Clinical nephrology最新文献

{"title":"Clinicopathological correlation of Oxford MEST-C scores for IgA nephropathy in native renal biopsies: A single-center study.","authors":"Khushbu Agarwal, Kamal Kanodia, Shreya Solanki, Rashmi Patel, Kamlesh Suthar, Lovelesh Nigam, Drashti Thakkar, Twinkle Rajani","doi":"10.5414/CN111887","DOIUrl":"10.5414/CN111887","url":null,"abstract":"<p><strong>Introduction: </strong>IgA nephropathy (IgAN) is a common glomerulonephritis with varied clinical presentations across regions, showing more aggressive progression in Asians. However, its exact prevalence and clinicopathological profile in India remain unclear.</p><p><strong>Materials and methods: </strong>The study included all patients of all age groups with primary IgAN on kidney biopsy from March 2016 to December 2023. Clinical and pathological parameters were noted. The MEST-C scores were correlated with the serum creatinine level, proteinuria, and hematuria.</p><p><strong>Results: </strong>Of a total of 3,811 native renal biopsies, 218 (5.72%) revealed IgAN, out of which 183 (4.8%) had more than 8 viable glomeruli, allowing MEST-C scoring to be done. The mean age was 32.84 ± 14.22 years, and the male-to-female ratio was 1.5 : 1. At presentation, 53.2% had hypertension, 90% had microscopic hematuria, and 5% had gross hematuria. The mean proteinuria was 3.87 ± 3.67 g/day, with 52% showing nephrotic-range proteinuria and 48% showing nephrotic syndrome manifestation. Oxford MEST-C scoring revealed M1 in 97.8%, E1 in 30.1%, S1 in 60.1%, T1 in 46.4%, T2 in 3.8%, and crescents in 27.8% of biopsies. The mean serum creatinine was significantly higher in cases with E1, S1, T1/2, and C1/2 scores (p < 0.05). Hematuria was significantly higher (p < 0.05) with E1 scores. On follow-up (mean 35 months), patients who presented early with only mesangial hypercellularity had good prognosis while those with endocapillary hypercellularity, crescents, tubular atrophy, and interstitial fibrosis at the time of biopsy had poor prognosis.</p><p><strong>Conclusion: </strong>IgAN affects young individuals with diverse symptoms and rapid progression. In Western India, most patients present late, highlighting the need for early diagnosis and routine screening to improve outcomes.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"414-423"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510108","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":"Tocilizumab prevented the progression of AA amyloidosis derived from adult-onset Still's disease.","authors":"Kaoru Nakamaki, Goh Kodama, Kensei Taguchi, Kei Fukami","doi":"10.5414/CN111879","DOIUrl":"10.5414/CN111879","url":null,"abstract":"<p><p>Adult-onset Still's disease (AOSD) is a systemic inflammatory disease characterized by spiking fever, salmon-pink skin rash, and polyarthritis. Overproduction of interleukin (IL)-1 and IL-6 is one of the causes of AOSD, the pharmacological inhibition of which was proven to be effective. Meanwhile, uncontrolled AOSD causes several complications, such as reactive hemophagocytic lymphohistiocytosis; however, kidney involvement has been barely studied because of its rarity. We encountered a 54-year-old female with uncontrolled chronic AOSD who showed nephrotic range proteinuria, microhematuria, and rapid progressive glomerulonephritis. A kidney biopsy revealed amyloid A deposition, mes-angiolysis, crescent formation, and massive accumulation of macrophages. Steroid pulse therapy, followed by tocilizumab, a IL-6 receptor inhibitor, in combination with oral glucocorticoids dramatically improved kidney and cardiac manifestations with reduction in systemic inflammation. This case highlights the importance of regular monitoring of urinalysis in patients with AOSD, and the early recognition followed by anti-inflammatory treatment can stabilize kidney involvement.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"424-430"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156369","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":"Decoding inflammation: Novel biomarkers illuminate CRP dynamics in peritoneal dialysis patients.","authors":"Lijia Chen, Ling Chen, Lingyun Liu, Nan Mao, Li Zang, Weijing Lai","doi":"10.5414/CN111806","DOIUrl":"10.5414/CN111806","url":null,"abstract":"<p><strong>Objective: </strong>To identify factors linked to systemic inflammation and evaluate the predictive value of novel inflammatory biomarkers in peritoneal dialysis (PD) patients.</p><p><strong>Materials and methods: </strong>We enrolled 111 maintenance PD patients, stratified by C-reactive protein (CRP) into a normal group (CRP < 3 mg/L) and an inflammation group (CRP ≥ 3 mg/L). We compared clinical characteristics, laboratory parameters, and novel inflammatory biomarkers. Analyses included group comparisons, Spearman correlations between CRP and clinical parameters, multiple linear regression relating novel biomarkers to CRP, and binary logistic regression with receiver operating characteristic (ROC) analysis for predictive value.</p><p><strong>Results: </strong>The inflammation group had significantly lower urine volume, hemoglobin (HGB), prealbumin (pre-ALB), potassium (K), magnesium (Mg), and transferrin saturation (TSAT), but higher serum ferritin (SF) and white blood cell count (WBC) (p < 0.05). CRP positively correlated with age, neutrophils, monocytes, WBC, SF, glucose, glycated hemoglobin A1c (HbA1c), triglycerides, β2-microglobulin, and novel indices include systemic immune inflammation index (SII), platelet-lymphocyte ratio (PLR), platelet-albumin ratio (PAR), systemic inflammation response index (SIRI), albumin-prealbumin ratio (APR), and aggregate index of systemic inflammation (AISI) (p < 0.05). Negative correlations existed with HGB, pre-ALB, residual urea clearance index (Kt/V), residual creatinine clearance (CCr), residual glomerular filtration rate (GFR), and electrolytes (Na, Cl, Mg) (p < 0.05). Multiple linear regression identified AISI and APR as independent predictors of CRP levels. ROC analysis showed that the combination of AISI and APR had superior diagnostic utility for systemic inflammation compared to individual indices.</p><p><strong>Conclusion: </strong>Systemic inflammation in PD patients is associated with impaired nutrition, anemia, and reduced residual renal function. AISI and APR strongly correlate with CRP, and their combination significantly enhances prediction of systemic inflammation, providing a valuable clinical tool for risk stratification.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"361-369"},"PeriodicalIF":0.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510145","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":"Systemic effects of metabolic acidosis.","authors":"Raymond Chen, Caitlin Kumala, Lynh Vu, Biff F Palmer","doi":"10.5414/CN111953","DOIUrl":"10.5414/CN111953","url":null,"abstract":"<p><p>Metabolic acidosis is a primary reduction in serum bicarbonate concentration and a consequent decrease in blood pH, which has profound implications for systemic physiology. This literature review synthesizes the current evidence of metabolic acidosis's effect on cardiovascular, vascular, pulmonary, gastrointestinal, endocrine, musculoskeletal, renal, and metabolic systems. Cardiovascular effects include impaired cardiac contractility, altered ion exchange currents, and decreased β-adrenergic response. Vascular response is dependent on vessel size, promoting vasodilation in large arteries and vasoconstriction in small vessels via NO and Ca²⁺-dependent pathways. Pulmonary adaptations include hyperventilation, altered hemoglobin-oxygen affinity via the Bohr effect, and increased pulmonary vascular resistance. Gastrointestinal effects include activation of acid-sensitive neuronal pathways causing increased mucus gel thickness, HCO₃^- secretion, and mucosal blood flow. Endocrine effects include growth hormone resistance, decreased thyroid hormone secretion, and negative shifts in Ca²⁺-PO4- balance. Renal effects include predisposition to calcium-oxalate stones and acceleration of chronic kidney disease through inflammatory mechanisms. Overall, this review aims to explore the physiological effects of metabolic acidosis, highlighting mechanism contributing to organ dysfunction.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"341-351"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282462","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":"Impact of immune marker-based microinflammation on dialysis efficacy in diabetic nephropathy patients: Development of an early prediction model.","authors":"Meiyang Zhou, Haole Huang, Canxin Zhou","doi":"10.5414/CN111843","DOIUrl":"10.5414/CN111843","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD) is widely used for treating end-stage renal disease (ESRD) in diabetic nephropathy patients. Suboptimal dialysis outcomes are often linked to chronic microinflammation, yet predictive models integrating immune markers remain limited.</p><p><strong>Materials and methods: </strong>In this prospective cohort study, 236 diabetic nephropathy patients undergoing PD were categorized into high-inflammation (HI) and microinflammation (MI) groups based on serum levels of CRP, IL-6, and TNF-α. Clinical and biochemical data - including Kt/V, infection rates, and survival - were collected. Logistic regression was applied to identify predictors of poor dialysis outcomes and construct a predictive model.</p><p><strong>Results: </strong>The HI group showed significantly lower dialysis efficiency (Kt/V < 1.5), increased peritonitis and catheter infections, and reduced survival. Elevated CRP, IL-6, and TNF-α levels were observed alongside higher creatinine, urea nitrogen, fasting glucose, lipids, and notable electrolyte and acid-base imbalances. Logistic regression identified CRP, IL-6, TNF-α, Kt/V, infection rates, and selected biochemical markers as independent predictors of poor outcomes. The resulting predictive model yielded an AUC of 0.87, demonstrating strong discriminative power.</p><p><strong>Conclusion: </strong>Microinflammation is a key determinant of dialysis efficacy in diabetic nephropathy patients receiving PD. The proposed model, based on inflammatory and dialysis-related parameters, offers a promising approach for early risk stratification and personalized treatment. Further validation may enhance long-term management and survival outcomes in this population.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"308-317"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147371978","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":"Corrigendum for the article Clin Nephrol. 2025; 104: 318-327.","authors":"Ci Sun, Haixia Zhang, Ying Lu, Sheng Feng, Kai Song, Weiwei Li","doi":"10.5414/CN111702Cor","DOIUrl":"10.5414/CN111702Cor","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"360"},"PeriodicalIF":1.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466845","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 relevance of transplant renal vein stenosis in the early post-operative period.","authors":"Fu-Shun Pan, Gang Huang, Rong-Hai Deng, Ming Liu","doi":"10.5414/CN111945","DOIUrl":"10.5414/CN111945","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the progression of transplant renal vein stenosis (TRVS) in the early post-operative period and its impact on clinical outcomes.</p><p><strong>Materials and methods: </strong>This prospective study enrolled 23 consecutive patients with TRVS detected by contrast-enhanced ultrasound (CEUS). Duplex ultrasound (DUS) was performed on days 1, 30, and 90 after transplantation. The DUS measurements included peak velocity (PV) of stenosis and peak velocity ratio of stenosis to pre-stenosis (PV-ratio). The differences in DUS measurements across different timepoints were evaluated by linear mixed-effects model.</p><p><strong>Results: </strong>The mean serum creatinine (SCr) levels at days 30 and 90 were 131 (range, 46 - 196) μmol/L, and 103 (range, 70 - 136) μmol/L, respectively. Two TRVS cases were caused by mural thrombi, the remaining 21 cases were free of any surgical complications. The mean TRVS-PV at days 1, 30, and 90 were 335 ± 92, 221 ± 86, and 134 ± 59 cm/s, respectively. The mean PV-ratio at days 1, 30, and 90 were 9.3 ± 5.0, 3.5 ± 1.9, and 2.0 ± 1.3, respectively. Linear mixed-effects model revealed a significant main effect of timepoint on SCr, TRVS-PV, and PV-ratio (p < 0.01 for all), exhibiting a gradually declining trend. There was no significant main effect of timepoint on arterial parameters.</p><p><strong>Conclusion: </strong>TRVS unrelated to thrombotic causes in the early post-operative period is a transient finding not correlating with short-term outcome.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"325-332"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147372024","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":"Fibronectin glomerulopathy caused by genetic FN1 mutation: A case report and literature review.","authors":"Bairu Shi, Yang Xia, Kejia Li, Long Jin, Xian Sun, Hui Yu","doi":"10.5414/CN111907","DOIUrl":"10.5414/CN111907","url":null,"abstract":"<p><strong>Background: </strong>Fibronectin glomerulopathy (FGP), also known as fibronectin deposition glomerulopathy (GFND), is a rare hereditary autosomal dominant glomerular disease. Its clinical manifestations are proteinuria, hematuria, hypertension, and hyperkalemic distal renal tubular acidosis, which often progresses slowly to end-stage renal disease.</p><p><strong>Case description: </strong>We report a 21-year-old woman with fibronectin glomerulopathy who underwent renal puncture at the age of 10. The pathology was considered to be thrombotic microangiopathy, and it was not treated regularly. This time, renal puncture was performed again due to proteinuria combined with elevated serum creatinine. Light microscopy showed severe mesangial matrix hyperplasia of glomeruli with dense deposition and foam cell aggregation in capillary loops. Fibrinogen immunostaining was positive. Electron microscope showed severe hyperplasia of mesangial matrix, and a large amount of electron-dense matter deposited in mesangial area. Perfect genetic testing suggested that the FN1 gene was heterozygous for NM_212482.4 (c.2918A>G), that is, Y973C mutation. Therefore, she was diagnosed with fibronectin glomerulopathy and was given sacubitril valsartan sodium tablets 200 mg b.i.d. orally.</p><p><strong>Conclusion: </strong>We report a case of a patient with fibronectin glomerulopathy and review the literature of this disease. The disease often has insidious onset, and fibronectin deposition is a typical pathological change that can result. The disease slowly progresses to end-stage renal disease. At present, there is no specific treatment. It is advocated to use reninangiotensin-aldosterone system blockers to strictly control blood pressure and proteinuria, and the overall prognosis is poor. Genetic testing techniques may be helpful in early diagnosis of the disease.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"352-359"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123935","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, retrospective experience of glucagon-like peptide-1 receptor agonists in kidney transplant recipients: A single-center case series.","authors":"Priyamvada Singh, Melissa McGowan, Lauren Von Stein, Johanna Papanikolla, Annelise Nolan, Hannah Lingren, Noah Jagielski, Navdeep Singh, Shumei Meng, Todd Pesavento","doi":"10.5414/CN111893","DOIUrl":"10.5414/CN111893","url":null,"abstract":"<p><p>We conducted a retrospective chart review of adult kidney transplant recipients (KTxR) with type 2 diabetes treated with a glucagon-like peptide-1 receptor agonist (GLP-1RA). A total of 211, 207, 161, and 92 KTxR were followed for 6, 12, 36, and 60 months, respectively. Over 5 years, we observed statistically significant reductions in the primary endpoints of weight, HbA1c, and major adverse cardiovascular events (MACE). The mean weight reduction was as follows: 1.17 kg at 6 months (p < 0.006), 1.2 kg at 12 months (p < 0.03), 3.7 kg at 36 months (p < 0.0001), and 4.1 kg at 60 months (p = 0.001) compared to baseline. The HbA1c levels showed reductions of 0.6 mmol/mol at 6 months (p < 0.0001), 0.5 mmol/mol at 12 months (p = 0.0004), 0.3 mmol/mol at 36 months (p = 0.04), and 0.35 mmol/mol at 60 months (p = 0.35). MACE rates fell from 45.5% at GLP-1RA initiation to 18.9% during follow-up (OR 3.6 (2.3 - 5.6), p < 0.0001). Insulin requirements decreased from 50 to 27 units over 5 years. Kidney function reduces over time in KTx, likely secondary to hemodynamic or vascular-mediated risk factors, chronic immunosuppressive agents, treatment for rejections, and solitary transplanted kidney. In our study, estimated glomerular filtration rate (eGFR) not only stayed stable but also showed a trend towards improvement (eGFR improved from 50 to 53 mL/min/1.73m²). Further prospective randomized trials are needed to assess GLP-1RA efficacy and safety in KTxR.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"318-324"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466788","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":"Relationship of serum α-Klotho with diabetic kidney disease and mortality in diabetes: A population-based observational study.","authors":"Liling Zhang, Di Fan, Tingting Zhu, Lei Geng, Linwang Gan, Santao Ou, Defeng Yin, Yong Xu","doi":"10.5414/CN111769","DOIUrl":"10.5414/CN111769","url":null,"abstract":"<p><p>This study aimed to investigate the associations between serum α-Klotho levels and diabetic kidney disease (DKD), as well as all-cause mortality among individuals with diabetes. We included participants from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016. Multivariable logistic regression and Cox proportional hazards models were used to evaluate the relationships of serum α-Klotho with DKD and mortality, respectively. Restricted cubic splines were applied to examine potential nonlinear associations. Subgroup analyses were performed to assess the robustness of the findings. A total of 3,098 participants were enrolled. The fully adjusted odds ratio (95% confidence interval (CI)) for the association between serum α-Klotho and DKD was 0.47 (0.33, 0.67; p < 0.001). Similarly, the hazard ratio for all-cause mortality was 0.61 (0.36, 0.96; p = 0.043). Restricted cubic spline analyses revealed nonlinear relationships between serum α-Klotho and both DKD and all-cause mortality. Kaplan-Meier curves indicated that participants in the lower quartiles of serum α-Klotho had significantly reduced survival probabilities. After Bonferroni correction, subgroup analyses showed no significant interactions between serum α-Klotho and all-cause mortality across populations. In conclusion, serum α-Klotho is significantly associated with DKD and all-cause mortality in diabetes.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"297-307"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147372010","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}