Nefrologia最新文献_第7页

Recomendaciones para la evaluación y tratamiento del paciente con diabetes y albuminuria. Papel del antagonismo mineralocorticoide no esteroideo 糖尿病和蛋白尿患者的评估和治疗建议。非甾体类矿物皮质激素拮抗作用

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-11 DOI: 10.1016/j.nefro.2025.501359

Juan Payán López , Pedro Chinchurreta Capote , Antonio Hormigo Pozo , Luis Castilla-Guerra , José Carlos Fernández-García , Rosa Fernández Olmo , María José Espigares Huete

Patients with type 2 diabetes mellitus (T2DM) have an increased risk of developing chronic kidney disease (CKD). CKD is defined by both a decline in glomerular filtration rate and the presence of albuminuria. Although the measurement of the urine albumin-to-creatinine ratio is recommended from the time of T2DM diagnosis and subsequently at least once a year, in clinical practice, this assessment is underutilized in many patients. The pathophysiology of diabetic kidney disease involves hemodynamic, metabolic, pro-inflammatory, and pro-fibrotic factors. Likewise, in cardio-reno-metabolic syndrome, excessive or dysfunctional adiposity plays a fundamental role, promoting the development of kidney disease, T2DM and cardiovascular disease. Therefore, its management requires a multifactorial approach that includes the use of renin-angiotensin-aldosterone system inhibitors (targeting hemodynamic factors), SGLT2 inhibitors (targeting both hemodynamic and metabolic factors), finerenone (with anti-inflammatory and anti-fibrotic effects), and GLP-1 receptor agonists with demonstrated renal benefits (targeting metabolic factors), with the aim of more effectively slowing CKD progression and reducing the risk of cardiovascular complications. In this review article, we propose strategies to facilitate the proper assessment and implementation of guideline-recommended treatment in patients with diabetes and albuminuria, presenting a ten-point framework to improve the comprehensive and collaborative management of these patients.

2型糖尿病（T2DM）患者发生慢性肾脏疾病（CKD）的风险增加。CKD的定义是肾小球滤过率下降和蛋白尿的存在。虽然推荐从T2DM诊断时开始测量尿白蛋白与肌酐比值，随后每年至少一次，但在临床实践中，这种评估在许多患者中未得到充分利用。糖尿病肾病的病理生理涉及血流动力学、代谢、促炎和促纤维化因素。同样，在心肾代谢综合征中，过度或功能失调的肥胖在肾脏疾病、2型糖尿病和心血管疾病的发展中起着根本性的作用。因此，其管理需要多因素的方法，包括使用肾素-血管紧张素-醛固酮系统抑制剂（针对血流动力学因素），SGLT2抑制剂（针对血流动力学和代谢因素），芬烯酮（具有抗炎和抗纤维化作用），以及具有肾脏益处的GLP-1受体激动剂（针对代谢因素）。目的是更有效地减缓CKD的进展，降低心血管并发症的风险。在这篇综述文章中，我们提出了促进糖尿病和蛋白尿患者指南推荐治疗的正确评估和实施的策略，提出了一个十点框架，以改善对这些患者的综合和协作管理。

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引用次数: 0

Encuesta GLANCE: conocimiento e implementación de las recomendaciones del documento de GLOSEN para el diagnóstico y tratamiento de la nefritis lúpica GLANCE调查：了解和执行GLOSEN文件中关于狼疮肾炎诊断和治疗的建议

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-09 DOI: 10.1016/j.nefro.2025.501354

Manuel Macía , Gema Fernández-Juárez , Ana I. Ávila , Mar Espino , Mario Espinosa , Xavier Fulladosa , Clara García-Carro , Marian Goicoechea , Enrique Morales , Luis F. Quintana , Jorge E. Rojas-Rivera , Manuel Praga

In 2023, the Spanish Society of Nephrology's Glomerular Diseases Study Group (GLOSEN) published a consensus document containing the most pertinent information and clinical recommendations for the diagnosis, treatment, and follow-up of lupus nephritis (LN). GLANCE is a project that emerged from the need to evaluate the extent of knowledge and application of these GLOSEN recommendations in routine clinical practice for the management of LN. To achieve this, an online self-administered survey was conducted to gather opinions on the recommendations and assess their impact on clinical practice. Fifty-one Spanish nephrologists with more than three years of experience in managing LN and handling more than one LN patient per month, participated in the survey. All participants demonstrated a comprehensive understanding and high overall acceptance of the GLOSEN recommendations. However, discrepancies were noted regarding criteria for partial remission and relapse, as well as treatment goals during the initial months of progression, underscoring the need for a more detailed consensus. Other findings highlighted the limited number of nephrologists using specific scales to assess extrarenal manifestations and the tendency to extend immunosuppressive treatments beyond the recommended 3–5-year period outlined in the document. This emphasizes the necessity for further studies on the discontinuation of these drugs and their association with the risk of relapse in LN.

2023年，西班牙肾脏病学会肾小球疾病研究组（GLOSEN）发表了一份共识文件，其中包含狼疮肾炎（LN）的诊断、治疗和随访的最相关信息和临床建议。GLANCE是一个项目，旨在评估GLOSEN建议在LN管理的常规临床实践中的知识和应用程度。为了实现这一目标，进行了一项在线自我管理调查，以收集对建议的意见并评估其对临床实践的影响。51名西班牙肾病专家参与了调查，他们在管理肾病方面有三年以上的经验，并且每月处理1例以上的肾病患者。所有参与者都表现出对GLOSEN建议的全面理解和高度接受。然而，在部分缓解和复发的标准以及进展最初几个月的治疗目标方面存在差异，强调需要更详细的共识。其他研究结果强调，使用特定量表评估肾外表现的肾病学家数量有限，并且倾向于将免疫抑制治疗延长至文件中概述的推荐的3 - 5年期间。这强调了有必要进一步研究这些药物的停药及其与LN复发风险的关系。

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引用次数: 0

Ravulizumab como alternativa en la microangiopatía trombótica inducida por gemcitabina: reporte de un caso clínico Ravulizumab作为吉西他滨引起的血栓性微血管病的替代物：临床病例报告

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-09 DOI: 10.1016/j.nefro.2025.501356

Cristina Riaza Ortiz , Marta Calvo Arévalo , Marta Álvarez Nadal , Antonio Casado , Ana I. Sánchez-Fructuoso , Clara García-Carro

Thrombotic microangiopathy (TMA) is characterized by endotelial damage, microangiopathic hemolytic anemia, thrombocytopenia and organ damage, particularly renal. In oncology, TMA can be secondary to the cancer itself or related to oncological treatments. TMA associated with gemcitabine has a poor prognosis, with high mortality and complement activation plays a central role in its pathophisiology. While eculizumab has shown efficacy and improved outcomes in this condition, evidence regarding the use of ravulizumab remains scarce. We present the case of an 81-year-old woman with arterial hypertension and a history of left breast cancer treated with surgery and radiotherapy, currently diagnosed with stage iv left breast angiosarcoma treated with gemcitabine after progression on paclitaxel. She developed a hypertensive emergency, anemia (Hb 6.9 g/dL), thrombocytopenia (68,000 platelets), impaired renal function (creatinine 1.64 mg/dL) and elevated LDH (1,126 U/L). Suspecting gemcitabine-induced TMA, the treatment was discontinued and ravulizumab was initiated, resulting in rapid renal and hematological response. Oncological treatment with pazopanib was reintroduced, leading to recurrence of TMA. That treatment was suspended and another dose of ravulizumab was administered, with good response. TMA is a significant cause of morbidity and mortality in cancer patients, contributing to progression to chronic kidney disease and the discontinuation of oncological treatment. This case highlights the role of ravulizumab in gemcitabine-associated TMA, offering advantages in frail patients due to its longer half-life, reduced administration frequency and favorable outcomes.

血栓性微血管病（TMA）的特点是内皮损伤、微血管致病性溶血性贫血、血小板减少和器官损伤，特别是肾脏损伤。在肿瘤学中，TMA可能继发于癌症本身，也可能与肿瘤治疗有关。与吉西他滨相关的TMA预后差，死亡率高，补体激活在其病理病理中起核心作用。虽然eculizumab在这种情况下显示出疗效和改善的结果，但关于使用ravulizumab的证据仍然很少。我们报告了一例81岁的女性，她患有动脉高血压，曾接受过手术和放疗的左乳腺癌，目前诊断为iv期左乳腺血管肉瘤，在紫杉醇治疗进展后，经吉西他滨治疗。她出现了高血压急症、贫血（Hb 6.9 g/dL）、血小板减少（68,000个血小板）、肾功能受损（肌酐1.64 mg/dL）和LDH升高（1,126 U/L）。怀疑吉西他滨诱导的TMA，停止治疗并启动ravulizumab，导致肾脏和血液系统快速反应。再次使用帕唑帕尼进行肿瘤治疗，导致TMA复发。该治疗暂停，并给予另一剂量的ravulizumab，效果良好。TMA是癌症患者发病和死亡的一个重要原因，有助于慢性肾脏疾病的进展和肿瘤治疗的中断。该病例强调了ravulizumab在吉西他滨相关TMA中的作用，由于其半衰期较长、给药频率较低和预后良好，在虚弱患者中具有优势。

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引用次数: 0

From stage 1 to end-stage renal failure: Amyloid β42, amyloid β40, amyloid β42/40 ratio, p-tau181 and cognitive function relationship 从1期到终末期肾功能衰竭：淀粉样β42、淀粉样β40、淀粉样β42/40比值、p-tau181与认知功能的关系

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-09 DOI: 10.1016/j.nefro.2025.501357

Yasemin Coşkun Yavuz , Zeynep Biyik , Firdevs Sak , Muslu Kazım Korez , Sedat Abusoglu , Lutfullah Altintepe

Introduction and objective

It was aimed to examine the relationship between cognitive impairment (CI) and Aβ40, 42, Aβ42/40 ratio and p-tau181 in chronic kidney disease (CKD) patients at all stages.

Patients

The patients were divided into four groups; control, the early stage CKD (stage 1–3), the advanced stage CKD (stage 4–5) and the hemodialysis group. All patients completed the MMSE and MoCA tests for CI. The Aβ40, Aβ42, p-tau181 levels of all participants were measured.

Result

The result of the MMSE was significantly lower in CKD group (p = 0.005). There was a significant negative correlation between the MMSE and CKD stages (Spearman's rho = −0.29, p = 0.001). The Aβ42 level was significantly lower in the hemodialysis patients. The highest Aβ40 level was observed in the hemodialysis patients, and the Aβ40 level was significantly higher in the advanced CKD group as compared to the early CKD patients and controls (p < 0.001). The Aβ42/40 ratio was low in the hemodialysis patients (p = 0.001). There was a significant negative correlation between the MMSE and Aβ40 (Spearman's rho = 0.18, p = .018), and a positive correlation between the MMSE and the Aβ42/40 ratio (Spearman's rho = −0.360, p < .001). MoCA was negatively correlated with the Aβ40 levels (Spearman's rho = −0.185, p = .019). In the multiple analysis with the MMSE, it was determined high Aβ40 level was correlated with the low MMSE score.

Conclusion

It was found that there was a significant relationship between CI and the Aβ40 level in the CKD patients, that CI increased as the CKD stages progressed, that there was a significant negative correlation between the MMSE and MoCA tests and Aβ40, and there was a significant positive correlation between the MMSE and the Aβ42/Aβ40 ratio.

目的探讨慢性肾病（CKD）患者认知功能障碍（CI）与Aβ40、42、Aβ42/40比值及p-tau181的关系。患者将患者分为四组；对照组、早期CKD（1-3期）、晚期CKD（4-5期）和血液透析组。所有患者均完成了CI的MMSE和MoCA测试。测量所有参与者的a - β40、a - β42、p-tau181水平。结果CKD组MMSE评分明显低于CKD组（p = 0.005）。MMSE与CKD分期之间存在显著负相关（Spearman’s rho = - 0.29, p = 0.001）。血液透析患者Aβ42水平明显降低。Aβ40水平在血液透析患者中最高，且晚期CKD组Aβ40水平明显高于早期CKD患者和对照组（p < 0.001）。血液透析患者Aβ42/40比值较低（p = 0.001）。MMSE与a - β40呈显著负相关（Spearman’s rho = 0.18, p = 0.018）， MMSE与a - β42/40呈显著正相关（Spearman’s rho = - 0.360, p < 0.001）。MoCA与Aβ40水平呈负相关（Spearman’s rho = - 0.185, p = 0.019）。在与MMSE的多重分析中，确定了高Aβ40水平与低MMSE评分相关。结论CKD患者CI与a β40水平存在显著相关，CI随CKD分期的进展而升高，MMSE和MoCA与a β40呈显著负相关，MMSE与a β42/ a β40呈显著正相关。

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引用次数: 0

Novel evidence on the management of HCV-associated glomerular disease hcv相关肾小球疾病治疗的新证据

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-07 DOI: 10.1016/j.nefro.2025.501349

Fabrizio Fabrizi , Maria F. Donato , Carlo M. Alfieri , Manuel A. Podestà , Luca Nardelli , Giuseppe Castellano

Hepatitis C virus infection and chronic kidney disease are major public health issues globally and HCV plays activity in various organs and systems including kidneys. Recent large-scale epidemiological studies have highlighted the negative impact of HCV on the incidence and progression of chronic kidney disease in the adult general population of the western world. In addition, HCV-related glomerular disease is a well-known complication of chronic HCV and novel improvements concerning its management has been achieved. A novel systematic review with meta-analysis reported a strong relationship between HCV infection and higher risk of proteinuria in the general population. Twenty-three studies (n = 198,967 unique patients) were identified and overall effect estimate was significant in cross-sectional (OR, 1.47, 95% CI, 1.3; 1.66) (P < 0.001) and longitudinal surveys (HR, 1.79, 95% CI, 1.17; 2.74) (P < 0.001). The treatment of HCV-related glomerular disease includes now antiviral (direct-acting antiviral agents, DAAs), immunosuppressive and symptomatic drugs. In addition to selective immunosuppression (rituximab, RTX), various combinations of all-oral interferon-free regimens provided with fast and pangenotypic activity is giving us the possibility to treat patients with HCV-related glomerular disease, with and without kidney impairment, and to obtain some clinical benefit. We have collected by a narrative review of the medical literature a cohort of patients (n = 104) with HCV-related glomerular disease, the frequency of sustained viral response was 91% (90/99); complete or partial clinical response was found in 29% (n = 30) or 42% (n = 43), respectively. Recent evidence from a Spanish multicenter survey (n = 139 patients with HCV-related mixed cryoglobulinemia) suggests that successful antiviral therapy lowers significantly 24-h proteinuria, promotes immunological response and improves kidney/patient survival. In conclusion, HCV-related glomerulonephritis remains a difficult-to-treat disease even though the extensive use of DAAs has changed the natural history of HCV and made this disease uncommon.

丙型肝炎病毒感染和慢性肾脏疾病是全球主要的公共卫生问题，丙型肝炎病毒在包括肾脏在内的多个器官和系统中发挥活性。最近的大规模流行病学研究强调了HCV对西方成年人慢性肾脏疾病发病率和进展的负面影响。此外，HCV相关肾小球疾病是一种众所周知的慢性HCV并发症，其治疗已经取得了新的进展。一项新的系统综述与荟萃分析报告了HCV感染与普通人群蛋白尿高风险之间的密切关系。共确定了23项研究（n = 198,967例独特患者），在横断面调查（OR, 1.47, 95% CI, 1.3; 1.66）（P < 0.001）和纵向调查（HR, 1.79, 95% CI, 1.17; 2.74）（P < 0.001）中，总体效果估计是显著的。目前丙型肝炎相关肾小球疾病的治疗包括抗病毒药物（直接作用抗病毒药物，DAAs）、免疫抑制剂和对症药物。除了选择性免疫抑制（利妥昔单抗，RTX）外，各种具有快速和泛型活性的全口服无干扰素方案的组合，使我们有可能治疗伴有或不伴有肾脏损害的hcv相关肾脏病患者，并获得一些临床益处。我们通过对医学文献的叙述性回顾收集了一组hcv相关肾小球疾病患者（n = 104），持续病毒反应的频率为91% (90/99)；完全或部分临床缓解分别为29% （n = 30）和42% （n = 43）。最近来自西班牙多中心调查（n = 139例hcv相关混合冷球蛋白血症患者）的证据表明，成功的抗病毒治疗可显著降低24小时蛋白尿，促进免疫反应并提高肾脏/患者生存率。总之，尽管DAAs的广泛使用改变了HCV的自然史，使这种疾病变得罕见，但HCV相关的肾小球肾炎仍然是一种难以治疗的疾病。

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引用次数: 0

External validation of a predictive model for one-year mortality in incident hemodialysis patients: A Portuguese cohort 突发血液透析患者一年死亡率预测模型的外部验证：一项葡萄牙队列研究

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-06 DOI: 10.1016/j.nefro.2025.501346

Telma Pais , Beatriz Teixeira , Miguel Carrilho , José Agapito Fonseca , Cristina Outerelo , Sofia Jorge , Cristina Resina , José António Lopes , Joana Gameiro

Background

Prognostic assessment after starting hemodialysis is challenging, with mortality in the first year estimated to be 15%. Clark et al. developed the Recovery and Death Outcome risk score, which accurately predicted the likelihood of renal recovery to dialysis independence and of death within 1 year after in-hospital dialysis initiation, respectively. We aimed to validate the Death Outcome risk score to predict one-year mortality after dialysis start in our population.

Methods

Retrospective analysis of hospitalized patients starting hemodialysis in a tertiary-care hospital from January 1st, 2016, to December 31st, 2019. All-cause mortality risk one year after discharge was calculated according to the ReDO Death score. Patients were classified into death outcome risk groups and Cox regression was used to determine if the risk score was predictive of one-year mortality. The discriminatory ability for the ReDO Death score to predict mortality was determined using the receiver operating characteristic (ROC) curve.

Results

Three hundred sixty-nine patients were included, mostly male (59.9%), with mean age 71.1 ± 14.3 years and median Charlson score 7 ± 3. The one-year mortality rate was 22.2%. The ReDO Death score accurately predicted the one-year risk of mortality, with an area under the ROC of 0.741 [95% CI (0.687–0.794), p < 0.001]. The optimal REDO Death risk cut-off was >30%, with a hazard ratio of 6.57 [95% CI (3.48–12.2), p < 0.001] for one-year mortality risk (sensitivity 78.0% and specificity 60.6%).

Conclusion

We validated the ReDO Death score for 1-year mortality prediction after starting hemodialysis during hospitalization in a Portuguese population. This score can be used as a tool to inform goals-of-care discussion at the time of transition to out-of-hospital care.

开始血液透析后的预后评估具有挑战性，第一年的死亡率估计为15%。Clark等人开发了恢复和死亡结局风险评分，分别准确预测肾恢复到透析独立的可能性和住院透析开始后1年内死亡的可能性。我们的目的是验证死亡结局风险评分，以预测我们人群开始透析后一年的死亡率。方法回顾性分析2016年1月1日至2019年12月31日在某三级医院开始血液透析的住院患者。出院后1年的全因死亡风险根据ReDO死亡评分计算。将患者分为死亡结局风险组，并使用Cox回归来确定风险评分是否可预测一年死亡率。使用受试者工作特征（ROC）曲线确定ReDO Death评分预测死亡率的区分能力。结果共纳入369例患者，男性居多（59.9%），平均年龄71.1±14.3岁，Charlson评分中位数为7±3分。1年死亡率为22.2%。ReDO Death评分准确预测1年死亡风险，ROC下面积为0.741 [95% CI (0.687-0.794), p <；0.001]。最佳REDO死亡风险临界值为30%，风险比为6.57 [95% CI (3.48-12.2), p <；0.001]的1年死亡风险（敏感性78.0%，特异性60.6%）。结论：我们验证了葡萄牙人群住院期间开始血液透析后1年死亡率预测的ReDO死亡评分。这个分数可以作为一种工具，告知在过渡到院外护理时的护理目标讨论。

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引用次数: 0

Oxalate stones in a cystinuria patient 胱氨酸尿病患者的草酸结石

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-06 DOI: 10.1016/j.nefro.2025.501348

Matthias Grech, Julian Delicata

引用次数: 0

Are your kidneys ok? Detect early to protect kidney health 你的肾脏还好吗？及早发现，保护肾脏健康

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-05 DOI: 10.1016/j.nefro.2025.501344

Joseph A. Vassalotti , Anna Francis , Augusto Cesar Soares Dos Santos Jr , Ricardo Correa-Rotter , Dina Abdellatif , Li-Li Hsiao , Stefanos Roumeliotis , Agnes Haris , Latha A. Kumaraswami , Siu-Fai Lui , Alessandro Balducci , Vassilios Liakopoulos , World Kidney Day Joint Steering Committee

Early identification of kidney disease can protect kidney health, prevent kidney disease progression and related complications, reduce cardiovascular disease risk and decrease mortality. We must ask “Are your kidneys ok?” using serum creatinine to estimate kidney function and urine albumin to assess for kidney and endothelial damage. Evaluation for causes and risk factors for chronic kidney disease (CKD) includes testing for diabetes and measurement of blood pressure and body mass index. This World Kidney Day we assert that case finding in high-risk populations, or even population level screening, can decrease the burden of kidney disease globally. Early-stage CKD is asymptomatic, simple to test for and recent paradigm shifting CKD treatments such as sodium glucose co-transporter-2 inhibitors dramatically improve outcomes and favor the cost-benefit analysis for screening or case-finding programs. Despite this, numerous barriers exist, including resource allocation, healthcare funding, healthcare infrastructure and healthcare-professional and population awareness of kidney disease. Coordinated efforts by major kidney non-governmental organizations to prioritise the kidney health agenda for governments and aligning early detection efforts with other current programs will maximise efficiencies.

早期发现肾脏疾病可以保护肾脏健康，预防肾脏疾病进展及相关并发症，降低心血管疾病风险，降低死亡率。我们必须问“你的肾脏还好吗？”用血清肌酐评估肾功能，用尿白蛋白评估肾脏和内皮损伤。对慢性肾脏疾病（CKD）的病因和危险因素的评估包括糖尿病的检测和血压和体重指数的测量。在这个世界肾脏日，我们断言，在高危人群中发现病例，甚至在人群水平上进行筛查，可以减轻全球肾脏疾病的负担。早期CKD无症状，易于检测，最近的CKD治疗如葡萄糖共转运蛋白-2抑制剂显著改善了预后，有利于筛查或病例发现项目的成本效益分析。尽管如此，仍然存在许多障碍，包括资源分配、卫生保健资金、卫生保健基础设施以及卫生保健专业人员和人口对肾脏疾病的认识。主要的肾脏非政府组织协调努力，优先考虑政府的肾脏健康议程，并将早期检测工作与其他现有项目结合起来，将最大限度地提高效率。

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引用次数: 0

Afectación renal en el síndrome de Sjögren: más allá de la nefritis tubulointersticial Sjogren综合征肾脏疾病：管间性肾炎以外

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-04 DOI: 10.1016/j.nefro.2025.501341

Óscar Porto Fuentes , Javier González Cepeda , Cristina Vega Cabrera , José Manuel Martín de Bustamante , Ángel Robles Marhuenda , Jorge Álvarez Troncoso , Elena Martínez Robles , Ana Noblejas Mozo , Juan José Ríos Blanco , Eugenia García Fernández , Clara Itzíar Soto Abánades

引用次数: 0

The multiple functions of insulin-like growth factor 1 in kidney disease 胰岛素样生长因子1在肾脏疾病中的多重功能

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-06-04 DOI: 10.1016/j.nefro.2025.501337

Juan Miguel Díaz Tocados , Aurora Pérez Gómez , Juan Diego Domínguez Coral , José Manuel Valdivielso

Unilateral nephrectomy (Uni-Nx) produces compensatory hypertrophy of the remnant kidney. In this anabolic process, the upregulation of renal insulin-like growth factor 1 (IGF-1) plays a key role, which has inspired numerous studies considering the potential regenerative actions of the IGF-1 and the subsequent increase in the glomerular filtration rate. Thus, IGF-1 administration has shown to be able to induce renal hypertrophy, increase glomerular size and enhance glomerular filtration rate, without reaching glomerulosclerosis. Moreover, protein uptake also contributes to renal hypertrophy by increasing renal and circulating IGF-1 levels. In this respect, circulating IGF-1 concentration has been used as a marker of the nutritional status in end-stage CKD patients and has been associated with hormones that participate in the regulation of appetite. Moreover, IGF-1 regulate mineral metabolism, participating in phosphate resorption and calcitriol production by increasing 1-α-hydroxylase activity. Furthermore, IGF-1 is key for bone growth in pediatric patients, acting directly in chondrocytes, osteoblasts and, in a lesser manner, in osteoclasts. In addition, IGF-1 is an important inductor of erythroid proliferation, being able to maintain erythrocytic homeostasis in anephric patients. Nevertheless, the actions of the IGF-1 are attenuated in the context of renal disease, which may be promoted by the presence of inhibitory factors, such as the IGF binding proteins, and inability to trigger intracellular downstream signaling despite of normal IGF-1 receptor expression in cell surface. This review highlights the importance of the IGF-1 in the context of CKD and its potential contribution to renal and also systemic disorders.

单侧肾切除术（Uni-Nx）产生残余肾代偿性肥大。在这个合成代谢过程中，肾胰岛素样生长因子1 （IGF-1）的上调起着关键作用，这激发了许多研究，考虑到IGF-1的潜在再生作用以及随后肾小球滤过率的增加。因此，IGF-1可以诱导肾肥大，增大肾小球大小，提高肾小球滤过率，但不会导致肾小球硬化。此外，蛋白质摄取也通过增加肾脏和循环中的IGF-1水平来促进肾脏肥大。在这方面，循环IGF-1浓度已被用作终末期CKD患者营养状况的标志，并与参与食欲调节的激素有关。此外，IGF-1调节矿物质代谢，通过增加1-α-羟化酶活性参与磷酸盐的吸收和骨化三醇的产生。此外，IGF-1是儿童患者骨生长的关键，直接作用于软骨细胞、成骨细胞，并以较小的方式作用于破骨细胞。此外，IGF-1是红细胞增殖的重要诱导剂，能够维持肾衰患者的红细胞稳态。然而，在肾脏疾病的情况下，IGF-1的作用减弱，这可能是由于抑制因子的存在，如IGF结合蛋白，以及尽管细胞表面正常的IGF-1受体表达，但无法触发细胞内下游信号传导。这篇综述强调了IGF-1在CKD背景下的重要性及其对肾脏和全身疾病的潜在贡献。

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引用次数: 0