The Iranian Journal of Kidney Diseases (IJKD), a peer-reviewed journal in English, is the official publication of the Iranian Society of Nephrology. The aim of the IJKD is the worldwide reflection of the knowledge produced by the scientists and clinicians in nephrology. It has been published quarterly since 2007 and every 2 months since January 2011. The IJKD provides a new platform for the advancement of the field. The journal’s objective is to serve as a focal point for debates and exchange of knowledge and experience among researchers in a global context. Original papers, case reports, and invited reviews on all aspects of kidney diseases, hypertension, dialysis, and transplantation will be covered by the IJKD. Research on the basic science, clinical practice, and socio-economics of renal health are all welcomed by the journal editors. Indexing/Abstracting. SCI Expanded, MEDLINE, EMBASE, Scopus, Cinahl, CAB International, Index Copernicus, Index Medicus for the WHO Eastern Mediterranean Region (IMEMR), Scientific Information Database (SID), and Google Scholar
Association of Renal CD68+ Cell Infiltration with Oxford Classification in IgA Nephropathy
Introduction. IgA nephropathy (IgAN) is the most common form of primary glomerulonephritis worldwide. The Oxford classification (MEST-C) a standardized histopathological scoring system evaluating mesangial hypercellularity (M), endocapillary hypercellularity (E), segmental glomerulosclerosis (S), interstitial fibrosis/tubular atrophy (T), and cellular or fibrocellular crescents (C), provides a histopathological framework to predict disease progression. However, the role of immune cell infiltration—particularly CD68+ macrophages—in these pathological features remains underexplored. Objective. To investigate the association between renal CD68+ macrophage infiltration and the Oxford classification parameters in patients with IgA nephropathy. Methods. This study included 146 patients with biopsy-proven IgAN at Hasheminejad Kidney Center between 2013 and 2020. Immunohistochemical staining for CD68 was performed on paraffin-embedded kidney biopsy sections. CD68+ macrophages were quantified separately in the glomerular and interstitial compartments. Finally, the associations between macrophage counts and Oxford classification components (M, E, S, T, C) were analyzed. Results. Glomerular CD68+ cell counts were significantly higher in samples with M1, E1, T1, and C1 lesions (P < .05). Interstitial CD68+ cells were significantly elevated in T1 lesions (mean: 10.6 vs. 4.7 in T0; P < .001). Receiver operating characteristic (ROC) analysis demonstrated high diagnostic accuracy for interstitial CD68+ cells in predicting T1 (AUC = 0.98) and for glomerular CD68⁺ macrophage in predicting E1 (AUC = 0.88). Conclusion. CD68+ macrophage infiltration is closely associated with active and chronic lesions in IgAN, particularly endocapillary hypercellularity and tubular atrophy. Quantification of CD68+ macrophage may serve as a valuable histological marker for assessing disease activity and guiding prognosis in IgAN.
Copyright (c) 2026 Iranian Journal of Kidney Diseases
Kidney Health for All: Caring for People, Protecting the Planet
The current kidney care model - focused on late-stage disease and in-center hemodialysis - is unsustainable, because of costs, environmental burden, poor outcomes, and reduced quality of life. The 78th World Health Assembly’s recognition of kidney disease as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, “Kidney Health for All: Caring for People, Protecting the Planet”, calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, environment and society. Dialysis itself must become more eco-friendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly for elderly and frail patients, if the quality-of-life benefits outweigh the perspectives offered by dialysis. Achieving this shift requires coordinated action across all stakeholders; education and engagement of the public, policy makers and health professionals to raise awareness about the threat of kidney disease; and an urgent move toward patient-centered care.
Risk Factors for Mortality in Patients with Severe Acute Kidney Injury Treated with CRRT: A Single-Center Retrospective Study
Introduction. To explore the risk factors of in-hospital death in patients with severe acute kidney injury (AKI) after continuous renal replacement therapy (CRRT) and to build a prediction model. Methods. In total, 378 patients with AKI were treated in the ICU of affiliated hospital of Fujian Medical University, Zhangzhou City, between June 2018 and August 2024. All patients received CRRT. According to prognosis, patients were divided into the survivor and mortality groups. The clinical data from both groups were compared. A nomogram prediction model was developed based on independent risk factors identified through multivariable logistic regression analysis. Results. Overall, 195 patients (51.59%) died in the hospital. Compared with the Acute Physiology and Chronic Health Evaluation II (APACHE II), the mortality group had significantly higher Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, mechanical ventilation rates, lactic acid levels, SCr at baseline, the last recorded SCr before death or discharge, duration of anuria before CRRT, total duration of RRT, and ICU stay, while initial and final eGFR were significantly lower (all, P < .05). Multivariable logistic regression analysis showed that APACHE Ⅱ score, SOFA score, duration of anuria before CRRT, and total duration of RRT were independent risk factors for hospital death in AKI (P < .05), while initial higher eGFR was a protective factor (P < .05). The consistency index (C-index) of the nomogram model was 0.751 (95%CI: 0.683~0.819), and the AUC of the ROC curve was 0.738 (95%CI: 0.701~0.775), which had good discrimination. The evaluation results of the calibration curve and clinical decision curve suggested that the model was accurate and effective. Conclusion. The APACHE II score, SOFA score, anuria duration before CRRT, and total RRT time were independently associated with in-hospital mortality of AKI patients treated with CRRT. These findings demonstrate the severity markers of AKI; nevertheless, prospective validation will remain necessary.
Impact of Dapagliflozin on Kidney Function Decline in Chronic Kidney Disease Patients: A Systematic Review
Introduction. This systematic review aimed to evaluate the impact of dapagliflozin therapy on the progression of chronic kidney disease (CKD) in individuals with CKD. Methods. A comprehensive search for randomized controlled trials (RCTs) concerning dapagliflozin was conducted across multiple databases, including PubMed, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, and Google Scholar, from their inception until January 10, 2025. Of 2,806 identified studies, 15 trials met the inclusion criteria. Upon careful assessment to avoid overlapping populations, 11 publications derived from the Dapagliflozin and Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD) parent trial were excluded, leaving four unique independent trials for narrative synthesis. Due to substantial heterogeneity (I² > 90%) and the limited number of studies, meta-analysis was not performed and findings are presented narratively. Results. A total of 15 articles were identified, 11 were secondary analyses of the DAPA-CKD trial (NCT03036150) reporting on the same 4,304 participants. Following exclusion of overlapping publications, four unique trials remained. The findings for eGFR decline were highly variable across studies, ranging from a mean difference of -6.60 mL/min/1.73m² (Cherney et al., 2020) to +0.93 mL/min/1.73m² (Heerspink et al., 2020). Substantial heterogeneity (I² = 93.7%) precluded meaningful meta-analysis. For composite renal outcomes, only one unique trial reported this outcome, preventing quantitative synthesis. Conclusion. While the effect of Dapagliflozin on eGFR decline was inconclusive due to substantial heterogeneity, the available evidence from the DAPA-CKD trial suggests a reduction in the risk of adverse clinical renal outcomes. However, the limited number of independent trials and considerable heterogeneity underscore the need for more standardized RCTs. Overall, dapagliflozin appears to confer renal protective benefits and is considered safe for patients with CKD.
Eculizumab in Systemic Lupus Erythematosus Complicated with Thrombotic Microangiopathy
Thrombotic microangiopathy (TMA) is a rare but serious complication of systemic lupus erythematosus (SLE) in children, which is often resistant to different medical treatments. This is the report of a 13 years old female with a newly diagnosed SLE, complicated with a refractory course of SLE-TMA. Eculizumab had an effective therapeutic impact with clinical and laboratory improvement of TMA.
Tip Lesion Variant of Focal Segmental Glomerulosclerosis in Familial Relapsing Polychondritis
Relapsing polychondritis (RP) is a rare autoimmune disorder with minimal reported renal involvement. We describe the first case of tip lesion variant of focal segmental glomerulosclerosis (FSGS) in a 60-year-old male with familial RP. The patient initially presented with nephrotic syndrome concomitant with RP, which was diagnosed 17 years ago; renal biopsy revealed minimal change disease at that time. Over the subsequent 17 years, he experienced four RP flares without nephrotic syndrome recurrence until his recent presentation with severe nephrotic syndrome. Repeated renal biopsy confirmed tip lesion variant of FSGS, demonstrating excellent response to corticosteroid therapy with prednisolone 1 mg/kg/day; proteinuria declined from 7g/24h to 0.98g/24h and serum albumin increased from 0.9g/dL to 2.2g/dL within three months. This case underscores the importance of considering FSGS in RP-associated nephrotic syndrome and suggests potential shared immune/genetic mechanisms. To our knowledge, this represents both the first report of tip lesion FSGS in RP and the first documented familial RP case with FSGS development.
Familial relapsing polychondritis, Tip lesion FSGS, nephrotic syndrome, autoimmunity, corticosteroids.
1. Nephrology & Kidney Diseases :Focal segmental glomerulosclerosis (FSGS),Tip lesion variant FSGS,Nephrotic syndrome,Glomerular diseases,Proteinuria
2. Rheumatology & Autoimmunity :Relapsing polychondritis (RP),Familial autoimmune disorders,Cartilage-associated diseases 3. Pathology :Renal biopsy findings,IgM/C3 glomerular deposits,Minimal change disease progression 4. Immunology :Autoantibody cross-reactivity,Immune complex-mediated injury 5. Genetics :COL2A1 mutations (hypothesis),Familial clustering of RP/FSGS 6. Therapeutics :Corticosteroid-responsive FSGS,mTOR pathway in glomerular disease
Effect of Melatonin Supplementation on Glycemic and Lipid Profiles in Kidney Transplant Recipients: A Clinical Trial
Introduction. Melatonin plays a crucial role in regulating sleep and has potent antioxidant properties. However, the relationship between melatonin supplementation and metabolic factors related to diabetes and lipid profiles—which are associated with increased mortality in kidney transplant recipients has not yet been fully clarified. Methods. This randomized, double-blind, placebo-controlled trial was conducted at Labbafinejad Hospital, Tehran, Iran. Adult kidney transplant recipients (≥6 months post-transplant) received either 6 mg/day melatonin or placebo for three months. A modified intention-to-treat analysis included 42 patients per group. The primary outcomes were changes in fasting blood sugar (FBS) and HbA1c levels, while secondary outcomes included blood pressure and lipid profile parameters. Between-group effects were estimated using linear regression adjusted for baseline values and confounders. Results. In the melatonin group, FBS decreased by a median of 6.5 mg/dL (P < .001) and HbA1c by 0.25 units (P < .001), whereas both parameters increased in the placebo group. The adjusted between-group effect favored melatonin for HbA1c (β = −0.30%; 95% CI: −0.59 to −0.01; P < .001) but not for FBS (β = −2.61 mg/dL; 95% CI: −17.93 to 12.71; P = .283). Triglyceride levels decreased by 16 mg/dL in the melatonin group compared with an increase of 13.5 mg/dL in the placebo group (adjusted β = −23.77 mg/dL; 95% CI: −45.50 to −2.04; P = .032). No significant differences were observed in blood pressure and renal function. Conclusion. Melatonin supplementation for three months modestly improved glycemic control and lowered serum triglyceride levels in kidney transplant recipients, with no effects on blood pressure or kidney function. These results support melatonin’s potential as an adjunct therapy for metabolic dysregulation in this population, warranting further investigation into its long-term benefits.
Evaluation of the Performance of Biomarkers in Predicting Hemodialysis Patients Survival Using Time-Dependent ROC Curve
Introduction. End-stage kidney disease (ESKD) is a growing global public health problem, and patients undergoing hemodialysis (HD) experience a high mortality rate despite advances in medical care. Identifying reliable prognostic biomarkers is therefore essential. Regression-based survival models are widely used in HD studies; however, while they estimate associations, they do not directly quantify the predictive accuracy of biomarkers. This study aimed to evaluate the predictive performance of selected baseline biomarkers for survival in HD patients using the time-dependent receiver operating characteristic (ROC) curve. Methods. This retrospective cohort study included 2,192 ESKD patients undergoing maintenance HD in Fars province, Iran, between 2011 and 2020. Time-dependent area under the ROC curve (AUC) values were calculated to assess the prognostic performance of baseline biomarkers at 3, 12, 24, and 36 months after initiation of dialysis. Results. Age, serum albumin, creatinine, and calcium showed relatively better predictive performance for survival. For age, the AUCs at 3, 12, 24, and 36 months were 64.2, 57.1, 57.1, and 58.8, respectively, while corresponding values for serum albumin were 67.5, 62.3, 61.4, and 59.8. Serum albumin and calcium demonstrated higher discrimination for early survival, whereas serum creatinine showed more stable predictive performance over the follow-up period. The combined risk score outperformed individual biomarkers, with AUCs of 71.2, 63.9, 63.5, and 64.1 at 3, 12, 24, and 36 months, respectively. Conclusion. Time-dependent ROC analysis revealed time-varying prognostic performance of baseline biomarkers in HD patients and demonstrated improved discrimination when biomarkers were combined into a composite risk score.
This study is conducted to evaluate the predictive performance of some baseline biomarkers in predicting the survival of HD patients using the time-dependent ROC curve.
In this retrospective cohort study, data of all patients undergoing maintenance HD who survived the initial 3 months on maintenance HD in centers affiliated with Shiraz University of Medical Sciences (SUMS), Fars Province, Iran, were used.
Joint Modeling of Multivariate Longitudinal Measurements and Survival Data: Application to Hemodialysis Data
Introduction. In studies involving hemodialysis patients, repeated laboratory measurements (longitudinal data) and survival outcomes are often analyzed separately, which can lead to biased results due to ignoring measurement errors and the intrinsic dependency between the two analyses. Joint modeling has emerged as a powerful approach to handle such data. This study aims to investigate the impact of six time-varying biochemical markers, along with baseline covariates, on the survival of hemodialysis patients using a multivariate joint model. Methods. A longitudinal cohort of 894 maintenance hemodialysis (MHD) patients, who had started dialysis between 2004 and 2023, were included. Baseline and follow-up clinical information and monthly laboratory measurements were analyzed. A multivariate linear mixed-effects model was jointly fitted with a Cox proportional hazards model to simultaneously assess the longitudinal biomarkers and time-to-event data. Analyses were performed using R software. Results. The model indicated that older age (Hazard Ratio, HR = 1.02, P < .001), male gender (HR = 1.72, P < .001), diabetes mellitus (HR = 1.61, P < .001), walking disability at admission (HR = 1.78, P < .001), and catheter-based vascular access (HR = 1.71, P < .001) were significantly associated with an increased risk of mortality. Higher square root of phosphate levels (HR = 13.97, P < .001) were linked to increased, and higher square root of creatinine (HR = 0.32, P < .001), hemoglobin (HR = 0.75, P = .009) and albumin (HR = 0.31, P < .001) levels were associated with decreased mortality. Conclusion. Findings of the joint model confirm the importance of baseline clinical risk factors and modifiable biochemical markers on the survival outcomes of hemodialysis patients.
Joint Modeling of Longitudinal Biomarkers and Survival in Hemodialysis
Machine Learning-Based Prediction of 30-Day Hospital Readmission in Patients with Chronic Kidney Disease: A Retrospective Cohort Study
Introduction. Chronic Kidney Disease (CKD) is associated with high 30-day hospital readmission rates due to progressive renal dysfunction, multiple comorbidities, and complications related to dialysis and catheter use. Artificial Intelligence (AI) and Machine Learning (ML) offer promising tools for early identification of high-risk patients. To develop and evaluate ML models for predicting 30-day hospital readmission among CKD patients and identify key clinical and laboratory predictors related to readmission risk. Methods. This retrospective study analyzed 277 hospitalized patients with CKD at Hasheminejad Kidney Center (2019–2022). Forty-four demographic, clinical, and laboratory features were included. Preprocessing included handling missing data, normalization, outlier removal, categorical encoding, and oversampling. Six ML models, including eXtreme Gradient Boosting (XGBoost), Random Forest, Decision Tree, AdaBoost, Multilayer Perceptron (MLP), and Logistic Regression, were trained using a 70/30 train-test split with cross-validation. Feature selection employed SHAP values, mutual information, F-values, SVM, and chi-squared tests. Results. XGBoost outperformed other models (accuracy > 90%). The strongest predictors were estimated Glomerular Filtration Rate (eGFR), Blood Urea Nitrogen (BUN) and creatinine levels, age, presence of diabetes mellitus and hypertension, catheter-related infection, and triglycerides, intact Parathyroid hormone (iPTH), and albumin levels. Catheter infection emerged as a modifiable, high-impact predictor. The SHAP values analysis confirmed strong contributions of kidney function markers, inflammatory indicators, and metabolic variables to re-admission risk. Conclusion. ML-based prediction models, particularly XGBoost, demonstrated high accuracy in identifying CKD patients at risk of 30-day readmission. Integration of these models into clinical workflows may improve early intervention, reduce hospital readmissions, and support evidence-based nephrology care.
Risk Factors for High-Grade Vesicoureteral Reflux in ChildrenTwo Years or Younger with Febrile Urinary Tract Infections
Introduction. High-grade vesicoureteral reflux (VUR) in infants with febrile urinary tract infections is linked to a heightened risk of renal scarring. Identifying risk factors for high-grade vesicoureteral reflux could enable more selective use of voiding cystourethrography, thereby reducing unnecessary invasive procedures. This study aimed to determine the independent risk factors of high-grade vesicoureteral reflux in children ≤ two years with febrile urinary tract infections. Methods. According to the defined sample size, a total of 223 children aged two years or younger were referred to the nephrology clinic of Dr.Sheikh children’s hospital affiliated to Mashhad University of Medical Sciences from March 2006 to August 2023, meeting the inclusion criteria. Participants who underwent both kidney ultrasound and voiding cystourethrography (VCUG) were included in the analysis. Univariable and multivariable logistic regression tests were utilized to identify independent risk factors of high-grade VUR. Results. Of 223 children included in the study, 180 were girls (80.7%). The median age at the presentation was 8.5 months. High-grade vesicoureteral reflux was identified in 23.8%. The univariable analysis revealed that male sex, abnormal renal ultrasound, hydronephrosis, prenatal hydronephrosis, and infections with non- E.coli as potential risk factors. In the multivariable analysis, male sex (OR = 4.41, P < .001), abnormal renal ultrasound (OR = 3.35, P < .001), hydronephrosis (OR = 5.69, P < .001), and prenatal hydronephrosis (OR = 6.31, P = .004) were confirmed independent risk factors . Conclusion. Male sex, abnormal kidney ultrasound, hydronephrosis, and prenatal hydronephrosis are independent risk factors of high-grade vesicoureteral reflux in children aged ≤2 years with febrile urinary tract infections.
Predictors of Kidney and Patient Survival in Monoclonal Gammopathy–Associated Kidney Disease: A Single-Center Cohort from Colombia
Introduction. Monoclonal gammopathies can induce various kidney disorders through the deposition of monoclonal immunoglobulin. Precise recognition and classification are essential for predicting outcomes and customizing treatment. However, data on prognostic factors in Hispanic and Latin American populations remain scarce. This study aimed to determine the predictors of kidney and patient survival in adults with biopsy-proven monoclonal gammopathy-associated kidney disease. Methods. We conducted a retrospective cohort involving 98 individuals with biopsy-confirmed disease evaluated between 2011 and 2022. Kidney and patient survival were estimated using Kaplan-Meier analysis, and differences across histopathologic subtypes were assessed with the log-rank test. Predictors of end-stage kidney disease (ESKD) and mortality were identified using univariate and multivariable Cox regression after verification of the proportional hazards’ assumption. Results. Approximately one third of patients required kidney replacement therapy (KRT) at presentation. The need for KRT (hazard ratio [HR] 4.86, 95% confidence interval [CI] 2.01-11.79) and an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m² (HR 4.02, 95% CI 1.38-11.71) independently predicted progression to ESKD. Amyloidosis (HR 2.38, 95% CI 1.22-4.86) and age > 60 years (HR 1.96, 95% CI 1.06-3.61) were associated with higher mortality. The median follow-up was 41 months (interquartile range 24-68); 31% progressed to ESKD and 46% died. Conclusions. Severe kidney dysfunction and the need for replacement therapy at diagnosis are strong predictors of poor renal outcomes. Amyloidosis and older age significantly affect overall survival. Early recognition of high-risk patients and access to effective, clone-directed therapy are essential to improve prognosis in resource-limited settings.
Paraproteinemias, Monoclonal gammopathy of undetermined significance, Kidney biopsy, AL amyloidosis, Monoclonal gammopathy of renal significance, Multiple myeloma.
Prognostic factors for ESKD in monoclonal gammapathies.
Nephrology, Pathology, Clinical Medicine, Hematology
Years of Potential Life Lost (YPLL), the Key Metric in Strategic Planning for Chronic Kidney Disease Care
Muscle Mass Deficit Indexed to Body Surface Area Predicts Poor Physical Health and Quality of Life in Hemodialysis Patients
Introduction. Hemodialysis patients experience significantly lower quality of life compared to the healthy individuals, largely due to symptoms such as bone pain, fatigue, pruritus, anorexia, inflammation, malnutrition, and anemia. This study aimed to investigate the effects of sarcopenia and low muscle mass on quality of life, with a particular focus on physical health indices. Methods. The study included 62 patients on maintenance hemodialysis. Sarcopenia was diagnosed using the fat-free mass index (FFMI), defined as skeletal muscle mass divided by height squared (kg/m²). Additionally, skeletal muscle mass was normalized to body surface area (BSA); values below the sample mean of 46.12 kg/m² were classified as low muscle mass. Quality of life was assessed with the Kidney Disease Quality of Life (KDQOL) Version 1.3 questionnaire and scored using the KDQOL-SF™ Version 1.3 Scoring Program. Results. Sarcopenia was present in 18 patients (29%) according to FFMI. Patients scored lowest in general health (35.6), energy/fatigue (40.9), and both SF-12 physical (37.5) and mental health (37.2) domains. Sarcopenic patients reported significantly higher pain scores (60.97 ± 29.54 vs. 46.19 ± 27.37; P = .046), but other domains did not differ. Patients with low muscle mass/BSA (kg/m2) had lower sleep (51.5 ± 11.7 vs. 59.6 ± 13.0; P = .01), energy/fatigue (35.6 ± 20.1 vs. 52.8 ± 20.7; P = .005), and SF-12 physical health scores (35.7 ± 9.0 vs. 40.6 ± 8.3; P = .03). Muscle mass indexed to BSA was an independent predictor of the SF-12 physical health composite score. Conclusion. Low muscle mass, particularly when indexed to BSA, is associated with reduced physical health in hemodialysis patients and poorer quality of life across multiple domains. BSA-indexed muscle mass showed stronger and more consistent associations than FFMI-based definitions.
Body surface area, Hemodialysis, Low Muscle Mass, Physical Health, Quality of life, Sarcopenia
Genetic Associations Between Gastrointestinal Diseases and Chronic Kidney Disease: An Integrated Mendelian Randomization and Bioinformatics Analysis
Introduction. Chronic kidney disease (CKD) is a progressive condition with complex genetic and environmental influences. This study aims to investigate the genetic causal relationships between gastrointestinal diseases and CKD using the Mendelian Randomization (MR) approach and bioinformatics analysis. Methods. We analyzed genetic associations between nineteen gastrointestinal diseases including celiac disease (CeD), inflammatory bowel disease (IBD), intestinal malabsorption, and CKD. A two- sample MR analysis was performed using publicly available Genome-Wide Association Studies (GWAS) data with SingleNucleotide Polymorphisms (SNPs) as instrumental variables (IVs). The primary analysis employed the inverse variance weighted (IVW) method, with MR-Egger and weighted median as supplements. To explore potential biological mechanisms, Functional Mapping and Annotation (FUMA) analysis was used to map genes corresponding to IVs, followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Results. Significant genetic causal effects were observed for CeD (OR = 1.021, 95% CI = 1.002–1.041, P = .032), IBD (OR = 1.051, 95% CI = 1.014–1.089, P = .006), and intestinal malabsorption (OR = 1.031, 95% CI = 1.006–1.056, P = .013) on the risk of developing CKD. Other gastrointestinal diseases did not demonstrate significant causal effects on CKD. Reverse MR analyses did not reveal significant causal effects of CKD on CeD, IBD, or intestinal malabsorption, respectively. FUMA analysis identified 93 genes associated with CeD, 143 genes with IBD, and 26 genes with intestinal malabsorption. GO and KEGG enrichment analyses highlighted key pathways, including T-cell receptor signaling, cytokine-cytokine receptor interaction, chromatin regulation, and immune-related pathways. Conclusions. This study provides genetic and bioinformatics evidence linking CeD, IBD, and intestinal malabsorption to an increased risk of CKD, highlighting the systemic impact of immune dysregulation and inflammation on kidney health.
Efficacy and Safety of Oral Antidiabetic Drugs in People with Diabetes and Chronic Kidney Disease: A Systematic Review
This study is a systematic review assessing the efficacy and safety of oral antidiabetic drugs in managing type 2 diabetes mellitus in people with chronic kidney disease (CKD), focusing on their dosing and effects on renal function and glycemic control. A systematic search of online databases was conducted for published from January 2023 to September 2024. Studies that focused on oral antidiabetic drugs for individuals with diabetes and CKD, and reported outcomes such as glycemic control, renal function, and adverse events were included. A risk-of-bias assessment was performed to evaluate study quality. A total of 21 studies that met the criteria were included. The evidences indicate that SGLT2 (Sodium-Glucose Cotransporter-2) inhibitors and GLP-1 (Glucagon-like peptide-1) receptor agonists provide renal protective benefits. SGLT2 inhibitors are more effective especially in early-stages of CKD. DPP-4 (Dipeptidyl peptidase 4) inhibitors are safe across various CKD stages and require minimal dose adjustments. Metformin remains a popular drug for glycemic control but should be monitored and even discontinued in advanced stages of CKD because of the risk of lactic acidosis. Sulfonylureas were related to hypoglycemia risk. Oral antidiabetic drugs, especially SGLT2 inhibitors and GLP-1 receptor agonists, are suggested in managing blood glucose in CKD patients owing to their renal and cardiovascular benefits. Individualized therapy is an important factor as drug safety and efficacy are influenced by CKD stage, comorbid conditions, and hypoglycemia risk. Individualized therapy helps maximize renal and cardiovascular protection while minimizing adverse outcomes. Regular monitoring of HbA1c (hemoglobin A1c), GFR (glomerular filtration rate), and albuminuria is recommended.
Copyright (c) 2025 Iranian Journal of Kidney Diseases
Predictive Factors for Successful Discontinuation of Continuous Renal Replacement Therapy: A Retrospective Single-Center Observational Study
Introduction. Determining the optimal timing for discontinuing continuous renal replacement therapy (CRRT) in intensive care units (ICUs) remains a significant clinical challenge. This study aimed to identify the clinical and laboratory determinants of successful CRRT discontinuation in critically ill patients with acute kidney injury (AKI). Methods. This retrospective, single-center observational study was conducted in Gülhane Training and Research Hospital, Ankara, Türkiye. A total of 396 patients who received CRRT between January 2019 and March 2023 were screened. After excluding patients with prior renal replacement therapy (RRT) (n = 66) and end-stage kidney disease (n = 250), 80 patients were included in the final analysis. Successful discontinuation was defined as independence from any RRT for at least seven consecutive days following CRRT cessation. Clinical variables were compared between the successful and unsuccessful groups. Results. The mean age of the patients was 71.16 ± 14.96 years. In univariate analysis, successful discontinuation was significantly associated with higher 24-h urine output during CRRT [385 (0–3880) mL vs. 100 (0–1850) mL; P = .010], a stable or decreasing lactate trend in the first four hours (69% vs. 40%; P = .033), and a lower requirement for invasive mechanical ventilation (36.4% vs. 58.3%; P = .050). Receiver operating characteristic (ROC) curve analysis identified 24-h urine output as a significant predictor of success (Area under the curve (AUC) = 0.666; 95% Confidence interval (CI): 0.546–0.786; P = .011) with a threshold of 365 cc/24h (sensitivity: 52.3%, specificity: 80.6%). In the final logistic regression model, urine output in the last 24 hours remained an independent predictor of weaning success (Odds ratio (OR) = 1.001; 95% CI: 1.000–1.002; P = .009). Conclusion. The 24-h urine output preceding CRRT termination and the trend of lactate levels during the 4-hour period post-initiation are important predictive values for the success of CRRT discontinuation.
A Study on the Correlation between Metabolic Syndrome and Proteinuria in Chronic Kidney Disease
Introduction. To assess the frequency of metabolic syndrome (MS) and its association with proteinuria in patients with chronickidney disease (CKD). Methods. A cross-sectional study was conducted among 386 CKD patients from June 2022 to June 2023. Prevalence of MS was calculated, clinical characteristics of CKD patients with and without MS were compared, and multivariable logistic regression was performed to estimate associations between the components of MS with the categories of proteinuria. Results. The prevalence of MS was 24.9% among the 386 CKD patients. Patients with MS had greater 24-h urinary protein excretion and lower estimated glomerular filtration rate (eGFR) compared to patients without MS (P < .05). The proportion of patients withMS increased across proteinuria strata: mild (< 1.0 g/day) 14.4%, moderate (1.0 to 3.5 g/day) 35.2%, and severe (≥ 3.5 g/day) 49.0% (P < .05). In adjusted models, increased postprandial blood glucose (PBG), hypertension, and the ratio of triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) were independent associations with increased burden of proteinuria. Conclusion. Metabolic syndrome was independently associated with increased proteinuria burden in CKD. Early recognition and treatment of metabolic risk factors, especially dysglycemia, hypertension, and dyslipidemia, may help to promote renal protection and improve overall patient health.
Hospitalization Causes in Kidney Transplant Recipients: A Cross-Sectional Study from Isfahan, Iran
Introduction. Kidney transplantation significantly improves survival and quality of life in End-Stage Kidney Disease (ESKD). However, kidney transplant recipients (KTRs) are prone to complications leading to hospitalization. Data on hospitalization etiologies among Iranian KTRs remain limited. Methods. This cross-sectional study included all KTRs hospitalized in the two centers with kidney transplant department in Isfahan between March 2023 and March 2024. Demographic, clinical, and laboratory data were collected from medical records. Etiologies of admission were classified, and descriptive and analytical statistics were calculated using SPSS, version 22. Results. A total of 408 patients (60.7% male, mean age 45.6 ± 15.2 years) were included. The most frequent comorbidities were diabetes mellitus (DM) (27.2%) and hypertension (HTN) (22.2%). Most patients (42.5%) had undergone transplantation for more than 10 years. The leading causes of admission were constitutional symptoms including fever, myalgia, and fatigue in 165 (40.4%), azotemia in 55 (13.5%), dysuria in 23 (5.6%) and limb edema in 21 (5.1%) patients. The main final diagnosis in hospitalized KTRs were infections (42.5%) and acute kidney injury (AKI)/AKI superimposed on chronic kidney disease (CKD) (15.6%). Laboratory findings revealed a mean serum creatinine of 2.58 ± 2.16 mg/dL, with 50% above 1.7 mg/dL. Anemia (Hb < 10 g/dL) was present in 43.7% of cases. Urinalysis showed hematuria in 50.3% and pyuria in 64.2% of patients. Graft failure requiring dialysis occurred in 9 (2.2%) patients. Eighteen (4.4%) patients died during hospitalization period. Conclusion. Infections and acute kidney injury (AKI) were the predominant causes of hospitalization among Isfahan KTR population.
Bibliometric Analysis of Uremia Research: 2021–2025
Introduction. This study aimed to perform a bibliometric analysis of academic research on uremia, identifying research hotspots, development trends, and international collaboration networks in this field. Methods. Relevant publications related to uremia were retrieved from Web of Science database. Bibliometric analysis was conducted using R software. Co-occurrence analysis of keywords, co-citation network analysis, and author/country collaboration analysis were performed to explore research focuses and academic influence. Results. From 2021 to 2022, research on uremia mainly concentrated on traditional areas such as chronic kidney disease, hemodialysis, and patient management. Since 2023, the focus has gradually shifted toward emerging topics including plasma biomarkers, inflammation mechanisms, and precision patient care. Co-citation network analysis revealed that studies related to chronic kidney disease and hemodialysis had the strongest academic influence, while research on inflammation and uremia also occupied central positions in the network. International collaboration was most active in China, the United States, and Europe, reflecting a trend toward cross-border and interdisciplinary research. Meanwhile, keywords such as gut microbiota, metabolomics, and precision medicine are increasingly frequent, highlighting new research frontiers. Conclusion. This study demonstrates that uremia research is shifting from traditional areas such as chronic kidney disease and hemodialysis toward emerging themes including inflammation, biomarkers, and patient management. These findings provide objective evidence of research hotspots and trends in uremia and underscore the importance of enhancing international and interdisciplinary collaboration.
Uremia; Bibliometrics; Chronic Kidney Disease; Inflammation; Dialysis
Association Between Occult Kidney Disease and COVID-19 Mortality: Evidence from a Retrospective Study
Introduction. Occult kidney disease (OKD), a term that describes the initial phase of renal failure, is usually overlooked in routine clinical evaluations. Therefore, the goal of this study was to determine whether OKD is associated with the disease severity and mortality in COVID-19 patients. Methods. A retrospective study was conducted in patients with COVID-19. COVID-19 was considered based on a positive reverse transcriptase-polymerase chain reaction test for SARS-CoV-2. OKD was defined with an estimated glomerular filtration rate < 60 ml/min/1.73 m2 and creatinine concentrations ≤1.3 mg/dl. Results. A total of 809 patients with COVID-19 were selected for the study. The frequency of OKD, acute kidney injury, and chronic kidney disease was 7.7%, 15.0%, and 12.4%, respectively. The logistic regression analysis adjusted showed that OKD (OR = 1.86; CI 95%: 1.05-3.32), acute kidney injury (OR = 2.03; CI 95%: 1.42-2.89), and chronic kidney disease (OR = 3.07; CI 95%: 1.90-4.97) were associated with mortality by COVID-19. Conclusion. Our results indicate that OKD is associated with increased mortality in patients with COVID-19.
Comparative Analysis of Quality of Life and Surgical Outcomes Following Laparoscopic Versus Open Living Donor Nephrectomy: A Randomized Clinical Trial
Introduction. This study aimed to evaluate and compare quality of life and surgical outcomes following laparoscopic donor nephrectomy (LDN) versus the standard open donor nephrectomy (ODN) technique. Methods. This open-label randomized clinical trial was conductedat Imam Khomeini Hospital, Urmia, Iran, from 2022 to 2023). Ninety-one kidney donors were randomly assigned to the ODN (n = 46) or LDN (n = 45) group. Outcomes included hemoglobin changes, renal function, hospitalization length, operation time, time to return to normal activities, complications, and one-year quality of life (SF-36). Data were analyzed using t-tests and Chi-square tests (P < .05). Results. The mean duration of surgery was significantly longer in the LDN group compared to the ODN group (3.13 ± 0.37 vs. 2.30 ± 0.37 hours; P < .001). However, the ODN group experienced a significantly greater reduction in hemoglobin (-1.59 ± 0.78 vs. -1.04 ± 0.94; P = .004) and longer hospitalization (4.06 ± 0.38 vs. 3.31 ± 0.55 days; P < .001). Furthermore, a significantly higher proportion of LDN patients returned to normal activities within one month of surgery (84.1% vs. 54.5%; P = .004). There were no significant differences regarding urinary output, complications,or long-term quality of life (P > .05). Conclusion. Although laparoscopic donor nephrectomy requires a longer operative time, it offers superior clinical benefits, including reduced blood loss, shorter hospital stays, and faster functional recovery. These findings support the adoption of the laparoscopic approach as the preferred standard of care for living kidney donors to optimize postoperative recovery.
Patient Preferences and Information Gaps Underlying the Predominance of Hemodialysis in Türkiye: A Cross-Sectional Survey of 1908 Patients
Introduction. Chronic kidney disease (CKD) is an important public health problem that is increasingly prevalent in Türkiye and the world. Patients with CKD should be informed about renal replacement therapy (RRT) before progression to end-stage kidney disease, and the most appropriate therapy should be selected for each patient. Although three different renal replacement therapy modalities exists, hemodialysis appears to be the most commonly chosen. In this study, we aimed to investigate why hemodialysis is often selected as the first-line therapy by patients. Methods. In this cross-sectional, survey study; patients aged 18-80, who had been receiving treatment for more than three months and had initiated hemodialysis as their first RRT between 2010 and 2020 in Kahramanmaras, Kocaeli, and Istanbul were included. Patients completed a self-administered multiple-choice questionnarire. Results. A total of 1908 patients were included in the study. Before initiating hemodialysis, 61.1% of patients were under nephrology follow-up, whereas 38.3% had no prior follow-up. Alternative therapies to hemodialysis (peritoneal dialysis and kidney transplantation) were explained to 720 patients (37.7%), but not to 1,159 patients (60.7%). A total of 635 patients (33.3%) were asked about their treatment preferences, while 66% were not. After hemodialysis initiation, 937 patients (49.1%) were listed for cadaveric kidney transplantation, wheras 49.5% were not. Conclusion. Our study is a large, cross-sectional investigation of 1908 patients who selected hemodialysis as their initial RRT. The reasons patients choose hemodialysis over other modalities have long been debated, and substantial knowledge gaps among patients have been identified. We believe that nephrologist follow-up and patient information are important in choosing renal replacement therapy
Chronic kidney disease, hemodialysis, kidney transplantation, peritoneal dialysis
Distribution of CYP3A4*1/*1B (rs2740574) and CYP3A5*1/*3 (rs776746) Genetic Variants in Renal Transplant Recipients Treated with Sirolimus in Urmia (Iran)
Introduction. Rapamycin, also referred to as Sirolimus, is an immunosuppressive medication used in kidney transplantation to prevent organ rejection. Sirolimus is metabolized predominantly by the enzymes CYP3A4 and CYP3A5. The objective of this study was to evaluate the distribution of CYP3A4*1/*1B (rs2740574, −392A > G) and CYP3A5*1/*3 (rs776746, 6986A > G) genetic variants in renal transplant recipients treated with Sirolimus in Urmia (Iran). Methods. This assessment involved thirty-nine renal transplant recipients in Urmia Imam Khomeini University Hospital, Urmia (Iran) who were treated with a daily dose of 1mg/day Sirolimus. The CYP3A4*1/*1B and CYP3A5*1/*3 allelic variants were identified using the Restriction Fragment Length Polymorphism-Polymerase Chain Reaction (RFLP-PCR) technique. Results. The frequencies of CYP3A4 *1/*1 (-392AA), CYP3A4 *1/*1B (-392AG), and CYP3A4 *1B/*1B (-392GG) genotypes and CYP3A4 *1 (-392A) and CYP3A4 *1B (-392G) alleles were 37(94.87%), 2(5.13%), 0(0%), 76(97%), and 2(3%), respectively. The genotypic distribution for CYP3A5 was 0(0%) for CYP3A5*1/*1 (6986AA), 6(15.38%) for CYP3A5*1/*3 (6986AG), and 33(84.62%) for CYP3A5*3/*3 (6986GG). The allelic frequencies were 6(8%) for CYP3A5*1 (6986A) and 72(92%) for CYP3A5*3 (6986G). Only one patient with CYP3A4
Kidney Disease, Dialysis, Transplantation
Non-Diabetic Kidney Disease Confirmed by Biopsy in Patients with Diabetes: A Single-Center Registry Report
Introduction. Diabetic kidney disease (DKD) is a major complication of diabetes mellitus (DM), often leading to kidney failure. This study was designed to assess the prevalence and clinicopathological correlations of biopsy-confirmed non-diabetic kidney disease (NDKD) in patients with diabetes. Method. A retrospective analysis was conducted by including 547 diabetic patients who underwent kidney biopsies. Data on demographics, laboratory results (including serum creatinine and urine protein levels), clinical symptoms, medical history, and histopathological diagnoses were collected. Result. Among the patients, 261 (47.7%) were diagnosed with DKD, while 286 (52.3%) had NDKD. The most prevalent histopathologicalfinding in NDKD was membranous glomerulonephritis (13.9%), followed by focal and segmental glomerulosclerosis (9.7%) and IgA nephropathy (5.7%). Key predictors for DKD included longer duration of diabetes mellitus (odds ratio [OR]: 1.12), elevated HbA1c levels (OR: 1.26), and the presence of retinopathy at the time of biopsy (OR: 7.97), all with P < .05. No significant differences were observed in the frequency of hematuria between the DKD and NDKD groups. Conclusion. Membranous glomerulonephritis was the most common diagnosis among NDKD patients. The findings suggest a strong correlation between the duration of diabetes mellitus, the presence of retinopathy, and HbA1c levels with DKD development, indicating a need for revised criteria for kidney biopsy decisions in diabetic individuals to enhance diagnostic accuracy and treatment strategies.
The Association Between Serum Sodium Variation During Pediatric Intensive Care Unit Admission and the Risk of Clinical Outcomes in Critically Ill Children: A Retrospective Cohort Study
Introduction. Dysnatremia at Pediatric Intensive Care Unit (PICU) has been associated with adverse outcomes; however, the impact of sodium variation during PICU stay remains underexplored. We aimed to assess the association between dysnatremia and sodium fluctuations during PICU admission and the probability of prolonged PICU stay (≥7days) and mortality. Methods. This retrospective cohort study included 966 critically ill children (2019–2022) with at least two serum sodium measurements during PICU admission. Patients were classified as normonatremic, hyponatremic, hypernatremic, or mixed dysnatremic based on all sodium values. Sodium fluctuation was defined as the difference between the highest and lowest sodium levels during admission and categorized into quartiles. Associations of dysnatremia categories and sodium fluctuation with prolonged PICU stay and PICU mortality were evaluated using multivariable logistic regression. Results. During the PICU admission, 542 patients developed dysnatremia. The PICU-acquired dysnatremia was independently associated with higher odds of prolonged PICU stay after adjusting for major confounders. The PICU-acquired hypernatremia (OR:5.23;95%CI:1.72-15.92) and mixed dysnatremia (OR:2.89;95%CI:1.14-7.29) had significantly higher odds for PICU mortality. Even mild sodium fluctuations (4-8mmoL/L) during PICU admission were significantly associated with higher odds of prolonged PICU stay. The highest (≥15mmol/L) fluctuations in serum sodium levels during PICU admission were also significantly associated with higher odds of PICU mortality (OR:2.74;95%CI:1.11-6.79). Conclusion. Our findings underscore the importance of careful monitoring of serum sodium levels during PICU admission to improve clinical outcomes. These results should be interpreted in light of the retrospective design and the unavailability of standardized illness-severity scores (e.g., PRISM or PIM) in the dataset.
serum sodium variation during Pediatric Intensive Care Unit admission and the risk of clinical outcomes in critically ill children
The Trend of Mortality Rate and Years of Life Lost Due to Kidney Failure in Fars Province, Iran, During the Years 2004-2019
Introduction. Chronic kidney disease is a general term for heterogeneous disorders that affect the structure and function of the kidney. This study was conducted to determine the mortality rate and years of life lost due to kidney failure in southern Iran. Method. In this retrospective, population-based descriptive trend study, all deaths due to kidney failure in Fars province were extracted from the electronic population-based death registration system (EDRS). The crude mortality rate, age-standardized mortality rate, years of life lost (YLL) and YLL rate data were calculated. The Joinpoint Regression method was used to examine the trend. Results. During the 16-year study period, 2853 deaths due to kidney failure occurred in Fars province. Of this number, 57.2% (1633 cases) were men. The crude mortality rate had a stable trend in men and an increasing trend in women. However, the age-standardized mortality rate had a stable trend in both sexes. The total years of life lost due to kidney failure were 19366 in men and 15769 in women. According to the Joinpoint regression analysis, the trend of YLL rate due to premature mortality was stable and the annual percent change (APC) were -2.6% (95% CI -5.6 to 0.4, P = .088) and 1.8% (95% CI -1.9 to 5.6, P = .318) for males and females respectively. Conclusions. The trend of crude mortality rate had a stable trend in men and an increasing trend in women. Also, the trend of YLL was stable for both sexes. The increasing trend in mortality among women may be due to increases in life expectancy and the increasing prevalence of non-communicable diseases such as hypertension and diabetes mellitus.
A Girl with End-Stage Kidney Disease Due to Granulomatosis with Polyangiitis Presenting with Gastrointestinal Bleeding “a rare presentation”
Granulomatosis with polyangiitis (GPA) is an uncommon vasculitis affecting small- and medium-sized vessels, predominantly in adults (average age approximately 45 years) and infrequently in children. It can involve multiple organ systems. In patients with end-stage kidney disease (ESKD) due to GPA, disease activity is often tends to wane after the commencement of dialysis. We report a 12-year-old girl with ESKD due to GPA who presented with severe gastrointestinal (GI) bleeding and profound anemia, owing to diffuse microaneurysms in the small bowel (particularly the ileum) and colon—an exceedingly rare manifestation. She responded dramatically to induction therapy comprising methylprednisolone pulse, plasmapheresis, rituximab followed by maintenance therapy with prednisolone and mycophenolate mofetil. This case highlights that while the recurrence risk of ANCA-associated vasculitis in dialysis patients is low, the possibility remains and may present with atypical extrarenal involvement. Given the elevated risk of infection with immunosuppression in ESKD patients, maintenance immunosuppressive therapy may be discontinued in the absence of extrarenal disease—but this decision necessitates careful consideration.
Granulomatosis with polyangiitis, Intestinal involvement Wegener granulomatosis, Case report
Inflammatory Mediators in Kidney Disease: A Focus on IL-6in SLE-Associated CKD
Introduction. Systemic lupus erythematosus (SLE) is an autoimmune condition that can lead to severe renal impairment, including chronic kidney disease (CKD) or end-stage kidney disease (ESKD). This study aimed to evaluate the serum levels of key pro-inflammatory cytokines which are well-known to mediate tissue injury and fibrosis in the context of kidney diseases—interleukin-1 beta (IL-1β), IL-6, tumor necrosis factor-alpha (TNF-α), and IL-12—in CKD and ESKD patients with and without SLE, as well as in healthy controls, to explore their role in disease progression. Methods. This cross-sectional study was conducted over a 15-month period in three governmental medical centers of Golestan Province, Iran (Sayyad Shirazi Hospital, 5th Azar hospital, and Al-Jalil hospital). A total of 118 individuals (age 18-65 years) were enrolled and divided into three groups:38 CKD or ESKD patients with SLE, 40 CKD or ESKD patients without SLE, and 40 healthy controls. For subgroup analyses, CKD (stages3-4) and ESKD (stage 5) patients were considered separately. Those patients meeting the American College of Rheumatology criteria for SLE, while excluding those with infections, malignancies, or other autoimmune disorders were selected. Blood samples were collected, and serum cytokine levels were measured using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney U tests, with P ≤ .05 considered significant. Results. CKD patients with SLE showed significantly higher serum levels of IL-1β, TNF-α, and IL-12 compared to CKD patients without SLE and healthy controls (P < .05). IL-6 levels were notably higher in CKD patients compared to ESKD patients, irrespective of SLE status (P < .05). ESKD patients exhibited increased IL-1β, TNF-α, and IL-12 levels, while IL-6 levels were lower than those in CKD patients. Conclusion. IL-6 appears to play a crucial role in the pathogenesis of kidney disease, particularly in patients with SLE, and may serve as a therapeutic target. The differential regulation of cytokines in CKD and ESKD suggests that inflammatory pathways vary based on disease stage and the presence of SLE.
Stepwise Interpretation of Albumin Fraction Abnormalities on Serum Protein Capillary Electrophoresis in Nephrotic Syndrome: A Case Series
Serum protein electrophoresis (SPEP) is commonly used in the diagnostic evaluation of nephrotic syndrome (NS) to rule out monoclonal gammopathies. However, NS itself and various other factors may cause transient bisalbuminemia, resulting in albumin fraction irregularities in capillary SPEP and complicating interpretation. This study proposes a stepwise approach for interpreting albumin fraction irregularities, illustrated through three representative cases of NS. Case 1: a 44-year-old woman with isolated proteinuria, Case 2: a 36-year-old woman with diabetic foot infection, and Case 3: a 58-year-old man with ankylosing spondylitis, all presenting with nephrotic-range proteinuria. On initial SPEP case 1 exhibited a distinct sharp peak, while cases 2 and 3 showed irregular bands between the albumin and α1 regions. A stepwise interpretative approach was applied: First, technical errors were excluded by repeat analysis using alternative capillaries on the same analyzer. Second, potential biochemical interferences were evaluated. Third, SPEP was repeated using freshly collected samples. Fourth, persistent albumin fraction irregularities prompted consideration of biochemical albumin modifications, such as glycosylated or carbamylated forms. Fifth, other causes including drugs, heavy metal toxicity, liver disease, and systemic inflammation were excluded. Finally, additional tests such as immunofixation electrophoresis were performed to rule out monoclonal proteins. In the absence of monoclonal proteins, the condition was interpreted as bisalbuminemia related to NS. Using this approach, transient bisalbuminemia was considered the most likely cause in Cases 1 and 2, whereas the disappearance of the irregular band in Case 3 suggested a preanalytical artifact. Systematic interpretation of albumin fraction irregularities can help distinguish true pathology from benign or artifactual patterns in patients with NS.