Nefrologia最新文献

{"title":"Desafíos del embarazo en receptoras de trasplante de páncreas y riñón. Experiencia en nuestro centro","authors":"Ester Cholbi ,&nbsp;Elena Moreno Maestre ,&nbsp;Jordi Espí Reig ,&nbsp;Ana Paz Ventura Galiano ,&nbsp;Pablo González-Calero Borrás ,&nbsp;Diego Rodríguez Ortega ,&nbsp;María Ramos Cebrián ,&nbsp;Juan Francisco Merino Torres ,&nbsp;Beatriz Marcos Puig ,&nbsp;Eva María Montalvá Orón ,&nbsp;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}

{"title":"Peritoneal dialysis-related infections due to nontuberculous Mycobacteria in children and adolescents: A critical review of reported cases","authors":"John Dotis ,&nbsp;Antonia Kondou ,&nbsp;Vasiliki Karava ,&nbsp;Athina Papadopoulou ,&nbsp;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}

{"title":"Future directions of nsMRAs in CKD treatment: Focus on etiologic stratification and drug synergies","authors":"Songhe Chen ,&nbsp;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 ,&nbsp;Raquel Pinto ,&nbsp;Joaquim Milheiro ,&nbsp;Adriana Dias ,&nbsp;Joana Abreu ,&nbsp;Carla Lima ,&nbsp;Cátia Pêgo ,&nbsp;Tânia Sousa ,&nbsp;Rita Cabral ,&nbsp;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}

{"title":"El KFRE como criterio de remisión a las consultas de enfermedad renal crónica avanzada","authors":"Eduardo Gallego-Valcarce,&nbsp;Angela Rey-Cárdenas,&nbsp;Eva López-Melero,&nbsp;Ana María Tato-Ribera,&nbsp;Deborah Roldan,&nbsp;Sofía López San Román,&nbsp;Ángel Méndez Abreu,&nbsp;Clara Cases-Corona,&nbsp;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 &gt;<!--> <!-->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 &lt;<!--> <!-->30<!--> <!-->mL/min, we proposed a retrospective cohort study to evaluate whether the application of a KFRE &gt;<!--> <!-->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: &lt;<!--> <!-->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 &lt;<!--> <!-->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> <!-->&lt;<!--> <!-->.05) started RRT and 45.8% vs 79.8% (<em>P</em> <!-->&lt;<!--> <!-->.05) remained in the clinic; at 4<!--> <!-->years, 60.7% vs 15.6% (<em>P</em> <!-->&lt;<!--> <!-->.05) started RRT and 16.7% vs 52.3% (<em>P</em> <!-->&lt;<!--> <!-->.05) remained in the clinic. In the group with KFRE&lt;<!--> <!-->10% those ≥<!--> <!-->75<!--> <!-->years vs &lt;<!--> <!-->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> <!-->&lt;<!--> <!-->.05). In the group with KFRE ≥<!--> <!-->10% those ≥<!--> <!-->75<!--> <!-->years and those &lt;<!--> <!-->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> <!-->&lt;<!--> <!-->.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}

{"title":"Healthcare resource utilization and costs of chronic kidney disease in Spain across KDIGO categories: Insights from real-world evidence","authors":"Rafael Santamaria ,&nbsp;Carlos Escobar ,&nbsp;Unai Aranda ,&nbsp;Beatriz Palacios ,&nbsp;Margarita Capel ,&nbsp;Ignacio Hernández ,&nbsp;Ana Cebrián ,&nbsp;Roberto Alcázar ,&nbsp;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}

{"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}

{"title":"Isorhynchophylline protects against ferroptosis in diabetic nephropathy by activating Nrf2","authors":"Ting Yu ,&nbsp;Fengling Chen ,&nbsp;Bing You ,&nbsp;Xiaopan Zhang ,&nbsp;Yilin Wang ,&nbsp;Ying Huang ,&nbsp;Xiang Shao ,&nbsp;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&amp;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}

{"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}

{"title":"Hemoadsorption with HA 380 as an adjuvant therapy in multiple myeloma","authors":"Ana Cunha ,&nbsp;Beatriz Gil Braga ,&nbsp;Sofia Sousa ,&nbsp;João Pimenta ,&nbsp;Bruno Fraga Dias ,&nbsp;Cristina Freitas ,&nbsp;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}