Keyword: Kazakhstan

ABSTRACT: Background & Objective: Acute tubulointerstitial nephritis (ATIN) is a potentially reversible cause of acute kidney injury (AKI). However, when presenting with rapid loss of renal function and fever of unknown origin, ATIN frequently mimics rapidly progressive glomerulonephritis (RPGN). In Kazakhstan, patients presenting with severe renal dysfunction (eGFR <10 mL/min/1.73m²) are frequently denied or delayed from undergoing diagnostic kidney biopsy due to institutional safety concerns, procedural hesitation, and a regional deficit in subspecialized nephropathology services. This abstract demonstrates the critical diagnostic value of renal biopsy in advanced AKI with clinicopathological dissociation and highlights systemic diagnostic barriers in Central Asia.
Case Presentation: A 41-year-old female with no prior history of kidney disease presented in June 2026 with an unexplained persistent fever (37.0–38.0°C). Despite empirical antibacterial therapy ('ex juvantibus'), her fever persisted. Over 8 weeks, serial laboratory testing revealed a dramatic, rapidly progressive decline in kidney function (Table 1): serum creatinine escalated from a baseline of 70 µmol/L (eGFR 96 mL/min/1.73m²) in June 2026 to 130 µmol/L (09.07.2026), 381 µmol/L (31.07.2026), 441 µmol/L (06.08.2026), and peaked at 524 µmol/L (20.08.2026, eGFR 8.6 mL/min/1.73m²). Remarkably, diuresis remained fully preserved, and urinary abnormalities were strikingly mild (proteinuria 0.13–0.60 g/L, absence of active urinary sediment/hematuria). Immunological evaluation showed positive immunoblot reactivity to SS-B, RP11, and Mi-2α; however, classic systemic connective tissue disease criteria were not met, and ANCA, anti-GBM, and C3/C4 levels were unremarkable. Due to severe renal failure (eGFR <10 mL/min), local clinical evaluation in Kazakhstan hesitated to perform a kidney biopsy, categorizing the condition as RPGN vs. ESRD (CKD Stage 5). The patient subsequently traveled to Turkiye (Istanbul) for an urgent ultrasound-guided renal biopsy on August 20, 2026. Light microscopy (22 glomeruli) revealed intact glomeruli without crescents or necrosis, but severe active interstitial inflammation (mononuclear and neutrophilic infiltrate, tubulitis, leukocyte casts) and acute tubular injury, alongside early chronic tubulointerstitial changes. Direct immunofluorescence was negative. Immediate high-dose corticosteroid therapy (IV Methylprednisolone pulse 80 mg followed by oral Prednisolone 32 mg/day with gradual taper) was initiated. Renal function responded dramatically: serum creatinine dropped from 524 µmol/L to 294.1 µmol/L within 7 days (27.08.2026), 218.9 µmol/L (02.09.2026), and reached 148.2 µmol/L (10.09.2026, eGFR 39.0 mL/min/1.73m²), with complete normalization of inflammatory markers (CRP 1.1 mg/L). Hemodialysis was completely avoided.
Conclusions & Policy Implications: Discrepancy between profound renal failure and mild urinary sediment (clinicopathological dissociation) strongly points toward acute tubulointerstitial disease rather than RPGN. Severe reduction in eGFR should not be considered an absolute contraindication to diagnostic kidney biopsy. Without biopsy, this patient would likely have been mislabeled as end-stage renal disease (ESRD) and initiated on lifelong maintenance dialysis. There is an urgent health policy imperative in Kazakhstan to modernize nephrobiopsy protocols, invest in state-of-the-art biopsy technology, and establish dedicated nephropathology training to prevent irreversible progression of treatable renal diseases.

ABSTRACT: Relevance: Urolithiasis is a widespread urological disease worldwide, characterized by the formation of stones in any part of the urinary tract, including the kidneys, ureters, bladder, and urethra. In CIS countries, the proportion of urolithiasis among urological diseases ranges from 33.9% in Russia to 58.2% in Kyrgyzstan, while in Tajikistan, Uzbekistan, and Kazakhstan it is at the level of 42.2–56.1%, showing an increasing trend in incidence. Globally, the prevalence of urolithiasis varies from 1% to 20%, with higher risk observed in regions with hot climates and high environmental pollution, which is associated with increased fluid loss and higher salt concentration in urine. Within the framework of this study, a retrospective analysis of 162,538 hospitalizations among 132,915 patients with urolithiasis in the Republic of Kazakhstan was conducted for the period 2014–2021. The overall hospitalization rate was 1.31 cases per 1,000 population. The highest rates were observed in the Turkestan region and Almaty city, corresponding to the geographical concept of the “stone belt.” The majority of hospitalizations were recorded among patients aged 50 years and older. A comparison of urban and rural populations showed a higher disease burden in urban areas, likely associated with lifestyle factors and better access to medical care. In conclusion, urolithiasis remains a significant medical and social problem in Kazakhstan. In 2021, approximately 106 million new cases were reported worldwide; despite the increase in absolute incidence, standardized rates and DALYs have decreased, and mortality remains consistently low (<0.5 per 100,000 population), indicating improvements in diagnosis, prevention, and treatment.
Aim of the study: To analyze the dynamics and regional characteristics of urolithiasis morbidity among the population of the Republic of Kazakhstan.
Study materials and objectives: A retrospective analysis was conducted using data from annual official health reports (National Bureau of Statistics of the Republic of Kazakhstan) for the period 2015–2024.To assess national trends in urolithiasis morbidity over the period 2015–2024.To compare urolithiasis incidence rates between urban and rural populations.To develop practical recommendations for the prevention, early detection, and management of urolithiasis.
Results: In Kazakhstan, the incidence of urolithiasis demonstrated a wave-like pattern: an increase during 2015–2018, a decrease in 2019–2021, and a renewed upward trend from 2022 onwards. By 2024, the indicators exceeded the average level of the studied period. Urban areas showed relatively stable dynamics, whereas rural areas demonstrated more pronounced fluctuations.
In 2024, the incidence rate among the urban population reached 85.9 cases per 100,000 population, showing a renewed increase after the decline observed in 2020–2021. A similar post-decline increase was observed in rural areas, with marked regional variability.The highest rural incidence was recorded in the Almaty region, exceeding 150 cases per 100,000 population in 2023–2024. In urban areas, the highest rate was observed in Atyrau city, reaching up to 198 cases per 100,000 population in 2024, while in Aktobe city it reached 153.5 cases per 100,000 population.
Conclusion: In recent years, an increase in the incidence of urolithiasis and pronounced regional differences have been observed. Therefore, it is necessary to strengthen preventive measures, improve early diagnosis, and enhance the control of risk factors in regions with high incidence rates.

ABSTRACT: Background: Chronic kidney disease (CKD) is a major global health challenge, yet population-based data from Central Asia are scarce. We conducted a population-based screening study to assess kidney function distribution and associated risk factors in Astana, Kazakhstan.
Methods: In March 2024, 636 adults were screened through convenience sampling at four major institutions in Astana. After excluding incomplete data, 569 participants were analyzed. Demographic, lifestyle, and clinical information were collected, and serum creatinine was used to estimate glomerular filtration rate (eGFR). Reduced renal function was defined as eGFR <90 mL/min/1.73 m². Group comparisons and logistic regression analyses were performed to identify risk factors for reduced renal function.
Results: The median age of participants was 46 years (IQR 33–55), and 79.8% were women. Median eGFR was 92.8 (IQR 79.8–111.3) mL/min/1.73 m²; 54.1% had eGFR ≥90, 42.4% had eGFR 60–89, and 3.5% had eGFR 45–59. Reduced renal function was more common among older adults, females and those with hypertension and heart failure. In multivariable analysis, older age and female sex were independent predictors of reduced renal function. Awareness was low: only 15.0% of individuals with eGFR 45–59 reported having CKD.
Conclusion: This study provides the population-based evidence on kidney function in Astana, Kazakhstan. Reduced renal function was common, particularly among older adults. Findings highlight the importance of population-based screening and targeted prevention strategies to address kidney health in Kazakhstan.

ABSTRACT: The advent of targeted complement inhibitors represents a paradigm shift in managing complement-mediated nephropathies. Integrating these therapies into healthcare systems, particularly in resource-variable settings, requires strategic planning.
A national council of experts was convened in October 2024 with the purpose of obtaining a clinical expert opinion to develop practical recommendations for improving the organization and optimization of medical care for patients with C3 glomerulopathy (C3G) and IgA nephropathy (IgAN) in Kazakhstan.
The council identified critical systemic gaps, including inconsistent use of renal biopsy, lack of specialized nephropathology, absence of treatment algorithms, and fragmented patient care. A consensus was reached on key recommendations for a new national clinical protocol. These include mandating pathological confirmation, creating detailed treatment and monitoring algorithms, establishing a national registry and coordination center, and investing in specialized training for healthcare professionals.
The systematic framework proposed by the council provides an actionable roadmap to overcome barriers to care. This model ensures equitable patient access to novel therapies and may serve as a blueprint for other nations navigating the integration of advanced treatments into clinical practice.