Clinical and Experimental Nephrology最新文献

{"title":"Diabetic peripheral neuropathy as an independent predictor of renal function decline in type 2 diabetes: a propensity score-matched retrospective cohort study using DPN-Check^®.","authors":"Hiroyuki Ito, Manami Yamamoto, Hideyuki Inoue, Yuko Kuwahara, I Chiaki, Mizuki Matsushita, Suzuko Matsumoto, Shinichi Antoku, Tomoko Yamasaki, Toshiko Mori, Sayuri Miura, Kenichi Nishio, Akifusa Takaki, Chizuko Yukawa","doi":"10.1007/s10157-026-02885-y","DOIUrl":"10.1007/s10157-026-02885-y","url":null,"abstract":"<p><strong>Background: </strong>Diabetic peripheral neuropathy (DPN) is highly prevalent in type 2 diabetes, but its specific impact on long-term renal outcomes remains unclear. We aimed to determine whether DPN, objectively assessed using the DPN-Check^® device, independently predicts accelerated renal function decline.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated 323 Japanese patients with type 2 diabetes who underwent neuropathy assessment using DPN-Check^® between 2015 and 2017. Propensity score matching for baseline covariates (including age, HbA1c, estimated glomerular filtration rate [eGFR], and albuminuria) yielded 174 well-matched patients (87 with DPN, 87 without DPN). The primary outcome was a composite of renal events (≥ 30% eGFR decline, renal replacement therapy, or renal or cardiovascular death) over a five-year follow-up. Secondary outcomes included annual eGFR slopes and sensitivity analyses stratified by baseline albuminuria categories.</p><p><strong>Results: </strong>Over five years, renal events occurred significantly more frequently in the DPN group (19 versus 6 events; log-rank P < 0.01). Multivariate Cox regression confirmed DPN as an independent predictor of renal events (adjusted hazard ratio 3.18, 95% CI 1.34 to 8.77, P < 0.01). The DPN group exhibited a steeper annual eGFR decline (-1.9 vs. -1.1 mL/min/1.73 m²/year, P < 0.01). Stratified analysis revealed that DPN significantly predicted renal events even in patients with normoalbuminuria.</p><p><strong>Conclusions: </strong>DPN measured by DPN-Check^® independently predicts subsequent renal deterioration in type 2 diabetes. Routine objective neuropathy screening can enhance renal risk stratification and guide clinical management.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1315-1323"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148013636","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":"Distinct glomerular and tubulointerstitial injury pathways in infective endocarditis-associated glomerulonephritis: a case series.","authors":"Kei Kono, Naoki Sawa, Hiroki Mizuno, Yusuke Yoshimura, Yuki Oba, Masayuki Yamanouchi, Noriko Inoue, Akinari Sekine, Kiho Tanaka, Eiko Hasegawa, Tatsuya Suwabe, Takeshi Fujii, Yutaka Takazawa, Kenichi Ohashi, Yutaka Yamaguchi, Takehiko Wada, Yoshifumi Ubara","doi":"10.1007/s10157-026-02880-3","DOIUrl":"10.1007/s10157-026-02880-3","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis-associated glomerulonephritis (IE-GN) causes acute kidney injury with unclear pathogenesis. Previous studies focused on glomerular lesions with limited understanding of tubulointerstitial involvement. We investigated clinicopathological characteristics of renal involvement in IE, focusing on distinct injury patterns in glomeruli and tubulointerstitium.</p><p><strong>Methods: </strong>We conducted a retrospective case series of five male patients (age 46-74 years) with confirmed infective endocarditis (IE) who underwent kidney biopsy at Toranomon Hospital between January 1, 2001, and August 31, 2024. The diagnosis of IE was made based on the modified Duke criteria (2011).</p><p><strong>Results: </strong>Blood cultures were positive for Streptococcus (n = 4) and Granulicatella (n = 1). Acute kidney injury was present in three patients with eGFR of 6.5-23.9 mL/min/1.73 m². Light microscopy revealed two glomerular injury patterns: diffuse endocapillary proliferative glomerulonephritis with neutrophilic infiltration (n = 2) and necrotizing glomerulonephritis with fibrin deposition (n = 3). Patients with severe renal dysfunction demonstrated extensive tubulointerstitial inflammation with neutrophil and macrophage infiltration, while those with preserved renal function showed minimal tubulointerstitial involvement despite similar glomerular immune complex deposition. Immunofluorescence demonstrated granular IgA, IgM, and C3 deposits. Electron microscopy revealed inflammatory cell infiltration, endocapillary proliferation, and subendothelial and mesangial electron-dense deposits. Gram-positive bacteria were detected in one kidney specimen and in cardiac valve vegetation. Patients receiving surgical treatment (n = 3) achieved favorable outcomes.</p><p><strong>Conclusions: </strong>This analysis of five cases suggests that IE-GN involves dual pathogenic pathways: immune complex-mediated glomerular injury and tubulointerstitial injury related to bacterial burden, with tubulointerstitial lesions more strongly associated with renal dysfunction.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1303-1314"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263686","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":"Applications of donor-derived cell-free DNA in kidney transplantation healthcare: view from a prospective single-center study.","authors":"Phuong Thanh Nguyen, Hirofumi Nakaoka, Shigeki Mitsunaga, Hiromichi Aoyama, Hiroshi Kitamura, Kenichi Saigo, Ituro Inoue","doi":"10.1007/s10157-026-02889-8","DOIUrl":"10.1007/s10157-026-02889-8","url":null,"abstract":"<p><strong>Background: </strong>Non-invasive biomarkers are essential for monitoring transplant health, particularly for detecting acute rejection. Donor-derived cell-free DNA (dd-cfDNA) has emerged as a promising biomarker in solid organ transplantation, but optimized methodology and comprehensive evaluation in kidney transplantation (KTx), especially in Japan, are currently limited.</p><p><strong>Methods: </strong>We developed a customized approach for dd-cfDNA quantification and evaluated its utility as a biomarker in KTx. In this prospective longitudinal study, 322 blood samples were collected from 39 KTx recipients, mostly within the first year and up to 5 years post-transplant. Quantification was performed using a modified targeted sequencing protocol using a 1,000-SNP probe panel tailored to East Asian genetic backgrounds. The resulting dd-cfDNA values were correlated with clinical parameters and histological findings.</p><p><strong>Results: </strong>General longitudinal dynamics of dd-cfDNA in KTx patients were comprehensively described. Elevated dd-cfDNA was consistently associated with acute rejection and graft injuries. In particular, dd-cfDNA significantly distinguished rejection from non-rejection episodes (p = 1.9 × 10^- 4) and showed moderate consistency with serum markers and biopsy findings. Noticeable surges of dd-cfDNA were reported in antibody-mediated rejection and various forms of kidney injury. Distinct from conventional serum markers, dd-cfDNA exhibited a significant inverse correlation with immunosuppressant trough levels (Spearman's rho = - 0.25, p = 8 × 10^- 3).</p><p><strong>Conclusions: </strong>Our study demonstrated that dd-cfDNA is a robust, non-invasive biomarker for detecting allograft rejection and injury in KTx and is superior for monitoring patients' immunosuppressive response. We also present a scalable, cost-effective sequencing-based methodology for quantifying dd-cfDNA, suitable for clinical application.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1368-1379"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142911","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":"Anemia prevalence and treatment patterns in chronic kidney disease: a nationwide observational study using a Japanese primary care database (2018-2023).","authors":"Tetsuhiro Tanaka, Shinji Asada, Kohei Suzuki, Yuki Toyoshima","doi":"10.1007/s10157-026-02873-2","DOIUrl":"10.1007/s10157-026-02873-2","url":null,"abstract":"<p><strong>Background: </strong>Anemia in chronic kidney disease (CKD) is associated with poor outcomes, including CKD progression, mortality, and cardiovascular events. Standard treatments include iron supplements and injectable erythropoiesis-stimulating agents (ESAs). Oral hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PHIs) have recently emerged as a new treatment option, providing easier accessibility for general practitioners.</p><p><strong>Methods: </strong>This real-world descriptive study used the Japan Medical Data Survey database to analyze the prevalence of anemia, anemia treatment, and treatment type in non-dialysis patients with CKD and treated in primary care clinics. Data from 1 January 2018 to 31 December 2023 were assessed and analyzed by subgroups (year, CKD stage, patient age, treatment setting, sex, and region).</p><p><strong>Results: </strong>This study included 397,419 patients. Anemia treatment rates increased from 16.4% (2018) to 22.7% (2023), accompanied by an increased proportion of patients with hemoglobin levels ≥ 11 g/dL (78.8%-87.9%). From 2020, use of HIF-PHIs increased and use of ESAs decreased, with HIF-PHIs overtaking ESAs in 2022-2023. During 2022-2023 (N = 340,398), patients with more severe CKD stages had lower hemoglobin levels and an increased prevalence of anemia (11.6% [CKD G3a]-73.6% [CKD G5]). Older patients tended to have lower hemoglobin values, increased anemia prevalence, more severe CKD, and increased use of HIF-PHIs and ESAs.</p><p><strong>Conclusion: </strong>Use of HIF-PHIs in primary care settings in Japan is increasing, resulting in changes to anemia treatment received by patients with CKD.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":"1292-1302"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351095","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":"Inflammatory and traditional risk factors associated with the progression of chronic kidney disease in patients with rheumatoid arthritis.","authors":"Masafumi Sugiyama, Sayo Morita, Takashi Tsuchimoto, Saki Tsuchimoto, Chise Minami, Koji Kinoshita, Shinya Rai","doi":"10.1007/s10157-026-02937-3","DOIUrl":"https://doi.org/10.1007/s10157-026-02937-3","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a significant comorbidity in patients with rheumatoid arthritis (RA). The relative contributions of inflammatory and traditional renal risk factors to CKD progression remain unclear.</p><p><strong>Methodology: </strong>We retrospectively analyzed 601 RA patients. Renal function and urinary abnormalities were assessed using creatinine-based estimated glomerular filtration rate (eGFR) and urinary albumin. We examined the factors associated with high or very high CKD risk in KDIGO heatmap and progression of CKD stage over five years using two models: logistic regression and Cox proportional hazards models. Furthermore, Propensity score methods were used to assess the association between methotrexate (MTX) use and CKD stage progression.</p><p><strong>Results: </strong>CKD stage progression occurred in 106 patients. Both inflammatory and traditional renal risk factors were associated with high or very high CKD risk. In Cox analyses, age, lower baseline eGFR, anemia, and CRP ≥0.5 mg/dL were associated with CKD stage progression. In patients with baseline eGFR ≥60 mL/min/1.73 m², CRP ≥0.5 mg/dL was independently associated with progression, whereas proteinuria and albuminuria were more relevant in patients with baseline eGFR <60 mL/min/1.73 m². After adjusting for confounding variables using propensity score matching, there was no association between MTX use and an increased risk of kidney stage progression.</p><p><strong>Conclusions: </strong>Risk factors for CKD progression in RA may differ according to baseline eGFR. In patients with preserved eGFR, residual inflammation appears to be a relevant factor. In contrast, proteinuria, albuminuria, and anemia are more significant in patients with reduced eGFR.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857087","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":"Nationwide attribute-based cross-classification reveals distinct risk patterns of major complications in ADPKD.","authors":"Hiroshi Kataoka, Saori Nishio, Junichi Hoshino, Keiju Hiromura, Yoshitaka Isaka, Satoru Muto","doi":"10.1007/s10157-026-02938-2","DOIUrl":"10.1007/s10157-026-02938-2","url":null,"abstract":"<p><strong>Background and hypothesis: </strong>Autosomal dominant polycystic kidney disease (ADPKD) imposes a substantial burden through diverse renal and extrarenal complications; however, risk-based screening strategies remain insufficiently aligned with patient heterogeneity. We hypothesized that attribute-based cross-classification would identify clinically meaningful risk patterns beyond conventional single-factor approaches.</p><p><strong>Methods: </strong>We analyzed anonymized nationwide registry data (2015-2021) from 12,466 patients with ADPKD. Multivariable logistic regression assessed associations between six prespecified attributes-sex, age, CKD stage, hypertension, total kidney volume, and annual total kidney volume growth rate-and eight major complications. Attribute-based cross-classification was used to describe absolute prevalence patterns across clinically interpretable subgroups.</p><p><strong>Results: </strong>Complication burden was substantial, with liver cysts (86.1%), kidney pain (29.7%), and intracranial aneurysms (18.5%) being most common. Distinct attribute-specific patterns were observed: intracranial aneurysms were more frequent in women and older individuals, whereas intracranial hemorrhage was strongly associated with hypertension. Advanced CKD was associated with multiple complications, whereas liver cysts and kidney pain followed different patterns. Cross-classification identified distinct prevalence patterns, including 25.3% among women aged ≥ 50 years for intracranial aneurysms and 31.9% among patients aged < 50 years with CKD stages 4-5 for gross hematuria/cyst bleeding.</p><p><strong>Conclusions: </strong>Attribute-based cross-classification revealed clinically meaningful heterogeneity in ADPKD complications. Distinct combinations of patient attributes defined clinically relevant prevalence patterns that may support risk-stratified screening and monitoring strategies in ADPKD. Importantly, this approach provides a clinically interpretable and scalable framework that may be applicable to routine care without reliance on complex modeling.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825776","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":"Real-world long-term outcomes and safety of avacopan for antineutrophil cytoplasmic antibody-associated vasculitis with advanced renal dysfunction: a multicenter cohort study (4U-AAV Study).","authors":"Kumiko Muta, Kenta Torigoe, Emi Hasegawa, Mineaki Kitamura, Akihiro Fukuda, Masao Kikuchi, Tetsu Miyamoto, Takeshi Nakata, Naoya Fukunaga, Shoichi Fujimoto, Tomoya Nishino","doi":"10.1007/s10157-026-02936-4","DOIUrl":"https://doi.org/10.1007/s10157-026-02936-4","url":null,"abstract":"<p><strong>Background: </strong>Avacopan is a promising steroid-sparing option for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV); however, its efficacy and safety in high-risk patients, such as those with severe renal dysfunction, remain unclear.</p><p><strong>Methods: </strong>This retrospective observational study (4U-AAV study) analyzed adult patients newly diagnosed with AAV and ANCA-associated glomerulonephritis in six medical centers in Kyushu, Japan. Patients treated with avacopan were evaluated, and those receiving conventional therapy were used as a reference. The primary outcomes were all-cause mortality or initiation of maintenance renal replacement therapy, and the secondary outcomes included complete remission, AAV- or treatment-related complications, and drug-related adverse events.</p><p><strong>Results: </strong>Seventy-four patients were enrolled, of whom 20 received avacopan. With avacopan, the median estimated glomerular filtration rate was 15.4 (interquartile range [IQR]: 9.2-38.0) mL/min/1.73 m², and the median proteinuria was 3.2 (IQR: 1.2-6.3) g/gCr. During the 24-month follow-up, no deaths occurred in the avacopan-treated patients. The proportions of patients requiring maintenance kidney replacement therapy and achieving complete remission at 6 and 12 months appeared descriptively comparable to those receiving conventional treatment. The cumulative incidence of infections over 24 months was 16.2% with avacopan, whereas 50.2% with conventional treatment. Liver enzyme level elevation as adverse events was observed in 37.2% and 15.5% with avacopan and conventional treatment, respectively.</p><p><strong>Conclusion: </strong>In real-world practice, long-term renal outcomes of avacopan appeared descriptively comparable to those of conventional therapy in patients with AAV and renal dysfunction; however, elevated liver enzyme levels were frequent, highlighting the need for careful monitoring and further prospective studies.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825783","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 of angiotensin receptor-neprilysin inhibitor therapy with changes in eGFR slope and home blood pressure in patients with chronic kidney disease.","authors":"Akio Namikawa, Yuko Shibuya, Daiki Yoshino, Dai Sato, Yoshitaka Furuto","doi":"10.1007/s10157-026-02934-6","DOIUrl":"https://doi.org/10.1007/s10157-026-02934-6","url":null,"abstract":"<p><strong>Background: </strong>Evidence regarding the renoprotective effects of angiotensin receptor-neprilysin inhibitor (ARNI) in patients with chronic kidney disease (CKD) remains limited. We investigated the association of ARNI initiation with changes in estimated glomerular filtration rate (eGFR) slope and home blood pressure in patients with non-dialysis CKD.</p><p><strong>Methods: </strong>This retrospective single-center study included 89 patients with non-dialysis CKD who were switched from renin-angiotensin system inhibitors to sacubitril/valsartan because of insufficient blood pressure control. Changes in eGFR slope before and after ARNI initiation were evaluated using linear mixed-effects models. Associations between post-treatment home systolic blood pressure (post-HSBP) and eGFR slope were also assessed.</p><p><strong>Results: </strong>Mean age was 72 ± 11 years, and baseline eGFR was 29 ± 15 mL/min/1.73 m². The eGFR slope changed from - 3.81 to - 1.28 mL/min/1.73 m²/year after ARNI initiation, corresponding to a slope difference of + 2.52 mL/min/1.73 m²/year (95% CI, 1.98 to 3.06; P < 0.001). Home blood pressure decreased from 136 ± 13/79 ± 12 to 130 ± 10/75 ± 10 mmHg (both P < 0.01). Lower post-HSBP was associated with greater attenuation of eGFR decline in the interaction analysis (β =  - 0.83, 95% CI - 1.51 to - 0.14; P = 0.018). ARNI was generally well tolerated throughout the observation period.</p><p><strong>Conclusions: </strong>In patients with non-dialysis CKD, ARNI initiation was associated with attenuation of eGFR decline and improved blood pressure control. Better home blood pressure control was associated with greater attenuation of eGFR decline. These findings support a potential role of ARNI as a treatment option for patients with CKD and insufficient blood pressure control despite RAS inhibitor therapy.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788980","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":"Longitudinal associations between albuminuria and renal function and annual brain volume changes: the Ohasama study.","authors":"Shingo Nakayama, Michihiro Satoh, Satoshi Yamaguchi, Ayana Saito, Hiroki Nobayashi, Megumi Tsubota-Utsugi, Yukako Tatsumi, Takahisa Murakami, Takahito Yagihashi, Maya Toyama, Takuo Hirose, Azusa Hara, Takefumi Mori, Kei Asayama, Naoko Mori, Masahiro Kikuya, Kyoko Nomura, Hirohito Metoki, Takayoshi Ohkubo","doi":"10.1007/s10157-026-02927-5","DOIUrl":"https://doi.org/10.1007/s10157-026-02927-5","url":null,"abstract":"<p><strong>Background: </strong>Longitudinal studies have not examined the associations between albuminuria and renal function and changes in brain volume. Therefore, we investigated it in a general Asian population after excluding individuals with antihypertensive medication use and accounting for loss to follow-up bias.</p><p><strong>Methods: </strong>We analyzed data from 114 participants aged ≥ 50 years without a history of ischemic heart disease, stroke, or antihypertensive treatment in Ohasama town, Japan. Brain volumes were measured using magnetic resonance imaging. Multiple linear regression was performed to assess the associations between urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) and annual symmetric percentage change (ASPC) in brain volume after adjusting for covariates. Dropout bias was adjusted using inverse probability weighting (IPW).</p><p><strong>Results: </strong>The mean age of participants was 66.9 years, 72.8% of whom were women, and the mean follow-up period was 4.78 years. After IPW, high UACR was associated with ASPCs in the frontal lobe (standardized regression coefficient [β] = - 0.24, 95% confidence interval [CI] = - 0.43 to - 0.056, P = 0.011), cingulate gyrus (β = - 0.18, 95% CI = - 0.35 to - 0.0081, P = 0.040), parahippocampal gyrus (β = - 0.20, 95% CI = - 0.38 to - 0.026, P = 0.025), and insula (β = - 0.19, 95% CI = - 0.37 to - 0.018, P = 0.031), and eGFR was not associated with ASPCs in any brain region. However, these associations did not remain significant after correction for multiple comparisons.</p><p><strong>Conclusion: </strong>We found associations between albuminuria and volume decline in the frontal lobe, cingulate gyrus, parahippocampal gyrus, and insula. Albuminuria may be associated with regional brain volume decline.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789074","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":"Clinical rather than genetic factors predict hepatic cyst burden and growth in autosomal dominant polycystic kidney disease: a cohort study of 332 genotyped patients.","authors":"Keiji Takahashi, Haruna Kawano, Tomoki Kimura, Yan Lu, Satoru Muto, Shigeo Horie","doi":"10.1007/s10157-026-02935-5","DOIUrl":"https://doi.org/10.1007/s10157-026-02935-5","url":null,"abstract":"<p><strong>Background: </strong>Autosomal dominant polycystic kidney disease (ADPKD) frequently involves polycystic liver disease (PLD), which can impair quality of life. While genotype strongly predicts renal outcomes, determinants of hepatic cyst burden and progression remain unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed 332 genotyped patients with ADPKD. Total liver volume was quantified on serial CT to calculate height-adjusted TLV (HtTLV) and annual percentage growth (ΔHtTLV/year). To reduce baseline dependency inherent to ratio-based outcomes, we additionally evaluated a log-transformed growth metric (log[HtTLV2/HtTLV1]/year). Associations with demographic, clinical, and medication factors were examined using multivariable linear regression.</p><p><strong>Results: </strong>Genotype was not associated with hepatic cyst prevalence, baseline HtTLV, or growth. Greater hepatic cyst burden (HtTLV) was independently associated with female sex, Mayo class C-E, smoking history, and higher BMI. For progression, calcium channel blocker (CCB) use remained independently associated with higher growth in both ΔHtTLV/year and log-transformed models, whereas other antihypertensive classes were not. Baseline HtTLV was strongly associated with subsequent growth across models.</p><p><strong>Conclusions: </strong>In this cohort, clinical factors were more closely associated with PLD burden and progression than genotype. CCB exposure was consistently associated with higher hepatic growth metrics; however, because residual confounding by indication remains possible, causality cannot be inferred. Nevertheless, this association represents a clinically important hypothesis that should be evaluated in future prospective studies.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789023","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}