Search Results (384)

Kidney stone disease is a common urinary system disorder with a continuously rising global incidence, posing a major public health challenge. As a classic traditional Chinese medicine for the treatment of kidney stones, Lysimachia christinae Hance (LCH) has not yet been fully elucidated in terms of its pharmacological mechanism. In this study, a rat model of calcium oxalate kidney stones and a calcium oxalate monohydrate (COM)-induced injury model of human renal tubular epithelial (HK-2) cells were established. Combined with transcriptomic analysis and experimental verification, the therapeutic effect and underlying molecular mechanism of LCH against kidney stones were systematically explored. Results demonstrated that LCH extract significantly reduced serum levels of blood urea nitrogen (BUN) and creatinine (Cr), as well as renal tissue levels of kidney injury molecule-1 (KIM-1) and cystatin-C (Cys-C) in rats with calcium oxalate crystal-induced renal injury, and diminished calcium oxalate crystal deposition and adhesion in rat renal tissues as well as HK-2 cells, thus exerting a robust renoprotective effect. Mechanistically, transcriptome sequencing indicated that the anti-nephrolithiasis effect of LCH was closely related to the inhibition of oxidative stress and ferroptosis. LCH extract reversed CaOx crystal-induced upregulation of NADPH oxidase 2 (NOX2) and downregulation of superoxide dismutase 2 (SOD2), reduced intracellular oxygen species (ROS) levels, downregulated the expression of transferrin receptor 1 (TFR1) and acyl-CoA synthetase long-chain family member 4 (ACSL4) while upregulating that of ferritin heavy chain 1 (FTH1), solute carrier family 7 member 11 (SLC7A11) and glutathione peroxidase 4 (GPX4), and diminished intracellular iron accumulation, thereby effectively ameliorating crystal-mediated renal injury. The present study demonstrates that the therapeutic effect of LCH on kidney stones is closely related to the regulation of the NOX2/ROS signaling axis and ferroptosis, providing novel theoretical evidence for its clinical application. Full article

Objectives: To develop and rigorously evaluate a Hybrid Multi-Path Attention Convolutional Neural Network (HMPA-CNN) for the classification of kidney diseases across heterogeneous institutional datasets and imaging modalities. Materials and Methods: The proposed HMPA-CNN employs dual parallel pathways to disentangle spatial (3 × 3 convolutions) and textural (5 × 5 convolutions) representations, followed by attention-based feature recalibration and gated fusion. Performance was assessed on five geographically distinct datasets comprising 29,148 CT and MRI images collected from Turkey, Bangladesh, Jordan, Iraq, and publicly available international sources. The evaluation framework included three-class tumor discrimination, four-class renal pathology classification, six-class tumor subtyping, binary kidney stone detection, and chronic kidney disease (CKD) assessment under cross-modality conditions. Results: The model achieved 99.76% overall accuracy on the KidneyNeXt three-class dataset, 99.96% on the four-class multi-institutional CT dataset, and 99.74% on the independent Jordan cohort under a four-class configuration. In the more granular six-class tumor subtyping task, overall accuracy was 96.36%. The same architecture achieved 93.85% overall accuracy on the MRI-based CKD classification task, suggesting that the framework can be adapted to a different imaging modality. Across most classification tasks, specificity exceeded 99%, with benign–malignant misclassification remaining below 2%. Performance declined to 91.96% for kidney stone detection, reflecting the intrinsic difficulty of small-object localization in axial CT images. Conclusions: The dual-path architecture consistently preserved high discriminative performance across institutions, diagnostic granularities, and imaging modalities. Its stable specificity and low benign–malignant confusion suggest potential utility as a supportive tool within renal imaging workflows, particularly for screening and structured diagnostic assistance. Clinically, benign–malignant misclassification is the most critical error, as it may delay oncologic evaluation or lead to unnecessary follow-up. Therefore, the model should be used as a decision-support tool rather than an autonomous diagnostic system. Further prospective validation is required to determine its impact in routine clinical practice. Full article

Background/Objectives: There is a seemingly high prevalence of dietary supplement use in the kidney stone population. We aimed to understand patients’ perceptions of dietary supplements and their role in the management of kidney stones. Methods: We performed a standardized survey of patients presenting for management of kidney stones. We investigated the knowledge and use of apple cider vinegar (ACV), turmeric, and cranberry extract, as well as opinions on the safety of dietary supplements and sources of information. Descriptive statistics were used to summarize demographic and survey data. Results: Ninety-five patients were surveyed; 18 (18.9%) patients reported using ACV, 19 (20%) reported using cranberry extract, and 11 (11.6%) reported using turmeric. Similar numbers reported having heard of these dietary supplements being used for kidney stone prevention and/or treatment. Most patients believed these dietary supplements to be probably (ACV, n = 61, 64.2%; cranberry, n = 62, 65.3%; turmeric, n = 61, 64.2%) or definitely (ACV, n = 22, 23.2%; cranberry, n = 28; 29.5%; turmeric, n = 22, 23.2%) safe. For those who had heard about these supplements being used to treat or prevent kidney stones, friends/family (n = 25, 26.3%), online websites (n = 21, 22.1%), and social media (n = 15, 15.8%) were the most common sources of information. Conclusions: Apple cider vinegar, turmeric and cranberry extract have unknown risks or benefits in the management of kidney stones. Furthermore, their impact on stone pathophysiology remains unclear; however, many of our surveyed patient population uses them. Our study provides insight into patients’ use and perception of dietary supplements that clinicians should consider in the management of kidney stones. Further studies are needed to better counsel patients on the safety and efficacy of dietary supplements. Full article

Therapeutic interventions within the urinary system are often limited by the complex and tortuous anatomy of the renal pelvis and ureters, restricting access to deep regions and increasing the risk of mucosal trauma. In this study, we present a multifunctional, magnetically controlled ferrofluid droplet robotic platform engineered for high deformability and precision navigation. A custom electromagnetic actuation system was developed and optimized via COMSOL Multiphysics (version 6.3, COMSOL Inc., Stockholm, Sweden) simulations to generate programmable magnetic fields. Experimental validation in both simplified environments and anatomically realistic 3D-printed urinary tract models demonstrated the droplets’ capacity for controlled locomotion, reversible deformation, and traversing constrictions significantly smaller than their resting diameter. The droplets’ locomotion and extreme deformability are governed by the dynamic balance between the applied magnetic gradient forces, the restoring interfacial tension of the ferrofluid, and the fluidic viscous drag. Quantitatively, the droplets achieved robust translational velocities up to 260 mm/s under single-coil actuation (51 mT, 20 Hz) and 108 mm/s under a more stable dual-coil configuration (51 mT, 8.3 Hz). Furthermore, two clinically relevant functionalities were successfully executed: rapid vibration-induced release of encapsulated dye for targeted drug delivery, and the precise mechanical capture and transport of artificial kidney stones. These results establish a highly versatile platform for minimally invasive urological procedures, highlighting the immense potential of soft magnetic microrobotics for integrated therapeutic applications. Full article

Background and Clinical Significance: Over recent decades, percutaneous nephrolithotomy (PCNL) has emerged as a primary treatment, firmly establishing itself as the cornerstone approach for managing large kidney stones. Postoperative bleeding commonly stems from an arteriovenous fistula (AVF), a connection between a damaged artery with high flow and a damaged vein with low flow, or from a pseudoaneurysm (PA), which involves arterial blood leaking into the tissue, causing a localized hematoma. The preferred technique for addressing such vascular complications is selective trans-arterial angioembolization, widely regarded as the gold standard. Case Presentation: In this article, we present the case of a 42-year-old woman who experienced delayed bleeding eight years after PCNL and a previous angioembolization. The patient presented with macroscopic hematuria, and further investigations, including cystoscopy, contrast-enhanced abdominal-pelvic CT, and angiography, were performed. To stop the bleeding, we identified and performed selective angioembolization (SAE) of a small arterial branch arising from an inferior branch of the right renal artery. Conclusions: To the best of our knowledge, this is the initial documented instance of delayed bleeding manifesting eight years post-PCNL and angioembolization. This occurrence is exceptionally rare, given that the patient exhibited no urological signs or symptoms over the intervening years, and no predictive or risk factors were identified. Full article

Background: Accurate differentiation of kidney diseases such as cysts, tumors, stones, and normal tissue from computed tomography (CT) images remains challenging due to overlapping visual characteristics and variability in data distributions. While deep learning approaches have shown promising results, many existing studies rely on image-level data splitting and focus primarily on accuracy, which may lead to overly optimistic performance and limited clinical reliability. Methods: This study proposes KDH-Net (Kidney Disease Hybrid Network), a hybrid deep learning framework for multiclass kidney disease characterization that integrates EfficientNetB0, ResNet50, and MobileNetV2 through feature-level fusion. A two-stage training strategy is adopted to enhance optimization stability. To ensure realistic performance assessment, experiments on the primary dataset are conducted under a patient-level evaluation protocol, eliminating potential data leakage. The framework further incorporates calibration analysis, statistical validation, and explainable artificial intelligence to evaluate prediction reliability and interpretability. Results: On the patient-level dataset, KDH-Net achieves an overall accuracy of 0.93 with a macro-average F1-score of 0.91, demonstrating balanced performance across all classes. Confidence analysis indicates meaningful alignment between prediction confidence and correctness, while Grad-CAM visualizations highlight anatomically relevant regions associated with each class. Conclusions: The results demonstrate that KDH-Net provides a stable, reliable, and interpretable framework for kidney CT characterization. The proposed system is designed to support clinical decision-making by offering trustworthy predictions under realistic evaluation conditions, rather than replacing clinical expertise. Full article

Objectives: Primary hyperoxaluria type III (PH3) causes kidney stones in children and adults. Gas chromatography/mass spectrometry (GC/MS)-based metabolomics has been applied to study patients with primary hyperoxaluria types I and II, 2,8-dihydroxyadenine lithiasis, and xanthinuria types I to III. This study was performed to verify the usefulness of this technique for the diagnosis of PH3. Specifically, we evaluated an 8-month-old infant with recurrent kidney stones. Methods: GC/MS-based metabolomics was performed on spot urine samples using initial urease pretreatment without fractionation. Results: Metabolomics revealed increased levels of 2,4-dihydroxyglutarate and 4-hydroxyglutamate. No simultaneous elevations of these two critical biomarkers were observed in other patients, except for one case of PH3 confirmed by the identification of HOGA1 mutations. A moderate increase in 4-hydroxyglutamate has been observed only in cases of primary hyperammonemia, in which analytes such as orotate, uridine, glutamine, or proline, but not 2,4-dihydroxyglutarate, are biomarkers, thus distinguishing PH3 from primary hyperammonemia. Conclusions: GC/MS-based urine metabolomics enables the rapid screening and chemical diagnosis of PH3 and other congenital anomalies that cause urolithiasis. This technique can also be used to monitor disease progression, as patients with PH3 benefit from long-term follow-up, particularly when transitioning from childhood to adulthood. The timely identification of patients with hereditary urolithiasis is crucial. To address this, a discussion was had about the current diagnostic criteria. Full article

Urinary stone disease is common, recurrent, and increasingly managed through imaging-driven pathways, yet standard-dose CT of the kidneys, ureters, and bladder (CT KUB) raises concerns about cumulative radiation exposure and the limited use of quantitative imaging information for risk stratification. This review synthesizes contemporary evidence on dose-optimized CT, advanced spectral technologies, and artificial intelligence (AI)-enabled analytics that are reshaping diagnosis, treatment selection, and triage. This review summarizes data supporting low-dose and ultra-low-dose CT protocols that preserve diagnostic accuracy while substantially reducing dose, and discusses how dual-energy CT, photon-counting CT, and radiomics facilitate noninvasive stone characterization and extraction of imaging biomarkers beyond size and location. It also reviews AI approaches for automated detection, segmentation, and volumetric quantification across CT, KUB, and ultrasounds, highlighting their potential to standardize stone-burden metrics. It further examines predictive models, including logistic regression, nomograms, and machine learning, for perioperative infectious complications, emergency department admission or intervention, procedure success, and long-term recurrence, and outlines reporting and validation frameworks and implementation considerations, including software as a medical device regulation and human oversight. In contrast to prior reviews that consider imaging and AI separately, this review integrates dose reduction, spectral characterization, and AI-driven analytics within real-world clinical pathways to distinguish established clinical applications from those that remain investigational. Integrating advanced CT and AI outputs into well-validated prediction models embedded in real-world workflows may enable safer imaging, more consistent triage, and more personalized follow-up for urinary stone disease. Full article

Cardiovascular disease (CVD) is the world’s leading cause of death and continues to rise in prevalence, contributing to healthcare and economic costs. Following diagnosis, patients are advised to adopt medication regimens, increase physical activity, and modify dietary intake to reduce disease progression and prevent additional comorbidities. Oxalate is a small molecule in plant-derived foods such as spinach, potatoes, almonds, and peanuts and is also produced endogenously. Although oxalate is traditionally studied in the context of kidney stone disease, recent evidence suggests that it may be a dietary contributor to inflammation and oxidative stress in CVD. Elevated systemic oxalate levels promote reactive oxygen species (ROS) generation and activate inflammatory pathways such as nuclear factor-kappa B (NF-κB), mitogen-activated protein kinase (MAPK), and the NLRP3 inflammasome, which are key players in CVD. In this narrative review, we discuss the current literature describing the role of inflammation in CVD and evaluate emerging evidence that dietary oxalate may influence immune, oxidative, and vascular mechanisms contributing to CVD development and progression. In addition, we highlight populations that may be most vulnerable to oxalate-mediated vascular effects. We conclude by describing existing gaps in knowledge and potential future directions for the field. Understanding these mechanisms further may guide dietary recommendations and delineate oxalate’s potential role as a modifiable risk factor for CVD. Full article

Posterior acoustic shadowing is a fundamental physical phenomenon associated with calcified stones in ultrasound image, yet it has not been fully exploited in automated ultrasound analysis. This study aimed to develop an explainable, semi-automatic rule-based framework that explicitly incorporates posterior acoustic shadow characteristics for stone detection and localization in a clinically guided manner. A rule-based framework was designed to generate stone candidates using morphological enhancement and to evaluate them through local contrast analysis, posterior shadow region assessment, and shape-based penalties. A composite score integrating these features was used to rank candidates. The method was evaluated on 52 kidney stone and 66 gallbladder stone ultrasound images, stratified into three diagnostic confidence categories. Performance was assessed using an ablation study and centroid distance error measured in pixels relative to expert-defined references. In the 50–60% confidence group, the accuracy increased from 0.29 to 0.64 for kidney stones and from 0.30 to 0.60 for gallbladder stones when posterior shadow information was included. Centroid distance errors in the ≥80% confidence group were 1.26 ± 0.28 mm for kidney stones and 1.44 ± 0.91 mm for gallbladder stones. The proposed framework enhances diagnostic confidence by leveraging physically grounded posterior acoustic shadow analysis and provides a reproducible augmentation to conventional ultrasound-based stone assessment. Full article

Nephrolithiasis is a prevalent urological disorder worldwide, whose pathogenesis involves a complex network of crystal formation, cellular injury, and microenvironmental dysregulation. As a critical mechanism for regulating cellular functions, protein post-translational modifications (PTMs) have been increasingly implicated in multiple facets of kidney stone formation, including crystal–cell interactions, oxidative stress responses, and inflammatory signaling pathways. This review systematically synthesizes the biochemical foundations of PTMs, the molecular microenvironment of nephrolithiasis, and the roles of key modifications such as phosphorylation and acetylation in the pathogenesis of calculi. It further explores the translational potential of PTM detection technologies in clinical practice. Current evidence indicates that PTMs influence the nucleation, growth, and aggregation of crystals by modulating the activity of pro-/anti-lithogenic proteins, the expression of cell adhesion molecules, and inflammatory pathways. Consequently, therapeutic strategies targeting PTMs may offer novel avenues for the prevention and management of kidney stones. Future research should focus on integrating multi-omics approaches with functional validation to elucidate the dynamic regulatory networks of PTMs within the stone microenvironment, thereby advancing the development of precision medicine. Full article

Background and Objectives: Ureteral access sheaths (UASs) are widely used in retrograde intrarenal surgery (RIRS) to facilitate irrigation and instrument access. Recently, flexible and navigable suction UASs (FANS-UASs) have been developed to enhance visibility and stone fragment evacuation; however, their comparative effectiveness remains uncertain. This study aimed to evaluate the clinical outcomes of FANS-UAS versus conventional UAS during RIRS for renal stones. Materials and Methods: A systematic review and meta-analysis were performed following PRISMA guidelines. PubMed, Embase, and the Cochrane Library were searched through May 2025 for comparative studies of FANS-UAS and conventional UAS. Study quality was assessed using the Scottish Intercollegiate Guidelines Network checklist. Primary outcomes included stone-free rate (SFR), operative time, complications, and hospital stay. Subgroup analyses were conducted according to stone size (≤2 cm vs. >2 cm). Results: Nine studies involving 1791 patients were included. FANS-UAS demonstrated a significantly higher SFR (OR = 5.99, 95% CI: 2.86–12.51; I² = 86.7%) and fewer complications (OR = 0.33, 95% CI: 0.23–0.45; I² = 0%). Operative time and hospital stay did not differ significantly between groups. Subgroup analysis showed no significant SFR difference for stones ≤2 cm, whereas for stones >2 cm, FANS-UAS tended to yield higher SFR—though based on limited evidence. Conclusions: FANS-UASs appear to improve stone clearance and reduce perioperative complications in RIRS without increasing operative burden. While further high-quality randomized trials are needed, current evidence supports the growing adoption of FANS-UAS in endourological practice. Full article

Wetlands, frequently termed the “kidneys of the Earth,” represent one of the most vital global ecosystems. Despite their limited spatial extent, plateau wetlands function as unique ecological units that play a pivotal role in the global carbon cycle, water resource regulation, and biodiversity conservation, while exhibiting acute sensitivity to climate change. Advances in remote sensing technology—characterized by macro-scale cover-age, temporal efficiency, and non-invasive operations—have established it as a corner-stone for the dynamic monitoring and analysis of these environments. This study presents a bibliometric synthesis of 2138 publications (1982–2024) retrieved from the Web of Science Core Collection. We systematically evaluated publication trajectories, international collaborative networks, disciplinary shifts, core journals, and the spatiotemporal evolution of research hotspots. Our findings reveal an exponential growth in scholarly output alongside a marked diversification of research fields. Geographically, research is predominantly clustered around the Tibetan Plateau, flanked by the Alps and the Himalayas, with sparse representation in other regions. Future endeavors should prioritize underrepresented low-latitude and remote regions through strengthened international synergy and the integration of emerging technologies, such as UAVs and hyperspectral sensors. Full article

Objective: The optimal surgical approach for 1.0–2.0 cm renal stones in solitary kidney patients remains controversial. This retrospective study compared mini-percutaneous nephrolithotomy (mPCNL) and flexible ureteroscopy (f-URS) outcomes in this vulnerable population. Methods: Between June 2018 and April 2024, 50 patients with solitary kidneys and 1.0–2.0 cm renal stones underwent either mPCNL (n = 26) or f-URS (n = 24). Outcomes included 3-month stone-free rate (SFR), complications (Clavien–Dindo classification), and renal function (serum creatinine, eGFR by CKD-EPI equation) at the baseline, 72 h, and 1 month. Results: Stone-free rates were comparable (mPCNL 96.2% vs. f-URS 91.7%, p = 0.157). The f-URS group demonstrated significantly less hemoglobin decline (2.2 ± 0.9 vs. 5.7 ± 2.4 g/dL, p < 0.001) and shorter hospitalization (4.1 ± 1.1 vs. 7.8 ± 1.6 days, p < 0.001). All Grade II complications (8.3%, requiring transfusion) occurred in the mPCNL group. At 1 month, serum creatinine decreased more with f-URS (15.4 ± 7.96 vs. 8.7 ± 4.23 μmol/L, p < 0.001), with greater eGFR improvement (16.7 ± 4.7 vs. 15.4 ± 5.2 mL/min/1.73 m², p = 0.023). Conclusions: In this retrospective cohort, f-URS achieved comparable stone clearance to mPCNL alongside a superior early safety profile and better short-term renal functional preservation. These preliminary findings suggest that f-URS represents a viable nephron-sparing option for this high-risk population. However, these results are considered hypothesis-generating, and further prospective, long-term studies are required to evaluate the durability of these functional benefits. Full article

Despite the known association between calcium and magnesium in drinking water and stone risk, the difference in stone prevention of purified water remineralized with varying calcium-to-magnesium ratios (Ca:Mg) remains unclear. Objectives: This study investigates the impact of different Ca:Mg in the remineralization of purified water on calcium oxalate crystallization and renal injury. Methods: Sixty male Sprague-Dawley rats were induced calcium oxalate crystals by a sodium oxalate diet and divided into six groups, where they drank purified water with or without remineralized varying Ca:Mg (0.5, 3.4, 10, 20, 100). Serum and urine biomarkers of renal function, renal injury, mineral metabolism, bone metabolism, and urine calcium oxalate crystals were detected. Kidneys were isolated for pathological examination. Results: Findings showed that remineralization by 0.5 and 3.4 Ca:Mg significantly reduced urinary calcium oxalate crystallization, renal injury, and improved renal function, while extreme ratios (Ca:Mg over 10) showed no benefits. Conclusions: These results elucidate the pathophysiological effects of Ca:Mg in drinking water on renal health, particularly emphasizing the protective role of the 0.5 and 3.4 in inhibiting calcium oxalate crystallization and mitigating renal injury. It provides a quantifiable reference for purified water remineralization aimed at stone prevention. Full article