Nephrology

SGLT2 inhibitors benefit nonalbuminuric diabetic CKD in routine practice

In a nationwide Taiwanese cohort of type 2 diabetes with nonalbuminuric CKD, SGLT2 inhibitor use lowered multiple major cardiorenal outcomes over 3 years. In pre-matched analyses, SGLT2 inhibitors were associated with markedly lower risks of dialysis, macroalbuminuria, MACE, AKI, and all-cause mortality. After propensity matching, SGLT2 inhibitor use remained associated with reduced progression to macroalbuminuria and substantially lower all-cause mortality. These data support prescribing SGLT2 inhibitors even in nonalbuminuric diabetic CKD, a phenotype underrepresented in randomized trials. 1

ICU admission AKI stage strongly predicts 90-day death and KRT dependence

This population-based Ontario cohort examined 484,956 ICU admissions with known outpatient baseline creatinine from 2009–2021. AKI on admission (22% of patients) was graded by KDIGO and showed a clear risk gradient for 90-day mortality versus no AKI. Adjusted odds of 90-day death were nearly doubled with stage 1 AKI and about 2.5-fold higher with stages 2 and 3. Risks of 90-day KRT dependence increased progressively with AKI stage, reaching more than eightfold higher with stage 3. 2

Obinutuzumab achieves high remission rates in rituximab-resistant membranous nephropathy

This single-center prospective trial treated 20 adults with primary membranous nephropathy and rituximab-resistant nephrotic syndrome using three 1,000 mg obinutuzumab infusions. At 12 months, 16 of 20 patients achieved the composite outcome of normoalbuminemia with complete or partial remission, including 4 complete remissions. Proteinuria and albumin and IgG fractional clearances markedly decreased, while serum albumin increased and dyslipidemia and hypocalcemia improved; GFR stabilized. Anti-PLA2R antibodies and B cells were depleted at 12 months, with sustained clinical response in the 10 patients followed to 24 months. 3

Five-variable nomogram predicts treatment failure in culture-negative PD peritonitis

This multicenter retrospective study developed and externally validated a nomogram to predict 30-day treatment failure in culture-negative PD-associated peritonitis. Among 288 derivation patients and 103 external validation patients, treatment failure was defined as catheter removal or peritonitis-related death. Five predictors were selected: day-3 effluent WBC count, serum albumin, total cholesterol, magnesium, and phosphorus levels. The model showed high discrimination with AUCs around 0.85–0.90 and good calibration in both internal and external cohorts. 4