Nephrology最新文献

Aim: This study aimed to explore the serum levels of mannose binding lectin-associated serine protease 2(MASP-2) and 3(MASP-3) in primary membranous nephropathy (PMN) patients and its correlation with clinical activity and short-term prognosis.

Methods: Serum levels of MASP-2, MASP-3 and C5a were measured in 72 PMN patients, 71 IgAN patients and 30 healthy controls via enzyme-linked immunosorbent assay (ELISA). Correlations between complement activation biomarkers and clinical parameters were analysed using Spearman correlation. Logistic regression analysis was used to identify risk factors for short-term clinical non-remission in PMN patients, and the predictive performance of the factors was evaluated using ROC curves and the area under the ROC curve (AUC).

Results: Serum MASP-2 levels in the PMN group were lower than in both the healthy control and IgAN groups, while levels in the IgAN group were higher than in the healthy control group. Serum levels of MASP-3 and C5a in the PMN group were not significantly different from those in the IgAN group. Both patient groups had significantly elevated serum levels of MASP-3 and C5a compared to the healthy control group. In PMN patients, serum MASP-3 and C5a levels correlated with clinical indicators such as eGFR, serum creatinine and 24-h urinary protein. Multivariate logistic regression analysis revealed that serum anti-phospholipase A₂ receptor antibody (anti-PLA₂R-ab) and MASP-3 were independent risk factors for the non-remission of PMN at 12 months. The combined detection of serum MASP-3 and anti-PLA₂R-ab had a greater AUC for predicting early non-remission than either factor alone.

Conclusion: Serum MASP-3 and C5a can serve as biomarkers reflecting the clinical severity of PMN. The combined detection of serum MASP-3 and anti-PLA₂R-ab will improve the prediction efficiency of PMN prognosis.

Objective: To research the diagnostic value and mechanism of miR-1281 involved in type 2 diabetes mellitus (T2DM) and diabetic kidney disease (DKD).

Methods: One hundred and eighteen patients with T2DM (68 DKD patients) and 35 healthy individuals were included. Fasting venous blood and one-time morning urine were collected for biochemical testing. RT-qPCR detected miR-1281 expression, ROC curve assessed the diagnostic value of miR-1281 for T2DM and DKD, and logistic regression predicted risk factors affecting the progression of DKD. ELISA analysed inflammatory cytokine expression, and Pearson correlation assessed its relevance to miR-1281. CCK8 detected cell proliferation and flow cytometry recorded apoptosis.

Results: miR-1281 was upregulated in T2DM patients and increased more significantly in DKD patients. The ROC curves indicated that miR-1281 had diagnostic value in predicting T2DM and DKD, and miR-1281 was closely related to the pathological characteristics of DKD patients. The logistic results showed that increased miR-1281 expression was a risk factor for DKD progression. ELISA showed that inflammatory cytokines (IL-6, IL-18, TNF-α) were significantly increased in patients with T2DM, and Pearson correlation analysis indicated a positive correlation between miR-1281 and inflammatory cytokine expression. The high-glucose environment promoted cell proliferation, decreased apoptosis, and increased inflammatory factor levels, but transfection of the miR-1281 inhibitor resisted the adverse effects of the high-glucose environment on cells.

Conclusion: miR-1281 promotes glomerular cell proliferation, inhibits apoptosis, and increases the level of intracellular inflammation, leading to impaired renal function in T2DM patients.

Podocyte infolding glomerulopathy is a rare pathological entity characterised by invagination of the podocyte cell membrane into the glomerular basement membrane with presence of microspheres and/or microtubules on electron microscopy. Without an ultrastructure study, it is often confused with and misdiagnosed as membranous nephropathy. The pathogenesis of this disease remains unclear and the majority of cases show association with connective tissue disorders. There is an ongoing debate on whether it represents a distinct disease entity or merely an unusual renal pathological finding of coexisting disease. Till date, only a single case report has been reported from India. We present a series of 4 cases from India along with a review of literature. This case series aims to provide some insights highlighting the clinical, light microscopic, and diagnostic electron microscopic aspects of this uncommon entity.

The field of medicine has long been marked by gender disparities, with men predominantly occupying higher academic ranks while women were underrepresented. In recent years, there have been marked changes in the gender ratio among medical professionals in Nephrology. This study analysed gender dynamics within the Indian Nephrology fraternity. The primary objectives were to evaluate the gender distribution among nephrology residents/fellows in subspecialty courses over the past decade (2013-2023), faculty members, and heads of departments (HODs). Data was collected from 27 academic centres. Data from 27 institutions showed a consistent increase in nephrology residents, from 76 in 2013 to 112 in 2023. The proportion of female residents increased significantly from 22.4% in 2013 to 38.4% in 2023. A statistically significant increase in female residents (p < 0.05), alongside a corresponding decrease in male residents, was noted. Among faculty members, 22.4% were females, and 20.4% of HODs were female. Female representation on the governing council of the Indian Society of nephrology (ISN) was limited. Since its inception, the role of ISN secretary has been held by eight individuals, all of whom have been male. Since 1971, the ISN has had a total of 42 presidents, with only 4 being female. The editorialship of IJN has never been stewarded by a female member to date. The findings demonstrate a positive trend towards gender parity in India's nephrology workforce over the past decade, reflecting broader societal acceptance and enhanced support for women in nephrology.

Aim: The limited evidence reports the relationship between plasma dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) and Diabetic kidney disease (DKD) in patients with Type 2 Diabetes Mellitus (T2DM). Therefore, the present study aimed to evaluate the diagnostic potential of dp-ucMGP in DKD among T2DM patients.

Method: This cross-sectional study was conducted from December 2023 to January 2025, including 75 T2DM patients. Participants were classified into three groups based on urinary albumin-to-creatinine ratio (UACR): Normoalbuminuria, microalbuminuria, and macroalbuminuria with n = 25 in each group. Pearson correlation analysis was performed to assess the relationship between dp-ucMGP and other biochemical parameters. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the diagnostic potential of dp-ucMGP for early detection of DKD. A p value < 0.05 was considered statistically significant.

Results: The plasma dp-ucMGP levels were significantly higher in T2DM patients in the macroalbuminuria group, with a mean of 1069.86 ± 417.56 pmol/L, followed by the microalbuminuria (842.72 ± 342.02 pmol/L) and normoalbuminuria (586.38 ± 336.15 pmol/L) groups. Similarly, higher dp-ucMGP levels were observed in patients with DKD severity stage IV (1401.53 ± 401.49 pmol/L). A negative correlation with eGFR (r = -0.807, p < 0.0001) and a positive correlation with age, serum creatinine, UACR, blood urea, uric acid and triglycerides were observed. The area under the curve (AUC) was 0.913 (95% CI: 0.820-0.960; p < 0.0001) for dp-ucMGP.

Conclusion: In conclusion, our findings revealed that plasma dp-ucMGP could be a potential biomarker to predict the early detection of DKD in patients with T2DM.

New-onset lupus nephritis (LN) poses a diagnostic and management challenge during pregnancy. This is more pertinent in the indigenous population, where the prevalence is higher, and the clinical phenotype tends to be more severe. We report the case of a 30-year-old G3P2 indigenous female, living in remote Queensland, with a late presentation of nephrotic syndrome at 30 weeks gestation. A clinical diagnosis of Class V LN was made without a kidney biopsy due to maternal and foetal risk, and she was empirically treated with steroids and disease-modifying agents to good effect. She remained normotensive with appropriate foetal growth and delivered a healthy male infant at 37 weeks. A renal biopsy taken 9 weeks after commencement of therapy demonstrated Class II LN, likely representing a resolving flare in the presence of improved clinical symptoms.

Kava plant root (piper methysticum) is an ingredient used in ceremonial drinks throughout Pacific and South Sea Island communities. Kava is made up of kavalactones; psychoactive compounds that act as central nervous system depressants. The rare occurrence of kavalactone toxicity manifests most commonly with hepatotoxicity, and cases of myoglobinuria have been reported. Our case describes an association of significant kava tea ingestion with acute tubulo-interstitial nephritis. An 18-year-old male, without any medical comorbidities, presented with oliguric acute kidney injury after ingesting 15 cups of kava tea. His creatinine at admission was 223umolL and peaked at 96 h post ingestion at 970umol/L despite intravenous fluid administration. His urine ACR was 196 mg/mmol, with microscopic haematuria; a creatinine kinase was 780 U/L, C3 was mildly reduced (0.77 g/L) with normal C4, and the remainder of a glomerulonephritis screen was negative. He did not have any evidence of hepatotoxicity but was bradycardic with a prolonged QT interval. A urine drug screen was negative for other substances. A kidney biopsy demonstrated severe acute tubulointerstitial nephritis without acute tubular necrosis or evidence of myoglobulin-related injury. He was commenced on oral corticosteroids and had complete recovery of his kidney function after 2 weeks, without requiring kidney replacement therapy. Toxicology analysis of the kava powder identified four different kavalactones without additional substances.

Aim: Membranous nephropathy (MN) is the leading cause of nephrotic syndrome in adults, with 80% of cases being primary MN of unknown origin. While the influence of sex hormones on chronic kidney disease (CKD) is thoroughly established, the role of sex hormone-binding globulin (SHBG) in MN is still uncertain.

Methods: We performed a Mendelian randomization (MR) analysis to assess the causal impact of SHBG on MN, utilising data from genome-wide association studies (GWAS). The main analysis utilised the inverse variance weighted (IVW) method, while various additional and sensitivity analyses were conducted to evaluate the causal estimates.

Results: We obtained 51 valid instrumental variables (IVs) of SHBG from large-scale open-access GWASs. Genetic forecasting of SHBG notably raised the likelihood of MN in males (IVW odds ratios [OR] = 2.992, 95% confidence interval [CI] = [1.643, 5.446], p = 3.370 × 10^-4). Three additional MR analyses consistently demonstrated a positive causal relationship between SHBG and MN, with all p values being less than 0.05. MR-Egger intercept analysis showed no evidence of horizontal pleiotropy (p > 0.05).

Conclusion: Elevated serum SHBG concentrations were directly associated with an increased risk of primary MN in males. Further research is needed to explore the effectiveness of SHBG in assessing and predicting MN risk.