Search Results (1,564)

Chronic kidney disease (CKD) affects over 850 million individuals worldwide, yet conventional risk stratification approaches fail to capture complex disease progression patterns. Current machine learning approaches suffer from inefficient parameter optimization and limited clinical interpretability. We developed an integrated framework combining advanced Bayesian optimization with explainable artificial intelligence for enhanced CKD risk assessment. Our approach employs XGBoost ensemble learning with intelligent parameter optimization through Optuna (a Bayesian optimization framework) and comprehensive interpretability analysis using SHAP (SHapley Additive exPlanations) to explain model predictions. To address algorithmic “black-box” limitations and enhance clinical trustworthiness, we implemented four-tier risk stratification using stratified cross-validation and balanced evaluation metrics that ensure equitable performance across all patient risk categories, preventing bias toward common cases while maintaining sensitivity for high-risk patients. The optimized model achieved exceptional performance with 92.4% accuracy, 91.9% F1-score, and 97.7% ROC-AUC, significantly outperforming 16 baseline algorithms by 7.9–18.9%. Bayesian optimization reduced computational time by 74% compared to traditional grid search while maintaining robust generalization. Model interpretability analysis identified CKD stage, albumin-creatinine ratio, and estimated glomerular filtration rate as primary predictors, fully aligning with established clinical guidelines. This framework delivers superior predictive accuracy while providing transparent, clinically-meaningful explanations for CKD risk stratification, addressing critical challenges in medical AI deployment: computational efficiency, algorithmic transparency, and equitable performance across diverse patient populations. Full article

Background: Chronic kidney disease (CKD) is largely driven by inflammation. Mesenchymal stem cells (MSCs) show therapeutic potential; however, their efficacy across CKD etiologies remains unclear. Methods: Comprehensive searches were conducted in PubMed, Cochrane, ScienceDirect, Scopus and Google Scholar. Effect sizes for inflammation and renal function outcomes were meta-analyzed. Results: Of 2514 studies screened, 52 met inclusion criteria (49 animal studies, 3 randomized controlled trials). In animal models, MSCs significantly reduced interleukin-6 (mean difference [MD] = −155.80; 95% CI: −249.10, −62.51; p = 0.001) and tumor necrosis factor-α (TNF-α) (MD = −35.53; 95% CI: −52.75, −18.30; p < 0.0001). In patients, TNF-α reduction was not significant (MD = −0.74; 95% CI: −2.20, 0.73; p = 0.32). Serum creatinine decreased in animals (MD = −0.38; 95% CI: −0.46, −0.29; p < 0.00001), but not in patients (MD = −0.59; 95% CI: −1.92, 0.74; p = 0.39). Blood urea nitrogen decreased in animals (MD = −19.27; 95% CI: −23.50, −15.04; p < 0.00001), and glomerular filtration rate improved (standardized MD = 1.83; 95% CI: 0.51, 3.15; p = 0.007), with no change in patients. Conclusion: MSCs improve inflammation and renal function in CKD animal models; however, evidence in patients remains inconclusive. Full article

Background/Objectives: Proteinuria, a marker of renal dysfunction, has been implicated in cancer risk, yet its role in gastric carcinogenesis remains underexplored in high-incidence populations. This study evaluated the association between urine dipstick proteinuria severity and gastric cancer incidence in a nationwide Korean cohort. Methods: We analyzed data from the Korean National Health Insurance Service–National Sample Cohort, including 220,941 adults aged > 40 years, without a diagnosis of cancer, who received health examinations in 2009. Proteinuria was classified by single dipstick testing as negative, 1+, or ≥2+. Participants were followed for a mean of 4.37 ± 0.49 years (965,601.2 person-years). Multivariable Cox proportional hazards models adjusted for age, sex, body mass index, systolic blood pressure, fasting glucose, LDL cholesterol, estimated glomerular filtration rate, smoking status, alcohol intake, and physical activity were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During follow-up, 1934 participants (0.88%) developed gastric cancer. A significant dose–response relationship emerged (p for trend = 0.037). In fully adjusted models, 1+ proteinuria conferred no significant risk increase (HR 1.10; 95% CI, 0.80–1.51), whereas ≥2+ proteinuria was associated with a 42% higher gastric cancer risk (HR 1.42; 95% CI, 1.00–2.02). Conclusions: Severe dipstick proteinuria independently predicts elevated gastric cancer risk in Korean adults. Integration of urine dipstick testing into gastric cancer screening protocols may offer a simple, cost-effective strategy for risk stratification, particularly in high-incidence settings. Full article

Background/Objectives: Prognostic biomarkers are essential for guiding the clinical management of pulmonary hypertension (PH). This study aimed to assess both established and novel biomarkers—specifically, the red cell distribution width-to-estimated glomerular filtration rate ratio (RGR) and the NT-proBNP-to-albumin ratio (NTAR)—for their ability to predict length of hospital stay (LOS), prolonged LOS (ELOS), in-hospital mortality, and 3-month all-cause mortality in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods: A retrospective analysis was conducted on 275 PH-related hospital regular admissions (148 PAH; 127 CTEPH). Established biomarkers—including serum albumin, neutrophil-to-lymphocyte ratio (NLR), Log NT-proBNP, red cell distribution width (RDW), and estimated glomerular filtration rate (eGFR)—as well as novel indices (RGR, and NTAR) were examined for their relationships with LOS, ELOS, in-hospital mortality, and 3-month all-cause mortality. Spearman correlation, univariate logistic regression, and ROC analyses evaluated biomarker relationships and predictive performance. Results: Serum albumin independently predicted in-hospital and 3-month mortality in PAH, while in CTEPH, it inversely correlated with LOS and strongly predicted prolonged hospitalization and mortality (AUC = 0.833). NLR had limited correlation with LOS but predicted mortality across both groups. RDW correlated weakly with LOS, significantly predicting prolonged hospitalization (threshold > 52.1 fL) in PAH but not in CTEPH. Preserved renal function (eGFR > 60 mL/min/1.73 m²) was inversely associated with LOS in CTEPH patients, suggesting a protective effect. Additionally, reduced eGFR significantly predicted mortality in both PAH (AUC = 0.701; optimal cut-off ≤ 97.4 mL/min/1.73 m²) and CTEPH (AUC = 0.793; optimal cut-off ≤ 59.2 mL/min/1.73 m²) groups. NTAR (AUC = 0.817) outperformed Log NT-proBNP alone in predicting extended hospitalization and mortality, whereas RGR correlated with LOS and predicted in-hospital mortality. Phenotype-specific analysis demonstrated that inflammatory and renal biomarkers had a stronger prognostic impact in CTEPH. Conclusions: Stratification by PH phenotype highlighted the greater prognostic significance of inflammatory and renal indices, particularly in patients with CTEPH. Incorporating NTAR and RGR into clinical workflows may enhance risk stratification and enable more precisely targeted interventions to improve outcomes in pulmonary hypertension. Full article

Background/Objectives: Chronic kidney disease (CKD) is a prevalent condition with many cases remaining undiagnosed, although early detection is essential. Adipose tissue distribution—particularly perirenal fat thickness (PrFT)—has recently been linked to renal pathophysiology. This study assessed the association between CT-derived parameters of fat distribution and kidney morphology with CKD. Materials and Methods: This retrospective study included 237 patients (117 subjects, 120 controls) who underwent abdominal CT and had serum creatinine data. The dataset was randomly split (70% training, 30% test) to develop and evaluate a logistic regression model. CKD was defined as estimated Glomerular Filtration Rate (eGFR) < 60 mL/min/1.73 m². PrFT was measured as the distance from the posterior renal capsule to the posterior abdominal wall; renal hilum fat was segmented using a −195 to −45 HU range. Additional parameters (measured using automated segmentation tools) included kidney volume (KV), visceral/subcutaneous fat areas, skeletal muscle area and attenuation, and liver attenuation. Bilateral measurements were averaged. Results: KV (OR = 0.249, 95% CI: 0.146–0.422, p < 0.001) and PrFT (2nd tercile: OR = 7.720, 95% CI: 2.860–20.839; 3rd tercile: OR = 16.892, 95% CI: 5.727–49.822; both p < 0.001) were identified as independent predictors of CKD. These variables were used to construct a simplified model, which demonstrated moderate clinical applicability (AUC = 0.894) when evaluated on the test subset. Conclusions: KV and PrFT emerged as independent predictors of CKD, forming the basis of a simplified model with potential for opportunistic clinical application. This approach may facilitate earlier detection of CKD in patients undergoing CT imaging for unrelated clinical reasons. These imaging parameters are not intended to replace serum creatinine or eGFR but may serve as complementary predictors in specific clinical contexts. Full article

Background: Latent tuberculosis infection (LTBI) is a major global health concern, particularly among individuals with chronic kidney disease (CKD), who are at increased risk of reactivation due to impaired immunity and frequent exposure to immunosuppressive therapies. Despite growing reliance on interferon-gamma release assays (IGRAs) such as QuantiFERON-TB Gold In-Tube (QFT-GIT) in BCG-vaccinated populations, data on IGRA performance across CKD stages remain limited in resource-limited settings. Objective: To determine the prevalence of LTBI and indeterminate IGRA results across CKD stages in a Thai population and assess the clinical utility of IGRA in this context. Materials and Methods: We conducted a cross-sectional study among 785 Thai adults receiving care at a national infectious disease institute, including diabetes clinic patients, hospital staff, and individuals on hemodialysis. Each participant underwent QFT-GIT testing, and the CKD stage was classified using the estimated glomerular filtration rate (eGFR) closest prior to testing. Results: Overall IGRA positivity was 22.2%, peaking in CKD stage G3 (31.6%) and declining in stage G5 (11.0%), where indeterminate results were also highest (6.8%). Limitations: Single-center design and lack of confirmatory testing may limit generalizability. Conclusions: IGRA performance is reliable in early-to-moderate CKD but less so in advanced stages. LTBI is prevalent in CKD stages G2–G4, supporting stage-specific approaches to LTBI screening and caution against overreliance on IGRA in advanced renal impairment. Full article

Sepsis is a life-threatening condition caused by an abnormal host response to infection, leading to organ dysfunction and potentially death. Acute kidney injury (AKI) is a critical complication of sepsis. Various pathways, especially signaling through Toll-like receptors (TLRs) and the nucleotide-binding oligomerization domain, leucine-rich repeat and pyrin domain-containing protein 3 (NLRP3) inflammasome, contribute to inflammation and tissue damage. Cilastatin, a renal dehydropeptidase I inhibitor, has shown promise in protecting against AKI induced by nephrotoxic drugs. This study assessed cilastatin’s effectiveness in preventing AKI and inflammation caused by sepsis and its impact on survival. Sepsis was induced in male Sprague-Dawley rats using the cecal ligation puncture (CLP) model, with four groups: sham (control), CLP, sham + cilastatin, and CLP + cilastatin. Cilastatin (150 mg/kg) was administered immediately and 24 h after sepsis induction. Kidney injury was evaluated 48 h later by assessing serum creatinine, blood urea nitrogen, glomerular filtration rate, proteinuria, kidney injury molecule-1 levels, and renal morphology. Inflammatory and fibrotic biomarkers, particularly related to the TLR4 and NLRP3 pathways, were also measured. Cilastatin treatment prevented kidney dysfunction, reduced inflammatory markers, and improved survival by 33%. These results suggest that cilastatin could be a beneficial therapeutic strategy for sepsis-related AKI, improving outcomes and reducing mortality. Full article

Background: Multiple studies demonstrated that nutritional risk and malnutrition were associated with prolonged hospitalization, extended rehabilitation duration, and increased mortality among patients with cardiovascular diseases (CVD). However, current research on dietary behaviors and nutritional status in hospitalized CVD patients remains insufficient. Objective: This study systematically evaluated the concordance between cardiology inpatients’ and clinicians’ subjective nutritional status assessments and objective energy and protein intake achievement rates, while comprehensively investigating the multidimensional associations among Nutritional Risk Screening 2002 (NRS 2002), Global Leadership Initiative on Malnutrition (GLIM), blood parameters, and dietary intake. Methods: This study adopted a cross-sectional design to investigate hospitalized patients in the department of cardiology. Dietary knowledge and behavior data were collected through questionnaires, and actual dietary intake was recorded. Nutritional risk assessment and malnutrition diagnosis were performed for all inpatients. Differences between subjective evaluations and actual intake were compared, and the correlation between blood biochemical indicators and nutritional status was analyzed. Results: The study enrolled 618 valid cases, with male and female patients accounting for 67.48% and 32.52%, respectively. The patients’ age was 61.89 ± 12.88 years. The NRS 2002 score was 3.01 ± 0.94, with 132 inpatients diagnosed with malnutrition according to GLIM criteria. Energy and protein intake reached only 63.09 ± 18.23% and 74.98 ± 22.86% of target values, respectively. NRS 2002 showed significant correlations with estimated glomerular filtration rate (eGFR), C-reactive protein (CRP), albumin (ALB), etc. No significant difference was found between physician and inpatient evaluations (χ² = 1.465, p < 0.05). Both ordinal and multivariable logistic regression analyses demonstrated significant discrepancies between subjective assessments (inpatient perceptions and physician evaluations) and objective energy and protein intake levels (p < 0.05). Conclusions: Hospitalized cardiovascular patients commonly exhibited insufficient nutritional intake and limited dietary awareness. A mismatch existed between patient/clinician perceptions and objectively assessed nutritional intake. Subjective evaluations could not accurately reflect actual nutritional status, necessitating enhanced nutritional monitoring—including nutritional risk screening, biochemical testing, and dietary surveys—along with personalized interventions. Future efforts should enhance collaboration between clinicians and dietitians to improve patients’ nutritional status and clinical prognosis. Full article

Background/Objectives: Patients with chronic hypoparathyroidism are at increased risk of kidney complications. Also, chronic kidney disease is associated with increased cardiovascular risk. The aim was to analyze the factors that influence kidney function, including cardiovascular diseases (CVD), in a cohort of patients with chronic hypoparathyroidism. Methods: This was a retrospective longitudinal study that included 100 patients with chronic hypoparathyroidism. Results: The estimated glomerular filtration rate (eGFR) was associated with the duration of disease (p = 0.014). During follow-up, a significant decrease in eGFR was observed over time (p < 0.001), and changes in the eGFR were associated with the duration of disease (p < 0.001). We found that the eGFR was lower in patients with urolithiasis (p = 0.003), hypertension (p < 0.001), type 2 diabetes (p = 0.031) and dyslipidemia (p < 0.001). In total, 14% of patients had a chronic kidney disease (CKD), and these patients had a longer duration of disease (p < 0.001). The percentage of patients with urolithiasis (p = 0.003), nephrocalcinosis (p = 0.008), hypertension (p = 0.005), type 2 diabetes (p < 0.001), dyslipidemia (p < 0.001), coronary heart disease (p = 0.008), and arrhythmia (p < 0.001) was higher in patients with CKD. Logistic regression models showed that disease duration was associated with CKD (OR = 1.11; 95% CI [1.03–1.22]; p = 0.008). We used ROC curves to assess the usefulness of disease duration as a marker of CKD, and the AUC was 0.850 (95% CI 0.763–0.937, p < 0.001). A duration of disease > 15.5 years had a sensitivity of 85.7% and a specificity of 71.9% for a diagnosis of CKD. Conclusions: The duration of disease appears to be a predictor of the presence of renal dysfunction in patients with chronic hypoparathyroidism. In addition, the coexistence of CVD factors could result in greater renal damage. Full article

Objective: To evaluate the perioperative outcomes, functional impact, and oncologic efficacy of off-clamp robotic-assisted partial nephrectomy (RAPN) in patients with renal masses across multiple high-volume centers. Materials and Methods: We conducted a retrospective multicenter study including 563 patients (group 1) who underwent clampless RAPN between January 2018 and December 2024. Patients with solitary kidneys, tumors >7 cm, or prior renal surgery were excluded. The standardized surgical technique involved tumor resection without clamping of the renal artery, followed by the use of hemostatic agents and standard/selective suturing of the resection bed on demand. Patients in group 1 were compared to 244 consecutive patients treated in the same centres and treated with RAPN with an on-clamp procedure (group 2). Primary outcomes included operative time, blood loss, and complications, while secondary outcomes assessed renal function preservation and oncologic control at an at least 12-month follow-up. Results: The median operative time was 118 min (IQR: 100–140 min), and median estimated blood loss was 150 mL (range: 50–400 mL). The overall complication rate was 9.2%, with most classified as Clavien–Dindo Grade I–II. No intraoperative conversions to open surgery were recorded. Renal function was well preserved, with a median estimated glomerular filtration rate (eGFR) decline of 4.1% at three months (p > 0.05), and no cases of acute kidney injury. Oncologic outcomes were favorable, with a positive surgical margin rate (PSM) of 2.4% and two cases of tumor recurrences (0.36%) documented at a 12-month follow-up. Conclusions: The off-clamp RAPN is a safe and effective nephron-sparing approach, offering significant renal function preservation while maintaining oncologic efficacy. This technique minimizes ischemia–reperfusion injury and post-surgical fibrosis, providing a viable alternative to on-clamp RAPN. Further prospective trials are warranted to confirm long-term benefits and refine patient selection criteria. Full article

Background/Objectives: Chronic kidney disease (CKD) is a significant risk factor for thrombogenic and bleeding events in patients with atrial fibrillation (AF). Left atrial appendage occlusion (LAAO) is increasingly utilized as an alternative to oral anticoagulation. We aimed to compare LAAO against medical therapy in advanced CKD patients (A-CKD). Methods: We conducted a retrospective cohort study to compare patients with AF who had undergone LAAO (intervention group) or patients receiving oral anticoagulation (OAC) (control group). All of them had the diagnosis of A-CKD (estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m²). The primary endpoint was a composite of stroke, transient ischemic attack (TIA), systemic embolism (SE), and major bleeding. Secondary endpoints included: an efficacy combined endpoint (a composition of stroke, TIA, and SE); major bleedings (defined as Bleeding Academic Research Consortium (BARC) ≥ 3), and mortality at follow-up. A propensity score matching was used to balance the populations. Results: In total, 81 and 102 patients composed the LAAO and anticoagulation groups. Mean age was 78.27 ± 10.3 and 81.2 ± 9.07 (p = 0.069) and female sex was 38.3% and 44.1%, respectively. Patients who underwent LAAO had a higher HAS-BLED score: 3.46 ± 0.85 vs. 3.77 ± 1.06, p = 0.011. Median follow-up was 19.0 months [IQR: 10.9–33.5]. There were no differences in the primary combined endpoint at 3-years follow-up—22.2% vs. 34.2% (hazard ratio (HR) 0.63, CI-95%: 0.353–1.11, p = 0.102)—nor respecting the efficacy combined endpoint: 3.7% vs. 6.9% (HR 0.54, CI-95%: 0.14–2.09, p = 0.355). Patients under anticoagulation treatment did present major bleedings (BARC ≥ 3) more often than the intervention group: 38.3%vs50% (HR 0.52, CI-95%: 0.28–0.96, p = 0.031). A total of 15 patients (14.7%) from the control group underwent LAAO during follow-up. After a propensity score matching analysis, the primary combined endpoint was more frequent in the control group (HR 0.47, CI-95%: 0.25–0.90, p = 0.019). Conclusions: Compared with oral anticoagulation therapy, LAAO had no differences in efficacy, but fewer major bleeding rates were found. Full article

Background: The association between blood pressure (BP) dipping profiles and kidney function among chronic kidney disease (CKD) patients has been well established within the literature, but studies conducted on kidney transplant (KT) patients remain limited. Individual KT studies have small sample sizes and conflicting results. Meta-analysis overcomes these limitations by pooling data to increase statistical power and provide robust clinical guidance. This meta-analysis systematically assesses the impact of BP patterns on KT and CKD populations, aiming to highlight improved BP management strategies in these populations. Materials and methods: A comprehensive search was conducted up to September 9th, 2024, using multiple electronic databases. Results: The current study included 7 studies with a total of 788 patients. KT recipients showed a higher prevalence of non-dipper blood pressure profile than CKD patients. Also, those with a dipper profile had a significantly higher estimated glomerular filtration rate (eGFR) compared to non-dippers and reverse dippers, implying better graft function. No significant differences were observed in acute rejection risk, proteinuria, renal resistive index, cholesterol, or triglycerides across blood pressure profiles. Conclusions: These findings reveal a high prevalence of non-dipping blood pressure profiles in KT and CKD patients, linked to worse renal and cardiovascular outcomes, while also highlighting the need for ambulatory blood pressure monitoring and tailored BP management strategies in these high-risk populations to potentially improve outcomes. However, the observational nature of available studies limits causal inference, and further prospective research is required to establish definitive therapeutic recommendations. Full article

Ambient air pollutants (APs) are associated with increased chronic kidney disease (CKD) risk in general populations, but their renal impact on HIV/AIDS patients remains understudied. This dynamic cohort included 7981 HIV/AIDS patients without baseline kidney disease from Wuhan and Zhenjiang, followed every 6 months with fasting blood tests to assess the triglyceride-glucose (TyG) index and estimated glomerular filtration rate (eGFR). Monthly average exposures to six APs were estimated from geocoded residential addresses. Modified Poisson regression models were used to assess associations between cumulative AP exposure and CKD incidence, with mediation analysis conducted to explore the potential role of the TyG index. Weighted quantile sum regression was applied to evaluate the joint effects of six APs. During the follow-up period, 168 new cases of CKD were identified. Each interquartile range increase in PM_2.5, PM₁₀, and SO₂ corresponded to a 16.5%, 18.9%, and 9.7% higher CKD risk, respectively, with the TyG index mediating 10.21%, 9.16%, and 5.14% of these associations. PM_2.5 demonstrated the highest attribution weight (44.4%) for CKD risk elevation in mixed-exposure models. Chronic ambient AP exposure, particularly PM_2.5, synergistically elevates CKD risk in HIV/AIDS patients with glucolipid dysregulation potentially being involved, necessitating targeted air quality policies to mitigate AP impacts on this vulnerable population. Full article

Aim: To assess oxidative–inflammatory biomarker prediction of incident CKD after 1-year follow-up in a population with overweight/obesity and metabolic syndrome. Methods: Prospective nested case–control study comprising 117 CKD incident cases and 117 matched controls free of CKD after 1-year follow-up conducted in 55–75-year-old participants. Controls were time-matched 1:1 to cases by intervention group, age (≤65 vs. >65 years), and sex. Serum creatinine (SCr), cystatin C (CyC), and urine albumin-to-creatinine ratio (UACR) were measured at baseline, and CKD Epidemiology Collaboration equations for Caucasians were used to assess SCr, CyC, and CyC-SCr-based estimated Glomerular Filtration Rate (eGFR). Baseline levels of malondialdehyde (MDA), carbonyls, tumour necrosis factor alpha (TNFα), interleukin (IL)-1β, IL-1ra, IL-6, monocyte chemoattractant protein 1 (MCP-1), and leptin were determined from fasting serum samples. An inflammatory-oxidative stress score based on these biomarkers was calculated. Incident CKD was defined by eGFR-SCr <60 mL/min/1.73 m², and/or UACR ≥30 mg/g in the absence of CKD at baseline. Results: UACR positively correlated with pro-inflammatory markers (IL-1β; TNFα) and oxidative damage marker (MDA); eGFR-cyC showed negative correlations with IL-1β and IL-1ra, and eGFR-SCr with leptin. The odds ratios (OR; 95% CI) for incident CKD in the highest vs. the lowest tertile of IL-1ra IL-6 and TNFα were (2.22; 1.22–4.04), (7.03; 2.88–17.14), and (3.79; 1.79–8.02), respectively. The inflammatory–oxidative stress score was associated with incident CKD (OR per 1-SD increment: 2.06; 1.49–2.83). Conclusions: Inflammatory/oxidative stress is associated with CKD incidence in individuals with high cardiovascular risk, underscoring the importance in identify early inflammation to prevent this disease. Full article

Background and Clinical Significance: Membranoproliferative glomerulonephritis (MPGN) is a rare and heterogeneous pattern of immune-mediated glomerular injury, often associated with infections, autoimmune disorders, or monoclonal gammopathies. Idiopathic cases remain a diagnostic challenge and frequently require empirical immunosuppressive treatment. There is increasing interest in environmental triggers that may activate the immune system in genetically or immunologically predisposed individuals. We report an unusual case of idiopathic immune complex-mediated MPGN with a relapsing course potentially associated with vaccine-induced immune reactivation. Case Presentation: A 35-year-old male with no significant medical history aside from untreated dyslipidemia and active smoking presented with a hypertensive emergency and acute kidney injury (AKI). Laboratory investigations revealed nephrotic-range proteinuria, microscopic hematuria, and reduced estimated glomerular filtration rate (eGFR). Kidney biopsy demonstrated type I immune complex-mediated MPGN with a diffuse endocapillary proliferative pattern and granular subendothelial deposits (IgG+++, C3+++, C1q++). An extensive work-up ruled out secondary causes, supporting a diagnosis of idiopathic MPGN. Immunosuppressive therapy with corticosteroids and mycophenolate mofetil led to a partial clinical response. However, after receiving multiple vaccinations, the patient experienced clinical deterioration. A second biopsy revealed persistent proliferative changes and new deposits of IgM++, C4d++, and both kappa and lambda light chains. This prompted a reintroduction of immunosuppressive therapy, which resulted in subsequent clinical improvement. Conclusions: This case supports the hypothesis that vaccine-induced immune reactivation may serve as a potential trigger for disease relapse in idiopathic MPGN. Clinicians should remain alert to environmental stimuli that may influence disease activity in immune-mediated glomerulopathies. Further research is needed to elucidate the underlying immunopathogenic mechanisms. Full article