Pub Date : 2025-12-01DOI: 10.1016/j.ekir.2025.09.025
Jonathan Barratt , Laura H. Mariani , Jai Radhakrishnan , Dana V. Rizk , James A. Tumlin , Richard A. Lafayette
IgA nephropathy (IgAN) is a rare, chronic, immune-mediated kidney disease characterized by a slow, progressive decline in kidney function. As a disease without an existing cure and a leading cause of chronic kidney disease (CKD) and kidney failure, IgAN requires effective interventions for disease modification. However, identifying interventions as “disease modifying” is challenging in IgAN because of a lack of consensus on the term and uncertainty about suitable markers by which “disease modification” should be defined. This review discusses how “disease modification” could be defined in IgAN, based on the simple premise of the need to preserve nephrons and avoid progression to kidney failure within the patient’s lifetime. In addition, how disease modification can be meaningfully assessed (e.g., the impact of an intervention on mortality and kidney failure, estimated glomerular filtration rate [eGFR], urinary protein or albumin, nonvisible [microscopic] hematuria, and markers of underlying IgAN pathology) is examined. Further, the concept of a multifaceted approach to IgAN management is discussed, targeting both the IgAN-specific processes leading to nephron loss and the generic maladaptive responses to IgAN-induced nephron loss.
{"title":"Defining Disease Modification in IgA Nephropathy: Toward a Paradigm Shift in Management","authors":"Jonathan Barratt , Laura H. Mariani , Jai Radhakrishnan , Dana V. Rizk , James A. Tumlin , Richard A. Lafayette","doi":"10.1016/j.ekir.2025.09.025","DOIUrl":"10.1016/j.ekir.2025.09.025","url":null,"abstract":"<div><div>IgA nephropathy (IgAN) is a rare, chronic, immune-mediated kidney disease characterized by a slow, progressive decline in kidney function. As a disease without an existing cure and a leading cause of chronic kidney disease (CKD) and kidney failure, IgAN requires effective interventions for disease modification. However, identifying interventions as “disease modifying” is challenging in IgAN because of a lack of consensus on the term and uncertainty about suitable markers by which “disease modification” should be defined. This review discusses how “disease modification” could be defined in IgAN, based on the simple premise of the need to preserve nephrons and avoid progression to kidney failure within the patient’s lifetime. In addition, how disease modification can be meaningfully assessed (e.g., the impact of an intervention on mortality and kidney failure, estimated glomerular filtration rate [eGFR], urinary protein or albumin, nonvisible [microscopic] hematuria, and markers of underlying IgAN pathology) is examined. Further, the concept of a multifaceted approach to IgAN management is discussed, targeting both the IgAN-specific processes leading to nephron loss and the generic maladaptive responses to IgAN-induced nephron loss.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 12","pages":"Pages 4174-4187"},"PeriodicalIF":5.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651861","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 : 2025-12-01DOI: 10.1016/j.ekir.2025.09.026
Celia M.B. Souza , Bibiana S.O. Fam , Giovanna C. Giudicelli , Nathan Araujo Cadore , Mariléa F. Feira , Mayara Jorgens Prado , Thayne W. Kowalski , Osvaldo Alfonso P. Artigalás , Renan B. Lemes , Maíra Ribeiro Rodrigues , Mauro R.S. Junior , William C. Silva , Maicon D. Torely , Franciele M. Barbosa , Alexandre da Costa Pereira , Lygia V. Pereira , Tábita Hünemeier , Francisco V. Veronese , Fernanda S.L. Vianna
{"title":"APOL1 G1/G2 Variants Associated With CKD in Afro-Brazilians","authors":"Celia M.B. Souza , Bibiana S.O. Fam , Giovanna C. Giudicelli , Nathan Araujo Cadore , Mariléa F. Feira , Mayara Jorgens Prado , Thayne W. Kowalski , Osvaldo Alfonso P. Artigalás , Renan B. Lemes , Maíra Ribeiro Rodrigues , Mauro R.S. Junior , William C. Silva , Maicon D. Torely , Franciele M. Barbosa , Alexandre da Costa Pereira , Lygia V. Pereira , Tábita Hünemeier , Francisco V. Veronese , Fernanda S.L. Vianna","doi":"10.1016/j.ekir.2025.09.026","DOIUrl":"10.1016/j.ekir.2025.09.026","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 12","pages":"Pages 4289-4293"},"PeriodicalIF":5.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145652074","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 : 2025-12-01DOI: 10.1016/j.ekir.2025.10.012
Fatima Ayub , John Arthur , Md Rajibul Hasan , Luis A. Juncos , Joseph Hunter Holthoff
{"title":"Response To the Letter to the Editor Entitled “First Report of Daratumumab Therapy in Refractory THSD7A-Positive Membranous Nephropathy”","authors":"Fatima Ayub , John Arthur , Md Rajibul Hasan , Luis A. Juncos , Joseph Hunter Holthoff","doi":"10.1016/j.ekir.2025.10.012","DOIUrl":"10.1016/j.ekir.2025.10.012","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 12","pages":"Pages 4316-4317"},"PeriodicalIF":5.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651854","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 : 2025-12-01DOI: 10.1016/j.ekir.2025.09.005
Maxime Vignac , Dorian Nezam , François Grolleau , Pauline Morel , Dimitri Titeca-Beauport , Stanislas Faguer , Alexandre Karras , Justine Solignac , Noémie Jourde-Chiche , François Maurier , Hamza Sakhi , Khalil El Karoui , Rafik Mesbah , Pierre Louis Carron , Vincent Audard , Didier Ducloux , Romain Paule , Jean-François Augusto , Julien Aniort , Aurélien Tiple , Benjamin Terrier
Introduction
The identification of prognostic factors for renal failure in antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) remains a challenge. The benefit of plasma exchange (PLEX) has been questioned, and the target population remains to be defined. We investigated the outcome of patients requiring renal replacement therapy (RRT) at baseline and factors associated with their prognosis at 1 year.
Methods
This retrospective multicenter study evaluated the 1-year composite end point of death or end-stage kidney disease (ESKD) in patients with biopsy-proven renal AAV involvement.
Results
Of the 394 patients included, 105 (26.6%) were on dialysis at baseline. Of these, 60 (57.1%) reached the composite end point compared with 29 patients (10.0%) who were not on RRT at baseline (P < 0.001). On multivariate analysis, age and sex were not associated with the composite outcome (P = 0.945 and P = 0.154, respectively); however, myeloperoxidase (MPO)-ANCA was (odds ratio [OR]: 3.60; 95% confidence interval [CI]: 1.79–7.60), as was a high baseline histologic renal risk score (OR: 1.29; 95% CI 1.17–1.44). The most strongly associated factor remained the need for dialysis at baseline (OR: 10.91; 95% CI: 5.52–22.70). Of the 91 patients surviving after requiring dialysis at baseline, 45 were weaned from RRT (49.5%) at 1 year, and PLEX was independently associated with a reduced risk of the composite outcome (OR: 0.23, 95% CI: 0.05–0.80).
Conclusion
MPO-ANCA, need for dialysis, and high histological renal risk score at baseline were associated with the 1-year composite end point of death or ESKD. Almost half of the patients on dialysis at baseline were off dialysis at 1 year, with a better prognosis in those who had received PLEX.
{"title":"Effect of Baseline Dialysis and Plasma Exchange on Renal Prognosis in Patients With Antineutrophil Cytoplasmic Autoantibody–Associated Vasculitis","authors":"Maxime Vignac , Dorian Nezam , François Grolleau , Pauline Morel , Dimitri Titeca-Beauport , Stanislas Faguer , Alexandre Karras , Justine Solignac , Noémie Jourde-Chiche , François Maurier , Hamza Sakhi , Khalil El Karoui , Rafik Mesbah , Pierre Louis Carron , Vincent Audard , Didier Ducloux , Romain Paule , Jean-François Augusto , Julien Aniort , Aurélien Tiple , Benjamin Terrier","doi":"10.1016/j.ekir.2025.09.005","DOIUrl":"10.1016/j.ekir.2025.09.005","url":null,"abstract":"<div><h3>Introduction</h3><div>The identification of prognostic factors for renal failure in antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) remains a challenge. The benefit of plasma exchange (PLEX) has been questioned, and the target population remains to be defined. We investigated the outcome of patients requiring renal replacement therapy (RRT) at baseline and factors associated with their prognosis at 1 year.</div></div><div><h3>Methods</h3><div>This retrospective multicenter study evaluated the 1-year composite end point of death or end-stage kidney disease (ESKD) in patients with biopsy-proven renal AAV involvement.</div></div><div><h3>Results</h3><div>Of the 394 patients included, 105 (26.6%) were on dialysis at baseline. Of these, 60 (57.1%) reached the composite end point compared with 29 patients (10.0%) who were not on RRT at baseline (<em>P</em> < 0.001). On multivariate analysis, age and sex were not associated with the composite outcome (<em>P</em> = 0.945 and <em>P</em> = 0.154, respectively); however, myeloperoxidase (MPO)-ANCA was (odds ratio [OR]: 3.60; 95% confidence interval [CI]: 1.79–7.60), as was a high baseline histologic renal risk score (OR: 1.29; 95% CI 1.17–1.44). The most strongly associated factor remained the need for dialysis at baseline (OR: 10.91; 95% CI: 5.52–22.70). Of the 91 patients surviving after requiring dialysis at baseline, 45 were weaned from RRT (49.5%) at 1 year, and PLEX was independently associated with a reduced risk of the composite outcome (OR: 0.23, 95% CI: 0.05–0.80).</div></div><div><h3>Conclusion</h3><div>MPO-ANCA, need for dialysis, and high histological renal risk score at baseline were associated with the 1-year composite end point of death or ESKD. Almost half of the patients on dialysis at baseline were off dialysis at 1 year, with a better prognosis in those who had received PLEX.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 12","pages":"Pages 4199-4206"},"PeriodicalIF":5.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651923","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 : 2025-12-01DOI: 10.1016/j.ekir.2025.10.002
Mariana Murea , Andrea K. Viecelli
{"title":"New RCTs Advance Incremental Dialysis With Clinically-Guided HD and HDF-Based Prescriptions","authors":"Mariana Murea , Andrea K. Viecelli","doi":"10.1016/j.ekir.2025.10.002","DOIUrl":"10.1016/j.ekir.2025.10.002","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 12","pages":"Pages 4129-4131"},"PeriodicalIF":5.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651759","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 : 2025-12-01DOI: 10.1016/j.ekir.2025.09.035
Seong Geun Kim , Chia-Ter Chao , Kornchanok Vareesangthip , Winston Fung , Mariko Miyazaki , Sayaka Ishigaki , Jungeon Kim , Donghyung Lee , Hyeong-Cheon Park , Young-Ki Lee , Kyung Don Yoo , Korean Society of Nephrology Disaster Preparedness and Response Committee
Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) represent growing global health burdens, driven by aging populations and increasing prevalence of diabetes and hypertension. Patients with ESKD face significant lifestyle limitations, particularly regarding mobility and travel, because of treatment schedules, medical complexity, and heightened vulnerability to complications. Air and long-distance travel pose distinct risks—cardiovascular stress, infection, and logistical challenges—that demand tailored assessment and preparation. This review outlines key travel-related complications in CKD and patients on dialysis, including cardiovascular and thromboembolic events, infection, jet lag, and vascular access risks. It further examines aeromedical considerations, such as hypobaric hypoxemia and venous thromboembolism (VTE), and evaluates airline-specific medical clearance protocols in major global carriers. Detailed recommendations are provided for hemodialysis and peritoneal dialysis (PD) patients, including pre-travel assessment, medication and supply management, international dialysis coordination, and inflight precautions.
{"title":"From Dialysis to Destinations: Safe Travel Strategies for Patients With CKD","authors":"Seong Geun Kim , Chia-Ter Chao , Kornchanok Vareesangthip , Winston Fung , Mariko Miyazaki , Sayaka Ishigaki , Jungeon Kim , Donghyung Lee , Hyeong-Cheon Park , Young-Ki Lee , Kyung Don Yoo , Korean Society of Nephrology Disaster Preparedness and Response Committee","doi":"10.1016/j.ekir.2025.09.035","DOIUrl":"10.1016/j.ekir.2025.09.035","url":null,"abstract":"<div><div>Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) represent growing global health burdens, driven by aging populations and increasing prevalence of diabetes and hypertension. Patients with ESKD face significant lifestyle limitations, particularly regarding mobility and travel, because of treatment schedules, medical complexity, and heightened vulnerability to complications. Air and long-distance travel pose distinct risks—cardiovascular stress, infection, and logistical challenges—that demand tailored assessment and preparation. This review outlines key travel-related complications in CKD and patients on dialysis, including cardiovascular and thromboembolic events, infection, jet lag, and vascular access risks. It further examines aeromedical considerations, such as hypobaric hypoxemia and venous thromboembolism (VTE), and evaluates airline-specific medical clearance protocols in major global carriers. Detailed recommendations are provided for hemodialysis and peritoneal dialysis (PD) patients, including pre-travel assessment, medication and supply management, international dialysis coordination, and inflight precautions.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 12","pages":"Pages 4162-4173"},"PeriodicalIF":5.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651860","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 : 2025-12-01DOI: 10.1016/j.ekir.2025.09.044
Hiddo J.L. Heerspink , Alessia Fornoni , Lesley A. Inker , Irene L. Noronha , Hernán Trimarchi , Muh Geot Wong , Alisha Smith , Robert Shepherd , Carl W. White , David Fuller , Jonathan Barratt
{"title":"DMX-200 in Patients With Primary Focal Segmental Glomerulosclerosis: Results of the Phase 2 ACTION2 Trial","authors":"Hiddo J.L. Heerspink , Alessia Fornoni , Lesley A. Inker , Irene L. Noronha , Hernán Trimarchi , Muh Geot Wong , Alisha Smith , Robert Shepherd , Carl W. White , David Fuller , Jonathan Barratt","doi":"10.1016/j.ekir.2025.09.044","DOIUrl":"10.1016/j.ekir.2025.09.044","url":null,"abstract":"","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"10 12","pages":"Pages 4272-4276"},"PeriodicalIF":5.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651995","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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