The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future car...The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future cardiovascular(CV)diseases.Chronic kidney disease,a state of chronic inflammation caused by oxidative stress,metabolic abnormalities,infection,and uremic toxins damages the endothelium.ED is also associated with a decline in estimated glomerular filtration rate.After kidney transplantation,endothelial functions undergo immediate but partial restoration,promising graft longevity and enhanced CV health.However,the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED,culminating in poor CV health and graft survival.ED in kidney transplant recipients is an underrecognized and poorly studied entity.CV diseases are the leading cause of death among kidney transplant candidates with functioning grafts.ED contributes to the pathogenesis of many of the CV diseases.Various biomarkers and vasoreactivity tests are available to study endothelial functions.With an increasing number of transplants happening every year,and improved graft rejection rates due to the availability of effective immunosuppressants,the focus has now shifted to endothelial protection for the prevention,early recognition,and treatment of CV diseases.展开更多
BACKGROUND The progression of diabetic kidney disease(DKD)affects the patient’s kidney glomeruli and tubules,whose normal functioning is essential for maintaining normal calcium(Ca)and phosphorus(P)metabolism in the ...BACKGROUND The progression of diabetic kidney disease(DKD)affects the patient’s kidney glomeruli and tubules,whose normal functioning is essential for maintaining normal calcium(Ca)and phosphorus(P)metabolism in the body.The risk of developing osteoporosis(OP)in patients with DKD increases with the aggravation of the disease,including a higher risk of fractures,which not only affects the quality of life of patients but also increases the risk of death.AIM To analyze the risk factors for the development of OP in patients with DKD and their correlation with Ca-P metabolic indices,fibroblast growth factor 23(FGF23),and Klotho.METHODS One hundred and fifty-eight patients with DKD who were admitted into the Wuhu Second People’s Hospital from September 2019 to May 2021 were selected and divided into an OP group(n=103)and a normal bone mass group(n=55)according to their X-ray bone densitometry results.Baseline data and differences in Ca-P biochemical indices,FGF23,and Klotho were compared.The correlation of Ca-P metabolic indices with FGF23 and Klotho was discussed,and the related factors affecting OP in patients with DKD were examined by multivariate logistic regression analysis.RESULTS The OP group had a higher proportion of females,an older age,and a longer diabetes mellitus duration than the normal group(all P<0.05).Patients in the OP group exhibited significantly higher levels of intact parathyroid hormone(iPTH),blood P,Ca-P product(Ca×P),fractional excretion of phosphate(FeP),and FGF23,as well as lower estimated glomerular filtration rate,blood Ca,24-hour urinary phosphate excretion(24-hour UPE),and Klotho levels(all P<0.05).In the OP group,25-(OH)-D3,blood Ca,and 24-hour UPE were negatively correlated with FGF23 and positively correlated with Klotho.In contrast,iPTH,blood Ca,Ca×P,and FeP exhibited a positive correlation with FGF23 and an inverse association with Klotho(all P<0.05).Moreover,25-(OH)-D3,iPTH,blood Ca,FePO4,FGF23,Klotho,age,and female gender were key factors that affected the lumbar and left femoral neck bone mineral density.CONCLUSION The Ca-P metabolism metabolic indexes,FGF23,and Klotho in patients with DKD are closely related to the occurrence and development of OP.展开更多
BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from mode...BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from modern approaches of proteomic analysis of liquid biopsies(serum,urine)represent a promising innovation in the monitoring of kidney transplant recipients.AIM To investigate the diagnostic utility of protein biomarkers derived from proteomics approaches in renal allograft assessment.METHODS A systematic review was conducted in accordance with PRISMA guidelines,based on research results from the PubMed and Scopus databases.The primary focus was on evaluating the role of biomarkers in the non-invasive diagnosis of transplant-related com-plications.Eligibility criteria included protein biomarkers and urine and blood samples,while exclusion criteria were language other than English and the use of low resolution and sensitivity methods.The selected research articles,were categorized based on the biological sample,condition and methodology and the significantly and reproducibly differentiated proteins were manually selected and extracted.Functional and network analysis of the selected proteins was performed.RESULTS In 17 included studies,58 proteins were studied,with the cytokine CXCL10 being the most investigated.Biological pathways related to immune response and fibrosis have shown to be enriched.Applications of biomarkers for the assessment of renal damage as well as the prediction of short-term and long-term function of the graft were reported.Overall,all studies have shown satisfactory diagnostic accuracy of proteins alone or in combination with conventional methods,as far as renal graft assessment is concerned.CONCLUSION Our review suggests that protein biomarkers,evaluated in specific biological fluids,can make a significant contribution to the timely,valid and non-invasive assessment of kidney graft.展开更多
The role of antibodies in kidney transplant(KT)has evolved significantly over the past few decades.This role of antibodies in KT is multifaceted,encompassing both the challenges they pose in terms of antibody-mediated...The role of antibodies in kidney transplant(KT)has evolved significantly over the past few decades.This role of antibodies in KT is multifaceted,encompassing both the challenges they pose in terms of antibody-mediated rejection(AMR)and the opportunities for improving transplant outcomes through better detection,prevention,and treatment strategies.As our understanding of the immunological mechanisms continues to evolve,so too will the approaches to managing and harnessing the power of antibodies in KT,ultimately leading to improved patient and graft survival.This narrative review explores the multifaceted roles of antibodies in KT,including their involvement in rejection mechanisms,advancements in desensitization protocols,AMR treatments,and their potential role in monitoring and improving graft survival.展开更多
Obstructive uropathy represents a major risk of acute kidney injury.From an epidemiological point of view,it is responsible for 5%to 10%of cases of acute renal failure and 4%of cases of end-stage kidney disease.Althou...Obstructive uropathy represents a major risk of acute kidney injury.From an epidemiological point of view,it is responsible for 5%to 10%of cases of acute renal failure and 4%of cases of end-stage kidney disease.Although obstructive uropathy is a recognized disease,there is a significant lack of detailed research on this topic from both a nephrological and urological perspective.The majority of published research focuses on the pathophysiology of the topic and neglects a comprehensive analysis of diagnostic and treatment approaches supported by current data.In this context,it is crucial to assess the overall hemodynamic status,especially in the presence of urosepsis.Once clinical stability is assured,it is important to focus on symptom management,usually by controlling pain.Ultimately,it is crucial to decide immediately whether the patient should receive a prompt urinary diversion.Urinary diversion is an essential part of the treatment of obstructive uropathy and should be initiated promptly and without unnece-ssary delay once the diagnosis has been confirmed.Functional recovery of the obstructed kidney after decompression of the urinary tract depends on the degree of obstruction,the duration of the obstruction and the presence of a concomitant urinary tract infection.The timing and proper treatment of this condition determines the recovery of kidney function after an obstruction and prevents the development of chronic kidney disease.In this editorial,we emphasized the pathophysiological role and clinical significance of obstructive uropathy in the context of acute kidney injury.展开更多
Kenya, a lower-middle-income country in East Africa, faces a rising burden of chronic kidney disease (CKD), with an estimated 12,500 individuals suffering from end-stage renal disease (ESRD). Renal transplantation—th...Kenya, a lower-middle-income country in East Africa, faces a rising burden of chronic kidney disease (CKD), with an estimated 12,500 individuals suffering from end-stage renal disease (ESRD). Renal transplantation—the preferred treatment option for ESRD, remains underutilized. Since the first transplant in 1978, seven centers have been established, with 829 transplants performed by 2022. Living-related renal transplants (LRRT) dominate, while deceased donor renal transplantation (DDRT) is yet to be implemented. Recent data show improved outcomes, with one-year graft survival rates up to 96%, but challenges such as acute rejection rates (32.8%) and limited donor outcome data persist. Barriers include high costs, limited insurance coverage, inadequate laboratory infrastructure, and a transplant workforce shortage. Efforts to establish DDRT programs are underway but are hampered by the absence of organ procurement systems and insufficient laboratory capabilities. Future priorities include reducing costs and expanded insurance coverage for transplant care. Investments in laboratory infrastructure, local tissue typing, and surgical training are essential. Strengthening international collaborations and public education campaigns can improve donor pools and transplantation access. Strategic policy reforms and resource allocation are vital to scaling up Kenya’s kidney transplant program and addressing the unmet needs of its ESRD population.展开更多
Rhabdomyolysis is a severe condition characterized by the breakdown of muscle tissue leading to the release of intracellular components into the bloodstream.This condition,when associated with acute kidney injury(AKI)...Rhabdomyolysis is a severe condition characterized by the breakdown of muscle tissue leading to the release of intracellular components into the bloodstream.This condition,when associated with acute kidney injury(AKI),can result in significant morbidity and mortality,particularly in the context of coronavirus disease 2019(COVID-19).This editorial discusses a retrospective study on patients with COVID-19 who developed rhabdomyolysis-related AKI.The study highlights that patients with rhabdomyolysis exhibited higher inflammatory markers,such as Creactive protein,ferritin,and procalcitonin,and experienced worse clinical outcomes compared to those with other causes of AKI.The findings underscore the importance of early recognition and management of rhabdomyolysis in COVID-19 patients to improve prognosis and reduce mortality rates.展开更多
In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a comp...In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a complex interplay of renal and hepatic pathophysiology,with AKI acting as an initiator through maladaptive repair mechanisms.These mechanisms—such as tubular cell cycle arrest,inflammatory cascades,and fibrotic processes—are exacerbated by the hemodynamic and neurohormonal disturbances characteristic of cirrhosis.Following AKI episodes,persistent kidney dysfunction or acute kidney disease(AKD)often serves as a bridge to CKD.AKD represents a critical phase in renal deterioration,characterized by prolonged kidney injury that does not fully meet CKD criteria but exceeds the temporal scope of AKI.The progression from AKD to CKD is further influenced by recurrent AKI episodes,impaired renal autoregu-lation,and systemic comorbidities such as diabetes and metabolic dysfunction-associated steatotic liver disease,which compound kidney damage.The clinical management of AKI and CKD in cirrhotic patients requires a multidimensional approach that includes early identification of kidney injury,the application of novel biomarkers,and precision interventions.Recent evidence underscores the inadequacy of traditional biomarkers in predicting the AKI-to-CKD progression,necessitating novel biomarkers for early detection and intervention.展开更多
BACKGROUND Equations for estimation glomerular filtration rate(eGFR)have been associated with poor clinical performance and their clinical accuracy and reliability have been called into question.AIM To assess the long...BACKGROUND Equations for estimation glomerular filtration rate(eGFR)have been associated with poor clinical performance and their clinical accuracy and reliability have been called into question.AIM To assess the longitudinal changes in measured glomerular filtration rate(mGFR)in patients with autosomal dominant polycystic kidney disease(ADPKD).METHODS Analysis of an ambispective data base conducted on consecutive patients diagnosed with ADPKD.The mGFR was assessed by iohexol clearance;while eGFR was calculated by three different formulas:(1)The chronic kidney disease epidemiology collaboration(CKD-EPI);(2)Modification of diet in renal disease(MDRD);and(3)The 24-hour urine creatinine clearance(CrCl).The primary end-points were the mean change in mGFR between the baseline and final visit,as well as the comparison of the mean change in mGFR with the change estimated by the different formulas.RESULTS Thirty-seven patients were included in the study.As compared to baseline,month-6 mGFR was significantly decrease by-4.4 mL/minute±10.3 mL/minute(P=0.0132).However,the CKD-EPI,MDRD,and CrCl formulas underestimated this change by 48.3%,89.0%,and 45.8%respectively,though none of these differences reached statistical significance(P=0.3647;P=0.0505;and P=0.736,respectively).The discrepancies between measured and estimated glomerular filtration rate values,as evaluated by CKD-EPI(r=0.29,P=0.086);MDRD(r=0.19,P=0.272);and CrCl(r=0.09,P=0.683),were not correlated with baseline mGFR values.CONCLUSION This study indicated that eGFR inaccurately reflects the decline in mGFR and cannot reliably track changes over time.This poses significant challenges for clinical decision-making,particularly in treatment strategies.展开更多
BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft ...BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft loss or graft dysfunction.Nevertheless,circumstances may arise where selecting the RK over the left kidney(LK)is unavoidable.Consequently,it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.AIM To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.METHODS We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023.We included all kidney donors who were over 18,fit to donate,and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry.The variables examined comprised donor and recipient demographics,and outcome measures included technical graft loss(TGL),delayed or slow graft function(SGF),and post-transplant serum creatinine(SC)trends.We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.RESULTS Of the 250 transplants performed during the period,56(22%)were RKs.The recipient demographics and transplant factors were comparable for the right and LKs,except that the donor warm and cold ischemia time were shorter for RKs.TGL and SGF each occurred in 2%(n=1)of RKs and 0.5%(n=1)of LKs,the difference being insignificant.These complications,however,were not related to the venous anastomosis.One RK(2%)developed delayed graft function after 48 hours,which was attributable to postoperative hypoxia rather than the surgical technique.The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.CONCLUSION The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants,provided that careful patient selection and precise surgical techniques are employed.展开更多
The occurrence of acute kidney injury(AKI)in critically ill patients is often associated with increased morbidity and mortality rates.Despite extensive research,a consensus is yet to be arrived,especially regarding th...The occurrence of acute kidney injury(AKI)in critically ill patients is often associated with increased morbidity and mortality rates.Despite extensive research,a consensus is yet to be arrived,especially regarding the optimal timing and indications for initiation of kidney replacement therapy(KRT)for critically ill patients.There is no clear guidance available on the timing of weaning from KRT.More recently,various biomarkers have produced promising prognostic pre-diction in such patients,regarding the need for KRT and its termination.Most of these biomarkers are indicative of kidney damage and stress,rather than re-covery.However,large-scale validation studies are required to guide the cutoff values of these biomarkers among different patient cohorts so as to identify the optimum timing for KRT.This article reviews the kidney biomarkers in detail and summarizes the individual roles of biomarkers in the decision-making process for initiation and termination of the KRT among critically ill AKI patients and the supportive literature.展开更多
Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 3...Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 34% mortality in under-five children with severe acute malnutrition. This study aimed to determine the impacts of severe acute malnutrition on the kidney among the admitted under-five children. Methods: In this prospective longitudinal observational study, a total of 190 children aged 6 to 59 months were enrolled from Iringa and Dodoma tertiary hospitals. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated Glomerular Filtration Rate (eGFR) and urine albumin creatinine ratio (uACR) were used to determine RD. Data analysis was done using SPSS version 26 and statistical significance was assumed for factors with p-value Results: Out of 190 children with severe acute malnutrition, 36 (19%) had renal dysfunction. Factors associated with RD in malnourished children were the history of local herbs used within one week (AOR = 5.85, 95% CI [1.41, 24.319], p = 0.0152), Acute watery diarrhea with severe dehydration (AOR = 2.15, 95% CI [1.033, 4.711], p = 0.0166), and positive urine leukocytes (AOR = 19.91, 95% CI [4.09, 96.989], p = 0.0002). At three months of follow up, out of 36 children with RD, 20 (55.56%) attained full recovery, while 4 (11.11%) developed chronic kidney disease (CKD). Children with RD had prolonged hospital stays for more than 14 days with a mean 12.25 ± 5.00 days compared to those with no RD with a mean 6.29 ± 1.68 days (p Conclusion: Renal dysfunction is common among children with severe acute malnutrition. It is associated with prolonged hospital stays and increased mortality. Further studies which can determine the burden of RD in children with severe acute malnutrition as compared to those with no severe acute malnutrition are needed.展开更多
BACKGROUND C3 glomerulopathies(C3G)are a rare cause of kidney failure resulting from complement dysregulation.Small studies demonstrate a high rate of recurrence and poor outcomes in kidney transplantation.Treatment e...BACKGROUND C3 glomerulopathies(C3G)are a rare cause of kidney failure resulting from complement dysregulation.Small studies demonstrate a high rate of recurrence and poor outcomes in kidney transplantation.Treatment efficacy in this setting with eculizumab,a terminal complement inhibitor,is largely unknown.AIM To determine the outcomes of kidney transplantation in patients with C3G and the potential impact of eculizumab.METHODS We retrospectively studied kidney transplant recipients who underwent a post-transplant biopsy confirming C3G between January 1,1993 and December 31,2023 at a single center.Only the first episode of kidney transplant was reviewed.The electronic medical records were reviewed for post-transplant allograft function,indication for biopsy,time to biopsy from transplant,time to allograft failure from transplantation,post-C3G treatment,complement laboratory testing,and concurrent malignancy/infection.Reports,and when available slides and immunofluorescence/electron microscopic images,were re-reviewed by a renal pathologist.RESULTS A total of fifteen patients were included in this study.Fourteen patients had suspected recurrent disease,with a pre-transplant native kidney report of C3G.One patient developed de novo C3G.Median post kidney transplant clinical follow up time was 91 months.Median time to recurrence was 7 months with median graft survival of 48 months post kidney transplantation.The most common index biopsy pattern of injury was endocapillary prolif-erative glomerulonephritis(often with exudative features)with or without mesangial hypercellularity(56%)followed by membranoproliferative glomerulonephritis(25%).Most patients developed membranoproliferative glomerulonephritis pattern of injury on follow up biopsies(63%).Seven patients with recurrent disease received treatment with eculizumab with a median graft survival of 73 months,with five functioning grafts by the end of the study period.Seven patients with recurrent disease did not receive therapy,and all lost their graft with a median graft survival of 22 months(P=0.003).CONCLUSION C3G following kidney transplantation is mostly a recurrent disorder with a poor prognosis in untreated patients.Untreated recurrence has a poor prognosis with median allograft survival<2 years.Early treatment with eculizumab may improve transplant outcomes in patients with recurrent C3G.展开更多
Objective:To understand the facilitators and barriers for frail kidney transplant recipients(KTRs)practicing Baduanjin,and to provide a theoretical basis for developing intervention strategies.Subjects and Methods:Sem...Objective:To understand the facilitators and barriers for frail kidney transplant recipients(KTRs)practicing Baduanjin,and to provide a theoretical basis for developing intervention strategies.Subjects and Methods:Semi-structured interviews were conducted with 10 frail KTRs who participated in a 3-month Baduanjin practice.The Colaizzi seven-step analysis method was used to analyze,summarize,and extract themes from the interview data.Results:Two themes were extracted:facilitators and barriers.Facilitators included intrinsic motivation and perceived benefits,while barriers included conflicts with practice time,worsening physical condition,lack of immediate benefits,and difficulty integrating into daily life.Conclusion:The practice of Baduanjin by frail KTRs is influenced by various factors.Healthcare professionals should develop personalized intervention plans that take into account these factors and the needs of the patients.展开更多
Chronic kidney disease(CKD),which represents a significant global health concern,is characterized by a gradual decline in kidney function,leading to complications such as electrolyte imbalance,cardiovascular disease,a...Chronic kidney disease(CKD),which represents a significant global health concern,is characterized by a gradual decline in kidney function,leading to complications such as electrolyte imbalance,cardiovascular disease,and immune dysfunction.Standard CKD management includes dietary modifications,ketoana-logues supplementation,blood pressure and blood glucose control,hydration maintenance,and treatment of the underlying causes.Emerging evidence has indicated a significant role of the gut microbiota in CKD,and that dysbiosis of the gut microbiota contributes to the progression of CKD towards end-stage renal disease.Probiotics and prebiotics have recently garnered attention owing to their potential to enhance gastrointestinal health and well-being by restoring the balance of the gut microbiota.Specific probiotic strains,including Lactobacillus and Bifidobacterium,promote beneficial bacterial growth,suppress harmful bacteria,and exert anti-inflammatory,antihypertensive,and antidiabetic effects.The combination of Streptococcus thermophilus,Lactobacillus acidophilus,Bifidobacterium longum,and Bacillus coagulans has demonstrated potential as a therapeutic formulation for CKD management in various studies,highlighting its promise in treating CKD;however,supporting evidence remains limited,making it crucial to conduct further investigations to determine the specific effects of different probiotic formulations on outcomes in patients with CKD.展开更多
In the 19^(th)century,von Frerichs F and Flint A identified a type of acute renal impairment associated with advanced liver disease,characterized by oliguria,absence of proteinuria,and normal renal histology,which was...In the 19^(th)century,von Frerichs F and Flint A identified a type of acute renal impairment associated with advanced liver disease,characterized by oliguria,absence of proteinuria,and normal renal histology,which was later termed hepatorenal syndrome(HRS).HRS primarily affects cirrhotic patients with ascites and often follows severe infections,digestive hemorrhages,or high-volume paracentesis.Pathophysiologically,HRS involves low glomerular filtration rate,hypotension,renin-angiotensin axis activation,water clearance,hyponatremia,and minimal urinary sodium excretion.These conditions mimic those seen in decreased effective circulatory volume(ECV)scenarios such as septic shock or heart failure.HRS represents a specific form of prerenal acute kidney injury(AKI)in patients with baseline renal ischemia,where the kidney attempts to correct decreased ECV by retaining sodium and water.Intense renal vasoconstriction,passive hyperemia from ascites,and acute tubular necrosis(ATN)with specific urinary sediment changes are observed.Persistent oliguria may transition HRS to ATN,although this shift is less straightforward than in other prerenal AKI contexts.Notably,liver grafts from HRS patients can recover function more rapidly than those from other ischemic conditions.Experimental studies,such as those by Duailibe et al,using omega-3 fatty acids in cirrhotic rat models,have shown promising results in reducing oxidative stress and improving kidney function.These findings suggest potential therapeutic strategies and underscore the need for further research to understand the mechanisms of HRS and explore possible treatments.Future research should address the impact of omega-3 on survival and secondary outcomes,as well as consider the balance of therapeutic risks and benefits in severe liver disease.展开更多
HLA-C,HLA-DP and HLA-DQ are thought to be benign due to low expression and few initial negative studies.Historically,most allocation programs used HLA-A,HLA-B and HLA-DR antigens for matching.With the advent and use o...HLA-C,HLA-DP and HLA-DQ are thought to be benign due to low expression and few initial negative studies.Historically,most allocation programs used HLA-A,HLA-B and HLA-DR antigens for matching.With the advent and use of single-bead antigen assays,more was learned about donor-specific antibodies(DSAs)against these antigens.Interest in these antigens and antibodies grew when cases of acute antibody-mediated rejection(AMR),mixed rejections,chronic AMR,and reduced graft survival were reported with DSAs against these antigens.Although the deleterious effects of these DSAs are more pronounced in retransplants,harmful effects have also been observed in first-time recipients.DSAs against each of these antigens can trigger rejection alone.Their combination with DSAs against HLA-A,HLA-B and HLA-DR can cause more damage.It has been shown that strategies that reduce mismatches for these antigen lead to fewer rejections and better graft survival.There is a need for greater consensus on the universal typing of these antigens prior to transplantation for better patient and graft outcomes.This review focuses on the interaction of these antigens with lymphocytes and killer immunoglobulin receptors,arguments for not typing them,detailed analyses of the literature about their harmful effects,potential strategies moving forward,and recommendations for the future.展开更多
Iron deficiency(ID)is a prevalent complication of chronic kidney disease(CKD),often managed reactively when associated with anaemia.This scoping review evaluates the evidence supporting intravenous(IV)iron therapy in ...Iron deficiency(ID)is a prevalent complication of chronic kidney disease(CKD),often managed reactively when associated with anaemia.This scoping review evaluates the evidence supporting intravenous(IV)iron therapy in non-anaemic individuals with CKD and ID,focusing on safety,efficacy,and emerging therapeutic implications.Current diagnostic markers,including serum ferritin,transferrin saturation,and reticulocyte haemoglobin content,are reviewed alongside their limitations in the context of inflammation and variability.The pathophysiology of ID in CKD is explored,highlighting the roles of hepcidin,hypoxia-inducible factor pathways,and uraemic toxins.Comparative studies reveal that IV iron offers a more rapid correction of iron stores,improved com-pliance,and fewer gastrointestinal side effects compared to oral iron.Evidence from trials such as“iron and heart”and“iron and muscle”suggests potential benefits of IV iron on functional capacity and fatigue,though findings were sta-tistically non-significant.Insights from heart failure trials support the safety and efficacy of IV iron in improving quality of life and reducing hospitalizations,with newer formulations like ferric derisomaltose demonstrating favourable safety profiles.This review underscores the need for standardized screening protocols for ID in CKD,even in the absence of anaemia,to facilitate earlier intervention.Future research should prioritise robust outcome measures,larger sample sizes,and person-specific treatment strategies to optimise dosing and administration frequency.Tailored approaches to IV iron therapy have the potential to significantly improve functional outcomes,quality of life,and long-term health in people with CKD.展开更多
Chronic kidney disease (CKD) is characterized by high morbidity, high mortality, and poor prognosis, while health literacy is the goal of health education and an important outcome of health promotion, crucial for impr...Chronic kidney disease (CKD) is characterized by high morbidity, high mortality, and poor prognosis, while health literacy is the goal of health education and an important outcome of health promotion, crucial for improving health outcomes. Therefore, this paper reviews the conceptual evolution, theoretical models, and assessment tools of health literacy, as well as the current status, influencing factors, and intervention strategies of health literacy in CKD patients. The aim is to raise awareness among healthcare professionals regarding health literacy in CKD and to provide a reference for further research on health literacy in CKD patients.展开更多
Chronic kidney disease(CKD)is one kind of illness with abnormal renal structure and function caused by many factors.Probiotics can be used to regulate intestinal microflora and enhance intestinal mucosal barrier,thus,...Chronic kidney disease(CKD)is one kind of illness with abnormal renal structure and function caused by many factors.Probiotics can be used to regulate intestinal microflora and enhance intestinal mucosal barrier,thus,intervention with probiotics may be regarded as one of the potential ways to protect against CKD.In vitro and in vivo experiments showed that Lactiplantibacillus plantarum MA2(MA2),a probiotic separated from traditional Chinese Tibetan kefir grains,could degrade the uremic toxins including creatinine,urea nitrogen and uric acid.Oral administration of MA2 or its inactive strains(IMA2)could decrease serum uremic toxins of adenine-induced CKD mice,and also elevate the relative expression of claudin-1.Meanwhile,intervention of MA2 or IMA2 decreased the contents of lipopolysaccharide,Toll-like receptor 4(TLR4)and interleukin-1β(IL-1β)in the kidney.16S rDNA sequencing results indicated that the intervention of MA2 or IMA2 regulated the gut microbiota structure by elevating the abundance of Lactobacillus,and decreasing the abundance of Proteobacteria.Thus,oral administration of MA2 or IMA2 can reduce the uremic toxins in CKD mice by regulating gut microflora and restoring the intestinal mucosal barrier.Our study provided a theoretical basis for the application of MA2 and its postbiotics in the CKD intervention and treatment.展开更多
文摘The endothelium modulates vascular homeostasis owing to a variety of vasoconstrictors and vasodilators.Endothelial dysfunction(ED),characterized by impaired vasodilation,inflammation,and thrombosis,triggers future cardiovascular(CV)diseases.Chronic kidney disease,a state of chronic inflammation caused by oxidative stress,metabolic abnormalities,infection,and uremic toxins damages the endothelium.ED is also associated with a decline in estimated glomerular filtration rate.After kidney transplantation,endothelial functions undergo immediate but partial restoration,promising graft longevity and enhanced CV health.However,the anticipated CV outcomes do not happen due to various transplant-related and unrelated risk factors for ED,culminating in poor CV health and graft survival.ED in kidney transplant recipients is an underrecognized and poorly studied entity.CV diseases are the leading cause of death among kidney transplant candidates with functioning grafts.ED contributes to the pathogenesis of many of the CV diseases.Various biomarkers and vasoreactivity tests are available to study endothelial functions.With an increasing number of transplants happening every year,and improved graft rejection rates due to the availability of effective immunosuppressants,the focus has now shifted to endothelial protection for the prevention,early recognition,and treatment of CV diseases.
文摘BACKGROUND The progression of diabetic kidney disease(DKD)affects the patient’s kidney glomeruli and tubules,whose normal functioning is essential for maintaining normal calcium(Ca)and phosphorus(P)metabolism in the body.The risk of developing osteoporosis(OP)in patients with DKD increases with the aggravation of the disease,including a higher risk of fractures,which not only affects the quality of life of patients but also increases the risk of death.AIM To analyze the risk factors for the development of OP in patients with DKD and their correlation with Ca-P metabolic indices,fibroblast growth factor 23(FGF23),and Klotho.METHODS One hundred and fifty-eight patients with DKD who were admitted into the Wuhu Second People’s Hospital from September 2019 to May 2021 were selected and divided into an OP group(n=103)and a normal bone mass group(n=55)according to their X-ray bone densitometry results.Baseline data and differences in Ca-P biochemical indices,FGF23,and Klotho were compared.The correlation of Ca-P metabolic indices with FGF23 and Klotho was discussed,and the related factors affecting OP in patients with DKD were examined by multivariate logistic regression analysis.RESULTS The OP group had a higher proportion of females,an older age,and a longer diabetes mellitus duration than the normal group(all P<0.05).Patients in the OP group exhibited significantly higher levels of intact parathyroid hormone(iPTH),blood P,Ca-P product(Ca×P),fractional excretion of phosphate(FeP),and FGF23,as well as lower estimated glomerular filtration rate,blood Ca,24-hour urinary phosphate excretion(24-hour UPE),and Klotho levels(all P<0.05).In the OP group,25-(OH)-D3,blood Ca,and 24-hour UPE were negatively correlated with FGF23 and positively correlated with Klotho.In contrast,iPTH,blood Ca,Ca×P,and FeP exhibited a positive correlation with FGF23 and an inverse association with Klotho(all P<0.05).Moreover,25-(OH)-D3,iPTH,blood Ca,FePO4,FGF23,Klotho,age,and female gender were key factors that affected the lumbar and left femoral neck bone mineral density.CONCLUSION The Ca-P metabolism metabolic indexes,FGF23,and Klotho in patients with DKD are closely related to the occurrence and development of OP.
文摘BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from modern approaches of proteomic analysis of liquid biopsies(serum,urine)represent a promising innovation in the monitoring of kidney transplant recipients.AIM To investigate the diagnostic utility of protein biomarkers derived from proteomics approaches in renal allograft assessment.METHODS A systematic review was conducted in accordance with PRISMA guidelines,based on research results from the PubMed and Scopus databases.The primary focus was on evaluating the role of biomarkers in the non-invasive diagnosis of transplant-related com-plications.Eligibility criteria included protein biomarkers and urine and blood samples,while exclusion criteria were language other than English and the use of low resolution and sensitivity methods.The selected research articles,were categorized based on the biological sample,condition and methodology and the significantly and reproducibly differentiated proteins were manually selected and extracted.Functional and network analysis of the selected proteins was performed.RESULTS In 17 included studies,58 proteins were studied,with the cytokine CXCL10 being the most investigated.Biological pathways related to immune response and fibrosis have shown to be enriched.Applications of biomarkers for the assessment of renal damage as well as the prediction of short-term and long-term function of the graft were reported.Overall,all studies have shown satisfactory diagnostic accuracy of proteins alone or in combination with conventional methods,as far as renal graft assessment is concerned.CONCLUSION Our review suggests that protein biomarkers,evaluated in specific biological fluids,can make a significant contribution to the timely,valid and non-invasive assessment of kidney graft.
文摘The role of antibodies in kidney transplant(KT)has evolved significantly over the past few decades.This role of antibodies in KT is multifaceted,encompassing both the challenges they pose in terms of antibody-mediated rejection(AMR)and the opportunities for improving transplant outcomes through better detection,prevention,and treatment strategies.As our understanding of the immunological mechanisms continues to evolve,so too will the approaches to managing and harnessing the power of antibodies in KT,ultimately leading to improved patient and graft survival.This narrative review explores the multifaceted roles of antibodies in KT,including their involvement in rejection mechanisms,advancements in desensitization protocols,AMR treatments,and their potential role in monitoring and improving graft survival.
文摘Obstructive uropathy represents a major risk of acute kidney injury.From an epidemiological point of view,it is responsible for 5%to 10%of cases of acute renal failure and 4%of cases of end-stage kidney disease.Although obstructive uropathy is a recognized disease,there is a significant lack of detailed research on this topic from both a nephrological and urological perspective.The majority of published research focuses on the pathophysiology of the topic and neglects a comprehensive analysis of diagnostic and treatment approaches supported by current data.In this context,it is crucial to assess the overall hemodynamic status,especially in the presence of urosepsis.Once clinical stability is assured,it is important to focus on symptom management,usually by controlling pain.Ultimately,it is crucial to decide immediately whether the patient should receive a prompt urinary diversion.Urinary diversion is an essential part of the treatment of obstructive uropathy and should be initiated promptly and without unnece-ssary delay once the diagnosis has been confirmed.Functional recovery of the obstructed kidney after decompression of the urinary tract depends on the degree of obstruction,the duration of the obstruction and the presence of a concomitant urinary tract infection.The timing and proper treatment of this condition determines the recovery of kidney function after an obstruction and prevents the development of chronic kidney disease.In this editorial,we emphasized the pathophysiological role and clinical significance of obstructive uropathy in the context of acute kidney injury.
文摘Kenya, a lower-middle-income country in East Africa, faces a rising burden of chronic kidney disease (CKD), with an estimated 12,500 individuals suffering from end-stage renal disease (ESRD). Renal transplantation—the preferred treatment option for ESRD, remains underutilized. Since the first transplant in 1978, seven centers have been established, with 829 transplants performed by 2022. Living-related renal transplants (LRRT) dominate, while deceased donor renal transplantation (DDRT) is yet to be implemented. Recent data show improved outcomes, with one-year graft survival rates up to 96%, but challenges such as acute rejection rates (32.8%) and limited donor outcome data persist. Barriers include high costs, limited insurance coverage, inadequate laboratory infrastructure, and a transplant workforce shortage. Efforts to establish DDRT programs are underway but are hampered by the absence of organ procurement systems and insufficient laboratory capabilities. Future priorities include reducing costs and expanded insurance coverage for transplant care. Investments in laboratory infrastructure, local tissue typing, and surgical training are essential. Strengthening international collaborations and public education campaigns can improve donor pools and transplantation access. Strategic policy reforms and resource allocation are vital to scaling up Kenya’s kidney transplant program and addressing the unmet needs of its ESRD population.
文摘Rhabdomyolysis is a severe condition characterized by the breakdown of muscle tissue leading to the release of intracellular components into the bloodstream.This condition,when associated with acute kidney injury(AKI),can result in significant morbidity and mortality,particularly in the context of coronavirus disease 2019(COVID-19).This editorial discusses a retrospective study on patients with COVID-19 who developed rhabdomyolysis-related AKI.The study highlights that patients with rhabdomyolysis exhibited higher inflammatory markers,such as Creactive protein,ferritin,and procalcitonin,and experienced worse clinical outcomes compared to those with other causes of AKI.The findings underscore the importance of early recognition and management of rhabdomyolysis in COVID-19 patients to improve prognosis and reduce mortality rates.
文摘In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a complex interplay of renal and hepatic pathophysiology,with AKI acting as an initiator through maladaptive repair mechanisms.These mechanisms—such as tubular cell cycle arrest,inflammatory cascades,and fibrotic processes—are exacerbated by the hemodynamic and neurohormonal disturbances characteristic of cirrhosis.Following AKI episodes,persistent kidney dysfunction or acute kidney disease(AKD)often serves as a bridge to CKD.AKD represents a critical phase in renal deterioration,characterized by prolonged kidney injury that does not fully meet CKD criteria but exceeds the temporal scope of AKI.The progression from AKD to CKD is further influenced by recurrent AKI episodes,impaired renal autoregu-lation,and systemic comorbidities such as diabetes and metabolic dysfunction-associated steatotic liver disease,which compound kidney damage.The clinical management of AKI and CKD in cirrhotic patients requires a multidimensional approach that includes early identification of kidney injury,the application of novel biomarkers,and precision interventions.Recent evidence underscores the inadequacy of traditional biomarkers in predicting the AKI-to-CKD progression,necessitating novel biomarkers for early detection and intervention.
文摘BACKGROUND Equations for estimation glomerular filtration rate(eGFR)have been associated with poor clinical performance and their clinical accuracy and reliability have been called into question.AIM To assess the longitudinal changes in measured glomerular filtration rate(mGFR)in patients with autosomal dominant polycystic kidney disease(ADPKD).METHODS Analysis of an ambispective data base conducted on consecutive patients diagnosed with ADPKD.The mGFR was assessed by iohexol clearance;while eGFR was calculated by three different formulas:(1)The chronic kidney disease epidemiology collaboration(CKD-EPI);(2)Modification of diet in renal disease(MDRD);and(3)The 24-hour urine creatinine clearance(CrCl).The primary end-points were the mean change in mGFR between the baseline and final visit,as well as the comparison of the mean change in mGFR with the change estimated by the different formulas.RESULTS Thirty-seven patients were included in the study.As compared to baseline,month-6 mGFR was significantly decrease by-4.4 mL/minute±10.3 mL/minute(P=0.0132).However,the CKD-EPI,MDRD,and CrCl formulas underestimated this change by 48.3%,89.0%,and 45.8%respectively,though none of these differences reached statistical significance(P=0.3647;P=0.0505;and P=0.736,respectively).The discrepancies between measured and estimated glomerular filtration rate values,as evaluated by CKD-EPI(r=0.29,P=0.086);MDRD(r=0.19,P=0.272);and CrCl(r=0.09,P=0.683),were not correlated with baseline mGFR values.CONCLUSION This study indicated that eGFR inaccurately reflects the decline in mGFR and cannot reliably track changes over time.This poses significant challenges for clinical decision-making,particularly in treatment strategies.
文摘BACKGROUND Transplant teams often hesitate to use the right kidney(RK)in living donor(LD)transplants due to the complexities of anastomosing the short,thin-walled right renal veins,which can potentially lead to graft loss or graft dysfunction.Nevertheless,circumstances may arise where selecting the RK over the left kidney(LK)is unavoidable.Consequently,it is crucial to thoroughly examine the implications of such a choice on the overall transplant outcome.AIM To compare transplant outcomes between recipients of RK and LK while examining the factors that influence these outcomes.METHODS We retrospectively analyzed data from adult patients who received LD kidney transplants involving meticulous patient selection and surgical techniques at our center from January 2020 to December 2023.We included all kidney donors who were over 18,fit to donate,and had undergone diethylenetriamine pentaacetic acid split function and/or computed tomography based volumetry.The variables examined comprised donor and recipient demographics,and outcome measures included technical graft loss(TGL),delayed or slow graft function(SGF),and post-transplant serum creatinine(SC)trends.We used a logistic regression model to assess the likelihood of adverse outcomes considering the donor kidney side.RESULTS Of the 250 transplants performed during the period,56(22%)were RKs.The recipient demographics and transplant factors were comparable for the right and LKs,except that the donor warm and cold ischemia time were shorter for RKs.TGL and SGF each occurred in 2%(n=1)of RKs and 0.5%(n=1)of LKs,the difference being insignificant.These complications,however,were not related to the venous anastomosis.One RK(2%)developed delayed graft function after 48 hours,which was attributable to postoperative hypoxia rather than the surgical technique.The post-transplant SC trend and mean SC at the last follow-up were similar across both kidney sides.CONCLUSION The donor kidney side has little impact on post-transplant adverse events and graft function in LD transplants,provided that careful patient selection and precise surgical techniques are employed.
文摘The occurrence of acute kidney injury(AKI)in critically ill patients is often associated with increased morbidity and mortality rates.Despite extensive research,a consensus is yet to be arrived,especially regarding the optimal timing and indications for initiation of kidney replacement therapy(KRT)for critically ill patients.There is no clear guidance available on the timing of weaning from KRT.More recently,various biomarkers have produced promising prognostic pre-diction in such patients,regarding the need for KRT and its termination.Most of these biomarkers are indicative of kidney damage and stress,rather than re-covery.However,large-scale validation studies are required to guide the cutoff values of these biomarkers among different patient cohorts so as to identify the optimum timing for KRT.This article reviews the kidney biomarkers in detail and summarizes the individual roles of biomarkers in the decision-making process for initiation and termination of the KRT among critically ill AKI patients and the supportive literature.
文摘Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 34% mortality in under-five children with severe acute malnutrition. This study aimed to determine the impacts of severe acute malnutrition on the kidney among the admitted under-five children. Methods: In this prospective longitudinal observational study, a total of 190 children aged 6 to 59 months were enrolled from Iringa and Dodoma tertiary hospitals. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated Glomerular Filtration Rate (eGFR) and urine albumin creatinine ratio (uACR) were used to determine RD. Data analysis was done using SPSS version 26 and statistical significance was assumed for factors with p-value Results: Out of 190 children with severe acute malnutrition, 36 (19%) had renal dysfunction. Factors associated with RD in malnourished children were the history of local herbs used within one week (AOR = 5.85, 95% CI [1.41, 24.319], p = 0.0152), Acute watery diarrhea with severe dehydration (AOR = 2.15, 95% CI [1.033, 4.711], p = 0.0166), and positive urine leukocytes (AOR = 19.91, 95% CI [4.09, 96.989], p = 0.0002). At three months of follow up, out of 36 children with RD, 20 (55.56%) attained full recovery, while 4 (11.11%) developed chronic kidney disease (CKD). Children with RD had prolonged hospital stays for more than 14 days with a mean 12.25 ± 5.00 days compared to those with no RD with a mean 6.29 ± 1.68 days (p Conclusion: Renal dysfunction is common among children with severe acute malnutrition. It is associated with prolonged hospital stays and increased mortality. Further studies which can determine the burden of RD in children with severe acute malnutrition as compared to those with no severe acute malnutrition are needed.
文摘BACKGROUND C3 glomerulopathies(C3G)are a rare cause of kidney failure resulting from complement dysregulation.Small studies demonstrate a high rate of recurrence and poor outcomes in kidney transplantation.Treatment efficacy in this setting with eculizumab,a terminal complement inhibitor,is largely unknown.AIM To determine the outcomes of kidney transplantation in patients with C3G and the potential impact of eculizumab.METHODS We retrospectively studied kidney transplant recipients who underwent a post-transplant biopsy confirming C3G between January 1,1993 and December 31,2023 at a single center.Only the first episode of kidney transplant was reviewed.The electronic medical records were reviewed for post-transplant allograft function,indication for biopsy,time to biopsy from transplant,time to allograft failure from transplantation,post-C3G treatment,complement laboratory testing,and concurrent malignancy/infection.Reports,and when available slides and immunofluorescence/electron microscopic images,were re-reviewed by a renal pathologist.RESULTS A total of fifteen patients were included in this study.Fourteen patients had suspected recurrent disease,with a pre-transplant native kidney report of C3G.One patient developed de novo C3G.Median post kidney transplant clinical follow up time was 91 months.Median time to recurrence was 7 months with median graft survival of 48 months post kidney transplantation.The most common index biopsy pattern of injury was endocapillary prolif-erative glomerulonephritis(often with exudative features)with or without mesangial hypercellularity(56%)followed by membranoproliferative glomerulonephritis(25%).Most patients developed membranoproliferative glomerulonephritis pattern of injury on follow up biopsies(63%).Seven patients with recurrent disease received treatment with eculizumab with a median graft survival of 73 months,with five functioning grafts by the end of the study period.Seven patients with recurrent disease did not receive therapy,and all lost their graft with a median graft survival of 22 months(P=0.003).CONCLUSION C3G following kidney transplantation is mostly a recurrent disorder with a poor prognosis in untreated patients.Untreated recurrence has a poor prognosis with median allograft survival<2 years.Early treatment with eculizumab may improve transplant outcomes in patients with recurrent C3G.
基金funded by the General Program of the National Natural Science Foundation of China(82072553)the Fundamental Research Funds for the Central Universities(2022-JYB-JBZR-026).
文摘Objective:To understand the facilitators and barriers for frail kidney transplant recipients(KTRs)practicing Baduanjin,and to provide a theoretical basis for developing intervention strategies.Subjects and Methods:Semi-structured interviews were conducted with 10 frail KTRs who participated in a 3-month Baduanjin practice.The Colaizzi seven-step analysis method was used to analyze,summarize,and extract themes from the interview data.Results:Two themes were extracted:facilitators and barriers.Facilitators included intrinsic motivation and perceived benefits,while barriers included conflicts with practice time,worsening physical condition,lack of immediate benefits,and difficulty integrating into daily life.Conclusion:The practice of Baduanjin by frail KTRs is influenced by various factors.Healthcare professionals should develop personalized intervention plans that take into account these factors and the needs of the patients.
文摘Chronic kidney disease(CKD),which represents a significant global health concern,is characterized by a gradual decline in kidney function,leading to complications such as electrolyte imbalance,cardiovascular disease,and immune dysfunction.Standard CKD management includes dietary modifications,ketoana-logues supplementation,blood pressure and blood glucose control,hydration maintenance,and treatment of the underlying causes.Emerging evidence has indicated a significant role of the gut microbiota in CKD,and that dysbiosis of the gut microbiota contributes to the progression of CKD towards end-stage renal disease.Probiotics and prebiotics have recently garnered attention owing to their potential to enhance gastrointestinal health and well-being by restoring the balance of the gut microbiota.Specific probiotic strains,including Lactobacillus and Bifidobacterium,promote beneficial bacterial growth,suppress harmful bacteria,and exert anti-inflammatory,antihypertensive,and antidiabetic effects.The combination of Streptococcus thermophilus,Lactobacillus acidophilus,Bifidobacterium longum,and Bacillus coagulans has demonstrated potential as a therapeutic formulation for CKD management in various studies,highlighting its promise in treating CKD;however,supporting evidence remains limited,making it crucial to conduct further investigations to determine the specific effects of different probiotic formulations on outcomes in patients with CKD.
文摘In the 19^(th)century,von Frerichs F and Flint A identified a type of acute renal impairment associated with advanced liver disease,characterized by oliguria,absence of proteinuria,and normal renal histology,which was later termed hepatorenal syndrome(HRS).HRS primarily affects cirrhotic patients with ascites and often follows severe infections,digestive hemorrhages,or high-volume paracentesis.Pathophysiologically,HRS involves low glomerular filtration rate,hypotension,renin-angiotensin axis activation,water clearance,hyponatremia,and minimal urinary sodium excretion.These conditions mimic those seen in decreased effective circulatory volume(ECV)scenarios such as septic shock or heart failure.HRS represents a specific form of prerenal acute kidney injury(AKI)in patients with baseline renal ischemia,where the kidney attempts to correct decreased ECV by retaining sodium and water.Intense renal vasoconstriction,passive hyperemia from ascites,and acute tubular necrosis(ATN)with specific urinary sediment changes are observed.Persistent oliguria may transition HRS to ATN,although this shift is less straightforward than in other prerenal AKI contexts.Notably,liver grafts from HRS patients can recover function more rapidly than those from other ischemic conditions.Experimental studies,such as those by Duailibe et al,using omega-3 fatty acids in cirrhotic rat models,have shown promising results in reducing oxidative stress and improving kidney function.These findings suggest potential therapeutic strategies and underscore the need for further research to understand the mechanisms of HRS and explore possible treatments.Future research should address the impact of omega-3 on survival and secondary outcomes,as well as consider the balance of therapeutic risks and benefits in severe liver disease.
文摘HLA-C,HLA-DP and HLA-DQ are thought to be benign due to low expression and few initial negative studies.Historically,most allocation programs used HLA-A,HLA-B and HLA-DR antigens for matching.With the advent and use of single-bead antigen assays,more was learned about donor-specific antibodies(DSAs)against these antigens.Interest in these antigens and antibodies grew when cases of acute antibody-mediated rejection(AMR),mixed rejections,chronic AMR,and reduced graft survival were reported with DSAs against these antigens.Although the deleterious effects of these DSAs are more pronounced in retransplants,harmful effects have also been observed in first-time recipients.DSAs against each of these antigens can trigger rejection alone.Their combination with DSAs against HLA-A,HLA-B and HLA-DR can cause more damage.It has been shown that strategies that reduce mismatches for these antigen lead to fewer rejections and better graft survival.There is a need for greater consensus on the universal typing of these antigens prior to transplantation for better patient and graft outcomes.This review focuses on the interaction of these antigens with lymphocytes and killer immunoglobulin receptors,arguments for not typing them,detailed analyses of the literature about their harmful effects,potential strategies moving forward,and recommendations for the future.
文摘Iron deficiency(ID)is a prevalent complication of chronic kidney disease(CKD),often managed reactively when associated with anaemia.This scoping review evaluates the evidence supporting intravenous(IV)iron therapy in non-anaemic individuals with CKD and ID,focusing on safety,efficacy,and emerging therapeutic implications.Current diagnostic markers,including serum ferritin,transferrin saturation,and reticulocyte haemoglobin content,are reviewed alongside their limitations in the context of inflammation and variability.The pathophysiology of ID in CKD is explored,highlighting the roles of hepcidin,hypoxia-inducible factor pathways,and uraemic toxins.Comparative studies reveal that IV iron offers a more rapid correction of iron stores,improved com-pliance,and fewer gastrointestinal side effects compared to oral iron.Evidence from trials such as“iron and heart”and“iron and muscle”suggests potential benefits of IV iron on functional capacity and fatigue,though findings were sta-tistically non-significant.Insights from heart failure trials support the safety and efficacy of IV iron in improving quality of life and reducing hospitalizations,with newer formulations like ferric derisomaltose demonstrating favourable safety profiles.This review underscores the need for standardized screening protocols for ID in CKD,even in the absence of anaemia,to facilitate earlier intervention.Future research should prioritise robust outcome measures,larger sample sizes,and person-specific treatment strategies to optimise dosing and administration frequency.Tailored approaches to IV iron therapy have the potential to significantly improve functional outcomes,quality of life,and long-term health in people with CKD.
文摘Chronic kidney disease (CKD) is characterized by high morbidity, high mortality, and poor prognosis, while health literacy is the goal of health education and an important outcome of health promotion, crucial for improving health outcomes. Therefore, this paper reviews the conceptual evolution, theoretical models, and assessment tools of health literacy, as well as the current status, influencing factors, and intervention strategies of health literacy in CKD patients. The aim is to raise awareness among healthcare professionals regarding health literacy in CKD and to provide a reference for further research on health literacy in CKD patients.
基金financially supported by the National Natural Science Foundation of China(31801514)China Postdoctoral Science Foundation(2020M680895)。
文摘Chronic kidney disease(CKD)is one kind of illness with abnormal renal structure and function caused by many factors.Probiotics can be used to regulate intestinal microflora and enhance intestinal mucosal barrier,thus,intervention with probiotics may be regarded as one of the potential ways to protect against CKD.In vitro and in vivo experiments showed that Lactiplantibacillus plantarum MA2(MA2),a probiotic separated from traditional Chinese Tibetan kefir grains,could degrade the uremic toxins including creatinine,urea nitrogen and uric acid.Oral administration of MA2 or its inactive strains(IMA2)could decrease serum uremic toxins of adenine-induced CKD mice,and also elevate the relative expression of claudin-1.Meanwhile,intervention of MA2 or IMA2 decreased the contents of lipopolysaccharide,Toll-like receptor 4(TLR4)and interleukin-1β(IL-1β)in the kidney.16S rDNA sequencing results indicated that the intervention of MA2 or IMA2 regulated the gut microbiota structure by elevating the abundance of Lactobacillus,and decreasing the abundance of Proteobacteria.Thus,oral administration of MA2 or IMA2 can reduce the uremic toxins in CKD mice by regulating gut microflora and restoring the intestinal mucosal barrier.Our study provided a theoretical basis for the application of MA2 and its postbiotics in the CKD intervention and treatment.
