World journal of nephrology最新文献

{"title":"Radiation safety in interventional nephrology.","authors":"Julian Yaxley","doi":"10.5527/wjn.v14.i3.105366","DOIUrl":"10.5527/wjn.v14.i3.105366","url":null,"abstract":"<p><p>Fluoroscopic imaging is widely utilised for diagnostic and therapeutic procedures and is fundamental to the establishment and maintenance of dialysis vascular access. To optimise outcomes and avoid injury to patients and healthcare providers, radiation technology must be applied effectively and safely in clinical practice. Radiation safety may be overlooked by nephrology training curricula. This narrative review discusses the theoretical and practical principles of radiation management in fluoroscopy-guided procedures and is intended as a primer for trainees and nephrologists working in interventional settings.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"14 3","pages":"105366"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194267","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":"Antimicrobial dosing considerations in critically ill patients with acute kidney injury: A review.","authors":"Caroline Tee, Melissa Ngai, Kay Choong See","doi":"10.5527/wjn.v14.i3.102667","DOIUrl":"10.5527/wjn.v14.i3.102667","url":null,"abstract":"<p><p>Sepsis-associated acute kidney injury is common in critically ill patients and is strongly associated with an increased risk of adverse outcomes and mortality. While early and appropriate antimicrobials for sepsis have been associated with an increased probability of survival, adequate dosing is a challenge in these patients. Critical illness with acute kidney injury is characterized by marked physiological derangements. This impacts the pharmacokinetic and pharmacodynamic profiles of antimicrobials, which complicates the predictability of drug disposition. Conventional antimicrobial dosing may not be optimal in this patient population, leading to under or overexposure to antimicrobials. This review summarizes an overview of the drug dosing considerations and relevant evidence of appropriate dosing strategies of common antimicrobials encountered in critically ill patients with acute kidney injury to optimize therapeutic efficacy and to reduce toxicity and adverse events.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"14 3","pages":"102667"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194214","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":"Management of earthquake-related acute renal injury.","authors":"Fikri M Abu-Zidan, Kamal Idris, Arif Alper Cevik","doi":"10.5527/wjn.v14.i3.107201","DOIUrl":"10.5527/wjn.v14.i3.107201","url":null,"abstract":"<p><p>This frontier will highlight the principles of diagnosis and management of earthquake crush syndrome and related acute kidney injury (AKI) based on our two recently published highly accessed collective review articles. Continuous prolonged pressure of the rubble on injured muscles following earthquakes may cause crush injuries. When the patient is extricated and the compressed muscles are relieved, an ischemia-reperfusion injury, with systematic serious metabolic disturbances, occurs. This includes hyperkalemia, rhabdomyolysis, and AKI. AKI is caused by three mechanisms. Prerenal factors include: (1) Hypovolemia due to bleeding; (2) Dehydration due to lack of water; (3) Ischaemia-reperfusion injury; and (4) Cardiac depression caused by released toxins. Renal factors include the nephrotoxic effects of the uric acid and bilirubin, tubular casts obstructing the tubules, or the direct deposition of phosphorus and calcium inside the kidneys. Pelvic fractures may cause urethral rupture with postrenal obstruction. The management principles of crush syndrome and AKI include: (1) Proper fluid therapy to maintain adequate urine output; (2) Preventing and treating hyperkalemia; and (3) Renal replacement therapy when indicated in cases of severe hyperkalemia, severe acidemia, volume overload, or severe uremia. Recognizing these conditions and treating them timely and properly will save many patients.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"14 3","pages":"107201"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194216","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":"Cystatin C-based equations: Enhancing accuracy in kidney function tests for type 2 diabetes.","authors":"Guido Gembillo, Concetto Sessa, Domenico Santoro","doi":"10.5527/wjn.v14.i3.102756","DOIUrl":"10.5527/wjn.v14.i3.102756","url":null,"abstract":"<p><p>Approximately 30%-40% of individuals with diabetes develop chronic kidney disease during their lifetime, and patients with type 2 diabetes mellitus have a high risk of developing and progressing to this condition. The two comorbidities represent a lethal combination that exacerbates both diseases. It is crucial to measure the glomerular filtration rate and to monitor and assess the renal functionality of these patients. Serum creatinine, the traditional marker of kidney assessment, has been shown to be susceptible to too many variables that can significantly alter the final estimated glomerular filtration rate outcome. Cystatin C-based formulas appear to have reasonable accuracy in this population and help to ensure better tailored therapy and renal assessment. The purpose of this editorial was to provide an examination of the advantage of using cystatin C as a valid marker for determining estimated glomerular filtration rate, free from any interfering factors, allowing a more accurate assessment of renal function.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"14 3","pages":"102756"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194258","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":"Safety, feasibility, and efficacy of surgical intervention for Urolithiasis in patients with chronic kidney disease: A systematic review.","authors":"Shiv C Navriya, Om K Yadav, Ankit Shettar, Mahendra Singh, Jaydeep Jain, Shashank Kumar, Deepak P Bhirud, Gautam R Choudhary, Arjun S Sandhu","doi":"10.5527/wjn.v14.i3.105288","DOIUrl":"10.5527/wjn.v14.i3.105288","url":null,"abstract":"<p><strong>Background: </strong>Urolithiasisposes challenges in patients with chronic kidney disease (CKD), necessitating careful consideration of surgical interventions due to potential complications.</p><p><strong>Aim: </strong>To assess the safety, feasibility, and efficacy of surgical interventions for urolithiasis in CKD patients.</p><p><strong>Methods: </strong>Systematic review adhering to PRISMA guidelines. Comprehensive searches of PubMed, Scopus, Cochrane Library, Web of Science, and Embase were conducted for studies published from January 2014 to June 2024. Studies involving adult patients (≥ 18 years) with CKD undergoing surgical interventions for urolithiasis, including randomized controlled trials, cohort studies, case-control studies, and observational studies. Studies involving pediatric patients, those not specifically addressing CKD patients, review articles, commentaries, and editorials. Despite an extensive search, only six studies met the strict inclusion criteria, reflecting the limited available data on this topic. This limitation has been acknowledged and discussed.</p><p><strong>Results: </strong>A total of 6 studies met the inclusion criteria, encompassing a diverse range of surgical interventions such as percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), and extracorporeal shock wave lithotripsy (ESWL). Perioperative and postoperative complications varied across studies, with bleeding, infection, and acute kidney injury being the most common. The risk of complications was higher in patients with advanced CKD. Technical success rates were generally high, but feasibility was influenced by patient-specific factors such as CKD stage and comorbidities. Modifications to standard surgical techniques were often necessary. Stone-free rates and recurrence rates varied, with PCNL generally achieving higher stone-free rates compared to URS and ESWL. Long-term outcomes on renal function were inconsistent, highlighting the need for individualized treatment plans.</p><p><strong>Conclusion: </strong>Surgical interventions for urolithiasis in CKD patients are associated with significant risks but can be effective in achieving stone clearance and symptom relief. The safety, feasibility, and efficacy of these interventions depend on patient-specific factors, necessitating a tailored approach. Further high-quality studies are needed to develop standardized guidelines and improve clinical outcomes in this complex patient population.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"14 3","pages":"105288"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194288","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 heat shock proteins in renal function and adaptation to heat stress: Implications for global warming.","authors":"Tam Thai Thanh Tran, Khang Vi Tran, Tri Duc Nguyen, Ngan Tuong Thien Pham, Tin Hoang Nguyen","doi":"10.5527/wjn.v14.i3.107571","DOIUrl":"10.5527/wjn.v14.i3.107571","url":null,"abstract":"<p><p>The escalating global temperature, with 2024 as the hottest year, emphasizes the critical link between climate change and kidney health. Extreme heat, a consequence of global warming, causes multifaceted effects on human physiology, including renal function alterations. This review investigates physiological and molecular mechanisms of heat stress-induced kidney injury, including acute kidney injury, chronic kidney disease (CKD), and urinary stone formation. It highlights how heat stress contributes to renal dysfunction <i>via</i> dehydration, electrolyte imbalances, and activation of the renin-angiotensin-aldosterone system and antidiuretic hormone pathways, particularly in vulnerable populations like outdoor workers, the elderly, and pregnant women. The review also emphasizes the roles of heat shock proteins (HSPs)-HSP27, HSP60, HSP70, and HSP90-in maintaining cellular integrity by preventing protein aggregation and repairing damaged proteins in renal tissues. Dysregulation of these proteins under prolonged heat stress is implicated in CKD progression. This review highlights the urgent need for targeted public health interventions: (1) Hydration; (2) Workplace cooling; (3) Community education; and (4) Developing pharmacological therapies targeting HSPs. A multidisciplinary approach involving nephrology, environmental science, and public health is essential to mitigate the increasing burden of heat-related kidney disease in the era of global climate change.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"14 3","pages":"107571"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202732","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":"Global emergence of the chikungunya epidemic: A narrative review of the virus-kidney relationship in Pakistan and beyond.","authors":"Tabassum Elahi, Muhammed Mubarak, Saima Ahmed, Farzana Rasheed Narejo","doi":"10.5527/wjn.v14.i3.107415","DOIUrl":"10.5527/wjn.v14.i3.107415","url":null,"abstract":"<p><p>Chikungunya, a vector-borne viral disease, has become a critical global health issue due to its capacity for widespread outbreaks, especially in tropical and subtropical regions, and its recent global expansion. The resurgence of Chikungunya virus (CHIKV) in Karachi, Pakistan, has amplified public health challenges, driven by factors such as urbanization, climate change, and socioeconomic vulnerabilities, including limited healthcare infrastructure. Clinically, the disease primarily manifests with fever, rash, and debilitating joint pain, which often leads to prolonged discomfort and decreased quality of life. However, emerging evidence points to atypical and severe complications affecting the neurological, cardiac, and kidney systems, increasing the risk of morbidity and mortality. Kidney involvement in Chikungunya is of particular concern, with acute kidney injury being identified as a critical complication. Timely diagnosis of the infection and early identification of individuals at heightened risk of progressing to severe kidney dysfunction is crucial to improving patient outcomes. Such individuals often include those with pre-existing kidney conditions or other underlying comorbidities, making them more susceptible to complications. This narrative review aims to synthesize and expand upon the current understanding of the mechanisms underlying CHIKV-induced kidney injury. These mechanisms encompass direct viral invasion of kidney tissue, immune-mediated inflammatory responses that inadvertently damage the kidneys, and the aggravation of pre-existing kidney pathologies. Furthermore, the complex interplay between the virus and the host's immune system may exacerbate kidney complications, highlighting the multifaceted nature of CHIKV pathophysiology.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"14 3","pages":"107415"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202673","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":"Uncommon presentation and management of a giant renal cyst abscess: A case report.","authors":"Abdullahi Khalid, Kabir Babajide Yakubu, Ahmed Mohammed Umar, Bashir Garba Aljannare, Nasiru Ahmad Aminu, Olusegun George Obadele, Abdullahi Abdulwahab-Ahmed","doi":"10.5527/wjn.v14.i3.108703","DOIUrl":"10.5527/wjn.v14.i3.108703","url":null,"abstract":"<p><strong>Background: </strong>Renal cysts, especially the cortical type, are a prevalent renal pathology. Most cases are asymptomatic and detected incidentally during abdominal imaging examination for unrelated complaints. They are often benign, but they can rarely transform into cystic renal malignancies. When huge or complicated, especially with an abscess, it may become symptomatic from the renal capsular stretch or inflammation. The open surgical, endoscopic, laparoscopic, and robotic approaches are available for symptomatic renal cyst treatment. This paper aims to report our experience in the management of a case of a giant renal cyst abscess.</p><p><strong>Case summary: </strong>This is a 26-year-old housewife who was referred to the urology outpatient clinic with a history of left flank pain and swelling for 5 months, with the transabdominal ultrasound scan and computerized tomography scan findings of a huge left renal cortical cyst (Bosniak I). She had associated anorexia, weight loss, nausea, and intermittent fever, which on one occasion was severe and high-grade with chills and rigors. This warranted hospital admission, analgesic and antibiotic therapy. The physical examination was unremarkable at presentation except for a ballotable and mildly tender left lumbar cystic mass. Her vital signs were stable. There was leukocytosis with relative neutrophilia. Further review of the imaging films confirmed the diagnosis of a left giant renal cortical cyst abscess. She was counselled and had open surgical exploration, drainage of 300 mL of pus, cyst unroofing with marsupialization, and was discharged home on the 10^th postoperative day.</p><p><strong>Conclusion: </strong>Treatment of giant simple renal cortical cyst abscesses should be individualized depending on the pathology in question, the surgeon's experience, patient preference and availability of facilities for endoscopic, laparoscopic or robotic modalities. Notwithstanding open surgical exploration, cyst unroofing and marsupialization are useful modalities in giant renal cortical cyst abscesses and are associated with patient satisfaction.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"14 3","pages":"108703"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194272","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":"Structural and functional kidney abnormalities in patients with Human immunodeficiency virus infection: A cross-sectional perspective.","authors":"Sivaprakash Sundaramoorthy, Devarajan Radha, Amalraj Ravi, Kotha Sugunakar Reddy, Sakthivadivel Varatharajan","doi":"10.5527/wjn.v14.i3.107093","DOIUrl":"10.5527/wjn.v14.i3.107093","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease is a progressive disease that evolves towards the development of end-stage renal disease. The superimposition of renal impairment on a complex disease, namely human immunodeficiency virus (HIV) infection, will raise the burden of comorbidities and, predict worse outcomes in this group of the population.</p><p><strong>Aim: </strong>To evaluate the structural and functional defects of kidney in patients with HIV infection.</p><p><strong>Methods: </strong>This cross-sectional study involved 227 patients with HIV infection. Participants were selected by simple random sampling method. Eligible participants included HIV infection-positive adults aged 18 years and above. Exclusion criteria encompassed individuals with preexisting hypertension, diabetes mellitus, chronic kidney disease, chronic liver disease, and those receiving nephrotoxic drugs. Informed consent was obtained. Data collection involved recording medical histories, conducting clinical examinations, and performing baseline blood investigations and ultrasonography to assess renal function and structural abnormalities.</p><p><strong>Results: </strong>The mean age of participants was 41 years. Females constituted 66.5%; 78% were on Tenofovir-based regimen. The mean duration of HIV infection was 5 years; mean duration of antiretroviral therapy was 4 years. 67.4% had a body mass index over 25. World Health Organization staging of HIV infection revealed that 41.9% were in stage 3, 30% in stage 2. 35.7% had cluster differentiation 4 counts < 200. The mean creatinine was 1 mg/dL and mean urea was 25.1 mg/dL. 54.6% had estimated glomerular filtration rate of < 60. Enlarged kidneys in 39.2% and increased echogenicity in 82.8% of participants. A decline in estimated glomerular filtration rate and an increase in kidney size was significantly associated with advancing HIV stages.</p><p><strong>Conclusion: </strong>Both structural and functional kidney abnormalities are common in patients with HIV infection. These abnormalities increase with disease progression, underscoring the need for regular and consistent renal monitoring.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"14 3","pages":"107093"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194284","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":"Ocular biomarkers in diabetes mellitus with diabetic kidney disease: A minireview.","authors":"Nitin K Menia, Arvind Kumar Morya, Parul C Gupta, Raja Ramachandran","doi":"10.5527/wjn.v14.i3.109470","DOIUrl":"10.5527/wjn.v14.i3.109470","url":null,"abstract":"<p><p>Diabetes mellitus ranks among the most prevalent non-communicable diseases worldwide, affecting a vast number of individuals. It can impact almost every organ in the body, leading to serious complications such as diabetic retinopathy (DR), diabetic nephropathy, and diabetic neuropathy. Scientific literature indicates that patients with severely compromised kidney function may develop non-responsive DR. Moreover, anaemia in individuals with diabetic kidney disease (DKD) complicates DR and can contribute to significant health issues. Optical coherence tomography (OCT) is a widely used non-invasive imaging tool for diagnosing, managing, and predicting DR. OCT findings in patients with DR and DKD include cystoid macular oedema, diffuse retinal thickening, disruptions in the ellipsoid layer, hyperreflective dots, and damage to the external limiting membrane. The review examines OCT patterns of diabetic macular oedema in DKD, correlating these patterns with declines in kidney function and visual acuity. Additionally, we review various biomarkers linked to DR in DKD patients and the growing importance of novel imaging biomarkers in predicting and connecting the severity of DR with DKD.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"14 3","pages":"109470"},"PeriodicalIF":0.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194287","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}