Nephrology Updates

Placental Versus Complement Biology in Postpartum Thrombotic Microangiopathy Attribution https://www.ajkd.org/article/S0272-6386(26)01044-9/fulltext?rss=yes Van Doorn et al. present a valuable synthesis of sFlt-1/PlGF ratios and complement assays in pregnancy-associated thrombotic microangiopathy (TMA).1 I would like to highlight a conceptual issue raised by case COM005 that bears directly on clinical interpretation and bedside management.

In Reply to “Placental Versus Complement Biology in Postpartum Thrombotic Microangiopathy Attribution” https://www.ajkd.org/article/S0272-6386(26)01045-0/fulltext?rss=yes We thank Dr Sahutoglu for his Letter.1 Pregnant women with increased levels of antiangiogenic factors, such as, sFlt1, are at risk of preeclampsia/HELLP. sFlt1 has been shown to cause preeclampsia in mice, with glomerular endotheliosis.2 Most, if not all, kidney biopsies from preeclamptic patients show glomerular endotheliosis, while thrombosis is rare.3 sFlt1 levels fall after delivery, with rapid clinical improvement.

Spectrum of Anti–Factor B-Associated Glomerular Diseases in Adults https://www.ajkd.org/article/S0272-6386(26)01048-6/fulltext?rss=yes Autoantibodies targeting complement factor B (anti-FB) are among the most recently described alternative pathway anomalies. Although they have been strongly associated with post-infectious glomerulonephritis in children, the clinical phenotypes associated with such antibodies, along with their effects on the alternative pathway in adults, remain elusive and require further characterization, which was the goal of this study.

Health-Related Quality of Life After Living Kidney Donation: Qualitative Studies Can Provide an Important Perspective https://www.ajkd.org/article/S0272-6386(26)01040-1/fulltext?rss=yes We read with great interest the meta-analysis by van de Laar et al1 who report that living kidney donors' quality of life was significantly better than that of the general population and healthy controls. While these findings are valuable, we believe that quality of life questionnaires alone may not fully reflect the psychological complexity of living donation. In a recent systematic review, we showed that qualitative studies often reveal a more complex experience for donors,2,3 combining both positive aspects and good quality of life with negative ones (vulnerability, ambivalence, anxiety, and changes in the relationship with the recipient).

Deceased Donor Kidney Allocation Changes and Pediatric Recipients: Are We Making the Best Match? https://www.ajkd.org/article/S0272-6386(26)00974-1/fulltext?rss=yes Kidney transplantation remains a precious and limited resource, with the number of waitlisted patients far exceeding the number of deceased donor kidney transplants performed each year. The kidney transplant community continues to be committed to meeting the mandate for equity set out by the National Organ Transplant Act, by continually adapting kidney allocation policies to optimize justice, to maximize utility, and to benefit recipients and the community. When changes in allocation policies are made, it is important to re-evaluate how implementation of those policies affects vulnerable groups, especially pediatric patients.

KDOQI US Commentary on the KDIGO 2024 Clinical Practice Guideline for the Management of Lupus Nephritis https://www.ajkd.org/article/S0272-6386(26)00921-2/fulltext?rss=yes The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the KDIGO 2024 Clinical Practice Guideline for the Management of Lupus Nephritis (LN). The management of LN has become increasingly individualized, and treatment options are expanding; for example, since the release of the KDIGO guideline, the US Food and Drug Administration has approved obinutuzumab in addition to belimumab and voclosporin for the treatment of LN, and the enrollment of patients in chimeric antigen receptor (CAR) T-cell therapy clinical trials is changing the treatment landscape for autoimmune diseases including systemic lupus erythematosus.

Approved therapies in the IgA nephropathy armamentarium: a summary of the evidence https://www.kisupplements.org/article/S2157-1716(26)00005-5/fulltext?rss=yes Historically, IgA nephropathy (IgAN) was managed using supportive care, with a suggested 6 months of immunosuppressive therapy considered for patients at high risk of progressive kidney function decline (proteinuria, >0.75–1 g/d) despite ≥90 days of optimized supportive care. The evolving treatment landscape includes agents that target immunologic aspects of IgAN or better preserve kidney function, or both. Recent approvals include Nefecon, sparsentan, iptacopan, atrasentan, and sibeprenlimab. Nefecon, a targeted-release formulation of budesonide, is the only US Food and Drug Administration and European Medicines Agency fully approved agent that is designed to target the primary source of IgAN: galactose-deficient IgA1 production in the gut mucosa.

Editorial Board https://www.kisupplements.org/article/S2157-1716(26)00008-0/fulltext?rss=yes

Subscription Information https://www.kisupplements.org/article/S2157-1716(26)00009-2/fulltext?rss=yes

Title Page https://www.kisupplements.org/article/S2157-1716(26)00010-9/fulltext?rss=yes

Table of Contents https://www.kisupplements.org/article/S2157-1716(26)00011-0/fulltext?rss=yes

Perceptions of Hispanic Patients with Advanced CKD About Communication and Engagement Regarding Kidney Transplantation: A Qualitative Study https://www.ajkd.org/article/S0272-6386(26)01006-1/fulltext?rss=yes Access to kidney transplantation (KT) for Hispanic patients with advanced chronic kidney disease (CKD) is often attributed to spoken languages different from their healthcare providers. Effective communication, however, is not limited to language, and involves consideration of social context and background; and if successful, can lead to better engagement. Understanding patients’ perspectives on the communication and engagement with their providers regarding KT may inform clinical practice and this was the objective of this study.

The Nephrologist’s Guide to Lower Urinary Tract Conditions: A Urology-Based Review https://www.ajkd.org/article/S0272-6386(26)01005-X/fulltext?rss=yes Lower urinary tract symptoms and disorders are commonly encountered by nephrologists, as they often coexist with or may contribute to various kidney diseases. Thus, an understanding of lower urinary tract disorders and when consultation with urology is warranted is essential to nephrology practice. In this review, we examine lower urinary tract physiology and outline a practical, clinically oriented approach to the initial work-up for lower urinary tract symptoms, including history, physical examination and office-based testing.

Considerations on BMI Stratification in ADPKD Body-Composition Research https://www.ajkd.org/article/S0272-6386(26)01001-2/fulltext?rss=yes We read with great interest the study by Dha Woon Im et al. in the American Journal of Kidney Diseases, “Associations of Skeletal Muscle Mass and Body Mass Index With Clinical Outcomes in Autosomal Dominant Polycystic Kidney Disease1.” In a multicenter real-world cohort using AI-based body-composition quantification, the authors report that higher muscle quality is associated with lower all-cause mortality and possibly lower ESKD risk, whereas greater low-attenuation muscle area is linked to higher ESKD risk, with heterogeneity across BMI strata.

In Reply to “Considerations on Body Mass Index Stratification in Autosomal Dominant Polycystic Kidney Disease Body-Composition Research” https://www.ajkd.org/article/S0272-6386(26)01002-4/fulltext?rss=yes We appreciate the insightful comments by Hu and Long regarding our study on skeletal muscle mass, body mass index (BMI), and clinical outcomes in autosomal dominant polycystic kidney disease (ADPKD).

Risks of Postpartum Kidney Disease Following Preeclampsia and Gestational Hypertension https://www.ajkd.org/article/S0272-6386(26)01004-8/fulltext?rss=yes Preeclampsia and gestational hypertension affect over 1 in 8 pregnancies in the US. Gestational hypertension differs, in part, from preeclampsia by not being associated with proteinuria. However, it is unclear whether these two conditions differ in their risk of subsequent kidney disease. We studied the postpartum risks of kidney disease, comparing individuals with a history of gestational hypertension to those with prior preeclampsia.

Time in Target Range for Hemoglobin A1c and Systolic Blood Pressure: Association With Adverse Kidney Events https://www.ajkd.org/article/S0272-6386(26)01003-6/fulltext?rss=yes Time in target range (TTR) for systolic blood pressure (SBP) and hemoglobin A1c (HbA1c) integrates information about average and variability of levels over time. Their impact on kidney outcomes has not been fully evaluated. This study aimed to investigate the association of HbA1c-TTR and SBP-TTR, individually and jointly, with kidney outcomes among patients with type 2 diabetes and hypertension.

A Call for More Sensitive Patient-Centered Communication and Support After Canceled Transplant Surgeries https://www.ajkd.org/article/S0272-6386(26)00995-9/fulltext?rss=yes In rare instances, specific medical terminology or colloquial phrases commonly used when referencing processes or procedures can inadvertently upset organ donors and transplant candidates. One notable example is the transplant community’s shift away from the term “organ harvesting” to “organ recovery” to describe the transfer of an organ from donor to recipient. This linguistic change occurred after patients and families shared that the phrase, “harvesting” felt dehumanizing and disrespectful to the generosity and dignity of donors.