Search Results (2,709)

Background and Objectives: Chronic lung diseases act as multi-organ conditions in which systemic inflammation, vascular dysfunction, and fibrosis intersect. The pulmo-renal continuum—functional crosstalk between lungs and kidneys—remains poorly characterized. We compared year-long changes in endothelin-1 (ET-1), galectin-3 (Gal-3), renal indices (eGFR, ACR), and quantitative CT densitometry in COPD and systemic sclerosis-associated ILD (SSc-ILD). Materials and Methods: In this prospective observational study (January 2023–December 2024), 112 patients were consecutively enrolled (COPD, n = 58; SSc-ILD, n = 54). Assessments were performed at baseline and 12 months. ET-1 (ELISA) and Gal-3 (chemiluminescence) were measured in serum; eGFR was calculated by the creatinine-based CKD-EPI (2021) equation; ACR was photometric. High-resolution chest CT provided lung volume and parenchymal density (Hounsfield units) at six predefined axial levels per lung. Non-parametric statistics were applied: Wilcoxon signed-rank (within-group), Mann–Whitney U (between-group), and Spearman rank correlations for associations; results are reported with p-values (and 95% CIs). Results: Baseline eGFR was normal (COPD 90.37; SSc-ILD 92.4 mL/min/1.73 m²). eGFR declined by 6.76% in COPD (p = 0.001) and 3.16% in SSc-ILD (p = 0.029). ET-1 increased in both cohorts but more in COPD (+83.78%, p = 0.0002) than in SSc-ILD (+23.83%, p = 0.0001). Gal-3 rose significantly only in SSc-ILD (+10.2%, p = 0.043). FVC decreased in COPD (−4.01%, p = 0.01) and was unchanged in SSc-ILD. Total lung volume declined in SSc-ILD (−6.08%, p = 0.02) but not in COPD. CT density shifts were small: several slices in COPD and one slice (L6) in SSc-ILD reached statistical but not biological relevance. Conclusions: COPD exhibited larger vascular and renal biomarker shifts (ET-1 up, eGFR down, ACR up), suggesting systemic inflammation and early renal involvement. In SSc-ILD, biomarker and CT changes predominantly reflected pulmonary fibrosis progression with limited renal impact. Integrating biomarkers with quantitative CT may help delineate organ-specific trajectories along the pulmo-renal continuum; longer, larger studies are warranted. Limitations: This was a single-center cohort with a modest sample (58 COPD and 54 SSc-ILD) and a 12-month, two-time-point follow-up, which may not capture long-term trajectories and may limit it generalizability; larger multicenter studies with an extended follow-up are warranted. Full article

Chronic kidney disease (CKD) is a fast-growing cause of death worldwide. Systemic hypertension and diabetes mellitus are the major causes of kidney damage leading to a reduction in glomerular filtration rate and to urinary protein loss. Sodium–glucose cotransporter 2 inhibitors (SGLT2is) are drugs able to address both of these deleterious effects, preventing kidney damage from progressing. Initially born as hypoglycemic agents, SGLT2is subsequently proved to have not only positive metabolic but also pleiotropic effects on the kidney and the cardiovascular system. Indeed, they improve the metabolic profile, reducing uric acid, blood sugar levels, and body weight. Moreover, they exert an anti-inflammatory and antifibrotic effect, reducing endothelial dysfunction and reactive oxygen species (ROS) production. Finally, they reduce renal hyperfiltration and control blood pressure, inducing osmotic diuresis and restoring tubulo-glomerular feedback. All these metabolic, anti-inflammatory, and hemodynamic effects contribute to significantly reducing the risk of cardiorenal events, as widely demonstrated in randomized clinical trials. The pleiotropic actions of SGLT2is together with their good tolerability make them a pillar treatment of CKD regardless of the presence of diabetes mellitus. Further studies will be needed in order to expand the indications to populations previously excluded from clinical trials such as transplant recipients or glomerulonephritis patients. This narrative review aims to summarize current knowledge regarding the nephroprotective mechanisms of SGLT2is which, after initial use as a hypoglycemic agent, have assumed a pivotal role in the actual and future management of patients with CKD. Full article

Spherical Adsorptive Carbon (SAC), a type of oral sorbent, is prescribed to chronic kidney disease (CKD) patients to remove uremic toxins. However, evidence regarding its effectiveness in delaying chronic kidney disease (CKD) progression remains insufficient. We aimed to evaluate the impact of SAC on CKD progression in patients with CKD stage 3 or higher using nationwide data. In this retrospective cohort study, we included patients diagnosed with CKD stage ≥3 from the Korea National Health Insurance System database between January 2020 and December 2022. Outcomes were compared between SAC users (N = 1289) and non-users (N = 1289) after 1:1 propensity score matching (PSM). After PSM, the time from index date to end-stage kidney disease (ESKD) was significantly longer in the SAC user group compared to the non-user group (246.8 days vs. 118.6 days, p < 0.001). In Cox regression analysis, the risk of ESKD was significantly lower in the SAC group (HR = 0.37, 95% CI: 0.29–0.48). However, the risk of dialysis initiation did not show a significant difference between the two groups (HR = 0.83, 95% CI: 0.27–2.59). This nationwide cohort study suggests that SAC treatment may delay progression from CKD stage 3 to ESKD, although it did not significantly reduce the risk of dialysis initiation. Full article

This study examines the potential of purwoceng (Pimpinella pruatjan) to prevent chronic kidney damage through its antioxidant and anti-inflammatory properties. To evaluate both efficacy and safety, purwoceng extract was assessed for its phytochemical content and administered to five groups of rats: a healthy control group, a cisplatin-induced nephrotoxicity model, and three treatment groups receiving purwoceng at doses of 20, 30, and 40 mg/kg BW/day. In silico predictions were used for confirmation of in vitro and in vivo results. Renal function was monitored through serum creatinine and urea levels before and after treatment, while kidney tissue was evaluated histopathologically. The results indicate that purwoceng extract complies with safety standards. Notably, a dose of 20 mg/kg BW/day improved glomerular structure in cisplatin-exposed rats, suggesting a nephroprotective effect possibly mediated by vasodilatory and antioxidant mechanisms. In contrast, higher doses (30–40 mg/kg BW) increased urea and creatinine levels, and histological signs indicated only tubule damage. In silico predictions indicate that pinellic acid strongly binds to Cyclooxygenase-2 and Inducible Nitric Oxide Synthase, suggesting its anti-inflammatory potential and benefits for glomerular structure. Therefore, the bioactive compounds in purwoceng may help prevent chronic kidney disease, emphasizing the need for careful dose regulation to avoid toxicity. Full article

Background: Inflammation and nutritional status are known to affect outcomes in patients with chronic obstructive pulmonary disease (COPD). However, their prognostic relevance in critically ill COPD patients remains unclear. This study investigated whether C-reactive protein (CRP), serum albumin, and the CRP/albumin ratio (CAR) were associated with in-hospital mortality in ICU patients with COPD. Methods: We conducted a retrospective cohort study using data from the MIMIC-IV database. Adult ICU patients with a diagnosis of COPD were included. We analyzed CRP, albumin, CAR, glucose, lactate, and creatinine. The primary outcome was in-hospital mortality. Multivariable logistic regression was used to identify variables that were independently associated with in-hospital mortality. Subgroup analyses stratified by age and sex were performed. Results: We included 1000 ICU patients with COPD. In-hospital mortality was 19.6%. In univariate analyses, glucose, creatinine, and lactate levels were significantly higher in non-survivors. In multivariable models, only elevated creatinine (OR 1.60, 95% CI 1.01–2.53) remained independently associated with mortality, while glucose was no longer statistically significant. CRP, albumin, and CAR were not significantly associated with in-hospital mortality. Subgroup analyses showed consistent results across age and sex strata. Conclusion: In critically ill COPD patients, glucose and creatinine levels upon ICU admission were independently associated with in-hospital mortality, whereas inflammation- and nutrition-related markers, such as CRP, albumin, and CAR, were not. However, given that albumin is heavily influenced by systemic inflammation, it cannot serve as a standalone nutritional marker in the ICU setting. Composite nutritional scores such as the Nutritional Risk Screening (NRS-2002) or the Global Leadership Initiative on Malnutrition (GLIM), which were not available in the MIMIC-IV database, may provide more accurate assessments. These findings highlight the need for integrated risk models incorporating metabolic and renal parameters for early prognostication. Full article

Diabetes is a chronic and complex pathological syndrome that includes a series of disorders and imbalances, whose first characterization is hyperglycemia, although, as it is a multifactorial phenomenon, it requires risk reduction strategies beyond glycemic control. Continuous education and support for diabetes self-management are essential to prevent acute complications and reduce the risk of long-term complications. Therefore, the guidelines for the treatment of diabetes emphasize the importance of lifestyle changes, including a reduced-calorie diet and increased physical activity. However, for many people, these changes can be difficult to maintain in the long term and eventually they must resort to pharmacological treatment that in most cases requires the combined use of two or more antidiabetic drugs with different mechanisms of action. This review explores the different pharmacological agents, authorized and used therapeutically, for the control of diabetes, especially type 2 diabetes, and analyzes the development strategies of multi-target agents whose effects, through distinct mechanisms and by acting on more than one receptor, could represent a promising alternative in the treatment of a multifactorial disease such as diabetes. As regards therapeutic uses, from metformin to glucose transporter inhibitors (SGLT2i), the potential mechanisms of action, pharmacological and clinical effects, safety, and use in therapeutics are described, presenting, as far as reasonably possible, diverse comparisons between them. In conclusion, although metformin remains the first-line agent for the treatment of type 2 diabetes, the choice of a second-line agent depends on several factors, in particular the cardiovascular risk profile, weight, and renal function of the patient; moreover, the ideal pharmacological treatment, although expected and desired, has in fact not been achieved so far, and physicians must consider not only the glycemic efficacy of the agent but also all the other potential benefits, balanced by the possible adverse effects. Compounds modulating multiple signaling pathways are a promising approach to manage this multifactorial disorder, with the primary objective of maintaining the therapeutic efficacy observed in several clinical studies, alongside reducing adverse effects, the main reason for the discontinuation of developments, to levels that enable a favorable risk–benefit balance. Full article

Galectin-3 (Gal-3), a multifunctional protein, plays a pivotal role in a wide range of physiological and pathological processes in the human body. Substantial evidence has linked its overexpression and secretion to the pathogenesis of various conditions, including diabetes mellitus, heart failure, fibrosis, atherosclerosis, and chronic kidney disease. Diabetes mellitus, a persistent metabolic disorder, exerts profound effects on both renal and cardiovascular systems. Contemporary research has investigated a range of various biomarkers aimed at predicting the early onset of renal and cardiac dysfunction in diabetic patients. An early decline in glomerular filtration rate (GFR) may occur even with normal urinary albumin excretion. Given that NT-proBNP concentrations are influenced by GFR, there is a critical need to identify biomarkers capable of detecting early cardio–renal injury in individuals with diabetes. Elevated Gal-3 levels in diabetic patients have been associated with an increased risk of all-cause mortality, cardiovascular disease, and progressive kidney failure and may serve as an indicator of subclinical cardiac and renal dysfunction. Incorporating Gal-3 assessment into clinical practice has the potential to improve diagnostic precision and support personalized management for cardiovascular, renal, and metabolic disorders. This review aims to elucidate the role of Gal-3 as a pivotal biomarker for diagnosis, prognosis, and therapeutic guidance in general in different types of diseases which involve cardio–renal complications. Full article

Background/Objectives: This study aimed to determine the in-hospital mortality rate after upper gastrointestinal (GI) bleeding in geriatric patients with comorbidities. Additionally, it sought to identify effective cut-off values for predicting high-risk patients using AIMS65 and Rockall scores and to assess the impact of oral anticoagulant and NSAID use on mortality. Methods: A retrospective cohort study was conducted on 64 patients aged 60 and above with at least one comorbidity who were admitted for upper GI bleeding between January 2023 and June 2024. AIMS65 and Rockall scores were calculated for each patient. The relationship between these scores, medication use, and mortality was analyzed using statistical methods, including ROC analysis and Kaplan–Meier survival curves. Results: The mean age was 77.6 years, and all patients had at least one chronic disease; 57.8% used medications increasing bleeding risk. In-hospital mortality was 18.7%, with no significant association for oral anticoagulants (p = 0.275) or NSAIDs (p = 0.324). Sepsis, heart failure, chronic renal failure, and malignancy were strongly linked to mortality in univariate analysis; multivariate analysis confirmed sepsis and malignancy as independent predictors, with a trend for heart failure. AIMS65 ≥ 2 (sensitivity 90.1%, AUC = 0.920) and Rockall ≥ 6 (sensitivity 91.7%, AUC = 0.822) were both effective in predicting mortality, with risk rising cumulatively with higher scores (p < 0.001). Conclusions: In-hospital mortality after upper GI bleeding is high in elderly patients with multiple comorbidities, mainly from sepsis, malignancy, and heart failure. AIMS65 and Rockall scores effectively predict mortality and may support earlier intervention. The small, high-risk cohort limits generalizability, underscoring the need for multicenter validation. Full article

Peroxisomes are cellular organelles involved in multiple metabolic processes, including lipid oxidation, lipid synthesis, and the metabolism of reactive oxygen species. Peroxisomal disorders arise from defects in peroxisomal biogenesis or peroxisomal enzymes. Patients with severe peroxisomal disorders often present with a range of distinctive physical features and congenital malformations, such as neuronal migration defects, renal cysts, and bony stippling in the patellae and long bones. Liver disease has also been reported in some patients with peroxisomal biogenesis disorders, although the exact molecular mechanisms underlying its development remain unclear. Metabolic dysfunction-associated steatotic liver disease (MASLD) is now recognised as one of the most prevalent causes of chronic liver disease globally, due to its widespread incidence and potential for serious complications. This review aims to highlight the possible involvement of peroxisomal defects in the pathogenesis of MASLD. Full article

Chronic kidney disease (CKD) is a global health challenge, marked by significant morbidity and mortality and a rising economic burden. Despite established therapies such as renin–angiotensin system (RAS) inhibitors and SGLT2 inhibitors, a substantial residual risk of CKD progression and cardiovascular events persists. This gap is largely attributed to the sustained overactivation of the mineralocorticoid receptors by aldosterone, a key driver of renal inflammation and fibrosis. This review aims to bridge the understanding between aldosterone’s intricate pathophysiology and emerging therapeutic strategies designed to address this unmet clinical need. We discuss the physiological regulation of aldosterone synthesis and secretion, the phenomenon of aldosterone breakthrough under conventional RAS blockade and the diverse mechanisms through which aldosterone mediates kidney damage. We evaluate novel non-steroidal mineralocorticoid receptor antagonists, exemplified by finerenone, which demonstrate superior safety profiles and valid efficacy in reducing renal and cardiovascular outcomes in clinical trials. Additionally, we examine aldosterone synthase inhibitors as an upstream therapeutic approach to directly reduce aldosterone production. These novel agents represent promising avenues to mitigate residual risk and improve long-term outcomes for patients with CKD. Full article

Background: Chronic kidney disease (CKD) is largely driven by inflammation. Mesenchymal stem cells (MSCs) show therapeutic potential; however, their efficacy across CKD etiologies remains unclear. Methods: Comprehensive searches were conducted in PubMed, Cochrane, ScienceDirect, Scopus and Google Scholar. Effect sizes for inflammation and renal function outcomes were meta-analyzed. Results: Of 2514 studies screened, 52 met inclusion criteria (49 animal studies, 3 randomized controlled trials). In animal models, MSCs significantly reduced interleukin-6 (mean difference [MD] = −155.80; 95% CI: −249.10, −62.51; p = 0.001) and tumor necrosis factor-α (TNF-α) (MD = −35.53; 95% CI: −52.75, −18.30; p < 0.0001). In patients, TNF-α reduction was not significant (MD = −0.74; 95% CI: −2.20, 0.73; p = 0.32). Serum creatinine decreased in animals (MD = −0.38; 95% CI: −0.46, −0.29; p < 0.00001), but not in patients (MD = −0.59; 95% CI: −1.92, 0.74; p = 0.39). Blood urea nitrogen decreased in animals (MD = −19.27; 95% CI: −23.50, −15.04; p < 0.00001), and glomerular filtration rate improved (standardized MD = 1.83; 95% CI: 0.51, 3.15; p = 0.007), with no change in patients. Conclusion: MSCs improve inflammation and renal function in CKD animal models; however, evidence in patients remains inconclusive. Full article

Hemodialysis-associated pericarditis is a significant but insufficiently acknowledged complication in patients with end-stage renal disease (ESRD). It can manifest as either uremic pericarditis, typically occurring before or shortly after the initiation of dialysis, or dialysis-associated pericarditis, which results from prolonged dialysis treatment. The condition is associated with substantial morbidity and potential mortality due to risks, such as cardiac tamponade and constrictive pericarditis. Pericardial involvement in ESRD most frequently presents as acute uremic or dialysis-associated pericarditis, whereas chronic constrictive pericarditis represents a less common manifestation. The aim of the article is to review the current understanding of the epidemiology, pathophysiology, clinical presentation, diagnostic criteria and therapy strategies of this pathology based on a case of hemodialysis-associated pericarditis in a patient diagnosed with sudden shortness of breath during a hemodialysis session. When assessing pericarditis in this group of population, it is recommended to distinguish between uremic and dialysis-associated forms, to recognize clinical warning signs, and to customize the treatment. Probably the therapy should include anti-inflammatory drugs, colchicine, intensified dialysis, and in severe cases, even pericardiocentesis or surgical intervention. Rising awareness and timely intervention are critical to improve outcomes in this vulnerable population. Full article

The accumulation of blood toxins, including urea, uric acid, creatinine, bilirubin, p-cresyl sulfate, and indoxyl sulfate, poses severe health risks for patients with renal failure. Effective removal strategies are essential to mitigate complications associated with chronic kidney disease (CKD) and improve patient outcomes. Functional carbon-based materials, such as activated carbon (activated charcoal) and graphene oxide, have emerged as promising adsorbents due to their large surface area, adjustable porosity, and biocompatibility. This review comprehensively explores the latest advancements in carbon-based materials for blood purification across three key therapeutic modalities: (1) Hemoperfusion, where activated and modified carbonaceous materials enhance the adsorption of small-molecule and protein-bound toxins; (2) Hemodialysis, where functionalized carbon materials improve clearance rates and reduce treatment duration; and (3) Oral Therapeutics, where orally administered carbon adsorbents show potential in lowering systemic toxin levels in CKD patients. Furthermore, we present a comparative analysis of these approaches, highlighting their advantages, limitations, and future research directions for optimizing carbon-based detoxification strategies. The findings discussed in this review emphasize the significance of material engineering in advancing blood purification technologies. By enhancing the efficiency of toxin removal, carbon-based materials have the potential to revolutionize renal failure treatment, offering improved clinical outcomes and enhanced patient quality of life. Full article

Background: Differentiating acute kidney injury (AKI) from chronic kidney disease (CKD) in children remains a critical unmet need due to the limitations of current clinical and biochemical markers. Conventional ultrasound lacks the sensitivity to discern subtle parenchymal alterations. This study explores the application of ultrasound radiomics—a novel, non-invasive, and quantitative image analysis method—for distinguishing AKI from CKD in pediatric patients. Methods: In this retrospective cross-sectional pilot study, kidney ultrasound images were obtained from 31 pediatric subjects: 8 with oliguric AKI, 14 with CKD, and 9 healthy controls. Renal parenchyma was manually segmented, and 124 advanced texture features were extracted using the open-source ©PyFeats. Features encompassed multiple categories (e.g., GLCM, GLSZM, WP). Statistical comparisons evaluated intergroup differences. Principal Component Analysis identified the top 10 most informative features, which were used to train supervised machine learning models. Model performance used five-fold cross-validation. Results: Radiomic analysis revealed significant intergroup differences (p < 0.05). CKD cases exhibited increased echogenicity and heterogeneity, particularly in GLCM and GLSZM features, consistent with chronic fibrosis. AKI cases displayed more homogeneous texture, likely reflecting edema or acute inflammation. While echogenicity separated diseased from healthy kidneys, it lacked specificity between AKI and CKD. Among ML models, XGBoost achieved the highest macro-averaged F1 score (0.90), followed closely by SVM and Random Forest, demonstrating strong classification performance. Conclusions: Radiomics-based texture analysis of grayscale ultrasound images effectively differentiated AKI from CKD in this pilot study, offering a promising, non-invasive imaging biomarker for pediatric kidney disease. These preliminary findings justify prospective validation in larger, multicenter cohorts. Full article

IgA nephropathy (IgAN) is the most prevalent primary glomerulonephritis worldwide, with a heterogeneous clinical course that may progress to end-stage kidney disease (ESKD) in approximately 20% of patients. Despite recent advances, including the U.S. Food and Drug Administration (FDA) approval of three novel agents, optimal therapeutic strategies remain uncertain, and access to new drugs is often limited. This underscores the need to evaluate established and widely available options such as mycophenolate mofetil (MMF). The aim of this review is to critically assess the role of MMF, either as monotherapy or in combination with systemic corticosteroids, in the treatment of IgAN based on evidence cited in the KDIGO 2024 Draft Guidelines. We analyzed seven major clinical studies—five randomized controlled trials and two long-term observational studies—with particular focus on the influence of histological activity on treatment outcomes. The Oxford classification was applied to explore whether specific histological variables correlate with prognosis and predict treatment response. Trials conducted in Chinese cohorts demonstrated significant benefits of MMF, including proteinuria reduction, delayed progression to ESKD, and improved long-term renal outcomes, particularly in patients with recent disease onset and active proliferative lesions such as endocapillary hypercellularity and crescent formation. In contrast, studies from Western populations generally failed to demonstrate comparable benefit possibly due to differences in disease chronicity, histopathological patterns, and genetic background. Overall, MMF appears most effective when initiated early and in patients with histologic evidence of intraglomerular inflammation. It may represent a viable steroid-sparing option in appropriately selected patients, particularly where access to newly approved agents is restricted. These population- and pathology-based differences highlight the need for individualized treatment decisions and further research to refine the therapeutic role of MMF in IgAN. Full article