Search Results (20,968)

Background: Kidney transplantation (KT) improves survival and quality of life in patients with end-stage kidney disease; however, long-term allograft survival remains a major challenge. Brain natriuretic peptide (BNP), a biomarker of cardiorenal stress and volume status, may be associated with early postoperative physiological changes after KT. This study evaluated the association between early postoperative BNP changes and long-term allograft survival, and explored the potential role of BNP-derived parameters in relation to graft outcomes. Methods: This retrospective cohort study included adult recipients of deceased-donor KT between 2009 and 2018. Patients were categorized according to early graft function. Serum BNP levels were measured preoperatively and within postoperative 24 h, and the percentage increase (dBNP ratio) was calculated. Cox regression and receiver operating characteristic analyses were used to identify risk factors for graft failure and evaluate the discriminatory performance of BNP-derived biomarkers, respectively. Results: Among the 179 recipients, postoperative BNP levels and dBNP ratios differed significantly across graft function groups, with higher values in delayed graft function. After multivariate adjustment, the dBNP ratio remained significantly associated with graft failure (hazard ratio, 1.16; 95% confidence interval, 1.10–1.21; p < 0.001). Additionally, the dBNP ratio demonstrated better discriminatory performance for graft failure compared with postoperative BNP alone (area under the curve, 0.815 vs. 0.596; p < 0.001), with an exploratory cutoff of approximately 18%. Recipients with a dBNP ratio ≥ 18% had poorer early graft function, lower longitudinal estimated glomerular filtration rates, and significantly reduced graft survival. Conclusions: An increased early postoperative dBNP ratio was significantly associated with adverse long-term kidney allograft outcomes. However, given the potential for residual confounding, these findings should be interpreted as associative and hypothesis-generating rather than predictive. Full article

Prostate-specific membrane antigen (PSMA) is an essential zinc-dependent metalloprotease classified within the type II transmembrane protein family, often referred to as glutamate carboxypeptidase II (GCPII). PSMA is recognized as a particularly promising target for both the diagnosis and therapeutic intervention of prostate cancer. In this study, we designed and synthesized PSMA-targeted DOTA-loaded bimodal conjugate 11 with SulfoCy5 fluorescent dye, performed in vitro characterization, and analyzed biodistribution in vivo. At 40–100 nM concentrations, the resulting conjugate demonstrated reliable visualization of tumor cells, on par with the reference PSMA-SylfoCy5 compound. In vivo biodistribution analysis of [⁶⁸Ga]Ga-11 in mice demonstrated a reduction in renal accumulation in comparison with dye-free conjugate [⁶⁸Ga]Ga-10. The specificity of [⁶⁸Ga]Ga-11 for PSMA was confirmed in a murine LNCaP xenograft model: its effective accumulation in tumors and kidneys, as well as relatively rapid elimination from non-target tissues, make it a promising agent for PET imaging but not radionuclide therapy. Full article

Background/Objectives: Chronic kidney disease (CKD) remains a major public health challenge due to its silent progression and late clinical detection. Recent advances in machine learning have demonstrated promising performance in CKD detection; however, most existing approaches focus primarily on binary classification or rely on longitudinal or specialized biomarkers that are not routinely available in clinical practice. While several studies attempt risk stratification, few integrate risk modeling with stage-aware hierarchical decision frameworks suitable for routine clinical workflows. This study proposes a risk-oriented, explainable, and hierarchical machine learning framework for CKD classification using real-world laboratory data from 746 patients in a Saudi population. Methods: The proposed framework is designed as a hierarchical machine learning pipeline that mirrors clinical practice by sequentially identifying CKD presence, performing disease staging only for confirmed cases, and estimating risk for individuals without overt CKD. Specifically, an XGBoost model with recursive feature elimination (RFE) was employed for binary CKD detection, followed by a multilayer perceptron (MLP) model with SelectKBest for stage classification. A unified preprocessing pipeline, clinically informed feature selection, and validated machine learning models were employed to develop the hierarchical prediction system. Results: The system achieved 97% accuracy and F1-score in binary CKD classification, and up to 85% accuracy and 86% F1-score in stage classification. In addition, an interpretable risk scoring mechanism and SHAP-based explanations enabled early identification of CKD-like laboratory patterns using routine laboratory tests. Conclusions: The proposed system provides a transparent and deployable framework that supports preventive nephrology and clinically meaningful decision-making. Full article

Ciliopathies, initially known as fibrocystic liver diseases, encompass a group of inherited disorders characterized by cystic dilatation of intrahepatic bile ducts and portal fibrosis, frequently associated with renal anomalies. These disorders are now recognized as resulting from defects in primary cilia. The hepatic manifestations, such as congenital hepatic fibrosis (CHF), Caroli syndrome, and polycystic liver disease, arise from ductal plate malformation. Recent studies have implicated variants in the TULP3 (Tubby related protein variant 3) gene in a novel monogenic ciliopathy affecting the liver, kidneys, and heart. We report an 8-year-old boy who presented with variceal bleeding and evolved to a progressive phenotype of CHF. Whole exome sequencing revealed a homozygous novel TULP3 mutation. The patient was managed by endotherapy and propranolol prophylaxis. Due to repeated episodes of variceal bleeding and progressive worsening of hepatic synthetic functions, he underwent a living donor liver transplantation at the age of 12 years. Full article

Bloodstream infection (BSI) is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD), particularly those receiving hemodialysis. Delayed identification of pathogens and their resistance profiles can lead to inappropriate therapy and adverse outcomes. This review evaluates rapid molecular diagnostic approaches for detecting pathogens and resistance markers in BSI, with emphasis on their application in CKD. These technologies provide faster microbiological information by enabling direct or accelerated detection of pathogens and selected resistance determinants. Clinical studies indicate that their use supports prompt adjustment of antimicrobial therapy, especially when combined with antimicrobial stewardship and applied after blood culture positivity. In CKD, identification of the causative organism facilitates treatment selection aligned with renal function and helps reduce unnecessary exposure to nephrotoxic agents. However, diagnostic accuracy differs among platforms, and detection of resistance genes does not consistently reflect phenotypic susceptibility. Furthermore, most evidence is derived from mixed hospital populations rather than CKD-specific cohorts. These factors require careful interpretation within the clinical context. Rapid molecular diagnostics can enhance antimicrobial decision-making in BSI, but their effectiveness depends on integration with conventional microbiology and structured care pathways. Further research in CKD populations is required to clarify their impact on clinical outcomes and to support implementation in nephrology practice. Full article

Gender medicine represents a key paradigm for advancing equitable and effective healthcare by systematically integrating sex- and gender-related differences into medical research and clinical practice. Despite regulatory efforts and international guidelines, significant gaps persist in the consideration of sex and gender across medical disciplines, including nephrology. Biological factors—including genetic, hormonal, and metabolic differences—interact with social, cultural, and environmental determinants to influence chronic kidney disease (CKD) susceptibility, clinical presentation, progression, and response to therapy. Insufficient consideration of sex and gender contributes to persistent disparities in CKD progression, cardiovascular outcomes, access to kidney transplantation, adverse drug reactions, dialysis outcomes, and pregnancy-related kidney complications. This narrative review outlines the historical development of gender medicine and critically appraises its relevance and unresolved challenges in kidney disease, with a focus on sex-specific differences in selected conditions, including autosomal dominant polycystic kidney disease, glomerular diseases, acute kidney injury, and pregnancy-associated kidney disorders. Integrating sex- and gender-informed approaches into nephrology is not merely an ethical requirement but a scientific necessity to improve risk stratification, personalize therapeutic strategies, and promote truly equitable and effective kidney care. Full article

Patients with chronic kidney disease (CKD) have a markedly increased cardiovascular risk that is not fully explained by traditional risk factors. Gut-derived uremic toxins, indoxyl sulfate (IS), indole-3-acetic acid (IAA), and p-cresyl sulfate (pCS), are poorly cleared by dialysis and may contribute to vascular damage. This cross-sectional observational study included 70 patients with CKD under different clinical conditions (pre-dialysis, peritoneal dialysis, hemodialysis, and kidney transplantation) and 17 healthy controls. Serum levels of IS, IAA, pCS and Klotho were measured, and vascular damage was assessed by carotid intima–media thickness (IMT) using ultrasound. CKD patients showed higher concentrations of IS, IAA, and pCS compared with controls, with the highest levels observed in hemodialysis patients. Peritoneal dialysis was associated with elevated IS and pCS, whereas in kidney transplantation, IS and IAA levels did not differ significantly from controls, and pCS remained elevated. Carotid IMT was higher in patients with diabetes and those undergoing hemodialysis. IAA correlated significantly with left/mean IMT, and mean IMT was the only parameter associated with previous cardiovascular events. These findings suggest that gut-derived uremic toxins, particularly IAA, might be associated with subclinical vascular damage in advanced CKD, although larger studies are needed to confirm these associations. Full article

RCC remains a therapeutically challenging malignancy, particularly in its metastatic stage, in which treatment resistance and limited response durability persist despite recent advances in immunotherapy and targeted therapies. Although immune checkpoint inhibitors (ICIs) have significantly improved outcomes for a subset of patients, reliable prognostic and predictive biomarkers to guide therapy selection are still lacking. Current clinical models, such as the International Metastatic RCC Database Consortium (IMDC) risk score, offer only limited insight into the molecular and immunologic complexity of RCC. Emerging molecular biomarkers implicated in resistance mechanisms reflect the underlying heterogeneity of RCC and may inform future therapeutic strategies. Kidney Injury Molecule-1 (KIM-1), a transmembrane protein that is up-regulated in RCC and detectable in circulation, has demonstrated potential as a non-invasive biomarker for diagnosis, prognosis, and treatment monitoring. Liquid-biopsy approaches, including the analysis of circulating tumour DNA (ctDNA), microRNAs (miRNAs), and long non-coding RNAs (lncRNAs), are also gaining traction due to their minimally invasive nature and potential for real-time disease monitoring. This review aims to provide a structured overview of emerging biomarkers in metastatic RCC, critically evaluate their current clinical applicability, and propose a biologically informed framework for their integration into clinical decision-making. In addition, we propose a conceptual IMDC-Plus framework that integrates clinical, biological, and early dynamic markers to improve risk stratification in the era of immunotherapy (IO). Full article

Background: Chronic kidney disease (CKD) is highly prevalent among older adults, particularly those living in care homes, where early identification and effective management are essential to improving outcomes. Aim: This scoping review aimed to explore and map educational interventions designed to support care home staff in the prevention, assessment, and management of CKD. Methods: A scoping review (ScR) was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for ScR (PRISMA-ScR) checklist. A systematic search of six major databases was conducted following the Joanna Briggs Institute methodology. Results: A total of 6599 records were identified and 5573 titles and abstracts were screened; 10 full texts were assessed, but no studies met the inclusion criteria. Conclusions: This empty review highlights a significant gap in the literature and reinforces the need for targeted research to develop and evaluate training interventions for care home staff managing residents with CKD. Full article

Background: Urgent-start peritoneal dialysis (UPD) has emerged as an alternative modality for initiating kidney replacement therapy when immediate hemodialysis is not available. However, early initiation after catheter placement may increase the risk of mechanical complications. Evidence from real-world settings, particularly in resource-limited healthcare systems, remains limited. Objective: To determine the frequency of early complications associated with urgent-start peritoneal dialysis and to identify clinical factors associated with their occurrence. Methods: We conducted a prospective observational cohort study including adult patients with chronic kidney disease who initiated peritoneal dialysis within 14 days after catheter placement at a public hospital in Mexico. Patients were followed for 30 days after dialysis initiation. The primary outcome was the occurrence of any dialysis-related complication within 30 days after initiation of peritoneal dialysis. Comparisons were performed according to dialysis initiation timing (<72 h vs. ≥72 h). Multivariable logistic regression was used to identify independent predictors of complications. Results: Sixty-five patients were included, of whom 29 (44.6%) developed complications within the first 30 days. Mechanical complications predominated, particularly pericatheter leakage (18.5%) and drainage failure (10.8%). Patients who initiated dialysis within 72 h after catheter placement experienced a significantly higher complication rate. In multivariable analysis, initiation of peritoneal dialysis within <72 h remained independently associated with complications (OR 5.75, 95% CI 1.06–31.29, p = 0.043). Conclusions: Initiating peritoneal dialysis within 72 h after catheter placement was associated with a significantly increased risk of early complications. When clinically feasible, delaying dialysis initiation beyond 72 h may reduce mechanical complications in urgent-start peritoneal dialysis programs. Full article

Skeletal muscle development and physiological homeostasis are profoundly influenced by environmental cues. Among these factors, ambient temperature represents a critical determinant of growth performance and metabolic adaptation in mammals. However, the effects of different ambient temperature ranges on skeletal muscle characteristics and on responses across multiple visceral tissues remain poorly understood. In this study, five ambient temperature conditions (16 °C, 20 °C, 24 °C, 28 °C, and 32 °C) were established to investigate their physiological impacts in a mouse model. Our results demonstrate that ambient temperature markedly influences growth performance and skeletal muscle phenotype. Notably, mice housed at 20 °C showed relatively preserved grip strength and a shift in myofiber cross-sectional area distribution, although these findings did not consistently indicate superior skeletal muscle development across all indices. Further analysis revealed that ambient temperature significantly modulated the expression profiles of myosin heavy chain (MyHC) isoforms in skeletal muscle. Specifically, cold exposure was associated with an upregulation of the slow-twitch-related MyHC I, whereas heat stress correlated with an elevation of the fast-twitch-related MyHC IIb. Functional assessments indicated that exposure to colder or hotter conditions was associated with impaired muscle performance, as reflected by reduced grip strength at 16 °C, 28 °C, and 32 °C, and decreased endurance capacity at 28 °C and 32 °C. Histological analyses of major visceral organs revealed no obvious structural alterations in the heart, liver, spleen, lung, or kidney across temperature conditions. However, exposure to thermal extremes (16 °C and 32 °C) significantly reduced intestinal villus height, suggesting compromised intestinal integrity under temperature stress. Collectively, these findings indicate that ambient temperature is associated with multi-tissue changes in skeletal muscle characteristics, functional performance, and intestinal morphology. This study provides new insights into how environmental temperature modulates tissue adaptation and physiological homeostasis in mammals. Full article

Background/Objectives: Sepsis-associated acute kidney injury (SA-AKI) involves complex disturbances in renal microcirculation that may precede overt biochemical evidence of renal dysfunction. This study aimed to characterize early renal perfusion patterns during the emergency department (ED) phase of sepsis, as assessed by the renal resistive index (RRI) and the semiquantitative power Doppler ultrasonography score (SPDUS), and to explore their relationship with subsequent SA-AKI trajectories. Methods: In this prospective observational study, adult ED patients who met the Sepsis-3 criteria were enrolled. Renal perfusion was evaluated using the RRI and SPDUS at ED admission and repeated at the fourth hour. SA-AKI was classified as transient or non-transient based on renal recovery patterns. Trajectory comparisons were performed to identify early physiological differences. Receiver operating characteristic (ROC) analyses were conducted for descriptive and exploratory assessment of perfusion pattern separation between injury trajectories. Results: Fifty-four patients were included, with 35 classified as transient and 19 as non-transient SA-AKI. Patients with non-transient injury exhibited lower baseline SPDUS₀ grades and higher RRI₀ values compared with those with transient injury. These differences were evident at ED presentation, prior to the initiation of advanced organ support, and persisted at the fourth hour, with the non-transient group continuing to show lower SPDUS₄ and higher RRI₄ values than the transient group. These findings reflect distinct early renal microcirculatory perfusion patterns across SA-AKI trajectories. Sensitivity, specificity, and cut-off values are reported for descriptive and exploratory purposes only and should not be interpreted as validated clinical thresholds. Conclusions: Early alterations in renal microcirculatory perfusion are detectable during the ED phase of sepsis and differ between transient and non-transient SA-AKI trajectories. Baseline RRI and SPDUS values provide physiological insight into early renal perfusion abnormalities and evolving microcirculatory dysfunction in sepsis, but should not be interpreted as predictive tools. Full article

Background: Antimicrobial resistance coupled with the lack of new antibiotics calls for the responsible use of antibiotics, including old antimicrobials. Aminoglycosides are effective against bacteria in acute appendicitis, a common intra-abdominal infection. Their use has been discouraged recently, but their place in therapy is based on studies performed in the era of lower resistance rates, and with multiple dosing regimens. Methods: In a prospective randomized open-label study, we compared the efficacy and safety of gentamicin in one daily dose and metronidazole (GTM+MZ) to ertapenem (ETP) and to cefuroxime with metronidazole (CXM+MZ) in adult patients surgically treated for acute appendicitis. Efficacy was assessed via the duration of antibiotic treatment and hospital stay, c-reactive protein (CRP) dynamics, and post-operative complications. Nephrotoxicity was assessed with urine biomarkers. Statistical analysis comprised mixed-model analysis of variance (ANOVA) with the missing-data-imputation method and linear mixed model (LMM). Results: One hundred-and-sixty-six patients were included in this study. There were no significant differences among the three groups in the durations of treatment and lengths of stay (p = 0.093, p = 0.222). CRP level was the lowest (p = 0.003) in the ETP group. There were five complications during hospitalization, with two of them classified as infectious. Both occurred in the GTM+MZ group; however, the difference was not statistically significant (p = 0.330). No difference was found in complications in the month following the operation (p = 0.763). Biomarkers indicating kidney injury showed the same trend in all three groups. Conclusions: Our results suggest the use of once-daily dose of gentamicin following an appendectomy for acute appendicitis. Gentamicin may be used to decrease selective pressure of other antimicrobials. Full article

Introduction: Chronic kidney disease and kidney failure are associated with a decline in physical abilities resulting in severe health-related complications. Existing systematic reviews and meta-analyses show that exercise interventions in patients on haemodialysis enhance physical functioning, cardiovascular health, muscle strength, and overall quality of life. However, the available literature mostly stem from adult cohorts outside Africa. Thus, this scoping review aims to evaluate existing literature on the impact of exercise programs on paediatric patients undergoing haemodialysis in Africa. Methods: A systematic search of electronic databases, including CINAHL, EBSCO, Medline, PubMed, and Scopus, was conducted following the Arksey and O’Malley methodological framework for scoping reviews and complied with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines. The inclusion criteria was applied to identify peer-reviewed articles published between 2015 and 2025, focusing on the effects, impact, and benefits of exercises and physical activity programs in paediatric patients undergoing haemodialysis aged up to 18 years. The selection process was done by two researchers pertaining to importing search results, removing duplicates, screening titles and abstracts, and analysis the reference lists of selected studies to ensure comprehensive coverage. Results: Two exercise-based intervention studies were eligible in the final review. In both studies, the duration of the intervention was about two months, and they included sample sizes of 60 and 50 participants. The first study, using the Paediatric Quality of Life Inventory (PedsQL-I), reported significant improvements across all dimensions in quality-of-life following muscle stretching and isometric exercises. The second study, employing the Paediatric Quality of Life Multidimensional Fatigue Scale (PedsQL-MFS) and the Depression Anxiety Stress Scale (DASS), found reductions in fatigue and psychological distress, and positive biochemical changes. A notable omission was the lack of detail regarding contraindications and precautionary measures. These are essential for informing clinical decision-making and ensuring exercises are safe. Discussion: The findings underscore the importance of incorporating exercise into the standard care of paediatric patients undergoing haemodialysis to facilitate better health outcomes. The fact that only two relevant studies were found highlights a narrow regional scope within Africa as both studies originated from a single country. Further research is needed to develop and implement effective exercise interventions tailored to other countries in Africa. Full article

Background: Hemodialysis patients are particularly vulnerable to hepatitis B virus (HBV) due to immunosuppression and repeated vascular access. While universal childhood vaccination has reduced population-level HBV prevalence, dialysis units require tailored prevention and monitoring strategies. This study aimed to characterize HBV serologic profiles, evaluate immune responses, and assess the kinetics of antibody waning in a diverse hemodialysis population. Methods: We retrospectively analyzed 565 adult hemodialysis patients (2015–2024), assessing HBV seroprevalence, seroconversion, booster response, and antibody waning. Subgroup comparisons were made by ethnicity and birth cohort (pre- vs. post-1992 national vaccine rollout). Time-to-waning analyses were performed using Kaplan–Meier methods. Results: HBsAg and anti-HBc were positive in 4.1% and 31.7% of patients, respectively; 3.7% were HCV seropositive. No HBsAg seroconversions occurred, and 2.1% of initially anti-HBc-negative patients seroconverted. Among patients with isolated anti-HBc, 80.9% developed protective anti-HBs titers, and none became HBsAg- or HBV DNA-positive. Waning anti-HBs titers occurred in 67.5% (median: 7.3 months), with 87.4% demonstrating a serologic response following documented vaccine delivery. Patients born after 1992 showed higher isolated anti-HBs positivity and lower anti-HBc prevalence. Ethnic subgroup analysis showed higher exposure rates but similar booster response among minority patients. Conclusions: HBV serologic profiles in this hemodialysis cohort reflected the interplay of immunosuppression, vaccination practices, and evolving epidemiologic trends. Subgroups exhibited variable vaccine responses, differing patterns of antibody waning, and a low incidence of new infections. These findings support tailored, population-specific HBV monitoring and prevention strategies in dialysis care. Full article