Clinical and Experimental Nephrology最新文献

{"title":"High prevalence and mortality risk of nocturia in cardiovascular-kidney-metabolic syndrome: a national cohort study and clinical validation.","authors":"Weicheng Xiao, Wentan Zhao, Feng Jin, Dongying Wang, Meihua Bao, Jinying Wang, Langping Ling","doi":"10.1007/s10157-026-02949-z","DOIUrl":"https://doi.org/10.1007/s10157-026-02949-z","url":null,"abstract":"<p><strong>Background: </strong>Nocturia is increasingly recognized as a manifestation of systemic cardiovascular, renal, and metabolic dysfunction, yet its prevalence and prognostic significance within the cardiovascular-kidney-metabolic (CKM) syndrome framework remain unclear.</p><p><strong>Methods: </strong>We analyzed 11,910 participants from NHANES (2005-2018) and 865 individuals from a hospital-based cohort. Logistic regression assessed associations between CKM stages and nocturia, while Cox proportional hazards models evaluated relationships between nocturia and all-cause and cardiovascular mortality in CKM stages 1-4. Restricted cubic spline analyses explored dose-response relationships.</p><p><strong>Results: </strong>In NHANES, nocturia prevalence increased with CKM stage, from 17.6% in stage 0 to 45.97% in stages 3-4 (P < 0.0001). Compared with stage 0, CKM stages 1-2 and 3-4 were associated with higher odds of nocturia (OR 2.05, 95% CI 1.59-2.64; OR 4.52, 95% CI 3.34-6.10). Nocturia was linked to increased all-cause (HR 1.54, 95% CI 1.34-1.78) and cardiovascular mortality (HR 1.88, 95% CI 1.37-2.57), with significant dose-response relationships. Similar findings were observed in the hospital-based cohort, where CKM stages 1-2 and 3-4 were associated with 2.79-fold and 4.77-fold higher odds of nocturia, respectively.</p><p><strong>Conclusion: </strong>Nocturia is common in CKM syndrome and independently associated with increased all-cause and cardiovascular mortality. These findings highlight nocturia as a clinically relevant marker associated with adverse outcomes in CKM populations.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069270","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":"Prevalence, risk factors, and the screening value of basal cortisol for adrenal insufficiency after corticosteroid therapy in children with idiopathic nephrotic syndrome.","authors":"Teja Sri Konatala, Lesa Dawman, Pujitha Vallabhaneni, Karalanglin Tiewsoh, Jaivinder Yadav, Naresh Sachdeva","doi":"10.1007/s10157-026-02954-2","DOIUrl":"https://doi.org/10.1007/s10157-026-02954-2","url":null,"abstract":"<p><strong>Background: </strong>Children with idiopathic nephrotic syndrome (INS) receive prolonged glucocorticoids that can suppress the hypothalamic-pituitary-adrenal (HPA) axis and cause adrenal insufficiency (AI). We estimated the prevalence, risk factors, and basal-cortisol screening performance of biochemical AI in children with INS in remission and off corticosteroids.</p><p><strong>Methods: </strong>In this single-centre cross-sectional study, 138 children with INS, off corticosteroids for ≥3 months after ≥2 weeks of full-dose prednisolone, underwent a standard-dose ACTH stimulation test (25 IU intramuscular Acton Prolongatum). Peak cortisol <500 nmol/L (18 µg/dL) defined AI.</p><p><strong>Results: </strong>Biochemical AI occurred in 26/138 children (18.8%). Low basal cortisol (< 138 nmol/L) occurred in 18 (13.0%) but captured only 12 of 26 cases. Suppression did not differ by NS subtype (p = 0.392). Suppressed children were older at enrolment (median 129 vs 97 months; p = 0.044) and had ≈31% lower basal cortisol (159.0 vs 230.5 nmol/L; p < 0.001). Basal cortisol moderately discriminated AI (AUC 0.798; negative predictive value 92.9% at an exploratory cut-off of 186.5 nmol/L). Prevalence declined with time off steroids (23.1%, 21.2%, and 13.2% at 3-6, 6-12, and >12 months; p = 0.400). Exploratory multivariable analysis, limited by few events, identified no significant predictors. All five children with peritonitis-related hypotension had AI.</p><p><strong>Conclusions: </strong>Biochemical AI affects one in five children with INS after prolonged corticosteroid therapy and may persist beyond one year. Basal morning cortisol may serve as an initial screen, but this exploratory threshold requires validation in independent cohorts. Dynamic testing and stress-dose preparedness remain important.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069316","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":"Inflammation and kidney function decline in rheumatoid arthritis: mind the eGFR category threshold.","authors":"Charlotte Delrue, Marijn M Speeckaert","doi":"10.1007/s10157-026-02950-6","DOIUrl":"https://doi.org/10.1007/s10157-026-02950-6","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008014","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":"Associations between erythropoietin resistance and iron metabolism markers in patients undergoing extended-hours and conventional hemodialysis.","authors":"Takumi Yamada, Nobuhiro Nishibori, Masaki Okazaki, Manabu Hishida, Takahiro Imaizumi, Shimon Kurasawa, Shigefumi Ishikawa, Ryosuke Ishikawa, Yoshihiro Nakamura, Toru Kondo, Yuhei Otobe, Hangsoo Kim, Kazuhiro Furuhashi, Hirotake Kasuga, Fumika Kaneda, Shoichi Maruyama","doi":"10.1007/s10157-026-02947-1","DOIUrl":"https://doi.org/10.1007/s10157-026-02947-1","url":null,"abstract":"<p><strong>Background: </strong>Extended-hours hemodialysis, defined as ≥6 h/session, three or four times per week, has been associated with lower erythropoietin resistance index (ERI), although the biological mechanisms remain unclear. We aimed to compare the associations between ERI and iron metabolism markers in patients undergoing extended-hours versus conventional hemodialysis.</p><p><strong>Methods: </strong>We included patients who received either extended-hours or conventional hemodialysis between January and March 2020. The ERI was calculated by dividing the weekly erythropoiesis-stimulating agent (ESA) dose, expressed as epoetin equivalents divided by body weight and hemoglobin level. Linear and non-linear associations were evaluated using multivariable linear regression and restricted cubic spline (RCS) analyses.</p><p><strong>Results: </strong>We analyzed 366 patients (178 receiving extended-hours hemodialysis and 188 receiving conventional hemodialysis). Hemoglobin levels were 10.9 and 11.2 g/dL, median ferritin levels were 34.8 and 63.6 ng/mL, and median transferrin saturation (TSAT) values were 16.9% and 20.5%, respectively. Extended-hours hemodialysis was associated with a lower ERI after multivariable adjustment (coefficient, -4.49 IU/kg/week per g/dL; 95% confidence interval, -6.76 to -2.22). In the RCS analysis, ERI increased with decreasing ferritin levels in the conventional hemodialysis group, whereas no increase was observed at lower ferritin levels in the extended-hours group. A similar trend was observed with respect to TSAT.</p><p><strong>Conclusions: </strong>Extended-hours hemodialysis was associated with lower ERI. Exploratory RCS analyses suggested potential modality-related differences in the relationships between ERI and ferritin or TSAT. These findings suggest that the association between iron status and ESA responsiveness may differ by dialysis modality and warrants further investigation.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007999","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":"Zebra bodies in hydroxychloroquine-naïve class V lupus nephritis.","authors":"Takahiro Goshima, Yuki Miyaguchi, Norihiro Suga","doi":"10.1007/s10157-026-02943-5","DOIUrl":"https://doi.org/10.1007/s10157-026-02943-5","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008040","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":"Systematic review and network meta-analysis for the 2026 update of the evidence-based clinical practice guidelines for the management with immunosuppressive therapies and biologic agents of membranous nephropathy.","authors":"Reiji Takami, Hiroki Nishiwaki, Yasushi Tsujimoto, Yuji Oe, Keisuke Onishi, Yuki Oba, Shinnosuke Sugihara, Yoshitaka Miyaoka, Mai Yoshida, Masahiko Yazawa, Tadashi Sofue, Izaya Nakaya, Takuji Ishimoto, Takehiko Kawaguchi, Noriaki Kurita, Sayaka Shimizu, Kengo Furuichi, Hirokazu Okada, Takehiko Wada","doi":"10.1007/s10157-026-02944-4","DOIUrl":"https://doi.org/10.1007/s10157-026-02944-4","url":null,"abstract":"<p><strong>Background: </strong>Multiple immunosuppressive therapies are used to induce remission in membranous nephropathy, but differences in study populations, treatment regimens, and outcome definitions complicate comparisons of their relative efficacy and safety. We aimed to synthesize randomized evidence comparing immunosuppressive therapies, including rituximab.</p><p><strong>Methods: </strong>We conducted a systematic review and network meta-analysis of randomized controlled trials for adult patients with idiopathic membranous nephropathy. Outcomes included mortality, kidney failure, remission of nephrotic syndrome, decline in kidney function, infections, and adverse events. Random-effects network meta-analyses were performed, and the certainty of evidence for each comparison was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework.</p><p><strong>Results: </strong>A total of 52 randomized controlled trials involving multiple immunosuppressive strategies were included. Several treatments, including adrenocorticotropic hormone, tacrolimus, intravenous cyclophosphamide, and oral cyclophosphamide, were associated with higher complete or partial remission rates compared with placebo, standard treatment, or no treatment. Oral cyclophosphamide was also associated with a lower risk of kidney failure in some comparisons, whereas azathioprine, cyclosporine, and glucocorticoids were associated with lower relapse rates. However, the certainty of evidence across most efficacy and safety outcomes was low to very low because of risk of bias, imprecision, heterogeneity, and incoherence. Infection outcomes were inconsistently reported and estimates were generally imprecise.</p><p><strong>Conclusion: </strong>Treatment effects differed across interventions, but the overall certainty of the evidence was limited, highlighting the need for well-designed, adequately powered randomized trials with standardized methodologies.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008047","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":"A new frontier in edema management: the potential of tolvaptan for refractory edema with hyponatremia in pediatric nephrotic syndrome.","authors":"Vignesh, Shobha Sharma, Srinivasavaradan Govindrajan, Kanika Kapoor, Anita Rani","doi":"10.1007/s10157-026-02939-1","DOIUrl":"https://doi.org/10.1007/s10157-026-02939-1","url":null,"abstract":"<p><strong>Background: </strong>Severe nephrotic edema in children often necessitates use of one or more diuretics. Moderate to severe hyponatremia co-exist in such patients. Tolvaptan, a vasopressin receptor antagonist, has shown promise in treating edema in adult as well as pediatric cases, however in children there is not much data. This study aims to explore the use of tolvaptan in severe nephrotic edema with hyponatremia in children.</p><p><strong>Methods: </strong>Children with Nephrotic syndrome (1-12 years) with severe edema were screened for eligibility and received furosemide (2-4 mg/kg/d) for 48 h, those refractory to furosemide (weight loss < 3%) with hyponatremia (Na < 130mEq/L) were administered tolvaptan (0.3-1 mg/kg/d) for 48 h after excluding hypovolaemia, elevated liver enzyme and reduced eGFR (< 60 ml/min/1.73m2). Parameters were compared before and after 48 h of tolvaptan.</p><p><strong>Results: </strong>A total of 60 (44 males, 16 females) patients were enrolled with mean age of 5.71 ± 2.16 years. After 48 h of tolvaptan administration, there was significant reduction in body weight (21.98 ± 6.33 to 21.02 ± 6.28 p < 0.001). and increase in 24-hour urine volume from 700 (400-1060) mL/day [1.56 ± 0.91 mL/kg/hour] to 1200 (900-1637.5) mL/day [3.17 ± 2.53 mL/kg/hour] (p < 0.001). The mean serum sodium level increased significantly from 125.87 ± 3.77 mEq/L to 131.18 ± 4 mEq/L (p < 0.0001). There was no significant change in liver enzymes after tolvaptan.</p><p><strong>Conclusions: </strong>Tolvaptan effectively reduces edema, increases urine output while improving serum sodium levels in pediatric nephrotic syndrome with refractory edema without any significant side effects.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008046","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":"Does the reported eGFR decline reflect a previously described cohort? Comment on \"Effects of processed low-protein brown rice on patients with chronic kidney disease\".","authors":"Momina Rehman, Ajeet Kumar, Laksh Aneel Uttwani","doi":"10.1007/s10157-026-02946-2","DOIUrl":"https://doi.org/10.1007/s10157-026-02946-2","url":null,"abstract":"","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988539","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":"Risks of arteriovenous fistula failure in hemodialysis patients older than 75 years.","authors":"Shunta Hori, Mitsuru Tomizawa, Kuniaki Inoue, Akira Tachibana, Yuki Oda, Kenta Onishi, Yosuke Morizawa, Daisuke Gotoh, Yasushi Nakai, Makito Miyake, Katsunori Yoshida, Tatsuo Yoneda","doi":"10.1007/s10157-026-02941-7","DOIUrl":"https://doi.org/10.1007/s10157-026-02941-7","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous fistula (AVF) failure remains a major clinical problem in older patients undergoing hemodialysis. However, the relative contributions of risk factors and their time-dependent effects remain unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed 303 patients aged ≥ 75 years in whom AVFs were created. Cox proportional hazards models were used to identify the independent predictors of AVF failure within 1 year. Relative importance was assessed using the likelihood ratio chi-square statistic, and time-dependent effects were evaluated using Schoenfeld residuals.</p><p><strong>Results: </strong>AVF failure within 1 year occurred in 30 patients (9.9%), including 10 patients who experienced early failure. Malnutrition, prolonged surgical time, and arterial calcification were identified as independent predictors. Each factor contributed comparably, accounting for approximately one-third of the model contribution. The effect of surgical time was attenuated after approximately 6 months.</p><p><strong>Conclusions: </strong>AVF failure in older patients is multifactorial, with comparable contributions from vascular, nutritional, and procedural factors.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955162","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 analyses of nephrotic syndrome after liver transplantation.","authors":"Yuta Matsukuma, Kenji Ueki, Shohei Yoshiya, Eri Ataka, Hirofumi Okamoto, Akihiro Tsuchimoto, Shunsuke Yamada, Toshiaki Nakano, Takeo Toshima, Kosuke Masutani, Kazuhiko Tsuruya, Tomoharu Yoshizumi, Tetsuro Ago","doi":"10.1007/s10157-026-02945-3","DOIUrl":"https://doi.org/10.1007/s10157-026-02945-3","url":null,"abstract":"<p><strong>Background: </strong>Pathological renal injuries after liver transplantation are multifactorial, yet the clinicopathological characteristics of glomerulonephritis presenting as nephrotic syndrome remain unclear. This study aimed to investigate its clinicopathological features, treatment, and outcomes.</p><p><strong>Methods: </strong>We retrospectively identified 12 patients with NS who underwent kidney biopsy after liver transplantation and investigated their clinicopathological findings, treatment, and clinical course.</p><p><strong>Results: </strong>At the time of biopsy, the mean time after liver transplantation was 3.4 years, and mean age was 58.9 years. Mean estimated glomerular filtration rate (eGFR) and urinary protein-to-creatinine ratio (UP/UCr) were 40.1 ± 15.6 mL/min/1.73 m² and 6.74 ± 3.01 g/gCr, respectively. The pathological diagnoses were: IgA nephropathy (IgA-N) in 5 patients (42%), membranoproliferative glomerulonephritis (MPGN) in 2 patients, diabetic nephropathy in 2 patients, thrombotic microangiopathy in 1 patient, pauci-immune crescentic glomerulonephritis (CrGN) in 1 patient, and membranous nephropathy in 1 patient. All patients were treated with induction or dose escalation of angiotensin II receptor blockers, and patients with IgA-N or CrGN received steroid pulse therapy; In patients with IgA-N, mean UP/UCr significantly decreased from 9.01 ± 3.32 g/gCr to 1.45 ± 1.40 g/gCr after 2 years. During the 5.8-year follow-up period, 8 patients (67%) achieved incomplete remission (< 3.5 g/gCr), but 3 patients (one each with IgA-N, MPGN and CrGN) progressed to end-stage kidney disease.</p><p><strong>Conclusions: </strong>The pathological findings of NS after liver transplantation in this selected cohort are heterogeneous, therefore kidney biopsy might be valuable for evaluating the condition and guiding the selection of appropriate therapeutic strategies.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955104","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}