Development Of Chronic Kidney Disease Research Articles

The potential of MOFs embedded in banana cellulose materials for application in dialysis

The accumulation of uremic toxins in the human body presents a fatal issue that leads to the development of chronic kidney disease. The effective removal of these toxins from the bloodstream is crucial for enhancing the efficacy of hemodialysis and improving the survival rate. A comprehensive understanding of the interactions between an adsorbent and the uremic toxins is vital in the development of efficient materials for the elimination of these hazardous compounds. In this study, we investigate the adsorption behavior of various toxins, namely cresol sulfate, and creatinine, using banana cellulose and its modified form with MOFs, namely Ni-BTC, Cu-BTC, and Co-BTC. The adsorption behavior is characterized using the Langmuir and Freundlich models. The analysis reveals that the Langmuir model provides a better fit to the isotherm data compared to the Freundlich model. Furthermore, the adsorption kinetics data indicate that both banana cellulose and its modified form with MOFs adhere to the pseudo-second-order rate models rather than the pseudo-first-order model. The capacities for adsorption of cresol sulfate by banana cellulose, Ni-BTC@cellulose, Cu-BTC@cellulose, and Co-BTC@cellulose were measured to be 115, 402, 509, and 577 mg/g, respectively. Conversely, the capacities for adsorption of creatinine were found to be 166, 514, 605, and 704 mg/g, respectively. The underlying mechanism of adsorption is contingent upon the van der Waals interactions and π–π interactions. Furthermore, even after undergoing five cycles, the removal efficiency for cresol sulfate and creatinine remained at 88 % and 85 %, respectively. These findings demonstrate the renderability of MOFs@cellulose. The antimicrobial activity of the prepared MOFs was recorded for all MOFs composites against tested pathogenic microbes. Additionally, the MOFs@cellulose exhibited a satisfactory level of blood compatibility. Consequently, these exceptional MOFs@cellulose present a promising opportunity for reducing costs associated with clinical hemodialysis.

The mechanisms of ferroptosis in the pathogenesis of kidney diseases.

The pathological features of acute and chronic kidney diseases are closely associated with cell death in glomeruli and tubules. Ferroptosis is a form of programmed cell death characterized by iron overload-induced oxidative stress. Ferroptosis has recentlygained increasing attention as a pathogenic mechanism of kidney damage. Specifically, the ferroptosis signaling pathway has been found to be involved in the pathological process of acute and chronic kidney injury, potentially contributing to the development of both acute and chronic kidney diseases. This paper aims to elucidate the underlying mechanisms of ferroptosis and its role in the pathogenesis of kidney disease, highlighting its significance and proposing novel directions for its treatment.

Succinylation of Park7 activates a protective metabolic response to acute kidney injury.

Acute kidney injury (AKI) is extremely prevalent among hospitalizations and presents a significant risk for the development of chronic kidney disease and increased mortality. Ischemia caused by shock, trauma, and transplant are common causes of AKI. To attenuate ischemic AKI therapeutically, we need a better understanding of the physiological and cellular mechanisms underlying damage. Instances of ischemia are most damaging in proximal tubule epithelial cells (PTECs) where hypoxic signaling cascades, and perhaps more rapidly, posttranslational modifications (PTMs), act in concert to change cellular metabolism. Here, we focus on the effects of the understudied PTM, lysine succinylation. We have previously shown a protective effect of protein hypersuccinylation on PTECs after depletion of the desuccinylase sirtuin5. General trends in the results suggested that hypersuccinylation led to upregulation of peroxisomal activity and was protective against kidney injury. Included in the list of changes was the Parkinson's-related deglycase Park7. There is little known about any links between peroxisome activity and Park7. In this study, we show in vitro and in vivo that Park7 has a crucial role in protection from AKI and upregulated peroxisome activity. These data in combination with published results of Park7's protective role in cardiovascular damage and chronic kidney disease lead us to hypothesize that succinylation of Park7 may ameliorate oxidative damage resulting from AKI and prevent disease progression. This novel mechanism provides a potential therapeutic mechanism that can be targeted.NEW & NOTEWORTHY Succinylation is an understudied posttranslational modification that has been shown to increase peroxisomal activity. Furthermore, increased peroxisomal activity has been shown to reduce oxidative stress and protect proximal tubules after acute kidney injury. Analysis of mass spectrometry succinylomic and proteomic data reveals a novel role for Parkinson's related Park7 in mediating Nrf2 antioxidant response after kidney injury. This novel protection pathway provides new insights for kidney injury prevention and development of novel therapeutics.

Comparative mathematical modeling of causal association between metal exposure and development of chronic kidney disease.

Previous studies have identified several genetic and environmental risk factors for chronic kidney disease (CKD). However, little is known about the relationship between serum metals and CKD risk. We investigated associations between serum metals levels and CKD risk among 100 medical examiners and 443 CKD patients in the medical center of the First Hospital Affiliated to China Medical University. Serum metal concentrations were measured using inductively coupled plasma mass spectrometry (ICP-MS). We analyzed factors influencing CKD, including abnormalities in Creatine and Cystatin C, using univariate and multiple analysis such as Lasso and Logistic regression. Metal levels among CKD patients at different stages were also explored. The study utilized machine learning and Bayesian Kernel Machine Regression (BKMR) to assess associations and predict CKD risk based on serum metals. A chained mediation model was applied to investigate how interventions with different heavy metals influence renal function indicators (creatinine and cystatin C) and their impact on diagnosing and treating renal impairment. Serum potassium (K), sodium (Na), and calcium (Ca) showed positive trends with CKD, while selenium (Se) and molybdenum (Mo) showed negative trends. Metal mixtures had a significant negative effect on CKD when concentrations were all from 30th to 45th percentiles compared to the median, but the opposite was observed for the 55th to 60th percentiles. For example, a change in serum K concentration from the 25th to the 75th percentile was associated with a significant increase in CKD risk of 5.15(1.77,8.53), 13.62(8.91,18.33) and 31.81(14.03,49.58) when other metals were fixed at the 25th, 50th and 75th percentiles, respectively. Cumulative metal exposures, especially double-exposure to serum K and Se may impact CKD risk. Machine learning methods validated the external relevance of the metal factors. Our study highlights the importance of employing diverse methodologies to evaluate health effects of metal mixtures.

THE ASSOCIATION BETWEEN LONG-TERM BLOOD PRESSURE MANAGEMENT AND THE DEVELOPMENT OF CHRONIC KIDNEY DISEASES IN PATIENTS WITH PRIMARY ALDOSTERONISM FOLLOWING TREATMENT

Objective: The effect of optimal blood pressure control on the decline of renal function in patients with primary aldosteronism (PA) following treatment are still needed to confirm in large sample cohort studies. The present study aimed to investigate the association between long-term blood pressure management and the development of chronic kidney disease in patients with PA following treatment. Design and method: In this retrospective chort study, patients with confirmed PA,and aged >20 years who visited the hypertension center of People's hospital of Xinjiang Autonomous Region between 2011 to 2022 were enrolled and were followed up until June 2023. We analyzed the association between the mean blood pressure control and the development of CKD. The mean blood pressure control depended on the mean of three follow-up visits,in-office BPs after diagnosis of PA and treatment at least three months. Multifactorial analysis was performed using logistic regression, with demographic variables (age, sex, and body mass index,etc.), and clinical characteristics (including smoking, alcohol consumption,etc.) as adjusted. Restricted cubic spline regression was used to find the optimal blood pressure cut-off point. SPSS 27.0 and R4.3.1 were used for the above statistical analysis. Results: This study finally included 4406 PA patients with at least three follow-up blood pressure visits at intervals greater than three months, and after adjusting related confounders, the mean follow-up time was 5.08 years, the mean age was 49.5 years,mean systolic blood pressure was significantly associated with CKD (OR: 1.018 [1.008-1.029], P < 0.001). Compared with the group with SBP >=140 mmHg, 120 =< SBP <130 mmHg(OR: 0.561 [0.406-0.777],P<0.001), 130 =<SBP<140 mmHg(OR: 0.593 [0.445-0.791], P<0.001). The RCS showed that systolic blood pressure in the 119-133 mmHg range. Conclusions: Control of SBP at 120-130 mmHg in patients with PA is associated with better renal outcome. Compared with the group with SBP >=140 mmHg, the risk was reduced by 44% and 41% in the groups with 120 =<SBP<130 mmHg and 130 =<SBP<140 mmHg, respectively.

Chronic kidney disease is accompanied by behavioral deficits in rodents

Clinical reports indicate a bidirectional relationship between mental illness and chronic systemic disease. Kidney injury and inflammation have been linked to brain dysfunction and alterations in learning and memory, as well as development of anxiety and depression, however, the underlying neurophysiological mechanisms remain elusive. In the current study, we investigated whether a chronic kidney disease (CKD) state is suffcient to produce deficits in rodent stress behaviors using a mild or severe model of CKD. Male rats were exposed to either 21 days of 0.75% adenine diet (AD) (model of mild CKD), or a combination of AD with unilateral nephrectomy (AD/Unx), prior to the start of AD (model of severe CKD). Control rats received sham surgery and remained on normal diet/chow throughout the experimental paradigm. CKD development in the rat models was determined by a significant increase in serum creatinine used as index for kidney function. Behavioral testing results demonstrate that mild CKD model, especially in combination with unilateral nephrectomy (severe CKD model), is accompanied by anhedonia (i.e., decreased sucrose preference) and increased anxiety-like behaviors in the novelty-suppressed feeding, open field and elevated plus maze tests. These findings suggest that impairment of kidney functionality is suffcient to increase behavioral emotionality in rodents consistent with development of depressive-like and anxiogenic phenotype. Ongoing studies are focused on identifying neurophysiological mechanisms linking renal disease with neurological abnormalities. Furthering our understanding of these mechanisms may aid in the development of improved treatments and prevention strategies for management of mental health comorbidities associated with kidney disease. Des Moines University IOER Research & Grant Award. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Pathogenesis of ferroptosis on chronic kidney disease and traditional Chinese medicine intervention: a review

Chronic kidney disease(CKD) is an insidious disease that has become a significant global public health issue due to its high incidence rate, low awareness, low diagnostic rate, poor prognosis, and high medical costs. Recent studies have shown that CKD development is associated with varying degrees of ferroptosis features. Traditional Chinese medicine(TCM) can regulate iron metabolism, lipid peroxidation, antioxidant systems to inhibit ferroptosis and delay the progression of CKD. Consequently, the intervention mechanism of ferroptosis has become one of the focuses of CKD research. TCM has thousands of years of traditional experience and wisdom. It focuses on the overall regulation of human body functions and can stimulate the body's disease resistance and recovery capabilities, which has certain advantages in treating CKD. However, there is currently a lack of comprehensive articles on the application of TCM in intervening ferroptosis to treat CKD and the pathogenesis of ferroptosis in CKD. Therefore, this article summarizes the latest research progress both domestically and internationally, briefly introduces the main mechanisms of ferroptosis, and systematically reviews the relationship between ferroptosis and CKD. The article integrates TCM theories related to ferroptosis in CKD, including "deficiency" "stasis" "phlegm turbidity" and "toxins" and summarizes the research status of active ingredients and herbal formulas in intervening ferroptosis to treat CKD. By considering ferroptosis from a new perspective, this article aims to provide new targets and directions for the application of TCM in treating CKD.

Elevated Renal Oxidative Stress and Na+ Transporters are Associated with Hypertension in Postpartum Preeclamptic Rats

Background: Approximately 5-10% of US pregnancies result in preeclampsia (PE). PE is characterized by new onset hypertension (HTN) during pregnancy and is usually accompanied by end-organ damage, especially in the kidneys. Postpartum (PP) women and dams that had PE have an increased risk of developing HTN and chronic kidney disease (CKD) later in life. However, mechanisms linking PE to the long-term development of HTN and CKD are unknown. One aspect that may contribute to renal injury in PP PE women and dams is oxidative stress. Elevated concentrations of oxidative stress have been shown to augment the abundance and activity of renal transporters to increase sodium (Na+) reabsorption and blood volume. These alterations in renal transporters can consequently increase Na+ and water to facilitate HTN. Thus, we hypothesize that at 6 weeks PP (~3 human years), PE dams will display increased oxidative stress, renal Na+ transporter abundance, and elevated blood pressure (BP). Methods: Pregnant Sprague Dawley rats were randomly assigned to two groups: normal (CON) and PE dams. On gestational day 14, the reduced uterine perfusion pressure surgery was performed to mimic placental ischemia and generate a model of PE. Dams gave birth naturally and weaned for 3 weeks. After 6 weeks PP, BP was measured via carotid catheterization, and kidneys were removed and sectioned. Western blots were used to quantify renal Na+ transporters: Na+ K+ 2Cl− transporter (NKCC2) in the kidney medulla (KM) and epithelial Na+ channel (ENaC) in both the kidney cortex (KC) and KM. Oxidative stress was evaluated by heat shock protein 1 (HSP-1), copper zinc superoxide dismutase (CuZnSOD), and manganese superoxide dismutase (MnSOD) via Western blots. Hydrogen peroxide (H2O2) and antioxidant capacity concentrations were assessed via colorimetric assays. Results: PP PE dams had increased BP (126.3±6.18vs105.7±3.74 mmHg, p<0.05) at 6 weeks after birth. KC HSP-1, H2O2, MnSOD, and antioxidant capacity were unchanged between groups. However, KC CuZnSOD protein abundance was decreased in PP PE dams (69.51±11.64vs100±5.73 IU/Protein/Control%, p<0.05). In the KM, HSP-1 abundance (113.7±3.3vs100±5.07 IU/Protein/Control%, p=0.06) and H2O2 concentrations (1.97±0.11vs1.31± 0.38 nM H2O2/mg Protein, p=0.08) were elevated in PP PE dams. MnSOD, CuZnSOD, and antioxidant capacity were unchanged between groups in the KM. No changes occurred in KC and KM ENaC protein abundance. However, NKCC2 protein abundance was elevated by ~50% in PP PE dams (151.71±22.17vs100±5.59 IU/Protein/Control%, p=0.06). Conclusion: In summary, BP, oxidative stress, and NKCC2 were elevated in PP PE dams at 6 weeks. Perhaps, the presence of oxidative stress in the KM may lead to increased NKCC2 abundance. However, more studies are warranted to make this conclusion. NKCC2 elevation may result in increased Na+ and water reabsorption, leading to an increase in BP. Future studies will assess the role of renal oxidative stress to regulate Na+ transporters in PP PE dams and determine the timeline after birth (PP) in which changes in oxidative stress, Na+ transporters, and BP occur. In summary, this study is clinically relevant because it indicates that both oxidative stress and NKCC2 in the KM, separately or together, may have a formative role in the pathogenesis of HTN and CKD in PP PE women later in life. This research was supported by the Neurobiology of Aging and Alzheimer’s Disease Training Program (funded by NIH training grant T32 AG020494). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Linking Altered Nephrogenesis with Hypertension using Single Nuclei RNA Sequencing of Fetal Kidney at E15.5, E16.5 and E17.5 in a Novel Nephron Deficient Rat Model

This study sought to elucidate molecular mechanisms linking altered nephrogenesis in the HSRA rat, a novel model of nephron deficiency, to the development of hypertension and chronic kidney disease (CKD) later in life. The HSRA model gives rise to offspring born with a single kidney (-S) 50-75% of the time. The single kidneys from HSRA-S animals exhibit reduced nephron endowment compared to either kidney from two-kidney offspring (-C). We hypothesize that early molecular factors during development contribute to the observed reduction in nephron number in -S animals. Timed breeding and embryonic kidney isolation from -S and -C animals were performed at gestational days (GD) 15.5, 16.5, or 17.5. Single nuclei RNA sequencing (snRNA-seq) was conducted using n=3 -S kidneys and n=3 -C kidneys for each timepoint. The library was prepared using a 10x Chromium Single Cell 3’ kit, followed by sequencing on an Illumina NextSeq2000. The average number of cells captured per sample was 16,997, yielding an average of 25,335 reads/cell, with a median of 1,512 genes/cell identified. Bioinformatic analysis using Cell Ranger and Seurat (v4) revealed various renal progenitor cell types including metanephric mesenchymal (MM) and ureteric bud cells, alongside tubular, stromal, and glomerular endothelial progenitors. Podocytes emerged by GD17.5, originating from the MM cell population, as evidenced by their extension from this cluster. Global differential expression analysis revealed minimal transcriptional differences between -S and -C fetal kidneys at GD 16.5 and 17.5. However, a down-regulation of ribosomal genes was observed on GD15.5 in the -S group, suggesting premature cellular differentiation contributing to the diminished nephron formation. Markedly, cell type-specific gene expression differences were observed at GD 16.5 and 17.5, highlighting the superior resolution that snRNAseq provides compared to bulk RNA sequencing methods. We are currently performing trajectory analysis using Monocle3 to investigate cellular fate pathways and uncover genes involved during nephron progenitor cell differentiation. These preliminary findings shed light on the cellular and molecular landscape during critical developmental stages in the kidney of the HSRA rat that could link developmental factors affecting nephron number to hypertension and CKD pathologies later in life. This research was generously supported by the Graduate School of Health Sciences at UMMC. MRG is supported by NIH R01HL137673. The UMMC Molecular and Genomics Facility is supported, in part, by funds from the NIGMS, including Molecular Center of Health and Disease-COBRE (P20GM144041-Garrett), Mississippi INBRE (P20GM103476-Flynt), and Cardiorenal and Metabolic Diseases-COBRE (P20GM104357-Hall). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Podocyte involvement in the pathogenesis of preterm-related long-term chronic kidney disease.

With the continuous advancement of neonatal intensive care technology, the survival rate of preterm infants is gradually increasing. However, this improvement in survival is accompanied by long-term prognostic implications in various systems. In the field of renal diseases, current epidemiological data indicate that preterm birth is a significant risk factor for the development of long-term chronic kidney disease (CKD). This not only imposes an economic burden on patients families but also severely impacts their quality of life. Understanding the underlying mechanisms involved in this process could offer potential strategies for early prevention and management of CKD. Although the nephron number hypothesis is currently widely accepted as a mechanism, there has been limited exploration regarding podocytes - one of the most important structures within nephrons - in relation to long-term CKD associated with preterm birth. Therefore, this review aims to summarize current knowledge on how prematurity influences CKD development overall, while specifically focusing on our current understanding of podocytes in relation to prematurity.

Racial Disparities in Fluid Intake and Plasma Copeptin in Young Adults

INTRO: Underhydration, or habitual low water intake, is associated with increased plasma copeptin, a surrogate marker of arginine vasopressin. Importantly, plasma copeptin is associated with development of cardiovascular disease (CVD) and chronic kidney disease (CKD). Compared with White individuals, Black individuals are more likely to be underhydrated, to develop CVD and end-stage CKD, and exhibit higher plasma copeptin in middle-age and older adulthood. However, there is limited information on potential racial differences in plasma copeptin in young apparently healthy adults, which may have implications for incident CVD and CKD. Therefore, we sought to determine whether young Black adults reported lower fluid intake and exhibited higher plasma copeptin concentration when compared with young White adults. Methods: We analyzed pre-existing data from two registered clinical trials (NCTs 04576338 and 05132556). Participants (n=86, sex; 40F/46M, race; White n=48, Black n=38, age; 21±2 years, BMI; 25±4 kg/m2) completed a three-day food and fluid log and underwent a venous blood draw to measure plasma copeptin concentration (BRAHMS Copeptin proAVP KRYPTOR). Food and fluid records were analyzed using the Nutrition Data System for Research for % fluid from food or water. Separately, records were used to operationalize beverage intake into 8 categories (water, sugar-sweetened beverages (SSB), milk/non-dairy alternatives, 100% juice, non-caloric beverages, plain coffee or tea, milk/sugar added coffee or tea, and alcohol). Statistical analyses included Mann-Whitney U tests for fluid intake data and ANCOVA for plasma copeptin concentration (controlled for site). Plasma copeptin was log transformed. Additionally, we assessed relations between fluid intakes and plasma copeptin concentration using Spearman’s (ρ) correlations. We set α at ≤ 0.05. Results: Compared with White adults, Black adults consumed less total fluid (Black; 1981 ±1035 vs. White; 2780±1242mL), water, alcohol, and coffee/tea (plain and milk/sugar-added), but more juice (all p’s<0.05). There were no differences in % fluid from food or water, milk/non-dairy alternatives, non-caloric beverages, or SSBs. Black individuals exhibited ~22% higher plasma copeptin concentration (Black; 5.5±2.8 vs. White; 4.5±2.8pmol/L, ANCOVA p=0.022). Irrespective of race, copeptin was negatively correlated with water intake (ρ=-0.230, p=0.034). CONCLUSION: Black young adults reported a significantly lower fluid intake and exhibited higher plasma copeptin concentration when compared with White young adults. Future studies should attempt to address racial disparities in hydration practices, which may attenuate racial differences in copeptin and corresponding health disparities. NIH-K01HL147998 (ATR), Auburn University Offce of Vice President for Research Support Program (ATR). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

A Novel Mouse Model of Physical Inactivity to Study the Role of Mitochondria in Chronic Kidney Disease

Chronic kidney disease (CKD) is a progressive disorder marked by a decline in kidney function. It is thought that a decline in mitochondrial function likely contributes to the pathogenesis of CKD, but the detailed mechanisms remain unclear. This gap in knowledge is contributed by a lack of a murine CKD model that does not rely on injury, toxin, or gene deletion to induce reduced kidney function. In humans, obesity and sedentary behavior strongly contribute to the development of CKD. The aim of the study was to employ small mouse cage (SMC) housing, a novel mouse physical inactivity model that was recently developed in our lab, and test whether it can be used to reliably induce CKD in mice. Wildtype C57BL6J mice were given standard chow or Western high-fat diet (HFD) with or without SMC intervention for 24 weeks to examine the effects of HFD and SMC on glomerular filtration rate (GFR) and respiration on isolated mitochondria from kidney cortex. Although the GFR values of the HFD+SMC group trended higher than other groups, the kidney function was still considered to be normal. Neither HFD nor HFD+SMC group had developed CKD, but mitochondrial respiration of SMC+HFD (1512.64 ± 77.86 pmol·sec−1·mgprotein−1) was significantly greater than that of the HFD-only group (1307.82 ± 79.08 pmol·sec−1·mgprotein−1, p = 0.0017) or the standard chow group (1104.69 ±143.12 pmol·sec−1·mgprotein−1, p = 0.0314. One-way ANOVA followed by Tukey’s test for multiple comparisons). Increased mitochondrial respiration may suggest a hyperfiltration-induced stress response, as commonly observed in the early stages of CKD in humans, and/or an increase in respiration to compensate for reduced effciency of oxidative phosphorylation. We interpret these data to mean that HFD and HFD+SMC are beginning to show adaptations that are in an early phase of CKD development. However, this model requires further optimization to yield the CKD phenotype. Therefore, we intend to further adapt the intervention to induce symptomatic CKD. We envision that developing preclinical models of CKD will help better elucidate its molecular mechanism and identify therapeutic targets for treating CKD in human patients. DK107397, DK127979. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Zinc and Chronic Kidney Disease: A Review.

Chronic kidney disease (CKD) poses a major global public health challenge. The World Health Organization's data shows that CKD affects about 10% of the world's population, particularly in low- and middle-income countries. Due to limited access to diagnosis and treatment, CKD has become the 12th leading cause of death worldwide. The advanced stage of CKD can lead to kidney failure, which is clinically referred to as end-stage renal disease (ESRD). In such cases, patients can only sustain life through dialysis or kidney transplantation. However, the long-term affordability of these treatments remains low. Moreover, the effectiveness of kidney transplantation is modest, posing a significant treatment barrier in resource-limited settings, and significantly impacting patient survival. To address this issue, we suggest using dietary supplementation of the trace element zinc to impede CKD development and prolong patient survival.

Sex disparities in the association between serum cotinine and chronic kidney disease.

Despite the existence of numerous studies highlighting the adverse effects of smoking on kidney function, the investigation of the correlation between serum cotinine and chronic kidney disease (CKD) remains inconclusive due to insufficient evidence. Consequently, the primary objective of this study was to ascertain the association between serum cotinine levels and CKD. This study analyzed data from 10900 Americans participating in the National Health and Nutrition Examination Survey between 2005 and 2016. The independent variable under investigation was log serum cotinine, while the dependent variable was the presence of CKD. To investigate the potential linear and non-linear correlations between serum cotinine and CKD, logistic regression models and generalized additive models (GAM) were employed. Furthermore, stratified analyses and interaction tests were conducted to evaluate potential disparities in the relationship between serum cotinine and CKD, based on sex. The median age in the study participants was 49.28 ± 17.96 years, and the median log serum cotinine (ng/mL) was -0.54 ± 1.68. The prevalence of CKD was found to be 17.04%. Multifactorial regression analysis did not show a statistically significant association between log serum cotinine and CKD (OR=1.02; 95% CI: 0.98-1.06, p=0.4387). A statistically significant non-linear association between log serum cotinine and CKD was also not observed in the GAM analysis (p non-linear value=0.091). Subgroup analyses revealed sex differences in the association between log serum cotinine and CKD. Briefly, males had a positive association between log serum cotinine and incident CKD (OR=1.08; 95% CI: 1.02-1.15, p=0.0049). In females, there was a U-shaped association between log serum cotinine and CKD, with an optimal inflection point for log serum cotinine of -0.30 (serum cotinine=0.5 ng/mL). Cross-sectional analyses of NHANES data showed gender differences in the association between serum cotinine and the development of CKD.

Unveiling Selected Influences on Chronic Kidney Disease Development and Progression.

Currently, more and more people are suffering from chronic kidney disease (CKD). It is estimated that CKD affects over 10% of the population worldwide. This is a significant issue, as the kidneys largely contribute to maintaining homeostasis by, among other things, regulating blood pressure, the pH of blood, and the water-electrolyte balance and by eliminating unnecessary metabolic waste products from blood. What is more, this disease does not show any specific symptoms at the beginning. The development of CKD is predisposed by certain conditions, such as diabetes mellitus or hypertension. However, these disorders are not the only factors promoting the onset and progression of CKD. The primary purpose of this review is to examine renin-angiotensin-aldosterone system (RAAS) activity, transforming growth factor-β1 (TGF-β1), vascular calcification (VC), uremic toxins, and hypertension in the context of their impact on the occurrence and the course of CKD. We firmly believe that a deeper comprehension of the cellular and molecular mechanisms underlying CKD can lead to an enhanced understanding of the disease. In the future, this may result in the development of medications targeting specific mechanisms involved in the decline of kidney function. Our paper unveils the selected processes responsible for the deterioration of renal filtration abilities.

Exploring potential predictors of Henoch-Schönlein purpura nephritis: a pilot investigation on urinary metabolites.

Henoch-Schönlein purpura nephritis (HSPN) is the most severe manifestation of Henoch-Schönlein purpura (HSP). This study aimed to determine the role of urine metabolomics in predicting HSPN and explore the potential mechanisms of HSP. A liquid chromatography-tandem mass spectrometry-based untargeted metabolomics analysis was performed to investigate the urinary metabolic profiles of 90 participants, comprising 30 healthy children (group CON) and 60 patients with HSP, including 30 HSP patients without renal involvement (group H) and 30 HSPN patients (group HSPN). The differentially expressed metabolites (DEMs) were identified using orthogonal partial least squares discriminant analysis (OPLS-DA), and subsequent bioinformatics analysis was conducted to elucidate the perturbed metabolic pathways. A total of 43 DEMs between H and HSPN groups were analyzed by the Kyoto Encyclopedia of Gene and Genome (KEGG) database, and the result indicates that glycine, serine and threonine metabolism, and cysteine and methionine metabolism were significantly disturbed. A composite model incorporating propionylcarnitine and indophenol sulfate was developed to assess the risk of renal involvement in pediatric patients with HSP. Conclusion: This study reveals the metabolic alterations in healthy children, HSPN patients, and HSP patients without renal involvement. Furthermore, propionylcarnitine and indophenol sulfate may be potential predictive biomarkers of the occurrence of HSPN. What is Known: • HSP is the predominant type of vasculitis observed in children. The long-term prognosis of HSP is contingent upon the extent of renal impairment. In severe nephritis, a delay in appropriate treatment may lead to fibrosis progression and subsequent development of chronic kidney disease (CKD), even leading to renal failure. • The application of metabolomics in investigating diverse renal disorders has been documented. Urine is a robust and sensitive medium for metabolomics detection. What is New: • The metabolic profiles were identified in urine samples of healthy children and those with HSP at the early stage of the disease. Different metabolites were identified between HSP patients without nephritis and those who developed HSPN. • These different metabolites may affect oxidative stress in the progression of HSPN.

CD226 promotes renal fibrosis by regulating macrophage activation and migration.

It has been found that CD226 plays an important role in regulating macrophage function, but its expression and function in macrophages during renal fibrogenesis have not been studied. Our data demonstrated that CD226 expression in macrophages was obviously upregulated in the unilateral ureteral obstruction model, while CD226 deficiency attenuated collagen deposition in renal interstitium along with fewer M1 within renal cortex and renal medulla and a lower level of proinflammatory factors compared to that of control littermates. Further studies demonstrated that Cd226-/- bone marrow-derived macrophages transferring could significantly reduce the tubular injury, collagen deposition, and proinflammatory cytokine secretion compared with that of Cd226+/+ bone marrow-derived macrophages transferring in the unilateral ureteral obstruction model. Mechanistic investigations revealed that CD226 promoted proinflammatory M1 macrophage accumulation in the kidney via suppressing KLF4 expression in macrophages. Therefore, our results uncovered a pathogenic role of CD226 during the development of chronic kidney disease by promoting monocyte infiltration from peripheral blood into the kidney and enhancing macrophage activation toward the inflammatory phenotype by suppressing KLF4 expression.

The role of mitophagy in the development of chronic kidney disease.

Chronic kidney disease (CKD) represents a significant global health concern, with renal fibrosis emerging as a prevalent and ultimate manifestation of this condition. The absence of targeted therapies presents an ongoing and substantial challenge. Accumulating evidence suggests that the integrity and functionality of mitochondria within renal tubular epithelial cells (RTECs) often become compromised during CKD development, playing a pivotal role in the progression of renal fibrosis. Mitophagy, a specific form of autophagy, assumes responsibility for eliminating damaged mitochondria to uphold mitochondrial equilibrium. Dysregulated mitophagy not only correlates with disrupted mitochondrial dynamics but also contributes to the advancement of renal fibrosis in CKD. While numerous studies have examined mitochondrial metabolism, ROS (reactive oxygen species) production, inflammation, and apoptosis in kidney diseases, the precise pathogenic mechanisms underlying mitophagy in CKD remain elusive. The exact mechanisms through which modulating mitophagy mitigates renal fibrosis, as well as its influence on CKD progression and prognosis, have not undergone systematic investigation. The role of mitophagy in AKI has been relatively clear, but the role of mitophagy in CKD is still rare. This article presents a comprehensive review of the current state of research on regulating mitophagy as a potential treatment for CKD. The objective is to provide fresh perspectives, viable strategies, and practical insights into CKD therapy, thereby contributing to the enhancement of human living conditions and patient well-being.

Novel insights into the protective effects of leonurine against acute kidney injury: Inhibition of ER stress-associated ferroptosis via regulating ATF4/CHOP/ACSL4 pathway

Acute kidney injury (AKI) is a common and serious global health problem with high risks of mortality and the development of chronic kidney diseases. Leonurine is a unique bioactive component from Leonurus japonicus Houtt. and exerts antioxidant, antiapoptotic or anti-inflammatory properties. This study aimed to explore the benefits of leonurine on AKI and the possible mechanisms involved, with a particular focus on the regulation of ferroptosis and endoplasmic reticulum (ER) stress. Our results showed that leonurine exhibited prominent protective effects against AKI, as evidenced by the amelioration of histopathological alterations and reduction of renal dysfunction. In addition, leonurine significantly suppressed ferroptosis in AKI both in vivo and in vitro by effectively restoring ultrastructural abnormalities in mitochondria, decreasing ACSL4 and 4-HNE levels, scavenging reactive oxygen species (ROS), as well as increasing GPX4 and GSH levels. In parallel, leonurine also markedly mitigated ER stress via down-regulating PERK, eIF-2α, ATF4, CHOP and CHAC1. Further studies suggested that ER stress was closely involved in erastin-induced ferroptosis, and leonurine protected tubular epithelial cells in vitro by inhibiting ER stress-associated ferroptosis via regulating ATF4/CHOP/ACSL4 signalling pathway. Mechanistically, ATF4 silencing in vitro regulated CHOP and ACSL4 expressions, ultimately weakening both ER stress and ferroptosis. Notably, analyses of single-cell RNA sequencing data revealed that ATF4, CHOP and ACSL4 in renal tubular cells were all abnormally upregulated in patients with AKI compared to healthy controls, suggesting their contributions to the pathogenesis of AKI. Altogether, these findings suggest that leonurine alleviates AKI by inhibiting ER stress-associated ferroptosis via regulating ATF4/CHOP/ACSL4 signalling pathway, thus providing novel mechanisms for AKI treatment.

Screening of Asymptomatic Urinary Tract Infection among School Childrens through Dipstick and Microscopic Examination

Background: Urinary tract infections (UTI) are among the most prevalent pediatric infectious diseases, leading to substantial healthcare utilization including hospitalization and antibiotic therapy. Despite the asymptomatic nature of many pediatric UTIs, these infections can contribute to significant morbidity if left undiagnosed and untreated, including the development of chronic kidney disease. Objective: This study aimed to assess the prevalence of asymptomatic UTIs in school-going children and to evaluate the effectiveness of dipstick and microscopic urinalysis as diagnostic tools. Methods: A cross-sectional study was conducted with 67 asymptomatic school-aged children in the district of Nowshera, KP. Urine samples were analyzed using urine dipstick tests followed by microscopic examination to detect the presence of pyuria, hematuria, and proteinuria. The study excluded children previously diagnosed with UTI or any other infectious disease. SPSS version 25 was utilized for data analysis, with results presented in descriptive statistics. Results: Of the total children screened, 40 (59.7%) were male, and 27 (40.3%) were female. Age distribution was split between 3 to 7 years (25.4%) and 8 to 15 years (74.6%). The dipstick and microscopic examinations revealed UTI positivity in 46 children (68.7%). Specifically, pyuria was detected in 32.83%, hematuria in 32.83%, and proteinuria in 18% of the screened children. Conclusion: The study highlights the high prevalence of asymptomatic UTIs among school children and emphasizes the necessity for routine urine examinations as an integral component of pediatric healthcare to prevent future complications. Furthermore, dipstick and microscopic analyses were validated as efficient diagnostic tools for early detection of UTIs.