KIDNEYS

Investigation of some bacterial causes of urinary tract infection in diabetic patients in Al-Muthanna Province

Maytham Abas Makki — 2025-08-31

Background. Urinary tract infections (UTIs) are among the most common infections affecting diabetic patients, contributing to increased morbidity and healthcare burden. This study purposed to investigate the prevalence and bacterial causes of UTIs among diabetic patients in Al-Muthanna Province, Iraq, and to determine the antimicrobial susceptibility patterns of the isolated pathogens. Materials and methods. A total of 200 urine samples were collected from diabetic patients presenting with UTI symptoms. Bacterial identification and antibiotic susceptibility testing were conducted using standard microbiological methods. Results. The results showed that 123 (61.5 %) samples were positive for bacterial growth. Escherichia coli was the most prevalent organism (52 %), followed by Klebsiella pneumoniae (19.5 %), Staphylococcus aureus (13 %), Proteus mirabilis (8 %), and Pseudomonas aeruginosa (6.5 %). High resistance was observed against ampicillin and TMP-SMX, while nitrofurantoin and imipenem showed the highest sensitivity. Conclusions. These findings underscore the need for continuous surveillance and appropriate empirical therapy to manage UTIs in diabetic individuals.

Sharba method: innovative one-sided laparoscopic approach for continuous ambulatory peritoneal dialysis catheter placement

Laith Fathi Sharba — 2025-08-31

Background. This study aims to evaluate whether modifications to the surgical technique can improve peritoneal catheter longevity. In our view, this longevity may be enhanced in two distinct ways. The proposed method facilitates the insertion of a second contralateral catheter and may offer advantages in kidney transplantation (although most procedures are now performed retroperitoneally) and other nephrological surgical interventions, due to the absence of lateral surgical access and reduced risk of adhesions, particularly in cases requiring intraperitoneal surgery. Materials and methods. The study includes 410 cases of one-sided laparoscopic continuous ambulatory peritoneal dialysis (CAPD) catheter placement between 2018 and December 2022, with data collected from our center in Najaf. Additionally, a comparative survey was conducted on 118 cases using the traditional two-sided laparoscopic CAPD technique, performed by different surgeons at another center in the same city. Our technique underwent periodic refinements to address complications observed over time, although the core procedural steps remained consistent. Techniques used by other surgeons, both domestically and internationally, vary in certain aspects while sharing similarities in others. Feedback from transplant surgeons was collected for patients who later underwent kidney transplantation, allowing comparison with other approaches and evaluation of postoperative complications potentially avoided with our method. Results. The study analyzed age distribution among patients undergoing laparoscopic CAPD, ranging from 8 months to 85 years, with the youngest excluded due to incomplete data. Comparative feedback showed slightly better outcomes for the one-sided technique, though without statistical significance (p = 0.24530). Early failure rates were higher in the two-sided group, while late catheter patency failures were more frequent in the one-sided group, mostly unrelated to the technique itself. Revision rates and success were also assessed, revealing a significantly higher success rate for the one-sided approach (95 %) compared to the two-sided method (33.33 %). Conclusions. Our findings suggest that the one-sided laparoscopic CAPD catheter insertion technique represents a promising alternative to the traditional two-sided approach. It demonstrates favorable late patency outcomes and significantly higher revision success rates. Although transplant surgeon feedback slightly favored the one-sided method, the difference was not statistically significant. Further long-term studies are needed to validate these results, but this technique may help reduce complications and improve catheter longevity.

A comparative study between N-acetylcysteine and L-carnitine in the management of male infertility (placebo-controlled trial)

Mohanned Hussam Mohammed Saeed — 2025-08-19

Background. Male infertility is a globally recognised health condition, which is mainly reported in the age range of 35–39 years. Males from at least three in six couples are impacted by infertility on a global scale. Research evidence reveals the therapeutic benefits of L-carnitine and N-acetylcysteine for infertile males; however, the current evidence is limited by high heterogeneity in contemporary studies. Therefore, this study aimed to investigate the influence of these treatments on sperm parameters and the semen’s malondialdehyde level and total antioxidant capacity. Materials and methods. This randomised placebo-controlled clinical trial deployed 180 male patients with normal female factor and idiopathic oligoasthenoteratozoospermia from January 2021 to December 2024. The patients in the age group of 25–40 years were randomised into L-carnitine (1000 mg oral dose), N-acetylcysteine (oral dose), and placebo (sugar sachets) treatments. The baseline data included the patient’s age and sperm parameters (including sperm motility, sperm concentration, sperm morphology, and semen volume). The semen parameters in the study groups were re-investigated after six months of the study intervention. Additionally, total antioxidant capacity and malondialdehyde levels in the semen were evaluated before and after the treatment administration. Results. The six-monthly analysis revealed that the sperm parameters, including sperm motility (38 and 38 vs. 4 %), morphology (30 vs. 29 vs. 7 %), and concentration (25 and 24 vs. 2 %), significantly improved with the administration of N-acetylcysteine and L-carnitine, respectively, in comparison to the placebo. However, semen volume (6 and 5 vs. 4 %) was not impacted by either treatment and did not differ significantly from the placebo group (p > 0.05). Compared to pretreatment, N-acetylcysteine monotherapy improved the total antioxidant capacity (1.92 ± 0.12 vs. 2.61 ± 0.12; p = 0.01) and reduced the level of malondialdehyde (2.46 ± 0.11 vs. 1.85 ± 0.10; p = 0.01) in the semen. However, in comparison to the placebo, these improvements were not observed with L-carnitine monotherapy. Conclusions. The oral L-carnitine and N-acetylcysteine treatments effectively improved sperm concentration, morphology, and motility in male patients with infertility. However, as a single-agent therapy, no statistically significant differences were observed between the outcomes of N-acetylcysteine and L-carnitine. In addition, N-acetylcysteine appeared superior to L-carnitine in reducing the oxidative stress and malondialdehyde levels in the seminal plasma. Prospective studies should identify the mechanisms underlying the efficacy of L-carnitine/N-acetylcysteine and evaluate the safety and effectiveness of combination antioxidant treatments against male infertility.

The level of blood lead, zinc and relationship with the metallothionein gene polymorphism in chronic kidney failure

Arwa M. Nasser — 2025-08-09

Background. Chronic kidney disease is defined by renal damage or an estimated glomerular filtration rate less than 60 ml/min/1.73 m2. Lead is a ubiquitous environmental factor that can contribute to lengthy clinical complications in individuals with chronic kidney disease. They can be exposed to changes in zinc homeostasis. The MT2A gene also expresses a wide range of physiological and pathological effects. Materials and methods. This study involved 60 blood samples from individuals with kidney disease on hemodialysis, and 60 samples from apparently healthy individuals as a control. The purpose was to identify the molecular character of the genotype of the MT2A gene SNP (A>G) (rs28366003) in a cohort of chronic kidney disease subjects and apparently healthy controls. Results. Blood lead and zinc serum levels were compared between patients and healthy controls by flame atomic absorption spectrophotometry. Lead contents were significantly and considerably higher, with significant differences (p > 0.01) between the patient cohort and the healthy controls, while serum zinc was significantly decreased. Males are more affected than females with chronic kidney disease, and individuals older than 40 years had a greater risk of complications. Hypertension has a meaningful positive relation to chronic kidney disease, and it is therefore considered a possible risk factor. The rs28366003 A>G genotype associated with increased risk of kidney disease in Iraqi patients demonstrated considerable variation. The median age of kidney disease patients was 20 to 69 years. Genotypes and allele frequencies of rs28366003, A>G in the kidney disease population: 51.7 % (n = 31) were wild-type (AA), 33.3 % (n = 20) were heterozygous (AG) and 15 % (n = 9) were homozygous (GG). The allele frequencies of A and G were 68.3 and 31.7 %. Conclusions. Thus, the drop in zinc levels and the harmful increase in blood lead in chronic kidney failure patients who possess SNP variants of the MT2A gene, specifically rs28366003, may be involved in kidney disease susceptibility.

The role of shilajit in reducing the toxicity of monosodium glutamate on liver enzyme and kidney functions in albino mice

Emad Mahmoud Eltayef — 2025-08-01

Background. A flavor enhancer that sees extensive usage in the food business is monosodium glutamate (MSG). While many studies have shown that long-term consumption of MSG can cause oxidative stress in animals, especially in their liver and kidneys, it was the goal of this study to examine the biochemical effects of hepatitis and kidney inflammation caused by different doses of MSG and the protective effect of shilajit water extract in albino mice. This research is designed to assess the biochemical toxicity of various dosages of MSG on the kidney and liver function in albino mice. Materials and methods. Fifty adult mice were randomly assigned to one of five groups (10 animals each). In contrast to the experimental group (G2) that received MSG at a dose of 2 g/kg body weight, the control group (G1) received pure water. The third group (G3) received the same amount of MSG plus 100 mg/kg of shilajit extract. In contrast to the fourth group (G4), which received a higher dose of MSG (4 g/kg body weight), the fifth group (G5) received the same amount of MSG in addition to 200 mg/kg of shilajit. The oral medications were maintained daily for a period of 14 days. On day 15, the animals were euthanized after being put to sleep. Following that, biochemical analysis was performed on the collected samples. This included testing for renal function indicators (such as creatinine and urea) and liver enzymes (such as AST, GGT, ALP, and ALT). Results. Compared to the control group, groups G2 and G4, which received just MSG, had a significant rise (P ≤ 0.05) in liver enzyme levels (ALP, AST, and ALT), suggesting substantial liver damage. On the other hand, shilajit extract showed a significant decrease in these levels, suggesting that it may provide some protection against the toxicity caused by MSG. Conclusions. The current study found that when high doses of monosodium glutamate were administered, it caused significant disturbances in the function of both the liver and the kidneys. They were manifested by a significant increase in the levels of liver enzymes (AST, ALT, ALP, and GGT), as well as an increase in renal function indicators (urea and creatinine), which indicated that these organs had suffered tissue and functional damage as a result of excessive oxidative stress.

Immune response on interferon-gamma in rats infected with C.albicans

Doaa Hazem Mohammed — 2025-08-01

Background. Candida albicans is the most frequent etiologic agent that causes opportunistic fungal infection called candidiasis, a disease whose systemic manifestation could prove fatal and whose incidence is increasing as a result of an expanding immunocompromised population. Here we review the role of interferon-gamma (IFN-γ) in host protection against invasive candidiasis. This study investigates the time- and sex-dependent variations in IFN-γ levels in C.albicans-infected rats, offering insights into the function of this cytokine in fungal immunity. Materials and methods. This study involved 100 rats, with 50 in the experimental group and 50 in the control group, each consisting of 25 males and 25 females. The experimental group received cyclosporine A (10 mg) 24 hours prior to the infection to suppress the immune response and facilitate C.albicans growth, whereas the control group was administered distilled water instead of C.albicans suspension. Following four days of infection, group 1 was anesthetized, and a blood sample was collected to measure IFN-γ levels. Group 2 was assessed at 8 days, group 3 at 12 days, group 4 at 16 days, and group 5 at 20 days, alongside the control group. Results. The present study demonstrated a significant increase (p < 0.05) in IL-10 concentration in both male and female rats infected with C.albicans compared to the control group. There was a significant increase in IFN-γ concentration in C.albicans-infected rats of both sexes, with a p value < 0.05, with progression of disease; the highest concentration was reached on the 12th day of the experiment and then decline. In contrast, no significant changes were observed in the control group over the same period. Conclusions. The research highlights the essential function of IFN-γ in the immune response to Candida albicans infections, observing that the absence of notable differences between male and female rats suggests that additional factors affect IFN-γ regulation. The necessity for additional research on the interactions between sex hormones and cytokines is underscored, offering insights into the sex- and time-dependent regulation of IFN-γ during infections, while also highlighting the need for clarification of observed discrepancies and their underlying mechanisms.

Calcium and phosphorus imbalances as biochemical markers in chronic kidney disease: a case-control study

Noora Q. Al-Khafaji — 2025-07-26

Background. Chronic kidney disease (CKD) is characterized by progressive deterioration of renal function and is commonly associated with biochemical abnormalities, particularly in calcium and phosphate metabolism. These disturbances play a key role in the pathophysiology of secondary hyperparathyroidism, vascular calcification, and bone mineral disorders. This study purposed to investigate serum calcium and phosphorus profiles in patients with CKD undergoing hemodialysis, evaluate their correlation with renal function indicators, and compare the findings with those of healthy individuals to assess their diagnostic and prognostic relevance. Materials and methods. A comparative cross-sectional study was conducted involving 60 patients with end-stage renal disease (aged 25–72 years; 66.7 % male) undergoing long-term hemodialysis at Al-Hussain Hospital between December 2024 and June 2025, and 30 age- and sex-matched healthy controls. Serum levels of urea, creatinine, calcium, and phosphorus were analyzed using standard biochemical methods. Statistical analysis was performed using SPSS v26, with significance set at p < 0.05. Pearson’s correlation was used to assess relationships between parameters. Results. CKD patients exhibited significantly elevated levels of serum phosphorus (5.37 ± 0.47 mg/dL) and creatinine (7.46 ± 1.15 mg/dL), along with reduced calcium (5.54 ± 0.41 mg/dL) compared to healthy controls (phosphorus: 3.34 ± 0.14 mg/dL, calcium: 9.34 ± 0.14 mg/dL, p < 0.0001 for all). A moderate positive correlation was observed between creatinine and phosphorus (r = 0.54), while calcium levels negatively correlated with phosphorus (r = –0.30). Conclusions. Hyperphosphatemia and hypocalcemia are highly prevalent in patients with advanced CKD and are strongly associated with impaired renal function. The moderate correlation between phosphorus and creatinine suggests that phosphorus levels may serve as a surrogate marker for renal deterioration. Routine monitoring of calcium and phosphorus, alongside conventional markers, is vital for early detection of mineral metabolism disturbances and timely management of CKD-related complications.

Gender disparities in kidney transplant access and outcomes: a population-based analysis

Hemlata Dewangan — 2025-08-09

Background. Kidney transplantation is seen as a better treatment option in end-stage kidney disease (ESKD) because it offers greater longevity as well as quality of life. Access to kidney transplantation and post-transplantation outcomes is generally hindered by gender disparities. Women are underrepresented as kidney recipients but overrepresented as living donors. Gender disparities in kidney transplantation exist as a result of various factors, such as biological and sociocultural one, including sensitization from prior pregnancies, biological differences in the immune system, or gendered patterns of health care access or referral. Women receive fewer transplant referrals, face delays in evaluations, and obtaining encouragement for transplant compared with men. Materials and methods. This population-based study uses the Early Steps to Transplant Access Registry data and focuses on ESKD patients from Georgia, North and South Carolina. It examines gender differences across the full transplant care continuum, from referral to post-transplant outcomes. We statistically adjusted for clinical prognostic variables and demographic factors to evaluate the independent contribution of gender on transplant access and outcomes. Results. Our examination shows that women with ESKD are significantly less likely to be listed or receive a kidney transplant compared to men, even after controlling for other variables. The requirements persist throughout the transplant process, and the inequities are evident at every stage. While biologically related considerations of risk (graft rejection) and differences in metabolism of immunosuppressive medications likely partially explain some variance in outcomes, gender-related social determinants (e.g., provider bias) and systemic inequities generally explain more variance in the access gap for women, by comparison. It is also important to note new emerging challenges of great concern, such as the under-researched healthcare needs of transgender people, and the impact of COVID-19 on transplant recipients that compound gender inequities related to access to transplantation. Conclusions. This study highlights the pressing need to identify and address gender equity considerations in kidney transplantation decisions. Although there may be clinical justification for gender inequities, these issues emanate predominantly from modifiable sociocultural and institutional factors. Transplantation systems have not officially considered sex- and gender-sensitive means to eliminate barriers to access. Immediate policy intervention, education, and support are needed to ensure equitable access and equity of outcomes for all people, especially those from diverse gender identities.

Analysis of the use of artificial intelligence systems for the development of physical exercise programs during rehabilitation of nephrology patients

V.V. Bezruk — 2025-07-16

Background. Artificial intelligence (AI) is a direction of mathematical computer modeling based on the abstract essence of mathematical thinking. Chronic kidney disease (CKD) is a nosological unit, its final stage (end-stage renal disease) has seen an exponential increase over the past decade and is considered by the World Health Organization as a global problem by cause of death. The global healthcare industry is one of the main planes for practical application of modern developments in the field of AI thanks to machine learning algorithms that provide new opportunities for solving the most complex problems of medicine and pharmacy. The purpose was to analyze the possibility of using physical exercise complexes (PECs) created by AI system in patients with CKD undergoing renal replacement therapy and to compare PECs created by AI with the list of PECs used in clinical practice (systematic reviews and meta-analyses) for rehabilitation care in nephrology. Materials and methods. Scientometric analysis of professional literature from electronic databases PubMed, Embase, Scopus and Web of Science, Cochrane CENTRAL was conducted. According to the purpose of the study, the following methods were used: bibliosemantic, systematic approach, descriptive modeling using AI systems — Gemini and ChatGPT. Results. AI systems (Gemini and ChatGPT) proposed exercise programs for patients with CKD that take into account different stages of rehabilitation (respiratory, aerobic, strength, stretching and relaxation). At the time of the descriptive modeling, the database used by Gemini and ChatGPT is sufficient for their routine use in the development of exercise therapy complexes for the rehabilitation of nephrological patients with different nosologies. Conclusions. Artificial intelligence is a tool in the hands of a physician to provide medical care; the quality of this tool will depend on the qualifications of the physician who will teach (machine learning) AI to use their knowledge and competencies to optimize the process of creating rehabilitation complexes for patients with kidney disease from the standpoint of evidence-based medicine.

Analysis of salt transport indices, calcification markers, and FGF23 in patients with nephrolithiasis and crystalluria

O. Nikitin — 2025-09-14

Background. Nephrolithiasis (NL) is a common polyetiological urological disease that is frequently associated with reduced bone mineral density. One of the shared key factors contributing to both osteoporosis and NL is insufficient intake of calcium-rich products. Another common pathogenic mechanism involves the activation of calcification factors, such as osteopontin (OPN), osteocalcin (OC), and fibroblast growth factor 23 (FGF23). The purpose was to evaluate indices of salt transport, calcification markers (ОС, ОРN), and FGF23 in patients with nephrolithiasis and crystalluria. Materials and methods. The study was conducted at the Department of Urology of the Bogomolets National Medical University, and the Urology Department of the Kyiv Regional Clinical Hospital. The work was carried out in accordance with the research plan and is a fragment of the research project “Optimization of the management of patients with urolithiasis with concomitant osteoporosis” (state registration number 0125U000958). The diagnosis of NL was established based on the criteria according to the 2023 guidelines of the European Association of Urology. The assessment of salt transport, osteopontin, and FGF23 was carried out in a certified laboratory (Medical Laboratory “DILA”, Kyiv, Ukraine). Osteocalcin was measured in the Ukrainian Osteoporosis Center and Department of Clinical Physiology and Pathology of Locomotion Apparatus of the State Institution “D.F. Chebotarеv Institute of Gerontology of the National Academy of Medical Sciences of Ukraine” (Kyiv, Ukraine). Results. Нigher rates of oxaluria were observed in patients with NL and crystalluria, which was predominant in the study groups compared to other indicators studied. The levels of calcification markers (OPN, OC) and FGF23 were significantly lower in patients from group I compared to those with NL and crystalluria. Conclusions. The level of FGF23 showed a positive association with serum phosphate levels, which is consistent with its physiological mechanism of action. Further study is needed to determine the specific changes in calcification markers (OPN, OC) and FGF23 depending on changes in bone mineral density.

Endothelial dysfunction and reduced glomerular filtration rate in individuals of different age groups with signs of cardio-renal-metabolic syndrome: angio- and renoprotection pathways

V.P. Chizhova — 2025-09-14

Background. Cardio-renal-metabolic syndrome (CRMS) is a cluster of pathological conditions that combine metabolic disorders, cardiovascular dysfunction, and kidney damage, forming an interconnected system of complications. Endothelial dysfunction plays a key role in the development and progression of this syndrome as an early marker of vascular damage associated with impaired vasodilation, chronic inflammation, and pro-atherogenic changes. At the same time, a decrease in the estimated glomerular filtration rate (eGFR) reflects not only kidney function but also the overall risk of cardiovascular events and mortality. Given the population aging and the increasing prevalence of CRMS among individuals of various age groups, especially middle-aged and elderly, studying the relationship between endothelial dysfunction and reduced eGFR is highly relevant. Early diagnosis of these changes may allow timely identification of individuals at high cardiorenal risk and implementation of approaches to the prevention, early detection, and treatment. The purpose was to assess kidney function and vascular endothelial status in individuals of different age groups with signs of CRMS and to evaluate the potential for correction of the detected changes using Lespedeza capitata extract as a potential nephro- and angioprotective agent. Materials and methods. A total of 152 individuals of various ages were initially examined. Based on inclusion criteria, 58 people were excluded for various reasons. Comprehensive examination was carried out in 94 individuals (mean age of 54.82 ± 0.97 years), most of them demonstrated decreased eGFR, elevated urinary albumin-to-creatinine ratio (UACR), and impaired endothelial function. To correct these changes, Lespedeza capitata extract was added to standard antihypertensive therapy. The supplement was administered at a dose of one capsule three times daily regardless of meals, for one month, to pre-screened individuals (n = 39). Effectiveness criteria included changes in eGFR, UACR, and markers of endothelial function (flow-mediated dilation assessed by reactive hyperemia). The observation period was one month. The examination included standard clinical, anthropometric, laboratory, and instrumental methods. Results. With age, a tendency toward decreased eGFR was observed: from 79.73 ± 1.91 mL/min/1.73 m2 in middle-aged individuals (47.28 ± 0.72 years) to 64.01 ± 2.21 mL/min/1.73 m2 in the elderly (67.18 ± 0.49 years). Among middle-aged people, eGFR was within G2 category (60–89 mL/min/1.73 m2) in 100 % of cases, while in 46 % of elderly individuals, it had decreased to G3a category (45–59 mL/min/1.73 m2). Normal or high eGFR (G1 category, ≥ 90 mL/min/1.73 m2) was preserved in only 10 % of elderly participants. Among middle-aged individuals with a slight decrease in eGFR within the G2 category (60–89 mL/min/1.73 m2), increased UACR was found in a third of the examined people, while in the elderly, a decrease in eGFR to 40–59 mL/min/1.73 m2 prevails, which is considered as chronic kidney disease within the G3a category accompanied by an increase in the UACR in 25 % of individuals. When assessing the functional state of the endothelium of large vessels, it was found that among the examined participants (n = 94) with different categories of eGFR (G1, G2, G3a), signs of endothelial dysfunction were observed in 54 (57.45 %).Of these, 19 patients (35.18 %) demonstrated severe impairment characterized by a vasospastic response to reactive hyperemia (by D.S. Celermajer method), indicating impaired endothelium-dependent vasodilation. Among individuals with endothelial dysfunction in large vessels, 70.4 % (n = 38) had UACR < 30 mg/g, 29.6 % (n = 16) had increased UACR: 10 people — at the level of 30–300 mg/g, and 6 people had UACR > 300 mg/g. At the same time, among individuals with preserved endothelial function, 65 % (n = 26) had UACR < 30 mg/g, 14 individuals had UACR of 30–300 mg/g, and none had UACR > 300 mg/g. Thus, UACR > 300 mg/g was recorded exclusively among patients with endothelial dysfunction (5 people, 9.2 %), showing a statistically significant difference (χ2 = 0.01; p = 0.03). Among individuals with eGFR reduced within categories G2 (60–89 mL/min/1.73 m2) and G3a (45–59 mL/min/1.73 m2), there was a decrease in microvascular endothelial function in 84 %. Among them, UACR < 30 mg/g was observed in 50.00 %, 30–300 mg/g — in 43.75 %, and > 300 mg/g — in 6.25 %. In participants with preserved microvascular endothelial function (16 %), the distribution was 33.3 % (< 30 mg/g) and 66.7 % (30–300 mg/g), with no individuals having UACR > 300 mg/g. Though this trend was not statistically significant (χ2 = 0.08, p = 0.13), it mirrored the association of UACR > 300 mg/g with large-vessel endothelial dysfunction. Importantly, a mutual burden phenomenon was observed in individuals with eGFR 45–89 mL/min/1.73 m2, with 56.25 % having combined large- and small-vessel endothelial dysfunction. Among them, 44.44 % had UACR of 30–300 mg/g and 11.11 % had UACR > 300 mg/g. The absence of UACR > 300 mg/g among patients with preserved endothelial function in both middle-aged and elderly groups confirms a strong association between significant albuminuria and endothelial dysfunction. UACR > 300 mg/g may indicate severe vascular wall damage and systemic endothelial dysfunction. To correct the detected changes, 39 individuals of various ages with manifestations of CRMS were prescribed Lespedeza capitata extract in addition to standard antihypertensive therapy. After one month of treatment, all patients showed an increase in flow-mediated dilation, indicating restored endothelial function in both large and microcirculatory vessels. Restoration of endothelial function was accompanied by a stable trend toward increased proportion of people with UACR < 30 mg/g (χ2 = 0.04, p = 0.07), suggesting improved kidney function with Lespedeza capitata extract. This effect is likely due to the proven nephroprotective action of Lespedeza capitata extract, making it a promising agent for the prevention and treatment of chronic kidney disease. Conclusions. Individuals of different age groups with CRMS demonstrated a mutual burden phenomenon: more than half of patients with eGFR of 45–89 mL/min/1.73 m2 (56.25 %) had both macro- and microvascular endothelial dysfunction, often accompanied by elevated UACR (> 300 mg/g in 11.11 %). These findings highlight the importance of UACR as a potential early marker of endothelial dysfunction during the initial stages of renal function decline. Elevated UACR may reflect existing endothelial injury, while low or moderate levels (UACR < 30 or 30–300 mg/g) may still be observed in patients with preserved endothelial function. For nephro- and angioprotection in individuals with CRMS, the addition of Lespedeza capitata extract to standard antihypertensive therapy is advisable.

Appeal of Editor-in-Chief

No authors — 2025-08-31

No abstract

The role of urea in pathological conditions

O.B. Kvasnytska — 2025-07-16

Modern research shows the significant role of the urea and its products in the development of a number of diseases. Its pathological effects are based on dysfunction of the urea cycle enzymes of congenital or acquired nature, realized through the activation of oxidative stress, apoptosis, carbamylation, hormonal dysregulation. Studying the mechanisms of action of this organic compound on pathophysiological processes opens up broad prospects for the application of new pharmacological approaches to the treatment of kidney, liver, cardiovascular and nervous diseases, and oncopathology. On the other hand, isolated determination of the blood urea level or its ratio with creatinine and albumin are reliable prognostic markers of severity and mortality in various pathologies.

Gamma-aminobutyric acid as an element of the mechanisms of cerebro-renal interactions

N.D. Filipets — 2025-07-16

The presence of many common aspects in autoregulatory mechanisms and processes of ensuring the constancy of the internal environment determines the uniqueness of the cerebro-renal system. Gamma-aminobutyric acid (GABA), in addition to the key coordinating role in brain activity and its metabolism, has inherent regulatory effects in non-neuronal tissues. Given the fact that there is a relationship between GABA levels and the functional and metabolic state of other organs and systems, the aim of the work is to focus on scientific information regarding local GABAergic systems, the location of their components in the nephron and the renal effects of GABA under different conditions. In addition to the fact that GABA has therapeutic potential against acute kidney injury and chronic kidney disease, pharmacological modulators of GABA can provoke nephrotoxicity. The reasons for the diversity of renal responses under the influence of GABA and agents with agonist activity are multifactorial in nature, which should be taken into account, and within the framework of GABAergic strategies, effective and safe therapeutic approaches should be sought and applied.

Nephrological aspects of Bardet-Biedl syndrome in pediatric practice: a clinical case and literature review

M.Yu. Iskiv — 2025-09-14

Bardet-Biedl syndrome (BBS) is an autosomal recessive ciliopathy characterized by retinitis pigmentosa, obesity and related complications, postaxial polydactyly, cognitive impairments, hypogonadotropic hypogonadism and/or genitourinary anomalies, as well as developmental defects and/or parenchymal diseases of the kidneys. Traditionally, diagnosis of BBS has relied on the presence of clinical manifestations, with subsequent confirmation through genetic testing. However, clinical features of BBS manifest at various ages, which may delay diagnostic processes. The average age of BBS diagnosis is 8–9 years, but the presence of congenital renal anomalies together with other features, such as polydactyly or syndactyly, which can be detected prenatally or at birth, provides grounds for including BBS in the differential diagnosis much earlier. Additionally, the presence of renal and genitourinary anomalies results in chronic kidney disease (CKD). In some patients, CKD may progress to renal failure, which is the main cause of mortality among individuals with BBS. This article presents data on possible manifestations of BBS, the role of kidney injury in its diagnosis, as well as other syndromes and clinical features that require differentiation from BBS. A clinical case is also described of a patient with BBS presenting with polydactyly, retinal dystrophy, overweight, other congenital anomalies, and, notably, renal involvement, which enabled suspicion and diagnosis of BBS at the age of 3 years. Although BBS has no specific treatment, early detection allows for the involvement of a multidisciplinary team in patient management and may reduce the risk of severe complications, such as CKD.