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The aim of this study was to investigate the characteristics of the bone trabeculae pattern in the mandible of patients with chronic kidney disease (CKD) using fractal dimension analysis in cone beam computed tomography (CBCT) exams. The sample comprised 20 adult patients, divided into two groups: a group of 10 individuals with CKD and a control group of 10 people matched for sex and age similar to the first group. The software ImageJ was used to do fractal analysis on the mandibular condyle and body of each individual. Statistical analysis included the use of the intraclass correlation coefficient (ICC) for the examiner’s standardization and the student t-test for fractal analysis. The results showed a lower complexity of bone microarchitecture in the CKD group compared to the healthy patients. The fractal values found in the mandible of individuals were significantly lower for both body and condyle in the CKD group. The decrease in bone quality interferes directly in the planning of clinical and surgical interventions, therefore, fractal analysis appears to be a potential, simple, and economic method for examining bone quality through imaging exams.

Innate lymphoid cells (ILCs) are a recently discovered lymphocyte population with high cytokine productive capacity. Type-2 ILCs (ILC2s) are the most studied, and they exert a rapid type-2 immune response to eliminate helminth infections. Massive and sustainable ILC2 activation induces allergic tissue inflammation, so it is important to maintain correct ILC2 activity for immune homeostasis. The ILC2-activating cytokine IL-33 is released from epithelial cells upon tissue damage, and it is upregulated in various kidney disease mouse models and in kidney disease patients. Various kidney diseases eventually lead to renal fibrosis, which is a common pathway leading to end-stage renal disease and is a chronic kidney disease symptom. The progression of renal fibrosis is affected by the innate immune system, including renal-resident ILC2s; however, the roles of ILC2s in renal fibrosis are not well understood. In this review, we summarize renal ILC2 function and characterization in various kidney diseases and highlight the known and potential contributions of ILC2s to kidney fibrosis.

Background Children with prune belly syndrome (PBS) are at higher risk of developing kidney dysfunction and requiring kidney replacement therapy (KRT). While studies have described surgical and survival outcomes in these populations, there has yet to be a focused synthesis of evidence regarding kidney outcomes in this population. Here, the focus of this scoping review was to highlight knowledge gaps and report standards on kidney outcomes in PBS of all ages. Methods Following scoping review methodology, EMBASE, MEDLINE, and Scopus were searched for peer-reviewed literature that describe kidney outcomes in PBS. All studies with a broad set of kidney outcomes (such as kidney function measures, chronic kidney disease (CKD), KRT and associated outcomes) were included. Findings were summarized and qualitatively synthesized. Results Of the 436 unique records identified, 25 were included for synthesis. A total of 17 studies (441 patients) reported on kidney insufficiency outcomes, with an estimated prevalence of CKD ranging from 8 to 66%. A total of 15 studies (314 patients) described KRT, primary kidney transplant, and outcomes. Of these, the age for KRT ranged from 4 to 21 years, and graft survival ranged from 22 to 87% by last follow-up (range 1.3–27 years). Conclusions There is significant variability in studies reporting kidney outcomes in PBS which limits meaningful synthesis. There is a need for future studies with comprehensive reporting of confounders and drivers for kidney insufficiency in PBS.

Background The previously published “Dose Response Multicentre International Collaborative Initiative (DoReMi)” study concluded that the high mortality of critically ill patients with acute kidney injury (AKI) was unlikely to be related to an inadequate dose of renal replacement therapy (RRT) and other factors were contributing. This follow-up study aimed to investigate the impact of daily fluid balance and fluid accumulation on mortality of critically ill patients without AKI (N-AKI), with AKI (AKI) and with AKI on RRT (AKI-RRT) receiving an adequate dose of RRT. Methods We prospectively enrolled all consecutive patients admitted to 21 intensive care units (ICUs) from nine countries and collected baseline characteristics, comorbidities, severity of illness, presence of sepsis, daily physiologic parameters and fluid intake-output, AKI stage, need for RRT and survival status. Daily fluid balance was computed and fluid overload (FO) was defined as percentage of admission body weight (BW). Maximum fluid overload (MFO) was the peak value of FO. Results We analysed 1734 patients. A total of 991 (57 %) had N-AKI, 560 (32 %) had AKI but did not have RRT and 183 (11 %) had AKI-RRT. ICU mortality was 22.3 % in AKI patients and 5.6 % in those without AKI ( p  < 0.0001). Progressive fluid accumulation was seen in all three groups. Maximum fluid accumulation occurred on day 2 in N-AKI patients (2.8 % of BW), on day 3 in AKI patients not receiving RRT (4.3 % of BW) and on day 5 in AKI-RRT patients (7.9 % of BW). The main findings were: (1) the odds ratio (OR) for hospital mortality increased by 1.075 (95 % confidence interval 1.055–1.095) with every 1 % increase of MFO. When adjusting for severity of illness and AKI status, the OR changed to 1.044. This phenomenon was a continuum and independent of thresholds as previously reported. (2) Multivariate analysis confirmed that the speed of fluid accumulation was independently associated with ICU mortality. (3) Fluid accumulation increased significantly in the 3-day period prior to the diagnosis of AKI and peaked 3 days later. Conclusions In critically ill patients, the severity and speed of fluid accumulation are independent risk factors for ICU mortality. Fluid balance abnormality precedes and follows the diagnosis of AKI.

Objectives: The cause of chronic kidney disease (CKD) remains uncertain in the majority of affected individuals, but the influence of socioeconomic status on CKD progression has recently gained attention. We compared the risk of CKD progression among 18 occupational classifications using an annual health checkup database.Methods: We used the annual health checkup data and health insurance claims data of the Japan Health Insurance Association in Kyoto prefecture between April 2012 and March 2016. The primary outcome for survival analysis was defined as a more than 30% change in the estimated glomerular filtration rate (eGFR) from the first health checkup. We used the Cox proportional hazards model for time-to-event analyses to estimate the hazard ratios and 95% CIs for the primary outcome, adjusting for age, sex, eGFR, body mass index, blood pressure, blood sugar, dyslipidemia, uric acid, urinary protein, and existence of kidney disease at first health checkup.Results: We analyzed 239 506 employees, and 1736 (0.7%) individuals whose eGFR had decreased by 30% or more; the mean follow-up period was 2.8 years. When we compared the risk with that for “manufacturing,” 5 categories of industries (“information and communications”; “transport and postal services”; “accommodations, eating and drinking services”; “living-related and personal services and amusement service”; “medical, health care and welfare”) were associated with a decline in the increased risk of eGFR after adjusting for the confounding factors and/or mediators.Conclusions: We provide evidence that the risk of CKD progression depends on occupational type. Further research is needed to confirm the mechanism and causal relationships involved.

Background The prevalence of chronic kidney disease (CKD) is increasing globally, and understanding the association between CKD and employment status is crucial. This cross-sectional study aimed to investigate the association of CKD with employment and occupation type among patients with CKD. Methods We analyzed data from 36,732 Korean adults aged ≥ 30 years, who participated in the Korean National Health and Nutrition Examination Survey between 2014 and 2021. CKD was detected based on the estimated glomerular filtration rate, and the employment status of the participants was classified into distinct categories: full-time permanent employment, unemployment, self-employment, and precarious employment. We analyzed the data using multiple logistic regression. Results We observed a significant association between CKD and a higher likelihood of unemployment compared to that in individuals without CKD (odds ratio, 1.70; 95% confidence interval, 1.47–1.96). This association was more prominent in patients with severe CKD. In the multivariable logistic analysis, patients with CKD had a higher likelihood for precarious employment (odds ratio, 1.29; 95% confidence interval, 0.92–1.88), self-employment (odds ratio, 1.3; 95% confidence interval, 0.90–1.88), and unemployment (odds ratio, 2.10; 95% confidence interval, 1.51–2.92) compared to individuals without CKD. Conclusions Our study demonstrated that CKD is associated with a higher likelihood of unemployment and engagement in precarious employment. These findings highlight the challenges faced by patients with CKD in obtaining stable employment and emphasize the need for interventions to improve the employment outcomes of individuals with CKD.

Introduction: Spontaneous bladder rupture (SBR) is a rare cause of ascites. A systematic review identified only 351 reported cases in the literature. This condition is frequently misdiagnosed due to vague symptom presentation and failure to promptly link SBR to its common risk factors, such as pelvic irradiation and alcohol intoxication. Its presentation is not different from the most common causes of ascites, and the differential diagnosis is essential. Case Presentation: Here, we present a case of a male with liver disease with portal hypertension, a previous history of cancer, and prior surgery with an artificial urinary sphincter placement who developed acute recurrent ascites and rapidly progressing acute kidney failure requiring dialysis. Extensive workup revealed that the kidney failure was caused by SBR, resulting in urinary ascites. The bladder rupture was treated by surgery, leading to complete resolution of the patient’s symptoms. Conclusion: The diagnosis of SBR requires a high level of suspicion due to its rarity and nonspecific symptoms. Here, we present an extensive review of differential diagnoses of ascites and the pathway for the final diagnosis of SBR.

To determine the application of various components of the Kidney Disease Improving Global Outcomes (KDIGO) bundle in managing patients at high-risk for AKI progression ([TIMP2]•[IGFBP7] >0.3) in the real-world setting. Patients with a [TIMP2]•[IGFBP7] test ordered between 5/23/16–2/28/18 were evaluated. We reviewed the medical record for evidence of implementation of the KDIGO bundle in response to biomarker test results. Evidence including explicit documentation in physicians' note discussing [TIMP2]•[IGFBP7] results and implicit evidence from review of dose adjusted medications, discontinued nephrotoxins and therapeutic drug monitoring. 105 [TIMP2]•[IGFBP7] tests were conducted in 100 patients (54% female; mean age 55.4 ± 16.8; 89% in the ICU). Sixty-one patients had a value of >0.3 and 46 (75.4%) of these patients received at least one management strategy consistent with KDIGO. By contrast, nine patients (23.1%) with [TIMP2]•[IGFBP7] ≤0.3 received one or more components of the KDIGO bundle (p < .001). In a real-world setting the use of urinary [TIMP2]•[IGFBP7] as an AKI risk screening tool resulted in differential application of various components of the KDIGO bundle for patient management for those with a positive test result. •[TIMP2]•[IGFBP7] has demonstrated value as an early warning signal to manage patients at risk for acute kidney injury (AKI) development in randomized controlled trials.•55% of patients had at least one component of the KDIGO bundle applied and ensuring adequate volume status, monitoring urine output and avoiding initiation of nephrotoxins were the most common.•This evaluation suggests similar benefits of [TIMP2]•[IGFBP7] for patient management in the real-world setting.

Benign prostatic hyperplasia (BPH) is a common disease affecting male urinary system function and quality of life, with its incidence increasing due to population ageing and unhealthy lifestyles. Modern medicine mainly adopts symptomatic treatments such as 5-alpha reductase inhibitors and alpha1 adrenergic receptor blockers. However, due to the complex pathogenesis of BPH, these drugs can only partially alleviate symptoms and have shortcomings such as high treatment costs and significant side effects. BPH is similar to the descriptions of “Jīng Lóng” and “Lóng Bì” in traditional Chinese medicine (TCM), and its onset is closely related to liver and kidney dysfunction. Kidney insufficiency and blood stasis are common clinical syndromes of BPH. Compared with modern medicine, treatment based on syndrome differentiation of TCM can achieve good results in treating this subtype of BPH. Therefore, guided by the holistic view of TCM, adopting a holistic and systematic research approach to explore therapeutic targets and potential therapeutic components for BPH with a specific syndrome can provide new ideas for the clinical treatment of BPH. This study integrated clinical metabolomics and network pharmacology to identify therapeutic targets for kidney insufficiency and blood stasis-type BPH. Serum analysis of BPH patients and healthy controls for testosterone, estradiol, SRD5α2, NF-κB p65, and TGF-β levels, alongside metabolomics and network pharmacology, revealed hormonal imbalance, increased inflammatory/fibrotic markers, and 58 differential metabolites in BPH. Pathway enrichment analysis identified 6 key metabolic pathways, while network pharmacology constructed four compound-reaction-enzyme-gene networks and pinpointed 178 potential targets, including 23 core targets. Reverse screening against the Yaozh Database-Natural Product AI Engine Platform matched 11 druggable targets with 49 interacting components, and target-component fitting analysis confirmed the reliability of 8 core targets. This combined approach validated the findings of hormonal imbalance and significant metabolic pathway changes and provided valuable insights for BPH treatment and drug development.