Pub Date : 2025-11-20DOI: 10.1016/j.xkme.2025.101190
Deborah H. Wilson , Avrey Hughes , Samantha Curriero , Sarah Szanton , Deidra C. Crews , Mara McAdams-DeMarco , Daniel C. Brennan , Melissa deCardi Hladek
<div><h3>Rationale & Objective</h3><div>There is a critical need for interventions that help improve outcomes for individuals requiring a kidney transplant but are waitlisted as inactive. We explored the perspectives of dialysis patients and clinicians to develop community aging in place-advancing better living for elders (CAPABLE)–transplant. CAPABLE utilizes a home-visiting registered nurse, occupational therapist, and handy worker who work with older adults to create action plans that change behaviors to improve safety, independence, and health.</div></div><div><h3>Study Design</h3><div>Qualitative semi-structured interviews.</div></div><div><h3>Setting & Participants</h3><div>Individuals treated with dialysis and inactive on the transplant list (n = 20) and transplant clinicians (n = 6) from an urban transplant center.</div></div><div><h3>Outcomes</h3><div>The adaptation of CAPABLE into CAPABLE-transplant.</div></div><div><h3>Analytical Approach</h3><div>Following Braun and Clark’s method of thematic analysis to inform intervention adaptation.</div></div><div><h3>Results</h3><div>Three major themes were identified: (1) mismatch of expectations with subthemes: communication keeps breaking down; high volume at center impedes follow-up; (2) agency: from fragmentation to functionality with subthemes: patient agency needs enhancing; digital literacy is key to improving communication capacity; preposttransplant education needs to be ongoing; (3) “You gotta keep climbing that mountain ‘till you reach the goal” with a subtheme of navigating compliance while struggling with symptom burden.</div></div><div><h3>Limitations</h3><div>A single-center perspective and small sample size.</div></div><div><h3>Conclusions</h3><div>By comparing the patient and clinician experience, specific adaptations for CAPABLE-transplant that address modifiable factors to decrease time inactive on the kidney transplant waitlist were identified. These included adding a digital literacy component to the home-visiting team to improve patient-clinician communication, ongoing education about the transplant process to improve health literacy, and activities to strengthen mental fortitude, self-efficacy, and agency. The core components of CAPABLE remain important to improve physical function, medication management, pain, and depressive symptoms. Patients and clinicians expressed support for CAPABLE-transplant to help improve self-efficacy, agency, and engagement along the transplant continuum.</div></div><div><h3>Plain-Language Summary</h3><div>People listed as inactive on the kidney transplant waitlist need interventions to decrease time listed as inactive. Qualitative interviews with dialysis patients and transplant clinicians identified areas of need that could be addressed by a home-based intervention. We used the data to adapt an existing intervention called community aging in place-advancing better living for elders (CAPABLE) into CAPABLE-transplant. Adding a digital l
{"title":"“You Gotta Keep Climbing That Mountain to Reach the Goal”: Perspectives of Transplant Waitlisted Dialysis Patients. A Qualitative Study","authors":"Deborah H. Wilson , Avrey Hughes , Samantha Curriero , Sarah Szanton , Deidra C. Crews , Mara McAdams-DeMarco , Daniel C. Brennan , Melissa deCardi Hladek","doi":"10.1016/j.xkme.2025.101190","DOIUrl":"10.1016/j.xkme.2025.101190","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>There is a critical need for interventions that help improve outcomes for individuals requiring a kidney transplant but are waitlisted as inactive. We explored the perspectives of dialysis patients and clinicians to develop community aging in place-advancing better living for elders (CAPABLE)–transplant. CAPABLE utilizes a home-visiting registered nurse, occupational therapist, and handy worker who work with older adults to create action plans that change behaviors to improve safety, independence, and health.</div></div><div><h3>Study Design</h3><div>Qualitative semi-structured interviews.</div></div><div><h3>Setting & Participants</h3><div>Individuals treated with dialysis and inactive on the transplant list (n = 20) and transplant clinicians (n = 6) from an urban transplant center.</div></div><div><h3>Outcomes</h3><div>The adaptation of CAPABLE into CAPABLE-transplant.</div></div><div><h3>Analytical Approach</h3><div>Following Braun and Clark’s method of thematic analysis to inform intervention adaptation.</div></div><div><h3>Results</h3><div>Three major themes were identified: (1) mismatch of expectations with subthemes: communication keeps breaking down; high volume at center impedes follow-up; (2) agency: from fragmentation to functionality with subthemes: patient agency needs enhancing; digital literacy is key to improving communication capacity; preposttransplant education needs to be ongoing; (3) “You gotta keep climbing that mountain ‘till you reach the goal” with a subtheme of navigating compliance while struggling with symptom burden.</div></div><div><h3>Limitations</h3><div>A single-center perspective and small sample size.</div></div><div><h3>Conclusions</h3><div>By comparing the patient and clinician experience, specific adaptations for CAPABLE-transplant that address modifiable factors to decrease time inactive on the kidney transplant waitlist were identified. These included adding a digital literacy component to the home-visiting team to improve patient-clinician communication, ongoing education about the transplant process to improve health literacy, and activities to strengthen mental fortitude, self-efficacy, and agency. The core components of CAPABLE remain important to improve physical function, medication management, pain, and depressive symptoms. Patients and clinicians expressed support for CAPABLE-transplant to help improve self-efficacy, agency, and engagement along the transplant continuum.</div></div><div><h3>Plain-Language Summary</h3><div>People listed as inactive on the kidney transplant waitlist need interventions to decrease time listed as inactive. Qualitative interviews with dialysis patients and transplant clinicians identified areas of need that could be addressed by a home-based intervention. We used the data to adapt an existing intervention called community aging in place-advancing better living for elders (CAPABLE) into CAPABLE-transplant. Adding a digital l","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101190"},"PeriodicalIF":3.4,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-19DOI: 10.1016/j.xkme.2025.101189
Ayman Al Jurdi , Abraham Cohen Bucay , Pitchaphon Nissaisorakarn , Hannah Gilligan , Claire T. Avillach , Veronica E. Klepeis , Rex N. Smith , Ragnar Palsson , Kassem Safa , Leonardo V. Riella
Immunoglobulin A (IgA) nephropathy is a common cause of kidney failure and can recur after kidney transplantation, increasing the risk of allograft loss. Effective treatments for recurrent IgA nephropathy in kidney transplant recipients are urgently needed. Iptacopan is a complement factor B inhibitor that received accelerated approval by the US Food and Drug Administration in August 2024 for the treatment of high-risk native IgA nephropathy based on trials that excluded transplant recipients. In this case series, we report our early experience with iptacopan in three individuals with biopsy-confirmed recurrent IgA nephropathy after kidney transplant. All received iptacopan for ≥3 months in combination with a short course of systemic corticosteroids. Two individuals demonstrated significant reductions in proteinuria and resolution of microscopic hematuria. One individual developed progressive graft dysfunction; repeat biopsy showed persistent active glomerulonephritis with codeposition of IgG, suggesting a more aggressive or atypical disease phenotype. These early data suggest that iptacopan, in combination with short-term corticosteroids, may offer therapeutic benefit in selected kidney transplant recipients with recurrent IgA nephropathy, warranting further investigation.
{"title":"Early Experience With Iptacopan for Recurrent IgA Nephropathy After Kidney Transplantation","authors":"Ayman Al Jurdi , Abraham Cohen Bucay , Pitchaphon Nissaisorakarn , Hannah Gilligan , Claire T. Avillach , Veronica E. Klepeis , Rex N. Smith , Ragnar Palsson , Kassem Safa , Leonardo V. Riella","doi":"10.1016/j.xkme.2025.101189","DOIUrl":"10.1016/j.xkme.2025.101189","url":null,"abstract":"<div><div>Immunoglobulin A (IgA) nephropathy is a common cause of kidney failure and can recur after kidney transplantation, increasing the risk of allograft loss. Effective treatments for recurrent IgA nephropathy in kidney transplant recipients are urgently needed. Iptacopan is a complement factor B inhibitor that received accelerated approval by the US Food and Drug Administration in August 2024 for the treatment of high-risk native IgA nephropathy based on trials that excluded transplant recipients. In this case series, we report our early experience with iptacopan in three individuals with biopsy-confirmed recurrent IgA nephropathy after kidney transplant. All received iptacopan for ≥3 months in combination with a short course of systemic corticosteroids. Two individuals demonstrated significant reductions in proteinuria and resolution of microscopic hematuria. One individual developed progressive graft dysfunction; repeat biopsy showed persistent active glomerulonephritis with codeposition of IgG, suggesting a more aggressive or atypical disease phenotype. These early data suggest that iptacopan, in combination with short-term corticosteroids, may offer therapeutic benefit in selected kidney transplant recipients with recurrent IgA nephropathy, warranting further investigation.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101189"},"PeriodicalIF":3.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1016/j.xkme.2025.101187
Octavio Rene García Flores , Mayra Eugenia Avilés Ramírez , Jose Carlos Gasca Aldama , Marco Vidals Sánchez , María Virgilia Soto Abraham , Martha Arisbeth Villanueva Pérez , Magdalena Madero , Enzo Vásquez Jiménez
In patients with mechanical ventilation or critically ill patients there are various mechanisms for kidney function impairment, ranging from systemic disease to intrinsic kidney etiology. Kidney biopsy is the study of choice for the diagnosis, treatment decision and prognosis of kidney disease. Ten critically ill patients on mechanical ventilation underwent kidney biopsy using 2 kidney biopsy techniques: the standard technique (prone position) in 5 patients and the lateral position (left lateral decubitus position) in 5 patients. Most of our patients had a kidney histological diagnosis secondary to autoimmune disease that required induction treatment. Despite the risk factors for complications, only one patient received a transfusion of packed red blood cells. The prone group had the highest number of deaths due to the severity of the patient’s disease and unrelated to the procedure. Kidney biopsy in patients with mechanical ventilation is a high-risk procedure that should be performed on selected patients who can benefit from a histological diagnosis.
{"title":"Kidney Biopsy in Patients With Mechanical Ventilation: A Report of Ten Cases","authors":"Octavio Rene García Flores , Mayra Eugenia Avilés Ramírez , Jose Carlos Gasca Aldama , Marco Vidals Sánchez , María Virgilia Soto Abraham , Martha Arisbeth Villanueva Pérez , Magdalena Madero , Enzo Vásquez Jiménez","doi":"10.1016/j.xkme.2025.101187","DOIUrl":"10.1016/j.xkme.2025.101187","url":null,"abstract":"<div><div>In patients with mechanical ventilation or critically ill patients there are various mechanisms for kidney function impairment, ranging from systemic disease to intrinsic kidney etiology. Kidney biopsy is the study of choice for the diagnosis, treatment decision and prognosis of kidney disease. Ten critically ill patients on mechanical ventilation underwent kidney biopsy using 2 kidney biopsy techniques: the standard technique (prone position) in 5 patients and the lateral position (left lateral decubitus position) in 5 patients. Most of our patients had a kidney histological diagnosis secondary to autoimmune disease that required induction treatment. Despite the risk factors for complications, only one patient received a transfusion of packed red blood cells. The prone group had the highest number of deaths due to the severity of the patient’s disease and unrelated to the procedure. Kidney biopsy in patients with mechanical ventilation is a high-risk procedure that should be performed on selected patients who can benefit from a histological diagnosis.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101187"},"PeriodicalIF":3.4,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146023168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 10.1016/j.xkme.2025.101186
Erin E. Tapper , Johanna M. Huusko , Alicia M. Scocchia , Kimberly Gall , Mary-Beth Roberts , Manuel Bernal-Quirós , Satu Valo , Inka Saarinen , Matias Rantanen , Tuuli Pietila , Massimiliano Gentile , Lotta Koskinen , Meenakshi Mahey Kumar , Samuel Myllykangas , Juha Koskenvuo
<div><h3>Rationale & Objective</h3><div>Mounting evidence supports that identifying the specific molecular etiology for individuals with cystic kidney disease (CyKD) is important for prognostication, surveillance, identifying related living donors, and defining familial risk, even in cases in which a clinical diagnosis appears straightforward. In this study, we aimed to investigate the yield of genetic findings and the unique variant characteristics using multigene panel testing (MGPT) in a referral laboratory setting for an unselected population of patients with an indication of CyKD.</div></div><div><h3>Study Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting & Participants</h3><div>A retrospective analysis of 1,235 genetic testing reports from patients with suspected CyKD who pursued MGPT was performed.</div></div><div><h3>Findings</h3><div>A positive result in a gene associated with CyKD was identified in 49.4% (610/1235) of patient reports, identifying 468 unique variants classified as pathogenic or likely pathogenic in 20 unique genes. Variants in <em>PKD1</em>, a gene complicated by homology to 6 different pseudogenes, contributed to 65.6% (400/610) of positive results. Copy number variants (CNVs) were identified in 9.5% (58/610) of positive results, with 30.4% (17/56) of deletions consisting of 4 exons or less. Variants of uncertain significance that were suspicious for being pathogenic (susVUS) were identified in 57.0% (94/165) of patients with inconclusive results.</div></div><div><h3>Limitations</h3><div>Genetic analysis was targeted to the genes included on the panel at the time of testing. As new evidence emerges supporting additional gene-disease associations, there is potential for additional positive results.</div></div><div><h3>Conclusions</h3><div>Thoughtful selection of carefully curated MGPT optimized to detect technically challenging variants can identify the molecular etiology in individuals presenting with CyKD. Further investigation of susVUS through segregation analysis in families may contribute to additional positive results.</div></div><div><h3>Plain-Language Summary</h3><div>Data informing the yield of multigene panel testing (MGPT) for individuals with cystic kidney disease (CyKD) is increasing. In this study, we retrospectively reviewed MGPT results from 1,235 individuals with suspected CyKD. A positive result in one of 20 CyKD-associated genes, including <em>PKD1</em>, was identified in 49.4% (610/1235) of patient reports. Copy number variants (CNVs) accounted for 9.5% (58/610) of positive results, with 30.4% (17/56) of deletions consisting of 4 exons or less. Suspicious variants of uncertain significance were identified in 57.0% (94/165) of patients with inconclusive results. MGPT can identify the molecular etiology of CyKD and, prior to ordering, should be carefully evaluated for relevant gene content, capabilities for technically challenging genes like <em>PKD1,</em> sensitivity to detect
{"title":"Results of Multigene Panel Testing, Including PKD1, in >1,200 Patients With Cystic Kidney Disease: A Retrospective Analysis","authors":"Erin E. Tapper , Johanna M. Huusko , Alicia M. Scocchia , Kimberly Gall , Mary-Beth Roberts , Manuel Bernal-Quirós , Satu Valo , Inka Saarinen , Matias Rantanen , Tuuli Pietila , Massimiliano Gentile , Lotta Koskinen , Meenakshi Mahey Kumar , Samuel Myllykangas , Juha Koskenvuo","doi":"10.1016/j.xkme.2025.101186","DOIUrl":"10.1016/j.xkme.2025.101186","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Mounting evidence supports that identifying the specific molecular etiology for individuals with cystic kidney disease (CyKD) is important for prognostication, surveillance, identifying related living donors, and defining familial risk, even in cases in which a clinical diagnosis appears straightforward. In this study, we aimed to investigate the yield of genetic findings and the unique variant characteristics using multigene panel testing (MGPT) in a referral laboratory setting for an unselected population of patients with an indication of CyKD.</div></div><div><h3>Study Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting & Participants</h3><div>A retrospective analysis of 1,235 genetic testing reports from patients with suspected CyKD who pursued MGPT was performed.</div></div><div><h3>Findings</h3><div>A positive result in a gene associated with CyKD was identified in 49.4% (610/1235) of patient reports, identifying 468 unique variants classified as pathogenic or likely pathogenic in 20 unique genes. Variants in <em>PKD1</em>, a gene complicated by homology to 6 different pseudogenes, contributed to 65.6% (400/610) of positive results. Copy number variants (CNVs) were identified in 9.5% (58/610) of positive results, with 30.4% (17/56) of deletions consisting of 4 exons or less. Variants of uncertain significance that were suspicious for being pathogenic (susVUS) were identified in 57.0% (94/165) of patients with inconclusive results.</div></div><div><h3>Limitations</h3><div>Genetic analysis was targeted to the genes included on the panel at the time of testing. As new evidence emerges supporting additional gene-disease associations, there is potential for additional positive results.</div></div><div><h3>Conclusions</h3><div>Thoughtful selection of carefully curated MGPT optimized to detect technically challenging variants can identify the molecular etiology in individuals presenting with CyKD. Further investigation of susVUS through segregation analysis in families may contribute to additional positive results.</div></div><div><h3>Plain-Language Summary</h3><div>Data informing the yield of multigene panel testing (MGPT) for individuals with cystic kidney disease (CyKD) is increasing. In this study, we retrospectively reviewed MGPT results from 1,235 individuals with suspected CyKD. A positive result in one of 20 CyKD-associated genes, including <em>PKD1</em>, was identified in 49.4% (610/1235) of patient reports. Copy number variants (CNVs) accounted for 9.5% (58/610) of positive results, with 30.4% (17/56) of deletions consisting of 4 exons or less. Suspicious variants of uncertain significance were identified in 57.0% (94/165) of patients with inconclusive results. MGPT can identify the molecular etiology of CyKD and, prior to ordering, should be carefully evaluated for relevant gene content, capabilities for technically challenging genes like <em>PKD1,</em> sensitivity to detect","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101186"},"PeriodicalIF":3.4,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 10.1016/j.xkme.2025.101182
Linna Wang, Miaomiao Yang, Lei Yan, Fengmin Shao
<div><h3>Rationale & Objective</h3><div>Idiopathic membranous nephropathy (IMN) is a major cause of nephrotic syndrome. Although rituximab has improved outcomes, resistance or intolerance occurs in a subset of patients. Zuberitamab, a chimeric anti-CD20 immunoglobulin G1 monoclonal antibody, may offer an alternative therapeutic option. This study aimed to evaluate the effectiveness and safety of zuberitamab in patients with phospholipase A2 receptor (PLA2R)–associated IMN.</div></div><div><h3>Study Design</h3><div>Single-center, retrospective observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Sixty patients with biopsy-proven or serologically diagnosed PLA2R-associated IMN were treated with zuberitamab at Henan Provincial People’s Hospital between July 2023 and June 2024. Thirty-five received zuberitamab as first-line therapy; 25 received it as second-line therapy following prior immunosuppressive treatment.</div></div><div><h3>Intervention(s)</h3><div>Zuberitamab infusions administered in 2-3 doses over several months, guided by B-cell kinetics.</div></div><div><h3>Outcomes</h3><div>The primary outcome was complete or partial remission of proteinuria at 3 and 6 months. Secondary outcomes included changes in serum albumin, serum creatinine, estimated glomerular filtration rate, CD19+ B cells, and anti-PLA2R antibody titers.</div></div><div><h3>Results</h3><div>At month 3, 80% (48/60) of patients achieved remission (5 complete and 43 partial). By month 6, 13 patients achieved complete remission (11 first line and 2 second line; <em>P</em> = 0.03), and 35 achieved partial remission. Serum albumin levels improved, whereas proteinuria and creatinine levels declined in both groups. At 6 months, PLA2R antibody < 2 RU/mL was seen in 90.9% (30/33) of first-line and 81.0% (17/21) of second-line patients (<em>P</em> = 0.29). No serious adverse events were observed.</div></div><div><h3>Limitations</h3><div>Single-center, retrospective design; short follow-up; no direct comparator group; incomplete biomarker data owing to testing limitations.</div></div><div><h3>Conclusions</h3><div>Zuberitamab was associated with favorable clinical and immunologic responses in patients with IMN, including those previously treated with rituximab. These findings support its potential role as a therapeutic option, warranting further validation in prospective studies.</div></div><div><h3>Plain-language Summary</h3><div>Membranous nephropathy is a kidney disease that often causes severe protein loss in the urine. While current treatments like rituximab can be effective, not all patients respond, and some relapse. We studied a newer treatment option called zuberitamab, a type of antibody therapy that also targets immune cells involved in this disease. We looked at 60 patients who received this treatment and tracked how they responded over time. Most patients improved, with many experiencing reduced protein levels and better kidney function.
{"title":"First-line and Second-line Therapy of Zuberitamab in Idiopathic Membranous Nephropathy: A Single-center Retrospective Study","authors":"Linna Wang, Miaomiao Yang, Lei Yan, Fengmin Shao","doi":"10.1016/j.xkme.2025.101182","DOIUrl":"10.1016/j.xkme.2025.101182","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Idiopathic membranous nephropathy (IMN) is a major cause of nephrotic syndrome. Although rituximab has improved outcomes, resistance or intolerance occurs in a subset of patients. Zuberitamab, a chimeric anti-CD20 immunoglobulin G1 monoclonal antibody, may offer an alternative therapeutic option. This study aimed to evaluate the effectiveness and safety of zuberitamab in patients with phospholipase A2 receptor (PLA2R)–associated IMN.</div></div><div><h3>Study Design</h3><div>Single-center, retrospective observational cohort study.</div></div><div><h3>Setting & Participants</h3><div>Sixty patients with biopsy-proven or serologically diagnosed PLA2R-associated IMN were treated with zuberitamab at Henan Provincial People’s Hospital between July 2023 and June 2024. Thirty-five received zuberitamab as first-line therapy; 25 received it as second-line therapy following prior immunosuppressive treatment.</div></div><div><h3>Intervention(s)</h3><div>Zuberitamab infusions administered in 2-3 doses over several months, guided by B-cell kinetics.</div></div><div><h3>Outcomes</h3><div>The primary outcome was complete or partial remission of proteinuria at 3 and 6 months. Secondary outcomes included changes in serum albumin, serum creatinine, estimated glomerular filtration rate, CD19+ B cells, and anti-PLA2R antibody titers.</div></div><div><h3>Results</h3><div>At month 3, 80% (48/60) of patients achieved remission (5 complete and 43 partial). By month 6, 13 patients achieved complete remission (11 first line and 2 second line; <em>P</em> = 0.03), and 35 achieved partial remission. Serum albumin levels improved, whereas proteinuria and creatinine levels declined in both groups. At 6 months, PLA2R antibody < 2 RU/mL was seen in 90.9% (30/33) of first-line and 81.0% (17/21) of second-line patients (<em>P</em> = 0.29). No serious adverse events were observed.</div></div><div><h3>Limitations</h3><div>Single-center, retrospective design; short follow-up; no direct comparator group; incomplete biomarker data owing to testing limitations.</div></div><div><h3>Conclusions</h3><div>Zuberitamab was associated with favorable clinical and immunologic responses in patients with IMN, including those previously treated with rituximab. These findings support its potential role as a therapeutic option, warranting further validation in prospective studies.</div></div><div><h3>Plain-language Summary</h3><div>Membranous nephropathy is a kidney disease that often causes severe protein loss in the urine. While current treatments like rituximab can be effective, not all patients respond, and some relapse. We studied a newer treatment option called zuberitamab, a type of antibody therapy that also targets immune cells involved in this disease. We looked at 60 patients who received this treatment and tracked how they responded over time. Most patients improved, with many experiencing reduced protein levels and better kidney function.","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101182"},"PeriodicalIF":3.4,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1016/j.xkme.2025.101183
Mineaki Kitamura MD, PhD , Pooya Zardoost DO , Anjali A. Satoskar MD
{"title":"Glomerular Disease in Patients With Acute Kidney Injury After Vancomycin Treatment—Need for Kidney Biopsy","authors":"Mineaki Kitamura MD, PhD , Pooya Zardoost DO , Anjali A. Satoskar MD","doi":"10.1016/j.xkme.2025.101183","DOIUrl":"10.1016/j.xkme.2025.101183","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101183"},"PeriodicalIF":3.4,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-10DOI: 10.1016/j.xkme.2025.101185
Christof Aigner , Zoltán Prohászka , Ágnes Szilágyi , Georg A. Böhmig , Klaus Arbeiter , Alice Schmidt , Gere Sunder-Plassmann
Complement mediated thrombotic microangiopathy (C-TMA) is a rare disease resulting in kidney failure and other organ manifestations. Current treatments include the complement C5 blockers eculizumab and ravulizumab as well as plasma therapy. We report on a young adult man with a long-standing history of genetic C-TMA (GC-TMA) because of a likely pathogenic missense variant in CFH. After several years without clinical signs of TMA and normal kidney function (CKD G1A2), without recent specific therapies, he presented with acute kidney injury, microangiopathic hemolysis, and nephrotic range proteinuria. Plasma therapy and ravulizumab failed to stop hemolysis, and he commenced kidney replacement therapy 11 days after admission. Laboratory analyses disclosed suboptimal complement inhibition and low free ravulizumab serum concentrations. Four weeks after admission, we started treatment with crovalimab, a novel humanized anti-C5 antibody. Hemolysis improved immediately and kidney function recovered after 3 months of dialysis treatment and improved continuously during 1 year of therapy with crovalimab. The excellent and rapid response to crovalimab potentially suggests that the engineering of crovalimab, facilitating also subcutaneous administration, may result in a different pharmacokinetic and pharmacodynamic profile of crovalimab as compared with standard C5 inhibitors in patient with nephrotic range proteinuria.
{"title":"Crovalimab Rescue Therapy in a Case With Genetic Complement Mediated Thrombotic Microangiopathy","authors":"Christof Aigner , Zoltán Prohászka , Ágnes Szilágyi , Georg A. Böhmig , Klaus Arbeiter , Alice Schmidt , Gere Sunder-Plassmann","doi":"10.1016/j.xkme.2025.101185","DOIUrl":"10.1016/j.xkme.2025.101185","url":null,"abstract":"<div><div>Complement mediated thrombotic microangiopathy (C-TMA) is a rare disease resulting in kidney failure and other organ manifestations. Current treatments include the complement C5 blockers eculizumab and ravulizumab as well as plasma therapy. We report on a young adult man with a long-standing history of genetic C-TMA (GC-TMA) because of a likely pathogenic missense variant in <em>CFH</em>. After several years without clinical signs of TMA and normal kidney function (CKD G1A2), without recent specific therapies, he presented with acute kidney injury, microangiopathic hemolysis, and nephrotic range proteinuria. Plasma therapy and ravulizumab failed to stop hemolysis, and he commenced kidney replacement therapy 11 days after admission. Laboratory analyses disclosed suboptimal complement inhibition and low free ravulizumab serum concentrations. Four weeks after admission, we started treatment with crovalimab, a novel humanized anti-C5 antibody. Hemolysis improved immediately and kidney function recovered after 3 months of dialysis treatment and improved continuously during 1 year of therapy with crovalimab. The excellent and rapid response to crovalimab potentially suggests that the engineering of crovalimab, facilitating also subcutaneous administration, may result in a different pharmacokinetic and pharmacodynamic profile of crovalimab as compared with standard C5 inhibitors in patient with nephrotic range proteinuria.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101185"},"PeriodicalIF":3.4,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1016/j.xkme.2025.101175
Léa Pessin , Mary K. Roberts , Avrum Gillespie , Catherine R. Butler , Andrea Corradi , Arinala Randrianasolo , Jonathan Daw
<div><h3>Rationale & Objective</h3><div>There are substantial racial/ethnic disparities in access to kidney replacement therapies (KRT). Although existing work often focuses on discrete treatment outcomes, a holistic depiction of racial/ethnic groups’ differential experiences requires a longitudinal approach.</div></div><div><h3>Study Design</h3><div>A sequence analysis in national registry data.</div></div><div><h3>Setting & Participants</h3><div>Adults aged 18-64 years with incident kidney failure in 2009 in the United States Renal Data System database.</div></div><div><h3>Exposure</h3><div>Race/ethnicity (non-Hispanic Asian American [Asian-NH], non-Hispanic African American or Black [Black-NH], Hispanic, and non-Hispanic White [White-NH]) and age group (18-44 years and 45-64 years).</div></div><div><h3>Outcome</h3><div>Ten-year KRT modality sequences (in-center dialysis, home dialysis, deceased donor kidney transplant [DDKT], living donor kidney transplant, stopped dialysis, and mortality).</div></div><div><h3>Analytical Approach</h3><div>Using sequence analysis, longitudinal KRT modalities were characterized using descriptive statistics and visualized with state distribution plots, stratified by race/ethnicity and age.</div></div><div><h3>Results</h3><div>The study included 50,776 adults with kidney failure (24% 18-44 years old and 76% 45-64 years old; 3.6% Asian-NH, 35.8% Black-NH, 17.7% Hispanic, and 42.9% White-NH). Among those aged 18-44, Hispanic and Asian-NH patients more frequently survived 10 years compared with Black-NH and White-NH patients. Among non-White patients, receipt of DDKT increased in years 4-6. Asian-NH patients had the highest DDKT receipt frequency. Asian-NH and White-NH patients more frequently experienced treatment sequences with 3 or more KRT modalities, and these sequences more commonly included transplant. Among patients initially receiving home dialysis, Asian-NH and White-NH patients more commonly transitioned to transplant compared with Black-NH and Hispanic patients. Compared with patients aged 18-44 years, racial/ethnic differences in KRT treatment sequences were attenuated among those aged 45-64 years.</div></div><div><h3>Limitations</h3><div>Descriptive analyses cannot identify causal mechanisms. Excluding patients missing KRT modality may limit generalizability.</div></div><div><h3>Conclusions</h3><div>Patterns in the KRT modality sequences offer a more nuanced view of racial/ethnic disparities in access to treatments for incident kidney failure.</div></div><div><h3>Plain-Language Summary</h3><div>Although much prior research has investigated racial/ethnic differences in kidney failure treatments, they typically focus on one outcome at a time instead of looking at a patient’s full treatment course. This project uses data from the United States Renal Data System to show patterns in patient history in kidney replacement therapies. Patterns in patient history for kidney replacement therapies are shown
{"title":"Kidney Replacement Therapy Sequences: Racial/Ethnic Disparities in End-Stage Kidney Disease Patients’ 10-Year Treatment Histories","authors":"Léa Pessin , Mary K. Roberts , Avrum Gillespie , Catherine R. Butler , Andrea Corradi , Arinala Randrianasolo , Jonathan Daw","doi":"10.1016/j.xkme.2025.101175","DOIUrl":"10.1016/j.xkme.2025.101175","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>There are substantial racial/ethnic disparities in access to kidney replacement therapies (KRT). Although existing work often focuses on discrete treatment outcomes, a holistic depiction of racial/ethnic groups’ differential experiences requires a longitudinal approach.</div></div><div><h3>Study Design</h3><div>A sequence analysis in national registry data.</div></div><div><h3>Setting & Participants</h3><div>Adults aged 18-64 years with incident kidney failure in 2009 in the United States Renal Data System database.</div></div><div><h3>Exposure</h3><div>Race/ethnicity (non-Hispanic Asian American [Asian-NH], non-Hispanic African American or Black [Black-NH], Hispanic, and non-Hispanic White [White-NH]) and age group (18-44 years and 45-64 years).</div></div><div><h3>Outcome</h3><div>Ten-year KRT modality sequences (in-center dialysis, home dialysis, deceased donor kidney transplant [DDKT], living donor kidney transplant, stopped dialysis, and mortality).</div></div><div><h3>Analytical Approach</h3><div>Using sequence analysis, longitudinal KRT modalities were characterized using descriptive statistics and visualized with state distribution plots, stratified by race/ethnicity and age.</div></div><div><h3>Results</h3><div>The study included 50,776 adults with kidney failure (24% 18-44 years old and 76% 45-64 years old; 3.6% Asian-NH, 35.8% Black-NH, 17.7% Hispanic, and 42.9% White-NH). Among those aged 18-44, Hispanic and Asian-NH patients more frequently survived 10 years compared with Black-NH and White-NH patients. Among non-White patients, receipt of DDKT increased in years 4-6. Asian-NH patients had the highest DDKT receipt frequency. Asian-NH and White-NH patients more frequently experienced treatment sequences with 3 or more KRT modalities, and these sequences more commonly included transplant. Among patients initially receiving home dialysis, Asian-NH and White-NH patients more commonly transitioned to transplant compared with Black-NH and Hispanic patients. Compared with patients aged 18-44 years, racial/ethnic differences in KRT treatment sequences were attenuated among those aged 45-64 years.</div></div><div><h3>Limitations</h3><div>Descriptive analyses cannot identify causal mechanisms. Excluding patients missing KRT modality may limit generalizability.</div></div><div><h3>Conclusions</h3><div>Patterns in the KRT modality sequences offer a more nuanced view of racial/ethnic disparities in access to treatments for incident kidney failure.</div></div><div><h3>Plain-Language Summary</h3><div>Although much prior research has investigated racial/ethnic differences in kidney failure treatments, they typically focus on one outcome at a time instead of looking at a patient’s full treatment course. This project uses data from the United States Renal Data System to show patterns in patient history in kidney replacement therapies. Patterns in patient history for kidney replacement therapies are shown","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 2","pages":"Article 101175"},"PeriodicalIF":3.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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