）， RRT接受率较高（43%对8%，P < 0.001）。UFR预测新的或持续的严重AKI（受试者工作曲线下面积[ROC； AUROC]: 0.89； 95%可信区间[CI]: 0.82-0.95, P < 0.001），最佳临界值为4 ml/kg/h（阳性预测值[PPV]: 83%，阴性预测值[NPV]: 82%）， RRT接受率（AUROC: 0.84; 95% CI: 0.76-0.93, P < 0.001]），最佳临界值为1 ml/kg/h （PPV: 68%, NPV: 86%）。UFR预测具有相似试验特征的3期AKI患者的RRT接受情况。结论fst在高AKI风险儿童中的应用不一致，但对新发或持续性严重AKI具有预后价值，包括RRT接受情况，与AKI分期无关。

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引用次数: 0

Long Nocturnal Hemodialysis and the Most Difficult UltraTrail Race 漫长的夜间血液透析和最困难的超铁比赛

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ekir.2025.09.034

Antoine Chatrenet , Fabrice Huré , Claudia D’Alessandro , Anne Courbalay , Ariane Collet , Christophe Maladré , Eric Laruelle , Giorgina Barbara Piccoli

引用次数: 0

Immunosuppression-Free Kidney Transplantation after Haploidentical Hematopoietic Stem Cell Transplantation in Fanconi Anemia 单倍体造血干细胞移植后无免疫抑制肾移植治疗范可尼贫血

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ekir.2025.09.041

Jessica Kachmar , Martin Castelle , David Saint Gilles , George Terinte-Balcan , Margaux Boistault , Thomas Blanc , Julien Zuber , Evgenia Preka , Olivia Boyer , Marina Charbit , Guillaume Dorval

引用次数: 0

Urine Screening for Early Diagnosis of Young Individuals With Alport Syndrome: A Call for Action 尿液筛查早期诊断年轻人阿尔波特综合征：行动呼吁

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ekir.2025.10.014

Michelle N. Rheault , Oliver Gross

引用次数: 0

Combining Treatment and Histopathology: Understanding Kidney Recovery in Severe Antineutrophil Cytoplasmic Autoantibody–Associated Rapidly Progressive Glomerulonephritis 结合治疗和组织病理学：了解严重抗中性粒细胞胞浆自身抗体相关的快速进展性肾小球肾炎的肾脏恢复

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ekir.2025.10.007

Jolijn R. van Leeuwen , Y.K. Onno Teng

引用次数: 0

CKDs at the Crossroads: From Failures to Future Therapies 十字路口的ckd：从失败到未来的治疗

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ekir.2025.09.050

Farah Wehbe , Mark Elliott , Adeera Levin

Chronic kidney disease (CKD) is a public health emergency because it is common and carries an increasing burden of morbidity and mortality. Until recently, treatment options for CKD and its adverse systemic effects were limited; however, we now have multiple approved therapies and a growing pipeline of promising treatments under evaluation. Despite the strong evidence and guideline recommendations supporting the broad use of approved therapies, uptake in practice remains lower than expected, potentially limiting the benefits of these advances. Early identification of CKD remains a prerequisite for therapy, yet screening and cost-effectiveness continue to be debated globally. In this review, we discuss the currently available pharmacologic treatments for CKD that have proven kidney and cardiac benefits with a specific focus on addressing barriers to implementation and ongoing trials that will inform their routine clinical use. We then discuss treatments that are in late-phase clinical trials that may expand the therapeutic options for CKD in the next few years. This will necessitate a personalized approach to management to determine which therapies will work best for which patients. Finally, we touch on therapeutic strategies that did not demonstrate clinical benefits despite rational physiologic support.

This review addresses the know-do gap that exists in applying proven therapies for people with CKD and provides clinicians with practical tools and knowledge to improve clinical uptake, while acknowledging global challenges of access and affordability.

慢性肾脏疾病（CKD）是一种突发公共卫生事件，因为它是常见的，并且具有越来越高的发病率和死亡率。直到最近，CKD的治疗选择和它的全身不良反应是有限的；然而，我们现在有多种已获批准的治疗方法，还有越来越多的有前景的治疗方法正在评估中。尽管有强有力的证据和指南建议支持广泛使用已批准的治疗方法，但实际应用仍低于预期，这可能限制了这些进展的益处。早期识别CKD仍然是治疗的先决条件，但筛查和成本效益仍在全球范围内争论不休。在这篇综述中，我们讨论了目前已被证实对肾脏和心脏有益的CKD药物治疗方法，并特别关注解决实施障碍和正在进行的试验，这些试验将为其常规临床应用提供信息。然后我们讨论了处于后期临床试验的治疗方法，这些治疗方法可能会在未来几年扩大CKD的治疗选择。这将需要一种个性化的管理方法，以确定哪种疗法对哪种患者最有效。最后，我们触及治疗策略，没有表现出临床效益，尽管合理的生理支持。本综述解决了在CKD患者应用已证实的治疗方法方面存在的知识差距，并为临床医生提供了实用的工具和知识，以提高临床应用，同时承认全球在可及性和可负担性方面的挑战。

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引用次数: 0

Insights From the UK on Fibromuscular Dysplasia in Pregnancy 英国对妊娠期纤维肌肉发育不良的见解

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ekir.2025.09.013

Sharmilee Rengarajan , Henry H.L. Wu , Rajkumar Chinnadurai , Jenny Myers , Edward Lake , Aine de Bhailis , Philip Thomas , Amit Herwadkar , Constantina Chrysochou

引用次数: 0

Mass Spectrometry of Minimal Change Disease and Focal Segmental Glomerulosclerosis 微小变化疾病和局灶节段性肾小球硬化的质谱分析

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-12-01 DOI: 10.1016/j.ekir.2025.09.043

Fernando C. Fervenza , Maria J. Vargas-Brochero , Hanna Debiec , Benjamin Madden , Luciana Andrade , Ladan Zand , Pierre Ronco , Sanjeev Sethi

Introduction

The relation between minimal change disease (MCD) and primary focal segmental glomerulosclerosis (FSGS) (pFSGS) remains debatable, and the recent discovery of antinephrin and antislit antibodies, supports the hypothesis of a continuum disease. However, the overall expression of podocyte proteins in these disease states is not known.

Methods

In this observational proteomic study, we used laser microdissection and mass spectrometry (LMD/MS) to determine the proteomic profile of podocyte proteins in kidney biopsies of adult patients with MCD (n = 6), pFSGS (n = 7), secondary FSGS (sFSGS) (n = 10), and genetic FSGS (gFSGS) (n = 6). Time-zero kidney transplant (T0) (n = 6), IgA nephropathy (IgAN) (n = 5) and membranous nephropathy (MN) (n = 8) served as nonproteinuric and proteinuric controls, respectively. MS results were expressed as total spectrum representing the relative abundance of the specific protein. In addition, immunofluorescence (IF) staining assessing nephrin (NPHS1) and podocin (NPHS2) were performed.

Results

LMD/MS show moderate baseline total spectrum of podocyte proteins, NPHS1, NPHS2, CD2-associated protein, alpha-actinin-2, inverted formin-2 (INF2), and dystroglycan 1 (DAG1) in T0 and MN controls. In contrast, there was a significant loss of all 6 podocyte proteins in MCD, pFSGS, sFSGS, and gFSGS but not in MN cases. IF staining confirmed podocyte loss of NPHS1 and NPHS2 in MCD, pFSGS, sFSGS, and gFSGS but not in T0 or MN.

Conclusion

LMD/MS and IF staining show significant and comparable loss of podocyte proteins involving the slit diaphragm and actin cytoskeleton in MCD, pFSGS, sFSGS, and gFSGS suggesting a common final pathway of podocyte injury. Surprisingly, despite similar degrees of proteinuria, MN was not associated with significant loss of podocyte proteins.

最小改变病（MCD）和原发性局灶节段性肾小球硬化（FSGS）（pFSGS）之间的关系仍然存在争议，最近发现的抗肾上腺素和抗狭缝抗体支持了连续性疾病的假设。然而，足细胞蛋白在这些疾病状态中的总体表达尚不清楚。方法在这项观察性蛋白质组学研究中，我们采用激光显微解剖和质谱（LMD/MS）技术测定了成年MCD患者（n = 6）、pFSGS （n = 7）、继发性FSGS （n = 10）和遗传性FSGS （n = 6）肾脏活检中足细胞蛋白的蛋白质组学特征。零时间肾移植（T0）（n = 6）、IgA肾病（IgAN）（n = 5）和膜性肾病（MN）（n = 8）分别作为非蛋白尿和蛋白尿对照。质谱结果表示为代表特定蛋白相对丰度的总谱。此外，免疫荧光（IF）染色评估nephrin （NPHS1）和podocin （NPHS2）。结果slmd /MS显示，T0和MN对照中足细胞蛋白、NPHS1、NPHS2、cd2相关蛋白、α -肌动蛋白-2、倒置形成蛋白-2 （INF2）和糖醛酸失调蛋白1 （DAG1）的基线总谱中等。相比之下，MCD、pFSGS、sFSGS和gFSGS患者的6种足细胞蛋白都有明显的缺失，而MN患者则没有。IF染色证实MCD、pFSGS、sFSGS和gFSGS中足细胞缺失NPHS1和NPHS2，但T0和MN中未见。结论lmd /MS和IF染色显示MCD、pFSGS、sFSGS和gFSGS中裂隙隔膜和肌动蛋白细胞骨架等足细胞蛋白的显著损失，提示足细胞损伤有共同的最终途径。令人惊讶的是，尽管有相似程度的蛋白尿，MN与足细胞蛋白的显著损失无关。

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