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Topic Review
Hypouricemia and the Kidneys
Hypouricemia, defined as a serum uric acid level ≤ 2.0 mg/dL, can be produced by the renal wasting of uric acid. Considering normal values of the fractional excretion of uric acid (~10%), the essential role of the kidneys is closer to the conservation rather than elimination of uric acid. Thus, impaired uric-acid-transport function in the proximal tubule leads to hypouricemia. In many cases, hypouricemia can go unnoticed because it usually occurs without symptoms. Its clinical consequences need to be investigated.
  • 666
  • 30 Nov 2022
Topic Review
Definitive Diagnosis in Renal Cell Carcinoma
Despite significant progress regarding clinical detection/imaging evaluation modalities and genetic/molecular characterization of pathogenesis, advanced renal cell carcinoma (RCC) remains an incurable disease and overall RCC mortality has been steadily rising for decades. Concomitantly, clinical definitions have been greatly nuanced and refined. RCCs are viewed as a heterogeneous series of cancers, with the same anatomical origin, but fundamentally different metabolisms and clinical behaviors. 
  • 664
  • 29 Nov 2022
Topic Review
Treatment of Congenital Adrenal Hyperplasia
Congenital adrenal hyperplasia (CAH) is a common genetic disorder in endocrinology, especially its milder clinical presentation, often caused by a partial or total deficiency of the 21-hydroxylase enzyme located in the adrenal cortex. CAH is characterized by the overproduction of androgen, along with variable degrees of cortisol and aldosterone deficiency. The age at diagnosis can provide some information about underlying mutations, with those diagnosed at birth/early infancy more likely to have severe enzymatic defects, which may include adrenal insufficiency, sexual development disorders, short stature in adulthood, hirsutism, and a higher risk for metabolic syndrome and infertility. Non-classic CAH, a milder form of CAH, is usually manifested later in life and is a common differential diagnosis of Polycystic Ovary Syndrome and should be actively evaluated during initial studies of clinical or biochemical hyperandrogenism.
  • 649
  • 05 May 2023
Topic Review
Microbiome in Chronic Kidney Disease
Chronic kidney disease (CKD) is a progressive disease, with high morbidity and mortality in adult population. Its incidence is increasing constantly, and approximately 10% of people are affected by some form of CKD, which is associated with almost 1.2 million deaths worldwide. Cardiovascular disease is the main cause of death, followed by infections and malignancies. The gut microbiome is a complex collection of microorganisms with discrete characteristics and activities. Its important role is not restricted to food digestion and metabolism, but extends to the evolution, activation and function of the immune system. Several factors, such as mode of birth, diet, medication, ageing and chronic inflammation, can modify the intestinal microbiota. Chronic kidney disease (CKD) seems to have a direct and unique effect, as increased urea levels result in alteration of the gut microbiome, leading to overproduction of its metabolites. Therefore, potentially noxious microbial uremic toxins, which have predominantly renal clearance, including p-cresyl sulfate, indoxyl sulfate and N-oxide of trimethylamine [Trimethylamine-N-Oxide (TMAO)], accumulate in human’s body, and are responsible not only for the clinical implications of CKD, but also for the progression of renal failure itself. Certain changes in gut microbiome are observed in patients with end stage renal disease (ESRD), either when undergoing hemodialysis or after kidney transplantation.
  • 648
  • 22 Nov 2022
Topic Review
Cell Therapies in Acute Kidney Injury
The incidence of renal disease is gradually increasing worldwide, and this condition has become a major public health problem because it is a trigger for many other chronic diseases. Cell therapies using multipotent mesenchymal stromal cells, hematopoietic stem cells, macrophages, and other cell types have been used to induce regeneration and provide a cure for acute and chronic kidney disease in experimental models. 
  • 645
  • 18 Jan 2023
Topic Review
Soluble Isoform of Flt-1 in Chronic Kidney Disease
Placental growth factor (PlGF) and its receptor, fms-like tyrosine kinase-1 (Flt-1), are important regulators involved in angiogenesis, atherogenesis, and inflammation. Elevation of circulating soluble isoform of Flt-1 (sFlt-1) and downregulation of sFlt-1 in the vascular endothelium by uremic toxins and oxidative stress both exacerbate heart failure and atherosclerosis. Circulating sFlt-1 is inconsistent with sFlt-1 synthesis, because levels of matrix-bound sFlt-1 are much higher than those of circulating sFlt-1, as verified by a heparin loading test, and are drastically reduced in chronic kidney disease (CKD).
  • 644
  • 30 Nov 2022
Topic Review
Autologous Immune Cell-Based Therapy Treat Vasculogenic Erectile Dysfunction
Vasculogenic erectile dysfunction (ED) due to endothelial dysfunction and atherosclerosis of penile arteries is the most common cause of ED, especially in men over fifty. Cell-based regenerative therapies include platelet-rich plasma (PRP), both heterologous and autologous stem cell therapy (SCT), and peripheral blood mononuclear cells (PBMNC), highlighting the role played by immune cell populations, which may represent the new frontier of vasculogenic erectile dysfunction treatment.
  • 641
  • 06 Sep 2022
Topic Review
Glomerular Diseases
Glomerular disease is a disease of glomerular inflammation caused by immune-mediated damage to capillary endothelium, mesangium, or basement membrane. The clinical presentations of glomerular disease are diverse. Patients may have asymptomatic microscopic or gross hematuria and often develop proteinuria and even the severe as nephrotic syndrome.
  • 636
  • 31 Mar 2022
Topic Review
Dietary Fiber in Progression of Chronic Kidney Disease
Nutrition is one of the fundamental approaches to promoting and preventing all kinds of diseases, especially kidney diseases. Dietary fiber forms a significant aspect of renal nutrition in treating chronic kidney disease (CKD). Dietary fiber intake influences the composition and metabolism of the gut microbiome with proven roles in reducing uremic toxin production, preserving kidney function, and retarding the progression of CKD through mechanisms of regulating metabolic, immunological, and inflammatory processes. Understanding dietary fiber’s pathogenesis and mechanistic action in modulating host and microbiome interactions provides a potential adjunct therapeutic target for preventing, controlling, and treating CKD patients.
  • 633
  • 14 Mar 2022
Topic Review
Antibiotics Used for Urinary Tract Infections in Pregnancy
Urinary tract infection (UTI) is considered to be a major problem in pregnant women. It is also one of the most prevalent infections during pregnancy, being diagnosed in as many as 50–60% of all gestations. Therefore, UTI treatment during pregnancy is extremely important and management guidelines have been published worldwide to assist physicians in selecting the right antibiotic for each patient, taking into account the maternal and fetal safety profile.
  • 633
  • 29 Dec 2022
Topic Review
Endogenous and pharmacological Nrf2 activation in CKD
The nuclear factor erythroid 2‐related factor 2 (Nrf2) protects the cell against oxidative damage. The Nrf2 system comprises a complex network that functions to ensure adequate responses to redox perturbations, but also metabolic demands, and cellular stresses. It must be kept within a physiologic activity range. Oxidative stress and alterations in Nrf2 system activity are central for chronic kidney disease (CKD) progression and CKD-related morbidity. Activation of the Nrf2 system in CKD is in multiple ways related to inflammation, kidney fibrosis, and mitochondrial and metabolic effects. In human CKD, both endogenous Nrf2 activation and repression exist. The state of the Nrf2 system varies with cause of kidney disease, comorbidities, stage of CKD, and severity of uremic toxin accumulation and inflammation. Earlier CKD stage, rapid progression of kidney disease, and inflammatory processes are associated with more robust Nrf2 system activation. Advanced CKD is associated with stronger Nrf2 system repression. Nrf2 activation is related to oxidative stress and moderate uremic toxin and nuclear factor kappa B (NF-κB) elevations. Nrf2 repression relates to high uremic toxin and NF-κB concentrations, and may be related to Kelch-like ECH-associated protein 1 (Keap1)-independent Nrf2 degradation. Pharmacological Nrf2 activation by bardoxolone methyl, curcumin, and resveratrol have been described but new strategies for Nrf2-targeted therapies in CKD need to be developed.
  • 632
  • 17 May 2023
Topic Review
Pediatric Atypical Hemolytic Uremic Syndrome
Atypical hemolytic uremic syndrome (aHUS) is a rare disorder characterized by dysregulation of the alternate pathway. The diagnosis of aHUS is one of exclusion, which complicates its early detection and corresponding intervention to mitigate its high rate of mortality and associated morbidity. Heterozygous mutations in complement regulatory proteins linked to aHUS are not always phenotypically active, and may require a particular trigger for the disease to manifest. This list of triggers continues to expand as more data is aggregated, particularly centered around COVID-19 and pediatric vaccinations. Novel genetic mutations continue to be identified though advancements in technology as well as greater access to cohorts of interest, as in diacylglycerol kinase epsilon (DGKE). DGKE mutations associated with aHUS are the first non-complement regulatory proteins associated with the disease, drastically changing the established framework. 
  • 625
  • 22 Dec 2021
Topic Review
An Updated Classification of Cardiorenal Syndrome
Cardiorenal syndrome (CRS) is defined as progressive, combined cardiac and renal dysfunction. Here, the pathomechanisms and clinical hallmarks of both chronic heart failure and chronic kidney disease are presented, and an updated classification of CRS is proposed.
  • 624
  • 10 Jun 2022
Topic Review
Oncolyic Virotherapy for Prostate Cancer
As the most common cancer of the genitourinary system, prostate cancer (PCa) is a global men′s health problem whose treatments are an urgent research issue. Treatment options for PCa include active surveillance (AS), surgery, endocrine therapy, chemotherapy, radiation therapy, immunotherapy, etc. However, as the cancer progresses, the effectiveness of treatment options gradually decreases, especially in metastatic castration-resistant prostate cancer (mCRPC), for which there are fewer therapeutic options and which have a shorter survival period and worse prognosis. For this reason, oncolytic viral therapy (PV), with its exceptional properties of selective tumor killing, relatively good safety in humans, and potential for transgenic delivery, has attracted increasing attention as a new form of anti-tumor strategy for PCa.
  • 622
  • 01 Nov 2022
Topic Review
Sex Differences in Human Diabetic Kidney Disease
Diabetic kidney disease (DKD) is a secondary disease of type 1 and type 2 diabetes mellitus (T1DM and T2DM). This microvascular complication develops in approximately 30% of patients with T1DM and 40% of patients with T2DM and is characterized by the presence of albuminuria and the progressive loss of renal function.
  • 618
  • 23 Apr 2023
Topic Review
Robotic Systems in Urology and Prostate Cancer Surgery
Robot-assisted surgical systems (RASS) have revolutionised the management of many urological conditions with robot-assisted radical prostatectomy (RARP) being considered by many to be the preferred surgical approach.
  • 615
  • 07 Apr 2023
Topic Review
Botulinum Toxin-A Injection Treat Chronic Pelvic Pain Syndrome
Pain management of patients with chronic pelvic pain syndrome (CPPS) is challenging, because pain is often refractory to conventional treatments. Botulinum toxin A (BTX-A) may represent a promising therapeutic strategy for these patients. This entry summarizes the literature for prospective studies evaluating the use of BTX-A in the treatment of CPPS. A pooled meta-analysis of the included studies was performed considering only patients underwent BTX-A injection and comparing pain scores evaluated at baseline and at the last available follow up. We found that BTX-A could be an efficacious treatment for some specific CPPS subtypes. Higher level studies are needed to assess the efficacy and safety of BTX-A and provide objective indications for its use in CPPS management.
  • 612
  • 25 Jan 2022
Topic Review
Greco-Arabic Contribution to The Urolithiasis Management and Treatment
Many Greco-Arabic Muslim scientists have contributed to medicine and surgery in the diagnosis, surgery and natural medicines for the treatment of urolithiasis.
  • 611
  • 17 Aug 2022
Topic Review
Impact of COVID-19 on Kidney of Diabetic Patients
Given the current state of COVID-19, it is crucial to reveal its evolving relationship with and effect on different body organ systems and their diseases. The severity and outcome of COVID-19 have a very complex relationship, especially to the vital organs including the kidney, either in their state of health or disease. Additionally, it is well known that diabetes affects the kidney, leading to diabetic nephropathy. The kidney is also affected by different pathological and immunopathological reactions with COVID-19 infection, leading to acute kidney injury.
  • 608
  • 27 Jun 2022
Topic Review
Volatile Anesthetic-Induced Organ Protection
Ischemia reperfusion injury (IRI) is inevitable in kidney transplantation and negatively impacts graft and patient outcome. Reperfusion takes place in the recipient and most of the injury following ischemia and reperfusion occurs during this reperfusion phase; therefore, the intra-operative period seems an attractive window of opportunity to modulate IRI and improve short- and potentially long-term graft outcome. Commonly used volatile anesthetics such as sevoflurane and isoflurane have been shown to interfere with many of the pathophysiological processes involved in the injurious cascade of IRI. 
  • 601
  • 29 Apr 2021
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