Introduction: Cystoscopy is a urological procedure that, despite its minimally invasive nature, carries a risk of postoperative urinary tract infection (UTI), and preventing such infections is clinically important. Ceftriaxone, a broad‑spectrum third‑generation cephalosporin, is commonly used in surgical prophylaxis, yet its effectiveness in reducing post‑cystoscopy UTI has not been clearly established. Objectives: This study aimed to evaluate whether a single preoperative dose of ceftriaxone reduces the incidence of postoperative UTI in patients who received ceftriaxone compared to those who did not. Patients and Methods: This prospective case‑control study was conducted at Al‑Diwaniyha Teaching hospital in Iraq between April 2022 and April 2024, enrolling 200 patients undergoing flexible cystoscopy who were divided into two equal groups; one received a single preoperative dose of one gram of ceftriaxone, while the other had no antibiotic prophylaxis. Baseline demographic data were collected, and urine cultures were obtained within 24 hours before cystoscopy and again 5–7 days postoperatively. Outcomes assessed included postoperative urine culture results, occurrence of symptomatic UTI, and UTI requiring treatment, allowing comparison of infection rates between the ceftriaxone and control groups. Results: The results showed that non-use of prophylactic ceftriaxone was not significantly associated with higher rates of post-operative infection outcomes. For post-operative urine culture positivity, symptomatic UTI, and UTI requiring treatment, the odds ratios were 1.51, 1.34, and 1.70 in the unadjusted model and 1.33, 1.17, and 1.49 in the adjusted model (adjusted for age and gender as a confounder), respectively; however, all analyses were non-significant (P > 0.05). Conclusion: Omitting prophylactic ceftriaxone during flexible cystoscopy was not linked to increased post-procedural UTI, indicating that routine use may be unnecessary, requiring more judicious antibiotic therapy management.
Peptide receptor radionuclide therapy (PRRT) using radiolabeled somatostatin analogs like 177Lu-DOTATATE) is highly effective for metastatic neuroendocrine tumors (NETs). However, a significant dose-limiting toxicity is radiation-induced nephropathy, primarily driven by a phenomenon termed the proximal tubular trap. Following glomerular filtration, radiolabeled peptides are avidly reabsorbed by proximal tubular epithelial cells (PTECs) via the megalin/cubilin receptor-mediated endocytosis pathway. This intracellular retention concentrates the radionuclide within the tubules, leading to prolonged, localized irradiation of renal tissue, particularly the radiosensitive proximal tubules and microvasculature. Cumulative radiation exposure causes DNA damage, oxidative stress, inflammation, and ultimately progressive tubular atrophy, interstitial fibrosis, and glomerulosclerosis, manifesting clinically as declining glomerular filtration rate (GFR), proteinuria, and potentially end-stage renal disease months to several years post-therapy.
Chronic kidney disease (CKD) is a global health burden, often complicated by anemia due to impaired erythropoietin production and iron dysregulation. Vadadustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), has emerged as a promising therapeutic option for managing anemia in CKD patients. By stabilizing hypoxia-inducible factors, vadadustat enhances endogenous erythropoietin production and improves iron metabolism, offering a novel approach to treating CKD-associated anemia. Recent clinical trials demonstrate that vadadustat effectively increases hemoglobin levels, reduces the need for erythropoiesis-stimulating agents (ESAs), and improves patients’ quality of life. However, concerns regarding its safety, including potential risks of thromboembolic events and hypertension, warrant careful patient selection and monitoring. Comparative analyses with standard therapies, such as ESAs and other HIF-PH inhibitors, highlight vadadustat’s advantages in terms of oral administration and cost-effectiveness, while also identifying areas for further research.
Acute kidney injury (AKI) is a critical complication that can arise in the aftermath of earthquakes, particularly due to crush syndrome, which is the second most frequent cause of mortality in such disasters. The causes of AKI in earthquake victims are multifactorial, including direct renal trauma, hypovolemia, rhabdomyolysis and hemodynamic alterations. Rhabdomyolysis, the breakdown of damaged muscle tissue, is a primary contributor, releasing intracellular components into the bloodstream that can overwhelm the kidneys. Patients with chronic kidney disease (CKD), diabetes, or hypertension are more susceptible to AKI. These conditions impair renal function, making the kidneys more vulnerable to additional stressors such as dehydration or rhabdomyolysis.
Introduction: Kidney transplantation is a critical treatment for end-stage kidney disease, but its costs vary widely across countries and over time. Objectives: This study investigates changes in kidney transplantation costs between 2019 and 2023 using data from the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA). Methods: This ecological study analyzed kidney transplantation costs reported globally for 2019 and 2023 using data from the ISN-GKHA. The study included countries with complete cost data for both years, excluding those with missing or inconsistent records. Data collection focused on extracting first-year and subsequent annual transplantation costs from the publicly available ISN database. The primary outcome was the change in transplantation costs over time, evaluated to identify trends and regional variations in expenses across the included countries. Results: The trend from 2019 to 2023 in kidney transplantation costs varies by continent and globally. In Latin America, Brazil showed the highest increase, while Bolivia had the smallest. Oceania and Southeast Asia saw Australia with the largest increase and Indonesia with a decrease. Western Europe had the Netherlands with the greatest rise and Germany with a decrease. Saudi Arabia had the highest increase in the Middle East, while the West Bank and Gaza had the least. South Asia’s Bangladesh showed a modest increase. In North America, the United States experienced the largest increase, whereas Canada had a decrease. North and East Asia saw Japan with the most notable increase and China with a decrease. Africa had Morocco with the highest increase and Egypt with the smallest. Eastern and Central Europe recorded the largest rise in Slovenia and the smallest in Serbia. Overall, the United States had the most significant increase, while Germany showed the greatest decrease. Conclusion: The findings highlight significant regional disparities in kidney transplantation costs globally, emphasizing the necessity for targeted healthcare policies and ongoing monitoring to ensure cost-effective and equitable access to transplantation services worldwide.
