Nefrologia最新文献

英文中文

Importancia de la codificación tras el diagnóstico de enfermedad renal crónica: del código N18.9 (CIE/ICD-10) al papel de los laboratorios clínicos 慢性肾脏疾病诊断后编码的重要性：从代码N18.9 （ICD /ICD-10）到临床实验室的作用

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-08-30 DOI: 10.1016/j.nefro.2025.501410

María Isabel Troya , Jordi Bover , Anna Cia Hidalgo , Susana Malumbres , Maya Sánchez-Bayá , Elisabet Massó , Verónica Coll-Brito , Paula Anton-Pampols , Iara da Silva , Jordi Soler-Majoral , Elisabeth Marcos , Beatriz Moreiras Abril , Noemí Pérez-León , Marta Morera García , Joan Pau Golf Zaragoza , Xavier Jusmet Miguel , Yolanda Lejardi Estevez , Rosa López-Alarcón , Ignacio Blanco , Cristian Morales Indiano , Jordi Ara

引用次数: 0

Alfabetización en salud renal en la era digital: la experiencia de la plataforma Salud Renal Siempre 数字时代的肾脏健康素养：永远肾脏健康平台的经验

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-08-27 DOI: 10.1016/j.nefro.2025.501409

María Dolores Arenas Jiménez, Julia Audije-Gil, Paula Manso, David Hernán, Fabiola Dapena, Ana Balseiro, Cristina Sanz

引用次数: 0

An approximation to the prevalence of focal segmental glomerulosclerosis: A systematic review of world literature over the past 32 years 局灶节段性肾小球硬化患病率的近似值：对过去32年世界文献的系统回顾

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-08-20 DOI: 10.1016/j.nefro.2025.501404

Citlalli Orizaga-de-la-Cruz , Francisco Alejandro Lagunas-Rangel , Anel Gómez-García , Venice Chávez-Valencia

Background

Focal segmental glomerulosclerosis (FSGS) is a histopathological lesion characterized by scarring in specific sections of some glomeruli, accompanied by podocyte injury. Worldwide, the prevalence of FSGS and its temporal trends have not been sufficiently studied. However, some reports suggest an increase in the frequency of FSGS in recent decades. Understanding the epidemiology of FSGS is crucial for clinicians to improve diagnosis and treatment.

Objective

This study critically evaluates global prevalence trends of FSGS over the past 32 years (1992–2024), highlighting variations between countries through a systematic review.

Methods

A systematic search of Medline, Embase and ScienceDirect was conducted to identify relevant studies. The reliability of prevalence data was assessed by critical appraisal of selected publications.

Results

The prevalence of FSGS varies significantly between regions. East Asian countries have a relatively low prevalence, with a mean around 7%. In contrast, countries in South Asia, the Middle East and the Americas have a higher prevalence of around 18%. European countries show an intermediate prevalence of about 11%. African countries do not show a clear pattern, with high and low prevalence rates in different countries.

Conclusions

The prevalence of FSGS differs by geographic region and ethnicity. While South Asian countries have maintained a consistently low prevalence, other regions have experienced an increase in FSGS cases over time. This study improves the understanding of global patterns of FSGS, providing valuable epidemiological insights for clinicians and researchers.

局灶节段性肾小球硬化（FSGS）是一种组织病理学病变，其特征是肾小球特定部位的瘢痕形成，并伴有足细胞损伤。在世界范围内，FSGS的流行及其时间趋势尚未得到充分的研究。然而，一些报告表明，近几十年来，FSGS的频率有所增加。了解FSGS的流行病学对临床医生提高诊断和治疗至关重要。目的：本研究对过去32年（1992-2024年）FSGS的全球流行趋势进行了批判性评估，通过系统回顾强调了各国之间的差异。方法系统检索Medline、Embase、ScienceDirect等数据库，筛选相关研究。患病率数据的可靠性是通过对选定出版物的批判性评价来评估的。结果地区间FSGS患病率差异显著。东亚国家的患病率相对较低，平均约为7%。相比之下，南亚、中东和美洲国家的患病率更高，约为18%。欧洲国家的中间患病率约为11%。非洲国家没有显示出明确的模式，不同国家的流行率有高有低。结论FSGS的患病率因地区和民族的不同而存在差异。虽然南亚国家的流行率一直很低，但随着时间的推移，其他地区的FSGS病例有所增加。本研究提高了对FSGS全球模式的理解，为临床医生和研究人员提供了有价值的流行病学见解。

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引用次数: 0

TC-peritoneografía: técnica diagnóstica clave en diálisis peritoneal. Nuestra experiencia CT腹膜造影：腹膜透析的关键诊断技术。我们的经验

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-08-12 DOI: 10.1016/j.nefro.2025.501394

M. Moreiras-Plaza, A. Fijó-Prieto, A. Canto-Calviño, B. Santaclara-Pousada, V. Toledo-Cepeda

Non-infectious complications are common in Peritoneal Dialysis, and usually require imaging tests for diagnosis and evaluation. Computerized tomography (CT)-peritoneography is a CT modality in which, before imaging, radiological contrast is instilled into the peritoneum mixed with the dialysis solution. CT-peritoneography is a simple, fast and accessible test, with a higher diagnostic yield than other more modern imaging techniques, especially in the case of leaks and hernias. We present our experience and results with CT-peritoneography over 10 years. We conclude that CT-peritoneography is the technique of choice for the diagnosis of many of the non-infectious complications in Peritoneal Dialysis, especially in cases of dialysate leakage or hernias.

非感染性并发症在腹膜透析中很常见，通常需要影像学检查进行诊断和评估。计算机断层扫描(CT)-腹膜造影是一种CT方式，在成像之前，将放射造影剂与透析液混合注入腹膜。ct -腹膜造影是一种简单、快速和容易获得的检查方法，比其他更现代的成像技术具有更高的诊断率，特别是在渗漏和疝气的情况下。我们介绍了近10年来ct腹膜造影的经验和结果。我们得出结论，ct腹膜造影是诊断腹膜透析中许多非感染性并发症的首选技术，特别是在透析液渗漏或疝气的情况下。

引用次数: 0

Towards a better prevention in cardio-kidney metabolic syndrome: Role of aldosterone and albuminuria 为了更好地预防心肾代谢综合征：醛固酮和蛋白尿的作用

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-08-11 DOI: 10.1016/j.nefro.2025.501399

Luis M. Ruilope , Bertram Pitt , Alejandro de la Sierra , Gema Ruiz-Hurtado

引用次数: 0

Respuesta a la carta al editor «Sarcopenia: la importancia de las fórmulas» 对《Sarcopenia：公式的重要性》编辑信的答复

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-07-22 DOI: 10.1016/j.nefro.2025.501390

E. García-Menéndez, J. Portolés, A. Muñoz-Sánchez, A. Tato Ribera, C. Yuste Lozano, M. Ossorio González, P. López-Sánchez, D. Janeiro Marín

引用次数: 0

Factores que influyen en la depuración de toxinas urémicas unidas a proteínas en hemodiafiltración 影响血液滤过蛋白结合尿素毒素纯化的因素

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-07-22 DOI: 10.1016/j.nefro.2025.501391

Víctor Joaquín Escudero-Saiz , Elena Cuadrado-Payán , María Rodríguez-García , Gregori Casals , Lida María Rodas , Néstor Fontseré , José Jesús Broseta , Francisco Maduell

Introduction

Protein-bound uremic toxins (PBUTs) have a high affinity for albumin and they are associated with increased cardiovascular morbidity and mortality in hemodialysis patients. Among them, p-cresyl sulfate (pCS) and indoxyl sulfate (IS) stand out due to their high toxicity. Post-dilution hemodiafiltration (HDF) is one of the dialysis techniques that has shown the greatest benefits in terms of patient survival.

Materials and methods

This observational, single-center, cross-sectional study evaluated PBUT clearance in 137 patients undergoing post-dilution HDF, analyzing the factors that influence their removal. Reduction ratios (RRs) of IS and pCS were measured, as well as their correlation with dialysis parameters and clinical variables.

Results

The mean RR for IS was 53.4% ± 9.3%, and for pCS, 48.2% ± 11.3%. A significant correlation was observed between the RR of both toxins (r = 0.606; P < 0.01), suggesting similar elimination mechanisms. In addition, total convective volume showed a positive correlation with the RR of pCS (r = 0.19; P = 0.027) and a weak correlation with the RR of IS (r = 0.155; P = 0.07). A significant difference in clearance was found according to sex, with higher RRs in women (P < 0.001 for IS and P = 0.008 for pCS).

Conclusions

The clearance of PBUTs is primarily diffusive. Enhancing all variables related to this physical principle will improve the elimination of these toxins. Post-dilution HDF with high convective volume slightly increases this clearance. However, the results remain insufficient given the high toxicity of these molecules. New strategies, such as the use of adsorptive membranes and competitive molecules, are needed to optimize their removal and reduce the negative cardiovascular impact in hemodialysis patients.

蛋白结合尿毒症毒素（PBUTs）对白蛋白具有高亲和力，并且与血液透析患者心血管发病率和死亡率增加有关。其中，对甲酚硫酸盐（pCS）和吲哚酚硫酸盐（IS）因其高毒性而引人注目。稀释后血液滤过（HDF）是透析技术之一，在患者生存方面显示出最大的好处。材料和方法本观察性、单中心、横断面研究评估了137例稀释后HDF患者的PBUT清除情况，分析了影响清除的因素。测定IS和pCS的降低率（rr），并与透析参数和临床变量进行相关性分析。结果IS和pCS的平均RR分别为53.4%±9.3%和48.2%±11.3%。两种毒素的相对危险度呈显著相关（r = 0.606; P < 0.01），表明两种毒素的消除机制相似。总对流体积与pCS的RR呈正相关（r = 0.19, P = 0.027），与IS的RR呈弱相关（r = 0.155, P = 0.07）。根据性别发现清除率有显著差异，女性的rr较高（IS为P <； 0.001， pc为P = 0.008）。结论PBUTs的清除以弥漫性清除为主。加强与这一物理原理有关的所有变量将有助于消除这些毒素。高对流体积的稀释后HDF稍微增加了这个间隙。然而，考虑到这些分子的高毒性，结果仍然不够充分。需要新的策略，如使用吸附膜和竞争分子，来优化它们的去除并减少血液透析患者的负面心血管影响。

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引用次数: 0

Experience with new anti-CD20 monoclonal antibodies for immune-mediated glomerulopathies in a tertiary hospital 新型抗cd20单克隆抗体在三级医院治疗免疫介导性肾小球疾病的经验

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-17 DOI: 10.1016/j.nefro.2025.501372

Jorge Iván Zamora , Marina López-Martínez , Natalia Ramos , Sheila Bermejo , Irene Agraz , Clara García-Carro , Marc Patricio , Juan Carlos León , Néstor Toapanta , Oriol Bestard , María José Soler

In the recent years, new humanized anti-CD20 monoclonal antibodies have been developed to optimize B-cell depletion. Our objective is to describe the experience at our center with the use of new anti-CD20 drugs in glomerular diseases. We included patients from our center treated with second-generation anti-CD20 monoclonal antibodies for glomerular diseases between January 2017 and January 2024. Patients were followed for one year after the initiation of treatment. Six patients were included, 2 (33%) men, with a median age of 59.5 (49–75) years. Diagnoses were 2 (33%) minimal change disease, 1 (16.7%) mixed cryoglobulinemia type-II, 1 (16.7%) membranous nephropathy, 1 (16.7%) fibrillary glomerulonephritis (FGN), and 1 (16.7%) focal segmental glomerulosclerosis. The indications for the new anti-CD20 therapy were 4 (66%) for refractory disease, 1 (16.7%) recurrent flares, and 1 (16.7%) due to an anaphylactic reaction to rituximab. The new anti-CD20 used were obinutuzumab in 4 (66%) and ofatumumab in 2 patients (33%). Before the start of the treatment median creatinine was 1.39 mg/dL (0.91–2.38) median serum albumin 2.7 g/dL [2.5–3.9 g/dL] and urine protein–creatinine ratio (UPCR) 5.75 g/g [2.38–4.85 g/g]. A total of 5 (83%) patients achieved partial/complete remission within the first 6 months of follow-up. By month twelve of the follow-up 4 (66.67%) patients remained with partial/complete remission. None of the patients had serious side effects. In conclusion, the use of new anti-CD20 therapies for the treatment of immune-mediated glomerular diseases is a safe and effective alternative for its treatment. Further research and clinical trials should be conducted to confirm these positive results.

近年来，新的人源抗cd20单克隆抗体被开发出来，以优化b细胞的消耗。我们的目的是描述我们中心在肾小球疾病中使用新的抗cd20药物的经验。我们纳入了2017年1月至2024年1月期间接受第二代抗cd20单克隆抗体治疗肾小球疾病的患者。患者在开始治疗后随访一年。纳入6例患者，2例（33%）男性，中位年龄59.5（49-75）岁。诊断为轻度病变2例（33%），混合型冷球蛋白血症1例（16.7%），膜性肾病1例（16.7%），纤维性肾小球肾炎（FGN） 1例（16.7%），局灶节段性肾小球硬化1例（16.7%）。新的抗cd20治疗的适应症为难治性疾病4例（66%），复发性耀斑1例（16.7%），利妥昔单抗过敏反应1例（16.7%）。新使用的抗cd20药物为4例（66%）的obinutuzumab和2例（33%）的ofatumumab。治疗开始前中位肌酐为1.39 mg/dL(0.91-2.38)，血清白蛋白中位2.7 g/dL [2.5-3.9 g/dL]，尿蛋白-肌酐比值（UPCR）为5.75 g/g [2.38-4.85 g/g]。在前6个月的随访中，共有5例（83%）患者达到部分/完全缓解。随访12个月时，4例（66.67%）患者保持部分/完全缓解。这些病人都没有严重的副作用。总之，使用新的抗cd20疗法治疗免疫介导的肾小球疾病是一种安全有效的治疗方案。应该进行进一步的研究和临床试验来证实这些积极的结果。

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引用次数: 0

Hacia una hemodiálisis sostenible: de la reflexión a la práctica 实现可持续血液透析：从思考到实践

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-16 DOI: 10.1016/j.nefro.2025.501368

Marta Arias-Guillén , M. Dolores Arenas , Claudia Yuste

引用次数: 0

Association of hemoglobin and red cell distribution width ratio with new cardiovascular events in peritoneal dialysis patients 腹膜透析患者血红蛋白和红细胞分布宽度比与新心血管事件的关系

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-14 DOI: 10.1016/j.nefro.2025.501370

Rong Wei , Wenying Zhang , Na Tian , Xiaojiang Zhan , Fenfen Peng , Xiaoyang Wang , Qingdong Xu , Ning Su , Juan Wu , Xingming Tang , Xiaoran Feng , Xianfeng Wu , Qian Zhou , Zhiyong Xie , Jianbo Liang , Yueqiang Wen

Objective

Peritoneal dialysis (PD) patients, who are more likely to have a poor prognosis for new cardiovascular events (CVE), are the focus of our research. We aim to investigate whether the hemoglobin-to-red cell distribution width (HRR) ratio is associated with a higher risk of new-onset CVE in PD patients. This research could potentially lead to new strategies for predicting and preventing new-onset CVE in PD patients.

Methods

One thousand four hundred seventy-four patients from November 1, 2005, to December 31, 2016, were divided into high and low HRR groups using restricted cubic spline (RCS). Various statistical methods were utilized to study the impact of HRR changes on new-onset CVE in PD patients, including Kaplan–Meier cumulative incidence curves, multivariate COX regression, competitive risk analysis, and forest plots to analyze subgroup interactions.

Results

During the follow-up period, 104 new-onset CVEs were recorded. Restricted cubic spline showed a non-linear relationship between HRR and new-onset CVE. A multifactorial COX regression analysis model showed reduced HRR as an independent risk factor for new-onset CVE (HR, 1.737; 95% CI 1.119–2.695, P = 0.014). Kaplan–Meier analysis showed a significant difference in survival between the two groups of patients (P = 0.002). The competing risks model found that after excluding endpoint events, there was still a significant difference in new-onset CVE (P = 0.0009) between the different HRR groups. In subgroup analyses, there were no significant differences between groups.

Conclusions

Low hemoglobin to red cell distribution width ratio (HRR) is associated with a higher risk of new-onset CVE in PD patients.

目的腹膜透析（PD）患者新发心血管事件（CVE）预后较差，是我们研究的重点。我们的目的是研究血红蛋白与红细胞分布宽度（HRR）比值是否与PD患者新发CVE的高风险相关。这项研究可能为预测和预防PD患者新发CVE提供新的策略。方法将2005年11月1日至2016年12月31日收治的1474例患者采用限制性三次样条法（RCS）分为高、低HRR组。采用Kaplan-Meier累积发病率曲线、多变量COX回归、竞争风险分析、森林图分析亚组相互作用等多种统计方法研究HRR变化对PD患者新发CVE的影响。结果随访期间共记录新发cve 104例。受限三次样条曲线显示HRR与新发CVE呈非线性关系。多因素COX回归分析模型显示，HRR降低是新发CVE的独立危险因素（HR, 1.737; 95% CI, 1.119-2.695, P = 0.014）。Kaplan-Meier分析显示两组患者的生存率有显著差异（P = 0.002）。竞争风险模型发现，在排除终点事件后，不同HRR组之间新发CVE仍有显著差异（P = 0.0009）。在亚组分析中，各组间无显著差异。结论慢血红蛋白与红细胞分布宽度比（HRR）与PD患者新发CVE风险增高有关。

{"title":"Association of hemoglobin and red cell distribution width ratio with new cardiovascular events in peritoneal dialysis patients","authors":"Rong Wei , Wenying Zhang , Na Tian , Xiaojiang Zhan , Fenfen Peng , Xiaoyang Wang , Qingdong Xu , Ning Su , Juan Wu , Xingming Tang , Xiaoran Feng , Xianfeng Wu , Qian Zhou , Zhiyong Xie , Jianbo Liang , Yueqiang Wen","doi":"10.1016/j.nefro.2025.501370","DOIUrl":"10.1016/j.nefro.2025.501370","url":null,"abstract":"<div><h3>Objective</h3><div>Peritoneal dialysis (PD) patients, who are more likely to have a poor prognosis for new cardiovascular events (CVE), are the focus of our research. We aim to investigate whether the hemoglobin-to-red cell distribution width (HRR) ratio is associated with a higher risk of new-onset CVE in PD patients. This research could potentially lead to new strategies for predicting and preventing new-onset CVE in PD patients.</div></div><div><h3>Methods</h3><div>One thousand four hundred seventy-four patients from November 1, 2005, to December 31, 2016, were divided into high and low HRR groups using restricted cubic spline (RCS). Various statistical methods were utilized to study the impact of HRR changes on new-onset CVE in PD patients, including Kaplan–Meier cumulative incidence curves, multivariate COX regression, competitive risk analysis, and forest plots to analyze subgroup interactions.</div></div><div><h3>Results</h3><div>During the follow-up period, 104 new-onset CVEs were recorded. Restricted cubic spline showed a non-linear relationship between HRR and new-onset CVE. A multifactorial COX regression analysis model showed reduced HRR as an independent risk factor for new-onset CVE (HR, 1.737; 95% CI 1.119–2.695, <em>P</em>  =0.002). The competing risks model found that after excluding endpoint events, there was still a significant difference in new-onset CVE (<em>P</em>  <!-->0.0009) between the different HRR groups. In subgroup analyses, there were no significant differences between groups.</div></div><div><h3>Conclusions</h3><div>Low hemoglobin to red cell distribution width ratio (HRR) is associated with a higher risk of new-onset CVE in PD patients.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"45 10","pages":"Article 501370"},"PeriodicalIF":2.6,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610414","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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