Clinical Kidney Journal[JOURNAL]
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200 papers
Validation of biomarker-based stratification for risk of long-term outcomes after acute kidney injury.
Noble R, Watt J, Irvine A … +4 more , Kurth MJ, Fitzgerald P, Ruddock MW, Selby NM
Clin Kidney J · 2026 May · PMID 42094028 · Full text
BACKGROUND: Acute kidney injury (AKI) is common and associated with adverse long-term outcomes. Previously we have shown that a four-biomarker model of soluble tumour necrosis factor receptor-1 and -2 (sTNFR1, sTNFR2), c...
BACKGROUND: Acute kidney injury (AKI) is common and associated with adverse long-term outcomes. Previously we have shown that a four-biomarker model of soluble tumour necrosis factor receptor-1 and -2 (sTNFR1, sTNFR2), cystatin C and estimated glomerular filtration rate (eGFR) measured 90 days after AKI performed well in predicting subsequent kidney disease progression. However, external validation in independent cohorts is essential to move these findings towards clinical application. METHODS: A prospective, observational cohort of adults with AKI within 72 h of onset was assembled. Participants had study visits at time of AKI, then 30, 60 and 90 days later for biomarker sampling. Outcomes were assessed at 1 year, including major adverse kidney events (MAKE365, a composite of >25% decline in eGFR from baseline, kidney replacement therapy or death) and kidney disease progression. Logistic regression models incorporating biomarker combinations were evaluated using area under the receiver operating characteristic curve (AUC). RESULTS: From 122 participants recruited at time of AKI, 89 survived and had biomarker measurements available from outpatient study visits. Of these, 35% developed MAKE365 and 30% had kidney disease progression at 1 year. The biomarker model (sTNFR1, sTNFR2, cystatin C, eGFR) measured at Day 90 discriminated those with MAKE365 with an AUC of 0.79 [95% confidence interval (CI) 0.68-0.91], and kidney disease progression with AUC 0.79 (95% CI 0.67-0.91). The biomarker model had comparable performance at earlier timepoints of Day 30 and 60. CONCLUSIONS: A biomarker panel comprising sTNFR1, sTNFR2, cystatin C and eGFR reliably predicts adverse outcomes up to 1 year post-AKI. This provides external validation of findings from previous biomarker discovery studies, and shows how this biomarker combination could be used to identify patients at lowest risk. This may support biomarker-guided approaches for personalized post-AKI risk stratification and follow-up.
Personalized nutrition in haemodialysis: a scoping review of studies published between 2015 and 2025.
Rojas-Pérez JF, González-Salvatierra S, Oncina-Cánovas A … +3 more , Padial M, López-Jiménez V, Olveira G
Clin Kidney J · 2026 May · PMID 42094027 · Full text
BACKGROUND: Protein-energy wasting, chronic inflammation, and functional decline are prevalent among patients undergoing haemodialysis (HD) and are associated with adverse outcomes and reduced quality of life. Although a...
BACKGROUND: Protein-energy wasting, chronic inflammation, and functional decline are prevalent among patients undergoing haemodialysis (HD) and are associated with adverse outcomes and reduced quality of life. Although a substantial body of literature exists on nutritional management in HD, evidence has evolved considerably in recent years. Nutritional care in HD remains inconsistent and is limited by restrictive dietary paradigms and organizational barriers. OBJECTIVE: To map evidence published between 2015 and 2025 on nutritional management in adult patients undergoing HD, focusing on personalized strategies, barriers to effective nutritional care, and patient-centred, function-oriented implementation. METHODS: A scoping review was conducted following Joanna Briggs Institute methodology and reported according to PRISMA Extension for Scoping Reviews. PubMed/MEDLINE, Scopus, Web of Science, and Europe PMC were searched for English-language studies published between January 2015 and August 2025. RESULTS: A total of 30 studies were included. The literature describes diverse personalized nutritional approaches, including oral and intradialytic supplementation, plant-forward dietary patterns, microbiota-oriented strategies, and targeted nutrient supplementation. Reported outcomes included nutritional biomarkers, inflammation, body composition, functional measures, and patient-reported experience. Key barriers to effective nutritional care were poor dietary adherence, psychosocial burden, limited health literacy, inconsistent professional guidance, and organizational constraints. Morphofunctional assessment tools provided added value beyond biochemical parameters, and the studies highlighted specific considerations for nutritional risk assessment in older adults undergoing HD. CONCLUSIONS: This scoping review highlights a shift towards more personalized and function-oriented nutritional care in HD, while underscoring persistent barriers and substantial evidence heterogeneity. The findings support future research and the development of more integrated, patient-centred, and sustainable nutritional care models.
A new self-management engagement scale for haemodialysis patients (PRIESM CKD-HD): development and validation.
Wild HM, Wellsted D, Davenport A … +2 more , Cockwell P, Farrington K
Clin Kidney J · 2026 May · PMID 42094026 · Full text
BACKGROUND: Self-management should be better defined within kidney research and clinical practice. A focus on dialysis related tasks and adherence continues to be central to current measures. PRIESM CKD-HD (Patient Repor...
BACKGROUND: Self-management should be better defined within kidney research and clinical practice. A focus on dialysis related tasks and adherence continues to be central to current measures. PRIESM CKD-HD (Patient Reported Instrument for Engagement in Self-Management for people with Chronic Kidney Disease, receiving Haemodialysis) aligns with a biopsychosocial model and measures engagement in self-management by people receiving haemodialysis (HD). This provides the opportunity to identify gaps and foster discussion about targeted support. METHODS: Scale development was undertaken using a sequential mixed-methods approach, comprising literature review, qualitative interviews with HD patients ( = 27), expert consensus ( = 19) and cognitive testing ( = 11). A large-scale survey ( = 363) across three kidney centres was conducted to validate the scale, with subgroup follow-up 4-6 weeks later. Exploratory factor analyses were conducted to assess model fit, reliability and validity. RESULTS: PRIESM CKD-HD is a valid and reliable measurement. Exploratory factor analysis indicated a three-factor model consisting of daily managing and impact (α = 0.91), communication (α = 0.84) and clinical care (α = 0.66). Model statistics, χ = 703, 296 df, < .001, CFI = 0.87, TLI = 0.86, RMSEA = 0.07, SRMR = 0.07, overall α = 0.92. Correlation with measures of depression [r(328) = -0.74, < .001] and self-efficacy [r(337) = 0.75, < .001] provided further evidence of validity. Test-retest reliability r = 0.84, < .001, indicates good linear agreement over time ( = 95). CONCLUSIONS: PRIESM CKD-HD is the first measure of self-management that reframes the concept from the patient perspective and incorporates the psychosocial aspects of treatment impact and daily managing for HD patients. Findings suggest the perception that not all individuals wish to self-manage should be refuted.
Predicting first-year kidney graft loss at the time of donor offer using machine learning and competing-risk analysis in a Latin American cohort.
Garcia-Lopez A, Cuervo-Rojas J, Garcia-Lopez J … +1 more , Giron-Luque F
Clin Kidney J · 2026 May · PMID 42088642 · Full text
BACKGROUND: Kidney transplantation faces organ shortages, underscoring the need for early risk stratification of graft loss. We developed and validated a 12-month prediction model that treats death as a competing event....
BACKGROUND: Kidney transplantation faces organ shortages, underscoring the need for early risk stratification of graft loss. We developed and validated a 12-month prediction model that treats death as a competing event. METHODS: We conducted a retrospective cohort study of 2030 adult kidney transplant recipients (2008-2023) from Colombia's largest transplant network. Models included a random survival forest for competing risks (RSF-CR) and Fine-Gray (FG) regression. Internal validation used stratified cross-validation. Model performance was evaluated via discrimination (C-index), calibration and clinical utility (decision curve analysis). RESULTS: Key predictors included donor type, stroke cause of death (deceased donor), recipient age, donor creatinine, panel reactive antibodies (PRA) class I >20, expanded criteria donor, donor age, years on dialysis, PRA class II >20, donor hypertension, donor-recipient compatibility and retransplantation. The RSF-CR model outperformed the FG, achieving a C-index of 0.87 (versus 0.72) and high sensitivity (88%). It accurately identified low-risk candidates (negative predictive value 98%) and showed a positive net benefit. CONCLUSION: We developed and validated a predictive model for first-year graft loss in kidney transplant recipients using a machine learning for competing risks model. The model showed strong discriminative ability and moderate calibration. Further temporal validation in our population and external validation in other clinical contexts is required to ensure its applicability.
Erythroferrone is associated with the hepcidin-to-ferritin ratio and cardiovascular mortality in chronic kidney disease.
Pistis KD, Qureshi AR, Beshara S … +3 more , Lindholm B, Stenvinkel P, Bárány P
Clin Kidney J · 2026 May · PMID 42088641 · Full text
BACKGROUND: The role of erythroferrone, a hormone synthesized in erythroid cells that suppresses hepatic production of hepcidin to increase systemic iron availability during erythropoiesis expansion, has not been suffici...
BACKGROUND: The role of erythroferrone, a hormone synthesized in erythroid cells that suppresses hepatic production of hepcidin to increase systemic iron availability during erythropoiesis expansion, has not been sufficiently characterized in chronic kidney disease (CKD). Therefore, we evaluated its determinants and its association with mortality risk in patients with CKD stages 3-5. METHODS: In this cross-sectional study with longitudinal follow-up, erythroferrone, hepcidin, ferritin, transferrin saturation (TSAT), C-reactive protein (CRP) and nutritional status were assessed in 377 CKD patients [92 patients with CKD stages 3-4, 210 non-dialysed patients with CKD stage 5 and 75 patients on peritoneal dialysis (PD)]. Regression analyses were performed to investigate the association between erythroferrone and relevant variables. The association between erythroferrone and mortality risk was analysed using Fine-Gray analysis, accounting for kidney transplantation as a competing risk. RESULTS: Erythroferrone, hepcidin and ferritin were higher in PD patients and in CKD 5 patients as compared with CKD 3-4 patients, whereas the hepcidin-to-ferritin ratio did not differ between the cohorts. In linear regression analysis, erythroferrone was positively associated with the reticulocyte count, CRP and CKD severity and negatively associated with TSAT and the hepcidin-to-ferritin ratio (and hepcidin). Further adjustment for erythropoiesis-stimulating agents (ESAs) revealed that erythroferrone no longer showed an association with the severity of CKD or CRP levels. Finally, erythroferrone was linked to both all-cause mortality and cardiovascular mortality. CONCLUSIONS: Erythroferrone in CKD patients associated with the reticulocyte count and ESA dose and was inversely correlated with the hepcidin-to-ferritin ratio and TSAT, while its relationship with CKD stage may reflect ESA therapy. Higher circulating erythroferrone levels are associated with an increased mortality risk.
Artificial intelligence for predicting paediatric acute kidney injury: a systematic review and meta-analysis.
Raina R, Shirode P, Shah R … +4 more , Chepyala A, Tibrewal A, Sethi SK, Cheungpasitporn W
Clin Kidney J · 2026 May · PMID 42079462 · Full text
BACKGROUND: Acute kidney injury (AKI) in hospitalised children is a major complication associated with significant morbidity and mortality. The integration of artificial intelligence (AI)/machine learning (ML) models may...
BACKGROUND: Acute kidney injury (AKI) in hospitalised children is a major complication associated with significant morbidity and mortality. The integration of artificial intelligence (AI)/machine learning (ML) models may enable early detection and risk stratification. This systematic review evaluates the performance of AI/ML models for predicting paediatric AKI across clinical settings. METHODS: We systematically searched PubMed, Embase, and Web of Science for studies applying AI/ML models to predict AKI in paediatric populations. Studies reporting performance metrics such as the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and F1 score were included. RESULTS: Among 470 records identified, 11 studies met the inclusion criteria, with 14 AI/ML models used. The overall sample size included 33 949 paediatric patients with an AKI proportion of 12.5%. Meta-analyses of the AUC were conducted on neural network, gradient boosting, and logistic regression. Gradient boosting had the highest pooled AUC of 0.873 (95% confidence interval 0.836-0.909). Random forest demonstrated the highest median sensitivity (0.821), specificity (0.942), PPV (0.860), NPV (0.935), and accuracy (0.821); however, these metrics could not be pooled due to inconsistent reporting and limited validation. CONCLUSION: Gradient boosting, random forest, and logistic regression demonstrated reasonable predictive performance for paediatric AKI prediction within specific clinical contexts. However, small sample size, heterogeneity, lack of testing/validation cohorts, insufficient data, and inconsistent patient populations and AKI diagnostic criteria restrict generalisability.
Safety and feasibility of initiating peritoneal dialysis within 24 h after percutaneous versus surgical catheter placement.
Cortez-Flores BG, Barrientos CR, Galindo P … +7 more , Hernández RG, Reyna-Blanco J, Roldán RG, Aguilar HBG, Morales JSB, Sanchez-Alvarez JE, Moguel-González B
Clin Kidney J · 2026 May · PMID 42079461 · Full text
BACKGROUND: End-stage kidney disease (ESKD) is a rising global health challenge. Despite superior quality of life and cost-effectiveness, only 11% of patients initiate renal replacement therapy with peritoneal dialysis (...
BACKGROUND: End-stage kidney disease (ESKD) is a rising global health challenge. Despite superior quality of life and cost-effectiveness, only 11% of patients initiate renal replacement therapy with peritoneal dialysis (PD), primarily due to the traditional extended break-in period. Recent advancements in percutaneous catheter placement have facilitated urgent-start and early-start PD protocols. This study compared the break-in period [immediate-start PD (<24 h)] and catheter placement-related complications between percutaneous and surgical techniques. METHODS: This retrospective multicenter study analyzed 429 patients who underwent PD catheter insertion at three Mexican nephrology centers; 416 patients had confirmed ESKD. Techniques included mini-laparotomy and percutaneous methods (stylet or Seldinger). Data collection encompassed baseline characteristics, break-in periods and 30-day complications, classified as minor (mechanical and infectious) or major (bleeding, visceral perforation and death). RESULTS: The majority of patients initiated PD within 24 h of catheter placement, and 49% within 6 h, 88% of patients using the Stylet technique and 58% of those using the Seldinger technique, compared with 3.8% using mini-laparotomy ( < .001). Percutaneous techniques represented 97% of the break-in periods within 6 h, whereas mini-laparotomy accounted for 91% of the break-in periods between 25 and 72 h. Complications affected 30% of the patients overall, with mechanical issues (23%) predominating, including outflow failure (19%) and catheter migration (9.1%), with no differences observed between techniques ( = .9, = .8). The rate of repositioning was greater with the use of percutaneous methods (13%-14% vs 4%, = .008). Infections were more common with mini-laparotomy (14% vs 7.4%-8.3%, = .12), with exit-site infections (8.1% vs 1.4%-2.2%, = .006) and tunnelitis (6.0% vs 0.7%-2.8%, = .041) exhibiting significance. Mini-laparotomy increased the risk of infection (odds ratio 2.13, 95% confidence interval 1.02-4.44; = .043). CONCLUSION: Immediate-start PD, defined as initiation within 24 h of catheter placement, is safe and feasible. These findings support the expansion of nephrologist training in percutaneous placement.
Furosemide plus oral sodium chloride for syndrome of inappropriate antidiuresis after fluid restriction failure.
Chienwichai K, Laipanngam P, Jiwakanon S … +4 more , Chaiviriyawong K, Wattanakul J, Chang A, Mongkolrattanakul P
Clin Kidney J · 2026 May · PMID 42079460 · Full text
BACKGROUND: Syndrome of inappropriate antidiuresis (SIAD) is a common cause of hyponatraemia, with fluid restriction (FR) failing in nearly half of patients. Although furosemide combined with oral sodium chloride (NaCl)...
BACKGROUND: Syndrome of inappropriate antidiuresis (SIAD) is a common cause of hyponatraemia, with fluid restriction (FR) failing in nearly half of patients. Although furosemide combined with oral sodium chloride (NaCl) tablets is widely used as second-line therapy, evidence supporting its effectiveness after FR failure remains limited, and predictors of response have not been established. METHODS: This prospective multicentre cohort study enrolled hospitalized adults with SIAD who failed FR at two tertiary centres in Thailand between October 2022 and September 2025. Patients received oral NaCl tablets (3.6 g daily) and furosemide (40 mg daily) while continuing FR. The primary outcome was the daily rate of serum sodium correction. Predictors of response were identified using multivariable linear mixed-effects models. RESULTS: Among 88 patients (68% male; median age 65 years), the median baseline serum sodium was 124 mmol/l. Serum sodium increased by 1.51 mmol/l per day [95% confidence interval (CI) 1.37-1.66], reaching a median of 130 mmol/l by day 4 and 134 mmol/l by day 7. Three factors independently predicted faster correction: higher body weight (β 0.85 mmol/l per 10 kg; 95% CI 0.28-1.42), lower baseline sodium (β -0.58 per 1 mmol/l lower; 95% CI -0.77 to -0.39), and drug-induced aetiology (β 7.17 mmol/l; 95% CI 3.48-10.85). Adverse events included hypokalaemia (51%), hypomagnesaemia (29.5%), and acute kidney injury (18.2%). Overcorrection occurred in one (1.1%) patient. CONCLUSIONS: Furosemide combined with oral NaCl tablets is a practical second-line option for SIAD after FR failure, achieving sodium correction of 1.5 mmol/l per day. Higher body weight, lower baseline sodium, and drug-induced aetiology predict faster correction. Randomized controlled trials are needed to confirm efficacy.
Frailty assessment in kidney transplantation: insights from a European survey.
Velioglu A, Erlandsson H, Demir E … +8 more , Hellemans R, Gandolfini I, de Weerd A, Dedinska I, Sharif A, Schiffer M, Hilbrands L, Mariat C
Clin Kidney J · 2026 May · PMID 42079459 · Full text
BACKGROUND: Frailty has been identified as an important determinant of adverse transplant-related outcomes; however, its integration into routine kidney transplant practice remains limited. METHODS: This was a web-based...
BACKGROUND: Frailty has been identified as an important determinant of adverse transplant-related outcomes; however, its integration into routine kidney transplant practice remains limited. METHODS: This was a web-based cross-sectional survey assessing current practice patterns and perceptions on frailty assessments among transplant physicians distributed by the DESCaRTES working group of the European Renal Association. The survey consisted of questions about frailty perceptions and practices both pre- and post-transplant. RESULTS: A total of 134 responses (response rate 39.2%) were recorded. Although 98.5% recognized frailty as a risk factor for adverse outcomes, only 6.7% reported routinely performing a standardized frailty assessment in pre-transplant evaluations. Nearly 30% never evaluated frailty, and 24.6% did so only in selected high-risk patients, primarily based on age, comorbidities or prolonged dialysis duration. Physical function was recognized as the most important component of frailty assessments; however, no single assessment tool was consistently implemented. The main barriers to integrating frailty assessments into clinical practice were lack of trained staff, absence of standardized guidelines, and uncertainty about clinical usefulness. Post-transplant frailty assessments were rarely conducted routinely, despite 74.6% acknowledging their potential value. CONCLUSIONS: Despite widespread recognition of frailty as a significant determinant influencing transplant outcomes, its routine assessment in clinical practice remains limited across European centers. Variability in assessment tools, lack of guidelines and insufficient training resources contribute to this gap. Addressing these barriers through targeted education, validation of practical assessment tools, and consensus-driven protocols is essential to support the integration of frailty evaluation into both pre- and post-transplant care.
Citrullinated histone H3 identifies neutrophil extracellular trap formation and correlates with renal disease activity in ANCA-associated vasculitis.
Kamijo N, Mii A, Tani T … +8 more , Nakazato R, Ishikawa A, Kashiwagi T, Ohashi R, Kuwana M, Shimizu A, Sakai Y, Iwabu M
Clin Kidney J · 2026 May · PMID 42079458 · Full text
BACKGROUND: Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) often manifests with necrotizing glomerulonephritis. Neutrophil extracellular traps (NETs) are implicated in its pathogenesis; citrullinated his...
BACKGROUND: Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) often manifests with necrotizing glomerulonephritis. Neutrophil extracellular traps (NETs) are implicated in its pathogenesis; citrullinated histone H3 (H3Cit) is a specific marker of NET formation. To date, no studies have assessed the relationship between H3Cit-positive cells and disease activity in patients with AAV. In this study, we assessed whether H3Cit-positive cells in renal tissue were associated with disease activity. METHODS: We retrospectively evaluated 50 patients newly diagnosed with AAV by renal biopsy between January 2011 and August 2024. Paraffin-embedded specimens underwent immunohistochemical staining for H3Cit. Patients were classified as H3Cit-positive or H3Cit-negative groups based on the presence of H3Cit-positive cells in glomeruli and/or interstitium. Clinical parameters and histopathological features were compared. Additionally, correlations between H3Cit-positive cell counts and urinary biomarkers were evaluated. RESULTS: H3Cit-positive cells were detected in 42 cases (84%) within the interstitium; of these 42 cases, they were also detected in 23 within the glomeruli. Compared with H3Cit-negative cases, the positive group had significantly higher urinary β-microglobulin (β-MG) and N-acetyl-β-D-glucosaminidase index values. Interstitial H3Cit-positive cell counts positively correlated with urinary β-MG levels. The positive group showed more frequent crescent formation and peritubular capillaritis, and H3Cit-positive cells were present in all arteritic lesions. CONCLUSIONS: H3Cit-positive cells in renal tissue were associated with active glomerular and tubulointerstitial lesions in AAV cases and correlated with urinary markers of interstitial injury. H3Cit immunostaining may serve as a pathological marker of renal disease activity in AAV cases and support clinical assessment at the time of biopsy.
Vaccine efficacy in CKD patients not on dialysis: a systematic review and meta-analysis.
Lertussavavivat T, Isaranuwatchai S, Eiam-Ong S … +2 more , Praditpornsilpa K, Susantitaphong P
Clin Kidney J · 2026 May · PMID 42079457 · Full text
BACKGROUND: Patients with chronic kidney disease (CKD) have increased infection risk, contributing to higher rates of hospitalization and mortality. While vaccines can prevent or reduce the severity, data primarily focus...
BACKGROUND: Patients with chronic kidney disease (CKD) have increased infection risk, contributing to higher rates of hospitalization and mortality. While vaccines can prevent or reduce the severity, data primarily focus on dialysis-dependent patients. This meta-analysis aimed to evaluate vaccine efficacy in non-dialysis CKD patients (CKD-ND). METHODS: We systematically searched the MEDLINE, Embase, Scopus and OVID databases through April 2025 for randomized controlled and observational studies reporting the vaccine efficacy in stage 1-5 CKD-ND patients. Efficacy was assessed using laboratory markers (seroconversion, antibody titres) and clinical outcomes. The quality of the studies was assessed by ROBINS-I V2 and RoB2. A random effects model was used to estimate pooled effect size with 95% confidence interval. RESULTS: Twenty-eight studies involving >500 000 participants were included covering hepatitis B virus (HBV), COVID-19, influenza, herpes zoster, pneumococcus and human papillomavirus (HPV) vaccines. Most studies were graded fair quality. Ten studies on HBV vaccination revealed a pooled seroconversion rate of 80% that decreased to 60% at 12 months post-vaccination. For COVID-19, the pooled anti-spike immunoglobulin G titre was 228.39 BAU/ml, with a reduced risk of COVID-19 infection following a boosting dose. Two doses of the influenza vaccine yielded higher seroconversion rates than a single dose, but the antibody levels declined over time, indicating waning immunity. The zoster vaccine showed a pooled adjusted hazard ratio of 0.74 for herpes zoster incidence compared with those who were unvaccinated. Pneumococcal vaccine elicited a modest transient response and was associated with reduced hospitalization and community-acquired pneumonia risk. The HPV vaccine demonstrated 100% seroconversions, although with lower HPV neutralizing antibody levels. CONCLUSION: Vaccination in CKD-ND patients is associated with a high rate of seroconversion and seroprotection across multiple vaccines. However, these surrogate markers may not fully reflect clinical effectiveness. Further studies are needed to evaluate the impact of vaccination on demonstrated clinical outcomes, particularly infection-related morbidities and mortalities.
Levetiracetam-associated high-anion gap metabolic acidosis and secondary ketogenesis: a case series.
Al-Baqain K, Sharawi S, Khabbaz O … +5 more , Ghishan S, Ash-Shawareb Y, Kheetan M, Shweihat Y, Khitan Z
Clin Kidney J · 2026 May · PMID 42079456 · Full text
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Peripheral and renal interstitial T-cell profiles associated with treatment response in lupus nephritis: a retrospective cohort study.
Wang J, Rong Y, Zhu M … +7 more , Tu Y, Chen D, Qiu D, Xu F, Liang D, Chen L, Zhang H
Clin Kidney J · 2026 May · PMID 42079455 · Full text
BACKGROUND: Lupus nephritis (LN) treatment response remains heterogeneous. We investigated associations between peripheral/renal T-cell profiles and treatment response, and explored renal T-cell infiltration as a mediato...
BACKGROUND: Lupus nephritis (LN) treatment response remains heterogeneous. We investigated associations between peripheral/renal T-cell profiles and treatment response, and explored renal T-cell infiltration as a mediator. METHODS: This retrospective cohort study analyzed data from 424 LN patients. Peripheral CD4/CD8 T-cell counts were measured via flow cytometry, and renal interstitial infiltrations were assessed immunohistochemically. Associations with treatment response were evaluated using generalized linear and logistic regression models, adjusting for clinicopathological factors. Mediation analysis examined renal T-cell infiltration in connecting peripheral immunity and treatment outcomes. RESULTS: The study cohort consisted of 424 patients with biopsy-confirmed LN, predominantly female (84.67%), with a mean age of 30.37 ± 11.18 years. Responders, comprising 68.4% of the cohort, exhibited significantly higher peripheral CD4 T-cell counts (median 310 vs. 265 cells/μl, = .002) and CD4/CD8 ratios (0.94 vs. 0.73, < .01), with adjusted OR of 1.002 (95% CI 1.001-1.003) and 2.462 (95% CI 1.414-4.288), respectively. These associations remained significant after Bonferroni correction. Nonresponders showed increased renal interstitial CD8 T-cell infiltration (148 vs. 80 cells/mm, < .001), while higher renal interstitial CD4/CD8 ratios predicted remission (OR = 8.312, 95% CI 2.593-26.645). The peripheral CD4/CD8 ratio provided incremental predictive value over standard clinical-pathological indices (AUC improvement: 0.711 vs. 0.678, = .022). Mediation analysis revealed that the renal interstitial CD4/CD8 ratio mediated 11.97% of the total effect of the peripheral CD4/CD8 ratio on treatment response (indirect effect β = 0.011, = .016). CONCLUSION: Peripheral and renal interstitial T-cell profiles, particularly CD4/CD8 ratios, are significantly associated with treatment response in LN. Renal interstitial T-cells partially mediate the impact of peripheral immune status on clinical outcomes.
Renal tubular calcium phosphate microcrystallopathy and age-related kidney function decline: The Aging Kidney Study.
Kosaki K, Mori S, Matsui M … +10 more , Yoshioka M, Park J, Nishitani N, Yoshikoshi S, Murasaki W, Saito C, Gosho M, Maeda S, Kuro-O M, Yamagata K
Clin Kidney J · 2026 May · PMID 42079454 · Full text
BACKGROUND: Elevated phosphate concentration in proximal tubular fluid promotes calcium phosphate microcrystallopathy, thereby accelerating the progression of chronic kidney disease (CKD). However, the clinical significa...
BACKGROUND: Elevated phosphate concentration in proximal tubular fluid promotes calcium phosphate microcrystallopathy, thereby accelerating the progression of chronic kidney disease (CKD). However, the clinical significance of proximal tubular phosphate exposure in humans remains uncertain. We aimed to determine whether estimated proximal tubular fluid phosphate concentration (ePTFp) is independently associated with age-related kidney function decline in adults with and without CKD. METHODS: We conducted a 5-year prospective cohort study involving 308 adults with and without CKD. ePTFp-a novel, noninvasive index-and serum fibroblast growth factor 23 (FGF23) concentrations were derived from blood and urine measurements. Kidney function decline, expressed as estimated glomerular filtration rate (eGFR) slope, was modeled using linear mixed-effects analysis. Associations of ePTFp and serum FGF23 with eGFR slope were examined using multivariable regression analysis, adjusting for potential covariates at baseline, including age, sex, several comorbidities, current smoking status, eGFR, and urinary glomerular and tubular injury markers. RESULTS: Over 5 years, eGFR declined in participants with and without CKD, with a steeper decline in those with CKD. Higher baseline ePTFp and serum FGF23 were inversely correlated with eGFR slope. In multiple adjusted models, elevated ePTFp remained independently associated with faster eGFR decline, whereas the serum FGF23 association was attenuated after covariate adjustment. CONCLUSIONS: Elevated ePTFp was independently linked to accelerated kidney function decline, underscoring the clinical relevance of calcium phosphate microcrystallopathy. ePTFp may represent a practical biomarker with implications for prevention and treatment strategies targeting the aging kidney with proximal tubular phosphate exposure.
Timing of urate-lowering therapy and risk of kidney failure and mortality in CKD: an application of the parametric G-formula.
Ko A, Sim H, Kwon S … +6 more , Han SH, Abu-Alfa A, Kim DK, Lim CS, Lee JP, Lee W
Clin Kidney J · 2026 May · PMID 42079453 · Full text
BACKGROUND: The optimal timing for initiating urate-lowering therapy (ULT) in chronic kidney disease (CKD) remains uncertain. Although randomized trials have provided robust evidence, their neutral findings and limited f...
BACKGROUND: The optimal timing for initiating urate-lowering therapy (ULT) in chronic kidney disease (CKD) remains uncertain. Although randomized trials have provided robust evidence, their neutral findings and limited follow-up leave questions regarding whether earlier intervention improves long-term outcomes. METHODS: Using two nationwide CKD cohorts in Korea ( = 27 260 and 9727), we applied the parametric g-formula to estimate simulated risks for end-stage kidney disease (ESKD) and all-cause mortality under alternative ULT thresholds. Data were divided into 6-month intervals, and six strategies were simulated: observed practice (reference), initiation when serum urate (sUA) reached ≥7, 8, 9, or 10 mg/dl, and no treatment. Models accounted for time-varying confounders affected by prior therapy, and cumulative risks were estimated over 22 years. RESULTS: Deferring ULT to higher sUA thresholds or not initiating therapy was associated with dose-dependent increases in mortality and ESKD risk. Initiating therapy at 7-8 mg/dl was associated with lower 22-year cumulative risks of mortality by -0.76%p (95% CI -0.91 to -0.59) and -0.37%p (-0.44 to -0.29), and ESKD by -1.23%p (-1.44 to -0.98) and -0.43%p (-0.55 to -0.31), estimated to correspond to 100-300 fewer deaths or kidney failure events per 10 000 patients. CONCLUSIONS: Timely initiation of ULT, particularly before serum urate exceeds 9 mg/dl, is associated with improved long-term renal and survival outcomes in CKD. These findings, which may remain undetected in shorter randomized trials, underscore the utility of the g-formula in observational studies as a valuable complement to evidence from randomized trials.
Kidney biopsy findings in patients with obesity exhibit a wide spectrum of disease entities.
Martinez A, Letourneau P, Rabeyrin M … +6 more , Picard C, Guebre-Egziabher F, Fouque D, Caussy C, Soulage C, Koppe L
Clin Kidney J · 2026 Apr · PMID 42078125 · Full text
BACKGROUND: Obesity is a growing public health concern and an independent contributor to chronic kidney disease, with obesity-related glomerulopathy (ORG) representing a distinct but insufficiently characterized entity....
BACKGROUND: Obesity is a growing public health concern and an independent contributor to chronic kidney disease, with obesity-related glomerulopathy (ORG) representing a distinct but insufficiently characterized entity. This study aimed to comprehensively describe the spectrum of kidney histological damage in patients with obesity and overt kidney disease. METHODS: We reviewed 503 native kidney biopsies performed at Hospices Civils de Lyon between 2019 and 2022, identifying 103 adults with obesity. Glomerular histology was compared to 206 controls matched 2:1 for age, sex, hypertension, and diabetes. RESULTS: In the cohort with obesity, mean body mass index (BMI) was 35.1 kg/m²; 83% had hypertension and 33% had diabetes. Biopsies were performed for active urinary sediment (56%), proteinuria (49%), and acute or chronic kidney failure (31% of cases each). The mean estimated glomerular filtration rate was 47 ml/min/1.73 m², and proteinuria was 3.13 g/day. The post-biopsy complication rate was similar between groups. A wide spectrum of renal lesions was observed: hypertensive nephrosclerosis (34%), acute tubular necrosis (34%), diabetic nephropathy (17%), IgA nephropathy (13%), and other glomerulonephritides. ORG was identified in 25.2% of cases, isolated in 6.8% and associated with other lesions in 18.4%, while 74.8% had alternative diagnoses. Although no significant difference in glomerular size was observed between patients with obesity and controls, glomerular diameter was positively correlated with BMI ( = .049). CONCLUSION: ORG is not the predominant cause of kidney disease in patients with obesity. Given the wide range of alternative diagnoses and the safety of the procedure, renal biopsy should be considered to guide accurate diagnosis and optimize management.
Microscopic haematuria is a risk factor for acute kidney injury in minimal change disease.
Lu H, Ma L, Shen Y … +1 more , Sun Q
Clin Kidney J · 2026 Apr · PMID 42038168 · Full text
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A trial of hypoimmune allogeneic CD19-targeting T cells in refractory systemic lupus erythematosus.
Ivković V, Vaglio A
Clin Kidney J · 2026 Apr · PMID 42038167 · Full text
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Renal allograft malakoplakia mimicking malignancy: the value of combined morphological and functional imaging.
Fordel N, Neirynck V, Seghers C … +9 more , Sciot R, Tousseyn T, Verlinden H, Vanderpluijm C, Schepens N, Kuypers D, Jallah P, van den Hout H, Naesens M
Clin Kidney J · 2026 Apr · PMID 42038166 · Full text
BACKGROUND: Malakoplakia is a rare, chronic granulomatous inflammatory condition that primarily affects the genitourinary tract, albeit rarely renal allografts. This article highlights the clinical presentation and radio...
BACKGROUND: Malakoplakia is a rare, chronic granulomatous inflammatory condition that primarily affects the genitourinary tract, albeit rarely renal allografts. This article highlights the clinical presentation and radiological features of renal allograft malakoplakia and aims to identify knowledge gaps by a pooled analysis of case reports. METHODS: This study contains a detailed case report focusing on the presentation and radiological evolution of renal allograft malakoplakia, followed by a pooled analysis of 38 histologically confirmed cases, extracted from 34 publications. Descriptive statistics were applied. RESULTS: Malakoplakia of the renal allograft generally affects female (79%), middle-aged (mean 48 years) kidney transplant recipients in the first 2 years after transplantation (68.4%, mean 19 months), with a history of recurrent UTIs (87%) and considered at high immunological risk (70%). Acute kidney injury (AKI) was the most common presentation of allograft malakoplakia (84% of cases). Three main patterns can be differentiated on imaging: parenchymal lesions (40%), abscess-like formations (34%), and pseudotumoral masses (26%). Ultrasound, CT, MRI, and FDG-PET-CT can result in initial detection, assess disease extent, and treatment response. However, these imaging modalities cannot reliably differentiate malakoplakia from malignant or other infectious processes, making histopathological confirmation essential for definitive diagnosis. There are no standardized treatment protocols, nor guidelines concerning antibiotic duration, reduction of immunosuppression, and definition of remission. Despite treatment, one-fifth of cases result in graft failure and one-fifth in death. CONCLUSIONS: Renal allograft malakoplakia is a rare but serious condition that in worst cases leads to graft loss and death. Prospective studies are needed to establish standardized diagnostic and therapeutic approaches, including the potential role of FDG-PET-CT in monitoring treatment response.
Liver fraction of circulating alkaline phosphatase is elevated in chronic kidney disease and associates with mortality in patients treated with haemodialysis.
Smout D, Haarhaus M, D'Haese P … +8 more , Jørgensen HS, Claes K, Bammens B, Van Craenenbroeck AH, Meijers B, Van Hoof V, Cavalier E, Evenepoel P
Clin Kidney J · 2026 Apr · PMID 42038165 · Full text
BACKGROUND: Serum total alkaline phosphatase (ALP) is a robust predictor of all-cause mortality in both the general population and in patients with chronic kidney disease (CKD). Individual ALP isozymes and isoforms exert...
BACKGROUND: Serum total alkaline phosphatase (ALP) is a robust predictor of all-cause mortality in both the general population and in patients with chronic kidney disease (CKD). Individual ALP isozymes and isoforms exert specific physiological functions and may therefore inform separately on different disease processes and risks related to these. Serum ALP consists predominantly of bone and liver isoforms, with a smaller contribution from the intestinal isoenzyme. We aimed to characterize the impact of CKD on serum ALP fractions and to identify clinical and biochemical correlates. METHODS: Serum ALP liver, bone and intestinal fractions were analysed by electrophoresis in 523 individuals across stages of CKD (stage G1-2: = 90; G3: = 100; G4-5: = 139; G5D: = 194) and in 21 kidney-healthy controls. Associations with demographics and parameters of mineral metabolism and inflammation were examined. In haemodialysis patients, we further explored the association between ALP isozymes and all-cause mortality. RESULTS: Total ALP levels increased significantly across stages of CKD, with liver, bone and intestinal fractions all contributing. In patients with CKD G5D, circulating levels of all three fractions were more than two-fold higher than in controls. Bone ALP associated with PTH while liver ALP associated with C-reactive protein, both independent of demographics and kidney function. Higher liver ALP levels associated with increased mortality risk, independent of traditional risk factors and inflammation. CONCLUSIONS: In patients with CKD, elevations in liver, bone and intestinal ALP fractions reflect distinct biological pathways and may differentially inform on risk related to different disease processes. While bone ALP reflects bone metabolism, liver ALP is linked with inflammation. The elevation in CKD and the independent association of liver ALP fraction with mortality in patients treated with haemodialysis calls for additional clinical and mechanistic studies.
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