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Journal of Nephrology
Journal Prestige (SJR): 1.003  Citation Impact (citeScore): 2 Number of Followers: 4  Hybrid journal (It can contain Open Access articles)ISSN (Print) 1121-8428 - ISSN (Online) 1724-6059 Published by Springer-Verlag  [2468 journals]
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- Correction to: Phenotypic quantification of Nphs1‑deficient mice
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PubDate: 2024-08-08
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- Correction to: Improving outcomes in atherosclerotic renovascular disease:
importance of clinical presentation and multi‑disciplinary review-
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PubDate: 2024-08-05
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- Two writers and physicians–examples of dedication to humanism
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PubDate: 2024-08-05
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- High prevalence of thromboembolic events in autosomal dominant polycystic
kidney disease: a longitudinal study-
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PubDate: 2024-08-05
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- Unbalanced circulating Humanin levels and cardiovascular risk in chronic
hemodialysis patients: a pilot, prospective study-
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Abstract: Background Mortality and cardiovascular (CV) risk prediction in individuals with end-stage kidney disease (ESKD) on chronic hemodialysis (HD) remains challenging due to the multitude of implicated factors. In a multicenter ESKD-HD cohort, we tested the prognostic yield of the assessment of circulating Humanin, a small mitochondrial-derived peptide involved in CV protection, on CV events and mortality. Methods We conducted a prospective, observational, pilot study on 94 prevalent HD patients. The prognostic capacity of circulating Humanin levels was tested on a primary composite (all-cause mortality + non-fatal CV events) and a secondary exploratory endpoint (all-cause mortality alone). Results Baseline Humanin level was comparable in patients reaching the primary or secondary endpoint as compared to others (p = 0.69 and 0.76, respectively). Unadjusted followed by multivariable Cox regression analyses adjusted for age, left ventricular mass index (LVMi), E/e’, pulse pressure and diabetes mellitus indicated a non-linear relationship between Humanin levels and the composite outcome with the highest Hazard Ratio (HR) associated with very low (< 450.7 pg/mL; HR ranging from 4.25 to 2.49) and very high (> 759.5 pg/mL; HR ranging from 5.84 to 4.50) Humanin values. Restricted cubic splines fitting univariate and multivariate Cox regression analyses visually confirmed a curvilinear trend with an increasing risk observed for lower and higher Humanin values around the median, respectively. A similar, u-shaped association was also evidenced with the secondary endpoint. Conclusions Altered Humanin levels may impart prognostic information in ESKD-HD patients at risk of death or CV events. Future investigations are needed to confirm whether Humanin measurement could improve CV and mortality risk prediction beyond traditional risk models. Graphical abstract
PubDate: 2024-08-05
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- Lupus-like manifestations after allogenic hematopoietic stem cell
transplantation: a rare case of chronic graft-versus-host disease-
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Abstract: Chronic graft-versus-host disease (GvHD) is the leading cause of late death in allogenic hematopoietic stem cell transplantation recipients, of which the kidney is a potential target. In this article, we report an extremely rare case of chronic GvHD, characterized by immune complex-mediated diffuse proliferative glomerulonephritis and various autoantibodies detected in the serum; it is the first case of lupus-like chronic GvHD reported to date. The patient responded well to intensive immunosuppressive therapy and reached complete remission. Mycophenolate mofetil was more effective than tacrolimus in this case, suggesting that treatment of kidney diseases associated with chronic GvHD should be based on pathogenesis and pathological patterns. Graphical abstract
PubDate: 2024-08-04
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- Consistency of alerts generated by, and implementation of, the NHS England
acute kidney injury detection algorithm in English laboratories-
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Abstract: Background National Health Services (NHS) England mandates that an acute kidney injury (AKI) detection algorithm be embedded in laboratories. We evaluated the implementation of the algorithm and the consistency of alerts submitted to the United Kingdom Renal Registry (UKRR). Methods Code was developed to simulate the syntax of the AKI detection algorithm, executed on data from local laboratories submitted to the UKRR, including alerts and serum creatinine (SCr) results spanning 15 months before and after the alert submission. Acute kidney injury alerts were categorized into stages 0/1/2/3. Inter-rater agreement (Gwet’s AC1) was used to compare local and centrally derived alerts at individual laboratory and commercial laboratory information management system (LIMS) levels, penalizing extreme disagreements. Results The analysis included 9,096,667 SCr results from 29 labs (475,634 patients; median age 72 years, 47% female) between algorithm activation and data extraction (September 30, 2020). Laboratories and the central simulation generated 1,579,633 and 1,646,850 non-zero AKI alerts, respectively. Agreement was high within known laboratory information management system providers (0.97–0.98) but varied across individual laboratories (overall range 0.17–0.98, 0.17–0.23 in three). Agreement tended to be lower (Gwet’s AC1 0.88) with the highest baseline SCr quartile (median 164 μmol/L). Conclusions Overall, alerts submitted to the UKRR are a valid source of AKI surveillance but there are concerns about inconsistent laboratory practices, incomplete adoption of the NHSE algorithm code, alert suppression, and variable interpretation of guidelines. Future efforts should audit and support laboratories with low agreement rates, and explore reasons for lower agreement in individuals with pre-existing CKD. Graphical abstract
PubDate: 2024-08-04
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- Lessons for the clinical nephrologist: fibromuscular dysplasia in older
adults-
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PubDate: 2024-08-01
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- Effect of no-touch versus conventional technique on arteriovenous
fistula outcomes: a randomised controlled trial-
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Abstract: Background Autologous arteriovenous fistulae (AVFs) are the best type of vascular access in patients with kidney failure. However, the conventional technique has a high failure rate. We performed a randomised controlled trial to investigate whether the no-touch technique has a higher maturation and patency rate than that of the conventional technique for creating AVFs. Methods This study was a single-centre randomised controlled trial involving patients with kidney failure requiring an AVF for haemodialysis access. A total of 179 patients undergoing their first radial artery-cephalic fistula were randomized 1:1 to the no-touch technique (n = 90) or conventional technique (n = 89). The maturation and patency rate of the two techniques were compared and analysed. Results The preoperative baseline data showed no differences between groups. When comparing the no-touch technique to the conventional technique, the maturation rate was 93% vs. 89% and the 1-year primary function patency was 72% vs. 62%, respectively. Factors associated with AVF failure included age > 55 years (OR = 2.417, 95% CI 1.242–4.703), female sex (OR = 2.149, 95% CI 1.099–4.202), and vein diameter ≤ 1.8 mm (OR = 3.664, 95% CI 1.714–7.832). For patients with small veins the maturation rate was 92.98% vs. 80% and the 1-year primary function patency was 68.42% vs. 40% for the no-touch technique and conventional technique, respectively. Conclusions The no-touch technique has a higher maturation and patency rate than the conventional technique for creating an autologous AVF, especially in patients with small veins. This technique may provide a better outcome for patients with small cephalic veins. Graphical abstract
PubDate: 2024-08-01
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- Suicide among patients with chronic kidney disease in the United States:
1999–2020-
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PubDate: 2024-07-31
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- Endothelium-related biomarkers, hyperphosphatemia and mortality in
hemodialysis patients: a moderation analysis-
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PubDate: 2024-07-31
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- Cluster analysis-based classification of fatigue in stable maintenance
hemodialysis patients: a prospective cohort study-
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Abstract: Clinical trial registration This study has been registered (ChiCTR2100045493) 2021/04/03.
PubDate: 2024-07-30
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- Insights into the real-world practice of vascular access care pathways in
Italy: data from a national survey-
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Abstract: Background International guidelines issued recommendations for vascular access (VA) care for hemodialysis, but there are no registry data regarding this topic in Italy. Methods A survey consisting of 17 items was sent to all Italian dialysis wards, via the Italian Society of Nephrology (SIN) website, from April to June 2021. The items were defined, discussed and approved by experts in vascular access management within the Italian Society of Nephrology. A total of 124 dialysis units answered, accounting for 14% of all dialysis units. The survey thus encompasses all regions within the country, with some regional variations in terms of adherence. Results One hundred twenty-four facilities provided data, regarding 12,276 patients: 61% had an arteriovenous fistula (AVF), 34% had a central venous catheter (CVC), and 5% had an arteriovenous graft (AVG). Among them, two-thirds of the facilities reported having a vascular access care pathway, formally standardized in 79% of cases. Forty-six % of centers had a fully equipped vascular access care pathway, encompassing preoperative mapping (80%), vascular access setup (71%), arteriovenous fistula maturation monitoring (76%), first-level (80%) and second-level (78%) monitoring, and surgical and/or endovascular treatment of complications (66%). Vascular access monitoring was computerized in 39% of facilities. First-level monitoring (physical examination) was primarily done by nurses in two-thirds of facilities. Of note, 45% of centers had nurses who were skilled in ultrasound-guided cannulation. Quite surprisingly, facilities with less than 100 patients had a greater prevalence of arteriovenous fistulas than those with more than 100 patients (p = 0.0023). A protocolled vascular access care pathway was associated with a higher likelihood of having an arteriovenous fistula (70% AVF vs 42,1% CVC; p = 0.04). The presence in the facility of interventional nephrologists or nurses with ultrasound-guided cannulation skills significantly reduced the prevalence of central venous catheters. Conclusion These survey data further strengthen the need for formal and shared vascular access monitoring protocols. Graphical abstract
PubDate: 2024-07-30
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- Aortic valve thrombosis in nephrotic syndrome: a case report
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Abstract: We report a rare case of aortic valve thrombosis in a 55-year-old man. He had reduced urine output and generalized edema four days before admission. He felt sick and had chest pain on the day of admission. Severe hypoalbuminemia and massive proteinuria were present, and a diagnosis of nephrotic syndrome was made. An electrocardiogram showed findings suspicious for acute myocardial infarction, and emergency catheterization was performed. However, no coronary artery stenosis or occlusion was found at that time. A subsequent contrast-enhanced CT scan and transesophageal echocardiography revealed a thrombus in the aortic valve. The thrombus nearly occluded the left coronary artery. Emergency surgery was performed to remove the thrombus. His postoperative course was stable, but nephrotic syndrome persisted. A renal biopsy diagnosed minimal change disease. Treatment with 50 mg/day of prednisolone induced remission, and he was discharged on day 43. There were no aortic valve abnormalities. Nephrotic syndrome was considered the main contributor to thrombus formation. Aortic valve thrombosis associated with nephrotic syndrome is a very rare but potentially fatal condition that requires attention. Graphical abstract
PubDate: 2024-07-30
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- Vascular access in incremental hemodialysis: is less always more'
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PubDate: 2024-07-29
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- Artificial intelligence for forecasting live donor kidney function
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PubDate: 2024-07-29
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- Prediction of post-donation renal function using machine learning
techniques and conventional regression models in living kidney donors-
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Abstract: Background Accurate prediction of renal function following kidney donation and careful selection of living donors are essential for living-kidney donation programs. We aimed to develop a prediction model for post-donation renal function following living kidney donation using machine learning. Methods This retrospective cohort study was conducted with 823 living kidney donors between 2009 and 2020. The dataset was randomly split into training (80%) and test sets (20%). The main outcome was the post-donation estimated glomerular filtration rate (eGFR) 12 months after nephrectomy. We compared the performance of machine learning techniques, traditional regression models, and models from previous studies. The best-performing model was selected based on the mean absolute error (MAE) and root mean square error (RMSE). Results The mean age of the participants was 45.2 ± 12.3 years, and 48.4% were males. The mean pre-donation and post-donation eGFRs were 101.3 ± 13.0 and 68.8 ± 12.7 mL/min/1.73 m2, respectively. The XGBoost model with the eGFR, age, serum creatinine, 24-h urine creatinine, 24-h urine sodium, creatinine clearance, cystatin C, cystatin C-based eGFR, computed tomography volume of the remaining kidney/body weight, normalized GFR of the remaining kidney measured through a diethylenetriaminepentaacetic acid scan, and sex, showed the best performance with a mean absolute error of 6.23 and root mean square error of 8.06. An easy-to-use web application titled Kidney Donation with Nephrologic Intelligence (KDNI) was developed. Conclusions The prediction model using XGBoost accurately predicted the post-donation eGFR after living kidney donation. This model can be applied in clinical practice using KDNI, the developed web application. Graphical abstract
PubDate: 2024-07-29
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- Two cases of typical HUS in adults treated with an anti-C5 monoclonal
antibody: a new perspective'-
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Abstract: Hemolytic uremic syndrome (HUS) is a rare clinical entity, especially in adults. In its typical form the causative factor that triggers the cascade of immunologic and inflammatory events is a Shiga toxin-producing pathogen, found in the patient’s stool. Renal and neurologic involvement usually prevails and requires immediate care. Regarding this potentially life-threatening condition, little is known and the mainstay is supportive care. However, some interesting evidence has come up about the use of eculizumab, an anti-C5 monoclonal antibody, mainly in pediatric patients with typical HUS. Herein, we present two cases with typical HUS caused by two different strains of Escherichia coli (Shiga toxin-producing enterohemorrhagic and enteropathogenic) who were both treated effectively with anti-C5 monoclonal antibodies (eculizumab and ravulizumab). Graphical abstract
PubDate: 2024-07-29
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- Ethical and legal aspects of end of life in dialysis patients: an
Italian point of view-
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Abstract: Abstract In the Western world, thanks to continuous progress in the medical field, and to changes in society, the concept of death seems to be increasingly replaced by that of “keeping alive at all costs”. Thus also dialysis, a life-sustaining treatment for patients suffering from kidney failure, in some cases can no longer be seen as a treatment aimed at prolonging life, but as a treatment to temporarily avert death. In fact, the literature highlights that dialysis is not always associated with greater life expectancy and better quality of life for fragile patients with kidney failure. This point-of-view paper discusses legal and ethical principles of respect for patient autonomy (beneficence, non-maleficence, justice and professional integrity) inherent in the choice to suspend or to not start dialysis treatment, while following a pathway of conservative and/or palliative therapy.
PubDate: 2024-07-29
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- Association of the podocyte phenotype with extracapillary hypercellularity
in patients with diabetic kidney disease-
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Abstract: Background Extracapillary hypercellularity was recently identified as a poor prognostic factor for diabetic kidney disease (DKD), but its nature, pathogenesis, and relationship with glomerular sclerosis are still unclear. Methods We retrospectively studied 107 patients with biopsy-proven DKD, recruited from January 2018 through December 2020. We compared the clinicopathologic characteristics of 25 patients with extracapillary hypercellularity lesions (the extracapillary hypercellularity group) to those of 82 patients without extracapillary hypercellularity (the control group). Multiple cell-specific markers were used for immunohistochemical staining to analyse the types of cells that exhibited extracapillary hypercellularity. Podocyte phenotype changes were evaluated via immunohistochemical staining for Synaptopodin and Nephrin, and foot process width was measured via transmission electron microscopy. Results Patients with extracapillary hypercellularity lesions had more severe clinical features than patients without extracapillary hypercellularity in DKD, as indicated by elevated proteinuria and serum creatinine levels, and decreased serum albumin. Pathologically, extracapillary hypercellularity was accompanied by increased mesangial hyperplasia and interstitial fibrosis. Severe obliterative microvascular disease was observed more frequently in the extracapillary hypercellularity group than in the control group. At cell type analysis, 25 patients in the DKD-extracapillary hypercellularity group showed that a mixture of cells expressed either Wilm’s tumor-1 or paired box protein 2. Furthermore, DKD-extracapillary hypercellularity patients had significant loss of podocyte phenotype and severe foot process effacement. Cells in extracapillary hypercellularity had increased hypoxia-induced factor-1 alpha expression. Conclusions Extracapillary hypercellularity is associated with severe renal dysfunction and renal sclerosis. Vascular damage is closely related to severe podocyte hypoxia injury and requires additional attention in future research. Graphical abstract
PubDate: 2024-07-27
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