Loss Of Renal Function Research Articles

Endotoxin-Retentive Filters for the Online Preparation of Ultrapure Dialysis Fluid and Non-Pyrogenic Substitution Fluid: A Critical Review and Reference Guide

Poor water treatments and concentrates to prepare dialysis fluids favor bacterial growth-producing pyrogens (e.g., endotoxins) that may cross hemodialysis, particularly high-flux, membranes. This puts hemodialysis patients at risk of acute bacteremia, pyrogenic reactions, long-term complications, loss of residual renal function, and poor nutritional status. Consequently, regulatory bodies worldwide recommend using ultrapure dialysis fluid for routine hemodialysis. Requests are also growing for the online production of sterile non-pyrogenic substitution fluid from ultrapure dialysis fluid. This way, large volumes of infusion solution may be safely and economically produced, enabling more end-stage kidney disease patients to benefit from the greater capacity of hemodiafiltration to remove toxins than purely diffusive hemodialysis treatment. Ultrapure dialysis and substitution fluids are often produced upstream from hemodialyzers by online filtration of standard dialysis fluid through cascades of bacteria- and endotoxin-retentive filters (ETRFs). Commercial ETRFs differ for membranes, operation, performance, duration and maintenance protocols, connection to a dialysis machine, disinfection procedures, and replacement schedule. Although suboptimal ETRF choice may increase treatment costs, the difficulty in gathering comparative information on commercial ETRFs complicates their selection. To aid dialysis centers in selecting the most convenient and suitable ETRF for their needs, herein, relevant characteristics of commercial ETRFs are reported and critically reviewed for a quick yet effective comparison.

P-1553. Impact of Urinary Tract Infection due to Carbapenem Resistant Gram Negative Bacteria in Patients with Kidney Transplant

Abstract Background Carbapenem resistance is a fearsome reality, especially in transplant patients, and urinary tract infections may cause severe illness and graft loss. Methods In this 10-year retrospective cohort we analyzed kidney transplanted patients with gram-negative carbapenem-resistant urinary tract infection (UTI). We evaluated overall prevalence, risk factors for 14-day clinical response and development of acute kidney injury or graft loss during infection. Patients ≥ 18 years old with symptomatic infections or loss of renal function attributed to UTI were included. We excluded patients with kidney abscesses or intra-abdominal complications, death within 24 h, non-active antimicrobial treatment. Results From urocultures collected from 2013 – 2023, 11.583 isolated gram-negative bacteria, of which 14.2% were carbapenem resistant. From these, 87 patients were included. 72.4% were male, aged 56.9 ± 13.6 years old and median transplant time was 15.8 (2 - 89.6) months; 83.9% had upper UTI. The most prevalent bacteria was Klebsiella pneumoniae, with 75 samples (86.2%). 41 (47.1%) were carbapenemase producers: 29.8% serino and 18.3% metallo-beta lactamases. Patients were treated with: amikacin (58.6%) polymyxin B (47.1%), polymyxin E (32.2%), tigecycline (5.7%) ceftazidime-avibactam (8.0%). In 46.0% of the cases, these drugs were combined. 82.8% had complete resolution of symptoms and negative follow-up urine cultures in 14 days. Independent risk factors for non-response were baseline hemodynamic instability (p< 0.01) and polymyxin B treatment (p< 0.01). Control urocultures were collected from 79 (90.8%); 15 (18.9%) had the same bacteria. Sixty-eight patients (79.1%) who were not in dialysis at baseline were evaluated for AKI,from which 45 (66.1%) developed AKI during therapy and 8 (11.7%) had renal graft loss. 12 (13.8%) patients died in 30-days. Conclusion Carbapenem resistant bacteria are increasingly prevalent in renal transplant patients and associated to AKI and graft loss potentially due to the use of nephrotoxic drugs. Polymyxin B and hemodynamic instability were independent preditors non-clinical response in 14-days, which should be further evaluated due to the non-urinary concentration of this antibiotic. Disclosures All Authors: No reported disclosures

Baicalin: a potential therapeutic agent for acute kidney injury and renal fibrosis.

Acute kidney injury (AKI) is a common critical clinical disease that is linked to significant morbidity, recurrence, and mortality. It is characterized by a fast and prolonged loss in renal function arising from numerous etiologies and pathogenic pathways. Renal fibrosis, defined as the excessive accumulation of collagen and proliferation of fibroblasts within renal tissues, contributes to the structural damage and functional decline of the kidneys, playing a pivotal role in the advancement of Chronic Kidney Disease (CKD). Until now, while continuous renal replacement therapy (CRRT) has been utilized in the management of severe AKI, there remains a dearth of effective targeted therapies for AKI stemming from diverse etiologies. Similarly, the identification of specific biomarkers and pharmacological targets for the treatment of renal fibrosis remains a challenge. Baicalin, a naturally occurring compound classified within the flavonoid group and commonly found in the Chinese herb Scutellaria baicalensis, has shown a range of pharmacological characteristics, such as antioxidant, anti-inflammatory, antifibrotic, antitumor and antiviral effects, as evidenced by research studies. Research shows that Baicalin has potential in treating kidney diseases like AKI and renal fibrosis. This review aims to summarize Baicalin's progress in these areas, including its molecular mechanism, application in treatment, and absorption, distribution, metabolism, and excretion. Baicalin's therapeutic effects are achieved through various pathways, including antioxidant, anti-inflammatory, antifibrosis, and regulation of apoptosis and cell proliferation. Besides, we also hope this review may give some enlightenment for treating AKI and renal fibrosis in clinical practice.

Segmentation of ADPKD Computed Tomography Images with Deep Learning Approach for Predicting Total Kidney Volume

Background: Total Kidney Volume (TKV) is widely used globally to predict the progressive loss of renal function in patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD). Typically, TKV is calculated using Computed Tomography (CT) images by manually locating, delineating, and segmenting the ADPKD kidneys. However, manual localization and segmentation are tedious, time-consuming tasks and are prone to human error. Specifically, there is a lack of studies that focus on CT modality variation. Methods: In contrast, our work develops a step-by-step framework, which robustly handles both Non-enhanced Computed Tomography (NCCT) and Contrast-enhanced Computed Tomography (CCT) images, ensuring balanced sample utilization and consistent performance across modalities. To achieve this, Artificial Intelligence (AI)-enabled localization and segmentation models are proposed for estimating TKV, which is designed to work robustly on both NCCT and Contrast-Computed Tomography (CCT) images. These AI-based models incorporate various image preprocessing techniques, including dilation and global thresholding, combined with Deep Learning (DL) approaches such as the adapted Single Shot Detector (SSD), Inception V2, and DeepLab V3+. Results: The experimental results demonstrate that the proposed AI-based models outperform other DL architectures, achieving a mean Average Precision (mAP) of 95% for automatic localization, a mean Intersection over Union (mIoU) of 92% for segmentation, and a mean R2 score of 97% for TKV estimation. Conclusions: These results clearly indicate that the proposed AI-based models can robustly localize and segment ADPKD kidneys and estimate TKV using both NCCT and CCT images.

Quality of life of patients with chronic kidney disease on hemodialysis Nuble, Chile, 2023

Introduction: chronic kidney disease involves a gradual and irreversible loss of renal function, impacting nephrons and quality of life due to dialytic treatment on physical, psychological, and independence levels. The objective was to determine the quality of life of users with chronic kidney disease undergoing hemodialysis in Nuble, Chile. Methods: a quantitative, descriptive study with 153 users was conducted. The Kidney Disease and Quality of Life – 36 questionnaire was administered, assessing quality of life across four subscales. Results: the majority (59,5 %) were male, with 51,6 % aged over 61. The average quality of life score was 47,7, with notable emphasis on "Perception of physical and mental health" (71,9 %) and "Burden of kidney disease" (77,1 %).Conclusions: the quality of life of users with chronic kidney disease in this study was characterized by an average below 50 %, indicating a generally low evaluation

Predictors and prognostic significance of the volume load trajectory: a longitudinal study in patients on peritoneal dialysis

Volume overload in peritoneal dialysis patients is a common issue that can lead to poor prognosis. We employed a group trajectory model to categorize volume load trajectories and examined the factors associated with each trajectory class to explore the impact of different trajectory groups on clinical prognosis and residual renal function (RRF). This single-center prospective cohort study included 214 patients on maintenance peritoneal dialysis within a tertiary hospital. The ratio of extracellular water to total body water was measured using Bioimpedance analysis. The SAS 9.4 PROC Traj procedure was used to examine the group-based trajectory of the patients. A multivariate logistic regression model was used to calculate the adjusted odds ratios (aOR) of the associated factors to predict the trajectory class of participants. The average age of the included patients was 53.56 (SD: 11.77) years, with a male proportion of 46.7% and a median follow-up time of 6 months. The normal stable group accounted for 35.05% of the total population and maintained a normal and stable level, the moderate stable group accounted for 52.8% of the total population and showed a slightly higher and stable level, and the high fluctuation group accounted for 12.15% of the total population and showed a high and fluctuating level. A multivariate logistic regression analysis revealed that age, diabetes, and albumin levels are significant factors influencing the categorization of volume load trajectories. There were statistically significant differences in both the technical survival rate and the loss of residual renal function among the three trajectory groups.

Lycopene alleviates 5-fluorouracil-induced nephrotoxicity by modulating PPAR-γ, Nrf2/HO-1, and NF-κB/TNF-α/IL-6 signals

5-Fluorouracil (5-FU) is one of the most used anticancer drugs. However, its nephrotoxicity-associated drawback is of clinical concern. Lycopene (LYC) is a red carotenoid with remarkable anti-inflammatory and anti-oxidative properties. In this study, rats were divided randomly into five groups: control, lycopene (10 mg) (10 mg/kg/day; P.O), 5-FU (30 mg/kg/day; i.p.), Lycopene (5 mg) + 5-FU (5 mg/kg + 30 mg/kg/day), and lycopene (10 mg) + 5-FU (10 mg/kg + 30 mg/kg/day). LYC attenuated the loss of renal function induced by 5-FU in a dose-dependent manner. Rats co-treated with LYC had lower serum urea, creatinine, uric acid and KIM-1 levels, and a higher serum albumin level than those receiving 5-FU alone. Furthermore, co-treatment with the high dose of LYC maintained renal oxidant–antioxidant balance by ameliorating/preventing the loss of antioxidants and the elevation of malondialdehyde. Rats treated with 5-FU had markedly lower renal levels of PPAR-gamma, HO-1, Nfr2, and Il-10 and higher levels of NF-kB, TNF-alpha, and IL6 compared to the control rats. Co-treatment with LYC attenuated the reduction in PPAR-gamma, HO-1, Nfr2, and IL-10 levels and moderated the elevated levels of NF-kB, TNF-alpha, and IL-6. The kidneys from rats co-treated with lycopene (10 mg) + 5-FU did not show the degenerative changes in the glomerular tufts and tubules observed for the rats treated with 5-FU alone. In conclusion, LYC is a promising therapeutic strategy for attenuating 5-FU-induced nephrotoxicity through the restoration of antioxidant activities and inhibition of inflammatory responses by modulating PPAR-γ, Nrf2/HO-1, and NF-κB/TNF-α/IL-6, signals.

Extrarenal Stone Migration After PNL and RIRS: Effectiveness of Conservative Follow-up in Light of Literature

This study aims to evaluate rare cases of extrarenal stone migration after endoscopic stone surgery in light of the literature. Complications such as stone migration can rarely be seen after flexible ureterorenoscopy (RIRS) and percutaneous nephrolithotomy (PNL), which are widely used in the treatment of urolithiasis. In this case report, extrarenal stone migration was detected in a 43-year-old man who had previously undergone PNL and RIRS, but since the patient was asymptomatic, conservative follow-up was applied instead of surgical intervention. In the patient's CT scans, it was seen that the stone was lateral to the psoas major muscle and did not cause significant inflammation or edema in the surrounding tissues. When the cases in the literature were examined, extrarenal stone migration is usually associated with symptoms such as pain, infection or loss of renal function and requires surgery, but in this case, surgery was not applied due to the asymptomatic course. This situation shows the importance of conservative approaches and that they can be an alternative to surgery. In conclusion, the increase in such cases reported in the literature may guide the management of extrarenal stone complications. This study emphasizes conservative treatment strategies, especially in patients with asymptomatic extrarenal stone migration.

Clinical course and outcome of adult patients with primary focal segmental glomerulosclerosis with kidney function loss on presentation.

Kidney function loss or renal insufficiency indicated by elevated creatinine levels and/or an estimated glomerular filtration rate (eGFR) < 60 mL/minute/1.73 m² at presentation in patients with primary focal segmental glomerulosclerosis (FSGS) is commonly seen as a poor prognostic marker for kidney survival. However, a pre>vious study from our center suggested this may be due to hemodynamic factors. To observe the clinical and biochemical parameters, treatment response, kidney survival, and overall outcomes of adult patients with primary FSGS presenting with kidney function insufficiency. This retrospective observational study was conducted at the Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from January 1995 to December 2017. During this period, 401 biopsy-proven primary FSGS patients were identified, of which 98 (24.4%) presented with kidney function loss or renal insufficiency defined as eGFR < 60 mL/minute/1.73 m² at presentation and were studied in detail. Among the 98 patients with renal function loss on presentation, the mean age was 30.9 years ± 13.6 years with a male-to-female ratio of 2.5:1. The mean serum creatinine level was 2.2 mg/dL ± 1.3 mg/dL and mean eGFR 37.1 mL/minute/1.73 m2 ± 12.8 mL/minute/1.73 m2. The mean 24-hour urinary protein excretion was 5.9 g/day ± 4.0 g/day, and the mean serum albumin was 2.1 g/dL ± 1.0 g/dL (median: 1.5 g/dL). The mean systolic blood pressure (BP) was 132.7 mmHg ± 19.8 mmHg, and the mean diastolic BP was 87.4 mmHg ± 12.7 mmHg. Steroid treatment was given to 81 (82.6%) of 98 patients for an average duration of 19.9 weeks ± 14.4 weeks, with a mean total steroid dose of 4.4 g ± 1.5 g. Treatment response showed that 20 (24.6%) patients achieved complete remission, 9 (11.1%) achieved partial remission, and 52 (64.1%) did not respond. The baseline eGFR was significantly lower in the non-responsive group (P = 0.006). The distribution of FSGS variants was also significantly different among steroid-responsive and non-responsive groups (P = 0.012). Renal function loss in FSGS patients at presentation does not necessarily indicate irreversible kidney function loss and a significant number of patients respond to appropriate treatment of the underlying disease.

Macrophage membrane-biomimetic ROS-responsive platinum nanozyme clusters for acute kidney injury treatment.

Acute kidney injury (AKI) is a common clinical syndrome characterized by the rapid loss of renal filtration function. No standard therapeutic agent option is currently available. The development and progression of AKI is a continuous and dynamical pathological process. Oxidative stress and inflammatory responses are the primary influencing factors. Here, we developed a biomimetic nano-system (MM-PtNCs) with reactive oxygen species (ROS)-responsive platinum nanozyme clusters (PtNCs) wrapped in macrophage membrane (MM) to alleviate AKI by modulating oxidative stress and inflammation. The inflammatory cytokines receptors retained on MM surface allowed the biomimetic nano-system to target renal inflammation and neutralize these pro-inflammatory cytokines to ameliorate inflammation. PtNCs exhibit free radical scavenging-ability and catalase (CAT)-like activity to scavenge ROS and regulate the oxidative stress situations both in injured cells and tissues. Meanwhile, it could responsively dissociate into ultrasmall platinum nanoparticles under AKI-specific ROS conditions to eliminate ROS and eventually excreted through the renal filtration system. In a mouse model of ischemia/reperfusion-induced AKI, systemic injection of MM-PtNCs significantly reduced renal damage and restored kidney function. Additionally, MM-PtNCs effectively prevented the progression of AKI to chronic kidney disease. In conclusion, MM-PtNCs may propose a multi-faceted regulatory approach for clinical AKI treatment.

Translation into Portuguese (Brazil), cultural adaptation and validation of Parathyroid Assessment of Symptoms (PAS) in patients with chronic kidney disease and hyperparathyroidism.

Chronic kidney disease (CKD) is related to high morbidity and mortality and loss of quality of life. Likewise, hyperparathyroidism is associated to progressive loss of renal function, with increased phosphate and decrease calcium levels, which induce the secretion of parathyroid hormone. To translate into Portuguese (Brazil), culturally adapt and validate the questionnaire Parathyroid Symptoms Assessment (PAS), following reliability and validity criteria in patients with chronic kidney disease and hyperparathyroidism. Methodological and cross-sectional study, carried out at São Lucas Hospital/PUCRS, Porto Alegre, Brazil. The PAS questionnaire validation process followed protocols from previous studies. After translating into Portuguese, it was applied to 100 patients with secondary (SHPT) and tertiary or persistent (THPT) hyperparathyroidism. For PAS validation data, patients responded to the Short Form Health 36 (SF-36) questionnaire. Reliability criteria were evaluated using intraclass correlation coefficient (ICC) and Cronbach's alpha (α-C). Validity was assessed by Spearman's correlation coefficient between PAS and SF-36 values. Participant's mean age was 55.6 ± 15.6 years, 61% was male, and 68% was diagnosed with SHPT. Among 100 patients, 53% performed a PAS retest (ICC = 0.83). The internal reliability by α-C was 0.86. Negative correlations were observed between PAS questions and SF-36 physical and mental domains, which ranged from 0.3 to 0.7. The Brazilian version of the PAS questionnaire was found to be valid and reliable. The PAS questionnaire can be used to evaluate quality of life in Brazilian patients with hyperparathyroidism who speak Portuguese.

A portable easy-to-use triboelectric sensor for arteriovenous fistula monitoring in dialysis patients

Hemodialysis is the primary treatment for patients with total loss of renal function and is performed through a vascular access called an arteriovenous fistula (AVF). AVF can be associated with several complications, such as stenosis, thrombosis, and aneurysms. While digital subtraction angiography (DSA) is the gold standard for AVF monitoring, its limited availability, invasiveness, and harmfulness has enabled Doppler ultrasound (DUS) as alternative technique. Herein, the development of a portable device based on a triboelectric sensor for AVF monitoring that exploits the concept of impedance cardiography (ICG) is presented. The triboelectric sensor consists of a thin polyvinylidene fluoride (PVDF) layer placed close to the AVF to evaluate the triboelectric ICG signal (T-ICG), thus avoiding the need for standard multiple-electrode equipment. Electrocardiographic (ECG) dry electrodes based on a composite of polydimethylsiloxane (PDMS) and multi-walled carbon nanotubes (MWCNTs) were fabricated. Concept validation was performed in a cohort of hemodialysis patients with and without AVF stenosis. The results demonstrated a linear dependence between blood flow and the maximum deviation (dZ/dtmax) of the T-ICG pattern. Patients with stenosis showed a statistically significant change in morphology at the B-point. The extent of stenosis was evaluated by analyzing the temporal slope of the ICG pattern in the B- and C-point regions, evidencing a linear trend for stenosis from 20 % up to 60 %. The proposed device represents an innovative approach compared with the gold clinical standards for the continuous monitoring of AVF in hemodialysis patients.

Unraveling Uncertainty: The Impact of Biological and Analytical Variation on the Prediction Uncertainty of Categorical Prediction Models.

Interest in prediction models, including machine learning (ML) models, based on laboratory data has increased tremendously. Uncertainty in laboratory measurements and predictions based on such data are inherently intertwined. This study developed a framework for assessing the impact of biological and analytical variation on the prediction uncertainty of categorical prediction models. Practical application was demonstrated for the prediction of renal function loss (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equation) and 31-day mortality (advanced ML model) in 6360 emergency department patients. Model outcome was calculated in 100 000 simulations of variation in laboratory parameters. Subsequently, the percentage of discordant predictions was calculated with the original prediction as reference. Simulations were repeated assuming increasing levels of analytical variation. For the ML model, area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity were 0.90, 0.44, and 0.96, respectively. At base analytical variation, the median [2.5th-97.5th percentiles] percentage of discordant predictions was 0% [0%-28.8%]. In addition, 7.2% of patients had >5% discordant predictions. At 6× base analytical variation, the median [2.5th-97.5th percentiles] percentage of discordant predictions was 0% [0%-38.8%]. In addition, 11.7% of patients had >5% discordant predictions. However, the impact of analytical variation was limited compared with biological variation. AUROC, sensitivity, and specificity were not affected by variation in laboratory parameters. The impact of biological and analytical variation on the prediction uncertainty of categorical prediction models, including ML models, can be estimated by the occurrence of discordant predictions in a simulation model. Nevertheless, discordant predictions at the individual level do not necessarily affect model performance at the population level.

Enhanced glomerular transfection by BMP7 gene nanocarriers inhibits CKD and promotes SOX9-dependent tubule regeneration

Renal fibrosis and loss of kidney function are key characteristics of chronic kidney disease (CKD). To address the lack of effective treatments, multifunctional layer-by-layer (LbL) assembled polymeric gene-carrier nanoparticles (PCHS-NP) are prepared to realize preferential accumulation and retention within renal glomerular cells, thereby effectively leveraging cortically localized structures for the synthesis and paracrine secretion of the antifibrotic growth factor, bone morphogenetic protein-7 (BMP7). PCHS-NP had stable homogenous morphologies, kidney-targeting functionality, antioxidative effects, and high transfection efficiency. In unilateral ureteral obstruction (UUO)-induced renal fibrosis, a single systemic injection of PCHS-NP prevents tubular atrophy and interstitial fibrosis, and the resultant tissue microenvironment is more conducive to tubular regeneration driven by the upregulation of proliferative SOX9-expressing tubular cells. In longer-term folic acid (FA)-induced renal fibrosis, we show that early, late, and repeat systemic injections restore kidney health and function. This study indicates that PCHS-NP accomplish a promising therapeutic option for the treatment of CKD.

C3 glomerulopathy: a kidney disease mediated by alternative pathway deregulation.

C3 glomerulopathy (C3G) is an ultra-rare complement-mediated kidney disease caused by to the deregulation of the alternative pathway (AP) of proximal complement. Consequently, all effector loops of the complement are active and can lead to pathologies, such as C3a- and C5a-mediated inflammation, C3b opsonization, surface C3b-mediated AP C3 convertase assembly, C3 cleavage product deposition in the glomerulus, and lytic C5b-9/MAC cell damage. The most common pathologic mechanisms are defective chronic alternative pathway deregulation, mostly occurring in the plasma, often causing C3 consumption, and chronic complement-mediated glomerular damage. C3G develops over several years, and loss of renal function occurs in more than 50% of patients. C3G is triggered by both genetic and autoimmune alterations. Genetic causes include mutations in individual complement genes and chromosomal variations in the form of deletions and duplications affecting genes encoding complement modulators. Many genetic aberrations result in increased AP C3 convertase activity, either due to decreased activity of regulators, increased activity of modulators, or gain-of-function mutations in genes encoding components of the convertase. Autoimmune forms of C3G do also exist. Autoantibodies target individual complement components and regulators or bind to neoepitopes exposed in the central alternative pathway C3 convertase, thereby increasing enzyme activity. Overactive AP C3 convertase is common in C3G patients. Given that C3G is a complement disease mediated by defective alternative pathway action, complement blockade is an emerging concept for therapy. Here, we summarize both the causes of C3G and the rationale for complement inhibition and list the inhibitors that are being used in the most advanced clinical trials for C3G. With several inhibitors in phase II and III trials, it is expected that effectice treatment for C3G will become availabe in the near future.

Impact of Tumor Volume and Other Factors on Renal Function After Partial Nephrectomy.

Background and Objectives: One of the main objectives of partial nephrectomy is to preserve as much renal function as possible. However, the removal of functioning nephrons and ischemic damage secondary to the clamping of the renal pedicle can be associated with a certain degree of renal function loss. We aim to evaluate the relationship between tumor volume and other factors on renal function in the short term (1-3 months) and long term (6-12 months) in our series of partial nephrectomies. Methods: A retrospective study was conducted on 147 patients who underwent open or laparoscopic partial nephrectomy between 2018 and 2022. Tumor volume was estimated through reconstructions from the computed tomography images. Univariate and multivariate analyses of the data were performed. Results: The mean age was 58.2 years, with an average glomerular filtration rate (GFR) of 79 mL/min/m2. Of all partial nephrectomies, 76.2% were laparoscopic, 57.1% were T1a tumors, and the mean volume was 17 cc. The average ischemia time during surgery was 14.3 min, with a mean hemoglobin loss of 2.8 g/dL in the immediate postoperative period. No significant differences were found either in the short or long term regarding ischemia time (p = 0.57, p = 0.32) or tumor volume (p = 0.57, p = 0.33). However, in the multivariate analysis, it was observed that the variable with the greatest influence on short-term renal function was perioperative glomerular filtration, while in the long term, ischemia time, age, and tumor volume also had an influence. Conclusions: Tumor volume is not an independent factor for renal function deterioration in the short or long term. Short-term renal function is primarily determined by perioperative glomerular filtration. Perioperative glomerular filtration, ischemia time, age, and tumor volume can jointly predict long-term renal function.

The Added Value of Controlling Nutritional Status (Conut) Score for Preoperative Counselling on Significant Early Loss of Renal Function After Radical Nephrectomy for Renal Cell Carcinoma

Background and Objectives: We aimed at evaluating the impact of Controlling Nutritional Status (CONUT) score on clinically significant decline in estimated glomerular filtration rate (eGFR) in patients with non-metastatic Clear Cell Renal Cell Carcinoma (ccRCC) undergoing radical nephrectomy (RN). Materials and methods: We retrospectively analyzed a multi-institutional cohort of 140 patients with ccRCC who underwent RN between 2016 and 2018 at three Urological Centers. The CONUT score was calculated with an algorithm including serum albumin, total lymphocyte count, and cholesterol. Clinical and pathologic features were analyzed using Fisher’s exact test for categorical variables and a Mann–Whitney U test for continuous variables. To define the independent predictors of clinically significant eGFR decline, univariable (UVA) and multivariable (MVA) binomial logistic regression analyses were performed in order to assess the Odds Ratio (OR) with 95% Confidence Intervals (CIs). Results: The optimal cut-off value to discriminate between a low and high CONUT score was assessed by calculating the ROC curve. The area under the curve (AUC) was 0.67 (95%CI 0.59–0.78) with the most appropriate cut-off value at 2 points. Overall, 46 patients (32.9%) had a high CONUT score (&gt;2). Statistically significant variables associated with eGFR decline at 24 months were age ≥ 70 (OR 2.01; 95%CI 1.17–3.09; p 0.05), stage II–III chronic kidney disease (CKD) (OR 6.05; 95%CI 1.79–28.3; p 0.001), and a high CONUT score (OR 3.98; 95%CI 1.58–10.4; p 0.004). Conclusions: The CONUT score is a low-time-consuming, cost-effective, and promising tool able to preoperatively screen patients at risk of developing CKD after a RN.

Nox4 is involved in acute kidney injury associated to intravascular hemolysis

Massive intravascular hemolysis occurs not unfrequently in many clinical conditions. Breakdown of erythrocytes promotes the accumulation of heme-derivates in the kidney, increasing oxidative stress and cell death, thus promoting acute kidney injury (AKI). NADPH oxidase 4 (Nox4) is a major source of reactive oxygen species (ROS) in the kidney, however it is unknown the role of Nox4 in hemolysis and whether inhibition of this enzyme may protect from heme-mediated injury. To answer these questions, we elicited intravascular hemolysis in wild type and Nox4 knockout mice. We also evaluated whether nephrotoxic effects of heme may be reduced by using Nox4 siRNA and pharmacologic inhibition with GKT137831, a Nox4 inhibitor, both in vivo and in cultured renal cells. Our results showed that induction of massive hemolysis elicited AKI characterized by loss of renal function, morphological alterations of the tubular epithelium and podocytes, oxidative stress, inflammation, mitochondrial dysfunction, blockade of autophagy and cell death. These pathological effects were significantly prevented in Nox4-deficient mice and in animals treated with GKT137831. In vitro studies showed that Nox4 disruption by specific siRNAs or Nox4 inhibitors declined heme-mediated ROS production and cell death. Our data identify Nox4 as a key enzyme involved in intravascular hemolysis-induced AKI. Thus, Nox4 inhibition may be a potential therapeutic approach to prevent renal damage in patients with severe hemolytic crisis.

HIF-1α induced FGF18 alleviates renal ischemia/reperfusion injury via YAP.

Acute kidney injury (AKI) is a devastating clinical condition characterized by an abrupt loss of renal function. The pathophysiology of AKI involves diverse processes and elements, of which survival and regeneration have been established to be significant hallmarks. And early studies have confirmed the fundamental role of FGFs in the regulation of AKI pathology, although the association between FGF18 and AKI still remains elusive. Our study demonstrates a substantial up-regulation of FGF18 in the renal tubules of mice subjected to ischemia. Notably, targeted overexpression of FGF18 effectively mitigates the impairment of kidney function induced by AKI. Mechanistically, FGF18 facilitates cell proliferation and anti-apoptosis in RTECs by enhancing the expression of YAP and facilitating its translocation to the nucleus. Aside from that, we also discovered that the substantial expression of FGF18 under ischemic conditions is HIF-1α dependent. This study aims to uncover the inherent mechanism behind the beneficial effects of FGF18 in attenuating AKI. By doing so, it aims to offer novel insights into the development of therapeutic strategies for AKI.

A Study to Assess the Effectiveness of Video Assisted Teaching Programme on Knowledge, Attitude and Practice Regarding Renal Rehabilitation among Patients with Chronic Kidney Disease Who are Admitted in the Mamata General and Super Specialty Hospital, at Khammam, Telanagana

ABSTRACT Background: Kidneys are one of the vital organs in the human body. Kidneys perform vital functions like excretion of waste products, maintenance of water balance, thus maintaining the homeostasis. In addition, kidneys perform many other functions such as role in Homeostasis, Production of Erythrocyte, Endocrine function, Regulation of Blood Sugar and regulation of Blood Calcium level. Because the kidney performs a wide variety of functions, the effects of loss of renal function not only in kidney but also in other organ systems.Hemo dilaysis is used for clients with acute or irreversible renal failure and fluid and electrolyte imbalances. It is usually the treatment of choice when toxic agents, such as barbiturates after an over dose need to be removed quickly. The availability of the treatment for clients with end stage renal failure (ESRF) has become more prevalent. The population receiving hemo dilaysis now represents a wide cross-section of age rehabilitative potential of socio-economic status. Materials and Methods: For the present study, quantitative Evaluative Approach ,Pre – Experimental research design, one group pretest and one group post test design.The study was conducted in the Mamata General and super specialty Hospital at Khammam, Telangana. Results: The above table shows that the pre test mean knowledge score is 10.05 and standard deviation is 3.77 where as post test mean score is 18.02 and standard deviation is 3.36 and mean difference is 7.97, the paired ‘t’ test calculated value is 14.89, which is greater than table value with df value of 79at (p&lt;0.05) level. Conclusion: The main study was conducted in Mamata general and super specialty hospital, at Khammam, Telanagana . The sample sizes 30. The sample was selected by using non probability of convenient sampling technique among those fulfill the criteria.