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        <title>Frontiers in Nephrology | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/nephrology</link>
        <description>RSS Feed for Frontiers in Nephrology | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-08-11T13:06:55.86+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1826486</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1826486</link>
        <title><![CDATA[Development and validation of a routine urinalysis-based risk stratification model for IgA nephropathy in a multicenter real-world hospital population]]></title>
        <pubdate>2026-08-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Chi Wang</author><author>Wan He</author><author>QingYuan Zheng</author><author>Yuan Zhong</author><author>Meng Tang</author><author>ChunYing Zhang</author><author>Yong He</author>
        <description><![CDATA[BackgroundIgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Routine urinalysis is universally accessible but underutilized for IgAN risk stratification. This study aimed to develop and validate a urinalysis-based risk stratification model for IgAN in a multicenter real-world hospital population.MethodsThis retrospective multicenter study was based on routine urinalysis records from 8 hospitals. A total of 354 patients had biopsy-confirmed primary IgAN, and 18,002 controls had no documented IgAN diagnosis after electronic medical record (EMR) review. The dataset was randomly divided into a training cohort (70%) and a hold-out validation cohort (30%). LASSO penalized logistic regression was used for variable selection. Model performance was evaluated by discrimination, calibration, and decision curve analysis (DCA). Bootstrap validation with 1000 resamplings was performed. An 8-variable simplified model was additionally developed.ResultsLASSO regression selected 13 variables for the primary full model. The primary model achieved an AUC of 0.849 (95% CI: 0.824–0.873) in the training cohort and 0.861 (95% CI: 0.833–0.890) in the validation cohort. Calibration was good in the training cohort (Brier score = 0.017), while moderate calibration deviation was observed in the validation cohort (Brier score = 0.020). The model yielded a high negative predictive value (>0.99). The 8-variable simplified model retained favorable discrimination with a validation AUC of 0.840.ConclusionsThis routine urinalysis-based model may serve as an accessible laboratory-based risk stratification tool for identifying patients with relatively low or elevated predicted probability of IgAN in real-world hospital settings. It should be interpreted as an adjunct to clinical evaluation rather than as a stand-alone diagnostic test or replacement for renal biopsy.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1861999</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1861999</link>
        <title><![CDATA[Immunoglobulin replacement therapy in antineutrophil cytoplasmic antibody-associated vasculitis with rituximab-associated hypogammaglobulinemia: infection outcomes and disease course in a retrospective cohort]]></title>
        <pubdate>2026-08-04T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Matthew Gross</author><author>Aditi Singh</author><author>Raj Roshan</author><author>Antoine Azar</author><author>Duvuru Geetha</author>
        <description><![CDATA[ObjectiveTo evaluate whether immunoglobulin replacement therapy (IgR), initiated for infection prophylaxis in patients with ANCA-associated vasculitis (AAV) receiving rituximab, is associated with changes in infection burden, disease activity, and the ability to de-escalate immunosuppression.MethodsWe performed a retrospective single-center study of 16 patients with AAV treated with rituximab who developed secondary hypogammaglobulinemia (IgG <600 mg/dL) and subsequently received IgR between 2014 and 2024. Patients receiving IgR for primary immunodeficiency were excluded. Data collected included demographics, ANCA serotype, relapse history, infection burden, immunosuppressive regimen, and serum IgG levels before and after IgR. Primary outcomes were infections and disease relapse before versus after IgR initiation. Secondary outcomes included changes in serum IgG and rituximab use.ResultsPrior to IgR, mean IgG was 287 ± 98 mg/dL, 14/14 patients tested had impaired vaccine responses, and 13/16 (81%) experienced recurrent or severe infections. Seven patients (44%) had at least one disease relapse while on rituximab maintenance. After IgR, mean IgG increased to 1018 ± 234 mg/dL, with normalization in 14/15 (93%). Recurrent or severe infections decreased to 1/16 (6%). Following IgR initiation, no disease relapses were observed during a median follow-up of 29.0 months (IQR 14.5-61.4; range 2.8-127.8), despite rituximab discontinuation in 10 patients and dose-interval extension in the remaining 6 patients. IgR was discontinued in 3 patients without relapse.ConclusionIn this cohort of AAV patients with rituximab-associated hypogammaglobulinemia, IgR demonstrated improved immunoglobulin levels and reduced infection burden and was associated with sustained disease remission despite immunosuppression de-escalation. Further studies are needed to determine whether IgR influences disease activity in AAV.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1864349</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1864349</link>
        <title><![CDATA[Hepatitis E virus infection in kidney transplant recipients: a pilot cross-sectional study of serological markers and allograft function in Northern Serbia]]></title>
        <pubdate>2026-07-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Sonja B. Golubović</author><author>Jelena D. Stojčević Maletić</author><author>Lada V. Petrović</author><author>Tamaš R. Petrović</author><author>Violeta V. Knežević</author><author>Maja S. Ružić</author>
        <description><![CDATA[BackgroundHepatitis E virus (HEV) is an emerging cause of chronic hepatitis and extrahepatic disease in solid organ transplant recipients. Data on kidney transplant populations, particularly in endemic regions, remain limited. This pilot study aimed to quantify the prevalence of HEV exposure and active infection in kidney transplant recipients and examine associations between HEV markers and allograft function.MethodsIn this single-centre cross-sectional pilot study, 25 adult kidney transplant recipients (mean age 48.9 ± 14.4 years, median 13.0 years post-transplant) with available HEV serology and/or RNA testing were included. Clinical data, liver enzymes, estimated glomerular filtration rate (eGFR, mL/min/1.73 m²), and urinary albumin-to-creatinine ratio were obtained from medical records; allograft function was categorised as better versus worsening based on longitudinal clinical and laboratory trends documented in medical records. HEV exposure and active infection were assessed using anti-HEV IgG and IgM antibodies (Euroimmun ELISA; reactive ≥ 1.1, borderline 0.8–1.1, negative < 0.8) and HEV RNA in serum and stool.ResultsAnti-HEV antibodies were present in 19/25 (76%) patients; HEV RNA was detected in 2/25 (8%) patients, with concurrent serum and stool positivity confirmed in both cases. eGFR data were available in 15 patients (60%). IgG serostatus was not associated with eGFR differences, but IgM-positive recipients had significantly lower eGFR (median 35.5 vs 57.5 mL/min/1.73 m²; p = 0.018; Cliff’s δ = 0.74) and higher liver enzyme activity. In an exploratory regression model (n = 15), anti-HEV IgM positivity was associated with approximately 29.8 mL/min/1.73 m² lower eGFR (R² = 0.50), though this estimate is hypothesis-generating given the small sample. Anti-HEV IgM was the strongest individual predictor of worsening graft function (OR = 3.00; 95% CI 0.37–24.5).ConclusionsIn this endemic setting, kidney transplant recipients showed high HEV seroprevalence and an exploratory association between IgM positivity and impaired allograft function. These hypothesis-generating findings support targeted HEV evaluation—including RNA testing—in kidney transplant recipients with unexplained graft dysfunction or mild transaminase elevation in an endemic South-Eastern European setting. Larger longitudinal studies with kidney biopsies are needed to define the renal impact of HEV and determine whether anti-HEV IgM may serve as a risk-stratification marker.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1830698</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1830698</link>
        <title><![CDATA[The effect of nurse-led bladder training on urinary tract outcomes after kidney transplantation]]></title>
        <pubdate>2026-07-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>G. Albertema</author><author>A.C.P. Boskma</author><author>B.H. Meppelink</author><author>J.M. Vonk</author><author>S.J.L. Bakker</author><author>A. Ozyilmaz</author><author>M.F.C De Jong</author>
        <description><![CDATA[IntroductionOptimal bladder function is crucial for kidney transplant success. Bladder training could help prevent dysfunction and complications, yet evidence-based guidelines for bladder training methods are limited. This study evaluates two protocols: standard hourly training versus tailored to preoperative urine output, assessing urinary tract outcomes.MethodsThis pre-post study used data from the TransplantLines data and biobank on kidney transplant patients admitted in 2019 (standard bladder training) and 2022 (new protocol) to a Dutch academic hospital. Standard bladder training involved hourly urination with regular post-void residual checks, whereas the new protocol adjusted urination frequency and scan schedules based on preoperative urine output. Logistic regression analyses were performed to evaluate the following outcomes: residual urine volume > 100ml, urinary tract infection or re-catheterization within three months post-transplantation.ResultsThe analysis included 211 patients (70% male, mean age 55, n=100 standard protocol, n=111 new protocol). Multivariate analysis showed no differences between the protocols in the investigated outcomes. A significant interaction between protocol and age on re-catheterization was found suggesting higher re-catheterization risk in older patients under the new protocol.DiscussionThe revised protocol might promote patient well-being and simultaneously improve nurse working conditions.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1818921</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1818921</link>
        <title><![CDATA[Analysis of risk factors for adverse outcomes in HIV/AIDS patients with ESRD undergoing hemodialysis: a cohort study]]></title>
        <pubdate>2026-07-27T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Guohai Wei</author><author>Zhenghong Huang</author><author>Lizhen Feng</author><author>Qing Wang</author><author>Zhenkun Zhang</author><author>Bo Chen</author>
        <description><![CDATA[BackgroundInfection is the second leading cause of death and hospitalization in hemodialysis (HD) patients. The occurrence of infections in HIV/AIDS patients with End-Stage Renal Disease (ESRD) undergoing maintenance hemodialysis is influenced by patient characteristics and related treatment regimens. Currently, there is limited data both domestically and internationally on the risk factor analysis for adverse outcome following infections in HIV/AIDS patients with ESRD receiving maintenance hemodialysis. This study aims to identify the risk factors associated with adverse outcomes following infections during hemodialysis in patients with HIV/AIDS and ESRD.MethodsIn this retrospective cohort study, we evaluated the 9-month treatment outcomes of 70 HIV/AIDS patients with ESRD and concurrent infections undergoing maintenance hemodialysis at a hospital in Guangxi between January 2019 and December 2024. The patients were divided into adverse outcome group(defined as mortality or severe complications leading to prolonged hospitalization) and survival group. Data analysis was performed using IBM SPSS Statistics version 26.0, with statistical significance set at P ≤ 0.05, to identify adverse outcome risk factors for concurrent infections in HIV/AIDS patients with ESRD.ResultsAmong the 70 enrolled patients, the age ranged from 11 to 86 years. Adverse outcomes occurred in 48 cases (68.57%), while 22 patients (31.43%) survived without severe events. Multivariate analysis identified low-level hemoglobin(HB)(OR 0.952(95%CI 0.908,0.998),P = 0.042) and platelet (PLT)(OR 0.987(95%CI 0.975,1.000),P = 0.046).ConclusionAdverse outcomes are common among HIV/AIDS patients with ESRD who develop infections during maintenance hemodialysis. Low hemoglobin and low platelet levels are significant risk factors for poor prognosis in this patient population. Early identification and management of these hematologic abnormalities may help improve clinical outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1867473</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1867473</link>
        <title><![CDATA[Research advances on acute kidney injury and brain dysfunction]]></title>
        <pubdate>2026-07-23T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Min Li</author><author>Xiaohui Liao</author><author>Jingyang Ran</author>
        <description><![CDATA[Acute kidney injury (AKI) is a prevalent critical clinical condition primarily characterized by a sharp deterioration of renal function within 48 hours. Accumulating clinical evidence has demonstrated that AKI predisposes patients to multisystem complications, among which renal–brain axis dysfunction is well recognized. This condition manifests as delirium, coma and stroke, also elevates the risk of chronic cognitive impairment, dementia and depression. Such complications not only increase short-term all-cause mortality but also severely impair the long-term quality of life in survivors, thereby placing a substantial socioeconomic burden on global healthcare systems. Current mechanistic investigations into AKI-associated brain dysfunction have predominantly centered on canonical pathological pathways, including systemic inflammatory response, oxidative stress, hippocampal neuronal injury, uremic toxin accumulation and others. Emerging evidence indicates that insulin resistance (IR) is highly prevalent in AKI patients and closely correlated with the pathophysiological progression of AKI. We will discuss the specific role of IR in AKI-induced cognitive impairment. Additionally, this review highlights the prospective application of combined multimodal neuroimaging and machine learning algorithms. By integrating readily available multidimensional clinical data, the establishment of early risk prediction models for AKI-related brain dysfunction can facilitate timely identification and precise intervention for high-risk populations. Furthermore, we elaborate the therapeutic potential of targeted anti-inflammatory strategies and natural bioactive compounds in ameliorating AKI-associated brain dysfunction. Collectively, this review provides novel insights for the development of optimized, safe and effective clinical interventions in the future.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1815147</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1815147</link>
        <title><![CDATA[Beyond the test: patient-reported concerns and worries regarding kidney conditions and APOL1 genetic testing among Black patients]]></title>
        <pubdate>2026-07-22T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Rengin Elsurer Afsar</author><author>Bryan Clair</author><author>Aliza Anwar Memon</author><author>John C. Edwards</author><author>Kana N. Miyata</author><author>Baris Afsar</author><author>Mark Schnitzler</author><author>Huiling Xiao</author><author>Amber Carriker</author><author>Fadee Abu Al Rub</author><author>Chi-yuan Hsu</author><author>Anthony N. Muiru</author><author>Barry I. Freedman</author><author>Marie D. Philipneri</author><author>Yasar Caliskan</author><author>Krista L. Lentine</author><author>St. Louis APOL1 Study Collaborators

 </author>
        <description><![CDATA[BackgroundApolipoprotein L1 (APOL1) renal risk variants (RRVs) contribute to the increased risk of kidney disease among Black Americans, but use of genetic testing may be limited by patient concerns regarding clinical implications and effects on family.MethodsBlack adults were prospectively enrolled for APOL1 genotyping, surveys, and clinical record review beginning in January 2019 at a Midwestern U.S. medical center (NCT05656261). Patient-reported concerns about kidney conditions and potential worry related to having an APOL1 high-risk genotype were analyzed at baseline and 3-months.ResultsAmong 200 participants enrolled with completed 3-month follow-up as of January 2025, 17.5% (35/200) carried an APOL1 high-risk genotype (2 RRVs). At baseline, concern about kidney conditions was common: 39% reported being extremely concerned, 34% very concerned, 12% somewhat concerned, 10% a little concerned, and 6% not concerned at all. Higher baseline concern was observed among women and those with a family history of both kidney disease and hypertension. At 3 months, concern levels were unchanged in 45% of participants, decreased in 36%, and increased in 19%. APOL1 high-risk genotypes were more common in those with an increase, compared to a decrease, in kidney concern at follow-up (29% vs 11%; P = 0.02). Worry related to having an APOL1 high-risk genotype declined over time, from 14% at baseline to 8% at 3 months.ConclusionIn this prospective cohort, patient-reported concerns about kidney conditions were common and generally stable, with higher levels observed in certain subgroups. Although APOL1 high-risk genotypes were more common among participants whose kidney concerns increased than among those whose concerns decreased, overall patient-reported worry about genetic risk declined. These findings may help inform patient education and counseling surrounding APOL1 testing.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1919658</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1919658</link>
        <title><![CDATA[Inflammation, infection, and immune dysregulation in chronic kidney disease: translational and epidemiological perspectives]]></title>
        <pubdate>2026-07-22T00:00:00Z</pubdate>
        <category>Mini Review</category>
        <author>Aminu Shittu</author>
        <description><![CDATA[Chronic kidney disease (CKD) represents a growing global health challenge associated with substantial morbidity, mortality, and healthcare burden. Although metabolic and haemodynamic factors, particularly diabetes mellitus and hypertension, remain major contributors, increasing evidence demonstrates that persistent inflammation and immune dysregulation are central mechanisms influencing CKD initiation, progression, and complications. The renal immune microenvironment consists of complex interactions among resident kidney cells, infiltrating immune cells, inflammatory mediators, and molecular signalling networks that regulate tissue repair, fibrosis, and disease outcomes. Persistent activation of innate and adaptive immune responses promotes cytokine release, oxidative stress, endothelial dysfunction, and maladaptive tissue remodelling, contributing to progressive loss of kidney function. Infectious diseases and altered host–microbiome interactions may further amplify systemic inflammation and immune imbalance, particularly in vulnerable populations. Advances in immunology and molecular medicine have identified inflammatory biomarkers and immune-related pathways with potential applications in early detection, risk stratification, and targeted interventions. This Mini Review synthesizes current evidence linking inflammation, infection, and immune dysregulation with CKD progression, highlighting translational opportunities and epidemiological perspectives. Integrating mechanistic insights with population-level evidence may accelerate precision approaches for improving CKD prevention, monitoring, and therapeutic outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1796660</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1796660</link>
        <title><![CDATA[A four-parameter laboratory risk stratification model at admission for 90-day mortality in hepatorenal syndrome-acute kidney injury: a single-center derivation and internal validation study]]></title>
        <pubdate>2026-07-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Julian Müller-Kühnle</author><author>Mathias Becker</author><author>Severin Schricker</author><author>Wolfram Zoller</author><author>Jörg Latus</author><author>Moritz Schanz</author>
        <description><![CDATA[BackgroundHepatorenal syndrome-acute kidney injury (HRS-AKI) is a high-mortality complication of advanced cirrhosis. Early risk stratification after hospital admission may support clinical assessment and research on escalation pathways, but simple admission-based models that avoid in-hospital data leakage remain limited.MethodsWe performed a retrospective single-center derivation and internal-validation study of hospitalized adults with chart-review-confirmed HRS-AKI according to contemporary ADQI/ICA criteria. Candidate predictors were restricted a priori to admission laboratory values to minimize data leakage. Admission variables were prioritized using random-forest importance rankings under prespecified parsimony constraints, followed by endpoint-specific closed-form logistic regression models using an identical four-predictor set across outcomes. The primary endpoint was 90-day all-cause mortality. In-hospital hemodialysis and ICU admission were prespecified secondary endpoints and are reported as exploratory. Internal validation used bootstrap resampling with assessment of apparent and optimism-corrected discrimination and overall accuracy; calibration slope and calibration-in-the-large/intercept were reported descriptively. For contextual benchmarking, admission MELD, MELD-Na, and MELD 3.0 were evaluated as single-predictor logistic benchmark models for 90-day mortality within the same cohort.ResultsThe final analysis included 77 patients. The final predictor set comprised INR, albumin, ln(total bilirubin), and ln(C-reactive protein). For 90-day mortality, the final four-laboratory model showed an apparent AUC of 0.781 (95% CI, 0.715-0.926) and an optimism-corrected AUC of 0.758 (95% CI, 0.648-0.859), with an apparent Brier score of 0.144 (95% CI, 0.081-0.176), an optimism-corrected Brier score of 0.168 (95% CI, 0.117-0.212), an optimism-corrected calibration slope of 0.770, and an optimism-corrected calibration-in-the-large/intercept of 0.168. Performance for in-hospital hemodialysis and ICU admission was limited, with optimism-corrected AUCs of 0.580 (95% CI, 0.451-0.733) and 0.631 (95% CI, 0.514-0.737), respectively. MELD-family benchmarks showed numerically lower within-cohort discrimination than the four-laboratory model; these comparisons were descriptive and hypothesis-generating.ConclusionsIn this single-center derivation and internal-validation study, an admission-based four-laboratory model showed moderate internally validated discrimination for 90-day mortality in hospitalized patients with HRS-AKI. The model should be interpreted as a preliminary risk-stratification approach requiring external validation and, if necessary, recalibration before clinical use. Secondary endpoint models for hemodialysis and ICU admission are exploratory and should not be used for threshold-based decision-making.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1863912</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1863912</link>
        <title><![CDATA[Spatial transcriptomic analysis of kidney biopsies identifies activation of complement and SPP1 networks in Staphylococcus infection-associated glomerulonephritis]]></title>
        <pubdate>2026-07-17T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Spyros Karaiskos</author><author>Luis Santana-Quintero</author><author>Cherri Bott</author><author>Rahul Paul</author><author>Sergey V. Brodsky</author><author>Isabelle Ayoub</author><author>Samir V. Parikh</author><author>Brad H. Rovin</author><author>Tibor Nadasdy</author><author>Hira L. Nakhasi</author><author>Sreenivas Gannavaram</author><author>Anjali A. Satoskar</author>
        <description><![CDATA[BackgroundStaphylococcus infection-associated glomerulonephritis (SAGN) has emerged as the leading cause of infection-related glomerulonephritis (IRGN) in the Western subcontinents, but pathogenesis remains poorly understood in the absence of animal models and detailed molecular mechanisms.MethodsTo dissect the complex underlying immunopathology, we analyzed formalin-fixed paraffin-embedded kidney biopsy tissues from three patients with SAGN and one normal control kidney (NCK) using single-cell spatial transcriptomics (analyzing a total of 3,993 cell-specific transcriptomes). The SAGN biopsies showed diffuse endocapillary hypercellularity with focal crescents. Following annotation of various cell types, we constructed cell communication networks using CellChat to identify ligand–receptor interactions in normal and SAGN kidneys.ResultsSecreted phosphoprotein 1 (SPP1/osteopontin) emerged as the most enriched signaling network in SAGN with markedly increased autocrine and paracrine SPP1–CD44 activity among tubular segments and parietal epithelial cells (PECs). In contrast, SPP1-integrin signaling was mainly observed in healthy control kidneys. Consistent with previous reports, complement pathway activation was detected exclusively in diseased kidneys, with PECs as principal signal receivers, suggesting the potential role in crescent formation. Transcripts for C2, C3, CD55, Factor B, and Factor D showed significant upregulation in SAGN. In contrast, vascular endothelial growth factor (VEGF), angiopoietin-like proteins (ANG PTL), and progranulin/granulin networks exhibited decreased communication probabilities in SAGN versus NCK, suggesting the suppression of protective angiogenic and anti-inflammatory signaling. Immunofluorescence staining for SPP1 showed increased staining in renal tubular segments in SAGN biopsies, supporting our transcriptomic data.ConclusionSPP1 and complement pathways appear to drive pro-inflammatory responses, while protective VEGF signaling is compromised, providing potential therapeutic targets for this disease.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1899385</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1899385</link>
        <title><![CDATA[Safety and efficacy of rituximab-free ABO incompatible kidney transplantation: a German multicenter cohort study]]></title>
        <pubdate>2026-07-17T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ulrich Pein</author><author>Klemens Budde</author><author>Lutz Liefeldt</author><author>Anja Gäckler</author><author>Rolf Weimer</author><author>Hristos Karakizlis</author><author>Claudia Sommerer</author><author>Louise Benning</author><author>Christine Kurschat</author><author>Dirk Stippel</author><author>Ana Harth</author><author>Julia Weinmann-Menke</author><author>Martina Koch</author><author>Birgit Kortus-Goetze</author><author>Stefan Reuter</author><author>Nils Lachmann</author><author>Anja Mühlfeld</author>
        <description><![CDATA[BackgroundABO-incompatible living kidney transplantation (ABOi-LKT) has become an established procedure with long-term patient and graft survival comparable to ABO-compatible transplantation. However, intensified immunosuppression increases the risk of severe infectious complications, particularly in the early post-transplant period. This study investigated whether ABOi-LKT in patients with low baseline anti-ABO isoagglutinin titers can be performed safely without rituximab and thereby reduce infectious complications.MethodsIn this multicenter retrospective cohort study, recipients of ABOi-LKT with low pretransplant anti-ABO titers (≤1:16) were compared according to rituximab use. Clinical outcomes, graft function, rejection episodes, surgical complications, and infectious events were analyzed.ResultsEleven German transplant centers identified 46 patients who underwent ABOi-LKT without rituximab between 2016 and 2024 and 85 low-titer recipients who received rituximab (single dose 375 mg/m²). Baseline characteristics and median pretransplant anti-ABO titers (1:2) were comparable between groups. Patients underwent a median of two extracorporeal antibody eliminations and received comparable immunosuppression. Graft function at discharge and after 3 and 12 months, as well as proteinuria, did not differ between cohorts. One graft loss due to acute antibody-mediated rejection occurred in the rituximab-free group, whereas two graft losses (one rejection, one BK polyomavirus nephropathy) and one patient death occurred in the rituximab group. Rates of surgical complications (34.8% vs. 36.5%), blood transfusions (21.7% vs. 17.6%), and rejection episodes (15% vs. 20%; p=0.499) were similar. In contrast, infectious complications were significantly more frequent among rituximab-treated patients, with a 2.4-fold increased infection risk (p=0.018). Infection-related hospitalizations occurred significantly more often in the rituximab group (64.6% vs. 31.3%; p=0.003).ConclusionsABOi-LKT without rituximab appears safe in recipients with low pretransplant anti-ABO titers. Short-term graft function, graft survival, patient survival, and immunological outcomes were comparable to rituximab-based desensitization. Importantly, omission of rituximab was associated with significantly fewer infectious complications and infection-related hospitalizations, supporting a tailored, lower-intensity immunosuppressive approach in selected low-risk patients.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1883351</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1883351</link>
        <title><![CDATA[Efficacy and safety of vitamin D supplementation in diabetic kidney disease: an umbrella review of systematic reviews and meta-analyses]]></title>
        <pubdate>2026-07-15T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Víctor Juan Vera-Ponce</author><author>Jhosmer Ballena-Caicedo</author>
        <description><![CDATA[BackgroundDiabetic kidney disease (DKD), including classical diabetic nephropathy, is a leading cause of chronic kidney disease and kidney replacement therapy. Vitamin D supplementation has been proposed to reduce albuminuria, but the available reviews are heterogeneous and redundant.ObjectiveTo critically evaluate and summarize the efficacy and safety of native vitamin D and active vitamin D analogs in adults with DKD, including studies reported as diabetic nephropathy (DN).MethodsAn overview of reviews registered in PROSPERO (CRD420251250914). Systematic reviews, with or without meta-analysis, were searched in MEDLINE/PubMed, Embase, the Cochrane Library, Web of Science, and Scopus, without language restrictions, through April 2, 2026. Methodological quality was assessed with AMSTAR-2, risk of bias with ROBIS, overlap with Corrected Covered Area (CCA), and certainty of evidence with GRADE. The synthesis used one anchor review per outcome, without de novo quantitative reanalysis.ResultsEleven reviews met the eligibility criteria; nine provided evidence derived from randomized trials or separable randomized-trial data, and two were retained as contextual evidence. GRADE certainty was low for the surrogate urinary outcomes UACR and UAER, low to very low for 24-hour proteinuria, and very low or not evaluable for renal function, kidney replacement therapy, mortality, cardiovascular events, safety, and metabolic-inflammatory outcomes. Overlap was high (overall CCA, 13.5%; RCT-derived corpus, 14.1%). The evidence was compatible with low-certainty reductions in surrogate urinary outcomes, especially UACR and UAER, without consistent benefit for eGFR, serum creatinine, kidney replacement therapy, mortality, or cardiovascular events; safety was insufficiently reported.ConclusionsVitamin D shows a low-certainty reduction in surrogate urinary markers of albuminuria/proteinuria in DKD, but current evidence is insufficient to support vitamin D as a specific renoprotective intervention beyond conventional indications for deficiency or mineral and bone disorders.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251250914, identifier CRD420251250914.]]></description>
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        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1809424</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1809424</link>
        <title><![CDATA[Case Report: Renal sarcoidosis coexisting with membranous and IgA nephropathy, a very uncommon association]]></title>
        <pubdate>2026-07-13T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Mariel Hernández-Pérez</author><author>Daniel Enos</author><author>Rocío Contreras Faundez</author><author>Joaquín Ramírez Herrera</author><author>Pablo Tapia Riedemann</author><author>Gonzalo P. Méndez</author><author>Jorge Gutiérrez Ventura</author>
        <description><![CDATA[IntroductionSarcoidosis is a multisystemic inflammatory disease of unknown etiology with more frequent lung and lymph node involvement. Despite kidney involvement occurring between 25% and 43%, it may be underdiagnosed, with interstitial granulomatous nephritis and nephrocalcinosis being the most common features, and glomerular disease being less frequent.Case reportA 43-year-old man came to the emergency room (ER) because of macroscopic hematuria, arthralgias, pitting inferior extremities edema, asthenia, and dry cough without dyspnea. Evaluation revealed nephrotic range proteinuria and glomerular hematuria, suggesting an impure nephrotic syndrome. The kidney biopsy showed features of membranous nephropathy and granulomatous interstitial nephritis, with immunofluorescence showing codominant mesangial immunoglobulin A (IgA) and immunoglobulin G (IgG) deposits.Management and outcomeSteroids plus angiotensin receptor blocker (ARB) antagonists were effective, with symptoms subsiding and proteinuria level decreasing after 8 months of follow-up.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1921166</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1921166</link>
        <title><![CDATA[Correction: Intradialytic blood pressure instability and associated factors among hemodialysis patients in Somalia: a retrospective study]]></title>
        <pubdate>2026-07-07T00:00:00Z</pubdate>
        <category>Correction</category>
        <author>Abdulrashid Hashi Mohamed</author><author>Mohamud Mire Waberi</author><author>Feyza Aksu</author><author>Nurto Abdulkadir Said</author><author>Said Abdirahman Ahmed</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1864478</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1864478</link>
        <title><![CDATA[Correction: Effect of preexisting human leukocyte antigen donor-specific antibodies especially human leukocyte antigen-DQ on kidney transplant outcome]]></title>
        <pubdate>2026-06-30T00:00:00Z</pubdate>
        <category>Correction</category>
        <author>Sonia Mehrotra</author><author>Raj Kumar Sharma</author><author>Rakesh Kapoor</author><author>Rajesh Kumar Jaiswal</author><author>Rohit Kapoor</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1862772</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1862772</link>
        <title><![CDATA[Plasma proteomics based on machine learning predict the early risk of kidney outcomes in patients with DKD: a prospective cohort study from UK Biobank]]></title>
        <pubdate>2026-06-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Li Jiang</author><author>Tingting Li</author><author>Haojun Zhang</author><author>Xiai Wu</author><author>Tingting Zhao</author>
        <description><![CDATA[BackgroundDiabetic kidney disease (DKD) is the predominant cause of end-stage kidney disease worldwide. Early identification of patients at heightened risk for adverse kidney outcomes remains a critical unmet clinical need.MethodsWe conducted a prospective cohort study of 918 DKD participants from the UK Biobank. Baseline plasma proteomic profiling quantified 1,463 proteins using Olink proximity extension assays. Three nested Cox proportional hazards models with incremental covariate adjustment identified proteins associated with composite kidney outcomes. To prevent information leakage, all feature selection, hyperparameter optimization, and model development were performed exclusively within the training cohort (70% random split) via a multi-stage pipeline integrating LASSO-Cox regression, Random Survival Forest, Boruta algorithm, and Sequential Forward Selection. XGBoost Cox modeling with SHAP interpretability analysis quantified variable contributions. Predictive performance was validated through Kaplan–Meier survival analysis, 15-year longitudinal trajectory modeling, ROC benchmarking, 10-fold nested cross-validation, and sensitivity analyses restricted to KDIGO-defined DKD. An interactive web application was developed for clinical translation.ResultsOf 1,463 proteins examined, 633 demonstrated significant associations with kidney outcomes across all three Cox models. Functional enrichment highlighted immune-inflammatory pathways, PI3K-Akt signaling, and chemokine cascades as central to DKD progression. The machine learning framework identified an 11-protein signature, which was refined to 10 core biomarkers (HLA-E, EFNA1, GPR158, FSTL3, ART3, GM2A, CLEC1A, CKAP4, IFNGR1, EPHA2) following survival and longitudinal trajectory validation. The protein-only model achieved robust discrimination (AUC = 0.808 [95% CI 0.767–0.848] for composite outcomes; AUC = 0.807 [95% CI 0.765–0.848] for renal death), comparable to fully integrated models incorporating demographics and metabolic variables. Systematic benchmarking across 101 algorithm combinations identified LASSO-RSF as optimal (C-index = 0.94 in training; 0.73 in independent testing), with reliable calibration through mid-term follow-up (Integrated Calibration Index = 0.019–0.022). The web-based tool enables real-time, personalized risk stratification.ConclusionsThis study establishes a validated 10-protein signature for early prediction of kidney outcomes in DKD. The systematic machine learning framework and deployable web application provide accessible, interpretable risk assessment to support precision nephrology and preemptive clinical intervention.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1781576</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1781576</link>
        <title><![CDATA[Accuracy of valganciclovir dosing following kidney transplantation and its impact on clinical outcomes]]></title>
        <pubdate>2026-06-26T00:00:00Z</pubdate>
        <category>Brief Research Report</category>
        <author>Jessica Forsyth</author><author>David Randall</author><author>Raj Thuraisingham</author>
        <description><![CDATA[Valganciclovir is widely used as prophylaxis against cytomegalovirus (CMV) infection following solid organ transplantation. However, valganciclovir requires dose adjustment based on kidney function. This retrospective observational study at a London kidney transplant center explored the accuracy of valganciclovir dosing in the first 3 months following transplantation and its impact on clinical outcomes. Data for adult kidney transplant recipients (KTRs) receiving valgancivloir prophylaxis between 2017 to 2019 was analyzed. The primary outcome was the difference between the prescribed and optimum valganciclovir dose (calculated by creatinine clearance) on days 10–92 after surgery. Secondary outcomes included associations between valganciclovir dosing with CMV DNAemia, cytopenias and rejection. For the 90 KTRs included, the valganciclovir dose was optimum for 51%, underdosed for 31% and overdosed for 18% of the study period. Significant associations were shown for underdosing and CMV DNAemia (B = 2.88, SE = 1.14, p=0.01, 95% CI [1.90,166.1]) as well as overdosing and neutropenia (B = 2.29, SE 0.99, p=0.02, 95% CI [1.42,68.71]). This study highlights the difficulty in optimally dosing valganciclovir in KTRs post-operatively and importantly shows significant associations between suboptimal dosing and clinical outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1822440</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1822440</link>
        <title><![CDATA[Intradialytic blood pressure instability and associated factors among hemodialysis patients in Somalia: a retrospective study]]></title>
        <pubdate>2026-06-23T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Abdulrashid Hashi Mohamed</author><author>Mohamud Mire Waberi</author><author>Feyza AKSU</author><author>Nurto Abdulkadir Said</author><author>Said Abdirahman Ahmed</author>
        <description><![CDATA[BackgroundIntradialytic blood pressure (BP) instability—manifesting as intradialytic hypotension (IDH) or hypertension (IDHT)—is increasingly recognized as a contributor to cardiovascular morbidity in hemodialysis patients. Despite its clinical significance, data on intradialytic BP behavior from sub-Saharan Africa remain scarce.ObjectiveTo determine the prevalence and clinical factors associated with intradialytic BP changes among chronic kidney disease (CKD) patients on maintenance hemodialysis in a tertiary hospital in Somalia.MethodsWe conducted a retrospective observational study of adult patients undergoing maintenance hemodialysis at Mogadishu Somali Turkish Training and Research Hospital between June and September 2022. Intradialytic hypotension was defined as a ≥20 mmHg drop in systolic BP and/or ≥10 mmHg drop in mean arterial pressure (MAP), while IDHT was defined as a >10 mmHg increase in systolic BP and/or ≥15 mmHg increase in MAP from pre- to post-dialysis. Demographic, clinical, dialysis, and laboratory variables were extracted. Logistic regression models were used to evaluate factors associated with IDH and IDHT, with reduced modeling for IDHT because of the small number of events.ResultsAmong 149 patients (mean age 51.1 ± 16.4 years; 57.7% female), the prevalence of IDH and IDHT was 55.0% and 12.1%, respectively. Most patients (74.5%) had hypertension and 96.5% used an arteriovenous fistula. In multivariable analysis, higher pre-dialysis systolic BP (OR 1.037; 95% CI 1.018–1.056) and ultrafiltration goal (OR 1.537; 95% CI 1.002–2.357) were associated with IDH. Because pre-dialysis systolic BP contributed to the outcome definition, this association should be interpreted cautiously. In the reduced IDHT model, ultrafiltration goal was inversely associated with IDHT (OR 0.543; 95% CI 0.298–0.990), while antihypertensive medication burden was not statistically significant. Exploratory electrolyte tertile analysis showed a higher proportion of IDH among patients in lower calcium and higher phosphate tertiles.ConclusionIntradialytic BP instability was common among hemodialysis patients in Somalia, particularly IDH. Given the retrospective design, reliance on pre- and post-dialysis BP measurements, and limited number of IDHT events, the findings should be interpreted as associative and hypothesis-generating. Routine BP monitoring and further prospective studies are warranted to better characterize hemodynamic instability in resource-constrained dialysis settings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1790723</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1790723</link>
        <title><![CDATA[No association between delayed graft function and BK polyomavirus infection reactivation after kidney transplantation: a systematic review and meta-analysis]]></title>
        <pubdate>2026-06-23T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Thidarat Kitrungphaiboon</author><author>Felicity Evison</author><author>Suzy Gallier</author><author>Adnan Sharif</author>
        <description><![CDATA[IntroductionAn association between delayed graft function (DGF) and BK polyomavirus (BKPyV) DNAemia is not well defined.MethodsWe investigated this with 1) a retrospective review of a single-center cohort analysis, and 2) a systematic review & meta-analysis of published data. Kidney transplant recipients at a single-center between 01/01/2007-30/06/2018 were analyzed. Comparative analyses were done with logistic regression models based upon clinical risk factors. Following a systematic review of published studies, meta-analysis was performed using the DerSimonian-Laird random effects model.ResultsIn our single-center analysis, we analyzed 1,770 kidney transplant recipients with median follow up 5.3 years (interquartile range 2.7-8.7 years).  BKPyVDNAemia was associated with; male sex (8.3% versus 5.3% respectively, p=0.017), ABO-incompatible transplantation (10.3% versus 4.6% respectively, p=0.004) and DGF (9.0% versus 6.3% respectively, p=0.048). In a multivariate analysis, only recipient male sex and ABO-incompatible transplantation was associated with BKPyVDNAemia. In a systematic review of published literature, we identified 11 studies and performed a meta-analysis of empirical data including our Birmingham cohort data. No significant association was observed between DGF rates and BKPyVDNAemia (OR 1.00, 95% CI 0.67-1.50).DiscussionWe did not identify any association between DGF rates and subsequent BKPyVDNAemia.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fneph.2026.1895403</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fneph.2026.1895403</link>
        <title><![CDATA[Correction: Successful reintegration of a very elderly patient with rapidly progressive glomerulonephritis due to microscopic polyangiitis after multidisciplinary treatment: a case report]]></title>
        <pubdate>2026-06-19T00:00:00Z</pubdate>
        <category>Correction</category>
        <author>Tatsuo Tsukamoto</author><author>Yui Fukuda</author><author>Kaoru Ohue</author><author>Atsuto Niwa</author><author>Sanae Ogura</author><author>Takuya Ishimura</author><author>Takaya Handa</author><author>Tomomi Endo</author><author>Takeshi Matsubara</author>
        <description></description>
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