BMC Nephrology最新文献

Background: Perform proteomic and metabolomic analysis on bilateral renal pelvis urine of patients with unilateral calcium oxalate kidney stones to identify the specific urinary microenvironment associated with stone formation.

Methods: Using cystoscopy-guided insertion of ureteral catheters, bilateral renal pelvis urine samples are collected. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is employed to identify differential proteins and metabolites in the urine microenvironment. Differentially expressed proteins and differential metabolites are further analyzed for their biological functions and potential metabolic pathways through Gene Ontology (GO) analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, Reactome pathway analysis and Biomolecular Interaction Network Database protein-protein interaction (PPI) network analysis.

Results: In the urine from the stone-affected side, 36 differential proteins were significantly upregulated, 4 differential proteins were downregulated, and 10 differential metabolites were significantly upregulated. Functional and pathway analyses indicate that the differentially expressed proteins are primarily involved in inflammatory pathways and complement and coagulation cascades, while the differential metabolites are mainly associated with oxidative stress.

Conclusion: The proteomic and metabolomic profiles of the urinary microenvironment in stone-affected kidneys provide a more precise reflection of the pathophysiological mechanisms involved in stone formation and development.

Background: Metabolic syndrome (MetS) has been demonstrated to be associated with various types of cancer, but its specific relationship with kidney cancer remains inconclusive. Therefore, this study conducts a Meta-analysis to systematically evaluate the potential link between metabolic syndrome and the risk of kidney cancer development.

Methods: Observational studies were retrieved from PubMed, Embase, Cochrane Library, and Web of Science. Two independent reviewers extracted study characteristics and assessed the quality of the studies. A random-effects model was employed to account for heterogeneity, and subgroup analyses were conducted to explore the impact of study characteristics on the results. Publication bias was evaluated using funnel plot symmetry and Egger's regression test.

Results: Six studies were included, with 10 results extracted for the Meta-analysis. The findings indicated that MetS is an independent risk factor for kidney cancer (HR: 1.44, 95% CI: 1.31-1.59, P < 0.001). Heterogeneity between studies was significant (Cochran's Q test, P < 0.001; I² = 83.7%), indicating substantial variability. Subgroup analyses revealed consistent associations across gender, follow-up duration, and MetS diagnostic criteria (P > 0.05), but significant variations by race and study design (P < 0.05). The funnel plot appeared symmetrical, and Egger's regression test (P = 0.425) confirmed a low risk of publication bias.

Conclusion: MetS is independently associated with an increased susceptibility to RCC in the adult population, although the strength of this association varies across different study designs and regions due to the observed heterogeneity.

Background: Administration of oral nutritional supplements (ONS) inside hemodialysis (HD) units before sessions is an increasingly adopted option. Our aim was to assess the effects of predialytic ONS on nutritional status and quality of life (QOL) in HD patients.

Methods: One hundred HD patients were enrolled in this prospective, multicentric randomized clinical trial. Patients were assigned to receive ONS (25 gm protein powder) 1 h prior to the start of the HD session (predialytic) or maintained on their routine nutrition regimen for 3 months.

Results: At study end, supplemented patients showed a significant increase in serum albumin (p < 0.001), and a non-significant decrease in the median subjective global assessment (SGA) score. While in the control group, serum albumin remained stable, and the median SGA score increased significantly (p < 0.001). Body mass index and anthropometric measures did not differ between both groups. The supplemented patients showed significant improvement in three subscales of the Kidney Disease Quality of Life-36, without a significant change in QOL in control patients. Supplemented patients had significantly higher blood pressure (BP) (p = 0.037), lower urea reduction ratio (p = 0.020) and Kt/V (p = 0.021), higher serum calcium, lower total cholesterol and lower CRP (p = 0.047) levels compared to controls. There was no significant difference between groups regarding serum sodium, potassium, or phosphorus or adverse events.

Conclusions: Predialytic ONS administration may contribute to improvements in serum albumin, and QOL. The effects on BP, CRP, and the reduction in dialysis adequacy, should be carefully considered while adopting such strategy.

Clinical trials registration: ClinicalTrials.gov NCT05952570.

First registration date: 2/07/2023.

Background: Gut dysbiosis is thought to be involved in the pathogenesis and progression of chronic kidney disease and end-stage kidney disease (ESKD). However, differences in the composition and function of gut microbiota in hemodialysis patients are not consistently concluded.

Methods: A total of 20 patients receiving maintenance hemodialysis (MHD) treatment at the Blood Purification Center of Bethune International Peace Hospital from March 2021 to December 2022 were included based on the inclusion criteria. Additionally, 20 healthy volunteers matched for age, gender, and body mass index were recruited from the Health Examination Center as the healthy control (HC) group. The structure of the gut microbiota community in the study subjects was analyzed using second-generation high-throughput sequencing technology based on 16S rRNA and amplicon sequence variants (ASV) analysis.

Results: There were significant differences in gut microbial communities between the two groups. At the genus level, significant differences were found in 19 genera. Among them, Escherichia-Shigella, Lachnospira, Parasutterella, [Ruminococcus]-torques-group, Butyricicoccus, and Streptococcus were significantly decreased, while Phascolarctobacterium, Ruminococcaceae-UBA1819, Erysipelotrichaceae-UCG-003, Flavonifractor, and Erysipelatoclostridium were significantly increased in MHD patients. In particular, the abnormal decrease in the abundance of p-Proteobacteria.c-Gammaproteobacteria.o-Enterobacterales.f-Enterobacteriaceae.g-Escherichia-Shigella might be a significant characteristic of gut microbiota in MHD patients.

Conclusion: The decreased abundance of Escherichia-Shigella is a signature gut microbiota alteration in patients with ESKD undergoing MHD, and Escherichia-Shigella may represent a key bacterial group warranting exploration in the field of hemodialysis. The dysbiosis of gut microbiota holds promise as a therapeutic target and biomarker for the diagnosis and treatment of MHD.

Background: This study aimed to detail acute tubulointerstitial nephritis (ATIN) patients, from relevant clinical manifestations to outcomes.

Methods: We reviewed ATIN patients between 2018 and 2022. All demographic data, labs, biopsy findings, treatment protocols, and outcomes were reported.

Results: ATIN was diagnosed in nine patients, eight by kidney biopsy and one clinically. Drug-induced ATIN (DI-ATIN) was reported in five patients, including rifampin (RIF), allopurinol, mesalamine, and two with cephalosporins. Severe ATIN resulted after the first dose of RIF aligned with liver injury, hemolysis, and thrombocytopenia. Also, mesalamine and allopurinol induced gradual kidney failure a few months after the drug initiation. A patient with Tubulointerstitial nephritis and uveitis (TINU) syndrome showed refractory uveitis presenting during glucocorticoids (GCs) tapering, which resolved quickly with azathioprine (AZA) when not responding to GCs reescalation. Among the rarest cases, ATIN induced by a kidney-limited sarcoidosis, G6PD patient with hemolysis induced ATIN, and isolated ATIN induced by ANCA-associated vasculitis (AAV) with positive C-ANCA, which the latter representing the first case in our country and the fourth case worldwide. Labs showed anemia (88.8%), ESR elevation (85.7%), microscopic hematuria (in all patients), pyuria (44.4%), and proteinuria (77.7%). Biopsies showed interstitial infiltrations mainly with lymphocytes and monocytes. Eosinophils were found in one biopsy and neutrophils showed in 4 biopsies (50%).

Conclusion: ATIN is a disease with a diagnostic challenge, thus clinicians should maintain a high suspicion for diagnosis. The combination of AKI with positive tests (especially abnormal urine sediment, ESR elevation, and anemia) may suggest ATIN diagnosis and further support the treatment initiation, particularly when kidney biopsy is unable to be performed or when the inciting agent is predictable.

Background: Since the prevalence of kidney stones and cardiovascular diseases (CVD) is increasing globally and also in Iran, it is vital to assess the associations between both disorders. The current study aimed to investigate the association between kidney stones and the risk of CVD.

Methods: This study was cross-sectional in design, which used the data of the Rafsanjan cohort study (RCS), a population-based Prospective epidemiological research study in Iran (PERSIAN) that recruited 10,000 participants of both genders aged 35-70 years from four urban and suburban areas of Rafsanjan. Demographic factors, medical history, personal habits, biochemical parameters including Fasting blood sugar (FBS), glomerular filtration rate (GFR), creatine (Cr), Blood urea nitrogen (BUN), urine specific gravity (USG), and lipids of the participants were collected according to standard protocols.

Results: The results showed that the risk of CVD was higher in men (51.02%) than in women (48.98%). Also, the results showed the highest risk of CVD development for age ≥ 56 years old. The results were presented in about 31% of patients with kidney stones, 19.5% of patients with abnormal urine tests, 9.84% with Proteinuria, more than 33% with abnormal USG, and more than 94% of patients with abnormal GFR had CVD. The odds of CVD were increased in patients with kidney stones (22%), female (25%), and age ≥ 56 years old (24%).

Conclusions: There was a high prevalence of kidney stones and CVD risk factors, such as gender, age, and kidney stones that increased the risk of cardiovascular disease.

Background: Tranexamic acid is an anti-fibrinolytic drug recommended in the setting of post-partum hemorrhage and non-obstetrical massive bleeding. Its putative role in the pathogenesis of renal cortical necrosis is unclear and has been rarely reported.

Case presentation: We report the case of a young woman who developed anuric acute kidney injury upon administration of tranexamic acid in the setting of mild traumatic hemorrhage. Early contrast-enhanced computed tomography revealed diffuse defects of cortical enhancement in both kidneys, consistent with the diagnosis of acute bilateral renal cortical necrosis. Biological tests did not detect hallmarks of thrombotic microangiopathy or disseminated intravascular coagulation and testing for acquired thrombophilic disorders were negative. The patient remained dialysis-dependent for two months and then partially recovered renal function to an estimated glomerular filtration rate of 40 ml/min/1.73 m².

Conclusions: This case illustrates the potential prothrombotic effect of tranexamic acid administered in the context of non-obstetric acute bleeding and the importance of re-considering its prescription in the presence of concomitant estrogenic impregnation in order to alleviate the risk of occurrence of renal cortical necrosis. It also addresses the predictive value of kidney imaging for the severity of renal cortical necrosis and subsequent renal recovery.

Backgrounds: Patients with End-Stage Kidney Disease (ESKD) receiving Hemodialysis (HD) face significant psychosocial and physical challenges. Improving their resilience by integrating protective factors is important for effectively managing the difficulties associated with the disease and its treatment. This study intended to identify factors associated with resilience among patients with ESKD receiving HD.

Methods: A cross-sectional analytical study was done among 143 patients with ESKD receiving HD in a Tertiary Hospital "A" in Nepal. A non-probability convenience sampling technique was used to select samples. Data were collected following ethical approval through face-to-face interviews. A Nepali version of socio-demographic and clinical characteristics-related questions and five standardized and structured instruments were used to measure resilience, family support, illness cognition, self-efficacy, and self-esteem. Data were analyzed with descriptive and inferential statistics (i.e., correlation and multiple linear regression) using the Statistical Package for Social Science Software version 16.

Results: The respondents had intermediate (49.0%), low (27.3%), and high (23.7%) levels of resilience. Illness cognition, self-efficacy, and self-esteem had statistically significant positive associations with resilience. However, age was negatively associated with resilience. These associated variables account for 64.0% of the variance in resilience (Adjusted R² = 0.64).

Conclusions: The highest proportion of patients with ESKD receiving HD had an intermediate level of resilience. Factors such as illness cognition, self-efficacy, and self-esteem play an important role in enhancing resilience while advancing age appears to diminish it. Therefore, focusing on enhancing illness cognition, self-efficacy, and self-esteem with special care on older patients may be an effective strategy for improving resilience in patients with ESKD receiving HD.

Trial registration: Not applicable.

Background: Acute kidney injury (AKI) is a sudden and reversible decrease in kidney function, causing the retention of waste products in the blood and potentially resulting in severe complications or death if not timely managed. Studies on AKI among traumatic brain injury patients in low-income nations like Ethiopia is very critical due to the limited healthcare resources, high burden of trauma-related injuries, and lack of robust data on the incidence and risk factors of AKI in such settings, which hinders effective prevention and treatment strategies tailored to these vulnerable populations Therefore, this study aimed to assess the incidence and predictors of AKI among traumatic brain injury patients.

Methods: A retrospective cohort study was conducted among 450 adult patients with traumatic brain injuries admitted to Tibebe-Ghion Specialized Hospital in Ethiopia. Kaplan- Meir curve and Log rank test were used to estimate and compare survival probability of different categories. A multivariable Cox proportional hazards model was used to identify determinants of acute kidney injury (AKI).

Results: The incidence of AKI was 10.9%, with a median follow-up period of 42 days. Significant predictors of AKI among traumatic brain injury patients included age (AHR: 1.05, 95% CI: 1.02-1.07), severe head injury (AHR: 1.46, 95% CI: 1.02-2.09), unreactive pupillary response (AHR: 4.82, 95% CI: 1.82-12.72), and hypotension (AHR: 3.45, 95% CI: 1.71-6.96).

Conclusions: The study found that AKI occurs in more than one in ten patients with traumatic brain injuries, with significant predictors including older age, severe head injury, unreactive pupillary response, and hypotension. These findings highlight the need for careful monitoring and early intervention for high-risk patients to prevent AKI and improve overall outcomes. Implementing targeted prevention and treatment strategies in settings with limited resources can help mitigate the burden of AKI and enhance patient care in vulnerable populations.