Keyword: eGFR
3 results found.
Congress Abstract
Central Asian Journal of Nephrology, 2(2, Suppl. 1), 2026, cajn_A35, https://doi.org/10.63946/cajn/19541
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.
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.
Congress Abstract
Central Asian Journal of Nephrology, 2(2, Suppl. 1), 2026, cajn_A31, https://doi.org/10.63946/cajn/19522
ABSTRACT:
Background: The early onset of chronic kidney disease often lacks symptoms, leading to delayed diagnosis and treatment. Regular laboratory testing can detect the disease before it begins, which helps clinicians determine the appropriate treatment for patients. This review sought to assess how ongoing tracking of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) contributes to understanding the progression of chronic kidney disease (CKD) and determining the risk levels for patients.
Methods: A thorough review of evidence from international clinical practice guidelines, systematic reviews, meta-analyses, and extensive observational cohort studies was conducted. Special attention was given to how eGFR and UACR changed over time and how these changes were linked to the development of advanced CKD, kidney failure, cardiovascular issues, and death. The most recent recommendations from the 2024 KDIGO CKD guideline were included.
Results: Evidence shows that regularly checking eGFR and UACR is essential for effectively monitoring chronic kidney disease. In a group of 91,319 people, a reduction of 30% or more in estimated glomerular filtration rate (eGFR) was linked to a significantly higher risk of developing advanced chronic kidney disease, with a hazard ratio of 7.53 (95% CI, 6.70–8.45).Similarly, an increase of 30% or more in urinary albumin-to-creatinine ratio (UACR) was associated with a hazard ratio of 1.78 (95% CI, 1.59–1.98). At the same time, when both UACR increased and eGFR decreased, the hazard ratio was 15.15 (95% CI, 12.43–18.46) compared to when these values remained stable. KDIGO suggests that patients with chronic kidney disease should have their glomerular filtration rate and albuminuria checked at least once every year.For those at greater risk, more regular check-ups are advised, especially if the results could impact treatment choices. Even though these recommendations were provided, a systematic review of 59 studies that included 3,036,41 patients showed significant shortcomings in standard monitoring practices: the estimated glomerular filtration rate (eGFR) was checked in 81.3% of patients, but testing for albuminuria was done in just 47.4%.
Conclusion: Regular laboratory testing, especially repeated checks of eGFR and UACR, is important for early identification of CKD progression and for assessing individual risk levels. The continued limited use of albuminuria testing highlights a significant gap in care that aligns with established guidelines. Integrating structured laboratory surveillance into routine clinical practice may facilitate timely therapeutic optimization and contribute to delaying kidney failure and reducing cardiorenal complications.
Methods: A thorough review of evidence from international clinical practice guidelines, systematic reviews, meta-analyses, and extensive observational cohort studies was conducted. Special attention was given to how eGFR and UACR changed over time and how these changes were linked to the development of advanced CKD, kidney failure, cardiovascular issues, and death. The most recent recommendations from the 2024 KDIGO CKD guideline were included.
Results: Evidence shows that regularly checking eGFR and UACR is essential for effectively monitoring chronic kidney disease. In a group of 91,319 people, a reduction of 30% or more in estimated glomerular filtration rate (eGFR) was linked to a significantly higher risk of developing advanced chronic kidney disease, with a hazard ratio of 7.53 (95% CI, 6.70–8.45).Similarly, an increase of 30% or more in urinary albumin-to-creatinine ratio (UACR) was associated with a hazard ratio of 1.78 (95% CI, 1.59–1.98). At the same time, when both UACR increased and eGFR decreased, the hazard ratio was 15.15 (95% CI, 12.43–18.46) compared to when these values remained stable. KDIGO suggests that patients with chronic kidney disease should have their glomerular filtration rate and albuminuria checked at least once every year.For those at greater risk, more regular check-ups are advised, especially if the results could impact treatment choices. Even though these recommendations were provided, a systematic review of 59 studies that included 3,036,41 patients showed significant shortcomings in standard monitoring practices: the estimated glomerular filtration rate (eGFR) was checked in 81.3% of patients, but testing for albuminuria was done in just 47.4%.
Conclusion: Regular laboratory testing, especially repeated checks of eGFR and UACR, is important for early identification of CKD progression and for assessing individual risk levels. The continued limited use of albuminuria testing highlights a significant gap in care that aligns with established guidelines. Integrating structured laboratory surveillance into routine clinical practice may facilitate timely therapeutic optimization and contribute to delaying kidney failure and reducing cardiorenal complications.
Congress Abstract
Central Asian Journal of Nephrology, 2(2, Suppl. 1), 2026, cajn_A18, https://doi.org/10.63946/cajn/19512
ABSTRACT:
Introduction: Chronic kidney disease (CKD) is frequently diagnosed after clinically meaningful loss of kidney function. Creatinine-based estimated glomerular filtration rate (eGFR) may fail to identify early renal dysfunction, while cystatin C, albuminuria and artificial intelligence (AI)-based prediction models may improve early detection and risk stratification. This umbrella review synthesizes current evidence regarding the diagnostic and prognostic value of these approaches and identifies limitations to their clinical implementation.
Methods: We synthesized published systematic reviews and meta-analyses evaluating adults with CKD or individuals at risk of CKD. Evidence addressing cystatin C, albuminuria, or AI/machine-learning models for CKD detection or progression was considered. Outcomes included diagnostic accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and prognostic associations. Findings were summarized descriptively according to reported pooled estimates and study limitations.
Results: A meta-analysis of 19 studies evaluating serum cystatin C for CKD detection reported pooled sensitivity of 0.85 (95% CI, 0.81–0.89), specificity of 0.87 (95% CI, 0.84–0.90), and AUC of 0.92 (95% CI, 0.90–0.94). Another meta-analysis including 35 studies and 23,667 participants found that the combined creatinine/cystatin C CKD-EPI equation achieved 7.50% higher accuracy than creatinine-based eGFR alone. A 2025 systematic review of risk-factor-based CKD screening included 24 studies from 11 countries; eGFR was used in 22 studies and albumin-creatinine ratio in 14, while confirmed CKD prevalence ranged from 4.4% to 17.1%. For AI, a systematic review identified 68 eligible studies from 648 records, but only 6/68 were conducted in clinical settings. A subsequent meta-analysis of 33 AI studies reported pooled sensitivity of 0.43, specificity of 0.92 and AUC of 0.89, with substantial heterogeneity.
Conclusion: Cystatin C and combined creatinine/cystatin C assessment demonstrate improved diagnostic performance compared with creatinine-based assessment alone. Albuminuria remains an important component of targeted CKD screening, while AI models show promising predictive performance but limited clinical validation. Prospective multicenter studies integrating biomarkers and interpretable AI models are warranted to establish whether these approaches improve clinically meaningful early CKD detection.
Methods: We synthesized published systematic reviews and meta-analyses evaluating adults with CKD or individuals at risk of CKD. Evidence addressing cystatin C, albuminuria, or AI/machine-learning models for CKD detection or progression was considered. Outcomes included diagnostic accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and prognostic associations. Findings were summarized descriptively according to reported pooled estimates and study limitations.
Results: A meta-analysis of 19 studies evaluating serum cystatin C for CKD detection reported pooled sensitivity of 0.85 (95% CI, 0.81–0.89), specificity of 0.87 (95% CI, 0.84–0.90), and AUC of 0.92 (95% CI, 0.90–0.94). Another meta-analysis including 35 studies and 23,667 participants found that the combined creatinine/cystatin C CKD-EPI equation achieved 7.50% higher accuracy than creatinine-based eGFR alone. A 2025 systematic review of risk-factor-based CKD screening included 24 studies from 11 countries; eGFR was used in 22 studies and albumin-creatinine ratio in 14, while confirmed CKD prevalence ranged from 4.4% to 17.1%. For AI, a systematic review identified 68 eligible studies from 648 records, but only 6/68 were conducted in clinical settings. A subsequent meta-analysis of 33 AI studies reported pooled sensitivity of 0.43, specificity of 0.92 and AUC of 0.89, with substantial heterogeneity.
Conclusion: Cystatin C and combined creatinine/cystatin C assessment demonstrate improved diagnostic performance compared with creatinine-based assessment alone. Albuminuria remains an important component of targeted CKD screening, while AI models show promising predictive performance but limited clinical validation. Prospective multicenter studies integrating biomarkers and interpretable AI models are warranted to establish whether these approaches improve clinically meaningful early CKD detection.