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Immune Complex-Mediated Membranoproliferative Glomerulonephritis Secondary to Primary Biliary Cholangitis: A Rare Case Report 继发于原发性胆汁性胆管炎的免疫复合物介导的膜增生性肾小球肾炎:罕见病例报告
Pub Date : 2024-07-04 DOI: 10.33590/emjnephrol/lqjl1550
Kadir Intas, G. Okyay, A. Sağlam, M. Aylı
Immune complex-mediated membranoproliferative glomerulonephritis (iMPGN) can develop in association with autoimmune diseases such as primary biliary cholangitis (PBC), a chronic cholestatic liver disease characterised by destruction of the small and medium-sized bile ducts. Although the pathogenesis cannot be clearly defined, iMPGN and PBC overlap through the activation of innate and adaptive immune cells and the production of proinflammatory mediators. In this report, the authors present a case in which iMPGN and PBC were diagnosed simultaneously.
免疫复合物介导的膜增生性肾小球肾炎(iMPGN)可与原发性胆汁性胆管炎(PBC)等自身免疫性疾病同时发生,原发性胆汁性胆管炎是一种慢性胆汁淤积性肝病,其特点是中小型胆管遭到破坏。虽然发病机制尚不明确,但 iMPGN 和 PBC 通过激活先天性和适应性免疫细胞以及产生促炎介质而相互重叠。在本报告中,作者介绍了一例同时诊断出 iMPGN 和 PBC 的病例。
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引用次数: 0
Influence of Potassium Intake on the Renoprotective Response to Sodium Restriction and Hydrochlorothiazide in Patients with Diabetic Nephropathy 钾摄入对糖尿病肾病患者钠限制和氢氯噻嗪肾保护反应的影响
Pub Date : 2024-07-04 DOI: 10.33590/emjnephrol/wxnl1545
Caspar Lieshout, L. Vogt, A. Kwakernaak, M. Hemmelder, Goos Laverman, Gerjan Navis, Martin Borst
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引用次数: 0
ERA 2024 Interview: Peter Stenvinkel ERA 2024 访谈:彼得-斯滕文克尔
Pub Date : 2024-07-04 DOI: 10.33590/emjnephrol/cxaz4342
P. Stenvinkel
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引用次数: 0
Kidneys and Blood Pressure: A Key Link 肾脏与血压关键环节
Pub Date : 2024-07-04 DOI: 10.33590/emjnephrol/newl9732
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引用次数: 0
Accessibility and Affordability Issues for Renal Replacement Therapy Remain Challenges in Resource-Limited Healthcare Settings: A Case Report and Critique of Literature for Chronic Kidney and End-Stage Renal Disease 在资源有限的医疗环境中,肾脏替代疗法的可及性和可负担性问题仍是一项挑战:慢性肾病和终末期肾病病例报告和文献综述
Pub Date : 2024-07-04 DOI: 10.33590/emjnephrol/jukr8145
Janvier Nzayikorera
Chronic kidney disease (CKD) continues to be a global public health problem. Globally, the prevalence of CKD is approximately 8–16% in the general population. Most patients with CKD advance to kidney failure and require dialysis or kidney transplantation. Screening for CKD, diagnosing CKD, treating CKD and its consequences to stop its progression, and renal replacement therapy (RRT) are all parts of comprehensive CKD care. A 28-year-old male presented with complaints of awareness of his heart beating, abdomen and lower limb swelling, and generalised body weakness for 2 days. His blood pressure was 222/147 mmHg on admission day. Six days post-admission, he displayed violent chest pain and dyspnoea, along with profound generalised body swelling. Laboratory studies revealed creatinine of 22.49 mg/dL (0.6–1.1), urea of 236.5 mg/dL (10.0–50), albumin of 2.15 mg/dL (3.8–5.1), potassium of 7.19 mmol/L (3.5–5.5), and haemoglobin of 6.2 g/dL (8.0–17.0). The diagnoses of uremic pericarditis, pulmonary oedema, hyperkalaemia, hypertensive emergency, and normochromic anaemia secondary to end-stage renal diseases were made. He qualified for the RRT. CKD is a serious, non-communicable disease that is commonly encountered in clinical practice in both developed and developing countries and needs the utmost attention. RRT is crucial for comprehensive CKD management; however, in resource-limited healthcare settings, RRT is non-accessible and non-affordable. The lack of RRT marks the mistreatment of patients with renal diseases by the global healthcare system. The author calls for designing new strategies that aim to ensure equitable accessibility and affordability for RRT globally.
慢性肾脏病(CKD)仍然是一个全球性的公共卫生问题。在全球范围内,慢性肾脏病的发病率约占总人口的 8-16%。大多数慢性肾脏病患者会发展到肾衰竭,需要透析或肾移植。筛查慢性肾功能衰竭、诊断慢性肾功能衰竭、治疗慢性肾功能衰竭及其后果以阻止其进展以及肾脏替代疗法(RRT)都是慢性肾功能衰竭综合治疗的组成部分。一名 28 岁的男性前来就诊,主诉两天来一直感觉心脏跳动、腹部和下肢肿胀、全身无力。入院当天血压为 222/147 mmHg。入院六天后,他出现剧烈胸痛和呼吸困难,全身浮肿。实验室检查显示肌酐为 22.49 mg/dL(0.6-1.1),尿素为 236.5 mg/dL(10.0-50),白蛋白为 2.15 mg/dL(3.8-5.1),钾为 7.19 mmol/L(3.5-5.5),血红蛋白为 6.2 g/dL(8.0-17.0)。他被诊断为尿毒症性心包炎、肺水肿、高钾血症、高血压急症和终末期肾病继发的正常色素性贫血。他符合接受 RRT 的条件。慢性肾脏病是一种严重的非传染性疾病,在发达国家和发展中国家的临床实践中都很常见,需要引起高度重视。RRT 对于全面治疗慢性肾脏病至关重要;然而,在资源有限的医疗环境中,RRT 无法获得,也负担不起。缺乏 RRT 标志着全球医疗保健系统对肾病患者的虐待。作者呼吁制定新的战略,旨在确保全球范围内 RRT 的公平可及性和可负担性。
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引用次数: 0
Is Lack of Consensus on the Management of Chronic Active Antibody-Mediated Rejection Harming Renal Transplant Recipients? 对慢性活动性抗体介导排斥反应的处理缺乏共识是否会伤害肾移植受者?
Pub Date : 2024-04-04 DOI: 10.33590/emjnephrol/11000024
L. Rostaing
In 2022, over 92,000 kidney transplants were performed globally. With advancements in transplant science, 1-year graft survival rates have reached 94.3% for deceased donor kidney transplant recipients, and 97.8% for living recipients. However, 5-year graft survival remains at 76.3% and 86.5%. Antibody-mediated rejection (AMR) is one of the most common causes of immune-related allograft rejection. Chronic active AMR (CABMR) typically develops 6–12 months post-transplant; 76% of kidney transplant recipients with CABMR experience graft loss 1.9 years after diagnosis. Despite these alarming figures, consensus guidelines on the management of post-transplant patients have not been updated with advancements in testing and protocol biopsies, and there is currently no consensus in Europe on CABMR management.
2022 年,全球共进行了 92,000 多例肾移植手术。随着移植科学的进步,已故捐赠肾移植受者的 1 年移植物存活率达到 94.3%,活体受者的 1 年移植物存活率达到 97.8%。然而,5 年移植物存活率仍分别为 76.3% 和 86.5%。抗体介导的排斥反应(AMR)是免疫相关异体移植排斥反应最常见的原因之一。慢性活动性AMR(CABMR)通常在移植后6-12个月出现;76%患有CABMR的肾移植受者在确诊1.9年后出现移植物丢失。尽管这些数字令人震惊,但有关移植后患者管理的共识指南并未随着检测和活检方案的进步而更新,目前欧洲尚未就 CABMR 的管理达成共识。
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引用次数: 0
The Effect of Tip Placement on Fibrin Sheath Formation in Poorly Functioning Tunnelled Haemodialysis Lines 针尖放置对功能不佳的隧道血液透析线纤维蛋白鞘形成的影响
Pub Date : 2023-07-27 DOI: 10.33590/emjnephrol/10307734
Jordan Loon, J. Woodley-Cook
Background and Objectives: Fibrin sheath formation is a common cause of haemodialysis (HD) line dysfunction requiring frequent interventional line exchanges. This study assessed HD tip and line placement, line length, and demographics in poorly functioning HD lines due to fibrin sheath formation, to determine if there is a correlation between these factors and repeatedly poor function.Patients and Methods: Patient medical records were retrospectively reviewed to include those who have had poorly functioning HD lines with fluoroscopic evidence of a fibrin sheath from 2011–2019. Analysis of variance and t-tests were performed to determine the significance of various factors on the time until a line exchange was required.Results: Patients with an HD tip placed in the inferior vena cava underwent an exchange the soonest (130.23 days), while tips in the superior vena cava went the longest without required intervention (968.80 days; p=0.007). Lines in the left internal jugular vein had the most days without intervention, and lines in the femoral vein had the least (1,132.80 versus 142.50 days, respectively; p=0.007). Furthermore, 19 cm lines went 816.75 days without intervention, and 42 cm lines went 114.73 days without intervention (p=0.049). Intervention-free days decreased if the patient had undergone previous interventions (p<0.001). Patients with diabetes required intervention before those without diabetes (694.09 versus 917.08 days, respectively; p=0.033).Conclusion: Factors such as HD tip and line placement, line length, previous interventions, and diabetic status demonstrated a correlation with how frequently tunnelled HD lines required intervention due to fibrin sheath formation.
背景和目的:纤维蛋白鞘形成是血液透析(HD)线功能障碍的常见原因,需要频繁的介入线交换。本研究评估了由于纤维蛋白鞘形成而导致功能不良的HD线的尖端和线位置、线长度和人口统计学特征,以确定这些因素是否与反复的功能不良有关。患者和方法:回顾性回顾患者的医疗记录,包括2011-2019年有纤维蛋白鞘荧光证据的HD细胞系功能不良的患者。进行方差分析和t检验,以确定各因素对所需换行时间的显著性。结果:下腔静脉置尖的患者置换时间最短(130.23天),上腔静脉置尖的患者置换时间最长(968.80天;p = 0.007)。左颈内静脉线在未干预的情况下最长,股静脉线最短(分别为1132.80天和142.50天);p = 0.007)。19 cm系无干预816.75 d, 42 cm系无干预114.73 d (p=0.049)。如果患者之前接受过干预,则无干预天数减少(p<0.001)。糖尿病患者比无糖尿病患者需要干预的时间分别为694.09天和917.08天;p = 0.033)。结论:HD尖端和线的位置、线的长度、先前的干预和糖尿病状态等因素表明,由于纤维蛋白鞘的形成,隧道HD线需要干预的频率与这些因素相关。
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引用次数: 0
Filling the Gap by Targeting the Gut: First Disease-Modifying Treatment Approved for IgA Nephropathy 通过靶向肠道填补空白:首个被批准用于IgA肾病的疾病改善治疗
Pub Date : 2023-07-27 DOI: 10.33590/emjnephrol/10302464
Jennifer Taylor
This symposium took place during the 60th European Renal Association (ERA) Congress, held in Milan, Italy, and virtually. Bengt Fellström, Uppsala University, Sweden, described the relationship between IgA nephropathy (IgAN) and gastrointestinal mucosal reactivity. Fellström then outlined the history of Nefecon (Calliditas Therapeutics, Stockholm, Sweden, and STADA Arzneimittel, Bad Vilbel, Germany), which was developed based on the assumption that the gut plays a major role in the pathophysiology of the disease, and that there was a high unmet need for a well-tolerated and effective therapy. Nefecon was specifically designed to target the origins of IgAN. A Phase IIb clinical trial showed, for the first time, that 9 months of treatment with Nefecon was well-tolerated and effective in patients at risk of disease progression. Jonathan Barratt, University of Leicester, UK, and John Walls Renal Unit, Leicester General Hospital, UK, presented biomarker data supporting the efficacy data in clinical trials, and presented topline data from Part B of the Phase III NefIgArd trial. Specifically, the results demonstrated an average 5.05 mL/min/1.73 m2 estimated glomerular filtration rate (eGFR) treatment benefit in favour of Nefecon versus placebo over 2 years. This confirmed that the eGFR benefit of 9 months of active treatment with Nefecon was maintained during the observational follow-up. The eGFR benefit with Nefecon versus placebo was consistent regardless of baseline urine protein-creatinine ratio (UPCR). At 2 years, the 30% reduction in UPCR in the Nefecon versus placebo arm was similar to the percentage reduction at the end of the 9-month treatment period, plus 15 months follow-up off treatment. Patients treated with Nefecon experienced decreasing levels of proteinuria while on active treatment and for 3 months afterwards, suggesting a continued biologic effect. Barratt presented UK registry data showing that, despite being treated with the current standard of care for IgAN, three-quarters of adults and half of paediatric patients developed kidney failure or died within 20 years of disease onset. Barratt suggested a paradigm shift in the treatment approach for all patients with IgAN, who have a risk of developing kidney failure in their lifetime.
本次研讨会在意大利米兰举行的第60届欧洲肾脏协会(ERA)大会期间举行。Bengt Fellström,瑞典乌普萨拉大学,描述了IgA肾病(IgAN)和胃肠道粘膜反应性之间的关系。Fellström随后概述了Nefecon (Calliditas Therapeutics, Stockholm, Sweden, and STADA Arzneimittel, Bad Vilbel, Germany)的历史,它是基于肠道在疾病的病理生理中起主要作用的假设而开发的,并且对耐受性良好且有效的治疗有很高的未满足的需求。Nefecon是专门针对IgAN的起源而设计的。一项IIb期临床试验首次显示,在有疾病进展风险的患者中,9个月的Nefecon治疗耐受性良好且有效。英国莱斯特大学的Jonathan Barratt和英国莱斯特综合医院的John Walls肾科提出了支持临床试验疗效数据的生物标志物数据,并提出了III期NefIgArd试验B部分的顶线数据。具体来说,结果显示Nefecon与安慰剂相比,平均5.05 mL/min/1.73 m2的肾小球滤过率(eGFR)治疗获益超过2年。这证实了在观察性随访期间,Nefecon积极治疗9个月的eGFR获益得以维持。无论基线尿蛋白-肌酐比值(UPCR)如何,Nefecon与安慰剂相比,eGFR获益是一致的。2年后,Nefecon组与安慰剂组相比,UPCR减少30%的比例与9个月治疗期结束时的百分比相似,再加上15个月的随访治疗。用Nefecon治疗的患者在积极治疗期间和治疗后3个月的蛋白尿水平下降,表明持续的生物效应。Barratt提出的英国登记数据显示,尽管接受了目前的IgAN标准治疗,四分之三的成年人和一半的儿科患者在发病20年内发生肾衰竭或死亡。Barratt建议对所有IgAN患者的治疗方法进行范式转变,这些患者在其一生中有发生肾衰竭的风险。
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引用次数: 0
Review of the 60th European Renal Association (ERA) Congress 第60届欧洲肾脏协会(ERA)大会回顾
Pub Date : 2023-07-27 DOI: 10.33590/emjnephrol/10304934
Jaki Smith
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引用次数: 0
Deceased Donor Transplantation: Patient Selection, Ethics, and New Approaches 死亡供体移植:患者选择、伦理和新方法
Pub Date : 2023-07-27 DOI: 10.33590/emjnephrol/10305728
Darcy Richards
RENAL transplantation was a hot topic at the 60th European Renal Association (ERA) Congress 2023, which took place both virtually and in-person in Milan, Italy, between 15th–18th June. One such session saw experts in transplant medicine, surgery, and transplant ethics deliver presentations on deceased donor kidney transplantation. Co-chaired by Marta Crespo, Hospital del Mar, Barcelona, Spain, and Christophe Mariat, University Hospital Saint-Étienne, Saint-Priest-en-Jarez, France, this symposium delivered invaluable insights into donor selection, transplant ethics, and approaches to improve graft viability and implementation.
肾脏移植是2023年6月15日至18日在意大利米兰举行的第60届欧洲肾脏协会(ERA)大会上的一个热门话题。在其中一个会议上,移植医学、外科和移植伦理方面的专家发表了关于已故供体肾移植的报告。本次研讨会由西班牙巴塞罗那del Mar医院的Marta Crespo和法国圣普雷斯-恩-哈雷斯大学圣医院-Étienne的Christophe Mariat共同主持,就捐赠者选择、移植伦理以及提高移植物生存能力和实施的方法提供了宝贵的见解。
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引用次数: 0
期刊
EMJ Nephrology
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