Int Urol Nephrol [JOURNAL]
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200 papers
Association of phosphodiesterase type 5 inhibitor use with cardiovascular and renal outcomes in male kidney transplant recipients with benign prostatic hyperplasia or erectile dysfunction.
Hsu JY, Li JR, Chen CS … +1 more , Yang CJ
Int Urol Nephrol · 2026 May · PMID 42133261 · Publisher ↗
PURPOSE: Phosphodiesterase type 5 (PDE5) inhibitors are commonly prescribed for erectile dysfunction (ED) and benign prostatic hyperplasia (BPH) in kidney transplant recipients (KTRs), but their cardiovascular and renal...
PURPOSE: Phosphodiesterase type 5 (PDE5) inhibitors are commonly prescribed for erectile dysfunction (ED) and benign prostatic hyperplasia (BPH) in kidney transplant recipients (KTRs), but their cardiovascular and renal associations in this population remain unexamined. This study evaluated these associations in male KTRs with ED or BPH. METHODS: This retrospective cohort study used TriNetX Global Collaborative Network data (January 2015-December 2023). Male KTRs ≥ 40 years with ED or BPH were identified using a unified diagnosis index date in both arms, with PDE5 inhibitor exposure bounded to days 0-365. Three drug strata (tadalafil 5 mg daily, tadalafil, sildenafil) were propensity-matched 1:1 against controls on thirty covariates. Balance was assessed by standardized mean differences. Primary outcomes (all-cause mortality, MACE excluding death, MAKE excluding death) were analyzed by Cox regression and Kaplan-Meier methods. Secondary outcomes comprised individual components (AMI, stroke, and dialysis initiation). RESULTS: All-cause mortality was inversely associated with PDE5 inhibitor exposure across all six strata (HR 0.574-0.697). MACE excluding death was inversely associated in the ED cohort for tadalafil 5 mg daily (HR 0.527) and tadalafil all doses (HR 0.620), but not sildenafil; no composite associations reached significance in the BPH cohort. Two secondary outcomes survived Benjamini-Hochberg correction: MACE excluding death and AMI in the ED tadalafil all-doses stratum (q = 0.023 and q = 0.041). Negative control outcomes near unity supported propensity score balance. CONCLUSION: PDE5 inhibitor exposure was associated with lower all-cause mortality in male KTRs with ED or BPH. Composite cardiovascular and renal associations were stratum-dependent. These findings are hypothesis-generating and require prospective evaluation.
Glucagon like peptide-1 receptor agonist therapy and long-term renal outcomes after radical nephrectomy: a propensity-matched cohort analysis.
Ahmad NB, Kassim A, Manivasagam SS … +1 more , Raman JD
Int Urol Nephrol · 2026 May · PMID 42128993 · Publisher ↗
OBJECTIVE: To evaluate the association between glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy and long-term renal function outcomes following radical nephrectomy (RN). METHODS: Using the TriNetX Research Net...
OBJECTIVE: To evaluate the association between glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy and long-term renal function outcomes following radical nephrectomy (RN). METHODS: Using the TriNetX Research Network, we identified adults who underwent RN between 2005 and 2025. Patients were stratified based on GLP-1 RA use in the peri-operative period. Propensity score matching (1:1) was performed to control for demographic factors, baseline laboratory parameters, and relevant comorbidities. Baseline renal function, including serum creatinine and estimated glomerular filtration rate (eGFR), was included in the matching process. Renal outcomes included acute kidney injury (AKI), chronic kidney disease (CKD) stage 3, CKD stage 4, CKD stage 5, dialysis dependence, and eGFR, assessed at 1-, 2-, and 5-year follow-up intervals. Time-to-event analyses were conducted using Kaplan-Meier methods and Cox proportional hazards models. RESULTS: After matching, 3316 patients (1658) per group) were included in the final analysis. GLP-1 RA users demonstrated significantly lower AKI incidence at 1 year (6.3% vs 12.4%), 2 years (9.5% vs 16.8%), and 5 years (13.4% vs 22.1%) (all p < 0.001). GLP-1 RA use was associated with significantly lower incidence of CKD Stage 3 (at 1 year (12.3% vs 17.2%), 2 years (15.% vs 21.7%, and 5 years (19.7%, vs 25.4%), CKD stage 4 at 1 year (3.1% vs 6.9%), 2 years (4.7% vs 9.0%), and 5 years (6.2% vs 10.9%), and CKD stage 5 at 2 years (1.2% vs 3.9%) and 5 years (1.7% vs 4.7%) (all p < 0.001). Dialysis dependence was also markedly reduced in the GLP-1 RA cohort (2 years: 1.0% vs 5.6%; 5 years: 1.7% vs 7.3%; all p < 0.001). Kaplan-Meier analyses demonstrated improved AKI-free, advanced CKD-free, and dialysis-free survival among GLP-1 RA users, with Cox proportional hazards models confirming significantly lower hazards of AKI, advanced CKD (stage 3-5), and dialysis dependence. CONCLUSION: GLP-1 RA therapy is associated with improved renal function outcomes following radical nephrectomy, with the most consistent benefit observed in reducing progression to advanced CKD (stage 3-5) and dialysis dependence. These findings support further investigation of GLP-1 RAs as a potential renal protective strategy in patients after nephrectomy.
MOTS-c is associated with oxidative stress and arterial stiffness in peritoneal dialysis patients: a pilot study.
Musolino M, Roumeliotis A, Roumeliotis S … +15 more , Zicarelli M, Ruosi F, Greco M, Misiti R, Foti DP, Sgouropoulou V, Kocic G, Veljkovic A, Neofytou IE, Alekos I, Papas E, Duni A, Bolignano D, Dounousi E, Liakopoulos V
Int Urol Nephrol · 2026 May · PMID 42126770 · Publisher ↗
PURPOSE: Oxidative stress (OS) and endothelial dysfunction are major drivers of cardiovascular disease (CVD) in peritoneal dialysis (PD). MOTS-c, a mitochondria-derived peptide, is emerging as a key regulator of skeletal...
PURPOSE: Oxidative stress (OS) and endothelial dysfunction are major drivers of cardiovascular disease (CVD) in peritoneal dialysis (PD). MOTS-c, a mitochondria-derived peptide, is emerging as a key regulator of skeletal muscle health, metabolic homeostasis, and vascular function, yet its role in the uremic environment remains unexplored. We investigated the relationship between MOTS-c levels, OS markers, and vascular stiffness in PD patients. METHODS: This pilot, clinical study included 32 stable PD patients (mean age 60.7 ± 1.2 years, 62.5% male). MOTS-c levels were quantified in serum (sMOTS-c), urine (uMOTS-c), and peritoneal dialysate (dMOTS-c). Systemic oxidative status was assessed via plasma Advanced Oxidation Protein Products (AOPPs). Vascular function was evaluated by carotid-femoral Pulse Wave Velocity (PWV), and left ventricular systolic function was assessed echocardiographically. RESULTS: Urinary MOTS-c (uMOTS-c) levels were inversely correlated with serum AOPPs (R = - 0.592, p = 0.012) and a positive association with PWV (R = 0.708, p = 0.001) and left ventricular systolic function (R = 0.440, p = 0.04). Conversely, dialysate MOTS-c (dMOTS-c) were strongly and inversely correlated with PWV (R = - 0.717, p = 0.019) as well as systolic and diastolic blood pressure (R = -0.5, p < 0.01). CONCLUSION: Ηigher urinary MOTS-c was linked to lower systemic oxidative stress, suggesting a potential protective role, and associated with greater arterial stiffness, potentially reflecting a compensatory response to vascular injury. In contrast, higher peritoneal MOTS-c levels were associated with an improved vascular profile. These findings suggest a novel 'Mitochondrial-Vascular Axis' in uremia, highlighting MOTS-c as a potential biomarker.
Bone mineral density using dual-energy X-ray absorptiometry in children with nephrotic syndrome: a cross-sectional study.
Mohanty A, John J, Sahu S … +2 more , Behera KK, Satapathy AK
Int Urol Nephrol · 2026 May · PMID 42126769 · Publisher ↗
PURPOSE: Children with nephrotic syndrome (NS) receive long-term steroid therapy and hence there is an increased risk of bone mineral disease. The objective of the study was to compare the bone mineral density (BMD) in c...
PURPOSE: Children with nephrotic syndrome (NS) receive long-term steroid therapy and hence there is an increased risk of bone mineral disease. The objective of the study was to compare the bone mineral density (BMD) in children with NS with that of healthy age-matched controls by using Dual-energy x-ray absorptiometry (DXA) and its correlation with metabolic parameters. METHODS: A single-center cross-sectional study was conducted to assess the BMD using DXA scan in children aged 5-14 years with NS compared to age and gender-matched healthy children in a tertiary care center. Sixty-two children were included (31 with NS and 31 healthy children as controls), and BMD's were assessed using a DXA scan. Z-scores were calculated and correlated with biochemical parameters such as serum alkaline phosphatase, calcium, phosphate, parathormone, and vitamin D. RESULTS: Low BMD was observed in almost 64.5% of children with NS. The mean BMD and height adjusted Z score were lower in children with NS than healthy children. The mean BMD/Z-score in NS and controls were-left femur neck (- 2.18 ± 1.49 vs - 0.461 ± 0.94), right femur neck (- 2.47 ± 1.54 vs - 0.50 ± 0.88), spine (- 1.72 ± 1.16 vs - 0.603 ± 0.80), respectively and these differences were statistically significant (p < 0.05). The correlation between cumulative steroid dose and BMD/Z-score was not statistically significant. CONCLUSION: Children with NS had lower BMD and serum vitamin D levels than healthy children despite calcium and vitamin D supplementation, and they need periodic evaluation.
Perioperative and clinical outcomes in patients undergoing Retzius-sparing robot assisted radical prostatectomy stratified by the degree of obesity.
Fransis K, Tappero S, Dautricourt S … +4 more , De Laet C, De Wachter S, Dirix P, De Win G
Int Urol Nephrol · 2026 May · PMID 42126768 · Publisher ↗
BACKGROUND: Robot-assisted radical prostatectomy (RARP) is a widely adopted and effective treatment for localized prostate cancer. The Retzius-sparing approach (RS-RARP) has been shown to significantly improve early urin...
BACKGROUND: Robot-assisted radical prostatectomy (RARP) is a widely adopted and effective treatment for localized prostate cancer. The Retzius-sparing approach (RS-RARP) has been shown to significantly improve early urinary continence recovery while maintaining comparable long-term oncological outcomes relative to the anterior approach. However, the impact of body mass index (BMI) on RS-RARP outcomes remains insufficiently investigated. The present study aimed to address this gap. METHODS: A retrospective analysis was conducted on 596 patients who underwent RS-RARP between April 2016 and December 2023, including 197 normal-weight, 287 overweight, and 112 obese individuals. Perioperative, oncological, and functional outcomes were assessed. RESULTS: Estimated blood loss was significantly higher in obese patients. No statistically significant differences in urinary continence rates were observed at any time point. Immediate continence rates were 77%, 72%, and 79%, while one-year continence rates were 97%, 96%, and 98% in the normal-weight, overweight, and obese groups, respectively. Oncological outcomes were comparable across groups, although a non-significant trend toward a higher rate of pN1 disease was observed in obese patients (12% vs. 10% vs. 8%, p = 0.1). RS-RARP was found to be feasible and safe across all BMI categories. CONCLUSIONS: The current study suggests that RS-RARP portends optimal early and one-year urinary continence recovery rates, regardless of BMI. No statistically significant differences were noted regarding safety and oncological outcomes among the three BMI categories.
Effect of tobacco avoidance on the incidence of non-hereditary renal cell carcinoma in patients over 18 years of age: systematic review and meta-analysis.
Valdés Vásquez JF, García-Perdomo HA
Int Urol Nephrol · 2026 May · PMID 42118473 · Publisher ↗
OBJECTIVE: Risk factors for kidney cancer are divided into modifiable and non-modifiable factors. Among the former, smoking stands out, whose relationship with the disease has been extensively studied, from the intensity...
OBJECTIVE: Risk factors for kidney cancer are divided into modifiable and non-modifiable factors. Among the former, smoking stands out, whose relationship with the disease has been extensively studied, from the intensity of consumption to the effects of cessation. However, the impact of avoiding smoking is not precisely known. This study aimed to estimate the effect of avoiding tobacco use on the risk of renal cell carcinoma (RCC) in patients over 18 years of age with no family history. METHODS: A systematic review of clinical trials and observational studies was conducted in the Medline, Embase, CENTRAL, and LILACS databases. Patients aged 18 years or older with a confirmed histological diagnosis of RCC were included. The primary outcome was RCC development. Risk of bias was assessed using the Newcastle-Ottawa tool, and a meta-analysis of the included studies was performed. RESULTS: Of 49 studies identified, 7 met the inclusion criteria, totaling 4,430 patients. In the total population, tobacco avoidance was associated with a lower risk of RCC (RR = 0.69; 95% CI 0.56-0.84; I = 20%). In the analysis by sex, men showed an RR of 0.52 (95% CI 0.32-0.85; I = 57%), while in women the RR was 0.83 (95% CI 0.48-1.45; I = 61%) and did not differ significantly. CONCLUSIONS: Smoking avoidance is associated with a substantial reduction in the risk of RCC, especially in men. Further studies with uniform definitions of avoidance are needed to assess its long-term effect.
Early-start vs. conventional-start peritoneal dialysis in AKI from cardiorenal syndrome type 1: a randomized controlled trial (STARRT-PD).
Parapiboon W, Yupaniad S, Saengngammongkhol P … +2 more , Niyomsirivanich P, Simtharakaew T
Int Urol Nephrol · 2026 May · PMID 42118472 · Publisher ↗
PURPOSE: Peritoneal dialysis (PD) is a feasible option for acute kidney injury (AKI) in hemodynamically unstable patients. However, the optimal timing for initiating PD in cardiorenal syndrome type 1 (CRS1) remains uncle...
PURPOSE: Peritoneal dialysis (PD) is a feasible option for acute kidney injury (AKI) in hemodynamically unstable patients. However, the optimal timing for initiating PD in cardiorenal syndrome type 1 (CRS1) remains unclear. METHODS: In a cardiac care unit of a tertiary hospital in Thailand, CRS1 patients who had AKI stage II between October 2020 and September 2021 were enrolled in a randomized, open-label controlled study. Patients were randomized into two groups: early-start PD strategy (starting PD within 24 h after AKI stage II) and conventional-start PD strategy (starting PD at 72 h if reaching AKI stage III or with an indication). The primary outcome was 30-day mortality. Secondary outcomes included fluid balance, sodium removal during the first 5 days, and PD safety. RESULTS: 77 CRS1 patients were enrolled, and 53 eligible participants were included in a modified intention-to-treat analysis (26 in the early-start group and 27 in the conventional-start group). Dialysis was initiated in 26 patients (100%) in the early-start group and 11 patients (40%) in the conventional-start group. The 30-day mortality was 65% (17 patients) in the early-start group and 40% (11 patients) in the conventional-start group (relative risk 1.68; 95% confidence interval 0.92-3.07; p = 0.07). The first 5-day fluid balance and sodium removal were comparable between the two groups. PD-related complications occurred in 6 events (early-start) and 3 events (conventional-start). CONCLUSION: Among CRS1 patients with AKI, early-start and conventional-start PD showed comparable 30-day mortality risk (Thai Clinical Trial Registry number, TCTR20200928003).
Clinical profile and management outcomes of small renal masses: a collaborative multi-institutional Indian study led by the society of genitourinary oncologists.
Sakthivel DK, Addla S, Pooleri GK … +8 more , Raghunath SK, Tamhankar A, Sharma G, Gautam G, Singh A, Shah R, Rawal S, Ragavan N
Int Urol Nephrol · 2026 May · PMID 42115506 · Publisher ↗
BACKGROUND: Small renal masses (SRMs), defined as renal tumors < 4 cm, are increasingly detected due to the widespread use of imaging modalities. Data from India regarding the clinical characteristics and outcomes of SRM...
BACKGROUND: Small renal masses (SRMs), defined as renal tumors < 4 cm, are increasingly detected due to the widespread use of imaging modalities. Data from India regarding the clinical characteristics and outcomes of SRMs remain limited. This multi-institutional study led by the Society of Genitourinary Oncologists aims to delineate the demographic, radiological, and pathological profiles of SRMs in the Indian population and evaluate management outcomes following partial nephrectomy. METHODS: A retrospective analysis was conducted across multiple tertiary care centers in India from January 2013 to December 2022. Patients aged ≥ 18 years with SRMs undergoing partial nephrectomy were included. Data on demographics, clinical presentation, radiology (including RENAL nephrometry score), intraoperative factors, postoperative outcomes, and histopathology were analyzed. Statistical associations between renal scores, BMI, tumor stage, and histologic type were assessed. RESULTS: A total of 432 patients were analyzed, with a male predominance (76.6%) and mean age of 51.8 ± 12.9 years. Most SRMs (80.3%) were incidentally detected. Robotic-assisted partial nephrectomy was performed in 85% of cases, with a mean operative time of 228.7 ± 91.8 min and clamp time of 25.5 ± 9.1 min. The overall complication rate was 7%. Clear cell RCC was the most common histology (71.1%), while benign lesions accounted for 11.6%. Positive margins were seen in 1.4% of cases. BMI correlated significantly with renal complexity (p = 0.010). At a median follow-up of 36 months, recurrence occurred in 0.9% of patients. Female patients under 45 years had a higher incidence of benign pathology (34.1%, p < 0.001). CONCLUSIONS: This first large-scale Indian collaborative study highlights unique epidemiologic and pathologic trends in SRMs, including lower benign histology rates and higher complexity in obese patients. Robotic partial nephrectomy demonstrated favorable perioperative and oncologic outcomes. The findings support individualized management strategies and emphasize the need for structured follow-up protocols in the Indian setting.
Clinical outcomes of benign prostatic hyperplasia surgery in men with detrusor underactivity versus normal contractility: a systematic review and meta-analysis.
Calvillo-Ramirez A, Esparza-Miranda LA, Casas-Huesca AP … +4 more , Gutierrez HR, Hinojosa-Gonzalez DE, Khalil M, Sidana A
Int Urol Nephrol · 2026 May · PMID 42115505 · Publisher ↗
PURPOSE: Detrusor underactivity (DUA) may coexist in up to one-third of men with benign prostatic hyperplasia (BPH) and is traditionally associated with poorer surgical outcomes, as impaired contractility may limit posto...
PURPOSE: Detrusor underactivity (DUA) may coexist in up to one-third of men with benign prostatic hyperplasia (BPH) and is traditionally associated with poorer surgical outcomes, as impaired contractility may limit postoperative voiding recovery. Existing evidence, however, remains conflicting. We aimed to compare perioperative and functional outcomes in men with DUA and those with normal contractility (NC) following BPH surgery. METHODS: A systematic review and meta-analysis were conducted adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and Scopus were systematically searched for comparative studies. Subgroup analyses were performed according to procedure type. Outcomes included perioperative events and changes in functional parameters. RESULTS: Fourteen studies including 4,345 patients (2060 DUA and 2,285 NC) were analyzed. HoLEP was the most common procedure, followed by TURP. Postoperative urinary retention (OR 1.63, 95% CI 1.21-2.20) and minor complications (OR 1.31, 95% CI 1.08-1.59) were more frequent in the DUA group, while major complication rates were similar (OR 1.46, 95% CI 0.81-2.65). At 6 months, changes in Qmax and PVR were comparable between groups. Reduction in IPSS favored NC patients at 6 months but was no longer observed at 1 year. CONCLUSIONS: BPH surgery appears to be safe and effective in men with concomitant DUA. Although postoperative urinary retention and minor complications were more frequent in patients with DUA, major complications and functional outcomes were similar, particularly beyond the early postoperative period. Given that most available data are retrospective and definitions of DUA remain heterogeneous, further randomized studies employing a standardized DUA definition are needed.
Clinical phenotypes and treatment patterns in men with chronic pelvic pain: a tertiary referral cohort.
Kennedy AJ, Weitzman E, Um J … +2 more , Zwaans BMM, Peters KM
Int Urol Nephrol · 2026 May · PMID 42106502 · Publisher ↗
PURPOSE: Men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have heterogeneous symptoms and variable responses to treatment. We sought to identify clinical and treatment factors associated with pain impr...
PURPOSE: Men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) have heterogeneous symptoms and variable responses to treatment. We sought to identify clinical and treatment factors associated with pain improvement. Specifically, which presenting features and management strategies are associated with clinically meaningful reductions in pain among men with CP/CPPS? METHODS: We performed a retrospective review of men evaluated for chronic pelvic or genitourinary pain by a single specialist from February 2023 to July 2025. Patients were included based on ICD codes for pelvic pain, genitourinary pain, or chronic prostatitis. Demographics, presenting symptoms, and initial and most recent visual analog scale (VAS) pain scores were collected. Intervention types were compared by analyzing VAS scores before and after receiving an intervention. RESULTS: 157 men were included, of which 103 had follow-up VAS data. The median follow up was 277 days and median symptom duration prior to presentation was 24 months. Diffuse pelvic pain was the most common phenotype (51.6%). The mean baseline and most recent VAS scores were 3.4 and 2.1, respectively. The greatest improvements were associated with penile block (- 3.8), spermatic cord block (- 2.6), and hydrodistension with cautery of ulcers (- 2.6). Cystoscopy was performed in 26.8% of patients. While often non-diagnostic (31%), cystoscopy frequently diagnosed inflammatory lesions (31%) and BPH (19%). CONCLUSION: Most patients with CP/CPPS experienced clinically meaningful pain reduction following subspecialist evaluation. Diffuse pain without clear triggers is common. Greater improvement with nerve blocks and treatment of Hunner's lesions supports a phenotype-driven approach. However, studies are needed to isolate and validate treatment effects.
Exploring novel skin biomarkers related to pruritus in dialysis patients.
van Lieshout TS, Bennett S, Vreeken J … +8 more , Kezic S, Kemperman PMJH, Luiten RM, Spithoven EM, Penne EL, Rustemeyer T, van Jaarsveld BC, Abrahams AC
Int Urol Nephrol · 2026 May · PMID 42106501 · Publisher ↗
PURPOSE: Pruritus is a common and distressing symptom among dialysis patients, yet its underlying mechanisms remain incompletely understood. Most previous research has focused on systemic inflammatory markers, while litt...
PURPOSE: Pruritus is a common and distressing symptom among dialysis patients, yet its underlying mechanisms remain incompletely understood. Most previous research has focused on systemic inflammatory markers, while little is known about local skin alterations contributing to pruritus. This study aimed to characterize skin biomarker profiles in dialysis patients with pruritus, in comparison with dialysis patients without pruritus and healthy controls, and to explore differences between pruritic and non-pruritic skin sites. METHODS: In this multi-center cross-sectional exploratory study, stratum corneum samples were obtained using the tape-stripping method from 91 participants (67 dialysis patients and 24 healthy controls). Biomarkers were quantified, and adjusted linear and logistic (mixed) models were used to assess group differences and skin site variations. RESULTS: Dialysis patients with pruritus exhibited a significantly elevated IL-1RA/IL-1α ratio and reduced IL-18 levels compared to non-pruritic patients. There was also a strong indication of concomitant increases in IL-1RA and IFN-β in pruritic skin. Across all dialysis patients, IL-8, CCL17, and CXCL10 levels were significantly lower than in healthy controls, independent of pruritus status. CONCLUSION: Dialysis patients with pruritus demonstrate distinct alterations in skin immune profiles suggestive of localized inflammation and potential involvement of the opioid pathway. These findings provide new insights into the inflammatory mechanisms underlying pruritus in this population and may inform the development of targeted, personalized therapies.
Comment on "Predictive value of the C-reactive protein-albumin-lymphocyte (CALLY) index for all-cause mortality in peritoneal dialysis patients".
Huang W, Shi Y, Yang Y
Int Urol Nephrol · 2026 May · PMID 42105172 · Publisher ↗
Abstract loading — click title to view on PubMed.
Secreted frizzled-related protein 1 augments vascular smooth muscle cell calcification via activating the Wnt/β-catenin/Runx2 axis.
Chen H, Zhang G, Jin J … +11 more , Cheng MJ, Zhang D, Niu Z, Zhu R, Qian Y, Liang X, He L, Zhou W, Zhang S, Bai Y, Xu JS
Int Urol Nephrol · 2026 May · PMID 42105171 · Publisher ↗
PURPOSE: Vascular calcification (VC) is highly prevalent and a significant cardiovascular risk factor in patients with chronic kidney disease (CKD). Secreted frizzled-related protein 1 (SFRP1) is a secreted glycoprotein...
PURPOSE: Vascular calcification (VC) is highly prevalent and a significant cardiovascular risk factor in patients with chronic kidney disease (CKD). Secreted frizzled-related protein 1 (SFRP1) is a secreted glycoprotein closely associated with the Wnt/β-catenin pathway which plays a crucial role in bone formation, but its function and mechanism in VC remain unknown. METHODS: Serum and radial artery tissues were collected from CKD patients with or without VC. The cellular model of VSMCs' calcification was established under high-phosphate conditions in vitro. Western blot, qRT-PCR, and immunofluorescence were used to detect SFRP1 expression. The function of SFRP1 was identified by transfection with sh-SFRP1 and pCMV3-SFRP1 plasmid. RESULTS: Initially, bioinformatics analysis showed that SFRP1 expression was significantly elevated in high-phosphate-stimulated rat VSMCs. Subsequently, we discovered that the expression of SFRP1 was dramatically increased in the calcified arteries of CKD patients. Functionally, when SFRP1 was knocked down, the calcification process and the expression of Runx2 were attenuated. In contrast, SFRP1 overexpression exacerbated the β-GP-induced VSMCs' calcification. Mechanistically, we confirmed the activation of Wnt/β-catenin signaling in the in vitro calcification model and this activation was inhibited by SFRP1 knockdown. Furthermore, when the Wnt/β-catenin signaling was enhanced with LiCl, the suppressing effect of SFRP1 knockdown on β-GP-induced osteogenic transdifferentiation of VSMCs was reversed, and calcification was promoted. CONCLUSION: We identified that SFRP1 promoted vascular calcification in CKD partly by regulating the Wnt/β-catenin/Runx2 axis, suggesting that SFRP1 may be a potential biomarker and therapeutic target for VC in CKD.
Meta-analysis of the impact of serum phosphorus reduction on the prognosis of non-dialysis CKD patients: evidence based on clinical outcomes.
Xin Y, Wang R, Guo Y … +2 more , Qiu Y, Fu B
Int Urol Nephrol · 2026 May · PMID 42105170 · Publisher ↗
BACKGROUND: Existing research on phosphorus-lowering in CKD predominantly focuses on dialysis patients and intermediate biomarkers like serum phosphorus and PTH, lacking evidence on hard clinical outcomes such as ESRD pr...
BACKGROUND: Existing research on phosphorus-lowering in CKD predominantly focuses on dialysis patients and intermediate biomarkers like serum phosphorus and PTH, lacking evidence on hard clinical outcomes such as ESRD progression or mortality in non-dialysis CKD. With limited supporting evidence in KDIGO guidelines, this study systematically evaluates active phosphate-lowering on mortality and renal progression in this population. METHODS: This study identified and included eligible RCTs from Chinese and English databases up to August 2025, including CNKI, Wanfang, VIP, CBM, Cochrane, Embase, Medline, and PubMed. Methodologically, it innovatively categorized subjects into "greater reduction" and "smaller reduction" groups based on actual achieved serum phosphate reduction, rather than by intervention type, to directly evaluate the relationship between phosphorus-lowering efficacy and clinical outcomes (mortality and dialysis). RESULTS: A total of 27 randomized controlled trials were included, involving 3149 non-dialysis CKD patients. Meta-analysis shows that actively reducing serum phosphorus can significantly delay the progression of renal function in non-dialysis CKD patients, reduce their all-cause mortality rate (RR, 0.52; 95% CI 0.35-0.75; heterogeneity I = 0%), and lower the risk of entering dialysis (RR, 0.60; 95% CI 0.48-0.75; heterogeneity I = 0%). CONCLUSION: The results of the meta-analysis suggest that for non-dialysis CKD patients, actively intensifying phosphate-lowering therapy can effectively delay disease progression, delay dialysis initiation, and reduce the risk of death. The research results provide important basis for individualized phosphorus management strategies for non-dialysis CKD patients, and provide strong data support for the recommendations of controlling serum phosphorus in the KDIGO guidelines.
Impact of SGLT2 inhibitors on urinary tract infections in patients with diabetes mellitus and ileal urinary diversion: a retrospective cohort study.
Arnold N, Hischier R, Vartolomei MD … +5 more , Schneidewind L, Giudici N, Röthlisberger R, Kiss B, Roth B
Int Urol Nephrol · 2026 May · PMID 42105169 · Publisher ↗
PURPOSE: The impact of sodium-glucose linked transporter-2 inhibitors (SGLT2i) on urinary tract infection (UTI) risk remains uncertain and may be dose-dependent. No prior studies have evaluated their effect in patients w...
PURPOSE: The impact of sodium-glucose linked transporter-2 inhibitors (SGLT2i) on urinary tract infection (UTI) risk remains uncertain and may be dose-dependent. No prior studies have evaluated their effect in patients with urinary diversion after cystectomy. This study evaluated the association between SGLT2i use and UTI in patients with diabetes mellitus (DM) after cystectomy and ileal urinary diversion. METHODS: We conducted a retrospective single-center cohort study including all patients with DM who underwent cystectomy with ileal urinary diversion between March 1996 and November 2023. Primary outcome was UTI occurrence, assessed by incidence rate and infection-free survival (IFS). Secondary outcomes included asymptomatic bacteriuria and glucosuria. UTI incidence rate was compared using Poisson regression. IFS was evaluated using Kaplan-Meier curves, log-rank test and Cox regression analysis. RESULTS: Among 123 included patients with DM and ileal urinary diversion, 18 (14.6%) received SGLT2i therapy. Median follow-up was 35 months (IQR 12-83). Overall, 121 UTI were documented, 6 (5.0%) in patients with and 115 (95.0%) without SGLT2i treatment, corresponding to incidence rates of 0.206 vs. 0.210 UTI/patient/year (p = 0.959). Median IFS was 9 months (IQR 3-31) in the SGLT2i and 17 months (IQR 5-74) in the non-SGLT2i group, with no significant difference (p = 0.489). CONCLUSION: In this cohort, SGLT2i therapy was not associated with an increased risk of UTI in patients with DM and ileal urinary diversion after cystectomy. These findings suggest no evident signal for increased infection risk; however, prospective studies are warranted to confirm these observations.
Methodological considerations on the safety and efficacy of adding voclosporin to standard treatment for lupus nephritis: a commentary.
Ni M, Hu W, Gao L … +1 more , Mao Y
Int Urol Nephrol · 2026 May · PMID 42101735 · Publisher ↗
Abstract loading — click title to view on PubMed.
Comparison of clinical outcomes of cabozantinib plus nivolumab and lenvatinib plus pembrolizumab in patients with metastatic renal cell carcinoma.
Nakamura K, Yoshida K, Kobari Y … +9 more , Nemoto Y, Ishihara H, Fukuda H, Iizuka J, Shimmura H, Kobayashi H, Hashimoto Y, Kondo T, Takagi T
Int Urol Nephrol · 2026 May · PMID 42098521 · Publisher ↗
PURPOSE: This study aimed to evaluate the treatment outcomes and safety of cabozantinib plus nivolumab (C + N) and lenvatinib plus pembrolizumab (L + P) for patients with metastatic renal cell carcinoma (mRCC). METHODS:...
PURPOSE: This study aimed to evaluate the treatment outcomes and safety of cabozantinib plus nivolumab (C + N) and lenvatinib plus pembrolizumab (L + P) for patients with metastatic renal cell carcinoma (mRCC). METHODS: This multicenter retrospective analysis included 92 patients with mRCC treated with either C + N or L + P as first-line therapy between April 2018 and August 2024. Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs) were compared. Multivariable analysis was performed to identify independent prognostic factors for PFS. RESULTS: Fifty-three patients received C + N and 39 received L + P. PFS (24.1 months vs. not reached, P = 0.725) and OS (46.7 months vs. not reached, P = 0.912) were not significantly different between the C + N and L + P groups. Over a median follow-up duration of 13.9 months, 31 patients experienced disease progression and 12 died. ORR was higher in the C + N group than in the L + P group (79% vs. 49%, P = 0.002), whereas DCR (100% vs. 95%, P = 0.096) and grade ≥ 3 TRAEs (47% vs. 36%, P = 0.280) were comparable. In the multivariable analysis, the treatment regimen (C + N as a reference) was not significantly associated with PFS (hazard ratio: 0.76, P = 0.476). Favorable/intermediate International mRCC Database Consortium risk was identified as an independent prognostic factor for PFS. CONCLUSION: Treatment with C + N and L + P resulted in comparable PFS, OS, and safety profiles in patients with mRCC. Both regimens can be used to treat mRCC based on individual characteristics.
Comparison of monoplanar, cross-table bull's-eye, and a hybrid ultrasound-fluoroscopy technique for renal access in supine PCNL: a cognitive mapping approach.
Koçakgöl H, Turan A, Akkuş MÇ … +5 more , Öztürk ME, Öztürk Koçakgöl D, Altay MS, Atar M, Karabulut İ
Int Urol Nephrol · 2026 May · PMID 42095979 · Publisher ↗
PURPOSE: Percutaneous needle access is a critical step in percutaneous nephrolithotomy (PCNL). Supine PCNL, favored for its anesthetic and physiological benefits, can be performed using various puncture techniques. This...
PURPOSE: Percutaneous needle access is a critical step in percutaneous nephrolithotomy (PCNL). Supine PCNL, favored for its anesthetic and physiological benefits, can be performed using various puncture techniques. This study compared the efficacy and radiation safety of monoplanar, cross-table bull's-eye, and a combined ultrasound (US)-fluoroscopy-guided access technique for supine PCNL. METHODS: Between January 2021 and March 2025, 130 patients undergoing supine PCNL were reviewed in three groups: monoplanar (Group A, n = 41), cross-table bull's-eye (Group B, n = 45), and combined US-fluoroscopy (Group C, n = 44). In Group C, pre-procedural US established a cognitive vectorial roadmap to determine needle trajectory and depth. Punctures were performed under 0° fluoroscopy, with on-demand refinements using 0-30° rotation and cephalad angulation for depth verification. Perioperative outcomes and radiation times were compared. RESULTS: Total operative time, stone-free (SF) rates, complications, blood transfusion rates, creatinine (Cr) change, hemoglobin (Hb) loss, nephrostomy and hospital stay did not differ significantly among groups (p > 0.05). However, mean fluoroscopy time for successful puncture was significantly lower in the combined US-fluoroscopy group (26.59 s) compared to monoplanar (42.82 s) and cross-table bull's-eye (40.62 s) techniques (p < 0.001). CONCLUSION: The combined US-fluoroscopy-guided technique is feasible for supine PCNL and significantly reduces radiation exposure. By integrating US-derived cognitive planning with on-demand fluoroscopic verification, this hybrid approach facilitates efficient needle puncture without compromising procedural precision or clinical success. It serves as a valuable alternative for optimizing radiation safety in urologic practice.
The role of intraoperative tranexamic acid in transurethral resection of the prostate: a systematic review and meta-analysis of randomised-controlled trials.
Hehir CM, Calpin GG, Dowling GP … +2 more , Daly GR, McGuire BB
Int Urol Nephrol · 2026 May · PMID 42095978 · Publisher ↗
PURPOSE: To critically appraise and evaluate the safety and efficacy of intraoperative tranexamic acid (TXA) administration during transurethral resection of the prostate (TURP). METHODS: A systematic search of online da...
PURPOSE: To critically appraise and evaluate the safety and efficacy of intraoperative tranexamic acid (TXA) administration during transurethral resection of the prostate (TURP). METHODS: A systematic search of online databases was conducted to identify randomised-controlled trials (RCTs) which compared surgical outcomes and complication rates in patients undergoing TURP for benign prostatic hyperplasia (BPH) who were treated with TXA (intervention) as compared to placebo/none (control). The efficacy of intraoperative TXA was evaluated through outcomes related to blood loss, rate of blood transfusion and operative time. The safety of TXA was evaluated through pooled analysis of both deep venous thrombosis and pulmonary emboli. RESULTS: Nine RCTs met the inclusion criteria for this meta-analysis in which a total of 661 patients underwent TURP for BPH (331 TXA: 330 Control). There was significantly less intraoperative bleeding in the TXA group (MD -40.23 mL [95%CI -66.76 to -13.71], p = 0.003), which was reflected in a significantly lesser haemoglobin drop on the first postoperative day (MD -0.55 g/dL [95%CI -0.71 to -0.39], p < 0.00001). TXA was associated with a significantly shorter operative time (MD -9.77 min [95%CI -16.97 to -2.58], p = 0.008), with patients who received TXA exposed to a significantly reduced risk of blood transfusion (0.99% TXA vs. 7.69% Control, OR 0.16 [95%CI 0.03-0.93], p = 0.04). There was no statistically significant increase in risk of DVT in the TXA group, p = 0.46. CONCLUSION: Intraoperative administration of TXA is safe and effective in reducing intraoperative blood loss, operative time and postoperative haemoglobin (Hb) drop with resultant decrease in blood transfusion requirements. This meta-analysis did not detect any significant increase in venous thrombosis or risk of pulmonary embolism incurred by TXA administration.
Alignment between AI clinical decision tools and multidisciplinary tumor board decisions in prostate cancer.
Koc A, Akpinar O, Keskin A … +2 more , Tarhan HI, Guzelsoy M
Int Urol Nephrol · 2026 May · PMID 42090098 · Publisher ↗
PURPOSE: This study aimed to evaluate the concordance between treatment recommendations generated by LLMs and decisions made by a multidisciplinary uro-oncology tumor board. METHODS: Forty-eight consecutive prostate canc...
PURPOSE: This study aimed to evaluate the concordance between treatment recommendations generated by LLMs and decisions made by a multidisciplinary uro-oncology tumor board. METHODS: Forty-eight consecutive prostate cancer cases previously discussed at a multidisciplinary tumor board were retrospectively analyzed. For each case, treatment recommendations were generated using five LLM platforms (ChatGPT-4o, ChatGPT, Perplexity, Copilot, and DeepSeek) based on standardized clinical summaries. Four independent urology specialists evaluated the concordance between LLM recommendations and tumor board decisions using a 5-point Likert scale. Differences among models were assessed using the Friedman test followed by Bonferroni-corrected Wilcoxon signed-rank tests. Inter-rater agreement was calculated using the intraclass correlation coefficient. RESULTS: Significant differences in concordance were observed among the evaluated AI platforms (χ = 32.16, p < 0.001). Perplexity and ChatGPT-4o demonstrated the highest alignment with tumor board decisions, each achieving a median Likert score of 4.75, whereas Copilot showed the lowest concordance (median 3.00). DeepSeek and ChatGPT demonstrated intermediate performance. Post hoc analyses revealed that Perplexity significantly outperformed several lower-performing platforms; however, no statistically significant difference was observed between Perplexity and ChatGPT-4o (p = 0.149). Expert evaluations showed strong inter-rater agreement (ICC = 0.82). CONCLUSION: Large language models can demonstrate substantial concordance with multidisciplinary tumor board decisions in prostate cancer management. However, variability among models and the risk of hallucinated information indicate that LLMs should function as clinical decision-support tools under expert supervision rather than as autonomous decision-makers.
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