Background: Superb microvascular imaging (SMI) is an innovative ultrasound image processing technique that provides greater detail and better visualization of small branching vessels. We assume that SMI will provide sufficient information regarding the severity of chronic kidney disease (CKD) and reflecting histological changes. Aims: The aims was to assess the capabilities of SMI imaging regarding the early detection of kidney dysfunction and renal fibrosis in comparison to the reference standard renal biopsy for the early diagnosis of kidney fibrosis. Methods: SMI was performed in patients (n = 52) with CKD stage 2–5, where some of them underwent biopsy proven CKD and fibrosis as part of the diagnosis. In addition, biochemical tests were performed, including kidney function tests, urine collection for proteinuria, and the estimation of GFR by MDRD or CKD-EPI eGFR in CKD patients and healthy controls (n = 17). All subjects underwent SMI, where vascularity is expressed as the SMI index (a low index reflects low vascularity/fibrosis and vice versa). Results: The SMI vascular index was significantly lower in CKD patients as compared with healthy controls (72.2 ± 12.9 vs. 49.9 ± 16.7%, p < 0.01). Notably, a moderate correlation between the SMI index and eGFR was found among the CKD patients (r = 0.56, p < 0.001). Similarly, a strong correlation was found between SCr and the SMI index of the diseased subjects (r = −0.54, p < 0.001). In patients who underwent renal biopsy, the SMI index corresponded with the histological alterations and CKD staging. Conclusions: This study demonstrated that SMI imaging may be utilized in CKD patients of various stages for the evaluation of chronic renal morphological changes and for differentiation between CKD grades.

Chronic kidney disease (CKD) is a progressive condition that affects more than 10% of the population worldwide, accounting for more than 843 million (M) individuals. The prevalence of CKD (844 M patients) is higher than that of diabetes mellitus (422 M patients), cancer (42 M patients), and HIV (37 M patients), but people are often less aware of it. Global expert groups predict reductions in the nephrology workforce in the next decade, with a declining interest in nephrology careers. Over time, KDIGO guidelines have also focused on topics related to the prevention or management of CKD patients in real-life settings. On these premises, a new educational program with international experts in the field of nephrology took place from November 2022 until March 2023 in Milan, Italy. This multinational masterclass provided an educational platform providing unbiased education on diagnosis and treatment by sharing the most recent research data on CKD and comorbidities, therefore creating a snowball effect to increase the implementation of best practices worldwide, using examples from ‘real-life’ patient outcomes. This paper provides an overview of the International Nephrology Masterclass (INM) concept, summarizing the key lectures and discussions, and giving an outline of future key developments.

Renal involvement in β-thalassemia minor (β-TMin) has been described mainly in case reports and small observational studies, and its clinical significance remains incompletely characterized. Using real-world data from routinely collected electronic medical records, we performed a retrospective cohort study including 1516 adult patients with β-TMin insured by Clalit Healthcare Services to explore renal abnormalities identified during routine clinical care. Urine testing for hematuria, microalbuminuria, and proteinuria was not performed systematically but was ordered at clinicians’ discretion, resulting in evaluation of a clinically selected subset of patients. Among those tested, hematuria, microalbuminuria, and proteinuria were commonly documented, often in the absence of hypertension, diabetes mellitus, congestive heart failure, or impaired kidney function, consistent with largely subclinical renal involvement. Patients who underwent urine testing were older and had more comorbidities than untested patients, indicating potential selection bias. Correlation analyses showed weak associations between hematological and renal parameters, while ferritin levels correlated modestly with selected proteinuria measures. Due to the retrospective design and non-systematic urine assessment, population-level prevalence and clinical impact cannot be determined. Therefore, prospective studies with standardized renal evaluations are needed to better characterize the frequency, mechanisms, and clinical relevance of renal abnormalities in β-TMin.