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Chronic kidney disease (CKD) causes specific hormonal disturbances, such as variations in leptin and testosterone levels and function. These disturbances can promote errors in signaling interaction and cellular information processing and can be implicated in the pathogenesis of atherosclerosis. This study investigates the factors that affect leptin in CKD patients and examines how leptin is related to markers of vascular disease. We conducted a cross-sectional study of 162 patients with CKD in pre-dialysis and dialysis stages. We recorded clinical and laboratory data, including leptin, testosterone, and subclinical atherosclerosis markers like brachial–ankle pulse wave velocity (ba PWV) in pre-dialysis CKD patients and flow-mediated vasodilation (FMD) and nitroglycerin-mediated vasodilation (NMD) in hemodialysis (HD) patients. Leptin was significantly correlated with testosterone in CKD pre-dialysis stages (p < 0.001) and also in HD (p = 0.026), with adipose tissue mass in pre-dialysis stages (p < 0.001), and also in HD (p < 0.001). In women HD patients, leptin correlated with NMD (p = 0.039; r = −0.379); in all HD patients, leptin correlated with C reactive protein (p = 0.007; r = 0.28) and parathormone (p = 0.039; r = −0.220). Our research emphasizes the connection between leptin, adipose tissue, and testosterone in all stages of CKD. Leptin was associated with NMD in HD women and correlated with inflammatory syndrome and parathyroid hormone in all HD patients. [ABSTRACT FROM AUTHOR]

Background: Arteriovenous fistula (AVF) failure due to thrombosis is a major cause of morbidity in patients undergoing regular hemodialysis (HD). Advanced glycation end products (AGEs) and their receptor (RAGE) might contribute to inflammation, neointimal hyperplasia, and thrombosis. RAGE has a C-truncated secretory receptor form, called soluble RAGE (sRAGE). In this study, we aimed to evaluate the association of serum sRAGE with AVF failure due to thrombosis in HD patients. Methods: Eighty-eight prevalent HD patients with functional AVF were included in the study. The presence of stenosis, clinical and laboratory data, and serum sRAGE was evaluated at inclusion. sRAGE concentration was measured by a competitive enzyme-linked immunosorbent assay, and stenosis was detected by ultrasound. Patients were prospectively followed up for 36 months. During this period, AVF failure (defined as the absence of blast or palpable thrill and impossible cannulation with 2 needles because of complete thrombosis) was noted and thrombosis was certified by ultrasound examination. Results: During follow-up, 16 (18.18%) patients lost their vascular access due to thrombosis. In multivariate Cox regression analysis, sRAGE was a significant predictor of vascular access thrombosis (hazard ratio = 1.15, 95% confidence interval: 1.03–1.25, p = 0.012). Kaplan-Meier analysis showed a significantly lower AVF patency time in patients with sRAGE >16.78 ng/mL than those with sRAGE <16.78 ng/mL (p = 0.02). In the subgroup of patients with stenosis at baseline, sRAGE, serum albumin, obesity, and ischemic heart disease were associated with thrombosis. Conclusion: In our study, baseline, systemic sRAGE is associated with the occurrence of thrombosis of AVF, and this marker has a significant impact on AVF survival. [ABSTRACT FROM AUTHOR]

Background and aims. Cardiovascular (CV) disease is the leading cause of morbidity and mortality in hemodialysis (HD) patients. Kidney disease is associated with increased oxidative stress (OS), a nontraditional CV risk factor. Few studies evaluate the effect of OS markers on CV events (CVE) and survival in HD patients. The aim of this study is to examine potential determinants of OS markers and their predictive role on survival and CV morbidity and mortality in HD patients during a long-term follow-up (108 months). Methods. We conducted an analytical cross-sectional prospective observational study, carried on a cohort of randomly selected HD patients. We registered in 44 HD patients baseline characteristics, OS markers, mortality and CVE over a period of 108 months and we used statistical analysis (descriptive, Kaplan-Meier, univariate and multivariate Cox model) for interpretation. Results. Bound malondialdehyde (bMDA) was positively correlated with serum calcium, protein carbonyls (PC) were inversely correlated with diastolic blood pressure (DBP) and directly correlated with ferritin, NOx was directly correlated with ceruloplasmin) and serum albumin. Of the measured OS markers only bMDA was related to survival (HR=3.29 95% CI (1.28-8.44), p=0.01), and approached statistical significance in the effect on CV mortality (HR=2.85 95% CI (0.88-9.22), p=0.07). None of the measured OS markers was associated with CVE. Conclusions. bMDA has a strong predictive value on survival in HD patients in a long-term follow-up (9 years). Its value is correlated with CV mortality but is not a predictor of CV events. Regular assessment of MDA in HD patients and the development of strategies aimed at reducing oxidative stress in these patients might be beneficial. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular morbidity is the first factor that influences survival in chronically hemodialyzed patients. For this reason a permanent evaluation of cardiovascular risk and of efficient therapeutic methods are necessary This study followed the cardiovascular events and deceased frequency in chronically hemodialyzed patients under ACEI and beta-blocker therapy, in our region. We also followed, the effects of these therapies on some cardiovascular risk factors and on plasma potassium and we registered the use frequency of the study medication in the chronically hemodialyzed patients. Metods: 106 chronically hemodialyzed patients were investigated; among these 58 patients were selected, under beta-blocker±ACEI therapy. Two groups were formed: group A: 36 patients under beta-blocker therapy and group B: 22 patients under ACEI and beta-blocker therapy. Clinical and biological data were also recorded when the study started, including diabetes mellitus, cardiovascular history, some cardiovascular risk factors. Taking into consideration the age, sex, diabetes mellitus and cardiovascular history presence, we formed the subgroups. We followed the groups for 24 month and we noted the deceased and the cardiovascular events frequency: angina pectoris, including acute myocardial infarction, peripheral arterial disease events, stroke. We analyzed the groups and subgroups by comparison. Results: The frequency use of ACEI therapy was not frequent: 20,75%. No significant differences in the frequency of CE, or deceased number, were found between the groups and subgroups with and without ACEI therapy. Among the monitored cardiovascular risk factors, only SBP was lower and the serum albumin levels was higher in patients under association ACEI betablokers therapy (p=0,05 for SBP and p=0,08 for serum albumin, if mean values were compared between groups A and B, respectively p=0,02 for SBP and p=0,05 for serum albumin if mean values was compared between subgroup older than 50 years). The mean value of serum potassium did not reach dangerous levels in either group, and there were no significant differences between two groups Conclusion: The therapeutic beta-blockers-ACEI association was rarely use in our chronically hemodialyzed patients. Even if this therapeutic association didn`t significantly reduce the cardiovascular events and deceased number, in that period, when we compared it with isolated betablokers use, it significantly decreased BP, and it was associated with a higher serum albumin. The mean value of serum potassium was not significantly modified in ACEI beta-blokers association groups. [ABSTRACT FROM AUTHOR]

Purpose: To provide epidemiologic data on kidney biopsy from Romania., Methods: Retrospective observational study of kidney biopsy records for adult patients from a referral center in the north-western part of Romania, reported for 2014-2023., Results: 556 biopsies were performed, corresponding to an incidence of 12 biopsies/m person-year with over 50% increase over the last reported year. Optimal core for optic microscopy was available in 81.4%, immunofluorescence was performed in 86.3%, and electron microscopy in 35.2% of patients. The mean age at biopsy was 47.12 years, and 53.8% were males. Indications for kidney biopsy were nephrotic syndrome in 63.1% of patients, nephritic in 25.9% of patients, asymptomatic urinary abnormalities in 2.9%, acute kidney injury/rapid progressive renal failure in 3.6%, and chronic kidney disease in 1.4%. The most frequent diagnostic categories were membranous nephritis (14.7%), IgA nephropathy (13.9%), focal segmental glomerulosclerosis (11,1%), minimal change disease (12,2%), lupus nephritis (10,9%), vasculitis (7.6%), and membranoproliferative glomerulonephritis (8%). The age of diagnosis increased for IgA Nephropathy over time while it decreased for membranous nephritis., Conclusions: Our study adds data for the completion of the kidney biopsy map in our region., (© 2024 Yuriy Maslyennikov et al., published by Sciendo.)

Brown tumors, an exceptional bone complication of severe primary (PHP) or renal (secondary) hyperparathyroidism (RHP), are caused by long-standing, elevated parathormone (PTH)-induced osteoclast activation causing multinucleated giant cell conglomerates with hemosiderin deposits in addition to the local production of cytokines and growth factors. We aim to present an adult case series including two females displaying this complication as part of a multidisciplinary complex panel in high PTH-related ailments. The approach was different since they had distinct medical backgrounds and posed a wide area of challenges amid real-life settings, namely, a 38-year-old lady with PHP and long-term uncontrolled hypercalcemia (with a history of pregnancy-associated PHP, the removal of a cystic jaw tumor, as well as a family and personal positive diagnosis of polycystic kidney disease, probably a PHP-jaw tumor syndrome), as well as, a 26-year-old woman with congenital single kidney and chronic renal disease-associated RHP who was poorly controlled under dialysis and developed severe anemia and episodes of metabolic acidosis (including one presentation that required emergency hemodialysis and was complicated with convulsive seizures, followed by resuscitated respiratory arrest). Both subjects displayed a severe picture of PHP/RHP with PTH levels of >1000 pg/mL and >2000 pg/mL and elevated serum bone turnover markers. Additionally, they had multiple brown tumors at the level of the ribs and pelvis (asymptomatically) and the spine, skull, and pelvis (complicated with a spontaneous cervical fracture). As an endocrine approach, the control of the underlying parathyroid disease was provided via surgery in PHP (for the postparathyroidectomy hungry bone syndrome) via medical intervention (with vitamin D analogs) in RHP. Additionally, in this case, since the diagnosis was not clear, a multidisciplinary decision to perform a biopsy was taken (which proved inconclusive), and the resection of the skull tumor to confirm the histological traits. This series highlights the importance of addressing the entire multidisciplinary panel of co-morbidities for a better outcome in patients with PHP/RHP-related brown tumors. However, in the instance of real-life medicine, poor compliance and reduced adherence to recommendations might impair the overall health status. Thus, sometimes, a direct approach at the level of cystic lesion is taken into consideration; this stands for a narrow frame of decision, and it is a matter of personalized decision. As seen here, brown tumors represent the hidden face of PHP/RHP, primarily the complex and severe forms, and awareness is essential even in the modern era.

Anthocyanins are extensively studied for their health-related properties, including antibacterial activity against urinary tract infections (UTI). Among common fruits, blueberries, with their remarkable antioxidant capacity, are one of the richest sources. Anthocyanin-rich extracts were obtained from four varieties: Snowchaser, Star, Stella Blue and Cristina Blue, grown in the hot climate of Southern Spain. Their total anthocyanins contents (TAC) were determined spectrophotometrically, and the anthocyanin profile by ultra high performance liquid chromatography - tandem mass spectrometer (UHPLC-MS/MS). Their antioxidant activity was assessed by oxygen radical absorbance capacity (ORAC) assay, while antibacterial activity against strains isolated from UTI patients was assessed in vitro, helping to select the varieties with the highest bioactive potential. Star showed the highest TAC and antioxidant activity (1663 ± 159 mg of cyanidin-3- O -glucoside (cy-3- O -glu) equivalents/100 g fresh weight (FW), 6345 ± 601 μmol Trolox equivalents (TE)/100 g FW, respectively), followed by Cristina Blue, Stella Blue and Snowchaser. As far as we know, this is the first time that cyanidin-3-rutinoside has been identified in blueberries. The extracts inhibited all the tested strains, MICs ranging from 0.4 mg/mL (for Stella Blue extract against UTI P. aeruginosa ) to 9.5 mg/mL (for all extracts against UTI K. pneumoniae ssp. pneumoniae ). This is the first study that assessed in vitro the antibacterial activity of blueberries against Klebsiella pneumoniae , Providencia stuartii and Micrococcus spp. strains isolated from UTI.