FGF-23 Levels before and after Renal Transplantation

Phosphatonin fibroblast growth factor-23 (FGF-23) is involved in phosphate (P) excretion and vitamin D metabolism. Recently, FGF-23 has been suggested to be responsible for the hypophosphatemia and inappropriately low calcitriol levels observed after renal transplantation. We performed a prospective study to investigate FGF-23 levels in patients with end-stage renal disease before and after renal transplantation and their probable association with markers of bone and mineral metabolism. Intact FGF-23 levels were determined before and at 3, 6, and 12 months posttransplantation in 18 renal transplant recipients. Intact parathyroid hormone (iPTH), calcium (Ca), P, 25(OH)VitD, and 1,25(OH)2VitD levels were measured at the same time periods. Renal threshold phosphate concentration (TmPO4/GFR) was also calculated at 3, 6, and 12 months posttransplantation. The results showed that FGF-23 levels decreased by 89% 3 months posttransplantation (346 ± 146 versus 37 ± 9 pg/mL, P < .01) and remained stable throughout the study period. iPTH and P levels also decreased significantly after renal transplantation, while Ca and 1,25(OH)2VitD increased. Pretransplantation FGF-23 was significantly correlated with P levels at 3 months posttransplantation (P < .005). In conclusion, FGF-23 levels decrease dramatically after successful renal transplantation. Pre-transplantation FGF-23 correlate with P levels 3 months posttransplantation

Predictors of outcome in idiopathic rapidly progressive glomerulonephritis (IRPGN)

BACKGROUND: Small vessel vasculitides are known to follow a devastating course towards end-stage renal disease, unless treated with immunosuppressive regiments. We investigated the value of clinical, histological and immunohistochemical parameters as predictors of outcome at diagnosis in patients with pauci immune necrotizing glomerulonephritis. METHODS: In 34 patients the percentage and evolution stage of crescents, the presence of glomerular necrosis, the degree or severity of arteriosclerosis, as well as the extent of tubulointerstitial infiltration, interstial fibrosis and tubular atrophy were assessed. Monoclonal antibodies were used to identify infiltrating macrophages, α-SMA(+) and PCNA(+) cells, the expression of integrins α3β1 and LFA-1β, the adhesion molecule ICAM-1, the growth factor TGF-β1 and the terminal complement component C5b-9. RESULTS: 24 pts (70.6%) showed a complete or partial response to the treatment. The follow-up period was 20 ± 22 months. At multivariate analysis, serum CRP (p = 0.024), the intensity of tubular expression of C5b-9 (p < 0.0001) as well as the extent of glomerular and tubular expression of α3β1 integrin (p = 0.001 and 0.008 respectively) independently predicted the response to treatment. The response rate was better in ANCA(+) pts (p = 0.008). The extent of interstitial infiltrate (p < 0.0001), the severity of tubulointerstitial fibrosis (p < 0.0001) and the severity of tubular TGF-β1 expression (p < 0.0001) were independent predictors of long term outcome of renal function. CONCLUSION: Patients with ANCA-associated renal vasculitis seem to respond better to the treatment. Acute phase reactants, such as CRP, implying a more intense parenchymal inflammatory reaction, as well as the intensity of the de novo expression of C5b-9 and the glomerular and tubular expression of α3β1 integrin predict the response to therapy. The severity of TIN lesions and of the tubulo-interstitial TGF-β1 and C5b-9 expression predict an unfavourable outcome

Clinical Study FGF-23 Levels before and after Renal Transplantation

Recommended by Bruce Kaplan Phosphatonin fibroblast growth factor-23 (FGF-23) is involved in phosphate (P) excretion and vitamin D metabolism. Recently, FGF-23 has been suggested to be responsible for the hypophosphatemia and inappropriately low calcitriol levels observed after renal transplantation. We performed a prospective study to investigate FGF-23 levels in patients with end-stage renal disease before and after renal transplantation and their probable association with markers of bone and mineral metabolism. Intact FGF-23 levels were determined before and at 3, 6, and 12 months posttransplantation in 18 renal transplant recipients. Intact parathyroid hormone (iPTH), calcium (Ca), P, 25(OH)VitD, and 1,25(OH) 2 VitD levels were measured at the same time periods. Renal threshold phosphate concentration (TmPO 4 /GFR) was also calculated at 3, 6, and 12 months posttransplantation. The results showed that FGF-23 levels decreased by 89% 3 months posttransplantation (346 ± 146 versus 37 ± 9 pg/mL, P &lt; .01) and remained stable throughout the study period. iPTH and P levels also decreased significantly after renal transplantation, while Ca and 1,25(OH) 2 VitD increased. Pretransplantation FGF-23 was significantly correlated with P levels at 3 months posttransplantation (P &lt; .005). In conclusion, FGF-23 levels decrease dramatically after successful renal transplantation. Pre-transplantation FGF-23 correlate with P levels 3 months posttransplantation

Transforming urinary stone disease management by artificial intelligence-based methods: A comprehensive review

Objective: To provide a comprehensive review on the existing research and evi-dence regarding artificial intelligence (AI) applications in the assessment and management of urinary stone disease.Methods: A comprehensive literature review was performed using PubMed, Scopus, and Google Scholar databases to identify publications about innovative concepts or supporting applica-tions of AI in the improvement of every medical procedure relating to stone disease. The terms "endourology", "artificial intelligence", "machine learning", and "urolithiasis"were used for searching eligible reports, while review articles, articles referring to automated procedures without AI application, and editorial comments were excluded from the final set of publica-tions. The search was conducted from January 2000 to September 2023 and included manu-scripts in the English language.Results: A total of 69 studies were identified. The main subjects were related to the detection of urinary stones, the prediction of the outcome of conservative or operative management, the optimization of operative procedures, and the elucidation of the relation of urinary stone chemistry with various factors.Conclusion: AI represents a useful tool that provides urologists with numerous amenities, which explains the fact that it has gained ground in the pursuit of stone disease management perfection. The effectiveness of diagnosis and therapy can be increased by using it as an alter-native or adjunct to the already existing data. However, little is known concerning the poten-tial of this vast field. Electronic patient records, containing big data, offer AI the opportunity to develop and analyze more precise and efficient diagnostic and treatment algorithms. Never-theless, the existing applications are not generalizable in real-life practice, and high-quality studies are needed to establish the integration of AI in the management of urinary stone dis-ease.CNN ; CNN

COSMOS: the dialysis scenario of CKD-MBD in Europe

Background Chronic kidney disease-mineral and bone disorders (CKD-MBD) are important complications of CKD5D patients that are associated with mortality. Methods COSMOS is a multicentre, open cohort, prospective, observational 3-year study carried out in haemodialysis patients from 20 European countries during 2005-07. The present article describes the main characteristics of the European dialysis population, the current practice for the prevention, diagnosis and treatment of secondary hyperparathyroidism and the differences across different European regions. Results The haemodialysis population in Europe is an aged population (mean age 64.8 ± 14.2 years) with a high prevalence of diabetes (29.5%) and cardiovascular disease (76.0%), and 28.7% of patients have been on haemodialysis more than 5 years. Patients from the former Eastern countries are younger (59.3 ± 14.3 versus 66.0 ± 13.9), having a lower proportion of diabetics (24.1 versus 30.7%). There were relevant differences in the frequency of measurement of the main CKD-MBD biochemical parameters [Ca, P and parathyroid hormone (PTH)] and the Eastern countries showed a poorer control of these biochemical parameters (K/DOQI and K/DIGO targets). Overall, 48.0% of the haemodialysis patients received active vitamin D treatment. Calcitriol use doubled that of alfacalcidiol in the Mediterranean countries, whereas the opposite was found in the non-Mediterranean countries. The criteria followed to perform parathyroidectomy were different across Europe. In the Mediterranean countries, the level of serum PTH considered to perform parathyroidectomy was higher than in non-Mediterranean countries; as a result, in the latter, more parathyroidectomies were performed in the year previous to inclusion to COSMOS. Conclusions The COSMOS baseline results show important differences across Europe in the management of CKD-MB

Safety of intravenous ferric carboxymaltose versus oral iron in patients with nondialysis-dependent CKD: an analysis of the 1-year FIND-CKD trial.

Background: The evidence base regarding the safety of intravenous (IV) iron therapy in patients with chronic kidney disease (CKD) is incomplete and largely based on small studies of relatively short duration. Methods: FIND-CKD (ClinicalTrials.gov number NCT00994318) was a 1-year, open-label, multicenter, prospective study of patients with nondialysis-dependent CKD, anemia and iron deficiency randomized (1:1:2) to IV ferric carboxymaltose (FCM), targeting higher (400-600 µg/L) or lower (100-200 µg/L) ferritin, or oral iron. A post hoc analysis of adverse event rates per 100 patient-years was performed to assess the safety of FCM versus oral iron over an extended period. Results: The safety population included 616 patients. The incidence of one or more adverse events was 91.0, 100.0 and 105.0 per 100 patient-years in the high ferritin FCM, low ferritin FCM and oral iron groups, respectively. The incidence of adverse events with a suspected relation to study drug was 15.9, 17.8 and 36.7 per 100 patient-years in the three groups; for serious adverse events, the incidence was 28.2, 27.9 and 24.3 per 100 patient-years. The incidence of cardiac disorders and infections was similar between groups. At least one ferritin level ≥800 µg/L occurred in 26.6% of high ferritin FCM patients, with no associated increase in adverse events. No patient with ferritin ≥800 µg/L discontinued the study drug due to adverse events. Estimated glomerular filtration rate remained the stable in all groups. Conclusions: These results further support the conclusion that correction of iron deficiency anemia with IV FCM is safe in patients with nondialysis-dependent CKD

Study of the effect of three endourological procedures on the induction of acute renal dysfunction

Backgroundː Observational studies on the association of endourological procedures with renal parenchymal damage are lacking. This randomized trial examined the effect of standard-percutaneous-nephrolithotomy (sPCNL) in comparison to miniaturized-PCNL (mini-PCNL) and retrograde-intrarenal-surgery (RIRS) for nephrolithiasis treatment on novel biomarkers of renal injury. Methodsː Seventy-five patients were randomized in 1:1:1 ratio to receive sPCNL, mini-PCNL and RIRS for nephrolithiasis. The ratios of neutrophil-gelatinase-associated-lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) normalized for urinary creatinine (Cr) were calculated from urine samples collected at baseline (2-hours-preoperatively) and at 2, 6, 24 and 48-hours postoperatively. Two-way mixed ANOVA for repeated measurements was used to evaluate the effects of type of procedure and time on studied biomarkers. Resultsː Between baseline and 2-hours postoperatively, no significant differences were observed in NGAL/Cr changes between sPCNL[9.46 (4.82-14.9)], mini-PCNL[12.78 (1.69-25.24)] and RIRS[6.42 (2.61-23.90)] (p=0.902). Similarly, no between-group differences were observed of KIM-1/Cr (p=0.853) and IL-18 (p=0.980) at 2-hours, and all biomarkers at any time-point postoperatively. Within-groups, significant increases from baseline were noted for NGAL/Cr (sPCNL p<0.001; mini-PCNL p<0.001; RIRS, p=0.001), KIM-1/Cr and IL-18/Cr at 2-hours; progressively lower increases from baseline were noted in all groups for KIM-1/Cr and IL-18/Cr at 6-, 24- and 48-hours postoperatively. As such a significant effect of time but not of type of procedure was evidenced with two-way mixed ANOVA. No significant between-group differences were observed in acute-kidney-injury incidence and complications. Conclusionsː The endourological procedures under study are associated with similar patterns of early tubular injury, detected by novel biomarkers, that is largely reduced within 48 hours and no changes in glomerular function.Εισαγωγήː Δεν υπάρχουν μελέτες παρατήρησης σχετικά με τη συσχέτιση των ενδοουρολογικών επεμβάσεων με τη βλάβη του νεφρικού παρεγχύματος. Αυτή η τυχαιοποιημένη δοκιμή εξέτασε την επίδραση της τυπικής διαδερμικής νεφρολιθοτομής (sPCNL) σε σύγκριση με τη μικρογραφία PCNL (mini-PCNL) και την ανιούδσ ενδονεφρική χειρουργική (RIRS) για τη θεραπεία νεφρολιθίασης σε νέους βιοδείκτες νεφρικής βλάβης. Μέθοδοιː Εβδομήντα πέντε ασθενείς τυχαιοποιήθηκαν σε αναλογία 1:1:1 για να λάβουν sPCNL, mini-PCNL και RIRS για νεφρολιθίαση. Οι αναλογίες λιποκαλίνης σχετιζόμενης με ουδετερόφιλο-ζελατινάση (NGAL), μορίου νεφρικής βλάβης-1 (KIM-1) και ιντερλευκίνης-18 (IL-18) που κανονικοποιήθηκαν για την κρεατινίνη ούρων (Cr) υπολογίστηκαν από δείγματα ούρων που συλλέχθηκαν κατά την έναρξη ( 2 ώρες-προεγχειρητικά) και στις 2, 6, 24 και 48 ώρες μετεγχειρητικά. Χρησιμοποιήθηκε αμφίδρομη μικτή ANOVA για επαναλαμβανόμενες μετρήσεις για την αξιολόγηση των επιδράσεων του τύπου της διαδικασίας και του χρόνου στους βιοδείκτες που μελετήθηκαν. Αποτελέσματαː Μεταξύ της βασικής εκτίμησης και των 2 ωρών μετεγχειρητικά, δεν παρατηρήθηκαν σημαντικές διαφορές στις αλλαγές NGAL/Cr μεταξύ sPCNL [9,46 (4,82-14,9)], mini-PCNL [12,78 (1,69-25,24)] και RIRS [6.42 (2.61-23.90)] (p=0.902). Ομοίως, δεν παρατηρήθηκαν διαφορές μεταξύ των ομάδων του KIM-1/Cr (p=0,853) και του IL-18 (p=0,980) στις 2 ώρες, και όλων των βιοδεικτών σε οποιοδήποτε χρονικό σημείο μετεγχειρητικά. Εντός των ομάδων, σημειώθηκαν σημαντικές αυξήσεις από την αρχική τιμή για το NGAL/Cr (sPCNL p<0,001, mini-PCNL p<0,001, RIRS, p=0,001), KIM-1/Cr και IL-18/Cr στις 2 ώρες. Σταδιακά χαμηλότερες αυξήσεις από την έναρξη σημειώθηκαν σε όλες τις ομάδες για τα KIM-1/Cr και IL-18/Cr στις 6, 24 και 48 ώρες μετεγχειρητικά. Ως εκ τούτου, μια σημαντική επίδραση του χρόνου αλλά όχι του τύπου της επέμβασης αποδείχθηκε με αμφίδρομη μικτή ANOVA. Δεν παρατηρήθηκαν σημαντικές διαφορές μεταξύ των ομάδων στη συχνότητα εμφάνισης και τις επιπλοκές οξείας νεφρικής βλάβης. Συμπεράσματα: Οι ενδοουρολογικές επεμβάσεις που μελετώνται σχετίζονται με παρόμοια μοτίβα πρώιμης σωληναριακής βλάβης, που ανιχνεύονται από νέους βιοδείκτες, τα οποία μειώνονται σε μεγάλο βαθμό εντός 48 ωρών και δεν υπάρχουν αλλαγές στη σπειραματική λειτουργία