Search Results (3,164)

Air pollution is associated with many adverse health outcomes, including kidney diseases. Kidney diseases, especially chronic kidney disease, are a significant public health issue globally. The burden of kidney disease is expected to rise due to population aging and the growing prevalence of diabetes and hypertension. End-stage kidney disease is associated with significant healthcare costs, morbidity, and mortality. Long-term exposure to air pollution was associated with increased risk for chronic kidney disease progression to kidney replacement therapy. Evidence on the effect of short-term exposure to air pollution on renal function is rather limited. Kidney transplant patients are likely to be even more susceptible to detrimental effects of air pollutants. Exposure to air pollution results in a higher risk for delayed graft function, acute rejection, and mortality. In this review we would like to summarize the state of knowledge on the influence of air pollution on outcomes in end-stage kidney failure and kidney transplantation. Full article

Introduction: Renal cell carcinoma (RCC) develops metastatic disease in 30–50% of patients during their disease course, with approximately one quarter presenting with metastases at diagnosis. While the lungs, liver, bones, brain, and adrenal glands are the most frequent metastatic sites, duodenal involvement is exceptionally rare. This uncommon presentation poses diagnostic and therapeutic challenges, particularly regarding the role of surgical resection in the metastatic setting. Objective: We aim to evaluate the clinical presentation, management strategies, and outcomes of patients with duodenal metastasis from RCC, with particular emphasis on the potential role of surgery, through a systematic review of the literature. Methods: A comprehensive electronic search of Medline, Embase, and Scopus was conducted according to PRISMA guidelines. The following MeSH terms were applied: Kidney Neoplasms [MeSH] AND Duodenal Neoplasms/metastasis [MeSH]. Eligible studies included original reports or case series describing RCC with duodenal metastasis. Demographic, clinical, surgical, and survival data were extracted and synthesized. Results: Of 89 records identified, 83 underwent full-text review and 51 met inclusion criteria, representing 55 patients. The median age at diagnosis was 64 years, and 80% of primary tumors arose from the right kidney. Nearly all patients (98%) were symptomatic, most commonly with upper gastrointestinal bleeding, anemia, or obstructive features. Pancreaticoduodenectomy was the predominant surgical approach, performed with curative intent in selected cases. Patients undergoing surgery achieved a 5-year overall survival of 70%, compared with 0% among non-operated patients. Conclusions: Duodenal metastasis from RCC remains an uncommon entity, limiting the strength of available evidence. Nevertheless, our findings suggest that surgical management—when feasible and decided within a multidisciplinary framework—can provide meaningful survival benefit and should be considered as a complement to contemporary systemic therapies for metastatic RCC Full article

Background/Objectives: Cancer survivors can develop heart conditions such as aortic valve disease because of age and other shared risk factors. If this valve condition becomes symptomatic, the prognosis is poor if the valve is not replaced. Surgical aortic valve replacement (SAVR) is one mode of treatment. Methods: Of 2500 consecutive patients who underwent SAVR with a biological valve, 388 patients were cancer survivors. They were compared for preoperative characteristics, operative parameters, postoperative adverse events, need for resources, and long-term survival. For the latter, the six most common tumors (prostate, breast, colorectal, bladder, pulmonary, and hematologic) and the effect of the interval between cancer treatment and cardiac surgery were scrutinized. Results: Cancer increased significantly over time. Pulmonary and kidney disease differed between the groups, but cardiac comorbid conditions did not. Operative parameters, early adverse events, and need for resources did not differ. Median survival time was significantly reduced in cancer survivors: 104 (97–112) versus 119 (116–122) months, and this was driven by an interval of less than 5 years and prior lung cancer. Prior cancer was the least important of ten predictors for long-term mortality. Conclusions: The outcome of cancer survivors after SAVR is acceptable. For patients with pulmonary cancer, the outcome is poor. Full article

Background: Robot-assisted partial nephrectomy (RAPN) is a standard approach for localized renal cell carcinoma (RCC), emphasizing renal functional preservation. The Minimum Layer Resection (MLR) method, guided by 3D virtual partial nephrectomy (3DvPN) planning, was developed to balance oncological safety with parenchymal preservation. This study evaluated functional and oncological outcomes of RAPN with MLR and identified predictors of renal functional decline. Methods: We retrospectively analyzed 237 patients (after screening 312 cases) who underwent RAPN between 2012 and 2022 with ≥36-month follow-up. 3DvPN planning was used to guide MLR when feasible; both MLR and non-MLR were available and applied throughout the study period according to predefined indications. The primary endpoint was the percentage of estimated glomerular filtration rate (eGFR) preservation at 36 months; a ≥10% decline was clinically significant. Secondary endpoints included perioperative outcomes, acute kidney injury (AKI), and oncological outcomes such as margin involvement and recurrence. Results: The median age was 60 years, tumor size 29 mm, and warm ischemia time 21 min, with selective or superselective clamping achieved in 62.8% of cases. Postoperative AKI occurred in 25.0% (no patient required dialysis). At 3 years, the median eGFR preservation rate was 84.4%, and 28.5% of patients experienced a ≥10% decline. Independent predictors of short-term decline (14 days) were BMI > 25 kg/m², AKI, and WIT > 25 min, whereas long-term decline (36 months) was associated with tumor size > 30 mm and WIT > 25 min. Margin involvement was 1.7%, recurrence 3.8%, and major complications (Clavien–Dindo ≥IV) occurred in 1.7%. Conclusions: In conclusion, RAPN with the MLR technique under 3DvPN guidance demonstrated favorable perioperative outcomes, acceptable oncologic safety, and good mid-term renal functional preservation (up to 36 months). The approach provides a reproducible surgical strategy that maximizes parenchymal preservation while maintaining negative surgical margins. Prospective multicenter studies with longer follow-up are warranted to confirm long-term durability and to define the role of MLR in routine practice. Full article

Obstructive nephropathy is a common clinical condition caused by urinary retention. After urine flow is restored, kidney function is recovered. However, the effectiveness of this process can be influenced by many factors, including the age of the patient. In this study, we analyzed the following parameters in young and old rats subjected to a 3-day reversible unilateral ureteral obstruction (R-UUO): AKI severity, renal tissue proliferation and histology, inflammatory and fibrosis marker expression, as well as autophagosomal-lysosomal and mitochondrial function. Compared to old rats, young animals exhibited more pronounced renal tissue proliferation and higher expression of profibrotic markers (Col1a1, Fn1, Tgfb1, MMP2), but diminished expression of pro-inflammatory markers (Il1b, Tnfa, Cd32) in response to R-UUO. Additionally, young rats showed more pronounced activity of autophagy, as indicated by increased beclin-1 levels. R-UUO induced severe damage to the mitochondrial respiratory chain in old animals, as indicated by reduced complex I, IV, cytochrome c, VDAC protein levels, and impaired mitochondrial biogenesis (associated with decreased Pgc1a mRNA expression). Thus, we demonstrated that despite restored urine outflow, kidneys exhibited autophagy activation, inflammatory response, and mitochondrial dysfunction after R-UUO. Negative alterations in the kidney were age-dependent indicating necessity for therapeutic strategies optimization for patients of different ages. Full article

Background/Objectives: Weight gain after kidney transplantation is frequent but heterogeneous, often accompanied by changes in body composition that influence long-term outcomes. This study analysed one-year changes in body compartments and their demographic and clinical determinants. Methods: A prospective cohort of 112 adult kidney recipients transplanted between September 2020 and June 2022 at a Spanish tertiary hospital was followed. Body weight, muscle mass, fat mass, visceral fat and total body water were assessed by multi-frequency bioelectrical impedance at discharge, and at 3, 6 and 12 months. Associations with sociodemographic, clinical and comorbidity variables were examined using repeated-measures ANOVA and comparative tests. Results: At 12 months, mean weight gain was 3.6 ± 6.5 kg (5.1%). Increases were greater in men, younger patients, non-dialysis candidates, those with previous transplantation and living donor grafts. Muscle mass rose during the first three months and then stabilised, with greater gains in men and haemodialysis patients. Fat mass decreased initially and then increased, particularly in women, younger recipients and living donor transplants. Visceral fat progressively increased after three months, with higher levels in men and older patients. Total body water declined in women, younger recipients and first transplant patients. Patients with new-onset diabetes gained less weight, while smokers gained more. Conclusions: Post-transplant body composition is shaped by sex, age, BMI, comorbidities and donor type. Monitoring compartments beyond body weight may allow early detection of adverse metabolic trajectories. Tailored nutritional and lifestyle interventions are needed to optimise long-term outcomes. Full article

Background: The combined impact of impaired kidney function and subclinical myocardial injury (SCMI) on cardiovascular (CV) mortality has not been well studied. We aimed to evaluate their individual and joint associations with cardiovascular mortality. Methods: We analyzed data from 6057 participants (mean age 57.0 ± 13.0 years) in the U.S. Third National Health and Nutrition Examination Survey. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Electrocardiographic SCMI was defined as a cardiac infarction/injury score ≥ 10. CV mortality was determined from the National Death Index. Multivariable logistic regression assessed baseline cross-sectional associations between eGFR and SCMI. Cox proportional hazards models were used to examine the individual and combined associations of eGFR and SCMI with CV mortality. Results: At baseline, 1297 participants (21.4%) had SCMI. In multivariable logistic regression analysis, eGFR < 45 mL/min/1.73 m² (vs. ≥45) was not associated with SCMI (OR [95% CI]: 1.10 [0.84–1.45]). Over a median follow-up of 18.4 years, 690 CV deaths occurred. In separate Cox models, both SCMI (vs. no SCMI) and eGFR < 45 (vs. ≥45) were associated with increased CV mortality risk (HR [95% CI]: 1.36 [1.16–1.60] and 1.56 [1.24–1.99], respectively). Compared with participants with eGFR ≥ 45 and no SCMI, those with both eGFR < 45 and SCMI had the highest CV mortality risk (HR [95% CI]: 2.36 [1.65–3.36]), followed by eGFR < 45 alone (1.47 [1.09–1.96]) and SCMI alone (1.33 [1.11–1.58]). Conclusions: Both reduced eGFR and SCMI were independently associated with CV mortality. Their coexistence showed the highest risk, but without statistical significance compared with each alone, possibly reflecting limited power and distinct mechanisms. Full article

Secondary hyperparathyroidism (SHPT) in chronic kidney disease often necessitates parathyroidectomy (PTX), but this definitive treatment can precipitate hungry bone syndrome (HBS)—a profound, prolonged hypocalcemia caused by the rapid skeletal uptake of minerals after surgery. HBS results from the abrupt cessation of parathyroid hormone (PTH)-driven bone resorption while bone formation continues, leading to intensive mineral deposition (mainly calcium) into chronically demineralized bone. Clinically, HBS ranges from asymptomatic biochemical disturbances to life-threatening hypocalcemia with tetany, seizures, and/or cardiac arrhythmias. This illustrative review synthesizes current knowledge of HBS pathogenesis and management in the context of SHPT. We detail how the high-turnover bone remodeling state of SHPT (osteitis fibrosa cystica) creates an expansive unmineralized osteoid pool that avidly mineralizes post-PTX. We also explore molecular mechanisms (e.g., RANKL/OPG dysregulation, Wnt/β-catenin activation, osteocyte-driven signals, and calcium-sensing receptor effects) that underpin this process. Key preoperative risk factors for HBS include very elevated PTH and alkaline phosphatase levels, large skeletal calcium deficits, younger patient age, and total PTX. We outline the typical postoperative course of HBS, phased from immediate acute hypocalcemia to a nadir and gradual recovery. Prevention and management strategies are emphasized, centered on vigilant monitoring and aggressive calcium and calcitriol supplementation, with preoperative optimization (e.g., vitamin D loading, calcimimetics) to mitigate severity. By enhancing risk stratification and perioperative care, clinicians can improve outcomes and safely navigate patients through this challenging complication of endocrine surgery. Full article

Senescence is a dynamic, multifaceted process implicated in tissue aging, organ dysfunction, and intricately associated with numerous chronic diseases. As senescent cells accumulate, they drive inflammation, fibrosis, and metabolic disruption through the senescence-associated secretory phenotype (SASP). Despite its clinical relevance, senescence remains challenging to detect non-invasively due to its heterogeneous nature and the lack of universal biomarkers. Recent advances in the development of specific imaging probes for positron emission tomography (PET) enable in vivo visualization of senescence-associated pathways across key organs, such as the lung, heart, kidney, and metabolic processes. For instance, [¹⁸F]FPyGal, a β-galactosidase-targeted tracer, has demonstrated selective accumulation in senescent cells in both preclinical and early clinical studies, while FAP-targeted radioligands are emerging as tools for imaging fibrotic remodeling in the lung, liver, kidney, and myocardium. This review examines a new generation of PET radioligands targeting hallmark features of senescence, with the potential to track and measure the process, the ability to be translated into clinical interventions for early diagnosis, and longitudinal monitoring of senescence-driven pathologies. By integrating organ-specific imaging biomarkers with molecular insights, PET probes are poised to transform our ability to manage and treat age-related diseases through personalized approaches. Full article

Non-diabetic chronic kidney disease (ND-CKD) refers to the progressive and irreversible decline in kidney function occurring in the absence of diabetes mellitus—a distinction that sets it apart from the more prevalent diabetic CKD. While diabetic nephropathy remains the leading cause of CKD globally, ND-CKD encompasses a heterogeneous group of etiologies, including hypertensive nephrosclerosis, glomerulonephritis, and interstitial nephritis. Its incidence and prevalence are steadily increasing, particularly in aging populations, and are often underrecognized. Importantly, ND-CKD is not a benign entity; it independently contributes to systemic inflammation, oxidative stress, and metabolic dysregulation, which in turn amplify cardiovascular risk. Among the most severe complications is heart failure (HF), a complex syndrome arising from structural and functional impairments in cardiac performance. Despite ongoing advancements in HF management, mortality remains unacceptably high, ranging from 2–3% at 30 days to up to 50–75% over five years. Standard pharmacologic therapies frequently fall short in halting disease progression and may provoke undesirable side effects. This therapeutic gap has spurred growing interest in natural compounds with multi-targeted effects. Bioactive molecules such as arjunolic acid, kaempferol, luteolin, and resveratrol have shown anti-inflammatory and antioxidant properties that may offer dual benefits for both renal and cardiac function. By modulating shared molecular pathways—including those involved in inflammation, oxidative damage, and cellular dysfunction—these agents hold promise as adjunctive treatments in ND-CKD complicated by heart failure. Full article

Introduction: Primary glomerulopathies are immune-driven kidney diseases. IgA nephropathy (IgAN) and membranoproliferative glomerulonephritis (MPGN) are prevalent entities with a risk of chronic progression. Immune checkpoints, such as PD-1/PD-L1, CTLA-4/CD86, and CD200R/CD200, regulate activation and tolerance in T, B, and NK cells, and also exist in soluble forms, reflecting systemic immune balance. Objective: To compare immune checkpoint profiles in IgAN and MPGN versus healthy volunteers (HV) through surface expression, soluble serum levels, and PBMC transcripts, with attention to sex-related differences and diagnostic value assessed by ROC curves. Materials and Methods: Ninety age-matched subjects were studied: IgAN (n = 30), MPGN (n = 30), HV (n = 30). Flow cytometry evaluated checkpoint expression on CD4+/CD8+ T cells, CD19+ B cells, and NK cells. ELISA quantified sPD-1, sPD-L1, sCTLA-4, sCD86, sCD200, sCD200R; PBMC transcript levels were assessed. Group comparisons, sex stratification, and ROC analyses were performed. Results: Lymphocyte distributions were preserved, but IgAN patients showed anemia and impaired renal function, while MPGN patients had greater proteinuria and dyslipidemia. GN patients displayed increased PD-1/PD-L1 and CD200R/CD200, with reduced CTLA-4/CD86, compared to HV. Serum analysis revealed elevated sPD-1, sPD-L1, sCD200, sCD200R and decreased sCTLA-4, sCD86. PBMC transcripts paralleled these trends, with PD-1/PD-L1 mainly increased in MPGN. Sex had minimal impact. ROC analyses showed strong GN vs. HV discrimination by CD19⁺CTLA-4⁺, PD-1/PD-L1, and CD200/CD200R, but limited ability to separate IgAN from MPGN. Conclusions: IgAN and MPGN share a sex-independent checkpoint signature: PD-1/PD-L1 and CD200R/CD200 upregulation with CTLA-4/CD86 downregulation. CD19⁺, CTLA-4⁺, and soluble PD-1/PD-L1/CD200(R) emerge as promising biomarkers requiring further validation. Full article

Background: End-stage renal disease (ESRD) affects up to 25% of lung transplant recipients within 10 years. The selection process for kidney transplantation versus dialysis reflects complex clinical decision-making that has not been systematically characterized. Methods: This retrospective observational study analyzed all lung transplant recipients who developed ESRD at our center from 2010 to 2024 (n=32), comparing those receiving kidney transplantation (n = 18) versus those remaining on dialysis (n = 14). We developed an exploratory Clinical Selection Score to retrospectively characterize observed selection patterns and calculated E-values to assess robustness to unmeasured confounding. Results: Kidney transplant recipients were younger (35.7 ± 12.9 vs. 48.4 ± 14.8 years, p = 0.013) with better selection characteristics quantified by our Clinical Selection Score (4.1 ± 0.8 vs. 1.6 ± 1.1 points, p < 0.001). The score showed excellent discrimination (C-statistic 0.82). Living donors were available for 88.9% of transplanted patients versus 0% of dialysis patients. In our selected cohorts, mortality was 22.2% in kidney transplant recipients vs. 78.6% in dialysis patients (p = 0.002), with median survival of 161.6 vs. 126.6 months (p = 0.021). After adjustment for age, kidney transplantation was observed to be associated with 72% lower mortality risk (HR 0.28, 95% CI 0.09–0.89, p = 0.031), though selection bias limits causal interpretation. The E-value of 6.61 suggests robustness to unmeasured confounding. Conclusions: This observational study describes real-world selection patterns and their associated outcomes in lung transplant recipients with ESRD. While carefully selected patients receiving kidney transplantation experienced favorable results, many patients were appropriately managed with dialysis based on medical and non-medical factors. Our analysis provides transparency about selection criteria and outcomes to inform clinical decision-making. Larger multicenter studies are needed to validate these findings and develop prediction tools. Full article

Background/Objectives: Complex endovascular solutions have expanded treatment options for complex abdominal aortic aneurysms (cAAA), particularly in elderly high-risk patients. However, these techniques are limited by anatomical constraints and costs, while the superiority over open repair (OSR) remains debatable. This study aimed to compare short- and mid-term outcomes of OSR for cAAA in patients aged ≥80 versus <80 years. Methods: Retrospective analysis was performed for patients who underwent OSR for cAAA between 2017 and 2022 at two tertiary vascular centers. A total of 226 patients (median age 71 years [IQR 66–80]; 89% male) were included, of whom 74 were aged ≥80 years. Primary endpoints were 30-day mortality, major adverse cardiovascular events (MACE), and early reintervention. Secondary endpoints included length of stay (LOS), acute kidney injury, new renal dysfunction, mid-term survival (≤5 years), and procedure-related reintervention. Propensity score matching (PSM) was performed to adjust for baseline differences. Results: Out of 1087 screened patients, 226 met the inclusion criteria: 74 octogenarians and 152 younger patients. Thirty-day mortality was significantly higher in octogenarians (9.5% vs. 0.7%; p < 0.001), as was the incidence of MACE (8.2% vs. 1.9%; p = 0.026). Rates of kidney impairment LOS and other major complications were comparable. During a median follow-up of 42.7 months, mid-term survival and freedom from reintervention did not differ significantly between groups. PSM analysis confirmed higher early mortality and cardiovascular events in octogenarians but similar mid-term outcomes. Conclusions: Although octogenarians undergoing OSR for cAAA face increased early mortality and cardiovascular complications, their mid-term survival and freedom from reintervention are comparable to younger patients. These results suggest that age alone should not represent a contraindication to open repair in appropriately selected individuals. Full article

Background: Noninfectious complications of peritoneal dialysis (PD) are common in infants. Mechanical dysfunctions with abdominal compartment syndrome, hydrothorax with respiratory failure, and medication-induced chyloperitoneum are rare during PD. In this case report, we aim to present several life-threatening events and the timely management of a PD infant. Case Presentation: This male infant is a case of infantile nephronophthisis, NPHP3/renal-hepatic–pancreatic dysplasia type 1, with end-stage kidney disease, and he received PD therapy at 4 months of age. Because of the young age with low body weight and hepatosplenomegaly with a limited abdominal cavity, intra-abdominal pressure-associated noninfectious complications frequently occurred. Acute respiratory failure with abdominal dullness was detected at 5 months of age. Abdominal compartment syndrome caused by PD catheter outflow obstruction from omental wrapping was diagnosed via laparoscopic revision surgery. Hyperkalemia, decreased PD drainage volume, and sudden respiratory distress occurred at 10 months old. Hydrothorax due to pleuroperitoneal communication was confirmed by scintigraphy. After thoracoscopic diaphragmatic bleb repair and plication surgery were performed, no recurrence of hydrothorax was observed. Calcium channel blocker-induced chyloperitoneum was observed at 13 months of age. Chylous ascites disappeared after tapering off the calcium channel blocker in 3 days. After the patient grew up with a larger peritoneal cavity, no more pressure-associated complications of PD occurred. Conclusions: The key to successful treatment of rare and life-threatening noninfectious complications of PD in young infants lies in early detection and timely intervention. A limited abdominal cavity is not a contraindication for PD therapy, especially in very young infants with low body weight, because hemodialysis is not a choice of long-term dialysis modality. Full article

Lassa fever (LF) is an acute viral hemorrhagic fever that poses a substantial public health security threat in West Africa. The non-specific clinical presentation of LF, coupled with a lack of reliable point-of-care diagnostics, means delayed diagnosis, leading to severe complications and mortality during epidemics. A systematic review and meta-analyses were performed by conducting an extensive online search using PubMed, Web of Science, Scopus, CINAHL, and Google Scholar (PROSPERO protocol identifier number CRD42024587426). Only peer-reviewed studies written in English were included in publications from 1 September 2014, to 31 August 2024. The analysis and reporting followed PRISMA guidelines. The quality of the included studies was assessed using the critical appraisal tools developed from the Joanna Briggs Institute Systematic Review Checklist for cohort studies. We included 19 studies that contained data from 4177 patients hospitalized with LF of any age. Most included studies employed a retrospective cohort design and were conducted in Nigeria (16/19; 84.2%). The mortality rate was highest in a Sierra Leonean study (63.0%), whereas a group-based analysis of Nigerian studies using a random-effects model identified Owo as having the highest mortality rate of 13% (95% CI: 6–23; I² = 98%). The pooled mortality rate for severe LF was 19% (95% confidence interval [CI]:10–32). The most common complications of LF are acute kidney injury (AKI) at a pooled proportion of 19% (95% CI; 13–26; I² = 89%)), followed by abnormal bleeding at a pooled proportion of 17% (95% CI; 9–30; I² = 98%), and central nervous system (CNS) dysfunction at a pooled proportion of 15% (95% CI; 6–32; I2 = 98%). With one out of every five hospitalized LF patients likely to die in West Africa, accelerating the development of rapid diagnostic tests, licensed vaccines, and novel therapeutics is crucial. Strengthening community engagement and risk communication, developing regional treatment guidelines, decentralizing LF care units, and training healthcare workers using a harmonized curriculum will enhance early diagnosis and effective case management, thereby reducing severe complications and mortality. Full article