International Urology and Nephrology最新文献

{"title":"The impact of COVID-19 on sexual behavior, male sexual function, and reproductive health: an interdisciplinary narrative review from a urological perspective.","authors":"G Della Rosa, M Raffo, S Tammaro, M Morelli, D Arcaniolo, S D Pandolfo, C Sciorio, L Romano, C Manfredi, L Cindolo, M De Sio, L Spirito","doi":"10.1007/s11255-026-05190-5","DOIUrl":"10.1007/s11255-026-05190-5","url":null,"abstract":"<p><p>The COVID-19 pandemic profoundly modified daily life and interpersonal relationships, with relevant consequences on sexual health, which integrates biological, psychological, and social components. This narrative review summarizes current evidence regarding the impact of the pandemic on sexual behavior, sexual function, and male reproductive health. A comprehensive literature search of recent studies and clinical reports was performed focusing on psychosexual wellbeing, erectile function, fertility, and healthcare access during and after infection or lockdown periods. Current evidence indicates that lockdown-related stress, anxiety, and depression were consistently associated with reduced sexual desire and frequency of sexual activity, as reported in predominantly cross-sectional, questionnaire-based studies conducted during lockdown periods, particularly among couples with children and non-cohabiting partners, whereas alternative sexual practices increased. Sexual activity generally recovered after restrictions were lifted. Emerging data suggest a possible association between COVID-19 and erectile dysfunction mediated by endothelial damage, hypogonadism, and psychological distress, while long-COVID symptoms may further worsen sexual function. Male fertility alterations related to inflammatory and oxidative stress pathways have also been reported. Overall, the pandemic primarily affected sexuality through psychosocial mechanisms, although potential organic effects of SARS-CoV-2 infection on erectile function and fertility cannot be excluded. This review provides an interdisciplinary synthesis of current evidence with a specific focus on clinically relevant urological implications, including erectile dysfunction and male reproductive health, which remain incompletely addressed in the existing literature.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4549-4555"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative performance of predictive nomograms for pathological upstaging in clinical T1 renal masses: an independent external validation.","authors":"Yanay Shaked, Boris Kaptzan, Ron Marom, Michael Vainrib, Amos Neheman, Omri Schwarztuch Gildor","doi":"10.1007/s11255-026-05232-y","DOIUrl":"10.1007/s11255-026-05232-y","url":null,"abstract":"<p><strong>Background: </strong>Preoperative identification of pathological upstaging (≥ pT3a) in clinical T1 (cT1) renal masses is critical for surgical planning. We externally validated three established predictive models, Barra, Nocera, and Mei, to assess their discrimination, calibration, and clinical utility in a contemporary cohort.</p><p><strong>Patients and methods: </strong>We retrospectively reviewed patients undergoing surgery for cT1 renal masses at our institution. The primary endpoint was pathological upstaging to pT3a. Model performance was evaluated using the Area Under the Curve (AUC) for discrimination and the Brier Score for overall accuracy. Calibration was assessed using parametric and nonparametric Loess-smoothed curves. Clinical utility was quantified using Standardized Decision Curve Analysis.</p><p><strong>Results: </strong>The institutional upstaging rate was 17.1% (19/111), and clear cell histology predominated (77.5%). Nocera (AUC = 0.736) and Barra (AUC = 0.733) had higher point estimates of discriminative ability than Mei (AUC = 0.677), but the differences were not significant. All models descriptively overestimated absolute risk. However, Mei demonstrated the highest absolute calibration stability, whereas the Nocera model showed significant global unreliability (U = 0.052, p = 0.021). The Barra model achieved the lowest overall error (Brier Score = 0.122) and the highest clinical net benefit within the decisive 8%-18% decision window, although the overall accuracy differences were not statistically significant.</p><p><strong>Conclusion: </strong>All nomograms are useful risk-stratification adjuncts, but wide confidence intervals and low event counts mean these findings are exploratory. No single model is definitively superior. Nocera and Barra are effective for relative risk-ranking, while Mei provides superior absolute precision for patient counseling.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4783-4790"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of behavioral therapy and different dosages of mirabegron for the treatment of male overactive bladder patients.","authors":"You-Ting Tsai, Yao-Chi Chuang, Hung-Jen Wang, Wei-Chia Lee, Yuan-Chi Shen","doi":"10.1007/s11255-026-05220-2","DOIUrl":"10.1007/s11255-026-05220-2","url":null,"abstract":"<p><strong>Purpose: </strong>Behavioral therapy is the established first-line treatment for overactive bladder (OAB), followed by pharmacotherapy as the second-line intervention. Mirabegron, a β3-adrenoceptor agonist, has demonstrated comparable efficacy to antimuscarinics. This study aims to evaluate the real-world efficacy of behavioral therapy, both as a monotherapy and in combination with mirabegron, for male patients with OAB.</p><p><strong>Methods: </strong>This pooled analysis from three studies involved 280 adult male OAB patients assigned to behavioral therapy alone or combined with mirabegron (25 mg or 50 mg) for 12 weeks. The primary outcome was the change in the Overactive Bladder Symptom Score (OABSS) from baseline to week 12. Secondary outcomes included changes in the International Prostate Symptom Score (IPSS), Patient Perception of Bladder Condition (PPBC), Quality of Life (QOL) score, maximum flow rate (Qmax), and post-void residual (PVR) volume.</p><p><strong>Results: </strong>At week 12, all groups exhibited significant within-group improvements in total OABSS, with no statistically significant inter-group differences. Significant improvements were also observed in the IPSS, QOL, PPBC, urge urinary incontinence (UUI), and nocturia across all groups. Notably, behavioral therapy demonstrated substantial therapeutic potential for storage symptoms (IPSS storage sub-score), particularly regarding UUI and nocturia. No negative impacts on PVR or Qmax were observed across the three treatment arms at week 12.</p><p><strong>Conclusion: </strong>In real-world clinical practice, both behavioral therapy and combination therapy with varied dosages of mirabegron effectively alleviate OAB symptoms in male patients without compromising voiding function. Beyond conventional pharmacotherapy, optimizing the role of behavioral therapy remains a fundamental component of comprehensive OAB management.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4757-4765"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148138099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human papillomavirus (HPV) and p16^INK4a expression in early-onset prostate cancer.","authors":"Ibrahim Erkut Avci, Hasan Yilmaz, Murat Sayan, Enes Abdullah Baynal, Busra Yaprak Bayrak","doi":"10.1007/s11255-026-05218-w","DOIUrl":"10.1007/s11255-026-05218-w","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the potential role of human papillomavirus (HPV) in early onset prostate cancer (PCa) through HPV-DNA detection and genotyping, and immunohistochemical evaluation of p16^INK4a expression.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included patients diagnosed with PCa at ≤ 55 years of age between 2010 and 2021. Patients with a familial history of PCa, incomplete medical records, immunodeficiency, or insufficient tissue for molecular analysis were excluded. Formalin-fixed, paraffin-embedded (FFPE) prostate biopsy samples were analyzed for HPV-DNA using the HPV 3.5 LCD-Array Kit (Chipron GmbH, Berlin, Germany), a multiplex PCR-based assay targeting 32 HPV genotypes. Immunohistochemical staining for p16^INK4a was performed to assess its expression. Clinical data, including PSA levels, Gleason score, ISUP grade, and EAU risk group, were compared between HPV-positive and HPV-negative cases.</p><p><strong>Results: </strong>HPV-DNA was detected in 12 of 45 cases (26.7%), with genotype 62 being the most frequent. Multiple HPV genotypes were identified in three cases (6.7%). p16^INK4a immunopositivity was observed in 91.7% of HPV-positive tumors compared with 69.7% of HPV-negative tumors (p = 0.240). HPV-positive patients showed higher ISUP grades than HPV-negative patients (p = 0.029) and were more likely to be in intermediate or high-risk groups (p = 0.028). No significant differences were observed in PSA levels or Gleason scores.</p><p><strong>Conclusion: </strong>The detection of HPV-DNA in a considerable proportion of early onset PCa specimens, together with the more frequent but not statistically significant p16^INK4a positivity in HPV-positive tumors, suggests a possible association with prostate tumor biology. However, the presence of low-risk HPV genotypes and the non-specific nature of p16^INK4a expression complicate the interpretation of a direct oncogenic role.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4767-4774"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpreting short-term eGFR improvement with telitacicept in IgA nephropathy.","authors":"Shuang Pang, Qinghao Yan, Liping Yue","doi":"10.1007/s11255-026-05253-7","DOIUrl":"10.1007/s11255-026-05253-7","url":null,"abstract":"","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"5125-5126"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum complement C3 as a candidate biomarker for monitoring progression from chronic kidney disease to kidney failure.","authors":"Cheng Chen, Xiaoyan Xie, Xuemei Chen, Jinke Geng, Yuqi He, Qi Jing, Yonghua Chen, Mutian Han","doi":"10.1007/s11255-026-05161-w","DOIUrl":"10.1007/s11255-026-05161-w","url":null,"abstract":"<p><strong>Objective: </strong>To monitor the progression of chronic kidney disease to kidney failure is a pressing clinical challenge given its increasing incidence.</p><p><strong>Methods: </strong>In a retrospective cohort of 764 patients admitted to our hospital between June 2021 and June 2024, we performed a comprehensive analysis of serum complement C3/C4 levels.</p><p><strong>Results: </strong>Longitudinal assessment revealed a progressive, dose-dependent decline in serum C3 that correlated with disease advancement from renal insufficiency to chronic renal failure and ultimately to kidney failure. To further investigate the role of C3, we utilized an adenine-induced nephropathy model in mice. C3^-/- (C3-deficient) mice exhibited heightened susceptibility to renal injury, reflected by significant elevations in urea, uric acid, and creatinine levels. Flow cytometric analysis showed an 11% reduction in renal CD19⁺ B cell infiltration in C3^-/- mice compared with wild-type controls. Mechanistically, C3 promotes B cell recruitment via the CD21/CD35 complement receptors, and these recruited B cells upregulate IL-10 to exert a renoprotective effect. Logistic regression identified serum C3 as a candidate predictive biomarker for distinguishing kidney failure.</p><p><strong>Conclusions: </strong>Serum C3 may represent a candidate biomarker worthy of further prospective validation for tracking the progression of CKD. Our research findings are expected to establish a novel prognostic framework for risk stratification of CKD patients through continuous serum C3 monitoring, offering a critical window for early intervention in end-stage renal disease.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4911-4923"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147771284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penile curvature surgery in contemporary practice: effectiveness, satisfaction, and complications after corporoplasty in a tertiary referral center.","authors":"Josvany-René Sánchez-Curbelo, Massimiliano Raffo, Gibrán Castro Treviño, Doron Vantman Luft, Álvaro Vives Suñé, José Antonio Arrús Soldi, Luis Malca Caballero, Sebastián Dumas, Maurizio De Rocco Ponce, Ricardo Contreras García, Gabino Adalid, Francesco Montorsi, Andrea Salonia, Eduard Ruiz-Castañé","doi":"10.1007/s11255-026-05245-7","DOIUrl":"10.1007/s11255-026-05245-7","url":null,"abstract":"<p><strong>Purpose: </strong>Penile curvature due to Peyronie's disease (PD) or congenital penile curvature (CPC) may impair sexual function and quality of life. We aimed to evaluate effectiveness, safety, and patient satisfaction after corporoplasty at a tertiary referral center.</p><p><strong>Methods: </strong>We retrospectively analyzed 324 men undergoing corporoplasty between 2020 and 2025. Patients were stratified according to curvature etiology (PD vs. CPC) and surgical technique (16-dot plication, Yachia, modified Nesbit, Surgisis grafting). Curvature severity was assessed during pharmacologically induced erection and classified as mild (< 30°), moderate (30-60°), or severe (> 60°). Outcomes assessed at 6-48 months included postoperative erectile function (IIEF-5), Global Assessment Questionnaire (GAQ-1/GAQ-2), satisfaction, complications, side effects, anesthesia type, and operative setting.</p><p><strong>Results: </strong>274 (84.6%) had PD and 50 (15.4%) CPC. Moderate curvature was present in 217 (67%) patients and severe curvature in 100 (31%). Local anesthesia was used in 256 (79%) cases, and 253 (78.1%) procedures were ambulatory. Overall, 181 (56%) patients reported normal postoperative erectile function, 211 (65%) improved sexual quality of life, and 249 (77%) satisfaction with surgery. Descriptively, CPC patients showed higher rates of preserved postoperative erectile function than PD patients (47 [94%] vs. 137 [50%]). Complete straightening was achieved in 298 (92%) patients, while re-curvature occurred in 26 (8%). Complications developed in 67 (20.7%) patients and side effects in 89 (27.5%), penile shortening being the most common.</p><p><strong>Conclusions: </strong>Corporoplasty provided high anatomical success and favorable patient satisfaction in both PD and CPC. CPC patients showed descriptively more favorable functional and satisfaction outcomes, while penile shortening and re-curvature represented the main determinants of dissatisfaction.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4821-4827"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From black box to glass box: explainable artificial intelligence for acute kidney injury prediction-a scoping review and the GLASS-AKI translational framework proposal.","authors":"Wan-Ling Lin, Shih-Shuan Fang, Sheng-Han Chen","doi":"10.1007/s11255-026-05241-x","DOIUrl":"10.1007/s11255-026-05241-x","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence models for acute kidney injury (AKI) prediction achieve strong discriminative accuracy, yet clinical adoption remains constrained by model opacity and alarm fatigue. Explainable artificial intelligence (XAI) methods may enhance clinician trust and alert acceptance; however, the extent of their clinical validation and implementation remains unclear.</p><p><strong>Methods: </strong>We performed a scoping review following PRISMA-ScR guidelines. PubMed, Embase, Web of Science, CINAHL, IEEE Xplore, and ACM Digital Library were searched from January 2012 through February 2026. Studies applying XAI methods to AKI prediction or management in adult inpatients were eligible. Prediction model studies were appraised using PROBAST. We additionally propose the GLASS-AKI conceptual framework as a structured research agenda derived from identified gaps.</p><p><strong>Results: </strong>Thirty-four studies met inclusion criteria (total patient population > 2.1 million). SHAP-based attribution was the most frequently reported XAI technique (26/34; 76.5%), followed by LIME (9; 26.5%), attention-weight visualization (7; 20.6%), and rule-based surrogates (5; 14.7%). Reported AUROC values ranged from 0.71 to 0.95 (median 0.84). Critically, XAI was applied as a post hoc explanation method in 88.2% of studies and did not inherently alter model discriminative performance. Prospective clinical deployment data were limited to 4 studies (11.8%). PROBAST assessment identified high overall risk of bias in 79.4% of studies, predominantly in the Analysis domain. No study integrated multi-omic biomarker signals with real-time XAI reasoning at the point of care.</p><p><strong>Conclusions: </strong>XAI methods are increasingly applied to AKI prediction models, but prospective evidence linking explainability to improved clinician behavior or patient outcomes remains limited. We propose the GLASS-AKI framework as a conceptual research agenda-not a validated system-to guide future multicenter prospective evaluation of integrated XAI-biomarker approaches.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4611-4624"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic efficacy and predictive factors for a successful outcome after platelet-rich plasma injections in men with post-prostatectomy urinary incontinence.","authors":"Chia-Cheng Yang, Yuan-Hong Jiang, Hann-Chorng Kuo","doi":"10.1007/s11255-026-05200-6","DOIUrl":"10.1007/s11255-026-05200-6","url":null,"abstract":"<p><strong>Purpose: </strong>Post-prostatectomy incontinence (PPI) is a well-recognized complication of transurethral or radical prostatectomy. Platelet-rich plasma (PRP) has been used in regenerative medicine. This study aimed to evaluate the therapeutic efficacy of repeated PRP injections into the urethral sphincter for PPI.</p><p><strong>Methods: </strong>Totally 71 patients with PPI refractory to conservative treatments. Each patient received four monthly PRP injections into the urethral sphincter. The primary endpoint was the Global Response Assessment (GRA) score for urinary incontinence improvement. Secondary endpoints included changes in the visual analog scale (VAS) for urinary incontinence, the Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7), daily pad usage, and urodynamic parameters three months after the fourth PRP injection.</p><p><strong>Results: </strong>The mean age was 71.0 ± 7.2 years, with a mean PPI duration of 35.5 ± 36.8 months. After PRP injections, the mean GRA score was 1.30 ± 1.23. A GRA score of 2 or 3 was reported in 29 (40.8%) patients, and a GRA score of = 1 was reported in 27 (38.0%), and 15 (21.1%) showed no improvement or reported worsening. Significant improvements were observed in the VAS score, UDI-6 score, and abdominal leak point pressure (ALPP). The increase in ALPP was significantly greater in the successful group than in the failed group (49.3 ± 78.3 vs. 4.9 ± 52.4 cmH2O, p = 0.028). Baseline cystometric bladder capacity (CBC) was identified as a significant predictor of a successful outcome (p = 0.047).</p><p><strong>Conclusions: </strong>Repeated urethral sphincter PRP injections can reduce the severity of PPI and increase ALPP in 40.8% patients with PPI. The results of this study support PRP as an exceptional therapy with low success but few complications.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4713-4720"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From AKI to CKD mechanisms of maladaptive repair and disease progression.","authors":"Qiming Fan, Kexin Zhang, Jiajun Sang, Chengxia Kan, Zhentao Guo, Xiaodong Sun","doi":"10.1007/s11255-026-05238-6","DOIUrl":"10.1007/s11255-026-05238-6","url":null,"abstract":"<p><p>Acute kidney injury (AKI) and chronic kidney disease (CKD) were traditionally regarded as distinct clinical entities, largely defined by the reversibility or irreversibility of renal dysfunction. However, growing clinical and experimental evidence now supports a continuum model in which AKI serves as a major initiating event for subsequent CKD development and progression. Even when conventional indices suggest functional recovery, persistent subclinical injury may drive long-term structural, metabolic, and transcriptional alterations that predispose the kidney to chronic damage. In this review, we synthesize current clinical, epidemiological, and mechanistic evidence linking AKI to CKD, with particular emphasis on maladaptive repair. We propose that maladaptive tubular epithelial repair represents the central coordinating event in this transition. Failed redifferentiation, sustained cell cycle arrest, partial epithelial reprogramming, and metabolic inflexibility convert injured tubular cells from targets of injury into active drivers of chronic remodeling. Persistent inflammation and immune dysregulation amplify tissue injury. Meanwhile, microvascular rarefaction and endothelial dysfunction reduce oxygen delivery and promote chronic hypoxia. Moreover, mitochondrial dysfunction, lipid accumulation, defective organelle quality control, and sustained cellular stress signaling reinforce tubular vulnerability and limit regenerative capacity. Emerging evidence also indicates that epigenetic and transcriptional memory may stabilize maladaptive cellular states, thereby lowering the threshold for re-injury and accelerating CKD progression. By integrating these interconnected pathways, we present a unified framework for the AKI-to-CKD continuum and discuss key translational opportunities, including time-sensitive intervention, mechanistic stratification, and biomarker-guided risk prediction. A more precise understanding of post-AKI remodeling may enable early and individualized strategies to prevent CKD progression.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"4893-4907"},"PeriodicalIF":2.2,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148217743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}