Nephron[JOURNAL]
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200 papers
Home-Based Dialysis and Person-Centered Care: A Scoping Review.
Nygaard-Andersen B, Torbjørnsen A, Hougaard PF … +3 more , Leonardsen AL, Wolf A, Finderup J
Nephron · 2025 · PMID 40031884 · Full text
INTRODUCTION: Managing dialysis at home requires the involvement of the patient in decisions, treatment, and their illness and health. Evidence-based person-centered care interventions focus on listening to the patient's...
INTRODUCTION: Managing dialysis at home requires the involvement of the patient in decisions, treatment, and their illness and health. Evidence-based person-centered care interventions focus on listening to the patient's narrative, establishing a partnership between patients and healthcare professionals, and documenting care and treatment in a shared health plan. Therefore, a person-centered care intervention is expected to enhance the patient's ability to manage dialysis at home. This study aimed to identify and map evidence for person-centered interventions and home-based dialysis for individuals with kidney failure. METHODS: A scoping review was conducted based on the approach of Arksey and O'Malley. A systematic search was carried out in Medline, CINAHL, and Scopus for articles in all languages and without time restrictions. Person-centered care interventions concerning home dialysis were included. Two independent researchers assessed the literature. Data were extracted using NVIVO, and a relational analytical framework was employed to synthesize the data. RESULTS: The search identified 9,443 articles, of which 16 met the inclusion criteria. A total of 13 person-centered care interventions were identified. Eight interventions aimed to involve the patient in the decision regarding the type of dialysis modality, with six interventions identified to involve the patient in treatment, illness, and health. Only one intervention was identified to involve the patient in the decisions that follow once the patient has commenced dialysis treatment. Five interventions showed a correlation between a person-centered care intervention and the number of patients in home dialysis. CONCLUSION: There is a need for interventions for patients in home dialysis to be adapted to a more person-centered care approach, particularly regarding the involvement of the patient in their treatment, illness, and health, as well as the decisions that follow the initiation of dialysis treatment.
Change in Urine Albumin-Creatinine Ratio and Occurrence of Hyperkalemia in Patients Initiating Finerenone in the USA: A Cohort Study from the FOUNTAIN Platform.
Kovesdy CP, Ebert N, Vizcaya D … +17 more , Walsh M, Kosiborod MN, Layton JB, Ziemiecki R, Johannes CB, Pladevall-Vila M, Gee PO, Jefferson N, Chicoye A, Lopes M, Thapa BB, Curhan G, Rangel L, Bhartia M, Liu F, Farjat AE, Oberprieler NG
Nephron · 2025 · PMID 40015260 · Full text
INTRODUCTION: In 2021, finerenone - a novel, selective nonsteroidal mineralocorticoid receptor antagonist - was approved in the USA to treat adults with chronic kidney disease (CKD) and type 2 diabetes (T2D). This study...
INTRODUCTION: In 2021, finerenone - a novel, selective nonsteroidal mineralocorticoid receptor antagonist - was approved in the USA to treat adults with chronic kidney disease (CKD) and type 2 diabetes (T2D). This study aimed to describe characteristics and short-term outcomes of patients prescribed finerenone since regulatory approval. METHODS: This was a retrospective cohort study using claims and electronic health records data from the OM1 Real-World Data Cloud™. A total of 15,948 US adults with a previous diagnosis of CKD and T2D who initiated 10 mg or 20 mg finerenone between July 2021 and August 2023 were included. Dosing was evaluated at baseline and over up to 12-month follow-up. Change from baseline in urine albumin-to-creatinine ratio (UACR) was evaluated at 4 and 12 months (among 913 and 443 patients, respectively, with available repeat UACR values). Hyperkalemia occurrence was determined at 12 months and over total follow-up. RESULTS: Median follow-up was 7.2 months. Mean age was 70.3 years, and 44.1% were female. At baseline (-365; 0 days), 70% had CKD stage 3; for patients with UACR measurements, 80.8% had moderate/severe albuminuria (≥30 mg/g). Median UACR was 203 mg/g. Co-medication use was ACE inhibitors/ARBs (51%), SGLT2is (38%), and GLP-1 RAs (26%). 86% of patients initiated 10 mg finerenone, and among 2,212 patients still under observation at 12 months, 70% were on 10 mg. For finerenone initiators with available UACR data, UACR was reduced by 33% at 4 months and 38% at 12 months. Hyperkalemia occurred in 1.2% of the cohort by 12 months (incidence 2.0 per 100 person-years). CONCLUSION: Patients who initiated finerenone had a notable reduction in median UACR at 4 months, sustained at 12 months; hyperkalemia occurrence appeared to be low. These initial findings from US clinical practice should be complemented by results from other real-world cohorts of patients started on finerenone.
Serum Levels of B-Cell Activating Factor and A Proliferation-Inducing Ligand in Children with Steroid-Sensitive Nephrotic Syndrome.
Ling C, Chen Z, Hua L … +7 more , Zhang H, Wu D, Xi Y, Lei L, Quan S, Li X, Liu X
Nephron · 2025 · PMID 40010307 · Publisher ↗
INTRODUCTION: The therapeutic efficacy of B-cell-depleting anti-CD20 treatments is well established for children with steroid-sensitive nephrotic syndrome (SSNS), thus suggesting that B cells may play an important role i...
INTRODUCTION: The therapeutic efficacy of B-cell-depleting anti-CD20 treatments is well established for children with steroid-sensitive nephrotic syndrome (SSNS), thus suggesting that B cells may play an important role in the occurrence of this disease. However, the role of B-cell survival factors and cytokines in SSNS has yet to be fully elucidated. METHODS: We used commercially available ELISA kits to determine the serum levels of B-cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL) in 84 children with SSNS and 25 healthy controls. Then, we performed correlation analysis between these two serum factors and clinical parameters in children with SSNS. RESULTS: The serum level of BAFF in the relapse group was 1,295.2 ± 584.2 pg/mL, significantly higher than other groups (p < 0.001). The serum level of APRIL in the relapse group was 2,830.5 ± 945.8 pg/mL, significantly higher than the other groups (p < 0.001). The proportion (%) of memory B cells was positively correlated with the levels of BAFF and APRIL in children with SSNS (Pearson's correlation coefficient: r = 0.351, p = 0.001; Pearson's r = 0.234, p = 0.032). The proportion (%) of transitional B cells was negatively correlated with the levels of BAFF (Pearson's r = -0.237, p = 0.030) while the serum levels of IgG were negatively correlated with those of APRIL (Pearson's r = -0.274, p = 0.012). CONCLUSIONS: Our data indicate that BAFF appears to play a role in the recurrence of SSNS while APRIL appears to play a role in the pathogenesis of this condition, thus indicating that these molecules represent potential therapeutic targets for SSNS.
The Inflammatory Pathogenetic Pathways of Fabry Nephropathy and Agalopathy: <italic>GLA</italic> Variant Induction of Endoplasmic Reticulum Stress.
Feriozzi S, Feriozzi S, Rozenfeld P
Nephron · 2025 · PMID 39978321 · Publisher ↗
BACKGROUND: Fabry disease (FD) is a monogenic disease with highly variable clinical features. This variability suggests that additional pathogenetic pathways may exist besides the intra-lysosomal deposition of globotriao...
BACKGROUND: Fabry disease (FD) is a monogenic disease with highly variable clinical features. This variability suggests that additional pathogenetic pathways may exist besides the intra-lysosomal deposition of globotriaosylceramide (Gb3) and its deacylated form globotriaosylsphingosine (LysoGb3) caused by an enzyme deficiency. SUMMARY: It has been demonstrated that intralysosomal accumulation of Gb3 and LysoGb3 triggers an inflammatory response. Monocytes, macrophages, and dendritic cells overexpress the adhesion molecules, and cytokines release occurs, including interleukin β, tumor necrosis factor-alpha (TNFα), and transforming growth factor beta. These processes determine the activation of inflammation processes associated with chronic inflammation and tissue fibrosis. The pathogenetic mechanisms stimulated by Gb3 and LysoGb3 deposition could break free from the original activation, causing an irreversible effect, in which Fabry disease-specific therapy can play a limited role. A new disease mechanism, "Agalopathy" would coexist with enzyme deficiency. Missense variants in the coding sequence of the GLA gene would generate the misfolding of the altered protein alpha-galactosidase A. Emergence of misfolded proteins may generate stress of the endoplasmic reticulum, leading to induction of the unfolded protein response (UPR). The UPR causes the release of pro-inflammatory cytokines and contributes to inflammatory status. This mechanism could be activated independently of glycolipid deposition, and its relationship with inflammatory pathways deserves more research. Strikingly, a zebrafish GLA knockout model that naturally lacks the enzyme that synthesizes Gb3 shows many alterations in lysosomal functions. KEY MESSAGES: These pieces of evidence suggest the involvement of alternative pathways independent of Gb3 in FD pathogenesis. This review aims to describe these processes' role in the pathogenesis of renal damage in FD or Agalopathy nephropathies.
Subclinical Inflammation and Renal Allograft Dysfunction: Myth or Reality?
Couceiro C, Visent M, Cruzado JM
Nephron · 2025 Feb · PMID 39961286 · Publisher ↗
BACKGROUND: Since the implementation of the Banff classification, the diagnosis and treatment of transplant rejection have been standardised. However, the rigid categorisation of transplant pathology has limited our pers...
BACKGROUND: Since the implementation of the Banff classification, the diagnosis and treatment of transplant rejection have been standardised. However, the rigid categorisation of transplant pathology has limited our perspective on allograft inflammation, particularly disregarding those inflammatory infiltrates who do not reach the category of rejection. SUMMARY: The term subclinical inflammation was introduced to designate the inflammation found in protocol biopsies, without significant renal function deterioration. Following the introduction of modern immunosuppression with tacrolimus and mycophenolate, subclinical rejection rate decreased, and less attention was paid to this entity. However, in the last decades, several studies have evaluated the impact of lower levels of inflammation and demonstrated its negative consequences on long-term outcomes. Although, in some patients, this subclinical inflammation is not permanent and can spontaneously disappear. The uncomplete definition of subclinical inflammation, which only considers renal function stability, and the evaluation of the biopsy as a definitive diagnosis, and not as a picture of an evolving process, are the main reasons why managing this inflammation represents a challenge, especially when there is no pathogenic mechanism identified. KEY MESSAGES: In this review, we revise the "natural" history of inflammation in the kidney allograft and its possible origins based on cellular composition and transcriptomic expression changes in kidney biopsies. In addition, we propose an updated definition and an approach to manage it.
Developing and Tailoring a Person-Centred Pathway for Mental Health Care for People Receiving Dialysis.
Schick-Makaroff K, Berendonk C, Salum M … +11 more , Yoeun P, Wichart J, Armstrong M, Thompson S, Elliott M, Lee L, Smith T, Reintjes F, Fillier D, Klarenbach S, Sawatzky R
Nephron · 2025 · PMID 39956103 · Full text
INTRODUCTION: Mental health symptoms are underdiagnosed and undertreated among people receiving dialysis treatment. Despite a high prevalence of depression (40%) and anxiety (42%) symptoms in this population, internation...
INTRODUCTION: Mental health symptoms are underdiagnosed and undertreated among people receiving dialysis treatment. Despite a high prevalence of depression (40%) and anxiety (42%) symptoms in this population, international guidance does not exist. To address this gap, a multi-phase project involved collaboration by diverse groups in Alberta, Canada to develop and tailor a pathway that supports person-centred mental health care for Albertans receiving dialysis. METHODS: This mixed methods patient-oriented research was conducted in two phases. Phase 1 included: (a) an online clinician survey (n = 199), (b) 11 focus groups and 2 interviews involving 10 people with lived experience and 44 clinicians and administrators, and (c) a scoping review of evidence-based pharmacological treatment. Descriptive analyses of the survey data and summative content analysis of qualitative data (written survey comments and data from focus groups and interviews) were conducted to understand current processes, health services, and interventions for mental health care in Alberta Kidney Care for people receiving dialysis, and to determine appropriateness and opportunities of existing mental health services and interventions. The results were used to develop preliminary statements to inform development of the pathway. Attributes of centeredness in health care - being unique, being heard, and shared responsibility - guided pathway development. Phase 2 involved building consensus on these statements via two rounds of modified Delphi surveys (n = 59 and 51 for rounds 1 and 2, respectively), followed by a consensus call on a virtual platform for discussion and voting involving 27 participants. Voters rated their agreement for each statement using a 3-point Likert scale. Consensus was defined a priori as ≥80% agreement by two groups of voters: people with lived experience and clinicians/others. RESULTS: Phase 1 results informed the development of 68 statements in round 1 of Delphi voting; 42 were approved. Based on voter comments, 11 new statements were developed and 23 statements were revised. Round 2 of Delphi voting included 34 statements. A call was held with people with lived experience to understand why they voted differently than clinicians/others. We learned that some statement language was too technical, such as "assessment" or "score." We talked through each statement and people with lived experience verbally approved the intention of all statements. Through this dialogue, and round 2 voting, 20 statements were approved. A consensus call was held, concluding with voting on 5 statements previously not approved by both groups; 3 were approved. In total, 66 statements were approved for use in development of a pathway addressing symptoms of depression and anxiety, as well as coping. Approved statements guided depiction of the pathway as an algorithm for initial conversations, assessment, follow-up (including "red-flags" or urgent referrals), and management with non-pharmacological and pharmacological supports. CONCLUSION: Strategies to ensure person-centeredness provided all involved parties with opportunities to engage in meaningful ways in pathway development, a novel approach which may provide transferable lessons for kidney programs across Canada and internationally.
Membranoproliferative Glomerulonephritis with Striated Ultrastructural Deposits with Significantly Elevated Fibrinogen and Fibronectin on Mass Spectrometry Analysis: A Case Report and Literature Review.
Ishida M, Yamamoto S, Iwashige Y … +9 more , Miyazawa S, Nakata H, Seta K, Yahata K, Minamiguchi S, Endo Y, Mii A, Shimizu A, Yanagita M
Nephron · 2025 · PMID 39947166 · Full text
Glomerular diseases with organized deposits can be classified into various etiologies. A diagnostic algorithm based on clinical and pathological findings has been proposed. However, some cases cannot be diagnosed using e...
Glomerular diseases with organized deposits can be classified into various etiologies. A diagnostic algorithm based on clinical and pathological findings has been proposed. However, some cases cannot be diagnosed using existing algorithms. Here, we report the case of a 77-year-old man diagnosed with membranoproliferative glomerulonephritis (MPGN) with striated ultrastructural deposits, micro-filament-like substructures with straight bands arranged in parallel in the subendothelial space by two sequential renal biopsies. His examinations and clinical findings were incompatible with known glomerular diseases with organized deposits. Dialysis was initiated 10 months after the second biopsy procedure. Furthermore, we report the first mass spectrometry analysis of laser micro-dissected glomeruli with striated ultrastructural deposits, which revealed significant levels of fibrinogen and fibronectin. Immunostaining was positive for fibrinogen, fibrin, and fibronectin in the subendothelial space. These findings suggest that the deposits were composed of a fibrin-fibronectin complex and that accumulation of these fibrin-fibronectin complexes possibly induced endothelial injury, leading to MPGN. We also reviewed the literature on the clinical and pathological characteristics of the four cases with striated ultrastructural deposits. Our investigation showed that all patients had the MPGN pattern and striated ultrastructural deposits in the subendothelial space, and all underwent hemodialysis within 3 years of renal biopsy. Clinicians should be aware of the findings of glomerulonephritis with striated ultrastructural deposits since this disease may be a new entity and has a poor prognosis.
CHADS-VASc Score as a Predictor of Cardiovascular and All-Cause Mortality in a Prospective Cohort of Hemodialysis Patients of Predominantly African Ancestry: The PROHEMO.
Gutiérrez-Peredo GB, Gutiérrez-Peredo AJ, Montaño-Castellón I … +12 more , Marques da Silva Neto M, Albuquerque da Silva F, Silva Martins MT, Mendes Matos C, Correia Monteiro JM, Guimarães Silva P, Lopes GB, Barreto Lopes M, Correia LC, Pecoits-Filho R, Norris KC, Lopes AA
Nephron · 2025 · PMID 39933494 · Full text
UNLABELLED: <p>Background: Patients with chronic kidney disease undergoing maintenance hemodialysis (MHD) have an increased mortality. The CHADS-VASc score, initially used for stroke prediction in atrial fibrillation, is...
UNLABELLED: <p>Background: Patients with chronic kidney disease undergoing maintenance hemodialysis (MHD) have an increased mortality. The CHADS-VASc score, initially used for stroke prediction in atrial fibrillation, is relevant for various cardiovascular conditions. This study evaluates its effectiveness in predicting cardiovascular and all-cause mortality in MHD patients. METHODS: Data are from the "Prospective Study of the Prognosis of Patients on Chronic Hemodialysis" (PROHEMO) in Salvador, Brazil. Patients were divided by CHADS-VASc scores: ≤2 and >2. Cox regression estimated hazard ratios (HR) for death, both unadjusted and adjusted for confounders. We assessed the distribution of each score variable and its association with mortality. A modified CHADS-VASc score was created due to the low percentage of patients over 75 (1.3%) and normotensive (4.6%). RESULTS: A total of 237 patients (mean age 51.6 years; 57.0% male) were included in the study. There were 55 deaths, 21 from cardiovascular causes. For patients with a CHADS-VASc score >2, the unadjusted hazard of all-cause mortality was doubled (HR = 2.05; 95% CI: 1.20, 3.49) compared to those with a score ≤2, and the risk for cardiovascular deaths was more than threefold (HR = 3.53; 95% CI: 1.46, 8.54). These ratios remained consistent after adjusting for covariates. In the most comprehensive Cox model, the HR for all-cause mortality was 2.43 (95% CI: 1.38, 4.23) and for cardiovascular mortality was 3.52 (95% CI: 1.40, 8.84), similar to results from the modified CHADS-VASc score. CONCLUSIONS: The results support the CHADS-VASc score as a practical tool for identifying MHD patients at higher risk of mortality, especially from cardiovascular causes. </p>.
Implementing the Nurse-Led Optimization of Volume and Blood Pressure - Enabling at Multi-Levels Using Technology Program for Chronic Kidney Disease: A Prospective Cohort Study.
Huang Z, Ng LC, Mok I … +2 more , Tan CS, Lim CC
Nephron · 2025 · PMID 39900015 · Full text
BACKGROUND: Fluid overload is a common manifestation of chronic kidney disease (CKD) and is associated with increased hospitalizations and death. However, severe symptomatic fluid overload is potentially preventable with...
BACKGROUND: Fluid overload is a common manifestation of chronic kidney disease (CKD) and is associated with increased hospitalizations and death. However, severe symptomatic fluid overload is potentially preventable with early recognition of mild fluid overload and timely institution of appropriate pharmacotherapy and fluid restriction. We implemented and evaluated the outcomes of a nurse-led clinic that incorporated objective fluid volume assessment using body impedance analysis (BIA) into structured patient education and action plan coaching to patients with CKD and fluid overload. METHODS: This was a single-center prospective pre-post-implementation study of adults who participated in the program between August 2022 and April 2024. Patients were eligible if they had CKD not requiring dialysis and had fluid overload and/or systolic blood pressure (BP) >160 mm Hg or diastolic BP >100 mm Hg. The clinical effectiveness outcomes were symptoms and signs of fluid overload and improvement in BP. The patient-reported effectiveness outcomes were chronic disease self-management assessed using the Partner in Health (PIH) questionnaire and health-related quality of life assessed by the EuroQOL-5 Dimension (EQ5D5L) survey. The clinical safety outcomes were (1) hypotension with systolic BP <90 mm Hg and (2) worsening kidney function. RESULTS: Among 107 patients referred to the nurse-led program, 96 attended the first visit. Median age was 68.5 (IQR 60.2, 77.3) years, and eGFR was 21.6 (14.0, 39.7) mL/min/1.73 m2. Almost all participants (93.8%) had symptoms of fluid overload within the past 1 month before the first review. BIA was performed for 52 (54.2%) patients, and the median overhydration was 2.4 (1.3, 3.6) L. The second and third visits were attended by 38 (39.6%) and 28 (29.2%) patients, respectively. For these 28 patients at program completion, symptoms and signs of fluid overload were less frequent and systolic BP (137 [121, 143] vs. 151 [132, 166] mm Hg, p = 0.03) and self-management (PIH score 96 [89, 104] vs. 72 [57, 88], p = 0.001) had improved compared to their baseline visit. EQ5D5L scores were significantly different. None experienced hypotension (systolic BP <90 mm Hg), and kidney function did not change significantly during follow-up. CONCLUSION: A nurse-led program that incorporated objective fluid volume assessment, structured patient education, and action plan coaching for patients with CKD and fluid overload improved the BP and self-management of those who completed the program.
Acute Tubular Necrosis Attributed to High-Dose Everolimus with High-Potency Bisphosphonates for Advanced Breast Cancer: A Case Report.
Loewenstein I, Urtreger NO, Schwartz D … +2 more , Zubkov A, Ingbir M
Nephron · 2025 · PMID 39900014 · Publisher ↗
INTRODUCTION: Everolimus (EVR)-induced kidney injury is rarely reported. Conversely, acute tubular necrosis (ATN) is a recognized complication of high-dose bisphosphonate therapy. CASE PRESENTATION: SM, a 69-year-old fem...
INTRODUCTION: Everolimus (EVR)-induced kidney injury is rarely reported. Conversely, acute tubular necrosis (ATN) is a recognized complication of high-dose bisphosphonate therapy. CASE PRESENTATION: SM, a 69-year-old female patient with advanced breast cancer, developed severe kidney injury necessitating renal replacement therapy (RRT) shortly after initiating EVR treatment, while concurrently receiving chronic high-potency bisphosphonate therapy. Kidney biopsy confirmed ATN. Upon discontinuation of both EVR and bisphosphonates, her renal function gradually improved over several months, leading to the cessation of RRT. At a 2-year follow-up, her kidney function has returned to baseline. CONCLUSION: In this case report, we outline the patient's clinical course and provide a pathophysiological rationale for the synergistic effect of EVR and bisphosphonates in promoting ATN. With the increasing use of EVR in various oncologic indications, we emphasize the reversible nature of this kidney injury and stress the importance of timely recognition and intervention.
Understanding the Support Needs of People with Autosomal Dominant Polycystic Kidney Disease: A Qualitative Phenomenological Descriptive Study.
Rasmussen KS, Khatir DS, Birn H … +2 more , Poulsen SE, Finderup J
Nephron · 2025 · PMID 39874952 · Publisher ↗
INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is a prevalent hereditary kidney disease and the fourth most common cause of kidney failure. Patients may be aware of their condition from an early age o...
INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is a prevalent hereditary kidney disease and the fourth most common cause of kidney failure. Patients may be aware of their condition from an early age or discover it unexpectedly, with varying levels of familial knowledge about the disease. This chronic condition presents significant challenges for healthcare professionals. The study aimed to investigate how people with ADPKD experience their participation in a dedicated ADPKD clinic and to investigate their support needs in managing their disease in everyday life. METHODS: A qualitative phenomenological descriptive study was conducted, involving semi-structured telephone interviews with patients who attended a newly established dedicated ADPKD clinic between March and April 2023. The data were analyzed using Malterud's principles of systematic text condensation. RESULTS: In total, 18 out of 22 patients agreed to participate in the interviews. Six themes emerged from the interviews. Participants expressed feelings of uncertainty about their future and highlighted the necessity for personalized care tailored to their individual circumstances. They reported challenges in coping with emotions associated with the disease and sought assistance in making difficult decisions. Maintaining control over their health and illness was a significant theme, alongside a desire for increased knowledge about their condition. CONCLUSION: Our study supports existing knowledge in this area. In this study, the participants experienced satisfaction with the dedicated ADPKD clinic, feeling well informed, listened to, and more at ease after the check-up. Investing in a dedicated ADPKD clinic could help alleviate the uncertainty that many people with ADPKD experience.
Personalized Care in CKD: Moving Beyond Traditional Biomarkers.
McDonnell T, Banks RE, Taal MW … +2 more , Vuilleumier N, Kalra PA
Nephron · 2025 · PMID 39848232 · Full text
BACKGROUND: Traditional biomarkers, such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR), have long been central to chronic kidney disease (CKD) diagnosis and management, leadi...
BACKGROUND: Traditional biomarkers, such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (uACR), have long been central to chronic kidney disease (CKD) diagnosis and management, leading to a standardized CKD classification system. However, these biomarkers are non-specific and fail to capture the heterogeneity within CKD and the nuances of an individual's disease mechanism, limiting personalized treatment approaches. There is an increasing need for novel biomarkers that reflect the diverse pathophysiological processes underlying CKD progression, enabling more precise risk prediction and treatment strategies. SUMMARY: This review examines the limitations of current CKD biomarkers and classification systems, highlighting the need for a precision medicine approach. While traditional markers like eGFR and uACR are foundational, they inadequately capture CKD's complexity. Emerging biomarkers offer insights into specific disease processes, such as inflammation, oxidative stress, fibrosis, and tubular injury, which are crucial for personalized care. The article discusses the potential benefits of integrating these novel biomarkers into clinical practice, including more accurate risk prediction, tailored treatments, and personalized clinical trial designs, as well as the barriers to their implementation. Furthermore, advancements in multi-omics and high-throughput techniques offer opportunities to identify novel causative proteins with druggable targets, pushing CKD care towards greater precision. KEY MESSAGES: Current CKD classification systems, based on non-specific biomarkers, fail to capture CKD's heterogeneity. Incorporating biomarkers reflecting diverse pathophysiological mechanisms can enhance risk prediction, customized treatments, and personalized clinical trials. High-throughput multi-omic techniques present a promising path towards precision medicine in nephrology.
Prospective Evaluation of Remote Software Based Surveillance Supplementing Clinical Monitoring for Haemodialysis Vascular Access.
Eltahan AR, Pondor Z, Donne RL … +9 more , Lewis D, Raman M, Cowperthwaite J, Resiga ML, Hinchliffe P, Lim J, Gleave P, Allsopp J, Poulikakos D
Nephron · 2025 · PMID 39832484 · Full text
BACKGROUND: Efficient arteriovenous vascular access (VA) surveillance is vital for early identification of dysfunctional access, allowing timely intervention to prevent thrombosis. This study compares the efficacy of add...
BACKGROUND: Efficient arteriovenous vascular access (VA) surveillance is vital for early identification of dysfunctional access, allowing timely intervention to prevent thrombosis. This study compares the efficacy of adding remote software surveillance to standard clinical care across our units. METHODS: We conducted a 12-month prospective study on maintenance haemodialysis (HD) patients using Vasc-Alert software technology to assist clinical decision-making in 2 satellite HD units (group 1) and standard care in the remaining 3 HD units (group 2). Patients with Vasc-Alert-derived high Access Risk Score (ARS) (≥7) underwent clinical assessment and were referred for fistulogram based on relevant Kidney Disease Outcome Quality Initiative (KDOQI) criteria. Data on referrals for fistulogram, subsequent VA events, access abandonment, and complication-free days-extended (CFD-extended) were collected. VA survival analysis of post-intervention primary patency rate at 3 and 6 months was conducted. RESULTS: There were 23 (28.1%) pre-emptive correction of stenosis and 6 (7.3%) thrombosis episodes in group 1, compared to 40 (19.5%) and 21 (10.2%) in group 2 (p value 0.155, 0.587), respectively). Among the thrombotic episodes, 83% of cases in group 1 had been detected during surveillance and referred for diagnostic fistulogram ± angioplasty but developed thrombosis while awaiting elective intervention compared to 19% in group 2 (p = 0.004). Median time from fistulogram request to thrombosed VA was 26 days (interquartile range: 21-42 days). Group 1 exhibited better post-intervention primary patency rates and longer CFD compared to group 2 (p value <0.001, 0.002, respectively). CONCLUSION: Incorporating Vasc-Alert technology into VA clinical surveillance pathway was associated with improved early detection of high-risk VA, higher primary patency rates, and longer CFD-extended compared to standard of care. Improving elective interventional radiology capacity for timely intervention (<3 weeks from referral) is crucial to materialise the benefits of enhanced surveillance in preventing acute thrombosis.
GlomCon Hawaii: The First International Hybrid Glomerular Diseases Conference.
Ebrahimi N, Gholizadeh Ghozloujeh Z, Poyan Mehr A … +5 more , Seethapathy H, Robson K, Waguespack DR, Pitogo RM, Norouzi S
Nephron · 2025 · PMID 39827877 · Publisher ↗
Abstract loading — click title to view on PubMed.
Chronic Kidney Disease in Diabetes: Is Fish Oil the Answer?
Gnudi L
Nephron · 2025 · PMID 39827875 · Full text
Abstract loading — click title to view on PubMed.
Mendelian Randomization Analysis Reveals a Causal Relationship between Membranous Nephropathy and the Gut Microbiome.
Yuan D, Chen Y, Zheng H … +4 more , Liu G, Yang Q, Chen L, Li Q
Nephron · 2025 · PMID 39819736 · Publisher ↗
INTRODUCTION: With the increasing prevalence of membranous nephropathy (MN), the gut microbiome (GM) is increasingly implicated in its cause, yet the intricate mechanisms remain unclear. Whether changes in the diversity...
INTRODUCTION: With the increasing prevalence of membranous nephropathy (MN), the gut microbiome (GM) is increasingly implicated in its cause, yet the intricate mechanisms remain unclear. Whether changes in the diversity and richness of gut microbial populations among MN patients contribute to disease prevalence is still unanswered, necessitating further exploration into the potential causative link between the GM and MN. METHODS: We conducted a comprehensive bidirectional mendelian randomization (MR) study. We selected 211 bacterial taxa using genome-wide association study (GWAS) data provided by the MiBioGen consortium, while GWAS data relevant to MN were obtained from ebi-a-GCST010005. The inverse-variance weighted (IVW) method was the primary technique used to delineate the causal relationship between exposures and outcomes. To confirm the robustness of our results, we used additional methods, including MR-Egger, weighted median, simple mode, and weighted mode. Sensitivity analyses included tests for pleiotropy, heterogeneity, and leave-one-out sensitivity to ensure the integrity of our conclusions. Finally, reverse MR analyses were conducted to assess the likelihood of reverse causality. RESULTS: Using various analytical methods, including the IVW approach, MR-Egger, weighted median, simple mode, and weighted mode, our study identified six microbial taxa with a statistically significant causal link to MN, as indicated by p values <0.05. The implicated taxa are Butyrivibrio (OR = 1.25, 95% CI: 1.001-1.565, p = 0.048), Butyricicoccus (OR = 2.15, 95% CI: 1.005-4.621, p = 0.048), Catenibacterium (OR = 1.49, 95% CI: 1.043-2.134, p = 0.028), Ruminiclostridium 5 (OR = 1.78, 95% CI: 1.140-2.763, p = 0.03), Ruminococcaceae UCG-003 (OR = 1.78, 95% CI: 1.140-2.763, p = 0.011), and Bacillales (OR = 1.52, 95% CI: 1.135-2.025, p = 0.005). Each of these taxa has been established as a risk factor for MN. Notably, Ruminococcaceae UCG-003 and Bacillales were identified as having a bidirectional causal relationship with the disease. CONCLUSION: Our MR study has revealed a causal link between six microbial taxa and MN, highlighting their potential involvement in the disease's development. These findings represent an initial step into this complex field and underscore the need for more in-depth research.
Recurrence of Glomerular Diseases after Kidney Transplantation: What Do We Know New?
Rodrigo E, Belmar L, Pérez-Canga JL
Nephron · 2025 Jan · PMID 39778555 · Publisher ↗
BACKGROUND: The recurrence of primary glomerulonephritis (GN) following kidney transplantation poses a significant threat to graft survival. To enhance kidney transplant outcomes, we must lessen the burden of recurrence....
BACKGROUND: The recurrence of primary glomerulonephritis (GN) following kidney transplantation poses a significant threat to graft survival. To enhance kidney transplant outcomes, we must lessen the burden of recurrence. In recent years, there has been progress in understanding the incidence, risk factors for recurrence, pathophysiology, biomarkers, and therapeutics, making it worthwhile to conduct an update on primary GN that may recur following kidney transplantation. SUMMARY: We conducted a narrative review of the literature on the novel discoveries of primary GN that can recur following kidney transplantation. To summarize, developing a broad consensus on recurrence diagnosis would greatly advance our understanding, and its development would be a valuable collaborative effort. The key risk factors for recurrence have been better understood, particularly in individuals with complement-related or monoclonal gammopathy-related recurrent membranoproliferative GN. Furthermore, we can identify better recurrent IgA nephropathy patients who are more likely to experience graft loss. New biomarkers for membranous nephropathy (anti-PLA2R-Ab) and focal and segmental glomerulosclerosis (anti-nephrin-Ab) can assist in identifying and monitoring patients at risk of recurrence. Regarding therapy, the focal and segmental glomerulosclerosis consensus will enhance recurrence treatment. Some complement inhibitors and anti-CD38 monoclonal antibodies are already promising in treating and healing recurrent C3 glomerulopathy and focal and segmental glomerulosclerosis, respectively. Finally, new drugs developed specifically to treat IgA nephropathy in the native kidney will also change the outcome of IgA nephropathy recurrence. KEY MESSAGES: Although there has been progress in understanding the recurrence of primary GN following kidney transplantation, a worldwide effort should be undertaken to gather research that will allow for improved diagnosis, monitoring, and management of these patients.
Metabolic Syndrome, Nonalcoholic Fatty Liver Disease, and Graft Inflammation: An Unaddressed Pathogenic Link after Kidney Transplantation.
Fariña-Hernández A, González-Rinne A, Hernández-Bustabad A … +8 more , Guerra-Rodríguez RM, Saiz-Udaeta AP, Alonso-Titos J, Marrero D, Rivero-González A, Santana-Quintana CA, Ruíz-Esteban P, Hernández D
Nephron · 2024 Dec · PMID 39715600 · Publisher ↗
Kidney transplantation (KT) is the treatment of choice for chronic kidney disease patients, but there is a continued loss of grafts in the long-term (50% at 10 years) due to either patient death or chronic allograft dysf...
Kidney transplantation (KT) is the treatment of choice for chronic kidney disease patients, but there is a continued loss of grafts in the long-term (50% at 10 years) due to either patient death or chronic allograft dysfunction. Metabolic syndrome (MS) is very prevalent after KT (30-40%) and its components contribute to the appearance of nonalcoholic fatty liver disease/metabolic dysfunction-associated fatty liver disease (NAFLD/MAFLD) and nonalcoholic steatohepatitis (NASH), which represent the hepatic component of MS. Furthermore, about 20-40% of KT recipients present early graft inflammation, including subclinical inflammation. Thus, the relationship between NAFLD-MAFLD/NASH and graft inflammation may be bidirectional, though no definite link between NAFLD-NASH and graft inflammation is currently known. Additionally, MS-related risk factors are associated with modern immunosuppressants and a negative synergistic effect on graft and patient survival seems plausible. Indeed, proinflammatory cytokines and adipokines released by adipose tissue can generate a low-grade inflammatory state and endothelial dysfunction, both involved in the appearance of CVD, and these disorders are associated with worsening liver lesions and subclinical and clinical atheromatosis. In this review, we discuss the recent clinical evidence regarding the prevalence and risk factors of MS and NAFLD/MAFLD following KT. Additionally, we propose the potential linking mechanism between NAFLD/MAFLD-NASH and post-KT graft inflammation, as well as alternative therapies for NAFLD after KT. Prevention of long-term life-threatening complications in this particular population rests upon better understanding and management of these severe clinical complications.
A Case of Complete Remission of Glucocorticoid-Dependent Nephrotic Syndrome after Targeted-Release Formulation of Budesonide Treatment in a Patient with Mild Mesangial Proliferative IgA Nephropathy.
Mitsopoulos E, Pateinakis P, Keskinis C … +1 more , Papadopoulou D
Nephron · 2025 · PMID 39715598 · Publisher ↗
The combination of nephrotic syndrome with mild histopathological lesions of IgA nephropathy is considered by some as a special form of IgA nephropathy with superimposed minimal change disease (MCD) while by others as a...
The combination of nephrotic syndrome with mild histopathological lesions of IgA nephropathy is considered by some as a special form of IgA nephropathy with superimposed minimal change disease (MCD) while by others as a coincidental deposition of IgA in patients with MCD (MCD-IgAN). We present the first case of complete remission of nephrotic syndrome in a 55-year-old man with MCD-IgAN after the administration of a targeted-release formulation of budesonide (TRF-budesonide). The patient's treatment with TRF-budesonide, even though methylprednisolone, mycophenolate mofetil, and cyclophosphamide had been previously tried, is of particular importance because it not only suggests that TRF-budesonide appears to be a promising treatment for MCD-IgAN but may also provide a new therapeutic option for patients with podocytopathies.
Association between Metabolic Disorders and Impaired Kidney Function Thereafter in the Japanese General Population.
Kin F, Takase H, Kawakatsu N … +3 more , Hayashi K, Isogaki T, Dohi Y
Nephron · 2025 · PMID 39709956 · Publisher ↗
INTRODUCTION: Metabolic syndrome (MetS) and chronic kidney disease are both important risk factors for cardiovascular disease and are closely related to each other. We retrospectively investigated whether MetS or its com...
INTRODUCTION: Metabolic syndrome (MetS) and chronic kidney disease are both important risk factors for cardiovascular disease and are closely related to each other. We retrospectively investigated whether MetS or its components increase the risk of development of impaired kidney function in the Japanese general population. METHODS: This is a retrospective cohort study which enrolled 14,917 participants who visited our hospital for physical checkups from 2008 to 2018 and had normal estimated glomerular filtration rate (eGFR ≥60 mL/min/1.73 m2) during the baseline examination. Participants were followed up for the median of 1,847 days until 2019 with the development of impaired kidney function (eGFR <60 mL/min/1.73 m2) as the endpoint. The definition of MetS was based on Japanese diagnostic criteria (2005). RESULTS: Throughout the study, 2,150 participants (25.9 per 1,000 person-year) developed impaired kidney function after their baseline checkup. The incidence of impaired kidney function was more frequent in participants with MetS (39.3 per 1,000 person-year) than without (24.2 per 1,000 person-year, p < 0.001). Moreover, each MetS component was positively associated with the incidence of impaired kidney function, where the incidence of impaired kidney function increased with the number of MetS components at baseline (0, 1, 2, and ≥3 component(s); 17.3, 26.9, 32.9, and 39.7 per 1,000 person-year, respectively). Multivariate Cox hazard analysis revealed that MetS was an independent risk factor for impaired kidney function after adjusting for known risk factors (hazard ratio, 1.29; 95% confidence interval, 1.15-1.45). CONCLUSIONS: Testing for MetS and its components can help evaluate the risk of developing impaired kidney function in the general population.
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