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Nephrology  Education

An atypical anti-GBM disease complicated by idiopathic nodular glomerulosclerosis: Case report 

Jianhua Qin, Tingting Zhu, Haiyan Zhang, and Santao Ou

Volume 99 (2023) p. 98 - 104

Abstract

Clinical Nephrology, Vol. 99 – No. 2/2023 (98-104)

An atypical anti-GBM disease complicated by idiopathic nodular glomerulosclerosis: Case report 

Jianhua Qin¹#²*, Tingting Zhu¹#²*, Haiyan Zhang³, and Santao Ou¹#²

¹Department of Nephrology, The Affiliated Hospital of Southwest Medical University, ²Sichuan Clinical Research Center for Nephrology, Luzhou City, China, and ³Department of Pathology, University of California San Diego Health, CA, USA
Both atypical anti-glomerular basement membrane (anti-GBM) disease and idiopathic nodular glomerulosclerosis are rare diseases. We report a case of a 53-year-old non-diabetic male who presented with leg edema, nephritic range proteinuria, microscopic hematuria, and decreased renal function. The renal biopsy demonstrated membranoproliferative glomerulonephritis (MPGN) pattern of glomerular injury with focal crescent and segmental nodular glomerulosclerosis. The immunofluorescence studies showed intense linear IgG (IgG1 and IgG4) deposits along the GBM but negative serology. Electron microscopy demonstrated GBM thickening and fibrillar deposition. The presence of MPGN with crescents and the linear IgG along the GBM were consistent with a diagnosis of atypical ant-GBM disease. Superimposed nodular glomerulosclerosis was considered to be idiopathic by excluding other glomerular diseases characterized by fibrillar deposition and nodular glomerulosclerosis. Both diseases were found to have a strong causative association with patient’s history of long-term heavy smoking. This unusual case with combination of atypical anti-GBM disease and idiopathic nodular glomerulosclerosis, has brought great challenge for the diagnosis and also made the clinical course highly complicated. This nodular glomerulosclerosis with anti-GBM-like glomerulonephritis may represent a distinct pattern of kidney injury observed in heavy smokers.

*Contributed equally.Correspondence to:
Tingting Zhu, MD
Department of Nephrology
The Affiliated Hospital of Southwest Medical University
Luzhou City, China
Email: [email protected]

Original

Relationship of serum α-Klotho with diabetic kidney disease and mortality in diabetes: A population-based observational study 

Liling Zhang, Di Fan, Tingting Zhu, Lei Geng, Linwang Gan, Santao Ou, Defeng Yin, and Yong Xu

Volume 105 (2026) p. 297 - 307

Abstract

Clinical Nephrology, Vol. 105 – No. 5/2026 (297-307)

Relationship of serum α-Klotho with diabetic kidney disease and mortality in diabetes: A population-based observational study 

Liling Zhang¹, Di Fan², Tingting Zhu¹, Lei Geng¹, Linwang Gan¹, Santao Ou¹, Defeng Yin³, and Yong Xu⁴

¹Department of Nephrology, ²Department of Anesthesiology, ³Department of Emergency, and ⁴Department of Endocrinology and Metabolism, The Affiliated Hospital, Southwest Medical University, Luzhou, China
This study aimed to investigate the associations between serum α-Klotho levels and diabetic kidney disease (DKD), as well as all-cause mortality among individuals with diabetes. We included participants from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016. Multivariable logistic regression and Cox proportional hazards models were used to evaluate the relationships of serum α-Klotho with DKD and mortality, respectively. Restricted cubic splines were applied to examine potential nonlinear associations. Subgroup analyses were performed to assess the robustness of the findings. A total of 3,098 participants were enrolled. The fully adjusted odds ratio (95% confidence interval (CI)) for the association between serum α-Klotho and DKD was 0.47 (0.33, 0.67; p < 0.001). Similarly, the hazard ratio for all-cause mortality was 0.61 (0.36, 0.96; p = 0.043). Restricted cubic spline analyses revealed nonlinear relationships between serum α-Klotho and both DKD and all-cause mortality. Kaplan–Meier curves indicated that participants in the lower quartiles of serum α-Klotho had significantly reduced survival probabilities. After Bonferroni correction, subgroup analyses showed no significant interactions between serum α-Klotho and all-cause mortality across populations. In conclusion, serum α-Klotho is significantly associated with DKD and all-cause mortality in diabetes.Correspondence to:
Yong Xu
Department of Endocrinology and Metabolism
The Affiliated Hospital
Southwest Medical University
No. 25, Taiping Street,
Jiangyang District, Luzhou 646000, China
Email: [email protected]

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