BMC Nephrology最新文献

Background: Electronic (e-)alerts for rising serum creatinine values are increasingly used as clinical indicators of acute kidney injury (AKI). The aim of this study was to investigate to what degree AKI episodes, as identified using e-alerts, correlated with coding for AKI in the hospital record for a national cohort of hospitalised children and examine whether coding corresponded with 30-day mortality after an AKI episode.

Methods: A cross-section of AKI episodes based on alerts issued for children under 18 years in England during 2017 were linked to hospital records. Multivariable logistic regression was used to examine patient and clinical factors associated with AKI coding. Agreement between coding and 30-day mortality was examined at hospital level.

Results: 6272 AKI episodes in 5582 hospitalised children were analysed. Overall, coding was poor (19.7%). Older age, living in the least deprived quintile (odds ratio (OR) 1.4, 95% Confidence Interval (CI) 1.1, 1.7) and higher peak AKI stage (stage 1 reference; stage 2 OR 2.0, 95% CI 1.7, 2.4; stage 3 OR 8.6, 95% CI 7.1, 10.6) were associated with higher likelihood of coding in the hospital record. AKI episodes during birth admissions were less likely to be coded (OR 0.4, 95% CI 0.3, 0.5). No correlation was seen between coding and 30-day mortality.

Conclusions: The proportion of AKI alert-identified episodes coded in the hospital record is low, suggesting under-recognition and underestimation of AKI incidence. Understanding the reasons for inequalities in coding, variation in coding between hospitals and how alerts can enhance clinical recognition is needed.

Anderson-Fabry disease (AFD) is a multisystem X-linked lysosomal storage disorder caused by a deficiency in the enzyme α-galactosidase A (α-Gal A). This deficiency results in the intracellular accumulation of glycosphingolipids, primarily uncleaved globotriaosylceramide (Gb3) and its deacylated form, lyso-globotriaosylceramide (Lyso-Gb3), leading to progressive organ damage and functional impairment. The diagnostic evaluation for AFD involves clinical assessment and family history, supported by biochemical testing (α-Gal A enzyme activity and Lyso-Gb3 levels) and genetic analysis of the GLA gene. In cases of unexplained renal impairment or when genetic analysis is inconclusive, kidney biopsy is often required to confirm the diagnosis and guide targeted treatments. However, histological findings in kidney biopsies may sometimes be nonspecific, complicating the diagnostic process. This article aims to provide an updated perspective on the role of kidney biopsy in AFD, illustrating two cases that exemplify its pivotal role in confirming or excluding the suspected disease, proving to be both decisive and confounding in this complex clinical setting.

De novo donor-specific antibody (dnDSA) generation is the most important marker of antibody-mediated rejection (AMR). However, not all dnDSAs induce AMR. The effects of mismatched eplets on dnDSA production and the occurrence AMR remain controversial. We analyzed 64 cases of dnDSA positive kidney transplantation that occurred between 2017 and 2021 at our center to reveal the relationships between mismatched eplet and dnDSA generation and the characteristics of antibody-specific and AMR associated mismatched eplets. Among the 64 dnDSA positive cases, 114 dnDSA were produced. Both the average production time and medium fluorescence index (MFI) value of human leukocyte antigen (HLA) II dnDSA were higher than those of HLA I (time, p = 0.024; MFI, p = 0.032). More HLA II dnDSAs were generated in the AMR group (p < 0.001). The frequency of HLA II dnDSAs was higher in cases of longer antibody generation time, higher MFI, and AMR( p < 0.05). The differences in the numbers of mismatched HLA I and II eplets were statistically significant between the rejection and no rejection groups (p = 0.030). dnDSA-specific and AMR associated mismatched eplets were strongly correlated (p < 0.0001). The dominant mismatched eplets included 41 T, 163R, 25Q, 78 V, 47QL and 55PP. dnDSA-specific eplets accounted for majority of the total mismatched eplets of donors and recipients. The amino acids with increased proportions of dnDSA-specific eplets were mainly non-polarity amino acids (p < 0.0001). AMR-associated mismatched eplets accounted for majority of the dnDSA-specific mismatched eplets. Arginine, histidine, glutamine, glutamate, lysine and asparagine levels increased significantly in the rejection group compared with the no rejection group (p < 0.001). The amino acids with increased proportions of AMR-associated mismatched eplets were all polar (p < 0.0001) and mainly positively charged (p < 0.0001). The polarity and charge of amino acids in mismatched eplets may be the key factors affecting the occurrence of AMR after kidney transplantation.

Complement plays a central role in organ ischemia/reperfusion injury (IRI) and allograft rejection. A retrospective observational study included a cohort of 73 non-diabetic deceased donor kidney allograft recipients. We collected data on donor and recipient demographic, clinical and laboratory parameters. The main outcomes of our study were delayed graft function (DGF) and kidney allograft function during five years posttransplant. Gene single nucleotide polymorphisms (SNPs) for complement components C3 (rs2230199, G_C) and FH (rs800292, G_A) were determined. The genotyping results for FH polymorphism (184G > A) showed a distribution of GG (71.2%) and GA (28.8%) genotypes, with the AA genotype not detected in the cohort. The genotype frequencies of the C3 polymorphism (304 C > G) were CC (71.2%), CG (26.0%) and GG (2.8%).Analysis of FH SNP demonstrated that patients with the GG genotype had a statistically higher frequency of DGF compared to those with the GA genotype (67.3% vs. 38.1%, p = 0.022). Univariate linear regression analysis confirmed that the FH GG genotype was the only significant determinant of DGF (p = 0.025). Analysis of C3 SNP showed that patients with the GC/GG genotype demonstrated significantly lower levels of creatinine clearance compared to those with the CC genotype at 1 year (p = 0.002), 3 years (p = 0.001) and 5 years (p = 0.010) posttransplant. These findings underscore the importance of genetic factors in influencing renal outcomes post-transplant.

Background: This meta-analysis aims to investigate the impact of abnormalities in mineral metabolic markers, including serum phosphate and calcium, intact parathyroid hormone (iPTH), and fibroblast growth factor 23 (FGF23) on the risk of fractures in patients with chronic kidney disease (CKD).

Methods: A systematic search was conducted across MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register for Controlled Trials. The outcomes were association of mineral metabolic markers with the risk of fractures in patients with chronic kidney disease. Pooled risk estimates and 95% confidence intervals (CIs) were calculated using fixed-effects or random-effects models.

Results: Thirty-two studies were included in the meta-analysis. High and low levels of serum phosphate in hemodialysis (HD) patients were both associated with an increased risk of fractures (RR = 1.08, 95% CI 1.02-1.15, P = 0.013; RR = 1.13, 95% CI 1.02-1.25, P = 0.022, respectively). Similarly, abnormal levels of iPTH in CKD patients, both high and low, were associated with increased fracture risk (RR = 1.25, 95% CI 1.20-1.31, P < 0.001; RR = 1.41, 95% CI 1.10-1.82, P = 0.007, respectively). Elevated FGF23 levels were also linked to an increased risk of fractures (RR = 1.32, 95% CI 1.06-1.66, P = 0.015). While a higher level of calcium exhibited a trend towards reduced fracture incidence without statistical significance (RR = 0.90, 95% CI 0.77-1.05, P = 0.181), lower calcium levels tended to increase fracture risk without statistical significance (RR = 1.11, 95% CI 0.99-1.24, P = 0.087). Notably, subjects treated with calcium and phosphorus modulating drugs demonstrated a statistically significant reduction in fractures among CKD patients undergoing dialysis (phosphate binders, RR = 0.79, 95% CI 0.70-0.89; cinacalcet, RR = 0.74, 95% CI 0.59-0.93; vitamin D analogues, RR = 0.82, 95% CI 0.74-0.92, respectively).

Conclusion: This meta-analysis underscores the association between abnormal mineral metabolic markers, including high serum phosphate, iPTH, and FGF23, and an increased risk of fractures in CKD patients. Notably, both elevated and decreased levels of phosphate and iPTH contribute to fracture risk. The efficacy of active vitamin D, phosphorus binders, and cinacalcet in preventing fractures was observed in HD patients but not in the non-dialysis CKD population.

Trial registration: PROSPERO CRD42023493951.

Diabetic kidney disease (DKD) represents the predominant and severe microvascular complication associated with diabetes, frequently culminating in End-Stage Kidney Disease (ESKD). The escalating prevalence of diabetes has correspondingly led to a rise in DKD incidence, imposing significant challenges on both individuals and society. The etiology of DKD is multifaceted and remains devoid of definitive therapeutic interventions. This article examines the pharmacological actions and mechanisms of different drugs used for the prevention and treatment of DKD that are currently in clinical use or undergoing development. The goal is to offer insights for early intervention based on therapeutic combinations to potentially slow kidney disease progression.

Introduction: Over the past two decades, there has been a notable rise in the number of individuals afflicted with End-Stage Renal Disease, resulting in an increased demand for renal replacement therapies. While periodic dialysis is beneficial, it can negatively impact a patient's quality of life and does not fully replicate the secretory functions of the kidneys. Additionally, the scarcity of organ donors and complications associated with organ transplants have underscored the importance of tissue engineering. Regenerative medicine is revolutionized by developing decellularized organs and tissue engineering, which is considered a cutting-edge area of study with enormous potential. Developing bioengineered kidneys using tissue engineering approaches for renal replacement therapy is promising.

Method and materials: We aimed to systematically review the essential preclinical data to promote the translation of tissue engineering research for kidney repair from the laboratory to clinical practice. A PubMed search strategy was systematically implemented without any linguistic restrictions. The assessment focused on complete circumferential and inlay procedures, thoroughly evaluating parameters such as cell seeding, decellularization techniques, recellularization protocols, and biomaterial types.

Results: Of the 1,484 studies retrieved from the following primary searches, 105 were included. Kidneys were harvested from eight different species. Nine studies performed kidney decellularization from discarded human kidneys. Sixty-four studies performed whole organ decellularization. Some studies used acellular scaffolds to produce hydrogels, sheets, and solutions. Decellularization is achieved through physical, chemical, or enzymatic treatment or a combination of them. Sterilization of acellular scaffolds was also thoroughly and comparatively evaluated. Lastly, different recellularization protocols and types of cells used for further cell seeding were demonstrated.

Conclusion: A comprehensive review of the existing literature about kidney tissue engineering was conducted to evaluate its effectiveness in preclinical investigations. Our findings indicate that enhancements in the design of preclinical studies are necessary to facilitate the successful translation of tissue engineering technologies into clinical applications.

Nutcracker syndrome and Wilkie syndrome are rare and often diagnosed incidentally during imaging investigations for other conditions and, on occasion, together. In this paper, we present the case of a 36-year-old patient with quasi-permanent symptoms including epigastralgia, loss of appetite, early satiety, left lumbar colic pain, normal stool and dysuria. The clinical examination revealed a non-distended abdomen, sensitivity to palpation in the epigastrium and hypogastrium regions, frequent urination in small amounts, and a body mass index (BMI) of 15 kg/m2, indicating severe protein calorie malnutrition. Laboratory tests indicated persistent microscopic hematuria without proteinuria with repeated urinary infections. Abdominal-pelvic ultrasound with Doppler revealed a left renal vein dilated up to 10 mm in the left paraaortic region (Nutcracker syndrome) and distal duodenal obstruction with distension in the same region, which was also confirmed by gastroduodenoscopy (Wilkie syndrome). Abdominal‒pelvic computed tomography angiography revealed a malformed and dilated left renal vein that was compressed as a result of aorto-mesenteric obstruction and communicating with an aberrant left paravertebral and paraspinal network extending to L1 and L5 and thrombosis of the left ovarian vein. The patient benefitted from conservative treatment, which intended to correct the malabsorption syndrome with the help of a nutritionist, who suggested a personalized diet to help gain weight. As a result, the patient was able to avoid surgical treatment. The case is peculiar in that the patient presented with a very rare form of Nutcracker syndrome (posterior type) associated with another rare syndrome, Wilkie syndrome.

Background: Kidney dysfunction among adults living with Human Immuno-Deficiency Virus (HIV) increases the risk of drug-related side effects, acute kidney injury, hospitalization, and progression to end-stage kidney disease. In developing regions like Africa, where access to kidney transplants and dialysis is limited, early detection of kidney disease among adults living with HIV has significant clinical and financial implications. Therefore, the objective of this review was to determine the pooled prevalence and identify associated factors of kidney dysfunction among adults living with HIV in Africa.

Methods: The report was presented according to the Preferred Reporting Items for Systematic Review and Meta-Analyses checklists. The articles were searched using PubMed/MEDLINE, EMBASE, Scopus, Wiley Online Library, CINAHL/EBSCO, OVID/Wolters Kluwer, Cochrane Library, Google Scholar, Science Direct, and African Journal Online. Data were extracted using Microsoft Excel and exported to STATA MP Version 11 Software for analysis. Heterogeneity of studies was assessed by Cochran's Q test and I² statistics. Publication bias was detected by the visual inspection of the funnel plot and statistical Egger's test.

Results: In this study, the pooled prevalence of kidney dysfunction among adults living with HIV in Africa is estimated to be 16.85% (95% CI: 13.08 - 20.62, I²=96.2%, p-value = 0.000). Female sex (POR = 1.82; 95% CI; 1.31, 2.53), age ≥ 50 years (POR = 8.94; 95% CI: 1.82, 43.93), body mass index ≥ 30 kg/m² (POR = 4.70; 95% CI: 3.07, 7.22), diabetes mellitus (POR = 2.84; 95% CI: 1.59, 5.07), CD4 count < 200 cells/mm³ (POR = 3.64; 95% CI: 1.63, 8.13) and anemia (POR = 3.73, 95% CI = 2.00-6.94) were factors associated with kidney dysfunction among adults living with HIV.

Conclusions: This study revealed that the pooled prevalence of kidney dysfunction among adults living with HIV in Africa remains significant. Female sex, age ≥ 50 years, body mass index ≥ 30 kg/m², diabetes mellitus, CD4 count < 200 cells/mm³ and anemia were factors associated with kidney dysfunction. To reduce the morbidity and mortality associated with kidney dysfunction, it is advisable to create awareness and initiating early interventions through health education during their follow-up time, and initiating suitable medication at an early stage.

Objective: To investigate the predictors of renal function recovery after treatment of severe renal impairment in unilateral upper urinary tract obstruction (UUTO).

Methods: A retrospective analysis was conducted on 153 patients with unilateral UUTO-induced severe renal injury admitted to the First Affiliated Hospital of Chongqing Medical University from January 2014 to January 2023. Independent variables included pre-treatment estimated glomerular filtration rate (eGFR), pre-treatment ^99mTc-diethylenetriaminepentaacetic acid (^99mTc-DTPA) dynamic renal scintigraphy GFR values, C-reactive protein (CRP) levels, and body mass index. These variables were subjected to multiple linear regression analysis to predict changes in GFR (GFRd) post-treatment, with statistical significance set at P < 0.05. Categorical variables, including sex, site of obstruction, eGFR value and nephrectomy were compared with GFRd using two-sample t-tests or one-way ANOVA, with significance at P < 0.05.

Results: Multiple linear regression identified a significant correlation between pre-treatment ^99mTc-DTPA dynamic renal scintigraphy GFR values and CRP levels with GFRd. Female patients and those with renal pelvic obstruction exhibited a higher mean GFRd compared to males and those with ureteral obstruction, although this did not reach statistical significance.

Conclusion: Pre-treatment ^99mTc-DTPA dynamic renal scintigraphy GFR values and CRP levels are pivotal in assessing treatment efficacy for severe renal insufficiency secondary to UUTO, with the former being indispensable for evaluating compromised unilateral renal function.