Search Results (120)

Background/Objectives: Growing evidence indicates that melatonin contributes to kidney development and function, while disruptions of fetal circadian signaling have been linked to congenital anomalies of the kidney and urinary tract (CAKUT). This study aimed to characterize the developmental and spatial expression patterns of melatonin receptors MTNR1A and MTNR1B in normal human fetal kidneys and in CAKUT phenotypes. Methods: This study analyzed 40 human fetal kidney specimens, including healthy controls and CAKUT cases (horseshoe kidneys, duplex kidneys, and dysplastic kidneys), obtained from spontaneous abortions and pregnancy terminations. Samples were classified into developmental phases Ph2–Ph4 according to established morphological criteria. Immunofluorescence staining was used to visualize MTNR1A and MTNR1B expression. Quantitative analysis was performed using ImageJ, measuring the fluorescence area percentage. Statistical comparisons were conducted using a two-way ANOVA. Results: In control kidneys, MTNR1A expression was predominantly observed in glomeruli and interstitial cells and showed a descending trend across developmental stages, whereas MTNR1B was localized to glomeruli and strongly to the apical membranes of tubules, particularly distal tubules, without substantial developmental variation. CAKUT phenotypes exhibited higher expression of both receptors compared to controls. Significant phase-dependent differences in MTNR1A expression were observed in horseshoe, duplex, and dysplastic kidneys. MTNR1B expression decreased across developmental stages in dysplastic kidneys and differed significantly between Ph3 and Ph4 in duplex kidneys. At Ph3, duplex kidneys showed the highest MTNR1B expression. Conclusions: Altered developmental expression patterns of MTNR1A and MTNR1B in CAKUT suggest an association between melatonin signaling and abnormal human kidney development. Full article

Background: The evaluation of renal function in neonates is challenging due to maternal creatinine transfer, reduced muscle mass, and non-steady-state physiology. Cystatin C emerged as a promising biomarker for assessing neonatal glomerular filtration rate. This review summarizes evidence from studies evaluating serum and urine cystatin C in healthy neonates and high-risk groups, including preterm newborns, neonates with acute kidney injury, and those with congenital kidney and urinary tract defects. Methods: Twenty studies were included and qualitatively synthesized following PRISMA guidelines. Results: In the included studies, serum cystatin C exhibited consistent postnatal patterns independent of maternal influence and showed a strong correlation with gestational age and renal development. Cystatin C enabled earlier detection of renal dysfunction compared to serum creatinine, especially in preterm infants and critically ill neonates. In babies with congenital renal abnormalities, cystatin C levels were associated with disease severity and clinical outcomes, while the cystatin C-based estimated glomerular filtration rate surpassed creatinine-based estimations. Urinary cystatin C correlated with tubular damage and increased risk of chronic kidney disease during follow-up. Conclusions: Cystatin C is a reliable biomarker for evaluating neonatal renal function, although further standardization and validation are required for clinical implementation. Full article

Background: Severe lower urinary tract dysfunction (LUTD) in neurologically and anatomically normal children is uncommon and frequently underdiagnosed. When severe, functional voiding disorders may closely mimic obstructive or reflux pathology, leading to diagnostic errors, unnecessary invasive procedures, and potential risk to the upper urinary tract. Case presentation: We present three pediatric cases (aged 3–10 years) referred for recurrent febrile urinary tract infections, incontinence, or acute urinary retention in the absence of neurological or structural abnormalities. Urodynamic evaluation identified three distinct severe functional phenotypes: detrusor overactivity with reduced bladder capacity, poor compliance with detrusor–sphincter dyssynergia and secondary high-grade vesicoureteral reflux (Hinman syndrome), and detrusor underactivity with significant post-void residual volumes. All patients demonstrated marked bladder wall remodeling on cystoscopy, including trabeculation and pseudopolypoid mucosal changes. Case discussion: Despite similar clinical severity, the cases illustrated substantial functional heterogeneity and differing risks of upper urinary tract involvement. Urodynamic phenotyping proved central to diagnosis, differentiation from structural disease, and treatment planning. Multimodal conservative management—including urotherapy, pelvic floor biofeedback, targeted pharmacologic therapy, and, when indicated, clean intermittent catheterization or antibiotic prophylaxis—led to resolution of recurrent infections and meaningful improvement in bladder function during medium-term follow-up, although symptom recurrence occurred in one patient after treatment withdrawal. Conclusions: These cases highlight the heterogeneity and potential reversibility of severe functional LUTD in otherwise healthy children. Early functional recognition based on urodynamic assessment is essential to avoid misdiagnosis, prevent unnecessary surgical intervention, and protect renal function. Conservative, function-oriented management remains the cornerstone of effective treatment. The findings are discussed in the context of the existing literature on severe non-neurogenic LUTD and Hinman syndrome. Full article

Background: Despite being a pillar of heart failure (HF) management, the guideline-directed initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2is) may be challenging due to the barrier of associated urinary tract infections (UTIs). Although there is a known risk, it remains unclear whether UTI incidence differs between patients with and without a prior history of UTIs. Methods: This study aimed to evaluate the risk–benefit profile of initiating an SGLT2i in patients with a history of UTIs. This retrospective, single-center healthcare system cohort analysis included adult patients hospitalized and taking an SGLT2i between 1 January 2020, and 31 August 2024. The included patients were divided into two cohorts: patients with and without a history of UTI pre-SGLT2i (described in this study as UTI-naive). Patients with urogenital structural abnormalities, indwelling catheters, or high-risk profiles were excluded. The primary outcome was the incidence of UTIs post-SGLT2i initiation. Secondary outcomes included the number of UTIs within 30, 60, and 90 days after starting an SGLT2i. Results: A total of 280 patients were evaluated for this study, of which 250 were included for analysis. Of those, 197 were UTI-naive, and 53 had a history of UTI pre-SGLT2i use. The most utilized SGLT2i was empagliflozin (75.6%). Amongst the cohorts, 20.4% of the UTI-naive patients developed a UTI post-SGLT2i versus 30.2% in patients with a historical UTI (p = 0.13). Conclusions: There was no significant difference in UTIs developed up to 90 days post-SGLT2i initiation, regardless of previous infections, suggesting that a history of UTI should not be a barrier to differing first-line therapy. Full article

Background: Although Duchenne muscular dystrophy (DMD) is primarily characterized as a skeletal muscle-wasting disorder, the resulting pathophysiological changes extend to multiple non-muscle tissues and organ systems. Among these, renal and urinary tract dysfunctions have been reported, albeit in relatively few studies, as potential complications in DMD patients, sometimes occurring from an early age. Importantly, as life expectancy improves, the incidence of renal impairment is also expected to increase. This narrative review summarizes the available evidence on kidney involvement in DMD and discusses the associated biomarkers of renal dysfunction within the context of multisystem disease progression. Methods: The review draws on data from both human and animal studies and analyzes published evidence to explore kidney involvement in DMD, with a focus on clinical manifestations, biomarkers of renal dysfunction, and potential pathogenic mechanisms. Results: Available data indicate a close association between cardiac and renal dysfunction, particularly in patients with advanced-stage DMD. The review explores potential underlying mechanisms of renal impairment, including intrinsic dystrophin deficiency in the kidney, secondary effects of cardiovascular complications, and the nephrotoxic impact of drug therapies, highlighting renal function as an active determinant of clinical risk. Conclusions: While cardiac function monitoring is already a cornerstone of multidisciplinary care for this multisystem disease, systematic assessment of renal function should also be implemented, with implications for clinical management and drug safety. Moreover, the risk of drug-induced nephrotoxicity warrants attention in both clinical management and the development of novel therapeutic strategies for DMD. Full article

Urine analysis is a straightforward, non-invasive testing method that, when integrated with metabolomics, shows great potential for detecting small-molecule metabolites as biomarkers of abnormal metabolic activity in the urinary tract, including drug interactions, toxicity, and diseases. However, integrated and comparative analyses of multiple urinary tract pathologies are currently limited. In this study, ¹²C2/¹³C2-chemical dansylation labeling was used to explore the urinary amine/phenol-metabolome profiles of eight urological conditions compared with normal profiles. We obtained ten samples for each condition (disease and normal) from a total of 90 participants, pooling them as representative samples, and constructed metabolite panels to differentiate various urological conditions. We discovered nine metabolites that were dysregulated between urine samples from patients with and without cancer. Another seven metabolites were differentially expressed between the benign prostatic hyperplasia group and the prostate cancer group. Among 1854 peak pairs of metabolites in an amine/phenol submetabolome analyzed by dansyl chloride derivatization coupled with LC–MS/MS, 1747 (94.2%) were detectable in urine specimens from all nine groups. Notably, 18 identified metabolites showed substantial stability across all urological conditions. Given the considerable variability in urine metabolite composition, these metabolites could potentially be used for normalization in urine metabolome analysis, addressing the need for stably expressed molecules as internal standards in the development of urinary biomarkers. Our findings provide the preliminary insights into the stability of urinary metabolomics and the metabolic perturbations associated with different urinary tract-related pathologies. Full article

Kidney disorders in dogs are frequently observed but remain underexplored in Chiang Mai, Thailand. This retrospective study aimed to estimate the prevalence and identify risk factors associated with azotemia in dogs presented to the Chiang Mai University Small Animal Veterinary Teaching Hospital between May 2017 and December 2021. Medical and laboratory records from 16,146 dogs were reviewed, and demographic, lifestyle, hematologic, and biochemical factors were analyzed using univariable and multivariable logistic regression to determine associations with azotemia. Overall, 3505 dogs (21.7%) were classified as azotemic, of which 43.5% had acute kidney injury, 5.9% had chronic kidney disease, and 50.6% were undetermined due to incomplete records. During winter, being mixed-breed, of older age, male sex, being fed with homemade and mixed diets, and drinking tap or mixed water sources were significantly associated with increased risk of azotemia (p < 0.05), whereas living outdoors or indoor-outdoor reduced the risk. Affected dogs typically showed elevated urea and creatinine concentrations, anemia, and abnormal white blood cell profiles, indicating systemic inflammation or dehydration. Concurrent diseases that were significantly associated with azotemia included pancreatitis, trauma, urinary tract injury, pyometra, and cardiovascular disorders. These findings indicate that canine azotemia in this region arises from multifactorial causes, emphasizing the need for early screening, balanced nutrition, access to clean water, and timely management of concurrent diseases are essential to improve kidney health and clinical outcomes in dogs. Full article

Background/Objectives: To compare postoperative infectious complication rates after ureteroscopy (URS) in patients with anatomical anomalies of the urinary tract and neurogenic bladder to those in patients without these conditions, and to analyze associated risk factors, urine culture profiles, and stone composition in these special populations. Methods: This retrospective cohort study included patients undergoing URS at a single tertiary referral center. Patients were stratified into three groups: anatomical anomalies of the urinary tract (n = 23), neurogenic bladder (n = 30), and controls (n = 297). Demographic data, perioperative details, preoperative urine culture results, stone composition, and postoperative complications were collected and compared. Univariable analyses and chi-square or Kruskal–Wallis tests were used as appropriate. Results: Patients with anatomical anomalies of the urinary tract and neurogenic bladder had significantly higher rates of postoperative infectious complications compared to controls (30.4% and 33.3% vs. 4.0%; p < 0.001). Preoperative urine cultures were more frequently positive in these groups, with Escherichia coli, Enterococcus faecalis, and Pseudomonas aeruginosa being the most common pathogens. Stone analysis revealed a higher proportion of struvite and mixed calcium phosphate stones in the anatomical anomalies of the urinary tract and neurogenic bladder groups compared to controls, who predominantly formed calcium oxalate stones (75%). Conclusions: Patients with anatomical anomalies of the urinary tract or neurogenic bladder are at higher risk of postoperative infectious complications following URS, likely due to more frequent colonization and anatomical or functional urinary tract abnormalities. These findings underscore the importance of tailored perioperative management, including targeted antimicrobial strategies and careful surgical planning, to mitigate risks in these high-risk populations. Full article

Background/Objectives: A variant of autism spectrum disorder (ASD) known as Asperger syndrome (AS) shows increasing incidence worldwide, affecting between 0.02% and 0.03% of children. Patients display abnormal conduct, are limited in social interaction and communication, and are more often affected by micturition disorders, incontinence, and voiding symptoms than typically developing children. Methods: The present study aimed to review the literature related to the current management of lower urinary tract conditions in children with Asperger syndrome and to present a case of a 14-year-old girl with ASD, with characteristic impairments, including communication challenges, stereotyped, repetitive behaviors, and chronic constipation with concomitant bladder dysfunction, presenting recurrent urinary tract infections (UTIs) and lower urinary tract symptoms (LUTS), including voiding and filling storage symptoms. For the AS, she was treated with a selective serotonin reuptake inhibitor (Sertraline). An abdominal ultrasound, PLUTTS—pediatric lower urinary symptoms scoring (21); QL-quality of life (3); voiding diary; and uroflowmetry were performed, revealing an incomplete urinary retention (incomplete bladder emptying of 120 mL), a prolonged and interrupted curve, a maximum urinary flow rate (Qmax) 7 mL/s, and a UTI with Enterococcus. Results: Besides psychiatric reevaluation and antibiotic therapy, functional magnetic stimulation (FMS) sessions were performed. After eight sessions (20 min, 35 MHz, every second day), the ultrasound control and the uroflowmetry showed no residual urine, and the Qmax was 17 mL/s. The curve continued to be interrupted: PLUTSS-11, QL-1. FMS was continued at two sessions per week. At the 3-month follow-up, no residual urine was detected, and Qmax reached 24 mL/s. Conclusions: ASD is an incapacitating/debilitating condition that significantly impairs social functioning. In many cases, in addition to psychological symptoms, other conditions such as LUTS and constipation may coexist. Antipsychotics and antidepressants are frequently prescribed for these patients, often leading to various side effects, including micturition disorders. Therefore, screening for LUTS is recommended, and, if indicated, treatment—especially non-pharmacological and non-invasive approaches, such as FMS—should be considered. Full article

Background/Objectives: To characterize functional brain activation during smiling and to assess cognitive profiles in patients with Ochoa (Urofacial) syndrome (UFS). Materials and Methods: In a block-design fMRI paradigm, participants alternated between imitating a smiling emoji and viewing a fixation cross. Images were preprocessed and analyzed in SPM12; Smile > Rest contrasts were tested with a voxelwise threshold of p < 0.001 (uncorrected). Cognitive levels were assessed using age-appropriate Wechsler scales administered by certified psychologists. Results: Six patients (mean age 20 years; 50% female) with genetically/clinically confirmed UFS were included. Smile > Rest elicited robust activation in the supplementary motor area (highest Z = 4.70), insula (largest cluster), dorsal anterior cingulate, primary motor cortex, and frontal eye fields, among others. Five patients completed cognitive testing; Full-Scale IQ ranged 50–74, consistent with mild intellectual disability to borderline intellectual functioning. Conclusions: During voluntary smiling, UFS patients exhibit activation patterns that overlap extensively with those reported in healthy cohorts. Nevertheless, cognitive performance was limited in this sample. Given the rarity of UFS and the small cohort, findings should be interpreted cautiously and validated in multicenter studies. Full article

Background/Objectives: Limited research exists on risk factors for urinary tract infections (UTIs) in kidney transplant recipients, particularly in high-risk groups such as ABO-incompatible or donor-specific antibody (DSA)-positive cases. Early UTIs, especially within the first month post-transplant, impact on acute rejection and long-term graft outcomes, highlighting the need for risk factor identification and management. Methods: Among 157 living donor kidney transplant cases performed at our institution between 2009 and 2024, 128 patients were included after excluding cases with >72 h of perioperative prophylactic antibiotics or urological complications. UTI was defined as the presence of pyuria and a positive urine culture, accompanied by clinical symptoms requiring antibiotic treatment, occurring within one month post-transplantation. Results: The median onset of UTI was postoperative day 8 (interquartile range, IQR: 6.8–9.3). No subsequent acute rejection episodes were observed. The median serum creatinine at 1 month postoperatively was 1.3 mg/dL (IQR: 1.1–1.7), and this was not significantly different from those who did not develop UTI. In univariate analysis, low or high BMI (<20 or >25), longer dialysis duration (>2.5 years), desensitization therapy (plasmapheresis + rituximab), elevated preoperative neutrophil-to-lymphocyte ratio (NLR) (≥3), and longer warm ischemic time (WIT) (≥7.8 min) were significantly associated with an increased infection risk of UTI (p = 0.010, 0.036, 0.028, 0.015, and 0.038, respectively). Multivariate analyses revealed that abnormal BMI, longer dialysis duration, desensitization therapy, and longer WIT were independent risk factors for UTI (p = 0.012, 0.031, 0.008, and 0.033, respectively). The incidence of UTI increased with the number of risk factors: 0% (0/16) for zero, 10% (5/48) for one, 31% (16/51) for two, 45% (5/11) for three, and 100% (2/2) for four risk factors. Conclusions: Desensitization therapy, BMI, dialysis duration, and WIT were identified as independent risk factors for perioperative UTI. In patients with risk factors, additional preventive strategies should be considered, with extended antibiotic prophylaxis being one potential option. Full article

Background: Colovesical fistulas are abnormal communications between the colon and urinary bladder, most commonly caused by diverticular disease. Although colovesical fistulas are rare, they should be suspected in patients presenting with recurrent urinary tract infections, pneumaturia, or fecaluria. We integrated two case reports with a retrospective national cohort analysis to assess the surgical treatment of colovesical fistulas. Methods: We report two cases of colovesical fistulas, both secondary to sigmoid diverticulitis, treated surgically via minimally invasive approaches. A retrospective analysis using the National Inpatient Sample database from 2016 to 2022 was conducted to compare outcomes of open surgery with those of minimally invasive surgery. Propensity score matching and multivariable regression analyses were used to evaluate clinical outcomes. Results: The first patient underwent hand-assisted laparoscopic sigmoidectomy with fistula takedown and has remained asymptomatic at 8 months, while the second patient underwent robotic-assisted sigmoidectomy with staged ileostomy reversal and has remained asymptomatic at 1 month. National data analysis showed no significant difference in mortality (<1% versus <1%, p = 0.931), wound complications (1.4% versus 1.0%; p = 0.554), or postoperative sepsis or shock (7.1% versus 5.6%; p = 0.114) between open and minimally invasive surgical approaches. However, the minimally invasive surgery group had significantly shorter length of stay than the open surgery group (6.9 versus 7.3 days, p < 0.001). Conclusions: Minimally invasive repair of colovesical fistulas was associated with shorter hospital stays than open surgery, with no significant differences in major complications. Early identification and timely surgical management are critical for achieving favorable outcomes. Full article

Background: Urinary tract infections (UTIs) represent a significant public health concern, particularly in children with structural abnormalities such as vesicoureteric reflux. Prolonged antibiotic exposure in these patients often contributes to the emergence of multidrug-resistant organisms and restricts therapeutic options. Probiotics have emerged as a potential adjuvant strategy to reduce infection recurrence. Case Presentation: A female infant born at term (38.6 weeks), with a prenatal diagnosis of bilateral hydronephrosis, experienced recurrent UTIs from the neonatal period despite both prophylactic and therapeutic antibiotic regimens. Serial urine cultures revealed infections caused by extended-spectrum beta-lactamase (ESBL)-producing E. coli and K. pneumoniae. Methods: The isolated strains were evaluated in vitro against Lactiplantibacillus sp. LH01, a probiotic strain derived from human milk. Following confirmation of its antimicrobial activity, an individualised intervention was initiated: daily oral administration of 1 mL of the probiotic (10⁹ CFU/mL) for one month, under medical supervision and without concurrent antibiotic therapy. Results: The probiotic demonstrated 89% inhibition efficiency against multidrug-resistant strains, accompanied by a notable reduction in UTIs frequency. Follow-up cultures showed reduced pathogen growth and a loss of the ESBL phenotype, facilitating clinical management and allowing previously contraindicated surgical interventions. Conclusions: Lactiplantibacillus sp. LH01 proved a safe and effective adjuvant in managing recurrent, resistant UTIs in a paediatric patient, highlighting the promise of probiotic therapies. Full article

Introduction: Urinary tract infections (UTIs) remain a significant public health issue worldwide, particularly affecting the geriatric population with increased morbidity and mortality. Aging-related immune changes, comorbidities, and urogenital abnormalities contribute to the higher incidence and complexity of UTIs in elderly patients. Antimicrobial resistance, especially extended-spectrum beta-lactamase (ESBL) production and carbapenem resistance, poses a major challenge in managing UTIs in this group. Methods: This retrospective, multicenter study included 776 patients aged 65 and older, hospitalized with a diagnosis of urinary tract infection between January 2019 and August 2024. Clinical, laboratory, and microbiological data were collected and analyzed. Urine samples were obtained under sterile conditions and pathogens identified using conventional and automated systems. Antibiotic susceptibility testing was performed according to CLSI standards. Logistic regression analyses were conducted to identify factors associated with ESBL production, carbapenem resistance, and mortality. Results: Among the patients, the median age was 78.9 years, with 45.5% female. ESBL production was detected in 56.8% of E. coli isolates and carbapenem resistance in 1.2%. Klebsiella species exhibited higher carbapenem resistance (37.8%). Independent predictors of ESBL production included the presence of urogenital cancer and antibiotic use within the past three months. Carbapenem resistance was associated with recent hospitalization, absence of kidney stones, and infection with non-E. coli pathogens. Mortality was independently associated with intensive care admission at presentation, altered mental status, Gram-positive infections, and comorbidities such as chronic obstructive pulmonary disease and urinary incontinence. Discussion: Our findings suggest that urinary pathogens and resistance patterns in elderly patients are similar to those in younger adults reported in the literature, highlighting the need for age-specific awareness in empiric therapy. The identification of risk factors for multidrug-resistant organisms emphasizes the importance of targeted antibiotic stewardship, especially in high-risk geriatric populations. Multicenter data contribute to regional understanding of resistance trends, aiding clinicians in optimizing management strategies for elderly patients with UTIs. Conclusions: This study highlights that E. coli and Klebsiella species are the primary causes of UTIs in the elderly, with resistance patterns similar to those seen in younger adults. The findings also contribute important data on risk factors for ESBL production and carbapenem resistance, supported by a robust patient sample. Full article

Background and clinical significance: Ectopic ureters are a rare urinary tract malformation, typically diagnosed in childhood and infrequently in adulthood. The prenatal detection by ultrasound and magnetic resonance imaging (MRI) of this clinical entity has scarcely been reported. Careful foetal scanning during the late second and third trimester might provide clues and lead to prenatal detection. However, even the postnatal diagnosis is challenging, and often delayed towards adulthood, since the condition may present with nonspecific symptoms, leading to underdiagnosis or misdiagnosis. In female patients, approximately 25% of ectopic ureters open into the vagina. Due to the high risk of recurrent urinary tract infections and the potential development of uretero-hydronephrosis, timely diagnosis is essential, and prompt surgical correction is mandated. Case presentation: We report the case of a 33-year-old GII PI patient diagnosed with cystic dysplasia of the left foetal kidney at the 16 WG (weeks of gestation) scan. The malformation was consistent at 21 WG when karyotyping by amniocentesis identified a normal female molecular karyotype. MRI performed at 28 weeks confirmed the left renal dysplasia and raised the suspicion of an abnormal insertion of the left ureter into the vagina. After delivery, the vaginal ureteral ectopy was confirmed at 3 weeks postpartum via cystoscopy. Postpartum whole exome sequencing identified a variant of uncertain significance (VUS) mutation in the SOX 13 gene (SRY-box transcription factor 13). Renal scintigraphy performed 7 months postnatally identified a hypo/afunctional left kidney which led to the indication of nephrectomy by the paediatric urologist. The surgical intervention was performed at 8 months postpartum with a favourable outcome. Conclusions: Ectopic ureters are a pathology generating life-long morbidity and discomfort of the offspring and young adult. Awareness to this pathology must be raised among clinicians, especially regarding the potential detection by minute prenatal ultrasound examinations, followed by MRI to refine diagnosis. Postnatally, the persistence of suspicious yet unspecific symptoms, in both males and females, must trigger thorough imaging/cystoscopic examination to reach diagnosis and provide correct management. Full article