Nephrology
Fruquintinib raised the risk of proteinuria and severe hypertension across four randomised trials
A pooled safety analysis gives onconephrology its monitoring targets for this VEGF receptor inhibitor; higher protein intake moved creatinine, cystatin C and eGFR without showing injury; and contrast ultrasound performed well for renal masses.
Measured GFR finds no link between testosterone and kidney function decline in middle-aged men
Iohexol clearance over 11 years undercuts a hypothesis built on creatinine; a new research assay may one day let NELL1 membranous nephropathy be diagnosed and tracked in blood; and an ACC statement tackles DOAC underuse and misdosing, including in kidney disease.
An early eGFR dip on spironolactone did not cancel its benefit in HFpEF
A TOPCAT Americas analysis shows the eGFR fall after starting spironolactone is common and prognostic, but benefit persisted either way; SGLT2 inhibitor benefit held at every BMI; and high-dose vitamin C in severe burns increased mortality.
Bicarbonate did not prevent major adverse kidney events in acidotic shock
SODa-BIC found no reduction in death, dialysis or persistent renal dysfunction at 30 days. Also: South-East Asia sits at the edge of the ISPD peritonitis benchmark, androgen deprivation and AKI, the limits of time-zero transplant biopsy, and fluconazole fails in congenital vasopressin resistance.
GLP-1 agonists cut the composite kidney outcome by a fifth in type 2 diabetes, across 20 trials and 83,000 patients
An updated meta-analysis confirms kidney benefit alongside cardiovascular protection. Also: lorundrostat lowered blood pressure and albuminuria on top of SGLT2 inhibitors in CKD, a life-course view of congenital kidney anomalies, and eating during haemodialysis did not reduce adequacy but did lower blood pressure.
Obinutuzumab outperformed tacrolimus for complete remission in membranous nephropathy
The phase 3 MAJESTY trial, published in June, found complete remission at two years in 37% with obinutuzumab versus 6% with tacrolimus. Also: the trade-offs of ABO-incompatible kidney transplantation, exercise during dialysis, nandrolone in CKD, and an FDA supplement for finerenone.
AF in Asian patients: standard-dose DOACs did better than warfarin — and better than reduced doses
A patient-level analysis of the four pivotal DOAC trials finds larger benefits in Asian patients, including those with lower creatinine clearance. Also: a standardised anti-nephrin assay, whole-genome sequencing in CAKUT, and suction ureteroscopy.
KDIGO maps where B-cell therapy works in glomerular disease, and where it does not
A quiet harvest on this desk, so today's edition draws on the stronger work of recent months: a Controversies Conference report that sorts anti-CD20, BAFF/APRIL and CAR T by disease, real-world pegcetacoplan data in C3 glomerulopathy, and a warning that dialysis vintage blunts vaccine response.
Dexmedetomidine cut postoperative complications in high-risk elderly surgery
A 272-patient trial in patients with a revised cardiac risk index of 3 or more found fewer complications and a shorter stay; small-donor paediatric kidney grafts were lost mostly during one centre's learning phase; and creatinine clearance turns up genetic loci that eGFR misses.
Membranous nephropathy gets a second serology, and it tracks proteinuria
A luciferase immunoassay for anti-NELL1 antibodies reaches 90% sensitivity and 100% specificity against biopsy, with titres following proteinuria; admission hypoalbuminaemia in burns triples the odds of acute kidney injury; and one child in three has AKI after liver transplantation.
Complement inhibitors arrive without the rules for using them
An International Society of Nephrology forum sets out what is and is not known about placing alternative-pathway inhibitors in C3 glomerulopathy and IgA nephropathy; and a KDIGO implementation summit names the barriers that keep guideline therapy out of Asia-Pacific practice.
High-dose vitamin C doubled 28-day mortality in severe burns, and correcting acidosis still did nothing for the kidneys
VICTORY was stopped early for harm, with 28-day mortality of 15.0% against 7.6%; a new histologic class identifies the fastest progressors in diabetic nephropathy; pre-filter haemodiafiltration clears middle molecules better in children but raises blood pressure; and measured GFR clears testosterone of driving age-related decline.
An early eGFR dip on spironolactone did not cancel its cardiovascular benefit in HFpEF
A TOPCAT Americas analysis argues against stopping an MRA for an early creatinine rise, GLP-1 agonists cut a composite kidney outcome by 20% across 20 trials, and SGLT2 inhibitor benefit held whatever the BMI.
Obinutuzumab beat tacrolimus six-fold on complete remission in membranous nephropathy - and the eGFR endpoint did not follow
In MAJESTY, 37% versus 6% reached complete remission at two years. But the hierarchical testing stopped at sustained eGFR decline, which showed no significant effect - so everything below it in the sequence is descriptive.
The renal case for SGLT2 inhibition, and a three-day window after ischaemic injury
The renal basis for SGLT2 inhibition set out in full, a rodent experiment that dates the window for repair after ischaemic injury, a peroxisomal pathway in APOL1 podocytopathy, and the guideline framework that already covers cardiovascular-kidney-metabolic disease.
Blocking C3 drops proteinuria by four-fifths in a disease with nothing else
Twenty-five mostly paediatric patients with C3 glomerulopathy resistant to immunosuppression show what complement inhibition does outside a trial; a small probiotic trial reports an eGFR benefit without giving the numbers; and dialysis patients mount a good RSV response, six weeks late.
Small donors, a learning curve, and the price paid by the first fifteen children
Single-kidney grafts from donors under 15 kg lose a quarter of grafts in the first year until a centre has done sixteen of them; a creatinine clearance GWAS finds loci that muscle mass had been hiding; and 9,041 children settle the balanced-fluid question for the kidney.
A blood test for NELL1 membranous nephropathy that tracks proteinuria, and ferric citrate matches sevelamer while treating the anaemia
A luciferase immunoassay detects and monitors NELL1 autoantibodies without a biopsy, an iron-based binder is non-inferior on phosphate and better on haemoglobin, and low vitamin D tracks with CKD progression on evidence graded very low.
Complement inhibitors arrive without a rulebook, and KDIGO asks why the guidelines are not being followed
An international forum sets out what is still unknown about using complement inhibitors in C3 glomerulopathy and IgA nephropathy; FGF23 turns out to be a moderate biomarker in acute kidney injury with heavy heterogeneity; and a KDIGO summit across 13 Asia-Pacific countries names the barriers that keep proven therapy off the prescription.
Four doses of dapagliflozin halved acute kidney injury after cardiac surgery
A Dutch randomised trial gave 784 elective cardiac surgery patients dapagliflozin 10 mg from the day before surgery through the second postoperative day. Acute kidney injury fell from 52% to 28%. Plus SGLT2 inhibitors disappoint in polycystic kidney disease, and KDIGO places the new IgA nephropathy drugs.
Driving blood pressure below 140 after thrombectomy costs kidneys
A secondary analysis of OPTIMAL-BP links intensive post-thrombectomy blood pressure lowering to more than double the acute kidney injury, KDIGO comments on where three newly approved IgA nephropathy drugs fit, and SGLT2 inhibitors still have no established benefit in polycystic kidney disease.
Intensive blood pressure lowering after thrombectomy doubled acute kidney injury, and AKI marked far worse neurological outcomes
In 287 patients after successful endovascular thrombectomy, intensive blood pressure management raised seven-day AKI from 6.4% to 13.6%. Most injury was stage 1, yet patients who sustained it achieved functional independence in 13.8% against 49.0%, and died from stroke in 37.9% against 3.1%.