Search Results (88)

Introduction: Renal artery stenosis can significantly impact long-term graft survival rates following kidney transplant. Early recognition and management can improve the longevity of the kidney allograft. We aimed to evaluate the clinical role of duplex ultrasound in the diagnosis of renal artery stenosis (RAS). We also wanted to evaluate the current incidence of renal artery stenosis at our institute. Methods: A retrospective, consecutive series of 367 patients who underwent renal transplantation between 1 January 2020 and 30 December 2024 was conducted. We collected data regarding the recipients’ age, body mass index, and comorbidities. All patients diagnosed with renal artery stenosis were identified. The incidence of kidney transplant artery stenosis and presentation were recorded. All general physical parameters and laboratory data were collected and analyzed. Results: A total of 28 patients had initial suspicion of renal artery stenosis, documented via initial dedicated duplex ultrasound of the transplanted kidney. The initial mean systolic BP at initial US was 151 (99–213) mmHg, and mean creatinine was 2.43 (1.28–6.38) mg/dL. However, on repeat duplex ultrasound, three patients showed no features of renal artery stenosis and had no physical parameters consistent with RAS. A total of 25 patients diagnosed with RAS on initial duplex ultrasound underwent angiography. Twenty-four patients were confirmed with RAS on angiography, while one patient had a normal angiogram. Among patients diagnosed with TRAS, the mean resistive index was 0.71 ± 0.17 at the upper pole, 0.73 ± 0.19 at the mid pole, and 0.71 ± 0.21 at the lower pole. The mean peak systolic velocity was 462.57 ± 166.28 cm/s. Conclusions: Duplex ultrasound is an important initial tool for diagnosing transplant renal artery stenosis. An increase in peak systolic velocity was observed in our cohort; however, resistive indices were largely within acceptable limits. Management should be guided by clinical parameters (e.g., elevated systolic BP and rising creatinine) alongside imaging findings. Full article

Background and Objectives: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are increasingly used in type 2 diabetes (T2D) due to their cardiorenal benefits and weight-lowering effects. However, concerns have emerged regarding their potential adverse impact on lean mass and muscle strength particularly in patients at risk for sarcopenia. This study aimed to evaluate the effects of empagliflozin on skeletal muscle mass. Secondary objectives were to assess changes in glycemic control, body weight, fat mass and handgrip strength. Materials and Methods: In this 24-week real-world observational study, 31 adult patients with T2D were assigned to either empagliflozin or non-SGLT2i treatment groups. Patients did not receive a high-protein diet, a resistance exercise program or any other weight-reducing medications such as glucagon-like peptide-1 (GLP-1)-based therapies. Anthropometric measurements, body composition via bioelectrical impedance analysis (BIA), and handgrip strength testing were performed at baseline and after 6 months. Sarcopenia was defined according to EWGSOP2 criteria. Results: The empagliflozin group showed significant improvements in HbA1c, fasting plasma glucose, body weight, waist circumference, and fat mass (p < 0.05 for all). No significant changes were observed in the empagliflozin group after 6 months in appendicular skeletal muscle mass index (from 7.81 ± 1.33 kg/m² to 7.84 ± 1.38 kg/m², p = 0.154). No statistically significant changes were observed in handgrip strength in either group. Conclusions: Empagliflozin treatment over six months led to favorable changes in metabolic parameters and fat mass without detrimental effects on skeletal muscle mass or muscle strength. In clinical practice, the selection of antidiabetic therapies should consider individual glycemic targets, cardiovascular and renal risks, weight management, comorbidities and sarcopenia risk. Resistance exercises and adequate dietary protein intake should be recommended to preserve muscle mass in at-risk patients. Larger randomized trials are needed to confirm the long-term effects of SGLT2 inhibitors on body composition particularly in older adults. Full article

Duplex-Doppler ultrasonography has become an essential tool in the diagnosis and management of kidney diseases, allowing clinicians to assess renal hemodynamics, detect vascular abnormalities, and monitor disease progression. Among the various Doppler-derived parameters, the renal resistive index (RRI) has gained particular attention both as a diagnostic tool and a prognostic marker in nephrology. Traditionally considered an indicator of parenchymal perfusion, recent evidence highlights its strong association with systemic hemodynamic factors, particularly arterial stiffness, positioning RRI as a valuable tool for evaluating patients with systemic vascular impairment, such as hypertension, diabetes mellitus, and atherosclerosis. RRI has been strongly linked to vascular damage, which in turn is influenced by inflammation and endothelial dysfunction, making it a reliable marker of cardiovascular damage and a potential predictor of cardiovascular risk. Furthermore, emerging studies suggest that RRI could serve as a dynamic parameter to monitor vascular changes induced by therapeutic interventions. This narrative review summarizes the classic and evolving applications of RRI, from its origin as a renal hemodynamic marker to its emerging role as a systemic vascular biomarker with diagnostic and prognostic significance in cardiovascular and metabolic diseases. Full article

Background: Serum uric acid and serum creatinine ratio (SUA/sCr) is strongly linked to increased cardiovascular risk. Atherosclerotic renal artery stenosis (ARAS) is a secondary cause of hypertension and is associated with ischemic nephropathy, congestive heart failure, accelerated cardiovascular disease, and autonomic dysfunction. The aim of this study was to investigate whether SUA levels and SUA/sCr could represent markers of autonomic dysfunction and increased left ventricular mass index (LVMI) in patients with ARAS. Methods: Patients diagnosed with ARAS were enrolled in the study. All patients underwent clinical evaluation, biochemical analysis, 24 h electrocardiogram (ECG), and Renal Doppler Ultrasound with renal resistive index parameters. Heart rate variability for global autonomic dysfunction was assessed through the analysis of a 24 h ECG to detect the standard deviation of normal-to-normal RR intervals (SDNN). Echocardiographic measurement of LVMI was performed. Results: A total of 27 patients (F = 16 (59%), median age 67 years (IQR 60–77)) diagnosed with ARAS were enrolled in the study. We found a statistically significant negative linear correlation between SUA/sCr and SDNN (r = −0.519, p < 0.01). We found a statistically significant positive linear correlation between SUA/sCr and LVMI (r = 0.413, p < 0.05). Median SDNN was significantly lower in patients with SUA ≥ 5.6 mg/dL than in patients with SUA < 5.6 mg/dL (94.2 (IQR 86.8–108.1) vs. 112.8 (IQR 108.9–114.7), p < 0.01). Median LVMI was significantly higher in patients with SUA ≥ 5.6 mg/dL compared to patients with SUA < 5.6 mg/dL (133 g/m² (IQR 120–149) vs. 111 g/m² (IQR 99–129), p < 0.05). Conclusion: In patients with ARAS, SUA/sCr is associated with autonomic dysfunction and LVMI in ARAS patients. The ratio and related cut-off value of SUA/sCr could represent a useful biomarker to evaluate cardiovascular risk in ARAS patients. Full article

Background: Diabetes mellitus (DM) is a global health challenge with a severe health burden. Approximately 40% of diabetic patients develop diabetic kidney disease (DKD), leading to kidney failure. Autologous dendritic cell therapy may enhance renal function by modulating vascular markers. Methods: Involving 35 patients, this quasi-experimental study assessed the pulsatility index (PI), resistive index (RI), vascular endothelial growth factor (VEGF), and endothelin levels before and four weeks following autologous dendritic cell administration. Results: A significant reduction in median PI was found from 1.61 ± 0.63 to 1.21 ± 0.26 (p < 0.001). The increase in mean RI was insignificant from 0.74 ± 0.07 to 0.75 ± 0.06 (p = 0.17). The median VEGF showed a slight reduction from 522.10 ± 608.6 to 473.70 ± 550 (p = 0.589) and endothelin from 1.74 ± 0.71 to 1.63 ± 0.76 (p = 0.554). Conclusions: This study shows that autologous dendritic cell therapy may improve kidney perfusion in DKD patients, indicated by a significant reduction in the PI. These findings suggest potential therapeutic benefits for renal perfusion in DKD. Full article

Objective: Various insulin resistance (IR) indices have been developed to assess cardiovascular (CVS) risk. We compared the association between ten IR indices and cardiac, renal, and vascular end-organ measures in a predominantly young (age 45.0 ± 18.3 years) South African Black population. Methods: We assessed the relationships between ten IR indices (homeostatic model assessment for IR [HOMA-IR], quantitative insulin sensitivity check index [QUICKI], metabolic score for IR [METS-IR], triglyceride–glucose index [TyG], TyG–body mass index [TyG-BMI], TyG–waist circumference [TyG-WC], TyG–waist-to-height ratio [TyG-WHtR], triglyceride to high-density cholesterol concentration [TyG-HDL], lipid accumulation product [LAP], visceral adiposity index [VAI]) and end-organ measures in 779 community participants of African ancestry. Results: HOMA-IR and QUICKI were the only IR indices consistently associated with end-organ measures (left ventricular [LV] mass index, p ≤ 0.005; LV relative wall thickness, p < 0.0001; early-to-late mitral velocity, p ≤ 0.01; E/e’, p ≤ 0.002; e’, p < 0.0001; pulse wave velocity, p = 0.036 (HOMA-IR only); glomerular filtration rate [GFR], p < 0.0001), independent of confounders. Furthermore, HOMA-IR was consistently higher, and QUICKI lower, in those with compared to those without end-organ damage (LV hypertrophy [p ≤ 0.03], concentric LV [p < 0.03], and reduced GFR [p ≤ 0.008]), independent of confounders. Importantly, the associations between HOMA-IR or QUICKI and end-organ measures were independent of additional CVS risk factors, including adiposity measures, and were replicated in the participants without diabetes mellitus (n = 669) and in the participants without high blood pressure (n = 505). Conclusions: In a predominantly young community of African ancestry, of ten recommended IR indices, only HOMA-IR and QUICKI were consistently associated with end-organ damage independent of CVS risk factors. Full article

This study investigates the phytochemical composition, anti-inflammatory, antioxidant, and antiproliferative activities of A. absinthium and A. annua flowers and leaf ethanol extracts in acute rat inflammation model. Polyphenolic compounds were analyzed quantitatively (total phenolic (TPC) and total flavonoids (TFCs)) and qualitatively by HPLC-ESI MS analysis. The antioxidant activity was evaluated in vitro (by DPPH, FRAP, H₂O₂, and NO scavenging tests), and in vivo (by total oxidative status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), and key oxidative damage markers). Inflammation was evaluated via nuclear factor-kB-p65 (NfkB-p65), and canonical NLRP3 inflammasome activation (with IL-1β, IL-18, caspase-1, and gasdermin D). The antiproliferative activity against human ovarian tumor cells (A2780cis, OVCAR-3, and OAW-42) was evaluated by the MTT assay, focusing on the modulation of multidrug resistance (MDR) pumps and the PARP-1 enzyme. Liver and renal toxicity were tested by measuring transaminases (ALT and AST), creatinine, and urea. The study results indicated that A. absinthium and A. annua flowers and leaf ethanol extracts have rich polyphenol content and moderate in vitro antioxidant activity. Tested extracts display an important antiproliferative activity against the ovarian tumor cell lines A2780cis, OVCAR-3, and OAW-42 based on chemoresistance countering and apoptotic mechanisms. There were differences related to the cell type and plant extract type. The tested plant extracts had significant and dose-dependent in vivo anti-inflammatory and antioxidant activity, with the A. annua flowers extract having the lowest efficiency. The anti-inflammatory and antioxidant activity biomarkers correlated with the extracts’ chemical composition. There was no inflammation-induced hepatotoxicity, but renal dysfunction was associated. Only AANL improved the renal function. These results can be used to design and develop remedies with combined anti-inflammatory, antioxidant, and anti-proliferative activities. Full article

Ischemia-reperfusion injury (IRI) is a common cause of acute kidney injury (AKI) in the aging population. Gender studies show that aging is associated with loss of protection from AKI in the female population. While ER stress contributes to IRI-induced AKI in the young, ER regulation during IR in the aged kidney is unclear. Because current evidence suggests hydrogen sulfide (H₂S) modulates ER stress, we investigated whether exogenous supplementation of diallyl trisulfide (DATS), an H₂S donor, mitigates AKI in aged female kidneys. Wild-type (WT, C57BL/6J) mice aged 75–78 weeks were treated with or without DATS before and after renal IRI. IRI increased ER stress proteins, inflammation, and fibrosis markers in the IRI kidney compared to the control. DATS mitigated ER stress, and reduced inflammation and fibrosis markers in the IRI kidney. Further, IRI kidneys demonstrated reduced blood flow, vascularity, angiogenesis, increased resistive index (RI), and reduced function. DATS treatment upregulated PI3K, AKT, p-mTOR, and pMAPK signaling to stimulate angiogenesis, which improved vascular density, blood flow, and renal function. Together, our results suggest that DATS rescues the aged female kidney IRI by modulating ER stress and upregulation of angiogenesis. Full article

The renal resistive index (RRI), a Doppler ultrasound-derived parameter measuring renal vascular resistance, has emerged as a promising non-invasive tool to evaluate renal hemodynamics in critically ill patients, particularly those with acute respiratory distress syndrome (ARDS) and heart failure (HF). This narrative review examines the current evidence for RRI measurement in these conditions, exploring its physiological bases, methodology, clinical applications, and limitations. In ARDS, RRI reflects the complex interactions between positive pressure ventilation, hypoxemia, and systemic inflammation, showing a role in predicting acute kidney injury and monitoring response to interventions. In HF, RRI is able to assess venous congestion and cardiorenal interactions and can also serve as a prognostic indicator. Many studies have shown RRI’s superiority or complementarity to traditional biomarkers in predicting renal dysfunction, although its interpretation requires consideration of multiple patient-related factors. Key challenges include operator dependency, lack of standardization, and complex interpretation in multi-organ dysfunction. Future research should focus on measurement standardization, development of automated techniques, investigation of novel applications like intraparenchymal renal resistive index variation, and validation of RRI-guided management strategies. Despite its limitations, RRI represents a valuable tool that offers bedside and real-time insights into renal hemodynamics and potential guidance for therapeutic interventions. Further research is needed to fully clarify its clinical potential and address current limitations, particularly in critical care settings involving multiple organ dysfunction. Full article

Background/Objectives: Considering the physiological analogies between the eye and the kidney, this study aimed to investigate the potential relationship between retinal vascular density, assessed using Optical Coherence Tomography Angiography (OCT-A), and the renal resistive index (RRI) in patients with arterial hypertension. Methods: A total of 82 hypertensive patients (mean age 48 ± 13) were enrolled in the study. Participants underwent routine biochemical evaluations, office-based blood pressure measurement, 24 h ambulatory blood pressure monitoring, OCT-A imaging, and renal Doppler ultrasound examinations. Results: The mean RRI in the study population was 0.616 ± 0.06. Participants were divided into two groups based on the 75th percentile threshold of the RRI distribution (0.66, 95% CI 0.64–0.68). The group with RRI > 75th percentile, which appeared to have a higher number of smokers, exhibited significantly higher mean triglyceride and urinary albumin excretion (UAE) levels and a significantly reduced estimated glomerular filtration rate (eGFR) as compared to the group with RRI < 75th percentile. Among the hemodynamic parameters, 24 h pulse pressure (PP), daytime and nighttime PP, and nighttime systolic blood pressure (SBP) were significantly higher in the group with RRI > 75th percentile. Regarding retinal vascular density indices, the only significant difference was observed in the deep foveal vascular plexus, which displayed a reduced density in the group with RRI > 75th percentile. Logistic regression analysis revealed that RRI > 75th percentile was independently associated with increased nighttime mean pulse pressure (OR = 1.13, 95% CI: 1.049–1.221, p = 0.0014) and reduced deep foveal vascular density (OR = −0.5026, 95% CI: 1.0493–1.2211, p = 0.0044). Conclusions: Our findings demonstrate that ocular microvascular alterations are associated with RRI, a marker with a well-established prognostic value for renal disease progression and systemic macrovascular dysfunction. These results further substantiate the close relationship between renal and ocular microcirculation. Full article

Background and Objectives: Insulin resistance (IR) is a key factor involved in the development of type 2 diabetes (T2D). Besides its role in the pathogenesis of T2D, insulin resistance is associated with impairment of glycemic control, reduced achievement of glycemic targets, and increases in cardiovascular risk and diabetes complications, being thus a negative prognosis factor. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are therapies for T2D which demonstrated, besides glycemic control, improvements of biomarkers traditionally associated with IR and inflammation. This study aimed to evaluate the impact of SGLT2i treatment on IR and inflammation biomarkers in patients with T2D. Materials and Methods: In a retrospective study, 246 patients with T2D treated with SGLT2i for a median of 5 years were evaluated regarding IR (estimated glucose disposal rate—eGDR, triglyceride/glucose index, triglyceride/HDLc index) and inflammation biomarkers (neutrophils to lymphocyte ratio, platelets to lymphocytes ratio and C-reactive protein) before and after intervention with SGLT2i. Results: After a median 5 years of SGLT2i treatment, patients with T2D had a higher eGDR (6.07 vs. 5.24 mg/kg/min; p < 0.001), lower triglyceride/HDLc ratio (3.34 vs. 3.52, p < 0.001) and lower triglyceride/glucose index (9.23 vs. 9.58; p < 0.001). The inflammation biomarkers decreased after SGLT2i therapy: C-reactive protein (3.07 mg/L vs. 4.37 mg/L), NLR (0.68 vs. 0.72; p < 0.001), and PLR (115 vs. 122; p < 0.001). Intervention with SGLT2i also improved the biomarkers associated with diabetes complications and cardiovascular risk: HbA1c (7.1% vs. 8.4%; p < 0.001), body mass index (30.0 vs. 31.5 kg/m²; p < 0.001) and urinary albumin to creatinine ratio (4.75 vs. 11.00 mg/g; p < 0.001). Conclusions: Treatment with SGLT2i in patients with T2D leads to decreases in IR and inflammation. These mechanisms may partially explain the additional cardiovascular and renal risk reductions associated with SGLT2i therapy, alongside the improvements in glycemic control, in patients with T2D. Full article

Background: Bupropion, an atypical antidepressant and smoking cessation aid, is known for its potential to cause seizures, cardiotoxicity and neurotoxicity in overdose scenarios. However, overdoses may present variably, and muscular and renal complications, such as rhabdomyolysis and acute kidney injury (AKI), can emerge in unexpected ways. Previous reports have shown that severe overdoses can lead to a spectrum of complications, but the precise mechanisms linking bupropion overdose with rhabdomyolysis remain poorly understood. Clinical presentation: This paper presents the management of a severe rhabdomyolysis case following deliberate ingestion of 4 g of immediate-release bupropion. The report highlights the unexpected presentation of bupropion overdose, including a lack of typical neurotoxic or muscular symptoms, and the subsequent involvement of multiple factors in the decision to initiate early renal replacement therapy, despite the absence of overt acute kidney injury (AKI). Conclusions: This case underscores the importance of individualized patient assessment and the challenges of managing rare and complex drug overdoses. Early intervention with renal replacement therapy, despite the absence of acute kidney injury, may be justified in cases of significant rhabdomyolysis and potential renal complications. Clinicians should maintain a high degree of suspicion for complications like rhabdomyolysis in overdose scenarios and consider early renal support in patients at risk of renal failure, even in the absence of overt kidney injury. The findings also point to the need for a more nuanced approach to diagnosing and treating bupropion overdose in critically ill patients. Full article

Introduction: An increased renal resistive index (RRI) and proteinuria can predict an estimated glomerular filtration rate (eGFR) decline in patients with chronic kidney disease (CKD) of various causes. This study hypothesized that the RRI and proteinuria interact to determine disease progression in patients with CKDs of unknown origin. Patients and Methods: One hundred and fifty six patients (age 76.0 ± 8.1 years, 63.5% males) were analyzed for anthropometric, kidney morphology, blood pressure, 24 h urinary protein excretion, and RRI. The CKD-EPI equation was used to calculate the eGFR at baseline and after a two-year follow-up. Patients with an elevated (≥0.80) or normal (<0.80) RRI and significant (≥150 mg/day) or physiological (<150 mg/day) proteinuria were evaluated for the likelihood of at least a 30% drop in the eGFR or the onset of end-stage kidney disease (endpoint). Results: Hypertension and diabetes were the predominant cardiovascular risk factors (90.4%). Fifty patients (32%) met the endpoint. Elevated RRIs (odds ratio, OR, 4.28; 95% confidence interval, CI, 1.82–10.6; p = 0.001) and significant proteinuria (OR 3.59, 95% CI 1.59–8.48, p = 0.003) were independent predictors of the endpoint in a multivariate logistic model. Patients with an elevated RRI and significant proteinuria were more likely to meet the endpoint (R1P1: 65.2%) compared to those with only proteinuria (R0P1: 39.5%, p = 0.043) or both normal factors (R0P0: 10.9%, p < 0.001) but not to those with only an elevated RRI (R1P0: 42.3%, p = 0.094). Continuous RRIs (partial correlation r = −0.245, p < 0.001) and 24 h urinary protein excretion (partial r = −0.226, p = 0.003) were inversely and independently correlated with eGFR% change. R1P1 showed a higher eGFR% reduction (−38.0% ± 20.4%) compared to R0P1 (−25.3% ± 19.0%, p = 0.043) and R0P0 (−8.8% ± 25.1%, p < 0.001) but not to R1P0 (−29.6% ± 21.0%, p = 0.192). Conclusions: An increased RRI and proteinuria were independent predictors of disease progression. When interaction was considered, the negative effect of an elevated RRI on CKD progression was evident in both proteinuric and non-proteinuric patients, whereas the negative effect of proteinuria on disease progression was only significant in patients with no elevated RRIs. Full article

Background/Objectives: Inadequate cardiovascular adaptation during pregnancy impairs endothelial function and vascular resistance, contributing to complications such as pre-eclampsia (PE) and gestational hypertension (GH). Neprilysin (NEP), a protease involved in vascular regulation, has been linked to PE, but its role in endothelial function and vascular adaptation remains unclear. This pilot study investigates the associations between soluble neprilysin (sNEP) and markers of vascular and renal function in high-risk pregnancies without PE. Methods: Observed parameters were analyzed in 29 high-risk pregnant women across early, mid-, and late pregnancy. sNEP levels were analyzed alongside body mass index (BMI), endothelial dysfunction (ADMA), arterial stiffness (pulse wave velocity, PWV), retinal microvasculature (central retinal arteriolar and venular equivalents, CRAE and CRVE), and kidney function markers. The impact of gestational hypertension (GH) and prior smoking on sNEP levels was also evaluated. Results: In early and mid-pregnancy, sNEP was inversely associated with BMI. During mid-pregnancy, sNEP showed a positive correlation with CRAE and an inverse correlation with PWV, suggesting reduced arterial stiffness. By late pregnancy, sNEP was positively associated with glomerular filtration rate and inversely correlated with creatinine and protein levels, reflecting improved kidney function. Women with GH exhibited elevated sNEP, while former smokers had lower sNEP levels in early pregnancy. Conclusions: These findings suggest that sNEP plays a role in vascular and renal adaption during pregnancy, offering new perspectives on vascular tone regulation in high-risk pregnancies. Further research is needed to clarify these mechanisms and their clinical relevance. Full article

Background/Objectives: Secondary mitral regurgitation (MR) is a common valvular heart disease burdening the prognosis of patients with co-existing chronic heart failure. Transcatheter edge-to-edge mitral valve repair (MV-TEER) is a minimally invasive treatment option for high-risk patients. However, the effects of MV-TEER on expanded hemodynamics, tissue perfusion, and quality of life, particularly in patients with advanced renal failure, remain underexplored. Methods: This prospective, single-center study evaluated the impact of MV-TEER on hemodynamics, renal function, and quality of life in 45 patients with severe MR. Non-invasive bioimpedance monitoring with NICaS^® was used to assess hemodynamics pre- and 3–5 days post-procedure. Quality of life was assessed using the EQ-5D-3L questionnaire before and 3 months post-procedure. For further analysis, patients were divided into subgroups based on the estimated baseline glomerular filtration rate (eGFR < 35 mL/min vs. eGFR ≥ 35 mL/min). Results: A significant reduction in systemic vascular resistance (SVR; p = 0.003) and an increase in eGFR (p = 0.03) were observed in the entire cohort after MV-TEER, indicating improved tissue perfusion. Notably, particularly patients with eGFR < 35 mL/min showed a significant increase in cardiac output (CO; p = 0.035), cardiac index (CI; p = 0.031), and eGFR (p = 0.018), as well as a reduction in SVR (p = 0.007). Consistent with these findings, quality of life significantly improved, with the EQ-5D-3L index and EQ-VAS score increasing from 0.44 to 0.66 (p < 0.001) and from 51.7% to 62.9% (p < 0.001). Full article