International Urology and Nephrology最新文献

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The role of non-operative management for high-grade renal injuries.
IF 1.8 4区 医学
International Urology and Nephrology Pub Date : 2025-03-05 DOI: 10.1007/s11255-025-04434-0
Emily M Kokush, Kunj Jain, John Fastenau, Aleksander Popovic, Meher Pandher, Alexis M Driscoll, Robert E Weiss, Evan Kovac, Ziad C Sifri, Amjad Alwaal
{"title":"The role of non-operative management for high-grade renal injuries.","authors":"Emily M Kokush, Kunj Jain, John Fastenau, Aleksander Popovic, Meher Pandher, Alexis M Driscoll, Robert E Weiss, Evan Kovac, Ziad C Sifri, Amjad Alwaal","doi":"10.1007/s11255-025-04434-0","DOIUrl":"https://doi.org/10.1007/s11255-025-04434-0","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the long-term outcomes of non-operative, operative, and minimally invasive surgery management of high-grade renal injuries (Grades III-V) in an underserved population at a high-volume trauma center.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of 93 patients who sustained high-grade renal trauma and presented to University Hospital, a Level 1 trauma center, between 2017 and 2022. The patients were categorized by initial management strategy: non-operative, operative, or minimally invasive surgery (endoscopic urologic and interventional radiologic procedures). Outcome variables included length of hospital stay, complications, mortality, long-term renal function, and the need for additional procedures. We analyzed associations between management strategies and outcomes, adjusting for injury mechanism and severity.</p><p><strong>Results: </strong>Non-operative management was the most common strategy (60%), followed by operative (20%) and minimally invasive surgery (20%). Operative management was associated with a higher rate of complications and reoperations (p = 0.007) and significantly longer hospital stays (p < 0.001). Non-operative management demonstrated similar long-term renal function compared to operative and minimally invasive approaches (p = 0.087), with fewer complications. No non-operative patients required subsequent procedural management, while 32% of those initially managed operatively or minimally invasively required additional interventions.</p><p><strong>Conclusions: </strong>Non-operative management is a safe and effective approach for hemodynamically stable patients with high-grade renal trauma, leading to fewer complications and similar long-term renal outcomes compared to operative and minimally invasive strategies. These findings support renal preservation through non-operative management, especially in underserved populations.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557077","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}
引用次数: 0
Sodium-glucose co-transporter inhibitors for APOL1 kidney disease: A call for studies.
IF 1.8 4区 医学
International Urology and Nephrology Pub Date : 2025-03-04 DOI: 10.1007/s11255-025-04443-z
Baris Afsar, Rengin Elsurer Afsar, Yasar Caliskan, Krista L Lentine
{"title":"Sodium-glucose co-transporter inhibitors for APOL1 kidney disease: A call for studies.","authors":"Baris Afsar, Rengin Elsurer Afsar, Yasar Caliskan, Krista L Lentine","doi":"10.1007/s11255-025-04443-z","DOIUrl":"https://doi.org/10.1007/s11255-025-04443-z","url":null,"abstract":"<p><p>Renal risk variants in the apolipoprotein L1 (APOL1) gene confer protection against trypanosomiasis, but these risk variants (G1 and G2 variants) also predispose to kidney disease among individuals, especially from Sub-SaharanAfrica. Currently, the mechanisms of how these renal risk variants induce kidney damage are not precisely defined, but lysosomal and mitochondrial dysfunction, altered ion channel activity, altered autophagy, and disordered immunity are suggested. Currently, there is no specific treatment for APOL1 kidney disease (APOL1-KD) although several potential disease-specific therapeutic agents are being evaluated in clinical trials. Non-specific interventions include proteinuria screening, salt restriction, and renin-angiotensin-aldosterone system inhibition but are not sufficient to prevent kidney disease progression in APOL1-KD. Given the lack of specific treatment options, more efforts are necessary to reduce kidney disease progression. Sodium glucose co-transport-2 (SGLT2) inhibitors (SGLT2i) are gaining attention for benefits in proteinuric kidney diseases and exert many beneficial effects which theoretically may be beneficial in the context of APOL1-KD. These beneficial effects include but are not limited to increased natriuresis, decreased proteinuria/albuminuria, and mitochondrial dysfunction. SGLT2i have antioxidant, anti-inflammatory and anti-fibrotic effects. In the current review, we highlight the potential reasons for exploring the use of SGLT2i in APOL1-KD. Future studies are warranted to explore if SGLT2i use can provide protection in APOL1-KD.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557076","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}
引用次数: 0
Economic evaluation of surgical treatments for urolithiasis in a public hospital.
IF 1.8 4区 医学
International Urology and Nephrology Pub Date : 2025-03-03 DOI: 10.1007/s11255-025-04422-4
Juan F Sánchez Garcia, Adrian Freire Rodríguez, Marco Vinicio Benavides Pineda, Marta Castro Jul, Maximo Castro Iglesias, Jorge Sánchez Ramos, Miguel Pérez Shoch, Sabela López García, Carlos Muller-Artega, María Fernanda Lorenzo Gómez
{"title":"Economic evaluation of surgical treatments for urolithiasis in a public hospital.","authors":"Juan F Sánchez Garcia, Adrian Freire Rodríguez, Marco Vinicio Benavides Pineda, Marta Castro Jul, Maximo Castro Iglesias, Jorge Sánchez Ramos, Miguel Pérez Shoch, Sabela López García, Carlos Muller-Artega, María Fernanda Lorenzo Gómez","doi":"10.1007/s11255-025-04422-4","DOIUrl":"https://doi.org/10.1007/s11255-025-04422-4","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the costs associated with the surgical treatment of urolithiasis using percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS), and to analyze the influence of direct and indirect costs on patient economy and the healthcare system.</p><p><strong>Materials and methods: </strong>A total of 179 patients who underwent surgery for urolithiasis between January 1 and December 31, 2023, were included. Direct costs were recorded, encompassing expenses related to the surgical procedure, hospital stay, and healthcare costs, which included consultations, diagnostic procedures and non-hospital medications. Indirect costs were evaluated as non-healthcare costs, specifically focusing on productivity loss due to absenteeism in employed patients. Average costs per patient were calculated in euros (€).</p><p><strong>Results: </strong>The study found no statistically significant differences in the median total direct costs between patients undergoing PCNL: €15,976 [€13,135-€21,698] and URS: €14,044 [€9,691-€17,696]; p = 0.148). Similarly, the median indirect costs were comparable: €7,800 [€2,323-€7,800] for PCNL and €5,390 [€2,254-€11,136] for URS (p = 0.514). After the interventions, the median time off work was 56 days for PCNL and 30 days for URS, with associated median expenses of €3,558 (± €2,681) and €1,967 [€1,083-€3,168], respectively.</p><p><strong>Conclusion: </strong>The study found no significant differences in direct or indirect costs between PCNL and URS, suggesting both have a comparable economic impact. While factors like procedure complexity and hospitalization may affect individual costs, they do not create notable disparities. A comprehensive evaluation of both direct and indirect costs remains crucial to optimize resource allocation and support informed clinical decision-making in the healthcare system.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542016","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}
引用次数: 0
Observation of the efficacy and safety of obinutuzumab in the treatment of refractory idiopathic membranous nephropathy.
IF 1.8 4区 医学
International Urology and Nephrology Pub Date : 2025-03-02 DOI: 10.1007/s11255-025-04407-3
Luyao Li, Sha Wang, Mingming Wei, Qi Zhang, Lin Fang, Xin Fan, Miaomiao Cheng, Chengrui Zhang, Hua Liang, Xiaoyan Xiao, Xiangdong Yang
{"title":"Observation of the efficacy and safety of obinutuzumab in the treatment of refractory idiopathic membranous nephropathy.","authors":"Luyao Li, Sha Wang, Mingming Wei, Qi Zhang, Lin Fang, Xin Fan, Miaomiao Cheng, Chengrui Zhang, Hua Liang, Xiaoyan Xiao, Xiangdong Yang","doi":"10.1007/s11255-025-04407-3","DOIUrl":"https://doi.org/10.1007/s11255-025-04407-3","url":null,"abstract":"<p><strong>Background: </strong>This study analyzed the clinical data of 25 patients with refractory idiopathic membranous nephropathy (RIMN) treated with obinutuzumab, aiming to investigate its efficacy and safety.</p><p><strong>Methods: </strong>A retrospective study was conducted on patients with RIMN who were treated with obinutuzumab, admitted to the Department of Nephrology at Qilu Hospital of Shandong University and the Affiliated Hospital of Jining Medical College from March 2022 to November 2023. The treatment of obinutuzumab was determined based on the individual patient's specific circumstances. We collected clinical data including urinary protein-to-creatinine ratio (UPCR), serum albumin, creatinine, estimated glomerular filtration rate (eGFR) and circulating anti-phospholipase 2 receptor (PLA2R) antibodies for a minimum of 12 months. The clinical efficacy and safety of obinutuzumab were evaluated in these patients.</p><p><strong>Results: </strong>Among the 25 patients, 19 (76.0%, responders) achieved partial (n = 16) or complete (n = 3) response with obinutuzumab treatment. The median time to achieve partial response was 3.5 months [interquartile range (IQR) 3.0-12.0 months], and 6 patients were unresponsive to the treatment. After treatment with obinutuzumab, 19 of the 21 patients (90.5%) with positive phospholipase 2 receptor (PLA2R) antibodies achieved complete immunological remission (anti-PLA2R antibodies level < 2 RU/mL). The median time to negativity was 6.0 months (IQR 3.0-9.0 months). The two patients who remained positive had PLA2R antibodies titers that decreased below 14 RU/mL and both achieved clinical remission. The renal function remained stable during the follow-up period. No relapse was observed. No severe adverse events related to obinutuzumab were observed.</p><p><strong>Conclusion: </strong>Obinutuzumab could effectively relieve proteinuria, stabilize renal function and maintain good safety in patients with RIMN.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536823","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}
引用次数: 0
Associations between frailty status and humoral response to SARS-cov-2 vaccination in kidney transplantation and dialysis. 肾移植和透析患者的虚弱状况与对 SARS-cov-2 疫苗接种的体液反应之间的关系。
IF 1.8 4区 医学
International Urology and Nephrology Pub Date : 2025-03-01 Epub Date: 2024-10-01 DOI: 10.1007/s11255-024-04220-4
Henry H L Wu, Rajkumar Chinnadurai
{"title":"Associations between frailty status and humoral response to SARS-cov-2 vaccination in kidney transplantation and dialysis.","authors":"Henry H L Wu, Rajkumar Chinnadurai","doi":"10.1007/s11255-024-04220-4","DOIUrl":"10.1007/s11255-024-04220-4","url":null,"abstract":"","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"1037-1038"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346789","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}
引用次数: 0
Amniotic bladder therapy: study of micronized amnion/chorion for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) at 6 months. 羊膜膀胱疗法:微粉化羊膜/绒毛膜治疗间质性膀胱炎/膀胱疼痛综合征(IC/BPS)6 个月的研究。
IF 1.8 4区 医学
International Urology and Nephrology Pub Date : 2025-03-01 Epub Date: 2024-10-23 DOI: 10.1007/s11255-024-04251-x
Kyle O'Hollaren, Jack Considine, Codrut Radoiu, Raghav Madan, Aron Liaw, Nivedita Dhar
{"title":"Amniotic bladder therapy: study of micronized amnion/chorion for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) at 6 months.","authors":"Kyle O'Hollaren, Jack Considine, Codrut Radoiu, Raghav Madan, Aron Liaw, Nivedita Dhar","doi":"10.1007/s11255-024-04251-x","DOIUrl":"10.1007/s11255-024-04251-x","url":null,"abstract":"<p><strong>Background: </strong>Intravesical application of birth tissue has been reported to inhibit inflammation, alleviate collagen fiber accumulation, and enhance bladder tissue generation. We have previously reported that intra-detrusor micronized amnion monolayer (AM) injections provide short-term clinical improvement in refractory IC/BPS patients. Herein, we evaluate the therapeutic responses and adverse events of micronized amnion/chorion bilayer (AC) in patients with refractory IC/BPS with 6 months follow-up.</p><p><strong>Methods: </strong>Fifteen patients affected by IC/BPS who failed conventional therapy received 100 mg of reconstituted micronized AC was injected intra-detrusor via cystoscopy under general anesthesia, using a 23-gauge needle. Twenty 0.5-mL injections were administered into the lateral and posterior bladder walls, avoiding the dome and trigone. Changes in interstitial cystitis symptom index (ICSI), Interstitial cystitis problem index (ICPI), Bladder pain/ interstitial cystitis symptom score (BPIC-SS) and Overactive Bladder Assessment Tool (OAB), from baseline to 6 months post-injection were evaluated retrospectively. The safety of injections was analyzed.</p><p><strong>Results: </strong>Fifteen total refractory IC/BPS patients with an average age of 41.1 ± 14.5 years were included in the study, receiving intra-detrusor injections of 100 mg of micronized AC. One month after injections, significant improvement in IC/BPS symptom scores was noted in all patients. All patients maintained a sustained clinical response at 6 months post-injection. No product-related adverse events were observed.</p><p><strong>Conclusion: </strong>Our findings indicate that the AC formulation significantly reduces time to symptom relief in patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS) and maintains a sustained response up to 6 months post-injection. These results suggest a promising clinical benefit of using an amnion/chorion bilayer product for treating IC/BPS. Further research is needed to confirm these findings and assess the long-term durability of this treatment approach. This study represents the first evidence supporting the clinical advantages of an amnion/chorion bilayer product in managing IC/BPS.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"753-758"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500536","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}
引用次数: 0
Relationship of serum calcium concentration with chronic kidney disease and mortality in type 2 diabetes mellitus patients: evidence from the NHANES 1999-2018. 血清钙浓度与 2 型糖尿病患者慢性肾病和死亡率的关系:来自 1999-2018 年国家健康调查的证据。
IF 1.8 4区 医学
International Urology and Nephrology Pub Date : 2025-03-01 Epub Date: 2024-11-15 DOI: 10.1007/s11255-024-04272-6
Minzi Qiu, Yanxia Chen, Ben Ke, Xiangdong Fang, Chengyun Xu, Jinghai Hua
{"title":"Relationship of serum calcium concentration with chronic kidney disease and mortality in type 2 diabetes mellitus patients: evidence from the NHANES 1999-2018.","authors":"Minzi Qiu, Yanxia Chen, Ben Ke, Xiangdong Fang, Chengyun Xu, Jinghai Hua","doi":"10.1007/s11255-024-04272-6","DOIUrl":"10.1007/s11255-024-04272-6","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to explore the relationship of serum calcium (Ca) concentration with diabetic kidney disease (DKD) and all-cause mortality among type 2 diabetes mellitus (T2DM) patients using National Health and Nutrition Examination Surveys (NHANES).</p><p><strong>Methods: </strong>Data of T2DM patients aged ≥ 40 years were screened from the NHANES database from 1999 to 2018. The outcomes were the risk of DKD diagnosed by urine albumin-to-creatinine ratio (UACR) ≥ 30 mg/g or estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m<sup>2</sup> and the risk of all-cause mortality ascertained by linkage to National Death Index (NDI) records through 31 December 2019. The weighted univariate and multivariate logistic regression model and cox proportional hazard model were utilized to explore the relationships of serum Ca concentration with DKD and all-cause mortality, respectively, with odds ratios (ORs), hazard ratios (HRs) and 95% confidence interval. The relationships were further explored stratified by age, gender, body mass index (BMI), the duration of T2DM, and the history of cardiovascular disease (CVD), cancer and DKD.</p><p><strong>Results: </strong>Totally, 6595 T2DM patients were included. Of these patients, 2441 (37.01%) had DKD and 1868 (28.32%) deaths occurred over a mean follow-up of 104.50 (± 1.61) months. In fully adjusted model, we observed high serum Ca concentration was associated with high risk of DKD (OR = 1.45, 95% CI 1.18-1.77) and high all-cause mortality risk (HR = 1.33, 95% CI 1.16-1.52). These relationships remained significant after performing subgroup analyses. The Restricted cubic spline curves shown that linear correlations were observed between serum Ca concentration and DKD as well as all-cause mortality (P < 0.05).</p><p><strong>Conclusions: </strong>Elevated serum Ca concentration may predict the high risk of DKD and poor prognosis in T2DM patients, and future large-scale and well-designed prospective cohort study is needed to explore the association of serum Ca concentration and DKD and prognosis in T2DM patients.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"1009-1018"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638946","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}
引用次数: 0
Predictive performance of machine learning models for kidney complications following coronary interventions: a systematic review and meta-analysis. 冠状动脉介入术后肾脏并发症的机器学习模型预测性能:系统综述和荟萃分析。
IF 1.8 4区 医学
International Urology and Nephrology Pub Date : 2025-03-01 Epub Date: 2024-10-31 DOI: 10.1007/s11255-024-04257-5
Soroush Najdaghi, Delaram Narimani Davani, Davood Shafie, Azin Alizadehasl
{"title":"Predictive performance of machine learning models for kidney complications following coronary interventions: a systematic review and meta-analysis.","authors":"Soroush Najdaghi, Delaram Narimani Davani, Davood Shafie, Azin Alizadehasl","doi":"10.1007/s11255-024-04257-5","DOIUrl":"10.1007/s11255-024-04257-5","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) and contrast-induced nephropathy (CIN) are common complications following percutaneous coronary intervention (PCI) or coronary angiography (CAG), presenting significant clinical challenges. Machine learning (ML) models offer promise for improving patient outcomes through early detection and intervention strategies.</p><p><strong>Methods: </strong>A comprehensive literature search following PRISMA guidelines was conducted in PubMed, Scopus, and Embase from inception to June 11, 2024. Study characteristics, ML models, performance metrics (AUC, accuracy, sensitivity, specificity, precision), and risk-of-bias assessment using the PROBAST tool were extracted. Statistical analysis used a random-effects model to pool AUC values, with heterogeneity assessed via the I<sup>2</sup> statistic.</p><p><strong>Results: </strong>From 431 initial studies, 14 met the inclusion criteria. Gradient Boosting Machine (GBM) and Support Vector Machine (SVM) models showed the highest pooled AUCs of 0.87 (95% CI: 0.82-0.92) and 0.85 (95% CI: 0.80-0.90), respectively, with low heterogeneity (I<sup>2</sup> < 30%). Random Forest (RF) had a similar AUC of 0.85 (95% CI: 0.78-0.92) but significant heterogeneity (I<sup>2</sup> > 90%). Multilayer perceptron (MLP) and XGBoost models had moderate pooled AUCs of 0.79 (95% CI: 0.74-0.84) with high heterogeneity. RF showed strong accuracy (0.83, 95% CI: 0.70-0.96), while SVM had balanced sensitivity (0.69, 95% CI: 0.63-0.75) and specificity (0.73, 95% CI: 0.60-0.86). Age, serum creatinine, left ventricular ejection fraction, and hemoglobin consistently influenced model efficacy.</p><p><strong>Conclusions: </strong>GBM and SVM models, with robust AUCs and low heterogeneity, are effective in predicting AKI and CIN post-PCI/CAG. RF, MLP, and XGBoost, despite competitive AUCs, showed considerable heterogeneity, emphasizing the need for further validation.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"855-874"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545339","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}
引用次数: 0
Sodium-chloride difference is not strongly correlated with base excess in chronic kidney disease: an anion gap problem. 钠-氯差异与慢性肾病患者碱过量的关系不大:阴离子间隙问题。
IF 1.8 4区 医学
International Urology and Nephrology Pub Date : 2025-03-01 Epub Date: 2024-11-11 DOI: 10.1007/s11255-024-04274-4
Moritz Kerbl-Knapp, Gregor Lindner, Georg-Christian Funk, Christoph Schwarz
{"title":"Sodium-chloride difference is not strongly correlated with base excess in chronic kidney disease: an anion gap problem.","authors":"Moritz Kerbl-Knapp, Gregor Lindner, Georg-Christian Funk, Christoph Schwarz","doi":"10.1007/s11255-024-04274-4","DOIUrl":"10.1007/s11255-024-04274-4","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of metabolic acidosis is high in patients with chronic kidney disease (CKD). For the diagnosis, a blood gas analysis is necessary, but not always available. The aim of the study was to evaluate the base excess (BE) of the sodium-chloride difference (BE<sub>Na-Cl</sub> = Na<sup>+</sup>-Cl<sup>-</sup>-34 mmol/l) as a screening parameter for hyperchloremic metabolic acidosis.</p><p><strong>Methods and statistical analysis: </strong>We retrospectively performed acid-base analyses of 168 non-dialysed patients with CKD according to the physiologic and to the Stewart's approach. We performed linear regression analysis, Bland-Altman plot and receiver operating characteristics (ROC) analysis of BE<sub>Na-Cl</sub> and BE to evaluate the accuracy of BE<sub>Na-Cl</sub> predicting the BE. We further investigated possible confounding factors.</p><p><strong>Results: </strong>The corrected R<sup>2</sup> for the correlation of BE<sub>Na-Cl</sub> and BE was 0.60 (p < 0.001). The Bland-Altman plot showed a good overall agreement. The bias was negligible, but the 95%-limits of agreement showed a wide interval (10.4 mmol/l). For BE ≤ 2 mmol/l, the ROC analysis yielded an AUC of 0.89 and moderate sensitivity (0.75) and specificity (0.86) for the optimal BE<sub>Na-Cl</sub> threshold (≤ 2 mmol/l). Subgroup analysis showed similar results. The main factor for the imprecision of BE<sub>Na-Cl</sub> predicting the BE across all stages of CKD is the variability of the serum anion gap (SAG).</p><p><strong>Conclusions: </strong>The BE<sub>Na-Cl</sub> is not an adequate parameter for screening of hyperchloremic acidosis because of the high variability of the SAG. Only, if the BE<sub>Na-Cl</sub> is ≤ 5 mmol/l, a hyperchloremic acidosis should be suspected. Therefore, a complete blood gas analysis is necessary for the correct diagnosis of acid-base disorders in patients with chronic kidney disease.</p>","PeriodicalId":14454,"journal":{"name":"International Urology and Nephrology","volume":" ","pages":"981-988"},"PeriodicalIF":1.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620768","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}
引用次数: 0
Increased risk of genitourinary cancer in kidney transplant recipients: a large-scale national cohort study and its clinical implications. 肾移植受者罹患泌尿生殖系统癌症的风险增加:一项大规模全国队列研究及其临床意义。
IF 1.8 4区 医学
International Urology and Nephrology Pub Date : 2025-03-01 Epub Date: 2024-10-23 DOI: 10.1007/s11255-024-04244-w
Hyunho Kim, Kyung-Hee Chae, Arum Choi, Mi-Hyeong Kim, Ji Hyung Hong, Bum Soon Choi, Sukil Kim, Tae Hyun Ban
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