Nephrology

Case-based algorithms for integrating new therapies in adult IgA nephropathy

This review summarizes recent randomized trial evidence for newly approved IgA nephropathy therapies alongside traditional supportive care. It outlines practical sequencing of renin–angiotensin blockade, SGLT2 inhibitors, targeted-release budesonide, and systemic immunosuppression using real-world case scenarios. Treatment selection is framed around proteinuria burden, kidney function trajectory, extra-renal manifestations, and individual contraindications. The authors emphasize ongoing reassessment of risk, close toxicity monitoring, and flexibility as additional agents enter clinical practice. 1

Continuing RAAS inhibitors in stable ICU patients with mild AKI appears safe

This retrospective study included 1,576 chronic RAAS inhibitor users admitted to ICU without advanced AKI, dialysis, hyperkalemia, or hypotension. After propensity matching, continuing RAAS inhibitors did not increase risk of stage 2–3 AKI within seven days (HR 0.82, 95% CI 0.63–1.06). Continuation was associated with lower 90-day mortality and dialysis requirement (HR 0.69 and 0.64, respectively). Patients who continued therapy in the ICU were far more likely to remain on RAAS inhibitors after discharge. Mortality was similar between those resuming RAAS inhibitors at discharge and those continuing throughout, underscoring the importance of long-term adherence. 2

MASLD independently increases kidney failure risk in CKD

This Korean NHIS cohort evaluated 187,881 individuals with CKD over a median 9.28 years. Compared with no steatotic liver disease, MASLD was associated with higher adjusted kidney failure risk (HR 1.146, 95% CI 1.078–1.219). MASLD with increased alcohol intake or other specific etiologies did not show statistically significant risk versus no steatosis. The association was stronger in females, older patients, and those without hypertension, albuminuria, or smoking. Findings support incorporating MASLD status into CKD risk stratification and shared hepatology–nephrology management. 3

Difelikefalin reduces pruritus and improves quality of life in Chinese hemodialysis patients

This phase 3 randomized, placebo-controlled trial tested intravenous difelikefalin for moderate-to-severe CKD-associated pruritus in Chinese in-center hemodialysis patients. At week 4, difelikefalin yielded greater improvement in WI-NRS itch scores versus placebo, with a least squares mean difference of −0.81 (P = .0003). By week 12, a higher proportion achieved ≥3-point WI-NRS improvement on difelikefalin versus placebo (48.7% vs 33.8%; nominal P = .0235). Health-related quality of life improved on 5-D itch and Skindex-10 in most patients during the open-label extension. Adverse events were mainly mild or moderate and consistent with the known safety profile, supporting its use in this population. 4