Current Issue : July-September Volume : 2026 Issue Number : 3 Articles : 5 Articles
Background: Hyperuricemia is a well-known problem in end-stage kidney disease. Currently, the end-stage kidney disease patients may be treated with comprehensive conservative management, hemodialysis, or peritoneal dialysis, which impact uric acid levels distinctly. We assessed the impact of these strategies on uric acid control and identified the factors that influence it. Methods: We conducted a preliminary case–control study comparing patients in comprehensive conservative management, hemodialysis and peritoneal dialysis. For each patient, we evaluated demographic characteristics, comorbidities, body mass index, protein intake, urine output and blood test results. Results: In the entire population, uric acid levels were slightly higher in the comprehensive conservative management group. Furthermore, uric acid control was influenced primarily by body mass index (β = −0.005, p = 0.03) and treatment modality (β = −0.0026, p = 0.05). In comprehensive conservative management, body mass index (β = −0.007, p = 0.02) and urine urea excretion (β = 0.014, p = 0.04) were independent predictors of uric acid level. Conversely, only the suggested protein intake (β = 0.16, p = 0.05), potassium levels (β = −0.046, p = 0.04) and allopurinol therapy (β = −0.073, p = 0.03) were independent predictors of uric acid in hemodialysis patients. Finally, only the recommended protein intake (B = −0.005, p = 0.03) was associated with uric acid levels in patients undergoing peritoneal dialysis. Conclusions: In our series, uric acid control correlates with the treatment modality used for end-stage kidney disease and dietary protein intake....
Background: Comparative real-world data on the pharmacokinetics of once-daily tacroli-mus formulations in de novo kidney transplantation remain limited. We compared tacro-limus exposure and dosing requirements with Envarsus and Advagraf during the early post-transplant period. Methods: We conducted a prospective, observational, single-cen-ter study including adult de novo kidney transplant recipients treated with once-daily tacrolimus as either Envarsus or Advagraf. The immunosuppressive protocol was based on thymoglobulin induction, with delayed initiation of tacrolimus at an initial dose of 0.15 mg/kg/day, prednisone, and sirolimus as the third immunosuppressive agent. Trough concentrations (C0), daily dose, and dose-normalized trough exposure (C0/D) were as-sessed at 48 h and over 3 months (days 7, 14, 30, 60, and 90). Dose adjustments were guided by therapeutic drug monitoring and Bayesian individualization to achieve target trough ranges (6–10 ng/mL during month 1; 5–7 ng/mL thereafter). Clinical effectiveness and safety outcomes were evaluated through month 3. Results: Ninety recipients were included (Advagraf n = 43; Envarsus n = 47). At 48 h, Envarsus achieved higher trough concentrations and higher C0/D than Advagraf (C0: 10.7 vs. 7.7 ng/mL; C0/D: 1.30 vs. 0.75 (ng/mL)/mg; both p < 0.001). From week 1 to month 3, trough concentrations were similar between groups (week 1: 8.5 vs. 8.5 ng/mL, p = 0.968; month 3: 5.7 vs. 5.1 ng/mL, p = 0.234), but Envarsus required lower daily doses (week 1: 6.4 vs. 9.9 mg/day, p = 0.001; month 3: 3.2 vs. 4.1 mg/day, p = 0.021) and maintained higher C0/D (week 1: 1.53 vs. 1.00, p = 0.001; month 3: 1.94 vs. 1.57 (ng/mL)/mg, p = 0.012). At 48 h, infra-therapeutic troughs were less frequent with Envarsus (6.7% vs. 40.5%, p = 0.0001), while supra-therapeutic levels were more frequent (57.8% vs. 18.9%), and tacrolimus discontinuation due to high troughs oc-curred more often (23.4% vs. 7.0%, p = 0.032). Over 3 months, the proportion of measure-ments within the therapeutic range was similar (57.6% vs. 64.5%, p = 0.705). Efficacy and safety were similar between groups. Conclusions: In de novo kidney transplant recipients, Envarsus provides higher early tacrolimus exposure and consistently higher dose-nor-malized trough exposure than Advagraf, enabling lower maintenance doses while main-taining similar short-term effectiveness and safety. However, early overexposure was more frequent with Envarsus at 0.15 mg/kg/day, supporting careful early monitoring and consideration of lower starting doses....
Introduction: Bladder squamous cell carcinoma, closely associated with endemic urinary schistosomiasis in sub-Saharan Africa, presents distinctive characteristics. This study aimed to describe the sociodemographic, clinical, and histopathological profile of this disease in Guinea. Methodology: A retrospective descriptive study was conducted at Conakry University Hospital between January 2015 and December 2024, including 35 patients with histologically confirmed bladder squamous cell carcinoma. Sociodemographic, clinical, cystoscopic, and histopathological data were analyzed. Results: The mean age was 57.4 years with predominance in the 60 - 69 age group (42.86%). Female predominance was observed (male-to-female ratio 0.59:1). Freshwater bathing was the main risk factor (80%). Hematuria was the primary presenting symptom (88.57%). Diagnosis was late, with 57.14% of patients having ECOG ≥ 3 and 54.29% presenting with renal failure. Tumors were predominantly solid (85.71%), sessile (91.43%), and multifocal (88.57%), with large size (median 7.8 cm) and ureteral orifice involvement (71.43%). Histological analysis revealed 91.43% muscle-invasive tumors and 97.14% high-grade tumors. Schistosoma haematobium eggs were identified in 34.29% of specimens. Conclusion: Bladder squamous cell carcinoma is associated with vesical schistosomiasis in Guinea and characterized by late diagnosis at the muscle-invasive stage. Strengthening schistosomiasis prevention and improving early detection are essential to enhance prognosis....
Background and Objectives: Extracellular matrix (ECM) and collagen remodeling contribute to chronic kidney disease (CKD) progression and vascular access dysfunction. Conventional histological techniques rely on staining and provide limited sensitivity for detecting early or subtle ECM alterations. Nonlinear optical imaging modalities, including second-harmonic generation (SHG), third-harmonic generation (THG), and multiphoton fluorescence (MPF) microscopy, enable label-free, high-resolution visualization of fibrillar collagen and may offer additional structural information. This study aimed to evaluate the added value of nonlinear imaging beyond conventional histology for assessing ECM remodeling in renal and vascular tissues. Materials and Methods: A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines. PubMed and Web of Science were searched for studies published between 1 January 2015, and 4 April 2025, investigating ECM or collagen remodeling in renal or vascular tissues using SHG, THG, or MPF microscopy. After screening 115 records, 10 studies were included in the qualitative synthesis. In addition, representative SHG, THG, and MPF images of excised human arteriovenous fistula (AVF) tissue were acquired as illustrative feasibility examples to demonstrate the application of these imaging modalities. The use of human tissue was approved by the Vilnius Regional Biomedical Research Ethics Committee (approval No. 2022/6-1443-917). Results: The included studies demonstrated that nonlinear microscopy enables label-free assessment of collagen density, organization, and fiber orientation. SHG imaging differentiated healthy from diseased tissues and has been reported to support fibrosis assessment and staging in preclinical and selected clinical studies and revealed microstructural remodeling patterns not readily detected by conventional histology. The illustrative AVF images demonstrated collagen disorganization consistent with patterns reported in the reviewed literature and are presented solely to demonstrate imaging feasibility, without implying disease phenotype or clinical outcome associations. Conclusions: Nonlinear optical microscopy provides complementary structural information on ECM organization that is not accessible with standard histological techniques. Further validation and methodological standardization are required to support its broader application in clinical nephrology and vascular medicine....
Introduction: Chronic kidney disease (CKD) is not uncommon in children. It constitutes a major public health problem for both poor and developed countries. The objective of this study was to describe the sociodemographic, clinical, and prognostic profile of CKD in children to contribute to the improvement of its management. Methodology: This was a retrospective, descriptive study conducted from January 2020 to December 2024 in the pediatric departments of the CHU-ME and CHU-R. All patients aged between 3 months to 15 years admitted for CKD were included. The variables studied were sociodemographic, clinical, paraclinical and evolutionary. Results: During the study period, 42,123 pediatric patients were admitted. Of these, 50 met the inclusion criteria for CKD, resulting in a hospital prevalence of 0.11%. The mean age was 10.3 years with extremes being 3 months and 15 years. Males constituted 56% (n = 28) of the cohort, with a sex ratio of 1.3. The most common clinical presentations were proteinuria, detected on urine dipstick in 94% (n = 47) of cases, and edema of the lower limbs (78%, n = 39). All patients (100%) presented with anemia. A majority of patients (70%, n = 35) were in stage 5 CKD, according to KDIGO guidelines. Hemodialysis was required for 58% (n = 29) of patients, often due to complications such as uremic coma. The overall mortality rate was 42% (n = 21), with deaths primarily attributed to cardiorespiratory complications. Conclusion: The prevalence of chronic renal failure in children is low (0.11%). The clinical picture is dominated by proteinuria and peripheral edema. Chronic glomerulonephritis represented the most frequent etiologies. Hemodialysis is the only therapeutic option. Overall mortality remains high....
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