Kidney International Reports最新文献

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Kidney Supportive Care: Principles, Practice, and Pathways for Fiji 肾脏支持护理：斐济的原则、实践和途径

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-11-24 DOI: 10.1016/j.ekir.2025.11.028

Yogeshni Chandra , Anis Ta’eed , Kelly Li , Shilpanjali Jesudason , Mark Brown

引用次数: 0

Planning Renal Replacement Therapy in Factor VII Deficiency 七因子缺乏患者肾替代治疗计划

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-11-24 DOI: 10.1016/j.ekir.2025.11.023

Ahmet Murt , Ertugrul Erol , Sefa Ergun , Muhlis Cem Ar

引用次数: 0

Advance Care Planning: We Need to Change Our Approach to Improve Patient and Clinician Engagement 提前护理计划：我们需要改变我们的方法，以提高患者和临床医生的参与

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-11-24 DOI: 10.1016/j.ekir.2025.11.027

Kathryn Ducharlet , Dov Degen , Lawrence P. McMahon

引用次数: 0

Circulating Testican-2 and MGT5A are Markers of Membranous Nephropathy 循环睾丸素-2和MGT5A是膜性肾病的标志

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-11-20 DOI: 10.1016/j.ekir.2025.11.020

Taesoo Kim , Wenjun Ju , Aditya Surapaneni , Yang Li , Donghai Wen , Claire Trivin-Avillach , Ivy A. Rosales , Laurence H. Beck Jr. , Viji Nair , Damian Fermin , Jarcy Zee , Insa M. Schmidt , Anand Srivastava , Ragnar Palsson , Isaac E. Stillman , Matthias Kretzler

Introduction

Membranous nephropathy (MN) is a common cause of nephrotic syndrome usually diagnosed using kidney biopsy.

Methods

We examined the association of 6592 plasma proteins with a diagnosis of MN in the Boston Kidney Biopsy Cohort (BKBC, n = 434), with replication of the top hits in the Nephrotic Syndrome Study Network (NEPTUNE, n = 132).

Results

In BKBC, 2 proteins, testican-2 and alpha-1,6-mannosylglycoprotein 6-beta-N-acetylglucosaminyltransferase (MGT5A), were associated with MN when compared with the reference diagnosis (normal or thin basement membrane [TBM] disease) as well as when compared with all other diagnoses among individuals who had undergone kidney biopsy for the indication of proteinuria or nephrotic syndrome. In NEPTUNE, plasma levels of both proteins, as well as glomerular expression of their cognate genes, were increased in MN compared with minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS). In receiver operating characteristic curve analyses, the addition of plasma testican-2 and MGT5A levels significantly improved discrimination of MN from other diagnoses in BKBC and NEPTUNE compared with models incorporating age, sex, race, estimated glomerular filtration rate (eGFR), and proteinuria.

Conclusion

Together, these findings motivate interest in testican-2 and MGT5A as markers and potential functional participants in MN. More work is required to understand the biological role of these proteins in the glomerular basement membrane in relation to immune complex deposition as well as to assess their performance as biomarkers alongside circulating autoantibodies in patients with MN.

膜性肾病（MN）是肾病综合征的常见病因，通常通过肾活检诊断。方法我们在波士顿肾活检队列（BKBC, n = 434）中检测了6592种血浆蛋白与MN诊断的关系，并在肾病综合征研究网络（NEPTUNE, n = 132）中复制了最热门的结果。结果在BKBC中，睾丸素-2和α -1,6-甘露糖糖蛋白6- β - n-乙酰氨基葡萄糖转移酶（MGT5A）两种蛋白与MN的相关性与参考诊断（正常或薄基底膜[TBM]病）以及其他诊断（以蛋白尿或肾病综合征为指征进行肾活检的个体）均有相关性。在NEPTUNE中，与微小变化病（MCD）和局灶节段性肾小球硬化（FSGS）相比，MN中这两种蛋白的血浆水平以及它们同源基因的肾小球表达均升高。在受试者工作特征曲线分析中，与纳入年龄、性别、种族、估计肾小球滤过率（eGFR）和蛋白尿的模型相比，血浆睾丸素-2和MGT5A水平的增加显著提高了BKBC和NEPTUNE中MN与其他诊断的区别。总之，这些发现激发了人们对睾丸素-2和MGT5A作为MN标记物和潜在功能参与者的兴趣。需要更多的工作来了解这些蛋白质在肾小球基底膜中与免疫复合物沉积有关的生物学作用，以及评估它们与MN患者循环自身抗体一起作为生物标志物的性能。

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引用次数: 0

Virtual Care Utilization and Peritonitis Risk in Rural and Indigenous Peritoneal Dialysis Patients 农村和本地腹膜透析患者的虚拟护理利用和腹膜炎风险

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-11-20 DOI: 10.1016/j.ekir.2025.11.013

Anurag Singh , Anam Liaqat , Talal Khalid , Karen Walkey , Vanessa Wheeler , Khalid Bashir , Mark Elliott , Adeera Levin

Introduction

Peritoneal dialysis (PD) provides an essential home-based kidney replacement therapy, particularly for rural and Indigenous populations with limited access to in-center hemodialysis. Trust, continuity, and technical proficiency are critical for safe PD care. The COVID-19 pandemic accelerated virtual care delivery, coinciding with increased PD-associated peritonitis.

Methods

We conducted a retrospective cohort study (2021–2023) with an embedded qualitative component at a regional hospital in Northern British Columbia, Canada. Demographic, clinical, and virtual care data were extracted from the provincial databases and patient charts. Peritonitis episodes were classified using structured Root Cause Analysis (RCA). We used multivariable logistic regression to assess associations between patient factors and peritonitis risk. We used semi-structured interviews with 12 patients on PD to explore perceptions of trust, training adequacy, and care continuity.

Results

Among 45 adult patients on PD (mean age 63.5 ± 12.1 years), 78 peritonitis episodes occurred. Patients from rural Indigenous communities represented 33.3% of the cohort but accounted for 70.5% of episodes. RCA attributed 63.8% of episodes to technique failure, 19.1% to acute events, and 17.0% to psychosocial stressors. Peritonitis was associated with residence in an Indigenous community (odds ratio [OR]: 2.45, 95% confidence interval [CI]: 1.01–5.94, P = 0.049), high virtual care exposure (≥ 85% of visits; OR: 2.85, 95% CI: 1.19–6.84, P = 0.019), and technique failure (OR: 3.12, 95% CI: 1.42–6.84, P = 0.005). Qualitative themes included diminished trust, inadequate hands-on training, and perceived clinical detachment.

Conclusion

High virtual care exposure was associated with increased risk of peritonitis, particularly among patients in rural Indigenous communities. Adapting PD models to strengthen trust, hands-on training, and cultural safety may improve outcomes.

腹膜透析（PD）提供了一种基本的家庭肾脏替代疗法，特别是对于农村和土著人口，他们无法获得中心血液透析。信任、连续性和技术熟练是PD安全护理的关键。COVID-19大流行加速了虚拟医疗服务，同时pd相关性腹膜炎增加。方法我们在加拿大不列颠哥伦比亚省北部的一家地区医院进行了一项回顾性队列研究（2021-2023）。人口统计、临床和虚拟护理数据是从省级数据库和患者图表中提取的。使用结构化根本原因分析（RCA）对腹膜炎发作进行分类。我们使用多变量逻辑回归来评估患者因素与腹膜炎风险之间的关系。我们对12名PD患者进行了半结构化访谈，以探讨对信任、培训充分性和护理连续性的看法。结果45例成年PD患者（平均年龄63.5±12.1岁）发生腹膜炎78例。来自农村土著社区的患者占队列的33.3%，但占发作的70.5%。RCA将63.8%的发作归因于技术失败，19.1%归因于急性事件，17.0%归因于心理社会压力。腹膜炎与居住在土著社区（优势比[OR]: 2.45, 95%可信区间[CI]: 1.01-5.94, P = 0.049）、高虚拟护理暴露（≥85%的就诊；OR: 2.85, 95% CI: 1.19-6.84, P = 0.019）和技术失败（OR: 3.12, 95% CI: 1.42-6.84, P = 0.005）相关。定性主题包括信任减少、实践培训不足和感知到的临床脱离。结论高虚拟护理暴露与腹膜炎风险增加有关，特别是在农村土著社区的患者中。调整PD模式以加强信任、实践培训和文化安全可能会改善结果。

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引用次数: 0

Heterogeneity of Estimated GFR Slopes According to Etiology, Estimated GFR and Urinary Albumin-to-Creatinine Ratio in a Large Cohort of Patients With CKD 在大型CKD患者队列中，根据病因、估计GFR和尿白蛋白/肌酐比值估计GFR斜率的异质性

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-11-20 DOI: 10.1016/j.ekir.2025.11.021

Charlotte Behning , Ulla T. Schultheiss , Jennifer Nadal , Heike Meiselbach , Sebastian Schönherr , Lukas Forer , Elke Schaeffner , Vera Krane , Markus P. Schneider , Matthias Schmid , Florian Kronenberg , Anna Köttgen , Kai-Uwe Eckardt , Fruzsina Kotsis

Introduction

The rate of decline in estimated glomerular filtration rate (GFR, eGFR) is increasingly recognized as a quantitative marker of chronic kidney disease (CKD) progression. However, data on eGFR slopes have mainly been reported in cohorts enriched for fast progression and the heterogeneity of eGFR slopes across the spectrum of CKD remains poorly defined.

Methods

In 5214 participants of the German CKD (GCKD) study, we modeled eGFR slopes using per-protocol and clinical measurements. We used linear-mixed effects models, with eGFR slope as the outcome and baseline demographics as independent variables to (i) describe eGFR slope heterogeneity; (ii) assess differences by CKD etiology, eGFR and urinary albumin-to-creatinine ratio (UACR) categories, sex, and age; and (iii) determine associations of slopes with estimated eGFR decline (30%, 40%, and 57%) and observed end points (kidney failure with replacement therapy, mortality).

Results

On average, 9 eGFR values per participant (interquartile range: 7–12) over 6.5 years were used for slope calculation. The adjusted mean annual eGFR slope was −1.43 ml/min per 1.73 m². Slopes were similar across eGFR categories, but steeper with higher UACR. Faster eGFR decline was observed in participants of younger age and in those with polycystic kidney disease or diabetic kidney disease (DKD). Although eGFR slopes did not consistently differ by sex, women with diabetes as the leading cause of CKD had lower slopes than their male counterparts. A rapid annual decline (> 5 ml/min per 1.73 m²) occurred in 4.3%, with variation in frequency by CKD cause and UACR.

Conclusion

In conclusion, though the average eGFR slope was low, it varied considerably, depending on CKD etiology and UACR. This data may help to put slope estimates in individual patients and defined subpopulations into perspective.

肾小球滤过率（GFR, eGFR）的下降率越来越被认为是慢性肾脏疾病（CKD）进展的定量标志物。然而，关于eGFR斜率的数据主要是在快速进展的队列中报道的，并且eGFR斜率在整个CKD谱系中的异质性仍然不明确。方法在5214名德国CKD （GCKD）研究参与者中，我们使用每个方案和临床测量来模拟eGFR斜率。我们使用线性混合效应模型，将eGFR斜率作为结果，基线人口统计数据作为自变量来(i)描述eGFR斜率的异质性；（ii）评估CKD病因、eGFR和尿白蛋白与肌酐比（UACR）类别、性别和年龄的差异；（iii）确定坡度与估计eGFR下降（30%，40%和57%）和观察终点（替代治疗肾衰竭，死亡率）的关系。结果平均每个参与者在6.5年期间使用9个eGFR值（四分位数间距为7-12）进行斜率计算。调整后的年平均eGFR斜率为- 1.43 ml/min / 1.73 m2。不同eGFR类别的斜率相似，但UACR越高，斜率越陡。在年龄较小的参与者和患有多囊肾病或糖尿病肾病（DKD）的参与者中观察到eGFR下降更快。虽然eGFR斜率在性别上没有一致的差异，但糖尿病作为CKD主要原因的女性的斜率比男性低。4.3%的患者出现快速的年下降（每1.73 m2下降5 ml/min），随CKD原因和UACR的变化而变化。结论eGFR平均斜率较低，但因CKD病因和UACR的不同而有较大差异。这些数据可能有助于对个体患者和确定的亚群进行斜率估计。

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引用次数: 0

Characterizing the NIH Activity and Chronicity Indices in 2 Independent Lupus Nephritis Cohorts 2个独立狼疮性肾炎队列中NIH活性和慢性指标的表征

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-11-20 DOI: 10.1016/j.ekir.2025.11.011

Valentina Querin , Natasha Jordan , David P. D’Cruz , David Isenberg , Suzanne Wilhelmus , Helmut Schumacher , H. Terence Cook , Augusto Vaglio , Ingeborg M. Bajema

Introduction

The inclusion of National Institutes of Health (NIH) activity index (AI) and chronicity index (CI) in the ISN/Renal Pathology Society (ISN/RPS) classification of lupus nephritis (LN) aims to provide a precise characterization of the amount of active and chronic lesions next to lupus class. We here investigate the distribution of NIH indices within 2 international LN cohorts, their relationship with the ISN/RPS classes and which lesions most significantly contribute to these scores.

Methods

We collected 194 biopsies from 2 cohorts of patients with LN and calculated the NIH AI and CI according to the revised 2018 ISN/RPS classification. For statistical analysis we mainly used nonparametric tests. An exploratory factor analysis was applied to the lesion scores.

Results

The NIH AI score was usually medium-low, reaching a maximum value of 16 of 24, whereas the NIH CI reached 10 of 12. Both indices were higher in classes III, IV, and mixed compared with others (P < 0.0001). Endocapillary hypercellularity was present in > 70% of biopsies, showing a strong correlation with neutrophils/karyorrhexis (r = 0.78, P < 0.0001) and cellular crescents (P < 0.0001). Chronic lesions showed a strong correlation with each other (P < 0.0001), except for fibrous crescents which had the strongest correlation with cellular crescents (r = 0.33, P < 0.0001). The inclusion of all lesions in an exploratory factor analysis uncovered 2 underlying main factors that accurately reflect the NIH AI and CI.

Conclusion

This study revealed key aspects of the NIH AI and CI that may guide future modifications of these indices, leading to a more balanced and reliable scoring system.

将美国国立卫生研究院（NIH）活动性指数（AI）和慢性性指数（CI）纳入美国国际肾脏病学会（ISN/RPS）狼疮性肾炎（LN）的分类，旨在提供狼疮分类旁边的活动性和慢性病变数量的精确表征。我们在此调查了NIH指数在2个国际LN队列中的分布，它们与ISN/RPS类别的关系，以及哪些病变对这些分数的贡献最大。方法从2组LN患者中收集194例活检，并根据修订的2018年ISN/RPS分类计算NIH AI和CI。对于统计分析，我们主要使用非参数检验。对病变评分进行探索性因素分析。结果NIH AI评分一般为中低，24分中最高16分，而NIH CI为12分中最高10分。III类、IV类和混合类的两项指标均高于其他类别（P < 0.0001）。70%的活组织检查显示毛细血管内细胞增多，与中性粒细胞/核分裂（r = 0.78, P < 0.0001）和细胞新月（P < 0.0001）密切相关。慢性病变之间的相关性很强（P < 0.0001），但纤维性月牙与细胞性月牙的相关性最强（r = 0.33, P < 0.0001）。将所有病变纳入探索性因素分析，揭示了准确反映NIH AI和CI的2个潜在主要因素。本研究揭示了NIH AI和CI的关键方面，可以指导这些指标的未来修改，从而形成更平衡和可靠的评分系统。

{"title":"Characterizing the NIH Activity and Chronicity Indices in 2 Independent Lupus Nephritis Cohorts","authors":"Valentina Querin , Natasha Jordan , David P. D’Cruz , David Isenberg , Suzanne Wilhelmus , Helmut Schumacher , H. Terence Cook , Augusto Vaglio , Ingeborg M. Bajema","doi":"10.1016/j.ekir.2025.11.011","DOIUrl":"10.1016/j.ekir.2025.11.011","url":null,"abstract":"<div><h3>Introduction</h3><div>The inclusion of National Institutes of Health (NIH) activity index (AI) and chronicity index (CI) in the ISN/Renal Pathology Society (ISN/RPS) classification of lupus nephritis (LN) aims to provide a precise characterization of the amount of active and chronic lesions next to lupus class. We here investigate the distribution of NIH indices within 2 international LN cohorts, their relationship with the ISN/RPS classes and which lesions most significantly contribute to these scores.</div></div><div><h3>Methods</h3><div>We collected 194 biopsies from 2 cohorts of patients with LN and calculated the NIH AI and CI according to the revised 2018 ISN/RPS classification. For statistical analysis we mainly used nonparametric tests. An exploratory factor analysis was applied to the lesion scores.</div></div><div><h3>Results</h3><div>The NIH AI score was usually medium-low, reaching a maximum value of 16 of 24, whereas the NIH CI reached 10 of 12. Both indices were higher in classes III, IV, and mixed compared with others (<em>P</em> < 0.0001). Endocapillary hypercellularity was present in > 70% of biopsies, showing a strong correlation with neutrophils/karyorrhexis (<em>r</em> = 0.78, <em>P</em> < 0.0001) and cellular crescents (<em>P</em> < 0.0001). Chronic lesions showed a strong correlation with each other (<em>P</em> < 0.0001), except for fibrous crescents which had the strongest correlation with cellular crescents (<em>r</em> = 0.33, <em>P</em> < 0.0001). The inclusion of all lesions in an exploratory factor analysis uncovered 2 underlying main factors that accurately reflect the NIH AI and CI.</div></div><div><h3>Conclusion</h3><div>This study revealed key aspects of the NIH AI and CI that may guide future modifications of these indices, leading to a more balanced and reliable scoring system.</div></div>","PeriodicalId":17761,"journal":{"name":"Kidney International Reports","volume":"11 2","pages":"Article 103686"},"PeriodicalIF":5.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841655","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}

引用次数: 0

Impact of Preeclampsia on Long-Term Kidney Function in a Low-Resourced Setting 低资源环境下子痫前期对长期肾功能的影响

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-11-20 DOI: 10.1016/j.ekir.2025.11.014

Bianca Davidson , Kate Bramham , Kathryn Manning , Ayesha Osman , Abigail Blumenthal , Katherine Clark , Alice Beadmore-Gray , Brian Rayner , Nicola Wearne , Erika S.W. Jones

Introduction

Hypertensive disorders of pregnancy (HDPs) affect approximately 10% of pregnancies, with disproportionate morbidity and mortality in low- and middle-income countries. Although long-term cardiovascular and kidney sequelae of preeclampsia are established in high-income settings, data from low- and middle-income countries remain scarce. We assessed incident hypertension, kidney dysfunction, and albuminuria following preeclampsia and associated risk factors.

Methods

A prospective cohort study was conducted at Groote Schuur Hospital, South Africa, from January 2020 to October 2024. Clinical, demographic, and biochemical data were collected at delivery, first follow-up, and at 1- and 2-year visits. Logistic regression was used to assess predictors of hypertension, reduced estimated glomerular filtration rate (eGFR), and albuminuria, at time points stated above.

Results

Of 241 women enrolled, 93 and 34 completed 1- and 2-year follow-up, respectively. The median age was 30 years (interquartile range [IQR]: 25–35), 50% had pregnancy-related acute kidney injury (AKI, Pr-AKI) and liver injury. Most (65%) delivered before 34 weeks. Incident hypertension persisted in 44% at first visit, 47% at 1 year, and 45% at 2 years. Reduced eGFR (< 90 ml/min per 1.73 m²) occurred in 22% at first visit and 20% at 1-year. Albuminuria persisted in > 50%. Pr-AKI predicted reduced eGFR (P = 0.013) and albuminuria (P = 0.015) at 1 year. HIV predicted reduced eGFR at first visit (P = 0.001), whereas elevated body mass index (BMI) predicted hypertension at 1 year (odds ratio [OR]: 3.98, P = 0.036).

Conclusion

Cardio-renal sequelae following preeclampsia were strikingly common, underscoring the need for integrated postpartum surveillance. In this cohort, Pr-AKI was an important determinant of chronic kidney disease (CKD).

妊娠高血压疾病（HDPs）影响约10%的妊娠，在低收入和中等收入国家发病率和死亡率不成比例。虽然在高收入环境中确定了子痫前期的长期心血管和肾脏后遗症，但来自低收入和中等收入国家的数据仍然很少。我们评估了子痫前期高血压、肾功能障碍和蛋白尿的发生率及相关危险因素。方法于2020年1月至2024年10月在南非Groote Schuur医院进行前瞻性队列研究。在分娩、第一次随访以及1年和2年随访时收集临床、人口统计学和生化数据。在上述时间点，采用Logistic回归评估高血压、肾小球滤过率（eGFR）降低和蛋白尿的预测因子。结果在241名入组妇女中，分别有93名和34名完成了1年和2年的随访。中位年龄为30岁（四分位间距[IQR]: 25-35岁），50%的患者有妊娠相关性急性肾损伤（AKI, Pr-AKI）和肝损伤。大多数（65%）在34周前分娩。首次就诊时高血压发生率为44%，1年后为47%，2年后为45%。首次就诊时eGFR降低22%（每1.73 m2降低90 ml/min）， 1年后降低20%。蛋白尿持续在50%。Pr-AKI预测1年后eGFR （P = 0.013）和蛋白尿（P = 0.015）降低。HIV预测首次就诊时eGFR降低（P = 0.001），而体重指数（BMI）升高预测1年后高血压（优势比[OR]: 3.98, P = 0.036）。结论子痫前期的心肾后遗症非常普遍，强调了产后综合监测的必要性。在这个队列中，Pr-AKI是慢性肾脏疾病（CKD）的一个重要决定因素。

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引用次数: 0

A Phase 1B Trial of Cannabidiol for Symptom Management in Kidney Failure 大麻二酚用于肾衰竭症状管理的1B期试验

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-11-19 DOI: 10.1016/j.ekir.2025.11.022

Brendan Smyth , Taewon Yi , Kristy P. Robledo , Rebecca Gordon , Andrew J. McLachlan , Rachael L. Morton , Iain S. McGregor , Meg Jardine

引用次数: 0

Slit Diaphragm Molecular Changes in Recurrent FSGS With Antinephrin Autoantibodies 抗肾上腺素自身抗体复发性FSGS的狭缝隔膜分子变化

IF 5.7 2区医学 Q1 UROLOGY & NEPHROLOGY

Kidney International Reports

Pub Date : 2025-11-19 DOI: 10.1016/j.ekir.2025.11.010

Yoko Shirai , Kenichiro Miura , Shigeru Horita , Naoko Ito , Sekiko Taneda , Junki Koike , Kazuho Honda , Motoshi Hattori

引用次数: 0

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