Acute kidney injury after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a Portuguese population

Background: Acute kidney injury (AKI) after cytoreductive surgery followed by the infusion of hyperthermic intraperitoneal chemothera-py (CRS/HIPEC) is associated with a higher rate of major complica-tions, resulting in prolonged hospitalization and increased mortality. Our objective was to evaluate the incidence of AKI and further pro-gression to chronic kidney disease (CKD) in patients submitted to this procedure and recognize the associated risk factors. Methods: This retrospective study collected demographic, tumor -related, intraoperative, and postoperative data from 182 patients who underwent CRS/HIPEC from January 2016 to December 2019. Re-nal impairment was defined according to Kidney Disease Improv-ing Global Outcomes criteria for AKI. We conducted univariate and multiple logistic regression analyses to assess the association between variables of interest and AKI. Results: Twenty-three patients (12.6%) developed AKI. In the AKI group, the risk for developing CKD was six times higher (odds ra-tio (OR) 6.48, confidence interval (CI) 1.601 -26.255). Multivariate regression identified higher risk of developing AKI in patients who underwent HIPEC with cisplatin (OR 12.21, CI 1.26 -109.70, P = 0.025), in each additional day spent in the intensive care unit (ICU) (OR 2.42, CI 1.07 -5.45, P = 0.033), and an association for each unit increase in estimated glomerular filtration rate (eGFR) before HIPEC (OR 0.96, CI 0.94 -0.98, P = 0.037) and AKI development. Conclusion: Patients who are at higher risk of AKI after CRS/HIPEC include those who performed cisplatin HIPEC regimen, had poorer preoperative renal function and had longer ICU stays. Early institu-tion of preventive measures and frequent monitoring should be considered to minimize AKI risk and its associated morbidity, such as CKD progression.info:eu-repo/semantics/publishedVersio

Vascular Calcification and Cardiovascular Risk in Chronic Kidney Disease: A Problem That Is Here to Stay

Cardiovascular disease is the primary cause of morbidity and mortality in chronic kidney disease (CKD) population, particularly in end stage renal disease (ESRD). This could be explained in part due to the presence of traditional cardiovascular risk factors, such as older age, hypertension, dyslipidemia and diabetes, but is also associated with nontraditional cardiovascular risk factors related to CKD, like inflammation, anemia, abnormal calcium and phosphate metabolism and extracellular fluid volume overload, which may contribute to intimal or medial wall arterial calcification. Vascular calcification (VC) is a dynamic process, resulting from the dysregulation of the balance of molecules that promote and those that inhibit this course. It is important for clinicians to both acknowledge and recognize the pathways and risk factors of VC in order to improve cardiovascular health in CKD patients. This chapter will focus on the biology of VC, the association with CKD, risk factor modification, screening and prevention of VC and cardiovascular disease in CKD patients

Plasmatic Klotho and FGF23 levels as biomarkers of CKD-associated cardiac disease in type 2 diabetic patients

Research over the past decade has focused on the role of Klotho as a cardio protective agent that prevents the effects of aging on the heart and reduces the burden of cardiovascular disease CVD. The role of the interaction between fibroblast growth factor 23-(FGF-23)/Klotho in Klotho-mediated actions is still under debate. The main objective was to ascertain the potential use of plasmatic Klotho and FGF23 as markers for CKD-associated cardiac disease and mortality.info:eu-repo/semantics/publishedVersio

FGF23-klotho axis as predictive factors of fractures in type 2 diabetics with early chronic kidney disease

Background: The aim of our study was to evaluate the relevance of FGF23-klotho axis in the predisposition for bone fractures in type 2 diabetic patients with early chronic kidney disease. Methods: In a prospective study we included 126 type 2 diabetic patients with CKD stages 2-3 (from 2010 to 2017). We used descriptive statistics, ANOVA and chi-square test. Our population was divided into two groups according to the occurrence of a bone fracture event or not, and the groups were compared considering several biological and laboratorial parameters. We employed a multiple regression model to identify risk factors for bone fracture events and hazard ratios (HR) were calculated using a backward stepwise likelihood ratio (LR) Cox regression. Results: Patients with a fracture event displayed higher levels of FGF-23, Phosphorus, PTH, TNF-alpha, OxLDL, HOMA-IR, calcium x phosphorus product and ACR and lower levels of Osteocalcin, alpha-Klotho, 25(OH)D3 and eGFR compared with patients without a fracture event (p < 0.001). The number of patients with a fracture event was higher than expected within inclining CKD stages (chi 2, p = 0.06). The occurrence of fracture and the levels of TNF-alpha, klotho, 25(OH)D3 and OxLDL were found to predict patient entry into RRT (p < 0.05). Age, osteocalcin, alpha-Klotho and FGF-23 independently influenced the occurrence of bone fracture (p < 0.05). Conclusions: alpha-Klotho and FGF-23 levels may have a good clinical use as biomarkers to predict the occurrence of fracture events. (C) 2019 Elsevier Inc. All rights reserved.info:eu-repo/semantics/publishedVersio

Take a closer look at TINU syndrome; analysis of a case

Tubulointerstitial nephritis and uveitis syndrome (TINU) combines tubulointerstitial nephritis and uveitis and is a known cause of kidney failure in children and adults. This is a challenging diagnosis since renal and ocular manifestations may not occur simultaneously and may be present in several alternative diagnosis. The authors report the case of a 28-year-old patient with acute kidney injury (AKI) and biopsy-proven acute tubulointerstitial nephritis. Bilateral symptomatic uveitis presented six months after the initial presentation. Physicians in charge of patients with kidney disease attributed to acute tubulointerstitial nephritis must bear in mind the need for ophthalmologic surveillance for at least one year post-diagnosis. Although a diagnosis of exclusion, its incidence may be higher than described. Kidney disease is believed to be self-limited and prognosis still, most patients will require systemic therapy and relapses are common

Renal thrombotic microangiopathy in an ANCA-associated vasculitis

Anti-neutrophil cytoplasmic antibody (ANCA) disease remains a diagnostic challenge due to the heterogeneity of possible clinical presentations. We present the case of a 63-year-old white male with a known history of ANCA-associated vasculitis (AAV) with anti-myeloperoxidase antibodies (MPO) – mainly with respiratory manifestations – treated with corticosteroids and cyclophosphamide, resulting in partial improvement. Six months later he was referred to the nephrology department for rapidly progressive renal failure and a kidney biopsy was performed, which showed several glomeruli globally sclerosed and others presenting fibrous crescents. Vascular involvement was also noted with several small arteries revealing endothelial swelling and entrapped erythrocytes within a fibrin thrombus. Immunofluorescence was negative. A high percentage of parenchymal fibrosis and no evidence of active extra-renal manifestations dictated no specific treatment. The patient is currently monitored in a low clearance nephrology consultation. Evidence of thrombotic microangiopathy (TMA) is an uncommon histological finding in kidney biopsies of patients with AAV, being associated with worst prognosis

Tip Lesion Variant of Focal and Segmental Glomerulosclerosis in a COVID-19 Patient

Acute kidney injury is a common complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Several pathologic findings are continually being reported, showing a probably multifactorial etiology. The authors present a case of a patient diagnosed with a tip lesion variant of focal segmental glomerulosclerosis (FSGS) in the setting of COVID-19. A 43-year-old African American female with no known renal disease presented to the emergency department with a 6-day history of fatigue, headache, hypoageusia, myalgia, cough, nausea, and vomiting. Laboratory tests confirmed SARS-CoV-2 infection. During hospitalization, there was a progressive decline in kidney function and evidence of nephrotic-range proteinuria without nephrotic syndrome. Biopsy specimen showed a tip lesion variant of FSGS. Genetic test revealed a homozygous variant of uncertain clinical significance (c.397G&#x3e;A [p.V133M]) in the epithelial membrane protein 2 (EMP2) gene. To our knowledge, this is the first case report of a tip lesion in a COVID-19 patient with no renal history. More studies are warranted to define susceptible groups and identify the detailed mechanisms of COVID-19-related kidney disease that would allow for specific management of this complication

Regenerative Potential of Nasal Septal Cartilage Cells: A Comprehensive Scoping Review with Clinical Translational Implications

This scoping review aims to assess the evidence regarding the regenerative and reparative potential of nasal septal cartilage-derived cells in clinical applications. The review will explore various cell types derived from nasal septum cartilage, which have the potential for cartilage and bone formation. The study will evaluate the therapeutic potential of these cells in enhancing tissue repair and regeneration through various analyses, including histological, molecular, biochemical, and immunological assessments. The review will include in vivo and clinical research studies and employ multiple databases for data collection and analysis