Nephron[JOURNAL]
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200 papers
Association between Anti-Nephrin Antibodies and Podocytopathies: A Systematic Review and Meta-Analysis.
Wang J, Chen J, Chen Z … +2 more , Guo Z, Bao H
Nephron · 2026 · PMID 41518631 · Publisher ↗
OBJECTIVE: The aim of the study was to explore the positive rate of anti-nephrin antibodies in various podocytopathies and their relationship with the clinical characteristics and outcomes of podocytopathies. METHODS: Me...
OBJECTIVE: The aim of the study was to explore the positive rate of anti-nephrin antibodies in various podocytopathies and their relationship with the clinical characteristics and outcomes of podocytopathies. METHODS: Medical literature studies from the PubMed database and the Web of science database from the establishment of the databases to July 28, 2025, were retrieved online. The main exploration indicator is the positive rate of anti-nephrin antibody in podocytopathies. Other indicators include the diagnostic role of anti-nephrin antibodies and their relationship with the clinical features and outcomes of podocytopathies. Analysis was conducted using the R software package "Meta" and "Mada." RESULTS: A meta-analysis included a total of 1,567 patients from 15 studies. The positive rates of anti-nephrin antibodies in adult patients with primary podocytopathies, minimal change disease, primary focal segmental glomerulosclerosis (FSGS), and children with idiopathic nephrotic syndrome (NS) were 41%, 51%, 32%, and 39%, respectively. Anti-nephrin antibodies are almost undetectable in patients with secondary FSGS, membranous nephropathy and other glomerular diseases. In podocytopathies with nephrotic-range proteinuria or without the use of immunosuppressants, the positive rate increased. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of anti-nephrin antibody in differentiating steroid-sensitive NS (SSNS) from non-SSNS in children were 0.57, 0.83, 3.40, and 0.55, respectively. Patients positive for anti-nephrin antibody had higher urinary protein levels and lower serum albumin levels and were more prone to recurrence, but there were no statistically significant differences in gender, age, renal function, and remission rate. The heterogeneity of the positive rate results of anti-nephrin antibodies in the literature is very high (I2 >80%), and most subgroup analyses cannot explore the source of the heterogeneity. CONCLUSION: Anti-nephrin antibodies have a relatively high positive rate in podocytopathies and have a differentiating effect on SSNS and non-SSNS in children. Anti-nephrin antibodies are associated with the clinical severity and recurrence of podocytopathies.
Integrated sTim-3 and PLA2R-Ab Levels Improve Risk Stratification in PLA2R-Positive Membranous Nephropathy.
Zheng T, Du Y, Tang X … +8 more , Shao X, Chen L, Kao S, Qin Y, Zhou X, Zhao X, Gao H, Huang B
Nephron · 2026 · PMID 41493895 · Publisher ↗
INTRODUCTION: The utility of M-type phospholipase A2 receptor antibody (PLA2R-Ab) for risk stratification in membranous nephropathy (MN) remains suboptimal, while soluble T-cell immunoglobulin and mucin-domain containing...
INTRODUCTION: The utility of M-type phospholipase A2 receptor antibody (PLA2R-Ab) for risk stratification in membranous nephropathy (MN) remains suboptimal, while soluble T-cell immunoglobulin and mucin-domain containing-3 (sTim-3) has been confirmed as a critical immune regulator in kidney diseases. This study investigated the prognostic value of sTim-3 in PLA2R-associated MN (PMN) and the efficacy of its combination with PLA2R-Ab. METHODS: Serum PLA2R-Ab and sTim-3 levels were measured at baseline in 50 PMN patients using highly sensitive time-resolved fluorescence immunoassay (TRFIA) method. Patients were stratified into complete remission, partial remission, and no remission (NR) groups according to 12-month treatment outcomes. RESULTS: Prognostic cut-off discriminating NR from remission: sTim-3 = 17.63 ng/mL; PLA2R-Ab = 50 RU/mL (KDIGO high-risk threshold). The non-remission rate for patients with PLA2R-Ab <50 RU/mL was 23.58%, whereas the sTim-3 + PLA2R-Ab combination achieved 0%. Among 16 "high-risk" patients (PLA2R-Ab >50 RU/mL), sTim-3 demonstrated 93.75% accuracy in predicting outcomes. Remarkably, all 8 patients who achieved actual remission exhibited sTim-3 levels below 17.63 ng/mL. Double positivity (PLA2R-Ab >50 RU/mL and sTim-3 >17.63 ng/mL) identified a refractory subgroup with significantly poorer treatment response compared to other groups. CONCLUSION: sTim-3 serves as a complementary biomarker to PLA2R-Ab. Combined detection optimizes PMN risk stratification: PLA2R-Ab >50 RU/mL and sTim-3 >17.63 ng/mL indicates an immune-activated state requiring intensive immunosuppression, preventing overtreatment in PLA2R-Ab-high patients with favorable immune status.
Mitochondria to the Rescue: Organelle Trafficking in Renal Health and Disease.
Perico L, Remuzzi G, Benigni A
Nephron · 2026 · PMID 41417683 · Publisher ↗
BACKGROUND: Mitochondria are central regulators of cellular metabolism, redox signaling, and apoptosis. Their dysfunction plays a pivotal role in the pathogenesis of kidney diseases, including acute kidney injury and dia...
BACKGROUND: Mitochondria are central regulators of cellular metabolism, redox signaling, and apoptosis. Their dysfunction plays a pivotal role in the pathogenesis of kidney diseases, including acute kidney injury and diabetic nephropathy. SUMMARY: Recent advances have unveiled horizontal mitochondrial transfer as a novel intercellular communication by which renal cells exchange mitochondria to promote tissue repair through the modulation of metabolic processes, oxidative stress, apoptosis, and fibrosis. KEY FINDINGS: Horizontal mitochondrial transfer, mediated by tunneling nanotubes and extracellular vesicles, has emerged as a potential homotypic rescue mechanism between injured tubular and glomerular cells. In addition, heterotypic mitochondrial transfer from mesenchymal stromal cells to renal cells has been described. These findings open new perspectives for exploring therapeutic mitochondrial transplantation in both acute and chronic kidney diseases. Nonetheless, significant challenges remain, including elucidating the poorly characterized biological mechanisms underlying mitochondrial transfer, optimizing delivery strategies, and defining the long-term safety and efficacy of mitochondrial-based therapies.
Successful Living Kidney Donation from Heterozygous Carrier Parents to Siblings with Coenzyme Q8B Nephropathy: Two Case Series.
Morita K, Nakanishi R, Ogura K … +9 more , Shinzato T, Matsuo K, Tanaka S, Matsumoto M, Yamamoto S, Kitayama H, Nagano C, Nozu K, Nagai K
Nephron · 2026 · PMID 41411216 · Full text
<p>Introduction: Coenzyme Q8B (COQ8B) nephropathy is an autosomal recessive hereditary disorder caused by primary coenzyme Q10 (CoQ10) deficiency. It manifests as a genetic steroid-resistant nephrotic syndrome (SRNS), ty...
<p>Introduction: Coenzyme Q8B (COQ8B) nephropathy is an autosomal recessive hereditary disorder caused by primary coenzyme Q10 (CoQ10) deficiency. It manifests as a genetic steroid-resistant nephrotic syndrome (SRNS), typically of childhood-onset. CoQ10 supplementation is a treatment option; however, it is not always effective in an entire patient population, leading to end-stage kidney disease. Kidney transplantation (KTx) is an effective treatment option for genetic SRNS; however, living KTx within biologically related members is associated with increased risk of allograft failure in recipients and future kidney dysfunction in donors. Here, we present two successful cases of living kidney donations from heterozygous carrier parents to their siblings with COQ8B nephropathy. Case Presentation: The family comprised two parents and three siblings. Two of the daughters were diagnosed with proteinuria at 11 and 8 years of age, respectively. COQ8B nephropathy diagnosis was confirmed by next-generation and Sanger sequencing analysis, which revealed a novel compound heterozygous mutation in the COQ8B gene (c.737G>A and c.1468C>T). An older sister missed an opportunity for CoQ10 supplementation due to late diagnosis, whereas a younger sister did not respond to CoQ10 supplementation. Living kidney donation from father to the older sister and from mother to the younger sister was successfully performed without post-transplant recurrence in recipients or kidney dysfunction in donors within 5 and 2 years of follow-up. Conclusion: Parent-to-child KTx may be an effective treatment option within family members affected with COQ8B nephropathy. </p>.
Bench to Bedside: Translating Discoveries to Clinical Care in Kidney Disease.
Epler K, Fuhrman DY, Hebbar S … +2 more , Vallon V, Hepokoski M
Nephron · 2025 Dec · PMID 41406055 · Full text
BACKGROUND: Acute kidney injury (AKI) pathophysiology and repair are heterogenous processes, and clinical outcomes are difficult to predict. As a result, promising treatments in preclinical models have failed to translat...
BACKGROUND: Acute kidney injury (AKI) pathophysiology and repair are heterogenous processes, and clinical outcomes are difficult to predict. As a result, promising treatments in preclinical models have failed to translate to human subjects, and treatment options for AKI are primarily supportive. SUMMARY: To address this, one of the AKI and CRRT 2025 preconference symposium plenary sessions showcased cutting-edge translational work to guide the scientific community of AKI investigators. Topics included those focused on stratifying risk for AKI reflected in the concept of kidney fitness, characterizing the molecular phenotypes of AKI, improving diagnostics, and identifying novel therapeutic targets. KEY MESSAGES: This article provides a review of these topics and a summary of how they address challenges to translating new therapies in AKI from bench to bedside.
Association between Hemoglobin-To-Red Cell Distribution Width Ratio and Left Ventricular Hypertrophy in Non-Dialysis CKD Stage 3-5 Patients: A Cross-Sectional Study.
Wang L, Zhang L, Xiang F … +3 more , Ding X, Fang Y, Jiang W
Nephron · 2026 · PMID 41401114 · Publisher ↗
INTRODUCTION: Left ventricular hypertrophy (LVH) is a common cardiovascular complication in chronic kidney disease (CKD), driven by anemia and nutritional deficiencies. The hemoglobin-to-red cell distribution width ratio...
INTRODUCTION: Left ventricular hypertrophy (LVH) is a common cardiovascular complication in chronic kidney disease (CKD), driven by anemia and nutritional deficiencies. The hemoglobin-to-red cell distribution width ratio (HRR) reflects these factors, but its association with LVH in CKD remains unclear. This study aimed to investigate the relationship between HRR and LVH in non-dialysis CKD stage 3-5 patients. METHODS: In this cross-sectional study, 195 patients were included. HRR was calculated from hemoglobin and red cell distribution width. LVH was diagnosed by echocardiography (LV mass index >115 g/m2 in men, >95 g/m2 in women). Logistic regression assessed HRR-LVH association, including subgroup and restricted cubic spline analyses. Mediation analysis explored the role of intact parathyroid hormone (iPTH) and N-terminal pro-brain natriuretic peptide (NT-proBNP). RESULTS: Patients with LVH (n = 40) had significantly lower HRR (median 0.62 vs. 0.81, p < 0.001). HRR was inversely associated with LVH (adjusted OR 0.41 per SD increase, p = 0.005), with the highest HRR tertile showing the lowest LVH risk (adjusted OR 0.23, p = 0.044). Subgroup analyses showed consistent associations. Mediation analysis indicated iPTH and NT-proBNP explained 37% and 21.1% of the HRR-LVH relationship. CONCLUSION: HRR may be a simple marker for cardiovascular risk stratification in CKD. Prospective studies should assess whether interventions targeting HRR reduce LVH incidence.
Introduction.
Ogawa Y, Sugitani A
Nephron · 2025 · PMID 41385488 · Publisher ↗
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Kidney Transplantation in the Era of Climate Change: Environmental, Structural, and Ethical Implications for Future-Ready Practice.
Jain P, Suliman O, Wu HHL … +1 more , Chinnadurai R
Nephron · 2026 · PMID 41379748 · Full text
<p>Background: Kidney transplantation and dialysis are the two main modalities of kidney replacement therapy, and both are increasingly challenged by the current climate emergency landscape. Dialysis has long been scruti...
<p>Background: Kidney transplantation and dialysis are the two main modalities of kidney replacement therapy, and both are increasingly challenged by the current climate emergency landscape. Dialysis has long been scrutinised for its high energy and water demands, but transplantation, while generally more sustainable over the long term, also warrants critical evaluation concerning environmental accountability, equity, and resilience. Summary: In this review, we compare the environmental and structural dimensions of dialysis and transplantation, while examining how climate change uniquely affects transplant recipients and grafts. We highlight the vulnerabilities of immunosuppressed recipients to heat stress and infectious diseases, the risks of cold chain disruption for organ preservation and shipment, and the impact of graft failure necessitating return to dialysis. We then consider how green nephrology principles can be applied to transplantation, drawing on emerging UK data, global policy frameworks such as the European Green Deal, and lessons from low- and middle-income countries. Digital healthcare solutions such as hybrid virtual clinics are explored as tangible strategies to reduce the carbon footprint of follow-up care. Recent life-cycle analyses also provide comparative estimates of dialysis and transplantation emissions, underscoring the importance of nuanced evaluation of both modalities. Key Messages: We conclude with a forward-looking agenda for clinicians and policymakers to embed environmental and social responsibility into both dialysis and transplantation, ensuring that kidney replacement therapy as a whole is resilient and sustainable in a warming world. </p>.
Discovery Pipeline for Acute Kidney Injury: Molecules, Mechanisms, Models, and Targets.
Chatterjee T, Rutkowski J, Soranno DE … +5 more , Goggins E, Okusa M, Prenna S, Cantaluppi V, Zarjou A
Nephron · 2026 · PMID 41313738 · Full text
BACKGROUND: Acute kidney injury (AKI) represents a multifaceted clinical syndrome marked by precipitous loss of kidney function, high morbidity and mortality, and a strong propensity for progression to chronic kidney dis...
BACKGROUND: Acute kidney injury (AKI) represents a multifaceted clinical syndrome marked by precipitous loss of kidney function, high morbidity and mortality, and a strong propensity for progression to chronic kidney disease. Collectively, these challenges underscore the imperative to delineate conserved molecular and signaling networks that are uniformly engaged across diverse AKI etiologies. SUMMARY: Herein, we survey five emerging research domains poised to transform AKI pathophysiology and therapeutic paradigms. First, lymphatic network remodeling has been implicated as a critical determinant of renal immunodynamics and interstitial fluid homeostasis, whereby modulation of VEGF-C/D signaling reshapes immune cell trafficking and fibrogenic responses. Second, we will cover emerging evidence that positions macrophage ferritin heavy chain as a key regulator of macrophage phenotype and subsequent kidney ferroptosis susceptibility via coordinated regulation of synuclein-⍺, and Spic. Third, we will emphasize incorporating development as a biological variable into experimental design based on evidence that identifies age-dependent divergences in injury susceptibility, and progression of disease. Fourth, we cover mechanosensitive ion channels that are activated by therapeutic ultrasound offering novel opportunities to harness the cholinergic anti-inflammatory pathway for nephroprotection. Finally, targeting tubular epithelial cell senescence and mitochondrial bioenergetics as a promising approach to limit progression of kidney disease will be discussed. KEY MESSAGES: Collectively, these emerging mechanisms deepen our understanding of AKI pathophysiology and unveil novel therapeutic targets with the potential to transform the treatment landscape.
Biallelic <italic>TMEM72</italic> Variants in Patients with a Nephronophthisis-Like Phenotype.
Claus LR, Snoek R, Faber S … +32 more , Roskothen-Shevchuk AJC, Sendino Garví E, Peters EDJ, Savelberg SMC, Duran K, van der Zwaag B, Nguyen TQ, Broekhuizen R, Brummelhuis WJ, Rookmaaker M, van der Veen SW, Elferink MG, Karras A, Raymond L, Mousseaux C, Sadeghi-Alavijeh O, Sayer JA, Olinger E, Neatu R, Klämbt V, Stokman MF, Knoers NVAM, Tessadori F, Gale DP, Boldt K, Ueffing M, Slaats GG, Roepman R, Hildebrandt F, Mesnard L, van Haaften G, van Eerde AM
Nephron · 2026 · PMID 41308066 · Full text
UNLABELLED: <p>Introduction: Nephronophthisis (NPHP) is an autosomal recessive kidney disease resulting mainly from primary cilium defects, with unspecific and variable symptoms that can progress to kidney failure needin...
UNLABELLED: <p>Introduction: Nephronophthisis (NPHP) is an autosomal recessive kidney disease resulting mainly from primary cilium defects, with unspecific and variable symptoms that can progress to kidney failure needing replacement therapy at a young age. Currently, up to 64% of likely NPHP cases can be diagnosed by assessing known genes. Therefore, there is a need to gain more insight in what genes can cause this disease. METHODS: In a diagnostic setting, we performed broad genetic testing in patients with advanced kidney disease. We carried out in silico and in vitro analyses for TMEM72, including immunohistochemistry and affinity proteomics, and in vivo experiments to further interpret our findings. RESULTS: We identified biallelic TMEM72 variants in 9 patients from six families with a phenotype suggestive for NPHP. Five families presented with kidney failure at a (young) adult age. One family had a different phenotype with prenatal onset of kidney failure and neurological symptoms. The phenotypes of the patients correspond to TMEM72 expression mainly in the kidney. In silico analyses indicate that homozygous loss-of-function variants are likely not tolerated in TMEM72. Immunohistochemistry staining of kidney biopsies revealed altered localization and expression of TMEM72 in cases compared to controls. In human-derived tubuloids, we showed that TMEM72 localizes to the cilium. Furthermore, using an affinity proteomics approach, we found an association of TMEM72 and ciliary function, more specifically in selective ciliary cholesterol transport. CONCLUSION: We present the first genetic evidence, underlined by immunohistochemistry and protein binding assays, linking TMEM72 variants to kidney disease and ciliary function. We conclude that TMEM72 is a candidate gene for NPHP. Future work is needed to further characterize TMEM72 variants and unravel its disease mechanism. </p>.
Exercise Intervention in Patients with Metabolic Syndrome and Renal Disease: A Prospective Study (EXRED).
Rivero Martín O, Morales Febles R, Delgado Mallén PI … +11 more , Reseghetti E, Miquel Rodríguez RM, Estupiñán Torres S, Cobo Caso MA, Cruz C, Díaz Martín L, González Martín AR, Sánchez Báez DJ, Hernández Marrero DJ, Luis Lima S, Porrini E
Nephron · 2026 · PMID 41308049 · Publisher ↗
INTRODUCTION: In patients with chronic kidney disease (CKD) of diverse causes, obesity and metabolic syndrome (MS) accelerate disease progression. Therapeutic exercise could be effective in treating obesity and MS in pat...
INTRODUCTION: In patients with chronic kidney disease (CKD) of diverse causes, obesity and metabolic syndrome (MS) accelerate disease progression. Therapeutic exercise could be effective in treating obesity and MS in patients with CKD. However, the evidence in this area is limited. The aim of this research was to evaluate the effect of an individualized exercise program on major metabolic and renal outcomes in patients with CKD, obesity, and MS. METHODS: This was an interventional exploratory study that included patients with established CKD - estimated glomerular filtration rate (GFR) ≥30 mL/min, obesity, and MS treated by therapeutic exercise (aerobic and resistance) for 6 months. We evaluated changes in renal outcomes - measured glomerular filtration rate (mGFR) with iohexol-DBS and albuminuria, and metabolic outcomes - weight and MS traits. Biochemical, anthropometric, and renal function were performed every 3 months. RESULTS: Forty patients were evaluated. All were overweight or obese, mGFR was 58 ± 20 mL/min, and the urine albumin-creatinine ratio (UACR) was 256 mg/g [IQR: 38-774]. Based on weight reduction (>5%), patients were classified as "responders" (n = 30) and "nonresponders" (n = 10). Responders had a major reduction in body mass index from 35 ± 4 to 31 ± 4 kg/m2 (p < 0.001), triglycerides, HbA1c, systolic and diastolic blood pressure, and UACR from 222 [20-610] to 89 [17-413] mg/g (p < 0.01), whereas mGFR diminished (≥7%) in half of them and remained stable in the other half. Nonresponders experienced no changes. No major side effects were observed. CONCLUSION: In patients with CKD, obesity, and MS, exercise is an effective treatment to reduce weight, MS traits, and albuminuria. Changes in mGFR are heterogeneous. Understanding the impact of weight reduction on GFR changes is crucial in CKD. The role of exercise in nephrological care deserves further attention. The study trial registration number is NCT06576518.
Erratum.
Nephron · 2026 · PMID 41296655 · Publisher ↗
In the article by Jeon et al. entitled "The Impact of C-Reactive Protein-To-Albumin Ratio on Mortality in Patients with Acute Kidney Injury Requiring Continuous Renal Replacement Therapy: A Multicenter Retrospective Stud...
In the article by Jeon et al. entitled "The Impact of C-Reactive Protein-To-Albumin Ratio on Mortality in Patients with Acute Kidney Injury Requiring Continuous Renal Replacement Therapy: A Multicenter Retrospective Study" [Nephron. 2024;148:379-389; https://doi.org/10.1159/000534970], the license type has been changed to CC-BY-NC.The original article has been updated.
Outcomes and Decision Stability in Older Adults following Structured Counseling on Dialysis versus Conservative Management for Kidney Failure: A Prospective Study.
Santacruz J, Del Peso G, García-Llana H … +5 more , Ossorio M, Castillo A, Bajo MA, Sánchez-Villanueva R, Alonso-Babarro A
Nephron · 2026 · PMID 41289232 · Publisher ↗
BACKGROUND: The management of kidney failure in older adults has increasingly adopted patient-centered approaches, with conservative kidney management (CKM) recognized as a valid alternative to dialysis in selected cases...
BACKGROUND: The management of kidney failure in older adults has increasingly adopted patient-centered approaches, with conservative kidney management (CKM) recognized as a valid alternative to dialysis in selected cases. Structured counseling is commonly used to support informed decision-making and align treatment with patient goals. However, evidence on its structured application and impact on treatment decisions in this population remains limited. This study evaluates the clinical characteristics, treatment choices, decision stability, and outcomes of older adults with kidney failure who, after a structured counseling session ("Welcome Meeting") at La Paz University Hospital, chose either CKM or dialysis. METHODS: This prospective, observational, single-center cohort study (April 2015 to December 2019) included participants aged >75 years with CKD-EPI <12 mL/min (<15 mL/min for those with diabetes), Charlson Comorbidity Index >5, and functional impairment (Barthel Index <95 or Palliative Performance Scale <60). All participants received a structured counseling session to support treatment decision-making. Participants then chose either dialysis or CKM. Predictors included treatment choice, clinical outcomes, symptom burden, and healthcare utilization. Decision stability was defined as sustained adherence to the initial treatment choice over the course of follow-up. Analyses were adjusted for potential confounders including age, sex, comorbidity, and functional status. Data were analyzed using SPSS version 27. RESULTS: A total of 103 participants were included (mean age: 84.9 ± 5.5 years); 72% chose CKM and 28% opted for dialysis. CKM participants were older, more often female (p = 0.009), and had greater functional and cognitive impairment (p < 0.001). They also reported more weakness or lack of energy (p = 0.03), constipation (p = 0.03), and poor mobility (p < 0.001) at baseline. At the standardized follow-up assessment, depressive symptoms measured with the IPOS-Renal scale showed a significant reduction in the dialysis group (p = 0.043), while vomiting (p = 0.021) and sore or dry mouth (p = 0.049) increased significantly in the CKM group. Healthcare utilization was higher among dialysis participants. Of the 69 deaths, 65 occurred in the CKM group. Decision stability revealed only 5% of CKM participants switching later to dialysis, with no treatment transitions observed in the dialysis group. CONCLUSION: After a structured counseling session, elderly kidney failure participants who chose CKM were older, female, and presented greater cognitive and functional impairment. This approach supported informed choices and was associated with a high adherence to the initial treatment decision. Further studies are needed to expand this line of research.
Comparing Outcomes of Spousal Kidney Transplants with Living-Related Donors in DSA-Positive Recipients: Is the Risk Increased in Husband-to-Wife Donation?
Ozkara F, Haberal G, Yeter HH … +3 more , Yildirim T, Erdem Y, Yilmaz SR
Nephron · 2026 · PMID 41289207 · Publisher ↗
INTRODUCTION: The number of spousal donor transplantation (SDT) has increased since the early 1990s. Although the SDT is performed successfully today, several concerns remain regarding compatibility. In particular, in hu...
INTRODUCTION: The number of spousal donor transplantation (SDT) has increased since the early 1990s. Although the SDT is performed successfully today, several concerns remain regarding compatibility. In particular, in husband-to-wife donations, donor-specific antibodies (DSAs) positivity may develop as a consequence of previous pregnancies, thereby posing a risk to graft survival. However, data on outcomes in recipients with a history of pregnancy and the development of DSA are limited. In this study, we aimed to compare the outcomes of transplantation between high-risk spouses and transplantation from living donors. METHODS: This study was conducted in our nephrology and transplantation department. It involved 59 spousal donors and 72 living-related donors with DSAs who were older than >18 years of age. We evaluated the consecutive patients who had kidney transplantation between 2010 and 2020. RESULTS: We analyzed data from 59 SDTs with 72 living-related donor transplants (LRDTs) with DSA positivity. Within the first year after transplantation, the acute rejection rate was highest in the husband-to-wife (H-to-W) group (p = 0.01). Compared with LRDT, H-to-W transplants were associated with an increased risk of acute rejection (OR [95% CI]: 4.231 [1.122-15.957], p = 0.03). Cox regression analysis demonstrated a higher risk of rejection in kidney transplants from H to W within the first year of kidney transplantation (HR: 3.734 [95% CI: 1.087-12.825], p = 0.03). There was no increase in creatinine doubling time between groups and no increase in risk of rejection in 5 years. During the follow-up period, graft loss was reported in 3 patients, comprising 2 in the LRDT group and 1 in the W-to-H group. CONCLUSION: SDT, particularly when DSA has developed, appears to be associated with a higher risk of rejection during the first year compared with LRDT with similar DSA. Nevertheless, similar graft survival suggests that H-to-W spousal transplants appear to be safe in the long term.
Advance Care Planning as Key to Person-Centered Care: A Co-Design Study Involving Adults with Chronic Kidney Disease, Family Members, and Healthcare Professionals.
Frandsen CE, Trettin B, Kristensen IV … +1 more , Agerskov H
Nephron · 2026 · PMID 41269982 · Publisher ↗
INTRODUCTION: Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. Advance c...
INTRODUCTION: Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. Advance care planning is recommended for adults with chronic kidney disease and is an approach to facilitating person-centered care. The approach is useful at all stages of the disease and not solely related to end of life or serious disease events but also concerns management of physical, emotional, and psychological challenges throughout the illness trajectory. Living with chronic kidney disease is burdensome, and there is a need for family members to be involved in the process to support their loved ones. Therefore, this study aimed to describe a co-design, pilot test, and evaluation of an ACP intervention for adults with CKD supported by their family members. Furthermore, the article explores and critically discusses how this approach aligns with principles around person-centered care. METHODS: The project was inspired by the framework of complex interventions and divided into three phases, which consisted of four sub-studies: a cross-sectional survey, an interview study, workshops for intervention development, and a qualitative evaluation of the intervention. Qualitative studies were conducted with a phenomenological-hermeneutic approach inspired by Ricoeur's interpretation theory. Quantitative data were analyzed using both descriptive and inferential statistics managed by STATA. For intervention development, co-design was applied, and data were analyzed using the action research spiral. RESULTS: Living with chronic kidney disease impacted family and everyday life and led to changes in family identity and roles for both adults with chronic kidney disease and family members. There was a desire for family members to be involved in the advance care planning process to be able to support their loved ones. Healthcare professionals experienced barriers to engaging in care planning, and they had a desire for a systematic and disease-specific approach. This knowledge was used to design an advance care planning intervention in close collaboration with the consumers with a focus on person-centered care and family. The advance care planning intervention supported an open dialog about thoughts and concerns and created a shared understanding and unique knowledge. CONCLUSION: The study provided valuable insights into the importance of supporting adults with chronic kidney disease in understanding and sharing their preferences and wishes for care and daily life and for involving family members in the ACP process to support their loved ones. Thus, an ACP intervention with a person-centered and family-focused approach was developed to improve care on an individual and family level throughout the illness trajectory. The ACP discussions were significant for adults with CKD, family members, and healthcare professionals and informed approaches to care and treatment.
Decisional Regret in Adults Facing Treatment Choices for Kidney Failure: A Systematic Review.
Bispo I, Bressan M, Rego F … +1 more , Rêgo G
Nephron · 2026 · PMID 41269912 · Publisher ↗
INTRODUCTION: Choosing the treatment for kidney failure, whether dialysis or conservative kidney management, is challenging. Many adults may experience regret about this decision, leading to poor quality of life. This re...
INTRODUCTION: Choosing the treatment for kidney failure, whether dialysis or conservative kidney management, is challenging. Many adults may experience regret about this decision, leading to poor quality of life. This review aimed to determine the proportion of patients who report decisional regret after making treatment choices for kidney failure, as well as to identify the factors that contribute to it. METHODS: This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search was performed through the databases PubMed, Web of Science, Scopus, APA PsycInfo, and through websites. The search strategy included terms of three main categories: adults with kidney failure or estimated glomerular filtration rate less than 30 mL/min/1.73 m2, kidney failure treatment, and decisional regret. RESULTS: Studies examining decisional regret in adults undergoing kidney replacement therapy, those in the pre-dialysis phase, or those receiving conservative kidney management were included. Initially, 1,712 articles were found by the reported research, and 22 of them were selected. The proportion of regret ranged from none to 62% and the factors most related to it were the lack of information, lack of patient autonomy, social and physical burden, and decisional conflict. CONCLUSIONS: Decisional regret is a common experience among adults facing treatment choices for kidney failure, particularly when patient autonomy is compromised, or information is inadequate. Regret is also associated with decisional conflict, and with emotional, social and physical burden, impacting quality of life. Effective communication between healthcare professionals and patients plays a vital role in reducing decisional regret, leading to improved outcomes and greater patient satisfaction. Additionally, practical tools such decision aids can enhance shared decision-making and empower patients to make informed and autonomous choices.
Contiguous Gene Deletion Involving <italic>COL4A1</italic> and <italic>COL4A2</italic> in a Patient with Thin Basement Membrane Nephropathy: A Case Report.
Henein M, Russo F, Bernard C … +2 more , Cybulsky AV, Kitzler TM
Nephron · 2026 · PMID 41269897 · Full text
<p>Introduction: Type IV collagen trimers are major structural components of the kidney glomeruli and tubules. Several loss-of-function COL4A1 and COL4A2 variants have been reported to cause cerebral small vessel disease...
<p>Introduction: Type IV collagen trimers are major structural components of the kidney glomeruli and tubules. Several loss-of-function COL4A1 and COL4A2 variants have been reported to cause cerebral small vessel disease. However, there is little evidence to suggest that loss-of-function variants in these genes can cause kidney disease. Case Presentation: Here we report a case of a patient with thin basement membrane nephropathy and chronic kidney disease (CKD) who was found to bear a 1.9 Mb heterozygous contiguous gene deletion of chromosome 13q33.3-q34 that includes COL4A1 and a large region of COL4A2. Conclusion: We propose that haploid expression of COL4A1 in combination with COL4A2 can lead to thin basement membrane nephropathy and CKD. </p>.
Sex Differences in Kidney Function Decline in the Healthy General Population.
Saastad V, Rinde LB, Enoksen IT … +3 more , Porrini E, Eriksen BO, Melsom T
Nephron · 2026 · PMID 41252341 · Publisher ↗
BACKGROUND: There are considerable sex and gender differences in the epidemiology of chronic kidney disease (CKD), with CKD stage 3, defined as a glomerular filtration rate (GFR) below 60, being more prevalent in women....
BACKGROUND: There are considerable sex and gender differences in the epidemiology of chronic kidney disease (CKD), with CKD stage 3, defined as a glomerular filtration rate (GFR) below 60, being more prevalent in women. This raises questions about whether sex differences in age-related GFR decline contribute to this paradox. Only a few studies have investigated this issue, and most of these studies used estimated GFR (eGFR) based on creatinine (eGFRcrea) or cystatin C. SUMMARY: This article reviews studies examining age-related GFR decline in men and women from the general population. The conflicting findings on sex differences in GFR decline are likely influenced by variations in study populations, including differences in comorbidities, as well as the methods used to assess GFR. Further research is essential to accurately address trajectories of GFR decline in men and women. KEY MESSAGES: Sex and gender differences in GFR levels and age-related GFR decline rates may influence the observed differences in CKD prevalence between men and women. Possible differences in age-related GFR decline between men and women may stem from a combination of biological factors, including sex hormones, different methods to assess GFR, and differences in the prevalence and impact of risk factors. Current eGFR equations may not accurately capture sex differences in measured GFR decline. Further research is needed to better understand these differences and their clinical implications.
Navigating Disparities and Overcoming Barriers to Access Diabetic Kidney Disease Therapies: A Proposed Multifactorial Approach.
Petrosyan R, Caballero AE, Henry TL … +1 more , Puchalski AR
Nephron · 2026 · PMID 41231738 · Full text
<p>Background: Diabetic kidney disease (DKD) is a serious complication arising from long-term diabetes, disproportionately affecting historically marginalized populations, such as racial and ethnic minority groups, popul...
<p>Background: Diabetic kidney disease (DKD) is a serious complication arising from long-term diabetes, disproportionately affecting historically marginalized populations, such as racial and ethnic minority groups, populations with low socioeconomic status, or a lower level of education. This review explores the causes of these disparities and barriers to accessing DKD therapies and proposes solutions. Summary: Socioeconomic factors like lack of health insurance, low income, and limited health literacy significantly hinder access to DKD therapies for marginalized communities. Additionally, inadequate access to healthcare services further exacerbates the issue. Clinical factors also contribute to the inequity. Under-recognition of DKD, under-prescription of effective medications, and a lack of a patient-centered healthcare environment are prominent concerns. Implicit bias among healthcare professionals may also play a role. Patient factors include limited awareness of DKD, challenges with treatment adherence, and frequent healthcare interruptions. Policy interventions like the Inflation Reduction Act, expanding health insurance coverage, and increasing reimbursement for DKD therapies can improve affordability and access. Additionally, a shift toward preventive care models is crucial. Clinical interventions focus on improving early detection, accurate diagnosis, and proper management of DKD. Educating healthcare providers about the benefits of DKD therapies and implementing value-based kidney care programs are essential steps. Patient interventions involve raising awareness about DKD, implementing culturally appropriate educational programs, and fostering community-based support systems. Key Messages: Addressing these disparities requires a multipronged approach involving policy changes, improved healthcare delivery, and patient education. This collaborative effort can ensure equitable access to DKD therapies and improve health outcomes for all populations. </p>.
Lactitol-Induced Acute Kidney Injury with Oxalate Nephropathy: A Case Report.
Guan M, Hu H, Song H … +1 more , Wan Q
Nephron · 2026 · PMID 41231736 · Publisher ↗
INTRODUCTION: Oxalate nephropathy, characterized by calcium oxalate crystal deposition in renal tissue, represents an underrecognized etiology of acute and chronic kidney injury. Secondary hyperoxaluria can emerge from d...
INTRODUCTION: Oxalate nephropathy, characterized by calcium oxalate crystal deposition in renal tissue, represents an underrecognized etiology of acute and chronic kidney injury. Secondary hyperoxaluria can emerge from diverse pathogenetic mechanisms, including excessive oxalate precursor intake, augmented intestinal absorption, or iatrogenic interventions. The therapeutic potential of glucocorticoids in managing this condition remains incompletely elucidated. CASE PRESENTATION: A 66-year-old man with no significant prior medical history developed acute kidney injury (AKI), manifesting as a profound serum creatinine elevation from 81 µmol/L to 1,140.4 µmol/L. The patient had consumed a "corn germ powder" supplement containing lactitol for five consecutive months, concurrently experiencing persistent diarrhea. Initial laboratory investigations revealed severe renal dysfunction without notable proteinuria or hematuria. Renal ultrasonography demonstrated normal kidney morphology and dimensions. Definitive kidney biopsy revealed extensive calcium oxalate crystal deposition within renal tubular structures, conclusively diagnosing oxalate nephropathy. Therapeutic intervention comprised prednisone (60 mg daily) and comprehensive supportive management. Following a 3-month treatment protocol with gradual corticosteroid dose reduction, the patient's renal function demonstrated substantial improvement, with serum creatinine declining to 118.2 µmol/L. CONCLUSION: This case underscores lactitol-induced secondary oxalate nephropathy as a rare yet clinically significant contributor to AKI. Prompt diagnostic recognition and targeted therapeutic intervention, potentially incorporating glucocorticoid therapy, may substantially facilitate renal functional recovery. Clinicians should maintain heightened awareness of nephrotoxic risks associated with over-the-counter laxative supplements and consider oxalate nephropathy in cryptogenic renal dysfunction scenarios.
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