Fabry disease (FD) is an X-linked hereditary lysosomal storage disorder resulting from a deficiency of the alphagalactosidase enzyme. It is characterized by extensive systemic involvement, affecting kidneys, cardiac, and neurological systems. Cite this article as: T ürkmen E , K öse M Ö, Ç ınar E , Ç ınar B P. S triking l ip a ngiokeratomas i n a F abry d isease p atient. Turk J Nephrol. 2026;35(4):331-333.
Background: Anti–glomerular basement membrane (anti-GBM) disease is a rare, life-threatening cause of rapidly progressive glomerulonephritis, often presenting with pulmonary kidney syndrome and frequently progressing to end-stage kidney disease (ESKD) if diagnosis and treatment are delayed. Methods: The authors conducted a retrospective observational study including all patients ≥ 10 years with serological and/or biopsy-proven anti-GBM disease treated at a tertiary care center in South India between January 2016 and January 2025. Demographic, clinical, serological, histopathological, and treatment data were collected, and predictors of dialysis independence, ESKD, and mortality were analyzed. Results: Thirty-two patients were identified; mean age was 39.8 years, and 53% were male. At presentation, 81.3% required dialysis, mean serum creatinine was 9.15 mg/dL, and 25% had pulmonary hemorrhage; anti–neutrophil cytoplasmic antibody co-positivity was seen in 34.4%. All patients received plasma exchange plus corticosteroids and cyclophosphamide. At the last follow-up, 25% recovered kidney function, 62.5% were dialysis dependent, and 12.5% had died. Multivariable logistic regression analysis demonstrated that dialysis requirement at presentation and interstitial fibrosis on kidney biopsy were independent predictors of failure to achieve kidney recovery, while older age and pulmonary involvement predicted mortality. Conclusions: In this single-center Indian cohort, anti-GBM disease was characterized by delayed presentation with advanced kidney failure, leading to low kidney recovery and high ESKD burden despite standard therapy. Early recognition, rapid referral, and timely initiation of plasma exchange–based immunosuppression are crucial to improve outcomes in resource-limited settings. Cite this article as: Janardhanan JJ, Kamat N, Prakash TS, Rapur R. Clinical profile and predictors of kidney and patient outcomes in anti– glomerular basement membrane disease: a 10-year single-center experience from South India. Turk J Nephrol. Published online September 25, 2026;35(4):276-287.
Background: Patients undergoing hemodialysis encounter numerous stressors in their daily lives, necessitating effective adaptation strategies to cope with these challenges. Although several instruments exist to assess adaptation, most are generic and not specifically designed for particular stressful contexts such as hemodialysis. This study aimed to design and evaluate the psychometric properties of the Hemodialysis Patient Adaptation Questionnaire (HPAQ). Methods: This methodological study used a sequential exploratory mixed-methods approach conducted in Tehran, Iran, from February 2024 to July 2025. It comprised three phases. In phase one, a qualitative study was conducted to gain a detailed understanding of the concept and dimensions of adaptation among hemodialysis patients. In phase two, the HPAQ was developed based on the qualitative findings. Phase three focused on assessing its psychometric properties. Results: Initially, 47 items were generated based on seven identified dimensions of adaptation. Psychometric evaluation demonstrated strong validity and reliability (scale content validity index [SCVI] = 0.90; Cronbach’s alpha = 0.917). Following content and construct validity analyses, the final questionnaire included 30 items across four factors: (1) Gradual Acceptance of Reality, (2) Perceived Support, (3) Situation Management, and (4) Submission to Divine Decree. The results confirmed that the HPAQ possesses satisfactory validity, reliability, and psychometric soundness. Conclusion: The findings indicate that the developed questionnaire is a comprehensive, specific, valid, and reliable indigenous instrument for assessing adaptation among patients undergoing hemodialysis in Iran. It can be utilized to design and implement targeted interventions to enhance patient adaptation. Further studies are recommended to re-evaluate the HPAQ in other hemodialysis populations to ensure its broader applicability. Cite this article as: Afaghi E, Mohammadi E, Ahmadi F, Kazemnejad A. Development and psychometric evaluation of the hemodialysis patient adaptation questionnaire: an exploratory sequential mixed-method study. Turk J Nephrol. Published online September 25, 2026;35(4):266-275.
Background: Chronic kidney disease (CKD) is often accompanied by systemic inflammation and malnutrition. This study aimed to evaluate whether hematological inflammatory markers—the neutrophil-to-lymphocyte ratio (NLR), platelet-tolymphocyte ratio (PLR), and systemic immune–inflammation index (SII)—are associated with nutritional status, as determined by the prognostic nutritional index (PNI) and to explore their potential predictive value in identifying patients at risk of malnutrition. Methods: A total of 267 adult patients admitted to the nephrology outpatient clinic were included in this cross-sectional study. Malnutrition was defined using a PNI cut-off value of <42.3. Inflammatory markers were calculated from complete blood count parameters. Statistical analyses included group comparisons and correlation analyses between nutritional and inflammatory indices. Results: Albumin levels were higher in females than males (P = .031), while other parameters did not differ by sex. No significant differences were observed among age groups. Anemic patients had higher white blood cell, NLR, PLR, and SII levels and lower albumin and PNI values compared with non-anemic patients (all P < .001). In multivariable linear regression, NLR and PLR were negatively associated with PNI, whereas SII showed a positive association (all P < .001). Logistic regression analysis showed that PLR was significantly associated with malnutrition (odds ratio (OR) = 1.015, P = .003). Receiver operating characteristic analysis demonstrated the highest discriminative ability for PLR (area under the curve (AUC) = 0.842), followed by NLR (AUC = 0.789) and SII (AUC = 0.717). Conclusion: Inflammatory indices, particularly PLR and NLR, are significantly associated with nutritional status in CKD patients. These simple hematological markers may help identify patients at risk of malnutrition in routine clinical practice. Cite this article as: Delibaş EA., Y, Kuyucu E. The relationship between malnutrition defined by prognostic nutritional index and hematological inflammatory markers (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune–inflammation index): A cross ectional study in patients with chronic kidney disease. Turk J Nephrol., 2026;35(4):303-310.
IgA nephropathy (IgAN), also termed Berger disease, is the prevalent form of primary glomerulonephritis worldwide and a major associated risk factor for chronic kidney disease (CKD), commonly among young adults.
