Int Urol Nephrol [JOURNAL]
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200 papers
Laparoendoscopic single-site versus conventional laparoscopic living donor nephrectomy: a systematic review and meta-analysis of randomized controlled trials.
Liu H, Wang L, Yang J … +3 more , Chen S, Shi W, Li X
Int Urol Nephrol · 2026 May · PMID 42090097 · Publisher ↗
BACKGROUND: Laparoendoscopic single-site donor nephrectomy (LESS-DN) has been proposed as a minimally invasive alternative to conventional laparoscopic donor nephrectomy (CLDN), but its perioperative advantages remain co...
BACKGROUND: Laparoendoscopic single-site donor nephrectomy (LESS-DN) has been proposed as a minimally invasive alternative to conventional laparoscopic donor nephrectomy (CLDN), but its perioperative advantages remain controversial. This meta-analysis aimed to compare the outcomes of LESS-DN and CLDN based on randomized controlled trials (RCTs). METHODS: PubMed, Embase, and the Cochrane Library were searched up to August 20, 2025, for English-language RCTs comparing LESS-DN and CLDN. The risk of bias was assessed using the original Cochrane Risk of Bias tool (RoB 1.0), and pooled analyses were performed using Review Manager 5.4.1 software. RESULTS: Four randomized controlled trials involving 274 donors (LESS-DN, n = 136; CLDN, n = 138) were included. There were no significant differences between groups in operative time, warm ischemia time, estimated blood loss, length of hospital stay, time to extraction, or overall complication rates. CONCLUSIONS: Based on the currently available randomized evidence, no statistically significant differences were detected between LESS-DN and CLDN in the perioperative outcomes analyzed in living kidney donors. Further adequately powered, multicenter randomized trials-particularly evaluating postoperative pain, patient-reported recovery, and cosmetic satisfaction-are warranted.
Long-term safety of overactive bladder medications in men receiving pharmacotherapy for benign prostatic enlargement: a real-world study using inverse probability of treatment weighting.
Soda T, Yamauchi T, Otsuka H … +2 more , Makino Y, Okada T
Int Urol Nephrol · 2026 May · PMID 42090096 · Publisher ↗
PURPOSE: Despite guideline recommendations to use overactive bladder (OAB) medications in men with benign prostatic enlargement (BPE) presenting with storage symptoms, prescription rates remain low, possibly due to conce...
PURPOSE: Despite guideline recommendations to use overactive bladder (OAB) medications in men with benign prostatic enlargement (BPE) presenting with storage symptoms, prescription rates remain low, possibly due to concern about worsening voiding symptoms. We evaluated the impact of OAB medications on safety outcomes in men receiving pharmacotherapy for BPE in a real-world setting. METHODS: We retrospectively reviewed 899 patients who received α-blockers, 5α-reductase inhibitors, or phosphodiesterase-5 inhibitors between April 2014 and December 2023. We assessed the association between adding antimuscarinics or β-agonists and acute urinary retention (AUR) using inverse probability of treatment weighting based on propensity scores; missing baseline covariates were handled by multiple imputation. RESULTS: Median follow-up was 28.7 months. At baseline, OAB users had lower PSA (2.5 vs. 3.6 ng/mL), smaller prostate volume (35 vs. 43 mL), and lower post-void residual (PVR) (12 vs. 35 mL) than non-users (all p < 0.001). 5α-reductase inhibitor use was less common in the OAB group (16.1% vs. 23.8%; p = 0.019). AUR incidence did not differ significantly between groups before (log-rank p = 0.054) or after weighting (hazard ratio 1.18; 95% CI 0.38-3.62; p = 0.776). Among OAB-treated patients, baseline AUR was significantly associated with discontinuation due to increased PVR (hazard ratio 9.10; 95% CI 1.81-45.6; p = 0.010). CONCLUSION: In men with BPE on pharmacotherapy, addition of OAB medications was not associated with increased risk of AUR. Baseline AUR may predict subsequent discontinuation due to elevated PVR, indicating the need for careful monitoring in such patients.
Value of PSA density in PI-RADS 3 lesions: a single-center retrospective observational study.
Rodriguez-Parras P, Zambudio-Munuera A, Donaire-Barrera A … +4 more , Yañez-Castillo Y, Del Carmen Cano-Garcia M, Arrabal-Martin M, Arrabal-Polo MA
Int Urol Nephrol · 2026 May · PMID 42087020 · Publisher ↗
PURPOSE: The aim of this study was to evaluate whether Prostate-specific antigen density (PSAD) improves risk stratification for clinically significant prostate cancer in patients with PI-RADS 3 lesions and to assess its...
PURPOSE: The aim of this study was to evaluate whether Prostate-specific antigen density (PSAD) improves risk stratification for clinically significant prostate cancer in patients with PI-RADS 3 lesions and to assess its potential role in reducing unnecessary biopsies. METHODS: A single-center retrospective observational study was conducted at Hospital Universitario Clínico San Cecilio (Granada, Spain) between January 2022 and December 2025. A total of 203 patients with a PI-RADS 3 lesion who underwent systematic and targeted biopsy were included. Clinically significant prostate cancer was defined as ISUP ≥ 2. Univariate analysis, logistic regression (age and PSAD ≥ 0.15 ng/mL/cc), ROC curve analysis, and diagnostic performance metrics for PSAD ≥ 0.15 were performed. RESULTS: Prostate cancer was detected in 73/203 patients (36%) and csPCa in 21/203 (10.3%). PSAD was higher in csPCa cases (0.17 vs 0.11; p = 0.001). PSAD ≥ 0.15 was independently associated with csPCa (OR 4.56; 95% CI 1.58-13.14; p = 0.005), as was age (OR 1.08 per year; p = 0.036). PSAD yielded an AUC of 0.722 and the combined age + PSAD model an AUC of 0.751. With PSAD ≥ 0.15, sensitivity was 76.2%, specificity 61.0%, and negative predictive value 95.7%. CONCLUSION: In conclusion, PSAD provides clinical value for risk stratification in PI-RADS 3 lesions and may support biopsy avoidance strategies in selected patients.
Prediction is not decision: why frailty must guide clinical choices in hemodialysis.
Cristiano F
Int Urol Nephrol · 2026 May · PMID 42084798 · Publisher ↗
Abstract loading — click title to view on PubMed.
Holmium laser enucleation of the prostate after prostatic urethral lift: the state of bother.
Patel A, Guo JN, Xu P … +3 more , McDonald A, Fadl-Alla A, Krambeck A
Int Urol Nephrol · 2026 May · PMID 42082863 · Publisher ↗
INTRODUCTION: We sought to investigate the effect PUL has on pre-operative irritative voiding symptoms in patients presenting for HoLEP, and if this leads to different post-operative outcomes. METHODS: This is a single-i...
INTRODUCTION: We sought to investigate the effect PUL has on pre-operative irritative voiding symptoms in patients presenting for HoLEP, and if this leads to different post-operative outcomes. METHODS: This is a single-institution retrospective analysis of our prospective HoLEP registry. Propensity score matching of prostate size and history of urinary retention was used to match the patients who had prior PUL with patients without prior benign prostatic hyperplasia (BPH) surgery 1:2. We analyzed baseline demographics, operative details, post-operative outcomes, and pre-operative/post-operative International Prostate Symptom Score (IPSS) and Michigan Incontinence Symptom Index (MISI). RESULTS: Of the 2114 patients who underwent HoLEP, 1242 had sufficient data. There were 59 patients who had a HoLEP after prior PUL and a control cohort was made consisting of 118 patients. At baseline, the control group had more alpha blocker use (69% vs 54% (p=0.05)) and higher American Association of Anesthesia scores. Enucleation efficiency was similar between groups (1.82 vs 1.94 g/min (p=0.634)) but morcellation efficiency was lower in the PUL arm (9.8 vs 7.2 g/min (p<0.001)). More patients in the PUL cohort required anti-cholinergics and beta-3 agonists post-operatively (8.5% vs 19%, p=0.084). With regards to symptom scores, pre-operative MISI severity scores were significantly higher in the PUL group (median 6 vs 3 (p = 0.011)) and no other differences were noted. CONCLUSIONS: Patients presenting for HoLEP after prior PUL have significantly higher MISI severity scores. This does not translate to differences in post-operative outcomes compared to those who had HoLEP as their first BPH surgery.
Synergistic relaxation of ureteral smooth muscle by doxazosin and vardenafil: experimental implications for medical expulsive therapy.
Uysal B, Tumer E, Kaplan E … +4 more , Tore F, Eroglu M, Celikaslan H, Dokuyucu R
Int Urol Nephrol · 2026 May · PMID 42071078 · Publisher ↗
PURPOSE: This study aimed to investigate the relaxant effects of doxazosin (an α₁-adrenergic receptor blocker) and vardenafil (a phosphodiesterase type 5 inhibitor) on rabbit ureteral smooth muscle using an in vitro orga...
PURPOSE: This study aimed to investigate the relaxant effects of doxazosin (an α₁-adrenergic receptor blocker) and vardenafil (a phosphodiesterase type 5 inhibitor) on rabbit ureteral smooth muscle using an in vitro organ-bath model, and to determine whether sequential administration enhances relaxation, particularly in different ureteral segments. METHODS: Ureteral segments (middle and distal) were obtained from 15 adult male New Zealand White rabbits and mounted in organ baths containing oxygenated Krebs-Henseleit solution at 37 °C. Each ureteral segment (middle and distal) obtained from the animals was treated as an independent experimental unit. Thus, a total of 15 middle and 15 distal ureteral segments were analyzed (n = 15 per group). Contractions were induced by 60 mmol/L KCl, and relaxation responses to doxazosin and vardenafil-applied separately or sequentially-were recorded isometrically. The degree of relaxation was expressed as a percentage of the initial KCl-induced contraction. Data were analyzed using one-way ANOVA followed by Tukey's post hoc test. RESULTS: Both doxazosin and vardenafil produced significant relaxation in KCl-precontracted tissues (p < 0.001). In the middle ureter, relaxation responses were 47.3 ± 3.6% for doxazosin and 33.7 ± 3.5% for vardenafil. In the distal ureter, relaxation increased to 54.6 ± 2.2% and 40.8 ± 2.2%, respectively. Sequential administration of doxazosin followed by vardenafil yielded the greatest relaxation (84.1 ± 3.9% in middle, 88.4 ± 3.1% in distal segments; p < 0.001), whereas the reverse order produced a lower but still significant response (57.4 ± 4.8% and 80.5 ± 4.4%, respectively). Overall, distal segments exhibited greater pharmacologic sensitivity than middle ones. CONCLUSION: Doxazosin and vardenafil both exert potent relaxant effects on ureteral smooth muscle, with enhanced efficacy when administered sequentially-especially in distal segments. These findings provide mechanistic insight into the synergistic interaction between α₁-adrenergic blockade and PDE5 inhibition and support the rationale for combination therapy in facilitating distal ureteral stone passage.
Safety evaluation of finerenone and identification of factors contributing to nephrotoxicity: re-analysis using FDA adverse event reporting system data.
Du C, Zhao Z
Int Urol Nephrol · 2026 May · PMID 42069979 · Publisher ↗
BACKGROUND: To evaluate finerenone-associated adverse events (AEs) and to investigate the association between finerenone use and renal injury via data mining of the Food and Drug Administration Adverse Event Reporting Sy...
BACKGROUND: To evaluate finerenone-associated adverse events (AEs) and to investigate the association between finerenone use and renal injury via data mining of the Food and Drug Administration Adverse Event Reporting System (FAERS). METHODS: To minimize statistical bias, the data extraction period was set from database inception (2004) to provide a stable background for disproportionality analysis. Four disproportionality algorithms (ROR, PRR, BCPNN, and MGPS) and stricter case-screening methods were employed to improve analytical precision. Additionally, a clinical priority evaluation was conducted to rank clinical risks and surveillance levels for these AEs. Supplementary analysis was performed to assess the relationship between finerenone and renal injury, as well as associated risk factors. RESULTS: A total of 1316 finerenone-related reports were identified. 30 AEs were detected as significantly positive signals, with most being related to renal function (15 PTs, 50%), blood pressure (5 PTs, 16.67%), and blood potassium (4 PTs, 13.33%). Among them, blood glucose increased, blood creatine increased, and flank pain were new potential AEs. Acute kidney injury, hyperkalemia, renal impairment, glomerular filtration rate decreased, blood creatinineincreased, blood potassium increased, and hyponatremia exhibited moderate clinical priority levels and warrant further study. Signals reflecting renal injury were detected in patients regardless of baseline nephropathy. Male sex, taking more than 3 drugs, and using amlodipine may be risk factors for finerenone-related nephrotoxicity. CONCLUSIONS: These results highlight new finerenone-related AEs, provide ranked guidance for pharmacovigilance through clinical priority evaluation, and clarify factors that influence renal injury, providing guidance for individualized treatment and improved drug safety.
Evaluating the feasibility and safety of 48-h short-stay pathway for robot-assisted laparoscopic partial nephrectomy: a propensity score-matched analysis.
Tang C, Chu N, Shi C … +5 more , Chang Z, Zhao T, He H, Zhang Y, Jing L
Int Urol Nephrol · 2026 May · PMID 42069978 · Publisher ↗
OBJECTIVE: To compare perioperative outcomes between the 48-h short-stay pathway and traditional inpatient management for patients undergoing robot-assisted partial nephrectomy (RAPN), and to evaluate the feasibility, sa...
OBJECTIVE: To compare perioperative outcomes between the 48-h short-stay pathway and traditional inpatient management for patients undergoing robot-assisted partial nephrectomy (RAPN), and to evaluate the feasibility, safety, recovery efficiency, and economic benefits of the 48-h short-stay pathway. METHODS: This retrospective study included 175 patients who underwent RAPN between February 2022 and June 2024. Patients were assigned to a 48-h short-stay group (n = 60) or a traditional inpatient group (n = 115). A 1:1 propensity score matching (PSM) was conducted to balance baseline characteristics, including age, sex, BMI, comorbidities, tumor features, surgeon identity, and surgical year. Perioperative outcomes, recovery indicators, complications, and medical costs were compared. RESULTS: After PSM, 53 matched pairs were analyzed. The short-stay group showed significantly shorter operative time, less intraoperative blood loss, shorter warm ischemia time, earlier mobilization, earlier oral intake, faster bowel function recovery, and shorter bed rest (all P < 0.05). The short-stay group had 71.7% of patients discharged on postoperative day (POD) 1 and 100% within 48 h, while the traditional group had 22.6% on POD1, 33.96% on POD2, and 43.4% on POD ≥ 3 (P < 0.001). Both total and postoperative hospital stays were significantly shorter in the short-stay group (2.00 vs. 6.00 days, P < 0.001), with lower hospitalization costs (P < 0.001). Postoperative creatinine was lower in the short-stay group (P = 0.023), while creatinine change was comparable (P = 0.063). Complication rates, emergency department visits, and 30-day readmission rates were similar between groups (all P > 0.05). The short-stay group had a significantly lower drain placement rate (P = 0.002) without increased adverse events. CONCLUSION: The 48-h short-stay pathway for selected patients undergoing RAPN is feasible and safe. It accelerates postoperative recovery, shortens hospital stay, reduces medical costs, and optimizes healthcare resource utilization, without compromising safety or oncological early outcomes.
Efficacy and safety of papillary vs non-papillary access to the calyces in patients undergoing percutaneous lithotripsy: a GRADE-assessed systematic review and meta-analysis.
Amin F, Abid A, Rehaam W … +5 more , Talab T, Ullah F, Saleem Z, Sultana M, Ahmed AB
Int Urol Nephrol · 2026 May · PMID 42067742 · Publisher ↗
BACKGROUND: Percutaneous nephrolithotomy (PCNL) access is traditionally obtained via papillary puncture to minimize bleeding, though non-papillary access is frequently utilized in everyday clinical practice due to practi...
BACKGROUND: Percutaneous nephrolithotomy (PCNL) access is traditionally obtained via papillary puncture to minimize bleeding, though non-papillary access is frequently utilized in everyday clinical practice due to practical considerations such as anatomical variations and stone location. Because existing comparative studies have yielded inconsistent findings, this systematic review and meta-analysis aimed to synthesize existing evidence evaluating the safety and efficacy of papillary versus non-papillary access during PCNL. METHODS: A comprehensive systematic search of databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov, alongside grey literature, was conducted from inception until December 2025. Randomized controlled trials and observational studies comparing papillary and non-papillary access for renal calculi in patients undergoing PCNL were included. Data were pooled using a random-effects model to calculate mean differences (MD) and odds ratios (OR) alongside their 95% confidence intervals (CIs). RESULTS: A total of six studies comprising 856 patients met the inclusion criteria. Pooled analyses demonstrated no statistically significant differences between the papillary and non-papillary access groups regarding hemoglobin drop (MD 0.09 g/dL, 95% CI -0.19 to 0.37), transfusion rates (OR 1.28, 95% CI 0.59 to 2.74), changes in postoperative serum creatinine levels (MD 0.02 mg/dL, 95% CI -0.03 to 0.07), duration of hospital stay (MD 0.08 days, 95% CI -0.28 to 0.44), stone-free status (OR 1.20, 95% CI 0.76 to 1.89), or operative duration (MD 2.81 min, 95% CI -2.06 to 7.68). Heterogeneity across most outcomes was minimal. Meta-regression identified stone size as the only significant moderator, which negatively influenced operative duration. CONCLUSION: Papillary and non-papillary access techniques during PCNL appear to provide comparable clinical outcomes with no significant differences in major perioperative parameters. The clinical decision-making regarding the selection of access technique should be individualized, considering patient anatomy, stone characteristics, and surgical expertise rather than strict adherence to a single standardized puncture strategy.
Blood pressure effects of SGLT2 inhibitors in kidney transplant recipients: a systematic review and meta-analysis.
Ahmad A, Mankani MH, Al-Kahil A … +6 more , Khan M, Ismail M, Bilancini M, Verma S, Nadeem MA, Ahmed AS
Int Urol Nephrol · 2026 Apr · PMID 42056360 · Publisher ↗
BACKGROUND: Post-transplant hypertension is common in kidney transplant recipients and contributes to cardiovascular risk and allograft dysfunction. Most available data come from studies where the primary indication for...
BACKGROUND: Post-transplant hypertension is common in kidney transplant recipients and contributes to cardiovascular risk and allograft dysfunction. Most available data come from studies where the primary indication for SGLT2 inhibitor use was post-transplant diabetes mellitus or cardiorenal protection, with blood pressure assessed as a secondary outcome. OBJECTIVES: To systematically evaluate the impact of SGLT2 inhibitors on blood pressure, metabolic and renal outcomes, and safety in kidney transplant recipients. METHODS: PubMed, Embase, and Scopus clinical trial registries were systematically searched from inception to October 20, 2025. Randomized controlled trials and observational studies were included. Primary outcomes were changes in systolic and diastolic blood pressure at 3, 6, and 12 months. Secondary outcomes included body weight, glycated hemoglobin (HbA1c), renal function, and adverse events. RESULTS: Twelve studies comprising 1,292 participants were included. In controlled difference-in-differences analyses (5 studies), SGLT2 inhibitors showed no significant blood pressure reductions versus control at any time point. Exploratory single-arm analyses suggested within-group systolic blood pressure reductions at 3 and 6 months; however, these estimates are at high risk of bias and cannot establish treatment effect. CONCLUSION: Exploratory single-arm analyses suggested modest short-term reductions in systolic blood pressure and suggested metabolic effects with an acceptable safety profile. However, controlled difference-in-differences analyses showed no significant blood pressure reductions versus control. Most available evidence derives from studies in which SGLT2 inhibitors were not initiated specifically for blood pressure control. Dedicated randomized controlled trials are required to determine their role in the management of post-transplant hypertension.
The lactate-lactylation axis in acute kidney injury: mechanisms from metabolic reprogramming to epigenetic regulation and clinical therapeutic prospects.
Chen J, Zhang Y, Ni S … +3 more , Qi J, Mo Y, Nie X
Int Urol Nephrol · 2026 Apr · PMID 42056359 · Publisher ↗
Acute kidney injury (AKI) is a common critical clinical syndrome among hospitalized patients, characterized by high incidence and mortality rates. Currently, the pathogenesis of AKI remains incompletely understood, and e...
Acute kidney injury (AKI) is a common critical clinical syndrome among hospitalized patients, characterized by high incidence and mortality rates. Currently, the pathogenesis of AKI remains incompletely understood, and effective clinical treatments are lacking. Lactate, a metabolic byproduct of glycolysis, is involved in numerous pathophysiological processes within the kidney and functions as a regulator of lactylation, a recently identified posttranslational modification (PTM). The regulation of lactylation is closely controlled by several key enzymes and metabolic pathways, creating a dynamic and complex modification network. By modulating protein function and gene expression, lactylation significantly impacts the progression of various diseases. Recent evidence suggests that lactylation acts as a pivotal regulatory hub in the pathophysiology of AKI and is intricately linked to core AKI mechanisms, such as inflammation, metabolic reprogramming, and mitochondrial dysfunction. This review presents an investigation of renal lactate metabolism homeostasis and the disruption of this homeostasis, thoroughly discussing the biological underpinnings of lactylation, including the core enzymes involved, and focuses on elucidating the mechanisms of lactylation in AKI. Additionally, the potential of targeting the lactate-lactylation axis as a promising therapeutic strategy for AKI is discussed.
Tumor-derived extracellular vesicles exert promotional effects on metastasis in renal cell carcinoma through the delivery of microRNA-671-5p.
Huang X, Shi T, Zhou J … +1 more , Peng F
Int Urol Nephrol · 2026 Apr · PMID 42047981 · Publisher ↗
PURPOSE: Tumor-derived extracellular vesicles (EVs) can deliver microRNAs (miRNAs) to promote tumor development. Herein, this study explored whether tumor-derived EVs carrying miR-671-5p facilitated renal cell carcinoma...
PURPOSE: Tumor-derived extracellular vesicles (EVs) can deliver microRNAs (miRNAs) to promote tumor development. Herein, this study explored whether tumor-derived EVs carrying miR-671-5p facilitated renal cell carcinoma (RCC) cell growth. METHODS: miR-671-5p expression in RCC cells and the collected EVs was assessed. After gain- and loss-of-function assays and EV co-culture, cell viability, invasion and migration, and apoptosis were measured. RNA pull-down and dual-luciferase reporter assays were used to analyze the binding between miR-671-5p and inhibitor of growth 5 (ING5). The function of EVs in RCC metastasis in vivo was evaluated through tumor transplantation in nude mice. RESULTS: miR-671-5p was up-regulated in RCC cells and EVs from ACHN cells. miR-671-5p down-regulation inhibited RCC cell proliferation, invasion, and migration but accelerated cell apoptosis. EVs derived from ACHN cells carried miR-671-5p into RCC cells. RCC cell invasion, migration, and proliferation were diminished but cell apoptosis was elevated after co-culture with EVs carrying inhibitors-miR-671-5p. Mechanistically, ING5 was a target of miR-671-5p. ING5 silencing abrogated the effects of EVs carrying inhibitors-miR-671-5p on RCC cells. EVs accelerated tumor growth, increased tumor volume, and elevated Ki-67-positive cells in mice, accompanied by increased miR-671-5p expression and decreased ING5 expression, whereas EVs carrying inhibitors-miR-671-5p contributed to opposite results. CONCLUSION: Tumor-derived EVs carrying miR-671-5p target ING5 to promote RCC cell growth.
Modulating effects of bee venom (Apis mellifera intermissa) against ethylene glycol-induced oxidative nephrotoxicity in male mice.
Dahdouh F, Belhamzaoui K, Bourouba A … +4 more , Bourouba A, Kherroub A, Mahidine L, Djebar-Berrebbah H
Int Urol Nephrol · 2026 Apr · PMID 42045611 · Publisher ↗
PURPOSE: Bee venom (BV) is a well-studied nephroprotective agent, however, its efficacy against ethylene glycol (EG)-induced nephrotoxicity has not been previously investigated. Therefore, this study aimed to assess the...
PURPOSE: Bee venom (BV) is a well-studied nephroprotective agent, however, its efficacy against ethylene glycol (EG)-induced nephrotoxicity has not been previously investigated. Therefore, this study aimed to assess the protective effect of BV in mitigating EG-mediated alterations in renal function markers, oxidative stress, and histopathological injury in male mice. METHODS: Renal toxicity was induced in adult male mice by daily oral gavage of 20% EG (2 mL/kg body weight). BV was administered intraperitoneally as a co-treatment over the same exposure period. Evalauted ndpoints included physiological indices (body weight, water intake, urine output, absolute and relative kidney weights), renal filtration markers (serum and urinary urea, creatinine, albumin, and creatinine clearance), urinary electrolytes (Ca⁺, Na⁺, K⁺, Mg⁺), oxidative stress markers (renal MDA, GSH, catalase, and GST), and histological assessment of tubular injury and inflammation. RESULTS: EG administration induced significant systemic and renal impairment, characterized by decreased body weight, increased water intake, urine output, absolute and relative kidney weights, along with reduced creatinine clearance, albuminuria, hypercalciuria, and decreased urinary electrolytes (Na⁺, K⁺, Mg⁺). Pathogenesis was associated with oxidative stress, as evidenced by elevated MDA and depletion of antioxidant defenses (GSH, catalase, GST), and manifested histologically as tubular necrosis and inflammatory infiltration. BV treatment significantly reduced renal and systemic alterations, enhancing renal function, stabilizing physiological markers, and boosting antioxidant defenses. CONCLUSION: BV confers significant but partial nephroprotection against EG-induced oxidative renal injury through suppression of lipid peroxidation, preservation of glutathione status, enhancement of catalase/GST detoxification, and attenuation of tubular and inflammatory damage. These findings support further mechanistic and dose-response optimization studies prior to clinical translation.
Nutritional support in acute kidney injury requiring continuous renal replacement therapy: from metabolic alterations to clinical recommendations.
Alarcón-Fuentes J, Pedreros-Rosales C, Cornejo-Arriagada B … +2 more , Müller-Ortiz H, Ramírez-Guerrero G
Int Urol Nephrol · 2026 Apr · PMID 42045610 · Publisher ↗
This narrative review examines the metabolic and nutritional challenges faced by critically ill patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT). Recent evidence and internat...
This narrative review examines the metabolic and nutritional challenges faced by critically ill patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT). Recent evidence and international guidelines were reviewed to synthesize the current understanding of nutrient losses, metabolic alterations, and clinical implications. CRRT induces additional depletion of amino acids, proteins, water-soluble vitamins, and trace elements, aggravating the catabolic stress inherent to critical illness. It also modifies carbohydrate, lipid, and micronutrient metabolism, while also providing or removing non-nutritional calories through dialysate and anticoagulation solutions. These complex interactions demand a tailored nutritional strategy that compensates for therapy-related losses and metabolic disturbances. A coordinated, multidisciplinary approach integrating nutritional assessment, close monitoring, and timely adjustment of therapy may optimize metabolic recovery, reduce complications, and improve clinical outcomes in this high-risk population.
Comment on "Intradialytic protein supplementation: fish vs whey protein in hemodialysis patients".
Burfat S, Ochani P, Ochani A
Int Urol Nephrol · 2026 Apr · PMID 42043689 · Publisher ↗
Abstract loading — click title to view on PubMed.
Serum complement C3 as a candidate biomarker for monitoring progression from chronic kidney disease to kidney failure.
Chen C, Xie X, Chen X … +5 more , Geng J, He Y, Jing Q, Chen Y, Han M
Int Urol Nephrol · 2026 Apr · PMID 42034881 · Publisher ↗
OBJECTIVE: To monitor the progression of chronic kidney disease to kidney failure is a pressing clinical challenge given its increasing incidence. METHODS: In a retrospective cohort of 764 patients admitted to our hospit...
OBJECTIVE: To monitor the progression of chronic kidney disease to kidney failure is a pressing clinical challenge given its increasing incidence. METHODS: In a retrospective cohort of 764 patients admitted to our hospital between June 2021 and June 2024, we performed a comprehensive analysis of serum complement C3/C4 levels. RESULTS: Longitudinal assessment revealed a progressive, dose-dependent decline in serum C3 that correlated with disease advancement from renal insufficiency to chronic renal failure and ultimately to kidney failure. To further investigate the role of C3, we utilized an adenine-induced nephropathy model in mice. C3 (C3-deficient) mice exhibited heightened susceptibility to renal injury, reflected by significant elevations in urea, uric acid, and creatinine levels. Flow cytometric analysis showed an 11% reduction in renal CD19 B cell infiltration in C3 mice compared with wild-type controls. Mechanistically, C3 promotes B cell recruitment via the CD21/CD35 complement receptors, and these recruited B cells upregulate IL-10 to exert a renoprotective effect. Logistic regression identified serum C3 as a candidate predictive biomarker for distinguishing kidney failure. CONCLUSIONS: Serum C3 may represent a candidate biomarker worthy of further prospective validation for tracking the progression of CKD. Our research findings are expected to establish a novel prognostic framework for risk stratification of CKD patients through continuous serum C3 monitoring, offering a critical window for early intervention in end-stage renal disease.
Integrated bioinformatics analysis and clinical validation identifies TNFSF14 and CD40 as novel biomarkers for chronic kidney disease progression and tubulointerstitial injury.
Gu X, Lu Y, Sha H … +4 more , Zhang H, Chen H, Qiu M, Chen X
Int Urol Nephrol · 2026 Apr · PMID 42033552 · Publisher ↗
BACKGROUND: Chronic kidney disease (CKD) is a global public health burden characterized by irreversible renal function loss and progressive fibrosis. Non-invasive biomarkers reflecting intra-renal inflammation and early...
BACKGROUND: Chronic kidney disease (CKD) is a global public health burden characterized by irreversible renal function loss and progressive fibrosis. Non-invasive biomarkers reflecting intra-renal inflammation and early tubulointerstitial injury remain an unmet clinical need. We combined bioinformatics analysis with clinical validation to characterize two immune-related genes, TNFSF14 and CD40, in CKD progression. METHODS: Two independent CKD transcriptomic datasets (GSE66494, n = 61; GSE97709, n = 48) were retrieved from the GEO database. Differentially Expressed Genes (DEGs) were screened with FDR adjustment. Clinical validation was performed in 140 CKD patients (KDIGO Stages I-V) and 60 healthy controls. TNFSF14 and CD40 levels were quantified in serum/urine via ELISA, with intra-renal expression assessed via immunofluorescence in 80 biopsy specimens. Multivariable regression was used to evaluate independent predictive value. RESULTS: TNFSF14 and CD40 were identified as core hub genes enriched in the TNF signaling pathway. Both markers were significantly elevated in serum/urine of CKD patients (Adjusted P < 0.05), with upregulation localized to renal tubular epithelial cells. Urinary levels increased in a CKD stage-dependent manner, positively correlating with serum creatinine/BUN and inversely with eGFR. Urinary TNFSF14 and CD40 were independent predictors of advanced CKD, with a combined diagnostic model achieving an AUC of 0.892 (95% CI: 0.851-0.933). CONCLUSIONS: TNFSF14 and CD40 are robust molecular signatures of tubulointerstitial injury, and their urinary levels serve as non-invasive biomarkers for CKD detection and risk stratification.
A high-sugar diet-induced animal model for insulin resistance, oxidative stress, and diabetic nephropathy: insights into empagliflozin's therapeutic potential.
Fardin A, Gholami E, Maleki M … +2 more , Parsaei H, Yaribeygi H
Int Urol Nephrol · 2026 Apr · PMID 42033551 · Publisher ↗
BACKGROUND: Excessive sugar consumption has been implicated in the development of insulin resistance and diabetic nephropathy (DN). The present study aimed to establish a novel animal model of DN using a high-sugar diet...
BACKGROUND: Excessive sugar consumption has been implicated in the development of insulin resistance and diabetic nephropathy (DN). The present study aimed to establish a novel animal model of DN using a high-sugar diet (HSD) and evaluate the renoprotective effects of empagliflozin. METHODS: Male Wistar rats were divided into four groups: Normal, Normal + Empagliflozin, Diabetic, and Diabetic + Empagliflozin. Diabetes was induced using a 35% sugar-water solution and a low-dose of streptozotocin. Empagliflozin (15 mg/kg/day) was administered via gavage. Biochemical parameters, renal function markers, oxidative stress indicators, and histopathological assessments were performed. RESULTS: HSD significantly increased fasting blood glucose (FBS) (242.71 mg/dl in Diabetic vs. 96.6 mg/dl in Normal), insulin levels (0.63 vs. 0.288), and homeostatic model assessment for insulin resistance (HOMA-IR) (0.2716 vs. 0.0687), indicating severe insulin resistance. Empagliflozin treatment significantly reduced FBS (128 mg/dl), improved insulin sensitivity (insulin 0.2725, HOMA-IR 0.0854), and partially restored β-cell function (HOMA-B 1.5779). The diabetic group exhibited impaired renal function, with elevated blood urea nitrogen (BUN 38 mg/dl), creatinine (3.44 mg/dl), and proteinuria (2600 mg/24 h). Empagliflozin reduced these markers to near-normal levels (BUN 17 mg/dl, creatinine 0.44 mg/dl, proteinuria 135 mg/24 h). Oxidative stress parameters showed that empagliflozin increased antioxidant activities (SOD 83.31 U/ml, CAT 0.048 U/ml, GLT 0.341 nMol/ml) and decreased lipid peroxidation (MDA 7.69 nMol/ml). Histological analysis revealed that empagliflozin ameliorated glomerular and tubular damage, reducing necrosis and fibrosis in diabetic kidneys. CONCLUSION: A high-sugar diet induced insulin resistance and diabetic nephropathy in rats, characterized by metabolic disturbances, oxidative stress, and renal dysfunction. Empagliflozin demonstrated significant renoprotective effects by enhancing insulin sensitivity, improving kidney function, reducing oxidative stress, and mitigating histopathological damage. These findings highlight HSD's potential as a key driver of insulin resistance and DN and empagliflozin's potential as a therapeutic agent in managing diabetes-induced kidney injury, particularly in the context of excessive dietary sugar intake.
Causal association between sleep disorders and nephrolithiasis: a two-sample Mendelian randomization study.
Huang L, Fan L, Wang S … +3 more , Liu H, Zeng Q, Sun G
Int Urol Nephrol · 2026 Apr · PMID 42026399 · Publisher ↗
PURPOSE: Observational evidence indicates an association between sleep disorders and the risk of nephrolithiasis (kidney stones), but whether this relationship reflects a causal effect remains uncertain. The causal relat...
PURPOSE: Observational evidence indicates an association between sleep disorders and the risk of nephrolithiasis (kidney stones), but whether this relationship reflects a causal effect remains uncertain. The causal relationship between genetically determined sleep disorders and the risk of nephrolithiasis using a two-sample Mendelian randomization (MR) approach was investigated. METHODS: This two-sample MR study utilized genome-wide association summary data for both sleep disorders and nephrolithiasis. The main analysis was conducted using the inverse variance weighted method, while confirmatory analyses employed the weighted mode, weighted median, and MR-Egger regression approaches to test for consistency and robustness. Heterogeneity among instrumental variables was evaluated using Cochran's Q-test, and the potential for horizontal pleiotropy was assessed with the MR-Egger regression intercept. To further gauge the robustness and consistency of the findings, a leave-one-out sensitivity analysis was performed, systematically omitting each single-nucleotide polymorphism in turn. RESULTS: Genetically predicted sleep apnea was associated with nephrolithiasis (OR = 1.0032, 95% CI: 1.0011-1.0053, P = 0.0025) and nephrolithiasis intervention (OR = 1.0027, 95% CI: 1.0008-1.0046, P = 0.0057) and that combined sleep disorders were associated with nephrolithiasis (OR = 1.0042, 95% CI: 1.0014-1.0070, P = 0.0032) and nephrolithiasis intervention (OR = 1.0027, 95% CI: 1.0004-1.0050, P = 0.0240). The MR-Egger test indicated no pleiotropy, and the Q-test revealed no heterogeneity for the causal associations above. The MR-PRESSO test showed no horizontal pleiotropy among the tested SNPs for the identified causal associations. The leave-one-out analysis revealed similar results. CONCLUSION: This MR study revealed causal associations between sleep disorders and nephrolithiasis. Further studies are needed to confirm these findings and elucidate the underlying mechanisms.
Hydrocelectomy under local anesthesia with systemic analgesic support: real-world feasibility and patient acceptance.
Jaeger C, Mager R, Duwe G … +7 more , Haack M, Thomas A, Roelz N, Frey LJ, Brandt M, Haferkamp A, Dotzauer R
Int Urol Nephrol · 2026 Apr · PMID 42026398 · Publisher ↗
PURPOSE: Following implementation of a standardized hydrocelectomy protocol under local anesthesia combined with systemic analgesia at a tertiary referral center, we evaluated its feasibility, safety, and patient accepta...
PURPOSE: Following implementation of a standardized hydrocelectomy protocol under local anesthesia combined with systemic analgesia at a tertiary referral center, we evaluated its feasibility, safety, and patient acceptance. METHODS: In this retrospective single-center study, 35 consecutive patients underwent hydrocelectomy between May 2024 and August 2025 via a standardized in situ spermatic cord block. All patients received protocol-based systemic analgesia (1 g metamizole i.v. and 7.5 mg piritramide s.c.). Anticoagulants were paused 48 h preoperatively and resumed postoperatively, while antiplatelet therapy was continued. The primary endpoint was completion without conversion to analgosedation or general anesthesia. Secondary endpoints included procedural pain (VAS), postoperative complications (Clavien-Dindo), and patient satisfaction. RESULTS: Hydrocelectomy was completed under local anesthesia and systemic analgesic support in 33/35 patients (94%). One patient required conversion to analgosedation, one to general anesthesia. Seventeen patients (48.5%) were ASA III-IV. Median peak procedural pain was moderate (VAS 6, IQR 0-8) and inversely correlated with age (ρ = - 0.485, p = 0.005). Two patients (5.7%) required surgical revision (Clavien-Dindo IIIb), and four minor complications were managed conservatively. No complications were attributed to the anesthetic technique, and no recurrence occurred within 90 days. Overall, 87.5% of patients were satisfied and would recommend it. CONCLUSION: Hydrocelectomy under local anesthesia combined with systemic analgesia is feasible, safe, and well tolerated. Despite transient moderate procedural pain, most patients did not require conversion to procedural sedation or general anesthesia, with high satisfaction. These results support a patient-centered, resource-efficient approach, particularly for older and comorbid patients, including those with ASA III-IV classification, and warrant further prospective evaluation.
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