Int Urol Nephrol [JOURNAL]
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200 papers
Hemodialysis-induced QRS-T spatial angle dynamics: a methodological and clinical appraisal.
Ni M, Wang Z, Xu L … +2 more , Kang J, Lu K
Int Urol Nephrol · 2026 Mar · PMID 41915105 · Publisher ↗
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Why bladder emptying reduces the false-positive results of dynamic renal scintigraphy?
Tyagi P, Yoshimura N, Chermansky C
Int Urol Nephrol · 2026 Mar · PMID 41910717 · Publisher ↗
Dynamic renal scintigraphy (DRS) is an imaging modality of choice for diagnosing the structural and functional obstruction in the urinary tract after intravenous injection of radiotracers such as Tc-99 m diethylenetriami...
Dynamic renal scintigraphy (DRS) is an imaging modality of choice for diagnosing the structural and functional obstruction in the urinary tract after intravenous injection of radiotracers such as Tc-99 m diethylenetriaminepentaacetic acid (DTPA). While upper urinary tract obstruction can prolong the elimination half-life > 20 min of Tc-99 m DTPA, false-positive diagnosis of upper urinary tract obstruction can also result from lower renal excretion of Tc-99 m DTPA due to reduced urinary production in dehydrated individuals, and reduced renal excretion increases the reabsorption of Tc-99 m DTPA from the bladder. Here, we dissected the purported cause for the false-positive results of prolonged elimination half-life > 20 min of Tc-99 m DTPA during dynamic image acquisition for DRS before bladder emptying. The prevalent view in nuclear medicine implicates back pressure of bladder as the purported cause of false positive results and ignores the contribution of kidney recycling Tc-99 m DTPA reabsorbed from bladder. Here, we distilled published clinical evidence to draw a mechanistic insight into the role of Tc-99 m DTPA reabsorption from the bladder in DRS.
Bibliometric analysis of Alport syndrome: genetic foundations, clinical implications, and the transition to precision medicine.
Tian H, Zhang M
Int Urol Nephrol · 2026 Mar · PMID 41902978 · Publisher ↗
BACKGROUND: Alport syndrome is a rare genetic disorder characterized by progressive renal impairment, hearing loss, and ocular abnormalities. Our study aimed to elucidate global research trends on Alport syndrome through...
BACKGROUND: Alport syndrome is a rare genetic disorder characterized by progressive renal impairment, hearing loss, and ocular abnormalities. Our study aimed to elucidate global research trends on Alport syndrome through bibliometric analysis. METHODS: A comprehensive bibliometric analysis of Alport syndrome literature (1990-2025) was performed using WoS and Scopus. After merging and de-duplication (n = 2371), CiteSpace, VOSviewer, and Bibliometrix facilitated network visualization, co-occurrence, co-citation, and historiographic evaluations. RESULTS: Research on Alport syndrome has grown exponentially since 1990 (2371 documents; 6.04% annual growth), dominated by original articles and moderate international collaboration. The USA leads in output, collaboration, and citations; China's volume is rising with evolving global impact. A hub-and-cluster author structure (e.g., Savige, Gross, Kashtan) publishes mainly in nephrology journals (Kidney International, JASN, Pediatric Nephrology), with interdisciplinary citation flows. Co-citation and bursts trace a shift from GBM/type IV collagen genetics to precision diagnostics and renoprotective therapy. Landmark studies established COL4 mutations, genotype-phenotype links, and early ACE inhibition, defining a gene-structure-phenotype-therapy axis. CONCLUSION: Alport syndrome research has progressed from genetic discovery toward more integrative and precision-focused approaches, supported by expanding global collaboration and contributions from key nephrology journals. Emerging priorities-including earlier diagnosis, renoprotective strategies, and advanced molecular techniques-reflect a sustained shift toward more personalized research directions that may inform future clinical management.
Effect of large language model on diagnostic accuracy and clinical completeness among nephrology fellows managing transplant infection.
Meshram HS, Bhagat C, Puri S … +4 more , Gadireddy SR, Modasia B, Batheja V, Mathur RP
Int Urol Nephrol · 2026 Mar · PMID 41888321 · Publisher ↗
BACKGROUND: Infections are the predominant etiologies of post-transplant mortality in India, yet a structured infectious disease curriculum for nephrology fellows is limited. We evaluated whether large language model (LL...
BACKGROUND: Infections are the predominant etiologies of post-transplant mortality in India, yet a structured infectious disease curriculum for nephrology fellows is limited. We evaluated whether large language model (LLM)-augmented clinical reasoning could improve diagnostic accuracy, clinical completeness, and clinical efficiency in managing complex transplant infection scenarios. METHODS: This was a prospective, single-center, pre (LLM-unaided)-post (LLM-aided)-study (washout period of 7 days). We investigated 1200 responses generated on 30 expert-validated kidney transplant infectious disease vignettes (50 sub-questions). 12 final-year nephrology fellows participated voluntarily in the study. Intervention was Open AI ChatGPT-4o generated exemplar responses. Responses were scored for accuracy (0-100%), completeness (0-3 scale), and time-to-answer by blinded assessors. Inter-rater reliability and paired differences were also analyzed. FINDINGS: Median accuracy increased from 72% (65·5-78·5) in the unaided arm to 85·5% (79·0-91·0) in the aided arm with Δ = + 13·0%, p-value < 0·001. Completeness improved from 1·9 (1·6-2·1) to 2·5 (2·3-2·8) (p-value < 0·001). Median time-to-answer decreased from 7.1 (5.9-8.4) to 5.9 (4.8-7.1) minutes (p = 0.002). The most significant gains occurred in fungal (+ 19·2%) and viral (+ 17·5%) infections, especially in immunosuppressant modulation and antifungal treatment protocols. Minimal or no benefit was observed in dual infection scenarios and niche dose-duration knowledge. Only a single clinically significant hallucination (3·3%) occurred. CONCLUSION: Our findings primarily support the role of LLM-generated outputs as structured educational tools to enhance clinical reasoning training among nephrology fellows. Real-world clinical deployment requires additional validation, safety safeguards, and prospective outcome studies.
Intimal CD31-positive relative surfaces are associated with the dysfunction of autologous arteriovenous fistulas in patients receiving dialysis.
Li J, Wu Y, Wang X … +4 more , Zhang Y, Wang D, Shen L, Hou G
Int Urol Nephrol · 2026 Mar · PMID 41886043 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the association between specific histological features of the cephalic vein, assessed intraoperatively, and subsequent dysfunction of primary radiocephalic arteriovenous fistulas (...
OBJECTIVE: This study aimed to evaluate the association between specific histological features of the cephalic vein, assessed intraoperatively, and subsequent dysfunction of primary radiocephalic arteriovenous fistulas (RCAVFs). METHODS: In this retrospective cohort analysis, we analyse data from 170 consecutive patients with end-stage renal disease who underwent first-time RCAVF creation between January 2020 and November 2023, after applying predefined inclusion and exclusion criteria. A segment of the cephalic vein had been harvested during surgery and was subjected to standardized histopathological analysis. Key parameters were quantified using digital morphometry and immunohistochemistry: medial microvascular density (CD31-positive relative surface area), intimal thickness, and medial collagen fiber orientation via second-harmonic generation microscopy. AVF failure was defined as the inability to use the fistula successfully for dialysis within 12 months postoperatively. Univariate and multivariate logistic regression, ROC analysis, and restricted cubic spline models were employed to identify and characterize predictors. RESULTS: Within 12 months postoperatively, 40 patients (23.5%) experienced AVF failure. In multivariate analysis, only a larger medial CD31-positive relative surface area remained a significant independent predictor of failure (odds ratio = 1.48 per 0.1% increase, 95% CI 1.15-1.90, P < 0.01). Intimal thickness showed a significant but weaker linear association. The CD31-positive area provided the highest individual predictive accuracy (AUC = 0.78), and a model combining it with intimal thickness achieved an AUC of 0.82. Nonlinear analysis revealed a threshold effect for CD31, with risk plateauing beyond a density of approximately 1.7%. Collagen fiber orientation was not associated with outcomes. CONCLUSIONS: Intraoperative medial microvascular density of the cephalic vein is a potential histopathological biomarker associated with AVF failure in this retrospective cohort. This finding underscores the importance of the pre-existing biological state of the venous wall, offering a novel marker that may refine risk stratification and shift focus on biological mechanisms in vascular access management.
Evaluation of explainable machine learning models for predicting mid-term stone recurrence after percutaneous nephrolithotomy: a retrospective observational cohort study.
Kose MG, Altay D, Guler A … +4 more , Kardas S, Taskin V, Arslan B, Ozdemir E
Int Urol Nephrol · 2026 Mar · PMID 41880132 · Publisher ↗
OBJECTIVE: To develop an explainable machine learning (ML) model to predict mid-term (3 years) stone recurrence (SR) after percutaneous nephrolithotomy (PCNL). This single-center retrospective observational cohort study...
OBJECTIVE: To develop an explainable machine learning (ML) model to predict mid-term (3 years) stone recurrence (SR) after percutaneous nephrolithotomy (PCNL). This single-center retrospective observational cohort study compared nonlinear algorithms with logistic regression (LR) and evaluated the predictive value of systemic inflammatory markers, clinical and stone-related features. MATERIALS AND METHODS: We retrospectively analyzed 412 PCNL patients with complete preoperative and 3-year follow-up data between 2014 and 2021. The patients were split chronologically into 70% training and 30% independent test sets. Random Forest (RF), Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), and LR models were trained using clinical, stone, and hematologic parameters, including inflammatory indices. Model performance and interpretability were evaluated using the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, specificity, Cohen's kappa, and SHapley Additive exPlanations (SHAP). RESULTS: The RF model demonstrated the highest predictive performance (AUROC:0.92, accuracy:88%, kappa:0.773, p < 0.001) in the test set and outperformed the other algorithms. Residual stone size (RES) > 3 mm was the strongest predictor of SR (sensitivity, 96%; specificity, 72%). Inflammatory markers had limited independent predictive value. Decision curve analysis showed the net clinical benefit of RF, and SHAP analysis identified stone burden and RES as the most influential features. CONCLUSION: An explainable RF model effectively predicted 3-year recurrence after PCNL and emphasized the importance of achieving RES ≤ 3 mm. Although inflammatory markers contributed little to the prediction, this model has potential to enable personalized risk assessment to guide postoperative care if it is externally validated in multicenter cohorts before clinical implementation.
Global epidemiology of hepatitis B virus infection in dialysis patients: a systematic review and meta-analysis of prevalence, immunity, risk factors, and beyond.
Pranto AH, Suez E, Uddin ME … +10 more , Tonmoy HS, Meem MMRM, Montasir F, Nourin F, Ahmed F, Abir SN, Islam DZ, Ajmal M, Begum R, Khandker SS
Int Urol Nephrol · 2026 Mar · PMID 41880131 · Publisher ↗
Hepatitis B infection is a global threat caused by the Hepatitis B virus (HBV), which can be transmitted through blood transfusions. Again, dialysis is a mechanical process that is used to filter the blood of patients wi...
Hepatitis B infection is a global threat caused by the Hepatitis B virus (HBV), which can be transmitted through blood transfusions. Again, dialysis is a mechanical process that is used to filter the blood of patients with chronic kidney disease (CKD). In this study, we aimed to evaluate the worldwide prevalence of HBV infection using primary published data on hepatitis B virus surface antigen (HBsAg) and HBV-DNA prevalence among dialysis patients. To obtain the data, we searched three different online databases, and from 479 studies, 79 articles were selected for this study. Besides prevalence analysis, study outliers, quality, and characteristics were identified as well. We found the pooled prevalence of HBsAg and HBV-DNA to be 7.0% (95%CI: 6.1-8.0) and 1.5% (95%CI: 1.0-1.9), respectively, although, excluding the outliers, the prevalence of HBsAg became 6.3%, but HBV-DNA remained the same. Besides, we determined that 49.2% (95%CI: 30.2-68.1) of dialysis patients took the HBV vaccine, and 40.0% (95%CI: 31.1-48.8) of patients developed natural immunity (anti-HBV antibody). Among continent-based analyses, Australia was determined to have the highest prevalence of HBsAg (8.7%), and Asia and Africa were found to have the same and highest prevalence of HBV-DNA (4.1%). Among risk factors, blood transfusion was the highest, followed by duration of dialysis, HCV/other infections, renal diseases, and so on. This study indicates the importance of careful and contamination risk-free dialysis among patients, vaccination, and early diagnosis of HBV to avoid and prevent the risk of HBV infection.
Stage-specific associations of HER2 overexpression with clinical and pathological features in bladder cancer: a systematic review and meta-analysis.
Guo C, Wei J, Wang Y … +3 more , Zhang L, Wu X, Sheng X
Int Urol Nephrol · 2026 Mar · PMID 41876828 · Publisher ↗
BACKGROUND: Human epidermal growth factor receptor 2 (HER2) overexpression is an established oncogenic driver and therapeutic target in several malignancies, but its clinical significance in urothelial carcinoma (UC) of...
BACKGROUND: Human epidermal growth factor receptor 2 (HER2) overexpression is an established oncogenic driver and therapeutic target in several malignancies, but its clinical significance in urothelial carcinoma (UC) of the bladder remains controversial due to disease heterogeneity and lack of standardized assessment. OBJECTIVE: To synthesize evidence on the stage-specific associations of HER2 overexpression with clinicopathological features in bladder UC through a systematic review and meta-analysis. METHODS: We conducted a PRISMA-compliant systematic review and meta-analysis, searching PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure (CNKI) up to November 6, 2025. Included studies were retrospective observational cohorts of treatment-naive bladder UC patients with HER2 assessed by immunohistochemistry (IHC). Data on HER2 positivity (various IHC thresholds) stratified by clinicopathological variables were extracted. Random-effects models calculated pooled risk differences (RD) with 95% CI (confidence intervals), stratified by non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive/metastatic bladder cancer (MIBC/mUC). Heterogeneity was assessed via I, and subgroup analyses explored IHC thresholds. RESULTS: 19 studies were included (9 on NMIBC, 10 on MIBC/mUC), comprising a total of 2799 patients (NMIBC: 1751; MIBC/mUC: 1048). In NMIBC, HER2 overexpression was significantly associated with higher T stage (RD: 0.11, 95% CI: 0.08-0.15), higher grade (RD: 0.22, 95% CI: 0.16-0.28), multifocality (RD: 0.10, 95% CI: 0.05-0.15), recurrence (RD: 0.22, 95% CI: 0.10-0.35), and progression (RD: 0.31, 95% CI: 0.23-0.39). In MIBC/mUC, significant association was observed only with lymph node metastasis (RD: 0.11, 95% CI: 0.03-0.19). Associations were consistent across IHC thresholds. CONCLUSIONS: HER2 overexpression exhibits stage-specific patterns, strongly linked to aggressive features and progression risk in NMIBC but primarily to lymphatic spread in MIBC/mUC. These findings provide preliminary evidence supporting HER2 as a stage-specific biomarker, with implications for risk stratification and emerging targeted therapies.
Predictive value of the C-reactive protein-albumin-lymphocyte (CALLY) index for all-cause mortality in peritoneal dialysis patients.
Fu X, Guo X, Jiang Z … +2 more , Liu M, Liu Y
Int Urol Nephrol · 2026 Mar · PMID 41874922 · Publisher ↗
BACKGROUND: The C-reactive protein-albumin-lymphocyte (CALLY) index is an emerging integrated inflammatory biomarker that reflects a patient's inflammatory, nutritional, and immune status; its application in peritoneal d...
BACKGROUND: The C-reactive protein-albumin-lymphocyte (CALLY) index is an emerging integrated inflammatory biomarker that reflects a patient's inflammatory, nutritional, and immune status; its application in peritoneal dialysis (PD) patients remains unexplored. METHODS: This retrospective cohort study enrolled 955 PD patients and divided them into four groups according to the CALLY quartiles. Kaplan-Meier analysis assessed differences in survival rates. Cox regression models and time-dependent receiver operating characteristic (ROC) curves evaluated the impact of CALLY and other indices on all-cause mortality. Decision curve analysis (DCA) estimated predictive performance and clinical utility. RESULTS: The highest CALLY quartile group exhibited a significantly lower risk of all-cause mortality compared to the lowest quartile group (HR: 0.26, 95%CI: 0.12-0.57, p = 0.001). ROC analysis demonstrated that CALLY achieved higher predictive accuracy, with an area under the curve (AUC) of 0.753 (95%CI: 0.686-0.821), compared with C-reactive protein to lymphocyte ratio (CLR) (AUC: 0.730, 95%CI: 0.656-0.803) and C-reactive protein (AUC: 0.676, 95%CI: 0.598-0.755). Adding CALLY to a conventional risk model improved discrimination (Harrell's C-index: 0.824 vs. 0.807, p = 0.014), demonstrating its potential incremental value for mortality prediction in PD patients. CONCLUSION: The CALLY index can independently predict all-cause mortality in PD patients, and may have incremental value beyond traditional risk factors, with potential clinical decision-making value.
Integrated single-cell and bulk transcriptomic analysis identifies epithelial cell-related biomarkers and immune subtypes in focal segmental glomerulosclerosis.
Zhang J, Ning H, Hou Y … +1 more , Tang N
Int Urol Nephrol · 2026 Mar · PMID 41872652 · Publisher ↗
BACKGROUND: Focal segmental glomerulosclerosis (FSGS) is a major cause of nephrotic syndrome and chronic kidney disease, characterized by podocyte injury and glomerular scarring. Its heterogeneity complicates early diagn...
BACKGROUND: Focal segmental glomerulosclerosis (FSGS) is a major cause of nephrotic syndrome and chronic kidney disease, characterized by podocyte injury and glomerular scarring. Its heterogeneity complicates early diagnosis and treatment. METHODS: We integrated bulk and single-cell RNA-seq datasets (GSE200818, GSE200828, and GSE176465) to investigate epithelial cell-related molecular alterations in FSGS. Differentially expressed genes (DEGs) were identified and analyzed for functional enrichment. Machine learning algorithms (random forest and support vector machine) were applied to construct a diagnostic gene signature. Immune cell infiltration was assessed using ssGSEA, and molecular subtypes were defined via consensus clustering. Independent datasets (GSE133288 and GSE108109) were used for validation. RESULTS: A total of 133 epithelial cell-associated DEGs were identified. Enrichment analysis indicated transcriptional regulation and viral infection pathways. Three diagnostic genes-B4GALT5, CSRNP1, and CYP3A5-were selected and shown to have excellent diagnostic accuracy (AUC > 0.97) in both discovery and validation cohorts, including podocyte-enriched samples. Immune profiling revealed increased infiltration of activated CD8⁺ T cells, NK cells, and dendritic cells in FSGS, with B4GALT5 positively correlated with multiple immune subsets. Consensus clustering stratified patients into two molecular subtypes with distinct immune features. CONCLUSIONS: This integrative analysis identifies epithelial cell-related biomarkers and immune-associated subtypes in FSGS, providing promising tools for diagnosis and patient stratification. While robust across multiple datasets, further experimental validation is needed to confirm mechanistic relevance.
Predictors of chronic kidney diseases and kidney failure in patients with CAKUT: a cohort study.
Greco R, Provenzano M, Mollica A … +3 more , Pezzi G, Di Dio M, Papalia T
Int Urol Nephrol · 2026 Mar · PMID 41872651 · Publisher ↗
BACKGROUND AND AIMS: Congenital anomalies of the kidney and urinary tract (CAKUT) are a group of disorders responsible for the majority of pediatric end-stage renal disease cases. The CAKUT group is phenotypically variab...
BACKGROUND AND AIMS: Congenital anomalies of the kidney and urinary tract (CAKUT) are a group of disorders responsible for the majority of pediatric end-stage renal disease cases. The CAKUT group is phenotypically variable and can affect the kidney alone and/or the lower urinary tract. The aim of the study was to assess the risk factors for the onset of chronic kidney disease (CKD) and the progression to kidney failure (KF, i.e., the need for dialysis or kidney transplantation) in a cohort of patients with CAKUT. METHOD: We conducted a longitudinal study at the Nephrology, Dialysis, and Transplantation Unit of Annunziata Hospital of Cosenza. We enrolled consecutive patients with CAKUT from 2005 to 2020. Risk factors for CKD and KF were assessed via Cox regression. RESULTS: We studied 87 CAKUT patients (33 females and 54 males). Proteinuria and hypertension were present in 32.2% and 24.1%, respectively, and a high prevalence of urinary tract infections (UTI 56.3%). CAKUT distribution was: 24 bilateral parenchymal abnormalities (BA), 38 renal parenchymal unilateral diseases (PUD), and 25 tubular unilateral diseases (TUD). Proteinuria was more prevalent in BA than in PUD or TUD (54.2% vs 15.8% and 36%, p = 0.006), whereas regular growth was less frequent in BA (33.3% vs 81.6% and 88%, p < 0.001). During a median study follow-up of 205 months, 30 CKD events and 14 KF were registered. BA, anemia, proteinuria, and regular growth independently predicted CKD, while anemia and BA were associated with KF. CONCLUSION: The long follow-up in these children with CAKUT allowed us to find the predictive risk factors for CKD and progression of KF. Early and appropriate treatment of these risk factors could improve the prognosis of renal disease.
Effect of probiotic and synbiotic administration on the nutritional status of hemodialysis patients: a randomized-controlled trial.
Saad WM, Moheb Y, Wafa E … +2 more , Elhadedy MA, Sobh MA
Int Urol Nephrol · 2026 Mar · PMID 41872650 · Publisher ↗
PURPOSE: Malnutrition affects up to 54% of hemodialysis patients and is associated with increased mortality. We evaluated the effects of probiotic and synbiotic supplementation on nutritional status in maintenance hemodi...
PURPOSE: Malnutrition affects up to 54% of hemodialysis patients and is associated with increased mortality. We evaluated the effects of probiotic and synbiotic supplementation on nutritional status in maintenance hemodialysis patients. METHODS: This single-blind randomized-controlled trial enrolled 60 hemodialysis patients randomly assigned to receive Lactobacillus plantarum (10 billion CFU twice daily), synbiotic (L. plantarum plus 3 g oat fiber β-glucans daily), or standard care for 24 weeks. Primary outcomes included triceps skinfold thickness, normalized protein catabolic rate (nPCR), and body mass index (BMI). Secondary outcomes included serum albumin, total protein, cholesterol, and leptin. RESULTS: All 60 patients completed the trial. Triceps skinfold thickness increased significantly in the probiotic group (3.3 ± 2.2 mm) and synbiotic group (4.7 ± 2.2 mm) compared to placebo (0.0 ± 1.6 mm, p < 0.001). BMI increased more in treatment groups (probiotic: 1.4 ± 1.0 kg/m; synbiotic: 1.7 ± 0.4 kg/m) than in the placebo group (0.7 ± 0.9 kg/m, p < 0.001). The probiotic group showed a significant within-group increase in albumin (0.25 ± 0.37 g/dL, p = 0.008), though between-group differences were not significant. No significant changes occurred in nPCR, total protein, cholesterol, or leptin. No serious adverse events were reported. CONCLUSION: Probiotic and synbiotic supplementation safely and effectively improved anthropometric nutritional markers in hemodialysis patients, representing feasible adjunctive strategies for managing malnutrition. TRIAL REGISTRATION: ClinicalTrials.gov NCT06891105 (prospectively registered April 2025).
Biomechanic characterization of normal urethra using uro-dynamic MRI during voiding.
Johnson C, Gonzalez-Pereira JP, Kounga M … +2 more , Bushman W, Roldan-Alzate A
Int Urol Nephrol · 2026 Mar · PMID 41872649 · Publisher ↗
INTRODUCTION: Dynamic volumetric MRI was used to non-invasively assess urethral biomechanics in a single healthy male subject during voiding. METHODS: Volumetric lower urinary tract (LUT) images were obtained throughout...
INTRODUCTION: Dynamic volumetric MRI was used to non-invasively assess urethral biomechanics in a single healthy male subject during voiding. METHODS: Volumetric lower urinary tract (LUT) images were obtained throughout the voiding effort using the uro-dynamic MRI methodology. These were subsequently segmented using MIMICS. Segmented urethral volumes were divided into prostatic, membranous, penile and bulbous urethra and were used to quantify urethral diameters over time, length and different phases of flow. Idealized instantaneous resistances were calculated for the posterior (prostatic and membranous) urethra. RESULTS: The analysis was separated into time and length averaged, and step-by-step analysis. Step-by-step analysis revealed more variation in the initial flow and terminal flow than during robust flow. Time and length averaged analysis showed the membranous urethra had the narrowest lumen and greatest resistance to flow. Correlation of urethral diameters with flow showed strong correlations with both the prostatic and membranous urethral segments. CONCLUSION: This single-subject study confirms the potential of uro-dynamic MRI to provide noninvasive assessment of lower urinary tract anatomy and urethral biomechanics during voiding.
Impact of PSMA PET on the management and clinical outcomes of patients with biochemical failure of prostate cancer after definitive treatment: a systematic review and meta-analysis.
Zhu G, Xiong X, Peng Z … +6 more , Zhu W, Huang W, Yang J, Wang S, Xu H, Yang L
Int Urol Nephrol · 2026 Mar · PMID 41872648 · Publisher ↗
PURPOSE: Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is emerging as an imaging modality with an established role for assessment of prostate cancer. This review aims to evaluate the impact...
PURPOSE: Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is emerging as an imaging modality with an established role for assessment of prostate cancer. This review aims to evaluate the impact of PSMA PET on the management and clinical outcomes in men with biochemical failure of prostate cancer. METHODS: We conducted a comprehensive literature search of the electronic databases from inception to August, 2025. The outcomes of interest included prostate-specific antigen (PSA) responses, biochemical recurrence-free survival (BRFS), biochemical progression-free survival (BPFS), and overall survival (OS). Meta-regression and subgroup analyses were conducted to explore the heterogeneity. Sensitivity analysis was performed to assess the robustness of the results. RESULTS: A total of 71 studies comprising 9948 patients were included in this systematic review and meta-analysis. The pooled proportion of patients experiencing a management change following PSMA PET was 53% (95% CI: 48-58%). A decrease in serum PSA level was observed in 75% (95% CI: 65-85%) of patients. For survival outcomes, the pooled estimates for 1-, 2-, and 3-year biochemical recurrence-free survival (BRFS) were 62% (95% CI: 52-71%), 66% (95% CI: 55-77%), and 62% (95% CI: 46-78%), respectively. The corresponding estimates for biochemical progression-free survival (BPFS) were 77% (95% CI: 65-88%), 84% (95% CI: 71-97%), and 79% (95% CI: 61-96%), respectively. CONCLUSIONS: This meta-analysis suggests that PSMA PET-guided management is associated with favorable oncologic outcomes in men with biochemical recurrence, with over half of patients experiencing a change in management strategy and a substantial proportion demonstrating a biochemical response. Nevertheless, due to considerable heterogeneity across studies, these conclusions remain preliminary and require confirmation through more robust prospective evidence.
MHC class II and PLA2R investigating the epitope presentation deficits driving antibody production in membranous nephropathy.
Ouzaouit A, Wu Z, Garcia HC … +8 more , Peprah AF, Yan Y, Sun M, Li P, Quan X, Jiang T, Yang Z, Chen H
Int Urol Nephrol · 2026 Mar · PMID 41870742 · Publisher ↗
Membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults, particularly affecting the glomerular region of the kidney. While MN can occur at any age, its onset typically peaks in individuals in their...
Membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults, particularly affecting the glomerular region of the kidney. While MN can occur at any age, its onset typically peaks in individuals in their 50s. It is characterized by subepithelial immune complex deposits that thicken the glomerular basement, impairing filtration and causing proteinuria. While secondary MN is linked to conditions, such as hepatitis B, malignancies, autoimmune diseases, and drug exposure, primary MN (PMN) is often autoimmune in origin and is distinguished by the presence of autoantibodies against the M-type phospholipase A2 receptor (PLA2R) predominance of IgG4, which are absent in most secondary forms. The discovery of PLA2R antibodies has revolutionized PMN diagnosis and monitoring, offering a non-invasive biomarker that correlates with disease activity and remission. Diagnostic techniques, such as immunofluorescence and transmission electron microscopy, reveal characteristic IgG4 and C3 deposition, and podocyte damage. For better prognostic and diagnostic outcomes, reliance on PLA2R-IgG4 specific antibodies is needed, as this approach offers higher specificity and sensitivity compared to simply detecting the concentration of PLA2R-IgG antibodies. While there are better diagnostic and therapeutic options, challenges remain in fully elucidating the mechanisms behind antibody production and their role in disease progression. This review highlights the central mechanism that triggers PLA2R-associated immune responses by T cells, which examined these molecular interactions. Additionally, identifying novel PLA2R epitopes that bind to MHC II molecules, which is an important step moving from the current unspecific immunosuppressive therapies toward antigen-specific MN treatments.
Observation on the short-term efficacy of telitacicept in the treatment of primary IgA nephropathy.
Gu X, Xu C, Hu Y … +2 more , Chen L, Liang M
Int Urol Nephrol · 2026 Mar · PMID 41870741 · Publisher ↗
AIM: Given the limitations of current Immunoglobulin A nephropathy (IgAN) therapies, this study sought to evaluate the short-term efficacy and safety of the novel agent Telitacicept, a dual inhibitor of B lymphocyte stim...
AIM: Given the limitations of current Immunoglobulin A nephropathy (IgAN) therapies, this study sought to evaluate the short-term efficacy and safety of the novel agent Telitacicept, a dual inhibitor of B lymphocyte stimulator (BLyS) and a proliferation-inducing ligand (APRIL), in a real-world clinical setting. METHODS: This study employed a single-center, retrospective, self-controlled before-after design. Twelve patients with primary IgAN on stable background therapy comprising angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) and a sodium-glucose cotransporter 2 inhibitor (SGLT2i) received add-on Telitacicept treatment for 6 months. Data on 24-h urinary protein excretion (24hUP) and estimated glomerular filtration rate (eGFR) were collected at baseline, 3 months, and 6 months. Urinary red blood cell count and safety-related indicators were collected at baseline and 6 months. Efficacy and safety were assessed by comparing intra-individual data across these time points. RESULTS: After Telitacicept treatment, 24hUP decreased at 3 and 6 months with statistical significance (p = 0.016, 0.004, respectively). The median 24hUP decreased from 1.13 g/24 h (IQR 0.62-2.24) at baseline to 0.52 g/24 h (IQR 0.26-1.33) at 3 months and was maintained at 0.51 g/24 h (IQR 0.15-1.07) at 6 months, yielding a clinical remission rate of 75.0%. Concurrently, the median eGFR increased from 61.09 mL/min/1.73 m at baseline to 77.44 mL/min/1.73m at 6 months, with statistical significance (p = 0.008), and 83.3% of patients showed renal function improvement. The median urinary red blood cell count decreased from 159.00 cells/μL to 15.00 cells/μL with statistical significance (p = 0.005), and 70.0% of patients with baseline hematuria achieved hematuria remission. The incidence of adverse events was low (4 cases), and all were mild. Non-high-density lipoprotein cholesterol (non-HDL-C) levels decreased, with statistical significance (p = 0.028), while other cardiovascular risk indicators remained stable. CONCLUSION: Add-on Telitacicept to standard supportive care may reduce proteinuria, improve renal function, and promote hematuria remission in patients with primary IgAN, with a favorable safety profile.
Haemostatic effectiveness of intranasal desmopressin for tunnelled dialysis catheter placement: a pilot randomised controlled trial.
Arshad AR, Yusuf R
Int Urol Nephrol · 2026 Mar · PMID 41863745 · Publisher ↗
PURPOSE: This study aimed to evaluate the effectiveness of intranasal desmopressin in reducing exit-site bleeding during the placement of tunnelled dialysis catheters. METHODS: This open-label randomised controlled trial...
PURPOSE: This study aimed to evaluate the effectiveness of intranasal desmopressin in reducing exit-site bleeding during the placement of tunnelled dialysis catheters. METHODS: This open-label randomised controlled trial was done on patients aged ≥ 12 years undergoing placement of tunnelled dialysis catheters. Exclusion criteria included current use of anticoagulants, platelet count < 50 × 10/l, previous tunnelled dialysis catheter insertions at the same site, blood pressure > 180/110 mmHg, and unwillingness. Patients in the intervention arm were administered intranasal desmopressin, 10 μg in each nostril, 30 min before the procedure. Patients in the control arm did not receive desmopressin. All patients were monitored for bleeding from the TDC exit site for 24 h after the procedure. For persistent bleeding, a purse-string suture was applied approximately 1 cm from the exit site. RESULTS: There were 86 patients aged 56.41 ± 15.64 years. The majority of the catheters (79; 91.86%) were placed in the right internal jugular vein. In the intervention arm, six patients (13.95%) experienced bleeding from the catheter exit site, compared to eleven patients (25.58%) in the control arm (p = 0.176). Purse-string suturing was required for six (13.95%) patients in the intervention arm and ten (23.26%) patients in the control arm (p = 0.268). No patient reported significant side effects. CONCLUSION: There was a statistically insignificant reduction in exit-site bleeding with intranasal desmopressin. TRIAL REGISTRY: Iranian Clinical Trial Registry (IRCT20240215061017N2).
Association of β-blocker use with 28 day in-hospital mortality in critically ill patients with acute kidney injury: a propensity score-matched and inverse probability -weighted analysis of the eicu database.
Tang J, Shen D, Li S … +3 more , Yuan X, Ma Y, Hu B
Int Urol Nephrol · 2026 Mar · PMID 41851598 · Publisher ↗
PURPOSE: The impact of β-blocker therapy on outcomes in critically ill patients with acute kidney injury (AKI) remains uncertain. While theoretical benefits exist, these are often offset by concerns related to hemodynami...
PURPOSE: The impact of β-blocker therapy on outcomes in critically ill patients with acute kidney injury (AKI) remains uncertain. While theoretical benefits exist, these are often offset by concerns related to hemodynamic instability. METHODS: This retrospective cohort study employed the multicenter eICU Collaborative Research Database (2014-2015). Adult patients diagnosed with AKI within 48 h of ICU admission were included. Patients initiating β-blocker therapy within 48 h of ICU admission were compared to non-users. The primary outcome was 28-day all-cause mortality. To control for potential confounding, we applied multivariable Cox regression, propensity score matching (PSM, 1:1), and inverse probability of treatment weighting (IPTW). Sensitivity analyses included subgroup evaluations, multiple imputation, competing risk analysis, and calculation of the E-value. RESULTS: Among 3,799 eligible patients, 1,291 (34.0%) received β-blockers. Before PSM, unadjusted 28-day in-hospital mortality was significantly lower in the β-blocker group compared to non-users (18.75% vs. 25.52%, p < 0.001). After PSM (1,186 matched pairs), baseline characteristics were well balanced. The survival benefit persisted in the matched cohort (19.06% vs. 25.13%, p < 0.001). In the multivariable Cox model adjusted for all covariates, β-blocker use was associated with a significant reduction in 28-day mortality (HR 0.62; 95% CI 0.53-0.73; p < 0.001). IPTW analysis yielded consistent estimates (ATE HR 0.71; 95% CI 0.65-0.79; p < 0.001), as did PSM analyses (ATT HR 0.67; 95% CI 0.56-0.80; p < 0.001). Subgroup analyses demonstrated consistent protective effects across most subgroups, with significant effect modification observed only for SOFA and GCS scores (both p for interaction < 0.05). The E-value of 2.17 suggested robustness to unmeasured confounding. CONCLUSION: In this large, multicenter observational cohort of critically ill patients with AKI, early β-blocker therapy (initiated within 48 h of ICU admission) was consistently associated with lower 28-day in-hospital mortality across multiple analytical approaches and sensitivity analyses. These findings highlight a need for prospective studies to evaluate the potential causal benefits of β-blockers in this high-risk population.
Genetic causal association between kidney stones and proton pump inhibitors.
Jiang Y, Lin L, Cheng C … +1 more , Zhou L
Int Urol Nephrol · 2026 Mar · PMID 41849060 · Publisher ↗
PURPOSE: Kidney stone disease is a common metabolic disorder with high recurrence rates and an associated risk of chronic kidney disease, while proton pump inhibitors (PPIs) are widely used medications with potential lin...
PURPOSE: Kidney stone disease is a common metabolic disorder with high recurrence rates and an associated risk of chronic kidney disease, while proton pump inhibitors (PPIs) are widely used medications with potential links to renal complications. Previous observational studies have suggested an association between PPI use and kidney stones, but the causal relationship remains unclear. This study aimed to investigate the causal effect of PPIs on kidney stones using the Mendelian randomization (MR) analysis. METHODS: We utilized large-scale genome-wide association study (GWAS) data to construct genetic instruments for PPI use (including esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole) from the UK Biobank, with kidney stone outcomes derived from the FinnGen Consortium. Additionally, a drug target MR (DTMR) analysis was performed using genetic proxies of the H⁺/K⁺-ATPase (encoded by ATP4A and ATP4B), the core target of PPIs. Five MR models were applied to assess causality, with sensitivity analyses to validate robustness. RESULTS: The results showed no significant causal association between genetically predicted PPIs use and kidney stone risk (esomeprazole: OR = 0.99, 95% CI 0.90-1.09, p = 0.884; lansoprazole: OR = 1.04, 95% CI 0.92-1.17, p = 0.559; omeprazole: OR = 1.03, 95% CI 0.91-1.17, p = 0.628; rabeprazole: OR = 1.02, 95% CI 0.99-1.05, p = 0.088; pantoprazole: OR = 1.01, 95% CI 0.97-1.05, p = 0.687). DTMR analysis also revealed no significant association between genetic proxies of ATP4A/ATP4B and kidney stones across multiple sensitivity thresholds. CONCLUSION: In conclusion, this study found no evidence supporting a causal role for PPIs in increasing kidney stone risk, providing genetic-level evidence to support the safe use of PPIs in patients with gastric ulcers or gastroesophageal reflux disease.
Prospective comparative evaluation of clinical efficacy and safety of Intravesical gemcitabine-docetaxel versus BCG in adjuvant management of BCG-naive non-muscle invasive urothelial bladder cancer in Indian population.
Srivastava A, Trivedi S, Singh Y … +5 more , Kumar U, Kumar L, Data S, Kumar A, Sankhwar SN
Int Urol Nephrol · 2026 Mar · PMID 41843343 · Publisher ↗
BACKGROUND: Intravesical Bacillus Calmette-Guérin (BCG) is the standard adjuvant therapy for intermediate/high-risk non-muscle-invasive bladder cancer (NMIBC) but is limited by failure, toxicity, and global supply constr...
BACKGROUND: Intravesical Bacillus Calmette-Guérin (BCG) is the standard adjuvant therapy for intermediate/high-risk non-muscle-invasive bladder cancer (NMIBC) but is limited by failure, toxicity, and global supply constraints. Sequential Intravesical gemcitabine-docetaxel (Gem/Doce) can offer a rational chemotherapy alternative. METHODS: In this prospective randomized, parallel-arm interventional study comparing efficacy and safety of Gem/Doce versus BCG in BCG-naïve intermediate/high-risk NMIBC, patients aged 18-80 years with complete TURBT of primary localised bladder lesion(s) were included. Gem/Doce induction comprised weekly gemcitabine (1000 mg) and docetaxel (40 mg) Intravesical instillations for 6 weeks, with monthly maintenance per risk group. BCG induction (weekly 80 mg OncoBCG for 6 weeks) was followed by risk-based maintenance as per SWOG protocol. Outcomes (RFS, high-grade RFS, PFS, CSS, OS) were evaluated post-induction, and at 6 and 12 months. Adverse events were graded by CTCAE v5.0. RESULTS: 91 patients (Gem/Doce n = 43; BCG n = 48) were evaluated. At 6 and 12 months, RFS was 95.35% and 90.71% in Gem/Doce versus 83.33% and 77.08% in BCG. Intermediate-risk category had higher 12 month RFS with Gem/Doce (93.55% vs 81.82%, p = 0.041). High-grade RFS was higher with Gem/Doce (97.67% and 93.02%) than BCG (93.75% and 89.58%). At 12 months, PFS, CSS, and OS were superior with Gem/Doce: PFS 97.67% vs 95.83%, CSS 100% vs 97.92%, and OS 100% vs 95.83%. Fewer patients reported AEs with Gem/Doce (13.95% vs 35.42%), with fewer Grade 1-2 events (p < 0.01) and no Grade ≥ 3 events vs. three in BCG. Dysuria, bladder spasm, and frequency were higher with BCG. CONCLUSIONS: Sequential Gem/Doce is an effective and better-tolerated alternative to BCG in BCG-naïve NMIBC, demonstrating superior intermediate-risk RFS and comparable survival outcomes. Long-term validation through larger multi-centre studies is warranted.
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