美国肾脏病杂志 (AJKD) 是美国国家肾脏基金会的官方期刊，在全球范围内被公认为临床肾脏病学内容的领导者。每个月 AJKD 都会发布原始调查报告，描述与肾脏疾病、高血压、透析疗法和肾移植相关的最新发现。除了对所有 AJKD 内容进行严格的同行评审外，原始调查还要接受例行的统计审查，并遵循一致的结构化格式。每一期的病例报告都揭示了新的疾病和潜在的治疗策略。

The American Journal of Kidney Diseases (AJKD) is the official journal of the National Kidney Foundation and is recognized globally as a leader in the field of clinical nephrology. Each month, AJKD publishes original research reports that describe the latest findings related to kidney disease, hypertension, dialysis, and kidney transplantation. All content in AJKD undergoes rigorous peer review, and original investigations are subject to routine statistical review and follow a consistent structured format. Each issue's case reports reveal new diseases and potential treatment strategies.

《美国肾脏病杂志》（American Journal of Kidney Diseases，AJKD）是美国国家肾脏基金会的官方期刊，全球公认的临床肾脏病学领域的领导者。每月，AJKD 发布原始研究报告，介绍与肾脏疾病、高血压、透析和肾移植相关的最新发现。所有AJKD的内容都经过严格的同行评审，原始研究还需接受例行的统计审查，并遵循一致的结构化格式。此外，每期的病例报告揭示了新的疾病和潜在的治疗策略。

American Journal of Kidney Diseases

Rationale & ObjectiveCystatin C is recommended for estimating glomerular filtration rate (eGFR) when estimates based on creatinine (eGFRcr) are not thought to be accurate enough for clinical decision making. While global adoption is slow, routine cystatin C testing in Sweden has been available for over a decade, providing real-world evidence about the magnitude of differences between eGFRcys and eGFRcr and their association with clinical outcomes.Study designObservational study.Setting & Participants158,601 adults (48% women, mean 62 years, eGFRcr 80 and eGFRcys 73 ml/min/1.73/m2) undergoing testing for creatinine and cystatin C on the same day in connection with a healthcare encounter during 2010-2018 in Stockholm, Sweden.ExposuresPercentage difference of eGFRcys minus eGFRcr (eGFRdiffcys-cr).OutcomesKidney failure with replacement therapy (KFRT), acute kidney injury (AKI), atherosclerotic cardiovascular disease (ASCVD), heart failure (HF) and death.Analytical ApproachMultivariable Cox proportional hazards regression.ResultsDiscordances between eGFRcr and eGFRcys were common, with eGFRcys being lower than eGFRcr (negative eGFRdiffcys-cr) in most cases (65%). Patients with larger negative eGFRdiffcys-cr were older, more often female, with higher eGFRcr and albuminuria, and more comorbid conditions. Compared to patients with similar eGFRcys and eGFRcr, the lowest quartile (eGFRcys >27% lower than eGFRcr) had a higher hazard ratio (HR) of all study outcomes (AKI HR 2.6; 95% CI 2.4-2.9, KFRT 1.4; 1.2-1.6, ASCVD 1.4; 1.3-1.5, HF 2.0; 1.9-2.2 and all-cause death 2.6; 2.5-2.7). Conversely, patients in the highest quartile (positive eGFRdiffcys-cr) were at lower risk.LimitationsObservational study, lack of information on indications for Cystatin C testing.ConclusionsCystatin C testing in routine care shows that many patients have lower eGFRcys than eGFRcr, and these patients had a higher risk of multiple adverse outcomes.

Juan-Jesús Carrero

Edouard L. Fu

Yingying Sang

Shoshana Ballew

Marie Evans

Carl-Gustaf Elinder

Peter Barany

Lesley A. Inker

Andrew S. Levey

Josef Coresh

Morgan E. Grams

Discordances Between Creatinine- and Cystatin C–Based Estimated GFR and Adverse Clinical Outcomes in Routine Clinical Practice

Debbie Chen

Michael Shlipak

Rebecca Scherzer

Nisha Bansal

Alison Potok

Dena Rifkin

Joachim Ix

Anthony Muiru

Chi-Yuan Hsu

Michelle Estrella

Hui Xue

Mark Rutkowski

Drew Clausen

Dennis Walsh

Mose Wintner

Himanshu Kathuria

Tadashi Funahashi

172 Intra-individual Differences in Creatinine Versus Cystatin C–based Estimated Glomerular Filtration Rate and Risk of Incident Heart Failure

RATIONALE & OBJECTIVE
In prior research and in practice, the difference between eGFR calculated from cystatin C and from creatinine has not been assessed for clinical significance and relevance. We evaluated if these differences contain important information about frailty.


STUDY DESIGN
A cohort analysis of the Systolic Blood Pressure Intervention Trial (SPRINT).


SETTING
& participants: 9092 hypertensive SPRINT participants who had baseline measurements of serum creatinine, cystatin C, and frailty.


EXPOSURE
eGFRs calculated using CKD-EPI equations (eGFRCys and eGFRCr), and eGFRDiff calculated as eGFRCys - eGFRCr.


OUTCOMES
A validated 35-item frailty index (FI) that included questionnaire data on general and physical health, limitations of activities, pain, depression, sleep, energy level, self-care, smoking status, as well as past medical history, cognitive assessment, and laboratory data. We defined frailty as a FI score > 0.21 (range: 0 - 1). The incidence of injurious falls, hospitalizations, cardiovascular events, and mortality was also recorded.


ANALYTICAL APPROACH
We used logistic regression to model the cross-sectional association of baseline eGFRDiff with frailty among all SPRINT participants. Adjusted proportional hazards regression was used to evaluate the association of eGFRDiff with adverse outcomes and mortality.


RESULTS
Mean age was 68 (±9) years; mean eGFRCys was 73 (±23), mean eGFRCr was 72 (±20), and mean eGFRDiff was 0.5 (±15) mL/min/1.73 m2. In adjusted models, each SD higher eGFRDiff was associated with 24% lower odds of prevalent frailty (OR=0.76; 95%CI: [0.71; 0.81]), as well as with lower incidence rate of injurious falls (HR=0.84; 95%CI: [0.77; 0.92]), hospitalization (HR=0.91; 95%CI: [0.88; 0.95]), cardiovascular events (HR=0.89; 95%CI: [0.81; 0.97]), and all-cause mortality (HR=0.71; 95%CI: [0.63; 0.82]), p<0.01.


LIMITATIONS
Gold standard measure of kidney function and assessment of muscle mass were not available.


CONCLUSIONS
The difference between eGFRCys and eGFRCr is associated with frailty and health status. Positive eGFRDiff is strongly associated with lower risks of longitudinal adverse outcomes and mortality, even after adjusting for CKD stage and baseline frailty.

O. Alison Potok

Joachim H. Ix

Michael G. Shlipak

Ronit Katz

Amret T. Hawfield

Michael V. Rocco

Walter T. Ambrosius

Monique E. Cho

Nicholas M. Pajewski

Anjay Rastogi

Dena E. Rifkin

The Difference Between Cystatin C– and Creatinine-Based Estimated GFR and Associations With Frailty and Adverse Outcomes: A Cohort Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)

Secondary hyperparathyroidism occurs early in the course of chronic renal failure. Early in the course, a deficit of calcitriol and an abnormality in the calcium sensor receptor may be the important factors; later, with advanced renal failure, hyperphosphatemia becomes an additional important pathogenic factor. Important clinical problems in dialysis patients are as follows: (1) hyperphosphatemia, which contributes to high morbidity and mortality of dialysis patients (a clinical approach to maintaining a normal serum phosphorus is essential and is discussed in this review); (2) a high calcium X phosphorus product leading to coronary artery calcifications (factors leading to calcifications are also discussed); and (3) calciphylaxis, which has been observed with increasing frequency in these patients (an increase in the total calcium load may be the most important pathogenic factor leading to this syndrome). Therapeutic considerations regarding the use of new vitamin D analogues devoid of a hypercalcemic and/or a hyperphosphatemic effect are also mentioned.

Francisco Llach

Francisco Velasquez Forero

Secondary hyperparathyroidism in chronic renal failure: Pathogenic and clinical aspects

慢性肾功能衰竭中的继发性甲状旁腺功能亢进：发病机制与临床方面

Monoclonal immunoglobulin (MIg) crystalline nephropathies are rare lesions resulting from precipitation of MIgs in the kidney as intracellular or extracellular crystals. We describe a patient with multiple myeloma (IgGλ) and diabetes who presented with nephrotic range proteinuria. Kidney biopsy revealed membranous nephropathy superimposed on diabetic glomerulosclerosis. Glomeruli were negative for PLA2R, THSD7A, and NELL-1. Ultrastructurally, the subepithelial deposits were composed of crystals (ranging from rhomboid to rod to needle shaped), which failed to stain for immunoglobulins by routine immunofluorescence but stained for IgG + λ by paraffin immunofluorescence after pronase digestion. RNA-based immunoglobulin repertoire sequencing performed on bone marrow aspirate identified an IgGλ (γ1) clone which was highly atypical, combining an extensively mutated (23.6%) Ig heavy chain derived from the IGHV1-24 with low pI and unusual mutations and a light chain derived from an extremely rare germline gene (IGLV10-54). This report expands the pathologic spectrum of MIg crystalline nephropathies by describing a unique case of crystalline nephropathy with IgGλ deposits manifesting as membranous nephropathy.

Salvatore E. Mignano

Virginie Pascal

Nnaemezie E. Odioemene

William Forehand

Vincent Javaugue

Samar M. Said

Sanjeev Sethi

Christophe Sirac

Samih H. Nasr

Monoclonal Immunoglobulin Crystalline Membranous Nephropathy

单克隆免疫球蛋白结晶膜性肾病

Nicole E Wyatt

Levan Gakhokidze

Gautam Bhave

Juan Pablo Arroyo

Am J Kidney Dis

Hyperkalemia in a Patient With Resolving Acute Kidney Injury

 resolving急性肾损伤患者中的高钾血症

In October of 2023, the American Heart Association (AHA) published a scientific statement and advisory that defined a novel entity, the Cardiovascular-Kidney-Metabolic (CKM) Syndrome.1,2 The overall framework proposes that a substantial proportion of cardiovascular disease (CVD) burden is attributable to a syndrome that extends in stages from: Stage 1) obesity, Stage 2) metabolic/kidney risk factors for CVD (diabetes mellitus, chronic kidney disease (CKD), hypertension, and dyslipidemia), Stage 3) subclinical CVD, and finally Stage 4) clinical CVD. The report that describes the CKM paradigm documents the scientific justification for a syndrome, highlights the overlap in risk factors among individuals with obesity, diabetes, CKD, and CVD, and aligns the evidence and guideline statements that address screening, prevention, and management of these conditions. Overall, the CKM Syndrome is an aspirational framework that pulls from a wide body of literature and disease-specific guidelines with an overall, shared goal of reducing CVD at a population level. But, for clinicians at the front lines of CVD prevention, those of us in primary care, will the new syndrome enhance or complicate our practice?

Sara-Megumi Rumrill

Michael G Shlipak

The New Cardiovascular-Kidney-Metabolic (CKM) Syndrome: An Opportunity for CKD Detection and Treatment in Primary Care

新心血管-肾脏-代谢综合征（CKM）：初级保健中CKD检测与治疗的机会

Proteinuria plays a central role in the diagnosis of kidney disease and has a high prognostic value. The test methods used differ considerably regarding impact on test accuracy, sensitivity, and specificity. Therefore, knowledge of the methodology is crucial for the interpretation of the results. In addition to the distinction between semi-quantitative and quantitative tests, there are also relevant differences within the two methods. In general, semi-quantitative tests are easy to handle but have limitations such as: i) incomplete quantification, ii) a lack of specificity regarding the type of proteinuria, iii) a high rate of false positive tests with the need for re-testing with a quantitative method for verification. In contrast, quantitative methods, especially immunoassays, have the advantages of: i) high test accuracy, ii) the possibility of targeted detection of specific protein molecules in addition to albumin. However, these methods are more expensive and require access to a laboratory or an electronic point of care device. In this review, the different types of tests for proteinuria, their underlying methodologies and their strengths and weaknesses are discussed in detail to allow a rational decision of use and a correct interpretation of the results depending on the clinical context.

Nikolai Carl Hodel

Katharina M Rentsch

Daniel Henry Paris

Michael Mayr

Methods for Diagnosing Proteinuria: When to Use Which Test, and Why

诊断蛋白尿的方法：何时使用何种检测，及其原因

Living donor kidney transplant (LDKT) is the treatment of choice for patients with advanced kidney disease. Kidney paired donation (KPD), originally proposed to overcome immunological barriers, has now evolved to address biological and chronological incompatibilities and reduce financial disincentives. This strategy has allowed maximization of the number of LDKTs. In 2021, of the 5971 LDKT, 1115 (18.6%) were facilitated by KPD. While KPD programs vary in size and structure, privately owned KPD programs dominate the landscape. Participation in KPD is far from universal, as 40% transplant centers do not offer KPD. Across the nation, there are large areas devoid of transplant centers offering KPD. As a result, some donor and recipient candidates are missing opportunities for a successful LDKT. Some private KPD programs provide financial and legal protections to living donors. Therefore, access to such donor protections is variable and not available to all donors. In this perspective, we review the evolution of KPD programs, explore ways to enhance participation, discuss the need for transparency about living donation options to donor and recipient candidates, and ultimately, call for national action for regulatory oversight and to make living kidney donation financially neutral regardless of participation in KPD.

Abhishek Kumar

Angie G Nishio Lucar

Mona D Doshi

Pushing the Boundaries of Living Donation Through Kidney Paired Donation

通过肾脏配对捐赠拓展活体捐赠的边界

Dorey A Glenn

Calvin Andrews

Qian Liu

Jarcy Zee

Sarah Mansfield

Abigail Smith

Michelle M O'Shaughnessy

Andrew Bomback

Keisha Gibson

Larry A Greenbaum

Ronald J Falk

Susan L Hogan

Amy Mottl

Michelle R Denburg

Glucocorticoid Exposure and Infection in Children and Adults With Glomerular Disease: Findings From the Cure Glomerulonephropathy Study

糖皮质激素暴露与肾小球疾病儿童和成人的感染：来自Cure Glomerulonephropathy研究的结果

Abbreviation	Am. J. Kidney. Dis.
Journal Impact	9.60
Quartiles(Global)	UROLOGY & NEPHROLOGY(Q1)

ISSN	0272-6386, 1523-6838
h-index	240
Top Journals	Yes

Publication Information	Publisher: W.B. Saunders，Publishing cycle: Monthly，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1981，Proportion of original research papers: 91.85%，Self Citation Rate:3.20%， Gold OA Rate: 28.54%
Average review cycle	网友分享经验：一般,3-8周
Average recruitment ratio	网友分享经验：较难

American Journal of Kidney Diseases

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