Nefrologia最新文献

{"title":"Alfa-1-microglobulina en primera orina de la mañana. Interés clínico","authors":"María Carande del Río ,&nbsp;Nicolas R. Robles ,&nbsp;Alfonso Parejo Martín ,&nbsp;Cristina Xavier Aller ,&nbsp;Beatriz Sacristan Enciso ,&nbsp;Juan López Gómez","doi":"10.1016/j.nefro.2025.501447","DOIUrl":"10.1016/j.nefro.2025.501447","url":null,"abstract":"<div><h3>Introduction</h3><div>The reference sample for quantifying alpha-1-microglobulin is 24-hour urine. However, although it is usually quantified in the second urine sample of the morning, the first urine sample of the morning is the least influenced by the glomerular filtration rate. Likewise, there are conflicting opinions on the influence of age and gender on quantification.</div></div><div><h3>Patients and methods</h3><div>A total of 434 urine tests were selected, 182 with a glomerular filtration rate between 4 and 89<!--> <!-->ml/min/1.73 m² and 252 with a glomerular filtration rate &gt;90<!--> <!-->ml/min/1.73 m². Of these 252, 122 corresponded to first-morning urine samples with a density &gt;1015 and 130 to 24-hour urine samples with a urine volume between 400-3000<!--> <!-->m/24<!--> <!-->hours, without microalbuminuria. Of the 122, 30 had an alpha-1-microglobulin value &gt;4.3<!--> <!-->mg/l and corresponded to patients with diseases that cause tubular damage. The correlation between first morning and 24-hour alpha-1-microglobulin was performed with 42 urine samples, out of the 434 selected, for which both urine samples had been requested.</div></div><div><h3>Results</h3><div>The correlation between the first morning urine and 24-hour urine measurements was 0.92. No statistically significant differences were found between creatinine-corrected alpha-1-microglobulin with age, or between men and women in the first morning urine or 24-hour urine samples (<em>P</em>&gt;.05). The upper limit P_97.5 in normal individuals was 12.9<!--> <!-->mg/24<!--> <!-->hours and 7.08 mg/l/g creatinine in first morning urine. Approximately 77% of patients with creatinine-corrected alpha-1-microglobulin &gt;7.08 in first morning urine, without decreased glomerular filtration or microalbuminuria, were patients with hypertension or diabetes.</div></div><div><h3>Conclusion</h3><div>The first urine sample of the morning can be used to quantify alpha-1-microglobulin due to its good correlation with 24-hour urine samples, as well as not being affected by age or gender. A quantification &gt;7.08 mg/l/g creatinine in the first morning urine should raise suspicion of the onset of tubular damage, especially in hypertensive or diabetic patients.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 3","pages":"Article 501447"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147413307","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":"Intoxicación por metformina: características clínicas, tratamiento y pronóstico","authors":"Isabel Galcerán Herrera ,&nbsp;Clara Rosales Escorihuela ,&nbsp;Silvia Collado Nieto ,&nbsp;Mª Jesús López Casanova ,&nbsp;Oriol Pallas Villaronga ,&nbsp;Leire García Campo ,&nbsp;Marta Crespo ,&nbsp;August Supervía","doi":"10.1016/j.nefro.2025.501429","DOIUrl":"10.1016/j.nefro.2025.501429","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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&lt;<!--> <!-->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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 2","pages":"Article 501429"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090853","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":"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","authors":"Maria Jesús Puchades ,&nbsp;Juan Casas ,&nbsp;Julio Nuñez ,&nbsp;Elena Gimenez-Civera ,&nbsp;Boris Gonzales ,&nbsp;Marco Montomoli ,&nbsp;Rafael de la Espriella ,&nbsp;Miguel Gonzalez-Rico ,&nbsp;Isidro Torregrosa ,&nbsp;Carlos J. Peña ,&nbsp;Aleix Cases ,&nbsp;Jose Luis Gorriz","doi":"10.1016/j.nefro.2025.501418","DOIUrl":"10.1016/j.nefro.2025.501418","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>Forty-one patients completed the study. The 6-MWT increased from 296<!--> <!-->±<!--> <!-->101<!--> <!-->m to 314<!--> <!-->±<!--> <!-->106<!--> <!-->m at week 1 (<em>p</em> <!-->&lt;<!--> <!-->0.01), and to 325<!--> <!-->±<!--> <!-->111 meters at week 4 (<em>p</em> <!-->&lt;<!--> <!-->0.01). PGA, EQ-5D questionnaire and Piper Fatigue scale significantly improved at week 4 from baseline (<em>p</em> <!-->&lt;<!--> <!-->0.05), after adjustment in the last 2 variables. Hemoglobin levels did not increase significantly during the follow-up.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 2","pages":"Article 501418"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090851","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":"Irisin and the kidney: Key points to know?","authors":"Danilo Candido de Almeida ,&nbsp;Juan Sebastian Henao Agudelo","doi":"10.1016/j.nefro.2025.501443","DOIUrl":"10.1016/j.nefro.2025.501443","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 2","pages":"Article 501443"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090858","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":"Registro de aféresis terapéutica de la Sociedad Española de Nefrología. Análisis de la actividad en los últimos 5 años","authors":"E. Rodríguez ,&nbsp;L. Sánchez-Cámara ,&nbsp;E. Márquez ,&nbsp;A. Herreros ,&nbsp;S. Benito ,&nbsp;M. Fernández-Lucas ,&nbsp;M.V. Rubio ,&nbsp;R. Franquelo ,&nbsp;R. Escaño ,&nbsp;N. Ramos ,&nbsp;E. Tamarit ,&nbsp;J.M. Benlliure ,&nbsp;O. Siverio ,&nbsp;M.I. Gallardo ,&nbsp;M.P. Valenzuela ,&nbsp;E. Davin ,&nbsp;N. Martín-Alemany ,&nbsp;L.M. Cueto ,&nbsp;M.T. Padrón ,&nbsp;M.T. Rodrigo de Tomás ,&nbsp;D. Barraca","doi":"10.1016/j.nefro.2025.501413","DOIUrl":"10.1016/j.nefro.2025.501413","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Objective</h3><div>To describe the activity of nephrology services participating in the TA registry of the SEN (AFT-SEN) between 2019 and 2023.</div></div><div><h3>Material and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 2","pages":"Article 501413"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090855","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":"Kidney transplantation for the treatment of ESRD caused by hereditary type 2 Dent Nephropathy which carries a rare ORCL mutation","authors":"Chuanyou Xia ,&nbsp;Lingquan Meng ,&nbsp;Guanbao Tang ,&nbsp;Shuo Wang ,&nbsp;Panpan Han ,&nbsp;Xiaoming Zhang ,&nbsp;Jianning Wang ,&nbsp;Jiwei Yang","doi":"10.1016/j.nefro.2025.501415","DOIUrl":"10.1016/j.nefro.2025.501415","url":null,"abstract":"","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 2","pages":"Article 501415"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090852","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":"¿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,&nbsp;María José Ortega,&nbsp;Covadonga López del Moral,&nbsp;Rosalía Valero,&nbsp;Juan Carlos Ruiz,&nbsp;María de la Oliva Valentín,&nbsp;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 (-0.2<!--> <!-->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.</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}

{"title":"Eficacia de iptacopán en glomerulonefritis membranoproliferativa por inmunocomplejos idiopática refractaria al tratamiento convencional","authors":"Raquel López Hidalgo ,&nbsp;Mercedes Caba Molina ,&nbsp;Francisco Javier Ruiz Escolano ,&nbsp;Elena Delgado Sánchez de Murga ,&nbsp;Ma Teresa Fernández Quirós ,&nbsp;Ma José Espigares Huete","doi":"10.1016/j.nefro.2025.501426","DOIUrl":"10.1016/j.nefro.2025.501426","url":null,"abstract":"<div><div>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.</div><div>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.</div><div>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.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 2","pages":"Article 501426"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090750","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":"Glomerulonefritis fibrilar: características clínico-patológicas y tratamiento en un centro terciario español","authors":"Efraín Tatis ,&nbsp;Natalia Ramos Terrades ,&nbsp;María Alejandra Gabaldón ,&nbsp;Irene Agraz ,&nbsp;Marina López-Martinez ,&nbsp;Sara Núñez-Delgado ,&nbsp;Juan Carlos León ,&nbsp;Néstor Toapanta ,&nbsp;Sheila Bermejo ,&nbsp;Oriol Bestard ,&nbsp;María José Soler","doi":"10.1016/j.nefro.2025.501417","DOIUrl":"10.1016/j.nefro.2025.501417","url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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 &lt;<!--> <!-->500<!--> <!-->mg/g with normal renal function; partial remission as &gt;50% reduction in proteinuria to &lt;<!--> <!-->2000<!--> <!-->mg/g with stable renal function; and no remission as absence of improvement, progression to end-stage kidney disease (ESKD), or death.</div></div><div><h3>Results</h3><div>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 (&lt;3<!--> <!-->g/dL) was associated with worse prognosis (HR 6.52, <em>P</em>=.04); proteinuria &gt;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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 2","pages":"Article 501417"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090859","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":"Tele-nephrology in practice: Economic impact and primary care perspectives","authors":"Sofia Sousa ,&nbsp;Sofia Santos ,&nbsp;Beatriz Braga ,&nbsp;Ana Cunha ,&nbsp;Idalina Beirão","doi":"10.1016/j.nefro.2025.501432","DOIUrl":"10.1016/j.nefro.2025.501432","url":null,"abstract":"<div><h3>Aims</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":18997,"journal":{"name":"Nefrologia","volume":"46 2","pages":"Article 501432"},"PeriodicalIF":2.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090854","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}