Clinical nephrology最新文献

Background: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

Aims: To evaluate the progression of transplant renal vein stenosis (TRVS) in the early post-operative period and its impact on clinical outcomes.

Materials and methods: 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.

Results: 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.

Conclusion: TRVS unrelated to thrombotic causes in the early post-operative period is a transient finding not correlating with short-term outcome.

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.

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.

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.

Background: 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.

Case description: 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.

Conclusion: 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.

Objective: The safety and efficacy of denosumab in patients undergoing hemodialysis for osteoporosis remain underexplored. Therefore, guidelines are unclear regarding whether denosumab can be safely used in these patients. This study aimed to present the experience of denosumab treatment in a small cohort of patients for up to 3 years.

Materials and methods: This study evaluated the effects of denosumab on bone metabolism in 12 patients with end-stage kidney disease (ESKD) and osteoporosis undergoing long-term hemodialysis in an observational cohort setting. These patients were maintained on high doses of calcium carbonate (1,250 mg/day) and vitamin D (1,000 IU/day) supplementation during denosumab treatment to prevent hypocalcemia. Eleven patients with ESKD undergoing hemodialysis who did not receive osteoporosis treatment were followed for the same period as a control group. Changes in biochemical markers, bone mineral density (BMD), and clinical outcomes were analyzed over a 3-year follow-up period.

Results: The results revealed no significant differences in lumbar spine BMD but indicated a trend toward high femoral BMD values in the denosumab treatment group at the 2- and 3-year follow-up points. However, 2 patients experienced severe hypocalcemia. Most cases of denosumab discontinuation were due to a lack of BMD improvement.

Conclusion: These findings highlight the potential of denosumab in managing osteoporosis in patients undergoing hemodialysis but also underscore the need for careful monitoring of calcium levels to mitigate adverse effects. Therefore, adequate calcium replacement is required to prevent severe hypocalcemia. This study provides valuable real-world evidence to guide therapeutic strategies for improving bone health in patients with ESKD.

IgA nephropathy (IgAN) is the most common primary glomerular disease in the world; it is associated with the intestinal microbiota, diet, genetics, etc., and is mainly diagnosed by kidney biopsy. Patients with IgAN may develop end-stage renal disease (ESRD) within decades of diagnosis, placing an enormous burden on patients and society. Therefore, early prediction and effective measures are needed to prevent disease progression. To date, a large number of studies have explored biomarkers of IgAN progression. In this paper, IgAN biomarkers are discussed to guide the early diagnosis, prevention, and treatment of this disease.

Background and aims: Minor lower-limb amputations are limb and potentially life-saving procedures. However, they are associated with serious adverse events, including acute kidney injury (AKI).

Materials and methods: We conducted a single-center retrospective study to determine the incidence of AKI after these procedures, identify risk factors, and assess impact on patient survival.

Results: We included 201 patients. AKI occurred in 18.9% using AKIN criteria, and 24.9% using KDIGO criteria. Only 1 patient required temporary dialysis. Patients with AKI were older (73.0 ± 10.4 vs. 68.5 ± 11.8 years, p = 0.033), had a higher incidence of chronic kidney disease (CKD); estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73m² (39.5 vs. 14.7%, p = 0.001), and/or chronic obstructive pulmonary disease (COPD) (28.9 vs. 13.5% p = 0.028), and higher use of diuretics (68.4 vs. 49.1%, p = 0.049), fluoroquinolones (71.1 vs. 52.8% p = 0.047), and/or carbapenems (10.5 vs. 2.5%, p = 0.043) compared to patients without AKI. eGFR < 45 mL/min/1.73m² (OR: 3.24, CI: 1.40 - 7.52, p = 0.006), use of fluoroquinolones (OR: 3.19, CI: 1.30 - 7.82, p = 0.012), and day-1 C-reactive protein (CRP) (OR: 1.01, CI: 1.00 - 1.01, p = 0.009) were established as independent risk factors for AKI. Cumulative survival was not significantly lower in patients with AKI (log rank: 0.02, p = 0.88).

Conclusion: AKI is a potential complication following minor lower-limb amputations. Age, COPD, diuretics, fluoroquinolones, and carbapenems were associated with increased incidence of AKI. An eGFR < 45 mL/min/1.73m², day-1 C-reactive protein, and fluoroquinolone use were identified as independent risk factors for AKI.

Introduction: This study is a retrospective analysis of patients undergoing maintenance hemodialysis (MHD) at our institution. The objective is to assess bone density and the prevalence of osteoporosis among these patients, as well as to analyze associated risk factors.

Materials and methods: A total of 131 MHD patients undergoing regular dialysis treatment at our hemodialysis center from September 2022 to December 2023 were included, and bone mineral density (BMD) values of lumbar spine (L1 - L3) of the patients were measured using QCT. Data were analyzed using the SPSS computer software version 26.0 to assess the relationship between BMD and clinical biochemical parameters in end-stage renal disease patients.

Results: We found that of the 131 patients included, 82 were males and 49 were females, with a male to female ratio of 1.67 : 1, age 56.92 ± 13.37 years, and dialysis age of 24 (12 - 60) months. In the overall population, 25 cases (19.1%) were osteoporotic, 45 cases (34.4%) had low bone mass, and 61 cases (46.56%) had normal bone mass. Regarding risk factors, BMD was significantly negatively correlated with age (β = -1.788, p < 0.001), hypertension (β = -21.605, p = 0.018) and significantly positively correlated with total iron-binding capacity (β = 0.803, p = 0.01). Further logistics regression showed that age, decreased total iron binding, calcium-phosphorus product, and intact parathyroid hormone (iPTH) ≥ 300 pg/mL were independent risk factors for osteoporosis in MHD patients.

Conclusion: Abnormal BMD is prevalent in patients with MHD. Age, decreased total iron binding capacity, calcium-phosphorus product, and iPTH ≥ 300 pg/mL are independent risk factors for the development of osteoporosis in patients undergoing maintenance hemodialysis.