Ongoing changes in healthcare are expected to significantly reshape the hospital landscape in the coming years. Within this context and in order to respond appropriately, an up-to-date assessment of the structural and process quality of dialysis access care is essential. Between April and July 2024, 160 German inpatient nephrology departments were invited to participate in an anonymous online survey. Data were analysed descriptively. A total of 64 hospitals responded (response rate: 40%). Of these, 23% (n = 15) were university hospitals, 45% (n = 29) were tertiary care providers, and 32% (n = 20) were primary (n = 1) or secondary care hospitals (n = 19). 19% (n = 12) were certified as a dialysis access centre. Availability of dialysis access surgery like arteriovenous fistulas (AVF), tunnelled-haemodialysis catheters (tHDC), and peritoneal dialysis (PD) catheters procedures was generally rated as good, with 80% performed in an inpatient setting. Satisfaction with access to AVF interventions trends to decrease with increasing hospital size. Overall, 58% of respondents favoured greater nephrology involvement, particularly in tHDC placement (92%), PD catheter placement (36%), and AVF procedures (44%). Nevertheless, only 25% reported planning to expand nephrological interventions. Key barriers included limited hands-on experience, lack of structured training curricula, inadequate infrastructure, and interdepartmental competition. Economic pressure and the shift toward outpatient care were cited as additional challenges. Most hospital nephrologists are satisfied with the service and timely availability of dialysis access surgery or interventions. While there is a strong desire to increase nephrological involvement, only a few hospitals plan to expand these services. Standardized training programs are needed to strengthen the field of interventional nephrology. The online version contains supplementary material available at 10.1186/s12882-026-04988-w.
Body composition parameters (such as BMI and waist-to-hip ratio) have a certain predictive value for blood pressure. In patients undergoing maintenance hemodialysis (MHD), BMI can affect dialysis adequacy and blood pressure control levels, and there are differences in body composition at different BMI levels. The aim of this study was to investigate the association between hypertension during dialysis and body composition in non-overweight/overweight obese patients. A total of 248 patients undergoing maintenance hemodialysis (MHD) at this center were enrolled. Body composition was measured using an InBody bioelectrical impedance analyzer prior to dialysis. Intra-dialysis blood pressure data from the preceding three months were collected via the hemodialysis system. Patients were categorized based on their dry weight at enrollment: those with BMI < 23 kg/m² were classified as the non-overweight group, and those with BMI ≥ 23 kg/m² as the overweight/obese group. LASSO regression was employed to identify body composition variables associated with hypertension during hemodialysis. Based on LASSO regression results, multivariate linear regression and logistic regression analyses were conducted to evaluate the impact of pre-dialysis body composition on blood pressure (BP) in non-overweight and overweight/obese hemodialysis patients. The overall prevalence of hypertension was 86% (214/248), and the proportion of overweight/obese patients was 41.0% (102/248). TBW and Protein were positively correlated with hypertension in non-overweight male patients (OR (95% CI): 1.28 (0.34-1.98); OR (95% CI): 1.97 (1.51-3.33)), and BMC was negatively associated with hypertension in non-overweight male patients (OR (95% CI): 0.10 (0.01-0.70)). In overweight obese female patients, Fat was positively associated with hypertension (OR (95% CI): 1.12 (1.01-2.26)). This study identified risk factors for elevated blood pressure associated with gender and BMI in a subset of the MHD Asian population. The study also provided evidence that different body composition factors (such as total body water, protein, bone mineral content, and fat) drive hypertension risk in different MHD subgroups, rather than being determined solely by BMI.
Oxidized albumin has emerged as a promising biomarker in blood for assessing oxidative stress and multiple organ dysfunction. Recent advances suggest its potential detectability in urine, offering a noninvasive avenue for early diagnosis and monitoring of kidney disease. This review synthesizes current knowledge on oxidized albumin, its pathophysiological relevance, and the evolving methodologies for its detection, highlighting its translational potential in clinical nephrology.
Combined liver-kidney transplantation (CLKT) is associated with substantial intraoperative hemodynamic instability and metabolic stress. The role of modifiable intraoperative perfusion-related exposures in early allograft dysfunction (EAD) remains incompletely defined. In this retrospective cohort study, adult and pediatric CLKT recipients (2016-2025) were evaluated. Intraoperative exposures included cumulative duration of mean arterial pressure (MAP) below 65 and 55 mmHg, norepinephrine area under the curve, and serial serum lactate measurements. EAD was defined using established criteria. Discriminatory performance was assessed using receiver operating characteristic analysis, and associations were explored using logistic regression. Among 25 recipients, EAD occurred in 8 (32%). Patients with EAD had significantly longer cumulative durations of MAP < 65 mmHg and higher end-of-surgery serum lactate levels. The cumulative duration of MAP < 65 mmHg demonstrated strong discriminatory performance for EAD (AUC 0.85; 95% CI 0.60-1.00), and end-of-surgery serum lactate also showed robust discrimination (AUC 0.82). Vasopressor exposure did not differ between groups. In multivariable analysis, cumulative MAP < 65 mmHg exposure showed a borderline association with EAD. Thirty-day and 90-day mortality were markedly higher in the EAD group (50% and 62.5%, respectively) compared with 0% in the non-EAD group; however, given the small number of events and complete separation between groups, these findings should be regarded as exploratory. EAD after CLKT is associated with sustained moderate hypotension and impaired metabolic recovery. These hypothesis-generating findings suggest that intraoperative perfusion adequacy may represent a potentially modifiable determinant of early graft function, warranting prospective validation in larger, multicenter cohorts.
Early detection of preeclampsia may reduce maternal and fetal morbidity and mortality. While angiogenic biomarkers (sFlt-1 and PlGF) are clinically useful, their sensitivity is imperfect. Podocyte injury is implicated in preeclampsia; urinary transcription factor 21 (TCF21) may serve as a non-invasive marker of glomerular involvement. In this case-control study, 160 women with preeclampsia and 64 normotensive pregnant controls matched for age and gestational age were enrolled to evaluate the diagnostic utility of urinary TCF21 and its performance alongside angiogenic markers (sFlt-1, PlGF) at the time of clinical presentation for suspected preeclampsia. Preeclampsia cases were stratified into mild (n = 92) and severe (n = 68) disease, and each group was further stratified into early-onset and late-onset preeclampsia. Biomarker performance was assessed using logistic regression, receiver operating characteristic (ROC) analysis, and multivariable modeling. Compared with controls, women with preeclampsia had higher sFlt-1 (11.4-fold; p < 0.001), a higher sFlt-1/PlGF ratio (40.6-fold; p < 0.001), and higher urinary TCF21 (1.7-fold; p < 0.001), with lower PlGF (− 68%; p < 0.001). Urinary TCF21 demonstrated moderate discrimination for preeclampsia (AUC 0.769) and was inferior to the sFlt-1/PlGF ratio (AUC 0.812). At the prespecified cutoff of > 370 pg/mL, urinary TCF21 achieved 60.6% sensitivity and 90.6% specificity (LR + 6.45; LR − 0.43). Urinary TCF21 showed an exploratory inverse association with severity (r = − 0.258, p < 0.001) and diastolic blood pressure (r = − 0.244, p = 0.002). In multivariable analysis, urinary TCF21 remained independently associated with preeclampsia (adjusted odds ratio 2.83 per 50 pg/mL; 95% CI 1.49–5.59; p = 0.002), and combined models improved discrimination (AUC 0.87; 95% CI 0.82–0.91). Urinary TCF21 is a novel, non-invasive biomarker associated with preeclampsia and showed a hypothesis-generating inverse association with disease severity. In this case-control cohort, its high specificity suggests potential adjunct confirmatory performance at presentation when interpreted alongside angiogenic testing; however, cutoffs and probability thresholds are exploratory and require prospective external validation. Future studies should include creatinine-normalized reporting, assay standardization, and longitudinal sampling to evaluate predictive utility prior to symptom onset. First clinical evaluation of urinary TCF21 in preeclampsia: This is the first study to investigate urinary transcription factor 21 (TCF21) – a podocyte-specific transcription factor—as a non-invasive biomarker in preeclampsia. Independent signal beyond angiogenic imbalance: Urinary TCF21 remains significantly associated with preeclampsia after adjustment for established clinical factors and the sFlt-1/PlGF ratio, indicating a distinct renal/podocyte component not captured by angiogenic markers alone. High specificity suggests adjunct confirmatory potential at presentation: At a cutoff > 370 pg/mL, urinary TCF21 showed 90.6% specificity with a positive likelihood ratio (LR+) of 6.45 in this case-control cohort. These findings are hypothesis-generating and support consideration of urinary TCF21 as an adjunct to angiogenic testing pending prospective external validation. Novel, hypothesis-generating inverse association with disease severity: Unlike angiogenic biomarkers that typically track severity, urinary TCF21 showed an inverse relationship with preeclampsia severity, which may reflect dynamic biomarker kinetics, podocyte stress responses, altered shedding, or depletion in advanced disease and requires longitudinal validation. Improved discrimination using a multi-pathway panel: A multivariable model combining urinary TCF21, the sFlt-1/PlGF ratio, and clinical variables demonstrated significantly improved diagnostic discrimination (AUC 0.87, 95% CI 0.82–0.91) compared with models using either pathway alone, thereby integrating signals of placental dysfunction and glomerular injury into a single diagnostic framework. Translational feasibility for non-invasive stratification: Urine-based detection of TCF21 may offer a practical adjunct to reflect renal/podocyte involvement and refine phenotype characterization at presentation. Clinical implementation will require assay standardization, creatinine-normalized reporting, and validation in independent prospective cohorts. • Introduces a novel biomarker concept: Establishes urinary TCF21—a podocyte-specific transcription factor—as a new, non-invasive candidate biomarker for preeclampsia. • Connects placental and renal pathways: Provides clinical evidence that urinary TCF21 captures a renal/podocyte injury signal that is complementary to angiogenic imbalance (sFlt-1/PlGF), supporting a dual-pathway disease model. • Demonstrates independent diagnostic value: Shows that urinary TCF21 remains independently associated with preeclampsia after adjusting for clinical risk factors and angiogenic markers. • Identifies a distinctive, hypothesis-generating severity pattern: Urinary TCF21 showed an inverse association with disease severity, suggesting a dynamic podocyte-related signal distinct from the linear severity relationship seen with angiogenic biomarkers; this finding requires mechanistic and longitudinal validation. • Advances multi-marker risk modeling: Demonstrates improved discrimination when urinary TCF21 is integrated with the sFlt-1/PlGF ratio and clinical variables, supporting a multidimensional panel for diagnosis and stratification. • Highlights translational practicality: Proposes a feasible urine-based approach for adjunct testing and risk refinement at presentation, with performance and cutoffs requiring assay standardization and external validation before clinical use.
Iron overload promotes atherosclerosis in mice and causes vascular dysfunction in humans with Hemochromatosis. However, data are controversial on whether systemic iron availability within physiological limits affects the pathogenesis of atherosclerosis. We, therefore, performed an individual participant data (IPD) meta-analysis and studied the association between serum iron biomarkers with common carotid intima-media thickness (CC-IMT); in addition, since sex influences iron metabolism and vascular diseases, we studied if there are sex-specific differences. We pooled the IPD and analysed the data on adults (age≥18y) by orthogonal approaches: machine learning (ML) and a single-stage meta-analysis. For ML, we tuned a gradient-boosted tree regression model (XGBoost) and subsequently, we interpreted the features using variable importance. For the single-stage metaanalysis, we examined the association between iron biomarkers and CC-IMT using spline-based linear mixed models, accounting for sex interactions and study-specific effects. To confirm robustness, we repeated analyses on imputed data using multivariable regression adjusted for key covariates identified through machine learning. Further, subgroup analyses were performed in children and adolescents (age<18y). In addition, to evaluate causality, we used UK Biobank data to examine associations between the hemochromatosis (HFE) genotypes (C282Y/H63D) and mean CC-IMT in ~ 42,500 participants with carotid ultrasound data, using sex-stratified linear regression (adjusted for age, assessment centre, and genetic principal components). We included IPD from 21 studies (N = 10,807). The application of the ML model showed moderate predictive performance and identified iron biomarkers (transferrin, ferritin, transferrin saturation, and iron) as key features for IMT prediction. Multivariable analyses showed non-linear sex-specific relationships for ferritin and transferrin with CC-IMT, both only among females at specific ranges. Ferritin showed a significant positive association [Ferritin > 233 ng/mL: β = 0.04, 95% CI (0.002, 0.08), p = 0.037], while transferrin showed negative associations at specific ranges [ Transferrrin 231–263 mg/dL: β=-0.21, 95% CI (-0.43, 0.003), p = 0.054; Transferrrin > 263 mg/dL: β=-0.73, 95% CI (-1.48, 0.01), p = 0.05]; No significant associations were found between CC-IMT in those with HFE genotypes in either sex in the UK Biobank. Our observational data show that iron biomarkers - ferritin and transferrin are non-linearly associated with CC-IMT specifically in females, while a significant causal association between the HFE genotype and CC-IMT could not be demonstrated in the UK Biobank data. We conclude that our observational findings may reflect residual confounding, reverse causation, or other non-causal mechanisms rather than a direct causal relationship. No financial support was received for this meta-analysis. The protocol for this study is registered in the PROSPERO database ( CRD42020155429; https://www.crd.york.ac.uk/). The online version contains supplementary material available at 10.1186/s12872-026-05796-8.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Early detection of renal involvement in ANCA-associated vasculitis (AAV) is crucial, as functional changes often precede anatomical damage. Current diagnostic standards, such as the measurement of serum creatinine, renal biopsy and urinary analyses have limitations due to delayed detection and lack of specifity. Functional renal MRI (fMRI) techniques, including diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), arterial spin labeling (ASL) and blood oxygenation level dependent (BOLD) offer promising non-invasive alternatives for assessing renal function in AAV. The aim of this study was to evaluate the feasibility of non-invasive assessment of renal changes associated with AAV using mpMRI (multiparametric MRI). This study evaluated 7 patients and 10 healthy controls: patients with rapidly progressive glomerulonephritis (RPGN) due to AAV (n = 3), AAV patients without clinical signs of renal involvement (n = 4), and healthy controls (n = 10). All participants underwent functional renal MRI. Key parameters, including the apparent diffusion coefficient (ADC), fractional anisotropy (FA), and ASL-based renal perfusion and T2* parameter maps, were acquired and analyzed. The following differences in renal imaging parameters were observed between RPGN patients and healthy controls: RPGN patients showed reduced ADC values in the renal medulla and increased FA values compared to controls. Additionally, ASL values in the renal cortex were lower in RPGN patients. T2* values were lower in RPGN patients compared to the healthy control group in the cortex, and higher in the medulla. Patients with AAV without confirmed renal involvement also showed alterations in ADC, T2* and FA values compared to healthy controls. Our findings indicate that mpMRI parameter might detect renal changes in AAV. Therefore, mpMRI might offer novel opportunities for non-invasive detection of disease-associated changes.
暂无摘要（点击查看详情）
Obinutuzumab is a novel glycoengineered type II anti-CD20 monoclonal antibody with more potent and sustained B-cell depletion than rituximab. This study aimed to evaluate the efficacy and safety of obinutuzumab monotherapy in adult patients with minimal change disease (MCD). We conducted a retrospective study including adult MCD patients treated with obinutuzumab or glucocorticoids (GC) between January 1, 2020 and June 30, 2025. The primary outcome was complete remission (CR) of nephrotic syndrome. Secondary outcomes included relapse and adverse events. 38 patients were enrolled (16 in the obinutuzumab group, 22 in the GC group). 9 patients in the obinutuzumab group had steroid-dependent or steroid-resistant MCD, and 7 were new-onset MCD treated with obinutuzumab due to GC intolerance, contraindications, or comorbidities. In new-onset MCD, patients receiving obinutuzumab were older with higher prevalence of hypertension, BMI, and HbA1c. The CR rate was 68.8% (11/16) in the obinutuzumab group, with no significant differences in CR rate or time to remission compared with GC. Multivariate Cox regression showed that obinutuzumab treatment was not independently associated with CR. No relapses were observed in the obinutuzumab group during follow-up, whereas 27.3% of GC-treated patients relapsed. This single-center retrospective study provides preliminary evidence that obinutuzumab monotherapy may induce and maintain remission in selected adult MCD patients (e.g., those with GC contraindications or intolerance). While its remission rate is comparable to conventional GC therapy in our cohort, further prospective validation is required before it can be recommended as a routine alternative to GC.
暂无摘要（点击查看详情）
Congenital anomalies of the kidney and urinary tract (CAKUT) comprise a heterogeneous group of developmental disorders with diverse genetic etiologies. However, it remains unclear whether these genetic factors converge on shared cellular programs across development and tissues. We analyzed the expression of 91 curated CAKUT-associated genes across publicly available single-cell RNA sequencing datasets from human fetal and adult kidney, ureter, and bladder. These data were complemented by early embryonic transcriptomic profiles to characterize temporal expression dynamics and cell-type specificity. During kidney development, key CAKUT genes, including EYA1, SIX1, PAX2, and FOXC1, showed strong preferential expression in mesangial and mesonephric nephron tubule epithelial cells, highlighting early roles in ureteric bud induction and branching morphogenesis. Temporal analysis identified two distinct expression patterns: an early-peak group (EYA1, SIX1, SIX2, PAX2, ITGA8) with maximal expression during early nephrogenesis followed by decline, and a late-rise group, including MUC1, with increasing expression toward adult stages. Across tissues, CAKUT genes exhibited a conserved enrichment in stromal and mesenchymal cell populations. Our findings reveal a shared stromal-mesenchymal gene expression signature underlying CAKUT pathogenesis. These results suggest that diverse genetic perturbations may converge on early mesodermal lineage programs that are critical for ureteric bud formation and kidney patterning, providing a unifying cellular framework for understanding CAKUT.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）