Clinical and Experimental Nephrology最新文献

{"title":"Diagnostic accuracy of doppler-derived renal ultrasound parameters for predicting acute kidney injury after cardiac surgery: a systematic review and meta-analysis.","authors":"Laura Esperanza Jiménez Gómez, Cándida Díaz-Brochero, Daniela Patiño Hernández, Sergio Velasco Malagón, Juan Daniel Caicedo-Ruiz, Daniel Martin, Luis Carlos Triana Moreno","doi":"10.1007/s10157-026-02931-9","DOIUrl":"https://doi.org/10.1007/s10157-026-02931-9","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a frequent and clinically significant complication following cardiac surgery. Doppler-derived renal ultrasound parameters-including the renal resistive index (RRI), semiquantitative power Doppler ultrasound (PDU) scales, and intrarenal venous flow (IRVF)-have been proposed as early, noninvasive predictors of postoperative AKI, but their diagnostic accuracy in this setting remains uncertain.</p><p><strong>Methods: </strong>We conducted a systematic review of diagnostic test accuracy studies evaluating RRI, PDU, or IRVF for predicting AKI within 7 days after cardiac surgery in adult intensive care unit patients. MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science, and clinical trial registries were searched through June 2025. Sensitivity, specificity, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) were extracted or calculated. Meta-analysis was performed for RRI using hierarchical bivariate models; IRVF and PDU were summarized descriptively due to limited studies and heterogeneity.</p><p><strong>Results: </strong>Fourteen studies comprising 1,204 patients were included (12 RRI, 3 IRVF, 1 PDU). RRI thresholds between 0.71 and 0.74 demonstrated the highest diagnostic performance (AUC range 0.72-0.93). IRVF showed modest discrimination (AUC 0.62-0.66). Evidence for PDU was limited to one study. Substantial clinical and methodological heterogeneity was observed and overall certainty of evidence ranged from low to moderate.</p><p><strong>Conclusions: </strong>Among Doppler-derived renal ultrasound parameters, RRI appears to have the most consistent diagnostic accuracy for predicting AKI after cardiac surgery. However, methodological heterogeneity, the limited number of studies, and the low-to-moderate certainty of the evidence preclude definitive clinical recommendations. Prospective multicenter validation studies with standardized protocols and prespecified thresholds are warranted.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104595","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":"Quality of life in hyperkalemia: baseline analysis of a cohort study of management of hyperkalemia in patients with chronic kidney disease or heart failure in Japan.","authors":"Ken-Ei Sada, Hajime Yamazaki, Takafumi Wakita, Yosuke Yamamoto, Jui Wang, Yoshihiro Onishi, Tadateru Hamada, Ryotaro Ide, Masayoshi Takeda, Shunichi Fukuhara, Yugo Shibagaki","doi":"10.1007/s10157-026-02951-5","DOIUrl":"https://doi.org/10.1007/s10157-026-02951-5","url":null,"abstract":"<p><strong>Background: </strong>Hyperkalemia is common in chronic kidney disease (CKD) and chronic heart failure (CHF), often leading to treatment dilemmas regarding renin-angiotensin-aldosterone system (RAAS) inhibitors. Although potassium binders and dietary restrictions are central to chronic management, their quality-of-life (QOL) impact remains insufficiently described. This study aimed to characterize real-world treatment patterns and evaluate treatment impact on QOL.</p><p><strong>Methods: </strong>We analyzed baseline data from a prospective cohort in Japanese nephrology and cardiology outpatient clinics. Participants were adults with CKD (≥ stage G3) or CHF (New York Heart Association class II-IV) who initiated potassium binders within 6 months. Clinical data, serum potassium values, and patient-reported outcomes (generic QOL, disease/treatment-specific QOL, and adherence measures) were obtained at enrollment.</p><p><strong>Results: </strong>Among 347 patients, the median age was 75 years, and 74% were male; 93% had CKD. At enrollment, 59% were prescribed a RAAS inhibitor. Dietary therapy was implemented in 29%. Physical scores of generic QOL were lower than population norms, whereas mental scores were comparable. Treatment-specific QOL scores suggested that potassium binders may have had a relatively small impact on QOL compared with dietary therapy. Adherence to potassium binders was high.</p><p><strong>Conclusions: </strong>Concurrent use of RAAS inhibitors and potassium binders was common, consistent with a role for binders in supporting RAAS inhibitor continuation. Potassium binders showed little perceived impact, indicating that pharmacologic potassium control may be acceptable to patients managing multiple lifestyle limitations.</p><p><strong>Study registration: </strong>The study was registered with ClinicalTrials.gov (NCT05297409).</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104863","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":"Imeglimin pretreatment improves survival and attenuates sepsis-associated acute kidney injury following Escherichia coli challenge in diabetic mice.","authors":"Hiroyasu Goto, Kengo Tomita, Koji Kuwata, Kazuma Mori, Masahiro Nakashima, Hiroyuki Nakashima, Manabu Kinoshita, Naoki Oshima","doi":"10.1007/s10157-026-02956-0","DOIUrl":"https://doi.org/10.1007/s10157-026-02956-0","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a serious condition that induces systemic inflammation and multiple organ injuries, including sepsis-associated acute kidney injury (SA-AKI). Diabetes is a risk factor for SA-AKI that can worsen sepsis outcomes. We investigated whether the novel oral antihyperglycemic drug and AMP-kinase (AMPK) activator imeglimin could ameliorate SA-AKI and the survival in diabetic mice by improving the mitochondrial function.</p><p><strong>Methods: </strong>Male C57BLKS/J Iar -+Lepr^db/+Lepr^db (db/db) mice were fed imeglimin-mixed (Ime) or vehicle (Veh) foods for two weeks followed by an Escherichia coli (E. coli) challenge. Survival, kidney functions, serum cytokine, lactate and ketone levels, and the mitochondrial function were examined. To exclude the glucose-lowering effect of imeglimin on sepsis outcomes, we also studied using a streptozotocin (STZ)-induced diabetic mouse model.</p><p><strong>Results: </strong>The Ime group showed ameliorated survival rate and kidney injury after E. coli challenge compared to the Veh group in db/db and STZ mice. The Ime group showed a significantly higher p-AMPK/AMPK ratio than Veh. The mitochondrial membrane potential of tubular cells and the kidney ATP concentration improved in the Ime group of both diabetes types, although the recovery of fatty acid oxidation and changes in serum lactate and ketone levels differed between db/db and STZ mice. The level of serum IL-6 was also lower in the Ime group than the Veh group.</p><p><strong>Conclusion: </strong>Imeglimin could prevent SA-AKI and increase the survival rate after E. coli challenge. The preservation of mitochondrial function via AMPK enhancement by imeglimin presumably resulted in early resolution of the metabolic deterioration due to sepsis.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104884","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":"Coexistence of ANCA-associated glomerulonephritis and membranous nephropathy: a scoping review.","authors":"Ryosuke Saiki, Kan Katayama, Mutsuki Mori, Kaoru Dohi","doi":"10.1007/s10157-026-02904-y","DOIUrl":"10.1007/s10157-026-02904-y","url":null,"abstract":"<p><strong>Background: </strong>Coexistence of anti-neutrophil cytoplasmic antibody -associated glomerulonephritis (ANCA-GN) and membranous nephropathy (MN) is rare. This scoping review mapped evidence on clinicopathologic features, phenotypic heterogeneity, and reporting gaps relevant to future rigorous phenotype-specific comparative studies.</p><p><strong>Methods: </strong>Comprehensive searches of PubMed, Web of Science, and CENTRAL from inception to April 16, 2026 identified original studies of patients with coexisting ANCA-GN and MN. Two reviewers independently extracted study and participant characteristics, renal and systemic findings, serologic and antigen data, associated conditions, treatments, outcomes, phenotype categories, and temporal relationships. Individual-level cases were assigned using a prespecified phenotype framework.</p><p><strong>Results: </strong>Seventy studies (140 patients) were included, comprising 113 individually charted cases and one aggregate-only cohort of 27 patients. Among individual-level cases, median age was 60 years; median serum creatinine, 2.75 mg/dL; and median proteinuria, 3.7 g/day or g/g creatinine (g/gCr). The overlap was phenotypically heterogeneous, including 66 likely myeloperoxidase (MPO)-associated/ANCA-GN-related cases, 10 likely primary-MN-like overlap cases, 31 secondary/associated cases, and 6 unclassifiable cases. Temporal relationship was ascertainable for all 113 cases: 101 (89.4%) had concurrent onset (≤ 6 months), 7 (6.2%) had MN preceding ANCA-GN, and 5 (4.4%) had ANCA positivity preceding MN. The evidence base was constrained by case-report predominance, selective antigen testing, sparse longitudinal biomarker/follow-up data, and nonuniform outcome reporting.</p><p><strong>Conclusions: </strong>Coexisting ANCA-GN and MN is a rare, clinically important, and heterogeneous spectrum rather than a single pooled entity. Future studies should use phenotype-specific designs with standardized antigen testing, crescent reporting, longitudinal ANCA assessment, consistent outcome definitions, and explicit follow-up.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1451-1456"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-sensitivity Glasgow prognostic score and infection-related mortality in maintenance hemodialysis patients: 10-year outcomes of the Q-Cohort Study.","authors":"Yutaro Hirashima, Shunsuke Yamada, Hiromasa Kitamura, Hiroto Hiyamuta, Masatomo Taniguchi, Kazuhiko Tsuruya, Tetsuro Ago, Toshiaki Nakano","doi":"10.1007/s10157-026-02906-w","DOIUrl":"10.1007/s10157-026-02906-w","url":null,"abstract":"<p><strong>Background: </strong>Infection is a major cause of death in patients undergoing maintenance hemodialysis (HD). We examined whether the high-sensitivity Glasgow prognostic score (hsGPS), derived from serum C-reactive protein (CRP) and albumin, is associated with infection-related mortality.</p><p><strong>Methods: </strong>This retrospective cohort study included 3529 patients undergoing maintenance HD enrolled between December 31, 2006 and December 31, 2007 and followed until December 31, 2016. We used a high-sensitivity Glasgow prognostic score (hsGPS), defined using a lower CRP threshold in a GPS-type manner as follows: score 0, CRP ≤ 0.3 mg/dL and albumin ≥ 3.5 g/dL; score 1, CRP > 0.3 mg/dL or albumin < 3.5 g/dL; and score 2, CRP > 0.3 mg/dL and albumin < 3.5 g/dL. Associations were evaluated using Kaplan-Meier analysis, Cox proportional hazards models, Fine-Gray competing-risk models, and restricted cubic spline analyses.</p><p><strong>Results: </strong>During a median follow-up of 3199 days, 1748 deaths occurred, including 451 infection-related deaths. In descriptive Kaplan-Meier analysis, infection-related death-free survival was lower in higher hsGPS groups. In the multivariable-adjusted Cox model, hazard ratios for infection-related mortality were 1.79 (95% confidence interval [CI] 1.43-2.24) for hsGPS 1 and 2.38 (95% CI 1.71-3.31) for hsGPS 2, compared with hsGPS 0. Competing-risk analyses showed similar trends, although the associations were attenuated. Restricted cubic spline analyses showed higher risk at lower albumin levels and higher CRP levels.</p><p><strong>Conclusions: </strong>Higher hsGPS was associated with higher infection-related mortality in patients undergoing maintenance HD. hsGPS may serve as a simple risk stratification tool in this population.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1475-1486"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344040","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":"Hyperkalemia risk and potassium trajectory after finerenone initiation: a real-world cohort study.","authors":"Nobuhiro Hashimoto, Yusuke Sakaguchi, Miyu Naito, Syuzo Makino, Akito Takashima, Hiromitsu Miyakawa, Hiroki Okushima, Mitsutoshi Asai, Terumasa Hayashi","doi":"10.1007/s10157-026-02898-7","DOIUrl":"10.1007/s10157-026-02898-7","url":null,"abstract":"<p><strong>Background: </strong>Finerenone improves cardiovascular and kidney outcomes in patients with type 2 diabetes and chronic kidney disease; however, hyperkalemia remains a safety concern in routine practice. We evaluated the incidence of hyperkalemia, factors associated with its occurrence, and temporal patterns of serum potassium after finerenone initiation.</p><p><strong>Methods: </strong>We conducted a single-center retrospective observational cohort study of patients who initiated finerenone between May 2022 and August 2025. The primary outcome was incident hyperkalemia (serum potassium ≥ 5.5 mEq/L). Candidate variables were selected using least absolute shrinkage and selection operator (LASSO)-penalized Cox regression, and associations were estimated using multivariable Cox proportional hazards models. Potassium trajectories were assessed using mixed-effects models over 12 months (6 months before and after finerenone initiation), with subgroup analyses by kidney function and baseline potassium.</p><p><strong>Results: </strong>Among 289 eligible patients, 280 were included (mean age 68 years; 68% male; mean baseline eGFR of 36.8 mL/min/1.73 m²). Hyperkalemia occurred in 38 patients. Incident hyperkalemia was associated with higher baseline potassium and log-transformed C-reactive protein and with use of diuretics and potassium binders. Mean serum potassium increased by approximately 0.10 mEq/L over six months, with the largest rise in the first 1-2 months. Patients with eGFR < 30 mL/min/1.73 m² or baseline potassium ≥ 4.5 mEq/L had higher potassium levels throughout follow-up.</p><p><strong>Conclusions: </strong>Finerenone was generally well tolerated, with modest potassium increases. In our real-world cohort, hyperkalemia occurred in a notable proportion of patients, underscoring the importance of early monitoring, particularly in those with reduced kidney function or elevated baseline potassium.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1433-1440"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197567","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":"Self-reported POCUS practice and confidence after structured workshop for early-career nephrologists: a questionnaire study.","authors":"Fumiya Kitano, Masafumi Sakai, Kana Shirai, Keisuke Yoshida, Yugo Shibagaki, Masahiko Yazawa","doi":"10.1007/s10157-026-02909-7","DOIUrl":"10.1007/s10157-026-02909-7","url":null,"abstract":"<p><strong>Introduction: </strong>Point-of-care ultrasound (POCUS) is increasingly incorporated into nephrology practice, yet comparative data on educational strategies and the durability of their effects remain limited. We conducted a questionnaire-based study to examine whether a structured workshop (WS) differs from on-the-job training (OJT) in shaping self-reported POCUS practice and confidence among early-career nephrologists.</p><p><strong>Methods: </strong>In August 2025, nephrologists with fewer than 15 postgraduate years at a single academic center were surveyed. Participants were categorized into three cohorts: those who attended a structured WS program (didactic lectures and hands-on training) in 2023, those who received OJT only in 2024, and those who received OJT only in 2025. All assessments were retrospectively reported at a single survey time point. Outcomes included self-rated confidence in examination frequency, technical skill, image interpretation, and mentoring others using a 5-point Likert scale.</p><p><strong>Results: </strong>Thirty-four respondents (79.1% of all eligible nephrologists) were analyzed. In recalled post-training assessments, the WS group demonstrated higher confidence in interpretation and mentoring compared with OJT cohorts, whereas no differences were observed in technical skill or examination frequency. At the time of the survey, no significant between-group differences persisted. Within the WS group, confidence scores declined across all domains over time.</p><p><strong>Conclusion: </strong>In this exploratory study, structured workshops were associated with greater recalled post-training confidence in interpretative and mentoring domains, but these gains attenuated without reinforcement. Sustainable integration of nephrology-specific POCUS may require longitudinal, organization-supported educational frameworks rather than isolated instructional interventions, such as OJT alone.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1504-1509"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344072","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":"Defective autophagy in diabetic nephropathy sensitizes podocytes to hyperuricemia induced injury by amplifying inflammasome activation.","authors":"Chengyu Cao, Yan Fang, Yingxiao Ding, Anyan Li, Fei Jiang, Li Fang","doi":"10.1007/s10157-026-02929-3","DOIUrl":"10.1007/s10157-026-02929-3","url":null,"abstract":"<p><p>Hyperuricemia was associated with faster progression of proteinuria in diabetic nephropathy. However, the underlying mechanisms remained largely unknown. Therefore, this study aimed to explore whether there was a tightly regulated process involved in susceptibility to hyperuricemia under diabetic conditions. We established a diabetes model with hyperuricemia superimposed both in vivo and in vitro. The urinary albumin: creatinine ratio, biomarkers of podocyte damage, markers of inflammasome activation, and autophagosome markers were assessed. In vivo, we found that hyperuricemia aggravated podocyte injury in a diabetic mouse model, manifested by significantly increased albuminuria levels and severe slit diaphragm abnormalities. In addition, significantly excessive inflammasome activation, which might initiate hyperinflammation resulting in podocyte injury, was also found in the glomeruli of the superposed model, accompanied by diminished staining of the autophagosome marker LC3. Accordingly, in vitro, we revealed that high glucose pretreatment induced autophagic deficiency, potentiating inflammasome activation in podocytes. Furthermore, we confirmed that 3-methylamphetamine (3-MA), an inhibitor of autophagy, could aggravate uric acid-induced inflammasome activation in a dose- and time-dependent manner, whereas rapamycin, an inducer of autophagy, could alleviate uric acid-induced inflammasome activation in a dose- and time-dependent manner. Collectively, our data suggested that autophagic deficiency occurring in diabetic kidney disease might sensitize podocytes to hyperuricemia-induced injury by amplifying inflammasome activation. Enhancement of autophagy might provide a promising avenue for ameliorating inflammasome activation and preventing podocyte injury in established diabetic nephropathy.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1415-1425"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700910","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":"Early glomerular capillary C4d is associated with poor graft function in kidney transplant recipients with preformed donor-specific antibodies.","authors":"Yuki Shimamoto, Manabu Okada, Takahisa Hiramitsu, Asami Takeda, Ayano Ienaga, Tomoki Himeno, Yuki Hasegawa, Kenta Futamura, Shunji Narumi, Yoshihiko Watarai, Takaaki Kobayashi","doi":"10.1007/s10157-026-02919-5","DOIUrl":"10.1007/s10157-026-02919-5","url":null,"abstract":"<p><strong>Background: </strong>The role of positive glomerular capillary C4d (C4dglom) in chronic antibody-mediated rejection (ABMR) has been examined. However, the role of C4dglom in the development of transplant glomerulopathy (TG) and graft outcomes in the early phase after kidney transplantation (KT) among patients with preformed donor-specific antibodies (preDSAs) remains undetermined.</p><p><strong>Methods: </strong>In this single-center, retrospective cohort study, we included 110 kidney transplant recipients (KTRs) with preDSAs (2008-2024, median follow-up: 7.8 years). Overall, 325 index and indication biopsies were performed within 1 year post-KT. All biopsy specimens were stained with immunofluorescent C4d. C4dglom was defined as global, moderate to severe, pseudolinear glomerular capillary wall staining, and peritubular capillary C4d (C4dptc), as described in Banff 2019. Patients were divided into two groups, with or without C4dglom, within 1 year post-KT. The association between C4dglom and TG was evaluated. Further, among KTRs with ABMR or TG, the incidence of a 30% decline in estimated glomerular filtration rate (eGFR) within 1 year post-KT and eGFR at 1 year post-KT were compared according to the presence or absence of C4dglom or C4dptc.</p><p><strong>Results: </strong>Twenty-two cases of C4dglom and 26 cases of TG were identified within 1 year post-KT. C4dglom was associated with TG development. In the TG group, C4dglom positivity was associated with a significantly lower 30% decline in eGFR-free survival than C4dglom negativity (45.7% vs 92.9%, p = 0.036), whereas C4dptc positivity was not (71.4% vs 70.3%, p = 0.979).</p><p><strong>Conclusion: </strong>C4dglom was associated with subsequent TG and even poor graft function.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1487-1494"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418931","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":"Eldecalcitol in older adults with kidney vulnerability: a narrative review of risk-based use, dose adjustment, and monitoring.","authors":"Yoshitaka Furuto, Daiki Yoshino, Akio Namikawa, Dai Sato, Yuko Shibuya","doi":"10.1007/s10157-026-02930-w","DOIUrl":"10.1007/s10157-026-02930-w","url":null,"abstract":"<p><p>Eldecalcitol is an active vitamin D analogue used for osteoporosis in Japan. Its usual dose is 0.75 μg/day, but calcium-related adverse effects can become clinically important when reduced kidney reserve, frailty, low body weight, poor intake, dehydration risk, interacting medicines, or unreliable follow-up coexist. This narrative review synthesizes trial, post-marketing, pharmacovigilance, and real-world monitoring evidence to define a practical safety framework. Eldecalcitol reduces vertebral fractures compared with alfacalcidol, whereas hip-fracture protection has not been established; therefore, its role should be determined by the patient's fracture pattern, treatment objective, kidney function, and availability of alternatives with established hip-fracture efficacy. Before treatment, clinicians should confirm osteoporosis, measure total serum calcium with albumin (and use albumin-adjusted calcium where appropriate), and assess serum creatinine with reported eGFR. Primary hyperparathyroidism and other metabolic bone disorders should be considered when baseline findings are atypical. Creatinine-based eGFR is the pragmatic minimum standard; cystatin C is most useful when low muscle mass or discordance makes kidney reserve uncertain. A lower dose of 0.5 μg/day is a dose-adjustment or re-challenge option after calcium normalization; it does not remove the need for calcium surveillance and clinical reassessment, and long-term fracture-prevention efficacy at that dose is not established. Eldecalcitol should be withheld during poor intake, dehydration, or acute illness and reconsidered when calcium rises or kidney function deteriorates. Safe use therefore requires risk-based selection rather than passive routine-dose prescribing, planned biochemical follow-up, and explicit treatment reassessment.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1392-1397"},"PeriodicalIF":2.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148668697","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}