Int Urol Nephrol [JOURNAL]
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200 papers
Sustained tenascin-C activation drives AKI-to-CKD progression via the Wnt/β-catenin pathway.
He Y, Li H, Zhang J … +2 more , Zhu Z, Chen S
Int Urol Nephrol · 2026 Mar · PMID 41790418 · Publisher ↗
Acute kidney injury (AKI) serves as an independent risk factor contributing to the progression toward chronic kidney disease (CKD). Tenascin-C (TNC), an extracellular matrix glycoprotein, has been implicated in renal pro...
Acute kidney injury (AKI) serves as an independent risk factor contributing to the progression toward chronic kidney disease (CKD). Tenascin-C (TNC), an extracellular matrix glycoprotein, has been implicated in renal protection following AKI. However, its involvement in the transition from AKI to CKD remains unclear. This study investigates the role of TNC in murine models subjected to varying severities of ischemia/reperfusion injury (IRI), including mild IRI (20 min of ischemia) and severe IRI (30 min of ischemia). Mild IRI induced a transient renal dysfunction accompanied by transient TNC activation, followed by apparent recovery of renal structure and function within the period. In contrast, severe IRI triggered sustained and excessive TNC expression, coinciding with the onset of renal fibrosis. To assess the contribution of persistent TNC expression in promoting AKI-to-CKD progression, TNC was either overexpressed or silenced using shRNA plasmids. In vivo, TNC overexpression five days post-IRI activated β-catenin signaling and accelerated CKD development. Conversely, TNC knockdown suppressed β-catenin activation and mitigated disease progression. In vitro, TNC was found to interact with Wnt ligands via epidermal growth factor receptor (EGFR), as demonstrated by co-immunoprecipitation assays, thereby amplifying Wnt-induced β-catenin activation. These findings suggest that sustained, rather than transient, TNC activation may play a critical role in facilitating the AKI-to-CKD transition by modulating Wnt/β-catenin signaling through EGFR.
Effect of perivascular adipose tissue on patency and maturation rate of arteriovenous fistula in hemodialysis patients.
Lv H, Hou G, Zhu F … +4 more , Dong P, Wang J, Zhi J, Li J
Int Urol Nephrol · 2026 Mar · PMID 41784686 · Publisher ↗
PURPOSE: This prospective observational study aimed to examine the effects of the volume of perivascular adipose tissue (PVAT) and the fat attenuation index (FAI) on maturation and primary patency following the formation...
PURPOSE: This prospective observational study aimed to examine the effects of the volume of perivascular adipose tissue (PVAT) and the fat attenuation index (FAI) on maturation and primary patency following the formation of an initial arteriovenous fistula (AVF). METHODS: This study enrolled 106 patients who underwent first-time upper limb AVF creation. PVAT volume and FAI were quantified using non-contrast computed tomography (CT) within 2 weeks postoperatively. Patients were monitored for 12 months to evaluate primary patency and maturation. Statistical analyses included receiver operating characteristic (ROC) curve analysis to determine optimal cutoff values for group stratification, Kaplan-Meier survival analysis with the Log-rank tests, and multivariable Cox proportional hazards regression to identify independent risk factors. RESULTS: A total of 33 patients (31.1%) exhibited adverse events within 1 year. ROC analysis determined the optimal cutoffs for group stratification of 4.32 cm for PVAT volume and -75.8 Hounsfield Units for FAI. According to Kaplan-Meier analysis, patients with lower PVAT volume and higher FAI had significantly worse primary patency (Log-rank P < 0.05). Lower PVAT volume (hazard ratio [HR]: 1.15, 95% confidence interval (CI) 1.03-1.28, P = 0.02) and higher FAI (HR: 1.06, 95% CI 1.01-1.12, P = 0.03) were identified as independent risk factors for adverse events in independent multivariable Cox models that were adjusted for age and AVF configuration. However, FAI was not significantly associated with the AVF maturation rate in survival analysis. CONCLUSIONS: In this prospective cohort, lower PVAT volume and higher FAI were independently associated with an increased risk of adverse events and decreased primary patency following AVF formation. According to these findings, AVF outcomes may be influenced by the perivascular adipose microenvironment, and PVAT volume and FAI may be useful imaging biomarkers for risk assessment.
Ultrasound maximum vein diameter contextualizes testicular asymmetry in adolescent varicocele.
Okur Ö, Sönmez B, Can M … +2 more , Evciler H, Oral A
Int Urol Nephrol · 2026 Mar · PMID 41779255 · Publisher ↗
PURPOSE: To characterize the clinical patterns linking ultrasound-measured maximum vein diameter (MVD), testicular asymmetry, and short-term trajectories in adolescents with varicocele, with emphasis on the natural cours...
PURPOSE: To characterize the clinical patterns linking ultrasound-measured maximum vein diameter (MVD), testicular asymmetry, and short-term trajectories in adolescents with varicocele, with emphasis on the natural course of asymmetry and postoperative outcomes. METHODS: We retrospectively reviewed adolescents diagnosed with varicocele between 2010 and 2025. Baseline evaluation included testicular volumes, MVD, and color Doppler reflux characteristics. Management was conservative or surgical based on clinical indications. The primary outcomes were baseline testicular asymmetry and its resolution (catch-up growth) during follow-up. Prespecified secondary outcomes included postoperative pain status, hydrocele development and its time course, epididymal cysts, and testicular microlithiasis. RESULTS: Across distinct within-cohort analyses, MVD was associated with asymmetry trajectories. In adolescents who underwent surgery for asymmetry, an exploratory ROC-derived threshold (approximately MVD ≥ 3.5 mm) indicated a higher likelihood of postoperative catch-up growth. Conversely, among adolescents with baseline asymmetry managed conservatively, MVD < 3.5 mm was more frequently observed in those whose asymmetry resolved without surgery, whereas higher MVD values were associated with persistence. Most symptomatic patients improved postoperatively; however, persistent pain was not predicted by preoperative MVD or Doppler reflux status. Hydrocele occurred predominantly in the first postoperative year and declined thereafter, without an evident impact on catch-up growth. Epididymal cysts were more frequently identified postoperatively, while the prevalence of testicular microlithiasis remained stable throughout the follow-up period. CONCLUSIONS: MVD is a practical adjunct that may help contextualize asymmetry and inform surveillance versus intervention; in our cohort, an exploratory threshold of ~ 3.5 mm differentiated asymmetry trajectories within operative and non-operative subgroups. Postoperative epididymal cysts were more frequently detected, and testicular microlithiasis prevalence remained stable, warranting further study.
Microbiome alterations and their potential impact on infection risk in chronic kidney disease and end-stage kidney disease: a narrative review.
Stefanelli LF, Cattarin L, Martino FK … +4 more , Del Prete D, Pierantonio B, Nalesso F, Mazzitelli M
Int Urol Nephrol · 2026 Mar · PMID 41779254 · Publisher ↗
Chronic kidney disease [CKD] is associated with profound alterations of both gut microbiota composition and functions, commonly referred to as gut dysbiosis. These changes are driven by several factors such as dietary re...
Chronic kidney disease [CKD] is associated with profound alterations of both gut microbiota composition and functions, commonly referred to as gut dysbiosis. These changes are driven by several factors such as dietary restrictions, medications, and uremia, which further contribute to patients with CKD to their pro-inflammatory and immunocompromised state. Recent evidence suggests that dysbiosis may also increase susceptibility to infections, which remain a leading cause of morbidity and mortality in CKD patients. In this review, we aimed at examining the features of the altered gut microbiome in patients with CKD, its potential role in promoting infection risk, and current therapeutic strategies targeting the gut microbiota to mitigate CKD-related complications.
SCGB1A1 suppresses prostate cancer proliferation and metastasis by modulating the MAPK signaling pathway.
Zhao W, Zhou X, Qi G … +2 more , Zhou Y, Li F
Int Urol Nephrol · 2026 Mar · PMID 41779253 · Publisher ↗
BACKGROUND: Prostate cancer represents a prevalent urological malignancy, but the molecular mechanisms underlying the differentiation of distinct tumor cell subtypes have not been fully elucidated. METHODS: We conducted...
BACKGROUND: Prostate cancer represents a prevalent urological malignancy, but the molecular mechanisms underlying the differentiation of distinct tumor cell subtypes have not been fully elucidated. METHODS: We conducted an analysis of paired single-cell RNA sequencing data from the public database on prostate cancer, and discovered differentially expressed genes between tumor cells and normal epithelial cells. We evaluated the expression of SCGB1A1 in prostate cell lines and tissue samples, and assessed migration, invasion, and proliferation through CCK-8, EdU, wound healing, and Transwell experiments. We performed pathway enrichment analysis to explore the downstream mechanism of SCGB1A1 (Secretoglobin Family 1A Member 1). RESULTS: Single-cell transcriptomic analysis revealed a marked reduction in SCGB1A1⁺ epithelial cells within tumor tissues, accompanied by an increased abundance of KLK3⁺ tumor epithelial cells. SCGB1A1 expression was significantly downregulated in both prostate cancer cell lines and tumor epithelial cells. Functional assays demonstrated that SCGB1A1 overexpression suppressed the proliferation, migration, invasion, and epithelial-mesenchymal transition (EMT) of prostate cancer cells. SCGB1A1 expression is negatively correlated with the activation of the MAPK signaling pathway, which may be associated with its tumor-suppressive effects. CONCLUSION: Our findings identify SCGB1A1 as a previously underappreciated tumor-suppressive role in prostate cancer and reveal its role in modulating MAPK signaling and EMT. The depletion of SCGB1A1⁺ epithelial cells characterizes the malignant epithelial phenotype, suggesting its potential as a candidate diagnostic biomarker and therapeutic target that requires further clinical validation.
A qualitative study on treatment decision-making experiences of primary caregivers of children with difficult-to-treat nephrotic syndrome.
Lü C, Zhang C, Luan X … +2 more , Sun N, Liu L
Int Urol Nephrol · 2026 Mar · PMID 41774398 · Publisher ↗
PURPOSE: This study focuses on difficult-to-treat nephrotic syndrome (DTNS), a condition that imposes severe physical and psychological burdens on patients and their families, to assess the experiences and psychological...
PURPOSE: This study focuses on difficult-to-treat nephrotic syndrome (DTNS), a condition that imposes severe physical and psychological burdens on patients and their families, to assess the experiences and psychological states of primary caregivers during the treatment decision-making process. METHODS: We conducted semi-structured, in-depth interviews with 15 primary caregivers of children with difficult-to-treat nephrotic syndrome at a tertiary women's and children's hospital in China and analyzed the verbatim transcripts using inductive thematic analysis. RESULTS: The primary caregivers had a mean age of 36 years, with approximately 73% being female; the children's average disease duration was 6 years, and 95% of families reported inadequate knowledge about the disease. Although 80% of families adopted combined immunosuppressive therapy, only 20% expressed satisfaction with the effectiveness of the treatment regimens. In the analysis of drug effects, 70% of caregivers believed that glucocorticoid therapy had significant efficacy, but 40% of families reported serious adverse effects that affected the child's quality of life; approximately 60% of caregivers mentioned a markedly increased infection risk associated with immunosuppressants; 75% of primary caregivers experienced considerable psychological pressure; and 60% exhibited emotional fluctuations when the condition relapsed. CONCLUSION: The findings reveal multiple challenges faced by caregivers in coping with DTNS, emphasizing the importance of information access, decision-making support for treatment, and psychological health services. Future research should explore effective strategies to improve support systems for patients and families, thereby enhancing clinical treatment quality and patient quality of life.
More work for the same pay: trends in urethroplasty reimbursement from the medicare physician fee schedule (2013-2023).
Rajan T, Garde A, Scarberry K … +2 more , Kovell RC, Abou Ghayda R
Int Urol Nephrol · 2026 Mar · PMID 41774397 · Publisher ↗
OBJECTIVES: Urethroplasty is the gold standard for recurrent urethral stricture disease per the 2016 American Urological Association (AUA) guideline. Its sustainability depends on economic viability; however, recent paym...
OBJECTIVES: Urethroplasty is the gold standard for recurrent urethral stricture disease per the 2016 American Urological Association (AUA) guideline. Its sustainability depends on economic viability; however, recent payment cuts and inflationary pressures threaten reimbursement. This study analyzed: (1) trends in Medicare providers performing urethroplasty, (2) urethroplasty procedure volumes, and (3) nominal and inflation-adjusted Medicare reimbursement from 2013-2023, contextualized against comparator urologic procedures. METHODS: This was a retrospective, cross-sectional study using the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule and Medicare Part B Physician and Other Practitioners datasets from 2013-2023. Urethroplasty procedures were identified using CPT codes 53,400, 53,405, 53,410, 53,415, and 53,430. Comparator procedures included Cystourethroscopy with Direct Vision Internal Urethrotomy (DVIU, CPT 52276) and Endoscopic/Robotic-Assisted Radical Prostatectomy (CPT 55866). Reimbursement values were adjusted to August 2025 U.S. dollars using the Consumer Price Index. RESULTS: Urethroplasty provider numbers and procedure volumes increased 33-45% and 36-65%, respectively. Nominal urethroplasty reimbursement remained stable (-2.5% to + 22.8%), while inflation-adjusted reimbursement declined 18-25% across all types. By contrast, DVIU demonstrated declining provider participation (-33.9%) and procedure volumes (-46.5%), with inflation-adjusted reimbursement declining 27.4%. Endoscopic prostatectomy showed growing provider participation (+ 33.4%) and volumes (+ 27.3%), but experienced the most severe nominal (-26.5%) and inflation-adjusted (-43.5%) reimbursement decline of all procedures examined. CONCLUSIONS: Urethroplasty faces a distinctive economic burden: rising clinical demand paired with stagnant nominal and substantially declining real reimbursement. While reimbursement erosion affects all urologic procedures studied, the combination of increasing utilization and inadequate payment adjustment is uniquely pronounced for reconstructive urology. Long-term sustainability will require reimbursement models that align payment with evidence-based, high-value surgical care.
Exploration of symptom clusters and their trajectories in maintenance hemodialysis patients.
Liu X, Zhao H, Peng Y … +3 more , Zheng J, Zhou Y, Lin C
Int Urol Nephrol · 2026 Mar · PMID 41774396 · Publisher ↗
PURPOSE: To investigate symptom clusters and their longitudinal trajectories in patients undergoing maintenance hemodialysis (MHD). METHODS: A convenience sample of 510 MHD patients was enrolled between June 2022 and Jun...
PURPOSE: To investigate symptom clusters and their longitudinal trajectories in patients undergoing maintenance hemodialysis (MHD). METHODS: A convenience sample of 510 MHD patients was enrolled between June 2022 and June 2023. Symptom assessments were conducted at four time points: baseline (T1), 4 months (T2), 8 months (T3), and 12 months (T4), using a general information questionnaire and the dialysis symptom index (DSI). Exploratory factor analysis was applied to identify symptom clusters, and latent class growth modeling was used to examine the longitudinal trajectories of these symptom clusters over the one-year follow-up period. RESULTS: Exploratory factor analysis revealed seven symptom clusters: emotional symptoms, water-electrolyte imbalances, gastrointestinal symptoms, uremia-related symptoms, sleep disturbances, sexual symptoms, and sexual-emotional symptoms. The first five clusters-emotional, water-electrolyte imbalances, gastrointestinal, uremia-related, and sleep disturbances-exhibited common patterns over time. Latent class growth models identified 3 distinct trajectories within each symptom cluster, reflecting heterogeneous patterns of symptom progression. CONCLUSION: This one-year longitudinal study revealed heterogeneous developmental trajectories across symptom clusters in MHD patients. These findings underscore the importance of continuous symptom assessment and monitoring, particularly in patients with persistently high symptom severity. Tailored intervention strategies should be developed to address the specific needs of different patient subgroups, thereby alleviating symptom burden and enhancing the effectiveness of nursing care. Symptom management efforts may be prioritized based on the severity and trajectory of symptom clusters.
Hemodialysis-induced variability of the QRS-T spatial angle reveals distinct electrophysiological patterns in patients with end-stage renal disease.
Bociek A, Terpiłowska S, Bołtuć-Dziugieł K … +2 more , Dąbrowski W, Jaroszyński A
Int Urol Nephrol · 2026 Mar · PMID 41764666 · Publisher ↗
BACKGROUND: Cardiovascular mortality remains the leading cause of death among patients with end-stage renal disease (ESRD). The QRS-T spatial angle (QRSTsa), indicating ventricular electrical heterogeneity, has been show...
BACKGROUND: Cardiovascular mortality remains the leading cause of death among patients with end-stage renal disease (ESRD). The QRS-T spatial angle (QRSTsa), indicating ventricular electrical heterogeneity, has been shown to predict major adverse cardiac events and sudden cardiac death. However, evidence regarding the effect of a single haemodialysis (HD) session on QRSTsa is inconsistent. METHODS: Forty-three patients with ESRD undergoing maintenance HD were evaluated. Digital electrocardiography (ECG) and vectorcardiography (VCG) were recorded immediately before, halfway through, and after HD. The QRSTsa was calculated using the inverse Dower transformation method. Biochemical analyses, including oxidative stress biomarkers such as total oxidant status to total oxidant capacity ratio (TOS/TOC), total antioxidant status to total antioxidant capacity ratio (TAS/TAC), oxidised low-density lipoprotein (oxLDL), and malondialdehyde (MDA), were performed before and after HD. Patients were stratified according to changes in QRSTsa into increasing and decreasing/stable QRSTsa groups. Multivariable regression identified predictors of QRSTsa dynamics. RESULTS: QRSTsa exhibited a biphasic response, significantly increasing during the first half of HD (p = 0.0342) and partially returning toward baseline by the end of treatment (p = 0.0415). QRSTsa increased in 40% of patients (Δ +17.77 ± 17.16°, p < 0.0001) and decreased or was stable in 60% (Δ -9.04 ± 24.36°, p = 0.0351). Patients with QRSTsa increase showed significantly higher elevations in oxLDL (p = 0.020) and TOS/TOC (p = 0.0378), and had lower baseline antioxidant reserve. Independent predictors of QRSTsa increase included baseline oxLDL, prolongation of the corrected QT interval (QTc) during late HD, and female sex (adjusted R = 0.391, p = 0.0002). In an alternative regression model oxLDL can be replaced by TOS/TOC (adjusted R = 0.322, p = 0.003). CONCLUSIONS: Haemodialysis induces heterogeneous alterations in QRSTsa, identifying subgroups with differing electrophysiological responses. Increased QRSTsa was associated with greater oxidative stress burden, QTc prolongation, and female sex, suggesting higher arrhythmic vulnerability. QRSTsa may serve as a dynamic marker of intradialytic electrical instability. Larger studies are warranted to validate clinical utility and therapeutic implications.
Adjuvant bladder thermal irrigation for ultrasound-guided botulinum toxin a injection in refractory bladder pain syndrome: a retrospective cohort study.
Tang C, Li J, Yang L … +3 more , Song C, Zhu J, Pan H
Int Urol Nephrol · 2026 Feb · PMID 41762409 · Publisher ↗
PURPOSE: This retrospective preliminary study aimed to evaluate whether adjuvant bladder thermal irrigation (TI) enhances the efficacy of ultrasound-guided botulinum toxin type A (BoNT-A) injection in patients with refra...
PURPOSE: This retrospective preliminary study aimed to evaluate whether adjuvant bladder thermal irrigation (TI) enhances the efficacy of ultrasound-guided botulinum toxin type A (BoNT-A) injection in patients with refractory bladder pain syndrome (BPS). METHODS: We analyzed patients with refractory BPS who received an initial ultrasound-guided injection of 100 U BoNT-A into the bladder trigone between February 2019 and January 2025. Patients were divided into two groups based on irrigation temperature: the Thermal Irrigation Group (TI Group, n = 38) received warm saline irrigation at 43 °C ± 2 °C, and the Room-Temperature Irrigation Group (CON Group, n = 38) received irrigation at 22-25 °C. Propensity score matching (PSM) was used to balance baseline characteristics. The primary endpoint was median duration of efficacy. Secondary endpoints included changes in Visual Analogue Scale (VAS) pain scores and O'Leary-Sant Symptom Score (OSS) at 1, 3, and 6 months, and the Global Response Assessment (GRA) at 6 months. RESULTS: After PSM, 32 matched pairs (n = 64) were included. The median duration of efficacy was significantly longer in the TI group than in the CON group (34.5 weeks vs. 24.0 weeks, log-rank test P = 0.012; HR = 0.52, 95% CI 0.31-0.88). At 3 months, the TI group demonstrated significantly greater pain reduction (adjusted mean VAS difference: -1.00, 95% CI -2.05 to 0.05, P = 0.008). At 6 months, the overall treatment success rate (GRA ≥ 2) was 71.9% in the TI group versus 50.0% in the CON group (OR = 2.57, 95% CI: 1.02-6.49, P = 0.043). CONCLUSION: Adjuvant bladder thermal irrigation was associated with a longer duration of efficacy and greater symptom improvement in refractory BPS patients receiving BoNT-A injection, with a favorable safety profile. These findings support the need for prospective randomized trials to confirm the role of thermal irrigation as an efficacy enhancer for intravesical BoNT-A therapy.
Discrepancies in interpretation and residual confounding by dementia in studies of electrolyte impairments and frailty.
Li W, Xu JB, Zhao YB … +1 more , Liu H
Int Urol Nephrol · 2026 Feb · PMID 41746464 · Publisher ↗
Abstract loading — click title to view on PubMed.
Transrenal antegrade ureteral occlusion assisting percutaneous nephrolithotomy: a preliminary single-center comparative study.
Yu Z, Huang X, Xie J … +4 more , Liu Y, Zhang T, Liu Z, Huang J
Int Urol Nephrol · 2026 Feb · PMID 41746463 · Publisher ↗
OBJECTIVE: To preliminarily evaluate the effectiveness and safety of transrenal antegrade ureteral occlusion as an adjunct to mini-percutaneous nephrolithotomy (mPCNL), with particular attention to stone fragment migrati...
OBJECTIVE: To preliminarily evaluate the effectiveness and safety of transrenal antegrade ureteral occlusion as an adjunct to mini-percutaneous nephrolithotomy (mPCNL), with particular attention to stone fragment migration and perioperative outcomes. METHODS: We retrospectively reviewed patients who underwent mPCNL for renal calculi between December 2021 and December 2023 at a single tertiary center. According to intraoperative use of an antegrade ureteral occluder, patients were assigned to an occlusion-assisted mPCNL group (OA-mPCNL) or a standard mPCNL group. Group allocation was based on surgeon preference rather than predefined criteria. Baseline characteristics were compared to assess comparability. Perioperative outcomes, including operative time, blood loss, renal pelvic pressure (RPP), postoperative stone migration, stone-free rate, secondary procedures, and complications graded by the Clavien-Dindo system, were analyzed. RESULTS: Eighty-four patients were included (42 per group). Baseline demographics and stone characteristics were comparable between groups. The incidence of postoperative stone migration was significantly lower in the OA-mPCNL group (2.4% vs. 16.7%, P = 0.029). There were no significant differences in operative time, hemoglobin decline, RPP, length of hospital stay, first-stage stone-free rate, or overall complication rate (P > 0.05). Although the requirement for secondary RIRS/URL was lower in the OA-mPCNL group (2.4% vs. 14.3%, P = 0.048), the overall auxiliary procedure rate did not differ significantly between groups. CONCLUSIONS: Antegrade ureteral occlusion during mPCNL was associated with a lower incidence of stone fragment migration without compromising perioperative safety. However, given the retrospective design and potential selection bias, these findings should be interpreted as preliminary and hypothesis-generating rather than definitive evidence of superiority.
PD-1/PD-L1 inhibitors plus chemotherapy versus chemotherapy alone for ARPI-pretreated and chemotherapy-naive metastatic castration-resistant prostate cancer: a pooled analysis of KEYNOTE-921 and CheckMate 7DX trials.
Zou Q, Huang Q, Li J … +1 more , Li Q
Int Urol Nephrol · 2026 Feb · PMID 41741934 · Publisher ↗
BACKGROUND: The optimal treatment strategy for androgen receptor pathway inhibitor (ARPI)-pretreated and chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) remains unclear. Chemotherapy has limite...
BACKGROUND: The optimal treatment strategy for androgen receptor pathway inhibitor (ARPI)-pretreated and chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) remains unclear. Chemotherapy has limited efficacy as a monotherapy in unselected mCRPC patients. In contrast, the addition of PD-1/PD-L1 inhibitors to chemotherapy (Chemo-IO) may enhance antitumor activity. We conducted a meta-analysis using data from phase 3 randomized controlled trials (RCTs), with the objective of assessing the comparative efficacy and safety of Chemo-IO and chemotherapy alone in this population. METHODS: Six databases were searched. We included phase 3 RCTs that compared Chemo-IO with chemotherapy alone. The study defined radiographic progression-free survival (rPFS) and overall survival (OS) as the primary outcomes. Secondary outcome measures comprised the survival rates, objective response rate (ORR), and safety. Hazard ratios (HRs) and risk ratios (RRs) were pooled; the choice between fixed- and random-effects models depended on the observed heterogeneity. RESULTS: KEYNOTE-921 and CheckMate 7DX trials, involving 2060 patients, were ultimately included. There were no significant differences in rPFS (HR: 0.91 [0.81-1.03], P = 0.13) or OS (HR: 0.99 [0.87-1.12], P = 0.83) between the two groups. PD-L1-positive status correlated with superior survival outcomes (OS and rPFS) among patients treated with the Chemo-IO regimen. In addition, there were no significant differences in ORR (RR: 1.01 [0.80-1.27], P = 0.94), disease control rate (DCR; RR: 1.02 [0.90-1.15], P = 0.76), or PSA response (RR: 0.98 [0.89-1.09], P = 0.71) between the groups. The incidence of grade 3-5 treatment-related adverse events (TRAEs), TRAE-related dose delays, and discontinuations was higher among patients receiving Chemo-IO. Within this treatment arm, the most frequent grade 3-5 TRAEs were decreased neutrophil count (7.98%), neutropenia (7.20%), and anemia (3.98%). At the cutoff, more patients in the Chemo-IO group were excluded due to AEs, whereas fewer were excluded due to disease progression. CONCLUSIONS: Chemo-IO did not improve survival or response compared with chemotherapy alone in unselected ARPI-pretreated and chemotherapy-naïve mCRPC and was associated with increased toxicity, although a potential benefit was observed in PD-L1-positive patients. TRAIL REGISTRATION: PROSPERO ID: CRD 420261284437.
Sound therapy in renal disease management: a narrative review by the Kasr Al-Ainy Nephrology Group (KANG).
Soliman AR, Elkhatib M, El-Khashab S … +7 more , Abdelaziz TS, Hammad H, Ahmed RM, Maamoun HA, Dorgham A, Fayed A, Marzouk A
Int Urol Nephrol · 2026 Feb · PMID 41739358 · Publisher ↗
BACKGROUND: Sound therapy, a non-invasive practice using auditory stimuli such as music, tones, or specific frequencies, has demonstrated physiological and psychological benefits in neurology, pain management, and mental...
BACKGROUND: Sound therapy, a non-invasive practice using auditory stimuli such as music, tones, or specific frequencies, has demonstrated physiological and psychological benefits in neurology, pain management, and mental health. Its application in renal disease management, however, is still emerging. OBJECTIVE: To summarize current knowledge regarding the potential effects of sound therapy on kidney diseases-including chronic kidney disease (CKD), acute kidney injury (AKI), dialysis, and kidney transplantation-and to highlight directions for future research. METHODS: The Kasr Al-Ainy Nephrology Group (KANG) conducted a comprehensive narrative review with systematic search methodology in PubMed and major databases up to 2025. Search terms included "sound therapy," "music therapy," "vibroacoustic therapy," and "renal disease." Eligible studies comprised animal experiments, clinical trials, and observational studies reporting renal or symptom-related outcomes. This review examines both auditory interventions (music therapy, vibroacoustic therapy) and mechanical modalities (therapeutic ultrasound), acknowledging their distinct mechanisms. Evidence quality is generally low to moderate. RESULTS: Proposed mechanisms of benefit include stress reduction, autonomic regulation, blood pressure (BP) modulation, and improved microcirculation. Animal studies suggest renal protective effects, while small human trials in hemodialysis patients report reductions in anxiety, pain, and BP. Evidence in peritoneal dialysis and transplantation remains scarce. Vibroacoustic and frequency-specific sound stimulation appear promising but are insufficiently studied. CONCLUSION: Preliminary evidence indicates that sound therapy may improve comfort and psychological well-being in renal patients, with possible physiological benefits. However, the evidence base is weak. Large, well-designed, multidisciplinary trials are required to establish efficacy, optimize protocols, and assess safety before integration into routine nephrology care.
External validation of combining clinical parameters and urinary biomarker clusters and development of a nomogram for identifying bladder-centric interstitial cystitis/bladder pain syndrome in patients with lower urinary tract symptoms.
Tian JH, Yu WR, Jhang JF … +2 more , Jiang YH, Kuo HC
Int Urol Nephrol · 2026 Feb · PMID 41733854 · Publisher ↗
BACKGROUND AND OBJECTIVE: This study performed external validation by analyzing whether a combination of clinical parameters and urinary biomarker cluster could identify bladder-centric interstitial cystitis/bladder pain...
BACKGROUND AND OBJECTIVE: This study performed external validation by analyzing whether a combination of clinical parameters and urinary biomarker cluster could identify bladder-centric interstitial cystitis/bladder pain syndrome (IC/BPS) in a separate cohort of patients with lower urinary tract dysfunction (LUTD). METHODS: In total, 273 patients with LUTD were enrolled in this study. Thirteen urinary biomarkers were assayed. After excluding Hunner's lesion disease and other confusable urological diseases, patients were diagnosed with IC/BPS and different LUTD subtypes, and the sensitivity and specificity for IC/BPS diagnosis were calculated according to urinary biomarker clusters and clinical parameters. The data were randomly divided into the training (80%) and testing (20%) datasets for model development and validation. A nomogram for identifying IC/BPS was then developed based on the training dataset. RESULTS: The patients were classified into the IC/BPS (n = 224) and non-IC/BPS LUTD (n = 49) groups. In total, 164 (86.3%) of 190 patients who met the urinary biomarker cluster criteria and 60 (72.3%) of 83 who did not were finally diagnosed with IC/BPS. The diagnostic accuracy of the urinary biomarker cluster was 0.648. After adding clinical parameters including age, bladder pain visual analog score, and IC Problem Index, the specificity and sensitivity reached 0.900 and 0.909, respectively, for the testing dataset. A nomogram for IC/BPS diagnosis was constructed based on these clinical and biomarker parameters. A total score of 96 could identify bladder-centric IC/BPS. CONCLUSIONS AND CLINICAL IMPLICATIONS: External validation of urinary biomarker clusters plus clinical parameters has a good sensitivity and specificity for predicting bladder-centric IC/BPS in a cohort of patients with LUTD.
Comment on: "The impact of protein intake on kidney adverse events in critically ill patients: a systematic review and meta-analysis".
Ali M
Int Urol Nephrol · 2026 Feb · PMID 41729418 · Publisher ↗
Abstract loading — click title to view on PubMed.
Prospective pilot evaluation of a deep learning model for kidney stone detection on CT using a web-based workflow platform.
Öksüz C
Int Urol Nephrol · 2026 Feb · PMID 41722009 · Publisher ↗
Rapid and reliable detection of kidney stones on non-contrast abdominal CT is essential for timely decision-making in emergency radiology. However, rising imaging volumes and workflow pressures continue to limit reportin...
Rapid and reliable detection of kidney stones on non-contrast abdominal CT is essential for timely decision-making in emergency radiology. However, rising imaging volumes and workflow pressures continue to limit reporting capacity, creating a need for AI systems capable of supporting routine diagnostic practice. Although many AI-based stone detection models have been proposed, most rely on retrospective datasets, and few have been evaluated prospectively within environments that reflect real radiology workflow conditions. This study prospectively evaluates the performance, usability, and workflow compatibility of a deep learning-based kidney stone detection model deployed within a web-based platform designed to emulate key components of routine radiology practice, enabling forward-in-time evaluation without direct integration into routine clinical operations such as PACS/RIS or clinical reporting. A dual-stage convolutional neural network was developed using an internal dataset of 235 cases (3,452 slices) and validated through five-fold patient-level cross-validation. An independent set of 732 slices served as an independent hold-out set. For prospective evaluation, the trained model was integrated into a secure, browser-based interface supporting case upload, slice-level review, independent radiologist labeling, and visualization of AI-generated predictions. Over a six-month period, three radiologists uploaded and annotated a total of 5,152 anonymized CT slices. The platform dynamically calculated diagnostic metrics and logged human-AI interactions to assess performance stability and concordance. The pilot deployment demonstrated strong diagnostic performance under real-world variability, achieving 97.83% accuracy, 94.64% sensitivity, 98.27% specificity, 88.50% precision, and a Cohen's kappa of 0.90. Concordance between radiologists and the model exhibited increasing stability across sequential pilot stages. These findings present a reproducible framework for transitioning radiological AI systems from retrospective validation toward workflow-aligned, prospective pilot deployment. Although full PACS/RIS integration was not attempted, the results underscore the importance of pilot-stage evaluation as a critical intermediary step toward clinical implementation and regulatory approval.
An international public-private partnership model for kidney replacement therapy in Uzbekistan: lessons and challenges.
Sankarasubbaiyan S, Kasiviswanathan S, Shah KD … +5 more , Khurshid U, Sobrirov D, Ravshanbek R, Daminov BT, Jha V
Int Urol Nephrol · 2026 Feb · PMID 41712035 · Publisher ↗
PURPOSE: Uzbekistan is an independent country in Central Asia, with a population of 35.6 million and a GDP per capita of $2254. There is a growing need for affordable kidney replacement therapy in the country. METHODS: A...
PURPOSE: Uzbekistan is an independent country in Central Asia, with a population of 35.6 million and a GDP per capita of $2254. There is a growing need for affordable kidney replacement therapy in the country. METHODS: A public-private partnership was established between the Uzbekistan government and a large private hemodialysis provider to enhance access to high-quality, safe, and effective maintenance hemodialysis. We describe the hemodialysis service delivery model, resources, and services, and also the demographics of the patient population, dialysis practices, and programme outcomes from 2022 to December 2024. FINDINGS: In the first phase, hemodialysis facilities were established in three cities: Bogot, Nukus, and Urgench and later in Tashkent. The HD technician/nurse-to-patient ratio was 1:4. Nephrology-trained physicians managed hemodialysis and provided overall supervision. Approximately 46% of patients were between 41 and 60 years old, 58% were male, and 51% had a high school education level. The most common cause of chronic kidney disease was glomerulonephritis (44%). 70% had a functioning arteriovenous fistula, 32% were on three times weekly dialysis, 16% were Hepatitis C positive. Mean follow-up was 351 days. The outcomes were: 26% died, 6% went for a kidney transplant and 47% continued hemodialysis at the same centre. Government hospitals provide support for acute care and biochemical monitoring. DISCUSSION: This project showcases an innovative model for delivering hemodialysis care in Uzbekistan, highlighting how the private sector can contribute to closing gaps in healthcare delivery services.
Impact of frailty on overall survival and complications in patients with prostate cancer: a systematic review and meta-analysis.
Chen Q, Wu J, Cai Q
Int Urol Nephrol · 2026 Feb · PMID 41712034 · Publisher ↗
PURPOSE: The current systematic review and meta-analysis was designed to assess if the presence of frailty had an adverse impact on overall survival (OS) and complication rates of patients with prostate cancer. METHODS:...
PURPOSE: The current systematic review and meta-analysis was designed to assess if the presence of frailty had an adverse impact on overall survival (OS) and complication rates of patients with prostate cancer. METHODS: Two reviewers explored the PubMed, Web of Science, Embase, and Scopus databases until January 3rd, 2026, for studies examining the impact of frailty on OS and complications in patients with prostate cancer. Data on OS were pooled as a hazard ratio (HR), while short-term mortality and complications were pooled as odds ratios (OR) in a random-effects model. RESULTS: 13 studies with 173,378 patients were included. Pooled analysis showed that the presence of frailty was associated with a statistically significant increase in the risk of lower OS in prostate cancer patients (HR: 1.98, 95% CI 1.48, 2.63, I = 64%). On subgroup analysis based on location, study design, sample size, treatment, frail proportion, adjustment of comorbidities, and Gleason score, the direction of the association remained consistent (HR > 1); however, statistical significance varied by treatment modality and region. Meta-analysis indicated a tendency of higher mortality in the frail group, but the result did not achieve statistical significance (OR: 3.35, 95% CI 0.52, 21.69, I = 74%). Meta-analysis also showed that frailty was a significant predictor of all complications (OR: 1.94, 95% CI 1.83, 2.06, I = 0%) and major complications (OR: 1.94, 95% CI 1.42, 2.64, I = 77%) in patients with prostate cancer. Outcomes remained unchanged in significance on sensitivity analysis. CONCLUSIONS: The presence of frailty can lead to significantly lower OS and a higher risk of complications in patients with prostate cancer. Given the scarce data, the association between frailty and short-term mortality should be interpreted as exploratory.
"One Size Does Not Fit All" is only the beginning: the need for proportional, patient-level decisions in elderly CKD.
Cristiano F
Int Urol Nephrol · 2026 Feb · PMID 41706408 · Publisher ↗
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