Nonmydriatic Ocular Fundus Imaging in a General Emergency Department: Feasibility and Novel Considerations for Systematic Screening.

Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide, disproportionately affecting underserved and safety-net populations. Los Angeles County Department of Health Services (LAC-DHS) Kidney Health Workgroup has developed pragmatic population health frameworks and Expected Practices for DKD co-management with primary-care providers: pragmatic definitions of low kidney function (LKF, <50% of normal) and very low kidney function (VLKF, <25%), and proteinuria severity classification as early (>150 mg/g), heavy (>1 g/g), and massive (>7 g/g) to guide referral urgency; biopsy-agnostic diagnosis of DKD when four out of five criteria are met, including diabetes history or A1c more than 6%, LKF, proteinuria, diabetic microangiopathy, and larger kidney length (>12 cm) or faster CKD progression (>25 ml/min/year); Kidney Disease Integrated Therapy (KDIT) combining four medication categories (RAAS blockade, SGLT2 inhibitors, GLP-1 agonists, nonsteroidal mineralocorticoid antagonist) and renal nutrition and lifestyle medicine (PLADO/PLAFOND diets), adequate hydration, and exercise; and eConsults to support timely detection, dialysis vascular access placement, shared decision-making, and ESRD care coordination. The DKD management model demonstrates that resource-limited systems can deliver innovative, high-quality kidney care and provide a scalable framework for equity-focused and pragmatic kidney care in municipal health systems.

Comparative Effectiveness of Prasugrel Versus Ticagrelor in Dialysis-Dependent End Stage Renal Disease Patients Undergoing Percutaneous Coronary Intervention.

Personalized NIR-II probes for comprehensive monitoring and evaluation of dialysis vascular access.

Introduction: Diabetic Nephropathy (DN) is a frequent and severe complication of Type 2 Diabetes Mellitus (T2DM) that often progresses to End-Stage Renal Disease (ESRD). Renal Resistive Index (RI) and Urine Albumin-to-Creatinine Ratio (UACR) are valuable indicators used to evaluate renal microvascular health and DN progression. Doppler ultrasonography of the renal arteries is a non invasive tool for analysing renal blood flow, with RI providing insight into vascular resistance by comparing systolic and diastolic flow velocities. Aim: To assess the impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors on RI in T2DM patients. Materials and Methods: A quasi-experimental study involving 148 participants, categorised into normoalbuminuric and microalbuminuric groups, was conducted at SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India. Patients received SGLT2 inhibitors for three months, after which RI and UACR were reassessed. Paired t-tests were used to compare pre- and postintervention values within groups, while independent t-tests and Chi-square tests were applied to compare baseline characteristics and outcomes between groups. A p-value &lt;0.05 was considered statistically significant. Results: Post-treatment findings showed significant reductions in RI and UACR values, indicating improved renal haemodynamics and reinforcing the renal protective role of SGLT2 inhibitors (p-value &lt;0.001). Conclusion: These results underscore the therapeutic relevance of SGLT2 inhibitors in preserving renal microcirculation and delaying DN progression.

Diabetic nephropathy (DN) represents the most common cause of end-stage renal disease (ESRD) worldwide, affecting 20-40% of diabetic patients. Current therapeutic strategies remain insufficient to halt disease progression, underscoring the need for novel interventions. This comprehensive review examines the multifaceted pathogenesis of DN and evaluates the therapeutic potential of berberine (BBR) by analyzing molecular, cellular,and epigenetic mechanisms. We demonstrate that BBR, a bioactive alkaloid derived from Coptidis rhizome, protects the kidneys via multiple interrelated mechanisms. BBR improves glucose metabolism by activating AMPK signaling, reduces inflammatory responses by inhibiting the NF-κB pathway, and alleviates oxidative stress by upregulating the Nrf2 pathway. Furthermore, BBR inhibits renal fibrosis by blocking the TGF-β/Smad3 signaling and preserves podocyte function by promoting autophagy via inhibition of the mTOR pathway. Additionally, BBR modulates metabolism, suppresses the polyol pathway, and influences epigenetic processes, including DNA methylation and miRNA expression. BBR represents a promising multi-target therapeutic agent for DN, demonstrating potential superior efficacy over traditional single-pathway treatments. These results elucidate the multifaceted mechanisms of action of BBR, providing a robust scientific rationale for its therapeutic application and highlighting its potential as a novel strategy for the of metabolic kidney diseases.

Diabetic Kidney Disease (DKD) is a major cause of End-Stage Renal Disease (ESRD) and lacks effective treatments. Tangmaikang Granules (TMK), a multi-herb traditional Chinese medicine formulation, have shown potential in managing DKD. However, the precise active components, molecular mechanisms, and therapeutic advantages of TMK remain unclear. This study tests the hypothesis that TMK granules exert protective effects on DKD by targeting multiple pathways involved in oxidative stress, inflammation, and apoptosis in podocytes through a multi-targeted approach. The aim was to identify TMK's bioactive components, evaluate its therapeutic potential, and uncover its molecular mechanisms in DKD. The bioactive constituents in TMK were determined through ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Drug targets were identified using SwissTargetPrediction and SuperPred, whereas DKD-associated targets were obtained from the GeneCards, DisGeNET, OMIM, and TTD databases. A Protein-Protein Interaction (PPI) network was constructed, and key targets were identified via topological analysis. Molecular docking and dynamics simulations were performed to evaluate stable binding interactions. GO and KEGG pathway enrichment analyses were conducted to uncover relevant signaling pathways. TMK's effects on oxidative stress, inflammation, and apoptosis in podocytes were assessed using CCK-8, flow cytometry, RT-qPCR, ELISA, and Western blot assays. Thirty active compounds and 384 potential therapeutic targets were identified, with eight key targets. Pathway enrichment analysis revealed TMK's involvement in AGE-RAGE, EGFR, HIF-1, and apoptosis pathways, affecting inflammatory cytokine responses and oxidative stress. In vitro experiments demonstrated that TMK significantly reduced oxidative stress, inflammation, and apoptosis in podocytes by inhibiting the MAPK and NF-κB pathways. TMK granules target DKD through a multi-component, multi-target strategy, effectively mitigating oxidative stress and suppressing inflammatory and apoptotic pathways. This study integrates advanced computational and experimental methods, demonstrating TMK's unique therapeutic potential and providing a robust foundation for its clinical application in DKD management.

Low vision intervention in end-stage corneal disease.

Use of plastic cannulae in haemodialysis: A scoping review.

Harmine attenuates renal fibrosis via Twist1 suppression: A novel anti-fibrotic strategy for chronic kidney disease with efficacy/safety profiling.

Wilms' tumor 1 in urinary exosomes as a non-invasive biomarker for diabetic nephropathy.

Mechanical stress accelerates vascular calcification by Piezo1/BMP2 of vascular smooth muscle cells.

Alagille Syndrome (ALGS) is a rare multisystem disorder of autosomal dominant type which is primarily caused due to mutations in the JAG1 gene and, less commonly, NOTCH2, both integral to Notch signalling. Clinically, ALGS is further characterised by cholestatic liver disease because of intrahepatic bile duct paucity, along with some cardiac and skeletal abnormalities, ocular defects, renal involvement, and distinct facial features. Diagnosis of ALGS depends upon the presence of at least three of five main clinical features, which are later supported through liver biopsy, genetic testing, and imaging. Differential diagnosis of ALGS includes biliary atresia, Progressive Familial Intrahepatic Cholestasis (PFIC), neonatal hepatitis, and syndromes with overlapping phenotypes such as Noonan and Kabuki syndromes. Management in such cases is largely supportive, which mainly focuses on relieving cholestasis and pruritus, along with proper nutritional adequacy, and addressing systemic complications. Liver transplant is reserved only for end-stage disease or intractable symptoms. A multidisciplinary approach is an essential aspect of treatment to improve patient outcomes, along with quality of life.

Obesity and inactivity cluster the strongest risk factor for the development of heart failure in a population-based study.

Objective To investigate the relationships between Subjective Global Assessment (SGA)-determined nutritional status and cardiac index (CI), protein-energy wasting (PEW), prognostic factors, and clinical parameters in peritoneal dialysis patients with end-stage renal disease (ESRD). Methods A total of 80 ESRD patients treated between December 2019 and December 2021 were categorized into well-nourished (n = 36) and malnourished (n = 44) groups based on SGA scoring. Nutritional status, CI, and PEW were assessed. Clinical parameters and prognostic factors, including C-reactive protein (CRP), fetuin-A, and interleukin-6 (IL-6), were measured. Multivariate logistic regression and Spearman’s correlation analyses were employed to identify independent influencing factors and assess variable relationships. Results Significant intergroup differences (p < 0.05) were observed for PEW prevalence, CI, CRP, fetuin-A, IL-6, serum creatinine, and albumin levels. Binary logistic regression identified PEW status, CI, fetuin-A, IL-6, serum creatinine, and albumin levels as independent factors associated with malnutrition. Spearman’s correlation analysis revealed strong positive correlations between SGA scores and PEW prevalence, CI, fetuin-A, IL-6, serum creatinine, and albumin (all p < 0.001). The combined prognostic model demonstrated excellent discriminatory power, with an area under the curve (AUC) of 0.960 (p < 0.05). Conclusion SGA-determined nutritional status significantly influences CI, PEW development, and key clinical biomarkers in ESRD patients. Systematic assessment of these parameters provides valuable prognostic stratification and can guide therapeutic interventions for malnutrition management in this population.

Diabetes Mellitus (DM) remains one of the commonest causes of structural and functional kidney abnormalities leading to End Stage Renal Disease (ESRD).

Peritoneal dialysis (PD) and hemodialysis (HD) are the two primary renal replacement therapies for patients with end-stage renal disease (ESRD). While PD is an effective and convenient modality, long-term use can lead to ultrafiltration failure, recurrent peritonitis, and progressive structural alterations in the peritoneal membrane, necessitating a transition to HD. In recent years, rather than a complete transition, the combined use of PD and HD has emerged as a viable alternative, offering potential advantages for selected patient populations.This retrospective study included patients with PD-related complications, such as resistant hypervolemia, frequent peritonitis episodes, peritoneal failure, and clinical deterioration. Based on eligibility criteria, patients were either transitioned to HD or initiated on combined PD+HD therapy. A total of 28 patients underwent transition to HD, while 26 received PD+HD combination therapy. Survival rates, Kt/V, residual urine output, and various laboratory parameters were evaluated and compared between the two groups. Both groups demonstrated significant improvements in Kt/V, volume stabilization, and cardiovascular stability after transitioning from PD. However, no statistically significant differences were observed in laboratory parameters between the two groups. These findings suggest that for patients experiencing PD failure, frequent peritonitis, or fluid overload, combined PD+HD therapy may serve as a feasible alternative to conventional HD. Careful patient selection and individualized treatment planning are crucial for optimizing outcomes. Given its comparable efficacy to HD, combined PD+HD therapy may represent an important option for patients requiring a tailored approach to dialysis.

Systemic lupus erythematosus (SLE), a chronic autoimmune disease, progresses to lupus nephritis (LN) in 50–60% of patients, driving end-stage renal disease (ESRD). Identifying LN-associated cellular senescence hub genes and drug targets is critical for elucidating pathogenesis and advancing targeted therapies. Integrated transcriptomic data from LN patients (GSE61635, GSE121239; n = 441) were analyzed to identify differentially expressed genes (DEGs) using the limma package (|log2FC| > 0.5 and FDR < 0.05). Cellular senescence-associated differentially expressed genes (CS-DEGs) were further filtered through hypergeometric testing using the CellAge database. Functional enrichment analysis performed with ClusterProfiler and DOSE packages revealed significantly enriched pathways based on GO, KEGG, and GSEA terms (FDR < 0.05). A protein-protein interaction (PPI) network was constructed using STRING data and visualized in Cytoscape to prioritize hub genes. The drug-target interactions of these hub genes were subsequently validated via molecular docking and dynamics simulations using CB-Dock2. A total of 1,098 DEGs (555 upregulated, 543 downregulated) were identified. Functional enrichment revealed 60 CS-DEGs significantly enriched in viral response, myeloid differentiation, and antiviral defense (FDR < 0.05). KEGG analysis highlighted their roles in lipid metabolism/atherosclerosis, NOD-like receptor signaling, and Influenza A. PPI-based topological and modular analyses prioritized CCL2, MYD88, STAT1, JUN, JAK2, and FOS as hub genes, further refined to CCL2, JUN, JAK2, and FOS via ceRNA network. Drug screening identified thalidomide as a potential candidate, with strong binding affinity to all targets, particularly CCL2 (ΔG = −92.7 kcal/mol, forming three stable hydrogen bonds). This study revealed the role of CS-DEGs in viral response, immune regulation, and lipid metabolism in LN. Network analysis prioritized CCL2, JUN, JAK2, and FOS as hub genes. Thalidomide exhibited strong binding to these targets, notably CCL2 (ΔG = −92.7 kcal/mol), suggesting therapeutic potential via CCL2-mediated mechanisms. These findings advance LN pathogenesis understanding and precision-targeted therapies.

A 47 year old G4P3013 with diabetes induced end stage renal disease on Peritoneal Dialysis (PD) was admitted for treatment refractory uterine bleeding requiring surgical intervention.

The incidence of kidney diseases has been increasing due to changes in modern lifestyles and the ecological environment. The progression of kidney disease is characterized by ongoing renal damage and a gradual decline in renal function, ultimately leading to end-stage renal disease. The limitations of present medications have brought many disadvantages to patients. Consequently, identifying bioactive molecules has emerged as a critical strategy in the development of novel therapies for kidney diseases, particularly those derived from natural medicinal resources. This review presents a comprehensive analysis of renoprotective effects and underlying mechanisms of the medicinal plant Scutellaria baicalensis Georgi based on evidence retrieved from multiple databases, including Web of Science, PubMed, and CNKI. Flavonoids from S. baicalensis have been demonstrated to have good renoprotective properties by mitigating inflammation and oxidative stress, inhibiting cell apoptosis, reducing renal fibrosis, etc. Baicalein, wogonin, baicalin, and wogonoside are considered as the main bioactive components of the renoprotective effect of S. baicalensis. Further research on candidate molecules derived from S. baicalensis represents a promising strategy for the development of novel therapeutic agents targeting kidney diseases.