Kidney & blood pressure research最新文献

Kidney stones are common and can arise from many etiologies including genetic and environmental. Biallelic pathogenic variants in the solute carrier family 34-member 3 (SLC34A3) gene cause Hereditary Hypophosphatemic Rickets with Hypercalciuria (HHRH), while both monallaelic and biallelic pathogenic variants in SLC3A1 cause cystinuria. Here, we report the clinical phenotype of a patient with concomitant biallelic and monoallelic pathogenic variants in SLC34A3 and SLC3A1 respectively.

Introduction: The identification of non-diabetic kidney disease (NDKD) in diabetic patients is critically important. Unlike diabetic nephropathy, NDKD often requires additional therapeutic interventions beyond standard diabetes care. There is a need to develop computational methods using electronic medical record data to identify NDKD in diabetic patients for whom kidney biopsy is not an option.

Methods: The study included 1136 diabetic patients who underwent kidney biopsy at a tertiary teaching hospital. We collected 103 parameters from electronic medical records, including demographic characteristics, physical examination results, laboratory tests, and the status of diabetic retinopathy. We developed seven models to detect NDKD, including k-nearest neighbors, random forest, extreme gradient boosting (XGB), lasso Logistic regression, support vector machine, naïve bayes, and multilayer perceptron (MLP), in the training set (n=908), and compared their performances in the testing set (n=228). The SHapley Additive exPlanations (SHAP) approach was used to analyze the importance of features.

Results: Biopsy-confirmed NDKD was present in 53% of the 1136 participants. In the testing set, the area under the receiver operating characteristic curve (AUC) for NDKD detection using XGB, Lasso regression, and MLP reached 0.8, with performances that were stable regardless of whether variable normalization was performed. Among them, XGB revealed the highest AUC (0.833; 95% CI: 0.800 to 0.864) without feature normalization, which was statistically superior to the other models according to DeLong's tests. After feature normalization, SVM achieved the highest AUC of 0.841 (95% CI: 0.817to 0.861) among all models. In addition to established predictive factors for NDKD (e.g., hematuria and absence of diabetic retinopathy), SHAP analysis identified several features, such as low IgG levels, that contributed significantly to the differentiation models.

Conclusion: Despite performance variations in different modeling techniques, machine learning models may have the potential to facilitate the detection of NDKD for patients with contraindications for kidney biopsy. Further efforts are warranted to improve accuracy and facilitate their translation into clinical practice.

Introduction: There have been reports that the traditional Chinese medicine formula Xiaoyu Xiezhuo Decoction (XYXZD) protects against kidney damage. Its possible mechanisms in renal ischemia-reperfusion damage (IRI) are yet unknown, though. Investigating XYXZD's function and possible therapeutic effects on renal IRI is the goal of this investigation.

Methods: Liquid chromatography-mass spectrometry and network pharmacology were applied to identify key target genes associated with XYXZD and renal IRI. Molecular docking was employed to forecast the binding affinity of bioactive compounds to these targets. The effects of nobiletin (NOB) on macrophage polarization, inflammatory cytokine production, mitochondrial function, and oxidative stress were evaluated. The impact of NOB on HK-2 mitochondrial dynamics through M1 macrophage polarization was evaluated via the Cell Counting Kit-8 assay, enzyme-linked immunosorbent assay, western blotting, and transmission electron microscopy.

Results: Network pharmacology analysis identified matrix metalloproteinase-9 (MMP9) and poly(ADP-ribose) polymerase 1 (PARP1) as key regulatory factors linking macrophage polarization and mitochondrial function. Molecular docking revealed a strong binding affinity between NOB and MMP9. NOB reduced M1 macrophage polarization, along with the downregulation of pro-inflammatory cytokines interleukin-1 beta (IL-1β) and interleukin-6 (IL-6). In HK-2 cells, NOB mitigated mitochondrial dysfunction by modulating M1 macrophage polarization, reducing reactive oxygen species (ROS) production, and restoring mitochondrial dynamics.

Conclusion: By preventing M1 macrophage polarization, lowering inflammation, and reestablishing mitochondrial homeostasis in renal tubular epithelial cells, this study showed that NOB has renoprotective benefits. These results provided fresh perspectives on NOB's potential as a treatment for renal IRI.

Background: Sarcopenia is a common yet underrecognized complication of chronic kidney disease (CKD), often affecting younger patients and progressing more rapidly than age-related muscle loss. It is driven by a combination of metabolic, hormonal, and inflammatory abnormalities associated with declining renal function.

Summary: This review outlines the key mechanisms linking CKD to sarcopenia, including metabolic acidosis, uremic toxin accumulation, hormonal dysregulation, insulin resistance, and chronic inflammation. These factors impair muscle protein turnover and promote protein-energy wasting (PEW). The review also discusses diagnostic limitations and emerging therapeutic strategies, such as individualized nutrition, resistance training, and gut microbiota modulation.

Key messages: Sarcopenia in CKD contributes to increased morbidity and mortality. Early identification and personalized, multidisciplinary interventions are essential to preserve muscle health and improve patient outcomes.

Background: Renal denervation (RDN) is an emerging therapy for resistant hypertension. The Therapeutic Intravascular Ultrasound (TIVUS) system offers a non-occlusive, multi-directional approach, but its long-term efficacy and safety remain unknown.

Purpose: To evaluate 10-year outcomes following RDN using the TIVUS system in patients with severe resistant hypertension.

Materials and methods: We prospectively followed 12 patients who underwent bilateral ultrasound RDN as part of the TIVUS trial. Office BP was measured at baseline, 1, 3, 6, and 12 months; 24-hour ambulatory BP at years 1, 2, 5, and 10. Estimated glomerular filtration rate (eGFR) and adverse events were tracked. BP changes were analyzed using mixed-effects models adjusted for baseline covariates.

Results: Mean age was 65 ± 8 years; 75 % had diabetes. Baseline office BP averaged 176/84 mmHg. The RDN procedure was completed in all patients without complications. Systolic office BP decreased by 22 mmHg at 1 month (p < 0.001) and 37.6 mmHg at 12 months (p < 0.001). At 10 years, office BP reductions were -38.7/-14.3 mmHg (p < 0.001). Ambulatory BP declined similarly: ASBP from 149.4 ± 9.8 to 128.4 ± 10.0 mmHg (Δ≈-20) and ADBP from 85.0 ± 8.5 to 74.4 ± 9.2 mmHg (Δ≈-10.6). The 10-year change in antihypertensive defined daily doses was -1.60 (95 % CI -2.70 to -0.40; p = 0.002). eGFR declined modestly (68.6 to 60.2 mL/min/1.73 m²), consistent with aging. No procedure-related adverse events occurred.

Conclusions: TIVUS ultrasound RDN achieved durable BP reduction with preserved renal function over 10 years.

Background: Tolvaptan is the first drug approved by the FDA for rapidly progressive polycystic kidney disease (PKD). However, there are no studies reporting real-world clinical practice using tolvaptan to treat Chinese patients with autosomal-dominant polycystic kidney disease (ADPKD).

Methods: This retrospective multicentre cohort study analyzed ADPKD patients diagnosed by genetic or imaging tests, comparing those treated with tolvaptan(15 mg, twice daily) to unmedicated patients. Clinical course, estimated glomerular filtration rate (eGFR), total kidney volume (TKV), SF-36 score, and adverse events (AEs) were recorded for 83 patients, with 40 in the treatment group and 43 in the control group.

Results: Compared with the control group, the tolvaptan treatment significantly delayed the increase in height-adjusted total kidney volume growth rate (htTKV%) in the 1st and 2nd years (1 year: difference:-5.58, 95% confidence interval (CI): -8.39 to -2.78, p < 0.001; 2 year: difference: -9.75, 95% CI: -13.1 to -6.31), p < 0.001). Compared with the control group, the effect of tolvaptan on eGFR was more pronounced in the 2nd year of treatment (2 year: difference: 6.79, 95% CI: 5.10-8.48, p < 0.001). Tolvaptan attenuated the AEs, such as fatigue, back pain, and anxiety, to some extent, while the incidence of water-related AEs, such as thirst, polyuria, and urinary frequency, was significantly higher than that in the control group (p < 0.001, p = 0.006, p = 0.009, respectively). According to the Short-Form 36 (SF-36) health survey, the physical component summary (PCS) score was significantly improved in the treatment group (p < 0.001).

Conclusion: This real-world analysis showed that tolvaptan appears to be effective in delaying the clinical course of ADPKD patients in China, extending the results of previous clinical trials in other populations.

Objective: This study aimed to examine the relationship between the C-reactive protein-albumin-lymphocyte (CALLY) index, a composite measure of inflammation, nutritional status, and immune function, and chronic kidney disease (CKD).

Methods: The study employed a population-based cohort retrospective analysis design, integrating the NHANES dataset (n = 24,538) and the clinical cohort of China (n = 7,102). The present study sought to assess the association and predictive efficacy of the CALLY index for CKD. To this end, multi-stage logistic regression modeling, receiver operating characteristic (ROC) analysis, and restricted cubic spline (RCS) analysis were employed. The analysis controlled for demographic factors, lifestyle, and metabolic diseases.

Results: The study indicated a negative correlation between the CALLY index and CKD, with a 1% reduction (odds ratio (OR) = 0.99, 95% confidence interval (CI) = 0.99-0.99) and a 3% reduction (OR = 0.97, 95% CI = 0.96-0.98) in CKD risk for every 1-unit increase in the index, respectively, in the U.S. and Chinese cohorts. The ROC analyses yielded a multifactorial-adjusted AUC for the U.S. cohort of 0.803 (95% CI: 0.795-0.810), and the Chinese cohort was 0.676 (95% CI: 0.657-0.695). Threshold effect analyses demonstrated that the risk significantly reduced when CALLY<2.313 (OR=0.77 for the US cohort and OR=0.63 for the Chinese cohort), and the association disappeared above the threshold. Subgroup analyses indicated that hypertension and obesity status modified the predictive efficacy of the CALLY index.

Conclusion: The CALLY index demonstrates a negative correlation with CKD. Its cross-cohort robustness and threshold effect provide a foundation for implementing early screening and stratified intervention strategies. However, the index's clinical translational value remains to be validated in future studies.

Background: The monkeypox virus is currently circulating in Africa and has been declared a public health emergency of international concern. Due to lifelong immunosuppressive therapy, kidney transplant recipients are susceptible to infections and at high risk for developing serious complications.

Summary: We summarized the clinical data of 11 patients from the database. 10 cases occurred in males, with age ranging from 25 to 62 years old. Common clinical features include rashes, anorectal pain, fever, pharyngitis, diarrhea, dyspnea and abdominal pain. Median duration of symptoms at presentation was 54 days (range, 21-120 days). Once diagnosed, immunosuppressive agents were adjusted among seven patients (7/11). 10 cases received antiviral medication including tecovirimat, cidofovir and brincidofovir. The median time to initiate treatment was 16.5 days (range, 4-35 days). The majority (10/11) had a good prognosis, with one monkeypox-related death in the cohort.

Key messages: Monkeypox infection is spreading fast over the world and presents a major concern to kidney transplant recipients. In this immunocompromised group, we should focus more on effective preventative and treatment techniques. Further research is needed to standardize management algorithms.

Introduction: Renal injury is a significant complication in ST-segment elevation myocardial infarction (STEMI) and is associated with poor outcomes. The recently introduced term acute kidney disease (AKD) describes persistent renal dysfunction lasting 7-90 days post-acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL), a biomarker for tubular injury, has shown promise in predicting AKI. This study aimed to evaluate NGAL's diagnostic utility for predicting AKD in STEMI patients.

Methods: This prospective observational study included 312 patients admitted with STEMI. NGAL levels were measured within 2 hours of admission. AKI and AKD were defined using KDIGO criteria, and patients with chronic inflammation or end-stage renal disease were excluded. Receiver operating characteristic (ROC) analysis was performed to evaluate NGAL's predictive value for AKD and its optimal value for prediction.

Results: Overall, 64 patients developed AKI (21%), with 30 (47%) progressing to AKD. Patients with AKD had higher admission NGAL levels (median 165 ng/ml) compared to those with resolved AKI (112 ng/ml) or no AKI (88 ng/ml, p<0.001). NGAL had a good predictive ability for AKD (area under the ROC of 0.784), with a threshold of >150 ng/ml having 65% sensitivity and 77% specificity for correct prediction. Multivariate analysis confirmed NGAL >150 ng/ml as an independent predictor of AKD (HR 6.4, 95% CI 1.94-21.06, p<0.001).

Conclusions: Elevated NGAL levels are independently associated with AKD development in STEMI patients. These findings suggest NGAL could be a valuable biomarker for early risk stratification, supporting timely interventions to mitigate persistent renal injury. Further research is warranted to confirm its clinical utility.