All Articles

Kathleen M Hill Gallant¹, Douglas Jermasek², Brooks Oppenheimer³, Sheila Doss⁴

¹University of Minnesota-Twin Cities, St. Paul, MN, USA

²Unicycive Therapeutics, Inc., Los Altos, CA, USA

³Reason Research, Philadelphia, PA, USA

⁴American Nephrology Nurses Association, Pitman, NJ, USA

Introduction: ~600k US end-stage kidney disease patients undergo dialysis, and >43% have serum phosphorus >5.5mg/dL, increasing bone disorder and mortality. Recent studies report phosphate binder (PB) non-adherence rates up to 78%.

Objective: Understanding patient perspectives on PB therapy challenges to improve adherence and outcomes.

Methods: 20-minute online survey was conducted (2/15-5/16/24) with patients from the National Kidney Foundation email list. Eligibility: on dialysis (in-center or home), ≥40 years old, using ≥1 phosphate management treatment, and insured. The survey assessed patient perspectives on daily pill burden, PB-related challenges, non-adherence drivers, and impact of PB attributes on compliance.

Results: 200 patients surveyed. PBs had the highest daily pill requirements (4.8 pills/day) vs. diabetes, high cholesterol, high blood pressure, and depression medications (1.2-2.6 pills or injections/day). Among non-compliant group (≤80% compliant), 58% rated taking PBs as directed as “extremely important,” vs. 67%-100% for other medications. PB non-compliance was ~3-fold higher vs. other medications (37% of patients vs. 12-18%, p≤0.05). Self-reported non-compliant patients were 2.6-times more likely to report uncontrolled phosphate levels. Among 126 patients with <100% compliance, top barriers were forgetting to take PBs, too many pills, and large pill size. Patients were 4- and 2-times more likely to be compliant with fewer and smaller pills, respectively.

Conclusion: PBs had the highest pill burden and lowest compliance. Pill number and size were two of the top barriers. Patients preferred regimens with fewer, smaller pills. Reducing pill burden and enhancing the perceived importance of phosphate control may improve adherence and phosphate management.

Umesh B Khanna¹, Prem Prakash Varma², Tarun K Jeloka³, A K Bhalla⁴, Deodatta S Chafekar⁵, Umapati N Hegde⁶, Manoj K Singhal⁷, Sunil Prakash⁸, Sanjeev Gulati⁹, Manju Aggarwal¹⁰, Raj Kumar Sharma¹¹, Rajasekara Chakravarthi¹², Rajan Ravichandran¹³, Sanjeev Kumar Hiremath¹⁴, Anupam Roy¹⁵, Rajesh R Nair¹⁶, Sanjay Srinivasa¹⁷, Apoorva Jain¹⁸, Umang Kasturi¹⁹

¹Consultant Nephrologist, Founder & Director of Kidney Associates, Mumbai, Maharashtra.

²Chairman, Dept of Nephrology, Primus Hospital, New Delhi

³HOD, Manipal Hospitals, Baner, Pune, Maharashtra

⁴Chairman & HOD, Department of Nephrology, Sir Ganga Ram Hospital, New Delhi

⁵Supreme Kidney Care, Nashik

⁶Muljibhai Patel Urological Hospital, Nadiad, Gujarat

⁷Principal Director - Nephrology and Kidney Transplantation, Max Super Speciality Hospital New Delhi

⁸Principal Director & HOD, Department of Nephrology & Transplant Service, BLK - Max Super Speciality Hospital, New Delhi

⁹Executive Director and Head, Nephrology at Fortis Hospitals, Vasant Kunj, New Delhi.

¹⁰Chairperson, Department of Nephrology and Kidney Transplantation, Artemis Health Institute, Sector 51, Gurgaon.

¹¹Director & Head Department of Nephrology & Kidney Transplant Medicine, Medanta Kidney & Urology Institute, Lucknow.

¹²Clinical Director & HOD Nephrology & Transplant services, Yashoda Hospitals, Hitec City, Hyderabad, Telangana

¹³Director nephrology, MIOT International, Chennai

¹⁴Consultant Nephrologist, Sagar Hospitals, Bengaluru

¹⁵Associate Director, Department of Nephrology & Renal Transplant, Venkateshwar Hospital, New Delhi

¹⁶Professor and HOD of Nephrology Amrita Institute of Medical Sciences and Research Centre Amrita School of Medicine Kochi.

¹⁷Consultant Nephrologist, Dr Sanjay"S Center For Kidney and Diabetes, Bengaluru

¹⁸Professor and Head, Dept. of Nephrology, Sarojini Naidu Medical College, Agra, UP

¹⁹Nephrologist at Sir Ganga Ram Hospital, New Delhi

Calcium and phosphorus homeostasis is crucially regulated by interactions between the kidneys, intestines, and bones, with key hormones like vitamin D, parathyroid hormone (PTH), and fibroblast growth factor 23 playing central roles. As chronic kidney disease (CKD) advances, especially to end-stage renal disease (ESRD), this balance is disrupted, leading to hyperphosphatemia, characterized by serum phosphorus levels >4.5 mg/dL. Hyperphosphatemia is a significant risk factor for cardiovascular complications and mortality in CKD patients, with prevalence ranging from 21% to 40% in those on dialysis, varying by region due to dietary patterns and dialysis practices.

Effective management includes dietary phosphorus restriction and phosphate binders(PBs). Sucroferric oxyhydroxide (SO), an iron-based PB, has shown promise due to its ability to reduce serum phosphorus with a lower pill burden compared to alternatives like sevelamer. This expert opinion aimed to guide SO use in CKD patients with hyperphosphatemia. The experts from various regions of India convened for a structured discussion moderated through live polling. Key insights emphasized that SO is effective, well-tolerated, and cost-effective, offering improved patient adherence due to reduced pill burden.

This guidance is intended to enhance treatment strategies, optimize patient outcomes, and address gaps in current clinical practice for managing hyperphosphatemia in CKD.

Séraphin Ahoui^1*, Khadidjatou Sake Alassan², Féïchola Audrey Marina Hounkpatin², Giovanna Zossoungbo³,Nicolas H. Amegan²,Evariste Eteka¹,Nicanor Houeto¹,Aimé Vinasse¹, Joseph Godonou¹, Missikè Aubin Melikan¹, Jacques Vigan³, Moutawakilou Gomina⁴

¹Department of Nephrology, Faculty of Medicine, University of Parakou, Parakou, Benin

²Department of hepatogastroenterology, Faculty of Medicine, University of Parakou, Bénin

³Department of Nephrology, Faculty of Health Sciences, University of Abomey Calavi, Benin

⁴Department of Medical Biology, Faculty of Medicine, University of Parakou, Bénin

Introduction: Acute kidney injury is one of the major complications that can occur during liver cirrhosis.

Objective: to study the frequency and factors associated with acute kidney injury in CHUD-B/A cirrhotic patients in 2022.

Patients and methods: This was a cross-sectional, descriptive study with prospective data collection over a period from February 1 to June 30, 2022. A systematic recruitment of cirrhotic patients received in consultation and in hospitalization was made. AKI was defined according to the ADQI- IAC classification. Statistical analysis was performed using SPSS 21 software. The association between the identified factors and the variable of interest was determined by the Odds Ratio (OR) and its 95% confidence interval.

Results: A total of 73 cirrhotic patients were included and 14 of them had AKI. The frequency of AKI in cirrhotics was 19.2%. The mean age was 48.6 ± 16.9 years with a sex ratio of 13. Factors associated with AKI were hepatic encephalopathy (p=0.006) and Child-Pugh C score (p=0.031).

Conclusion: Acute kidney injury among cirrhotic patients is highly frequent. Its screening should be systematic for cirrhosis patients in order to improve their medical care and survival.

Michael Levy^1*, Alex Berrios²

¹Patient Advisory Council, Satellite Healthcare

²Engagement Specialist, Interwell Health

Effective regulation of phosphate levels is essential for managing the health of the nearly 600,000 dialysis patients in the United States, over 43% of whom exceed the recommended serum phosphate target of 5.5 mg/dL. Current phosphate binders present significant challenges, including large pills that are hard to swallow, pills that require thorough chewing, which may be difficult for patients with impaired dentition, frequent dosing, gastrointestinal adverse effects, and the need to take them while in public, which can lead to non-adherence and reduced social eating. Coupled with stringent dietary restrictions, confusion over administration timing, and high medication cost, these factors severely compromise patients’ quality of life. Addressing these barriers requires a comprehensive strategy: clinicians must recognize the difficulties faced by patients, bridge knowledge gaps regarding dietary phosphorus, and explore novel therapies that reduce pill size and burden without sacrificing efficacy. By mitigating these challenges, healthcare providers can enhance treatment experiences, strengthen patient-clinician relationships, and ultimately improve overall quality of life for dialysis patients. With a focus on patients’ perspectives, this review highlights the critical need for patient-centered approaches in phosphate management to ensure better clinical outcomes and patient satisfaction.

Jinil Yoo^*, Hugo Villanueva

Division of Nephrology, Montefiore Medical Center – Albert Einstein College of Medicine, Bronx, NY, USA

Lupus nephritis (LN), a common and serious complication of systemic lupus erythematosus (SLE) is considered as a typical immune-complex mediated disease, and currently classified into 6 classes, primarily based on histologic findings of glomerular involvement, which became accepted worldwide for diagnosis, prognosis, and treatment guide. In recent years, a rising numbers of cases are reported to have a nonimmune complex-mediated glomerular podocytopathy among SLE patients presenting with nephrotic syndrome. The kidney biopsy done in those patients showed some with minimal change disease-like features, some with mesangial proliferation and some with focal segmental glomerulosclerosis on light microscopy (LM), but all with diffuse foot process effacement (FPE), and no glomerular capillary proliferation/inflammation on LM as seen in class lll and IV LN and no glomerular capillary immune deposits on immunofluorescence (IF) study, observed in class V LN, suggestive of podocyte injury caused by a nonimmune complex mediated pathway, called as “lupus podocytopathy”. Although it is not accepted as a class of LN, the case of lupus podocytopathy of non-immune complex origin is growing and emerging as a distinct entity, of active lupus nephritis, since lupus podocytopathy usually occurs concurrently with extrarenal and active serologic activity, and mostly within 6 months of SLE onset.

Marta Ligero¹, Kinga Bernatowicz¹, Raquel Perez-Lopez^1,2*

Radiomics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, 08035, Spain

Radiology Department, Vall d’Hebron University Hospital, Barcelona, 08035, Spain

^*M.L. and K.B. are joint first authors. They have contributed equally to the literature systematic review and drafting of the manuscript.

The application of advanced computational analysis to medical imaging opens a plethora of opportunities in the field of radiology, allowing for more accurate tissue characterization and, eventually, advancing towards precision medicine through imaging biomarkers. In this review, we briefly introduce the methodology for radiomics analysis and the main challenges for implementation of radiomics-based tools in clinical practice. Based on systematic review of published studies, we also summarize here the main advances regarding CT-based radiomics applications in renal cancer with regards to tumor characterization (diagnosis, grading, prognosis), gene expression prediction (radiogenomics) and response evaluation.

Issaka Yougbare

Systemic lupus erythematosus (SLE) is an autoimmune disease with a broad spectrum of clinical manifestations, but its pathogenesis remains fairly understood. Cyclic nucleotide signaling pathways in immune cells and kidney are emerging as cellular mechanisms governing SLE disease progression. Upregulations of cGMP/cAMP metabolism lead to lupus nephritis and abnormal kidney remodeling/hypertrophy. PDE4 family remains the major cAMP hydrolyzing enzyme as PDE1 is responsible for cGMP breakdown in kidney. SLE disease progression to lupus nephritis is correlated with increase PDE1 and PDE4 activities resulting in lower cyclic nucleotide levels in kidney. Administration of Nimodipine, a PDE1 inhibitor prevents the lymphoproliferative phenotype and exert anti-proliferative effects on mesangial cells while PDE4 inhibitor NCS 613 prevents inflammatory cytokines release, immune complex deposition, and nephritis in MRL/lpr lupus prone mice. In this review, we highlight recent findings of alterations of cyclic nucleotide signaling pathways in lupus nephritis. Given the role of cAMP/cGMP signaling in kidney function, dual inhibition of PDE1 and PDE4 may represent a promising therapeutic approach to tackle lupus nephritis.

Sin Sil Ha¹, Kazi Rubaina^1,2, Chung-Shien Lee^1,2, Veena John², Nagashree Seetharamu^2*

¹St. John’s University, College of Pharmacy and Health Sciences, Department of Clinical Health Professions, 8000 Utopia Parkway, Queens, NY 11439, USA.

²Division of Medical Oncology and Hematology, Northwell Health Cancer Institute, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY 11042, USA

Despite reports of amifostine possibly protecting nephrotoxicity from cisplatin, it has not been recommended by any guidelines committees or routinely prescribed in clinical practice over the past decade. In this article, we review literature and guidelines regarding use of amifostine in oncology practice for protection against adverse effects from certain chemotherapeutic agents, in particular as a nephro-protectant in patients receiving cisplatin.

Charles Taylor^1*, Brian Birch^1,2

¹University of Southampton, Faculty of Medicine

²University Hospitals Southampton NHS FT, Southampton, UK

³Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Sabrina R. Gonsalez¹, Aline L. Cortes¹, Mayara A. Romanelli¹, Paula Mattos-Silva², Andrew C. Curnow³, Minolfa C. Prieto^3,4, Marcelo Einicker-Lamas², Lucienne S. Lara¹

¹Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

²Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

³Department of Physiology, School of Medicine, Tulane University School of Medicine, New Orleans, LA, USA

⁴Tulane Hypertension and Renal Center of Excellence, Tulane University, New Orleans, LA, USA

Lysophosphatidic acid (LPA) protects the kidneys from tissue ischemic reperfusion injury (IRI), but its impact on renal function is primarily limited to glomerular function. We estimated the status of renal function by a complete glomerular and tubular functional analysis to test the hypothesis that LPA treatment during ischemia-reperfusion (I/R) protects renal function by attenuating IRI. Male Wistar rats were subjected to bilateral kidney I/R. Along with ischemia, LPA was administered. LPA increased levels of plasma LPA, downregulated LPA2R, prevented interstitial fibronectin and TGF-β1 accumulation, and prevented a decrease in glomerular filtration rate (GFR). I/R increased urine volume and proteinuria and decreased fractional Na+ excretion (FENa) and urine osmolality. These effects were not prevented by LPA. The reduction in FENa was attributed to disruption in tubular Na+ transport and downregulation of protein kinase C (PKC) activity. LPA treatment maintained (Na++K+)ATPase activity to the control level, due to a sustained sensitivity to PLC/PKC pathway. Na+-ATPase activity was insensitivity to LPA treatment. This ineffectiveness was associated with downregulation of LPA2R, resulting in low FENa. Altogether, LPA treatment maintained normal kidney structure and prevented the reduction of glomerular function. However, even in the setting of preserved GFR, impaired tubular function may present a high risk for silent progression of kidney disease.

Derick S Alves¹, Fabiana Elias², Helvécio L S Junior³, Guilherme Thizen³, Rômulo S A Eloi⁴, Carlos E Fonseca-Alves¹*

¹Institute of Health Science, Paulista University – UNIP, Bauru – SP, Brazil.

²Universidade Federal da Fronteira Sul (UFFS), Realeza, PR, Brazil.

³Departamento de Medicina Veterinária, Faculdade UPIS, Brasília, DF - Brazil.

⁴HistoPato-Análise Anatomopatológica Veterinária, Brasília, DF, Brazil.

Urinary bladder cancer is uncommon in dogs, corresponding to 1% of all reported canine malignancies. Smooth muscle neoplasms can be benign (leiomyomas) or malignant (leiomyosarcoma) and are rare in humans and animals. As the incidence of urinary bladder leiomyosarcoma in dogs is low, our report presents the clinical and pathological aspects of primary urinary bladder leiomyosarcoma in a dog. A 10-year-old boxer breed dog was referred to the veterinary hospital presenting with dysuria for a month, appetite loss for seven days, abdominal distension for two weeks, and anuria for the last three days. After a physical examination and laboratory tests, an abdominal mass was diagnosed, and a laparotomy was performed. During the surgery, it was found that the urinary bladder neoplasm occupied the bladder trigone region, involving the ureters, and causing obstruction. The urinary bladder was reconstructed successfully, and the patient was kept under post-operative evaluation. In the post-operative recovery, an acute kidney disease was observed, which was irresponsive to the clinical treatment. Due to the advanced stage of the disease and the non-response to treatment, euthanasia was performed after surgery, and the animal was sent for necropsy. In this case, leiomyosarcoma was manifested as an expansive, low infiltration, and non-metastatic disease, causing obstruction of the ureters and consequent hydronephrosis.

Nawar M. Shara, PhD^1,2,3*, Sameer Desale, MS¹, Barbara V. Howard, PhD^1,2,3, Zeid Diab^1,4, Wm. James Howard, MD⁵, Lyle G. Best, MD⁶, Wenyu Wang, PhD⁷, Elisa T. Lee, PhD⁷, Richard B. Devereux, MD⁸, Xiyao Ai, MS⁹, Jason G. Umans, MD, PhD^1,2,3

¹ MedStar Health Research Institute, Hyattsville, MD, United States.

² Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, United States.

³ Georgetown University, Washington, DC, United States.

⁴ Virginia Commonwealth University, Richmond, VA, United States.

⁵ MedStar Washington Hospital Center, Washington, DC, United States.

⁶ Missouri Breaks Industries Research Inc., Eagle Butte, SD, United States.

⁷ College of Public Health, University of Oklahoma, Oklahoma City, OK, United States.

⁸ Weill Cornell Medicine, New York, NY, United States.

⁹ American University, Washington, DC, United States.

American Indians (AI) have a high prevalence of diabetes, obesity, cardiovascular disease (CVD), and chronic kidney disease. Inclusion of kidney function and other population-specific characteristics in equations used to predict atherosclerotic CVD (ASCVD) risk may help define risk more accurately in populations with these chronic diseases. We used data from the Strong Heart Study (SHS), a population-based longitudinal cohort study of AI, to modify the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort ASCVD risk equations and then explored the performance of the new equations in predicting ASCVD in AI. The study included baseline SHS exam data from 4213 individuals between 45 and 75 years of age, collected in 13 communities from 3 geographic areas in the United States and spanning a wide range of tribal backgrounds, with continuous follow-up data from 1989 to 2015. Using SHS data for blood pressure, diabetes, cholesterol, smoking, and renal function, Cox proportional hazard models were developed to predict ASCVD-free time for AI men and women. ASCVD risk in AI calculated using the SHS-modified equations were compared to risk calculated using the ACC/AHA pooled cohort equations for African Americans (AAs) and Whites. Goodness-of-fit measures for ASCVD risk prediction showed that the SHS-modified equations fit the data from the SHS better than the ACC/AHA equations for AAs and Whites. Adjusting risk prediction equations using population data from the SHS and including measures of renal function significantly improved ASCVD risk prediction in our AI cohort.

Mansoor N Ali

Consultant Nephrologist, Renal Unit, Department of Renal Medicine, St. Luke’s Hospital, Bradford Teaching Hospitals NHS Foundation Trust, BD5 0NA

Francis Lemire¹, Anne-Sophie Blais¹, Katherine Moore¹ and Stephane Bolduc¹*

¹Division of Urology, Department of Surgery, CHU de Québec - Université Laval Research Center, Québec, Canada

Purpose of the review: Vesicoureteral reflux (VUR) is a common pathology encountered in pediatric urology. If left untreated, this condition can lead to infectious complications, hypertension and loss of renal function by scars. There is a trend for minimally invasive procedures to minimise treatment-related complications. Endoscopic subureteral injection of bulking agent in the treatment of VUR is an example of minimally invasive options. Several bulking agents have been studied and the perfect agent has not yet been discovered. Polyacrylamide hydrogel is a relatively new agent used to treat VUR and its use will be reviewed.

Recent findings: Three modern studies from a Canadian group have evaluated the use of polyacrylamide hydrogel for endoscopic injection to treat VUR. The first study reported a cure rate of 81.2% without major complication. In the second study, injection of polyacrylamide hydrogel was compared to dextranomer hyaluronic acid and no significant difference was observed, with overall success rate of 73.1% and 77.5% respectively. The third trial evaluated the long-term efficacy and safety of polyacrylamide hydrogel with a 36-month follow-up. Overall success at 3 months was 70.7% and no patient had de novo hydronephrosis or calcification of the agent at 36 months.

Conclusion: Polyacrylamide hydrogel seems to be a safe and effective alternative bulking agent in the treatment of VUR. The contribution from other centers to validate those data would be valuable.

Beuy Joob ¹*, Viroj Wiwanitkit ¹

¹Sanitation 1 Medical Academic Center, Bangkok Thailand

¹Honorary professor, dr. DY Patil University, Pune, India