It is well known that prevalent chronic kidney disease (CKD) is associated with excess morbidity and mortality compared to non-CKD. Few studies have examined this association in incident CKD….

A role for rituximab (RTX and other anti-CD19/20 monoclonal antibodies, such as obinutuzumab has been suggested for therapy of steroid-sensitive nephrotic syndrome (SSNS) with a frequently relapsing steroid-dependent (FR/SD) response…

The “primary” form of the focal segmental glomerulosclerosis (FSGS) lesion (commonly associated with the presence of circulating permeability-promoting factors…

It is very clear that monogenetic diseases commonly underlie the clinical entity known as steroid-resistant nephrotic syndrome (SRNS) in both children and adults…

Chronic kidney disease (as defined by KDIGO-CKD criteria) is fairly common among living kidney donors subjected to uni-nephrectomy, especially in older donors with age-associated decline in pre-transplant GFR…

Long-term survivors of kidney transplantation suffer from numerous complications. Often, they die due to side effects of immunosuppressive medications…

IgA nephropathy (IgAN) is a common glomerular disease that is not infrequently accompanied by superimposed crescentic glomerulonephritis (GN) of varying severity. Extensive crescentic disease…

It is not presently known if minimal change disease (MCD) and primary focal and segmental glomerulosclerosis (pFSGS) are separate disease entities or part of a continuous spectrum of a single…

The relationship of blood pressure (BP; systolic, diastolic, pulse pressure, mean arterial pressure) in dialysis patients with diabetes is greatly complicated by competing risks and co-morbidities. Many studies failed…

Because of non-specific symptomatology, Fabry’s disease may elude diagnosis during progression of….

Novel urinary biomarkers for the early prediction of AKI in newly admitted patients to Intensive Care Units (ICU) have been developed but the overall clinical utility of these….

Calciphylaxis (Calcific Uremic Arteriopathy, CUA) is an uncommon but devastating and often fatal complication of…

The search for clinical, laboratory, and histological biomarkers useful for predicting outcomes in IgA nephropahy (IgAN) continues at a fairly rapid pace, but actual progress…

Viral-induced glomerular disease is a very important part of the spectrum of glomerulonephritis, especially since many…

Observational, long-term cohort studies can play an important role for generating testable hypotheses to improve our….

The “gold standard” for evaluation of urinary total protein excretion…

The treatment of membranous nephropathy (MN; PLA2R associated) has improved greatly in recent years, but uncertainties still exist concerning the treatment of such patients who have already advanced to stage…

Kidney fibrosis is one of the final common end-points of progressive CKD in both diabetic and non-diabetic patients. But very few studies have attempted to evaluate kidney fibrosis and its…

The therapy of secondary hyperparathyroidism (SHPTH) in patients with advanced chronic kidney disease (CKD) presenting with 25-hydroxyvitamin D deficiency is not well established. Three approaches are …

Persistent high-grade hematuria is associated with an adverse impact on prognosis in IgA Nephropathy (IgAN), independent of proteinuria according to retrospective observational studies…

The definition of chronic kidney disease (CKD) using estimated glomerular filtration (eGFR) equations (indexed to a standard body surface area [BSA] of 1.73 m2) has been recognized as…

Calcium deposition in the kidney parenchyma (using special stains such as the von Kossa stain), also known as dystrophic calcification, is a relatively common finding (about 10%) in native kidney…

Uromodulin (UMOD or Tamm-Horsfall Protein) is synthesized and secreted by the thick ascending limb of the loop of Henle in the kidney. Mutations of the UMOD gene have been linked…

Accurate and reproducible prediction of the long-term (5–10 years) outcomes in individuals or groups of patients with biopsy-proven IgA nephropathy (IgAN) is a very desirable goal…..

Fibrillary glomerulonephritis (FGN) is a rare form of primary glomerular disease defined by the common co-deposition of IgG and DNAJB9 and fibril formation. Its etiology and pathogenesis are unknown…

Prediction of the long-term outcomes in individual patients with IgA nephropathy (IgAN) using pathological parameters has long been a “holy grail” in Nephrology….

The COVID-19 pandemic unleashed a new wave (indeed a torrent) of an old and well-recognized phenomenon; namely, the development of de novo or an exacerbation of underlying kidney disease in…

Anti-GBM disease poses a serious threat to survival and preservation of kidney function, especially if it is discovered or treated late in its evolution. It is a rare disease…

Various definitions of acute kidney injury (AKI) are in common use, globally. But comparisons of the utility of these definitions for AKI following cardiac surgery have come to….

The optimum dosage and preparation of renin-angiotensin system inhibitors (RASi) for slowing the progression of progressive proteinuric CKD remains somewhat uncertain,..

The comparative effectiveness of various modalities of dialysis in patients with kidney failure has long been controversial, in large part due to the paucity of long-term randomized clinical trials….

Sodium balance in patients with kidney failure treated by dialysis is highly variable and incompletely understood, in pathophysiological terms. Sodium excess is linked both to hypertension and…

Disorders of mitochondria (MT), often due to mutations of the MT genome, are uncommon and usually present in infancy or childhood. The kidney aspects of these disorders are quite varied….

Primary membranous nephropathy (pMN) (that form not associated with systemic disease, like SLE) can occasionally present with or develop super-imposed crescentic glomerulonephritis (GN)…

Individualized (precision) therapy of ANCA-associated vasculitis (AAV) is a goal that will likely improve long-term outcomes of this very pathogenically heterogenous and clinically variable disorder….

The comparative effectiveness of various modalities of dialysis in patients with kidney failure has long been controversial, in large part due to the paucity of long-term randomized clinical trials…

It is well known that IgA nephropathy (IgAN) in a recipient of a kidney allograft (or isograft) has high propensity to redevelop in the kidney graft. This recurrence is believed…

Living related or unrelated (altruistic) donor kidney transplantation is practically universally applied as an option for therapy of kidney failure, often as a preemptive procedure to avoid the need for…

Low urinary creatinine excretion (hypocreatininuria) and low serum creatinine are often observed in euvolemic hyponatremia (due to the syndrome of inappropriate anti-diuretic hormone release;…

Patients with chronic glomerulonephritis (GN) often have underlying immunological abnormalities that can be further altered by concomitant immunosuppressive (IS) therapy…

The lesion of FSGS can be due to many quite different pathogenic mechanisms. Sorting out the correct disease diagnosis can be a difficult challenge in individual cases and requires a…

Laboratory testing for anti-GBM antibodies has been available (for research or clinical care) for many decades. Yet standardization across laboratories is virtually non-existent and uncertainty remains…

Protein-bound uremic solutes are very inefficiently removed by standard dialytic techniques. Adding adsorption or displacement measures might…

A beneficial role for the use of infusions of human serum albumin (iso-oncotic [4%] or hyper-oncotic [20%]) during the management of acute kinder injury (AKI) with continuous renal replacement therapy…

The role and value of novel serum and/or urinary biomarkers in the diagnosis and prognosis evaluation of lupus nephritis continues to be highly uncertain….

A recurrence of the original disease that affected the native kidney in the allografts (or isografts) of patients undergoing kidney transplantation is a common problem that has a significant impact…

Little doubt exists that a variable fraction of patients with acute kidney injury (AKI; defined by the creatinine-based KDIGO criteria) can eventually develop new-onset…

Transmission electron microscopy (TEM) is often performed as a routine part of the pathologic examination of native kidney biopsies and also kidney transplant biopsies. However…

Disease-related loss of nephrons (but not normal aging-related loss of nephrons) is commonly associated with the enlargement (hypertrophy) of residual, less-damaged glomeruli. Comorbid conditions…

The added patient-centered benefit of early versus late initiation of hemodialysis (HD) therapy for patients with severe AKI has been widely debated for many years without a clear…

It is now generally recognized that the generic disorder designated as acute kidney disease (AKD) by KDIGO is a manifestation of many individual diseases that do not meet the criteria…

Evaluation of fluid overload in patients requiring hemodialysis for ESKD or AKI can be unreliable. Bedside assessment of lung water (B lines, TBLN) or inferior vena cava diameter (IVCD) with…

The report of the benefits of dapagliflozin on the progression of CKD in patients with non-diabetic kidney disease by Heerspink et al. [1] in late 2020 was a…

For many decades elective percutaneous kidney biopsy in the prone position was uniformly performed during a short hospital stay, so that patients could be…

The short-term benefits (1–3 years) attending the routine use of induction adjuvant therapy with interleukin-2 (IL-2) receptor antagonists (basiliximab or daclizumab) in…

Obesity is a well-established modifiable risk factor for cardiovascular disease (CVD) in the general population. However, the role of obesity for CVD risk is not well studied in subjects with…

Chronic kidney disease of undetermined etiology (CKDu) is endemic in several parts of the world, especially among agricultural workers exposed to high ambient temperatures, episodic dehydration…

The role of kidney biopsy in patients with type 2 diabetes mellitus (T2DM) is constantly being re-examined. It is very clear that a fraction of patients with T2DM presenting with…

Flare-ups (relapses) of lupus nephritis (LN) are common and when frequent represent a major factor contributing to a poor long-term outcome. Predicting and…

The optimum dosage and preparation of renin-angiotensin system inhibitors (RASi) for slowing the progression of progressive proteinuric CKD remains somewhat uncertain, although…

The relationships between tissue and circulating advanced glycan end-products (AGEP) maintained on chronic hemodialysis (HD) for kidney failure are uncertain. Serum levels of AGEP and…

Patients with autosomal dominant polycystic kidney disease (ADPKD) and advanced chronic kidney disease are not uncommonly considered as candidates for elective or emergent bilateral nephrectomy (BN) because of…

Percutaneous biopsy (PB), of either native or transplanted kidney, is commonly performed using a variety of needle sizes (14, 16 or 18 G), according to the preferences, training, and experience…

The selection of donor kidneys for optimal post-transplant outcomes is an important issue, and discarding kidneys based on clinical criteria decreases the availability of organs. Pre-implantation biopsies of potential donor…

Focal and segmental glomerulosclerosis (FSGS) is a histological glomerular lesion, not a specific disease. Primary forms of FSGS, presumably due to a circulating permeability factor (or factors), can be recognized…

Recurrent focal segmental glomerulosclerosis (FSGS) in a kidney allograft performed in a patient with kidney failure presumed to be due to primary (permeability factor-related) FSGS is a common…

Lupus nephritis (LN) continues to be a challenging disorder for both nephrologists and rheumatologists. This topic is an ever-changing one and the pace of change appears to be accelerating as…

It is generally observed that creatinine is secreted by the proximal tubule (via an organic anion transporter) in subjects with normal or even modestly impaired function leading to…

The benefits of renin-angiotensin system (RAS) inhibition for slowing the progress of diabetes-related CKD with overt proteinuria is well established. The utility (efficacy and safety) of adding…

Mannose-binding lectin, complement components 3 and 4d, IgG4 and PLA2R antigen (and/or thrombospondin 7A; THSD7A) are frequently co-deposited or hyperexpressed in the glomeruli of patients with primary membranous nephropathy. Strong…

Traditionally, thrombotic micro-angiopathy (TMA) is believed to mainly be a consequence of events paying out at the interface of the endothelial cells of the vascular tree and the circulation, including…

IgA nephropathy (IgAN) is a common disorder that progresses to kidney failure in about 30% of patients followed for 2 decades or more. It also commonly recurs in transplanted kidneys….

Little doubt exists that progressive chronic kidney disease (CKD) imposes added risks of mortality, mainly from cardiovascular disease (CVD). This relationship is a very complex one involving a multitude of…

Observational data have strongly implicated excessive ultrafiltration rates (UFR) as a possible contributor to adverse outcome in hemodialysis treatment of kidney failure. Many variables can affect this association, including…

Acute decompensated heart failure (AHF) is commonly associated with renal functional impairment and diuretic resistance. The assessment of “spot” [Una+] may be useful in identifying diuretic resistance and the need…

The COVID-19 pandemic has presented many challenges in treatment and organ support. The “cytokine storm” commonly associated with severe forms of COVID-19 raises the possibility of using extracorporeal blood purification…

Several reports, going back 5–7 years, noted increased levels of an estimated glomerular filtration rate (eGFR) in a variable number of patients with severe sepsis or trauma admitted to the…

Kidney biopsy in patients with diabetes mellitus (typically type 2; T2DM) and CKD (proteinuria with or without reduced GFR) is often performed to evaluate the possibility of the presence of…

ANCA-associated vasculitis (AAV) preferentially affects an older population of adults. The use of potent immunosuppressive agents (such as cyclophosphamide [CYC] or rituximab [RTX]) for treatment might expose these older patients…

Obesity and its association with CKD is well described but prediction of the incident CKD from a description of obesity is understudied. As a modifiable risk factor such an analysis…

It is well known that the space of distribution of bicarbonate anion (HCO3–) following intravenous infusion of hypertonic sodium bicarbonate is independent of blood pH but is highly correlated with…

The adverse effects of iodinated contrast media (CM) on kidney function continues to be very controversial. It is likely that the effects of CM have been overstated in the past….

The information concerning the impact of primary membranous nephropathy (MN) on the mother and fetus in pregnancy is scanty. Liu et al. have at least partially filled this gap with…

The calculated plasma osmolality (Posm=2 X plasma [Na+] = serum urea nitrogen/ 2.8 + serum glucose/1.8) is higher in hemodialysis patients (averaging 307 ±9 mOsm/kg H20) compared to…

Several randomized and controlled studies have documented that “acute kidney injury” (defined by a rising level of serum creatinine) can accompany intensive blood pressure control regimens designed to achieve systolic…

Radio-contrast media volume may have an important influence on the risk of contrast-associated acute kidney injury (AKI). Zahler et al. have carried out a retrospective, observational (and uncontrolled) study to…

The mortality and occurrence of cardiovascular (CV) events appears to be similar between…

Typically, IgG deposition is scanty or absent (“pauci-immune”) in antineutrophil cytoplasmic antibody (ANCA) vasculitis but…

The optimal treatment strategy for induction of a remission in antineutrophil cytoplasmic antibody-associated (ANCA) vasculitis with severe renal involvement is…

About 3.5 million African-Americans (A-A of West African ancestry) and some Hispanics possess two high alleles (G1 and/or G2) of apolipoprotein L1 (APOL1)…

Plasma volume (PV) assessment by clinical means (arterial or venous blood pressure, orthostasis, pulse rate, skin turgor, capillary refilling rate, etc.) is often insensitive and unreliable…

Endothelial injury and subclinical inflammation (“micro-inflammation”) are both quite common in CKD and their origins are numerous and diverse…

Chronic kidney disease (CKD) as currently defined is believed to be associated with an increased risk for a variety of adverse events, including shortened life expectancy,…

It is generally agreed that the magnitude and composition of proteins excreted in the urine has an important impact on the prognosis of chronic kidney disease…

Complications of pregnancy (e.g. hypertension, premature birth, intra-uterine growth retardation, urgent C-section, etc.) are generally believed to be associated…

The use of serum and/or urinary biomarkers for the prediction of the occurrence and/or severity of AKI among hospitalized (mostly Intensive Care Units; ICU) is of great and growing interest…

The microscopical anatomy of subjects with diabetes but exhibiting normal urinalyses and kidney function is largely unknown…

Autosomal dominant polycystic kidney diseases (ADPKD) is generally regarded as a prototypical hereditary tubulo-interstitial kidney disease…

Control of pre-dialysis (and inter-dialysis) serum phosphorous levels (P) is regarded as a desirable, but challenging, goal in dialytic care of ESKD patients. The level of P in the serum…

The landmark SPRINT trial [1] of intensive vs standard anti-hypertensive therapy in older, non-diabetic subjects at a high-risk of cardiovascular disease (CVD) demonstrated an overall clear-cut…

Both blood pressure control (with antihypertensive agents) and lowering low density lipoprotein (LDL) cholesterol levels (with statins) are widely regarded as…

A decrease in glomerular filtration rate (GFR), and an increase in albuminuria are both recognized potential risk factors for cardiovascular disease (CVD) and all-cause mortality (ACM) in both diabetic and…

In 2018 Kidney Disease: Improving Global Outcomes (KDIGO) updated its clinical practice guidelines for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorders (CKD–MBD). Recommendations and…

Overt albuminuria (Urine Albumin-to-Creatinine Ratio (UACR) > 300 mg/gm) is a well established biomarker for progression of CKD, all-cause mortality and cardiovascular events in patients with type 2 diabetes mellitus…

The “opioid epidemic” in the USA is widely reported in many media sources, but data concerning trends in opioid use among patients with specific diseases, other than cancer, is rather…

Patients with ESRD undergoing renal replacement therapy (averaging about 4 hours each) frequently complain of fatigue, sluggishness, weakness and other constitutional symptoms…

Hypotension occurring during hemodialysis treatment sessions is a common and vexing problem. It can often be traced to excessive or to rapid…

The pathological “pattern-of-injury” designated as membranous nephropathy (MN) is pathogenetically heterogeneous. Among those subjects with this lesion of MN who have apparently primary rather than secondary MN, about 65 –…

The elderly continue to be a growing segment of patients with end-stage renal disease (ESRD) who are treated by dialysis. As expected, they have a mortality rate largely because of…

Acute kidney injury (AKI), defined by rapid and often transient changes in serum creatinine concentration (with or without oliguria), is a common problem, especially…

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a progressive form of Chronic Kidney Disease (CKD), although there is extensive variability in the progression rate even among…

The rate of progression of CKD from one KDIGO defined category (”stage”) to subsequent “stages” (called “dwell time”(DT)) is commonly…

Calciphylaxis is a serious, potentially life-threatening complication of ESRD that may be precipitated (or aggravated) by vitamin K antagonists (such as warfarin) used for necessary anticoagulation. Alternative non-warfarin anti-coagulation strategies…

The relationships between sodium chlorid (NaCl) intake and clinical outcomes in hemodialysis patients (such as mortality rates) are…

An adaptation of magnetic resonance imaging (MRI) technology has made it possible to non-invasively asses…

Albuminuria, even in the high normal range (> 10 and < 30 mg/d), is associated with the presence or development of…

Surprisingly, the normal limits of venous serum total CO2 (tCO2; a surrogate for serum HCO3- concentration) in adults are not well established…

The current estimating equations for glomerular filtration rate (GFR) exhibit consistent inaccuracies (bias and precision) and as a result…

The dialysis treatment session length (DSL) in conventional thrice weekly hemodialysis therapy has been long suspected to contribute importantly to…

The presence of CKD in adults (mostly older) is a common global problem, although the precise incidence and prevalence of CKD, the changes in frequency over-time and its variation between…

It is generally accepted that systemic inflammatory processes can enhance or induce proteinuria, especially in subjects with pre-existing glomerular disorders. However, much less is known…

The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines recommend confirmatory testing for estimated glomerular filtration rate (eGFR) using cystatin C or…

The intestinal microbiome has become a facet of human biology that is attracting great interest, including among investigators in the field of kidney disease. In CKD, “uremic” toxins may be…

The optimal management of ischemic coronary artery disease in patients with end-stage renal disease (ESRD) awaiting renal transplantation remains as a conundrum. Avoidance of a cardiovascular (CV) death following renal…

The ability to reliably and accurately predict the response to treatment of glomerular disease with specific regimens would be a great advance…

Disturbances of acid-base homeostasis very commonly complicate critical illnesses. Arterial blood gases (ABG) combined with assessment of serum electrolytes (especially the anion gap and delta bicarbonate) are traditionally used…

Left ventricular hypertrophy (LVH) is common in chronic kidney disease (CKD) and in end-stage renal disease (ESRD) treated by dialysis. The failure of LVH to regress or its progression can…

In a very remarkable retrospective “registry-based” study, Hou and colleagues examined the changes in the spectrum of kidney disease derived from careful study of 40,759 native kidney biopsies…