Clinical and Experimental Nephrology最新文献

{"title":"Exploring factors associated with Kidney Disease Quality of Life in patients with advanced chronic kidney disease: the Reach-J CKD cohort study.","authors":"Hironori Nakamura, Reiko Okubo, Michiko Kumagai, Mariko Anayama, Yasushi Makino, Katsuhiko Tamura, Masaki Nagasawa, Hirokazu Okada, Shoichi Maruyama, Junichi Hoshino, Takashi Wada, Ichiei Narita, Kunihiro Yamagata","doi":"10.1007/s10157-025-02628-5","DOIUrl":"10.1007/s10157-025-02628-5","url":null,"abstract":"<p><strong>Background: </strong>Although several studies have examined the Kidney Disease Quality of Life (KDQOL) in patients with chronic kidney disease (CKD), the factors associated with kidney-related symptoms have not been fully explored.</p><p><strong>Methods: </strong>This nationwide multicenter cohort study enrolled 2248 patients. To identify the factors associated with each item or the three KDQOL domains, such as burden of kidney disease, symptoms/problems of kidney disease, and impact of kidney disease on daily life, multiple regression analysis was performed using baseline data.</p><p><strong>Results: </strong>The study population had a mean age of 69.1 ± 12.6 years, comprised 64.7% men, and had mean estimated glomerular filtration rate (eGFR) of 23.2 ± 10.4 mL/min/1.73 m². Mean serum creatinine levels were 1.4 ± 0.2, 2.3 ± 0.5, and 4.5 ± 1.5 mg/dL for G3b, G4, and G5, respectively. The mean scores in the three KDQOL domains among CKD stages showed significantly decreasing trends. Of all the 11 symptoms assessed, 6 had scores that significantly decreased as the CKD stage progressed and 9 had scores that significantly decreased as the age category group increased. Multiple regression analysis revealed eGFR as a significantly associated factor for 5 of 11 symptoms. Age, body mass index, and comorbidities were also detected as significant factors for some symptoms.</p><p><strong>Conclusions: </strong>In addition to eGFR, several factors were associated with symptoms in patients with CKD. Nephrologists need to recognize renal dysfunction-specific symptoms and explore other plausible causes of nonspecific symptoms.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"765-776"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of renal fibrosis using scanning acoustic microscopy.","authors":"Takane Ito, Hideki Kumagai, Takahiro Kanai, Jun Aoyagi, Yuko Ono, Katsutoshi Miura, Kazuto Kobayashi, Toshihiro Tajima, Hitoshi Osaka","doi":"10.1007/s10157-024-02621-4","DOIUrl":"10.1007/s10157-024-02621-4","url":null,"abstract":"<p><strong>Background: </strong>Renal fibrosis is strongly correlated with renal functional outcomes. Therefore, this is a significant finding in determining renal prognosis. There are various reports on the imaging evaluation of renal fibrosis, but these are not well established. Scanning acoustic microscopy (SAM) uses ultra-high-frequency ultrasound to visualize tissues in just over a minute. SAM can simultaneously measure acoustic data such as speed of sound (SOS). SOS indicates the elasticity (stiffness) of a material. In this study, we aimed to compare and evaluate SAM acoustic intensity images and SOS data with light microscopy images of renal lesions, especially renal fibrosis.</p><p><strong>Methods: </strong>Renal specimens containing fibrosis were selected. The acoustic intensity images were compared to PAS-stained images. SOS data of the tubulointerstitium were compared with Masson's trichrome (MT)-stained images. The blue intensity of MT staining, which indicates fibrosis, was numerically valued using image-processing software. Furthermore, the correlations between it and the SOS values were evaluated.</p><p><strong>Results: </strong>The acoustic intensity images suggested tubular atrophy and interstitial expansion in the same areas as in the PAS staining. SOS values of interstitial expansion with fibrosis were higher than normal area, interstitial expansion without fibrosis. A weak positive correlation was observed between the SOS values and the blue intensity of MT staining.</p><p><strong>Conclusions: </strong>SOS data can be used to evaluate renal fibrosis. The combination of SOS data and MT-stained images enables a more detailed evaluation of renal fibrosis. This study can contribute to the evaluation of renal fibrosis and has potential clinical applications in the future.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"720-733"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the incidence of proteinuria and changes in eGFR among febuxostat and topiroxostat users.","authors":"Shingo Nakayama, Michihiro Satoh, Maya Toyama, Hideaki Hashimoto, Takahisa Murakami, Takuo Hirose, Taku Obara, Takefumi Mori, Hirohito Metoki","doi":"10.1007/s10157-025-02630-x","DOIUrl":"10.1007/s10157-025-02630-x","url":null,"abstract":"<p><strong>Background: </strong>Febuxostat and topiroxostat are non-purine selective xanthine oxidoreductase inhibitors commonly used for hyperuricaemia treatment in Japan. However, comparative data on the effects of febuxostat and topiroxostat on renal function and proteinuria are limited. This study compared proteinuria incidence and changes in the estimated glomerular filtration rate (eGFR) among prevalent febuxostat and topiroxostat users.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using databases provided by DeSC Healthcare, Inc. (Tokyo, Japan). We identified 17,446 individuals (11.8% women; mean age 67.4 years) with eGFR ≥ 30 mL/min/1.73 m² and no history of cardiovascular disease or proteinuria at baseline. Separate analyses were performed for individuals with eGFR < 60 mL/min/1.73 m² and those with eGFR ≥ 60 mL/min/1.73 m². The adjusted hazard ratio (HR) for proteinuria incidence in topiroxostat users compared with febuxostat users was assessed using the Cox model. Changes in eGFR were compared between the two groups using multiple regression analysis.</p><p><strong>Results: </strong>During the mean follow-up period of 1.79 years, 1,433 participants developed proteinuria. In non-diabetic individuals with eGFR ≥ 60 mL/min/1.73 m², the adjusted HR for proteinuria incidence in topiroxostat users compared with febuxostat users was 0.60 (95% confidence interval, 0.40-0.91; p = 0.016). No significant differences were observed in eGFR changes between the two groups with eGFR < 60 and ≥ 60 mL/min/1.73 m².</p><p><strong>Conclusion: </strong>Topiroxostat prevalent users had a lower risk of proteinuria than febuxostat prevalent users in non-diabetic individuals with eGFR ≥ 60 mL/min/1.73 m². Our findings suggest that topiroxostat might be more effective than febuxostat in preventing proteinuria in non-diabetic individuals with eGFR ≥ 60 mL/min/1.73 m².</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"797-806"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between hemoglobin level and mortality in patients undergoing maintenance hemodialysis: a nationwide dialysis registry in Japan.","authors":"Takaaki Kosugi, Takeshi Hasegawa, Takahiro Imaizumi, Hiroki Nishiwaki, Hirokazu Honda, Yasuhiko Ito, Kazuhiko Tsuruya, Masanori Abe, Norio Hanafusa, Takahiro Kuragano","doi":"10.1007/s10157-025-02632-9","DOIUrl":"10.1007/s10157-025-02632-9","url":null,"abstract":"<p><strong>Background: </strong>The optimal hemoglobin (Hb) range in patients undergoing hemodialysis remains controversial. We aimed to investigate the association between Hb levels and mortality in patients undergoing hemodialysis and explore the potential factors modifying this association.</p><p><strong>Methods: </strong>This observational study utilized a nationwide database from the Japanese Renal Data Registry spanning from 2019 to 2021. This study included 265,779 patients undergoing hemodialysis thrice a week. The association between Hb levels and all-cause and cause-specific mortality was investigated using Cox regression analysis. The nonlinear relationship between Hb levels and outcomes was investigated using restricted cubic spline analysis.</p><p><strong>Results: </strong>During a median follow-up period of 24 months, 45,734 patients died. Compared to the reference Hb category of 10-10.9 g/dL, the risk of all-cause mortality was higher in the Hb categories of < 9.0, 9.0-9.9, and ≥ 13 g/dL with adjusted hazard ratios (95% confidence intervals) of 1.24 (1.20-1.29), 1.09 (1.06-1.12), and 1.19 (1.14-1.25), respectively. Restricted cubic spline analysis also showed a U-shaped relationship between Hb level and mortality. The subgroup analysis indicated that the Hb category of 12.0-12.9 g/dL was associated with increased mortality risk in patients with a dialysis vintage of ≥ 10 years and those with a history of cerebral infarction.</p><p><strong>Conclusion: </strong>Hb levels of < 10.0 and ≥ 13.0 g/dL were significantly associated with an increased mortality risk compared to an Hb level of 10.0-10.9 g/dL in patients undergoing hemodialysis.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"831-842"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glomerular diameter is associated with a reduction in urinary protein by treatment with dapagliflozin in patients with chronic kidney disease.","authors":"Arata Osanami, Hiroaki Komatsu, Yufu Gocho, Keitaro Nishizawa, Marenao Tanaka, Yuichi Nakamura, Masato Furuhashi","doi":"10.1007/s10157-025-02625-8","DOIUrl":"10.1007/s10157-025-02625-8","url":null,"abstract":"<p><strong>Background: </strong>Several clinical trials showed that sodium-glucose cotransporter 2 (SGLT2) inhibitors have protective effects against chronic kidney disease (CKD) in both patients with and those without type 2 diabetes mellitus. Since one of the renoprotective mechanisms of SGLT2 inhibitors is thought to be amelioration of glomerular hyperfiltration, we hypothesized that an enlarged glomerular diameter, which suggests increased single-nephron glomerular filtration rate, is associated with a reduction in urinary protein after treatment with an SGLT2 inhibitor.</p><p><strong>Methods: </strong>This study was a retrospective multicentered study including 28 adult patients with CKD who underwent kidney biopsy and were then treated with dapagliflozin, an SGLT2 inhibitor. The association of glomerular diameter with changes in urinary protein 4-8 weeks after the initiation of treatment with dapagliflozin was investigated.</p><p><strong>Results: </strong>Maximum glomerular diameter was significantly and positively correlated with change in urinary protein-to-creatinine ratio (UPCR) (R² = 0.44; P < 0.001). Maximum glomerular diameter was significantly larger in patients who achieved ≥ 30% reduction in UPCR after the initiation of treatment with dapagliflozin than in patients who achieved < 30% reduction in UPCR (219.4 ± 23.9 vs. 188.0 ± 29.0; P = 0.005). After adjustment of age, sex and estimated glomerular filtration rate, maximum glomerular diameter was independently associated with change in UPCR (β = 0.645, P < 0.001). Furthermore, maximum glomerular diameter was independently associated with ≥ 30% reduction in UPCR (odds ratio: 1.07, 95% confidential interval: 1.01-1.14).</p><p><strong>Conclusion: </strong>Glomerular diameter is independently associated with an early change in UPCR after the initiation of treatment with dapagliflozin in patients with CKD.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"777-787"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between estrogen and kidney function: population based evidence and mutual bidirectional Mendelian randomization study.","authors":"Shisheng Han, Guangliang Xie, Yi Wang","doi":"10.1007/s10157-024-02623-2","DOIUrl":"10.1007/s10157-024-02623-2","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have suggested a potential role of estrogen in the pathophysiology of chronic kidney disease (CKD); however, the association and causality between estrogen and kidney function remain unclear.</p><p><strong>Methods: </strong>The cross-sectional correlation between serum estradiol concentration and estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) was analyzed using data from the National Health and Nutrition Examination Survey 2013-2016. Causality was tested using mutual bidirectional Mendelian randomization (MR) approaches based on six large-scale GWAS studies. Weighted generalized multivariate linear regression was employed to estimate the association between estradiol and eGFR and ACR, and a restricted cubic spline analysis was utilized to investigate potential nonlinear relationships.</p><p><strong>Results: </strong>A total of 8932 participants were included. Serum estradiol concentration was positively associated with eGFR after adjusting for potential covariates (β, 0.76; 95% CI 0.24 to 1.27) and with ACR (β, 5.99; 95% CI 1.62 to 10.36). A nonlinear positive association was found between estradiol and eGFR, while an inverse \"V\"-shaped relationship was seen with ACR. Sensitivity analyses confirmed the stability of the relationship between estradiol and eGFR but indicated a less robust association with ACR. Stratified analysis showed that the association between estradiol and eGFR was particularly significant in populations with CKD and hypertension. All forward MR analyses demonstrated a positive causal relationship between estradiol and eGFR, but no causality was found between estradiol and ACR. No reverse causal association was observed.</p><p><strong>Conclusions: </strong>Serum estradiol concentration was causally associated with eGFR. Further longitudinal research is needed to validate these findings.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"753-764"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of tolvaptan in real‑world Japanese patients with autosomal dominant polycystic kidney disease: final results of SLOW‑PKD surveillance.","authors":"Toshio Mochizuki, Satoru Muto, Kyoko Suzue, Satoshi Komaniwa, Toshiki Tanaka, Yasuhiko Fukuta, Yuko Yamashige","doi":"10.1007/s10157-025-02634-7","DOIUrl":"10.1007/s10157-025-02634-7","url":null,"abstract":"<p><strong>Background: </strong>Tolvaptan, a vasopressin type 2 receptor antagonist, has been used to treat autosomal dominant polycystic kidney disease in Japan since 2014.</p><p><strong>Methods: </strong>This long-term, real-world, post-marketing surveillance (PMS) was conducted in Japan from March 2014 to March 2022. Safety was assessed based on adverse drug reactions (ADRs). For efficacy, changes in the slope of total kidney volume (TKV) and estimated glomerular filtration rate (eGFR) were assessed before and during the administration of tolvaptan.</p><p><strong>Results: </strong>A total of 1676 patients were enrolled, with mean TKV (n = 1000) of 2149 ± 1339 mL and eGFR (n = 1641) of 44.4 ± 21.7 mL/min/1.73 m². Frequent ADRs were hepatic function abnormal (9.6%), hyperuricaemia (8.3%), and thirst (8.1%). Most of the increased alanine aminotransferase exceeding 3 times the upper limit of the reference level occurred from 3  to  14 months after the start of treatment, but about 20% was observed after 15 months. There was no increase in ADRs over 36 months, suggesting that no other safety concerns need to be monitored during administration over 3-7 years. The mean slope of the estimated TKV increase before and during tolvaptan treatment was 6.58 and 3.71%/year, respectively (P = 0.0020). The mean slope of eGFR decline was - 3.63 and - 3.26 mL/min/1.73 m²/year, respectively (P = 0.2728).</p><p><strong>Conclusion: </strong>There were no major problems with the safety of tolvaptan treatment, and efficacy in limiting TKV increase in this PMS was comparable to the previous, pivotal randomized control trials. Trial registration ClinicalTrials.gov; NCT02847624.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"807-817"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic kidney disease is a major risk factor for mortality in triglyceride deposit cardiomyovasculopathy patients.","authors":"Yasuyuki Nagasawa, Satomi Okamura, Yuki Nishimura, Tomomi Yamada, Hideyuki Miyauchi, Yusuke Nakano, Tetsuya Amano, Yuko Kawaguchi, Shinichiro Fujimoto, Ken-Ichi Hirano","doi":"10.1007/s10157-024-02618-z","DOIUrl":"10.1007/s10157-024-02618-z","url":null,"abstract":"<p><p>Triglyceride deposit cardiomyovasculopathy (TGCV) is a rare cardiovascular disorder caused by defective intracellular lipolysis of triglyceride, resulting in heart failure and diffuse narrowing atherosclerosis. Recently, the registry of TGCV patients in Japan revealed that the 3-year overall survival rate was 80.1% and the 5-year overall survival rate was 71.8%. In this study, the effect on mortality of chronic kidney disease (CKD), diabetes malleus (DM), hypertension (HT), and dyslipidemia (DL) was analyzed using this retrospective registry of TGCV patients. The 3-year survival rate was 71.3% in the CKD group and 91.7% in the non-CKD group, and the 5-year survival rate was 61.8% in CKD group and 84.4% in the non-CKD group. The Kaplan-Meier analysis revealed that CKD is a risk factor for mortality in TGCV patients (p = 0.006). Although TGCV patients with CKD were older than those without CKD, Cox proportional hazard model analyses including age indicated that CKD has a significant association of the prognosis of TGCV patients (hazard ratio 2.33 [1.12-4.86], p = 0.024). DM, HT, and DL did not increase mortality in TGCV patients, although these risk factors were established in the general population. TGCV might cause cardiac disorders and kidney disease at the same time, because podocyte foot process disorder in the glomeruli might be caused by TGCV itself, while CKD should be a risk factor for mortality in TGCV patients as is true in the general population. In conclusion, CKD is a major risk factor for mortality in TGCV patients and thus should be paid attention to in these patients.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"866-871"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"cnm-positive Streptococcus mutans, a major pathogen in dental caries, may exacerbate IgA nephropathy via the tonsils.","authors":"Seigo Ito, Taro Misaki, Shuhei Naka, Daiki Matsuoka, Kana Suehara, Yuto Suehiro, Yasuyuki Nagasawa, Ryota Nomura, Michiyo Matsumoto-Nakano, Kazuhiko Nakano","doi":"10.1007/s10157-025-02708-6","DOIUrl":"https://doi.org/10.1007/s10157-025-02708-6","url":null,"abstract":"<p><strong>Background: </strong>Streptococcus mutans is a major pathogen in dental caries. This organism, which expresses Cnm protein encoded by the cnm gene, has been associated with the pathogenesis of IgA nephropathy (IgAN). Although tonsillectomy is used to treat IgAN, its efficacy is presently unclear in patients with IgAN who harbor cnm-positive S. mutans.</p><p><strong>Methods: </strong>The presence of cnm-positive S. mutans in saliva specimens from 158 patients with IgAN was determined by polymerase chain reaction assay. The patients were divided according to the results of cnm-positive S. mutans detection and history of tonsillectomy into those who were cnm-positive S. mutans (-), tonsillectomy (-) (group A, n = 57); cnm-positive S. mutans (-), tonsillectomy ( +) (group B, n = 62); cnm-positive S. mutans ( +), tonsillectomy (-) (group C, n = 19); and cnm-positive S. mutans ( +), tonsillectomy ( +) (group D, n = 20). The patients' clinical data were compared between the four groups.</p><p><strong>Results: </strong>The proportions of patients with proteinuria > 2 + and an estimated glomerular filtration rate < 60 mL/min/1.73 m² were significantly greater in group C than in the other groups (p < 0.0083). Moreover, the proportion of patients with a serum IgA concentration of > 347 mg/dL was significantly higher in group C than in the other groups (p < 0.05).</p><p><strong>Conclusions: </strong>These findings suggest that exacerbation of IgAN by cnm-positive S. mutans is possibly mediated by the tonsils and that tonsillectomy may be particularly effective in patients with IgAN and cnm-positive S. mutans in the oral cavity.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological cohort study of kidney biopsy findings resulting in dialysis during long-term follow-up exceeding 30 years.","authors":"Yoichi Oshima, Naoki Sawa, Masayuki Yamanouchi, Akinari Sekine, Hiroki Mizuno, Daisuke Ikuma, Yuki Oba, Noriko Inoue, Kiho Tanaka, Eiko Hasegawa, Tatsuya Suwabe, Kei Kono, Keiichi Kinowaki, Kenichi Ohashi, Yutaka Yamaguchi, Junichi Hoshino, Yoshifumi Ubara","doi":"10.1007/s10157-025-02706-8","DOIUrl":"https://doi.org/10.1007/s10157-025-02706-8","url":null,"abstract":"<p><strong>Background: </strong>Numerous kidney diseases progress to end-stage kidney disease (ESKD); however, a limited number of cohort studies have evaluated the underlying kidney diseases through kidney biopsy (KB).</p><p><strong>Methods: </strong>We retrospectively evaluated all patients who initiated dialysis at Toranomon Hospital, Japan, from 1985 to 2019, and whose underlying kidney disease had been diagnosed by KB. The data on histopathological diagnosis and various clinical characteristics were collected and analyzed for 357 patients.</p><p><strong>Results: </strong>The most prevalent underlying diseases, which constituted the primary endpoint of this study, were diabetic nephropathy (DN; n = 100, 28.0%), IgA nephropathy (IgAN; n = 99, 27.7%), and focal segmental glomerulosclerosis (n = 34, 9.5%). Benign nephrosclerosis (BNS; n = 1, 0.3%), that is, arteriosclerosis/arteriolosclerosis without distinct glomerulopathy, was rare. As the secondary endpoint, Cox regression analysis revealed that lower eGFR (p < 0.0001), higher proteinuria (p < 0.0001), older age (p = 0.005) and presence of DN (p = 0.008) were significant independent risk factors for early dialysis initiation. In the subgroup analysis, when comparing DN and IgAN, significantly earlier dialysis initiation was observed in DN than in IgAN by log-rank analysis (p < 0.0001), as well as after adjustment for baseline clinical characteristics using propensity score matching (n = 45 each) (p = 0.023).</p><p><strong>Conclusions: </strong>We identified a list of kidney diseases that were at risk for ESKD at the time of KB through a long-term follow-up. DN and IgAN are the two primary causes of ESKD, whereas BNS is an infrequent direct cause of ESKD in patients requiring kidney biopsy.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}