BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft ...BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft loss or graft dysfunction.Nevertheless,circumstances may arise where selecting the RK over the left kidney(LK)is unavoidable.Consequently,it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.AIM To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.METHODS We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023.We included all kidney donors who were over 18,fit to donate,and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry.The variables examined comprised donor and recipient demographics,and outcome measures included technical graft loss(TGL),delayed or slow graft function(SGF),and post-transplant serum creatinine(SC)trends.We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.RESULTS Of the 250 transplants performed during the period,56(22%)were RKs.The recipient demographics and transplant factors were comparable for the right and LKs,except that the donor warm and cold ischemia time were shorter for RKs.TGL and SGF each occurred in 2%(n=1)of RKs and 0.5%(n=1)of LKs,the difference being insignificant.These complications,however,were not related to the venous anastomosis.One RK(2%)developed delayed graft function after 48 hours,which was attributable to postoperative hypoxia rather than the surgical technique.The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.CONCLUSION The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants,provided that careful patient selection and precise surgical techniques are employed.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
The role of antibodies in kidney transplant(KT)has evolved significantly over the past few decades.This role of antibodies in KT is multifaceted,encompassing both the challenges they pose in terms of antibody-mediated...The role of antibodies in kidney transplant(KT)has evolved significantly over the past few decades.This role of antibodies in KT is multifaceted,encompassing both the challenges they pose in terms of antibody-mediated rejection(AMR)and the opportunities for improving transplant outcomes through better detection,prevention,and treatment strategies.As our understanding of the immunological mechanisms continues to evolve,so too will the approaches to managing and harnessing the power of antibodies in KT,ultimately leading to improved patient and graft survival.This narrative review explores the multifaceted roles of antibodies in KT,including their involvement in rejection mechanisms,advancements in desensitization protocols,AMR treatments,and their potential role in monitoring and improving graft survival.展开更多
Objective Diabetic kidney disease is a serious complication of diabetes,which is the leading cause of end-stage renal disease worldwide.Approximately 40%of individuals with diabetes develop diabetic kidney disease.At ...Objective Diabetic kidney disease is a serious complication of diabetes,which is the leading cause of end-stage renal disease worldwide.Approximately 40%of individuals with diabetes develop diabetic kidney disease.At present,the most important drugs for diabetic kidney disease include renin-angiotensin-aldosterone system inhibitors,angiotensin receptor blockers,sodium-glucose cotransporter-2 inhibitors,and newly approved aldosterone receptor antagonists.However,to date,there are still no effective drugs to prevent diabetic kidney disease from progressing to end-stage renal disease.Network pharmacology combined with bioinformatics and pharmacology provides a powerful tool for studying the mechanism of drug action.Traditional Chinese medicine has accumulated rich experience in the treatment of diabetic kidney disease,and its multi-target,multi-component,and multi-pathway characteristics provide new ideas for modern medicine.This article reviews the research progress of network pharmacology and drug therapy in diabetic kidney disease.展开更多
Diabetic kidney disease(DKD)has a high incidence and mortality rate and lacks effective preventive and therapeutic methods.Apoptosis is one of the main reasons for the occurrence and development of DKD.Mesenchymal ste...Diabetic kidney disease(DKD)has a high incidence and mortality rate and lacks effective preventive and therapeutic methods.Apoptosis is one of the main reasons for the occurrence and development of DKD.Mesenchymal stem cells(MSCs)have shown great promise in tissue regeneration for DKD treatment and have protective effects against DKD,including decreased blood glucose and urinary protein levels and improved renal function.MSCs can directly differ-entiate into kidney cells or act via paracrine mechanisms to reduce apoptosis in DKD by modulating signaling pathways.MSC-derived extracellular vesicles(MSC-EVs)mitigate apoptosis and DKD-related symptoms by transferring miRNAs to target cells or organs.However,studies on the regulatory mechanisms of MSCs and MSC-EVs in apoptosis in DKD are insufficient.This review compre-hensively examines the mechanisms of apoptosis in DKD and research progress regarding the roles of MSCs and MSC-EVs in the disease process.展开更多
The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the risi...The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the rising global prevalence of these conditions,understanding their interconnections is essential.The study emphasizes the importance of shared risk factors,such as obesity,type 2 diabetes,dyslipidemia,and oxidative stress,and calls for multidisciplinary screening strategies.This approach would improve patient outcomes and reduce the socio-economic burden.While the study contributes valuable insights from a Chinese population,further research across diverse populations is necessary to validate and extend these findings globally.Ultimately,the research underscores the need for integrated prevention programs to better manage these interconnected diseases and improve health outcomes.展开更多
BACKGROUND The progression of diabetic kidney disease(DKD)affects the patient’s kidney glomeruli and tubules,whose normal functioning is essential for maintaining normal calcium(Ca)and phosphorus(P)metabolism in the ...BACKGROUND The progression of diabetic kidney disease(DKD)affects the patient’s kidney glomeruli and tubules,whose normal functioning is essential for maintaining normal calcium(Ca)and phosphorus(P)metabolism in the body.The risk of developing osteoporosis(OP)in patients with DKD increases with the aggravation of the disease,including a higher risk of fractures,which not only affects the quality of life of patients but also increases the risk of death.AIM To analyze the risk factors for the development of OP in patients with DKD and their correlation with Ca-P metabolic indices,fibroblast growth factor 23(FGF23),and Klotho.METHODS One hundred and fifty-eight patients with DKD who were admitted into the Wuhu Second People’s Hospital from September 2019 to May 2021 were selected and divided into an OP group(n=103)and a normal bone mass group(n=55)according to their X-ray bone densitometry results.Baseline data and differences in Ca-P biochemical indices,FGF23,and Klotho were compared.The correlation of Ca-P metabolic indices with FGF23 and Klotho was discussed,and the related factors affecting OP in patients with DKD were examined by multivariate logistic regression analysis.RESULTS The OP group had a higher proportion of females,an older age,and a longer diabetes mellitus duration than the normal group(all P<0.05).Patients in the OP group exhibited significantly higher levels of intact parathyroid hormone(iPTH),blood P,Ca-P product(Ca×P),fractional excretion of phosphate(FeP),and FGF23,as well as lower estimated glomerular filtration rate,blood Ca,24-hour urinary phosphate excretion(24-hour UPE),and Klotho levels(all P<0.05).In the OP group,25-(OH)-D3,blood Ca,and 24-hour UPE were negatively correlated with FGF23 and positively correlated with Klotho.In contrast,iPTH,blood Ca,Ca×P,and FeP exhibited a positive correlation with FGF23 and an inverse association with Klotho(all P<0.05).Moreover,25-(OH)-D3,iPTH,blood Ca,FePO4,FGF23,Klotho,age,and female gender were key factors that affected the lumbar and left femoral neck bone mineral density.CONCLUSION The Ca-P metabolism metabolic indexes,FGF23,and Klotho in patients with DKD are closely related to the occurrence and development of OP.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
Rhabdomyolysis is a severe condition characterized by the breakdown of muscle tissue leading to the release of intracellular components into the bloodstream.This condition,when associated with acute kidney injury(AKI)...Rhabdomyolysis is a severe condition characterized by the breakdown of muscle tissue leading to the release of intracellular components into the bloodstream.This condition,when associated with acute kidney injury(AKI),can result in significant morbidity and mortality,particularly in the context of coronavirus disease 2019(COVID-19).This editorial discusses a retrospective study on patients with COVID-19 who developed rhabdomyolysis-related AKI.The study highlights that patients with rhabdomyolysis exhibited higher inflammatory markers,such as Creactive protein,ferritin,and procalcitonin,and experienced worse clinical outcomes compared to those with other causes of AKI.The findings underscore the importance of early recognition and management of rhabdomyolysis in COVID-19 patients to improve prognosis and reduce mortality rates.展开更多
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 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
Chikungunya,a vector-borne viral disease,has become a critical global health issue due to its capacity for widespread outbreaks,especially in tropical and subtropical regions,and its recent global expansion.The resurg...Chikungunya,a vector-borne viral disease,has become a critical global health issue due to its capacity for widespread outbreaks,especially in tropical and subtropical regions,and its recent global expansion.The resurgence of Chikun-gunya virus(CHIKV)in Karachi,Pakistan,has amplified public health challen-ges,driven by factors such as urbanization,climate change,and socioeconomic vulnerabilities,including limited healthcare infrastructure.Clinically,the disease primarily manifests with fever,rash,and debilitating joint pain,which often leads to prolonged discomfort and decreased quality of life.However,emerging evi-dence points to atypical and severe complications affecting the neurological,cardiac,and kidney systems,increasing the risk of mor-bidity and mortality.Kidney involvement in Chikungunya is of particular concern,with acute kidney injury being identified as a critical complication.Timely diagnosis of the infection and early identification of individuals at heigh-tened risk of progressing to severe kidney dysfunction is crucial to improving patient outcomes.Such individuals often include those with pre-existing kidney conditions or other underlying comorbidities,making them more susceptible to complications.This narrative review aims to synthesize and expand upon the current understanding of the me-chanisms underlying CHIKV-induced kidney injury.These mechanisms en-compass direct viral invasion of kidney tissue,immune-mediated inflammatory responses that inadvertently damage the kidneys,and the aggravation of pre-existing kidney pathologies.Furthermore,the complex interplay between the virus and the host's immune system may exacerbate kidney complications,high-lighting the multifaceted nature of CHIKV pathophysiology.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
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
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
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
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
文摘BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft loss or graft dysfunction.Nevertheless,circumstances may arise where selecting the RK over the left kidney(LK)is unavoidable.Consequently,it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.AIM To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.METHODS We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023.We included all kidney donors who were over 18,fit to donate,and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry.The variables examined comprised donor and recipient demographics,and outcome measures included technical graft loss(TGL),delayed or slow graft function(SGF),and post-transplant serum creatinine(SC)trends.We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.RESULTS Of the 250 transplants performed during the period,56(22%)were RKs.The recipient demographics and transplant factors were comparable for the right and LKs,except that the donor warm and cold ischemia time were shorter for RKs.TGL and SGF each occurred in 2%(n=1)of RKs and 0.5%(n=1)of LKs,the difference being insignificant.These complications,however,were not related to the venous anastomosis.One RK(2%)developed delayed graft function after 48 hours,which was attributable to postoperative hypoxia rather than the surgical technique.The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.CONCLUSION The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants,provided that careful patient selection and precise surgical techniques are employed.
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The role of antibodies in kidney transplant(KT)has evolved significantly over the past few decades.This role of antibodies in KT is multifaceted,encompassing both the challenges they pose in terms of antibody-mediated rejection(AMR)and the opportunities for improving transplant outcomes through better detection,prevention,and treatment strategies.As our understanding of the immunological mechanisms continues to evolve,so too will the approaches to managing and harnessing the power of antibodies in KT,ultimately leading to improved patient and graft survival.This narrative review explores the multifaceted roles of antibodies in KT,including their involvement in rejection mechanisms,advancements in desensitization protocols,AMR treatments,and their potential role in monitoring and improving graft survival.
文摘Objective Diabetic kidney disease is a serious complication of diabetes,which is the leading cause of end-stage renal disease worldwide.Approximately 40%of individuals with diabetes develop diabetic kidney disease.At present,the most important drugs for diabetic kidney disease include renin-angiotensin-aldosterone system inhibitors,angiotensin receptor blockers,sodium-glucose cotransporter-2 inhibitors,and newly approved aldosterone receptor antagonists.However,to date,there are still no effective drugs to prevent diabetic kidney disease from progressing to end-stage renal disease.Network pharmacology combined with bioinformatics and pharmacology provides a powerful tool for studying the mechanism of drug action.Traditional Chinese medicine has accumulated rich experience in the treatment of diabetic kidney disease,and its multi-target,multi-component,and multi-pathway characteristics provide new ideas for modern medicine.This article reviews the research progress of network pharmacology and drug therapy in diabetic kidney disease.
基金Supported by Science and Technology Research Program of Jilin Provincial Department of Education,No.JJKH20231218KJProject of the Jilin Provincial Administration of Traditional Chinese Medicine,No.2024111.
文摘Diabetic kidney disease(DKD)has a high incidence and mortality rate and lacks effective preventive and therapeutic methods.Apoptosis is one of the main reasons for the occurrence and development of DKD.Mesenchymal stem cells(MSCs)have shown great promise in tissue regeneration for DKD treatment and have protective effects against DKD,including decreased blood glucose and urinary protein levels and improved renal function.MSCs can directly differ-entiate into kidney cells or act via paracrine mechanisms to reduce apoptosis in DKD by modulating signaling pathways.MSC-derived extracellular vesicles(MSC-EVs)mitigate apoptosis and DKD-related symptoms by transferring miRNAs to target cells or organs.However,studies on the regulatory mechanisms of MSCs and MSC-EVs in apoptosis in DKD are insufficient.This review compre-hensively examines the mechanisms of apoptosis in DKD and research progress regarding the roles of MSCs and MSC-EVs in the disease process.
文摘The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the rising global prevalence of these conditions,understanding their interconnections is essential.The study emphasizes the importance of shared risk factors,such as obesity,type 2 diabetes,dyslipidemia,and oxidative stress,and calls for multidisciplinary screening strategies.This approach would improve patient outcomes and reduce the socio-economic burden.While the study contributes valuable insights from a Chinese population,further research across diverse populations is necessary to validate and extend these findings globally.Ultimately,the research underscores the need for integrated prevention programs to better manage these interconnected diseases and improve health outcomes.
文摘BACKGROUND The progression of diabetic kidney disease(DKD)affects the patient’s kidney glomeruli and tubules,whose normal functioning is essential for maintaining normal calcium(Ca)and phosphorus(P)metabolism in the body.The risk of developing osteoporosis(OP)in patients with DKD increases with the aggravation of the disease,including a higher risk of fractures,which not only affects the quality of life of patients but also increases the risk of death.AIM To analyze the risk factors for the development of OP in patients with DKD and their correlation with Ca-P metabolic indices,fibroblast growth factor 23(FGF23),and Klotho.METHODS One hundred and fifty-eight patients with DKD who were admitted into the Wuhu Second People’s Hospital from September 2019 to May 2021 were selected and divided into an OP group(n=103)and a normal bone mass group(n=55)according to their X-ray bone densitometry results.Baseline data and differences in Ca-P biochemical indices,FGF23,and Klotho were compared.The correlation of Ca-P metabolic indices with FGF23 and Klotho was discussed,and the related factors affecting OP in patients with DKD were examined by multivariate logistic regression analysis.RESULTS The OP group had a higher proportion of females,an older age,and a longer diabetes mellitus duration than the normal group(all P<0.05).Patients in the OP group exhibited significantly higher levels of intact parathyroid hormone(iPTH),blood P,Ca-P product(Ca×P),fractional excretion of phosphate(FeP),and FGF23,as well as lower estimated glomerular filtration rate,blood Ca,24-hour urinary phosphate excretion(24-hour UPE),and Klotho levels(all P<0.05).In the OP group,25-(OH)-D3,blood Ca,and 24-hour UPE were negatively correlated with FGF23 and positively correlated with Klotho.In contrast,iPTH,blood Ca,Ca×P,and FeP exhibited a positive correlation with FGF23 and an inverse association with Klotho(all P<0.05).Moreover,25-(OH)-D3,iPTH,blood Ca,FePO4,FGF23,Klotho,age,and female gender were key factors that affected the lumbar and left femoral neck bone mineral density.CONCLUSION The Ca-P metabolism metabolic indexes,FGF23,and Klotho in patients with DKD are closely related to the occurrence and development of OP.
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Rhabdomyolysis is a severe condition characterized by the breakdown of muscle tissue leading to the release of intracellular components into the bloodstream.This condition,when associated with acute kidney injury(AKI),can result in significant morbidity and mortality,particularly in the context of coronavirus disease 2019(COVID-19).This editorial discusses a retrospective study on patients with COVID-19 who developed rhabdomyolysis-related AKI.The study highlights that patients with rhabdomyolysis exhibited higher inflammatory markers,such as Creactive protein,ferritin,and procalcitonin,and experienced worse clinical outcomes compared to those with other causes of AKI.The findings underscore the importance of early recognition and management of rhabdomyolysis in COVID-19 patients to improve prognosis and reduce mortality rates.
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 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Chikungunya,a vector-borne viral disease,has become a critical global health issue due to its capacity for widespread outbreaks,especially in tropical and subtropical regions,and its recent global expansion.The resurgence of Chikun-gunya virus(CHIKV)in Karachi,Pakistan,has amplified public health challen-ges,driven by factors such as urbanization,climate change,and socioeconomic vulnerabilities,including limited healthcare infrastructure.Clinically,the disease primarily manifests with fever,rash,and debilitating joint pain,which often leads to prolonged discomfort and decreased quality of life.However,emerging evi-dence points to atypical and severe complications affecting the neurological,cardiac,and kidney systems,increasing the risk of mor-bidity and mortality.Kidney involvement in Chikungunya is of particular concern,with acute kidney injury being identified as a critical complication.Timely diagnosis of the infection and early identification of individuals at heigh-tened risk of progressing to severe kidney dysfunction is crucial to improving patient outcomes.Such individuals often include those with pre-existing kidney conditions or other underlying comorbidities,making them more susceptible to complications.This narrative review aims to synthesize and expand upon the current understanding of the me-chanisms underlying CHIKV-induced kidney injury.These mechanisms en-compass direct viral invasion of kidney tissue,immune-mediated inflammatory responses that inadvertently damage the kidneys,and the aggravation of pre-existing kidney pathologies.Furthermore,the complex interplay between the virus and the host's immune system may exacerbate kidney complications,high-lighting the multifaceted nature of CHIKV pathophysiology.
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.
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.
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.
