Clinical nephrology Journal Impact Factor & Information

Publisher: Dustri-Verlag

Journal description

Clinical Nephrology appears monthly and publishes manuscripts containing original material with emphasis on the following topics: prophylaxis, pathophysiology, immunology, diagnosis, therapy, experimental approaches and dialysis and transplantation.

Current impact factor: 1.13

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 1.129
2013 Impact Factor 1.232
2012 Impact Factor 1.288
2011 Impact Factor 1.171
2010 Impact Factor 1.058
2009 Impact Factor 1.373
2008 Impact Factor 1.413
2007 Impact Factor 1.32
2006 Impact Factor 1.418
2005 Impact Factor 1.543
2004 Impact Factor 1.316
2003 Impact Factor 1.341
2002 Impact Factor 1.341
2001 Impact Factor 1.531
2000 Impact Factor 1.638
1999 Impact Factor 1.553
1998 Impact Factor 1.323
1997 Impact Factor 1.437
1996 Impact Factor 1.643
1995 Impact Factor 1.441
1994 Impact Factor 1.339
1993 Impact Factor 1.575
1992 Impact Factor 1.456

Impact factor over time

Impact factor

Additional details

5-year impact 1.15
Cited half-life >10.0
Immediacy index 0.16
Eigenfactor 0.00
Article influence 0.34
Website Clinical Nephrology website
Other titles Clinical nephrology
ISSN 0301-0430
OCLC 1747233
Material type Periodical
Document type Journal / Magazine / Newspaper

Publisher details


  • Pre-print
    • Archiving status unclear
  • Post-print
    • Archiving status unclear
  • Conditions
    • We have contacted this publisher on multiple occasions, and have not been able to obtain a response to our enquiries. If you have any information on this publisher's policy, please submit an update using the form below.
  • Classification
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Ultrasound-guided percutaneous renal biopsy (PRB) is an important diagnostic tool for nephrologists. Athough widely used and without question of pivotal importance for the diagnosis of renal diseases, little systematic data regarding standardized indications, outcomes, or consequences for this procedure are available. The aim of this study was to compare the clinically suspected diagnosis with the morphological results and the potential impact of PRB on the treatment of the patient. Methods: 205 patients who underwent PRB of the native kidney within a 4-year period were included in this retrospective analysis. The biopsy results (BR), discharge diagnosis (DD), and the suspected diagnoses (SD) of the attending nephrologists prior to biopsy were documented. Results: Mean age of the patients was 58 (range 44 - 77) years. The majority of patients (61%) received PRB during an acute disease phase, whereas 39% had elective PRB. Percutaneous biopsy of the native kidney led to a discharge diagnosis in 92% of the patients, with low complication rates (with 3 out of 205 patients had major bleeding complications). In ~ 2/3, the nephrologists were correct with the suspected diagnosis prior to the biopsy. In ~ 74% of the biopsies, a disease was identified that was potentially responsive to treatment modification. Conclusions: In summary, PRB was found to be a safe procedure that confirmed the suspected clinical diagnosis in two thirds of patients. As one third of the histopathological analyses demonstrated a non-suspected disease, the biopsies were of major importance for the correct treatment of the patients.
    Clinical nephrology 09/2015; DOI:10.5414/CN108591
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    ABSTRACT: Objectives: Despite significant advances in the epidemiology of acute kidney injury (AKI), there is no reliable method to predict renal recovery. Using acute kidney injury network (AKIN) criteria, we tested whether higher urinary L-FABP (uL-FABP) concentrations in the patients with AKIN stage 3 (AKIN3) after nephrology consultation would predict failure to recover. Methods: This is a prospective cohort study of 114 patients with AKIN3 at WuXi People's Hospital from August 2011 to July 2014. The levels of serum creatinine, urine creatinine, and uL-FABP were obtained at the time of nephrology consultation. Results: Patients who recovered had lower uL-FABP than those who failed to recover at time of nephrology consultation (71.42 (11.1 - 118.3) vs. 335.18 (103.9 - 422.3) ng/mg×creatinine, p < 0.001). Urinary L-FABP predicted failure to recover with an area under the receiver operating characteristic curve of 0.906 (95% CI 0.837 - 0.953). A clinical model using age, APACHE II score and acute tubular necrosis severity scoring index (ATN-ISS) predicted failure to recover with an area under the curve of 0.825 (95% CI 0.743 - 0.890). When uL-FABP was compared to the clinical model, the reclassification of risk of renal recovery had significantly improved by 35.1%. Conclusion: Urinary L-FABP appears to be a useful biomarker to predict failure to recover during hospitalization in the cohort of patients with AKIN3.
    Clinical nephrology 09/2015; DOI:10.5414/CN108635
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    ABSTRACT: Alkaptonuria is a genetic disorder characterized by an accumulation of homogentisic acid due to an enzymatic defect of homogentisate 1,2 dioxygenase. The homogentisic acid is excreted exclusively by both glomerular filtration and tubular secretion leading to the renal parenchyma being exposed to high concentrations of homogentisic acid. The alkaptonuric patients are at higher risk of renal stones (and of prostate stones for males), usually in the later stages of the disease. We describe the case of a 51-year-old man whose renal and prostate stones were analyzed by X-ray diffraction and infrared spectroscopy, respectively. We review the cases of alkaptonuria (AKU) patients reported in the literature for whom the composition of kidney or prostate stones was assessed with physical or chemical techniques. In this paper, we also discuss the advantages and drawbacks of the different methodologies.
    Clinical nephrology 09/2015; DOI:10.5414/CN108608
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    ABSTRACT: Objective: To evaluate the efficacy and safety of calcitriol in the prevention and treatment of glucocorticoid-induced osteoporosis. Methods: 66 patients treated with glucocorticoids (GC) for primary nephrotic syndrome (NS) were randomly assigned to 3 groups. Groups were designated as follows: calcitriol alone (n = 22), calcitriol plus calcium carbonate (n = 23), or calcium carbonate alone (n = 21). Serum markers of bone metabolism and bone mineral density (BMD) were tested at 3 different time points: the initiation of GC treatment (baseline), 12 weeks, and 24 weeks after the initiation of treatment. Results: Levels of serum 25-hydroxy vitamin D, serum osteocalcin, and total serum collagen type N-terminal extension of the peptide were significantly decreased following GC therapy (p < 0.05). β-collagen serum-specific sequences were significantly increased following GC therapy. The above-mentioned changes were less dramatic in patients treated with calcitriol, although the differences were significant (p < 0.05). Changes in serum levels of calcium, phosphorus, alkaline phosphatase, and parathyroid hormone (PTH) were not significant. 24 weeks after the initiation of treatment, BMD of the lumbar spine and femoral bone significantly decreased in all of 3 groups. However, patients who received calcitriol had significantly higher BMD of the lumbar spine than patients who received calcium carbonate alone (calcitriol plus calcium carbonate vs. calcium carbonate alone: 0.82 ± 0.19 g/cm2 vs. 0.62 ± 0.23 g/cm2 p < 0.05; calcitriol vs. calcium carbonate alone 0.805 ± 0.203 g/cm2 vs. 0.615 ± 0.225 g/cm2 p < 0.05), respectively. No serious adverse events were observed. Conclusion: Calcitriol may be more effective than calcium carbonate in preventing and treating GC-induced osteoporosis in patients with NS.
    Clinical nephrology 09/2015; DOI:10.5414/CN108473
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    ABSTRACT: Background: Epoetin-zeta (epoetin-ζ) (sold as Retacrit™/Silapo™) is a biologic product that was approved by the European Medicines Agency in 2007 after demonstrating biosimilarity to its reference product epoetin-α (Eprex™), based on a comprehensive comparability exercise including extensive biophysical characterization and three double-blind randomized controlled trials. Since 2008, epoetin-ζ has been prescribed by physicians across Europe to treat anemia of renal disease in many thousands of patients. Methods: Provided here are results of the PASCO I study (post-authorization safety cohort observation of silapo/retacrit (epoetin-ζ) administered intravenously for the treatment of renal anemia). The primary study endpoint was the frequency of adverse events of special interest (AESI) occurring in patients receiving epoetin-ζ over a 1-year study observation period. Results: The safety set included 1,634 patients who received at least 1 dose of epoetin-ζ during the study period. These patients experienced AESI at these frequencies: clotting of artificial kidney 9.8%, lack of efficacy 2.3%, cerebrovascular events (including cerebrovascular accident, cerebral infarction, cerebral hemorrhage, and transient ischemic attack) 1.8%, myocardial infarction 1.7%, acute myocardial infarction 1.2%, clinically relevant hyperkalemia 0.4%, deep vein thrombosis 0.2%, convulsion 0.2%, hypertensive encephalopathy 0.1%, and pulmonary embolism 0.1%. No patients were reported as having anaphylactoid reactions, angioedema, erythropoietinneutralizing antibodies, or pure red cell aplasia. The median weekly follow-up dose of epoetin-ζ was 158.6 IU/kg. Mean hemoglobin concentration ranged between 11.3 and 11.7 g/dL. From the safety set, 228 patients died (14.0%), while 1,135 patients (74.9%; excluding 119 with data missing) continued treatment with epoetin-ζ following the 12-month observation. Conclusion: The PASCO I study contributes significantly to current knowledge about the frequency of adverse events associated with the use of epoetin-ζ for the treatment of renal anemia and demonstrates a pattern of adverse events comparable with data for other existing epoetin products in Europe.
    Clinical nephrology 09/2015; DOI:10.5414/CN108484
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    ABSTRACT: Background: Successful hemodialysis (HD) requires circuit anticoagulation, with either unfractionated heparin (UFH) or low molecular weight heparin (LMWH) - it is not clear if differences in risk or benefit between these agents exist. We report our experience of major bleeding in patients on hemodialysis receiving either LMWH or UFH for anticoagulation of the dialysis circuit. We also examined any effect of anti-platelet agents or oral anticoagulants on bleeding rates. Methods: An observational, retrospective, single-center study. Bleeding episodes are described using the International Society of Thrombosis and Hemostasis (ISTH) definition of a major bleeding event, and by extending this group to include all bleeds that led to a hospital admission (clinically significant). Incident event rates are reported per 100 at risk patient years, and event-free survival calculated using multivariate analysis by Cox-proportional hazard ratio. Results: We report on 522 patients (792 years of exposure) in the UFHHD cohort and 889 patients (1,200 years of exposure) in the LMWH-HD cohort. The incidence of a major bleed was 1.33%, and 1.92% bleeds respectively. The incidences of clinically significant bleeding rates were 3.33% and 3.96% respectively. There was no significant difference in bleed free survival between UFH compared to LMWH (OR 0.904, CI 0.557 - 1.468, p = 0.684). Warfarin or anti-platelet usage did not increase the risk of bleeding when comparing patients not on any anticoagulants. Conclusions: There is no difference in bleeding rates between hemodialysis patients treated with either UFH or LMWH for anticoagulation of the extracorporeal circuit. We believe that both heparins have similar safety profiles when used for extracorporeal anticoagulation and that bleeding risk should not determine the choice of anticoagulation.
    Clinical nephrology 09/2015; DOI:10.5414/CN108624
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    ABSTRACT: This is a retrospective study including 36 Saudi children who were on automated peritoneal dialysis (APD) at the Al-Hada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia during seven years. A total of 10 boys and 26 girls with end-stage renal disease (ESRD) received APD for a total of 731.75 months. 36 episodes of peritonitis occurred in 17 children (47%). The frequency of peritonitis was one episode per 20.3 treatment months. Catheters were changed in 3 patients (8%). Three patients were switched to chronic hemodialysis, while 4 underwent successful renal transplantation. Results revealed that 11 patients (19%) were culturenegative, while 25 (81%) were culturepositive. Gram-positive organisms were responsible for the majority of peritonitis episodes (50%) followed by Gram-negative organisms (31%); occurrence was more frequent in young patients. Empiric antibiotic therapy covered both gram-positive and gram-negative organisms. However, all gram-positive isolated microorganisms showed sensitivity to vancomycin. On the other hand, most gram-negative organisms showed sensitivity to ceftazidime or tobramycin.
    Clinical nephrology 09/2015; DOI:10.5414/CN108631
  • Clinical nephrology 09/2015; 84 (2015)(3):127-129. DOI:10.5414/CNP84127
  • Clinical nephrology 09/2015; 84(9). DOI:10.5414/CN108513
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    ABSTRACT: Aminoglycosides are a major weapon against serious Gram-negative rod infections, yet aminoglycoside usage is limited by the risk of nephrotoxicity. The risk of toxicity is reduced by extended-interval dosing of aminoglycosides, defined as 5 - 7 mg/kg given intravenously in intervals of 24 hours or greater based on serum drug concentrations. In critically ill patients undergoing continuous venovenous hemofiltration, there are few published reports of the pharmacokinetics of extended-interval dosing of aminoglycosides. We evaluated the pharmacokinetics of extended-interval dosing of gentamicin and tobramycin in 9 critically ill patients on continuous venovenous hemofiltration at Dartmouth-Hitchcock Medical Center between April 2007 and September 2011. Aminoglycoside elimination half-life values were highly variable (median 7 hours, range 3 - 26 hours) and did not correlate with total body weight or estimated creatinine clearance derived from the dose of continuous venovenous hemofiltration. Five of 9 patients cleared infection, but only 4 patients survived to hospital discharge, 2 of whom were dialysis-dependent. Extended interval aminoglycoside dosing during continuous venovenous hemofiltration yields unpredictable half-lives and drug levels among high-risk critically ill patients. Close monitoring of serum aminoglycoside levels is required.
    Clinical nephrology 08/2015; DOI:10.5414/CN108559
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    ABSTRACT: Amyloidosis results from the pathologic deposition of beta pleated sheet fibrils within various organs including the kidney. Most often, the deposition is composed of the well-known monoclonal immunoglobulin light chains (AL) or serum amyloid A protein (AA). Recently, a new type of amyloidogenic protein was discovered, leukocyte chemotactic factor 2 (LECT2). This type of amyloid tends to have an affinity to kidney and liver and is recognized as a distinct clinico-pathologic type of amyloidosis, presenting with varying degrees of impaired kidney function and proteinuria. Herein, a case of this uncommon novel amyloidosis is presented with a brief review of the literature.
    Clinical nephrology 08/2015; DOI:10.5414/CN108549
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    ABSTRACT: Podocyte depletion is a characteristic feature of progressive renal failure. We hypothesize that studying the podocyte mRNA level in urinary sediment may provide diagnostic and prognostic information in adult nephrotic syndrome. We studied 25 patients with minimal change nephropathy (MCN), 25 with focal segmental glomerulosclerosis (FSGS), and 17 healthy controls. The mRNA levels of nephrin, podocin, and synaptopodin in urinary sediment were quantified. There were significant differences in the urinary sediment nephrin and podocin, but not synaptopodin, mRNA levels between diagnosis groups. Post-hoc analysis further showed that urinary nephrin mRNA levels of the MCN group were lower than those in the control and FSGS groups, although the difference between MCN and FSGS groups did not reach statistical significance. The degree of proteinuria inversely correlated with urinary nephrin mRNA levels in the MCN (r = -0.526, p = 0.007) as well as in the FSGS group (r = -0.521, p = 0.008). For the FSGS group, the rate of renal function decline significantly correlated with baseline urinary synaptopodin mRNA levels (r = -0.496, p = 0.012). Urinary nephrin and podocin mRNA levels were reduced in patients with MCN and probably FSGS, and the magnitude of reduction correlated with the degree of proteinuria. Urinary synaptopodin mRNA levels correlated with the subsequent rate of renal function decline in patients with FSGS. Our result indicates that urine sediment podocyte mRNA levels provide novel insights in the pathophysiology of nephrotic syndrome and could be useful for risk stratification.
    Clinical nephrology 08/2015; DOI:10.5414/CN108607
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    ABSTRACT: The impact of the United States Prospective Payment System (PPS) "bundle payment system" on anemia management within small dialysis organizations (SDOs) was studied to evaluate the financia burden on SDOs. Facilities enrolled in the original study on SDOs were grouped into three hemoglobin (Hb) categories by subject-months: > 25% of subjectmonths with Hb < 10 g/dL (sub-10); > 25% of subject-months with Hb > 12 g/dL (super-12); remaining facilities (10 - 12 group). Subjectlevel data aggregated to facility level for Hb concentration, intravenous (IV) epoetin α (EA) dose per administration, dose titration, and EA administration frequency during the baseline and follow-up periods were described. Baseline demographic characteristics were imbalanced between the sub-10 (n = 7) and super-12 facilities (n = 5). Mean (SD) Hb concentrations were similar for sub-10 (11.1 (3.0) g/dL) and super-12 (11.6 (2.2) g/dL) facilities during the baseline period, but differed during the follow-up period (10.4 (2.7) vs. 11.4 (2.3) g/dL). The median (Q1, Q3) EA IV dose per administration during follow-up was 3,726 (3,467, 3,961) and 5,712 (4,816, 7,324) units in the sub-10 and super-12 facilities, respectively. A small trend toward upward titration was seen. Results suggest a difference in anemia management between sub-10 and super-12 facilities during the first year of PPS implementation. Future analyses evaluating patterns of reimbursement and shifts in clinical practice guidelines are warranted globally.
    Clinical nephrology 08/2015; DOI:10.5414/CN108573
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    ABSTRACT: Colchicine is an approved agent in the management and prophylaxis of gout and familial Mediterranean fever but its therapeutic value is limited by its narrow therapeutic index. Multisystem toxicity is uncommonly reported; and is often associated with renal impairment and/or specific drug interactions. We report two cases of colchicine toxicity marked by severe neuromyopathy in a diabetic with stage 4 chronic kidney disease (CKD) and a renal transplant recipient. Both patients presented with diarrhea, acute on chronic kidney injury and progressive muscle weakness while on colchicine for several weeks or longer. In addition to kidney disease, risk factors for colchicine toxicity included maintenance therapy with simvastatin in the first patient and cyclosporine in the second. Creatine phosphokinase (CPK) was elevated in both cases at presentation and neurophysiologic studies showed a pattern of severe myopathy with axonal sensorimotor neuropathy. The first patient recovered from neurological weakness in a few weeks, but the second patient suffered an extraordinarily protracted and severe neuromuscular disability for a year. The two cases reinforce the need for extra vigilance in prescribing and monitoring colchicine therapy in renal patients with specific attention to drug interactions known to increase the risk of toxicity, thus avoiding such combinations in patients with renal impairment.
    Clinical nephrology 08/2015; DOI:10.5414/CN108343
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    ABSTRACT: A 60-year-old female with an extensive history of stone disease and shock wave lithotripsy presents with recurrent and increasingly severe renal colic. Work-up reveals obstruction with translucent debris that is found to be composed of keratin. Her history of chronic irritation of the collecting system has resulted in keratinizing squamous metaplasia (KSM) with hyperkeratosis that has sloughed from the upper urinary tract and has become lodged in the ureter. Because of the worsening of her symptoms on conservative management, the patient elected for a nephrectomy and her symptoms have since resolved. KSM of the renal pelvis is a relatively rare phenomenon and most often presents with irritative symptoms. It is thought to result from chronic irritation of the urothelium. KSM has been found to be coincident with squamous cell cancers of the urinary tract, though clear data implicating KSM as a premalignant lesion is lacking. We present a case of recurrent renal colic secondary to sloughing keratin debris from KSM.
    Clinical nephrology 08/2015; DOI:10.5414/CN108581
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    ABSTRACT: There are few reports of IgA nephropathy (IgAN) with antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis. The authors report the clinical and pathological findings in 14 patients with IgAN and ANCA seropositivity. These retrospective cases consisted of 4 men and 10 women with a mean age of 44.4 ± 12.7 years. ANCA-positivity was documented by EUROBlot kits and indirect immunofluorescence in all patients. The results of EUROBlot kits were positive in 14 patients (12 MPO-ANCA, 2 PR3-ANCA). Indirect immunofluorescence was positive in 14 patients (12 P-ANCA, 2 C-ANCA). Three of 14 IgAN with ANCA-positive patients showed severe clinical manifestations with crescents involving a mean of 56% glomeruli, including heavy proteinuria (mean 24-hour urine protein: 3.8 g/d), hematuria and acute renal failure (mean creatinine: 4.5 ± 3.7 mg/dL). The remaining 11 patients with no crescents showed various degrees of proteinuria (mean 24-hour urine protein: 2.4 ± 2.4 g/d), hematuria and serum creatinine levels (median creatinine: 0.9 (IQR, 0.5 - 1.4) mg/dL). The follow-up period for 10 patients had an average length of 14.0 ± 11.2 months. Among the three patients with crescents who had been treated with steroids and cyclophosphamide, one patient became dialysis dependent at the time of biopsy and remained on dialysis after treatment, another died of acute heart failure, and the last one showed improvement in renal function after treatment and did not develop end-stage renal disease (ESRD) 26 months after renal biopsy. The remaining 7 patients with no crescents were treated with steroids, cyclophosphamide, renin-angiotensin system inhibitors, and/or Traditional Chinese Medicine; 6 had stabilized or improved renal function and one progressed to ESRD with worsening renal function. These findings suggest not all ANCAs are involved in the pathology of IgAN. In patients with IgAN and ANCAs, identification of pathogenic vs. non-pathogenic ANCAs is recommended.
    Clinical nephrology 08/2015; 84(9). DOI:10.5414/CN108571
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    ABSTRACT: Aims: X-linked Alport syndrome (AS) is a monogenic inherited disorder of type IV collagen, a structural protein in the kidney and cochlea. Males typically exhibit a severe phenotype with end-stage renal disease (ESRD) and/or deafness by early adulthood. Because of the presence of two X chromosomes, females often have a less severe phenotype and hence the diagnosis of AS is often not considered. Herein, we present a case of an adolescent girl with proteinuria and hematuria in the setting of a strong family history of AL. Case report: The mother and maternal aunt of the proband had both presented with dipstick positive hematuria and proteinuria at age 8 years. These girls were not evaluated by nephrology until mid-adolescence when they had worsening creatinine levels. Kidney biopsy in the younger sister demonstrated segmental glomerulosclerosis with segmental thinning and lamination of the glomerular basement membrane, consistent with AS. Kidney biopsy in the older sister was performed just prior to the need for renal replacement therapy and showed only global glomerulosclerosis. Both sisters were transplanted by the age of 20 years. Their mother subsequently developed ESRD at age 53 years. With the advent of genetic testing, the proband and her family were brought in for evaluation. It had been assumed this family of AS had autosomal dominant transmission, however, genetic testing of the proband was positive for a splice site mutation of COL4A5 located on the X-chromosome. Sequencing of genes COL4A3, COL4A4, and COL4A6 were negative for mutation. Conclusions: The current case report demonstrates the importance of considering skewed X-inactivation in females who exhibit signs or symptoms of Xlinked disorders.
    Clinical nephrology 08/2015; DOI:10.5414/CN108561
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    ABSTRACT: BK virus is ubiquitous worldwide, with infection usually occurring in early childhood. BK virus replicates prolifically under immunosuppressive conditions, causing inflammation along the genitourinary tract and progressing clinically to hemorrhagic cystitis, ureteral stenosis, and tubulointerstitial nephritis. Most BK virusassociated nephropathy occurs in renal allograft patients after kidney transplantation, although some case reports have described BK virus-associated nephropathy in the native kidney, particularly in patients with human immunodeficiency virus infection. Here we present the case of a 49-year-old male with acquired immunodeficiency syndrome (AIDS) and renal dysfunction with hydronephrosis. The renal biopsy showed tubulointerstitial nephritis with lymphoplasmacytic infiltrates and intranuclear inclusions in the tubular epithelium, which are typical findings for BK virus-associated nephropathy. In addition, immunohistochemical staining revealed that the SV40 large T antigen exhibited a nuclear localization in tubular cells. To the best of our knowledge, this is the first case report of BK virus-associated nephropathy combined with hydronephrosis that was diagnosed by biopsy in a patient with AIDS.
    Clinical nephrology 08/2015; DOI:10.5414/CN108482