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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]

Nephro Pharmacology

Comparative analysis of roxadustat efficacy between maintenance hemodialysis and peritoneal dialysis patients 

Liling Zhang, Yan Huang, Defeng Yin, Tingting Zhu, Qi Liu, Ying Li, and Linwang Gan

Volume 101 (2024) p. 34 - 42

Abstract

Clinical Nephrology, Vol. 101 – No. 1/2024 (34-42)

Comparative analysis of roxadustat efficacy between maintenance hemodialysis and peritoneal dialysis patients 

Liling Zhang¹*, Yan Huang¹*, Defeng Yin², Tingting Zhu¹, Qi Liu¹, Ying Li¹, and Linwang Gan¹

¹Department of Nephrology, ²Department of Emergency, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
Background: This study evaluated the comparative efficacy of roxadustat for renal anemia between patients on maintenance hemodialysis (HD) and peritoneal dialysis (PD).
Materials and methods: 93 maintenance dialysis patients who regularly followed up from August 2015 to June 2021 were enrolled. Despite receiving a therapeutic dose ≥ 12,000 U/week of erythropoiesis-stimulating agents (E+SA) in the past 12 weeks, this had not worked very well. Subjects were assigned to the HD group (n = 60) or the PD group (n = 33) based on their dialysis treatment modality. All patients received oral roxadustat and were followed up for 24 weeks, after which their hemoglobin, serum iron, transferrin saturation, and ferritin were tested.
Results: We observed that the hemoglobin level of PD patients was significantly increased from 76.1 ± 15.7 g/L to 106 ± 23.8 g/L (p < 0 .001), while it significantly increased from 73.8 ± 12.9 g/L to 100.7 ± 20.2 g/L (p < 0.001) in the HD patients. After 1 and 3 months of roxadustat treatment, the hemoglobin level and its change in the PD group was significantly higher compared to that in the HD group despite the higher dose of roxadustat in the latter group. In addition, roxadustat was noted to reduce cholesterol levels and stabilize serum iron levels in parallel with improving hemoglobin levels.
Conclusion: Roxadustat can effectively increase the hemoglobin level of maintenance dialysis patients, even in those with low erythropoietin response or erythropoietin resistance, and, more importantly, its efficacy in PD patients was more significant.

*Contributed equally.Correspondence to:
Linwang Gan, MD
Department of Nephrology
the Affiliated Hospital of Southwest Medical University
No. 25 Taiping Street
Luzhou 646000, Sichuan Province, China
Email: [email protected]

Original

Incidence trends of kidney cancer in China from 1990 to 2019: A joinpoint and age-period-cohort analysis 

Liling Zhang, Yuansheng Li, Ningjun Ren, Tingting Zhu, Dongmei Zhang, Saotao Ou, and Defeng Yin

Volume 101 (2024) p. 181 - 190

Abstract

Clinical Nephrology, Vol. 101 – No. 4/2024 (181-190)

Incidence trends of kidney cancer in China from 1990 to 2019: A joinpoint and age-period-cohort analysis 

Liling Zhang¹#²*, Yuansheng Li³*, Ningjun Ren³*, Tingting Zhu¹#², Dongmei Zhang¹#², Saotao Ou¹#², and Defeng Yin⁴

¹Department of Nephrology, ²Sichuan Clinical Research Center for Nephropathy, The Affiliated Hospital of Southwest Medical University, ³School of Public Health, Southwest Medical University, Longmatan District, and ⁴Department of Emergency Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
Background: Occupational carcinogens, smoking, and obesity are believed to be the main causing agents of kidney cancer. China is undergoing rapid industrialization, and hence the people’s lifestyles have witnessed tremendous changes. However, the trend of kidney cancer incidence during the late 20^th and early 21^st centuries remains unexplored in China.
Materials and methods: Data from the Global Burden of Diseases (GBD; 2019) was retrieved for the incidence of kidney cancer from 1990 to 2019. The rates of disease average annual percentage changes (AAPC) were assessed using joinpoint regression analysis. Age-period-cohort (APC) model was used to assess age, period, and cohort effects on the incidence of the disease simultaneously.
Results: An increase in age-standardized incidence rates (ASIR) of kidney cancer was observed from 1990 to 2019 in total residents (1.33 – 4.24), men (1.56 – 6.15), and women (1.11 – 2.31) per 100,000 population suggesting a more obvious increase in males than in females. A consistent increase in age effects was observed in all age groups, especially in males. On the other hand, the 70 – 74 age group in females showed greater age effects. In addition, the period effects analysis showed that the incidence of kidney cancer increased with time. Moreover, the analysis of cohort effects showed a decrease in the disease in birth cohorts, especially before 1940.
Conclusion: The incidence of kidney cancer is increasing rapidly in China. The kidney cancer burden will rise in the next decades due to population aging, environmental pollution, occupation, food safety, and so on. Results of this study suggest that more etiological studies should be performed to identify the driving factors for kidney cancer trends, and appropriate preventive measures should be implemented for the age-, period-, and cohort-related factors in the population.

*Contributed equallyCorrespondence to:
Defeng Yin
Department of Emergency
The Affiliated Hospital of Southwest Medical University
Luzhou 646000, Sichuan Province, 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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