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Chronic kidney disease (CKD) is associated with a high burden of cardiovascular remodeling and increased risk of heart failure with preserved ejection fraction (HFpEF). However, the interpretation of natriuretic peptide-based HFpEF diagnostic remains challenging in CKD populations, where structural cardiac abnormalities and elevated NT-proBNP levels frequently coexist. We conducted a cross-sectional study including ambulatory patients with CKD stages G3-G4 and NYHA II dyspnea. Clinical, metabolic, vascular, and echocardiographic assessments were performed. HFpEF was assessed using a modified HFA-PEFF-based approach derived from the ESC-recommended diagnostic algorithm. We evaluated the impact of NT-proBNP thresholds on HFpEF classification and explored the relationship between NT-proBNP, echocardiographic diastolic dysfunction, and structural cardiac abnormalities. The cohort displayed a high cardiometabolic burden (74.9%), and structural cardiac abnormalities were highly prevalent. Using a modified HFA-PEFF diagnostic algorithm, HFpEF was identified in 52.9% of patients. However, when the biomarker domain was excluded, 86.7% of patients remained within the intermediate-probability range. In an exploratory analysis, a cutoff of 700 pg/mL was identified as the cohort-adapted threshold with the best diagnostic balance and identified 19.8% patients as having HFpEF. Patients with CKD G3-G4 exhibited substantial structural and functional cardiovascular abnormalities despite no prior diagnosis of heart failure. HFpEF classification varied according to the NT-proBNP threshold applied, while NT-proBNP demonstrated limited discriminatory performance for echocardiographic diastolic dysfunction. These findings support the need for more refined and CKD-sensitive approaches for HFpEF characterization in this population.

Background Sexual dysfunction is common among dialysis and transplant patients. Our study evaluated the prevalence, risk factors, and severity of erectile dysfunction (ED) post-transplant in a single center. Methods We conducted a single-centre, observational, non-interventional study of adult male renal graft recipients. Sociodemographic and clinical data were collected, and erectile function was assessed with the International Index of Erectile Function (IIEF) questionnaire. Results 179 patients transplanted between 1995 and 2021 were enrolled (170 answered the questionnaire). Mild, moderate, and severe ED was noted in 33.5%, 20.6% and 10.6% of cases, respectively. ED prevalence increased with age (42.6% of patients < 40, 47.4% of patients aged 40–60, 78.9% of patients > 60). The total mean IIEF score was 16.32 ± 6.93 (erectile function 19.22 ± 7.9, orgasmic function 6.8 ± 2.9, sexual desire 6.43 ± 2.1, intercourse satisfaction 8.96 ± 3.7, overall satisfaction 6.78 ± 2.6). Age, alcohol consumption, type, time on dialysis pre-transplant, and donor type were significantly associated with erectile dysfunction (p < 0.05). Most patients (93.5%) were treated for comorbidities in addition to immunosuppression. Severe ED was significantly more common among patients taking alpha blockers and non-steroidal anti-inflammatory drugs. Conclusions Self-reported erectile dysfunction post renal transplantation seems influenced by age, alcohol intake, dialysis history, donor type and certain drugs, but not by comorbidities (hypertension, diabetes, heart disease).

Kidney transplant recipients (KTRs) remain vulnerable to infectious complications and malignancies due to chronic immunosuppression, both of which may contribute to allograft dysfunction and adverse clinical outcomes. This study aimed to evaluate the prevalence of viral infections and post-transplant malignancies among hospitalized KTRs and to identify factors associated with acute kidney injury (AKI) and chronic graft dysfunction. We conducted a prospective observational study including 215 adult KTRs admitted to a tertiary transplant center over a one-year period. Clinical data, malignancy history, and viral detection for BK polyomavirus (BKV), cytomegalovirus (CMV), Epstein–Barr virus (EBV), and parvovirus B19 were analyzed. AKI occurred in 65.6% of patients, while chronic graft dysfunction was present in 21.4%. Viral positivity was detected in 16.7% of the cohort, most frequently BKV and CMV. Infectious etiologies represented the most common cause of AKI. Viral positivity was significantly associated with infectious mechanisms of AKI and was independently associated with AKI in multivariable analysis (adjusted OR 3.01, p = 0.02). In a separate multivariable model, malignancy history (aOR 9.30), viral positivity (aOR 3.33), and concurrent AKI (aOR 3.42) were independently associated with chronic graft dysfunction. These findings suggest that viral reactivation and malignancy history cluster with clinical states of increased graft vulnerability in hospitalized KTRs. Integrated evaluation of infectious, immunologic, and clinical factors may improve risk stratification and management of transplant recipients presenting with acute illness.

Erectile dysfunction (ED) affects the great majority of people undergoing dialysis and also the majority of patients undergoing kidney transplantation. In this study, we investigated the degree of erectile dysfunction (ED), as well as its prevalence, contributory variables, and overall impact after renal transplant. Adult male kidney transplant patients were the subject of an observational, non-interventional study that was conducted at a single center. Age, time and type of dialysis before transplantation, comorbidities, factors associated with cardiovascular risk, data on sexual history, physical examination, and laboratory results were among the clinical data we examined. In addition to gathering clinical and demographic characteristics, the International Index of Erectile Function (IIEF) questionnaire was used to evaluate sexual function. A total of 170 renal transplanted patients between 20 and 70 years old (mean age: 45.40±11.5) were included in this study. All of the patients had immunosuppressive treatment with a calcineurin inhibitor (cyclosporine or tacrolimus) and had a normal glomerular filtration rate (GFR). The prevalence of sexual dysfunction increased with age (42.6% of patients under 40, 47.4% of patients in the 40-60 age group, and 78.9% of patients over 60). Mild, moderate, and severe ED was noted in 33.5%, 20.6%, and 10.6% of cases, respectively, and 51 (30%) patients reported having a normal sexual function. While calcium channel blockers (122 cases) were the most commonly used antihypertensive medication and chronic glomerulosclerosis (55.3%) was the most common cause of chronic kidney disease (CKD) before transplantation, none of these variables appear to have affected the severity of erectile dysfunction. The only medications associated with sexual dysfunction were alpha-blockers and aspirin (75 mg) (p=0.026 and p=0.013, respectively). Although kidney transplantation has positive impacts on the quality of life, erectile dysfunction is a frequent condition among patients with renal transplants, and it has an increased frequency with age. In our study, it has been observed that only a small percentage of the research group had a normal sexual function, although most of the patients were young, and that alpha-blockers and aspirin (75 mg) are associated with erectile dysfunction.

Renal artery aneurysms, although rare, may give rise to complications both per se (due to the risk of thrombosis and subsequent wall rupture) and by impairment of the renal function (due to extrinsic compression and high blood pressure). We describe a paucisymptomatic young patient with acute thrombosis of a massive dissecting renal artery aneurysm, for which the successful treatment was performed through ex-vivo vascular surgery followed by autotransplantation of the reconstructed kidney. The aneurysm was described through abdominal echography, computed tomography angiography, and transfemoral transcatheter arterial angiography. It originated from an atypical branch emerging at 90 degrees from the left renal artery. After a short branching off, it degenerated into a dissected aneurysmal sac as large as half a kidney (outer diameter of 60 mm), compressing the lower pole of the left kidney and delaying the lower half nephrogram. Ex-vivo surgical exclusion of the aneurysm was successfully performed. The kidney was reimplanted in the left iliac fossa (termino-lateral anastomosis between the renal artery and external left iliac artery, termino-terminal ureteric anastomosis) with excellent postoperative outcomes. For most asymptomatic aneurysms, expectant treatment is a reasonable approach. However, interventional or surgical repair is indicated in certain circumstances depending on the size of the aneurysm and its natural history, rupture risk, and interventional/surgical risks. The renovascular hypertension, dissecting and thrombotic events, its giant size, the young fertile age, and the presence of the flank pain were all indicative of the need for aneurysm exclusion in our case.

Introduction Patients with end-stage kidney disease (ESKD) on dialysis have a special profile, including constant uremic status and frequent comorbidities, such as diabetes mellitus, arterial hypertension and coronary artery disease, as well as complications related to dialysis. All listed factors can influence or be the cause of sexual dysfunction in both men and women. There is a high incidence (70%) and prevalence (82%) of erectile dysfunction in men with CKD. Purpose In this meta-analysis, we aimed to evaluate the impact of renal transplantation in patients with end-stage chronic kidney disease and erectile dysfunction, using the same study population before and after transplantation. Data sources: we searched MEDLINE (PubMed ), Embase, Scopus and Cochrane Library (Inception to August 2022) and clinicaltrials.gov (Inception to August 2022) without language restrictions. Study selection : eligible studies evaluated the same patients with end-stage kidney disease before and after renal transplantation using IEEF questionnaire. Data extraction: reviewers working independently and in duplicate extracted data and assessed the risk of bias. Data synthesis: the final analysis included 28 cohort studies, comprising 2252 participants. Results Our results showed improvement in erectile function after renal transplantation. Our study shows a 13% improvement in erectile dysfunction after renal transplantation. Conclusions The results of this meta-analysis would suggest improvement in erectile dysfunction after renal transplantation.

Rates of late allograft loss have improved slowly in the last decades. Well described traditional risk factors that influence allograft survival include cardiovascular events, rejection, infections and post-transplant neoplasia. Here, we critically evaluate the influence of several non-immunological, non-traditional risk factors and describe their impact on allograft survival and cardiovascular health of kidney transplant recipients. We assessed the following risk factors: arterial stiffness, persistent arteriovenous access, mineral bone disease, immunosuppressive drugs residual levels variability, hypomagnesemia, glomerular pathological alterations not included in Banff criteria, persistent inflammation and metabolic acidosis.

3D modelling is a design method that allows the creation of digital models of components and assemblies with high precision and flexibility. The paper presents the 3D modelling process of two components used in bevel gear transmissions: a bevel gear and a bevel pinion shaft. The 3D models were created using two CAD systems widely used in the industry - NX and CATIA - highlighting the main stages of geometric construction and parametric definition. The purpose of the paper is to demonstrate the importance and efficiency of CAD modelling in the design of components with complex geometry, as well as to highlight the advantages offered by computer-aided design environments in terms of precision and optimisation of the development process.

3D modelling is a design method that allows the creation of digital models of components and assemblies with high precision and flexibility. The paper presents the 3D modelling process of two components used in bevel gear transmissions: a bevel gear and a bevel pinion shaft. The 3D models were created using two CAD systems widely used in the industry - NX and CATIA - highlighting the main stages of geometric construction and parametric definition. The purpose of the paper is to demonstrate the importance and efficiency of CAD modelling in the design of components with complex geometry, as well as to highlight the advantages offered by computer-aided design environments in terms of precision and optimisation of the development process.