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Urinary Oxalate Excretion During Pregnancy in Primary Hyperoxaluria Type 1: A Report of 4 Cases 原发性高草酸尿症 1 型患者妊娠期尿草酸盐排泄情况:4 例报告
IF 3.9 Q2 Medicine Pub Date : 2024-04-16 DOI: 10.1016/j.xkme.2024.100824
Jing Miao , Ramila A. Mehta , Andrea Kattah , Suzanne M. Norby , John C. Lieske , Dawn S. Milliner

Primary hyperoxaluria (PH) is a rare genetic disorder characterized by excessive oxalate production because of specific gene defects. PH1 is the most prevalent type, causing recurrent kidney stone disease and often leading to chronic kidney disease and kidney failure. Our previous study suggested that pregnancy did not adversely affect kidney function in female patients with PH. In this study, we identified 4 PH1 cases with urinary oxalate (UOx) measurements during pregnancy from the Rare Kidney Stone Consortium and Oxalosis and Hyperoxaluria Foundation PH registry to investigate UOx levels during pregnancy in patients with PH1. The PH Registry is approved by the Institutional Review Board of Mayo Clinic (Rochester, MN). All 4 showed a decrease in UOx during pregnancy when compared with before pregnancy and after delivery. These findings contrast with those of the general population, in which the UOx tends to increase during pregnancy because of a simultaneous physiological increase in the glomerular filtration rate. Elucidating the mechanism underlying reduced UOx during pregnancy in PH1 could suggest novel PH therapies. These findings could also affect the clinical management and have implications regarding the safety of withholding novel PH1-directed molecular therapies that currently have uncertain safety profiles during pregnancy. We highlight the need for additional data on urinary changes in patients with PH and other populations while pregnant to clarify changes in UOx throughout pregnancy.

原发性高草酸尿症(PH)是一种罕见的遗传性疾病,其特点是由于特定的基因缺陷而产生过多的草酸盐。PH1 是最常见的类型,可引起反复肾结石,通常会导致慢性肾病和肾衰竭。我们之前的研究表明,妊娠不会对 PH 女性患者的肾功能产生不利影响。在本研究中,我们从罕见肾结石联盟和草酸盐及高草酸盐尿症基金会 PH 登记处找到了 4 例 PH1 患者,并测量了她们在怀孕期间的尿草酸盐(UOx)水平,以调查 PH1 患者在怀孕期间的 UOx 水平。PH登记处获得了梅奥诊所(明尼苏达州罗切斯特市)机构审查委员会的批准。与怀孕前和分娩后相比,所有 4 人在怀孕期间的氧化亚氮水平都有所下降。这些研究结果与普通人群的研究结果形成了鲜明对比,普通人群在怀孕期间由于肾小球滤过率的生理性增加,尿氧化还原酶往往会增加。阐明PH1患者妊娠期尿氧化还原减少的机制可以为新型PH疗法提供建议。这些发现还可能影响临床管理,并对妊娠期暂停目前安全性尚不确定的新型 PH1 定向分子疗法的安全性产生影响。我们强调需要更多有关 PH 患者和其他人群在怀孕期间尿液变化的数据,以明确整个孕期的氧化亚氮变化。
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引用次数: 0
Acute Kidney Injury and Subsequent Kidney Failure With Replacement Therapy Incidence in Older Adults With Advanced CKD: A Cohort Study of US Veterans 美国退伍军人队列研究:晚期慢性肾脏病老年人的 AKI 和后续肾衰竭替代疗法发生率
IF 3.9 Q2 Medicine Pub Date : 2024-04-16 DOI: 10.1016/j.xkme.2024.100825
Danira Medunjanin , Bethany J. Wolf , Roberto Pisoni , David J. Taber , John L. Pearce , Kelly J. Hunt

Rationale & Objective

Advanced age is a major risk factor for chronic kidney disease (CKD) development, which has high heterogeneity in disease progression. Acute kidney injury (AKI) hospitalization rates are increasing, especially among older adults. Previous AKI epidemiologic analyses have focused on hospitalized populations, which may bias results toward sicker populations. This study examined the association between AKI and incident kidney failure with replacement therapy (KFRT) while evaluating age as an effect modifier of this relationship.

Study Design

Retrospective cohort study.

Setting & Participants

24,133 Veterans at least 65 years old with incident CKD stage 4 from 2011 to 2013.

Exposures

AKI, AKI severity, and age.

Outcomes

KFRT and death.

Analytical Approach

The Fine-Gray competing risk regression was used to model AKI and incident KFRT with death as a competing risk. A Cox regression was used to model AKI severity and death.

Results

Despite a nonsignificant age interaction between AKI and KFRT, a clinically relevant combined effect of AKI and age on incident KFRT was observed. Compared with our oldest age group without AKI, those aged 65-74 years with AKI had the highest risk of KFRT (subdistribution HR [sHR], 14.9; 95% CI, 12.7-17.4), whereas those at least 85 years old with AKI had the lowest (sHR, 1.71; 95% CI, 1.22-2.39). Once Veterans underwent KFRT, their risk of death increased by 44%. A 2-fold increased risk of KFRT was observed across all AKI severity stages. However, the risk of death increased with worsening AKI severity.

Limitations

Our study lacked generalizability, was restricted to ever use of medications, and used inpatient serum creatinine laboratory results to define AKI and AKI severity.

Conclusions

In this national cohort, advanced age was protective against incident KFRT but not death. This is likely explained by the high frequency of deaths observed in this population (51.1%). Nonetheless, AKI and younger age are substantial risk factors for incident KFRT.

Plain Language Summary

Older adults are at risk of acute kidney injury (AKI) and subsequent nonrecovery from AKI, resulting in long-term dialysis. Hospitalized patients have often been used in the past to study AKI. This could lead to biased conclusions when inferring from sicker populations. That is why we created a national cohort of 24,133 Veterans at least 65 years old with incident chronic kidney disease (CKD) stage 4 to examine the relationship between AKI and age and subsequent kidney failure with replacement therapy (KFRT). The data have showed that AKI and younger age are substantial risk factors for incident KFRT. As for older age, it appears to be protective against KFRT but not death. This is likely ex

理由与ampamp; 目标高龄是慢性肾脏病(CKD)发展的主要风险因素,而慢性肾脏病的发展具有高度异质性。急性肾损伤(AKI)住院率正在上升,尤其是在老年人中。以往的急性肾损伤流行病学分析主要针对住院人群,这可能会使分析结果偏向于病情较重的人群。本研究探讨了AKI与肾衰竭替代疗法(KFRT)之间的关系,同时评估了年龄对这一关系的调节作用。研究设计回顾性队列研究.研究地点及范围; 参与者24,133名退伍军人,年龄至少65岁,2011年至2013年期间发生CKD四期.暴露AKI、AKI严重程度和年龄.结果KFRT和死亡.分析方法Fine-Gray竞争风险回归用于模拟AKI和KFRT事件,死亡为竞争风险。结果尽管AKI和KFRT之间的年龄交互作用不显著,但观察到AKI和年龄对KFRT事件有临床相关的联合影响。与无 AKI 的最大年龄组相比,65-74 岁的 AKI 患者发生 KFRT 的风险最高(亚分布 HR [sHR],14.9;95% CI,12.7-17.4),而至少 85 岁的 AKI 患者发生 KFRT 的风险最低(sHR,1.71;95% CI,1.22-2.39)。一旦退伍军人接受了 KFRT,他们的死亡风险就会增加 44%。在所有 AKI 严重程度分期中,KFRT 的风险都增加了 2 倍。局限性我们的研究缺乏普遍性,仅限于曾经使用过的药物,并使用住院患者的血清肌酐化验结果来定义 AKI 和 AKI 严重程度。这可能是因为在该人群中观察到的死亡频率较高(51.1%)。白话摘要老年人面临急性肾损伤(AKI)的风险,随后可能无法从 AKI 中恢复,导致长期透析。过去常常使用住院患者来研究 AKI。这可能会导致从病情较重的人群中推断出有偏差的结论。因此,我们建立了一个由 24,133 名至少 65 岁、患有慢性肾脏病 (CKD) 4 期的退伍军人组成的全国队列,以研究 AKI 与年龄和随后的肾衰替代治疗 (KFRT) 之间的关系。数据显示,AKI 和较年轻的年龄是发生 KFRT 的主要风险因素。至于年龄较大,似乎对 KFRT 有保护作用,但对死亡没有保护作用。这可能是由于在我们的队列中观察到的高死亡频率造成的。
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引用次数: 0
Factor B Inhibition with Iptacopan in Recurrent C3 Glomerulopathy Following Kidney Transplant: A Report of Two Cases 肾移植后复发性 C3 肾小球病中的 B 因子抑制与 Iptacopan:两个病例的报告
IF 3.9 Q2 Medicine Pub Date : 2024-04-12 DOI: 10.1016/j.xkme.2024.100823
Víctor J. Escudero-Saiz , Ángela Gonzalez , Adriana García-Herrera , Ana B. Larque , Andrew S. Bomback , Laura Morantes , Marta Martínez-Chillarón , Júlia Ollé , Elena Guillén , Marc Xipell , Alicia Molina-Andújar , Diana Rodríguez , Elena Cuadrado , Judit Cacho , Carolt Arana , Núria Esforzado , Carla Bastida , Esteban Poch , Fritz Diekman , David Cucchiari , Miquel Blasco

C3 glomerulopathy is a rare disease caused by fluid phase dysregulation of the alternative complement pathway. Currently, treatment depends on clinical and histological severity and includes nephroprotection, unspecific immunosuppression, and terminal complement blockers (C5), without having an etiological treatment approved. C3 glomerulopathy has high recurrence rates after kidney transplantation with a high risk of graft loss. Fortunately, new molecules are being developed that specifically target the proximal alternative complement pathway, such as iptacopan, a factor B inhibitor that showed promising results in native kidneys and cases of transplant recurrence in a phase 2 clinical trial. We present 2 “real-world” cases of C3 glomerulopathy recurrence in kidney allografts treated with iptacopan, with initial excellent clinical response and safety profile, especially with early introduction. We also present follow-up biopsies that showed no C3 deposition during factor B inhibition. Our cases suggest that proximal blockade of the alternative complement pathway can be effective and safe in the treatment of C3 glomerulopathy recurrence in kidney transplantation, bringing other questions such as dual blockade (eg, in C3 and C5), the optimal patient profile to benefit from factor B inhibition or treatment duration and its potential use in other forms of membranoproliferative glomerulonephritis (eg, immune complex-mediated).

C3 肾小球病是一种罕见的疾病,由替代性补体途径的液相失调引起。目前,治疗方法取决于临床和组织学的严重程度,包括肾保护、非特异性免疫抑制和末端补体阻断剂(C5),但尚未批准病因治疗方法。C3 肾小球病在肾移植后的复发率很高,移植物丢失的风险也很高。幸运的是,目前正在开发专门针对近端替代补体途径的新分子,例如 B 因子抑制剂 iptacopan,在一项二期临床试验中,它在原生肾脏和移植复发病例中显示出良好的效果。我们介绍了两例接受伊帕考潘治疗的异体肾脏C3肾小球病复发的 "真实世界 "病例,这些病例最初的临床反应和安全性都非常好,尤其是在早期使用的情况下。我们还介绍了随访活检结果,结果显示因子 B 抑制期间没有 C3 沉积。我们的病例表明,近端阻断替代补体途径可有效、安全地治疗肾移植中的C3肾小球病复发,这也带来了其他问题,如双重阻断(如C3和C5)、从因子B抑制中获益的最佳患者情况或治疗持续时间,以及在其他形式的膜增生性肾小球肾炎(如免疫复合物介导的肾小球肾炎)中的潜在应用。
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引用次数: 0
Pretransplant Treatment to Avoid Recurrent Membranous Nephropathy in a Kidney Transplant Recipient: A Case Report 避免肾移植受者复发膜性肾病的移植前治疗:病例报告
IF 3.9 Q2 Medicine Pub Date : 2024-04-12 DOI: 10.1016/j.xkme.2024.100822
Erik L. Lum , Jonathan E. Zuckerman , Lama Abdelnour , Jennifer Terenzini , Gurbir Singh , Suphamai Bunnapradist

Kidney transplant candidates with high anti–M-type phospholipase A2 receptor antibody activity may be at increased risk for early postkidney transplant recurrence and allograft loss. Pretransplant treatment to induce serological remission may be warranted to improve allograft survival. In this case report, a patient seeking their third kidney transplant, who lost 2 prior living donor transplants from early recurrent membranous nephropathy, underwent pretransplant treatment for membranous nephropathy with serological remission and no evidence of recurrent disease.

抗 M 型磷脂酶 A2 受体抗体活性较高的肾移植候选者可能会增加肾移植后早期复发和异体移植损失的风险。可能需要进行移植前治疗以诱导血清学缓解,从而提高异体移植的存活率。在本病例报告中,一名寻求第三次肾移植的患者曾因早期复发性膜性肾病而失去两次活体移植机会,在接受移植前膜性肾病治疗后血清学缓解,且无复发迹象。
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引用次数: 0
23NaMRI Assessed Cyst Sodium Concentration in Polycystic Kidney Disease to Identify Cyst Metabolic Activity: A Proof of Concept Study 23NaMRI 评估多囊肾患者的囊钠浓度以确定囊代谢活动:概念验证研究
IF 3.9 Q2 Medicine Pub Date : 2024-04-11 DOI: 10.1016/j.xkme.2024.100820
Sandrine Lemoine MD, PhD , Alireza Akbari PhD , Christopher W. McIntyre MD, PhD
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引用次数: 0
The Importance of Recognizing Pain in Patients With Autosomal Dominant Polycystic Kidney Disease 认识常染色体显性遗传多囊肾患者疼痛的重要性
IF 3.9 Q2 Medicine Pub Date : 2024-04-09 DOI: 10.1016/j.xkme.2024.100821
Paul Geertsema , Ruud Stellema , Niek F. Casteleijn
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引用次数: 0
Deprescribing in Dialysis: Operationalizing “Less is More” Through a Multimodal Deprescribing Intervention 透析中的去处方:通过多模式去处方干预来实现 "少即是多"
IF 3.9 Q2 Medicine Pub Date : 2024-04-04 DOI: 10.1016/j.xkme.2024.100819
Madhusudan Vijayan , Dinushika Mohottige
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引用次数: 0
Measuring Albuminuria in Individuals With Obesity: Pitfalls of the Urinary Albumin-Creatinine Ratio 测量肥胖症患者的白蛋白尿:尿白蛋白-肌酐比值的误区
IF 3.9 Q2 Medicine Pub Date : 2024-04-01 DOI: 10.1016/j.xkme.2024.100804
Avry Chagnac , Allon N. Friedman

An increased urinary albumin excretion rate is an important early risk factor for chronic kidney disease and other major outcomes and is usually measured using the urinary albumin-creatinine ratio (ACR). Obesity is highly prevalent in the general and chronic kidney disease populations and is an independent risk factor for moderately increased albuminuria (henceforth, moderate albuminuria). In this review, we describe how the ACR was developed and used to define moderate albuminuria. We then investigate how biases related to urinary creatinine excretion are introduced into the ACR measurement and how the use of the 30-mg/g threshold decreases the performance of the test in populations with higher muscle mass, with a primary focus on why and how this occurs in the obese population. The discussion then raises several strategies that can be used to mitigate such bias. This review provides a comprehensive overview of the medical literature on the uses and limitations of ACR in individuals with obesity and critically assesses related issues. It also raises into question the widely accepted 30-mg/g threshold as universally adequate for the diagnosis of moderate albuminuria. The implications of our review are relevant for clinicians, epidemiologists, and clinical trialists.

尿白蛋白排泄率升高是慢性肾脏病和其他主要疾病的重要早期风险因素,通常采用尿白蛋白-肌酐比值(ACR)进行测量。肥胖在普通人群和慢性肾脏病人群中非常普遍,是白蛋白尿中度增加(以下简称中度白蛋白尿)的独立风险因素。在本综述中,我们将介绍 ACR 是如何制定并用于定义中度白蛋白尿的。然后,我们研究了与尿肌酐排泄有关的偏差是如何被引入 ACR 测量的,以及 30 毫克/克阈值的使用是如何降低肌肉质量较高人群的测试性能的,主要重点是肥胖人群出现这种情况的原因和方式。讨论随后提出了几种可用于减轻这种偏差的策略。本综述全面概述了有关 ACR 在肥胖症患者中的应用和局限性的医学文献,并对相关问题进行了批判性评估。它还对普遍接受的 30 毫克/克阈值作为诊断中度白蛋白尿的标准提出了质疑。我们的综述对临床医生、流行病学家和临床试验专家具有重要意义。
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引用次数: 0
External Validation of the Kidney Failure Risk Equation Among Urban Community-Based Chinese Patients With CKD 中国城市社区慢性肾病患者肾衰竭风险方程的外部验证
IF 3.9 Q2 Medicine Pub Date : 2024-03-26 DOI: 10.1016/j.xkme.2024.100817
Ling Pan , Jinwei Wang , Yang Deng , Yexiang Sun , Zhenyu Nie , Xiaoyu Sun , Chao Yang , Guohui Ding , Ming-Hui Zhao , Yunhua Liao , Luxia Zhang

Rationale & Objective

The Kidney Failure Risk Equations have been proven to perform well in multinational databases, whereas validation in Asian populations is lacking. This study sought to externally validate the equations in a community-based chronic kidney disease cohort in China.

Study Design

A retrospective cohort study.

Setting & Participants

Patients with and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 dwelling in an industrialized coastal city of China.

Exposure

Age, sex, eGFR, and albuminuria were included in the 4-variable model, whereas serum calcium, phosphate, bicarbonate, and albumin levels were added to the previously noted variables in the 8-variable model.

Outcome

Initiation of long-term dialysis treatment.

Analytical Approach

Model discrimination, calibration, and clinical utility were evaluated by Harrell’s C statistic, calibration plots, and decision curve analysis, respectively.

Results

A total of 4,587 participants were enrolled for validation of the 4-variable model, whereas 1,414 were enrolled for the 8-variable model. The median times of follow-up were 4.0 (interquartile range: 2.6-6.3) years for the 4-variable model and 3.4 (2.2-5.6) years for the 8-variable model. For the 4-variable model, the C statistics were 0.750 (95% CI: 0.615-0.885) for the 2-year model and 0.766 (0.625-0.907) for the 5-year model, whereas the values were 0.756 (0.629-0.883) and 0.774 (0.641-0.907), respectively, for the 8-variable model. Calibration was acceptable for both the 4-variable and 8-variable models. Decision curve analysis for the models at the 5-year scale performed better throughout different net benefit thresholds than the eGFR-based (<30 mL/min/1.73 m2) strategy.

Limitations

A large proportion of patients lack albuminuria measurements, and only a subset of population could provide complete data for the 8-variable equation.

Conclusions

The kidney failure risk equations showed acceptable discrimination and calibration and better clinical utility than the eGFR-based strategy for incidence of kidney failure among community-based urban Chinese patients with chronic kidney disease.

Plain-Language Summary

Accurate and reliable risk evaluation of chronic kidney disease (CKD) prognosis can be helpful for physicians to make decisions concerning treatment opportunity and therapeutic strategy. The kidney failure risk equation is an outstanding model for predicting risk of kidney failure among patients with CKD. However, the equation is lacking validation among Chinese populations. In the current study, we demonstrated that the equation had good discrimination among an urban community-based cohort of patients with

理论依据和目的肾衰竭风险方程在跨国数据库中已被证明表现良好,但在亚洲人群中却缺乏验证。本研究试图在中国一个基于社区的慢性肾脏病队列中对该方程进行外部验证。暴露年龄、性别、eGFR 和白蛋白尿被纳入 4 变量模型,而血清钙、磷酸盐、碳酸氢盐和白蛋白水平被添加到 8 变量模型中。结果开始长期透析治疗。分析方法通过哈雷尔 C 统计量、校准图和决策曲线分析分别评估了模型的区分度、校准度和临床实用性。4 变量模型的中位随访时间为 4.0 年(四分位间范围:2.6-6.3),8 变量模型的中位随访时间为 3.4 年(2.2-5.6)。在 4 变量模型中,2 年模型的 C 统计量为 0.750(95% CI:0.615-0.885),5 年模型的 C 统计量为 0.766(0.625-0.907),而 8 变量模型的 C 统计量分别为 0.756(0.629-0.883)和 0.774(0.641-0.907)。4 变量模型和 8 变量模型的校准结果均可接受。与基于 eGFR(30 mL/min/1.73 m2)的策略相比,这些模型在不同净获益阈值下的 5 年决策曲线分析效果更好。结论与基于 eGFR 的策略相比,肾衰竭风险方程对基于社区的中国城市慢性肾脏病患者肾衰竭发生率显示出可接受的区分度和校准性,以及更好的临床实用性。肾衰竭风险方程是预测 CKD 患者肾衰竭风险的杰出模型。然而,该方程在中国人群中缺乏验证。在本次研究中,我们证明了该方程在中国城市社区的 CKD 患者队列中具有良好的区分度。校准也是可以接受的。决策曲线分析也表明,该方程的表现优于传统的基于肾功能的策略。这些结果为利用肾衰竭风险方程得出的预测结果改善中国社区 CKD 患者的管理提供了依据。
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引用次数: 0
Kidney Replacement Therapy Use at End-of-Life Among Critically Ill Chinese and Non-Hispanic White Americans: A Single-Center Study 重症华裔和非西班牙裔美国白人临终前使用肾脏替代疗法的情况:一项单中心研究
IF 3.9 Q2 Medicine Pub Date : 2024-03-26 DOI: 10.1016/j.xkme.2024.100818
Seba Babroudi MD , Joshua Hyun Bin Whang BA , Avery C. Glover MD, MBA , Tamara Vesel MD , David A. Drew MD, MS
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引用次数: 0
期刊
Kidney Medicine
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