Nephron最新文献

{"title":"Advance Care Planning as Key to Person-Centered Care: A Co-Design Study Involving Adults with Chronic Kidney Disease, Family Members, and Healthcare Professionals.","authors":"Christina Egmose Frandsen, Bettina Trettin, Ingrid Villadsen Kristensen, Hanne Agerskov","doi":"10.1159/000549599","DOIUrl":"10.1159/000549599","url":null,"abstract":"<p><strong>Introduction: </strong>Advance care planning is a process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. Advance care planning is recommended for adults with chronic kidney disease and is an approach to facilitating person-centered care. The approach is useful at all stages of the disease and not solely related to end of life or serious disease events but also concerns management of physical, emotional, and psychological challenges throughout the illness trajectory. Living with chronic kidney disease is burdensome, and there is a need for family members to be involved in the process to support their loved ones. Therefore, this study aimed to describe a co-design, pilot test, and evaluation of an ACP intervention for adults with CKD supported by their family members. Furthermore, the article explores and critically discusses how this approach aligns with principles around person-centered care.</p><p><strong>Methods: </strong>The project was inspired by the framework of complex interventions and divided into three phases, which consisted of four sub-studies: a cross-sectional survey, an interview study, workshops for intervention development, and a qualitative evaluation of the intervention. Qualitative studies were conducted with a phenomenological-hermeneutic approach inspired by Ricoeur's interpretation theory. Quantitative data were analyzed using both descriptive and inferential statistics managed by STATA. For intervention development, co-design was applied, and data were analyzed using the action research spiral.</p><p><strong>Results: </strong>Living with chronic kidney disease impacted family and everyday life and led to changes in family identity and roles for both adults with chronic kidney disease and family members. There was a desire for family members to be involved in the advance care planning process to be able to support their loved ones. Healthcare professionals experienced barriers to engaging in care planning, and they had a desire for a systematic and disease-specific approach. This knowledge was used to design an advance care planning intervention in close collaboration with the consumers with a focus on person-centered care and family. The advance care planning intervention supported an open dialog about thoughts and concerns and created a shared understanding and unique knowledge.</p><p><strong>Conclusion: </strong>The study provided valuable insights into the importance of supporting adults with chronic kidney disease in understanding and sharing their preferences and wishes for care and daily life and for involving family members in the ACP process to support their loved ones. Thus, an ACP intervention with a person-centered and family-focused approach was developed to improve care on an individual and family level throughout the illness trajectory. The ACP discussions were significant for adults w","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"244-256"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573446","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 Outcomes of Patients with Monoclonal Gammopathy of Renal Significance.","authors":"Gerard Gurumurthy, Jenna Fielding, Philip Crea, Durga A K Kanigicherla","doi":"10.1159/000553058","DOIUrl":"10.1159/000553058","url":null,"abstract":"<p><p><p>Background: Monoclonal gammopathy of renal significance (MGRS) is a rare group of renal disorders caused by monoclonal immunoglobulins from non-malignant B-cell or plasma cell clones, with distinct amyloid (MGRS-A) and non-amyloid (MGRS-NA) subtypes. Although these are often grouped together, whether they share similar clinical phenotypes and outcomes is uncertain. We therefore examined similarities and differences between these subtypes in a contemporary real-world cohort.</p><p><strong>Methods: </strong>We performed a single-centre retrospective evaluation of 17 biopsy-confirmed MGRS patients (10 MGRS-A, 7 MGRS-NA). Baseline parameters, treatment exposure, renal and haematologic responses, survival, and relapse were analysed descriptively with exploratory subgroup comparisons.</p><p><strong>Results: </strong>MGRS-NA patients presented with significantly worse baseline renal function (median estimated glomerular filtration rate 18.0 mL/min/1.73 m2 vs. 49.0 mL/min/1.73 m2 in MGRS-A, p < 0.05) and progressed faster to dialysis (p < 0.01). Haematologic responses (≥VGPR) were achieved in 57.1% of MGRS-NA and 50% of MGRS-A patients, but these did not significantly correlate with renal improvement. Survival was similar between groups, with deaths in 28.6% of MGRS-NA and 20% of MGRS-A. Relapse occurred in 47.1% of patients, with median times of 51 months in MGRS-NA and 69 months in MGRS-A. Treatment, primarily bortezomib-based chemotherapy, was associated with toxicities (94.1%), yet renal responses remained limited.</p><p><strong>Conclusion: </strong>The findings highlight the poor prognosis and rapid renal decline in MGRS-NA. We highlight the need for early diagnosis and an integrated renal-haematologic service to improve outcomes in this rare population. </p>.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"659-666"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252434","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":"Rhabdomyolysis and Acute Kidney Injury after the New York City Marathon.","authors":"Jordan L Rosenstock, Douglas R Farrell, Steven G Coca, Salman Millwala, Sahar Mahani, Miriam Chung, Jamie Hirsch, Lili Chan, Pooja A Gownivaripally, Gregg Husk, Maria V DeVita, Tonia Kim","doi":"10.1159/000552131","DOIUrl":"10.1159/000552131","url":null,"abstract":"<p><p><p>Background: The 2022 NYC Marathon was the hottest on record. At several hospitals near the race's finish, a larger volume of heat stress-related kidney injury was observed. We sought to examine the incidence of post-marathon rhabdomyolysis observed with respect to race day temperature and humidity.</p><p><strong>Methods: </strong>All charts of patients who had a creatine phosphokinase (CPK) level >5,000 U/L on the date of the marathon and subsequent 4 days for the years 2017-2023 at four NYC hospitals were reviewed. Patients were included for analysis if marathon participation was indicated in the chart and no other causes of rhabdomyolysis were evident. Race day heat was measured as heat index to capture the effects of both temperature and humidity.</p><p><strong>Results: </strong>In 2022, there were 24 runners with post-marathon rhabdomyolysis, compared to 15 total patients for the other 5 marathons combined. Cases of post-marathon rhabdomyolysis strongly correlated to race day heat index. In addition to record heat, the 2022 NYC Marathon had the largest change in heat as compared to the previous 14-day average. The 2022 cohort skewed male (20 male: 4 female), was on average 32.2 years of age, and presented within 2 days of the marathon. The average peak CPK was 21,426 IU/L (range 5,177 to 88,430 IU/L). All patients received intravenous fluids. Only 1 patient had a further rise in creatinine, reaching a peak of 8.69 mg/dL (from 5.81 on arrival) before starting hemodialysis.</p><p><strong>Conclusion: </strong>The 2022 NYC Marathon was the hottest on record, and was found to have the highest incidence of post-marathon rhabdomyolysis. Cases of rhabdomyolysis correlated with the race day heat index. Additionally, 2022 had the largest change in race day temperature, which may present an additional risk. </p>.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"583-590"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13299126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777045","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":"Lactitol-Induced Acute Kidney Injury with Oxalate Nephropathy: A Case Report.","authors":"Mijie Guan, Haofei Hu, Haiying Song, Qijun Wan","doi":"10.1159/000548254","DOIUrl":"10.1159/000548254","url":null,"abstract":"<p><strong>Introduction: </strong>Oxalate nephropathy, characterized by calcium oxalate crystal deposition in renal tissue, represents an underrecognized etiology of acute and chronic kidney injury. Secondary hyperoxaluria can emerge from diverse pathogenetic mechanisms, including excessive oxalate precursor intake, augmented intestinal absorption, or iatrogenic interventions. The therapeutic potential of glucocorticoids in managing this condition remains incompletely elucidated.</p><p><strong>Case presentation: </strong>A 66-year-old man with no significant prior medical history developed acute kidney injury (AKI), manifesting as a profound serum creatinine elevation from 81 µmol/L to 1,140.4 µmol/L. The patient had consumed a \"corn germ powder\" supplement containing lactitol for five consecutive months, concurrently experiencing persistent diarrhea. Initial laboratory investigations revealed severe renal dysfunction without notable proteinuria or hematuria. Renal ultrasonography demonstrated normal kidney morphology and dimensions. Definitive kidney biopsy revealed extensive calcium oxalate crystal deposition within renal tubular structures, conclusively diagnosing oxalate nephropathy. Therapeutic intervention comprised prednisone (60 mg daily) and comprehensive supportive management. Following a 3-month treatment protocol with gradual corticosteroid dose reduction, the patient's renal function demonstrated substantial improvement, with serum creatinine declining to 118.2 µmol/L.</p><p><strong>Conclusion: </strong>This case underscores lactitol-induced secondary oxalate nephropathy as a rare yet clinically significant contributor to AKI. Prompt diagnostic recognition and targeted therapeutic intervention, potentially incorporating glucocorticoid therapy, may substantially facilitate renal functional recovery. Clinicians should maintain heightened awareness of nephrotoxic risks associated with over-the-counter laxative supplements and consider oxalate nephropathy in cryptogenic renal dysfunction scenarios.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"99-106"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513623","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":"Mitochondria to the Rescue: Organelle Trafficking in Renal Health and Disease.","authors":"Luca Perico, Giuseppe Remuzzi, Ariela Benigni","doi":"10.1159/000550092","DOIUrl":"10.1159/000550092","url":null,"abstract":"<p><strong>Background: </strong>Mitochondria are central regulators of cellular metabolism, redox signaling, and apoptosis. Their dysfunction plays a pivotal role in the pathogenesis of kidney diseases, including acute kidney injury and diabetic nephropathy.</p><p><strong>Summary: </strong>Recent advances have unveiled horizontal mitochondrial transfer as a novel intercellular communication by which renal cells exchange mitochondria to promote tissue repair through the modulation of metabolic processes, oxidative stress, apoptosis, and fibrosis.</p><p><strong>Key findings: </strong>Horizontal mitochondrial transfer, mediated by tunneling nanotubes and extracellular vesicles, has emerged as a potential homotypic rescue mechanism between injured tubular and glomerular cells. In addition, heterotypic mitochondrial transfer from mesenchymal stromal cells to renal cells has been described. These findings open new perspectives for exploring therapeutic mitochondrial transplantation in both acute and chronic kidney diseases. Nonetheless, significant challenges remain, including elucidating the poorly characterized biological mechanisms underlying mitochondrial transfer, optimizing delivery strategies, and defining the long-term safety and efficacy of mitochondrial-based therapies.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"228-237"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794454","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":"Endothelial Glycocalyx: From Microscope Stage to Bedside.","authors":"Sara Conti, Michael S Goligorsky, Susanna Tomasoni","doi":"10.1159/000550816","DOIUrl":"10.1159/000550816","url":null,"abstract":"<p><strong>Background: </strong>It sounds paradoxical that a tiny component of the cellular mantle known as glycocalyx is also the most ubiquitous, more so than mitochondria or nuclei, endowing glycocalyx coverage to every cell with no exceptions. Despite a relatively short history, this organelle has received exponentially growing attention and number of publications as reflected in the last decade. This cellular mantle consists of 4 transmembrane proteins and 6 GPI-anchored proteins, all of which are decorated with glycosaminoglycans like heparan, chondroitin and dermatan sulfates, and hyaluronic acid. All this has been exhaustively reviewed.</p><p><strong>Summary: </strong>Our goal here will be to briefly sketch the important common features of glycocalyx, especially of endothelial cells, and to focus on clinically pertinent practical aspects of this structure. We will describe visual and biochemical detection challenges, highlight the usefulness of identifying and quantifying glycocalyx fragments in biological fluids while broadening the spectrum of specimens for diagnostic purposes, and discuss how these parameters may provide valuable clues regarding their therapeutic relevance as pharmacological targets.</p><p><strong>Key message: </strong>The glycocalyx represents a clinically valuable target and advances in its detection can enhance diagnostic precision and strengthen its translational relevance.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"402-411"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125744","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":"Water Consumption and Chronic Hemodialysis Therapy: Where Do We Stand? Where Must We Go? Review of Clinical Practices.","authors":"Charles Chazot, Romain Vial, Alain Birbes, Catherine Lasseur, Hafsah Hachad, Maxime Espi, Jocelyne Rey, Fabrice Huré, Isabelle Ethier, Maryvonne Hourmant","doi":"10.1159/000551009","DOIUrl":"10.1159/000551009","url":null,"abstract":"<p><strong>Background: </strong>Chronic hemodialysis therapy is a life-saving procedure requiring large amounts of water whereas this natural resource availability declines with increasing temperatures and the dialysis needs are far from being covered in many world areas.</p><p><strong>Summary: </strong>Reducing water consumption in hemodialysis relies on the moto \"reduce, reuse, and recycle.\" Because of a significant amount of water is discarded to the drain by the procedure, the efficiency of the reverse osmosis (RO) of the water treatment system is a key factor of water consumption during the hemodialysis session. Along decades, the RO devices have become more efficient, with a decrease of the rejected part of water from around 70 to below 30%. The optimization of the maintenance and disinfection procedures of the water loop, as well as the practice of acid concentrate delivery to the dialysis machine, can reduce significantly water needs. Reducing dialysate flow is also effective, even with convective modalities, but more studies are needed to confirm long-term patient safety. The co-decision with the patient on dialysis modality choice including alternatives to hemodialysis must take into account the environmental impact after appropriate information. Other aspects of water sparing are presented including, among others, the reuse of RO water reject and the spent dialysate recycling.</p><p><strong>Key message: </strong>Green dialysis including the water preservation must become a \"top of the list\" priority for all the dialysis stakeholders to preserve the access and the future of this tremendous progress of medical history.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"381-391"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365813","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":"Contiguous Gene Deletion Involving COL4A1 and COL4A2 in a Patient with Thin Basement Membrane Nephropathy: A Case Report.","authors":"Marc Henein, Felicia Russo, Chantal Bernard, Andrey V Cybulsky, Thomas M Kitzler","doi":"10.1159/000549595","DOIUrl":"10.1159/000549595","url":null,"abstract":"<p><strong>Introduction: </strong>Type IV collagen trimers are major structural components of the kidney glomeruli and tubules. Several loss-of-function COL4A1 and COL4A2 variants have been reported to cause cerebral small vessel disease. However, there is little evidence to suggest that loss-of-function variants in these genes can cause kidney disease.</p><p><strong>Case presentation: </strong>Here we report a case of a patient with thin basement membrane nephropathy and chronic kidney disease (CKD) who was found to bear a 1.9 Mb heterozygous contiguous gene deletion of chromosome 13q33.3-q34 that includes COL4A1 and a large region of COL4A2.</p><p><strong>Conclusion: </strong>We propose that haploid expression of COL4A1 in combination with COL4A2 can lead to thin basement membrane nephropathy and CKD.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"238-243"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12788829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573570","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":"The Impact of Air Pollution on Kidney Function: A Two-Sample Mendelian Randomization Study.","authors":"Hao Wu, Zixian Yu, Ziyun Yu, Yan Du, Lu Li","doi":"10.1159/000550247","DOIUrl":"10.1159/000550247","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) represents a major global health challenge that leads to considerable morbidity and mortality. The influence of particulate matter (PM)_2.5, PM_2.5-10, PM₁₀, nitrogen oxides (NO_X), nitrogen dioxide (NO₂) on renal diseases has raised concerns. However, the etiological relation remains uncertain. This study aimed to establish genetic support for causal links between environmental exposures and renal impairment.</p><p><strong>Methods: </strong>A two-sample Mendelian randomization (MR) study was launched based on genome-wide association study. The inverse variance weighted method served as the primary analysis, complemented by four other approaches (MR-Egger, MR-Weighted median, weighted mode, and simple mode). The results were reinforced by MR-Egger regression, MR-PRESSO, and leave-one-out analysis.</p><p><strong>Results: </strong>The MR analysis revealed that exposed to PM_2.5-10 significantly increases the risk of developing CKD (OR: 1.631; 95% confidence interval [CI]: 1.161, 2.290), eGFR_crea (β: -0.013; 95% CI: -0.021, -0.004), and eGFR_cys (β: -0.024; 95% CI: -0.039, -0.008). NO_x exposure correlated with declining eGFR_cys (β: -0.016; 95% CI: -0.029, -0.003). NO₂ correlated with increased urine albumin-to-creatinine ratio levels (β: 0.039; 95% CI: 0.009, 0.069). However, no significant association was found between exposure to PM_2.5 or PM₁₀ and impaired renal function, with no evidence of significant heterogeneity or horizontal pleiotropy.</p><p><strong>Conclusion: </strong>By employing MR analysis, we found that elevated levels of air pollutants, specifically PM_2.5-10, can causally worsen kidney function. These results facilitate a deeper comprehension of the pathogenesis and treatment of air pollution-induced renal damage.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"351-363"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086479","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":"Beyond Oral Anticoagulants Two Case Reports of Biopsy-Proven Heparin-Induced Anticoagulant-Related Nephropathy.","authors":"Tefik Islami, Marilena Gregorini, Maria Antonietta Grignano, Nicoletta Serpieri, Vincenzo Sepe, Eleonora Francesca Pattonieri, Elisabetta Margiotta, Grazia Soccio, Valentina Portalupi, Emma Diletta Stea, Elia Reseghetti, Sara Moscardino, Andreana De Mauri, Francesca Castoldi, Paolo Delvino, Gioacchino D Apos Ambrosio, Palma Minutillo, Laura Verga, Lorenzo Cavagna, Teresa Rampino","doi":"10.1159/000550757","DOIUrl":"10.1159/000550757","url":null,"abstract":"<p><strong>Introduction: </strong>Anticoagulant-related nephropathy (ARN) is an emerging and often unrecognized form of acute kidney injury. Histologically characterized by glomerular hemorrhage and intratubular erythrocyte casts, ARN is a serious complication associated with increased morbidity and progression to chronic kidney disease. Although it has been described in association with oral anticoagulants, the literature regarding ARN induced by non-oral agents, such as low-molecular weight heparin (LMWH), remains extremely scarce. This report aims to fill this gap, highlighting the importance of early diagnosis in complex clinical settings.</p><p><strong>Case presentations: </strong>We present two cases of biopsy-proven ARN induced by LMWH in patients with concomitant active renal disease. The first case is a 53-year-old man with ANCA-associated vasculitis who, after starting enoxaparin for deep vein thrombosis, experienced worsening renal function despite improvement in his pulmonary and serological vasculitis markers. A second renal biopsy was crucial to diagnose the superimposed ARN, leading to a change in therapy and renal recovery. The second case is a 73-year-old man with chronic kidney disease who developed an acute kidney injury initially attributed to post-infectious glomerulonephritis. The initiation of prophylactic LMWH was followed by further, severe deterioration of renal function requiring dialysis. In this case as well, a second biopsy revealed the presence of superimposed ARN. The discontinuation of anticoagulant therapy led to the resolution of hematuria and the cessation of dialysis. In both cases, the diagnosis was confirmed by positive Perl's staining and immunohistochemical findings of tubular damage.</p><p><strong>Conclusions: </strong>These cases demonstrate that ARN is not an exclusive complication of oral anticoagulants but can also be induced by LMWH. ARN can mask or overlap with other renal pathologies, making diagnosis difficult. Renal biopsy, sometimes repeated, remains the gold standard for an accurate differential diagnosis. This makes it possible to avoid inappropriate therapy escalation and to guide correct clinical management. Greater awareness of this clinical entity is necessary in all anticoagulated patients who develop acute kidney injury.</p>","PeriodicalId":18998,"journal":{"name":"Nephron","volume":" ","pages":"513-524"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609333","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}