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Recent advances have improved our understanding of the epidemiology and pathophysiology of acute kidney injury (AKI). So far, the Kidney Disease: Improving Global Outcome guidelines define and stratify kidney injury based on increases in serum creatinine level and/or decreases in urine output. Although the term AKI acknowledges the existence of cellular injury, its diagnosis is still only defined by the reduced excretory function of the kidney. New biomarkers that aid a better understanding of the relationship between acute tubular injury and kidney dysfunction have been identified, reflecting the advances in molecular biology. The expression of some of these novel biomarkers precedes changes in conventional biomarkers or can increase their predictive power. Therefore, they might enhance the clinical accuracy of the definition of AKI. This review summarizes the limitations of the current AKI classification and a panel of candidate biomarkers for augmenting AKI classification and recognition of AKI subphenotypes. We expect that the integration of appropriately selected biomarkers in routine clinical practice can improve AKI care.

Additional file 1: Figure S1. Study flow chart. The diagram describes the protocol used for the enrolment of patients in the present study. ACEis, angiotensin-converting-enzyme inhibitors; ARB, angiotensin II receptor blockers; IV, intravenous; NSAIDs, non-steroidal anti-inflammatory drugs. Figure S2. Changes in eGFR among patients receiving high oral protein loading compared to those receiving standard care prior to cardiac surgery. The figure illustrates the changes in eGFR among patients receiving preoperative high oral protein loading (dark-grey circles), as compared to those in patients receiving standard care (light-grey circles) at different time points (a) and compared to the preoperative values (b). Horizontal lines indicate median values, boxes indicate the inter-quartile range, and whiskers indicate the minimum and maximum values. Data beyond the whiskers are plotted as outliers (circles). The number of patients in each group at different time points for each group are presented in parentheses. eGFR, estimated glomerular filtration rate. Figure S3. Serum creatinine levels among patients receiving high oral protein loading compared to those receiving standard preoperative care prior to cardiac surgery. (a) Serum creatinine levels at the time of admission as well at 3 and 12 months after surgery. (b) Change in serum creatinine levels relative to the time of admission. Light grey: patients with standard preoperative care; dark grey: patients receiving preoperative high oral protein loading. Points are mean values with error bars indicating the 95% confidence intervals. The number of patients in each group at different time points for each group are presented in parentheses. Figure S4. Serum creatinine levels categorized by the occurrence of AKI and AKI reversal at hospital discharge among patients receiving preoperative high oral protein loading compared to those receiving standard preoperative care. (a) Serum creatinine levels at the time of admission as well at 3 and 12 months after surgery. (b) Change in serum creatinine levels, relative to the time of admission. Light grey: patients with standard preoperative care; dark grey: patients receiving preoperative high oral protein loading. Number of patients at different time points for each group are presented in parentheses. AKI, acute kidney injury. Table S1. Bioimpedance vector analysis of the protein loading group categorized by occurrence of postoperative AKI. Table S2. Baseline, operative, ICU and follow-up characteristics categorized by occurrence of AKI. Table S3. Serum creatinine levels among patients receiving high oral protein loading, as compared to those in patients receiving standard care prior to cardiac surgery.

Acute kidney injury (AKI) is a life-threatening condition characterized by a rapid and transient decrease in kidney function. AKI is part of an array of conditions collectively defined as acute kidney diseases (AKD). In AKD, persistent kidney damage and dysfunction lead to chronic kidney disease (CKD) over time. A variety of insults can trigger AKI; however, chemotherapy-associated nephrotoxicity is increasingly recognized as a significant side effect of chemotherapy. New biomarkers are urgently needed to identify patients at high risk of developing chemotherapy-associated nephrotoxicity and subsequent AKI. However, a lack of understanding of cellular mechanisms that trigger chemotherapy-related nephrotoxicity has hindered the identification of effective biomarkers to date. In this review, we aim to (1) describe the known and potential mechanisms related to chemotherapy-induced AKI; (2) summarize the available biomarkers for early AKI detection, and (3) raise awareness of chemotherapy-induced AKI.

Point-of-Care Ultrasonography (PoCUS) aims to include a fifth pillar (insonation) in the classical physical examination in order to obtain images to answer specific questions by the clinician at the patient's bedside, allowing rapid identification of structural or functional abnormalities, enabling more accurate volume assessment and supporting diagnosis, as well as guiding procedures. In recent years, PoCUS has started becoming a valuable tool in day-to-day clinical practice, adopted by healthcare professionals from various medical specialties, never replacing physical examination but improving patient and medical care and experience. Renal patients represent a wide range of diseases, which lends PoCUS a special role as a valuable tool in different scenarios, not only for volume-related information but also for the assessment of a wide range of acute and chronic conditions, enhancing the sensitivity of conventional physical examination in nephrology. PoCUS in the hands of a nephrologist is a precision medicine tool.

At the time of renal replacement therapy, approximately 20% of critically ill patients have septic shock. In this study, medium cutoff (MCO) continuous venovenous hemodialysis (CVVHD) was compared to high-flux membrane continuous venovenous hemodiafiltration (CVVHDF) in terms of hemodynamic improvement, efficiency, middle molecule removal, and inflammatory system activation.This is a monocenter crossover randomized study. Between December 31, 2017, and December 31, 2019, 20 patients with septic shock and stage 3 acute kidney injury (AKI) admitted to 2 Italian ICUs were enrolled. All patients underwent CVVHD with Ultraflux® EMiC®2 and CVVHDF with AV1000S® without washout. Each treatment lasted 24 h.Compared to AV1000S®-CVVHDF, EMIC®2-CVVHD normalized cardiac index (β = -0.64; p = 0.02) and heart rate (β = 5.72; p = 0.01). Interleukin-8 and myeloperoxidase removal were greater with AV1000S®-CVVHDF than with EMiC®2-CVVHD (β = 0.35; plt; 0.001; β = 0.43; p = 0.03, respectively). Leukocytosis improved over 24 h in EMiC®2-CVVHD-treated patients (β = 4.13; p = 0.03), whereas procalcitonin levels decreased regardless of the modality (β = 0.89; p = 0.01) over a 48-h treatment period. Reduction rates, instantaneous plasmatic clearance of urea, creatinine, and β2-microglobulin were similar across modalities. β2-Microglobulin removal efficacy was greater in the EMiC®2 group (β = 0-2.88; p = 0.002), while albumin levels did not differ. Albumin was undetectable in the effluent in both treatments.In patients with septic shock and severe AKI, the efficacy of uremic toxin removal was comparable between MCO-CVVHD and CVVHDF. Further, MCO-CVVHD was associated with improved hemodynamics. Fraction of filtration and transmembrane pressure reduction and the maintenance of equal efficacy might be the key features of CVVHD with MCO membranes in critically ill patients.

Background and Aim: Acute pelvic pain during pregnancy can be challenging to identify and manage. Ultrasound is still the most often utilized imaging modality for pregnant and postpartum women. The present study aimed to evaluate the ultrasonography role in various causes of pelvic pain in first trimester of pregnancy. Patients and Methods: This descriptive cross-sectional study was carried out on 286 pelvic pain pregnant women of first trimester. It was conducted in the department of Radiology in collaboration with Obstetrics and Gynecology department of Jinnah Hospital, Lahore from March 2022 to November 2022. Pregnant women with pelvic pain during early pregnancy were enrolled. Patient’s demographic details i.e. age, gestational age, HC, molar pregnancy, CRL, Fibroid, FHR, and bleeding on ultrasound were recorded. Data analysis was done using SPSS version 27. . Results: The overall mean age of participants was 26.84±2.86 years (18 to 45 years). Patients distribution based on age were as follows: 76 (26.6%) in 18-25 years, 156 (54.5%) in 26-35 years, and 54 (18.9%) in 36-45 years. Out of the total 286 pregnant women, the prevalence of bleeding, fibroids, cyst, and ectopic pregnancy was 92 (32.2%), 42 (14.7%), 56 (19.6%), and 18 (6.3%) respectively. The prevalence of pelvic pain causes such as Corpus luteal cyst, Dermoid Cyst, Ectopic pregnancy, Intramural Fibroid, Submucosal Fibroid, and sub serosal fibroid was 38/54 (70.4%), 26/34 (76.5%), 22/28 (78.6%), 1/20 (5%), 4/10 (40%), and 1/22 (4.5%) respectively. Conclusion: Bleeding was the most dominant finding followed by cyst and fibroids in pregnant women with chronic pelvic pain during early pregnancy. Pelvic pain in the early pregnancy can be difficult to treat. In assessing these individuals, ultrasound is a critical imaging modality. Keywords: Pelvic pain, ultrasonography, causes, first trimester, pregnancy

\ud Background: In Saudi Arabia, fuel dispensing facilities commonly present around the residential\ud places, educational institutions, and various health care facilities. Fuel pollutants such as benzene,\ud toluene, and xylenes (BTX) and its alkyl derivatives are harmful to human health because of their\ud toxic, mutagenic, or carcinogenic properties. The aim of this study was to determine the BTX\ud concentration levels of common pollutants in and around fuel stations and their harmful health effects\ud in the urban cites of KSA. Methods: Forty fuel dispensing facilities were randomly selected on the\ud basis of three different areas: residential, traffic intersection, and petrol pump locations (refueling\ud stations). Portable ambient analyzer was used for measuring BTX concentration. t‑test was applied\ud to determine the difference between these different areas. Results: All mean concentration values\ud of pollutants such as BTX around residential, traffic intersection, and fuel stations are exceeding\ud the limits of air quality standards values (P < 0.01). The mean levels of benzene are 10.3 and 11.07\ud ppm in Dammam and Khobar, respectively, and they exceed the reference level of 0.5 ppm. Hazard\ud quotient was more than >1, which shows that carcinogenic probability has increased those who were\ud living and working near fuel stations. Conclusions: The results found that the high concentration\ud of pollutants (BTX) is in the environment around fuel stations. The environmental contamination\ud associated with BTX in petrol fuel stations impulses the necessity of preventive programs to reduce\ud the further air quality deterioration and reduce the harmful health effects.\ud Keywords: Air, benzene, fuel, pollution, toluene, xylenes