Staff Publication

Epidemiology of metatarsal fractures in Shropshire 2020-2023 (2025)

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Type of publication:

Journal article

Author(s):

*Garton, Mark; *Rowlands, Jenni; *Roach, Richard.

Citation:

Archives of Osteoporosis. 20(1):126, 2025 Sep 18

Abstract:

The epidemiology of metatarsal fractures remains poorly understood. We identified retrospectively all adults with >= 1 radiologically confirmed metatarsal fracture, over 3 years. Young men and women had similar fracture rates, but overall risks were significantly higher for women (RR 1.99, 95% CI 1.76-2.26), driven by age-related falls in male fracture incidence.

PURPOSE: Metatarsal fractures are clinically and economically important and may reflect trauma, insufficiency or fatigue. However, their epidemiology remains poorly understood. We evaluated radiologically confirmed metatarsal fractures identified within Shropshire over a 3-year period.

METHODS: Radiology reports were searched for all patients aged >= 18 years between 2020 and 2023, using the terms 'metatarsal' AND 'fracture', to identify patients with >= 1 confirmed metatarsal fracture. Age at fracture, sex, fracture description and mechanism were recorded, and population fracture rates estimated, using local census data.

RESULTS: A total of 1121 (758 female) individual patients aged 50.7 (18.9) years, fractured 1370 metatarsals, usually the fifth in isolation, with fewer individuals fracturing two, three or four metatarsals.
Fractures were located at the metatarsal base (59%), shaft (26%), neck (12%) or head (3%); were mostly oblique, transverse or comminuted; and were usually caused by low-energy inversion injuries or falls. Fracture rates per 100,000 were 105 for women aged 18-29 years, rising to 153 and 142 in the sixth and ninth decades, with comparative male rates of 102, 40 and 31. Overall, women had more metatarsal fractures than men (RR 1.99, 95% CI 1.76-2.26), the sex difference being highest for metatarsal head fractures (RR 2.98 95% CI 1.34-6.60) and lowest for shaft fractures (RR 1.67, 95% CI 1.32-2.12).

CONCLUSION: Most metatarsal fractures are isolated low-energy injuries of the fifth metatarsal. Overall, women suffer twice as many fractures as men, driven by sustained high fracture rates in older women and a steep age-related decline among men. The underlying reasons for this pronounced sex difference are unclear and require further study.

DOI: 10.1007/s11657-025-01603-7

Ultrasound shear wave elastography - a reliable protocol for the assessment of the stiffness of the supraspinatus tendon (2025)

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Type of publication:

Journal article

Author(s):

*Black, Martin; *Lumsden, Gordon; *Dodenhoff, Ron

Citation:

Shoulder And Elbow. 17585732251376351, 2025 Sep 15. [epub ahead of print]

Abstract:

Background: The continued evolution of shear wave elastography (SWE) in the measurement of supraspinatus tendon stiffness can assist in both rehabilitation and surgical monitoring with the potential to improve patient outcomes. It can provide non-invasive, quantitative data of elastic properties of tendons which are altered in the presence of pathological change. This study evaluates the inter- and intra-rater reliability of a standardised SWE assessment protocol of the supraspinatus
tendon.

Methods: Shear wave velocity (SWV, m/s) values of 52 healthy, asymptomatic supraspinatus tendons were recorded using SWE. Two raters scanned each tendon on two separate occasions, seven days apart, using a strict protocol.

Results: Intraclass correlation coefficient (ICC) for inter-rater reliability was 0.78. Intra-rater reliability was 0.81 for rater one and 0.89 for rater two, respectively. Minimal detectable change (MDC95) ranged between 1.28 and 1.82 m/s for intra- and inter-rater reliability. Mean SWV values (m/s) for rater one were 9.08 +/- 1.44 and 9.29 +/- 1.48; and for rater two 8.72 +/- 1.35 and 8.87 +/- 1.43, for trial one and two.

Conclusion: The results demonstrate reliable SWV measurements between and within raters in the supraspinatus tendon, providing normative values and a protocol which may be utilised clinically. Level of evidence: Level III Diagnostic Study.

DOI: 10.1177/17585732251376351

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Early Versus Delayed Diuretic Administration and Urine-Guided Strategies in Acute Decompensated Heart Failure: A Systematic Review of Clinical Outcomes (2025)

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Type of publication:

Systematic review

Author(s):

Muzammil, Rabeet; Mohammad, Ahmad; Hammad, Muhammad; Ahmed, Adeel; Hussain, Aadil; Rashid, Wardah; Yousaf, Rabia; Singla, Shivam; Singla, Bhavna; *Ekomwereren, Osatohanmwen; Asante Baadu, Francis; Irshad, Ahmad.

Citation:

Cureus. 17(8):e89408, 2025 Aug.

Abstract:

This systematic review explores the impact of diuretic timing and strategy on outcomes in patients with acute decompensated heart failure (ADHF). A total of seven studies were included, comprising randomized controlled trials (RCTs), pre-specified sub-analyses, and observational data. Early administration of intravenous loop diuretics, particularly within the first 60 to 90 minutes of hospital arrival, was generally associated with improved short-term outcomes, including reduced in-hospital and 30-day mortality. Furthermore, guided diuretic strategies using urine sodium or urinary biomarkers showed promise in enhancing decongestion efficiency and predicting therapeutic response, although long-term benefits remain uncertain. Despite some heterogeneity in study design, timing definitions, and outcome measures, this review underscores the clinical significance of prompt and tailored diuretic therapy. These findings highlight the need for timely intervention and more personalized management strategies in ADHF, while also identifying gaps for future large-scale trials.

DOI: 10.7759/cureus.89408

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Atypical Presentation of Varicella-Zoster Virus Encephalitis in an Elderly Immunocompetent Adult: Early Diagnosis and Positive Outcome Following Treatment (2025)

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Type of publication:

Journal article

Author(s):

*Adewoye, Oluwaseun G; Halim, Mohamed A; *Srinivasan, Meena; *Owolabi, Olasunkanmi H.

Citation:

Cureus. 17(7):e88535, 2025 Jul.

Abstract:

Varicella encephalitis following herpes zoster ophthalmicus (HZO) is a rare but serious complication that can occur due to the reactivation of the varicella-zoster virus (VZV). HZO involves the ophthalmic division of the trigeminal nerve, typically presenting with a dermatomal rash, and can lead to various ocular complications. In some cases, this reactivation can extend to the central nervous system, resulting in encephalitis, which can lead to significant morbidity and mortality, particularly in immunocompromised or elderly individuals. This report describes a case of VZV encephalitis complicating HZO in an elderly immunocompetent male who presented with altered mental status following an initial presentation of HZO in the absence of a dermatomal rash, with a tentative diagnosis of an acute ischemic stroke. Early diagnostic confirmation was achieved through cerebrospinal fluid analysis and polymerase chain reaction, which identified VZV central nervous system infection. The patient was administered intravenous acyclovir, leading to complete neurological recovery. This case underscores the necessity of including VZV encephalitis in the differential diagnosis of acute encephalopathy, even when typical dermatological signs are absent. Furthermore, it emphasizes the critical role of prompt antiviral therapy in ensuring favorable clinical outcomes. Additionally, this case illustrates that VZV encephalitis can mimic stroke-like symptoms, highlighting the potential for misdiagnosis and the importance of considering infectious etiologies in such presentations.

DOI: 10.7759/cureus.88535

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Practical Considerations in the Management of Frail Older People with Diabetes (2025)

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Type of publication:

Journal article

Author(s):

*Abdelhafiz, Dima; Abdelhafiz, Ahmed.

Citation:

Diseases. 13(8), 2025 Aug 06.

Abstract:

With increasing life expectancy, the number of older people living with comorbid diabetes and frailty is increasing. The development of frailty accelerates diabetes-related adverse outcomes. Frailty is a multidimensional syndrome with physical, mental and social aspects which is associated with increased risk of hypoglycaemia, dementia and hospitalisation. Therefore, regular screening for all aspects of frailty should be an integrated part of the care plans of older people with diabetes. In addition, every effort should be made for prevention, which includes adequate nutrition combined with regular resistance exercise training. In already frail older people with diabetes, metabolic targets should be relaxed and hypoglycaemic agents should be of low hypoglycaemic risk potential. Furthermore, the metabolic phenotype of frailty should be considered when choosing hypoglycaemic agents and determining targets. With increasing severity of frailty, proactive chronological plans of de-escalation, palliation and end-of-life care should be considered. These plans should be undertaken in a shared decision-making manner which involves patients and their families. This ensures that patients' views, wishes and preferences are in the heart of these plans.

DOI: 10.3390/diseases13080249

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Surgical Treatment of Wrist and Hand Deformity in Children with Cerebral Palsy (2025)

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Type of publication:

Journal article

Author(s):

*Patel, Ravi; *Khan, Muhammad Murtaza; *Gurukiran, Gurukiran; Carsi, Maria Belen; Singh, Rohit Amol.

Citation:

Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 92(4):210-217, 2025 Aug.

Abstract:

Cerebral palsy (CP) is a complex disorder resulting from injury to developing brain. It involves multimodal and multidisciplinary approach that involves various disciplines of medical science. The entire focus of this approach is to provide patients with this disorder the best quality of life. Although CP can affect both upper and lower limbs, the functional expectation of upper limb is much higher and complex. This implies particularly to hand and wrist based on complex functional movements expected of them. This puts orthopaedic surgeons in a unique position in managing these patients. It is worth mentioning here that it is not about offering them a surgical intervention the emphasis should lie on the entire process of selection, evaluation, and intervention. All these steps need to be considered very thoroughly so that the best outcome is achieved based on patients' expectation at present and keeping the future consideration in mind as well. This paper focuses only on children with hand and wrist deformity. Although children have a great healing potential, but they have high functional demand and longer-life expectancy in general so getting things right for the first time should be of paramount importance. This paper tries to address this issue by reviewing the literature to help orthopaedic surgeons in developing an algorithm in their mind when offering intervention. The consideration of inclusion and exclusion criteria along with review of literature has been considered with this background in mind. This paper primarily addresses the surgical aspect of disease and steps that are critical in this regard. Follow up planning, long-term outcome, rehabilitation planning, use of conservative treatment has not been considered in this review.

DOI: 10.55095/achot2025/011

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Is AI the Game-Changer for Polyp Detection in Colon Capsule Endoscopy? Insights from the CESCAIL Study (2025)

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Type of publication:

Conference abstract

Author(s):

Lei I.I.; Parisi I.; Bhandare A.; Perez F.P.; Lee T.; Shehkar C.; McStay M.; Anderson S.; Watson A.; Conlin A.; Badreldin R.; Malik K.; Jacob J.; Dixon A.; *Butterworth J.; Parson N.; Koulaouzidis A.; Robertson A.; Treceno P.; Arasaradnam R.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A9-A10), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Colon Capsule Endoscopy (CCE) provides a noninvasive alternative to colonoscopy for evaluating the lower gastrointestinal (LGI) tract. However, its widespread use has been limited by prolonged reading times and variability in diagnostic accuracy, often affected by factors such as bowel preparation quality and completion rates. In recent years, artificial intelligence (AI) has demonstrated potential in overcoming these limitations, particularly in small bowel CE, by enabling clinicians to achieve high diagnostic accuracy with significantly reduced reading times. The CESCAIL multi-centre study aims to evaluate a Computer-Aided Detection (CADe) system (AiSPEEDTM) to enhance polyp detection efficiency in CCE. Objective The primary aim is to assess AI-assisted CCE readings' diagnostic accuracy and non-inferiority in detecting polypoid lesions compared to standard readings using a per-patient analysis. The secondary objective focuses on mean reading time to evaluate the efficiency of each approach. Methods Patients aged 18 years or older, referred under urgent cancer or post-polypectomy surveillance pathway to one of the 14 CESCAIL participating centres across the UK, were prospectively enrolled in the study. Participants underwent CCE examinations, which were analysed using the AiSPEEDTM system, a convolutional neural network designed for automated polyp detection. Clinicians conducted initial manual readings, followed by AI-assisted readings, which involved an AI-automated first read, a review and annotation by a pre-reader, and a clinician assessment of selected images to create a report. Results Between February 2022 and September 2024, 673 patients were included in the final analysis. The overall completion rate was 77.1%, with adequate bowel preparation achieved in 78.1% of the standard pathway and 74.9% of the AI-assisted pathway (McNemar p=0.1). In the standard pathway, 403 patients (59.9%) required further investigation, including 243 (36.1%) colonoscopies and 138 (20.5%) flexible sigmoidoscopies. In the per-patient analysis, the diagnostic yield for polyp detection leading to a follow-up colonoscopy was 71.9% (484/673) for AI-assisted reading and 63.6% (428/ 673) for standard reading, confirming non-inferiority (p<0.0001). The diagnostic accuracy was 0.96 (95% CI: 0.95-0.98) for AI-assisted reading and 0.91 (95% CI: 0.89- 0.93) for standard reading (McNemar p<0.0001). The mean clinician reading time per video was 8.7 (SD=11.3) minutes for AI-assisted reading, compared to 47.3 (SD=24) minutes for standard reading, with a 5-fold reduction. Conclusion AI-assisted reading using AiSPEEDTM demonstrated significantly higher detection yield with improved diagnostic accuracy coupled with reduced reading time for polyp detection in CCE compared to standard clinician readings. These findings emphasise AI's potential to enhance efficiency and scalability in CCE, supporting its broader adoption for LGI investigations in clinical practice.

DOI: 10.1136/gutjnl-2025-BSG.14

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Decoding the Strength of AI-Assisted Reading in Colon Capsule Endoscopy: Factors Influencing Accuracy in Polyp Detection; CESCAIL Study's Interim Result (2025)

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Type of publication:

Oral presentation

Author(s):

Lei I.I.; Parisi I.; Bhandare A.; Perez F.P.; Lee T.; Shekhar C.; McStay M.; Anderson S.; Watson A.; Conlin A.; Badreldin R.; Malik K.; Jacob J.; Dixon A.; *Butterworth J.; Parsons N.; Robertson A.; Koulaouzidis A.; Arasaradnam R.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A48-A49), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Artificial Intelligence (AI) assisted reading in Small Bowel Capsule Endoscopy (SBCE) has recently been shown to achieve comparable and potentially superior accuracy compared to standard clinician reading. In Colon Capsule Endoscopy (CCE), AI algorithms have also demonstrated some promising results.1 However, the extent of AI-assisted reading's advantage remains unclear, particularly regarding its performance across different polyp sizes, morphologies, locations, and non-polyp-related factors. Understanding this is essential for optimising AI performance and clinical integration. Objective(s) This CESCAIL sub-analysis evaluates the per-polyp diagnostic accuracy of AI-assisted versus standard clinician reads (pathways) and identifies key factors influencing AIassisted accuracy using AiSPEEDTM. Methods A total of 1,803 polyps from 673 patients were analysed at the per-polyp level to assess diagnostic accuracy in terms of sensitivity and PPV, as well as the factors influencing the improved accuracy of AI-assisted readings compared to standard clinician readings. Factors examined included polyp size, morphology, location, patient demographics (age and sex), bowel preparation quality, capsule excretion rates, comorbidities, medications, reading time, and video duration. Statistical methods included, McNemar's test, superiority and noninferiority analyses, Generalised Estimating Equations, and generalized linear models with interaction terms, were employed to identify key predictors of enhanced diagnostic accuracy in both AI-assisted and standard readings. Results AI-assisted reading demonstrated significantly higher sensitivity with clear superiority for smaller polyps (<10 mm) compared to larger ones (>=10 mm) (OR 2.27 vs 0.88, p<0.0001). While there was no observed difference in diagnostic accuracy between pathways for polyps >=10 mm, noninferiority was established. AI accuracy remained consistent between polyps measuring 6-9 mm and <=5 mm (p=0.64). The most notable improvement was observed with hyperplastic polyps (OR 5.4, p<0.0001), particularly in the rectal region (OR 5.7, p<0.0001). No significant differences were identified for pedunculated, subpedunculated, LST, or SSL polyps. Furthermore, AI-assisted readings were significantly more accurate for left-sided polyps compared to right-sided ones (OR 2.36 vs 1.66, p<0.0001), although AI-assisted reads outperformed standard reads in both locations. Conclusion This study highlights the strengths of AI-assisted reading, particularly for detecting smaller adenomas and hyperplastic polyps, with notable accuracy in the left colon. Next-generation AI should focus on distinguishing significant from diminutive polyps and enhancing polyp characterisation, especially for right-sided lesions.

DOI: 10.1136/gutjnl-2025-BSG.72

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From Capsule to Scope: Predicting Colon Capsule Endoscopy Conversion to Optical Endoscopy - Insights from the CESCAIL Study (2025)

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Type of publication:

Poster presentation

Author(s):

Lei I.I.; Parisi I.; Bhandare A.; Perez F.; Lee T.; Shehkar C.; McStay M.; Anderson S.; Watson A.; Conlin A.; Badreldin R.; Malik K.; Jacob J.; Dixon A.; *Butterworth J.; Parsons N.; Koulaouzidis A.; Arasaradnam R.

Citation:

Gut. Conference: BSG Annual Meeting, BSG LIVE 2025. Glasgow United Kingdom. 74(Supplement 1) (pp A269-A270), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Colon capsule endoscopy (CCE) has emerged as a non-invasive alternative to traditional colonoscopy for low-risk patients. However, its adoption is limited by low completion rates and the inability to perform biopsies or polyp removal, often resulting in CCE-to-conventional colonoscopy conversion (CCC). This conversion carries financial implications, contributes to patient dissatisfaction due to repeated procedures, and imposes a potential environmental burden from increased hospital visits. Objective(s) The aim is to identify the factors that predict issues with bowel cleansing, capsule excretion rates, pathology detection, and the need for CCC. Methods In this prospective analysis of the CESCAIL study (November 2021-June 2024), 603 patients who underwent CCE were included. Predictive factors-including patient demographics, comorbidities, medications, and laboratory results-were analysed across symptomatic and surveillance groups. Statistical techniques such as LASSO regression, linear regression, and logistic regression were applied. Results Among the 603 participants analyzed, elevated f-Hb levels (OR=1.48, 95% CI: 1.18-1.86, p=0.0002) and smoking (OR=1.44, 95% CI: 1.01-2.11, p=0.047) were significantly associated with CCE-to-conventional colonoscopy conversion (CCC). However, an AUC of 0.62 after adjusting for confounders suggests f-Hb is a weak predictor of CCC. Diabetes was linked to poor bowel preparation (OR=0.40, 95% CI: 0.18-0.87, p=0.022). Alcohol use (p=0.004), smoking (p=0.003), and psychological conditions (p=0.001) were significantly associated with an increased polyp count, while haemoglobin levels (p=0.046) showed a marginal negative association with polyp numbers. Additionally, antidepressants (p=0.003) were associated with larger polyps, whereas betablockers (p=0.001) were linked to smaller polyps. Conclusion Non-smokers with lower f-Hb levels are less likely to require CCC. Effective patient selection criteria are essential for minimising conversion rates and improving the efficiency of CCE services. These findings highlight the need for validation across diver

DOI: 10.1136/gutjnl-2025-BSG.428

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Quantifying association of early proteinuria and estimated glomerular filtration rate changes with long-term kidney failure in C3 glomerulopathy and immune-complex membranoproliferative glomerulonephritis using the United Kingdom RaDaR Registry (2025)

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Type of publication:

Journal article

Author(s):

Downward L.; Proudfoot C.; Webb N.J.A.; Abat S.; Adalat S.; Agbonmwandolor J.; Ahmad Z.; Alejmi A.; Almasarwah R.; Annear N.; Araujo M.; Asgari E.; Ayers A.; Baharani J.; Balasubramaniam G.; Jo-Bamba Kpodo F.; Bailey L.; Bansal T.; Barratt A.; Barratt J.; Bates M.; Bayne N.; Bendle J.; Benyon S.; Bergmann C.; Bhandari S.; Bingham C.; Boddana P.; Bond S.; Braddon F.; Bramham K.; Branson A.; Brearey S.; Bridgett V.; Brocklebank V.; Budwal S.; Byrne C.; Cairns H.; Camilleri B.; Campbell G.; Capell A.; Carmody M.; Carson M.; Cathcart T.; Catley C.; Cesar K.; Chan M.; Chea H.; Chess J.; Cheung C.K.; Chick K.-J.; Chitalia N.; Christian M.; Chrysochou T.; Clark K.; Clayton C.; Clissold R.; Cockerill H.; Coelho J.; Colby E.; Colclough V.; Conway E.; Cook H.T.; Cook W.; Cooper T.; Coward R.J.; Crosbie S.; Cserep G.; Date A.; Davidson K.; Davies A.; Dhaun N.; Dhaygude A.; Diskin L.; Dixit A.; Doctolero E.A.; Dorey S.; Downard L.; Drayson M.; Dreyer G.; Dutt T.; Etuk K.; Evans D.; Finch J.; Flinter F.; Fotheringham J.; Francis L.; Gallagher H.; Game D.; Garcia E.L.; Gavrila M.; Gear S.; Geddes C.; Gilchrist M.; Gittus M.; Goggolidou P.; Goldsmith C.; Gooden P.; Goodlife A.; Goodwin P.; Grammatikopoulos T.; Gray B.; Griffith M.; Gumus S.; Gupta S.; Guzman R.; Hamilton P.; Hamrang-Yousefi S.; Harper L.; Harris T.; Haskell L.; Hayward S.; Hegde S.; Hendry B.; Hewins S.; Hewitson N.; Hillman K.; Hiremath M.; Howson A.; Htet Z.; Huish S.; Hull R.; Humphries A.; Hunt D.P.J.; Hunter K.; Hunter S.; Ijeomah-Orji M.; Inston N.; Jayne D.; Jenfa G.; Jenkins A.; Johnson S.; Jones C.A.; Jones C.; Jones A.; Jones R.; Kamesh L.; Kanigicherla D.; Frankl F.K.; Karim M.; Kaur A.; Kavanagh D.; Kearley K.; Kerecuk L.; Khwaja A.; King G.; Kislowska E.; Klata E.; Kokocinska M.; Koziell A.; Lambie M.; Lawless L.; Ledson T.; Lennon R.; Levine A.P.; Maggie Lai L.W.; Lipkin G.; Lovitt G.; Lyons P.; Mabillard H.; Mackintosh K.; Mahdi K.; Maher E.; Marchbank K.J.; Mark P.B.; Masoud S.; Masunda B.; Mavani Z.; Mayfair J.; McAdoo S.; Mckinnell J.; Melhem N.; Meyrick S.; Moochhala S.; Morgan P.; Morgan A.; Muhammad F.; Murray S.; Novobritskaya K.; Ong A.C.M.; Oni L.; Osmaston K.; Padmanabhan N.; Parkes S.; Patrick J.; Pattison J.; Paul R.; Percival R.; Perkins S.J.; Persu A.; Petchey W.G.; Pickering M.C.; Pinney J.; Pitcher D.; Plumb L.; Plummer Z.; Popoola J.; Post F.; Power A.; Pratt G.; Pusey C.; Pywell S.; Rabara R.; Rabuya M.; Raju T.; Javier C.; Roberts I.S.D.; Roufosse C.; Rumjon A.; Salama A.; Saleem M.; Sandford R.N.; *Sandu K.S.; Sarween N.; Sayer J.A.; Sebire N.; Selvaskandan H.; Shah S.; Sharma A.; Sharples E.J.; Sheerin N.; Shetty H.; Shroff R.; Simms R.; Sinha M.; Sinha S.; Smith K.; Smith L.; Srivastava S.; Steenkamp R.; Stott I.; Stroud K.; Swallow D.; Swift P.; Szklarzewicz J.; Tam F.; Tan K.; Taylor R.; Tischkowitz M.; Thomas K.; Tse Y.; Turnbull A.; Turner A.N.; Tyerman K.; Usher M.; Venkat-Raman G.; Walker A.; Walsh S.B.; Waters A.; Watt A.; Webster P.; Wechalekar A.; Welsh G.I.; West N.; Wheeler D.; Wiles K.; Willcocks L.; Williams A.; Williams E.; Williams K.; Wilson D.H.; Wilson P.D.; Winyard P.; Wong E.; Wong K.; Wood G.; Woodward E.; Woodward L.; Woolf A.; Wright D.; Wong E.K.S.; Gale D.P.

Citation:

Kidney International. 108(3) (pp 455-469), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Introduction: C3 glomerulopathy (C3G) and immune-complex membranoproliferative glomerulonephritis (IC-MPGN) are rare disorders that frequently result in kidney failure over the long-term. Presently, there are no disease-specific treatments approved for these disorders, although there is much interest in the therapeutic potential of complement inhibition. However, the limited duration and necessarily small size of controlled trials means there is a need to quantify how well short-term changes in estimated glomerular filtration rate (eGFR) and proteinuria predict the clinically important outcome of kidney failure. Method(s): We address this using longitudinal data from the UK Registry of Rare Kidney Diseases (RaDaR) involving retrospective and prospective data collection with linkage to hospital laboratories via automated feeds of 371 patients. Analyses of kidney survival were conducted using Kaplan-Meier and Cox regression with eGFR slope estimated using linear mixed models. Result(s): In a median of 11.0 (inter quartile range 7.4-15.1) years follow-up, 148 patients (40%) reached kidney failure. There was no significant difference in progression to kidney failure between C3G and IC-MPGN groups. Baseline urine protein-creatinine ratio (UPCR), although high, was not associated with kidney failure in either group. Two-year eGFR slope had a modest association with kidney failure. In contrast, both 20%-50% and 50 mg/mmol reductions in UPCR between 0-12 months were associated with lower kidney failure risk in both groups. Notably, those with a UPCR under 100 mg/mmol at 12 months had a substantially lower risk of kidney failure (hazard ratio 0.10 (95% confidence interval 0.03-0.30). Conclusion(s): Overall, proteinuria a short time after diagnosis is strongly associated with long-term outcomes and a UPCR under 100 mg/mmol at one year is associated with a substantially lower kidney failure risk.

DOI: 10.1016/j.kint.2025.06.003

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