World journal of nephrology最新文献

{"title":"Alpha-1-microglobulin as an early biomarker in renal extrahepatic manifestations of hepatitis C virus infection.","authors":"Enas A R Alkareemy, Nashwa M Azoz, Ghada S Abdelnaiem, Rabea A Gadelkareem, Kawsar A Saleh, Essam M Abdel Aziz","doi":"10.5527/wjn.v15.i2.116866","DOIUrl":"10.5527/wjn.v15.i2.116866","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis C virus (HCV)-related nephropathy often progresses silently and is commonly underrecognized until chronic kidney disease or acute kidney injury occurs. Urinary alpha-1-microglobulin (Uα1M) is a promising early biomarker of proximal tubule dysfunction. It may help detect the subclinical renal extrahepatic manifestations of HCV earlier than traditional markers such as serum creatinine (SCr). The early renal manifestations of HCV include microalbuminuria, hematuria, tubular injury, and immune-mediated glomerulopathy.</p><p><strong>Aim: </strong>To evaluate the efficacy of Uα1M in identifying the early kidney involvement in patients with HCV infection.</p><p><strong>Methods: </strong>A case-control study was conducted from February 2022 to February 2024 at the Clinic of Nephrology Outpatient, Department of Internal Medicine, and Clinic of El-Rajhy Hepatitis Outpatient at Assiut University Hospitals. This study involved 158 patients aged ≥ 18 years, divided into HCV and control groups. The HCV group included 79 patients diagnosed as HCV-positive by HCV + antibodies and positive real-time polymerase chain reaction for HCV-RNA. The control group included 79 participants who were age-matched and sex-matched, and HCV-negative healthy individuals. The primary outcome was the rate of increased level of Uα1M.</p><p><strong>Results: </strong>The two groups were comparable in age and sex distribution. The mean hemoglobin level and platelet count were significantly lower in HCV patients than in controls, respectively. Blood urea nitrogen (BUN), SCr, and estimated glomerular filtration rate (eGFR) showed no significant differences. The urinary albumin/creatinine ratio was significantly higher in HCV-positive patients, with increased prevalence of microalbuminuria and macroalbuminuria. Uα1M levels were markedly elevated in the HCV group. It correlated positively with BUN and SCr, and negatively with eGFR, aspartate aminotransferase, and alanine aminotransferase. Uα1M levels were significantly higher in patients with hematuria (<i>P</i> = 0.007) and those with impaired eGFR (<i>P</i> < 0.001) than those without these disorders. Only five HCV-positive patients underwent renal biopsy, and all showed membranoproliferative glomerulonephritis. The Uα1M levels higher than the 3.52 mg/L cutoff had strong diagnostic ability to distinguish HCV-positive from HCV-negative subjects, with an area under the curve of 0.864 (95% confidence interval: 0.801-0.913), 77.0% accuracy, 60.0% sensitivity, 93.7% specificity, 90.4% positive predictive value, and 69.8% negative predictive value (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Uα1M served as a valuable early renal tubular biomarker for detecting subclinical kidney involvement in chronic HCV patients. It showed a moderate correlation to BUN and mild correlation to SCr and eGFR, with membranoproliferative glomerulonephritis pathology predominance in biopsied cases. In addition, i","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 2","pages":"116866"},"PeriodicalIF":0.0,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13324507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148378587","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 treatments and current strategies for mineral, vascular, and bone disorders in chronic kidney disease.","authors":"Olesya Ilkun, Firouzeh Jazayeri, Amir Kazory","doi":"10.5527/wjn.v15.i1.114146","DOIUrl":"10.5527/wjn.v15.i1.114146","url":null,"abstract":"<p><p>Progressive loss of kidney function in chronic kidney disease and end-stage kidney disease leads to distinct pathological changes in mineral and bone metabolism. Historically, the management of these patients focused on lowering their serum phosphate, parathyroid hormone, and normalizing serum calcium. However, persistently high morbidity and mortality of these patients from cardiovascular diseases and after bone fractures call for more specific therapies. Here, we summarize established and emerging therapies for managing the three main domains of mineral bone disorder in patients with advanced chronic kidney disease and end-stage kidney disease: Control of mineral imbalance, management of vascular disease or other soft tissue calcifications, and management of bone disorders.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 1","pages":"114146"},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517888","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":"Effects of micro and nano plastics on renal health.","authors":"Jean Demarquoy","doi":"10.5527/wjn.v15.i1.115039","DOIUrl":"10.5527/wjn.v15.i1.115039","url":null,"abstract":"<p><p>Research on microplastics (MPs) and kidney health is rapidly expanding, yet major knowledge gaps remain. Human exposure remains poorly characterized, with limited data on MPs levels in drinking water, food, indoor air, urine, blood, and kidney tissues. Most animal models rely on high-dose, short-term exposures, whereas studies employing environmentally realistic doses and long-term designs are required to evaluate links with chronic kidney disease and fibrosis. Mechanistic insights are also incomplete; the roles of ferroptosis, pyroptosis, and complement activation, as well as the influence of particle size, shape, polymer type, and surface charge, warrant further investigation. Co-exposures are another critical issue, as MPs act as vectors for heavy metals, persistent organic pollutants, and plastic additives, while also interacting with the gut microbiota and immune system. Clinical implications are particularly concerning: Dialysis fluids, intravenous solutions, and medical devices may represent unrecognized sources of exposure. Addressing these gaps will require multidisciplinary approaches, harmonized detection methods, and clinical monitoring to assess the burden and health consequences of MPs in vulnerable populations. This review underscores the kidney as a potential target organ for MP accumulation and highlights the urgent need for human biomonitoring.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 1","pages":"115039"},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517676","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 with maximum tolerable doses of dapagliflozin and telmisartan.","authors":"Amit S Pasari, Sushrut Gupta, Prasad Gurjar, Vishal Ramteke, Sunny Malde, Twinkle Pawar, Vijay Jeyachandran, Pranjal Kashiv, Shubham Dubey, Mohit Kurundwadkar, Kapil Sejpal, Charulata Bawankule, Nishant Deshpande, Manish Ramesh Balwani","doi":"10.5527/wjn.v15.i1.117173","DOIUrl":"10.5527/wjn.v15.i1.117173","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Diabetic kidney disease (DKD) remains a leading cause of end-stage renal disease (ESRD), with persistent proteinuria contributing to renal and cardiovascular complications. Despite dual therapy with renin-angiotensin-aldosterone system (RAAS) blockers and sodium-glucose co-transporter-2 inhibitors (SGLT2is), residual proteinuria persists in a substantial subset of patients. Finerenone, a novel nonsteroidal mineralocorticoid receptor antagonist, has shown promise in reducing albuminuria and slowing chronic kidney disease progression. This study evaluated the additive effect of finerenone exclusively in patients receiving maximum tolerable doses of both dapagliflozin and telmisartan unlike previously available studies evaluating its effect on patients with maximum tolerated dose of angiotensin receptor blocker alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To evaluate the efficacy and safety of finerenone in reducing proteinuria in patients with DKD who were receiving maximally tolerated doses of dapagliflozin and telmisartan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective, single-center observational study evaluated 33 patients with DKD and residual proteinuria. All patients received finerenone 10 mg daily for 24 weeks. Key parameters assessed at baseline and follow-up included urinary albumin-to-creatinine ratio (UACR), estimated glomerular filtration rate, and serum potassium. Responders were defined as patients who exhibited a reduction in UACR at follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean reduction in UACR was 9.5% (&lt;i&gt;P&lt;/i&gt; = 0.256). Twenty-two patients (66.7%) responded to treatment with a reduction in UACR, while 11 patients (33.3%) showed no reduction. When stratified by baseline albuminuria, responders with initial UACR &lt; 1000 mg/g, 1000-3000 mg/g, and &gt; 3000 mg/g showed average reductions of -47.9%, -39.0%, and -32.8%, respectively, suggesting a gradient treatment effect. Finerenone was well tolerated with mild hyperkalemia (serum potassium &gt; 5.0 mmol/L) noted in 15.2% of patients with mean increase in serum potassium by 6.4% (&lt;i&gt;P&lt;/i&gt; = 0.016). No cases required treatment discontinuation due to hyperkalemia. Renal function remained stable during the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Finerenone was associated with an overall reduction in albuminuria, with the magnitude of response varying according to baseline UACR. Greater proportional reductions were observed in patients with lower baseline albuminuria, while patients with moderate to severe albuminuria demonstrated a more heterogeneous response, including both responders and non-responders. Despite this variability, finerenone was generally safe and well tolerated. These findings support the use of finerenone as part of a multimodal strategy for proteinuria management in DKD, particularly as add-on therapy in patients receiving optimized RAAS blockade and SGLT2 inhibition, with the greatest benefit seen when introduced earlier in the course of alb","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 1","pages":"117173"},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517764","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":"Long-term patiromer adherence and renin-angiotensin aldosterone system inhibitor utilization: A retrospective study.","authors":"Nathan Kleinman, Tejas Desai, Charuhas Thakar","doi":"10.5527/wjn.v15.i1.113599","DOIUrl":"10.5527/wjn.v15.i1.113599","url":null,"abstract":"<p><strong>Background: </strong>Renin-angiotensin aldosterone system inhibitors (RAASi) reduce mortality risk in patients with heart failure, and slow progression of chronic kidney disease. However, hyperkalemia limits initiation, continuation, and reaching adequate dosing of RAASi therapy. Randomized trials have shown that patiromer users are more likely to continue taking RAASi.</p><p><strong>Aim: </strong>To test the hypothesis of whether patiromer facilitates optimal RAASi use in the real-world.</p><p><strong>Methods: </strong>This study compared RAASi use in patients adherent with patiromer [proportion of days covered (PDC) > 80%] to patients with lower adherence (PDC ≤ 80%). Pre-pandemic (2014 to 2019) prescription claims data, member demographics, and plan information were used for individuals whose first patiromer prescription (index date) was during 2015-2018. PDC for patiromer was measured 6 months post-index. Patients were divided into two cohorts: Those with patiromer PDC > 80% (adherent) and those with patiromer PDC ≤ 80% (lower adherence). RAASi use was compared between cohorts during the 6 months post-index period.</p><p><strong>Results: </strong>Nearly 25% of all patiromer users were adherent, with a patiromer PDC > 80%. Adherent patiromer use was associated with significantly more angiotensin-converting enzyme inhibitor, angiotensin-receptor blocker, and mineralocorticoid receptor antagonist days supply than lower patiromer adherence (10%, 8%, and 9% higher, respectively). Also, angiotensin-converting enzyme inhibitor, angiotensin-receptor blocker, and mineralocorticoid receptor antagonist PDC were significantly greater in adherent patiromer patients than in lower adherence patiromer patients (5%, 6%, and 10% higher, respectively).</p><p><strong>Conclusion: </strong>This study provides evidence that patients adherent with patiromer use more RAASi than lower-adherence patients. Prior studies show RAASi use reduces mortality risk and kidney disease progression.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 1","pages":"113599"},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective effects of cerium oxide on ibuprofen-induced renal injury in rats with ureteral obstruction.","authors":"Salih Toruk, Avni Babacan, Mustafa Arslan, Volkan Şıvgın, Şaban Cem Sezen, Hakan Boyunağa","doi":"10.5527/wjn.v15.i1.114142","DOIUrl":"10.5527/wjn.v15.i1.114142","url":null,"abstract":"<p><strong>Background: </strong>Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain management, but they can cause nephrotoxicity, particularly in patients with existing renal impairment. Cerium oxide (CeO₂), an antioxidant nanoparticle, may provide protection against renal damage caused by NSAIDs.</p><p><strong>Aim: </strong>To assess the protective effects of CeO₂ against ibuprofen-induced renal injury in a rat model of unilateral ureteral obstruction (UUO).</p><p><strong>Methods: </strong>Thirty male Wistar albino rats, weighing between 300 g and 425 g, were randomly divided into five groups (<i>n</i> = 6 each): Control (sham), UUO only, UUO + ibuprofen, UUO + ibuprofen + CeO₂, and UUO + CeO₂. UUO was surgically induced in all groups except the control group. Treatments were administered for a duration of 21 days. Serum levels of blood urea nitrogen, creatinine, malondialdehyde, and nitric oxide were measured. In addition, histopathological analysis was performed on both kidneys to assess parameters such as glomerular vacuolization (GV), tubular dilation, vascular hypertrophy, tubular necrosis, Bowman's space dilation, hyaline casts, lymphocyte infiltration, and tubular desquamation.</p><p><strong>Results: </strong>In the right (non-obstructed) kidneys, the UUO + CeO₂ group exhibited significantly lower levels of GV, tubular hyaline casts, and tubular desquamation compared to the UUO + ibuprofen group (<i>P</i> < 0.05). In the left (obstructed) kidneys, the CeO₂-treated group also exhibited significant reductions in GV, vascular hypertrophy, and tubular hyaline casts (<i>P</i> < 0.05). Furthermore, malondialdehyde levels were markedly decreased in the CeO₂ groups, whereas nitric oxide levels were elevated in the ibuprofen group. Blood urea nitrogen and creatinine levels increased across all UUO groups, but no significant differences were observed between the treatment groups.</p><p><strong>Conclusion: </strong>CeO₂ attenuates ibuprofen-induced renal injury in rats with UUO, likely through antioxidative mechanisms. These findings suggest that CeO₂ could serve as a potential nephroprotective adjunct during NSAID therapy in patients with obstructive renal conditions.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 1","pages":"114142"},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518052","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":"Association of chronic kidney disease with in-hospital mortality of cardiogenic shock patients undergoing veno-arterial extracorporeal membrane oxygenation.","authors":"Mounika Reddy Vadiyala, Jeffy Varghese, Giorgi Chilingarashvili, Vibhor Ahluwalia, Sakshi Sharma, Syed Mohammad Moosi Raza, Harsh Sura, Adhvithi Pingili, Rupak Desai","doi":"10.5527/wjn.v15.i1.113212","DOIUrl":"10.5527/wjn.v15.i1.113212","url":null,"abstract":"<p><strong>Background: </strong>Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) improves survival in patients with cardiogenic shock (CS), but data on chronic kidney disease (CKD) as a predictor of mortality in these patients is limited.</p><p><strong>Aim: </strong>To assess the association between CKD and in-hospital mortality in CS patients undergoing VA-ECMO through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>We reviewed studies up to February 2024 that evaluated CKD's impact on in-hospital mortality in CS patients treated with extracorporeal membrane oxygenation. Databases included PubMed, Google Scholar, EMBASE, and Scopus. A random-effects model was used to calculate the pooled unadjusted odds ratio, <i>I</i> ² statistics to determine heterogeneity, and leave-one-out sensitivity analysis to assess robustness, with <i>P</i> < 0.05 considered statistically significant.</p><p><strong>Results: </strong>Thirteen studies, involving 12185 CS patients treated with VA-ECMO (mean age 63, 68% males), were included. CKD was significantly associated with an increased in-hospital mortality (odds ratio = 1.89, 95% confidence interval: 1.4-2.55, <i>P</i> < 0.01). Leave-one-out analysis confirms robustness of the association between CKD and increased in-hospital mortality post-extracorporeal membrane oxygenation (<i>I</i> ² = 75%). Despite substantial heterogeneity, the association remains significant, indicating that CKD is a critical risk factor in these patients.</p><p><strong>Conclusion: </strong>CKD is strongly associated with an increased in-hospital mortality in CS patients treated with VA-ECMO. Despite study heterogeneity, this association remains robust, highlighting CKD as a critical prognostic factor.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 1","pages":"113212"},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517872","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":"Computed tomography of renal emergencies: A comprehensive diagnostic guide for radiology residents.","authors":"Sai Swarupa R Vulasala, Jacob Robinson, Corey Engel, Yanni Zulia, Aryan Sharma, Dheeraj Reddy Gopireddy, Grit Adler, Mayur Virarkar","doi":"10.5527/wjn.v15.i1.114185","DOIUrl":"10.5527/wjn.v15.i1.114185","url":null,"abstract":"<p><p>Renal emergencies include a wide variety of pathologies requiring immediate diagnosis and management to reduce morbidity and mortality. Imaging plays a crucial role in identifying the underlying condition, which guides clinical decision-making. In this review, we discuss the computed tomography imaging findings of a diverse spectrum of renal pathologies, categorized by traumatic, vascular, obstructive, and infectious conditions.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 1","pages":"114185"},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517629","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":"Long-term outcomes following arteriovenous fistula ligation in kidney transplant recipients.","authors":"Jia-Xi Zhu, Michelle Willicombe, Jeremy S Crane","doi":"10.5527/wjn.v15.i1.115895","DOIUrl":"10.5527/wjn.v15.i1.115895","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous fistulae (AVFs) are the preferred mode of vascular access amongst patients with end-stage kidney disease, and many remain patent following kidney transplantation. While emerging evidence demonstrates cardiovascular benefits to AVF ligation post-transplantation, current guidelines provide no clear consensus on the management of functioning AVFs post-transplant. Additionally, the impact of AVF ligation on allograft outcomes is unclear. Therefore, clarifying the potential benefits of post-transplant AVF ligation is clinically important.</p><p><strong>Aim: </strong>To investigate the clinical impact of AVF ligation post-transplantation and compare the outcomes in kidney transplant recipients on dialysis <i>via</i> a central venous catheter (CVC) <i>vs</i> AVF prior to transplantation.</p><p><strong>Methods: </strong>Kidney transplant recipients who had undergone AVF ligation or excision at a single center (<i>n</i> = 176) were identified using electronic health records. Two comparator groups were selected: Recipients with AVFs who had not undergone AVF ligation, and recipients who were 'AVF-free', having received hemodialysis <i>via</i> a CVC. Patient and allograft outcomes were captured <i>via</i> a prospectively maintained transplant database. The median follow-up post-AVF ligation was 90 months.</p><p><strong>Results: </strong>There were significant differences in patient characteristics between transplant recipients undergoing post-transplant AVF ligation <i>vs</i> non-ligation; the former were more likely to be female (<i>P</i> = 0.045), younger (<i>P</i> = 0.002), and non-diabetic (<i>P</i> < 0.001). There were further differences in patient and allograft characteristics between recipients with pre-transplant AVF <i>vs</i> CVC. Patients receiving dialysis <i>via</i> pre-transplant CVC had superior death-censored allograft survival compared with patients with pre-transplant AVFs [hazard ratio (HR): 0.74, 0.57-0.97, <i>P</i> = 0.028]. Post-transplant AVF ligation was associated with improved death-censored allograft survival amongst kidney transplant recipients compared to non-ligation (HR: 0.42, 0.26-0.66, <i>P</i> < 0.001). There were no differences in mortality rates.</p><p><strong>Conclusion: </strong>Post-transplant AVF ligation may improve allograft survival. However, due to significant differences between patients undergoing AVF ligation <i>vs</i> non-ligation, these findings are susceptible to selection bias and should be interpreted cautiously. Randomized controlled trials are needed in patient groups who may stand to benefit the most from cardiovascular protection from AVF ligation.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 1","pages":"115895"},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147518046","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":"Dual-score framework: National Early Warning Score 2 and quick Sequential Organ Failure Assessment scores in acute pyelonephritis.","authors":"Punith R Jain, Suryaram Aravind, Prajeeth Reddy K, Manikantan Shekar, Velmurugan Palaniyandi, Hariharasudhan Sekar, Sriram Krishnamoorthy","doi":"10.5527/wjn.v15.i1.114165","DOIUrl":"10.5527/wjn.v15.i1.114165","url":null,"abstract":"<p><strong>Background: </strong>Acute pyelonephritis (APN) is a significant part of the healthcare burden globally. Early risk stratification in APN is crucial to guide intensive care unit (ICU) admission and anticipate in-hospital mortality. The relevance of scoring tools like quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score 2 (NEWS2) in urology-specific infections has been unclear. Our study is among the first to prospectively compare the qSOFA and NEWS2 scores exclusively in non-emphysematous APN, a real-world cohort previously overlooked in research.</p><p><strong>Aim: </strong>To assess the accuracy of NEWS2 and qSOFA scores in predicting ICU admission, in-hospital mortality and their role in guiding urological interventions among adults with APN.</p><p><strong>Methods: </strong>A prospective observational study, conducted at a tertiary care centre in South India over two years, on adult patients diagnosed clinically and radiologically with APN. Comprehensive clinical, laboratory, and imaging parameters were recorded. The cohort was stratified into patients requiring ICU and not requiring ICU to assess differences across parameters. The discriminative power of the NEWS2 and qSOFA scores for predicting expedited care and mortality was analyzed.</p><p><strong>Results: </strong>The NEWS2 score ≥ 5 emerged as a robust tool, identifying nearly all patients requiring ICU admission [sensitivity, 98.1%; area under the receiver operating characteristic curve (AUC): 0.977; <i>P</i> < 0.05] and predicting intervention with high accuracy (AUC-0.823; <i>P</i> < 0.05). However, the qSOFA ≥ 2 score proved to be the silent sentinel of mortality (AUC-0.839; <i>P</i> < 0.05), outperforming the NEWS2 score in prognostication. Interestingly, patients who later required ICU care had elevated NEWS2 scores at baseline, suggesting the missed early red flags. To the best of our knowledge, this is the first and largest prospective study to compare NEWS2 and qSOFA scores exclusively in non-obstructive, non-emphysematous APN.</p><p><strong>Conclusion: </strong>In APN, NEWS2 (≥ 5) proved to be a pragmatic trigger for ICU triage, while qSOFA (≥ 2) better flagged in-hospital mortality. Together, they form a complementary framework as a simple, objective, and lifesaving bedside tool.</p>","PeriodicalId":94272,"journal":{"name":"World journal of nephrology","volume":"15 1","pages":"114165"},"PeriodicalIF":0.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517578","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}