The gut-brain axis and trimethylamine N-oxide: an emergent biomarker in neurological diseases.

Cassiaside C alleviates IRI-induced AKI through restoring the expression of ATGL to reduce lipid droplet accumulation.

Metformin-associated lactic acidosis: Bridging pharmacokinetic determinants, metabolic pathways, and clinical outcomes.

Connexin32 inhibits renal tubulointerstitial fibrosis in diabetic kidney disease by regulating NOX4/MRTF-A positive feedback loop.

Thrombotic thrombocytopenic purpura (TTP) is a rare hematologic emergency that can rapidly progress to multiorgan failure and death if untreated. The role of extracorporeal membrane oxygenation (ECMO) in this setting is limited, and extracorporeal cardiopulmonary resuscitation (ECPR) has not been previously described. We report a case of a pregnant woman with suspected TTP who developed refractory pulseless electrical activity cardiac arrest before initiation of plasma exchange. Extracorporeal cardiopulmonary resuscitation with venoarterial ECMO was initiated despite profound thrombocytopenia (platelets 8,000/μL) as a bridge to definitive therapy, with rapid recovery of cardiac and renal function. She achieved full neurologic recovery and was discharged home without functional deficits. This case highlights the potential role of ECPR as a life-saving bridge in selected patients with TTP despite severe thrombocytopenia.

Background: Hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and preterm delivery are associated with higher long-term cardiovascular, metabolic, and kidney disease risk. Their implications for living kidney donation remain uncertain. Methods: We conducted a retrospective cohort study of 498 female living kidney donors (2000–2017) from the Mayo Clinic Living Donor Program with documented pregnancy histories, pre-donation CT angiography, implantation kidney biopsy, and measured GFR. Donors with prior HDP (n=45), GDM (n=18), or preterm delivery (n=65) were compared with donors without adverse pregnancy outcomes (APO; n=385). Kidney morphometry, histology, and function were analyzed with adjustment for age at donation and first pregnancy, parity, and hypertension. Post-donation kidney outcomes were assessed using surveys and medical record review. Results: Donors with prior HDP and GDM had higher BMI at donation (+7.9% and +8.9%; p=0.006 and 0.04), whereas donors with preterm delivery had lower BMI (−4.8%; p=0.03) compared with donors with no APO. After adjustment, donors with HDP showed no differences in kidney volumes, biopsy features, or kidney function at donation or during follow-up. Donors with GDM had larger total and cortical kidney volumes (9.5–10%), less arterial luminal stenosis, and higher 5-year post-donation eGFR (+15%; p=0.03). Donors with preterm delivery had a lower risk of eGFR <45 mL/min/1.73 m 2 (HR 0.28; p=0.03). Conclusions: Prior adverse pregnancy outcomes were not associated with adverse kidney structure at donation or accelerated kidney function decline post-donation. These findings support that APO history alone should not preclude living kidney donation when other eligibility criteria are met.

Although monocyte-to-lymphocyte ratio (MLR), monocyte-to-HDL cholesterol ratio (MHR), and prognostic nutritional index (PNI) - have been associated with renal function in patients with diabetes mellitus, their repeatability and predictive value remain unclear. This study aims to evaluate the 6-month repeatability of these indices in diabetic patients using metrics such as the Intraclass Correlation Coefficient (ICC), compare their reliability indices, and investigate longitudinal associations between these indices with change in renal function. This longitudinal study included 51 patients diagnosed with type 2 diabetes mellitus, each assessed at two visits separated by 6 months. Inflammatory indices were calculated using standard formulas. The 6-month measurement repeatability of each inflammatory index was evaluated using the ICC. Longitudinal associations were based on changes in inflammatory indices and renal function over a 6-month period. PNI showed good to excellent 6-month reliability (ICC(3,1)= 0.81; ICC(3,2) = 0.90), while MLR and MHR demonstrated moderate reliability. Baseline inflammatory indices were not independent predictors of eGFR at 6 months after adjustment for baseline renal function. In contrast, longitudinal analyses showed that changes in MLR and PNI were associated with changes in renal function, and ΔPNI was independently associated with ΔeGFR after adjustment. Inflammatory indices were reproducible over 6 months, with PNI showing the highest reliability. While baseline values had limited short-term predictive value, changes in PNI were independently associated with changes in eGFR, indicating longitudinal assessment of inflammatory-nutritional status in patients with T2DM.

Aim: Many studies have demonstrated that physical inactivity and reduced renal function are associated with an increased risk of all-cause mortality. However, most of this evidence is derived from non-Chinese populations. This study aimed to investigate the association of physical activity (PA) with the risk of all-cause mortality among Chinese adults with and without impaired kidney function. Materials & methods: We conducted a prospective cohort study among a population in Jiangsu Province, China. Cox proportional hazards regression models were used to explore the associations of estimated glomerular filtration rate (eGFR) and PA with all-cause mortality, as well as to test for potential interactions between eGFR and PA. Results: A total of 6266 participants with complete data were included in the analysis, with a median age of 52years and 44% being male. Of these participants, 1034 (16.5%) had an eGFR <60ml/min/1.73m2. During a median follow-up 9.1years (interquartile range [IQR]: 7.7-9.9), 196(3.1%) participants died. Participants with eGFR <60ml/min/1.73m2 had a significantly higher risk of death (hazard ratio [HR]=1.93; 95% confidence interval [CI]:1.39-2.68) compared with eGFR ≥60ml/min/1.73m2. A significant interaction was observed between PA and eGFR in relation to all-cause mortality risk (p for interaction=0.004). Notably, participant with eGFR <60ml/min/1.73m2 and low PA had a highest risk of all-cause mortality, compared with those with eGFR ≥60ml/min/1.73m2 and high PA (HR: 4.06; 95% CI: 2.34-7.03). Conclusion: PA, a key lifestyle factor, is a potentially modifiable risk factor for both individuals with normal renal function and those with impaired kidney function. Consistent with existing literature, participants with decreased renal function exhibited a significantly higher risk of all-cause mortality. Notably, our analysis further revealed that the risk of all-cause mortality was the highest among participants with impaired renal function and low PA.

Risks of Hypocalcemia and Other Bone Mineral Disorders for Denosumab Versus Zoledronate Across the Spectrum of Kidney Function: A Target Trial Emulation.

Interaction of Kidney Function and Dapagliflozin in Patients With Acute Heart Failure: A Pre-Specified Analysis of DICTATE-AHF.

While the FLOW trial established the renoprotective effects of subcutaneous semaglutide, real-world evidence regarding the long-term renal effects of therapeutic switching from injectable glucagon-like peptide-1 receptor agonists (GLP-1RAs) to oral semaglutide remains limited. We evaluated long-term changes in renal function following this therapeutic switch. This retrospective cohort study included 36 patients with type 2 diabetes (T2D) who were switched from liraglutide or dulaglutide to oral semaglutide (7mg/day). Changes in the urinary albumin-to-creatinine ratio (UACR) and annual estimated glomerular filtration rate (eGFR) slope were compared between the 3-year periods immediately before and after the switch. Three years after switching, the median UACR significantly decreased from 54.3 to 35.8mg/g creatinine (p < 0.05). The annual eGFR slope improved from - 1.92 (95% CI - 2.66 to - 1.18) before switching to - 0.26 (95% CI - 1.01 to 0.50) mL/min/1.73 m2/year after switching (difference: 1.67; p < 0.01). Subgroup analysis showed a significant improvement in eGFR slope among patients with baseline eGFR ≥ 60mL/min/1.73 m2 (difference: 1.85; p < 0.01). Reductions in glycated hemoglobin (- 0.33%, p < 0.05) and body weight (- 3.50kg, p < 0.01) were sustained at 3years. Improvement in eGFR slope was significantly associated with the magnitude of weight loss (p < 0.05) and lower baseline HbA1c (p < 0.01). Therapeutic switching from injectable GLP-1RAs to oral semaglutide was associated with attenuation of renal function decline and reduction in albuminuria over 3years. These findings suggest potential long-term renal benefits of oral semaglutide in routine clinical practice.

Outcomes of Retrograde Transileal Ureteric Stents for Chronic Urinary Drainage: Comparison with Chronic Nephrostomy Tube Drainage.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated efficacy and safety in patients with type 2 diabetes mellitus, chronic kidney disease, and heart failure. However, their effects in heart transplant recipients, a population with high cardiovascular risk, remain poorly understood. Clinical trials and observational studies were included. A systematic search was conducted in PubMed, Scopus, EMBASE, and Web of Science. Mean differences (MD) were calculated for continuous outcomes and risk ratios (RR) for binary outcomes, both with 95% confidence intervals (CI). Analyses were performed using RevMan version 5.4.1. Five retrospective cohort studies including 1512 heart transplant recipients (312 SGLT2i users and 1200 controls) were analyzed. SGLT2i use was not associated with significant changes in renal function (MD in eGFR: 3.96 mL/min/1.73 m2; 95% CI: -2.33 to 10.26; p = 0.22) or glycemic control (MD in HbA1c: -0.20%; 95% CI: -0.73 to 0.34; p = 0.47). Mortality was comparable between groups (RR: 0.64; 95% CI: 0.29-1.40; p = 0.26), with no significant increase in urinary tract infections (RR: 1.40; 95% CI: 0.25-7.72; p = 0.70). However, SGLT2i use was associated with significant reductions in body mass index (MD: -0.90 kg/m2; 95% CI: -1.67 to -0.14; p = 0.02) and systolic blood pressure (MD: -4.69 mmHg; 95% CI: -7.27 to -2.12; p < 0.001). In heart transplant recipients, the use of SGLT2 inhibitors was not associated with significant improvements in renal function or glycemic control and did not increase mortality or the incidence of urinary tract infections. However, SGLT2 inhibitor therapy was associated with significant reductions in body mass index and systolic blood pressure, suggesting a potential cardiometabolic benefit in this high-risk population. Given that hypertension and obesity are well-established cardiovascular risk factors and that hypertension, in particular, is a common complication among heart transplant recipients, these blood pressure and weight-lowering effects may be clinically meaningful. PROSPERO CRD420251057335.

SSTR-PET is routinely used to select patients with neuroendocrine neoplasms (NEN) for peptide receptor radionuclide therapy (PRRT). As the kidneys are organs at risk, this study evaluated whether renal uptake on pre-therapeutic SSTR-PET/CT reflects split or global renal function and correlates with renal absorbed dose during [177Lu]Lu-DOTA-TATE therapy. In this retrospective study, 85 NEN patients treated with [177Lu]Lu-DOTA-TATE between 2013 and 2023 were included. All underwent SSTR-PET/CT using [18F]SiTATE, [68Ga]Ga-DOTA-TATE, or [68Ga]Ga-DOTA-TOC plus serum kidney function tests and [99mTc]Tc-MAG3 scintigraphy. Renal PET uptake was compared with serum and scintigraphic kidney parameters. In 30 patients, renal absorbed dose was estimated using post-treatment SPECT/CT. Renal uptake on SSTR-PET/CT moderately correlated with split renal function assessed by [99mTc]Tc-MAG3 across all tracers, particularly using SUVmean ([18F]SiTATE (r = 0.462; p = 0.010); [68Ga]Ga-DOTA-TATE (r = 0.515; p = 0.004); [68Ga]Ga-DOTA-TOC (r = 0.546; p = 0.004)). No relevant correlation was observed between total renal PET uptake and tubular extraction rate, eGFR, or serum creatinine. Renal PET uptake showed moderate correlations with mean absorbed doses in selected tracer cohorts ([18F]SiTATE; r = 0.585; p = 0.076; [68Ga]Ga-DOTA-TATE; r = 0.649; p = 0.049). A strong negative correlation between TER and absorbed dose was seen only for [18F]SiTATE (r = - 0.768; p = 0.010). SSTR-PET/CT showed moderate potential to estimate pre-therapeutic split renal function and renal absorbed dose. However, global renal function could not be reliably estimated using PET/CT. Larger studies are warranted to validate PET/CT-based kidney assessment for individualized PRRT planning.

Post-liver transplant complications-cancer, infections, and renal dysfunction-impose substantial clinical and economic impact on recipients. This study evaluated clinical impacts and cost-effectiveness of adding everolimus (EVR) to a calcineurin inhibitor (CNI)-based regimen in liver transplant recipients, aiming to identify how co-occurring major complications affect cost-effectiveness. We conducted a cohort analysis and a cost-utility analysis, dividing recipients into CNI with and without EVR groups. We calculated adjusted hazard ratios (HRs) for the risk of cancer and posttransplant infection with EVR combination therapy using a Cox regression model. A Markov model that captured the co-occurrence of liver disease, infection, and renal dysfunction was constructed to estimate costs and quality-adjusted life years (QALYs) and compare the incremental cost-effectiveness ratio (ICER) of adding EVR to CNI. A hypothetical cohort of 10 000 liver transplant recipients aged 55 y was simulated during 30 y. The addition of EVR significantly reduced the risk of cancer (HR 0.435; 95% confidence interval 0.279-0.678) while increasing the infection risk in subsequent years (HR 1.468; 95% confidence interval 1.053-2.045). Cost-utility analysis demonstrated the CNI with EVR strategy was cost-effective, with an ICER of US$5298/QALY, well below the $25 000/QALY threshold. In analyses quantifying how co-occurring events shift value, the ICER was $9307/QALY when limited to liver disease, decreased to $4363/QALY with renal dysfunction included, and increased to $10 464/QALY when infection was added. Overall, CNI with EVR regimen in liver transplant remained cost-effective across co-occurring outcomes and perspectives, supporting risk-benefit balancing across cancer, posttransplant infection, and renal function.

Independent association between acute kidney injury and kidney function trajectory.

Chronic kidney disease (CKD) in children exposes the developing brain to uremic and vascular insults, yet blood-based markers of the pediatric kidney-brain axis remain underexplored. We characterized neuron-specific enolase (NSE) and brain-derived neurotrophic factor (BDNF) across the spectrum of pediatric kidney disease. Prospective cohort of 75 children with measured GFR: 12 comparators with normal kidney function, 31 with non-dialysis CKD stages G2-G5, and 32 kidney transplant recipients (KTx). Biomarkers were measured by ELISA at baseline and after 3.2years. Cross-sectional and longitudinal analyses adjusted for age and group. NSE correlated inversely with age (r = - 0.46, p < 0.001) and did not differ between groups after age adjustment. NSE-age slopes were comparable in comparators and CKD but flat in transplanted children, indicating loss of the developmental decline in this group. BDNF correlated positively with measured GFR (r = 0.31, p = 0.018) and was lower in CKD than in comparators, consistent with reduced neurotrophic reserve in pediatric uremia. Circulating NSE in childhood reflects developmental stage rather than CKD status. Group comparisons in pediatric biomarker studies require age adjustment. Transplantation alters the NSE-age relationship beyond what kidney function explains. BDNF tracks kidney function in pediatric CKD. Age-stratified reference intervals are required before either marker can guide clinical decisions.

Peri-arterial neural tissue surrounding the renal artery contributes to sympathetic overactivity in hypertension. During adrenal surgery, surgical peri-arterial neural dissection may interrupt these fibers and exert a renal denervation-like effect. Whether this maneuver improves postoperative blood pressure control remains unclear. We retrospectively reviewed 127 hypertensive patients who underwent adrenal surgery between January 2022 and March 2025. According to intraoperative findings, patients were classified into a surgical peri-arterial neural dissection group or a nondissection group. After 1:2 manual matching by age, sex, and hypertension duration, 54 patients were included. Postoperative hypertension remission and changes in antihypertensive medication use, quantified by the defined daily dose, were assessed. Multivariable logistic regression was used to explore factors associated with postoperative nonremission. Renal and adrenal function markers were compared between groups. The surgical peri-arterial neural dissection group had a higher remission rate than the nondissection group (50.0% versus 16.1%; P=0.008). Surgical peri-arterial neural dissection was independently associated with lower odds of postoperative nonremission (odds ratio, 0.150 [95% CI, 0.030-0.744]; P=0.020), supporting its potential role in improving postoperative blood pressure control. Patients in the dissection group showed greater reductions in antihypertensive medication use (median change in defined daily dose, -1.0 versus 0.0; P=0.006). Creatinine, blood urea nitrogen, cortisol, and adrenocorticotropic hormone levels were similar between groups. Surgical peri-arterial neural dissection performed during adrenal surgery was associated with improved postoperative blood pressure control and reduced medication burden without evidence of impaired renal or adrenal function.

Minimal change disease (MCD) is a common cause of nephrotic syndrome in adults, with limited evidence available on its treatment and prognosis. In this study, we retrospectively included the clinical characteristics and treatment results of adult MCD patients in our center and explored and analyzed potential risk factors for relapse in MCD patients. We included 51 adult MCD patients with a median age of 29 years, and 30 were men. Among them, 16 patients (31.37%) had acute kidney injury (AKI) at presentation. The average urinary protein excretion was 6.39 ± 5.54 g. Notably, 29 (59%) patients had hematuria; 16 (31.37%) patients developed AKI; and 25 patients (49.02%) experienced at least 1 relapse. 13 patients (25.49%) experienced 2 relapses, and 9 patients (17.65%) experienced 3 or more relapses during the observation period. Compared with non-relapse patients, relapse patients were younger (mean age, 18 years (18 - 32 years)), and fewer patients (n = 8, 32%) had positive urinary red blood cells. The time from treatment to remission and baseline albumin, renal function, urine protein quantification, and other laboratory indicators did not significantly differ between the two groups (all, p > 0.05). Single and multivariate logistic regression analysis revealed age of onset, drug-related adverse effects during treatment, and AKI as the risk factors for relapse. This study identified young age at onset, treatment-related adverse effects, and AKI as independent risk factors for relapse in adult-onset MCD patients. Rituximab may be an effective treatment for relapsed MCD patients.

Therapeutic effect of cilastatin administration in LPS-induced retinotoxicity.