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Open research questions in Renal Diseases and Glomerulopathies

42 unresolved questions extracted from the limitations and future-work sections of 409 Renal Diseases and Glomerulopathies papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Several limitations of this study warrant acknowledgment. Accord- ingly, we could not assess whether higher baseline titers (still below 5 ng/mL) influence the subsequent risk of ARA development or clinical outcomes.

    The impact of anti-rituximab antibodies on rituximab efficacy in children with frequently relapsing or steroid-dependent nephrotic syndrome · 2026 · DOI

  • PXDN may participate in fibrotic remodeling processes and represents a potential therapeutic target, warranting further investigation in CKD progression.

    Peroxidasin expression patterns predict fibrosis and kidney function decline in IgA nephropathy · 2026 · DOI

  • Abstract Peroxidasin (PXDN), a heme-containing peroxidase involved in basement membrane assembly, has been increasingly implicated in fibrotic processes, yet its role in kidney disease remains unclear.

    Peroxidasin expression patterns predict fibrosis and kidney function decline in IgA nephropathy · 2026 · DOI

  • The global sclerotic glomeruli ratio (GSGR) may reflect chronic kidney damage and help predict progression, but its prognostic value and optimal threshold remain unclear.

    Histopathological predictors of renal outcomes in idiopathic membranous nephropathy with a focus on global sclerotic glomeruli ratio · 2026 · DOI

  • Complement dysregulation may occur secondary to systemic immune activation, but its relationship with inflammatory bowel disease (IBD) remains poorly defined.

    C3 glomerulopathy associated with anti-factor H autoantibodies in a child with inflammatory bowel disease · 2026 · DOI

  • Although a direct causal relationship between influenza and PSGN has not been established, viral illnesses may obscure the identification of antecedent streptococcal infection or contribute to exaggerated immune activation.

    A Unique Presentation and Clinical Course of Poststreptococcal Glomerulonephritis Following Recent Influenza Infection: A Case Report · 2026 · DOI

  • Although IgAN was first described over 50 years ago and significant advances have been made in its pathophysiology to date, the appropriate treatment, especially IS therapy for IgAN, remains uncertain (11).

    Real-world study of telitacicept in the treatment of IgA nephropathy · 2026 · DOI

  • Ofatumumab (OFA), a fully humanized anti-CD20 monoclonal antibody, represents a potential alternative, yet its use in children remains poorly documented.

    Subcutaneous Ofatumumab for remission maintenance in pediatric idiopathic nephrotic syndrome: a case series · 2026 · DOI

  • Background: Rapidly progressive glomerulonephritis (RPGN) is an uncommon but severe pediatric renal disorder, and its incidence and etiological patterns remain poorly defined.

    Demographic and Renal Histopathological Profile of Rapidly Progressive Glomerulonephritis in Children · 2026 · DOI

  • For clinical practice: Albumin should be reserved for acute inpatient management of NS patients with confirmed underfill physiology and severe or diuretic-resistant edema, administered sequentially (albumin then furosemide) at 0.5–1 g/kg of 20–25% albumin (or equivalent protein mass as 5% solution), with careful monitoring for volume overload and hypertension. Routine The International Journal of Medical Science and Health Research Downloaded from theInternationalmedicaljournal.org. For personal use only. No other uses without permission. Copyright © International Medical Journal Corp. Ltd. All rights reserved 197 Research Article Volume 48, Issue No. 01. 2026 E-ISSN : 3048-1368 P-ISSN : 3048-1376 outpatient or chronic albumin therapy is not supported by current evidence. Primary treatment efforts should focus on achieving remission of proteinuria through immunosuppressive therapy. For policy and formularies: Hospitals should implement evidence-based guidelines for albumin use, including prospective audit and feedback, to reduce inappropriate prescribing and associated costs. Alternatives such as FFP or mannitol should be considered in resource-limited settings. For future research: An adequately powered, multicenter RCT in pediatric NS with confirmed hypovolemia, comparing albumin plus furosemide to furosemide alone, with stratification by volume status and measurement of patient-centered outcomes, is urgently needed. A prospective registry or randomized trial comparing aggressive versus conservative albumin protocols in congenital NS is also required. REFERENCES 1. Kitsios GD, Mascari P, Ettunsi R, Gray A (2014) Co-administration of furosemide with albumin for overcoming diuretic resistance in patients with hypoalbuminemia: a meta-analysis. Journal of critical care. https://doi.org/10.1016/j.jcrc.2013.10.004 2. Lee T-H, Kuo G, Chang C-H, et al (2021) Diuretic effect of co-administration of furosemide and albumin in comparison to furosemide therapy alone: An updated systematic review and meta- analysis. PLoS ONE. https://doi.org/10.1371/journal.pone.0260312 3. Nawaz SB, Zafar M (2025) Intravenous Albumin for Oedema in Children With Nephrotic Syndrome: A Systematic Review and Mapping of the Evidence Landscape. Cureus. https://doi.org/10.7759/cureus.95142 4. Tadayoni F, Mirrahimi B, Charousae H, et al (2025) Comparison of Sequential versus Concurrent Albumin and Furosemide in Pediatric Nephrotic Syndrome Patients: A Blinded Randomized Controlled Clinical Trial. The Journal of Pediatric Pharmacology and Therapeutics. https://doi.org/10.5863/JPPT-24-00026 5. Garg A, Kalra S, Kumar A, Kanitkar M (2020) A Crossover Comparative Study to Assess Efficacy of 5% vs. 20% Albumin in the Treatment of Anasarca in Children with Idiopathic Nephrotic Syndrome. Journal of Nepal Paediatric Society. https://doi.org/10.3126/jnps.v40i3.29110 The International Journal of Medical Science and Health Research Downloaded from theInternationalmedicaljournal.org. For personal use only. No other uses without permission. Copyright © International Medical Journal Corp. Ltd. All rights reserved 198 Research Article Volume 48, Issue No. 01. 2026 E-ISSN : 3048-1368 P-ISSN : 3048-1376 6. Ellis D (2016) Pathophysiology, Evaluation, and Management of Edema in Childhood Nephrotic Syndrome. Frontiers in Pediatrics. https://doi.org/10.3389/fped.2015.00111 7. Jethwani P, Krishnan N (2021) Pathogenesis and Treatment of Refractory Oedema in Nephrotic Syndrome. EMJ Urology. https://doi.org/10.33590/emjurol/21-00041 8. Singh V, Berwal P, Saini T, Mishra N (2021) ALBUMIN VERSUS FRESH FROZEN PLASMA IN MANAGING DIURETIC RESISTANT EDEMA IN CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME. https://doi.org/10.32553/IJMBS.V5I1.1677 9. Ho J, Adnan A, Kueh Y, et al (2019) Human albumin infusion for treating oedema in people with nephrotic syndrome.

    The Relationship between The Use of Albumin and The Management of Nephrotic Syndrome with Hypovolemia : A Systematic Review · 2026 · DOI

  • Considering these possibilities, future research should focus on therapeutic approaches that directly modulate mucosal immune environments, such as normalizing cytokine and chemokine pro- files, strengthening epithelial barrier integrity, enhancing antimi- crobial peptide secretion, and correcting homing defects. However, the long-term durability of therapeutic effects of these novel agents and adverse effects associ- ated with prolonged administration remain unclear and need to be elucidated in ongoing and future clinical trials.

    The role of mucosal immune dysregulation in the pathogenesis of immunoglobulin A nephropathy · 2026 · DOI

  • Further studies of BEN should be directed to determination of incidence and prevalence of disease in different endemic foci, investigations of different insufficiently examined aetiological factors as well as pathomorphological features of the disease by the use of modern methods.

    Investigation of Balkan endemic nephropathy in Serbia: How to proceed? · 2010 · DOI

  • 3 g/d, the available evidence remains insufficient to precisely characterize the potential incremental benefit of reducing proteinuria below 0.

    Impact of proteinuria levels on long-term kidney outcomes in IgA nephropathy: a meta-analysis · 2026 · DOI

  • On the basis of limited data, several promising novel biomarkers specifically related to IgA nephropathy pathophysiology have been proposed and need to be validated and standardized for use in routine clinical care.

    The expanding role of biomarkers in the management of IgA nephropathy · 2026 · DOI

  • However, the available evidence remains limited and is derived predominantly from individual case reports, small retrospective series, and a limited number of observational studies.

    Concurrent Anti-glomerular Basement Membrane (Anti-GBM) Disease and Immunoglobulin A Nephropathy (IgAN) Presenting With Severe Pulmonary-Renal Syndrome: A Case Report · 2026 · DOI

  • However, clinical diagnosis still relies on invasive renal biopsy, and non-invasive biomarkers capable of capturing both systemic immune activation and kidney-specific alterations remain lacking.

    Multi-Omics Characterization of Plasma and Urine Extracellular Vesicles Identifies Non-Invasive Biomarkers for IgA Nephropathy · 2026 · DOI

  • IgA vasculitis with nephritis is a kidney manifestation of a systemic disorder, typical of the pediatric age, in which both the diagnosis of kidney involvement and its management are poorly defined, and an interdisciplinary approach is crucial.

    IPNA clinical practice recommendations for the diagnosis and management of children with IgA nephropathy and IgA vasculitis nephritis · 2024 · DOI

  • Ho­wever, supportive therapy does not always achieve its goals and cannot affect the autoimmune pathogenesis of the disease, while the role of immunosuppressants and systemic glucocorticoids remains controversial.

    Glucocorticoids for the treatment of IgA nephropathy: pros and cons. Research data and own experience · 2023 · DOI

  • Combined therapy is preferable for all patients who suffer from significant glucocorticoid- related toxicity or in cases where glucocorticoids alone are insufficient to treat the condition.

    Retroperitoneal fibrosis – diagnosis and treatment · 2022 · DOI

  • Although fibrinoid necrosis of small vessels has been associated with microemboli of cholesterol, necrotising angiitis in the kidney has not been reported as a manifestation of cholesterol embolisation.

    Necrotising glomerulonephritis associated with cholesterol microemboli. · 1985 · DOI

  • In patients with this syndrome complex and poorly understood physiological mechanisms come into play to maintain the plasma volume, and these coapensatory mech- anisms may modify the response to diuretic drugs used in the treatment of oedema.

    Salt-poor Human Albumin in Management of Nephrotic Syndrome · 1974 · DOI

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42 open questions have been extracted from the limitations and future-work passages of 409 Renal Diseases and Glomerulopathies papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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