給專業人員期刊摘要

Kidney International 2026-07｜本期新刊導讀

最後審閱 2026-06-19 31 分鐘

標籤2

本期共 102 篇，其中 8 篇 OA。

本期主軸

本期最強的臨床主線，是在不確定性中提高決策解析度：lupus nephritis 的 asymptomatic serological reactivation 是否應先行加藥、diabetes patient 何時值得 kidney biopsy，以及 intensive blood pressure lowering 的 kidney signal 究竟代表 hard-event harm，還是主要由 eGFR slope 驅動。這三組文章共同要求讀者分清 phenotype、surrogate endpoint、背景治療與 selection bias。

第二條主線是 precision nephrology 的落地。從 NELL1 serology、urinary extracellular vesicle proteomics、spatial transcriptomics、genetic testing，到 APOL1、C3G、ADPKD 與 rare-disease reclassification，重點已從『是否有關聯』轉向『哪一個 molecular subgroup、何種 assay、能否改變治療或家族決策』。同時，多篇 basic/translational work 顯示 DKD、AKI、vascular calcification 與 transplant rejection 不能再用單一路徑解釋。

第三條主線是系統與方法：KDIGO guideline life cycle、GRADE EtD、B-cell targeting、green dialysis，以及 survival machine learning／win statistics，提醒 evidence synthesis、implementation、environmental footprint 與 statistical interpretation 本身就是臨床品質的一部分。Neonatal AKI、tropical infection–associated AKI 與大量 image/case articles，則把早期辨識、mechanical obstruction、感染與 atypical phenotype 拉回 bedside。

必讀導讀

A prospective multicenter randomized controlled trial pre-emptive increase in immunosuppression for asymptomatic serological reactivation in patients with lupus nephritis in clinical remission — OA · RCT

這是本期最直接改變臨床決策的試驗。研究將 $49$ 位處於 clinical remission、但出現 asymptomatic serological reactivation 的 lupus nephritis 患者，隨機分為 pre-emptive treatment 與 observation。介入組短期提高 prednisolone 至 $0.4$ – $0.5\,\mathrm{mg/kg/day}$ ，並把 mycophenolate 或 azathioprine 調至預定劑量後再漸減； $24$ 個月內介入組沒有 kidney flare，對照組有 $5$ 例，kidney-flare–free survival 為 $100\%$ 對 $80\%$ ，overall-flare–free survival 為 $91\%$ 對 $52\%$ 。訊號明確，但樣本小、族群高度篩選，尚不足以支持對所有 serology 波動者一律加藥。

常見誤判：僅憑 anti-dsDNA/C3 變化，未排除感染、未確認持續性，也未評估 steroid toxicity，即全面提高免疫抑制。

Clinical and histologic predictors of non-diabetic kidney disease in patients with diabetes mellitus — OA · observational

這項 OA 大型 biopsy cohort 納入 $49{,}075$ 位有 diabetes 且接受 native kidney biopsy 的患者。NDKD 出現在 $58.8\%$ ：其中 $35.9\%$ 沒有 concurrent diabetic nephropathy，另有 $22.9\%$ 與 diabetic nephropathy 並存；AKI、acute nephritic syndrome，以及年齡極端者較容易找到 NDKD。研究也報告 NDKD 患者較 DN alone 者 $2.56$ 倍不易進展至 ESKD。臨床價值在於支持『非典型 phenotype 要 biopsy』，但這是被選擇去切片的族群，不能把 $58.8\%$ 外推到所有 diabetes patients。

常見誤判：把 diabetes patient 的 proteinuria、hematuria 或 kidney function decline 全部歸因於 DKD，或反過來把 biopsy cohort 的 NDKD prevalence 套用一般門診。

Individual participant-level analysis of four randomized clinical trials examined therapeutic effects of blood pressure lowering on hierarchical kidney outcome using win statistics — OA · IPD analysis

這項 OA individual participant-level post hoc analysis 整合 SPRINT、ACCORD-BP、SHEP 與 ALLHAT，共 $61{,}248$ 人，以七層 hierarchical composite kidney endpoint 和 win odds 比較治療。intensive BP lowering 在 SPRINT 的 $\mathrm{WO}=0.61$ （ $95\%\,\mathrm{CI}\ 0.58$ – $0.64$ ），ACCORD-BP 為 $0.64$ （ $0.59$ – $0.68$ ），看似對 kidney outcome 不利；但超過一半 pairwise comparisons 是由 three-year eGFR slope 決定，而非 kidney failure 或 death。這不推翻 intensive BP 的 cardiovascular benefit，而是要求把 early hemodynamic eGFR change、long-term slope 與 hard renal events 分開解讀。

常見誤判：把 win odds 小於 $1$ 直接翻譯成『增加 kidney failure』，忽略結果主要由較低層級的 eGFR slope 主導。

Neonatal acute kidney injury: diagnosis, recognition, and prevention — OA · narrative review

這篇 OA narrative review 把 neonatal AKI 從 definition、risk recognition、biomarker 到 prevention 與 follow-up 串成可執行流程。核心問題是 SCr 與 urine output 都落後於 injury，且受到 maternal creatinine、gestational age、fluid balance 與低 muscle mass 影響；因此應先辨識 prematurity、HIE、NEC、cardiac surgery、sepsis 與 nephrotoxin exposure，再做 targeted monitoring。文中整理 uNGAL、cystatin C、renal angina approaches，也強調 Baby NINJA 類 stewardship 可把 AKI incidence 從 $30.9\%$ 降至 $11.0\%$ 。出院診斷、blood pressure 與 kidney function follow-up 同樣是照護的一部分。

常見誤判：SCr 單次未上升就認定沒有 neonatal AKI，或只在發生 oliguria 後才開始盤點 nephrotoxin exposure。

A post hoc analysis of BLISS-LN found Belimumab plus mycophenolate mofetil improves kidney outcomes versus placebo plus mycophenolate mofetil in active lupus nephritis — post hoc

僅依摘要評論：這是 BLISS-LN 的 post hoc analysis，聚焦 active lupus nephritis 中 belimumab 加 mycophenolate mofetil，相較 placebo 加 mycophenolate mofetil 的 kidney outcomes。摘要特別指出原試驗納入 pure class V LN，也允許 cyclophosphamide-based standard therapy，使其與其他 LN trials 的橫向比較不易。臨床上應把這篇視為『在特定 background therapy 與 pathology strata 下理解 adjunctive belimumab』，而不是單純把不同 trial 的 response rates 並排。摘要未提供 effect size、subgroup interaction 或 safety 數字，不能進一步量化 benefit。

常見誤判：把 belimumab 視為可取代 MMF／cyclophosphamide 的單藥，或忽略 pure class V 與 induction backbone 對 trial comparability 的影響。

Targeting B cells in immune-mediated kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference — consensus

僅依摘要評論：KDIGO controversies conference 對 B-cell–targeted therapy 採 disease-specific，而非 class-wide 的判讀。摘要明確指出 rituximab 在 IgA nephropathy 的 efficacy 有限；相對地，BAFF/APRIL pathway inhibitors 與 anti-CD38 agents 已出現 proteinuria reduction 與較慢 eGFR decline 的訊號。真正的臨床問題不只是『是否耗竭 B cells』，還包括 target 位階、plasma cell persistence、infection risk、vaccination timing、monitoring biomarker、成本與可近性。此文適合作為 rapidly evolving pipeline 的框架，但不是逐藥處方 guideline。

常見誤判：把 anti-CD20、BAFF/APRIL inhibition 與 anti-CD38 視為同一機轉、同一 efficacy，並跨 glomerular diseases 直接外推。

Tubulointerstitial diseases: an updated framework for diverse and emerging entities — narrative review

僅依摘要評論：這篇 review 反對把所有 tubulointerstitial injury 都收進模糊的『AIN/TIN』標籤，提出八類 etiologic/attributive framework：drug effect、autoimmune/immune-mediated、infection-associated、hereditary/genetic、toxic/metabolic、monoclonal protein–associated、mimics，以及 idiopathic/other，並承認類別可重疊。臨床價值在於把 biopsy pattern、exposure timeline、serology、microbiology、monoclonal work-up 與 genetics 串聯，讓 diagnosis 能對應可撤除因子或 targeted therapy；摘要未提供各類的敏感度、特異度或 treatment algorithm。

常見誤判：看到 interstitial inflammation、eosinophils 或 tubular injury 就直接診斷 drug-induced AIN，忽略 infection、MGRS、genetic disease 與 mimics。

Anti–glomerular basement membrane disease: variant forms and underlying mechanisms — narrative review

僅依摘要評論：anti-GBM disease 仍是需要在數小時至數日內完成辨識與治療的 nephrologic emergency。此 review 聚焦 variant forms 與 underlying mechanisms，目的在補足典型 rapidly progressive GN、pulmonary hemorrhage、crescent formation 之外的診斷灰區。摘要指出 standard care 的 plasma exchange 加 intensive immunosuppression 已改善 patient survival，但 kidney survival 仍差，關鍵常是 delayed recognition 與 treatment initiation。臨床閱讀重點應放在何時即使 phenotype、serology 或 pathology 不完全典型，仍需維持高 suspicion 並加速 biopsy／confirmatory testing。

常見誤判：因 pulmonary hemorrhage 缺席、serology 不典型或 biopsy signal 不完全符合教科書，就過早排除 anti-GBM disease。

指南／綜論／方法學與其他文章逐篇導讀

指南／綜論／方法學

文章	類型／取得性	導讀重點
7. Role of the Kidney in Glucose Homeostasis: The Basis for Pharmacotherapy and Prevention of Cardio-Renal Complications in Diabetes	narrative review	從腎臟在 glucose homeostasis、回收與能量調節的角色，串聯 diabetes pharmacotherapy 與 cardio-renal risk prevention；摘要偏生理背景。僅依摘要評論。
14. KDIGO Life Cycle of Guideline Development Series Part 2: From Initiation to Publication: the KDIGO Guideline Development Process	guideline methods	交代 KDIGO 從立項、工作範圍、工作組、公開審查到出版的治理流程，重點是透明度、利益衝突與可追溯決策。僅依摘要評論。
15. KDIGO Life Cycle of Guideline Development Series– Part 4: Translating Evidence into KDIGO Guideline Statements	guideline methods	說明 KDIGO 如何以 adapted GRADE EtD 把證據轉為方向與強度兼具的 statements，並納入效益、傷害、價值、資源與落地性。僅依摘要評論。
16. KDIGO Life Cycle of Guideline Development Series– Part 3: Evidence synthesis for Guideline Development: The KDIGO Approach	guideline methods	聚焦 key questions、outcome prioritization、文獻辨識與 GRADE evidence synthesis，提醒 evidence certainty 與 recommendation strength 並非同義。僅依摘要評論。
17. Kidney Disease: Improving Global Outcomes (KDIGO) life cycle of guideline development series: part 1: introduction to a new series	methods review	作為系列導論，定位 KDIGO 在全球腎臟健康與標準化照護中的角色，也說明為何需要公開 guideline life cycle。僅依摘要評論。
21. The kidney in the middle: KDIGO guidelines address multiple key components of cardiovascular-kidney-metabolic syndrome	narrative review	以 CKM syndrome 為框架，整合 obesity、diabetes、hypertension、dyslipidemia、CVD 與 CKD，強調跨科風險辨識與共同治療目標。僅依摘要評論。
45. Advances in survival analyses: machine learning methods and model comparison	methods	延伸傳統 survival analysis 至 machine-learning prediction 與 model comparison，並附 R code；讀者應分開評估 discrimination、calibration 與臨床效用。僅依摘要評論。
59. Kidney cancer screening: novel concepts beyond population-level screening	narrative review	不主張全民 kidney cancer screening，而比較 high-risk populations、與其他腹部疾病共篩及混合策略，以提高盛行率並改善成本效益。僅依摘要評論。
68. Complement inhibitors and B cell–modifying agents for IgA nephropathy—a Kidney Disease: Improving Global Outcomes (KDIGO) commentary	guideline commentary	回應 2025 IgAN guideline 更新，將 complement inhibitors 與 B-cell–modifying agents 放入快速變動的治療版圖；重點是適應症與證據成熟度。僅依摘要評論。
72. Unique aspects of acute kidney injury associated with infections in the tropics: presentation, challenges, and opportunities	narrative review	整理 tropical infection–associated AKI 的病原、volume depletion、shock 與 immune mechanisms，並把診斷延遲、資源限制及 surveillance 不足視為可介入問題。僅依摘要評論。
88. Green dialysis: environmentally sustainable care, growth, and innovation: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference	consensus	KDIGO green dialysis 共識把 water、energy、consumables、transport 與 equipment life cycle 納入品質指標，倡議在不犧牲安全下系統減碳。僅依摘要評論。

臨床研究、試驗與研究短報

文章	類型／取得性	導讀重點
2. A cluster randomized controlled trial (GOAL trial) evaluated a comprehensive geriatric assessment for frail older people with chronic kidney disease	cluster RCT	評估 outpatient CGA 能否改善 frail older adults with CKD 的 patient-centered goal attainment；摘要未提供效應量，暫不能判定 benefit 或 neutral。僅依摘要評論。
3. Quantitative Serological Detection of NELL1 Autoantibodies in Membranous Nephropathy	diagnostic method	開發 anti-NELL1 quantitative serology，目標減少對 biopsy staining 或 mass spectrometry 的依賴；摘要也提醒 ELISA specificity 可能不足以單獨確診。僅依摘要評論。
5. A pilot study of magnetic resonance fingerprinting and radiomics analysis in autosomal dominant polycystic kidney disease	pilot imaging	以 MRF 的 quantitative $T_1/T_2$ maps 搭配 radiomics，比較腎功能正常的年輕 ADPKD 與健康者，探索早期結構性 phenotype。僅依摘要評論。
6. Genome-Wide Association Study of Creatinine Clearance Identifies New Loci for Kidney Function	GWAS	改用 creatinine clearance 做 GWAS，以降低 muscle mass 對 eGFRcrea 的偏差，並探索 kidney function 的 sex dimorphism；結果細節未呈現。僅依摘要評論。
8. Respiratory syncytial virus vaccination induces delayed but robust humoral and cellular immunity in patients receiving hemodialysis	immunogenicity	聚焦 hemodialysis 患者接種 RSV vaccine 後的 humoral 與 cellular immunity；標題指向反應延遲但強健，仍需結果數據判讀持續性。僅依摘要評論。
10. Real-world outcomes of pegcetacoplan treatment in C3 glomerulopathy and immune-complex membranoproliferative glomerulonephritis	real-world	提供 pegcetacoplan 用於 C3G 與 IC-MPGN 的 real-world 經驗；摘要未交代樣本、蛋白尿或 eGFR 變化，宜視為早期訊號。僅依摘要評論。
22. Optimizing risk-benefit in highly sensitized kidney recipient antigen delisting increasing donor access	research letter	以 automated HLA antigen delisting 擴大 highly sensitized candidates 的 donor access，核心是可接受風險界線與中心間標準化。僅依摘要評論。
28. Distinct proteomic signatures of urinary extracellular vesicles link to albuminuria and treatment responses in diabetic kidney disease	biomarker study	分析 DKD 的 urinary extracellular vesicle proteome，區分 albuminuria 與 antialbuminuric therapy 造成的 signatures，具 biomarker 與 mechanism 雙重用途。僅依摘要評論。
50. Insights from the BLISS-LN Phase 3 study of biomarker associations with kidney response to belimumab in lupus nephritis	biomarker study	BLISS-LN biomarker analysis 比較 belimumab 與 placebo 下的 biomarker trajectories，並尋找 kidney response predictors；摘要未提供可直接用於選藥的 cutoff。僅依摘要評論。
55. Independent association between acute kidney injury and kidney function trajectory	observational	試圖更嚴格控制 baseline differences，檢驗 mild–moderate AKI 與後續 eGFR trajectory 的獨立 association；不可把 association 直接解讀為因果。僅依摘要評論。
63. Genetic testing in kidney transplantation and living kidney donor risk assessment	genetic study	在 cause unknown 的 recipients 與 living donors 進行 genetic testing，評估 diagnostic yield 與 donor risk stratification；臨床重點是 pretest phenotype 與家族解釋。僅依摘要評論。

基礎與轉譯研究

文章	類型／取得性	導讀重點
1. Non-invasive quantitative assessment of kidney injury using near-infrared autofluorescence imaging	preclinical	探索 near-infrared autofluorescence imaging 作為 non-invasive quantitative readout，以追蹤 tubular epithelial injury 與 fibrosis；目前仍屬量測技術與轉譯驗證階段。僅依摘要評論。
4. Genome-wide Screen Identifies Peroxisomal Role in APOL1 Podocytopathy	mechanistic	以 genome-wide screen 連結 APOL1 risk variants、inflammation/hypoxia 與 peroxisomal biology，提出 podocyte injury 的新節點。僅依摘要評論。
9. The role of platelet-derived growth factor in uremic vascular calcification	mechanistic	檢驗 PDGF/PDGFR-β 是否驅動 uremic vascular calcification 中的 VSMC phenotypic switch，可能連結 CKD-MBD 與血管重塑。僅依摘要評論。
11. Strategic timing of contralateral nephrectomy after ischemic acute kidney injury prevents chronic kidney disease by enhancing progenitor proliferation, attenuating polyploidization and reshaping the immune response	animal model	利用 unilateral ischemic AKI 後 contralateral nephrectomy 模型，解析 timing、progenitor proliferation、polyploidization 與 immune remodeling；不可直接外推臨床 nephrectomy。僅依摘要評論。
24. Nociceptive sensory nerves induce an IL4Rαhi anti-inflammatory macrophage subset that protects against kidney ischemia-reperfusion injury	mechanistic	提出 TRPV1+ nociceptive nerves–macrophage neuroimmune axis，可誘導 IL4Rαhi anti-inflammatory macrophages 以減輕 ischemia-reperfusion injury。僅依摘要評論。
25. Effectiveness and mechanistic effects of green mamba peptide MQ232 in an orthologous mouse model of autosomal dominant polycystic kidney disease	animal model	在 orthologous ADPKD mouse model 評估 green mamba–derived V2R inverse agonist MQ232，並與 tolvaptan 的 signaling effects 作機轉區辨。僅依摘要評論。
26. Therapeutic efficacy and antigenicity of a novel PEGylated IgA protease in preclinical models of IgA nephropathy	preclinical	PEGylated IgA protease 直接清除 glomerular IgA deposits，概念上不同於抑制 IgA production 或 downstream inflammation；仍是 preclinical。僅依摘要評論。
27. Role of the post-translational ISGylation of interferon regulatory factor 9 in diabetes-induced podocyte injury	mechanistic	由 single-cell regulatory network 找到 podocyte IRF9 activity 上升，進一步檢驗 ISGylation 在 diabetes-induced injury 的作用。僅依摘要評論。
29. SERCA2 deficiency in tubular epithelial cells drives ferroptosis in acute kidney injury regulating endoplasmic reticulum mitochondrial calcium homeostasis via voltage dependent anion channel 1 oligomerization	mechanistic	聚焦 SERCA2 deficiency、ER–mitochondrial calcium transfer、VDAC1 oligomerization 與 ferroptosis，建立 tubular AKI 的 calcium–lipid peroxidation 軸。僅依摘要評論。
30. Mitochondrial respiratory capacity in kidney podocytes is high, age-dependent, and sexually dimorphic	methods study	以避免 podocyte dissociation artifact 的新策略量測 mitochondrial respiration，並檢視 age 與 sex dimorphism；方法本身是重要貢獻。僅依摘要評論。
48. A MEF2C transcription factor network regulates proliferation of glomerular endothelial cells in diabetic kidney disease	OA · translational	以 $132$ 份 human kidney specimens 和多種 spatial/single-cell platforms 定義 DKD proliferative endothelial cell niche；MEF2C activity 與 neovascularization、nodular sclerosis 相關，SGLT2i exposure 則與 signature 回復相關。
49. Estrogen protects female mice with chronic kidney disease from fibroblast growth factor 23-induced left ventricular hypertrophy	OA · animal model	在 progressive CKD mouse model 中，female mice 即使較早出現 FGF23 excess 仍未形成 LVH；estradiol 抑制 calcineurin/NFAT hypertrophic signaling，ovariectomy 則解除保護。
51. The calcimimetic etelcalcetide restores cardiac function in chronic hyperphosphatemia via calcium sensing receptor–cAMP activation	animal model	檢驗 etelcalcetide 在 chronic hyperphosphatemia 下是否經 CaSR–cAMP signaling 改善 cardiac function，提供 calcimimetic 可能的 extra-parathyroid mechanism。僅依摘要評論。
52. Reversal of advanced diabetic kidney disease in mice treated with a monoclonal anti-VEGFR1 antibody	animal model	在 advanced mouse DKD 比較 VEGF-A、VEGFR1 與 VEGFR2 targeting；摘要只交代問題，結果需搭配同期 commentary 理解 receptor-specific effects。僅依摘要評論。
54. Roles of WNK1 and mTORC2 in aldosterone-independent regulation of potassium secretion in the distal nephron	mechanistic	在 mouse distal nephron 解析 WNK1 與 mTORC2 對 aldosterone-independent potassium secretion 的作用，修正『鉀排泄主要由 aldosterone 決定』的簡化模型。僅依摘要評論。
56. Intragraft clonal expansion of cytotoxic CD8+ and CD4+ T cells in antibody-mediated kidney transplant rejection	translational	以 intragraft T-cell clonality 檢視 AMR，挑戰 antibody-versus-T-cell 二分法，並關注 cytotoxic CD8+ 與 CD4+ clones 的協同角色。僅依摘要評論。
62. Absence of glomerular IgA1 deposition despite overexpression of galactose-deficient IgA1 in the B cell c1galt1 knockout mouse	animal model	B-cell C1galt1 knockout 雖提高 Gd-IgA1，卻未出現 glomerular IgA1 deposition，支持 Gd-IgA1 alone 可能不足以完成 IgAN pathogenesis。僅依摘要評論。
71. Reduced podocyte stiffness is a feature of proteinuric kidney disease	mechanistic	把 podocyte stiffness 納入 proteinuric kidney disease 的 biomechanics，補足只看 signaling 與 morphology 的不足；能否成為 target 尚待驗證。僅依摘要評論。
73. N-propargylglycine restores survival by preventing calcium oxalate stone formation, tubular injury, and kidney dysfunction in a lethal mouse model of primary hyperoxaluria type 2	OA · animal model	在 lethal PH2 mouse model，oral N-PPG 抑制 HYPDH/PRODH2，降低 hyperoxaluria、阻止 CaOx stones 與 tubular injury，並把 $24$ 週 survival 恢復至 wild-type controls；仍需 human safety/PK。
75. Proteinase 3 drives murine diabetic kidney disease by mediating caspase-3-dependent apoptosis of podocytes	animal model	探討 myeloid serine protease PR3 是否經 caspase-3–dependent podocyte apoptosis 推動 murine DKD，連結 innate immunity 與 filtration barrier loss。僅依摘要評論。

Clinical Journey、病例、影像與診斷題

文章	類型／取得性	導讀重點
12. Bilateral Renal Fungal Balls in a Premature Infant	image case	premature infant 的 Candida sepsis 先後形成 bilateral obstructive fungal balls，提醒即使單側已引流，仍須 serial ultrasound 監測對側。僅依摘要評論。
13. The Calcified Cocoon: Obstructive Peritoneal Sclerosis in Peritoneal Dialysis	image case	長期 PD、反覆 peritonitis 與 fungal peritonitis 後出現 bowel obstruction，影像指向 calcified encapsulating peritoneal sclerosis；需及早區分一般 ileus。僅依摘要評論。
18. CUBN-AMN pathway loss in chronic benign proteinuria	case	嬰幼兒起 persistent isolated proteinuria，但 albumin 與 kidney function 長期正常，提示 CUBN-AMN pathway defect，而非一概視為 podocytopathy。僅依摘要評論。
19. From dysphagia to kidney disease: Alport syndrome with leiomyomatosis	case	progressive dysphagia 與多處 leiomyomatosis 合併 Alport phenotype，提醒遇食道或生殖泌尿 smooth-muscle lesions 時須考慮 syndromic kidney disease。僅依摘要評論。
20. Unmasking the great masquerader with mass spectrometry	case	full-house membranous pattern 被初判 class V lupus nephritis，但 serology 與常見 antigens 不支持；mass spectrometry 提供重新分類關鍵。僅依摘要評論。
32. Giant renal allograft aneurysm: late detection and embolization	image case	kidney-pancreas graft 後多年發現 $4.4\times3.4\,\mathrm{cm}$ intraparenchymal aneurysm，顯示 preserved graft function 不能排除高風險 vascular lesion。僅依摘要評論。
37. Giant polycystic horseshoe kidney removed at transplantation	image case	巨大 polycystic horseshoe kidney 造成 transplant space 問題，凸顯 native nephrectomy timing 需依 symptoms、anatomy 與 graft placement 個別決策。僅依摘要評論。
38. IFT140 ADPKD with dominant hepatic cystic disease	image case	IFT140-associated ADPKD 可呈 hepatic cyst–dominant phenotype 且 kidney function 保留，提醒 phenotype 不典型時 genetics 能修正 family counseling。僅依摘要評論。
40. Renal actinomycosis from an intrarenal toothpick	image case	反覆 renal abscess、hydronephrosis 與 antibiotics failure 最終指向 intrarenal foreign body 與 actinomycosis；慢性感染須追問穿透性異物。僅依摘要評論。
41. Angioinvasive renal aspergillosis with calcium oxalate deposits	image case	immunocompetent patient 仍可發生 angioinvasive renal aspergillosis；calcium oxalate deposits 可成 pathologic clue，勿因免疫狀態低估 invasive fungus。僅依摘要評論。
42. Bilateral staghorn calculi in primary hyperoxaluria type 1	image case	childhood-onset recurrent stones、bilateral staghorn calculi 與 impaired kidney function 應優先考慮 primary hyperoxaluria，而非反覆單純 lithotripsy。僅依摘要評論。
43. Obstructive renal Candida fungus balls in an SGLT2-inhibitor user	image case	SGLT2 inhibitor–associated glucosuria 背景下出現 obstructive Candida fungal balls，提醒反覆 UTI、obstruction 或 AKI 時需 imaging，而非只停藥。僅依摘要評論。
44. A patient with aortic dilation and polycystic kidney disease	case	young adult type A aortic dissection 合併 bicuspid valve 與 previously unrecognized polycystic kidneys，提示 syndromic/genetic evaluation 不能只聚焦 ADPKD。僅依摘要評論。
46. Pegcetacoplan prophylaxis for recurrent C3 glomerulopathy with multifactorial genetic background	case	嬰兒期 C3G、低 C3 與 multifactorial genetic background，案例探討 transplant recurrence 前使用 pegcetacoplan prophylaxis 的風險管理。僅依摘要評論。
47. Urinary chloride unlocks the mechanism of hyponatremic seizures	case	recurrent hypovolemic hyponatremic seizures 與 profuse sweating 情境下，urinary chloride 有助區分 renal 與 extrarenal salt loss，避免只看 urine sodium。僅依摘要評論。
69. A missense mutation in the SAA1 protein causing hereditary amyloid A amyloidosis	case	AA amyloidosis 卻無 systemic inflammation 且 serum SAA undetectable，促使進行 SAA1 sequencing；hereditary AA amyloidosis 可模仿 acquired disease。僅依摘要評論。
74. Perrault syndrome unmasked: genomic reclassification of a Fabry-like CKDx phenotype	case	hearing loss、ovarian failure、lactic acidosis 與 CKDx 曾被當 Fabry-like phenotype，genomic reclassification 指向 Perrault syndrome，強調 phenotype-first 但不止於單一診斷。僅依摘要評論。
76. Extramedullary plasmacytoma with renal involvement	image case	multiple myeloma 病史合併 gross hematuria 與 severe AKI，需考慮 extramedullary plasmacytoma 的 renal involvement，而非只歸因 cast nephropathy。僅依摘要評論。
77. Giant ureteral calculus from congenital distal ureteral stenosis	image case	兒童反覆腹痛多年、lower ureter giant calculus 合併 congenital distal stenosis，顯示 persistent unilateral symptoms 應及早做 urinary tract imaging。僅依摘要評論。
78. Disappearing glomeruli: loss of linear IgG in anti-GBM nephritis	image case	anti-GBM nephritis 在 advanced destructive lesions 可見 linear IgG signal 消失，提醒 negative/weak immunofluorescence 不一定排除既往 anti-GBM injury。僅依摘要評論。
79. Diffuse marrow FDG uptake revealing lymphoma-associated hypercalcemia	image case	severe hypercalcemia 與 AKI 需要 dialysis 時，diffuse marrow FDG uptake 可引導至 lymphoma-associated mechanism；勿只停在 PTH-independent classification。僅依摘要評論。
80. Hypertension from UPJ obstruction by crossing renal vessel	image case	adolescent hypertension、unilateral hydronephrosis 與 preserved cortex 最終連結 crossing vessel–related UPJ obstruction，提示 obstructive causes 可無尿液異常。僅依摘要評論。
81. Migrating peritoneal dialysis catheter into an inguinal hernia	OA · image case	PD cycler data 先偵測 lost dwell 與 drainage alarms，影像證實 catheter migrated into recurrent inguinal hernia；突然 flow failure 且 laxative/heparin 無效時應查 mechanical cause。
82. Renal hemosiderosis in paroxysmal nocturnal hemoglobinuria	image case	PNH chronic intravascular hemolysis 可造成 tubular hemosiderin deposition，即使 creatinine 正常仍有 proteinuria/hematuria；Prussian blue 是關鍵線索。僅依摘要評論。
83. Empagliflozin-associated Armanni-Ebstein lesions in IgA nephropathy	image case	nondiabetic IgAN patient 使用 empagliflozin 後出現 persistent glucosuria 與 Armanni-Ebstein lesions，提醒 histology 可反映 pharmacologic glycosuria 而非 uncontrolled diabetes。僅依摘要評論。
84. When autosomal dominant polycystic kidney disease becomes atypical: aADPKD	image case	高度 asymmetric cyst burden、無 liver cysts 且 family history 不典型時，應進一步做 phenotype 與 genetic clarification，而非硬套典型 ADPKD prognosis。僅依摘要評論。
85. Light chain crystalline podocytopathy and tubulopathy	image case	low-grade proteinuria 主要由 free κ light chain 而非 albumin 構成，biopsy 顯 crystalline podocytopathy/tubulopathy；protein composition 可先提示 MGRS。僅依摘要評論。
86. Genitourinary tuberculosis in lupus nephritis	image case	lupus nephritis patient 有 sterile pyuria、frequency 與 cloudy urine 時，genitourinary tuberculosis 應納入鑑別；immunosuppression 會改變 pretest probability。僅依摘要評論。
102. The Case / Relapsing nephrotic syndrome	Q&A	minimal change disease 近 $6$ 年 remission 後 abrupt nephrotic relapse，伴 pyuria/hematuria；診斷題重點是重查 trigger、secondary cause 與 repeat biopsy 必要性。僅依摘要評論。

社論、評論、Digest、人文與期刊資訊

文章	類型／取得性	導讀重點
34. Estradiol protects kidney tubules against ferroptosis	commentary	以 sex differences 解析 estradiol、ferroptosis 與 tubular susceptibility，提醒 animal findings 與 human observational signals 並不完全一致。僅依摘要評論。
36. In memoriam: Raymond Ardaillou (1930–2026)	humanities	追念 Raymond Ardaillou 對 renal physiology、research mentorship 與 nephrology community 的長期貢獻；屬人物紀念而非臨床證據。僅依摘要評論。
39. In memoriam: Lise Bankir (1942–2026)	humanities	追念 Lise Bankir 在 urine concentration、renal physiology 與臨床腎臟學的影響，也呈現其 mentorship 與學術倫理傳承。僅依摘要評論。
57. Kidney International introduces new article type: Clinical Journey in Translational Medicine	editorial	介紹 Clinical Journey in Translational Medicine：以 case 為起點，連結 diagnostic reasoning、genetics、pathology、biomarkers 與 mechanism。僅依摘要評論。
58. Perivascular fat, hypertension, and cardiovascular disease	commentary	強調 perivascular adipose tissue 的質地與部位比 total fat mass 更影響 vascular tone、hypertension 與 CKM risk。僅依摘要評論。
60. Kidney xenotransplantation at a clinical inflection point	commentary	評述 kidney xenotransplantation 從 experimental proof 走向 clinical deployment 的轉折，核心仍是 immunologic safety、infection surveillance 與 ethics。僅依摘要評論。
65. Autoimmunoglobulin-triggered extracellular vesicles as new players in membranous nephropathy: friends or foes?	commentary	探討 autoantibody–immune complex 觸發的 extracellular vesicles 在 MN 中可能既傳遞 injury signals，也參與 antigen/complex handling。僅依摘要評論。
67. Finding the etiology of membranoproliferative glomerulonephritis	editorial	以 immunofluorescence 先區分 IC-MPGN 與 C3 glomerulopathy，再追 infection、autoimmunity 與 monoclonal gammopathy；形態只是起點。僅依摘要評論。
70. The thirsty kidney: genomic adaptation to heat and aridity	commentary	以 East African pastoralist populations 為例，討論 heat/aridity 下的 genomic adaptation 與 renal water conservation；不宜把群體適應簡化成個體臨床優勢。僅依摘要評論。
87. Intercalated cell subtype identity is controlled by reciprocal suppression of transcription factors	commentary	整理 collecting duct α/β intercalated cell identity 的 reciprocal transcription-factor suppression，連結 acid-base transport 與 cell-fate plasticity。僅依摘要評論。
89. Neglected no longer: lymphatic vessels in the rejecting allograft	commentary	將 rejecting allograft 的 lymphatic vessels 納入 mixed rejection microenvironment，提醒 late graft loss 不是單一 antibody 或 T-cell pathway。僅依摘要評論。
90. Phenotype first: a data-driven approach to genetic penetrance	commentary	主張以 phenotype-first、population-scale data 重新估計 genetic penetrance，避免只依 variant label 推論疾病必然發生。僅依摘要評論。
91. Proteogenomic dissection of kidney disease and cardiovascular-kidney-metabolic syndrome	commentary	以 proteogenomics 串聯 kidney disease 與 CKM syndrome，目的在找 shared pathways、causal candidates 與可分層 biomarkers。僅依摘要評論。
92. Hybrid CARs: rewiring macrophage signaling for targeted therapy in acute and chronic kidney inflammation	commentary	評述 hybrid CAR macrophages 在 acute/chronic kidney inflammation 的 targeted therapy 潛力；重要問題是 antigen specificity、persistence 與 off-target injury。僅依摘要評論。
93. Table of Contents	front matter	本期內容索引，功能是核對欄目、頁序與文章配置；不含可供臨床或研究推論的摘要內容。僅依欄目資訊評論。
94. Subscription Information	front matter	訂閱與取得方式說明，屬期刊服務資訊，不提供研究問題、方法或結果，不能作為證據來源。僅依欄目資訊評論。
95. Editorial Board	front matter	編輯委員名單反映期刊治理與學術審查架構，但不含研究內容或可評讀的臨床主張。僅依欄目資訊評論。
96. journal club	journal club	Journal Club 僅列 Tur 等人於 2025 年的選讀文獻，未附摘要或評析，故無法判斷研究設計與臨床結論。僅依欄目資訊評論。
97. in this issue	news	本期精選指出 VEGFR1 blockade 在多個 mouse DKD models 改善 albuminuria 與 histology，而 VEGF-A/VEGFR2 inhibition 反而惡化。僅依摘要評論。
98. What does it mean to win? Interpreting hierarchical kidney outcomes in hypertension trials	commentary	提醒 hierarchical kidney outcome 的 win statistic 在 severe events 稀少時，多由 eGFR slope 決定；因此『贏』不等於減少 kidney failure。僅依摘要評論。
99. A potential role for effector T cells with Fc receptors in kidney transplant antibody-mediated rejection	commentary	評論 AMR 中 clonally expanded Fc receptor–bearing effector T cells 的可能角色，補充 NK-cell–centric model，並支持 mixed effector framework。僅依摘要評論。
100. Resolving the VEGF paradox in DKD: VEGFR1 blockade shows promising renoprotection	commentary	解析 DKD 的 VEGF paradox：pan-VEGF-A 或 VEGFR2 blockade 可能有害，selective VEGFR1 blockade 則在 advanced models 顯示 renoprotection。僅依摘要評論。
101. Asymptomatic serologic reactivation in patients with lupus nephritis in clinical remission: to treat or not to treat?	commentary	把 pre-emptive escalation RCT 放回現行 watchful waiting context，強調 flare prevention benefit 必須與 steroid/immunosuppression toxicity 同時衡量。僅依摘要評論。

臨床可帶走的 10 點

lupus nephritis 處於 clinical remission 但 serology 持續再活化時，不再只有『一律觀察』這個選項；先確認感染、adherence、trend 與毒性，再做個別化 pre-emptive escalation。
diabetes 不等於 diabetic nephropathy。AKI、acute nephritic syndrome、hematuria、proteinuria pattern 不典型或 course 不合預期時，kidney biopsy 的 diagnostic yield 可能足以改變治療。
hierarchical composite endpoint 必須拆解各層貢獻；當 win statistic 主要由 eGFR slope 決定，不能把結果等同 kidney failure risk。
neonatal AKI 是 silent disease；prematurity、HIE、NEC、cardiac surgery、sepsis 與 nephrotoxin exposure 應觸發 protocolized SCr/UOP monitoring，而非等 creatinine 明顯上升。
B-cell therapy 不能以 drug class 一概而論。anti-CD20、BAFF/APRIL inhibition 與 anti-CD38 的 target、disease fit、感染風險和 monitoring 都不同。
tubulointerstitial pathology 是 pattern，不是 etiology。藥物、感染、自體免疫、monoclonal protein、遺傳與 mimics 必須依 exposure、laboratory 與 pathology 共同歸因。
anti-GBM disease 的診斷門檻要低、治療節奏要快；非典型 phenotype 或不完整檢驗組合不能成為延遲 biopsy／confirmatory testing 的理由。
SGLT2 inhibitor 使用者若有 fungal UTI、obstruction 或 AKI，應主動做 imaging；但罕見 fungal ball 或 histologic glucosuria lesion 不應被誤讀為否定其整體 cardio-renal benefit。
transplant rejection 越來越像 mixed immune ecosystem：antibody、NK cells、clonally expanded effector T cells 與 lymphatics 可能同時參與，單一分類未必涵蓋全部 biology。
genetic testing 的價值在 phenotype refinement、living donor safety 與 family counseling；variant label 本身不等於 penetrance，也不應脫離 clinical context 解讀。

完整文章連結（按文章類型分組）

期刊資訊

Table of Contents — front matter
Subscription Information — front matter
Editorial Board — front matter

本期主軸

必讀導讀

A prospective multicenter randomized controlled trial pre-emptive increase in immunosuppression for asymptomatic serological reactivation in patients with lupus nephritis in clinical remission — OA · RCT

Clinical and histologic predictors of non-diabetic kidney disease in patients with diabetes mellitus — OA · observational

Individual participant-level analysis of four randomized clinical trials examined therapeutic effects of blood pressure lowering on hierarchical kidney outcome using win statistics — OA · IPD analysis

Neonatal acute kidney injury: diagnosis, recognition, and prevention — OA · narrative review

A post hoc analysis of BLISS-LN found Belimumab plus mycophenolate mofetil improves kidney outcomes versus placebo plus mycophenolate mofetil in active lupus nephritis — post hoc

Targeting B cells in immune-mediated kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference — consensus

Tubulointerstitial diseases: an updated framework for diverse and emerging entities — narrative review

Anti–glomerular basement membrane disease: variant forms and underlying mechanisms — narrative review

指南／綜論／方法學與其他文章逐篇導讀

指南／綜論／方法學

臨床研究、試驗與研究短報

基礎與轉譯研究

Clinical Journey、病例、影像與診斷題

社論、評論、Digest、人文與期刊資訊

臨床可帶走的 10 點

完整文章連結（按文章類型分組）

臨床試驗、臨床研究、研究短報與診斷方法

指南、共識、綜論與方法學

基礎與轉譯研究

Clinical Journey、病例、影像與診斷題

社論、評論、Digest、Journal Club、新聞與人文

期刊資訊