World journal of nephrology最新文献

Chronic kidney disease (CKD) has an intricate relationship with hepatitis B virus (HBV) due to impaired immune status and repeated risk for HBV exposure in people with CKD. Extensive discussion is required on issues related to disease burden, progression of acute HBV infection to chronic infection, impaired immune response to the hepatitis B vaccine, optimal vaccination schedules and strategies, etc. In this review, we attempted to summarize the updated existing knowledge on these topics. In addition, the implication of HBV in the pathogenesis of glomerular disease is also discussed. This review extensively focused on issues related to hepatitis B vaccine induced immune response in CKD patients-serological and cell-mediated immune responses to the vaccine, with particular emphasis on effect of CKD stages on vaccine response, newer types of hepatitis B vaccines for non-responders, revaccination strategies, and the durability of vaccine-induced immunity. We also discussed the literature on risk of HBV transmission following organ from hepatitis B surface antigen (HBsAg)-positive donors, along with perioperative management when the donor is HBsAg-positive but the recipient is HBsAg-negative.

Background: End-stage renal disease is the final stage of chronic kidney disease, with hemodialysis as the primary treatment in India. Despite its prevalence, limited studies have focused on patient-reported outcomes, such as symptom burden and health-related quality of life.

Aim: To evaluate the symptom burden among adult hemodialysis patients and identify factors influencing their outcomes.

Methods: A multi-center, cross-sectional study was conducted among 157 adult hemodialysis patients in Chennai from March 2024 to June 2024. The Dialysis Symptom Index tool was used to assess 30 physical and emotional symptoms. Correlations between symptom severity and clinical parameters, such as hemoglobin levels and urea reduction ratio (URR), were analyzed.

Results: Moderate symptoms were reported by 48% of participants, with worry, insomnia, and feeling unwell identified as the most severe. Psychological symptoms significantly correlated with lower hemoglobin levels, while shortness of breath was linked to suboptimal URR values. Approximately 38% of patients had URR < 65%, which was associated with increased symptom burden.

Conclusion: Hemodialysis patients experience a substantial psychological and sleep-related symptom burden, emphasizing the need for dialysis adequacy and better hemoglobin management. Enhanced strategies addressing these factors could significantly improve patient outcomes.

Background: Chronic kidney disease (CKD) is a major independent stroke risk factor. This study characterizes 22-year national trends and disparities in stroke mortality among United States adults with CKD.

Aim: To evaluate 22-year national trends and demographic disparities in stroke mortality among United States adults with CKD to inform targeted strategies for reducing cerebrovascular risk in this vulnerable population.

Methods: Using Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research Multiple Cause-of-Death data (1999-2020), we analyzed stroke deaths (underlying cause) with CKD (contributing cause) among adults ≥ 25 years. Age-adjusted mortality rates per 100000 population were calculated. Joinpoint regression estimated annual percentage changes (APCs) and average APCs with 95% confidence intervals, stratified by sex, race/ethnicity, region, and urbanization.

Results: Among 37308 stroke deaths with CKD, the overall age-adjusted stroke mortality rates (AAMR) declined from 1.08 (95%CI: 1.03-1.13) in 1999 to 0.71 (95%CI: 0.68-0.75) in 2020 (average annual percent change: -1.79%). Significant trends included a decline from 1999-2009 (APC: -4.25%), followed by an increase from 2009-2012 (APC: 23.25%), a sharp decline from 2012-2015 (APC: -28.10%), and another increase from 2015-2020 (APC: 8.72%). Males had higher mortality than females (AAMR 0.79 vs 0.71). Non-Hispanic Black individuals had the highest AAMR (1.95), followed by Hispanic (0.87) and Non-Hispanic White individuals (0.63). Regionally, the West had the highest AAMR (0.89). State-level mortality varied more than three-fold (District of Columbia: 1.27 vs Arizona: 0.38). Small metropolitan areas had the highest urbanization-stratified AAMR.

Conclusion: While stroke mortality among United States adults with CKD significantly declined over two decades, reflecting improvements in prevention and management, substantial disparities persist. The findings underscore the critical need for targeted public health interventions to address underlying biological, structural, and systemic determinants of cerebrovascular risk in this vulnerable population.

Background: Acute kidney injury (AKI) is a severe complication of acute pancreatitis (AP) associated with increased morbidity and mortality. Early prediction of AKI remains a clinical challenge owing to the limitations of traditional biomarkers, such as serum creatinine.

Aim: To evaluate the concentration and predictive value of plasma neutrophil gelatinase-associated lipocalin (NGAL) in patients with AP and AKI.

Methods: This cross-sectional descriptive study was conducted from October 2021 to June 2023 at Bach Mai Hospital. In total, 219 patients were enrolled, including 51 patients with AP and AKI, 168 patients with AP but without AKI, and 35 healthy controls. Plasma NGAL levels were measured and compared between groups. Receiver operating characteristic curve analysis was performed to determine the predictive value of NGAL levels for the severity of AKI and AP.

Results: Among AP and AKI cases, 47.1% were classified as Kidney Disease: Improving Global Outcomes stage 1, 33.3% as stage 2, and 19.6% as stage 3. The AP with AKI group (570.9 ng/mL) had significantly higher median plasma NGAL concentrations than the AP without AKI group (400.6 ng/mL) and the healthy control group (234.3 ng/mL) (P < 0.01). The NGAL levels increased proportionally with AKI severity. A plasma NGAL cutoff value of 504.29 ng/mL predicted AKI with 60.8% sensitivity and 68.4% specificity (area under the curve = 0.684; P < 0.001). A cutoff of 486.03 ng/mL predicted AP severity with 66.1% sensitivity and 66.4% specificity (area under the curve = 0.651; P < 0.005). NGAL positively correlated with international normalized ratio, urea, creatinine, lactate dehydrogenase, and lactate levels.

Conclusion: Plasma NGAL levels predicted both AKI development and disease severity. Therefore, NGAL should be considered a useful biomarker for the early evaluation of patients with AP.

Acute fatty liver of pregnancy (AFLP) is a rare but potentially life-threatening liver disease associated with mitochondrial dysfunction. It is characterized by microvesicular hepatic steatosis and typically occurs in the third trimester, though it may rarely present postpartum. AFLP is considered a non-thrombotic microangiopathy (TMA) but may present with overlapping TMA features. Its incidence ranges from 1 in 7000 to 1 in 20000 pregnancies, although milder cases may go unrecognized. AFLP can rapidly progress to acute liver failure and 20% to 40% of affected women exhibit clinical features of preeclampsia. Acute kidney injury (AKI) is a frequent complication, observed in 55% to 75% of AFLP cases, which is significantly higher than the 7% to 20% occurrence seen in preeclampsia or hemolysis, elevated liver enzymes, and low platelets syndrome. The exact mechanism behind AKI in AFLP remains unclear, but renal histology has shown tubular deposits of free fatty acids, which correlate with current theories regarding liver pathology. While AFLP-associated AKI is often reversible after delivery, some patients may develop persistent AKI that requires dialysis. Therapeutic plasma exchange (TPE) has been explored in these cases, but available evidence is limited. This review summarizes the current understanding of the epidemiology, pathophysiology, clinical features, and management of AKI in the context of AFLP, and discusses the potential role of adjunctive therapies such as TPE.

Antiphospholipid antibodies (aPLs) are a heterogeneous group of autoantibodies that include anticardiolipin antibodies, anti-β2 glycoprotein I antibodies, and lupus anticoagulant. The presence of aPLs is the main characteristic feature of antiphospholipid syndrome (APS), an autoimmune disease with multifactorial etiology. Kidney involvement is a well-recognized complication associated with both primary and secondary APS. Kidney involvement in APS presents with renal artery thrombosis, renal vein thrombosis, allograft loss due to thrombosis after kidney transplantation, and injury to the renal microvasculature, also known as APS nephropathy (APSN). APSN is the characteristic manifestation of kidney involvement in APS and occurs as a result of vaso-occlusive disease in the intrarenal vasculature. Diagnosis and risk stratification of APS are complex and still evolving. This review synthesizes and updates the available evidence in literature regarding risk factors, pathogenesis, and diagnosis of APS and APSN.

The number of children requiring renal transplants is on the rise, increasing the need for the availability of donor kidneys. It is a challenge to match the need and the available pool. Hence, a renal transplant recipient undergoes rigorous scrutiny to ensure the best possible outcome. In this context, children with obesity harm the long-term outcome when they receive renal transplantation due to higher and more severe postoperative complications. In addition, reports indicate that renal graft survival appears to be compromised in recipient children who are obese. An in-depth review of the available evidence from the literature is required for better understanding.

Background: Hair straightening products containing formaldehyde, glycolic acid, and glyoxylic acid may be nephrotoxic, as several studies have reported acute kidney injury (AKI) induced by these chemicals.

Aim: To investigate the clinical features, complications, and treatment of AKI resulting from topical exposure to hair-straightening products.

Methods: The study protocol was registered with PROSPERO under the registration number CRD420251010513. PubMed, Web of Science, and Scopus were searched from inception to April 3, 2025, for case reports and case series describing patients diagnosed with AKI-defined as an increase in serum creatinine of ≥ 0.3 mg/dL, following exposure to hair-straightening products. Means and standard deviations were used to describe continuous variables and frequencies and percentages were reported for dichotomous variables.

Results: The search yielded 168 potentially relevant articles, of which six case reports and two case series met the inclusion criteria, collectively providing data on 34 patients for 36 incidents (in one case report, three AKI episodes occurred in the same patient). In 20 incidents, the hair product was identified as "formaldehyde-free", while in 16 incidents, the chemical composition was unknown. All patients were female (mean age: 28.53 ± 11.72 years; range: 10-58 years) and the median time for the development of AKI was 2 days. The mean serum creatinine level at admission was 5.24 ± 2.83 mg/dL (range: 1.9-13.2 mg/dL). The most common presenting symptoms were vomiting (n = 29/36; 80.6%), nausea (n = 25/36; 69%), and abdominal pain (n = 13/36; 36%). Complications included one patient who developed severe dyspnea with bilateral lung infiltrates and another who developed severe hypertension and hyperkalemia. Twenty-one incidents were managed conservatively, five required steroid therapy, three required hemodialysis, and three required both hemodialysis and steroids. All patients recovered and were discharged.

Conclusion: The findings of this systematic review highlight the need for caution when using hair-straightening products due to their potential to cause AKI.