BMC Nephrology最新文献

{"title":"Patient perspective and satisfaction with different types of vascular access in hemodialysis: a systematic review and meta-analysis.","authors":"Amirali Ahrabi, Sepideh Poshtdar, Javad Salimi, Mohammad Ashouri, Mehdi Yaseri","doi":"10.1186/s12882-025-04393-9","DOIUrl":"10.1186/s12882-025-04393-9","url":null,"abstract":"<p><strong>Background: </strong>To assess satisfaction and perspectives of adult hemodialysis (HD) patients on different vascular access (VA) types (AVF, AVG, CVC) by synthesizing quantitative studies using validated questionnaires, focusing on overall satisfaction, physical symptoms, social functioning, and complications.</p><p><strong>Methods: </strong>We systematically searched Medline, Web of Science, and Scopus for studies assessing adult HD patients' perspectives on VA using structured questionnaires. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed using a random-effects model across three pairwise comparisons: AVF vs. CVC, AVF vs. AVG, and CVC vs. AVG.</p><p><strong>Results: </strong>Of 1,253 records, 11 studies (n = 2910) met inclusion criteria. AVF patients had higher overall satisfaction compared to those with CVCs (MD: 7.06%, 95% CI: 2.98-11.14). Compared to AVG, AVF patients had higher overall satisfaction, though not statistically significant (MD: 5.12%, 95% CI: - 0.42 to 10.66; p = 0.069). Dissatisfaction with physical symptoms was significantly higher in AVF patients than in those with CVCs (MD: 8.76%, 95% CI: 4.19 to 13.34). Compared to CVC, AVF patients reported significantly lower dissatisfaction in both social functioning (MD: - 9.48%, 95% CI: - 15.98 to - 2.98) and dialysis-related complications (MD: - 10.08%, 95% CI: -12.66 to -7.50).</p><p><strong>Conclusions: </strong>AVFs are associated with higher overall patient satisfaction compared to other VA types. While AVF patients experience more physical discomfort, this is outweighed by significantly greater satisfaction in areas such as social functioning and dialysis-related complications. These findings emphasize the importance of considering patient-reported outcomes when evaluating VA options in HD care.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"457"},"PeriodicalIF":2.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844398","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":"Kidney outcomes after bariatric surgery: a population-based cohort study.","authors":"Christian Goul Sørensen, Simon Kok Jensen, Reimar Wernich Thomsen, Bente Jespersen, Sigrid Bjerge Gribsholt, Christian Fynbo Christiansen","doi":"10.1186/s12882-025-04378-8","DOIUrl":"10.1186/s12882-025-04378-8","url":null,"abstract":"<p><strong>Background: </strong>Bariatric surgery may mitigate obesity-related chronic kidney disease (CKD) but may concurrently increase the risk of acute kidney injury (AKI) and hyperoxaluria. We examined kidney outcomes after bariatric surgery.</p><p><strong>Methods: </strong>Using population-based registries, we included individuals with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in Denmark between 2006 and 2018. These were age- and sex-matched 1:5 to individuals with hospital-diagnosed overweight/obesity without bariatric surgery. Cumulative incidences (risks) of AKI, nephrolithiasis, CKD (stage G3-G5), and kidney failure with replacement therapy (KFRT) were computed, accounting for the competing risk of death. Cox regression was used to estimate hazard ratios (HR) adjusted for age, sex, and comorbidity.</p><p><strong>Results: </strong>We included 18,827 individuals with bariatric surgery (17,200 RYGB and 1,627 SG) and 94,135 individuals in the matched overweight/obesity cohort (median age 41 years, median follow-up 8.1 years). The one-year risk of AKI following bariatric surgery was 2.7%, while the ten-year risks of nephrolithiasis, CKD, and KFRT were 3.5%, 0.4%, and 0.2%, respectively. When comparing individuals with bariatric surgery with those with overweight/obesity, the adjusted HRs were increased at 1.63 (95% CI; 1.38, 1.92) for AKI and 1.73 (95% CI; 1.56, 1.91) for nephrolithiasis. In contrast, adjusted HRs were decreased at 0.41 (95% CI; 0.26, 0.66) for CKD and 0.63 (95% CI; 0.42, 0.95) for KFRT. Similar results were observed versus a population comparison cohort.</p><p><strong>Conclusions: </strong>Bariatric surgery was associated with an increased risk of AKI and nephrolithiasis, while long-term risks of CKD and KFRT were lower than in matched individuals with overweight/obesity.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"458"},"PeriodicalIF":2.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844397","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":"DNA methylation in chronic kidney disease.","authors":"Ye Cheng, Pei Liu, Guiling Xie, Wenjun Li, Huan Jing, Yanna Chen, Hongtao Chen, Youlin Fan, Jun Zhou","doi":"10.1186/s12882-024-03916-0","DOIUrl":"10.1186/s12882-024-03916-0","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is a condition that affects people on a global scale. After various stages of progression, CKD is finally characterized by renal fibrosis. As the most pervasive and well-studied epigenetic modification, DNA methylation has recently been associated with the development of renal fibrosis. Gaining a better understanding of the link between DNA methylation and CKD would provide new targets or enable the development of epigenetic therapies for CKD. This review discusses the mechanisms by which DNA methylation regulates gene expression during the pathological process of CKD, including the role of DNA methyltransferases (DNMTs). This review summarizes DNA methylation in CKD, particularly its crucial role in CKD-related conditions, such as diabetic kidney disease (DKD) and chronic allograft injury. Conventional demethylating agents have been discussed as well as the need for less toxic demethylating agents for clinical applications. Finally, some of the problems and obstacles specified in previous DNA methylation studies have been considered. This information aims to promote further investigations into the role of DNA methylation in CKD by providing novel insights into the mechanism by which methylation affects the progression and regression of CKD, which would result in the development of alternate treatments.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"455"},"PeriodicalIF":2.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12345035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144844395","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":"Effects of sodium bicarbonate therapy on cognitive and cerebrovascular function in midlife and older adults with chronic kidney disease: a pilot randomized trial.","authors":"Fangning Gu, Zhiying You, Nell Hawkins, Rachael Reddin, Rahaf Hamour, Allison Shapiro, Christina Coughlan, Douglas Seals, Seth Furgeson, Angelina Dixon, Kristen L Nowak, Jessica Kendrick","doi":"10.1186/s12882-025-04388-6","DOIUrl":"10.1186/s12882-025-04388-6","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic acidosis may create a pathway to cognitive impairment in chronic kidney disease (CKD) by contributing to cerebrovascular dysfunction. Trials examining the effect of sodium bicarbonate (NaHCO₃) on cognitive function are lacking.</p><p><strong>Methods: </strong>We conducted a randomized, double-blind, placebo-controlled pilot study examining the effect of 12 months of NaHCO₃ on cognitive function in 34 patients aged 50-80 years with CKD stage 3b-4 (eGFR 15-44 ml/min/1.73m²) with metabolic acidosis (serum bicarbonate level 16-22 mEq/L). Participants were randomized 1:1 to NaHCO₃ or placebo. The primary endpoint was change in overall cognition (Cognitive Function Composite score) assessed by the NIH Toolbox® Cognition Battery over 12 months. Secondary endpoints were change in cerebrovascular reactivity and pulsatility of the middle cerebral artery (MCA) assessed by Transcranial Doppler Ultrasonography over 12 months.</p><p><strong>Results: </strong>33 patients completed the study. After 12 months of treatment with NaHCO₃ therapy, the Cognitive Function Composite score increased significantly from baseline (mean ± SD, 47.3 ± 8.5 to 49.3 ± 11.0, p = 0.03), however, there was no difference compared to placebo (p = 0.39). NaHCO₃ therapy resulted in a significant reduction in time to perform the Trail Making Test-A (median [IQR], 31.3 [27.0, 36.3] to 29.0 [19.4, 38.2] seconds, p = 0.02), however there was no difference compared to placebo (p = 0.29). After 12 months of treatment, there was a significant increase in resting pulsatility index of the MCA in the placebo group, but there were no statistical differences between groups (p = 0.71). NaHCO₃ treatment resulted in a significant decrease in baseline mean blood flow velocity of the MCA (p = 0.03), but there was no difference from placebo (p = 0.11).</p><p><strong>Conclusions: </strong>Although there were trends supporting a role for sodium bicarbonate in having an effect on cognitive function, this was not significant in this underpowered study. A larger study is recommended.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov (NCT04600323) on 10/19/2020.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"454"},"PeriodicalIF":2.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833949","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 efficacy of different types of intradialytic exercise for patients undergoing hemodialysis: a systematic review and network meta-analysis of randomized controlled trials.","authors":"HaiQiang Jiang, Yu Wang, Jia Peng, Shuang Wu, Chuanfang Wu","doi":"10.1186/s12882-025-04381-z","DOIUrl":"10.1186/s12882-025-04381-z","url":null,"abstract":"<p><strong>Background: </strong>Intradialytic exercise interventions improve dialysis efficacy; however, their comparative efficacy remains unclear, limiting evidence-based clinical practice.</p><p><strong>Objective: </strong>To systematically review and compare the effects of different intradialytic exercises on dialysis adequacy in patients undergoing hemodialysis.</p><p><strong>Methods: </strong>A systematic search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library for randomized controlled trials evaluating the efficacy of intradialytic exercise on dialysis adequacy in patients undergoing hemodialysis. Studies published in the database from its inception to November 1, 2023, were included. Statistical analyses were performed using Stata 15.0.</p><p><strong>Results: </strong>A total of 24 studies involving 786 patients were included in this analysis. The interventions comprised intradialytic aerobic exercise (IAE), intradialytic resistance exercise (IRE), combined intradialytic aerobic and resistance exercise (IAE + IRE), intradialytic respiratory muscle exercise (IRME), intradialytic electrical muscle stimulation (IEMS), and routine hemodialysis nursing (RHN). Among all pairwise comparisons, only IRME versus RHN showed a statistically significant difference (MD = 0.09, 95% CI: 0.03-0.16). No statistically significant differences were observed in any other pairwise comparisons, including those involving RHN and those between different exercise modalities. Nevertheless, IAE + IRE demonstrated the highest surface under the cumulative ranking curve (SUCRA) values for both the urea clearance index and reduction rate.</p><p><strong>Conclusion: </strong>Current evidence is insufficient to conclude that any specific type of intradialytic exercise significantly improves dialysis adequacy. Nevertheless, SUCRA rankings indicate a potential benefit, with IAE + IRE demonstrating the highest probability of benefit. Given the limited statistical power, further high-quality studies are warranted to confirm these findings. The review protocol has been registered with PROSPERO(CRD42023484645).</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"450"},"PeriodicalIF":2.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820565","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":"Rethinking incremental hemodialysis: dissecting the statistics from the biological signals.","authors":"Tuncay Sahutoglu","doi":"10.1186/s12882-025-04186-0","DOIUrl":"10.1186/s12882-025-04186-0","url":null,"abstract":"<p><p>The TATH study informs the feasibility of twice-weekly hemodialysis in select patients. However, associated biological signals suggest underdialysis despite preserved residual kidney function. We highlight the importance of volume status and adequacy in comparator groups to truly assess the benefits and limitations of incremental dialysis strategies in modern nephrology.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"452"},"PeriodicalIF":2.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820550","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":"A randomized trial to evaluate the pharmacokinetics, pharmacodynamics, and safety of vadadustat in patients with anemia associated with chronic kidney disease receiving hemodialysis.","authors":"Pamela Navarro-Gonzales, Ajit Chavan, Don Wang, Steven K Burke, Kevin Dykstra","doi":"10.1186/s12882-025-04367-x","DOIUrl":"10.1186/s12882-025-04367-x","url":null,"abstract":"<p><strong>Background: </strong>Vadadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor for treatment of anemia in dialysis-dependent chronic kidney disease (CKD) with a starting dose of 300 mg once daily (dose adjustments up to 600 mg). A recent phase 1b study evaluated the pharmacokinetics, pharmacodynamics, and safety of higher vadadustat doses (500-900 mg) in healthy volunteers. Here we report the pharmacokinetic (PK), pharmacodynamic (PD), and safety characterization of higher doses of vadadustat in patients with CKD receiving dialysis.</p><p><strong>Methods: </strong>This phase 1b, randomized, open-label study evaluated the pharmacokinetics and pharmacodynamics of vadadustat (600, 750, or 900 mg) in patients with CKD-related anemia receiving hemodialysis over a 10-day treatment period. Forty-six eligible patients were randomized to vadadustat 600, 750, or 900 mg daily or an intravenous erythropoiesis-stimulating agent. For vadadustat groups, blood samples for PK and PD analyses were collected on Day 1 and Day 8. PK analyses included area under the plasma concentration time curve (AUC) from dosing to last quantifiable concentration and to infinity, and to maximum plasma concentration (C_max). PD analyses measured serum erythropoietin (EPO), hemoglobin, and red blood cells (RBCs). Safety assessments included adverse events in the safety population (patients who received ≥ 1 dose of study drug). Patients underwent a 30-day safety follow-up period after the last dose of study drug.</p><p><strong>Results: </strong>In the vadadustat groups, a dose-dependent increase in plasma exposure of vadadustat (C_max and AUC) with modest accumulation was observed on Day 1 and Day 8. Vadadustat increased plasma EPO concentrations, with a variable EPO response observed in each group. Relative to baseline, mean hemoglobin and RBC levels remained unchanged, with no significant changes observed in any treatment group. Vadadustat was welltolerated.</p><p><strong>Conclusions: </strong>The current study characterized the PK and PD response (EPO and reticulocytes) and safety profile of vadadustat at doses of 600, 750, and 900 mg in patients with CKD receiving dialysis. Overall, vadadustat was well tolerated. These findings will contribute to the development of higher-dose regimens for further investigation in phase 3 studies.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov ID NCT03992066; https://clinicaltrials.gov/study/NCT03992066 ; Retrospectively registered on June 18, 2019. Accessed January 13, 2025.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"453"},"PeriodicalIF":2.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820548","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":"From acute kidney injury to chronic kidney disease in children: maladaptive repair and the need for long-term surveillance - a literature review.","authors":"Ying-Hao Deng, Qian Liu, Xiao-Qin Luo","doi":"10.1186/s12882-025-04392-w","DOIUrl":"10.1186/s12882-025-04392-w","url":null,"abstract":"<p><p>Pediatric Acute Kidney Injury (AKI) is an increasingly prevalent global health concern that extends far beyond a transient clinical event, posing a significant risk for long-term kidney dysfunction. This review consolidates current knowledge on the pathophysiological transition from pediatric AKI to Chronic Kidney Disease (CKD), critically evaluating the mechanisms of maladaptive repair, the utility of biomarkers, and the state of long-term surveillance strategies. The progression to CKD is driven by maladaptive repair, a process where the kidney's healing mechanisms become dysregulated following a severe or prolonged insult. This pathological cascade involves persistent inflammation, endothelial dysfunction, tubular epithelial cell cycle arrest, and the activation of myofibroblasts, culminating in irreversible interstitial fibrosis and nephron loss. The kidneys of preterm infants and neonates are particularly vulnerable; preterm infants may have incomplete nephrogenesis, leading to a reduced nephron endowment, while neonates exhibit functional immaturity. An AKI during these critical early periods can have a disproportionately large impact, amplifying the lifetime risk for hypertension and accelerated CKD. Evidence confirms that pediatric AKI survivors face a substantially increased risk of incident CKD, hypertension, and proteinuria, even when serum creatinine levels return to baseline. Current diagnostic tools, reliant on creatinine, are insensitive and lag behind the actual injury, hindering timely intervention. While novel biomarkers show promise for early AKI detection, their ability to predict the transition to CKD remains an area of active investigation. Major conclusions from this review highlight that pediatric AKI must be reframed as a sentinel event that necessitates a long-term approach to kidney health. However, care is often fragmented, a challenge compounded by a lack of pediatric-specific, evidence-based follow-up guidelines. Future progress depends on dedicated research into the unique aspects of maladaptive repair in developing kidneys, the validation of predictive biomarkers, and the development of targeted, age-appropriate therapies.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"449"},"PeriodicalIF":2.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820549","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 effect of oral melatonin on the quality of life, sleep and blood pressure of hemodialysis patients: a randomized clinical trial.","authors":"Rozina Abbasi Larki, Arash Iranmanesh, Danial Gholami, Leila Manzouri","doi":"10.1186/s12882-025-04387-7","DOIUrl":"10.1186/s12882-025-04387-7","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"451"},"PeriodicalIF":2.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820551","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":"Bevacizumab-associated glomerular microangiopathy: a case report and literature review.","authors":"Rui Jiang, Rui-Zhi Yu, Hai-Feng Yang, Li-Xin Wang, Jun-Jie Lin","doi":"10.1186/s12882-025-04385-9","DOIUrl":"10.1186/s12882-025-04385-9","url":null,"abstract":"<p><p>Here we present a case of bevacizumab-associated glomerular microangiopathy (Bmab-GMA), a rare and distinct glomerular pathology, in a middle-aged male patient who developed progressive renal impairment following adjuvant chemotherapy with bevacizumab for surgically resected lung adenocarcinoma. The patient presented with new-onset hypertension and mild elevation in serum creatinine. Renal biopsy revealed characteristic histopathological features, including pseudothrombotic deposits of periodic acid-Schiff (PAS)-positive hyaline material within glomerular capillaries on light microscopy, and subendothelial and mesangial electron-dense deposits with segmental widening of the subendothelial space on electron microscopy. The diagnosis of Bmab-GMA was established based on these clinicopathological findings. Management with bevacizumab discontinuation and antihypertensive therapy resulted in clinical stabilization. This case highlights the diagnostic challenges and management considerations of this rare entity, while identifying elevated soluble complement membrane attack complex (C5b-9) as evidence of complement activation, a potential pathological mechanism requiring further investigation for future therapeutic development.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"26 1","pages":"445"},"PeriodicalIF":2.4,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811716","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}