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}
Pub Date : 2025-11-07DOI: 10.1016/j.xkme.2025.101174
Michael P. Toal , Christopher J. Hill , Michael P. Quinn , Emily P. McQuarrie , Charuhas V. Thakar , Ciaran O’Neill , Alexander P. Maxwell
<div><h3>Rationale & Objective</h3><div>There is substantial variation in kidney biopsy practices within and between countries; however, the reasons for this are unclear due to limited research among large diverse populations. The aim of this study was to explore variations in attitude to the indications and contraindications for native kidney biopsy in the United States (US).</div></div><div><h3>Study Design</h3><div>A case-vignette questionnaire was developed. A propensity-to-biopsy score (0-44) was generated from responses to indications and contraindications, with a higher score indicating an increased likelihood to recommend biopsy. Dissemination of the questionnaire occurred by email, social media, and the National Kidney Foundation.</div></div><div><h3>Setting & Participants</h3><div>A total of 295 nephrologists/fellows from 43 states within the US participated.</div></div><div><h3>Exposure</h3><div>All participants completed an identical questionnaire on kidney biopsy practice.</div></div><div><h3>Outcomes</h3><div>Responses were collected on indications, contraindications, and attitudes to biopsy.</div></div><div><h3>Analytical Approach</h3><div>Anonymized IP addresses were collected for comparison between US states. Data were also collected on the demographics of the individual and the type of institution in which the doctor was based.</div></div><div><h3>Results</h3><div>In an adjusted multiple linear regression analysis, higher propensity-to-biopsy scores were demonstrated in US clinicians who were male, younger and more frequent performers of kidney biopsy (<em>P</em> = 0.05). There were significant differences between the 18 US states with 5 or more participants (<em>P</em> < 0.001) with the mean propensity-to-biopsy score ranging from 20.3 (Wisconsin) to 29.2 (New Jersey and Virginia). Increased biopsy propensity was also observed in US states with higher nephrologist density and lower statewide deprivation (<em>P</em> = 0.006).</div></div><div><h3>Limitations</h3><div>The condensed clinical scenarios may not accurately replicate real-world cases, and clinicians opted in often using social media, so generalizability is limited.</div></div><div><h3>Conclusions</h3><div>Attitudes to kidney biopsy practice in the US are highly variable, and clinician or institutional characteristics do not fully explain these discrepancies. Further research is required to understand the factors that influence clinical decision making.</div></div><div><h3>Plain-Language Summary</h3><div>A kidney biopsy can be used to diagnose particular types of kidney disease; however, it exposes patients to a small risk of serious bleeding. A questionnaire was completed by kidney specialist doctors in the United States to determine when this test is best used. There were significant differences in attitudes between these doctors based on their sex, age, and state. States with less poverty and more specialist doctors were shown to have greater willingness t
{"title":"Variation in Attitudes to Native Kidney Biopsy Practice in the United States","authors":"Michael P. Toal , Christopher J. Hill , Michael P. Quinn , Emily P. McQuarrie , Charuhas V. Thakar , Ciaran O’Neill , Alexander P. Maxwell","doi":"10.1016/j.xkme.2025.101174","DOIUrl":"10.1016/j.xkme.2025.101174","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>There is substantial variation in kidney biopsy practices within and between countries; however, the reasons for this are unclear due to limited research among large diverse populations. The aim of this study was to explore variations in attitude to the indications and contraindications for native kidney biopsy in the United States (US).</div></div><div><h3>Study Design</h3><div>A case-vignette questionnaire was developed. A propensity-to-biopsy score (0-44) was generated from responses to indications and contraindications, with a higher score indicating an increased likelihood to recommend biopsy. Dissemination of the questionnaire occurred by email, social media, and the National Kidney Foundation.</div></div><div><h3>Setting & Participants</h3><div>A total of 295 nephrologists/fellows from 43 states within the US participated.</div></div><div><h3>Exposure</h3><div>All participants completed an identical questionnaire on kidney biopsy practice.</div></div><div><h3>Outcomes</h3><div>Responses were collected on indications, contraindications, and attitudes to biopsy.</div></div><div><h3>Analytical Approach</h3><div>Anonymized IP addresses were collected for comparison between US states. Data were also collected on the demographics of the individual and the type of institution in which the doctor was based.</div></div><div><h3>Results</h3><div>In an adjusted multiple linear regression analysis, higher propensity-to-biopsy scores were demonstrated in US clinicians who were male, younger and more frequent performers of kidney biopsy (<em>P</em> = 0.05). There were significant differences between the 18 US states with 5 or more participants (<em>P</em> < 0.001) with the mean propensity-to-biopsy score ranging from 20.3 (Wisconsin) to 29.2 (New Jersey and Virginia). Increased biopsy propensity was also observed in US states with higher nephrologist density and lower statewide deprivation (<em>P</em> = 0.006).</div></div><div><h3>Limitations</h3><div>The condensed clinical scenarios may not accurately replicate real-world cases, and clinicians opted in often using social media, so generalizability is limited.</div></div><div><h3>Conclusions</h3><div>Attitudes to kidney biopsy practice in the US are highly variable, and clinician or institutional characteristics do not fully explain these discrepancies. Further research is required to understand the factors that influence clinical decision making.</div></div><div><h3>Plain-Language Summary</h3><div>A kidney biopsy can be used to diagnose particular types of kidney disease; however, it exposes patients to a small risk of serious bleeding. A questionnaire was completed by kidney specialist doctors in the United States to determine when this test is best used. There were significant differences in attitudes between these doctors based on their sex, age, and state. States with less poverty and more specialist doctors were shown to have greater willingness t","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101174"},"PeriodicalIF":3.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787273","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.2025.101181
Bartholomeus T. van den Berge , Jitske Jansen , Quinty Leusink , Sanne Kleuskens , Sharon Bootsman , Anne-Els van de Logt , Coralien Vink , Jack FM. Wetzels , Bart Smeets , Rutger J. Maas
<div><h3>Rationale & Objective</h3><div>Clinical outcome of primary nephrotic syndrome (PNS) is highly variable, and predicting an individual patient’s treatment response remains difficult. PNS is characterized by means of podocyte injury and loss. We hypothesized that histologic parameters related to podocyte depletion predict treatment response.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>We analyzed biopsy tissue of 106 patients with PNS (minimal change disease, N = 26; focal segmental glomerulosclerosis, N = 21; and membranous nephropathy [MN], N = 59) and 9 controls. Minimal change disease and focal segmental glomerulosclerosis were considered manifestations of the same entity, defined as idiopathic nephrotic syndrome (iNS), and analyzed as one group. Patients’ baseline clinical and follow-up data were recorded. Kidney biopsies, stained for podocyte-specific and fibrosis markers, were quantitatively analyzed.</div></div><div><h3>Predictors</h3><div>Glomerular density, glomerulosclerosis, podocyte number, podocyte density, and cortical fibrosis.</div></div><div><h3>Outcomes</h3><div>Complete remission (CR) and delayed treatment response.</div></div><div><h3>Analytical Approach</h3><div>Odds ratios and receiver operating characteristic—the area under the curve (ROC-AUC) values identified predictors.</div></div><div><h3>Results</h3><div>In patients with iNS, the respective partial remission and CR rates were 29% and 60% during a median follow-up of 40 months. The majority of patients received high-dose corticosteroid treatment. Quantitation of cortical fibrosis had the highest discriminative power (ROC-AUC value, 0.79; 95% CI, 0.655-0.923) to predict CR. Other significant predictors included podocyte density, nonsclerotic glomerular density, and percentage of nonsclerotic glomeruli.</div><div>In patients with MN, respective partial remission and CR rates were 41% and 54% during a median follow-up of 50 months. The percentage of nonsclerotic glomeruli and nonsclerotic glomerular density were predictors for CR (patients receiving immunosuppressive treatment [ROC-AUC value, 0.71; 95% CI, 0.535-0.893]; patients receiving nonimmunosuppressive treatment alone [ROC-AUC value, 0.80; 95% CI, 0.584-1.000]).</div></div><div><h3>Limitations</h3><div>Relatively small cohorts prevented the use of covariates.</div></div><div><h3>Conclusions</h3><div>In patients with iNS, higher podocyte density and nonsclerotic glomerular density, and lower glomerulosclerosis and cortical fibrosis predicted CR. In patients with MN, lower glomerulosclerosis and higher nonsclerotic glomerular density predicted CR. Biopsy parameters may thus be useful for estimating proteinuria outcome.</div></div><div><h3>Plain-Language Summary</h3><div>Primary nephrotic syndrome (PNS) is characterized by podocyte injury and loss. According to the podocyte depletion hypothesis, the outcome of glomerular injury
{"title":"Biopsy Morphometrics as Predictors of Treatment Response in Primary Nephrotic Syndrome","authors":"Bartholomeus T. van den Berge , Jitske Jansen , Quinty Leusink , Sanne Kleuskens , Sharon Bootsman , Anne-Els van de Logt , Coralien Vink , Jack FM. Wetzels , Bart Smeets , Rutger J. Maas","doi":"10.1016/j.xkme.2025.101181","DOIUrl":"10.1016/j.xkme.2025.101181","url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Clinical outcome of primary nephrotic syndrome (PNS) is highly variable, and predicting an individual patient’s treatment response remains difficult. PNS is characterized by means of podocyte injury and loss. We hypothesized that histologic parameters related to podocyte depletion predict treatment response.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study.</div></div><div><h3>Setting & Participants</h3><div>We analyzed biopsy tissue of 106 patients with PNS (minimal change disease, N = 26; focal segmental glomerulosclerosis, N = 21; and membranous nephropathy [MN], N = 59) and 9 controls. Minimal change disease and focal segmental glomerulosclerosis were considered manifestations of the same entity, defined as idiopathic nephrotic syndrome (iNS), and analyzed as one group. Patients’ baseline clinical and follow-up data were recorded. Kidney biopsies, stained for podocyte-specific and fibrosis markers, were quantitatively analyzed.</div></div><div><h3>Predictors</h3><div>Glomerular density, glomerulosclerosis, podocyte number, podocyte density, and cortical fibrosis.</div></div><div><h3>Outcomes</h3><div>Complete remission (CR) and delayed treatment response.</div></div><div><h3>Analytical Approach</h3><div>Odds ratios and receiver operating characteristic—the area under the curve (ROC-AUC) values identified predictors.</div></div><div><h3>Results</h3><div>In patients with iNS, the respective partial remission and CR rates were 29% and 60% during a median follow-up of 40 months. The majority of patients received high-dose corticosteroid treatment. Quantitation of cortical fibrosis had the highest discriminative power (ROC-AUC value, 0.79; 95% CI, 0.655-0.923) to predict CR. Other significant predictors included podocyte density, nonsclerotic glomerular density, and percentage of nonsclerotic glomeruli.</div><div>In patients with MN, respective partial remission and CR rates were 41% and 54% during a median follow-up of 50 months. The percentage of nonsclerotic glomeruli and nonsclerotic glomerular density were predictors for CR (patients receiving immunosuppressive treatment [ROC-AUC value, 0.71; 95% CI, 0.535-0.893]; patients receiving nonimmunosuppressive treatment alone [ROC-AUC value, 0.80; 95% CI, 0.584-1.000]).</div></div><div><h3>Limitations</h3><div>Relatively small cohorts prevented the use of covariates.</div></div><div><h3>Conclusions</h3><div>In patients with iNS, higher podocyte density and nonsclerotic glomerular density, and lower glomerulosclerosis and cortical fibrosis predicted CR. In patients with MN, lower glomerulosclerosis and higher nonsclerotic glomerular density predicted CR. Biopsy parameters may thus be useful for estimating proteinuria outcome.</div></div><div><h3>Plain-Language Summary</h3><div>Primary nephrotic syndrome (PNS) is characterized by podocyte injury and loss. According to the podocyte depletion hypothesis, the outcome of glomerular injury","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101181"},"PeriodicalIF":3.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787456","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.2025.101179
Hoimonty Mazumder , Easter Protiva Gain , Monir Hossain Shimul , Faizah Farah , Naznin Alam , Xichen Mou , Fawaz Mzayek , Chunrong Jia , Matthew P. Smeltzer , Hongmei Zhang , Howard H. Chang , Robert Lowell Davis , Joshua S. Fu , Csaba P. Kovesdy , M. Mahbub Hossain , Abu Mohd Naser
<div><h3>Rationale & Objectives</h3><div>Extreme ambient temperatures have been associated with a higher risk of acute and chronic health outcomes, including cardiovascular, respiratory, infectious, and kidney diseases. However, there is a lack of synthesized comprehensive evidence regarding the association of ambient temperature and renal colic in existing literature.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis of epidemiological studies.</div></div><div><h3>Setting & Population</h3><div>Population of any geographic areas regardless of their age, sex/gender, ethnicity, or any other population characteristics.</div></div><div><h3>Selection Criteria for Studies</h3><div>We conducted literature searches in PubMed, Scopus, CINAHL complete, Web of Sciences, and additional sources until June 4, 2024, following the Population-Exposure-Comparator-Outcome (PECO) framework.</div></div><div><h3>Exposure</h3><div>Daily ambient temperature.</div></div><div><h3>Outcomes</h3><div>Confirmed cases of renal colic, including its underlying causes, such as kidney stone/nephrolithiasis or urolithiasis, urinary tract infection, and pyelonephritis, etc.</div></div><div><h3>Data Extraction</h3><div>Two investigators performed data extraction to ensure data consistency and quality.</div></div><div><h3>Analytical Approach</h3><div>Random-effects meta-analyses using the DerSimonian and Laird method.</div></div><div><h3>Results</h3><div>Of 982 initially retrieved articles, we included 26 articles in the systematic review, of which 23 were eligible for the heat effect meta-analysis and 7 were included in the cold effect meta-analysis. Despite high heterogeneity, the result showed a 2.4% higher risk of renal colic for 1°C higher daily ambient temperature (Cohen’s d, 0.013 [95% CI, 0.010-0.015]; RR, 1.024 [95% CI, 1.020-1.028]; <em>I</em><sup><em>2</em></sup>, 99.7%, <em>P</em> <0.001). For a 1 °C lower daily ambient temperature, the risk of renal colic was 1.5% (Cohen’s d, 0.008 [95% CI: –0.000 to 0.016]; RR, 1.015 [95% CI, 1.000-1.029]; <em>I</em><sup><em>2</em></sup>, 73.2%; <em>P</em> > 0.05), although not statistically significant.</div></div><div><h3>Limitations</h3><div>Limitations of this systematic review include high heterogeneity and publication bias.</div></div><div><h3>Conclusions</h3><div>Elevated daily ambient temperature is associated with the risk of renal colic, suggesting an adverse effect of high ambient temperature on kidney function.</div></div><div><h3>Registration</h3><div>PROSPERO registration number: CRD420245555</div></div><div><h3>Plain-language Summary</h3><div>Ambient temperature is a risk factor for acute kidney injury and chronic kidney disease but evidence on its role in renal colic has not been explored. We conducted a meta-analysis including 26 studies to evaluate the heat and cold effect of ambient temperature on renal colic risk. We found that high ambient temperature increases the risk of re
{"title":"Ambient Temperature and Risk of Renal Colic: A Systematic Review and Meta-analysis","authors":"Hoimonty Mazumder , Easter Protiva Gain , Monir Hossain Shimul , Faizah Farah , Naznin Alam , Xichen Mou , Fawaz Mzayek , Chunrong Jia , Matthew P. Smeltzer , Hongmei Zhang , Howard H. Chang , Robert Lowell Davis , Joshua S. Fu , Csaba P. Kovesdy , M. Mahbub Hossain , Abu Mohd Naser","doi":"10.1016/j.xkme.2025.101179","DOIUrl":"10.1016/j.xkme.2025.101179","url":null,"abstract":"<div><h3>Rationale & Objectives</h3><div>Extreme ambient temperatures have been associated with a higher risk of acute and chronic health outcomes, including cardiovascular, respiratory, infectious, and kidney diseases. However, there is a lack of synthesized comprehensive evidence regarding the association of ambient temperature and renal colic in existing literature.</div></div><div><h3>Study Design</h3><div>Systematic review and meta-analysis of epidemiological studies.</div></div><div><h3>Setting & Population</h3><div>Population of any geographic areas regardless of their age, sex/gender, ethnicity, or any other population characteristics.</div></div><div><h3>Selection Criteria for Studies</h3><div>We conducted literature searches in PubMed, Scopus, CINAHL complete, Web of Sciences, and additional sources until June 4, 2024, following the Population-Exposure-Comparator-Outcome (PECO) framework.</div></div><div><h3>Exposure</h3><div>Daily ambient temperature.</div></div><div><h3>Outcomes</h3><div>Confirmed cases of renal colic, including its underlying causes, such as kidney stone/nephrolithiasis or urolithiasis, urinary tract infection, and pyelonephritis, etc.</div></div><div><h3>Data Extraction</h3><div>Two investigators performed data extraction to ensure data consistency and quality.</div></div><div><h3>Analytical Approach</h3><div>Random-effects meta-analyses using the DerSimonian and Laird method.</div></div><div><h3>Results</h3><div>Of 982 initially retrieved articles, we included 26 articles in the systematic review, of which 23 were eligible for the heat effect meta-analysis and 7 were included in the cold effect meta-analysis. Despite high heterogeneity, the result showed a 2.4% higher risk of renal colic for 1°C higher daily ambient temperature (Cohen’s d, 0.013 [95% CI, 0.010-0.015]; RR, 1.024 [95% CI, 1.020-1.028]; <em>I</em><sup><em>2</em></sup>, 99.7%, <em>P</em> <0.001). For a 1 °C lower daily ambient temperature, the risk of renal colic was 1.5% (Cohen’s d, 0.008 [95% CI: –0.000 to 0.016]; RR, 1.015 [95% CI, 1.000-1.029]; <em>I</em><sup><em>2</em></sup>, 73.2%; <em>P</em> > 0.05), although not statistically significant.</div></div><div><h3>Limitations</h3><div>Limitations of this systematic review include high heterogeneity and publication bias.</div></div><div><h3>Conclusions</h3><div>Elevated daily ambient temperature is associated with the risk of renal colic, suggesting an adverse effect of high ambient temperature on kidney function.</div></div><div><h3>Registration</h3><div>PROSPERO registration number: CRD420245555</div></div><div><h3>Plain-language Summary</h3><div>Ambient temperature is a risk factor for acute kidney injury and chronic kidney disease but evidence on its role in renal colic has not been explored. We conducted a meta-analysis including 26 studies to evaluate the heat and cold effect of ambient temperature on renal colic risk. We found that high ambient temperature increases the risk of re","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101179"},"PeriodicalIF":3.4,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787288","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 : 2025-11-06DOI: 10.1016/j.xkme.2025.101176
Hyeran Park , Ji-Yun Song , Hae-Young Lopilly Park , Byung Ha Chung , Hanbi Lee
Fluctuations in intraocular pressure (IOP) during hemodialysis (HD) have been a challenging and troublesome issue, particularly in patients with impaired aqueous humor outflow. In this report, we present a case of a 72-year-old man receiving HD with a history of glaucoma who experienced worsening of IOP fluctuations during HD and subsequently achieved IOP stabilization after transitioning to peritoneal dialysis (PD). Despite medical management and surgical interventions, his IOP remained uncontrolled, and visual disturbances persisted. After the unsuccessful treatment, we considered PD as an alternative therapy owing to its theoretical potential to stabilize osmotic disequilibrium during HD. As a result, conversion to PD resulted in stabilization of IOP within normal ranges. However, the pre-existing visual damage remained irreversible. This report represents the first attempt to address IOP fluctuations by transitioning from HD to PD, offering an option for IOP regulation in patients receiving HD. Moreover, it underscores the need for early and proactive adjustments in dialysis treatment to preserve vision and quality of life.
{"title":"Peritoneal Dialysis Conversion as a Salvage Therapy for Refractory Intraocular Pressure Fluctuations During Hemodialysis in a Patient With End-Stage Kidney Disease","authors":"Hyeran Park , Ji-Yun Song , Hae-Young Lopilly Park , Byung Ha Chung , Hanbi Lee","doi":"10.1016/j.xkme.2025.101176","DOIUrl":"10.1016/j.xkme.2025.101176","url":null,"abstract":"<div><div>Fluctuations in intraocular pressure (IOP) during hemodialysis (HD) have been a challenging and troublesome issue, particularly in patients with impaired aqueous humor outflow. In this report, we present a case of a 72-year-old man receiving HD with a history of glaucoma who experienced worsening of IOP fluctuations during HD and subsequently achieved IOP stabilization after transitioning to peritoneal dialysis (PD). Despite medical management and surgical interventions, his IOP remained uncontrolled, and visual disturbances persisted. After the unsuccessful treatment, we considered PD as an alternative therapy owing to its theoretical potential to stabilize osmotic disequilibrium during HD. As a result, conversion to PD resulted in stabilization of IOP within normal ranges. However, the pre-existing visual damage remained irreversible. This report represents the first attempt to address IOP fluctuations by transitioning from HD to PD, offering an option for IOP regulation in patients receiving HD. Moreover, it underscores the need for early and proactive adjustments in dialysis treatment to preserve vision and quality of life.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101176"},"PeriodicalIF":3.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787333","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 : 2025-11-06DOI: 10.1016/j.xkme.2025.101177
Yuvaram N.V. Reddy MBBS, MPH , Sri Lekha Tummalapalli MD, MBA, MAS , Vishnu S. Potluri MD, MPH , Adam Mussell MA , Joel T. Adler MD, MPH , Amol S. Navathe MD, PhD
{"title":"Transplantation in Mandatory Kidney Payment Models: Understanding the Potential Influence of the ESRD Treatment Choices Model on the Increasing Organ Transplant Access Model","authors":"Yuvaram N.V. Reddy MBBS, MPH , Sri Lekha Tummalapalli MD, MBA, MAS , Vishnu S. Potluri MD, MPH , Adam Mussell MA , Joel T. Adler MD, MPH , Amol S. Navathe MD, PhD","doi":"10.1016/j.xkme.2025.101177","DOIUrl":"10.1016/j.xkme.2025.101177","url":null,"abstract":"","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"8 1","pages":"Article 101177"},"PeriodicalIF":3.4,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145787334","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：