Certain molecules, such as GLP-1 agonists and endothelin antagonists, possess nephroprotective properties. When treating IgA nephropathy, endothelin antagonists and sibeprenlimab have shown effectiveness in slowing the progression of chronic kidney isease. Additionally, the infusion of amino acids can reduce the incidence of mild acute kidney injury following cardiac surgery. In hemodialysis, the sodium content in the dialysate appears to affect patient mortality rates. For individuals starting hemodialysis after the age of 75, there is a modest survival benefit, although it comes at the cost of reduced time spent at home. In the future, noninvasive biomarkers may enable early detection of renal graft rejection.

Certain molecules, such as GLP-1 agonists and endothelin antagonists, possess nephroprotective properties. When treating IgA nephropathy, endothelin antagonists and sibeprenlimab have shown effectiveness in slowing the progression of chronic kidney isease. Additionally, the infusion of amino acids can reduce the incidence of mild acute kidney injury following cardiac surgery. In hemodialysis, the sodium content in the dialysate appears to affect patient mortality rates. For individuals starting hemodialysis after the age of 75, there is a modest survival benefit, although it comes at the cost of reduced time spent at home. In the future, noninvasive biomarkers may enable early detection of renal graft rejection.

Residual kidney function (RKF) is defined as the production of a clinically significant amount of urine in dialysis patients. Observational studies suggest that those with preserved RKF have a better prognosis than anuric patients. Preserved RKF allows the prescription of a lower dialysis dose compared to the traditional thrice weekly schedule. Such an "incremental" approach has also been associated with a better global prognosis. In view of the overall growth of incremental HD in the western world, we review the main studies supporting this approach, as well as the benefits and limitations related to RKF preservation.

Residual kidney function (RKF) is defined as the production of a clinically significant amount of urine in dialysis patients. Observational studies suggest that those with preserved RKF have a better prognosis than anuric patients. Preserved RKF allows the prescription of a lower dialysis dose compared to the traditional thrice weekly schedule. Such an "incremental" approach has also been associated with a better global prognosis. In view of the overall growth of incremental HD in the western world, we review the main studies supporting this approach, as well as the benefits and limitations related to RKF preservation.

The year 2023 is marked by the arrival on the market of lecanemab for the treatment of Alzheimer's disease. New biomarkers have demonstrated their usefulness in monitoring peripheral neuropathies and diagnosing synucleinopathies. A genetic study has highlighted the role of nervous system cells in the risk of progression of multiple sclerosis (MS). The adverse effects of anticonvulsant treatments after prenatal exposure and on lipid metabolism have been clarified. New anti-CGRP treatments have demonstrated their efficacy in migraine attacks and chronic migraines. The criteria for thrombectomy have been further broadened. And finally, rehabilitation is refining the management of cerebrovascular patients and those with secondary progressive MS.

Microscopic hematuria (MH) is a frequent biological finding. In most cases, the etiology is benign, symptomatic and reversible. The diagnostic approach allows classifying hematuria as glomerular or non-glomerular. For non-glomerular hematuria, the risk of urinary tract neoplasia is 5% and should always be evaluated1. To use resources efficiently, patients requiring additional and invasive exam must be identified and distinguished from those who will only require a follow up. This article reviews the diagnostics approach of MH by integrating the new recommendations of the American urology association published in 2020.

Abstract Background and Aims Living donor (LD) selection is a crucial step in kidney transplantation (KTX). The impact of hypertension (HT) of LD on later kidney graft function remains insufficiently understood. Method We retrospectively reviewed recipients of LD KTX at a single tertiary center (Geneva University Hospitals, Geneva, Switzerland) from January 2003 to December 2021 with a follow-up until December 2022. LD blood pressure (BP) values obtained with office measurement and 24 h ambulatory BP monitoring (ABPM) were the main predictors, while recipients estimated glomerular filtration rate (eGFR) and proportion of kidney fibrosis on biopsies were the outcomes. Multivariate analyses were adjusted for the following pre-KTX donor characteristics: Age, gender, ethnicity, body mass index and eGFR. Results In total, 212 LD KTX recipients were included with LD mean age 51 ± 11 and 133 women (62.7%). According to European guidelines definition, 73 (34.4%) LD were hypertensive based on office BP. On a sub-group of 112 LD with ABPM, 64 (57.1%) were hypertensive. Systolic office BP was negatively associated with eGFR at 6 months, 1 year, 5 year and 10 year follow-up (p < 0.05 for all). Systolic office BP was positively associated with kidney fibrosis at 1 year follow-up (p < 0.05). Those associations were not significant after multivariate adjustment. Age at donation remained significantly associated eGFR and kidney fibrosis after multivariate adjustment (p < 0.05 in both models). Conclusion Based on our experience, a significant proportion of LD are hypertensive at kidney donation. While an adverse impact of HT on later kidney function and fibrosis could be measured, this effect seemed negligible after accounting for other more relevant clinical characteristics, with age at donation being decisive.

Molecules such as sparsentan and budesonide look promising to treat proteinuric IGA nephropathy. SLGT2 inhibitors have a prominent place in nephroprotection and could be used in the treatment of acute kidney injury due to heart failure as well. High volume hemodiafiltration compared to hemodialysis improves survival in dialysis patients. Lessening dialysate temperature does not improve hemodynamic stability during the dialysis session. Sodium bicarbonate does not seem to protect renal function in renal transplant patients. SGLT2 inhibitors may have a beneficial effect in these patients in terms of nephroprotection.

Severe cases of IGA nephropathy might benefit from corticosteroid therapy. Inflimidase may be a promising treatment of Goodpasture disease. SGLT2 inhibitors and acetazolamide act synergistically with loop diuretics in the treatment of acute cardiac failure. In hemodialysis, use of lung ultrasound to determine the ultrafiltration seems to decrease hospitalizations due to acute heart failure but does not reduce patient-centered outcomes. Icodextrin may mitigate the loss of ultrafiltration in PD patients who are carriers of the Aquaporin I promotor TT genotype. MICA-antibodies have an impact on the risk of graft rejection. Xenotransplantation may become a reality.Une corticothérapie peut être proposée dans les formes sévères de néphropathie à IgA. L’inflimidase est une molécule prometteuse dans le traitement de la maladie de Goodpasture. Les inhibiteurs du SGLT2 et l’acétazolamide sont des diurétiques d’appoint aux diurétiques de l’anse dans le traitement de l’insuffisance cardiaque aiguë. En hémodialyse, l’ultrason pulmonaire pour déterminer le volume d’ultrafiltration diminue les hospitalisations pour insuffisance cardiaque mais pas la morbimortalité globale. L’hémodialyse incrémentale gagne en popularité. L’icodextrine permet de pallier la baisse de l’ultrafiltration chez les patients en dialyse péritonéale porteurs du génotype TT du promoteur de l’aquaporine-1. Les anticorps anti-MICA dirigés spécifiquement contre le greffon rénal ont un impact sur le risque de rejet du greffon. La xénotransplantation devient une réalité.

Severe cases of IGA nephropathy might benefit from corticosteroid therapy. Inflimidase may be a promising treatment of Goodpasture disease. SGLT2 inhibitors and acetazolamide act synergistically with loop diuretics in the treatment of acute cardiac failure. In hemodialysis, use of lung ultrasound to determine the ultrafiltration seems to decrease hospitalizations due to acute heart failure but does not reduce patient-centered outcomes. Icodextrin may mitigate the loss of ultrafiltration in PD patients who are carriers of the Aquaporin I promotor TT genotype. MICA-antibodies have an impact on the risk of graft rejection. Xenotransplantation may become a reality.

Objective: Pre-eclampsia (PE) is as a risk factor for subsequent cardiovascular and kidney disease. Serum copeptin correlates with adverse kidney outcomes in the general population and is increased during PE as compared to healthy pregnancy. We describe the association between copeptin and subsequent kidney outcomes in pregnant women. Design and method: We enrolled 372 patients with PE and 82 with healthy pregnancy in this prospective cohort study. Serum copeptin was measured at 6 weeks post-partum (PP). Office blood pressure (BP), eGFR and albuminuria were measured at 6 weeks as well as at 1 year PP in a sub-group of 110 patients. Interaction effect was tested using likelihood ratio test (LRT). Results: As compared to healthy controls, patients with PE were less frequently Caucasian, more likely smokers and had higher body mass index (p < 0.05). At 6 weeks PP, copeptin levels were similar between groups. At one year PP, systolic BP (SBP), diastolic BP (DBP) and albuminuria were higher in PE as compared to control patients (p < 0.05) while eGFR was similar between groups. A significant interaction existed between copeptin and PE status regarding DBP at 1 year PP (p = 0.045 for LRT). A similar but borderline interaction existed between copeptin and PE status for albuminuria at 1 year PP (p = 0.126 for LRT). Conclusions: At 6 weeks PP, women who suffered from PE do not have increased copeptin levels as compared to healthy controls. However, in case of PE only, copeptin levels are associated with subsequent adverse kidney outcome. Whether this association is causal and would represent a potential therapeutic target remains to be tested.

Plasma exchange is often prescribed in nephrology and represents a technical as well as logistic challenge. It is thus important to master its most frequent indications. In this narrative review, we discuss main diseases requiring therapeutic plasma exchange in nephrology: anti-glomerular basement membrane disease, thrombotic microangiopathy as well as various clinical scenarios in kidney transplant. We also review plasma exchange in ANCA associated vasculitis, where indications have recently been restricted owing to recent scientific evidences.Dans sa pratique clinique, le néphrologue est souvent confronté à la prescription d’échanges plasmatiques, qui représentent toujours un défi technique et logistique. Il est donc nécessaire d’avoir une bonne connaissance des indications fréquentes. Dans cet article narratif, nous rappelons les principales pathologies bénéficiant de ce type de prise en charge en néphrologie : maladie anti-membrane basale glomérulaire, microangiopathies thrombotiques, ainsi que divers scénarios en transplantation rénale. Finalement, nous revenons sur le cas des vasculites à ANCA, domaine dans lequel les indications aux échanges plasmatiques ont récemment été limitées suite à de nouvelles données scientifiques.

Plasma exchange is often prescribed in nephrology and represents a technical as well as logistic challenge. It is thus important to master its most frequent indications. In this narrative review, we discuss main diseases requiring therapeutic plasma exchange in nephrology: anti-glomerular basement membrane disease, thrombotic microangiopathy as well as various clinical scenarios in kidney transplant. We also review plasma exchange in ANCA associated vasculitis, where indications have recently been restricted owing to recent scientific evidences.

Accurate quantitative analysis in liquid chromatography-mass spectrometry (LC-MS) benefits from calibration curves generated in the same matrix as the study sample. In the case of endogenous compound quantification, as no blank matrix exists, the multitargeted internal calibration (MTIC) is an attractive and straightforward approach to avoid the need for extensive matrix similarity evaluation. Its principle is to take advantage of stable isotope labeled (SIL) standards as internal calibrants to simultaneously quantify authentic analytes using a within sample calibration. An MTIC workflow was developed for the simultaneous quantification of metabolites related to chronic kidney disease (CKD) using a volumetric microsampling device to collect 20 μL of serum or plasma, followed by a single-step extraction with acetonitrile/water and liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. Since a single concentration of internal calibrant is necessary to calculate the study sample concentration, the instrument response function was investigated to determine the best SIL concentration. After validation, the trueness of 16 endogenous analytes in authentic human serum ranged from 72.2 to 116.0%, the repeatability from 1.9 to 11.3%, and the intermediate precision ranged overall from 2.1 to 15.4%. The proposed approach was applied to plasma samples collected from healthy control participants and two patient groups diagnosed with CKD. Results confirmed substantial concentration differences between groups for several analytes, including indoxyl sulfate and cortisone, as well as metabolite enrichment in the kynurenine and indole pathways. Multitargeted methodologies represent a major step toward rapid and straightforward LC-MS/MS absolute quantification of endogenous biomarkers, which could change the paradigm of MS use in clinical laboratories.

Major advances in the treatment of nondiabetic chronic nephropathy and ANCA associated-renal vasculitis were published within the past two years. A new formula for assessing GFR was developed that does not take ethnicity into account. For hemodialysis patients, hemodiafiltration does not diminish uremic neuropathy. In hemodialysis patients, DOACs induce less bleeding than K vitamin antagonists. Weaning of steroids should be more rapid in some transplant patients. COVID-19 vaccination is less effective in dialysis and transplant patients and will necessitate a third dose.

Objective: Every year, as a prediction risk of developing preeclampsia, experts are attracted by polymorphisms of some genes involved in the regulation of vascular tone and endothelial function. The purpose - to establish the features of Met235Thr polymorphism in the AGT gene in the development of severe preeclampsia. Design and method: We examined 139 pregnant women in the third trimester of gestation which were divided into 2 groups: The main group - 56 pregnant women with severe preeclampsia. The control group is 83 conditionally healthy women. The age of the pregnant women was 19–37 years. The material for the study was DNA samples from pregnant women. Isolation of DNA from blood and PCR analysis were performed with kits of reagents and test systems from Ampli Prime Ribot-prep. Results: The shares of the Thr allele, being at very close levels in values, were insignificantly less in the control group, where they were 36.9%, versus 38.4% among patients with severe preeclampsia. The detection rate of the homozygous wild Met / Met genotype of the Met235Thr polymorphism of the AGT gene was also insignificantly higher in the control group, being at the level of 43.0% (x2 = 0.15; p = 0.70; RR = 0.92; 95% CI: 0.33–2.54; OR = 0.87; 95% CI: 0.42–1.79), which was insignificantly higher than among patients with severe preeclampsia 39.5%. The heterozygous Met / Thr genotype, also relatively evenly distributed between the groups, was insignificantly less frequently detected in the control group, amounting to 40.2% (x2 = 0.20; p = 0.67; RR = 1.1; 95% CI: 0.41–2.97; OR = 1.18; 95 % CI: 0.58–2.41), versus 44.2% among patients with severe preeclampsia. The homozygous mutant Thr / Thr genotype, also being at a comparable level, prevailed statistically insignificantly in the control group (16.8%), relative to the group of patients (16.3%) (x2 = 0.01; p = 0.94; RR = 0.97; 95% CI: 0.25–3.72; OR = 0.96; 95% CI: 0.38–2.44) Conclusions: We can conclude that the Met235Thr polymorphism in the AGT gene in women with severe preeclampsia has clinical prognostic significance.

Abstract BACKGROUND AND AIMS Preservation of residual kidney function (RKF) in maintenance haemodialysis (HD) patients is associated with better survival and quality of life. RKF may be better preserved with an incremental HD (frequency < 3x/week) regimen in patients starting HD. Since 2013, incremental HD is routinely used at our centre. METHOD Incremental HD was implemented in incident HD patients with a urine output of >600 mL/day, a urea clearance (KRU) ≥2 mL/min and an interdialytic weight gain < 2.5 kg. Patients were clinically assessed every week and a 24-h urine collection was ordered every other month in order to measure RKF. RESULTS From January 2013 to December 2020, 296 patients started chronic dialysis, with 162 on thrice-weekly HD, 63 on incremental HD and 71 on peritoneal dialysis (PD). Patients on incremental HD did not differ from those on thrice-weekly HD or PD in terms of age, gender and comorbidity score. Diuresis, eGFR and KRU at incremental HD initiation were 1842 ± 749 mL/day, 6.7 ± 3.1 mL/min and 4.0 ± 1.8 mL/min, respectively. Among patients on incremental HD, four could retrieve a sufficient RKF to become dialysis-independent and two were transplanted. Among the 57 remaining patients on incremental HD, median duration until transition to a thrice-weekly HD regimen or death was 10 (6–20) months. Within the first year of dialysis, median survival and hospital-free days were higher in patients starting with incremental HD as compared with thrice-weekly HD: 91% versus 77%, P = 0.02 and 348 (316–362) versus 338 (295–354) days; P = 0.03. CONCLUSION These preliminary results show that incremental HD can be implemented in incident HD patients as long as regular clinical and RKF assessments are found adequate. A median duration of 10 months before transition to thrice-weekly HD can be expected in this setting. Results of randomised clinical trials assessing long-term survival and quality of life in incremental HD are awaited prior to its large-scale implementation.

Kidneys undergo structural as well as functional aging. Imaging and microscopic exams show alterations that manifest as a decline in glo merular filtration rate (GFR) over time. As a GFR < 60 ml/min/1,73m2 during more than three months is sufficient to diagnose chronic kidney disease (CKD), a large proportion of elderly fall into this category. However, morphological, clinical and epidemiological data show that the decline in GFR with age is not per se associated with adverse consequences. An age-adapted definition of CKD would allow managing patients on an individual prognostic basis rather than on an arbitrary biological construct.

Arteriovenous fistula (AVF) remains the vascular access of choice in hemodialysis but generates cardiovascular constraints. Its creation immediately induces an increase in cardiac output. Increased venous return and subsequent volume overload lead to biventricular remodeling, and eventually to dysfunction. High-output heart failure (HOHF) caused by high-flow AVF is a recognized but not strictly defined clinical entity, based on the combination of hypervolemia with an elevated cardiac output. A Qa greater than 2 L/min is a risk factor for HOHF, particularly in susceptible patients. The most used flow reduction procedure is post-anastomotic vein caliber reduction by a banding technique, relieving symptoms and partially reversing previously induced structural abnormalities, but the benefit often remains limited in time.