Nefrologia最新文献

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

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-11-01 Epub Date: 2025-07-22 DOI: 10.1016/j.nefro.2025.501390

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

引用次数: 0

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 : 2025-11-01 Epub 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

Increased serum phosphate concentration within the normal reference levels is associated with all-cause mortality in non-dialysis CKD patients: A five-year prospective cohort study 非透析慢性肾病患者血清磷酸盐浓度在正常参考水平内升高与全因死亡率相关：一项为期五年的前瞻性队列研究

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-11-01 Epub Date: 2025-06-13 DOI: 10.1016/j.nefro.2025.501352

Ana Cerqueira , Janete Quelhas-Santos , Núria Paulo , Claúdia Camila Dias , Manuel Pestana

Introduction and objectives

Cardiovascular (CV) morbidity and mortality are markedly increased in non-dialysis patients with chronic kidney disease (CKD). Thus, the precise management of CV risk factors involved in CKD is crucial to improving outcomes. Serum phosphate (Pi) and FGF-23 levels have been linked with a higher risk of CV events in CKD. However, the exact thresholds of Pi and FGF-23, at which the risk of adverse events increases remain unknown.

Materials and methods

We evaluated the expression of intact FGF-23 (iFGF-23) and Pi in a non-dialysis CKD patient population (n = 82; 42M:40F; median age 61 years) and investigated their association with CV and renal outcomes, in a five-year follow-up period.

Results

At baseline, the median estimated glomerular filtration rate (eGFR), iFGF-23, and Pi were 45 mL/min/1.73 m² (IQ 26.6–73.1), 69.9 μg/mL (IQ 33–117) and 3.4 mg/dL (IQ 3.3–3.9), respectively. Univariate analysis showed a strong association of both iFGF-23 and Pi with age, Charlson Comorbidity Index, hypertension, and diabetes. In addition, iFGF-23 and Pi were both associated with the composite outcome (major CV and cerebrovascular events – MACCEs, hospitalizations, and all-cause mortality) during follow-up. Moreover, Pi was independently associated with all-cause mortality during follow-up. The segmentation of the population in terciles, according to Pi (<3 mg/dL; 3–3.6 mg/dL; ≥3.7 mg/dL) within reference serum levels, showed a distribution of the fatality of 0%, 20% and 80% (p = 0.034), respectively.

Conclusions

Our results reinforce the association of both iFGF-23 and Pi with composite CV outcomes in non-dialysis CKD patients and further suggest that Pi, within current reference levels, may behave as an independent risk factor for mortality in this population. It is suggested that reassessing Pi reference levels for early therapeutic intervention in this population may be justified.

介绍和目的：慢性肾脏疾病（CKD）非透析患者的心血管（CV）发病率和死亡率显著增加。因此，精确管理CKD相关的心血管危险因素对改善预后至关重要。血清磷酸盐（Pi）和FGF-23水平与CKD中心血管事件的高风险相关。然而，不良事件风险增加的Pi和FGF-23的确切阈值仍然未知。材料和方法我们在一个非透析CKD患者群体（n = 82; 42M:40F；中位年龄61岁）中评估了完整的FGF-23 （iFGF-23）和Pi的表达，并在5年的随访期间研究了它们与CV和肾脏结局的关系。结果基线时，肾小球滤过率（eGFR）、iFGF-23和Pi的中位数分别为45 mL/min/1.73 m2 （IQ 26.6-73.1）、69.9 μg/mL （IQ 33-117）和3.4 mg/dL （IQ 3.3-3.9）。单因素分析显示，iFGF-23和Pi与年龄、Charlson合并症指数、高血压和糖尿病有很强的相关性。此外，在随访期间，iFGF-23和Pi均与复合结局（主要心血管和脑血管事件- MACCEs，住院和全因死亡率）相关。此外，Pi与随访期间的全因死亡率独立相关。根据参考血清水平内的Pi值（<3 mg/dL; 3 - 3.6 mg/dL;≥3.7 mg/dL）对种群进行分割，死亡率分布分别为0%、20%和80% （p = 0.034）。在非透析CKD患者中，研究结果强化了iFGF-23和Pi与复合CV结果的关联，并进一步表明Pi在当前参考水平范围内可能是该人群死亡的独立危险因素。因此，重新评估Pi参考水平对该人群进行早期治疗干预可能是合理的。

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引用次数: 0

Sarcopenia: la importancia de las fórmulas 骨骼肌萎缩症：公式的重要性

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-11-01 Epub Date: 2025-06-12 DOI: 10.1016/j.nefro.2025.501367

José Ignacio Minguela Pesquera, Iñigo Moina Eguren

引用次数: 0

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 : 2025-11-01 Epub 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

Tacrolimus formulations in de novo kidney transplantation: Evidence from a paired kidney study 他克莫司制剂在新生肾移植中的应用：来自配对肾脏研究的证据

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-10-01 Epub Date: 2025-06-07 DOI: 10.1016/j.nefro.2025.501351

Verónica López , Juan Pablo Gámez , Myriam León , Juana Alonso-Titos , Cristina Gutiérrez , Carolina Polo , Teresa Vázquez , Pedro Ruiz-Esteban , Domingo Hernández

引用次数: 0

Promoviendo giros en el manejo de la enfermedad renal del paciente con obesidad 促进扭转肥胖患者肾病的管理

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-10-01 Epub Date: 2025-06-09 DOI: 10.1016/j.nefro.2025.501358

Albert Lecube , Jorge Iván Zamora , Sharona Azriel , Esther Barreiro , Guadalupe Blay , Juana Carretero-Gómez , Andreea Ciudin , José Manuel Fernández-García , Lilliam Flores , Ana de Hollanda , Marina López-Martínez , Eva Martínez , Inka Miñambres , Violeta Moizé , Cristóbal Morales , Violeta Ramírez , Javier Salvador , Marta Supervía , Víctor Valentí , Germán Vicente-Rodríguez , María José Soler

引用次数: 0

Relevancia de las interacciones entre el complemento y el sistema de contacto de la coagulación en la enfermedad renal 肾病中补充剂与凝血接触系统相互作用的相关性

IF 2.6 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia

Pub Date : 2025-10-01 Epub Date: 2025-06-06 DOI: 10.1016/j.nefro.2025.501347

Alberto López-Lera , Fernando Corvillo , Laura González-Sánchez , Marta Melgosa , Pilar Sánchez-Corral

The complement system is a network of soluble and cell surface proteins primarily involved in innate immune responses. Complement signalling is essential for pathogen defence and homeostasis, but an activation-regulation imbalance can lead to tissue damage. This phenomenon has been implicated in kidney diseases such as atypical Haemolytic Uraemic Syndrome (aHUS), frequently associated with dysfunction of the complement regulator Factor H (FH). Physiologically, complement interacts with the coagulation, fibrinolysis, renin-angiotensin and kallikrein-kinin systems (KKS). The KKS is a proinflammatory and procoagulant cascade comprised of the protease prekallikrein, the coagulation factors XI (FXI) and XII (FXII), and the cofactor/substrate high-molecular-weight kininogen. KKS can be activated conformationally or proteolytically. KKS activation in vitro triggers a number of biochemical interactions between FXI, FXII, FH and other complement proteins that result in direct or secondary complement activation. These functional links point to an overall complement pro-activating role for the KKS that has implications for coagulation and immunity, but whose physiological consequences in vivo remain largely unexplored. This review aims to summarize the main physiopathological events of KKS activation in the context of complement-mediated kidney disease, with particular emphasis in aHUS.

补体系统是一个由可溶性蛋白和细胞表面蛋白组成的网络，主要参与先天免疫反应。补体信号对病原体防御和体内平衡至关重要，但激活调节失衡可能导致组织损伤。这种现象与肾脏疾病有关，如非典型溶血性尿毒综合征（aHUS），通常与补体调节因子H （FH）功能障碍有关。生理上，补体与凝血、纤溶、肾素-血管紧张素和钾化钾素-激肽系统（KKS）相互作用。KKS是一种促炎和促凝级联蛋白，由蛋白酶prekallikrein、凝血因子XI （FXI）和XII （FXII）以及辅助因子/底物高分子量激肽原组成。KKS可以被构象或蛋白水解激活。体外KKS激活触发FXI、FXII、FH和其他补体蛋白之间的一系列生化相互作用，导致直接或次生补体激活。这些功能联系表明，KKS具有整体补体促激活作用，对凝血和免疫有影响，但其在体内的生理后果仍未得到充分研究。本综述旨在总结补体介导的肾脏疾病中KKS激活的主要生理病理事件，特别强调在aHUS中。

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引用次数: 0

Validación multicéntrica de la fórmula Kidney Failure Risk Equation (KFRE) en pacientes españoles con enfermedad renal crónica avanzada 西班牙晚期慢性肾病患者肾脏失败风险方程式（KFRE）的多中心验证

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