Introduction This study was designed to validate the formula of New Baseline Glomerular Filtration Rate (NB-GFR) within a multicenter cohort of southern Chinese patients who underwent radical nephrectomy (RN) or partial nephrectomy (PN), with a specific focus on assessing its accuracy and effectiveness. Methods The predictive capability of the formula proposed by professor Palacios DA for estimating NB-GFR after PN or RN was evaluated, with a focus on its efficacy in the southern Chinese population. A retrospective analysis was conducted involving 398 RN patients and 185 PN patients from three hospitals between 2015 and 2022. The correlation between the postoperative NB-GFR predicted by the equation and the actual GFR of the patients was analyzed, and the level of agreement was assessed. Results We found strong positive correlation between NB-GFR and GFR after PN, with a correlation coefficient of R = 0.645, 95% confidence interval (95% confidence interval (CI)) [0.552–0.722], P < 0.001. Moderate positive correlation was observed between NB-GFR and GFR after RN, with R = 0.434, 95% CI [0.339–0.501]. Lin’s concordance correlation coefficient (CCC) analysis demonstrated a moderate concordance between post-operative GFR and NB-GFR, with a CCC value of 0.522 (95% CI [0.461–0.579], P < 0.001) for RN and 0.533 (95% CI [0.472–0.589], P < 0.001) for PN. Conclusion The NB-GFR prediction equation demonstrates moderate concordance with actual postoperative GFR in southern Chinese patients undergoing RN or PN, indicating broad application potential.

The clinical courses of BK polyomavirus nephropathy (BKPyVN) are variable. This study aimed to evaluate the usefulness of repeat donor-derived cell-free DNA (dd-cfDNA) monitoring in identifying clinical courses. Repeat allograft biopsy and dd-cfDNA monitoring were performed at 6-12 months post-intervention or when renal allograft dysfunction occurred. Results demonstrated that recipients with rejection had a higher plasma dd-cfDNA fraction (2.23% [1.17%, 5.52%]; n = 13) than those with resolved BKPyVN (0.80% [0.66%, 0.91%]; n = 30; p < 0.001) or persistent BKPyVN (0.82% [0.61%, 1.12%]; n = 10; p = 0.002). Compared to baseline at BKPyVN diagnosis, urine dd-cfDNA concentration decreased in recipients with resolved BKPyVN post-intervention (3.90 [1.35, 5.80] ng/mL vs. 7.88 [6.00, 15.37] ng/mL; p < 0.001), but not in persistent BKPyVN (9.02 [5.26, 10.35] ng/mL vs. 7.96 [6.43, 10.21] ng/mL; p = 0.463). Changes in urine dd-cfDNA concentration were positively correlated with changes in the extent of SV40 LTag-positive staining, while changes in plasma dd-cfDNA fraction positively correlated with changes in glomerulitis score. A plasma dd-cfDNA fraction > 1.12% following BKPyVN intervention could identify rejection (AUC = 0.924), and a urine dd-cfDNA concentration > 5.95 ng/mL could identify persistent BKPyVN (AUC = 0.840). In summary, repeat dd-cfDNA monitoring integrated with clinical data can serve as an adjunct to identify BKPyVN clinical courses.

Abstract Objective This study aimed to investigate the etiology, clinical manifestations, management strategies, and clinical outcome of hemodialysis-related allergic reactions. Methods A retrospective cohort study was conducted to analyze clinical data from patients who experienced hemodialysis-related allergic reactions at the Affiliated Hospital of Jiangnan University between January 2020 and December 2025. Patients undergoing maintenance hemodialysis—with no prior history of these allergic reactions—served as the control group. Their clinical characteristics and reaction profiles were systematically analyzed. Results A total of 40 cases of hemodialysis-related allergic reactions were identified as the study group. Isolated pruritus and skin rash were observed in 25 patients (62.5%); hemodialysis-related leukopenia and thrombocytopenia, in 4 cases (10.0%); and severe anaphylactic reactions, in five cases (12.5%); Five cases exhibited atypical hemodialysis-related allergic reactions (12.5%), including hypotension within 10 min of hemodialysis initiation, malaise, nausea, and vomiting. The predominant etiological factors identified were hypersensitivity to the hemodialyzer membrane ( n = 11, 27.5%), AVF needles kits and hemodialysis extracorporeal circuit tubing (Ethylene Oxide Residue) ( n = 27, 67.5%), and Nafamostat Mesylate ( n = 2, 5%). Thorough saline pre-rinsing of the extracorporeal circuit remained the primary preventive strategy against EO-induced hypersensitivity. Switching to irradiated-sterilized acetate-membrane or wet-membrane dialyzers effectively prevented dialyzer hypersensitivity reaction. Glucocorticoid administration was effective in mitigating severe anaphylactic reactions. Patients in the study group exhibited significantly higher plasma eosinophil counts and C-reactive protein concentrations, and significantly lower hemoglobin levels, and serum albumin concentrations compared with the control group. Conclusion Hemodialysis-related allergic reactions are primarily attributable to hypersensitivity responses to dialyzer membranes, residual ethylene oxide in extracorporeal circuit components, and occasionally Nafamostat Mesylate administered during the procedure. Glucocorticoid administration was effective in attenuating severe anaphylactic reactions. Allergic reactions that repeatedly occur during hemodialysis may be associated with an underlying chronic micro-inflammatory state.

In recent years, immune checkpoint inhibitors (ICIs) have emerged as a critical component of hematological malignancies and solid malignant tumors therapy. However, clinical practice has revealed that these agents may induce immune-related adverse events (irAEs). Notably, renal irAEs stands out as a significant clinical concern, frequently necessitating treatment discontinuation and thereby enabling tumor progression. Renal irAEs constitutes a critical consideration for patients with cancer complicated by chronic kidney disease (CKD). This review systematically examines the immunologic pathogenesis of ICIs-induced renal disease, susceptibility genes, non-invasive biomarkers, and efficient intervention strategies. It further analyzes the critical considerations regarding renal irAEs that oncologists must address, based on real-world evidence from ICIs therapy in cancer patients with CKD, including those who are renal transplantation recipients or have end-stage renal disease (ESRD). Additionally, the promising targeted immunotherapy for malignant tumors is expected to improve both renal outcomes and survival prognosis in cancer patients.

BackgroundAcute rejection remains a major complication in pediatric kidney transplantation. The Banff Activity Index (AI) and Chronicity Index (CI) have recently been proposed as quantitative composites of histological lesions that represent the extent of active and chronic injury, respectively. Emerging evidence suggests that these indices provide additional value for prognostic assessment. However, their clinical significance in pediatric recipients remains unclear.MethodsThis single-center retrospective study included 535 pediatric kidney transplant recipients who underwent transplantation between 2015 and 2025. AI and CI were calculated according to Banff lesion scores. Logistic regression was used to identify risk factors for rejection, and graft functional outcomes were evaluated using Kaplan–Meier analysis and longitudinal estimated glomerular filtration rate (eGFR) trajectories across rejection phenotypes and AI/CI categories.ResultsAmong 535 recipients, 98 (18.3%) experienced 126 rejection episodes. Independent risk factors for rejection included HLA-DR mismatch (OR 1.60, 95% CI 1.09–2.43, p = 0.021), previous transplantation (OR 3.05, 95% CI 1.03–8.53, p = 0.036), preformed donor-specific antibodies (pfDSA) (OR 3.11, 95% CI 1.08–8.31, p = 0.027), and recipient aged 9–15 years (OR 2.05, 95% CI 1.30–3.29, p = 0.002). Both AI and CI scores varied significantly across rejection phenotypes, with mixed rejection showing the highest levels of histological activity and chronicity (AI: p < 0.001; CI: p = 0.017). Higher AI scores were associated with a stepwise decline in eGFR at diagnosis (p = 0.001), but this difference was no longer significant during long-term follow-up. In contrast, high CI (≥ 4) was linked to lower eGFR at 3 years post-rejection compared with low CI (< 4) (35.9 vs. 62.8 mL/min/1.73 m²; p = 0.016). High CI (≥ 4) at the first biopsy was independently associated with donation after circulatory death (DCD) (OR 3.95, p = 0.04) and biopsy performed ≥ 3 years post-transplantation (OR 3.80, p = 0.05).ConclusionAcute rejection remains significantly associated with adverse long-term graft outcomes in pediatric kidney transplantation. CI ≥ 4 was associated with long-term functional decline, whereas AI primarily reflected short-term functional impairment.

Abstract Flos Sophorae Immaturus (FSI) is usually used as a uric acid (UA)-lowering food in Chinese folk. However, the UA-lowering mechanism of FSI and the effect of processing methods on its UA-lowering ability are still unclear. Herein, the hyperuricemia mice model was established and treated with purified FSI polyphenols before and after ultrasound-assisted heating treatment (UAHT). Results showed that FSI polyphenols possessed significant xanthine oxidase (XOD) and adenosine deaminase (ADA) inhibitory activities after UAHT, thereby blocking UA production. FSI after UAHT (200 and 500 mg/kg) alleviated hyperuricemia in mice by improving kidney oxidative stress and regulating kidney urate transporter expression. Thus, the restoration of kidney injury was also an important pathway through which FSI polyphenols alleviate hyperuricemia. Interestingly, quercetin exhibited better anti-hyperuricemia effect in vivo and in vitro. The increase in quercetin content was positively correlated with the UAHT‑mediated enhancement of the anti‑hyperuricemia effect of FSI polyphenols. In general, modifying the polyphenol composition of FSI through processing to further enhance its anti-hyperuricemia activity is a feasible processing strategy. Graphical Abstract

BackgroundDual kidney transplantation (DKT) from small pediatric donors, either en-bloc or split dual kidney transplantation, contributes to mitigating organ scarcity. This study investigates the prognosis of DKT from pediatric deceased donors, and influencing factors.MethodA retrospective study included recipients who underwent DKT from pediatric donors between 2012 and 2022. Recipients were categorized into low mismatch (BWLM, n = 30) and high mismatch (BWHM, n = 10) groups based on donor-recipient weight ratio of 1:10. Outcome encompassed recipient and graft survival, renal function, and adverse events.ResultForty recipients were included. The average follow-up period was 54.6 months. The 1, 3, and 5-year patient survival were 97.4%, with no significant differences between en-bloc and split dual kidney transplantation or between BWLM and BWHM groups. The graft survival at 1, 3, and 5 years were 89.9%, the graft survival of BWHM group was lower than BWLM group (70% vs 96.7%, p = 0.039). The average eGFR at 1, 3, and 5 years postoperatively were (78.93 +/- 25.23), (83.82 +/- 32.4), and (85.92 +/- 37.08) mL/min/1.73 m2, respectively. The BWHM group also experienced higher rates of graft-related surgical complications (p = 0.006) and urinary tract surgical complications (p = 0.042).ConclusionDKT from pediatric donors yields favorable outcomes, with similar graft survival and complication rates across surgical subgroups. However, significant donor-recipient weight mismatch, particularly when the ratio is less than 1:10, may contribute to increased surgical complications and poorer graft survival. Efforts to minimize extreme weight mismatch are recommended to optimize outcomes.

Objective:To elucidate the risk stratification of gram-positive bacteria in the preservation fluid (PF), investigate antibiotic resistance and its role in early post-kidney transplant infections, and assess the efficacy of preemptive-anti-Gram-positive antibiotic (P-antiGP) therapy. Methods:This retrospective study analyzed the clinical data of 144 kidney transplant donors and 218 recipients between April 2015 and October 2020. Recipients with any of the high-virulence gram-positive bacteria (such as Enterococcus faecium, Enterococcus faecalis, and Staphylococcus aureus) in PF were defined as high-risk group. Recipients with other pathogens in PF were defined as low-risk group. Results:The high-risk group had a significantly higher incidence of infection events as compared with the low-risk group (42.6% vs. 26.2%, p = 0.014). Multivariate analysis indicated a trend toward an increased risk of early post-transplant infections in the high-risk group (adjusted OR = 1.855, 95% CI: 0.991-3.464, p = 0.052). Seven recipients (1.5%) were diagnosed as possible donor-derived infections (P-DDIs) and all of them were from the high-risk group. 56.4% (123/218) of recipients had multidrug-resistant organisms (MDROs) in PF and 12.4% (27/218) had extensively-resistant organisms (XDROs). The P-DDIs rate was notably higher in the extensively drug-resistant (XDR) group than non-XDR group (11.1% vs. 2.1%, p = 0.014). The incidence of P-DDIs was significantly lower (p = 0.025) in recipients with P-antiGP therapy (4.3%) as compared to recipients who did not (23.8%). Conclusion:E. faecium, E. faecalis, and S. aureus in PF are considered high-virulence gram-positive bacteria, and recipients with these pathogens are categorized as high-risk group. Additionally, a high prevalence of antibiotic resistance exists among gram-positive bacteria in PF, correlating with post-transplant infections. Furthermore, The addition of P-antiGP therapy as a preemptive therapy in the high-risk group can effectively reduce the incidence of P-DDIs.

Kidney autotransplantation is a surgical procedure with multiple indications and advancing technological approaches. Kidney autotransplantation is used to address complex kidney-related diseases including renal vascular lesions, ureteral diseases, tumors, loin pain-hematuria syndrome, and conditions affecting a solitary kidney or both kidneys. Renal artery lesions, including aneurysms and stenoses, often necessitate kidney autotransplantation in cases involving renal artery bifurcation or distant failure of endovascular repair. Complex ureteral lesions such as ureteral avulsions are commonly treated with kidney autotransplantation. Renal tumors, especially centrally located tumors or those involving the renal hilum, are treated using this technique while preserving renal function. It is worth emphasizing that this would be a rarely used last-resort technique in the modern era of minimally invasive nephron-sparing surgery. Kidney autotransplantation may be indicated for the rare condition of loin pain-hematuria syndrome when conservative measures fail. Additionally, individuals with solitary or bilateral kidney disease benefit from kidney autotransplantation to preserve their renal function. Traditional open-kidney autotransplantation involves renal extraction, workbench repair, and renal reimplantation. Technological advancements have introduced minimally invasive techniques including laparoscopic- and robot-assisted kidney autotransplantation, which reduce surgical trauma and recovery times. These techniques have shown promising outcomes, and robotic platforms have the potential to further reduce complications. In this study, we reviewed diverse indications and recent technological innovations in the field of kidney autotransplantation.

Cytomegalovirus (CMV) infections are commonly observed in immunocompromised patients. However, hemorrhagic cystitis (HC) is an exceptionally rare manifestation. Here, we report a pediatric kidney transplant recipient who developed CMV-related HC, presenting with acute painful macrohematuria, bladder wall thickening, and graft hydronephrosis during the early posttransplant period.

IntroductionAnemia is prevalent after kidney transplantation (KTx) and is associated with reduced graft survival. The associations between temporal changes in hemoglobin (Hb) level in the early posttransplant period with left ventricular (LV) and atrial (LA) function and strain are unknown.MethodsThe study cohort included 71 successful pediatric KTx recipients between January 2021 and September 2022. Echocardiography was used to evaluate the cardiac structure, function, and strain both before and after KTx. Temporal changes in Hb values within 6 months after KTx were evaluated. According to the LV mass index (LVMI), recipients were divided into a left ventricular hypertrophy (LVH) group and a non-LVH group.ResultsBefore KTx, the LVH group had a lower level of Hb and a higher incidence of anemia than the non-LVH group. However, this difference between the groups disappeared after KTx. Changes in Hb were faster in the LVH group than in the non-LVH group. There was a negative association between the absence of an Hb increase and diastolic blood pressure, the LVMI, early diastolic mitral annulus velocity to early diastolic filling wave ratio (E/E’), and the left atrial emptying volume index (LAEVI), while there was a positive association between LV ejection fraction (LVEF), LV global longitudinal strain, and LA strain. The LVMI and changes in LVEF showed a negative correlation, whereas changes in the LAEVI showed a positive correlation with the absence of Hb increase during the early period after KTx.ConclusionChildren with LVH have a lower level of Hb before KTx and a higher level of Hb increase in the early postoperative period following KTx. LVMI and changes in LVEF and LAEVI have predictive value in absence of Hb increase in pediatric KTx recipients.

This study investigated whether ginkgolide B alleviates renal and podocyte injury in membranous nephropathy by inhibiting ferroptosis. Rats with passive Heymann nephritis received ginkgolide B (7.5 mg/kg/day) or vehicle. Ginkgolide B significantly ameliorated nephrotic syndrome, reducing 24-hour urinary protein excretion, and improving serum albumin levels. It also normalized lipid profiles and enhanced renal function, with all changes achieving statistical significance at p<0.05. Histopathological analysis revealed reduced glomerular immune deposits, preserved podocyte density indicated by improved WT-1 nuclear expression/distribution, and restored slit diaphragm integrity shown by increased CD2AP expression. Mechanistically, ginkgolide B suppressed ferroptosis by significantly decreasing reactive oxy-gen species and lipid peroxides, reducing iron deposition, downregulating ferroptosis drivers NCOA4, ACSL4, and LPCAT3, and restoring glutathione peroxidase 4 activity (p<0.05 for all). These findings demonstrate that ginkgolide B mitigates membranous nephropathy-associated renal and podocyte injury by inhibiting ferroptosis.

PurposeComprehension of the anatomical characteristics of pediatric kidney tumors is crucial for making surgical decisions. Previous kidney tumor nephrometry systems failed to incorporate two significant factors: tumor thrombus and multifocality. We develop a refined nephrometry system based on a comprehensive understanding of the characteristics exhibited by pediatric kidney tumors.MethodsThe TUMORS nephrometry scoring system comprises 6 indicators, including tumor (T)hrombus, (U)rinary collecting system involvement, (M)ultiple tumors, (O)utward property, (R)adius, and (S)ite relative to the polar lines. Each renal unit was assessed and scored independently. The complexity characteristics of kidney tumors were summarized, and the correlation was compared with RENAL nephrometry system. Furthermore, the complexity of kidney tumors was compared across different surgical procedures.ResultsA total of 43 patients were enrolled, involving 70 kidney units. Radical nephrectomy (RN) was performed on 13 kidneys, while the remaining 57 kidneys underwent nephron sparing surgery. In the NSS group, tumors in 37 kidneys were resected in vivo, whereas 20 kidneys underwent tumor resection ex vivo followed by kidney autotransplantation. According to the TUMORS nephrometry scoring system, there were 13, 34 and 23 kidney units classified as low, moderate and high complexity, respectively. Tumors that underwent RN or ex vivo removal exhibited higher complexity. The complications and positive margins of NSS were not statistically significant in relation to tumor complexity.ConclusionThe TUMORS nephrometry scoring system holds significant guidance for the decision of surgical protocol and can be applied to the preoperative evaluation.