Kimura’s disease (KD) is a rare chronic inflammatory disorder with a high incidence of renal involvement. In this report, we present a case study of KD-associated nephrotic syndrome combined with minimal change disease (MCD) and acute renal tubular injury. Meanwhile, the clinical and histopathological characteristics of 26 patients with KD presenting with renal involvement were retrospectively evaluated. Here, we report a case study of a 59-year-old male patient with KD confirmed by a lymph node biopsy. He developed widespread edema and decreased urine output. A palpable swollen mobile and non-tender lymph node behind the left ear was observed upon admission. A renal biopsy revealed minimal-change lesions and acute renal tubular injury. The patient received hemodialysis because of the oliguria and renal insufficiency, and an initial dose of 40 mg/d methylprednisolone and then continued treatment with 40 mg/d prednisolone. He exhibited a good clinical response to the steroid after 6 weeks of treatment. Of the other 26 patients included in the review, 13 patients presented with mesangial proliferative glomerulonephritis, 4 with membranous nephropathy, 3 with MCD, 3 with focal segmental glomerulosclerosis, 2 with IgA nephropathy and 1 with acute tubular injury. With the exception of 2 patients who progressed to end-stage renal disease and received hemodialysis, the majority of patients responded well to treatment with corticosteroids alone. MCD combined with acute renal tubular injury is rare in patients with KD presenting with renal involvement. Corticosteroids may be a beneficial treatment for renal injury in patients with KD.

Background: Idiopathic membranous nephropathy (IMN) remains the leading cause of adult nephrotic syndrome. Immunosuppressive therapy with cyclophosphamide (CTX) is often successful in reducing proteinuria, but its use is associated with severe side effects. Tacrolimus (TAC) is effective in achieving complete remission (CR) in patients with IMN. However, whether it is as effective as CTX in inducing and maintaining complete or partial remission in these patients is unknown. This trial aims to test TAC monotherapy for its non-inferiority to CTX in inducing long-term remission of proteinuria.Methods: Patients with biopsy-proven IMN with nephrotic syndrome will be randomized into a 12-month treatment period with oral TAC of 0.05–0.1 mg/kg/day for 6 months or with CTX + glucocorticoid. The efficacy of the treatment will be assessed by the remission status (based on changes in proteinuria) and relapse rate.Discussion: This study will test whether treatment with TAC monotherapy is superior to CTX with glucocorticoid in inducing long-term remission of proteinuria in patients with adult IMN. The role of serum anti-PLA2R antibodies in the early assessment of the response to therapy using different therapeutic regimens will also be clarified.Trial registration: ClinicalTrials.gov ChiCTR1800016140. Registered 12 June 2017.http://www.chictr.org.cn.

IgA nephropathy has a poor prognosis. This network meta-analysis aims to evaluate the efficacy and safety of all currently available drugs comprehensively and systematically for the treatment of IgA nephropathy. We searched MEDLINE, EMBASE, Cochrane Library until Nov 15, 2024. Primary outcomes were 24-hour proteinuria and UPCR; secondary included ESRD, doubling serum creatinine (SCr), and adverse events (AEs). Bayesian analysis provided RRs and SUCRA rankings. Analyzing 37 RCTs (4889 patients) with 15 interventions: For reducing 24-hour proteinuria, AZA+CTX ranked highest (SUCRA 95.8%), superior to systemic corticosteroids (45.2%), other immunosuppressants (CsA 82.1%, MMF 72.1%, AZA 43.9%, CTX 21.0%), BAFF/APRIL inhibitors (63.6%), HCQ (62.9%), and RASi (16.4%). For UPCR reduction, BAFF/APRIL inhibitors (91.3%) and ERA (74.2%) outperformed systemic corticosteroids (46.8%), other immunosuppressants (MMF 74.0%, AZA+CTX 68.2%, TAC 43.8%), and TRF-budesonide (65.5%). Regarding renal protection, LEF (doubling SCr: 92.6%; ESRD: 79.1%) and systemic corticosteroids (doubling SCr: 77.0%; ESRD: 72.6%) were effective for both endpoints. For ESRD risk reduction, SGLT2i ranked second (77.0%), followed by TRF-budesonide (58.4%), with AZA+CTX being least favorable (5.5%). Safety analysis showed higher AE/SAE risks with CTX/AZA+CTX; TRF-budesonide had the next highest SAE ranks, though inter-group differences were non-significant. AZA+CTX was associated with an effective reduction in 24-hour proteinuria in small RCTs, but it also increased the risk of renal failure progression and had poor safety. Systemic corticosteroids and TRF-budesonide balanced proteinuria reduction with slowing renal failure, though SAE vigilance is needed. Among new agents, BAFF/APRIL inhibitors and ERA excelled at UPCR reduction with favorable safety. In supportive care, SGLT2i significantly reduced CKD progression risk while maintaining a favorable safety profile. CRD42024582600 The online version contains supplementary material available at 10.1186/s12882-026-04848-7.

Intradialytic hypotension (IDH) is one of the most common complications of hemodialysis. In order to prevent IDH, Artificial intelligence (AI) was utilized in predicting the onset of IDH. Different variables and different AI methods were used to improve the diagnostic test accuracy but resulted in different findings. We conducted a systematic review and meta-analysis to quantitatively analyze the diagnostic test accuracy of AI models in predicting IDH in HD patients and investigated the factors influencing the diagnostic test accuracy. Medline, Embase, and the Cochrane Library were searched using combined free texts and MeSH terms relating to hemodialysis, hypotension and AI (prior to Sep, 2025 and English-language publications included). Two authors independently screened the studies, and extracted and analyzed the data. A quantitative random-effects meta-analysis using Rutter and Gatsonis hierarchical summary receiver operating characteristics (HSROC) model was applied to summarize the SROC curves. Between-study heterogeneity was explored using multiple methods, and funnel plot analysis was used to identify publication bias. A total of 142 articles were identified and 19 studies with 33,214(95%CI: 405.08 to 3065.86) subjects and 4,350,177(95%CI: 0 to 35865.73) sessions met the inclusion criteria. Decision tree, support vector machine, XGBoost, extreme gradient boosting, recurrent neural network, and random forest were used in the studies. The summary area under the SROC curve(AUC) was 0.86(95%CI: 0.83 to 0.89), showing that the sensitivity of AI for prediction of IDH was 0.74(95%CI: 0.66 to 0.82), specificity was 0.85 (95%CI: 0.77to 0.91).These results indicate that it has moderate diagnostic ability for prediction of IDH during hemodialysis and high accuracy in excluding negative patients, although some missed diagnosis remain unavoidable. The Deeks’ funnel plot asymmetry test showed no evidence of publication bias (P = 0.68). This comprehensive systematic review and meta-analysis of AI models demonstrates promising accuracy for predicting IDH in hemodialysis patients. However, current limited studies and between-study heterogeneity limit its clinical application. More standardized approaches are needed for the development and validation of prediction models and randomized clinical trials, including unified IDH definition criteria, standardized data collection and model development protocols, and consistent external validation standards, to evaluate the clinical value of IDH prediction models.