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Current Issues on Kidney Diseases Diagnosis and Management 2025
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Current Issues on Kidney Diseases Diagnosis and Management 2025

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Clinical Diagnosis and Prognosis".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 4153

Special Issue Editor

Prof. Dr. Luis Yu

E-Mail Website
Guest Editor
Nephrology Division, School of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil
Interests: AKI; dialysis; glomerulopathies; education
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The kidneys are very important in mantaining fluid homeostasis and filtrate wastes from the body. It is estimated that around 10% of the world’s population is living with chronic kidney disease (CKD). This morbid and mortal condition affects people of all ages and races. In addition, CKD varies according to regions and countries around the globe; however, it is specially ominous in disadvantaged populations, where socio-economic factors and poor and limited access to medical care may further aggravate the CKD burden.

Many kidney diseases and morbid conditions may lead to acute kidney injury (AKI) and/or CKD. Several renal diseases, such as glomerulopathies, polycistic kidney disease, post-infectious glomerulonephritis, vasculitis, and renal involvement in systemic diseases, along with arterial hypertension, diabetes, and obesity, may cause temporary or definite renal impairment.

For this reason, this Special Issue wishes to gather relevant scientific information that would enlarge our knowledge and improve the diagnosis and management of kidney diseases and renal involvement in systemic diseases and morbid conditions.

Prof. Dr. Luis Yu
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • kidney diseases
  • renal involvement
  • AKI
  • CKD
  • glomerulopathies
  • diagnosis
  • treatment
  • dialysis
  • epidemiology
  • nephritic syndrome
  • nephrotic syndrome
  • biomarkers
  • urinalysis
  • oliguria
  • poliuria
  • electrolytes
  • acid-base balance

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Published Papers (6 papers)

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14 pages, 5303 KiB  
Article
The Zucker Diabetic Fatty Rat as a Model for Vascular Changes in Diabetic Kidney Disease: Characterising Hydronephrosis
by Amy McDermott, Nathalie Sarup Panduro, Iman Taghavi, Hans Martin Kjer, Stinne Byrholdt Søgaard, Michael Bachmann Nielsen, Jørgen Arendt Jensen and Charlotte Mehlin Sørensen
Diagnostics 2025, 15(6), 782; https://doi.org/10.3390/diagnostics15060782 - 20 Mar 2025
Viewed by 293
Abstract
Background/Objectives: Diabetic kidney disease (DKD) is a significant concern for global healthcare, particularly in individuals with diabetes. The Zucker rat strain is a commonly used model of type 2 diabetes, despite awareness that this animal can develop hydronephrosis. In this study, we present [...] Read more.
Background/Objectives: Diabetic kidney disease (DKD) is a significant concern for global healthcare, particularly in individuals with diabetes. The Zucker rat strain is a commonly used model of type 2 diabetes, despite awareness that this animal can develop hydronephrosis. In this study, we present novel imaging data evaluating the accuracy of this animal model in replicating the vascular aspects of human DKD while examining the impact of hydronephrosis on its validity as a disease model. Methods: This study reused data from a population of male Zucker Diabetic Fatty (ZDF; n = 22) rats and Zucker Lean (ZL) rats (n = 22) aged 12 to approximately 40 weeks. Vascular casting was performed to enable visualisation of the renal vasculature. Anatomical regional volumes and vascular density data were obtained from μCT scans using image thresholding and manual analysis. The effects of hydronephrosis were evaluated using renal functional parameters and histological examination. Results: A significantly lower cortical vascular density, as well as lower total renal vascular density, was seen in ZDF rats compared to ZL rats, independent of age. We identified that hydronephrosis affected 92% of ZDF rats and 69% of ZL rats. Hydronephrosis cavity size was significantly correlated with the degree of hyperglycaemia and rate of diuresis but had no other detected impact on renal function, vascularity, or tissue histological architecture. Conclusions: These findings support using the Zucker rat strain as a model for vascular changes in DKD. Despite identifying severe hydronephrosis in this population, it had minimal quantifiable impact on renal function or diabetes modelling. Full article
(This article belongs to the Special Issue Current Issues on Kidney Diseases Diagnosis and Management 2025)
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11 pages, 1153 KiB  
Article
PromarkerD Versus Standard of Care Biochemical Measures for Assessing Future Renal Function Decline in Type 2 Diabetes
by Kirsten E. Peters, Isabella A. Joubert, Scott D. Bringans, Wendy A. Davis, Richard J. Lipscombe and Timothy M. E. Davis
Diagnostics 2025, 15(6), 662; https://doi.org/10.3390/diagnostics15060662 - 9 Mar 2025
Viewed by 1081
Abstract
Background/Objectives: The current standard of care for assessing chronic kidney disease complicating diabetes (DKD) includes measurement of estimated glomerular filtration rate (eGFR) and urinary albumin:creatinine ratio (uACR) but both tests have limitations. The present study compared the biomarker-based Promarker®D test with [...] Read more.
Background/Objectives: The current standard of care for assessing chronic kidney disease complicating diabetes (DKD) includes measurement of estimated glomerular filtration rate (eGFR) and urinary albumin:creatinine ratio (uACR) but both tests have limitations. The present study compared the biomarker-based Promarker®D test with conventional biochemical measures for predicting future kidney function decline in adults with type 2 diabetes (T2D). Methods: Baseline concentrations of apolipoprotein A-IV, CD5 antigen-like protein and insulin-like growth factor binding protein 3 were combined with age, serum HDL cholesterol and eGFR to generate PromarkerD risk scores for incident DKD/eGFR decline ≥ 30% (the primary endpoint) in 857 adults with T2D (mean age 65.4 years, 54% males). Logistic regression modelling was used to compare the association of (i) PromarkerD, (ii) eGFR, (iii) uACR, and (iv) eGFR plus uACR with this outcome during 4 years of follow-up. Results: Study participants were classified by PromarkerD as low (63%), moderate (13%), or high risk (24%) for kidney function decline at baseline. Over a mean 4.2 years, 12.5% developed the primary endpoint. PromarkerD scores showed significantly higher predictive performance (area under the receiver operating characteristic curve (AUC) 0.88 (95% confidence interval (CI) 0.85–0.91)) compared to conventional biochemical measures (AUC = 0.63–0.82). There was a progressive increase in risk with moderate and high risk by PromarkerD exhibiting greater odds of the primary endpoint compared to those at low risk (odds ratios (OR) (95% CI) 8.11 (3.99–16.94) and 21.34 (12.03–40.54), respectively, both p < 0.001). Conclusions: PromarkerD more accurately identifies adults with T2D at risk of kidney function decline than current usual care biochemical tests. Full article
(This article belongs to the Special Issue Current Issues on Kidney Diseases Diagnosis and Management 2025)
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10 pages, 1553 KiB  
Article
Nephrotic and Non-Nephrotic Focal Segmental Glomerulosclerosis: Clinical Characteristics, Etiology, and Columbia Classification
by Gabriel Figueiredo, Luis Yu, Lectícia Barbosa Jorge, Viktoria Woronik and Cristiane Bitencourt Dias
Diagnostics 2025, 15(2), 120; https://doi.org/10.3390/diagnostics15020120 - 7 Jan 2025
Viewed by 797
Abstract
Introduction: Focal segmental glomerulosclerosis (FSGS) is a pattern of kidney injury with diverse causes and pathogeneses, resulting in podocyte injury and depletion. It can be classified as primary, genetic, or secondary. Because FSGS classically has a worse prognosis in patients with nephrotic [...] Read more.
Introduction: Focal segmental glomerulosclerosis (FSGS) is a pattern of kidney injury with diverse causes and pathogeneses, resulting in podocyte injury and depletion. It can be classified as primary, genetic, or secondary. Because FSGS classically has a worse prognosis in patients with nephrotic syndrome, most studies have focused on the treatment and evolution of these patients, resulting in a lack of data related to patients without nephrotic syndrome. The objective of this study was to establish the main etiologies, characteristics, and evolution of renal disease in FSGS patients with nephrotic and non-nephrotic proteinuria. Methods: This was a retrospective, single-center study that included 140 patients with a biopsy-confirmed diagnosis of FSGS in the 2009–2017 period. Patients were separated into those with and those without nephrotic syndrome at diagnosis, and these two groups were compared in terms of the clinical characteristics, histological profile, and outcome. Non-nephrotic patients with unfavorable progression were selected for ultrastructural analysis with electron microscopy. Results: During the study period, 32.9% of the patients with FSGS had non-nephrotic proteinuria at diagnosis. This group had a larger proportion of patients with hypertension and a not otherwise specified FSGS variant on histology. The proportion of patients with secondary forms of FSGS was comparable between the two groups, with HIV infection and systemic lupus erythematosus being predominant. Progression to renal replacement therapy occurred in 31.3% of the patients in the nephrotic group and in 26.8% of those in the non-nephrotic group, with no statistical difference between them. All of the non-nephrotic group patients who progressed to renal replacement therapy were analyzed by electron microscopy, the diagnosis of FSGS was confirmed, and there was the finding of high chronicity in these patients. Conclusions: Among patients with FSGS, those without nephrotic syndrome had a poor renal outcome at a frequency similar to that of those with nephrotic syndrome. Factors related to better renal survival were having had a complete response to treatment in the case of those with nephrotic syndrome and having achieved proteinuria values of less than 1.5 g/day in the case of those without nephrotic syndrome. Full article
(This article belongs to the Special Issue Current Issues on Kidney Diseases Diagnosis and Management 2025)
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16 pages, 864 KiB  
Article
Analysis of the Sensitivity and Specificity of Histopathological Findings for Diagnosing Lupus Nephritis
by Epitácio Rafael da Luz Neto, Maria Brandão Tavares, Ana Gabriela de Jesus Torres de Melo, Washington L. C. dos-Santos, Denise Maria Avancini Costa Malheiros and Luís Yu
Diagnostics 2024, 14(23), 2681; https://doi.org/10.3390/diagnostics14232681 - 27 Nov 2024
Viewed by 913
Abstract
Background: Since the introduction of the SLICC criteria in 2012, biopsy-proven lupus nephritis (LN) has been the only independent diagnostic criterion for systemic lupus erythematosus (SLE). This was reaffirmed by the EULAR/ACR in 2019, emphasizing the importance of renal biopsy in LN. However, [...] Read more.
Background: Since the introduction of the SLICC criteria in 2012, biopsy-proven lupus nephritis (LN) has been the only independent diagnostic criterion for systemic lupus erythematosus (SLE). This was reaffirmed by the EULAR/ACR in 2019, emphasizing the importance of renal biopsy in LN. However, the current classification lacks specific histopathological criteria for defining LN. This study describes the histological findings of patients with LN, compares them with those of other glomerular diseases, and evaluates their diagnostic accuracy in a large Latin American population. Methods: This retrospective cohort included 731 kidney biopsies from two distinct academic centers. The patients were divided into two groups as follows: a LN group and a control group comprising patients with membranous nephropathy, IgA nephropathy, membranoproliferative glomerulonephritis, pauci-immune glomerulonephritis, and proliferative glomerulonephritis. Sensitivity and specificity analyses were conducted for various histopathological features. Results: We identified the following five features strongly correlated with LN: mesangial proliferation, subendothelial deposits, C1q staining ≥1+, dominant IgG, and ≥4 positive immunofluorescence elements. Combined, these features yielded an area under the ROC curve of 0.94 (95% CI: 0.91–0.95). These results were validated in a diverse population. In membranous nephropathy, histological features such as mesangial deposits, C1q positivity, and ≥4 positive immunofluorescence elements effectively distinguished class V LN from non-lupus membranous nephropathy, with an area under the ROC curve of 0.85 (95% CI: 0.76–0.93). Conclusions: The combination of mesangial proliferation, subendothelial deposits, C1q staining ≥1+, dominant IgG, and ≥4 positive immunofluorescence elements offer good accuracy for diagnosing renal involvement in SLE in a large Latin American population. In the absence of pathognomonic features, combined criteria are valuable diagnostic tools, particularly when other SLE criteria are lacking. Full article
(This article belongs to the Special Issue Current Issues on Kidney Diseases Diagnosis and Management 2025)
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8 pages, 1018 KiB  
Article
Agreement Between Resting Energy Expenditure Predictive Formulas and Indirect Calorimetry in Non-Dialysis Dependent Chronic Kidney Disease
by Mariana Cassani de Oliveira, Marina Nogueira Berbel Bufarah, Rodrigo Bueno de Oliveira, Cassiana Regina de Góes and André Luís Balbi
Diagnostics 2024, 14(22), 2603; https://doi.org/10.3390/diagnostics14222603 - 20 Nov 2024
Viewed by 697
Abstract
Background and Aims: The gold standard method for measuring resting energy expenditure (REE) is indirect calorimetry (IC) using an expensive device that requires specialized training. To overcome the limitations of IC, REE prediction formulas are used in patients with chronic kidney disease (CKD). [...] Read more.
Background and Aims: The gold standard method for measuring resting energy expenditure (REE) is indirect calorimetry (IC) using an expensive device that requires specialized training. To overcome the limitations of IC, REE prediction formulas are used in patients with chronic kidney disease (CKD). However, it is still controversial which of these formulas has greater accuracy compared to IC. We aimed to determine the accuracies of REE measured by IC and estimated by formulas in patients with CKD. Methods: Fifty-three patients with stage 4–5 CKD underwent IC and five current REE prediction formulas. Accuracy was measured by Lin’s correlation coefficient. Bland–Altman repeated measures analysis was used to assess the agreement of the formulas’ results with those of IC. Precision was measured by the predicted IC ± 10% and 20%. Systematic bias was assessed by the Student’s t-test, and linear regression was used to assess proportionality bias. Results: Patients had a mean estimated glomerular filtration rate (eGFR) of 12 ± 4 mL/min/1.73 m2, a mean age of 65 years, and 62% were male. The mean REE measured by IC was 1341 ± 37 Kcal/day, and the formula with the lowest mean bias (0.1509 [−653.5121; 398.9056]), best correlation (r = 0.789; p = 0.000), and best accuracy (85%) was the formula developed by Fernandes and Cols (REE (kcal/day) = 854 + (7.4 × body weight) + (179 × sex) − (3.3 × age) + (2.1 × eGFR) + 26 (if diabetes)). Conclusions: The Fernandes and Cols equation had good accuracy and was valuable for estimating energy requirements in the population studied. Full article
(This article belongs to the Special Issue Current Issues on Kidney Diseases Diagnosis and Management 2025)
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10 pages, 6130 KiB  
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Thyroid-like Follicular Carcinoma of the Kidney: The Follicles Are out There in the Kidney—Now What?
by Stefan Spiric, Bojana Rancic, Branko Kosevic, Ivica Nikolic, Snezana Cerovic and Bozidar Kovacevic
Diagnostics 2025, 15(9), 1111; https://doi.org/10.3390/diagnostics15091111 - 27 Apr 2025
Viewed by 99
Abstract
Thyroid-like follicular carcinoma of the kidney (TLFC-K) is a rare primary kidney carcinoma with fewer than 60 reported cases. Current data suggest that TLFC-K has low malignant potential, with only a few reported cases of unfavorable clinical behavior. Histologically, TLFC-K is indistinguishable from [...] Read more.
Thyroid-like follicular carcinoma of the kidney (TLFC-K) is a rare primary kidney carcinoma with fewer than 60 reported cases. Current data suggest that TLFC-K has low malignant potential, with only a few reported cases of unfavorable clinical behavior. Histologically, TLFC-K is indistinguishable from kidney metastasis of well-differentiated follicular cell-derived thyroid carcinomas. Furthermore, folliculo-tubular patterns can be seen in different types of kidney lesions, making assessing follicular architecture in the kidney diagnostically challenging. We present a case of TLFC-K with a list of differential diagnoses. A hyperechoic tumor was found incidentally in the upper pole of the right kidney of a 66-year-old man. The patient underwent a radical nephrectomy. Histologically, the tumor was well-circumscribed, composed of follicular/tubular structures of different sizes filled with colloid-like material. Immunohistochemically, the absence of a positive reaction for thyroglobulin and TTF-1 excluded the secondary origin of the tumor from the thyroid. Tumor cells also showed diffuse positivity for vimentin and PAX8 and focal positivity for CK7 and CD10. The results of all other applied immunostaining tests did not align with those of different types of kidney tumors that may exhibit predominantly follicular patterns. Accordingly, TLFC-K was diagnosed. The patient shows no signs of disease relapse at the 5-month follow-up. Full article
(This article belongs to the Special Issue Current Issues on Kidney Diseases Diagnosis and Management 2025)
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