Search Results (1,089)

Chronic kidney disease (CKD) is a progressive condition associated with metabolic disturbances, systemic inflammation, and the accumulation of gut-derived uremic toxins. Increasing evidence highlights the role of gut microbiota dysbiosis in the progression of CKD through the gut–kidney axis. Consequently, microbiome-targeted nutritional strategies, including probiotics, prebiotics, and synbiotics, have emerged as promising complementary approaches to modulate intestinal microbial composition and metabolic functions. This review summarizes and critically evaluates the current clinical evidence regarding the use of these interventions in CKD patients. Clinical studies indicate that supplementation with probiotics, prebiotics, and synbiotic formulations may promote beneficial shifts in the composition of the gut microbiota, enhance saccharolytic fermentation, and increase the production of short-chain fatty acids (SCFAs). These changes have been associated with reduced circulating levels of gut-derived uremic toxins such as indoxyl sulfate and p-cresyl sulfate, as well as with the attenuation of systemic inflammation and oxidative stress. However, available trials remain heterogeneous in terms of study design, probiotic strains, prebiotic substrates, dosing regimens, and patient populations, and are frequently limited by small sample sizes and short intervention durations. As a result, evidence for improvements in renal function and long-term clinical outcomes remains inconclusive. While synbiotics may offer theoretical advantages by combining microbial supplementation with targeted substrates that support microbial growth and metabolic activity, current evidence does not consistently demonstrate superior clinical efficacy. Overall, these interventions often improve surrogate biomarkers, but their effects on renal function and hard clinical outcomes remain uncertain. Larger, longer-duration multicenter randomized controlled trials with standardized formulations are needed to establish their clinical utility and to better elucidate microbiota–host interactions in CKD. Advancing this field may support the development of personalized microbiome-based therapeutic strategies aimed at modulating the gut–kidney axis and ultimately improving clinical outcomes in CKD patients. Full article

Background: Diabetic nephropathy (DN), also referred to as diabetic kidney disease, represents one of the most common microvascular complications of type 2 diabetes mellitus (T2DM) and remains a leading cause of end-stage renal disease worldwide. Conventional clinical markers, including albuminuria and estimated glomerular filtration rate (eGFR), are widely used for diagnosis and staging but may have limited sensitivity for detecting early renal injury and predicting disease progression. In recent years, circulating microRNAs (miRNAs) have emerged as promising non-invasive biomarkers that reflect underlying molecular mechanisms of diabetic nephropathy and may complement traditional clinical indicators. Objective: The present study aimed to evaluate serum and urinary levels of hsa-miRNA-770-5p across different stages of diabetic nephropathy and to assess its potential diagnostic value in relation to established indicators of renal function. Methods: A total of 257 participants were included and divided into four groups: healthy controls, patients with T2DM without nephropathy, patients with T2DM and DN in CKD stages I–II, and patients with DN undergoing maintenance hemodialysis (MHD). Serum and urinary levels of miRNA-770-5p were measured using quantitative real-time polymerase chain reaction (qPCR) and analyzed using the 2^−ΔΔCt method. Statistical analyses included comparisons between groups using ANOVA, correlation analyses with renal function parameters such as eGFR and proteinuria/albuminuria, and receiver operating characteristic (ROC) curve analysis to evaluate diagnostic performance. Results: Serum levels of miRNA-770-5p were significantly elevated in patients with DN and in patients undergoing maintenance hemodialysis compared with healthy controls and patients with T2DM without nephropathy. In contrast, urinary levels of miRNA-770-5p were markedly reduced in patients with DN. Serum levels in patients with T2DM without nephropathy were slightly lower than those observed in healthy controls. Significant correlations were identified between miRNA-770-5p levels and renal function parameters, including eGFR and proteinuria/albuminuria, supporting the biological relevance of this microRNA in renal injury. ROC curve analysis demonstrated good discriminatory ability for differentiating DN from T2DM without nephropathy (serum AUC = 0.82; urine AUC = 0.79). Conclusions: hsa-miRNA-770-5p demonstrates distinct and opposite patterns in serum and urine that correlate with the severity of diabetic nephropathy. The complementary changes observed in circulating and urinary levels support the potential of miRNA-770-5p as a non-invasive biomarker that may complement conventional clinical markers and provide additional insight into the molecular mechanisms involved in the development and progression of diabetic nephropathy. Full article

Lupus nephritis (LN) stands out as one of the most critical complications of systemic lupus erythematosus (SLE), affecting almost 60% of the patient population. Even though more therapies have been made available for LN in the past decade, clinical outcomes remain less than ideal: nearly 10% to 30% of LN cases still advance to end-stage kidney disease (ESKD), still making the management of LN a clinical challenge. Therefore, the primary aim of treatment of LN is simple: to halt the progression toward chronic kidney disease (CKD) and prevent renal failure. In this review, we briefly describe the immunopathological basis of LN, which provides the scientific rationale for new drug development. We will focus on the current in-use medications, especially on proliferative LN, building on the legacy of the 20th century, and we will outline new emerging targeted and innovative therapies. We will also present the standard-of-care as informed by international guidelines and review the management of special groups, including children and pregnant women. Full article

Background: Chronic kidney disease (CKD) is characterized by irreversible structural damage and functional deterioration of the kidneys. Esculetin (ES), with its anti-inflammatory, antioxidant, and immunomodulatory activities, shows potential in delaying renal function decline. This study aimed to investigate the protective effect of ES on adenine-induced CKD in mice and its underlying molecular mechanism, with a focus on its role in preventing the transition from acute kidney injury (AKI) to CKD. Methods: A AKI-to-CKD transition mice model was established by feeding mice a 0.2% adenine diet, and ES (30, 60 mg/kg) was co-administered for 4 weeks as a prophylactic intervention. Serum creatinine (SCr), blood urea nitrogen (BUN), and renal histopathology (HE, Masson, IHC) were evaluated to assess renal injury. Network pharmacology and transcriptomics were combined to screen the targets, and Western blot was used to verify the signaling pathways. Results: ES significantly reduced SCr and BUN levels in CKD mice and alleviated renal tubular dilation and inflammatory infiltration. ES decreased pro-inflammatory factors (IL-1β, IL-6, TNF-α) and MDA levels and enhanced SOD activity. Additionally, ES inhibited renal interstitial collagen deposition and reversed epithelial–mesenchymal transition (EMT) by upregulating E-cadherin and downregulating α-SMA levels. Mechanism studies confirmed that ES significantly inhibited the phosphorylation levels of p-EGFR, p-SRC, p-PI3K, p-AKT, and p-p65 in renal tissues. Conclusions: ES effectively inhibits inflammation, oxidative stress, and fibrosis by modulating the EGFR/SRC/PI3K/AKT/NF-κB signaling axis, thereby preventing the AKI-to-CKD transition in the adenine-induced renal injury model and alleviating the progression of chronic renal damage. Full article

Background/Objectives: Chronic kidney disease (CKD) is associated with substantial clinical and economic burden, largely driven by progression to dialysis. Nutritional interventions have shown potential in delaying disease progression, yet evidence on their cost-effectiveness remains limited. This study evaluated the long-term cost–utility profile of a low-protein diet supplemented with ketoanalogues (s-LPD) versus a standard low-protein diet (LPD) in patients with stage 4+ CKD from both the Italian National Health System (NHS) and societal perspectives. Methods: A Markov model with monthly cycles simulated disease progression from pre-dialysis to dialysis or death. Clinical inputs were derived from the published literature, while costs reflected 2024 Italian tariffs. Three effectiveness scenarios (optimistic, conservative, and pessimistic) were explored to account for uncertainty in the treatment effect. Outcomes included costs, life-years, quality-adjusted life-years (QALYs), and incremental cost–utility ratios. Deterministic and probabilistic sensitivity analyses assessed model robustness. Results: Across all scenarios, s-LPD improved survival (up to +0.59 life-years), increased QALYs (up to +0.48), and delayed dialysis initiation (up to +2.88 years) compared with LPD. From the NHS perspective, s-LPD was dominant in the optimistic scenario and cost-effective in both conservative and pessimistic scenarios, with cost savings or only a marginal cost that increases under extreme assumptions. Probabilistic sensitivity analyses confirmed a high probability of cost-effectiveness across scenarios. Results remained robust in additional scenario analyses, including the societal perspective. Conclusions: This first Italian cost–utility analysis of s-LPD highlights that s-LPD is a cost-effective strategy for patients with advanced CKD, offering clinically meaningful benefits while reducing or containing healthcare costs. These findings support the adoption of s-LPD as part of conservative management strategies aimed at safely delaying dialysis initiation. Full article

Background: Tuberculosis (TB) remains a major global health threat, particularly in low- and middle-income countries, with TB infection (TBI) serving as the primary source of TB disease. While HIV infection has long been recognised as a major risk factor for TB progression, the rise of Non-Communicable Diseases (NCDs), which may exert immunosuppressive effects, further compounded by their treatment, contributes to increased TB susceptibility. This scoping review synthesises evidence from systematic reviews on medical and behavioural risk factors for TBI progression to TB disease, for both asymptomatic and symptomatic disease. Methods: A preliminary literature search was conducted on 11 January 2025, in PUBMED using the keywords “tuberculosis,” “asymptomatic or subclinical tuberculosis” “risk factors,” and “systematic review” followed by targeted reviews on the identified medical and behavioural risk factors for TB infection progression to TB disease. Results: A total of 25 systematic reviews were included. Medical risk factors for progression from TB infection to TB disease included diabetes mellitus (DM), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), undernutrition (including iron and vitamin D deficiency), cancer—particularly haematological malignancies—and immunosuppressive therapies (TNF-α inhibitors and glucocorticoids). Iron and vitamin D deficiency, particularly severe deficiency, is linked to increased TB risk, especially among people living with HIV. Behavioural risk factors, including tobacco, drug, and alcohol use, were also highlighted. Geographic variations in TB prevalence, diagnostic practices, and healthcare systems contributed to differences in risk estimates across reviews. No systematic reviews were identified that examined risk factors for asymptomatic TB. Conclusions: The convergence of TB with NCDs, compounded by immunosuppressive therapies, poses a public health challenge in high TB burden settings. Effective TB prevention requires targeted screening, along with enhanced management of these NCDs. Nutritional support, particularly screening and treatment of anaemia and vitamin D deficiency, may benefit individuals with TBI, comorbid NCDs, and HIV. A multidisciplinary approach, integrating behavioural interventions and tailored prevention strategies, is essential to achieving WHO’s End TB targets. Addressing the evidence gap on risk factors for asymptomatic TB is also critical to improve early detection and interrupt transmission. Full article

Chronic kidney disease (CKD) is on the rise, with sarcopenia accompanying CKD in an estimated 25% of patients, featuring as a potentially debilitating issue that should not be overlooked. Sarcopenia, characterized by a loss of skeletal muscle mass and strength, is multifactorial. The aging process, uremic toxins, systemic inflammation, oxidative stress, gut dysbiosis, hormonal dysregulation, dietary deficits, and even air pollution are among the major parameters being implicated in sarcopenia among patients with CKD. Additionally, the existence of various comorbidities, such as type 2 diabetes mellitus (T2DM), depression, and cardiovascular diseases (CVD), also contribute to the chronic low-grade inflammation associated with skeletal muscle inflammation and atrophy. The purpose of this review is to delve into the complex interplay of multiple factors being involved in the pathogenesis of sarcopenia in patients with CKD. Moreover, we aim to shed light upon nutritional aspects that could delay the development and progression of sarcopenia among patients with CKD. To address vitamin D deficiency, micronutrients and macronutrients together with physical activity remain the cornerstone of delaying the progression of sarcopenia in this sub-population. Additionally, experimental drugs exhibiting therapeutic potential are also being discussed. As sarcopenia and quality of life are interconnected, the timely recognition of sarcopenia, together with nutritional and therapeutic interventions, is of the utmost importance in our crusade for a better quality of life (QoL) in patients with CKD. Full article

Chronic kidney disease (CKD) and kidney aging share many pathological and molecular features, with cellular senescence emerging as a potentially important contributor to disease progression. Senescent cells accumulate in the kidneys due to persistent stressors, contributing to chronic inflammation and fibrosis via the senescence-associated secretory phenotype (SASP). This review explores the intersection between CKD and renal aging, focusing on the mechanisms driving senescence, its impact on kidney function, and potential therapeutic interventions. We explore various senotherapeutic approaches, such as senolytics, senomorphics, and rejuvenating agents, and highlight the increasing role of artificial intelligence (AI) and machine learning (ML) in detecting and monitoring senescent cells, enabling high-throughput and precise assessment across experimental and clinical settings. Understanding these mechanisms offers new avenues for developing targeted treatments to slow CKD progression and improve patient outcomes. Full article

Introduction: Chronic Kidney Disease (CKD) is a leading public health problem worldwide, with limited therapeutic options to halt its progression. Recent evidence implicates non-coding RNAs (ncRNAs), specifically long non-coding RNAs (lncRNAs) and microRNAs (miRNAs), as critical regulators in renal pathophysiology and the transition from Acute Kidney Injury (AKI) to CKD. This review aims to synthesize recent findings regarding the role of ncRNAs in CKD pathogenesis, emphasizing their potential as diagnostic biomarkers and therapeutic targets. Methods: A systematic search was conducted in the PubMed/MEDLINE and Scopus databases for original research articles published over the last five years. Studies were selected based on specific eligibility criteria focusing on the correlation of ncRNAs with the development, diagnosis, and therapy of CKD. A total of 14 studies were included in the final review. Results: This review identified a dual landscape of ncRNAs function. Several lncRNAs, including H19, MALAT1, NEAT1_2, and LINC00963, were found to act as pathogenic drivers, promoting inflammation, apoptosis, and fibrosis through pathways such as TGF-β/Smad and NF-κB. Specifically, MALAT1 and NEAT1_2 are pivotal in driving the AKI-to-CKD transition. Conversely, specific miRNAs, such as miR-204, miR-26a, miR-451, miR-101, and miR-486-5p, exhibited protective effects by attenuating oxidative stress, preserving endothelial function, and inhibiting epithelial–mesenchymal transition (EMT). Dysregulation of these molecules was also observed in systemic conditions affecting the kidney, such as congestive heart failure and β-thalassemia. Conclusions: ncRNAs are central players in the molecular mechanisms underlying renal injury and maladaptive repair. The identified lncRNAs and miRNAs offer promising avenues for non-invasive diagnosis and the development of novel targeted therapies to prevent fibrosis and slow the progression of CKD. Full article

Background: The prognosis of chronic kidney disease (CKD) typically requires longitudinal estimated glomerular filtration rate (eGFR) data, making risk stratification difficult at initial consultation. Furthermore, eGFR-based clinical decisions often overlook the critical factor of patient age. This study aimed to establish a simplified predictive model for progressive CKD and quantify the impact of clinical interventions. Methods: Utilizing a historical dataset (1988–2003) from the pre-renin-angiotensin system inhibitor (RASi) and pre-sodium-glucose cotransporter 2 inhibitor (SGLT2i) era, we developed heatmaps to predict the probability of reaching eGFR < 30 mL/min/1.73 m² by age 80 years. The model also estimated the risk reduction from smoking cessation and pharmacological therapies. The predictive performance for age + eGFR was assessed using standard calibration and discrimination metrics, and clinical utility was evaluated using decision curve analysis across a range of threshold probabilities. Risk reclassification analyses compared age +eGFR-based categories with conventional eGFR-based stratification. Results: Regarding the risk of eGFR < 30 mL/min/1.73 m² by age 80 years, simulations confirmed a correlation between age and eGFR. At age 40 years, an eGFR of ~57 mL/min/1.73 m² indicated a 50% probability of progressing to CKD stage 4 by age 80 years. This threshold decreases to 53 and 48 mL/min/1.73 m² at 50 and 60 years of age, respectively. Calibration and discrimination analyses demonstrated acceptable agreement between predicted and observed risks. Decision curve analysis showed that an age + eGFR threshold of approximately 115 primarily provided a net benefit at lower threshold probabilities, supporting intensified surveillance strategies, whereas an age +eGFR of 100 showed a positive net benefit across a broader range of thresholds, comparable to the conventional eGFR < 45 mL/min/1.73 m² criterion. While proteinuria markedly increased risk, smoking cessation provided a 9.4–11.2% risk reduction. Combined RASi and SGLT2i treatment showed the greatest impact, reducing progression probability by 31.2–40.0% (e.g., reducing a 50.0% baseline risk to 32.1% in 40-year-old men). Conclusions: The age + eGFR rule represents a simple, clinically interpretable heuristic for age-adjusted risk stratification based on a single eGFR measurement and may offer potential clinical utility for guiding surveillance intensity and consideration of earlier intervention strategies. However, external validation is required before clinical application. Full article

Background/Objectives: Appropriate nutritional management constitutes one of the key elements of conservative treatment and renal replacement therapy in patients with chronic kidney disease (CKD). The level of patients’ nutritional knowledge may significantly influence adherence to dietary recommendations, the rate of disease progression, and the frequency of complications. The aim of this study was to assess the level of nutritional knowledge, dietary habits, adherence to dietary recommendations, and nutritional status of patients with CKD according to disease stage. Methods: This cross-sectional study was conducted among 98 adult patients diagnosed with CKD. A questionnaire assessing nutritional knowledge and dietary behaviors was administered. An overall nutritional knowledge score was calculated based on eight questionnaire items assessing nutritional knowledge. Nutritional status was evaluated using the Subjective Global Assessment (SGA) and the Simplified Nutritional Appetite Questionnaire (SNAQ). Anthropometric, clinical, and biochemical data were collected. Statistical analysis was performed using tests appropriate to the data distribution. Results: The level of nutritional knowledge varied and was dependent on CKD stage. Patients in more advanced stages of the disease demonstrated significantly higher awareness of dietary recommendations compared with those in earlier stages. The median nutritional knowledge score was 6 points, with 46.9% of participants demonstrating insufficient knowledge (<6 points) and 53.1% achieving adequate knowledge (≥6 points). The greatest knowledge deficits concerned the control of phosphorus, potassium, sodium, and fluid intake. Discrepancies were also observed between declared knowledge and actual dietary behaviors. Good nutritional status (SGA A) was identified in 73 patients, risk of malnutrition or moderate malnutrition (SGA B) in 22 individuals, and severe malnutrition (SGA C) in 3 patients. SNAQ indicated good appetite in the study population, with an average consumption of three meals per day, and identified a risk of weight loss in 6% of patients. Overweight and obesity were present in more than half of the study population, while underweight was observed in 4%. Conclusions: Nutritional knowledge among patients with CKD remains insufficient, particularly in the early stages of the disease. The findings highlight the necessity of early and systematic implementation of individualized nutritional education as an integral component of slowing disease progression. Full article

Background: Artificial intelligence in nephrology has largely focused on predictive models for outcomes such as acute kidney injury (AKI), chronic kidney disease (CKD) progression, and transplant complications. Although these models demonstrate technical performance, their real-world clinical impact has remained limited because prediction alone rarely translates into coordinated clinical action. Clinical artificial intelligence agents represent workflow-native systems that operate in real time, interact bidirectionally with clinical environments, adapt to evolving patient and workflow states, and support coordinated clinical action rather than generating isolated predictions. This review proposes clinical artificial intelligence agents as a new paradigm for integrating artificial intelligence directly into nephrology workflows. Methods: We conducted a narrative synthesis of emerging literature on artificial intelligence systems, agentic artificial intelligence architectures, clinical decision support, and digital health infrastructures relevant to kidney care. Drawing from interdisciplinary sources in medicine, health informatics, and artificial intelligence research, we developed a conceptual framework describing the architecture, governance requirements, and evaluation principles of clinical artificial intelligence agents in nephrology. Results: Clinical artificial intelligence agents represent workflow-integrated systems capable of continuously perceiving patient data, reasoning under clinical constraints, planning tasks, and supporting coordinated clinical actions over time. We describe a layered architecture consisting of perception, cognition, planning and control, action, and learning components. Potential applications span the nephrology care continuum, including CKD management, AKI monitoring, dialysis and continuous renal replacement therapy (CRRT) optimization, kidney transplantation care coordination, glomerulonephritis management, and supervised patient-facing systems. Conclusions: Clinical artificial intelligence agents shift the role of artificial intelligence from isolated prediction toward longitudinal clinical orchestration. Future evaluation should prioritize workflow integration, time-to-action, clinician oversight, safety, and patient-centered outcomes rather than relying solely on traditional model performance metrics. This roadmap provides a conceptual foundation for the responsible development and clinical integration of agentic artificial intelligence systems in nephrology. Full article

Chronic kidney disease (CKD) involves uremic toxin-driven tubular injury and systemic vascular dysfunction, in which mitochondrial impairment and apoptotic cell loss contribute to progressive tissue deterioration. Accordingly, a targeted EV platform is required to enable efficient miRNA delivery to the toxin-stressed tubular–endothelial compartment. Based on our previous study showing that melatonin restores miR-4516 levels under CKD-related stress, we directly loaded miR-4516 into engineered extracellular vesicles (EVs) to evaluate its effects on mitochondrial function and cell survival. Here, we engineered EVs with a G3-C12/RGD surface modification and established a miR-4516 loading strategy to enhance delivery to kidney proximal tubule cells and vascular endothelial cells. miR-4516 loading increased EV-associated miR-4516 levels without major changes in particle size distribution, and EV identity was supported by CD9 and CD81 expression. Confocal microscopy and flow cytometry demonstrated increased cellular uptake of miR-4516-loaded G3-C12/RGD-EVs compared with control EVs in TH1 proximal tubule cells and HUVECs. Under indoxyl sulfate stress, engineered EV treatment restored intracellular miR-4516 and improved mitochondrial function, as indicated by recovery of respiratory Complex I and Complex IV activities and improved Seahorse bioenergetic parameters (OCR/ECAR, basal and maximal respiration, ATP-linked respiration, and spare respiratory capacity). Annexin V staining further indicated reduced toxin-induced apoptosis. In an adenine diet-induced CKD mouse model, intravenous administration of miR-4516-loaded G3-C12/RGD-EVs improved urinary albumin-to-creatinine ratio (UACR), blood urea nitrogen (BUN), and serum creatinine. These findings indicate that miR-4516-loaded, targeting-engineered EVs may mitigate uremic toxin-associated mitochondrial dysfunction and renal impairment in CKD. Full article

Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a systemic disorder with clinically significant extrapulmonary manifestations. Among these, renal dysfunction—manifesting as chronic kidney disease (CKD) and acute kidney injury (AKI)—is highly prevalent, frequently underdiagnosed, and strongly associated with adverse clinical outcomes. Meta-analytic data indicate that COPD is associated with more than a twofold increase in CKD prevalence, independent of shared risk factors such as age, smoking, hypertension, and diabetes. CKD in COPD is associated with increased mortality, exacerbation burden, and healthcare utilization. AKI represents a particularly severe expression of renal involvement, occurring most commonly during acute exacerbations of COPD (AECOPD). Although the reported incidence of AKI during AECOPD varies widely by clinical setting—from approximately 2% in population-based studies to over 20% in hospitalized cohorts—its presence is consistently associated with marked increases in mortality, respiratory failure, need for mechanical ventilation, and hospital length of stay. This review synthesizes current evidence supporting a lung–kidney interorgan crosstalk framework in COPD, whereby chronic and acute pulmonary pathophysiology generates systemic disturbances that progressively impair renal structure and function. The heart is incorporated as a physiological intermediary, modulating hemodynamic transmission and venous congestion, without constituting the primary disease axis. Recognizing the role of kidney complications in COPD is crucial, as it influences how we diagnose, predict outcomes, and treat patients—especially when there are sudden flare-ups. Full article

Chronic Kidney Disease (CKD) is a global health crisis, projected to be the fifth leading cause of death by 2040. Its progression is driven by a reinforcing loop of mitochondrial dysfunction, oxidative stress, and chronic inflammation. The AMPK-NRF2–FOXO axis serves as a central “redox-metabolic rheostat” that maintains renal homeostasis but is commonly dysfunctional in CKD. Herein, we explore the molecular crosstalk within this network, where AMPK acts as a metabolic and redox sensor, NRF2 governs the cytoprotective response, and FOXO isoforms regulate autophagy, antioxidative defense, and senescence. We highlight the functional paradoxes within the axis and evaluate the benefits and drawbacks of nutraceuticals and pharmacological agents, such as NRF2 inducer bardoxolone methyl, underscoring the necessity for context-dependent modulation. Furthermore, we examine the AMPK–NRF2–FOXO axis within the current clinical management, according to the 2024/2026 KDIGO guidelines. These guidelines reflect a shift toward a multi-targeted pharmacological approach involving metformin, SGLT2 inhibitors, GLP-1 receptor agonists, finerenone, and hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors. Full article