Treatment Of Renal Disease Research Articles

Recent Developments and Current Challenges of Heparin-Grafted Hemodialysis Membranes

Hemodialysis (HD) is a life-sustaining extracorporeal blood purifying treatment for end-stage renal disease (ESRD) patients. However, this membrane-based therapy is associated with acute side effects, life-threatening chronic conditions, and unacceptably high morbidity and mortality rates. Numerous surface coatings have been developed to improve the blood compatibility of biomaterials. Heparin is a widely used anticoagulant substance that increases the clotting time and increases the membrane hemocompatibility in terms of platelet adhesion and protein adsorption and anti-clotting activity. However, using heparin is challenging due to its severe or life-threatening side effects such as heparin-induced thrombocytopenia (HIT), in addition to heparin induced thrombocytopenia and thrombosis (HITT). In addition, heparin is strongly electronegative and exhibits a binding affinity for the positive active sites of human serum proteins, which is an additional challenge. Consequently, covalently immobilized heparin would create a more charged surface to induce more blood–membrane interactions, and consequently more adsorbed human serum proteins and biochemical pathway activations, which can negatively affect dialysis patients. Therefore, the current critical review has thoroughly focused on different heparin HD membrane systems, the challenges of heparin-coated dialysis membranes, and the factors affecting its hemocompatibility, in addition to the methods that can be used to enhance its hemocompatibility. Furthermore, this review summarizes the advantages and disadvantages of heparin-grafted methods. Furthermore, the influence of the heparin-immobilization method on the hemocompatibility and performance of the HD membrane was comprehensively analyzed. Finally, we conclude with the future perspectives for the strategies toward the heparinization and heparin-like/mimicking modification of membrane surfaces.

Genetic diagnosis and treatment of hereditary renal tubular disease with hypokalemia and alkalosis.

Renal tubules play an important role in maintaining water, electrolyte, and acid-base balance. Renal tubule dysfunction can cause electrolyte disorders and acid-base imbalance. Clinically, hypokalemic renal tubular disease is the most common tubule disorder. With the development of molecular genetics and gene sequencing technology, hereditary renal tubular diseases have attracted attention, and an increasing number of pathogenic genes related to renal tubular diseases have been discovered and reported. Inherited renal tubular diseases mainly occur due to mutations in genes encoding various specific transporters or ion channels expressed on the tubular epithelial membrane, leading to dysfunctional renal tubular reabsorption, secretion, and excretion. An in-depth understanding of the molecular genetic basis of hereditary renal tubular disease will help to understand the physiological function of renal tubules, the mechanism by which the kidney maintains water, electrolyte, and acid-base balance, and the relationship between the kidney and other systems in the body. Meanwhile, understanding these diseases also improves our understanding of the pathogenesis of hypokalemia, alkalosis and other related diseases and ultimately promotes accurate diagnostics and effective disease treatment. The present review summarizes the most common hereditary renal tubular diseases (Bartter syndrome, Gitelman syndrome, EAST syndrome and Liddle syndrome) characterized by hypokalemia and alkalosis. Further detailed explanations are provided for pathogenic genes and functional proteins, clinical manifestations, intrinsic relationship between genotype and clinical phenotype, diagnostic clues, differential diagnosis, and treatment strategies for these diseases.

Effect Evaluation of Clinical Diagnosis and Treatment of Renal Diseases by Biochemical Immunoassay

Effect Evaluation of Clinical Diagnosis and Treatment of Renal Diseases by Biochemical Immunoassay

Prediction model of delayed graft function based on clinical characteristics combined with serum IL-2 levels

BackgroundKidney transplantation is an effective treatment for end-stage renal disease (ESRD). Delayed graft function (DGF) is a common complication after kidney transplantation and exerts substantial effects on graft function and long-term graft survival. Therefore, the construction of an effective model to predict the occurrence of DGF is particularly important.MethodsSeventy-one patients receiving their first kidney transplant at the First Affiliated Hospital of Nanchang University from October 2020 to October 2021 were enrolled in the discovery cohort. Based on clinical characteristics and serum markers, a logistic regression model was used to simulate the risk of DGF in the discovery cohort. The DGF prediction model was named the prediction system and was composed of risk factors related to DGF. Thirty-two patients receiving a kidney transplant at the First Affiliated Hospital of Nanchang University from October 2021 to February 2022 were enrolled in the validation cohort. The validation cohort was used to verify the accuracy and reliability of the prediction model.ResultsCold ischemia time (CIT), donor history of diabetes mellitus, donor interleukin-2 (IL-2) level and donor terminal creatinine level constitute the prediction system. In the validation test, the area under the receiver operating characteristic curve (AUC) was 0.867 for the prediction system, and good calibration of the model was confirmed in the validation cohort.ConclusionsThis study constructed a reliable and highly accurate prediction model that provides a practical tool for predicting DGF. Additionally, IL-2 participates in the kidney injury process and may be a potential marker of kidney injury.

Nursing Countermeasures of Continuous Renal Replacement Treatment in End-Stage Renal Disease with Refractory Hypotension in the Context of Smart Health.

This work is aimed at exploring the nursing strategies and effects of continuous renal replacement therapy (CRRT) for end-stage renal disease (ESRD) with refractory hypotension under the background of smart health. 40 ESRD patients with refractory hypotension who received CRRT treatment were enrolled as the research objects and were randomly rolled into the intervention group and the control group, with 20 cases in each group. Patients in the control group received routine nursing, and those in the intervention group received individualized nursing. The incidence of hypotension, dry body weight, serous cavity effusion, renal function indicators (blood urea nitrogen (BUN) and creatinine (Cre)), and patient satisfaction were compared between the two groups. The results showed that the probability of hypotension in the intervention group was 9.38%, which was lower than that in the control group (34.38%). The probability of early termination of dialysis in the intervention group was 0%, which was lower than that in the control group (18.75%), and the difference was statistically significant (P < 0.05). The decreases of BUN and Cre in the intervention group were significantly greater than those in the control group, and the differences were statistically significant (P < 0.05). The proportion of water growth less than 10% during dialysis in the intervention group was 98.44%, which was greater than that in the control group (93.45%), and the difference was statistically significant (P < 0.05). The ultrafiltration volume after dialysis in the intervention group was 2850 ± 400 mL, which was greater than that in the control group 2350 ± 350 mL. After intervention, the proportion of patients with pleural effusion in the intervention group was 10% less than that in the control group (20%), and the difference was statistically significant (P < 0.05). The satisfaction rate of the intervention group was 97.66%, which was higher than that of the control group (65.63%). In conclusion, individualized nursing was more helpful to the recovery of ESRD patients with refractory hypotension treated with CRRT than routine nursing.

Paraoxonase 1 Ameliorates Renal Lipotoxicity by Activating Lipophagy and Inhibiting Pyroptosis

Several studies in recent years have shown that lipid overload causes lipotoxic damage to the kidney, and oxidative stress, inflammation, and autophagic arrest are all important mechanisms of renal lipotoxicity. However, effective measures with therapeutic effects on renal lipotoxicity are limited. The present study indicated the protective effect of the paraoxonase 1 (PON1) against renal lipotoxicity in high-fat diet-fed scavenger receptor class B type I-deficient (SR-BI-/-) mice. The results showed that SR-BI-/- mice exhibited significant renal pathologic characteristics, such as oxidative stress, inflammation, and fibrosis, under a normal chow diet, and were accompanied by dyslipidemia and reduced plasma PON1 activity and renal PON1 levels. PON1 overexpression significantly attenuated the above pathologic changes in the kidneys of SR-BI-/- mice fed with a high-fat diet. Mechanistically, PON1 may ameliorate renal oxidative stress by reducing reactive oxygen species production, reduce renal lipid accumulation by inhibiting AKT/mechanistic target of rapamycin kinase pathway to activate lipophagy, and reduce the occurrence of inflammation and cell death by inhibiting Nod-like receptor family protein 3 inflammasome-mediated pyroptosis. The present study is the first to show that PON1 overexpression can effectively alleviate renal lipotoxicity injury, and PON1 may be a promising therapeutic strategy for the treatment of renal lipotoxicity-related diseases.

Treatment Patterns and Characteristics of Dialysis Facilities Randomly Assigned to the Medicare End-Stage Renal Disease Treatment Choices Model

In 2021, Medicare launched the End-Stage Renal Disease Treatment Choices (ETC) model, which randomly assigned approximately 30% of dialysis facilities to new financial incentives to increase use of transplantation and home dialysis; these financial bonuses and penalties are calculated by comparing living-donor transplantation, transplant wait-listing, and home dialysis use in ETC-assigned facilities vs benchmarks from non-ETC-assigned (ie, control) facilities. Because model participation is randomly assigned, evaluators may attribute any downstream differences in outcomes to facility performance rather than any imbalance in baseline characteristics. To identify preintervention imbalances in dialysis facility characteristics that should be recognized in any ETC model evaluations. This cross-sectional study compared ETC-assigned and control dialysis facility characteristics in the United States from 2017 to 2018. A total of 6062 facilities were included. Data were analyzed from February 2021 to May 2022. Assignment to the ETC model. Dialysis facilities' preintervention transplantations and home dialysis use, facility characteristics (notably, profit and chain status), patient demographic characteristics, and community socioeconomic characteristics. Among 316 927 patients, with 6 178 855 attributed patient-months, the mean (SD) age in January 2017 was 59 (11) years, and 132 462 (42%) were female. Patients in ETC-assigned facilities had 9% (0.2 [95% CI, 0.1-0.2] percentage points) lower prevalence of living donor transplantation, 12% (3.2 [95% CI, 3.0-3.3] percentage points) lower prevalence of transplantation wait-listing, and 4% (0.4 [95% CI, 0.3-0.4] percentage points) lower prevalence of peritoneal dialysis use compared with control facilities. ETC-assigned facilities were 14% (5.1 [95% CI, 0.9-9.4] percentage points) more likely than control facilities to be owned by the second largest dialysis organization. Relative to control facilities, ETC-assigned facilities also treated 34% (6.6 [95% CI, 6.5-6.7] percentage point) fewer patients with Hispanic ethnicity and were located in communities with median household incomes that were 4% ($2500; 95% CI, $500-$4500) lower on average. In this study, dialysis facilities in ETC-assigned regions had lower preintervention prevalence of transplantation wait-listing, living donor transplantation, and peritoneal dialysis use, relative to control facilities. ETC-assigned and control facilities also differed with respect to other facility, patient, and community characteristics. Evaluators should account for these preintervention imbalances to minimize bias in their inferences about the model's association with postintervention outcomes.

Improving Access to Renal Transplantation for Highly Sensitized Patients.

Transplantation is accepted to be the best form of treatment for end-stage renal disease, and it is also clear that the longer the patients wait on dialysis, the worse their overall graft and patient outcomes are, posttransplantation. The presence of increasing levels of anti-HLA antibodies progressively increases waiting times, especially highly sensitized patients (HSP) with panel reactivity (PRA) >85%. Currently, in the EuroTransplant (ET) allocation programs, the presence of antibody, even at a low level as detected by single antigen beads, generates a virtual PRA (vPRA). This results in unacceptable antigen matches so that offers are not made to these patients, increasing their expected wait time. ET allocates organs in three different systems. The Acceptable match program is successful in transplanting sensitized patients, but only a tiny percentage of potential recipients are eligible. The standard ET kidney allocation system integrates patients’ PRA into a mismatch probability (MMP), which generates additional points with the aim of assisting HSP to be transplanted. However, despite this, and partly because of the low donor rates in Germany, the median waiting time for patients with a vPRA of >95% is 13.2 y (and >10 y for patients with vPRA <95%). The ET senior programme that allocates kidneys on the basis of blood group, waiting time, and region (to minimize ischemic time) also disadvantages HSP. In this article, Zecher et al1 have analyzed the impact of vPRA levels of the various ET allocation systems in Germany and the factors disadvantaging HSP, including the effectiveness of the MMP to compensate for sensitization. Many of their findings are not surprising. For HSP, the higher their vPRA, the longer their median wait times are, except organs offered in the acceptable match system. This is only open to about 2% of patients, and the shorter waiting times reflect that the German patients in this program are in a pool with all ET countries, most of whom have much shorter waiting times. The MMP was designed to compensate for sensitization (as well as blood group and HLA type), and although incorporation of vPRA in 2020 did improve the correlation between vPRA and the score, the effect was not marked, and a high score could be generated with low or even zero vPRA. Furthermore, the maximum MMP score is only 100 out of a total of 800 points, thus limiting its efficacy to significantly reduce waiting times for HSP. The analysis of their cohort of patients on the waiting list, therefore, demonstrated that the MMP compensation was very inadequate. They also found that there was a high organ rejection rate in transplant centers for immunological reasons, suggesting inadequate or incorrect unacceptable antigen mismatches data provided to ET. Finally, the authors found large (> 2-fold) differences in the probability of transplantation between the 7 regions within Germany. This may partly be explained by variation in donation rate but is likely to represent different approaches to listing unacceptable antigen mismatches, including single antigen beads data. Clearly, HSP are and will always be disadvantaged by their sensitization, but in the interest of equity, their waiting times should be reduced as much as possible to improve long-term outcomes. Zecher et al1 highlight several important issues resulting in excessive waiting times, especially for HSP. There should be considerable scope to modify reporting of acceptable and unacceptable antigens to ET, and modification of the allocation algorithms could significantly improve waiting times for these severely disadvantaged patients. Comparison of individual center practice is also likely to identify factors that might reduce center and regional variation. German (and all ET) data could be used to model alterations to the allocation algorithms to improve waiting times for HSP and for better equity to other groups of patients, such as ethnic minorities. Lessons may be learned from offering algorithms in other countries. For instance, one of the key objectives for the 2019 UK Kidney Offering Scheme was to avoid prolonged waiting times that are predictable, which is particularly relevant to HSP. In the development of the scheme, different methods of prioritization were considered. These included priority tiers and different points weightings based on factors including sensitization, matchability, and waiting time, and the methods were evaluated by analyzing simulated data across different potential schemes. The 2019 UK scheme is expected to significantly reduce variation in waiting time in sensitized patients, and this reduction is also expected to be seen across other factors, including ethnicity. Although this paper highlights inequities in the ET system and Germany in particular, it highlights the need for all organ allocation algorithms to be reviewed and alternatives extensively modeled to generate algorithms to improve overall equity.

Housing: A Critical Contributor to Kidney Disease Disparities.

Housing: A Critical Contributor to Kidney Disease Disparities.

Relationship Between Angiotensin II Type 1 Receptor Antibody Positivity and Cytokine Gene Polymorphism in Renal Transplant Patients When Organ Rejection Occurs.

Kidney transplant remains the gold standard for the treatment of end-stage renal disease. Relationships between the presence of non-HLA antibodies, antibodies to AT1R, and cytokine gene polymorphisms with rejection have recently been shown. We sought to determine whether the presence of antibodies to AT1R and cytokine gene polymorphisms affected the development of rejection in pediatric and adult patients, whether a relationship is present between cytokine polymorphism and level of antibodies to AT1R, and whether their presence can be a biomarker pretransplant. Our study included 100 pediatric and adult kidney transplant patients plus 50 healthy controls. Levels of AT1R antibodies (by enzyme-linked immunosorbent assay) and gene polymorphisms of the cytokines transforming growth factor β, tumor necrosis factor α, interleukins 6 and 10, and interferon gamma cytokines (by sequence- specific primer-polymerase chain reaction) were studied retrospectively and evaluated with the SPSS statistical program. We found no statistically significant relationship between levels of antibodies to AT1R and gene polymorphisms among the studied cytokines in patients with rejection compared with the healthy controls and patients with uneventful courses posttransplant. However, higher levels of antibodies to AT1R were observed in pediatric compared with adult transplant recipients (P < .001). A statistically significant relationship was also observed between transforming growth factor β1 C/C G/C low-release and interleukin 6 G/C high-release gene polymorphism and levels of antibodies to AT1R (P < .001). Because we observed that some gene polymorphisms among the studied cytokines may affect AT1R antibody levels, future studies are needed to understand the mechanism of the relationship. In addition, studies with larger groups are required to sufficiently confirm that higher antibody levels are present in pediatric versus adult patients.

Performance evaluation of a point of care cartridge of the new GEM Premier ChemSTAT analyzer

Background and aimsGEM Premier ChemSTAT is a new point-of-care system providing rapid creatinine, BUN and tCO2 measurements together with electrolytes, metabolites, hematocrit, pH and pCO2 from a single whole blood specimen in acute care settings such as emergency departments and intensive care units. Accurate measurements of whole blood creatinine can aid in the diagnosis and treatment of renal diseases. Materials and methodsHeparinized whole blood samples from different clinical locations were evaluated on the GEM Premier ChemSTAT and results compared to plasma from the same samples on the Beckman AU5800 or whole blood on the GEM Premier 4000. Precision studies were conducted with whole blood and quality control material. ResultsChemSTAT correlated well with plasma samples on the AU5800 (regression slopes (S): 0.957–1.159, correlation coefficients (r)≥0.952) and with whole blood specimens on the GEM Premier 4000 (S: 0.9646–1.124, r ≥ 0.974). The repeatability was 0.1%–3.1% and QC precision were within lab and manufacturers’ specifications. ConclusionChemSTAT demonstrated strong correlation to the comparative methods and excellent precision. Combining with its continuous quality management, ChemSTAT is suitable for acute care settings to provide rapid, reliable results, which could minimize time-to-treatment and improve patient outcome.

Effects and Clinical Value of Peritoneal Dialysis on Water and Water Balance, Adverse Reactions, Quality of Life, and Clinical Prognosis in Patients with Decompensated Chronic Nephropathy: A Systematic Review and Meta-Analysis.

Objective To systematically evaluate the effects of peritoneal dialysis and hemodialysis on renal function and quality of life in patients with end-stage renal disease. An evidence-based medical rationale would be provided for peritoneal dialysis or hemodialysis treatment in patients with end-stage renal disease. Methods The PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), China VIP Database, Wanfang, and China Biomedical Literature Database (CBM) online databases were searched. Comparisons on the effects of peritoneal dialysis on renal function and quality of life were taken between patients with end-stage renal disease (RD). The data were extracted independently by two researchers. The bias-risk-included literatures were assessed according to the Cochrane manual 5.1.0 standard. RevMan 5.4 statistical software was used to analyze the collected data via meta-analysis. Results Seven RCT articles were finally included. A total of 745 samples were analyzed via meta-analysis. The obvious heterogeneities of serum creatinine (Scr) and blood urea nitrogen (BUN) were discovered (P < 0.00001) in the selective investigations. According to the results of this analysis, it was indicated that the renal function of patients with end-stage renal disease treated by peritoneal dialysis was significantly better than that of hemodialysis. According to the meta-analysis, there was obvious heterogeneity of life quality among the included research data. It was indicated that the score of quality of life of patients with end-stage renal disease treated by peritoneal dialysis was significantly better than that of hemodialysis. Conclusion Compared with hemodialysis in the treatment of end-stage renal disease, the renal function and quality of life of patients with peritoneal dialysis are better than those of hemodialysis. More further studies and follow-up with higher methodological quality and longer intervention time are still needed for further verification.

Microbiological surveillance of dialysis unit-prefogging verses postfogging in a tertiary care hospital: A cross-sectional study

: Haemodialysis is the most effective modality in treatment of end stage renal disease (ESRD). Patients undergoing the haemodialysis treatment are at a higher risk of acquiring systemic infections. : Microbiological surveillance of Dialysis Unit both prefogging and postfogging by air culture and swab culture.: This observational retrospective study was conducted at the department of Microbiology in a super speciality Post Graduate institute. The mean bacterial and fungal load and surface swab cultures pre and post fogging from the dialysis unit of the hospital were evaluated. Antibiotic resistance testing of isolates was performed by modified Kirby Bauer’s disc diffusion method as per CLSI 2017 and EUCAST guidelines. This study provides a comparative Microbiological surveillance of Dialysis Unit both prefogging and postfogging by Air culture and Swab cultures. : Total of 42 Air culture (21 pre and 21 postfogging) and 588 swab culture (294 pre and 294 post fogging) samples were received in the microbiology department and the mean bacterial and fungal load were evaluated and calculated. Prefogging results were within the normal limits and the load was futher reduced postfogging, according to standard guidelines. Aerobic culture and sensitivity of surface swab cultures were done, out of which 11 (32.34%) prefogging swab culture samples, showed single growth of gram positive bacteria that were reduced to no growth post fogging.

Anti-glomerular Basement Membrane Glomerulonephritis: A Study in Real Life.

IntroductionAnti-glomerular basement membrane (anti-GBM) disease is a severe entity with few therapeutic options including plasma exchange and immunosuppressive agents. The aim of this study was to analyze the clinical and pathological features that predict the evolution of end-stage kidney disease (ESKD) and the kidney survival in a cohort of patients with anti-GBM disease with renal involvement in real life.MethodsA retrospective multicentre observational study including 72 patients from 18 nephrology departments with biopsy-proven anti-GBM disease from 1999 to 2019 was performed. Progression to ESKD in relation to clinical and histological variables was evaluated.ResultsCreatinine at admission was 8.6 (± 4) mg/dL and 61 patients (84.7%) required dialysis. Sixty-five patients (90.3%) underwent plasma exchange. Twenty-two patients (30.6%) presented pulmonary hemorrhage. Kidney survival was worse in patients with creatinine levels > 4.7 mg/dL (3 vs. 44% p < 0.01) and in patients with > 50% crescents (6 vs. 49%; p = 0.03). Dialysis dependence at admission and creatinine levels > 4.7 mg/dL remained independent significant predictors of ESKD in the multivariable analysis [HR (hazard ratio) 3.13 (1.25–7.84); HR 3 (1.01–9.14); p < 0.01]. The discrimination value for a creatinine level > 4.7 mg/dL and 50.5% crescents had an area under the curve (AUC) of 0.9 (95% CI 0.82–0.97; p < 0.001) and 0.77 (95% CI 0.56–0.98; p = 0.008), respectively. Kidney survival at 1 and 2 years was 13.5 and 11%, respectively. Patient survival at 5 years was 81%.ConclusionIn real life, patients with severe anti-GBM disease (creatinine > 4.7 mg/dL and > 50% crescents) remained with devastating renal prognosis despite plasma exchange and immunosuppressive treatment. New therapies for the treatment of this rare renal disease are urgently needed.

CKD Stage Prediction and Suitable Diet Recommendation: A Survey

Abstract: Chronic kidney disease is one of the world's most complicated illnesses. Renal failure occurs when the kidneys have been afflicted for a long time. Filtration of waste and surplus fluid from the blood is the job of the kidneys. Because waste builds up as kidneys fail, early detection of chronic renal disease and proper treatment are critical in today's medical industry. On the subject of chronic renal disease prediction, there are numerous research studies available. Kidney disease prediction employs a variety of effective approaches and algorithms. A large number of research publications apply data science techniques for renal disease prediction, with promising outcomes. Some studies gathered training datasets from hospitals, which were then trained using efficient machine learning algorithms, yielding positive results. One of the most difficult challenges in the present medical field is identifying this complex kidney illness. Doctors have a difficult time manually identifying the condition. ML algorithms have been used in research to generate appropriate models, and the best model is evaluated to provide better outcomes. Keywords: CKD, Naïve Bayes, Support Vector Machine, Logistic Regression, KNN, CNN

PPARβ/δ Augments IL-1β-Induced COX-2 Expression and PGE2 Biosynthesis in Human Mesangial Cells via the Activation of SIRT1.

Peroxisome proliferator-activated receptor β/δ (PPARβ/δ), a ligand-activated nuclear receptor, regulates lipid and glucose metabolism and inflammation. PPARβ/δ can exert an anti-inflammatory effect by suppressing proinflammatory cytokine production. Cyclooxygenase-2 (COX-2)-triggered inflammation plays a crucial role in the development of many inflammatory diseases, including glomerulonephritis. However, the effect of PPARβ/δ on the expression of COX-2 in the kidney has not been fully elucidated. The present study showed that PPARβ/δ was functionally expressed in human mesangial cells (hMCs), where its expression was increased by interleukin-1β (IL-1β) treatment concomitant with enhanced COX-2 expression and prostaglandin E2 (PGE2) biosynthesis. The treatment of hMCs with GW0742, a selective agonist of PPARβ/δ, or the overexpression of PPARβ/δ via an adenovirus-mediated approach significantly increased COX-2 expression and PGE2 production. PPARβ/δ could further augment the IL-1β-induced COX-2 expression and PGE2 production in hMCs. Moreover, both PPARβ/δ activation and overexpression markedly increased sirtuin 1 (SIRT1) expression. The inhibition or knockdown of SIRT1 significantly attenuated the effects of PPARβ/δ on the IL-1β-induced expression of COX-2 and PGE2 biosynthesis. Taken together, PPARβ/δ could augment the IL-1β-induced COX-2 expression and PGE2 production in hMCs via the SIRT1 pathway. Given the critical role of COX-2 in glomerulonephritis, PPARβ/δ may represent a novel target for the treatment of renal inflammatory diseases.

Peritoneal dialysis after failed kidney transplantation; a case series with review of the literature

Kidney transplantation is a definite treatment for end-stage renal disease (ESRD). However, management of allograft dysfunction has remained a major challenge and some patients return to dialysis after renal transplantation. Studies showed that peritoneal dialysis (PD) results in a higher chance of survival and a lower risk of delayed allograft dysfunction compared to hemodialysis (HD). For this reason, this study explored the initiation of PD in six patients with renal allograft dysfunction in Tabriz Imam Reza hospital (referral PD center). This case reported the results of PD and incremental PD among these patients with failed kidney transplantation. Creatinine and hemoglobin levels, duration of starting PD, PD exchange, PD modality, immunosuppressive drugs mortality rate and urine volume were evaluated during the study. In conclusion, although re-transplantation is a gold standard therapy in failed kidney transplant patients, PD or incremental PD could be a suitable and home-based modality for preserving renal function and urine output in these patients.

A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway

ObjectivesComparative economic assessments of renal replacement therapies (RRT) are common and often used to inform national policy in the management of end-stage renal disease (ESRD). This study aimed to assess existing cost-effectiveness analyses of dialysis modalities and consider whether the methods applied and results obtained reflect the complexities of the real-world treatment pathway experienced by ESRD patients.MethodsA systematic literature review (SLR) was conducted to identify cost-effectiveness studies of dialysis modalities from 2005 onward by searching Embase, MEDLINE, EBM reviews, and EconLit. Economic evaluations were included if they compared distinct dialysis modalities (e.g. in-centre haemodialysis [ICHD], home haemodialysis [HHD] and peritoneal dialysis [PD]).ResultsIn total, 19 cost-effectiveness studies were identified. There was considerable heterogeneity in perspectives, time horizon, discounting, utility values, sources of clinical and economic data, and extent of clinical and economic elements included. The vast majority of studies included an incident dialysis patient population. All studies concluded that home dialysis treatment options were cost-effective interventions.ConclusionsDespite similar findings across studies, there are a number of uncertainties about which dialysis modalities represent the most cost-effective options for patients at different points in the care pathway. Most studies included an incident patient cohort; however, in clinical practice, patients may switch between different treatment modalities over time according to their clinical need and personal circumstances.Promoting health policies through financial incentives in renal care should reflect the cost-effectiveness of a comprehensive approach that considers different RRTs along the patient pathway; however, no such evidence is currently available.

Effects of methanolic leaf extracts of &lt;em&gt;Jatropha curcas&lt;/em&gt;, &lt;em&gt;Alchonnea cordifolia&lt;/em&gt;, &lt;em&gt;Secamone afzelii&lt;/em&gt; in Doxorubicin-induced hypertensive nephropathy in pregnant Wistar rats

This study assessed the Effects of methanolic leaf extracts of Jatropha curcas, Alchonnea cordifolia, Secamone afzelii in Doxorubicin-induced hypertensive nephropathy in pregnant Wistar rats. Plant samples (leaves) were washed severally with distilled water, air-dried, and crushed to powder and were filtered, then soaked in 200mL of methanol for 12 hours. The LD50 was determined to ascertain the safety of the plant extracts for use. Female Wistar rats, aged 3 days apart, used in the study, were acclimatized for one week. Doxorubicin nephropathy was induced with 3.5mg dose intravenously through the caudal vein. Urea levels were found to have increased significantly in the third trimester (9.3 mmol/L) in the hypertensive nephropathic group. Hypertensive nephropathy also caused an increase in plasma Creatinine levels (333.64 μmol/L) and (172.73 μmol/L) in the third trimester and postpartum, respectively. The administration of plant extracts resulted in a significant decrease in urine creatinine (845.45–481.82 μmol/L) and a significant increase in Protein- Creatinine Ratio (PCR, 3.0–7.3 mg/dL) in the nephropathic group, but a contrary report in the post-partum group, with significant increases in micro-protein (17.1–21.9 mg/dL). Plasma urea and plasma creatinine had a significant relationship in the third trimester (r=0.853 and 0.810, p=0.01). Plasma urea, on the other hand, had no significant association with plasma creatinine throughout the postpartum period. This study’s findings suggested that Jatropha curcas, Alchonnea cordifolia, and Secamone afzelii extracts could be useful in the treatment of chronic renal disease.

Perforin: An intriguing protein in allograft rejection immunology (Review).

Chronic kidney disease (CKD) is a worldwide public health problem. The constantly increasing prevalence of CKD requires further research into new additional strategies in its management. The preferred treatment of end-stage renal disease (ESRD) is renal transplantation. Kidney transplant patients benefit from substantial improvement in their quality and duration of life. For these to be feasible, the long-term graft and host survival optimization of the renal transplant recipient must be ensured and chronic allograft dysfunction (CAN) must be prevented. Once an equilibrium in the allograft tolerance is established, renal transplanted patients would benefit from the withdrawal or the reduction of immunosuppression therapy. Identification of early predictive biomarkers of CAN is essential. Recent publications have revealed that in long-term immune tolerance and graft survival several populations of immune cells are involved. Starting from the identification of perforin (PRF) in pathological renal glomeruli and following with the analysis of the molecular expression of PRF in renal biopsy samples, it appears that serum PRF is one of the potential biomarkers of graft dysfunction. Over the years, this protein has captured the attention of the medical world, conducting research that could potentially lead to the discovery of an innovative biomarker. Discovering and understanding the involvement of PRF in developing CAN may open up new therapeutic pathways that would ensure the survival of the kidney transplant. In this review the authors examined the structure, the role and the present understanding of the mechanisms by which serum PRF may be involved in chronic graft dysfunction as well as its role as an immune tolerance biomarker for chronic dysfunction of the renal graft.