World journal of nephrology最新文献

{"title":"Renal elastography in kidney disease: Current evidence, limitations, and future directions.","authors":"José Luis Mora-Loján, Omar Farid García-Trujillo, Grecia Vélez-Hurtado, Edoardo Bermúdez-Mercado, Fernanda Pacheco-Salazar, Joana Balderas-Juarez, Froylan David Martínez-Sánchez","doi":"10.5527/wjn.119841","DOIUrl":"10.5527/wjn.119841","url":null,"abstract":"<p><p>Renal elastography has gained attention as a noninvasive way to estimate tissue stiffness and, indirectly, structural kidney damage. In general, elastography is considered a noninvasive test (NIT) for assessing liver fibrosis, and it has been widely adopted and even proposed as a potential alternative to liver biopsy in selected settings. However, its use as an NIT has not been completely translated to the kidney, largely due to fundamental differences in tissue structure and hemodynamics. Unlike the relatively homogeneous liver, the kidney is anisotropic and highly dependent on perfusion. Therefore, stiffness measurements may be affected by blood flow, vascular resistance, and interstitial pressure at the time of measurement, making them more difficult to interpret. There is growing evidence that shear-wave elastography can detect structural changes in chronic kidney disease, hypertension-related damage, acute kidney injury, and some glomerular disorders. That said, findings remain inconsistent. The reported cut-off values vary widely between studies, and reproducibility remains limited. Technical factors, such as inter-device and acquisition-protocol variability, further complicate the comparison of imaging results. In practice, elastography provides information about tissue mechanics and may be complementary to conventional imaging and laboratory markers. However, it might not be specific if used alone. Combined approaches of specifically shear-wave elastography with functional and biochemical NIT could provide better diagnostic performance and reflect a more clinically useful approach. Overall, renal elastography is better viewed as a complementary tool rather than a replacement for histology. Future research should focus on standardization, improving cross-platform validation, and generating longitudinal data to clarify its role in clinical decision-making and risk assessment.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 3","pages":"119841"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803890","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":"Renal artery stenting for atherosclerotic renal artery stenosis: A review of contemporary data.","authors":"Andrew E Warfield, Christopher S Morris, Anant D Bhave, Geoffrey M Scriver, Alan Massouh, Joshua Kallen, Richard T Solomon, Bill S Majdalany","doi":"10.5527/wjn.124524","DOIUrl":"10.5527/wjn.124524","url":null,"abstract":"<p><p>Renal artery stenting has been less frequently performed following the results of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions trial. In this trial, stenting demonstrated no benefit over medical therapy in a composite outcome including mortality as well as cardiovascular and renal events. However, these findings must be interpreted in the context of the study population, which included many patients less likely to benefit from intervention due to relatively mild renal artery stenosis, as well as less severe hypertension and renal dysfunction. More recent investigations have focused on identifying subgroups of patients who may benefit from revascularization. Identified subgroups include patients with high systolic blood pressure, diastolic hypertension, worsening kidney function, greater antihypertensive burden, flash pulmonary edema, and mild-range proteinuria. Many of these variables illustrate a clinical picture of a patient with severe ischemic kidney disease leading to problems with hypertension and volume regulation that has not yet irreparably damaged the renal parenchyma. Deciding which patients fit into this picture, and therefore should be stented, presents a challenge. This review synthesizes the current evidence surrounding these predictive variables and explores how they may be integrated into clinical decision-making.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 3","pages":"124524"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803873","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":"Efficacy of finerenone in reducing proteinuria in diabetic kidney disease on dapagliflozin and telmisartan: A disease-modifying approach.","authors":"Antresa Jose, Abul Bashar Mohammad Kamrul-Hasan, Cornelius J Fernandez, Joseph M Pappachan","doi":"10.5527/wjn.120295","DOIUrl":"10.5527/wjn.120295","url":null,"abstract":"<p><p>With the alarming rise in the global prevalence of the disease, type 2 diabetes mellitus (T2DM) has recently become the leading cause of chronic kidney disease (CKD) worldwide. Proteinuria, the earliest and common indicator of diabetic kidney disease (DKD), not only increases the risk of progression of CKD to end-stage renal disease (ESRD) but also multiplies the risk of cardiovascular (CV) disease in patients with diabetes. Medications such as angiotensin-converting enzyme inhibitors (ACEis), angiotensin II receptor blockers (ARBs), sodium-glucose cotransporter-2 inhibitors (SGLT-2is), and mineralocorticoid receptor antagonists (MRAs) have been shown to reduce proteinuria and therefore possess disease-modifying properties in patients with DKD. Clinical trials have demonstrated the efficacy of finerenone, a highly selective, non-steroidal MRA, in reducing renal and CV outcomes in patients with long-standing T2DM. The benefits of various SGLT-2is have also been observed in multiple studies. Therefore, a combination of these medications, with independent but complementary mechanisms of action, could provide superior benefits as add-on therapies to ACEis/ARBs rather than using either alone. This Opinion Review explores disease-modifying strategies in patients with DKD based on the most up-to-date evidence.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 3","pages":"120295"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804204","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":"Emerging therapies and diagnostic innovations for multidrug-resistant infections in kidney allograft recipients: Challenges and future directions.","authors":"Aditya Shetty, Mythri Shankar","doi":"10.5527/wjn.118797","DOIUrl":"10.5527/wjn.118797","url":null,"abstract":"<p><p>Multidrug-resistant (MDR) bacterial infections are a major cause of morbidity, mortality, and graft loss in kidney transplant recipients, who are particularly vulnerable due to intensive immunosuppression, frequent healthcare exposure, and recurrent antibiotic use. The rising prevalence of resistance among key uropathogens and bloodstream isolates has outpaced the development and uptake of transplant-specific diagnostic and therapeutic strategies. This mini-review synthesizes contemporary evidence on MDR gram-negative and gram-positive infections in kidney allograft recipients, focusing on extended-spectrum beta-lactamase-producing <i>Enterobacterales</i>, carbapenem-resistant <i>Enterobacterales</i>, difficult-to-treat <i>Pseudomonas aeruginosa</i>, carbapenem-resistant <i>Acinetobacter baumannii</i>, vancomycin-resistant <i>Enterococci</i>, methicillin-resistant <i>Staphylococcus aureus</i>, and <i>Clostridioides difficile</i> infection. We outline epidemiology, risk factors, and clinical impacts on patient and graft outcomes, including the association of recurrent urinary tract infection and MDR bloodstream infection with reduced estimated glomerular filtration rate, increased hospitalization, and higher death-censored graft failure. The article highlights advances in rapid molecular diagnostics (such as polymerase chain reaction, matrix-assisted laser desorption/ionization-time of flight, and syndromic panels) that shorten time to organism and resistance detection, enabling earlier optimization and de-escalation of antimicrobial therapy. Emerging agents - including novel beta-lactam/beta-lactamase inhibitor combinations, siderophore cephalosporins, and investigational boronate beta-lactamase inhibitors - are discussed, emphasizing nephrotoxicity profiles, drug-drug interactions with calcineurin inhibitors, and evidence gaps in transplant populations. We also review the evolving roles of phage therapy, monoclonal antibodies, vaccines, and therapeutic drug monitoring (including area under the curve/minimum inhibitory concentration-guided vancomycin dosing and cautious reuse of aminoglycosides) in this high-risk cohort. Finally, we propose a pragmatic stewardship framework tailored to kidney transplant units, integrating individualized perioperative prophylaxis, avoidance of unnecessary treatment of asymptomatic bacteriuria, early device removal, and minimization of broad-spectrum exposure to limit MDR selection and <i>Clostridioides difficile</i> infection. A transplant-specific approach that combines rapid diagnostics, rational deployment of new antimicrobials, and rigorous stewardship is essential to improve survival and preserve allograft function in the era of MDR infections after kidney transplantation.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 3","pages":"118797"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804167","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":"SLC30A8 (ZnT8) at the crossroads of epigenetics and microRNA regulation in type 2 diabetes and nephropathy.","authors":"Varun Kumar Sharma, Mirza Masroor Ali Beg, Shilpy Singh, Sourabh Kumar Singh, Dharmsheel Shrivastav","doi":"10.5527/wjn.122565","DOIUrl":"10.5527/wjn.122565","url":null,"abstract":"<p><p>Diabetic nephropathy (DN) is a major kidney disease and linked to type 2 diabetes mellitus (T2DM), and it significantly which increases the global health burden. In the pathogenesis of DN, ZnT8 is essential for zinc transport into insulin granules; it ensures proper insulin crystallization, storage, and secretion while safeguarding β-cells against oxidative stress. it is suggested that the in pathogenesis of DN, the role of the SLC30A8/ZnT8/PDX-1 axis is underexplored along with its mechanism linking β-cell impairment to T2DM progression and renal fibrosis. In this review, we explore the role of microRNA-mediated regulation of SLC30A8/ZnT8 <i>via</i> PDX-1. Under hyperglycaemic and glucolipotoxic conditions, elevated level of miR-375 and miR-765 suppresses PDX-1 (master regulator of β-cell identity) and transcription of SLC30A8, culminating in ZnT8 silencing. PDX-1 directly binds to SLC30A8 enhancers and modulates its expression. Therapeutic targeting of this pathway <i>via</i> miR-375 and miR-765 antagomirs, CRISPR editing, ZnT8 overexpression, or zinc supplementation offers promise for restoring β-cell function and mitigating DN. Large scale clinical trial and epigenetic studies on patient cohorts will help and guide precision interventions.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 3","pages":"122565"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803963","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":"Effect of pentoxifylline on inflammatory markers in non-diabetic chronic kidney disease patients: A prospective, interventional, open label.","authors":"Ashraf Hassan Abd El Mobdy, Hayam Ahmed Hebah, Mohammed Ali Ezzat, Basant Abdelkarim Eid Mohamed, Fatma Abdelrahman Ahmed","doi":"10.5527/wjn.120037","DOIUrl":"10.5527/wjn.120037","url":null,"abstract":"<p><strong>Background: </strong>Pentoxifylline (PTX), a methylxanthine derivative, has been shown to exert notable anti-inflammatory and antiproteinuric actions in diabetic kidney disease, contributing to improved sodium handling, attenuation of renal hypertrophy, and reductions in tumour necrosis factor-alpha (TNF-α), interleukin-6 levels, and albuminuria.</p><p><strong>Aim: </strong>To determine the impact of PTX on inflammatory biomarkers and the progression of chronic kidney disease (CKD) in non-diabetic patients.</p><p><strong>Methods: </strong>This prospective, interventional, open label, randomized controlled clinical study was conducted on 42 participants aged 18 years or older, of both genders, with CKD stages 3 or 4 and proteinuria < 1 g/24 hours. Participants were placed into two equal groups. Group 1 had standard therapy, including angiotensin-converting enzyme inhibitors (ACEIs; ramipril 1.25 mg), calcium acetate (700 mg), alfacalcidol (0.25 µg), antihypertensives, and diuretics. Group 2 had the same standard therapy plus PTX 400 mg (Trental^®) two times per day for six consecutive months.</p><p><strong>Results: </strong>There was no significant relationship between TNF-α and high-sensitivity C-reactive protein (hs-CRP) and participants' gender in both groups. An essential direct correlation was observed between TNF-α and creatinine in both groups. A critical direct correlation was observed between hs-CRP and calcium in group B. There was a significant inverse correlation between the change in TNF-α and estimated glomerular filtration rate, as well as between the change in TNF-α and the urinary protein-to-creatinine ratio. The change in protein creatinine ratio noted in group 2 was mainly due to changes in mean arterial pressure, followed by changes in TNF-α.</p><p><strong>Conclusion: </strong>In non-diabetic CKD patients, adjunctive treatment with PTX was associated with significant decreases in C-reactive protein levels and proteinuria. The reduction in proteinuria was mainly explained by changes in mean arterial pressure, followed by changes in TNF-α, indicating that hemodynamic factors may play a more prominent role than inflammatory modulation in mediating this effect.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 3","pages":"120037"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804174","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":"Vaccination gaps and infection risk at dialysis initiation.","authors":"Pranjal Kashiv, Manish Ramesh Balwani, Priyanka Tolani, Amit Pasari, Khushboo Saxena, Vivek B Kute","doi":"10.5527/wjn.119445","DOIUrl":"10.5527/wjn.119445","url":null,"abstract":"<p><p>In this editorial, we comment on the study by Puri <i>et al</i> published in the <i>World Journal of Nephrology</i>, which highlights a neglected gap in preventive care at dialysis initiation: Inadequate protection against vaccine-preventable and endemic infections in advanced chronic kidney disease. In an incident hemodialysis cohort from a tertiary centre in North India, the authors report major deficiencies in adult vaccination against hepatitis B virus, pneumococcus, and influenza at dialysis entry, with more than half of patients having received none of the recommended immunizations. Concurrently, a substantial burden of tuberculosis - predominantly extrapulmonary - was observed, underscoring a dual infectious vulnerability at the outset of renal replacement therapy in endemic, resource-constrained settings. Importantly, vaccination uptake aligned with markers of health-system engagement rather than patient characteristics or presumed biological limitations: Prior nephrology follow-up and structured pre-transplant evaluation were associated with higher vaccination rates and indicators of anticipatory care, including permanent vascular access. These findings suggest that impaired immunogenicity may not be the sole barrier to vaccination in advanced kidney disease and are consistent with an association between delayed referral, fragmented care pathways, and avoidable infectious risk. Although limited by its single-centre, cross-sectional design, this study supports viewing dialysis initiation as a sentinel checkpoint for infection prevention. We argue for integrating vaccination assessment, delivery, serologic monitoring, and tuberculosis screening into pre-dialysis and dialysis-start workflows to operationalize preventive nephrology in routine practice.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 3","pages":"119445"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804017","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":"Role of fibroblast growth factor-23 in renal disease activity and bone density involvement in patients with lupus nephritis.","authors":"Nashwa M Azoz, Ammar A Ammar, Howaida A Nafady, Rabea A Gadelkareem, Essam M Abdel Aziz, Randa A Elzohne","doi":"10.5527/wjn.v15.i3.120318","DOIUrl":"10.5527/wjn.v15.i3.120318","url":null,"abstract":"<p><strong>Background: </strong>Systemic lupus erythematosus-associated lupus nephritis (LN) represents a major contributor to disease-related morbidity. Disturbances in bone metabolism frequently coexist with LN, driven in part by persistent inflammation and impaired renal function. These factors are closely linked to decreased bone mineral density (BMD) and a heightened risk of fractures. Fibroblast growth factor-23 (FGF-23) has recently been recognized as a key regulator of mineral homeostasis and may serve as a marker reflecting both renal disease activity and skeletal involvement. Nevertheless, its precise role in LN activity and its impact on bone health remain inadequately defined.</p><p><strong>Aim: </strong>To determine the predictive value of FGF-23 in renal disease activity and bone density changes in patients with LN.</p><p><strong>Methods: </strong>A cross-sectional hospital-based study included 100 adult patients with LN. Patients were classified into active (<i>n</i> = 50) and inactive LN (<i>n</i> = 50). All patients underwent clinical assessment, laboratory investigations, renal imaging, renal biopsy when indicated, and BMD assessment using dual-energy X-ray absorptiometry. Serum FGF-23 was measured using enzyme-linked immunosorbent assay. Statistical analysis included comparative tests, correlation analysis, logistic regression, and receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>Patients with active LN had significantly higher FGF-23 levels compared with those with inactive LN (149.44 ± 37.09 pg/mL <i>vs</i> 122.56 ± 36.91 pg/mL; <i>P</i> < 0.001). BMD was significantly lower in patients with active LN (0.42 ± 0.19 g/cm² <i>vs</i> 0.56 ± 0.16 g/cm²; <i>P</i> < 0.001), with low BMD observed in 80% of patients with active LN <i>vs</i> 26% of those with inactive LN. FGF-23 level showed a significant negative correlation with BMD (<i>r</i> = -0.67, <i>P</i> = 0.001). Elevated FGF-23 level independently predicted low BMD (odds ratio = 4.18) and active LN (odds ratio = 2.18). At a cut-off point of ≥ 135 pg/mL, FGF-23 predicted low BMD with 79.5% accuracy.</p><p><strong>Conclusion: </strong>FGF-23 may be a promising biomarker for renal disease activity and BMD in patients with LN. Its elevation may reflect the interplay between disturbances in mineral metabolism, inflammatory processes, and renal involvement. Nevertheless, further large-scale, longitudinal studies are required to validate these observations and clarify the clinical utility of FGF-23 in patients with LN.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 3","pages":"120318"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803984","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":"Letter to the Editor: Artificial intelligence in nephrology point-of-care ultrasonography - opportunities, limitations, and future directions.","authors":"Abhilash Koratala, Filipa Ferreira, Hugo Diniz","doi":"10.5527/wjn.124607","DOIUrl":"10.5527/wjn.124607","url":null,"abstract":"<p><p>We read with interest the retrospective cohort study by Silipigni <i>et al</i> entitled \"Role of point-of-care ultrasonography in kidney disease management: A single solution for multiple challenges\". Artificial intelligence (AI) is rapidly reshaping the way clinicians learn, perform, and interpret point-of-care ultrasonography (POCUS). In nephrology, AI-assisted image acquisition, automated measurements, and emerging decision-support tools offer opportunities to improve efficiency and expand access to POCUS training. At the same time, important limitations remain, particularly when ultrasound findings must be integrated with physiology and clinical context. In this commentary, we discuss the current role of AI in nephrology POCUS, examine potential pitfalls of overreliance on automated interpretation, and consider future applications that may extend beyond image analysis toward physiologic assessment and hemodynamic phenotyping. Ultimately, we suggest that AI should be used to enhance, not replace clinicians' understanding of anatomy, physiology, and patient-specific pathophysiology.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 3","pages":"124607"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803741","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":"Lactulose <i>vs Lactobacillus acidophilus</i> for patients with chronic kidney disease: A randomized controlled trial.","authors":"Alshaimaa S Mubarak, Ashraf Elshazly, Abdelrahman Mokhtar, Rabea A Gadelkareem, Nashwa M Azoz","doi":"10.5527/wjn.120870","DOIUrl":"10.5527/wjn.120870","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic kidney disease (CKD) is associated with progressive accumulation of uremic toxins and chronic systemic inflammation. CKD management focuses on treating the underlying disease, controlling risk factors, slowing disease progression, and initiating renal replacement therapy in stage 5. Early CKD is often asymptomatic or presents with mild symptoms such as fatigue and nocturia, whereas symptoms become progressively more severe after stage 3 and worsen further with renal failure. Modulation of the gut microbiota using prebiotics or probiotics has emerged as a promising adjunctive therapeutic strategy. Lactulose, a non-absorbable disaccharide, and &lt;i&gt;Lactobacillus acidophilus&lt;/i&gt; (LA), a probiotic, are commonly used to target gut-derived uremic toxins.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To compare the effects of lactulose and LA on renal functions, inflammatory markers, and gastrointestinal symptoms in patients with non-dialysis CKD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective comparative study was done on a total of 150 patients with non-dialysis CKD stage 3-5 who were randomly subdivided into three groups: The lactulose group included 50 patients with non-dialysis CKD stage 3-5 who received lactulose 30 mL per day divided into 3 doses; the LA group included 50 patients with non-dialysis CKD stage 3-5 who received one tablet of LA twice daily; and group C included 50 patients with non-dialysis CKD stage 3-5 who didn't receive lactulose or LA. Baseline clinical and laboratory parameters were recorded. Renal function tests (serum creatinine and blood urea), inflammatory markers, and gastrointestinal symptoms were assessed before and after the intervention period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 150 patients with non-dialysis CKD stages 3-5 were enrolled and equally randomized into three groups: Lactulose (&lt;i&gt;n&lt;/i&gt; = 50), LA (&lt;i&gt;n&lt;/i&gt; = 50), and control (&lt;i&gt;n&lt;/i&gt; = 50). The three groups were comparable in terms of age, sex distribution, body mass index, smoking status, comorbidities, and CKD stage at baseline. Baseline laboratory parameters showed no significant differences among the groups. At the end of the 3-month follow-up period, the LA group achieved the greatest improvement in renal function parameters&lt;b&gt;,&lt;/b&gt; as reflected by significantly larger reductions in delta levels of blood urea and serum creatinine compared with both the lactulose and control groups. The mean change in blood urea was -12.45 ± 3.01 mg/dL in the LA group, -5.00 ± 2.45 mg/dL in the lactulose group, and -1.79 ± 3.01 mg/dL in the controls (&lt;i&gt;P&lt;/i&gt; = 0.03). Similarly, the mean change in serum creatinine was -20.01% ± 3.45% in the LA group, but -7.33% ± 2.88% in the lactulose group and -6.55% ± 2.44% in the controls (&lt;i&gt;P&lt;/i&gt; &lt; 0.001). Improvements in albumin-to-creatinine ratio and estimated glomerular filtration rate were observed in all groups but did not reach statistical significance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Both ","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 3","pages":"120870"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803698","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}