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, Google Scholar (The Others in Processing)
Critical Care Nephrology in the Era of Planetary Health: Aligning Intensive Kidney Care with the Vision of World Kidney Day
Copyright (c) 2026 Research Journal of Critical Care Nephrology 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
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 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
Our Journal: Bridging Research and Clinical Practice
Copyright (c) 2025 Research Journal of Critical Care Nephrology https://creativecommons.org/licenses/by/4.0
Fluid Resuscitation in Sepsis and Septic Shock; What to Give and How Much to Give: A Systematic Review of Randomized Controlled Trials
Introduction. The optimal composition and volume of intravenous fluids for sepsis resuscitation remain uncertain. We conducted a systematic review focused on two core questions: what fluid to administer and how much to give in adult sepsis and septic shock. Methods. We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials published from January 2020 to September 2025. Eligible trials enrolled adults with sepsis or septic shock and compared either fluid composition (e.g., balanced crystalloids, saline, albumin, plasma) or resuscitation volume/strategy (restrictive versus liberal or protocolized versus usual care). Two reviewers screened and extracted data; risk of bias was assessed using RoB 2. Owing to clinical heterogeneity and overlapping parent datasets, findings were synthesized qualitatively. Results. We identified contemporary multicenter RCTs and prespecified or post hoc analyses spanning ED and ICU settings. Balanced crystalloids consistently reduced hyperchloremic acidosis and showed context-dependent signals for improved short-term outcomes versus saline; absolute mortality effects were modest. Albumin and plasma-based strategies produced transient physiologic gains without durable outcome benefits. Large trials comparing volume strategies (CLASSIC, CLOVERS) showed no overall mortality difference despite approximately two liters less fluid and earlier vasopressors in restrictive arms. Subgroup data suggested advantage for restrictive, vasopressor-prioritized care in advanced chronic kidney disease, while mechanistic sub-studies demonstrated no adverse effects on cardiac strain or endothelial glycocalyx. Feasibility trials targeting non-resuscitation fluids reduced administered volumes without safety concerns. Conclusions. Current randomized evidence supports balanced crystalloids as default resuscitation fluids and indicates that clinically guided restrictive strategies are generally as safe as liberal ones, with potential benefit in fluid-intolerant phenotypes. Effectiveness depends less on a fixed fluid or volume and more on timing, patient context, and physiologic tolerance, reinforcing the paradigm of precision fluid therapy.
sepsis, septic shock, fluid therapy, crystalloids, saline solution, albumins, resuscitation, vasoconstrictor agents, randomized controlled trials
The Evolving Role of the Nephrology Critical Care Nurse
Diagnostic Efficacy and Imaging Characteristics of MRI Combined with CT in Children with Duplex Kidney
Introduction. To analyze the diagnostic efficacy and imaging characteristics of MRI combined with CT in children with duplication of kidney. Methods. A retrospective analysis was conducted of the clinical data of 40 children with duplication of kidney admitted to our hospital between January 2019 and January 2024 and confirmed surgically. All patients underwent MRI and CT examinations, with surgery as the gold standard. The diagnostic efficacy of MRI and CT in children with duplication of kidney was analyzed. Results. CT confirmed 32 cases of duplication of kidney, with a diagnostic rate of 80%. MRI confirmed 33 cases of duplication of kidney, with a diagnostic rate of 82.50%. CT combined with MRI confirmed 39 cases of duplication of kidney, with a diagnostic rate of 97.50%. The diagnostic rate of CT combined with MRI for duplication of kidney was higher than that of CT or MRI alone (P < .05). The diagnostic accuracy of CT combined with MRI for hydronephrosis duplication was 100%, significantly higher than the 77.27 and 81.82% rates of CT and MRI alone (P < .05) . There was no significant difference in the diagnostic accuracy of CT or MRI alone for developmental and dysplastic duplication (P > .05). Conclusions. MRI combined with CT has a high diagnostic efficacy for duplex kidney and its classification in children, which can provide a reference for clinical diagnosis and treatment and can be vigorously promoted in clinical practice.
duplication of kidney, MRI, CT, diagnostic performance, imaging characteristics
Immune Suppressive Medications Role in the Prognosis of COVID-19 Among Kidney Transplant Recipients
Introduction. Kidney transplant recipients are among the most critical individuals when facing COVID-19 pneumonia with increased risk of morbidities and mortalities. Immune suppressive medications are essential to prevent from rejection, while due to their immune associated properties, these drugs are one of the major culprits for severe pneumonia. The current study aims to investigate the role of these agents in prognosis of COVID-19 pneumonia. Methods. The current cross-sectional study was conducted on 139 kidney transplanted recipients hospitalized due to COVID-19 pneumonia. The transplant-related medications including angiotensin convertase enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs), corticosteroids, calcineurin inhibitors, mycophenolate mofetil, and mammalian targets of rapamycin inhibitors were recorded and their prognosticating role in the mortality and survival of the patients was evaluated through logistic and cox regression in crude and adjusted models: 1) age and gender, and 2) age, gender, medical diseases and COVID-19 severity. Results. Based on logistic regression assessment, none of the consumed drugs by kidney transplant recipients had a preventive role in the mortality of the patients in either crude or adjusted models (P > .05). However, cox regression measures revealed that treatment with ACEI/ARB was accompanied by longer survival in the crude (HR = 0.532, 95% CI: 0.333 to 0.851, P = .008) and adjusted models 1 (HR = 0.515, 95% CI: 0.318 to 0.833, P = .007) and 2 (HR = 0.583, 95% CI: 0.349 to 0.975, P = .040), respectively. Conclusions. Based on the findings of the current study, ACEI/ ARB use was accompanied with decreased length of ICU stay among the kidney transplant patients with COVID-19 infection, while the other medications did not have any effect.
Surviving Sepsis Is Not Enough, Time to Confront Post-sepsis Syndrome, A Narrative Review
While global advances in sepsis care have reduced acute mortality, many survivors face a persistent burden of Post-Sepsis Syndrome (PSS), a complex condition encompassing physical, cognitive, psychological, immunologic, and social sequelae. Despite its prevalence, post-sepsis care remains fragmented and under recognized within routine critical care pathways. Relevant literature on post-sepsis outcomes was reviewed through major scientific databases, focusing on studies exploring the physical, cognitive, psychological, immunologic, and social consequences of sepsis. Observational, interventional, and review articles contributing to the understanding of post-sepsis syndrome were evaluated, and findings were synthesized narratively across key thematic domains. Recent multi-center and population-based studies reveal that over half of sepsis survivors experience at least one PSS component within the first year after discharge. Persistent fatigue, neuromuscular weakness, cognitive dysfunction, depression, anxiety, and increased susceptibility to infections are the most common manifestations. Hospital readmission and long-term functional decline remain frequent, while structured follow-up and rehabilitation services are scarce. Awareness among clinicians and policy frameworks addressing survivorship are limited. The reduction of in-hospital sepsis mortality has unveiled a new challenge; survivorship. Long-term recovery requires coordinated and multidisciplinary care extending beyond ICU discharge. Integrating PSS surveillance, rehabilitation programs, and patient education into national sepsis strategies is essential to improve functional outcomes and quality of life.
Dexmedetomidine on the Prognosis of Patients With Sepsis-related Acute Kidney Injury
Introduction. To investigate the effect of dexmedetomidine (DEX) on the prognosis and renal function recovery in patients with sepsis-associated AKI (SA-AKI). Methods. A prospective observational study was conducted, enrolling patients with SA-AKI admitted to the ICU of Suzhou Municipal Hospital from July 2021 to June 2023. Patients were divided into a DEX group and a non-DEX group according to the sedation regimen. Results. After matching, a total of 204 patients (102 in each group) were included, with balanced baseline (SMD < 10%). The primary endpoint: DEX significantly reduced the risk of 28-day mortality (adjusted HR = 0.556, 95% CI:0.317 to 0.975; P = .041), with a particularly significant benefit in patients with non septic shock (HR = 0.372, P = .016) and AKI stage 1 (HR = 0.375, P = .035). Secondary endpoints: DEX significantly improved the rate of renal function recovery (adjusted OR = 2.841, 95% CI:1.427 to 5.656; P = .003), and the efficacy was modified by AKI stage (P-interaction = .005) and shock status (P-interaction = .006). The benefit was most prominent in patients with AKI stage 1 (P = .009) ; the benefit was clear in patients with non-septic shock (P = .011). There was a strong trend toward benefit in patients with septic shock (P = .054). There was no difference in ICU length of stay between the two groups (P > .05). Conclusions. DEX significantly improves survival and promotes renal function recovery in patients with SA-AKI, particularly in patients with stage 1 AKI and non-septic shock. The potentially significant benefit observed in patients with septic shock warrants further validation in a larger sample.
Dexmedetomidine; sepsis; acute kidney injury; mortality; intensive care
Sepsis Management in Post-bariatric Surgery Patients Using Extracorporeal Blood Purification Treatment, A Case Series
Introduction. Bariatric surgery (BS) is among the most effective treatments for severe obesity. However, it is essential to acknowledge the risk of serious short-term complications following the procedure. Case Presentation. We report four cases of Iranian patients admitted due to severe short-term complications following sleeve gastrectomy (SG), which included peritonitis, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and sepsis. Based on their diagnoses and individual needs, two patients underwent exploratory laparotomy. All four cases were successfully treated with intravenous antibiotics, intensive supportive care, and continuous renal replacement therapy (CRRT) along with extracorporeal hemoperfusion. Conclusions. SG is one of the most commonly performed metabolic procedures worldwide. However, it can lead to severe, life threatening complications, such as sepsis resulting from peritonitis and pneumonia. These cases underscore the importance of early recognition and effective treatment strategies for this patient population. A strict postoperative follow-up is essential for the early detection and management of complications, ultimately reducing morbidity and mortality rates.
sepsis, bariatric surgery, extracorporeal blood purification, continuous renal replacement therapy (CRRT)
Association Between Lipid-related Parameters and the Carotid Intima-media Thickness, Relating to Type 2 Diabetes Mellitus
Introduction. Higher carotid intima-media thickness (CIMT), indicates a greater burden of subclinical atherosclerosis (AS) and cardiovascular disease (CVD). The AS is related to insulin resistance and lipid oxidation. Detection of reliable and affordable surrogate markers and metabolic components for assessing the CVD risk is world-shaking. This study aimed to inspect the relationship between lipid-related parameters and CIMT, considering the impact of type 2 diabetes mellitus (T2DM). Methods. This cross-sectional study was conducted on a total of 244 participants (113 men and 131 women), including 118 diagnosed with diabetes (DM) and 126 without diabetes (non DM). Duplex ultrasonography parameters, demographic, physical, biochemical assessments, and lipid-related parameters were measured. Correlation and linear regression analyses assessed the relationship between the lipid-related parameters and CIMT. Results. The DM patients’ levels of triglyceride-glucose (TyG) index were significantly higher than the non-DM ones, however, the two groups demonstrated no statistically significant difference in CIMT levels. CIMT was correlated with low-density lipoprotein (r = 0.33, P = .033) in the DM group and with age (r = 0.41, P < .001) in the non-DM group. The multivariate linear regression model demonstrated age, TyG-BMI, and LDL/HDL ratio as the significant associates of CIMT, with age having the largest standardized regression coefficient of 0.311 (P < .001). Conclusions. The current study revealed direct associations of CIMT with age, TyG-BMI, and LDL/HDL ratio, taking into account the DM/non-DM binary among the study participants.