Nefrologia最新文献

Intoxicación por metformina: características clínicas, tratamiento y pronóstico 二甲双胍中毒：临床特征、治疗和预后

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2026-02-01 DOI: 10.1016/j.nefro.2025.501429

Isabel Galcerán Herrera , Clara Rosales Escorihuela , Silvia Collado Nieto , Mª Jesús López Casanova , Oriol Pallas Villaronga , Leire García Campo , Marta Crespo , August Supervía

Objectives

To identify potential severity predictive factors in patients with metformin intoxication (MI), defined as the need for renal replacement therapy (RRT) and/or patient death.

Methods

Retrospective observational study of patients who presented to the Emergency Department of Hospital del Mar in Barcelona and were diagnosed of MI between January 2010 and April 2024. Data were collected through medical record review.

Results

Seventy-two patients were included (43.1% men and 56.9% women), with an average age of 74.8 ± 10.9 years. We defined the primary end point as need for RRT and/or patient death. Fifty patients (69.4%) met the criteria for the primary end point, 39 needed RRT (54.2%) and 21 patients died (28%). Patients who met the primary end point had higher levels of creatinine (7.0 ± 3.2 vs 5.1 ± 3.6 mg/dl, p = 0.03, lactate (14.1 ± 7.3 vs 7.4 ± 4.1 mmol/l, p< 0.001) and gap anion (37.1 ± 11.5 vs 30.4 ± 9.8, p = 0.002), and lower levels of pH (7.02 ± 0.22 vs 7.17 ± 0.15, p = 0.005) and bicarbonate (8.8 ± 5.4 vs 12.7 ± 5.3, p = 0.005) at diagnosis. Metformin levels were determined in 52 patients (72.2%), being higher in patients who met the primary end point (20.1 [12.7-44.3] vs 8.4 [3.8-22.4] μg/ml, p = 0.05). Multivariate analysis identified that lactate levels at admission was the only predictive factor for the primary end point, with an area under the ROC curve of 0.78. The cut-off point for lactate as a predictor for the primary end point was established at ≥9.6 nmol/l, p = 0.01. Also, multivariate analysis identified that metformin levels at admission were a predictive factor for the need for RRT, with an area under the ROC curve of 0.75 and a cut-off point for metformin levels of ≥9.4 μg/ml, p = 0.002.

Conclusions

MI is a severe intoxication, with high mortality and need for RRT. In our study, the only predictive factor for the need of RRT and/or patient death was the level of lactate. Metformin levels at admission were related with the need for RRT.

目的确定二甲双胍中毒（MI）患者的潜在严重程度预测因素，定义为需要肾脏替代治疗（RRT）和/或患者死亡。方法回顾性观察研究2010年1月至2024年4月在巴塞罗那del Mar医院急诊科诊断为心肌梗死的患者。数据是通过病历审查收集的。结果纳入患者72例（男性43.1%，女性56.9%），平均年龄74.8±10.9岁。我们将主要终点定义为RRT的需要和/或患者死亡。50例患者（69.4%）符合主要终点标准，39例患者（54.2%）需要RRT， 21例患者死亡（28%）。达到主要终点的患者在诊断时肌酐（7.0±3.2 vs 5.1±3.6 mg/dl, p = 0.03）、乳酸（14.1±7.3 vs 7.4±4.1 mmol/l, p = 0.001）和间隙阴离子（37.1±11.5 vs 30.4±9.8,p = 0.002）水平较高，pH（7.02±0.22 vs 7.17±0.15,p = 0.005）和碳酸氢盐（8.8±5.4 vs 12.7±5.3,p = 0.005）水平较低。52例患者（72.2%）检测到二甲双胍水平，达到主要终点的患者二甲双胍水平较高（20.1 [12.7-44.3]vs 8.4 [3.8-22.4] μg/ml, p = 0.05）。多因素分析发现，入院时乳酸水平是主要终点的唯一预测因素，ROC曲线下面积为0.78。乳酸作为主要终点预测因子的临界值为≥9.6 nmol/l, p = 0.01。此外，多因素分析发现，入院时二甲双胍水平是RRT需求的预测因素，ROC曲线下面积为0.75，二甲双胍水平≥9.4 μg/ml的截断点，p = 0.002。结论smi是一种严重的中毒，死亡率高，需要RRT治疗。在我们的研究中，需要RRT和/或患者死亡的唯一预测因素是乳酸水平。入院时二甲双胍水平与RRT的需要有关。

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引用次数: 0

Impact of intravenous ferric carboxymaltose on physical performance and patient-reported outcomes in elderly patients with non-dialysis CKD, mild anemia, and iron deficiency: A pilot study 静脉注射羧麦芽糖铁对非透析慢性肾病、轻度贫血和缺铁的老年患者的身体表现和患者报告的结果的影响：一项试点研究

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2026-02-01 DOI: 10.1016/j.nefro.2025.501418

Maria Jesús Puchades , Juan Casas , Julio Nuñez , Elena Gimenez-Civera , Boris Gonzales , Marco Montomoli , Rafael de la Espriella , Miguel Gonzalez-Rico , Isidro Torregrosa , Carlos J. Peña , Aleix Cases , Jose Luis Gorriz

Background

Iron deficiency (ID) is highly prevalent in chronic kidney disease (CKD) and it's associated with poorer quality of life (QoL) and functional capacity. Intravenous iron therapy is limited to CKD patients with ID and anemia to avoid/delay the need or reduce the dose of erythropoiesis-stimulating agents, according to guidelines. We hypothesized that treatment with IV iron in CKD patients with ID and borderline anemia may improve their physical performance and QoL, independently of its effects on hemoglobin.

Methods

Prospective, single-arm study in CKD patients with ID and mild anemia. The 6-min walk test (6-MWT), Piper fatigue scale, Patient's global assessment (PGA) and QoL (EQ-5D) questionnaires were evaluated at baseline, and at weeks 1 and 4 after receiving IV ferric carboxymaltose. Changes in continuous endpoints and their longitudinal trajectories were estimated with linear mixed regression models (LMRMs).

Results

Forty-one patients completed the study. The 6-MWT increased from 296 ± 101 m to 314 ± 106 m at week 1 (p < 0.01), and to 325 ± 111 meters at week 4 (p < 0.01). PGA, EQ-5D questionnaire and Piper Fatigue scale significantly improved at week 4 from baseline (p < 0.05), after adjustment in the last 2 variables. Hemoglobin levels did not increase significantly during the follow-up.

Conclusions

IV ferric carboxymaltose (IV FCM) was associated with a significant short-term improvement in the 6-MWT in CKD patients with iron deficiency and mild anemia. PGA, EQ-5D and Piper Fatigue Scale also improved at 4 weeks. These findings suggest a potential short-term benefit of IV ferric carboxymaltose on physical performance and PROMs in this population, independent of hemoglobin changes; however, given the small sample size and absence of a control group, results should be interpreted with caution and considered hypothesis-generating.

背景：缺铁（ID）在慢性肾脏疾病（CKD）中非常普遍，并与较差的生活质量（QoL）和功能能力相关。根据指南，静脉铁治疗仅限于伴有ID和贫血的CKD患者，以避免/延迟对促红细胞生成药物的需要或减少剂量。我们假设静脉注射铁治疗合并ID和边缘性贫血的CKD患者可以改善他们的身体表现和生活质量，独立于其对血红蛋白的影响。方法前瞻性单臂研究CKD合并ID和轻度贫血患者。6分钟步行测试（6-MWT）、Piper疲劳量表、患者整体评估（PGA）和生活质量（EQ-5D）问卷在基线、静脉注射三羧基麦糖铁后的第1周和第4周进行评估。用线性混合回归模型（LMRMs）估计连续终点及其纵向轨迹的变化。结果41例患者完成了研究。6-MWT从第1周的296±101 m增加到314±106 m (p < 0.01)，第4周增加到325±111 m （p < 0.01）。PGA、EQ-5D问卷和Piper疲劳量表在第4周较基线显著改善（p < 0.05）。在随访期间，血红蛋白水平没有显著升高。结论IV型羧麦芽糖铁（IV FCM）可显著改善缺铁和轻度贫血的CKD患者的6-MWT。PGA、EQ-5D和Piper疲劳量表在4周时也有所改善。这些发现表明，静脉注射三羧基麦芽糖铁对这一人群的身体机能和PROMs有潜在的短期益处，与血红蛋白的变化无关；然而，考虑到小样本量和缺乏对照组，结果应谨慎解释，并考虑到假设产生。

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引用次数: 0

Registro de aféresis terapéutica de la Sociedad Española de Nefrología. Análisis de la actividad en los últimos 5 años 西班牙肾脏学会治疗性非专利药注册。过去5年的活动分析

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2026-02-01 DOI: 10.1016/j.nefro.2025.501413

E. Rodríguez , L. Sánchez-Cámara , E. Márquez , A. Herreros , S. Benito , M. Fernández-Lucas , M.V. Rubio , R. Franquelo , R. Escaño , N. Ramos , E. Tamarit , J.M. Benlliure , O. Siverio , M.I. Gallardo , M.P. Valenzuela , E. Davin , N. Martín-Alemany , L.M. Cueto , M.T. Padrón , M.T. Rodrigo de Tomás , D. Barraca

Introduction

Therapeutic apheresis (TA) is an extracorporeal technique used to treat various renal and non-renal pathologies, for which the ASFA guidelines provide recommendations. In Spain, nephrology services have progressively adopted various forms of TA, and since 2018, the Spanish Society of Nephrology (SEN) has maintained a national TA registry to monitor its use.

Objective

To describe the activity of nephrology services participating in the TA registry of the SEN (AFT-SEN) between 2019 and 2023.

Material and methods

A descriptive observational study was conducted that included all treatments consecutively recorded in the AFT-SEN registry between 2019 and 2023. A total of 4,331 procedures performed on 525 patients across 19 nephrology services were analysed.

Results

The median age was 43.7 years, and 49.6% of patients were female. The main indications were neurological diseases (33%), renal diseases (22%), and metabolic diseases (19.6%). Sixty percent of the procedures were performed for acute episodes and 40% in chronic programmes. The most commonly used technique was plasma exchange (72.2%), followed by double filtration (19.7%). Adverse effects occurred in 7% of sessions, primarily hypotension and vascular access issues.

Conclusions

The AFT-SEN registry represents the first multicentre initiative in Spanish nephrology. The data demonstrate the expansion and diversification of TA techniques and the implementation of chronic programmes. They also show that TA is being integrated into clinical nephrology practice, with an acceptable safety profile.

导读：治疗性采血（TA）是一种体外技术，用于治疗各种肾脏和非肾脏疾病，ASFA指南对此提供了建议。在西班牙，肾脏病服务已逐步采用各种形式的TA，自2018年以来，西班牙肾脏病学会（SEN）维持了一个国家TA登记处，以监测其使用情况。目的了解2019年至2023年肾脏科服务机构参与临床肾健康评估（AFT-SEN） TA登记的活动情况。材料和方法进行了一项描述性观察性研究，纳入了2019年至2023年期间连续记录在AFT-SEN登记处的所有治疗。共分析了19个肾科服务部门525名患者的4331例手术。结果患者中位年龄为43.7岁，女性占49.6%。主要适应证为神经系统疾病（33%）、肾脏疾病（22%）、代谢性疾病（19.6%）。60%的手术用于急性发作，40%用于慢性发作。最常用的技术是血浆置换（72.2%），其次是双重过滤（19.7%）。7%的疗程发生不良反应，主要是低血压和血管通路问题。结论：AFT-SEN登记代表了西班牙肾病学的第一个多中心倡议。数据表明，技术咨询技术的扩展和多样化以及长期规划的实施。他们还表明，TA正被纳入临床肾脏病实践，具有可接受的安全性。

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引用次数: 0

Irisin and the kidney: Key points to know? 鸢尾素与肾：要点知道吗？

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2026-02-01 DOI: 10.1016/j.nefro.2025.501443

Danilo Candido de Almeida , Juan Sebastian Henao Agudelo

Irisin, a myokine generated through the proteolytic cleavage of fibronectin type III domain-containing protein 5 (FNDC5), has been increasingly recognized as a critical mediator of the salutary effects of physical exercise on metabolic homeostasis, energy metabolism, and the regulation of inflammatory, oxidative, and fibrotic pathways. Recent investigations have delineated a significant association between irisin levels and renal pathophysiology, particularly within the context of chronic kidney disease. Emerging evidence suggests that irisin may play a modulatory role in renal function, with particular relevance to diabetic nephropathy and acute kidney injury. Therefore, this mini-review consolidates current findings on the mechanistic underpinnings of irisin's involvement in renal pathophysiology, elucidating its intricate interplay with kidney disease. Additionally, we highlight the potential of irisin as a promising biomarker and therapeutic target in nephrology.

鸢尾素是一种通过纤维连接蛋白III型结构域蛋白5 （FNDC5）的蛋白水解裂解产生的肌因子，已被越来越多地认为是体育锻炼对代谢稳态、能量代谢以及炎症、氧化和纤维化途径调节的有益作用的关键介质。最近的研究已经描述了鸢尾素水平与肾脏病理生理之间的显著关联，特别是在慢性肾脏疾病的背景下。新的证据表明，鸢尾素可能在肾功能中起调节作用，特别是与糖尿病肾病和急性肾损伤有关。因此，这篇小型综述巩固了鸢尾素参与肾脏病理生理的机制基础的现有发现，阐明了鸢尾素与肾脏疾病的复杂相互作用。此外，我们强调鸢尾素作为一种有前途的生物标志物和肾病治疗靶点的潜力。

引用次数: 0

Kidney transplantation for the treatment of ESRD caused by hereditary type 2 Dent Nephropathy which carries a rare ORCL mutation 肾移植治疗遗传性2型凹陷肾病引起的ESRD，该肾病携带罕见的ORCL突变

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2026-02-01 DOI: 10.1016/j.nefro.2025.501415

Chuanyou Xia , Lingquan Meng , Guanbao Tang , Shuo Wang , Panpan Han , Xiaoming Zhang , Jianning Wang , Jiwei Yang

引用次数: 0

¿Cuál es el impacto clínico del uso de la ecuación EKFC en la estimación de filtrado glomerular por creatinina en pacientes trasplantados renales? 使用EKFC方程估计肌酐滤过肾小球对肾移植患者的临床影响是什么？

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2026-02-01 DOI: 10.1016/j.nefro.2025.501430

Miguel Martínez-Belotto, María José Ortega, Covadonga López del Moral, Rosalía Valero, Juan Carlos Ruiz, María de la Oliva Valentín, Emilio Rodrigo

Background and objective

Chronic kidney disease (CKD) is a prevalent condition, typically assessed using indirect markers such as estimated glomerular filtration rate (eGFR). The CKDEPI-2009 equation has been the most widely used estimation equation over the past decade. However, due to its limitations, alternative formulas aiming for greater accuracy compared to measured GFR (mGFR) have been developed. In 2020, the European Kidney Function Consortium (EKFC) validated a new, more precise equation covering the full age spectrum, which has been studied in various populations but remains underexplored in kidney transplant recipients. Our objectives were to evaluate the impact of changing estimation equations in this population, to measure comorbidity prediction and to check CKD reclassification.

Materials and methods

We conducted a retrospective observational study including all kidney transplant recipients at our center from 2006 to 2022 with graft survival greater than one year. We analyzed differences between CKD-EPI 2009 and EKFC across the entire cohort and within subgroups based on diabetes mellitus, sex, and age. We compared the prediction of CKD-related comorbidities, including anemia, acidosis, hyperkalemia, and hyperphosphatemia. We assessed concordance and reclassification across CKD stages based on KDIGO criteria.

Results

In a cohort of 616 kidney transplant recipients, EKFC and CKD-EPI 2009 showed a high correlation with excellent agreement across all subgroups (Intraclass Correlation Coefficient = 0.9945). EKFC provided significantly lower estimates than CKD-EPI 2009 (-0.2 mL/min/1.73 m²), particularly in CKD stages 1–3a, in women (-0.6 ml/min/1,73 m²), and in patients over 60 years (-1.4 mL/min/1.73 m²). Concordance in KDIGO staging was very good (weighted κ = 0.946). EKFC reclassified 6.5% of patients into a different CKD stage, mainly in earlier stages and more frequently in patients over 60. ROC curve analysis showed no clinically significant differences in predicting CKD-related comorbidities.

Conclusions

In kidney transplant recipients, EKFC and CKD-EPI 2009 show high correlation and are largely interchangeable. EKFC yields slightly lower eGFR values, particularly in women, older patients, and those with mild CKD, but the magnitude of these differences is small and of limited clinical relevance. These findings are consistent with the literature in this underrepresented population.

背景和目的慢性肾脏疾病（CKD）是一种普遍的疾病，通常使用间接标志物进行评估，如估计肾小球滤过率（eGFR）。CKDEPI-2009方程是过去十年中使用最广泛的估计方程。然而，由于其局限性，与测量的GFR （mGFR）相比，旨在提高精度的替代公式已经开发出来。2020年，欧洲肾功能联盟（EKFC）验证了一个新的、更精确的涵盖全年龄谱的方程，该方程已在不同人群中进行了研究，但在肾移植受者中仍未得到充分探索。我们的目的是评估改变估计方程对该人群的影响，测量合并症预测并检查CKD重分类。材料和方法我们进行了一项回顾性观察性研究，纳入了2006年至2022年在我们中心接受肾移植的所有移植生存期大于1年的患者。我们分析了CKD-EPI 2009和EKFC在整个队列和基于糖尿病、性别和年龄的亚组中的差异。我们比较了ckd相关合并症的预测，包括贫血、酸中毒、高钾血症和高磷血症。我们根据KDIGO标准评估CKD分期的一致性和再分类。结果在616例肾移植受者队列中，EKFC和CKD-EPI 2009在所有亚组中均表现出高度相关，一致性极好（类内相关系数= 0.9945）。EKFC提供的估计值明显低于CKD- epi 2009 (-0.2 mL/min/1.73 m2)，特别是在CKD 1 - 3a期，女性（-0.6 mL/min/1.73 m2）和60岁以上患者（-1.4 mL/min/1.73 m2）。KDIGO分期一致性很好（加权κ = 0.946）。EKFC将6.5%的患者重新分类为不同的CKD阶段，主要是早期阶段，60岁以上的患者更常见。ROC曲线分析显示在预测ckd相关合并症方面无临床显著差异。结论在肾移植受者中，EKFC与CKD-EPI 2009具有较高的相关性和互换性。EKFC产生的eGFR值略低，特别是在女性、老年患者和轻度CKD患者中，但这些差异的幅度很小，临床相关性有限。这些发现与这一未被充分代表的人群的文献一致。

{"title":"¿Cuál es el impacto clínico del uso de la ecuación EKFC en la estimación de filtrado glomerular por creatinina en pacientes trasplantados renales?","authors":"Miguel Martínez-Belotto, María José Ortega, Covadonga López del Moral, Rosalía Valero, Juan Carlos Ruiz, María de la Oliva Valentín, Emilio Rodrigo","doi":"10.1016/j.nefro.2025.501430","DOIUrl":"10.1016/j.nefro.2025.501430","url":null,"abstract":"<div><h3>Background and objective</h3><div>Chronic kidney disease (CKD) is a prevalent condition, typically assessed using indirect markers such as estimated glomerular filtration rate (eGFR). The CKDEPI-2009 equation has been the most widely used estimation equation over the past decade. However, due to its limitations, alternative formulas aiming for greater accuracy compared to measured GFR (mGFR) have been developed. In 2020, the European Kidney Function Consortium (EKFC) validated a new, more precise equation covering the full age spectrum, which has been studied in various populations but remains underexplored in kidney transplant recipients. Our objectives were to evaluate the impact of changing estimation equations in this population, to measure comorbidity prediction and to check CKD reclassification.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective observational study including all kidney transplant recipients at our center from 2006 to 2022 with graft survival greater than one year. We analyzed differences between CKD-EPI 2009 and EKFC across the entire cohort and within subgroups based on diabetes mellitus, sex, and age. We compared the prediction of CKD-related comorbidities, including anemia, acidosis, hyperkalemia, and hyperphosphatemia. We assessed concordance and reclassification across CKD stages based on KDIGO criteria.</div></div><div><h3>Results</h3><div>In a cohort of 616 kidney transplant recipients, EKFC and CKD-EPI 2009 showed a high correlation with excellent agreement across all subgroups (Intraclass Correlation Coefficient=0.9945). EKFC provided significantly lower estimates than CKD-EPI 2009 (-0.2mL/min/1.73 m<sup>2</sup>), particularly in CKD stages 1–3a, in women (-0.6ml/min/1,73m<sup>2</sup>), and in patients over 60 years (-1.4mL/min/1.73 m<sup>2</sup>). Concordance in KDIGO staging was very good (weighted κ=0.946). EKFC reclassified 6.5% of patients into a different CKD stage, mainly in earlier stages and more frequently in patients over 60. ROC curve analysis showed no clinically significant differences in predicting CKD-related comorbidities.</div></div><div><h3>Conclusions</h3><div>In kidney transplant recipients, EKFC and CKD-EPI 2009 show high correlation and are largely interchangeable. EKFC yields slightly lower eGFR values, particularly in women, older patients, and those with mild CKD, but the magnitude of these differences is small and of limited clinical relevance. These findings are consistent with the literature in this underrepresented population.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 2","pages":"Article 501430"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Eficacia de iptacopán en glomerulonefritis membranoproliferativa por inmunocomplejos idiopática refractaria al tratamiento convencional 依他他班对特发性免疫复合物引起的膜增生性肾小球肾炎的疗效

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2026-02-01 DOI: 10.1016/j.nefro.2025.501426

Raquel López Hidalgo , Mercedes Caba Molina , Francisco Javier Ruiz Escolano , Elena Delgado Sánchez de Murga , Ma Teresa Fernández Quirós , Ma José Espigares Huete

Membranoproliferative glomerulonephritis due to immune complexes (MPGN-IC) idiopathic is a diagnosis of exclusion, made after ruling out the most common etiological processes associated with this pattern of glomerular injury (infectious, autoimmune diseases, gammopathies, among others). Idiopathic MPGN-IC shares with C3 glomerulopathy the activation of the alternative complement pathway, often evidenced by decreased serum C3 levels.

Currently, there is no specific treatment for this type of glomerulonephritis; however, various immunosuppressive agents (such as prednisone, mycophenolate, cyclophosphamide, rituximab) have been used depending on the severity of the case.

We present a clinical case diagnosed with idiopathic MPGN-IC presenting as an aggressive nephritic-nephrotic syndrome with rapidly progressive renal deterioration unresponsive to conventional therapy, requiring hemodialysis. Complete remission was achieved after initiating treatment with iptacopan, an oral inhibitor of factor B of the alternative complement pathway, and we demonstrate the patient's evolution over 12 months of treatment.

由于免疫复合物引起的膜增生性肾小球肾炎（MPGN-IC）特发性是一种排除性诊断，在排除了与这种肾小球损伤模式（感染性、自身免疫性疾病、伽马病等）相关的最常见病因过程后做出。特发性MPGN-IC与C3肾小球病变共享替代补体途径的激活，通常由血清C3水平降低证明。目前，对于这种类型的肾小球肾炎没有特异性的治疗方法；然而，根据病情的严重程度，已经使用了各种免疫抑制剂（如强的松、霉酚酸盐、环磷酰胺、美罗华）。我们报告了一个临床病例，诊断为特发性MPGN-IC，表现为侵袭性肾病综合征，伴有快速进行性肾脏恶化，对常规治疗无反应，需要血液透析。iptacopan是一种口服补体途径的B因子抑制剂，在开始治疗后，患者获得了完全缓解，我们证明了患者在12个月的治疗过程中的演变。

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引用次数: 0

Tele-nephrology in practice: Economic impact and primary care perspectives 远程肾脏病学的实践：经济影响和初级保健的观点

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2026-02-01 DOI: 10.1016/j.nefro.2025.501432

Sofia Sousa , Sofia Santos , Beatriz Braga , Ana Cunha , Idalina Beirão

Aims

Telemedicine used in nephrology has demonstrated non-inferiority to traditional care and acceptance by healthcare professionals and patients; however, cost effectiveness was less commonly reported. We aim to describe our centre's experience with virtual consultations (VCs) and estimate cost reduction, as well as assess general practitioners’ (GPs) perspectives.

Methods

Retrospective study of the patients referred for VC between January 2020 and December 2022 at Unidade Local de Saúde de Santo António (ULSSA). We analyzed patients’ demographics, including distance to hospital and autonomy, and estimated economic savings related to nephrologist's time, patient transport and lost workdays. To assess GPs’ perspective, we administered a brief, closed-question survey to GPs to assess awareness, use, and satisfaction with VCs.

Results

A total of 456 patients were included, of which 260 (57%) were female and median age was 80 years old (IQR 72–87). Distance from the hospital varied between one and 540 km, with a median distance of 16 km (IQR 6–19). Estimated total savings were €16,697.89, equivalent to €36.62 per patient per consult. The nephrologist time cost was estimated at €966.11 for virtual consultations compared with €3622.92 for initial face-to-face consultations, resulting in a time-related cost reduction of €2656.81. Forty-seven GPs of a total of 236 GPs (20%) completed the survey; from the responders, 28% had used VCs and 77% reported satisfaction with the response. Prescription guidance was the most identified strength of VC. Lack of awareness was the main barrier to use.

Conclusions

In this single-center experience, VCs reduced costs and travel burden while being acceptable to GPs. However, many GPs were unaware of this pathway, underscoring the need for promotion and integration in primary-care workflows. Future multicentre studies should evaluate clinical outcomes including avoidable face-to-face visits, hospitalizations, time to advice) and include patient and nephrologist perspective.

aimsteledicine在肾脏病学中的应用已被证明优于传统护理，并被医疗保健专业人员和患者所接受；然而，成本效益的报告较少。我们的目标是描述我们中心的经验与虚拟咨询（vc）和估计成本降低，以及评估全科医生（全科医生）的观点。方法回顾性研究2020年1月至2022年12月在Unidade Local de Saúde de Santo António （ULSSA）转诊的VC患者。我们分析了患者的人口统计数据，包括到医院的距离和自主权，并估计了与肾脏科医生的时间、患者的运输和损失的工作日相关的经济节约。为了评估全科医生的观点，我们对全科医生进行了一项简短的封闭式调查，以评估对风险投资的认识、使用和满意度。结果共纳入456例患者，其中女性260例（57%），中位年龄80岁（IQR 72 ~ 87）。到医院的距离从1公里到540公里不等，中间距离为16公里（IQR 6-19）。估计总节省为16,697.89欧元，相当于每位患者每次咨询36.62欧元。虚拟咨询的肾病专家时间成本估计为966.11欧元，而初次面对面咨询的时间成本为3622.92欧元，与时间相关的成本减少了2656.81欧元。在236名全科医生中，有47名（20%）完成了调查；在回应者中，28%的人使用过风险投资，77%的人对回应表示满意。处方指导是VC最明显的优势。缺乏认识是使用的主要障碍。结论在这种单中心体验中，风险投资降低了成本和差旅负担，同时也为全科医生所接受。然而，许多全科医生不知道这一途径，强调了在初级保健工作流程中推广和整合的必要性。未来的多中心研究应评估临床结果（包括可避免的面对面访问、住院情况、咨询时间），并纳入患者和肾病专家的观点。

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引用次数: 0

Glomerulonefritis fibrilar: características clínico-patológicas y tratamiento en un centro terciario español 纤维性肾小球肾炎：西班牙三级机构的临床病理特征和治疗

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2026-02-01 DOI: 10.1016/j.nefro.2025.501417

Efraín Tatis , Natalia Ramos Terrades , María Alejandra Gabaldón , Irene Agraz , Marina López-Martinez , Sara Núñez-Delgado , Juan Carlos León , Néstor Toapanta , Sheila Bermejo , Oriol Bestard , María José Soler

Introduction

Fibrillary glomerulonephritis (FGN) has a poor prognosis and lacks standardized treatment. In this study, we describe clinicopathological characteristics, clinical course, and management of patients with FGN at our center.

Materials and methods

A retrospective cohort study of 13 patients diagnosed with FGN by positive DNAJB9 at kidney biopsy between 2019 and 2024. Demographic data, comorbidities, laboratory values, histopathological findings, and treatments were collected, Complete remission was defined as proteinuria < 500 mg/g with normal renal function; partial remission as >50% reduction in proteinuria to < 2000 mg/g with stable renal function; and no remission as absence of improvement, progression to end-stage kidney disease (ESKD), or death.

Results

The mean age was 61.4 years, 69,2% male, median proteinuria of 2318 mg/g (38% nephrotic range) and serum creatinine 1.64 mg/dL, Histopathological findings: 29% global glomerulosclerosis. The most frequent pattern was membranoproliferative (61.6%), followed by mesangial (30.8%) and membranous in 1 patient (7.7%), Hypoalbuminemia (<3 g/dL) was associated with worse prognosis (HR 6.52, P=.04); proteinuria >3500 mg/g and creatinine showed non-significant trends. Immunosuppression was given in 84.6% of patients: rituximab (RTX) (61.5%), RTX + mycophenolate (7.7%), sequential RTX followed by ocrelizumab and obinutuzumab (7.7%), and corticosteroids alone (7.7%). Partial remission was achieved in 30.8%, all within the exclusive RTX group, A total of 38.4% progressed to ESKD or death.

Conclusions

In our study, FGN showed poor prognosis and partial response to RTX. FGN with hypoalbuminemia had worse outcomes. Prospective studies and larger cohorts are needed to validate these findings and optimize its management.

纤维性肾小球肾炎（FGN）预后差，缺乏标准化治疗。在本研究中，我们描述了我们中心FGN患者的临床病理特征，临床病程和管理。材料与方法对2019年至2024年间13例经肾活检DNAJB9阳性诊断为FGN的患者进行回顾性队列研究。收集了患者的人口学资料、合并症、实验室值、组织病理学结果和治疗方法。完全缓解定义为蛋白尿≥500mg /g且肾功能正常；部分缓解，蛋白尿减少50%至2000 mg/g，肾功能稳定；无改善、进展为终末期肾病（ESKD）或死亡而无缓解。结果平均年龄61.4岁，男性69.2%，中位蛋白尿2318 mg/g（肾病范围38%），血清肌酐1.64 mg/dL，组织病理学表现：29%全球肾小球硬化。最常见的是膜增生性（61.6%），其次是系膜性（30.8%）和膜性（7.7%），低白蛋白血症（3 g/dL）与较差的预后相关（HR 6.52， P= 0.04）；蛋白尿3500 mg/g，肌酐无明显变化趋势。84.6%的患者给予免疫抑制：利妥昔单抗（RTX）（61.5%）， RTX +霉酚酸酯（7.7%），序贯RTX后奥克雷单抗和obinutuzumab(7.7%)，单独使用皮质类固醇（7.7%）。30.8%的患者部分缓解，全部在RTX组，总共38.4%的患者进展为ESKD或死亡。结论在我们的研究中，FGN预后较差，RTX部分有效。FGN伴低白蛋白血症的预后较差。需要前瞻性研究和更大的队列来验证这些发现并优化其管理。

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引用次数: 0

Micro/nanoplastics and kidney—Letter to the Editor 微/纳米塑料与肾脏——致编辑的信

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2026-02-01 DOI: 10.1016/j.nefro.2025.501407

Leonard Whye Kit Lim

引用次数: 0