Peritoneal dialysis (PD)-related infections due to nontuberculous Mycobacteria (NTM) are rare in children and adolescents but appear to be increasingly recognized. To better understand the clinical profile, characteristics, management and outcomes of these infections, we conducted a systematic review of pediatric cases reported in the literature. We identified 25 episodes in 23 patients under the age of 18, drawn from 19 studies. The mean age was 7.35 years with a slight male predominance. The most common underlying condition leading to end stage renal disease and initiation of PD, was congenital anomalies of the kidney and urinary tract, particularly hypoplastic or dysplastic kidneys. Clinical manifestations were non-specific, often including fever, abdominal pain and cloudy effluent. Among the reported cases 52% presented with peritonitis, 36% with exit site infection and 12% had both. Mycobacterium abscessus and Mycobacteriumfortuitum emerged as the most prevalent species, each accounting for a comparable proportion of the recovered isolates. Notably, Mycobacterium chelonae was the most frequent isolated specie among infants. Diagnosis was frequently delayed and treatment required prolonged antibiotic regimens. Catheter removal was performed in almost all cases, while most patients were temporarily switched to hemodialysis. Mortality rate was low approaching 4%. These findings underscore the need for heightened clinical suspicion, early diagnosis and aggressive management to improve outcomes in pediatric patients with PD-related infections due to NTM.
{"title":"Peritoneal dialysis-related infections due to nontuberculous Mycobacteria in children and adolescents: A critical review of reported cases","authors":"John Dotis , Antonia Kondou , Vasiliki Karava , Athina Papadopoulou , Nikoleta Printza","doi":"10.1016/j.nefro.2025.501406","DOIUrl":"10.1016/j.nefro.2025.501406","url":null,"abstract":"<div><div>Peritoneal dialysis (PD)-related infections due to nontuberculous <em>Mycobacteria</em> (NTM) are rare in children and adolescents but appear to be increasingly recognized. To better understand the clinical profile, characteristics, management and outcomes of these infections, we conducted a systematic review of pediatric cases reported in the literature. We identified 25 episodes in 23 patients under the age of 18, drawn from 19 studies. The mean age was 7.35 years with a slight male predominance. The most common underlying condition leading to end stage renal disease and initiation of PD, was congenital anomalies of the kidney and urinary tract, particularly hypoplastic or dysplastic kidneys. Clinical manifestations were non-specific, often including fever, abdominal pain and cloudy effluent. Among the reported cases 52% presented with peritonitis, 36% with exit site infection and 12% had both. <em>Mycobacterium abscessus</em> and <em>Mycobacterium</em> <em>fortuitum</em> emerged as the most prevalent species, each accounting for a comparable proportion of the recovered isolates. Notably, <em>Mycobacterium chelonae</em> was the most frequent isolated specie among infants. Diagnosis was frequently delayed and treatment required prolonged antibiotic regimens. Catheter removal was performed in almost all cases, while most patients were temporarily switched to hemodialysis. Mortality rate was low approaching 4%. These findings underscore the need for heightened clinical suspicion, early diagnosis and aggressive management to improve outcomes in pediatric patients with PD-related infections due to NTM.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501406"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963287","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.2025.501388
Songhe Chen , Pingbo Bao
{"title":"Future directions of nsMRAs in CKD treatment: Focus on etiologic stratification and drug synergies","authors":"Songhe Chen , Pingbo Bao","doi":"10.1016/j.nefro.2025.501388","DOIUrl":"10.1016/j.nefro.2025.501388","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501388"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963246","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}
{"title":"The usual suspect or an unusual culprit? A case of catheter hypersensitivity in peritoneal dialysis","authors":"Catarina Veiga , Raquel Pinto , Joaquim Milheiro , Adriana Dias , Joana Abreu , Carla Lima , Cátia Pêgo , Tânia Sousa , Rita Cabral , Sérgio Lemos","doi":"10.1016/j.nefro.2025.501395","DOIUrl":"10.1016/j.nefro.2025.501395","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501395"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963348","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.2025.501412
Eduardo Gallego-Valcarce, Angela Rey-Cárdenas, Eva López-Melero, Ana María Tato-Ribera, Deborah Roldan, Sofía López San Román, Ángel Méndez Abreu, Clara Cases-Corona, Enrique Gruss
Background and objective
The KDIGO guidelines recommend as a criterion for referral to ACKD consultations a risk > 10% of requiring renal replacement therapy (RRT) before 2 years. This risk should be assessed with externally validated prediction models. The prediction model KFRE and the Grams model meet these requirements. In an ACKD unit with a remission criterion of eGFR < 30 mL/min, we proposed a retrospective cohort study to evaluate whether the application of a KFRE > 10% as a remission criterion allows differentiation of patients according to their clinical and analytical characteristics and their evolution.
Patients and methods
We studied 573 patients followed in the ACKD clinic for at least 4 years. In the first consultation we classified them into two groups according to their 2-year KFRE: < 10% or ≥ 10%. We compared their clinical and analytical characteristics and whether the prognoses made by Grams’ model at baseline matched the observed evolution. Both groups were analysed according to two age ranges: older and younger than 75 years.
Results
Patients with KFRE ≥ 10% (53.4%), with respect to those with KFRE < 10%, were significantly younger and their annual eGFR loss was greater. They had different evolution: at 2 years, 38.9% vs 3% (P < .05) started RRT and 45.8% vs 79.8% (P < .05) remained in the clinic; at 4 years, 60.7% vs 15.6% (P < .05) started RRT and 16.7% vs 52.3% (P < .05) remained in the clinic. In the group with KFRE< 10% those ≥ 75 years vs < 75 years initiated RRT and died previously in a significantly different proportion at 2 years: 1.2 vs 6.1% and 23.7 vs 6.1% respectively (P < .05). In the group with KFRE ≥ 10% those ≥ 75 years and those < 75 years initiated RRT and previously died in a significantly different proportion at 2 years: 25.9 vs 46.4% and 32.1 vs 5.7%, respectively (P < .05). Prediction models predicted all these differences quite accurately.
Conclusions
A KFRE ≥ 10% at 2 years would be an appropriate criterion for referral to ACKD consultations, since it would select a group of patients who are really going to require RRT in the medium term, regardless of their age, and would avoid the referral of patients at low risk of requiring RRT, mainly elderly patients.
背景和目的KDIGO指南建议，2年前需要肾替代治疗（RRT）的风险为10%的患者转诊ACKD的标准。这种风险应该通过外部验证的预测模型进行评估。预测模型KFRE和Grams模型满足了这些要求。在一个以eGFR 30 mL/min为缓解标准的ACKD单元中，我们提出了一项回顾性队列研究，以评估使用KFRE 10%作为缓解标准是否可以根据患者的临床和分析特征及其演变来区分患者。患者和方法我们研究了573例在ACKD诊所随访至少4年的患者。在第一次咨询中，我们根据其2年KFRE分为两组：<； 10%或≥10%。我们比较了他们的临床和分析特征，以及Grams模型在基线时的预后是否与观察到的进化相匹配。这两组人都是根据两个年龄范围进行分析的：老年人和75岁以下的人。结果与KFRE≥10%的患者相比，KFRE≥10%的患者（53.4%）明显年轻化，且年eGFR损失更大。他们有不同的演变：在2年时，38.9% vs 3% （P < 0.05）开始RRT， 45.8% vs 79.8% （P < 0.05）仍留在临床；4年时，60.7% vs 15.6% （P < 0.05）的患者开始RRT， 16.7% vs 52.3% （P < 0.05）的患者仍留在临床。在KFRE<； 10%的组中，≥75岁和≥75岁的患者在2年开始RRT和先前死亡的比例有显著差异：分别为1.2 vs 6.1%和23.7 vs 6.1% （P < 0.05）。在KFRE≥10%的组中，≥75岁和≥75岁开始RRT并先前死亡的患者在2年时的比例有显著差异：分别为25.9 vs 46.4%和32.1 vs 5.7% （P < 0.05）。预测模型相当准确地预测了所有这些差异。结论2年时KFRE≥10%将是转诊ACKD的合适标准，因为它将选择一组中期确实需要RRT的患者，而不考虑其年龄，并避免转诊需要RRT的低风险患者，主要是老年患者。
{"title":"El KFRE como criterio de remisión a las consultas de enfermedad renal crónica avanzada","authors":"Eduardo Gallego-Valcarce, Angela Rey-Cárdenas, Eva López-Melero, Ana María Tato-Ribera, Deborah Roldan, Sofía López San Román, Ángel Méndez Abreu, Clara Cases-Corona, Enrique Gruss","doi":"10.1016/j.nefro.2025.501412","DOIUrl":"10.1016/j.nefro.2025.501412","url":null,"abstract":"<div><h3>Background and objective</h3><div>The KDIGO guidelines recommend as a criterion for referral to ACKD consultations a risk ><!--> <!-->10% of requiring renal replacement therapy (RRT) before 2<!--> <!-->years. This risk should be assessed with externally validated prediction models. The prediction model KFRE and the Grams model meet these requirements. In an ACKD unit with a remission criterion of eGFR <<!--> <!-->30<!--> <!-->mL/min, we proposed a retrospective cohort study to evaluate whether the application of a KFRE ><!--> <!-->10% as a remission criterion allows differentiation of patients according to their clinical and analytical characteristics and their evolution.</div></div><div><h3>Patients and methods</h3><div>We studied 573 patients followed in the ACKD clinic for at least 4<!--> <!-->years. In the first consultation we classified them into two groups according to their 2-year KFRE: <<!--> <!-->10% or ≥<!--> <!-->10%. We compared their clinical and analytical characteristics and whether the prognoses made by Grams’ model at baseline matched the observed evolution. Both groups were analysed according to two age ranges: older and younger than 75<!--> <!-->years.</div></div><div><h3>Results</h3><div>Patients with KFRE ≥<!--> <!-->10% (53.4%), with respect to those with KFRE <<!--> <!-->10%, were significantly younger and their annual eGFR loss was greater. They had different evolution: at 2<!--> <!-->years, 38.9% vs 3% (<em>P</em> <!--><<!--> <!-->.05) started RRT and 45.8% vs 79.8% (<em>P</em> <!--><<!--> <!-->.05) remained in the clinic; at 4<!--> <!-->years, 60.7% vs 15.6% (<em>P</em> <!--><<!--> <!-->.05) started RRT and 16.7% vs 52.3% (<em>P</em> <!--><<!--> <!-->.05) remained in the clinic. In the group with KFRE<<!--> <!-->10% those ≥<!--> <!-->75<!--> <!-->years vs <<!--> <!-->75<!--> <!-->years initiated RRT and died previously in a significantly different proportion at 2<!--> <!-->years: 1.2 vs 6.1% and 23.7 vs 6.1% respectively (<em>P</em> <!--><<!--> <!-->.05). In the group with KFRE ≥<!--> <!-->10% those ≥<!--> <!-->75<!--> <!-->years and those <<!--> <!-->75<!--> <!-->years initiated RRT and previously died in a significantly different proportion at 2<!--> <!-->years: 25.9 vs 46.4% and 32.1 vs 5.7%, respectively (<em>P</em> <!--><<!--> <!-->.05). Prediction models predicted all these differences quite accurately.</div></div><div><h3>Conclusions</h3><div>A KFRE ≥<!--> <!-->10% at 2<!--> <!-->years would be an appropriate criterion for referral to ACKD consultations, since it would select a group of patients who are really going to require RRT in the medium term, regardless of their age, and would avoid the referral of patients at low risk of requiring RRT, mainly elderly patients.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501412"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963325","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.2025.501414
Rafael Santamaria , Carlos Escobar , Unai Aranda , Beatriz Palacios , Margarita Capel , Ignacio Hernández , Ana Cebrián , Roberto Alcázar , Manuel Gorostidi
Aim
To determine the healthcare resource utilization and costs in patients with chronic kidney disease (CKD) across the KDIGO stages in real-world clinical practice in Spain.
Methods
Observational, retrospective study using the BIG-PAC database. Adults with ≥1 measurement of estimated glomerular filtration rate (eGFR) and albuminuria closest to 1st January 2018 were included. Annual healthcare resource utilization and healthcare costs per patient were analyzed within a two-year follow-up period.
Results
70,385 subjects were included, of whom 30.0% had CKD. The proportion of patients with ≥1 hospitalization ranged from 12.0% to 52.9% in categories G3a to G5 A1, from 6.0% to 47.4% in categories G1 to G5 A2 and from 13.5% to 69.8% in categories G1 to G5 A3. First year mean (SD) total cost ranged from 2486.65 (1724.25) to 16,085.75 (11,731.67), 1567.67 (1293.56) to 14,647.70 (11,031.45) and 2799.43 (1800.53) to 20,584.74 (11,563.63) Euros, respectively. Overall, the main driver for total cost was hospitalizations. All these numbers increased as eGFR declined or albuminuria increased and, in general, there was a slight decrease during the second year in all categories.
Conclusions
In real-world, CKD may be associated with high healthcare resource utilization and costs that increase as renal function worsens or albuminuria levels increase. Reducing economic burden through primordial and primary prevention policies, and comprehensive management with kidney protective drugs should be a priority.
{"title":"Healthcare resource utilization and costs of chronic kidney disease in Spain across KDIGO categories: Insights from real-world evidence","authors":"Rafael Santamaria , Carlos Escobar , Unai Aranda , Beatriz Palacios , Margarita Capel , Ignacio Hernández , Ana Cebrián , Roberto Alcázar , Manuel Gorostidi","doi":"10.1016/j.nefro.2025.501414","DOIUrl":"10.1016/j.nefro.2025.501414","url":null,"abstract":"<div><h3>Aim</h3><div>To determine the healthcare resource utilization and costs in patients with chronic kidney disease (CKD) across the KDIGO stages in real-world clinical practice in Spain.</div></div><div><h3>Methods</h3><div>Observational, retrospective study using the BIG-PAC database. Adults with ≥1 measurement of estimated glomerular filtration rate (eGFR) and albuminuria closest to 1st January 2018 were included. Annual healthcare resource utilization and healthcare costs per patient were analyzed within a two-year follow-up period.</div></div><div><h3>Results</h3><div>70,385 subjects were included, of whom 30.0% had CKD. The proportion of patients with ≥1 hospitalization ranged from 12.0% to 52.9% in categories G3a to G5 A1, from 6.0% to 47.4% in categories G1 to G5 A2 and from 13.5% to 69.8% in categories G1 to G5 A3. First year mean (SD) total cost ranged from 2486.65 (1724.25) to 16,085.75 (11,731.67), 1567.67 (1293.56) to 14,647.70 (11,031.45) and 2799.43 (1800.53) to 20,584.74 (11,563.63) Euros, respectively. Overall, the main driver for total cost was hospitalizations. All these numbers increased as eGFR declined or albuminuria increased and, in general, there was a slight decrease during the second year in all categories.</div></div><div><h3>Conclusions</h3><div>In real-world, CKD may be associated with high healthcare resource utilization and costs that increase as renal function worsens or albuminuria levels increase. Reducing economic burden through primordial and primary prevention policies, and comprehensive management with kidney protective drugs should be a priority.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501414"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963326","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.2025.501392
Luis Rafael Álvarez Velázquez
{"title":"Tunelización en «U» para catéteres femorales tunelizados: ¿una alternativa funcional y reproducible?","authors":"Luis Rafael Álvarez Velázquez","doi":"10.1016/j.nefro.2025.501392","DOIUrl":"10.1016/j.nefro.2025.501392","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501392"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963247","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.2025.501408
Ting Yu , Fengling Chen , Bing You , Xiaopan Zhang , Yilin Wang , Ying Huang , Xiang Shao , Bo Sun
Background
Diabetic nephropathy (DN) is a life-threatening complication of diabetes mellitus (DM) and the leading cause of end-stage renal disease. Ferroptosis, a novel iron-dependent mode of cell death, has been identified to participate in the pathogenesis of DN. Isorhynchophylline (IRN) is a tetracyclic indole oxide alkaloid present in Uncaria rhynchophylla (Rubiaceae), which shows protective effects against diabetic encephalopathy and acute kidney injury. Our study intends to determine whether IRN ameliorates DN progression through inhibiting ferroptosis.
Methods
The db/db diabetic mice and high glucose (HG)-stimulated human kidney tubular epithelial HK-2 cells were used to explore the potential therapeutic value of IRN in vivo and in vitro. Blood glucose levels, body weight, kidney weight, serum creatinine (SCr), blood urea nitrogen (BUN), and albumin-to-creatinine ratio (UACR) were detected to assess diabetic symptoms and renal functions in db/db mice. Hematoxylin–eosin (H&E) and periodic acid-Schiff staining (PAS) staining were performed to observe renal pathohistological changes in diabetic mice. Iron contents as well as malondialdehyde (MDA) and glutathione (GSH) in mouse tissue homogenates and HK-2 cell supernatants were examined to assess iron accumulation and oxidative stress. The levels of ferroptosis-related proteins and Nrf2/HO-1 signaling-related proteins as well as Nrf2 nuclear translocation in mouse renal tissues and HK-2 cells were detected by western blotting and immunofluorescence staining.
Results
IRN administration alleviated diabetic symptoms and improved renal functions in diabetic mice. IRN mitigated renal histologic damage, including glomerular hypertrophy, mesangial matrix accumulation, capillary basement membrane thickening, and thylakoid stroma expansion in diabetic mice. IRN treatment inhibited ferroptosis in both diabetic mice and HG-induced HK-2 cells by reducing iron content and MDA levels, elevating GSH levels, upregulating the protein levels of FTH-1, GPX4, and SLC7A11, and downregulating the protein levels ofTFR-1 and NCOA4. Mechanistically, IRN treatment enhanced Nrf2 and HO-1 protein levels and Nrf2 nuclear translocation in renal tissues of diabetic mice and HG-exposed HK-2 cells.
Conclusion
IRN plays a renoprotective role in DN by suppressing ferroptosis, which might be ascribed to the Nrf2/HO-1 pathway activation, highlighting the potential therapeutic application of IRN for DN treatment.
{"title":"Isorhynchophylline protects against ferroptosis in diabetic nephropathy by activating Nrf2","authors":"Ting Yu , Fengling Chen , Bing You , Xiaopan Zhang , Yilin Wang , Ying Huang , Xiang Shao , Bo Sun","doi":"10.1016/j.nefro.2025.501408","DOIUrl":"10.1016/j.nefro.2025.501408","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic nephropathy (DN) is a life-threatening complication of diabetes mellitus (DM) and the leading cause of end-stage renal disease. Ferroptosis, a novel iron-dependent mode of cell death, has been identified to participate in the pathogenesis of DN. Isorhynchophylline (IRN) is a tetracyclic indole oxide alkaloid present in <em>Uncaria rhynchophylla</em> (Rubiaceae), which shows protective effects against diabetic encephalopathy and acute kidney injury. Our study intends to determine whether IRN ameliorates DN progression through inhibiting ferroptosis.</div></div><div><h3>Methods</h3><div>The db/db diabetic mice and high glucose (HG)-stimulated human kidney tubular epithelial HK-2 cells were used to explore the potential therapeutic value of IRN <em>in vivo</em> and <em>in vitro</em>. Blood glucose levels, body weight, kidney weight, serum creatinine (SCr), blood urea nitrogen (BUN), and albumin-to-creatinine ratio (UACR) were detected to assess diabetic symptoms and renal functions in db/db mice. Hematoxylin–eosin (H&E) and periodic acid-Schiff staining (PAS) staining were performed to observe renal pathohistological changes in diabetic mice. Iron contents as well as malondialdehyde (MDA) and glutathione (GSH) in mouse tissue homogenates and HK-2 cell supernatants were examined to assess iron accumulation and oxidative stress. The levels of ferroptosis-related proteins and Nrf2/HO-1 signaling-related proteins as well as Nrf2 nuclear translocation in mouse renal tissues and HK-2 cells were detected by western blotting and immunofluorescence staining.</div></div><div><h3>Results</h3><div>IRN administration alleviated diabetic symptoms and improved renal functions in diabetic mice. IRN mitigated renal histologic damage, including glomerular hypertrophy, mesangial matrix accumulation, capillary basement membrane thickening, and thylakoid stroma expansion in diabetic mice. IRN treatment inhibited ferroptosis in both diabetic mice and HG-induced HK-2 cells by reducing iron content and MDA levels, elevating GSH levels, upregulating the protein levels of FTH-1, GPX4, and SLC7A11, and downregulating the protein levels ofTFR-1 and NCOA4. Mechanistically, IRN treatment enhanced Nrf2 and HO-1 protein levels and Nrf2 nuclear translocation in renal tissues of diabetic mice and HG-exposed HK-2 cells.</div></div><div><h3>Conclusion</h3><div>IRN plays a renoprotective role in DN by suppressing ferroptosis, which might be ascribed to the Nrf2/HO-1 pathway activation, highlighting the potential therapeutic application of IRN for DN treatment.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501408"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963324","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.2025.02.003
Miguel Angel María-Tablado
{"title":"Benefit of lipid control in chronic disease and diabetes: Beyond statins","authors":"Miguel Angel María-Tablado","doi":"10.1016/j.nefro.2025.02.003","DOIUrl":"10.1016/j.nefro.2025.02.003","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 101327"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963244","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.2025.501369
Ana Cunha , Beatriz Gil Braga , Sofia Sousa , João Pimenta , Bruno Fraga Dias , Cristina Freitas , Ana Castro
{"title":"Hemoadsorption with HA 380 as an adjuvant therapy in multiple myeloma","authors":"Ana Cunha , Beatriz Gil Braga , Sofia Sousa , João Pimenta , Bruno Fraga Dias , Cristina Freitas , Ana Castro","doi":"10.1016/j.nefro.2025.501369","DOIUrl":"10.1016/j.nefro.2025.501369","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 1","pages":"Article 501369"},"PeriodicalIF":2.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963245","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.2025.501411
Sonia Sharma , Ankur Gupta
Kidney transplantation (KT) is the most effective treatment for end-stage kidney disease. With advancements in modern immunosuppression, graft survival rates for standard-risk recipients have significantly improved, reaching approximately 95% in the first year, 85% at five years, and 65% at 10 years. However, long-term outcomes remain challenging due to chronic graft loss and drug-related toxicities. Immunosuppressive drugs, with narrow therapeutic range of safety and efficacy, require drug-monitoring strategies to optimize outcomes. In KT, the standard triple maintenance regimen of tacrolimus, mycophenolate mofetil (MMF), and prednisolone is practiced and MMF is typically administered as a fixed-dose drug. However, evidence suggests that dosage adjustments based on concentration monitoring yield superior clinical outcomes. MMF, an ester prodrug of mycophenolic acid (MPA), necessitates area under the concentration curve (AUC) monitoring due to its complex pharmacokinetics and an exposure level of 30–60 mg/L h is considered adequate for transplant recipients. However, fixed dosing practices continued, due to controversial evidence and lack of familiarity with AUC and monitoring techniques. AUC monitoring has also been proposed for tacrolimus, a calcineurin inhibitor (CNI), instead of routinely used trough concentration, particularly in “rapid metabolizers” who may experience higher peak concentrations and toxicities. To enhance transplant outcomes, a comprehensive understanding of AUC and relevance to immunosuppressant exposure is critical. This review will primarily focus on MPA AUC exposure in post-kidney transplant patients, explore and explain methods for AUC monitoring, and highlight recent developments in tacrolimus AUC monitoring.
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