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Albumin use in cirrhosis:a nephrology viewpoint on key considerations and cautionary notes

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Hepatobiliary Surgery and Nutrition 2024年第3期13卷 536-539页

作者： Abhilash Koratala Amir Kazory Division of Nephrology Department of MedicineMedical College of WisconsinMilwaukeeWIUSA Division of Nephrology Hypertension and Renal TransplantationUniversity of FloridaGainesvilleFLUSA

The constant need to reduce the variability of clinical practice and to improve the quality of care of the patients and their outcomes have led to the increasing emphasis on evidence-based *** there is a paucity of robust data on a specific topic or there are conflicting conclusions from available studies,clinical practice recommendations may prove helpful to fill the gap and assist with clinical *** are a variety of such recommendations,such as consensus statements,practice guidelines,and position statements,each with a specific set of methodology and *** statements are comprehensive documents meant to elucidate,justify,and recommend a particular approach to a clinical *** papers often present a detailed understanding of the issues in question,discuss the pros and cons of the available options,and provide the rationale for the position that is set *** other forms of clinical practice consensus,position statements innately provide information on the level of evidence and the strength of what the panel of experts agrees *** are several consensus group methods by which these statements can be *** is a systematic process to create and measure consensus,which is particularly well suited where input is required from a large number of geographically dispersed experts.

关键词： Cirrhosis hepatorenal albumin point-of-care ultrasound(POCUS) ultrasound

Update on the reciprocal interference between immunosuppressive therapy and gut microbiota after kidney transplantation

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World Journal of transplantation 2024年第1期14卷 72-83页

作者： Maurizio Salvadori Giuseppina Rosso department of renal transplantation Careggi University HospitalFlorence 50139TuscanyItaly Division of Nephrology San Giovanni di Dio HospitalFlorence 50143ToscanaItaly

Gut microbiota is often modified after kidney *** principally happens in the first period after *** and,most of all,immunosuppressive drugs are the main *** relationship between immunosuppressive drugs and the gut microbiota is *** one side immunosuppressive drugs modify the gut microbiota,often generating dysbiosis;from the other side microbiota may interfere with the immunosuppressant pharmacokinetics,producing products more or less active with respect to the original *** phenomena have influence over the graft outcomes and clinical consequences as rejections,infections,diarrhea may be caused by the dysbiotic ***,calcineurin inhibitors such as tacrolimus and cyclosporine,mycophenolate mofetil and mTOR inhibitors are the immunosuppressive drugs whose effect on the gut microbiota is better *** contrast is well known how the gut microbiota may interfere with glucocorticoids,which may be transformed into *** may be transformed by microbiota into a product called M1 that is 15-fold less active with respect to *** pro-drug mycophenolate mofetil is normally transformed in mycophenolic acid that according the presence or not of microbes producing the enzyme glucuronidase,may be transformed into the inactive product.

关键词： Immunosuppressive therapy Kidney transplantation Gut microbiota Dysbiosis Pathobionts Graft outcomes

Peritoneo-Vaginal Leaks in Peritoneal Dialysis: A Report of 3 Cases

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Open Journal of Nephrology 2024年第2期14卷 176-184页

作者： Mariam Jdidou Sara Elmakkoul Nabil Hmaidouch Naima Ouzeddoun Loubna Benamar department of Nephrology Dialysis and Renal Transplantation Ibn Sina University Hospital Rabat Morocco

Introduction: Peritoneal dialysis (PD) is an extra-renal purification technique indicated for patients with end-stage kidney disease (ESKD). Although it has many advantages, it also has a number of complications, such as peritoneo-vaginal leakage of dialysate. Cases Reports: Three male patients, aged 70, 50 and 77 respectively, with ESKD were placed on PD. All three patients presented with inadequate drainage and the progressive appearance of bilateral hydrocele, which occurred one year (late leakage), two and four days (early leakage) respectively after the initiation of exchanges. The etiological investigation led to the conclusion of a peritoneo-vaginal leak associated with an inguinal hernia in only one case. The two cases of early leakage were treated by temporary suspension of PD, with a good response in one case and failure in the second, leading to hisdefinitive transfer to hemodialysis (HD);however, the hernia repair enabled immediate resumption of PD in the third patient. Discussion and Conclusion: Peritoneo-vaginal leakage is a rare mechanical complication in PD. The clinical examination plays an essential role in confirming the diagnosis and in the therapeutic decision. If the diagnosis is uncertain, or if there is a clinical need to show the anatomy of the leak, an imaging approach becomes desirable. This complication should not prevent the progression of PD in the management of patients with ESKD.

关键词： Peritoneal Dialysis Peritoneal Leakage Hernia-Peritoneal Scintigraphy

Impact of low-intensity extracorporeal shockwave therapy on vascular parameters and sexual function in patients with arteriogenic erectile dysfunction

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Asian Journal of Andrology 2024年第4期26卷 344-348页

作者： Matteo Rubino Anna Ricapito Marco Finati Ugo G Falagario Pasquale Annese Vito Mancini Gian Maria Busetto Luigi Cormio Giuseppe Carrieri Carlo Bettocchi Andrology Unit Department of Urology and Renal TransplantationUniversity of FoggiaFoggia 71122Italy department of Molecular Medicine and Surgery Karolinska InstitutetStockholm 17177Sweden department of Urology Bonomo Teaching HospitalUniversity of FoggiaAndria 76123Italy.

Previous published studies have shown an improvement of penile hemodynamic parameters after low-intensity extracorporeal shockwave therapy(Li-ESWT).However,the clinical significance of these findings remains unclear,and definitive selection criteria for Li-ESWT based on preexisting comorbidities have yet to be *** was an observational study of 113 patients with ED,evaluated between January 2019 and December 2021 in Andrology Unit at the department of Urology and renal transplantation,University of Foggia(Foggia,Italy).Penile dynamic Doppler was performed to evaluate vascular parameters and 5-item version of the International Index of Erectile Dysfunction(IIEF-5)questionnaire was administered to assess the severity of *** was repeated 1 month after *** with a peak systolic velocity(PSV)30 cm s−1 at posttherapeutic penile dynamic Doppler.A clinically significant IIEF-5 score improvement was observed in 7 patients,21 patients,and 2 patients with mild-to-moderate,moderate,and severe pretreatment ED,*** different outcomes were assessed based on smoking habits,previous pelvic surgery,or use of oral phosphodiesterase-5 inhibitor(PDE5i).On the other side,only 1(6.7%)in 15 patients with diabetes mellitus showed an IIEF-5 score improvement after *** treatment determined a significant increase in PSV and correlated IIEF-5 improvement in ED *** advantage seemed particularly evident for moderate ED and was not affected by smoking habits,previous pelvic surgery,and use of ***,diabetic patients did not benefit from the treatment.

关键词： arteriogenic erectile dysfunction International Index of Erectile Function low-intensity extracorporeal shockwave therapy peak systolic velocity

Hepatocellular SETDB1 Regulates Hepatic Ischemia-Reperfusion Injury through Targeting Lysine Methylation of ASK1 Signal

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Research 2024年第3期6卷 305-317页

作者： Kang Xia Tianyu Wang Zhongbao Chen Jiayu Guo Bo Yu Qi Chen Tao Qiu Jiangqiao Zhou Shusen Zheng department of Organ transplantation Renmin Hospital of Wuhan UniversityWuhanChina department of Urology Renmin Hospital of Wuhan UniversityWuhanChina. department of general surgery Renmin Hospital of Wuhan UniversityWuhanChina Division of Hepatobiliary and Pancreatic Surgery Department of SurgeryFirst Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina Key Laboratory of Combined Multi-Organ transplantation Ministry of Public HealthHangzhouChina Key Laboratory of Organ transplantation HangzhouZhejiang ProvinceChina Key Laboratory of the Diagnosis and Treatment of Organ transplantation CAMSHangzhouChina.

Background: Hepatic ischemia-reperfusion injury (HIRI) stands as an unavoidable complication arising from liver surgery, profoundly intertwined with its prognosis. The role of lysine methyltransferase SET domain bifurcated 1 (SETDB1) in HIRI remains elusive, despite its confirmation as a potential therapeutic target for diverse diseases. Here, we investigated the mechanism by which SETDB1 regulated HIRI. Methods: RNA sequencing data were used to identify the expression and potential targets of SETDB1 through bioinformatics analysis. To elucidate the impact of SETDB1 on HIRI, both an in vivo model of HIRI in mice and an in vitro model of hepatocyte hypoxia/reoxygenation were established. Biochemical and histological analyses were used to investigate the influence of SETDB1 on liver damage mediated by HIRI. Chromatin immunoprecipitation and coimmunoprecipitation were implemented to explore the in-depth mechanism of SETDB1 regulating HIRI. Results: We confirmed that hepatocellular SETDB1 was up-regulated during HIRI and had a close correlation with HIRI-related inflammation and apoptosis. Moreover, inhibition of SETDB1 could mitigate HIRI-induced liver damage, inflammation, and apoptosis. Through our comprehensive mechanistic investigation, we revealed that SETDB1 interacts with apoptosis-signal-regulating kinase 1 (ASK1) and facilitates the methylation of its lysine residues. Inhibition of SETDB1 resulted in reduced phosphorylation of ASK1, leading to a marked suppression of downstream c-Jun N-terminal kinase (JNK)/p38 signaling pathway activation. The therapeutic effect on inflammation and apoptosis achieved through SETDB1 inhibition was nullified by the restoration of JNK/p38 signaling activation through ASK1 overexpression. Conclusions: The findings from our study indicate that SETDB1 mediates lysine methylation of ASK1 and modulates the activation of the ASK1–JNK/p38 pathway, thus involved in HIRI-induced inflammation and apoptosis. These results suggest that SETD

关键词： SETDB1 inflammation ASK1

Autosomal Dominant Polycystic Kidney Disease: Epidemiological, Clinical Aspects and Predictive Factors of Poor renal Prognosis (About 300 Cases)

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Open Journal of Nephrology 2024年第2期14卷 275-293页

作者： Rihab Dkhissi Nada El Kadiri Tarik Bouattar Loubna Benamar Naima Ouzeddoun department of Nephrology-Dialysis-renal transplantation IbnSina Hospital Mohammed V University Rabat Morocco

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is a common, multisystemic, and progressive hereditary disease. It accounts for 6 to 8% of incident cases of end-stage chronic renal disease (ESRD) in developed countries. The aim of this study is to describe the predictive factors for the development of end-stage chronic kidney disease (CKD) in the course of this disease. Material and Methods: This is a retrospective, descriptive, and analytical study including 300 cases of ADPKD collected at the Nephrology department of Ibn-Sina Hospital in Rabat over a period of 30 years (1993 to 2023). Included in the study are all patients with ADPKD meeting the ultrasound diagnostic criteria. The analysis focused on demographic, clinical, paraclinical, evolutionary data, as well as prognostic factors associated with renal function deterioration. Results: The mean age of patients at diagnosis is 51.53 +/− 17 years [16 - 93] with a male predominance. The median serum creatinine at diagnosis is 15.5 mg/l [10 - 34]. 21% of patients had ESRD (eGFR 300 mg/24h (21%). The most common cystic complication is hemorrhage (12.3%). 21.3% of patients had hepatorenal polycystic disease. In adjusted analysis, the predictive risk factors for the occurrence of ESRD were smoking (p = 0.019), anemia (p Conclusion: ADPKD can progress insidiously to ESRD. Identification and early treatment of predictive factors for poor renal prognosis could contribute to a better outcome for this disease.

关键词： ADPKD ESRD Factors of Poor renal Prognosis renal and Extra-renal Manifestations

renal Transplant Artery Stenosis: Clinical Manifestations, Diagnosis and Treatment

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Open Journal of Nephrology 2024年第2期14卷 262-274页

作者： Rihab Dkhissi Latifa Driouch Naima Ouzeddoun Loubna Benamar Tarik Bouattar department of Nephrology-Dialysis-renal transplantation IbnSina Hospital Mohammed V University Rabat Morocco

Introduction: renal transplant artery stenosis (RTAS) is a common and early complication of renal transplantation, which can lead to severe post-transplant hypertension, as well as significant morbidity and mortality, particulary graft loss. The aim of this study is to determine the prevalence, clinico-radiological characteristics and evaluate the outcomes of luminal angioplasty as a first-line treatment for RTAS, through the analysis of medical records of 27 kidney transplant patients. Material and Methods: This is a retrospective, single-center, and descriptive study conducted at the Nephrology department of the Ibn-Sina Hospital in Rabat, including 27 renal transplant patients with RTAS during the period from 1998 to 2023. All patients with clinically suspected RTAS and confirmed by Doppler ultrasound of the transplanted renal artery were included in the study. Results: The mean age of donors was 48.66 ± 13.55 years, with a female predominance (65%). The donor was deceased in 15% of cases. The mean age of the recipients was 39 ± 16 years with a male-to-female ratio of 4.4. The median onset of RTAS was 3.6 ± 3.4 months after renal transplantation. Seven patients (26%) had high blood pressure (HBP) before their transplantation. Six patients (22%) had hypertriglyceridemia and 7 patients (26%) had pure hypercholesterolemia. The main clinical signs were worsening of preexisting HBP, de novo HBP and acute renal failure (ARF). Stenosis was confirmed by renal Doppler ultrasound in all patients. It was severe in 63%, with a stenosis degree greater than 70%. Six patients underwent angioplasty, resulting in the stabilization of graft function with a nadir of 15 mg/l creatinine and blood pressure control with dual therapy in 5 patients. No graft loss cases were noted. Conclusion: RTAS is a significant vascular complication of renal transplantation that predicts unfavorable outcomes for both the patient and the graft. Early diagnosis is crucial to successfully restore graft f

关键词： RTAS Post Transplant Hypertension Graft Function Luminal Angioplasty

Secondary Hyperparathyroidism in Dialysis Patients: Short- and Long-Term Outcomes of Conservative Parathyroidectomy

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Open Journal of Nephrology 2024年第2期14卷 147-156页

作者： Imane Saidi Sara Elmaakoul Naima Ouzeddoun Loubna Benamar department of Nephrology-Dialysis-renal transplantation IbnSina Hospital Mohammed V University Rabat Morocco

Secondary hyperparathyroidism (HPT) is frequent in dialysis patients. Parathyroidectomy (PTX) is indicated for patients who failed medical therapy. We reviewed the data from 184 dialysis patients who underwent PTX between January 2015 and January 2023. We aimed to evaluate the short and long term outcomes of PTX in dialysis patients, comparing the conservative 3/4 versus 7/8 techniques in this population.166 dialysis patients with secondary HPT were included. A conservative subtotal PTX (sPTX) 7/8 was performed in 72% of patients and sPTX 3/4 in 28% of them. Severe postoperative hypocalcaemiaocurred in 45 patients (27%). Hypocalcaemia was significantly more frequent in the sPTX 7/8 group (p = 0.012). One case of persistent HPT (0.6%) and 20 cases of recurrence (12%) were diagnosed. Recurrence was more frequent in the sPTX 3/4 group (15%). No deaths were reported during the perioperative period.

关键词： Secondary Hyperparathyroidism Dialysis Chronic Kidney Disease Conservative Subtotal Parathyroidectomy

M2-type macrophage membrane-mediated delivery of Carvedilol nanocomplex for acute liver failure treatment and remodeling inflammatory microenvironment

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Nano Research 2024年第7期17卷 6362-6375页

作者： Mingge Shang Yaohui Zhang Junjie Qian Wenchao Wang Xizhi Yu Jiacheng Huang Lin Zhou Shusen Zheng Division of Hepatobiliary and Pancreatic Surgery Department of SurgeryThe First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China NHC Key Laboratory of Combined Multi-organ transplantation Key Laboratory of Organ TransplantationHangzhou 310003China Key Laboratory of the diagnosis and treatment of organ transplantation Research Unit of Collaborative Diagnosis and Treatment for Hepatobiliary and Pancreatic CancerChinese Academy of Medical Sciences(2019RU019)Hangzhou 310003China State Key Laboratory for Diagnosis and Treatment of Infectious diseases National Clinical Research Center for Infectious DiseasesHangzhou 310003China department of Thyroid Surgery The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College Hangzhou 310000China

Interactions of hepatic macrophages with local inflammatory microenvironment is the key factor promoting the development of acute liver failure(ALF).Hence,reprogramming pro-inflammatory M1 into anti-inflammatory M2 phenotype may offer a promising strategy for treating ALF by targeting *** group found Carvedilol possessed potential anti-inflammatory property previously,which had been scarcely reported in *** present a synergy strategy to induce macrophages into the phenotype M2-type anti-inflammatory macrophages with interleukin-4(IL-4)and IL-10 at *** Carvedilol is loaded on the macrophage membrane-camouflaged biomimetic nano-platform(termed as M2M@CNP)to evade reticuloendothelial system(RES)and afford Carvedilol delivery to the inflammatory environment with overproduced reactive oxygen species(ROS),further prolonging its circulation and *** released Carvedilol produced anti-inflammatory,antioxidant and anti-apoptosis effects,combining local M2-type cell membranes(M2-CM)inhibited pro-inflammatory cytokines and ROS levels,which in turn promoted and amplified M1 to M2 phenotype polarization *** study offers new insights into the rational design of biomimetic nanosystems for safe and effective ALF therapy to accelerate the clinical translation.

关键词： acute liver failure hepatic drug delivery M2 macrophage-camouflaged nanoplatform inflammatory microenvironment macrophage polarization