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Advances in the Diagnosis and Management of Kidney Diseases

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 27575

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Special Issue Editor

Dr. Daeeun Choi

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Guest Editor

Department of Nephrology, School of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
Interests: hemodialysis; clinical nephrology; dialysis; chronic renal failure; kidney transplantation; acute kidney injury; hypertension; nephrotoxicity; chronic kidney failure; kidney

Special Issue Information

Dear Colleagues,

Kidney disease appears in various forms: it can be asymptomatic or present with severe symptoms that require immediate intensive care with renal replacement therapy. Various kidney diseases can be evaluated through urinalysis, blood chemistry, chest PA, KUB, and renal sonography. Recently, research on various types of biomarkers for the early detection of acute and chronic kidney damage has been actively conducted, and the discovery of new biomarkers through blood and pathology in the field of glomerular kidney disease has led to new diagnosis and management paradigms. Recently, rapidly developing medical diagnostic technology and the challenge of disease mechanism-based specialized targeted therapy have been presented through animal and clinical studies in the area of kidney disease.

This Special Issue seeks research related to new discoveries in the diagnosis and management of kidney disease. We look forward to receiving original articles, reviews, and short communications highlighting research results on biomarkers in various fields, enhanced imaging technology, new pathologic diagnosis, new approaches to disease mechanisms, specialized targeted therapy, and the diagnosis and management of kidney diseases using artificial intelligence.

Dr. Daeeun Choi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (13 papers)

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Research

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13 pages, 3191 KiB

Open AccessArticle

Risk Prediction Model for Chronic Kidney Disease in Thailand Using Artificial Intelligence and SHAP

by Ming-Che Tsai, Bannakij Lojanapiwat, Chi-Chang Chang, Kajohnsak Noppakun, Piyapong Khumrin, Ssu-Hui Li, Chih-Ying Lee, Hsi-Chieh Lee and Krit Khwanngern

Diagnostics 2023, 13(23), 3548; https://doi.org/10.3390/diagnostics13233548 - 28 Nov 2023

Cited by 1 | Viewed by 1002

Abstract

Chronic kidney disease (CKD) is a multifactorial, complex condition that requires proper management to slow its progression. In Thailand, 11.6 million people (17.5%) have CKD, with 5.7 million (8.6%) in the advanced stages and >100,000 requiring hemodialysis (2020 report). This study aimed to develop a risk prediction model for CKD in Thailand. Data from 17,100 patients were collected to screen for 14 independent variables selected as risk factors, using the IBK, Random Tree, Decision Table, J48, and Random Forest models to train the predictive models. In addition, we address the unbalanced category issue using the synthetic minority oversampling technique (SMOTE). The indicators of performance include classification accuracy, sensitivity, specificity, and precision. This study achieved an accuracy rate of 92.1% with the top-performing Random Forest model. Moreover, our empirical findings substantiate previous research through highlighting the significance of serum albumin, blood urea nitrogen, age, direct bilirubin, and glucose. Furthermore, this study used the SHapley Additive exPlanations approach to analyze the attributes of the top six critical factors and then extended the comparison to include dual-attribute factors. Finally, our proposed machine learning technique can be used to evaluate the effectiveness of these risk factors and assist in the development of future personalized treatment. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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11 pages, 1122 KiB

Open AccessArticle

Albuminuria Is Affected by Urinary Tract Infection: A Comparison between Biochemical Quantitative Method and Automatic Urine Chemistry Analyzer UC-3500

by Yi-Ju Chou, Chun-Chun Yang, Shang-Jen Chang and Stephen Shei-Dei Yang

Diagnostics 2023, 13(21), 3366; https://doi.org/10.3390/diagnostics13213366 - 02 Nov 2023

Viewed by 1213

Abstract

The automated urine reagent strip test is a cost-effective tool for detecting albuminuria in patients. However, prior research has not investigated how urinary tract infections (UTIs) affect the test’s accuracy. Therefore, this study aims to assess the impact of UTIs on albuminuria diagnosis using both the biochemical quantitative method and the test strip method of the Fully Automatic Urine Chemistry Analyzer, UC-3500 (Sysmex, Kobe, Japan). From March to December 2019, we prospectively collected midstream urine from adult female UTI patients before and after one week of cephalexin treatment. The urine samples were subjected to culture, routine urinalysis, and albuminuria diagnosis using the biochemical quantitative method and UC-3500. Albuminuria was defined as a urine albumin to creatinine ratio (UACR) ≥ 30 mg/g in the biochemical quantitative method. The results were compared between the two methods. Among fifty-four female patients (average age: 50.5 ± 4.4 years) with UTIs, 24 (44.44%) had transient albuminuria. The quantitative UACR significantly decreased after one week of antibiotic treatment (median: 53 mg/g to 9 mg/g; median difference: −0.54, p < 0.0001). UC-3500 exhibited a higher false positive rate for diagnosing albuminuria during UTIs (42%) compared to after treatment (19%). Its agreement with the biochemical quantitative method was moderate during UTI (κ = 0.49, 95% confidence interval [CI]: 0.24–0.73) and good after treatment (κ = 0.65, 95% CI: 0.45–0.86). UC-3500’s accuracy in diagnosing albuminuria is influenced by UTIs, leading to either transient albuminuria or a false positive reaction of the test strip. UTI should be excluded or treated before its application in albuminuria screening. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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14 pages, 1800 KiB

Open AccessArticle

Diagnostic and Prognostic Roles of C-Reactive Protein, Procalcitonin, and Presepsin in Acute Kidney Injury Patients Initiating Continuous Renal Replacement Therapy

by Suyeon Han, Moo-Jun Kim, Ho-Joon Ko, Eu-Jin Lee, Hae-Ri Kim, Jae-Wan Jeon, Young-Rok Ham, Ki-Ryang Na, Kang-Wook Lee, Song-I. Lee, Dae-Eun Choi and Heyrim Park

Diagnostics 2023, 13(4), 777; https://doi.org/10.3390/diagnostics13040777 - 18 Feb 2023

Cited by 2 | Viewed by 1800

Abstract

For reducing the high mortality rate of severe acute kidney injury (AKI) patients initiating continuous renal replacement therapy (CRRT), diagnosing sepsis and predicting prognosis are essential. However, with reduced renal function, biomarkers for diagnosing sepsis and predicting prognosis are unclear. This study aimed to assess whether C-reactive protein (CRP), procalcitonin, and presepsin could be used to diagnose sepsis and predict mortality in patients with impaired renal function initiating CRRT. This was a single-center, retrospective study involving 127 patients who initiated CRRT. Patients were divided into sepsis and non-sepsis groups according to the SEPSIS-3 criteria. Of the 127 patients, 90 were in the sepsis group and 37 were in the non-sepsis group. Cox regression analysis was performed to determine the association between the biomarkers (CRP, procalcitonin, and presepsin) and survival. CRP and procalcitonin were superior to presepsin for diagnosing sepsis. Presepsin was closely related to the estimated glomerular filtration rate (eGFR) (r = −0.251, p = 0.004). These biomarkers were also evaluated as prognostic markers. Procalcitonin levels ≥3 ng/mL and CRP levels ≥31 mg/L were associated with higher all-cause mortality using Kaplan–Meier curve analysis. (log-rank test p = 0.017 and p = 0.014, respectively). In addition, procalcitonin levels ≥3 ng/mL and CRP levels ≥31 mg/L were associated with higher mortality in univariate Cox proportional hazards model analysis. In conclusion, a higher lactic acid, sequential organ failure assessment score, eGFR, and a lower albumin level have prognostic value to predict mortality in patients with sepsis initiating CRRT. Moreover, among these biomarkers, procalcitonin and CRP are significant factors for predicting the survival of AKI patients with sepsis-initiating CRRT. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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12 pages, 1519 KiB

Open AccessArticle

Ultrasound Renal Score to Predict the Renal Disease Prognosis in Patients with Diabetic Kidney Disease: An Investigative Study

by Young Rok Ham, Eu Jin Lee, Hae Ri Kim, Jae Wan Jeon, Ki Ryang Na, Kang Wook Lee and Dae Eun Choi

Diagnostics 2023, 13(3), 515; https://doi.org/10.3390/diagnostics13030515 - 31 Jan 2023

Cited by 2 | Viewed by 6507

Abstract

Renal disease associated with type 2 diabetes mellitus (T2DM) has become the leading cause of chronic kidney disease (CKD). Renal ultrasonography is an imaging examination required in the work-up of renal disease. This study aimed to identify the differences in renal ultrasonographic findings between patients with and without DM, and to evaluate the relationship between renal ultrasound findings and renal prognosis in patients with DM. A total of 252 patients who underwent renal ultrasonography at Chungnam National University Hospital were included. Kidney disease progression was defined as a ≥10% decline in the annual estimated glomerular filtration rate (eGFR), which, in this paper, is referred to as ΔeGFR/year, or the initiation of renal replacement therapy after follow-up. The renal scoring system was evaluated by summing up the following items: the value of renal parenchymal echogenicity (0: normal; 1: mildly increased; and 2: increased) and the shape of the cortical margin (0: normal and 1: irregular; right kidney length/height (RH—0 or 1), mean cortical thickness/renal length/height (CKH—0 or 1), and cortical thickness/parenchymal thickness (CK/PK—0 or 1) based on the median: 0—above median, and 1—below median). Patients with DM had thicker renal PKH than those without, despite having lower eGFRs (0.91 ± 0.15, 0.86 ± 0.14, p = 0.006). In the progression group, the renal scores were significantly higher than those from the non-progression group. In the multivariate logistic regression analysis, the higher renal scores, presence of DM, and younger age were independently predicted for renal disease progression after adjusting for confounding variables, such as the presence of hypertension, serum hemoglobin and albumin levels, and UPCR. In conclusion, patients with high renal scores were significantly associated with renal disease progression. Our results suggest that renal ultrasonography at the time of diagnosis provides useful prognostic information in patients with kidney disease. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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14 pages, 8546 KiB

Open AccessArticle

Are Renal Cell Carcinoma with Fibromyomatous Stroma (RCC-FMS) and Thyroid-like Follicular Carcinoma of the Kidney (TLFCK) Really Independent Variants?

by Stefano Stanca, Laura Boldrini, Paola Anna Erba and Pinuccia Faviana

Diagnostics 2023, 13(1), 86; https://doi.org/10.3390/diagnostics13010086 - 28 Dec 2022

Viewed by 1645

Abstract

Background: Renal cell carcinoma with fibromyomatous stroma (RCC-FMS) is a recent provisional entity already recognised in the 2016 WHO Classification of Cancer of the Urinary Tract and Male Genital Organs 4th Edition as renal cell carcinoma with (angio)leiomyomatous stroma, histologically defined as a tumour characterised by clear cells intertwined in a conspicuous vascular stroma. In the casuistry taken into consideration, another proposed variant, thyroid-like follicular carcinoma of the kidney (TLFCK), endowed with a morphology mimicking thyroid parenchyma, was examined. The aim of this work was to parse the theoretical system, experimental data and diagnostic impact of these new entities proposed in the field of renal neoplasms. Materials and Methods: An analysis of 120 cases of kidney tumours from the Department of Surgical, Medical, Molecular and Critical Area at the University of Pisa was run. Subsequently, all samples were reassessed by two pathologists with expertise in uropathology, whose revaluation provided a histomorphological study combined with subsequent and coherent immunohistochemical analyses of CK7, CD10, CAIX, CK34betaE12, CD117, vimentin, TTF-1 and thyroglobulin. These analyses were performed using the Ventana Benchmark Automated Staining System (Ventana Medical Systems, Tucson, AZ, USA) and Ventana reagents. Results: On the one hand, the data, thus brought to light, did not show an immunohistochemical profile consistent with that proposed for RCC-FMS. However, it should be emphasised that the morphological background also unearthed a poor specificity for RCC-FMS. This was specifically due to a stromal component which was, in any case, evident, although characterised by a wide range of presentation, in clear cell renal cell carcinoma (ccRCC). This latter is, indeed, the reference background for this theorised variant. On the other hand, a thyroid-like pattern was highlighted in 11 cases, more specifically in 10 ccRCCs and in one oncocytoma, presenting itself as a type of neoplastic appearance rather than as the peculiar morphological pattern of a standalone cancer. Conclusions: In the light of these results, RCC-FMS and TLFCK appear to be more appropriately variants of already categorised neoplastic entities rather than new independent neoplasias. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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16 pages, 518 KiB

Open AccessArticle

Prevalence and Predictors of Renal Disease in a National Representative Sample of the Romanian Adult Population: Data from the SEPHAR IV Survey

by Călin Pop, Oana Florentina Gheorghe Fronea, Ioana Antonia Branea, Lucian Mihai Itu, Roxana Darabont, Irinel Parepa, Theodora Benedek and Maria Dorobantu

Diagnostics 2022, 12(12), 3199; https://doi.org/10.3390/diagnostics12123199 - 16 Dec 2022

Cited by 5 | Viewed by 1525

Abstract

Background: The prevalence of chronic kidney disease (CKD) correlates with the prevalence of hypertension (HT). We studied the prevalence and predictors of CKD in a representative sample of the Romanian adult population. Methods: A sample of 1470 subjects were enrolled in the SEPHAR IV (Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk) survey. All subjects were evaluated for blood pressure (BP) and extensive evaluations of target organ damage, blood, and urine samples were undertaken. Results: A total of 883 subjects were included in the statistical analysis. Those experiencing CKD with an eGFR < 60 mL/min/1.73 m² were older at 71.94 ± 7.4 years (n = 19, 2.15%) compared with those without renal impairment at 50.3 ± 16.21 years (n = 864, 97.85%), p < 0.0001. The prevalence of CKD among hypertensives (379 from 883) was 4.49% (17/379), while 17 out of 19 subjects with CKD had HT (89.47%). After adjusting for age, sex, and diabetic status, only serum uric acid (SUR) > 6.9 mg/dL (OR: 6.61; 95% CI: 2.063, 10.83; p = 0.004) was an independent risk factor and a predictor of CKD. Conclusions: The prevalence of CKD in hypertensive Romanian adults was more than ten times higher than in the normotensive population. Levels of SUR > 6.9 mg/dL were predictors of CKD. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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13 pages, 2981 KiB

Open AccessArticle

Thrombosis in Chronic Kidney Disease in Children

by Tudor Ilie Lazaruc, Lavinia Bodescu Amancei Ionescu, Vasile Valeriu Lupu, Carmen Muntean (Duicu), Roxana Alexandra Bogos, Anca Ivanov, Georgiana Scurtu, Iuliana Magdalena Starcea, Ingrith Crenguta Miron and Maria Adriana Mocanu

Diagnostics 2022, 12(12), 2931; https://doi.org/10.3390/diagnostics12122931 - 24 Nov 2022

Cited by 3 | Viewed by 1876

Abstract

Venous thromboembolism (VTE) in children is a rare condition. An increased incidence has been observed in the last few years due to several factors, such as increased survival in chronic conditions, especially chronic kidney disease (CKD), use of catheters, and increased sensitivity of diagnostic tools. VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE in children is associated with a two to six times higher mortality risk and a 5–10% prevalence of post-thrombotic syndrome. Overall, 5% of VTE episodes in children are associated with chronic kidney disease. The etiology of VTE in chronic kidney disease covers a wide range of pathologies. Various types of thrombotic complications may occur during long-term use of a chronic dialysis catheter. VTE occurs in 3% of children with nephrotic syndrome (NS). The risks for VTE and arterial thromboembolism (ATE) were particularly high in the first 6 months after the onset of NS. Other causes of VTE are graft rejection due to thrombosis of vascular anastomoses after kidney transplantation (3%) and autoimmune diseases (lupus nephritis, antiphospholipid syndrome). In this state-of-the-art overview, we have reviewed the physiologic and pathologic mechanisms underlying pediatric thrombosis and updated current diagnostic and treatment options, emphasizing personal experience as well. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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15 pages, 4552 KiB

Open AccessArticle

Assessment of Urinary Exosomal NHE3 as a Biomarker of Acute Kidney Injury

by Yanting Yu, Zhiyun Ren, Anni Xie, Yutao Jia, Ying Xue, Ping Wang, Daxi Ji and Xiaoyan Wang

Diagnostics 2022, 12(11), 2634; https://doi.org/10.3390/diagnostics12112634 - 30 Oct 2022

Cited by 4 | Viewed by 1378

Abstract

The diagnosis of acute kidney injury (AKI) traditionally depends on the serum creatinine (Scr) and urine output, which lack sufficient sensitivity and specificity. Using urinary exosomes as a biomarker has unique advantages. To assess whether urinary exosomal Na⁺/H⁺ exchanger isoform 3 (NHE3) protein could serve as a biomarker of AKI, we constructed four AKI rat models: cisplatin (7.5 mg/kg) injected intraperitoneally (IP), furosemide (20 mg/kg, IP) with a low-NaCl (0.03%) diet, a low-NaCl (0.03%) diet with candesartan (1 mg/kg, IP) and bilateral ischemia and reperfusion (I/R) injury for 40 min. Additionally, we assessed six sepsis-associated AKI patients and six healthy volunteers. Urinary exosomes were extracted by ultracentrifugation, and the NHE3 protein abundance was tested by immunoblotting for all the AKI rats and human subjects. The isolated cup-shaped particles with an average diameter of 70 nm and enrichment in CD63 were identified as exosomes. NHE3 abundance was six times higher in exosomes than in the whole urine. In cisplatin-induced AKI rats, urinary exosomal NHE3 was increased on day 2, one day earlier than the increases in Scr and blood urea nitrogen (BUN). In additional rats, urinary exosomal NHE3 decreased along with the decline in Scr after EPO pretreatment. In volume-depletion AKI induced by furosemide injection with a low-NaCl diet, the urinary exosomal NHE3 expression was higher than that in the control. Under a low-NaCl diet with candesartan-related AKI, the urinary exosomal NHE3 was elevated on day 5, earlier than Scr. In I/R-injury AKI, the urinary exosomal NHE3 was also raised compared with that in the control. In humans, the urinary exosomal NHE3 level was also elevated in sepsis-associated AKI patients in comparison with that in the healthy volunteers. The urinary exosomal NHE3 was increased in multiple AKI; it may be used as a diagnostic biomarker of AKI. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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16 pages, 2569 KiB

Open AccessArticle

Metabolomic Signature of Diabetic Kidney Disease in Cerebrospinal Fluid and Plasma of Patients with Type 2 Diabetes Using Liquid Chromatography-Mass Spectrometry

by Huan-Tang Lin, Mei-Ling Cheng, Chi-Jen Lo, Gigin Lin and Fu-Chao Liu

Diagnostics 2022, 12(11), 2626; https://doi.org/10.3390/diagnostics12112626 - 29 Oct 2022

Cited by 4 | Viewed by 1808

Abstract

Diabetic kidney disease (DKD) is the major cause of end stage renal disease in patients with type 2 diabetes mellitus (T2DM). The subtle metabolic changes in plasma and cerebrospinal fluid (CSF) might precede the development of DKD by years. In this longitudinal study, CSF and plasma samples were collected from 28 patients with T2DM and 25 controls, during spinal anesthesia for elective surgery in 2017. These samples were analyzed using liquid chromatography-mass spectrometry (LC-MS) in 2017, and the results were correlated with current DKD in 2017, and the development of new-onset DKD, in 2021. Comparing patients with T2DM having new-onset DKD with those without DKD, revealed significantly increased CSF tryptophan and plasma uric acid levels, whereas phosphatidylcholine 36:4 was lower. The altered metabolites in the current DKD cases were uric acid and paraxanthine in the CSF and uric acid, L-acetylcarnitine, bilirubin, and phosphatidylethanolamine 38:4 in the plasma. These metabolic alterations suggest the defective mitochondrial fatty acid oxidation and purine and phospholipid metabolism in patients with DKD. A correlation analysis found CSF uric acid had an independent positive association with the urine albumin-to-creatinine ratio. In conclusion, these identified CSF and plasma biomarkers of DKD in diabetic patients, might be valuable for monitoring the DKD progression. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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Review

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13 pages, 700 KiB

Open AccessReview

All That Glitters in cfDNA Analysis Is Not Gold or Its Utility Is Completely Established Due to Graft Damage: A Critical Review in the Field of Transplantation

by Victor Jiménez-Coll, Jaouad El kaaoui El band, Santiago Llorente, Rosana González-López, Marina Fernández-González, Helios Martínez-Banaclocha, José Antonio Galián, Carmen Botella, María Rosa Moya-Quiles, Alfredo Minguela, Isabel Legaz and Manuel Muro

Diagnostics 2023, 13(12), 1982; https://doi.org/10.3390/diagnostics13121982 - 06 Jun 2023

Cited by 1 | Viewed by 1138

Abstract

In kidney transplantation, a biopsy is currently the gold standard for monitoring the transplanted organ. However, this is far from an ideal screening method given its invasive nature and the discomfort it can cause the patient. Large-scale studies in renal transplantation show that approximately 1% of biopsies generate major complications, with a risk of macroscopic hematuria greater than 3.5%. It would not be until 2011 that a method to detect donor-derived cell-free DNA (dd-cfDNA) employing digital PCR was devised based on analyzing the differences in SNPs between the donor and recipient. In addition, since the initial validation studies were carried out at the specific moments in which rejection was suspected, there is still not a good understanding of how dd-cfDNA levels naturally evolve post-transplant. In addition, various factors, both in the recipient and the donor, can influence dd-cfDNA levels and cause increases in the levels of dd-cfDNA themselves without suspicion of rejection. All that glitters in this technology is not gold; therefore, in this article, we discuss the current state of clinical studies, the benefits, and disadvantages. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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19 pages, 927 KiB

Open AccessReview

Current Insights into the Significance of the Renal Resistive Index in Kidney and Cardiovascular Disease

by Roxana Darabont, Diana Mihalcea and Dragos Vinereanu

Diagnostics 2023, 13(10), 1687; https://doi.org/10.3390/diagnostics13101687 - 10 May 2023

Cited by 4 | Viewed by 3282

Abstract

Initially, the renal resistive index (RRI) was investigated with the aim of improving diagnosis in kidney diseases, but this goal was not met. Recently, many papers have highlighted the prognostic significance of the RRI in chronic kidney disease: specifically, in estimating the revascularization success of renal artery stenoses or the evolution of the graft and the recipients in renal transplantation. Moreover, the RRI has become significant in the prediction of acute kidney injury in critically ill patients. Studies in renal pathology have revealed correlations of this index with parameters of systemic circulation. The theoretical and experimental premises of this connection were then reconsidered, and studies analyzing the link between RRI and arterial stiffness, central and peripheral pressure, and left ventricular flow were conducted with this purpose. Many data currently indicate that RRI is influenced more by pulse pressure and vascular compliance than by renal vascular resistance—assuming that RRI reflects the complex interplay between systemic circulation and renal microcirculation and should be considered a marker of systemic cardiovascular risk beyond its prognostic relevance for kidney disease. In this review, we overview the clinical research that reveals the implications of RRI in renal and cardiovascular disease. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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15 pages, 1862 KiB

Open AccessReview

Pitfalls of Thrombotic Microangiopathies in Children: Two Case Reports and Literature Review

by Adriana Mocanu, Roxana Alexandra Bogos, Tudor Ilie Lazaruc, Anca Lavinia Cianga, Vasile Valeriu Lupu, Ileana Ioniuc, Mirabela Alecsa, Ancuta Lupu, Anca Viorica Ivanov, Ingrith Crenguta Miron and Iuliana Magdalena Starcea

Diagnostics 2023, 13(7), 1228; https://doi.org/10.3390/diagnostics13071228 - 24 Mar 2023

Cited by 3 | Viewed by 1659

Abstract

Thrombotic microangiopathy can present itself in the form of several clinical entities, representing a real challenge for diagnosis and treatment in pediatric practice. Our article aims to explore the evolution of two rare cases of pediatric thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS) with extremely similar clinical pictures, which, coincidentally, presented at approximately the same time in our hospital. These cases and our literature review demonstrate the multiple facets of thrombotic microangiopathy, which can produce various determinations and salient manifestations even among the pediatric population. TTP and aHUS may represent genuine diagnostic pitfalls through the overlap of their clinical and biological findings, although they develop through fundamentally different mechanisms that require different therapeutic approaches. As a novelty, we underline that COVID-19 infection cannot be excluded as potential trigger for TTP and aHUS in our patients and we predict that other reports of such an association will follow, raising a complex question of COVID-19’s implication in the occurrence and evolution of thrombotic microangiopathies. On this matter, we conducted literature research that resulted in 15 cases of COVID-19 pediatric infections associated with either TTP or aHUS. Taking into consideration the morbidity associated with TTP and aHUS, an elaborate differential diagnosis and prompt intervention are of the essence. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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Other

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7 pages, 1016 KiB

Open AccessCase Report

Immune Complex Glomerulonephritis in a Patient with Myelodysplastic Syndrome with Ring Sideroblasts Treated with Luspatercept

by Sigurd Delanghe, Tri Q. Nguyen, Dominiek Mazure, Amélie Dendooven and Marijn M. Speeckaert

Diagnostics 2023, 13(1), 11; https://doi.org/10.3390/diagnostics13010011 - 21 Dec 2022

Cited by 1 | Viewed by 1610

Abstract

Myelodysplastic syndromes (MDS) are a group of clonal myeloid disorders distinguished by dysplastic bone marrow and peripheral blood cells, ineffective hematopoiesis, and an increased risk of developing acute myeloid leukemia (AML). MDS with ring sideroblasts (MDS-RS) is a favorable outcome subtype with a lower frequency of AML transformation. The FDA recently approved luspatercept for the treatment of patients with very-low-, low-, and intermediate-risk MDS-RS who have failed to correct anemia with an erythropoiesis-stimulating agent (ESA) and require two units of red blood cells over an eight-week period. This drug’s pharmacology is based on the critical role of the transforming growth factor-beta (TGF-β) pathway in regulating erythropoiesis. In this case report, we describe for the first time an acute kidney injury caused by membranoproliferative glomerulonephritis (MPGN) in a patient with MDS-RS who was treated with luspatercept. We propose that a multi-hit hypothesis could explain the immunopathogenesis. A first unknown hit may stimulate IgA immune complex production, whereas luspatercept administration acts as a second hit, causing Smad1-5-8 phosphorylation. This intriguing case report on immune-complex-mediated proliferative glomerulonephritis following luspatercept treatment generates hypotheses and stimulates further research in this area. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Kidney Diseases)

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