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Introduction: Chronic kidney diseases affect patients with multiple respiratory complications by varied etiopathogenesis adversely affecting the outcome in them. The aim of the study is to find out the respiratory manifestations among patients with chronic kidney disease. Methods: The descriptive cross-sectional study was carried out Tribhuvan University Teaching Hospital from January 2019 to March 2019 after ethical approval. One hundred and two patients with established chronic kidney diseases being treated in a tertiary hospital for a month were included for the study. Clinical evaluation and relevant investigations; chest x ray, pleural fluid analysis, sputum analysis, echocardiography, biochemical investigations and hematological investigations were done to assess the respiratory manifestations of the patients. Results: Pulmonary edema 41 (24.84%) was the most common manifestation followed by pleural effusion 18 (10.9%). Pleural effusions were predominantly bilateral and transudative type. Pneumonia 17 (10.3%) was predominantly lobar pneumonia. Sixteen (9.7%) of the patients were screened positive for obstructive sleep apnea syndrome. Pulmonary tuberculosis was present in 9 (5.45%) patients. Conclusions: Varieties of respiratory complications can present in varied spectrum in patients with chronic kidney diseases and this carries adverse outcome to patient management as well as affects the quality of life of the patient and their family.

Background: Renal diseases remain an increasing public health issue affecting millions of people. The kidney is a highly energetic organ that is rich in mitochondria. Numerous studies have demonstrated the important role of mitochondria in maintaining normal kidney function and in the pathogenesis of various renal diseases, including acute kidney injuries (AKI) and chronic kidney diseases (CKD). Summary: Under physiological conditions, fine-tuning mitochondrial energy balance, mitochondrial dynamics (fission and fusion processes), mitophagy, and biogenesis maintain mitochondrial fitness. While under AKI and CKD conditions, disruption of mitochondrial energy metabolism leads to increased oxidative stress. In addition, mitochondrial dynamics shift to excessive mitochondrial fission, mitochondrial autophagy is impaired, and mitochondrial biogenesis is also compromised. These mitochondrial injuries regulate renal cellular functions either directly or indirectly. Mitochondria-targeted approaches, containing genetic (microRNAs) and pharmaceutical methods (mitochondria-targeting antioxidants, mitochondrial permeability pore inhibitors, mitochondrial fission inhibitors, and biogenesis activators) are emerging as important therapeutic strategies for AKI and CKD. Key messages: Mitochondria play a critical role in the pathogenesis of AKI and CKD. This review provides an updated overview of mitochondrial homeostasis under physiological conditions and the involvement of mitochondrial dysfunction in renal diseases. Finally, we summarize the current status of mitochondria-targeted strategies in attenuating renal diseases.

Globally, chronic kidney disease of unknown etiology (CKDu) has been recognized as an emerging cause contributing to the rise in chronic kidney disease (CKD). Nevertheless, in the Kingdom of Saudi Arabia, the epidemiology of CKDu remains understudied. The aim of this study was to assess the epidemiological, clinical, and laboratory characteristics of the CKDu population. From May 2021 to May 2022, a retrospective cross-sectional study was conducted on patients with Stage 4-5 CKD who presented to King Fahd Hospital in Jeddah. On the basis of the cause of CKD, patients were categorized into two groups: those with traditional risk factors for CKD (CKDt) and those without a recognizable cause of CKD (CKDu). Out of a total of 500 patients with Stage 4-5 CKD who were enrolled in the study, 100 patients were found to have CKDu. Compared with the 400 patients with CKDt, the patients in the CKDu group were younger (a mean age of 52.3 years vs. 66.1 years, P <0.001), with the majority in the middle age group of 40-65 years old (68% vs. 43%, P <0.001). They were predominantly males (72% vs. 56%, P = 0.003), with less hyperkalemia (4.29 vs. 5.13, P <0.043), and presented without a previous history of CKD (57% vs. 31%, P = 0.001). Among the 500 patients who were studied, 100 patients (20%) presented with CKDu who were predominantly younger males without a known history of CKD. Further studies on a nationwide scale are warranted., (Copyright © 2023 Copyright: © 2023 Saudi Journal of Kidney Diseases and Transplantation.)

In recent years, the role of intestinal homeostasis in health has received increasing interest, significantly improving our understanding of the complex pathophysiological interactions of the gut with other organs. Microbiota dysbiosis, impaired intestinal barrier, and aberrant intestinal immunity appear to contribute to the pathogenesis of immune-related chronic kidney diseases (CKD). Meanwhile, the relationship between the pathological changes in the respiratory tract (e.g., infection, fibrosis, granuloma) and immune-related CKD cannot be ignored. The present review aimed to elucidate the new underlying mechanism of immune-related CKD. The lungs may affect kidney function through intestinal mediation. Communication is believed to exist between the gut and lung microbiota across long physiological distances. Following the inhalation of various pathogenic factors (e.g., particulate matter 2.5 mum or less in diameter, pathogen) in the air through the mouth and nose, considering the anatomical connection between the nasopharynx and lungs, gut microbiome regulates oxidative stress and inflammatory states in the lungs and kidneys. Meanwhile, the intestine participates in the differentiation of T cells and promotes the migration of various immune cells to specific organs. This better explain the occurrence and progression of CKD caused by upper respiratory tract precursor infection and suggests the relationship between the lungs and kidney complications in some autoimmune diseases (e.g., anti-neutrophil cytoplasm antibodies -associated vasculitis, systemic lupus erythematosus). CKD can also affect the progression of lung diseases (e.g., acute respiratory distress syndrome and chronic obstructive pulmonary disease). We conclude that damage to the gut barrier appears to contribute to the development of immune-related CKD through gut-lung-kidney interplay, leading us to establish the gut-lung-kidney axis hypothesis. Further, we discuss possible therapeutic interventions and targets. For example, using prebiotics, probiotics, and laxatives (e.g., Rhubarb officinale) to regulate the gut ecology to alleviate oxidative stress, as well as improve the local immune system of the intestine and immune communication with the lungs and kidneys., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Liu, Wang, Zhang, Fang, Liu, Ding and Zhang.)

Acute kidney injury (AKI) and chronic kidney disease (CKD) are common kidney diseases in clinics with high morbidity and mortality, but their pathogenesis is intricate. Tryptophan (Trp) is a fundamental amino acid for humans, and its metabolism produces various bioactive substances involved in the pathophysiology of AKI and CKD. Metabolomic studies manifest that Trp metabolites like kynurenine (KYN), 5-hydroxyindoleacetic acid (5-HIAA), and indoxyl sulfate (IS) increase in AKI or CKD and act as biomarkers that facilitate the early identification of diseases. Meanwhile, KYN and IS act as ligands to exacerbate kidney damage by activating aryl hydrocarbon receptor (AhR) signal transduction. The reduction of renal function can cause the accumulation of Trp metabolites which in turn accelerate the progression of AKI or CKD. Besides, gut dysbiosis induces the expansion of Enterobacteriaceae family to produce excessive IS, which cannot be excreted due to the deterioration of renal function. The application of Trp metabolism as a target in AKI and CKD will also be elaborated. Thus, this study aims to elucidate Trp metabolism in the development of AKI and CKD, and explores the relative treatment strategies by targeting Trp from the perspective of metabolomics to provide a reference for their diagnosis and prevention., (© 2023 Wiley-VCH GmbH.)

Objectives: Chronic kidney disease (CKD) is a global health issue, ranking as the third leading cause of death worldwide. CKD diagnosis and management depend on clinical laboratory tests, necessitating consistency for precise patient care. Global harmonization of CKD testing through clinical practice guidelines (CPGs) is recommended. Prior to CPG development, assessing the current CKD testing landscape is crucial. In 2022, the European Federation of Laboratory Medicine (EFLM) conducted an online survey among European laboratories associated with EFLM, evaluating CKD testing practices, including new glomerular filtration rate (GFR) estimation methods. This report summarizes the 2022 survey findings and offers recommendations for improving CKD test standardization., Methods: An online survey was conducted in November 2022 using a questionnaire hosted on LimeSurvey sent to European laboratories affiliated with the EFLM. The survey results were recorded in Excel files and analysed., Results: The results highlight significant discrepancies among countries in unit expression, methods, cystatin C use, and GFR calculation equations. Additionally, limited attention to pediatric renal biology specifics, varied proteinuria and albuminuria result expressions, and limited awareness of GFR measurement methods through iohexol clearance are noted., Conclusions: In an effort to enhance the standardization of crucial biomarkers utilized in nephrology for evaluating renal function and diagnosing kidney injuries, the EFLM Task Group on CKD suggests nine practical recommendations tailored for European laboratories. The group is confident that implementing these measures will minimize result expression discrepancies, ultimately leading to enhanced patient care., (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Circadian variation in blood pressure (BP) has been shown to determine cardiovascular events in people with chronic kidney diseases (CKDs). Studies aimed at elucidating the relationship between diurnal variation in BP and cardiovascular disease have yielded conflicting results, and very few of these studies have been conducted on CKD patients in Sub-Saharan Africa, hence the need for this study. Subjects and Methods: Eighty-five adult participants comprising 54 patients with CKD (36 males and 18 females) and 31 hypertensive patients (16 males and 15 females) free of CKD were recruited for 24 h ambulatory BP monitoring and cardiovascular risk factor assessment. Results: Patients with CKD had a higher mean clinic systolic BP (159.8 ± 28.6 vs. 147.9 ± 19.0 mmHg, P = 0.049) and reduced estimated glomerular filtration rate (19.2 ± 18.6 vs. 106.2 ± 30.6, P < 0.0001) when compared with hypertensives free of CKD. The mean 24 h ambulatory SBP (135.9 ± 28.5 vs. 120.3 ± 11.8 mmHg, P = 0.007), diastolic BP (82.6 ± 18.1 vs. 74.8 ± 9.0 mmHg, P = 0.034) and mean arterial pressure (100.9 ± 21.2 vs. 90.6 ± 10.2 mmHg, P = 0.018) were higher amongst CKD patients. Compared with hypertensive without CKD, daytime hypertension (58.9% vs. 21.4, P = 0.001), nocturnal hypertension (80.4% vs. 50.0%, P = 0.004) and non-dippers (92.0% vs. 73.1%, P = 0.026) were commoner in people with CKD. White coat effect was more common amongst hypertensives without CKD (74.2% vs. 38.0%, P = 0.002). The mean left atrial diameter and left ventricular mass index were higher in CKD group. Conclusion: This study highlights the high prevalence of varied phenotypes in circadian rhythm amongst CKD patients. Ambulatory blood pressure monitoring may be useful for early risk stratification of CKD patients. Large longitudinal study is needed to assess the prognostic implication of the findings.

In the past decade, advances in the validation of surrogate end points for chronic kidney disease (CKD) progression have heightened interest in evaluating therapies in early CKD. In December 2020, the National Kidney Foundation sponsored a scientific workshop in collaboration with the US Food and Drug Administration (FDA) to explore patient, provider, and payor perceptions of the value of treating early CKD. The workshop reviewed challenges for trials in early CKD, including trial designs, identification of high-risk populations, and cost-benefit and safety considerations. Over 90 people representing a range of stakeholders including experts in clinical trials, nephrology, cardiology and endocrinology, patient advocacy organizations, patients, payors, health economists, regulators and policy makers attended a virtual meeting. There was consensus among the attendees that there is value to preventing the development and treating the progression of early CKD in people who are at high risk for progression, and that surrogate end points should be used to establish efficacy. Attendees also concluded that cost analyses should be holistic and include aspects beyond direct savings for treatment of kidney failure; and that safety data should be collected outside/beyond the duration of a clinical trial. Successful drug development and implementation of effective therapies will require collaboration across sponsors, patients, patient advocacy organizations, medical community, regulators, and payors., (Copyright © 2022 National Kidney Foundation, Inc. All rights reserved.)

Chronic kidney disease (CKD) is a common and progressive disease that has become a major public health problem on a global scale. Renal fibrosis is a common feature in the pathogenesis of CKD, which is mainly related to the excessive accumulation and deposition of extracellular matrix caused by various inflammatory factors. No ideal treatment has yet been established. In recent years, based on the traditional Chinese medicine (TCM) theory of CKD and its molecular mechanism, clinical evidence or experimental studies have confirmed that a variety of Chinese materia medica (CMM) and their effective components can delay the progress of CKD. TCM believes that the pathogenesis of CKD is the deficiency in the root and excess in the branch, and the deficiency and excess are always accompanied by the disease. The strategies of TCM in treating CKD are mainly based on invigorating Qi, tonifying the kidneys, promoting blood circulation, removing stasis, eliminating heat and dampness, removing turbidity, and eliminating edema, and these effects are multitargeted and multifunctional. This review attempts to summarize the theories and treatment strategies of TCM in the treatment of CKD and presents the efficacy and mechanisms of several CMMs supported by clinical evidence or experimental studies. In addition, the relationship between the macroscopic of TCM and the microscopic of modern medicine and the problems faced in further research were also discussed.

Chronic kidney disease (CKD) is a global health issue, ranking as the third leading cause of death worldwide. CKD diagnosis and management depend on clinical laboratory tests, necessitating consistency for precise patient care. Global harmonization of CKD testing through clinical practice guidelines (CPGs) is recommended. Prior to CPG development, assessing the current CKD testing landscape is crucial. In 2022, the European Federation of Laboratory Medicine (EFLM) conducted an online survey among European laboratories associated with EFLM, evaluating CKD testing practices, including new glomerular filtration rate (GFR) estimation methods. This report summarizes the 2022 survey findings and offers recommendations for improving CKD test standardization. An online survey was conducted in November 2022 using a questionnaire hosted on LimeSurvey sent to European laboratories affiliated with the EFLM. The survey results were recorded in Excel files and analysed. The results highlight significant discrepancies among countries in unit expression, methods, cystatin C use, and GFR calculation equations. Additionally, limited attention to pediatric renal biology specifics, varied proteinuria and albuminuria result expressions, and limited awareness of GFR measurement methods through iohexol clearance are noted. In an effort to enhance the standardization of crucial biomarkers utilized in nephrology for evaluating renal function and diagnosing kidney injuries, the EFLM Task Group on CKD suggests nine practical recommendations tailored for European laboratories. The group is confident that implementing these measures will minimize result expression discrepancies, ultimately leading to enhanced patient care. [ABSTRACT FROM AUTHOR]

Abstract Background As chronic kidney disease (CKD) is amongst the current global health challenges, this study is aiming to evaluate the long-term intake of total polyphenol and its subclasses in association with CKD incidence. Methods For the purpose of this study, a sample of 3021 Iranian adults (47 % men, aged 20–79 years) with no CKD diagnosis at baseline, were selected from the Tehran Lipid and Glucose Study population. The total intake of polyphenol and its major subclasses were assessed by a validated food frequency questionnaire and categorized as flavonoids, phenolic acids, stilbenes, and lignans. Although the morphological abnormalities of the kidneys or 3-month persistent urinalysis can distinctively define CKD, the glomerular filtration rate (eGFR) reduction is accepted as a more precise index of renal function. Therefore, eGFR

Background:Thyroid hormones have a very crucial role in the regulation of metabolism, proteins synthesis and influencing functions of various other hormones in the human body. While both kidneys play an essential role in the metabolism of thyroid hormone by conversion of thyroxine (T4) to triiodothyronine (T3). In patients with chronic kidney diseases, frequent abnormal thyroid functions are observed. Aim:To study the pattern of thyroid dysfunction in chronic kidney disease population and to evaluate the correlation existing in between severity of kidney failure and thyroid dysfunction Methods:This cross sectional observational study was conducted in the department of internal medicine in a tertiary care hospital, central India. 100 chronic kidney disease patients were included in the study. Diagnosis of chronic kidney failure was performed as per criteria laid down by Kidney Disease Outcome Quality Initiative. Blood was drawn for estimation of serum creatinine, GFR and thyroid profile. Results: Among 100 CKD patients, most of them (64%) were male with age ranging from 18 to 80 years with mean age of 57.08±10.35 years. Of the total patients, 6%, 12%, 29%, 26% & 27% patients belonged to CKD Stages 1,2,3,4 & 5 respectively. Low T3 is the most common thyroid dysfunction & the earliest abnormality noticed in CKD patients. The prevalence of low T3 syndrome in this study was 48%. Increasing trend for Low T3 prevalence with increasing severity of CKD was noticed in this study and was statistically significant (P

Chronic kidney diseases proliferate due to hypertension, diabetes, anemia, obesity, smoking etc. Patients with such conditions are sometimes unaware of first symptoms, complicating disease diagnosis. This paper presents chronic kidney disease (CKD) prediction model to classify CKD patients from NCKD (Non-CKD). The proposed study has two main stages. First, we found the odds ratio through logistic regression and comparison test to identify early risk factors from kidneys’ MRI and differentiate CKD from NCKD subjects. In stage 2, LR, LDA, MLP classifiers were applied to predict CKD and NCKD by extracting features from MRI. The odds ratio of blood glucose random and serum creatinine was found higher, and levels of sodium, Potassium, packed cell volume, white blood cell count, and red blood cell count were found lesser in CKD. The comparison results show increase levels in blood glucose random, serum creatinine and decreased levels found in sodium, potassium, packed cell volume, White blood cell and red blood cell count respectively in CKD patients than NCKD subjects. The accuracies of LR were 98.5% and 97.5% for train & test datasets. While LDA accuracy was 96.07% and 96.6% for train and test datasets. Likewise, MLP attained were 95% and 94.1% accuracy for train and test datasets. Finally, we used 5-fold CV approach on the LR model. The mean accuracies of LR were 0.954 and 0.942 for training and testing data respectively. According to LR the serum creatinine, Albumin, Diabetes mellitus, red blood cells count, pus cell and hypertension were found to be the most significant features to discriminate the CKD patients from NCKD. The proposed strategy is best suited for practical implementation for reducing the disease’s prevalence. [ABSTRACT FROM AUTHOR]

We present a new approach to evaluate the importance of ambulatory nephrology care in patients with chronic kidney disease (CKD). Methods: An anonymized health claims database of German insurance companies was searched in a retrospective analysis for patients with CKD using the codes of the International Classification of Diseases, 10th German modification. A total of 105,219 patients with CKD were identified. Patients were assigned to the group “timely referral,” when nephrology care was present in the starting year 2009, or initiated during the following 3 years in CKD1–4. Using frequency matching for age and gender, 21,024 of the late referral group were matched with the equal number of patients in the timely referral group. Hospital admission rates, total treatment costs, and kidney function (change in CKD stages, start of dialysis, mortality) were documented each year during the 4-year follow-up. Results: Hospital admission rates (110%–186%) and total treatment costs (119%–160%) were significantly higher (P < 0.03) in late referral compared with timely referral. In the timely referral group, significantly more patients did not change their CKD stage (65%–72.9% vs. 52%–64.6%, P < 0.05) compared with late referral. Starting in CKD3 more patients tended to start dialysis in 1 year in timely referral (1.9 ± 0.6 vs. 1.0 ± 0.4, P = 0.1). In contrast, death rates were significantly higher in the late referral group (18.8 ± 1.8% vs. 6.7 ± 0.4%, P = 0.0001). Discussion: Timely referral to outpatient nephrology care is associated with slowed disease progression, less hospital admissions, reduced total treatment costs, and improved survival in patients with CKD.

Patients with cardiovascular disease (CVD) and chronic kidney disease (CKD) show high rates of cardiorenal outcomes. In addition, the progression towards renal failure and cardiovascular events rises as CKD worsens. Several studies suggest that the activation of the mineralocorticoid receptor (MR) induces cardiac and renal injury, including inflammation and fibrosis. Finerenone is a novel, nonsteroidal, selective MR antagonist (MRA) which has demonstrated anti-inflammatory and anti-fibrotic effects in pre-clinical studies. Moreover, two large trials (FIDELIO-DKD and FIGARO-DKD) investigated the renal and cardiovascular outcomes in patients with mild to severe CKD in type 2 diabetes which received finerenone. On these bases, this comprehensive review aims to summarize the current knowledge regarding finerenone and its effects on CKD and the cardiovascular system, emphasizing its role in modifying cardiorenal outcomes.

The purpose of this manuscript is to review the effects of sodium-glucose cotransport protein 2 inhibitors (SGLT2is) in patients with chronic kidney disease according to basic mechanisms, current recommendations, and future perspectives. Based on growing evidence from randomized, controlled trials, SGLT2is have proven their benefit on cardiac and renal adverse complications, and their indications expanded into the following five categories: glycemic control, reduction in atherosclerotic cardiovascular disease (ASCVD), heart failure, diabetic kidney disease, and nondiabetic kidney disease. Although kidney disease accelerates the progression of atherosclerosis, myocardial disease, and heart failure, so far, no specific drugs were available to protect renal function. Recently, two randomized trials, the DAPA-CKD and EMPA-Kidney, demonstrated the clinical benefit of the SGLT2is dapagliflozin and empagliflozin in improving the outcome in patients with chronic kidney disease. For the consistently positive results in cardiorenal protection, the SGLT2i represents an effective treatment to reduce the progression of kidney disease or death from cardiovascular causes in patients with and without diabetes mellitus.

Chronic kidney disease of uncertain aetiology (CKDu) is an advanced version of chronic kidney disease (CKD) which bears a high burden on the world health economy. More than 200 articles were analysed to understand the disease responsible for more than 30,000 deaths per year. CKDu is a non-communicable occupational disease that has a progressive deterioration of the kidney in the absence of CKD risk factors such as hypertension, diabetes and glomerulonephritis, while the diagnosis is only possible at the later stages when kidney function is no longer effective. Published evidence for the existence of CKDu was found for around 35 countries. This is a growing health issue in Asia, Central America, Africa and Middle East with identified hot spots. Despite many research studies over decades, the exact root causes are still uncertain. Six main suspected causative factors are identified. Those are heat stress, strenuous labour, dehydration, use of agrochemicals, exposure to heavy metals and the use of polluted water and agricultural lands. This review summarizes four key areas which are CKDu and its general medical background, worldwide prevalence, suspected causative factors and potential circumventing steps to mitigate against CKDu. The importance of further studies addressing early detection and surveillance methods, contribution of nephrotoxins in environmental health, soil chemistry on transporting nephrotoxins, geological parameters which influence the prevalence of the disease and other related sectors to overcome the mysterious nature is highlighted. Mitigation steps to lessen the burden of CKDu are also identified., (© 2022. The Author(s).)

Introduction It has been demonstrated that urinary neutrophil gelatinase-associated lipocalin (NGAL) and calprotectin are helpful biomarkers in the differentiation of intrinsic and prerenal acute kidney injury. Objective The present cross-sectional study investigates, whether urinary biomarkers are able to differentiate primarily inflammatory from non-inflammatory entities in chronic kidney disease (CKD). Methods Urinary calprotectin, NGAL, and kidney injury molecule-1 (KIM-1) concentrations were assessed in a study population of 143 patients with stable CKD and 29 healthy controls. Stable renal function was defined as an eGFR fluctuation ≤5 ml/min/1.73 m2 in the past 12 months. Pyuria, metastatic carcinoma, and renal transplantation were regarded as exclusion criteria. Diabetic nephropathy, hypertensive nephropathy, and polycystic kidney disease were categorized as ‘primarily non-inflammatory renal diseases’ (NIRD), whereas glomerulonephritis and vasculitis were regarded as ‘primarily inflammatory renal diseases’ (IRD). Results Urinary calprotectin and NGAL concentrations significantly differed between CKD and healthy controls (p 0.05 each). Albumin exceeds the diagnostic power of the investigated biomarkers by far. Conclusions The urinary biomarkers calprotectin, NGAL, and KIM-1 have no diagnostic value in the differentiation of primarily inflammatory vs. non-inflammatory etiologies of CKD.

Abstract Background Concentration of the urine is primarily regulated via vasopressin dependent aquaporin-2 water channels in the apical membrane of kidney principal cells. It is unclear whether urine concentration ability in ADPKD differs from other patients with similar degree of impaired renal function (non-ADPKD patients). The purpose of this case control study was to measure urine concentration ability in ADPKD patients compared to non-ADPKD patients and healthy controls. Methods A seventeen hour long water deprivation test was carried out in 17 ADPKD patients (CKD I-IV), 16 non-ADPKD patients (CKD I-IV), and 18 healthy controls. Urine was collected in 4 consecutive periods during water deprivation (12 h, 1 h, 2 h and 2 h, respectively) and analyzed for osmolality (u-Osm), output (UO), fractional excretion of sodium (FENa), aquaporin2 (u-AQP2) and ENaC (u-ENaC). Blood samples were drawn trice (after 13-, 15-, and 17 h after water deprivation) for analyses of osmolality (p-Osm), vasopressin (p-AVP), and aldosterone (p-Aldo). Results U-Osm was significantly lower and FENa significantly higher in both ADPKD patients and non-ADPKD patients compared to healthy controls during the last three periods of water deprivation. During the same periods, UO was higher and secretion rates of u-AQP2 and u-ENaC were lower and at the same level in the two groups of patients compared to controls. P-AVP and p-Osm did not differ significantly between the three groups. P-Aldo was higher in both groups of patients than in controls. Conclusions Urine concentration ability was reduced to the same extent in patients with ADPKD and other chronic kidney diseases with the same level of renal function compared to healthy controls. The lower urine excretion of AQP2 and ENaC suggests that the underlying mechanism may be a reduced tubular response to vasopressin and aldosterone. Trial registration Current Controlled Trial NCT04363554 , date of registration: 20.08.2017.

Abstract Chronic kidney diseases (CKD) are an economic burden and occur worldwide in all age groups, and the advancement of kidney disease at some point leads to deregulate or influence the function of other body organs and to find a specific target to halt the disease progression which is a tedious challenge. Regardless of the underlying mechanisms, it is essential to consider and evaluate the involvement and association of individual endogenous mediators and environmental factors in the progression of CKD to accumulate the required knowledge. More than a dozen pathways leading to relentless progression of CKD have been identified so far, but the association of serotonin 5-HT2A receptor with progressive renal injury is still under process. Scientific reports demonstrated that the 5-HT2A receptor plays a significant role in renal metabolism, glomerular function, and renal vascular tone. So a better understanding of the evolving role of serotonin 5-HT2A-mediated pathophysiological mechanisms of CKD may be a helpful tool to identify new therapeutic targets. In this review, we will discuss recent interventions, pharmacological target, and the possible implication of serotonin 5-HT2A receptors with associated mechanistic trails leading to CKD.

Telomeres are dynamic DNA nucleoprotein structures located at the end of chromosomes where they maintain genomic stability. Due to the end replication problem, telomeres shorten with each cell division. Critically short telomeres trigger cellular senescence, which contributes to various degenerative and age-related diseases, including chronic kidney diseases (CKDs). Additionally, other factors such as oxidative stress may also contribute to accelerated telomere shortening. Indeed, telomeres are highly susceptible to oxidative damage due to their high guanine content. Here, we provide a comprehensive review of studies examining telomere length (TL) in CKDs to highlight the association between TL and the development and progression of CKDs in humans. We then focus on studies investigating TL in patients receiving kidney replacement therapy. The mechanisms of the relationship between TL and CKD are not fully understood, but a shorter TL has been associated with decreased kidney function and the progression of nephropathy. Interestingly, telomere lengthening has been observed in some patients in longitudinal studies. Hemodialysis has been shown to accelerate telomere erosion, whereas the uremic milieu is not reversed even in kidney transplantation patients. Overall, this review aims to provide insights into the biological significance of telomere attrition in the pathophysiology of kidney disease, which may contribute to the development of new strategies for the management of patients with CKDs.

Chronic kidney disease (CKD) is one of the major and exacerbating global health burdens, which is characterized by no curative treatments and high morbidity and mortality. Since malnutrition has become an important factor determining the final clinical outcomes of CKD, soy products, high-quality plant-based sources of proteins and other nutrients, are recommended by many physicians for CKD patients. However, it has been reported that adherence to this dietary advice among those patients is low. In order to dissect the potential reasons behind this phenomenon and to subsequently develop target intervention to improve the current situation, we designed and conducted a self-administered questionnaire survey in 3 medical centers in China. Total 570 patients responded to our survey and data analysis reveals that 85.6% of the respondents were aware of the necessaries of high-quality protein diets for CKD patients, but only 41.9% of patients knew that soy foods provide high-quality proteins needed. In contrast, up to 90.4% of patients were affected by the notion that patients with CKD should avoid soy products. Besides, comparing with other groups, higher percentage of patients undergoing peritoneal dialysis recognized soy products as foods with high-quality proteins, however, as many as 68.8% of them did not consume any soy foods due to the concerns of adverse effects on the progress of CKD. Our data suggest that a significant portion of patients with CKD do not consume soy foods, which could be mainly resulted from their misconception towards soy products delivered by medical workers or social media. Evidence-based updated education of patients and medical workers on soy foods would be a necessary strategy for improving nutrition status of CKD patients and their clinical outcomes.

Introduction: It has been observed that chronic kidney diseases(CKD) are often associated with thyroid dysfunction .Thyroid functional derangements in CKD are linked with excessive mortality from cardiovascular causes and death in CKD patients due to accelerated development of atherosclerosis. Keeping in view the cardiovascular mortality associated with the deranged thyroid profile there is need to understand the relationship between the thyroid and the kidney more thoroughly and verify the accuracy of earlier findings. Aims & Objectives: The study aimed to assess the thyroid profile in patients with kidney disease and to correlate T3 and TSH with S Creatinine and Glomerular filteration rate (GFR) and to finally to study the C Reactive Protein (CRP) positivity in CKD patients with thyroid dysfunction . Methods: The study group comprised of 70 patients with kidney diseases from 30 to 65years from Out Patient and Inpatient Departments of the a tertiary hospital. Results: Out of the 70 patients in the study 38(54.29%) of patients were males and 32 (45.71% ) patients were females. 44 patients (62.8%) had thyroid disorder .30% of patients had Hypothyroidism, 20% had Sub clinical Hypothyroidism and 7.14% had Low T3 syndrome, 4.2% had Low T4, 1.4% patient had high T4 and 26 patients (37.2%) were euthyroid patients. The prevalence of thyroid dysfunction was higher in the group with GFR <15ml/min(Stage 5) ( statistically insignificantly).Patients with higher TSH and low T3 were more prevalent in patients with lower GFR though statistically significant correlation could not be elicited. CRP positivity in CKD patients with thyroid dysfunction was significantly higher than those without any thyroid dysfunction . Conclusion : Hence, it can be concluded that thyroid disorders are common in patients with chronic kidney diseases and the prevalence of thyroid dysfunction corresponds with severity of CKD. Therefore, it is essential that we screen the patients with CKD for thyroid dysfunction routinely, and manage accordingly in order to avoid excessive cardiac mortality and progression of CKD. [ABSTRACT FROM AUTHOR]

Background: The increase of chronic kidney disease (CKD) incidence and its related costs in developing countries have urged all levels of society prevent this disease. Prevention can be effectively done when someone has good knowledge about the disease. This study aimed to observe the change in knowledge about CKD before and after education sessions in the form of talk shows as well as through the leaflet media among senior high school students. Methods: This was a cross-sectional observational quantitative study on 71 first-grade students participated in World Kidney Day 2019 event. The questionnaire was distributed before and after the education program and data collected were analyzed using the Wilcoxon-signed rank test and Mann-Whitney test to explore changes in the level of knowledge based on the characteristics of the subjects. Results: The median level of student knowledge before education was 76% (16-96%), which increased to 92% (28-100%) after education (p

As the nation’s largest chronic kidney disease (CKD) cohort, the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) was established to investigate the clinical course, risk factors for progression, and adverse outcomes of CKD. From 2011 to 2016, the KNOW-CKD recruited 2,238 adult patients with CKD from stage G1 to G5 who were not receiving renal replacement therapy from nine tertiary care hospitals throughout Korea. As of 2019, the KNOW-CKD has published more than 50 articles in the areas of socio-economics, nutrition, quality of life, health-related habits, CKD progression, cardiovascular comorbidity and outcome, anemia, mineral bone disease, biomarker discovery, and international and inter-ethnic comparisons. The KNOW-CKD will eventually offer a prediction model for long-term consequences of CKD, such as the occurrences of end-stage renal disease, cardiovascular disease, and death, thereby enabling the identification and treatment of at-risk populations that require extra medical attention.

Abstract Background Recently, the role of IL-19, IL-20 and IL-24 has been reported in renal disorders. However, still little is known about their biological role. Methods Localization of IL-20RB was determined in human biopsies and in the kidneys of mice that underwent unilateral ureteral obstruction (UUO). Renal Il19, Il20 and Il24 expression was determined in ischemia/reperfusion, lipopolysaccharide, streptozotocin, or UUO induced animal models of kidney diseases. The effects of H2O2, LPS, TGF-β1, PDGF-B and IL-1β on IL19, IL20 and IL24 expression was determined in peripheral blood mononuclear cells (PBMCs). The extents of extracellular matrix (ECM) and α-SMA, Tgfb1, Pdgfb, and Ctgf expression were determined in the kidneys of Il20rb knockout (KO) and wild type (WT) mice following UUO. The effect of IL-24 was also examined on HK-2 tubular epithelial cells and NRK49F renal fibroblasts. Results IL-20RB was present in the renal biopsies of patients with lupus nephritis, IgA and diabetic nephropathy. Amount of IL-20RB increased in the kidneys of mice underwent UUO. The expression of Il19, Il20 and Il24 increased in the animal models of various kidney diseases. IL-1β, H2O2 and LPS induced the IL19, IL20 and IL24 expression of PBMCs. The extent of ECM, α-SMA, fibronectin, Tgfb1, Pdgfb, and Ctgf expression was lower in the kidney of Il20rb KO compared to WT mice following UUO. IL-24 treatment induced the apoptosis and TGF-β1, PDGF-B, CTGF expression of HK-2 cells. Conclusions Our data confirmed the significance of IL-19, IL-20 and IL-24 in the pathomechanism of renal diseases. Furthermore, we were the first to demonstrate the pro-fibrotic effect of IL-24.