Kidney involvement in mantle cell lymphoma is rare. We report a case of mantle cell lymphoma diagnosed after rapidly progressive glomerulonephritis with biopsy-proven paraneoplastic anti-neutrophil cytoplasmic antibody positive pauci-immune cresentic glomerulonephritis. Lymphoma treatment resulted in improved kidney function. This report demonstrates that pauci-immune cresentic glomerulonephritis can cause kidney impairment as the initial manifestation of mantle cell lymphoma. Physicians should be aware of the atypical presentations of the disease.
{"title":"ANCA positive pauci-immune glomerulonephritis as presenting feature of mantle cell lymphoma: A case report and review of literature","authors":"Gizem Kumru , Merve Yüksel , Yasemin Geriş , Emine Selin Yıldırım , Saba Kiremitci , Işınsu Kuzu , Önder Arslan","doi":"10.1016/j.nefro.2025.501363","DOIUrl":"10.1016/j.nefro.2025.501363","url":null,"abstract":"<div><div>Kidney involvement in mantle cell lymphoma is rare. We report a case of mantle cell lymphoma diagnosed after rapidly progressive glomerulonephritis with biopsy-proven paraneoplastic anti-neutrophil cytoplasmic antibody positive pauci-immune cresentic glomerulonephritis. Lymphoma treatment resulted in improved kidney function. This report demonstrates that pauci-immune cresentic glomerulonephritis can cause kidney impairment as the initial manifestation of mantle cell lymphoma. Physicians should be aware of the atypical presentations of the disease.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501363"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963283","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}
Pub Date : 2026-01-01DOI: 10.1016/j.nefro.2025.501416
Sebastián Jaurretche , Germán Perez , Norberto Antongiovanni , María Victoria del Rosal , María Luana Brajkovic , Fernando Perretta , Graciela Venera
Background
Vascular endothelial growth factor (VEGF) is associated with renal pathogenesis of Fabry disease (FD). Proteomic studies have demonstrated that circulating levels of VEGF are higher in young FD patients compared with controls and an overexpression of tissue VEGF in animal models of Fabry nephropathy has been reported. In kidneys, VEGF-A is predominantly produced by podocytes, and its action on endothelial dysfunction is known. An alternative VEGF-A isoform, VEGF-A165b, confers benefit in microvascular disease states, and it was studied in diabetic nephropathy having demonstrated a protective function, acting on the restoration of the podocyte glycol-calyx.
Methods
Cross-sectional design. Urinary mRNA was obtained by RT-qPCR.
Results
48 subjects were included; 24 FD patients (17F/7M – 23.7 ± 17.5 ys) and 24 healthy volunteers (17F/7M – 23.0 ± 17.0 ys). 12 adults and 12 pediatrics in both populations Median uACR (p = 0.999) and eGFR (p = 0.999) were similar between both groups. FD genotypes included were R301Q, R363H, R227Q, del3&4exon, L106R, E398X, L415P and C238Y; 15 FD patients were treatment naïve and 9 receiving ERT (agalsidase-β); median time of ERT was 15.6 ± 28.3 months. Comparative expression of urinary VEGF-165b-mRNA was higher among FD patients versus controls although without statistical significance (p = 0.369). No significant correlations were found between urinary VEGF-165b-mRNA and variables “Age” (p = 0.845), “Gender” (p = 0.369), “αGal-A” (p = 0.631), “Genotype” (p = 0.142), “Phenotype” (p = 0.898), “uACR” (p = 0.744), “eGFR” (p = 0.059) and “ERT or Naïve” (p = 0.507). A significant correlation between urinary VEGF-165b-mRNA and “time of ERT treatment” was found (p = 0.05).
Conclusion
Overexpression of urinary VEGF-165b-mRNA (with known renal cyto-protective effects) is a probable response to injury in FD nephropathy. The only variable correlated with the highest urinary expression of VEGF-165b-mRNA was the time of ERT treatment. Probably in patients with longer treatment time there is a decrease in FD damage. A limitation of the present work is the low sample size and cross-sectional design.
{"title":"Urinary VEGF-A165b mRNA expression in Fabry disease: Pilot study","authors":"Sebastián Jaurretche , Germán Perez , Norberto Antongiovanni , María Victoria del Rosal , María Luana Brajkovic , Fernando Perretta , Graciela Venera","doi":"10.1016/j.nefro.2025.501416","DOIUrl":"10.1016/j.nefro.2025.501416","url":null,"abstract":"<div><h3>Background</h3><div>Vascular endothelial growth factor (VEGF) is associated with renal pathogenesis of Fabry disease (FD). Proteomic studies have demonstrated that circulating levels of VEGF are higher in young FD patients compared with controls and an overexpression of tissue VEGF in animal models of Fabry nephropathy has been reported. In kidneys, VEGF-A is predominantly produced by podocytes, and its action on endothelial dysfunction is known. An alternative VEGF-A isoform, VEGF-A165b, confers benefit in microvascular disease states, and it was studied in diabetic nephropathy having demonstrated a protective function, acting on the restoration of the podocyte glycol-calyx.</div></div><div><h3>Methods</h3><div>Cross-sectional design. Urinary mRNA was obtained by RT-qPCR.</div></div><div><h3>Results</h3><div>48 subjects were included; 24 FD patients (17F/7M – 23.7<!--> <!-->±<!--> <!-->17.5 ys) and 24 healthy volunteers (17F/7M – 23.0<!--> <!-->±<!--> <!-->17.0 ys). 12 adults and 12 pediatrics in both populations Median uACR (<em>p</em> <!-->=<!--> <!-->0.999) and eGFR (<em>p</em> <!-->=<!--> <!-->0.999) were similar between both groups. FD genotypes included were R301Q, R363H, R227Q, del3&4exon, L106R, E398X, L415P and C238Y; 15 FD patients were treatment naïve and 9 receiving ERT (agalsidase-β); median time of ERT was 15.6<!--> <!-->±<!--> <!-->28.3 months. Comparative expression of urinary VEGF-165b-mRNA was higher among FD patients versus controls although without statistical significance (<em>p</em> <!-->=<!--> <!-->0.369). No significant correlations were found between urinary VEGF-165b-mRNA and variables “Age” (<em>p</em> <!-->=<!--> <!-->0.845), “Gender” (<em>p</em> <!-->=<!--> <!-->0.369), “αGal-A” (<em>p</em> <!-->=<!--> <!-->0.631), “Genotype” (<em>p</em> <!-->=<!--> <!-->0.142), “Phenotype” (<em>p</em> <!-->=<!--> <!-->0.898), “uACR” (<em>p</em> <!-->=<!--> <!-->0.744), “eGFR” (<em>p</em> <!-->=<!--> <!-->0.059) and “ERT or Naïve” (<em>p</em> <!-->=<!--> <!-->0.507). A significant correlation between urinary VEGF-165b-mRNA and “time of ERT treatment” was found (<em>p</em> <!-->=<!--> <!-->0.05).</div></div><div><h3>Conclusion</h3><div>Overexpression of urinary VEGF-165b-mRNA (with known renal cyto-protective effects) is a probable response to injury in FD nephropathy. The only variable correlated with the highest urinary expression of VEGF-165b-mRNA was the time of ERT treatment. Probably in patients with longer treatment time there is a decrease in FD damage. A limitation of the present work is the low sample size and cross-sectional design.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501416"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963285","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}
Pub Date : 2026-01-01DOI: 10.1016/j.nefro.2025.501360
Natàlia Ramos Terrades , Patrocinio Rodríguez Benítez , Jose Manuel Urbizu Gallardo , María de Valdenebro , Mercedes Salgueira , Alicia Molina Andujar , Judith Martins , Alejandra Ramos-Galí , Juan Antonio Moreno , Cristina de la Cuerda , Maria Jesus Lloret , David Menéndez , Isabel Acosta-Ochoa , Gregorio Romero-González , Esteban Poch , en representación del Grupo FRA de la SEN
{"title":"Documento de consenso para el diagnóstico y tratamiento de la insuficiencia renal aguda","authors":"Natàlia Ramos Terrades , Patrocinio Rodríguez Benítez , Jose Manuel Urbizu Gallardo , María de Valdenebro , Mercedes Salgueira , Alicia Molina Andujar , Judith Martins , Alejandra Ramos-Galí , Juan Antonio Moreno , Cristina de la Cuerda , Maria Jesus Lloret , David Menéndez , Isabel Acosta-Ochoa , Gregorio Romero-González , Esteban Poch , en representación del Grupo FRA de la SEN","doi":"10.1016/j.nefro.2025.501360","DOIUrl":"10.1016/j.nefro.2025.501360","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501360"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963286","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}
Pub Date : 2026-01-01DOI: 10.1016/j.nefro.2025.501393
Dolores Redondo-Pachón , Anna Bach-Pascual , Clara Amat-Fernandez , Betty Chamoun-Huacon , Olatz Garin , Yolanda Pardo , Erica Briones-Vozmediano , Esther Rubinat-Arnaldo , Marta Crespo-Barrio , Guillermo Pedreira-Robles , María José Pérez-Sáez
Background and objective
Patient-reported outcomes (PROMs) are key tools for advancing patient-centered clinical practice, with proven benefits for health outcomes. Their application has been extended to different chronic diseases, but there are few studies involving patients with chronic kidney disease (CKD), a population that is aging and frail. The aim of this study was to assess the relationship between frailty and self-reported health-related quality of life in patients with advanced CKD who are eligible for kidney transplantation (KT).
Material and methods
KT candidates who were evaluated in the outpatient clinic were included in the study. The PROMIS-29® and PROMIS-Global Health® questionnaires were administered, and T-scores were calculated for each domain. Frailty was assessed using the Fried scale, categorizing participants as frail/pre-frail if FRIED >0. Sociodemographic and clinical variables were also collected.
Results
139 KT candidates were included in the study: 32% were women, the mean age was 63.5 years, 43.9% were on dialysis, and 64.5% were frail. 71.2% responded to the administered PROMIS. Overall, KT candidates reported their mental health as good (48 ± 7.4) and their physical health as fair (42.8 ± 7.3). T-scores for anxiety, fatigue, social functioning, sleep disturbance, pain, and depression were within the normal range compared to the general population. When comparing frail with robust patients, only the physical domain of PROMIS-Global Health® and physical function of PROMIS-29® were worse in the frail group. No differences were found in the other domains.
Conclusions
Frail kidney transplant candidates report worse physical function when assessed using PROMs tools. The systematic implementation of PROMs might help to implement strategies to optimize access to the waiting list, improve postKT outcomes, and enhance overall patient care.
背景和目的患者报告结果（PROMs）是推进以患者为中心的临床实践的关键工具，已被证明对健康结果有好处。它们的应用已经扩展到不同的慢性疾病，但涉及慢性肾脏疾病（CKD）患者的研究很少，这是一个老龄化和虚弱的人群。本研究的目的是评估符合肾移植（KT）条件的晚期CKD患者虚弱和自我报告的健康相关生活质量之间的关系。材料和方法在门诊进行评估的skt候选人纳入研究。进行promise -29®和promise - global Health®问卷调查，并计算每个领域的t得分。使用Fried量表评估虚弱程度，如果Fried为0，则将参与者分为虚弱/虚弱前期。还收集了社会人口学和临床变量。结果139例KT候选患者纳入研究：32%为女性，平均年龄63.5岁，43.9%为透析患者，64.5%为体弱患者。71.2%的人对给予的PROMIS有反应。总体而言，KT候选人的心理健康状况良好（48±7.4），身体健康状况一般（42.8±7.3）。与一般人群相比，焦虑、疲劳、社交功能、睡眠障碍、疼痛和抑郁的t得分都在正常范围内。当比较体弱和健壮的患者时，体弱组只有promise - global Health®的物理域和promise -29®的物理功能更差。在其他领域没有发现差异。结论：当使用PROMs工具进行评估时，虚弱的肾移植候选人报告身体功能较差。PROMs的系统实施可能有助于实施优化等待名单访问的策略，改善kt后的结果，并加强整体患者护理。
{"title":"Medidas de resultados percibidos por el paciente (PROM) en la consulta de acceso a trasplante renal y su relación con la fragilidad","authors":"Dolores Redondo-Pachón , Anna Bach-Pascual , Clara Amat-Fernandez , Betty Chamoun-Huacon , Olatz Garin , Yolanda Pardo , Erica Briones-Vozmediano , Esther Rubinat-Arnaldo , Marta Crespo-Barrio , Guillermo Pedreira-Robles , María José Pérez-Sáez","doi":"10.1016/j.nefro.2025.501393","DOIUrl":"10.1016/j.nefro.2025.501393","url":null,"abstract":"<div><h3>Background and objective</h3><div>Patient-reported outcomes (PROMs) are key tools for advancing patient-centered clinical practice, with proven benefits for health outcomes. Their application has been extended to different chronic diseases, but there are few studies involving patients with chronic kidney disease (CKD), a population that is aging and frail. The aim of this study was to assess the relationship between frailty and self-reported health-related quality of life in patients with advanced CKD who are eligible for kidney transplantation (KT).</div></div><div><h3>Material and methods</h3><div>KT candidates who were evaluated in the outpatient clinic were included in the study. The PROMIS-29® and PROMIS-Global Health® questionnaires were administered, and T-scores were calculated for each domain. Frailty was assessed using the Fried scale, categorizing participants as frail/pre-frail if FRIED<!--> <!-->>0. Sociodemographic and clinical variables were also collected.</div></div><div><h3>Results</h3><div>139 KT candidates were included in the study: 32% were women, the mean age was 63.5 years, 43.9% were on dialysis, and 64.5% were frail. 71.2% responded to the administered PROMIS. Overall, KT candidates reported their mental health as good (48<!--> <!-->±<!--> <!-->7.4) and their physical health as fair (42.8<!--> <!-->±<!--> <!-->7.3). T-scores for anxiety, fatigue, social functioning, sleep disturbance, pain, and depression were within the normal range compared to the general population. When comparing frail with robust patients, only the physical domain of PROMIS-Global Health® and physical function of PROMIS-29® were worse in the frail group. No differences were found in the other domains.</div></div><div><h3>Conclusions</h3><div>Frail kidney transplant candidates report worse physical function when assessed using PROMs tools. The systematic implementation of PROMs might help to implement strategies to optimize access to the waiting list, improve postKT outcomes, and enhance overall patient care.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501393"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963289","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}
Acute kidney injury (AKI) is associated with high morbidity and mortality, an increased risk of developing or worsening chronic kidney disease (CKD), and elevated healthcare costs. There are no registries analyzing the incidence of hospital-acquired AKI. The objectives of this study were to determine the incidence of AKI among hospitalized adult patients in Andalusia, analyse its impact on in-hospital mortality and economic burden, identify clinical units where quality improvement strategies could be implemented, and evaluate the impact of nephrology involvement on clinical outcomes in this population.
Materials and Methods
This retrospective study included hospital admissions of patients aged over 18 years across healthcare facilities affiliated with the Andalusian Public Health System between 2017 and 2021. Data were obtained from the Minimum Basic Data Set (CMBD) provided by the Technical Advisory Subdirectorate for Information Management of the Andalusian Health Service (SAS), covering 82 hospitals and 28 specialized units. A sub-analysis was conducted on the 11 clinical units with the highest AKI incidence: Nephrology, Cardiovascular Surgery, Internal Medicine, Infectious Diseases, Cardiology, Gastroenterology, Hematology and Clinical Hemotherapy, Pulmonology, Medical Oncology, Orthopedic Surgery and Traumatology, and Urology.
Results
The overall incidence of AKI during the study period was 58.5 per 1,000 hospitalizations (5.8% of total admissions), increasing from 46.7 to 68.3 per 1,000 admissions between 2017 and 2021. Incidence varied significantly among clinical units, ranging from 11.3 to 305 cases per 1,000 hospitalizations. Nephrology (305/1,000), Internal Medicine (172.9/1,000), and Infectious Diseases (108/1,000) had the highest incidence rates. AKI diagnosis was associated with prolonged hospital stay (13.55 days in patients with AKI vs. 7.69 days in those without), increased healthcare costs (€107,377.51 vs. €56,342.69), and higher in-hospital mortality (23.03% vs. 4.03%).
Conclusions
The relatively low overall AKI incidence may be underestimated due to study limitations. Nevertheless, the data reveal a progressive increase in hospital-acquired AKI over the study period, with a marked impact on length of stay, healthcare costs, and mortality. Implementing more effective care models focused on prevention, early detection, and treatment of AKI could improve patient safety and reduce associated costs. The proactive integration of Nephrology within the multidisciplinary management of AKI emerges as a key factor in improving both short- and long-term outcomes and promoting the sustainability of the healthcare system by mitigating the economic burden of AKI.
{"title":"Incidencia e impacto clínico-económico del fracaso renal agudo intrahospitalario en Andalucía","authors":"Marina Almenara Tejederas , Wenceslao Aguilera Morales , Blanca Angulo Vázquez , Melissa Cintra Cabrera , Alfonso Lara Ruiz , Mercedes Salgueira Lazo","doi":"10.1016/j.nefro.2025.501397","DOIUrl":"10.1016/j.nefro.2025.501397","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Acute kidney injury (AKI) is associated with high morbidity and mortality, an increased risk of developing or worsening chronic kidney disease (CKD), and elevated healthcare costs. There are no registries analyzing the incidence of hospital-acquired AKI. The objectives of this study were to determine the incidence of AKI among hospitalized adult patients in Andalusia, analyse its impact on in-hospital mortality and economic burden, identify clinical units where quality improvement strategies could be implemented, and evaluate the impact of nephrology involvement on clinical outcomes in this population.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study included hospital admissions of patients aged over 18 years across healthcare facilities affiliated with the Andalusian Public Health System between 2017 and 2021. Data were obtained from the Minimum Basic Data Set (CMBD) provided by the Technical Advisory Subdirectorate for Information Management of the Andalusian Health Service (SAS), covering 82 hospitals and 28 specialized units. A sub-analysis was conducted on the 11 clinical units with the highest AKI incidence: Nephrology, Cardiovascular Surgery, Internal Medicine, Infectious Diseases, Cardiology, Gastroenterology, Hematology and Clinical Hemotherapy, Pulmonology, Medical Oncology, Orthopedic Surgery and Traumatology, and Urology.</div></div><div><h3>Results</h3><div>The overall incidence of AKI during the study period was 58.5 per 1,000 hospitalizations (5.8% of total admissions), increasing from 46.7 to 68.3 per 1,000 admissions between 2017 and 2021. Incidence varied significantly among clinical units, ranging from 11.3 to 305 cases per 1,000 hospitalizations. Nephrology (305/1,000), Internal Medicine (172.9/1,000), and Infectious Diseases (108/1,000) had the highest incidence rates. AKI diagnosis was associated with prolonged hospital stay (13.55 days in patients with AKI vs. 7.69 days in those without), increased healthcare costs (€107,377.51 vs. €56,342.69), and higher in-hospital mortality (23.03% vs. 4.03%).</div></div><div><h3>Conclusions</h3><div>The relatively low overall AKI incidence may be underestimated due to study limitations. Nevertheless, the data reveal a progressive increase in hospital-acquired AKI over the study period, with a marked impact on length of stay, healthcare costs, and mortality. Implementing more effective care models focused on prevention, early detection, and treatment of AKI could improve patient safety and reduce associated costs. The proactive integration of Nephrology within the multidisciplinary management of AKI emerges as a key factor in improving both short- and long-term outcomes and promoting the sustainability of the healthcare system by mitigating the economic burden of AKI.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501397"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963321","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}
Pub Date : 2026-01-01DOI: 10.1016/j.nefro.2025.501398
María Isabel Rebollo Mateos , José López Castro
Introduction
Living donor kidney transplantation is a crucial treatment for chronic kidney disease, yet it raises significant ethical issues. This systematic review addresses these issues by analysing scientific literature from the past ten years. The objectives include identifying and thoroughly analysing the most common ethical dilemmas, describing them, examining the perspectives of various involved groups, and analysing clinical strategies to address them.
Material and methods
Databases such as PubMed, Scopus, and Mendeley were used, following PRISMA guidelines, and 49 relevant studies were included.
Results
The identified dilemmas encompass equity in access to transplantation, distributive justice, informed consent, transplant tourism, coercion, and ethical issues related to desensitization.
Discussion
The review highlights the need for multidisciplinary approaches and unified protocols to tackle these ethical challenges. It underscores the importance of adhering to fundamental ethical principles, aligning with international bioethical statements.
{"title":"Ethical dilemmas of living donor kidney transplantation: A systematic review","authors":"María Isabel Rebollo Mateos , José López Castro","doi":"10.1016/j.nefro.2025.501398","DOIUrl":"10.1016/j.nefro.2025.501398","url":null,"abstract":"<div><h3>Introduction</h3><div>Living donor kidney transplantation is a crucial treatment for chronic kidney disease, yet it raises significant ethical issues. This systematic review addresses these issues by analysing scientific literature from the past ten years. The objectives include identifying and thoroughly analysing the most common ethical dilemmas, describing them, examining the perspectives of various involved groups, and analysing clinical strategies to address them.</div></div><div><h3>Material and methods</h3><div>Databases such as PubMed, Scopus, and Mendeley were used, following PRISMA guidelines, and 49 relevant studies were included.</div></div><div><h3>Results</h3><div>The identified dilemmas encompass equity in access to transplantation, distributive justice, informed consent, transplant tourism, coercion, and ethical issues related to desensitization.</div></div><div><h3>Discussion</h3><div>The review highlights the need for multidisciplinary approaches and unified protocols to tackle these ethical challenges. It underscores the importance of adhering to fundamental ethical principles, aligning with international bioethical statements.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501398"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963322","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}
Pub Date : 2026-01-01DOI: 10.1016/j.nefro.2025.501402
Maria Planella-Cornudella , Neus Roca-Saladrigues , Victor Lopez-Baez , Elias Jatem-Escalante , Eduard Sole-Mir , Xavier Gomez-Arbones , Alvaro Madrid-Aris , Alfons Segarra-Medrano
Background and objective
Calcineurin inhibitors (CNI) are the first-line treatment for steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS), though response rates vary. This study analyzed lymphocyte activation through IL-2 receptor expression on T lymphocytes and serum IL-2Rα (soluble CD25) levels in these patients to evaluate their relationship with response to CNI therapy.
Materials and methods
A multicenter case-control study was conducted with 39 patients with steroid-resistant FSGS, diagnosed via renal biopsy, and 23 healthy controls. Clinical, biochemical, and immunological variables were assessed. Soluble CD25 levels were measured using ELISA, and lymphocyte activation was analyzed by flow cytometry. Treatment criteria and response evaluation followed KDIGO guidelines. Diagnostic performance was assessed using ROC curves for soluble CD25.
Results
The 48.7% of patients responded to CNI treatment. Soluble CD25 levels and IL-2 expression on CD3 T lymphocytes were significantly associated with CNI response (P<.01): responders had higher CD25 levels (477 ± 84.47 pg/ml) compared to non-responders (290.28 ± 85.98 pg/ml). Responders showed a significant reduction in soluble CD25 (−35.8%) and CD3-IL2+ cells after remission, alongside increases in CD8 DR+ cells and regulatory T cells. ROC analysis identified a soluble CD25 cutoff of 324 pg/ml, with 94% sensitivity and 75% specificity for predicting response to CNI.
Conclusions
Elevated soluble CD25 levels and T cell activation were associated with better CNI response. Soluble CD25 could be a predictive biomarker to identify patients with higher likelihood of response, optimizing therapeutic decisions and avoiding unnecessary treatments in steroid-resistant FSGS.
{"title":"Expresión linfocitaria y niveles de IL-2 en el síndrome nefrótico corticorresistente por glomeruloesclerosis focal y segmentaria: implicaciones en la respuesta a los inhibidores de calcineurina","authors":"Maria Planella-Cornudella , Neus Roca-Saladrigues , Victor Lopez-Baez , Elias Jatem-Escalante , Eduard Sole-Mir , Xavier Gomez-Arbones , Alvaro Madrid-Aris , Alfons Segarra-Medrano","doi":"10.1016/j.nefro.2025.501402","DOIUrl":"10.1016/j.nefro.2025.501402","url":null,"abstract":"<div><h3>Background and objective</h3><div>Calcineurin inhibitors (CNI) are the first-line treatment for steroid-resistant nephrotic syndrome (SRNS) due to focal segmental glomerulosclerosis (FSGS), though response rates vary. This study analyzed lymphocyte activation through IL-2 receptor expression on T lymphocytes and serum IL-2Rα (soluble CD25) levels in these patients to evaluate their relationship with response to CNI therapy.</div></div><div><h3>Materials and methods</h3><div>A multicenter case-control study was conducted with 39 patients with steroid-resistant FSGS, diagnosed via renal biopsy, and 23 healthy controls. Clinical, biochemical, and immunological variables were assessed. Soluble CD25 levels were measured using ELISA, and lymphocyte activation was analyzed by flow cytometry. Treatment criteria and response evaluation followed KDIGO guidelines. Diagnostic performance was assessed using ROC curves for soluble CD25.</div></div><div><h3>Results</h3><div>The 48.7% of patients responded to CNI treatment. Soluble CD25 levels and IL-2 expression on CD3 T lymphocytes were significantly associated with CNI response (<em>P</em><.01): responders had higher CD25 levels (477<!--> <!-->±<!--> <!-->84.47 pg/ml) compared to non-responders (290.28<!--> <!-->±<!--> <!-->85.98 pg/ml). Responders showed a significant reduction in soluble CD25 (−35.8%) and CD3-IL2<sup>+</sup> cells after remission, alongside increases in CD8 DR<sup>+</sup> cells and regulatory T cells. ROC analysis identified a soluble CD25 cutoff of 324 pg/ml, with 94% sensitivity and 75% specificity for predicting response to CNI.</div></div><div><h3>Conclusions</h3><div>Elevated soluble CD25 levels and T cell activation were associated with better CNI response. Soluble CD25 could be a predictive biomarker to identify patients with higher likelihood of response, optimizing therapeutic decisions and avoiding unnecessary treatments in steroid-resistant FSGS.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501402"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963323","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}
Pub Date : 2026-01-01DOI: 10.1016/j.nefro.2025.501405
Pablo Molina , Elena Galván , Laura Porcar , Amparo Alba , Amanda Hernandis , Pilar Pascual , Mercedes González-Moya , Belén Vizcaíno , Sandra Beltrán , María Rodrigo , Asunción Sancho
{"title":"Hemodiálisis nocturna domiciliaria con bajo flujo de líquido de diálisis: reporte de los dos primeros casos en España","authors":"Pablo Molina , Elena Galván , Laura Porcar , Amparo Alba , Amanda Hernandis , Pilar Pascual , Mercedes González-Moya , Belén Vizcaíno , Sandra Beltrán , María Rodrigo , Asunción Sancho","doi":"10.1016/j.nefro.2025.501405","DOIUrl":"10.1016/j.nefro.2025.501405","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501405"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963351","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}
Pub Date : 2026-01-01DOI: 10.1016/j.nefro.2025.501400
Ester Cholbi , Elena Moreno Maestre , Jordi Espí Reig , Ana Paz Ventura Galiano , Pablo González-Calero Borrás , Diego Rodríguez Ortega , María Ramos Cebrián , Juan Francisco Merino Torres , Beatriz Marcos Puig , Eva María Montalvá Orón , Isabel Beneyto Castelló
Background and objective
Chronic kidney disease affects up to 6% of women of childbearing age, leading to fertility issues and low pregnancy rates. In patients with diabetes mellitus and chronic kidney disease, simultaneous pancreas-kidney transplantation restores renal function and endogenous insulin production, thereby increasing the likelihood of a successful pregnancy. However, pregnancy after transplantation remains high-risk. Several factors may influence maternal and fetal outcomes, including preconception counseling, appropriate maternal medical management, and the careful selection of immunosuppressive therapy to avoid fetal toxicity. Although obstetric, perinatal, and nephrology care have improved since the first reported pregnancy in a simultaneous pancreas-kidney transplantation recipient in 1986, further research is still needed to fully understand its impact on maternal, fetal, and graft outcomes, particularly in the context of combined organ transplantation. The objective of this study is to describe the clinical course of pregnant simultaneous pancreas-kidney transplantation recipients and to evaluate both the impact of transplantation on pregnancy and the prognostic factors that may influence outcomes.
Materials and methods
We conducted a descriptive analysis of a case series involving six pregnancies in simultaneous pancreas-kidney transplantation recipients managed at our center. Renal and pancreatic graft function, as well as maternal and fetal outcomes during gestation, were summarized quantitatively and graphically. Detailed, anonymized clinical data were collected for each patient throughout the follow-up period.
Results
All pregnancies occurred more than one year after transplantation, allowing for adjustment of immunosuppressive regimens to minimize teratogenic risk. Renal and pancreatic graft function remained stable throughout the follow-up. Three patients experienced uncomplicated pregnancies. The remaining three required hospitalization due to complications: one case of hyperemesis gravidarum, one of preeclampsia, and one of threatened preterm labor secondary to polyhydramnios. Except for one, all deliveries were performed via cesarean section for obstetric indications, resulting in live, healthy neonates. Four births were preterm, with low-birth-weight infants.
Conclusions
In our experience, pregnancies in simultaneous pancreas-kidney transplantation recipients were associated with favorable maternal and fetal outcomes. Careful planning and close multidisciplinary monitoring by nephrology, endocrinology, and obstetrics are essential to optimize results during pregnancy.
{"title":"Desafíos del embarazo en receptoras de trasplante de páncreas y riñón. Experiencia en nuestro centro","authors":"Ester Cholbi , Elena Moreno Maestre , Jordi Espí Reig , Ana Paz Ventura Galiano , Pablo González-Calero Borrás , Diego Rodríguez Ortega , María Ramos Cebrián , Juan Francisco Merino Torres , Beatriz Marcos Puig , Eva María Montalvá Orón , Isabel Beneyto Castelló","doi":"10.1016/j.nefro.2025.501400","DOIUrl":"10.1016/j.nefro.2025.501400","url":null,"abstract":"<div><h3>Background and objective</h3><div>Chronic kidney disease affects up to 6% of women of childbearing age, leading to fertility issues and low pregnancy rates. In patients with diabetes mellitus and chronic kidney disease, simultaneous pancreas-kidney transplantation restores renal function and endogenous insulin production, thereby increasing the likelihood of a successful pregnancy. However, pregnancy after transplantation remains high-risk. Several factors may influence maternal and fetal outcomes, including preconception counseling, appropriate maternal medical management, and the careful selection of immunosuppressive therapy to avoid fetal toxicity. Although obstetric, perinatal, and nephrology care have improved since the first reported pregnancy in a simultaneous pancreas-kidney transplantation recipient in 1986, further research is still needed to fully understand its impact on maternal, fetal, and graft outcomes, particularly in the context of combined organ transplantation. The objective of this study is to describe the clinical course of pregnant simultaneous pancreas-kidney transplantation recipients and to evaluate both the impact of transplantation on pregnancy and the prognostic factors that may influence outcomes.</div></div><div><h3>Materials and methods</h3><div>We conducted a descriptive analysis of a case series involving six pregnancies in simultaneous pancreas-kidney transplantation recipients managed at our center. Renal and pancreatic graft function, as well as maternal and fetal outcomes during gestation, were summarized quantitatively and graphically. Detailed, anonymized clinical data were collected for each patient throughout the follow-up period.</div></div><div><h3>Results</h3><div>All pregnancies occurred more than one year after transplantation, allowing for adjustment of immunosuppressive regimens to minimize teratogenic risk. Renal and pancreatic graft function remained stable throughout the follow-up. Three patients experienced uncomplicated pregnancies. The remaining three required hospitalization due to complications: one case of hyperemesis gravidarum, one of preeclampsia, and one of threatened preterm labor secondary to polyhydramnios. Except for one, all deliveries were performed via cesarean section for obstetric indications, resulting in live, healthy neonates. Four births were preterm, with low-birth-weight infants.</div></div><div><h3>Conclusions</h3><div>In our experience, pregnancies in simultaneous pancreas-kidney transplantation recipients were associated with favorable maternal and fetal outcomes. Careful planning and close multidisciplinary monitoring by nephrology, endocrinology, and obstetrics are essential to optimize results during pregnancy.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501400"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963284","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}
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