Urinary Research Articles

Pathology of the Genitourinary System in Women Who Received Radiation Exposure with Radioactive Iodine During Pregnancy as a Result of the Accident at the Chernobyl NPP

Pathology of the Genitourinary System in Women Who Received Radiation Exposure with Radioactive Iodine During Pregnancy as a Result of the Accident at the Chernobyl NPP

NOX-2 Inhibitors may be Potential Drug Candidates for the Management of COVID-19 Complications.

COVID-19 is an RNA virus that attacks the targeting organs, which express angiotensin-converting enzyme-2 (ACE-2), such as the lungs, heart, renal system, and gastrointestinal tract. The virus that enters the cell by endocytosis triggers ROS production within the confines of endosomes via a NOX-2 containing NADPH-oxidase. Various isoforms of NADPH oxidase are expressed in airways and alveolar epithelial cells, endothelial and vascular smooth muscle cells, and inflammatory cells, such as alveolar macrophages, monocytes, neutrophils, and T-lymphocytes. The key NOX isoform expressed in macrophages and neutrophils is the NOX-2 oxidase, whereas, in airways and alveolar epithelial cells, it appears to be NOX-1 and NOX-2. The respiratory RNA viruses induce NOX-2-mediated ROS production in the endosomes of alveolar macrophages. The mitochondrial and NADPH oxidase (NOX) generated ROS can enhance TGF-β signaling to promote fibrosis of the lungs. The endothelium-derived ROS and platelet-derived ROS, due to activation of the NADPH-oxidase enzyme, play a crucial role in platelet activation. It has been observed that NOX-2 is generally activated in COVID-19 patients. The post-COVID complications like pulmonary fibrosis and platelet aggregation may be due to the activation of NOX-2. NOX-2 inhibitors may be a useful drug candidate to prevent COVID-19 complications like pulmonary fibrosis and platelet aggregation.

Changes in Interprofessional Practice During the COVID-19 Pandemic and the Effect on Patient Outcomes: A Retrospective Observational Study.

Changes in healthcare delivery were required during the first year of the COVID-19 pandemic. The purpose of this study was to determine the impact of the approach to care of the COVID-19 patient on nursing sensitive indicators and nutrition therapy and the utilization of rehabilitation services during the first year of the pandemic in the acute care setting. A retrospective study of 894 patients admitted with a COVID-19 diagnosis was conducted between March 2020 and February 2021 in 3-month cohorts. All charts were reviewed for general demographics and hospital data, nursing quality indicators, and nutritional and rehabilitation services for the first 30 days of admission. Differences in patient characteristics were noted among the cohorts. Variations were observed between time points in hospital-acquired pressure injury occurrence, with mechanical ventilation and proning being independent predictors of hospital-acquired pressure injuries. There were differences noted in the percentage of patients with a central line-associated bloodstream infection among the time points (P < .001), but there were no differences noted in catheter-associated urinary tract infections (P = .20). Overall, 15.5% had a malnutrition diagnosis, with most patients receiving 50% of prescribed calorie and protein needs. Rehabilitation services increased over time with these services being initiated earlier in the later cohorts (P < .001). The results of this study demonstrated the impact of the pandemic on outcomes in the areas of nursing, nutrition, and rehabilitation, which varied across quarterly cohorts as we learned and developed new practices and adapted to a novel pandemic.

Long-Term Water Vapor Thermal Therapy Outcomes Across a Broad Range of Prostate Volumes.

Water vapor thermal therapy (WVTT) is a minimally invasive therapy designed to treat lower urinary tract symptoms associated with benign prostatic hyperplasia. Long-term outcomes with large (>80 cc) and small (<30 cc) prostate volumes (PVs) remain limited. We report 48-month outcomes for a multiethnic cohort of WVTT-treated men, stratified by PV. In this single-center retrospective study, patients were stratified by PV: < 30 cc, 30 to 80 cc, or > 80 cc. Outcome measures, including International Prostate Symptom Score, quality of life, International Index of Erectile Function, medication usage, and adverse events, were analyzed at baseline and at 1-, 3-, 6-, 12-, 24-, 36-, and/or 48-month follow-up. Two hundred fifty-two patients met inclusion; 35 (13.9%) had PVs < 30 cc, 196 (77.8%) had PVs 30 to 80 cc, and 21 (8.3%) had PVs > 80 cc. Most patients were Asian (33.7%) or non-Hispanic Black (29.4%). International Prostate Symptom Score and quality of life improved in all cohorts from baseline at all follow-ups (all P < .05), with no differences between cohorts. International Index of Erectile Function-Orgasmic Function and -Erectile Function domains improved in 30 to 80 cc patients at 48 months. Alpha blocker and/or 5-alpha reductase inhibitor usage decreased at all follow-ups in < 30 cc and 30 to 80 cc patients and remained durable to only 6 months for > 80 cc patients. No significant differences in adverse events or reoperation rates were observed between cohorts. Our study suggests WVTT to be efficacious, durable, and safe in managing lower urinary tract symptoms across PVs, although PV > 80 cc patients may require benign prostatic hyperplasia medication at long-term follow-up. Further research is desired to clarify WVTT's role regarding sexual function and in treating men with larger PVs.

Immunologic Crosstalk of Endoplasmic Reticulum Stress Signaling in Bladder Cancer.

Bladder cancer (BC) is a common malignant tumor of the urinary system. While current approaches involving adjuvant chemotherapy, radiotherapy, and immunotherapy have shown significant progress in BC treatment, challenges, such as recurrence and drug resistance, persist, especially in the case of muscle-invasive bladder cancer (MIBC). This is mainly due to the lack of pre-existing immune response cells in the tumor immune microenvironment. Micro-environmental changes (such as hypoxia and under-nutrition) can cause the aggregation of unfolded and misfolded proteins in the lumen, which induces endoplasmic reticulum (ER) stress. ER stress and its downstream signaling pathways are closely related to immunogenicity and tumor drug resistance. ER stress plays a pivotal role in a spectrum of processes within immune cells and the progression of BC cells, encompassing cell proliferation, autophagy, apoptosis, and resistance to therapies. Recent studies have increasingly recognized the potential of natural compounds to exhibit anti-BC properties through ER stress induction. Still, the efficacy of these natural compounds remains less than that of immune checkpoint inhibitors (ICIs). Currently, the ER stress-mediated immunogenic cell death (ICD) pathway is more encouraging, which can enhance ICI responses by mediating immune stemness. This article provides an overview of the recent developments in understanding how ER stress influences tumor immunity and its implications for BC. Targeting this pathway may soon emerge as a compelling therapeutic strategy for BC.

Compliance to International Guidelines and Rational Use of Antibiotics in Urinary Tract Infections in a Country without National Guidance: A Cross-Sectional Study

Compliance to International Guidelines and Rational Use of Antibiotics in Urinary Tract Infections in a Country without National Guidance: A Cross-Sectional Study

Isolation and Antibiotic Susceptibility of Escherichia coli from Urinary Tract Infections

Isolation and Antibiotic Susceptibility of Escherichia coli from Urinary Tract Infections

Comprehensive Collection of Whole-Slide Images and Genomic Profiles for Patients with Bladder Cancer

Bladder cancer is one of the leading causes of cancer-related mortality in the urinary system. Understanding genomic information is important in the treatment and prognosis of bladder cancer, but the current method used to identify mutations is time-consuming and labor-intensive. There are now many novel and convenient ways to predict cancerous genomics from pathological slides. However, the publicly available datasets are limited, especially for Asian populations. In this study, we developed a dataset consisting of 75 Asian cases of bladder cancers and 112 Whole-Slide Images with one to two images obtained for each patient. This dataset provides information on the most frequently and clinically significant mutated genes derived by whole-exome sequencing in these patients. This dataset will facilitate exploration and development of novel diagnostic and therapeutic technologies for bladder cancer.

Chronic inflammation in benign prostatic hyperplasia: Pathophysiology and treatment options.

Benign prostatic hyperplasia, a prevalent condition in aging men, is characterized by the proliferation of prostatic epithelial and stromal cells, which leads to bladder outlet obstruction and the exacerbation of lower urinary tract symptoms. There is increasing evidence that chronic prostatic inflammation contributes to the pathogenesis and progression of benign prostatic hyperplasia. This review explores the complex relationship between chronic inflammation and benign prostatic hyperplasia, focusing on the underlying mechanisms, clinical implications, and current therapeutic approaches. The pathophysiology of benign prostatic hyperplasia is multifaceted, involving factors such as hormonal changes, hypoxia, urine reflux into prostatic ducts and stroma, autoimmune responses, and infection-induced inflammation. Inflammatory cytokines, particularly interleukin-17 and interleukin-8, may play key roles in tissue remodeling and smooth muscle contraction within the prostate, thereby influencing benign prostatic hyperplasia progression. Current therapies for benign prostatic hyperplasia include α1-blockers, phosphodiesterase 5 inhibitors, 5α-reductase inhibitors, and plant-based treatments (e.g., pollen extract). These therapies aim to alleviate symptoms by reducing prostatic inflammation, improving blood flow, and inhibiting hormonal pathways involved in prostatic enlargement. However, patients with chronic prostatic inflammation often experience more severe lower urinary tract symptoms and may be resistant to conventional treatments. This resistance has prompted the exploration of alternative therapies targeting inflammation. Chronic prostatic inflammation plays a central role in the pathogenesis and severity of benign prostatic hyperplasia. An understanding of its mechanisms will enable the development of more effective treatments to improve the quality of life among patients with benign prostatic hyperplasia.

Dose rationale for the use of meropenem/vaborbactam combination in paediatric patients with Gram-negative bacterial infections.

Meropenem/vaborbactam combination is approved in adults by FDA and EMA for complicated urinary tract infections and by EMA also for other Gram-negative infections. We aimed to characterise the pharmacokinetics of both moieties in an ongoing study in children and use a model-based approach to inform adequate dosing regimens in paediatric patients. Over 4196 blood samples of meropenem and vaborbactam (n = 414 subjects) in adults, together with 114 blood samples (n = 39) in paediatric patients aged 3 months to 18 years were available for this analysis. Data were analysed using a population with prior information from a pharmacokinetic model in adults to inform parameter estimation in children. Simulations were performed to assess the suitability of different dosing regimens to achieve adequate probability of target attainment (PTA). Meropenem/vaborbactam PK was described with two-compartment models with first-order elimination. Body weight and CLcr were significant covariates on the disposition of both drugs. A maturation function was evaluated to explore changes in clearance in neonates. PTA ≥90% was derived for children aged ≥3 months after 3.5-h IV infusion of 40 mg/kg Q8h of both meropenem and vaborbactam and 2 g/2 g for those ≥50 kg. Extrapolation of disposition parameters suggest that adequate PTA is achieved after a 3.5-h IV infusion of 20 mg/kg for neonates and infants (3 months). An integrated analysis of adult and paediatric data allowed accurate description of sparsely sampled meropenem/vaborbactam PK in paediatric patients and provided recommendations for the dosing in neonates and infants (3 months).

Incidence of urinary tract infections in patients with permanent percutaneous nephrostomy after implementation of a standardized care program.

Percutaneous nephrostomy tubes (PNT), which are used in some cancer hospitals, are associated with an increase in urinary tract infections (UTI). To determine the impact of a standardized care program on the incidence of UTIs requiring hospitalization (UTI-RH). Retrospective study that included patients with a first PNT inserted. The incidence, relative risk (RR), costs and outcomes of patients with UTI-RH were compared during the period before (P0) vs. after the intervention (P1). 113 PNTs were inserted during P0, and 74 at P1. During P0, 61 patients (53.9%) experienced 64 UTI-RH events in 22,557 PNT days. At P1, four patients (5.4%) had a UTI-RH in 6,548 PNT days (IRR: 0.21, 95% CI: 0.05-0.57). The RR was 0.09 (95% CI: 0.03-0.25). Monthly cost per day/bed was USD 3,823 at P0 and USD 1,076 at P1, and for antibiotics, it was USD 790 at P0 and USD 123.5 at P1. This study highlights the importance of a standardized care program for permanent percutaneous devices, since this reduces antibiotic use, hospitalization, and the cost of care.

Predictive Value of Multiple Scoring Systems in the Prognosis of Septic Patients with Different Infection Sites: Analysis of the Medical Information Mart for the Intensive Care IV Database

The heterogeneity nature of sepsis is significantly impacted by the site of infection. This study aims to explore the predictive value of multiple scoring systems in assessing the prognosis of septic patients across different infection sites. Data for this retrospective cohort study were extracted from the Medical Information Mart for Intensive Care IV database (MIMIC-IV) (v2.2). Adult patients meeting the criteria for sepsis 3.0 and admitted to the intensive care unit (ICU) were enrolled. Infection sites included were pneumonia, urinary tract infection (UTI), cellulitis, abdominal infection, and bacteremia. The primary outcome assessed was 28-day mortality. The sequential Organ Failure Assessment (SOFA) score, Oxford Acute Severity of Illness Score (OASIS), and Logistic Organ Dysfunction System (LODS) score were compared. Binomial logistic regression analysis was conducted to evaluate the association between these variables and mortality. Additionally, differences in the area under the curve (AUC) of receiver operating characteristic (ROC) among the scoring systems were analyzed. A total of 4721 patients were included in the analysis. The average 28-day mortality rate was 9.4%. Significant differences were observed in LODS, OASIS, and SOFA scores between the 28-day survival and non-survival groups across different infection sites (p &lt; 0.01). In the pneumonia group and abdominal infection group, both the LODS and OASIS scoring systems emerged as independent risk factors for mortality in septic patients (odds ratio [OR]: 1.165, 95% confidence interval [CI]: 1.109–1.224, p &lt; 0.001; OR: 1.047, 95% CI: 1.028–1.065, p &lt; 0.001) (OR: 1.200, 95% CI: 1.091–1.319, p &lt; 0.001; OR: 1.060, 95% CI: 1.025–1.095, p &lt; 0.001). For patients with UTI, the LODS, OASIS, and SOFA scoring systems were identified as independent risk factors for mortality (OR: 1.142, 95% CI: 1.068–1.220, p &lt; 0.001; OR: 1.062, 95% CI: 1.037–1.087, p &lt; 0.001; OR: 1.146, 95% CI: 1.046–1.255, p = 0.004), with the AUC of LODS score and OASIS significantly higher than that of the SOFA score (p = 0.006). Among patients with cellulitis, the OASIS and SOFA scoring systems were identified as independent risk factors for mortality (OR: 1.055, 95% CI: 1.007–1.106, p = 0.025; OR: 1.187, 95% CI: 1.005–1.403, p = 0.044), with no significant difference in prognosis prediction observed (p = 0.243). In the bacteremia group, the LODS scoring system was identified as an independent risk factor for mortality (OR: 1.165, 95% CI: 1.109–1.224, p &lt; 0.001). The findings suggest that LODS scores offer better prognostic accuracy for predicting the mortality risk in septic patients with pneumonia, abdominal infections, bacteremia, and UTI compared to SOFA scores.

"Catheter replacement in catheter-associated urinary tract infection: current state of evidence ".

Catheter associated urinary tract infection (CAUTI) is the most common healthcare associated infection. A significant knowledge gap exists regarding the necessity of catheter replacement as part of CAUTI treatment. Current guidelines recommend replacement for faster recovery and to prevent recurrences, but adherence is low. In this systematic review, we aimed to assess the available evidence regarding catheter replacement for CAUTI. Eligible studies investigated the effect of catheter replacement in CAUTI on clinical outcomes and/or recurrence rates, irrespective of catheter type or setting. We searched electronic literature databases from inception to October 15th, 2023. Information was extracted regarding setting, eligibility criteria, definition of CAUTI, timing of replacement, and outcomes. Of the 257 identified studies, four were considered relevant and included. Two were randomized controlled trials (RCT) and two were observational studies. One RCT showed higher rates of clinical recovery and lower recurrence rates in the replacement group, while results of the other RCT favoured retainment, with a lower recurrence rate in the retainment group, although longer antimicrobial treatment in this group. Two observational studies were inconclusive. Current guidelines rely heavily on recommendations from a single study, emphasizing the need for further research. The burden of catheter replacement, including patient discomfort and resource impact, warrants careful consideration. A randomized trial is essential to provide more evidence on the effect of catheter replacement on clinical outcomes including CAUTI recurrence.

Influence of regulatory peptides on neurogenic lower urinary tract dysfunction in multiple sclerosis. Data of one center

Objective: Cclinical evaluation of the effectiveness and safety of the effect of the regulatory polypeptide drug on neurogenic overactive bladder (OAB) in patients with multiple sclerosis (MS).Materials and methods: 41 patients with MS and urodynamically confirmed detrusor overactivity were included in a prospective, single-center, simple comparative clinical trial with sequential drug changes. The initial function of the lower urinary tract and its dynamic changes during therapy were studied by filling out a voiding diary and questionnaires using the EDSS, NBSS, SF-Qualiveen, I-QOL questionnaires. The control drug Solifenacin (patient group 1) is a specific competitive antagonist of muscarinic receptors of the M3 subtype, which causes detrusor contraction. The Study Drug (patient group 2) is a complex of regulatory polypeptides that have an organotropic effect on the bladder. Drug administration: control drug for 4 weeks, then an observation period of 4 weeks, after which - taking the Study Drug for 30 days. The results were monitored immediately after the end of taking the Study Drugs, after which they were compared with the initial data. Statistical analysis was carried out by the program “Statistica 10” (StatSoft Inc., USA), using non-parametric data analysis with median analysis, Wilcoxon test and Mann-Whitney U-test search. The results of differences were considered statistically significant if the probability of error was &lt;5% (p&lt;0.05).Results: Vvoiding diary: 14.6% and 24.4% of patients in groups 1 and 2, respectively, were freed from urinary incontinence; from nocturia —- 31.7% and 56.1% of patients for groups 1 and 2, respectively, the frequency of daily urination was normalized in 53.6% and 70.7% of patients in groups 1 and 2, respectively. NBSS questionnaire: decrease in the total questionnaire score by 29.2% and 47.4% for groups 1 and 2, respectively. SF-Qualiveen questionnaire: an increase in the overall assessment score by 42.3% for group 1 versus +66.5% for group 2. I-QOL questionnaire: improvement in quality of life by 56.0% and 80.4% for groups 1 and 2, respectively. The Study Drug has a higher safety profile compared to Solifenacin.Conclusion: Tthe effectiveness of the Study Drug in the correction of neurogenic OAB is higher in comparison with Solifenacin, which is reflected in a decrease in urgency, pollakiuria, the number of episodes of urinary incontinence and a significant improvement in the quality of life of these patients. The Study Drug demonstrates a high safety profile in the study.

Role of estradiol and C-reactive protein levels on genitourinary syndrome in menopausal women

Menopause leads to decreased estradiol levels affecting tissue health and causing local inflammation in the genital organs and urinary tract. The rise of blood C-reactive protein (CRP) levels in menopausal women may indicate systemic inflammation associated with estradiol decline. The aim of this study was to determine the relationship between serum estradiol and CRP levels on genitourinary syndrome in menopausal women. A cross-sectional study was conducted among menopausal women who had not experienced menstruation for at least 12 consecutive months at Prof. dr. Chairuddin P. Lubis Hospital, Medan, Indonesia, in 2023. Estradiol and CRP levels were measured using enzyme-linked immunosorbent assay (ELISA) and the presence of genitourinary syndrome was assessed using the Menopause-Specific Quality of Life (MENQOL) questionnaire. The mean levels of estradiol and CRP were compared to menopausal women with and without genitourinary syndrome with the Mann-Whitney test. To assess the correlation between estradiol and CRP levels, and between their levels with the presence of genitourinary symptoms, the Spearman correlation test was used. The genitourinary syndrome was reported in 25% of the total included menopausal women. Our data indicated that the mean estradiol levels were not significantly different between menopausal women with and without genitourinary syndrome (9.13±2.47 pg/mL vs 18.96±31.23 pg/mL, p=0.881). The mean serum CRP level of menopausal women with genitourinary syndrome (9.72±6.30 mg/L) was higher than that of women without the syndrome (2.09±1.26 mg/L) with p&lt;0.001. In addition, serum CRP level, not estradiol, was correlated with the symptom score of genitourinary syndrome. This study highlights that to identify and manage genitourinary syndrome, monitoring of CRP levels is essential in menopausal women.

An update on natural bioactive components of traditional preparations for the treatment of nephrolithiasis; a review

An update on natural bioactive components of traditional preparations for the treatment of nephrolithiasis; a review

Sleep Disorders and Dementia Risk in Older Patients with Kidney Failure: A Retrospective Cohort Study.

Community-dwelling older adults with sleep disorders are at higher risk of developing dementia. Greater than 50% of older patients with kidney failure experience sleep disorders, which may explain their high burden of dementia. Among 216,158 patients (age ≥66 years) with kidney failure (United States Renal Data System; 2008-2019), we estimated the risk of dementia (including subtypes) associated with sleep disorders using Cox proportional-hazard models with propensity score weighting. We tested whether positive airway pressure (PAP) therapy was associated with reduced dementia risk among patients with obstructive sleep apnea (OSA). 26.3% of patients were diagnosed with sleep disorders; these patients had a higher five-year unadjusted cumulative incidence for any type of dementia (36.2% vs. 32.3%; P<0.001), vascular dementia (4.4% vs. 3.7%; P<0.001), and other/mixed dementia (29.3% vs. 25.8%; P<0.001). Higher risk of any type of dementia was identified in patients with insomnia (aHR=1.42; 95%CI: 1.34-1.51), sleep-related breathing disorders (SRBDs) (aHR=1.20; 95%CI: 1.17-1.23), and other sleep disorders (aHR=1.24; 95%CI: 1.11-1.39). Higher vascular dementia risk was observed in patients with insomnia (aHR=1.43; 95%CI: 1.19-1.73), SRBDs (aHR=1.15; 95%CI: 1.07-1.24). Patients with SRBDs (aHR=1.07; 95%CI: 1.00-1.15) were at higher risk of Alzheimer's disease. Among patients with OSA, PAP therapy was associated with lower risk for any type of dementia (aHR=0.82; 95%CI: 0.76-0.90), and vascular dementia (aHR=0.65; 95%CI: 0.50-0.85). Older patients with kidney failure and sleep disorders are at a higher risk of dementia. Sleep is an important modifiable factor that should be considered for targeted interventions to mitigate dementia risk in patients with kidney failure. For patients with OSA, PAP therapy is associated with lower dementia risk.

Prevalence, Determinants, and Antibiotic Resistance Patterns of Urinary Tract Infections in Antenatal Women in an Urban Resettlement Colony and Slum in Delhi, India: A Cross-sectional Study

Abstract Background: Urinary tract infection (UTI) is the most common bacterial infection occurring in pregnant women with untreated, recurrent, and inadequately treated bacteriuria accentuating the risk of multiple adverse fetal and maternal health outcomes. The study objective was to determine the proportion of UTIs and their predictors along with antibiotic resistance patterns of causative organisms in pregnant women. Materials and Methods: This cross-sectional study was conducted among 348 pregnant women in an urban resettlement and slum colony. Urine samples were examined through semi-quantitative culture on plated Mac Conkey and blood agar. Antibiotic susceptibility testing was done on Muller Hinton agar using the modified Stokes’ disc diffusion method. Results: At least one symptom related to UTI was reported by 35.7% (95% CI: 30.7-41.1) of the participants. The proportion of pregnant women detected having UTI on urine culture was 7.4% (n = 24, 95% CI: 5.1-10.8) with 13 (54.2%) asymptomatic and 11 (45.8%) symptomatic cases. Overcrowding was a significant predictor of UTI. The most common organisms detected were Escherichia coli (n = 12), Klebsiella pneumoniae (n = 7), Staphylococcus aureus (n = 3), and Acinetobacter species (n = 2). Conclusions: The use of individual toilets and active screening for UTI through culture and sensitivity testing in pregnant women should be promoted in low-resource settings irrespective of symptoms. The initiation of presumptive antibiotic therapy for UTI cases in pregnant women should be restricted to painful micturition due to high false positivity of other symptoms with Nitrofurantoin being a likely preferred drug for empirical administration due to its low resistance pattern among isolated organisms.

Improved prenatal assessment of kidney disease using multiple ultrasound features.

Congenital anomalies of the kidney and the urinary tract (CAKUT), often discovered in utero, cover a wide spectrum of outcomes ranging from normal postnatal kidney function to fetal death. The current ultrasound workup does not allow for an accurate assessment of the outcome. The present study aimed to significantly improve the ultrasound-based prediction of postnatal kidney survival in CAKUT. Histological analysis of kidneys of 15 CAKUT fetuses was performed to better standardize the ultrasound interpretation of dysplasia and cysts. Ultrasound images of 140 CAKUT fetuses with 2-year postnatal follow-up were annotated for amniotic fluid volume and kidney number, size, dysplasia and/or cysts using standardized ultrasound readout. Association of ultrasound features and clinical data (sex and age at diagnosis) with postnatal kidney function was studied using logistic regression. Amniotic fluid proteome associated to kidney dysplasia or cysts was characterized by mass spectrometry. Histologically, poor ultrasound corticomedullary differentiation was associated to dysplastic lesions and ultrasound hyperechogenicity was associated to the presence of microcysts. Of all ultrasound and clinical parameters, reduced amniotic volume, dysplasia and cysts were the best predictors of poor outcome (Odd ratio = 57 [95%CI: 11-481], 20 [3-225] and 7 [1-100], respectively). Their combination into an algorithm improved prediction of postnatal kidney function compared to amniotic volume alone (area under the ROC curve = 0.92 [0.86-0.98] in a 10-fold cross validation). Dysplasia and cysts were correlated (Cramer's V coefficient = 0.44, p<0.0001), but amniotic fluid proteome analysis revealed that they had distinct molecular origin (extracellular matrix and cell contacts versus cellular death, respectively), probably explaining the additivity of their predictive performances. Antenatal clinical advice for CAKUT pregnancies can be improved by a more standardized and combined interpretation of ultrasound data.

Trends and Inequalities in Diabetes-Related Complications Among U.S. Adults, 2000-2020.

We examined national trends in diabetes-related complications (heart failure [HF], myocardial infarction [MI], stroke, end-stage renal disease [ESRD], nontraumatic lower-extremity amputation [NLEA], and hyperglycemic crisis) among U.S. adults with diagnosed diabetes during 2000-2020 by age-group, race and ethnicity, and sex. We also assessed trends in inequalities among those subgroups. Hospitalization rates for diabetes-related complications among adults (≥18 years) were estimated using the 2000-2020 National (Nationwide) Inpatient Sample. The incidence of diabetes-related ESRD was estimated using the United States Renal Data System. The number of U.S. adults with diagnosed diabetes was estimated from the National Health Interview Survey. Annual percent change (APC) was estimated for assessment of trends. After declines in the early 2000s, hospitalization rates increased for HF (2012-2020 APC 3.9%, P < 0.001), stroke (2009-2020 APC 2.8%, P < 0.001), and NLEA (2009-2020 APC 5.9%, P < 0.001), while ESRD incidence increased (2010-2020 APC 1.0%, P = 0.044). Hyperglycemic crisis increased from 2000 to 2020 (APC 2.2%, P < 0.001). MI hospitalizations declined during 2000-2008 (APC -6.0%, P < 0.001) and were flat thereafter. On average, age inequalities declined for hospitalizations for HF, MI, stroke, and ESRD incidence but increased for hyperglycemic crisis. Sex inequalities increased on average for hospitalizations for stroke and NLEA and for ESRD incidence. Racial and ethnic inequalities declined during 2012-2020 for ESRD incidence but increased for HF, stroke, and hyperglycemic crisis. There was a continued increase of several complications in the past decade. Age, sex, and racial and ethnic inequalities have worsened for some complications.