Background:The management of renal neoplasms in adolescent patients poses unique clinical challenges due to their transitional position between paediatric and adult populations.This age group exhibits marked heterogen...Background:The management of renal neoplasms in adolescent patients poses unique clinical challenges due to their transitional position between paediatric and adult populations.This age group exhibits marked heterogeneity in tumour histology,ranging from entities commonly observed in paediatric oncology to tumours typical of adult age,as well as rare histological subtypes that exceptionally affect the kidney.Given the substantial differences in clinical protocols between paediatric and adult populations,rigorous multidisciplinary evaluation is essential to determine optimal diagnostic and therapeutic strategies for adolescent patients.Case Description:We present four cases from our tertiary referral centre that illustrate the variability in radiological and histopathological presentations and clinical outcomes in this population,underscoring the critical importance of a multidisciplinary approach.Case 1 demonstrates the typical management of Wilms’tumour in an older paediatric patient.Case 2 exemplifies the diagnostic challenge of distinguishing between Wilms’tumour and renal cell carcinoma at the upper end of the adolescent spectrum.Case 3 revealed the unexpected diagnosis of renal Ewing sarcoma in a 13-year-old female.Case 4 highlights the potential for severe perioperative complications,including life-threatening thromboembolic events,in a patient with Wilms’tumour.Conclusions:The variability in tumour types,biological behaviour,and potential for severe complications underscores the necessity of comprehensive multidisciplinary management in specialized hospital settings.An integrated approach ensures accurate diagnosis,individualized treatment planning,and effective management of complications,ultimately optimizing outcomes for adolescent patients with renal neoplasms.展开更多
Glyphosate(GLY),a widely used herbicide,has been extensively applied in both the agricultural and non-agricultural sectors worldwide.The rate of GLY use varies considerably depending on the crop type and local farming...Glyphosate(GLY),a widely used herbicide,has been extensively applied in both the agricultural and non-agricultural sectors worldwide.The rate of GLY use varies considerably depending on the crop type and local farming practices,which can be up to approximately 53.5%of agricultural land in certain regions.展开更多
Elaidic acid(EA)is a typical trans fatty acid(TFA)that emerges during the processing of various fatty foods.In this study,we found that EA induced renal injury with necroptosis.Pretreatment with a reactive oxygen spec...Elaidic acid(EA)is a typical trans fatty acid(TFA)that emerges during the processing of various fatty foods.In this study,we found that EA induced renal injury with necroptosis.Pretreatment with a reactive oxygen species(ROS)inhibitor and a RIPK3 inhibitor alleviated EA-induced necroptosis.The data indicated that EA induced renal necroptosis through ROS/RIPK3/MLKL pathway.In mechanistic studies,we explored how EA induced ROS production.Results indicated that EA caused mitochondrial damage by testing MMP,MFN1,VDAC,and FIS1.Further,EA suppressed mitophagy by testing the levels of LC3,p62,PINK1,Parkin,colocalization of LC3 and Mito-Tracker Red.Mitophagy is a process of selective degradation of damaged mitochondria.A large number of damaged mitochondria couldn't be cleared by mitophagy in time,which increased ROS levels in renal cells.Pretreatment with a mitophagy activator decreased EA-induced ROS levels and mitochondrial damage.Taken together,our data identified that EA induced renal necroptosis by destroying mitochondria and inhibiting mitophagy,thereby activating the ROS/RIPK3/MLKL pathway.展开更多
BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM ...BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM To explore the correlations among life satisfaction,pleasure levels,and negative emotions in patients with CRF.METHODS One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included.The Depression,Anxiety,and Stress Scale(DASS-21),Satisfaction with Life Scale(SWLS),and Temporal Experience of Pleasure Scale(TEPS)were used to evaluate negative emotions,life satisfaction,and pleasure level,respectively.Pearson’s correlation coefficient analyzed the correlation between life satisfaction,pleasure level,and negative emotions.Linear regression analysis identified the factors affecting negative emotions.RESULTS The average DASS-21 score among patients with CRF was 51.90±2.30,with subscale scores of 17.90±1.50 for depression,18.53±1.18 for anxiety,and 15.47±2.36 for stress,all significantly higher than the domestic norm(P<0.05).The average SWLS score was 22.17±4.90.Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores(P<0.05),but not with the individual depression,anxiety,or stress dimensions.The average TEPS score was 67.80±8.34.TEPS scores were negatively correlated with the DASS-21 score and the stress dimension(P<0.05),but not with depression or anxiety.Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores(P<0.05).CONCLUSION Patients with CRF experience high levels of negative emotions,which are negatively correlated with life satisfaction and pleasure.Furthermore,pleasure level had an impact on negative emotions.展开更多
Background:The traditional method of heterotopic abdominal heart transplantation(HTx)involves crossclamping the inferior vena cava,which inevitably leads to bilateral lower limb ischemia(LI).This study first aimed to ...Background:The traditional method of heterotopic abdominal heart transplantation(HTx)involves crossclamping the inferior vena cava,which inevitably leads to bilateral lower limb ischemia(LI).This study first aimed to investigate the impact of LI on renal function in rats subjected to unilateral nephrectomy(UNx).Second,a modified method utilizing renal vessel-assisted anastomosis in rats with left UNx was compared with the traditional method for abdominal HTx.Methods:Male Sprague-Dawley rats were utilized as subjects for both experimental phases.In experiment 1,the animals were divided into four groups:sham operation group;LI group-rats undergoing occlusion of the abdominal aorta and vena cava below the renal vessels;UNx group-rats with left UNx;and LI+UNx group.All operated animals were monitored for up to 7 days for biochemical markers,renal histopathology,and survival rates.In experiment 2,we introduced the renal vessel-assisted method as the experimental group and compared it against the traditional method as the control within rat heterotopic HTx models.We assessed operative characteristics,echocardiography results,histological findings,and graft survival.Results:First,LI resulted in acute kidney dysfunction characterized by a decrease in 7day survival rates and creatinine clearance rates in both the LI and LI+UNx groups compared to the sham operation and UNx groups.Particularly,histopathological damage in the kidney and liver did not exhibit significant effects during this period.Second,the implementation of the renal vessel-assisted method significantly reduced bleeding volume at suture sites and enhanced the 7day survival rate compared to the traditional method.Conclusion:Acute kidney injury was induced by LI postoperation in treated rats.The renal vessel-assisted method demonstrated its effectiveness as a superior alternative that mitigates complications associated with the traditional method.展开更多
Impacted upper ureteral stones are definedas calculi that remain lodged in the same location within the upper ureter for more than two months,1 and they are typically associated with inflammation,mucosal edema,and fib...Impacted upper ureteral stones are definedas calculi that remain lodged in the same location within the upper ureter for more than two months,1 and they are typically associated with inflammation,mucosal edema,and fibrosisof the surrounding ureteral wall.These stones often lead to significantclinical consequences,including persistent flankpain,hydronephrosis,infection,impaired renal function,and in severe cases,irreversible kidney damage.展开更多
Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenv...Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenvatinib and everolimus represents a viable option,and the present review aimed to summarize its activity,effectiveness,and safety.Methods:A systematic review of the literature was conducted using PubMed,targeting studies published between 2018 and 2025.Eligible studies included English-language prospective and retrospective trials reporting survival outcomes in mRCC patients treated with lenvatinib and everolimus after at least one ICI-containing regimen.Results:Nine studies met the inclusion criteria,encompassing a total of 441 patients.The lenvatinib and everolimus combination was primarily used in the third and subsequent lines of therapy.Median overall survival ranged from 7.5 to 24.5 months,while median progression-free survival was more consistent,between 6.1 and 6.7 months,except for one study reporting 12.9 months.Objective response rates varied widely(14.0%–55.7%).Adverse events of grade≥3 did not exceed the expected rate,with diarrhoea and proteinuria as the most reported events.Dose reductions and treatment discontinuations due to toxicity occurred but were generally lower than in prior pivotal trials.Conclusions:Real-world evidence suggests that lenvatinib and everolimus represent an effective and safe option after ICI failure in mRCC patients.Nevertheless,the lack of randomized phase III trials and the heterogeneity of existing studies highlight the need for more robust prospective research to guide post-ICI therapeutic strategies.展开更多
Renal cell carcinoma(RCC)is a challenging urologic malignancy characterized by its aggressive nature,including invasion,metastasis,and treatment resistance.To explore multi-targeted therapies,we established an advance...Renal cell carcinoma(RCC)is a challenging urologic malignancy characterized by its aggressive nature,including invasion,metastasis,and treatment resistance.To explore multi-targeted therapies,we established an advanced clear cell renal cell carcinoma(cc RCC)model via orthotopic tumor transplantation in mice,and established another model simulating post-surgical recurrence by performing radical nephrectomy.We engineered a genetic circuit to reprogram the host liver as a bioreactor,enabling the production and delivery of in vivo self-assembled si RNAs(IVSA-si RNAs)for co-targeting VEGFR2 and m TOR.The efficacy and toxicity of this IVSA-si RNA system were evaluated and compared with the combination therapy of sunitinib and everolimus.In the established models,the combination therapy of sunitinib and everolimus showed efficacy but induced severe adverse effects.In contrast,IVSA-si RNAs potently silenced VEGFR2 and m TOR expression,achieving therapeutic effects in both advanced and radical nephrectomy cc RCC models without discernible toxicity.展开更多
BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular ana...BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.展开更多
BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in comp...BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in complement factor H(CFH),complement factor I,or complement factor H-related(CFHR)proteins.Both renal transplantation and pregnancy are independent triggers for recurrence.This case highlights a genetically high-risk patient who achieved a successful term pregnancy after renal transplantation without complement inhibition,emphasizing individualized risk stratification,close surveillance,and multidisciplinary management for favourable maternal and graft outcomes.CASE SUMMARY A 32-year-old woman with end-stage renal disease secondary to genetically confirmed complement-mediated TMA—homozygous CFH exon 17 deletion and CFHR3-CFHR1 duplication—was maintained on dialysis for 2.5 years before undergoing a successful live-donor kidney transplant from her mother.Post-transplant immunosuppression included tacrolimus,mycophenolate mofetil,and prednisolone,later modified to azathioprine during pregnancy planning.One-year post-transplant,she conceived spontaneously.Pregnancy was complicated by transient gestational hypertension,controlled with nifedipine,labetalol,and amlodipine.Proteinuria remained<150 mg/day;white blood cell counts 5.8-7.2×109/L without cytopenia.Serum creatinine ranged 0.9-1.1 mg/dL,and tacrolimus trough levels 5-7 ng/mL.At 36 weeks,she delivered a healthy 3 kg infant by elective caesarean section.Postpartum follow-up at three months confirmed stable maternal and graft function.CONCLUSION High-risk complement-mediated TMA patients can achieve successful pregnancy post-transplant through individualized care without mandatory complement blockade.展开更多
Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes.Herein,we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clini...Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes.Herein,we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clinic with an incidentally found renal mass.After shared decision making patient proceeded with a Robotic Assisted Laparoscopy(RAL)left sided partial nephrectomy.Final pathology confirmed the presence of high nuclear grade mixed clear cell and papillary renal cell carcinoma(RCC)of the left kidney(pT3aN0M0).This case elucidates a very rare incidence of a patient seen to have a collision tumor,and furthermore demonstrates guideline-based treatment.展开更多
AIMTo investigate the role of contrast enhanced ultrasound(CEUS)in evaluating patients with renal function impairment(RFI)showing:(1)acute renal failure(ARF)of suspicious vascular origin;or(2)suspicious renal lesions....AIMTo investigate the role of contrast enhanced ultrasound(CEUS)in evaluating patients with renal function impairment(RFI)showing:(1)acute renal failure(ARF)of suspicious vascular origin;or(2)suspicious renal lesions.METHODSWe retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF(first group of 50 subjects)or assess previously found suspicious renal lesions(second group of 41 subjects with acute or chronic RFI).After preliminary grey-scale and color Doppler investigation,each kidney was investigated individually with CEUS,using 1.2-2.4 mL of a sulfur hexafluoride-filled microbubble contrast agent.Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS.We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second group.RESULTSIn the first group,CEUS detected renal infarction or cortical ischemia in 18/50 patients(36%;95%CI:23.3-50.9)and 1/50 patients(2%;95%CI:0.1-12),respectively.The detection rate of infarction was significantly higher(P=0.0002;McNemar test)compared to color Doppler ultrasonography(10%).No vascular causes of ARF were identified in the remaining 31/50 patients(62%).In the second group,CEUS detected 41 lesions on 39 patients,allowing differentiation between solid lesions(21/41;51.2%)vs complex cysts(20/41;48.8%),and properly addressing 15/39 patients to intervention when feasible based on clinical conditions(surgery and cryoablation in 13 and 2 cases,respectively).Cysts were categorized Bosniak II,IIF,III and IV in 8,5,4 and 3 cases,respectively.In the remaining two patients,CEUS found 1 pseudolesion and 1 subcapsular hematoma.CONCLUSIONCEUS showed high detection rate of renal perfusion abnormalities in patients with ARF,influencing the management of patients with acute or chronic RFI and renal masses throughout their proper characterization.展开更多
BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with si...BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with significant long-term morbidity,and histological abnormalities such as crescentic glomerulonephritis are infrequently reported.PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.METHODS This prospective observational study was conducted at Lady Ridgeway Hospital(Colombo,Sri Lanka)over 15 months.Children with PSAGN were enrolled based on clinical and laboratory criteria.Persistent proteinuria≥2+for 2 weeks and serum creatinine>100μmol/L warranted renal biopsy,assessed via light microscopy and immunofluorescence.Normalization of complement 3(C3)within 6 to 8 weeks was required for inclusion.Data on clinical features,urine protein levels,and renal function were collected from patient records,and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing.Ethical approval was obtained from the Ethical Review Committee,Lady Ridgeway Hospital for Children(Ref No:LRH/ERC/2021/60).RESULTS Forty-four patients were recruited.There were 27(61.4%)male patients and 17(38.6%)female patients.Thirty-seven(84%)of them were above 5 years of age.Twenty(45%)patients had a history of skin sepsis,and eighteen(41%)had a history of throat infection.Among patients with proteinuria≥2+,53%had serum creatinine>100µmol/L,while among those with proteinuria<2+,7%had serum creatinine>100µmol/L.The association of high-degree proteinuria with elevated serum creatinine was significant(χ²=7.8,P=0.005)in PSAGN.The odds ratio of the logistic regression model was 1.049(95%confidence interval:1.003-1.098),indicating a positive direction with statistically significant association(P=0.037).There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance.Ten children underwent renal biopsy.Crescents(less than 50%)were demonstrated in five children,while three children had typical diffuse proliferative glomer-ulonephritis.One child had severe acute tubular necrosis,and another had crescentic glomerulonephritis(crescents>50%).The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine(>100μmol/L)in children with PSAGN.The majority of children with persistent proteinuria≥2+for more than 2 weeks and the highest recorded serum creatinine>100μmol/L had atypical renal histological findings.展开更多
BACKGROUND Metastasis of renal cell carcinoma(RCC)to the skeletal muscle and small bowel is an exceedingly rare occurrence.Both of these sites are unusual sites for RCC to metastasize to and to occur simultaneously is...BACKGROUND Metastasis of renal cell carcinoma(RCC)to the skeletal muscle and small bowel is an exceedingly rare occurrence.Both of these sites are unusual sites for RCC to metastasize to and to occur simultaneously is even less common.CASE SUMMARY A 58-year-old male with known history of RCC presented with a recurrence that was diagnosed through imaging and biopsies.Mucosa abnormalities of small bowel noted during endoscopy were biopsied as well as lesion in the psoas muscle that was noted.CONCLUSION This case report emphasizes that RCC can not only recur but can do so even decades later and present as metastatic foci at atypical sites.展开更多
Diabetic kidney disease(DKD)has emerged as one of the leading causes of chronic kidney disease and end-stage renal disease worldwide.In the progression of DKD,renal tubular injury plays a pivotal role,with stress-indu...Diabetic kidney disease(DKD)has emerged as one of the leading causes of chronic kidney disease and end-stage renal disease worldwide.In the progression of DKD,renal tubular injury plays a pivotal role,with stress-induced senescence of renal tubular epithelial cells(RTECs)being a critical cellular event contributing to tubular damage in DKD.Recent studies have revealed that multiple mechanisms,including oxidative stress,mitochondrial autophagy,endoplasmic reticulum stress,and epigenetic modifications,can induce stress-induced senescence in RTECs,thereby driving the progression of DKD.In recent years,research has demonstrated that traditional Chinese medicine(TCM)can regulate these mechanisms through multiple targets and key pathways,inhibiting stress-induced senescence in RTECs and ameliorating the progression of DKD.TCM has been widely applied in clinical practice with proven efficacy.This article systematically summarizes the concept of cellular senescence,delves into the relationship between stress-induced senescence of RTECs and DKD,analyzes the mechanisms underlying the formation of stress-induced senescence in RTECs within the context of DKD,and reviews the research progress of TCM in anti-senescence treatment for DKD.The aim is to provide a reference for future research and the development of novel therapeutic strategies.展开更多
Renal cell carcinoma(RCC)is an aggressive tumor known for its propensity to invade the inferior vena cava(IVC)into the heart.Cardiac metastasis of RCC without IVC involvement is rare.Even rarer is ventricular arrhythm...Renal cell carcinoma(RCC)is an aggressive tumor known for its propensity to invade the inferior vena cava(IVC)into the heart.Cardiac metastasis of RCC without IVC involvement is rare.Even rarer is ventricular arrhythmia as the primary manifestation of cardiac metastasis of RCC with only two cases reported.[1,2]We add to the literature the third case,the diagnosis of which was only possible with cardiac magnetic resonance(CMR).展开更多
BACKGROUND Acute kidney injury(AKI)is a frequent complication after liver transplantation(LT).How to realize the early diagnosis of AKI,perform active intervention,and reduce the mortality of post-LT patients is an ur...BACKGROUND Acute kidney injury(AKI)is a frequent complication after liver transplantation(LT).How to realize the early diagnosis of AKI,perform active intervention,and reduce the mortality of post-LT patients is an urgent problem to be solved.AIM To investigate the accuracy of hepatorenal index(HRI)and renal resistive index(RRI)in monitoring of early AKI after LT.METHODS This observational study included adult deceased-donor LT recipients at our center between February 2022 and February 2023 with no preoperative renal dysfunction.The HRI and RRI were recorded once per day in the postoperative period through to postoperative day(POD)7.We followed up with the patients at 1 month after LT.The patients were divided into the AKI and non-AKI groups according to the Kidney Disease Improving Global Outcomes criteria.RESULTS Of 121 patients were included in the study(mean age:50.18±8.88years;female:17.36%).AKI developed in 53 patients(43.80%).The AKI and non-AKI groups were similar in terms of their baseline characteristics.An HRI of≤1.12 on POD 1 detected AKI with a sensitivity of 62.30%and a specificity of 87.80%[area under the receiver operating characteristic curve(AUC)=0.801,P<0.01].An RRI of≥0.65 on POD 1 detected AKI with a sensitivity of 87.80%and a specificity of 67.60%(AUC=0.825,P<0.01).The HRI combined with the RRI was more effective at detecting AKI than either the HRI or RRI alone(AUC=0.890,P<0.01).The HRI increased as AKI resolved while the RRI decreased as AKI resolved.CONCLUSION The HRI and RRI are non-invasive bedside indices that can identify the occurrence and recovery of early AKI after LT.展开更多
The kidneys play a critical role in maintaining glucose homeostasis.Under normal renal tubular function,most of the glucose filtered from the glomeruli is re-absorbed in the proximal tubules,leaving only trace amounts...The kidneys play a critical role in maintaining glucose homeostasis.Under normal renal tubular function,most of the glucose filtered from the glomeruli is re-absorbed in the proximal tubules,leaving only trace amounts in the urine.Glycosuria can occur as a symptom of generalized proximal tubular dysfunction or when the reabsorption threshold is exceeded or the glucose threshold is reduced,as seen in familial renal glycosuria(FRG).FRG is characterized by persistent glycosuria despite normal blood glucose levels and tubular function and is primarily associated with mutations in the sodium/glucose cotransporter 5A2 gene,which encodes the sodium-glucose cotransporter(SGLT)2.Inhibiting SGLTs has been proposed as a novel treatment strategy for diabetes,and since FRG is often considered an asymptomatic and benign condition,it has inspired preclinical and clinical studies using SGLT2 inhibitors in type 2 diabetes.However,patients with FRG may exhibit clinical features such as lower body weight or height,altered systemic blood pressure,diaper dermatitis,amino-aciduria,decreased serum uric acid levels,and hypercalciuria.Further research is needed to fully understand the pathophysiology,molecular genetics,and clinical manifestations of renal glucosuria.展开更多
文摘Background:The management of renal neoplasms in adolescent patients poses unique clinical challenges due to their transitional position between paediatric and adult populations.This age group exhibits marked heterogeneity in tumour histology,ranging from entities commonly observed in paediatric oncology to tumours typical of adult age,as well as rare histological subtypes that exceptionally affect the kidney.Given the substantial differences in clinical protocols between paediatric and adult populations,rigorous multidisciplinary evaluation is essential to determine optimal diagnostic and therapeutic strategies for adolescent patients.Case Description:We present four cases from our tertiary referral centre that illustrate the variability in radiological and histopathological presentations and clinical outcomes in this population,underscoring the critical importance of a multidisciplinary approach.Case 1 demonstrates the typical management of Wilms’tumour in an older paediatric patient.Case 2 exemplifies the diagnostic challenge of distinguishing between Wilms’tumour and renal cell carcinoma at the upper end of the adolescent spectrum.Case 3 revealed the unexpected diagnosis of renal Ewing sarcoma in a 13-year-old female.Case 4 highlights the potential for severe perioperative complications,including life-threatening thromboembolic events,in a patient with Wilms’tumour.Conclusions:The variability in tumour types,biological behaviour,and potential for severe complications underscores the necessity of comprehensive multidisciplinary management in specialized hospital settings.An integrated approach ensures accurate diagnosis,individualized treatment planning,and effective management of complications,ultimately optimizing outcomes for adolescent patients with renal neoplasms.
基金supported by grants from the National Key Research and Development Program of China(2023YFC3603100 and 2023YFC3603105)“Leading Goose”R&D Program of Zhejiang(2022C03076-4),China.
文摘Glyphosate(GLY),a widely used herbicide,has been extensively applied in both the agricultural and non-agricultural sectors worldwide.The rate of GLY use varies considerably depending on the crop type and local farming practices,which can be up to approximately 53.5%of agricultural land in certain regions.
基金supported by National Key Research and Development Program of China(2023YFD1800902).
文摘Elaidic acid(EA)is a typical trans fatty acid(TFA)that emerges during the processing of various fatty foods.In this study,we found that EA induced renal injury with necroptosis.Pretreatment with a reactive oxygen species(ROS)inhibitor and a RIPK3 inhibitor alleviated EA-induced necroptosis.The data indicated that EA induced renal necroptosis through ROS/RIPK3/MLKL pathway.In mechanistic studies,we explored how EA induced ROS production.Results indicated that EA caused mitochondrial damage by testing MMP,MFN1,VDAC,and FIS1.Further,EA suppressed mitophagy by testing the levels of LC3,p62,PINK1,Parkin,colocalization of LC3 and Mito-Tracker Red.Mitophagy is a process of selective degradation of damaged mitochondria.A large number of damaged mitochondria couldn't be cleared by mitophagy in time,which increased ROS levels in renal cells.Pretreatment with a mitophagy activator decreased EA-induced ROS levels and mitochondrial damage.Taken together,our data identified that EA induced renal necroptosis by destroying mitochondria and inhibiting mitophagy,thereby activating the ROS/RIPK3/MLKL pathway.
文摘BACKGROUND Anxiety,depression,and other negative emotions are common among patients with chronic renal failure(CRF).Analyzing the factors related to negative emotions is necessary to provide targeted nursing care.AIM To explore the correlations among life satisfaction,pleasure levels,and negative emotions in patients with CRF.METHODS One hundred patients with CRF who received therapy at the First Affiliated Hospital of Jinzhou Medical University between December 2022 and February 2025 were included.The Depression,Anxiety,and Stress Scale(DASS-21),Satisfaction with Life Scale(SWLS),and Temporal Experience of Pleasure Scale(TEPS)were used to evaluate negative emotions,life satisfaction,and pleasure level,respectively.Pearson’s correlation coefficient analyzed the correlation between life satisfaction,pleasure level,and negative emotions.Linear regression analysis identified the factors affecting negative emotions.RESULTS The average DASS-21 score among patients with CRF was 51.90±2.30,with subscale scores of 17.90±1.50 for depression,18.53±1.18 for anxiety,and 15.47±2.36 for stress,all significantly higher than the domestic norm(P<0.05).The average SWLS score was 22.17±4.90.Correlation analysis revealed a negative correlation between the SWLS and total DASS-21 scores(P<0.05),but not with the individual depression,anxiety,or stress dimensions.The average TEPS score was 67.80±8.34.TEPS scores were negatively correlated with the DASS-21 score and the stress dimension(P<0.05),but not with depression or anxiety.Linear regression analysis showed that TEPS scores significantly influenced DASS-21 scores(P<0.05).CONCLUSION Patients with CRF experience high levels of negative emotions,which are negatively correlated with life satisfaction and pleasure.Furthermore,pleasure level had an impact on negative emotions.
基金The Youth Project of Tianjin Natural Science Foundation,Grant/Award Number:23JCQNJC01380。
文摘Background:The traditional method of heterotopic abdominal heart transplantation(HTx)involves crossclamping the inferior vena cava,which inevitably leads to bilateral lower limb ischemia(LI).This study first aimed to investigate the impact of LI on renal function in rats subjected to unilateral nephrectomy(UNx).Second,a modified method utilizing renal vessel-assisted anastomosis in rats with left UNx was compared with the traditional method for abdominal HTx.Methods:Male Sprague-Dawley rats were utilized as subjects for both experimental phases.In experiment 1,the animals were divided into four groups:sham operation group;LI group-rats undergoing occlusion of the abdominal aorta and vena cava below the renal vessels;UNx group-rats with left UNx;and LI+UNx group.All operated animals were monitored for up to 7 days for biochemical markers,renal histopathology,and survival rates.In experiment 2,we introduced the renal vessel-assisted method as the experimental group and compared it against the traditional method as the control within rat heterotopic HTx models.We assessed operative characteristics,echocardiography results,histological findings,and graft survival.Results:First,LI resulted in acute kidney dysfunction characterized by a decrease in 7day survival rates and creatinine clearance rates in both the LI and LI+UNx groups compared to the sham operation and UNx groups.Particularly,histopathological damage in the kidney and liver did not exhibit significant effects during this period.Second,the implementation of the renal vessel-assisted method significantly reduced bleeding volume at suture sites and enhanced the 7day survival rate compared to the traditional method.Conclusion:Acute kidney injury was induced by LI postoperation in treated rats.The renal vessel-assisted method demonstrated its effectiveness as a superior alternative that mitigates complications associated with the traditional method.
文摘Impacted upper ureteral stones are definedas calculi that remain lodged in the same location within the upper ureter for more than two months,1 and they are typically associated with inflammation,mucosal edema,and fibrosisof the surrounding ureteral wall.These stones often lead to significantclinical consequences,including persistent flankpain,hydronephrosis,infection,impaired renal function,and in severe cases,irreversible kidney damage.
文摘Background:While the treatment of metastatic renal cell carcinoma(mRCC)is evolving due to immune checkpoint inhibitors(ICIs),optimal strategies for later lines of therapy have yet to be defined.The combination of lenvatinib and everolimus represents a viable option,and the present review aimed to summarize its activity,effectiveness,and safety.Methods:A systematic review of the literature was conducted using PubMed,targeting studies published between 2018 and 2025.Eligible studies included English-language prospective and retrospective trials reporting survival outcomes in mRCC patients treated with lenvatinib and everolimus after at least one ICI-containing regimen.Results:Nine studies met the inclusion criteria,encompassing a total of 441 patients.The lenvatinib and everolimus combination was primarily used in the third and subsequent lines of therapy.Median overall survival ranged from 7.5 to 24.5 months,while median progression-free survival was more consistent,between 6.1 and 6.7 months,except for one study reporting 12.9 months.Objective response rates varied widely(14.0%–55.7%).Adverse events of grade≥3 did not exceed the expected rate,with diarrhoea and proteinuria as the most reported events.Dose reductions and treatment discontinuations due to toxicity occurred but were generally lower than in prior pivotal trials.Conclusions:Real-world evidence suggests that lenvatinib and everolimus represent an effective and safe option after ICI failure in mRCC patients.Nevertheless,the lack of randomized phase III trials and the heterogeneity of existing studies highlight the need for more robust prospective research to guide post-ICI therapeutic strategies.
基金supported by grants from the National Natural Science Foundation of China(No.32022015,31871295 and 82373158)the Training Program of the Major Research Plan of the National Natural Science Foundation of China(No.92268120)+1 种基金the Starry Night Science Fund of Zhejiang University Shanghai Institute for Advanced Study(No.SN-ZJU-SIAS-008)CAMS Innovation Fund for Medical Sciences(No.CIFMS-2021-I2M-5–015)。
文摘Renal cell carcinoma(RCC)is a challenging urologic malignancy characterized by its aggressive nature,including invasion,metastasis,and treatment resistance.To explore multi-targeted therapies,we established an advanced clear cell renal cell carcinoma(cc RCC)model via orthotopic tumor transplantation in mice,and established another model simulating post-surgical recurrence by performing radical nephrectomy.We engineered a genetic circuit to reprogram the host liver as a bioreactor,enabling the production and delivery of in vivo self-assembled si RNAs(IVSA-si RNAs)for co-targeting VEGFR2 and m TOR.The efficacy and toxicity of this IVSA-si RNA system were evaluated and compared with the combination therapy of sunitinib and everolimus.In the established models,the combination therapy of sunitinib and everolimus showed efficacy but induced severe adverse effects.In contrast,IVSA-si RNAs potently silenced VEGFR2 and m TOR expression,achieving therapeutic effects in both advanced and radical nephrectomy cc RCC models without discernible toxicity.
文摘BACKGROUND With the increasing use of laparoscopic techniques in living-donor kidney transplantation,limitations in donor vessel length,particularly of the right renal vein,pose significant challenges for vascular anastomosis to the recipient’s external iliac vein.These anatomical constraints can complicate graft implantation and increase the risk of postoperative complications.CASE SUMMARY To address the issue of short right renal veins,several surgical strategies have been proposed.In this report,we describe our experience with three cases in which venous extension was successfully achieved using a venous cuff interposition technique during back-table reconstruction.This approach was used to facilitate secure vascular anastomosis and improve graft positioning in anatomically complex transplant scenarios.CONCLUSION Venous cuff interposition represents an effective technique for managing short renal veins in living-donor kidney transplantation.It provides additional length and flexibility,easing anastomotic tension and supporting successful transplantation.
文摘BACKGROUND Complement-mediated thrombotic microangiopathy(TMA)is a rare endothelial injury syndrome caused by dysregulated activation of the alternative complement pathway,often linked to genetic abnormalities in complement factor H(CFH),complement factor I,or complement factor H-related(CFHR)proteins.Both renal transplantation and pregnancy are independent triggers for recurrence.This case highlights a genetically high-risk patient who achieved a successful term pregnancy after renal transplantation without complement inhibition,emphasizing individualized risk stratification,close surveillance,and multidisciplinary management for favourable maternal and graft outcomes.CASE SUMMARY A 32-year-old woman with end-stage renal disease secondary to genetically confirmed complement-mediated TMA—homozygous CFH exon 17 deletion and CFHR3-CFHR1 duplication—was maintained on dialysis for 2.5 years before undergoing a successful live-donor kidney transplant from her mother.Post-transplant immunosuppression included tacrolimus,mycophenolate mofetil,and prednisolone,later modified to azathioprine during pregnancy planning.One-year post-transplant,she conceived spontaneously.Pregnancy was complicated by transient gestational hypertension,controlled with nifedipine,labetalol,and amlodipine.Proteinuria remained<150 mg/day;white blood cell counts 5.8-7.2×109/L without cytopenia.Serum creatinine ranged 0.9-1.1 mg/dL,and tacrolimus trough levels 5-7 ng/mL.At 36 weeks,she delivered a healthy 3 kg infant by elective caesarean section.Postpartum follow-up at three months confirmed stable maternal and graft function.CONCLUSION High-risk complement-mediated TMA patients can achieve successful pregnancy post-transplant through individualized care without mandatory complement blockade.
文摘Renal cell carcinoma is a heterogeneous group of renal tumors characterized by several histological subtypes.Herein,we discuss an unusual case of a 55-year-old male who presented as a consultation to our urology clinic with an incidentally found renal mass.After shared decision making patient proceeded with a Robotic Assisted Laparoscopy(RAL)left sided partial nephrectomy.Final pathology confirmed the presence of high nuclear grade mixed clear cell and papillary renal cell carcinoma(RCC)of the left kidney(pT3aN0M0).This case elucidates a very rare incidence of a patient seen to have a collision tumor,and furthermore demonstrates guideline-based treatment.
文摘AIMTo investigate the role of contrast enhanced ultrasound(CEUS)in evaluating patients with renal function impairment(RFI)showing:(1)acute renal failure(ARF)of suspicious vascular origin;or(2)suspicious renal lesions.METHODSWe retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF(first group of 50 subjects)or assess previously found suspicious renal lesions(second group of 41 subjects with acute or chronic RFI).After preliminary grey-scale and color Doppler investigation,each kidney was investigated individually with CEUS,using 1.2-2.4 mL of a sulfur hexafluoride-filled microbubble contrast agent.Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS.We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second group.RESULTSIn the first group,CEUS detected renal infarction or cortical ischemia in 18/50 patients(36%;95%CI:23.3-50.9)and 1/50 patients(2%;95%CI:0.1-12),respectively.The detection rate of infarction was significantly higher(P=0.0002;McNemar test)compared to color Doppler ultrasonography(10%).No vascular causes of ARF were identified in the remaining 31/50 patients(62%).In the second group,CEUS detected 41 lesions on 39 patients,allowing differentiation between solid lesions(21/41;51.2%)vs complex cysts(20/41;48.8%),and properly addressing 15/39 patients to intervention when feasible based on clinical conditions(surgery and cryoablation in 13 and 2 cases,respectively).Cysts were categorized Bosniak II,IIF,III and IV in 8,5,4 and 3 cases,respectively.In the remaining two patients,CEUS found 1 pseudolesion and 1 subcapsular hematoma.CONCLUSIONCEUS showed high detection rate of renal perfusion abnormalities in patients with ARF,influencing the management of patients with acute or chronic RFI and renal masses throughout their proper characterization.
文摘BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with significant long-term morbidity,and histological abnormalities such as crescentic glomerulonephritis are infrequently reported.PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.METHODS This prospective observational study was conducted at Lady Ridgeway Hospital(Colombo,Sri Lanka)over 15 months.Children with PSAGN were enrolled based on clinical and laboratory criteria.Persistent proteinuria≥2+for 2 weeks and serum creatinine>100μmol/L warranted renal biopsy,assessed via light microscopy and immunofluorescence.Normalization of complement 3(C3)within 6 to 8 weeks was required for inclusion.Data on clinical features,urine protein levels,and renal function were collected from patient records,and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing.Ethical approval was obtained from the Ethical Review Committee,Lady Ridgeway Hospital for Children(Ref No:LRH/ERC/2021/60).RESULTS Forty-four patients were recruited.There were 27(61.4%)male patients and 17(38.6%)female patients.Thirty-seven(84%)of them were above 5 years of age.Twenty(45%)patients had a history of skin sepsis,and eighteen(41%)had a history of throat infection.Among patients with proteinuria≥2+,53%had serum creatinine>100µmol/L,while among those with proteinuria<2+,7%had serum creatinine>100µmol/L.The association of high-degree proteinuria with elevated serum creatinine was significant(χ²=7.8,P=0.005)in PSAGN.The odds ratio of the logistic regression model was 1.049(95%confidence interval:1.003-1.098),indicating a positive direction with statistically significant association(P=0.037).There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance.Ten children underwent renal biopsy.Crescents(less than 50%)were demonstrated in five children,while three children had typical diffuse proliferative glomer-ulonephritis.One child had severe acute tubular necrosis,and another had crescentic glomerulonephritis(crescents>50%).The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine(>100μmol/L)in children with PSAGN.The majority of children with persistent proteinuria≥2+for more than 2 weeks and the highest recorded serum creatinine>100μmol/L had atypical renal histological findings.
文摘BACKGROUND Metastasis of renal cell carcinoma(RCC)to the skeletal muscle and small bowel is an exceedingly rare occurrence.Both of these sites are unusual sites for RCC to metastasize to and to occur simultaneously is even less common.CASE SUMMARY A 58-year-old male with known history of RCC presented with a recurrence that was diagnosed through imaging and biopsies.Mucosa abnormalities of small bowel noted during endoscopy were biopsied as well as lesion in the psoas muscle that was noted.CONCLUSION This case report emphasizes that RCC can not only recur but can do so even decades later and present as metastatic foci at atypical sites.
基金supported by the Hebei Natural Science Foundation(Grant No.H2022110019).
文摘Diabetic kidney disease(DKD)has emerged as one of the leading causes of chronic kidney disease and end-stage renal disease worldwide.In the progression of DKD,renal tubular injury plays a pivotal role,with stress-induced senescence of renal tubular epithelial cells(RTECs)being a critical cellular event contributing to tubular damage in DKD.Recent studies have revealed that multiple mechanisms,including oxidative stress,mitochondrial autophagy,endoplasmic reticulum stress,and epigenetic modifications,can induce stress-induced senescence in RTECs,thereby driving the progression of DKD.In recent years,research has demonstrated that traditional Chinese medicine(TCM)can regulate these mechanisms through multiple targets and key pathways,inhibiting stress-induced senescence in RTECs and ameliorating the progression of DKD.TCM has been widely applied in clinical practice with proven efficacy.This article systematically summarizes the concept of cellular senescence,delves into the relationship between stress-induced senescence of RTECs and DKD,analyzes the mechanisms underlying the formation of stress-induced senescence in RTECs within the context of DKD,and reviews the research progress of TCM in anti-senescence treatment for DKD.The aim is to provide a reference for future research and the development of novel therapeutic strategies.
文摘Renal cell carcinoma(RCC)is an aggressive tumor known for its propensity to invade the inferior vena cava(IVC)into the heart.Cardiac metastasis of RCC without IVC involvement is rare.Even rarer is ventricular arrhythmia as the primary manifestation of cardiac metastasis of RCC with only two cases reported.[1,2]We add to the literature the third case,the diagnosis of which was only possible with cardiac magnetic resonance(CMR).
基金Supported by the Clinical+X Scientific Research Project of Affiliated Hospital of Qingdao University,No.QYFY+X202101060Natural Science Foundation of Shandong Province,No.ZR2023MH240.
文摘BACKGROUND Acute kidney injury(AKI)is a frequent complication after liver transplantation(LT).How to realize the early diagnosis of AKI,perform active intervention,and reduce the mortality of post-LT patients is an urgent problem to be solved.AIM To investigate the accuracy of hepatorenal index(HRI)and renal resistive index(RRI)in monitoring of early AKI after LT.METHODS This observational study included adult deceased-donor LT recipients at our center between February 2022 and February 2023 with no preoperative renal dysfunction.The HRI and RRI were recorded once per day in the postoperative period through to postoperative day(POD)7.We followed up with the patients at 1 month after LT.The patients were divided into the AKI and non-AKI groups according to the Kidney Disease Improving Global Outcomes criteria.RESULTS Of 121 patients were included in the study(mean age:50.18±8.88years;female:17.36%).AKI developed in 53 patients(43.80%).The AKI and non-AKI groups were similar in terms of their baseline characteristics.An HRI of≤1.12 on POD 1 detected AKI with a sensitivity of 62.30%and a specificity of 87.80%[area under the receiver operating characteristic curve(AUC)=0.801,P<0.01].An RRI of≥0.65 on POD 1 detected AKI with a sensitivity of 87.80%and a specificity of 67.60%(AUC=0.825,P<0.01).The HRI combined with the RRI was more effective at detecting AKI than either the HRI or RRI alone(AUC=0.890,P<0.01).The HRI increased as AKI resolved while the RRI decreased as AKI resolved.CONCLUSION The HRI and RRI are non-invasive bedside indices that can identify the occurrence and recovery of early AKI after LT.
文摘The kidneys play a critical role in maintaining glucose homeostasis.Under normal renal tubular function,most of the glucose filtered from the glomeruli is re-absorbed in the proximal tubules,leaving only trace amounts in the urine.Glycosuria can occur as a symptom of generalized proximal tubular dysfunction or when the reabsorption threshold is exceeded or the glucose threshold is reduced,as seen in familial renal glycosuria(FRG).FRG is characterized by persistent glycosuria despite normal blood glucose levels and tubular function and is primarily associated with mutations in the sodium/glucose cotransporter 5A2 gene,which encodes the sodium-glucose cotransporter(SGLT)2.Inhibiting SGLTs has been proposed as a novel treatment strategy for diabetes,and since FRG is often considered an asymptomatic and benign condition,it has inspired preclinical and clinical studies using SGLT2 inhibitors in type 2 diabetes.However,patients with FRG may exhibit clinical features such as lower body weight or height,altered systemic blood pressure,diaper dermatitis,amino-aciduria,decreased serum uric acid levels,and hypercalciuria.Further research is needed to fully understand the pathophysiology,molecular genetics,and clinical manifestations of renal glucosuria.
