Renal Function Outcomes Research Articles

Evaluation of renal fibrosis using scanning acoustic microscopy.

Renal fibrosis is strongly correlated with renal functional outcomes. Therefore, this is a significant finding in determining renal prognosis. There are various reports on the imaging evaluation of renal fibrosis, but these are not well established. Scanning acoustic microscopy (SAM) uses ultra-high-frequency ultrasound to visualize tissues in just over a minute. SAM can simultaneously measure acoustic data such as speed of sound (SOS). SOS indicates the elasticity (stiffness) of a material. In this study, we aimed to compare and evaluate SAM acoustic intensity images and SOS data with light microscopy images of renal lesions, especially renal fibrosis. Renal specimens containing fibrosis were selected. The acoustic intensity images were compared to PAS-stained images. SOS data of the tubulointerstitium were compared with Masson's trichrome (MT)-stained images. The blue intensity of MT staining, which indicates fibrosis, was numerically valued using image-processing software. Furthermore, the correlations between it and the SOS values were evaluated. The acoustic intensity images suggested tubular atrophy and interstitial expansion in the same areas as in the PAS staining. SOS values of interstitial expansion with fibrosis were higher than normal area, interstitial expansion without fibrosis. A weak positive correlation was observed between the SOS values and the blue intensity of MT staining. SOS data can be used to evaluate renal fibrosis. The combination of SOS data and MT-stained images enables a more detailed evaluation of renal fibrosis. This study can contribute to the evaluation of renal fibrosis and has potential clinical applications in the future.

Comparative efficacy of different drugs in acute heart failure with renal dysfunction: a systematic review and network meta-analysis

ObjectiveThis network meta-analysis was to compare the efficacy of different drugs on cardiac function, renal function, and clinical outcomes in patients with acute heart failure (AHF) accompanied by renal dysfunction.MethodsPubMed, EMBASE, Cochrane Library, and Web of Science were searched to screen all clinical trials of AHF between January 1st 2001 and March 31th 2024. The primary outcome measures were N-terminal pro-B type natriuretic peptide (NT-proBNP), B-type natriuretic peptide (BNP), glomerular filtration rate (GFR), blood urea nitrogen, serum creatinine, all-cause mortality within 60 days, and cardiovascular mortality.ResultsAfter screening 30,697 citations, 13 studies (21,745 patients) were included, and drugs including nesiritide, dopamine, tolvaptan, levosimendan, dobutamine, furosemide, and spirolactone, and high dose of diuretics (HDD, furosemide, and spirolactone) were estimated. The results indicated that HDD had the best efficacy in reducing NT-proBNP levels. In detail, HDD notably reduced NT-proBNP levels compared to conventional treatment or placebo (PLC) [MD = −950.24; 95% CrI (−1,832.21, −64.12)]. Levosimendan significantly increased GFR levels compared to PLC [MD = 14.46; 95% CrI (3.88, 25.97)] and tolvaptan [MD = 13.83; 95% CrI (2.31, 25.33)]. No significant difference was found in 60-day all-cause mortality and cardiovascular mortality across drugs.ConclusionHDD showed the best efficacy in reducing NT-proBNP levels compared with dopamine and nesiritide, and levosimendan could significantly improve GFR levels, with no marked difference in the effect of various drugs on 60-day all-cause mortality. Hence, HDD and levosimendan may be optimal agents in the treatment of AHF with renal dysfunction.Systematic Review RegistrationPROSPERO, identifier (CRD42023454616).

Comparative Analysis of Renal Function Outcomes Following Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis.

Obesity is a significant risk factor for chronic kidney disease (CKD), with metabolic bariatric surgery offering potential renal benefits. However, there is limited comparative data on the impact of Roux-en-Y gastric bypass (RYGB) versus laparoscopic sleeve gastrectomy (LSG) on renal function in individuals with obesity without end-stage renal disease (ESRD). The objective of this study was to compare renal function outcomes following RYGB and LSG in patients with obesity, focusing on estimated glomerular filtration rate (eGFR), serum creatinine, albumin-creatinine ratio (ACR), and serum cystatin C. A systematic review and meta-analysis were conducted following Cochrane and PRISMA guidelines. Data from 17 observational studies (n = 3339) were analyzed. Primary outcomes included changes in eGFR, ACR, serum creatinine, and cystatin C. Secondary outcomes included excess weight loss (%EWL) and total weight loss (%TWL). Statistical analysis involved fixed and random-effects models based on heterogeneity levels. RYGB demonstrated significant improvements in eGFR (SMD = - 0.71; 95% CI - 0.89 to - 0.52, p < 0.00001) and serum cystatin C (MD = - 0.10; 95% CI - 0.17 to - 0.03, p = 0.004) compared to LSG. No significant differences were found for serum creatinine (MD = - 1.06; 95% CI - 4.42 to 2.30, p = 0.54) or ACR (MD = 1.95; 95% CI - 0.39 to 4.29, p = 0.10). RYGB also showed greater long-term weight loss, particularly at 5years (%EWL: MD = 22.00; 95% CI 6.56 to 37.44, p = 0.005). RYGB offers similar renal improvements with superior weight loss compared to LSG in individuals with obesity without ESRD. These findings emphasize the need for personalized treatment approaches and further research to validate these outcomes.

Characterizing Renal Function Predictors and Outcomes in Liver Transplant Recipients Who Have Preoperative Renal Dysfunction

Characterizing Renal Function Predictors and Outcomes in Liver Transplant Recipients Who Have Preoperative Renal Dysfunction

Adequate Volume Restitution with Midodrine Versus Albumin in Patients with Refractory Ascites Undergoing Large-Volume Paracentesis: A Comparative Analysis

Large-volume paracentesis (LVP) is a cornerstone in the management of refractory ascites in cirrhotic patients, but it is associated with significant hemodynamic complications, including paracentesis-induced circulatory dysfunction (PICD). Current guidelines advocate for the use of albumin to mitigate these risks; however, its high cost and limited availability have prompted the exploration of alternative therapies such as midodrine, an α1-adrenergic agonist with vasoconstrictive properties. This study aims to compare the efficacy and safety of midodrine versus albumin in maintaining hemodynamic stability and preventing PICD post-LVP. We conducted a prospective, randomized trial involving patients with refractory ascites, evaluating hemodynamic parameters, renal function, and clinical outcomes. Our findings suggest that midodrine offers a cost-effective alternative to albumin with comparable efficacy in volume restitution, although certain patient subgroups may benefit more from specific interventions. Further research is warranted to optimize patient selection and treatment protocols.

Prognostic impact of mild renal dysfunction in patients undergoing valve surgery.

To analyse the impact of mild renal dysfunction on the prognosis of patients undergoing valve surgery. A total of 6210 consecutive patients (3238 women; mean age 59.2 ± 12.7 years) who underwent left-sided heart valve surgery between 2000 and 2022 were included in the study cohort. The primary outcome was all-cause death, and the secondary outcome was a composite of death, reoperation, stroke and heart failure. The restricted cubic spline function was utilized to investigate the association between estimated glomerular filtration rate and clinical outcomes, which was validated using inverse probability of treatment weighting-adjusted analysis. Severities of baseline renal dysfunction were none in 1520 (24.5%), mild in 3557 (57.3%), moderate in 977 (15.7%), severe in 59 (1.0%) and end-stage in 97 (1.6%). Clinical outcomes varied significantly according to the degree of baseline renal dysfunction. The restricted cubic spline function curve showed a non-linear association, indicating that the significantly adverse effects of low estimated glomerular filtration rate on clinical outcomes were diminished in cases of mild renal dysfunction. This finding was corroborated by inverse probability of treatment weighting-adjusted analysis, and subgroup analyses did not show significant differences in clinical outcomes according to the presence of mild renal dysfunction (all-cause mortality, hazard ratio: 1.08; 95% confidence interval 0.90-1.28; P = 0.413; composite outcome, hazard ratio: 1.06; 95% confidence interval 0.92-1.21; P = 0.421). In patients undergoing valve surgery, long-term clinical outcomes were significantly associated with the degree of baseline renal function impairment but not with the presence of mild renal dysfunction, demonstrating a non-linear association between baseline renal function and postoperative outcomes.

Prospective Evaluation of Outcomes and Complications in Ultra-Mini-Percutaneous Nephrolithotomy for Pediatric Nephrolithiasis: A Three-Year Study

Objective: This prospective study aimed to evaluate the outcomes and complications of Ultra-Mini Percutaneous Nephrolithotomy (UM-PCNL) in pediatric patients with renal calculi over a three-year period (2021-2023). We assessed Stone-Free Rates (SFR), operative success and perioperative complications to determine the efficacy and safety of UM-PCNL in children. Methods: Seventy-eight pediatric patients (aged 1-17 years) underwent UM-PCNL for renal calculi larger than 10 mm. Preoperative imaging, including ultrasonography and computed tomography, was utilized to assess stone size and location. Surgical outcomes, including SFR, operative time and the need for second-look procedures, were evaluated. Complications were graded using the Clavien-Dindo classification. Statistical analysis was conducted using SPSS, with a significance threshold of p &lt; 0.05. Results: The mean stone size was 18.2 ± 5.4 mm and the overall SFR after a single UM-PCNL procedure was 78.2%. Clinical success (defined as either stone-free status or clinically insignificant residual fragments) was achieved in 89.7% of patients. The mean operative time was 67 ± 22 minutes. Second-look procedures were required in 11.5% of cases. The overall complication rate was 19.2%, with no major complications (Clavien grade III-V). Minor complications included transient fever (6.4%), hematuria (12.8%) and urinary leakage (5.1%). Conclusion: UM-PCNL is a safe and effective procedure for managing pediatric nephrolithiasis, offering high stone-free rates and low complication risks. The use of smaller instruments reduces renal trauma, bleeding and the need for blood transfusions. These findings support UM-PCNL as a first-line treatment option for larger renal stones in pediatric patients. Further studies with long-term follow-up are recommended to assess recurrence and long-term renal function outcomes.

Different impact of chronic kidney disease in older patients with heart failure according to frailty

Abstract Introduction Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the impact of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF. Methods Our data come from the FRAGIC study ("Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of older outpatients with heart failure"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Results We included 499 patients, mean age 81.4 ± 4.3 years, 38% women. Mean estimated glomerular filtration rate (eGFR) was 52.1±17.5 ml/min/1.72 m2. Patients were classified in three groups: eGFR ≥60 ml/min/1.72m2 (normal: 182 patients, 36%), eGFR 30-59 ml/min/1.72m2 (moderately impaired: 261 patients, 52.7%), and eGFR &amp;lt; 30 ml/min/1.72m2 (severely impaired: 56 patients, 11.3%). Patients with severe renal dysfunction were older, more often female, and presented a worse clinical profile, with higher comorbidity burden and frailty. Baseline variables according to eGFR group are depicted in Table 1. After a median follow up of 371 days, 58 patients (11.6%) died. One year mortality was higher in patients with worse renal function (8.8%, 11% and 21% according to normal, moderate and severe renal dysfunction respectively, p=0.036) and in frail patients (Figure 1). In multivariate analysis, frailty, but not severe renal dysfunction, was associated with one year mortality (frailty HR 2.05 95%CI 1.11-3.78 p 0.021, eGFR &amp;lt; 30 and 30-60 ml/min/1.72m2 HR 1.39 95%CI 0.62-3.09 p0.424 and 1.09 95%CI 0.58-2.09 p0.793 respectively). Conclusions Most HF patients ≥75 years have renal dysfunction. The association between renal function and clinical outcomes is different according to frailty status. CKD is related to worse prognosis only in non-frail patientsCumulative incidence of 1-year mortalityTable 1.Baseline characteristics

The use of metabolomics and machine learning algorithms to predict post-transplant diabetes mellitus in renal transplant patients on Tacrolimus therapy.

Tacrolimus (TAC) has significantly improved kidney graft survival following transplantation, though it is associated with adverse side effects. The most prevalent complication resulting from excessive TAC exposure is the onset of de novo diabetes mellitus (DM), a condition that can negatively impact both renal graft function and patient outcomes. De novo DM is linked to an increased risk of chronic transplant dysfunction, as well as cardiovascular morbidity and mortality. Although the underlying mechanisms remain unclear, emerging research in the field of omics shows promise. The aim of this study was to investigate the metabolomic profile of kidney transplant patients who developed de novo DM, in comparison to those who did not, following TAC exposure, using untargeted metabolomic analysis through ultra-high-performance liquid chromatography-mass spectrometry (UHPLC-MS) and machine learning algorithms. A cohort of 34 kidney transplant patients on a Tacrolimus regimen for at least 6 months was enrolled in the study, with serum samples collected from each patient. Comprehensive profiling of serum metabolites was performed, enabling the classification of patients into de novo diabetes mellitus and non diabetes groups. The metabolomic analysis of serum was conducted using UHPLC-MS. Of the 34 patients, 16 were diagnosed with TAC-induced diabetes. A total of 334 metabolites were identified in the serum samples, of which 10 demonstrated a significant correlation with the de novo diabetes mellitus group. Most of these metabolites were linked to alterations in lipid metabolism. The application of metabolomics in kidney transplant patients undergoing a Tacrolimus regimen is both feasible and effective in identifying metabolites associated with de novo diabetes mellitus. This approach may provide valuable insights into the metabolic alterations underlying TAC-induced diabetes.

Renal Allograft Function and the Tacrolimus C/D Ratio: Insights from a Prospective Study on MeltDose Tacrolimus

Background: The tacrolimus concentration-to-dose (C/D) ratio is valuable for optimizing nephrotoxicity-related renal outcomes. Prospective data on the C/D ratio in kidney transplant recipients newly treated with MeltDose tacrolimus are limited. We analyzed the C/D ratio pattern of MeltDose tacrolimus and its effect on posttransplant renal function, comparing it with the literature data on immediate-release tacrolimus (IR-Tac). Methods: In total, 101 adult kidney transplant recipients on a standard immunosuppressive regimen including MeltDose tacrolimus were enrolled in this prospective, multicenter cohort study and followed for 12 months. The C/D ratio classified patients as fast, intermediate, or slow metabolizers. Renal function was assessed via the estimated glomerular filtration rate (eGFR). MeltDose tacrolimus data were compared with previous IR-Tac data by bootstrapping. Results: The cohort exhibited a right-skewed C/D ratio distribution with a mean of 2.12 ng/mL × 1/mg, which was significantly greater than the 1.29 mean for IR-Tac (p &lt; 0.001). Compared with fast metabolizers, slow metabolizers of MeltDose tacrolimus experienced greater eGFR gains at 6 months post-transplantation (median +7.9 vs. −3.6 mL/min; p = 0.005). A Bayesian linear mixed-effects model predicting the eGFR at month 12 identified the baseline eGFR, time from transplant, body mass index, and log-transformed C/D ratio as significant variables. A one-unit increase in the log-transformed C/D ratio corresponded to an approximate increase of 4.5 mL/min in the eGFR at month 12. Conclusions: Slow metabolizers of MeltDose tacrolimus had significantly better renal function outcomes than fast metabolizers. MeltDose tacrolimus is associated with slower metabolism than is IR-Tac, as evidenced by its higher C/D ratios.

Robotic pyelolithotomy for the treatment of large renal stones: a single-center experience over seven years.

Urolithiasis prevalence varies globally between 1-20%, influenced by regional factors. Robotic pyelolithotomy (RPL) presents an interesting alternative to PCNL, considered the gold standard for symptomatic stones smaller than 20 mm, as it carries a risk of significant complications. However, studies on RPL are limited, especially in anatomically complex cases, where RPL proves to be particularly useful. The study aims to update and review outcomes of RPL in a high-volume robotic center. A retrospective analysis of 153 patients treated with RPL for staghorn kidney stones at a single center from February 2016 to December 2023 was conducted. Data including demographics, preoperative renal function, stone characteristics, operative and postoperative outcomes, and costs were collected. Stone-free rates (SFR) and complications were assessed at follow-up intervals up to 12 months post-surgery. The study showed an initial 3-month stone-free rate (SFR) of 93.5%, which decreased to 83.5% at 12-months. This trend may reflect new stone formation rather than procedure failure. Sub-analysis revealed a significant difference in SFR between patients with pelvic and pyelocalyceal stones at each follow-up. Multivariate regression analysis identified in the pyelocalyceal group that higher BMI and larger stones were associated with higher failure rates at both 6 and 12 months. RPL is a safe and effective treatment for large renal stones, offering a high SFR and low complication rate. It is particularly beneficial in cases with complex anatomy or requiring concurrent renal procedures. However, patient selection is crucial, considering factors like stone location and size. Further research is needed to compare RPL with other treatment methods.

Effects of perioperative use of renin-angiotensin system inhibitor on renal function and clinical outcomes in patients undergoing coronary artery bypass grafting surgery

To analyze the effects of preoperative renin-angiotensin system inhibitor (RASi) use on postoperative renal function and short-term and long-term prognosis in patients undergoing coronary artery bypass grafting (CABG). A retrospective cohort analysis was conducted. Based on the registration study data of CABG patients at Fuwai Hospital, Chinese Academy of Medical Sciences, the clinical data of adult patients who underwent CABG from January 2013 to December 2022 were analyzed. Preoperative use of RASi (PreRASi) was defined as receiving RASi treatment within 48 hours before surgery. Postoperative acute kidney injury (AKI) was defined using the diagnostic criteria of Kidney Disease: Improving Global Outcomes (KDIGO). Demographic characteristics, past medical history, comorbidities, preoperative medication, preoperative laboratory test results, specific information on surgical procedures, and postoperative treatment related data were extracted. The primary endpoint was the incidence of postoperative AKI. Secondary endpoints included in-hospital all-cause mortality and all-cause mortality within the longest follow-up period. According to whether RASi was used before surgery, the patients were divided into PreRASi group and No-PreRASi group. The baseline data of the two groups were balanced by propensity score matching (PSM). Logistic regression model and Cox proportional hazards model were used to assess the correlation between PreRASi and postoperative AKI and clinical outcomes, and analyze the subgroups of hypertension and heart failure with preserved ejection fraction (HFpEF) in the cohort. A total of 33 884 patients who underwent CABG were included, with a mean follow-up duration of (3.0±2.4) years and the longest follow-up duration up to 8.5 years. There were 9 128 cases (26.94%) in the PreRASi group and 24 756 cases (73.06%) in the No-PreRASi group. The incidence of postoperative AKI in the PreRASi group was 47.61% (4 346 cases), compared to 52.37% (12 964 cases) in the No-PreRASi group. Two groups were matched with 5 094 patients each. Compared to the No-PreRASi group, both before and after PSM, PreRASi was associated with a reduction of risk of postoperative AKI [before PSM: odds ratio (OR) = 0.834, 95% confidence interval (95%CI) was 0.793-0.877, P < 0.001; after PSM: OR = 0.875, 95%CI was 0.808-0.948, P = 0.001]. Subgroup analysis of hypertensive and HFpEF patients showed that PreRASi was associated with a decreased risk of postoperative AKI before and after PSM. The in-hospital mortality for the PreRASi and No-PreRASi groups were 0.61% (56 cases) and 0.49% (121 cases), respectively. Analysis of the overall cohort and subgroups with hypertension and HFpEF showed no correlation between PreRASi and in-hospital mortality or longest follow-up mortality. The perioperative use of RASi can reduce the risk of postoperative AKI in patients undergoing CABG, has a certain renal protective effect, but is not associated with short-term or long-term death risk after surgery.

The Relationship between Vascular Biomarkers (Serum Endocan and Endothelin-1), NT-proBNP, and Renal Function in Chronic Kidney Disease, IgA Nephropathy: A Cross-Sectional Study

IgA nephropathy (IgAN) is the most common primary glomerular disease. Endothelin-1 (ET-1) is one of the strongest vasoconstrictor materials in the blood. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) is associated with renal function and poor outcomes in chronic kidney disease (CKD). Serum endocan is a biomarker associated with proinflammatory cytokines, and the increase in the serum level plays a critical role in inflammatory, proliferative, and neovascularization processes and is associated with poor cardiovascular outcomes in patients with CKD too. Identifying high-risk patients using biomarkers could help to optimize their treatment. Ninety patients with biopsy-confirmed IgAN were included in the study (50 males/40 females, mean age: 54.9 ± 14.4 years). Serum endocan, ET-1, and NT-proBNP were measured by enzyme-linked immunosorbent assay kits. Echocardiography was performed, and carotid-femoral pulse wave velocity (cfPWV) was measured by SphygmoCor in this cross-sectional study. Patients were divided into two groups based on serum endocan median level (cut-off: 44 ug/L). There was significantly higher aorta systolic blood pressure (SBPao) (p = 0.013), NT-proBNP (p = 0.028), albumin/creatinine ratio (p = 0.036), and uric acid (p = 0.045) in the case of the higher endocan group compared to the lower. There was also significantly higher SBPao (p = 0.037) and NT-proBNP (p = 0.038) in the case of higher endothelin-1 (ET-1) levels compared to the lower (cut-off: 231 pg/mL) group by the two-sample t-test. Then, we divided the patients into two groups based on the eGFR (CKD 1–2 vs. CKD 3–5). The levels of serum endocan, NT-proBNP, cfPWV, SBPao, left ventricular mass index (LVMI), uric acid, and albuminuria were significantly higher in the CKD 3–5 group compared to the CKD 1–2 group. The serum endocan and NT-proBNP levels were significantly higher in the diastolic dysfunction group (p = 0.047, p = 0.015). There was a significant increase in serum endocan levels (CKD 1 vs. CKD 5; p = 0.008) with decreasing renal function. In IgAN, vascular biomarkers (endocan, ET-1) may play a role in endothelial dysfunction through vascular damage and elevation of SBPao. Serum endocan, ET-1, and NT-proBNP biomarkers may help to identify IgAN patients at high risk.

Personalized Prediction of Long-Term Renal Function Prognosis Following Nephrectomy Using Interpretable Machine Learning Algorithms: Case-Control Study.

Acute kidney injury (AKI) is a common adverse outcome following nephrectomy. The progression from AKI to acute kidney disease (AKD) and subsequently to chronic kidney disease (CKD) remains a concern; yet, the predictive mechanisms for these transitions are not fully understood. Interpretable machine learning (ML) models offer insights into how clinical features influence long-term renal function outcomes after nephrectomy, providing a more precise framework for identifying patients at risk and supporting improved clinical decision-making processes. This study aimed to (1) evaluate postnephrectomy rates of AKI, AKD, and CKD, analyzing long-term renal outcomes along different trajectories; (2) interpret AKD and CKD models using Shapley Additive Explanations values and Local Interpretable Model-Agnostic Explanations algorithm; and (3) develop a web-based tool for estimating AKD or CKD risk after nephrectomy. We conducted a retrospective cohort study involving patients who underwent nephrectomy between July 2012 and June 2019. Patient data were randomly split into training, validation, and test sets, maintaining a ratio of 76.5:8.5:15. Eight ML algorithms were used to construct predictive models for postoperative AKD and CKD. The performance of the best-performing models was assessed using various metrics. We used various Shapley Additive Explanations plots and Local Interpretable Model-Agnostic Explanations bar plots to interpret the model and generated directed acyclic graphs to explore the potential causal relationships between features. Additionally, we developed a web-based prediction tool using the top 10 features for AKD prediction and the top 5 features for CKD prediction. The study cohort comprised 1559 patients. Incidence rates for AKI, AKD, and CKD were 21.7% (n=330), 15.3% (n=238), and 10.6% (n=165), respectively. Among the evaluated ML models, the Light Gradient-Boosting Machine (LightGBM) model demonstrated superior performance, with an area under the receiver operating characteristic curve of 0.97 for AKD prediction and 0.96 for CKD prediction. Performance metrics and plots highlighted the model's competence in discrimination, calibration, and clinical applicability. Operative duration, hemoglobin, blood loss, urine protein, and hematocrit were identified as the top 5 features associated with predicted AKD. Baseline estimated glomerular filtration rate, pathology, trajectories of renal function, age, and total bilirubin were the top 5 features associated with predicted CKD. Additionally, we developed a web application using the LightGBM model to estimate AKD and CKD risks. An interpretable ML model effectively elucidated its decision-making process in identifying patients at risk of AKD and CKD following nephrectomy by enumerating critical features. The web-based calculator, found on the LightGBM model, can assist in formulating more personalized and evidence-based clinical strategies.

Short-Term Renal Function Outcomes after Renal Artery Stenting in Atherosclerotic Renal Artery Stenosis

Short-Term Renal Function Outcomes after Renal Artery Stenting in Atherosclerotic Renal Artery Stenosis

The risk factor for adverse pregnancy outcomes and its impact on clinical effect in IgA nephropathy: A retrospective observational study.

IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Pregnant IgAN patients are more susceptible to adverse pregnancy outcomes (APO). However, the risk factor for APO and its effects on the long-term renal outcome of pregnant IgAN patients remained unclear. We performed a retrospective observational study covering 2003-2019 that included 44 female IgAN patients with pregnancy history to investigate the risk factor for APO and its impact on clinical outcome in IgAN. Renal function outcome and proteinuria remission were evaluated in pregnant IgAN women with and without APO. In this retrospective and observational study, we found that patients with APO exhibited higher levels of serum creatinine and IgM, and lower haemoglobin levels while other clinical characteristics, pathological characteristics and therapy protocol had no significant difference. We found that anaemia and a higher level of serum IgM were independent risk factors for APO. IgAN pregnant women without APO experienced a higher proportion of proteinuria remission than those with APO, but there is no difference in the renal function outcome. Pregnant IgAN patients with higher risks, including lower haemoglobin levels and higher IgM levels deserve intensive monitoring, and aggressive therapy to reduce proteinuria should be carried out in pregnant IgAN patients with APO.

Are There any Differences in the Outcome of Non-valvular AF Patients with Moderate CKD, Taking Rivaroxaban or Warfarin?

Background: Warfarin has long been a reliable anticoagulant, prized for its affordability and extensive track record. However, with advancements in anticoagulant therapies, many uses of warfarin have been replaced by Novel Oral Anticoagulant (NOAC) agents. Atrial fibrillation (AF) is the most common heart rhythm disorder, affecting approximately 3% of the population. This arrhythmia significantly increases the risk of both morbidity and mortality, with the risk of ischemic stroke being five times higher compared to those without AF. The outcomes for patients with different comorbidities may vary when treated with either Rivaroxaban or Warfarin. Objectives: This study aims to evaluate renal function outcomes in AF patients with moderate chronic kidney disease (CKD) who are treated with either Warfarin or Rivaroxaban. Methods: This prospective cohort study involved 99 patients recently diagnosed with non-valvular AF (&lt; 1 year) and moderate CKD, who were treated with either Warfarin or Rivaroxaban. These patients were followed for one year after their initial presentation to our center. Laboratory data and other relevant documents were collected at each visit until the conclusion of the study year. Data were analyzed using SPSS version 27, with chi-square tests and t-tests applied as appropriate. Results: The study included two groups: 25 patients on Warfarin and 74 patients on Rivaroxaban. Gender and other demographic factors were evenly distributed between the two groups. The mean glomerular filtration rate (GFR) in the Rivaroxaban group improved non-significantly at 6 and 12 months, whereas a slight, non-significant decrease in GFR was observed in the Warfarin group. Acute kidney injury (AKI) occurred in 2 patients in the Rivaroxaban group. Gastrointestinal bleeding was reported in 5 patients, with incidents evenly distributed between the two groups. Conclusions: There was no significant difference in renal outcomes between patients with newly diagnosed non-valvular AF (&lt; 1 year) with moderate CKD treated with Warfarin or Rivaroxaban. However, for women with hypertension or high-risk thrombosis, Rivaroxaban may be associated with better renal outcomes.

Efficiency of HoLEP in patients with detrusor underactivity and renal dysfunction secondary to BPO

PurposeThe purpose of this study was to assess the bladder and renal functional outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic obstruction (BPO) complicated by detrusor underactivity (DU) and secondary renal dysfunction.MethodsThirty-one patients were included in this prospective study. Eligible patients had urinary retention, a bladder outlet obstruction index (BOOI) greater than 40, a bladder contractility index (BCI) less than 100, abnormal renal function at the initial diagnosis (serum creatinine > 132 µmol/L) and a renal pelvis anteroposterior diameter (PRAPD) > 1.5 cm bilaterally. All patients underwent HoLEP in a routine manner and were evaluated preoperatively and at 1, 3 and 6 months after surgery. The baseline characteristics of the patients, perioperative data, postoperative outcomes and complications were assessed.ResultsSignificant improvement was observed in the international prostate symptom score (IPSS), quality of life (QoL) score, maximal urinary flow rate (Qmax), post-void residual volume (PVR), Scr and RPAPD at the 6-month follow-up. Bladder wall thickness (BWT) exhibited a decreasing trend but did not significantly differ from the preoperative values. No grade 3 or higher adverse events occurred, and grade 3 and lower complications were treated conservatively. Three patients required reinsertion of indwelling catheters, and they were able to void spontaneously after two weeks of catheterisation training and medication treatment.ConclusionHoLEP is an effective treatment for men with BPO accompanied by DU and consequent renal function impairment. Patients are able to regain spontaneous voiding. Both bladder and renal functions were preserved and improved.

Predictors of outcomes in conservative management of high-grade renal trauma

BackgroundManagement of high-grade renal trauma is debatable, with the recent evidence embracing a conservative approach in the management of even grade 5 renal injuries. The study aimed to analyze the clinical profile of patients with high-grade renal trauma, assessing their management strategies, outcomes, complications, and need for ancillary procedures.MethodsA retrospective analysis of prospectively maintained data was performed involving blunt abdominal trauma patients with high-grade renal injuries (Grade 4 and 5) presenting to our hospital from January 2018 to December 2022. Patient data analyzed included demographics, clinical presentation, injury characteristics, complications, ancillary procedures, and mortality rates. All patients underwent renal functional assessment using an isotope renogram scan at the 3-month follow-up. Data collected were entered into a database and subjected to descriptive analysis using Jamovi version 2.3.28.ResultsThe study included 45 patients with a mean age of 29 years and a male-to-female ratio of 41:4. Most patients (n = 42) were managed conservatively. Thirty-eight patients had grade 4 injuries, and seven had grade 5 injuries. Twenty-six patients suffered renal parenchymal injuries alone, three patients had renal vascular injuries alone, and 16 patients had both parenchymal and vascular injuries. Grade 5 renal injury (p < 0.001), vascular high-grade injury (p < 0.001), angioembolization (p < 0.001), and blood transfusions (p = 0.021) were significantly associated with the incidence of poorly functioning kidney in high-grade renal trauma patients managed conservatively. Multinomial logistic regression analysis revealed angioembolization (p < 0.001), poorly functioning kidney post-trauma (p < 0.001), and blood transfusions (p < 0.001) were significantly associated with high-grade renal vascular injuries compared to high-grade renal parenchymal injuries.ConclusionConservative management is advisable for high-grade renal trauma in hemodynamically stable patients. High-grade vascular injuries are more severe than parenchymal injuries and correlate with poorer renal functional outcomes. Grade 5 renal injury, predominantly vascular high-grade injury, and the requirement for angioembolization and blood transfusions serve as significant predictors of poorly functioning kidneys post-trauma. Urologists should consider these predictors when counseling patients regarding potential outcomes following conservative management of high-grade renal trauma.

Abstract P423: Blood Pressure and Renal Function Outcomes After Revascularization of Renal Artery Stenosis in Patients from 3 Different Clinical Settings

The effects of renal percutaneous transluminal angioplasty (rPTA) of renal artery stenosis (RAS) on BP and renal function are controversial. We aim to search for possible differences in these outcomes in different clinical settings. We conducted an observational analysis of effects of rPTA in patients with RAS diagnosed as a result of: screening patients with peripheral artery disease (Vascular Dpt.; G1, n = 20), patients with resistant hypertension or with clinical suspicion of RAS (Hypertension Unit; G2, n = 28) or kidney transplant patients with renal function impairment and/or elevation of BP (Transplantation Unit; G.3, n = 21). RAS is defined as a reduction of ≥70% of the renal artery lumen. Sixty-nine patients were examined (mean age 67±12yr, 64% male). Overall, mean±S.D. baseline SBP/DBP (mmHg) was 147.4±20.6 and 75.7±1.8, and the estimated glomerular filtration rate (eGFR) was 48.7±27.0 mL/min/1.73m 2 . G.1 exhibited a higher prevalence of smoking patients (90%) and patients with past major vascular events (100%), lower DBP (70.0±9.8 mmHg) and better renal function (eGFR: 62.5±23.2 mL/min/1.73m 2 ), compared to G.2 and G.3. Twelve months after rPTA, BP decreased only in patients in G.2 and G.3: variation of (Δ) SBP(mmHg): mean (95%CI)= -18.9 (-26.7 to -11.0) and -20.0 (-29.8 to -10.1), respectively; p&lt;0.001 for both; ΔDBP (mmHg): mean (95%CI)= -6.6 (-10.7 to -2.4), p=0.003 and -6.3 (-11.7 to -0.8), p=0.027, respectively. Regarding renal function, it only improved in G.3: ΔeGFR (mL/min/1.73m 2 ): mean (95%CI)= 8.9 (1.5 to 16.4), p=0.022. ΔSBP was associated with baseline SBP (r= -0.709, p&lt;0.001) and the origin group (Rho = -0.362, p = 0.003); ΔeGFR was associated with baseline eGFR (r= -0.508, p&lt;0.001) and the origin group (Rho = 0.356, p = 0.004). Overall, median ΔSBP was -11 mmHg, and median ΔeGFR was +1.0 mL/min/1.73m 2 . An ANOVA analyzed factors associated with these changes. After adjusting for confounders, ΔSBP was dependent on baseline SBP and group of origin (both p&lt;0.05; adjusted R 2 0.340). ΔeGFR was dependent on baseline eGFR and diabetes (both p&lt;0.05; adjusted R 2 0.123). Blood pressure decreased in patients with suspected RAS because of resistant hypertension 12 months after rPTA. Both BP and renal function improved after rPTA in kidney transplant patients with diagnosis of RAS. Higher BP levels and lower eGFR correlated with better results. Patients with peripheral artery disease screened for RAS showed no change in BP or renal function after rPTA.