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Zoccali, Carmine; Mallamaci, Francesca
doi: 10.1007/s40620-023-01709-6pmid: 37594669
The traditional peer review process in medicine faces a crisis marked by publication delays, potential bias, and a lack of transparency. These issues hinder scientific progress and undermine the credibility of published medical findings, which inform healthcare practices and clinical decision-making. In response, innovative models like the Peer Community In (PCI) Research Reports (RR) have emerged, providing a rapid, transparent, and collaborative evaluation process for scientific research. Peer Community In Research Reports aims to address the issues within the traditional peer review system by focusing on preprints and fostering trust and credibility in published research. The success of the PCI RR model depends on the active engagement and support of researchers, publishers, and other stakeholders. Ideally, researchers should submit their work to PCI RR, while publishers should be open to embracing innovative peer review models. Policymakers and funding agencies should promote the adoption of open science principles and practices at a systemic level. In conclusion, addressing the crisis in the peer review process requires the collective efforts of the entire scientific community. By embracing and supporting innovative alternatives like the PCI RR model, stakeholders can help establish a more efficient and credible peer review system, ultimately benefiting scientific progress and patient care.
Schult, Lorena; Halbgebauer, Rebecca; Karasu, Ebru; Huber-Lang, Markus
doi: 10.1007/s40620-023-01718-5pmid: 37542608
Acute kidney injury development after trauma, burn, or sepsis occurs frequently but remains a scientific and clinical challenge. Whereas the pathophysiological focus has mainly been on hemodynamics and the downstream renal tubular system, little is known about alterations upstream within the glomerulus post trauma or during sepsis. Particularly for the glomerular endothelial cells, mesangial cells, basal membrane, and podocytes, all of which form the glomerular filter, there are numerous in vitro studies on the molecular and functional consequences upon exposure of single cell types to specific damage- or microbial-associated molecular patterns. By contrast, a lack of knowledge exists in the real world regarding the orchestrated inflammatory response of the glomerulus post trauma or burn or during sepsis. Therefore, we aim to provide an overview on the glomerulus as an immune target but also as a perpetrator of the danger response to traumatic and septic conditions, and present major players involved in the context of critical illness. Finally, we highlight research gaps of this rather neglected but worthwhile area to define future molecular targets and therapeutic strategies to prevent or improve the course of AKI after trauma, burn, or sepsis.Graphical abstract
Zhang, Yuhui; Zhao, Youlu; Wang, Jinwei; Zheng, Xizi; Xu, Damin; Lv, Jicheng; Yang, Li
doi: 10.1007/s40620-023-01731-8pmid: 37787893
BackgroundKidney involvement is common in hospitalized coronavirus disease 2019 (COVID-19) patients during the acute phase, little is known about the long-term impact of COVID-19 on the kidney.MethodsThis is a systematic review and meta-analysis on long-term renal outcomes among COVID-19 patients. We carried out a systematic literature search in PUBMED, EMBASE, SCOPUS, and Cochrane COVID-19 study register and performed the random-effects meta-analysis of rates. The search was last updated on November 23, 2022.ResultsThe study included 12 moderate to high-quality cohort studies involving 6976 patients with COVID-19-associated acute kidney injury and 5223 COVID-19 patients without acute kidney injury. The summarized long-term renal non-recovery rate, dialysis-dependent rate, and complete recovery rate among patients with COVID-19-associated AKI was 22% (12–33%), 6% (2–12%), and 63% (44–81%) during a follow-up of 90–326.5 days. Heterogeneity could be explained by differences in the prevalence of chronic kidney disease and proportion of acute kidney injury requiring renal replacement therapy using meta-regression; patients with more comorbidities or higher renal replacement therapy rate had higher non-recovery rates. The summarized long-term kidney function decrease rate among patients without acute kidney injury was 22% (3–51%) in 90–199 days, with heterogeneity partially explained by severity of infection.ConclusionPatients with more comorbidities tend to have a higher renal non recovery rate after COVID-19-associated acute kidney injury; for COVID-19 patients without acute kidney injury, decrease in kidney function may occur during long-term follow-up. Regular evaluation of kidney function during the post-COVID-19 follow-up among high-risk patients may be necessary.Graphical abstract
Balouzet, Clara; Michon-Colin, Arthur; Dupont, Léa; Vidal-Petiot, Emmanuelle; Prot-Bertoye, Caroline; Baron, Stéphanie; Ayari, Hamza; Cohen, Raphaël; Houillier, Pascal; Smadja, Corinne; Flamant, Martin; Courbebaisse, Marie
Bao, Daorina; Lv, Nan; Duan, Xiufang; Zhang, Xu; Wang, Jinwei; Wang, Suxia; Wang, Yu; Zhao, Ming-hui
doi: 10.1007/s40620-023-01605-zpmid: 37060437
BackgroundHyperechoic crystal deposits can be detected in the kidney medulla of patients with gout by ultrasonography examination. Chronic kidney disease (CKD) is usually accompanied with hyperuricemia. Whether hyperechoic crystal deposition could be detected by ultrasonography in CKD patients, and its clinical association are unknown.MethodsFive hundred and fifteen consecutive CKD patients were included in this observational study. Clinical, biochemical and pathological data were collected and analyzed.ResultsAltogether, 234 (45.4%) patients were found to have hyperuricemia and 25 patients (4.9%) had gout history. Hyperechoic crystal deposits in kidney medulla were found in forty-four (8.5%) patients, on ultrasonography. Compared with patients without hyperechoic crystal deposits, patients with deposits were more likely to be male, younger, with gout history and presenting with higher serum uric acid level, lower estimated glomerular filtration rate, lower urine pH, lower 24 h-urinary citrate and uric acid excretion, and with a higher percentage of ischemic nephropathy (all p < 0.05). On multivariable logistic analysis, the hyperechoic depositions were associated with age [0.969 (0.944, 0.994), p = 0.016], serum uric acid level [1.246 (1.027, 1.511), p = 0.026], Sqrt-transformed 24 h-urine uric acid excretion [0.923 (0.856, 0.996), p = 0.039], and ischemic nephropathy [4.524 (1.437, 14.239), p = 0.01], respectively.ConclusionsHyperechoic crystal deposition can be detected in kidney medulla by ultrasonography; in CKD patients their presence was associated with hyperuricemia as well as with ischemic nephropathy.Graphical abstract
Chen, Xuejing; Zhang, Xu; Wang, Yu; Wang, Suxia; Zhao, Minghui
doi: 10.1007/s40620-023-01644-6pmid: 37103770
BackgroundSevere hypertension may be a prominent manifestation of complement-mediated thrombotic microangiopathy. Furthermore, patients with severe hypertension-associated thrombotic microangiopathy may present with concurrent hematologic abnormalities that mimic complement-mediated thrombotic microangiopathy. Whether or not severe hypertension-associated thrombotic microangiopathy is associated with genetic susceptibility in complement- and/or coagulation-pathway genes remains unclear, and there is thus a need to identify clinicopathological clues to distinguish between these entities.MethodsForty-five patients with concomitant severe hypertension and thrombotic microangiopathy on kidney biopsy were identified retrospectively. Whole-exome sequencing was performed to identify rare variants in 29 complement- and coagulation-cascade genes. Clinicopathological features were compared between patients with severe hypertension-associated thrombotic microangiopathy and complement-mediated thrombotic microangiopathy with severe hypertension.ResultsThree patients with pathogenic variants diagnostic of complement-mediated thrombotic microangiopathy and two with anti-factor H antibody positivity were diagnosed with complement-mediated thrombotic microangiopathy with severe hypertension. Among the 40 patients with severe hypertension-associated thrombotic microangiopathy, 53 rare variants of uncertain significance were found in the analyzed genes in 34 (34/40, 85%) patients, of whom 12 patients harbored two or more variants. Compared with complement-mediated thrombotic microangiopathy patients with severe hypertension, patients with severe hypertension-associated thrombotic microangiopathy were more likely to have left ventricular wall thickening (p < 0.001), less-severe acute glomerular thrombotic microangiopathy lesions including mesangiolysis and subendothelial space widening (both p < 0.001), and less arteriolar thrombosis formation (p < 0.001).ConclusionsRare genetic variants involving complement and coagulation pathways can be found in patients with severe hypertension-associated thrombotic microangiopathy; their role needs further investigation. Cardiac remodeling and acute glomerular TMA lesions may help to differentiate between severe hypertension-associated thrombotic microangiopathy and complement-mediated thrombotic microangiopathy with severe hypertension.Graphical Abstract
Khoury, Shafik; Frydman, Shir; Abu-Katash, Haytham; Freund, Ophir; Shtark, Moshe; Goldiner, Ilana; Banai, Shmuel; Shacham, Yacov
doi: 10.1007/s40620-023-01652-6pmid: 37247163
BackgroundSeveral reports suggested that compliance with acute kidney injury care bundles among hospitalized patients resulted in improved kidney and patient outcomes. We investigated the effect of acute kidney injury care bundle utilization on the incidence of acute kidney injury and renal outcomes in a large cohort of myocardial infarction patients treated with percutaneous coronary intervention.MethodsWe included patients with myocardial infarction admitted following percutaneous coronary intervention between January 2008 and December 2020. From January 2016, acute kidney injury care bundle was implemented in our cardiac intensive care unit. Acute kidney injury care bundle consisted of simple standardized investigations and interventions, including strict monitoring of serum creatinine and urine analysis, planning investigations, treatment, and guidance about seeking nephrologist advice. Patients' records were evaluated for the occurrence of acute kidney injury, its severity, and recovery, before and after the implementation of acute kidney injury care bundle.ResultsWe included 2646 patients (1941 patients in the years 2008–2015 and 705 patients in the years 2016–2020). Implementation of care bundles resulted in a significant decrease in the occurrence of acute kidney injury from 190/1945 to 42/705 (10–6%; p < 0.001), with a trend for lower acute kidney injury score > 1 (20% vs. 25%; p = 0.07) and higher acute kidney injury recovery (62% vs. 45%, p = 0.001). Using a multivariable regression model, the use of care bundles resulted in a 45% decrease in the relative risk for acute kidney injury (HR 0.55, 95% CI 0.37–0.82, p < 0.001).ConclusionAmong patients with ST-elevation myocardial infarction, treated with percutaneous coronary intervention and admitted to our cardiac intensive care unit over the period January 2008–December 2020, compliance with acute kidney injury care bundle was independently associated with a significant decrease in occurrence of acute kidney injury and with better renal outcomes following acute kidney injury. Further interventions, such as e-alert systems for acute kidney injury, could improve utilization of the acute kidney injury care bundle and optimize its clinical benefits.Graphical abstract
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BackgroundSevere acute respiratory syndrome coronavirus 2 infection has caused significant morbidity and mortality. Vaccines produced against this virus have proven highly effective. However, adverse events following vaccination have also been reported. One of them is nephrotic syndrome, that can be associated with different pathologic pictures. This review aims to provide a wider understanding of incidence, etiopathogenesis, and management of nephrotic syndrome following vaccination against SARS-CoV-2.Methods and resultsA literature search was undertaken using appropriate keywords in various databases like PubMed, Google Scholar, Europe PMC, and Science Direct. Twenty-one articles were included following qualitative assessment. Data of 74 patients from these articles were included.DiscussionThe pathogenesis of nephrotic syndrome following COVID vaccination has been widely attributed to the activation of angiotensin-converting enzyme-2 receptors, leading to podocyte effacement. Relapses have also been reported in patients with prior history of nephrotic syndrome following COVID-19 vaccination. A renal biopsy is necessary to identify the histopathological picture. Management of COVID-19 vaccine-induced nephrotic syndrome was mainly reported as successfully attainable with corticosteroids and supportive management.ConclusionFurther investigations will help in establishing an early diagnosis and salvaging kidney function.Graphical abstract
doi: 10.1007/s40620-023-01612-0pmid: 37093492
BackgroundIn late 2018, the production of 51Chromium-labelled ethylenediamine tetra-acetic acid (51Cr-EDTA), a validated and widely used radio-isotopic tracer for measuring glomerular filtration rate, was halted. Technetium-99m-diethylenetriaminepentaacetic acid (99mTc-DTPA) has been validated for GFR measurement with a single bolus injection, a procedure not suitable in patients with extracellular compartment hyperhydration. In such cases, a bolus followed by continuous infusion of the tracer is required. The aim of this study was to evaluate whether 99mTc-DTPA with the infusion protocol can replace 51Cr-EDTA for GFR measurement.MethodsWe conducted a prospective single centre study during February and March 2019. All patients referred for GFR measurement received both radiotracers simultaneously: 51Cr-EDTA and 99mTc-DTPA bolus and continuous infusion were administered concomitantly through the same intravenous route. Over four and a half hours, plasma and urine samples were collected to calculate urinary and plasma clearance.ResultsTwenty-two patients were included (mean age 63.4 ± 17.5 years; 68% men). Mean urinary clearance of 51Cr-EDTA and 99mTc-DTPA was 52.4 ± 22.5 mL/min and 52.8 ± 22.6 mL/min, respectively (p = 0.47), with a mean bias of 0.39 ± 2.50 mL/min, an accuracy within 10% of 100% (95% CI 100; 100) and a Pearson correlation coefficient of 0.994. Mean plasma clearance of 51Cr-EDTA and 99mTc-DTPA was 54.8 ± 20.9 mL/min and 54.4 ± 20.9 mL/min, respectively (p = 0.61), with a mean bias of − 0.43 ± 3.89 mL/min, an accuracy within 10% of 77% (95% CI 59; 91) and a Pearson correlation coefficient of 0.983.ConclusionsUrinary and plasma clearance of 99mTc-DTPA can be used with the infusion protocol to measure GFR.Graphical abstract