Potentials of Natural Antioxidants in Reducing Inflammation and Oxidative Stress in Chronic Kidney Disease.

Chronic kidney disease (CKD) presents a substantial global public health challenge, with high morbidity and mortality. CKD patients often experience dyslipidaemia and poor glycaemic control, further exacerbating inflammation and oxidative stress in the kidney. If left untreated, these metabolic symptoms can progress to end-stage renal disease, necessitating long-term dialysis or kidney transplantation. Alleviating inflammation responses has become the standard approach in CKD management. Medications such as statins, metformin, and GLP-1 agonists, initially developed for treating metabolic dysregulation, demonstrate promising renal therapeutic benefits. The rising popularity of herbal remedies and supplements, perceived as natural antioxidants, has spurred investigations into their potential efficacy. Notably, lactoferrin, Boerhaavia diffusa, Amauroderma rugosum, and Ganoderma lucidum are known for their anti-inflammatory and antioxidant properties and may support kidney function preservation. However, the mechanisms underlying the effectiveness of Western medications and herbal remedies in alleviating inflammation and oxidative stress occurring in renal dysfunction are not completely known. This review aims to provide a comprehensive overview of CKD treatment strategies and renal function preservation and critically discusses the existing literature's limitations whilst offering insight into the potential antioxidant effects of these interventions. This could provide a useful guide for future clinical trials and facilitate the development of effective treatment strategies for kidney functions.

Comparison of Centrifugal and Pulsatile Perfusion to Preserve Donor Kidneys Using Ex Vivo Subnormothermic Perfusion.

Objective We have previously demonstrated benefits of kidney preservation utilizing an oxygenated subnormothermic ex vivo perfusion platform. Herein, we aim to compare pulsatile versus centrifugal (steady and uniform flow) perfusion with the goal of optimizing renal preservation with these devices. Materials and methods: Pig kidneys were procured following 30 min of warm ischemia by cross-clamping both renal arteries. Paired kidneys were cannulated and underwent either: oxygenated pulsatile or centrifugal perfusion using a hemoglobin oxygen carrier at room temperature with our ex vivo machine perfusion platform for 4 hr. Kidneys were reperfused with whole blood for 4 hr at 37° C. Renal function, pathology and evidence of inflammation were assessed post-perfusion. Results: Both pump systems performed equally well with organs exhibiting similar renal blood flow, and function post-reperfusion. Histologic evidence of renal damage using apoptosis staining and acute tubular necrosis scores was similar between groups. This was corroborated with urinary assessment of renal damage (NGAL 1) and inflammation (IL-6), as levels were similar between groups. Conclusion: In our porcine model with added warm ischemia simulating the effects of reperfusion after transplantation, pulsatile perfusion yielded similar renal protection compared with centrifugal perfusion kidney preservation. Both methods of perfusion can be used in ex vivo kidney perfusion systems.

Renal preservation by pure laparoscopic partial ureterectomy for contralateral ureteral metastasis 7 years after nephrectomy for renal cell carcinoma: A case report.

Contralateral ureteral metastasis after renal cell carcinoma (RCC) nephrectomy is uncommon. In such cases, a mass in the contralateral ureter needs to be differentiated from the primary ureteral tumor. If high grade primary ureteral tumor is found and total nephroureterectomy is performed, dialysis is introduced. In cases of metastasis of RCC, the kidney may be preserved by local treatment by partial ureterectomy. We report a case of contralateral ureteral metastasis after nephrectomy for right RCC. We underwent an originative method of pure laparoscopic partial ureterectomy and ureteral end-to-end anastomosis.

X-Capsular Incision for Tumor Enucleation (X-CITE)-Technique: A Method to Maximize Renal Parenchymal Preservation for Completely Endophytic Renal Tumors.

OBJECTIVE: To describe the X-Capsular Incision for Tumor Enucleation (X-CITE) technique to resect endophytic renal tumors while preserving the overlying renal parenchyma. SUBJECTS AND METHODS: We reviewed 1-year outcomes of 12 consecutive patients with a history of bilateral or multifocal renal tumors who presented to our institution with completely endophytic renal masse(s) between August 2017 and August 2018. Endophytic tumors were resected by making an X-shaped incision in the renal capsule and developing parenchymal flaps overlying the tumor pseudocapsule. Following tumor enucleation, the overlying parenchymal flaps were reapproximated. RESULTS: Median follow up was 19.9 months (range 10.6-14.9). Most patients also had additional exophytic tumors with a median of 5 renal tumors removed per operation with a median largest renal tumor size of 3.2 cm. No intraoperative or postoperative complications occurred. There was no decline in renal function after surgery when comparing median pre- and 12-month postoperative eGFR (94.5 vs 91.5, P= 0.18).). Postoperative nuclear mercaptoacetyltriglycine (MAG-3) renal scans demonstrated equal differential kidney function after surgery. Limitations include short-term follow-up and referral bias at center specializing in multi-focal kidney surgery. CONCLUSION: The X-Capsular Incision for Tumor Enucleation technique is feasible, safe and effective with minimal collateral damage in the treatment of completely endophytic renal masses. Further investigation should identify which patients may benefit from this procedure and explore intermediate and long-term outcomes.

Effects of Conversion From Calcineurin Inhibitors to Sirolimus or Everolimus on Renal Function and Possible Mechanisms in Liver Transplant Recipients.

Mammalian targets of rapamycin inhibitors (mTORIs), including sirolimus and everolimus, are used for minimizing calcineurin inhibitors after liver transplantation. However, head-to-head randomized comparisons of these 2 mTORIs are lacking. We assessed the differences in renoprotection and possible mechanisms between sirolimus and everolimus in liver transplant recipients. For this prospective cohort study, we recruited liver transplant recipients whose regimens were switched from tacrolimus to sirolimus or everolimus at a Taiwan medical center. Serial changes in estimated glomerular filtration rate (eGFR), urinary N-acetyl-ß-D-glucosaminidase, neutrophil gelatinase-associated lipocalin, 8-hydroxy-2'-deoxyguanosine, and transforming growth factor-ß1 during 1 year after mTORI conversion were compared within and between groups. In the 61 patients analyzed, no significant change in eGFR occurred within 12 months after conversion in both mTORI groups. Among patients with baseline eGFR <60 mL/min/1.73 m2 , eGFR improved at 6 months and 1 year after conversion (+12.3 and +12.0 mL/min/1.73 m2 , both P < .05). Urinary N-acetyl-ß-D-glucosaminidase decreased in both sirolimus and everolimus groups at 6 months (-68.7 ± 137.6 and -62.0 ± 92.4 U/g creatinine, both P < .05), and the reduction of urinary neutrophil gelatinase-associated lipocalin was significant in the sirolimus group (-4345.1 ± 7763.5 ng/g creatinine; P < .05). Neither transforming growth factor-ß1 nor 8-hydroxy-2´-deoxyguanosine changed significantly. In conclusion, the renoprotective effect of mTORI conversion was significant in liver transplant recipients with renal insufficiency, which was similar for sirolimus and everolimus, in the first year and may be associated with ameliorated tubular injury. Available evidence remains insufficient to determine which mTORI conversion therapy is more effective in renoprotection in the long run.

Role of CDK5/cyclin complexes in ischemia-induced death and survival of renal tubular cells.

Ischemia reperfusion processes induce damage in renal tubules and compromise the viability of kidney transplants. Understanding the molecular events responsible for tubule damage and recovery would help to develop new strategies for organ preservation. CDK5 has been traditionally considered a neuronal kinase with dual roles in cell death and survival. Here, we demonstrate that CDK5 and their regulators p35/p25 and cyclin I are also expressed in renal tubular cells. We show that treatment with CDK inhibitors promotes the formation of pro-survival CDK5/cyclin I complexes and enhances cell survival upon an ischemia reperfusion pro-apoptotic insult. These findings support the benefit of treating with CDK inhibitors for renal preservation, assisting renal tubule protection.

[Non-heart-beating renal donors: organization in a non-university hospital]. / Prélèvement rénal sur donneur décédé par arrêt cardiaque (DDAC): organisation dans un centre hospitalier non universitaire.

INTRODUCTION: In 2011 in France, all kidneys from patients with brain death and from living donors cannot meet the demand for renal transplants. Since 2006, sampling protocols kidneys from non-heart-beating donors (NHBD) are developed to increase the number of renal transplants. The objective was to describe the organization of a protocol NHBD in a non-university hospital. MATERIALS AND METHODS: Patients with inclusion criteria of protocol NHBD of the Agency of Biomedicine were prospectively included between 1st July 2011 and 31 December 2012. The protocol data were comparable to national data. Vascular canulation was performed by urologists. The epidemiological, clinical and biological characteristics of patients included, the different times and deadlines of the protocol, and data of renal transplantation were collected and analyzed. RESULTS: Over the period of 18 months, 16 patients were included in the protocol NHBD, with a median age of 42 years, and 87.5% of males; 93.8% of patients made a cardiac arrest outside the hospital. The median duration of no-flow was 4.3 minutes (0; 23), the median time between the cardiac arrest and admission to hospital was 90 minutes (0; 116), the median time between the cardiac arrest and the start of the normothermic recirculation was 139 minutes (40; 150), and the median duration of normothermic recirculation was 212 minutes (186; 240). For urologists, the median duration of mobilization was 178 minutes and 97 minutes after 20 h. Twenty-four kidneys were collected (75%) and 22 kidneys were transplanted (91.7%). The median duration of cold ischemia was 9 h 12 (5 h 25; 18 h 02). No primary non-function of graft was observed. Delayed graft function was observed in 50% of cases and the median duration of dialysis was 2 days (0; 19). After 12 months of inclusion, our center accounted for 8% of the national census and 16% of transplanted kidneys NHBD. CONCLUSION: The involvement of rescue, coordination, anesthesiologists and urologists, and the concentration of jobs in our center have helped to minimize response times NHBD in the protocol for maximum quality of kidneys taken with transplant rates and results are very encouraging.

Giant retroperitoneal liposarcoma- renal salvage by autotransplantation.

Liposarcomas are the most common retroperitoneal soft tissue tumors. We here in report a case of giant retroperitoneal sarcoma which weighed 24 kgs. Renal autotransplant of right kidney was done for organ preservation. The patient has done well after a follow up of 63 months. Complete surgical resection with organ preservation is the goal of treatment in patients with retroperitoneal liposarcomas.

The Management of Urinary Tuberculosis for Preservation of Renal Function / 대한비뇨기과학회지

During the period 1985-1989, 101 patients of urinary tuberculosis were treated at our hospital. Fifty-one of these patients were found to have obstructive dilatation of the urinary tract on pyelography. We reviewed these cases according to treatments for preservation of renal function. Twelve of these 51 cases were managed by chemotherapy only despite of the presence of obstructive dilatation. Eighteen of 51 cases required reconstructive treatment by partial nephrectomy (2), reimplantation of ureter into bladder (3), ileocystoplasty (2) and ileal conduit urinary diversion (1). In 24 of 51 cases, endourologic procedures were performed by stent indwelling (13), ureteral dilatation (7), endopyelotomy or endoinfundibulotomy (4). Seven cases had permanently a percutaneous nephrostomy to prevent further deterioration in renal function. In the cases that were managed only medically, 3(25.0%) improved, but, in reconstructive surgeries, improvement was noted in all cases and surgical morbidity was low. In 19 endourologic cases (79.2%), there has been a substantial improvement in renal function. Thus, in order to save more kidneys from destruction by tuberculosis despite of modern drug treatment, surgical or endourologic interventions are required when scar or stricture threatens to obstruct urinary flow.