Nephropathy In Patients Research Articles

Development and internal and external validation of a nomogram model for predicting the risk of chronic kidney disease progression in IgA nephropathy patients.

IgA nephropathy (IgAN) is the most common primary glomerular disease in chronic kidney disease (CKD), exhibiting significant heterogeneity in both clinical and pathological presentations. We aimed to explore the risk factors influencing short-term prognosis (≥90 days) and to construct a nomogram model for evaluating the risk of CKD progression in IgAN patients. Clinical and pathological data of patients diagnosed with IgAN through biopsy at two centers were retrospectively collected. Logistic regression was employed to analyze the training cohort dataset and identify the independent predictors to construct a nomogram model based on the final variables. The predictive model was validated both internally and externally, with its performance assessed using the area under the curve (AUC), calibration curves, and decision curve analysis. Out of the patients in the modeling group, 129 individuals (41.6%) did not achieve remission following 3 months of treatment, indicating a high risk of CKD progression. A multivariate logistic regression analysis demonstrated that body mass index, urinary protein excretion, and tubular atrophy/interstitial fibrosis were identified as independent predictors for risk stratification. A nomogram model was formulated utilizing the final variables. The AUCs for the training set, internal validation set, and external validation set were 0.746 (95% confidence intervals (CI) [0.691-0.8]), 0.764 (95% CI [0.68-0.85]), and 0.749 (95% CI [0.65-0.85]), respectively. The validation of the subgroup analysis also demonstrated a satisfactory AUC. This study developed and validated a practical nomogram that can individually predict short-term treatment outcomes (≥90 days) and the risk of CKD progression in IgAN patients. It provides reliable guidance for timely and personalized intervention and treatment strategies.

The use of allopurinol in prophylaxis against contrast-induced nephropathy in patients undergoing percutaneous coronary intervention

Abstract Background Contrast-induced nephropathy (CIN) is a serious complication after percutaneous coronary intervention (PCI). Inflammation and development of reactive oxygen species are among the postulated mechanisms of CIN. Allopurinol with anti-inflammatory action could be a preventive method of CI-AKI. Aim of the work To determine the effect of adding allopurinol to hydration in the prevention of CIN in patients undergoing PCI, with or without hyperuricemia. Methods One hundred and seven patients with moderate to high Mehran score undergoing elective PCI were randomly allocated to the allopurinol (n=52) or the control group (n=55). Those in the allopurinol group (hyperuricemic n=25, and normouricemic n= 27) received allopurinol 300 mg one day and one hour before PCI beside intravenous hydration (1 ml/kg/hour) normal saline, a maximum of 100 ml/hour for 12 hours pre and post coronary angiography. Patients in the control group (hyperuricemic n=26 and normouricemic n=29), received the same intravenous hydration only. Serum creatinine and urea were measured before and 48 hours after the procedure while the uric acid level was measured before the procedure only. CIN was defined by a percentage increase in serum creatinine of ≥25% or absolute serum creatinine ≥0.5 mg/dl, 48 hours after PCI. Results The mean age of the studied patients was 59.6 ± 9.1 years old, 59% were male. No difference between both groups regarding baseline characteristics or medications. Average Mehran score was 9.0 ± 1.2. CIN was observed in 5 patients in the allopurinol group (9.6%) and 15 patients in the control group (27.3%) (P = 0.017). There was no significant difference between both groups regarding the contrast volume (179.8 ± 68.1 vs. 153.8 ± 57.9 ml, p: 0.052). Hyperuricemia had no significant effect on increasing the incidence of CI-AKI either in patients with or without CKD (p=0.964). Conclusion Allopurinol on the top of hydration was found to decrease the incidence of CIN following PCI in patients with moderate to high Mehran score for CIN. The anti-inflammatory action of allopurinol could be the mechanism of this favorable effect, as baseline uric acid didn't affect the results. Further multi-center study with a larger sample size is needed to offer more definite results.

Efficacy of atorvastatin on renal function in patients with contrast-induced nephropathy after percutaneous coronary intervention

BackgroundAt present, the clinical methods for preventing and treating contrast-induced nephropathy (CIN) are limited, and statins can play a better role during this process. So, we aimed to assess the atorvastatin on renal function in nephropathy patients after percutaneous coronary intervention (PCI).MethodsIn this work, 100 elderly patients with coronary heart disease (CHD) were selected into an experimental group (Exp group, 50 cases, 40 mg/d po atorvastatin) and a control group (Ctrl group, 50 cases, 10 mg/d po atorvastatin). The renal function indicators, blood routine indicators, and the incidence of adverse reactions (ARs) were compared between patients in Exp and Ctrl groups.ResultsAfter surgery, the levels of serum creatinine (SCr), blood urea nitrogen (BUN), cystatin C (CysC), high-sensitivity C-reactive protein (hs-CRP), and interleukin (IL6) in patients in the Exp group were much lower, and the levels of estimated glomerular filtration rate (eGFR) and superoxide dismutase (SOD) were higher (all P < 0.05). Meanwhile, the incidences of ARs during hospitalization between patients in the Exp and Ctrl groups were all 8%, showing no observable difference (P > 0.05). Compared with conventional doses of atorvastatin, high-dose atorvastatin can effectively prevent renal function damage in patients with CIN, decrease the inflammation and oxidative stress in patients, and will not increase the risk of ARs during hospitalization.ConclusionTaken together, high-dose atorvastatin can be applied in treating patients with CHD after PCI due to its excellent efficacy and high safety.

Effects of APOE isoforms in diabetic nephropathy patients of South India.

Diabetic nephropathy (DN) is a grave complication and the most common renal dysfunction of diabetes mellitus. Genetic factors, including Apolipoprotein E (APOE) isoforms, have been implicated in the pathogenesis of DN. A total of 577 type 2 Diabetes mellitus subjects were categorized into diabetes non-nephropathic (Controls: n = 321), diabetes nephropathic (DN: n = 256) groups. Demographic, clinical, and biochemical parameters including age, BMI, lipid profiles (TC, LDL-C, HDL-C, TG), glucose metabolism (plasma glucose, HbA1c, serum insulin), renal function (UACR, PCR), and blood pressure (SBP, DBP) were assessed. APOE variant frequencies were determined using restriction fragment length polymorphism (RFLP) analysis, validated against Hardy-Weinberg equilibrium (HWE), and statistically correlated with each clinical and biochemical parameter. The DN group had an increased prevalence of hypertension, fatty liver, and dyslipidemia compared to the Control group. Biochemical analyses revealed elevated levels of TC (213.41mg/dL vs. 189.32mg/dL), LDL-C (134.46mg/dL vs. 107.56mg/dL), and reduced HDL-C (58.13mg/dL vs. 65.32mg/dL) in DN cases compared to Controls (all p < 0.0001). The APOE variants distribution showed a significant increase in E2 allele frequency (69.1% vs. 15.3%) and corresponding homozygous genotype (E2/2: 42.2% vs. 5.6%) in DN cohorts. The study found a higher frequency of E2 allele in the DN group compared to Controls, though no statistically significant risk of DN was linked to this allele. The results suggest a potential association for APOE polymorphisms, requiring broader studies to clarify the role of APOE polymorphisms in DN susceptibility.

High glucose-induced senescence contributes to tubular epithelial cell damage in diabetic nephropathy

Dysfunctional renal tubular epithelial cells, induced by high glucose, are commonly observed in the kidney tissues of diabetic nephropathy (DN) patients. The epithelial-mesenchymal transition (EMT) of these cells often leads to renal interstitial fibrosis and kidney damage in DN. High glucose also triggers mitochondrial damage and apoptosis, contributing further to the dysfunction of renal tubular epithelial cells. Cellular senescence, a recognized characteristic of DN, is primarily caused by high glucose. However, it remains unclear whether high glucose-induced cellular senescence in DN exacerbates the functional impairment of tubular epithelial cells. In this study, we examined the relationship between EMT and cellular senescence in kidney tissues from streptozotocin (STZ)-induced DN and HK-2 cells treated with high glucose (HG). We also investigated the impact of HG concentrations on tubular epithelial cells, specifically mitochondrial dysfunction, cellular senescence and apoptosis. These damages were primarily associated with the secretion of cytokines (such as IL-6, and TNF-α), production of reactive oxygen species (ROS), and an increase of intracellular Ca2+. Notably, resveratrol, an anti-aging agent, could effectively attenuate the occurrence of EMT, mitochondrial dysfunction, and apoptosis induced by HG. Mechanistically, anti-aging treatment leads to a reduction in cytokine secretion, ROS production, and intracellular Ca2+ levels.

Doppler ultrasound imaging and shear wave elastography for evaluation of interstitial fibrosis/tubular atrophy in IgA nephropathy.

The purpose of this study was to explore the value of Doppler ultrasound imaging and shear wave elastography (SWE) in evaluating renal interstitial fibrosis/tubular atrophy (IFTA). During April 2019 and November 2023, biopsy-proven IgA nephropathy (IgAN) patients were enrolled in our study. Conventional ultrasound, Doppler ultrasound imaging and SWE measurements were performed, and related parameters were collected. According to the Oxford classification of IgAN, interstitial fibrosis/tubular atrophy (T) lesions were grouped into T0, T1 and T2 group. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic accuracy of SWE in identifying IFTA. A total of 100 IgAN patients were enrolled in the final cohort. 67 patients were in the T0 group, and 33 patients were in the T1/T2 group. The average SWE values were 42.17 ± 9.11kPa in the T0 group and 36.83 ± 10.32kPa in the T1/T2 group (p = 0.01). Multivariate logistic regression revealed that the SWE value and end diastolic velocity (EDV) of the interlobar artery were found to be independent risk factors for IFTA. For the diagnosis of IFTA, the area under the ROC curve (AUC) of SWE alone was 0.652, whereas the AUC of SWE in combination with the EDV was 0.807 (p = 0.008). The combination of Doppler ultrasound imaging and SWE measurements could improve the diagnostic performance of quantitative assessment of IFTA in IgAN patients.

Prevalence of Diabetic Macular Edema Using Optical Coherence Tomography in Type 2 Diabetics With Nephropathy in Comparison With Type 2 Diabetics Without Nephropathy.

The primary vision-threatening complication in patients with diabetic retinopathy (DR) is diabetic macular edema (DME). Diabetic nephropathy (DN) often has DR that threatens their vision and has a risk of developing DME. Hence, the presence of DN could be the only risk factor for developing DME without the presence of other factors. Hence, this study proposes to predict the prevalence of DME using optical coherence tomography (OCT) in type 2 diabetics with nephropathy in comparison with diabetics without nephropathy. This is a cross-sectional study done on patients visiting the Ophthalmology Department at Saveetha Medical College and Hospital, Chennai, for one year. A total of 120 patients were included in the study, with 60 diabetic patients without nephropathy in Group 1 and 60 diabetic patients with nephropathy in Group 2. A detailed history was recorded. Their recent blood reports of fasting blood sugar, postprandial blood sugar, hemoglobin A1c (HbA1c), renal function test, and urine protein/creatinine ratio were all noted. Chronic kidney disease (CKD) staging in nephropathy patients as done by the nephrologist was also documented. The best corrected visual acuity (BCVA) was assessed for distant and near vision. A slit lamp examination and dilated fundus examination were done. Fundus findings were independently graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. OCT was done in all patients to confirm DME. In our study. males and females were 60 each in number. The majority of patients(32.5%) were >70 years old. A small percentage of patients (1.7%) in Group 1 had DM of >10 years, and 41.7% of the patients in Group 2 had DM of >10 years. Meanwhile, 73.3% of the patients in Group 1 had an HbA1c level between 6% and 7.5%, and 83.3% of the patients in Group 2 had an HbA1c level >7.5%. The percentage of patients with DME in Group 1 was 1.7%, and that in Group 2 was 21.7%. The majority of patients who had BCVA of 6/6 were in Group 1. The majority of patients with DME (46.4%) had stage V nephropathy. The coexistence of nephropathy in diabetic patients increases the incidence of DME. With long-standing diabetes and uncontrolled blood sugar levels being risk factors for developing DN and subsequently DME, such patients are to be screened regularly and advised on adequate glycemic control for achieving good visual prognosis and limit retinopathy progression. Moreover, the severity of DN should be kept in mind by nephrologists, and patients are to be promptly referred to the ophthalmology department for complete evaluation.

Diminished nuclear-localized β-adrenoceptor signalling activates YAP to promote kidney fibrosis in diabetic nephropathy.

Diabetic nephropathy (DN) is a leading cause of chronic kidney disease (CKD), which is characterized by mesangial matrix expansion that involves dysfunctional mesangial cells (MCs). However, the underlying mechanisms remain unclear. This study aims to delineate the spatiotemporal contribution of adrenergic signalling in diabetic kidney fibrosis to reveal potential therapeutic targets. A model of diabetic nephropathy was induced by in db/db mice. Gene expression in kidneys was profiled by RNA-seq analyses, western blot and immunostaining. Subcellular-localized fluorescence resonance energy transfer (FRET) biosensors determined adrenergic signalling microdomains in MCs. Effects of oral rolipram, a phosphodiesterase 4 (PDE4) inhibitor, on the model were measured. Our model exhibited impaired kidney function with elevated expression of adrenergic and fibrotic genes, including Adrb1, PDEs, Acta2 and Tgfβ. RNA-seq analysis revealed that MCs with dysregulated YAP pathway were crucial to the extracellular matrix secretion in kidneys from diabetic nephropathy patients. In cultured MCs, TGF-β promoted profibrotic gene transcription, which was regulated by nuclear-localized β-adrenoceptor signalling. Mechanistically, TGF-β treatment diminished nuclear-specific cAMP signalling in MCs and reduced PKA-dependent phosphorylation of YAP, leading to its activation. In parallel, db/db mouse kidneys showed increased expressions of PDE4B and PDE4D. Treatment with oral rolipram alleviated kidney fibrosis in db/db mice. Diabetic nephropathy impaired nuclear-localized β1-adrenoceptor-cAMP signalling microdomain through upregulating PDE4 expression, promoting fibrosis in MCs via PKA dephosphorylation-dependent YAP activation. Our results suggest PDE4 inhibition as a promising strategy for alleviating kidney fibrosis in diabetic nephropathy.

Correlation Of NAG, NGAL, and Oxidative Parameters For Patients With Diabetic Nephropathy

Background: Diabetic nephropathy is a clinical syndrome that is present in diabetic mellitus patients and characterized by albuminuria {&gt;200 or &gt;300 mg\day}, a gradual glomerular filtration rate decline along with hypertension. Objective: Study the correlation between N_acetyl-ß-D-glucamindase and human neutrophil gelatinase-associated lipocalin and oxidative parameters in diabetic nephropathy patients compared with a control group and several variables by Explaining the results scientifically. Method: The blood sample was collected from forty-five diabetic nephropathy patients and forty-five controls from Merjin Medical Hospital and Al-Imam Al-Sadiq Hospital in Iraq to assess N-acetyl-β-D-glucosaminidase and human neutrophil gelatinase-associated lipocalin levels by used Enzyme-Linked immunosorbent Assay technicality (ELISA) and also to determine the oxidative parameters (total oxidant system, total antioxidant capacity, malondialdehyde and glutathione) by used spectrophotometer. Result: positive correlation for N-acetyl-β-D-glucosaminidase with total oxidant status and malondialdehyde where the correlation coefficient (r=0.893**, 0.809**) at respectively and negative correlation with total antioxidant capacity and glutathione where the (r=-0.851**, -0.465**) at respectively, and exact correlation for human neutrophil gelatinase-associated lipocalin with total oxidant status, malondialdhyde, total antioxidant capacity, glutathione. Conclusion: The assessment of NAG, NAGL, and oxidant parameters can provide crucial information for the early diagnosis, management, and therapy of these patients with diabetic nephropathy.

Synergistic modulation of endoplasmic reticulum stress pathway, oxidative DNA damage and apoptosis by β-amyrin and metformin in mitigating hyperglycemia-induced renal damage using adult zebrafish model

Diabetic nephropathy (DN) can be prevented with early therapeutic intervention in diabetic patients. Recent investigations suggest that β-amyrin, a pentacyclic triterpenoid, could offer significant benefits with its potential antihyperglycemic and nephroprotective effects. We investigated the protective effects of β-amyrin alone and combined it with metformin, the cornerstone therapy for diabetes, using a hyperglycemic adult Zebrafish (ZF) model. The ZF were subjected to hyperglycemia by immersing them in 111 mM glucose solutions. Treatment efficacy was assessed by measuring serum glucose and insulin levels and antioxidant, ER stress, apoptosis, and proinflammatory markers. ZF kidneys were also studied for immunohistochemistry and histopathology. Results revealed that the combined treatment of β-amyrin and metformin resulted in a significant decrease (p ≤ 0.05) in blood glucose levels to 104.54 ± 1.63 mg/dL, in comparison to 388.75 ± 4.32 mg/dL in the untreated diseased control group. The reduction in hyperglycemia was more pronounced than treatment with either compound alone. Moreover, treatment with the combination restored renal function in diseased ZF, leading to significantly lower (p ≤ 0.05) serum urea (SU: 19.57 ± 1.61 mg/dL) and serum creatinine (SC: 0.56 ± 0.02 mg/dL) values compared to treatment with β-amyrin (SU:27.02 ± 0.96 mg/dL; SC: 0.7 ± 0.01 mg/dL) or metformin (SU: 24.53 ± 1.29 mg/dL; SC: 0.6 ± 0.02 mg/dL) alone. The treatment also reduced oxidative stress markers, apoptosis and ER stress markers, and proinflammatory cytokines. Histopathological analysis showed improved renal architecture with significantly lower (p ≤ 0.05) renal tubular injury scores with the combination than with individual treatment. This study provides novel insights into the combined therapeutic effects of β-amyrin and metformin in mitigating hyperglycemia-induced renal damage through key molecular pathways, highlighting a potentially effective therapeutic strategy for diabetic nephropathy. The findings hold promising translational relevance for developing combination therapies aimed at improving clinical outcomes in diabetic nephropathy patients.

PRR promotes hypertensive renal injury by activating Wnt/β-catenin signaling and inflammation infiltration in mice

Hypertension stands out as a substantial independent risk factor in the progression of chronic kidney disease; however, the exact pathological mechanisms remain elusive. Our preliminary studies find that Wnt/β-catenin control renin-angiotensin system (RAS) expression, thus playing an important role in the pathogenesis of hypertension and renal fibrosis. As an integral component of the RAS, the (pro)renin receptor (PRR) plays a crucial role in the activation of the RAS and hypertension. Recent studies suggest a reciprocal relationship between PRR and Wnt/β-catenin signaling, potentially contributing to hypertensive renal fibrosis development. To assess the role of PRR in mediating hypertensive nephropathy, we manipulated this signaling by over expression of PRR ligand or blockade of PRR by siPRR. In vivo, PRR induction promoted hypertension, proteinuria, renal fibrosis, inflammatory response and β-catenin activation in Ang II induced hypertension mice. Conversely, blockade of PRR inhibited Ang II mediated hypertension, renal fibrosis and inflammation. In vitro, PRR over expression renal tubular cells exacerbated the Ang II induced fibrotic response and inflammation. Moreover, PRR was upregulated in hypertensive nephropathy patients, and correlated with renal function and renal fibrosis. These results indicate that PRR interact with Wnt/β-catenin signaling promote the progression of hypertensive nephropathy. PRR could be served as a biomarker for the diagnosis and treatment of hypertensive renal fibrosis.

Prevalence, Incidence, and Risk Factors of Nephropathy in Patients with Prediabetes: Family History of Diabetes Mellitus Is Not Associated with Increased Risk of Nephropathy

Background: Nephropathy, a vascular complication of hyperglycemia in patients with diabetes mellitus (DM) and prediabetes, is the leading cause of chronic kidney disease. Objectives: This study aimed to investigate the incidence and prevalence of nephropathy and its risk factors in patients with prediabetes, with a particular focus on exploring the association between a family history (FH) of DM and nephropathy. Methods: In this retrospective study, we examined the medical records of 819 patients with prediabetes referred to the Isfahan Endocrine and Metabolism Research Center in 2004. We compared the prevalence of nephropathy in 2019 to baseline levels and assessed factors such as FH of DM in first-degree relatives and other nephropathy-related factors among patients with and without nephropathy. Results: The prevalence of nephropathy increased from 39% to 60.6% over 15 years, with a cumulative incidence of 21.6% and a mean annual incidence of 2.4%. There were differences in diastolic and systolic blood pressure, lipid markers, fasting and postprandial glucose levels, and glomerular filtration rate between patients with and without nephropathy; however, these differences were not statistically significant (P-value ≥ 0.05). Male sex (Odds ratio [OR]: 1.8), age (OR: 1.02), and Body Mass Index (BMI) (OR: 1.05) were significantly associated with nephropathy (P-value &lt; 0.05). No significant association was found between a positive FH of DM and nephropathy (P-value = 0.638). Conclusions: Our findings indicate that a FH of DM is not associated with an increased risk of nephropathy in patients with prediabetes. Instead, sex, age, and BMI play a more significant role. Therefore, these factors may be more critical in guiding preventive and treatment measures.

Efficacy and safety of telitacicept, a BLyS/APRIL dual inhibitor, in the treatment of IgA nephropathy: a retrospective case-control study.

Telitacicept, a B lymphocyte stimulator/A proliferation-inducing ligand dual-target fusion protein, has recently been used in autoimmune diseases. We assessed the efficacy and safety of telitacicept in immunoglobulin A nephropathy (IgAN) patients. This study included 42 IgAN patients who received telitacicept treatment, forming the 'whole telitacicept group'. Among them, 20 patients who had not previously received corticosteroid (CS) therapy or immunosuppressive (IS) agents were categorized as the 'newly treated telitacicept subgroup'. Additionally, 28 patients who were selected to match historical controls received conventional IS therapy (CS therapy with/without IS agents) and were classified as the 'conventional IS group'. Telitacicept was partially used in combination with conventional IS therapy, including initial CS in different doses. Various indicators were compared at 4-week intervals up to 24weeks among the three groups. After 24weeks of treatment, the 24-hour proteinuria decreased from 1.70g [interquartile range (IQR) 1.05-2.58] to 0.21g (IQR 0.39-0.13) (P=.043) in the newly treated telitacicept subgroup, from 1.78g (IQR 0.97-2.82) to 0.44g (IQR 1.48-0.16) (P=.001) in the conventional IS group and from 1.07g (IQR 0.66-1.99) to 0.26g (IQR 0.59-0.17) (P=.028) in the whole telitacicept group. The estimated glomerular filtration rate (eGFR) increased from 76.58±30.26ml/min/1.73m2 to 80.30±26.76ml/min/1.73m2 (P=.016) in the newly treated telitacicept subgroup, from 72.73±33.41ml/min/1.73m2 to 84.08±26.81ml/min/1.73m2 (P=.011) in the conventional IS group and from 70.10±32.88ml/min/1.73m2 to 71.21±31.49ml/min/1.73m2 (P=.065) in the whole telitacicept group. During follow-up periods, the efficacy rates of the three groups did not show statistically significant differences and no serious adverse events were observed. Telitacicept may be a safe and effective treatment for IgAN, offering reductions in proteinuria and increases in eGFR similar to conventional IS therapy. After a 24-week follow-up, the incidence of adverse events was lower for telitacicept than for conventional IS therapy.

Efficacy and safety of rituximab in patients with PLA2R associated membranous nephropathy and resolved HCV infection

Rituximab occasionally induces reactivation of hepatitis C virus (HCV) in patients with resolved HCV infection, sometimes with fatal consequences. As rituximab has become one of the first-line therapies for the treatment of phospholipase A2 receptor (PLA2R)-associated membranous nephropathy (MN) and is more widely used, there is a lack of studies reporting the effectiveness and safety of rituximab in patients with PLA2R-associated MN and resolved HCV infection. A single-center retrospective study was conducted on PLA2R-associated membranous nephropathy (MN) patients who were HCVAb positive but HCV-RNA negative and treated with rituximab. A total of 598 adult patients with PLA2R-associated MN who underwent rituximab therapy were screened. General clinical information, including gender, age, pathological data, and previous treatment plans, was collected from medical records. Routine blood tests, liver and kidney function assessments, blood lipid profiles, 24-h urine protein levels, anti-PLA2R antibody titers, circulating B-cell counts, and HCV viral loads were measured at the time of rituximab infusion and repeated at intervals of 1–3 months post-rituximab administration. A total of 8 patients were enrolled, with a median follow-up period of 19.00 (range: 16.00–25.25) months. Among the 8 patients, 5 were male, and the mean age was 50.13 ± 4.29 years. Histological findings indicated that tubuloreticular inclusions, mesangial deposits, intramembranous deposits, and subendothelial deposits were not observed in any of the 8 patients. The overall 1-year remission rate for these patients was 75%, accompanied by a significant reduction in proteinuria. Additionally, blood albumin levels increased significantly, and renal function remained stable. No increase in HCV viral load and stable liver function tests were observed throughout the entire follow-up period. This study suggested that on the basis of successful eradication of HCV virus with antiviral drugs, rituximab can effectively induce clinical remission of patients with PLA2R associated MN and resolved HCV infection, and does not lead to a significant increase in HCV virus load. However, this finding is based on a very small sample size and should be confirmed in larger clinical trials.

Relationship Between Modified Systemic Immune- inflammatory Index and Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction

Objective: Developing contrast induced nephropathy after primary PCI in patients with ST segment elevation myocardial infarction is a risky condition in terms of mortality and morbidity. Various studies have shown that the systemic inflammatory index predicts (SII) the development of CIN. Mean platelet volume (MPV) is an important indicator known to be associated with the platelet function and activation. Therefore, we revised SII and named it modified SII (mSII) by using NLR multiply MPV. Materials and Methods: This study includes patients who underwent pPCI due to STEMI in our cardiology department between February 2015 and February 2021. Modified SII was obtained by using MPV instead of platelet in the formula (mSII= NLR x MPV). Patients who underwent pPCI with STEMI were divided into two groups, those with CIN and those without CIN, and compared. Results: In the logistic regression analysis, it was observed that the mSII, NLR, GFR and contrast medium amount was independent predictor of CIN. The optimal threshold mSII for predicting CIN was &gt;42.5, with a 78.1% sensitivity and 52.3% specificity ([AUC]: 0.639, 95%CI: 0.602- 0.674, p&lt; 0.001). Pairwise comparison of ROC curves, it was observed that the predictive value of mSII for the development of CIN was better than NLR. (z-test = 3.144, P = 0.001) Conclusion: We think that mSII, which we have shown to be superior to SII in predicting the development of CIN and is very easy to calculate, is a parameter that can be considered in predicting the development of CIN after pPCI in STEMI patients.

A Novel Inflammatory Marker: Relationship Between Red Cell Distribution Width/Albumin Ratio and Vascular Complications in Patients with Type 2 Diabetes Mellitus.

To explore the relationship between Red cell distribution width/albumin ratio (RAR) and vascular complications, including atherosclerosis of the lower limbs, diabetic nephropathy(DN), and diabetic retinopathy(DR), in patients with type 2 diabetes mellitus(T2DM). The study included 427 patients with type 2 diabetes mellitus who were hospitalized in the Department of Endocrinology of the First Affiliated Hospital of Jinan University (Guangzhou, China) between April 1, 2022 and May 31, 2023. Baseline characteristics were displayed according to the quartiles of the RAR. Logistic regression analysis and receiver operating characteristic curves (ROC) were used to analyze the data. After adjusting for confounders, a higher RAR quartile(the fourth quartile) was associated with an increased risk of atherosclerosis of the lower limbs(OR: 2.973, 95% CI 1.281-6.906, p = 0.011), and diabetic nephropathy(OR: 2.876, 95% CI 1.315-6.287, p = 0.008) compared to the lowest RAR quartile. The patients were further divided into two groups according to urinary albumin to creatinine ratio (UACR≥30mg/g and UACR < 30mg/g) and Glomerular Filtration Rate (eGFR<60 mL·min⁻¹ (1.73 m²) ⁻¹ and eGFR≥60 mL·min⁻¹ (1.73 m²) ⁻¹). Similar results were observed. However, We found that RAR quartile did not significantly increase the likelihood of developing diabetic retinopathy(OR: 1.183, 95% CI 0.633-2.211, p = 0.598). The RAR ratio is associated with an increased risk of atherosclerosis of the lower limbs and diabetic nephropathy in patients with T2DM. The RAR ratio may be an important clinical marker of vascular complications in T2DM.

The clinical and pathological evaluation of patients with immunoglobulin A nephropathy by diffusion tensor imaging and intravoxel incoherent motion diffusion-weighted imaging.

To explore the efficacy of diffuse magnetic resonance imaging (MRI) for identifying clinicopathological changes in immunoglobulin A nephropathy (IgAN) patients. The study enrolled IgAN patients and healthy volunteers. IgAN patients were divided into Group 1 [estimated glomerular filtration rate (eGFR) ≥ 90 mL/min/1.73 m2], Group 2 (60 ≤ eGFR < 90 mL/min/1.73 m2), and Group 3 (eGFR < 60 mL/min/1.73 m2). Intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and diffusion tensor imaging (DTI) were performed via 3.0 T magnetic resonance. Diffuse MRI, clinical, and pathological indicators were collected and analysed. P < .05 was considered statistically significant. Forty-six IgAN patients and twenty-seven volunteers were enrolled. The apparent diffusion coefficient, diffusion coefficient (D), perfusion fraction (f), and fractional anisotropy (FA) were significantly different among IgAN subgroups and controls. These parameters were positively correlated with eGFR and negatively with creatinine, and inversely correlated with glomerular sclerosis, interstitial fibrosis, and tubular atrophy (all P < .05). They had significantly high area under the curve (AUC) for distinguishing IgAN patients from controls, while FA had the highest AUC in identifying Group 1 IgAN patients from volunteers. DTI and IVIM-DWI had the advantage of evaluating clinical and pathological changes in IgAN patients. DTI was superior at distinguishing early IgAN patients and might be a noninvasive marker for screening early IgAN patients from healthy individuals. DTI and IVIM-DWI could evaluate clinical and pathological changes and correlated with Oxford classification in IgAN patients. They could also identify IgAN patients from healthy populations, while DTI had superiority in differentiating early IgAN patients.

The Impact of Empagliflozin on Renal Function and Kidney Injury Markers in Patients with Diabetic Nephropathy

Background: Diabetic nephropathy affects approximately 50% of type 2 diabetes patients. Early detection of kidney disease is crucial to reducing the deterioration of renal function. Reversing microalbuminuria towards normal showed beneficial effects in delaying the onset of renal impairment or even reversing the progression of the disease. Recently, empagliflozin, a sodium/glucose cotransporter-2 inhibitor, has received attention for its anti-inflammatory and reno-cardioprotective effects. Objective: This interventional open-label randomized clinical trial aimed to evaluate the clinical outcome of empagliflozin as an add-on therapy for renal function parameters and other injury markers in type 2 diabetic nephropathy patients. Methods: The study enrolled twenty-one type 2 diabetic patients with nephropathy and nineteen without nephropathy. Each group received empagliflozin 10 mg/day for 16 weeks as an add-on to the traditional treatment. Blood and urine samples were collected at baseline and at week 16 to evaluate the glycemic status, renal function, tubular injury markers, and inflammatory and oxidative stress markers. Results: After 16 weeks, empagliflozin significantly reduced glycated hemoglobin A1c and urinary albumin/creatinine ratios in the nephropathy group. Compared with the non-nephropathy group, empagliflozin showed a significant increase in serum creatinine and a significant decrease in eGFRcr. Empagliflozin significantly reduced serum kidney injury molecule-1, cystatin C, interleukin-18, c-reactive protein, and malondialdehyde in both groups. Conclusions: Adding empagliflozin to the traditional oral antidiabetic drugs in diabetic nephropathy improved albuminuria with a mild increment in serum creatinine. Empagliflozin also effectively reduced renal injury markers, as well as inflammatory and oxidative stress markers.

The Predictive Value of H2FPEF Score for Contrast Induced Nephropathy in Patients Undergoing Coronary Angiography

The Predictive Value of H2FPEF Score for Contrast Induced Nephropathy in Patients Undergoing Coronary Angiography

Evaluation of lipid profile, liver function enzymes, and trace elements in Iraqi diabetic nephropathy patients.

Diabetic nephropathy, a common complication of type 2 diabetes (T2DM), is associated with abnormal lipid profiles, liver dysfunction, and kidney impairment. However, research on its association with trace elements in Iraqi patients is limited. The objective of the present study is to evaluate the association between lipid profile, liver function, and trace elements in diabetic nephropathy (DN) patients. In this study, 120 individuals were selected. Sixty of these individuals were labeled as the DN patient group, and 60 individuals were labeled as the healthy control group. A flame atomic absorption spectrophotometer (FAAS) was utilized to assess the levels of zinc (Zn), copper (Cu), and magnesium (Mg), whereas a flameless atomic absorption (FAA) was used to assess manganese (Mn). A colorimetric method was used based on the protocols included in the leaflets by Spinreact kits to determine the levels of lipid profiles and liver function enzymes in the serum. The mean value of high-density lipoprotein (HDL) decreased significantly in the DN patient group compared to the control group (p < 0.001) while cholesterol and low-density lipoprotein (LDL) decreased insignificantly. Conversely, the mean value of triglycerides (TGs) increased significantly in patient group ((p < 0.001) while very low-density lipoprotein (VLDL) increased insignificantly. On the other hand, the mean values of aspartate aminotransferase (AST), alanine transferase (ALT), alkaline phosphatase (ALP), and γ- glutamyl transferase (GGT) were significantly greater in DN patients compared to the healthy controls. Conversely, the mean values of total protein (TP) and albumin (Alb) were significantly lower in the DN patient group. In terms of trace elements, the mean values of Zn, Mg, and Mn were significantly lower in each of the patient groups compared to the healthy group. Conversely, a significant elevation in the means of Cu and Fe was observed in patients compared to the healthy group. Additionally, the findings revealed no association between BMI and lipid profile, liver enzymes, or trace elements. However, an association with age was limited to TGs, ALP, and GGT. The study's results show that the DN patients have abnormalities in their serum trace element levels. This means that these elements could be valuable indicators for monitoring and assessing the progression of DN. Understanding the correlation between lipid profile, liver function, and trace elements could offer valuable insights for managing and preventing diabetic nephropathy. More extensive studies, including an additional group of DM patients without nephropathy complications, are required, and could be used in practice due to the progression of the disease.