Immune response against antibiotic-resistant and antibiotic-sensitive staphylococcus aureus in a rat model of implant infection

Little is known about the in-vivo dynamics of biofilms associated with medical-device infections and their interplay with systemic inflammation, local immune responses, and tissue healing processes. There may be an opportunity to tailor therapeutic strategies to target these dynamics to improve treatment outcomes. We investigated immune responses to a methicillin-susceptible (ATCC 12600) and a multi-drug resistant (L1101) S. aureus strain using a rat subcutaneous implant model, analyzing local and systemic inflammation through 19 gene expressions over 21 days. Our goals were to identify differences in the immune response due to infection and also with respect to the two strains. We observed that systemic inflammation, indicated by α-2-macroglobulin, was elevated in the initial stages (up to day 7). Local inflammatory cytokine levels (IL-6, TNF-α, IL-6, TNF-α, IL-1β, IL10, IL-17, IL12a, IL12b, IFNG) varied by strain, typically higher against the clinical strain. Infections generally hindered early macrophage (MCSF1) and T-cell (CD4, CD5, CD6, CD8A) recruitment, particularly in cases involving the clinical strain. Conversely, a better healing response was observed in the infection of the more susceptible ATCC 12600 strain (VEGF, CXCR1, CXCR2, MMP-1, MMP-3, MMP-13). These results are crucial for understanding immune responses to such infections, guiding therapeutic strategies.

Comprehensive identification of stone-promoting proteins in the urine of kidney stone formers

Urinary proteins have crucial roles in modulating kidney stone formation. While stone-inhibiting urinary proteins are well characterized, stone-promoting urinary proteins are insufficiently explored. This knowledge gap limits our ability to fully comprehend the pathogenic mechanisms underlying nephrolithiasis and hampers the development of targeted therapeutic/preventive interventions. Therefore, we systematically identified stone-promoting proteins from the urine of 30 calcium oxalate (CaOx) nephrolithiatic patients (stone formers). Urinary proteins were fractionated by anion exchange and size-exclusion chromatography. A total of 15 protein fractions (SF1-SF15) were tested for their modulating activities on CaOx crystals by various assays compared with the control. The fractions with net CaOx-promoting activities were then identified by nanoLC-ESI-Qq-TOF MS/MS. From 15 fractions, 9 had net CaOx-promoting activities in all crystal assays. Among 3-99 proteins identified from these fractions, alpha-1acid glycoprotein 2, alpha-1-antitrypsin, apolipoprotein D, CD44 antigen, endosialin, fibrinogen alpha chain, interleukin-18-binding protein, kallikrein-1, retinol-binding protein 4, and titin have been found to increase in the urine of stone formers compared with controls, reinforcing their potential roles as CaOx stone promoters. This study offers the largest collection of CaOx stone-promoting proteins that will shed light on pathogenic mechanisms of nephrolithiasis and may allow further development of new drug targets to treat/prevent nephrolithiasis.

Renal fibrosis progression following partial unilateral ureteral obstruction: mechanisms and therapeutic insights

Ureteral obstruction, a common clinical condition, is associated with various renal disorders affecting all age groups and can lead to permanent renal damage. In Partial unilateral ureteral obstruction (PUUO), increased ureteral pressure, and decreased glomerular filtration rate (GFR) in the affected kidney cause cellular and molecular abnormalities, which ultimately lead to renal fibrosis if untreated. While removing the obstruction (RUUO) is essential to prevent long-term damage, additional therapeutic approaches may be necessary to fully restore kidney function. The PUUO model is used to induce renal fibrosis, primarily characterized by tubular injury resulting from obstructed urine flow. PUUO in rodents can simulate human chronic obstructive nephropathy at an accelerated rate. Although alleviating the obstruction can reduce immediate symptoms, it is often insufficient to reverse established fibrosis, emphasizing the need for adjunctive therapies. The renal response to RUUO depends on factors like the obstruction's duration and severity, as well as the contralateral kidney's functional state.

TET2 gene mutation status associated with poor prognosis of transition zone prostate cancer: a retrospective cohort study based on whole exome sequencing and machine learning models

Background

Prostate cancer (PCa) in the transition zone (TZ) is uncommon and often poses challenges for early diagnosis, but its genomic determinants and therapeutic vulnerabilities remain poorly characterized.

Methods

Tumor mutational landscape was characterized in nine patients with TZ PCa, identifying somatic variants through whole-exome sequencing (WES). Novel candidate variants relevant to driver gene were selected using rare-variant burden analysis. Kaplan-Meier curves with log-rank testing and Cox regression models were applied to evaluate the prognostic significance of selected mutant driver gene and clinicopathological characteristics in a cohort of 132 patients with TZ PCa. Significant prognostic determinants were integrated into a validated nomogram for individualized prediction of 3-, 4-, and 5-year biochemical recurrence-free survival (BRFS) and overall survival (OS) probabilities. Eight machine learning algorithms were employed to develop BRFS and OS prediction models in a cohort.

Results

A total of 5,036 somatic single nucleotide variants (SNVs) and 587 somatic insertion and deletion (INDELs) were discovered. Among eight driver gene mutations which were verified through Sanger sequencing, TET2 gene, with high mutation frequency and potential targeted drug relevance (bromodomain inhibitors and DOT1L inhibitors) was selected for further validation. Retrospective cohort study demonstrated that TET2 mutant status was significantly associated with Gleason score (p = 0.004) and distant metastasis (p = 0.002). Furthermore, TET2 mutant status was significantly correlated with inferior BRFS and OS and served as an independent predictor. Comparative evaluation of eight algorithms revealed the GBM model achieved superior discriminative ability for BRFS (AUC for 3-year: 0.752, 4-year: 0.786, 5-year: 0.796). The predictive model based on the GBM machine learning algorithm achieved the best predictive performance for OS (AUC for 3-year: 0.838, 4-year: 0.915, 5-year: 0.868). The constructed predictive nomogram provided evidence that TET2 mutant status integration conferred statistically significant improvements in model accuracy and clinical predictive value.

Conclusion

Our study elucidated the distinct genetic basis of prostate cancer in the transition zone and identified TET2 mutation as an independent prognostic determinant in TZ PCa. However, the limited sample size of this study necessitates cautious interpretation of these findings, and further validation in larger cohorts is warranted to confirm their generalizability.

E-cadherin as a surrogate marker of epithelial-to-mesenchymal transition for detection of diabetic nephropathy and subclinical atherosclerosis among children and adolescents with type 1 diabete

BACKGROUND

Epithelial-to-mesenchymal transition (EMT) may be involved in the pathogenesis of diabetic nephropathy (DN) among adults with type 2 diabetes. The current study aimed to evaluate the role of E-cadherin as a surrogate marker of EMT among children and adolescent with type 1 diabetes (T1D) and DN and its possible relation to carotid intima media thickness (CIMT).

RESEARCH DESIGN AND METHODS

Sixty participants with T1D were divided equally into two groups based on urinary albumin creatinine ratio (UACR) and compared with 30 healthy controls. Hemoglobin A1c (HbA1c), kidney function tests, serum E-cadherin and CIMT were assessed.

RESULTS

E-cadherin levels were significantly lower in patients with microalbuminuria (56.5 ± 15.8 ng/mL) compared with patients with normoalbuminuria (179.8 ± 45.1 ng/mL) and healthy controls (222.5 ± 39.9 ng/mL) (p < 0.001). E-cadherin correlated negatively with HbA1c (r = -0.42, p = 0.001), UACR (r = -0.89, p < 0.001) and CIMT (r = -0.716, p < 0.001). ROC curve analysis showed that the E-cadherin cutoff value 135 ng/mL could detect nephropathy with 96.67% sensitivity and 86.67% specificity. Logistic regression showed that E-cadherin was a significant independent factor for nephropathy.

CONCLUSIONS

E-cadherin is a potential biomarker reflecting EMT activity in both pathogenesis and progression of DN and subclinical atherosclerosis in pediatric patients with T1D.

Investigating the effect of icterus interference on a creatinine Roche enzymatic methodology

BackgroundIt is well established that high bilirubin concentrations can lead to erroneous creatinine results when measured by a Jaffe-based method. However, the effects of bilirubin on enzymatic methods appear less well-defined. The Roche Cobas 8000 enzymatic creatinine (CREP2) has an unconjugated bilirubin icterus limit of 20 mg/dL, equivalent to a bilirubin concentration of 342 µmol/L. Many hepatology patients have bilirubin levels much higher than this limit, and laboratories are unable to release creatinine results on these complex patients. This is particularly challenging for patient management, as creatinine is a key test and is a prerequisite for many procedures, imaging studies and treatments.MethodsTwo spiking studies were carried out, the first to define the interference effect of bilirubin on enzymatic creatinine measurement, and the second to see if this interference could be mitigated via dilution. Serum samples (n = 50) were spiked with a concentrated bilirubin solution. Indices, bilirubin and creatinine were measured using the Roche Cobas 8000 c702 automated analyser according to manufacturer instructions.ResultsThe spiking study found a negative linear relationship and as bilirubin concentrations increased, the measured creatinine concentration decreased (R2 = 0.7828, y = -0.0597x + 15.603). Samples with a bilirubin concentration over 246 µmol/L demonstrated an average 1.48% drop in creatinine concentration per 25 µmol/L increase in bilirubin.ConclusionsA service improvement was applied where creatinine results can be released on samples with a bilirubin concentration up to 550 µmol/L, with an appropriate comment, upon request by the clinician.

The association of perioperative serum albumin concentrations with outcome after deceased donor liver transplantation

BACKGROUND

Perioperative hypoalbuminemia has been associated with worse outcome after major surgery. Although hypoalbuminemia is common in patients with chronic liver disease and frequently occurs following liver transplantation (LT), data are sparse regarding perioperative hypoalbuminemia and outcome after LT.

METHODS

In this single-center retrospective study performed at the Medical University of Vienna, we evaluated adult patients undergoing orthotopic liver transplantation (OLT) between 2004 and 2019. The association between perioperative serum albumin concentrations and survival, acute kidney injury (AKI), and postoperative surgical complications was analyzed using cox and logistic regression models.

RESULTS

In total, 724 patients were analyzed. Serum albumin concentrations decreased from 32.0 ± 6.8 to 22.8 ± 4.8 g/l (nadir within 48 h following OLT). Overall survival was not associated with serum albumin concentrations on day 1, day 2, or at nadir within 48 h after OLT (Day1: HR:0.988, 95%CI:0.966-1.011, P = 0.306; Day2: HR:1.021, 95%CI:0.991-1.052, P = 0.167; Nadir: HR:0.998, 95%CI:0.971-1.025, P = 0.863). Serum albumin concentrations on day 1, day 2, or at nadir within 48 h after OLT were not associated with AKI (Day1: OR:0.975, 95%CI:0.949-1.002, P = 0.070; Day2: OR:1.011, 95%CI:0.971-1.053, P = 0.601; Nadir: HR:0.976, 95%CI:0.940-1.013, P = 0.20) or with postoperative complications (Day1: OR:0.997, 95%CI:0.976-1.059, P = 0.80; Day2: OR:1.002, 95%CI:0.973-1.032, P = 0.890; Nadir: HR:0.993, 95%CI:0.966-1.021, P = 0.610). However, we observed an increased risk for initiation of renal replacement therapy with lower serum albumin concentrations on the day preceding initiation (HR = 0.946; 95%CI:0.896-1.000; P = 0.049).

CONCLUSION

Hypoalbuminemia was not associated with reduced survival, the development of AKI, or postoperative surgical complications after OLT. However, postoperative hypoalbuminemia was associated with the timing of initiating renal replacement therapy after OLT.

Minimally invasive surgery in the operating rooms near you

PURPOSE OF REVIEW

This review delineates the benefits of minimally invasive surgery (MIS) and its utilization at surgical centers and our institution. It further explores the literature for comparative outcomes of performing MIS to traditional open surgery for a variety of surgical subspecialties.

RECENT FINDINGS

In addition to its proven safety when compared to the open surgical technique, MIS has broad applications in many surgical subspecialties to enhance perioperative outcomes in both pediatric and adult patients.

SUMMARY

Although there are certain disadvantages with regard to cost of implementation in nascent communities and total operating time when the surgical complexity increases (such as utilizing a robotic approach), the added benefit of improved patient outcomes due to smaller incision sites is repeatedly proven in the literature making this technique globally essential.

Serum midkine level and its association with subclinical coronary artery calcification and carotid atherosclerosis in chronic kidney disease

BACKGROUND

There are no studies investigating the role of midkine (MK) in vascular calcification (VC) or vascular disease associated with chronic kidney disease (CKD). This study assessed serum MK level and investigated its relationship with carotid atherosclerosis and coronary artery calcification (CAC) in non-dialysis CKD.

METHODS

The study comprised 80 controls and 185 adult patients with CKD at stages 3-5 who were free of cardiovascular diseases. Acute renal failure, chronic hemodialysis, severe liver disease, inflammatory states, anticoagulation therapy and cancer were excluded. The patients were classified based on presence of CAC score into severe and mild to moderate CAC groups. They were also divided into atherosclerotic and non-atherosclerotic groups based on carotid atherosclerosis. CBC, kidney function tests, lipid profile, intact parathyroid hormone (iPTH), and phosphorus were assessed. Serum levels of MK, tumor necrosis factor- α (TNF- α), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) were quantitatively tested using ELISA. Cardiac CT scan was done to calculate CAC score. Carotid ultrasonography was used to evaluate carotid intima media thickness (CIMT) and identify plaques.

RESULTS

All CKD categories, including CKD-3, CKD-4, and CKD-5, showed higher rates of carotid plaques (p = 0.007, p < 0.001, and p < 0.001, respectively), higher levels of MK (p < 0.001 for each), and higher CAC scores (p < 0.001 for each) as CKD worsened. Compared to mild to moderate CAC patients, severe CAC patients showed increased CIMT (p < 0.001) and raised serum levels of MK (p < 0.001), TNF-α (p = 0.001), IL-6 (p = 0.002), hs-CRP (p = 0.003), iPTH (p = 0.02), phosphorus (p < 0.001), total cholesterol (TC), and low density lipoprotein-cholesterol (LDL-C). Multivariate linear regression revealed that CAC was reliably predicted by MK (p = 0.008) and serum creatinine (p = 0.001). Carotid atherosclerotic patients had higher serum levels of MK, TNF-α, IL-6, hs-CRP, iPTH, phosphorus, TC, total triglycerides and LDL-C (p < 0.001 for each). Multivariate logistic regression showed that serum MK (p = 0.001), serum creatinine (p = 0.005), age (p < 0.001), iPTH (p = 0.007), and IL-6 (p = 0.024) were significant predictors of carotid atherosclerosis.

CONCLUSIONS

As CKD worsened, MK levels, carotid atherosclerosis and CAC increased. Serum MK was a reliable biomarker for asymptomatic carotid atherosclerosis and CAC in non-dialysis CKD, allowing prompt early diagnosis to avert cardiovascular morbidity and death in the future.

TRIAL REGISTRATION

The trial number was 1138 and its registration was approved by the hospital's Research Ethics Committee in 4/2024.

Initial experience with augmented reality in planning renal access for PCNL

Achieving renal access during percutaneous nephrolithotomy is challenging, with a complication rate of 10-20%. This study aims to assess a novel technique for planning access to the renal collecting system using augmented reality (AR). Using Digital Imaging and Communications in Medicine software (DICOM 2-print), we generated 3-dimensional (3D) models of patients with different types of kidney stones (staghorn, lower pole, and pelvic stones) who underwent PCNL between 2018 and 2022. After viewing the patient's CT scans, surgeons explored the anatomical models using an AR system with a stereoscopic 3D lens array display. Using questionnaires, we quantitatively estimated the model's contribution on a scale of "1" ("poor") to "5" ("excellent") to the surgeon's understanding of stone location, patient anatomy, and ease of access compared to 2D CT imaging. A total of 38 questionnaires were completed by 13 urologists. Estimating renal location, renal pelvis, and stone mass were better demonstrated by AR (5 vs. 4, p < 0.001). The orientation of adjacent organs was better understood using AR (5 vs. 4, p = 0.004). In 86.8% of cases, surgeons preferred using AR models both before and during surgery, with 69.2% suggesting that AR could enhance procedural safety. The time frames for testing the models differed between senior and junior practitioners (p = 0.016) and were significantly reduced with model experience (p < 0.001). When comparing CT to 3D imaging, AR models provide a better understating of stone location, patient anatomy, and route of access to the collecting system. Further research is required to implement this innovative technique preoperatively and intra-operatively.

Sleep-Related Disorders in Patients with CKD and Kidney Transplant Recipients

Sleep disorders such as insomnia, restless legs syndrome (RLS), and sleep apnea (SA) are common in patients with CKD. These conditions tend to become more prevalent and more severe as kidney function deteriorates and when a patient reaches ESKD. The prevalence of insomnia in the general population ranges from 4% to 29% compared with ( 1 ) 30%-67%, ( 2 ) 39%-54%, ( 3 ) 41%-79%, and ( 4 ) 9%-49% in patients with CKD, on hemodialysis, on peritoneal dialysis (PD), or in kidney transplant recipients (KTRs), respectively. RLS occurs in approximately 1%-15% of the general population compared with ( 1 ) 5%-18%, ( 2 ) 24%-33%, ( 3 ) 23%-64%, and ( 4 ) 6%-8% in patients with CKD, on hemodialysis, on PD, or in KTRs, respectively. Obstructive SA has been reported in ( 1 ) 40%-69%, ( 2 ) 25%-47%, ( 3 ) 9%-52%, and ( 4 ) 25%-30% in patients with CKD, on hemodialysis, on PD, or in KTRs, respectively. Fatigue is a complex symptom that has been reported in patients with CKD, ESKD, and in KTRs and can be associated with sleep disorders. Fatigue and sleep disorders have been associated with negative outcomes such as progression of CKD, increased risk of morbidity, mortality, and lower health-related quality of life. In this review, we highlight nonpharmacologic and pharmacologic options for treatment of these sleep disorders. Specifically, the diagnosis and evaluation, epidemiology, risk factors and associations, outcomes (such as CKD progression, morbidity, and mortality), treatment, and post-transplant outcomes for sleep disorders (insomnia, RLS, and SA) and fatigue will be discussed.

Desmodium caudatum (Thunb.) DC. extract attenuates hyperuricemia-induced renal fibrosis via modulating TGF-β1 pathway and uric acid transporters: Evidence from in vitro and in vivo studies

ETHNOPHARMACOLOGICAL RELEVANCE

Desmodium caudatum (Thunb.) DC., a traditional Chinese medicinal herb, has been used to treat conditions such as rheumatic back pain, diarrhea, jaundice-related hepatitis, and abscesses; it also serves as an anthelmintic. The extract of Desmodium caudatum (Thunb.) DC. (DCE) is also known for its antioxidant and anti-inflammatory properties. However, its impact on kidney fibrosis remains unclear.

AIM OF THE STUDY

This study investigated whether DCE can alleviate hyperuricemia-induced kidney fibrosis by modulating the transforming growth factor-β1 (TGF-β1) pathway, activating epithelial-mesenchymal transition (EMT), and regulating uric acid transporters.

MATERIALS AND METHODS

NRK52E cells were exposed to uric acid (UA) followed by DCE and isovitexin (IV) for 24 h. Cell damage was assessed using an Oxidative Stress Kit, ELISA, Gelatin Zymography, and Western blotting. In parallel, adenine-induced C57BL/6 mice received DCE and IV treatment for 11 weeks. After sacrifice, renal injury was assessed through histopathological examination and protein expression analysis of fibrosis markers, EMT indicators, and uric acid transporters.

RESULTS

DCE reduced reactive oxygen species (ROS) accumulation in uric acid-induced NRK52E cells and inhibited EMT by suppressing TGF-β1 and Slug while restoring E-cadherin expression. DCE treatment reduced fibrosis-related proteins (CTGF, collagen I, fibronectin, and α-SMA) in UA-treated cells and modulated uric acid transporters by increasing ABCG2 and OAT3 while decreasing URAT1 and GLUT9. In adenine-induced hyperuricemic C57BL/6 mice, DCE administration reduced serum uric acid levels and xanthine oxidase activity. Histological analysis showed that DCE attenuated renal fibrosis through decreased glomerular atrophy, reduced collagen deposition, and diminished α-SMA and fibronectin expression.

CONCLUSION

Our study demonstrates that DCE exerts protective benefits against hyperuricemia-induced renal fibrosis. The potential mechanism may involve suppressing the TGF-β1 signaling pathway and regulating the uric acid transporter, thereby mitigating kidney injury.

Telitacicept monotherapy for refractory idiopathic membranous nephropathy: a case report and literature review

Background

Patients with refractory membranous nephropathy (MN) face risks of progressive renal decline and end-stage renal disease (ESRD), with limited treatment efficacy. Telitacicept, a novel humanized recombinant fusion protein effective in lupus nephritis and immunoglobulin A nephropathy (IgAN), has few reports on its use in refractory MN.

Case presentation

In May 2023, an 82-year-old man was admitted to Shaoxing Second Hospital with bilateral lower extremity edema. A renal biopsy confirmed idiopathic membranous nephropathy (IMN). Standard therapies, including glucocorticoids (GC), cyclophosphamide (CYC), tacrolimus (TAC), and rituximab (RTX), were ineffective. He developed steroid-induced diabetes and acute renal failure during treatment. Complete proteinuria remission was achieved with telitacicept monotherapy. The patient is under ongoing clinical follow-up.

Conclusion

Telitacicept holds promise as a potential second-line therapy for refractory MN when conventional treatments prove ineffective. However, due to the current lack of robust evidence supporting its use in IMN, further research is warranted to establish its clinical efficacy and safety.

Association Between Magnesium Depletion Score and Peripheral Artery Disease in Middle-Aged and Older Population

The magnesium depletion score (MDS) is considered a new valuable predictor of body magnesium status. This study aimed to explore the association between MDS and PAD among participants aged ≥ 40 years on the National Health and Nutrition Examination Survey in 1999-2004. Survey-weighted multivariable logistic regression and restricted cubic spline models were used to assess the association between MDS and PAD. Survey-weighted multivariable logistic regression showed a significant positive association between MDS and the prevalence of PAD. For each unit increase in MDS, the risk of PAD increased by 24%. Compared to individuals with MDS = 0, those with MDS ≥ 3 had a 95% higher risk of PAD. Restricted triple spline analysis showed a linear dose-response relationship between MDS and PAD risk. Subgroup analysis indicated that this positive association was stronger in individuals aged > 60 years. Numerous future longitudinal cohort studies are required to validate our findings.

The Clinical Utility and Plausibility of Oxidative and Antioxidant Variables in Chronic and End-Stage Kidney Disease: A Review of the Literature

Oxidative stress (OS) is caused by an imbalance between the production of reactive oxygen species (ROS) in cells and tissues and the ability of the biological system to detoxify these products. In chronic kidney disease (CKD), OS contributes to deterioration of kidney function and disease progression. In patients with end-stage kidney disease undergoing hemodialysis or peritoneal dialysis, OS is further increased and associated with adverse clinical outcomes, including deterioration and subsequent loss of residual renal function, atherosclerosis, hypertension, cardiovascular disease and death. However, currently, there is no consensus or guidelines for the diagnosis and treatment of OS in these patients. Herein, we aim to present the existing data regarding biomarkers of OS, pro-oxidants (oxidized albumin, advanced oxidation protein products, xanthine oxidase/dehydrogenase, nitrite/nitrate, malondialdehyde) and antioxidants (superoxide dismutase, catalase, vitamin E, total antioxidant capacity, N-acetylcysteine) that are most clinically relevant and have been more extensively studied in patients with chronic kidney disease, aiming to provide a clearer understanding of this complex area.

Economic burden of hospitalization for Chinese children with chronic kidney disease: a comparison between patients with and without infection

Objective

To assess hospitalization costs in pediatric chronic kidney disease (CKD) patients, compare the economic burden between those with and without infections, and identify key factors influencing these costs, emphasizing the significant financial impact on families and healthcare systems.

Methods

This retrospective analysis included pediatric patients with CKD hospitalized between May 2011 and April 2020. Clinical characteristics, including demographics, etiology, urinary protein level, estimated glomerular filtration rate, and CKD stage, were analyzed. Hospitalization costs were compared between groups with and without infection using appropriate statistical methods.

Results

Among 721 pediatric CKD patients included in this study, 388 had primary kidney disease and 333 had secondary kidney disease. Patients in the infection group had significantly higher urine protein levels, longer hospital stays, and higher total hospital fees than those without infection (all P < 0.05). In the primary kidney disease cohort, patients aged 14-18 years incurred the highest costs (16,706 CNY, P = 0.009), while those with 1 + urine protein levels had expenses averaging 29,813 CNY (P = 0.035). In the secondary kidney disease cohort, the 3 + urine protein group had the highest costs (62,841 CNY, P < 0.001). Multiple linear regression identified age, urine protein level, and length of hospital stay as significant cost determinants. Patients with infection in the secondary kidney disease cohort had an average additional expenditure of 13,572.55 CNY compared to those without infection (P = 0.001).

Conclusion

This study highlights the economic burden of infection during pediatric CKD hospitalization, emphasizing the need for effective infection management strategies to reduce financial strain and improve outcomes.

Small tools, big impact and redefining endourology: the paradigm shift of ureteroscopy for large stones and percutaneous nephrolithotomy for small stones - a literature review

PURPOSE OF REVIEW

We aim to review the evolving paradigm in endourology, where technology has led us to manage small stones with ureteroscopy (URS) and large stones with miniaturized percutaneous nephrolithotomy (mPCNL) techniques. We analyse recent literature, their findings, emerging trends and newer technologies that are helping redefine modern day endourology in pushing these boundaries.

RECENT FINDINGS

A significant trend is the use of smaller devices to treat larger stones via ureteroscopy, and to treat smaller stones via percutaneous nephrolithotomy (PCNL). Improved laser technologies, smaller single use ureteroscopes and nephroscopes, suction access sheaths, all play a key role in this.The use of suction sheaths and vacuum assisted devices allows to control intrarenal pressure and help in reducing infectious and other complications whilst improving the stone-free rate (SFR). The treatment choice often depends on surgical expertise and available resources, guided by anatomical factors, stone composition and patient-specific considerations.

SUMMARY

The management of kidney stone disease has undergone a paradigm shift. While ureteroscopy is being done for larger renal stones, miniaturised PCNL is being done for small stones. This has been driven by a surge in technology, but a tailored and patient-centred approach is needed, and must be helped by guidelines and a multidisciplinary approach.

Point-of-care ultrasound reduces the impact on departmental radiology and echocardiography services: Results of 1-year service evaluation

Point-of-care ultrasound (POCUS) is becoming an increasing part of the assessment and management of patients within internal medicine. There is ample evidence confirming the diagnostic accuracy of POCUS in acutely unwell patients, but very little focus has been placed on the resource implications of introducing a POCUS service to a department. We provide here a complete evaluation of 1 year of reported scans in a district general hospital acute internal medicine department, analysing the impact on departmental imaging requests following a POCUS scan. Between January and December 2023, a total of 467 scans yielded 572 individual reports, comprising thoracic, abdominal, urinary tract, deep vein thrombosis, echocardiogram and musculoskeletal scans. Of these reports, a departmental imaging request followed in only 154 (26.9%) of cases. Even when excluding thoracic ultrasound (which typically is not performed within radiology services), 188/321 cases (58.6%) did not require a subsequent departmental imaging request. For all individual scan types, in at least 45% of cases a departmental scan request did not follow. Where departmental requests were placed, in 34/154 (22.1%) cases they were for outpatient imaging rather than inpatient scans, meaning that, in total, in only 120 (20.1%) instances did a POCUS scan lead to a subsequent inpatient imaging request. These data show that a dedicated internal medicine POCUS service will lead to significant reductions in inpatient radiology and echocardiography requests, rather than increasing the burden as previously hypothesised. They provide support to those departments considering setting up such a service.

Tracheobronchial Amyloidosis: A Rare Airway Disorder With Diagnostic and Therapeutic Challenges-A Case Report and Literature Review

Tracheobronchial amyloidosis (TBA) is a rare, localised form of amyloidosis characterised by the extracellular deposition of abnormal proteins within the tracheal and bronchial tissues. This condition, although uncommon, can significantly impact airway function, leading to symptoms such as persistent cough, dyspnea and airway obstruction. This report highlights the clinical presentation, diagnostic approaches and therapeutic options for TBA, emphasising the need for individualised management strategies and comprehensive patient care. This case describes a 62-year-old male with a history of smoking debuting with progressive hoarseness, dyspnea and dysphagia, who was initially diagnosed with tracheobronchial amyloidosis following biopsy of a subglottic mass. After surgical excision and a 3-year disease-free interval, he experienced multiple recurrences requiring further interventions, including bronchoscopic evaluation. Histopathological confirmation of recurrent amyloidosis led to a decision for strict follow-up, as symptoms remained mild post-biopsy.

Inhibition of Caspase-1 Suppresses GSDMD-mediated Peritoneal Mesothelial Cell Pyroptosis and Inflammation in Peritoneal Fibrosis

Pyroptosis, belonging to programmed cell death, is shown to be mediated by gasdermin D (GSDMD) and gains more and more attention in innate immunity and multiple diseases. However, the role of GSDMD-mediated pyroptosis in peritoneal fibrosis (PF) remains unclear. This study observed NLRP3 inflammasome activation and pyroptosis in the peritoneum of long-term peritoneal dialysis (PD) patients with PF. Moreover, it is found that high glucose (HG) can induce the activation of NLRP3 inflammasome by regulating TLR4/NF-κB and JNK/p38 MAPK signaling in human peritoneal mesothelial cells (HPMCs), leading to subsequent Caspase-1 activation. The cleaved Caspase-1 promoted pyroptosis-related transmembrane pore formation through activating GSDMD-N, and stimulated the HPMCs to secrete inflammatory factors including IL-1β and IL-18. GSDMD global deletion or pharmacologic pretreatment with Caspase-1 specific inhibitor VX-765 effectively inhibited the pyroptosis and inflammation, thereby ameliorating PF. Additionally, treatment with VX-765 and transfected with Caspase-1 siRNA or GSDMD siRNA also inhibited the transmembrane pore formation and inflammatory factors secretion in HG-induced HPMCs. Consistent with these results, delayed treatment with VX-765 also alleviated PF, indicating the therapeutic effect of VX-765. Taken together, the results demonstrate that pyroptosis may be a novel therapeutic target for peritoneal fibrosis.

Differences in Microorganism Profile in Periprosthetic Joint Infections of the Knee in Patients Affected by Chronic Kidney Disease

BACKGROUND

Periprosthetic joint infections (PJIs) are one of the most devastating complications of total knee arthroplasty (TKA). Patients who have chronic kidney disease (CKD) are more vulnerable to PJI. We aimed to answer the following questions: 1) What are the commonly observed pathogens in PJI after TKA in CKD patients, and do they differ from those in non-CKD patients? and 2) What are the risk factors for PJI after TKA in CKD patients?

METHODS

Patients who underwent surgery due to a chronic PJI of the TKA were retrospectively enrolled. The patients were divided into two groups as follows: patients those who had and those who did not have CKD. Demographic data and comorbidities of the patients were recorded. The microorganisms responsible for PJI were identified based on the biopsy results, and comparisons were made between the two groups. There were 331 patients in the CKD group and 2,238 in the control group. Patients who had CKD were significantly older (P < 0.001) and had higher Charlson Comorbidity Index scores (P < 0.001).

RESULTS

Binary logistic regression identified multiple microorganisms within the CKD group. The most common microorganisms in PJI were as follows: Staphylococcus epidermidis (odds ratio [OR] 1.38; P = 0.030; 95% confidence intervals (CI) 1.03 to 1.86), Staphylococcus aureus (OR 1.88; P < 0.001; 95% CI 1.36 to 2.61), Enterococcus faecalis (OR 2.39; P < 0.001; 95% CI 1.44 to 3.94), Escherichia coli (OR 1.76; P = 0.028; 95% CI 1.06 to 2.94), methicillin-resistant Staphylococcus aureus (OR 3.04; P = 0.024; 95% CI 1.15 to 8.02), polymicrobial infections (OR 1.52; P < 0.001; 95% CI 1.12 to 2.06).

CONCLUSION

Patients who had PJI and CKD demonstrated a higher incidence of infections with specific microorganisms, including Staphylococci, enterococci, gram-negative bacteria, and methicillin-resistant Staphylococcus aureus. To mitigate the high PJI risk in CKD patients, a treatment plan based on this microbial profile and a multidisciplinary assessment of CKD comorbidities before TKA is recommended.

Bone Metabolism Defects in Children With Idiopathic Hypercalciuria: An Update

Idiopathic hypercalciuria (IH) in adults is considered to be the most common identifiable metabolic risk factor for calcium nephrolithiasis, also contributing to osteopenia and osteoporosis. Data on children and adolescents associating IH with bone metabolism show that up to one-third of such patients present with lower bone mineral density (BMD), increasing the risk of osteopenia, osteoporosis, and bone fractures in adulthood. Several factors, such as the degree of hypercalciuria and the presence of calcium urolithiasis, seem to affect the severity of bone metabolism abnormalities in children with IH. In order to follow these patients, BMD has traditionally been estimated by dual-energy X-ray absorptiometry (DXA) scan. In children, chronological age should be taken into account when measuring BMD, as well as weight, height, and BMI. In addition, biochemical bone turnover markers provide surrogate indices of bone turnover and complement the static measurements of BMD. They respond rapidly to changes in bone physiology, and their measurement can be repeated more frequently. However, since children's bone mass increases constantly until after puberty, age, sex, and pubertal stage have to be taken into consideration when assessing these markers. In addition, relevant studies in children and adolescents have shown conflicting results. Regarding the management of patients with IH, identification and appropriate treatment are of great importance in order to prevent the formation of kidney stones, as well as to improve bone metabolism defects and decrease fracture risk. Such treatment measures include dietary interventions, potassium citrate supplementation and/or thiazide diuretics, and bisphosphonates in resistant cases. This review summarizes the latest data on bone metabolism defects in children and adolescents with IH, the possible pathomechanisms involved, the biochemical markers that could be used together with DXA to follow these patients, and the available treatment options.

Improving the bioactivity of cellulose acetate hemodialysis membranes through nanosilver modification

The effectiveness and safety of hemodialysis can be hindered by protein accumulation, mechanical instability of membranes and bacterial infection during the dialytic therapy. Herein, we show that cellulose acetate membranes modified with the low-fouling polymers (namely polyvinylpyrrolidone and polyethylene glycol), followed by the in situ reduction of different densities of silver oxide(I) nanoparticles, can effectively address these limitations. These improvements comprise the enhanced resistance to the protein fouling, improved antimicrobial capabilities against S. aureus, increased selectivity, and thermal stability and mechanical strength. The nano-enhanced membranes showed an improved albumin rejection rate of approximately 90 %, and the creatinine clearance rate ranged between 90 and 94 %. Our findings demonstrate that nanosilver-modified membranes can be readily prepared from precursor solutions to act as robust, biocompatible, and hydrophilic hemodialysis membranes with controlled bacteriostatic potential, antifouling properties and high toxin clearance.

Targeted therapeutic strategy for oral squamous carcinoma using celecoxib-loaded GABA/wheat gluten-alginate nanocarrier hydrogel with glutathione down-regulation and enhanced CCND2-mediated apoptosis

The intricate architecture of the oral cavity results in insufficient surgical excision of oral squamous cell carcinoma (OSCC) potentially increasing the risk of metastasis and recurrence during treatment. In situ generating injectable hydrogels, characterized by minimally invasive methods, encapsulating stability, and pH-responsive breakdown have emerged as viable delivery systems. Herein, we aim to explore a particular therapeutic modality involving the use of celecoxib-loaded GABA/wheat gluten‑sodium alginate (SA/WG-GABA+COX(40)) nanocarriers in enhancing apoptosis of OSCC (HSC-3 & SCC-25). Eventually, drug release profiles show that loaded COX and GABA demonstrated 96.04% and 98.1% at 7.2 pH. Interestingly, crucial experimental techniques like MTT assay, AO/EB staining, DAPI labeling for SCC-25, and HSC-3 displayed the highest cell lysis percentages of 86.5% and 93.3%. Notably, OSCC cell proliferation and migration and cell multiplications were limited with formulated WG/SA-GABA+COX(40) which was evident from In vitro ROS assay, flow cytometry, and JC-1 analysis. In vivo histology, blood serum biochemistry, and tumor examination in xenograft nude mice demonstrated that SA/WG-GABA+COX(40) mice reduced HSC-3 tumor cell proliferation. Downregulation of glutathione and activation of CCND2 signaling pathway caused HSC-3 OSCC cell death. Henceforth, present findings offer an advanced drug delivery method for targeted chemotherapy in treating OSCC.

Clinical Practice Guideline for detection and management of diabetic kidney disease: A consensus report by the Spanish Society of Nephrology

To address all the changes in the management of people with diabetes (DM) and chronic kidney disease (CKD), under the auspices of the Spanish Society of Nephrology (SEN), the Spanish Diabetic Nephropathy Study Group (GEENDIAB) decided to publish an updated Clinical Practice Guideline for detection and management of diabetic kidney disease (DKD). It is aimed at a wide audience of clinicians treating diabetes and CKD. The terminology of kidney disease in diabetic patients has evolved toward a more inclusive nomenclature that avoids underdiagnosis of this entity. Thus, the terms "diabetes and kidney disease" and "diabetic kidney disease" are those proposed in the latest KDIGO 2022 guidelines to designate the whole spectrum of patients who can benefit from a comprehensive therapeutic approach only differentiated according to eGFR range and albuminuria. Recommendations have been divided into five main areas of interest: Chapter 1: Screening and diagnosis of diabetic kidney disease, Chapter 2: Metabolic control in people with diabetes and CKD, Chapter 3: Blood pressure control in people with diabetic kidney disease, Chapter 4: Treatment targeting progression of CKD in people with diabetic kidney disease, and Chapter 5: Antiplatelet or anticoagulant therapy in people with diabetes and CKD. World Health Organization (WHO) recommendations for guideline development were followed to report this guideline. Systematic reviews were carried out, with outcome ratings and summaries of findings, and we reported the strength of recommendations following the "Grading of Recommendations Assessment, Development and Evaluation" GRADE evidence profiles.

Engineered Oxalate Decarboxylase Boosts Activity and Stability for Biological Applications

Oxalate decarboxylase (OxDC) from Bacillus subtilis is a Mn-dependent hexameric enzyme that converts oxalate to carbon dioxide and formate. Recently, OxDC has attracted the interest of the scientific community due to its biotechnological and medical applications for the treatment of hyperoxaluria, a group of pathologic conditions associated with excessive oxalate urinary excretion caused by either increased endogenous production or increased exogenous absorption. The fact that OxDC displays optimum pH in the acidic range represents a big limitation for most biotechnological applications involving processes occurring at neutral pH, where the activity and stability of the enzyme are remarkably reduced. Here, through bioinformatics-guided protein engineering followed by combinatorial mutagenesis and analyses of activity and thermal stability, we identified a double mutant of OxDC endowed with enhanced catalytic efficiency and stability under physiological conditions. The obtained engineered form of OxDC offers a potential tool for improved intestinal oxalate degradation in hyperoxaluria patients.

Targeting Insulin Resistance and Liver Fibrosis: CKD Screening Priorities in MASLD

Background and Aims: Chronic kidney disease (CKD) is a recognized extra-hepatic disease of nonalcoholic fatty liver disease (NAFLD). With the redefinition of NAFLD as metabolic dysfunction-associated steatotic liver disease (MASLD), the importance of cardiovascular metabolic factors in MASLD has been highlighted. However, whether MASLD remains independently associated with the prevalence of CKD is yet to be determined. Method: We analyzed data from 6567 non-pregnant adults from the National Health and Nutrition Examination Survey 2017-2020. MASLD was identified using liver ultrasound transient elastography and five cardiovascular risk factors. Multivariate logistic regression, subgroup analysis, and restricted cubic splines were employed to explore the associations and interactions within the data. Results: The prevalence of CKD across MASLD subgroups with different combinations of cardiometabolic risk factors varied. Univariate regression analysis indicated a significant association between MASLD and CKD (OR: 1.68, p < 0.001). This association was not significant after adjusting for diabetes (OR: 0.94, p = 0.74) or insulin resistance (OR: 1.00, p = 0.98) and was not significant in the fully adjusted model (OR: 0.87, p = 0.64). Subgroup analysis confirmed insulin resistance as a modifier in the MASLD-CKD relationship (p for interaction = 0.02). Multivariate analysis revealed that liver stiffness measurements (LSMs) were independently associated with CKD. LSM values showed an S-shaped correlation with CKD, with risk increasing above the 8.612 kPa threshold. Conclusions: This study suggests that the direct relationship between MASLD and CKD diminished when accounting for insulin resistance. Nevertheless, liver fibrosis emerges as an independent CKD risk factor, emphasizing the critical need for targeted CKD screening among MASLD patients, particularly those with insulin resistance or advanced fibrosis.

[Gender Disparities in Urolithiasis with a Special Focus on Oxalate Metabolism in the Liver]

The incidence and prevalence of urolithiasis are increasing in industrialized countries. In particular, an increase has been observed among young adults and women. The gender gap is closing, and gender equality (1:1) with regard to urolithiasis has already been documented for the USA. Studies have demonstrated that women have higher urine pH values than men, which promotes calcium phosphate crystallization. The tendency for men to develop calcium oxalate and uric acid stones is caused by the comparatively lower urine pH values. Malnutrition combined with a lack of exercise and the occurrence of metabolic syndrome with its underlying diseases (insulin resistance, type 2 diabetes mellitus, obesity, dyslipidaemia) are discussed as the causes of the increase in upper tract stone disease in industrialized countries. Non-alcoholic fatty liver disease (NAFLD), as the most common liver disease, is considered one of the complications of metabolic syndrome, with a prevalence of approximately 23% in Germany. Animal experiments and clinical studies have demonstrated a connection between NAFLD and increased oxalate excretion in urine. Based on the literature, NAFLD represents a possible cross-gender risk factor for kidney stone formation and is therefore considered to be a generally modifiable risk factor for recurrent urolithiasis. Simple recommendations concerning NAFLD should complement the general and metabolic workup in everyday clinical practice.

Novel Antihypertensive Medications to Target the Renin-Angiotensin System: Mechanisms and Research

An estimated 1.28 billion individuals in the global population suffer from hypertension. Importantly, uncontrolled hypertension is strongly linked to various cardiovascular and cerebrovascular diseases. The role of the renin-angiotensin system (RAS) is widely acknowledged in the development and progression of hypertension. This system comprises angiotensinogen, the renin/(pro)renin/(pro)renin receptor (PRR) axis, the renin/angiotensin-converting enzyme/angiotensin (Ang) II/Ang II type I receptor (AT1R) axis, the renin/angiotensin-converting enzyme (ACE) 2/Ang (1-7)/Mas receptor (MasR) axis, the alamandine/Mas-related G protein-coupled D (MrgD) receptor axis, and the renin/ACE/Ang II/Ang II type II receptor (AT2R) axis. Additionally, brain Ang III plays a vital role in regulating central blood pressure. The current overview presents the latest research findings on the mechanisms through which novel anti-hypertensive medications target the RAS. These include zilebesiran (targeting angiotensinogen), PRO20 (targeting the renin/(pro)renin/PRR axis), sacubitril/valsartan (targeting the renin/ACE/Ang II/AT1R axis), GSK2586881, Ang (1-7) and AVE0991 (targeting the renin/ACE2/Ang (1-7)/MasR axis), alamandine (targeting the alamandine/MrgD receptor axis), C21 and β-Pro7-Ang III (targeting the renin/ACE/Ang II/AT2R axis), EC33, and firibastat and NI956 (targeting brain Ang III).

Protective effect of soluble protein hydrolysate against H2O2‑induced intestinal injury: An interventional study

The present study aimed to investigate whether soluble protein hydrolysate (SPH) protects against intestinal oxidative stress injury. An in vitro lactate dehydrogenase assay was used to assess the cytotoxicity and protective effect of SPH. For in vivo assessment, friend virus B NIH Jackson mouse pups aged 21 days were administered with 5% w/v soluble protein hydrolysate (SPH) through drinking water for 14 days and then luminally injected with 0.3% or 0.6% H2O2. Thereafter, the fecal samples of mice were collected, and the mice were sacrificed. Intestinal epithelial injury was assessed, and the expressions of 84 oxidative stress‑related genes in intestinal tissues was determined. SPH prophylactically protected against H2O2‑induced oxidative stress injury in human intestinal epithelial cells. An animal model of oxidative stress‑induced intestinal injury was established using 0.3 and 0.6% H2O2. SPH treatment reduced oxidative stress (0.3% H2O2)‑induced gut injury in mice. As no accelerated body growth was observed in SPH‑treated mice, it was hypothesized that the underlying protective mechanism of SPH is not related to nutrient oversupply. Treatment with SPH upregulated five oxidative protective genes that were not consistent between the sexes. Some antioxidative genes, including ferritin heavy polypeptide‑1 (Fth1), heme oxygenase‑1 (Hmox1), NAD(P)H dehydrogenase quinone 1 (Nqo1) and superoxide dismutase 1 (Sod1), were commonly upregulated in both male and female mice. Overall, an antioxidative protective effect was observed following SPH treatment, which may be attributed to the upregulation of genes that protect against oxidative damage. The findings of the present study highlight the promising potential of SPH as a functional food for alleviating intestinal oxidative stress injury.

Brazilian Guidelines on evaluation and clinical management of Nephrolithiasis: Brazilian Society of Nephrology

The prevalence of nephrolithiasis has been increasing in recent years, affecting appro-ximately 10% and 15% of the population. Kidney stone disease is associated with syste-mic comorbidities such as cardiovascular dis-ease, diabetes mellitus, and obesity. The first Nephrolithiasis Guideline by the Brazilian Society of Nephrology was published in 2002, and since then, the accumulation of new clinical studies and guidelines has justified a review of the subject. This updated document, prepared by the Nephrolithiasis Committee of the Brazilian Society of Nephrology, reflects the advances in the management of patients with kidney stones. The guideline aims to provide recommendations for the diagnosis, prevention, and treatment of nephrolithiasis, based on the best available evidence. Topics covered include clinical evaluation, laboratory and imaging tests, as well as dietary and pharmacological interventions, and follow-up strategies.

Renal and Peripheral Blood Transcriptome Signatures That Predict Treatment Response in Proliferative Lupus Nephritis-A Prospective Study

Mechanisms contributing to non-response to treatment in lupus nephritis (LN) are unclear. We characterised the transcriptome of paired peripheral blood mononuclear cells (PBMCs) and renal tissues in LN before and after cyclophosphamide (CYC) treatment and identified markers that predicted treatment response. Total RNA isolated from paired PBMCs (n = 32) and renal tissues (n = 25) of 16 proliferative LN before CYC treatment, 6 months post-treatment, and during renal flare, was sequenced on Illumina Novaseq-6000 platform. Post-treatment, eight patients were clinical responders (CR), of whom four flared (FL), and eight were non-responders (NR). Comparative transcriptomic analyses before and after treatment within CR, NR, and FL groups was performed using DESeq2. Weighted gene co-expression network analysis (WGCNA) and ROC analysis was performed to identify and validate hub genes predictive of treatment response. Based on this, we observed that pathways such as degradation of cell cycle proteins, expression of G0 and G1 phase proteins, and apoptosis, were upregulated in CR PBMCs post-treatment, while IFN-γ signalling and ECM organisation were downregulated. In NR PBMCs, ECM molecules, neddylation and BCR signalling were upregulated post-CYC treatment, while in NR renal tissue, TLR, IFN and NF-κB signalling pathways were upregulated. In FL PBMCs, neutrophil degranulation and ROS and RNS production in phagocytes were downregulated following treatment, whereas, in the corresponding renal tissue, cell-ECM interactions and ISG15 antiviral mechanism were downregulated. After WGCNA and subsequent ROC analysis, TENM2, NLGN1 and AP005230.1 from PBMCs each predicted NR (AUC-0.91; p = 0.03), while combined model improved prediction (AUC-0.94; p = 0.02). AP005230.1 from renal tissue also predicted non-response (AUC-0.94; p = 0.01) and AC092436.3 from PBMCs predicted renal flare (AUC-0.81; p = 0.04). Our study identified significant DEGs/pathways specific to different treatment outcomes and hub genes that predicted non-response and renal flare.

Diagnostic and prognostic perspectives of Fabry disease via fiber evanescent wave spectroscopy advanced by machine learning

Fabry disease (FD) is a rare disorder resulting from a genetic mutation characterized by the accumulation of sphingolipids in various cells throughout the human body, leading to progressive and irreversible organ damage, particularly in males. Genetically-determined deficiency or reduced activity of the enzyme (alpha - Galactosidase; α-Gal) leads to the accumulation of sphingolipids in the lysosomes of various cell types, including the heart, kidneys, skin, eyes, central nervous system, and digestive system, triggering damage, leading to the failure of vital organs, and resulting in progressive disability and premature death. FD diagnostics currently depend on costly and time-intensive genetic tests and enzymatic analysis, often leading to delayed or inaccurate diagnoses, which contribute to rapid disease progression. In this research, mid-infrared Fiber Evanescent Wave Spectroscopy (FEWS) supported by statistical analysis and Machine Learning (ML) algorithms is shown to be an innovative and reliable method to detect globotriaosylsphingosine (Lyso-Gb3) FD biomarker in urine and serum samples by monitoring infrared spectra alone. ML showed a high selectivity for FD in the spectral range of Amide A and Amide I in blood serum, and α-D-galactosyl residues of glycosphingolipids in urine. The developed approach offers a promising, cost-effective express diagnostic tool sensitive enough for early FD detection and monitoring.

Varying clinical presentations of nutcracker syndrome: a case report

INTRODUCTION

The term nutcracker syndrome was initially established in 1972 to refer to the compressive effects on the left renal vein due to a narrow angle between the abdominal aorta and the superior mesenteric artery. Although the precise prevalence of nutcracker syndrome remains unknown, an incidence of up to 4% has been described in patients presenting with hematuria. The peak age of incidence is between 10 and 30 years, and it is equally prevalent among both genders, though earlier studies showed a predominantly female preponderance. About 70-80% of patients present initially with hematuria, though left flank pain and proteinuria may also be presenting symptoms. A high index of suspicion and appropriate imaging often helps in aiding diagnosis.

CASE PRESENTATION

In this case report, we present here two South Asian young females aged 23 and 30 years old. They presented with gross painless hematuria of a duration of 2 years (Case 1) and nonspecific symptoms of abdominal pain (Case 2), and they were diagnosed with nutcracker syndrome on investigation. Both patients were diagnosed by computed tomography angiography with defined aortomesenteric angles diagnostic of nutcracker syndrome. Patient 1 underwent saphenous venous bypass grafting and repositioning of left renal vein with symptomatic improvement, while patient 2 was managed conservatively and continues to be on close follow-up. In addition, we present a brief review of this syndrome so that better insight is obtained regarding diagnosis and management.

CONCLUSION

The diagnosis of nutcracker syndrome needs to be considered in patients who present with unexplained hematuria or proteinuria. Diagnosis by appropriate imaging studies is necessary, and treatment is dictated by the severity of symptoms. Surgical therapy remains the front-line treatment; however, endovascular techniques are becoming favored owing to advancements in stent technology.

Assessing the understandability and actionability of online resources for patients undergoing hemodialysis

INTRODUCTION

This study quantitatively evaluated the understandability and actionability of webpages for patients undergoing hemodialysis (HD).

METHODS

In June 2022, we searched on Google and Yahoo Japan using the top five keywords associated with end-stage kidney disease and HD to identify relevant materials. Subsequently, we used the Japanese version of the Patient Education Materials Assessment Tool to assess the understandability and actionability of these materials, rating them on a scale from 0% to 100%. The threshold was set at 70%.

RESULTS

Among the included 194 materials, the overall understandability was 66.7%, and the actionability was 33.3%. Only 38.7% and 16.5% of the materials were deemed understandable and actionable, respectively. Challenges included the need for plain language and concise summaries to improve understandability, along with the use of effective visual aids for actionability.

CONCLUSION

This study suggests that existing webpages on HD are not presented in a manner that patients can utilize.

Biological testing unification for hemodialysis membranes evaluation: A step towards standardization

Current hemodialysis treatments can cause adverse effects, many of which are linked to the membranes used in the process. These issues are being addressed through new materials and technologies, making it urgent to establish minimum guidelines for evaluating such membranes. This review proposes standardizing the biological tests and variables to evaluate the performance of new membranes, aiming to replicate hemodialysis conditions closely. The tests were categorized into protein adsorption, protein transmission, platelet adhesion, platelet activation, blood coagulation times, hemolysis, complement activation, and cytotoxicity. For protein adsorption, static tests are recommended as an initial step to rule out membrane adhesion, followed by dynamic tests that must be conducted using a crossflow system (>250 mL/min flow) and a solution mimicking real conditions (BSA, lysozyme, trypsin, pepsin, creatinine, urea, albumin, fibrinogen, and γ-globulin). Protein transmission tests must employ dynamic conditions, using human blood or platelet-rich plasma for a minimum time of 3.5 h. Complement activation should be tested using human blood and ELISA assays to detect C3, C5 TCC, and SC5b-9. Blood coagulation times (APTT, TT, FT, TCT, and TAT) should be measured with platelet-poor and platelet-rich plasma. Hemolysis tests should transition from water bath to continuous mode for at least 3.5 h. Cytotoxicity tests should compare the MTT assay with other methods (Alamar Blue, Lactate Dehydrogenase Assay, Flow Cytometry, or Trypan Blue Exclusion Test) and use different cell types for comprehensive validation. By implementing these minimum biological tests, membrane evaluations would more accurately reflect the real-world applications, ensuring biocompatibility, effectiveness, and efficiency.

Post-obstructive Acute Kidney Injury Due to a Retroperitoneal Mass

This case report discusses post-obstructive acute kidney injury (AKI) in a 26-year-old woman with neurofibromatosis type 1 (NF1) and uterine fibroids. The patient's AKI was diagnosed through elevated creatinine and blood urea nitrogen (BUN) levels and confirmed by transabdominal ultrasound and computed tomography (CT) scan, which revealed severe bilateral ureterohydronephrosis. The patient underwent fluoroscopic and sonographic bilateral nephrostomy tube placement, which significantly improved renal function. An exploratory laparotomy and superficial mass biopsy indicated a retroperitoneal tumor consisting of fibroadipose and muscular tissue with focal suppurative inflammation. The patient's renal function normalized by discharge. This case underscores the importance of early recognition, radiological evaluation, and timely intervention in managing AKI secondary to obstructive uropathy and calls for further research on optimal management strategies for AKI secondary to primary retroperitoneal masses.

Matrix Metalloproteinases in Ureteropelvic Junction Obstruction: Their Role in Pathogenesis and Their Use as Clinical Markers

The obstruction of the urinary tract is responsible for obstructive nephropathy (ON), also known as uropathy, which may then evolve in a renal parenchymal disease (hydronephrosis). Regarding the etiology of ON, it has been linked to the perturbation of processes occurring during the urinary tract development such as morphogenesis, maturation, and growth. Despite the research carried out in recent years, there is still a pressing need to elucidate the molecular processes underlying the disease. This may then result in the definition of novel biomarkers that can help in patient stratification and the monitoring of therapeutic choices. Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases with key roles in extracellular matrix remodeling due to their wide cleavage specificity and ability to modulate the bioavailability of growth factors. Despite the known changes in the local tissue microenvironment at the site of the urinary tract obstruction, the role of MMPs in ureteropelvic junction obstruction (UPJO) and, therefore, in the pathogenesis of renal damage in ON is not well-documented. In this review, we underline the possible roles of MMPs both in the pathogenesis of UPJO and in the progression of related hydronephrosis. The potential use of MMPs as biomarkers detectable in bodily fluids (such as the patient's urine) is also discussed.

Review of recent molecular pathology of bladder urothelial carcinoma

Bladder urothelial carcinoma (BUC) is a common malignant tumour with a high recurrence rate and mortality. Research on the molecular pathological basis of BUC is extensive. However, the specific pathogenesis and effective treatment of BUC remain to be further studied. Studies on mutation spectrum, DNA methylation, non-coding RNA, proliferation and apoptosis signalling pathways, cell cycle control, transcription factors, DNA damage repair, immune checkpoint and tumour microenvironment have provided therapeutic strategies for the diagnosis, treatment and prognosis evaluation of BUC. This study provided new insights into the molecular pathology of BUC, helped to improve the diagnosis, treatment and prognostic evaluation of patients and drove the use of precision medicine in the treatment of BUC.

Association between SARS-CoV-2 viral load and serum biomarkers with mortality in Mexican patients

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has resulted in high mortality among hospitalized patients; thus, identifying mortality markers in treating these patients is essential. To evaluate the association between viral load and serum biomarkers with mortality among hospitalized patients with COVID-19.

MATERIALS AND METHODS

A retrospective cohort study was conducted among 198 inpatient records from a tertiary hospital in Mexico City between January and April 2021. The association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and serum biomarkers with death due to COVID-19 was assessed using Cox regression models.

RESULTS

The median age was 54.9 years, and 61.6% were males. The mortality rate was 43.4%. After adjusting for potential confounders, patients with higher viral load [adjusted hazard ratio (aHR) = 1.56; 95% confidence interval (95% CI) = 1.01, 2.42; P value = 0.041]; and higher concentrations of BUN (aHR = 4.87;95% CI = 2.70, 8.79; P value = 0.001), creatinine (aHR = 1.60;95% CI = 1.01, 2.54; P value = 0.043), osmolality (aHR = 4.37;95% CI = 2.34, 8.14; P value = 0.001), and glucose (aHR = 2.41;95% CI = 1.40, 4.18; P value = 0.001) were more likely to have a fatal prognosis. Conversely, mortality risk was lower among patients with high concentrations of lymphocytes (aHR = 0.47;95% CI = 0.30, 0.72; P value = 0.001).

CONCLUSION

SARS-CoV-2 viral load and serum biomarkers such as BUN, creatinine, glucose, osmolarity, and lymphocytes could help physicians identify individuals who require closer monitoring.

Pelvic Varicose Veins in Women. Russian Experts Consensus

Pelvic Varicose Veins in Women. Russian Experts Consensus.

Targeting the Endocannabinoidome: A Novel Approach to Managing Extraintestinal Complications in Inflammatory Bowel Disease

Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder marked by persistent gastrointestinal inflammation and a spectrum of systemic effects, including extraintestinal manifestations (EIMs) that impact the joints, skin, liver, and eyes. Conventional therapies primarily target intestinal inflammation, yet they frequently fail to ameliorate these systemic complications. Recent investigations have highlighted the complex interplay among the immune system, gut, and nervous system in IBD pathogenesis, thereby underscoring the need for innovative therapeutic approaches. Methods: We conducted a comprehensive literature search using databases such as PubMed, Scopus, Web of Science, Science Direct, and Google Scholar. Keywords including "cannabinoids", "endocannabinoid system", "endocannabinoidome", "inflammatory bowel disease", and "extraintestinal manifestations" were used to identify peer-reviewed original research and review articles that explore the role of the endocannabinoidome (eCBome) in IBD. Results: Emerging evidence suggests that eCBome-a network comprising lipid mediators, receptors (e.g., CB1, CB2, GPR55, GPR35, PPARα, TRPV1), and metabolic enzymes-plays a critical role in modulating immune responses, maintaining gut barrier integrity, and regulating systemic inflammation. Targeting eCBome not only improves intestinal inflammation but also appears to mitigate metabolic, neurological, and extraintestinal complications such as arthritis, liver dysfunction, and dermatological disorders. Conclusions: Modulation of eCBome represents a promising strategy for comprehensive IBD management by addressing both local and systemic disease components. These findings advocate for further mechanistic studies to develop targeted interventions that leverage eCBome as a novel therapeutic avenue in IBD.

lncRNA EGOT Is the Marker of HPV Infection and a Prognostic Factor for HNSCC Patients

Background: High-risk human papillomavirus (HPV) contributes to oropharyngeal cancers through mechanisms involving the deregulation of host cell functions by oncoproteins E6 and E7. Changes in the epigenome, particularly involving long non-coding RNAs (lncRNAs), are crucial for understanding HPV-related carcinogenesis. Methods: This study aimed to analyze the expression levels of lncRNAs in HPV-related head and neck squamous cell carcinoma (HNSCC) to determine their biological and clinical significance, addressing the current gap in clinically validated biomarkers for early screening and therapeutic interventions. Results: The study highlights the significant overexpression of the EGOT gene in HPV-positive HNSCC samples, suggesting its potential as a marker to distinguish between HPV-negative and HPV-positive cases. Furthermore, high EGOT expression correlates with better overall survival (OS) and indicates possible resistance to therapy, making it a valuable prognostic factor. Conclusions: These findings underscore the potential of incorporating EGOT expression analysis in clinical practice for improved patient stratification and treatment outcomes in HNSCC.

Current understanding of adult nephrotic syndrome: Minimal change disease

The underlying molecular changes that result in minimal change disease (nephrotic syndrome) require an in-depth analysis. Current molecular studies have shown the involvement of zinc fingers and homeobox transcriptional factors in its pathogenesis. The application of therapeutic drugs relies on understanding the cascade of molecular events to determine their efficacy in managing the clinical condition.

Link between obstructive uropathy and acute kidney injury

Obstructive uropathy represents a major risk of acute kidney injury. From an epidemiological point of view, it is responsible for 5% to 10% of cases of acute renal failure and 4% of cases of end-stage kidney disease. Although obstructive uropathy is a recognized disease, there is a significant lack of detailed research on this topic from both a nephrological and urological perspective. The majority of published research focuses on the pathophysiology of the topic and neglects a comprehensive analysis of diagnostic and treatment approaches supported by current data. In this context, it is crucial to assess the overall hemodynamic status, especially in the presence of urosepsis. Once clinical stability is assured, it is important to focus on symptom management, usually by controlling pain. Ultimately, it is crucial to decide immediately whether the patient should receive a prompt urinary diversion. Urinary diversion is an essential part of the treatment of obstructive uropathy and should be initiated promptly and without unnecessary delay once the diagnosis has been confirmed. Functional recovery of the obstructed kidney after decompression of the urinary tract depends on the degree of obstruction, the duration of the obstruction and the presence of a concomitant urinary tract infection. The timing and proper treatment of this condition determines the recovery of kidney function after an obstruction and prevents the development of chronic kidney disease. In this editorial, we emphasized the pathophysiological role and clinical significance of obstructive uropathy in the context of acute kidney injury.

Hepatorenal syndrome: Paving a pathway from a fatal condition to an opportunity to preserve kidney function

In the 19th century, von Frerichs F and Flint A identified a type of acute renal impairment associated with advanced liver disease, characterized by oliguria, absence of proteinuria, and normal renal histology, which was later termed hepatorenal syndrome (HRS). HRS primarily affects cirrhotic patients with ascites and often follows severe infections, digestive hemorrhages, or high-volume paracentesis. Pathophysiologically, HRS involves low glomerular filtration rate, hypotension, renin-angiotensin axis activation, water clearance, hyponatremia, and minimal urinary sodium excretion. These conditions mimic those seen in decreased effective circulatory volume (ECV) scenarios such as septic shock or heart failure. HRS represents a specific form of prerenal acute kidney injury (AKI) in patients with baseline renal ischemia, where the kidney attempts to correct decreased ECV by retaining sodium and water. Intense renal vasoconstriction, passive hyperemia from ascites, and acute tubular necrosis (ATN) with specific urinary sediment changes are observed. Persistent oliguria may transition HRS to ATN, although this shift is less straightforward than in other prerenal AKI contexts. Notably, liver grafts from HRS patients can recover function more rapidly than those from other ischemic conditions. Experimental studies, such as those by Duailibe et al, using omega-3 fatty acids in cirrhotic rat models, have shown promising results in reducing oxidative stress and improving kidney function. These findings suggest potential therapeutic strategies and underscore the need for further research to understand the mechanisms of HRS and explore possible treatments. Future research should address the impact of omega-3 on survival and secondary outcomes, as well as consider the balance of therapeutic risks and benefits in severe liver disease.

Artificial intelligence-driven strategies for managing renal and urinary complications in inflammatory bowel disease

In this editorial, we discuss the article by Singh et al published in World Journal of Nephrology, stating the need for timely adjustments in inflammatory bowel disease (IBD) patients' long-term management plans. IBD is chronic and lifelong, with recurrence and remission cycles, including ulcerative colitis and Crohn's disease. It's exact etiology is unknown but likely multifactorial. Related to gut flora and immune issues. Besides intestinal symptoms, IBD can also affect various extraintestinal manifestations such as those involving the skin, joints, eyes and urinary system. The anatomical proximity of urinary system waste disposal to that of the alimentary canal makes early detection and the differentiation of such symptoms very difficult. Various studies show that IBD and it's first-line drugs have nephrotoxicity, impacting the patients' life quality. Existing guidelines give very few references for kidney lesion monitoring. Singh et al's plan aims to improve treatment management for IBD patients with glomerular filtration rate decline, specifically those at risk. Most of IBD patients are young and they need lifelong therapy. So early therapy cessation, taking into account drug side effects, can be helpful. Artificial intelligence-driven diagnosis and treatment has a big potential for management improvements in IBD and other chronic diseases.

Concept analysis of diabetes-related quality of life

BACKGROUND

Quality of life (QoL) is a common indicator of outcomes in people living with diabetes, but the concept of diabetes-related QoL (DRQoL) remains unclear. Clarifying core knowledge of DRQoL was the goal of this paper.

METHODS

A concept analysis was conducted according to Walker and Avant's framework. A systematic search of the published literature was conducted between 2002 and 2022 based on resource availability, current relevancy, and the quality of recent studies. Three major databases were used to identify the attributes, antecedents, consequences, and measures for DRQoL. Only articles investigating DRQoL among adult or elderly people living with diabetes that were published in English in peer-reviewed journals were analyzed.

RESULTS

In total, 4342 articles were screened, and only 401 articles underwent eligibility assessment. A total of 183 articles were included in the analysis. Most (59.78%) of them were observational studies and DRQoL as a primary outcome. We identified four critical components of DRQoL: (a) general health, (b) diabetes-related satisfaction, (c) diabetes impact, and (d) diabetes self-management. The antecedents were classified according to their contributions to DRQoL as follows: 25 positive-induced, 4 neutral-based, and 19 negative-induced antecedents. The consequences of DRQoL were mortality risk, personal health, satisfaction with health care, hospitalization risk, and failure to return to work. The referents varied widely, and 32 tools were found for DRQoL measurement. Furthermore, 12 scales for disease-specific DRQoL and 17 tools for general QoL were identified.

CONCLUSION

This paper provides a definition of DRQoL as well as its attributes, antecedents, consequences, and measures in adults with diabetes. The attributes of DRQoL included general health, diabetes-related satisfaction, diabetes impact, and diabetes self-management. A comprehensive understanding of DRQoL can improve the quality of care and can aid in the recognition of the needs of care among people living with diabetes.