Frontiers in nephrology最新文献

Introduction: Fatigue is a prevalent and burdensome symptom in Chronic Kidney Disease (CKD), with major impact on Health-Related Quality of Life (HRQoL). Physical activity has been linked to improvements in both fatigue and HRQoL. This study examined whether physical activity relates to HRQoL indirectly through fatigue and whether this relationship is moderated by sleep quality.

Methods: A total of 465 CKD patients (mean age = 53.78 years; 50% female) participated in the study. Fatigue, physical activity, HRQoL, and sleep quality were assessed and compared to general population norms and across treatment modalities using t-tests and ANCOVAs. Mediation, moderation, and moderated mediation analyses were conducted.

Results: CKD patients reported lower physical activity levels, HRQoL, and sleep quality, and higher fatigue than the general population (all ps <.001). Among treatment groups, transplant recipients showed the most favorable outcomes, while patients without renal replacement therapy reported the poorest. Higher levels of physical activity were associated with better HRQoL indirectly through fatigue, with small to moderate effect sizes. Stronger associations observed in those reporting better sleep quality.

Discussion: These findings indicate that physical activity is associated with better HRQoL in CKD patients through its relationship with fatigue, particularly among those with good sleep quality. Future research should explore fatigue across CKD stages to optimize interventions that target both physical activity and sleep.

Background: Focal xanthogranulomatous pyelonephritis (XGP) is a rare chronic renal inflammatory disorder in children that often mimics renal neoplasms, complicating diagnosis and management.

Methods: We describe two pediatric cases of focal XGP managed at our institution and provide a descriptive review of the literature (1975-2024), analyzing clinical presentation, imaging features, management strategies, and outcomes of this disease.

Results: Case 1: A 2-year-old boy presented with a febrile right flank mass and systemic inflammation. CT Scan revealed an 80 mm multilocular renal mass. Surgical drainage and biopsy confirmed focal XGP, and targeted antibiotics led to complete resolution with preserved renal function at two-year follow-up. Case 2: A 10-year-old girl presented with a 40 mm left renal mass and systemic inflammatory signs. CT-guided aspiration and histopathology confirmed focal XGP. She was managed conservatively with intravenous and oral antibiotics, achieving complete resolution and normal renal function at seven-year follow-up. Literature review of 34 pediatric XGP cases (median age 11.1 years) showed that 53% were focal lesions. Conservative management with antibiotics, with or without drainage, succeeded in 64% of cases, and overall outcomes were favorable, with stable renal function and no reported mortality.

Conclusion: This combined case series and descriptive literature review highlights that conservative, kidney-sparing management is a feasible and effective approach in selected pediatric focal XGP cases. Multicenter collaborations are needed to define standardized diagnostic and therapeutic protocols.

Introduction: Chronic Kidney Disease (CKD) significantly impacts patients' health-related quality of life (HRQoL), yet comprehensive evidence synthesis remains limited, particularly from African contexts. This systematic review aims to evaluate how CKD affects HRQoL in adult patients and identify the most impacted domains across disease stages, providing evidence to guide patient-centered care and health policy.

Methods: Following PRISMA-P 2020 guidelines, we will systematically search PubMed, Embase, Scopus, Web of Science, Cochrane Library, and grey literature for observational studies and clinical trials evaluating HRQoL in adults (≥18 years) with CKD using validated instruments (SF-36, KDQOL, EQ-5D). Two independent reviewers will conduct study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. Meta-analysis will be performed where feasible, with subgroup analyses by CKD stage, treatment modality, and geographic region.

Expected outcomes: This review will provide nurses and clinicians with comprehensive evidence on HRQoL impairments across CKD stages, inform development of targeted psychosocial interventions, and guide resource allocation for holistic patient care. Findings will support healthcare providers in addressing not only physiological parameters but also patients' subjective wellbeing and quality of life.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251036629.

Although the use of neurotoxic agents as weapons of war (CWAs) or in terrorist attacks is relatively uncommon, it has been documented on several occasions in recent history, including the Syrian civil war, the Tokyo subway attack, and the Salisbury incident. The toxidrome associated with these agents is well described; however, treatment remains largely supportive, as effective antidotes are not currently available. Conventional renal replacement therapies (RRT), such as hemodialysis or continuous modalities, are not recommended for managing neurotoxic agent poisoning due to their toxicodynamic properties. In contrast, hemoadsorption (HA), especially when combined with CRRT, has shown promise in organophosphate (OP) pesticide poisonings. Given the chemical similarities between neurotoxic CWAs and OP, HA may represent a rational therapeutic option in selected cases. Notably, substantial differences exist among these agents in terms of onset of action, routes of exposure, and pharmacodynamics, which critically affect both treatment effectiveness and the availability of a therapeutic window. While the management of such exposures has traditionally fallen under military medical services, documented use in terrorist contexts underscores the importance of civilian healthcare professionals being familiar with current treatment options. This article reviews the pathophysiological mechanisms and key chemical properties of neurotoxic agents and evaluates the potential role of HA as an adjunctive therapy in the management of patients exposed to these CWAs.

Background: Chronic kidney disease (CKD) affects nearly 10% of the global population and often progresses silently to end-stage renal disease, requiring dialysis or transplantation. Hypertension, prevalent in both adults and children, is a key driver of CKD progression. Acute kidney injury (AKI), particularly sepsis-associated AKI (S-AKI), poses a critical risk for long-term renal dysfunction, especially in patients with pre-existing CKD. S-AKI, defined by abrupt renal function decline during sepsis or septic shock, can accelerate CKD progression, yet its risk factors and outcomes across pediatric and adult populations remain incompletely characterized.

Objective: Aims to systematically evaluate existing research on the relationship between Risk Factors for CKD and Septic Shock with Hypertension in Adults and Children.

Methods: A systematic literature search was conducted using PubMed, Google Scholar, and the Cochrane Library for studies published between 2004 and 2024. Search terms included "chronic kidney disease," "septic shock," "hypertension," and "acute kidney injury." After applying PRISMA-based screening and eligibility criteria, 9 studies were included for qualitative synthesis.

Results: A total of 762 articles were identified through database searching. After screening and eligibility assessment, 9 studies were included in the final synthesis. The findings revealed that both CKD and hypertension are significant independent risk factors for S-AKI and septic shock. Preexisting albuminuria, uncontrolled blood pressure, advanced age, and diabetes mellitus were frequently associated with poor outcomes. Several studies highlighted the role of MPP and fluid resuscitation strategies in preventing AKI progression in septic patients. In pediatric populations, a history of AKI was strongly associated with new-onset hypertension and subsequent CKD development, increasing vulnerability to severe septic complications.

Conclusion: CKD and hypertension significantly increase the risk of septic complications and worsen renal outcomes, particularly in patients with fluid management challenges. Early identification of high-risk patients, individualized hemodynamic targets, and tailored fluid resuscitation strategies are critical in reducing morbidity and mortality. Special attention is needed in pediatric patients with limited nephron reserve, where long-term surveillance and early intervention may improve outcomes.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php, identifier PROSPERO (CRD420251146866).

Aims: Hypertensive kidney disease (HKD) contributes significantly to global morbidity and mortality. This study evaluated the burden of HKD in older adults (≥60 years) across 204 countries from 1990 to 2021 and projected trends to 2045.

Methods: Data from the Global Burden of Disease Study 2021 were used to estimate HKD prevalence, incidence, mortality, and disability-adjusted life years (DALYs). Age-standardized rates (ASRs) were calculated with 95% uncertainty intervals (UIs). Temporal trends were analyzed using Joinpoint regression. Slope and concentration indices quantified health inequality. Decomposition and frontier analyses explored burden drivers. Future projections were made using Nordpred-based Bayesian age-period-cohort models. Sensitivity analyses assessed model robustness. Risk-attributable mortality was also estimated.

Results: In 2021, global ASRs were 1674.9 (prevalence), 93.4 (incidence), 36.5 (mortality), and 631.1 (DALYs) per 100,000 older adults. High-SDI regions had higher prevalence (ASPR: 1857.8) and incidence (ASIR: 126.5), while low-SDI regions showed higher mortality (ASMR: 58.6) and DALY rates (ASDR: 972.7). Males across all age groups had higher prevalence (e.g. 95 plus: 9109.6 vs. 7031.5 per 100,000). Leading risk factors included low fruit intake (6.98 deaths per 100,000), high sodium, and lead exposure. From 1990-2021, ASIR (AAPC = 0.63%), ASMR (0.99%), and ASDR (0.77%) rose, while ASPR declined (-0.25%). Decomposition attributed burden increases mainly to population growth (72.3%) and aging (6.7%). Frontier analysis revealed substantial room for improvement in middle-SDI countries. Sensitivity analyses confirmed the stability of trend estimates and projections. Forecasts indicate that deaths in adults ≥90 will triple by 2045 (e.g. 95 plus: 75,271 vs. 20,242 in 2021).

Conclusion: HKD burden has grown substantially, with persistent geographic and socioeconomic disparities. Effective mitigation requires not only demographic- and region-specific interventions but also improved access to early detection and dietary risk reduction. Integration of kidney care into primary health systems and aging-focused strategies will be crucial to curb future disease escalation.

Aims: 1)To compare graft and patient survival rates following deceased donor kidney transplantation in Northern Territory (NT) First Nations Australians between 2001-2011 and 2012-2021. 2)To compare transplant outcomes between First Nations and non-Indigenous Australians during 2012-2021. 3)To assess the impact of eplet mismatches and predicted indirectly recognizable HLA epitopes II (PIRCHE) scores on transplant outcomes in First Nations Australians.

Background: Despite advancements in transplant outcomes across Australia, uncertainty exists regarding improvements in graft and patient survival rates for NT First Nations Australians. No study has evaluated the impact of molecular matching on post-transplant outcomes for NT First Nations Australians.

Methods: We performed a retrospective cohort study involving NT First Nations Australians transplanted between 2001-2021. Participants were divided into two groups: 2001-2011 and 2012-2021. For comparison, we also included non-Indigenous recipients transplanted during the 2012-2021 period. We analyzed graft and patient survival using Kaplan-Meier curves and assessed the association of eplets and PIRCHE scores with graft outcomes and de novo donor specific antibody (dnDSA) formation.

Results: Five-year graft and patient survival rates were 46% and 66% in the 2001-2011 cohort compared with 69.7% and 83.1% in the 2012-2021 cohort. For non-Indigenous recipients (2012-2021), 5-year graft and patient survival were 90.5% and 97.6%. Higher eplet mismatch loads and PIRCHE scores were not associated with graft survival, patient survival, or time to rejection among First Nations Australians.

Conclusion: Post-transplant outcomes for First Nations Australians have improved considerably, but they remain inferior to non-Indigenous Australians.