KIDNEYS

Artificial intelligence-guided perfusion metrics to predict delayed graft function in deceased-donor kidney transplantation

Dr. Bikramaditya Mukherjee — 2025-11-21

This study evaluates whether artificial intelligence (AI) applied to machine-perfusion signals can predict delayed graft function (DGF) in deceased-donor kidney transplantation. Background: DGF remains common and costly; hypothermic machine perfusion (HMP) generates high-fidelity physiologic data (flow, vascular resistance, pressure, temperature) that are underused in real-time decision-making. Methods: We analyzed authentic LifePort Kidney Transporter logs from three donor kidneys (~4 hours/run; >1,200 time points each), linked to verified early clinical outcomes. After cleaning, time-normalization, and feature engineering (e.g., resistance slope, flow-to-resistance ratio, temperature stability, pressure–flow correlation), a Random Forest classifier with 10-fold cross-validation modeled DGF (binary) from device-native features. Results: DGF occurred in one of three grafts (33.3%). Across runs, resistance showed an inverse, near-exponential relationship with flow (Pearson r = −0.87, p < 0.001); mean pressure remained ~30 mmHg and temperatures stabilized within 60 minutes. The AI model achieved AUC = 0.91 with accuracy 86.7%, sensitivity 100%, and specificity 80%, with resistance slope and mean flow contributing most to discrimination. Conclusion: Dynamic perfusion trajectories, captured noninvasively during HMP, encode clinically meaningful information about early graft function; AI converts these signals into an interpretable, real-time risk estimate that could standardize organ acceptance and reduce unnecessary discard, warranting multicenter validation for generalizability.

Association between urinary extracellular vesicle proteome and early detection of diabetic nephropathy in type 2 diabetes

Ms. Neepa Patel — 2025-11-21

Early detection of diabetic nephropathy (DN) remains limited by low-sensitivity clinical markers such as albuminuria and eGFR. Hypoxia-driven injury in proximal tubular epithelial cells (PTECs) is recognized as an early event in DN, yet its relationship to urinary extracellular vesicle (EV) cargo is not fully defined. Identifying hypoxia-responsive proteins and miRNAs released by PTECs may provide a mechanistic foundation for urinary EV–based early biomarkers. Secondary multi-omic datasets were analyzed, comprising matched PTEC hypoxia proteomic (377 proteins) and miRNA profiles (defined and novel miRNAs) collected from apical and basal compartments. After stringent quality filtering and normalization, differential expression analysis was conducted using log₂ fold change thresholds (|log₂FC| ≥ 1) and FDR ≤ 0.05. Significant features were grouped into four hypoxia-responsive signatures: apical and basal upregulated proteins, and apical and basal upregulated miRNAs. Functional enrichment (GO/KEGG) and extracellular vesicle annotation were performed to identify biologically relevant pathways and potential urinary EV biomarkers. A total of 112 apical and 94 basal proteins, as well as 51 apical and 38 basal miRNAs, were significantly altered under hypoxia. Dominant pathways included HIF-1 signaling, glycolysis, oxidative stress response, vesicle-mediated transport, and extracellular matrix remodeling. Several hypoxia-induced proteins (e.g., ENO1, RAB27A, HSP90B1) and miRNAs (miR-210, miR-29 family, and novel hypoxia-responsive candidates) overlapped with known EV components, supporting their potential detectability in urine. Hypoxia induces coordinated proteomic and miRNA remodeling in PTECs, generating EV-relevant molecular signatures with strong mechanistic relevance to early DN. These findings offer a robust foundation for developing non-invasive urinary EV biomarkers capable of detecting tubular stress before clinical decline.

Polymicrobial Infections and Rising Resistance in Diabetic Foot Ulcers: Clinical Implications for Antibiotic Management

Emmanuel Rajkumar S — 2025-11-21

Diabetes mellitus (DM) is a chronic metabolic disorder with significant complications including diabetic foot ulcers (DFUs). These ulcers often infected by a diverse range of bacterial pathogens represent a major challenge due to the rising prevalence of antimicrobial resistance (AMR). Foot infection in diabetic patients with chronic kidney disease (CKD) or diabetic kidney disease (DKD) is worse owing to uremic immune dysfunction, retarded wound healing, poor microvascular circulation, as well as changed antibiotic metabolism. Patients with dialysis-dependent issues and those of kidney-transplant are even at higher risk due to poor immunity and frequent contact with healthcare. It is important to the knowledge of the pathogen behavior and resistance patterns in this population to be informative in nephrology and renal-care management. This study investigated the antibiogram of bacterial pathogens isolated from male diabetic patients to understand resistance patterns and guide effective therapeutic strategies. Over two years, 102 male patients with DFUs from multispecialty hospitals in and around Madurai, Tamil Nadu, India, were examined. Deep swabs were collected and processed for bacterial isolation. Antibiotic susceptibility testing was conducted on the isolated bacteria. A total of 21 bacterial isolates were identified including 47.6% gram positive and 52.4% gram negative bacteria. Predominant isolates included Staphylococcus aureus, Pseudomonas sp. and Klebsiella sp. Antibiotic susceptibility testing revealed varied responses with cloxacillin and nitrofurantoin showing notable efficacy against gram positive bacteria while doxycycline and ciprofloxacin demonstrated the highest sensitivity against gram negative isolates. However, multidrug resistance was prevalent particularly in Staphylococcus sp., Acinetobacter sp. and Escherichia coli. The study highlights a significant prevalence of advanced stage ulcers delays in care seeking and polymicrobial infections complicating treatment. The findings underscore the necessity for targeted antibiotic therapy informed by routine antibiogram surveillance and the urgent implementation of antibiotic stewardship programs. Understanding pathogen resistance trends is crucial for optimizing treatment outcomes and mitigating the burden of antimicrobial resistance in diabetic populations. These findings have direct implications for kidney disease management, where antimicrobial resistance limits renal-safe antibiotic options for CKD, dialysis, and post-transplant patients.

Artificial Intelligence–Driven Pharmacotherapy Optimization in Chronic Kidney Disease: Bridging Clinical Pharmacology and Urology

Ms. Jyoti Patel — 2025-11-21

Chronic kidney disease (CKD) poses a constant threat to pharmacotherapy because of variable renal clearance, polypharmacy, and high-risk potential of intoxication with drugs. Although the clinical attentiveness has improved, safe and personalized dosing and especially of patients with interdisciplinary nephrology-urology care needs still have gaps. Artificial intelligence (AI) has become one of the possible ways to improve the precision in therapy, but it has not been widely integrated into clinical practice. The study was a qualitative descriptive study that examined the attitudes of 500 clinicians, nephrologists, urologists, and clinical pharmacologists, towards AI-driven pharmacotherapy optimization in CKD. Semi-structured interview questionnaires were used to collect the data, and it was tabulated in a structured Excel template. Based on the thematic analysis, which was done according to the framework of Braun and Clarke, it was possible to determine some of the major patterns, barriers, and facilitators relevant to the adoption of AI. There were 5 key themes: persistent dosing and polypharmacy issues; urology-related issues in CKD; the desire to use AI to support dosing and prediction and checking interactions, barriers (such as the lack of trust, workflow mismatch, and a lack of transparency), and facilitating factors (including seamless integration of EMR, interdisciplinary collaboration, and mechanisms to check interactions in real-time). Clinicians highlighted the necessity of AI systems to accommodate changes in renal and integrate cross-specialty data. According to the findings, there is a significant clinical need of AI-enhanced pharmacotherapy applications that can positively influence the safety, customization, and interdisciplinary CKD care coordination. These findings are used to develop future transparent, workflow-compatible, and clinically based AI frameworks to optimize medication management in nephrology and urology.

An Integrated Analysis Of Microbial Profiles, Drug Resistance And Socioeconomic Factors In Women With Diabetic Foot Ulcers

Emmanuel Rajkumar S — 2025-11-21

Diabetic foot ulcers (DFUs) can lead to significant health issues, including amputations and mortality. The prevalence of diabetes is notably higher among middle-aged and elderly women, especially those in the 61-70 age group, with socioeconomic disparities significantly impacting access to care. This study highlights the severe complications of DFUs in patients with diabetes mellitus (DM), particularly among women from low-income groups, where limited access to healthcare, lack of awareness, and delayed medical interventions exacerbate the condition. The financial burden of managing chronic wounds, particularly in rural areas, further complicates the already substantial healthcare costs associated with diabetes care. The analysis involved screening 171 patients to identify bacterial pathogens and determine their antibiotic resistance patterns. The results indicated that Gram-positive bacteria, predominantly Staphylococcus aureus (72 %), and Gram-negative bacteria, including Klebsiella sp., and Pseudomonas sp., made up the remaining 28%. These infections are often polymicrobial, posing treatment challenges due to their resistance to commonly used antibiotics. Antibiotic susceptibility tests revealed varying degrees of resistance among the bacterial isolates. Particularly E. coli and Klebsiella sp. showed sensitivity to tested whereas Pseudomonas sp., and Acinetobacter sp. exhibited high levels of resistance. These findings emphasize the importance of precise diagnostic testing and the selection of appropriate antibiotic regimens to effectively manage these infections. Overall, this study underscores the critical need for targeted interventions addressing socioeconomic disparities and improving access to healthcare for at-risk populations. It also stresses the necessity for tailored antibiotic treatments to combat the complex bacterial infections associated with DFUs.

Urinary exosomal microRNAs as predictors of acute kidney injury severity in critical care patients

Venu Anand Das Vaishnav — 2025-11-15

Acute kidney injury (AKI) is a complication of initial disease whose impact is gigantic and is predominantly lethal. Recuperation depends on not allowing additional harm, prompt diagnosis of the disease and evaluation of its severity. In this article, the prognostic role of urine exosomal microRNAs in AKI se verity prediction in critically ill patients is examined. These are people for whom early diagnosis of AKI becomes necessary. AKI patients with exosome-rich urine were discussed and the microRNAs that make
up certain were quantified and described. These microRNAs were selected based on possible causations of renal damage and involvement in renal function. The findings indicate a strong correlation between certain microRNAs and AKI severity. This shows the predictive potential of those molecules for renal damage and dysfunction. The presence of exosomal microRNAs in urine can predict AKI in a non-invasive manner, thus providing a rightful alternative to traditional methods that are more invasive and complicated. The implications of this study suggest that the use of microRNAs in practice can lead to an accurate diagnosis.
Furthermore, biomarkers can enhance patient-centered care by tailoring the severity of treatment to the degree of renal failure. Since it is a non-surgical method, it can minimize the number of repeat invasive treatments the patient must undergo, which enhances comfort while also reducing healthcare costs.
Further research is necessary to investigate the role of exosomal microRNAs in the context of AKI and to determine the long-term therapeutic benefits, beyond the current preliminary data, in larger, more diverse populations to confirm the results presented here.

Seroprevalence of Epstein-Barr virus among hemodialysis patients: post-exposure analysis

Mays B. Jalil — 2025-11-15

Background. Epstein-Barr virus (EBV) is a ubiquitous member of the γ-herpesvirus subfamily within the Herpesviridae family and is known to cause infectious mononucleosis. EBV may contribute to morbidity and mortality in hemodialysis patients. Hemodialysis is a procedure used in individuals with end-stage renal failure to remove waste products, salts, and excess fluids from the bloodstream. The aim of this study was to assess EBV IgG antibody infection in patients undergoing hemodialysis. Materials and methods. EBV IgG antibodies were evaluated in 88 blood samples collected from hospitalized hemodialysis patients using enzyme-linked immunosorbent assay. Results. The study included 51 males and 37 females, with an age range from  15 to  75 years, divided into four categories. The mean age was 52.00 ± 16.46 years. EBV seropositivity was found in 36.36 % of patients (23.86 % in males and 12.50 % in females), while 63.64 % tested negative. No statistically significant differences were observed between gender and age groups (P = 0.5). Among seropositive cases, 12.5 % showed co-infection with hepatitis C virus. The correlation was significant at the 0.01 level. Conclusions. A notable prevalence of EBV IgG antibodies was observed among hemodialysis patients. Seropositivity
reached 36.36 %, while 63.64 % of cases were negative. The highest proportion of seropositive individuals was found among elderly patients aged  75 years, accounting for 31.6 %.

Longitudinal analysis of post-transplant electrolyte disorders and their impact on graft survival

Lukeshwari Sahu — 2025-11-15

Imbalances in electrolytes are common complications after kidney transplantation. However,
the long-term influence of their focus on graft outcomes is understudied. The goal of the current study
is to analyze the incidence, the course, and the prognostic significance of electrolyte disturbances on
graft survivorship. The cohort study followed renal transplant recipients for three years, during which time
sodium, potassium, magnesium, calcium, and other clinical correlates were routinely assessed. The clinical
thresholds were then used to classify participants with unbalanced electrolytes, and survival outcomes
were assessed using Kaplan-Meier curves and Cox proportional hazards models. Results from the study
showed high prevalence of hyponatremia, hyperkalemia, and hypomagnesemia, all of which significantly
correlated with graft impairment survivorship; hypocalcemia had weaker correlations. Individuals who
had recurrent disturbances in the level of electrolytes suffered from a decline in graft function much earlier
than those who had normal content. Multivariate analysis showed that graft loss could not be avoided
even when demographic and immunologic confounders were accounted for, which reaffirms the notion
that electrolyte imbalance is a predictor of loss. Hence, the study outcomes call for the standard practice
of actively monitoring electrolytes with the goal of taking timely corrective action to improve long-term
outcomes following transplantation. The study found that an active, corrective approach to treating
electrolyte disorders is essential for achieving optimal transplant outcomes in conservatively managed
grafts.

Gut-derived uremic toxins and their role in accelerating cardiovascular events in chronic kidney disease

Deepak Kumar Sahu — 2025-11-15

Chronic kidney disease (CKD) is a long-lasting and progressive condition. It is caused by the
complicated buildup of many serum uremic toxins, some of which are made by the gut flora. Two uremic
toxins, indoxyl sulfate and p-cresyl sulfate, have been shown to worsen cardiovascular disease and
accelerate the progression of chronic kidney disease. These toxins harm the heart over time by causing
the blood arteries swell, creating oxidative stress, and making the endothelium work poorly or not at all. The
relationships between uremic toxins produced in the gastrointestinal tract and cardiovascular events in
individuals with CKD remain inadequately defined, especially with prospective new biomarkers that could
facilitate earlier diagnosis of cardiovascular events and the commencement of treatment. This aims to
conduct a systematic review and research on cardiovascular risk factors associated with specific gutderived uremic toxins, with a particular focus on blood pressure, atherosclerosis, and arterial stiffness in
individuals with CKD. This study aims to elucidate more definitions regarding the impact of these toxins on
clinical events and the pathobiology of cardiovascular illnesses in individuals with chronic renal disease.
Furthermore, when examining these data, we will consider treatment strategies aimed at modifying
certain factors by targeting the microbiome to maintain positive clinical outcomes, as well as interventions
that inhibit the production of gut-derived uremic toxins to eliminate or mitigate their adverse effects. By
controlling gut-derived uremic toxins, patients’ cardiovascular profiles and CKD risks can be modified,
improving clinical outcomes and quality of life.

Comparative outcomes of calcineurin inhibitor-free versus standard immunosuppression in kidney transplant recipients

Chiranjeev Singh — 2025-11-15

End-stage renal disease patients with improved lifestyle checks will profit more from a kidney
transplant than from any other type of treatment. Toxic sites with increased rejection risk are often treated
with calcineurin inhibitors (CNI) such as tacrolimus and cyclosporine-drugs. They are very effective at
reducing the risk of rejection but extremely nephrotoxic and metabolically disruptive protecting the body
from unwanted consequences while providing immunological assistance with CNI-free approaches, such
as belatacept-based and mTOR inhibitors that have been designed to mitigate the risk. To assess the effect
of CNI-based versus CNI-free immunosuppression, a big comparative study in more than one hundred
transplant patients was conducted on a one-year follow-up study. The belatacept-treated CNI-free cohort
was compared to the other cohort receiving the control treatment in addition to portal mycophenolate.
Objectives for the study were post-surgical organ rejection, survival of the transplanted organ, multiple
infections, and all nuances of nephrotoxic and metabolic derangement. The results were fewer fragments
and a CNI-free cohort, with improved acute rejection control and reduced total nephrotoxicity balance
pumps. These findings conclude that CNI-free is superior to CNI administered.

Metabolomic fingerprinting of dialysis patients for early detection of vascular calcification

Bhuneshwari Dewangan — 2025-11-15

Vascular calcification (VC) is one of the dreaded long-term dialysis complications. Its effect
on cardiac morbidity and mortality is still appalling and sadly undervalued. The inefficiency and absence
of modern methods of diagnosis are also illogical reasons for the distress of the health system. It implies
distressing the potential opportunity cost by early diagnosis. The research aimed to alleviate pain in patients
with VC and dialysis by targeting early diagnosis using new metabolomic techniques. The samples and
serum samples following LCM were gathered, normalized, and established by pre-treatment multivariate
statistical methods of principal component analysis and partial least squares discriminant analysis.
The metabolic profiles of VC patients and non-VC patients exhibited typical patterns. Apart from that,
understanding precisely which biomarkers it utilized actually had proper diagnostic accuracy because it
is noted in sensitivity, specificity, and AUC results. It was found that metabolomic fingerprinting is a potent
tool, which consequently implies that the current invasive diagnostic methods for VC in dialysis patients
must be put on the shelf in favor of a less invasive technique. It is also recommended as a second tool to
complement the pre- and post-diagnosis reaction to the VC.

Nutritional Awareness, Dietary Practices, and Biochemical Profiles Among Hemodialysis Patients in Omdurman, Sudan

Azhari A. Mohammed Nour — 2025-11-15

Background: Chronic kidney disease (CKD) is an emerging national health issue that frequently progresses to end-stage renal diseases (ESRD), which requires maintenance hemodialysis. Best nutrition is central to better clinical outcomes among such patients. However, in resource strained environments like Sudan, lack of appropriate nutritional awareness and access to organized dietary guidance is counterproductive to proper management.

Objective: The objective of this study was to assess the nutrition awareness, eating habits and the biochemical analyses of patients under hemodialysis in Omdurman, Sudan. Also, it addressed how adherence to dietary recommendations was affected by socio-demographic and clinical determinants.

Methods: A cross-sectional study based in the facility was carried out in the Friendship and Ombada Model Hospitals during September-December 2022. All eligible hemodialysis patients were used to gather data through structured questionnaires and analyzed under SPSS version 20. To summarize and interpret the findings, descriptive statistics and frequency distributions were used.

Results: 100 participants were involved in the study (64% men, 40% older than 50 years). Most of them claimed low/moderate levels of income (98 per cent) and poor levels of education with almost half of them (49 per cent) having undergone only preschool education. The leading comorbidity (91%) was hypertension. Despite the 3 out of 4 indicating compliance with dietary prescriptions and 59% having some kind of nutrition related education, significant shortcomings were noted especially in practicing sodium regulation, knowledge of food labels, and avoiding soft drinks. The biochemical tests revealed an increased level of serum phosphate (59) and creatinine (97). Only 42 percent were of normal BMI with 45 percent being underweight. In addition, the dietary consumption was also noted with low intake of fruits, vegetables, and legumes, as well as irregular protein intake.

Conclusion: In this research, the lack of nutritional awareness and adherence to a specific diet among patients under hemodialysis is significantly emphasized in Sudan. McNeely et al. (2017) state that the targeted nutrition education, dietary counseling, and coordinated multidisciplinary interventions should be employed urgently to improve patient outcomes and the general quality of life among this high-risk population.

Automated Ultrasound Image Segmentation Using AI: A Step Toward Non-invasive Kidney Disease Monitoring

Anurag Mishra — 2025-11-18

Non-invasive kidney evaluation through ultrasound imaging is quite common, but there is always a challenge in manual analysis of the kidney boundaries because of noise, brightness variation, and dependence on operators. The paper will examine a basic threshold-based segmentation algorithm to improve kidney boundaries in ultrasound images and their performance under different levels of image quality. Twenty-five kidney ultrasound images were pre-processed under the standardization and noise-reduction steps, and an automated boundary was further created through pixel-intensity thresholding. The standard of comparison was made of manual boundaries. The findings showed that the automated process had a close correspondence with manual contours in the majority of the cases, especially with the images that had moderate to high clarity. Comparison of the clarity groups revealed that there was a slight deviation of good quality images, moderate deviation in quality scanners, and higher variation amongst areas where noise or shadowing was evident. Morphological analysis also confirmed that the automated result did not cause significant changes in the general kidney anatomy, besides the fact that certain areas that had weak contrast had little differences. Also, the process of segmentation improved the visualization of structures by decreasing the effect of speckle interference and accentuating structure boundaries. On the whole, it can be concluded that an easy-to-use threshold-based segmentation method can offer a good and understandable kidney boundary extraction that can serve as a practical alternative to routine monitoring and clinical decision support, particularly in resource-limited environments.

“To understand the kidney is to understand life — from cell to society.”

No authors — 2025-11-11

Dear colleagues, readers, and friends,

You are holding the fourth issue of Kidneys, a journal that continues our shared mission: to unite knowledge, experience, and humanity around one of the most delicate systems in the human body.

The kidney is not just an organ. It is a source.