Treating autosomal dominant polycystic kidney disease (ADPKD) has always been a challenge because the disease is too complex for single-target drugs, which are often held back by side effects. This narrative review explores a different strategy: using plant-derived polyphenols to target multiple disease pathways at the same time. Looking at research from 2005 to 2026, we break down how key compounds like resveratrol, curcumin, naringenin, quercetin, and epigallocatechin-3-gallate (EGCG) actually work. Preclinical studies show these molecules can slow down cyst growth by tackling inflammation, rapid cell division, and tissue scarring all at once, while also resetting the skewed energy metabolism of cystic cells. Some mechanisms are strikingly specific, such as naringenin’s direct interaction with polycystin-2 and quercetin’s ability to clear senescent cells. Yet, the real-world hurdle is poor absorption; a recent clinical trial with standard curcumin fell short simply because the compound could not reach the kidneys in high enough concentrations. Moving forward, the field needs to focus on testing these compounds in realistic animal models, designing smart nanoformulations to improve bioavailability, and exploring combinations that could safely complement current therapies like tolvaptan.

Chloride, the leading extracellular anion, plays a crucial role in acid-base balance, fluid homeostasis, and neuromuscular function. Despite historical underrecognition, emerging evidence demonstrates significant associations between chloremia disturbances and critical care outcomes. This paper aims to narratively review the pathophysiology, clinical features, and management strategies of chloremia disturbances in critically ill patients. Chloremia disturbances are common in ICU patients, with both hypochloremia (<96 mEq/L) and hyperchloremia (>106 mEq/L) independently associated with increased mortality, prolonged ICU length of stay, and organ dysfunction. In sepsis, chloride levels exhibit a prognostic value, with threshold effects around 105 mEq/L. Hyperchloremia particularly increases acute kidney injury risk, while hypochloremia correlates with prolonged mechanical ventilation. The choice of resuscitation fluids significantly influences clinical outcomes, with balanced crystalloids potentially reducing adverse events if compared to normal saline solutions. Recent large-scale trials demonstrate lower rates of major adverse kidney events with chloride-restrictive strategies. Optimal management requires careful patient monitoring along with acid-base assessment. Treatment approaches must identify underlying causes to avoid complications. Prevention strategies include protocol-based fluid therapy, medication selection consideration, and early intervention in high-risk patients. Emerging technologies, including continuous monitoring systems and machine learning algorithms, offer promising advances for predicting and managing chloride disturbances.

Cardiorenal disease reflects a tightly interconnected pathophysiological continuum driven by neurohormonal activation, inflammation, oxidative stress, and progressive fibrosis. Among these mechanisms, mineralocorticoid receptor (MR) overactivation has emerged as a central mediator of cardiac and renal injury independent of blood pressure effects. Finerenone, a non-steroidal selective MR antagonist, exhibits distinct pharmacological properties compared with steroidal MR antagonists, including enhanced receptor selectivity, balanced cardiac and renal tissue distribution, and differential cofactor modulation that translates into potent anti-inflammatory and antifibrotic activity with an improved safety profile. Large outcome trials have established finerenone as an effective cardiorenal protective therapy. The FIDELIO-DKD and FIGARO-DKD trials demonstrated significant reductions in kidney disease progression and cardiovascular events in patients with type 2 diabetes and chronic kidney disease, with consistent benefits confirmed in the pooled FIDELITY analysis. More recently, the FINEARTS-HF trial extended these benefits to patients with heart failure with mildly reduced or preserved ejection fraction regardless of diabetes status. Across trials, hyperkalemia was infrequent when structured monitoring strategies were applied. Beyond established indications, emerging data suggest potential systemic effects on retinal and hepatic outcomes, while ongoing studies are evaluating finerenone in non-diabetic chronic kidney disease. Subgroup analyses consistently demonstrate preserved efficacy and favorable safety when finerenone is combined with sodium–glucose cotransporter-2 inhibitors, supporting complementary disease-modifying strategies. This review integrates molecular mechanisms, clinical trial evidence, systemic effects, and therapeutic positioning of finerenone within contemporary cardiorenal care, highlighting its expanding role in multidrug approaches targeting the cardiovascular–renal–metabolic axis.

Purpose: Aim of the paper is to present preliminary data on the correlation between the level of renal damage expressed through laboratory and retino-choroidal vascular parameter in non-diabetic hypertensive patients. Methods: Retrospective observational study included patients affected by Chronic Kidney Disease (CKD) or not evaluated by OCT and OCT-A. Clinical and laboratory parameters included blood pressure and renal function assessment. Results: Statistically significant differences were observed between the two subgroups as far as mean office blood pressure (BP) (p=0.013) and office systolic BP (p=0.011). OCT parameters showed no statistically significant differences. In OCT-A FAZ area was larger in no CKD patients in both capillary plexus (63.2±2.37% vs. 61.2±1.64%, p=0.004; and 63.1±2.73% vs. 61.2±2.01%, p=0.019, respectively), Vessel Density was lower in CKD group (in inner ring 36.8±2.7% vs. 38.8±1.64%, p=0.004; and 36.7±2.9% vs. 38.8±2.1%, p=0.002, respectively, and in outer ring 40.2±1.8% vs. 41.5±1.1%, p=0.012 and 40.4±1.8% vs. 42.0±1 %, p<0.001). No significant differences were observed with respect to Fractal Dimension, Vessel Tortuosity, or Vessel Length Density, but Capillary Density Index (CDI) was significant lower in CKD patients (p<0.001). Correlation between CDI and urinary albumin excretion (UAE) levels was significant negative (r= –0.49, p=0.0001). ROC curve analysis demonstrated discriminative ability of CDI in identifying UAE levels (AUC=0.777, p<0.0001). Conclusion: UAE association with reduction in CDI suggests a possible coexistence of endothelial damage at the retinal and renal levels.Retinal microvascular alterations are indicative of CKD, and OCTA can provide new biomarkers for early evaluation of the related damage.

BACKGROUND:Cardiorenal syndrome (CRS) represents a complex clinical entity characterized by the bidirectional dysfunction of the heart and kidneys. Despite advances in pharmacological therapy, CRS remains associated with high morbidity and mortality. Pathophysiological drivers, including oxidative stress, chronic inflammation, and mitochondrial derangements, create a self-perpetuating cycle of organ damage that necessitates multitarget therapeutic approaches. OBJECTIVE:This review synthesizes current preclinical evidence regarding the protective roles of plant-derived polyphenols-specifically bergamot, curcumin, quercetin, catechins, and resveratrol-in mitigating the cardiorenal continuum. METHODS:An analysis of recent literature was conducted, focusing on the molecular mechanisms by which these bioactives modulate redox balance, inflammatory signaling, and mitochondrial homeostasis in experimental models of CRS. RESULTS:Polyphenols act at the crossroads of several stress-response pathways. Key mechanisms include the activation of the Nrf2/HO-1 axis to enhance endogenous antioxidant defenses, the suppression of the NLRP3 inflammasome to attenuate systemic "inflammaging", and the preservation of mitochondrial quality through SIRT1/PINK1/Parkin-mediated mitophagy. Furthermore, emerging evidence highlights the role of polyphenols in modulating the gut-kidney-heart axis by reducing microbiota-derived uremic toxins. CONCLUSIONS:Preclinical data suggest that polyphenols are potent multifunctional agents capable of breaking the feedback loops of cardiorenal injury. While bioavailability remains a significant translational challenge, novel nano-delivery systems and synthetic analogs offer promising strategies for clinical application. Integrating these bioactives into CRS management could provide a decisive adjunctive strategy to improve metabolic homeostasis and prevent end-stage organ failure.

Intracranial aneurysms are a prevalent cerebrovascular condition and a leading cause of aneurysmal subarachnoid hemorrhage (aSAH). Beyond established risk factors, increasing attention has been focused on metabolic conditions that may modulate vascular inflammation and endothelial function. In this context, obesity has been proposed as potential modifiers of intracranial aneurysm vulnerability. However, clinical evidence remains inconsistent and, in some cases, counterintuitive. Most studies rely on body mass index (BMI) as a proxy for adiposity. Across population-based cohorts and clinical series, BMI has not consistently emerged as an independent risk factor for aneurysm formation or rupture after adjustment for major confounders. Conversely, several studies have reported inverse associations between higher BMI and the risk of aSAH or post-hemorrhagic mortality, findings that have contributed to the concept of an "obesity paradox." Nevertheless, these associations vary widely by study design, population characteristics, and clinical endpoints, and do not show a consistent linear response pattern. Interpretation of these findings is limited by substantial methodological constraints. BMI does not reflect body composition, fat distribution, or the biological activity of adipose tissue, and may instead capture overall health status or nutritional reserve. Overall, current clinical evidence does not support a consistent or independent role of BMI-defined obesity in intracranial aneurysm risk or prognosis. Reported inverse associations should be interpreted with caution, as they may reflect methodological constraints rather than true biological effects. Future research should incorporate direct and biologically meaningful measures of adiposity to better clarify the relationship between metabolic factors and aneurysm disease.

The gut microbiota is an established modulator of blood pressure, but the oral bacteriome and the fungal mycobiome have been examined largely in isolation from it and from each other. No previous synthesis has evaluated all three compartments within one analytical framework, or treated sex and ethnicity as primary analytical axes rather than adjustment covariates. Systematic review reported according to PRISMA 2020 and, for the synthesis, the SWiM guideline. PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception to 30 June 2026. Observational human studies in adults reporting gut, oral, or fungal microbiota data stratified by blood pressure status were eligible, together with Mendelian randomisation studies and studies with a nested experimental causal component. Two reviewers screened and extracted independently, with a third resolving disagreement. Risk of bias was assessed with the Newcastle–Ottawa Scale and certainty of evidence with GRADE adapted for exposure–outcome questions. Increased abundance of the Ruminococcus gnavus group was the most convergent taxon-level finding, replicated in three independent populations on two continents, including one prospective multi-ethnic cohort with full adjustment and correction for multiple comparisons (OR 1.07, 95% CI 1.01–1.14 for incident hypertension). In the oral compartment, depletion of the nitrate-reducing commensal Neisseria subflava converged across a United States prospective cohort and an Italian case–control study using unrelated methods, and salivary nitric oxide was approximately three-fold lower in hypertensive subjects. Depletion of the short-chain fatty acid producers Faecalibacterium and Roseburia and enrichment of Klebsiella were convergent but geographically restricted. Mycobiome evidence was contradictory: two studies reported fungal dysbiosis, one of them already at the pre-hypertensive stage, while a cross-cohort metagenome-wide study on two independent cohorts from Beijing and Dalian (N = 159 hypertensive patients, 101 healthy controls) identified 61 gut bacterial species with consistent altered abundance across both cohorts while finding no replicable mycobiome signal. Recurring across compartments and kingdoms was the collapse of microbial co-correlation networks in hypertension, alongside a dissociation between null alpha diversity and significant beta diversity. Associations differed by ethnicity within a single multi-ethnic cohort and were generally stronger in women. Certainty of evidence, assessed per individual convergent finding, was very low for every taxon-level finding and low for salivary nitric oxide; these ratings concern the attribution of hypertension to specific organisms, not the existence of a microbiota–hypertension association, which is supported at community level in every compartment examined and by experimental transfer models. That the microbiota differs in hypertension is well supported; which organisms are responsible is not. The most reproducible signal is structural rather than taxonomic, and conventional differential-abundance analysis is not designed to detect it. No individual microbial taxon is currently ready to serve as a marker of hypertension or to inform clinical practice.

Background: Cigarette smoking is a widely recognized risk factor for several diseases and a crucial problem in global health, as it contributes to the development and worsening of various diseases, resulting in an increase in both morbidity and mortality. One of the strategies to reduce the impact of tobacco damage is based on the transition from flammable to non-flammable nicotine products. Objectives: The aim of this narrative review is to summarize the effects of traditional cigarette smoking and non-combustible nicotine products on kidney function. Conclusions: The evidence shows that both combustible and non-combustible nicotine products have harmful effects on kidney health and may promote the onset and progression of kidney dysfunction, leading to chronic kidney disease (CKD).

Heart failure (HF) and chronic kidney disease (CKD) are prevalent conditions in older adults, often coexisting and significantly increasing the risk of hospitalization, cardiovascular events, and mortality. Traditional hospital-based care, while essential for acute management, is often insufficient to ensure continuity of care and optimal long-term outcomes. Home-based care, although promising for improving quality of life and reducing hospital-acquired complications, faces challenges related to treatment adherence, monitoring, and caregiver support. Recent evidence highlights the potential of multidisciplinary, patient-centered care models integrating physicians, nurses, pharmacists, and family caregivers. Technological innovations, including telemedicine, remote monitoring, mobile health applications, and artificial intelligence, have shown efficacy in early detection of clinical deterioration, improving adherence, and reducing cardiovascular events in HF and CKD patients. Structured patient education, caregiver training, and proactive follow-up are key elements to optimize transitions from hospital to home and to improve long-term outcomes, including reduced rehospitalizations and better quality of life. Future care strategies should focus on personalized, integrated approaches that combine technology, education, and multidisciplinary collaboration to address the complex needs of HF and CKD patients, while mitigating healthcare costs and enhancing overall patient well-being.

Background: 8-iso-prostaglandin-F2α (8-iso-PGF2α) is a recognized marker of oxidative stress. Previous studies suggested that 8-iso-PGF2α plays an important role in the pathogenesis of hypertension and cardiovascular (CV) diseases. However, limited data exist on the prognostic role of 8-iso-PGF2α in hypertensive patients undergoing primary prevention. The aim of this study was to assess the relationship between 8-iso-PGF2α and 10-year CV risk, as predicted by validated equations in hypertension patients without CV diseases. Materials and methods: A total of 432 individuals aged 40–75 years were enrolled. Plasma 8-iso-PGF2α was assessed through the ELISA method. CV risk was calculated by using the Framingham Risk Score (Fr-S) and the Atherosclerosis Cardiovascular Disease Risk Score (ASCVD-S). Low, moderate, or high CV risks were defined according to validated cutoffs. Results: Individuals with higher CV risk had significantly greater 8-iso-PGF2α values compared to those with low or moderate CV risk (p < 0.001). 8-iso-PGF2α correlated strongly with Fr-S and ASCVD-S in the entire population and in patients with normal renal function (all p < 0.001) but not in patients with eGFR < 60 mL/min/1.73 m2. These associations remained significant after adjustment for traditional factors included in the CV risk equations in the overall population and in patients with normal renal function. The 8-iso-PGF2α cutoffs that best distinguished patients with high CV risk were 310 pg/mL for Fr-S and 264 pg/mL for ASCVD-S in the overall population, with significant differences between the groups divided by eGFR (all p < 0.001). Conclusions: These findings highlight the potential utility of 8-iso-PGF2α as a biomarker for refining cardiovascular risk stratification in hypertensive patients, particularly those with preserved renal function. Future studies should explore its prognostic value in longitudinal cohorts and assess its integration into clinical risk models to enhance early prevention strategies for cardiovascular disease.

The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and derived-neutrophil-to-lymphocyte ratio (d-NLR), which can be obtained from complete blood count, have gained attention due to their widespread availability and low cost of testing; they have recently been proposed as prognostic markers in various chronic diseases. The primary objective of our study was to investigate the potential prognostic role of inflammatory markers derived from blood cell counts regarding all-cause mortality in patients with kidney failure undergoing hemodialysis, and the use of such markers in risk stratification based on the type of vascular access used. This retrospective study included 236 patients from the Nephrology Unit of Trento. Demographic, anamnestic, clinical, and biochemical data, as well as total mortality, were collected. Neutrophil-to-lymphocyte ratio and the erythropoietin resistance index were calculated. The study cohort was divided into tertiles based on the neutrophil-to-lymphocyte ratio distribution. Patients in the third tertile exhibited significantly lower mean values of weight, serum albumin, serum iron, and transferrin, whereas mean erythropoietin resistance index values, and age were higher compared to those in the first and second tertiles, in which mortalilty was also higher. The area under the ROC curve (AUC) for neutrophil-to-lymphocyte ratio related to total mortality (AUC = 0.64) was wider than that for C-reactive protein (AUC = 0.61). Cox regression analysis suggested that neutrophil-to-lymphocyte ratio was independently associated with mortality, even after adjusting for confounding factors. Our study suggests that neutrophil-to-lymphocyte ratio is a useful tool for the early risk stratification and management of patients with kidney failure.

Introduction: The American Academy of Pediatrics (AAP) published in 2017 new guidelines for the screening and management of hypertension in children containing different nomograms compared to the European guidelines, leading to a reclassification of blood pressure values, the consequences of which are still little investigated. The aim of our study was to evaluate the prevalence of high blood pressure values estimated with both the most recent American and European guidelines and to analyze the relationship of blood pressure increases with lifestyles and potentially risky behaviors in a school population in Western Sicily. Methods: On the occasion of the XV World Hypertension Day, blood pressure values of 1301 students aged between 13 and 18 were measured. Two questionnaires were administered, one relating to anamnestic data and anthropometric parameters and a second aimed at investigating lifestyle. For the diagnosis of increased blood pressure, both ESH and AAP criteria were considered. Results: The prevalence of elevated blood pressure was 7.5% according to ESH criteria and nearly twice as high using AAP criteria, with a more pronounced discrepancy in females. Individuals with elevated blood pressure were younger, exhibited higher body weight and BMI, and had an increased prevalence of overweight and obesity. Classification based on ESH criteria revealed higher alcohol and drug consumption among normotensive individuals. AAP criteria identified a higher proportion of males and greater height in the hypertensive group. Systolic blood pressure correlated significantly with height, weight, and BMI, with stronger associations in males, while diastolic pressure correlated with weight and BMI. Conclusions: To the best of our knowledge, our study is the only one to analyze the prevalence of increased blood pressure and its relationship with lifestyle factors and anthropometric data in adolescence in our region. Our study confirms that elevated blood pressure is common in adolescence, with higher prevalence using the 2017 AAP criteria than ESH guidelines.

Everywhere, independently of the care setting, there is an urgent, unsatisfied need to take care of patients with combined kidney and heart disease. In May 2023 we launched the Kidney-Heart Outpatient Service in the Nephrology and Dialysis Unit of “Paolo Giaccone” University Hospital in Palermo. The clinical mission of our Kidney-Heart Service is to provide a coordinated, multi- disciplinary care for non hospitalized patients with coexisting kidney and heart disease, with the aim to significantly reduce admissions and readmissions in hospital, improving patient outcomes and optimizing utilization of economic resources. In this letter we present the clinical objectives and services provided of this new service and the 1-year results.

Background/Objectives: Considering the physiological analogies between the eye and the kidney, this study aimed to investigate the potential relationship between retinal vascular density, assessed using Optical Coherence Tomography Angiography (OCT-A), and the renal resistive index (RRI) in patients with arterial hypertension. Methods: A total of 82 hypertensive patients (mean age 48 ± 13) were enrolled in the study. Participants underwent routine biochemical evaluations, office-based blood pressure measurement, 24 h ambulatory blood pressure monitoring, OCT-A imaging, and renal Doppler ultrasound examinations. Results: The mean RRI in the study population was 0.616 ± 0.06. Participants were divided into two groups based on the 75th percentile threshold of the RRI distribution (0.66, 95% CI 0.64–0.68). The group with RRI > 75th percentile, which appeared to have a higher number of smokers, exhibited significantly higher mean triglyceride and urinary albumin excretion (UAE) levels and a significantly reduced estimated glomerular filtration rate (eGFR) as compared to the group with RRI < 75th percentile. Among the hemodynamic parameters, 24 h pulse pressure (PP), daytime and nighttime PP, and nighttime systolic blood pressure (SBP) were significantly higher in the group with RRI > 75th percentile. Regarding retinal vascular density indices, the only significant difference was observed in the deep foveal vascular plexus, which displayed a reduced density in the group with RRI > 75th percentile. Logistic regression analysis revealed that RRI > 75th percentile was independently associated with increased nighttime mean pulse pressure (OR = 1.13, 95% CI: 1.049–1.221, p = 0.0014) and reduced deep foveal vascular density (OR = −0.5026, 95% CI: 1.0493–1.2211, p = 0.0044). Conclusions: Our findings demonstrate that ocular microvascular alterations are associated with RRI, a marker with a well-established prognostic value for renal disease progression and systemic macrovascular dysfunction. These results further substantiate the close relationship between renal and ocular microcirculation.

The neutrophil-to-lymphocyte ratio (NLR) has emerged as a readily accessible, cost-effective biomarker reflecting systemic inflammation. Chronic low-grade inflammation plays a pivotal role in the pathogenesis and progression of metabolic and cardiovascular disorders including chronic kidney disease (CKD), hypertension, diabetes mellitus, and cardiovascular disease (CVD). This review critically evaluates the current evidence on NLR as a prognostic marker across these interconnected conditions. A comprehensive literature search was conducted focusing on clinical and epidemiological studies investigating the association between NLR and CKD, hypertension, diabetes, and cardiovascular outcomes. Mechanistic insights into inflammation-driven pathophysiology and the predictive utility of NLR in disease progression and adverse events were synthesized. Elevated NLR is consistently associated with increased risk and severity of CKD, correlating with glomerular filtration decline, proteinuria, and mortality. In hypertension, higher NLR levels are linked to non-dipper blood pressure patterns, arterial stiffness, and increased cardiovascular risk. Among diabetic patients, NLR correlates with poor glycemic control and vascular complications. In cardiovascular disease, elevated NLR predicts major adverse cardiovascular events (MACE) and all-cause mortality, reflecting underlying immune dysregulation and endothelial dysfunction. Despite promising findings, direct comparisons with established inflammatory biomarkers remain limited, and heterogeneity exists across populations. NLR represents a simple yet powerful inflammatory biomarker with significant prognostic value in CKD, hypertension, diabetes, and cardiovascular disease. Its integration into clinical risk stratification models could enhance personalized medicine approaches. Future research should focus on longitudinal studies, validation in diverse cohorts, and comparative analyses with other inflammatory markers to fully delineate NLR’s clinical utility.

Background: The neutrophil-to-lymphocyte ratio (NLR) has emerged as a readily available marker of systemic inflammation and immune dysregulation. In patients undergoing hemodialysis, inflammation is a known contributor to erythropoietin resistance. However, the relationship between the NLR and the erythropoietin resistance index (ERI) has not been extensively characterized. Methods: A total of 317 hemodialysis patients were retrospectively evaluated and stratified into tertiles based on NLR levels. Biochemical, inflammatory, and anthropometric variables were compared across groups. Spearman's rank correlation was used to assess the relationship between the NLR and the ERI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive ability of the NLR for erythropoietin resistance, defined as ERI > 10. Subsequently, linear and logistic regression models were employed to examine the independent association between the NLR and the ERI, adjusting for relevant covariates. Results: Higher NLR tertiles were significantly associated with increased CRP, lower serum iron, and elevated ERI (p = 0.002). Spearman's analysis revealed a modest but significant correlation between the NLR and the ERI (ρ = 0.31, p < 0.0001). ROC analysis identified an NLR threshold of 4.4 for detecting ERI > 10. In multivariable analysis, the NLR was independently associated with the ERI both as a continuous variable (β = 0.848, p = 0.046) and as a binary outcome (OR = 1.22, 95% CI: 0.95-1.24, p = 0.0021), while serum iron and hemoglobin also emerged as significant predictors. Conclusions: In this cohort of hemodialysis patients, a higher NLR was independently associated with increased erythropoietin resistance, suggesting its potential utility as an accessible inflammatory biomarker in anemia management. These findings add to the limited but growing body of evidence supporting the prognostic role of the NLR in dialysis populations and warrant further validation in prospective studies.

Background:The renal resistive index (RRI) is a noninvasive indicator of renal vascular resistance and systemic hemodynamic status. Elevated RRI values have been consistently associated with subclinical vascular damage and target organ injury. Observational studies within the past decade have suggested that RRI may also serve as a prognostic marker for adverse cardiovascular outcomes and mortality. However, the evidence remains scattered and heterogeneous, and no systematic review has yet synthesized this body of literature. Objective:This systematic review aims to evaluate the association between elevated RRI and the risk of cardiovascular events, cardiovascular mortality, and all-cause mortality in adult populations. Methods:This protocol has been developed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. We will include observational studies (prospective and retrospective cohort studies and nested case-control studies) involving adults (≥18 years) with RRI measurements obtained through Doppler ultrasound. Studies focused on pediatric populations, pregnant women, and patients undergoing dialysis will be excluded. The primary exposure will be elevated RRI, typically defined as RRI of ≥0.70, compared to lower or normal values. The primary outcomes are cardiovascular events, cardiovascular mortality, and all-cause mortality with a minimum follow-up of 6 months. A comprehensive search will be conducted in PubMed, Embase, Web of Science, and Scopus, as well as in gray literature sources. Two independent reviewers will screen articles, extract data, and assess risk of bias using Version 2 of the Cochrane revised risk-of-bias tool for randomized controlled trials and the Risk of Bias in Nonrandomized Studies of Interventions and Risk of Bias in Nonrandomized Studies of Exposure tools for nonrandomized studies of interventions and exposure, respectively. Meta-analyses will be conducted if at least 3 studies report comparable data, and effect estimates will be calculated using raw data whenever possible. Subgroup and meta-regression analyses will be used to explore heterogeneity, whereas sensitivity analyses will be conducted to assess the robustness of the observed results. The Grading of Recommendations Assessment, Development, and Evaluation framework will be applied to evaluate the overall quality of evidence. Results:A preliminary exploratory search has been conducted to map the existing literature and confirm the absence of prior systematic reviews on this topic. The formal study selection and data extraction are expected to begin upon protocol acceptance with review completion anticipated by December 2026. Conclusions:By systematically synthesizing the available literature, this review will provide a comprehensive overview of the prognostic value of RRI in predicting cardiovascular outcomes and mortality. The findings may inform clinical decision-making, enhance cardiovascular risk stratification, and identify research gaps for future studies focused on standardizing RRI assessment and its clinical applications.

Duplex-Doppler ultrasonography has become an essential tool in the diagnosis and management of kidney diseases, allowing clinicians to assess renal hemodynamics, detect vascular abnormalities, and monitor disease progression. Among the various Doppler-derived parameters, the renal resistive index (RRI) has gained particular attention both as a diagnostic tool and a prognostic marker in nephrology. Traditionally considered an indicator of parenchymal perfusion, recent evidence highlights its strong association with systemic hemodynamic factors, particularly arterial stiffness, positioning RRI as a valuable tool for evaluating patients with systemic vascular impairment, such as hypertension, diabetes mellitus, and atherosclerosis. RRI has been strongly linked to vascular damage, which in turn is influenced by inflammation and endothelial dysfunction, making it a reliable marker of cardiovascular damage and a potential predictor of cardiovascular risk. Furthermore, emerging studies suggest that RRI could serve as a dynamic parameter to monitor vascular changes induced by therapeutic interventions. This narrative review summarizes the classic and evolving applications of RRI, from its origin as a renal hemodynamic marker to its emerging role as a systemic vascular biomarker with diagnostic and prognostic significance in cardiovascular and metabolic diseases.

Background: Acute kidney injury (AKI) has emerged as a significant complication in patients with coronavirus disease 2019 (COVID-19). The pathophysiology of COVID-19-associated AKI is multifactorial, involving both direct viral effects on renal cells and indirect mechanisms such as systemic inflammation and cytokine storms. This highlights the critical need for early detection and effective management strategies to mitigate kidney injury and improve patient outcomes. The aim of our study is to assess the potential predictive role of inflammatory biomarkers in determining the risk of developing COVID-19-associated AKI in patients with and without pre-existing CKD. Methods: This study included 84 patients stratified by pre-existing chronic kidney disease (CKD) status. Demographic, clinical, and laboratory data were collected, including vital signs, hematological profiles, renal function markers, inflammatory biomarkers, coagulation parameters, and treatments. Outcomes such as acute kidney injury (AKI) and in-hospital mortality were documented. Results: In patients with pre-existing CKD, IL-6 and NLR demonstrated high predictive accuracy for AKI onset. In patients without pre-existing CKD, white blood cell (WBC) count emerged as a significant predictor of AKI onset. Conclusions: The differential roles of IL-6, NLR, and WBC in predicting AKI onset highlight distinct physiopathological pathways influenced by COVID-19. In CKD+ patients, chronic inflammation and immune dysregulation are key drivers of AKI, with IL-6 and NLR serving as robust markers of this inflammatory state. In contrast, in CKD− patients, AKI may be more influenced by acute inflammatory responses and infectious factors, as reflected by WBC count.

Background/Objectives: Isolated nocturnal hypertension (INH) represents a unique phenotype that can only be identified through ambulatory blood pressure monitoring (ABPM). An increasing body of evidence suggests a significant association between INH and heightened cardiovascular morbidity, mortality, and, more recently, kidney disease progression. Considering these findings, this study aims to retrospectively assess the prevalence of INH and its relationship with glomerular filtration rate (GFR) and albumin excretion rate (AER) in a large cohort of hypertensive patients. Methods: A total of 1340 subjects selected from the patients of our European Hypertension Excellence Centre of the University of Palermo were enrolled. Biochemical tests, urinalysis, 24 h ambulatory blood pressure monitoring, and collection of anamnestic and anthropometric data were performed on each patient. Results: In our cohort, the prevalence of INH was 11%. Logistic regression analyses revealed that male sex, AER, and eGFR were significantly associated with the INH phenotype. AER ≥ 5.8 µg/min predicted the presence of INH with 73.7% sensitivity and 58.4% specificity. An eGFR < 60 mL/min/1.73 m2 was also correlated with INH, although its predictive value was less prominent. Multivariable regression models confirmed that AER and eGFR, along with male sex, were independent predictors of INH. In patients with normal blood pressure, AER and metabolic syndrome were also associated with INH. CKD (AER < 30 mg/day and eGFR < 60 mL/min/1.73 m2) was significantly linked to INH. Conclusions: Our research confirms the direct relationship between AER and INH and the inverse relationship between GFR and INH, thus underlining the leading role of renal function in the onset of INH, as widely observed in the literature. The confirmed association between renal markers and INH in the subgroup of subjects with a clinically normal blood pressure could help us to identify the subjects who should undergo ABPM.