The latest medical research on Kidney Cancer
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Request AccessAssociation between Monocyte-to-Lymphocyte Ratio and Inflammation in Chronic Kidney Disease : A Cross-Sectional Study.
Kidney and Blood Pressure ResearchInflammation plays a key role in chronic kidney disease (CKD). Monocyte-to-lymphocyte ratio (MLR) is a novel inflammatory marker. The purpose of this study was to evaluate the relationship between MLR and inflammation in CKD patients.
In total, 1809 subjects were recruited from Wanzhai Town, Zhuhai City, between December 2017 and March 2018 for a cross-sectional survey. Patients were categorized based on the absence (hypersensitive C-reactive protein (hsCRP) level ≦ 3 mg/L) or presence (hsCRP level > 3 mg/L) of inflammation. Logistic regression models and MLR quartiles were used to explore the relationship between MLR and inflammation in CKD patients.
Among 1809 subjects, 403 (22.2%) had CKD. Significant differences in systolic blood pressure, estimated glomerular filtration rate, white blood cell (WBC), neutrophil, monocyte, MLR, and Interleukin-6 (IL-6) levels were observed between noninflammatory group and inflammatory group. The highest MLR quartile had higher Scr, WBC, neutrophil, monocyte, IL-6, and hsCRP values and lower eGFR and lymphocyte values. Comparing the lowest quartile of MLR, the OR (95% CI) of inflammation risk in the highest quartile was 2.30 (1.24-4.27) after adjustment for confounding factors. The area under the curve of MLR for predicting inflammation was 0.631. The cutoff point for the MLR was 0.153.
A high MLR was significantly and independently associated with inflammation in patients with CKD, making MLR a potential marker for inflammation in this demographic. MLR may also predict the severity of CKD.
Prevalence of Chronic Kidney Disease among diagnosed and undiagnosed hypertensive individuals in the general population of the northern region of Senegal.
Kidney and Blood Pressure ResearchChronic kidney disease (CKD) is closely linked to high blood pressure (HBP) which is its leading cause in developing countries. Hypertension affect 1.2 billion people worldwide. However, a significant portion of individuals with HBP are undiagnosed and their kidney function is even less known. The objective of this study was to determine the prevalence and associated factors of chronic kidney disease among three sub-groups of blood pressure status (normotensive, diagnosed hypertension and undiagnosed hypertension) individuals.
We conducted a cross-sectional study in the general population of three northern regions in Senegal using a two-level cluster sampling method. The sample was constituted with a precision of 5% and a power of 80%, with an additional 10% attrition margin. Individuals aged 18 - 80 years were included in the study after consent. Pregnant women, hospitalized persons within the past three months, patients with general or urinary symptoms within the past seven days and individuals undergoing renal replacement therapy were excluded. Investigators collected Clinical and biological data at participants' homes using a modified version of the WHO's STEPwise questionnaire. Samples were collected for biochemical analysis (serum creatinine, lipid profile and blood sugar). Estimated GFR was calculated using the CKD-EPI 2021 formula.
A total of 2441 participants were included in the study with a mean age of 45.4 +/- 16.0 years and a sex ratio M/F of 0.4. The Overall prevalence of HBP and CKD were respectively 52.0% and 17.8%. Three out of every five hypertensive patients were undiagnosed. Chronic kidney disease was more frequent among known hypertensive patients (30.5%) compared to individuals with undiagnosed hypertension (19.1%) and normotensive individuals (10.9%). Multivariate analysis showed that CKD was associated with older age and female sex.
Undiagnosed hypertension is common among populations in northern Senegal. A high prevalence of CKD was found among both diagnosed and undiagnosed individuals with hypertension. Extending strategies for early detection and management in the general population could help prevent or reduce morbidity and mortality associated with CKD.
Aldosterone synthase inhibitors for cardiorenal protection: ready for prime time?
Kidney and Blood Pressure ResearchAldosterone, through its genomic and non-genomic effects, plays an important role in cardiovascular and renal injury. Steroidal mineralocorticoid receptor antagonists (MRAs) are fundamental to offset the aldosterone-mediated cardiorenal damage, but side effects may limit their use in a substantial proportion of patients. On the other hand, non-steroidal mineralocorticoid receptor antagonists (NS-MRA) showed improved selectivity and safety profile. However, interfering with the MRA could only partially inhibit aldosterone mediated effect both because of escaping mechanisms and potential non-genomic activity.
A recent randomized clinical trial showed a significant benefit of ASIs in patients with chronic kidney disease and albuminuria. However, further outcome based clinical trials are needed to confirm the promising role of ASIs in cardiorenal damage.
Association of urinary EGF, FABP3, and VCAM1 levels with the progression of early diabetic kidney disease.
Kidney and Blood Pressure ResearchIntroduction Diabetic kidney disease (DKD) is a common cause of chronic kidney disease with around 25-40% of patients with diabetes being affected....
Exploring the spatial distribution of interstitial cells in kidney tissue.
Kidney and Blood Pressure ResearchInterstitial cells are crucial to the development of kidney structure and function, although the mechanism underlying their role in it remains unclear to date. Our previous study identified cell clusters in human fetal kidney tissue, and we further analyzed the interstitial cell cluster within this context.
We extracted the barcoded cDNA from tissue samples and prepared spatial transcriptome libraries. Sequencing data was quality-checked, normalized, and clusters were identified using Seurat. Single-cell and spatial data were integrated using MIA and cell types were deconvoluted. DEGs in interstitial cells were identified and functionally annotated using DAVID. CellPhoneDB was used to predict ligand-receptor interactions between cell types.
The results of the present study revealed that this cluster of interstitial cells appeared to be scattered in the junction between the cortical and medullary regions. The subsequent KEGG pathway analysis revealed that the differentially expressed genes (DEGs) in this cluster of interstitial cells were involved in the WNT signaling pathway. The Gene Ontology (GO) analysis revealed that these DEGs were involved in multiple pathways associated with kidney development, with six of the genes (NKD2, TCF21, WNT5A, WNT4, MDK, and SFRP1) associated with kidney development exhibiting significant upregulation. Accordingly, it was inferred that these interstitial cells might be involved in regulating epithelial cell differentiation, ureteral bud development, and morphogenesis. The subsequent cell-cell communication analysis revealed that the cellular crosstalk was primarily regulated mainly by ligand-receptor pairs. Additionally, 17 genes reported to be associated with kidney disease were focused on, and these genes were found to be predominantly expressed in a single cell type.
In summary, the present study revealed the characteristics of a previously identified cluster of interstitial cells in the kidney tissue, thereby providing fresh insights into the process of kidney development.
Correlation between Fundus Damage and Renal Function Deterioration in Chronic Kidney Disease Patients.
Kidney and Blood Pressure ResearchThis study aimed to explore the correlation between the extent of fundus damage and the severity strategies for chronic kidney disease (CKD).
We collected data from 118 CKD patients, including general information, renal function indicators, and fundoscopic examination results. The stages of CKD and degrees of fundus lesions were graded. SPSS 25.0 software facilitated the analysis of correlations using Kendall's tau-b correlation analysis and ordinal regression analysis.
Statistically significant differences were observed among multiple CKD stages in the distribution of age, systolic blood pressure, diastolic blood pressure, hemoglobin, total cholesterol, homocysteine, cystatin C, serum creatinine, blood urea, eGFR, 24-hour urine protein, urine microalbumin, urine microalbumin/urine creatinine, and blood β2 microglobulin, complement C3. Notably, the levels of cytokeratin 19 fragment and transforming growth factor β significantly increased in all CKD stages. Kendall's tau-b correlation analysis revealed a significant positive correlation between CKD stage and fundus lesion grade. Ordinal regression analysis indicated that sex differences, total cholesterol levels, and hemoglobin levels were significant predictors of fundus lesion risk. Compared with patients at stage 5 CKD, the risk of fundus damage significantly lower in patients in stage 2 and stage 3, further demonstrating a positive correlation between renal function deterioration and increased risk of fundus damage.
Routine fundus screening and early intervention for fundus lesions are vital for assessing CKD deterioration, providing new directions for future related research.
Risk factors for major bleeding among patients with chronic kidney disease treated with acetylsalicylic acid.
Kidney and Blood Pressure ResearchIndividuals with chronic kidney disease (CKD) are at increased risk for thrombotic events and bleeding. Acetylsalicylic acid (ASA), an effective antiplatelet agent, is one of the most frequently used medications for both primary and secondary prevention of cardiovascular disease (CVD). However, it can also contribute to bleeding events due to its inherent antiplatelet effect. The objective of this study was to determine the characteristics of CKD patients at increased risk for bleeding under ASA therapy.
This retrospective analysis included patients with non-dialysis dependent CKD who were treated with ASA for primary prevention of CVD for at least 3 consecutive months and did not receive anti-coagulants or anti-platelets. Data were collected from electronic medical records from January 2014 to December 2018. CKD diagnosis was based on an estimated glomerular filtration rate of <60 ml/min/1.73 m2. CKD patients who experienced major bleeding events during ASA therapy (bleeding group) vs. all others (control group) were compared. Additional outcomes included first documented non-fatal cardiovascular event and all-cause mortality.
Of the 900 adult CKD patients included in this analysis, 82 (9.1%) had a major bleeding event during 31.6±25.9 months of follow-up. The most common bleeding site was gastrointestinal (52 cases, 63.4% of major bleeding events). Patients who had a major bleeding event were older (76.5±10 vs. 74±10.3 years, P=0.038). On multivariate analysis, age was the most important predictor of major bleeding event (odds ratio 1.029, 95% confidence interval 1.004-1.056).
Given its controversial efficacy in primary prevention of CVD in CKD patients, characterizing those at increased risk for bleeding under ASA therapy is important in the era of tailored medicine. Age, CKD stage and cardiovascular risk are key factors to consider regarding the safety and effectiveness of ASA for CKD patients.
Multidimensional assessment of physical function for people in dialysis: the Rehabilitation in hEmodialysis Area Centro Toscana (REACT) Study.
Kidney and Blood Pressure ResearchBACKGROUNDː Physical performance is poorly addressed in dialysis patients, due to several clinical and organizational barriers. In this study we in...
METABOLIC ALKALEMIA IN HYPERCALCIURIA STONE FORMERS: DOES IT MATTER?
Kidney and Blood Pressure ResearchTThe literature lacks whether metabolic alkalemia occurs in outpatients with hypercalciuric nephrolithiasis. Thus, we aim to investigate it because these patients are often treated with thiazides to reduce urinary calcium excretion. However, thiazides induce chloride losses due to the inhibition of Na-Cl cotransporter expressed in the renal distal tubule cells. Besides thiazide prescription, many of these patients are also supplemented with potassium citrate, which is an addition of alkali source in their bodies.
We collected clinical, demographic characteristics, and laboratory data from electronical medical charts of outpatients with calcium-kidney stones followed in our institution from January 2013 to July 2021. We diagnosed as metabolic alkalemia those cases in which the venous blood gas tests showed pH≥7.46 and bicarbonate concentration>26 mEq/L. Then, we applied statistical analysis to compare distinct categories between patients with and without metabolic alkalemia.
We diagnosed metabolic alkalemia in 4.3% of hypercalciuric nephrolithiasis outpatients, and we verified that thiazides had been used in all of them except in one case. Furthermore, we observed that the amount of thiazide taken daily was higher in patients with metabolic alkalemia than those without this imbalance. Additionally, hypokalemia was present in 37% of patients that developed metabolic alkalemia. We also found lower chloride, magnesium and ionic calcium serum concentrations in patients with metabolic alkalemia than in those without an acid-base disequilibrium.
Despite the low prevalence of metabolic alkalemia in hypercalciuric kidney stone formers, it is important to monitor these patients due to high incidence of hypokalemia and the potential presence of other electrolyte disorders.
Nutrition and Physical Activity in Older Adults with CKD patients: Two Sides of the Same Coin.
Kidney and Blood Pressure ResearchNutrition and physical activity are two major issues in the management of CKD patients who are often older, have comorbidities and are prone to malnutrition and physical inactivity, conditions that cause loss of quality of life and increase the risk of death. We performed a multidimensional assessment of nutritional status and of physical performance and activity in CKD patients on conservative therapy in order to assess the prevalence of sedentary behaviour and its relationship with body composition.
115 consecutive stable CKD patients aged 45-80 years were included in the study. They had no major skeletal, muscular or neurological disabilities. All patients underwent a multidimensional assessment of body composition, physical activity and exercise capacity.
Sedentary patients, as defined by mean daily METs < 1.5 were older and differed from non-sedentary patients in terms of body composition, exercise capacity and nutrient intake, even after adjusting for age. Average daily METs were positively associated with lean body mass, muscle strength, 6-MWT performance, but negatively associated with fat body mass, body mass index and waist circumference. In addition, a sedentary lifestyle may have negative effects on free fat mass, muscle strength and exercise capacity, and may increase fat body mass. Conversely, s decrease in muscle mass and/or an increase in fat mass may lead to a decrease in physical activity and exercise capacity.
There is a clear association and potential interrelationship between nutritional aspects and exercise capacity in older adults with CKD: they are really the two sides of the same coin.
Bidirectional Impact of Varying Severity of Acute Kidney Injury on Calcium Oxalate Stone Formation.
Kidney and Blood Pressure ResearchAcute Kidney Injury (AKI) is a prevalent renal disorder. The occurrence of AKI may promote the formation of renal calcium oxalate stones by exerting continuous effects on renal tubular epithelial cells. We aimed to delineate the molecular interplay between AKI and nephrolithiasis.
A mild (20 min) and severe (30 min) renal ischemia-reperfusion injury model was established in mice. Seven days after injury, calcium oxalate stones were induced using glyoxylate (Gly) to evaluate the impact of AKI on the formation of kidney stones. Transcriptome sequencing was performed on tubular epithelial cells (TECs) to elucidate the relationship between AKI severity and kidney stones. Key transcription factors (TF) regulating differential gene transcription levels were identified using motif analysis, and pioglitazone, ginkgetin, and fludarabine were used for targeted therapy to validate key transcription factors as potential targets for kidney stone treatment.
Severe AKI led to increased deposition of calcium oxalate crystals in renal, impaired kidney function, and upregulation of kidney stone-related gene expression. In contrast, mild AKI was associated with decreased crystal deposition, preserved kidney function, and downregulation of similar gene expression. Transcriptomic analysis revealed that genes associated with inflammation and cell adhesion pathways were significantly upregulated after severe AKI, while genes related to energy metabolism pathways were significantly upregulated after mild AKI. An integrative bioinformatic analysis uncovered a TF regulatory network within TECs, pinpointing that PKNOX1 was involved in the upregulation of inflammation-related genes after severe AKI, and inhibiting PKNOX1 function with Pioglitazone could simultaneously reduce the increase of calcium oxalate crystals after severe AKI in kidney. On the other hand, motif analysis also revealed the protective role of STAT1 in the kidneys after mild AKI, enhancing the function of STAT1 with Ginkgetin could reduce kidney stone formation, while the specific inhibitor of STAT1, Fludarabine, could eliminate the therapeutic effects of mild AKI on kidney stones.
Inadequate repair of tubular epithelial cells after severe AKI increases the risk of kidney stone formation, with the upregulation of inflammation-related genes regulated by PKNOX1 playing a role in this process. Inhibiting PKNOX1 function can reduce kidney stone formation. Conversely, after mild AKI, effective cell repair through upregulation of STAT1 expression can protect TEC function, reduce stone formation, and activating STAT1 function can also achieve the goal of treating kidney stones.
Association Between Changes in Preoperative Serum Creatinine and Acute Kidney Injury After Cardiac Surgery: A Retrospective Cohort Study.
Kidney and Blood Pressure ResearchLimited information exists regarding the impact of preoperative serum creatinine changes on cardiac surgery-associated acute kidney injury (CSA-AKI). This study aimed to investigate the development of AKI in patients with a baseline estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m2 who present with an elevation in preoperative serum creatinine.
This retrospective cohort study assessed patients who underwent open-heart surgery. Preoperative serum creatinine change was calculated as the ratio of the maximum preoperative serum creatinine value to the baseline creatinine (MCR). Patients were categorized into three groups based on MCR: non-elevation (≤1.0), mild elevation (1.0 to 1.5), and pronounced elevation (≥1.5). Multivariable logistic regression was used to estimate the risk of AKI, severe AKI, and non-recovery from AKI.
There were significant increases in the odds of AKI (adjusted odds ratio [OR], 1.42; 95% confidence interval [CI], 1.29-1.57; per 0.1 increase in MCR), severe AKI (adjusted OR, 1.28; 95% CI, 1.15-1.41), and AKI non-recovery (adjusted OR, 1.29; 95% CI, 1.16-1.43). Pronounced elevation in preoperative serum creatinine was associated with a higher risk of AKI (adjusted OR, 15.45; 95% CI, 6.63-36.00), severe AKI (adjusted OR, 3.62; 95% CI, 1.20-10.87), and AKI non-recovery (adjusted OR, 4.74; 95% CI, 1.63-13.89) than non-elevation. Mild elevation in preoperative serum creatinine was also significantly associated with AKI (adjusted OR, 3.76; 95% CI, 1.92-7.37).
Elevation in preoperative serum creatinine from baseline was associated with an increased risk of AKI; even mild elevation significantly increased the risk of AKI.
