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Acute Kidney Injury Complications and Kidney Replacement Therapy as Mediators of Mortality in Critically Ill Patients.

BACKGROUND: Acute kidney injury (AKI) is associated with increased mortality in critically ill patients. This study aimed to evaluate the association between AKI and 28-day mortality, with a focus on measurable AKI-related complications (serum bicarbonate, blood urea nitrogen-BUN, potassium and fluid balance) as potential mediators. METHODS: We extracted data for critically ill patients admitted between 2008 and 2019 from the MIMIC-IV database whose ICU length of stay exceeded 48 hours. Causal inference methods were employed to evaluate the association between AKI and 28-day mortality through…

De-Escalating Medical Evaluation for Kidney Transplantation: A Potential Avenue to Improve Access to Kidney Transplantation.

There is broad agreement among the US public, medical community, and policy community on a top priority to expand kidney transplantation to more patients while promoting quality and equity. How to achieve these goals within existing health systems is the key question. Essential to successful kidney transplantation is a proper pretransplant medical evaluation. However, an increasing body of evidence suggests that this process can be burdensome to patients and caregivers, resource-intensive for transplant programs and the healthcare system, and potentially perpetuate inequity in transplant acces…

When to start and discontinue kidney replacement therapy in acute kidney injury patients? A narrative review.

Acute kidney injury (AKI) affects up to 50% of critically ill patients, with mortality rates exceeding 40% in severe cases. Kidney replacement therapy (KRT) is a cornerstone in the management of severe AKI, yet the optimal timing for initiation and discontinuation remains uncertain. The debate between "early" initiation-guided by kidney injury biomarkers, trends in creatinine or urine output, and positive fluid balance-and "delayed" initiation-triggered by life-threatening complications-has been shaped by recent randomized controlled trials and meta-analyses, yet still lacks clearly defined pa…

Machine learning-based prediction of a high-risk kidney function trajectory class after acute kidney injury.

OBJECTIVES: Monitoring kidney function after acute kidney injury (AKI) hospitalisation is essential for identifying patients at risk of rapid progression. This study developed a machine learning (ML) model to predict membership in a high-risk longitudinal estimated glomerular filtration rate (eGFR) trajectory associated with subsequent kidney replacement therapy (KRT) initiation. METHODS: We conducted a cohort study of 88 632 adults with ≥2 post-discharge eGFR measurements between 2010 and 2017. Joint latent class mixed models were used to identify dynamic eGFR trajectories from 665 499 measu…

A facile polysaccharide hydrogel activates PPARγ via the Gut-Kidney axis to ameliorate chronic kidney disease.

Chronic Kidney Disease (CKD) features gut microbiota dysbiosis, systemic inflammation, and impaired barrier function. The formation of such a triad of "microbiota-metabolite-barrier" dysregulation underscores the therapeutic potential of a Gut-Kidney Axis intervention strategy. Traditional Chinese medicine highlights plant-derived polysaccharides as renoprotective modulators of the Gut-Kidney Axis, yet free polysaccharides suffer from limited colonic exposure, single-function delivery, and proximal-skewed fermentation. Thus, this study engineered a Morinda officinalis polysaccharide (MOPs)/Inu…

Long-Term Exposure to Fine Particulate Matter and Kidney Function among Patients with Polycystic Kidney Disease.

KEY POINTS: Long-term exposure to fine particulate matter was associated with faster decline in kidney function among patients with polycystic kidney disease. Associations were stronger in younger patients and those with preserved kidney function at baseline. The association was weaker among patients prescribed tolvaptan. BACKGROUND: Polycystic kidney disease (PKD) is the fourth leading cause of ESKD. Although the condition is primarily genetic, environmental exposures such as air pollution may influence disease progression. METHODS: We investigated whether long-term exposure to fine particu…

Deletion of decay-accelerating factor in kidney tubular cells mitigates kidney fibrosis in aristolochic acid nephropathy.

Local complement activation is increasingly recognized as a key contributor to kidney injury and fibrosis, although protective roles have also been described. The decay-accelerating factor (DAF, CD55) is a membrane-bound complement regulator that disrupts C3 and C5 convertases and limits complement activation on the cell surface. Although renal tubular epithelial cells (RTECs) are a major source of complement components in the kidney, the role of DAF in tubular injury and repair remains unclear. Here, we investigated the function of DAF in kidney tubules using global and tubule-specific DAF kn…

Kidney pathology findings in pediatric patients with kidney injury and inflammatory bowel disease: a case series.

BACKGROUND: Patients with inflammatory bowel disease (IBD) are at risk of kidney pathologies such as IgA nephropathy (IgAN) and tubulointerstitial nephritis (TIN). Data on kidney abnormalities and treatments in pediatric IBD patients with kidney disease are limited. This study describes kidney pathology, treatments, and outcomes in pediatric IBD patients who underwent kidney biopsy at our center. METHODS: We conducted a single-center retrospective case series at a quaternary pediatric hospital in Toronto, Canada. Pediatric IBD patients who underwent kidney biopsy between June 2018 and Februar…

Повторная оценка биопсии почек в связи с диабетической болезнью почек: гистопатология, курс клинической медицины и будущее точной нефрологии.

Фон: диабетическое заболевание почек (DKD) one :: основные причины хронических заболеваний и почечной недостаточности во всем мире. Хотя большинство пациентов, страдающих диабетом, диагностируются клинически на основе албуминурии, предполагаемого снижения уровня глумерной фильтрации и диабетической ретинопатии, одни только клинические параметры не могут надежно отличать биопсию, подтвержденную диабетической нефропатией (ННН), от недиабетической болезни почек (НДКД) или смешанных повреждений. Таким образом, биопсия почек для больных диабетом по-прежнему носит избирательный, а не рутинный характ

Совпадение в аннотации оригинала
Background: Diabetic kidney disease (DKD) is one of the leading causes of chronic kidney disease and kidney failure worldwide. Although most patients with diabetes are diagnosed clinically on the basis of albuminuria, estimated glomerular filtration rate decline, and diabetic retinopathy, clinical parameters alone may not reliably distinguish biopsy-proven d…

Point-of-Care Assessment of Kidney Function in Chronic Kidney Disease: Current Technologies and Future Perspectives.

Chronic kidney disease (CKD) requires assessment of both glomerular filtration and kidney damage, particularly albuminuria, for diagnosis, risk stratification, and longitudinal care. Point-of-care testing (POCT) can shorten turnaround time and improve access when conventional laboratory testing is unavailable or would delay a clinical pathway. This narrative review summarizes established and emerging POCT approaches for kidney assessment in CKD, with emphasis on creatinine/eGFR and urine albumin-to-creatinine ratio (UACR), and distinguishes analytical validity from workflow utility and patient…

Exploring the Role of Microbiota-Mediated Gut-Kidney Axis in Acute Kidney Injury: Immunomodulation and Therapy.

BACKGROUND: Acute kidney injury (AKI) remains a major clinical problem characterized by high morbidity and an increased risk of progression to chronic kidney disease (CKD). Immune cell infiltration and activation are important features of AKI; however, the upstream mechanisms that shape this inflammatory response are not fully understood. Emerging evidence suggests that gut microbiota dysbiosis and systemic immune activation may contribute to renal injury, but the functional significance of the gut-kidney axis in AKI pathogenesis remains to be further clarified. SUMMARY: This review synthesiz…

Acute Kidney Injury-to-Chronic Kidney Disease Transition-Associated Macrophage Subtypes: Biological Functions and Intercellular Crosstalk.

As a core organ responsible for metabolism and homeostatic regulation, the kidney performs physiological functions that encompass material excretion, fluid balance, electrolyte regulation, and endocrine control; and serves as a critical hub for maintaining the coordinated functioning of multiple organ systems. Kidney injury not only leads to disturbances in these core physiological functions but also generates systemic complications such as cardiovascular disease, hypertension, and diabetes mellitus through an "injury-inflammation-metabolic disorder" cascade. Epidemiologic studies and clinical…

Persistent kidney dysfunction after leptospirosis-associated acute kidney injury: a case series from coastal Karnataka, India.

BACKGROUND: Leptospirosis has been infrequently associated with persistent kidney dysfunction fulfilling the criteria for chronic kidney disease (CKD). However, the entity remains poorly characterised. This study aimed to describe the clinical profile, laboratory findings, treatment requirements, and kidney outcomes of patients without recognised CKD risk factors who had persistent kidney dysfunction fulfilling CKD criteria at three-month follow-up after leptospirosis-associated Acute Kidney Injury (AKI). METHODS: This descriptive case series was nested within a prospective cohort of hospital…

Personalized prediction model generated with machine learning for kidney function one year after living kidney donation.

Living kidney donors typically experience approximately a 30% reduction in kidney function after donation, although the degree of reduction varies among individuals. This study aimed to develop a machine learning (ML) model to predict serum creatinine (Cre) levels at one year post-donation using preoperative clinical data, including kidney-, fat-, and muscle-volumetry values from computed tomography. A total of 204 living kidney donors were included. Symbolic regression via genetic programming was employed to create an ML-based Cre prediction model using preoperative clinical variables. Valida…

Urinary peptide signature distinguishes autosomal recessive polycystic kidney disease from other causes of chronic kidney disease.

BACKGROUND: The diagnosis of autosomal recessive polycystic kidney disease (ARPKD) can be hampered by its pronounced phenotypic variability and ARPKD-mimicking phenocopies. Here, for the first time we specifically studied the urinary peptidome of patients with ARPKD with the aim of distinguishing ARPKD from other causes of chronic kidney disease (CKD). METHODS: Fifty-eight urine samples from patients with ARPKD, 662 urine samples from paediatric patients with CKD with various other CKD aetiologies and 45 samples from healthy children were included. The urinary peptidome was analysed by capill…

Health Care Utilization in Elderly Deceased Donor Kidney Transplant Recipients: Does Kidney Donor Profile Index Matter?

KEY POINTS: Health care utilization rates in elderly kidney transplant were no different between the high kidney donor profile index and low kidney donor profile index group. Number of readmissions and surgical interventions in elderly kidney transplant was no different between the high kidney donor profile index and low kidney donor profile index group. Death censored graft loss was higher in the high kidney donor profile index group, whereas the patient survival was no different between the high kidney donor profile index and low kidney donor profile index groups. BACKGROUND: High kidney do…

Integrating estimated glomerular filtration rate and kidney replacement therapy criteria within the definition of kidney failure.

INTRODUCTION: Guidelines define kidney failure based on initiation of maintenance kidney replacement therapy (KRT) or estimated glomerular filtration rate (eGFR) below 15 ml/min per 1.73 m2 for over 90 days, but most kidney failure registries track the incidence and outcomes of people who receive KRT only. The population burden of kidney failure and outcomes of patients identified by eGFR criteria remain understudied. METHODS: Using population-based datasets from Alberta, Canada, we studied adults who initiated KRT or had incident kidney failure defined by KRT or eGFR criteria between April 2…

Real needs of end-stage kidney disease patients awaiting kidney transplantation in China: A qualitative study.

OBJECTIVE: To explore the true needs of patients awaiting kidney transplantation in China through the language used by them. We addressed the literature gap concerning this critical aspect of patient care and counselling. METHODS: We interviewed 32 individuals-22 who were on the waiting list for a kidney transplant and 10 were kidney transplant recipients. The obtained data were analysed using Colaizzi seven-step method. RESULTS: Four themes encompassing 86 coded statements were identified and crosschecked with each participant for validation.The waiting period needs of the participants fell…

Purinoreceptor P2X7 in Extracellular ATP-Mediated Inflammation through the Spectrum of Kidney Diseases and Kidney Transplantation.

Extracellular purines not only play a critical role in maintaining a balanced inflammatory response but may also trigger disproportionate inflammation in various kidney pathologies. Extracellular ATP is the most well-characterized inflammatory purine, which serves as a potent extracellular danger-associated molecular pattern. It signals through the P2 purinoreceptors during both acute and chronic kidney damage. The purinoreceptor P2X7 (P2X7R) has been extensively studied in kidney disease because of its potent ability to enhance inflammation by activating the nucleotide-binding oligomerization…