Knockdown of fibrillin-1 suppresses retina-blood barrier dysfunction by inhibiting vascular endothelial apoptosis under diabetic conditions

AIM

To investigate the effects of fibrillin-1 (FBN1) deletion on the integrity of retina-blood barrier function and the apoptosis of vascular endothelial cells under diabetic conditions.

METHODS

Streptozotocin (STZ)-induced diabetic mice were used to simulate the diabetic conditions of diabetic retinopathy (DR) patients, and FBN1 expression was detected in retinas from STZ-diabetic mice and controls. In the Gene Expression Omnibus (GEO) database, the GSE60436 dataset was selected to analyze FBN1 expressions in fibrovascular membranes from DR patients. Using lentivirus to knock down FBN1 levels, vascular leakage and endothelial barrier integrity were detected by Evans blue vascular permeability assay, fluorescein fundus angiography (FFA) and immunofluorescence labeled with tight junction marker in vivo. High glucose-induced monkey retinal vascular endothelial cells (RF/6A) were used to investigate effects of FBN1 on the cells in vitro. The vascular endothelial barrier integrity and apoptosis were detected by trans-endothelial electrical resistance (TEER) assay and flow cytometry, respectively.

RESULTS

FBN1 mRNA expression was increased in retinas of STZ-induced diabetic mice and fibrovascular membranes of DR patients (GSE60436 datasets) using RNA-seq approach. Besides, knocking down of FBN1 by lentivirus intravitreal injection significantly inhibited the vascular leakage compared to STZ-DR group by Evans blue vascular permeability assay and FFA detection. Expressions of tight junction markers in STZ-DR mouse retinas were lower than those in the control group, and knocking down of FBN1 increased the tight junction levels. In vitro, 30 mmol/L glucose could significantly inhibit viability of RF/6A cells, and FBN1 mRNA expression was increased under 30 mmol/L glucose stimulation. Down-regulation of FBN1 reduced high glucose (HG)-stimulated retinal microvascular endothelial cell permeability, increased TEER, and inhibited RF/6A cell apoptosis in vitro.

CONCLUSION

The expression level of FBN1 increases in retinas and vascular endothelial cells under diabetic conditions. Down-regulation of FBN1 protects the retina of early diabetic rats from retina-blood barrier damage, reduce vascular leakage, cell apoptosis, and maintain vascular endothelial cell barrier function.

Targeted treatment of rat AKI induced by rhabdomyolysis using BMSC derived magnetic exosomes and its mechanism

Introduction: rhabdomyolysis (RM) is a serious syndrome. A large area of muscle injury and dissolution induces acute kidney injury (AKI), which results in a high incidence and mortality rate. Exosomes released by mesenchymal stem cells (MSCs) have been used to treat AKI induced by rhabdomyolysis and have shown regenerative effects. However, the most serious drawbacks of these methods are poor targeting and a low enrichment rate after systemic administration. Methods: in this study, we demonstrated that magnetic exosomes derived from bone marrow mesenchymal stem cells (BMSCs) can directly target damaged muscles rather than kidneys using an external magnetic field. Results: magnetic navigation exosomes reduced the dissolution of damaged muscles, greatly reduced the release of cellular contents, slowed the development of AKI. Discussion: in summary, our proposed method can overcome the shortcomings of poor targeting in traditional exosome therapy. Moreover, in the rhabdomyolysis-induced AKI model, we propose for the first time an exosome therapy mode that directly targets damaged muscles through magnetic navigation.

Uric acid mediates the relationship between mixed heavy metal exposure and renal function in older adult people

Background

Population aging is a pivotal trend observed globally, and the exposure to heavy metals can exacerbate the aging process and lead to kidney damage. However, the impact of combined heavy metal exposure on renal function among older individuals remains elusive. Our study employs machine learning techniques to delve into the effects and underlying mechanisms of mixed exposure to heavy metals on the renal function of the aging population.

Methods

This study extracted comprehensive data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2015 and 2020. A total of 3,175 participants aged 60 years and above, with complete information on six metals - lead, cadmium, manganese, cobalt, mercury, and selenium, along with relevant covariates, were included in the study. To assess the impact of single or mixed metal exposure on the renal function of older adult individuals, various statistical techniques were employed: multiple logistic regression, weighted quantitative sum (WQS) regression, Bayesian kernel machine regression (BKMR), and mediation effects analysis.

Results

Multiple logistic regression revealed that selenium and manganese were protective factors for chronic kidney disease (CKD). Cobalt was a risk factor for CKD. High concentrations of lead, cadmium, and cobalt were risk factors for urinary albumin creatinine ratio (ACR). WQS analyses revealed that mixed metal exposure was positively correlated with estimated glomerular filtration rate (eGFR) but negatively correlated with CKD. Selenium and manganese can neutralize the effects of other metals on eGFR. Mixed metal exposure was positively correlated with ACR, with lead and cadmium having a substantial effect. Mediation analysis showed that uric acid (UA) had a mediating effect of 9.7% and -19.7% in the association between mixed metals exposure and proteinuria and CKD, respectively.

Conclusion

The impact of heavy metals on renal function in the older adult differs from that of adolescents and adults. This study suggests that elevated levels of mixed metals exposure are linked to proteinuria and CKD, with UA serving as a mediating factor.

Insulin resistance as the molecular link between diabetes and Alzheimer's disease

Diabetes mellitus (DM) and Alzheimer's disease (AD) are two major health concerns that have seen a rising prevalence worldwide. Recent studies have indicated a possible link between DM and an increased risk of developing AD. Insulin, while primarily known for its role in regulating blood sugar, also plays a vital role in protecting brain functions. Insulin resistance (IR), especially prevalent in type 2 diabetes, is believed to play a significant role in AD's development. When insulin signalling becomes dysfunctional, it can negatively affect various brain functions, making individuals more susceptible to AD's defining features, such as the buildup of beta-amyloid plaques and tau protein tangles. Emerging research suggests that addressing insulin-related issues might help reduce or even reverse the brain changes linked to AD. This review aims to explore the rela-tionship between DM and AD, with a focus on the role of IR. It also explores the molecular mechanisms by which IR might lead to brain changes and assesses current treatments that target IR. Understanding IR's role in the connection between DM and AD offers new possibilities for treatments and highlights the importance of continued research in this interdisciplinary field.

Supplementation of vitamin E as an addition to a commercial renal diet does not prolong survival of cats with chronic kidney disease

BACKGROUND

The aim of this double-blind, placebo-controlled study was to investigate the effect of vitamin E supplementation as an addition to a commercial renal diet on survival time of cats with different stages of chronic kidney disease (CKD). In addition, we were interested whether vitamin E supplementation affects selected oxidative stress and clinical parameters. Thirty-four cats with CKD and 38 healthy cats were included in the study. Cats with CKD were classified according to the IRIS Guidelines; seven in IRIS stage 1, 15 in IRIS stage 2, five in IRIS stage 3 and seven in IRIS stage 4. Cats with CKD were treated according to IRIS Guidelines. Cats with CKD were randomly assigned to receive vitamin E (100 IU/cat/day) or placebo (mineral oil) for 24 weeks in addition to standard therapy. Plasma malondialdehyde (MDA) and protein carbonyl (PC) concentrations, DNA damage of peripheral lymphocytes and plasma vitamin E concentrations were measured at baseline and four, eight, 16 and 24 weeks thereafter. Routine laboratory analyses and assessment of clinical signs were performed at each visit.

RESULTS

Vitamin E supplementation had no effect on the survival time and did not reduce the severity of clinical signs. Before vitamin E supplementation, no significant differences in vitamin E, MDA and PC concentrations were found between healthy and CKD cats. However, plasma MDA concentration was statistically significantly higher (p = 0.043) in cats with early CKD (IRIS stages 1 and 2) than in cats with advanced CKD (IRIS stages 3 and 4). Additionally, DNA damage was statistically significantly higher in healthy cats (p ≤ 0.001) than in CKD cats. Plasma vitamin E concentrations increased statistically significantly in the vitamin E group compared to the placebo group four (p = 0.013) and eight (p = 0.017) weeks after the start of vitamin E supplementation. During the study and after 24 weeks of vitamin E supplementation, plasma MDA and PC concentrations and DNA damage remained similar to pre-supplementation levels in both the placebo and vitamin E groups.

CONCLUSIONS

Vitamin E supplementation as an addition to standard therapy does not prolong survival in feline CKD.

Olfactory Dysfunctions and Chronic Kidney Disease: A Scoping Review

Chronic kidney disease (CKD) represents a significant global public health challenge. Among the various clinical complications associated with CKD, olfactory dysfunction has been identified as a factor that substantially affects the quality of life of patients. This study aims to systematically explore the prevalence, implications, and therapeutic avenues of anosmia in CKD patients. This scoping review utilized the Arksey and O'Malley framework, incorporating the Joanna Briggs Institute methodology, and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The research question, formulated using the PIO framework, guided a thorough search of databases PubMed/Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library and gray literature sources. Eligibility criteria focused on studies involving CKD patients with olfactory dysfunctions. From an initial pool of 832 articles, 17 studies met the criteria, providing insights into olfactory alterations in 4,025 CKD patients. The data that have been reported, define that 55,34% of the sample experienced olfactory changes and the 8.5% experienced anosmia. This review revealed a complex interplay of factors contributing to olfactory alterations, including uremic toxins, dialysis procedures, electrolyte imbalances, and malnutrition. Findings suggested the potential recovery of olfactory function following kidney transplantation. Various assessment tools were utilized, with the University of Pennsylvania Smell Identification Test and Sniffin' Sticks emerging as the primary instruments. The observed variability in findings highlights the need for continued research to understand the mechanisms, enhance therapies, and improve quality of life for CKD patients with olfactory dysfunctions. Future studies should employ standardized methods, explore new assessment tools, and prioritize longitudinal assessments to advance our understanding and management of olfactory dysfunctions in this population.

Multimetal exposure: Challenges in diagnostics, prevention, and treatment

Extensive use of heavy metals has posed a serious concern for ecosystem and human too. Heavy metals are toxic in nature and their accumulation in human body causes serious disorders such as neurological disease, cardiac disease, gastrointestinal problems, skin disorders, reproductive disease, lungs diseases, and so on. Furthermore, heavy metals not only affect the human health but also have a negative impact on the economy. In the current review, we have elaborated the impact of heavy metal exposure on human health and socioeconomics. We have discussed the molecular mechanism involved in the heavy metal-induced human disorders such as oxidative stress, neuroinflammation, and protein misfolding. Finally, we discussed the preventive measure and treatment strategy that could counter the negative effects of heavy metal intoxications. In conclusion, there is a substantial correlation between heavy metals and the onset and advancement of several health issues. Chelation treatment could be a useful tactic to lessen the toxic metal load and the difficulties that come with it.

Olfactory function in diabetes mellitus

Diabetes mellitus (DM) is an increasingly common disease in both children and adults. In addition to neuronal and/or vascular disorders, it can cause chemosensory abnormalities including olfactory deterioration. The purpose of this article is to summarize current knowledge on olfactory function in DM, highlighting the impact of co-morbidities, especially obesity, thyroid dysfunction, chronic kidney disease and COVID-19 on olfactory outcomes. Research to date mostly shows that olfactory impairment is more common in people with diabetes than in the general population. In addition, the presence of concomitant diseases is a factor increasing olfactory impairment. Such a correlation was shown for type 1 diabetes, type 2 diabetes and gestational diabetes. At the same time, not only chronic diseases, but also DM in acute conditions such as COVID-19 leads to a higher prevalence of olfactory disorders during infection. Analyzing the existing literature, it is important to be aware of the limitations of published studies. These include the small number of patients studied, the lack of uniformity in the methods used to assess the sense of smell, frequently relying on rated olfactory function only, and the simultaneous analysis of patients with different types of diabetes, often without a clear indication of diabetes type. In addition, the number of available publications is small. Certainly, further research in this area is needed. From a practical point of view decreased olfactory performance may be an indicator for central neuropathy and an indication for assessing the patient's nutritional status, examining cognitive function, especially in older patients and performing additional diagnostic tests, such as checking thyroid function, because all those changes were correlated with smell deterioration.

Health of Holochilus chacarius (Rodentia: Cricetidae) in rice agroecosystem in a neotropical wetland assessed by histopathology

Small mammals have a short lifetime and are strictly associated with their environment. This work aimed to use histopathology to assess the health of Holochilus chacarius in a rice agroecosystem in the Pantanal of Mato Grosso do Sul. During necropsy, fragments of the lung, kidney, skin, liver, and reproductive system of 33 animals were collected and submitted to histological processing. Tissue damages were evaluated as mild, moderate, and severe and arranged in a matrix for further statistical analysis. Furthermore, we used generalized linear models to verify the influence of tissue changes on the body condition, obtained by a regression between body mass and length. In the lungs, we found an intense inflammatory infiltrate associated with anthracosis that had a negative influence on the body's condition. Also, we observed degenerative and inflammatory changes in the liver, kidneys, skin, and reproductive system that ranged from mild to moderate. The histopathological lesions observed in this study may be associated with environmental alterations of anthropic origin such as the exposure to soot from wildfires and heavy metals, evidenced by lesions in the lung, kidney, and liver. The present study provided a histopathological matrix as a new approach that allows to classify and quantify the tissue alterations. Tissue changes when associated with body condition demonstrated to be an effective tool to assess the health of small free-living mammals, showing that these animals can be used as bioindicators of environmental condition.

Vitamin Supplement Use in Patients With CKD: Worth the Pill Burden?

All vitamins play essential roles in various aspects of body function and systems. Patients with chronic kidney disease (CKD), including those receiving dialysis, may be at increased risk of developing vitamin deficiencies due to anorexia, poor dietary intake, protein energy wasting, restricted diet, dialysis loss, or inadequate sun exposure for vitamin D. However, clinical manifestations of most vitamin deficiencies are usually subtle or undetected in this population. Testing for circulating levels is not undertaken for most vitamins except folate, B12, and 25-hydroxyvitamin D because assays may not be available or may be costly to perform and do not always correlate with body stores. The last systematic review through 2016 was performed for the Kidney Disease Outcome Quality Initiative (KDOQI) 2020 Nutrition Guideline update, so this article summarizes the more recent evidence. We review the use of vitamins supplementation in the CKD population. To date there have been no randomized trials to support the benefits of any vitamin supplementation for kidney, cardiovascular, or patient-centered outcomes. The decision to supplement water-soluble vitamins should be individualized, taking account the patient's dietary intake, nutritional status, risk of vitamins deficiency/insufficiency, CKD stage, comorbid status, and dialysis loss. Nutritional vitamin D deficiency should be corrected, but the supplementation dose and formulation need to be personalized, taking into consideration the degree of 25-hydroxyvitamin D deficiency, parathyroid hormone levels, CKD stage, and local formulation. Routine supplementation of vitamins A and E is not supported due to potential toxicity. Although more trial data are required to elucidate the roles of vitamin supplementation, all patients with CKD should undergo periodic assessment of dietary intake and aim to receive various vitamins through natural food sources and a healthy eating pattern that includes vitamin-dense foods.

Emerging role of extracellular vesicles in diabetic retinopathy

Diabetic retinopathy (DR), a complex complication of diabetes mellitus (DM), is a leading cause of adult blindness. Hyperglycemia triggers DR, resulting in microvascular damage, glial apoptosis, and neuronal degeneration. Inflammation and oxidative stress play crucial roles during this process. Current clinical treatments for DR primarily target the advanced retinal disorder but offer limited benefits with inevitable side effects. Extracellular vesicles (EVs) exhibit unique morphological features, contents, and biological properties and can be found in cell culture supernatants, various body fluids, and tissues. In DR, EVs with specific cargo composition would induce the reaction of receptor cell once internalized, mediating cellular communication and disease progression. Increasing evidence indicates that monitoring changes in EV quantity and content in DR can aid in disease diagnosis and prognosis. Furthermore, extensive research is investigating the potential of these nanoparticles as effective therapeutic agents in preclinical models of DR. This review explores the current understanding of the pathological effects of EVs in DR development, discusses their potential as biomarkers and therapeutic strategies, and paves the way for further research and therapeutic advancements.

Antibacterial, antidiabetic, acute toxicity, antioxidant, and nephroproductive competence of extracts of Lannea coromandelica fruit through in-vitro and in-vivo animal model investigation

The anti-dermatophytic (Proteus vulgaris, Klebsiella pneumoniae, Enterobacter aerogenes, Propionibacterium acnes, Staphylococcus aureus, and Streptococcus pyogenes) and nephroprotective activities of methanol and aqueous extracts obtained from Lannea coromandelica fruit were investigated through in-vitro (agar well diffusion method) and in-vivo (animal model) study. The methanol extract showed considerable antibacterial activity against selective bacterial pathogens at increased concentration (15.0 mg mL-1) in the following order P. vulgaris (35.2 ± 1.6 mm) > E. aerogenes (32.1 ± 2.1 mm) > K. pneumoniae (29.3±2 mm) > P. acnes (28.2 ± 2.4 mm) > S. aureus (25.5 ± 2.4 mm) > S. pyogenes (24.3 ± 2.1 mm) than aqueous extract. The MIC values of this methanol and aqueous extract was found as 2.5-7.5 mg mL-1 and 5.0 to 1.0 mg mL-1 respectively. Different treatment sets (A-E) on a rat-based animal model study revealed that the methanol extract has excellent antioxidant and nephroprotective activity, as well as favorable effects on essential biochemical substances involved in active metabolic activities. As demonstrated by histopathological and microscopic examination, the biologically active chemical present in methanol extract had a positive effect on serum markers, enzyme, and non-enzyme-based antioxidant activities, as well as lowering the toxicity caused by EG in the rat (as nephroprotective activity) renal cells.

The Kidney-Gut Axis as a Novel Target for Nutritional Intervention to Counteract Chronic Kidney Disease Progression

A well-balanced diet is integral for overall health, aiding in managing key risk factors for kidney damage like hypertension while supplying necessary precursors for metabolite production. Dietary choices directly influence the composition and metabolic patterns of the gut microbiota, showing promise as therapeutic tools for addressing various health conditions, including chronic kidney diseases (CKD). CKD pathogenesis involves a decline in the glomerular filtration rate and the retention of nitrogen waste, fostering gut dysbiosis and the excessive production of bacterial metabolites. These metabolites act as uremic toxins, contributing to inflammation, oxidative stress, and tissue remodeling in the kidneys. Dietary interventions hold significance in reducing oxidative stress and inflammation, potentially slowing CKD progression. Functional ingredients, nutrients, and nephroprotective phytoconstituents could modulate inflammatory pathways or impact the gut mucosa. The "gut-kidney axis" underscores the impact of gut microbes and their metabolites on health and disease, with dysbiosis serving as a triggering event in several diseases, including CKD. This review provides a comprehensive overview, focusing on the gut-liver axis, and explores well-established bioactive substances as well as specific, less-known nutraceuticals showing promise in supporting kidney health and positively influencing CKD progression.

Neurovascular Relationships in AGEs-Based Models of Proliferative Diabetic Retinopathy

Diabetic retinopathy affects more than 100 million people worldwide and is projected to increase by 50% within 20 years. Increased blood glucose leads to the formation of advanced glycation end products (AGEs), which cause cellular and molecular dysfunction across neurovascular systems. These molecules initiate the slow breakdown of the retinal vasculature and the inner blood retinal barrier (iBRB), resulting in ischemia and abnormal angiogenesis. This project examined the impact of AGEs in altering the morphology of healthy cells that comprise the iBRB, as well as the effects of AGEs on thrombi formation, in vitro. Our results illustrate that AGEs significantly alter cellular areas and increase the formation of blood clots via elevated levels of tissue factor. Likewise, AGEs upregulate the expression of cell receptors (RAGE) on both endothelial and glial cells, a hallmark biomarker of inflammation in diabetic cells. Examining the effects of AGEs stimulation on cellular functions that work to diminish iBRB integrity will greatly help to advance therapies that target vision loss in adults.

Nephroprotective effect of PHYMIN-22 on ethylene glycol induced urolithiasis rat model

The present study was designed to evaluate the antiurolithiatic effect of PHYMIN-22 against ethylene glycol-induced urolithiasis in rats. Healthy Albino male rats with 200-230 g body weight were randomly divided into five groups, each with 5 animals, control group, EG group (0.75%), PHYMIN-22 treatment group (0.75% EG 14 days and 100 mg/kg PHYMIN-22 next 14 days), PHYMIN-22 drug control group (100 mg/kg) and cystone treatment group (0.75% EG 14 days and 750 mg/kg cystone next 14 days). Biochemical testing was adopted for measuring the blood and urine parameters, as well as the level of antioxidants including superoxide dismutase (SOD), Catalase (Cat), Glutathione peroxidase (GPx) and glutathione (GSH) in kidney tissues. Hematoxylin and eosin (HE) staining was utilized to observe the histopathological changes in the kidney tissue. End of the experiment the PHYMIN-22 treatment reduced the urine and serum calcium (p < 0.01; p < 0.01), oxalate (p < 0.01; p < 0.01), phosphate (p < 0.01; p < 0.01), uric acid (p < 0.001; p < 0.001), protein (p < 0.001; p < 0.001), and creatinine (p < 0.001; p < 0.001) respectively, serum indicators ALT (p < 0.001) and AST (p < 0.001) level and non-enzymic antioxidant GSH (p < 0.001) compared to EG induced urolithiasis animals (Diseased control group). PHYMIN-22 treatment significantly increased urine volume, pH, and body weight, and antioxidants include CAT (p < 0.001; p < 0.001), SOD (p ˃ 0.05; p < 0.05), and GPX (p < 0.01; p < 0.001) compared to Diseased control group animals. The effect of PHYMIN-22 on EG-induced urolithiasis animals could be by improving kidney function, normalizing the urine and serum parameters, maintaining the kidney antioxidants, eliminating crystal deposition, and excretion of unwanted ions from the kidney and urinary tract.

Diabetic Nephropathy: Significance of Determining Oxidative Stress and Opportunities for Antioxidant Therapies

Diabetes mellitus (DM) belongs to the category of socially significant diseases with epidemic rates of increases in prevalence. Diabetic nephropathy (DN) is a specific kind of kidney damage that occurs in 40% of patients with DM and is considered a serious complication of DM. Most modern methods for treatments aimed at slowing down the progression of DN have side effects and do not produce unambiguous positive results in the long term. This fact has encouraged researchers to search for additional or alternative treatment methods. Hyperglycemia has a negative effect on renal structures due to a number of factors, including the activation of the polyol and hexosamine glucose metabolism pathways, the activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, the accumulation of advanced glycation end products and increases in the insulin resistance and endothelial dysfunction of tissues. The above mechanisms cause the development of oxidative stress (OS) reactions and mitochondrial dysfunction, which in turn contribute to the development and progression of DN. Modern antioxidant therapies for DN involve various phytochemicals (food antioxidants, resveratrol, curcumin, alpha-lipoic acid preparations, etc.), which are widely used not only for the treatment of diabetes but also other systemic diseases. It has also been suggested that therapeutic approaches that target the source of reactive oxygen species in DN may have certain advantages in terms of nephroprotection from OS. This review describes the significance of studies on OS biomarkers in the pathogenesis of DN and analyzes various approaches to reducing the intensity of OS in the prevention and treatment of DN.

Determination of Risk Factors for Postoperative Acute Kidney Injury in Patients With Gynecologic Malignancies

Background Postoperative acute kidney injury (AKI) is an important cause of mortality and morbidity among surgical patients. There is little information on the occurrence of AKI after operations for gynecologic malignancies. This study aimed to determine the incidence of AKI in patients who underwent surgery for gynecological malignancies and determine the risk factors in those who developed postoperative AKI. Methodology A total of 1,000 patients were enrolled retrospectively from January 2007 to March 2013. AKI was defined according to the Kidney Disease Improving Global Outcomes 2012 Clinical Practice Guideline for Acute Kidney Injury. Perioperative variables of patients were collected from medical charts. Results The incidence of postoperative AKI was 8.8%, with stage 1 occurring in 5.9%, stage 2 in 2.4%, and stage 3 in 0.5% of the patients. Patients who had AKI were significantly older, had higher body mass index (BMI) higher preoperative C-reactive protein (CRP) levels, and more frequently had a history of distant organ metastasis when compared with those who did not have AKI. When compared with patients who did not develop AKI postoperatively, longer operation times and intraoperative usage of higher amounts of erythrocyte suspension and fresh frozen plasma were seen in those who developed AKI. Conclusions Patients who had AKI were older, had higher BMI with higher preoperative CRP levels, more frequent distant organ metastasis, longer operation times, and higher amounts of blood transfused intraoperatively. Defining preoperative, intraoperative, and postoperative risk factors for postoperative AKI and taking necessary precautions are important for the early detection and intervention of AKI.

Does Vitamin Supplementation Play a Role in Chronic Kidney Disease?

Although the role of vitamins in the human body is proven, guidelines for patients with chronic kidney disease (CKD) remain unclear. This narrative review summarizes the findings of 98 studies of CKD and the effects of vitamin D, B, C, A, E, and K supplementation on patients on dialysis for CKD, with the aim of summarizing the existing guidelines. The findings are promising, showing the potential effectiveness of vitamin supplementation with, for example, vitamins B, D, or C. However, recommendations are still ambiguous, especially in the case of vitamins A and K, due to the potential toxicity associated with higher doses for patients. Continued research is needed to rigorously evaluate the effectiveness and carefully consider the potential risks of some vitamin supplementation for patients with CKD.

In Vitro Biological Activity and Lymphoma Cell Growth Inhibition by Selected Mexican Medicinal Plants

Cancer is a major health problem with significant morbidity and mortality. In addition, plants are a source of metabolites with diverse biological properties, including antitumor potential. In this study, we investigated the in vitro murine lymphoma L5178Y-R cell growth inhibition, human peripheral blood mononuclear cells (PBMC) toxicity and proliferation, and antioxidant, hemolytic, and anti-hemolytic activities of methanol extracts from 15 plants of traditional use in Mexico. Justicia spicigera caused the highest tumor cell growth inhibition with a half maximal inhibitory concentration (IC50) of 29.10 µg/mL and a selectivity index >34.36 compared with those of PBMC, whereas Mimosa tenuiflora showed the highest lymphoproliferative activity from 200 µg/mL compared with that induced by concanavalin A. In addition, M. tenuiflora showed an antioxidant effect (IC50 = 2.86 µg/mL) higher than that of ascorbic acid. Regarding the hemolytic and anti-hemolytic activity, all extracts presented significant anti-hemolytic activity. The extract of J. spicigera is emerging as a possible source of effective antineoplastic compounds.

Beneficial and adverse effects of vitamin E on the kidney

This article reviews the beneficial and adverse effects of high-dose vitamin E supplementation on the vitamin E status and renal function in human and rodent studies. The high doses of vitamin E, which can cause renal effects, were compared to upper limits of toxicity (UL) as established by various authorities worldwide. In recent mice studies with higher doses of vitamin E, several biomarkers of tissue toxicity and inflammation were found to be significantly elevated. In these biomarker studies, the severity of inflammation and the increased levels of the biomarkers are discussed together with the need to re-evaluate ULs, given the toxic effects of vitamin E on the kidney and emphasizing oxidative stress and inflammation. The controversy in the literature about vitamin E effects on the kidney is mainly caused by the dose-effects relations that do not give a clear view, neither in human nor animals studies. In addition, more recent studies on rodents with new biomarkers of oxidative stress and inflammation give new insights into possible mechanisms. In this review, the controversy is shown and an advice given on the vitamin E supplementation for renal health.

Comparison between olfactory training and curcumin therapy in improving olfactory dysfunction in patients with chronic kidney disease

Objective

Olfactory dysfunction can be seen in chronic kidney disease (CKD) patients. We aimed to investigate the effects of olfactory training and curcumin on olfactory dysfunction in CKD patients and compare their impact with a placebo.

Methods

We conducted a double-blind, randomized, placebo-controlled trial in CKD patients, 2021-2022. We enrolled 60 participants in our study into three groups (curcumin, training, and control). Participants were randomized into trials and control groups and assessed using the Iran-smell identification test (Iran-SIT), a questionnaire of olfactory disorders (QOD), and a self-assessment tool. P-value < 0.05 was considered statistically significant.

Results

We gathered 58 participants (mean age of 56.1 ± 2.5, 56.9% men). All the tests showed that curcumin improved olfactory function after the trial, though it was significant in QOD (17.5 ± 11.8 vs. 13.1 ± 9.7, p = 0.045) and self-assessment results (8.5 ± 3.1 vs. 9.5 ± 4.0, p = 0.047). Moreover, compared to baseline, training patients experienced an increase in their olfactory function in Iran-SIT (15.3 ± 4.9 vs. 18.8 ± 2.7, p = 0.001), QOD (19.0 ± 10.4 vs. 12.2 ± 9.9, p = 0.003), and self-assessment tools (6.8 ± 1.8 vs. 8.2 ± 3.1, p = 0.027). In contrast, the olfactory function was unchanged in control in all the tests (p > 0.05). Also, the improved change of Iran-SIT and QOD scores during the trial was more significant in training compared to the curcumin group (p < 0.002).

Conclusion

The findings of this study indicate that olfactory training, even more than curcumin, can improve olfactory function in CKD patients. This information may help manage olfactory dysfunction in the CKD population.

Effects of mixed heavy metals on kidney function in premenopausal and postmenopausal women

OBJECTIVE

To evaluate the relationships between heavy metals (cadmium, lead, and mercury) and their mixtures and estimated glomerular filtration rate (eGFR) in premenopausal and postmenopausal women.

METHODS

Using data from the Korean National Health and Nutrition Examination Survey (2009-2017), multivariate linear regression models, marginal effects, and weighted quantile sum regression, we assessed the associations between single heavy metals and their mixtures and eGFR among 5,372 women.

RESULTS

Risks of reduced eGFR, comorbidities, and heavy metal exposure were found to be higher in postmenopausal women than in premenopausal women. A negative association of cadmium ( β = -2.97; 95% CI, -5.10 to -0.85) and a positive association of mercury ( β = 2.97; 95% CI, 1.49 to 4.44), with eGFR in postmenopausal women. Inverse associations of lead with eGFR in both premenopausal women ( β = -4.75; 95% CI, -6.04 to -3.46) and postmenopausal women ( β = -4.54; 95% CI, -6.96 to -2.13). Interactions were identified between lead and mercury, as well as cadmium and lead for eGFR among premenopausal women ( β = -2.04; 95% CI, -2.98 to -1.10) and postmenopausal women ( β = -3.52; 95% CI, -6.04 to -1.01), respectively. There was a negative association between mixed heavy metals and eGFR in both premenopausal women ( β = -2.23; 95% CI, -3.51 to -0.96) and postmenopausal women ( β = -3.86; 95% CI, -6.89 to -0.83). Lead was found as a key chemical related to reduced eGFR. Cutoff values for each heavy metal concentration related to eGFR were provided.

CONCLUSION

Postmenopausal women were more influenced by mixed heavy metals' effects on kidney function than premenopausal women. Early interventions (eg, water filtering, heavy metal yearly screening) in women, especially postmenopausal women, are needed to reduce the incidence of chronic kidney disease.

Histopathological and health risk assessment of heavy metals in the straw-colored fruit bat, Eidolon helvum, in Nigeria

There is heightening concern regarding heavy metals environmental pollution requiring renewed global attention because of their bioaccumulation and toxicity at varying levels. The concern is most important in the highly migratory Eidolon helvum (E. helvum) that is very common and traverses wide geographical areas within the sub-Saharan Africa. The present study aimed to evaluate levels of cadmium (Cd), lead (Pb), and zinc (Zn) bioaccumulation in 24 E. helvum of both sexes from Nigeria to assess their indirect health risks to the human consumers of the bats in addition to their direct bioaccumulation and toxic damages in the bats themselves based on standard procedures. Lead, Zn, and Cd bioaccumulation concentrations were 2.83 ± 0.35, 0.42 ± 0.03, and 0.05 ± 0.01 mg/kg, respectively, with significant (p < 0.05) Pb bioaccumulation compared to either Cd or Zn in the affected bats. However, only Pb (markedly) and Cd (marginally) bioaccumulated above small mammals' critical threshold levels as there are no existing established threshold levels for bats. Sex played no major role in their bioaccumulation levels. The bioaccumulation levels posed no life-long non-carcinogenic nor carcinogenic risks to the human consumers of the bats at detected concentrations. The observed lungs, liver, and kidney histopathological changes suggested the possible direct effects of the metals in the bats. Nevertheless, other anthropogenic factors might be responsible as no significant (p > 0.05) correlation existed between cellular changes and the bioaccumulation levels. The presence of the heavy metals and their bioaccumulations above critical threshold levels suggested some levels of environmental contamination and pollution, which might have direct and indirect health implications to the bats and their human consumers.

Drinking Water Sources along the Banks of Buriganga River of Bangladesh are Polluted and Possess Serious Health Risks: A Comprehensive In Vivo Analysis

Background

The river Buriganga, one of the major dumping zones of industrial wastes in Bangladesh, is responsible for contaminating the drinking water sources along its length. This study aimed to assess the water quality from these sources by monitoring the changes in hematological, biochemical, and histological parameters caused in healthy rats due to their consumption.

Methods

Using ethylenediaminetetraacetic acid (EDTA) as an anticoagulant agent, hematological and biochemical analyses of Sprague-Dawley rat models were executed in this study. Following blood sampling, the rats were sacrificed, and the heart, lungs, kidneys, liver, and spleen were separated to carry out the histological analysis. Later, to perform the statistical analysis, SPSS, V.25.0 was utilized.

Results

A significant rise (p < 0.02) in body weight was recorded due to increased protein synthesis, inflammations; increased lymphocyte, white blood cell (WBC), and neutrophil count but hemoglobin (20.0 ± 1.39 g/dL vs. 15.25 ± 0.36 g/dL; p) and red blood cell (RBC) count ((6.24 ± 0.45) × 106/µL vs. (5.47 ± 0.34) × 106/µL)) decreased due to infections and hematopoietic stem cell poisoning by pathogens in water samples. Elevated (p < 0.01) serum urea, creatinine, alanine, and aspartate aminotransferase levels indicated kidney malfunction and hepatic tissue necrosis. Histological analysis revealed gross lesions, internal hemorrhages in the brain; inflammations, granulomas, migrating macrophages in the spleen; fibrosis (resulting in hypo-perfusion), and collagen formation in cardiac muscles.

Conclusions

The findings in this study provide comprehensive evidence, based on in vivo analysis, that the water bodies around the Buriganga river are likely to be contaminated with toxic chemicals and microbial entities making them unfit for human consumption.

Transforming growth factor-β signaling: From tissue fibrosis to therapeutic opportunities

Fibrosis refers to the excessive deposition of extracellular matrix components in the processes of wound repair or tissue regeneration after tissue damage. Fibrosis occurs in various organs such as lung, heart, liver, and kidney tissues, resulting in the failure of organ structural integrity and its functional impairment. It has long been thought to be relentlessly progressive and irreversible process, but both preclinical models and clinical trials in multiorgans have shown that fibrosis is a highly dynamic process. Transforming growth factor-beta (TGF-β) is a superfamily of related growth factors. Many studies have described that activation of profibrotic TGF-β signaling promotes infiltration and/or proliferation of preexisting fibroblasts, generation of myofibroblasts, extracellular matrix deposition, and inhibition of collagenolysis, which leads to fibrosis in the pathological milieu. This review describes the effect of TGF-β signaling in fibrotic-associate lung, heart, liver, and kidney tissues, followed by a detailed discussion of canonical and non-canonical TGF-β signaling pathway. In addition, this review also discusses therapeutic options by using natural products and chemical agents, for targeting tissue fibrosis via modulating TGF-β signaling to provide a more specific concept-driven therapy strategy for multiorgan fibrosis.

Amelioration of 5-Fluorouracil Induced Nephrotoxicity by Acacia catechu through Overcoming Oxidative Damage and Inflammation in Wistar Rats

AIM

The research intended to explore the possible nephroprotective potential of the ethyl acetate fraction derived from Acacia catechu leaves against nephrotoxicity brought about by 5-fluorouracil (5-FU) in Wistar rats.

BACKGROUND

While possessing strong anticancer properties, 5-FU is hindered in its therapeutic application due to significant organ toxicity linked to elevated oxidative stress and inflammation.

OBJECTIVE

The study is undertaken to conduct an analysis of the ethyl acetate fraction of A. catechu leaves both in terms of quality and quantity, examining its impact on different biochemical and histopathological parameters within the context of 5-FU-induced renal damage in rats and elucidation of the mechanism behind the observed outcomes.

METHODOLOGY

Intraperitoneal injection of 5-FU at a dosage of 20 mg/kg/day over 5 days was given to induce nephrotoxicity in rats. The evaluation of nephrotoxicity involved quantifying serum creatinine, urea, uric acid, and electrolyte concentrations. Furthermore, superoxide dismutase, catalase antioxidant enzymes, and TNF-α concentration in serum were also measured.

RESULTS

5-FU injection led to the initiation of oxidative stress within the kidneys, leading to modifications in renal biomarkers (including serum creatinine, urea, uric acid, and Na+, K+ levels), and a reduction in antioxidant enzymes namely superoxide dismutase and catalase. Notably, the presence of the inflammatory cytokine TNF-α was significantly elevated due to 5-FU. Microscopic examination of renal tissue revealed tubular degeneration and congestion. However, treatment involving the ethyl acetate fraction derived from A. catechu leaves effectively and dose-dependently reversed the changes observed in renal biomarkers, renal antioxidant enzymes, inflammatory mediators, and histopathological features, bringing them closer to normal conditions. The observed recuperative impact was mainly attributed to the antioxidant and antiinflammatory properties of the fraction.

CONCLUSION

The ethyl acetate fraction of A. catechu leaves exhibited a mitigating influence on the renal impairment caused by 5-FU, showcasing its potential as a nephroprotective agent capable of preventing and ameliorating 5-FU-induced nephrotoxicity.

Research Progress on the Positive and Negative Regulatory Effects of Rhein on the Kidney: A Review of Its Molecular Targets

Currently, both acute kidney injury (AKI) and chronic kidney disease (CKD) are considered to be the leading public health problems with gradually increasing incidence rates around the world. Rhein is a monomeric component of anthraquinone isolated from rhubarb, a traditional Chinese medicine. It has anti-inflammation, anti-oxidation, anti-apoptosis, anti-bacterial and other pharmacological activities, as well as a renal protective effects. Rhein exerts its nephroprotective effects mainly through decreasing hypoglycemic and hypolipidemic, playing anti-inflammatory, antioxidant and anti-fibrotic effects and regulating drug-transporters. However, the latest studies show that rhein also has potential kidney toxicity in case of large dosages and long use times. The present review highlights rhein's molecular targets and its different effects on the kidney based on the available literature and clarifies that rhein regulates the function of the kidney in a positive and negative way. It will be helpful to conduct further studies on how to make full use of rhein in the kidney and to avoid kidney damage so as to make it an effective kidney protection drug.

Acute Oral Administration of Cerium Oxide Nanoparticles Suppresses Lead Acetate-Induced Genotoxicity, Inflammation, and ROS Generation in Mice Renal and Cardiac Tissues

Lead, a highly toxic pollutant, causes numerous health problems and affects nearly all biological systems thus arousing interest in using antioxidants to reduce its toxic effects. Therefore, the undertaken study estimated the influence of cerium oxide nanoparticles (CeO2-NPs) on the lead acetate-induced genotoxicity and inflammation in the kidney and heart tissues of mice. Twenty male mice were randomly divided into negative control and lead acetate and/or CeO2-NPs administrated groups. Comet and diphenylamine assays were conducted to assess the DNA damage and the expression of apoptosis-related genes and inflammatory cytokines were also measured in addition to the estimation of reactive oxygen species (ROS) level. Co-administration of CeO2-NPs significantly reduced the DNA damage and ROS generation caused by lead acetate in the kidney and heart tissues. The co-administration of CeO2-NPs also ameliorated the lead acetate-induced dysregulation in the expression levels of p53, K-ras, interleukin-6, and cyclooxygenase-2 in the kidney and heart. Conclusion: the co-administration of CeO2-NPs suppresses the genotoxicity, inflammation, and ROS generation resulting from lead acetate administration and restoring the genomic DNA integrity; thus, administration of CeO2-NPs is recommended to minimize the lead acetate-induced hazards.

Diagnosis of chronic renal insufficiency by Cockcroft formula in elderly adults with Diabetes Mellitus type ll

Objective: To determine the diagnosis of Chronic Renal Insufficiency, by Cockcroft formula, in type II diabetic patients aged 40 to 80 years old from the community of Santa Cruz, Hecelchakán during the period from August 2020 to July 2021. Materials and methods: This is a prospective, cross-sectional, descriptive and observational study in which the diagnosis of renal failure in any of its 5 stages will be investigated. Patients were asked for laboratory tests of plasma creatinine, weight and age, to later calculate the creatinine clearance using the Cockcroft and Gault formula and classify the stage of renal failure in which each patient is to formulate plans of practice of according to your state. Results: We found 10 cases with chronic kidney disease in stage 1, 3 men and 7 women, in stage 2 8 patients were found, 2 men and 6 women, and 5 patients with stage 3, all of them female. Conclusions: In the community of Santa Cruz, Hecelchakán, there is a prevalence of 3.9% in diabetes mellitus, 42 people who come monthly from a total population of 1,060 according to the November 2020 population census.

Harnessing the Full Potential of Multi-Omic Analyses to Advance the Study and Treatment of Chronic Kidney Disease

Chronic kidney disease (CKD) was the 12th leading cause of death globally in 2017 with the prevalence of CKD estimated at ~9%. Early detection and intervention for CKD may improve patient outcomes, but standard testing approaches even in developed countries do not facilitate identification of patients at high risk of developing CKD, nor those progressing to end-stage kidney disease (ESKD). Recent advances in CKD research are moving towards a more personalised approach for CKD. Heritability for CKD ranges from 30% to 75%, yet identified genetic risk factors account for only a small proportion of the inherited contribution to CKD. More in depth analysis of genomic sequencing data in large cohorts is revealing new genetic risk factors for common diagnoses of CKD and providing novel diagnoses for rare forms of CKD. Multi-omic approaches are now being harnessed to improve our understanding of CKD and explain some of the so-called 'missing heritability'. The most common omic analyses employed for CKD are genomics, epigenomics, transcriptomics, metabolomics, proteomics and phenomics. While each of these omics have been reviewed individually, considering integrated multi-omic analysis offers considerable scope to improve our understanding and treatment of CKD. This narrative review summarises current understanding of multi-omic research alongside recent experimental and analytical approaches, discusses current challenges and future perspectives, and offers new insights for CKD.

Disease-related malnutrition in chronic kidney disease

PURPOSE OF REVIEW

Disease-related malnutrition has complex and multifactorial pathophysiology. It is common in patients with chronic kidney disease (CKD) and has a devastating impact on morbidity and mortality. Given the rising numbers of patients diagnosed with CKD, disease-related malnutrition is an escalating clinical challenge. This review summarises current knowledge in relation to the development, screening and treatments for disease-related malnutrition in CKD.

RECENT FINDINGS

New research has identified other potential causes for the development of malnutrition in CKD, including changes in taste and smell, and effects of polypharmacy. Screening and assessment studies have investigated different tools in relation to the new Global Leadership Initiative on Malnutrition (GLIM) criteria. Different modalities of low protein diets and the potential use of pre and probiotics are being explored. Furthermore, the importance of nutritional support, and possibly exercise during dialysis is being examined in terms of reducing anabolic resistance and catabolism.

SUMMARY

Further research is required to better understand the nuances of the pathophysiology of disease-related malnutrition in CKD. This work should inform not only consistent terminology and the application of assessment tools specific to disease-related malnutrition in CKD but also the development of novel interventions that reflect its multifaceted pathophysiology and impact.

Estimation of Ecological and Human Health Risks Posed by Heavy Metals in Street Dust of Madrid City (Spain)

In this work, sampling was carried out in the urban area of Madrid to analyze the content of total heavy metals (Zn, Pb, Cu, Cr, Ni, and Cd) in the street dust. Contamination was evaluated using various indices, such as the Contamination Factor (CF), Enrichment Factor (EF), Geo-accumulation Index (Igeo), Potential Ecological Risk Index (RI), Pollution Load Index (PLI), the Human Health Index Hazard Index (HI), and Cancer Risk (CR). Pollution indices were related to traffic density and color. Traffic density was the factor that most influenced the values of the pollution indexes, but no significant differences were found with the color of street dust. The concentration of heavy metals in the urban dust of Madrid had the following sequence: Zn (895) > Cu (411) > Pb (290) > Cr (100) > Ni (42) > Cd (1.25 mg kg−1). The pollution levels were high or very high in Pb, Zn, and Cd regarding the environmental pollution indexes. Ingestion was the main route of exposure to heavy metals contained in street dust. The CR for adults and children is less than 1 × 10−6, which means that there is no risk for the population. However, the HI was 10 times higher in children than in adults.

Not Only COVID-19: Involvement of Multiple Chemosensory Systems in Human Diseases

Chemosensory systems are deemed marginal in human pathology. In appraising their role, we aim at suggesting a paradigm shift based on the available clinical and experimental data that will be discussed. Taste and olfaction are polymodal sensory systems, providing inputs to many brain structures that regulate crucial visceral functions, including metabolism but also endocrine, cardiovascular, respiratory, and immune systems. Moreover, other visceral chemosensory systems monitor different essential chemical parameters of “milieu intérieur,” transmitting their data to the brain areas receiving taste and olfactory inputs; hence, they participate in regulating the same vital functions. These chemosensory cells share many molecular features with olfactory or taste receptor cells, thus they may be affected by the same pathological events. In most COVID-19 patients, taste and olfaction are disturbed. This may represent only a small portion of a broadly diffuse chemosensory incapacitation. Indeed, many COVID-19 peculiar symptoms may be explained by the impairment of visceral chemosensory systems, for example, silent hypoxia, diarrhea, and the “cytokine storm”. Dysregulation of chemosensory systems may underlie the much higher mortality rate of COVID-19 Acute Respiratory Distress Syndrome (ARDS) compared to ARDSs of different origins. In chronic non-infectious diseases like hypertension, diabetes, or cancer, the impairment of taste and/or olfaction has been consistently reported. This may signal diffuse chemosensory failure, possibly worsening the prognosis of these patients. Incapacitation of one or few chemosensory systems has negligible effects on survival under ordinary life conditions but, under stress, like metabolic imbalance or COVID-19 pneumonia, the impairment of multiple chemosensory systems may lead to dire consequences during the course of the disease.

Lead exposure-induced changes in hematology and biomarkers of hepatic injury: protective role of TrévoTM supplement

Lead exposure has been linked to health challenges involving multiple organ failure. More than fifty percent of lead present in the human body is accumulated in the liver causing hepatic injury. A major mechanism of lead toxicity is oxidative stress. TrévoTM is a nutritional supplement with numerous bioactive natural products with detoxifying and antioxidant properties. This study was designed to investigate the hepatoprotective effects of TrévoTM dietary supplements against lead-hepatotoxicity in male Wistar rats. Thirty-five healthy animals were divided into five groups of seven each as follows: Group I=control; II=15 mg/kg of lead acetate (PbA); III= 2 mL/kg of TrévoTM + PbA; IV= 5 mL/kg of TrévoTM + PbA;V=5 mL/kg of TrévoTM . Animals were orally treated with TrévoTM for two days before co-administration with PbA intraperitoneally for 12 consecutive days. Animals were sacrificed 24 h after the last administration and blood were collected via cardiac puncture and processed for hematological parameters and assessment of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin (ALB). The liver was excised and processed for markers of oxidative stress and histopathological examination. Intraperitoneal administration of 15 mg/kg of PbA caused a significant increase in serum concentration of AST, ALT, while the concentration of ALB was significantly decreased (P<0.001). PbA caused a significant reduction in packed cell volume, hemoglobin while the total white blood cell count, neutrophils, lymphocytes, monocytes, eosinophils, and basophils were increased. Oxidative stress was significantly pronounced in the liver of rats exposed to PbA as observed in the high concentration of malonedialdehyde, decreased concentration of glutathione, the activity of catalase, superoxide dismutase, and glutathione-S-transferase. Pretreatment with TrévoTM was able to significantly prevent the anemic, oxidative damage, and hepatic injury initiated by PbA. Histological examination also corroborated the biochemical results. In conclusion, the study reveals that TrévoTM is effective in attenuating PbA-induced hepatotoxicity in male Wistar rats.

The dopamine system: insights between kidney and brain

BACKGROUND

Chronic kidney disease (CKD) is one of the most common diseases in adult age and it is typical of older adults. Recent data suggest that almost half of the elders have CKD. It is now clear that CKD is accompanied, in the early stages, by cognitive impairment, together with depression and subtle abnormalities in motor control (such as gait and balance alterations).

SUMMARY

Several data suggest a link between brain dopamine and kidney diseases. Metabolic syndrome and diabetes can affect dopamine neuron survival (leading to Parkinson's Disease). Several uremic toxins in CKD (uric acid, indoxyl sulphate) and trace elements accumulating in CKD (aluminium, manganese) can also modify the dopaminergic system. Hormones produced by the kidney such as vitamin D are neuroprotective for dopamine neurons. Dopaminergic drugs are useful for the treatment of a common sleep disorder in CKD, the restless legs syndrome. However, experiments on animal models of CKD show conflicting results regarding a modification of dopamine neurons.

KEY MESSAGES

Several observations suggest a limited relevance of the dopaminergic system in CKD-related cognitive impairment. However, a common sleep disturbance in CKD, the restless leg syndrome, improves with dopaminergic drugs. Therefore, it remains to be established the role of the dopamine system in subtle motor dysfunction observed in CKD, such as tremors, gait alterations, and central sleep apnea.

Neuroimmunoendocrine Link Between Chronic Kidney Disease and Olfactory Deficits

Chronic kidney disease (CKD) is a multifactorial pathology that progressively leads to the deterioration of metabolic functions and results from deficient glomerular filtration and electrolyte imbalance. Its economic impact on public health is challenging. Mexico has a high prevalence of CKD that is strongly associated with some of the most common metabolic disorders like diabetes and hypertension. The gradual loss of kidney functions provokes an inflammatory state and endocrine alterations affecting several systems. High serum levels of prolactin have been associated with CKD progression, inflammation, and olfactory function. Also, the nutritional status is altered due to impaired renal function. The decrease in calorie and protein intake is often accompanied by malnutrition, which can be severe at advanced stages of the disease. Nutrition and olfactory functioning are closely interconnected, and CKD patients often complain of olfactory deficits, which ultimately can lead to deficient food intake. CKD patients present a wide range of deficits in olfaction like odor discrimination, identification, and detection threshold. The chronic inflammatory status in CKD damages the olfactory epithelium leading to deficiencies in the chemical detection of odor molecules. Additionally, the decline in cognitive functioning impairs the capacity of odor differentiation. It is not clear whether peritoneal dialysis and hemodialysis improve the olfactory deficits, but renal transplants have a strong positive effect. In the present review, we discuss whether the olfactory deficiencies caused by CKD are the result of the induced inflammatory state, the hyperprolactinemia, or a combination of both.

Effect of pre-treatment and drying methods on the content of minerals, B-group vitamins and tocopherols in kale (Brassica oleracea L. var. acephala) leaves

Dried vegetables are widely used in food production. Kale leaves, due to their high health-promoting properties, can be a valuable raw material for drying. The aim of the study was to evaluate the effect of blanching, drying methods (air-drying, freeze-drying), the time and temperature of storage on the content of ash, minerals, vitamins B₁, B₂, and tocopherols in dried kale products. The dried products were evaluated directly after processing and after 12 months of storage at ambient temperature, 18–20 °C and cold temperature, 8–10 °C. In 100 g dry matter from fresh raw material the dominant minerals were potassium (2613 mg), calcium (1346 mg), phosphorus (432 mg), magnesium (129 mg). Kale leaves had 0.828 mg vitamin B₁, 1.533 mg vitamin B₂ and 16.55 mg total tocopherols per 100 g of dry matter. Blanching, applied prior to drying, significantly reduced the levels of minerals (3–38%) and vitamins (8–45%), except for calcium, zinc and manganese. This pre-treatment had, however, a beneficial effect, especially on vitamin retention during the storage of dried products. After 12 month storage, the losses of vitamin B₁, B₂ and total tocopherols in dried, previously blanched, raw materials ranged from 3 to 10%, 1 to 4%, and 1 to 16%, respectively, depending on the type of sample. In the dried products obtained from unblanched raw material, the losses were larger and amounted to 10–17%, 8–16% and 4–17%, respectively. Throughout drying and storage, the minerals examined were fairly stable. Dried kale is generally a good source of minerals and vitamins. However, blanching before drying is recommended. In addition, freeze-drying and storage in cold temperature allows for higher vitamin preservation in dried kale.

The association between olfactory and gustatory dysfunction and chronic kidney disease

BACKGROUND

Olfactory and gustatory changes may contribute to poor appetite and food aversion in chronic kidney disease (CKD), though the prevalence of olfactory and gustatory dysfunction is not known in the CKD population.

METHODS

We conducted a cross-sectional study among 3527 US adults aged ≥40 years old in the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2014. We measured the prevalence of olfactory and gustatory dysfunction among patients with CKD defined as eGFR < 60 ml/min/1.73m² using the "scratch and sniff" NHANES Pocket Smell Test and quinine whole-mouth test. We also examined the association between CKD and olfactory/gustatory dysfunction, and nutritional markers.

RESULTS

The prevalence of olfactory dysfunction was 30% among CKD and 15% among non-CKD (p < 0.001). The prevalence of gustatory dysfunction was 13% among CKD and 17% among non-CKD (p = 0.10). After adjusting for confounders, CKD was significantly associated with olfactory dysfunction (OR = 1.47, 95% CI [1.07, 2.01]; p = 0.02) but not gustatory dysfunction (OR = 1.76, 95%CI [0.99, 3.11]; p = 0.05). Among the CKD population, the odds of olfactory dysfunction was 72% higher for every 10 kg decrease in grip strength (OR = 1.72, 95% CI [1.39, 2.13]; adjusted p = 0.005).

CONCLUSION

CKD was associated with higher odds of olfactory but not gustatory dysfunction. Olfactory dysfunction was associated with lower grip strength among those with CKD. Screening and early intervening on olfactory dysfunction among CKD may preserve muscle strength and improve nutritional status in this vulnerable population.

Heavy Metal Accumulation in Rice and Aquatic Plants Used as Human Food: A General Review

Aquatic ecosystems are contaminated with heavy metals by natural and anthropogenic sources. Whilst some heavy metals are necessary for plants as micronutrients, others can be toxic to plants and humans even in trace concentrations. Among heavy metals, cadmium (Cd), arsenic (As), chromium (Cr), lead (Pb), and mercury (Hg) cause significant damage to aquatic ecosystems and can invariably affect human health. Rice, a staple diet of many nations, and other aquatic plants used as vegetables in many countries, can bioaccumulate heavy metals when they grow in contaminated aquatic environments. These metals can enter the human body through food chains, and the presence of heavy metals in food can lead to numerous human health consequences. Heavy metals in aquatic plants can affect plant physicochemical functions, growth, and crop yield. Various mitigation strategies are being continuously explored to avoid heavy metals entering aquatic ecosystems. Understanding the levels of heavy metals in rice and aquatic plants grown for food in contaminated aquatic environments is important. Further, it is imperative to adopt sustainable management approaches and mitigation mechanisms. Although narrowly focused reviews exist, this article provides novel information for improving our understanding about heavy metal accumulation in rice and aquatic plants, addressing the gaps in literature.

Management of acute kidney injury in gastrointestinal tumor: An overview

Gastrointestinal tumors remain a global health problem. Acute kidney injury (AKI) is a common complication during the treatment of gastrointestinal tumors. AKI can cause a decrease in the remission rate and an increase in mortality. In this review, we analyzed the causes and risk factors for AKI in gastrointestinal tumor patients. The possible mechanisms of AKI were divided into three groups: pretreatment, intrafraction and post-treatment causes. Treatment and prevention measures were proposed according to various factors to provide guidance to clinicians and oncologists that can reduce the incidence of AKI and improve the quality of life and survival rate of gastrointestinal tumor patients.

Synthetic Amphoteric Cryogels as an Antidote against Acute Heavy Metal Poisoning

The effectiveness of an amphoteric cryogel (AAC) as an oral sorbent (enerosorbent) for the treatment of acute poisoning of small animals (rats) with heavy metals (HMs) was studied in in vivo experiments. The morphological structure of the cryogel was examined using scanning electron microscopy/energy-dispersive X-ray analysis and confocal microscopy. The use of the cryogel in the treatment of rats administered an LD₅₀ dose of Cd(NO₃)₂, CsNO₃, Sr(NO₃)₂, or HgCl₂ in aqueous solution showed their high survival rate compared to the control group, which did not receive such treatment. The histological and chemical analysis of internal tissues and the biochemical analysis of the blood of the experimental animals showed the effectiveness of the cryogel in protecting the animals against the damaging effect of HMs on the organism comparable with unithiol, a chelating agent based on 2,3-dimercapto-1-propane sulfonic acid sodium salt (DMPS) approved for the treatment of acute poisoning with some heavy metals.

Diagnosis and Treatment Rules of Chronic Kidney Disease and Nursing Intervention Models of Related Mental Diseases Using Electronic Medical Records and Data Mining

Objective

On the basis of electronic medical records, the data mining technology was adopted to explore the law of chronic kidney disease (CKD) and the intervention mode of mental health of patients.

Methods

Based on the electronic medical records, the corresponding data extraction, database establishment, and data cleaning of CKD were performed. After that, the related data analysis, frequency analysis, cluster analysis, and nonparametric analysis were used to explore the laws of CKD diagnosis and treatment and nursing intervention mode of mental illness. The most common causes of CKD were chronic glomerulonephritis (43.76%), aristolochic acid nephritis (16.34%), diabetic nephritis (12.87%), and hypertensive nephritis (11.58%). The major treatment method for end-stage patients was alternative therapies, accounting for 46%. Compared with the depression score before intervention, that of the patients after the mindfulness therapy (50.99 ± 9.77 vs. 47.01 ± 9.33, P=0.024 < 0.5) and target behaviour nursing intervention (52.21 ± 8.12 vs. 48.01 ± 9.33, P=0.032 < 0.05) was obviously decreased.

Conclusion

The data mining technology based on electronic records showed a good application prospect in the analysis of the diagnosis and treatment of CKD; and target behaviour nursing and mindfulness intervention were effective psychological intervention models.

The Associations between Blood and Urinary Concentrations of Metal Metabolites, Obesity, Hypertension, Type 2 Diabetes, and Dyslipidemia among US Adults: NHANES 1999-2016

Background

Heavy metals are well known to be associated with cancer outcomes, but its association with obesity and cardiometabolic risk outcomes requires further study.

Methods

Adult data from the National Health and Examination Survey (NHANES Continuous 1999-2016, n = 12,636 to 32,012) with data for blood or urinary metals concentrations and body mass index were used. The study aim was twofold: (1) to determine the association between heavy metals and obesity and (2) to examine the influence of heavy metals on the relationship between obesity and hypertension, type 2 diabetes, and dyslipidemia. Logistic regression was used to examine the main effects and interaction effects of metals and obesity for the odds of prevalent hypertension, type 2 diabetes, and dyslipidemia. Models were adjusted for age, gender, ethnicity, smoking status, physical active status, and poverty-income ratio, with additional adjustment for creatinine in models with the urinary measures of heavy metals. High-low concentration categories were defined by grouping metal quintiles with the most similar associations with obesity.

Results

Blood lead had a negative linear association with obesity (odds ratio (OR)  = 0.42, 95% confidence interval (CI) = 0.37-0.47). In those with obesity, high blood lead was associated with lower risk of prevalent dyslipidemia, while no association was found in those without obesity. The study observed a curvilinear relationship between urinary antimony and obesity with the moderate group having the highest odds of obesity (OR = 1.36, 1.16-1.59). However, the relationship between urinary antimony and prevalent hypertension and dyslipidemia risk was linear, positive, and independent of obesity. While not associated with prevalent obesity risk, high urinary uranium was associated with 30% (P=0.01) higher odds for prevalent type 2 diabetes.

Conclusions

The impact of environmental factors on obesity and health may be complex, and this study reinforces the heterogeneous relationship between various metals, obesity, and obesity-related metabolic diseases even at levels observed in the general population.

Population Kidney Health. A New Paradigm for Chronic Kidney Disease Management

Statistical data extracted from national databases demonstrate a continuous growth in the incidence and prevalence of chronic kidney disease (CKD) and the ineffectiveness of current policies and strategies based on individual risk factors to reduce them, as well as their mortality and costs. Some innovative programs, telemedicine and government interest in the prevention of CKD did not facilitate timely access to care, continuing the increased demand for dialysis and transplants, high morbidity and long-term disability. In contrast, new forms of kidney disease of unknown etiology affected populations in developing countries and underrepresented minorities, who face socioeconomic and cultural disadvantages. With this background, our objective was to analyze in the existing literature the effects of social determinants in CKD, concluding that it is necessary to strengthen current kidney health strategies, designing in a transdisciplinary way, a model that considers demographic characteristics integrated into individual risk factors and risk factors population, incorporating the population health perspective in public health policies to improve results in kidney health care, since CKD continues to be an important and growing contributor to chronic diseases.

Addressing the Challenge of Potentially Hazardous Elements in the Reduction of Hypertension, Diabetes and Chronic Kidney Disease in the Caribbean

BACKGROUND

Environmental surveys have characterized trace elements such as lead (Pb), cadmium (Cd) and arsenic (As) as potential risk factors for non-communicable diseases. There have been few studies conducted in the Caribbean region to explore, define or clarify such findings locally. Furthermore, local pollution control efforts are often juxtaposed against more seemingly immediate economic concerns in poor communities.

OBJECTIVES

The present commentary is a call to action for the evaluation of potentially hazardous elements as potential risk indicators and/or factors of common noncommunicable diseases in the Caribbean.

DISCUSSION

Findings from Jamaican studies have identified exposure to potentially hazardous elements (PHE) via water, food, and other anthropogenic activities to the detriment of the resident population. Several attempts have been made to abate toxic metal exposure in children with relative success. However, high levels of PHE have been noted in vulnerable populations such as patients with hypertension, diabetes mellitus and chronic kidney disease. Currently, there is low priority towards infrastructure building within the Caribbean region that would promote and sustain long term monitoring and better inform environmental polices impacting chronic diseases.

CONCLUSIONS

Further investigations are needed to clarify the role that PHE play in increasing the risk or progression of non-communicable diseases, especially in vulnerable groups.

COMPETING INTERESTS

The authors declare no competing financial interests.

Lead Exposure Influences Serum Biomarkers, Hepatocyte Survival, Bone Marrow Hematopoiesis, and the Reproductive Cycle in Japanese Quails

Lead toxicity has been a hallmark issue of toxicology over the last decades. However, predictive and non-robust models did not provide complete data on low-dose lead interaction with the organism at different functional levels (e.g., blood-serum-liver-bone marrow-bursa fabricii-reproductive system axis). Japanese quails are an animal model with a strong immune system, making them suitable for the thorough assessment of in vivo chronic lead toxicity. In this study, we have exposed Japanese quails via water ingestion to 0.25 and 0.5 μg/mL lead(II) chloride (PbCl₂) for 20 days and assessed blood cells, serum biomarkers, hepatocyte survival, bone marrow hematopoiesis, bursa fabricii, and lead accumulation in eggs. Blood cells passed through morphological alterations (loss and inversion of the erythrocyte nucleus, multiple erythrocyte and thrombocyte aggregation, lymphocyte degradation, and blast cell infiltration). In the serum, PbCl₂ increased the activity of creatine kinase (CK) and lactate dehydrogenase (LDH); increased the level of cholesterol, sodium, creatinine, and urea; and reduced the level of proteins, triglycerides, chloride, potassium, calcium, and alkaline phosphatase (ALP) activity (P < 0.05). Liver tissue of the exposed animals exhibited apparent death of hepatocytes. In the bone marrow, macrophages and heterophils contained a vast number of the infiltrated/uptaken granules upon PbCl₂ exposure. Ultimately, PbCl₂ exposure elicited a series of events observed first in the blood and serum parameters and later translated to the hematopoietic centers.

Epidemiology of chronic kidney disease in Peru and its relation to social determinants of health

BACKGROUND

Chronic kidney disease (CKD) is a growing public health problem and an important cause of morbidity and mortality. Disparities in CKD may be related to social determinants and health inequalities in low- and middle-income countries. This study determined how social determinants of health influence trends in the prevalence and mortality of CKD in Peru.

METHODS

This was an ecological study based on a secondary analysis of health care and death records obtained from the Ministry of Health of Peru for the period 2010-2016. The standardized prevalence and mortality rates of CKD were descriptively reported using geospatial exploratory analysis. We also determined the association with social determinants of health according to the domains suggested by Healthy People 2020.

RESULTS

In the studied period, CKD prevalence increased by 300% and was associated with the health insurance coverage rate (β=5.9 [95% CI 0.82 to 10.92]), proportion of people with a secondary education level (β=11.4 [95% CI 1.94 to 20.93]), mean age (β=-10.7 [95% CI -19.33 to -2.12]), monetary poverty rate (β=-2.2 [95% CI -3.88 to -0.60]) and gross domestic product per capita (β=-63.2 [95% CI -117.81 to -8.52]). The standardized mortality decreased by 10% and was associated with mean age (β=-0.6 [95% CI -1.22 to -0.06]) and the proportion of people with a primary education level (β=-0.5 [95% CI -0.9 to -0.05]).

CONCLUSIONS

During the period 2010-2016, the prevalence of CKD increased and the mortality associated with CKD decreased. The observed changes were associated with some social determinants of health, such as increased health coverage and education. The health system of Peru must be prepared to take on the challenge.

Regulatory Role of Nano-Curcumin against Tartrazine-Induced Oxidative Stress, Apoptosis-Related Genes Expression, and Genotoxicity in Rats

The present study evaluates the regulatory effect of Nano-Curcumin (Nano-CUR) against tartrazine (TZ)-induced injuries on apoptosis-related gene expression (i.e., p53, CASP-3 and CASP-9), antioxidant status, and DNA damages in bone marrow in treated rats. Male rats were arbitrarily separated into five groups, and each group was comprised of 10 rats each. The 1st group served as control (G1). The 2nd group ingested 7.5 mg TZ/kg. b.w. (body weight). The 3rd group ingested Nano-CUR 1 g/kg b.w. The 4th and 5th groups were respectively administered with (1 g Nano-CUR + 7.5 mg TZ/kg. b.w.) and (2 g Nano-CUR + 7.5 mg TZ/kg. b.w.). At the end of the experiment, blood samples, livers, and kidneys were collected. Livers and kidneys were homogenized and used for the analysis of reduced glutathione, malonaldhyde, total antioxidant capacity, lipid peroxide antioxidant enzyme activities, apoptosis-related gene expression, and genotoxicity by comit test. The ingestion of TZ for 50 days resulted in significant decreases in body, and kidney weights in rats and a relative increase in the liver weight compared to control. In contrast, the ingestion of Nano-CUR with TZ remarkably upgraded the body weight and relative liver weight compared to the normal range in the control. Aditionally, TZ ingestion in rats increased the oxidative stress biomarkers lipid peroxide (LPO) and malonaldehyde (MDA) significantly, whereas it decreased the reduced glutathione (GSH) levels and total antioxidant capacity (TAC). Similarly, the levels of glutathione peroxidase (GPx), superoxide dismutase (SOD), and catalase (CAT) significantly deteriorated in response to TZ ingestion. Moreover, the results revealed a remarkable up-regulation in the level of expression for the three examined genes, including p53, CASP-3, and CASP-9 in TZ-ingested rats compared to the control. On the other hand, the comet assay result indicates that the ingestion of TZ induced DNA damage in bone marrow. Notably, the administration of Nano-CUR protected the kidney and liver of TZ-ingested rats as evidenced by a significant elevation in all antioxidant activities of tested enzymes (i.e, SOD, GPx, and CAT), vital recovery in GSH and TAC levels, and a statistical decrease in LPO and MDA compared to TZ-ingested rats. Interestingly, the ingestion of rats with TZ modulates the observed up-regulation in the level of expression for the chosen genes, indicating the interfering role in the signaling transduction process of TZ-mediated poisoning. The results indicate that the administration of Nano-CUR may protect against TZ-induced DNA damage in bone marrow. According to the results, Nano-CUR exerted a potential protective effect against oxidative stress, DNA damage, and the up-regulation of apoptosis-related genes induced by TZ ingested to rats.