Introduction Intrarenal Pressure (IRP) influences the safety of Ureteroscopy (URS) and Retrograde Intrarenal Surgery (RIRS), with excessive pressure potentially contributing to fluid absorption and infectious complications. This review evaluated the effects of pressure-modulating devices on fluid absorption, pressure dynamics, and perioperative outcomes in URS/RIRS. Methods A PRISMA-based systematic review was conducted and registered in PROSPERO (CRD420251238560). PubMed, Cochrane, and EBSCO were searched. Eligible studies were assessed using ROB 2 or the Newcastle–Ottawa Scale. Random-effects meta-analysis was performed for comparable outcomes. Results Four studies were included, comprising two randomized trials and two observational cohorts. Pressure-modulating systems significantly reduced fluid absorption (MD −159.71 mL; 95% CI −264.05 to −55.37; p = 0.003) and operative time (MD −22.93 min; 95% CI −45.28 to −0.58; p = 0.04). Postoperative fever was not significantly reduced (RD −0.05; 95% CI −0.18 to 0.08; p = 0.43). Discussion Pressure-modulating systems were associated with lower irrigation fluid absorption and shorter operative time. However, the reduction in postoperative fever was not statistically significant. Differences in devices, irrigation protocols, and pressure measurement methods may explain the variability between studies. Conclusion Available evidence suggests that intrarenal pressure–modulating devices enhance procedural safety during URS and RIRS by improving fluid dynamics without compromising treatment effectiveness. Further large-scale, multicenter trials are warranted to establish optimal pressure targets, harmonize outcome reporting, and clarify long-term clinical and economic implications.
Introduction/ Objectives Difficult cannulation of Arteriovenous Fistulae (AVF) remains a significant challenge, potentially affecting dialysis adequacy and increasing the risk of vascular access complications. This study aimed to assess the prevalence and describe AVF complications and Doppler-derived flow patterns among affected hemodialysis patients. Methods This retrospective observational study included adult maintenance hemodialysis patients treated at a single center in Tirana, Albania, between February 2024 and February 2025. Medical records and Doppler ultrasound findings were reviewed. Categorical variables were compared using Fisher’s exact test. Doppler analyses were descriptive because comparable measurements were unavailable for patients without difficult cannulation. Results : Of 141 screened patients, 96 had native AVFs, and 33 met the difficult-cannulation definition, representing 23.4% of the screened cohort and 34.4% of patients with native AVFs. Among these 33 patients, 99 Doppler measurements were analyzed: 17.2% showed low flow, 48.5% adequate flow, and 34.3% high flow. Thrombosis occurred in 19 patients (57.6%). AVFs aged 5-10 years had higher odds of calcification than AVFs aged less than 1 year (OR 15.00, 95% CI 1.60–140.20; p = 0.0096). Aneurysm or varicosity was also more frequent in the older group (p = 0.018). Discussion Doppler abnormalities were frequent among affected patients, but no association with difficult cannulation can be inferred without a comparison group. Conclusion Difficult cannulation was common in this cohort. The observed associations with AVF vintage are exploratory and require confirmation in prospective studies with standardized Doppler protocols and multivariable analysis.
Introduction Acute kidney injury affects about one in five hospitalised adults and substantially increases the risk of chronic kidney disease, yet conventional scoring systems poorly identify patients who will progress. This review critically appraises artificial intelligence and machine learning models for prognostication across the acute kidney injury–acute kidney disease–chronic kidney disease continuum. Methods A narrative review of 48 source articles was undertaken, covering persistent kidney injury, renal recovery, dialysis dependence, major adverse kidney events, mortality, and chronic kidney disease. Studies were examined for prediction endpoint, injury aetiology, algorithm, dataset, validation strategy, interpretability, and clinical applicability. Results Reported discrimination varied substantially across algorithms, endpoints, populations, datasets, and validation strategies, with several models outperforming conventional comparators in within-study comparisons. Serum creatinine dynamics, blood urea nitrogen, age, vasopressor use, urine output, and measures of comorbidity, including the Charlson Comorbidity Index (CCI), were recurrent predictors, although their importance varied by population and endpoint. Fewer than one-third of studies were externally validated; most were retrospective and at high risk of bias, calibration and fairness were seldom assessed, and no randomised evidence of improved patient outcomes exists. Discussion The evidence comprises heterogeneous, non-equivalent prediction tasks rather than a single modelled transition to chronic kidney disease. Cross-study performance comparisons are therefore unreliable, and post-hoc explanation tools cannot replace inherent interpretability, calibration, and prospective validation. Conclusion Artificial intelligence shows promise for prognostication after acute kidney injury, but clinical translation requires clearly defined endpoints, aetiology-aware modelling, prospective multicentre validation, fairness assessment, and randomised trials demonstrating patient benefit.
IntroductionThrombocytopenia can increase during Continuous Kidney Replacement Therapy (CKRT) in critically ill patients. This is the first systematic review that assesses whether thrombocytopenia during CKRT is clinically relevant. MethodsThe authors comprehensively evaluated CKRT-related thrombocytopenia data. Qualitative and quantitative tools were used to assess quality and risk of bias, epidemiology, causality, clinical outcomes, and possible mitigation and management strategies in the included publications. A subset analysis using Hedges’ g was conducted to assess the impact of the various parameters of interest. ResultsIndependent review of over 9,273 records by three authors produced 119 that met the inclusion criteria, and 85 full-text articles involving 29,217 patient samples were evaluated. A descriptive analysis is provided. Most studies were of poor quality (RCTs: 50%; Cohorts: 71%; Systematic Reviews/Meta-analyses: 66%; Cases: 67%). Case studies were fair (67%) to good (33%) quality. The level of certainty of the evidence was moderate for device-related, non-anticoagulant drugs, underlying conditions, and risk factor effects. A high level of evidence certainty was established for anticoagulant drugs, clinical outcomes (mortality/survival, bleeding risk, and filter life), and management and prevention. The subset analysis revealed small to large effect sizes for 19 parameters. DiscussionWhile platelet reductions exceeding 40% are associated with increased morbidity, the impact of CKRT on thrombocytopenia was reversible following treatment cessation in many patients. ConclusionThis systematic review is the first to conclude that CKRT-induced thrombocytopenia appears reversible and may not be clinically significant unless affected by additional risk factors, including medications and existing comorbid conditions.
IntroductionAminophylline, a non-selective phosphodiesterase inhibitor with smooth muscle relaxant effects, is established in pulmonary medicine but has not been systematically reviewed as an adjunct in ureteroscopic lithotripsy. This review assesses its efficacy and safety when administered either intravesically or intravenously. MethodsPubMed, Cochrane Library, EBSCO, and Google Scholar were searched to June 2025. Eligible studies were Randomized Controlled Trials (RCTs) or semi-experimental trials assessing aminophylline during ureteroscopic lithotripsy. Outcomes included Stone-Free Rate (SFR), operative time, ureteral access, stent requirement, pain, hematuria, Catheter-Related Bladder Discomfort (CRBD), and adverse events. Risk of bias was assessed with RoB 2.0 for RCTs and ROBINS-I for non-RCTs. ResultsEight studies (596 patients) were included. Intravesical aminophylline consistently improved ureteral access and reduced operative time; Lubana et al. showed higher success (82% vs 44%, p = 0.002) and less stenting (38% vs 68%, p = 0.011). Shabayek and Saafan reported reductions in intraureteral pressure, hematuria, and pain. Intravenous aminophylline showed mixed results: Barzegarnezhad found higher SFR (97.6% vs 84%), Ghadyan reported lower procedural success but less stenting, while Rehab et al. observed reduced CRBD (26% vs 59%, p = 0.025) and analgesic use. Adverse events were mild and transient. DiscussionEvidence is limited by small samples, heterogeneous designs, and variable definitions of “success.” Effect sizes may vary with stone size, location, and lithotripsy modality. Sensitivity analysis was not feasible, lowering certainty. ConclusionAminophylline may be a safe, low-cost adjunct to ureteroscopic lithotripsy, enhancing access, reducing operative time, and lowering morbidity. However, evidence remains low-certainty and hypothesis-generating, warranting larger multicenter RCTs.
