搜索结果：Journal of nephrology

This study aimed to evaluate blood pressure profiles in children with isolated renal ectopia by using ambulatory blood pressure monitoring (ABPM) to determine the prevalence and patterns of hypertension, and to explore the relationships between ectopy subtype and kidney function. Clinical and ABPM data from 24 children with isolated renal ectopia followed between January 2024 and January 2025 at Çukurova University Department of Pediatric Nephrology were evaluated. Type of ectopia, presence of decreased renal parenchymal uptake on dimercaptosuccinic acid (DMSA) scintigraphy, estimated glomerular filtration rate (eGFR) and presence of end organ damage were also assessed. On the day of ABPM, standard deviation scores (SDS) were recorded for anthropometric measurements and office and 24-hour BP values. Of 24 patients (66.7% male), 75% had simple ectopia and 25% had crossed-fused ectopia. Mean age was 11.3 ± 3.7 years. Masked hypertension was identified in 45.8%. eGFR negatively correlated with 24-hour systolic BP SDS (r = -0.456, P = .02), nighttime diastolic BP SDS (r = -0.417, P = .04), and nighttime systolic BP SDS (r = -0.487, P = .01). Decreased parenchymal uptake was present in 50% of patients and was associated with lower height SDS (P = .03), higher nighttime systolic BP SDS (P = .01) and increased frequency of systolic non-dipping (91.7% vs. 45.5%; P = .02). The crossed-fused renal ectopia group had a higher prevalence of vesicoureteral reflux (P = .009) and lower eGFR (P = .01). Children with isolated renal ectopia show a high prevalence of ABPM abnormalities, particularly masked hypertension and altered nocturnal blood pressure patterns. Regular monitoring of growth, kidney function, and blood pressure is essential to detect both early and late complications.

Team job crafting has emerged as an important organizational resource that may enhance nurses' professional functioning. However, its potential mechanisms in shaping nurses' career success remain insufficiently understood. This study examined the direct association between team job crafting and career success among nurses and explored the mediating roles of the three dimensions of Professional Quality of Life (ProQoL), including compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS). This secondary data analysis used cross-sectional survey data collected from a tertiary hospital in Sichuan Province, China, between January and March 2024. A total of 1870 nurses were included after data-quality screening. Validated Chinese versions of the Team Job Crafting Scale for Nurses, ProQoL scale, and Career Success Scale were administered. Descriptive statistics, Pearson correlations, and structural equation modeling (SEM) with bias-corrected bootstrapping were conducted to test the hypothesized mediation model. Team job crafting was positively associated with nurses' career success both directly (β = 0.113) and indirectly through two significant dimensions of ProQoL, CS and BO (total indirect effect β = 0.251, accounting for 69.0% of the total effect). Among these mediators, CS showed the strongest effect (β = 0.167; 45.9% of total effect), followed by BO (β = 0.095; 26.1% of total effect). In contrast, the mediating effect of STS was not significant (β = -0.011). Team job crafting is an important predictor of nurses' career success, operating primarily through increased CS and reduced BO. STS, however, does not appear to mediate this relationship. These findings highlight the potential value of team-based interventions that enhance CS and reduce BO to foster nurses' career success. Supportive team environments that promote positive professional experiences and mitigate emotional strain may, therefore, contribute to nurses' long-term career development.

Post-COVID-19 condition (PCC) is a complication of acute COVID-19, which often presents with a variety of symptoms. It can also impact individuals' overall well-being, capacity to carry out daily activities, engage in physical exercise, maintain employment, and their general quality of life. Therefore, this review aimed to examine the role of patient-reported outcome measures (PROMs) questionnaires in assessing patients with PCC through prevalence of abnormal tests. We searched three databases. Two reviewers independently screened articles using Laser Al and extracted relevant data using a piloted Google Sheets. We performed a meta-analysis using OpenMeta and RevManWeb and conducted a subgroup analysis based on the setting of the patients during their acute COVID-19 infection. We assessed the risk of bias using a modified ROBINS-I tool and the certainty using the Grading of Recommendations Assessment, Development, and Evaluation approach. No studies reported diagnostic test accuracy measures for questionnaires in PCC. However, 23 comparative studies reported on the prevalence of abnormal questionnaire results in patients with PCC. Outcomes showed that patients with PCC have higher abnormal results than controls, regardless of their setting during acute COVID-19 infection. The overall certainty of the evidence was low due to the high risk of bias, indirectness, and imprecision. This review sheds light on the importance of testing PROMs in patients with PCC using these questionnaires and the need for further testing their validity in this condition.

Dialysis adequacy measured by small solute clearance (e.g. urea and creatinine) have shown no correlation with patient outcomes so guidelines recommend focusing on patient reported outcome measures (PROMs) in addition to these traditional markers of dialysis adequacy. However, it is unknown whether this advice has translated into clinical practice in Australia and New Zealand. An anonymous online survey was distributed to clinicians caring for peritoneal dialysis (PD) patients through their respective nephrology societies, to appraise both centre-and staff-related approaches to PD adequacy. Ninety-seven participants completed the survey, largely from Australia (n=79, 81%) and, specifically, Victoria (n=46, 48%). Most participants were consultant nephrologists (n=55, 57%) with more than 10 years' nephrology experience. The majority stated using a combination of traditional measures of dialysis adequacy (creatinine clearance and Kt/V) and assessment of PROMs (n=81, 84%). Most used a formal PROM tool assessment (n=58, 60%). The majority favored routine measurement of small solute clearance because it provided a more comprehensive patient outlook, including residual kidney function and ultrafiltration, and allowed an opportunity for patients to raise financial or social concerns that could be monitored longitudinally. In Australia and New Zealand, most clinicians used a combination of numerical markers of dialysis adequacy and a PROM assessment. Regular measurement of small solute clearance was considered to have additional benefits of providing a more holistic appraisal of the patients progress and status. Further assessment of patients' perspective of regular assessments may provide useful insights to achieving a more person-centred approach in PD.

Dialysis-requiring acute kidney injury (AKI-D) is a frequent and severe in-hospital complication associated with high mortality, long-term kidney sequelae, and substantial resource use. National data on AKI-D impact and service organization in Italy are limited. We conducted a nationwide, web-based, 20-item survey endorsed by the Italian Society of Nephrology. We assessed care settings (dialysis units and other wards, including intensive care units [ICUs]), kidney replacement therapy (KRT) modalities in ICUs, staffing models, monitoring and anticoagulation strategies, and nephrologists' perspectives on barriers and priorities for improvement. Fifty-nine centers responded; analyses focused on 57 adult centers. AKI-D represented ∼20% to >60% of dialysis-unit activity. KRT was frequently delivered outside nephrology wards, most often in cardiac intensive care units (94%) and emergency departments (50.8%). In ICUs, nephrologists primarily prescribed KRT in 73.7% of centers; continuous KRT (CKRT) was available in 94.7%, and regional citrate anticoagulation was first-line in 82.5%. Dialysis dose was reassessed daily in 55.2% of centers. Routine antibiotic therapeutic drug monitoring during CKRT was available in 30.3%, and in 22.8% dedicated post-AKI outpatient clinics. Most indicators were similar between center types; however, structured antibiotic therapeutic drug monitoring during CKRT was more frequently available in University and Hub centers than in Spokes (43.5 vs 31.6 vs 7.1%, respectively, P = .031). Respondents highlighted heterogeneous protocols, limited dedicated staffing, and gaps in multidisciplinary coordination. AKI-D care in Italy is widespread but organizationally heterogeneous across settings, responsibilities, and key operational practices. Standardized pathways, training, and measurable monitoring tools are key priorities for improvement.

The overall prevalence of hypertension (HTN) among Israeli Jewish adolescents was reported to be 0.4% in males and 0.074% in females. The demographic characteristics of the Northern Israeli population are unique, with a nearly equal distribution of Arab and Jewish ethnicity. We describe the demographic and clinical characteristics of pediatric hypertensive patients in northern Israel. Data were retrospectively collected from the electronic medical records (EMRs) of pediatric patients aged 0-18 diagnosed with HTN at Rambam Health Care Campus between 2010-2020. Demographic characteristics, etiology, end-organ damage, and medical treatment data were collected and compared between specific subgroups. During the study period, 479 children diagnosed with HTN were included. Mean age at diagnosis was 9.6 years. Males made up 64% of the cohort. BMI > 85th percentile was recorded in 45%, and 17% were diagnosed with primary HTN. Primary HTN was more prevalent (32%) in adolescents, the majority of whom were of Jewish ancestry. Obesity prevalence was significantly higher in primary HTN patients. End-organ damage was more common in secondary HTN, subjects of Arab-Muslim origin, consanguinity, and younger age. At follow-up, 35.8% were not on antihypertensive medications. Calcium channel blockers (CCBs) were the most frequently prescribed anti-hypertensives. Higher rates of secondary HTN than reported in the literature were attributed to high consanguinity and resulted in extensive diagnostic procedures across all age groups, unlike what is recommended by the American Academy of Pediatrics (AAP) guidelines. Better adherence to guideline recommendations was demonstrated in patients referred to the pediatric nephrology institute, highlighting the importance of referring HTN patients to specialized clinics.Key words: Hypertension, Adolescents, Obesity.

Following the publication of the above paper, it was drawn to the Editor's attention by a concerned reader that, regarding the histological images shown in Fig. 2A on p. 117, the 'NC/3 h' and 'NC/6 h' data panels contained an overlapping section of data, suggesting that these data panels were derived from the same original source where different experimental conditions were reported. The authors have been contacted by the Editorial Office to offer an explanation for this apparent anomaly in the presentation of the data in their paper, and we are awaiting their response. Due to the fact that we have been made aware of potential issues surrounding the scientific integrity of this paper, we are issuing an Expression of Concern to notify readers of this potential problem while the Editorial Office continues to investigate this matter further.  [International Journal of Molecular Medicine 39: 113‑125, 2017; DOI: 10.3892/ijmm.2016.2809].

Background: Electrolyte disturbances are common in critically ill patients with acute kidney injury (AKI) and often require urgent intervention. Arterial blood gas (ABG) analyzers provide rapid point-of-care electrolyte measurements, but their agreement with central laboratory analyzers in critically ill patients with AKI remains uncertain. This study evaluated the agreement between ABG and central laboratory measurements of sodium (Na+), potassium (K+), and chloride (Cl-). Methods: We conducted a retrospective observational study of adult critically ill patients with AKI admitted to a tertiary university hospital ICU between January 2013 and June 2024. Patients with paired electrolyte measurements obtained from an ABG analyzer (ABL800 Basic, Radiometer) and a central laboratory analyzer (Abbott Alinity) within 10 min were included. Agreement was assessed using Bland-Altman analysis and Passing-Bablok regression. Results: A total of 1870 critically ill patients with AKI were included. The mean bias (95% limits of agreement [LOA]) between ABG and central laboratory measurements was -0.68 mmol/L (-11.41 to 10.06) for sodium, -0.17 mmol/L (-1.46 to 1.12) for potassium, and 7.18 mmol/L (-4.15 to 18.51) for chloride. Potassium showed the narrowest LOA. Pearson correlation coefficients were 0.736, 0.642, and 0.728 for sodium, potassium, and chloride, respectively. Clinically meaningful discrepancies were observed in 7.0% of sodium, 14.1% of potassium, and 31.4% of chloride measurements. Conclusions: ABG-derived sodium and potassium measurements showed relatively good agreement with central laboratory measurements, particularly for potassium. However, clinically meaningful discrepancies occurred in a subset of measurements, suggesting that preanalytical factors and specimen quality may influence measurement reliability. ABG-derived electrolyte measurements may support rapid bedside assessment, whereas central laboratory measurements remain the reference standard.

The interactions of pulmonary and renal physiology that underlie acute lung injury (ALI) and acute kidney injury (AKI) have been recognized for nearly a century. The understanding of lung-kidney crosstalk has evolved and is recognized as an important factor in patient management and outcomes. We aim to describe the association between fluid accumulation (FA) and ALI with outcomes of critically ill children and young adults requiring continuous renal replacement therapy (CRRT). Planned secondary analysis using data from the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK). ALI severity was defined using the Berlin oxygenation criteria. Fluid accumulation was categorized as ≤ 10%, > 10-20%, and > 20% at CRRT initiation. Illness severity was quantified using the Pediatric Logistic Organ Dysfunction Score 2 (PELOD-2). The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included (1) 28-day mechanical ventilation (IMV) free days, (2) 28-day ICU free days, and (3) major adverse kidney events at 90 days (MAKE90) defined by death, persistent kidney dysfunction (eGFR reduction by 25% of baseline), or new dialysis requirement. This is a multinational retrospective cohort study. Invasively ventilated patients aged 0-25 years from January 2015 to December 2021 requiring CRRT for AKI or FA with ALI. There were no interventions. A total of 312 patients were included in the analysis. ALI was mild in 67 (21.5%), moderate in 142 (45.5%), and severe in 103 (33.0%). Fluid accumulation was ≤ 10% in 166 (53.2%), > 10-20% in 60 (19.2%), and > 20% in 86 (27.6%). The ICU mortality was 44.6% (139/312). In the multivariable analysis, neither ALI nor FA category was associated with mortality or MAKE90. Time to CRRT initiation (aOR 1.04, 95% CI 1.01-1.08) and illness severity (aOR 1.25, 95% CI 1.14-1.37) were associated with mortality.  In children and young adults with ALI receiving CRRT for AKI or FA, longer time to CRRT initiation and illness severity at CRRT initiation were associated with mortality. When accounting for multiple factors, neither ALI nor FA at CRRT initiation were associated with MAKE90 or mortality. Our findings warrant further exploration in a prospective cohort. • Acute kidney injury (AKI) and acute lung injury (ALI) commonly coexist in critically ill children and are associated with increased morbidity and mortality through bidirectional organ crosstalk. • Fluid accumulation (FA) worsens both AKI and ALI, with higher degrees of FA associated with worse outcomes, with continuous renal replacement therapy (CRRT) frequently used to manage the consequences of AKI and FA. • In this multicenter international cohort of children and young adults with ALI receiving CRRT, longer time to CRRT initiation and illness severity at CRRT initiation, but neither ALI nor FA at CRRT initiation were associated with mortality were associated with mortality. • These findings suggest that FA thresholds at the start of interventions may be less discriminatory in populations with dynamic processes such as severe multiple organ failure.

Lupus nephritis (LN) is one of the leading causes of death and a major cause of morbidity in childhood-onset systemic lupus erythematosus (SLE). However, currently there is no tool to predict the risk of LN in patients with childhood-onset SLE. This study collected and retrospectively analysed data of paediatric patients who were first diagnosed with SLE at the West China Second Hospital of Sichuan University from January 2013 to December 2022. A nomogram prediction model for predicting the risk of LN was developed using LASSO-logistic regression analysis. Receiver operating characteristic (ROC) curve, calibration curves, and decision curve analysis were used to assess the performance of the prediction model. A total of 264 paediatric patients with childhood-onset SLE were included; 171 with and 93 without LN. LASSO regression and multivariate logistic regression analyses showed that serositis, anti-dsDNA positivity, low IgG, and low albumin were independent risk factors for identifying patients at high risk for LN and were thus included in predictive models to identify such high-risk groups. The final results show that the calibration curve is close to the ideal prediction situation, and the decision curve analysis and ROC curve (AUC = 0.874) suggest that the model has good predictive power. Four indicators, serositis, anti-dsDNA positivity, low IgG, and low albumin, were independent risk factors predictive of high-risk LN in patients with childhood-onset SLE. The model has been validated internally and performs well.

Peritoneal dialysis (PD)-associated peritonitis caused by zoonotic pathogens is uncommon and diagnostically challenging. Neisseria zoodegmatis, a Gram-negative coccobacillus residing in the oral flora of cats and dogs, has been reported only once previously in PD-associated peritonitis, with zoonotic transmission inferred but unproven. We report the case of a 90-year-old patient receiving automated PD who developed peritonitis following cat bite-related transfer-set damage, with partial response to empirical therapy and subsequent relapse. Conventional culture and MALDI-TOF mass spectrometry identified N. zoodegmatis, confirmed by 16S rRNA gene sequencing from colony isolates and PD effluent. Intermediate β-lactam susceptibility prompted escalation to carbapenem-based therapy. Third-generation nanopore sequencing demonstrated N. zoodegmatis as the dominant organism in PD effluent and identified the identical species in feline saliva, establishing molecular concordance. Sustained remission required strict environmental control. This is the second reported case of Neisseria zoodegmatis PD-associated peritonitis and the first one with molecular proof of zoonotic transmission, highlighting the selective role of long-read sequencing in complex or relapsing peritonitis, the need for antimicrobial reassessment after suspicion of pet-related contamination, and the importance of environmental intervention in preventing recurrence.

Precise quantification of dialysis efficiency requires assessment of solute mass transfer through analysis of spent dialysate. Total dialysate collection is impractical and difficult to implement in routine practice, while partial dialysate collection methods remain insufficiently validated. We evaluated the reliability of the Theraflux® sampler, a standalone device designed to automatically collect 1% of spent dialysate during hemodialysis sessions. This observational study was conducted in a French dialysis center between November 2021 and February 2022. Twenty chronic dialysis patients were initially enrolled; 16 patients undergoing hemodiafiltration were included in the final analysis. A total of 126 dialysis sessions were analyzed. The total dialysate volume estimated by the Theraflux® sampler was compared with the volume calculated by the dialysis machine. Agreement between measurements was assessed using repeated-measures Bland-Altman analysis. The median difference between dialysis machine-calculated dialysate volume and sampler-reported volume was 8.3 L (IQR 4.3-14.8), corresponding to a median discrepancy of 7.4% (IQR 4.5-11.6%). The sampler collected a median of 1.02% (IQR 1.00-1.07%) of total dialysate according to dialysis machine calculations and 0.96% (IQR 0.96-0.97%) according to sampler-derived values. Twelve sessions (9.4%) were identified as outliers. Excluding outliers improved agreement without reducing the average bias. The Theraflux® sampler demonstrated satisfactory reliability for partial spent dialysate collection during hemodiafiltration sessions. Its automated sampling system substantially reduces the logistical burden associated with total dialysate collection and may facilitate future studies assessing toxin mass transfer and albumin loss in routine clinical practice.

Little is known about IgA nephropathy (IgAN) occurring alongside other glomerulopathies. In this study, we aimed to analyze the laboratory and histological spectrum of lesions in such cases and address points which may aid in their diagnosis. This was a retrospective study at a tertiary care center in India, over a 4 year period. Data were gathered and analyzed regarding patients with IgAN occurring concurrently with other causes of glomerulopathies, including podocytopathies, diabetic kidney disease, membranous nephropathy (MN), anti-neutrophil cytoplasmic autoantibody  glomerulonephritis (ANCA-GN), anti-glomerular basement membrane glomerulonephritis (anti-GBM GN), and amyloidosis. Histology was reviewed by two pathologists. Median with interquartile range was used for descriptive data and compared using the Mann-Whitney U-test, apart from age for which mean with standard deviation (SD) was used and compared using Chi-square/Fisher's exact tests. Out of 1716 cases diagnosed with IgAN, 82 (4.7%) were found to have co-existing glomerulopathies. IgAN patients with podocytopathy were the youngest, with a mean age of 27.33 (± 14.56) years, with mesangial hypercellularity and segmental sclerosis being the most common lesions. IgAN with diabetic glomerulopathy most often affected older individuals, with a mean age of 51.50 (± 9.82) years. Patients with IgAN and either ANCA-GN or anti-GBM GN had the highest percentage of interstitial fibrosis and tubular atrophy (IFTA), and crescents. There were two cases only of concomitant AA amyloidosis. In case of IgAN with atypical or complex presentation, rapidly deteriorating kidney function, other co-existing glomerular pathologies should be ruled out, as these may require treatment modification.

Kidney transplantation is the optimal treatment for kidney failure; however, it represents a major physiological stress. Frailty is a clinical syndrome also characterized by decreased physiological reserve and a reduced ability to cope with stressor events. The aim of this study was to assess the association between frailty status and the likelihood of undergoing kidney transplantation. This retrospective observational study included all kidney transplant candidates waitlisted at the Kidney Transplant Center of the Parma University Hospital, Italy, between July 2018 and February 2020. Frailty status was assessed using the Fried Frailty Phenotype. Frailty was defined as a Fried frailty phenotype score ≥3, while a score of 1 or 2 indicated a pre-frail condition. The Aalen-Johansen estimator was used to estimate the cumulative probability of transplantation and death/withdrawal according to frailty status (frail vs non-frail). Adjusted analyses were performed using Fine-Gray multivariable regression models. Of the 171 patients enrolled, 39% were non-frail, 51% were pre-frail, and 10% were frail. Patients were followed for a median of 17 months; during this period, 42% underwent transplantation, whereas 6% died or were permanently removed from the waiting list. In adjusted analyses, frail and pre-frail patients combined had a 42% lower likelihood of undergoing transplantation compared with non-frail patients (SubHR 0.58, 95% CI 0.39-0.86; P = .006). Frailty among patients with advanced CKD on the kidney transplant waiting list was associated with a lower probability of undergoing transplantation.

Randomised clinical trials have transformed nephrology, driving major advances in the management of chronic kidney disease. Their success, however, depends not only on robust methodology but also on the professionals who deliver the protocols. This study aims to describe and critically discuss the role of the research nurse in randomized clinical trials in nephrology, highlighting their contribution to trial conduct, data quality, and patient engagement. Research nurses now play a critical and increasingly recognised role at the interface of science, clinical care and patient experience. Their responsibilities include guiding informed consent, ensuring adherence to Good Clinical Practice, coordinating complex study procedures, and maintaining high-quality data. Evidence from European nephrology trials, including ROTATE-3, FINESSE and other multicentre platforms, demonstrates that structured nursing involvement improves recruitment, retention and data integrity. Research nurses also contribute to protocol optimisation, feasibility assessments and scientific reporting, highlighting their evolution into true clinical research partners. Formal recognition, specialised training pathways and institutional support are essential to consolidate this role. Strengthening research nursing is a strategic priority to enhance trial efficiency and to advance kidney research across Europe. These findings position research nurses as key drivers of both operational efficiency and scientific quality in modern nephrology trials.

Although the extraperitoneal approach is standard in renal transplant, intraperitoneal placement is utilized in pediatric recipients and select adult cases. Concerns exist regarding the safety of percutaneous allograft biopsy in intraperitoneally placed kidneys due to potential visceral injury. We aimed to compare biopsy-related complication rates between intraperitoneal and extraperitoneal kidney transplant recipients. This retrospective cohort study (2022-2024) compared biopsy-related complications in 100 transplant recipients (50 intraperitoneal, 50 extraperitoneal) at Labbafinezhad Hospital. Only 23 patients underwent ultrasonography-guided allograft biopsy (13 intraperitoneal, 10 extraperitoneal) for clinical indications. Demographic, clinical, and transplant-related variables and postbiopsy complications were evaluated. The intraperitoneal group (mean age 39 ±12 years, 69% male) and the extraperitoneal group (mean age 37 ± 13 years, 60% male) were demographically comparable (P > .05). All transplants were from living donors. No significant differences were observed in baseline characteristics, including cause of end-stage renal disease, dialysis vintage, or number of previous transplants. Postbiopsy complications were rare and of minor severity in both cohorts. One patient (7.7% ) in the intraperitoneal group developed a small hematoma (grade 3), and 1 patient (7.7% ) had a minor perinephric collection (40 mL). No such events occurred in the extraperitoneal group, but this difference was not significant (P = .565). No instances of gross hematuria, clinically significant hemoglobin drop, transfusion requirement, hypotension, fistula, or need for angioembolization were recorded in either group. Ultrasonography-guided renal allograft biopsy appears to be a safe procedure with a similarly low complication profile in both intraperitoneal and extraperitoneal transplant recipients. Despite theoretical risks associated with intraperitoneal organ placement, our study found no evidence of increased major or minor complications, supporting the safety of percutaneous biopsy in this population when performed with image guidance.

Diabetic nephropathy (DN) is a major cause of chronic kidney disease. Proteinuria is a hallmark of DN. An active receptor-mediated pathway involving megalin and cubilin receptors and the Cl-/H+ antiporter ClC-5 is responsible for filtered albumin uptake in the proximal tubular epithelium. The aim of our pilot study was to analyze the patterns of megalin and ClC-5 expression in the kidney biopsies of patients with DN, minimal change disease (MCD), and controls, and their correlations with kidney dysfunction. Kidney biopsies of 10 DN and 8 MCD patients, and 9 controls (CTRs) were analyzed. Immunohistochemical and immunofluorescence staining, and morphometric analysis were performed to quantify megalin, ClC-5 and synaptopodin signals. The ClC-5 glomerular signal was significantly reduced in DN and MCD compared with controls. In MCD, ClC-5 was detected in podocytes and parietal cells, while in DN it was detected only in parietal cells and colocalized with CD44 in hypertrophic parietal cells (ANXA3+). Megalin was also significantly reduced in DN compared with controls, and the correlation between ClC-5 and megalin was lost at the glomerular level. At the tubular level, the ClC-5 signal was reduced in DN and MCD compared with controls. In both glomerulopathies, tubular ClC-5 and megalin expression correlated with proteinuria and kidney function. In DN, glycosylated hemoglobin inversely correlated with tubular megalin expression. We found impairment of the endocytic process in DN and MCD patients. In pateints with DN, hyperglycemia appeared to be associated with an altered endocytic process at the glomerular and tubular levels.

The prognosis of IgA nephropathy (IgAN) has long been uncertain due to its slow progression rate. For this reason, it has been considered a relatively benign disease with limited need for specific treatment. Recent registry data suggest that up to 75% of patients progress to kidney failure within 25 years. Moreover, the average age at the time of kidney biopsy has progressively increased, suggesting that one possible reason for worsening outcomes is the change in patient characteristics. Consequently, delayed kidney biopsies and thus later-stage diagnoses may reduce treatment efficacy and expose more patients to treatment-related adverse events. Traditional therapeutic options, including renin-angiotensin system (RAS) blockers and corticosteroids, have shown limited success in achieving complete remission. Newer agents, such as budesonide, sodium-glucose co-transporter-2 (SGLT2) inhibitors, and sparsentan, have shown improved proteinuria reduction but are still far from achieving remission. The efficacy of corticosteroids appears to depend on the degree of residual kidney function at the time of treatment initiation, with better outcomes observed in patients with higher baseline kidney function. The development of novel therapeutic agents, together with a deeper understanding of IgAN immunopathogenesis and chronic kidney disease (CKD), is reshaping treatment paradigms. As recommended by the new Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, treatment strategies now need to involve a combination approach targeting both immune dysregulation and CKD progression.

To evaluate the repeatability and consistency of rapid quantitative 23Na MRI of the human calf, an acquisition-weighted stack-of-stars (AW-SOSt) sequence was implemented on a 7T MRI system and used for all measurements. Three variants, differing only in nominal in-plane spatial resolution (2.5, 5.0, and 7.5 mm) and corresponding acquisition times (8:04, 4:02, and 2:41 min), while maintaining a constant slice thickness of 15 mm, were employed for imaging the calf skeletal muscle. Quantitative consistency across resolutions and repeatability was evaluated in simulations and consecutive measurements of 10 healthy volunteers. The apparent tissue sodium concentration (aTSC) was determined using a postprocessing pipeline consisting of a B0, B1, relaxation, and partial volume correction (PVC). Deviations of the determined aTSC from simulated ground truth were below 6.0%. The simulated coefficient of variation (CV) improved with decreasing spatial resolution from 1.1% to 0.9%. The in vivo findings matched the simulation results. The CV improved with increasing voxel size, decreasing from 2.7% at 2.5-mm resolution to 2.0% at 7.5-mm resolution. Measurements remained highly consistent across different in-plane resolutions, with a small increase in aTSC (≈0.2 mM) observed as a difference between lower resolutions (7.5 mm) and the highest resolution (2.5 mm). All applied protocols showed good repeatability and high consistency between the protocols. aTSC quantification using low-resolution 23Na MRI showed improved repeatability, whereas in vivo measurements showed no effect on quantitative accuracy. This study demonstrates that low-resolution 23Na MRI with short acquisition times combined with PVC could be a practical alternative to commonly used "high-resolution" techniques with long acquisition times for quantifying aTSC in calf muscle tissue.