Clinical nephrology最新文献

{"title":"Thomas Willis (1621 - 1675): First steps into kidney function.","authors":"Livia Ann Frost, Garabed Eknoyan","doi":"10.5414/CN111802","DOIUrl":"10.5414/CN111802","url":null,"abstract":"<p><p>This review analyzes the pivotal but underrecognized contribution of Thomas Willis (1621 - 1675) to the foundations of kidney function in the 17^th century. By comparing his early work <i>De Urinis</i> (1659), which interpreted urinary diagnosis through humoral traditions, with his subsequent <i>Pharmaceutice Rationalis</i> (1674 - 1675) we document a paradigm shift: progress from considering the kidney a passive filter to proposing it as an active regulatory organ that balanced urinary salts through tubular function. Building on the cardiac pump and blood circulation model of William Harvey and the tubular structure of the kidney of Lorenzo Bellini, Willis rejected the Galenic physiology that the kidney attracted blood because it was in its nature to do so in favor of a mechanical model of \"straining or percolation\" driven by the force of circulating blood. Willis also considered diabetes a blood disorder rather than a kidney disease, noting that diabetic urine differed from imbibed fluids being sweet \"as it were imbued with Honey or Sugar\". These conceptual advances - developed without microscopic evidence or chemical analysis - reveal a remarkable inductive reasoning. Documented by subsequent observations, Willis' work established three critical principles: the blood-clearing function of the kidney depends on circulatory dynamics, tubules modify urine composition, and urinary changes reflect systemic physiology rather than just renal pathology. His renal model, though incomplete, provided the first systematic framework for homeostasis that would be developed in the 19^th century. His writings clearly mark the initial but fundamental first steps in the evolution of our current understanding of kidney function.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"74-81"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336801","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; 103: 200-212.","authors":"Chen-Li Li, Yu-Qian Jiang, Wei Pan, Yan-Li Yang","doi":"10.5414/CN111509Cor","DOIUrl":"10.5414/CN111509Cor","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"82"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667259","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":"Renal manifestations of immune checkpoint inhibitors in the pediatric population.","authors":"Lydia Noh, Matthew Satariano, Jieji Hu, Elena Levtchenko, Rupesh Raina","doi":"10.5414/CN111756","DOIUrl":"10.5414/CN111756","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment and have become an essential part of therapy, but their use is associated with immune-related adverse events (irAE). Specifically, nephrotoxicity is well documented in adult populations but data regarding irAEs are limited in pediatric populations. This review examines the renal manifestations of ICIs and relevant clinical measures and treatments.</p><p><strong>Materials and methods: </strong>A comprehensive review of existing literature was conducted to assess the incidence, pathophysiology, and management of ICI-associated renal injuries in pediatric and adult populations.</p><p><strong>Results: </strong>The most common renal irAE associated with ICIs is acute kidney injury; however, ICIs have been implicated in transplant rejection and electrolyte disturbances including hyponatremia, hyperkalemia, hypophosphatemia, and metabolic acidosis. Pediatric ICI manifestation patterns are similar to those in adults, but research suggests earlier onset compared to adults. Though corticosteroids are the primary treatment for irAEs, standardized pediatric management guidelines require further improvement.</p><p><strong>Conclusion: </strong>ICIs carry concerning risks in pediatric populations, yet research in this area is lacking. This warrants further research into the recognition, treatment, and prevention of renal irAEs, particularly for the improvement of long-term outcomes.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"56-73"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343763","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":"Feasibility of nephrology electronic consults in an inner-city population.","authors":"Ewalola Ayo Ijaduola, Alexander Quarshie, Chamberlain Obialo","doi":"10.5414/CN111771","DOIUrl":"10.5414/CN111771","url":null,"abstract":"<p><strong>Background: </strong>In the United States (U.S.), economically disadvantaged populations have reduced access to subspecialty care. To improve accessibility to nephrology care early in the clinical course of chronic kidney disease (CKD), we designed a feasibility pilot study for electronic consults (eCons).</p><p><strong>Materials and methods: </strong>This retrospective cohort study evaluated eCons referral patterns, patient demographics, comorbidities, and rates of in-person visits following eCons. Our suggested referral criteria included CKD stages 1 - 3a with a urine albumin-creatinine ratio (UACR) < 300 mg/g, resistant hypertension, abnormal kidney imaging or urine sediment, electrolyte abnormalities, and nephrolithiasis.</p><p><strong>Results: </strong>A total of 103 patients completed eCons over a 12-month period. 98% self-identified as African Americans, and 2% as Caucasians. The rates of subsequent in-person visits for patients with CKD stages 2, 3a, 3b, 4, and 5 were 5/9 (56%), 8/28 (29%), 34/38 (90%), 11/14 (79%), and 9/9 (100%), respectively. Among the 103 patients, 40 (39%) had macroalbuminuria (UACR > 300 mg/g), and 51 (50%) had diabetes mellitus. The rates of subsequent in-person visits for patients with macroalbuminuria and diabetes mellitus were 87.5% and 76%, respectively. Patients with macroalbuminuria had greater odds of subsequent in-person visits than did those without macroalbuminuria, adjusted for age and sex (AOR, 6.15; 95% confidence interval (CI), 2.08 - 18.16; p = 0.001). Patients with diabetes mellitus were also more likely to have subsequent in-person visits than were those without diabetes mellitus (OR, 2.38; 95% CI, 1.02 - 5.57; p = 0.04).</p><p><strong>Conclusion: </strong>Electronic consultations are beneficial in the early CKD stages and in patients without diabetes or macroalbuminuria. In addition, both macroalbuminuria and diabetes influence the need for subsequent in-person evaluation.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"19-25"},"PeriodicalIF":1.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336803","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":"Rituximab for double-positive anti-GBM antibody and ANCA-associated glomerulonephritis: The first reported case in Asia and literature review.","authors":"Chang-Ying Chen, Ying-Ren Chen, Wei-Ren Lin, Wei-Hung Lin","doi":"10.5414/CN111588","DOIUrl":"10.5414/CN111588","url":null,"abstract":"<p><strong>Background: </strong>Double-positive patients exhibit both anti-glomerular basement membrane antibody and anti-neutrophil cytoplasmic antibody. Its initial treatment includes induction cyclophosphamide, glucocorticoids, and plasmapheresis, followed by maintenance therapy similar to that for anti-neutrophil cytoplasmic antibody-associated vasculitis. However, some patients suffer from refractoriness and intolerance to cyclophosphamide, creating an unmet need for second-line therapy. Moreover, no guidance has been provided on the choice of immunosuppressant agents for maintenance therapy.</p><p><strong>Case presentation: </strong>A 55-year-old Asian woman presented with post-prandial vomiting and a persistent high fever for 1 month. She was diagnosed as a double-positive patient after developing rapidly progressive glomerulonephritis, with a creatinine level of 332 μmol/L. She received induction therapy with cyclophosphamide, glucocorticoids, and plasmapheresis soon after diagnosis. However, worsening renal function and severe nausea and vomiting occurred after 3 monthly doses of cyclophosphamide. Four weekly doses of re-induction rituximab at 375 mg/m², followed by maintenance rituximab 500 mg every 6 months, were administered. The patient had a stable creatinine level of 208 μmol/L 17 months after diagnosis.</p><p><strong>Conclusion: </strong>Rituximab may be a viable alternative as an induction therapy for double-positive patients when first-line cyclophosphamide is not effective or is not tolerated. Moreover, rituximab may be an effective maintenance therapy for double-positive patients. This case study demonstrates not only the efficacy of rituximab in double-positive patients but also reports the first Asian case of the disorder treated successfully with rituximab.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"434-439"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079686","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":"The causal association of colorectal cancer on the risk of membranous nephropathy: A Mendelian randomization study.","authors":"Zhanxin Zhu, Jin Zhao, Yunlong Qin, Jinguo Yuan, Yumeng Zhang, Anjing Wang, Mei Han, Qiao Zheng, Xiaoxuan Ning, Shiren Sun","doi":"10.5414/CN111557","DOIUrl":"10.5414/CN111557","url":null,"abstract":"<p><strong>Background: </strong>Studies have suggested that colorectal cancer (CRC) and membranous nephropathy (MN) could be associated with each other. However, the existing conventional research methods fail to establish a conclusive relationship between the two conditions.</p><p><strong>Materials and methods: </strong>The genome-wide association data for CRC and MN were obtained from previously published genome-wide association studies (GWAS). Inverse variance weighted (IVW), weighted median, weighted mode, and Mendelian randomization (MR)-Egger regression, were employed to analyze the data. Sensitivity analyses were conducted using the heterogeneity test, pleiotropic test, and leave-one-out test. Additionally, a reverse MR analysis was conducted to evaluate any potential reverse causal effects.</p><p><strong>Results: </strong>The IVW analysis provided strong evidence supporting a causal link between CRC and MN (odds ratio (OR), 1.485; 95% confidence interval (CI), 1.131 - 1.951, p = 0.004). Similar findings were obtained from the weighted median analysis (OR, 1.515; 95% CI, 1.120 - 2.051, p = 0.007) and the weighted mode (OR, 1.572; 95% CI, 0.996 - 2.480, p = 0.084). The MR-Egger regression results indicated that the presence of horizontal pleiotropy was unlikely to bias the findings (intercept, -0.047; p = 0.611). MR-Egger regression did not show any causal association between CRC and MN (OR, 2.075; 95% CI, 0.584 - 7.373, p = 0.292). Reverse MR analysis suggested that MN is not a causative factor for CRC. Cochran's Q test, the funnel plot, and leave-one-out sensitivity analysis demonstrated the robustness of the MR study.</p><p><strong>Conclusion: </strong>Based on the genetic evidence obtained from this MR study, it can be concluded that CRC may serve as a risk factor for the development of MN. These findings will facilitate a future understanding of the mechanisms underlying MN.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"369-379"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291139","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":"Resolution of acute kidney injury following intensive dialysis for oxalate nephropathy.","authors":"John R Roth, Alessia Buglioni, Neera K Dahl","doi":"10.5414/CN111664","DOIUrl":"10.5414/CN111664","url":null,"abstract":"<p><p>Oxalate nephropathy refers to the deposition of calcium oxalate crystals within the renal parenchyma. The subsequent tubular-interstitial inflammation results in acute kidney injury and/or chronic kidney disease. This condition occurs in the setting of hyperoxaluria or increased urinary excretion of oxalate. Enteric hyperoxaluria is an increasingly recognized cause of secondary hyperoxaluria in which fat malabsorption promotes increased absorption of dietary oxalate. In the context of increasing utilization of bariatric procedures to address obesity, those who have undergone biliopancreatic diversions represent a growing subset of patients who later develop oxalate nephropathy. Presently, management options for affected individuals are limited to dietary interventions, and renal outcomes are poor. We present a case of stage III acute kidney injury from oxalate nephropathy in a bariatric patient who demonstrated renal recovery after decreasing serum oxalate levels through an early, intensive dialysis regimen.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"440-445"},"PeriodicalIF":1.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198408","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":"Age and sex-specific association between dyslipidemia treatment and mortality in elderly Korean hemodialysis patients: A retrospective cohort study by the Korean Society of Geriatric Nephrology.","authors":"Seong Geun Kim, Eun Hee Park, Woo Yeong Park, Jang-Hee Cho, Byung Chul Yu, Miyeun Han, Sang Heon Song, Gang-Jee Ko, Jae Won Yang, Sungjin Chung, Yu Ah Hong, Young Youl Hyun, Eunjin Bae, In O Sun, Hyunsuk Kim, Won Min Hwang, Sung Joon Shin, Soon Hyo Kwon, Hyoungnae Kim, Kyung Don Yoo","doi":"10.5414/CN111681","DOIUrl":"10.5414/CN111681","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are critical public health issues in South Korea, with an increasing number of dialysis patients. Cardiovascular outcomes, significantly affected by dyslipidemia, remain the leading cause of morbidity and mortality. This study explores the age and sex-specific impacts of dyslipidemia treatment on mortality in elderly hemodialysis patients.</p><p><strong>Materials and methods: </strong>We conducted a retrospective cohort study with 2,736 newly diagnosed hemodialysis patients aged 70 years and older from 16 Korean hospitals (January 2010 to December 2017). The impact of statin therapy on mortality was assessed considering baseline characteristics, comorbidities, and lipid profiles. Statistical analyses included Kaplan-Meier survival curves and Cox proportional hazards models with covariate adjustments.</p><p><strong>Results: </strong>Statin use significantly reduced all-cause mortality in both men and women (hazard ratio (HR), 0.76 (0.66 - 0.87) in men; HR, 0.85 (0.73 - 0.99) in women). This benefit was not statistically significant in patients aged 80 and above, especially among females. An inverse relationship between low-density lipoprotein (LDL) levels, and mortality was observed in men, while a U-shaped relationship was noted in females. The unfavorable effects associated with lower LDL levels were more pronounced in the female group.</p><p><strong>Conclusion: </strong>Dyslipidemia treatment improves survival in elderly hemodialysis patients, particularly in males, though benefits diminish in those aged 80 and above. Effective patient outcomes require addressing malnutrition and inflammation alongside lipid levels. Further research is necessary to refine treatment guidelines for this demographic.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"293-302"},"PeriodicalIF":1.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945162","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":"Avacopan for ANCA-associated vasculitis: Beyond the 52-week treatment course.","authors":"Ella Eisinger, Abdallah S Geara, Bryan Chang, Preethi Reddivari, Julia Ford, Ora Gewurz-Singer, Duvuru Geetha","doi":"10.5414/CN111775","DOIUrl":"10.5414/CN111775","url":null,"abstract":"<p><p>The landmark ADVOCATE trial, which lead to the approval of Avacopan (AVP) as adjunctive treatment of ANCA-associated vasculitis (AAV), treated patients with AVP for 52 weeks. In the real-world, some patients are prescribed AVP for a longer duration. In this study, we performed a multi-center retrospective cohort study of 15 adult patients with new and relapsing AAV treated with AVP for a duration of 52 weeks or longer. During a mean follow-up period of 96 (21) weeks, 1/15 patients experienced AAV flare, and none progressed to end-stage kidney disease. On last follow-up, the mean estimated glomerular filtration rate (eGFR) rise from baseline was 16 mL/min/1.73m². Infections were the most reported adverse effects including 5 infections requiring hospitalization. No abnormal liver function tests were reported during these prolonged courses of AVP beyond 52 weeks. AVP therapy for AAV showed excellent remission rates with marked improvement of the eGFR at 26- and 52-weeks follow-up. By prolonging the treatment with AVP beyond 52 weeks, the improvement in eGFR was sustained during the additional AVP treatment period. Infection complications were the most observed adverse effects. Further data on the longer-term use of AVP is needed.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"338-342"},"PeriodicalIF":1.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144741359","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":"The effects of switching from etelcalcetide to upacicalcet in hemodialysis patients with secondary hyperparathyroidism.","authors":"Eiichi Sato, Miyako Urata, Shohei Sato, Takao Ono, Manaka Degawa, Hongmei Lu, Mayumi Nomura, Daisuke Matsumura, Noriaki Moriyama, Mayuko Amaha, Tsukasa Nakamura","doi":"10.5414/CN111695","DOIUrl":"10.5414/CN111695","url":null,"abstract":"<p><strong>Aims: </strong>No English-language research papers have reported on the clinical use of upacicalcet, a novel intravenous calcimimetic agent for the treatment of secondary hyperparathyroidism (SHPT) in hemodialysis patients. Therefore, this study aimed to investigate the outcomes of switching from etelcalcetide to upacicalcet.</p><p><strong>Materials and methods: </strong>The subjects included 37 hemodialysis patients with SHPT treated with etelcalcetide before switching to upacicalcet. This study was a single-center retrospective study conducted in Japan. Serum levels of corrected calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), and the dose of maxacalcitol were assessed at 3 and 6 months after switching to upacicalcet.</p><p><strong>Results: </strong>As a result of the switch from etelcalcetide to upacicalcet, the serum corrected Ca level remained unchanged, from 8.9 ± 0.6 to 9.1 ± 0.7 mg/dL (p = 0.104) at 3 months and to 9.0 ± 0.6 mg/dL (p = 0.197) at 6 months. Meanwhile, the serum P level decreased from 6.3 ± 1.5 to 5.8 ± 1.5 mg/dL (p = 0.069) at 3 months and to 5.9 ± 1.9 mg/dL (p = 0.039) at 6 months. The iPTH level increased slightly, from 153.8 ± 100.3 pg/mL to 176.4 ± 124.6 pg/mL (p = 0.337) at 3 months and to 206.5 ± 168.7 pg/mL (p = 0.017) at 6 months. Multiple regression analysis revealed that the change in iPTH was related to the change in P levels.</p><p><strong>Conclusion: </strong>These findings suggested that upacicalcet may be a useful option for managing serum P levels in hemodialysis patients with SHPT.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"310-317"},"PeriodicalIF":1.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12573280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945174","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}