International Journal of Nephrology and Renovascular Disease最新文献

{"title":"Erratum: Safety and Efficacy of Therapeutic Plasma Exchange in Pediatric Non-Neurological Diseases [Corrigendum].","authors":"","doi":"10.2147/IJNRD.S637120","DOIUrl":"10.2147/IJNRD.S637120","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2147/IJNRD.S572328.].</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"637120"},"PeriodicalIF":2.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13361765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spatiotemporal Heterogeneity and the Impact of PM1 and Nitrogen Oxides on Chronic Kidney Disease Mortality in 39 European Countries (1990-2022): A Multi-Model Analysis.","authors":"Yuhe Si, Chunbao Mo, Qianqian Zhang, Yuchang Ma, Yukai Ye, Yunhao Jia, Jiahua Qian, Yihao Chen, Dian Wang, Jianxiong Ma","doi":"10.2147/IJNRD.S609735","DOIUrl":"10.2147/IJNRD.S609735","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) has become a significant public health burden in Europe, with marked spatiotemporal heterogeneity. Nitrogen oxides (NOx) and fine particulate matter (PM) are considered important environmental risk factors; however, the association of submicron particulate matter (PM1) with CKD mortality and the potential non-linear exposure-response patterns of these pollutants remain insufficiently characterized.</p><p><strong>Methods: </strong>In this ecological study, national-level aggregated data from 39 European countries from 1990 to 2022 were analyzed. Environmental exposure was assessed using population-density-weighted exposure estimates, and spatial heterogeneity was analyzed using a Geodetector approach. Linear mixed-effects models (LMM) and generalized additive mixed models (GAMM) were used to investigate the associations between environmental factors and age-standardized CKD mortality rates (ASMR). XGBoost, combined with SHAP interpretation tools, quantified the relative contributions and identified non-linear thresholds. Finally, a partial correlation network analysis revealed the interaction structures among environmental factors.</p><p><strong>Results: </strong>After adjusting for confounders, NOx and particulate matter exposures showed significant positive correlations with CKD mortality risk. LMM revealed a pronounced \"particle size effect\": the coefficient for PM1 (β = 0.220 deaths per 100,000 population on the raw ASMR scale) was higher than that for PM2.5 (0.199) and PM10 (0.141). GAMM results supported the robustness of these associations on the logit-transformed proportional scale, and higher HDI was inversely associated with CKD mortality (β_IQR = -0.056). XGBoost and LOESS analyses further revealed non-linear characteristics: particulate matter exposure exhibited an S-shaped saturation curve, whereas NOx exposure displayed a J-shaped threshold effect (with risk steeply increasing beyond 9 ppb). Network analysis indicated a strong positive correlation between high temperatures and CKD mortality (r = 0.42), whereas humidity was inversely correlated. Spatial detection further identified PM1 as the strongest explanatory factor of spatial variation in European CKD mortality rates (q = 0.243). Conversely, a higher Human Development Index (HDI) exhibited relatively robust protective effects against CKD mortality (β = -0.056).</p><p><strong>Conclusion: </strong>Our findings suggest that CKD mortality in Europe may be associated with NOx and fine PM (particularly PM1) exposure, which exhibit complex non-linear relationships. These findings support further evaluation of submicron particulate matter in environmental monitoring frameworks and suggest that transport-related pollution and heat-related climatic conditions warrant attention in strategies aimed at reducing regional CKD mortality disparities.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"609735"},"PeriodicalIF":2.3,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13356847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Disease in Advanced Chronic Kidney Disease in a Tertiary Institution, Johannesburg, South Africa.","authors":"Zikho Mbenya, Unati Nqebelele, Umar G Adamu, Dineo Mpanya, Nqoba Tsabedze, Mduduzi Mashabane","doi":"10.2147/IJNRD.S595470","DOIUrl":"10.2147/IJNRD.S595470","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with advanced chronic kidney disease (CKD). However, data on its prevalence and patterns in Sub-Saharan Africa remain scarce.</p><p><strong>Purpose: </strong>To determine the prevalence and spectrum of CVD among patients with advanced CKD in Johannesburg, South Africa.</p><p><strong>Patients and methods: </strong>This retrospective study enrolled adults aged ≥18 years with advanced CKD attending the renal clinic at Chris Hani Baragwanath Academic Hospital between 2009 and 2018. Demographic, clinical, laboratory, electrocardiographic, and echocardiographic variables were extracted from medical records. CVD was defined as heart failure, ischemic heart disease, arrhythmias, non-rheumatic valvular heart disease, pericardial disease, stroke, or peripheral vascular disease, supplemented by clinical, electrocardiographic, or echocardiographic findings. Patients were grouped by their CVD status. Multivariable logistic regression identified independent factors associated with CVD.</p><p><strong>Results: </strong>Among 300 participants (mean age of 55.3 ± 15.0 years, 54.3% males), CVD prevalence was 58.7%. The mean age at CVD diagnosis was 46.6 ± 13.7 years, with a median interval of 8.3 months (IQR, 2.5-27.6) between the onset of CKD and CVD diagnosis. Patients with CVD were younger than those without (52.8 ± 13.8 vs 58.8 ± 16.0 years; <i>p</i><0.001), had higher diastolic blood pressure (88.5 ± 20.6 vs 81.3 ± 17.6 mmHg; <i>p</i> = 0.002), and a higher prevalence of obesity (54.6% vs 38.7%; <i>p</i><0.001). Predominant CVD manifestations were ischemic ECG changes (95.1%) and diastolic dysfunction with heart failure (45.5%). Higher diastolic blood pressure (aOR 1.04; 95% CI 1.00-1.08; <i>p</i> = 0.029) and reduced estimated GFR (aOR 0.96; 95% CI 0.94-0.99; <i>p</i> = 0.022) were independent predictors of CVD.</p><p><strong>Conclusion: </strong>CVD is highly prevalent in advanced CKD and occurs at a young age. Early cardiovascular risk assessment and integrated cardio-renal management strategies are essential in this high-risk population.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"595470"},"PeriodicalIF":2.3,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13313005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective Effect of Biochanin A on the Diabetes-Induced Renal Damage.","authors":"Maryam Eskandari Mehrabadi, Atefeh Soltani, Amirali Mottaghi, Zahra Salemi","doi":"10.2147/IJNRD.S603484","DOIUrl":"10.2147/IJNRD.S603484","url":null,"abstract":"<p><strong>Objective: </strong>Angiogenesis and oxidative stress contribute to the pathogenesis of diabetic nephropathy (DN). The isoflavone biochanin A (BCA) has reported anti-inflammatory and antioxidant properties; we evaluated whether BCA modulates inflammatory and angiogenic markers in renal tissue of streptozotocin-induced diabetic rats.</p><p><strong>Materials and methods: </strong>Thirty-six male Wistar rats (180-200 g) were randomized into six groups (n = 6): non-diabetic control (vehicle), diabetic control (STZ 55 mg/kg, i.p.), and two diabetic groups treated with BCA (10 or 15 mg/kg; Oral). Treatments were administered for 42 days. On day 42 animals were sacrificed and blood and renal tissues collected. Renal VEGF, TNF-α, IL-1β, IL-6, IL-18, NF-κB, TGF-β, RAGE, CTGF, and MDA were measured by ELISA. Renal tissues evaluate histopathologically for mesangial expansion, cellularity, and angiogenesis.</p><p><strong>Results: </strong>BCA treatment reduced fasting blood glucose in diabetic rats and significantly decreased renal VEGF, TNF-α, and IL-1β concentrations versus diabetic controls (p < 0.05). No clear dose-response was observed between 10 and 15 mg/kg; other markers showed non-significant trends toward improvement.</p><p><strong>Conclusion/discussion: </strong>BCA reduced key angiogenic and proinflammatory markers in diabetic rat kidney, suggesting potential nephroprotective effects; further studies are needed to define mechanisms, optimal dosing, and long-term safety.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"603484"},"PeriodicalIF":2.3,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13229966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Metabolomic Profiling Reveals Distinct Signatures and Candidate Biomarkers in Chronic Kidney Disease.","authors":"Huimin Jin, Yun Gao, Haochen Zhang, Hanbing Li, Wenqi Wang, Keyi Zhang, Fenghua Zhang","doi":"10.2147/IJNRD.S597353","DOIUrl":"10.2147/IJNRD.S597353","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Chronic kidney disease (CKD) is accompanied by systemic metabolic dysregulation, and metabolomics provides a robust approach for identifying disease-specific metabolic signatures and potential biomarkers. Hypertension may be closely associated with metabolic disturbances in CKD. This study aimed to characterize serum metabolic alterations and dysregulated pathways in CKD, and screen candidate metabolite biomarkers for distinguishing CKD patients from healthy individuals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 65 participants (35 CKD patients and 30 healthy controls) were enrolled in this study. Serum metabolic profiling was performed using high-resolution mass spectrometry-based untargeted metabolomics, while targeted analysis of small molecule metabolites was conducted via liquid chromatography-mass spectrometry (LC-MS). Multivariate statistical analyses including principal component analysis (PCA) and orthogonal partial least squared-discriminant analysis (OPLS-DA) were applied to identify metabolic alterations between groups. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was used to annotate the functional roles of differentially expressed metabolites. Independent t-tests and Pearson correlation analyses were performed to validate the expression and correlation of key metabolites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1,426 metabolites were detected in all serum samples, with 1,246 successfully identified by secondary mass spectrometry. Differential analysis revealed 397 significantly altered metabolites (216 up-regulated and 181 down-regulated) between the CKD and control groups. KEGG enrichment analysis indicated that these differential metabolites were mainly involved in phenylalanine metabolism, arginine and proline metabolism, and glutathione metabolism, suggesting systemic metabolic dysfunction in CKD. Targeted analysis of catecholamines showed that serum concentrations of adrenaline and nicotinamide mononucleotide (NMN) were significantly altered in CKD patients compared with healthy controls (P &lt; 0.05), though no significant linear correlation was observed between these two metabolites and CKD progression via Pearson correlation analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The identified metabolic pathway dysregulations (amino acid metabolism and redox-related pathways) are core metabolic characteristics of CKD, which are closely associated with renal function impairment, oxidative stress and hypertension in CKD. Adrenaline and NMN may serve as potential candidate biomarkers for CKD, and their abnormal expression may be linked to the activation of the renin-angiotensin system and dysregulation of renal energy metabolism. However, the specific mechanistic roles of these two metabolites in CKD pathophysiology remain to be elucidated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study comprehensively characterized serum metabolic alterations in CKD and identified key dysre","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"597353"},"PeriodicalIF":2.3,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation and Evaluation of SPP1 as a Candidate Biomarker for Disease Monitoring in Focal Segmental Glomerulosclerosis.","authors":"Shanshan Li, Qinglin Ye, Qiuyan Tan, Xiaolai Li, Jing Huang, Boning Hu, Rirong Yang, Wei Li","doi":"10.2147/IJNRD.S593671","DOIUrl":"10.2147/IJNRD.S593671","url":null,"abstract":"<p><strong>Background: </strong>Secreted phosphoprotein 1 (SPP1), a glycoprotein encoded by the SPP1 gene, can be detected in body fluids and tumor tissues of various diseases, representing a promising candidate biomarker. However, its application in focal segmental glomerulosclerosis (FSGS) remains at the exploratory stage.</p><p><strong>Patients and methods: </strong>In a small-scale cohort, Bulk-RNA sequencing was employed to screen for core differentially expressed genes in urinary cells of FSGS patients, with SPP1 identified as a key candidate. RT-qPCR and ELISA were subsequently used to detect SPP1 expression in clinical urine samples. An adriamycin (ADR)-induced FSGS mouse model was established, and renal histopathological changes were evaluated using hematoxylin-eosin (HE), periodic acid-Schiff (PAS), and Masson staining. Immunohistochemistry and immunofluorescence were performed to examine the expression of SPP1, fibronectin, and F4/80 in renal tissues, with assessment of the effects of prednisone intervention.</p><p><strong>Results: </strong>Urinary SPP1 expression was significantly elevated in FSGS patients, particularly in those with CKD stage III. In the ADR mouse model, as glomerulosclerosis progressed, albuminuria levels increased, accompanied by enhanced expression of SPP1 and F4/80-positive macrophages. Prednisone treatment attenuated these parameters.</p><p><strong>Conclusion: </strong>SPP1 is involved in the progression of FSGS and is closely associated with renal immune inflammation and fibrosis. Prednisone exerts renoprotective effects by downregulating SPP1 expression and inhibiting macrophage infiltration, suggesting that SPP1 represents a promising molecular marker for disease monitoring and targeted intervention in FSGS.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"593671"},"PeriodicalIF":2.3,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IgA Dominant Infection Related Glomerulonephritis Mimicking Primary IgA Nephropathy in Methicillin-Sensitive <i>Staphylococcus aureus</i> Osteomyelitis.","authors":"Brandon Klor, Prakrati C Acharya, Ijemma Cunningham, Antonin Jaros, Bhagwan Dass","doi":"10.2147/IJNRD.S578405","DOIUrl":"10.2147/IJNRD.S578405","url":null,"abstract":"<p><p>IgA-dominant infection-related glomerulonephritis (IgA-IRGN) is a histopathological variant of staphylococcus-associated glomerulonephritis (SAGN) that occurs as a result of an immune response to <i>S. aureus</i> antigens, with subsequent deposition of IgA in the nephron. This can lead to acute kidney injury, hematuria, and proteinuria. It is important to differentiate IgAIRGN from primary IgA nephropathy (IgAN) because the treatment strategies differ. IgA-dominant IRGN requires treatment of the infection with antibiotics, whereas treatment of primary IgAN involves immunosuppression. Here, we present a case that highlights the clinical dilemma of distinguishing IgA nephropathy from IRGN. Our patient presented with chronic osteomyelitis secondary to Staph. The hospital course was complicated by acute renal failure that required dialysis. Renal biopsy showed IgA deposits, and the patient was initially treated with steroids for IgA Nephropathy. The patient did not respond to immunosuppressive treatments and had a second biopsy, clinical history, and course that closely resembled IgA-IRGN. The patient was eventually removed from dialysis after five months. In patients with documented <i>S. aureus</i> infection who present with acute kidney injury, hematuria, and proteinuria, IgA-IRGN should be considered as the etiology. Source control measures should be attempted when necessary and patients should be treated with an appropriate course of antibiotics. Proper diagnosis is important to avoid exposure to immunosuppressive medications and potentially worse outcomes in these patients.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"578405"},"PeriodicalIF":2.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147929575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Doppler Ultrasound Parameters as Predictors of Arteriovenous Fistula Maturation in End-Stage Renal Disease: A Prospective Cohort Study.","authors":"Somayeh Haji Ahmadi, Shokouh Sadeghi Zadeh, Morteza Shahbandari, Mohammadreza Elhaie","doi":"10.2147/IJNRD.S604523","DOIUrl":"10.2147/IJNRD.S604523","url":null,"abstract":"<p><strong>Background: </strong>Preoperative Doppler ultrasound (DUS) is routinely used to map upper-limb vessels before arteriovenous fistula (AVF) creation, yet the predictive value of individual morphologic and hemodynamic parameters remains inconsistent. This study evaluated whether preoperative vessel diameters and flow velocities predict functional AVF maturation in end-stage renal disease (ESRD).</p><p><strong>Methods: </strong>In a prospective cohort (January 2023-June 2025), adults with ESRD undergoing first-time upper-limb AVF creation received standardized DUS within 2 weeks preoperatively. Arterial and venous internal diameters and peak systolic velocities were measured at planned access sites; measurements were obtained in triplicate and averaged. Functional maturation was defined as sustained two-needle cannulation for hemodialysis at ≥300 mL/min for ≥3 consecutive sessions within 6 months, without endovascular or surgical intervention.</p><p><strong>Results: </strong>Ninety patients were enrolled; one patient was lost to follow-up before the primary outcome assessment, leaving 89 patients for analysis. Radiocephalic (Type 1) AVFs accounted for 32/90 (35.6%) and brachiocephalic (Type 2) AVFs for 58/90 (64.4%). Overall, 66/89 (74.2%) fistulas matured and 23/89 (25.8%) failed (12 early, 11 late). Maturation was not associated with fistula type, diabetes, or hypertension. Our study suggests that Larger distal radial artery diameter was paradoxically associated with failure (2.27±0.54 mm vs 1.98±0.52 mm; p=0.037) and remained significant after multivariable adjustment (coefficient=-1.892; p=0.006). No other assessed arterial or venous diameter or peak systolic velocity predicted outcome.</p><p><strong>Conclusion: </strong>Most preoperative DUS measurements did not predict AVF maturation; however, larger distal radial artery diameter paradoxically correlated with failure. Larger multicenter studies incorporating arterial wall pathology, venous outflow resistance, and detailed hemodynamics are warranted to refine preoperative decision-making. Arterial quality may be as important as size alone.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"604523"},"PeriodicalIF":2.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma Preconditioning of Cytokine Response: Comparison of Perioperative Cytokine Profiles in Elective Cardiac versus Orthopaedic Trauma Surgery Patients.","authors":"William T McBride, Allister Irvine, Mary Jo Kurth, Joanne Watt, Gavin W McLean, John V Lamont, Peter Fitzgerald, Mark W Ruddock","doi":"10.2147/IJNRD.S580859","DOIUrl":"10.2147/IJNRD.S580859","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a sudden decline in kidney function that poses a significant risk to patients undergoing surgery. Those who develop AKI face higher morbidity and mortality rates, extended hospital stays, and an increased risk of progressing to chronic kidney disease. Previously, we recruited two distinct patient cohorts, one undergoing elective cardiac surgery and one undergoing orthopaedic fracture surgery, to investigate biomarkers involved in the pathophysiology of AKI. This study is a retrospective analysis of data from the two surgical cohorts to examine if there are any similarities between cytokine responses.</p><p><strong>Methods: </strong>Pre- and post-operative blood and urine biomarker data from elective cardiac surgery patients (n=401) and orthopaedic fracture surgery patients (n=237) were analysed to compare baseline, ratio, and delta change differences.</p><p><strong>Results: </strong>Pre-operatively, baseline levels of most biomarkers were significantly higher in orthopaedic fracture patients compared to elective cardiac surgery patients. Post-operatively, most biomarker levels remained significantly higher in orthopaedic fracture surgery patients with the exception of urinary anti-inflammatory biomarkers which were higher in cardiac patients. Pre-operatively, renally favourable biomarker ratios were significantly higher in orthopaedic fracture surgery patients compared to elective cardiac surgery patients. In contrast, post-operatively, renally favourable biomarker ratios were significantly higher in elective cardiac surgery patients. The delta differences between pre- and post-operative biomarker levels were generally higher in the elective cardiac surgery patients compared with orthopaedic fracture surgery patients.</p><p><strong>Discussion: </strong>In this study, in patients which have experienced a fracture, the trauma of the initial injury activated their pro- and anti-inflammatory cytokine responses such that renally favourable ratios prevailed pre-operatively. The further pro-inflammatory response from fracture repair (during surgery) was compensated for by an already established anti-inflammatory perioperative response, suggesting that post-operative compensatory anti-inflammatory responses do not need to be of the same magnitude compared to a non-preconditioned (eg, elective cardiac) response. Cytokine profiling perioperatively could inform clinical decision making and improve patient outcomes by reducing the likelihood of an AKI event.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"580859"},"PeriodicalIF":2.3,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13123542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of Telmisartan Plus Amlodipine Compared to Telmisartan Plus Cilnidipine in Indian Patients with Hypertension and Renal Impairment: A Randomized, Open Label, Post Marketing Study (START Renal).","authors":"Uday Jadhav, Santanu Guha, Harsh Mittal, Chinmoy Barik, Chandrashekhar S Gillurkar, Sandeep Kumar Gupta, Mukulesh Gupta, Santosh Saklecha, Mayur Jadhav, Sanjay Y Choudhari, Saiprasad Patil, Sumit Bhushan, Divakar A, Hanmant Barkate","doi":"10.2147/IJNRD.S555573","DOIUrl":"10.2147/IJNRD.S555573","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the effectiveness and safety of telmisartan-amlodipine (TA) versus telmisartan-cilnidipine (TC) fixed-dose combinations (FDCs) in patients with hypertension and renal impairment.</p><p><strong>Patients and methods: </strong>This open label, randomized, multicentric, post-marketing study was conducted in India. Adult patients with hypertension and renal impairment, receiving a stable dose of telmisartan and not on calcium channel blockers, were enrolled. Participants were randomized (1:1) to receive the TA or TC FDC for 12 months. The primary endpoint was change in the urine albumin-creatinine ratio (UACR) from baseline to 12 months. Secondary endpoints included changes in estimated glomerular filtration rate (eGFR), serum creatinine, and serum uric acid at 6 and 12 months, and office systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 3, 6, 9, and 12 months. Similar parameters were assessed in the diabetic subpopulation. Adverse events were recorded and classified using system organ classification.</p><p><strong>Results: </strong>At 12 months, the TA and TC groups showed significant reductions in UACR by 119±157.7 mg/g and 97.5±128.6 mg/g, respectively (p<0.0001 for both). Improvements in eGFR and serum creatinine were comparable between groups (p>0.05). SBP reduction was significantly greater with TA at both 9 months (20.74±12.75 vs. 16.9±13.66) mmHg, (p=0.0430)] and 12 months (25.4±14.25 vs. 20.6±10.94) mmHg, (p=0.0397)], while DBP reductions were similar. The diabetic subgroup showed a superior SBP reduction favoring the TA group -24.5 (±13.75) mmHg (p≤.0001) Vs -18.9 (±10.68) mmHg (p≤.0001) while the renal parameters were similar between the two groups. A total of 17 mild drug-related adverse events were reported (TA: 8; TC: 9), with no serious events.</p><p><strong>Conclusion: </strong>Both the TA and TC FDCs were effective and well tolerated when treating hypertension with renal impairment. The TA FDC may provide better BP reduction with similar reno-protective benefits than the TC FDC.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"19 ","pages":"555573"},"PeriodicalIF":2.3,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13094586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}