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Background: Human blood metabolites have demonstrated close associations with chronic kidney disease (CKD) in observational studies. Nonetheless, the causal relationship between metabolites and CKD is still unclear. This study aimed to assess the associations between metabolites and CKD risk. Methods: We applied a two-sample Mendelian randomization (MR) analysis to evaluate relationships between 1400 blood metabolites and eight phenotypes (outcomes) (CKD, estimated glomerular filtration rate(eGFR), urine albumin to creatinine ratio, rapid progress to CKD, rapid decline of eGFR, membranous nephropathy, immunoglobulin A nephropathy, and diabetic nephropathy). The inverse variance weighted (IVW), MR-Egger, and weighted median were used to investigate the causal relationship. Sensitivity analyses were performed with Cochran's Q, MR-Egger intercept, MR-PRESSO Global test, and leave-one-out analysis. Bonferroni correction was used to test the strength of the causal relationship. Results: Through the MR analysis of 1400 metabolites and eight clinical phenotypes, a total of 48 metabolites were found to be associated with various outcomes. Among them, N-acetylleucine (OR = 0.923, 95%CI: 0.89–0.957, PIVW = 1.450 × 10–5) has a strong causal relationship with lower risk of CKD after the Bonferroni-corrected test, whereas Glycine to alanine ratio has a strong causal relationship with higher risk of CKD (OR = 1.106, 95%CI: 1.063–1.151, PIVW = 5.850 × 10–7). No horizontal pleiotropy and heterogeneity were detected. Conclusion: Our study offers groundbreaking insights into the integration of metabolomics and genomics to reveal the pathogenesis of and therapeutic strategies for CKD. It underscores 48 metabolites as potential causal candidates, meriting further investigation. [ABSTRACT FROM AUTHOR]

Context Chronic kidney disease (CKD) leads to alterations in fibroblast growth factor 23 (FGF23) and the renal-bone axis. This may be partly driven by altered inflammation and iron status. Vitamin D supplementation may reduce inflammation. Objective and methods Older adults with early CKD (estimated glomerular filtration rate (eGFR) 30–60 ml/min/1.73 m2; CKDG3a/b; n  = 35) or normal renal function (eGFR >90 ml/min/1.73 m2; CKDG1; n  = 35) received 12,000, 24,000 or 48,000 IU D3/month for 1 year. Markers of the renal-bone axis, inflammation and iron status were investigated pre- and post-supplementation. Predictors of c-terminal and intact FGF23 (cFGF23; iFGF23) were identified by univariate and multivariate regression. Results Pre-supplementation, comparing CKDG3a/b to CKDG1, plasma cFGF23, iFGF23, PTH, sclerostin and TNFα were significantly higher and Klotho, 1,25-dihydroxyvitamin D and iron were lower. Post-supplementation, only cFGF23, 25(OH)D and IL6 differed between groups. The response to supplementation differed between eGFR groups. Only in the CKDG1 group, phosphate decreased, cFGF23, iFGF23 and procollagen type I N-propeptide increased. In the CKDG3a/b group, TNFα significantly decreased, and iron increased. Plasma 25(OH)D and IL10 increased, and carboxy-terminal collagen crosslinks decreased in both groups. In univariate models cFGF23 and iFGF23 were predicted by eGFR and regulators of calcium and phosphate metabolism at both time points; IL6 predicted cFGF23 (post-supplementation) and iFGF23 (pre-supplementation) in univariate models. Hepcidin predicted post-supplementation cFGF23 in multivariate models with eGFR. Conclusion Alterations in regulators of the renal-bone axis, inflammation and iron status were found in early CKD. The response to vitamin D3 supplementation differed between eGFR groups. Plasma IL6 predicted both cFGF23 and iFGF23 and hepcidin predicted cFGF23. [ABSTRACT FROM AUTHOR]

Background: A coronavirus disease 2019 (COVID-19) outbreak led to a worldwide pandemic. COVID-19 not only caused acute symptoms during the severe phase of the disease, but also induced long-term side effects on the functioning of many organs and systems. Symptoms that were associated with the disease and present at least 3 months after recovery were named long COVID. The aim of this study was to assess if mild-to-moderate COVID-19 may lead to the dysfunction of respiratory, cardiovascular, neural, and renal systems in healthy blood donors who recovered from the disease at least 6 months earlier. Methods: Here, we examined 294 adults among volunteer blood donors divided into convalescents (n = 215) and healthy controls (n = 79). Concentrations of soluble CD163, TGF beta, Lp-PLA2, NCAM-1, S100, NGAL, and creatinine were measured either by ELISA or automated methods. The probability value p < 0.05 was considered as statistically significant. Results: We found significant differences in Lp-PLA2, S100, and NCAM-1 between convalescents and never-infected subjects. Lp-PLA2 and NCAM-1 were lower, and S100 higher, in convalescents than in the control group. Conclusion: Mild-to-moderate COVID-19 convalescents are at a low risk of developing lung fibrosis or chronic kidney disease. However, they should regularly carry out their prophylaxis examinations for early detection of possible negative outcomes of COVID-19. [ABSTRACT FROM AUTHOR]

Objectives To compare the diagnostic value of histogram features of multiple diffusion metrics in predicting early renal impairment in chronic kidney disease (CKD). Methods A total of 77 patients with CKD (mild group, estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2) and 30 healthy controls (HCs) were enrolled. Diffusion-weighted imaging was performed by using single-shot echo planar sequence with 13 b values (0, 20, 50, 80, 100, 150, 200, 500, 800, 1000, 1500, 2000, and 2500 s/mm2). Diffusion models including mono-exponential (Mono), intravoxel incoherent motion (IVIM), stretched-exponential (SEM), and kurtosis (DKI) were calculated, and their histogram features were analysed. All diffusion models for predicting early renal impairment in CKD were established using logistic regression analysis, and diagnostic efficiency was compared among the models. Results All diffusion models had high differential diagnosis efficiency between the mild group and HCs. The areas under the curve (AUCs) of Mono, IVIM, SEM, DKI, and the combined diffusion model for predicting early renal impairment in CKD were 0.829, 0.809, 0.760, 0.825, and 0.861, respectively. There were no significant differences in AUCs except SEM and combined model, SEM, and DKI model. There were significant correlations between eGFR/serum creatinine and some of histogram features. Conclusions Histogram analysis based on multiple diffusion metrics was practicable for the non-invasive assessment of early renal impairment in CKD. Advances in knowledge Advanced diffusion models provided microstructural information. Histogram analysis further reflected histological characteristics and heterogeneity. Histogram analysis based on multiple diffusion models could provide an accurate and non-invasive method to evaluate the early renal damage of CKD. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease or CKD has a high prevalence globally with associated high mortality and morbidity rates posing a significant health concern. With its progression, oxidative stress and inflammation are seen in affected subjects. The most common RRT (renal replacement therapy) is hemodialysis in Indian subjects. Aim: The present study aimed to comparatively assess the biochemical profile, oxidative markers, and immune modality profiles in pre and post-dialysis subjects with chronic kidney disease. Methods: The present study assessed 50 subjects with chronic kidney disease visiting the Institute and with a mean age of 60±12 years. The included subjects were undergoing dialysis three times a week for 4 hours of every session at the flow rate of 250-300 mL/min. Oxidative stress markers and inflammatory markers were assessed in all the subjects before and after dialysis in any one of the dialysis sessions of the included subjects. Results: An improvement in kidney function was seen following dialysis in CKD subjects along with a significant decrease in the oxidative stress and inflammatory markers following the single session of dialysis. Also, a significant reduction in other biochemical markers of serum was seen in study subjects after dialysis. Conclusions; The present study concludes that improvement in renal function along with a decrease in oxidative stress and inflammatory markers is seen following hemodialysis in subjects with chronic kidney disease. The study also suggested that hemodialysis is a better and most common treatment option in subjects with chronic kidney disease. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the incidence and risk factors of a 20% decrease from new baseline (NB)‐estimated glomerular filtration rate (eGFR) within 2 years after radical nephrectomy (RN) and partial nephrectomy (PN) and to examine the difference in the incidence of end‐stage renal disease (ESRD) with or without the 20% decrease. Methods: This retrospective study included 238 patients undergoing RN and 369 undergoing PN for cT1a‐cT3a renal cancer. The incidence of a 20% decrease from NB‐eGFR within 2 years after RN/PN was examined and its potential risk factors including surgery type were assessed by multivariate logistic regression analysis. The development of ESRD was analyzed as an endpoint and its incidence was compared according to the presence or absence of the 20% decrease from NB‐eGFR within 2 years. Results: Overall, the 20% decrease from NB‐eGFR within 2 years was observed in 37 patients (6.1%), including 10 (4.2%) and 27 (7.3%) after RN and PN, respectively (p = 0.117). Diabetes mellitus, proteinuria, and perioperative complications were shown to be independent risk factors for the 20% decrease from NB‐eGFR, while surgery type was not. During the median follow‐up of 65 months, the ESRD‐free survival rate at 6 years was 75.5% and 99.6% in patients with and without the 20% decrease from NB‐eGFR, respectively (p < 0.001), while no significant difference was observed between patients undergoing RN and PN (98.1% and 98.7%, p = 0.561). Conclusions: Because the incidence of ESRD after the 20% decrease from NB‐eGFR within 2 years was as high as 24.5% at 6 years, these patients should be followed with utmost care. [ABSTRACT FROM AUTHOR]

Objective: To identify the association between the changes in intestinal microflora and renal function in patients with chronic renal failure (CRF). Methods: This retrospective case-control study included 50 patients with CRF (study group), admitted to the Clinical Laboratory Department of Shenzhen People’s Hospital from March 2021 to May 2022, and 50 healthy individuals (control group). The association between the distribution of intestinal microflora and the glomerular filtration rate (GFR), levels of serum creatinine (SCr), blood urea nitrogen (BUN), and serum cystatin C (CysC) were analyzed. Results: Intestinal microflora of CRF patients had significantly higher levels of Enterococci compared to the control group (p-Value <0.05), while the levels of Bifidobacterium spp. and Escherichia coli were lower in the study group (p-Value <0.05). GFR was lower, and the levels of BUN, SCr, and CysC were higher in the study group compared to the control group (all p-Value <0.05). GFR, BUN, SCr and CysC levels in the study group negatively correlated with the levels of Bifidobacterium spp. and Lactobacillus spp. (r<0, P<0.05), and positively correlated with the abundance of Enterococcus spp. and Escherichia coli (r>0, P<0.05) in the intestinal microflora. Conclusions: Changes in intestinal microbiota are associated with a significant decrease in GFR and a marked increase in serum levels of renal function indicators, and alterations in the balance of intestinal microbiota may lead to further aggravation of the renal function damage in patients with CRF. [ABSTRACT FROM AUTHOR]

This article discusses the effect of COVID-19 vaccination on kidney function and HLA antibody formation in patients with end-stage kidney disease and on kidney replacement treatment. The study included patients with chronic kidney disease and kidney transplant recipients who received two mRNA-1273 COVID-19 vaccinations. The researchers found that there were no significant changes in kidney-related outcomes or the development of de novo HLA antibodies after vaccination. These findings suggest that COVID-19 vaccination is safe and does not worsen kidney damage or function in these patients. [Extracted from the article]

Background Antineutrophil-cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with kidney involvement (AAV-GN) frequently evolves to end-stage kidney disease (ESKD) despite aggressive immunosuppressive treatment. Several risk scores have been used to assess renal prognosis. We aimed to determine whether kidney function and markers of AAV-GN activity after 6 months could improve the prediction of ESKD. Methods This retrospective and observational study included adult patients with AAV-GN recruited from six French nephrology centers (including from the Maine-Anjou AAV registry). The primary outcome was kidney survival. Analyses were conducted in the whole population and in a sub-population that did not develop ESKD early in the course of the disease. Results When considering the 102 patients with all data available at diagnosis, Berden classification and Renal Risk Score (RRS) were not found to be better than kidney function [estimated glomerular filtration rate (eGFR)] alone at predicting ESKD (C-index = 0.70, 0.79, 0.82, respectively). Multivariables models did not indicate an improved prognostic value when compared with eGFR alone. When considering the 93 patients with all data available at 6 months, eGFR outperformed Berden classification and RRS (C-index = 0.88, 0.62, 0.69, respectively) to predict ESKD. RRS performed better when it was updated with the eGFR at 6 months instead of the baseline eGFR. While 6-month proteinuria was associated with ESKD and improved ESKD prediction, hematuria and serological remission did not. Conclusion This work suggests the benefit of the reassessment of the kidney prognosis 6 months after AAV-GN diagnosis. Kidney function at this time remains the most reliable for predicting kidney outcome. Of the markers tested, persistent proteinuria at 6 months was the only one to slightly improve the prediction of ESKD. [ABSTRACT FROM AUTHOR]

Introduction Our objective was to evaluate whether renal function, assessed as the estimated glomerular filtration rate (eGFR), is associated with the number of febrile urinary tract infections (FUTIs) in children diagnosed with neurogenic bladder (NB). Materials and Methods Clinical information of patients diagnosed with NB was prospectively collected between January 2013 and January 2022. Episodes of FUTI were recorded during the follow-up period, and the eGFR was calculated based on the serum cystatin C level. Grading (G1–G5) of chronic kidney disease (CKD) was conducted as described by the eGFR. Results In total, 463 children were included in the final analysis (265 males and 198 females; mean age: 23 months). The median follow-up time was 51 months. A total of 302 children had four or more FUTIs and 161 children had none to three FUTIs. The incidence of developing CKD G3 to G5 gradually increased from the first to third (1.3–2.4%) episodes of FUTI and drastically increased after four episodes (≥ 22.5%), with the incidence recorded to be 100% after eight FUTIs. The odds of CKD G3 to G5 in children with four FUTIs were 17.3 and 43.7 times greater after four and six FUTIs, respectively, than in children with one FUTI. Conclusion This study showed that recurrent FUTIs are common in children with NB and that the risk of rapid progression to CKD G3 to G5 increases substantially after four or more FUTIs episodes. [ABSTRACT FROM AUTHOR]

Background: Contrast-induced nephropathy (CIN) is kidney damage caused by contrast media in medical procedures like angiography and CT scans. It is linked to acute kidney injury and can affect long-term renal function. Factors like pre-existing kidney issues, diabetes, and heart failure increase the risk. CIN's impact on renal function in Bangladesh needs attention due to rising cardiovascular diseases and imaging procedures. Research explores CIN's mechanisms, risk factors, prevention, and management. Research conducted in other locations has demonstrated a correlation between CIN and both chronic kidney disease (CKD) and end-stage renal disease (ESRD). Understanding CIN's impact in Bangladesh is crucial for preventive strategies and better patient care. Aim of the study: This study aims to investigate CIN's impact on renal function in Bangladeshi patients undergoing angiography, and CT scans to improve clinical decision-making and outcomes. Methods: This is a prospective comparative study, a total of 207. Patients were enrolled and analyzed in this study. The study was conducted at the Department of Cardiology, Apollo Imperial Hospital, Chittagong, Bangladesh. Between March 2022 and March 2023, we examined the alterations in renal function subsequent to coronary angiography or contrast-enhanced computed tomography (CT). In this study we divided patients into two groups; Group A and Group B. A total of 72 patients with Coronary Angiography were in Group A and a total of 135 patients with contrast-enhanced computed tomography were in Group B. Result: The study population consisted of 195 patients, who were divided into two groups. The analysis comparing renal function at the time of coronary angiography and contrast-enhanced CT (eGFR ≥30 ml/min/1.73 m2 and eGFR ≤1.73 m2) revealed no significant difference in the occurrence of contrast-induced nephropathy (CIN). Age and diabetes mellitus, along with pre-existing renal dysfunction, were identified as factors associated with the two-year prognosis of renal function. Conclusion: Contrary to previous beliefs, the presence of contrast-induced nephropathy (CIN) does not pose a longterm risk to renal prognosis following coronary angiography or contrast-enhanced CT scans. Moreover, individuals with pre-existing renal dysfunction, including those with an eGFR <30 ml/min/1.73 m², do not face an elevated risk of developing CIN. These findings have significant implications, as they assure that patients with kidney disease requiring contrast-enhanced testing can undergo appropriate examinations without undue concern. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is one of the most common chronic diseases worldwide, with increasing rates of morbidity and mortality. Thus, early detection is essential to prevent severe adverse events and the progression of kidney disease to an end stage. Glomerular filtration rate (GFR) is the most appropriate index to evaluate renal function in both clinical practice and basic medical research. Several animal models have been developed to understand renal disease induction and progression. Specifically, murine models are useful to study the pathogenesis of renal damage, so a reliable determination of GFR is essential to evaluate the progression of CKD. However, as in clinical practise, the estimation of GFR in murine by levels of serum/urine creatinine or cystatin-C could not be accurate and needed other more reliable methods. As an alternative, the measurement of GFR by the clearance of exogenous markers like inulin, sinistrin, 51Cr-EDTA, 99mTc-DTPA, 125I-iothalamate, or iohexol could be performed. Nevertheless, both approaches—estimation or measurement of GFR—have their limitations and a standard method for the GFR determination has not been defined. Altogether, in this review, we aim to give an overview of the current methods for GFR assessment in murine models, describing each methodology and focusing on their advantages and limitations. [ABSTRACT FROM AUTHOR]

Objectives: To assess long‐term voiding and renal function (RF) changes after radical cystectomy (RC) and orthotopic neobladder (ONB) surgery in women without disease recurrence. Material and methods: Women who underwent RC and ONB reconstruction between 1995 and 2011 were included in this study. Patients who developed disease failure or were lost to follow‐up were excluded. The study outcomes were long‐term voiding function and the incidence and predictors of RF deterioration (defined as >20% decline of baseline). Analysis was performed using the log‐rank test and Cox regression analysis. Results: The study included 195 patients with a median (interquartile range) follow‐up of 98 (53–151) months, of whom 95 had >10 years of follow‐up. Daytime continence, night‐time continence and chronic urine retention (CUR) were identified in 170 (87%), 134 (69%) and 52 patients (27%), respectively. Among patients with >10 years of follow‐up, 82 (86%), 66 (70%) and 31 (33%) had daytime continence, night‐time continence and CUR at the last follow‐up visit, respectively. RF deterioration events occurred in 74 patients throughout the follow‐up and chronic kidney disease (CKD) stage III–V developed in 80 patients. Patients' age (hazard ratio [HR] 1.41, 95% confidence interval [CI]1.06–1.89; P = 0.02) and serous‐lined extramural tunnel diversion (HR 0.43, 95% CI 0.19–0.86; P = 0.02) were the independent predictors of RF deterioration. Among patients with >10 years of follow‐up, RF deteriorated in 46 patients (49%) and CKD stage III–V developed in 40 (42%). Conclusion: Women surviving more than 10 years after RC and ONB maintained acceptable continence status, apart from having a higher CUR rate, compared to those followed for <10 years. However, RF deterioration developed in nearly half of them. [ABSTRACT FROM AUTHOR]

There are few reports on short-term changes in renal function after surgical aortic valve replacement, and data are scarce regarding its impact on long-term outcomes. This is a retrospective study of patients who underwent isolated aortic valve replacement between 2009 and 2020 in four medical centers. Patients with end-stage renal disease were excluded. Renal function was assessed based on short-term changes. Multivariable regression models were used to identify predictors of improvement/deterioration. Cox proportional hazard models were used to assess survival trends. The study included 2402 patients, with a mean age of 69.3 years and a mean eGFR of 82.3 mL/min/1.73 m2. Short-term improvement rates were highest in stage 4 (24.4%) and stage 3 (16.8%) patients. Deterioration rates were highest in stage 1 (38.1%) and stage 2 (34.8%) patients. Deterioration in the chronic kidney disease stage was associated with a higher ten-year mortality (p < 0.001, HR 1.46); an improved stage trended toward improved survival (p = 0.14, HR 0.722). Patients with stage 3 and 4 kidney disease tended to remain stable or improve in the short term after aortic valve replacement while patients at stages 1 and 2 were at increased risk of deteriorating. [ABSTRACT FROM AUTHOR]

Background: It is uncertain if passive heat therapies are associated with adverse renal outcomes. We sought to evaluate the cross‐sectional and longitudinal associations of the frequency of sauna bathing with renal function measures and chronic kidney disease (CKD). Materials and Methods: Baseline self‐reported sauna bathing habits were assessed in 2071 men aged 42–61 years with normal kidney function. Baseline estimated glomerular filtration rate (GFR) and serum levels of creatinine, potassium (K) and sodium (Na) were measured, with only 11‐year measurements of K and Na 11 years in a random subset of participants due to logistical reasons. Study participants were followed up for CKD diagnosed using KDOQI guidelines, which were collected from the National Hospital Discharge Registry. The associations of frequency of sauna bathing with renal function measures were evaluated using regression analyses. Hazard ratios (HRs; 95% CIs) were estimated for CKD. Results: There were no significant changes in baseline levels of estimated GFR, creatinine and Na comparing 4–7 sauna sessions/week versus 1 sauna session/week; there was a slight increase in K.05 mmoL/L (95% CI,.00,.10; p =.033). There were no significant changes in levels of serum K and Na at 11 years. After 25.7 years overall median follow‐up, 188 CKD cases were recorded. Comparing 4–7 sauna sessions/week with 1 sauna session/week, there was no evidence of an association with CKD.84 (95% CI,.46–1.53; p =.56). Conclusions: Cross‐sectional and longitudinal observational evidence suggests that frequent sauna bathing is not associated with impaired renal function or the future risk of CKD. [ABSTRACT FROM AUTHOR]

Purpose: To compare the oncological and renal function outcomes for patients receiving microwave ablation (MWA) in tumors < 3 and 3–4 cm. Methods: Retrospective analysis of a prospectively maintained database identified patients with < 3 or 3–4 cm renal cancers undergoing MWA. Radiographic follow-up occurred at approximately 6 months post-procedure and annually thereafter. Serum creatinine and estimated glomerular filtration rate (eGFR) were calculated before and 6-months post-MWA. Local recurrence-free survival (LRFS) was estimated using the Kaplan–Meier method. Tumor size was evaluated as a prognostic factor using Cox proportional-hazards regression. Predictors for change in eGFR and chronic kidney disease (CKD) stage were modeled using linear and ordinal logistic regression. Results: A total of 126 patients fit the inclusion criteria. Overall recurrences were 2/62 (3.2%) and 6/64 (9.4%) for < 3 versus 3–4 cm. Both recurrences in the < 3 cm group were local, 4/6 in the 3–4 cm group were local and 2/6 were metastatic without local progression. For < 3 versus 3–4 cm, cumulative LRFS at 36 months was 94.6% versus 91.4%. Tumor size was not a significant prognostic factor for LRFS. Renal function did not change significantly after MWA. Patient comorbidities and RENAL nephrometry score significantly affected change in CKD. Conclusion: With comparable oncological outcomes, complication rates, and renal function preservation, MWA is a promising management strategy for renal masses of 3–4 cm in select patients. Our findings suggest that current AUA guidelines, which recommend thermal ablation for tumors < 3 cm, may need review to include T1a tumors for MWA, regardless of size. [ABSTRACT FROM AUTHOR]

Cardiovascular mortality is a leading cause of death in chronic kidney disease (CKD), as is IgA nephropathy (IgAN). The purpose of this study is to find different biomarkers to estimate the outcome of the disease, which is significantly influenced by the changes in vessels (characterized by arterial stiffness) and the heart. In our cross-sectional study, 90 patients with IgAN were examined. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) was measured as a heart failure biomarker by an automated immonoassay method, while the carboxy-terminal telopeptide of collagen type I (CITP) as a fibrosis marker was determined using ELISA kits. Arterial stiffness was determined by measuring carotid–femoral pulse wave velocity (cfPWV). Renal function and routine echocardiography examinations were performed as well. Based on eGFR, patients were separated into two categories, CKD 1-2 and CKD 3-5. There were significantly higher NT-proBNP (p = 0.035), cfPWV (p = 0.004), and central aortic systolic pressure (p = 0.037), but not CITP, in the CKD 3-5 group. Both biomarker positivities were significantly higher in the CKD 3-5 group (p = 0.035) compared to the CKD 1-2 group. The central aortic systolic pressure was significantly higher in the diastolic dysfunction group (p = 0.034), while the systolic blood pressure was not. eGFR and hemoglobin levels showed a strong negative correlation, while left ventricular mass index (LVMI), aortic pulse pressure, central aortic systolic pressure, and cfPWV showed a positive correlation with NT-proBNP. cfPWV, aortic pulse pressure, and LVMI showed a strong positive correlation with CITP. Only eGFR was an independent predictor of NT-proBNP by linear regression analysis. NT-proBNP and CITP biomarkers may help to identify IgAN patients at high risk for subclinical heart failure and further atherosclerotic disease. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between urinary ceruloplasmin (CP) and kidney injury molecule-1 (KIM-1) and renal function in patients with diabetic kidney disease (DKD) and their predictive value for poor prognosis. Methods: The clinical data of 160 patients with DKD who were admitted to Department of Nephrology, Army 82nd Group Military Hospital from January 2017 to January 2019 (DKD group) were retrospectively analyzed, and they were followed up for 3 years, according to whether they developed end-stage renal disease (ESRD), they were divided into poor prognosis group with 42 cases and good prognosis group with 118 cases. And another 56 patients with pure type 2 diabetes mellitus (T2DM) in the same period were selected as the T2DM group and 47 healthy individuals on physical examination as the control group. Urinary CP and KIM-1 levels were measured by microscopic method and enzyme-linked immunosorbent assay, and urinary albumin to creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) were calculated. Spearman correlation was used to analyze the correlation between urinary CP and KIM-1 and UACR and eGFR in patients with DKD. Univariate and multivariate Logistic regression were used to analyze the influencing factors of poor prognosis in patients with DKD. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of urinary CP and KIM-1 for poor prognosis in patients with DKD. Results: After 3 years of follow-up, 42 cases of 160 patients with DKD developed ESRD, and the incidence of poor prognosis was 26.25% (42/160). Urinary CP, KIM-1 and UACR in the DKD group were higher than those in the T2DM group and control group, and eGFR was lower than that in the T2DM group and control group (P<0.05). Urinary CP, KIM-1 and UACR in the T2DM group were higher than those in the control group, and eGFR was lower than that in the control group (P<0.05). Spearman correlation analysis showed that urinary CP and KIM-1 were positively correlated with UACR (all P<0.001), and negatively correlated with eGFR (all P<0.001). Multivariate Logistic regression analysis showed that hypertension, DKD stage 4, glycosylated hemoglobin (HbA1c) (higher), low-density lipoprotein cholesterol (LDL-C) (higher), UACR (higher), CP (higher), KIM-1 (higher) were independent risk factors for poor prognosis in patients with DKD(P<0.05), the eGFR (higher) was an independent protective factor(P<0.05). ROC curve analysis showed that the area under curve of urinary CP and KIM-1 in predicting poor prognosis of patients with DKD was greater than that of each indicator alone. Conclusions: Elevated urinary CP and KIM-1 in patients with DKD are closely associated with reduced renal function and poor prognosis, and the combination of urinary CP and KIM-1 has a high value in predicting the poor prognosis of patients with DKD. [ABSTRACT FROM AUTHOR]

Objective: To analyze the relationship between ceruloplasmin（CER）, squamous cell carcinoma associated antigen（SCCA） and chronic renal failure（CRF） and their predictive value for disease progression. Methods: A total of 169 patients with chronic renal failure admitted to our hospital from April 2019 to April 2021 were selected as the study subjects. According to 12 h urinary albumin quantification,the patients were divided into microalbuminuria group（＜200 mg/24 h, 102 cases） and macroalbuminuria group（＞200 mg/24 h, 67 cases）. The laboratory indexes and serum CER and SCCA levels of the two groups were compared, and the relationship between CER, SCCA and renal function indexes of patients with chronic renal failure was analyzed. Patients were followed up for 24 months to observe the progression of the disease. Area under receiver operating Characteristic Curve（AUC） was used to evaluate the predictive efficacy of CER combined with SCCA on the progression of the disease. Results: The levels of serum creatinine（Scr） and blood urea nitrogen（BUN） in moderate proteinuria group were higher than those in mild proteinuria group, and the glomerular filtration rate（GFR） was lower than that in mild proteinuria group（P＜0.05）. The levels of CER and SCCA in moderate proteinuria group were higher than those in mild proteinuria group（P＜0.05）. Pearson correlation analysis showed that CER and SCCA levels were positively correlated with Scr and BUN, but negatively correlated with GFR（P＜0.05）. Multivariate Logistic regression analysis showed that GFR,CER and SCCA were independent predictors of chronic renal failure（P＜0.05）. According to ROC curve analysis, the AUC of CER combined with SCCA in predicting the progression of chronic renal failure was 0.926,which was significantly higher than 0.683 of GFR（P＜0.05）. Conclusion: The levels of CER and SCCA are negatively correlated with renal function in patients with chronic renal failure. The combined efficacy of CER and SCCA in predicting the progression of patients’ disease is good and worthy of clinical attention. [ABSTRACT FROM AUTHOR]

To investigate the effect of sodium butyrate (NaB) on renal function in rats with chronic renal failure (CRF) by regulating silent information regulator 1 (SIRT1)/adenosine monophosphate activated protein kinase (AMPK) signal pathway. A total of 72 SD rats were selected, and they were randomly divided into six groups (12 rats/group): control group, Model group, low dose NaB group (100 mg/kg), medium dose NaB group (200 mg/kg), high dose NaB group (400 mg/kg), and inhibitor group (400 mg/kg NaB+2 mg/kg SIRT1/AMPK pathway inhibitor EX527). The CRF rat model was established by feeding 0.5% adenine feed, and after successful modeling, the corresponding drugs were injected by gavage and intraperitoneal injection. The levels of 24 h urine protein (24 h U-pro), serum creatinine (Scr) and blood urea nitrogen (BUN) in rats were detected with the kits. The hematoxylin-eosin (HE) and Masson staining were used to observe the pathological changes of the kidney, and the collagen volume fraction (CVF) was calculated. The alizarin red staining and aortic calcium content determination were used to evaluate aortic calcification. The levels of interleukin (IL)-6, IL-β and tumor necrosis factor-alpha (TNF-α) in kidney tissue of rats in each group were detected by enzyme-linked immunosorbent assay (ELISA). The levels of CAT, MDA and ROS in kidney tissue of rats were detected with catalase (CAT), malondialdehyde (MDA) and reactive oxygen species (ROS) detection kits. The western blot was used to detect the expression of SIRT1/AMPK signal pathway and bone morphogenetic protein 2 (BMP2) and Runt-related transcription factor 2 (Runx2) protein in rats in each group. Compared with the control group, the kidney tissue of rats in the model group was severely damaged, collagen fiber deposition was significant, aortic calcification was serious, CAT activity, SIRT1, p-AMPK/AMPK expression levels were significantly decreased (P<0.05), while CVF, aortic calcium content and SCr, BUN, 24h U-pro, IL-6, IL-β, TNF-α, MDA, ROS and BMP2, Runx2 protein expression levels were significantly increased (P<0.05). Compared with the model group, the renal tissue damage, collagen fiber deposition area, aortic calcification, CVF, aortic calcium content, and SCr, BUN, 24h U-pro, IL-6, IL-β, TNF-α, MDA, ROS and BMP2, Runx2 protein expression levels in the low, middle, and high dose NaB groups were significantly decreased (P<0.05), while CAT activity, SIRT1, p-AMPK/AMPK expression were significantly increased (P<0.05). EX527, an inhibitor of SIRT1/AMPK pathway, could reduce the improvement of aortic calcification and renal function in CRF rats by high-dose NaB (P<0.05). NaB may play a role in improving the renal function of CRF rats by activating SIRT1/AMPK signal pathway and reducing renal tissue inflammation, oxidative stress injury, aortic calcification and renal fibrosis. [ABSTRACT FROM AUTHOR]

Purpose: Modification of Diet in Renal Disease' (MDRD) and 'Chronic Kidney Disease Epidemiology Collaboration' (CKD-EPI) formulas are generally accepted and widely utilized tools to assess renal function. In this study, we aimed to investigate the power of the MDRD and CKDEPI formulas, which are the two most used formulas in the measurement of eGFR in patients with multiple myeloma (MM). Materials and Methods: A total of 40 patients, newly diagnosis with MM, were consecutively enrolled to the study and their records were analyzed in terms of demographic features and laboratory parameters of the patients, type of paraproteinemia and stage of disease. MDRD and CKD-EPI formulas were used to evaluate renal function. Results: The difference found between basal and thirdmonth estimated Glomerular Filtration Rate (eGFR) using MDRD (61±15.4 mL/min/1.73 m², third month 75±18.2 mL/min/1.73 m²) and CKD-EPI formulas (62±15.7 mL/min/1.73 m², third month 76±18.4 mL/min/1.73 m²) were significant. There was no significant difference between two formulas regarding basal and third month eGFR mean values. According to CKD staging, 12.5% of all subjects changed and 80% of them moved to better stage. Conclusion: CKD-EPI tends to produce higher eGFR values with compared to MDRD, especially when they are used to evaluate mildly impaired renal function. Hence, prevalence of renal disease was determined lower when assessed with CKD-EPI. Therefore, we recommend that it is important to use the same eGFR estimation formula for a consistent outcomes analysis. [ABSTRACT FROM AUTHOR]

It is known that prematurity and low birth weight are associated with chronic kidney disease and hypertension. A positive correlation between kidney volume and birth weight was also described. In our ongoing observational study we revealed highly abnormal kidney ultrasound and renal functions in a male patient (birth weight 370 grams) at the age of fi ve. It was his fi rst nephrology examination since discharge from the hospital. We believe that thorough follow up and timely diagnosis of developing renal insuffi ciency may help us to initiate proper treatment in high-risk children (Tab. 1, Fig. 1, Ref. 7). Text in PDF www.elis.sk. [ABSTRACT FROM AUTHOR]

Background: Scintigraphy with technetium‐99m‐labelled dimercaptosuccinic acid ([99mTc]Tc‐DMSA) is widely used for renal cortical imaging. Uptake of [99mTc]Tc‐DMSA has been shown to correlate with glomerular filtration rate (GFR). Prostate‐specific membrane antigen (PSMA) radiopharmaceuticals used for positron emission tomography (PET) show high renal uptake and are being investigated for renal imaging. [68Ga]Ga‐PSMA‐11 PET parameters have been shown to correlate with estimated GFR (eGFR). The aim of this study was to investigate the relationship between renal [18F]PSMA‐1007 uptake and eGFR. Methods: Hundred and eighty‐five patients underwent PET imaging at 1 and 2 h after injection of 4.0 ± 0.2 MBq [18F]PSMA‐1007. Serum creatinine levels were measured and GFR estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) and Modification of Diet in Renal Disease (MDRD) equations. Fifteen patients were excluded due to missing or incorrect data. Thus, data from 170 patients were analyzed. Kidneys were segmented in the PET images using a convolutional neural network with manual correction. For each kidney, mean standardized uptake value (SUVmean) and segmentation volume in millilitres were measured. Linear regression analyses were performed with eGFR as the outcome variable. Results: Variation in the eGFR values was explained to a significant degree by SUVmean and renal segmentation volume in both the 1 and 2 h images. This correlation was stronger for CKD‐EPI eGFR (1 h R2 = 0.64; 2 h R2 = 0.64) than for MDRD eGFR (1 h R2 = 0.47; 2 h R2 = 0.45). Conclusion: Renal [18F]PSMA‐1007 uptake parameters correlate with eGFR and are indicative of renal cortical function. [ABSTRACT FROM AUTHOR]

Background: Both direct and indirect effects of COVID-19 have been found in all age groups. In particular, adult data demonstrated significant changes in patients with chronic and metabolic disease (e.g., obesity, diabetes, chronic kidney disease (CKD), and metabolic associated fatty liver dysfunction (MAFLD)), while similar pediatric evidence is still limited. We aimed at investigating the impact of the COVID-19 pandemic lockdown on the relationship between MAFLD and renal function in children with CKD due to congenital abnormalities of the kidney and urinary tract (CAKUT). Methods: A total of 21 children with CAKUT and CKD ≥ stage 1 underwent a comprehensive evaluation within 3 months before and 6 months after the first Italian lockdown. Results: At follow-up, CKD patients with MAFLD presented higher BMI-SDS, serum uric acid, triglycerides, and microalbuminuria levels and lower eGFR levels than those without MAFLD (all p < 0.05). Higher ferritin and white blood cell concentrations were also found in patients with CKD diagnosed with MAFLD than peers without MAFLD (both p = 0.01). Compared to children without MAFLD, a higher delta of BMI-SDS, eGFR levels, and microalbuminuria levels was found in patients with MAFLD. Conclusions: Due to the negative influence of the COVID-19 lockdown on cardiometabolic health in childhood, a careful management of children with CKD is warranted. [ABSTRACT FROM AUTHOR]

The cardio-renal syndrome (CRS) type 2 is defined as a progressive loss of renal function following a primary insult to the myocardium that may be either acute or chronic but is accompanied by a decline in myocardial pump performance. The treatment of patients with CRS is difficult, and the disease often progresses to end-stage renal disease that is refractory to conventional therapy. While a good deal of information is known concerning renal injury in the CRS, less is understood about how reflex control of renal sympathetic nerve activity affects this syndrome. In this review, we provide insight into the role of the renal nerves, both from the afferent or sensory side and from the efferent side, in mediating renal dysfunction in CRS. We discuss how interventions such as renal denervation and abrogation of systemic reflexes may be used to alleviate renal dysfunction in the setting of chronic heart failure. We specifically focus on a novel cardiac sensory reflex that is sensitized in heart failure and activates the sympathetic nervous system, especially outflow to the kidney. This so-called Cardiac Sympathetic Afferent Reflex (CSAR) can be ablated using the potent neurotoxin resinferitoxin due to the high expression of Transient Receptor Potential Vanilloid 1 (TRPV1) receptors. Following ablation of the CSAR, several markers of renal dysfunction are reversed in the post-myocardial infarction heart failure state. This review puts forth the novel idea of neuromodulation at the cardiac level in the treatment of CRS Type 2. [ABSTRACT FROM AUTHOR]

Objective: With the rising prevalence of chronic kidney disease (CKD) and the increasing demand for joint arthroplasty, the management of CKD patients in the perioperative period of joint arthroplasty has become an issue worthy of attention for orthopedic surgeons. This study aimed to explore comprehensive perioperative period management strategies for CKD patients. Methods: From March 2017 to August 2022, 62 patients who underwent joint arthroplasty in our hospital were included in a retrospective study, including 31 CKD patients (mean age 69.8 ± 13.4 years old) and 31 non‐CKD patients (mean age 69.4 ± 14.2 years old). The outcome indicators were analyzed, including serum urea, serum creatinine, blood uric acid, hematocrit, and hemoglobin. Results: All patients included in the retrospective study had an average preoperative preparation time of 4.3 ± 2.6 days and an average hospitalization time of 11.0 ± 7.3 days. There were no significant differences in the changes in the serum urea values between the preoperative and postoperative measurements in the CKD patients or in the serum creatinine values and blood uric acid values (P > 0.05). The hemoglobin value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P < 0.05). The hematocrit value in postoperative measurements was lower than in preoperative measurements in the CKD patients (P < 0.001). Conclusion: Patients with CKD have distinct characteristics compared to non‐CKD patients, and they generally have a higher risk for postoperative complications and adverse events. Recognition of risk factors, suitable timing of surgery, the undertaking of protective strategies, and proper management of complications are vital for managing CKD patients in the perioperative period of joint arthroplasty. [ABSTRACT FROM AUTHOR]

Introduction: Chronic hypoxia is prevalent in chronic kidney disease (CKD), and blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) provides noninvasive evaluation of renal oxygenation. This study aimed to explore the correlation of renal oxygenation evaluated by BOLD-MRI with renal function. Methods: 97 non-dialysis patients with CKD stages 1–5 and healthy volunteers (HVs) were recruited in the study, all participants without diabetes. Based on their estimated glomerular filtration rate (eGFR), the patients were divided into two groups: CKD stages 1–3 (CKD 1–3) and CKD stages 4–5 (CKD 4–5). We measured cortical and medullary T2* (COT2* and MET2*) values in all participants by BOLD-MRI. Physiological indices were also recorded and compared among three groups. Correlation of T2* values with clinical characteristics was determined. Results: The COT2* values were significantly higher than MET2* values in all participants. The COT2* and MET2* values of three groups were ranked as HV > CKD 1–3> CKD 4–5 (p < 0.0001). There were positive correlations between the COT2* values, MET2* values and eGFR, hemoglobin (r > 0.4, p < 0.01). The 24-h urinary protein (24-h Upr) showed weak correlation with the COT2* value (rs = −0.2301, p = 0.0265) and no correlation with the MET2* value (p > 0.05). Urinary microprotein, including urinary alpha1-microglobulin, urinary beta2-microglobulin (β2-MG), and urinary retinol-binding protein (RBP), showed strong correlation with COT2* and MET2* values. According to the analysis of receiver operating characteristic curve, the optimal cut-points between HV and CKD 1–3 were "<61.17 ms" (sensitivity: 91.23%, specificity: 100%) for COT2* values and "<35.00 ms" (sensitivity: 77.19%, specificity: 100%) for MET2* values, whereas COT2* values ("<47.34 ms"; sensitivity: 90.00%, specificity: 92.98%) and MET2* values ("<25.09 ms"; sensitivity: 97.50%, specificity: 80.70%) between CKD 1–3 and CKD 4–5. Conclusion: The decline of renal oxygenation reflected on T2* values, especially in cortex, may be an effective diagnostic marker for early detection of CKD. [ABSTRACT FROM AUTHOR]

Background: After liver transplantation (LT), tacrolimus and ciclosporin treatment can lead to, partially concentration‐dependent, chronic kidney disease. Monitoring ciclosporin with two‐hour levels reduced overexposure and led to better renal function than trough‐monitoring (C0). For tacrolimus, a 4‐hour level (C4) can give a reasonable approximation of total drug exposure. We evaluated whether monitoring tacrolimus in stable patients after LT by C4 was superior to C0 regarding renal function, rejection and metabolic parameters. Methods: This open label randomized controlled trial compared C4 monitoring of tacrolimus BID (Prograft) to trough (C0) monitoring in stable LT recipients. The target range for C4 of 7.8–16 ng/ml was calculated to be comparable with target C0 of 4–8 ng/ml. Primary endpoint was the effect on renal function and secondary endpoints were the occurrence of treated biopsy‐proven acute rejection, blood pressure and metabolic parameters, during 3 months of follow‐up. Results: Fifty patients were randomized to C0 (n = 25) or C4 (n = 25) monitoring. There was no difference in renal function between the C0 and the C4 group (p =.98 and p =.13 for CG and MDRD at 3 months). Also, the amount of proteinuria was similar (p =.59). None of the patients suffered from graft loss or was treated for rejection. Metabolic parameters did not differ between the two groups. Conclusion: Tacrolimus 4‐hour monitoring in stable LT patients is not superior to trough monitoring, regarding the effect on renal function, but is safe for use to facilitate tacrolimus monitoring in an afternoon outpatient clinic. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a long-term condition characterized by poor prognosis and a high mortality rate. Panax notoginseng saponins (PNS) are the main active ingredient of the traditional Chinese herb Panaxnotoginseng(Burk.)F.H.Chen, which has been widely reported to have various pharmacological effects. Here, we examined the effect of PNS on renal function and the modulation of intestinal flora and intestinal barrier in a rat model of adenine-induced CKD. Adenine was used to establish a rat model of CKD, biochemical testing, histopathologic examination, ELISA, immunohistochemical assay, western blot assay, and fecal microbiota 16s rRNA analysis was used to test the effect of PNS on CKD rats. Adenine induced a significant decrease in glomerular filtration rate, an increase in urinary protein excretion rate, and pathological damage to renal tissue in CKD rats. TNF-α, MCP-1, IL-1β, IL-18, TMAO, and endotoxin levels were increased in the blood of the model rats. Application of PNS countered the effects of adenine, restoring the above parameters to the level observed in healthy rats. In addition, activation of the inflammatory proteins NF-κB (p65) and NLRP3 and the fibrosis-associated proteins α-SMA and smad3 were inhibited in the kidneys of CKD rats. Furthermore, PNS promoted the expression of the tight junction proteins Occludin and ZO-1, increased SIgA levels, strengthened intestinal immunity, reduced mechanical damage to the intestine, was reduced levels of DAO and D-LA. Our data suggest PNS may delay CKD by restoring gut microbiota, and through the subsequent generation of a microbial barrier and modulation of microbiota metabolites. In conclusion, PNS may inhibit the development of inflammation and fibrosis in the kidney tissue through regulation of intestinal microorganisms and inhibition of the activation of pro-inflammatory and pro-fibrotic proteins in the kidney. [ABSTRACT FROM AUTHOR]

To compare the hemodialysis effects of autologous arteriovenous fistula (AVF) and tunnel cuffed catheter (TCC) in patients with chronic renal failure (CRF) and their effects on inflammatory factors, nutritional level and renal function. 150 patients with CRF who were treated in Chaohu Hospital Affiliated to Anhui Medical University from January 2019 to January 2021 were included in the study. All patients were randomly divided into AVF group and TCC group, with 75 cases in each group. The hemodialysis effects of the two groups were observed and compared, the changes of inflammatory factors, nutritional level and renal function were compared between the two groups, and the complications of the two groups were recorded. 6 months after dialysis, the urea clearance index (KT/V) and urea clearance rate (URR) in AVF group were higher than those in TCC group (P<0.05). In AVF group at 6 months after dialysis, interleukin-6 (IL-6), tumor necrosis factor (TNF- α) and high-sensitivity C-reactive protein (hs-CRP) were lower than those in TCC group (P<0.05). Albumin (ALB) and prealbumin (PAB) in AVF group at 6 months after dialysis were higher than those in TCC group (P<0.05). 6 months after dialysis, urea nitrogen (BUN) and creatinine (Scr) in the two groups decreased compared with those before treatment, and those in AVF group were lower than those in TCC group (P<0.05). The incidence of complications in AVF group was lower than that in TCC group (P<0.05). The clinical effect of hemodialysis with AVF pathway in patients with CRF is more significant than that with TCC pathway. It can effectively improve the renal function of patients, reduce the level of blood inflammatory factors, and reduce the incidence of complications. It has a relatively slight impact on the nutritional status of the body, which has a better clinical application value. [ABSTRACT FROM AUTHOR]

Patients with chronic kidney disease are at increased risk of medication errors and adverse events due to decreased renal function, slowed drug metabolism and excretion, which puts forward higher requirements for clinicians in drug selection and drug dose determination. At present, clinical decision support system (CDSS) has been widely used to reduce drug errors and improve drug safety, providing a new idea for assisting clinicians to make drug decisions based on patients’ renal function level. This paper aims to review the construction methods, validation, deficiencies and optimization of CDSS based on renal function level, and provide reference for constructing efficient CDSS based on renal function level. [ABSTRACT FROM AUTHOR]

Objective: To evaluate long‐term renal function in patients with chronic kidney disease (CKD) Stage IIIa who underwent radical cystectomy and orthotopic neobladder (RC/ONB) compared to matched controls. Patients and Methods: Using our Institutional Review Board‐approved institutional database, patients with a glomerular filtration rate (GFR) of 45–59.9 mL/min/1.73 m2 who underwent RC/ONB were identified. A control group of patients with a GFR of ≥60 mL/min/1.73 m2 was selected. Groups were matched based on age, baseline hypertension/diabetes mellitus, perioperative chemotherapy, and preoperative hydronephrosis. A decrease in GFR of >10 mL/min/1.73 m2 during the follow‐up was considered significant. A multivariate Cox regression analysis was performed to identify predictors of GFR decline in each group. Results: Of 1237 patients who underwent RC/ONB, 508 patients were included (254 per group). The mean preoperative GFR was 53.3 mL/min/1.73 m2 in the study group and 78.8 mL/min/1.73 m2 in controls. The median follow‐up was 3.7 years. During follow‐up, GFR stayed at or above baseline in 51% of the study patients compared to 46% of the controls (P = 0.5). The mean time to a significant GFR decline in the study patients was significantly longer compared to the controls (5.6 vs 2 years, respectively; P < 0.001). In multivariate analysis, neoadjuvant chemotherapy was found to be the strongest predictor of a significant GFR decline as well as GFR decline below baseline (hazard ratio [HR] 2.15, 95% confidence interval [CI] 1.4–3.29, P = 0.004; and HR 2.15, 95% CI 1.4–3.29, P < 0.001, respectively). Conclusion: Patients with CKD Stage IIIa who undergo ONB appear to have comparable long‐term renal function to those with a GFR of ≥60 mL/min/1.73 m2. An ONB reconstruction is a safe option for patients with CKD Stage IIIa desiring a continent diversion. [ABSTRACT FROM AUTHOR]

• ITLN1 shows promise in alleviating radiation-induced kidney damage. • Activation of the Akt/GSK-3β/Nrf2 pathway plays a key role in the protective mechanism. • ITLN1 overexpression improves renal function and reduces oxidative stress. • Cellular apoptosis, inflammation, senescence, and fibrosis are mitigated by ITLN1. • This study offers insights for potential therapeutic strategies against radiation-induced kidney injury. Radiation-induced kidney injury is a common side effect of radiotherapy, as the pelvic region is in close proximity to the kidneys, posing a risk of inducing radiation-induced kidney injury when treating any pelvic malignancies with radiotherapy. This type of injury typically manifests as chronic kidney disease a few months after radiotherapy, with the potential to progress to end-stage renal disease. Radiation-induced damage involves various components of the kidney, including glomeruli, tubules, interstitium, and extracellular matrix. Therefore, investigating its molecular mechanisms is crucial. In this study, we extensively searched literature databases, selecting recent transcriptomic studies related to acute kidney injury (AKI) published in the past decade. We downloaded the raw RNA sequencing datasets GSE30718 and GSE66494 related to AKI from the GEO database and identified that intestinal-type lectin ITLN1 plays a significant role in regulating radiation-induced kidney injury in rats. Differential gene analysis was performed using chip data from the GEO database, and further bioinformatics analysis identified 13 genes that may be involved in regulating kidney injury, with ITLN1 being the most relevant to kidney damage, thus selected as the target gene for this study. Subsequently, a rat model of radiation-induced kidney injury was established for experimental validation, assessing kidney tissue morphology and injury extent through staining observation and immunohistochemical staining. The protective effect of ITLN1 on kidney function was evaluated by measuring changes in rat body weight and blood pressure, serum kidney injury markers, and kidney structure. The experimental results indicate that overexpression of ITLN1 can improve kidney function in rats with radiation-induced kidney injury by activating the Akt/GSK-3β/Nrf2 signaling pathway, suppressing oxidative stress, cell apoptosis, inflammation, cellular senescence, and fibrosis. This study highlights the significant role of ITLN1 in regulating kidney injury, providing a novel target for future treatments of radiation-induced kidney injury. [ABSTRACT FROM AUTHOR]

We aimed to investigate the value of amide proton transfer magnetic resonance imaging (APT-MRI) in the classification of chronic kidney disease (CKD). A total of 30 patients with chronic kidney disease (CKD) and 25 healthy volunteers were enrolled in this study. Patients with chronic kidney disease were divided into two groups according to glomerular filtration rates: mild and moderate-to-severe renal impairment. Differences in cortical and medullary APT values were compared, and the correlation between corticomedullary APT values and glomerular filtration rates was analyzed. Data were statistically analyzed using SPSS 23.0. Based on glomerular filtration rates, 14 patients were assigned to the mild renal impairment group, and 16 were assigned to the moderate-to-severe renal impairment group. Both of the cortical and medullary APT values showed a gradually increasing trend in the control, the mild, and the moderate-to-severe renal impairment groups. Cortical APT values were higher than medullary APT values in all the control and renal impairment groups (P < 0.05). APT values of the right renal cortex (r = −0.80, P < 0.05) and medulla (r = −0.83, P < 0.05) were negatively correlated with the glomerular filtration rate. Results of the receiver operating characteristic (ROC) curve analysis showed that corticomedullary APT values had high diagnostic efficacy in assessing different degrees of renal impairment. The APT values of the cortex and medulla in patients with CKD gradually increased with disease progression. These findings indicated that APT imaging can be used to evaluate renal function and renal injury in patients with CKD. [ABSTRACT FROM AUTHOR]

Background: Accuracy of glomerular filtration rate estimating (eGFR) equations has significant implications in cirrhosis, potentially guiding simultaneous liver kidney allocation and drug dosing. Most equations adjust for Black race, partially accounted for by reported differences in muscle mass by race. Patients with cirrhosis, however, are prone to sarcopenia which may mitigate such differences. We evaluated the association between baseline eGFR and incident acute kidney injury (AKI) in patients with cirrhosis with and without race adjustment. Methods: We conducted a retrospective national cohort study of veterans with cirrhosis. Baseline eGFR was calculated using multiple eGFR equations including Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), both with and without race adjustment. Poisson regression was used to investigate the association between baseline eGFR and incident AKI events per International Club of Ascites criteria. Results: We identified 72,267 patients with cirrhosis, who were 97.3% male, 57.8% white, and 19.7% Black. Over median follow-up 2.78 years (interquartile range 1.22–5.16), lower baseline eGFR by CKD-EPI was significantly associated with higher rates of AKI in adjusted models. For all equations this association was minimally impacted when race adjustment was removed. For example, removal of race adjustment from CKD-EPI resulted in a 0.1% increase in the association between lower eGFR and higher rate of AKI events per 15 mL/min/1.73 m2 change (p < 0.001). Conclusions: Race adjustment in eGFR equations did not enhance AKI risk estimation in patients with cirrhosis. Further study is warranted to assess the impacts of removing race from eGFR equations on clinical outcomes and policy. [ABSTRACT FROM AUTHOR]

Reports suggest that renal decline is greater among patients with non-valvular atrial fibrillation (NVAF) treated chronically with warfarin vs. some non-vitamin K antagonist oral anticoagulants. Using primary care electronic health records from the United Kingdom we followed adults with NVAF and who started rivaroxaban (20 mg/day, N = 5338) or warfarin (N = 6314), excluding those with estimated glomerular filtration rate (eGFR) <50 ml/min/1.73m2, end-stage renal disease (ESRD) or no eGFR or serum creatinine (SCr) values recorded in the previous year. Outcomes were: doubling SCr levels, ≥30% decline in eGFR and progression to ESRD. We calculated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for each outcome. Average eGFR slope was estimated using mixed model regression. After a mean follow-up 2.5 years, the number of incident cases of adverse renal events within the two cohorts was: doubling SCr (n = 322), ≥30% decline in eGFR (n = 1179), and progression to ESRD (n = 22). Adjusted HRs (95% CIs) for the renal outcomes among rivaroxaban vs. warfarin users were: doubling SCr, 0.63 (0.49–0.81); ≥30% decline in eGFR, 0.76 (0.67–0.86); ESRD, 0.77 (0.29–2.04). Similar results were observed among patients with diabetes or heart failure. Estimated mean decline in renal function over the study period was 2.03 ml/min/1.73 m2/year among warfarin users and 1.65 ml/min/1.73 m2/year among rivaroxaban users (p = 0.03). We found clear evidence that patients with NVAF, preserved renal function at baseline and treated with rivaroxaban had a markedly reduced risk and rate of renal decline compared with those treated with warfarin. [Display omitted] • In AF, rivaroxaban users had ~30% lower risk of adverse renal events (vs warfarin). • This finding was also seen in subgroups of patients with diabetes or heart failure. • Rate of renal decline was also faster in users of warfarin vs rivaroxaban (p = 0.03). [ABSTRACT FROM AUTHOR]

To observe the effects of Haikun Shenxi capsule combined with coated aldehyde oxystarch on renal function, inflammatory factors and quality of life in patients with chronic renal failure (CRF). 93 patients with CRF who were treat-ed in our hospital from May 2019 to April 2021 were selected. According to the two-color ball scheme, the patients were divided intocontrol group (46 cases) and study group (47 cases). The control group was treated with coated aldehyde oxystarch, and the study groupwas treated with Haikun Shenxi capsule combined with coated aldehyde oxystarch. The efficacy and medication safety of the two groups were observed. The changes of renal function, inflammatory factors and quality of life were compared between the two groups. The total clinical effective rate of the study group was higher than that of the control group(P<0.05). 8 weeks after treatment, the levels of serum creatinine(Scr), urea nitrogen (BUN) and β2-microglobulin（β2-MG) in both groups were decreased, and the study group was lower than the control group. The level of albumin (ALB) in the two groups was increased, and the study group was higher than the control group (P<0.05). 8 weeks after treatment, the levels of tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP) in both groups were decreased, and study group was lower than control group (P<0.05). 8 weeks after treatment, the scores of various items (physiological function, psychological function, social function and specific module) of chronic renal failure quality of Life Scale(QLICD-CRF2.0) in the study group were increased, and the study group was higher than the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Haikun Shenxi capsule combined with coated aldehyde oxystarch can effectively improve the renal function of patients with CRF, reduce the inflammatory response of the body, and improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

SCREAM (Stockholm CREAtinine Measurements project) was initiated in 2010 in collaboration with the healthcare provider of Stockholm County healthcare to quantify potential medication errors, estimate the burden of chronic kidney disease (CKD) and to illustrate the value of incorporating measures of kidney function into the medical decision process. Because most patients are unaware of their CKD and diagnoses are seldom issued, SCREAM took advantage of the commonness of serum/plasma creatinine testing, which can be used to estimate the glomerular filtration rate (eGFR) and classify the stage of CKD severity. SCREAM is periodically updated, and at present contains healthcare information of all residents in Stockholm region during 2006–2019 (about 3 million people), enriched with a broad range of laboratory measurements for those in whom creatinine or albuminuria has been measured (about 1.8 million people). This health information was linked with national administrative and quality registries via the unique personal identification number of each Swedish citizen, conforming the richest characterization in Sweden of the population's journey through health and disease. This review discusses the context of its creation, strengths and weakness, key findings and plans for the future. We summarize our findings related to the burden of CKD in Sweden, its adverse health risks (such as risk of infections, cancer or dementia) and how underlying kidney function alters the risk–benefit ratio of common medications. Results have had clinical impact and demonstrate the importance of population‐based research in the spectrum of clinical research to improve health. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between intraoperative anaesthetic parameters, primarily intraoperative hypotension, and postoperative renal function in patients undergoing nephrectomy. Patients and Methods: We reviewed data from 3240 consecutive patients who underwent nephrectomy between 2010 and 2018. Anaesthetic parameters evaluated included duration of hypotension, tachycardia, hypothermia, volatile anaesthetic use and mean arterial pressure in the post‐anaesthesia care unit. Outcomes included acute kidney injury (AKI) and estimated glomerular filtration rate (eGFR) within the first year after nephrectomy. Associations between anaesthetic parameters and outcomes were evaluated with multivariable logistic regression and generalised estimating equation, respectively, adjusted for predictors of renal function after nephrectomy. Results: Before nephrectomy, 677 (21%) patients had moderate–severe chronic kidney disease. A quarter of patients (n = 809) had postoperative AKI and 35% (n = 746) had Stage ≥3 chronic kidney disease 12‐months after surgery. Only 12% of patients (n = 386) had >5 min of intraoperative hypotension. While not statistically significant, longer duration of intraoperative hypotension was associated with slightly higher rates of AKI (odds ratio [OR] per 10‐min 1.14, 95% confidence interval [CI] 0.98, 1.32). Prolonged hypothermia was associated with increased rate of AKI (OR per 10‐min 1.02, 95% CI 1.00, 1.04), and decreased eGFR (change in eGFR per 10‐min −0.19, 95% CI −0.27, −0.12); however, these results have limited clinical significance. Conclusions: Under current practice, intraoperative anaesthetic parameters are tightly maintained, restricting the significance of their effect on postoperative renal function. Future studies should evaluate whether haemodynamic parameters during the early postoperative period, when they are monitored less frequently, are associated with renal functional outcome. [ABSTRACT FROM AUTHOR]

Background: Lithium-induced nephrotoxicity has long been debated. However, it has been rarely explored in Asian populations. The aim of the present study was to assess the effect of lithium maintenance therapy on estimated glomerular filtration rate (eGFR) in Korean patients diagnosed with a psychiatric illness. Methods: This was a single-centered, retrospective study that included patients treated with lithium or comparator drug (valproate) in Samsung Seoul Medical Center between November 1994 and July 2020. Patients diagnosed with ICD codes F20-33 who had ≥ 6 months of exposure to lithium or valproate were included. Patients had to have ≥ 1 baseline and ≥ 2 post-baseline eGFR data with post-baseline data having an interval of at least 30 days. Chronic kidney disease (CKD) was defined as CKD stage 3 (eGFR < 60 mL/min/1.732). To be considered as CKD, the threshold had to be met at two consecutive post-baseline measurements. Those treated with both lithium and valproate, diagnosed with CKD stages 3–5, diagnosed with a renal disease, or received kidney transplantation were excluded. Results: A total of 766 patients were included (242 treated with lithium and 524 with valproate). Two (0.8%) in the lithium group and 8 (1.5%) in the valproate group developed CKD stage 3. None developed CKD stages 4–5. Median yearly eGFR change was − 1.3 mL/min/1.732 (IQR: − 6.8, 1.7) for the lithium group and − 1.1 mL/min/1.732 (IQR: − 4.5, 1.5) for the valproate group, showing no significant difference between the two groups (p = 0.389). The rate of decline was more rapid for those with CKD in both groups. eGFR values of lithium and valproate groups did not show significant differences during a follow-up duration of 15 years or more. A significant negative correlation between baseline eGFR and yearly eGFR change was identified in a linear regression analysis. Conclusions: In Korean patients, treatment with lithium did not increase the risk of developing CKD compared to treatment with valproate. Prevalence of CKD was lower than those previously reported in western populations. Low baseline eGFR showed significant correlation with changes in renal function. [ABSTRACT FROM AUTHOR]

Background Activity of the sympathetic nervous system is increased in patients with hypertension and chronic kidney disease (CKD). Here we compare short- and long-term blood pressure (BP)-lowering effects of renal denervation (RDN) between hypertensive patients with or without CKD in the Global SYMPLICITY Registry. Methods Office and 24-h ambulatory BP (ABP) were assessed at prespecified time points after RDN. The presence of CKD was defined according to the estimated glomerular filtration rate (eGFR) and enrolled patients were stratified based on the presence (n  = 475, eGFR <60 mL/min/1.73 m2) or absence (n  = 1505, eGFR ≥60mL/min/1.73 m2) of CKD. Results Patients with CKD were older (P < 0.001) and were prescribed more antihypertensive medications (P < 0.001). eGFR decline per year was not significantly different between groups after the first year. Office and 24-h ABP were significantly reduced from baseline at all time points after RDN in both groups (all P < 0.001). After adjusting for baseline data, patients without CKD had a greater reduction in office systolic BP (−17.3 ± 28.3 versus −11.7 ± 29.9 mmHg; P = 0.009) but not diastolic BP at 36 months compared with those with CKD. Similar BP and eGFR results were found when the analysis was limited to patients with both baseline and 36-month BP data available. There was no difference in the safety profile of the RDN procedure between groups. Conclusions After adjusting for baseline data, 24-h systolic and diastolic ABP reduction were similar in patients with and without CKD after RDN, whereas office systolic but not diastolic BP was reduced less in patients with CKD. We conclude that RDN is an effective antihypertensive treatment option in CKD patients. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the long‐term effects of continent (neobladder) compared with incontinent (ileal conduit) urinary diversion. Methods: We carried out a retrospective review of our departmental database. Estimated glomerular filtration rate was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Neobladder and ileal conduit patients were matched in a 1:2 ratio and a propensity score‐matched analysis was carried out. Data were summarized using descriptive analysis. Trend plots were generated using baseline and follow‐up creatinine values to compare estimated glomerular filtration rate at 3 months, then annually for 5 years. Variables associated with estimated glomerular filtration rate were assessed using multivariate linear analysis. Results: Our cohort consisted of 137 patients (neobladder n = 50 and ileal conduit n = 87) with a median follow‐up time of 3 years (interquartile range 1–7 years). The ileal conduit group had shorter operative times (352 vs 444 min, P < 0.01), intracorporeal diversions were more common (66% vs 44%, P = 0.01), had prior abdominal surgery (66% vs 38%, P < 0.01) and had radiation (9% vs 0%, P = 0.03). The neobladder group more commonly had recurrent urinary tract infections (22% vs 3%, P < 0.01) and a steeper decrease in estimated glomerular filtration rate in the first year. On multivariate linear analysis, age/year (−0.59), body mass index per kg/m2 (−0.52), preoperative estimated glomerular filtration rate per unit (0.51), recurrent urinary tract infections (−14.03) and time versus day 90 (year 1, −7.52; year 2, −9.06; year 3, −10.78) were significantly associated with estimated glomerular filtration rate. Conclusion: Ileal conduits and neobladders showed a similar effect on the estimated glomerular filtration rate up to 5 years after robot‐assisted radical cystectomy. Recurrent urinary tract infections were associated with a worse estimated glomerular filtration rate. [ABSTRACT FROM AUTHOR]

Background Plasma copeptin is a surrogate of arginine vasopressin (AVP) secretion and is associated with a risk of renal and cardiovascular disease. We investigated associations between copeptin and renal events, cardiovascular events and mortality in type 1 diabetes (T1D). Methods We conducted a prospective cohort study on 658 individuals with T1D from Steno Diabetes Center Copenhagen. Plasma copeptin concentrations and conventional risk factors were assessed at baseline. The five endpoints were traced through national registries and electronic laboratory records. Results Baseline mean age was 55 ± 13 years and estimated glomerular filtration rate (eGFR) was 81 ± 26 mL/min/1.73 m2. The median follow-up was 6.2 years (interquartile range 5.8–6.7); 123 participants reached a combined renal endpoint [decline in eGFR ≥30%, end-stage kidney disease (ESKD) or all-cause mortality], 93 had a decrease in eGFR ≥30%, 21 developed ESKD, 94 experienced a combined cardiovascular endpoint and 58 died from all causes. Higher copeptin was associated with all endpoints in unadjusted Cox regression analyses. Upon adjustment for baseline eGFR, the associations were attenuated and remained significant only for the combined renal endpoint and decrease in eGFR ≥30%. Results were similar upon further adjustment for other risk factors, after which hazard ratios for the two renal endpoints were 2.27 (95% confidence interval 1.08–4.74) and 4.49 (1.77–11.4), respectively, for the highest versus the lowest quartile of copeptin. Conclusions Higher copeptin was an independent risk marker for a combined renal endpoint and decline in renal function. AVP may be a marker of renal damage or a factor whose contribution to renal and cardiovascular risk is partially mediated by renal damage. [ABSTRACT FROM AUTHOR]

Studies have shown that the use of statins could significantly improve lipid profiles; however, it remains controversial whether the use of statins could improve renal function in patients with chronic kidney disease (CKD). Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of statins on renal function in patients with CKD. We systematically searched PubMed, EMBASE, and the Cochrane Library databases for eligible RCTs from inception to October 2020. Pooled effect estimates were assigned as weighted mean differences (WMDs) with 95% confidence intervals (CIs) using the random-effects model. We selected 33 RCTs that recruited 37,391 patients with CKD patients. The summary results suggested that statin use significantly reduced urinary albumin (WMD: −2.04; 95%CI: −3.53 to −0.56; p =.007) and protein (WMD: −0.58; 95%CI: −0.95 to −0.21; p =.002) excretions and increased creatinine clearance (WMD: 0.86; 95%CI: 0.32–1.41; p =.002). However, there were no significant differences between statin and control groups in terms of changes in estimated glomerular filtration rate (WMD: 0.38; 95%CI: −0.04 to 0.79; p =.075), and serum creatinine levels (WMD: −0.07; 95%CI: −0.25, 0.12; p =.475). We found that statin use in patients with CKD may slow CKD progression by lowering urinary albumin and protein excretions or increasing creatinine clearance. Further large-scale RCTs should be conducted to evaluate the long-term effects of statins on renal outcomes. Abbreviations: CKD: chronic kidney disease; RCT: randomized controlled trials; WMD: weighted mean differences; CI: confidence intervals; ACEI: angiotensin-converting enzyme inhibitors; eGFR: estimated glomerular filtration rate [ABSTRACT FROM AUTHOR]

Background Acute kidney injury (AKI) is associated with a marked increase in mortality as well as subsequent chronic kidney disease (CKD) and end-stage kidney disease. We performed multiparametric magnetic resonance imaging (MRI) with the aim of identifying potential non-invasive MRI markers of renal pathophysiology in AKI and during recovery. Methods Nine participants underwent inpatient MRI scans at time of AKI; seven had follow-up scans at 3 months and 1 year following AKI. Multiparametric renal MRI assessed total kidney volume (TKV), renal perfusion using arterial spin labelling, T1 mapping and blood oxygen level-dependent (BOLD) R2* mapping. Results Serum creatinine concentration had recovered to baseline levels at 1-year post-AKI in all participants. At the time of AKI, participants had increased TKV, increased cortex/medulla T1 and reduced cortical perfusion compared with the expected ranges in healthy volunteers and people with CKD. TKV and T1 values decreased over time after AKI and returned to expected values in most but not all patients by 1 year. Cortical perfusion improved to a lesser extent and remained below the expected range in the majority of patients by 1-year post-AKI. BOLD R2* data showed a non-significant trend to increase over time post-AKI. Conclusions We observed a substantial increase in TKV and T1 during AKI and a marked decrease in cortical perfusion. Despite biochemical recovery at 1-year post-AKI, MRI measures indicated persisting abnormalities in some patients. We propose that such patients may be more likely to have further AKI episodes or progress to CKD and further longitudinal studies are required to investigate this. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid replacement therapy when it comes to chronic kidney disease (CKD) patients has the potential to save renal function. It is therefore of utmost importance to identify such cases and recognize when to initiate thyroid replacement therapy. Methods: This observational study was conducted on a cohort of 70 CKD patients from June 2020 to July 2020. All clinically stable patients for the last six months and on hemodialysis were included. Results: Around 30 (42.9%) cases belonged to stage 5, 37 (52.9%) belonged to stage 4, and 3 (4.3%) belonged to stage 3 of CKD. Hypothyroidism was seen in 17 (24.3%) cases. Conclusion: We found that the T3 hormone is inversely correlated with blood urea, creatinine levels, and positively correlated with hemoglobin levels. [ABSTRACT FROM AUTHOR]

Purpose: The current literature regarding the effect of blood loss (eBL) after nephron-sparing surgery (NSS) on long-term renal function is scarce. We tested the effect of eBL on the risk of developing chronic kidney disease (CKD) after NSS. Methods: Within an institutional prospectively maintained database, we identified 215 patients treated with NSS for cT1N0M0 renal mass at one European high-volume center. Multivariable logistic regression models tested the effect of eBL on the risk of developing CKD, after accounting for surgical complexity, individual clinical characteristics, and surgical experience. Multivariable linear regression models identified predictors of eBL. Results: After a median follow-up of 36 months, 55 (25.6%) patients experienced CKD after surgery. At multivariable analyses, eBL independently predicted higher risk of CKD after NSS (odds ratio [OR]: 1.16; 95% confidence intervals [CI] 1.04–1.30; p < 0.01). Specifically, the relationship between eBL and probability of CKD emerged as nonlinear, with a plateau from 0 to 500 mL of eBL and an increase afterward. When multivariable linear regression analyses investigated predictors of eBL, hypertension (Est: 127, 95% CI 12–242; p = 0.03), clinical size (Est: 47, 95% CI 7–87; p = 0.02), and PADUA score (Est: 42; 95% CI 4–80 p = 0.03) achieved independent predictor status for higher intraoperative eBL. Conversely, surgical experience was associated with lower eBL (p = 0.01). Conclusions: Intraoperative bleeding is independently associated with the risk of developing CKD after surgery, even after adjustment for well-known predictors of renal failure and tumor complexity. Hence, strategies aimed at maximally reducing such adverse events deserve special consideration. [ABSTRACT FROM AUTHOR]

Introduction: This study reports the incidence of chronic kidney disease (CKD) after intestinal transplant (IT) at a single, adult center in the United Kingdom. Methods: A retrospective review of IT was undertaken. Methods of renal function assessment pre‐transplant were compared. Post‐transplant renal function and renal sparing strategies were analyzed. Results: There was a 30% variation (p <.001) in estimated glomerular filtration rate (eGFR) and normalized GFR at assessment. In the first 3 months post‐transplant, there was a 40% decline in eGFR which was irreversible. Liver inclusion was not protective with similar eGFR at 3 months (60 ml/min/1.73 m2) compared with IT (55 ml/min/1.73 m2). The rate of decline in the first 2 months was less in multivisceral transplant (MVT; 21%) than IT (52%) suggesting surgical magnitude did not contribute. Thirty percentage of recipients had acute cellular rejection post‐transplant; 58% of these were in the first 3 months with a higher proportion in MVT (64%) than IT (27%). Tacrolimus exposure did not correlate with decline in renal function over the first 3 months post‐transplant. Conclusion: We demonstrated a 40% decline in renal function within 3 months post‐IT which was irreversible despite renal sparing strategies. Early intervention should be considered in patients with an acute decline in this post‐transplant period. [ABSTRACT FROM AUTHOR]

A close relationship exists between kidney function and a successful pregnancy outcome. Renal disease can affect the outcome of pregnancy, pregnancy can affect the course of preexisting renal disease, and pregnancy itself can cause acute renal impairment. This article will focus on outcomes of pregnancy in patients with CKD and also pregnancy outcome in patients with ESRD on chronic maintenance dialysis. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) affects more than 10% of the global population and is associated with significant morbidity and mortality. In most cases, this disease is developed silently, and it can progress to the end-stage renal failure. Therefore, early detection becomes critical for initiating effective interventions. Routine diagnosis of CKD requires both blood test and urinalyses in a clinical laboratory, which are time-consuming and have low sensitivity and specificity. Surface-enhanced Raman scattering (SERS) is an emerging method for rapidly assessing kidney function or injury. This study was designed to compare the differences between the SERS properties of the serum and urine for easy and simple detection of CKD. Enrolled for this study were 126 CKD patients (Stages 2–5) and 97 healthy individuals. SERS spectra of both the serum and urine samples were acquired using a Raman spectrometer (785 nm excitation). The correlation of chemical parameters of kidney function with the spectra was examined using prinicpal component analysis (PCA) combined with linear discriminant analysis (LDA) and partial least squares (PLS) analysis. Here, we showed that CKD was discriminated from non-CKD controls using PCA–LDA with a sensitivity of 74.6% and a specificity of 93.8% for the serum spectra, and 78.0% and 86.0 % for the urine spectra. The integration area under the receiver operating characteristic curve was 0.937 ± 0.015 (p < 0.0001) for the serum and 0.886 ± 0.025 (p < 0.0001) for the urine. The different stages of CKD were separated with the accuracy of 78.0% and 75.4% by the serum and urine spectra, respectively. PLS prediction (R2) of the serum spectra was 0.8540 for the serum urea (p < 0.001), 0.8536 for the serum creatinine (p < 0.001), 0.7500 for the estimated glomerular filtration rate (eGFR) (p < 0.001), whereas the prediction (R2) of urine spectra was 0.7335 for the urine urea (p < 0.001), 0.7901 for the urine creatinine (p < 0.001), 0.4644 for the eGFR (p < 0.001) and 0.6579 for the urine microalbumin (p < 0.001). In conclusion, the accuracy of associations between SERS findings of the serum and urine samples with clinical conclusions of CKD diagnosis in this limited number of patients is similar, suggesting that SERS may be used as a rapid and easy-to-use method for early screening of CKD, which however needs further evaluation in a large cohort study. [ABSTRACT FROM AUTHOR]