Peritoneal dialysis (PD) is widely used for treating end-stage renal disease (ESRD) in diabetic nephropathy patients. Suboptimal dialysis outcomes are often linked to chronic microinflammation, yet predictive models integrating immune markers remain limited. In this prospective cohort study, 236 diabetic nephropathy patients undergoing PD were categorized into high-inflammation (HI) and microinflammation (MI) groups based on serum levels of CRP, IL-6, and TNF-α. Clinical and biochemical data - including Kt/V, infection rates, and survival - were collected. Logistic regression was applied to identify predictors of poor dialysis outcomes and construct a predictive model. The HI group showed significantly lower dialysis efficiency (Kt/V < 1.5), increased peritonitis and catheter infections, and reduced survival. Elevated CRP, IL-6, and TNF-α levels were observed alongside higher creatinine, urea nitrogen, fasting glucose, lipids, and notable electrolyte and acid-base imbalances. Logistic regression identified CRP, IL-6, TNF-α, Kt/V, infection rates, and selected biochemical markers as independent predictors of poor outcomes. The resulting predictive model yielded an AUC of 0.87, demonstrating strong discriminative power. Microinflammation is a key determinant of dialysis efficacy in diabetic nephropathy patients receiving PD. The proposed model, based on inflammatory and dialysis-related parameters, offers a promising approach for early risk stratification and personalized treatment. Further validation may enhance long-term management and survival outcomes in this population.

Dialysis patients face high ischemic stroke risk, only partly explained by cardiometabolic and genetic factors. Homelessness, race, and other social determinants may further elevate risk, but the pathways affecting outcomes in dialysis patients remain uncharacterized. We conducted a retrospective cohort study using the TriNetX electronic health record network, identifying 8,821 adults with at least one homelessness code and 320,432 housed adults who initiated dialysis between 2014-2024 with ≥5 years of prior data. The primary outcome was time to first ischemic stroke within 5years. A multivariable Cox model adjusted for age, sex, race/ethnicity, and dialysis modality estimated the total homelessness effect (HR0). We then ran 3 hazard-attenuation models, each adding 1 composite mediator block, clinical (hypertension, diabetes, hyperlipidemia, obesity), psychosocial (nicotine dependence, depression), and social-adversity (ICD-10 Z56-Z65 codes), to calculate the percent reduction in the homelessness log-hazard. Sensitivity analyses used a composite stroke-or-death endpoint and a landmark survivor cohort excluding early deaths. Homelessness conferred a 4.61-fold higher 5-year stroke hazard. The clinical block attenuated this hazard by 12.1%, and the psychosocial block by 15.2%. In contrast, the social-adversity block amplified the effect by 27.4%, reflecting a suppressor phenomenon from under-documented social determinants of health codes. Sensitivity checks confirmed robustness, with a stroke-or-death HR 1.35 and death-free cohort HR 4.50. Pre-dialysis homelessness and Black race independently predict stroke risk in dialysis patients. This reaffirms the need for standardized social-needs screening, area-level deprivation measures, and advanced data-extraction methods to accurately capture social adversity and guide targeted interventions.

Renal clear cell carcinoma (RCC), the predominant subtype of kidney cancer, is characterized by paraneoplastic syndromes, of which membranous nephropathy (MN) represents the most common paraneoplastic glomerulonephritis. While phospholipase A2 receptor (PLA2R) antibodies indicate primary MN, the concurrent presence of light-chain amyloidosis may further complicate the clinical manifestations in malignancy-associated cases. A rare case of RCC concurrent with phospholipase A2 receptor PLA2R-positive MN and light chain amyloidosis is reported in this paper. An elderly male patient presented with nephrotic syndrome and a right renal mass. The patient underwent a nephrectomy after admission. Pathological examination confirmed the diagnosis of right kidney renal clear cell carcinoma. Renal biopsy revealed PLA2R-positive MN and AL amyloidosis. Interestingly, in this case, glomerular light chain staining showed no monoclonal restriction, but λ light chain deposition was found in the vessels. However, the nephrotic syndrome showed no improvement after tumor resection. The patient achieved remission following sequential treatment with bortezomib, dexamethasone, daratumumab, and rituximab. This case illustrates the complex interplay among RCC, PLA2R-positive MN, and AL amyloidosis, complicating patient management. Future research should focus on the immunological mechanisms of PLA2R antibody production in malignancy and the pathophysiological links among these conditions. Clinicians should remain vigilant for secondary causes of nephrotic syndrome in renal malignancy patients and adopt comprehensive, multidisciplinary approaches to improve outcomes.

It is recognized that topiramate use may affect risk of stone disease, but large population-based and weighted evaluations are absent. Furthermore, the suspected increased odds of stone disease have remained unquantified. We leveraged the nationally representative National Health and Nutrition Examination Survey (NHANES) to perform a population-based assessment of the association of current topiramate use on occurrence of stones presenting within the year immediately preceding survey participation. We utilized the 2017 - 2020 (Pre-COVID-19) NHANES data to assess association between current topiramate use and incidence of kidney stones. Weights and strata provided by NHANES were employed, and analyses were performed using survey package for STATA v14. 843 participants met analysis criteria, weighted to represent a nationally representative population of 23,064,066 noninstitutionalized U.S. adults. Logistic regression was used to analyze the relationship between the incidence of kidney stone passage in the last 12 months and current topiramate use. It was found that current topiramate use was associated with a statistically significant 810% increase in the odds of stone passage in the last 12 months (OR: 8.1, 95% CI (1.04-63.06), p = 0.046). None of the investigated demographic or pharmaceutical covariates (age, diabetes status, body mass index, or concomitant use of diuretics, proton pump inhibitors, or H2-blockers) demonstrated statistically significant association with topiramate use and thus were not included as covariates. Our results demonstrate that odds of a stone within the last 12 months is increased significantly with topiramate use. Additionally, we provide the initial quantification of the strength of this association, with an estimated 8-fold increase in odds of stone formation. These findings can allow improved risk counseling for patients considering topiramate use for providers.

The association between the atherogenic index of plasma (AIP) and chronic kidney disease (CKD) among individuals with different metabolic syndromes remains inadequately characterized. The aim of this study is to assess the correlations between AIP and the risk of CKD among individuals diagnosed with hypertension (HTN), diabetes mellitus (DM), and hyperuricemia (HUA). Data from the National Health and Nutrition Examination Survey, collected between 2009 and March 2020, were used to categorize eligible participants into HTN, DM, and HUA groups. Weighted logistic regression models and restricted cubic splines were employed to examine the correlations between AIP and CKD. The incremental predictive value of AIP, compared with conventional CKD risk factors, was assessed using the area under the curve, net reclassification improvement index, and integrated discrimination improvement. Among individuals in the HTN and DM groups, an increase of one unit in AIP was associated with a 17% increase in the risk of CKD (odds ratio (OR): 1.17, 95% confidence interval (CI): 1.10 - 1.25) and a 29% increase (OR: 1.29, 95% CI: 1.18 - 1.40), respectively. Conversely, within the HUA group, neither persistent AIP nor any of the three AIP levels demonstrated a statistically significant correlation with CKD. The findings demonstrated a significant association between AIP and CKD in individuals with HTN and DM, indicating a potential link between dyslipidemia and CKD risk within these populations. In contrast, AIP did not exhibit a significant association with CKD among individuals with HUA.

Atypical anti-glomerular basement membrane (GBM) nephritis is a rare autoimmune disease characterized by the linear deposition of immunoglobulin G (IgG) detected in the GBM without circulating anti-GBM antibodies or lung involvement. Atypical anti-GBM disease is distinguished from typical anti-GBM disease in both clinical and pathological features. Herein, we report 2 patients who developed mild proteinuria, hematuria, and elevated serum creatinine levels following coronavirus disease 2019 (COVID-19) vaccination. Renal biopsy found bright linear IgG deposition along the GBM, but anti-GBM antibodies were seronegative. Atypical anti-GBM nephritis was determined. The female patient improved with the treatment of valsartan. For the male patient, serum creatinine levels significantly decreased through two plasma exchange sessions, cyclophosphamide, and glucocorticoid. Atypical and typical anti-GBM nephritis are different clinical entities. They target different antigen epitopes and, therefore, atypical anti-GBM disease is not the early stage of typical anti-GBM disease. In atypical anti-GBM nephritis, monoclonal IgG deposition in the glomeruli is not equal to plasma cell dyscrasias but still needs close monitoring for hematologic diseases. The relationship between the disease and COVID-19 vaccination is uncertain and needs further exploration.

Metabolic health refers to the proper functioning and balance of metabolic processes in our bodies. The metabolism of carbohydrates, lipids, and proteins has a direct impact on the cardiovascular system. Recent advances in pharmacotherapy have introduced several drugs into clinical practice that can improve cardiometabolic health. Between September 2023 and March 2024, we systematically collected cardiometabolic data from 800 kidney transplant patients (KTPs) during their routine outpatient visits. These included clinical data - office blood pressure, body weight and height, body mass index (BMI), and waist circumference (WC) - and laboratory data such as high-sensitivity C-reactive protein (hs-CRP), lipid profile, lipoprotein(a) (Lp(a)), glycated hemoglobin (HbA1c), serum urate, serum albumin, and proteinuria from spot urine samples. Patients who required treatment adjustment were selected. Deviations from the desired values of individual components of the metabolic syndrome (blood pressure, WC, triglycerides, high-density lipoprotein cholesterol, and fasting glucose) were observed in 23-61.5% of patients. Elevated hs-CRP levels (5-10 mg/L), a known cardiovascular risk factor, were observed in 13.5% of patients. Lp(a) levels exceeded the upper normal limit (> 500mg/L) in 17% of patients. Only a small proportion of patients with moderate to advanced kidney disease - 13% and 23.6%, respectively - had low-density lipoprotein cholesterol levels within the reference range. Between 23% and 61.5% of patients failed to meet target values for individual components of metabolic health. The largest deviation (61.5%) was observed in WC among women. WC and waist-to-height ratio are two simple and reliable parameters for assessing metabolic status.

Patients with chronic kidney disease (CKD) often experience various nutritional disorders, leading to increased frailty, morbidity, and mortality. The aim of our study was to explore the impact of dietary habits and physical activity on body composition in non-dialysis CKD patients. This cross-sectional study included 199 non-frail CKD patients (stages 1-5) from the University Medical Center Ljubljana. Participants completed a food frequency questionnaire, and anthropometric measurements were collected. Body composition was assessed using bioelectrical impedance analysis (BIA), and muscle strength was evaluated with handgrip dynamometry. Central obesity was present in 79.9% of participants, and obesity based on body mass index (BMI) was found in 26.6%. Elevated fat mass was observed in 58.3% of patients. Sarcopenia was identified in 1%, and sarcopenic obesity in 0.5%. Based on the Global Leadership Initiative on Malnutrition (GLIM) criteria, 11.6% of patients were malnourished. Dietary analysis revealed too frequent intake of refined carbohydrates, red meat, and sweets, while intake of fruits and vegetables was not often enough. Dietary habits were suboptimal, with no significant differences between individuals with normal waist circumference and BMI and those with central obesity and elevated BMI. However, a significant difference was observed in physical activity, with those having central obesity engaging in less physical activity. Central obesity was the most prevalent nutritional disorder in non-frail CKD patients that was markedly more prevalent than obesity defined by BMI. Waist circumference was a more sensitive marker of increased fat mass determined with BIA than BMI. Inadequate dietary habits and insufficient physical activity were major contributing factors to the observed nutritional disorders in our CKD patients and call for long-term lifestyle modifications.