Nephrology

Kidney involvement in AAV confers high ESKD risk; higher early eGFR predicts lower ESKD incidence

In a systematic review of 49 studies (19,301 patients) with AAV and kidney involvement, pooled ESKD incidence was 14.2% at 1 year and 24.8% at 10 years. Higher eGFR at diagnosis was associated with a 5–6% lower ESKD risk per 1 mL/min/1.73 m2 increase. Higher eGFR at 6 months was associated with a 7–8% lower ESKD risk per 1 mL/min/1.73 m2 increase. Substantial heterogeneity across studies limits precision of pooled estimates and individual prognostication. 1

APOL1 high‑risk genotypes linked to greater risk of postdonation eGFR <45 in Black living donors

In a retrospective US cohort of 653 living donors (445 Black), 68 Black donors had APOL1 high‑risk genotypes and were followed a median 18.5 years after donation. Overall, 7.0% had eGFR <45; Black donors with APOL1 high‑risk genotypes had unadjusted RR 2.31 for eGFR <45 versus other Black donors. After adjustment for predonation eGFR the relative risk attenuated to 1.91 (P = .09), reflecting imprecision in adjusted estimates. Results support APOL1 genotyping for Black donor candidates to improve individualized risk counselling. 2

LLM‑assisted decision support in Kenyan primary care was safe but did not lower short‑term treatment failures

In a pragmatic cluster RCT of 16 Kenyan clinics (9,691 patients), LLM assistance did not significantly reduce 14‑day treatment failure (2.2% vs 2.0%). Adjusted odds ratio for treatment failure was 0.77 (95% CI 0.55–1.08; P = 0.13), suggesting any benefit is likely modest. No serious adverse events were attributed to the intervention and independent review found no safety signal. Applicability is greatest to low‑resource primary care settings; results do not address specialty nephrology workflows. 3