Kidney International Reports最新文献

英文中文

Immune Profiling Identifies High-Risk Neutrophil-Rich Subtype in Checkpoint Inhibitor Nephritis 免疫分析鉴定检查点抑制剂肾炎的高风险富中性粒细胞亚型

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2026-03-01 Epub Date: 2026-01-06 DOI: 10.1016/j.ekir.2025.103766

Idris Boudhabhay , Helene Lazareth , Julie Oniszczuk , Mathilde Burki , Olivier Aubert , Alaeddine Redissi , Hamza Sakhi , Elsa Ferriere , Elizabeth Fabre , Francesca Lucibello , Nicolas Girard , Anne Grunenwald , Houcine Hamidi , Emma Fleury , Marie Agnes Dragon-Durey , Florence Runyo , Camille Cohen , Stephanie Chhun , Nicolas Veyrenche , Anne Jamet , Pierre Isnard

Introduction

Immune checkpoint inhibitor (ICI)-induced acute interstitial nephritis (AIN) (ICI-AIN) is the leading cause of ICI-associated acute kidney injury (AKI). ICI-AIN is characterized by mononuclear immune infiltrates, although the mechanisms behind their toxicity remain unclear. We aimed to characterize these infiltrates in kidney biopsies and assess their correlation with clinical outcomes and therapeutic responses.

Methods

We retrospectively analyzed 49 biopsy-proven ICI-AIN cases using multiplex immunofluorescence to quantify immune cells (macrophages, neutrophils, B cells, T cells, and plasmocytes). Unsupervised clustering was used to identify patient groups, which we then correlated with clinical presentation and outcomes. Finally, we explored the role of C5a/C5aR1 in neutrophil recruitment.

Results

Unsupervised clustering revealed 3 immune phenotypes as follows: (i) low mononuclear (cluster 1), (ii) high mononuclear (cluster 2), and (iii) neutrophil-rich (cluster 3). Cluster 3 was associated with higher systemic inflammation (C-reactive protein: 84 vs. 15–24 mg/l, P = 0.0002; neutrophil-to-lymphocyte ratio (NLR): 7 vs. 3.2–2.3, P < 0.0001) and more severe initial AKI (peak creatinine: 360 vs. 215–208 μmol/l, P = 0.0001). Histologically, it was marked by granular casts and neutrophilic tubulitis (P < 0.0001). Despite the pyelonephritis-like appearance, urine cultures and metatranscriptomic analysis both ruled out infection. At 12 months, renal response rates to steroids were 93% (cluster 2), 67% (cluster 1), and 38% (cluster 3) (P = 0.004). Relapses occurred more frequently in cluster 3 (38% vs. 11% in cluster 1, 0% in cluster 2, P = 0.01). Urine C5a correlated with C5aR1+ neutrophil infiltration (rho = 0.78).

Conclusion

Our findings identify distinct ICI-AIN subtypes, with a neutrophil-rich cluster linked to complement activation and poor prognosis, offering insights into refining diagnosis and treatment strategies.

免疫检查点抑制剂（ICI）诱导的急性间质性肾炎（AIN）（ICI-AIN）是ICI相关急性肾损伤（AKI）的主要原因。ICI-AIN的特点是单核免疫浸润，尽管其毒性背后的机制尚不清楚。我们的目的是在肾活检中描述这些浸润，并评估它们与临床结果和治疗反应的相关性。方法回顾性分析49例活检证实的ci - ain病例，采用多重免疫荧光定量免疫细胞（巨噬细胞、中性粒细胞、B细胞、T细胞和浆细胞）。无监督聚类用于确定患者组，然后我们将其与临床表现和结果相关联。最后，我们探讨了C5a/C5aR1在中性粒细胞募集中的作用。结果聚类检测显示3种免疫表型：(i)低单核（簇1），（ii）高单核（簇2），（iii）富中性粒细胞（簇3）。集群3与更高的全身炎症（c反应蛋白：84 vs 15-24 mg/l， P = 0.0002；中性粒细胞与淋巴细胞比值（NLR）： 7 vs 3.2-2.3, P < 0.0001）和更严重的初始AKI（峰值肌酐：360 vs 215-208 μmol/l， P = 0.0001）相关。组织学上表现为颗粒状铸型和中性粒细胞小管炎（P < 0.0001）。尽管表现为肾盂肾炎样，但尿液培养和亚转录组学分析均排除了感染的可能。12个月时，类固醇的肾脏反应率分别为93%（第2类）、67%（第1类）和38%（第3类）（P = 0.004）。第3组复发频率更高（38% vs.第1组11%，第2组0%，P = 0.01）。尿C5a与C5aR1+中性粒细胞浸润相关（rho = 0.78）。我们的研究结果确定了不同的ICI-AIN亚型，其中富含中性粒细胞的簇与补体激活和不良预后有关，为改进诊断和治疗策略提供了见解。

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引用次数: 0

Kidney Health in a Warming World: Heat, Climate Change, and Implications for Care 变暖世界中的肾脏健康：热量、气候变化及其对护理的影响

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2026-03-01 Epub Date: 2026-01-27 DOI: 10.1016/j.ekir.2026.103802

Katherine A. Barraclough

引用次数: 0

ARPKD With Shrinking Kidneys and Progressive Loss of Kidney Function ARPKD伴肾脏萎缩和肾功能进行性丧失

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2026-03-01 Epub Date: 2025-12-30 DOI: 10.1016/j.ekir.2025.103755

José Arriola-Montenegro , Arjunmohan Mohan , Adriana V. Gregory , Timothy L. Kline , Peter C. Harris , Neera K. Dahl

引用次数: 0

Complement Alternative Pathway Dominance in Atypical Hemolytic Uremic Syndrome Revealed by Endothelial Bioassays 内皮生物检测揭示非典型溶血性尿毒症综合征补体替代途径优势

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2026-03-01 Epub Date: 2025-12-12 DOI: 10.1016/j.ekir.2025.103717

Donata Santarsiero , Sara Gastoldi , Valeria Guaschino , Elena Bresin , Ilaria Pagani , Andrea Pasini , Elena Romano , Ariela Benigni , Giuseppe Remuzzi , Marina Noris , Sistiana Aiello

引用次数: 0

A Pathway to High Quality Clinical Trials in IgA Vasculitis Nephritis: Meeting Proceedings From a Multiprofessional International Collaborative Workshop IgA血管炎肾炎的高质量临床试验途径：多专业国际合作研讨会会议记录

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2026-03-01 Epub Date: 2025-12-16 DOI: 10.1016/j.ekir.2025.103729

Louise Oni , Rona Smith , Seza Ozen , Chloe Williams , Elin Davies , Charlotte King , Paul Brogan , Mark Haas , Jonathan Barratt , Jeffrey Hafkin , Despina Eleftheriou , Karuna Keat , EMD Smith , Wen Ding , Chee Cheung , Caroline Platt , Evangéline Pillebout , Andrew Chetwynd , Areefa Alladin , Augusto Vaglio , Alan Salama

IgA vasculitis (IgAV) is an autoimmune disease that affects the small vessels of the skin, joints, gastrointestinal (GI) tract, and kidneys. In the long term, IgAV associated with nephritis (IgAV-N) can progress to kidney failure. Evidence-based clinical studies of IgAV-N are few, leading to huge variations in treatment approaches and suboptimal outcomes. The wealth of emerging efficacious treatments for IgA nephrology brings new opportunities to this disease. The aim of this report is to describe the proceedings of a multiprofessional collaborative workshop convened to identify the barriers to developing high quality evidence for patients with IgAV-N. A multiprofessional group consisting of 53 attendees from 13 countries met. The meeting was represented by a variety of professional backgrounds, including lay attendees, with different levels of expertise (32% professors and 19% midcareer doctors). Using predefined aims, key themes were extracted, and an action plan developed. Consensus was obtained that there is sufficient similarity between adults and children in terms of the organs involved, pathophysiology, histological features, and likely response to treatment. Important differences included the greater spontaneous improvement in children and worse kidney outcomes in some populations. It was agreed that patients at greatest risk of kidney failure should be the primary focus of initial clinical trials. Important considerations included the following: diagnostic classification for adult onset IgAV, observational data, evidence of scientific similarity to IgA nephropathy (IgAN), an age-inclusive approach to trial design, systemic disease secondary end points, and the inclusion of patient-reported outcomes. This manuscript communicates an expert-informed pathway to high-quality evidence for IgAV-N.

IgA血管炎（IgAV）是一种自身免疫性疾病，影响皮肤、关节、胃肠道和肾脏的小血管。长期来看，与肾炎相关的IgAV （IgAV- n）可发展为肾衰竭。基于证据的IgAV-N临床研究很少，导致治疗方法差异很大，结果不理想。新出现的有效治疗IgA肾病的方法为这种疾病带来了新的机会。本报告的目的是描述一个多专业合作研讨会的会议记录，该研讨会旨在确定为IgAV-N患者开发高质量证据的障碍。由来自13个国家的53名与会者组成的多专业小组举行了会议。与会人员来自各行各业，包括专业水平不同的非专业人士（32%为教授，19%为职业中期医生）。利用预先确定的目标，提取了关键主题，并制定了行动计划。人们一致认为，成人和儿童在受累器官、病理生理学、组织学特征和可能的治疗反应方面有足够的相似性。重要的差异包括儿童更大的自发改善和一些人群更差的肾脏预后。人们一致认为，肾功能衰竭风险最大的患者应该是初始临床试验的主要焦点。重要的考虑因素包括：成人发病IgAV的诊断分类、观察数据、与IgA肾病（IgAN）的科学相似性证据、试验设计的年龄包容性方法、全身性疾病次要终点，以及纳入患者报告的结局。这份手稿为IgAV-N提供了一条专家知情的高质量证据途径。

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引用次数: 0

Etiology of Chronic Renal Failure in Hodeida, Yemen 也门荷台达慢性肾衰竭的病因学

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2026-03-01 Epub Date: 2025-12-20 DOI: 10.1016/j.ekir.2025.103738

Nabeel Yahya Al-madwahi , Ahmed Hasan Batah , Muneer Gamil Alwesabi , Haitham Mohammed Jowah

引用次数: 0

Fulacimstat Reduces Angiotensin II in Kidney Allografts in a Cross-Sectional Exploratory Study 富拉西坦降低同种异体肾移植血管紧张素II的横断面探索性研究

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2026-03-01 Epub Date: 2025-12-24 DOI: 10.1016/j.ekir.2025.103745

Johannes J. Kovarik , Tarik Shoumariyeh , Oliver Domenig , Marko Poglitsch , Hanna Tinel , Chantal Kopecky , Klaus G. Schmetterer , Marcus D. Säemann , Christopher C. Kaltenecker

Introduction

The nephroprotective effects of renin-angiotensin system (RAS) blockade after kidney transplantation (KTx) remain ambiguous. It has been shown that chymase and not angiotensin (Ang)-converting enzyme (ACE) is the most efficient Ang II–forming enzyme. Here, we investigated the efficacy of the novel and highly selective chymase inhibitor fulacimstat (BAY 1142524) on Ang II formation in human allograft biopsy tissue.

Methods

In this cross-sectional, exploratory single-center study we analyzed biopsy samples of KTx recipients (n = 55) and healthy kidney donors (n = 13) with and without therapeutic RAS blockade. Using a mass spectrometry–based approach and using specific enzyme inhibitors, we performed metabolic assays to study enzyme activities of ACE and chymase and their specific contribution to intrarenal Ang II formation.

Results

In contrast to healthy kidneys, a distinct shift from ACE toward chymase-dependent Ang II formation was observed in aged (> 2 years) kidney allografts. Irrespective of RAS blockade, we demonstrated high efficacy of fulacimstat (BAY 1142524) to inhibit endogenous chymase-dependent Ang II formation in biopsy tissues of human kidney allografts.

Conclusion

Chymase is the key enzyme for Ang II production in aged graft vintage (> 2 years). Selective inhibition of tissue-specific chymase with fulacimstat (BAY 1142524) inhibits Ang II formation in human kidney allografts, indicating potential therapeutic effects.

肾移植（KTx）后肾素-血管紧张素系统（RAS）阻断的肾保护作用尚不明确。研究表明，凝乳酶而不是血管紧张素（Ang）转化酶（ACE）是最有效的Ang ii形成酶。在这里，我们研究了新型高选择性溶酶抑制剂富拉西司他（BAY 1142524）对人类同种异体移植活检组织中Ang II形成的影响。方法在这项横断面、探索性的单中心研究中，我们分析了有和没有治疗性RAS阻断的KTx受体（n = 55）和健康肾供者（n = 13）的活检样本。使用基于质谱的方法和使用特定的酶抑制剂，我们进行了代谢测定，研究ACE和乳糜酶的酶活性及其对肾内Ang II形成的特定贡献。结果与健康肾脏相比，老龄（2岁）同种异体肾脏移植中观察到从ACE向依赖于乳糜酶的Ang II形成的明显转变。不考虑RAS阻断，我们证明了富拉西坦（BAY 1142524）在抑制人肾同种异体移植活检组织中内源性乳糜依赖的Ang II形成方面具有很高的疗效。结论chymase是2年陈酿葡萄中产生Ang II的关键酶。富拉西坦选择性抑制组织特异性切酶（BAY 1142524）可抑制人肾同种异体移植物中Ang II的形成，表明潜在的治疗作用。

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引用次数: 0

Corrigendum to “CARI Guideline: Evidence-Based Recommendations for Balanced Electrolyte Solutions to Improve Kidney Transplant Outcomes” [Kidney International Reports Volume 10, Issue 8, August 2025, Pages 2566-2574] “CARI指南：基于证据的平衡电解质溶液改善肾移植结果的建议”的勘误表[肾脏国际报告第10卷，第8期，2025年8月，页2566-2574]

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2026-03-01 Epub Date: 2026-01-01 DOI: 10.1016/j.ekir.2025.103769

Colm O’Reilly , David Tunnicliffe , Allan Blackley , Michael Collins , Emmy O’Neill , Siah Kim , Karthik Venkataraman , Emily See , Ross Francis

引用次数: 0

Kidney health for all: caring for people, protecting the planet 人人享有肾脏健康：关爱人类，保护地球

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2026-03-01 Epub Date: 2026-02-19 DOI: 10.1016/j.ekir.2026.106360

Raymond Vanholder , Dina Abdellatif , Augusto Cesar Soares Dos Santos Jr. , Ricardo Correa-Rotter , Natarajan Gopalakrishnan , Bill Wang , Stefanos Roumeliotis , Alessandro Balducci , Ágnes Haris , Manjusha Yadla , Li-Li Hsiao

The current kidney care model—focused on late-stage disease and in-center hemodialysis—is unsustainable, because of costs, environmental burden, poor outcomes, and reduced quality of life. The 78th World Health Assembly’s recognition of kidney disease as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, “Kidney Health for All: Caring for People, Protecting the Planet,” calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, environment, and society. Dialysis itself must become more ecofriendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly for elderly and frail patients, if the quality-of-life benefits outweigh the perspectives offered by dialysis. Achieving this shift requires coordinated action across all stakeholders; education and engagement of the public, policy makers, and health professionals to raise awareness about the threat of kidney disease; and an urgent move toward patient-centered care.

由于成本、环境负担、预后差和生活质量降低，目前以晚期疾病和中心血液透析为重点的肾脏护理模式是不可持续的。第七十八届世界卫生大会认识到肾脏疾病是一种严重的健康威胁，这为重塑肾脏护理提供了一个重要机会。与此相一致，2026年世界肾脏日的主题“人人享有肾脏健康：关爱人类，保护地球”呼吁进行系统性变革。一个可持续的模式必须优先考虑早期发现和预防，减少对肾脏替代治疗的需求。肾移植和家庭透析有利于肾衰竭患者、环境和社会。透析本身必须在不影响护理质量的情况下变得更加环保，认识到行星扰动反过来影响肾脏健康。如果对生活质量的益处超过透析提供的前景，也应考虑保守护理，特别是对老年人和体弱患者。实现这一转变需要所有利益攸关方采取协调行动；对公众、决策者和卫生专业人员进行教育和参与，以提高对肾脏疾病威胁的认识；紧急转向以病人为中心的护理。

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引用次数: 0

Intradialytic Hypotensive Episodes are Only Occasionally Associated With Adverse Symptoms 溶栓性低血压发作仅偶尔伴有不良症状。

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2026-03-01 Epub Date: 2025-12-12 DOI: 10.1016/j.ekir.2025.103718

Sabrine Chaara , Paul A. Rootjes , Miquéla I.Y. Bergtop , Muriel P.C. Grooteman , Peiyun Liu , Menso J. Nubé , Gertrude Wijngaarden , Camiel L.M. de Roij van Zuijdewijn

Introduction

Although intradialytic hypotension (IDH) is a frequent complication of hemodialysis (HD), a consensus definition is lacking. Adverse symptoms and/or interventions are a prerequisite in guidelines; however, a threshold-based blood pressure (BP) definition appeared most strongly associated with mortality. In this study, we evaluated the association of IDH with both real-time symptoms and physical intradialytic patient-reported outcome measures (PID-PROMs) in prevalent HD and hemodiafiltration (HDF) patients.

Methods

This is a secondary analysis of the HOLLANT study, a randomized cross-over trial comparing 4 dialysis modalities (i.e., standard HD, cool high-flux HD, low-volume HDF, and high-volume HDF), each applied for 2 weeks in 40 patients. In each second treatment week, BP was measured every 15 minutes and when symptoms occurred. Symptoms were documented real-time and PID-PROMs were collected after each modality. Considering that symptoms occurred independent of dialysis mode, data from all treatment modalities were pooled. IDH was threshold-defined (systolic BP [SBP] < 90 or < 100 mm Hg, dependent on predialysis SBP). The incidence of symptomatic IDH (sIDH) and asymptomatic IDH (aIDH) was assessed, with sIDH defined by concurrent symptoms. When real-time symptoms arose, attribution to IDH was appraised according to the threshold, National Kidney Disease Outcomes Quality Initiative, and the European Best Practice Guideline definitions. Differences in PID-PROMs were analyzed in tertiles of IDH occurrence.

Results

In 20.1% of 458 treatments, 222 IDH episodes were observed (0.48/session). The majority occurred toward the end of dialysis and 98% was asymptomatic. Real-time reported symptoms (n = 24) were noted in 5.2% of the sessions. Although half were BP-related (n = 13/24), just 4 fulfilled the threshold criteria. Associations between IDH and PID-PROMs were largely absent.

Conclusion

aIDH exceeds sIDH by far. Therefore, symptom-based definitions severely underestimate aIDH incidence. Both real-time occurring symptoms and PID-PROMs are only occasionally associated with IDH.

导语：虽然透析性低血压（IDH）是血液透析（HD）的常见并发症，但缺乏共识的定义。不良症状和/或干预措施是指南的先决条件；然而，以阈值为基础的血压（BP）定义与死亡率的关系最为密切。在这项研究中，我们评估了IDH与流行HD和血液滤过（HDF）患者的实时症状和生理分析患者报告的结果测量（PID-PROMs）的关系。方法：这是HOLLANT研究的二次分析，这是一项随机交叉试验，比较了4种透析方式（即标准HD、冷高通量HD、低容量HDF和高容量HDF），每种透析方式在40例患者中应用2周。在第二个治疗周，每15分钟及出现症状时测量一次血压。实时记录症状，并在每种模式后收集pid - prom。考虑到症状的发生与透析方式无关，我们汇总了所有治疗方式的数据。IDH是阈值定义的（收缩压[SBP] < 90或< 100 mm Hg，取决于透析前收缩压）。评估有症状性IDH （sIDH）和无症状性IDH （aIDH）的发生率，以并发症状定义sIDH。当实时症状出现时，根据阈值、国家肾脏疾病结局质量倡议和欧洲最佳实践指南定义评估IDH的归因。分析IDH发生分位数中pid - prom的差异。结果：在458例治疗中，20.1%的患者出现222例IDH发作（0.48例/次）。大多数发生在透析结束时，98%无症状。实时报告的症状（n = 24）在5.2%的疗程中被记录。虽然一半与bp相关（n = 13/24），但只有4例符合阈值标准。IDH和pid - prom之间的关联基本不存在。结论：aIDH远远超过sIDH。因此，基于症状的定义严重低估了aIDH的发病率。实时发生的症状和pid - prom仅偶尔与IDH相关。

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