Background:Refined models of kidney disease are critical to better understand disease processes and study novel treatments while minimizing discomfort in research animals.The objective of this study was to report a te...Background:Refined models of kidney disease are critical to better understand disease processes and study novel treatments while minimizing discomfort in research animals.The objective of this study was to report a technique for minimally invasive partial kidney embolism in cats and describe outcomes following transcatheter administration of embolic microspheres with subsequent contralateral nephrectomy.Methods:Eleven,apparently healthy,male,purpose-bred cats underwent unilateral kidney embolism with 0.25 or 0.5 mL of embolic microparticle(40-120μm)suspension(0.2 mL microspheres/mL)delivered into the right renal artery under fluoroscopic guidance,followed 5 months later by contralateral nephrectomy.One month after nephrectomy,blood and urinary markers of kidney function were evaluated,and embolized kidneys were harvested for histopathology evaluation.Results:Renal artery embolization was possible in all cats.Two cats did not complete the study,one after experiencing congestive heart failure(n=1)and the other following evidence of complete kidney embolism precluding nephrectomy(n=1)postembolization.At study end,compared to baseline,cats had significant increases in median(range)serum creatinine(159.1μmol/L[141.4-530.4]versus 128.2μmol/L[92.8-150.3];p=0.0004),urea nitrogen(15.71 mmol/L[9.29-47.85]versus 7.50 mmol/L[6.07-8.57];p<0.0001),and symmetric dimethylarginine(0.74μmol/L[0.59-3.12]versus 0.67μmol/L[0.54-0.72];p=0.0288)concentrations.No differences in markers of kidney function were documented between dose groups.Conclusions:M inimally invasive kidney embolism is a promising technique for modeling kidney disease in cats.Understanding optimal dose,timing of nephrectomy,and longer-term consequences requires additional work.展开更多
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.Althou...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 unnece-ssary 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.展开更多
BACKGROUND Equations for estimation glomerular filtration rate(eGFR)have been associated with poor clinical performance and their clinical accuracy and reliability have been called into question.AIM To assess the long...BACKGROUND Equations for estimation glomerular filtration rate(eGFR)have been associated with poor clinical performance and their clinical accuracy and reliability have been called into question.AIM To assess the longitudinal changes in measured glomerular filtration rate(mGFR)in patients with autosomal dominant polycystic kidney disease(ADPKD).METHODS Analysis of an ambispective data base conducted on consecutive patients diagnosed with ADPKD.The mGFR was assessed by iohexol clearance;while eGFR was calculated by three different formulas:(1)The chronic kidney disease epidemiology collaboration(CKD-EPI);(2)Modification of diet in renal disease(MDRD);and(3)The 24-hour urine creatinine clearance(CrCl).The primary end-points were the mean change in mGFR between the baseline and final visit,as well as the comparison of the mean change in mGFR with the change estimated by the different formulas.RESULTS Thirty-seven patients were included in the study.As compared to baseline,month-6 mGFR was significantly decrease by-4.4 mL/minute±10.3 mL/minute(P=0.0132).However,the CKD-EPI,MDRD,and CrCl formulas underestimated this change by 48.3%,89.0%,and 45.8%respectively,though none of these differences reached statistical significance(P=0.3647;P=0.0505;and P=0.736,respectively).The discrepancies between measured and estimated glomerular filtration rate values,as evaluated by CKD-EPI(r=0.29,P=0.086);MDRD(r=0.19,P=0.272);and CrCl(r=0.09,P=0.683),were not correlated with baseline mGFR values.CONCLUSION This study indicated that eGFR inaccurately reflects the decline in mGFR and cannot reliably track changes over time.This poses significant challenges for clinical decision-making,particularly in treatment strategies.展开更多
The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future car...The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future cardiovascular(CV)diseases.Chronic kidney disease,a state of chronic inflammation caused by oxidative stress,metabolic abnormalities,infection,and uremic toxins damages the endothelium.ED is also associated with a decline in estimated glomerular filtration rate.After kidney transplantation,endothelial functions undergo immediate but partial restoration,promising graft longevity and enhanced CV health.However,the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED,culminating in poor CV health and graft survival.ED in kidney transplant recipients is an underrecognized and poorly studied entity.CV diseases are the leading cause of death among kidney transplant candidates with functioning grafts.ED contributes to the pathogenesis of many of the CV diseases.Various biomarkers and vasoreactivity tests are available to study endothelial functions.With an increasing number of transplants happening every year,and improved graft rejection rates due to the availability of effective immunosuppressants,the focus has now shifted to endothelial protection for the prevention,early recognition,and treatment of CV diseases.展开更多
BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from mode...BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from modern approaches of proteomic analysis of liquid biopsies(serum,urine)represent a promising innovation in the monitoring of kidney transplant recipients.AIM To investigate the diagnostic utility of protein biomarkers derived from proteomics approaches in renal allograft assessment.METHODS A systematic review was conducted in accordance with PRISMA guidelines,based on research results from the PubMed and Scopus databases.The primary focus was on evaluating the role of biomarkers in the non-invasive diagnosis of transplant-related com-plications.Eligibility criteria included protein biomarkers and urine and blood samples,while exclusion criteria were language other than English and the use of low resolution and sensitivity methods.The selected research articles,were categorized based on the biological sample,condition and methodology and the significantly and reproducibly differentiated proteins were manually selected and extracted.Functional and network analysis of the selected proteins was performed.RESULTS In 17 included studies,58 proteins were studied,with the cytokine CXCL10 being the most investigated.Biological pathways related to immune response and fibrosis have shown to be enriched.Applications of biomarkers for the assessment of renal damage as well as the prediction of short-term and long-term function of the graft were reported.Overall,all studies have shown satisfactory diagnostic accuracy of proteins alone or in combination with conventional methods,as far as renal graft assessment is concerned.CONCLUSION Our review suggests that protein biomarkers,evaluated in specific biological fluids,can make a significant contribution to the timely,valid and non-invasive assessment of kidney graft.展开更多
BACKGROUND Pediatric kidney transplantation is the treatment of choice for children with endstage renal disease;however,access to transplantation remains limited in lowand middle-income countries.Uzbekistan had no pri...BACKGROUND Pediatric kidney transplantation is the treatment of choice for children with endstage renal disease;however,access to transplantation remains limited in lowand middle-income countries.Uzbekistan had no prior institutional experience in performing pediatric living donor kidney transplantation(LDKT).AIM To report the implementation,surgical protocols,and clinical outcomes of the first pediatric LDKT program in Uzbekistan.METHODS This retrospective single-center study analyzed the first 20 pediatric LDKTs performed between April 2023 and February 2025.All donors were related family members who underwent either open or laparoscopic hand-assisted nephrectomy.Pre-transplant immunologic workup included HLA typing and anti-HLA antibody screening using solid-phase assays.Perioperative management was guided by Enhanced Recovery After Surgery Society principles.Primary outcomes included operative metrics,perioperative complications,graft function,biopsyproven rejection,and patient/graft survival.Statistical analysis utilized descriptive statistics,Kaplan–Meier survival estimates,and Fisher’s exact test where applicable.RESULTS Donors included 13 women and 7 men(median age:38 years;range:31–50).Median operative times were 182.5 minutes for open nephrectomy and 198.5 minutes for laparoscopic nephrectomy.No major intraoperative complications occurred;one donor developed a postoperative wound seroma.All recipients(aged 87–207 months)exhibited immediate graft function,with no delayed graft function observed.Median cold and warm ischemia times were 15 minutes(range:10–138)and 35 minutes(range:18–40),respectively.Median serum creatinine decreased from 198μmol/L on postoperative day 1 to 54μmol/L by day 7.Three rejection episodes were reported,two of which occurred in sensitized recipients.Two graft losses were attributed to late rejection.One patient died from hemorrhagic stroke six months post-transplant.At 24 months,patient and graft survival rates were 95%and 90%,respectively.CONCLUSION The successful implementation of a pediatric living donor kidney transplantation program in Uzbekistan yielded favorable short-and intermediate-term outcomes,with high graft survival and low complication rates.This experience may provide a practical framework for initiating similar programs in other resource-constrained healthcare settings.展开更多
Rhabdomyolysis(RM)is characterized by disrupting muscle cells and releasing intracellular components into circulation.Some symptoms associated with RM include muscle weakness,discolored urine,and myalgia.RM can be cau...Rhabdomyolysis(RM)is characterized by disrupting muscle cells and releasing intracellular components into circulation.Some symptoms associated with RM include muscle weakness,discolored urine,and myalgia.RM can be caused by coronavirus disease 2019(COVID-19)causing exaggerated immune response leading to muscle damage.Acute kidney injury(AKI),when presented with RM,leads to increased mortality.Examining RM-related AKI and its comparison to other AKI types in COVID-19 patients could improve the management of viral infections developing RM and AKI.RM potentially complicated COVID-19 infection course and is a major etiology of AKI.RM-related AKI had higher severity and mortality than other AKI types,with increased hypercoagulopathy and inflammatory markers.Findings also express procalcitonin use in follow-ups with severe COVID-19 patients.Study limitations include small sample size,absence of kidney biopsies,and focus on the first wave of the pandemic,which should be addressed in future research to generate accurate and relevant findings.展开更多
BACKGROUND Private insurance coverage is associated with higher rates of living donor kidney transplantation(LDKT)but whether this is attributable to confounding is not known.AIM To study the association between incre...BACKGROUND Private insurance coverage is associated with higher rates of living donor kidney transplantation(LDKT)but whether this is attributable to confounding is not known.AIM To study the association between increased access to private health insurance and LDKT.METHODS Retrospective cohort study using United States transplant registry data.We identified incident candidates aged 22-29 years who were waitlisted for a kidneyonly transplant from 2005-2014,excluding prior transplant recipients and those with missing data.We calculated the hazard of LDKT after waitlisting for those with private insurance vs other insurance pre-Affordable Care Act(ACA)vs post-ACA,using death and delisting as competing events,for candidates affected by the policy change(age 22-25 years)vs those who were not(age 26-29 years).RESULTS A total of 13817 candidates were included,of whom 46%were age 22-25 years and 54%were age 26-29 years.Among candidates aged 22-25 years at listing,those listed post-ACA were more likely to have private insurance compared to those listed pre-ACA(42%vs 35%),but there was no difference in private insurance coverage between eras among candidates aged 26-29 years at listing.In adjusted competing risk regression,privately insured patients age 22-25 years were less likely to receive a LDKT post-ACA compared to pre-ACA[hazard ratio(HR)=0.88,95%CI:0.78-1.00],as were those aged 22-25 years old with other insurance types(HR=0.80,95%CI:0.69-0.92).These associations were not seen among candidates age 26-29 years.CONCLUSION Candidates age 22-25 years were likelier to have private insurance post-ACA,without an increased rate in LDKT.Demonstrations of associations between insurance and LDKT are likely attributable to residual confounding.展开更多
Kidney transplant is the treatment of choice for patients with end-stage kidneydisease. Meticulous anaesthetic management is the cornerstone of good postoperativepatient and graft outcomes. Over the decades, the perio...Kidney transplant is the treatment of choice for patients with end-stage kidneydisease. Meticulous anaesthetic management is the cornerstone of good postoperativepatient and graft outcomes. Over the decades, the perioperative strategiesfor preoperative optimization, fluid management, immunosuppression, haemodynamicmonitoring, and pain management keep changing with the inclusionof newer studies. The aim of this review is to update anaesthesia colleagues forrecent advancements in perioperative care of patients undergoing kidney transplantation.展开更多
Small interfering RNA(siRNA),a promising revolutionary therapy,faces delivery obstacles due to its poor targeting,strong charge negativity and macromolecular nature.Clinical-approved siRNAs can now only be delivered t...Small interfering RNA(siRNA),a promising revolutionary therapy,faces delivery obstacles due to its poor targeting,strong charge negativity and macromolecular nature.Clinical-approved siRNAs can now only be delivered to the liver mediated by the chemically conjugated N-acetylgalactosamine(GalNAc)ligand,the conjugate can be effectively uptaken into cells through interaction with asialoglycoprotein receptor(ASGPR)highly expressed on liver hepatocytes.To further explore an efficient non-hepatic targeted delivery strategy,in this study,we designed a delivery system that chemically conjugated p53 siRNA to renal tubular cell-targeting peptides for targeting the kidney,which was suitable for industrial transformation.Results showed that peptide-siRNA conjugate could specifically enter renal tubular epithelial cells and silence target genes.In cisplatin-induced acute kidney injury(AKI)mice,peptide-siRNA conjugate blocked the p53-mediated apoptotic pathway and alleviated renal damage.The innovative proposed system to conjugate kidney-targeting peptides with siRNA achieved the efficient kidney-targeted delivery of si RNA and provided a prospective choice for treating AKI.展开更多
BACKGROUND Kidney is the vital organ that plays a great role in maintaining an optimal internal environment.The normal kidney function can be altered by physical injury or disease.Currently,chronic kidney disease(CKD)...BACKGROUND Kidney is the vital organ that plays a great role in maintaining an optimal internal environment.The normal kidney function can be altered by physical injury or disease.Currently,chronic kidney disease(CKD)is an increasing major health problem worldwide.In 2017,it was ranked as the 12th leading cause of death and is expected to rise to the 5th ranked cause of death by 2040.Therefore,early detection,increasing patients'awareness and treatment of CKD are required to hold the problem.However,despite its higher prevalence of hospitalized morbidity and mortality,little is known about the magnitude and associated factor of CKD in the Ethiopian context.Hence this study aimed to determine the magnitude of CKD and associated factors at Wolkite University Specialized Hospital(WKUSTH),South West Ethiopia.AIM To determine the magnitude,and associated factors of CKD in WKUSTH,Ethiopia.METHODS Institutional based cross-sectional study with secondary data was conducted from November 15,2021 to February 28,2022 at WKUSTH.Three hundred forty five(345)participants were selected by a convenient sampling technique.Creatinine and urea were measured using cobas311 fully automated chemistry analyzer and estimated glomerular filtration rate(eGFR)was calculated using CKD epidemiology collaboration formula.Sociodemographic and clinical data were collected by using a pretested questionnaire.Data were coded and entered into EpiData 3.1 version and exported to STATA version 14 for analysis.Bivariate analysis was used to screen candidate variables for multivariate analysis.In the multivariate analysis a P value<0.05 were considered statistically significant.RESULTS The magnitude of CKD by impaired eGFR were 54(15.7%)(95%CI:0.116-0.194).In multivariable analysis,older age[adjusted odds ratio(AOR)=5.91,95%CI:2.41-14.47)],hypertension(AOR=10.41,95%CI:4.55-23.81),diabetes mellitus(AOR=5.90,95%CI:2.14-16.23),high body mass index(AOR=3.0,95%CI:1.30-7.27),and anemia(AOR=2.94,95%CI:1.26-6.88)were independently associated with CKD.CONCLUSION The magnitude of CKD among adult patients admitted to WKUSTH was high.Hence,researchers need to do a population-based study and longitudinal study on the magnitude of CKD,associated factors.Estimation of GFR for all hospitalized patients might help to early detection of CKD and prevent complications.展开更多
Kenya, a lower-middle-income country in East Africa, faces a rising burden of chronic kidney disease (CKD), with an estimated 12,500 individuals suffering from end-stage renal disease (ESRD). Renal transplantation—th...Kenya, a lower-middle-income country in East Africa, faces a rising burden of chronic kidney disease (CKD), with an estimated 12,500 individuals suffering from end-stage renal disease (ESRD). Renal transplantation—the preferred treatment option for ESRD, remains underutilized. Since the first transplant in 1978, seven centers have been established, with 829 transplants performed by 2022. Living-related renal transplants (LRRT) dominate, while deceased donor renal transplantation (DDRT) is yet to be implemented. Recent data show improved outcomes, with one-year graft survival rates up to 96%, but challenges such as acute rejection rates (32.8%) and limited donor outcome data persist. Barriers include high costs, limited insurance coverage, inadequate laboratory infrastructure, and a transplant workforce shortage. Efforts to establish DDRT programs are underway but are hampered by the absence of organ procurement systems and insufficient laboratory capabilities. Future priorities include reducing costs and expanded insurance coverage for transplant care. Investments in laboratory infrastructure, local tissue typing, and surgical training are essential. Strengthening international collaborations and public education campaigns can improve donor pools and transplantation access. Strategic policy reforms and resource allocation are vital to scaling up Kenya’s kidney transplant program and addressing the unmet needs of its ESRD population.展开更多
In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a comp...In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a complex interplay of renal and hepatic pathophysiology,with AKI acting as an initiator through maladaptive repair mechanisms.These mechanisms—such as tubular cell cycle arrest,inflammatory cascades,and fibrotic processes—are exacerbated by the hemodynamic and neurohormonal disturbances characteristic of cirrhosis.Following AKI episodes,persistent kidney dysfunction or acute kidney disease(AKD)often serves as a bridge to CKD.AKD represents a critical phase in renal deterioration,characterized by prolonged kidney injury that does not fully meet CKD criteria but exceeds the temporal scope of AKI.The progression from AKD to CKD is further influenced by recurrent AKI episodes,impaired renal autoregu-lation,and systemic comorbidities such as diabetes and metabolic dysfunction-associated steatotic liver disease,which compound kidney damage.The clinical management of AKI and CKD in cirrhotic patients requires a multidimensional approach that includes early identification of kidney injury,the application of novel biomarkers,and precision interventions.Recent evidence underscores the inadequacy of traditional biomarkers in predicting the AKI-to-CKD progression,necessitating novel biomarkers for early detection and intervention.展开更多
BACKGROUNDThe impact of long-term dialysis (LTD) therapy on the survival benefit of kidneytransplantation compared to short-term dialysis (STD) remains unclear. Additionally,donor organ quality has been identified as ...BACKGROUNDThe impact of long-term dialysis (LTD) therapy on the survival benefit of kidneytransplantation compared to short-term dialysis (STD) remains unclear. Additionally,donor organ quality has been identified as a significant predictor ofpatient survival in deceased donor kidney transplantation.AIMTo investigate the effects of the best graft function within three months posttransplant,as well as dialysis duration, on transplant outcomes.METHODSA total of 255 patients were included in this retrospective cohort study. Patientswere divided into two groups: Those with LTD (≥ 15 years;Group LTD) and thosewith STD (< 15 years;Group STD). Clinical backgrounds and outcomes werecompared between the groups.RESULTSGroup LTD comprised 28 patients, while Group STD included 227 patients. Therewere no significant differences between the two groups in terms of age at transplant,donor age, lowest serum creatinine (best S-Cr) within three months posttransplant,or the frequency of cardiovascular events after transplantation. Multivariateanalysis identified age [hazard ratio (HR): 1.058;95%CI: 1.002-1.116;P =0.040], post-transplant incidence of cardiovascular disease (HR: 20.264;95%CI:6.052-67.850;P < 0.001), and best S-Cr (HR: 4.155;95%CI: 2.234-7.730;P < 0.001) asindependent predictors of mortality after transplantation. The pre-operative dialysisperiod was not statistically significant.CONCLUSIONThese findings suggest that early graft dysfunction, rather than dialysis duration, may serve as a critical risk factorfor poor transplant outcomes.展开更多
The occurrence of acute kidney injury(AKI)in critically ill patients is often associated with increased morbidity and mortality rates.Despite extensive research,a consensus is yet to be arrived,especially regarding th...The occurrence of acute kidney injury(AKI)in critically ill patients is often associated with increased morbidity and mortality rates.Despite extensive research,a consensus is yet to be arrived,especially regarding the optimal timing and indications for initiation of kidney replacement therapy(KRT)for critically ill patients.There is no clear guidance available on the timing of weaning from KRT.More recently,various biomarkers have produced promising prognostic pre-diction in such patients,regarding the need for KRT and its termination.Most of these biomarkers are indicative of kidney damage and stress,rather than re-covery.However,large-scale validation studies are required to guide the cutoff values of these biomarkers among different patient cohorts so as to identify the optimum timing for KRT.This article reviews the kidney biomarkers in detail and summarizes the individual roles of biomarkers in the decision-making process for initiation and termination of the KRT among critically ill AKI patients and the supportive literature.展开更多
BACKGROUND C3 glomerulopathies(C3G)are a rare cause of kidney failure resulting from complement dysregulation.Small studies demonstrate a high rate of recurrence and poor outcomes in kidney transplantation.Treatment e...BACKGROUND C3 glomerulopathies(C3G)are a rare cause of kidney failure resulting from complement dysregulation.Small studies demonstrate a high rate of recurrence and poor outcomes in kidney transplantation.Treatment efficacy in this setting with eculizumab,a terminal complement inhibitor,is largely unknown.AIM To determine the outcomes of kidney transplantation in patients with C3G and the potential impact of eculizumab.METHODS We retrospectively studied kidney transplant recipients who underwent a post-transplant biopsy confirming C3G between January 1,1993 and December 31,2023 at a single center.Only the first episode of kidney transplant was reviewed.The electronic medical records were reviewed for post-transplant allograft function,indication for biopsy,time to biopsy from transplant,time to allograft failure from transplantation,post-C3G treatment,complement laboratory testing,and concurrent malignancy/infection.Reports,and when available slides and immunofluorescence/electron microscopic images,were re-reviewed by a renal pathologist.RESULTS A total of fifteen patients were included in this study.Fourteen patients had suspected recurrent disease,with a pre-transplant native kidney report of C3G.One patient developed de novo C3G.Median post kidney transplant clinical follow up time was 91 months.Median time to recurrence was 7 months with median graft survival of 48 months post kidney transplantation.The most common index biopsy pattern of injury was endocapillary prolif-erative glomerulonephritis(often with exudative features)with or without mesangial hypercellularity(56%)followed by membranoproliferative glomerulonephritis(25%).Most patients developed membranoproliferative glomerulonephritis pattern of injury on follow up biopsies(63%).Seven patients with recurrent disease received treatment with eculizumab with a median graft survival of 73 months,with five functioning grafts by the end of the study period.Seven patients with recurrent disease did not receive therapy,and all lost their graft with a median graft survival of 22 months(P=0.003).CONCLUSION C3G following kidney transplantation is mostly a recurrent disorder with a poor prognosis in untreated patients.Untreated recurrence has a poor prognosis with median allograft survival<2 years.Early treatment with eculizumab may improve transplant outcomes in patients with recurrent C3G.展开更多
The epidermal growth factor receptor(EGFR)is a transmembrane glycoprotein that plays a crucial role in signal transduction and cellular responses.This review explores the function of EGFR in kidney physiology and its ...The epidermal growth factor receptor(EGFR)is a transmembrane glycoprotein that plays a crucial role in signal transduction and cellular responses.This review explores the function of EGFR in kidney physiology and its implications for various kidney diseases.EGFR signaling is essential for kidney function and repair mechanisms,and its dysregulation significantly impacts both acute and chronic kidney conditions.The review discusses the normal distribution of EGFR in kidney tubular segments,the mechanism of its activation and inhibition,and the therapeutic potential of EGFR-targeting antagonists and ligands.Additionally,it explores the pathophysiological characteristics observed in rodent models of kidney diseases through pharmacological and genetic inhibition of EGFR,highlighting therapeutic challenges and limitations such as species differences,variability in disease models,and potential adverse effects.Overall,the findings underscore the multifaceted role of EGFR in kidney diseases,influencing inflammation,fibrosis,and tissue injury.This complex involvement suggests that targeting EGFR may be a beneficial therapeutic strategy for managing these conditions,potentially mitigating inflammation and fibrosis while promoting tissue repair.展开更多
The global prevalence of diabetes has surged in recent years,with diabetic kidney disease(DKD)emerging as a major complication.Traditional therapies have had limited success in slowing progression to end-stage kidney ...The global prevalence of diabetes has surged in recent years,with diabetic kidney disease(DKD)emerging as a major complication.Traditional therapies have had limited success in slowing progression to end-stage kidney disease.However,novel therapies,particularly sodium-glucose cotransporter 2(SGLT2)inhibitors and glucagon-like peptide-1(GLP-1)receptor agonists,which were initially developed for hyperglycemia management,have transformed the treatment of obesity,heart failure,cardiovascular disease,and more recently,DKD.SGLT2 inhibitors have consistently and significantly reduced cardiovascular events,albuminuria,and glomerular filtration rate,highlighting their efficacy across diverse clinical presentations for patients with kidney impairment.Although fewer studies have specifically investigated GLP-1 receptor agonists in patients with kidney disease,existing evidence underscores their potential to slow renal disease progression,reduce albuminuria,and improve clinically relevant outcomes.However,further research is needed to better identify patients most likely to benefit from treatment.Together,these therapies represent valuable advancements for DKD,offering significant reductions in morbidity and mortality and shifting the management of the disease by becoming essential pillars for the treatment of these patients.展开更多
Background Acute kidney injury(AKI)is a frequent complication following heart transplantation.Some patients progress directly to chronic kidney disease(CKD),while a considerable proportion paradoxically exhibit rapid ...Background Acute kidney injury(AKI)is a frequent complication following heart transplantation.Some patients progress directly to chronic kidney disease(CKD),while a considerable proportion paradoxically exhibit rapid CKD progression despite a return of serum creatinine to normal levels following AKI resolution.This phenomenon adversely impacts long-term prognosis.This study aimed to inform early-risk stratification and preventive strategies for this vulnerable population.Methods This study enrolled 133 patients who underwent successful heart transplantation at Guangdong Provincial People's Hospital between January 1,2017,and May 31,2023,developed AKI within 7 days postoperatively,and achieved a return of serum creatinine to within the normal range within 3 months.At 18-month follow-up,we stratified patients into CKD and non-CKD groups using Kidney Disease:Improving Global Outcomes(KDIGO)criteria.Univariate and multivariable logistic regression were applied to identify predictors ofCKD progression.Results During the 18-month follow-up period,68 patients(51.1%)progressed to CKD following the return of serum creatinine to normal levels after AKI subsequent to heart transplantation.Subsequent multivariable analysis showed female sex[adjusted odds ratio(aOR):11.128,95%CI:1.863-66.488,P=0.008],age(per year:a0R:1.057,95%CI:1.008-1.109,P=0.023),preoperative valvular heart disease(aOR:4.818,95%CI:1.588-14.618,P=0.005),baseline serum creatinine(perμmol/L:a0R:1.093,95%CI:1.020-1.172,P=0.012),AKI Stage 2(vs.Stage 1:aOR:10.701,95%CI:2.177-52.596,P=0.004),Grade 4 hematuria(aOR:8.915,95%CI:1.517-50.595,P=0.014)and AKI-phase random glucose(per mmol/L:aOR:1.107,95%CI:1.009-1.214,P=0.032)were seven independent risk factors associated with CKD progression.The derived prediction model incorporating these seven independent risk factors demonstrated good discrimination[area under curve(AUC):0.848,95%CI:0.784-0.911,P<0.001].ConclusionssFemale sex,advanced age,preoperative valvular heart disease,elevated preoperative baseline serum creatinine,stage 2 AKI,gross hematuria(4+)during AKI,and elevated random blood glucose during AKI were independent risk factors for progression to CKD following the return of serum creatinine to normal levels after AKI in heart transplant recipients.Understanding these risk factors may help us identify high-risk patients and provide early intervention.展开更多
Aging is an inevitable process that is usually measured by chronological age,with people aged 65 and over being defined as"older individuals".There is disagreement in the current scientific literature regard...Aging is an inevitable process that is usually measured by chronological age,with people aged 65 and over being defined as"older individuals".There is disagreement in the current scientific literature regarding the best methods to estimate glomerular filtration rate(eGFR)in older adults.Several studies suggest the use of an age-adjusted definition to improve accuracy and avoid overdiagnosis.In contrast,some researchers argue that such changes could complicate the classification of chronic kidney disease(CKD).Several formulas,including the Modification of Diet in Renal Disease,CKD-Epidemiology Collaboration,and Cockcroft-Gault equations,are used to estimate eGFR.However,each of these formulas has significant limitations when applied to older adults,primarily due to sarcopenia and malnutrition,which greatly affect both muscle mass and creatinine levels.Alternative formulas,such as the Berlin Initiative Study and the Full Age Spectrum equations,provide more accurate estimates of values for older adults by accounting for age-related physiological changes.In frail older adults,the use of cystatin C leads to better eGFR calculations to assess renal function.Accurate eGFR measurements improve the health of older patients by enabling better medication dosing.A thorough approach that includes multiple calibrated diagnostic methods and a detailed geriatric assessment is necessary for the effective management of kidney disease and other age-related conditions in older adults.展开更多
文摘Background:Refined models of kidney disease are critical to better understand disease processes and study novel treatments while minimizing discomfort in research animals.The objective of this study was to report a technique for minimally invasive partial kidney embolism in cats and describe outcomes following transcatheter administration of embolic microspheres with subsequent contralateral nephrectomy.Methods:Eleven,apparently healthy,male,purpose-bred cats underwent unilateral kidney embolism with 0.25 or 0.5 mL of embolic microparticle(40-120μm)suspension(0.2 mL microspheres/mL)delivered into the right renal artery under fluoroscopic guidance,followed 5 months later by contralateral nephrectomy.One month after nephrectomy,blood and urinary markers of kidney function were evaluated,and embolized kidneys were harvested for histopathology evaluation.Results:Renal artery embolization was possible in all cats.Two cats did not complete the study,one after experiencing congestive heart failure(n=1)and the other following evidence of complete kidney embolism precluding nephrectomy(n=1)postembolization.At study end,compared to baseline,cats had significant increases in median(range)serum creatinine(159.1μmol/L[141.4-530.4]versus 128.2μmol/L[92.8-150.3];p=0.0004),urea nitrogen(15.71 mmol/L[9.29-47.85]versus 7.50 mmol/L[6.07-8.57];p<0.0001),and symmetric dimethylarginine(0.74μmol/L[0.59-3.12]versus 0.67μmol/L[0.54-0.72];p=0.0288)concentrations.No differences in markers of kidney function were documented between dose groups.Conclusions:M inimally invasive kidney embolism is a promising technique for modeling kidney disease in cats.Understanding optimal dose,timing of nephrectomy,and longer-term consequences requires additional work.
文摘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 unnece-ssary 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.
文摘BACKGROUND Equations for estimation glomerular filtration rate(eGFR)have been associated with poor clinical performance and their clinical accuracy and reliability have been called into question.AIM To assess the longitudinal changes in measured glomerular filtration rate(mGFR)in patients with autosomal dominant polycystic kidney disease(ADPKD).METHODS Analysis of an ambispective data base conducted on consecutive patients diagnosed with ADPKD.The mGFR was assessed by iohexol clearance;while eGFR was calculated by three different formulas:(1)The chronic kidney disease epidemiology collaboration(CKD-EPI);(2)Modification of diet in renal disease(MDRD);and(3)The 24-hour urine creatinine clearance(CrCl).The primary end-points were the mean change in mGFR between the baseline and final visit,as well as the comparison of the mean change in mGFR with the change estimated by the different formulas.RESULTS Thirty-seven patients were included in the study.As compared to baseline,month-6 mGFR was significantly decrease by-4.4 mL/minute±10.3 mL/minute(P=0.0132).However,the CKD-EPI,MDRD,and CrCl formulas underestimated this change by 48.3%,89.0%,and 45.8%respectively,though none of these differences reached statistical significance(P=0.3647;P=0.0505;and P=0.736,respectively).The discrepancies between measured and estimated glomerular filtration rate values,as evaluated by CKD-EPI(r=0.29,P=0.086);MDRD(r=0.19,P=0.272);and CrCl(r=0.09,P=0.683),were not correlated with baseline mGFR values.CONCLUSION This study indicated that eGFR inaccurately reflects the decline in mGFR and cannot reliably track changes over time.This poses significant challenges for clinical decision-making,particularly in treatment strategies.
文摘The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future cardiovascular(CV)diseases.Chronic kidney disease,a state of chronic inflammation caused by oxidative stress,metabolic abnormalities,infection,and uremic toxins damages the endothelium.ED is also associated with a decline in estimated glomerular filtration rate.After kidney transplantation,endothelial functions undergo immediate but partial restoration,promising graft longevity and enhanced CV health.However,the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED,culminating in poor CV health and graft survival.ED in kidney transplant recipients is an underrecognized and poorly studied entity.CV diseases are the leading cause of death among kidney transplant candidates with functioning grafts.ED contributes to the pathogenesis of many of the CV diseases.Various biomarkers and vasoreactivity tests are available to study endothelial functions.With an increasing number of transplants happening every year,and improved graft rejection rates due to the availability of effective immunosuppressants,the focus has now shifted to endothelial protection for the prevention,early recognition,and treatment of CV diseases.
文摘BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from modern approaches of proteomic analysis of liquid biopsies(serum,urine)represent a promising innovation in the monitoring of kidney transplant recipients.AIM To investigate the diagnostic utility of protein biomarkers derived from proteomics approaches in renal allograft assessment.METHODS A systematic review was conducted in accordance with PRISMA guidelines,based on research results from the PubMed and Scopus databases.The primary focus was on evaluating the role of biomarkers in the non-invasive diagnosis of transplant-related com-plications.Eligibility criteria included protein biomarkers and urine and blood samples,while exclusion criteria were language other than English and the use of low resolution and sensitivity methods.The selected research articles,were categorized based on the biological sample,condition and methodology and the significantly and reproducibly differentiated proteins were manually selected and extracted.Functional and network analysis of the selected proteins was performed.RESULTS In 17 included studies,58 proteins were studied,with the cytokine CXCL10 being the most investigated.Biological pathways related to immune response and fibrosis have shown to be enriched.Applications of biomarkers for the assessment of renal damage as well as the prediction of short-term and long-term function of the graft were reported.Overall,all studies have shown satisfactory diagnostic accuracy of proteins alone or in combination with conventional methods,as far as renal graft assessment is concerned.CONCLUSION Our review suggests that protein biomarkers,evaluated in specific biological fluids,can make a significant contribution to the timely,valid and non-invasive assessment of kidney graft.
文摘BACKGROUND Pediatric kidney transplantation is the treatment of choice for children with endstage renal disease;however,access to transplantation remains limited in lowand middle-income countries.Uzbekistan had no prior institutional experience in performing pediatric living donor kidney transplantation(LDKT).AIM To report the implementation,surgical protocols,and clinical outcomes of the first pediatric LDKT program in Uzbekistan.METHODS This retrospective single-center study analyzed the first 20 pediatric LDKTs performed between April 2023 and February 2025.All donors were related family members who underwent either open or laparoscopic hand-assisted nephrectomy.Pre-transplant immunologic workup included HLA typing and anti-HLA antibody screening using solid-phase assays.Perioperative management was guided by Enhanced Recovery After Surgery Society principles.Primary outcomes included operative metrics,perioperative complications,graft function,biopsyproven rejection,and patient/graft survival.Statistical analysis utilized descriptive statistics,Kaplan–Meier survival estimates,and Fisher’s exact test where applicable.RESULTS Donors included 13 women and 7 men(median age:38 years;range:31–50).Median operative times were 182.5 minutes for open nephrectomy and 198.5 minutes for laparoscopic nephrectomy.No major intraoperative complications occurred;one donor developed a postoperative wound seroma.All recipients(aged 87–207 months)exhibited immediate graft function,with no delayed graft function observed.Median cold and warm ischemia times were 15 minutes(range:10–138)and 35 minutes(range:18–40),respectively.Median serum creatinine decreased from 198μmol/L on postoperative day 1 to 54μmol/L by day 7.Three rejection episodes were reported,two of which occurred in sensitized recipients.Two graft losses were attributed to late rejection.One patient died from hemorrhagic stroke six months post-transplant.At 24 months,patient and graft survival rates were 95%and 90%,respectively.CONCLUSION The successful implementation of a pediatric living donor kidney transplantation program in Uzbekistan yielded favorable short-and intermediate-term outcomes,with high graft survival and low complication rates.This experience may provide a practical framework for initiating similar programs in other resource-constrained healthcare settings.
文摘Rhabdomyolysis(RM)is characterized by disrupting muscle cells and releasing intracellular components into circulation.Some symptoms associated with RM include muscle weakness,discolored urine,and myalgia.RM can be caused by coronavirus disease 2019(COVID-19)causing exaggerated immune response leading to muscle damage.Acute kidney injury(AKI),when presented with RM,leads to increased mortality.Examining RM-related AKI and its comparison to other AKI types in COVID-19 patients could improve the management of viral infections developing RM and AKI.RM potentially complicated COVID-19 infection course and is a major etiology of AKI.RM-related AKI had higher severity and mortality than other AKI types,with increased hypercoagulopathy and inflammatory markers.Findings also express procalcitonin use in follow-ups with severe COVID-19 patients.Study limitations include small sample size,absence of kidney biopsies,and focus on the first wave of the pandemic,which should be addressed in future research to generate accurate and relevant findings.
基金Supported by National Institute of Diabetes and Digestive and Kidney Diseases,United States,No.K23DK133729。
文摘BACKGROUND Private insurance coverage is associated with higher rates of living donor kidney transplantation(LDKT)but whether this is attributable to confounding is not known.AIM To study the association between increased access to private health insurance and LDKT.METHODS Retrospective cohort study using United States transplant registry data.We identified incident candidates aged 22-29 years who were waitlisted for a kidneyonly transplant from 2005-2014,excluding prior transplant recipients and those with missing data.We calculated the hazard of LDKT after waitlisting for those with private insurance vs other insurance pre-Affordable Care Act(ACA)vs post-ACA,using death and delisting as competing events,for candidates affected by the policy change(age 22-25 years)vs those who were not(age 26-29 years).RESULTS A total of 13817 candidates were included,of whom 46%were age 22-25 years and 54%were age 26-29 years.Among candidates aged 22-25 years at listing,those listed post-ACA were more likely to have private insurance compared to those listed pre-ACA(42%vs 35%),but there was no difference in private insurance coverage between eras among candidates aged 26-29 years at listing.In adjusted competing risk regression,privately insured patients age 22-25 years were less likely to receive a LDKT post-ACA compared to pre-ACA[hazard ratio(HR)=0.88,95%CI:0.78-1.00],as were those aged 22-25 years old with other insurance types(HR=0.80,95%CI:0.69-0.92).These associations were not seen among candidates age 26-29 years.CONCLUSION Candidates age 22-25 years were likelier to have private insurance post-ACA,without an increased rate in LDKT.Demonstrations of associations between insurance and LDKT are likely attributable to residual confounding.
文摘Kidney transplant is the treatment of choice for patients with end-stage kidneydisease. Meticulous anaesthetic management is the cornerstone of good postoperativepatient and graft outcomes. Over the decades, the perioperative strategiesfor preoperative optimization, fluid management, immunosuppression, haemodynamicmonitoring, and pain management keep changing with the inclusionof newer studies. The aim of this review is to update anaesthesia colleagues forrecent advancements in perioperative care of patients undergoing kidney transplantation.
基金supported by the National Key Technologies Research and Development Plan(No.2021YFE0106900)the National Natural Science Foundation of China(No.82173769)+1 种基金the Basic Research Cooperation Project of Beijing,Tianjin,Hebei from the Natural Science Foundation of Tianjin(No.20JCZXJC00070)the Applied Basic Research Multi-investment Foundation of Tianjin(No.21JCYBJC01540)。
文摘Small interfering RNA(siRNA),a promising revolutionary therapy,faces delivery obstacles due to its poor targeting,strong charge negativity and macromolecular nature.Clinical-approved siRNAs can now only be delivered to the liver mediated by the chemically conjugated N-acetylgalactosamine(GalNAc)ligand,the conjugate can be effectively uptaken into cells through interaction with asialoglycoprotein receptor(ASGPR)highly expressed on liver hepatocytes.To further explore an efficient non-hepatic targeted delivery strategy,in this study,we designed a delivery system that chemically conjugated p53 siRNA to renal tubular cell-targeting peptides for targeting the kidney,which was suitable for industrial transformation.Results showed that peptide-siRNA conjugate could specifically enter renal tubular epithelial cells and silence target genes.In cisplatin-induced acute kidney injury(AKI)mice,peptide-siRNA conjugate blocked the p53-mediated apoptotic pathway and alleviated renal damage.The innovative proposed system to conjugate kidney-targeting peptides with siRNA achieved the efficient kidney-targeted delivery of si RNA and provided a prospective choice for treating AKI.
文摘BACKGROUND Kidney is the vital organ that plays a great role in maintaining an optimal internal environment.The normal kidney function can be altered by physical injury or disease.Currently,chronic kidney disease(CKD)is an increasing major health problem worldwide.In 2017,it was ranked as the 12th leading cause of death and is expected to rise to the 5th ranked cause of death by 2040.Therefore,early detection,increasing patients'awareness and treatment of CKD are required to hold the problem.However,despite its higher prevalence of hospitalized morbidity and mortality,little is known about the magnitude and associated factor of CKD in the Ethiopian context.Hence this study aimed to determine the magnitude of CKD and associated factors at Wolkite University Specialized Hospital(WKUSTH),South West Ethiopia.AIM To determine the magnitude,and associated factors of CKD in WKUSTH,Ethiopia.METHODS Institutional based cross-sectional study with secondary data was conducted from November 15,2021 to February 28,2022 at WKUSTH.Three hundred forty five(345)participants were selected by a convenient sampling technique.Creatinine and urea were measured using cobas311 fully automated chemistry analyzer and estimated glomerular filtration rate(eGFR)was calculated using CKD epidemiology collaboration formula.Sociodemographic and clinical data were collected by using a pretested questionnaire.Data were coded and entered into EpiData 3.1 version and exported to STATA version 14 for analysis.Bivariate analysis was used to screen candidate variables for multivariate analysis.In the multivariate analysis a P value<0.05 were considered statistically significant.RESULTS The magnitude of CKD by impaired eGFR were 54(15.7%)(95%CI:0.116-0.194).In multivariable analysis,older age[adjusted odds ratio(AOR)=5.91,95%CI:2.41-14.47)],hypertension(AOR=10.41,95%CI:4.55-23.81),diabetes mellitus(AOR=5.90,95%CI:2.14-16.23),high body mass index(AOR=3.0,95%CI:1.30-7.27),and anemia(AOR=2.94,95%CI:1.26-6.88)were independently associated with CKD.CONCLUSION The magnitude of CKD among adult patients admitted to WKUSTH was high.Hence,researchers need to do a population-based study and longitudinal study on the magnitude of CKD,associated factors.Estimation of GFR for all hospitalized patients might help to early detection of CKD and prevent complications.
文摘Kenya, a lower-middle-income country in East Africa, faces a rising burden of chronic kidney disease (CKD), with an estimated 12,500 individuals suffering from end-stage renal disease (ESRD). Renal transplantation—the preferred treatment option for ESRD, remains underutilized. Since the first transplant in 1978, seven centers have been established, with 829 transplants performed by 2022. Living-related renal transplants (LRRT) dominate, while deceased donor renal transplantation (DDRT) is yet to be implemented. Recent data show improved outcomes, with one-year graft survival rates up to 96%, but challenges such as acute rejection rates (32.8%) and limited donor outcome data persist. Barriers include high costs, limited insurance coverage, inadequate laboratory infrastructure, and a transplant workforce shortage. Efforts to establish DDRT programs are underway but are hampered by the absence of organ procurement systems and insufficient laboratory capabilities. Future priorities include reducing costs and expanded insurance coverage for transplant care. Investments in laboratory infrastructure, local tissue typing, and surgical training are essential. Strengthening international collaborations and public education campaigns can improve donor pools and transplantation access. Strategic policy reforms and resource allocation are vital to scaling up Kenya’s kidney transplant program and addressing the unmet needs of its ESRD population.
文摘In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a complex interplay of renal and hepatic pathophysiology,with AKI acting as an initiator through maladaptive repair mechanisms.These mechanisms—such as tubular cell cycle arrest,inflammatory cascades,and fibrotic processes—are exacerbated by the hemodynamic and neurohormonal disturbances characteristic of cirrhosis.Following AKI episodes,persistent kidney dysfunction or acute kidney disease(AKD)often serves as a bridge to CKD.AKD represents a critical phase in renal deterioration,characterized by prolonged kidney injury that does not fully meet CKD criteria but exceeds the temporal scope of AKI.The progression from AKD to CKD is further influenced by recurrent AKI episodes,impaired renal autoregu-lation,and systemic comorbidities such as diabetes and metabolic dysfunction-associated steatotic liver disease,which compound kidney damage.The clinical management of AKI and CKD in cirrhotic patients requires a multidimensional approach that includes early identification of kidney injury,the application of novel biomarkers,and precision interventions.Recent evidence underscores the inadequacy of traditional biomarkers in predicting the AKI-to-CKD progression,necessitating novel biomarkers for early detection and intervention.
文摘BACKGROUNDThe impact of long-term dialysis (LTD) therapy on the survival benefit of kidneytransplantation compared to short-term dialysis (STD) remains unclear. Additionally,donor organ quality has been identified as a significant predictor ofpatient survival in deceased donor kidney transplantation.AIMTo investigate the effects of the best graft function within three months posttransplant,as well as dialysis duration, on transplant outcomes.METHODSA total of 255 patients were included in this retrospective cohort study. Patientswere divided into two groups: Those with LTD (≥ 15 years;Group LTD) and thosewith STD (< 15 years;Group STD). Clinical backgrounds and outcomes werecompared between the groups.RESULTSGroup LTD comprised 28 patients, while Group STD included 227 patients. Therewere no significant differences between the two groups in terms of age at transplant,donor age, lowest serum creatinine (best S-Cr) within three months posttransplant,or the frequency of cardiovascular events after transplantation. Multivariateanalysis identified age [hazard ratio (HR): 1.058;95%CI: 1.002-1.116;P =0.040], post-transplant incidence of cardiovascular disease (HR: 20.264;95%CI:6.052-67.850;P < 0.001), and best S-Cr (HR: 4.155;95%CI: 2.234-7.730;P < 0.001) asindependent predictors of mortality after transplantation. The pre-operative dialysisperiod was not statistically significant.CONCLUSIONThese findings suggest that early graft dysfunction, rather than dialysis duration, may serve as a critical risk factorfor poor transplant outcomes.
文摘The occurrence of acute kidney injury(AKI)in critically ill patients is often associated with increased morbidity and mortality rates.Despite extensive research,a consensus is yet to be arrived,especially regarding the optimal timing and indications for initiation of kidney replacement therapy(KRT)for critically ill patients.There is no clear guidance available on the timing of weaning from KRT.More recently,various biomarkers have produced promising prognostic pre-diction in such patients,regarding the need for KRT and its termination.Most of these biomarkers are indicative of kidney damage and stress,rather than re-covery.However,large-scale validation studies are required to guide the cutoff values of these biomarkers among different patient cohorts so as to identify the optimum timing for KRT.This article reviews the kidney biomarkers in detail and summarizes the individual roles of biomarkers in the decision-making process for initiation and termination of the KRT among critically ill AKI patients and the supportive literature.
文摘BACKGROUND C3 glomerulopathies(C3G)are a rare cause of kidney failure resulting from complement dysregulation.Small studies demonstrate a high rate of recurrence and poor outcomes in kidney transplantation.Treatment efficacy in this setting with eculizumab,a terminal complement inhibitor,is largely unknown.AIM To determine the outcomes of kidney transplantation in patients with C3G and the potential impact of eculizumab.METHODS We retrospectively studied kidney transplant recipients who underwent a post-transplant biopsy confirming C3G between January 1,1993 and December 31,2023 at a single center.Only the first episode of kidney transplant was reviewed.The electronic medical records were reviewed for post-transplant allograft function,indication for biopsy,time to biopsy from transplant,time to allograft failure from transplantation,post-C3G treatment,complement laboratory testing,and concurrent malignancy/infection.Reports,and when available slides and immunofluorescence/electron microscopic images,were re-reviewed by a renal pathologist.RESULTS A total of fifteen patients were included in this study.Fourteen patients had suspected recurrent disease,with a pre-transplant native kidney report of C3G.One patient developed de novo C3G.Median post kidney transplant clinical follow up time was 91 months.Median time to recurrence was 7 months with median graft survival of 48 months post kidney transplantation.The most common index biopsy pattern of injury was endocapillary prolif-erative glomerulonephritis(often with exudative features)with or without mesangial hypercellularity(56%)followed by membranoproliferative glomerulonephritis(25%).Most patients developed membranoproliferative glomerulonephritis pattern of injury on follow up biopsies(63%).Seven patients with recurrent disease received treatment with eculizumab with a median graft survival of 73 months,with five functioning grafts by the end of the study period.Seven patients with recurrent disease did not receive therapy,and all lost their graft with a median graft survival of 22 months(P=0.003).CONCLUSION C3G following kidney transplantation is mostly a recurrent disorder with a poor prognosis in untreated patients.Untreated recurrence has a poor prognosis with median allograft survival<2 years.Early treatment with eculizumab may improve transplant outcomes in patients with recurrent C3G.
基金supported by the Basic Science Research Program through the National Research Foundation of Korea(NRF)and funded by the Ministry of Education(2021R1I1A3056002,to Jinu Kim,RS-2023-00274853,to Daeun MOON).
文摘The epidermal growth factor receptor(EGFR)is a transmembrane glycoprotein that plays a crucial role in signal transduction and cellular responses.This review explores the function of EGFR in kidney physiology and its implications for various kidney diseases.EGFR signaling is essential for kidney function and repair mechanisms,and its dysregulation significantly impacts both acute and chronic kidney conditions.The review discusses the normal distribution of EGFR in kidney tubular segments,the mechanism of its activation and inhibition,and the therapeutic potential of EGFR-targeting antagonists and ligands.Additionally,it explores the pathophysiological characteristics observed in rodent models of kidney diseases through pharmacological and genetic inhibition of EGFR,highlighting therapeutic challenges and limitations such as species differences,variability in disease models,and potential adverse effects.Overall,the findings underscore the multifaceted role of EGFR in kidney diseases,influencing inflammation,fibrosis,and tissue injury.This complex involvement suggests that targeting EGFR may be a beneficial therapeutic strategy for managing these conditions,potentially mitigating inflammation and fibrosis while promoting tissue repair.
基金Supported by Industrial Technological Initiation Scholarship of National Council for Scientific and Technological Development,CNPq,Brazil,No.0932204294929829 and No.7414780530977345the Scientific Initiation Scholarship Programme(PIBIC)of National Council for Scientific and Technological Development,CNPq,Brazil,No.5763023359532159,No.6472982965854452,and No.7340128440641417the CNPq Research Productivity Fellow,No.4357511882624145.
文摘The global prevalence of diabetes has surged in recent years,with diabetic kidney disease(DKD)emerging as a major complication.Traditional therapies have had limited success in slowing progression to end-stage kidney disease.However,novel therapies,particularly sodium-glucose cotransporter 2(SGLT2)inhibitors and glucagon-like peptide-1(GLP-1)receptor agonists,which were initially developed for hyperglycemia management,have transformed the treatment of obesity,heart failure,cardiovascular disease,and more recently,DKD.SGLT2 inhibitors have consistently and significantly reduced cardiovascular events,albuminuria,and glomerular filtration rate,highlighting their efficacy across diverse clinical presentations for patients with kidney impairment.Although fewer studies have specifically investigated GLP-1 receptor agonists in patients with kidney disease,existing evidence underscores their potential to slow renal disease progression,reduce albuminuria,and improve clinically relevant outcomes.However,further research is needed to better identify patients most likely to benefit from treatment.Together,these therapies represent valuable advancements for DKD,offering significant reductions in morbidity and mortality and shifting the management of the disease by becoming essential pillars for the treatment of these patients.
基金supported by Guangzhou Science and Technology Project(No.202206080010)。
文摘Background Acute kidney injury(AKI)is a frequent complication following heart transplantation.Some patients progress directly to chronic kidney disease(CKD),while a considerable proportion paradoxically exhibit rapid CKD progression despite a return of serum creatinine to normal levels following AKI resolution.This phenomenon adversely impacts long-term prognosis.This study aimed to inform early-risk stratification and preventive strategies for this vulnerable population.Methods This study enrolled 133 patients who underwent successful heart transplantation at Guangdong Provincial People's Hospital between January 1,2017,and May 31,2023,developed AKI within 7 days postoperatively,and achieved a return of serum creatinine to within the normal range within 3 months.At 18-month follow-up,we stratified patients into CKD and non-CKD groups using Kidney Disease:Improving Global Outcomes(KDIGO)criteria.Univariate and multivariable logistic regression were applied to identify predictors ofCKD progression.Results During the 18-month follow-up period,68 patients(51.1%)progressed to CKD following the return of serum creatinine to normal levels after AKI subsequent to heart transplantation.Subsequent multivariable analysis showed female sex[adjusted odds ratio(aOR):11.128,95%CI:1.863-66.488,P=0.008],age(per year:a0R:1.057,95%CI:1.008-1.109,P=0.023),preoperative valvular heart disease(aOR:4.818,95%CI:1.588-14.618,P=0.005),baseline serum creatinine(perμmol/L:a0R:1.093,95%CI:1.020-1.172,P=0.012),AKI Stage 2(vs.Stage 1:aOR:10.701,95%CI:2.177-52.596,P=0.004),Grade 4 hematuria(aOR:8.915,95%CI:1.517-50.595,P=0.014)and AKI-phase random glucose(per mmol/L:aOR:1.107,95%CI:1.009-1.214,P=0.032)were seven independent risk factors associated with CKD progression.The derived prediction model incorporating these seven independent risk factors demonstrated good discrimination[area under curve(AUC):0.848,95%CI:0.784-0.911,P<0.001].ConclusionssFemale sex,advanced age,preoperative valvular heart disease,elevated preoperative baseline serum creatinine,stage 2 AKI,gross hematuria(4+)during AKI,and elevated random blood glucose during AKI were independent risk factors for progression to CKD following the return of serum creatinine to normal levels after AKI in heart transplant recipients.Understanding these risk factors may help us identify high-risk patients and provide early intervention.
文摘Aging is an inevitable process that is usually measured by chronological age,with people aged 65 and over being defined as"older individuals".There is disagreement in the current scientific literature regarding the best methods to estimate glomerular filtration rate(eGFR)in older adults.Several studies suggest the use of an age-adjusted definition to improve accuracy and avoid overdiagnosis.In contrast,some researchers argue that such changes could complicate the classification of chronic kidney disease(CKD).Several formulas,including the Modification of Diet in Renal Disease,CKD-Epidemiology Collaboration,and Cockcroft-Gault equations,are used to estimate eGFR.However,each of these formulas has significant limitations when applied to older adults,primarily due to sarcopenia and malnutrition,which greatly affect both muscle mass and creatinine levels.Alternative formulas,such as the Berlin Initiative Study and the Full Age Spectrum equations,provide more accurate estimates of values for older adults by accounting for age-related physiological changes.In frail older adults,the use of cystatin C leads to better eGFR calculations to assess renal function.Accurate eGFR measurements improve the health of older patients by enabling better medication dosing.A thorough approach that includes multiple calibrated diagnostic methods and a detailed geriatric assessment is necessary for the effective management of kidney disease and other age-related conditions in older adults.
