Research Journal of Critical Care Nephrology
The Research Journal of Critical Care Nephrology (RJCCN), is a peer-review, open-access journal publishes articles in English. The aim of the RJCCN is the worldwide reflection of the knowledge produced by the scientists and clinicians and nurses in nephrology especially critical care nephrology. It will be published quarterly since October 2025. The RJCCN provides a new platform for the advancement of the field. The journal’s objective is to serve as a focal point for debates and exchange of knowledge and experience among researchers in a global context. Original papers (Clinical Studies, Experimental Studies, Systematic Review and Meta-analysis), case reports, Special Reports, Brief Communications, and invited reviews and editorial on all aspects of kidney diseases, Nephrology, Organ Transplantation, Intra-abdominal hypertension, CRRT, AKI, ICU care in Nephrology, Shock, Sepsis, ECMO, ARDS, and all topics related to Nephrology and especially Critical Care Nephrology will be covered by the RJCCN. Research on the basic science, clinical practice, and socio-economics of renal health are all welcomed by the journal editors. Online ISSN: 3115-8463 Indexing/Abstracting. SID, Magiran, Civilica, Scientific-Research Accreditation from the Iranian Ministry of Health (Local Indexing), Dimensions, Google Scholar (The Others in Processing) Organization: It is self-published. Scope: Nephrology especially Critical Care Nephrology and related Topic Frequently: Quarterly Copyright Policy: © [Year] Author(s). All content on this website is licensed under the CC BY 4.0, unless otherwise stated. Publishing Access: Open-Access Peer Review Policy: Double-Blind Peer Review
Beyond Kidney Support: The New Frontiers of Critical Care Nephrology
Copyright (c) 2026 Amir Ahmad Nassiri (Author) https://creativecommons.org/licenses/by/4.0
Copyright (c) 2026 admin (Author) https://creativecommons.org/licenses/by/4.0
Prognosis of Severe Acute Kidney Injury Requiring Renal Replacement Therapy: A Systematic Review
Introduction. Acute kidney injury (AKI) requiring renal replacement therapy (RRT) represents the most severe spectrum of AKI in critically ill patients and is associated with high mortality and long-term morbidity. To systematically review short- and long-term outcomes and prognostic factors in adult patients with severe AKI requiring RRT in intensive care settings. Methods. A systematic search of PubMed, Embase, and the Cochrane Library was conducted from January 2000 to June 2024 in accordance with PRISMA 2020 guidelines. Adult studies reporting mortality and/or renal outcomes in AKI requiring RRT were included. Data were synthesized narratively. Results. Thirty-two studies involving over 80,000 patients were included. Short-term mortality ranged from 40% to 70%, with hospital mortality frequently exceeding 50%. Long-term mortality remained high, approaching 70 to 80% at 5 to 10 years. Renal recovery occurred in approximately 30 to 40% of survivors, while 10 to 20% remained dialysis-dependent at discharge. Prognosis was predominantly influenced by sepsis, multi-organ failure, illness severity scores, advanced age, and fluid overload. Conclusions. Severe AKI requiring RRT is associated with poor short- and long-term outcomes. Prognosis is driven primarily by the severity of critical illness rather than dialysis-related factors, highlighting the need for early risk stratification and structured post-ICU follow-up.
prognosis, acute kidney injury, renal replacement therapy, systematic review
Copyright (c) 2026 Meysam Ghanbari Saray, Mohammad Mahdi Heidari (Author) https://creativecommons.org/licenses/by/4.0
A Qualitative Study of Exercise Participation Intentions Among Patients Undergoing Maintenance Hemodialysis
Introduction. Exercise improves physical function and quality of life in patients undergoing maintenance hemodialysis (MHD). However, exercise participation remains suboptimal in this population. This study explored factors influencing exercise participation intentions among patients undergoing MHD to provide evidence for developing targeted interventions. Methods. A qualitative study was conducted using purposive sampling to recruit 16 patients undergoing MHD. Data were collected through semi-structured interviews and analyzed using Colaizzi’s phenomenological method. Themes were identified based on the Capability, Opportunity, Motivation–Behavior (COM-B) model. Results. Three major themes and 12 subthemes were identified. Capability included insufficient exercise-related knowledge, limited self-management skills, and poor perceived physical condition. Opportunity comprised the need for individualized exercise prescriptions and professional guidance, limited opportunities for exercise, positive social support, and social isolation. Motivation encompassed fear of exercise, recognition of the value of exercise, previous exercise habits and experiences, expectations of exercise benefits, and strengthened role identity. These factors collectively influenced patients’ willingness to participate in exercise. Conclusions. Exercise participation intentions among patients undergoing MHD are shaped by multiple capability-, opportunity-, and motivation-related factors. Healthcare professionals should strengthen exercise education, provide individualized exercise prescriptions and professional guidance, enhance social support, offer timely feedback on exercise outcomes, and implement multidimensional strategies to improve patients’ self-efficacy and motivation, thereby promoting greater participation in regular exercise.
maintenance hemodialysis, exercise intention, COM-B model, influence factor, qualitative study
Copyright (c) 2026 Qianqian Wei, Fei Chen, Lixia Yin, Yanan Ban, Hailin Zhang (Author) https://creativecommons.org/licenses/by/4.0
Efficacy of Prednisone Combined with Leflunomide in Lupus Nephritis and the Prognostic Value of TL1A and Serum Cystatin C
Introduction. To evaluate the therapeutic efficacy of prednisone combined with leflunomide in patients with lupus nephritis (LN) and investigate the prognostic value of serum tumor necrosis factor-like ligand 1A (TL1A) and cystatin C. Methods. This study included 64 patients with LN treated with prednisone and leflunomide between June 2020 and March 2022 and 64 healthy controls. Serum TL1A and cystatin C levels were measured before and after treatment. Clinical and laboratory parameters were compared, and the predictive values of TL1A and cystatin C for treatment response and prognosis were assessed using ROC analysis. Independent prognostic factors were identified by multivariate analysis. Results. Before treatment, serum TL1A and cystatin C levels were significantly higher in patients with LN than in healthy controls (P < .05). Both biomarkers decreased significantly after treatment but remained above control levels (P < .05). Treatment also significantly reduced 24-hour urinary protein, serum creatinine, and BUN, while increasing serum albumin and complement C3 (P < .05). Baseline TL1A and cystatin C levels were significantly lower in patients with an effective treatment response than in those with ineffective treatment (P < .05). ROC analysis showed good predictive performance for treatment response and prognosis. Multivariate analysis identified elevated 24-hour proteinuria, serum cystatin C, TL1A, and higher renal pathological grade as independent predictors of poor prognosis. Conclusions. Serum cystatin C and TL1A are promising biomarkers for predicting treatment response and prognosis in LN patients receiving prednisone plus leflunomide. Elevated levels of both biomarkers are independently associated with poor clinical outcomes.
TL1A, cystatin C, prednisone, leflunomide, lupus nephritis, efficacy, prognostic prediction
Copyright (c) 2026 Qing Li, Lixia Chen, Ming Gao (Author) https://creativecommons.org/licenses/by/4.0
The Gut-Kidney-GBM Axis: Emerging Evidence That Microbial Metabolites May Modify Glomerular Basement Membrane Perm-selectivity: A Systematic Review
Introduction. The glomerular basement membrane (GBM) is the final filtration barrier in the kidney, and its dysfunction is central to nephrotic syndrome. Emerging evidence suggests that gut microbiota-derived metabolites directly modify GBM perm selectivity, yet this axis remains underexplored. Methods. We conducted a systematic review following PRISMA guidelines, searching PubMed, Scopus, Web of Science, Embase, and Cochrane Library from January 2000 to April 2026. Studies examining relationships between gut microbiota or microbial metabolites (indoxyl sulfate, TMAO, p-cresyl sulfate, SCFAs) and GBM structure/function were included. Results. Mendelian randomization studies provide causal evidence linking Alistipes putredinis, Veillonellaceae, and RuminococcaceaeUCG002 to CKD risk. Indoxyl sulfate upregulates heparanase, degrading GBM heparan sulfate and disrupting charge selectivity. TMAO and p-cresyl sulfate activate AhR signaling, inducing aberrant sulfation patterns. Conversely, short-chain fatty acids (particularly butyrate) protect GBM via HDAC inhibition and Treg modulation. A novel gut-lymphatic-renal feedback loop involving Th17 cells explains treatment resistance in chronic nephrosis. Clinical studies suggest that AST-120 and probiotic supplementation may reduce proteinuria and improve eGFR, although heterogeneity across studies limits definitive conclusions. Conclusions. The gut-kidney-GBM axis represents a bona fide pathophysiological pathway in nephrotic syndrome. Microbiome targeted interventions represent promising but still investigational adjunctive strategies that require confirmatory human trials for preserving GBM integrity. Screening for gut dysbiosis and uremic toxins should guide personalized therapy in steroid-resistant nephrosis.
glomerular basement membrane, gut microbiota, indoxyl sulfate, chronic kidney disease, glomerular disease, nephrotic syndrome, steroid-resistant nephrosis, mendelian randomization
Copyright (c) 2026 Maryam Ghaffari Rahbar, Ali Zarei, Saeed Changizi Ashtyani, Farshid Haghverdi (Author) https://creativecommons.org/licenses/by/4.0
Effect of β-Hydroxy-β-methyl butyrate (HMB) Supplementation on Muscle Changes and Clinical Outcomes with Sonography Assessment in ICU: A Systematic Review
Introduction. To evaluate the effects of β-Hydroxy-β-methyl butyrate (HMB) supplementation on muscle changes in critically ill patients, focusing on muscle mass, strength, and functional recovery. Methods. A comprehensive literature search was conducted -across multiple electronic databases, including PubMed, Scopus, and Web of Science, from database inception to December 2023. Data extraction was performed using a standardized form, and quality assessment was -assessed using the Newcastle-Ottawa Scale (NOS). Results. Six randomized controlled trials (RCTs), comprising 398 participants, were included in the analysis. The studies enrolled intensive care unit (ICU) patients with trauma, liver cirrhosis, or those requiring mechanical ventilation. The interventions included HMB alone or HMB-containing formulations combined with other nutritional supplements, such as arginine and glutamine. The HMB dose was 3 g/d, and the duration of supplementation ranged from 10 to 84 days. Regarding muscle mass changes, no significant differences in diaphragm or quadriceps muscle thickness were found in one study (P = .87). In contrast, other studies demonstrated marginal improvements in muscle preservation. For example, one study found a reduction in femoral muscle volume of 11.4% in the HMB group compared with 14.4% in the control group, although this difference was not statistically significant (P = .18). However, a subgroup analysis of patients with lower SOFA scores showed that HMB supplementation significantly preserved muscle volume (P = .047). In another trial, HMB supplementation significantly improved quadriceps thickness (P < .05) compared with placebo. Additionally, significant improvements in muscle function were observed in the HMB group, including better performance in the chair-stand and six-minute walk tests (P < .05). HMB supplementation also reduced net protein breakdown and increased amino acid production in muscle, although these metabolic improvements did not consistently translate into measurable preservation of muscle mass. Conclusions. HMB supplementation in critically ill patients may offer modest benefits in preserving muscle mass and improving functional recovery, particularly in patients with less severe illness.
β-Hydroxy-β-methyl butyrate (HMB), critical illness, muscle atrophy, nutritional supplementation, muscle strength
Copyright (c) 2026 Sahar Kavand, Parisa Delkash, Afsaneh Safarian, Arezoo Ranjbar Arani, Minoo Heidari Almasi, Mohammad-Reza Jowshan, Hoda Zahedi, Fatemeh Mofidi (Author) https://creativecommons.org/licenses/by/4.0
From Exposure to Expertise: Rethinking POCUS Competency in Nephrocritical Care
Copyright (c) 2026 Abhilash Koratala (Author) https://creativecommons.org/licenses/by/4.0
Giggle Incontinence in an Adolescent Girl: A Case-based Review
Giggle incontinence is a form of urinary incontinence triggered by giggling or laughter, with two distinct pathophysiological theories proposed for its etiology. Both neurologic receptor imbalance and urologic dysfunction have been suggested as potential underlying mechanisms. We present a case-based review of a 12-year-old girl with refractory giggle incontinence who underwent comprehensive evaluation including physical examination, ultrasonography, bladder diary, uroflowmetry, and urodynamic studies. She was treated with a combined approach consisting of urotherapy and pelvic floor biofeedback. To enhance and accelerate therapeutic response, low-dose methylphenidate was added. Pharmacologic treatment was administered and tapered over four months, while non-pharmacologic interventions were continued for one year. Follow-up at 18 months demonstrated complete resolution of symptoms. A comprehensive literature review on giggle incontinence was conducted using PubMed, Scopus, and Google Scholar databases for studies published since 2000. Based on current evidence, treatment should be individualized according to the presumed underlying mechanism, and successful management requires strong cooperation between the patient, her parents, and the healthcare team. Based on our literature review, treatment depends on the causes, and success requires the patient’s and her parents’ trust and cooperation in carrying out the instructions.
Copyright (c) 2026 Banafshe Dormanesh, Bahareh Marghoob (Author) https://creativecommons.org/licenses/by/4.0
Critical Care Nephrology in the Era of Planetary Health: Aligning Intensive Kidney Care with the Vision of World Kidney Day
Copyright (c) 2026 Author(s) https://creativecommons.org/licenses/by/4.0
Diagnostic Accuracy of Serum and Urinary Neutrophil Gelatinase-associated Lipocalin for Predicting Sepsis-associated Acute Kidney Injury: A Systematic Review and Meta-Analysis
Introduction. Sepsis‑associated acute kidney injury (SA‑AKI) is a frequent and serious complication among critically ill patients and is associated with substantial morbidity and mortality. Conventional diagnostic markers such as serum creatinine and urine output often detect kidney injury only after functional decline and may be confounded in septic states. Neutrophil gelatinase‑associated lipocalin (NGAL) has emerged as a potential early biomarker of tubular injury; however, its diagnostic performance in sepsis remains uncertain. This systematic review and meta‑analysis evaluated the diagnostic accuracy of serum and urinary NGAL for predicting SA‑AKI in adults with sepsis. Methods. A systematic search of the PubMed database was conducted from inception to 2025 to identify studies evaluating serum, plasma, or urinary NGAL in adult patients with sepsis. Eligible studies reported diagnostic accuracy for AKI defined according to KDIGO, AKIN, or RIFLE criteria. Data extraction was performed independently by two reviewers. Pooled sensitivity, specificity, diagnostic odds ratios (DORs), and summary receiver operating characteristic (SROC) curves were estimated using a bivariate random‑effects model. Subgroup analyses explored differences according to clinical setting and timing of biomarker measurement. Results. Seventeen studies met the inclusion criteria. For serum NGAL, the pooled sensitivity was 0.77 (95% CI: 0.63 to 0.86) and pooled specificity was 0.68 (95% CI: 0.52 to 0.80), with an AUC of 0.773 and a diagnostic odds ratio of 6.15 (95% CI: 4.38 to 8.64). Urinary NGAL demonstrated comparable but slightly higher diagnostic performance, with pooled sensitivity of 0.75 (95% CI: 0.66 to 0.82), specificity of 0.71 (95% CI: 0.64 to 0.78), an AUC of 0.782, and a diagnostic odds ratio of 7.12 (95% CI: 4.17 to 12.16). Subgroup analyses suggested modestly improved diagnostic performance in ICU populations. Conclusions. Both serum and urinary NGAL demonstrate moderate diagnostic accuracy for predicting SA‑AKI in adult patients with sepsis. Urinary NGAL showed slightly better discriminatory performance in several clinical contexts. Rather than replacing established KDIGO‑based diagnostic criteria, NGAL may serve as a complementary biomarker to support early risk stratification. Larger prospective studies with standardized assay methods and diagnostic thresholds are needed before routine clinical implementation.
sepsis-associated acute kidney injury, neutrophil gelatinase-associated lipocalin, NGAL, biomarkers, diagnostic accuracy, systematic review, meta-analysis, sepsis, early detection
Efficacy of Hemoadsorption Therapy in Patients With Sepsis-associated Acute Kidney Injury: A Systematic Review and Meta-analysis
Introduction. Sepsis-associated acute kidney injury (SA-AKI) is a frequent and severe complication of sepsis with high mortality. Hemoadsorption has been increasingly used as an adjunct to continuous renal replacement therapy (CRRT) to remove inflammatory mediators, but its clinical efficacy in SA-AKI remains uncertain. We conducted a systematic review and meta-analysis to evaluate the effects of hemoadsorption added to CRRT in critically ill patients with SA-AKI. Methods. Following PRISMA guidelines, we systematically searched PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, ClinicalTrials.gov, and WHO ICTRP through December 1, 2025. Comparative studies evaluating hemoadsorption plus CRRT versus standard CRRT in septic patients with AKI were included. The primary outcome was mortality (28-, 60-, 90-day, ICU, and in-hospital). Secondary outcomes included ICU and hospital length of stay, CRRT duration, changes in SOFA score, vasopressor dose, lactate, IL-6, and procalcitonin. Random-effects meta-analyses were performed. Results. Fifteen studies involving 3,093 patients (1,509 hemoadsorption plus CRRT; 1,584 CRRT alone) were included. Overall, hemoadsorption was not associated with a significant reduction in 28-day mortality (RR = 0.79, 95% CI: 0.61 to 1.02) or other mortality endpoints. However, hemoadsorption significantly reduced SOFA score at 48 hours (MD = −2.79, 95% CI: −4.00 to −1.58), IL-6 levels at 24 hours, and lactate levels at 24 and 48 hours compared with CRRT alone. It also did not affect ICU or hospital length of stay or CRRT duration. Subgroup analyses suggested a significant reduction in 28-day mortality with specific adsorption modalities (oXiris, oXiris plus CytoSorb, and HA330-II), but not with polymyxin B. Conclusions. In critically ill patients with SA-AKI, adding hemoadsorption to CRRT improves short-term markers of organ dysfunction and metabolic derangement but does not confer a clear mortality benefit. Future large, multicenter trials with standardized protocols are needed to determine whether specific patient subgroups or adsorption modalities derive meaningful survival benefit.
hemoadsorption, sepsis, acute kidney injury, systematic review, meta analysis
Quantification of Optimal Strength and Frequency of Grip Exercises in Patients After Autogenous Arteriovenous Endovascular Fistula
Introduction. To observe the hemodynamic changes of the upper limb cephalic veins in patients with ESRD who were pre-treated with hemodialysis and required an arteriovenous internal fistula after grip exercise at different grip strengths and frequencies, and to explore the optimal grip exercise strength and frequency to promote blood circulation in the upper limb cephalic veins. Methods. 200 patients aged ≥ 18 years who had undergone internal fistula surgery were selected and divided into 2 groups, 100 patients in each group were divided into groups A and B. Group A determined the appropriate grip strength; group B used an electronic grip strength device to perform grip strength exercise at 4 frequencies of 15, 20, 25, and 30 times/min under the appropriate grip strength determined in group A. The changes in cephalic venous hemodynamics at different frequencies were observed. The hemodynamic changes of the cephalic vein at different frequencies were observed. Results. When the grip strength was 70 to 100% of the maximum grip strength, the cephalic venous blood flow velocity and vascular pressure increased significantly compared to the resting state (P < .01). Conclusions. Grip strength exercise can promote blood circulation in the cephalic veins of the upper limb, with 70 to 100% of the maximum grip strength and 25 exercises/min being the best method. This conclusion can provide a reference basis for clinical guidance on functional exercise of the upper limb and promotion of blood circulation in the cephalic veins of the upper limb and maturation of AVF in patients after AVF surgery.
autogenous arteriovenous endovascular fistula, maturation, grip exercise strength, grip exercise frequency, color doppler ultrasound, hemodynamics
Kidney Health for All: Caring for People, Protecting the Planet
The current kidney care model—focused on late-stage disease and in-center hemodialysis—is unsustainable, because of costs, environmental burden, poor outcomes, and reduced quality of life. The 78th World Health Assembly’s recognition of kidney disease as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, “Kidney Health for All: Caring for People, Protecting the Planet,” calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, environment, and society. Dialysis itself must become more ecofriendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly for elderly and frail patients, if the quality-of-life benefits outweigh the perspectives offered by dialysis. Achieving this shift requires coordinated action across all stakeholders; education and engagement of the public, policy makers, and health professionals to raise awareness about the threat of kidney disease; and an urgent move toward patient-centered care.
environment, green nephrology, prevention, screening, sustainable kidney care, World Kidney Day
Reno-protective Effects of Coreopsis Tinctoria Flavonoids in db/db Mice Models Through the AGE/RAGE Pathway
Introduction. The study investigates the renal protective effects of flavonoids derived from Coreopsis tinctoria Nutt in type 2 diabetes using db/db mice. Methods. With the db/m mice born in the same litter as the non-diabetic normal group, 8-week-old db/db mice were divided into four groups: a diabetes model group, a low-dose (0.4 g/kg) flavonoids group, a high-dose (1.2 g/kg) flavonoids group, and a metformin positive control group. Mice were treated daily for 8 weeks. Results. After 8 weeks of continuous gavage feeding, the high-dose group of flavonoids significantly improved fasting blood glucose levels in 16-week-old db/db mice, and both dosages of flavonoids reduced average daily water intake. The levels of serum creatinine (CRE) and BUN in db/db diabetic mice were significantly reduced by both high and low dosages of flavonoids, mitigating the loss of glomerular cells under hyperglycemic conditions, inhibiting glomerular hypertrophy and mesangial matrix hyperplasia, and demonstrating protective effects on renal function damage. The levels of AGEs in db/db mice kidneys were elevated compared to db/m mice, but significantly decreased with flavonoid treatment. Flavonoids also reduced RAGE protein expression and NF-κB activation. Additionally, both doses of flavonoids lowered MDA and IL-1β levels, and enhanced antioxidant enzyme activities. Conclusions. The study concludes that flavonoids from Coreopsis tinctoria Nutt can inhibit the accumulation of AGEs and binding to RAGE in kidneys, improve oxidative stress and inflammation, and protect against renal damage induced by hyperglycemia. This suggests their potential of flavonoids from Coreopsis tinctoria Nutt as functional food and medicine for diabetic nephropatthy.
Coreopsis Tinctoria, flavonoids, diabetic nephropathy, advanced glycation end products, receptor for AGE
Artificial Intelligence Models for Predicting Acute Kidney Injury in Adult Critical Care: A Systematic Review
Introduction. Acute kidney injury (AKI) is frequent in adult critical care and is associated with increased morbidity, mortality, and long-term kidney consequences. Artificial intelligence (AI) and machine-learning (ML) prediction models may enable earlier risk identification, but clinical adoption depends on robust reporting beyond discrimination, including calibration and clinical utility. Methods. We performed a PubMed-based systematic review (English; last 5 years) of AI/ML models predicting AKI in adult critical care/ICU populations. Records were screened and full texts were assessed for eligibility. For synthesis within the journal page limit, we restricted the final evidence set to studies reporting a complete usability-oriented outcome set: AKI definition, model type(s), prediction horizon, validation approach, AUROC/AUC, calibration, and decision curve analysis (DCA)/net benefit. Results. Of 357 records screened, 230 full texts were assessed, and 31 studies met complete-reporting criteria and were included. The most common model families included logistic regression baselines, random forest, gradient boosting/XGBoost, and deep learning. Reported AUROC/AUC values ranged from 0.64 to 1.00 (median 0.90), with the best-performing models typically reporting AUROC ≥ 0.95. External or temporal validation was reported in 74% (23/31). By design, 100% of included studies reported calibration (e.g., calibration plot and/or Brier score and/or Hosmer–Lemeshow) and 100% reported clinical utility using DCA/net benefit. Conclusions. Among usability-focused studies, AI/ML models show generally strong discrimination for AKI prediction in adult critical care, but reporting and validation practices remain heterogeneous. Standardized AKI definitions, transparent validation, calibration reporting, and decision-analytic evaluation are essential to support safe implementation.
acute kidney injury, critical care, intensive care unit, artificial intelligence, machine learning, prediction model, calibration, decision curve analysis, AUROC, clinical utility
Point-of-Care Ultrasound and Volume Status: Embracing Physiology Over Proxies
POCUS, ultrasound, right atrial pressure, hemodynamics, volume
The Integration of Palliative Care in the Critical Care Management of Patients with Advanced Renal Diseases: A Necessity in Patient-centered Outcome
Urinary Ammonium: A Renewed Compass for Renal and Extra-Renal Disorders, a Case Series
Introduction. Assessment of urinary ammonium (uNH4+) describes one of the kidney’s most important physiological functions, yet direct measurement is not routinely available. Historically, urine anion gap has been used as a surrogate for uNH4+, although this approach is unreliable, particularly in patients with chronic kidney disease. The ability to directly measure uNH4+ may therefore provide clinically relevant diagnostic and therapeutic information. Case Series. In this case series, we present three clinical cases illustrating the utility of uNH4+ measurement, now available as a bedside point-of-care measurement (KING, Kures®). These include comparison between a dysfunctional native kidney and a recovering transplanted graft, and the differential diagnosis of a-lactic metabolic acidosis in two distinct clinical settings. Across cases, uNH4+ provided timely physiological insight into tubular function, supporting diagnosis and recovery assessment beyond traditional markers. Conclusions. These observations underscore the importance of distinguishing tubular from glomerular function and complement traditional markers in renal assessment.
urinary electrolytes, ammonium, KING, renal transplant, chronic renal failure
Copyright (c) 2026 Lara Mary Titherington, Stefano Romagnoli, Pietro Caironi (Author) https://creativecommons.org/licenses/by/4.0
Inhibition of FSP1-MYH9 Interaction Reduces TGF-β-induced Podocyte Injury: Potential Therapeutic Role of Trifluoperazine
Introduction. Podocytes are crucial for maintaining the glomerular filtration barrier, and their injury is a major contributor to kidney diseases. FSP1 (Fibroblast-specific protein 1) has been implicated in various pathological conditions but its role in podocyte injury, especially under TGF-β (Transforming Growth Factor-Beta) stimulation, is not well understood. This study aims to explore the involvement of FSP1 and its interaction with MYH9 in TGF β-induced podocyte damage and assess the therapeutic potential of Trifluoperazine (TFP). Methods. Human podocytes were treated with TGF-β, followed by FSP1 knockdown using siRNA. A series of assays including CCK8, wound healing, F-actin staining, and CO-IP were performed to assess podocyte injury, migration, and FSP1-MYH9 interactions. The effects of TFP on these interactions and podocyte health were also evaluated. Results. TGF-β increased FSP1 expression in podocytes, leading to cell damage. FSP1 knockdown reduced injury by improving cell viability and cytoskeletal integrity. CO-IP revealed that FSP1 interacts with MYH9 to promote podocyte injury. TFP treatment reduced FSP1-MYH9 interaction, alleviating podocyte damage. Conclusion. FSP1 promotes TGF-β-induced podocyte injury through its interaction with MYH9, activating the P38 MAPK pathway. TFP disrupts this interaction, offering a promising therapeutic approach for treating podocyte-related kidney diseases.
FSP1, MYH9, podocyte injury, trifluoperazine
The Impact of Nurse-Led Continuous Renal Replacement Therapy Management on Clinical Outcomes in Adult Critically Ill Patients: A Systematic Review
Introduction. Continuous renal replacement therapy (CRRT) is a cornerstone treatment for hemodynamically unstable critically ill patients with acute kidney injury (AKI). Despite technological advances, CRRT outcomes remain variable, and the impact of nursing leadership in CRRT delivery has not been sufficiently synthesized. This study aims to evaluate the effect of nurse-led CRRT management on clinical and treatment-related outcomes in adult critically ill patients. Methods. A systematic review was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, CINAHL, and the Cochrane Library were searched for studies involving adult ICU patients receiving CRRT where nurse-led management was explicitly described. Primary outcomes included mortality, circuit lifespan, and unplanned circuit interruption or clotting. Secondary outcomes included delivered CRRT dose, treatment downtime, and CRRT-related complications. Results. Fifteen eligible studies were identified, including randomized and non-randomized designs evaluating nurse-led CRRT models compared with standard or physician-led care. Nurse-led CRRT management was associated with prolonged circuit lifespan and reduced unplanned interruptions in most studies. Mortality effects were variable. Heterogeneity across studies reflected differences in staffing models, protocols, and outcome definitions. Conclusions. Nurse-led CRRT management appears to improve key treatment-related outcomes and care continuity in adult ICU patients. These findings have important implications for workforce development and care models, particularly in low- and middle-income countries (LMICs).
acute kidney injury, continuous renal replacement therapy, critical care nursing, intensive care units, nurse-led care, adult
Point-of-Care Ultrasonography in Nephrology and Critical Care: A New Era of Bedside Precision
POCUS, Ultrasound, Nephrology, Hemodynamics, Critical Illness
Critical Care Nephrology: From the Original Vision to Today’s Reality
In Memoriam: Vale, Professor Rinaldo Bellomo (1956 to 2025)
Plasmacytoma in Membranoproliferative Glomerulonephritis: A Case Report
Multiple myeloma is a prevalent disease, whereas bone plasmacytoma is a localized neoplasm of monoclonal plasma cells, constituting a distinct plasma cell disorder that falls between monoclonal gammopathy of undetermined significance (MGUS) and multiple myeloma (MM). We present a 63-year old woman who exhibited proteinuria and acute kidney injury (AKI), subsequently diagnosed with membranoproliferative glomerulonephritis (MPGN) of unknown etiology. One year later, the patient developed a lytic bone lesion and diagnosed as having a solitary bone plasmacytoma. MPGN may be caused by immunological complexes or associated with monoclonal gammopathy; therefore, it is essential to assess individuals with MPGN to identify any typical or atypical etiologies of the condition.
plasmacytoma, membranoproliferative glomerulonephritis, multiple myeloma, monoclonal gammopathy of undetermined significance, acute kidney injury
Acute Kidney Injury in Adult Patients Receiving Extracorporeal Membrane Oxygenation: A Systematic Review
Introduction. Acute kidney injury (AKI) is a frequent and clinically important complication in adults receiving extracorporeal membrane oxygenation (ECMO), yet reported incidence and associated outcomes vary widely due to differences in populations, ECMO configuration, and AKI definitions. We systematically reviewed full-text studies reporting AKI and related outcomes in adult patients supported with veno-arterial (VA) and/or veno venous (VV) ECMO. Methods. A systematic search of PubMed identified 661 records; 660 remained after deduplication. Full texts available for assessment were screened for eligibility (n = 126). We included original adult ECMO/ECLS studies reporting extractable AKI and/or renal replacement therapy (RRT/CRRT) outcomes. Results. Forty-five studies were included in qualitative synthesis. AKI incidence was extractable in 29 studies and ranged from 2.3% to 89.0% (median 50.5%). RRT/CRRT use was extractable in 29 studies and ranged from 1.8% to 91.0% (median 53.3%). Mortality was extractable in 37 studies (ICU, in-hospital, or 30 day) and ranged from 6.0% to 95.0% (median 53.3%). KDIGO was the most frequently referenced AKI definition (reported in 26 studies), followed by RIFLE (19) and AKIN (11), with overlap across studies. Conclusions. AKI and RRT/CRRT use are common in adults receiving ECMO, with substantial variability driven by clinical heterogeneity and inconsistent AKI definitions and outcome reporting. Standardized AKI definitions and harmonized reporting of renal and mortality outcomes are needed to improve comparability and guide future ECMO–kidney research.
extracorporeal membrane oxygenation, ECMO, acute kidney injury, renal replacement therapy, CRRT, mortality
Restoration of Monocyte HLA-DR in Sepsis: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Introduction. Sepsis usually develops into an immunosuppressive state characterized by a reduction in monocyte HLA-DR expression. There have been many immunomodulatory and extracorporeal treatment options proposed to overcome this malfunction, but their overall effectiveness has not been determined. Methods. Randomized controlled trials were meta-analysed and systematically reviewed to evaluate therapies to restore monocyte HLA-DR expression in patients with sepsis in the adult population. Trials reporting quantitative post-treatment monocyte HLA-DR at an early follow-up time point were included. A random-effects model was used to pool standardized mean differences to control the heterogeneity among assay platforms. Results. Seven randomized clinical trials included eight treatment groups to be analyzed (a total of 329 subjects). All interventions (cytokine-based interventions, granulocyte-macrophage colony stimulating factor, interferon-γ, extracorporeal modalities, polymyxin-B hemoperfusion, continuous hemofiltration, hemofiltration–hemoadsorption) resulted in an increase in monocyte HLA-DR expression compared to control conditions. The overall effect size was large and statistically significant (SMD = 1.79, 95% CI: 1.18 to 2.40). Heterogeneity was high (I² ≈ 78%); however, leave-one-out sensitivity analyses demonstrated the robustness of the results, and the direction of the effect was always positive across all studies. Conclusions. Immunomodulatory and extracorporeal therapies consistently increase monocyte HLA-DR expression in sepsis, supporting the reversibility of sepsis-induced immunosuppression, with cytokine-based therapies showing the strongest effects. HLA-DR emerges as a key biomarker and therapeutic target, but evidence is limited by small, heterogeneous studies and reliance on surrogate endpoints. Larger, standardized trials with patient centred outcomes are needed to determine whether HLA-DR restoration improves survival.
sepsis, monocyte HLA-DR, immunosuppression, immunomodulatory therapy, meta-analysis
Psychological Interventions in Chronic Kidney Disease: A Comprehensive Review of Evidence-based Approaches in Clinical Practice
Psychological distress can contribute to maladaptive emotional regulation patterns, including repetitive listening to heartbreak music as a form of self-soothing that may unintentionally reinforce emotional self-harm cycles. This study aimed to examine the psychological predictors of emotional self-harm and evaluate the mediating role of repetitive exposure to heartbreak-related music. The research draws on existing literature in clinical psychology, emotion regulation, and cognitive-behavioral mechanisms. Findings suggest that individuals with higher levels of emotional vulnerability, rumination, and low self-efficacy are more likely to engage in repetitive listening to emotionally painful music, which may maintain or intensify cycles of emotional self-harm. The study highlights the need for clinical attention to music-related coping behaviors, especially in individuals prone to anxiety, depressive tendencies, or maladaptive emotional regulation. Implications for clinical practice and psychological interventions are discussed.
chronic kidney disease, depression, anxiety, cognitive behavioral therapy, psychotherapy, dialysis, kidney transplantation
Pregnancy-related Acute Kidney Injury: A Narrative Review of Epidemiology, Pathophysiology, and Clinical Management
Pregnancy-related acute kidney injury (Pr-AKI) is a severe complication of obstetric medicine that remains a significant cause of maternal and fetal morbidity and mortality. Although the burden has declined in many low- and middle-income countries (LMICs) following improvements in prenatal and obstetric care, its incidence has risen in high-income nations, due to older maternal age, the growing prevalence of diabetes and chronic hypertension, as well to more sensitive definition criteria and improved diagnostic tools. Physiological changes during pregnancy can lower the baseline serum creatinine level and may delay diagnosis. This review summarizes current evidence on the epidemiology, pathophysiology, etiologic mechanisms, diagnostic difficulties, management, and outcomes of Pr-AKI. Globally, the condition demonstrates a paradox, i.e., decreasing incidence but persistent mortality in LMICs and increasing incidence in developed countries. Hypertensive disorders of pregnancy, particularly preeclampsia, eclampsia, and the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, have become the predominant causes worldwide. Distinct trimester-specific patterns, overlap with thrombotic microangiopathies and acute fatty liver of pregnancy, and the need to balance maternal and fetal health make Pr-AKI uniquely complex. Improving Pr-AKI outcomes requires early recognition, pregnancy specific diagnostic biomarkers, and coordinated multidisciplinary care. Strengthening antenatal surveillance, expanding access to renal replacement therapy in resource-limited settings, and providing structured postpartum follow-up are essential to reducing the global burden of Pr-AKI.
acute kidney injury, hypertensive, preeclampsia, HELLP syndrome, maternal and fetal outcome, renal replacement therapy, pregnancy
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