World journal of nephrology最新文献

Pregnancy in women with lupus, particularly those with lupus nephritis (LN), carries an increased risk of adverse outcomes. Women with active LN at the time of conception are at a high risk of poor maternal and fetal outcomes. Recent studies indicate that even in the presence of quiescent disease, factors such as hypertension and positive lupus anticoagulant are predictors of worse pregnancy outcomes. Consequently, pre-conception evaluation is essential to ensure that pursuing pregnancy is safe and timely, and to facilitate proper planning for optimizing medical regimens, discontinuing teratogenic agents, and treating active disease. Additionally, pre-existing LN is associated with higher rates of preeclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome. Women with lupus and prior LN can have successful pregnancies, but a multidisciplinary approach with close monitoring is essential for optimal outcomes. By systematically reviewing the available evidence, this narrative review aims to provide a comprehensive update on the complex interaction between LN and pregnancy, offering insights to guide clinical practice and future research in this field.

The growing incidence of obesity and the rising trend of increased age during pregnancy have led to a high number of pregnant women with chronic kidney disease (CKD). Chronic hypertension is commonly associated with CKD and is not only the result of renal damage but is also the cause of declining renal function. Pregnancy and its unique physiological adaptations are affected by a decrease in the filtration capacity of the kidneys. Preeclampsia is a disorder of the vascular endothelium and is exacerbated by endothelial dysfunction resulting from CKD. Blood pressure targets must be strictly maintained owing to overlapping disease pathogenesis and to minimize cardiovascular damage. Moreover, preexisting renal dysfunction poses a challenge in identifying superimposed preeclampsia, which alters the management strategies in pregnancy. Fetal outcomes in patients with CKD are considerably affected by the presence of hypertension. This review is expected to aid in developing a focused and individualized treatment plan for hypertension in pregnant women with CKD to improve pregnancy outcomes and preserve postpartum renal function.

Background: Aging population is a significant issue in Viet Nam and across the globe. Elderly individuals are at higher risk of chronic kidney disease (CKD), especially those with diabetes. Several studies found that the estimated glomerular filtration rate (eGFR) determined using creatinine-based equations was not as accurate as that determined using cystatin C-based equations. Cystatin C-based equations may be beneficial in elderly patients with an age-associated decline in kidney function. Early determination of eGFR decline and associated factors would aid in appropriate interventions to improve kidney function in elderly patients with diabetes.

Aim: To determine the utility of cystatin C-based equations in early detection of eGFR decline and to explore factors associated with eGFR decline in elderly patients with diabetes.

Methods: This cross-sectional study included 93 participants aged ≥ 60 years evaluated in Can Tho University of Medicine and Pharmacy Hospital between October 2022 and July 2023, including 47 and 46 participants with and without diabetes respectively, according to the American Diabetes Association criteria for diabetes. The kappa coefficient, Student's t, Mann-Whitney, χ ², Pearson's correlation, multivariate logistic regression, and multiple linear regression analyses were employed.

Results: The eGFRs were lower with the cystatin C-based equations than with the creatinine-based equations. Good agreement was found between the Modification of Diet in Renal Disease (MDRD) and CKD Epidemiology Collaboration (CKD-EPI) 2021 creatinine-cystatin C equations (kappa = 0.66). In the diabetes group, 30% of the participants had low eGFR. Both plasma glucose and glycated hemoglobin were associated with an increased risk of eGFR decline (P < 0.05) and negatively correlated with eGFR (P = 0.001). By multivariate logistic regression, total cholesterol, and exercise were independently associated with low eGFR. By multiple linear regression, higher plasma glucose levels were correlated with lower eGFR (P = 0.026, r = -0.366).

Conclusion: Cystatin C-based equations were superior in the early detection of a decline in eGFR, and the MDRD equation may be considered as an alternative to the CKD-EPI 2021 creatinine-cystatin C equation. Exercise, plasma glucose, and total cholesterol were independently associated with eGFR in patients with diabetes.

Background: Glomerular diseases rank third among the causes of chronic kidney disease worldwide and in Indonesia, and its burden continues to increase, especially regarding the sociodemographic index. Kidney biopsy remains the gold standard for the diagnosis and classification of glomerular diseases. It is crucial for developing treatment plans, determining the degree of histologic changes, and identifying disease relapse.

Aim: To describe the patterns of biopsy-proven kidney diseases in adult patients.

Methods: We retrospectively reviewed the demographic, histopathologic, clinical, and laboratory data of 75 adult patients with biopsy-proven kidney diseases at our institution recorded from 2017 to 2022.

Results: Among the patients, 43 (57.3%) were females, and the mean age was 31.52 years ± 11.70 years. The most common histopathologies were lupus nephritis (LN) (33.3%), minimal change disease (MCD) (26.7%), and focal segmental glomerulosclerosis (10.7%). LN (41.7%) was frequently diagnosed in women and MCD (28.1%) in men. The most common cause of nephritic syndrome was LN (36.7%) and of nephrotic syndrome was MCD (40%).

Conclusion: Different kidney disease patterns were observed in different sexes, age categories, clinical syndromes, and biopsy dates relative to the coronavirus disease 2019 pandemic.

Background: Globally, diabetic nephropathy (DN) is the primary cause of chronic kidney disease. Currently, renal function is monitored indirectly using measures of serum creatinine, estimated glomerular filtration rate (eGFR), and proteinuria. Novel urinary biomarkers utilized in the early stages of DN have been described; these indicators can be used in the early identification of the disease, which is important for initiating treatment to halt or impediment the advance of diabetic nephropathy.

Aim: To estimate neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and periostin (POSTN) levels as novel urinary biomarkers in DN.

Methods: In this hospital based cross-sectional study, a total of 160 patients of both genders aged 18 years or more; 40 healthy participants and 120 patients with diabetes mellitus (DM) were included. Patients with DM were divided into normoalbuminuria (n = 40), microalbuminuria (n = 40), and macroalbuminuria (n = 40) groups as per urine albumin creatinine ratio (uACR). Blood urea, serum creatinine, uACR were measured. Urine NGAL, KIM-1, and POSTN were measured by enzyme linked immunosorbent assay. The eGFR was calculated and compared with urinary markers.

Results: NGAL, KIM-1, and POSTN levels increased significantly in normo, micro, and macroalbuminuria with the highest in the macroalbuminuria group. Albumin creatinine ratio (ACR) showed a positive correlation with NGAL, KIM-1, and POSTN levels. The eGFR showed a weak negative correlation with ACR, NGAL, KIM-1, and POSTN. NGAL was significantly lower in stage 1 compared to stage 2, 3, and 4 kidney disease. KIM-1 was significantly decreased in stage 1 compared to stage 4 kidney disease. POSTN was significantly decreased in stage 1 compared to stage 3 and 4 kidney disease. The receiver operator curve analysis of ACR, NGAL, KIM-1, and POSTN showed good sensitivity of 80%, 75.8%, 63.3%, and 80 % respectively with a cut-off of 12.5 mg/g, 4.5 μg/L, 1.5 ng/mL, and 37.5 ng/mL.

Conclusion: Urinary NGAL and POSTN are independent markers of DN.

Background: Kidney function loss or renal insufficiency indicated by elevated creatinine levels and/or an estimated glomerular filtration rate (eGFR) < 60 mL/minute/1.73 m² at presentation in patients with primary focal segmental glomerulosclerosis (FSGS) is commonly seen as a poor prognostic marker for kidney survival. However, a pre>vious study from our center suggested this may be due to hemodynamic factors.

Aim: To observe the clinical and biochemical parameters, treatment response, kidney survival, and overall outcomes of adult patients with primary FSGS presenting with kidney function insufficiency.

Methods: This retrospective observational study was conducted at the Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from January 1995 to December 2017. During this period, 401 biopsy-proven primary FSGS patients were identified, of which 98 (24.4%) presented with kidney function loss or renal insufficiency defined as eGFR < 60 mL/minute/1.73 m² at presentation and were studied in detail.

Results: Among the 98 patients with renal function loss on presentation, the mean age was 30.9 years ± 13.6 years with a male-to-female ratio of 2.5:1. The mean serum creatinine level was 2.2 mg/dL ± 1.3 mg/dL and mean eGFR 37.1 mL/minute/1.73 m² ± 12.8 mL/minute/1.73 m². The mean 24-hour urinary protein excretion was 5.9 g/day ± 4.0 g/day, and the mean serum albumin was 2.1 g/dL ± 1.0 g/dL (median: 1.5 g/dL). The mean systolic blood pressure (BP) was 132.7 mmHg ± 19.8 mmHg, and the mean diastolic BP was 87.4 mmHg ± 12.7 mmHg. Steroid treatment was given to 81 (82.6%) of 98 patients for an average duration of 19.9 weeks ± 14.4 weeks, with a mean total steroid dose of 4.4 g ± 1.5 g. Treatment response showed that 20 (24.6%) patients achieved complete remission, 9 (11.1%) achieved partial remission, and 52 (64.1%) did not respond. The baseline eGFR was significantly lower in the non-responsive group (P = 0.006). The distribution of FSGS variants was also significantly different among steroid-responsive and non-responsive groups (P = 0.012).

Conclusion: Renal function loss in FSGS patients at presentation does not necessarily indicate irreversible kidney function loss and a significant number of patients respond to appropriate treatment of the underlying disease.

Background: Juvenile systemic lupus erythematosus (SLE) is a severe, life-threatening disease. However, the role of rituximab in managing juvenile SLE remains undefined, although early biological intervention may improve disease outcomes.

Aim: To assess the differences in the outcomes of different types of rituximab administration (early and late).

Methods: In this retrospective cohort study, the information of 36 children with SLE with early (less than 6 months from onset) rituximab administration (ERA), and late (more than 1 year) rituximab administration (LRA) was analyzed. We compared initial disease characteristics at onset, at baseline (start of rituximab), and at the end of the study (EOS) at 12 months, as well as outcomes and treatment characteristics.

Results: The main differences at baseline were a higher daily median dose of corticosteroids, increased MAS frequency, and a higher Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in the ERA group. No differences in the main SLE outcomes between groups at the EOS were observed. The part of lupus nephritis patients who achieved remission changed from 44% to 31% in ERA and 32% to 11% in the LRA group. Patients with ERA had a shorter time to achieve low daily corticosteroid dose (≤ 0.2 mg/kg) at 1.2 (0.9; 1.4) years compared to 2.8 (2.3; 4.0) years (P = 0.000001) and higher probability to achieve this low dose [hazard ratio (HR) = 57.8 (95% confidence interval (CI): 7.2-463.2), P = 0.00001 and remission (SLEDAI = 0); HR = 37.6 (95%CI: 4.45-333.3), P = 0.00001]. No differences in adverse events, including severe adverse events, were observed.

Conclusion: ERA demonstrated a better steroid-sparing effect and a possibility of earlier remission or low disease activity, except for lupus nephritis. Further investigations are required.

Peritoneal dialysis (PD) is a commonly used modality for kidney replacement therapy for patients with end-stage kidney disease (ESKD). PD offers many benefits, including home-based care, greater flexibility, and preservation of residual kidney function compared to in-center hemodialysis. Nonetheless, patients undergoing PD often face significant challenges, including systemic inflammation, PD-related peritonitis, metabolic disorders, and cardiovascular issues that can negatively affect their quality of life and treatment outcomes. Recent studies have demonstrated the crucial role of the gut microbiome in overall health and treatment results, supporting the hypothesis that probiotics may bring potential benefits to the general population of ESKD patients. However, specific data on probiotic use in PD patients are limited. This opinion review aims to summarize the current knowledge on the relationship between PD and the gut microbiome and offers a novel perspective by specifically exploring how probiotic interventions could improve the outcomes of PD treatment. The review also outlines some clinical data supporting the effectiveness of probiotics in patients undergoing PD and considers the difficulties and restrictions in their application. Based on the current knowledge gaps, this study seeks to explore future research directions and their implications for clinical practice.

Recently, new findings have been clarified concerning both pathogenesis and treatment of IgA nephritis. The four hits theory has been confirmed but several genetic wide association studies have allowed finding several genes connected with the pathogenesis of the disease. All these new genes apply to each of the four hits. Additionally, new discoveries concerning the microbiota and its connection with immune system and IgA generation have allowed finding out the role of the mucosa in IgA nephropathy pathogenesis. The IgA treatment is also changed included the future possibilities. The treatment of the chronic kidney disease, associated with the nephropathy, is mandatory, since the beginning of the disease. The classical immunosuppressive agents have poor effect. The corticosteroids remain an important cornerstone in any phase of the disease. More effect is related to the treatment of B cells and plasma cells. In particular, in very recent studies have been documented the efficacy of anti B cell-activating factor and anti A proliferation-inducing ligand agents. Most of these studies are to date in phase II/III. Finally, new agents targeting complement are arising. These agents also are still in randomized trials and act principally in hit 4 where the immunocomplexes in the mesangium activate the different pathways of the complement cascade.

Vitamin B12 deficiency is a significant concern among patients with end-stage renal disease undergoing dialysis. However, there hasn't been extensive research conducted on this particular patient group. The reported incidence rates vary widely, ranging from 20% to 90%, reflecting the complexity of its diagnosis. Dialysis patients often face multiple nutritional deficiencies, including a lack of essential vitamins, due to factors such as dietary restrictions, impaired absorption, and nutrient loss during dialysis. Diagnosing vitamin B12 deficiency in these patients is challenging, and addressing it is crucial to prevent complications and improve their overall quality of life. This review paper delves into the available body of evidence on vitamin B12 deficiency in dialysis patients, examining the contributing risk factors, diagnostic challenges, potential complications, and available treatment options. It provides a well-rounded perspective on the topic, making it a valuable resource for researchers, healthcare practitioners, and policymakers interested in addressing the nutritional needs of dialysis patients.