Nailfold Capillary Density and Kidney Injury in CKD
9 affiliations
- 1Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, California, USA
- 2Halıcıoğlu Data Science Institute, University of California San Diego, La Jolla, California, USA
- 3Department of Computer Science and Artificial Intelligence, Plaksha University, Sahibzada Ajit Singh Nagar, Punjab, India
- 4San Diego Supercomputer Center, University of California San Diego, La Jolla, California, USA
- 5Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, San Diego, California, USA
- 6Department of Pathology, University of California San Diego, San Diego, California, USA
- 7Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
- 8School of Public Health, University of California San Diego, San Diego, California, USA
- 9Nephrology Section, Department of Medicine, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
Abstract
Background: Microvascular dysfunction plays a key role in the development and progression of chronic kidney disease (CKD). Evaluation of capillaries by microscopy of the nailfolds may provide noninvasive insight into systemic microvascular health, but its relationship with kidney function, proteinuria, and kidney histopathology in patients with CKD remains unknown.
Methods: We conducted a cross-sectional analysis of adults with CKD stages 2–5 (estimated glomerular filtration rate [eGFR] < 90 ml/min per 1.73 m2) recruited from nephrology outpatient clinics at a single academic medical center between January 2023 and December 2025. Participants underwent assessment of third and fourth finger nailfold microvascular structure and function using high-resolution video capillaroscopy at 100× magnification. The density of erythrocyte-perfused capillaries (capillaries/mm2) was quantified at baseline, after the release of arterial occlusion (HA) (hyperemic response), and during venous congestion (OA) using a deep learning–based image analysis pipeline. Associations between capillary density measures and kidney function (eGFR) and urine protein-to-creatinine ratio (uPCR) were evaluated using multivariable regression models. In a subset of participants who underwent clinically indicated kidney biopsy, capillary density measures were examined for associations with histopathologic findings, including glomerulosclerosis (GS) and interstitial fibrosis and tubular atrophy (IFTA), using similar multivariable models.
Results: Among 189 participants with CKD, mean (standard deviation [SD]) age was 63 (16) years; 49% were female, 42% had diabetes, and 87% had hypertension. Mean (SD) baseline capillary density was 54 (15) capillaries/mm2. The mean eGFR was 41 (22) ml/min per 1.73 m2 and median (interquartile range [IQR]) uPCR was 0.31 [IQR: 0.11–1.8] mg/mg. In adjusted models, higher capillary density was associated with higher eGFR (β, 0.33; 95% confidence interval [CI], 0.25–0.41) and lower uPCR (β −1.1; 95% CI −1.7 to −0.5) independent of CKD risk factors. Results were similar evaluating capillary count at HA and OA. Among the subset of 36 participants with kidney biopsy data, lower capillary density was associated with greater GS and IFTA severity, which remained significant after adjustment for demographic factors, eGFR, and proteinuria.
Conclusion: Finger nailfold capillary density is associated with kidney function, proteinuria, and biopsy markers of chronic kidney injury among adults with CKD. Capillaroscopy may provide a noninvasive tool to identify vascular and interstitial damage above and beyond eGFR and proteinuria in patients with CKD.
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BibTeX
@article{malhotra2026nailfold,
title = {{Nailfold Capillary Density and Kidney Injury in CKD}},
author = {Rakesh Malhotra and Armin Ahmadi and Masfiqur Rahaman and Amol Harsh and Jason Yang and Basma Ghanim and Subhasis Dasgupta and Robert N. Weinreb and Haiyan Zhang and Tauhidur Rahman and Alfons J.H.M. Houben and Joachim H. Ix},
journal = {Kidney International Reports},
year = {2026},
month = aug,
doi = {10.1016/j.ekir.2026.107033},
url = {https://doi.org/10.1016/j.ekir.2026.107033},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Nailfold Capillary Density and Kidney Injury in CKD
AU - Rakesh Malhotra
AU - Armin Ahmadi
AU - Masfiqur Rahaman
AU - Amol Harsh
AU - Jason Yang
AU - Basma Ghanim
AU - Subhasis Dasgupta
AU - Robert N. Weinreb
AU - Haiyan Zhang
AU - Tauhidur Rahman
AU - Alfons J.H.M. Houben
AU - Joachim H. Ix
PY - 2026
DA - 2026/08/20
JO - Kidney International Reports
DO - 10.1016/j.ekir.2026.107033
UR - https://doi.org/10.1016/j.ekir.2026.107033
AB - Background: Microvascular dysfunction plays a key role in the development and progression of chronic kidney disease (CKD). Evaluation of capillaries by microscopy of the nailfolds may provide noninvasive insight into systemic microvascular health, but its relationship with kidney function, proteinuria, and kidney histopathology in patients with CKD remains unknown. Methods: We conducted a cross-sectional analysis of adults with CKD stages 2–5 (estimated glomerular filtration rate [eGFR] < 90 ml/min per 1.73 m2) recruited from nephrology outpatient clinics at a single academic medical center between January 2023 and December 2025. Participants underwent assessment of third and fourth finger nailfold microvascular structure and function using high-resolution video capillaroscopy at 100× magnification. The density of erythrocyte-perfused capillaries (capillaries/mm2) was quantified at baseline, after the release of arterial occlusion (HA) (hyperemic response), and during venous congestion (OA) using a deep learning–based image analysis pipeline. Associations between capillary density measures and kidney function (eGFR) and urine protein-to-creatinine ratio (uPCR) were evaluated using multivariable regression models. In a subset of participants who underwent clinically indicated kidney biopsy, capillary density measures were examined for associations with histopathologic findings, including glomerulosclerosis (GS) and interstitial fibrosis and tubular atrophy (IFTA), using similar multivariable models. Results: Among 189 participants with CKD, mean (standard deviation [SD]) age was 63 (16) years; 49% were female, 42% had diabetes, and 87% had hypertension. Mean (SD) baseline capillary density was 54 (15) capillaries/mm2. The mean eGFR was 41 (22) ml/min per 1.73 m2 and median (interquartile range [IQR]) uPCR was 0.31 [IQR: 0.11–1.8] mg/mg. In adjusted models, higher capillary density was associated with higher eGFR (β, 0.33; 95% confidence interval [CI], 0.25–0.41) and lower uPCR (β −1.1; 95% CI −1.7 to −0.5) independent of CKD risk factors. Results were similar evaluating capillary count at HA and OA. Among the subset of 36 participants with kidney biopsy data, lower capillary density was associated with greater GS and IFTA severity, which remained significant after adjustment for demographic factors, eGFR, and proteinuria. Conclusion: Finger nailfold capillary density is associated with kidney function, proteinuria, and biopsy markers of chronic kidney injury among adults with CKD. Capillaroscopy may provide a noninvasive tool to identify vascular and interstitial damage above and beyond eGFR and proteinuria in patients with CKD.
SN - 2468-0249
ER -