Background Over the past decade, the therapeutic role of sodium-glucose co-transporter 2 inhibitors (SGLT2i) has evolved from oral hypoglycemic agents to agents with proven cardio- and reno-protective benefits, including use in non-diabetic kidney disease. Despite being one of the four pillars of chronic kidney disease management, real-world prescribing trends remain poorly characterized. Materials and Methods This retrospective observational study analyzed electronic medical records of patients attending the nephrology outpatient department at a tertiary care hospital to determine the proportion of patients prescribed an SGLT2 inhibitor among those with a Class Ia guideline recommendation. Subsequently, an online questionnaire-based survey was conducted among nephrologists to identify barriers to SGLT2i prescription. Results Among 5,701 patients who attended the Nephrology outpatient department in 2024, 399 met the criteria for Class Ia indication for SGLT2i therapy. The overall prescription rate was 20.3%, with 18.7% in patients with diabetes mellitus and 24.7% in those without. Factors significantly associated with SGLT2i prescription included younger age ( p = 0.004), presence of albuminuria ( p = 0.033), concomitant use of renin-angiotensin-aldosterone system (RAAS) inhibitors ( p = 0.002), and higher estimated glomerular filtration rate (eGFR) ( p = 0.026). Among 55 nephrologists who participated in the survey, only 55% reported prescribing SGLT2i in >25% of eligible patients. Conclusion Despite robust evidence supporting their benefits, SGLT2i prescription rates remain suboptimal among patients with Class Ia indications. Strategies such as early nephrology referral and educational initiatives to enhance awareness may improve the uptake of guideline-recommended therapy.

Background The existence of multiple diagnostic criteria results in inconsistencies in the reporting of incidence and outcomes of AKI in children, warranting the need for a single criterion. Materials and Methods We conducted a prospective observational cohort study in a tertiary care hospital, enrolling 502 children aged 1 month to 18 years. We compared the incidence and staging of AKI using serum creatinine (Scr)-based definitions from pRIFLE, AKIN, and KDIGO criteria. We also assessed AKI-associated mortality, need for kidney replacement therapy (KRT), and recovery of kidney function in each group. Results Among 502 children, AKI was identified in 12%, 11%, and 10.8%, respectively, using pRIFLE, AKIN, and KDIGO. All three criteria showed excellent agreement for Stage 1 AKI (κ > 0.98) and substantial agreement for Stages 2–3, with overall inter-definition concordance exceeding κ = 0.90. AKI was significantly associated with higher mortality (ORs 10.9–15.0; p < 0.001), with a consistent increase in KRT requirement with advancing AKI stage across all criteria (KRT requirement in Stage 3: >40% of patients with AKI; p < 0.05 for all definitions). The median AKI duration was 3 days, with ∼68% showing recovery of kidney function at discharge. Venn analysis showed that most cases were identified by all definitions, with pRIFLE detecting seven additional stage 1 AKI cases that did not translate to adverse outcomes. Conclusion All three definitions demonstrate excellent concordance and comparable clinical utility. AKI, irrespective of diagnostic criteria, is strongly associated with mortality and the need for KRT across all definitions.

Background We conducted this study to understand the experiences of stigma among maintenance hemodialysis patients. Materials and Methods Using purposive sampling, maintenance hemodialysis patients treated in the blood purification center of a domestic Grade A tertiary hospital from August 2024 to October 2024 were selected as the research subjects. Face-to-face semi-structured interviews were conducted with 14 patients, and the interview data were analyzed using Colaizzi’s seven-step method of interpretative phenomenology to extract themes. Results Three themes were extracted after sorting out the data of maintenance hemodialysis patients, including sources of stigma, behavioral manifestations of stigma, and experiences of coping with stigma. The sources of stigma included social prejudice, family pressure, and self-negation; the behavioral manifestations included concealing the condition, self-isolation, and body shame; the coping experiences included dynamic adjustment of mindset, seeking comfort on one’s own, and unmet support needs. Conclusion There is a vicious circle of stigma among maintenance hemodialysis patients, which impacts their return to normal life. Society should strengthen public awareness of maintenance hemodialysis, correct misperceptions, and enhance social support. Medical institutions should improve the relevant systems and supporting facilities to provide comprehensive support, including treatment, information, and emotional support, for patients.

Background Acute liver failure (ALF) is a life-threatening critical illness. We analyzed the transplant-free survival rate of patients with ALF treated with extracorporeal therapies such as plasmapheresis/continuous renal replacement therapy (CRRT), and determined the factors that increase the risk of mortality in ALF patients treated with these measures. Materials and Methods All adult patients with ALF meeting the criteria of the American Association for the Study of Liver Diseases 2005 (AASLD 2005) were included in the study. Patients with sepsis, acute respiratory distress syndrome, multiorgan failure, and irreversible brain damage were excluded from the study. Data were retrieved from electronic medical records. Demographic and biochemical parameters, King’s College Criteria (KCC), Acute Liver Failure-Early Dynamics (ALFED) score, Model for End-Stage Liver Disease (MELD) score, renal function test, inotropic requirements, need for mechanical ventilation, presence of sepsis, and need for liver transplantation were recorded. The mean MELD score was found to be 37, and the mean ALFED score was 2. The mean number of sessions of plasmapheresis was 3, and the mean hours of CRRT were 62.73 hours. The 30-day mortality rate and transplant-free survival rate were calculated. Results Of the 79 patients with ALF, 26 (32.9%) underwent plasmapheresis alone, 16 (20.3%) underwent continuous renal replacement therapy alone, while the largest group, comprising 37 patients (46.8%), underwent both plasmapheresis and continuous renal replacement therapy. Of these 79 patients with ALF, 44 (55.69%) survived without transplantation using plasmapheresis and CRRT as treatment modalities; 11 patients (13.92%) required liver transplantation. The transplant-free survival rate was 55.69% (n=44) among 79 patients with ALF who used plasmapheresis/CRRT or both as treatment modalities compared to 22.2% (n=20) in the standard medical treatment group (n=90) as historical controls. This difference in transplant-free survival rate was statistically significant, and the p-value was <0.0001. The mortality rate was 30.37% (n=24) among 79 patients with ALF who had used plasmapheresis/CRRT or both as treatment modalities, compared to 52.2% in the standard medical treatment group (historical controls). This difference in mortality rate is statistically significant, and the p-value is 0.007. The requirement for mechanical ventilation, inotrope requirement, and AKI are associated with increased risk of mortality. Conclusion In this cohort of patients with ALF, plasmapheresis and/or CRRT achieved a transplant-free survival rate of 55.7%, indicating a clinically meaningful survival benefit. These findings support the role of extracorporeal therapies as effective bridging or definitive interventions in the management of ALF, particularly in settings where liver transplantation is not immediately available.

Background IgA nephropathy (IgAN) is the most frequent primary glomerular disease worldwide. The prognostic role of CD68, a macrophage marker, is under debate. We investigated the prognostic value of CD68 macrophage count and its correlation with Oxford Scoring system (MEST-C scores) and C3 immunoreactivity in IgAN. Materials and Methods Kidney biopsies of all adult patients diagnosed with IgAN between 2011 and 2020 were evaluated using the Oxford MEST-C scoring system. Immuno-histochemical staining was performed using monoclonal antibodies against CD68. Glomerular macrophages were quantified & correlated with each component of the MEST-C score and the intensity of mesangial IgA and C3 immunostaining. Renal CD68 counts were also correlated with demographic and clinical features. Additionally, correlations were performed between glomerular & interstitial CD68, with the IgAN percent risk prediction score. Results Glomerular and interstitial CD68 were correlated with proteinuria ( p < 0.05). Hypertension, eGFR, and risk prediction scores correlated with the mean interstitial CD68. Correlation was observed between mesangial cellularity (M) and the mean glomerular or interstitial CD68. Correlation was also observed between interstitial fibrosis and tubular atrophy (IFTA) with mean interstitial CD68. The number of globally sclerosed & normal glomeruli and crescent (C) correlated with mean interstitial CD68. Conclusion We demonstrate a correlation of mesangial and interstitial CD68 macrophage count with a number of clinical parameters. Further studies with larger sample numbers and follow-up biopsies are required to validate it.